| Abdomen 2 views (74019) |
$267.40 |
$764 |
2.5× |
| Angiography extremity bilateral rs&i (75716) |
$9,905.35 |
$28,301 |
3.1× |
| Angiography extremity unilateral rs&i (75710) |
$1,495.20 |
$4,272 |
0.5× |
| Ankle 2 views (73600) |
$221.55 |
$633 |
2.5× |
| Aortography abdominal serialography rs&i (75625) |
$2,602.25 |
$7,435 |
0.8× |
| Artery X-Rays Adrenal Gland (75731) |
$809.20 |
$2,312 |
0.3× |
| Arthrogram elbow (73085) |
$672.70 |
$1,922 |
1.9× |
| Arthrogram hip (73525) |
$763.70 |
$2,182 |
2.2× |
| Arthrogram shoulder (73040) |
$763.70 |
$2,182 |
2.2× |
| Arthrogram wrist (73115) |
$672.70 |
$1,922 |
1.9× |
| Arthrography knee lt (73580) |
$763.70 |
$2,182 |
2.2× |
| Cervical spine 2 or 3 views (72040) |
$208.42 |
$595.50 |
2.4× |
| Chest 1 view (71045) |
$237.30 |
$678 |
2.7× |
| Clavicle complete (73000) |
$243.95 |
$697 |
2.8× |
| CT abdomen and pelvis without and with contrast (74178) |
$3,477.60 |
$9,936 |
9.9× |
| CT abdomen and pelvis without contrast (74176) |
$3,477.60 |
$9,936 |
14.5× |
| CT abdomen w contrast (74160) |
$1,542.80 |
$4,408 |
8.8× |
| CT abdomen w wo contrast (74170) |
$1,634.50 |
$4,670 |
9.3× |
| CT abdomen w/o contrast (74150) |
$749 |
$2,140 |
7.1× |
| CT angiography upper extremity lt (73206) |
$1,566.60 |
$4,476 |
8.9× |
| CT c-spine w/o contrast (72125) |
$1,412.25 |
$4,035 |
13.4× |
| CT cervical spine w&w/o contrast (72127) |
$1,412.25 |
$4,035 |
8.0× |
| CT cervical spine with contrast (72126) |
$1,412.25 |
$4,035 |
4.0× |
| CT chest w/wo contrast (71270) |
$1,725.85 |
$4,931 |
9.8× |
| CT chest with contrast (71260) |
$1,443.75 |
$4,125 |
8.2× |
| CT head/brain with contrast (70460) |
$1,107.75 |
$3,165 |
6.3× |
| CT head/brain without and with contrast (70470) |
$1,527.75 |
$4,365 |
8.7× |
| CT iac w contrast (70481) |
$1,203.30 |
$3,438 |
6.8× |
| CT lower ext w/o (73700) |
$962.50 |
$2,750 |
9.2× |
| CT lower extremity w wo contrast (73702) |
$2,313.85 |
$6,611 |
13.1× |
| CT lumbar spine w & w/o contrast (72133) |
$1,412.25 |
$4,035 |
8.0× |
| CT lumbar spine w/o contrast (72131) |
$1,587.95 |
$4,537 |
15.1× |
| CT lumbar spine with contrast (72132) |
$1,412.25 |
$4,035 |
4.0× |
| CT maxillofacial w contrast (70487) |
$1,155.52 |
$3,301.50 |
6.6× |
| CT maxillofacial w/o contrast (70486) |
$1,244.60 |
$3,556 |
11.9× |
| CT maxillofacial w/wo contrast (70488) |
$1,155.52 |
$3,301.50 |
6.6× |
| CT neck soft tissue w contrast (70491) |
$1,393.70 |
$3,982 |
7.9× |
| CT orbit sella/post fossa/ear w/o & w/contr matr (70482) |
$1,203.30 |
$3,438 |
6.8× |
| CT orbits w/o contrast (70480) |
$1,203.30 |
$3,438 |
11.5× |
| CT pelvis w & w/o contrast (72194) |
$1,542.80 |
$4,408 |
8.8× |
| CT pelvis w/o contrast (72192) |
$1,244.60 |
$3,556 |
11.9× |
| CT soft tissue neck w/o & w/contrast material (70492) |
$1,244.60 |
$3,556 |
7.1× |
| CT soft tissue neck w/o contrast (70490) |
$1,393.70 |
$3,982 |
13.3× |
| CT thoracic spine w/contrast (72129) |
$1,412.25 |
$4,035 |
8.0× |
| CT thoracic spine w/o contrast (72128) |
$1,412.25 |
$4,035 |
13.4× |
| CT thoracic spine w/wo contrast (72130) |
$1,412.25 |
$4,035 |
8.0× |
| CT thorax w/o contrast (71250) |
$1,725.85 |
$4,931 |
16.4× |
| CT upper extremity w/o & w/contrast material (73202) |
$916.65 |
$2,619 |
5.2× |
| CT upper extremity w/o contrast rt (73200) |
$1,244.60 |
$3,556 |
11.9× |
| CT upper extremity with contrast (73201) |
$916.65 |
$2,619 |
2.6× |
| Cta Abdl Aorta&Bi Iliofem W/Contrast&Postp (75635) |
$2,006.20 |
$5,732 |
11.4× |
| Cta Abdomen (74175) |
$2,386.30 |
$6,818 |
13.5× |
| CTA chest (71275) |
$1,083.95 |
$3,097 |
6.2× |
| Cta Head (70496) |
$1,967.35 |
$5,621 |
11.2× |
| CTA lwr ext w&w/o contrast (73706) |
$1,527.75 |
$4,365 |
8.7× |
| Cta Neck (70498) |
$2,100 |
$6,000 |
11.9× |
| Cta Pelvis (72191) |
$1,527.75 |
$4,365 |
8.7× |
| Cystography minimum 3 views rs&i (74430) |
$619.15 |
$1,769 |
1.8× |
| Diskogram cervical (72285) |
$2,459.45 |
$7,027 |
1.3× |
| Diskography lumbar (72295) |
$2,459.45 |
$7,027 |
1.3× |
| Dxa bone density study 1/> sites axial skel (77080) |
$253.05 |
$723 |
2.4× |
| Esophagus (74220) |
$420 |
$1,200 |
2.4× |
| Fluoroscopy up to 1 hr (76000) |
$488.95 |
$1,397 |
2.0× |
| Foot 2 views (73620) |
$275.80 |
$788 |
3.2× |
| Forearm 2 views (73090) |
$214.55 |
$613 |
2.5× |
| Full Mouth X-Ray Of Teeth - Xr Teeth Full Mouth (70320) |
$313.60 |
$896 |
1.3× |
| Hand 2 views (73120) |
$251.65 |
$719 |
2.4× |
| Hand 3 views (73130) |
$283.50 |
$810 |
3.2× |
| Humerus Min 2 Views Left (73060) |
$267.40 |
$764 |
3.1× |
| Interstitial radiation source applic complex (77778) |
$1,244.60 |
$3,556 |
1.8× |
| Knee 3 views (73562) |
$305.20 |
$872 |
3.5× |
| Lymphoscintigraphy (78195) |
$809.55 |
$2,313 |
1.5× |
| Mammary ductogram or galactogram multiple (77054) |
$458.85 |
$1,311 |
1.9× |
| Mammary ductogram or galactogram single (77053) |
$374.50 |
$1,070 |
1.6× |
| MRI upper extrem other than jt w/o & w/contras (73220) |
$1,244.60 |
$3,556 |
3.6× |
| Neck soft tissue (70360) |
$175.35 |
$501 |
2.0× |
| Osseous survey infant (77076) |
$243.95 |
$697 |
2.3× |
| Pelvis 1 or 2 views (72170) |
$221.55 |
$633 |
2.1× |
| Radex abscess/fistula/sinus tract rs&i (76080) |
$365.75 |
$1,045 |
0.7× |
| Radex hips bilateral with pelvis 2 views (73521) |
$206.15 |
$589 |
2.0× |
| Radiologic Exam Abdomen 1 View - Xr Abdomen 1 View (74018) |
$267.40 |
$764 |
3.1× |
| Radiologic Exam Abdomen 3+ Views - Xr Abdomen 3+ Views (74021) |
$320.95 |
$917 |
3.1× |
| Radiologic Exam Chest 2 Views - Xr Chest 2 Views (71046) |
$275.80 |
$788 |
3.2× |
| Radiologic exam teeth prtl exam < full mouth (70310) |
$313.60 |
$896 |
1.3× |
| Radiologic exam upr gi trc double contrast study (74246) |
$619.15 |
$1,769 |
3.5× |
| Radiologic exam upr gi trc single contrast study (74240) |
$619.15 |
$1,769 |
3.5× |
| Radiologic Examination Femur Minimum 2 Views - Xr Femur 2+ Vw Lt (73552) |
$237.30 |
$678 |
2.7× |
| Radiological examination surgical specimen (76098) |
$558.25 |
$1,595 |
1.0× |
| Ribs bilateral 3 views (71110) |
$251.65 |
$719 |
2.4× |
| Sacroiliac Joints < 3 Views (72200) |
$199.15 |
$569 |
1.9× |
| Scapula complete (73010) |
$176.40 |
$504 |
1.7× |
| Shuntogram indwelling nonvascular shunt rs&i (75809) |
$778.40 |
$2,224 |
7.4× |
| Spine thoracic 3 views (72072) |
$335.65 |
$959 |
3.2× |
| Thoracolumbar 2 views (72080) |
$313.60 |
$896 |
3.6× |
| Ultrasound, abdomen limited (76705) |
$320.95 |
$917 |
3.1× |
| Unlisted Diagnostic Radiographic Procedure (76499) |
$206.15 |
$589 |
2.4× |
| Unlisted fluoroscopic procedure (76496) |
$298.20 |
$852 |
3.4× |
| Urethrocystography retrograde rs&i (74450) |
$542.50 |
$1,550 |
2.3× |
| Urography (pyelography), intravenous, with or without KUB, with or without tomography (74400) |
$619.15 |
$1,769 |
3.5× |
| Us compl joint r-t w/image documentation (76881) |
$228.90 |
$654 |
2.2× |
| Us ob transvaginal (76817) |
$499.80 |
$1,428 |
4.8× |
| Us pelvic non ob complete (76856) |
$381.15 |
$1,089 |
3.6× |
| Us pelvic nonobstetric image dcmtn limited/f/u (76857) |
$228.90 |
$654 |
2.2× |
| Us pregnancy ltd (76815) |
$401.45 |
$1,147 |
3.8× |
| Us pregnant uterus 14 wk transabdl 1/1st gestat (76801) |
$405.30 |
$1,158 |
3.9× |
| Us retroperitoneal complete (76770) |
$477.40 |
$1,364 |
4.5× |
| Us retroperitoneal limited (76775) |
$365.75 |
$1,045 |
3.5× |
| Us scrotum and contents (76870) |
$405.30 |
$1,158 |
3.9× |
| Us soft tissue head/neck (76536) |
$340.20 |
$972 |
3.2× |
| Us spinal canal and contents (76800) |
$340.20 |
$972 |
3.2× |
| Us transrectal (76872) |
$313.60 |
$896 |
3.0× |
| Us transrectal prostate volume (76873) |
$313.78 |
$896.50 |
3.0× |
| Us xtr non-vasc lmtd (76882) |
$305.20 |
$872 |
2.9× |
| Venogram extremity bilateral (75822) |
$1,561.70 |
$4,462 |
1.0× |
| Venography caval inferior serialography rs&i (75825) |
$778.40 |
$2,224 |
0.2× |
| Venography extremity unilateral rs&i (75820) |
$778.40 |
$2,224 |
0.5× |
| Wrist 2 views (73100) |
$214.55 |
$613 |
2.5× |
| X-Ray Abdomen,Comp Acute Series - Xr Abdomen 2 Vws With Chest 1 View (74022) |
$313.60 |
$896 |
3.0× |
| X-Ray Ankle 3+ Vw - Xr Ankle 3+ Views Right (73610) |
$267.40 |
$764 |
3.1× |
| X-Ray Elbow 2 Vw - Xr Elbow 1-2 Views Right (73070) |
$228.90 |
$654 |
2.6× |
| X-Ray Elbow 3+ Vw - Xr Elbow 3+ Views Right (73080) |
$322.88 |
$922.50 |
3.7× |
| X-ray exam hip uni 1 view (73501) |
$183.40 |
$524 |
2.1× |
| X-Ray Exam Hip Uni 2-3 Views (73502) |
$183.40 |
$524 |
2.1× |
| X-Ray Exam Hips Bi 3-4 Views (73522) |
$206.15 |
$589 |
2.0× |
| X-Ray Exam Hips Bi 5/> Views (73523) |
$763.70 |
$2,182 |
7.3× |
| X-ray exam of femur 1 (73551) |
$237.30 |
$678 |
2.7× |
| X-Ray Facial Bones 3+ Vw - Xr Facial Bones 3+ Views (70150) |
$160.65 |
$459 |
1.5× |
| X-Ray Facial Bones <3 Vw - Xr Facial Bones 1-2 Views (70140) |
$190.75 |
$545 |
2.2× |
| X-Ray Foot 3+ Vw - Xr Foot 3+ Views Right (73630) |
$298.20 |
$852 |
3.4× |
| X-Ray Heel - Xr Calcaneus 2 Views Right (73650) |
$199.15 |
$569 |
2.3× |
| X-Ray Knee 4+ View - Xr Knee 4+ Views Right (73564) |
$305.20 |
$872 |
2.9× |
| X-Ray Knee Bilat Standing - Xr Knees Anteroposterior Standing Bilat (73565) |
$305.55 |
$873 |
3.5× |
| X-Ray Lumbar Spine 2/3 Vw - Xr Lumbar Spine 2-3 Views (72100) |
$344.05 |
$983 |
3.3× |
| X-Ray Lumbar Spine 6+ Vw - Xr Lumbar Spine 6+ Vws Including Bending (72114) |
$344.05 |
$983 |
3.3× |
| X-Ray Nasal Bones - Xr Nasal Bones (70160) |
$228.90 |
$654 |
2.6× |
| X-Ray Orbits - Xr Orbits Complete 4+ Views (70200) |
$280.18 |
$800.50 |
2.7× |
| X-Ray Pelvis 3+ Vw - Xr Pelvis 3+ Views (72190) |
$191.28 |
$546.50 |
1.8× |
| X-Ray Retrograde Pyelogram - Fl Pyelogram Retrograde (74420) |
$619.15 |
$1,769 |
1.8× |
| X-Ray Ribs 2 Vw Unilat - Xr Ribs 2 Views Right (71100) |
$228.90 |
$654 |
2.6× |
| X-Ray Ribs, Chest 3+ Vw - Xr Ribs 2 Vws Lt W/ Chest Anteroposterior (71101) |
$251.65 |
$719 |
2.4× |
| X-Ray Ribs, Chest 4+ Vw - Xr Ribs 3 Vws Bil W/ Chest Posteroanterior (71111) |
$251.65 |
$719 |
2.4× |
| X-Ray Sacroiliac Jts 3+ Vw - Xr Sacroiliac Joints 3+ Views (72202) |
$199.15 |
$569 |
1.9× |
| X-Ray Sacrum/Coccyx 2+ Vw - Xr Sacrum Coccyx 2+ Views (72220) |
$199.15 |
$569 |
2.3× |
| X-Ray Shoulder 2+ Vw - Xr Shoulder 2+ Views Right (73030) |
$160.65 |
$459 |
1.8× |
| X-Ray Sinuses 3+ Vw - Xr Paranasal Sinuses 3+ Views (70220) |
$214.55 |
$613 |
2.5× |
| X-Ray Sinuses <3 Vw - Xr Paranasal Sinuses 1-2 Views (70210) |
$175.70 |
$502 |
2.0× |
| X-Ray Skull 4+ Vw - Xr Skull Complete 4+ Views (70260) |
$359.80 |
$1,028 |
3.4× |
| X-Ray Skull <4 Vw - Xr Skull 1-3 Views (70250) |
$228.90 |
$654 |
2.2× |
| X-Ray Spine One View - Xr Spine (72020) |
$267.40 |
$764 |
3.1× |
| X-Ray Teeth Single - Xr Teeth 1 View (70300) |
$313.60 |
$896 |
3.6× |
| X-Ray Thoracic Spine 2 Vw - Xr Thoracic Spine 2 Views (72070) |
$313.60 |
$896 |
3.0× |
| X-Ray Toe(S) - Xr Toes 2+ Views Right (73660) |
$206.15 |
$589 |
2.4× |
| X-Ray Wrist 3+ Vw - Xr Wrist 3+ Views Right (73110) |
$206.15 |
$589 |
2.4× |
| Xr arthrogram ankle (73615) |
$672.70 |
$1,922 |
1.9× |
| Xr c-spine 6 or more views (72052) |
$298.20 |
$852 |
2.8× |
| Xr chest 4+ views (71048) |
$267.40 |
$764 |
2.5× |
| Xr finger(s) 2+ views (73140) |
$191.45 |
$547 |
2.2× |
| Xr shoulder 1 view (73020) |
$221.55 |
$633 |
2.5× |
| Xr spine cervical 4 or 5 views (72050) |
$298.20 |
$852 |
2.8× |
| Xr tibia/fibula 2 views (73590) |
$251.65 |
$719 |
2.9× |
| Xray knee 1 or 2 views rt (73560) |
$283.50 |
$810 |
3.2× |