| Abdomen 2 views (74019) |
$139.65 |
$399 |
1.3× |
| Ankle 2 views (73600) |
$181.30 |
$518 |
2.1× |
| Arthrogram hip (73525) |
$706.65 |
$2,019 |
2.0× |
| Arthrogram shoulder (73040) |
$235.90 |
$674 |
0.7× |
| Arthrogram wrist (73115) |
$152.95 |
$437 |
0.4× |
| Cervical spine 2 or 3 views (72040) |
$119.35 |
$341 |
1.4× |
| Chest 1 view (71045) |
$193.20 |
$552 |
2.2× |
| Chest 3 views (71047) |
$193.20 |
$552 |
2.2× |
| Clavicle complete (73000) |
$130.55 |
$373 |
1.5× |
| CT abdomen and pelvis without and with contrast (74178) |
$1,984.85 |
$5,671 |
5.7× |
| CT abdomen and pelvis without contrast (74176) |
$1,717.10 |
$4,906 |
7.2× |
| CT abdomen w/o contrast (74150) |
$1,984.85 |
$5,671 |
18.9× |
| CT c-spine w/o contrast (72125) |
$1,871.80 |
$5,348 |
17.8× |
| CT chest w/wo contrast (71270) |
$1,515.50 |
$4,330 |
8.6× |
| CT head/brain with contrast (70460) |
$1,001 |
$2,860 |
5.7× |
| CT lumbar spine with contrast (72132) |
$133.70 |
$382 |
0.4× |
| CT pelvis w/o contrast (72192) |
$1,336.30 |
$3,818 |
12.7× |
| Diskogram cervical (72285) |
$1,217.65 |
$3,479 |
0.6× |
| Diskography lumbar (72295) |
$1,217.30 |
$3,478 |
0.6× |
| Fluoroscopy up to 1 hr (76000) |
$177.45 |
$507 |
0.7× |
| Foot 2 views (73620) |
$187.95 |
$537 |
2.1× |
| Forearm 2 views (73090) |
$168.35 |
$481 |
1.9× |
| Hand 2 views (73120) |
$119.35 |
$341 |
1.1× |
| Hand 3 views (73130) |
$119.35 |
$341 |
1.4× |
| Humerus Min 2 Views Left (73060) |
$195.65 |
$559 |
2.2× |
| Joint Survey, Single View - Xr Joint Anteroposterior 2+ Joints (77077) |
$177.45 |
$507 |
1.7× |
| Knee 3 views (73562) |
$119.35 |
$341 |
1.4× |
| Mammary ductogram or galactogram single (77053) |
$360.15 |
$1,029 |
1.5× |
| Manual appl stress pfrmd phys/qhp joint films (77071) |
$32.20 |
$92 |
0.4× |
| MRA head w & w/o contrast (70546) |
$1,777.65 |
$5,079 |
5.1× |
| MRA head w/o contrast (70544) |
$361.20 |
$1,032 |
1.5× |
| MRA head with contrast (70545) |
$1,626.45 |
$4,647 |
4.6× |
| Mra Neck W/O &W/Contrast Material (70549) |
$1,777.65 |
$5,079 |
5.1× |
| MRA neck w/o contrast (70547) |
$361.20 |
$1,032 |
1.5× |
| MRI abdomen w/o & w/contrast material (74183) |
$2,500.75 |
$7,145 |
7.1× |
| MRI abdomen w/o contrast (74181) |
$1,942.50 |
$5,550 |
8.1× |
| MRI any jnt lwr ext with con lt (73722) |
$1,212.05 |
$3,463 |
1.5× |
| MRI any jt upper extremity w/contrast matrl (73222) |
$2,323.65 |
$6,639 |
3.0× |
| MRI c-spine with contrast (72142) |
$682.85 |
$1,951 |
1.9× |
| MRI cervical spine w/o contrast (72141) |
$1,942.50 |
$5,550 |
8.1× |
| MRI chest w/o contrast (71550) |
$1,846.25 |
$5,275 |
7.7× |
| MRI Forearm w/ Contrast Bilateral 73219 (73219) |
$145.95 |
$417 |
0.4× |
| MRI lower extrem oth/thn jt w/o contr matrl (73718) |
$1,846.25 |
$5,275 |
7.7× |
| MRI orbit face &/neck w/o contrast (70540) |
$899.85 |
$2,571 |
3.8× |
| MRI orbit/face/neck w&w/o cont (70543) |
$1,846.25 |
$5,275 |
5.3× |
| MRI pelvis w contrast (72196) |
$794.85 |
$2,271 |
2.3× |
| MRI pelvis w/o & w/contrast material (72197) |
$2,500.75 |
$7,145 |
7.1× |
| MRI pelvis w/o contrast (72195) |
$1,942.50 |
$5,550 |
8.1× |
| MRI scan of arm joint before and after contrast (73223) |
$2,500.75 |
$7,145 |
7.1× |
| MRI scan of leg joint before and after contrast (73723) |
$2,500.75 |
$7,145 |
7.1× |
| MRI spinal canal cervical w/o & w/contr matrl (72156) |
$2,500.75 |
$7,145 |
7.1× |
| MRI spinal canal lumbar w/contrast material (72149) |
$235.55 |
$673 |
0.7× |
| MRI spinal canal lumbar w/o & w/contr matrl (72158) |
$2,500.75 |
$7,145 |
7.1× |
| MRI spinal canal thoracic w/contrast matrl (72147) |
$2,214.45 |
$6,327 |
6.3× |
| MRI spinal canal thoracic w/o & w/contr matrl (72157) |
$2,500.75 |
$7,145 |
7.1× |
| MRI thoracic spine w/o contrast (72146) |
$1,989.75 |
$5,685 |
8.3× |
| MRI upper ext joint w/o contrast (73221) |
$1,942.50 |
$5,550 |
8.1× |
| MRI upper extrem other than jt w/o & w/contras (73220) |
$2,385.60 |
$6,816 |
6.8× |
| MRI upper extremity oth than jt w/o contr matrl (73218) |
$1,846.25 |
$5,275 |
7.7× |
| Neck soft tissue (70360) |
$178.50 |
$510 |
2.0× |
| Pelvis 1 or 2 views (72170) |
$129.15 |
$369 |
1.2× |
| Pr MRI, lower extr, w/o contrast f/u by contrast (73720) |
$2,385.60 |
$6,816 |
6.8× |
| Radex hips bilateral with pelvis 2 views (73521) |
$206.50 |
$590 |
2.0× |
| Radiolog exam mandible compl minimum 4 views (70110) |
$178.50 |
$510 |
1.7× |
| Radiologic Exam Abdomen 1 View - Xr Abdomen 1 View (74018) |
$139.65 |
$399 |
1.6× |
| Radiologic Exam Abdomen 3+ Views - Xr Abdomen 3+ Views (74021) |
$139.65 |
$399 |
1.3× |
| Radiologic Exam Chest 2 Views - Xr Chest 2 Views (71046) |
$172.20 |
$492 |
2.0× |
| Radiologic Examination Femur Minimum 2 Views - Xr Femur 2+ Vw Lt (73552) |
$111.65 |
$319 |
1.3× |
| Ribs bilateral 3 views (71110) |
$192.85 |
$551 |
1.8× |
| Shuntogram indwelling nonvascular shunt rs&i (75809) |
$326.55 |
$933 |
3.1× |
| Spine thoracic 3 views (72072) |
$281.05 |
$803 |
2.7× |
| Unlisted Diagnostic Radiographic Procedure (76499) |
$119.35 |
$341 |
1.4× |
| Urethrocystography retrograde rs&i (74450) |
$83.38 |
$238.24 |
0.3× |
| Urography (pyelography), intravenous, with or without KUB, with or without tomography (74400) |
$537.95 |
$1,537 |
3.1× |
| Us pelvic non ob complete (76856) |
$718.20 |
$2,052 |
6.8× |
| Us transrectal (76872) |
$278.25 |
$795 |
2.6× |
| Us xtr non-vasc lmtd (76882) |
$267.40 |
$764 |
2.5× |
| Wrist 2 views (73100) |
$119.35 |
$341 |
1.4× |
| X-Ray Abdomen,Comp Acute Series - Xr Abdomen 2 Vws With Chest 1 View (74022) |
$139.65 |
$399 |
1.3× |
| X-Ray Ankle 3+ Vw - Xr Ankle 3+ Views Right (73610) |
$181.30 |
$518 |
2.1× |
| X-Ray Elbow 2 Vw - Xr Elbow 1-2 Views Right (73070) |
$174.65 |
$499 |
2.0× |
| X-Ray Elbow 3+ Vw - Xr Elbow 3+ Views Right (73080) |
$119.35 |
$341 |
1.4× |
| X-ray exam hip uni 1 view (73501) |
$206.50 |
$590 |
2.4× |
| X-Ray Exam Hip Uni 2-3 Views (73502) |
$206.50 |
$590 |
2.4× |
| X-Ray Exam Hips Bi 3-4 Views (73522) |
$206.50 |
$590 |
2.0× |
| X-Ray Exam Hips Bi 5/> Views (73523) |
$206.50 |
$590 |
2.0× |
| X-ray exam of femur 1 (73551) |
$32.20 |
$92 |
0.4× |
| X-ray eye for foreign body (70030) |
$25.90 |
$74 |
0.3× |
| X-Ray Facial Bones 3+ Vw - Xr Facial Bones 3+ Views (70150) |
$119.35 |
$341 |
1.1× |
| X-Ray Facial Bones <3 Vw - Xr Facial Bones 1-2 Views (70140) |
$119.35 |
$341 |
1.4× |
| X-Ray Foot 3+ Vw - Xr Foot 3+ Views Right (73630) |
$187.95 |
$537 |
2.1× |
| X-Ray Heel - Xr Calcaneus 2 Views Right (73650) |
$31.85 |
$91 |
0.4× |
| X-Ray Knee 4+ View - Xr Knee 4+ Views Right (73564) |
$597.80 |
$1,708 |
5.7× |
| X-Ray Knee Bilat Standing - Xr Knees Anteroposterior Standing Bilat (73565) |
$183.40 |
$524 |
2.1× |
| X-Ray Lumbar Spine 2/3 Vw - Xr Lumbar Spine 2-3 Views (72100) |
$114.45 |
$327 |
1.1× |
| X-Ray Lumbar Spine 6+ Vw - Xr Lumbar Spine 6+ Vws Including Bending (72114) |
$235.55 |
$673 |
2.2× |
| X-Ray Lumbar Spine Flex/Exten - Xr Lumbar Spine 4+ Views W/ Flex Ext (72120) |
$244.30 |
$698 |
2.3× |
| X-Ray Nasal Bones - Xr Nasal Bones (70160) |
$172.20 |
$492 |
2.0× |
| X-Ray Pelvis 3+ Vw - Xr Pelvis 3+ Views (72190) |
$243.60 |
$696 |
2.3× |
| X-Ray Retrograde Pyelogram - Fl Pyelogram Retrograde (74420) |
$732.20 |
$2,092 |
2.1× |
| X-Ray Ribs 2 Vw Unilat - Xr Ribs 2 Views Right (71100) |
$193.20 |
$552 |
2.2× |
| X-Ray Ribs, Chest 3+ Vw - Xr Ribs 2 Vws Lt W/ Chest Anteroposterior (71101) |
$38.15 |
$109 |
0.4× |
| X-Ray Sacrum/Coccyx 2+ Vw - Xr Sacrum Coccyx 2+ Views (72220) |
$119.35 |
$341 |
1.4× |
| X-Ray Shoulder 2+ Vw - Xr Shoulder 2+ Views Right (73030) |
$119.35 |
$341 |
1.4× |
| X-Ray Skull 4+ Vw - Xr Skull Complete 4+ Views (70260) |
$117.78 |
$336.50 |
1.1× |
| X-Ray Skull <4 Vw - Xr Skull 1-3 Views (70250) |
$119.35 |
$341 |
1.1× |
| X-Ray Spine One View - Xr Spine (72020) |
$187.95 |
$537 |
2.1× |
| X-Ray Thoracic Spine 2 Vw - Xr Thoracic Spine 2 Views (72070) |
$259.35 |
$741 |
2.5× |
| X-Ray Thoracic Spine 4 Vw - Xr Thoracic Spine Complete 4+ Views (72074) |
$259.35 |
$741 |
2.5× |
| X-Ray Toe(S) - Xr Toes 2+ Views Right (73660) |
$146.30 |
$418 |
1.7× |
| X-Ray Wrist 3+ Vw - Xr Wrist 3+ Views Right (73110) |
$119.35 |
$341 |
1.4× |
| Xr c-spine 6 or more views (72052) |
$273 |
$780 |
2.6× |
| Xr chest 4+ views (71048) |
$47.95 |
$137 |
0.5× |
| Xr finger(s) 2+ views (73140) |
$114.45 |
$327 |
1.3× |
| Xr shoulder 1 view (73020) |
$119.35 |
$341 |
1.4× |
| Xr spine cervical 4 or 5 views (72050) |
$341.25 |
$975 |
3.2× |
| Xr tibia/fibula 2 views (73590) |
$199.85 |
$571 |
2.3× |
| Xray knee 1 or 2 views rt (73560) |
$183.75 |
$525 |
2.1× |