| Ankle 2 views (73600) |
$365 |
$730 |
4.2× |
| Aortography abdominal serialography rs&i (75625) |
$11,915.88 |
$23,831.76 |
3.8× |
| Arthrogram elbow (73085) |
$2,110.50 |
$4,221 |
6.0× |
| Arthrogram hip (73525) |
$2,110.50 |
$4,221 |
6.0× |
| Arthrogram shoulder (73040) |
$2,110.50 |
$4,221 |
6.0× |
| Arthrogram wrist (73115) |
$1,152 |
$2,304 |
3.3× |
| Arthrography knee lt (73580) |
$2,110.50 |
$4,221 |
6.0× |
| Cervical spine 2 or 3 views (72040) |
$604 |
$1,208 |
6.9× |
| Chest 1 view (71045) |
$365 |
$730 |
4.2× |
| Clavicle complete (73000) |
$365 |
$730 |
4.2× |
| Contrast Xray Throat/Cerv Esopha - Fl Esophagus Pharynx (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× |
| Diskogram cervical (72285) |
$16,313 |
$32,626 |
8.3× |
| Diskography lumbar (72295) |
$10,398.14 |
$20,796.28 |
5.3× |
| Esophagus (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× |
| Hand 3 views (73130) |
$365 |
$730 |
4.2× |
| Humerus Min 2 Views Left (73060) |
$365 |
$730 |
4.2× |
| 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× |
| Myelogram thoracic (72255) |
$4,007.50 |
$8,015 |
5.1× |
| Myelography 2 or more regions (72270) |
$4,007.50 |
$8,015 |
5.1× |
| Neck soft tissue (70360) |
$359.16 |
$718.32 |
4.1× |
| 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 hips bilateral with pelvis 2 views (73521) |
$730 |
$1,460 |
7.0× |
| Radiologic Exam Abdomen 1 View - Xr Abdomen 1 View (74018) |
$365 |
$730 |
4.2× |
| Radiologic Exam Abdomen 3+ Views - Xr Abdomen 3+ Views (74021) |
$572.50 |
$1,145 |
5.5× |
| Radiologic Exam Chest 2 Views - Xr Chest 2 Views (71046) |
$365 |
$730 |
4.2× |
| Radiologic exam colon single contrast study (74270) |
$604 |
$1,208 |
3.4× |
| Radiologic exam upr gi trc double contrast study (74246) |
$604 |
$1,208 |
3.4× |
| Radiologic exam upr gi trc single contrast study (74240) |
$604 |
$1,208 |
3.4× |
| Radiologic Examination Femur Minimum 2 Views - Xr Femur 2+ Vw Lt (73552) |
$198.25 |
$396.50 |
2.3× |
| Ribs bilateral 3 views (71110) |
$604 |
$1,208 |
5.8× |
| Sacroiliac Joints < 3 Views (72200) |
$604 |
$1,208 |
5.8× |
| Scapula complete (73010) |
$365 |
$730 |
3.5× |
| Shuntogram indwelling nonvascular shunt rs&i (75809) |
$320.64 |
$641.28 |
3.1× |
| Small bowel series (74250) |
$695.30 |
$1,390.60 |
3.9× |
| Speech evaluation complex (70371) |
$901 |
$1,802 |
3.8× |
| Spine thoracic 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× |
| Us pelvic nonobstetric image dcmtn limited/f/u (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 Abdomen,Comp Acute Series - Xr Abdomen 2 Vws With Chest 1 View (74022) |
$604 |
$1,208 |
5.8× |
| X-Ray Ac Jts - Xr Acromioclavicular Joints Bilateral (73050) |
$365 |
$730 |
4.2× |
| X-Ray Ankle 3+ Vw - Xr Ankle 3+ Views Right (73610) |
$365 |
$730 |
4.2× |
| X-Ray Colon Air Contrast - Fl Barium Enema Air Contrast (74280) |
$1,152 |
$2,304 |
6.5× |
| X-Ray Elbow 2 Vw - Xr Elbow 1-2 Views Right (73070) |
$365 |
$730 |
4.2× |
| X-Ray Elbow 3+ Vw - Xr Elbow 3+ Views Right (73080) |
$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 of small bowel - fl small bowel series enteroclysis tube (74251) |
$1,152 |
$2,304 |
6.5× |
| X-Ray Foot 3+ Vw - Xr Foot 3+ Views Right (73630) |
$365 |
$730 |
4.2× |
| X-ray guide gu dilation - ir nephrostomy dilation (74485) |
$9,038.50 |
$18,077 |
4.3× |
| X-Ray Heel - Xr Calcaneus 2 Views Right (73650) |
$365 |
$730 |
4.2× |
| X-Ray Jaw <4 Vw - Xr Mandible < 4 Views (70100) |
$365 |
$730 |
4.2× |
| X-Ray Knee 4+ View - Xr Knee 4+ Views Right (73564) |
$604 |
$1,208 |
5.8× |
| 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 Lumbar Spine Flex/Exten - Xr Lumbar Spine 4+ Views W/ Flex Ext (72120) |
$365 |
$730 |
3.5× |
| X-Ray Nasal Bones - Xr Nasal Bones (70160) |
$365 |
$730 |
4.2× |
| X-ray of voice box or throat (70370) |
$901 |
$1,802 |
10.3× |
| X-Ray Pelvis 3+ Vw - Xr Pelvis 3+ Views (72190) |
$604 |
$1,208 |
5.8× |
| X-Ray Ribs 2 Vw Unilat - Xr Ribs 2 Views Right (71100) |
$365 |
$730 |
4.2× |
| X-Ray Ribs, Chest 3+ Vw - Xr Ribs 2 Vws Lt W/ Chest Anteroposterior (71101) |
$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 Sacrum/Coccyx 2+ Vw - Xr Sacrum Coccyx 2+ Views (72220) |
$365 |
$730 |
4.2× |
| X-Ray Shoulder 2+ Vw - Xr Shoulder 2+ Views Right (73030) |
$365 |
$730 |
4.2× |
| X-Ray Spine One View - Xr Spine (72020) |
$365 |
$730 |
4.2× |
| X-Ray Sterno-Clavicluar Jt - Xr Sternoclavicular Joints 3+ Views (71130) |
$365 |
$730 |
4.2× |
| X-Ray Sternum 2+ Vw - Xr Sternum 2+ Views (71120) |
$365 |
$730 |
4.2× |
| X-Ray Thoracic Spine 2 Vw - Xr Thoracic Spine 2 Views (72070) |
$604 |
$1,208 |
5.8× |
| X-Ray Thoracic Spine 4 Vw - Xr Thoracic Spine Complete 4+ Views (72074) |
$604 |
$1,208 |
5.8× |
| X-Ray Toe(S) - Xr Toes 2+ Views Right (73660) |
$365 |
$730 |
4.2× |
| X-Ray Wrist 3+ Vw - Xr Wrist 3+ Views Right (73110) |
$365 |
$730 |
4.2× |
| Xr arthrogram ankle (73615) |
$2,110.50 |
$4,221 |
6.0× |
| Xr finger(s) 2+ views (73140) |
$365 |
$730 |
4.2× |
| Xr shoulder 1 view (73020) |
$385.62 |
$771.24 |
4.4× |
| Xr spine cervical 4 or 5 views (72050) |
$604 |
$1,208 |
5.8× |
| Xr tibia/fibula 2 views (73590) |
$365 |
$730 |
4.2× |
| Xray knee 1 or 2 views rt (73560) |
$365 |
$730 |
4.2× |