| Abdomen 2 views (74019) |
$115.50 |
$154 |
1.2× |
| Acute gastrointestinal blood loss imaging (78278) |
$665.25 |
$887 |
1.8× |
| Angiography extremity bilateral rs&i (75716) |
$2,733.75 |
$3,645 |
1.0× |
| Angiography extremity unilateral rs&i (75710) |
$2,733.75 |
$3,645 |
1.0× |
| Angiography pulmonary bilateral slctv rs&i (75743) |
$2,733.75 |
$3,645 |
1.0× |
| Angiography pulmonary unilateral slctv rs&i (75741) |
$1,165.50 |
$1,554 |
0.4× |
| Angiography visceral slctv/supraslctv rs&i (75726) |
$2,816.25 |
$3,755 |
0.6× |
| Angrph Cath F-Up Std Tcat Other Than Thrombylsis (75898) |
$566.25 |
$755 |
0.2× |
| Ankle 2 views (73600) |
$97.50 |
$130 |
1.2× |
| Antegrade urography radiological supvj & interpj (74425) |
$337.50 |
$450 |
1.1× |
| Aortogram thoracic (75605) |
$2,733.75 |
$3,645 |
0.5× |
| Aortography abdl bi iliofem low extrem cath rs&i (75630) |
$4,229.66 |
$5,639.55 |
1.5× |
| Aortography abdominal serialography rs&i (75625) |
$2,733.75 |
$3,645 |
1.0× |
| Aortography thoracic w/o serialography rs&i (75600) |
$2,733.75 |
$3,645 |
1.0× |
| Arthrogram hip (73525) |
$468.75 |
$625 |
1.5× |
| Arthrogram shoulder (73040) |
$553.50 |
$738 |
1.8× |
| Arthrography knee lt (73580) |
$468.75 |
$625 |
1.5× |
| Bone &/Joint Imaging Limited Area (78300) |
$633 |
$844 |
1.7× |
| Bone &/Joint Imaging Multiple Areas (78305) |
$536.25 |
$715 |
1.5× |
| Bone &/joint imaging whole body (78306) |
$633 |
$844 |
1.7× |
| Bone age studies (77072) |
$127.50 |
$170 |
1.3× |
| Bone Imaging 3 Phase (78315) |
$633 |
$844 |
1.7× |
| Bone survey complete (77075) |
$278.25 |
$371 |
2.9× |
| Brain image w/flow 4 + views (78606) |
$693.75 |
$925 |
1.4× |
| Brain Imaging Minimum 4 Static Views (78605) |
$693.75 |
$925 |
1.4× |
| Cervical spine 2 or 3 views (72040) |
$115.50 |
$154 |
1.5× |
| Chest 1 view (71045) |
$115.50 |
$154 |
1.5× |
| Chest 3 views (71047) |
$115.50 |
$154 |
1.5× |
| Cine/Vid X-Ray Throat/Esoph - Fl Esoph Barium Swlw W/ Video & Speech (74230) |
$375 |
$500 |
2.4× |
| Clavicle complete (73000) |
$115.50 |
$154 |
1.5× |
| Computed Tomography Thorax Lw Dose Lng Ca Scr C- (71271) |
$300 |
$400 |
3.2× |
| CT abdomen and pelvis without and with contrast (74178) |
$2,250 |
$3,000 |
7.1× |
| CT abdomen and pelvis without contrast (74176) |
$2,250 |
$3,000 |
10.4× |
| CT abdomen w contrast (74160) |
$1,327.50 |
$1,770 |
8.4× |
| CT abdomen w wo contrast (74170) |
$1,593 |
$2,124 |
10.0× |
| CT abdomen w/o contrast (74150) |
$1,146.38 |
$1,528.50 |
12.1× |
| CT angio hrt w/3d image (75574) |
$1,462.50 |
$1,950 |
4.6× |
| CT angiography upper extremity lt (73206) |
$1,950 |
$2,600 |
12.3× |
| CT c-spine w/o contrast (72125) |
$1,540.50 |
$2,054 |
16.3× |
| CT cervical spine w&w/o contrast (72127) |
$1,950 |
$2,600 |
12.3× |
| CT cervical spine with contrast (72126) |
$1,560 |
$2,080 |
4.9× |
| CT chest w/wo contrast (71270) |
$1,725.75 |
$2,301 |
10.9× |
| CT chest with contrast (71260) |
$1,380.75 |
$1,841 |
8.7× |
| CT head/brain with contrast (70460) |
$1,500 |
$2,000 |
9.4× |
| CT head/brain without and with contrast (70470) |
$1,734.75 |
$2,313 |
10.9× |
| CT heart contrast eval cardiac structure&morph (75572) |
$1,462.50 |
$1,950 |
4.6× |
| CT heart no contrast quant eval coronry calcium (75571) |
$99 |
$132 |
1.3× |
| CT hrt w/3d image congen (75573) |
$1,462.50 |
$1,950 |
4.6× |
| CT iac w contrast (70481) |
$950.62 |
$1,267.50 |
6.0× |
| CT limited/localized follow up study (76380) |
$990 |
$1,320 |
12.6× |
| CT lower ext w/o (73700) |
$1,500 |
$2,000 |
15.8× |
| CT lower extremity w wo contrast (73702) |
$1,252.50 |
$1,670 |
7.9× |
| CT lower extremity with contrast (73701) |
$1,181.25 |
$1,575 |
7.4× |
| CT lumbar spine w & w/o contrast (72133) |
$2,301 |
$3,068 |
14.5× |
| CT lumbar spine w/o contrast (72131) |
$1,540.50 |
$2,054 |
16.3× |
| CT lumbar spine with contrast (72132) |
$1,560 |
$2,080 |
4.9× |
| CT maxillofacial w contrast (70487) |
$1,327.50 |
$1,770 |
8.4× |
| CT maxillofacial w/o contrast (70486) |
$1,135.12 |
$1,513.50 |
12.0× |
| CT maxillofacial w/wo contrast (70488) |
$1,327.50 |
$1,770 |
8.4× |
| CT neck soft tissue w contrast (70491) |
$1,115.25 |
$1,487 |
7.0× |
| CT orbit sella/post fossa/ear w/o & w/contr matr (70482) |
$1,192.50 |
$1,590 |
7.5× |
| CT orbits w/o contrast (70480) |
$961.88 |
$1,282.50 |
10.2× |
| CT pelvis w & w/o contrast (72194) |
$1,471.50 |
$1,962 |
9.3× |
| CT pelvis w/o contrast (72192) |
$1,115.25 |
$1,487 |
11.8× |
| CT soft tissue neck w/o & w/contrast material (70492) |
$1,616.25 |
$2,155 |
10.2× |
| CT soft tissue neck w/o contrast (70490) |
$798.75 |
$1,065 |
8.4× |
| CT thoracic spine w/contrast (72129) |
$1,560 |
$2,080 |
9.8× |
| CT thoracic spine w/o contrast (72128) |
$1,540.50 |
$2,054 |
16.3× |
| CT thoracic spine w/wo contrast (72130) |
$1,540.50 |
$2,054 |
9.7× |
| CT thorax w/o contrast (71250) |
$1,150.50 |
$1,534 |
12.2× |
| CT upper extremity w/o & w/contrast material (73202) |
$1,252.50 |
$1,670 |
7.9× |
| CT upper extremity w/o contrast rt (73200) |
$1,035 |
$1,380 |
10.9× |
| CT upper extremity with contrast (73201) |
$1,275 |
$1,700 |
4.0× |
| Cta Abdl Aorta&Bi Iliofem W/Contrast&Postp (75635) |
$2,400 |
$3,200 |
15.1× |
| Cta Abdomen (74175) |
$2,137.50 |
$2,850 |
13.5× |
| CTA abdomen pelvis (74174) |
$2,250 |
$3,000 |
7.1× |
| CTA chest (71275) |
$1,462.50 |
$1,950 |
9.2× |
| Cta Head (70496) |
$1,950 |
$2,600 |
12.3× |
| CTA lwr ext w&w/o contrast (73706) |
$1,950 |
$2,600 |
12.3× |
| Cta Neck (70498) |
$1,950 |
$2,600 |
12.3× |
| Cta Pelvis (72191) |
$2,137.50 |
$2,850 |
13.5× |
| Cystography minimum 3 views rs&i (74430) |
$404.25 |
$539 |
1.3× |
| Diskogram cervical (72285) |
$1,631.25 |
$2,175 |
0.9× |
| Diskography lumbar (72295) |
$1,634.25 |
$2,179 |
0.9× |
| Dxa bone density study 1/> sites axial skel (77080) |
$163.50 |
$218 |
1.7× |
| Echoencephalography real time imaging (76506) |
$174 |
$232 |
1.8× |
| Esophagus (74220) |
$198.75 |
$265 |
1.3× |
| Fetal Biophysical Profile W/O Non-Stress Testing (76819) |
$252.75 |
$337 |
2.7× |
| Fluoroscopy up to 1 hr (76000) |
$300 |
$400 |
1.4× |
| Foot 2 views (73620) |
$97.50 |
$130 |
1.2× |
| Forearm 2 views (73090) |
$115.50 |
$154 |
1.5× |
| Full Mouth X-Ray Of Teeth - Xr Teeth Full Mouth (70320) |
$108.75 |
$145 |
0.5× |
| Gated Heart Planar Single (78472) |
$562.50 |
$750 |
1.6× |
| Hand 3 views (73130) |
$115.50 |
$154 |
1.5× |
| Heart Infarct Image (78466) |
$562.50 |
$750 |
1.6× |
| Hepatobil Syst Imag Inc Gb W/Pharma Intervenj (78227) |
$681.75 |
$909 |
1.4× |
| Hepatobiliary syst imaging including gallbladder (78226) |
$681.75 |
$909 |
1.9× |
| Humerus Min 2 Views Left (73060) |
$115.50 |
$154 |
1.5× |
| Hysterosalpingogram (74740) |
$816.75 |
$1,089 |
3.8× |
| Kidney imaging morphology (78700) |
$491.25 |
$655 |
1.4× |
| Kidney Img Morphology Vascular Flow 1 W/O Rx (78707) |
$496.16 |
$661.55 |
1.0× |
| Kidney img morphology vascular flow 1 w/rx (78708) |
$720.36 |
$960.48 |
1.5× |
| Kidney Img Morphology Vascular Flow Multiple (78709) |
$555 |
$740 |
1.1× |
| Knee 3 views (73562) |
$127.50 |
$170 |
1.6× |
| Liver & spleen imaging static only (78215) |
$681.75 |
$909 |
1.9× |
| Lung perf&ventilat diferentl (78598) |
$900 |
$1,200 |
1.8× |
| Lung perfusion differential (78597) |
$450 |
$600 |
1.2× |
| Lymphoscintigraphy (78195) |
$815.25 |
$1,087 |
1.7× |
| Meckels Diverticulum (78290) |
$506.25 |
$675 |
1.4× |
| MRA head w & w/o contrast (70546) |
$1,140 |
$1,520 |
3.6× |
| MRA head w/o contrast (70544) |
$929.25 |
$1,239 |
4.3× |
| MRA head with contrast (70545) |
$881.25 |
$1,175 |
2.8× |
| MRA neck w contrast (70548) |
$881.25 |
$1,175 |
2.8× |
| Mra Neck W/O &W/Contrast Material (70549) |
$1,140 |
$1,520 |
3.6× |
| MRA neck w/o contrast (70547) |
$787.50 |
$1,050 |
3.6× |
| MRI abdomen w/o & w/contrast material (74183) |
$1,125 |
$1,500 |
3.6× |
| MRI abdomen w/o contrast (74181) |
$900 |
$1,200 |
4.2× |
| MRI any jnt lwr ext with con lt (73722) |
$1,229.25 |
$1,639 |
1.7× |
| MRI any jt upper extremity w/contrast matrl (73222) |
$1,150.50 |
$1,534 |
1.6× |
| MRI breast w/o contrast bilateral (77047) |
$1,500 |
$2,000 |
6.9× |
| MRI breast w/o contrast unilat (77046) |
$1,125 |
$1,500 |
5.2× |
| MRI c-spine with contrast (72142) |
$1,048.50 |
$1,398 |
3.3× |
| MRI cervical spine w/o contrast (72141) |
$1,062 |
$1,416 |
4.9× |
| MRI chest w/o & w/contrast material (71552) |
$900 |
$1,200 |
2.8× |
| MRI chest w/o contrast (71550) |
$900 |
$1,200 |
4.2× |
| MRI chest with contrast (71551) |
$1,125 |
$1,500 |
1.6× |
| MRI Forearm w/ Contrast Bilateral 73219 (73219) |
$1,345.50 |
$1,794 |
4.3× |
| MRI lower extrem oth/thn jt w/contrast matrl (73719) |
$1,345.50 |
$1,794 |
4.3× |
| MRI lower extrem oth/thn jt w/o contr matrl (73718) |
$1,345.50 |
$1,794 |
6.2× |
| MRI orbit face &/neck w/o contrast (70540) |
$886.50 |
$1,182 |
4.1× |
| MRI orbit/face/neck w&w/o cont (70543) |
$1,209 |
$1,612 |
3.8× |
| MRI orbit/face/neck w/contrast (70542) |
$1,048.50 |
$1,398 |
3.3× |
| MRI pelvis w/o & w/contrast material (72197) |
$1,200 |
$1,600 |
3.8× |
| MRI pelvis w/o contrast (72195) |
$1,016.25 |
$1,355 |
4.7× |
| MRI scan of arm joint before and after contrast (73223) |
$1,150.50 |
$1,534 |
3.6× |
| MRI scan of leg joint before and after contrast (73723) |
$1,150.50 |
$1,534 |
3.6× |
| MRI spinal canal cervical w/o & w/contr matrl (72156) |
$1,222.50 |
$1,630 |
3.9× |
| MRI spinal canal lumbar w/contrast material (72149) |
$1,035 |
$1,380 |
3.3× |
| MRI spinal canal lumbar w/o & w/contr matrl (72158) |
$1,418.25 |
$1,891 |
4.5× |
| MRI spinal canal thoracic w/contrast matrl (72147) |
$1,048.50 |
$1,398 |
3.3× |
| MRI spinal canal thoracic w/o & w/contr matrl (72157) |
$1,222.50 |
$1,630 |
3.9× |
| MRI thoracic spine w/o contrast (72146) |
$1,062 |
$1,416 |
4.9× |
| MRI tmj (70336) |
$1,209 |
$1,612 |
5.6× |
| MRI upper ext joint w/o contrast (73221) |
$1,046.25 |
$1,395 |
4.8× |
| MRI upper extrem other than jt w/o & w/contras (73220) |
$1,345.50 |
$1,794 |
4.3× |
| MRI upper extremity oth than jt w/o contr matrl (73218) |
$1,345.50 |
$1,794 |
6.2× |
| Myelogram Cervical (72240) |
$588.75 |
$785 |
0.8× |
| Myelogram Lumbar (72265) |
$588.75 |
$785 |
0.8× |
| Myelogram thoracic (72255) |
$498.75 |
$665 |
0.7× |
| Myelography 2 or more regions (72270) |
$713.25 |
$951 |
1.0× |
| Myocardial Spect Multiple Studies (78452) |
$2,217.75 |
$2,957 |
1.9× |
| Neck soft tissue (70360) |
$115.50 |
$154 |
1.5× |
| Nm gastric emptying study (78264) |
$506.25 |
$675 |
1.4× |
| Nm gastroesophageal reflux study (78262) |
$506.25 |
$675 |
1.4× |
| Nm peritoneal-venous shunt patency (78291) |
$552 |
$736 |
1.5× |
| Nuclear medicine study of heart muscle at rest with stress (78453) |
$570.75 |
$761 |
0.5× |
| Nuclear medicine study of kidney and blood flow (78701) |
$504.08 |
$672.10 |
1.4× |
| Ob Us Follow-Up Per Fetus - Us Ob Follow Up Transabdominal Approach (76816) |
$162 |
$216 |
1.7× |
| Osseous survey infant (77076) |
$195 |
$260 |
2.1× |
| Osseous survey limited (77074) |
$111.16 |
$148.22 |
1.2× |
| Parathyroid imaging (78070) |
$375 |
$500 |
1.0× |
| Pelvis 1 or 2 views (72170) |
$115.50 |
$154 |
1.2× |
| Pr heart first pass single,planar (78481) |
$562.50 |
$750 |
1.1× |
| Pr MRI, lower extr, w/o contrast f/u by contrast (73720) |
$1,345.50 |
$1,794 |
4.3× |
| Pulmonary Perfusion Imaging Particulate (78580) |
$450 |
$600 |
1.2× |
| Pulmonary Ventilation & Perfusion Imaging (78582) |
$900 |
$1,200 |
1.8× |
| Radex abscess/fistula/sinus tract rs&i (76080) |
$228.75 |
$305 |
0.5× |
| Radex Entir Thrc Lmbr Crv Sac Spi W/Skull 1 Vw - Xr Scoliosis 1 Vw (72081) |
$115.50 |
$154 |
1.5× |
| Radex hips bilateral with pelvis 2 views (73521) |
$168.75 |
$225 |
1.8× |
| Radex mastoids compl minimum 3 views pr side (70130) |
$97.65 |
$130.20 |
1.0× |
| Radex X-Ray Exam Entire Spi 6/> Vw - Xr Entire Spine 6+ Vw (72084) |
$231 |
$308 |
2.4× |
| Radiolog exam mandible compl minimum 4 views (70110) |
$115.50 |
$154 |
1.2× |
| Radiologic Exam Abdomen 1 View - Xr Abdomen 1 View (74018) |
$111.08 |
$148.10 |
1.4× |
| Radiologic Exam Abdomen 3+ Views - Xr Abdomen 3+ Views (74021) |
$115.50 |
$154 |
1.2× |
| Radiologic Exam Chest 2 Views - Xr Chest 2 Views (71046) |
$115.50 |
$154 |
1.5× |
| Radiologic exam colon single contrast study (74270) |
$198.75 |
$265 |
1.3× |
| Radiologic Exam Esophagus Double Contrast Study (74221) |
$210 |
$280 |
1.3× |
| Radiologic exam upr gi trc double contrast study (74246) |
$198.75 |
$265 |
1.3× |
| Radiologic exam upr gi trc single contrast study (74240) |
$198.75 |
$265 |
1.3× |
| Radiologic Examination Femur Minimum 2 Views - Xr Femur 2+ Vw Lt (73552) |
$115.50 |
$154 |
1.5× |
| Radiological examination surgical specimen (76098) |
$161.25 |
$215 |
0.3× |
| Ribs bilateral 3 views (71110) |
$180 |
$240 |
1.9× |
| Rp loclzj tum plnr 2+area 1+d img/1 area img>2+d (78801) |
$375 |
$500 |
1.0× |
| Rp loclzj tum plnr whole body single day imaging (78802) |
$862.50 |
$1,150 |
1.8× |
| Rp loclzj tum spect 1 area single day imaging (78803) |
$862.50 |
$1,150 |
1.8× |
| Rp loclzj tum spect CT 2area 1d img/1 ar img>2+d (78832) |
$2,100 |
$2,800 |
1.6× |
| Rp loclzj tum spect w/CT 1 area 1 day imaging (78830) |
$1,875 |
$2,500 |
1.6× |
| Salivary gland function study (78232) |
$675 |
$900 |
1.9× |
| Salivary gland imaging (78230) |
$525 |
$700 |
1.5× |
| Salivary gland imaging serial images (78231) |
$600 |
$800 |
1.7× |
| Scanogram (77073) |
$142.12 |
$189.50 |
1.5× |
| Scapula complete (73010) |
$115.50 |
$154 |
1.2× |
| Screening digital breast tomosynthesis (77063) |
$37.50 |
$50 |
1.6× |
| Sella turcica (70240) |
$97.50 |
$130 |
1.2× |
| Shuntogram indwelling nonvascular shunt rs&i (75809) |
$136.85 |
$182.47 |
1.4× |
| Sialogram (70390) |
$228.75 |
$305 |
1.1× |
| Small bowel series (74250) |
$198.75 |
$265 |
1.3× |
| Spine thoracic 3 views (72072) |
$120 |
$160 |
1.3× |
| Testicular Imaging With Vascular Flow (78761) |
$487.50 |
$650 |
1.3× |
| Therapeutic Enema (74283) |
$262.50 |
$350 |
1.7× |
| Thyroid carcinoma metastases img whole body (78018) |
$640.50 |
$854 |
1.3× |
| Thyroid Imaging With Vascular Flow (78013) |
$330 |
$440 |
0.9× |
| Thyroid uptake measurement (78012) |
$442.50 |
$590 |
1.2× |
| Tomogram (76100) |
$174.04 |
$232.05 |
1.8× |
| Tumor Imaging Whole Body - Nm Tumor Local Whole Body Mult Days (78804) |
$926.25 |
$1,235 |
1.9× |
| Tumor Imaging, Limited Area - Nm Tumor Localization Limited (78800) |
$375 |
$500 |
1.0× |
| Ultrasound, abdomen limited (76705) |
$270.38 |
$360.50 |
2.9× |
| Umbilical-artery Doppler (OB) (76820) |
$187.50 |
$250 |
2.0× |
| Unlisted Diagnostic Radiographic Procedure (76499) |
$373.50 |
$498 |
4.7× |
| Unlisted Ultrasound Procedure (76999) |
$262.50 |
$350 |
3.3× |
| Upper Extremity Infant (73092) |
$115.50 |
$154 |
1.2× |
| Ureteral Reflux Study Rp Voiding Cystogram (78740) |
$491.25 |
$655 |
1.4× |
| Urethrocystography retrograde rs&i (74450) |
$397.50 |
$530 |
1.8× |
| Urethrocystography voiding (74455) |
$404.25 |
$539 |
1.9× |
| Urography (pyelography), intravenous, with or without KUB, with or without tomography (74400) |
$373.12 |
$497.50 |
2.3× |
| Urograpy infusion drip &/bolus techq w/wo tomo (74415) |
$345 |
$460 |
2.2× |
| Us abdl aorta screen aaa (76706) |
$225 |
$300 |
2.4× |
| Us breast unilateral limited (76642) |
$216 |
$288 |
2.7× |
| Us chest (76604) |
$235.50 |
$314 |
2.5× |
| Us guided compression repair (76936) |
$140.25 |
$187 |
0.7× |
| Us ob transvaginal (76817) |
$225 |
$300 |
2.4× |
| Us pelvic non ob complete (76856) |
$252.75 |
$337 |
2.7× |
| Us pelvic nonobstetric image dcmtn limited/f/u (76857) |
$135 |
$180 |
1.4× |
| Us pregnancy ltd (76815) |
$165.75 |
$221 |
1.8× |
| Us pregnant uterus 14 wk transabdl 1/1st gestat (76801) |
$280.50 |
$374 |
3.0× |
| Us retroperitoneal complete (76770) |
$278.25 |
$371 |
2.9× |
| Us retroperitoneal limited (76775) |
$278.25 |
$371 |
2.9× |
| Us scrotum and contents (76870) |
$278.25 |
$371 |
2.9× |
| Us soft tissue head/neck (76536) |
$252.75 |
$337 |
2.7× |
| Us transrectal (76872) |
$213.75 |
$285 |
2.3× |
| Us xtr non-vasc lmtd (76882) |
$252.75 |
$337 |
2.7× |
| Vasogram (74440) |
$345 |
$460 |
1.6× |
| Venogram extremity bilateral (75822) |
$1,059.38 |
$1,412.50 |
0.7× |
| Venography caval inferior serialography rs&i (75825) |
$2,645.62 |
$3,527.50 |
0.9× |
| Venography caval superior serialography rs&i (75827) |
$1,005 |
$1,340 |
0.7× |
| Venography epidural rs&i (75872) |
$1,166.25 |
$1,555 |
2.1× |
| Venography extremity unilateral rs&i (75820) |
$1,275 |
$1,700 |
0.9× |
| Venography Renal Bilateral (75833) |
$1,166.25 |
$1,555 |
0.4× |
| Wrist 2 views (73100) |
$97.50 |
$130 |
1.2× |
| X-Ray Abdomen,Comp Acute Series - Xr Abdomen 2 Vws With Chest 1 View (74022) |
$174.04 |
$232.05 |
1.8× |
| X-Ray Ac Jts - Xr Acromioclavicular Joints Bilateral (73050) |
$100.50 |
$134 |
1.3× |
| X-Ray Ankle 3+ Vw - Xr Ankle 3+ Views Right (73610) |
$115.50 |
$154 |
1.5× |
| X-Ray Colon Air Contrast - Fl Barium Enema Air Contrast (74280) |
$307.50 |
$410 |
1.9× |
| X-Ray Elbow 2 Vw - Xr Elbow 1-2 Views Right (73070) |
$115.50 |
$154 |
1.5× |
| X-Ray Elbow 3+ Vw - Xr Elbow 3+ Views Right (73080) |
$115.50 |
$154 |
1.5× |
| X-ray exam entire spi 4/5 vw (72083) |
$231 |
$308 |
2.4× |
| X-ray exam hip uni 1 view (73501) |
$115.50 |
$154 |
1.5× |
| X-Ray Exam Hip Uni 2-3 Views (73502) |
$115.50 |
$154 |
1.5× |
| X-ray exam of femur 1 (73551) |
$115.50 |
$154 |
1.5× |
| X-Ray Facial Bones 3+ Vw - Xr Facial Bones 3+ Views (70150) |
$115.50 |
$154 |
1.2× |
| X-Ray Foot 3+ Vw - Xr Foot 3+ Views Right (73630) |
$115.50 |
$154 |
1.5× |
| X-Ray Heel - Xr Calcaneus 2 Views Right (73650) |
$115.50 |
$154 |
1.5× |
| X-ray IV pyelogram+drip infusn (74410) |
$342 |
$456 |
2.2× |
| X-Ray Jaw <4 Vw - Xr Mandible < 4 Views (70100) |
$97.50 |
$130 |
1.2× |
| X-Ray Knee 4+ View - Xr Knee 4+ Views Right (73564) |
$127.50 |
$170 |
1.3× |
| X-Ray Knee Bilat Standing - Xr Knees Anteroposterior Standing Bilat (73565) |
$115.50 |
$154 |
1.5× |
| X-Ray Leg, Infant - Xr Lower Extremity 2+ Views Infant Left (73592) |
$115.50 |
$154 |
1.5× |
| X-Ray Lumbar Spine 2/3 Vw - Xr Lumbar Spine 2-3 Views (72100) |
$115.50 |
$154 |
1.2× |
| X-Ray Lumbar Spine 6+ Vw - Xr Lumbar Spine 6+ Vws Including Bending (72114) |
$168.75 |
$225 |
1.8× |
| X-Ray Lumbar Spine Flex/Exten - Xr Lumbar Spine 4+ Views W/ Flex Ext (72120) |
$115.50 |
$154 |
1.2× |
| X-Ray Nasal Bones - Xr Nasal Bones (70160) |
$115.50 |
$154 |
1.5× |
| X-Ray Orbits - Xr Orbits Complete 4+ Views (70200) |
$115.50 |
$154 |
1.2× |
| X-Ray Retrograde Pyelogram - Fl Pyelogram Retrograde (74420) |
$404.25 |
$539 |
1.3× |
| X-Ray Ribs 2 Vw Unilat - Xr Ribs 2 Views Right (71100) |
$115.50 |
$154 |
1.5× |
| X-Ray Ribs, Chest 3+ Vw - Xr Ribs 2 Vws Lt W/ Chest Anteroposterior (71101) |
$168.75 |
$225 |
1.8× |
| X-Ray Ribs, Chest 4+ Vw - Xr Ribs 3 Vws Bil W/ Chest Posteroanterior (71111) |
$168.75 |
$225 |
1.8× |
| X-Ray Sacroiliac Jts 3+ Vw - Xr Sacroiliac Joints 3+ Views (72202) |
$115.50 |
$154 |
1.2× |
| X-Ray Sacrum/Coccyx 2+ Vw - Xr Sacrum Coccyx 2+ Views (72220) |
$115.50 |
$154 |
1.5× |
| X-Ray Shoulder 2+ Vw - Xr Shoulder 2+ Views Right (73030) |
$115.50 |
$154 |
1.5× |
| X-Ray Sinuses 3+ Vw - Xr Paranasal Sinuses 3+ Views (70220) |
$108 |
$144 |
1.4× |
| X-Ray Skull 4+ Vw - Xr Skull Complete 4+ Views (70260) |
$168.75 |
$225 |
1.8× |
| X-Ray Skull <4 Vw - Xr Skull 1-3 Views (70250) |
$106.50 |
$142 |
1.1× |
| X-Ray Spine One View - Xr Spine (72020) |
$115.50 |
$154 |
1.5× |
| X-Ray Sterno-Clavicluar Jt - Xr Sternoclavicular Joints 3+ Views (71130) |
$115.50 |
$154 |
1.5× |
| X-Ray Sternum 2+ Vw - Xr Sternum 2+ Views (71120) |
$115.50 |
$154 |
1.5× |
| X-Ray Toe(S) - Xr Toes 2+ Views Right (73660) |
$115.50 |
$154 |
1.5× |
| X-Ray Wrist 3+ Vw - Xr Wrist 3+ Views Right (73110) |
$115.50 |
$154 |
1.5× |
| Xr arthrogram ankle (73615) |
$468.75 |
$625 |
1.5× |
| Xr c-spine 6 or more views (72052) |
$199.50 |
$266 |
2.1× |
| Xr chest 4+ views (71048) |
$106.50 |
$142 |
1.1× |
| Xr Cholecystography Oral Contrast (74290) |
$198.75 |
$265 |
1.3× |
| Xr finger(s) 2+ views (73140) |
$115.50 |
$154 |
1.5× |
| Xr shoulder 1 view (73020) |
$115.50 |
$154 |
1.5× |
| Xr spine cervical 4 or 5 views (72050) |
$199.50 |
$266 |
2.1× |
| Xr tibia/fibula 2 views (73590) |
$115.50 |
$154 |
1.5× |
| Xr tmj bilateral (70330) |
$128.36 |
$171.15 |
1.6× |
| Xray knee 1 or 2 views rt (73560) |
$115.50 |
$154 |
1.5× |