Imaging prices at Reston Hospital Center
Reston, VA · every code in this section with a posted price and a Medicare benchmark.
293 codes. Prices are the hospital's own posted facility charges.
Compare against other hospitals interactively →
| Procedure | Cash price | Gross charge | × Medicare |
|---|---|---|---|
| 3-D radiotherapy plan dose-volume histograms (77295) | $13,037.96 | $13,037.96 | 8.9× |
| Abdomen 2 views (74019) | $1,187.95 | $1,187.95 | 10.7× |
| Acute gi blood loss imaging (78278) | $2,020.22 | $2,020.22 | 4.8× |
| Angio Adrenal Bilat Select (75733) | $7,648.56 | $7,648.56 | 2.3× |
| Angiography extremity bilateral rs&i (75716) | $9,962.41 | $9,962.41 | 3.0× |
| Angiography extremity unilateral rs&i (75710) | $9,962.41 | $9,962.41 | 3.0× |
| Angiography pelvic slctv/supraslctv rs&i (75736) | $9,962.41 | $9,962.41 | 1.7× |
| Angiography pulmonary bilateral slctv rs&i (75743) | $9,962.41 | $9,962.41 | 3.0× |
| Angiography pulmonary unilateral slctv rs&i (75741) | $9,962.41 | $9,962.41 | 3.0× |
| Angiography Spinal Selective Rs&I (75705) | $9,962.41 | $9,962.41 | 1.7× |
| Angiography visceral slctv/supraslctv rs&i (75726) | $9,962.41 | $9,962.41 | 1.7× |
| Angrph Cath F-Up Std Tcat Other Than Thrombylsis (75898) | $2,264.60 | $2,264.60 | 0.7× |
| Angrph pulmonary nonslctv cath/ven njx rs&i (75746) | $6,798.60 | $6,798.60 | 2.0× |
| Ankle 2 views (73600) | $834.96 | $834.96 | 9.1× |
| Aortogram thoracic (75605) | $9,962.41 | $9,962.41 | 1.7× |
| Aortography abdl bi iliofem low extrem cath rs&i (75630) | $10,323.50 | $10,323.50 | 3.1× |
| Aortography abdominal serialography rs&i (75625) | $9,824.04 | $9,824.04 | 2.9× |
| Artery X-Rays Adrenal Gland (75731) | $6,798.60 | $6,798.60 | 2.0× |
| Arthrogram hip (73525) | $3,250.83 | $3,250.83 | 8.8× |
| Arthrogram shoulder (73040) | $1,992.70 | $1,992.70 | 5.4× |
| Arthrogram wrist (73115) | $1,892.13 | $1,892.13 | 5.1× |
| Basic dosimetry (77300) | $1,299.87 | $1,299.87 | 9.1× |
| Bone &/joint imaging whole body (78306) | $4,013.79 | $4,013.79 | 9.5× |
| Bone age studies (77072) | $582.95 | $582.95 | 5.3× |
| Bone Imaging 3 Phase (78315) | $3,602.81 | $3,602.81 | 8.5× |
| Bone survey complete (77075) | $1,770.90 | $1,770.90 | 16.0× |
| Bowel imaging (78290) | $2,955.42 | $2,955.42 | 7.0× |
| Brachytx isodose pln smpl w/dosimetry cal (77316) | $1,437.04 | $1,437.04 | 3.6× |
| Brain Imaging Min 4 Static Views W Vascular Flow (78606) | $1,558.67 | $1,558.67 | 2.7× |
| Cervical spine 2 or 3 views (72040) | $1,085.10 | $1,085.10 | 11.8× |
| Chest 1 view (71045) | $972.07 | $972.07 | 10.6× |
| Chest xray 3 views (71047) | $1,152.34 | $1,152.34 | 12.5× |
| Cine/Vid X-Ray Throat/Esoph - Fl Esoph Barium Swlw W/ Video & Speech (74230) | $1,023.76 | $1,023.76 | 5.5× |
| Clavicle complete (73000) | $731.35 | $731.35 | 7.9× |
| Computed Tomography Thorax Lw Dose Lng Ca Scr C- (71271) | $442.48 | $442.48 | 4.0× |
| Continuing medical physics consltj pr wk (77336) | $2,197.26 | $2,197.26 | 15.4× |
| Contrast Xray Throat/Cerv Esopha (74210) | $741.65 | $741.65 | 4.0× |
| CT abdomen and pelvis without and with contrast (74178) | $10,631.69 | $10,631.69 | 28.8× |
| CT abdomen and pelvis without contrast (74176) | $7,918.94 | $7,918.94 | 31.4× |
| CT abdomen w contrast (74160) | $4,787.94 | $4,787.94 | 25.8× |
| CT abdomen w wo contrast (74170) | $6,169.67 | $6,169.67 | 33.2× |
| CT abdomen w/o contrast (74150) | $4,108.10 | $4,108.10 | 37.1× |
| CT angio hrt w/3d image (75574) | $4,385.21 | $4,385.21 | 11.9× |
| CT angio lwr extr w/o&w/dye (73706) | $3,834.13 | $3,834.13 | 20.7× |
| CT angiography upper extremity lt (73206) | $3,869.31 | $3,869.31 | 20.8× |
| CT c-spine w/contrast (72126) | $5,587.89 | $5,587.89 | 15.1× |
| CT c-spine w/o contrast (72125) | $4,552.76 | $4,552.76 | 41.1× |
| CT cervical spine w&w/o contrast (72127) | $6,829.68 | $6,829.68 | 36.8× |
| CT chest w contrast (71260) | $4,624.16 | $4,624.16 | 24.9× |
| CT chest w/wo contrast (71270) | $6,172.34 | $6,172.34 | 33.2× |
| CT colonography w/dye (74262) | $3,914.29 | $3,914.29 | 21.1× |
| CT colonography w/o cntrst (74261) | $3,431.98 | $3,431.98 | 31.0× |
| CT head/brain with contrast (70460) | $3,978.20 | $3,978.20 | 21.4× |
| CT head/brain without and with contrast (70470) | $4,815.82 | $4,815.82 | 25.9× |
| CT heart contrast eval cardiac structure&morph (75572) | $1,728.30 | $1,728.30 | 4.7× |
| CT heart w/o contrast quant eval coronary calcium (75571) | $1,571.08 | $1,571.08 | 17.1× |
| CT iac w contrast (70481) | $4,459.18 | $4,459.18 | 24.0× |
| CT limited/localized follow up study (76380) | $2,740.54 | $2,740.54 | 29.8× |
| CT lower ext w/o (73700) | $4,592.13 | $4,592.13 | 41.5× |
| CT lower extremity w wo contrast (73702) | $7,620.96 | $7,620.96 | 41.1× |
| CT lower extremity w/contrast material (73701) | $6,241.69 | $6,241.69 | 33.6× |
| CT lumbar spine w & w/o contrast (72133) | $7,799.86 | $7,799.86 | 42.0× |
| CT lumbar spine w/contrast (72132) | $6,964.60 | $6,964.60 | 18.9× |
| CT lumbar spine w/o contrast (72131) | $6,184.94 | $6,184.94 | 55.9× |
| CT maxillofacial w contrast (70487) | $5,317.06 | $5,317.06 | 28.6× |
| CT maxillofacial w/wo contrast (70488) | $5,878.25 | $5,878.25 | 31.7× |
| CT maxillofacial wo contrast (70486) | $4,223.03 | $4,223.03 | 38.2× |
| CT orbit sella/post fossa/ear w/o & w/contr matr (70482) | $5,341.52 | $5,341.52 | 28.8× |
| CT orbits w/o contrast (70480) | $3,510.10 | $3,510.10 | 31.7× |
| CT pelvis w/o contrast (72192) | $4,304.22 | $4,304.22 | 38.9× |
| CT pelvis w/wo contrast (72194) | $6,356.50 | $6,356.50 | 34.2× |
| CT scan of arm combo (73202) | $6,427.26 | $6,427.26 | 34.6× |
| CT soft tissue neck w contrast (70491) | $4,613.91 | $4,613.91 | 24.9× |
| CT soft tissue neck w/o & w/contrast material (70492) | $5,482.72 | $5,482.72 | 29.5× |
| CT soft tissue neck w/o contrast (70490) | $3,508.98 | $3,508.98 | 31.7× |
| CT thoracic spine w/contrast (72129) | $6,964.60 | $6,964.60 | 37.5× |
| CT thoracic spine w/o contrast (72128) | $6,184.94 | $6,184.94 | 55.9× |
| CT thoracic spine w/wo contrast (72130) | $7,799.86 | $7,799.86 | 42.0× |
| CT thorax w/o contrast (71250) | $3,576.71 | $3,576.71 | 32.3× |
| CT upper ext wo (73200) | $4,104.64 | $4,104.64 | 37.1× |
| CT upper extremity with contrast (73201) | $6,427.26 | $6,427.26 | 17.4× |
| Cta Aa&Bi Iliofem Lxtr Rs&I C-/C+ Post-Pxessing (75635) | $4,322.76 | $4,322.76 | 23.3× |
| Cta Abdomen (74175) | $4,362.79 | $4,362.79 | 23.5× |
| CTA abdomen pelvis (74174) | $7,622.14 | $7,622.14 | 20.6× |
| CTA chest (71275) | $6,094.03 | $6,094.03 | 32.8× |
| Cta Head (70496) | $3,557.27 | $3,557.27 | 19.2× |
| Cta Neck (70498) | $3,697.93 | $3,697.93 | 19.9× |
| Cta Pelvis (72191) | $4,362.79 | $4,362.79 | 23.5× |
| Cystography minimum 3 views rs&i (74430) | $2,388.75 | $2,388.75 | 6.5× |
| Diskogram cervical (72285) | $7,245.62 | $7,245.62 | 3.5× |
| Diskography lumbar (72295) | $6,827.97 | $6,827.97 | 3.3× |
| Dxa bone density study 1/> sites axial skel (77080) | $1,587.99 | $1,587.99 | 14.4× |
| Esophagus (74220) | $954.11 | $954.11 | 5.1× |
| Facial bones min 3 views (70150) | $1,746.30 | $1,746.30 | 15.8× |
| Fetal biophysical profile non-stress testing (76818) | $1,863.44 | $1,863.44 | 16.8× |
| Fetal Biophysical Profile W/O Non-Stress Testing (76819) | $617.64 | $617.64 | 5.6× |
| Fluoroscopy up to 1 hr (76000) | $1,181.26 | $1,181.26 | 4.7× |
| Foot 2 views (73620) | $828.53 | $828.53 | 9.0× |
| Forearm 2 views (73090) | $1,135.65 | $1,135.65 | 12.3× |
| Hand 2 views (73120) | $731.35 | $731.35 | 6.6× |
| Hdr rdncl ntrstl/intrcav brachytx 1 channel (77770) | $993.52 | $993.52 | 1.3× |
| Hepatc Vngrph Wdg/Fr Hemodyn Eval Rs&I (75889) | $8,676.01 | $8,676.01 | 2.6× |
| Hepatc vngrph wdg/fr w/o hemodyn eval rs&i (75891) | $6,559.92 | $6,559.92 | 2.0× |
| Hepatobil Syst Imag Inc Gb W/Pharma Intervenj (78227) | $3,447.34 | $3,447.34 | 6.0× |
| Hepatobiliary syst imaging including gallbladder (78226) | $3,447.34 | $3,447.34 | 8.1× |
| Hysterosalpingogram (74740) | $2,489.26 | $2,489.26 | 9.9× |
| Kidney Img Morphology Vascular Flow 1 W/O Rx (78707) | $3,482.91 | $3,482.91 | 6.1× |
| Kidney img morphology vascular flow 1 w/rx (78708) | $5,955.96 | $5,955.96 | 10.4× |
| Knee 3 views (73562) | $1,004.60 | $1,004.60 | 10.9× |
| Lung perfusion differential (78597) | $2,928.63 | $2,928.63 | 6.9× |
| Lymphangiography Pelvic/Abdominal Unilat Rs&I (75805) | $4,896.53 | $4,896.53 | 1.5× |
| Lymphoscintigraphy (78195) | $1,938.18 | $1,938.18 | 3.4× |
| Magnetic resonance (eg, proton) imaging, any joint of upper extremity; with contrast material(s) Non-Facility (73222) | $6,887.48 | $6,887.48 | 8.3× |
| Magnetic resonance (eg, proton) imaging, upper extremity, other than joint; without contrast material(s), followed by… (73220) | $7,226.87 | $7,226.87 | 19.6× |
| Mlc imrt design & construction per imrt plan (77338) | $11,824.20 | $11,824.20 | 29.8× |
| Mr safety implant&/fb assmt clin staf 1st 15 min (76014) | $64.80 | $64.80 | 2.1× |
| MRA head w & w/o contrast (70546) | $10,397.18 | $10,397.18 | 28.2× |
| MRA head w/o contrast (70544) | $6,060.46 | $6,060.46 | 24.0× |
| MRA neck w contrast (70548) | $6,641.55 | $6,641.55 | 18.0× |
| Mra Neck W/O &W/Contrast Material (70549) | $10,208.14 | $10,208.14 | 27.6× |
| MRA neck w/o contrast (70547) | $6,010.88 | $6,010.88 | 23.8× |
| MRI abdomen w contrast (74182) | $11,438.24 | $11,438.24 | 31.0× |
| MRI abdomen w/o & w/contrast material (74183) | $11,120.51 | $11,120.51 | 30.1× |
| MRI abdomen w/o contrast (74181) | $10,439.49 | $10,439.49 | 41.3× |
| MRI any jt lower extrem w/contrast material (73722) | $9,434.40 | $9,434.40 | 11.4× |
| MRI any jt lower extrem w/o & w/contrast matrl (73723) | $11,091.32 | $11,091.32 | 30.0× |
| MRI c-spine with contrast (72142) | $7,495.26 | $7,495.26 | 20.3× |
| MRI cervical spine w/o contrast (72141) | $7,240.78 | $7,240.78 | 28.7× |
| MRI chest w/o & w/contrast material (71552) | $11,344.44 | $11,344.44 | 30.7× |
| MRI chest w/o contrast (71550) | $6,898.37 | $6,898.37 | 27.3× |
| MRI lower extrem oth/thn jt w/o & w/contr matr (73720) | $9,998.36 | $9,998.36 | 27.1× |
| MRI lower extrem oth/thn jt w/o contr matrl (73718) | $8,415.80 | $8,415.80 | 33.3× |
| MRI orbit face &/neck w/o contrast (70540) | $7,015.03 | $7,015.03 | 27.8× |
| MRI orbit face neck w contrast (70542) | $7,226.87 | $7,226.87 | 19.6× |
| MRI orbit/face/neck w&w/o cont (70543) | $11,408.21 | $11,408.21 | 30.9× |
| MRI pelvis w/o & w/contrast material (72197) | $11,650.06 | $11,650.06 | 31.5× |
| MRI pelvis w/o contrast (72195) | $6,374.02 | $6,374.02 | 25.2× |
| MRI spinal canal cervical w/o & w/contr matrl (72156) | $11,566.72 | $11,566.72 | 31.3× |
| MRI spinal canal lumbar w/contrast material (72149) | $7,495.26 | $7,495.26 | 20.3× |
| MRI spinal canal lumbar w/o & w/contr matrl (72158) | $11,566.72 | $11,566.72 | 31.3× |
| MRI spinal canal thoracic w/contrast matrl (72147) | $7,495.26 | $7,495.26 | 20.3× |
| MRI spinal canal thoracic w/o & w/contr matrl (72157) | $11,566.72 | $11,566.72 | 31.3× |
| MRI temporomandibular joint (70336) | $6,898.37 | $6,898.37 | 27.3× |
| MRI thoracic spine w/o contrast (72146) | $7,240.78 | $7,240.78 | 28.7× |
| MRI up ext w/o contrast (73218) | $6,379.54 | $6,379.54 | 25.3× |
| MRI upper ext joint w/o contrast (73221) | $7,062.62 | $7,062.62 | 28.0× |
| MRI, joint upper extrem combo (73223) | $11,408.21 | $11,408.21 | 30.9× |
| Myocardial Spect Multiple Studies (78452) | $7,629.58 | $7,629.58 | 5.6× |
| Myocardial spect single study at rest or stress (78451) | $5,516.85 | $5,516.85 | 4.0× |
| Neck soft tissue (70360) | $853.76 | $853.76 | 9.3× |
| Nm cisternogram (78630) | $2,271.27 | $2,271.27 | 4.0× |
| Nm gastric emptying study (78264) | $3,269.35 | $3,269.35 | 7.7× |
| Nm red cell sequestration (78140) | $1,662.65 | $1,662.65 | 3.9× |
| Ntsty modul radthx pln dose-vol histos (77301) | $12,828.84 | $12,828.84 | 8.8× |
| Parathyrd planar w/spect&CT (78072) | $4,892.21 | $4,892.21 | 8.5× |
| Parathyroid Planar Imaging (78070) | $2,601.55 | $2,601.55 | 6.1× |
| Pelvis 1 or 2 views (72170) | $1,144.65 | $1,144.65 | 10.3× |
| Prq Transhepatc Portograpy Hemodyn Eval Rs&I (75885) | $4,620 | $4,620 | 1.4× |
| Prq transhepatc portograpy w/o hemodyn evl intrp (75887) | $8,836.67 | $8,836.67 | 2.6× |
| Pulmonary Perfusion Imaging Particulate (78580) | $2,948.94 | $2,948.94 | 7.0× |
| Pulmonary Ventilation & Perfusion Imaging (78582) | $8,142.21 | $8,142.21 | 14.2× |
| Radex abscess/fistula/sinus tract rs&i (76080) | $2,264.60 | $2,264.60 | 3.9× |
| Radex Ankle Compl Minimum 3 Views (73610) | $1,135.65 | $1,135.65 | 12.3× |
| Radex Calcaneus Minimum 2 Views (73650) | $789.38 | $789.38 | 8.6× |
| Radex Elbw Compl Minimum 3 Views (73080) | $967.55 | $967.55 | 10.5× |
| Radex Entir Thrc Lmbr Crv Sac Spi W/Skull 1 Vw - Xr Scoliosis 1 Vw (72081) | $625.94 | $625.94 | 6.8× |
| Radex entir thrc lmbr crv sac spi w/skull 2/3 vw (72082) | $755.60 | $755.60 | 6.8× |
| Radex fingr minimum 2 views (73140) | $654.10 | $654.10 | 7.1× |
| Radex Foot Compl Minimum 3 Views (73630) | $1,114.82 | $1,114.82 | 12.1× |
| Radex Hand Minimum 3 Views (73130) | $852.21 | $852.21 | 9.3× |
| Radex Hip Unilateral With Pelvis 1 View (73501) | $933.46 | $933.46 | 10.1× |
| Radex Hip Unilateral With Pelvis Minimum 4 Views (73503) | $1,079.95 | $1,079.95 | 9.8× |
| Radex Hips Bilateral With Pelvis 2 Views (73521) | $1,079.95 | $1,079.95 | 9.8× |
| Radex Humerus Minimum 2 Views (73060) | $566.76 | $566.76 | 6.2× |
| Radex Kne 1/2 Views (73560) | $924.70 | $924.70 | 10.0× |
| Radex Kne Compl 4/More Views (73564) | $1,650.10 | $1,650.10 | 14.9× |
| Radex Mndbl Compl Minimum 4 Views (70110) | $1,676.40 | $1,676.40 | 15.1× |
| Radex Nasal Bones Complete Minimum 3 Views (70160) | $967.51 | $967.51 | 10.5× |
| Radex Pelvis Compl Minimum 3 Views (72190) | $1,162.81 | $1,162.81 | 10.5× |
| Radex Sho Compl Minimum 2 Views (73030) | $1,258.14 | $1,258.14 | 13.7× |
| Radex Sinuses Paransl < 3 Views (70210) | $1,078.13 | $1,078.13 | 11.7× |
| Radex Spine Lumbosacral Only Bending 2/3 Views (72120) | $617.24 | $617.24 | 5.6× |
| Radex Temporomandble Jt Opn & Clsd Mouth Bilat (70330) | $1,475.52 | $1,475.52 | 16.0× |
| Radex Toe Minimum 2 Views (73660) | $669.32 | $669.32 | 7.3× |
| Radex upper extremity infant minimum 2 views (73092) | $844.90 | $844.90 | 7.6× |
| Radex Wrst Compl Minimum 3 Views (73110) | $774.69 | $774.69 | 8.4× |
| Radex X-Ray Exam Entire Spi 6/> Vw - Xr Entire Spine 6+ Vw (72084) | $1,132.61 | $1,132.61 | 10.2× |
| Radiation Delivery Stereotactic Cranial Linear (77372) | $15,552.79 | $15,552.79 | 2.0× |
| Radiation treatment delivery level 1 (77402) | $1,102.19 | $1,102.19 | 10.2× |
| Radiation treatment delivery level 3 (77412) | $2,371.04 | $2,371.04 | 4.1× |
| Radiologic Exam Abdomen 1 View - Xr Abdomen 1 View (74018) | $1,081.06 | $1,081.06 | 11.7× |
| Radiologic exam chest 2 views (71046) | $1,065.86 | $1,065.86 | 11.6× |
| Radiologic exam colon single contrast study (74270) | $1,260.20 | $1,260.20 | 6.8× |
| Radiologic exam upr gi trc double contrast study (74246) | $1,599.24 | $1,599.24 | 8.6× |
| Radiologic exam upr gi trc single contrast study (74240) | $1,327.58 | $1,327.58 | 7.2× |
| Radiologic examination femur 1 view (73551) | $768.09 | $768.09 | 8.3× |
| Radiologic examination tibia & fibula 2 views (73590) | $1,489.06 | $1,489.06 | 16.2× |
| Radiological examination surgical specimen (76098) | $923.36 | $923.36 | 1.6× |
| Ribs bilateral 3 views (71110) | $1,138.85 | $1,138.85 | 10.3× |
| Rp loclzj tum plnr whole body single day imaging (78802) | $6,478.50 | $6,478.50 | 11.3× |
| Rp loclzj tum spect 1 area single day imaging (78803) | $4,708.22 | $4,708.22 | 8.2× |
| Rp loclzj tum spect w/CT 1 area 1 day imaging (78830) | $4,708.22 | $4,708.22 | 3.4× |
| Rp therapy intra-arterial particulate admn (79445) | $642.14 | $642.14 | 2.6× |
| Saline Infus Sonohysterography W/Color Doppler (76831) | $2,481.32 | $2,481.32 | 9.8× |
| Scapula (73010) | $757.06 | $757.06 | 6.8× |
| Screening Digital Breast Tomosynthesis Bi (77063) | $65.62 | $65.62 | 2.8× |
| Shoulder 1 view (73020) | $519.94 | $519.94 | 5.6× |
| Small bowel series (74250) | $954.11 | $954.11 | 5.1× |
| Spec telethx port pln parts hemibdy tot bdy (77321) | $2,376.74 | $2,376.74 | 6.0× |
| Special dosimetry (77331) | $737.89 | $737.89 | 5.2× |
| Special Physics Consult (77370) | $1,783.35 | $1,783.35 | 12.5× |
| Special treatment procedure (77470) | $11,355.76 | $11,355.76 | 19.4× |
| Spine thoracic 3 views (72072) | $852.21 | $852.21 | 7.7× |
| Stereotactic Body Radiation Delivery (77373) | $11,109.38 | $11,109.38 | 5.9× |
| Superior sagittal sinus venogram (75870) | $6,798.60 | $6,798.60 | 2.0× |
| Telethx isodose pln cplx w/basic dosimetry (77307) | $3,703.64 | $3,703.64 | 9.3× |
| Ther rad simulaj-aided field setting complex (77290) | $5,041.07 | $5,041.07 | 12.7× |
| Ther rad simulaj-aided field setting simple (77280) | $2,576.54 | $2,576.54 | 18.1× |
| Thoracolumbar 2 views (72080) | $631.74 | $631.74 | 6.9× |
| Thyroid Uptake W/Blood Flow Sngle/Mult Quan Meas (78014) | $3,085.95 | $3,085.95 | 7.3× |
| Tmj unilateral (70328) | $506.92 | $506.92 | 5.5× |
| Treatment device complex (77334) | $2,008.88 | $2,008.88 | 5.1× |
| Treatment device intermediate (77333) | $1,184.99 | $1,184.99 | 8.3× |
| Treatment devices simple (77332) | $1,477.56 | $1,477.56 | 10.4× |
| Ultrasound breast complete (76641) | $1,431.49 | $1,431.49 | 12.9× |
| Ultrasound Exam Aaa Screen (76706) | $742.95 | $742.95 | 6.7× |
| Ultrasound, abdomen limited (76705) | $2,184.39 | $2,184.39 | 19.7× |
| Umbilical-artery Doppler (OB) (76820) | $641.61 | $641.61 | 5.8× |
| Urethrocystogram voiding (74455) | $1,673.12 | $1,673.12 | 6.6× |
| Urethrocystography retrograde rs&i (74450) | $2,299.08 | $2,299.08 | 9.1× |
| Urography, infusion, drip technique and/or bolus technique; with nephrotomography Non-Facility (74415) | $3,674.42 | $3,674.42 | 19.8× |
| Us breast unilateral limited (76642) | $1,181.50 | $1,181.50 | 12.8× |
| Us chest (76604) | $1,945.28 | $1,945.28 | 17.6× |
| Us Cmprn Rpr Artl Pseudoarysm/Arven Fstl (76936) | $5,068.14 | $5,068.14 | 22.2× |
| Us compl joint r-t w/image documentation (76881) | $828.07 | $828.07 | 7.5× |
| Us encephalogram (76506) | $2,434.60 | $2,434.60 | 22.0× |
| Us infant hips w manipulation (76885) | $2,135.42 | $2,135.42 | 23.2× |
| Us lmtd joint/oth nonvasc xtr strux r-t w/img (76882) | $474.63 | $474.63 | 4.3× |
| Us ob limited (76815) | $1,438.28 | $1,438.28 | 13.0× |
| Us ob transvaginal (76817) | $761.50 | $761.50 | 6.9× |
| Us pelvic non ob complete (76856) | $1,297.57 | $1,297.57 | 11.7× |
| Us pelvic nonobstetric image dcmtn limited/f/u (76857) | $1,330.53 | $1,330.53 | 12.0× |
| Us pg uter img f&mat 14 wk tabdl 1/1st gestation (76801) | $1,172.83 | $1,172.83 | 10.6× |
| Us retroperitoneal complete (76770) | $2,258.46 | $2,258.46 | 20.4× |
| Us retroperitoneal limited (76775) | $1,511.54 | $1,511.54 | 13.7× |
| Us scrotum and contents (76870) | $2,135.42 | $2,135.42 | 19.3× |
| Us soft tissue head/neck (76536) | $1,655.68 | $1,655.68 | 15.0× |
| Us spinal canal and contents (76800) | $2,104.23 | $2,104.23 | 19.0× |
| Us transrectal (76872) | $2,986.81 | $2,986.81 | 27.0× |
| Venogram adrenal unilat (75840) | $6,798.60 | $6,798.60 | 2.0× |
| Venogram extremity bilateral (75822) | $1,788.91 | $1,788.91 | 1.1× |
| Venogram Extremity Unilateral (75820) | $894.82 | $894.82 | 0.5× |
| Venography caval inferior serialography rs&i (75825) | $9,962.41 | $9,962.41 | 3.0× |
| Venography caval superior serialography rs&i (75827) | $8,676.01 | $8,676.01 | 5.2× |
| Venography Renal Bilateral (75833) | $8,676.01 | $8,676.01 | 2.6× |
| Venography renal unilateral selective rs&i (75831) | $8,676.01 | $8,676.01 | 2.6× |
| Venography venous sinus/jugular cath rs&i (75860) | $8,676.01 | $8,676.01 | 2.6× |
| Venography, epidural, radiological supervision and interpretation Non-Facility (75872) | $1,360.17 | $1,360.17 | 2.0× |
| Venous sampling by catheter (75893) | $8,230.68 | $8,230.68 | 1.4× |
| Wrist 2 views (73100) | $648.02 | $648.02 | 7.0× |
| X-Ray Abdomen,Comp Acute Series - Xr Abdomen 2 Vws With Chest 1 View (74022) | $1,518.12 | $1,518.12 | 13.7× |
| X-Ray Ac Jts - Xr Acromioclavicular Joints Bilateral (73050) | $1,013.52 | $1,013.52 | 11.0× |
| X-Ray Colon Air Contrast - Fl Barium Enema Air Contrast (74280) | $1,657.77 | $1,657.77 | 8.9× |
| X-Ray Elbow 2 Vw - Xr Elbow 1-2 Views Right (73070) | $731.35 | $731.35 | 7.9× |
| X-Ray Exam Hip Uni 2-3 Views (73502) | $1,007.28 | $1,007.28 | 10.9× |
| X-Ray Exam Hips Bi 3-4 Views (73522) | $1,161.50 | $1,161.50 | 10.5× |
| X-ray exam of femur 2/> (73552) | $1,019.51 | $1,019.51 | 11.1× |
| X-ray eye for foreign body (70030) | $1,583.33 | $1,583.33 | 17.2× |
| X-Ray Facial Bones <3 Vw - Xr Facial Bones 1-2 Views (70140) | $793.05 | $793.05 | 8.6× |
| X-Ray Jaw <4 Vw - Xr Mandible < 4 Views (70100) | $1,301.62 | $1,301.62 | 14.1× |
| X-ray leg, infant (73592) | $701.76 | $701.76 | 7.6× |
| X-Ray Lumbar Spine 2/3 Vw - Xr Lumbar Spine 2-3 Views (72100) | $1,022.22 | $1,022.22 | 9.2× |
| X-Ray Lumbar Spine 6+ Vw - Xr Lumbar Spine 6+ Vws Including Bending (72114) | $1,518.12 | $1,518.12 | 13.7× |
| X-ray nose-rectum child f.b. (76010) | $828.53 | $828.53 | 9.0× |
| X-Ray Orbits - Xr Orbits Complete 4+ Views (70200) | $1,472.10 | $1,472.10 | 13.3× |
| X-ray retrograde pyelogram (74420) | $3,088.52 | $3,088.52 | 8.4× |
| X-Ray Ribs 2 Vw Unilat - Xr Ribs 2 Views Right (71100) | $1,065.26 | $1,065.26 | 11.6× |
| X-Ray Ribs, Chest 3+ Vw - Xr Ribs 2 Vws Lt W/ Chest Anteroposterior (71101) | $1,312.84 | $1,312.84 | 11.9× |
| X-Ray Ribs, Chest 4+ Vw - Xr Ribs 3 Vws Bil W/ Chest Posteroanterior (71111) | $1,532.37 | $1,532.37 | 13.8× |
| X-Ray Sacroiliac Jts 3+ Vw - Xr Sacroiliac Joints 3+ Views (72202) | $937.60 | $937.60 | 8.5× |
| X-Ray Sacrum/Coccyx 2+ Vw - Xr Sacrum Coccyx 2+ Views (72220) | $781.86 | $781.86 | 8.5× |
| X-Ray Sinuses 3+ Vw - Xr Paranasal Sinuses 3+ Views (70220) | $1,779.30 | $1,779.30 | 19.3× |
| X-Ray Skull 4+ Vw - Xr Skull Complete 4+ Views (70260) | $1,781.56 | $1,781.56 | 16.1× |
| X-Ray Skull <4 Vw - Xr Skull 1-3 Views (70250) | $1,234.97 | $1,234.97 | 11.2× |
| X-Ray Spine One View - Xr Spine (72020) | $916.63 | $916.63 | 10.0× |
| X-Ray Sterno-Clavicluar Jt - Xr Sternoclavicular Joints 3+ Views (71130) | $946.20 | $946.20 | 10.3× |
| X-Ray Sternum 2+ Vw - Xr Sternum 2+ Views (71120) | $1,130.37 | $1,130.37 | 12.3× |
| X-Ray Thoracic Spine 2 Vw - Xr Thoracic Spine 2 Views (72070) | $928.99 | $928.99 | 8.4× |
| Xr bone length studies (77073) | $928.99 | $928.99 | 8.4× |
| Xr c-spine 4 or 5 views (72050) | $1,063.16 | $1,063.16 | 9.6× |
| Xr c-spine 6 or more views (72052) | $1,160.77 | $1,160.77 | 10.5× |
| Xr chest 4+ views (71048) | $1,229.42 | $1,229.42 | 11.1× |
| Xr urogram antegrade (74425) | $1,199.34 | $1,199.34 | 3.2× |