| Ankle 2 views (73600) |
$404.98 |
$404.98 |
4.5× |
| Arthrography wrist lt (73115) |
$53.69 |
$53.69 |
0.1× |
| Clavicle complete (73000) |
$559.91 |
$559.91 |
6.2× |
| Computed tomography, bone mineral density study, 1 or more sites, axial skeleton (eg, hips, pelvis, spine) Age Under 21 (77078) |
$179.48 |
$179.48 |
2.0× |
| Computed tomography, orbit, sella, or posterior fossa or outer, middle, or inner ear; with contrast material(s) Age… (70481) |
$408.04 |
$408.04 |
2.2× |
| CT - st neck w&wo contr (70492) |
$431.05 |
$431.05 |
2.4× |
| CT abdomen and pelvis without and with contrast (74178) |
$306.80 |
$306.80 |
0.8× |
| CT abdomen and pelvis without contrast (74176) |
$265.50 |
$265.50 |
1.1× |
| CT abdomen w wo contrast (74170) |
$417.25 |
$417.25 |
2.3× |
| CT abdomen w/contrast (74160) |
$377.36 |
$377.36 |
2.1× |
| CT abdomen w/o contrast (74150) |
$352.82 |
$352.82 |
3.2× |
| CT angio abd&plvis cntrst mtrl w/wo cntrst imges (74174) |
$362.26 |
$362.26 |
1.0× |
| CT angio abdom w/o & w/dye (74175) |
$336.30 |
$336.30 |
1.8× |
| CT angio abdominal arteries (75635) |
$362.26 |
$362.26 |
2.0× |
| CT angiograph pelv w/o&w/dye (72191) |
$298.54 |
$298.54 |
1.6× |
| CT cervical spine w/contrast (72126) |
$360.49 |
$360.49 |
1.0× |
| CT cervical spine w/o contrast (72125) |
$343.62 |
$343.62 |
3.1× |
| CT chest w/contrast (71260) |
$368.16 |
$368.16 |
2.0× |
| CT extremity upper w & w/o contrast (73202) |
$368.16 |
$368.16 |
2.0× |
| CT head/brain with contrast (70460) |
$337.48 |
$337.48 |
1.8× |
| CT head/brain without and with contrast (70470) |
$377.36 |
$377.36 |
2.1× |
| CT lower ext w/wo contrast (73702) |
$543.04 |
$543.04 |
3.0× |
| CT lower extremity w contrast (73701) |
$343.62 |
$343.62 |
1.9× |
| CT lower extremity w/o contrast unilateral (73700) |
$325.21 |
$325.21 |
3.0× |
| CT lumbar spine w/contrast (72132) |
$365.09 |
$365.09 |
1.0× |
| CT lumbar spine w/o contrast (72131) |
$343.62 |
$343.62 |
3.1× |
| CT lumbar spine w/o then w/ con (72133) |
$381.97 |
$381.97 |
2.1× |
| CT maxillofacial area w/o contrast (70486) |
$339.01 |
$339.01 |
3.1× |
| CT maxillofacial w/contrast (70487) |
$386.57 |
$386.57 |
2.1× |
| CT maxillofacial w/o then w/ con (70488) |
$421.85 |
$421.85 |
2.3× |
| CT orbit sella ear w/o con (70480) |
$381.97 |
$381.97 |
3.5× |
| CT orbit/ear/fossa w/o then w/ con (70482) |
$431.05 |
$431.05 |
2.4× |
| CT pelvis w & w/o contrast (72194) |
$360.49 |
$360.49 |
2.0× |
| CT pelvis w/o contrast (72192) |
$325.21 |
$325.21 |
3.0× |
| CT soft tissue neck w/contrast (70491) |
$408.04 |
$408.04 |
2.2× |
| CT soft tissue neck w/o contrast (70490) |
$381.97 |
$381.97 |
3.5× |
| CT spine cervical w/wo contrast (72127) |
$377.36 |
$377.36 |
2.1× |
| CT thoracic spine w/contrast (72129) |
$360.49 |
$360.49 |
2.0× |
| CT thoracic spine w/o contrast (72128) |
$343.62 |
$343.62 |
3.1× |
| CT thoracic spine w/o then w/ con (72130) |
$377.36 |
$377.36 |
2.1× |
| CT thorax lung cancer scr c- (71271) |
$2,012.61 |
$2,012.61 |
18.4× |
| CT thorax w/o contrast (71250) |
$343.62 |
$343.62 |
3.1× |
| CT thorax w/o then w/ contrast (71270) |
$408.04 |
$408.04 |
2.2× |
| CT upper extremity w/dye (73201) |
$343.62 |
$343.62 |
0.9× |
| CT upper extremity w/o contrast rt (73200) |
$325.21 |
$325.21 |
3.0× |
| CTA chest w/wo contrast (71275) |
$302.08 |
$302.08 |
1.6× |
| CTA head w contrast (70496) |
$290.28 |
$290.28 |
1.6× |
| CTA lower extremity w/wo contrast unilateral (73706) |
$312.70 |
$312.70 |
1.7× |
| Cta Neck (70498) |
$290.28 |
$290.28 |
1.6× |
| CTA upper extremity w/wo contrast unilateral (73206) |
$312.70 |
$312.70 |
1.7× |
| Fluoroscopy up to 1 hour physician/qhp time (76000) |
$1,274.75 |
$1,274.75 |
5.1× |
| Humerus min 2 views (73060) |
$512.36 |
$512.36 |
5.6× |
| Ob us < 14 wks single fetus (76801) |
$352.82 |
$352.82 |
3.2× |
| Radex Entir Thrc Lmbr Crv Sac Spi W/Skull 1 Vw - Xr Scoliosis 1 Vw (72081) |
$87.44 |
$87.44 |
1.0× |
| Radex entir thrc lmbr crv sac spi w/skull 2/3 vw (72082) |
$42.95 |
$42.95 |
0.4× |
| Radex entir thrc lmbr crv sac spi w/skull 4/5 vw (72083) |
$42.95 |
$42.95 |
0.4× |
| Radex entir thrc lmbr crv sac spi w/skull 6/> vw (72084) |
$42.95 |
$42.95 |
0.4× |
| Radex hip unilateral with pelvis 2-3 views (73502) |
$665.52 |
$665.52 |
7.3× |
| Radex hips bilateral with pelvis 2 views (73521) |
$135 |
$135 |
1.2× |
| Radex spine cervical 2 or 3 views (72040) |
$532.30 |
$532.30 |
5.9× |
| Radex spine cervical 4 or 5 views (72050) |
$423.38 |
$423.38 |
3.9× |
| Radex spine cervical 6 or more views (72052) |
$592.12 |
$592.12 |
5.4× |
| Radex X-Ray Exam Thoracolmb 2+ Vw - Xr Thoracolumbar Spine 2 Views (72080) |
$1,607.25 |
$1,607.25 |
17.7× |
| Radiologic exam upr gi trc double contrast study (74246) |
$205.56 |
$205.56 |
1.1× |
| Radiologic Examination Femur Minimum 2 Views - Xr Femur 2+ Vw Lt (73552) |
$559.91 |
$559.91 |
6.2× |
| Radiologic examination, complete acute abdomen series, including 2 or more views of the abdomen (eg, supine, erect,… (74022) |
$95.11 |
$95.11 |
0.9× |
| Radiologic examination, spine; thoracic, minimum of 4 views Other Diagnostic Radiology FS (72074) |
$67.50 |
$67.50 |
0.6× |
| Temporomandibular joint arthrography, radiological supervision and interpretation Other Diagnostic Radiology FS (70332) |
$72.10 |
$72.10 |
0.3× |
| Ultrasound breast limited (76642) |
$409.50 |
$409.50 |
4.5× |
| Ultrasound, abdomen limited (76705) |
$498.55 |
$498.55 |
4.6× |
| Unlisted diagnostic radiographic procedure (76499) |
$546.34 |
$546.34 |
6.0× |
| Us abdominal aorta real time screen study aaa (76706) |
$997.10 |
$997.10 |
9.1× |
| Us breast uni real time with image complete (76641) |
$529.82 |
$529.82 |
4.9× |
| Us chest (76604) |
$253.11 |
$253.11 |
2.3× |
| Us compl joint r-t w/image documentation (76881) |
$230.10 |
$230.10 |
2.1× |
| Us obstetric transvaginal (76817) |
$208.62 |
$208.62 |
1.9× |
| Us pelvic limited or f/u non-ob (76857) |
$253.11 |
$253.11 |
2.3× |
| Us pelvis complete (76856) |
$457.72 |
$457.72 |
4.2× |
| Us retroperitoneal complete (76770) |
$228.56 |
$228.56 |
2.1× |
| Us retroperitoneal limited (76775) |
$230.10 |
$230.10 |
2.1× |
| Us scrotum (76870) |
$575.25 |
$575.25 |
5.3× |
| Us soft tissue head/neck (76536) |
$167.21 |
$167.21 |
1.5× |
| Us transrectal (76872) |
$245.44 |
$245.44 |
2.2× |
| Us transrectal prostate volume (76873) |
$245.44 |
$245.44 |
2.2× |
| X-Ray Ac Jts - Xr Acromioclavicular Joints Bilateral (73050) |
$280.72 |
$280.72 |
3.1× |
| X-Ray Ankle 3+ Vw - Xr Ankle 3+ Views Right (73610) |
$474.01 |
$474.01 |
5.2× |
| X-Ray Elbow 3+ Vw - Xr Elbow 3+ Views Right (73080) |
$391.76 |
$391.76 |
4.3× |
| X-ray exam of finger(s) (73140) |
$404.98 |
$404.98 |
4.5× |
| X-Ray Facial Bones <3 Vw - Xr Facial Bones 1-2 Views (70140) |
$59.83 |
$59.83 |
0.7× |
| X-Ray Foot 3+ Vw - Xr Foot 3+ Views Right (73630) |
$466.34 |
$466.34 |
5.1× |
| X-Ray Hand 3+ Vw - Xr Hand 3+ Views Right (73130) |
$466.34 |
$466.34 |
5.1× |
| X-Ray Heel - Xr Calcaneus 2 Views Right (73650) |
$305.62 |
$305.62 |
3.4× |
| X-Ray Jaw <4 Vw - Xr Mandible < 4 Views (70100) |
$55.22 |
$55.22 |
0.6× |
| X-Ray Knee 3 View - Xr Knee 3 Views Right (73562) |
$633.54 |
$633.54 |
7.0× |
| X-Ray Knee 4+ View - Xr Knee 4+ Views Right (73564) |
$844.73 |
$844.73 |
7.7× |
| X-Ray Lumbar Spine 2/3 Vw - Xr Lumbar Spine 2-3 Views (72100) |
$621.27 |
$621.27 |
5.7× |
| X-Ray Mastoids 3+ Vw - Xr Mastoids 3+ Views (70130) |
$400.38 |
$400.38 |
3.7× |
| X-Ray Ribs, Chest 4+ Vw - Xr Ribs 3 Vws Bil W/ Chest Posteroanterior (71111) |
$823.76 |
$823.76 |
7.5× |
| X-Ray Sacroiliac Jts 3+ Vw - Xr Sacroiliac Joints 3+ Views (72202) |
$500.08 |
$500.08 |
4.6× |
| X-Ray Sacrum/Coccyx 2+ Vw - Xr Sacrum Coccyx 2+ Views (72220) |
$592.12 |
$592.12 |
6.5× |
| X-Ray Shoulder 2+ Vw - Xr Shoulder 2+ Views Right (73030) |
$520.03 |
$520.03 |
5.7× |
| X-Ray Sinuses 3+ Vw - Xr Paranasal Sinuses 3+ Views (70220) |
$701.04 |
$701.04 |
7.7× |
| X-Ray Skull 4+ Vw - Xr Skull Complete 4+ Views (70260) |
$118.12 |
$118.12 |
1.1× |
| X-Ray Skull <4 Vw - Xr Skull 1-3 Views (70250) |
$559.91 |
$559.91 |
5.1× |
| X-Ray Toe(S) - Xr Toes 2+ Views Right (73660) |
$404.98 |
$404.98 |
4.5× |
| X-Ray Wrist 3+ Vw - Xr Wrist 3+ Views Right (73110) |
$532.30 |
$532.30 |
5.9× |
| Xr abdomen 1 view (74018) |
$55.22 |
$55.22 |
0.6× |
| Xr abdomen 2 views (74019) |
$637.60 |
$637.60 |
5.8× |
| Xr abdomen 3 views (74021) |
$343.20 |
$343.20 |
3.1× |
| Xr chest 1 view (71045) |
$55.22 |
$55.22 |
0.6× |
| Xr chest 2 views (71046) |
$67.50 |
$67.50 |
0.7× |
| Xr facial bones 3 views (70150) |
$559.91 |
$559.91 |
5.1× |
| Xr joint survey 1 view (77077) |
$1,368.33 |
$1,368.33 |
12.5× |
| Xr lower extremity 2 views infant (73592) |
$53.69 |
$53.69 |
0.6× |
| Xr mandible 4 views (70110) |
$621.27 |
$621.27 |
5.7× |
| Xr nasal bones (70160) |
$69.03 |
$69.03 |
0.8× |
| Xr spine 1 view (72020) |
$223.96 |
$223.96 |
2.5× |
| Xr sternum 2 views (71120) |
$437.19 |
$437.19 |
4.8× |
| Xray forearm 2 views (73090) |
$559.32 |
$559.32 |
6.2× |
| Xray knee 1 or 2 views rt (73560) |
$437.19 |
$437.19 |
4.8× |
| Xray neck soft tissue (70360) |
$360.49 |
$360.49 |
4.0× |
| Xray orbits complete min 4 views (70200) |
$523.09 |
$523.09 |
4.8× |
| Xray pelvis 1 or 2 views (72170) |
$475.54 |
$475.54 |
4.4× |
| Xray ribs unilat w/ pa chest 3v rt (71101) |
$559.91 |
$559.91 |
5.1× |
| Xray scapula complete (73010) |
$466.34 |
$466.34 |
4.3× |
| Xray spine thoracic 2 views (72070) |
$653.48 |
$653.48 |
6.0× |
| Xray spine thoracic 3 views (72072) |
$67.50 |
$67.50 |
0.6× |
| Xray tibia-fibula 2 views bil (73590) |
$559.91 |
$559.91 |
6.2× |
| Xray tmj's bilateral open-clsc (70330) |
$506.22 |
$506.22 |
5.6× |