| 3-D radiotherapy plan dose-volume histograms (77295) |
$1,676 |
$4,190 |
1.4× |
| Abdomen 1 View (74018) |
$144 |
$360 |
1.9× |
| Abdomen 2 views (74019) |
$172.80 |
$432 |
1.9× |
| Acute Gastrointestinal Blood Loss Imaging (78278) |
$887.20 |
$2,218 |
2.6× |
| Angio pulmonary bilat (75743) |
$2,462 |
$6,155 |
0.9× |
| Angiography extremity bilateral rs&i (75716) |
$2,462 |
$6,155 |
0.9× |
| Angiography extremity unilateral rs&i (75710) |
$2,462 |
$6,155 |
0.9× |
| Angrph pulmonary nonslctv cath/ven njx rs&i (75746) |
$639.20 |
$1,598 |
0.2× |
Ankle 2 views (73600) range across 2 matching MRF lines |
$140–$144 |
$350–$360 |
varies |
| Aortography thoracic serialography rs&i (75605) |
$4,092.80 |
$10,232 |
0.9× |
| Artery X-Rays Abdomen (75726) |
$4,713.60 |
$11,784 |
1.0× |
| Artery X-Rays Pelvis (75736) |
$4,092.80 |
$10,232 |
0.9× |
| Basic radiation dosimetry calculation (77300) |
$411.20 |
$1,028 |
3.5× |
| Bone age studies (77072) |
$142.40 |
$356 |
1.6× |
| Bone Imaging 3 Phase (78315) |
$626 |
$1,565 |
1.8× |
| Bone Imaging Whole Body (78306) |
$625.60 |
$1,564 |
1.8× |
| Bone survey infant (77076) |
$201.20 |
$503 |
2.2× |
| Brain Imaging Min 4 Static Views W Vascular Flow (78606) |
$332.80 |
$832 |
0.7× |
| Cat Scan Follow-Up Study (76380) |
$370.40 |
$926 |
4.9× |
| Chest 1 view (71045) |
$144 |
$360 |
1.9× |
| Chest 2 views (71046) |
$140.80 |
$352 |
1.9× |
| Clavicle complete (73000) |
$144 |
$360 |
1.9× |
| Computed Tomography Thorax Lw Dose Lng Ca Scr C- (71271) |
$443.60 |
$1,109 |
4.9× |
| Continuing medical physics consltj pr wk (77336) |
$568 |
$1,420 |
4.9× |
| Contrast Exam Abdominl Aorta (75625) |
$2,462 |
$6,155 |
0.9× |
| Contrast X-Ray Bladder (74430) |
$250 |
$625 |
0.8× |
| Contrast X-Ray Of Elbow (73085) |
$451.20 |
$1,128 |
1.5× |
| CT abdomen and pelvis without and with contrast (74178) |
$2,190.40 |
$5,476 |
7.3× |
| CT abdomen and pelvis without contrast (74176) |
$1,414.40 |
$3,536 |
6.9× |
| CT abdomen w contrast (74160) |
$521.60 |
$1,304 |
3.4× |
| CT abdomen w wo contrast (74170) |
$652.40 |
$1,631 |
4.3× |
| CT abdomen w/o contrast (74150) |
$434.80 |
$1,087 |
4.8× |
| CT Angio Abdomen and Pelvis (74174) |
$1,446.80 |
$3,617 |
4.8× |
| CT Angio Chest (71275) |
$671.60 |
$1,679 |
4.4× |
| CT Angio Head (70496) |
$954.80 |
$2,387 |
6.3× |
| Ct Angio Lwr Extr W/O&W/Dye (73706) |
$912.80 |
$2,282 |
6.0× |
| CT Angio Neck (70498) |
$1,027.20 |
$2,568 |
6.8× |
| Ct Angio Upr Extrm W/O&W/Dye (73206) |
$614.80 |
$1,537 |
4.1× |
| CT cervical spine w/ contrast (72126) |
$434.80 |
$1,087 |
1.4× |
| CT cervical spine w/o contrast (72125) |
$326 |
$815 |
3.6× |
| CT cervical spine w/wo cont (72127) |
$521.60 |
$1,304 |
3.4× |
| CT chest w contrast (71260) |
$521.60 |
$1,304 |
3.4× |
| CT chest w/wo contrast (71270) |
$652.40 |
$1,631 |
4.3× |
| CT head/brain with contrast (70460) |
$800.80 |
$2,002 |
5.3× |
| CT head/brain without and with contrast (70470) |
$1,057.60 |
$2,644 |
7.0× |
| CT heart no contrast quant eval coronry calcium (75571) |
$107.60 |
$269 |
1.4× |
| CT iac w contrast (70481) |
$810.80 |
$2,027 |
5.4× |
| CT l-spine w&w/o contrast (72133) |
$521.60 |
$1,304 |
3.4× |
| CT lower ext w/o (73700) |
$693.20 |
$1,733 |
7.7× |
| CT lower extremity w/contrast material (73701) |
$864 |
$2,160 |
5.7× |
| CT lumbar spine w contrast (72132) |
$434.80 |
$1,087 |
1.4× |
| CT lumbar spine w/o contrast (72131) |
$377.60 |
$944 |
4.2× |
| CT maxillofacial w contrast (70487) |
$810.80 |
$2,027 |
5.4× |
| CT maxillofacial wo contrast (70486) |
$674.80 |
$1,687 |
7.5× |
| CT neck tissue combo (70492) |
$1,193.60 |
$2,984 |
7.9× |
| Ct Orbit/Ear/Fossa W/O&W/Dye (70482) |
$1,118.40 |
$2,796 |
7.4× |
| CT orbits w/o contrast (70480) |
$674.80 |
$1,687 |
7.5× |
CT pelvis w/o contrast (72192) range across 2 matching MRF lines |
$434.80–$436 |
$1,087–$1,090 |
varies |
| CT scan of leg combo (73702) |
$1,139.60 |
$2,849 |
7.5× |
| CT scans face/jaw combo (70488) |
$1,070.40 |
$2,676 |
7.1× |
| CT soft tissue neck w contrast (70491) |
$944.80 |
$2,362 |
6.2× |
| CT soft tissue neck w/o contrast (70490) |
$826 |
$2,065 |
9.2× |
| CT thoracic spine w contrast (72129) |
$434.80 |
$1,087 |
2.9× |
| CT thoracic spine w/o contrast (72128) |
$324.80 |
$812 |
3.6× |
| CT thoracic spine w/wo cont (72130) |
$521.60 |
$1,304 |
3.4× |
| CT thorax w/o contrast (71250) |
$434.80 |
$1,087 |
4.8× |
| CT upper ext wo (73200) |
$686.80 |
$1,717 |
7.6× |
| CT upper extremity with contrast (73201) |
$856 |
$2,140 |
2.8× |
| Cta Abdl Aorta&Bi Iliofem W/Contrast&Postp (75635) |
$1,131.60 |
$2,829 |
7.5× |
| Cta Abdomen (74175) |
$1,131.60 |
$2,829 |
7.5× |
| CTA pelvis (72191) |
$514.40 |
$1,286 |
3.4× |
| Dilation ureters/urethra rs&i (74485) |
$830.80 |
$2,077 |
0.5× |
| Dxa Bone Density Axial (77080) |
$144 |
$360 |
1.6× |
| Echo Guide For Artery Repair (76936) |
$160.40 |
$401 |
0.9× |
| Esophagram (74220) |
$144 |
$360 |
1.0× |
| Fetal Biophys Profile W/Nst (76818) |
$248.80 |
$622 |
2.8× |
| Fetal Biophysical Profile W/O Non-Stress Testing (76819) |
$303.20 |
$758 |
3.4× |
Fluoroscopy up to 1 hr (76000) range across 2 matching MRF lines |
$170.40–$249.60 |
$426–$624 |
varies |
| Foot 2 views (73620) |
$143.20 |
$358 |
1.9× |
Forearm 2 views (73090) range across 2 matching MRF lines |
$143.20–$144 |
$358–$360 |
varies |
| Gastric emptying imaging study (78264) |
$528.80 |
$1,322 |
1.5× |
| Gated Heart Planar Single (78472) |
$429.60 |
$1,074 |
1.2× |
Hand 2 views (73120) range across 2 matching MRF lines |
$134.80–$142.40 |
$337–$356 |
varies |
| Hepatobil Syst Image W/Drug (78227) |
$626 |
$1,565 |
1.3× |
| Hepatobiliary System Imaging (78226) |
$398.80 |
$997 |
1.2× |
| Hysterosalpingogram (74740) |
$321.60 |
$804 |
1.6× |
| Infant hip ultrasound with hip movement (dynamic) (76885) |
$104 |
$260 |
1.4× |
| Infant hip ultrasound, limited static exam (76886) |
$85.60 |
$214 |
1.1× |
| K Flow/Funct Image Multiple (78709) |
$1,124.40 |
$2,811 |
2.4× |
| K Flow/Funct Image W/Drug (78708) |
$678.40 |
$1,696 |
1.4× |
| K Flow/Funct Image W/O Drug (78707) |
$597.20 |
$1,493 |
1.3× |
| Knee 3 Views (73562) |
$143.20 |
$358 |
1.9× |
| Liver & Spleen Imaging Static Only (78215) |
$398.80 |
$997 |
1.2× |
| Liver imaging static only (78201) |
$330.80 |
$827 |
0.7× |
| Lung Ventilat&Perfus Imaging (78582) |
$805.60 |
$2,014 |
1.7× |
| Lymph System Imaging (78195) |
$460 |
$1,150 |
1.0× |
| Magnetic Image Jaw Joint (70336) |
$459.60 |
$1,149 |
2.2× |
| Meckels Divert Exam (78290) |
$545.60 |
$1,364 |
1.6× |
| Mlc imrt design & construction per imrt plan (77338) |
$358.40 |
$896 |
1.1× |
| Mra Head W/O & W/Contrast Material (70546) |
$807.60 |
$2,019 |
2.7× |
| MRA head w/o contrast (70544) |
$459.60 |
$1,149 |
2.2× |
| Mra Neck W/O &W/Contrast Material (70549) |
$760 |
$1,900 |
2.5× |
| MRA neck w/o contrast (70547) |
$570 |
$1,425 |
2.8× |
| MRI abdomen w/o contrast (74181) |
$570 |
$1,425 |
2.8× |
| MRI any jt lower extrem w/contrast material (73722) |
$807.60 |
$2,019 |
1.2× |
| MRI any jt lower extrem w/o & w/contrast matrl (73723) |
$807.60 |
$2,019 |
2.7× |
| MRI any jt upper extremity w/contrast matrl (73222) |
$807.60 |
$2,019 |
1.2× |
| MRI Breast W/O Contrast Bilateral (77047) |
$546.40 |
$1,366 |
2.7× |
| MRI cervical spine w contrast (72142) |
$565.20 |
$1,413 |
1.9× |
| MRI cervical spine w/o cont (72141) |
$478.40 |
$1,196 |
2.3× |
| MRI chest w/o contrast (71550) |
$570 |
$1,425 |
2.8× |
| MRI chest wo w contrast (71552) |
$807.60 |
$2,019 |
2.7× |
| MRI lower extrem oth/thn jt w/o & w/contr matr (73720) |
$807.60 |
$2,019 |
2.7× |
| MRI lower extrem oth/thn jt w/o contr matrl (73718) |
$687.20 |
$1,718 |
3.3× |
| MRI lumbar spine w contrast (72149) |
$565.20 |
$1,413 |
1.9× |
| Mri Neck Spine W/O & W/Dye (72156) |
$652.40 |
$1,631 |
2.2× |
| MRI orbit face &/neck w/o contrast (70540) |
$570 |
$1,425 |
2.8× |
| Mri Orbt/Fac/Nck W/O &W/Dye (70543) |
$831.60 |
$2,079 |
2.8× |
| MRI pelvis w/o & w contrast (72197) |
$644.40 |
$1,611 |
2.1× |
| MRI pelvis w/o contrast (72195) |
$570 |
$1,425 |
2.8× |
| MRI thoracic spine w/o contrast (72146) |
$478.40 |
$1,196 |
2.3× |
| MRI upper extremity oth than jt w/o contr matrl (73218) |
$570 |
$1,425 |
2.8× |
| Mri Uppr Extremity W/O&W/Dye (73220) |
$807.60 |
$2,019 |
2.7× |
| MRI, abdomen, combo (74183) |
$807.60 |
$2,019 |
2.7× |
| MRI, dorsal spine combo (72157) |
$652.40 |
$1,631 |
2.2× |
| MRI, joint upper extrem (73221) |
$513.20 |
$1,283 |
2.5× |
| MRI, joint upper extrem combo (73223) |
$807.60 |
$2,019 |
2.7× |
| MRI, lumbar spine combo (72158) |
$652.40 |
$1,631 |
2.2× |
| Myocardial Spect Multiple Studies (78452) |
$860.40 |
$2,151 |
0.8× |
| Neck soft tissue (70360) |
$144 |
$360 |
1.9× |
| Ntsty modul radthx pln dose-vol histos (77301) |
$1,873.20 |
$4,683 |
1.6× |
| Nuclear Rx Intra-Arterial (79445) |
$1,129.20 |
$2,823 |
5.6× |
| Nuclear Rx Oral Admin (79005) |
$342.40 |
$856 |
1.7× |
| Ophthalmic ultrasound dx b-scan w/wo a-scan (76512) |
$66.80 |
$167 |
0.7× |
| Parathyroid Planar Imaging (78070) |
$252.40 |
$631 |
0.7× |
| Parathyroid planar imaging w/wo subtraction (78071) |
$378.40 |
$946 |
1.1× |
| Pelvis 1 or 2 views (72170) |
$144 |
$360 |
1.6× |
| PET image w/CT, full body (78816) |
$3,276 |
$8,190 |
2.7× |
| PET imaging CT attenuation skull base mid-thigh (78815) |
$3,276 |
$8,190 |
2.7× |
| Pulmonary Perfusion Imaging Particulate (78580) |
$437.20 |
$1,093 |
1.3× |
| Radex Abd Compl Aqt Abd W/S/E/D Views 1 View Ch (74022) |
$144 |
$360 |
1.6× |
| Radex abscess/fistula/sinus tract rs&i (76080) |
$558.40 |
$1,396 |
1.2× |
| Radex Ankle Complete Minimum 3 Views (73610) |
$137.60 |
$344 |
1.8× |
| Radex Calcaneus Minimum 2 Views (73650) |
$144 |
$360 |
1.9× |
| Radex elbow complete minimum 3 views (73080) |
$136 |
$340 |
1.8× |
| Radex Facial Bones Complete Minimum 3 Views (70150) |
$144 |
$360 |
1.6× |
| Radex fingr minimum 2 views (73140) |
$144 |
$360 |
1.9× |
| Radex foot complete minimum 3 views (73630) |
$143.20 |
$358 |
1.9× |
| Radex Hand Minimum 3 Views (73130) |
$137.20 |
$343 |
1.8× |
| Radex lower extremity infant minimum 2 views (73592) |
$144 |
$360 |
1.9× |
| Radex Mastoids Compl Minimum 3 Views PR Side (70130) |
$125.20 |
$313 |
1.4× |
| Radex Nasal Bones Complete Minimum 3 Views (70160) |
$144 |
$360 |
1.9× |
| Radex Ribs Unilateral 2 Views (71100) |
$144 |
$360 |
1.9× |
| Radex shoulder complete minimum 2 views (73030) |
$134.40 |
$336 |
1.8× |
| Radex Sinuses Paransl < 3 Views (70210) |
$144 |
$360 |
1.9× |
Radex Spine 1 View Specify Level (72020) range across 3 matching MRF lines |
$60–$144 |
$150–$360 |
varies |
| Radex Sternum Minimum 2 Views (71120) |
$144 |
$360 |
1.9× |
| Radex Toe Minimum 2 Views (73660) |
$144 |
$360 |
1.9× |
| Radex upper extremity infant minimum 2 views (73092) |
$144 |
$360 |
1.6× |
| Radex Wrist Complete Minimum 3 Views (73110) |
$144 |
$360 |
1.9× |
| Radex X-Ray Exam Entire Spi 6/> Vw - Xr Entire Spine 6+ Vw (72084) |
$291.20 |
$728 |
3.2× |
| Radiation treatment delivery level 3 (77412) |
$440.80 |
$1,102 |
0.9× |
| Radiolog exam mandible compl minimum 4 views (70110) |
$116 |
$290 |
1.3× |
| Radiologic Exam Abdomen 3+ Views - Xr Abdomen 3+ Views (74021) |
$142.80 |
$357 |
1.6× |
| Radiologic exam colon double contrast study (74280) |
$263.60 |
$659 |
1.7× |
| Radiologic exam colon single contrast study (74270) |
$195.60 |
$489 |
1.3× |
| Radiologic exam knee complete 4/more views (73564) |
$144 |
$360 |
1.6× |
| Radiologic exam pelvis compl minimum 3 views (72190) |
$144 |
$360 |
1.6× |
| Radiologic Exam Small Int Single Contrast Study (74250) |
$156.80 |
$392 |
1.0× |
| Radiologic exam swallow function contrast study (74230) |
$186.80 |
$467 |
1.2× |
| Radiologic examination femur 1 view (73551) |
$142.80 |
$357 |
1.9× |
| Radiologic examination femur minimum 2 views (73552) |
$178.40 |
$446 |
2.4× |
| Radiologic examination knee 1/2 views (73560) |
$144 |
$360 |
1.9× |
| Radiologic examination tibia & fibula 2 views (73590) |
$143.20 |
$358 |
1.9× |
| Renal Cyst Study (74470) |
$558.40 |
$1,396 |
1.2× |
| Ribs bilateral 3 views (71110) |
$144 |
$360 |
1.6× |
| Rp loclzj tum plnr 1 area single day imaging (78800) |
$1,120.40 |
$2,801 |
3.3× |
| Rp Loclzj Tum Plnr Whole Body 2+ Days Imaging (78804) |
$1,211.20 |
$3,028 |
2.6× |
| Rp Loclzj Tum Plnr Whole Body Single Day Imaging (78802) |
$1,187.60 |
$2,969 |
2.5× |
| Rp Therapy Intravenous Administration (79101) |
$413.60 |
$1,034 |
2.1× |
| Scapula (73010) |
$144 |
$360 |
1.6× |
| Screening Digital Breast Tomosynthesis Bi (77063) |
$128 |
$320 |
5.5× |
| Shoulder 1 view (73020) |
$144 |
$360 |
1.9× |
| Shoulder Arthrography (73040) |
$405.60 |
$1,014 |
1.3× |
Skull less than 4 views (70250) range across 2 matching MRF lines |
$138.40–$144 |
$346–$360 |
varies |
| Special Physics Consult (77370) |
$200.40 |
$501 |
1.7× |
| Special teletherapy port plan (77321) |
$386.80 |
$967 |
1.2× |
| Special treatment procedure (77470) |
$1,687.60 |
$4,219 |
3.5× |
| Stereotactic Body Radiation Delivery (77373) |
$3,443.20 |
$8,608 |
2.2× |
| Tbs technical calculation only (77091) |
$178.40 |
$446 |
2.4× |
| Telethx isodose pln cplx w/basic dosimetry (77307) |
$358.40 |
$896 |
1.1× |
| Telethx isodose pln smpl w/dosimetry calculation (77306) |
$386.80 |
$967 |
1.2× |
| Ther Rad Simulaj-Aided Field Setting Complex (77290) |
$882.80 |
$2,207 |
2.7× |
| Ther Rad Simulaj-Aided Field Setting Intermed (77285) |
$426.80 |
$1,067 |
1.3× |
| Ther rad simulaj-aided field setting simple (77280) |
$536.40 |
$1,341 |
4.6× |
| Thoracic spine 2 views (72070) |
$137.20 |
$343 |
1.5× |
| Thoracic spine 3 views (72072) |
$104 |
$260 |
1.2× |
| Thoracolumbar 2 views (72080) |
$168 |
$420 |
2.2× |
| Thyroid Met Imaging Body (78018) |
$384 |
$960 |
0.8× |
| Thyroid Uptake W/Blood Flow Sngle/Mult Quan Meas (78014) |
$273.60 |
$684 |
0.8× |
| Tx Devices Design & Construction Complex (77334) |
$388.80 |
$972 |
1.2× |
| Tx devices design & construction intermediate (77333) |
$511.20 |
$1,278 |
4.4× |
| Tx devices design & construction simple (77332) |
$511.20 |
$1,278 |
4.4× |
| Ultrasound Breast Limited (76642) |
$107.60 |
$269 |
1.4× |
| Ultrasound Elastography Parenchyma (76981) |
$126.40 |
$316 |
1.4× |
| Ultrasound Exam Aaa Screen (76706) |
$123.60 |
$309 |
1.4× |
| Ultrasound, abdomen limited (76705) |
$236.40 |
$591 |
2.6× |
| Upper gi w/o kub (74240) |
$462.40 |
$1,156 |
3.1× |
| Urethrocystogram voiding (74455) |
$250 |
$625 |
1.2× |
| Urethrocystography retrograde (74450) |
$250 |
$625 |
1.2× |
Us breast unilateral complete (76641) range across 2 matching MRF lines |
$122.40–$144 |
$306–$360 |
varies |
| Us chest (76604) |
$127.60 |
$319 |
1.4× |
| Us complete joint (76881) |
$192 |
$480 |
2.1× |
Us exam, pelvic, limited (76857) range across 4 matching MRF lines |
$127.60–$128.80 |
$319–$322 |
varies |
| Us head (76506) |
$126.40 |
$316 |
1.4× |
| Us lmtd joint/oth nonvasc xtr strux r-t w/img (76882) |
$192 |
$480 |
2.1× |
| Us ob detailed single fetus (76811) |
$584.80 |
$1,462 |
2.8× |
| Us ob limited 1 or more fetuses (76815) |
$246 |
$615 |
2.7× |
| Us ob transvaginal (76817) |
$246 |
$615 |
2.7× |
| Us pelvic non ob complete (76856) |
$318.80 |
$797 |
3.5× |
| Us pg uter img f&mat 14 wk tabdl 1/1st gestation (76801) |
$246 |
$615 |
2.7× |
| Us preg uterus real time f/u trnsabdl per fetus (76816) |
$246 |
$615 |
2.7× |
| Us retroperitoneal complete (76770) |
$164.80 |
$412 |
1.8× |
| Us retroperitoneal limited (76775) |
$244.80 |
$612 |
2.7× |
| Us scrotum and contents (76870) |
$157.60 |
$394 |
1.7× |
| Us spinal canal and contents (76800) |
$131.20 |
$328 |
1.5× |
| Us thyroid (76536) |
$138.40 |
$346 |
1.5× |
| Us transrectal (76872) |
$128.80 |
$322 |
1.4× |
| Vein X-Ray Chest (75827) |
$908.80 |
$2,272 |
0.7× |
| Venography extremity bilateral rs&i (75822) |
$813.20 |
$2,033 |
0.6× |
| Venography extremity unilateral rs&i (75820) |
$813.20 |
$2,033 |
0.6× |
| Wrist 2 views (73100) |
$138.80 |
$347 |
1.8× |
| X-Ray Ac Jts - Xr Acromioclavicular Joints Bilateral (73050) |
$104.40 |
$261 |
1.4× |
| X-Ray Aorta Leg Arteries (75630) |
$2,462 |
$6,155 |
0.9× |
| X-Ray Bend Only L-S Spine (72120) |
$144 |
$360 |
1.6× |
X-Ray Elbow 2 Vw - Xr Elbow 1-2 Views Right (73070) range across 2 matching MRF lines |
$138–$144 |
$345–$360 |
varies |
X-Ray Exam Breast Specimen (76098) range across 2 matching MRF lines |
$522.40–$577.60 |
$1,306–$1,444 |
varies |
| X-Ray Exam Entire Spi 1 Vw (72081) |
$144 |
$360 |
1.9× |
| X-Ray Exam Entire Spi 2/3 Vw (72082) |
$250.80 |
$627 |
2.8× |
| X-Ray Exam Hip Uni 1 View (73501) |
$144 |
$360 |
1.9× |
| X-Ray Exam Hip Uni 2-3 Views (73502) |
$143.20 |
$358 |
1.9× |
| X-Ray Exam Hips Bi 2 Views (73521) |
$121.60 |
$304 |
1.3× |
| X-Ray Exam Hips Bi 3-4 Views (73522) |
$227.60 |
$569 |
2.5× |
| X-Ray Exam Hips Bi 5/> Views (73523) |
$209.20 |
$523 |
2.3× |
| X-Ray Exam L-S Spine Bending (72114) |
$206.80 |
$517 |
2.3× |
| X-Ray Exam Neck Spine 2-3 Vw (72040) |
$144 |
$360 |
1.9× |
| X-Ray Exam Neck Spine 6/>Vws (72052) |
$64.40 |
$161 |
0.7× |
| X-Ray Exam Unilat Ribs/Chest (71101) |
$144 |
$360 |
1.6× |
| X-ray eye for foreign body (70030) |
$178.40 |
$446 |
2.4× |
| X-ray humerus (73060) |
$143.20 |
$358 |
1.9× |
| X-ray IV pyelogram (ivp) (74400) |
$304 |
$760 |
2.0× |
| X-ray IV pyelogram+tomography (74415) |
$420.80 |
$1,052 |
2.8× |
| X-Ray Jaw <4 Vw - Xr Mandible < 4 Views (70100) |
$33.20 |
$83 |
0.4× |
| X-Ray Knee Bilat Standing - Xr Knees Anteroposterior Standing Bilat (73565) |
$178.40 |
$446 |
2.4× |
| X-Ray Lumbar Spine 2/3 Vw - Xr Lumbar Spine 2-3 Views (72100) |
$141.60 |
$354 |
1.6× |
| X-ray nose-rectum child f.b. (76010) |
$95.20 |
$238 |
1.3× |
| X-Ray Ribs, Chest 4+ Vw - Xr Ribs 3 Vws Bil W/ Chest Posteroanterior (71111) |
$206.40 |
$516 |
2.3× |
| X-Ray Sacroiliac Jts 3+ Vw - Xr Sacroiliac Joints 3+ Views (72202) |
$98 |
$245 |
1.1× |
| X-Ray Sacroiliac Jts <3 Vw - Xr Sacroiliac Joints 1-2 Views (72200) |
$118.40 |
$296 |
1.3× |
| X-Ray Sacrum/Coccyx 2+ Vw - Xr Sacrum Coccyx 2+ Views (72220) |
$138.80 |
$347 |
1.8× |
| X-Ray Sinuses 3+ Vw - Xr Paranasal Sinuses 3+ Views (70220) |
$144 |
$360 |
1.9× |
| X-Ray Skull 4+ Vw - Xr Skull Complete 4+ Views (70260) |
$149.20 |
$373 |
1.7× |
| X-ray thoracic spine 4 vw (72074) |
$144 |
$360 |
1.6× |
| X-Ray Tmj Unilat (70328) |
$61.60 |
$154 |
0.8× |
| X-Ray Urinary Tract Exam With Contrast Material (74420) |
$469.20 |
$1,173 |
1.6× |
| X-Rays Bone Length Studies (77073) |
$147.20 |
$368 |
1.6× |
| X-Rays Bone Survey Complete (77075) |
$344.80 |
$862 |
3.8× |
| Xr c-spine 4 or 5 views (72050) |
$214 |
$535 |
2.4× |
| Xr facial bones less than 3 views (70140) |
$144 |
$360 |
1.9× |
| Xr orbits complete 4 views (70200) |
$90.80 |
$227 |
1.0× |
| Xr Tomogram Single Plane (76100) |
$293.20 |
$733 |
3.3× |