| Ankle 2 views (73600) |
$355.50 |
$711 |
4.1× |
| Aortography abdl bi iliofem low extrem cath rs&i (75630) |
$2,732.50 |
$5,465 |
0.9× |
| Bone age studies (77072) |
$215 |
$430 |
2.0× |
| Cervical spine 2 or 3 views (72040) |
$409.50 |
$819 |
4.7× |
| Chest 1 view (71045) |
$319 |
$638 |
3.6× |
| Clavicle complete (73000) |
$411 |
$822 |
4.7× |
| CT abdomen and pelvis without and with contrast (74178) |
$2,154 |
$4,308 |
6.1× |
| CT abdomen and pelvis without contrast (74176) |
$1,628 |
$3,256 |
6.8× |
| CT abdomen w contrast (74160) |
$998.50 |
$1,997 |
5.7× |
| CT abdomen w wo contrast (74170) |
$2,137.42 |
$4,274.84 |
12.1× |
| CT abdomen w/o contrast (74150) |
$786 |
$1,572 |
7.5× |
| CT c-spine w/o contrast (72125) |
$998.50 |
$1,997 |
9.5× |
| CT cervical spine w&w/o contrast (72127) |
$1,155.50 |
$2,311 |
6.6× |
| CT cervical spine with contrast (72126) |
$1,048.50 |
$2,097 |
3.0× |
| CT chest w/wo contrast (71270) |
$1,485.50 |
$2,971 |
8.4× |
| CT chest with contrast (71260) |
$1,414.50 |
$2,829 |
8.0× |
| CT head/brain with contrast (70460) |
$1,032.50 |
$2,065 |
5.9× |
| CT head/brain without and with contrast (70470) |
$2,034.73 |
$4,069.46 |
11.5× |
| CT iac w contrast (70481) |
$1,050.50 |
$2,101 |
6.0× |
| CT lower ext w/o (73700) |
$840 |
$1,680 |
8.0× |
| CT lower extremity w wo contrast (73702) |
$1,155.50 |
$2,311 |
6.6× |
| CT lower extremity with contrast (73701) |
$998.50 |
$1,997 |
5.7× |
| CT lumbar spine w & w/o contrast (72133) |
$1,155.50 |
$2,311 |
6.6× |
| CT lumbar spine w/o contrast (72131) |
$798.50 |
$1,597 |
7.6× |
| CT lumbar spine with contrast (72132) |
$998.50 |
$1,997 |
2.8× |
| CT maxillofacial w contrast (70487) |
$1,050.50 |
$2,101 |
6.0× |
| CT maxillofacial w/o contrast (70486) |
$1,309 |
$2,618 |
12.5× |
| CT maxillofacial w/wo contrast (70488) |
$1,155.50 |
$2,311 |
6.6× |
| CT neck soft tissue w contrast (70491) |
$884.50 |
$1,769 |
5.0× |
| CT orbit sella/post fossa/ear w/o & w/contr matr (70482) |
$1,155.50 |
$2,311 |
6.6× |
| CT orbits w/o contrast (70480) |
$1,350.56 |
$2,701.12 |
12.9× |
| CT pelvis w & w/o contrast (72194) |
$2,875.08 |
$5,750.16 |
16.3× |
| CT pelvis w/o contrast (72192) |
$806 |
$1,612 |
7.7× |
| CT soft tissue neck w/o & w/contrast material (70492) |
$1,155.50 |
$2,311 |
6.6× |
| CT soft tissue neck w/o contrast (70490) |
$786 |
$1,572 |
7.5× |
| CT thoracic spine w/contrast (72129) |
$1,101 |
$2,202 |
6.2× |
| CT thoracic spine w/o contrast (72128) |
$998.50 |
$1,997 |
9.5× |
| CT thoracic spine w/wo contrast (72130) |
$1,155.50 |
$2,311 |
6.6× |
| CT thorax w/o contrast (71250) |
$1,248 |
$2,496 |
11.9× |
| CT upper extremity w/o & w/contrast material (73202) |
$1,468 |
$2,936 |
8.3× |
| CT upper extremity w/o contrast rt (73200) |
$1,223 |
$2,446 |
11.6× |
| CT upper extremity with contrast (73201) |
$1,345.50 |
$2,691 |
3.8× |
| Cta Abdl Aorta&Bi Iliofem W/Contrast&Postp (75635) |
$3,658.82 |
$7,317.64 |
20.8× |
| CTA chest (71275) |
$4,270.12 |
$8,540.24 |
24.2× |
| Fluoroscopy up to 1 hr (76000) |
$418 |
$836 |
1.7× |
| Foot 2 views (73620) |
$303.50 |
$607 |
3.5× |
| Forearm 2 views (73090) |
$356.50 |
$713 |
4.1× |
| Hand 2 views (73120) |
$353 |
$706 |
3.4× |
| Hand 3 views (73130) |
$379.50 |
$759 |
4.3× |
| Humerus Min 2 Views Left (73060) |
$413 |
$826 |
4.7× |
| MRI abdomen w contrast (74182) |
$1,202.50 |
$2,405 |
3.4× |
| MRI abdomen w/o & w/contrast material (74183) |
$2,596.50 |
$5,193 |
7.4× |
| MRI abdomen w/o contrast (74181) |
$1,529.75 |
$3,059.50 |
6.4× |
| MRI any jnt lwr ext with con lt (73722) |
$1,202.50 |
$2,405 |
1.5× |
| MRI cervical spine w/o contrast (72141) |
$1,323 |
$2,646 |
5.5× |
| MRI chest w/o & w/contrast material (71552) |
$2,166.50 |
$4,333 |
6.2× |
| MRI chest w/o contrast (71550) |
$1,093 |
$2,186 |
4.6× |
| MRI chest with contrast (71551) |
$1,147.50 |
$2,295 |
1.5× |
| MRI Forearm w/ Contrast Bilateral 73219 (73219) |
$1,093 |
$2,186 |
3.1× |
| MRI orbit/face/neck w/contrast (70542) |
$1,093 |
$2,186 |
3.1× |
| MRI pelvis w contrast (72196) |
$1,325 |
$2,650 |
3.8× |
| MRI pelvis w/o & w/contrast material (72197) |
$2,383 |
$4,766 |
6.8× |
| MRI pelvis w/o contrast (72195) |
$1,199 |
$2,398 |
5.0× |
| MRI scan of leg joint before and after contrast (73723) |
$1,666.50 |
$3,333 |
4.8× |
| MRI spinal canal cervical w/o & w/contr matrl (72156) |
$2,383 |
$4,766 |
6.8× |
| MRI upper extrem other than jt w/o & w/contras (73220) |
$1,969.50 |
$3,939 |
5.6× |
| MRI upper extremity oth than jt w/o contr matrl (73218) |
$991 |
$1,982 |
4.1× |
| Myelogram Cervical (72240) |
$1,099.50 |
$2,199 |
1.4× |
| Myelogram Lumbar (72265) |
$1,099.50 |
$2,199 |
1.4× |
| Myelography 2 or more regions (72270) |
$1,099.50 |
$2,199 |
1.4× |
| Neck soft tissue (70360) |
$257.50 |
$515 |
2.9× |
| Pelvis 1 or 2 views (72170) |
$312.50 |
$625 |
3.0× |
| Pr sono bone density measure,peripheral (76977) |
$215.50 |
$431 |
2.1× |
| Radex abscess/fistula/sinus tract rs&i (76080) |
$270.50 |
$541 |
0.5× |
| Radex entir thrc lmbr crv sac spi w/skull 2/3 vw (72082) |
$386.50 |
$773 |
3.7× |
| Radex hips bilateral with pelvis 2 views (73521) |
$473.50 |
$947 |
4.5× |
| Radex mastoids compl minimum 3 views pr side (70130) |
$165 |
$330 |
1.6× |
| Radiolog exam mandible compl minimum 4 views (70110) |
$317 |
$634 |
3.0× |
| Radiologic Exam Abdomen 1 View - Xr Abdomen 1 View (74018) |
$319.50 |
$639 |
3.7× |
| Radiologic Exam Abdomen 3+ Views - Xr Abdomen 3+ Views (74021) |
$440.50 |
$881 |
4.2× |
| Radiologic Exam Chest 2 Views - Xr Chest 2 Views (71046) |
$331.50 |
$663 |
3.8× |
| Radiologic exam upr gi trc double contrast study (74246) |
$1,017.50 |
$2,035 |
5.8× |
| Radiologic Examination Femur Minimum 2 Views - Xr Femur 2+ Vw Lt (73552) |
$433 |
$866 |
5.0× |
| Ribs bilateral 3 views (71110) |
$591.50 |
$1,183 |
5.6× |
| Scanogram (77073) |
$260 |
$520 |
2.5× |
| Scapula complete (73010) |
$434.50 |
$869 |
4.1× |
| Superior sagittal sinus venogram (75870) |
$1,564 |
$3,128 |
0.5× |
| Temporomandble Jt Arthrography Rs&I (70332) |
$238 |
$476 |
1.0× |
| Ultrasound, abdomen limited (76705) |
$427.50 |
$855 |
4.1× |
| Us breast unilateral complete (76641) |
$605 |
$1,210 |
5.8× |
| Us chest (76604) |
$387 |
$774 |
3.7× |
| Us compl joint r-t w/image documentation (76881) |
$280 |
$560 |
2.7× |
| Us pelvic non ob complete (76856) |
$726.50 |
$1,453 |
6.9× |
| Us pelvic nonobstetric image dcmtn limited/f/u (76857) |
$443 |
$886 |
4.2× |
| Us retroperitoneal complete (76770) |
$632.75 |
$1,265.50 |
6.0× |
| Us scrotum and contents (76870) |
$574.25 |
$1,148.50 |
5.5× |
| Us soft tissue head/neck (76536) |
$526 |
$1,052 |
5.0× |
| Us transrectal (76872) |
$500.50 |
$1,001 |
4.8× |
| Us xtr non-vasc lmtd (76882) |
$213 |
$426 |
2.0× |
| Venogram orbital (75880) |
$1,513.50 |
$3,027 |
2.4× |
| Venography caval inferior serialography rs&i (75825) |
$4,438 |
$8,876 |
1.4× |
| Venography epidural rs&i (75872) |
$1,513.50 |
$3,027 |
2.4× |
| Venography Renal Bilateral (75833) |
$4,050 |
$8,100 |
1.3× |
| Venography renal unilateral selective rs&i (75831) |
$4,050 |
$8,100 |
1.3× |
| Venography venous sinus/jugular cath rs&i (75860) |
$1,564 |
$3,128 |
0.5× |
| Wrist 2 views (73100) |
$349.50 |
$699 |
4.0× |
| X-Ray Ac Jts - Xr Acromioclavicular Joints Bilateral (73050) |
$215 |
$430 |
2.5× |
| X-Ray Ankle 3+ Vw - Xr Ankle 3+ Views Right (73610) |
$372 |
$744 |
4.3× |
| X-Ray Elbow 2 Vw - Xr Elbow 1-2 Views Right (73070) |
$389.50 |
$779 |
4.5× |
| X-Ray Elbow 3+ Vw - Xr Elbow 3+ Views Right (73080) |
$419.50 |
$839 |
4.8× |
| X-ray exam hip uni 1 view (73501) |
$302 |
$604 |
3.5× |
| X-ray eye for foreign body (70030) |
$359.50 |
$719 |
4.1× |
| X-Ray Facial Bones 3+ Vw - Xr Facial Bones 3+ Views (70150) |
$281 |
$562 |
2.7× |
| X-Ray Facial Bones <3 Vw - Xr Facial Bones 1-2 Views (70140) |
$270 |
$540 |
3.1× |
| X-Ray Foot 3+ Vw - Xr Foot 3+ Views Right (73630) |
$336.50 |
$673 |
3.8× |
| X-Ray Heel - Xr Calcaneus 2 Views Right (73650) |
$298.50 |
$597 |
3.4× |
| X-Ray Knee 4+ View - Xr Knee 4+ Views Right (73564) |
$386.50 |
$773 |
3.7× |
| X-Ray Lumbar Spine 2/3 Vw - Xr Lumbar Spine 2-3 Views (72100) |
$428 |
$856 |
4.1× |
| X-Ray Nasal Bones - Xr Nasal Bones (70160) |
$285.50 |
$571 |
3.3× |
| X-Ray Orbits - Xr Orbits Complete 4+ Views (70200) |
$301.50 |
$603 |
2.9× |
| X-Ray Ribs 2 Vw Unilat - Xr Ribs 2 Views Right (71100) |
$388 |
$776 |
4.4× |
| X-Ray Sacrum/Coccyx 2+ Vw - Xr Sacrum Coccyx 2+ Views (72220) |
$301.50 |
$603 |
3.4× |
| X-Ray Shoulder 2+ Vw - Xr Shoulder 2+ Views Right (73030) |
$409.50 |
$819 |
4.7× |
| X-Ray Sinuses 3+ Vw - Xr Paranasal Sinuses 3+ Views (70220) |
$236.50 |
$473 |
2.7× |
| X-Ray Skull <4 Vw - Xr Skull 1-3 Views (70250) |
$332.75 |
$665.50 |
3.2× |
| X-Ray Sternum 2+ Vw - Xr Sternum 2+ Views (71120) |
$299.50 |
$599 |
3.4× |
| X-Ray Thoracic Spine 2 Vw - Xr Thoracic Spine 2 Views (72070) |
$403 |
$806 |
3.8× |
| X-Ray Toe(S) - Xr Toes 2+ Views Right (73660) |
$236.50 |
$473 |
2.7× |
| X-Ray Wrist 3+ Vw - Xr Wrist 3+ Views Right (73110) |
$401 |
$802 |
4.6× |
| Xr chest 4+ views (71048) |
$475 |
$950 |
4.5× |
| Xr finger(s) 2+ views (73140) |
$286 |
$572 |
3.3× |
| Xr tibia/fibula 2 views (73590) |
$358 |
$716 |
4.1× |
| Xr tmj bilateral (70330) |
$215 |
$430 |
2.5× |
| Xray knee 1 or 2 views rt (73560) |
$293 |
$586 |
3.4× |