| Abdomen 1 View (74018) |
$60.20 |
$140 |
0.8× |
| Abdomen 2 views (74019) |
$111.80 |
$260 |
1.2× |
| Ankle 2 views (73600) |
$60.20 |
$140 |
0.8× |
| Bone age studies (77072) |
$111.80 |
$260 |
1.2× |
| Chest 1 view (71045) |
$60.20 |
$140 |
0.8× |
| Chest 2 views (71046) |
$60.20 |
$140 |
0.8× |
| Chest 3 views (71047) |
$60.20 |
$140 |
0.8× |
| Cholecystography Oral Contrast (74290) |
$245.10 |
$570 |
1.5× |
| Clavicle complete (73000) |
$60.20 |
$140 |
0.8× |
| Contrast X-Ray Bladder (74430) |
$245.10 |
$570 |
0.8× |
| Esophagram (74220) |
$245.10 |
$570 |
1.5× |
| Fluoroscopy up to 1 hr (76000) |
$225.75 |
$525 |
1.0× |
| Foot 2 views (73620) |
$60.20 |
$140 |
0.8× |
| Forearm 2 views (73090) |
$60.20 |
$140 |
0.8× |
Hand 2 views (73120) range across 4 matching MRF lines |
$60.20–$111.80 |
$140–$260 |
varies |
Joint Survey Single View (77077) range across 3 matching MRF lines |
$111.80 |
$100–$260 |
1.2× |
| Knee 3 Views (73562) |
$60.20 |
$140 |
0.8× |
| Myelogram cervical (72240) |
$660.05 |
$1,535 |
0.9× |
| Myelogram Lumbar (72265) |
$660.05 |
$1,535 |
0.9× |
| Myelography thoracic (72255) |
$660.05 |
$1,535 |
0.9× |
| Neck soft tissue (70360) |
$60.20 |
$140 |
0.8× |
| Nonvascular Shunt X-Ray (75809) |
$111.80 |
$260 |
1.2× |
| Optic foramina (70190) |
$60.20 |
$140 |
0.8× |
| Pelvis 1 or 2 views (72170) |
$111.80 |
$260 |
1.2× |
| Radex Abd Compl Aqt Abd W/S/E/D Views 1 View Ch (74022) |
$111.80 |
$260 |
1.2× |
| Radex abscess/fistula/sinus tract rs&i (76080) |
$225.75 |
$525 |
0.5× |
| Radex Ankle Complete Minimum 3 Views (73610) |
$60.20 |
$140 |
0.8× |
| Radex Calcaneus Minimum 2 Views (73650) |
$60.20 |
$140 |
0.8× |
| Radex elbow complete minimum 3 views (73080) |
$60.20 |
$140 |
0.8× |
| Radex Facial Bones Complete Minimum 3 Views (70150) |
$111.80 |
$260 |
1.2× |
| Radex fingr minimum 2 views (73140) |
$60.20 |
$140 |
0.8× |
| Radex foot complete minimum 3 views (73630) |
$60.20 |
$140 |
0.8× |
Radex Hand Minimum 3 Views (73130) range across 4 matching MRF lines |
$60.20–$111.80 |
$140–$260 |
varies |
| Radex Nasal Bones Complete Minimum 3 Views (70160) |
$60.20 |
$140 |
0.8× |
| Radex Ribs Unilateral 2 Views (71100) |
$60.20 |
$140 |
0.8× |
| Radex shoulder complete minimum 2 views (73030) |
$60.20 |
$140 |
0.8× |
| Radex Sinuses Paransl < 3 Views (70210) |
$60.20 |
$140 |
0.8× |
| Radex Spine 1 View Specify Level (72020) |
$60.20 |
$140 |
0.8× |
| Radex Sternum Minimum 2 Views (71120) |
$60.20 |
$140 |
0.8× |
| Radex Temporomandble Jt Opn & Clsd Mouth Bilat (70330) |
$60.20 |
$140 |
0.8× |
| Radex Toe Minimum 2 Views (73660) |
$60.20 |
$140 |
0.8× |
| Radex Wrist Complete Minimum 3 Views (73110) |
$60.20 |
$140 |
0.8× |
| Radiolog exam mandible compl minimum 4 views (70110) |
$111.80 |
$260 |
1.2× |
| Radiologic exam colon double contrast study (74280) |
$245.10 |
$570 |
1.5× |
| Radiologic exam colon single contrast study (74270) |
$245.10 |
$570 |
1.5× |
| Radiologic exam pelvis compl minimum 3 views (72190) |
$111.80 |
$260 |
1.2× |
| Radiologic Exam Small Int Single Contrast Study (74250) |
$111.80 |
$260 |
0.7× |
| Radiologic exam swallow function contrast study (74230) |
$111.80 |
$260 |
0.7× |
| Radiologic examination femur minimum 2 views (73552) |
$60.20 |
$140 |
0.8× |
| Radiologic examination knee 1/2 views (73560) |
$60.20 |
$140 |
0.8× |
| Radiologic Examination Osseous Survey Limited (77074) |
$111.80 |
$260 |
1.2× |
| Radiologic examination tibia & fibula 2 views (73590) |
$60.20 |
$140 |
0.8× |
| Radiologic examination, internal auditory meati, complete Non-Facility (70134) |
$225.75 |
$525 |
0.5× |
| Ribs bilateral 3 views (71110) |
$111.80 |
$260 |
1.2× |
| Scapula (73010) |
$111.80 |
$260 |
1.2× |
| Shoulder 1 view (73020) |
$60.20 |
$140 |
0.8× |
| Sternoclavicular joints (71130) |
$60.20 |
$140 |
0.8× |
| Thoracic spine 2 views (72070) |
$111.80 |
$260 |
1.2× |
| Thoracic spine 3 views (72072) |
$111.80 |
$260 |
1.2× |
| Thoracolumbar 2 views (72080) |
$60.20 |
$140 |
0.8× |
| Ultrasound Exam Aaa Screen (76706) |
$111.80 |
$260 |
1.2× |
| Ultrasound, abdomen limited (76705) |
$111.80 |
$260 |
1.2× |
| Upper gi w/o kub (74240) |
— |
$570 |
— |
| Urethrocystogram voiding (74455) |
$225.75 |
$525 |
1.0× |
| Urethrocystography retrograde (74450) |
$225.75 |
$525 |
1.0× |
| Us chest (76604) |
$111.80 |
$260 |
1.2× |
| Us exam, pelvic, limited (76857) |
$111.80 |
$260 |
1.2× |
| Us lmtd joint/oth nonvasc xtr strux r-t w/img (76882) |
$111.80 |
$260 |
1.2× |
| Us pelvic non ob complete (76856) |
$111.80 |
$260 |
1.2× |
| Us retroperitoneal complete (76770) |
$111.80 |
$260 |
1.2× |
| Us retroperitoneal limited (76775) |
$111.80 |
$260 |
1.2× |
| Us scrotum and contents (76870) |
$111.80 |
$260 |
1.2× |
| Us thyroid (76536) |
$111.80 |
$260 |
1.2× |
| Us transrectal (76872) |
$111.80 |
$260 |
1.2× |
| Wrist 2 views (73100) |
$60.20 |
$140 |
0.8× |
| X-Ray Ac Jts - Xr Acromioclavicular Joints Bilateral (73050) |
$60.20 |
$140 |
0.8× |
| X-ray antegrade pyelogram tube (74425) |
$245.10 |
$570 |
0.8× |
| X-Ray Elbow 2 Vw - Xr Elbow 1-2 Views Right (73070) |
$60.20 |
$140 |
0.8× |
| X-Ray Exam Hip Uni 1 View (73501) |
$60.20 |
$140 |
0.8× |
| X-Ray Exam Hip Uni 2-3 Views (73502) |
$60.20 |
$140 |
0.8× |
| X-Ray Exam Hips Bi 2 Views (73521) |
$111.80 |
$260 |
1.2× |
| X-Ray Exam Hips Bi 3-4 Views (73522) |
$60.20 |
$140 |
0.6× |
| X-Ray Exam L-S Spine Bending (72114) |
$111.80 |
$260 |
1.2× |
| X-Ray Exam Neck Spine 2-3 Vw (72040) |
$60.20 |
$140 |
0.8× |
| X-Ray Exam Neck Spine 6/>Vws (72052) |
$111.80 |
$260 |
1.2× |
| X-Ray Exam Unilat Ribs/Chest (71101) |
$111.80 |
$260 |
1.2× |
| X-ray humerus (73060) |
$60.20 |
$140 |
0.8× |
| X-Ray Jaw <4 Vw - Xr Mandible < 4 Views (70100) |
$60.20 |
$140 |
0.8× |
| X-Ray Knee Bilat Standing - Xr Knees Anteroposterior Standing Bilat (73565) |
$60.20 |
$140 |
0.8× |
| X-Ray Lumbar Spine 2/3 Vw - Xr Lumbar Spine 2-3 Views (72100) |
$111.80 |
$260 |
1.2× |
| X-Ray Ribs, Chest 4+ Vw - Xr Ribs 3 Vws Bil W/ Chest Posteroanterior (71111) |
$111.80 |
$260 |
1.2× |
| X-Ray Sacroiliac Jts 3+ Vw - Xr Sacroiliac Joints 3+ Views (72202) |
$111.80 |
$260 |
1.2× |
| X-Ray Sacroiliac Jts <3 Vw - Xr Sacroiliac Joints 1-2 Views (72200) |
$111.80 |
$260 |
1.2× |
| X-Ray Sacrum/Coccyx 2+ Vw - Xr Sacrum Coccyx 2+ Views (72220) |
$60.20 |
$140 |
0.8× |
| X-Ray Sinuses 3+ Vw - Xr Paranasal Sinuses 3+ Views (70220) |
$60.20 |
$140 |
0.8× |
| X-Ray Skull 4+ Vw - Xr Skull Complete 4+ Views (70260) |
$111.80 |
$260 |
1.2× |
| X-Ray Stress View (77071) |
$60.20 |
$140 |
0.8× |
| X-ray thoracic spine 4 vw (72074) |
$111.80 |
$260 |
1.2× |
| X-Ray Tmj Unilat (70328) |
$60.20 |
$140 |
0.8× |
| X-Rays Bone Length Studies (77073) |
$111.80 |
$260 |
1.2× |
| Xr c-spine 4 or 5 views (72050) |
$111.80 |
$260 |
1.2× |
| Xr facial bones less than 3 views (70140) |
$60.20 |
$140 |
0.8× |
| Xr orbits complete 4 views (70200) |
$111.80 |
$260 |
1.2× |