| 3-D radiotherapy plan dose-volume histograms (77295) |
$2,429.73 |
$8,999 |
1.9× |
| Abdomen 1 View (74018) |
$95.85 |
$355 |
1.2× |
| Abdomen 2 views (74019) |
$220.05 |
$815 |
2.2× |
| Acute Gastrointestinal Blood Loss Imaging (78278) |
$697.95 |
$2,585 |
1.9× |
| Adrenal Cortex & Medulla Img (78075) |
$967.68 |
$3,584 |
0.8× |
| Angio internal mammary (75756) |
$1,388.07 |
$5,141 |
0.5× |
| Angio pulmonary bilat (75743) |
$3,564.27 |
$13,201 |
1.2× |
| Angiography Adrenal Bilateral Slctv Rs&I (75733) |
$3,246.75 |
$12,025 |
1.1× |
| Angiography extremity bilateral rs&i (75716) |
$2,240.46 |
$8,298 |
0.8× |
Angiography extremity unilateral rs&i (75710)
range across 4 matching MRF lines |
$1,482.57–$1,872.45 |
$5,491–$6,935 |
varies |
| Angiography pulmonary unilateral slctv rs&i (75741) |
$3,564.27 |
$13,201 |
1.2× |
| Angrph pulmonary nonslctv cath/ven njx rs&i (75746) |
$1,264.14 |
$4,682 |
0.4× |
| Ankle 2 views (73600) |
$69.12 |
$256 |
0.8× |
| Aortography thoracic serialography rs&i (75605) |
$4,500.90 |
$16,670 |
0.9× |
| Aortography thoracic w/o serialography rs&i (75600) |
$3,246.75 |
$12,025 |
1.1× |
| Artery X-Rays Abdomen (75726) |
$3,889.62 |
$14,406 |
0.7× |
| Artery X-Rays Pelvis (75736) |
$3,564.27 |
$13,201 |
0.7× |
| Artery X-Rays Spine (75705) |
$3,545.37 |
$13,131 |
0.7× |
| Arthrogram ankle (73615) |
$745.74 |
$2,762 |
2.3× |
| Arthrogram hip (73525) |
$599.67 |
$2,221 |
1.8× |
| Arthrogram Wrist (73115) |
$616.95 |
$2,285 |
1.9× |
| Basic radiation dosimetry calculation (77300) |
$103.95 |
$385 |
0.8× |
| Bone age studies (77072) |
$97.47 |
$361 |
1.0× |
| Bone Imaging 3 Phase (78315) |
$665.82 |
$2,466 |
1.8× |
| Bone Imaging Limited Area (78300) |
$612.09 |
$2,267 |
1.6× |
| Bone Imaging Multiple Areas (78305) |
$382.86 |
$1,418 |
1.0× |
| Bone Imaging Whole Body (78306) |
$956.07 |
$3,541 |
2.5× |
| Bone marrow imaging limited area (78102) |
$664.74 |
$2,462 |
1.8× |
| Bone survey infant (77076) |
$75.87 |
$281 |
0.8× |
| Brachytx isodose complex (77318) |
$355.59 |
$1,317 |
1.0× |
| Brachytx isodose intermed (77317) |
$468.45 |
$1,735 |
1.3× |
| Brachytx Isodose Plan Simple (77316) |
$184.95 |
$685 |
0.5× |
| Brain Flow Imaging Only (78610) |
$352.62 |
$1,306 |
0.7× |
| Brain Image W/Flow < 4 Views (78601) |
$618.30 |
$2,290 |
1.6× |
| Brain imaging < 4 static views (78600) |
$386.37 |
$1,431 |
1.0× |
| Brain Imaging Min 4 Static Views W Vascular Flow (78606) |
$735.75 |
$2,725 |
1.4× |
| Brain Imaging Minimum 4 Static Views (78605) |
$386.37 |
$1,431 |
0.8× |
| Brain Imaging Pet Metabolic Evaluation (78608) |
$2,781.54 |
$10,302 |
2.1× |
| Card Bl Pool Gated Spect Rest Wal Motn Ejct Frct (78494) |
$452.25 |
$1,675 |
1.2× |
| Cardiac blood pool imaging, first pass technique; multiple studies, resting and with stress (exercise and/or… (78483) |
$452.25 |
$1,675 |
0.9× |
| Cardiac MRI w/w/o contrast & further seq (75561) |
$1,936.44 |
$7,172 |
5.9× |
| Cardiac MRI w/w/o contrast w/stress (75563) |
$803.79 |
$2,977 |
1.1× |
| Cardiac Shunt Detection (78428) |
$452.25 |
$1,675 |
1.2× |
| Cat Scan Follow-Up Study (76380) |
$51.84 |
$192 |
0.6× |
| Cerebrospinal Fluid Flow W/O Matl Shunt Evaltj (78645) |
$278.91 |
$1,033 |
0.5× |
| Cerebrospinal fluid flow, imaging (not including introduction of material); ventriculography Non-Facility (78635) |
$630.72 |
$2,336 |
1.2× |
| Cerebrospinal Fluid Scan (78630) |
$1,035.18 |
$3,834 |
2.0× |
| Chest 1 view (71045) |
$79.92 |
$296 |
1.0× |
| Chest 2 views (71046) |
$117.99 |
$437 |
1.4× |
| Chest 3 views (71047) |
$158.22 |
$586 |
1.9× |
| Chest 4 or more views (71048) |
$170.37 |
$631 |
1.7× |
| Cholecystography Oral Contrast (74290) |
$120.96 |
$448 |
0.7× |
| Cineradiograpy/vidradiograpy xcpt where spec (76120) |
$167.40 |
$620 |
1.7× |
| Clavicle complete (73000) |
$109.89 |
$407 |
1.3× |
| Computed Tomography Thorax Lw Dose Lng Ca Scr C- (71271) |
$60.21 |
$223 |
0.6× |
| Continuing medical physics consltj pr wk (77336) |
$274.32 |
$1,016 |
2.2× |
| Contrast Exam Abdominl Aorta (75625) |
$4,500.90 |
$16,670 |
1.5× |
| Contrast X-Ray Bladder (74430) |
$470.88 |
$1,744 |
1.4× |
| Contrast X-Ray Of Elbow (73085) |
$442.53 |
$1,639 |
1.4× |
| Contrast X-Ray Of Knee Joint (73580) |
$291.33 |
$1,079 |
0.9× |
| Contrast Xray Throat/Cerv Esopha (74210) |
$117.45 |
$435 |
0.7× |
| CT abdomen and pelvis without and with contrast (74178) |
$2,904.39 |
$10,757 |
8.9× |
| CT abdomen and pelvis without contrast (74176) |
$1,698.03 |
$6,289 |
7.6× |
| CT abdomen w contrast (74160) |
$265.95 |
$985 |
1.6× |
| CT abdomen w wo contrast (74170) |
$231.39 |
$857 |
1.4× |
| CT abdomen w/o contrast (74150) |
$104.76 |
$388 |
1.1× |
| CT Angio Abdomen and Pelvis (74174) |
$2,102.76 |
$7,788 |
6.4× |
| CT Angio Chest (71275) |
$940.14 |
$3,482 |
5.7× |
| CT Angio Head (70496) |
$950.94 |
$3,522 |
5.8× |
| CT angio hrt w/3d image (75574) |
$265.95 |
$985 |
0.8× |
| Ct Angio Lwr Extr W/O&W/Dye (73706) |
$398.52 |
$1,476 |
2.4× |
| CT Angio Neck (70498) |
$947.16 |
$3,508 |
5.8× |
| Ct Angio Upr Extrm W/O&W/Dye (73206) |
$265.95 |
$985 |
1.6× |
| CT bone density (77078) |
$108 |
$400 |
1.3× |
| CT cervical spine w/ contrast (72126) |
$752.22 |
$2,786 |
2.3× |
| CT cervical spine w/o contrast (72125) |
$711.45 |
$2,635 |
7.3× |
| CT cervical spine w/wo cont (72127) |
$210.60 |
$780 |
1.3× |
| CT chest w contrast (71260) |
$484.11 |
$1,793 |
2.9× |
| CT chest w/wo contrast (71270) |
$383.40 |
$1,420 |
2.3× |
| CT colonography screening (74263) |
$132.03 |
$489 |
0.6× |
| CT colonogrphy dx image postprocess w/o contrast (74261) |
$95.31 |
$353 |
1.0× |
| CT head/brain with contrast (70460) |
$905.58 |
$3,354 |
5.5× |
| CT head/brain without and with contrast (70470) |
$947.70 |
$3,510 |
5.8× |
| CT heart contrast eval cardiac structure&morph (75572) |
$579.96 |
$2,148 |
1.8× |
| CT heart no contrast quant eval coronry calcium (75571) |
$51.84 |
$192 |
0.6× |
| CT hrt w/3d image congen (75573) |
$755.46 |
$2,798 |
2.3× |
| CT iac w contrast (70481) |
$883.17 |
$3,271 |
5.4× |
| CT l-spine w&w/o contrast (72133) |
$647.19 |
$2,397 |
3.9× |
| CT lower ext w/o (73700) |
$439.02 |
$1,626 |
4.5× |
| CT lower extremity w/contrast material (73701) |
$430.38 |
$1,594 |
2.6× |
| CT lumbar spine w contrast (72132) |
$670.14 |
$2,482 |
2.0× |
| CT lumbar spine w/o contrast (72131) |
$515.97 |
$1,911 |
5.3× |
| CT maxillofacial w contrast (70487) |
$740.61 |
$2,743 |
4.5× |
| CT maxillofacial wo contrast (70486) |
$666.90 |
$2,470 |
6.8× |
| CT neck tissue combo (70492) |
$242.19 |
$897 |
1.5× |
| Ct Orbit/Ear/Fossa W/O&W/Dye (70482) |
$891.81 |
$3,303 |
5.4× |
| CT orbits w/o contrast (70480) |
$761.40 |
$2,820 |
7.8× |
| CT pelvis w&w/o contrast (72194) |
$231.39 |
$857 |
1.4× |
| CT pelvis w/o contrast (72192) |
$120.42 |
$446 |
1.2× |
| CT scan of leg combo (73702) |
$466.02 |
$1,726 |
2.8× |
| CT scans face/jaw combo (70488) |
$695.79 |
$2,577 |
4.2× |
| CT soft tissue neck w contrast (70491) |
$682.56 |
$2,528 |
4.1× |
| CT soft tissue neck w/o contrast (70490) |
$120.42 |
$446 |
1.2× |
| CT thoracic spine w contrast (72129) |
$800.28 |
$2,964 |
4.9× |
| CT thoracic spine w/o contrast (72128) |
$714.42 |
$2,646 |
7.3× |
| CT thoracic spine w/wo cont (72130) |
$210.60 |
$780 |
1.3× |
| CT thorax w/o contrast (71250) |
$254.34 |
$942 |
2.6× |
| CT unlisted procedure (76497) |
$135.54 |
$502 |
1.7× |
| CT upper ext wo (73200) |
$767.34 |
$2,842 |
7.8× |
| CT upper extremity w/o & w/contrast material (73202) |
$210.60 |
$780 |
1.3× |
| CT upper extremity with contrast (73201) |
$842.94 |
$3,122 |
2.6× |
| Cta Abdl Aorta&Bi Iliofem W/Contrast&Postp (75635) |
$265.95 |
$985 |
1.6× |
| Cta Abdomen (74175) |
$932.04 |
$3,452 |
5.7× |
| CTA pelvis (72191) |
$562.68 |
$2,084 |
3.4× |
| Dacryocystography, nasolacrimal duct, radiological supervision and interpretation Non-Facility (70170) |
$294.84 |
$1,092 |
1.3× |
| Determination of central c-v hemodynamics (non-imaging) (eg, ejection fraction with probe technique) with or without… (78414) |
$452.25 |
$1,675 |
0.9× |
| Dilation ureters/urethra rs&i (74485) |
$1,548.18 |
$5,734 |
0.8× |
| Discography Cerv/Thor Spine (72285) |
$2,070.36 |
$7,668 |
1.1× |
| Diskography lumbar (72295) |
$1,494.45 |
$5,535 |
0.8× |
| Doppler Echo Fetal Puls Spectral F/U/Repeat (76828) |
$224.10 |
$830 |
2.3× |
| Doppler Echo Fetal Spectral Display Complete (76827) |
$199.26 |
$738 |
2.0× |
| Doppler Fetal Mid Cerebral Artery (76821) |
$224.37 |
$831 |
2.3× |
| Dxa Bone Density Axial (77080) |
$202.50 |
$750 |
2.1× |
| Dxa bone density study (77085) |
$141.48 |
$524 |
1.4× |
| Dxa bone density study 1/>sites appendiclr skel (77081) |
$177.66 |
$658 |
2.2× |
| Echo exam of fetal heart (76825) |
$199.26 |
$738 |
0.4× |
| Echo exam uterus (76831) |
$338.85 |
$1,255 |
1.5× |
| Echo Guide For Artery Repair (76936) |
$159.03 |
$589 |
0.8× |
| Echocardiography, fetal, cardiovascular system, real time with image documentation (2D), with or without M-mode… (76826) |
$150.66 |
$558 |
0.7× |
| Echograp Trans R Pros Study (76873) |
$226.26 |
$838 |
2.3× |
| Esophageal Motility Study (78258) |
$754.65 |
$2,795 |
2.0× |
| Esophagram (74220) |
$213.84 |
$792 |
1.3× |
| Fetal Biophys Profile W/Nst (76818) |
$148.23 |
$549 |
1.5× |
| Fetal Biophysical Profile W/O Non-Stress Testing (76819) |
$238.14 |
$882 |
2.4× |
| Fetal MRI w/placntl matrnl plvc img sing/1st ges (74712) |
$944.19 |
$3,497 |
4.2× |
| Fluoroscopy up to 1 hr (76000) |
$215.19 |
$797 |
1.0× |
| Follow-Up Angiography (75898) |
$2,333.34 |
$8,642 |
0.8× |
| Foot 2 views (73620) |
$98.55 |
$365 |
1.2× |
| Forearm 2 views (73090) |
$107.73 |
$399 |
1.3× |
| Gastric emptying imaging study (78264) |
$726.30 |
$2,690 |
1.9× |
| Gastric Mucosa Imaging (78261) |
$432.54 |
$1,602 |
1.2× |
| Gastrointestinal Protein Loss (78282) |
$375.57 |
$1,391 |
1.0× |
| Gated Heart Planar Single (78472) |
$1,017.36 |
$3,768 |
2.7× |
| Gated Heart, Multiple (78473) |
$452.25 |
$1,675 |
1.2× |
| Gstrc Emptng Imag Std W/Sm Bwl Col Trnst Mlt Day (78266) |
$413.64 |
$1,532 |
0.8× |
| Hand 2 views (73120) |
$92.34 |
$342 |
0.9× |
| Hdr Rdncl Ntrstl/Icav Brchtx (77772) |
$942.30 |
$3,490 |
1.4× |
| Hdr Rdncl Ntrstl/Icav Brchtx (77771) |
$1,401.84 |
$5,192 |
2.1× |
| Hdr Rdncl Ntrstl/Icav Brchtx 1 Channel (77770) |
$1,333.80 |
$4,940 |
2.0× |
| Heart first pass single,planar (78481) |
$452.25 |
$1,675 |
0.9× |
| Heart Image (Pet) Multiple (78492) |
$1,544.67 |
$5,721 |
1.2× |
| Hepatc Vngrph Wdg/Fr Hemodyn Eval Rs&I (75889) |
$2,641.41 |
$9,783 |
0.9× |
| Hepatc Vngrph Wdg/Fr W/O Hemodyn Eval Rs&I (75891) |
$4,100.22 |
$15,186 |
1.4× |
| Hepatobil Syst Image W/Drug (78227) |
$782.19 |
$2,897 |
1.5× |
| Hepatobiliary System Imaging (78226) |
$510.30 |
$1,890 |
1.4× |
| Ht Musc Image Planar Mult (78454) |
$1,430.19 |
$5,297 |
1.2× |
| Ht Muscle Image Spect Sing (78451) |
$983.34 |
$3,642 |
0.8× |
| Hyperthermia generated by interstitial probe(s); 5 or fewer interstitial applicators Non-Facility (77610) |
$574.02 |
$2,126 |
1.1× |
| Hyperthermia generated by interstitial probe(s); more than 5 interstitial applicators Non-Facility (77615) |
$574.02 |
$2,126 |
1.1× |
| Hyperthermia generated by intracavitary probe(s) Non-Facility (77620) |
$574.02 |
$2,126 |
1.1× |
| Hyperthermia, externally generated; deep (ie, heating to depths greater than 4 cm) Non-Facility (77605) |
$574.02 |
$2,126 |
0.9× |
| Hysterosalpingogram (74740) |
$208.17 |
$771 |
0.9× |
| Infant hip ultrasound with hip movement (dynamic) (76885) |
$304.56 |
$1,128 |
3.7× |
| Infant hip ultrasound, limited static exam (76886) |
$103.68 |
$384 |
1.3× |
| Infusion Ivp (74410) |
$306.72 |
$1,136 |
1.9× |
| Interstitial radiation source applic complex (77778) |
$894.78 |
$3,314 |
1.4× |
| Intracavitary Radiation Source Applic Complex (77763) |
$1,070.55 |
$3,965 |
1.6× |
| Intracavitary Radiation Source Applic Intermed (77762) |
$589.68 |
$2,184 |
1.1× |
| Intracavitary radiation source applic simple (77761) |
$589.68 |
$2,184 |
1.1× |
| Joint Survey Single View (77077) |
$305.64 |
$1,132 |
3.1× |
| K Flow/Funct Image Multiple (78709) |
$751.95 |
$2,785 |
1.5× |
| K Flow/Funct Image W/Drug (78708) |
$592.92 |
$2,196 |
1.2× |
| K Flow/Funct Image W/O Drug (78707) |
$433.35 |
$1,605 |
0.9× |
| Kidney Funcj Study Non-Img Radioisotopic Study (78725) |
$1,025.73 |
$3,799 |
2.7× |
| Kidney Imaging Morphol (78700) |
$573.21 |
$2,123 |
1.5× |
| Kidney Imaging Morphoogy W/Vascular Flow (78701) |
$444.15 |
$1,645 |
1.2× |
| Knee 3 Views (73562) |
$141.21 |
$523 |
1.7× |
| Labeled RBC Sequestration Differntl Organ/Tissue (78140) |
$637.74 |
$2,362 |
1.7× |
| Leveen/Shunt Patency Exam (78291) |
$507.33 |
$1,879 |
1.4× |
| Liver & Spleen Imaging Static Only (78215) |
$692.28 |
$2,564 |
1.8× |
| Liver & Spleen Imaging W/Vascular Flow (78216) |
$423.63 |
$1,569 |
1.1× |
| Lung Perf&Ventilat Diferentl (78598) |
$492.21 |
$1,823 |
1.0× |
| Lung perfusion differential (78597) |
$676.08 |
$2,504 |
1.8× |
| Lung Ventilat&Perfus Imaging (78582) |
$911.79 |
$3,377 |
1.8× |
| Lung Ventilation Imaging (78579) |
$729 |
$2,700 |
1.9× |
| Lymph System Imaging (78195) |
$590.76 |
$2,188 |
1.2× |
| Lymphangiography Extremity Only Bilateral Rs&I (75803) |
$1,356.21 |
$5,023 |
0.9× |
| Lymphangiography extremity only unilateral rs&i (75801) |
$471.15 |
$1,745 |
0.8× |
| Lymphangiography Pelvic/Abdominal Bilateral Rs&I (75807) |
$2,237.22 |
$8,286 |
0.8× |
| Magnetic Image Jaw Joint (70336) |
$642.87 |
$2,381 |
2.9× |
| Mammary ductogram or galactogram multiple (77054) |
$179.28 |
$664 |
0.8× |
| Mammary ductogram or galactogram single (77053) |
$187.92 |
$696 |
0.8× |
| Meckels Divert Exam (78290) |
$685.53 |
$2,539 |
1.8× |
| Mlc imrt design & construction per imrt plan (77338) |
$449.01 |
$1,663 |
1.3× |
| Mr safety determination physician/other qhp (76016) |
$65.34 |
$242 |
0.8× |
| Mr safety implant&/fb assmt clin staf 1st 15 min (76014) |
$18.09 |
$67 |
0.7× |
| Mr safety implt electronics prepj supvj phys/qhp (76018) |
$68.04 |
$252 |
0.8× |
| Mr safety implt pos&/immoblj (76019) |
$44.01 |
$163 |
0.8× |
| Mr safety med physics xm customization plng&mntr (76017) |
$179.55 |
$665 |
0.8× |
| Mra Head W/O & W/Contrast Material (70546) |
$416.61 |
$1,543 |
1.3× |
| MRA head w/o contrast (70544) |
$973.89 |
$3,607 |
4.3× |
| MRA head with contrast (70545) |
$231.39 |
$857 |
0.7× |
| MRA neck w contrast (70548) |
$231.39 |
$857 |
0.7× |
| Mra Neck W/O &W/Contrast Material (70549) |
$416.61 |
$1,543 |
1.3× |
| MRA neck w/o contrast (70547) |
$212.22 |
$786 |
0.9× |
| MRI abdomen w contrast (74182) |
$873.18 |
$3,234 |
2.7× |
| MRI abdomen w/o contrast (74181) |
$912.87 |
$3,381 |
4.1× |
| MRI any jt lower extrem w/contrast material (73722) |
$923.67 |
$3,421 |
1.3× |
| MRI any jt lower extrem w/o & w/contrast matrl (73723) |
$1,470.15 |
$5,445 |
4.5× |
| MRI any jt upper extremity w/contrast matrl (73222) |
$970.11 |
$3,593 |
1.3× |
| MRI brain functional w/o physician admnistration (70554) |
$193.32 |
$716 |
0.9× |
| MRI brain functional w/physician admnistration (70555) |
$193.32 |
$716 |
0.9× |
| MRI cardiac w/o contrast (75557) |
$2,179.98 |
$8,074 |
9.7× |
| MRI cervical spine w contrast (72142) |
$857.52 |
$3,176 |
2.6× |
| MRI cervical spine w/o cont (72141) |
$947.97 |
$3,511 |
4.2× |
| MRI chest w/o contrast (71550) |
$212.22 |
$786 |
0.9× |
| MRI chest with contrast (71551) |
$1,955.88 |
$7,244 |
2.7× |
| MRI chest wo w contrast (71552) |
$1,282.50 |
$4,750 |
3.9× |
| MRI lower extrem oth/thn jt w/contrast matrl (73719) |
$231.39 |
$857 |
0.7× |
| MRI lower extrem oth/thn jt w/o & w/contr matr (73720) |
$661.50 |
$2,450 |
2.0× |
| MRI lower extrem oth/thn jt w/o contr matrl (73718) |
$523.53 |
$1,939 |
2.3× |
| MRI lumbar spine w contrast (72149) |
$1,049.76 |
$3,888 |
3.2× |
| Mri Neck Spine W/O & W/Dye (72156) |
$1,276.29 |
$4,727 |
3.9× |
| MRI orbit face &/neck w/o contrast (70540) |
$1,385.37 |
$5,131 |
6.2× |
| MRI orbit face neck w contrast (70542) |
$416.61 |
$1,543 |
1.3× |
| Mri Orbt/Fac/Nck W/O &W/Dye (70543) |
$2,108.97 |
$7,811 |
6.4× |
| MRI pelvis w contrast (72196) |
$831.33 |
$3,079 |
2.5× |
| MRI pelvis w/o & w contrast (72197) |
$1,223.64 |
$4,532 |
3.7× |
| MRI pelvis w/o contrast (72195) |
$821.61 |
$3,043 |
3.7× |
| MRI spectroscopy (76390) |
$857.52 |
$3,176 |
10.5× |
| MRI thoracic spine w/o contrast (72146) |
$871.02 |
$3,226 |
3.9× |
| MRI upper extremity oth than jt w/contr matrl (73219) |
$799.74 |
$2,962 |
2.4× |
| MRI upper extremity oth than jt w/o contr matrl (73218) |
$692.82 |
$2,566 |
3.1× |
| Mri Uppr Extremity W/O&W/Dye (73220) |
$1,034.64 |
$3,832 |
3.2× |
| MRI, abdomen, combo (74183) |
$1,252.26 |
$4,638 |
3.8× |
| MRI, dorsal spine combo (72157) |
$1,206.09 |
$4,467 |
3.7× |
| MRI, dorsal spine contrast (72147) |
$901.80 |
$3,340 |
2.8× |
| MRI, joint upper extrem (73221) |
$212.22 |
$786 |
0.9× |
| MRI, joint upper extrem combo (73223) |
$1,438.02 |
$5,326 |
4.4× |
| MRI, lumbar spine combo (72158) |
$1,252.26 |
$4,638 |
3.8× |
| Musculoskeletal Nuclear Exam (78399) |
$280.26 |
$1,038 |
0.7× |
| Myelogram cervical (72240) |
$742.50 |
$2,750 |
1.0× |
| Myelogram Lumbar (72265) |
$655.83 |
$2,429 |
0.9× |
| Myelography thoracic (72255) |
$742.50 |
$2,750 |
1.0× |
| Myelograpy 2/more regions rs&i (72270) |
$742.50 |
$2,750 |
1.0× |
| Myocardial Imaging Infarct Avid Planar Qual/Quan (78466) |
$452.25 |
$1,675 |
1.2× |
| Myocardial Imaging Pet Metabolic Evaluation (78459) |
$1,544.67 |
$5,721 |
1.3× |
| Myocardial imaging, infarct avid, planar; with ejection fraction by first pass technique Non-Facility (78468) |
$761.13 |
$2,819 |
1.5× |
| Myocardial Perfusion Planar 1 Study Rest/Stress (78453) |
$994.41 |
$3,683 |
0.8× |
| Myocardial Spect Multiple Studies (78452) |
$983.34 |
$3,642 |
0.8× |
| Neck soft tissue (70360) |
$105.30 |
$390 |
1.3× |
| Nfs/Instlj Radioelmnt Sln 3 Mo Follow-Up Care (77750) |
$262.71 |
$973 |
0.7× |
| Njx Rp Loclzj Non-Img Probe Study Intravenous (78808) |
$287.55 |
$1,065 |
0.8× |
| Nm myocard infarct spect (78469) |
$452.25 |
$1,675 |
0.9× |
| Nm red cell survival study (78130) |
$637.74 |
$2,362 |
1.7× |
| Nm whole blood volume (78122) |
$637.74 |
$2,362 |
1.3× |
| Nonvascular Shunt X-Ray (75809) |
$840.24 |
$3,112 |
8.6× |
| Ntsty modul radthx pln dose-vol histos (77301) |
$2,138.13 |
$7,919 |
1.6× |
| Nuclear Rx Intra-Arterial (79445) |
$634.50 |
$2,350 |
2.9× |
| Nuclear Rx Oral Admin (79005) |
$549.99 |
$2,037 |
2.5× |
| Ob us nuchal meas 1 gest (76813) |
$94.23 |
$349 |
1.0× |
| Oph bmtry us echograpy a-scan io lens pwr cal (76519) |
$159.30 |
$590 |
1.6× |
| Oph us dx ant sgm us immersion b-scan/hr biom (76513) |
$157.41 |
$583 |
1.6× |
| Oph US Dx B-Scan&Quan a-Scan Sm Pt Enctr (76510) |
$211.68 |
$784 |
1.7× |
| Ophthalmic Biometry US Echograpy a-Scan (76516) |
$103.41 |
$383 |
1.1× |
| Ophthalmic ultrasound dx b-scan w/wo a-scan (76512) |
$183.33 |
$679 |
1.9× |
| Ophthalmic US Dx Corneal Pachymetry Uni/Bi (76514) |
$16.20 |
$60 |
0.6× |
| Ophthalmic us dx quantitative a-scan only (76511) |
$144.99 |
$537 |
1.5× |
| Optic foramina (70190) |
$67.50 |
$250 |
0.8× |
| Panoramic X-ray of jaws (70355) |
$52.65 |
$195 |
0.6× |
| Parathyroid imaging w/tomographic spect & CT (78072) |
$471.15 |
$1,745 |
0.9× |
| Parathyroid Planar Imaging (78070) |
$536.22 |
$1,986 |
1.4× |
| Parathyroid planar imaging w/wo subtraction (78071) |
$1,050.57 |
$3,891 |
2.8× |
| Pelvis 1 or 2 views (72170) |
$169.02 |
$626 |
1.7× |
| Perineogram (74775) |
$285.12 |
$1,056 |
1.3× |
| Peritoneogram Rs&I (74190) |
$373.95 |
$1,385 |
0.7× |
| Pet Image Skull-Thigh (78812) |
$1,739.34 |
$6,442 |
1.3× |
| Pet Image W/Ct Lmtd (78814) |
$1,739.34 |
$6,442 |
1.3× |
| PET image w/CT, full body (78816) |
$3,625.83 |
$13,429 |
2.7× |
| PET imaging CT attenuation skull base mid-thigh (78815) |
$3,026.16 |
$11,208 |
2.3× |
| Pet Imaging Limited Area Chest Head/Neck (78811) |
$1,739.34 |
$6,442 |
1.4× |
| Pet Myocardial Sngl Study (78491) |
$1,544.67 |
$5,721 |
1.2× |
| PET whole body (78813) |
$1,909.98 |
$7,074 |
1.4× |
| Platelet survival study Non-Facility (78191) |
$287.55 |
$1,065 |
0.8× |
| Prq Transhepatc Portograpy Hemodyn Eval Rs&I (75885) |
$3,246.75 |
$12,025 |
1.1× |
| Pulmonary Perfusion Imaging Particulate (78580) |
$844.02 |
$3,126 |
2.2× |
| Radex Abd Compl Aqt Abd W/S/E/D Views 1 View Ch (74022) |
$283.23 |
$1,049 |
2.9× |
| Radex abscess/fistula/sinus tract rs&i (76080) |
$238.14 |
$882 |
0.5× |
| Radex Ankle Complete Minimum 3 Views (73610) |
$84.51 |
$313 |
1.0× |
| Radex Calcaneus Minimum 2 Views (73650) |
$112.05 |
$415 |
1.4× |
| Radex elbow complete minimum 3 views (73080) |
$130.95 |
$485 |
1.6× |
| Radex Facial Bones Complete Minimum 3 Views (70150) |
$201.42 |
$746 |
2.1× |
| Radex fingr minimum 2 views (73140) |
$84.24 |
$312 |
1.0× |
| Radex foot complete minimum 3 views (73630) |
$97.74 |
$362 |
1.2× |
| Radex Hand Minimum 3 Views (73130) |
$76.41 |
$283 |
0.9× |
| Radex lower extremity infant minimum 2 views (73592) |
$76.41 |
$283 |
0.9× |
| Radex Mastoids Compl Minimum 3 Views PR Side (70130) |
$135.81 |
$503 |
1.4× |
| Radex Nasal Bones Complete Minimum 3 Views (70160) |
$111.51 |
$413 |
1.4× |
| Radex Pharynx/Larx W/Fluor&/Magnification Tq (70370) |
$130.14 |
$482 |
1.6× |
| Radex Ribs Unilateral 2 Views (71100) |
$94.50 |
$350 |
1.2× |
| Radex shoulder complete minimum 2 views (73030) |
$124.20 |
$460 |
1.5× |
| Radex Sinuses Paransl < 3 Views (70210) |
$119.88 |
$444 |
1.5× |
| Radex sm int w/mlt srl imges via enteroclss tube (74251) |
$180.09 |
$667 |
1.1× |
| Radex Spine 1 View Specify Level (72020) |
$107.73 |
$399 |
1.3× |
| Radex Sternum Minimum 2 Views (71120) |
$117.99 |
$437 |
1.4× |
| Radex Temporomandble Jt Opn & Clsd Mouth Bilat (70330) |
$77.74 |
$287.94 |
1.0× |
| Radex Toe Minimum 2 Views (73660) |
$84.78 |
$314 |
1.0× |
| Radex upper extremity infant minimum 2 views (73092) |
$91.26 |
$338 |
0.9× |
| Radex Wrist Complete Minimum 3 Views (73110) |
$98.01 |
$363 |
1.2× |
| Radex X-Ray Exam Entire Spi 6/> Vw - Xr Entire Spine 6+ Vw (72084) |
$181.44 |
$672 |
1.8× |
| Radiation Delivery Stereotactic Cranial Linear (77372) |
$9,709.74 |
$35,962 |
1.4× |
| Radiation treatment delivery level 1 (77402) |
$147.42 |
$546 |
1.5× |
| Radiation treatment delivery level 2 (77407) |
$179.55 |
$665 |
0.5× |
| Radiation treatment delivery level 3 (77412) |
$357.48 |
$1,324 |
0.7× |
| Radiolog exam mandible compl minimum 4 views (70110) |
$187.65 |
$695 |
1.9× |
| Radiologic Exam Abdomen 3+ Views - Xr Abdomen 3+ Views (74021) |
$286.74 |
$1,062 |
2.9× |
| Radiologic exam colon double contrast study (74280) |
$301.05 |
$1,115 |
1.8× |
| Radiologic exam colon single contrast study (74270) |
$182.25 |
$675 |
1.1× |
| Radiologic Exam Esophagus Double Contrast Study (74221) |
$151.74 |
$562 |
0.9× |
| Radiologic exam knee complete 4/more views (73564) |
$148.50 |
$550 |
1.5× |
| Radiologic exam pelvis compl minimum 3 views (72190) |
$213.57 |
$791 |
2.2× |
| Radiologic Exam Small Int Single Contrast Study (74250) |
$317.79 |
$1,177 |
1.9× |
| Radiologic exam swallow function contrast study (74230) |
$419.58 |
$1,554 |
2.5× |
| Radiologic exam teeth complete full mouth (70320) |
$170.91 |
$633 |
0.8× |
| Radiologic exam upr gi trc double contrast study (74246) |
$408.24 |
$1,512 |
2.5× |
| Radiologic examination femur 1 view (73551) |
$67.77 |
$251 |
0.8× |
| Radiologic examination femur minimum 2 views (73552) |
$120.15 |
$445 |
1.5× |
| Radiologic examination knee 1/2 views (73560) |
$98.01 |
$363 |
1.2× |
| Radiologic Examination Osseous Survey Limited (77074) |
$117.45 |
$435 |
1.2× |
| Radiologic Examination Salivary Gland Calculus (70380) |
$67.50 |
$250 |
0.8× |
| Radiologic examination tibia & fibula 2 views (73590) |
$88.83 |
$329 |
1.1× |
| Radiologic examination, internal auditory meati, complete Non-Facility (70134) |
$256.23 |
$949 |
0.5× |
| Radiologic examination, teeth; single view Non-Facility (70300) |
$52.65 |
$195 |
0.6× |
| Radiopharm Dacryocystography (78660) |
$386.37 |
$1,431 |
1.0× |
| Radiopharmaceutical therapy, by interstitial radioactive colloid administration Facility (79300) |
$346.14 |
$1,282 |
1.6× |
| Radiopharmaceutical therapy, by intra-articular administration Non-Facility (79440) |
$440.10 |
$1,630 |
2.0× |
| Radiopharmaceutical therapy, by intracavitary administration Non-Facility (79200) |
$440.10 |
$1,630 |
2.0× |
| Red Cell Volume Determination Spx 1 Sampling (78120) |
$637.74 |
$2,362 |
1.7× |
| Red Cell Volume Determination Spx Mult Samplings (78121) |
$637.74 |
$2,362 |
1.3× |
| Renal Cyst Study (74470) |
$373.95 |
$1,385 |
0.7× |
| Ribs bilateral 3 views (71110) |
$193.05 |
$715 |
2.0× |
| Rp loclzj tum plnr 1 area single day imaging (78800) |
$451.44 |
$1,672 |
1.2× |
| Rp loclzj tum plnr 2+area 1+d img/1 area img>2+d (78801) |
$231.66 |
$858 |
0.6× |
| Rp Loclzj Tum Plnr Whole Body 2+ Days Imaging (78804) |
$661.50 |
$2,450 |
1.3× |
| Rp Loclzj Tum Plnr Whole Body Single Day Imaging (78802) |
$713.34 |
$2,642 |
1.4× |
| Rp Loclzj Tum Spect 1 Area Single Day Imaging (78803) |
$1,335.96 |
$4,948 |
2.6× |
| Rp Ther Radiolbld Monoclonal Antibody IV Infus (79403) |
$440.10 |
$1,630 |
2.0× |
| Rp Therapy Intravenous Administration (79101) |
$248.94 |
$922 |
1.1× |
| Salivary Gland Function Study (78232) |
$693.63 |
$2,569 |
1.8× |
| Salivary Gland Imaging (78230) |
$570.24 |
$2,112 |
1.5× |
| Scapula (73010) |
$110.70 |
$410 |
1.1× |
| Screening Digital Breast Tomosynthesis Bi (77063) |
$32.40 |
$120 |
1.4× |
| Sella turcica (70240) |
$80.73 |
$299 |
1.0× |
| Shoulder 1 view (73020) |
$77.22 |
$286 |
0.9× |
| Shoulder Arthrography (73040) |
$266.76 |
$988 |
0.8× |
| Sialogram (70390) |
$373.95 |
$1,385 |
1.7× |
| Skull less than 4 views (70250) |
$114.48 |
$424 |
1.2× |
| Special dosimetry (77331) |
$155.25 |
$575 |
1.2× |
| Special Physics Consult (77370) |
$104.49 |
$387 |
0.8× |
| Special teletherapy port plan (77321) |
$395.28 |
$1,464 |
1.1× |
| Special treatment procedure (77470) |
$771.66 |
$2,858 |
1.5× |
| Speech evaluation, complex (70371) |
$211.41 |
$783 |
0.9× |
| Srs Multisource (77371) |
$15,906.51 |
$58,913 |
2.3× |
| Stereotactic Body Radiation Delivery (77373) |
$1,394.55 |
$5,165 |
0.8× |
| Sternoclavicular joints (71130) |
$187.65 |
$695 |
2.3× |
| Superior sagittal sinus venogram (75870) |
$2,333.34 |
$8,642 |
0.8× |
| Telethx isodose pln cplx w/basic dosimetry (77307) |
$498.15 |
$1,845 |
1.4× |
| Temporomandble Jt Arthrography Rs&I (70332) |
$436.86 |
$1,618 |
2.0× |
| Testicular Imaging W/Flow (78761) |
$573.48 |
$2,124 |
1.5× |
| Ther Rad Simulaj-Aided Field Setting Complex (77290) |
$731.16 |
$2,708 |
2.1× |
| Ther Rad Simulaj-Aided Field Setting Intermed (77285) |
$310.50 |
$1,150 |
0.9× |
| Ther rad simulaj-aided field setting simple (77280) |
$344.25 |
$1,275 |
2.7× |
| Therapeutic Enema Rdctj Intussusception/Obstrcj (74283) |
$211.95 |
$785 |
1.3× |
| Thoracic spine 2 views (72070) |
$167.13 |
$619 |
1.7× |
| Thoracic spine 3 views (72072) |
$251.64 |
$932 |
2.6× |
| Thoracolumbar 2 views (72080) |
$169.02 |
$626 |
2.1× |
| Thyroid carcinoma metastases imaging; with additional studies (eg, urinary recovery) Non-Facility (78016) |
$341.28 |
$1,264 |
0.9× |
| Thyroid Carcinoma Metastases Img Lmtd Area (78015) |
$439.02 |
$1,626 |
1.2× |
| Thyroid Imaging With Vascular Flow (78013) |
$506.52 |
$1,876 |
1.3× |
| Thyroid Met Imaging Body (78018) |
$637.20 |
$2,360 |
1.3× |
| Thyroid Uptake Measurement (78012) |
$294.30 |
$1,090 |
0.8× |
| Thyroid Uptake W/Blood Flow Sngle/Mult Quan Meas (78014) |
$601.02 |
$2,226 |
1.6× |
| Tx Devices Design & Construction Complex (77334) |
$676.62 |
$2,506 |
1.9× |
| Tx devices design & construction intermediate (77333) |
$215.73 |
$799 |
1.7× |
| Tx devices design & construction simple (77332) |
$187.38 |
$694 |
1.5× |
| Ultrasound Breast Limited (76642) |
$244.62 |
$906 |
3.0× |
| Ultrasound Elastography Parenchyma (76981) |
$102.33 |
$379 |
1.0× |
| Ultrasound Exam Aaa Screen (76706) |
$127.44 |
$472 |
1.3× |
| Ultrasound trgt dynamic microbubble 1st lesion (76978) |
$132.84 |
$492 |
0.4× |
| Ultrasound, abdomen limited (76705) |
$258.12 |
$956 |
2.6× |
| Umbilical-artery Doppler (OB) (76820) |
$219.51 |
$813 |
2.2× |
| Unlisted Dx Radiographic Procedure (76499) |
$66.69 |
$247 |
0.8× |
Unlisted fluoroscopic procedure (76496)
range across 3 matching MRF lines |
$66.69–$73.17 |
$247–$271 |
varies |
| Unlisted magnetic resonance procedure (76498) |
$66.69 |
$247 |
0.8× |
| Unlisted Procedure Clinical Brachytherapy (77799) |
$104.22 |
$386 |
1.1× |
| Upper gi w/o kub (74240) |
$244.08 |
$904 |
1.5× |
| Urea Breath Test C-14 Isotopic Acquisj Analysis (78267) |
$9.45 |
$35 |
0.9× |
| Urea breath test c-14 isotopic analysis (78268) |
$78.84 |
$292 |
0.8× |
| Ureteral Reflux Study (78740) |
$491.40 |
$1,820 |
1.3× |
| Urethrocystogram voiding (74455) |
$942.84 |
$3,492 |
4.2× |
| Urethrocystography retrograde (74450) |
$389.07 |
$1,441 |
1.7× |
| Us bone density measurement (76977) |
$176.31 |
$653 |
1.8× |
| Us breast unilateral complete (76641) |
$205.47 |
$761 |
2.1× |
| Us chest (76604) |
$255.15 |
$945 |
2.6× |
| Us complete joint (76881) |
$299.97 |
$1,111 |
3.1× |
| Us exam, pelvic, limited (76857) |
$276.75 |
$1,025 |
2.8× |
| Us head (76506) |
$244.08 |
$904 |
2.5× |
| Us kidney transplant (76776) |
$468.72 |
$1,736 |
4.8× |
| Us lmtd joint/oth nonvasc xtr strux r-t w/img (76882) |
$218.97 |
$811 |
2.2× |
| Us ob detailed single fetus (76811) |
$95.31 |
$353 |
0.4× |
| Us ob limited 1 or more fetuses (76815) |
$291.06 |
$1,078 |
3.0× |
| Us ob transvaginal (76817) |
$302.94 |
$1,122 |
3.1× |
| Us pelvic non ob complete (76856) |
$247.86 |
$918 |
2.5× |
| Us pg uter img f&mat 14 wk tabdl 1/1st gestation (76801) |
$363.42 |
$1,346 |
3.7× |
| Us preg uterus real time f/u trnsabdl per fetus (76816) |
$182.52 |
$676 |
1.9× |
| Us retroperitoneal complete (76770) |
$255.15 |
$945 |
2.6× |
| Us retroperitoneal limited (76775) |
$311.04 |
$1,152 |
3.2× |
| Us scrotum and contents (76870) |
$304.02 |
$1,126 |
3.1× |
| Us spinal canal and contents (76800) |
$233.82 |
$866 |
2.4× |
| Us thyroid (76536) |
$287.28 |
$1,064 |
2.9× |
| Us transrectal (76872) |
$95.31 |
$353 |
1.0× |
| Vascular Flow Imaging (78445) |
$486.27 |
$1,801 |
1.3× |
| Vasogram (74440) |
$306.72 |
$1,136 |
1.4× |
| Vein X-Ray Chest (75827) |
$1,197.72 |
$4,436 |
0.8× |
| Vein X-Ray Liver W/O Hemodyn (75887) |
$1,264.14 |
$4,682 |
0.4× |
| Vein X-Ray Skull Epidural (75872) |
$1,047.60 |
$3,880 |
1.8× |
| Vein X-Ray Spleen/Liver (75810) |
$2,124.90 |
$7,870 |
0.7× |
| Venogram Sinus/Jugular (75860) |
$2,333.34 |
$8,642 |
0.8× |
| Venography Adrenal Unilateral (75840) |
$3,246.75 |
$12,025 |
1.1× |
| Venography caval inferior serialography rs&i (75825) |
$3,376.89 |
$12,507 |
1.1× |
| Venography extremity bilateral rs&i (75822) |
$1,629.18 |
$6,034 |
1.1× |
| Venography extremity unilateral rs&i (75820) |
$1,250.91 |
$4,633 |
0.8× |
| Venography Orbital Rs&I (75880) |
$1,047.60 |
$3,880 |
1.8× |
| Venography Renal Bilateral (75833) |
$3,246.75 |
$12,025 |
1.1× |
| Venography Renal Unilateral (75831) |
$2,275.83 |
$8,429 |
0.8× |
| Venous sampling by catheter (75893) |
$3,477.33 |
$12,879 |
0.7× |
| Venous Thrombosis Imaging Venogram Bilateral (78458) |
$639.09 |
$2,367 |
1.7× |
| Vertebral fracture assessment via dxa (77086) |
$92.88 |
$344 |
1.1× |
| Wrist 2 views (73100) |
$88.02 |
$326 |
1.1× |
| X-Ray Ac Jts - Xr Acromioclavicular Joints Bilateral (73050) |
$113.13 |
$419 |
1.4× |
| X-ray antegrade pyelogram tube (74425) |
$579.96 |
$2,148 |
1.8× |
| X-Ray Aorta Leg Arteries (75630) |
$2,124.90 |
$7,870 |
0.7× |
| X-Ray Bend Only L-S Spine (72120) |
$135.81 |
$503 |
1.4× |
| X-Ray Elbow 2 Vw - Xr Elbow 1-2 Views Right (73070) |
$116.91 |
$433 |
1.4× |
X-Ray Exam Breast Specimen (76098)
range across 12 matching MRF lines |
$441.72–$484.92 |
$1,636–$1,796 |
varies |
| X-Ray Exam Entire Spi 1 Vw (72081) |
$133.11 |
$493 |
1.6× |
| X-Ray Exam Entire Spi 2/3 Vw (72082) |
$234.90 |
$870 |
2.4× |
| X-Ray Exam Entire Spi 4/5 Vw (72083) |
$480.06 |
$1,778 |
4.9× |
| X-Ray Exam Hip Uni 1 View (73501) |
$97.74 |
$362 |
1.2× |
| X-Ray Exam Hip Uni 2-3 Views (73502) |
$144.72 |
$536 |
1.8× |
| X-Ray Exam Hip Uni 4/> Views (73503) |
$149.85 |
$555 |
1.5× |
| X-Ray Exam Hips Bi 2 Views (73521) |
$136.62 |
$506 |
1.4× |
| X-Ray Exam Hips Bi 3-4 Views (73522) |
$289.17 |
$1,071 |
2.9× |
| X-Ray Exam Hips Bi 5/> Views (73523) |
$334.53 |
$1,239 |
3.4× |
| X-Ray Exam L-S Spine Bending (72114) |
$109.62 |
$406 |
1.1× |
| X-Ray Exam Neck Spine 2-3 Vw (72040) |
$162.27 |
$601 |
2.0× |
| X-Ray Exam Neck Spine 6/>Vws (72052) |
$201.96 |
$748 |
2.1× |
| X-Ray Exam Unilat Ribs/Chest (71101) |
$254.07 |
$941 |
2.6× |
| X-ray eye for foreign body (70030) |
$67.50 |
$250 |
0.8× |
| X-ray head for orthodontia (70350) |
$67.50 |
$250 |
0.8× |
| X-ray humerus (73060) |
$98.01 |
$363 |
1.2× |
| X-ray IV pyelogram (ivp) (74400) |
$250.29 |
$927 |
1.5× |
| X-ray IV pyelogram+tomography (74415) |
$306.72 |
$1,136 |
1.9× |
| X-Ray Jaw <4 Vw - Xr Mandible < 4 Views (70100) |
$144.72 |
$536 |
1.8× |
| X-Ray Knee Bilat Standing - Xr Knees Anteroposterior Standing Bilat (73565) |
$97.74 |
$362 |
1.2× |
| X-Ray Lumbar Spine 2/3 Vw - Xr Lumbar Spine 2-3 Views (72100) |
$169.02 |
$626 |
1.7× |
| X-ray nose-rectum child f.b. (76010) |
$109.89 |
$407 |
1.3× |
| X-Ray Ribs, Chest 4+ Vw - Xr Ribs 3 Vws Bil W/ Chest Posteroanterior (71111) |
$301.05 |
$1,115 |
3.1× |
| X-Ray Sacroiliac Jts 3+ Vw - Xr Sacroiliac Joints 3+ Views (72202) |
$227.61 |
$843 |
2.3× |
| X-Ray Sacroiliac Jts <3 Vw - Xr Sacroiliac Joints 1-2 Views (72200) |
$85.32 |
$316 |
0.9× |
| X-Ray Sacrum/Coccyx 2+ Vw - Xr Sacrum Coccyx 2+ Views (72220) |
$178.74 |
$662 |
2.2× |
| X-Ray Sinuses 3+ Vw - Xr Paranasal Sinuses 3+ Views (70220) |
$142.83 |
$529 |
1.7× |
| X-Ray Skull 4+ Vw - Xr Skull Complete 4+ Views (70260) |
$135 |
$500 |
1.4× |
| X-Ray Stress View (77071) |
$67.50 |
$250 |
0.8× |
| X-ray thoracic spine 4 vw (72074) |
$258.66 |
$958 |
2.6× |
| X-Ray Tmj Unilat (70328) |
$74.25 |
$275 |
0.9× |
| X-Ray Urinary Tract Exam With Contrast Material (74420) |
$309.42 |
$1,146 |
0.9× |
| X-Rays Bone Length Studies (77073) |
$168.75 |
$625 |
1.7× |
| X-Rays Bone Survey Complete (77075) |
$333.18 |
$1,234 |
3.4× |
| Xr c-spine 4 or 5 views (72050) |
$218.97 |
$811 |
2.2× |
| Xr facial bones less than 3 views (70140) |
$193.05 |
$715 |
2.4× |
| XR Mastoids < 3 Views Bilateral (70120) |
$103.68 |
$384 |
1.1× |
| Xr myelogram posterior fossa (70010) |
$742.50 |
$2,750 |
2.3× |
| Xr orbits complete 4 views (70200) |
$178.20 |
$660 |
1.8× |
| Xr Tomogram Single Plane (76100) |
$103.68 |
$384 |
1.1× |