| Abdomen 2 views (74019) |
$149.50 |
$230 |
1.6× |
| Acute gastrointestinal blood loss imaging (78278) |
$513.50 |
$790 |
1.4× |
| Ankle 2 views (73600) |
$113.75 |
$175 |
1.4× |
| Antegrade urography radiological supvj & interpj (74425) |
$99.78 |
$153.50 |
0.3× |
| Arthrogram elbow (73085) |
$129.35 |
$199 |
0.4× |
| Arthrogram hip (73525) |
$118.30 |
$182 |
0.4× |
| Arthrogram shoulder (73040) |
$129.35 |
$199 |
0.4× |
| Arthrogram wrist (73115) |
$144.30 |
$222 |
0.5× |
| Arthrography knee lt (73580) |
$155.35 |
$239 |
0.5× |
| Bone &/Joint Imaging Limited Area (78300) |
$199.55 |
$307 |
0.5× |
| Bone &/Joint Imaging Multiple Areas (78305) |
$276.25 |
$425 |
0.8× |
| Bone &/joint imaging whole body (78306) |
$464.75 |
$715 |
1.3× |
| Bone age studies (77072) |
$40.95 |
$63 |
0.4× |
| Bone Imaging 3 Phase (78315) |
$617.50 |
$950 |
1.7× |
| Bone survey complete (77075) |
$133.25 |
$205 |
1.4× |
| Brain image w/flow 4 + views (78606) |
$669.50 |
$1,030 |
1.4× |
| Brain Imaging Minimum 4 Static Views (78605) |
$268.45 |
$413 |
0.5× |
| Cerebrospinal Fluid Flow W/O Matl Shunt Evaltj (78645) |
$273 |
$420 |
0.6× |
| Cervical spine 2 or 3 views (72040) |
$113.75 |
$175 |
1.4× |
| Chest 1 view (71045) |
$113.75 |
$175 |
1.4× |
| Chest 3 views (71047) |
$113.75 |
$175 |
1.4× |
| Cine/Vid X-Ray Throat/Esoph - Fl Esoph Barium Swlw W/ Video & Speech (74230) |
$114.40 |
$176 |
0.7× |
| Cisternography Positive Contrast Rs&I (70015) |
$118.30 |
$182 |
0.2× |
| Clavicle complete (73000) |
$113.75 |
$175 |
1.4× |
| Computed Tomography Thorax Lw Dose Lng Ca Scr C- (71271) |
$136.50 |
$210 |
1.4× |
| CT abdomen and pelvis without and with contrast (74178) |
$477.75 |
$735 |
1.5× |
| CT abdomen and pelvis without contrast (74176) |
$406.25 |
$625 |
1.9× |
| CT abdomen w contrast (74160) |
$299 |
$460 |
1.9× |
| CT abdomen w wo contrast (74170) |
$409.50 |
$630 |
2.6× |
| CT abdomen w/o contrast (74150) |
$208 |
$320 |
2.2× |
| CT angiography upper extremity lt (73206) |
$884.65 |
$1,361 |
5.5× |
| CT c-spine w/o contrast (72125) |
$347.75 |
$535 |
3.7× |
| CT cervical spine w&w/o contrast (72127) |
$344.50 |
$530 |
2.2× |
| CT cervical spine with contrast (72126) |
$416 |
$640 |
1.3× |
| CT chest w/wo contrast (71270) |
$344.50 |
$530 |
2.2× |
| CT chest with contrast (71260) |
$386.75 |
$595 |
2.4× |
| CT head/brain with contrast (70460) |
$230.75 |
$355 |
1.4× |
| CT head/brain without and with contrast (70470) |
$273 |
$420 |
1.7× |
| CT heart contrast eval cardiac structure&morph (75572) |
$553.80 |
$852 |
1.7× |
| CT iac w contrast (70481) |
$409.50 |
$630 |
2.6× |
| CT limited/localized follow up study (76380) |
$261.95 |
$403 |
3.3× |
| CT lower ext w/o (73700) |
$214.50 |
$330 |
2.3× |
| CT lower extremity w wo contrast (73702) |
$538.85 |
$829 |
3.4× |
| CT lower extremity with contrast (73701) |
$269.75 |
$415 |
1.7× |
| CT lumbar spine w & w/o contrast (72133) |
$344.50 |
$530 |
2.2× |
| CT lumbar spine w/o contrast (72131) |
$221 |
$340 |
2.3× |
| CT lumbar spine with contrast (72132) |
$559 |
$860 |
1.8× |
| CT maxillofacial w contrast (70487) |
$276.25 |
$425 |
1.7× |
| CT maxillofacial w/o contrast (70486) |
$227.50 |
$350 |
2.4× |
| CT maxillofacial w/wo contrast (70488) |
$512.85 |
$789 |
3.2× |
| CT neck soft tissue w contrast (70491) |
$266.50 |
$410 |
1.7× |
| CT orbit sella/post fossa/ear w/o & w/contr matr (70482) |
$512.85 |
$789 |
3.2× |
| CT orbits w/o contrast (70480) |
$276.25 |
$425 |
2.9× |
| CT pelvis w & w/o contrast (72194) |
$347.75 |
$535 |
2.2× |
| CT pelvis w/o contrast (72192) |
$208 |
$320 |
2.2× |
| CT soft tissue neck w/o & w/contrast material (70492) |
$331.50 |
$510 |
2.1× |
| CT soft tissue neck w/o contrast (70490) |
$214.50 |
$330 |
2.3× |
| CT thoracic spine w/contrast (72129) |
$328.25 |
$505 |
2.1× |
| CT thoracic spine w/o contrast (72128) |
$221 |
$340 |
2.3× |
| CT thoracic spine w/wo contrast (72130) |
$642.20 |
$988 |
4.0× |
| CT thorax w/o contrast (71250) |
$312 |
$480 |
3.3× |
| CT upper extremity w/o & w/contrast material (73202) |
$354.25 |
$545 |
2.2× |
| CT upper extremity w/o contrast rt (73200) |
$214.50 |
$330 |
2.3× |
| CT upper extremity with contrast (73201) |
$477.75 |
$735 |
1.5× |
| Cta Abdl Aorta&Bi Iliofem W/Contrast&Postp (75635) |
$1,135.55 |
$1,747 |
7.1× |
| Cta Abdomen (74175) |
$863.20 |
$1,328 |
5.4× |
| CTA abdomen pelvis (74174) |
$477.75 |
$735 |
1.5× |
| CTA chest (71275) |
$419.25 |
$645 |
2.6× |
| Cta Head (70496) |
$555.75 |
$855 |
3.5× |
| CTA lwr ext w&w/o contrast (73706) |
$422.50 |
$650 |
2.6× |
| Cta Neck (70498) |
$568.75 |
$875 |
3.6× |
| Cta Pelvis (72191) |
$863.20 |
$1,328 |
5.4× |
| Cystography minimum 3 views rs&i (74430) |
$78 |
$120 |
0.2× |
| Dxa bone density study 1/> sites axial skel (77080) |
$78 |
$120 |
0.8× |
| Esophagus (74220) |
$208 |
$320 |
1.3× |
| Fetal biophysical profile non-stress testing (76818) |
$149.50 |
$230 |
1.6× |
| Fetal Biophysical Profile W/O Non-Stress Testing (76819) |
$146.25 |
$225 |
1.5× |
| Fluoroscopy up to 1 hr (76000) |
$126.42 |
$194.50 |
0.6× |
| Foot 2 views (73620) |
$113.75 |
$175 |
1.4× |
| Forearm 2 views (73090) |
$113.75 |
$175 |
1.4× |
| Gated Heart Planar Single (78472) |
$527.80 |
$812 |
1.5× |
| Hand 2 views (73120) |
$97.50 |
$150 |
1.0× |
| Hand 3 views (73130) |
$113.75 |
$175 |
1.4× |
| Ht muscle image spect sing (78451) |
$823.55 |
$1,267 |
0.7× |
| Humerus Min 2 Views Left (73060) |
$113.75 |
$175 |
1.4× |
| Hysterosalpingogram (74740) |
$89.05 |
$137 |
0.4× |
| Kidney imaging morphology (78700) |
$432.25 |
$665 |
1.2× |
| Kidney img morphology vascular flow 1 w/rx (78708) |
$548.60 |
$844 |
1.1× |
| Kidney Img Morphology Vascular Flow Multiple (78709) |
$548.60 |
$844 |
1.1× |
| Knee 3 views (73562) |
$113.75 |
$175 |
1.4× |
| Liver & spleen imaging static only (78215) |
$235.30 |
$362 |
0.6× |
| Lymphoscintigraphy (78195) |
$332.80 |
$512 |
0.7× |
| Manual appl stress pfrmd phys/qhp joint films (77071) |
$113.75 |
$175 |
1.4× |
| Meckels Diverticulum (78290) |
$243.75 |
$375 |
0.7× |
| Mr safety implant&/fb assmt clin staf 1st 15 min (76014) |
$32.50 |
$50 |
1.2× |
| Mr safety implt electronics prepj supvj phys/qhp (76018) |
$120.25 |
$185 |
1.4× |
| MRA head w/o contrast (70544) |
$536.25 |
$825 |
2.5× |
| MRA neck w contrast (70548) |
$863.20 |
$1,328 |
2.7× |
| Mra Neck W/O &W/Contrast Material (70549) |
$841.75 |
$1,295 |
2.6× |
| MRA neck w/o contrast (70547) |
$833.30 |
$1,282 |
3.8× |
| MRI abdomen w contrast (74182) |
$591.50 |
$910 |
1.9× |
| MRI abdomen w/o & w/contrast material (74183) |
$695.50 |
$1,070 |
2.2× |
| MRI abdomen w/o contrast (74181) |
$737.10 |
$1,134 |
3.4× |
| MRI any jnt lwr ext with con lt (73722) |
$991.25 |
$1,525 |
1.4× |
| MRI any jt upper extremity w/contrast matrl (73222) |
$991.25 |
$1,525 |
1.4× |
| MRI breast w/o contrast bilateral (77047) |
$1,547 |
$2,380 |
7.1× |
| MRI breast w/o contrast unilat (77046) |
$1,346.15 |
$2,071 |
6.2× |
| MRI c-spine with contrast (72142) |
$899.60 |
$1,384 |
2.8× |
| MRI cardiac w/o contrast (75557) |
$811.20 |
$1,248 |
3.7× |
| MRI cervical spine w/o contrast (72141) |
$617.50 |
$950 |
2.8× |
| MRI chest w/o & w/contrast material (71552) |
$1,437.80 |
$2,212 |
4.5× |
| MRI chest w/o contrast (71550) |
$840.45 |
$1,293 |
3.9× |
| MRI chest with contrast (71551) |
$991.25 |
$1,525 |
1.4× |
| MRI Forearm w/ Contrast Bilateral 73219 (73219) |
$884.65 |
$1,361 |
2.8× |
| MRI lower extrem oth/thn jt w/contrast matrl (73719) |
$526.50 |
$810 |
1.7× |
| MRI lower extrem oth/thn jt w/o contr matrl (73718) |
$679.25 |
$1,045 |
3.1× |
| MRI orbit face &/neck w/o contrast (70540) |
$811.20 |
$1,248 |
3.7× |
| MRI orbit/face/neck w&w/o cont (70543) |
$685.75 |
$1,055 |
2.2× |
| MRI orbit/face/neck w/contrast (70542) |
$884.65 |
$1,361 |
2.8× |
| MRI pelvis w contrast (72196) |
$884.65 |
$1,361 |
2.8× |
| MRI pelvis w/o & w/contrast material (72197) |
$692.25 |
$1,065 |
2.2× |
| MRI pelvis w/o contrast (72195) |
$679.25 |
$1,045 |
3.1× |
| MRI scan of arm joint before and after contrast (73223) |
$1,327.30 |
$2,042 |
4.2× |
| MRI scan of leg joint before and after contrast (73723) |
$653.25 |
$1,005 |
2.1× |
| MRI spinal canal cervical w/o & w/contr matrl (72156) |
$656.50 |
$1,010 |
2.1× |
| MRI spinal canal lumbar w/contrast material (72149) |
$899.60 |
$1,384 |
2.8× |
| MRI spinal canal lumbar w/o & w/contr matrl (72158) |
$653.25 |
$1,005 |
2.1× |
| MRI spinal canal thoracic w/contrast matrl (72147) |
$474.50 |
$730 |
1.5× |
| MRI spinal canal thoracic w/o & w/contr matrl (72157) |
$607.75 |
$935 |
1.9× |
| MRI thoracic spine w/o contrast (72146) |
$607.75 |
$935 |
2.8× |
| MRI tmj (70336) |
$1,327.30 |
$2,042 |
6.1× |
| MRI upper ext joint w/o contrast (73221) |
$461.50 |
$710 |
2.1× |
| MRI upper extrem other than jt w/o & w/contras (73220) |
$1,349.40 |
$2,076 |
4.2× |
| MRI upper extremity oth than jt w/o contr matrl (73218) |
$494 |
$760 |
2.3× |
| Myelogram Cervical (72240) |
$221.65 |
$341 |
0.3× |
| Myelogram Lumbar (72265) |
$196.30 |
$302 |
0.3× |
| Myelogram thoracic (72255) |
$196.30 |
$302 |
0.3× |
| Neck soft tissue (70360) |
$113.75 |
$175 |
1.4× |
| Nm adrenal scan (78075) |
$402.35 |
$619 |
0.3× |
| Nm cisternogram (78630) |
$386.10 |
$594 |
0.8× |
| Nm csf leak detection (78650) |
$349.05 |
$537 |
0.3× |
| Nm gastric emptying study (78264) |
$434.85 |
$669 |
1.2× |
| Nm gastroesophageal reflux study (78262) |
$442.65 |
$681 |
1.2× |
| Nuclear Rx Oral Admin (79005) |
$297.05 |
$457 |
1.4× |
| Orthopantogram (70355) |
$44.85 |
$69 |
0.6× |
| Osseous survey infant (77076) |
$91 |
$140 |
1.0× |
| Osseous survey limited (77074) |
$139.75 |
$215 |
1.5× |
| Parathyroid imaging (78070) |
$430.95 |
$663 |
1.2× |
| Pelvis 1 or 2 views (72170) |
$136.50 |
$210 |
1.4× |
| Pr MRI, lower extr, w/o contrast f/u by contrast (73720) |
$695.50 |
$1,070 |
2.2× |
| Pulmonary Perfusion Imaging Particulate (78580) |
$280.15 |
$431 |
0.8× |
| Radex abscess/fistula/sinus tract rs&i (76080) |
$98.15 |
$151 |
0.2× |
| Radex Entir Thrc Lmbr Crv Sac Spi W/Skull 1 Vw - Xr Scoliosis 1 Vw (72081) |
$52 |
$80 |
0.7× |
| Radex entir thrc lmbr crv sac spi w/skull 2/3 vw (72082) |
$97.50 |
$150 |
1.0× |
| Radex hips bilateral with pelvis 2 views (73521) |
$136.50 |
$210 |
1.4× |
| Radex mastoids compl minimum 3 views pr side (70130) |
$96.20 |
$148 |
1.0× |
| Radex X-Ray Exam Entire Spi 6/> Vw - Xr Entire Spine 6+ Vw (72084) |
$178.75 |
$275 |
1.9× |
| Radiolog exam mandible compl minimum 4 views (70110) |
$136.50 |
$210 |
1.4× |
| Radiologic Exam Abdomen 1 View - Xr Abdomen 1 View (74018) |
$113.75 |
$175 |
1.4× |
| Radiologic Exam Abdomen 3+ Views - Xr Abdomen 3+ Views (74021) |
$149.50 |
$230 |
1.6× |
| Radiologic Exam Chest 2 Views - Xr Chest 2 Views (71046) |
$113.75 |
$175 |
1.4× |
| Radiologic exam colon single contrast study (74270) |
$208 |
$320 |
1.3× |
| Radiologic Exam Esophagus Double Contrast Study (74221) |
$237.25 |
$365 |
1.5× |
| Radiologic exam upr gi trc double contrast study (74246) |
$208 |
$320 |
1.3× |
| Radiologic exam upr gi trc single contrast study (74240) |
$180.38 |
$277.50 |
1.1× |
| Radiologic Examination Femur Minimum 2 Views - Xr Femur 2+ Vw Lt (73552) |
$113.75 |
$175 |
1.4× |
| Radiological examination surgical specimen (76098) |
$39.65 |
$61 |
0.1× |
| Ribs bilateral 3 views (71110) |
$178.75 |
$275 |
1.9× |
| Rp loclzj tum plnr 2+area 1+d img/1 area img>2+d (78801) |
$345.80 |
$532 |
1.0× |
| Rp loclzj tum plnr whole body single day imaging (78802) |
$426.40 |
$656 |
0.9× |
| Rp loclzj tum spect 1 area single day imaging (78803) |
$795.60 |
$1,224 |
1.6× |
| Rp loclzj tum spect CT 2area 1d img/1 ar img>2+d (78832) |
$1,875.25 |
$2,885 |
1.4× |
| Rp loclzj tum spect w/CT 1 area 1 day imaging (78830) |
$1,654.25 |
$2,545 |
1.4× |
| Rp Therapy Intravenous Administration (79101) |
$227.50 |
$350 |
1.1× |
| Sacroiliac Joints < 3 Views (72200) |
$48.10 |
$74 |
0.5× |
| Scanogram (77073) |
$59.15 |
$91 |
0.6× |
| Scapula complete (73010) |
$136.50 |
$210 |
1.4× |
| Screening digital breast tomosynthesis (77063) |
$39 |
$60 |
1.7× |
| Sella turcica (70240) |
$71.82 |
$110.50 |
0.9× |
| Sialogram (70390) |
$129.35 |
$199 |
0.6× |
| Small bowel series (74250) |
$123.50 |
$190 |
0.8× |
| Spine thoracic 3 views (72072) |
$117 |
$180 |
1.2× |
| Temporomandble Jt Arthrography Rs&I (70332) |
$100.10 |
$154 |
0.5× |
| Therapeutic Enema (74283) |
$147.55 |
$227 |
0.9× |
| Thoracolumbar 2 views (72080) |
$59.15 |
$91 |
0.7× |
| Tmj unilateral (70328) |
$113.75 |
$175 |
1.4× |
| Tomogram (76100) |
$121.55 |
$187 |
1.3× |
| Tumor Imaging Whole Body - Nm Tumor Local Whole Body Mult Days (78804) |
$1,095.25 |
$1,685 |
2.2× |
| Tumor Imaging, Limited Area - Nm Tumor Localization Limited (78800) |
$381.22 |
$586.50 |
1.0× |
| Ultrasound, abdomen limited (76705) |
$133.25 |
$205 |
1.4× |
| Upper Extremity Infant (73092) |
$42.90 |
$66 |
0.5× |
| Ureteral Reflux Study Rp Voiding Cystogram (78740) |
$432.25 |
$665 |
1.2× |
| Urethrocystography retrograde rs&i (74450) |
$110.82 |
$170.50 |
0.5× |
| Urethrocystography voiding (74455) |
$131.30 |
$202 |
0.6× |
| Urography (pyelography), intravenous, with or without KUB, with or without tomography (74400) |
$137.80 |
$212 |
0.9× |
| Us abdl aorta screen aaa (76706) |
$146.25 |
$225 |
1.5× |
| Us breast unilateral complete (76641) |
$136.50 |
$210 |
1.4× |
| Us breast unilateral limited (76642) |
$113.75 |
$175 |
1.4× |
| Us chest (76604) |
$103.02 |
$158.50 |
1.1× |
| Us kidney transplant (76776) |
$156 |
$240 |
1.6× |
| Us ob detailed single fetus (76811) |
$241.80 |
$372 |
1.1× |
| Us ob transvaginal (76817) |
$133.25 |
$205 |
1.4× |
| Us pelvic non ob complete (76856) |
$133.25 |
$205 |
1.4× |
| Us pelvic nonobstetric image dcmtn limited/f/u (76857) |
$134.55 |
$207 |
1.4× |
| Us pregnancy ltd (76815) |
$136.50 |
$210 |
1.4× |
| Us pregnant uterus 14 wk transabdl 1/1st gestat (76801) |
$133.25 |
$205 |
1.4× |
| Us retroperitoneal complete (76770) |
$133.25 |
$205 |
1.4× |
| Us retroperitoneal limited (76775) |
$129.35 |
$199 |
1.4× |
| Us scrotum and contents (76870) |
$133.25 |
$205 |
1.4× |
| Us soft tissue head/neck (76536) |
$133.25 |
$205 |
1.4× |
| Us xtr non-vasc lmtd (76882) |
$136.50 |
$210 |
1.4× |
| Venogram extremity bilateral (75822) |
$864.50 |
$1,330 |
0.6× |
| Venography extremity unilateral rs&i (75820) |
$78 |
$120 |
0.1× |
| Wrist 2 views (73100) |
$113.75 |
$175 |
1.4× |
| X-Ray Abdomen,Comp Acute Series - Xr Abdomen 2 Vws With Chest 1 View (74022) |
$136.50 |
$210 |
1.4× |
| X-Ray Ac Jts - Xr Acromioclavicular Joints Bilateral (73050) |
$102.38 |
$157.50 |
1.3× |
| X-Ray Ankle 3+ Vw - Xr Ankle 3+ Views Right (73610) |
$113.75 |
$175 |
1.4× |
| X-Ray Colon Air Contrast - Fl Barium Enema Air Contrast (74280) |
$211.25 |
$325 |
1.3× |
| X-Ray Elbow 2 Vw - Xr Elbow 1-2 Views Right (73070) |
$113.75 |
$175 |
1.4× |
| X-Ray Elbow 3+ Vw - Xr Elbow 3+ Views Right (73080) |
$113.75 |
$175 |
1.4× |
| X-ray exam entire spi 4/5 vw (72083) |
$178.75 |
$275 |
1.9× |
| X-ray exam hip uni 1 view (73501) |
$92.62 |
$142.50 |
1.2× |
| X-Ray Exam Hip Uni 2-3 Views (73502) |
$89.38 |
$137.50 |
1.1× |
| X-ray exam hip uni 4/> views (73503) |
$91 |
$140 |
1.0× |
| X-Ray Facial Bones 3+ Vw - Xr Facial Bones 3+ Views (70150) |
$136.50 |
$210 |
1.4× |
| X-Ray Facial Bones <3 Vw - Xr Facial Bones 1-2 Views (70140) |
$55.25 |
$85 |
0.7× |
| X-Ray Foot 3+ Vw - Xr Foot 3+ Views Right (73630) |
$113.75 |
$175 |
1.4× |
| X-Ray Heel - Xr Calcaneus 2 Views Right (73650) |
$113.75 |
$175 |
1.4× |
| X-ray IV pyelogram+drip infusn (74410) |
$140.40 |
$216 |
0.9× |
| X-Ray Jaw <4 Vw - Xr Mandible < 4 Views (70100) |
$117 |
$180 |
1.5× |
| X-Ray Knee 4+ View - Xr Knee 4+ Views Right (73564) |
$136.50 |
$210 |
1.4× |
| X-Ray Knee Bilat Standing - Xr Knees Anteroposterior Standing Bilat (73565) |
$92.62 |
$142.50 |
1.2× |
| X-Ray Leg, Infant - Xr Lower Extremity 2+ Views Infant Left (73592) |
$42.90 |
$66 |
0.5× |
| X-Ray Lumbar Spine 2/3 Vw - Xr Lumbar Spine 2-3 Views (72100) |
$136.50 |
$210 |
1.4× |
| X-Ray Lumbar Spine 6+ Vw - Xr Lumbar Spine 6+ Vws Including Bending (72114) |
$136.50 |
$210 |
1.4× |
| X-Ray Nasal Bones - Xr Nasal Bones (70160) |
$113.75 |
$175 |
1.4× |
| X-Ray Nose-Rectum Child F.B. - Xr Nose to Rectum Foreign Body Peds (76010) |
$48.10 |
$74 |
0.6× |
| X-Ray Orbits - Xr Orbits Complete 4+ Views (70200) |
$103.35 |
$159 |
1.1× |
| X-Ray Pelvis 3+ Vw - Xr Pelvis 3+ Views (72190) |
$159.25 |
$245 |
1.7× |
| X-Ray Retrograde Pyelogram - Fl Pyelogram Retrograde (74420) |
$191.75 |
$295 |
0.6× |
| X-Ray Ribs 2 Vw Unilat - Xr Ribs 2 Views Right (71100) |
$113.75 |
$175 |
1.4× |
| X-Ray Ribs, Chest 3+ Vw - Xr Ribs 2 Vws Lt W/ Chest Anteroposterior (71101) |
$136.50 |
$210 |
1.4× |
| X-Ray Ribs, Chest 4+ Vw - Xr Ribs 3 Vws Bil W/ Chest Posteroanterior (71111) |
$97.50 |
$150 |
1.0× |
| X-Ray Sacroiliac Jts 3+ Vw - Xr Sacroiliac Joints 3+ Views (72202) |
$136.50 |
$210 |
1.4× |
| X-Ray Sacrum/Coccyx 2+ Vw - Xr Sacrum Coccyx 2+ Views (72220) |
$113.75 |
$175 |
1.4× |
| X-Ray Shoulder 2+ Vw - Xr Shoulder 2+ Views Right (73030) |
$113.75 |
$175 |
1.4× |
| X-Ray Sinuses 3+ Vw - Xr Paranasal Sinuses 3+ Views (70220) |
$113.75 |
$175 |
1.4× |
| X-Ray Sinuses <3 Vw - Xr Paranasal Sinuses 1-2 Views (70210) |
$82.55 |
$127 |
1.0× |
| X-Ray Skull 4+ Vw - Xr Skull Complete 4+ Views (70260) |
$117 |
$180 |
1.2× |
| X-Ray Skull <4 Vw - Xr Skull 1-3 Views (70250) |
$136.50 |
$210 |
1.4× |
| X-Ray Spine One View - Xr Spine (72020) |
$113.75 |
$175 |
1.4× |
| X-Ray Sterno-Clavicluar Jt - Xr Sternoclavicular Joints 3+ Views (71130) |
$82.88 |
$127.50 |
1.0× |
| X-Ray Sternum 2+ Vw - Xr Sternum 2+ Views (71120) |
$113.75 |
$175 |
1.4× |
| X-Ray Thoracic Spine 2 Vw - Xr Thoracic Spine 2 Views (72070) |
$136.50 |
$210 |
1.4× |
| X-Ray Thoracic Spine 4 Vw - Xr Thoracic Spine Complete 4+ Views (72074) |
$66.95 |
$103 |
0.7× |
| X-Ray Toe(S) - Xr Toes 2+ Views Right (73660) |
$113.75 |
$175 |
1.4× |
| X-Ray Wrist 3+ Vw - Xr Wrist 3+ Views Right (73110) |
$113.75 |
$175 |
1.4× |
| Xr arthrogram ankle (73615) |
$122.20 |
$188 |
0.4× |
| Xr c-spine 6 or more views (72052) |
$136.50 |
$210 |
1.4× |
| Xr chest 4+ views (71048) |
$149.50 |
$230 |
1.6× |
| Xr Cholecystography Oral Contrast (74290) |
$53.95 |
$83 |
0.3× |
| Xr finger(s) 2+ views (73140) |
$113.75 |
$175 |
1.4× |
| Xr shoulder 1 view (73020) |
$113.75 |
$175 |
1.4× |
| Xr spine cervical 4 or 5 views (72050) |
$136.50 |
$210 |
1.4× |
| Xr tibia/fibula 2 views (73590) |
$108.88 |
$167.50 |
1.4× |
| Xr tmj bilateral (70330) |
$113.75 |
$175 |
1.4× |
| Xray knee 1 or 2 views rt (73560) |
$65 |
$100 |
0.8× |