| Abdomen 1 View (74018) |
$365 |
$730 |
4.2× |
| Ankle 2 views (73600) |
$365 |
$730 |
4.2× |
| Arthrogram ankle (73615) |
$2,110.50 |
$4,221 |
6.0× |
| Arthrogram hip (73525) |
$2,110.50 |
$4,221 |
6.0× |
Arthrogram Wrist (73115) range across 3 matching MRF lines |
$1,152–$1,545.50 |
$2,304–$3,091 |
varies |
| Chest 1 view (71045) |
$365 |
$730 |
4.2× |
| Chest 2 views (71046) |
$365 |
$730 |
4.2× |
| Clavicle complete (73000) |
$365 |
$730 |
4.2× |
| Contrast Exam Abdominl Aorta (75625) |
$11,915.88 |
$23,831.76 |
3.8× |
| Contrast X-Ray Of Elbow (73085) |
$2,110.50 |
$4,221 |
6.0× |
| Contrast X-Ray Of Knee Joint (73580) |
$2,110.50 |
$4,221 |
6.0× |
| Contrast Xray Throat/Cerv Esopha (74210) |
$604 |
$1,208 |
3.4× |
| CT abdomen and pelvis without and with contrast (74178) |
$3,367.97 |
$6,735.94 |
9.6× |
| CT abdomen and pelvis without contrast (74176) |
$2,547.35 |
$5,094.70 |
10.6× |
| CT lower ext w/o (73700) |
$1,418.94 |
$2,837.88 |
13.5× |
| CT lumbar spine w/o contrast (72131) |
$1,574.63 |
$3,149.26 |
15.0× |
| Dilation ureters/urethra rs&i (74485) |
$9,038.50 |
$18,077 |
4.3× |
| Discography Cerv/Thor Spine (72285) |
$16,313 |
$32,626 |
8.3× |
Diskography lumbar (72295) range across 2 matching MRF lines |
$4,483.28–$16,313 |
$8,966.55–$32,626 |
varies |
| Esophagram (74220) |
$604 |
$1,208 |
3.4× |
| Fluoroscopy up to 1 hr (76000) |
$517 |
$1,034 |
2.2× |
| Foot 2 views (73620) |
$365 |
$730 |
4.2× |
| Forearm 2 views (73090) |
$365 |
$730 |
4.2× |
| Hand 2 views (73120) |
$604 |
$1,208 |
5.8× |
| Hysterosalpingogram (74740) |
$2,110.50 |
$4,221 |
8.8× |
| Knee 3 Views (73562) |
$365 |
$730 |
4.2× |
| Myelogram cervical (72240) |
$4,007.50 |
$8,015 |
5.1× |
| Myelogram Lumbar (72265) |
$4,007.50 |
$8,015 |
5.1× |
| Myelography thoracic (72255) |
$4,007.50 |
$8,015 |
5.1× |
| Myelograpy 2/more regions rs&i (72270) |
$4,007.50 |
$8,015 |
5.1× |
| Neck soft tissue (70360) |
$359.16 |
$718.32 |
4.1× |
| Nonvascular Shunt X-Ray (75809) |
$320.64 |
$641.28 |
3.1× |
| Pelvis 1 or 2 views (72170) |
$604 |
$1,208 |
5.8× |
| Perineogram (74775) |
$1,152 |
$2,304 |
4.8× |
| Peritoneogram Rs&I (74190) |
$2,110.50 |
$4,221 |
3.8× |
| Radex Abd Compl Aqt Abd W/S/E/D Views 1 View Ch (74022) |
$604 |
$1,208 |
5.8× |
| Radex Ankle Complete Minimum 3 Views (73610) |
$365 |
$730 |
4.2× |
| Radex Calcaneus Minimum 2 Views (73650) |
$365 |
$730 |
4.2× |
| Radex elbow complete minimum 3 views (73080) |
$365 |
$730 |
4.2× |
| Radex fingr minimum 2 views (73140) |
$365 |
$730 |
4.2× |
| Radex foot complete minimum 3 views (73630) |
$365 |
$730 |
4.2× |
| Radex Hand Minimum 3 Views (73130) |
$365 |
$730 |
4.2× |
| Radex Nasal Bones Complete Minimum 3 Views (70160) |
$365 |
$730 |
4.2× |
| Radex Pharynx/Larx W/Fluor&/Magnification Tq (70370) |
$901 |
$1,802 |
10.3× |
| Radex Ribs Unilateral 2 Views (71100) |
$365 |
$730 |
4.2× |
| Radex shoulder complete minimum 2 views (73030) |
$365 |
$730 |
4.2× |
| Radex sm int w/mlt srl imges via enteroclss tube (74251) |
$1,152 |
$2,304 |
6.5× |
| Radex Spine 1 View Specify Level (72020) |
$365 |
$730 |
4.2× |
| Radex Sternum Minimum 2 Views (71120) |
$365 |
$730 |
4.2× |
| Radex Toe Minimum 2 Views (73660) |
$365 |
$730 |
4.2× |
| Radex Wrist Complete Minimum 3 Views (73110) |
$365 |
$730 |
4.2× |
| Radiologic Exam Abdomen 3+ Views - Xr Abdomen 3+ Views (74021) |
$572.50 |
$1,145 |
5.5× |
| Radiologic exam colon double contrast study (74280) |
$1,152 |
$2,304 |
6.5× |
| Radiologic exam colon single contrast study (74270) |
$604 |
$1,208 |
3.4× |
| Radiologic exam knee complete 4/more views (73564) |
$604 |
$1,208 |
5.8× |
| Radiologic exam pelvis compl minimum 3 views (72190) |
$604 |
$1,208 |
5.8× |
| Radiologic Exam Small Int Single Contrast Study (74250) |
$695.30 |
$1,390.60 |
3.9× |
| Radiologic exam upr gi trc double contrast study (74246) |
$604 |
$1,208 |
3.4× |
Radiologic examination femur minimum 2 views (73552) range across 4 matching MRF lines |
$158.50–$310.60 |
$317–$621.20 |
varies |
| Radiologic examination knee 1/2 views (73560) |
$365 |
$730 |
4.2× |
| Radiologic examination tibia & fibula 2 views (73590) |
$365 |
$730 |
4.2× |
| Ribs bilateral 3 views (71110) |
$604 |
$1,208 |
5.8× |
| Scapula (73010) |
$365 |
$730 |
3.5× |
| Shoulder 1 view (73020) |
$385.62 |
$771.24 |
4.4× |
| Shoulder Arthrography (73040) |
$2,110.50 |
$4,221 |
6.0× |
| Speech evaluation, complex (70371) |
$901 |
$1,802 |
3.8× |
| Sternoclavicular joints (71130) |
$365 |
$730 |
4.2× |
| Thoracic spine 2 views (72070) |
$604 |
$1,208 |
5.8× |
| Thoracic spine 3 views (72072) |
$604 |
$1,208 |
5.8× |
| Thoracolumbar 2 views (72080) |
$365 |
$730 |
4.2× |
| Ultrasound, abdomen limited (76705) |
$572.50 |
$1,145 |
5.5× |
| Upper gi w/o kub (74240) |
$604 |
$1,208 |
3.4× |
| Us exam, pelvic, limited (76857) |
$552.50 |
$1,105 |
5.3× |
| Us scrotum and contents (76870) |
$676.50 |
$1,353 |
6.4× |
| Wrist 2 views (73100) |
$365 |
$730 |
4.2× |
| X-Ray Ac Jts - Xr Acromioclavicular Joints Bilateral (73050) |
$365 |
$730 |
4.2× |
| X-Ray Bend Only L-S Spine (72120) |
$365 |
$730 |
3.5× |
| X-Ray Elbow 2 Vw - Xr Elbow 1-2 Views Right (73070) |
$365 |
$730 |
4.2× |
| X-Ray Exam Hip Uni 1 View (73501) |
$365 |
$730 |
4.2× |
| X-Ray Exam Hip Uni 2-3 Views (73502) |
$365 |
$730 |
4.2× |
| X-Ray Exam Hips Bi 2 Views (73521) |
$730 |
$1,460 |
7.0× |
| X-Ray Exam Neck Spine 2-3 Vw (72040) |
$604 |
$1,208 |
6.9× |
| X-Ray Exam Unilat Ribs/Chest (71101) |
$604 |
$1,208 |
5.8× |
| X-ray humerus (73060) |
$365 |
$730 |
4.2× |
| X-Ray Jaw <4 Vw - Xr Mandible < 4 Views (70100) |
$365 |
$730 |
4.2× |
| X-Ray Knee Bilat Standing - Xr Knees Anteroposterior Standing Bilat (73565) |
$365 |
$730 |
4.2× |
| X-Ray Lumbar Spine 2/3 Vw - Xr Lumbar Spine 2-3 Views (72100) |
$604 |
$1,208 |
5.8× |
| X-Ray Ribs, Chest 4+ Vw - Xr Ribs 3 Vws Bil W/ Chest Posteroanterior (71111) |
$604 |
$1,208 |
5.8× |
| X-Ray Sacroiliac Jts 3+ Vw - Xr Sacroiliac Joints 3+ Views (72202) |
$604 |
$1,208 |
5.8× |
| X-Ray Sacroiliac Jts <3 Vw - Xr Sacroiliac Joints 1-2 Views (72200) |
$604 |
$1,208 |
5.8× |
| X-Ray Sacrum/Coccyx 2+ Vw - Xr Sacrum Coccyx 2+ Views (72220) |
$365 |
$730 |
4.2× |
| X-ray thoracic spine 4 vw (72074) |
$604 |
$1,208 |
5.8× |
| Xr c-spine 4 or 5 views (72050) |
$604 |
$1,208 |
5.8× |