| Abdomen 2 views (74019) |
$292.50 |
$390 |
3.1× |
| Ankle 2 views (73600) |
$105 |
$140 |
1.3× |
| Aortography thoracic w/o serialography rs&i (75600) |
$3,000 |
$4,000 |
1.0× |
| Cervical spine 2 or 3 views (72040) |
$165 |
$220 |
2.1× |
| Chest 1 view (71045) |
$161.25 |
$215 |
2.0× |
| Chest 3 views (71047) |
$450 |
$600 |
5.7× |
| Cine/Vid X-Ray Throat/Esoph - Fl Esoph Barium Swlw W/ Video & Speech (74230) |
$202.50 |
$270 |
1.3× |
| Clavicle complete (73000) |
$165 |
$220 |
2.1× |
| CT abdomen and pelvis without and with contrast (74178) |
$1,650 |
$2,200 |
5.2× |
| CT abdomen and pelvis without contrast (74176) |
$1,275 |
$1,700 |
5.9× |
| CT abdomen w contrast (74160) |
$1,650 |
$2,200 |
10.4× |
| CT abdomen w wo contrast (74170) |
$1,650 |
$2,200 |
10.4× |
| CT abdomen w/o contrast (74150) |
$1,275 |
$1,700 |
13.5× |
| CT angio hrt w/3d image (75574) |
$1,650 |
$2,200 |
5.2× |
| CT c-spine w/o contrast (72125) |
$1,275 |
$1,700 |
13.5× |
| CT cervical spine w&w/o contrast (72127) |
$1,650 |
$2,200 |
10.4× |
| CT cervical spine with contrast (72126) |
$1,650 |
$2,200 |
5.2× |
| CT chest w/wo contrast (71270) |
$1,275 |
$1,700 |
8.0× |
| CT chest with contrast (71260) |
$1,650 |
$2,200 |
10.4× |
| CT head/brain with contrast (70460) |
$1,650 |
$2,200 |
10.4× |
| CT head/brain without and with contrast (70470) |
$1,650 |
$2,200 |
10.4× |
| CT heart no contrast quant eval coronry calcium (75571) |
$1,275 |
$1,700 |
16.2× |
| CT limited/localized follow up study (76380) |
$1,275 |
$1,700 |
16.2× |
| CT lower ext w/o (73700) |
$1,275 |
$1,700 |
13.5× |
| CT lower extremity w wo contrast (73702) |
$1,650 |
$2,200 |
10.4× |
| CT lumbar spine w & w/o contrast (72133) |
$1,275 |
$1,700 |
8.0× |
| CT lumbar spine w/o contrast (72131) |
$1,275 |
$1,700 |
13.5× |
| CT lumbar spine with contrast (72132) |
$1,650 |
$2,200 |
5.2× |
| CT maxillofacial w/o contrast (70486) |
$1,275 |
$1,700 |
13.5× |
| CT neck soft tissue w contrast (70491) |
$1,650 |
$2,200 |
10.4× |
| CT orbit sella/post fossa/ear w/o & w/contr matr (70482) |
$1,650 |
$2,200 |
10.4× |
| CT orbits w/o contrast (70480) |
$1,275 |
$1,700 |
13.5× |
| CT pelvis w & w/o contrast (72194) |
$1,650 |
$2,200 |
10.4× |
| CT pelvis w/o contrast (72192) |
$1,275 |
$1,700 |
13.5× |
| CT soft tissue neck w/o & w/contrast material (70492) |
$1,650 |
$2,200 |
10.4× |
| CT soft tissue neck w/o contrast (70490) |
$1,275 |
$1,700 |
13.5× |
| CT thoracic spine w/contrast (72129) |
$1,650 |
$2,200 |
10.4× |
| CT thoracic spine w/o contrast (72128) |
$1,275 |
$1,700 |
13.5× |
| CT thoracic spine w/wo contrast (72130) |
$1,650 |
$2,200 |
10.4× |
| CT thorax w/o contrast (71250) |
$1,275 |
$1,700 |
13.5× |
| CT upper extremity w/o & w/contrast material (73202) |
$1,650 |
$2,200 |
10.4× |
| CT upper extremity w/o contrast rt (73200) |
$1,275 |
$1,700 |
13.5× |
| Cta Abdl Aorta&Bi Iliofem W/Contrast&Postp (75635) |
$1,650 |
$2,200 |
10.4× |
| Cta Abdomen (74175) |
$1,650 |
$2,200 |
10.4× |
| CTA chest (71275) |
$1,275 |
$1,700 |
8.0× |
| Cta Head (70496) |
$1,650 |
$2,200 |
10.4× |
| CTA head&neck c+ w/noncontrast img&post-pxessing (70471) |
$3,300 |
$4,400 |
10.4× |
| Cta Neck (70498) |
$1,650 |
$2,200 |
10.4× |
| Diskogram cervical (72285) |
$4,875 |
$6,500 |
2.8× |
| Diskography lumbar (72295) |
$4,875 |
$6,500 |
2.8× |
| Esophagus (74220) |
$450 |
$600 |
2.8× |
| Fluoroscopy up to 1 hr (76000) |
$120 |
$160 |
0.6× |
| Foot 2 views (73620) |
$105 |
$140 |
1.3× |
| Forearm 2 views (73090) |
$165 |
$220 |
2.1× |
| Hand 2 views (73120) |
$105 |
$140 |
1.1× |
| Hand 3 views (73130) |
$105 |
$140 |
1.3× |
| Humerus Min 2 Views Left (73060) |
$165 |
$220 |
2.1× |
| Knee 3 views (73562) |
$105 |
$140 |
1.3× |
| MRI cervical spine w/o contrast (72141) |
$540.70 |
$720.93 |
2.5× |
| MRI spinal canal cervical w/o & w/contr matrl (72156) |
$540.70 |
$720.93 |
1.7× |
| MRI thoracic spine w/o contrast (72146) |
$540.70 |
$720.93 |
2.5× |
| Myelogram Cervical (72240) |
$2,438.25 |
$3,251 |
3.4× |
| Myelogram Lumbar (72265) |
$3,591 |
$4,788 |
5.1× |
| Myelogram thoracic (72255) |
$2,550 |
$3,400 |
3.6× |
| Myelography 2 or more regions (72270) |
$7,236.75 |
$9,649 |
10.2× |
| Neck soft tissue (70360) |
$165 |
$220 |
2.1× |
| Pelvis 1 or 2 views (72170) |
$105 |
$140 |
1.1× |
| Radex abscess/fistula/sinus tract rs&i (76080) |
$716.25 |
$955 |
1.4× |
| Radex hips bilateral with pelvis 2 views (73521) |
$165 |
$220 |
1.7× |
| Radiologic Exam Abdomen 1 View - Xr Abdomen 1 View (74018) |
$292.50 |
$390 |
3.7× |
| Radiologic Exam Abdomen 3+ Views - Xr Abdomen 3+ Views (74021) |
$292.50 |
$390 |
3.1× |
| Radiologic Exam Chest 2 Views - Xr Chest 2 Views (71046) |
$285 |
$380 |
3.6× |
| Radiologic exam colon single contrast study (74270) |
$202.50 |
$270 |
1.3× |
| Radiologic exam upr gi trc double contrast study (74246) |
$202.50 |
$270 |
1.3× |
| Radiologic Examination Femur Minimum 2 Views - Xr Femur 2+ Vw Lt (73552) |
$165 |
$220 |
2.1× |
| Ribs bilateral 3 views (71110) |
$105 |
$140 |
1.1× |
| Sacroiliac Joints < 3 Views (72200) |
$105 |
$140 |
1.1× |
| Scapula complete (73010) |
$165 |
$220 |
1.7× |
| Sella turcica (70240) |
$105 |
$140 |
1.3× |
| Shuntogram indwelling nonvascular shunt rs&i (75809) |
$262.50 |
$350 |
2.8× |
| Spine thoracic 3 views (72072) |
$165 |
$220 |
1.7× |
| Thoracolumbar 2 views (72080) |
$165 |
$220 |
2.1× |
| Venography caval inferior serialography rs&i (75825) |
$2,644.50 |
$3,526 |
0.9× |
| Wrist 2 views (73100) |
$165 |
$220 |
2.1× |
| X-Ray Abdomen,Comp Acute Series - Xr Abdomen 2 Vws With Chest 1 View (74022) |
$600 |
$800 |
6.3× |
| X-Ray Ankle 3+ Vw - Xr Ankle 3+ Views Right (73610) |
$105 |
$140 |
1.3× |
| X-Ray Elbow 2 Vw - Xr Elbow 1-2 Views Right (73070) |
$105 |
$140 |
1.3× |
| X-Ray Elbow 3+ Vw - Xr Elbow 3+ Views Right (73080) |
$105 |
$140 |
1.3× |
| X-ray exam hip uni 1 view (73501) |
$105 |
$140 |
1.3× |
| X-Ray Exam Hip Uni 2-3 Views (73502) |
$105 |
$140 |
1.3× |
| X-ray eye for foreign body (70030) |
$62.25 |
$83 |
0.8× |
| X-Ray Facial Bones 3+ Vw - Xr Facial Bones 3+ Views (70150) |
$105 |
$140 |
1.1× |
| X-Ray Foot 3+ Vw - Xr Foot 3+ Views Right (73630) |
$105 |
$140 |
1.3× |
| X-Ray Heel - Xr Calcaneus 2 Views Right (73650) |
$165 |
$220 |
2.1× |
| X-Ray Knee 4+ View - Xr Knee 4+ Views Right (73564) |
$105 |
$140 |
1.1× |
| X-Ray Lumbar Spine 2/3 Vw - Xr Lumbar Spine 2-3 Views (72100) |
$165 |
$220 |
1.7× |
| X-Ray Lumbar Spine 6+ Vw - Xr Lumbar Spine 6+ Vws Including Bending (72114) |
$165 |
$220 |
1.7× |
| X-Ray Ribs 2 Vw Unilat - Xr Ribs 2 Views Right (71100) |
$105 |
$140 |
1.3× |
| X-Ray Ribs, Chest 3+ Vw - Xr Ribs 2 Vws Lt W/ Chest Anteroposterior (71101) |
$105 |
$140 |
1.1× |
| X-Ray Ribs, Chest 4+ Vw - Xr Ribs 3 Vws Bil W/ Chest Posteroanterior (71111) |
$127.50 |
$170 |
1.3× |
| X-Ray Sacroiliac Jts 3+ Vw - Xr Sacroiliac Joints 3+ Views (72202) |
$105 |
$140 |
1.1× |
| X-Ray Sacrum/Coccyx 2+ Vw - Xr Sacrum Coccyx 2+ Views (72220) |
$105 |
$140 |
1.3× |
| X-Ray Shoulder 2+ Vw - Xr Shoulder 2+ Views Right (73030) |
$105 |
$140 |
1.3× |
| X-Ray Skull 4+ Vw - Xr Skull Complete 4+ Views (70260) |
$105 |
$140 |
1.1× |
| X-Ray Skull <4 Vw - Xr Skull 1-3 Views (70250) |
$165 |
$220 |
1.7× |
| X-Ray Spine One View - Xr Spine (72020) |
$165 |
$220 |
2.1× |
| X-Ray Thoracic Spine 2 Vw - Xr Thoracic Spine 2 Views (72070) |
$165 |
$220 |
1.7× |
| X-Ray Wrist 3+ Vw - Xr Wrist 3+ Views Right (73110) |
$165 |
$220 |
2.1× |
| Xr c-spine 6 or more views (72052) |
$165 |
$220 |
1.7× |
| Xr chest 4+ views (71048) |
$450 |
$600 |
4.8× |
| Xr finger(s) 2+ views (73140) |
$105 |
$140 |
1.3× |
| Xr shoulder 1 view (73020) |
$105 |
$140 |
1.3× |
| Xr spine cervical 4 or 5 views (72050) |
$165 |
$220 |
1.7× |
| Xr tibia/fibula 2 views (73590) |
$165 |
$220 |
2.1× |
| Xray knee 1 or 2 views rt (73560) |
$105 |
$140 |
1.3× |