| Abdomen 2 views (74019) |
$205.44 |
$428 |
2.0× |
| Ankle 2 views (73600) |
$175.10 |
$364.80 |
2.1× |
| Arthrogram shoulder (73040) |
$1,012.92 |
$2,110.26 |
3.0× |
| Bone survey complete (77075) |
$304.32 |
$634 |
3.0× |
| Cervical spine 2 or 3 views (72040) |
$227.80 |
$474.57 |
2.7× |
| Chest 1 view (71045) |
$190.11 |
$396.07 |
2.3× |
| Clavicle complete (73000) |
$175.10 |
$364.80 |
2.1× |
| Computed Tomography Thorax Lw Dose Lng Ca Scr C- (71271) |
$124.80 |
$260 |
1.2× |
| CT abdomen and pelvis without and with contrast (74178) |
$1,890.24 |
$3,938 |
5.6× |
| CT abdomen and pelvis without contrast (74176) |
$1,081.25 |
$2,252.61 |
4.7× |
| CT abdomen w contrast (74160) |
$1,393.92 |
$2,904 |
8.3× |
| CT abdomen w wo contrast (74170) |
$1,847.04 |
$3,848 |
10.9× |
| CT abdomen w/o contrast (74150) |
$1,119.84 |
$2,333 |
11.1× |
| CT angiography upper extremity lt (73206) |
$1,555.68 |
$3,241 |
9.2× |
| CT c-spine w/o contrast (72125) |
$1,193.76 |
$2,487 |
11.9× |
| CT cervical spine w&w/o contrast (72127) |
$1,792.80 |
$3,735 |
10.6× |
| CT cervical spine with contrast (72126) |
$1,430.88 |
$2,981 |
4.3× |
| CT chest w/wo contrast (71270) |
$1,761.12 |
$3,669 |
10.4× |
| CT chest with contrast (71260) |
$1,412.16 |
$2,942 |
8.4× |
| CT head/brain with contrast (70460) |
$1,175.52 |
$2,449 |
7.0× |
| CT head/brain without and with contrast (70470) |
$1,505.76 |
$3,137 |
8.9× |
| CT heart contrast eval cardiac structure&morph (75572) |
$67.10 |
$139.80 |
0.2× |
| CT heart no contrast quant eval coronry calcium (75571) |
$50.09 |
$104.35 |
0.6× |
| CT iac w contrast (70481) |
$271.80 |
$566.25 |
1.6× |
| CT lower ext w/o (73700) |
$1,056.96 |
$2,202 |
10.5× |
| CT lower extremity w wo contrast (73702) |
$692.40 |
$1,442.50 |
4.1× |
| CT lower extremity with contrast (73701) |
$644.16 |
$1,342 |
3.8× |
| CT lumbar spine w & w/o contrast (72133) |
$1,792.80 |
$3,735 |
10.6× |
| CT lumbar spine w/o contrast (72131) |
$659.61 |
$1,374.18 |
6.6× |
| CT lumbar spine with contrast (72132) |
$1,430.88 |
$2,981 |
4.3× |
| CT maxillofacial w contrast (70487) |
$953.76 |
$1,987 |
5.7× |
| CT maxillofacial w/o contrast (70486) |
$1,063.20 |
$2,215 |
10.6× |
| CT maxillofacial w/wo contrast (70488) |
$1,505.76 |
$3,137 |
8.9× |
| CT neck soft tissue w contrast (70491) |
$1,023.36 |
$2,132 |
6.1× |
| CT orbits w/o contrast (70480) |
$271.80 |
$566.25 |
2.7× |
| CT pelvis w & w/o contrast (72194) |
$1,113.60 |
$2,320 |
6.6× |
| CT pelvis w/o contrast (72192) |
$1,212.96 |
$2,527 |
12.1× |
| CT soft tissue neck w/o & w/contrast material (70492) |
$1,113.60 |
$2,320 |
6.6× |
| CT soft tissue neck w/o contrast (70490) |
$961.92 |
$2,004 |
9.6× |
| CT thoracic spine w/contrast (72129) |
$1,430.88 |
$2,981 |
8.5× |
| CT thoracic spine w/o contrast (72128) |
$650.31 |
$1,354.82 |
6.5× |
| CT thoracic spine w/wo contrast (72130) |
$1,792.80 |
$3,735 |
10.6× |
| CT thorax w/o contrast (71250) |
$820.80 |
$1,710 |
8.2× |
| CT upper extremity w/o contrast rt (73200) |
$1,146.24 |
$2,388 |
11.4× |
| CT upper extremity with contrast (73201) |
$1,292.16 |
$2,692 |
3.9× |
| Cta Abdl Aorta&Bi Iliofem W/Contrast&Postp (75635) |
$1,345.92 |
$2,804 |
8.0× |
| Cta Abdomen (74175) |
$1,555.20 |
$3,240 |
9.2× |
| CTA abdomen pelvis (74174) |
$2,150.88 |
$4,481 |
6.4× |
| CTA chest (71275) |
$1,555.68 |
$3,241 |
9.2× |
| Cta Head (70496) |
$1,345.92 |
$2,804 |
8.0× |
| CTA lwr ext w&w/o contrast (73706) |
$1,555.68 |
$3,241 |
9.2× |
| Cta Neck (70498) |
$1,345.92 |
$2,804 |
8.0× |
| Cta Pelvis (72191) |
$1,536.48 |
$3,201 |
9.1× |
| Diskogram cervical (72285) |
$276.46 |
$575.95 |
0.1× |
| Diskography lumbar (72295) |
$7,830.23 |
$16,312.98 |
4.2× |
| Esophagus (74220) |
$289.99 |
$604.14 |
1.7× |
| Fluoroscopy up to 1 hr (76000) |
$451.20 |
$940 |
2.0× |
| Foot 2 views (73620) |
$175.10 |
$364.80 |
2.1× |
| Forearm 2 views (73090) |
$175.10 |
$364.80 |
2.1× |
| Hand 2 views (73120) |
$289.99 |
$604.14 |
2.9× |
| Hand 3 views (73130) |
$175.10 |
$364.80 |
2.1× |
| Humerus Min 2 Views Left (73060) |
$175.10 |
$364.80 |
2.1× |
| Knee 3 views (73562) |
$197.76 |
$412 |
2.4× |
| MRA head w/o contrast (70544) |
$1,521.12 |
$3,169 |
6.6× |
| MRA neck w contrast (70548) |
$1,308.44 |
$2,725.92 |
3.9× |
| MRA neck w/o contrast (70547) |
$1,521.12 |
$3,169 |
6.6× |
| MRI abdomen w contrast (74182) |
$1,866.24 |
$3,888 |
5.6× |
| MRI abdomen w/o contrast (74181) |
$1,866.24 |
$3,888 |
8.1× |
| MRI chest w/o & w/contrast material (71552) |
$2,052.96 |
$4,277 |
6.1× |
| MRI chest w/o contrast (71550) |
$1,805.76 |
$3,762 |
7.9× |
| MRI chest with contrast (71551) |
$1,866.24 |
$3,888 |
2.5× |
| MRI Forearm w/ Contrast Bilateral 73219 (73219) |
$1,866.24 |
$3,888 |
5.6× |
| MRI lower extrem oth/thn jt w/contrast matrl (73719) |
$1,866.24 |
$3,888 |
5.6× |
| MRI pelvis w/o & w/contrast material (72197) |
$1,678.56 |
$3,497 |
5.0× |
| MRI pelvis w/o contrast (72195) |
$1,522.56 |
$3,172 |
6.6× |
| MRI upper extrem other than jt w/o & w/contras (73220) |
$2,052.96 |
$4,277 |
6.1× |
| MRI upper extremity oth than jt w/o contr matrl (73218) |
$3,042.24 |
$6,338 |
13.3× |
| Neck soft tissue (70360) |
$175.10 |
$364.80 |
2.1× |
| Osseous survey limited (77074) |
$178.56 |
$372 |
1.8× |
| Pelvis 1 or 2 views (72170) |
$289.99 |
$604.14 |
2.9× |
| Pr MRI, lower extr, w/o contrast f/u by contrast (73720) |
$1,678.56 |
$3,497 |
5.0× |
| Radex abscess/fistula/sinus tract rs&i (76080) |
$1,012.92 |
$2,110.26 |
1.9× |
| Radex entir thrc lmbr crv sac spi w/skull 2/3 vw (72082) |
$279.36 |
$582 |
2.8× |
| Radex hips bilateral with pelvis 2 views (73521) |
$212.64 |
$443 |
2.1× |
| Radex mastoids compl minimum 3 views pr side (70130) |
$289.99 |
$604.14 |
2.9× |
| Radiolog exam mandible compl minimum 4 views (70110) |
$289.99 |
$604.14 |
2.9× |
| Radiologic Exam Abdomen 1 View - Xr Abdomen 1 View (74018) |
$185.76 |
$387 |
2.2× |
| Radiologic Exam Abdomen 3+ Views - Xr Abdomen 3+ Views (74021) |
$177.12 |
$369 |
1.8× |
| Radiologic Exam Chest 2 Views - Xr Chest 2 Views (71046) |
$101.95 |
$212.40 |
1.2× |
| Radiologic Examination Femur Minimum 2 Views - Xr Femur 2+ Vw Lt (73552) |
$372.96 |
$777 |
4.5× |
| Ribs bilateral 3 views (71110) |
$289.99 |
$604.14 |
2.9× |
| Sacroiliac Joints < 3 Views (72200) |
$289.99 |
$604.14 |
2.9× |
| Scapula complete (73010) |
$175.10 |
$364.80 |
1.7× |
| Sella turcica (70240) |
$185.76 |
$387 |
2.2× |
| Small bowel series (74250) |
$309.12 |
$644 |
1.8× |
| Spine thoracic 3 views (72072) |
$289.99 |
$604.14 |
2.9× |
| Tmj unilateral (70328) |
$175.10 |
$364.80 |
2.1× |
| Ultrasound, abdomen limited (76705) |
$442.31 |
$921.48 |
4.4× |
| Unlisted Diagnostic Radiographic Procedure (76499) |
$556.80 |
$1,160 |
6.7× |
| Upper Extremity Infant (73092) |
$289.99 |
$604.14 |
2.9× |
| Urography (pyelography), intravenous, with or without KUB, with or without tomography (74400) |
$552.87 |
$1,151.82 |
3.3× |
| Us abdl aorta screen aaa (76706) |
$270.55 |
$563.65 |
2.7× |
| Us breast unilateral complete (76641) |
$207.36 |
$432 |
2.1× |
| Us chest (76604) |
$265.16 |
$552.42 |
2.6× |
| Us compl joint r-t w/image documentation (76881) |
$477.60 |
$995 |
4.7× |
| Us kidney transplant (76776) |
$442.31 |
$921.48 |
4.4× |
| Us pelvic non ob complete (76856) |
$442.31 |
$921.48 |
4.4× |
| Us pelvic nonobstetric image dcmtn limited/f/u (76857) |
$321.60 |
$670 |
3.2× |
| Us pregnant uterus 14 wk transabdl 1/1st gestat (76801) |
$442.31 |
$921.48 |
4.4× |
| Us retroperitoneal complete (76770) |
$442.31 |
$921.48 |
4.4× |
| Us retroperitoneal limited (76775) |
$442.31 |
$921.48 |
4.4× |
| Us scrotum and contents (76870) |
$442.31 |
$921.48 |
4.4× |
| Us soft tissue head/neck (76536) |
$442.31 |
$921.48 |
4.4× |
| Us transrectal (76872) |
$442.31 |
$921.48 |
4.4× |
| Us xtr non-vasc lmtd (76882) |
$265.16 |
$552.42 |
2.6× |
| Wrist 2 views (73100) |
$175.10 |
$364.80 |
2.1× |
| X-Ray Abdomen,Comp Acute Series - Xr Abdomen 2 Vws With Chest 1 View (74022) |
$289.99 |
$604.14 |
2.9× |
| X-Ray Ac Jts - Xr Acromioclavicular Joints Bilateral (73050) |
$177.12 |
$369 |
2.1× |
| X-Ray Ankle 3+ Vw - Xr Ankle 3+ Views Right (73610) |
$175.10 |
$364.80 |
2.1× |
| X-Ray Elbow 2 Vw - Xr Elbow 1-2 Views Right (73070) |
$175.10 |
$364.80 |
2.1× |
| X-Ray Elbow 3+ Vw - Xr Elbow 3+ Views Right (73080) |
$242.35 |
$504.90 |
2.9× |
| X-ray exam hip uni 1 view (73501) |
$149.28 |
$311 |
1.8× |
| X-Ray Exam Hip Uni 2-3 Views (73502) |
$227.52 |
$474 |
2.7× |
| X-ray exam of femur 1 (73551) |
$147.36 |
$307 |
1.8× |
| X-ray eye for foreign body (70030) |
$175.10 |
$364.80 |
2.1× |
| X-Ray Facial Bones 3+ Vw - Xr Facial Bones 3+ Views (70150) |
$289.99 |
$604.14 |
2.9× |
| X-Ray Facial Bones <3 Vw - Xr Facial Bones 1-2 Views (70140) |
$175.10 |
$364.80 |
2.1× |
| X-Ray Foot 3+ Vw - Xr Foot 3+ Views Right (73630) |
$175.10 |
$364.80 |
2.1× |
| X-Ray Heel - Xr Calcaneus 2 Views Right (73650) |
$175.10 |
$364.80 |
2.1× |
| X-Ray Jaw <4 Vw - Xr Mandible < 4 Views (70100) |
$175.10 |
$364.80 |
2.1× |
| X-Ray Knee 4+ View - Xr Knee 4+ Views Right (73564) |
$289.99 |
$604.14 |
2.9× |
| X-Ray Leg, Infant - Xr Lower Extremity 2+ Views Infant Left (73592) |
$175.10 |
$364.80 |
2.1× |
| X-Ray Lumbar Spine 2/3 Vw - Xr Lumbar Spine 2-3 Views (72100) |
$289.99 |
$604.14 |
2.9× |
| X-Ray Lumbar Spine 6+ Vw - Xr Lumbar Spine 6+ Vws Including Bending (72114) |
$289.99 |
$604.14 |
2.9× |
| X-Ray Lumbar Spine Flex/Exten - Xr Lumbar Spine 4+ Views W/ Flex Ext (72120) |
$264.48 |
$551 |
2.6× |
| X-Ray Nasal Bones - Xr Nasal Bones (70160) |
$175.10 |
$364.80 |
2.1× |
| X-Ray Nose-Rectum Child F.B. - Xr Nose to Rectum Foreign Body Peds (76010) |
$552.87 |
$1,151.82 |
6.6× |
| X-Ray Orbits - Xr Orbits Complete 4+ Views (70200) |
$289.99 |
$604.14 |
2.9× |
| X-Ray Pelvis 3+ Vw - Xr Pelvis 3+ Views (72190) |
$289.99 |
$604.14 |
2.9× |
| X-Ray Ribs 2 Vw Unilat - Xr Ribs 2 Views Right (71100) |
$188.16 |
$392 |
2.2× |
| X-Ray Ribs, Chest 3+ Vw - Xr Ribs 2 Vws Lt W/ Chest Anteroposterior (71101) |
$289.99 |
$604.14 |
2.9× |
| X-Ray Ribs, Chest 4+ Vw - Xr Ribs 3 Vws Bil W/ Chest Posteroanterior (71111) |
$289.99 |
$604.14 |
2.9× |
| X-Ray Sacroiliac Jts 3+ Vw - Xr Sacroiliac Joints 3+ Views (72202) |
$289.99 |
$604.14 |
2.9× |
| X-Ray Sacrum/Coccyx 2+ Vw - Xr Sacrum Coccyx 2+ Views (72220) |
$175.10 |
$364.80 |
2.1× |
| X-Ray Shoulder 2+ Vw - Xr Shoulder 2+ Views Right (73030) |
$197.76 |
$412 |
2.4× |
| X-Ray Sinuses 3+ Vw - Xr Paranasal Sinuses 3+ Views (70220) |
$215.04 |
$448 |
2.6× |
| X-Ray Sinuses <3 Vw - Xr Paranasal Sinuses 1-2 Views (70210) |
$175.10 |
$364.80 |
2.1× |
| X-Ray Skull 4+ Vw - Xr Skull Complete 4+ Views (70260) |
$289.99 |
$604.14 |
2.9× |
| X-Ray Skull <4 Vw - Xr Skull 1-3 Views (70250) |
$289.99 |
$604.14 |
2.9× |
| X-Ray Spine One View - Xr Spine (72020) |
$185.76 |
$387 |
2.2× |
| X-Ray Sterno-Clavicluar Jt - Xr Sternoclavicular Joints 3+ Views (71130) |
$185.76 |
$387 |
2.2× |
| X-Ray Sternum 2+ Vw - Xr Sternum 2+ Views (71120) |
$185.76 |
$387 |
2.2× |
| X-Ray Thoracic Spine 2 Vw - Xr Thoracic Spine 2 Views (72070) |
$289.99 |
$604.14 |
2.9× |
| X-Ray Thoracic Spine 4 Vw - Xr Thoracic Spine Complete 4+ Views (72074) |
$289.99 |
$604.14 |
2.9× |
| X-Ray Toe(S) - Xr Toes 2+ Views Right (73660) |
$175.10 |
$364.80 |
2.1× |
| X-Ray Wrist 3+ Vw - Xr Wrist 3+ Views Right (73110) |
$188.16 |
$392 |
2.2× |
| Xr arthrogram ankle (73615) |
$384.48 |
$801 |
1.1× |
| Xr c-spine 6 or more views (72052) |
$289.99 |
$604.14 |
2.9× |
| Xr chest 4+ views (71048) |
$232.80 |
$485 |
2.3× |
| Xr Cholecystography Oral Contrast (74290) |
$552.87 |
$1,151.82 |
3.3× |
| Xr finger(s) 2+ views (73140) |
$175.10 |
$364.80 |
2.1× |
| XR Mastoids < 3 Views Bilateral (70120) |
$197.76 |
$412 |
2.0× |
| Xr shoulder 1 view (73020) |
$175.10 |
$364.80 |
2.1× |
| Xr spine cervical 4 or 5 views (72050) |
$284.68 |
$593.07 |
2.8× |
| Xr tibia/fibula 2 views (73590) |
$343.68 |
$716 |
4.1× |
| Xr tmj bilateral (70330) |
$212.64 |
$443 |
2.5× |
| Xray knee 1 or 2 views rt (73560) |
$259.39 |
$540.40 |
3.1× |