| Abdomen 2 views (74019) |
$77.66 |
$194.15 |
0.8× |
| Acute gastrointestinal blood loss imaging (78278) |
$482.20 |
$1,205.49 |
1.3× |
| Ankle 2 views (73600) |
$130.08 |
$325.20 |
1.6× |
| Bone &/Joint Imaging Limited Area (78300) |
$482.20 |
$1,205.49 |
1.3× |
| Bone &/Joint Imaging Multiple Areas (78305) |
$482.20 |
$1,205.49 |
1.3× |
| Bone &/joint imaging whole body (78306) |
$600 |
$1,500 |
1.6× |
| Bone age studies (77072) |
$73.44 |
$183.61 |
0.8× |
| Bone Imaging 3 Phase (78315) |
$532 |
$1,330 |
1.5× |
| Bone survey complete (77075) |
$100.76 |
$251.89 |
1.1× |
| Cervical spine 2 or 3 views (72040) |
$112.62 |
$281.54 |
1.4× |
| Chest 1 view (71045) |
$82.12 |
$205.29 |
1.0× |
| Chest 3 views (71047) |
$119.65 |
$299.13 |
1.5× |
| Cine/Vid X-Ray Throat/Esoph - Fl Esoph Barium Swlw W/ Video & Speech (74230) |
$210.07 |
$525.18 |
1.3× |
| Clavicle complete (73000) |
$27.42 |
$68.54 |
0.3× |
| CT abdomen and pelvis without and with contrast (74178) |
$904.44 |
$2,261.09 |
2.8× |
| CT abdomen and pelvis without contrast (74176) |
$646.92 |
$1,617.30 |
3.0× |
| CT abdomen w contrast (74160) |
$389.90 |
$974.76 |
2.4× |
| CT abdomen w wo contrast (74170) |
$421.87 |
$1,054.68 |
2.6× |
| CT abdomen w/o contrast (74150) |
$349.01 |
$872.53 |
3.7× |
| CT angiography upper extremity lt (73206) |
$540.28 |
$1,350.68 |
3.4× |
| CT c-spine w/o contrast (72125) |
$316.74 |
$791.85 |
3.3× |
| CT cervical spine w&w/o contrast (72127) |
$528.82 |
$1,322.06 |
3.3× |
| CT cervical spine with contrast (72126) |
$476.60 |
$1,191.50 |
1.5× |
| CT chest w/wo contrast (71270) |
$556.06 |
$1,390.16 |
3.5× |
| CT chest with contrast (71260) |
$517.91 |
$1,294.78 |
3.2× |
| CT head/brain with contrast (70460) |
$500.23 |
$1,250.58 |
3.1× |
| CT head/brain without and with contrast (70470) |
$617.50 |
$1,543.74 |
3.9× |
| CT iac w contrast (70481) |
$303.98 |
$759.96 |
1.9× |
| CT limited/localized follow up study (76380) |
$102.86 |
$257.16 |
1.3× |
| CT lower ext w/o (73700) |
$214.20 |
$535.49 |
2.3× |
| CT lower extremity w wo contrast (73702) |
$218.72 |
$546.80 |
1.4× |
| CT lower extremity with contrast (73701) |
$255.36 |
$638.42 |
1.6× |
| CT lumbar spine w & w/o contrast (72133) |
$482.31 |
$1,205.76 |
3.0× |
| CT lumbar spine w/o contrast (72131) |
$470.64 |
$1,176.59 |
4.9× |
| CT lumbar spine with contrast (72132) |
$569 |
$1,422.49 |
1.8× |
| CT maxillofacial w contrast (70487) |
$202.62 |
$506.54 |
1.3× |
| CT maxillofacial w/o contrast (70486) |
$115.55 |
$288.88 |
1.2× |
| CT maxillofacial w/wo contrast (70488) |
$306.98 |
$767.45 |
1.9× |
| CT neck soft tissue w contrast (70491) |
$334.60 |
$836.50 |
2.1× |
| CT orbit sella/post fossa/ear w/o & w/contr matr (70482) |
$431.76 |
$1,079.41 |
2.7× |
| CT orbits w/o contrast (70480) |
$276.34 |
$690.83 |
2.9× |
| CT pelvis w & w/o contrast (72194) |
$680.13 |
$1,700.32 |
4.3× |
| CT pelvis w/o contrast (72192) |
$422.13 |
$1,055.32 |
4.4× |
| CT soft tissue neck w/o & w/contrast material (70492) |
$412.19 |
$1,030.48 |
2.6× |
| CT soft tissue neck w/o contrast (70490) |
$290.24 |
$725.60 |
3.0× |
| CT thoracic spine w/contrast (72129) |
$519 |
$1,297.50 |
3.2× |
| CT thoracic spine w/o contrast (72128) |
$465.88 |
$1,164.70 |
4.9× |
| CT thoracic spine w/wo contrast (72130) |
$651.80 |
$1,629.50 |
4.1× |
| CT thorax w/o contrast (71250) |
$425.68 |
$1,064.21 |
4.5× |
| CT upper extremity w/o & w/contrast material (73202) |
$378.54 |
$946.36 |
2.4× |
| CT upper extremity w/o contrast rt (73200) |
$288.87 |
$722.18 |
3.0× |
| CT upper extremity with contrast (73201) |
$295.72 |
$739.30 |
0.9× |
| Cta Abdl Aorta&Bi Iliofem W/Contrast&Postp (75635) |
$1,013.92 |
$2,534.81 |
6.3× |
| Cta Abdomen (74175) |
$245.44 |
$613.60 |
1.5× |
| CTA abdomen pelvis (74174) |
$433.98 |
$1,084.96 |
1.4× |
| CTA chest (71275) |
$428.80 |
$1,071.99 |
2.7× |
| Cta Head (70496) |
$427.42 |
$1,068.55 |
2.7× |
| CTA lwr ext w&w/o contrast (73706) |
$485.76 |
$1,214.40 |
3.0× |
| Cta Neck (70498) |
$427.42 |
$1,068.55 |
2.7× |
| Cta Pelvis (72191) |
$532.14 |
$1,330.34 |
3.3× |
| Cystography minimum 3 views rs&i (74430) |
$235.41 |
$588.53 |
0.7× |
| Dxa bone density study 1/> sites axial skel (77080) |
$78.44 |
$196.11 |
0.8× |
| Dxa bone density study 1/>sites appendiclr skel (77081) |
$64.80 |
$162 |
0.8× |
| Dxa bone density study axial skeleton (77085) |
$83.95 |
$209.87 |
0.9× |
| Esophagus (74220) |
$178.30 |
$445.76 |
1.1× |
| Fetal biophysical profile non-stress testing (76818) |
$121.91 |
$304.78 |
1.3× |
| Fetal Biophysical Profile W/O Non-Stress Testing (76819) |
$124.08 |
$310.20 |
1.3× |
| Fluoroscopy up to 1 hr (76000) |
$156.16 |
$390.40 |
0.7× |
| Foot 2 views (73620) |
$76.09 |
$190.23 |
1.0× |
| Forearm 2 views (73090) |
$108.48 |
$271.20 |
1.4× |
| Gated Heart Planar Single (78472) |
$482.20 |
$1,205.49 |
1.3× |
| Hand 2 views (73120) |
$74.50 |
$186.24 |
0.8× |
| Hand 3 views (73130) |
$111.03 |
$277.58 |
1.4× |
| Hepatobil Syst Imag Inc Gb W/Pharma Intervenj (78227) |
$645.92 |
$1,614.81 |
1.3× |
| Hepatobiliary syst imaging including gallbladder (78226) |
$482.20 |
$1,205.49 |
1.3× |
| Ht muscle image spect sing (78451) |
$1,566.58 |
$3,916.44 |
1.3× |
| Humerus Min 2 Views Left (73060) |
$106.28 |
$265.69 |
1.3× |
| Hysterosalpingogram (74740) |
$177.75 |
$444.38 |
0.8× |
| Kidney Img Morphology Vascular Flow 1 W/O Rx (78707) |
$645.92 |
$1,614.81 |
1.3× |
| Kidney img morphology vascular flow 1 w/rx (78708) |
$645.92 |
$1,614.81 |
1.3× |
| Knee 3 views (73562) |
$109.16 |
$272.88 |
1.4× |
| Liver & spleen imaging static only (78215) |
$482.20 |
$1,205.49 |
1.3× |
| Lymphoscintigraphy (78195) |
$645.92 |
$1,614.81 |
1.3× |
| MRA head w & w/o contrast (70546) |
$544.45 |
$1,361.12 |
1.7× |
| MRA head w/o contrast (70544) |
$333.74 |
$834.34 |
1.5× |
| MRA head with contrast (70545) |
$422.23 |
$1,055.58 |
1.3× |
| MRA neck w contrast (70548) |
$429.66 |
$1,074.14 |
1.4× |
| Mra Neck W/O &W/Contrast Material (70549) |
$550.87 |
$1,377.18 |
1.7× |
| MRA neck w/o contrast (70547) |
$369.46 |
$923.65 |
1.7× |
| MRI abdomen w contrast (74182) |
$433.18 |
$1,082.94 |
1.4× |
| MRI abdomen w/o & w/contrast material (74183) |
$528.60 |
$1,321.49 |
1.7× |
| MRI abdomen w/o contrast (74181) |
$302.17 |
$755.42 |
1.4× |
| MRI any jnt lwr ext with con lt (73722) |
$568.56 |
$1,421.39 |
0.8× |
| MRI any jt upper extremity w/contrast matrl (73222) |
$894.09 |
$1,411.61 |
1.3× |
| MRI c-spine with contrast (72142) |
$620.82 |
$1,552.04 |
2.0× |
| MRI cervical spine w/o contrast (72141) |
$525 |
$1,312.51 |
2.4× |
| MRI chest w/o & w/contrast material (71552) |
$391.04 |
$977.60 |
1.2× |
| MRI chest w/o contrast (71550) |
$370.38 |
$925.95 |
1.7× |
| MRI chest with contrast (71551) |
$192.82 |
$482.03 |
0.3× |
| MRI Forearm w/ Contrast Bilateral 73219 (73219) |
$459.84 |
$1,149.62 |
1.4× |
| MRI lower extrem oth/thn jt w/contrast matrl (73719) |
$476.94 |
$1,192.36 |
1.5× |
| MRI lower extrem oth/thn jt w/o contr matrl (73718) |
$207.71 |
$519.27 |
1.0× |
| MRI orbit face &/neck w/o contrast (70540) |
$337.80 |
$844.50 |
1.6× |
| MRI orbit/face/neck w&w/o cont (70543) |
$548.86 |
$1,372.16 |
1.7× |
| MRI orbit/face/neck w/contrast (70542) |
$437.56 |
$1,093.89 |
1.4× |
| MRI pelvis w contrast (72196) |
$429.92 |
$1,074.81 |
1.4× |
| MRI pelvis w/o & w/contrast material (72197) |
$549.11 |
$1,372.78 |
1.7× |
| MRI pelvis w/o contrast (72195) |
$335.26 |
$838.16 |
1.5× |
| MRI scan of arm joint before and after contrast (73223) |
$715.56 |
$1,788.90 |
2.3× |
| MRI scan of leg joint before and after contrast (73723) |
$739.80 |
$1,849.50 |
2.3× |
| MRI spinal canal cervical w/o & w/contr matrl (72156) |
$739.16 |
$1,847.91 |
2.3× |
| MRI spinal canal lumbar w/contrast material (72149) |
$700.94 |
$1,752.35 |
2.2× |
| MRI spinal canal lumbar w/o & w/contr matrl (72158) |
$716.92 |
$1,792.30 |
2.3× |
| MRI spinal canal thoracic w/contrast matrl (72147) |
$499.77 |
$1,249.43 |
1.6× |
| MRI spinal canal thoracic w/o & w/contr matrl (72157) |
$542.41 |
$1,356.02 |
1.7× |
| MRI thoracic spine w/o contrast (72146) |
$736.44 |
$1,841.09 |
3.4× |
| MRI upper ext joint w/o contrast (73221) |
$181.61 |
$454.02 |
0.8× |
| MRI upper extrem other than jt w/o & w/contras (73220) |
$884.98 |
$2,212.44 |
2.8× |
| MRI upper extremity oth than jt w/o contr matrl (73218) |
$418.78 |
$1,046.96 |
1.9× |
| Myocardial Spect Multiple Studies (78452) |
$1,566.58 |
$3,916.44 |
1.3× |
| Neck soft tissue (70360) |
$64.52 |
$161.28 |
0.8× |
| Nm gastric emptying study (78264) |
$482.20 |
$1,205.49 |
1.3× |
| Ob Us Follow-Up Per Fetus - Us Ob Follow Up Transabdominal Approach (76816) |
$104.85 |
$262.12 |
1.1× |
| Osseous survey infant (77076) |
$103.92 |
$259.80 |
1.1× |
| Parathyroid imaging (78070) |
$482.20 |
$1,205.49 |
1.3× |
| Pelvis 1 or 2 views (72170) |
$94.01 |
$235.04 |
1.0× |
| Pr MRI, lower extr, w/o contrast f/u by contrast (73720) |
$731.22 |
$1,828.05 |
2.3× |
| Pulmonary Perfusion Imaging Particulate (78580) |
$482.20 |
$1,205.49 |
1.3× |
| Radex Entir Thrc Lmbr Crv Sac Spi W/Skull 1 Vw - Xr Scoliosis 1 Vw (72081) |
$78.95 |
$197.38 |
1.0× |
| Radex entir thrc lmbr crv sac spi w/skull 2/3 vw (72082) |
$123.93 |
$309.82 |
1.3× |
| Radex hips bilateral with pelvis 2 views (73521) |
$112.70 |
$281.76 |
1.2× |
| Radex mastoids compl minimum 3 views pr side (70130) |
$87.07 |
$217.67 |
0.9× |
| Radex X-Ray Exam Entire Spi 6/> Vw - Xr Entire Spine 6+ Vw (72084) |
$139.38 |
$348.46 |
1.5× |
| Radiolog exam mandible compl minimum 4 views (70110) |
$80.12 |
$200.31 |
0.8× |
| Radiologic Exam Abdomen 1 View - Xr Abdomen 1 View (74018) |
$64.03 |
$160.08 |
0.8× |
| Radiologic Exam Abdomen 3+ Views - Xr Abdomen 3+ Views (74021) |
$79.80 |
$199.51 |
0.8× |
| Radiologic Exam Chest 2 Views - Xr Chest 2 Views (71046) |
$97.90 |
$244.75 |
1.2× |
| Radiologic exam colon single contrast study (74270) |
$193.30 |
$483.23 |
1.2× |
| Radiologic exam upr gi trc double contrast study (74246) |
$204.16 |
$510.38 |
1.3× |
| Radiologic exam upr gi trc single contrast study (74240) |
$181.88 |
$454.69 |
1.1× |
| Radiologic Examination Femur Minimum 2 Views - Xr Femur 2+ Vw Lt (73552) |
$150.46 |
$376.16 |
1.9× |
| Radiological examination surgical specimen (76098) |
$331.53 |
$828.82 |
0.7× |
| Sacroiliac Joints < 3 Views (72200) |
$157.54 |
$393.87 |
1.7× |
| Scapula complete (73010) |
$71.84 |
$179.60 |
0.8× |
| Screening digital breast tomosynthesis (77063) |
$32 |
$80 |
1.4× |
| Small bowel series (74250) |
$150.16 |
$375.41 |
0.9× |
| Spine thoracic 3 views (72072) |
$78.52 |
$196.28 |
0.8× |
| Spleen imaging only (78185) |
$297.44 |
$743.60 |
0.8× |
| Testicular Imaging With Vascular Flow (78761) |
$482.20 |
$1,205.49 |
1.3× |
| Thoracolumbar 2 views (72080) |
$110.78 |
$276.94 |
1.4× |
| Thyroid Imaging With Vascular Flow (78013) |
$482.20 |
$1,205.49 |
1.3× |
| Thyroid uptake measurement (78012) |
$483.06 |
$1,207.65 |
1.3× |
| Thyroid Uptake W/Blood Flow Sngle/Mult Quan Meas (78014) |
$506.80 |
$1,267.01 |
1.4× |
| Tmj unilateral (70328) |
$64.74 |
$161.83 |
0.8× |
| Ultrasound, abdomen limited (76705) |
$136.58 |
$341.45 |
1.4× |
| Upper Extremity Infant (73092) |
$74.50 |
$186.24 |
0.8× |
| Urethrocystography retrograde rs&i (74450) |
$175.50 |
$438.76 |
0.8× |
| Urethrocystography voiding (74455) |
$179.98 |
$449.97 |
0.8× |
| Urography (pyelography), intravenous, with or without KUB, with or without tomography (74400) |
$155.84 |
$389.59 |
1.0× |
| Us breast unilateral complete (76641) |
$125.60 |
$314.02 |
1.3× |
| Us breast unilateral limited (76642) |
$119.18 |
$297.96 |
1.5× |
| Us chest (76604) |
$94.28 |
$235.69 |
1.0× |
| Us compl joint r-t w/image documentation (76881) |
$83.84 |
$209.60 |
0.9× |
| Us nrv&acc strux 1 xtr compre w/img pr extremity (76883) |
$124.78 |
$311.94 |
1.3× |
| Us ob detailed single fetus (76811) |
$213.12 |
$532.81 |
1.0× |
| Us ob transvaginal (76817) |
$98.52 |
$246.31 |
1.0× |
| Us pelvic non ob complete (76856) |
$157.62 |
$394.05 |
1.7× |
| Us pelvic nonobstetric image dcmtn limited/f/u (76857) |
$81.93 |
$204.82 |
0.9× |
| Us pregnancy ltd (76815) |
$94.32 |
$235.79 |
1.0× |
| Us pregnant uterus 14 wk transabdl 1/1st gestat (76801) |
$107.94 |
$269.86 |
1.1× |
| Us retroperitoneal complete (76770) |
$143.96 |
$359.89 |
1.5× |
| Us retroperitoneal limited (76775) |
$106.40 |
$266.02 |
1.1× |
| Us scrotum and contents (76870) |
$129.17 |
$322.93 |
1.4× |
| Us soft tissue head/neck (76536) |
$136.74 |
$341.86 |
1.4× |
| Vertebral fracture assessment via dxa (77086) |
$65.59 |
$163.98 |
0.8× |
| Wrist 2 views (73100) |
$69.47 |
$173.68 |
0.9× |
| X-Ray Abdomen,Comp Acute Series - Xr Abdomen 2 Vws With Chest 1 View (74022) |
$82.53 |
$206.32 |
0.9× |
| X-Ray Ac Jts - Xr Acromioclavicular Joints Bilateral (73050) |
$145.64 |
$364.09 |
1.8× |
| X-Ray Ankle 3+ Vw - Xr Ankle 3+ Views Right (73610) |
$202 |
$505 |
2.5× |
| X-Ray Colon Air Contrast - Fl Barium Enema Air Contrast (74280) |
$225.50 |
$563.75 |
1.4× |
| X-Ray Elbow 2 Vw - Xr Elbow 1-2 Views Right (73070) |
$107.24 |
$268.09 |
1.4× |
| X-Ray Elbow 3+ Vw - Xr Elbow 3+ Views Right (73080) |
$111.72 |
$279.32 |
1.4× |
| X-ray exam entire spi 4/5 vw (72083) |
$132.62 |
$331.56 |
1.4× |
| X-ray exam hip uni 1 view (73501) |
$64.36 |
$160.91 |
0.8× |
| X-Ray Exam Hip Uni 2-3 Views (73502) |
$116.06 |
$290.14 |
1.5× |
| X-Ray Exam Hips Bi 3-4 Views (73522) |
$137.36 |
$343.42 |
1.4× |
| X-ray eye for foreign body (70030) |
$65.12 |
$162.80 |
0.8× |
| X-Ray Facial Bones 3+ Vw - Xr Facial Bones 3+ Views (70150) |
$70.27 |
$175.68 |
0.7× |
| X-Ray Facial Bones <3 Vw - Xr Facial Bones 1-2 Views (70140) |
$340.93 |
$852.32 |
4.3× |
| X-Ray Foot 3+ Vw - Xr Foot 3+ Views Right (73630) |
$114.02 |
$285.07 |
1.4× |
| X-Ray Heel - Xr Calcaneus 2 Views Right (73650) |
$76.09 |
$190.23 |
1.0× |
| X-Ray Jaw <4 Vw - Xr Mandible < 4 Views (70100) |
$67.19 |
$167.98 |
0.8× |
| X-Ray Knee 4+ View - Xr Knee 4+ Views Right (73564) |
$122.66 |
$306.64 |
1.3× |
| X-Ray Knee Bilat Standing - Xr Knees Anteroposterior Standing Bilat (73565) |
$118.78 |
$296.96 |
1.5× |
| X-Ray Leg, Infant - Xr Lower Extremity 2+ Views Infant Left (73592) |
$63.60 |
$158.99 |
0.8× |
| X-Ray Lumbar Spine 2/3 Vw - Xr Lumbar Spine 2-3 Views (72100) |
$78.62 |
$196.53 |
0.8× |
| X-Ray Lumbar Spine 6+ Vw - Xr Lumbar Spine 6+ Vws Including Bending (72114) |
$165.02 |
$412.54 |
1.7× |
| X-Ray Lumbar Spine Flex/Exten - Xr Lumbar Spine 4+ Views W/ Flex Ext (72120) |
$78.98 |
$197.43 |
0.8× |
| X-Ray Nasal Bones - Xr Nasal Bones (70160) |
$65.92 |
$164.81 |
0.8× |
| X-Ray Nose-Rectum Child F.B. - Xr Nose to Rectum Foreign Body Peds (76010) |
$63.78 |
$159.46 |
0.8× |
| X-Ray Orbits - Xr Orbits Complete 4+ Views (70200) |
$81.65 |
$204.12 |
0.9× |
| X-Ray Pelvis 3+ Vw - Xr Pelvis 3+ Views (72190) |
$101.51 |
$253.78 |
1.1× |
| X-Ray Ribs 2 Vw Unilat - Xr Ribs 2 Views Right (71100) |
$227.22 |
$568.06 |
2.9× |
| X-Ray Ribs, Chest 3+ Vw - Xr Ribs 2 Vws Lt W/ Chest Anteroposterior (71101) |
$82.47 |
$206.18 |
0.9× |
| X-Ray Ribs, Chest 4+ Vw - Xr Ribs 3 Vws Bil W/ Chest Posteroanterior (71111) |
$146.98 |
$367.46 |
1.5× |
| X-Ray Sacroiliac Jts 3+ Vw - Xr Sacroiliac Joints 3+ Views (72202) |
$80.71 |
$201.77 |
0.8× |
| X-Ray Sacrum/Coccyx 2+ Vw - Xr Sacrum Coccyx 2+ Views (72220) |
$119.56 |
$298.90 |
1.5× |
| X-Ray Shoulder 2+ Vw - Xr Shoulder 2+ Views Right (73030) |
$113.83 |
$284.58 |
1.4× |
| X-Ray Sinuses 3+ Vw - Xr Paranasal Sinuses 3+ Views (70220) |
$66.90 |
$167.26 |
0.8× |
| X-Ray Sinuses <3 Vw - Xr Paranasal Sinuses 1-2 Views (70210) |
$64.86 |
$162.14 |
0.8× |
| X-Ray Skull 4+ Vw - Xr Skull Complete 4+ Views (70260) |
$80.55 |
$201.37 |
0.8× |
| X-Ray Skull <4 Vw - Xr Skull 1-3 Views (70250) |
$77.20 |
$192.99 |
0.8× |
| X-Ray Spine One View - Xr Spine (72020) |
$61.04 |
$152.61 |
0.8× |
| X-Ray Sterno-Clavicluar Jt - Xr Sternoclavicular Joints 3+ Views (71130) |
$68.12 |
$170.30 |
0.9× |
| X-Ray Sternum 2+ Vw - Xr Sternum 2+ Views (71120) |
$67.26 |
$168.16 |
0.8× |
| X-Ray Thoracic Spine 2 Vw - Xr Thoracic Spine 2 Views (72070) |
$210.20 |
$525.50 |
2.2× |
| X-Ray Thoracic Spine 4 Vw - Xr Thoracic Spine Complete 4+ Views (72074) |
$80.50 |
$201.23 |
0.8× |
| X-Ray Toe(S) - Xr Toes 2+ Views Right (73660) |
$62.68 |
$156.71 |
0.8× |
| X-Ray Wrist 3+ Vw - Xr Wrist 3+ Views Right (73110) |
$103.34 |
$258.36 |
1.3× |
| Xr c-spine 6 or more views (72052) |
$107.06 |
$267.65 |
1.1× |
| Xr finger(s) 2+ views (73140) |
$142.34 |
$355.86 |
1.8× |
| XR Mastoids < 3 Views Bilateral (70120) |
$78.04 |
$195.10 |
0.8× |
| Xr shoulder 1 view (73020) |
$60.05 |
$150.12 |
0.8× |
| Xr spine cervical 4 or 5 views (72050) |
$123.94 |
$309.84 |
1.3× |
| Xr tibia/fibula 2 views (73590) |
$78.62 |
$196.56 |
1.0× |
| Xr tmj bilateral (70330) |
$72.54 |
$181.36 |
0.9× |
| Xray knee 1 or 2 views rt (73560) |
$95.38 |
$238.46 |
1.2× |