| Abdomen 2 views (74019) |
$101.50 |
$145 |
1.1× |
| Ankle 2 views (73600) |
$108.71 |
$155.30 |
1.4× |
| Arthrogram shoulder (73040) |
$798.65 |
$1,140.93 |
2.5× |
| Cervical spine 2 or 3 views (72040) |
$86.02 |
$122.88 |
1.1× |
| Chest 1 view (71045) |
$161 |
$230 |
2.0× |
| Clavicle complete (73000) |
$108.71 |
$155.30 |
1.4× |
| CT abdomen and pelvis without and with contrast (74178) |
$442.30 |
$631.85 |
1.4× |
| CT abdomen and pelvis without contrast (74176) |
$406.55 |
$580.78 |
1.9× |
| CT abdomen w/o contrast (74150) |
$200.31 |
$286.15 |
2.1× |
| CT c-spine w/o contrast (72125) |
$200.31 |
$286.15 |
2.1× |
| CT cervical spine w&w/o contrast (72127) |
$442.30 |
$631.85 |
2.8× |
| CT chest with contrast (71260) |
$442.30 |
$631.85 |
2.8× |
| CT lower ext w/o (73700) |
$200.31 |
$286.15 |
2.1× |
| CT lower extremity w wo contrast (73702) |
$442.30 |
$631.85 |
2.8× |
| CT lower extremity with contrast (73701) |
$442.30 |
$631.85 |
2.8× |
| CT lumbar spine w/o contrast (72131) |
$200.31 |
$286.15 |
2.1× |
| CT lumbar spine with contrast (72132) |
$798.65 |
$1,140.93 |
2.5× |
| CT pelvis w/o contrast (72192) |
$200.31 |
$286.15 |
2.1× |
| CT thoracic spine w/o contrast (72128) |
$524.20 |
$748.86 |
5.5× |
| CT thorax w/o contrast (71250) |
$200.31 |
$286.15 |
2.1× |
| CT upper extremity w/o & w/contrast material (73202) |
$442.30 |
$631.85 |
2.8× |
| CT upper extremity w/o contrast rt (73200) |
$200.31 |
$286.15 |
2.1× |
| CT upper extremity with contrast (73201) |
$442.30 |
$631.85 |
1.4× |
| Diskography lumbar (72295) |
$2,818.38 |
$4,026.25 |
1.6× |
| Fluoroscopy up to 1 hr (76000) |
$406.55 |
$580.78 |
1.9× |
| Foot 2 views (73620) |
$108.71 |
$155.30 |
1.4× |
| Forearm 2 views (73090) |
$108.71 |
$155.30 |
1.4× |
| Hand 2 views (73120) |
$200.31 |
$286.15 |
2.1× |
| Hand 3 views (73130) |
$108.71 |
$155.30 |
1.4× |
| Humerus Min 2 Views Left (73060) |
$108.71 |
$155.30 |
1.4× |
| MRI cervical spine w/o contrast (72141) |
$406.55 |
$580.78 |
1.9× |
| MRI orbit face &/neck w/o contrast (70540) |
$406.55 |
$580.78 |
1.9× |
| MRI thoracic spine w/o contrast (72146) |
$406.55 |
$580.78 |
1.9× |
| MRI upper ext joint w/o contrast (73221) |
$406.55 |
$580.78 |
1.9× |
| Pelvis 1 or 2 views (72170) |
$200.31 |
$286.15 |
2.1× |
| Radex Entir Thrc Lmbr Crv Sac Spi W/Skull 1 Vw - Xr Scoliosis 1 Vw (72081) |
$108.71 |
$155.30 |
1.4× |
| Radex entir thrc lmbr crv sac spi w/skull 2/3 vw (72082) |
$200.31 |
$286.15 |
2.1× |
| Radiologic Exam Abdomen 1 View - Xr Abdomen 1 View (74018) |
$164.50 |
$235 |
2.1× |
| Radiologic Exam Abdomen 3+ Views - Xr Abdomen 3+ Views (74021) |
$200.31 |
$286.15 |
2.1× |
| Radiologic Exam Chest 2 Views - Xr Chest 2 Views (71046) |
$210 |
$300 |
2.7× |
| Radiologic Examination Femur Minimum 2 Views - Xr Femur 2+ Vw Lt (73552) |
$108.71 |
$155.30 |
1.4× |
| Scapula complete (73010) |
$131.82 |
$188.30 |
1.4× |
| Unlisted fluoroscopic procedure (76496) |
$108.71 |
$155.30 |
1.4× |
| Us compl joint r-t w/image documentation (76881) |
$200.31 |
$286.15 |
2.1× |
| Us pelvic nonobstetric image dcmtn limited/f/u (76857) |
$200.31 |
$286.15 |
2.1× |
| Us pregnancy ltd (76815) |
$200.31 |
$286.15 |
2.1× |
| Us retroperitoneal complete (76770) |
$200.31 |
$286.15 |
2.1× |
| Us xtr non-vasc lmtd (76882) |
$228.20 |
$326 |
2.4× |
| Venography extremity unilateral rs&i (75820) |
$1,072 |
$1,531.43 |
0.8× |
| Wrist 2 views (73100) |
$86.02 |
$122.88 |
1.1× |
| X-Ray Abdomen,Comp Acute Series - Xr Abdomen 2 Vws With Chest 1 View (74022) |
$200.31 |
$286.15 |
2.1× |
| X-Ray Ac Jts - Xr Acromioclavicular Joints Bilateral (73050) |
$108.71 |
$155.30 |
1.4× |
| X-Ray Ankle 3+ Vw - Xr Ankle 3+ Views Right (73610) |
$108.71 |
$155.30 |
1.4× |
| X-Ray Elbow 2 Vw - Xr Elbow 1-2 Views Right (73070) |
$108.71 |
$155.30 |
1.4× |
| X-Ray Elbow 3+ Vw - Xr Elbow 3+ Views Right (73080) |
$108.71 |
$155.30 |
1.4× |
| X-ray exam hip uni 1 view (73501) |
$126.10 |
$180.15 |
1.6× |
| X-Ray Exam Hip Uni 2-3 Views (73502) |
$116.41 |
$166.30 |
1.5× |
| X-Ray Foot 3+ Vw - Xr Foot 3+ Views Right (73630) |
$108.71 |
$155.30 |
1.4× |
| X-Ray Heel - Xr Calcaneus 2 Views Right (73650) |
$108.71 |
$155.30 |
1.4× |
| X-Ray Lumbar Spine 2/3 Vw - Xr Lumbar Spine 2-3 Views (72100) |
$200.31 |
$286.15 |
2.1× |
| X-Ray Shoulder 2+ Vw - Xr Shoulder 2+ Views Right (73030) |
$108.71 |
$155.30 |
1.4× |
| X-Ray Spine One View - Xr Spine (72020) |
$108.71 |
$155.30 |
1.4× |
| X-Ray Thoracic Spine 2 Vw - Xr Thoracic Spine 2 Views (72070) |
$200.31 |
$286.15 |
2.1× |
| X-Ray Toe(S) - Xr Toes 2+ Views Right (73660) |
$108.71 |
$155.30 |
1.4× |
| X-Ray Wrist 3+ Vw - Xr Wrist 3+ Views Right (73110) |
$86.02 |
$122.88 |
1.1× |
| Xr finger(s) 2+ views (73140) |
$108.71 |
$155.30 |
1.4× |
| Xr shoulder 1 view (73020) |
$86.02 |
$122.88 |
1.1× |
| Xr tibia/fibula 2 views (73590) |
$108.71 |
$155.30 |
1.4× |
| Xray knee 1 or 2 views rt (73560) |
$108.71 |
$155.30 |
1.4× |