| Acute gi blood loss imaging (78278) |
$360 |
$900 |
0.9× |
| Ankle 2 views (73600) |
$70.80 |
$177 |
0.8× |
| Arthrography knee lt (73580) |
$238.40 |
$596 |
0.7× |
| Arthrography wrist lt (73115) |
$238.40 |
$596 |
0.7× |
| Barium enema (74270) |
$146 |
$365 |
0.8× |
| Bone age studies (77072) |
$52.40 |
$131 |
0.5× |
| Bone imaging limited area (78300) |
$380.40 |
$951 |
0.9× |
| Bowel imaging (78290) |
$354 |
$885 |
0.8× |
| Cholecystography, oral contrast Other Diagnostic Radiology FS (74290) |
$30 |
$75 |
0.2× |
| Cine/Vid X-Ray Throat/Esoph - Fl Esoph Barium Swlw W/ Video & Speech (74230) |
$100 |
$250 |
0.5× |
| Clavicle complete (73000) |
$70.80 |
$177 |
0.8× |
| Computed tomography, bone mineral density study, 1 or more sites, axial skeleton (eg, hips, pelvis, spine) Age Under 21 (77078) |
$88.80 |
$222 |
1.0× |
| Computed tomography, orbit, sella, or posterior fossa or outer, middle, or inner ear; with contrast material(s) Age… (70481) |
$350 |
$875 |
1.9× |
| Contrast exam abdominl aorta (75625) |
$610.40 |
$1,526 |
0.2× |
| CT - st neck w&wo contr (70492) |
$388 |
$970 |
2.1× |
| CT abdomen and pelvis without and with contrast (74178) |
$676 |
$1,690 |
1.9× |
| CT abdomen and pelvis without contrast (74176) |
$472 |
$1,180 |
1.9× |
| CT abdomen w wo contrast (74170) |
$408 |
$1,020 |
2.2× |
| CT abdomen w/contrast (74160) |
$350 |
$875 |
1.9× |
| CT abdomen w/o contrast (74150) |
$223.20 |
$558 |
2.0× |
| CT angio abd&plvis cntrst mtrl w/wo cntrst imges (74174) |
$460 |
$1,150 |
1.3× |
| CT angio abdom w/o & w/dye (74175) |
$460 |
$1,150 |
2.5× |
| CT angio abdominal arteries (75635) |
$325.20 |
$813 |
1.8× |
| CT angio hrt w/3d image (75574) |
$250.80 |
$627 |
0.7× |
| CT angiograph pelv w/o&w/dye (72191) |
$432 |
$1,080 |
2.4× |
| CT cervical spine w/contrast (72126) |
$350 |
$875 |
1.0× |
| CT cervical spine w/o contrast (72125) |
$230 |
$575 |
2.1× |
| CT chest w/contrast (71260) |
$319 |
$797.50 |
1.7× |
| CT extremity upper w & w/o contrast (73202) |
$388 |
$970 |
2.1× |
| CT head/brain with contrast (70460) |
$350 |
$875 |
1.9× |
| CT head/brain without and with contrast (70470) |
$390 |
$975 |
2.1× |
| CT heart contrast eval cardiac structure&morph (75572) |
$175.20 |
$438 |
0.5× |
| CT heart w/o contrast quant eval coronary calcium (75571) |
$100 |
$250 |
1.1× |
| CT hrt w/3d image congen (75573) |
$175.20 |
$438 |
0.5× |
| CT limited/localized follow up study (76380) |
$190 |
$475 |
2.1× |
| CT lower ext w/wo contrast (73702) |
$388 |
$970 |
2.1× |
| CT lower extremity w contrast (73701) |
$350 |
$875 |
1.9× |
| CT lower extremity w/o contrast unilateral (73700) |
$223.20 |
$558 |
2.0× |
| CT lumbar spine w/contrast (72132) |
$350 |
$875 |
1.0× |
| CT lumbar spine w/o contrast (72131) |
$236.40 |
$591 |
2.2× |
| CT lumbar spine w/o then w/ con (72133) |
$490 |
$1,225 |
2.7× |
| CT maxillofacial area w/o contrast (70486) |
$228 |
$570 |
2.1× |
| CT maxillofacial w/contrast (70487) |
$350 |
$875 |
1.9× |
| CT maxillofacial w/o then w/ con (70488) |
$388 |
$970 |
2.1× |
| CT orbit sella ear w/o con (70480) |
$223.20 |
$558 |
2.0× |
| CT orbit/ear/fossa w/o then w/ con (70482) |
$388 |
$970 |
2.1× |
| CT pelvis w & w/o contrast (72194) |
$388 |
$970 |
2.1× |
| CT pelvis w/o contrast (72192) |
$236.40 |
$591 |
2.2× |
| CT soft tissue neck w/contrast (70491) |
$350 |
$875 |
1.9× |
| CT soft tissue neck w/o contrast (70490) |
$223.20 |
$558 |
2.0× |
| CT spine cervical w/wo contrast (72127) |
$388 |
$970 |
2.1× |
| CT thoracic spine w/contrast (72129) |
$350 |
$875 |
1.9× |
| CT thoracic spine w/o contrast (72128) |
$236.40 |
$591 |
2.2× |
| CT thoracic spine w/o then w/ con (72130) |
$522.80 |
$1,307 |
2.9× |
| CT thorax lung cancer scr c- (71271) |
$211.20 |
$528 |
1.9× |
| CT thorax w/o contrast (71250) |
$236.80 |
$592 |
2.2× |
| CT thorax w/o then w/ contrast (71270) |
$388 |
$970 |
2.1× |
| CT upper extremity w/dye (73201) |
$350 |
$875 |
1.0× |
| CT upper extremity w/o contrast rt (73200) |
$223.20 |
$558 |
2.0× |
| CTA chest w/wo contrast (71275) |
$410.20 |
$1,025.50 |
2.2× |
| CTA head w contrast (70496) |
$554 |
$1,385 |
3.0× |
| CTA lower extremity w/wo contrast unilateral (73706) |
$416 |
$1,040 |
2.3× |
| Cta Neck (70498) |
$572 |
$1,430 |
3.1× |
| CTA upper extremity w/wo contrast unilateral (73206) |
$393.60 |
$984 |
2.1× |
| Esophogram (74220) |
$100 |
$250 |
0.5× |
| Fetal biophysical profile non-stress testing (76818) |
$112 |
$280 |
1.0× |
| Fetal biophysical profile w/o nst (76819) |
$64 |
$160 |
0.6× |
| Fluoroscopy up to 1 hour physician/qhp time (76000) |
$166 |
$415 |
0.7× |
| Gastric emptying study (78264) |
$300 |
$750 |
0.7× |
| Gastric mucosa imaging (78261) |
$284 |
$710 |
0.7× |
| Gastroesophageal reflux study (78262) |
$284 |
$710 |
0.7× |
| Gated heart planar single (78472) |
$330 |
$825 |
0.8× |
| Hepatobil syst image w/drug (78227) |
$480 |
$1,200 |
0.8× |
| Hepatobiliary system imaging (78226) |
$340.80 |
$852 |
0.8× |
| Humerus min 2 views (73060) |
$52.80 |
$132 |
0.6× |
| Hysterosalpingography (74740) |
$223.60 |
$559 |
0.9× |
| Ivp (74400) |
$140.80 |
$352 |
0.8× |
| Ivp w tomography (74415) |
$84.80 |
$212 |
0.5× |
| Kidney imaging morphology; with vascular flow and function, multiple studies, with and without pharmacological… (78709) |
$372 |
$930 |
0.7× |
| Kidney imaging morphology; with vascular flow and function, single study without pharmacological intervention Age Under… (78707) |
$372 |
$930 |
0.7× |
| Kidney imaging morphology; with vascular flow and function, single study, with pharmacological intervention (eg,… (78708) |
$282.80 |
$707 |
0.5× |
| Liver & spleen; static only (78215) |
$384 |
$960 |
0.9× |
| Lung perf&ventilat diferentl (78598) |
$370 |
$925 |
0.7× |
| Lung ventilat&perfus imaging (78582) |
$368 |
$920 |
0.6× |
| Lung ventilation imaging (78579) |
$240 |
$600 |
0.6× |
| Magnetic resonance (eg, proton) imaging, any joint of lower extremity; without contrast material(s), followed by… (73723) |
$896 |
$2,240 |
2.5× |
| Magnetic resonance (eg, proton) imaging, lower extremity other than joint; without contrast material(s), followed by… (73720) |
$896 |
$2,240 |
2.5× |
| Mammary ductogram single (77053) |
$249.80 |
$624.50 |
1.0× |
| MRA head w & w/o contrast (70546) |
$896 |
$2,240 |
2.5× |
| MRA head w/contrast (70545) |
$506.40 |
$1,266 |
1.4× |
| MRA head w/o contrast (70544) |
$448 |
$1,120 |
1.8× |
| MRA neck w/contrast (70548) |
$566 |
$1,415 |
1.6× |
| MRA neck w/o contrast (70547) |
$532 |
$1,330 |
2.1× |
| MRA neck w/wo contrast (70549) |
$896 |
$2,240 |
2.5× |
| MRI abdomen w/contrast (74182) |
$582 |
$1,455 |
1.6× |
| MRI abdomen w/o & w/contrast material (74183) |
$896 |
$2,240 |
2.5× |
| MRI abdomen w/o contrast (74181) |
$448 |
$1,120 |
1.8× |
| MRI any jnt lwr ext with con lt (73722) |
$506.40 |
$1,266 |
0.6× |
| MRI bone marrow (77084) |
$448 |
$1,120 |
1.8× |
| MRI cervical spine w/o contrast (72141) |
$448 |
$1,120 |
1.8× |
| MRI cervical spine with contrast (72142) |
$530.40 |
$1,326 |
1.5× |
| MRI chest w & w/o contrast (71552) |
$1,209.80 |
$3,024.50 |
3.3× |
| MRI chest w/contrast (71551) |
$646 |
$1,615 |
0.8× |
| MRI chest w/o contrast (71550) |
$547 |
$1,367.50 |
2.2× |
| MRI joint upper ext w/contrast (73222) |
$506.40 |
$1,266 |
0.6× |
| MRI joint upr extr w/o&w/dye (73223) |
$896 |
$2,240 |
2.5× |
| MRI joint upr extrem w/o dye (73221) |
$448 |
$1,120 |
1.8× |
| Mri Lower Extremity W/O Dye (73718) |
$480 |
$1,200 |
1.9× |
| MRI lumbar spine with contrast (72149) |
$537.60 |
$1,344 |
1.5× |
| MRI lumbar w/wo contrast (72158) |
$995.20 |
$2,488 |
2.7× |
| MRI lwr ext w/o jnts with con rt (73719) |
$524 |
$1,310 |
1.4× |
| MRI orbit/face/neck w/contrast (70542) |
$515.20 |
$1,288 |
1.4× |
| MRI orbit/face/neck w/o & w/contrast (70543) |
$896 |
$2,240 |
2.5× |
| MRI orbit/face/neck w/o contrast (70540) |
$464 |
$1,160 |
1.9× |
| MRI pelvis w/ contrast (72196) |
$524 |
$1,310 |
1.4× |
| MRI pelvis w/o contrast (72195) |
$478 |
$1,195 |
1.9× |
| MRI pelvis w/wo contrast (72197) |
$896 |
$2,240 |
2.5× |
| MRI spine cervical wo/w contrast (72156) |
$995.20 |
$2,488 |
2.7× |
| MRI spine thoracic w/contrast (72147) |
$537.60 |
$1,344 |
1.5× |
| MRI thoracic spine w wo contrast (72157) |
$995.20 |
$2,488 |
2.7× |
| MRI thoracic spine w/o contrast (72146) |
$497.20 |
$1,243 |
2.0× |
| MRI tmj (70336) |
$448 |
$1,120 |
1.8× |
| MRI upper extremity oth than jt w/o contr matrl (73218) |
$480 |
$1,200 |
1.9× |
| Mri Upper Extremity W/Dye (73219) |
$524 |
$1,310 |
1.4× |
| MRI upr ext w/o jnts w/o-w/con rt (73220) |
$896 |
$2,240 |
2.5× |
| Myelogram thoracic (72255) |
$420 |
$1,050 |
0.5× |
| Myelography 2 or more regions (72270) |
$576 |
$1,440 |
0.7× |
| Myelography lumbosacral (72265) |
$420 |
$1,050 |
0.5× |
| Myocardial imaging, positron emission tomography (PET), perfusion study (including ventricular wall motionºs» and/or… (78491) |
$1,714 |
$4,285 |
1.1× |
| Myocardial perfusion planar 1 study rest/stress (78453) |
$313.60 |
$784 |
0.2× |
| Myocardial perfusion planar multiple studies (78454) |
$188.40 |
$471 |
0.1× |
| Myocardial spect single study at rest or stress (78451) |
$313.60 |
$784 |
0.2× |
| Nm bone 3 phase (78315) |
$360 |
$900 |
0.9× |
| Nm bone imaging whole body (78306) |
$288 |
$720 |
0.7× |
| Nm heart perfusion spect stress rest (78452) |
$1,274.40 |
$3,186 |
0.9× |
| Nm kidney function (78725) |
$180.80 |
$452 |
0.4× |
| Nm kidney imaging morphology (78700) |
$293.20 |
$733 |
0.7× |
| Nm liver image static only (78201) |
$367.20 |
$918 |
0.6× |
| Nm thyroid imaging only (78013) |
$384 |
$960 |
0.9× |
| Nose to rectum for fb child (76010) |
$52.40 |
$131 |
0.6× |
| Ob us < 14 wks single fetus (76801) |
$180 |
$450 |
1.6× |
| Ob us nuchal meas 1 gest (76813) |
$82 |
$205 |
0.8× |
| Ophthalmic ultrasound, diagnostic; B-scan and quantitative A-scan performed during the same patient encounter Age Under… (76510) |
$92 |
$230 |
0.7× |
| Parathyroid imaging (78070) |
$384 |
$960 |
0.9× |
| Pulmonary perfusion imaging particulate (78580) |
$240 |
$600 |
0.6× |
| Radex abscess/fistula/sinus tract rs&i (76080) |
$223.60 |
$559 |
0.4× |
| Radex entir thrc lmbr crv sac spi w/skull 2/3 vw (72082) |
$116.40 |
$291 |
1.1× |
| Radex entir thrc lmbr crv sac spi w/skull 4/5 vw (72083) |
$222 |
$555 |
2.0× |
| Radex hip unilateral with pelvis 1 view (73501) |
$70.80 |
$177 |
0.8× |
| Radex hip unilateral with pelvis 2-3 views (73502) |
$70.80 |
$177 |
0.8× |
| Radex hip unilateral with pelvis minimum 4 views (73503) |
$116.40 |
$291 |
1.1× |
| Radex hips bilateral with pelvis 2 views (73521) |
$116.40 |
$291 |
1.1× |
| Radex hips bilateral with pelvis minimum 5 views (73523) |
$222 |
$555 |
2.0× |
| Radex spine cervical 2 or 3 views (72040) |
$70.40 |
$176 |
0.8× |
| Radex spine cervical 4 or 5 views (72050) |
$88.40 |
$221 |
0.8× |
| Radex spine cervical 6 or more views (72052) |
$100 |
$250 |
0.9× |
| Radex X-Ray Exam Thoracolmb 2+ Vw - Xr Thoracolumbar Spine 2 Views (72080) |
$62 |
$155 |
0.7× |
| Radiologic Exam Chest 4+ Views - Xr Chest 4+ Views (71048) |
$134.40 |
$336 |
1.2× |
| Radiologic exam upr gi trc double contrast study (74246) |
$114 |
$285 |
0.6× |
| Radiologic exam upr gi trc single contrast study (74240) |
$166 |
$415 |
0.9× |
| Radiologic Examination Femur Minimum 2 Views - Xr Femur 2+ Vw Lt (73552) |
$52.80 |
$132 |
0.6× |
| Radiologic examination, complete acute abdomen series, including 2 or more views of the abdomen (eg, supine, erect,… (74022) |
$73.20 |
$183 |
0.7× |
| Radiologic examination, mastoids; less than 3 views per side Other Diagnostic Radiology FS (70120) |
$52.80 |
$132 |
0.5× |
| Radiologic examination, salivary gland for calculus Other Diagnostic Radiology FS (70380) |
$54.80 |
$137 |
0.6× |
| Rp loclzj tum plnr 1 area single day imaging (78800) |
$874.40 |
$2,186 |
2.1× |
| Rp loclzj tum plnr whole body 2+ days imaging (78804) |
$1,340.40 |
$3,351 |
2.4× |
| Rp loclzj tum plnr whole body single day imaging (78802) |
$462 |
$1,155 |
0.8× |
| Rp loclzj tum spect 1 area single day imaging (78803) |
$576 |
$1,440 |
1.0× |
| Rp loclzj tum spect 2 area/sep acquisj img (78831) |
$303.60 |
$759 |
0.2× |
| Saline infused sonohysterogram (76831) |
$180 |
$450 |
0.7× |
| Screening digital breast tomosynthesis; bilateral (77063) |
$28.80 |
$72 |
1.2× |
| Shoulder arthrogram (73040) |
$238.40 |
$596 |
0.7× |
| Small bowel series (74250) |
$102 |
$255 |
0.6× |
| Testicular imaging w/flow (78761) |
$293.20 |
$733 |
0.7× |
| Thyroid uptake single/multiple quant measurement (78012) |
$260 |
$650 |
0.6× |
| Thyroid uptake w/blood flow sngle/mult quan meas (78014) |
$526 |
$1,315 |
1.3× |
| Ultrasound breast limited (76642) |
$151.20 |
$378 |
1.7× |
| Ultrasound, abdomen limited (76705) |
$180 |
$450 |
1.6× |
| Unlisted CT procedure (76497) |
$124 |
$310 |
1.4× |
| Unlisted diagnostic radiographic procedure (76499) |
$275.20 |
$688 |
3.0× |
| Unlisted magnetic resonance procedure (76498) |
$394 |
$985 |
4.3× |
| Urethrocystography voiding (74455) |
$181.20 |
$453 |
0.7× |
| Urography retrograde w/wo kub (74420) |
$214 |
$535 |
0.6× |
| Us abdominal aorta real time screen study aaa (76706) |
$120 |
$300 |
1.1× |
| Us breast uni real time with image complete (76641) |
$151.20 |
$378 |
1.4× |
| Us chest (76604) |
$74 |
$185 |
0.7× |
| Us compl joint r-t w/image documentation (76881) |
$180 |
$450 |
1.6× |
| Us encephalogram (76506) |
$195.60 |
$489 |
1.8× |
| Us inft hips r-t img dynamic req phys/qhp manj (76885) |
$134.40 |
$336 |
1.5× |
| Us ob detailed single fetus (76811) |
$177.60 |
$444 |
0.7× |
| Us ob followup per fetus (76816) |
$180 |
$450 |
1.6× |
| Us ob limited 1 or more fetuses (76815) |
$180 |
$450 |
1.6× |
| Us obstetric transvaginal (76817) |
$180 |
$450 |
1.6× |
| Us pelvic limited or f/u non-ob (76857) |
$96 |
$240 |
0.9× |
| Us pelvis complete (76856) |
$180 |
$450 |
1.6× |
| Us retroperitoneal complete (76770) |
$180 |
$450 |
1.6× |
| Us retroperitoneal limited (76775) |
$180 |
$450 |
1.6× |
| Us scrotum (76870) |
$180 |
$450 |
1.6× |
| Us soft tissue head/neck (76536) |
$180 |
$450 |
1.6× |
| Us spinal canal (76800) |
$163.20 |
$408 |
1.5× |
| Us transrectal (76872) |
$180 |
$450 |
1.6× |
| Venogram extremity bilateral (75822) |
$458.40 |
$1,146 |
0.3× |
| Venogram ivc w serialography (75825) |
$610.40 |
$1,526 |
0.2× |
| Venogram svc w serialography (75827) |
$610.40 |
$1,526 |
0.4× |
| X-Ray Ac Jts - Xr Acromioclavicular Joints Bilateral (73050) |
$52 |
$130 |
0.6× |
| X-Ray Ankle 3+ Vw - Xr Ankle 3+ Views Right (73610) |
$70.80 |
$177 |
0.8× |
| X-ray aorta leg arteries (75630) |
$637.60 |
$1,594 |
0.2× |
| X-Ray Colon Air Contrast - Fl Barium Enema Air Contrast (74280) |
$200.40 |
$501 |
1.1× |
| X-Ray Elbow 3+ Vw - Xr Elbow 3+ Views Right (73080) |
$107.20 |
$268 |
1.2× |
| X-ray exam hips bi 3-4 views (73522) |
$116.40 |
$291 |
1.1× |
| X-ray exam of finger(s) (73140) |
$40.40 |
$101 |
0.4× |
| X-ray exam of small bowel - fl small bowel series enteroclysis tube (74251) |
$354 |
$885 |
1.9× |
| X-Ray Foot 2 Vw - Xr Foot 1-2 Views Right (73620) |
$52.80 |
$132 |
0.6× |
| X-Ray Foot 3+ Vw - Xr Foot 3+ Views Right (73630) |
$88 |
$220 |
1.0× |
| X-Ray Hand 3+ Vw - Xr Hand 3+ Views Right (73130) |
$52.80 |
$132 |
0.6× |
| X-Ray Heel - Xr Calcaneus 2 Views Right (73650) |
$52.80 |
$132 |
0.6× |
| X-Ray Jaw <4 Vw - Xr Mandible < 4 Views (70100) |
$52.80 |
$132 |
0.6× |
| X-Ray Knee 3 View - Xr Knee 3 Views Right (73562) |
$52.80 |
$132 |
0.6× |
| X-Ray Knee 4+ View - Xr Knee 4+ Views Right (73564) |
$52.80 |
$132 |
0.5× |
| X-Ray Knee Bilat Standing - Xr Knees Anteroposterior Standing Bilat (73565) |
$53.60 |
$134 |
0.6× |
| X-Ray Lumbar Spine 2/3 Vw - Xr Lumbar Spine 2-3 Views (72100) |
$84 |
$210 |
0.8× |
| X-Ray Lumbar Spine 6+ Vw - Xr Lumbar Spine 6+ Vws Including Bending (72114) |
$114 |
$285 |
1.0× |
| X-Ray Ribs 2 Vw Unilat - Xr Ribs 2 Views Right (71100) |
$64 |
$160 |
0.7× |
| X-Ray Ribs, Chest 4+ Vw - Xr Ribs 3 Vws Bil W/ Chest Posteroanterior (71111) |
$180 |
$450 |
1.6× |
| X-Ray Sacroiliac Jts 3+ Vw - Xr Sacroiliac Joints 3+ Views (72202) |
$52.80 |
$132 |
0.5× |
| X-Ray Sacrum/Coccyx 2+ Vw - Xr Sacrum Coccyx 2+ Views (72220) |
$52.80 |
$132 |
0.6× |
| X-Ray Shoulder 2+ Vw - Xr Shoulder 2+ Views Right (73030) |
$52.80 |
$132 |
0.6× |
| X-Ray Sinuses 3+ Vw - Xr Paranasal Sinuses 3+ Views (70220) |
$52.80 |
$132 |
0.6× |
| X-Ray Skull 4+ Vw - Xr Skull Complete 4+ Views (70260) |
$88 |
$220 |
0.8× |
| X-Ray Skull <4 Vw - Xr Skull 1-3 Views (70250) |
$52.80 |
$132 |
0.5× |
| X-Ray Sterno-Clavicluar Jt - Xr Sternoclavicular Joints 3+ Views (71130) |
$52.80 |
$132 |
0.6× |
| X-Ray Toe(S) - Xr Toes 2+ Views Right (73660) |
$40.40 |
$101 |
0.4× |
| X-Ray Wrist 2 Vw - Xr Wrist 1-2 Views Right (73100) |
$70 |
$175 |
0.8× |
| X-Ray Wrist 3+ Vw - Xr Wrist 3+ Views Right (73110) |
$70 |
$175 |
0.8× |
| Xr abdomen 1 view (74018) |
$70 |
$175 |
0.8× |
| Xr abdomen 2 views (74019) |
$70 |
$175 |
0.6× |
| Xr abdomen 3 views (74021) |
$86.40 |
$216 |
0.8× |
| Xr arthrogram elbow (73085) |
$238.40 |
$596 |
0.7× |
| Xr arthrogram hip (73525) |
$393.60 |
$984 |
1.1× |
| Xr bone density appendicular (77081) |
$66 |
$165 |
0.7× |
| Xr bone density axial (77080) |
$139.20 |
$348 |
1.3× |
| Xr bone length study (77073) |
$70.80 |
$177 |
0.6× |
| Xr bone survey infant (77076) |
$64 |
$160 |
0.6× |
| Xr bone survey limited (77074) |
$90 |
$225 |
0.8× |
| Xr chest 1 view (71045) |
$53.20 |
$133 |
0.6× |
| Xr chest 2 views (71046) |
$85.20 |
$213 |
0.9× |
| Xr chest 3 views (71047) |
$105.60 |
$264 |
1.2× |
| Xr cystogram 3+ views (74430) |
$181.20 |
$453 |
0.5× |
| Xr facial bones 3 views (70150) |
$64 |
$160 |
0.6× |
| Xr lower extremity 2 views infant (73592) |
$54.80 |
$137 |
0.6× |
| Xr lumbar spine 4 views w/ flex ext (72120) |
$52.80 |
$132 |
0.5× |
| Xr myelogram c-spine (72240) |
$420 |
$1,050 |
0.5× |
| Xr nasal bones (70160) |
$52.80 |
$132 |
0.6× |
| Xr spine 1 view (72020) |
$40.40 |
$101 |
0.4× |
| Xr sternum 2 views (71120) |
$52.80 |
$132 |
0.6× |
| Xr surgical specimen (76098) |
$223.60 |
$559 |
0.4× |
| Xr upper extremity 2 views infant (73092) |
$64 |
$160 |
0.6× |
| Xray elbow 2 views (73070) |
$52.80 |
$132 |
0.6× |
| Xray forearm 2 views (73090) |
$52.80 |
$132 |
0.6× |
| Xray internal auditory meati compl (70134) |
$88 |
$220 |
0.2× |
| Xray knee 1 or 2 views rt (73560) |
$66.80 |
$167 |
0.7× |
| Xray neck soft tissue (70360) |
$40.40 |
$101 |
0.4× |
| Xray orbits complete min 4 views (70200) |
$52.80 |
$132 |
0.5× |
| Xray pelvis 1 or 2 views (72170) |
$70.40 |
$176 |
0.6× |
| Xray ribs bilateral 3 views (71110) |
$52.80 |
$132 |
0.5× |
| Xray ribs unilat w/ pa chest 3v rt (71101) |
$126 |
$315 |
1.2× |
| Xray scapula complete (73010) |
$52.80 |
$132 |
0.5× |
| Xray sinuses paranasal <3 views (70210) |
$52.80 |
$132 |
0.6× |
| Xray spine thoracic 3 views (72072) |
$64 |
$160 |
0.6× |
| Xray tibia-fibula 2 views bil (73590) |
$52.80 |
$132 |
0.6× |
| Xray tmj open - closed unilat (70328) |
$69.60 |
$174 |
0.8× |
| Xray tmj's bilateral open-clsc (70330) |
$139.20 |
$348 |
1.5× |