| Acute gi blood loss imaging (78278) |
$950 |
$1,899 |
2.3× |
| Ankle 2 views (73600) |
$70 |
$140 |
0.8× |
| Clavicle complete (73000) |
$108 |
$216 |
1.2× |
| Complex dynamic pharyngeal and speech evaluation by cine or video recording Age Under 21 (70371) |
$307 |
$613 |
1.2× |
| Computed tomographic angiography, abdomen and pelvis, with contrast material(s), including noncontrast images, if… (74174) |
$476 |
$951 |
1.3× |
| Computed tomographic angiography, abdomen, with contrast material(s), including noncontrast images, if performed, and… (74175) |
$1,677 |
$3,354 |
9.1× |
| Computed tomographic angiography, abdominal aorta and bilateral iliofemoral lower extremity runoff, with contrast… (75635) |
$1,796 |
$3,591 |
9.7× |
| Computed tomographic angiography, chest (noncoronary), with contrast material(s), including noncontrast images, if… (71275) |
$1,178 |
$2,355.50 |
6.4× |
| Computed tomographic angiography, lower extremity, with contrast material(s), including noncontrast images, if… (73706) |
$1,732 |
$3,464 |
9.4× |
| Computed tomographic angiography, neck, with contrast material(s), including noncontrast images, if performed, and… (70498) |
$1,632 |
$3,263 |
8.8× |
| Computed tomographic angiography, pelvis, with contrast material(s), including noncontrast images, if performed, and… (72191) |
$1,195 |
$2,390 |
6.5× |
| Computed tomographic angiography, upper extremity, with contrast material(s), including noncontrast images, if… (73206) |
$1,735 |
$3,470 |
9.4× |
| Computed tomography, cervical spine; without contrast material, followed by contrast material(s) and further sections… (72127) |
$1,220 |
$2,440 |
6.6× |
| Computed tomography, lower extremity; without contrast material Age Under 21 (73700) |
$714 |
$1,428 |
6.5× |
| Computed tomography, lower extremity; without contrast material, followed by contrast material(s) and further sections… (73702) |
$1,167 |
$2,334 |
6.3× |
| Computed tomography, lumbar spine; without contrast material, followed by contrast material(s) and further sections Age… (72133) |
$1,219 |
$2,437 |
6.6× |
| Computed tomography, maxillofacial area; with contrast material(s) Age Under 21 (70487) |
$918 |
$1,835 |
5.0× |
| Computed tomography, maxillofacial area; without contrast material Age Under 21 (70486) |
$935 |
$1,870 |
8.5× |
| Computed tomography, orbit, sella, or posterior fossa or outer, middle, or inner ear; with contrast material(s) Age… (70481) |
$1,200 |
$2,399 |
6.5× |
| Computed tomography, orbit, sella, or posterior fossa or outer, middle, or inner ear; without contrast material Age… (70480) |
$1,027 |
$2,053 |
9.3× |
| Computed tomography, orbit, sella, or posterior fossa or outer, middle, or inner ear; without contrast material,… (70482) |
$1,407 |
$2,814 |
7.6× |
| Computed tomography, soft tissue neck; without contrast material followed by contrast material(s) and further sections… (70492) |
$1,136 |
$2,272 |
6.1× |
| Computed tomography, thoracic spine; without contrast material, followed by contrast material(s) and further sections… (72130) |
$1,218 |
$2,435 |
6.6× |
| Computed tomography, thorax, diagnostic; without contrast material, followed by contrast material(s) and further… (71270) |
$1,232 |
$2,464 |
6.7× |
| CT abdomen and pelvis without and with contrast (74178) |
$2,117 |
$4,234 |
5.8× |
| CT abdomen and pelvis without contrast (74176) |
$1,407 |
$2,814 |
5.6× |
| CT abdomen w & w/o contrast (74170) |
$1,448 |
$2,896 |
7.8× |
| CT abdomen w/contrast (74160) |
$1,191 |
$2,381 |
6.4× |
| CT abdomen w/o contrast (74150) |
$928 |
$1,855 |
8.4× |
| CT angio hrt w/3d image (75574) |
$1,400 |
$2,799 |
3.8× |
| CT cervical spine w/contrast (72126) |
$1,143 |
$2,286 |
3.1× |
| CT cervical spine w/o contrast (72125) |
$1,012 |
$2,023 |
9.2× |
| CT chest w/contrast (71260) |
$1,207 |
$2,413 |
6.5× |
| CT extremity upper w & w/o contrast (73202) |
$1,158 |
$2,315 |
6.3× |
| CT extremity upper w/o contrast (73200) |
$872 |
$1,743 |
7.9× |
| CT head/brain with contrast (70460) |
$1,083 |
$2,165 |
5.9× |
| CT head/brain without and with contrast (70470) |
$1,261 |
$2,521 |
6.8× |
| CT heart no contrast quant eval coronry calcium (75571) |
$234 |
$467 |
2.5× |
| CT l-spine w/contrast (72132) |
$962 |
$1,923 |
2.6× |
| CT lower extremity w/dye (73701) |
$875 |
$1,750 |
4.7× |
| CT lumbar spine w/o contrast (72131) |
$945 |
$1,889 |
8.6× |
| CT maxillofacial w/wo contrast (70488) |
$1,152 |
$2,304 |
6.2× |
| CT neck w/contrast (70491) |
$1,088 |
$2,175 |
5.9× |
| CT neck w/o contrast (70490) |
$745 |
$1,489 |
6.8× |
| CT pelvis w & w/o contrast (72194) |
$1,136 |
$2,272 |
6.1× |
| CT pelvis w/o contrast (72192) |
$928 |
$1,855 |
8.4× |
| CT thoracic spine w/contrast (72129) |
$998 |
$1,995 |
5.4× |
| CT thoracic spine w/o contrast (72128) |
$795 |
$1,589 |
7.2× |
| CT thorax lung cancer scr c- (71271) |
$827 |
$1,653 |
7.5× |
| CT thorax w/o contrast (71250) |
$827 |
$1,653 |
7.5× |
| CT upper extremity w/dye (73201) |
$886 |
$1,771 |
2.4× |
| CTA h&n c+ w/noncontrast img (70471) |
$472 |
$943 |
1.3× |
| CTA head w contrast (70496) |
$1,762 |
$3,524 |
9.5× |
| Cystography, minimum of 3 views, radiological supervision and interpretation Age Under 21 (74430) |
$329 |
$657 |
0.9× |
| Dacryocystography, nasolacrimal duct, radiological supervision and interpretation Age Under 21 (70170) |
$310 |
$620 |
1.2× |
| Dual-energy X-ray absorptiometry (DXA), bone density study, 1 or more sites; axial skeleton (eg, hips, pelvis, spine)… (77080) |
$382 |
$764 |
3.5× |
| Dxa bone density study axial skeleton (77085) |
$364 |
$728 |
3.3× |
| Dxa bone density/peripheral (77081) |
$327 |
$653 |
3.6× |
| Fetal biophys profile w/o nst (76819) |
$207.50 |
$414.50 |
1.9× |
| Fetal biophysical profile non-stress testing (76818) |
$351 |
$701 |
3.2× |
| Fluoroscopy up to 1 hour physician/qhp time (76000) |
$314 |
$628 |
1.2× |
| Gated heart planar single (78472) |
$886 |
$1,772 |
2.1× |
| Hepatobiliary syst imaging including gallbladder (78226) |
$898 |
$1,796 |
2.1× |
| Ht muscle image spect sing (78451) |
$1,350 |
$2,700 |
1.0× |
| Intestine imaging (eg, ectopic gastric mucosa, Meckel's localization, volvulus) Age Under 21 (78290) |
$728 |
$1,456 |
1.7× |
| Kidney imaging morphology; with vascular flow Age Under 21 (78701) |
$647 |
$1,294 |
1.5× |
| Kidney imaging morphology; with vascular flow and function, single study without pharmacological intervention Age Under… (78707) |
$676 |
$1,351 |
1.2× |
| Kidney imaging morphology; with vascular flow and function, single study, with pharmacological intervention (eg,… (78708) |
$686 |
$1,371 |
1.2× |
| Liver and spleen imaging; with vascular flow Age Under 21 (78216) |
$426 |
$852 |
1.0× |
| Lung perfusion imaging (78580) |
$541 |
$1,082 |
1.3× |
| Magnetic resonance (eg, proton) imaging, any joint of lower extremity; without contrast material(s), followed by… (73723) |
$1,821 |
$3,641 |
4.9× |
| Magnetic resonance (eg, proton) imaging, lower extremity other than joint; with contrast material(s) Age Under 21 (73719) |
$1,890 |
$3,779 |
5.1× |
| Magnetic resonance (eg, proton) imaging, lower extremity other than joint; without contrast material(s) Age Under 21 (73718) |
$1,718 |
$3,435 |
6.8× |
| Magnetic resonance (eg, proton) imaging, lower extremity other than joint; without contrast material(s), followed by… (73720) |
$2,509 |
$5,017 |
6.8× |
| Magnetic resonance (eg, proton) imaging, orbit, face, and/or neck; with contrast material(s) Age Under 21 (70542) |
$1,803 |
$3,605 |
4.9× |
| Magnetic resonance (eg, proton) imaging, orbit, face, and/or neck; without contrast material(s) Age Under 21 (70540) |
$1,579 |
$3,158 |
6.3× |
| Magnetic resonance (eg, proton) imaging, upper extremity, other than joint; with contrast material(s) Age Under 21 (73219) |
$1,845 |
$3,689 |
5.0× |
| Magnetic resonance (eg, proton) imaging, upper extremity, other than joint; without contrast material(s), followed by… (73220) |
$2,723 |
$5,446 |
7.4× |
| Magnetic resonance angiography, head; without contrast material(s), followed by contrast material(s) and further… (70546) |
$2,325 |
$4,650 |
6.3× |
| Magnetic resonance angiography, neck; without contrast material(s), followed by contrast material(s) and further… (70549) |
$2,455 |
$4,909 |
6.7× |
| Mammary ductogram or galactogram, multiple ducts, radiological supervision and interpretation Age Under 21 (77054) |
$294 |
$587 |
1.2× |
| Mammary ductogram single (77053) |
$241 |
$482 |
1.0× |
| Mandible min 4v (70110) |
$128 |
$255 |
1.2× |
| MRA head w/o contrast (70544) |
$1,770 |
$3,540 |
7.0× |
| MRA neck w/ contrast (70548) |
$1,540 |
$3,080 |
4.2× |
| MRA neck w/o contrast (70547) |
$878 |
$1,756 |
3.5× |
| MRI abdomen w/contrast (74182) |
$1,934 |
$3,868 |
5.3× |
| MRI abdomen w/o contrast (74181) |
$1,427 |
$2,853 |
5.7× |
| MRI abdomen w/wo contrast (74183) |
$2,625 |
$5,250 |
7.1× |
| MRI any jt lower extrem w/contrast material (73722) |
$1,638 |
$3,276 |
2.0× |
| MRI c-spine w&w/o cont (72156) |
$2,161 |
$4,322 |
5.9× |
| MRI cervical spine w/contrast (72142) |
$1,600 |
$3,200 |
4.3× |
| MRI chest w/contrast (71551) |
$1,317 |
$2,633 |
1.6× |
| MRI chest w/o contrast (71550) |
$1,066 |
$2,132 |
4.2× |
| MRI chest w/wo contrast (71552) |
$1,317 |
$2,633 |
3.6× |
| MRI joint upr extr w/o&w/dye (73223) |
$2,642 |
$5,284 |
7.2× |
| MRI joint upr extrem w/dye (73222) |
$2,009 |
$4,018 |
2.4× |
| MRI joint upr extrem w/o dye (73221) |
$1,467 |
$2,934 |
5.8× |
| MRI lumbar spine w/contrast (72149) |
$1,583 |
$3,165 |
4.3× |
| MRI lumbar spine w/wo contrast (72158) |
$2,138 |
$4,275 |
5.8× |
| MRI orbit/face/neck w&w/o cont (70543) |
$2,707 |
$5,414 |
7.4× |
| MRI pelvis w & w/o contrast (72197) |
$2,397 |
$4,794 |
6.5× |
| MRI pelvis w/o contrast (72195) |
$1,851 |
$3,702 |
7.4× |
| MRI spine cervical w/o contrast (72141) |
$1,518 |
$3,036 |
6.0× |
| MRI t-spine w&w/o cont (72157) |
$2,268 |
$4,535 |
6.2× |
| MRI thoracic spine w/contrast (72147) |
$1,657 |
$3,313 |
4.5× |
| MRI thoracic spine w/o contrst (72146) |
$1,583 |
$3,166 |
6.3× |
| MRI tmj (70336) |
$1,726 |
$3,452 |
6.9× |
| MRI upper extremity oth than jt w/o contr matrl (73218) |
$1,808 |
$3,615 |
7.2× |
| Myocardial spect multiple studies (78452) |
$1,735 |
$3,469 |
1.3× |
| Nm bone imaging whole body (78306) |
$788 |
$1,576 |
1.9× |
| Nm csf cisternogram (78630) |
$850 |
$1,700 |
1.5× |
| Nm gastric emptying (78264) |
$691 |
$1,381 |
1.6× |
| Nm lung ventilation imaging (78579) |
$494 |
$988 |
1.2× |
| Nm lymph system (78195) |
$986 |
$1,971 |
1.7× |
| Nuclear medicine study of bone and/or joint limited area (78300) |
$520 |
$1,040 |
1.2× |
| Nuclear medicine study to assess blood clot in vein using radiolabeled peptide (78456) |
$822 |
$1,644 |
0.6× |
| Ob us limited fetus(s) (76815) |
$161 |
$321 |
1.5× |
| Ob us nuchal meas 1 gest (76813) |
$116 |
$231 |
1.1× |
| Ophthalmic ultrasound, diagnostic; B-scan (with or without superimposed non-quantitative A-scan) Age Under 21 (76512) |
$161 |
$321 |
1.5× |
| Optic foramina (70190) |
$103 |
$205 |
1.1× |
| Parathyroid planar imaging (78070) |
$505 |
$1,009 |
1.2× |
| Radex abscess/fistula/sinus tract rs&i (76080) |
$615 |
$1,230 |
1.1× |
| Radex entir thrc lmbr crv sac spi w/skull 1 vw (72081) |
$81 |
$162 |
0.9× |
| Radex entir thrc lmbr crv sac spi w/skull 2/3 vw (72082) |
$91 |
$181 |
0.8× |
| Radex entir thrc lmbr crv sac spi w/skull 4/5 vw (72083) |
$99 |
$197 |
0.9× |
| Radex entir thrc lmbr crv sac spi w/skull 6/> vw (72084) |
$110 |
$219 |
1.0× |
| Radex hip unilateral with pelvis 1 view (73501) |
$83.50 |
$167 |
0.9× |
| Radex hip unilateral with pelvis 2-3 views (73502) |
$130 |
$260 |
1.4× |
| Radex hip unilateral with pelvis minimum 4 views (73503) |
$143 |
$286 |
1.3× |
| Radex hips bilateral with pelvis 2 views (73521) |
$82 |
$163.50 |
0.7× |
| Radex hips bilateral with pelvis minimum 5 views (73523) |
$171 |
$341 |
1.6× |
| Radex spine cervical 2 or 3 views (72040) |
$120 |
$239 |
1.3× |
| Radex spine cervical 4 or 5 views (72050) |
$211 |
$422 |
1.9× |
| Radex spine cervical 6 or more views (72052) |
$216 |
$431 |
2.0× |
| Radex spine thoracolumbar junction min 2 views (72080) |
$101 |
$201 |
1.1× |
| Radiologic exam chest 3 views (71047) |
$195 |
$389 |
2.1× |
| Radiologic exam chest 4+ views (71048) |
$230 |
$459 |
2.1× |
| Radiologic exam colon double contrast study (74280) |
$663 |
$1,325 |
3.6× |
| Radiologic exam colon single contrast study (74270) |
$413 |
$826 |
2.2× |
| Radiologic exam esophagus single contrast study (74220) |
$346 |
$692 |
1.9× |
| Radiologic exam small int single contrast study (74250) |
$374 |
$748 |
2.0× |
| Radiologic exam swallow function contrast study (74230) |
$288 |
$575 |
1.6× |
| Radiologic exam upr gi trc double contrast study (74246) |
$417 |
$834 |
2.3× |
| Radiologic exam upr gi trc single contrast study (74240) |
$284 |
$568 |
1.5× |
| Radiologic examination femur minimum 2 views (73552) |
$81 |
$161 |
0.9× |
| Radiologic examination from nose to rectum for foreign body, single view, child Age Under 21 (76010) |
$83 |
$165 |
0.9× |
| Radiologic examination, ankle; complete, minimum of 3 views Age Under 21 (73610) |
$90 |
$180 |
1.0× |
| Radiologic examination, complete acute abdomen series, including 2 or more views of the abdomen (eg, supine, erect,… (74022) |
$154 |
$308 |
1.4× |
| Radiologic examination, elbow; 2 views Age Under 21 (73070) |
$106 |
$212 |
1.2× |
| Radiologic examination, elbow; complete, minimum of 3 views Age Under 21 (73080) |
$112 |
$224 |
1.2× |
| Radiologic examination, facial bones; less than 3 views Age Under 21 (70140) |
$104 |
$208 |
1.1× |
| Radiologic examination, foot; complete, minimum of 3 views Age Under 21 (73630) |
$85 |
$169 |
0.9× |
| Radiologic examination, hand; minimum of 3 views Age Under 21 (73130) |
$124 |
$248 |
1.4× |
| Radiologic examination, internal auditory meati, complete Age Under 21 (70134) |
$948 |
$1,896 |
1.6× |
| Radiologic examination, knee; both knees, standing, anteroposterior Age Under 21 (73565) |
$101.50 |
$202 |
1.1× |
| Radiologic examination, knee; complete, 4 or more views Age Under 21 (73564) |
$156 |
$311 |
1.4× |
| Radiologic examination, mandible; partial, less than 4 views Age Under 21 (70100) |
$100 |
$200 |
1.1× |
| Radiologic examination, mastoids; complete, minimum of 3 views per side Age Under 21 (70130) |
$151 |
$301 |
1.4× |
| Radiologic examination, nasal bones, complete, minimum of 3 views Age Under 21 (70160) |
$103 |
$206 |
1.1× |
| Radiologic examination, pharynx and/or cervical esophagus, including scout neck radiograph(s) and delayed image(s),… (74210) |
$209 |
$418 |
1.1× |
| Radiologic examination, ribs, bilateral; including posteroanterior chest, minimum of 4 views Age Under 21 (71111) |
$171 |
$342 |
1.6× |
| Radiologic examination, ribs, unilateral; including posteroanterior chest, minimum of 3 views Age Under 21 (71101) |
$131 |
$261 |
1.2× |
| Radiologic examination, salivary gland for calculus Age Under 21 (70380) |
$107 |
$214 |
1.2× |
| Radiologic examination, shoulder, arthrography, radiological supervision and interpretation Age Under 21 (73040) |
$359 |
$718 |
1.0× |
| Radiologic examination, shoulder; complete, minimum of 2 views Age Under 21 (73030) |
$124 |
$248 |
1.4× |
| Radiologic examination, sinuses, paranasal, less than 3 views Age Under 21 (70210) |
$103 |
$205 |
1.1× |
| Radiologic examination, skull; less than 4 views Age Under 21 (70250) |
$124 |
$248 |
1.1× |
| Radiologic examination, spine, lumbosacral; 2 or 3 views Age Under 21 (72100) |
$130 |
$259 |
1.2× |
| Radiologic examination, spine, lumbosacral; complete, including bending views, minimum of 6 views Age Under 21 (72114) |
$227 |
$453 |
2.1× |
| Radiologic examination, spine; thoracic, minimum of 4 views Age Under 21 (72074) |
$156 |
$311 |
1.4× |
| Radiologic examination, wrist; complete, minimum of 3 views Age Under 21 (73110) |
$114 |
$227 |
1.2× |
| Radiologic examination; acromioclavicular joints, bilateral, with or without weighted distraction Age Under 21 (73050) |
$117 |
$234 |
1.3× |
| Radiologic examination; humerus, minimum of 2 views Age Under 21 (73060) |
$119 |
$237 |
1.3× |
| Radiologic examination; lower extremity, infant, minimum of 2 views Age Under 21 (73592) |
$79 |
$158 |
0.9× |
| Radiologic examination; orbits, complete, minimum of 4 views Age Under 21 (70200) |
$121 |
$241 |
1.1× |
| Radiologic examination; pharynx or larynx, including fluoroscopy and/or magnification technique Age Under 21 (70370) |
$205 |
$409 |
2.2× |
| Radiologic examination; sternoclavicular joint or joints, minimum of 3 views Age Under 21 (71130) |
$114 |
$227 |
1.2× |
| Radiologic examination; toe(s), minimum of 2 views Age Under 21 (73660) |
$81 |
$161 |
0.9× |
| Radiologic examination; upper extremity, infant, minimum of 2 views Age Under 21 (73092) |
$75 |
$150 |
0.7× |
| Radiopharmaceutical localization of tumor, inflammatory process or distribution of radiopharmaceutical agent(s)… (78803) |
$1,180 |
$2,359 |
2.1× |
| Review by radiologist of urinary bladder and urethra images with contrast and after passing urine (74455) |
$253 |
$506 |
1.0× |
| Rp loclzj tum plnr whole body single day imaging (78802) |
$874 |
$1,747 |
1.5× |
| Scapula complete (73010) |
$95 |
$189 |
0.9× |
| Screening digital breast tomosynthesis bi (77063) |
$108 |
$216 |
— |
| Shuntogram indwelling nonvascular shunt rs&i (75809) |
$372 |
$743 |
3.4× |
| Temporomandibular joint arthrography, radiological supervision and interpretation Age Under 21 (70332) |
$271 |
$541 |
1.1× |
| Therapeutic enema, contrast or air, for reduction of intussusception or other intraluminal obstruction (eg, meconium… (74283) |
$636 |
$1,271 |
3.4× |
| Thyroid imaging with vascular flow (78013) |
$446 |
$891 |
1.1× |
| Thyroid met imaging body (78018) |
$856 |
$1,712 |
1.5× |
| Thyroid uptake w/blood flow sngle/mult quan meas (78014) |
$515 |
$1,029 |
1.2× |
| Ultrasound, abdomen limited (76705) |
$320.50 |
$640.50 |
2.9× |
| Ultrasound, limited, joint or focal evaluation of other nonvascular extremity structure(s) (eg, joint space,… (76882) |
$161 |
$321 |
1.5× |
| Ultrasound, pelvic (nonobstetric), real time with image documentation; complete Age Under 21 (76856) |
$339 |
$677 |
3.1× |
| Ultrasound, pregnant uterus, real time with image documentation, fetal and maternal evaluation plus detailed fetal… (76811) |
$589 |
$1,178 |
2.3× |
| Ultrasound, pregnant uterus, real time with image documentation, fetal and maternal evaluation, first trimester (< 14… (76801) |
$430 |
$860 |
3.9× |
| Ultrasound, transrectal; prostate volume study for brachytherapy treatment planning (separate procedure) Age Under 21 (76873) |
$471 |
$942 |
4.3× |
| Urethrocystography retrograde rs&i (74450) |
$148 |
$296 |
0.6× |
| Urography (pyelography), intravenous, with or without KUB, with or without tomography Age Under 21 (74400) |
$463 |
$926 |
2.5× |
| Urography, infusion, drip technique and/or bolus technique; Age Under 21 (74410) |
$158 |
$316 |
0.9× |
| Us breast uni real time with image complete (76641) |
$284.50 |
$568 |
2.6× |
| Us chest (76604) |
$232.50 |
$465 |
2.1× |
| Us compl joint r-t w/image documentation (76881) |
$378 |
$756 |
3.4× |
| Us encephalogram (76506) |
$313 |
$626 |
2.8× |
| Us exam, pelvic, limited (76857) |
$161 |
$321 |
1.5× |
| Us inft hips r-t img dynamic req phys/qhp manj (76885) |
$354 |
$708 |
3.9× |
| Us ob transvaginal (76817) |
$329 |
$657 |
3.0× |
| Us retroperitoneal complete (76770) |
$356 |
$712 |
3.2× |
| Us retroperitoneal ltd (76775) |
$311 |
$622 |
2.8× |
| Us scrotum (76870) |
$370 |
$739 |
3.4× |
| Us soft tissue head/neck (76536) |
$341 |
$681 |
3.1× |
| Venography, extremity, bilateral, radiological supervision and interpretation Age Under 21 (75822) |
$1,964 |
$3,927 |
1.2× |
| Venography, extremity, unilateral, radiological supervision and interpretation Age Under 21 (75820) |
$1,785 |
$3,570 |
1.1× |
| X-ray exam hips bi 3-4 views (73522) |
$106 |
$212 |
1.0× |
| X-ray exam of finger(s) (73140) |
$106 |
$211 |
1.2× |
| X-ray exam of knee 1 or 2 (73560) |
$95 |
$189 |
1.0× |
| X-ray exam of small bowel - fl small bowel series enteroclysis tube (74251) |
$765 |
$1,529 |
4.1× |
| X-ray exam ribs bil 3 views (71110) |
$139 |
$277 |
1.3× |
| X-ray exam ribs uni 2 views (71100) |
$108 |
$216 |
1.2× |
| X-ray heel (73650) |
$73 |
$146 |
0.8× |
| X-ray of joint between lower spine and hip bone 3 or more views|PROFESSIONAL COMPONENT (72202) |
$115 |
$230 |
1.0× |
| Xr abdomen 1 view (74018) |
$90 |
$180 |
1.0× |
| Xr abdomen 2 views (74019) |
$120 |
$240 |
1.1× |
| Xr arthrogram ankle (73615) |
$299 |
$597 |
0.8× |
| Xr arthrogram elbow (73085) |
$290 |
$579 |
0.8× |
| Xr arthrogram hip (73525) |
$334 |
$668 |
0.9× |
| Xr arthrogram knee (73580) |
$360 |
$719 |
1.0× |
| Xr arthrogram wrist (73115) |
$328 |
$655 |
0.9× |
| Xr bone survey ltd (77074) |
$193 |
$386 |
1.8× |
| Xr chest 1 view (71045) |
$84 |
$168 |
0.9× |
| Xr chest 2 views (71046) |
$118 |
$236 |
1.3× |
| Xr eye foreign body (70030) |
$75 |
$149 |
0.8× |
| Xr facial bones 3+ views (70150) |
$142 |
$283 |
1.3× |
| Xr foot arthritis pa only bilateral - report(ortho pro) (73620) |
$73 |
$145 |
0.8× |
| Xr forearm 2 views (73090) |
$108 |
$216 |
1.2× |
| Xr hand 2v (73120) |
$89 |
$177 |
0.8× |
| Xr hysterosalpingogram (74740) |
$289 |
$578 |
1.1× |
| Xr myelogram c-spine (72240) |
$1,263 |
$2,526 |
1.5× |
| Xr myelogram l-spine (72265) |
$1,263 |
$2,526 |
1.5× |
| Xr myelogram t-spine (72255) |
$1,263 |
$2,526 |
1.5× |
| Xr neck soft tissue (70360) |
$88 |
$175 |
1.0× |
| Xr o knee w/ merchant view bilat - report(ortho pro) (73562) |
$130 |
$260 |
1.4× |
| Xr osseous survey complete (77075) |
$315 |
$629 |
2.9× |
| Xr pelvis 1-2 views (72170) |
$108 |
$216 |
1.0× |
| Xr pelvis min 3 view (72190) |
$112 |
$223 |
1.0× |
| Xr sacrum/coccyx 2+ views (72220) |
$102 |
$203 |
1.1× |
| Xr sella turcica (70240) |
$81 |
$161 |
0.9× |
| Xr shoulder 1 view (73020) |
$80 |
$159 |
0.9× |
| Xr sialogram (70390) |
$279 |
$557 |
1.1× |
| Xr sinuses 3+ views (70220) |
$133 |
$265 |
1.4× |
| Xr skull min 4 view (70260) |
$134 |
$268 |
1.2× |
| Xr spine 1 view (72020) |
$117 |
$234 |
1.3× |
| Xr spine thoracic 3v (72072) |
$142 |
$283 |
1.3× |
| Xr sternum 2+ views (71120) |
$108 |
$216 |
1.2× |
| Xr surgical specimen (76098) |
$547 |
$1,093 |
0.9× |
| Xr t-spine 2 views (72070) |
$129 |
$257 |
1.2× |
| Xr tibia/fibula 2 views (73590) |
$112 |
$224 |
1.2× |
| Xr tmj bilateral (70330) |
$133 |
$265 |
1.4× |
| Xr wrist 2 views (73100) |
$114 |
$227 |
1.2× |