| Acute gi blood loss imaging (78278) |
$684.60 |
$978 |
1.7× |
| Ankle 2 views (73600) |
$247.10 |
$353 |
2.8× |
| Cardiac MRI morphology & function w/o contrast (75557) |
$959 |
$1,370 |
3.9× |
| Cardiac MRI w/wo contrast & further seq (75561) |
$1,534.40 |
$2,192 |
4.3× |
| Clavicle complete (73000) |
$268.80 |
$384 |
3.0× |
| Computed tomographic angiography, abdomen and pelvis, with contrast material(s), including noncontrast images, if… (74174) |
$3,031.70 |
$4,331 |
8.5× |
| Computed tomographic angiography, abdomen, with contrast material(s), including noncontrast images, if performed, and… (74175) |
$1,265.60 |
$1,808 |
7.1× |
| Computed tomographic angiography, abdominal aorta and bilateral iliofemoral lower extremity runoff, with contrast… (75635) |
$2,397.50 |
$3,425 |
13.4× |
| Computed tomographic angiography, chest (noncoronary), with contrast material(s), including noncontrast images, if… (71275) |
$1,722 |
$2,460 |
9.6× |
| Computed tomographic angiography, lower extremity, with contrast material(s), including noncontrast images, if… (73706) |
$885.50 |
$1,265 |
4.9× |
| Computed tomographic angiography, neck, with contrast material(s), including noncontrast images, if performed, and… (70498) |
$1,738.80 |
$2,484 |
9.7× |
| Computed tomography, cervical spine; without contrast material, followed by contrast material(s) and further sections… (72127) |
$1,265.60 |
$1,808 |
7.1× |
| Computed tomography, lower extremity; without contrast material Age Under 21 (73700) |
$1,370.60 |
$1,958 |
12.8× |
| Computed tomography, lower extremity; without contrast material, followed by contrast material(s) and further sections… (73702) |
$1,265.60 |
$1,808 |
7.1× |
| Computed tomography, lumbar spine; without contrast material, followed by contrast material(s) and further sections Age… (72133) |
$1,265.60 |
$1,808 |
7.1× |
| Computed tomography, maxillofacial area; with contrast material(s) Age Under 21 (70487) |
$991.20 |
$1,416 |
5.5× |
| Computed tomography, maxillofacial area; without contrast material Age Under 21 (70486) |
$1,199.45 |
$1,713.50 |
11.2× |
| Computed tomography, orbit, sella, or posterior fossa or outer, middle, or inner ear; with contrast material(s) Age… (70481) |
$1,675.45 |
$2,393.50 |
9.3× |
| Computed tomography, orbit, sella, or posterior fossa or outer, middle, or inner ear; without contrast material Age… (70480) |
$793.80 |
$1,134 |
7.4× |
| Computed tomography, orbit, sella, or posterior fossa or outer, middle, or inner ear; without contrast material,… (70482) |
$1,392.30 |
$1,989 |
7.8× |
| Computed tomography, soft tissue neck; without contrast material followed by contrast material(s) and further sections… (70492) |
$1,265.60 |
$1,808 |
7.1× |
| Computed tomography, thoracic spine; without contrast material, followed by contrast material(s) and further sections… (72130) |
$1,265.60 |
$1,808 |
7.1× |
| Computed tomography, thorax, diagnostic; without contrast material, followed by contrast material(s) and further… (71270) |
$1,392.30 |
$1,989 |
7.8× |
| CT abdomen and pelvis without and with contrast (74178) |
$3,887.10 |
$5,553 |
10.9× |
| CT abdomen and pelvis without contrast (74176) |
$2,805.60 |
$4,008 |
11.5× |
| CT abdomen w & w/o contrast (74170) |
$1,483.30 |
$2,119 |
8.3× |
| CT abdomen w/contrast (74160) |
$1,265.60 |
$1,808 |
7.1× |
| CT abdomen w/o contrast (74150) |
$1,226.40 |
$1,752 |
11.5× |
| CT angio hrt w/3d image (75574) |
$1,265.60 |
$1,808 |
3.6× |
| CT cervical spine w/contrast (72126) |
$1,218 |
$1,740 |
3.4× |
| CT cervical spine w/o contrast (72125) |
$1,661.80 |
$2,374 |
15.6× |
| CT chest w/contrast (71260) |
$2,086.70 |
$2,981 |
11.6× |
| CT extremity upper w & w/o contrast (73202) |
$1,265.60 |
$1,808 |
7.1× |
| CT extremity upper w/o contrast (73200) |
$1,271.90 |
$1,817 |
11.9× |
| CT head/brain with contrast (70460) |
$1,139.60 |
$1,628 |
6.4× |
| CT head/brain without and with contrast (70470) |
$1,521.10 |
$2,173 |
8.5× |
| CT heart no contrast quant eval coronry calcium (75571) |
$236.60 |
$338 |
2.7× |
| CT l-spine w/contrast (72132) |
$1,824.90 |
$2,607 |
5.1× |
| CT limited/localized follow up study (76380) |
$573.30 |
$819 |
6.4× |
| CT lower extremity w/dye (73701) |
$1,139.60 |
$1,628 |
6.4× |
| CT lumbar spine w/o contrast (72131) |
$1,393.70 |
$1,991 |
13.0× |
| CT maxillofacial w/wo contrast (70488) |
$1,265.60 |
$1,808 |
7.1× |
| CT neck w/contrast (70491) |
$1,822.10 |
$2,603 |
10.2× |
| CT neck w/o contrast (70490) |
$791.70 |
$1,131 |
7.4× |
| CT pelvis w & w/o contrast (72194) |
$1,265.60 |
$1,808 |
7.1× |
| CT pelvis w/o contrast (72192) |
$1,602.30 |
$2,289 |
15.0× |
| CT thoracic spine w/contrast (72129) |
$1,265.60 |
$1,808 |
7.1× |
| CT thoracic spine w/o contrast (72128) |
$1,332.10 |
$1,903 |
12.5× |
| CT thorax lung cancer scr c- (71271) |
$573.30 |
$819 |
5.4× |
| CT thorax w/o contrast (71250) |
$1,449.70 |
$2,071 |
13.6× |
| CT upper extremity w/dye (73201) |
$1,339.10 |
$1,913 |
3.8× |
| CTA head w contrast (70496) |
$1,492.40 |
$2,132 |
8.3× |
| Cystography, minimum of 3 views, radiological supervision and interpretation Age Under 21 (74430) |
$1,218 |
$1,740 |
3.4× |
| Dual-energy X-ray absorptiometry (DXA), bone density study, 1 or more sites; axial skeleton (eg, hips, pelvis, spine)… (77080) |
$415.10 |
$593 |
3.9× |
| Dxa bone density study axial skeleton (77085) |
$251.30 |
$359 |
2.4× |
| Dxa bone density/peripheral (77081) |
$267.40 |
$382 |
3.0× |
| Fetal biophys profile w/o nst (76819) |
$494.20 |
$706 |
4.6× |
| Fluoroscopy up to 1 hour physician/qhp time (76000) |
$774.20 |
$1,106 |
3.2× |
| Gated heart planar single (78472) |
$760.20 |
$1,086 |
1.9× |
| Hepatobil syst imag inc gb w/pharma intervenj (78227) |
$2,360.40 |
$3,372 |
4.3× |
| Hepatobiliary syst imaging including gallbladder (78226) |
$1,187.90 |
$1,697 |
2.9× |
| Ht muscle image spect sing (78451) |
$2,632.70 |
$3,761 |
2.0× |
| Intestine imaging (eg, ectopic gastric mucosa, Meckel's localization, volvulus) Age Under 21 (78290) |
$760.20 |
$1,086 |
1.9× |
| Kidney imaging morphology; with vascular flow and function, multiple studies, with and without pharmacological… (78709) |
$987 |
$1,410 |
1.8× |
| Kidney imaging morphology; with vascular flow and function, single study, with pharmacological intervention (eg,… (78708) |
$1,542.80 |
$2,204 |
2.8× |
| Lung perfusion imaging (78580) |
$1,187.90 |
$1,697 |
2.9× |
| Magnetic resonance (eg, proton) imaging, any joint of lower extremity; without contrast material(s), followed by… (73723) |
$1,534.40 |
$2,192 |
4.3× |
| Magnetic resonance (eg, proton) imaging, lower extremity other than joint; with contrast material(s) Age Under 21 (73719) |
$1,534.40 |
$2,192 |
4.3× |
| Magnetic resonance (eg, proton) imaging, lower extremity other than joint; without contrast material(s) Age Under 21 (73718) |
$1,537.90 |
$2,197 |
6.3× |
| Magnetic resonance (eg, proton) imaging, lower extremity other than joint; without contrast material(s), followed by… (73720) |
$1,787.10 |
$2,553 |
5.0× |
| Magnetic resonance (eg, proton) imaging, orbit, face, and/or neck; with contrast material(s) Age Under 21 (70542) |
$1,534.40 |
$2,192 |
4.3× |
| Magnetic resonance (eg, proton) imaging, orbit, face, and/or neck; without contrast material(s) Age Under 21 (70540) |
$863.10 |
$1,233 |
3.5× |
| Magnetic resonance (eg, proton) imaging, upper extremity, other than joint; with contrast material(s) Age Under 21 (73219) |
$1,534.40 |
$2,192 |
4.3× |
| Magnetic resonance (eg, proton) imaging, upper extremity, other than joint; without contrast material(s), followed by… (73220) |
$1,660.75 |
$2,372.50 |
4.7× |
| Magnetic resonance angiography, head; with contrast material(s) Age Under 21 (70545) |
$1,534.40 |
$2,192 |
4.3× |
| Magnetic resonance angiography, head; without contrast material(s), followed by contrast material(s) and further… (70546) |
$1,534.40 |
$2,192 |
4.3× |
| Magnetic resonance angiography, neck; without contrast material(s), followed by contrast material(s) and further… (70549) |
$3,573.50 |
$5,105 |
10.0× |
| Mandible min 4v (70110) |
$175.70 |
$251 |
1.6× |
| MRA head w/o contrast (70544) |
$1,537.90 |
$2,197 |
6.3× |
| MRA neck w/ contrast (70548) |
$1,380.40 |
$1,972 |
3.9× |
| MRA neck w/o contrast (70547) |
$959 |
$1,370 |
3.9× |
| MRI abdomen w/contrast (74182) |
$1,534.40 |
$2,192 |
4.3× |
| MRI abdomen w/o contrast (74181) |
$959 |
$1,370 |
3.9× |
| MRI abdomen w/wo contrast (74183) |
$1,966.30 |
$2,809 |
5.5× |
| MRI any jt lower extrem w/contrast material (73722) |
$2,601.90 |
$3,717 |
3.2× |
| MRI c-spine w&w/o cont (72156) |
$2,090.90 |
$2,987 |
5.9× |
| MRI cervical spine w/contrast (72142) |
$1,534.40 |
$2,192 |
4.3× |
| MRI chest w/contrast (71551) |
$2,979.20 |
$4,256 |
3.7× |
| MRI chest w/o contrast (71550) |
$1,054.90 |
$1,507 |
4.3× |
| MRI chest w/wo contrast (71552) |
$1,534.40 |
$2,192 |
4.3× |
| MRI joint upr extr w/o&w/dye (73223) |
$1,686.30 |
$2,409 |
4.7× |
| MRI joint upr extrem w/dye (73222) |
$1,064.70 |
$1,521 |
1.3× |
| MRI joint upr extrem w/o dye (73221) |
$1,099.70 |
$1,571 |
4.5× |
| MRI lumbar spine w/contrast (72149) |
$1,534.40 |
$2,192 |
4.3× |
| MRI lumbar spine w/wo contrast (72158) |
$2,012.50 |
$2,875 |
5.6× |
| MRI orbit/face/neck w&w/o cont (70543) |
$1,787.10 |
$2,553 |
5.0× |
| MRI pelvis w & w/o contrast (72197) |
$2,111.20 |
$3,016 |
5.9× |
| MRI pelvis w/contrast (72196) |
$1,534.40 |
$2,192 |
4.3× |
| MRI pelvis w/o contrast (72195) |
$1,641.50 |
$2,345 |
6.7× |
| MRI spine cervical w/o contrast (72141) |
$1,634.50 |
$2,335 |
6.7× |
| MRI t-spine w&w/o cont (72157) |
$2,046.80 |
$2,924 |
5.7× |
| MRI thoracic spine w/contrast (72147) |
$1,534.40 |
$2,192 |
4.3× |
| MRI thoracic spine w/o contrst (72146) |
$1,634.50 |
$2,335 |
6.7× |
| MRI tmj (70336) |
$1,054.90 |
$1,507 |
4.3× |
| MRI upper extremity oth than jt w/o contr matrl (73218) |
$959 |
$1,370 |
3.9× |
| Myocardial spect multiple studies (78452) |
$3,920.70 |
$5,601 |
3.0× |
| Nm bone 3 phase (78315) |
$1,831.90 |
$2,617 |
4.5× |
| Nm bone imaging whole body (78306) |
$1,746.50 |
$2,495 |
4.3× |
| Nm gastric emptying (78264) |
$1,575.70 |
$2,251 |
3.9× |
| Nm lung ventilation imaging (78579) |
$760.20 |
$1,086 |
1.9× |
| Nm lymph system (78195) |
$1,336.30 |
$1,909 |
2.4× |
| Nuclear medicine study of bone and/or joint limited area (78300) |
$760.20 |
$1,086 |
1.9× |
| Ob us limited fetus(s) (76815) |
$396.20 |
$566 |
3.7× |
| Ob us nuchal meas 1 gest (76813) |
$494.20 |
$706 |
4.6× |
| Parathyroid planar imaging (78070) |
$1,288 |
$1,840 |
3.2× |
| Pulmonary ventilation & perfusion imaging (78582) |
$2,584.40 |
$3,692 |
4.7× |
| Radex entir thrc lmbr crv sac spi w/skull 1 vw (72081) |
$228.90 |
$327 |
2.6× |
| Radex entir thrc lmbr crv sac spi w/skull 2/3 vw (72082) |
$381.50 |
$545 |
3.6× |
| Radex hip unilateral with pelvis 1 view (73501) |
$212.80 |
$304 |
2.4× |
| Radex hip unilateral with pelvis 2-3 views (73502) |
$265.30 |
$379 |
3.0× |
| Radex hip unilateral with pelvis minimum 4 views (73503) |
$372.40 |
$532 |
3.5× |
| Radex hips bilateral with pelvis 2 views (73521) |
$396.90 |
$567 |
3.7× |
| Radex hips bilateral with pelvis minimum 5 views (73523) |
$505.40 |
$722 |
4.7× |
| Radex spine cervical 2 or 3 views (72040) |
$270.20 |
$386 |
3.0× |
| Radex spine cervical 4 or 5 views (72050) |
$340.90 |
$487 |
3.2× |
| Radex spine cervical 6 or more views (72052) |
$403.20 |
$576 |
3.8× |
| Radex spine thoracolumbar junction min 2 views (72080) |
$308.70 |
$441 |
3.5× |
| Radiologic exam abdomen 3+ views (74021) |
$319.90 |
$457 |
3.0× |
| Radiologic exam chest 4+ views (71048) |
$705.60 |
$1,008 |
6.6× |
| Radiologic exam colon double contrast study (74280) |
$891.10 |
$1,273 |
5.0× |
| Radiologic exam colon single contrast study (74270) |
$590.10 |
$843 |
3.3× |
| Radiologic exam esophagus double contrast study (74221) |
$649.60 |
$928 |
3.6× |
| Radiologic exam esophagus single contrast study (74220) |
$436.80 |
$624 |
2.4× |
| Radiologic exam small int single contrast study (74250) |
$191.10 |
$273 |
1.1× |
| Radiologic exam swallow function contrast study (74230) |
$702.80 |
$1,004 |
3.9× |
| Radiologic exam upr gi trc single contrast study (74240) |
$649.60 |
$928 |
3.6× |
| Radiologic examination femur 1 view (73551) |
$366.80 |
$524 |
4.1× |
| Radiologic examination femur minimum 2 views (73552) |
$198.10 |
$283 |
2.2× |
| Radiologic examination from nose to rectum for foreign body, single view, child Age Under 21 (76010) |
$378 |
$540 |
4.3× |
| Radiologic examination, ankle; complete, minimum of 3 views Age Under 21 (73610) |
$267.40 |
$382 |
3.0× |
| Radiologic examination, complete acute abdomen series, including 2 or more views of the abdomen (eg, supine, erect,… (74022) |
$319.90 |
$457 |
3.0× |
| Radiologic examination, elbow; 2 views Age Under 21 (73070) |
$326.90 |
$467 |
3.7× |
| Radiologic examination, elbow; complete, minimum of 3 views Age Under 21 (73080) |
$381.50 |
$545 |
4.3× |
| Radiologic examination, facial bones; less than 3 views Age Under 21 (70140) |
$366.80 |
$524 |
4.1× |
| Radiologic examination, foot; complete, minimum of 3 views Age Under 21 (73630) |
$244.30 |
$349 |
2.7× |
| Radiologic examination, hand; minimum of 3 views Age Under 21 (73130) |
$229.60 |
$328 |
2.6× |
| Radiologic examination, knee; both knees, standing, anteroposterior Age Under 21 (73565) |
$176.40 |
$252 |
2.0× |
| Radiologic examination, knee; complete, 4 or more views Age Under 21 (73564) |
$500.50 |
$715 |
4.7× |
| Radiologic examination, mandible; partial, less than 4 views Age Under 21 (70100) |
$366.80 |
$524 |
4.1× |
| Radiologic examination, nasal bones, complete, minimum of 3 views Age Under 21 (70160) |
$152.60 |
$218 |
1.7× |
| Radiologic examination, ribs, bilateral; including posteroanterior chest, minimum of 4 views Age Under 21 (71111) |
$360.50 |
$515 |
3.4× |
| Radiologic examination, ribs, unilateral; including posteroanterior chest, minimum of 3 views Age Under 21 (71101) |
$311.50 |
$445 |
2.9× |
| Radiologic examination, sacroiliac joints; less than 3 views Age Under 21 (72200) |
$270.90 |
$387 |
2.5× |
| Radiologic examination, shoulder, arthrography, radiological supervision and interpretation Age Under 21 (73040) |
$846.30 |
$1,209 |
2.4× |
| Radiologic examination, shoulder; complete, minimum of 2 views Age Under 21 (73030) |
$298.90 |
$427 |
3.4× |
| Radiologic examination, sinuses, paranasal, less than 3 views Age Under 21 (70210) |
$267.40 |
$382 |
3.0× |
| Radiologic examination, skull; less than 4 views Age Under 21 (70250) |
$342.30 |
$489 |
3.2× |
| Radiologic examination, spine, lumbosacral; 2 or 3 views Age Under 21 (72100) |
$282.10 |
$403 |
2.6× |
| Radiologic examination, spine, lumbosacral; bending views only, 2 or 3 views Age Under 21 (72120) |
$290.50 |
$415 |
2.7× |
| Radiologic examination, spine, lumbosacral; complete, including bending views, minimum of 6 views Age Under 21 (72114) |
$387.10 |
$553 |
3.6× |
| Radiologic examination, spine; thoracic, minimum of 4 views Age Under 21 (72074) |
$482.30 |
$689 |
4.5× |
| Radiologic examination, wrist; complete, minimum of 3 views Age Under 21 (73110) |
$281.40 |
$402 |
3.2× |
| Radiologic examination; acromioclavicular joints, bilateral, with or without weighted distraction Age Under 21 (73050) |
$294 |
$420 |
3.3× |
| Radiologic examination; humerus, minimum of 2 views Age Under 21 (73060) |
$240.10 |
$343 |
2.7× |
| Radiologic examination; lower extremity, infant, minimum of 2 views Age Under 21 (73592) |
$352.80 |
$504 |
4.0× |
| Radiologic examination; orbits, complete, minimum of 4 views Age Under 21 (70200) |
$396.20 |
$566 |
3.7× |
| Radiologic examination; sternoclavicular joint or joints, minimum of 3 views Age Under 21 (71130) |
$366.80 |
$524 |
4.1× |
| Radiologic examination; toe(s), minimum of 2 views Age Under 21 (73660) |
$158.90 |
$227 |
1.8× |
| Radiologic examination; upper extremity, infant, minimum of 2 views Age Under 21 (73092) |
$494.20 |
$706 |
4.6× |
| Review by radiologist of urinary bladder and urethra images with contrast and after passing urine (74455) |
$761.60 |
$1,088 |
3.1× |
| Rp loclzj tum spect w/CT 1 (78830) |
$2,632.70 |
$3,761 |
2.0× |
| Saline infusion sonohysterography (SIS), including color flow Doppler, when performed Age Under 21 (76831) |
$532.70 |
$761 |
2.2× |
| Scapula complete (73010) |
$324.10 |
$463 |
3.0× |
| Screening digital breast tomosynthesis bi (77063) |
$38.50 |
$55 |
— |
| Shuntogram indwelling nonvascular shunt rs&i (75809) |
$360.50 |
$515 |
3.4× |
| Thyroid imaging with vascular flow (78013) |
$799.40 |
$1,142 |
2.0× |
| Thyroid uptake single/multiple quant measurement (78012) |
$499.10 |
$713 |
1.2× |
| Thyroid uptake w/blood flow sngle/mult quan meas (78014) |
$2,191 |
$3,130 |
5.4× |
| Ultrasound breast limited (76642) |
$405.30 |
$579 |
4.6× |
| Ultrasound, abdomen limited (76705) |
$510.30 |
$729 |
4.8× |
| Ultrasound, limited, joint or focal evaluation of other nonvascular extremity structure(s) (eg, joint space,… (76882) |
$350 |
$500 |
3.3× |
| Ultrasound, pelvic (nonobstetric), real time with image documentation; complete Age Under 21 (76856) |
$613.90 |
$877 |
5.7× |
| Ultrasound, pregnant uterus, real time with image documentation, fetal and maternal evaluation plus detailed fetal… (76811) |
$761.60 |
$1,088 |
3.1× |
| Ultrasound, pregnant uterus, real time with image documentation, fetal and maternal evaluation, first trimester (< 14… (76801) |
$336.70 |
$481 |
3.2× |
| Ultrasound, transplanted kidney, real time and duplex Doppler with image documentation Age Under 21 (76776) |
$413.70 |
$591 |
3.9× |
| Umbilical-artery Doppler (OB) (76820) |
$44.10 |
$63 |
0.4× |
| Urography (pyelography), intravenous, with or without KUB, with or without tomography Age Under 21 (74400) |
$809.90 |
$1,157 |
4.5× |
| Us abdominal aorta real time screen study aaa (76706) |
$527.80 |
$754 |
4.9× |
| Us breast uni real time with image complete (76641) |
$514.50 |
$735 |
4.8× |
| Us chest (76604) |
$353.50 |
$505 |
3.3× |
| Us compl joint r-t w/image documentation (76881) |
$488.60 |
$698 |
4.6× |
| Us encephalogram (76506) |
$494.20 |
$706 |
4.6× |
| Us exam, pelvic, limited (76857) |
$339.15 |
$484.50 |
3.2× |
| Us inft hips r-t img dynamic req phys/qhp manj (76885) |
$366.80 |
$524 |
4.1× |
| Us inft hips r-t img lmtd static phys/qhp manj (76886) |
$366.80 |
$524 |
4.1× |
| US OB Follow-Up/Repeat (76816) |
$319.90 |
$457 |
3.0× |
| Us ob transvaginal (76817) |
$360.50 |
$515 |
3.4× |
| Us retroperitoneal complete (76770) |
$749.70 |
$1,071 |
7.0× |
| Us retroperitoneal ltd (76775) |
$375.20 |
$536 |
3.5× |
| Us scrotum (76870) |
$497.70 |
$711 |
4.7× |
| Us soft tissue head/neck (76536) |
$501.20 |
$716 |
4.7× |
| Us transrectal (76872) |
$350 |
$500 |
3.3× |
| Venography deep dorsal vein penis radiolgicl supervision interpretation (76499) |
$366.80 |
$524 |
4.1× |
| Venography, extremity, unilateral, radiological supervision and interpretation Age Under 21 (75820) |
$4,650.80 |
$6,644 |
2.9× |
| Vertebral fracture assessment via dxa (77086) |
$366.80 |
$524 |
4.1× |
| X-ray exam hips bi 3-4 views (73522) |
$399 |
$570 |
3.7× |
| X-ray exam of finger(s) (73140) |
$180.60 |
$258 |
2.0× |
| X-ray exam of knee 1 or 2 (73560) |
$333.20 |
$476 |
3.7× |
| X-ray exam ribs bil 3 views (71110) |
$263.90 |
$377 |
2.5× |
| X-ray exam ribs uni 2 views (71100) |
$291.20 |
$416 |
3.3× |
| X-ray heel (73650) |
$196.70 |
$281 |
2.2× |
| X-ray of joint between lower spine and hip bone 3 or more views|PROFESSIONAL COMPONENT (72202) |
$296.80 |
$424 |
2.8× |
| X-ray retrograde pyelogram (74420) |
$1,218 |
$1,740 |
3.4× |
| Xr abdomen 1 view (74018) |
$207.20 |
$296 |
2.3× |
| Xr abdomen 2 views (74019) |
$250.60 |
$358 |
2.3× |
| Xr bone age studies (77072) |
$431.90 |
$617 |
4.0× |
| Xr bone length study (77073) |
$444.50 |
$635 |
4.2× |
| Xr bone survey infant (77076) |
$444.50 |
$635 |
4.2× |
| Xr chest 1 view (71045) |
$189 |
$270 |
2.1× |
| Xr chest 2 views (71046) |
$241.50 |
$345 |
2.7× |
| Xr eye foreign body (70030) |
$85.40 |
$122 |
1.0× |
| Xr facial bones 3+ views (70150) |
$396.20 |
$566 |
3.7× |
| Xr foot arthritis pa only bilateral - report(ortho pro) (73620) |
$212.10 |
$303 |
2.4× |
| Xr forearm 2 views (73090) |
$352.10 |
$503 |
4.0× |
| Xr hand 2v (73120) |
$161 |
$230 |
1.5× |
| Xr hysterosalpingogram (74740) |
$761.60 |
$1,088 |
3.1× |
| Xr neck soft tissue (70360) |
$194.60 |
$278 |
2.2× |
| Xr o knee w/ merchant view bilat - report(ortho pro) (73562) |
$300.30 |
$429 |
3.4× |
| Xr osseous survey complete (77075) |
$678.30 |
$969 |
6.4× |
| Xr pelvis 1-2 views (72170) |
$315 |
$450 |
2.9× |
| Xr pelvis min 3 view (72190) |
$366.10 |
$523 |
3.4× |
| Xr sacrum/coccyx 2+ views (72220) |
$291.90 |
$417 |
3.3× |
| Xr shoulder 1 view (73020) |
$184.80 |
$264 |
2.1× |
| Xr sinuses 3+ views (70220) |
$366.80 |
$524 |
4.1× |
| Xr skull min 4 view (70260) |
$360.50 |
$515 |
3.4× |
| Xr spine 1 view (72020) |
$236.60 |
$338 |
2.7× |
| Xr spine thoracic 3v (72072) |
$431.90 |
$617 |
4.0× |
| Xr sternum 2+ views (71120) |
$352.80 |
$504 |
4.0× |
| Xr stress view joint (77071) |
$431.90 |
$617 |
4.9× |
| Xr surgical specimen (76098) |
$410.90 |
$587 |
0.7× |
| Xr t-spine 2 views (72070) |
$378 |
$540 |
3.5× |
| Xr tibia/fibula 2 views (73590) |
$262.50 |
$375 |
3.0× |
| Xr tmj bilateral (70330) |
$366.80 |
$524 |
4.1× |
| Xr tmj unilateral (70328) |
$242.90 |
$347 |
2.7× |
| Xr wrist 2 views (73100) |
$317.10 |
$453 |
3.6× |