| Angiography pulmonary bilateral slctv rs&i (75743) |
$633.60 |
$1,056 |
0.2× |
| Ankle 2 views (73600) |
$282 |
$470 |
3.2× |
| Antegrade urography radiological supvj & interpj (74425) |
$291.60 |
$486 |
0.8× |
| Arthrogram elbow (73085) |
$526.80 |
$878 |
1.5× |
| Arthrogram wrist (73115) |
$526.80 |
$878 |
1.5× |
| Bone age studies (77072) |
$179.40 |
$299 |
1.7× |
| Cardiac MRI w/w/o contrast & further seq (75561) |
$1,270.80 |
$2,118 |
3.6× |
| Cine/Vid X-Ray Throat/Esoph - Fl Esoph Barium Swlw W/ Video & Speech (74230) |
$432.60 |
$721 |
2.4× |
| CT colonography screening (74263) |
$450 |
$750 |
1.8× |
| CT colonography w/dye (74262) |
$300 |
$500 |
1.7× |
| CT head/brain without and with contrast (70470) |
$1,060.20 |
$1,767 |
5.9× |
| CT limited/localized follow up study (76380) |
$340.80 |
$568 |
3.8× |
| CT lower ext w/o (73700) |
$896.40 |
$1,494 |
8.4× |
| CT lumbar spine w/o contrast (72131) |
$1,027.80 |
$1,713 |
9.6× |
| CT maxillofacial w/o contrast (70486) |
$1,021.20 |
$1,702 |
9.6× |
| CT orbit sella/post fossa/ear w/o & w/contr matr (70482) |
$1,087.80 |
$1,813 |
6.1× |
| CT orbits w/o contrast (70480) |
$583.20 |
$972 |
5.5× |
| CT pelvis w & w/o contrast (72194) |
$1,102.80 |
$1,838 |
6.2× |
| Cta Abdl Aorta&Bi Iliofem W/Contrast&Postp (75635) |
$667.80 |
$1,113 |
3.7× |
| CTA lwr ext w&w/o contrast (73706) |
$650.40 |
$1,084 |
3.6× |
| Dxa bone density study 1/> sites axial skel (77080) |
$210.60 |
$351 |
2.0× |
| Dxa bone density study 1/>sites appendiclr skel (77081) |
$100.80 |
$168 |
1.1× |
| Echoencephalography real time imaging (76506) |
$441 |
$735 |
4.1× |
| Esophagus (74220) |
$432.60 |
$721 |
2.4× |
| Foot 2 views (73620) |
$238.80 |
$398 |
2.7× |
| Forearm 2 views (73090) |
$265.80 |
$443 |
3.0× |
| Kidney img morphology vascular flow 1 w/rx (78708) |
$993 |
$1,655 |
1.8× |
| Knee 3 views (73562) |
$315 |
$525 |
3.5× |
| Liver & Spleen Imaging W/Vascular Flow (78216) |
$1,060.20 |
$1,767 |
2.6× |
| Mammary ductogram or galactogram multiple (77054) |
$348.60 |
$581 |
1.4× |
| Mammary ductogram or galactogram single (77053) |
$357.30 |
$595.50 |
1.5× |
| Manual appl stress pfrmd phys/qhp joint films (77071) |
$142.20 |
$237 |
1.6× |
| MRA neck w contrast (70548) |
$1,270.80 |
$2,118 |
3.6× |
| MRI any jt upper extremity w/contrast matrl (73222) |
$1,270.80 |
$2,118 |
1.6× |
| MRI lower extrem oth/thn jt w/contrast matrl (73719) |
$788.55 |
$1,314.25 |
2.2× |
| MRI pelvis w/o & w/contrast material (72197) |
$1,270.80 |
$2,118 |
3.6× |
| MRI scan of arm joint before and after contrast (73223) |
$1,270.80 |
$2,118 |
3.6× |
| MRI spinal canal lumbar w/contrast material (72149) |
$1,270.80 |
$2,118 |
3.6× |
| MRI spinal canal thoracic w/contrast matrl (72147) |
$1,270.80 |
$2,118 |
3.6× |
| MRI thoracic spine w/o contrast (72146) |
$1,270.80 |
$2,118 |
5.2× |
| MRI upper ext joint w/o contrast (73221) |
$1,270.80 |
$2,118 |
5.2× |
| Neck soft tissue (70360) |
$189 |
$315 |
2.1× |
| Ob Us Follow-Up Per Fetus - Us Ob Follow Up Transabdominal Approach (76816) |
$314.40 |
$524 |
2.9× |
| Orthopantogram (70355) |
$309.60 |
$516 |
3.5× |
| Osseous survey infant (77076) |
$190.20 |
$317 |
1.8× |
| Osseous survey limited (77074) |
$308.40 |
$514 |
2.9× |
| Peritoneogram rs&i (74190) |
$201.60 |
$336 |
0.4× |
| Radex abscess/fistula/sinus tract rs&i (76080) |
$313.20 |
$522 |
0.6× |
| Radiolog exam mandible compl minimum 4 views (70110) |
$325.20 |
$542 |
3.0× |
| Ribs bilateral 3 views (71110) |
$412.20 |
$687 |
3.9× |
| Rp Therapy Intravenous Administration (79101) |
$315 |
$525 |
1.3× |
| Sacroiliac Joints < 3 Views (72200) |
$210 |
$350 |
2.0× |
| Spine thoracic 3 views (72072) |
$459 |
$765 |
4.3× |
| Therapeutic Enema (74283) |
$405 |
$675 |
2.3× |
| Thoracolumbar 2 views (72080) |
$154.80 |
$258 |
1.7× |
| Tomogram (76100) |
$147.60 |
$246 |
1.4× |
| Ultrasound, abdomen limited (76705) |
$579.60 |
$966 |
5.4× |
| Us compl joint r-t w/image documentation (76881) |
$510.60 |
$851 |
4.8× |
| Us ob detailed single fetus (76811) |
$411.60 |
$686 |
1.7× |
| Us ob transvaginal (76817) |
$420.60 |
$701 |
3.9× |
| Us pregnancy ltd (76815) |
$405 |
$675 |
3.8× |
| Us pregnant uterus 14 wk transabdl 1/1st gestat (76801) |
$254.40 |
$424 |
2.4× |
| Us retroperitoneal complete (76770) |
$761.40 |
$1,269 |
7.1× |
| Us scrotum and contents (76870) |
$41.40 |
$69 |
0.4× |
| Us transrectal (76872) |
$105.60 |
$176 |
1.0× |
| Wrist 2 views (73100) |
$224.40 |
$374 |
2.5× |
| X-Ray Ac Jts - Xr Acromioclavicular Joints Bilateral (73050) |
$300.60 |
$501 |
3.4× |
| X-Ray Elbow 3+ Vw - Xr Elbow 3+ Views Right (73080) |
$235.20 |
$392 |
2.6× |
| X-ray exam hip uni 1 view (73501) |
$377.90 |
$629.84 |
4.3× |
| X-ray exam hip uni 4/> views (73503) |
$464.47 |
$774.12 |
4.3× |
| X-Ray Exam Hips Bi 3-4 Views (73522) |
$464.47 |
$774.12 |
4.3× |
| X-Ray Exam Hips Bi 5/> Views (73523) |
$464.47 |
$774.12 |
4.3× |
| X-Ray Facial Bones 3+ Vw - Xr Facial Bones 3+ Views (70150) |
$177 |
$295 |
1.7× |
| X-Ray Foot 3+ Vw - Xr Foot 3+ Views Right (73630) |
$265.80 |
$443 |
3.0× |
| X-Ray Jaw <4 Vw - Xr Mandible < 4 Views (70100) |
$325.20 |
$542 |
3.7× |
| X-Ray Knee Bilat Standing - Xr Knees Anteroposterior Standing Bilat (73565) |
$295.65 |
$492.75 |
3.3× |
| X-Ray Lumbar Spine 6+ Vw - Xr Lumbar Spine 6+ Vws Including Bending (72114) |
$295.20 |
$492 |
2.8× |
| X-Ray Lumbar Spine Flex/Exten - Xr Lumbar Spine 4+ Views W/ Flex Ext (72120) |
$253.80 |
$423 |
2.4× |
| X-Ray Nasal Bones - Xr Nasal Bones (70160) |
$348.60 |
$581 |
3.9× |
| X-Ray Nose-Rectum Child F.B. - Xr Nose to Rectum Foreign Body Peds (76010) |
$162 |
$270 |
1.8× |
| X-Ray Orbits - Xr Orbits Complete 4+ Views (70200) |
$379.80 |
$633 |
3.6× |
| X-Ray Pelvis 3+ Vw - Xr Pelvis 3+ Views (72190) |
$220.80 |
$368 |
2.1× |
| X-Ray Sacrum/Coccyx 2+ Vw - Xr Sacrum Coccyx 2+ Views (72220) |
$394.34 |
$657.24 |
4.4× |
| X-Ray Shoulder 2+ Vw - Xr Shoulder 2+ Views Right (73030) |
$322.20 |
$537 |
3.6× |
| X-Ray Sinuses 3+ Vw - Xr Paranasal Sinuses 3+ Views (70220) |
$426.68 |
$711.14 |
4.8× |
| X-Ray Sinuses <3 Vw - Xr Paranasal Sinuses 1-2 Views (70210) |
$228 |
$380 |
2.6× |
| X-Ray Skull 4+ Vw - Xr Skull Complete 4+ Views (70260) |
$280.20 |
$467 |
2.6× |
| X-Ray Skull <4 Vw - Xr Skull 1-3 Views (70250) |
$261 |
$435 |
2.4× |
| X-Ray Spine One View - Xr Spine (72020) |
$169.20 |
$282 |
1.9× |
| X-Ray Sterno-Clavicluar Jt - Xr Sternoclavicular Joints 3+ Views (71130) |
$174 |
$290 |
2.0× |
| X-Ray Toe(S) - Xr Toes 2+ Views Right (73660) |
$316.95 |
$528.25 |
3.6× |
| X-Ray Wrist 3+ Vw - Xr Wrist 3+ Views Right (73110) |
$266.40 |
$444 |
3.0× |
| Xr arthrogram ankle (73615) |
$459 |
$765 |
1.3× |
| Xr Cholecystography Oral Contrast (74290) |
$306.60 |
$511 |
1.7× |
| Xr finger(s) 2+ views (73140) |
$199.20 |
$332 |
2.2× |
| Xr internal auditory meati complete (70134) |
$201.60 |
$336 |
0.4× |
| Xr optic foramina (70190) |
$142.80 |
$238 |
1.6× |
| Xr shoulder 1 view (73020) |
$216.60 |
$361 |
2.4× |
| Xr tmj bilateral (70330) |
$189.60 |
$316 |
2.1× |
| Xray knee 1 or 2 views rt (73560) |
$282 |
$470 |
3.2× |