| 3-D radiotherapy plan dose-volume histograms (77295) |
$1,356.75 |
$5,025 |
1.0× |
| Abdomen 1 View (74018) |
$102.60 |
$380 |
1.2× |
| Abdomen 2 views (74019) |
$138.51 |
$513 |
1.3× |
| Acute Gastrointestinal Blood Loss Imaging (78278) |
$514.08 |
$1,904 |
1.3× |
| Angio internal mammary (75756) |
$1,651.32 |
$6,116 |
0.5× |
| Angio pulmonary bilat (75743) |
$1,651.32 |
$6,116 |
0.5× |
| Angiography Adrenal Bilateral Slctv Rs&I (75733) |
$1,651.32 |
$6,116 |
0.5× |
| Angiography extremity bilateral rs&i (75716) |
$1,651.32 |
$6,116 |
0.5× |
| Angiography extremity unilateral rs&i (75710) |
$1,651.32 |
$6,116 |
0.5× |
| Angiography pulmonary unilateral slctv rs&i (75741) |
$1,651.32 |
$6,116 |
0.5× |
| Angrph pulmonary nonslctv cath/ven njx rs&i (75746) |
$1,651.32 |
$6,116 |
0.5× |
| Ankle 2 views (73600) |
$102.60 |
$380 |
1.2× |
Aortography thoracic serialography rs&i (75605) unusually low: confirm this is the full procedure |
$2,751.03 |
$10,189 |
0.5× |
Artery X-Rays Abdomen (75726) unusually low: confirm this is the full procedure |
$2,751.03 |
$10,189 |
0.5× |
| Artery X-Rays Adrenal Gland (75731) |
$1,651.32 |
$6,116 |
0.5× |
| Artery X-Rays Pelvis (75736) |
$4,126.55 |
$15,283.50 |
0.7× |
Artery X-Rays Spine (75705) unusually low: confirm this is the full procedure |
$2,751.03 |
$10,189 |
0.5× |
| Arthrogram ankle (73615) |
$350.33 |
$1,297.50 |
1.0× |
| Arthrogram hip (73525) |
$212.49 |
$787 |
0.6× |
| Arthrogram Wrist (73115) |
$233.55 |
$865 |
0.7× |
| Basic radiation dosimetry calculation (77300) |
$186.03 |
$689 |
1.4× |
| Bone age studies (77072) |
$138.51 |
$513 |
1.3× |
| Bone Imaging 3 Phase (78315) |
$514.08 |
$1,904 |
1.3× |
| Bone Imaging Limited Area (78300) |
$514.08 |
$1,904 |
1.3× |
| Bone Imaging Multiple Areas (78305) |
$514.08 |
$1,904 |
1.3× |
| Bone Imaging Whole Body (78306) |
$514.08 |
$1,904 |
1.3× |
| Bone marrow imaging limited area (78102) |
$514.08 |
$1,904 |
1.3× |
| Bone marrow imaging; whole body (78104) |
$514.08 |
$1,904 |
1.3× |
| Bone survey infant (77076) |
$138.51 |
$513 |
1.3× |
| Brachytx isodose complex (77318) |
$593.73 |
$2,199 |
1.6× |
| Brachytx isodose intermed (77317) |
$578.34 |
$2,142 |
1.6× |
| Brachytx Isodose Plan Simple (77316) |
$480.87 |
$1,781 |
1.3× |
| Brain Image W/Flow < 4 Views (78601) |
$514.08 |
$1,904 |
1.3× |
| Brain Imaging Min 4 Static Views W Vascular Flow (78606) |
$667.71 |
$2,473 |
1.2× |
| Brain Imaging Pet Metabolic Evaluation (78608) |
$1,357.02 |
$5,026 |
1.0× |
| Cardiac blood pool imaging, first pass technique; multiple studies, resting and with stress (exercise and/or… (78483) |
$667.71 |
$2,473 |
1.2× |
| Cardiac MRI w/w/o contrast & further seq (75561) |
$1,401.84 |
$5,192 |
4.0× |
| Cardiac MRI w/w/o contrast w/stress (75563) |
$2,724.03 |
$10,089 |
3.5× |
| Cat Scan Follow-Up Study (76380) |
$339.66 |
$1,258 |
3.9× |
| Cerebrospinal Fluid Flow W/O Matl Shunt Evaltj (78645) |
$667.71 |
$2,473 |
1.2× |
| Cerebrospinal fluid flow, imaging (not including introduction of material); ventriculography Non-Facility (78635) |
$667.71 |
$2,473 |
1.2× |
| Cerebrospinal Fluid Scan (78630) |
$667.71 |
$2,473 |
1.2× |
| Chest 1 view (71045) |
$93.15 |
$345 |
1.1× |
| Chest 2 views (71046) |
$93.15 |
$345 |
1.1× |
| Chest 3 views (71047) |
$93.15 |
$345 |
1.1× |
| Chest 4 or more views (71048) |
$125.55 |
$465 |
1.2× |
| Chg us nrv&acc strux 1 xtr compre w/img pr extremity (76883) |
$221.13 |
$819 |
2.1× |
| Cholecystography Oral Contrast (74290) |
$226.80 |
$840 |
1.3× |
| Cineradiograpy/vidradiograpy xcpt where spec (76120) |
$138.51 |
$513 |
1.3× |
| Cisternography Positive Contrast Rs&I (70015) |
$453.87 |
$1,681 |
0.6× |
| Clavicle complete (73000) |
$102.60 |
$380 |
1.2× |
| Computed Tomography Thorax Lw Dose Lng Ca Scr C- (71271) |
$207.90 |
$770 |
2.0× |
| Continuing medical physics consltj pr wk (77336) |
$301.86 |
$1,118 |
2.3× |
| Contrast Exam Abdominl Aorta (75625) |
$1,651.32 |
$6,116 |
0.5× |
| Contrast X-Ray Bladder (74430) |
$233.55 |
$865 |
0.7× |
| Contrast X-Ray Of Elbow (73085) |
$212.49 |
$787 |
0.6× |
| Contrast X-Ray Of Knee Joint (73580) |
$233.55 |
$865 |
0.7× |
| Corpora cavernosography (74445) |
$68.85 |
$255 |
0.7× |
| CT abdomen and pelvis without and with contrast (74178) |
$1,546.29 |
$5,727 |
4.5× |
| CT abdomen and pelvis without contrast (74176) |
$966.33 |
$3,579 |
4.1× |
| CT abdomen w contrast (74160) |
$750.06 |
$2,778 |
4.3× |
| CT abdomen w wo contrast (74170) |
$750.06 |
$2,778 |
4.3× |
| CT abdomen w/o contrast (74150) |
$457.11 |
$1,693 |
4.4× |
| CT Angio Abdomen and Pelvis (74174) |
$1,546.29 |
$5,727 |
4.5× |
| CT Angio Chest (71275) |
$750.06 |
$2,778 |
4.3× |
| CT Angio Head (70496) |
$741.96 |
$2,748 |
4.3× |
| CT angio hrt w/3d image (75574) |
$750.06 |
$2,778 |
2.2× |
| Ct Angio Lwr Extr W/O&W/Dye (73706) |
$1,125.09 |
$4,167 |
6.4× |
| CT Angio Neck (70498) |
$741.96 |
$2,748 |
4.3× |
| Ct Angio Upr Extrm W/O&W/Dye (73206) |
$750.06 |
$2,778 |
4.3× |
| CT Cere Prfuj Alys C+ W/O CT/Cta Same Anatomy (70473) |
$719.55 |
$2,665 |
4.1× |
| CT cervical spine w/ contrast (72126) |
$1,529.28 |
$5,664 |
4.4× |
| CT cervical spine w/o contrast (72125) |
$452.25 |
$1,675 |
4.3× |
| CT cervical spine w/wo cont (72127) |
$1,529.28 |
$5,664 |
8.8× |
| CT chest w contrast (71260) |
$750.06 |
$2,778 |
4.3× |
| CT chest w/wo contrast (71270) |
$750.06 |
$2,778 |
4.3× |
| CT colonography screening (74263) |
$1,079.19 |
$3,997 |
4.5× |
| CT colonogrphy dx image postprocess w/o contrast (74261) |
$447.39 |
$1,657 |
4.3× |
| CT head/brain with contrast (70460) |
$741.96 |
$2,748 |
4.3× |
| CT head/brain without and with contrast (70470) |
$741.96 |
$2,748 |
4.3× |
| CT heart contrast eval cardiac structure&morph (75572) |
$750.06 |
$2,778 |
2.2× |
CT heart no contrast quant eval coronry calcium (75571) range across 4 matching MRF lines |
$29.16–$108 |
$108–$400 |
varies |
| CT hrt w/3d image congen (75573) |
$750.06 |
$2,778 |
2.2× |
| CT iac w contrast (70481) |
$741.96 |
$2,748 |
4.3× |
| CT l-spine w&w/o contrast (72133) |
$1,546.29 |
$5,727 |
8.9× |
CT lower ext w/o (73700) range across 4 matching MRF lines |
$457.11–$685.67 |
$1,693–$2,539.50 |
varies |
CT lower extremity w/contrast material (73701) range across 3 matching MRF lines |
$750.06–$1,125.09 |
$2,778–$4,167 |
varies |
| CT lumbar spine w contrast (72132) |
$1,546.29 |
$5,727 |
4.5× |
| CT lumbar spine w/o contrast (72131) |
$457.11 |
$1,693 |
4.4× |
| CT maxillofacial w contrast (70487) |
$741.96 |
$2,748 |
4.3× |
| CT maxillofacial wo contrast (70486) |
$452.25 |
$1,675 |
4.3× |
| CT neck tissue combo (70492) |
$741.96 |
$2,748 |
4.3× |
| Ct Orbit/Ear/Fossa W/O&W/Dye (70482) |
$741.96 |
$2,748 |
4.3× |
| CT orbits w/o contrast (70480) |
$452.25 |
$1,675 |
4.3× |
| CT pelvis w&w/o contrast (72194) |
$750.06 |
$2,778 |
4.3× |
| CT pelvis w/o contrast (72192) |
$457.11 |
$1,693 |
4.4× |
| CT scan of leg combo (73702) |
$750.06 |
$2,778 |
4.3× |
| CT scans face/jaw combo (70488) |
$741.96 |
$2,748 |
4.3× |
| CT soft tissue neck w contrast (70491) |
$741.96 |
$2,748 |
4.3× |
| CT soft tissue neck w/o contrast (70490) |
$452.25 |
$1,675 |
4.3× |
| CT thoracic spine w contrast (72129) |
$750.06 |
$2,778 |
4.3× |
| CT thoracic spine w/o contrast (72128) |
$457.11 |
$1,693 |
4.4× |
| CT thoracic spine w/wo cont (72130) |
$750.06 |
$2,778 |
4.3× |
| CT thorax w/o contrast (71250) |
$457.11 |
$1,693 |
4.4× |
| CT unlisted procedure (76497) |
$349.65 |
$1,295 |
4.0× |
| CT upper ext wo (73200) |
$457.11 |
$1,693 |
4.4× |
| CT upper extremity w/o & w/contrast material (73202) |
$1,546.29 |
$5,727 |
8.9× |
| CT upper extremity with contrast (73201) |
$1,546.29 |
$5,727 |
4.5× |
| Cta Abdl Aorta&Bi Iliofem W/Contrast&Postp (75635) |
$750.06 |
$2,778 |
4.3× |
| Cta Abdomen (74175) |
$750.06 |
$2,778 |
4.3× |
| CTA head&neck c+ w/noncontrast img&post-pxessing (70471) |
$1,483.92 |
$5,496 |
4.3× |
| CTA pelvis (72191) |
$750.06 |
$2,778 |
4.3× |
| Dacryocystography, nasolacrimal duct, radiological supervision and interpretation Non-Facility (70170) |
$146.07 |
$541 |
0.6× |
| Dilation ureters/urethra rs&i (74485) |
$1,136.16 |
$4,208 |
0.5× |
| Discography Cerv/Thor Spine (72285) |
$1,114.56 |
$4,128 |
0.6× |
| Diskography lumbar (72295) |
$1,114.56 |
$4,128 |
0.6× |
| Doppler Echo Fetal Puls Spectral F/U/Repeat (76828) |
$221.13 |
$819 |
2.1× |
| Doppler Echo Fetal Spectral Display Complete (76827) |
$221.13 |
$819 |
2.1× |
| Doppler Fetal Mid Cerebral Artery (76821) |
$201.15 |
$745 |
1.9× |
| Dxa Bone Density Axial (77080) |
$138.51 |
$513 |
1.3× |
| Dxa bone density study 1/>sites appendiclr skel (77081) |
$102.60 |
$380 |
1.2× |
| Echo exam of fetal heart (76825) |
$981.18 |
$3,634 |
1.8× |
| Echo exam uterus (76831) |
$467.10 |
$1,730 |
2.0× |
| Echo Guide For Artery Repair (76936) |
$488.70 |
$1,810 |
2.3× |
| Echocardiography, fetal, cardiovascular system, real time with image documentation (2D), with or without M-mode… (76826) |
$467.10 |
$1,730 |
2.0× |
| Echograp Trans R Pros Study (76873) |
$343.71 |
$1,273 |
3.3× |
| Esophagram (74220) |
$226.80 |
$840 |
1.3× |
| Fetal Biophys Profile W/Nst (76818) |
$221.13 |
$819 |
2.1× |
| Fetal Biophysical Profile W/O Non-Stress Testing (76819) |
$221.13 |
$819 |
2.1× |
| Fetal MRI w/placntl matrnl plvc img sing/1st ges (74712) |
$876.15 |
$3,245 |
3.7× |
| Fluoroscopy up to 1 hr (76000) |
$275.40 |
$1,020 |
1.2× |
| Follow-Up Angiography (75898) |
$1,651.32 |
$6,116 |
0.5× |
| Foot 2 views (73620) |
$102.60 |
$380 |
1.2× |
| Forearm 2 views (73090) |
$102.60 |
$380 |
1.2× |
| Gastric emptying imaging study (78264) |
$514.08 |
$1,904 |
1.3× |
| Gastric Emptyng Imag Std W/Sm Bwl Transit (78265) |
$514.08 |
$1,904 |
1.3× |
| Gastroesophageal Reflux Exam (78262) |
$514.08 |
$1,904 |
1.3× |
| Gated Heart Planar Single (78472) |
$514.08 |
$1,904 |
1.3× |
| Gated Heart, Multiple (78473) |
$514.08 |
$1,904 |
1.3× |
| Gstrc Emptng Imag Std W/Sm Bwl Col Trnst Mlt Day (78266) |
$667.71 |
$2,473 |
1.2× |
Hand 2 views (73120) range across 3 matching MRF lines |
$138.51–$207.77 |
$513–$769.50 |
varies |
| Hdr Rdncl Ntrstl/Icav Brchtx (77772) |
$1,417.77 |
$5,251 |
2.0× |
| Hdr Rdncl Ntrstl/Icav Brchtx (77771) |
$1,417.77 |
$5,251 |
2.0× |
| Hdr Rdncl Ntrstl/Icav Brchtx 1 Channel (77770) |
$1,417.77 |
$5,251 |
2.0× |
| Heart first pass single,planar (78481) |
$667.71 |
$2,473 |
1.2× |
| Heart Image (Pet) Multiple (78492) |
$1,488.24 |
$5,512 |
1.0× |
| Hepatc Vngrph Wdg/Fr Hemodyn Eval Rs&I (75889) |
$1,651.32 |
$6,116 |
0.5× |
| Hepatc Vngrph Wdg/Fr W/O Hemodyn Eval Rs&I (75891) |
$1,651.32 |
$6,116 |
0.5× |
| Hepatobil Syst Image W/Drug (78227) |
$667.71 |
$2,473 |
1.2× |
| Hepatobiliary System Imaging (78226) |
$514.08 |
$1,904 |
1.3× |
| Ht Musc Image Planar Mult (78454) |
$1,782.81 |
$6,603 |
1.4× |
| Ht Muscle Image Spect Sing (78451) |
$1,782.81 |
$6,603 |
1.4× |
| Hyperthermia external generated superficial (77600) |
$816.21 |
$3,023 |
2.1× |
| Hyperthermia, externally generated; deep (ie, heating to depths greater than 4 cm) Non-Facility (77605) |
$816.21 |
$3,023 |
1.2× |
| Hysterosalpingogram (74740) |
$146.07 |
$541 |
0.6× |
| Infant hip ultrasound with hip movement (dynamic) (76885) |
$164.43 |
$609 |
1.9× |
| Infant hip ultrasound, limited static exam (76886) |
$164.43 |
$609 |
1.9× |
| Interstitial radiation source applic complex (77778) |
$4,382.10 |
$16,230 |
6.3× |
| Intracavitary Radiation Source Applic Complex (77763) |
$4,561.92 |
$16,896 |
6.6× |
| Intracavitary Radiation Source Applic Intermed (77762) |
$4,561.92 |
$16,896 |
8.3× |
| Intracavitary radiation source applic simple (77761) |
$4,561.92 |
$16,896 |
8.3× |
Intraop radiaj tx deliver electrons sngl tx sess (77425) likely a partial charge, not the full procedure |
$1,217.97 |
$4,511 |
0.2× |
Intraop radiaj tx deliver xray single tx session (77424) likely a partial charge, not the full procedure |
$1,217.97 |
$4,511 |
0.2× |
| Joint Survey Single View (77077) |
$138.51 |
$513 |
1.3× |
| K Flow/Funct Image Multiple (78709) |
$667.71 |
$2,473 |
1.2× |
| K Flow/Funct Image W/Drug (78708) |
$667.71 |
$2,473 |
1.2× |
| K Flow/Funct Image W/O Drug (78707) |
$667.71 |
$2,473 |
1.2× |
| Kidney Funcj Study Non-Img Radioisotopic Study (78725) |
$514.08 |
$1,904 |
1.3× |
| Kidney Imaging Morphol (78700) |
$514.08 |
$1,904 |
1.3× |
| Kidney Imaging Morphoogy W/Vascular Flow (78701) |
$514.08 |
$1,904 |
1.3× |
Knee 3 Views (73562) range across 4 matching MRF lines |
$102.60–$153.90 |
$380–$570 |
varies |
| Leveen/Shunt Patency Exam (78291) |
$514.08 |
$1,904 |
1.3× |
| Liver & Spleen Imaging Static Only (78215) |
$514.08 |
$1,904 |
1.3× |
| Liver & Spleen Imaging W/Vascular Flow (78216) |
$514.08 |
$1,904 |
1.3× |
| Liver imaging w/vascular flow (78202) |
$667.71 |
$2,473 |
1.2× |
| Lung Perf&Ventilat Diferentl (78598) |
$667.71 |
$2,473 |
1.2× |
| Lung perfusion differential (78597) |
$514.08 |
$1,904 |
1.3× |
| Lung Ventilat&Perfus Imaging (78582) |
$667.71 |
$2,473 |
1.2× |
| Lung Ventilation Imaging (78579) |
$514.08 |
$1,904 |
1.3× |
| Lymph System Imaging (78195) |
$667.71 |
$2,473 |
1.2× |
| Lymphangiography Extremity Only Bilateral Rs&I (75803) |
$1,078.65 |
$3,995 |
0.7× |
| Lymphangiography extremity only unilateral rs&i (75801) |
$423.09 |
$1,567 |
0.7× |
| Lymphangiography Pelvic/Abdominal Bilateral Rs&I (75807) |
$1,651.32 |
$6,116 |
0.5× |
| Lymphangiography, pelvic/abdominal, unilateral (75805) |
$1,651.32 |
$6,116 |
0.5× |
| Magnetic Image Jaw Joint (70336) |
$876.15 |
$3,245 |
3.7× |
| Magnetic resonance (eg, proton) imaging, brain (including brain stem andskull base), during open intracranial procedure… (70558) |
$680.13 |
$2,519 |
3.9× |
| Magnetic resonance (eg, proton) imaging, brain (including brain stem andskull base), during open intracranial procedure… (70557) |
$1,839.78 |
$6,814 |
3.4× |
| Magnetic resonance (eg, proton) imaging, brain (including brain stem andskull base), during open intracranial procedure… (70559) |
$680.13 |
$2,519 |
3.9× |
| Magnetic Resonance Elastography (76391) |
$876.15 |
$3,245 |
3.7× |
| Meckels Divert Exam (78290) |
$514.08 |
$1,904 |
1.3× |
Mlc imrt design & construction per imrt plan (77338) range across 3 matching MRF lines |
$1,780.92–$7,122.87 |
$6,596–$26,381 |
varies |
| Mr safety determination physician/other qhp (76016) |
$49.68 |
$184 |
0.6× |
| Mr safety implant&/fb assmt clin staf 1st 15 min (76014) |
$13.77 |
$51 |
0.5× |
| Mr safety implt electronics prepj supvj phys/qhp (76018) |
$51.84 |
$192 |
0.5× |
| Mr safety implt pos&/immoblj (76019) |
$33.48 |
$124 |
0.6× |
| Mr safety med physics xm customization plng&mntr (76017) |
$136.35 |
$505 |
0.6× |
| Mra Head W/O & W/Contrast Material (70546) |
$1,401.84 |
$5,192 |
4.0× |
| MRA head w/o contrast (70544) |
$876.15 |
$3,245 |
3.7× |
| MRA head with contrast (70545) |
$1,401.84 |
$5,192 |
4.0× |
| MRA neck w contrast (70548) |
$1,401.84 |
$5,192 |
4.0× |
| Mra Neck W/O &W/Contrast Material (70549) |
$1,401.84 |
$5,192 |
4.0× |
| MRA neck w/o contrast (70547) |
$876.15 |
$3,245 |
3.7× |
| MRI abdomen w contrast (74182) |
$1,401.84 |
$5,192 |
4.0× |
| MRI abdomen w/o contrast (74181) |
$876.15 |
$3,245 |
3.7× |
| MRI any jt lower extrem w/contrast material (73722) |
$2,724.03 |
$10,089 |
3.5× |
| MRI any jt lower extrem w/o & w/contrast matrl (73723) |
$2,724.03 |
$10,089 |
7.8× |
| MRI any jt upper extremity w/contrast matrl (73222) |
$2,724.03 |
$10,089 |
3.5× |
| MRI brain functional w/o physician admnistration (70554) |
$876.15 |
$3,245 |
3.7× |
| MRI brain functional w/physician admnistration (70555) |
$876.15 |
$3,245 |
3.7× |
| MRI Breast W/O Contrast Bilateral (77047) |
$876.15 |
$3,245 |
3.7× |
| MRI Breast Without Contrast Material Unilateral (77046) |
$876.15 |
$3,245 |
3.7× |
| MRI cardiac w/o contrast (75557) |
$876.15 |
$3,245 |
3.7× |
| MRI cervical spine w contrast (72142) |
$1,401.84 |
$5,192 |
4.0× |
| MRI cervical spine w/o cont (72141) |
$876.15 |
$3,245 |
3.7× |
| MRI chest w/o contrast (71550) |
$876.15 |
$3,245 |
3.7× |
| MRI chest with contrast (71551) |
$2,724.03 |
$10,089 |
3.5× |
| MRI chest wo w contrast (71552) |
$2,724.03 |
$10,089 |
7.8× |
| MRI lower extrem oth/thn jt w/contrast matrl (73719) |
$1,401.84 |
$5,192 |
4.0× |
MRI lower extrem oth/thn jt w/o & w/contr matr (73720) range across 3 matching MRF lines |
$1,401.84–$2,102.76 |
$5,192–$7,788 |
varies |
MRI lower extrem oth/thn jt w/o contr matrl (73718) range across 3 matching MRF lines |
$876.15–$1,314.23 |
$3,245–$4,867.50 |
varies |
| MRI lumbar spine w contrast (72149) |
$1,401.84 |
$5,192 |
4.0× |
| Mri Neck Spine W/O & W/Dye (72156) |
$1,401.84 |
$5,192 |
4.0× |
| MRI orbit face &/neck w/o contrast (70540) |
$876.15 |
$3,245 |
3.7× |
| MRI orbit face neck w contrast (70542) |
$1,401.84 |
$5,192 |
4.0× |
| Mri Orbt/Fac/Nck W/O &W/Dye (70543) |
$1,401.84 |
$5,192 |
4.0× |
| MRI pelvis w contrast (72196) |
$1,401.84 |
$5,192 |
4.0× |
| MRI pelvis w/o & w contrast (72197) |
$1,401.84 |
$5,192 |
4.0× |
| MRI pelvis w/o contrast (72195) |
$876.15 |
$3,245 |
3.7× |
| MRI spectroscopy (76390) |
$925.29 |
$3,427 |
10.7× |
| MRI thoracic spine w/o contrast (72146) |
$876.15 |
$3,245 |
3.7× |
| MRI upper extremity oth than jt w/contr matrl (73219) |
$1,401.84 |
$5,192 |
4.0× |
MRI upper extremity oth than jt w/o contr matrl (73218) range across 3 matching MRF lines |
$876.15–$1,314.23 |
$3,245–$4,867.50 |
varies |
| Mri Uppr Extremity W/O&W/Dye (73220) |
$1,401.84 |
$5,192 |
4.0× |
| MRI, abdomen, combo (74183) |
$1,401.84 |
$5,192 |
4.0× |
| MRI, dorsal spine combo (72157) |
$1,401.84 |
$5,192 |
4.0× |
| MRI, dorsal spine contrast (72147) |
$1,401.84 |
$5,192 |
4.0× |
| MRI, joint upper extrem (73221) |
$876.15 |
$3,245 |
3.7× |
| MRI, joint upper extrem combo (73223) |
$2,724.03 |
$10,089 |
7.8× |
| MRI, lumbar spine combo (72158) |
$1,401.84 |
$5,192 |
4.0× |
| Myelogram cervical (72240) |
$412.56 |
$1,528 |
0.5× |
| Myelogram Lumbar (72265) |
$412.56 |
$1,528 |
0.5× |
| Myelography thoracic (72255) |
$412.56 |
$1,528 |
0.5× |
| Myelograpy 2/more regions rs&i (72270) |
$412.56 |
$1,528 |
0.5× |
| Myocardial Imaging Pet Metabolic Evaluation (78459) |
$1,446.93 |
$5,359 |
1.1× |
| Myocardial Perfusion Planar 1 Study Rest/Stress (78453) |
$1,782.81 |
$6,603 |
1.4× |
| Myocardial Spect Multiple Studies (78452) |
$1,782.81 |
$6,603 |
1.4× |
| Myocrd Img Pet Metab Eval Single Study Cncrnt CT (78429) |
$1,499.85 |
$5,555 |
1.1× |
| Myocrd img PET prfuj 1std rest/stress cncrnt CT (78430) |
$1,488.24 |
$5,512 |
1.0× |
| Myocrd Img Pet Prfuj Mlt Std Rst&Strs Cncrnt CT (78431) |
$1,739.34 |
$6,442 |
0.8× |
| Myocrd Img Pet Prfuj W/Metab 2rtracer Cncrnt CT (78433) |
$1,905.66 |
$7,058 |
0.9× |
| N-invas est c ffr sw aly CTA (75580) |
$1,477.71 |
$5,473 |
1.7× |
| Neck soft tissue (70360) |
$102.60 |
$380 |
1.2× |
| Njx Rp Loclzj Non-Img Probe Study Intravenous (78808) |
$514.08 |
$1,904 |
1.3× |
| Nm csf leak detection (78650) |
$1,782.81 |
$6,603 |
1.4× |
| Nm whole blood volume (78122) |
$667.71 |
$2,473 |
1.2× |
| Nonvascular Shunt X-Ray (75809) |
$68.85 |
$255 |
0.7× |
| Ntsty modul radthx pln dose-vol histos (77301) |
$2,479.68 |
$9,184 |
1.8× |
| Nuclear Rx Intra-Arterial (79445) |
$345.06 |
$1,278 |
1.5× |
| Nuclear Rx Oral Admin (79005) |
$345.06 |
$1,278 |
1.5× |
| Ob us nuchal meas 1 gest (76813) |
$221.13 |
$819 |
2.1× |
| Oph bmtry us echograpy a-scan io lens pwr cal (76519) |
$221.13 |
$819 |
2.1× |
| Oph us dx ant sgm us immersion b-scan/hr biom (76513) |
$221.13 |
$819 |
2.1× |
| Ophthalmic Biometry US Echograpy a-Scan (76516) |
$221.13 |
$819 |
2.1× |
| Ophthalmic ultrasound dx b-scan w/wo a-scan (76512) |
$331.70 |
$1,228.50 |
3.2× |
| Ophthalmic US Dx Corneal Pachymetry Uni/Bi (76514) |
$74.93 |
$277.50 |
2.6× |
| Ophthalmic us dx quantitative a-scan only (76511) |
$221.13 |
$819 |
2.1× |
| Optic foramina (70190) |
$102.60 |
$380 |
1.2× |
| Panoramic X-ray of jaws (70355) |
$102.60 |
$380 |
1.2× |
| Parathyroid imaging w/tomographic spect & CT (78072) |
$667.71 |
$2,473 |
1.2× |
| Parathyroid Planar Imaging (78070) |
$514.08 |
$1,904 |
1.3× |
| Parathyroid planar imaging w/wo subtraction (78071) |
$514.08 |
$1,904 |
1.3× |
| Pelvis 1 or 2 views (72170) |
$138.51 |
$513 |
1.3× |
| Perineogram (74775) |
$292.14 |
$1,082 |
1.2× |
| Peritoneogram Rs&I (74190) |
$306.72 |
$1,136 |
0.6× |
| Pet Image Skull-Thigh (78812) |
$2,046.33 |
$7,579 |
1.4× |
| Pet Image W/Ct Lmtd (78814) |
$1,904.04 |
$7,052 |
1.3× |
| PET image w/CT, full body (78816) |
$2,351.97 |
$8,711 |
1.7× |
| PET imaging CT attenuation skull base mid-thigh (78815) |
$2,046.33 |
$7,579 |
1.4× |
| Pet Imaging Limited Area Chest Head/Neck (78811) |
$1,904.04 |
$7,052 |
1.5× |
| Pet Myocardial Sngl Study (78491) |
$1,488.24 |
$5,512 |
1.0× |
| PET whole body (78813) |
$2,351.97 |
$8,711 |
1.7× |
| Plasma Vol Radiopharm Vol Dilute Spx Mult Smples (78111) |
$1,782.81 |
$6,603 |
1.4× |
| Plasma volume, radiopharmaceutical volume-dilution technique (separate procedure); single sampling Non-Facility (78110) |
$1,782.81 |
$6,603 |
1.4× |
| Platelet survival study Non-Facility (78191) |
$514.08 |
$1,904 |
1.3× |
| Prq Transhepatc Portograpy Hemodyn Eval Rs&I (75885) |
$1,651.32 |
$6,116 |
0.5× |
| Pulmonary Perfusion Imaging Particulate (78580) |
$514.08 |
$1,904 |
1.3× |
| Radex Abd Compl Aqt Abd W/S/E/D Views 1 View Ch (74022) |
$138.51 |
$513 |
1.3× |
| Radex abscess/fistula/sinus tract rs&i (76080) |
$306.72 |
$1,136 |
0.6× |
Radex Ankle Complete Minimum 3 Views (73610) range across 3 matching MRF lines |
$102.60–$153.90 |
$380–$570 |
varies |
| Radex Calcaneus Minimum 2 Views (73650) |
$102.60 |
$380 |
1.2× |
| Radex elbow complete minimum 3 views (73080) |
$102.60 |
$380 |
1.2× |
| Radex Facial Bones Complete Minimum 3 Views (70150) |
$138.51 |
$513 |
1.3× |
| Radex fingr minimum 2 views (73140) |
$102.60 |
$380 |
1.2× |
Radex foot complete minimum 3 views (73630) range across 3 matching MRF lines |
$102.60–$153.90 |
$380–$570 |
varies |
Radex Hand Minimum 3 Views (73130) range across 4 matching MRF lines |
$161.46–$242.19 |
$598–$897 |
varies |
| Radex lower extremity infant minimum 2 views (73592) |
$153.90 |
$570 |
1.8× |
| Radex Mastoids Compl Minimum 3 Views PR Side (70130) |
$138.51 |
$513 |
1.3× |
| Radex Nasal Bones Complete Minimum 3 Views (70160) |
$102.60 |
$380 |
1.2× |
| Radex Pharynx/Larx W/Fluor&/Magnification Tq (70370) |
$102.60 |
$380 |
1.2× |
| Radex Ribs Unilateral 2 Views (71100) |
$102.60 |
$380 |
1.2× |
Radex shoulder complete minimum 2 views (73030) range across 3 matching MRF lines |
$102.60–$153.90 |
$380–$570 |
varies |
| Radex Sinuses Paransl < 3 Views (70210) |
$102.60 |
$380 |
1.2× |
| Radex sm int w/mlt srl imges via enteroclss tube (74251) |
$226.80 |
$840 |
1.3× |
| Radex Spine 1 View Specify Level (72020) |
$102.60 |
$380 |
1.2× |
| Radex Sternum Minimum 2 Views (71120) |
$102.60 |
$380 |
1.2× |
| Radex Temporomandble Jt Opn & Clsd Mouth Bilat (70330) |
$102.60 |
$380 |
1.2× |
| Radex Toe Minimum 2 Views (73660) |
$102.60 |
$380 |
1.2× |
| Radex upper extremity infant minimum 2 views (73092) |
$207.77 |
$769.50 |
2.0× |
| Radex Wrist Complete Minimum 3 Views (73110) |
$102.60 |
$380 |
1.2× |
| Radex X-Ray Exam Entire Spi 6/> Vw - Xr Entire Spine 6+ Vw (72084) |
$138.51 |
$513 |
1.3× |
| Radiation Delivery Stereotactic Cranial Linear (77372) |
$6,165.45 |
$22,835 |
0.8× |
| Radiation treatment delivery level 1 (77402) |
$213.30 |
$790 |
2.1× |
| Radiation treatment delivery level 2 (77407) |
$765.72 |
$2,836 |
2.0× |
| Radiation treatment delivery level 3 (77412) |
$1,096.74 |
$4,062 |
2.0× |
| Radiolog exam mandible compl minimum 4 views (70110) |
$138.51 |
$513 |
1.3× |
| Radiologic Exam Abdomen 3+ Views - Xr Abdomen 3+ Views (74021) |
$138.51 |
$513 |
1.3× |
| Radiologic exam colon double contrast study (74280) |
$226.80 |
$840 |
1.3× |
| Radiologic exam colon single contrast study (74270) |
$226.80 |
$840 |
1.3× |
| Radiologic Exam Esophagus Double Contrast Study (74221) |
$226.80 |
$840 |
1.3× |
Radiologic exam knee complete 4/more views (73564) range across 3 matching MRF lines |
$138.51–$207.77 |
$513–$769.50 |
varies |
| Radiologic exam pelvis compl minimum 3 views (72190) |
$138.51 |
$513 |
1.3× |
| Radiologic Exam Small Int Single Contrast Study (74250) |
$226.80 |
$840 |
1.3× |
| Radiologic exam swallow function contrast study (74230) |
$226.80 |
$840 |
1.3× |
| Radiologic exam upr gi trc double contrast study (74246) |
$226.80 |
$840 |
1.3× |
| Radiologic examination femur 1 view (73551) |
$102.60 |
$380 |
1.2× |
Radiologic examination femur minimum 2 views (73552) range across 3 matching MRF lines |
$102.60–$153.90 |
$380–$570 |
varies |
Radiologic examination knee 1/2 views (73560) range across 3 matching MRF lines |
$102.60–$153.90 |
$380–$570 |
varies |
| Radiologic Examination Osseous Survey Limited (77074) |
$138.51 |
$513 |
1.3× |
Radiologic examination tibia & fibula 2 views (73590) range across 3 matching MRF lines |
$102.60–$153.90 |
$380–$570 |
varies |
| Radiologic examination, internal auditory meati, complete Non-Facility (70134) |
$613.17 |
$2,271 |
1.1× |
| Radiologic examination, teeth; single view Non-Facility (70300) |
$102.60 |
$380 |
1.2× |
| Radiopharmaceutical therapy, by intracavitary administration Non-Facility (79200) |
$345.06 |
$1,278 |
1.5× |
| Red Cell Volume Determination Spx 1 Sampling (78120) |
$514.08 |
$1,904 |
1.3× |
| Red Cell Volume Determination Spx Mult Samplings (78121) |
$667.71 |
$2,473 |
1.2× |
| Remote afterloading high dose rate radionuclide skin surface brachytherapy, includes basic dosimetry, when performed;… (77768) |
$1,417.77 |
$5,251 |
3.7× |
| Remote afterloading high dose rate radionuclide skin surface brachytherapy, includes basic dosimetry, when performed;… (77767) |
$1,417.77 |
$5,251 |
3.7× |
| Ribs bilateral 3 views (71110) |
$138.51 |
$513 |
1.3× |
| Rp loclzj tum plnr 1 area single day imaging (78800) |
$514.08 |
$1,904 |
1.3× |
| Rp loclzj tum plnr 2+area 1+d img/1 area img>2+d (78801) |
$514.08 |
$1,904 |
1.3× |
| Rp Loclzj Tum Plnr Whole Body 2+ Days Imaging (78804) |
$1,782.81 |
$6,603 |
3.3× |
| Rp Loclzj Tum Plnr Whole Body Single Day Imaging (78802) |
$1,782.81 |
$6,603 |
3.3× |
| Rp Loclzj Tum Spect 1 Area Single Day Imaging (78803) |
$1,782.81 |
$6,603 |
3.3× |
| Rp loclzj tum spect 2 area/sep acquisj img (78831) |
$1,782.81 |
$6,603 |
1.4× |
| Rp loclzj tum spect CT 2area 1d img/1 ar img>2+d (78832) |
$2,019.33 |
$7,479 |
1.4× |
| Rp loclzj tum spect w/CT 1 area/acquisj 1day img (78830) |
$1,782.81 |
$6,603 |
1.4× |
| Rp Ther Radiolbld Monoclonal Antibody IV Infus (79403) |
$313.74 |
$1,162 |
1.4× |
| Rp Therapy Intravenous Administration (79101) |
$345.06 |
$1,278 |
1.5× |
| Salivary Gland Function Study (78232) |
$514.08 |
$1,904 |
1.3× |
| Salivary Gland Imaging (78230) |
$514.08 |
$1,904 |
1.3× |
| Salivary Gland Imaging Serial Images (78231) |
$514.08 |
$1,904 |
1.3× |
| Scapula (73010) |
$138.51 |
$513 |
1.3× |
| Screening Digital Breast Tomosynthesis Bi (77063) |
$27.27 |
$101 |
1.2× |
| Sella turcica (70240) |
$102.60 |
$380 |
1.2× |
| Shoulder 1 view (73020) |
$102.60 |
$380 |
1.2× |
| Shoulder Arthrography (73040) |
$212.49 |
$787 |
0.6× |
| Sialogram (70390) |
$219.11 |
$811.50 |
0.9× |
| Skull less than 4 views (70250) |
$138.51 |
$513 |
1.3× |
| Special dosimetry (77331) |
$216.54 |
$802 |
1.6× |
| Special Physics Consult (77370) |
$346.68 |
$1,284 |
2.6× |
| Special teletherapy port plan (77321) |
$495.18 |
$1,834 |
1.3× |
| Special treatment procedure (77470) |
$809.46 |
$2,998 |
1.5× |
| Stereotactic Body Radiation Delivery (77373) |
$4,534.65 |
$16,795 |
2.5× |
| Sternoclavicular joints (71130) |
$102.60 |
$380 |
1.2× |
| Superior sagittal sinus venogram (75870) |
$1,651.32 |
$6,116 |
0.5× |
| Surface Applic Low Dose Rate Radionuclide Source (77789) |
$185.76 |
$688 |
1.8× |
| Telethx isodose pln cplx w/basic dosimetry (77307) |
$540.54 |
$2,002 |
1.5× |
| Telethx isodose pln smpl w/dosimetry calculation (77306) |
$292.95 |
$1,085 |
0.8× |
| Temporomandble Jt Arthrography Rs&I (70332) |
$146.07 |
$541 |
0.6× |
| Testicular Imaging W/Flow (78761) |
$514.08 |
$1,904 |
1.3× |
| Ther Rad Simulaj-Aided Field Setting Complex (77290) |
$681.48 |
$2,524 |
1.8× |
| Ther Rad Simulaj-Aided Field Setting Intermed (77285) |
$532.71 |
$1,973 |
1.4× |
| Ther rad simulaj-aided field setting simple (77280) |
$364.50 |
$1,350 |
2.7× |
| Therapeutic Enema Rdctj Intussusception/Obstrcj (74283) |
$206.28 |
$764 |
1.2× |
| Thoracic spine 2 views (72070) |
$138.51 |
$513 |
1.3× |
| Thoracic spine 3 views (72072) |
$138.51 |
$513 |
1.3× |
| Thoracolumbar 2 views (72080) |
$102.60 |
$380 |
1.2× |
| Thyroid Carcinoma Metastases Img Lmtd Area (78015) |
$514.08 |
$1,904 |
1.3× |
| Thyroid Imaging With Vascular Flow (78013) |
$514.08 |
$1,904 |
1.3× |
| Thyroid Met Imaging Body (78018) |
$667.71 |
$2,473 |
1.2× |
| Thyroid Uptake Measurement (78012) |
$514.08 |
$1,904 |
1.3× |
| Thyroid Uptake W/Blood Flow Sngle/Mult Quan Meas (78014) |
$514.08 |
$1,904 |
1.3× |
| Tx Devices Design & Construction Complex (77334) |
$464.67 |
$1,721 |
1.2× |
| Tx devices design & construction intermediate (77333) |
$322.11 |
$1,193 |
2.4× |
| Tx devices design & construction simple (77332) |
$258.39 |
$957 |
1.9× |
| Ultrasound Breast Limited (76642) |
$246.65 |
$913.50 |
2.8× |
| Ultrasound Elastography Parenchyma (76981) |
$214.65 |
$795 |
2.1× |
| Ultrasound Exam Aaa Screen (76706) |
$221.13 |
$819 |
2.1× |
| Ultrasound trgt dynamic microbubble 1st lesion (76978) |
$362.88 |
$1,344 |
1.0× |
| Ultrasound, abdomen limited (76705) |
$221.13 |
$819 |
2.1× |
| Umbilical-artery Doppler (OB) (76820) |
$201.15 |
$745 |
1.9× |
Unlisted Dx Radiographic Procedure (76499) range across 3 matching MRF lines |
$147.69–$1,056.51 |
$547–$3,913 |
varies |
Unlisted fluoroscopic procedure (76496) range across 7 matching MRF lines |
$56.43–$1,651.32 |
$209–$6,116 |
varies |
Unlisted magnetic resonance procedure (76498) range across 8 matching MRF lines |
$625.59–$3,393.36 |
$2,317–$12,568 |
varies |
| Unlisted Procedure Clinical Brachytherapy (77799) |
$3,743.28 |
$13,864 |
36.9× |
| Unlisted us procedure (76999) |
$279.72 |
$1,036 |
3.2× |
| Upper gi w/o kub (74240) |
$226.80 |
$840 |
1.3× |
| Ureteral Reflux Study (78740) |
$514.08 |
$1,904 |
1.3× |
| Urethrocystogram voiding (74455) |
$146.07 |
$541 |
0.6× |
| Urethrocystography retrograde (74450) |
$146.07 |
$541 |
0.6× |
| Us breast unilateral complete (76641) |
$331.70 |
$1,228.50 |
3.2× |
| Us chest (76604) |
$221.13 |
$819 |
2.1× |
| Us complete joint (76881) |
$331.70 |
$1,228.50 |
3.2× |
| Us exam, pelvic, limited (76857) |
$221.13 |
$819 |
2.1× |
| Us head (76506) |
$221.13 |
$819 |
2.1× |
| Us kidney transplant (76776) |
$221.13 |
$819 |
2.1× |
Us lmtd joint/oth nonvasc xtr strux r-t w/img (76882) range across 3 matching MRF lines |
$221.13–$331.70 |
$819–$1,228.50 |
varies |
| Us ob detailed single fetus (76811) |
$467.10 |
$1,730 |
2.0× |
| Us ob limited 1 or more fetuses (76815) |
$221.13 |
$819 |
2.1× |
Us ob transvaginal (76817) range across 4 matching MRF lines |
$192.24–$221.13 |
$712–$819 |
varies |
| Us pelvic non ob complete (76856) |
$221.13 |
$819 |
2.1× |
| Us pg uter img f&mat 14 wk tabdl 1/1st gestation (76801) |
$221.13 |
$819 |
2.1× |
| Us preg uterus real time f/u trnsabdl per fetus (76816) |
$221.13 |
$819 |
2.1× |
| Us retroperitoneal complete (76770) |
$221.13 |
$819 |
2.1× |
| Us retroperitoneal limited (76775) |
$221.13 |
$819 |
2.1× |
| Us scrotum and contents (76870) |
$221.13 |
$819 |
2.1× |
| Us spinal canal and contents (76800) |
$221.13 |
$819 |
2.1× |
| Us thyroid (76536) |
$221.13 |
$819 |
2.1× |
| Us transrectal (76872) |
$221.13 |
$819 |
2.1× |
| Vascular Flow Imaging (78445) |
$514.08 |
$1,904 |
1.3× |
| Vasogram (74440) |
$146.07 |
$541 |
0.6× |
| Vein X-Ray Chest (75827) |
$811.08 |
$3,004 |
0.5× |
| Vein X-Ray Liver W/O Hemodyn (75887) |
$1,651.32 |
$6,116 |
0.5× |
| Vein X-Ray Skull Epidural (75872) |
$311.85 |
$1,155 |
0.5× |
| Vein X-Ray Spleen/Liver (75810) |
$1,651.32 |
$6,116 |
0.5× |
| Venogram Sinus/Jugular (75860) |
$1,651.32 |
$6,116 |
0.5× |
| Venography Adrenal Unilateral (75840) |
$1,651.32 |
$6,116 |
0.5× |
| Venography caval inferior serialography rs&i (75825) |
$1,651.32 |
$6,116 |
0.5× |
| Venography extremity bilateral rs&i (75822) |
$811.08 |
$3,004 |
0.5× |
| Venography extremity unilateral rs&i (75820) |
$811.08 |
$3,004 |
0.5× |
| Venography Orbital Rs&I (75880) |
$311.85 |
$1,155 |
0.5× |
| Venography Renal Bilateral (75833) |
$1,651.32 |
$6,116 |
0.5× |
| Venography Renal Unilateral (75831) |
$1,651.32 |
$6,116 |
0.5× |
Venous sampling by catheter (75893) unusually low: confirm this is the full procedure |
$2,751.03 |
$10,189 |
0.5× |
| Venous Thrombosis Imaging Venogram Bilateral (78458) |
$514.08 |
$1,904 |
1.3× |
| Wrist 2 views (73100) |
$102.60 |
$380 |
1.2× |
| X-Ray Ac Jts - Xr Acromioclavicular Joints Bilateral (73050) |
$102.60 |
$380 |
1.2× |
| X-ray antegrade pyelogram tube (74425) |
$233.55 |
$865 |
0.7× |
| X-Ray Aorta Leg Arteries (75630) |
$1,651.32 |
$6,116 |
0.5× |
| X-Ray Bend Only L-S Spine (72120) |
$138.51 |
$513 |
1.3× |
| X-Ray Elbow 2 Vw - Xr Elbow 1-2 Views Right (73070) |
$102.60 |
$380 |
1.2× |
| X-Ray Exam Breast Specimen (76098) |
$557.55 |
$2,065 |
1.0× |
| X-Ray Exam Entire Spi 1 Vw (72081) |
$102.60 |
$380 |
1.2× |
| X-Ray Exam Entire Spi 2/3 Vw (72082) |
$138.51 |
$513 |
1.3× |
| X-Ray Exam Entire Spi 4/5 Vw (72083) |
$138.51 |
$513 |
1.3× |
| X-Ray Exam Hip Uni 1 View (73501) |
$102.60 |
$380 |
1.2× |
| X-Ray Exam Hip Uni 2-3 Views (73502) |
$102.60 |
$380 |
1.2× |
| X-Ray Exam Hips Bi 2 Views (73521) |
$138.51 |
$513 |
1.3× |
X-Ray Exam Hips Bi 3-4 Views (73522) range across 4 matching MRF lines |
$138.51–$207.77 |
$513–$769.50 |
varies |
X-Ray Exam Hips Bi 5/> Views (73523) range across 3 matching MRF lines |
$138.51–$207.77 |
$513–$769.50 |
varies |
| X-Ray Exam L-S Spine Bending (72114) |
$138.51 |
$513 |
1.3× |
| X-Ray Exam Neck Spine 2-3 Vw (72040) |
$102.60 |
$380 |
1.2× |
| X-Ray Exam Neck Spine 6/>Vws (72052) |
$138.51 |
$513 |
1.3× |
| X-Ray Exam Unilat Ribs/Chest (71101) |
$138.51 |
$513 |
1.3× |
| X-ray eye for foreign body (70030) |
$102.60 |
$380 |
1.2× |
| X-ray head for orthodontia (70350) |
$102.60 |
$380 |
1.2× |
X-ray humerus (73060) range across 3 matching MRF lines |
$102.60–$153.90 |
$380–$570 |
varies |
| X-ray IV pyelogram (ivp) (74400) |
$226.80 |
$840 |
1.3× |
| X-ray IV pyelogram+tomography (74415) |
$226.80 |
$840 |
1.3× |
| X-Ray Jaw <4 Vw - Xr Mandible < 4 Views (70100) |
$102.60 |
$380 |
1.2× |
| X-Ray Knee Bilat Standing - Xr Knees Anteroposterior Standing Bilat (73565) |
$102.60 |
$380 |
1.2× |
| X-Ray Lumbar Spine 2/3 Vw - Xr Lumbar Spine 2-3 Views (72100) |
$138.51 |
$513 |
1.3× |
| X-ray nose-rectum child f.b. (76010) |
$102.60 |
$380 |
1.2× |
| X-Ray Ribs, Chest 4+ Vw - Xr Ribs 3 Vws Bil W/ Chest Posteroanterior (71111) |
$138.51 |
$513 |
1.3× |
X-Ray Sacroiliac Jts 3+ Vw - Xr Sacroiliac Joints 3+ Views (72202) range across 3 matching MRF lines |
$138.51–$207.77 |
$513–$769.50 |
varies |
| X-Ray Sacroiliac Jts <3 Vw - Xr Sacroiliac Joints 1-2 Views (72200) |
$138.51 |
$513 |
1.3× |
| X-Ray Sacrum/Coccyx 2+ Vw - Xr Sacrum Coccyx 2+ Views (72220) |
$102.60 |
$380 |
1.2× |
| X-Ray Sinuses 3+ Vw - Xr Paranasal Sinuses 3+ Views (70220) |
$102.60 |
$380 |
1.2× |
| X-Ray Skull 4+ Vw - Xr Skull Complete 4+ Views (70260) |
$138.51 |
$513 |
1.3× |
| X-Ray Stress View (77071) |
$102.60 |
$380 |
1.2× |
| X-ray thoracic spine 4 vw (72074) |
$138.51 |
$513 |
1.3× |
| X-Ray Tmj Unilat (70328) |
$102.60 |
$380 |
1.2× |
| X-Ray Urinary Tract Exam With Contrast Material (74420) |
$467.10 |
$1,730 |
1.3× |
| X-Rays Bone Length Studies (77073) |
$138.51 |
$513 |
1.3× |
| X-Rays Bone Survey Complete (77075) |
$138.51 |
$513 |
1.3× |
| Xr c-spine 4 or 5 views (72050) |
$138.51 |
$513 |
1.3× |
| Xr facial bones less than 3 views (70140) |
$102.60 |
$380 |
1.2× |
| Xr orbits complete 4 views (70200) |
$138.51 |
$513 |
1.3× |
| Xr Tomogram Single Plane (76100) |
$138.51 |
$513 |
1.3× |