| Acute gi blood loss imaging (78278) |
$1,221 |
$2,035 |
2.9× |
| Ankle 2 views (73600) |
$130.80 |
$218 |
1.4× |
| Brain imaging, minimum 4 static views; with vascular flow Age Under 21 (78606) |
$926.85 |
$1,544.75 |
1.6× |
| Clavicle complete (73000) |
$156.30 |
$260.50 |
1.7× |
| Computed tomographic angiography, abdomen and pelvis, with contrast material(s), including noncontrast images, if… (74174) |
$1,209.60 |
$2,016 |
3.3× |
| Computed tomographic angiography, abdomen, with contrast material(s), including noncontrast images, if performed, and… (74175) |
$1,209.90 |
$2,016.50 |
6.5× |
| Computed tomographic angiography, abdominal aorta and bilateral iliofemoral lower extremity runoff, with contrast… (75635) |
$2,100.90 |
$3,501.50 |
11.4× |
| Computed tomographic angiography, chest (noncoronary), with contrast material(s), including noncontrast images, if… (71275) |
$1,209.90 |
$2,016.50 |
6.5× |
| Computed tomographic angiography, lower extremity, with contrast material(s), including noncontrast images, if… (73706) |
$527.84 |
$879.74 |
2.9× |
| Computed tomographic angiography, neck, with contrast material(s), including noncontrast images, if performed, and… (70498) |
$1,144.80 |
$1,908 |
6.2× |
| Computed tomographic angiography, pelvis, with contrast material(s), including noncontrast images, if performed, and… (72191) |
$527.84 |
$879.74 |
2.9× |
| Computed tomographic angiography, upper extremity, with contrast material(s), including noncontrast images, if… (73206) |
$1,241.85 |
$2,069.75 |
6.7× |
| Computed tomography, cervical spine; without contrast material, followed by contrast material(s) and further sections… (72127) |
$1,859.40 |
$3,099 |
10.0× |
| Computed tomography, lower extremity; without contrast material Age Under 21 (73700) |
$952.65 |
$1,587.75 |
8.6× |
| Computed tomography, lumbar spine; without contrast material, followed by contrast material(s) and further sections Age… (72133) |
$1,497 |
$2,495 |
8.1× |
| Computed tomography, maxillofacial area; with contrast material(s) Age Under 21 (70487) |
$1,042.35 |
$1,737.25 |
5.6× |
| Computed tomography, maxillofacial area; without contrast material Age Under 21 (70486) |
$1,273.80 |
$2,123 |
11.6× |
| Computed tomography, orbit, sella, or posterior fossa or outer, middle, or inner ear; with contrast material(s) Age… (70481) |
$1,230.45 |
$2,050.75 |
6.7× |
| Computed tomography, orbit, sella, or posterior fossa or outer, middle, or inner ear; without contrast material Age… (70480) |
$995.70 |
$1,659.50 |
9.0× |
| Computed tomography, orbit, sella, or posterior fossa or outer, middle, or inner ear; without contrast material,… (70482) |
$1,509.60 |
$2,516 |
8.2× |
| Computed tomography, soft tissue neck; without contrast material followed by contrast material(s) and further sections… (70492) |
$1,144.80 |
$1,908 |
6.2× |
| Computed tomography, thoracic spine; without contrast material, followed by contrast material(s) and further sections… (72130) |
$1,770.68 |
$2,951.14 |
9.6× |
| Computed tomography, thorax, diagnostic; without contrast material, followed by contrast material(s) and further… (71270) |
$1,546.72 |
$2,577.88 |
8.4× |
| CT abdomen and pelvis without and with contrast (74178) |
$2,557.65 |
$4,262.75 |
6.9× |
| CT abdomen and pelvis without contrast (74176) |
$1,847.70 |
$3,079.50 |
7.3× |
| CT abdomen w & w/o contrast (74170) |
$1,373.25 |
$2,288.75 |
7.4× |
| CT abdomen w/contrast (74160) |
$1,198.05 |
$1,996.75 |
6.5× |
| CT abdomen w/o contrast (74150) |
$1,023.15 |
$1,705.25 |
9.3× |
| CT angio hrt w/3d image (75574) |
$898.80 |
$1,498 |
2.4× |
| CT cervical spine w/contrast (72126) |
$1,273.80 |
$2,123 |
3.5× |
| CT cervical spine w/o contrast (72125) |
$1,273.80 |
$2,123 |
11.6× |
| CT chest w/contrast (71260) |
$1,151.10 |
$1,918.50 |
6.2× |
| CT extremity upper w & w/o contrast (73202) |
$824.40 |
$1,374 |
4.5× |
| CT extremity upper w/o contrast (73200) |
$992.48 |
$1,654.12 |
9.0× |
| CT head/brain with contrast (70460) |
$1,126.50 |
$1,877.50 |
6.1× |
| CT head/brain without and with contrast (70470) |
$1,268.25 |
$2,113.75 |
6.9× |
| CT l-spine w/contrast (72132) |
$1,431.52 |
$2,385.88 |
3.9× |
| CT limited/localized follow up study (76380) |
$583.35 |
$972.25 |
6.4× |
| CT lower extremity w/dye (73701) |
$1,462.35 |
$2,437.25 |
7.9× |
| CT lumbar spine w/o contrast (72131) |
$1,080.22 |
$1,800.38 |
9.8× |
| CT maxillofacial w/wo contrast (70488) |
$780 |
$1,300 |
4.2× |
| CT neck w/contrast (70491) |
$1,010.55 |
$1,684.25 |
5.5× |
| CT neck w/o contrast (70490) |
$660.30 |
$1,100.50 |
6.0× |
| CT pelvis w & w/o contrast (72194) |
$1,281.45 |
$2,135.75 |
6.9× |
| CT pelvis w/o contrast (72192) |
$918.15 |
$1,530.25 |
8.3× |
| CT thoracic spine w/contrast (72129) |
$1,487.10 |
$2,478.50 |
8.0× |
| CT thoracic spine w/o contrast (72128) |
$1,273.80 |
$2,123 |
11.6× |
| CT thorax lung cancer scr c- (71271) |
$938.10 |
$1,563.50 |
8.5× |
| CT thorax w/o contrast (71250) |
$938.10 |
$1,563.50 |
8.5× |
| CT upper extremity w/dye (73201) |
$1,092.98 |
$1,821.62 |
3.0× |
| CTA head w contrast (70496) |
$1,123.50 |
$1,872.50 |
6.1× |
| Cystography, minimum of 3 views, radiological supervision and interpretation Age Under 21 (74430) |
$440.23 |
$733.72 |
1.2× |
| Dual-energy X-ray absorptiometry (DXA), bone density study, 1 or more sites; axial skeleton (eg, hips, pelvis, spine)… (77080) |
$256.80 |
$428 |
2.3× |
| Dxa bone density/peripheral (77081) |
$125.40 |
$209 |
1.4× |
| Fetal biophys profile w/o nst (76819) |
$293.85 |
$489.75 |
2.7× |
| Fluoroscopy up to 1 hour physician/qhp time (76000) |
$403.65 |
$672.75 |
1.6× |
| Gated heart planar single (78472) |
$1,469.40 |
$2,449 |
3.5× |
| Hepatobil syst imag inc gb w/pharma intervenj (78227) |
$1,033.05 |
$1,721.75 |
1.8× |
| Hepatobiliary syst imaging including gallbladder (78226) |
$571.35 |
$952.25 |
1.4× |
| Intestine imaging (eg, ectopic gastric mucosa, Meckel's localization, volvulus) Age Under 21 (78290) |
$877.20 |
$1,462 |
2.1× |
| Kidney imaging morphology; with vascular flow and function, single study, with pharmacological intervention (eg,… (78708) |
$1,003.05 |
$1,671.75 |
1.8× |
| Liver and spleen imaging; with vascular flow Age Under 21 (78216) |
$742.50 |
$1,237.50 |
1.8× |
| Lung perf&ventilat diferentl (78598) |
$1,102.20 |
$1,837 |
1.9× |
| Lung perfusion imaging (78580) |
$842.10 |
$1,403.50 |
2.0× |
| Magnetic resonance (eg, proton) imaging, any joint of lower extremity; without contrast material(s), followed by… (73723) |
$2,010.30 |
$3,350.50 |
5.5× |
| Magnetic resonance (eg, proton) imaging, lower extremity other than joint; with contrast material(s) Age Under 21 (73719) |
$1,702.50 |
$2,837.50 |
4.6× |
| Magnetic resonance (eg, proton) imaging, lower extremity other than joint; without contrast material(s) Age Under 21 (73718) |
$1,513.80 |
$2,523 |
6.0× |
| Magnetic resonance (eg, proton) imaging, lower extremity other than joint; without contrast material(s), followed by… (73720) |
$2,054.70 |
$3,424.50 |
5.6× |
| Magnetic resonance (eg, proton) imaging, orbit, face, and/or neck; with contrast material(s) Age Under 21 (70542) |
$2,247.68 |
$3,746.12 |
6.1× |
| Magnetic resonance (eg, proton) imaging, orbit, face, and/or neck; without contrast material(s) Age Under 21 (70540) |
$1,901.70 |
$3,169.50 |
7.6× |
| Magnetic resonance (eg, proton) imaging, upper extremity, other than joint; with contrast material(s) Age Under 21 (73219) |
$1,884 |
$3,140 |
5.1× |
| Magnetic resonance (eg, proton) imaging, upper extremity, other than joint; without contrast material(s), followed by… (73220) |
$2,010.30 |
$3,350.50 |
5.5× |
| Magnetic resonance angiography, head; with contrast material(s) Age Under 21 (70545) |
$1,859.40 |
$3,099 |
5.1× |
| Magnetic resonance angiography, head; without contrast material(s), followed by contrast material(s) and further… (70546) |
$1,903.80 |
$3,173 |
5.2× |
| Magnetic resonance angiography, neck; without contrast material(s), followed by contrast material(s) and further… (70549) |
$1,735.35 |
$2,892.25 |
4.7× |
| Mammary ductogram or galactogram, multiple ducts, radiological supervision and interpretation Age Under 21 (77054) |
$451.95 |
$753.25 |
1.8× |
| Mammary ductogram single (77053) |
$451.95 |
$753.25 |
1.8× |
| Mandible min 4v (70110) |
$252.45 |
$420.75 |
2.3× |
| MRA head w/o contrast (70544) |
$1,735.35 |
$2,892.25 |
6.9× |
| MRA neck w/ contrast (70548) |
$1,460.55 |
$2,434.25 |
4.0× |
| MRA neck w/o contrast (70547) |
$1,333.80 |
$2,223 |
5.3× |
| MRI abdomen w/contrast (74182) |
$2,262.15 |
$3,770.25 |
6.1× |
| MRI abdomen w/o contrast (74181) |
$2,014.80 |
$3,358 |
8.0× |
| MRI abdomen w/wo contrast (74183) |
$2,382.45 |
$3,970.75 |
6.5× |
| MRI any jt lower extrem w/contrast material (73722) |
$1,418.70 |
$2,364.50 |
1.7× |
| MRI bone marrow (77084) |
$1,552.50 |
$2,587.50 |
6.2× |
| MRI breast c- bilateral (77047) |
$1,908 |
$3,180 |
7.6× |
| MRI c-spine w&w/o cont (72156) |
$2,259.45 |
$3,765.75 |
6.1× |
| MRI cervical spine w/contrast (72142) |
$1,884 |
$3,140 |
5.1× |
| MRI chest w/contrast (71551) |
$2,262.15 |
$3,770.25 |
2.7× |
| MRI chest w/o contrast (71550) |
$2,014.80 |
$3,358 |
8.0× |
| MRI chest w/wo contrast (71552) |
$2,382.45 |
$3,970.75 |
6.5× |
| MRI joint upr extr w/o&w/dye (73223) |
$2,029.20 |
$3,382 |
5.5× |
| MRI joint upr extrem w/dye (73222) |
$1,632.30 |
$2,720.50 |
2.0× |
| MRI joint upr extrem w/o dye (73221) |
$1,418.40 |
$2,364 |
5.6× |
| MRI lumbar spine w/contrast (72149) |
$2,010.45 |
$3,350.75 |
5.5× |
| MRI lumbar spine w/wo contrast (72158) |
$2,136.45 |
$3,560.75 |
5.8× |
| MRI orbit/face/neck w&w/o cont (70543) |
$2,633.85 |
$4,389.75 |
7.2× |
| MRI pelvis w & w/o contrast (72197) |
$2,946.15 |
$4,910.25 |
8.0× |
| MRI pelvis w/contrast (72196) |
$2,314.35 |
$3,857.25 |
6.3× |
| MRI pelvis w/o contrast (72195) |
$2,088 |
$3,480 |
8.3× |
| MRI spine cervical w/o contrast (72141) |
$1,684.95 |
$2,808.25 |
6.7× |
| MRI t-spine w&w/o cont (72157) |
$2,011.35 |
$3,352.25 |
5.5× |
| MRI thoracic spine w/contrast (72147) |
$1,864.80 |
$3,108 |
5.1× |
| MRI thoracic spine w/o contrst (72146) |
$1,758.60 |
$2,931 |
7.0× |
| MRI tmj (70336) |
$2,020.05 |
$3,366.75 |
8.0× |
| MRI upper extremity oth than jt w/o contr matrl (73218) |
$1,651.50 |
$2,752.50 |
6.6× |
| Myelography, 2 or more regions (eg, lumbar/thoracic, cervical/thoracic, lumbar/cervical, lumbar/thoracic/cervical),… (72270) |
$1,388.40 |
$2,314 |
1.7× |
| Myocardial perfusion imaging, planar (including qualitative or quantitative wall motion, ejection fraction by first… (78453) |
$1,561.77 |
$2,602.95 |
1.1× |
| Myocardial spect multiple studies (78452) |
$2,388.45 |
$3,980.75 |
1.7× |
| Nm bone 3 phase (78315) |
$1,003.05 |
$1,671.75 |
2.4× |
| Nm bone imaging whole body (78306) |
$1,088.55 |
$1,814.25 |
2.6× |
| Nm csf cisternogram (78630) |
$2,011.80 |
$3,353 |
3.5× |
| Nm gastric emptying (78264) |
$951.60 |
$1,586 |
2.3× |
| Nm lymph system (78195) |
$1,064.10 |
$1,773.50 |
1.9× |
| Nuclear medicine study of bone and/or joint limited area (78300) |
$1,012.95 |
$1,688.25 |
2.4× |
| Ob us limited fetus(s) (76815) |
$251.25 |
$418.75 |
2.3× |
| Ophthalmic ultrasound, diagnostic; B-scan (with or without superimposed non-quantitative A-scan) Age Under 21 (76512) |
$424.35 |
$707.25 |
3.8× |
| Optic foramina (70190) |
$160.35 |
$267.25 |
1.7× |
| Parathyroid planar imaging (78070) |
$1,079.40 |
$1,799 |
2.6× |
| Parathyroid planar imaging w/wo subtraction (78071) |
$1,190.70 |
$1,984.50 |
2.8× |
| PET imaging CT attenuation skull base mid-thigh (78815) |
$5,017.20 |
$8,362 |
3.3× |
| PET imaging CT for attenuation limited area (78814) |
$5,017.20 |
$8,362 |
3.3× |
| PET imaging for CT attenuation whole body (78816) |
$5,017.20 |
$8,362 |
3.3× |
| Radex abscess/fistula/sinus tract rs&i (76080) |
$577.49 |
$962.48 |
1.0× |
| Radex entir thrc lmbr crv sac spi w/skull 2/3 vw (72082) |
$192.15 |
$320.25 |
1.7× |
| Radex hip unilateral with pelvis 1 view (73501) |
$90 |
$150 |
1.0× |
| Radex hip unilateral with pelvis 2-3 views (73502) |
$187.50 |
$312.50 |
2.0× |
| Radex hips bilateral with pelvis minimum 5 views (73523) |
$330 |
$550 |
3.0× |
| Radex spine cervical 2 or 3 views (72040) |
$218.40 |
$364 |
2.4× |
| Radex spine cervical 4 or 5 views (72050) |
$336.15 |
$560.25 |
3.0× |
| Radex spine cervical 6 or more views (72052) |
$370.80 |
$618 |
3.4× |
| Radex spine thoracolumbar junction min 2 views (72080) |
$225 |
$375 |
2.5× |
| Radiologic exam chest 3 views (71047) |
$223.05 |
$371.75 |
2.4× |
| Radiologic exam colon double contrast study (74280) |
$546.45 |
$910.75 |
3.0× |
| Radiologic exam colon single contrast study (74270) |
$453.15 |
$755.25 |
2.4× |
| Radiologic exam esophagus double contrast study (74221) |
$382.80 |
$638 |
2.1× |
| Radiologic exam esophagus single contrast study (74220) |
$297.75 |
$496.25 |
1.6× |
| Radiologic exam small int single contrast study (74250) |
$453.15 |
$755.25 |
2.4× |
| Radiologic exam swallow function contrast study (74230) |
$218.05 |
$363.42 |
1.2× |
| Radiologic exam upr gi trc double contrast study (74246) |
$463.95 |
$773.25 |
2.5× |
| Radiologic exam upr gi trc single contrast study (74240) |
$431.40 |
$719 |
2.3× |
| Radiologic examination femur minimum 2 views (73552) |
$225 |
$375 |
2.5× |
| Radiologic examination from nose to rectum for foreign body, single view, child Age Under 21 (76010) |
$160.35 |
$267.25 |
1.7× |
| Radiologic examination, ankle; complete, minimum of 3 views Age Under 21 (73610) |
$192.15 |
$320.25 |
2.1× |
| Radiologic examination, complete acute abdomen series, including 2 or more views of the abdomen (eg, supine, erect,… (74022) |
$296.85 |
$494.75 |
2.7× |
| Radiologic examination, elbow; 2 views Age Under 21 (73070) |
$128.25 |
$213.75 |
1.4× |
| Radiologic examination, elbow; complete, minimum of 3 views Age Under 21 (73080) |
$190.20 |
$317 |
2.1× |
| Radiologic examination, foot; complete, minimum of 3 views Age Under 21 (73630) |
$202.65 |
$337.75 |
2.2× |
| Radiologic examination, hand; minimum of 3 views Age Under 21 (73130) |
$202.65 |
$337.75 |
2.2× |
| Radiologic examination, knee; complete, 4 or more views Age Under 21 (73564) |
$264.45 |
$440.75 |
2.4× |
| Radiologic examination, nasal bones, complete, minimum of 3 views Age Under 21 (70160) |
$175.20 |
$292 |
1.9× |
| Radiologic examination, ribs, bilateral; including posteroanterior chest, minimum of 4 views Age Under 21 (71111) |
$225.21 |
$375.35 |
2.0× |
| Radiologic examination, ribs, unilateral; including posteroanterior chest, minimum of 3 views Age Under 21 (71101) |
$194.68 |
$324.48 |
1.8× |
| Radiologic examination, shoulder, arthrography, radiological supervision and interpretation Age Under 21 (73040) |
$480.75 |
$801.25 |
1.3× |
| Radiologic examination, shoulder; complete, minimum of 2 views Age Under 21 (73030) |
$209.10 |
$348.50 |
2.3× |
| Radiologic examination, sinuses, paranasal, less than 3 views Age Under 21 (70210) |
$96.75 |
$161.25 |
1.1× |
| Radiologic examination, skull; less than 4 views Age Under 21 (70250) |
$259.05 |
$431.75 |
2.3× |
| Radiologic examination, spine, lumbosacral; 2 or 3 views Age Under 21 (72100) |
$265.50 |
$442.50 |
2.4× |
| Radiologic examination, spine, lumbosacral; bending views only, 2 or 3 views Age Under 21 (72120) |
$129.23 |
$215.38 |
1.2× |
| Radiologic examination, spine, lumbosacral; complete, including bending views, minimum of 6 views Age Under 21 (72114) |
$400.35 |
$667.25 |
3.6× |
| Radiologic examination, wrist; complete, minimum of 3 views Age Under 21 (73110) |
$147.30 |
$245.50 |
1.6× |
| Radiologic examination; acromioclavicular joints, bilateral, with or without weighted distraction Age Under 21 (73050) |
$209.10 |
$348.50 |
2.3× |
| Radiologic examination; humerus, minimum of 2 views Age Under 21 (73060) |
$202.65 |
$337.75 |
2.2× |
| Radiologic examination; lower extremity, infant, minimum of 2 views Age Under 21 (73592) |
$137.40 |
$229 |
1.5× |
| Radiologic examination; sternoclavicular joint or joints, minimum of 3 views Age Under 21 (71130) |
$214.20 |
$357 |
2.3× |
| Radiologic examination; toe(s), minimum of 2 views Age Under 21 (73660) |
$147.30 |
$245.50 |
1.6× |
| Radiologic examination; upper extremity, infant, minimum of 2 views Age Under 21 (73092) |
$173.70 |
$289.50 |
1.6× |
| Review by radiologist of urinary bladder and urethra images with contrast and after passing urine (74455) |
$839.40 |
$1,399 |
3.3× |
| Rp loclzj tum plnr 1 area single day imaging (78800) |
$1,079.40 |
$1,799 |
2.6× |
| Rp loclzj tum plnr whole body 2+ days imaging (78804) |
$1,651.20 |
$2,752 |
2.9× |
| Rp loclzj tum plnr whole body single day imaging (78802) |
$1,561.77 |
$2,602.95 |
2.7× |
| Saline infusion sonohysterography (SIS), including color flow Doppler, when performed Age Under 21 (76831) |
$616.35 |
$1,027.25 |
2.4× |
| Scapula complete (73010) |
$155.25 |
$258.75 |
1.4× |
| Screening digital breast tomosynthesis bi (77063) |
$52.20 |
$87 |
— |
| Thyroid met imaging body (78018) |
$994.80 |
$1,658 |
1.7× |
| Thyroid uptake single/multiple quant measurement (78012) |
$951.60 |
$1,586 |
2.3× |
| Ultrasound breast limited (76642) |
$117.75 |
$196.25 |
1.3× |
| Ultrasound, abdomen limited (76705) |
$282.90 |
$471.50 |
2.6× |
| Ultrasound, limited, joint or focal evaluation of other nonvascular extremity structure(s) (eg, joint space,… (76882) |
$166.35 |
$277.25 |
1.5× |
| Ultrasound, pelvic (nonobstetric), real time with image documentation; complete Age Under 21 (76856) |
$512.40 |
$854 |
4.6× |
| Ultrasound, pregnant uterus, real time with image documentation, fetal and maternal evaluation, first trimester (< 14… (76801) |
$409.35 |
$682.25 |
3.7× |
| Ultrasound, transplanted kidney, real time and duplex Doppler with image documentation Age Under 21 (76776) |
$290.85 |
$484.75 |
2.6× |
| Umbilical-artery Doppler (OB) (76820) |
$129.23 |
$215.38 |
1.2× |
| Unlisted fluoroscopic procedure (76496) |
$208.50 |
$347.50 |
2.3× |
| Unlisted magnetic resonance procedure (eg, diagnostic, interventional) Age Under 21 (76498) |
$2,097.60 |
$3,496 |
22.8× |
| Unlisted miscellaneous procedure, diagnostic nuclear medicine (78999) |
$945 |
$1,575 |
2.2× |
| Ureteral reflux study (78740) |
$702.45 |
$1,170.75 |
1.7× |
| Urethrocystography retrograde rs&i (74450) |
$303.38 |
$505.62 |
1.2× |
| Urography (pyelography), intravenous, with or without KUB, with or without tomography Age Under 21 (74400) |
$451.35 |
$752.25 |
2.4× |
| Urography antegrade rs&i (74425) |
$488.55 |
$814.25 |
1.3× |
| Us abdominal aorta real time screen study aaa (76706) |
$206.55 |
$344.25 |
1.9× |
| Us breast uni real time with image complete (76641) |
$176.10 |
$293.50 |
1.6× |
| Us chest (76604) |
$239.10 |
$398.50 |
2.2× |
| Us compl joint r-t w/image documentation (76881) |
$479.25 |
$798.75 |
4.3× |
| Us encephalogram (76506) |
$315.30 |
$525.50 |
2.9× |
| Us exam, pelvic, limited (76857) |
$383.55 |
$639.25 |
3.5× |
| Us guided compression repair (76936) |
$316.25 |
$527.09 |
1.4× |
| Us inft hips r-t img dynamic req phys/qhp manj (76885) |
$228.15 |
$380.25 |
2.5× |
| US OB Follow-Up/Repeat (76816) |
$130.32 |
$217.20 |
1.2× |
| Us ob transvaginal (76817) |
$369.75 |
$616.25 |
3.4× |
| Us retroperitoneal complete (76770) |
$561.45 |
$935.75 |
5.1× |
| Us retroperitoneal ltd (76775) |
$335.10 |
$558.50 |
3.0× |
| Us scrotum (76870) |
$439.20 |
$732 |
4.0× |
| Us soft tissue head/neck (76536) |
$477 |
$795 |
4.3× |
| Us spinal canal (76800) |
$316.05 |
$526.75 |
2.9× |
| Us unlstd proc (76999) |
$200.70 |
$334.50 |
2.2× |
| Venography, extremity, unilateral, radiological supervision and interpretation Age Under 21 (75820) |
$1,681.60 |
$2,802.66 |
1.0× |
| X-ray exam of finger(s) (73140) |
$140.25 |
$233.75 |
1.5× |
| X-ray exam of knee 1 or 2 (73560) |
$147.30 |
$245.50 |
1.6× |
| X-ray exam ribs bil 3 views (71110) |
$320.10 |
$533.50 |
2.9× |
| X-ray exam ribs uni 2 views (71100) |
$259.05 |
$431.75 |
2.8× |
| X-ray heel (73650) |
$202.65 |
$337.75 |
2.2× |
| X-ray of joint between lower spine and hip bone 3 or more views|PROFESSIONAL COMPONENT (72202) |
$275.10 |
$458.50 |
2.5× |
| X-ray retrograde pyelogram (74420) |
$357 |
$595 |
1.0× |
| Xr abdomen 1 view (74018) |
$218.10 |
$363.50 |
2.4× |
| Xr abdomen 2 views (74019) |
$259.05 |
$431.75 |
2.3× |
| Xr arthrogram ankle (73615) |
$440.23 |
$733.72 |
1.2× |
| Xr arthrogram elbow (73085) |
$480.75 |
$801.25 |
1.3× |
| Xr arthrogram hip (73525) |
$440.23 |
$733.72 |
1.2× |
| Xr arthrogram knee (73580) |
$440.23 |
$733.72 |
1.2× |
| Xr arthrogram wrist (73115) |
$440.23 |
$733.72 |
1.2× |
| Xr bone age studies (77072) |
$149.55 |
$249.25 |
1.4× |
| Xr bone length study (77073) |
$212.40 |
$354 |
1.9× |
| Xr chest 1 view (71045) |
$194.25 |
$323.75 |
2.1× |
| Xr chest 2 views (71046) |
$200.10 |
$333.50 |
2.2× |
| Xr eye foreign body (70030) |
$160.35 |
$267.25 |
1.7× |
| Xr facial bones 3+ views (70150) |
$320.70 |
$534.50 |
2.9× |
| Xr foot arthritis pa only bilateral - report(ortho pro) (73620) |
$128.25 |
$213.75 |
1.4× |
| Xr forearm 2 views (73090) |
$187.50 |
$312.50 |
2.0× |
| Xr hand 2v (73120) |
$130.31 |
$217.19 |
1.2× |
| Xr hysterosalpingogram (74740) |
$275.21 |
$458.69 |
1.1× |
| Xr myelogram l-spine (72265) |
$1,388.40 |
$2,314 |
1.7× |
| Xr neck soft tissue (70360) |
$147.30 |
$245.50 |
1.6× |
| Xr o knee w/ merchant view bilat - report(ortho pro) (73562) |
$225 |
$375 |
2.5× |
| Xr osseous survey complete (77075) |
$709.20 |
$1,182 |
6.4× |
| Xr pelvis 1-2 views (72170) |
$149.55 |
$249.25 |
1.4× |
| Xr pelvis min 3 view (72190) |
$245.70 |
$409.50 |
2.2× |
| Xr sacrum/coccyx 2+ views (72220) |
$217.20 |
$362 |
2.4× |
| Xr sella turcica (70240) |
$96.75 |
$161.25 |
1.1× |
| Xr shoulder 1 view (73020) |
$147.30 |
$245.50 |
1.6× |
| Xr sialogram (70390) |
$338.10 |
$563.50 |
1.3× |
| Xr sinuses 3+ views (70220) |
$255 |
$425 |
2.8× |
| Xr skull min 4 view (70260) |
$325.35 |
$542.25 |
3.0× |
| Xr spine 1 view (72020) |
$117.60 |
$196 |
1.3× |
| Xr spine thoracic 3v (72072) |
$225 |
$375 |
2.0× |
| Xr sternum 2+ views (71120) |
$210.15 |
$350.25 |
2.3× |
| Xr surgical specimen (76098) |
$577.49 |
$962.48 |
1.0× |
| Xr t-spine 2 views (72070) |
$183.45 |
$305.75 |
1.7× |
| Xr tibia/fibula 2 views (73590) |
$150 |
$250 |
1.6× |
| Xr tmj unilateral (70328) |
$349.05 |
$581.75 |
3.8× |
| Xr wrist 2 views (73100) |
$96.75 |
$161.25 |
1.1× |