EXAMÂ NAME
|
COST
|
CPT/HCPCS CODE
|
Abdomen (KUB) |
$172.00 |
74000 |
Acromioclavicular (AC) joints, bilateral |
$172.00 |
73050 |
Acute abdominal series (chest, frontal view and obstruction series) |
$273.00 |
74022 |
Ankle, 2 views |
$172.00 |
73600 |
Ankle, 3 views |
$172.00 |
73610 |
Cervical Spine, 2 or 3 views |
$172.00 |
72040 |
Cervical Spine, 4 or 5 views |
$273.00 |
72050 |
Cervical Spine, 6 or more views |
$273.00 |
72052 |
Chest, 2 views, frontal and lateral |
$172.00 |
71020 |
Chest, 2 views, frontal and lateral, with fluoroscopy |
$470.00 |
71023 |
Chest, 2 views, frontal and lateral, with obilque |
$172.00 |
71022 |
Chest, 3 views, frontal, lateral, and apical lordotic |
$172.00 |
71021 |
Chest, 4 views, complete |
$273.00 |
71030 |
Chest, frontal view |
$172.00 |
71010 |
Chest, special views (eg, lateral decubitus, Bucky studies) |
$172.00 |
71035 |
Clavicle, 2 views |
$172.00 |
73000 |
Elbow, 2 views |
$172.00 |
73070 |
Elbow, 3 views |
$172.00 |
73080 |
Eye for foreign body |
$172.00 |
70030 |
Facial bones, minimum of 3 views |
$273.00 |
70150 |
Femur, 2 views |
$182.00 |
73552 |
Finger(s), minimum 2 views, per hand |
$172.00 |
73140 |
Foot, 2 views |
$172.00 |
73620 |
Foot, 3 views |
$172.00 |
73630 |
Forearm, 2 views |
$172.00 |
73090 |
Hand, 2 views |
$172.00 |
73120 |
Hand, 3 views |
$172.00 |
73130 |
Heel (Calcaneus), 2 views |
$172.00 |
73650 |
Hip, unilateral, 1 view |
$182.00 |
73501 |
Hip, unilateral, including pelvis when performed, 2 or 3 views |
$182.00 |
73502 |
Hip, unilateral, including pelvis when performed, minimum 4 views |
$302.00 |
73503 |
Hips, bilateral, including pelvis when performed, 2 views |
$302.00 |
73521 |
Hips, bilateral, including pelvis when performed, 3 or 4 views |
$302.00 |
73522 |
Hips, bilateral, including pelvis when performed, minimum 5 views |
$576.00 |
73523 |
Humerus, minimum of 2 views |
$172.00 |
73060 |
Internal auditory meatus |
$172.00 |
70134 |
Knee, 1 or 2 views |
$172.00 |
73560 |
Knee, 3 views |
$172.00 |
73562 |
Knee, 4 or more views |
$285.00 |
73564 |
Knees, bilateral, standing AP view |
$172.00 |
73565 |
Lumbar spine, 2 or 3 views |
$172.00 |
72100 |
Lumbar spine, 2 or 3 views, bending only |
$273.00 |
72120 |
Lumbar spine, 4 or 5 views |
$273.00 |
72110 |
Lumbar spine, minimum of 6 views, including bending views |
$273.00 |
72114 |
Mandible, minimum of 4 views |
$273.00 |
70110 |
Mastoids, minimum of 3 views per side |
$172.00 |
70130 |
Nasal bones, minimum of 3 views |
$172.00 |
70160 |
Neck, soft tissue |
$172.00 |
70360 |
Obstruction series (Upright abdomen and supine abdomen) |
$172.00 |
74020 |
Orbits, minimum of 4 views |
$172.00 |
70200 |
Osseus survey, complete (axial and appendicular skeleton) |
$273.00 |
77075 |
Osseus survey, limited |
$273.00 |
77074 |
Pelvis, 1 or 2 views |
$172.00 |
72170 |
Pelvis, minimum of 3 views |
$172.00 |
72190 |
Ribs, bilateral, 3 views |
$273.00 |
71110 |
Ribs, bilateral, minimum of 4 views with posteroanterior chest |
$273.00 |
71111 |
Ribs, unilateral, 2 views |
$172.00 |
71100 |
Ribs, unilateral, minimum of 3 views with posteroanterior chest |
$273.00 |
71101 |
Sacroiliac joints, minimum of 3 views |
$172.00 |
72202 |
Sacrum and coccyx, minimum of 2 views |
$172.00 |
72220 |
Scapula, complete |
$172.00 |
73010 |
Scoliosis study, 1 view |
$182.00 |
72081 |
Sella turcica |
$172.00 |
70240 |
Shoulder, 1 view |
$172.00 |
73020 |
Shoulder, minimum of 2 views |
$172.00 |
73030 |
Sinuses, paranasal, minimum of 3 views |
$172.00 |
70220 |
Skull, less than 4 views |
$172.00 |
70250 |
Skull, minimum of 4 views |
$273.00 |
70260 |
Spine, 1 view |
$172.00 |
72020 |
Sternoclavicular joint(s), minimum of 3 views |
$172.00 |
71130 |
Sternum, minimum of 2 views |
$172.00 |
71120 |
Temporomandibular joints, bilateral |
$172.00 |
70330 |
Thoracic spine, 3 views |
$273.00 |
72072 |
Tibia and fibula, 2 views |
$172.00 |
73590 |
Toe(s), minimum 2 views per foot |
$172.00 |
73660 |
Wrist, 2 views |
$172.00 |
73100 |
Wrist, minimum of 3 views |
$172.00 |
73110 |