| Abdomen 2 views (74019) |
$253 |
$506 |
2.5× |
| Acute gi blood loss imaging (78278) |
$1,034 |
$2,068 |
2.7× |
| Ankle 2 views (73600) |
$153 |
$306 |
1.8× |
| Arthrogram hip (73525) |
$875 |
$1,750 |
2.6× |
| Arthrogram knee (73580) |
$748 |
$1,496 |
2.2× |
| Arthrogram shoulder (73040) |
$875 |
$1,750 |
2.6× |
| Arthrogram wrist (73115) |
$920 |
$1,840 |
2.7× |
| Bone &/Joint Imaging Limited Area (78300) |
$558 |
$1,116 |
1.5× |
| Bone &/joint imaging whole body (78306) |
$883.75 |
$1,767.50 |
2.3× |
| Bone age studies (77072) |
$164.75 |
$329.50 |
1.6× |
| Bone Imaging 3 Phase (78315) |
$883.75 |
$1,767.50 |
2.3× |
| Bone survey complete (77075) |
$342 |
$684 |
3.4× |
| Bone survey infant (77076) |
$320.50 |
$641 |
3.2× |
| Bowel imaging (78290) |
$661 |
$1,322 |
1.7× |
| Brain Imaging Pet Metabolic Evaluation (78608) |
$3,466 |
$6,932 |
2.5× |
| Card Bpi Gtd =Brm Plnr 1 Std Rest/Strs (78472) |
$705.50 |
$1,411 |
1.8× |
| Cervical spine 2 or 3 views (72040) |
$190.75 |
$381.50 |
2.3× |
| Chest 1 view (71045) |
$119.50 |
$239 |
1.4× |
| Chest xray 3 views (71047) |
$195 |
$390 |
2.3× |
| Cine/Vid X-Ray Throat/Esoph - Fl Esoph Barium Swlw W/ Video & Speech (74230) |
$442.50 |
$885 |
2.6× |
| Clavicle complete (73000) |
$160.50 |
$321 |
1.9× |
| Computed Tomography Thorax Lw Dose Lng Ca Scr C- (71271) |
$120 |
$240 |
1.2× |
| CT abdomen and pelvis without and with contrast (74178) |
$2,350 |
$4,700 |
7.0× |
| CT abdomen and pelvis without contrast (74176) |
$1,705.25 |
$3,410.50 |
7.5× |
| CT abdomen w contrast (74160) |
$997 |
$1,994 |
5.9× |
| CT abdomen w wo contrast (74170) |
$1,206 |
$2,412 |
7.2× |
| CT abdomen w/o contrast (74150) |
$846.75 |
$1,693.50 |
8.4× |
| CT angio lwr extr w/o&w/dye (73706) |
$1,269 |
$2,538 |
7.5× |
| CT angiography upper extremity lt (73206) |
$1,903 |
$3,806 |
11.3× |
| CT c-spine w/contrast (72126) |
$870.75 |
$1,741.50 |
2.6× |
| CT c-spine w/o contrast (72125) |
$870.75 |
$1,741.50 |
8.7× |
| CT cere prfu aly c+wo CT/CTA (70473) |
$1,578 |
$3,156 |
9.4× |
| CT cervical spine w&w/o contrast (72127) |
$892 |
$1,784 |
5.3× |
| CT chest w contrast (71260) |
$1,042.50 |
$2,085 |
6.2× |
| CT chest w/wo contrast (71270) |
$1,319.25 |
$2,638.50 |
7.8× |
| CT head/brain with contrast (70460) |
$838 |
$1,676 |
5.0× |
| CT head/brain without and with contrast (70470) |
$1,024 |
$2,048 |
6.1× |
| CT iac w contrast (70481) |
$880 |
$1,760 |
5.2× |
| CT limited/localized follow up study (76380) |
$293 |
$586 |
3.5× |
| CT lower ext w/o (73700) |
$768.50 |
$1,537 |
7.7× |
| CT lower extremity w wo contrast (73702) |
$1,063 |
$2,126 |
6.3× |
| CT lower extremity w/contrast material (73701) |
$1,295.50 |
$2,591 |
7.7× |
| CT lumbar spine w & w/o contrast (72133) |
$740.25 |
$1,480.50 |
4.4× |
| CT lumbar spine w/contrast (72132) |
$985.25 |
$1,970.50 |
2.9× |
| CT lumbar spine w/o contrast (72131) |
$870.75 |
$1,741.50 |
8.7× |
| CT maxillofacial w contrast (70487) |
$866.75 |
$1,733.50 |
5.2× |
| CT maxillofacial w/wo contrast (70488) |
$1,075 |
$2,150 |
6.4× |
| CT maxillofacial wo contrast (70486) |
$733 |
$1,466 |
7.3× |
| CT orbit sella/post fossa/ear w/o & w/contr matr (70482) |
$1,053.75 |
$2,107.50 |
6.3× |
| CT orbits w/o contrast (70480) |
$757.50 |
$1,515 |
7.6× |
| CT pelvis w/o contrast (72192) |
$865.25 |
$1,730.50 |
8.6× |
| CT pelvis w/wo contrast (72194) |
$1,164 |
$2,328 |
6.9× |
| CT scan of arm combo (73202) |
$1,594 |
$3,188 |
9.5× |
| CT soft tissue neck w contrast (70491) |
$880 |
$1,760 |
5.2× |
| CT soft tissue neck w/o & w/contrast material (70492) |
$1,053.75 |
$2,107.50 |
6.3× |
| CT soft tissue neck w/o contrast (70490) |
$757.50 |
$1,515 |
7.6× |
| CT thoracic spine w/contrast (72129) |
$843.25 |
$1,686.50 |
5.0× |
| CT thoracic spine w/o contrast (72128) |
$870.75 |
$1,741.50 |
8.7× |
| CT thoracic spine w/wo contrast (72130) |
$890.50 |
$1,781 |
5.3× |
| CT thorax w/o contrast (71250) |
$870.75 |
$1,741.50 |
8.7× |
| CT upper ext wo (73200) |
$768.50 |
$1,537 |
7.7× |
| CT upper extremity with contrast (73201) |
$864 |
$1,728 |
2.6× |
| Cta Aa&Bi Iliofem Lxtr Rs&I C-/C+ Post-Pxessing (75635) |
$1,712.75 |
$3,425.50 |
10.2× |
| Cta Abdomen (74175) |
$1,238.75 |
$2,477.50 |
7.4× |
| CTA abdomen pelvis (74174) |
$1,887.75 |
$3,775.50 |
5.6× |
| CTA chest (71275) |
$1,279.75 |
$2,559.50 |
7.6× |
| Cta Head (70496) |
$1,279.75 |
$2,559.50 |
7.6× |
| Cta Neck (70498) |
$1,279.75 |
$2,559.50 |
7.6× |
| Cta Pelvis (72191) |
$1,269 |
$2,538 |
7.5× |
| Cystography minimum 3 views rs&i (74430) |
$480.50 |
$961 |
1.4× |
| Dxa bone density study 1/> sites axial skel (77080) |
$474.75 |
$949.50 |
4.7× |
| Dxa bone density study 1/>sites appendiclr skel (77081) |
$173 |
$346 |
2.1× |
| Dxa bone density study axial skeleton (77085) |
$335 |
$670 |
3.3× |
| Esophagus (74220) |
$447 |
$894 |
2.7× |
| Facial bones min 3 views (70150) |
$243 |
$486 |
2.4× |
| Fetal biophysical profile non-stress testing (76818) |
$475 |
$950 |
4.7× |
| Fetal Biophysical Profile W/O Non-Stress Testing (76819) |
$192.50 |
$385 |
1.9× |
| Fluoroscopy up to 1 hr (76000) |
$214.50 |
$429 |
0.9× |
| Foot 2 views (73620) |
$149.25 |
$298.50 |
1.8× |
| Forearm 2 views (73090) |
$160.50 |
$321 |
1.9× |
| Hand 2 views (73120) |
$229.50 |
$459 |
2.3× |
| Hepatobil Syst Imag Inc Gb W/Pharma Intervenj (78227) |
$1,141.50 |
$2,283 |
2.2× |
| Hepatobiliary syst imaging including gallbladder (78226) |
$983 |
$1,966 |
2.6× |
| Hysterosalpingogram (74740) |
$457 |
$914 |
2.0× |
| Kidney imaging morphology (78700) |
$604 |
$1,208 |
1.6× |
| Kidney Img Morphology Vascular Flow 1 W/O Rx (78707) |
$696.50 |
$1,393 |
1.3× |
| Kidney img morphology vascular flow 1 w/rx (78708) |
$810.50 |
$1,621 |
1.6× |
| Knee 3 views (73562) |
$203 |
$406 |
2.4× |
| Liver & spleen imaging static only (78215) |
$594.50 |
$1,189 |
1.6× |
| Liver imaging static only (78201) |
$1,721 |
$3,442 |
3.3× |
| Lung perf&ventilat diferentl (78598) |
$624 |
$1,248 |
1.2× |
| Lung ventilation imaging (78579) |
$711.50 |
$1,423 |
1.9× |
| Lymphoscintigraphy (78195) |
$905 |
$1,810 |
1.7× |
| Magnetic resonance (eg, proton) imaging, any joint of upper extremity; with contrast material(s) Non-Facility (73222) |
$1,989.50 |
$3,979 |
2.6× |
| Magnetic resonance (eg, proton) imaging, upper extremity, other than joint; with contrast material(s) Non-Facility (73219) |
$2,476.75 |
$4,953.50 |
7.4× |
| Magnetic resonance (eg, proton) imaging, upper extremity, other than joint; without contrast material(s), followed by… (73220) |
$2,737.50 |
$5,475 |
8.2× |
| MRA head w & w/o contrast (70546) |
$2,595 |
$5,190 |
7.8× |
| MRA head w/o contrast (70544) |
$1,208.50 |
$2,417 |
5.3× |
| MRA neck w contrast (70548) |
$1,232.50 |
$2,465 |
3.7× |
| Mra Neck W/O &W/Contrast Material (70549) |
$1,477 |
$2,954 |
4.4× |
| MRA neck w/o contrast (70547) |
$1,208.50 |
$2,417 |
5.3× |
| MRI abdomen w/o & w/contrast material (74183) |
$2,665 |
$5,330 |
8.0× |
| MRI abdomen w/o contrast (74181) |
$1,238.75 |
$2,477.50 |
5.4× |
| MRI any jt lower extrem w/contrast material (73722) |
$2,250 |
$4,500 |
3.0× |
| MRI any jt lower extrem w/o & w/contrast matrl (73723) |
$2,757 |
$5,514 |
8.2× |
| MRI c-spine with contrast (72142) |
$1,450 |
$2,900 |
4.3× |
| MRI cervical spine w/o contrast (72141) |
$1,208.50 |
$2,417 |
5.3× |
| MRI chest w/o & w/contrast material (71552) |
$2,171.50 |
$4,343 |
6.5× |
| MRI chest w/o contrast (71550) |
$1,136.25 |
$2,272.50 |
5.0× |
| MRI chest with contrast (71551) |
$1,263.50 |
$2,527 |
1.7× |
| MRI lower extrem oth/thn jt w/contrast matrl (73719) |
$2,436 |
$4,872 |
7.3× |
| MRI lower extrem oth/thn jt w/o & w/contr matr (73720) |
$2,754 |
$5,508 |
8.2× |
| MRI lower extrem oth/thn jt w/o contr matrl (73718) |
$1,246.50 |
$2,493 |
5.4× |
| MRI orbit face &/neck w/o contrast (70540) |
$1,208.50 |
$2,417 |
5.3× |
| MRI orbit/face/neck w&w/o cont (70543) |
$2,083.50 |
$4,167 |
6.2× |
| MRI pelvis w/contrast (72196) |
$579.50 |
$1,159 |
1.7× |
| MRI pelvis w/o & w/contrast material (72197) |
$1,777.50 |
$3,555 |
5.3× |
| MRI pelvis w/o contrast (72195) |
$1,205 |
$2,410 |
5.3× |
| MRI spinal canal cervical w/o & w/contr matrl (72156) |
$2,751.75 |
$5,503.50 |
8.2× |
| MRI spinal canal lumbar w/contrast material (72149) |
$1,450 |
$2,900 |
4.3× |
| MRI spinal canal lumbar w/o & w/contr matrl (72158) |
$2,688 |
$5,376 |
8.0× |
| MRI spinal canal thoracic w/contrast matrl (72147) |
$1,450 |
$2,900 |
4.3× |
| MRI spinal canal thoracic w/o & w/contr matrl (72157) |
$2,688 |
$5,376 |
8.0× |
| MRI temporomandibular joint (70336) |
$1,269 |
$2,538 |
5.5× |
| MRI thoracic spine w/o contrast (72146) |
$1,343.50 |
$2,687 |
5.9× |
| MRI up ext w/o contrast (73218) |
$1,217 |
$2,434 |
5.3× |
| MRI upper ext joint w/o contrast (73221) |
$1,232 |
$2,464 |
5.4× |
| MRI, joint upper extrem combo (73223) |
$2,737.50 |
$5,475 |
8.2× |
| Myelogram Lumbar (72265) |
$1,026.50 |
$2,053 |
1.4× |
| Myocardial Imaging Pet Metabolic Evaluation (78459) |
$3,182.50 |
$6,365 |
2.6× |
| Myocardial imaging, positron emission tomography (PET), perfusion study (including ventricular wall motionºs» and/or… (78491) |
$1,641 |
$3,282 |
1.2× |
| Myocardial imaging, positron emission tomography (PET), perfusion study (including ventricular wall motionºs» and/or… (78492) |
$3,332.50 |
$6,665 |
2.4× |
| Myocardial Spect Multiple Studies (78452) |
$3,268.75 |
$6,537.50 |
2.6× |
| Myocardial spect single study at rest or stress (78451) |
$1,508 |
$3,016 |
1.2× |
| Neck soft tissue (70360) |
$162 |
$324 |
1.9× |
| Nm gastric emptying study (78264) |
$489.50 |
$979 |
1.3× |
| Nm kidney scan w/flow (78701) |
$696.50 |
$1,393 |
1.8× |
| Ob us nuchal meas 1 gest (76813) |
$192.50 |
$385 |
1.9× |
| Osseous survey limited (77074) |
$289.50 |
$579 |
2.9× |
| Parathyroid Planar Imaging (78070) |
$660.50 |
$1,321 |
1.7× |
| Pelvis 1 or 2 views (72170) |
$157.50 |
$315 |
1.6× |
| PET image w/CT, skull-thigh (78815) |
$3,332.50 |
$6,665 |
2.4× |
| PET imaging CT for attenuation limited area (78814) |
$2,923 |
$5,846 |
2.1× |
| PET imaging for CT attenuation whole body (78816) |
$3,332.50 |
$6,665 |
2.4× |
| Pet Imaging Limited Area Chest Head/Neck (78811) |
$2,277.50 |
$4,555 |
1.8× |
| PET whole body (78813) |
$2,579 |
$5,158 |
1.9× |
| Positron emission tomography (PET) imaging; skull base to mid-thigh Non-Facility (78812) |
$3,332.50 |
$6,665 |
2.4× |
| Pulmonary Perfusion Imaging Particulate (78580) |
$739.50 |
$1,479 |
1.9× |
| Pulmonary Ventilation & Perfusion Imaging (78582) |
$1,059.50 |
$2,119 |
2.0× |
| Quan&charac c atherosclerotc plaq asses sev c ds (75577) |
$1,069.50 |
$2,139 |
1.2× |
| Radex abscess/fistula/sinus tract rs&i (76080) |
$448.50 |
$897 |
0.9× |
| Radex Ankle Compl Minimum 3 Views (73610) |
$240.25 |
$480.50 |
2.9× |
| Radex Calcaneus Minimum 2 Views (73650) |
$218.25 |
$436.50 |
2.6× |
| Radex Elbw Compl Minimum 3 Views (73080) |
$174 |
$348 |
2.1× |
| Radex Entir Thrc Lmbr Crv Sac Spi W/Skull 1 Vw - Xr Scoliosis 1 Vw (72081) |
$53 |
$106 |
0.6× |
| Radex entir thrc lmbr crv sac spi w/skull 2/3 vw (72082) |
$96.50 |
$193 |
1.0× |
| Radex Entir Thrc Lmbr Crv Sac Spi W/Skull 4/5 Vw (72083) |
$1,016 |
$2,032 |
10.1× |
| Radex fingr minimum 2 views (73140) |
$126.75 |
$253.50 |
1.5× |
| Radex Foot Compl Minimum 3 Views (73630) |
$240.25 |
$480.50 |
2.9× |
| Radex Hand Minimum 3 Views (73130) |
$247.50 |
$495 |
3.0× |
| Radex Hip Unilateral With Pelvis 1 View (73501) |
$111.75 |
$223.50 |
1.3× |
| Radex Hip Unilateral With Pelvis Minimum 4 Views (73503) |
$214.25 |
$428.50 |
2.1× |
| Radex Hips Bilateral With Pelvis 2 Views (73521) |
$214.25 |
$428.50 |
2.1× |
| Radex Hips Bilateral With Pelvis Minimum 5 Views (73523) |
$219.50 |
$439 |
2.2× |
| Radex Humerus Minimum 2 Views (73060) |
$252.50 |
$505 |
3.0× |
| Radex Kne 1/2 Views (73560) |
$162.50 |
$325 |
1.9× |
| Radex Kne Compl 4/More Views (73564) |
$235.75 |
$471.50 |
2.4× |
| Radex Mndbl Compl Minimum 4 Views (70110) |
$206.25 |
$412.50 |
2.1× |
| Radex Nasal Bones Complete Minimum 3 Views (70160) |
$159 |
$318 |
1.9× |
| Radex Pelvis Compl Minimum 3 Views (72190) |
$201.50 |
$403 |
2.0× |
| Radex Sho Compl Minimum 2 Views (73030) |
$177.50 |
$355 |
2.1× |
| Radex Sinuses Paransl < 3 Views (70210) |
$167.50 |
$335 |
2.0× |
| Radex Spine Lumbosacral Only Bending 2/3 Views (72120) |
$251.75 |
$503.50 |
2.5× |
| Radex Temporomandble Jt Opn & Clsd Mouth Bilat (70330) |
$247.75 |
$495.50 |
3.0× |
| Radex Toe Minimum 2 Views (73660) |
$130 |
$260 |
1.6× |
| Radex upper extremity infant minimum 2 views (73092) |
$251.25 |
$502.50 |
2.5× |
| Radex Wrst Compl Minimum 3 Views (73110) |
$165.50 |
$331 |
2.0× |
| Radex X-Ray Exam Entire Spi 6/> Vw - Xr Entire Spine 6+ Vw (72084) |
$125.25 |
$250.50 |
1.2× |
| Radiation treatment delivery level 3 (77412) |
$635 |
$1,270 |
1.2× |
| Radiologic Exam Abdomen 1 View - Xr Abdomen 1 View (74018) |
$189.25 |
$378.50 |
2.3× |
| Radiologic Exam Abdomen 3+ Views - Xr Abdomen 3+ Views (74021) |
$193.75 |
$387.50 |
1.9× |
| Radiologic exam chest 2 views (71046) |
$201.50 |
$403 |
2.4× |
| Radiologic exam colon single contrast study (74270) |
$660.75 |
$1,321.50 |
3.9× |
| Radiologic Exam Esophagus Double Contrast Study (74221) |
$430 |
$860 |
2.6× |
| Radiologic exam upr gi trc double contrast study (74246) |
$348.50 |
$697 |
2.1× |
| Radiologic exam upr gi trc single contrast study (74240) |
$349.50 |
$699 |
2.1× |
| Radiologic examination femur 1 view (73551) |
$111.75 |
$223.50 |
1.3× |
| Radiologic examination tibia & fibula 2 views (73590) |
$242.25 |
$484.50 |
2.9× |
| Radiologic examination, internal auditory meati, complete Non-Facility (70134) |
$263.50 |
$527 |
0.5× |
| Radiologic examination, mastoids; complete, minimum of 3 views per side Non-Facility (70130) |
$273 |
$546 |
2.7× |
| Radiological examination surgical specimen (76098) |
$644.50 |
$1,289 |
1.2× |
| Ribs bilateral 3 views (71110) |
$246.75 |
$493.50 |
2.5× |
| Rp loclzj tum spect 1 area single day imaging (78803) |
$883 |
$1,766 |
1.7× |
| Sacroiliac Joints < 3 Views (72200) |
$163 |
$326 |
1.6× |
| Saline Infus Sonohysterography W/Color Doppler (76831) |
$357 |
$714 |
1.6× |
| Scapula (73010) |
$159 |
$318 |
1.6× |
| Screening Digital Breast Tomosynthesis Bi (77063) |
$45.25 |
$90.50 |
1.9× |
| Shoulder 1 view (73020) |
$163.50 |
$327 |
2.0× |
| Sialogram (70390) |
$576 |
$1,152 |
2.5× |
| Small bowel series (74250) |
$489 |
$978 |
2.9× |
| Spine thoracic 3 views (72072) |
$219 |
$438 |
2.2× |
| Thoracolumbar 2 views (72080) |
$204.50 |
$409 |
2.4× |
| Thyroid imaging w/blood flow (78013) |
$371.50 |
$743 |
1.0× |
| Thyroid uptake measurement (78012) |
$196 |
$392 |
0.5× |
| Thyroid Uptake W/Blood Flow Sngle/Mult Quan Meas (78014) |
$482 |
$964 |
1.3× |
| Tomogram (76100) |
$363.50 |
$727 |
3.6× |
| Ultrasound breast complete (76641) |
$388 |
$776 |
3.9× |
| Ultrasound Exam Aaa Screen (76706) |
$431.25 |
$862.50 |
4.3× |
| Ultrasound, abdomen limited (76705) |
$445 |
$890 |
4.4× |
| Umbilical-artery Doppler (OB) (76820) |
$212 |
$424 |
2.1× |
| Urethrocystogram voiding (74455) |
$970.50 |
$1,941 |
4.2× |
| Urethrocystography retrograde rs&i (74450) |
$480.50 |
$961 |
2.1× |
| Urography, infusion, drip technique and/or bolus technique; with nephrotomography Non-Facility (74415) |
$696.50 |
$1,393 |
4.1× |
| Us breast unilateral limited (76642) |
$332.75 |
$665.50 |
4.0× |
| Us chest (76604) |
$98.50 |
$197 |
1.0× |
| Us encephalogram (76506) |
$171 |
$342 |
1.7× |
| Us lmtd joint/oth nonvasc xtr strux r-t w/img (76882) |
$418.50 |
$837 |
4.2× |
| Us ob detailed single fetus (76811) |
$408.50 |
$817 |
1.8× |
| Us ob limited (76815) |
$460.75 |
$921.50 |
4.6× |
| Us ob transvaginal (76817) |
$502.50 |
$1,005 |
5.0× |
| Us pelvic non ob complete (76856) |
$493.75 |
$987.50 |
4.9× |
| Us pelvic nonobstetric image dcmtn limited/f/u (76857) |
$296.75 |
$593.50 |
3.0× |
| Us pg uter img f&mat 14 wk tabdl 1/1st gestation (76801) |
$687.25 |
$1,374.50 |
6.9× |
| Us pg uter r-t img f-up tabdl appr pr fetus (76816) |
$388.50 |
$777 |
3.9× |
| Us retroperitoneal complete (76770) |
$621.75 |
$1,243.50 |
6.2× |
| Us retroperitoneal limited (76775) |
$601.25 |
$1,202.50 |
6.0× |
| Us scrotum and contents (76870) |
$475.75 |
$951.50 |
4.7× |
| Us soft tissue head/neck (76536) |
$438 |
$876 |
4.4× |
| Venogram extremity bilateral (75822) |
$1,839 |
$3,678 |
1.2× |
| Venogram Extremity Unilateral (75820) |
$1,720 |
$3,440 |
1.1× |
| Vertebral fracture assessment via dxa (77086) |
$367 |
$734 |
4.4× |
| Wrist 2 views (73100) |
$149.25 |
$298.50 |
1.8× |
| X-Ray Abdomen,Comp Acute Series - Xr Abdomen 2 Vws With Chest 1 View (74022) |
$292.25 |
$584.50 |
2.9× |
| X-Ray Ac Jts - Xr Acromioclavicular Joints Bilateral (73050) |
$198.50 |
$397 |
2.4× |
| X-Ray Colon Air Contrast - Fl Barium Enema Air Contrast (74280) |
$912 |
$1,824 |
5.4× |
| X-Ray Elbow 2 Vw - Xr Elbow 1-2 Views Right (73070) |
$157.50 |
$315 |
1.9× |
| X-Ray Exam Hip Uni 2-3 Views (73502) |
$64.50 |
$129 |
0.8× |
| X-Ray Exam Hips Bi 3-4 Views (73522) |
$214.25 |
$428.50 |
2.1× |
| X-ray exam of femur 2/> (73552) |
$47.75 |
$95.50 |
0.6× |
| X-ray eye for foreign body (70030) |
$438 |
$876 |
5.2× |
| X-Ray Facial Bones <3 Vw - Xr Facial Bones 1-2 Views (70140) |
$243 |
$486 |
2.9× |
| X-ray IV pyelogram (ivp) (74400) |
$592.50 |
$1,185 |
3.5× |
| X-Ray Knee Bilat Standing - Xr Knees Anteroposterior Standing Bilat (73565) |
$109 |
$218 |
1.3× |
| X-ray leg, infant (73592) |
$319 |
$638 |
3.8× |
| X-Ray Lumbar Spine 2/3 Vw - Xr Lumbar Spine 2-3 Views (72100) |
$204.50 |
$409 |
2.0× |
| X-Ray Lumbar Spine 6+ Vw - Xr Lumbar Spine 6+ Vws Including Bending (72114) |
$362 |
$724 |
3.6× |
| X-ray nose-rectum child f.b. (76010) |
$195.50 |
$391 |
2.3× |
| X-ray optic foramen (70190) |
$196 |
$392 |
2.3× |
| X-Ray Orbits - Xr Orbits Complete 4+ Views (70200) |
$248.25 |
$496.50 |
2.5× |
| X-ray retrograde pyelogram (74420) |
$775.50 |
$1,551 |
2.3× |
| X-Ray Ribs 2 Vw Unilat - Xr Ribs 2 Views Right (71100) |
$245.50 |
$491 |
2.9× |
| X-Ray Ribs, Chest 3+ Vw - Xr Ribs 2 Vws Lt W/ Chest Anteroposterior (71101) |
$221.50 |
$443 |
2.2× |
| X-Ray Ribs, Chest 4+ Vw - Xr Ribs 3 Vws Bil W/ Chest Posteroanterior (71111) |
$283.50 |
$567 |
2.8× |
| X-Ray Sacroiliac Jts 3+ Vw - Xr Sacroiliac Joints 3+ Views (72202) |
$229.25 |
$458.50 |
2.3× |
| X-Ray Sacrum/Coccyx 2+ Vw - Xr Sacrum Coccyx 2+ Views (72220) |
$170.75 |
$341.50 |
2.0× |
| X-Ray Sinuses 3+ Vw - Xr Paranasal Sinuses 3+ Views (70220) |
$240.50 |
$481 |
2.9× |
| X-Ray Skull 4+ Vw - Xr Skull Complete 4+ Views (70260) |
$289.25 |
$578.50 |
2.9× |
| X-Ray Skull <4 Vw - Xr Skull 1-3 Views (70250) |
$203 |
$406 |
2.0× |
| X-Ray Small Bowel Enteroclysis (74251) |
$562 |
$1,124 |
3.3× |
| X-Ray Spine One View - Xr Spine (72020) |
$136.50 |
$273 |
1.6× |
| X-Ray Sterno-Clavicluar Jt - Xr Sternoclavicular Joints 3+ Views (71130) |
$210.75 |
$421.50 |
2.5× |
| X-Ray Sternum 2+ Vw - Xr Sternum 2+ Views (71120) |
$194.25 |
$388.50 |
2.3× |
| X-Ray Thoracic Spine 2 Vw - Xr Thoracic Spine 2 Views (72070) |
$200.50 |
$401 |
2.0× |
| X-Ray Thoracic Spine 4 Vw - Xr Thoracic Spine Complete 4+ Views (72074) |
$204 |
$408 |
2.0× |
| Xr bone length studies (77073) |
$203.50 |
$407 |
2.0× |
| Xr c-spine 4 or 5 views (72050) |
$280.50 |
$561 |
2.8× |
| Xr c-spine 6 or more views (72052) |
$342 |
$684 |
3.4× |
| Xr chest 4+ views (71048) |
$204.50 |
$409 |
2.0× |
| Xr urogram antegrade (74425) |
$441.50 |
$883 |
1.3× |