| Ankle 2 views (73600) |
$157.93 |
$206 |
2.0× |
| Arthrogram shoulder (73040) |
$633.13 |
$249 |
2.0× |
| Cervical spine 2 or 3 views (72040) |
$157.93 |
$435 |
2.0× |
| Chest 1 view (71045) |
$157.93 |
$220 |
2.0× |
| Chest 3 views (71047) |
$157.93 |
$416 |
2.0× |
| Computed Tomography Thorax Lw Dose Lng Ca Scr C- (71271) |
$189.73 |
$2,000 |
2.0× |
| CT abdomen and pelvis without and with contrast (74178) |
$633.13 |
$4,166 |
2.0× |
| CT abdomen and pelvis without contrast (74176) |
$433.01 |
$1,674.75 |
2.0× |
| CT abdomen w contrast (74160) |
$318.32 |
$1,653 |
2.0× |
| CT abdomen w wo contrast (74170) |
$318.32 |
$4,166 |
2.0× |
| CT abdomen w/o contrast (74150) |
$189.73 |
$1,347 |
2.0× |
| CT c-spine w/o contrast (72125) |
$189.73 |
$1,778 |
2.0× |
| CT cervical spine w&w/o contrast (72127) |
$318.32 |
$1,778 |
2.0× |
| CT cervical spine with contrast (72126) |
$633.13 |
$1,594 |
2.0× |
| CT chest w/wo contrast (71270) |
$318.32 |
$3,772 |
2.0× |
| CT chest with contrast (71260) |
$318.32 |
$5,993.15 |
2.0× |
| CT head/brain with contrast (70460) |
$318.32 |
$1,780 |
2.0× |
| CT head/brain without and with contrast (70470) |
$318.32 |
$2,054 |
2.0× |
| CT heart no contrast quant eval coronry calcium (75571) |
$157.93 |
$1,199.24 |
2.0× |
| CT lower ext w/o (73700) |
$189.73 |
$1,279 |
2.0× |
| CT lower extremity w wo contrast (73702) |
$318.32 |
$1,475 |
2.0× |
| CT lumbar spine w & w/o contrast (72133) |
$318.32 |
$1,778 |
2.0× |
| CT lumbar spine w/o contrast (72131) |
$189.73 |
$1,592 |
2.0× |
| CT lumbar spine with contrast (72132) |
$633.13 |
$1,616 |
2.0× |
| CT maxillofacial w/o contrast (70486) |
$189.73 |
$1,929 |
2.0× |
| CT maxillofacial w/wo contrast (70488) |
$318.32 |
$1,929 |
2.0× |
| CT neck soft tissue w contrast (70491) |
$318.32 |
$1,677.27 |
2.0× |
| CT orbit sella/post fossa/ear w/o & w/contr matr (70482) |
$318.32 |
$2,011.23 |
2.0× |
| CT orbits w/o contrast (70480) |
$189.73 |
$1,511.66 |
2.0× |
| CT pelvis w & w/o contrast (72194) |
$318.32 |
$1,893 |
2.0× |
| CT pelvis w/o contrast (72192) |
$189.73 |
$1,490 |
2.0× |
| CT soft tissue neck w/o & w/contrast material (70492) |
$318.32 |
$1,881.17 |
2.0× |
| CT soft tissue neck w/o contrast (70490) |
$189.73 |
$1,881.17 |
2.0× |
| CT thoracic spine w/contrast (72129) |
$318.32 |
$1,746 |
2.0× |
| CT thoracic spine w/o contrast (72128) |
$189.73 |
$1,492 |
2.0× |
| CT thorax w/o contrast (71250) |
$189.73 |
$2,925 |
2.0× |
| CT upper extremity w/o contrast rt (73200) |
$189.73 |
$773.19 |
2.0× |
| CT upper extremity with contrast (73201) |
$633.13 |
$1,644.28 |
2.0× |
| Cta Abdl Aorta&Bi Iliofem W/Contrast&Postp (75635) |
$318.32 |
$1,354.12 |
2.0× |
| CTA abdomen pelvis (74174) |
$633.13 |
$2,007 |
2.0× |
| CTA chest (71275) |
$318.32 |
$2,890 |
2.0× |
| Cta Head (70496) |
$318.32 |
$1,809 |
2.0× |
| Cta Neck (70498) |
$318.32 |
$2,410 |
2.0× |
| Cystography minimum 3 views rs&i (74430) |
$633.13 |
$704.48 |
2.0× |
| Diskography lumbar (72295) |
$3,543.79 |
$1,877 |
2.0× |
| Foot 2 views (73620) |
$157.93 |
$206 |
2.0× |
| Forearm 2 views (73090) |
$157.93 |
$251 |
2.0× |
| Hand 2 views (73120) |
$189.73 |
$142 |
2.0× |
| Hand 3 views (73130) |
$157.93 |
$240 |
2.0× |
| Humerus Min 2 Views Left (73060) |
$157.93 |
$253 |
2.0× |
| Knee 3 views (73562) |
$157.93 |
$237 |
2.0× |
| MRA head w/o contrast (70544) |
$433.01 |
$2,102 |
2.0× |
| MRA neck w/o contrast (70547) |
$433.01 |
$2,102 |
2.0× |
| MRI abdomen w/o & w/contrast material (74183) |
$633.13 |
$3,538 |
2.0× |
| MRI abdomen w/o contrast (74181) |
$433.01 |
$2,024 |
2.0× |
| MRI any jnt lwr ext with con lt (73722) |
$1,422.65 |
$2,491 |
2.0× |
| MRI any jt upper extremity w/contrast matrl (73222) |
$1,422.65 |
$2,491 |
2.0× |
| MRI cervical spine w/o contrast (72141) |
$433.01 |
$2,138 |
2.0× |
| MRI lower extrem oth/thn jt w/o contr matrl (73718) |
$433.01 |
$2,024 |
2.0× |
| MRI orbit face &/neck w/o contrast (70540) |
$433.01 |
$2,958 |
2.0× |
| MRI orbit/face/neck w&w/o cont (70543) |
$633.13 |
$3,058 |
2.0× |
| MRI orbit/face/neck w/contrast (70542) |
$633.13 |
$2,958 |
2.0× |
| MRI pelvis w/o & w/contrast material (72197) |
$633.13 |
$3,731 |
2.0× |
| MRI pelvis w/o contrast (72195) |
$433.01 |
$2,024 |
2.0× |
| MRI scan of arm joint before and after contrast (73223) |
$633.13 |
$3,371 |
2.0× |
| MRI scan of leg joint before and after contrast (73723) |
$633.13 |
$3,371 |
2.0× |
| MRI spinal canal cervical w/o & w/contr matrl (72156) |
$633.13 |
$3,016 |
2.0× |
| MRI spinal canal lumbar w/o & w/contr matrl (72158) |
$633.13 |
$3,665 |
2.0× |
| MRI spinal canal thoracic w/o & w/contr matrl (72157) |
$633.13 |
$3,538 |
2.0× |
| MRI thoracic spine w/o contrast (72146) |
$433.01 |
$2,063 |
2.0× |
| MRI upper ext joint w/o contrast (73221) |
$433.01 |
$2,421 |
2.0× |
| MRI upper extrem other than jt w/o & w/contras (73220) |
$633.13 |
$3,352 |
2.0× |
| MRI upper extremity oth than jt w/o contr matrl (73218) |
$433.01 |
$2,024 |
2.0× |
| Neck soft tissue (70360) |
$157.93 |
$303.44 |
2.0× |
| Pelvis 1 or 2 views (72170) |
$189.73 |
$288 |
2.0× |
| Pr MRI, lower extr, w/o contrast f/u by contrast (73720) |
$633.13 |
$2,134 |
2.0× |
| Radex hips bilateral with pelvis 2 views (73521) |
$189.73 |
$321 |
2.0× |
| Radiologic Exam Abdomen 1 View - Xr Abdomen 1 View (74018) |
$157.93 |
$275 |
2.0× |
| Radiologic Exam Abdomen 3+ Views - Xr Abdomen 3+ Views (74021) |
$189.73 |
$340 |
2.0× |
| Radiologic Exam Chest 2 Views - Xr Chest 2 Views (71046) |
$157.93 |
$286 |
2.0× |
| Scapula complete (73010) |
$189.73 |
$180 |
2.0× |
| Spine thoracic 3 views (72072) |
$189.73 |
$534 |
2.0× |
| Thoracolumbar 2 views (72080) |
$157.93 |
$288 |
2.0× |
| Ultrasound, abdomen limited (76705) |
$189.73 |
$803 |
2.0× |
| Urography (pyelography), intravenous, with or without KUB, with or without tomography (74400) |
$318.32 |
$1,109.50 |
2.0× |
| Us pelvic non ob complete (76856) |
$189.73 |
$890 |
2.0× |
| Us pelvic nonobstetric image dcmtn limited/f/u (76857) |
$189.73 |
$890 |
2.0× |
| Us retroperitoneal complete (76770) |
$189.73 |
$979 |
2.0× |
| Us retroperitoneal limited (76775) |
$189.73 |
$803 |
2.0× |
| Us scrotum and contents (76870) |
$189.73 |
$723 |
2.0× |
| Us soft tissue head/neck (76536) |
$189.73 |
$760 |
2.0× |
| Us transrectal (76872) |
$189.73 |
$451 |
2.0× |
| Us xtr non-vasc lmtd (76882) |
$189.73 |
$704 |
2.0× |
| X-Ray Abdomen,Comp Acute Series - Xr Abdomen 2 Vws With Chest 1 View (74022) |
$189.73 |
$517 |
2.0× |
| X-Ray Ankle 3+ Vw - Xr Ankle 3+ Views Right (73610) |
$157.93 |
$289 |
2.0× |
| X-Ray Elbow 2 Vw - Xr Elbow 1-2 Views Right (73070) |
$157.93 |
$156 |
2.0× |
| X-Ray Elbow 3+ Vw - Xr Elbow 3+ Views Right (73080) |
$157.93 |
$251 |
2.0× |
| X-ray exam hip uni 1 view (73501) |
$157.93 |
$173 |
2.0× |
| X-Ray Exam Hip Uni 2-3 Views (73502) |
$157.93 |
$232 |
2.0× |
| X-ray exam of femur 1 (73551) |
$157.93 |
$290 |
2.0× |
| X-ray eye for foreign body (70030) |
$157.93 |
$234.60 |
2.0× |
| X-Ray Facial Bones 3+ Vw - Xr Facial Bones 3+ Views (70150) |
$189.73 |
$256 |
2.0× |
| X-Ray Foot 3+ Vw - Xr Foot 3+ Views Right (73630) |
$157.93 |
$256 |
2.0× |
| X-Ray Knee 4+ View - Xr Knee 4+ Views Right (73564) |
$189.73 |
$286 |
2.0× |
| X-Ray Lumbar Spine 2/3 Vw - Xr Lumbar Spine 2-3 Views (72100) |
$189.73 |
$424 |
2.0× |
| X-Ray Lumbar Spine 6+ Vw - Xr Lumbar Spine 6+ Vws Including Bending (72114) |
$189.73 |
$303.44 |
2.0× |
| X-Ray Lumbar Spine Flex/Exten - Xr Lumbar Spine 4+ Views W/ Flex Ext (72120) |
$189.73 |
$378 |
2.0× |
| X-Ray Orbits - Xr Orbits Complete 4+ Views (70200) |
$189.73 |
$240 |
2.0× |
| X-Ray Ribs 2 Vw Unilat - Xr Ribs 2 Views Right (71100) |
$157.93 |
$429 |
2.0× |
| X-Ray Ribs, Chest 4+ Vw - Xr Ribs 3 Vws Bil W/ Chest Posteroanterior (71111) |
$189.73 |
$415 |
2.0× |
| X-Ray Sacroiliac Jts 3+ Vw - Xr Sacroiliac Joints 3+ Views (72202) |
$189.73 |
$251 |
2.0× |
| X-Ray Sacrum/Coccyx 2+ Vw - Xr Sacrum Coccyx 2+ Views (72220) |
$157.93 |
$310 |
2.0× |
| X-Ray Shoulder 2+ Vw - Xr Shoulder 2+ Views Right (73030) |
$157.93 |
$249 |
2.0× |
| X-Ray Skull 4+ Vw - Xr Skull Complete 4+ Views (70260) |
$189.73 |
$432 |
2.0× |
| X-Ray Skull <4 Vw - Xr Skull 1-3 Views (70250) |
$189.73 |
$276 |
2.0× |
| X-Ray Spine One View - Xr Spine (72020) |
$157.93 |
$351 |
2.0× |
| X-Ray Thoracic Spine 2 Vw - Xr Thoracic Spine 2 Views (72070) |
$189.73 |
$435 |
2.0× |
| X-Ray Thoracic Spine 4 Vw - Xr Thoracic Spine Complete 4+ Views (72074) |
$189.73 |
$635 |
2.0× |
| X-Ray Toe(S) - Xr Toes 2+ Views Right (73660) |
$157.93 |
$256 |
2.0× |
| X-Ray Wrist 3+ Vw - Xr Wrist 3+ Views Right (73110) |
$157.93 |
$258 |
2.0× |
| Xr c-spine 6 or more views (72052) |
$189.73 |
$566 |
2.0× |
| Xr finger(s) 2+ views (73140) |
$157.93 |
$240 |
2.0× |
| Xr shoulder 1 view (73020) |
$157.93 |
$249 |
2.0× |
| Xr spine cervical 4 or 5 views (72050) |
$189.73 |
$576 |
2.0× |
| Xr tibia/fibula 2 views (73590) |
$157.93 |
$240 |
2.0× |
| Xray knee 1 or 2 views rt (73560) |
$157.93 |
$268 |
2.0× |