| Ankle 2 views (73600) |
$190.05 |
$191 |
2.4× |
| Arthrogram elbow (73085) |
$355.22 |
$357 |
1.1× |
| Arthrogram hip (73525) |
$355.22 |
$357 |
1.1× |
| Arthrogram shoulder (73040) |
$355.22 |
$357 |
1.1× |
| Arthrogram wrist (73115) |
$355.22 |
$357 |
1.1× |
| Arthrography knee lt (73580) |
$355.22 |
$357 |
1.1× |
| Cervical spine 2 or 3 views (72040) |
$190.05 |
$191 |
2.4× |
| Chest 1 view (71045) |
$155.22 |
$156 |
1.9× |
| Clavicle complete (73000) |
$190.05 |
$191 |
2.4× |
| CT abdomen and pelvis without and with contrast (74178) |
$1,095.50 |
$1,101 |
3.4× |
| CT abdomen and pelvis without contrast (74176) |
$782.08 |
$786 |
3.6× |
| CT abdomen w contrast (74160) |
$1,567.13 |
$1,575 |
9.7× |
| CT abdomen w wo contrast (74170) |
$1,880.55 |
$1,890 |
11.6× |
| CT abdomen w/o contrast (74150) |
$205.97 |
$207 |
2.1× |
| CT c-spine w/o contrast (72125) |
$205.97 |
$207 |
2.1× |
| CT cervical spine w&w/o contrast (72127) |
$1,880.55 |
$1,890 |
11.6× |
| CT cervical spine with contrast (72126) |
$886.55 |
$891 |
2.8× |
| CT chest w/wo contrast (71270) |
$1,880.55 |
$1,890 |
11.6× |
| CT chest with contrast (71260) |
$886.55 |
$891 |
5.5× |
| CT head/brain without and with contrast (70470) |
$1,043.26 |
$1,048.50 |
6.5× |
| CT lower ext w/o (73700) |
$782.08 |
$786 |
8.1× |
| CT lower extremity w wo contrast (73702) |
$1,880.55 |
$1,890 |
11.6× |
| CT lower extremity with contrast (73701) |
$1,567.13 |
$1,575 |
9.7× |
| CT lumbar spine w & w/o contrast (72133) |
$1,880.55 |
$1,890 |
11.6× |
| CT lumbar spine w/o contrast (72131) |
$782.08 |
$786 |
8.1× |
| CT lumbar spine with contrast (72132) |
$886.55 |
$891 |
2.8× |
| CT maxillofacial w/o contrast (70486) |
$782.08 |
$786 |
8.1× |
| CT maxillofacial w/wo contrast (70488) |
$1,880.55 |
$1,890 |
11.6× |
| CT neck soft tissue w contrast (70491) |
$1,567.13 |
$1,575 |
9.7× |
| CT orbit sella/post fossa/ear w/o & w/contr matr (70482) |
$1,880.55 |
$1,890 |
11.6× |
| CT orbits w/o contrast (70480) |
$1,358.18 |
$1,365 |
14.1× |
| CT pelvis w & w/o contrast (72194) |
$1,880.55 |
$1,890 |
11.6× |
| CT pelvis w/o contrast (72192) |
$782.08 |
$786 |
8.1× |
| CT soft tissue neck w/o & w/contrast material (70492) |
$1,880.55 |
$1,890 |
11.6× |
| CT soft tissue neck w/o contrast (70490) |
$1,358.18 |
$1,365 |
14.1× |
| CT thoracic spine w/contrast (72129) |
$1,567.13 |
$1,575 |
9.7× |
| CT thoracic spine w/o contrast (72128) |
$782.08 |
$786 |
8.1× |
| CT thoracic spine w/wo contrast (72130) |
$1,880.55 |
$1,890 |
11.6× |
| CT thorax w/o contrast (71250) |
$782.08 |
$786 |
8.1× |
| CT upper extremity w/o & w/contrast material (73202) |
$1,880.55 |
$1,890 |
11.6× |
| CT upper extremity w/o contrast rt (73200) |
$782.08 |
$786 |
8.1× |
| CT upper extremity with contrast (73201) |
$886.55 |
$891 |
2.8× |
| CTA abdomen pelvis (74174) |
$1,880.55 |
$1,890 |
5.8× |
| CTA chest (71275) |
$1,880.55 |
$1,890 |
11.6× |
| Cta Head (70496) |
$1,043.26 |
$1,048.50 |
6.5× |
| Cta Neck (70498) |
$1,880.55 |
$1,890 |
11.6× |
| Diskogram cervical (72285) |
$4,363.08 |
$4,385 |
2.4× |
| Diskography lumbar (72295) |
$4,363.08 |
$4,385 |
2.4× |
| Fluoroscopy up to 1 hr (76000) |
$566.16 |
$569 |
2.6× |
| Foot 2 views (73620) |
$190.05 |
$191 |
2.4× |
| Forearm 2 views (73090) |
$190.05 |
$191 |
2.4× |
| Hand 2 views (73120) |
$190.05 |
$191 |
2.0× |
| Hand 3 views (73130) |
$190.05 |
$191 |
2.4× |
| Humerus Min 2 Views Left (73060) |
$190.05 |
$191 |
2.4× |
| Hysterosalpingogram (74740) |
$715.41 |
$719 |
3.3× |
| Knee 3 views (73562) |
$198.01 |
$199 |
2.5× |
| Mammary ductogram or galactogram multiple (77054) |
$227.86 |
$229 |
1.0× |
| Mammary ductogram or galactogram single (77053) |
$172.14 |
$173 |
0.8× |
| Manual appl stress pfrmd phys/qhp joint films (77071) |
$178.11 |
$179 |
2.2× |
| MRA head w/o contrast (70544) |
$906.94 |
$911.50 |
4.1× |
| MRA neck w contrast (70548) |
$1,607.92 |
$1,616 |
5.0× |
| MRA neck w/o contrast (70547) |
$1,607.92 |
$1,616 |
7.3× |
| MRI abdomen w/o & w/contrast material (74183) |
$1,051.72 |
$1,057 |
3.3× |
| MRI abdomen w/o contrast (74181) |
$792.02 |
$796 |
3.6× |
| MRI any jnt lwr ext with con lt (73722) |
$906.94 |
$911.50 |
1.3× |
| MRI any jt upper extremity w/contrast matrl (73222) |
$906.94 |
$911.50 |
1.3× |
| MRI breast w/o contrast bilateral (77047) |
$2,070.60 |
$2,081 |
9.4× |
| MRI c-spine with contrast (72142) |
$1,607.92 |
$1,616 |
5.0× |
| MRI cervical spine w/o contrast (72141) |
$792.02 |
$796 |
3.6× |
| MRI chest w/o & w/contrast material (71552) |
$1,897.47 |
$1,907 |
5.9× |
| MRI chest w/o contrast (71550) |
$792.02 |
$796 |
3.6× |
| MRI Forearm w/ Contrast Bilateral 73219 (73219) |
$906.94 |
$911.50 |
2.8× |
| MRI lower extrem oth/thn jt w/contrast matrl (73719) |
$1,607.92 |
$1,616 |
5.0× |
| MRI lower extrem oth/thn jt w/o contr matrl (73718) |
$792.02 |
$796 |
3.6× |
| MRI orbit face &/neck w/o contrast (70540) |
$604.46 |
$607.50 |
2.7× |
| MRI orbit/face/neck w&w/o cont (70543) |
$639.29 |
$642.50 |
2.0× |
| MRI pelvis w/o & w/contrast material (72197) |
$1,897.47 |
$1,907 |
5.9× |
| MRI pelvis w/o contrast (72195) |
$792.02 |
$796 |
3.6× |
| MRI scan of arm joint before and after contrast (73223) |
$1,607.92 |
$1,616 |
5.0× |
| MRI scan of leg joint before and after contrast (73723) |
$1,051.72 |
$1,057 |
3.3× |
| MRI spinal canal cervical w/o & w/contr matrl (72156) |
$1,051.72 |
$1,057 |
3.3× |
| MRI spinal canal lumbar w/contrast material (72149) |
$906.94 |
$911.50 |
2.8× |
| MRI spinal canal lumbar w/o & w/contr matrl (72158) |
$1,252.71 |
$1,259 |
3.9× |
| MRI spinal canal thoracic w/contrast matrl (72147) |
$1,607.92 |
$1,616 |
5.0× |
| MRI spinal canal thoracic w/o & w/contr matrl (72157) |
$1,125.35 |
$1,131 |
3.5× |
| MRI thoracic spine w/o contrast (72146) |
$792.02 |
$796 |
3.6× |
| MRI tmj (70336) |
$1,378.08 |
$1,385 |
6.3× |
| MRI upper ext joint w/o contrast (73221) |
$205.97 |
$207 |
0.9× |
| MRI upper extrem other than jt w/o & w/contras (73220) |
$205.97 |
$207 |
0.6× |
| MRI upper extremity oth than jt w/o contr matrl (73218) |
$792.02 |
$796 |
3.6× |
| Pelvis 1 or 2 views (72170) |
$190.05 |
$191 |
2.0× |
| Pr MRI, lower extr, w/o contrast f/u by contrast (73720) |
$1,252.71 |
$1,259 |
3.9× |
| Radex hips bilateral with pelvis 2 views (73521) |
$190.05 |
$191 |
2.0× |
| Radiologic Exam Chest 2 Views - Xr Chest 2 Views (71046) |
$155.22 |
$156 |
1.9× |
| Radiologic exam upr gi trc single contrast study (74240) |
$190.05 |
$191 |
1.2× |
| Radiologic Examination Femur Minimum 2 Views - Xr Femur 2+ Vw Lt (73552) |
$168.16 |
$169 |
2.1× |
| Radiological examination surgical specimen (76098) |
$120.40 |
$121 |
0.2× |
| Sacroiliac Joints < 3 Views (72200) |
$190.05 |
$191 |
2.0× |
| Shuntogram indwelling nonvascular shunt rs&i (75809) |
$286.56 |
$288 |
3.0× |
| Ultrasound, abdomen limited (76705) |
$127.36 |
$128 |
1.3× |
| Us pelvic nonobstetric image dcmtn limited/f/u (76857) |
$522.38 |
$525 |
5.4× |
| Us retroperitoneal complete (76770) |
$522.38 |
$525 |
5.4× |
| Us xtr non-vasc lmtd (76882) |
$220.89 |
$222 |
2.3× |
| Wrist 2 views (73100) |
$190.05 |
$191 |
2.4× |
| X-Ray Abdomen,Comp Acute Series - Xr Abdomen 2 Vws With Chest 1 View (74022) |
$225.87 |
$227 |
2.3× |
| X-Ray Ankle 3+ Vw - Xr Ankle 3+ Views Right (73610) |
$190.05 |
$191 |
2.4× |
| X-Ray Elbow 2 Vw - Xr Elbow 1-2 Views Right (73070) |
$190.05 |
$191 |
2.4× |
| X-Ray Elbow 3+ Vw - Xr Elbow 3+ Views Right (73080) |
$190.05 |
$191 |
2.4× |
| X-ray exam hip uni 1 view (73501) |
$155.22 |
$156 |
1.9× |
| X-Ray Exam Hip Uni 2-3 Views (73502) |
$168.16 |
$169 |
2.1× |
| X-ray exam hip uni 4/> views (73503) |
$180.10 |
$181 |
1.9× |
| X-Ray Exam Hips Bi 3-4 Views (73522) |
$210.94 |
$212 |
2.2× |
| X-Ray Exam Hips Bi 5/> Views (73523) |
$229.85 |
$231 |
2.4× |
| X-ray exam of femur 1 (73551) |
$155.22 |
$156 |
1.9× |
| X-ray eye for foreign body (70030) |
$190.05 |
$191 |
2.4× |
| X-Ray Foot 3+ Vw - Xr Foot 3+ Views Right (73630) |
$190.05 |
$191 |
2.4× |
| X-Ray Heel - Xr Calcaneus 2 Views Right (73650) |
$190.05 |
$191 |
2.4× |
| X-Ray Lumbar Spine 2/3 Vw - Xr Lumbar Spine 2-3 Views (72100) |
$190.05 |
$191 |
2.0× |
| X-Ray Lumbar Spine 6+ Vw - Xr Lumbar Spine 6+ Vws Including Bending (72114) |
$190.05 |
$191 |
2.0× |
| X-Ray Pelvis 3+ Vw - Xr Pelvis 3+ Views (72190) |
$190.05 |
$191 |
2.0× |
| X-Ray Retrograde Pyelogram - Fl Pyelogram Retrograde (74420) |
$258.70 |
$260 |
0.8× |
| X-Ray Shoulder 2+ Vw - Xr Shoulder 2+ Views Right (73030) |
$190.05 |
$191 |
2.4× |
| X-Ray Spine One View - Xr Spine (72020) |
$155.22 |
$156 |
1.9× |
| X-Ray Thoracic Spine 2 Vw - Xr Thoracic Spine 2 Views (72070) |
$190.05 |
$191 |
2.0× |
| X-Ray Thoracic Spine 4 Vw - Xr Thoracic Spine Complete 4+ Views (72074) |
$205.97 |
$207 |
2.1× |
| X-Ray Toe(S) - Xr Toes 2+ Views Right (73660) |
$190.05 |
$191 |
2.4× |
| X-Ray Wrist 3+ Vw - Xr Wrist 3+ Views Right (73110) |
$190.05 |
$191 |
2.4× |
| Xr arthrogram ankle (73615) |
$387.06 |
$389 |
1.2× |
| Xr c-spine 6 or more views (72052) |
$190.05 |
$191 |
2.0× |
| Xr finger(s) 2+ views (73140) |
$190.05 |
$191 |
2.4× |
| Xr shoulder 1 view (73020) |
$155.22 |
$156 |
1.9× |
| Xr spine cervical 4 or 5 views (72050) |
$211.94 |
$213 |
2.2× |
| Xr tibia/fibula 2 views (73590) |
$190.05 |
$191 |
2.4× |
| Xray knee 1 or 2 views rt (73560) |
$190.05 |
$191 |
2.4× |