| 3-D radiotherapy plan dose-volume histograms (77295) |
$11,740.50 |
$13,045 |
6.8× |
| Abdomen 1 View (74018) |
$405 |
$450 |
3.7× |
| Abdomen 2 views (74019) |
$495 |
$550 |
3.8× |
| Acute Gastrointestinal Blood Loss Imaging (78278) |
$1,579.50 |
$1,755 |
3.2× |
| Adrenal Cortex & Medulla Img (78075) |
$3,159 |
$3,510 |
2.0× |
| Angio internal mammary (75756) |
$6,075 |
$6,750 |
1.5× |
| Angio pulmonary bilat (75743) |
$6,682.50 |
$7,425 |
1.7× |
| Angiography Adrenal Bilateral Slctv Rs&I (75733) |
$6,075 |
$6,750 |
1.5× |
| Angiography extremity bilateral rs&i (75716) |
$5,490 |
$6,100 |
1.4× |
| Angiography extremity unilateral rs&i (75710) |
$4,860 |
$5,400 |
1.2× |
| Angiography pulmonary unilateral slctv rs&i (75741) |
$5,467.50 |
$6,075 |
1.4× |
| Angrph pulmonary nonslctv cath/ven njx rs&i (75746) |
$5,224.50 |
$5,805 |
1.3× |
| Ankle 2 views (73600) |
$441 |
$490 |
4.1× |
| Aortography thoracic serialography rs&i (75605) |
$9,000 |
$10,000 |
1.3× |
| Aortography thoracic w/o serialography rs&i (75600) |
$5,346 |
$5,940 |
1.4× |
| Artery X-Rays Abdomen (75726) |
$8,100 |
$9,000 |
1.2× |
| Artery X-Rays Adrenal Gland (75731) |
$5,103 |
$5,670 |
1.3× |
| Artery X-Rays Pelvis (75736) |
$8,100 |
$9,000 |
1.2× |
| Artery X-Rays Spine (75705) |
$6,840 |
$7,600 |
1.0× |
| Arthrogram ankle (73615) |
$1,260 |
$1,400 |
2.9× |
| Arthrogram hip (73525) |
$1,579.50 |
$1,755 |
3.6× |
| Arthrogram Wrist (73115) |
$913.50 |
$1,015 |
2.1× |
| Basic radiation dosimetry calculation (77300) |
$2,610 |
$2,900 |
15.6× |
| Bone age studies (77072) |
$477 |
$530 |
3.7× |
| Bone Imaging 3 Phase (78315) |
$3,600 |
$4,000 |
7.2× |
| Bone Imaging Limited Area (78300) |
$1,647 |
$1,830 |
3.3× |
| Bone Imaging Multiple Areas (78305) |
$1,813.50 |
$2,015 |
3.6× |
| Bone Imaging Whole Body (78306) |
$2,520 |
$2,800 |
5.0× |
| Bone marrow imaging limited area (78102) |
$1,035 |
$1,150 |
2.1× |
| Bone marrow imaging; multiple areas (78103) |
$1,458 |
$1,620 |
2.9× |
| Bone marrow imaging; whole body (78104) |
$1,647 |
$1,830 |
3.3× |
| Bone survey infant (77076) |
$549 |
$610 |
4.2× |
| Brachytx isodose complex (77318) |
$3,690 |
$4,100 |
7.9× |
| Brachytx isodose intermed (77317) |
$2,340 |
$2,600 |
5.0× |
| Brachytx Isodose Plan Simple (77316) |
$1,800 |
$2,000 |
3.9× |
| Brain Flow Imaging Only (78610) |
$1,579.50 |
$1,755 |
2.3× |
| Brain Image W/Flow < 4 Views (78601) |
$1,647 |
$1,830 |
3.3× |
| Brain imaging < 4 static views (78600) |
$1,458 |
$1,620 |
2.9× |
| Brain Imaging Min 4 Static Views W Vascular Flow (78606) |
$2,065.50 |
$2,295 |
3.0× |
| Brain Imaging Minimum 4 Static Views (78605) |
$1,944 |
$2,160 |
2.9× |
| Brain Imaging Pet Metabolic Evaluation (78608) |
$4,617 |
$5,130 |
2.6× |
| Card Bl Pool Gated Spect Rest Wal Motn Ejct Frct (78494) |
$1,647 |
$1,830 |
3.3× |
| Cardiac MRI w/w/o contrast & further seq (75561) |
$5,670 |
$6,300 |
13.0× |
| Cardiac MRI w/w/o contrast w/stress (75563) |
$7,146 |
$7,940 |
7.3× |
| Cardiac Shunt Detection (78428) |
$1,458 |
$1,620 |
2.9× |
| Cardiovasc nucl exam unlisted (78499) |
$1,170 |
$1,300 |
2.3× |
| Cat Scan Follow-Up Study (76380) |
$540 |
$600 |
5.0× |
| Cerebrospinal Fluid Flow W/O Matl Shunt Evaltj (78645) |
$1,822.50 |
$2,025 |
2.7× |
| Cerebrospinal fluid flow, imaging (not including introduction of material); ventriculography Non-Facility (78635) |
$1,822.50 |
$2,025 |
2.7× |
| Cerebrospinal Fluid Scan (78630) |
$1,701 |
$1,890 |
2.5× |
| Chest 1 view (71045) |
$382.50 |
$425 |
3.5× |
| Chest 2 views (71046) |
$477 |
$530 |
4.4× |
| Chest 3 views (71047) |
$621 |
$690 |
5.7× |
| Chest 4 or more views (71048) |
$697.50 |
$775 |
5.3× |
| Chg us nrv&acc strux 1 xtr compre w/img pr extremity (76883) |
$378 |
$420 |
2.9× |
| Cholecystography Oral Contrast (74290) |
$1,080 |
$1,200 |
4.9× |
| Cineradiograpy/vidradiograpy xcpt where spec (76120) |
$387 |
$430 |
3.0× |
| Cisternography Positive Contrast Rs&I (70015) |
$1,710 |
$1,900 |
1.7× |
| Clavicle complete (73000) |
$454.50 |
$505 |
4.2× |
| Computed Tomography Thorax Lw Dose Lng Ca Scr C- (71271) |
$2,115 |
$2,350 |
16.2× |
| Continuing medical physics consltj pr wk (77336) |
$1,980 |
$2,200 |
11.8× |
| Contrast Exam Abdominl Aorta (75625) |
$4,590 |
$5,100 |
1.2× |
| Contrast X-Ray Bladder (74430) |
$972 |
$1,080 |
2.2× |
| Contrast X-Ray Of Elbow (73085) |
$972 |
$1,080 |
2.2× |
| Contrast X-Ray Of Knee Joint (73580) |
$1,458 |
$1,620 |
3.3× |
| Contrast Xray Throat/Cerv Esopha (74210) |
$783 |
$870 |
3.6× |
| Corpora cavernosography (74445) |
$495 |
$550 |
3.8× |
| CT abdomen and pelvis without and with contrast (74178) |
$5,040 |
$5,600 |
11.6× |
| CT abdomen and pelvis without contrast (74176) |
$2,970 |
$3,300 |
10.0× |
| CT abdomen w contrast (74160) |
$1,890 |
$2,100 |
8.6× |
| CT abdomen w wo contrast (74170) |
$2,160 |
$2,400 |
9.9× |
| CT abdomen w/o contrast (74150) |
$1,620 |
$1,800 |
12.4× |
| CT Angio Abdomen and Pelvis (74174) |
$4,950 |
$5,500 |
11.4× |
| CT Angio Chest (71275) |
$3,330 |
$3,700 |
15.2× |
| CT Angio Head (70496) |
$3,555 |
$3,950 |
16.2× |
| CT angio hrt w/3d image (75574) |
$2,308.50 |
$2,565 |
5.3× |
| Ct Angio Lwr Extr W/O&W/Dye (73706) |
$2,340 |
$2,600 |
10.7× |
| CT Angio Neck (70498) |
$3,555 |
$3,950 |
16.2× |
| Ct Angio Upr Extrm W/O&W/Dye (73206) |
$2,250 |
$2,500 |
10.3× |
| CT bone density (77078) |
$607.50 |
$675 |
5.6× |
| CT cervical spine w/ contrast (72126) |
$1,800 |
$2,000 |
4.1× |
| CT cervical spine w/o contrast (72125) |
$1,530 |
$1,700 |
11.7× |
| CT cervical spine w/wo cont (72127) |
$2,070 |
$2,300 |
9.5× |
| CT chest w contrast (71260) |
$2,596.50 |
$2,885 |
11.9× |
| CT chest w/wo contrast (71270) |
$2,902.50 |
$3,225 |
13.3× |
| CT colonography screening (74263) |
$1,458 |
$1,620 |
4.9× |
| CT Colonogrphy Dx Image Postprocess W/Contrast (74262) |
$1,980 |
$2,200 |
9.0× |
| CT colonogrphy dx image postprocess w/o contrast (74261) |
$1,350 |
$1,500 |
10.3× |
| CT head/brain with contrast (70460) |
$1,800 |
$2,000 |
8.2× |
| CT head/brain without and with contrast (70470) |
$1,980 |
$2,200 |
9.0× |
| CT heart contrast eval cardiac structure&morph (75572) |
$1,431 |
$1,590 |
3.3× |
| CT heart no contrast quant eval coronry calcium (75571) |
$1,116 |
$1,240 |
10.3× |
| CT hrt w/3d image congen (75573) |
$2,092.50 |
$2,325 |
4.8× |
| CT iac w contrast (70481) |
$2,250 |
$2,500 |
10.3× |
| CT l-spine w&w/o contrast (72133) |
$2,340 |
$2,600 |
10.7× |
| CT lower ext w/o (73700) |
$1,300.50 |
$1,445 |
10.0× |
| CT lower extremity w/contrast material (73701) |
$1,791 |
$1,990 |
8.2× |
| CT lumbar spine w contrast (72132) |
$1,948.50 |
$2,165 |
4.5× |
| CT lumbar spine w/o contrast (72131) |
$1,530 |
$1,700 |
11.7× |
| CT maxillofacial w contrast (70487) |
$2,250 |
$2,500 |
10.3× |
| CT maxillofacial wo contrast (70486) |
$1,908 |
$2,120 |
14.6× |
| CT neck tissue combo (70492) |
$2,520 |
$2,800 |
11.5× |
| Ct Orbit/Ear/Fossa W/O&W/Dye (70482) |
$2,520 |
$2,800 |
11.5× |
| CT orbits w/o contrast (70480) |
$2,070 |
$2,300 |
15.9× |
| CT pelvis w&w/o contrast (72194) |
$2,520 |
$2,800 |
11.5× |
| CT pelvis w/o contrast (72192) |
$1,800 |
$2,000 |
13.8× |
| CT scan of leg combo (73702) |
$2,250 |
$2,500 |
10.3× |
| CT scans face/jaw combo (70488) |
$2,520 |
$2,800 |
11.5× |
| CT soft tissue neck w contrast (70491) |
$2,070 |
$2,300 |
9.5× |
| CT soft tissue neck w/o contrast (70490) |
$1,620 |
$1,800 |
12.4× |
| CT thoracic spine w contrast (72129) |
$1,822.50 |
$2,025 |
8.3× |
| CT thoracic spine w/o contrast (72128) |
$1,530 |
$1,700 |
11.7× |
| CT thoracic spine w/wo cont (72130) |
$2,146.50 |
$2,385 |
9.8× |
| CT thorax w/o contrast (71250) |
$1,800 |
$2,000 |
13.8× |
| CT unlisted procedure (76497) |
$585 |
$650 |
5.4× |
| CT upper ext wo (73200) |
$1,440 |
$1,600 |
11.0× |
| CT upper extremity w/o & w/contrast material (73202) |
$2,065.50 |
$2,295 |
9.4× |
| CT upper extremity with contrast (73201) |
$1,710 |
$1,900 |
3.9× |
| Cta Abdl Aorta&Bi Iliofem W/Contrast&Postp (75635) |
$1,800 |
$2,000 |
8.2× |
| Cta Abdomen (74175) |
$3,420 |
$3,800 |
15.6× |
| CTA pelvis (72191) |
$2,430 |
$2,700 |
11.1× |
| Dacryocystography, nasolacrimal duct, radiological supervision and interpretation Non-Facility (70170) |
$913.50 |
$1,015 |
3.1× |
| Dilation ureters/urethra rs&i (74485) |
$2,700 |
$3,000 |
1.0× |
| Discography Cerv/Thor Spine (72285) |
$4,230 |
$4,700 |
1.7× |
| Diskography lumbar (72295) |
$4,230 |
$4,700 |
1.7× |
| Doppler Echo Fetal Puls Spectral F/U/Repeat (76828) |
$477 |
$530 |
3.7× |
| Doppler Echo Fetal Spectral Display Complete (76827) |
$729 |
$810 |
5.6× |
| Doppler Fetal Mid Cerebral Artery (76821) |
$760.50 |
$845 |
5.8× |
| Dxa Bone Density Axial (77080) |
$922.50 |
$1,025 |
7.1× |
| Dxa bone density study (77085) |
$270 |
$300 |
2.1× |
| Dxa bone density study 1/>sites appendiclr skel (77081) |
$549 |
$610 |
5.1× |
| Echo exam of fetal heart (76825) |
$1,458 |
$1,620 |
2.1× |
| Echo exam uterus (76831) |
$850.50 |
$945 |
2.9× |
| Echo Guide For Artery Repair (76936) |
$1,156.50 |
$1,285 |
4.3× |
| Echocardiography, fetal, cardiovascular system, real time with image documentation (2D), with or without M-mode… (76826) |
$1,215 |
$1,350 |
4.1× |
| Echograp Trans R Pros Study (76873) |
$837 |
$930 |
6.4× |
| Esophageal Motility Study (78258) |
$1,458 |
$1,620 |
2.9× |
| Esophagram (74220) |
$868.50 |
$965 |
4.0× |
| Fetal Biophys Profile W/Nst (76818) |
$765 |
$850 |
5.9× |
| Fetal Biophysical Profile W/O Non-Stress Testing (76819) |
$720 |
$800 |
5.5× |
| Fetal MRI w/placntl matrnl plvc img sing/1st ges (74712) |
$1,579.50 |
$1,755 |
5.3× |
| Fluoroscopy up to 1 hr (76000) |
$1,003.50 |
$1,115 |
3.4× |
| Follow-Up Angiography (75898) |
$4,500 |
$5,000 |
1.1× |
| Foot 2 views (73620) |
$432 |
$480 |
4.0× |
| Forearm 2 views (73090) |
$450 |
$500 |
4.1× |
| Gastric emptying imaging study (78264) |
$2,794.50 |
$3,105 |
5.6× |
| Gastric Emptyng Imag Std W/Sm Bwl Transit (78265) |
$3,307.50 |
$3,675 |
6.6× |
| Gastric Mucosa Imaging (78261) |
$1,458 |
$1,620 |
2.9× |
| Gastroesophageal Reflux Exam (78262) |
$1,579.50 |
$1,755 |
3.2× |
| Gated Heart Planar Single (78472) |
$2,916 |
$3,240 |
5.8× |
| Gated Heart, Multiple (78473) |
$3,159 |
$3,510 |
6.3× |
| Gstrc Emptng Imag Std W/Sm Bwl Col Trnst Mlt Day (78266) |
$3,789 |
$4,210 |
5.6× |
| Hand 2 views (73120) |
$531 |
$590 |
4.1× |
| Hdr Rdncl Ntrstl/Icav Brchtx (77772) |
$7,780.50 |
$8,645 |
8.9× |
| Hdr Rdncl Ntrstl/Icav Brchtx (77771) |
$7,200 |
$8,000 |
8.3× |
| Hdr Rdncl Ntrstl/Icav Brchtx 1 Channel (77770) |
$6,300 |
$7,000 |
7.2× |
| Heart first pass single,planar (78481) |
$1,701 |
$1,890 |
2.5× |
| Heart Image (Pet) Multiple (78492) |
$4,887 |
$5,430 |
2.7× |
| Hepatc Vngrph Wdg/Fr Hemodyn Eval Rs&I (75889) |
$6,075 |
$6,750 |
1.5× |
| Hepatc Vngrph Wdg/Fr W/O Hemodyn Eval Rs&I (75891) |
$5,589 |
$6,210 |
1.4× |
| Hepatobil Syst Image W/Drug (78227) |
$2,137.50 |
$2,375 |
3.2× |
| Hepatobiliary System Imaging (78226) |
$2,025 |
$2,250 |
4.1× |
| Ht Musc Image Planar Mult (78454) |
$3,280.50 |
$3,645 |
2.0× |
| Ht Muscle Image Spect Sing (78451) |
$3,402 |
$3,780 |
2.1× |
| Hysterosalpingogram (74740) |
$1,003.50 |
$1,115 |
3.4× |
| Image fusion (77399) |
$1,350 |
$1,500 |
8.0× |
| Infant hip ultrasound with hip movement (dynamic) (76885) |
$886.50 |
$985 |
8.2× |
| Infant hip ultrasound, limited static exam (76886) |
$495 |
$550 |
4.6× |
| Infusion Ivp (74410) |
$783 |
$870 |
3.6× |
Interstitial radiation source applic complex (77778)
range across 2 matching MRF lines |
$1,890–$6,840 |
$2,100–$7,600 |
varies |
| Intracavitary Radiation Source Applic Complex (77763) |
$3,510 |
$3,900 |
4.0× |
| Intracavitary Radiation Source Applic Intermed (77762) |
$2,970 |
$3,300 |
4.3× |
| Intraop radiaj tx deliver xray single tx session (77424) |
$19,089 |
$21,210 |
2.1× |
| Joint Survey Single View (77077) |
$477 |
$530 |
3.7× |
| K Flow/Funct Image Multiple (78709) |
$2,916 |
$3,240 |
4.3× |
| K Flow/Funct Image W/Drug (78708) |
$2,551.50 |
$2,835 |
3.8× |
| K Flow/Funct Image W/O Drug (78707) |
$2,551.50 |
$2,835 |
3.8× |
| Kidney Funcj Study Non-Img Radioisotopic Study (78725) |
$1,458 |
$1,620 |
2.9× |
| Kidney Imaging Morphol (78700) |
$2,551.50 |
$2,835 |
5.1× |
| Kidney Imaging Morphoogy W/Vascular Flow (78701) |
$2,187 |
$2,430 |
4.4× |
| Knee 3 Views (73562) |
$540 |
$600 |
5.0× |
| Labeled RBC Sequestration Differntl Organ/Tissue (78140) |
$1,458 |
$1,620 |
2.9× |
Leveen/Shunt Patency Exam (78291)
range across 2 matching MRF lines |
$1,080–$1,458 |
$1,200–$1,620 |
varies |
| Liver & Spleen Imaging Static Only (78215) |
$1,813.50 |
$2,015 |
3.6× |
| Liver & Spleen Imaging W/Vascular Flow (78216) |
$1,647 |
$1,830 |
3.3× |
| Liver imaging static only (78201) |
$2,137.50 |
$2,375 |
3.2× |
| Liver imaging w/vascular flow (78202) |
$2,331 |
$2,590 |
3.4× |
| Lung Perf&Ventilat Diferentl (78598) |
$1,944 |
$2,160 |
2.9× |
| Lung perfusion differential (78597) |
$1,660.50 |
$1,845 |
3.3× |
| Lung Ventilat&Perfus Imaging (78582) |
$1,822.50 |
$2,025 |
2.7× |
| Lung Ventilation Imaging (78579) |
$1,458 |
$1,620 |
2.9× |
| Lymph System Imaging (78195) |
$2,340 |
$2,600 |
3.5× |
| Lymphangiography Extremity Only Bilateral Rs&I (75803) |
$2,794.50 |
$3,105 |
1.4× |
| Lymphangiography extremity only unilateral rs&i (75801) |
$1,579.50 |
$1,755 |
2.0× |
| Lymphangiography Pelvic/Abdominal Bilateral Rs&I (75807) |
$6,561 |
$7,290 |
1.7× |
| Lymphangiography, pelvic/abdominal, unilateral (75805) |
$6,075 |
$6,750 |
1.5× |
| Magnetic Image Jaw Joint (70336) |
$1,800 |
$2,000 |
6.0× |
| Magnetic Resonance Elastography (76391) |
$2,047.50 |
$2,275 |
6.9× |
| Mammary ductogram or galactogram multiple (77054) |
$913.50 |
$1,015 |
3.1× |
| Mammary ductogram or galactogram single (77053) |
$792 |
$880 |
2.7× |
| Meckels Divert Exam (78290) |
$1,458 |
$1,620 |
2.9× |
| Mlc imrt design & construction per imrt plan (77338) |
$3,870 |
$4,300 |
8.3× |
| Mr safety determination physician/other qhp (76016) |
$247.50 |
$275 |
2.3× |
| Mr safety implant&/fb assmt clin staf 1st 15 min (76014) |
$162 |
$180 |
4.5× |
| Mr safety implt electronics prepj supvj phys/qhp (76018) |
$270 |
$300 |
2.3× |
| Mr safety implt pos&/immoblj (76019) |
$252 |
$280 |
3.4× |
| Mr safety med physics xm customization plng&mntr (76017) |
$585 |
$650 |
2.0× |
| Mra Head W/O & W/Contrast Material (70546) |
$3,870 |
$4,300 |
8.9× |
| MRA head w/o contrast (70544) |
$3,330 |
$3,700 |
11.2× |
| MRA head with contrast (70545) |
$3,600 |
$4,000 |
8.3× |
| MRA neck w contrast (70548) |
$4,230 |
$4,700 |
9.7× |
| Mra Neck W/O &W/Contrast Material (70549) |
$4,500 |
$5,000 |
10.3× |
| MRA neck w/o contrast (70547) |
$3,960 |
$4,400 |
13.3× |
| MRI abdomen w contrast (74182) |
$3,888 |
$4,320 |
8.9× |
| MRI abdomen w/o contrast (74181) |
$2,461.50 |
$2,735 |
8.3× |
| MRI any jt lower extrem w/contrast material (73722) |
$3,600 |
$4,000 |
3.7× |
| MRI any jt lower extrem w/o & w/contrast matrl (73723) |
$4,140 |
$4,600 |
9.5× |
| MRI any jt upper extremity w/contrast matrl (73222) |
$3,888 |
$4,320 |
4.0× |
| MRI bone marrow blood supply (77084) |
$1,948.50 |
$2,165 |
6.5× |
| MRI brain functional w/o physician admnistration (70554) |
$1,035 |
$1,150 |
3.5× |
| MRI brain functional w/physician admnistration (70555) |
$765 |
$850 |
2.6× |
| MRI Breast W/O Contrast Bilateral (77047) |
$3,240 |
$3,600 |
10.9× |
| MRI Breast Without Contrast Material Unilateral (77046) |
$2,880 |
$3,200 |
9.7× |
| MRI cardiac w/o cont stress (75559) |
$4,500 |
$5,000 |
6.6× |
| MRI cardiac w/o contrast (75557) |
$4,194 |
$4,660 |
14.1× |
| MRI cervical spine w contrast (72142) |
$4,050 |
$4,500 |
9.3× |
| MRI cervical spine w/o cont (72141) |
$3,514.50 |
$3,905 |
11.8× |
| MRI chest w/o contrast (71550) |
$2,916 |
$3,240 |
9.8× |
| MRI chest with contrast (71551) |
$3,402 |
$3,780 |
3.5× |
| MRI chest wo w contrast (71552) |
$3,888 |
$4,320 |
8.9× |
| MRI lower extrem oth/thn jt w/contrast matrl (73719) |
$3,600 |
$4,000 |
8.3× |
| MRI lower extrem oth/thn jt w/o & w/contr matr (73720) |
$4,140 |
$4,600 |
9.5× |
| MRI lower extrem oth/thn jt w/o contr matrl (73718) |
$3,159 |
$3,510 |
10.6× |
| MRI lumbar spine w contrast (72149) |
$4,050 |
$4,500 |
9.3× |
| Mri Neck Spine W/O & W/Dye (72156) |
$5,400 |
$6,000 |
12.4× |
| MRI orbit face &/neck w/o contrast (70540) |
$1,903.50 |
$2,115 |
6.4× |
| MRI orbit face neck w contrast (70542) |
$2,520 |
$2,800 |
5.8× |
| Mri Orbt/Fac/Nck W/O &W/Dye (70543) |
$4,950 |
$5,500 |
11.4× |
| MRI pelvis w contrast (72196) |
$3,730.50 |
$4,145 |
8.6× |
| MRI pelvis w/o & w contrast (72197) |
$5,589 |
$6,210 |
12.8× |
| MRI pelvis w/o contrast (72195) |
$3,402 |
$3,780 |
11.4× |
| MRI spectroscopy (76390) |
$1,822.50 |
$2,025 |
16.8× |
| MRI thoracic spine w/o contrast (72146) |
$3,505.50 |
$3,895 |
11.8× |
| MRI upper extremity oth than jt w/contr matrl (73219) |
$3,105 |
$3,450 |
7.1× |
| MRI upper extremity oth than jt w/o contr matrl (73218) |
$2,916 |
$3,240 |
9.8× |
| Mri Uppr Extremity W/O&W/Dye (73220) |
$3,762 |
$4,180 |
8.6× |
| MRI, abdomen, combo (74183) |
$5,224.50 |
$5,805 |
12.0× |
| MRI, dorsal spine combo (72157) |
$5,400 |
$6,000 |
12.4× |
| MRI, dorsal spine contrast (72147) |
$4,050 |
$4,500 |
9.3× |
| MRI, joint upper extrem (73221) |
$3,159 |
$3,510 |
10.6× |
| MRI, joint upper extrem combo (73223) |
$4,617 |
$5,130 |
10.6× |
| MRI, lumbar spine combo (72158) |
$5,400 |
$6,000 |
12.4× |
| Myelogram cervical (72240) |
$1,579.50 |
$1,755 |
1.6× |
| Myelogram Lumbar (72265) |
$1,593 |
$1,770 |
1.6× |
| Myelography thoracic (72255) |
$1,489.50 |
$1,655 |
1.5× |
| Myelograpy 2/more regions rs&i (72270) |
$1,800 |
$2,000 |
1.8× |
| Myocardial Imaging Infarct Avid Planar Qual/Quan (78466) |
$1,458 |
$1,620 |
2.9× |
| Myocardial Imaging Pet Metabolic Evaluation (78459) |
$4,617 |
$5,130 |
2.9× |
| Myocardial imaging, infarct avid, planar; with ejection fraction by first pass technique Non-Facility (78468) |
$1,458 |
$1,620 |
2.2× |
| Myocardial Perfusion Planar 1 Study Rest/Stress (78453) |
$2,916 |
$3,240 |
1.8× |
| Myocardial Spect Multiple Studies (78452) |
$5,287.50 |
$5,875 |
3.3× |
| Myocrd Img Pet Metab Eval Single Study Cncrnt CT (78429) |
$6,318 |
$7,020 |
3.5× |
| Myocrd img PET prfuj 1std rest/stress cncrnt CT (78430) |
$6,318 |
$7,020 |
3.5× |
| Myocrd Img Pet Prfuj Mlt Std Rst&Strs Cncrnt CT (78431) |
$7,897.50 |
$8,775 |
2.9× |
| Myocrd Img Pet Prfuj W/Metab 2rtracer Cncrnt CT (78433) |
$9,720 |
$10,800 |
3.5× |
| Myocrd Img Pet Prfuj W/Metab Dual Radiotracer (78432) |
$8,100 |
$9,000 |
4.3× |
| N-invas est c ffr sw aly CTA (75580) |
$5,220 |
$5,800 |
4.9× |
| Neck soft tissue (70360) |
$364.50 |
$405 |
3.4× |
| Nfs/Instlj Radioelmnt Sln 3 Mo Follow-Up Care (77750) |
$1,471.50 |
$1,635 |
3.1× |
| Njx Rp Loclzj Non-Img Probe Study Intravenous (78808) |
$1,458 |
$1,620 |
2.9× |
| Nm csf leak detection (78650) |
$2,916 |
$3,240 |
1.8× |
| Nm myocard infarct spect (78469) |
$2,160 |
$2,400 |
3.2× |
| Nm red cell survival study (78130) |
$1,458 |
$1,620 |
2.9× |
| Nm whole blood volume (78122) |
$1,701 |
$1,890 |
2.5× |
| Nonvascular Shunt X-Ray (75809) |
$477 |
$530 |
3.7× |
| Ntsty modul radthx pln dose-vol histos (77301) |
$15,178.50 |
$16,865 |
8.8× |
| Nuclear Rx Intra-Arterial (79445) |
$1,440 |
$1,600 |
4.9× |
| Nuclear Rx Oral Admin (79005) |
$1,458 |
$1,620 |
5.0× |
| Ob us nuchal meas 1 gest (76813) |
$486 |
$540 |
3.7× |
| Oph bmtry us echograpy a-scan io lens pwr cal (76519) |
$477 |
$530 |
3.7× |
| Oph us dx ant sgm us immersion b-scan/hr biom (76513) |
$477 |
$530 |
3.7× |
| Oph US Dx B-Scan&Quan a-Scan Sm Pt Enctr (76510) |
$828 |
$920 |
5.0× |
| Ophthalmic Biometry US Echograpy a-Scan (76516) |
$477 |
$530 |
3.7× |
| Ophthalmic Ultrasonic Foreign Body Localization (76529) |
$355.50 |
$395 |
3.3× |
| Ophthalmic ultrasound dx b-scan w/wo a-scan (76512) |
$477 |
$530 |
3.7× |
| Ophthalmic US Dx Corneal Pachymetry Uni/Bi (76514) |
$265.50 |
$295 |
7.4× |
| Ophthalmic us dx quantitative a-scan only (76511) |
$477 |
$530 |
3.7× |
| Optic foramina (70190) |
$328.50 |
$365 |
3.0× |
| Panoramic X-ray of jaws (70355) |
$355.50 |
$395 |
3.3× |
| Parathyroid imaging w/tomographic spect & CT (78072) |
$1,822.50 |
$2,025 |
2.7× |
| Parathyroid Planar Imaging (78070) |
$1,647 |
$1,830 |
3.3× |
| Parathyroid planar imaging w/wo subtraction (78071) |
$1,458 |
$1,620 |
2.9× |
| Pelvis 1 or 2 views (72170) |
$477 |
$530 |
3.7× |
| Perineogram (74775) |
$643.50 |
$715 |
2.2× |
| Peritoneogram Rs&I (74190) |
$1,350 |
$1,500 |
2.0× |
| Pet Image Skull-Thigh (78812) |
$5,287.50 |
$5,875 |
3.0× |
| Pet Image W/Ct Lmtd (78814) |
$4,860 |
$5,400 |
2.7× |
| PET image w/CT, full body (78816) |
$8,505 |
$9,450 |
4.8× |
| PET imaging CT attenuation skull base mid-thigh (78815) |
$7,290 |
$8,100 |
4.1× |
| Pet Imaging Limited Area Chest Head/Neck (78811) |
$3,888 |
$4,320 |
2.4× |
| Pet Myocardial Sngl Study (78491) |
$4,617 |
$5,130 |
2.6× |
| PET whole body (78813) |
$4,131 |
$4,590 |
2.3× |
| Plasma Vol Radiopharm Vol Dilute Spx Mult Smples (78111) |
$3,280.50 |
$3,645 |
2.0× |
| Platelet survival study Non-Facility (78191) |
$1,647 |
$1,830 |
3.3× |
| Prq Transhepatc Portograpy Hemodyn Eval Rs&I (75885) |
$6,075 |
$6,750 |
1.5× |
| Pulmonary Perfusion Imaging Particulate (78580) |
$1,458 |
$1,620 |
2.9× |
| Radex Abd Compl Aqt Abd W/S/E/D Views 1 View Ch (74022) |
$567 |
$630 |
4.3× |
| Radex abscess/fistula/sinus tract rs&i (76080) |
$1,035 |
$1,150 |
1.5× |
| Radex Ankle Complete Minimum 3 Views (73610) |
$540 |
$600 |
5.0× |
| Radex Calcaneus Minimum 2 Views (73650) |
$432 |
$480 |
4.0× |
| Radex elbow complete minimum 3 views (73080) |
$495 |
$550 |
4.6× |
| Radex Facial Bones Complete Minimum 3 Views (70150) |
$540 |
$600 |
4.1× |
| Radex fingr minimum 2 views (73140) |
$418.50 |
$465 |
3.9× |
| Radex foot complete minimum 3 views (73630) |
$585 |
$650 |
5.4× |
| Radex Hand Minimum 3 Views (73130) |
$630 |
$700 |
5.8× |
| Radex lower extremity infant minimum 2 views (73592) |
$355.50 |
$395 |
3.3× |
| Radex Mastoids Compl Minimum 3 Views PR Side (70130) |
$477 |
$530 |
3.7× |
| Radex Nasal Bones Complete Minimum 3 Views (70160) |
$400.50 |
$445 |
3.7× |
| Radex Pharynx/Larx W/Fluor&/Magnification Tq (70370) |
$414 |
$460 |
3.8× |
| Radex Ribs Unilateral 2 Views (71100) |
$396 |
$440 |
3.6× |
| Radex shoulder complete minimum 2 views (73030) |
$576 |
$640 |
5.3× |
| Radex Sinuses Paransl < 3 Views (70210) |
$342 |
$380 |
3.1× |
| Radex sm int w/mlt srl imges via enteroclss tube (74251) |
$1,080 |
$1,200 |
4.9× |
| Radex Spine 1 View Specify Level (72020) |
$306 |
$340 |
2.8× |
| Radex Sternum Minimum 2 Views (71120) |
$360 |
$400 |
3.3× |
| Radex Temporomandble Jt Opn & Clsd Mouth Bilat (70330) |
$729 |
$810 |
6.7× |
| Radex Toe Minimum 2 Views (73660) |
$540 |
$600 |
5.0× |
| Radex upper extremity infant minimum 2 views (73092) |
$477 |
$530 |
3.7× |
| Radex Wrist Complete Minimum 3 Views (73110) |
$585 |
$650 |
5.4× |
| Radex X-Ray Exam Entire Spi 6/> Vw - Xr Entire Spine 6+ Vw (72084) |
$850.50 |
$945 |
6.5× |
| Radiation Delivery Stereotactic Cranial Linear (77372) |
$46,800 |
$52,000 |
5.1× |
| Radiation treatment delivery level 1 (77402) |
$1,260 |
$1,400 |
9.9× |
| Radiation treatment delivery level 2 (77407) |
$1,800 |
$2,000 |
3.7× |
| Radiation treatment delivery level 3 (77412) |
$4,140 |
$4,600 |
6.0× |
| Radiolog exam mandible compl minimum 4 views (70110) |
$463.50 |
$515 |
3.6× |
| Radiologic Exam Abdomen 3+ Views - Xr Abdomen 3+ Views (74021) |
$630 |
$700 |
4.8× |
| Radiologic exam colon double contrast study (74280) |
$1,260 |
$1,400 |
5.8× |
| Radiologic exam colon single contrast study (74270) |
$837 |
$930 |
3.8× |
| Radiologic Exam Esophagus Double Contrast Study (74221) |
$886.50 |
$985 |
4.0× |
| Radiologic exam knee complete 4/more views (73564) |
$972 |
$1,080 |
7.4× |
| Radiologic exam pelvis compl minimum 3 views (72190) |
$571.50 |
$635 |
4.4× |
| Radiologic Exam Small Int Single Contrast Study (74250) |
$810 |
$900 |
3.7× |
| Radiologic exam swallow function contrast study (74230) |
$783 |
$870 |
3.6× |
| Radiologic exam teeth complete full mouth (70320) |
$607.50 |
$675 |
2.0× |
| Radiologic Exam Teeth Prtl Exam < Full Mouth (70310) |
$607.50 |
$675 |
2.0× |
| Radiologic exam upr gi trc double contrast study (74246) |
$1,579.50 |
$1,755 |
7.2× |
| Radiologic examination femur 1 view (73551) |
$279 |
$310 |
2.6× |
| Radiologic examination femur minimum 2 views (73552) |
$360 |
$400 |
3.3× |
| Radiologic examination knee 1/2 views (73560) |
$427.50 |
$475 |
3.9× |
| Radiologic Examination Osseous Survey Limited (77074) |
$477 |
$530 |
3.7× |
| Radiologic Examination Salivary Gland Calculus (70380) |
$220.50 |
$245 |
2.0× |
| Radiologic examination tibia & fibula 2 views (73590) |
$661.50 |
$735 |
6.1× |
| Radiologic examination, internal auditory meati, complete Non-Facility (70134) |
$1,093.50 |
$1,215 |
1.6× |
| Radiologic examination, teeth; single view Non-Facility (70300) |
$342 |
$380 |
3.1× |
| Radiopharm Dacryocystography (78660) |
$1,458 |
$1,620 |
2.9× |
| Radiopharmaceutical therapy, by intracavitary administration Non-Facility (79200) |
$1,890 |
$2,100 |
6.5× |
| Red Cell Volume Determination Spx 1 Sampling (78120) |
$1,458 |
$1,620 |
2.9× |
| Red Cell Volume Determination Spx Mult Samplings (78121) |
$1,701 |
$1,890 |
2.5× |
| Remote afterloading high dose rate radionuclide skin surface brachytherapy, includes basic dosimetry, when performed;… (77768) |
$7,200 |
$8,000 |
15.0× |
| Remote afterloading high dose rate radionuclide skin surface brachytherapy, includes basic dosimetry, when performed;… (77767) |
$6,210 |
$6,900 |
12.9× |
| Renal Cyst Study (74470) |
$1,579.50 |
$1,755 |
2.3× |
| Ribs bilateral 3 views (71110) |
$562.50 |
$625 |
4.3× |
| Rp loclzj tum plnr 1 area single day imaging (78800) |
$1,705.50 |
$1,895 |
3.4× |
| Rp loclzj tum plnr 2+area 1+d img/1 area img>2+d (78801) |
$1,773 |
$1,970 |
3.6× |
| Rp Loclzj Tum Plnr Whole Body 2+ Days Imaging (78804) |
$5,467.50 |
$6,075 |
8.1× |
| Rp Loclzj Tum Plnr Whole Body Single Day Imaging (78802) |
$4,252.50 |
$4,725 |
6.3× |
| Rp Loclzj Tum Spect 1 Area Single Day Imaging (78803) |
$4,252.50 |
$4,725 |
6.3× |
| Rp loclzj tum spect 2 area/sep acquisj img (78831) |
$5,467.50 |
$6,075 |
3.4× |
| Rp loclzj tum spect CT 2area 1d img/1 ar img>2+d (78832) |
$6,318 |
$7,020 |
3.5× |
| Rp loclzj tum spect w/CT 1 area/acquisj 1day img (78830) |
$4,860 |
$5,400 |
3.0× |
| Rp Ther Radiolbld Monoclonal Antibody IV Infus (79403) |
$1,885.50 |
$2,095 |
6.5× |
| Rp Therapy Intravenous Administration (79101) |
$2,065.50 |
$2,295 |
7.1× |
| Salivary Gland Function Study (78232) |
$1,458 |
$1,620 |
2.9× |
| Salivary Gland Imaging (78230) |
$1,458 |
$1,620 |
2.9× |
| Salivary Gland Imaging Serial Images (78231) |
$1,458 |
$1,620 |
2.9× |
| Scapula (73010) |
$477 |
$530 |
3.7× |
| Screening Digital Breast Tomosynthesis Bi (77063) |
$315 |
$350 |
13.5× |
| Sella turcica (70240) |
$342 |
$380 |
3.1× |
| Shoulder 1 view (73020) |
$355.50 |
$395 |
3.3× |
| Shoulder Arthrography (73040) |
$1,093.50 |
$1,215 |
2.5× |
| Sialogram (70390) |
$657 |
$730 |
2.2× |
| Skull less than 4 views (70250) |
$490.50 |
$545 |
3.8× |
| Special dosimetry (77331) |
$1,440 |
$1,600 |
8.6× |
Special Physics Consult (77370)
range across 3 matching MRF lines |
$2,250–$2,655 |
$2,500–$2,950 |
varies |
| Special teletherapy port plan (77321) |
$3,690 |
$4,100 |
7.9× |
| Special treatment procedure (77470) |
$5,400 |
$6,000 |
7.8× |
| Speech evaluation, complex (70371) |
$657 |
$730 |
2.2× |
| Spleen Imaging (78185) |
$1,647 |
$1,830 |
3.3× |
| Srs Multisource (77371) |
$123,298.20 |
$136,998 |
13.4× |
| Stereotactic Body Radiation Delivery (77373) |
$24,300 |
$27,000 |
10.9× |
| Sternoclavicular joints (71130) |
$355.50 |
$395 |
3.3× |
| Superior sagittal sinus venogram (75870) |
$4,950 |
$5,500 |
1.3× |
| Tbs technical calculation only (77091) |
$355.50 |
$395 |
3.3× |
| Telethx isodose pln cplx w/basic dosimetry (77307) |
$2,970 |
$3,300 |
6.4× |
| Telethx isodose pln smpl w/dosimetry calculation (77306) |
$1,620 |
$1,800 |
3.5× |
| Temporomandble Jt Arthrography Rs&I (70332) |
$828 |
$920 |
2.8× |
| Testicular Imaging W/Flow (78761) |
$1,458 |
$1,620 |
2.9× |
| Ther Rad Simulaj-Aided Field Setting Complex (77290) |
$6,417 |
$7,130 |
13.7× |
| Ther Rad Simulaj-Aided Field Setting Intermed (77285) |
$4,495.50 |
$4,995 |
9.6× |
| Ther rad simulaj-aided field setting simple (77280) |
$3,474 |
$3,860 |
20.7× |
| Therapeutic Enema Rdctj Intussusception/Obstrcj (74283) |
$900 |
$1,000 |
4.1× |
| Thoracic spine 2 views (72070) |
$558 |
$620 |
4.3× |
| Thoracic spine 3 views (72072) |
$630 |
$700 |
4.8× |
| Thoracolumbar 2 views (72080) |
$589.50 |
$655 |
5.4× |
| Thyroid Imaging With Vascular Flow (78013) |
$1,647 |
$1,830 |
3.3× |
| Thyroid Met Imaging Body (78018) |
$3,600 |
$4,000 |
5.3× |
| Thyroid Uptake Measurement (78012) |
$1,215 |
$1,350 |
2.4× |
| Thyroid Uptake W/Blood Flow Sngle/Mult Quan Meas (78014) |
$2,079 |
$2,310 |
4.2× |
| Tx Devices Design & Construction Complex (77334) |
$3,690 |
$4,100 |
7.9× |
| Tx devices design & construction intermediate (77333) |
$2,790 |
$3,100 |
16.6× |
| Tx devices design & construction simple (77332) |
$2,160 |
$2,400 |
12.9× |
| Ultrasound Breast Limited (76642) |
$450 |
$500 |
4.1× |
| Ultrasound elastography first target lesion (76982) |
$544.50 |
$605 |
4.2× |
| Ultrasound Elastography Parenchyma (76981) |
$634.50 |
$705 |
4.9× |
| Ultrasound Exam Aaa Screen (76706) |
$765 |
$850 |
5.9× |
| Ultrasound trgt dynamic microbubble 1st lesion (76978) |
$783 |
$870 |
1.8× |
| Ultrasound, abdomen limited (76705) |
$900 |
$1,000 |
6.9× |
| Umbilical-artery Doppler (OB) (76820) |
$549 |
$610 |
4.2× |
Unlisted Dx Radiographic Procedure (76499)
range across 3 matching MRF lines |
$162–$225 |
$180–$250 |
varies |
| Unlisted fluoroscopic procedure (76496) |
$1,800 |
$2,000 |
16.6× |
| Unlisted hematopoietic, reticuloendothelial and lymphatic procedure, diagnostic nuclear medicine (78199) |
$1,080 |
$1,200 |
2.2× |
| Unlisted magnetic resonance procedure (76498) |
$990 |
$1,100 |
9.1× |
Unlisted Procedure Clinical Brachytherapy (77799)
range across 3 matching MRF lines |
$2,340–$2,610 |
$2,600–$2,900 |
varies |
| Unlisted respiratory px dx nuclear medicine (78599) |
$202.50 |
$225 |
0.4× |
Unlisted us procedure (76999)
range across 4 matching MRF lines |
$720–$925.20 |
$800–$1,028 |
varies |
| Upper gi w/o kub (74240) |
$1,260 |
$1,400 |
5.8× |
| Urea Breath Test C-14 Isotopic Acquisj Analysis (78267) |
$58.50 |
$65 |
5.3× |
| Urea breath test c-14 isotopic analysis (78268) |
$2,070 |
$2,300 |
21.9× |
| Ureteral Reflux Study (78740) |
$1,336.50 |
$1,485 |
2.7× |
| Urethrocystogram voiding (74455) |
$1,003.50 |
$1,115 |
3.4× |
| Urethrocystography retrograde (74450) |
$850.50 |
$945 |
2.9× |
| Us breast unilateral complete (76641) |
$666 |
$740 |
5.1× |
| Us chest (76604) |
$684 |
$760 |
5.2× |
| Us complete joint (76881) |
$634.50 |
$705 |
4.9× |
| Us exam, pelvic, limited (76857) |
$526.50 |
$585 |
4.0× |
| Us head (76506) |
$855 |
$950 |
6.6× |
| Us kidney transplant (76776) |
$675 |
$750 |
5.2× |
| Us lmtd joint/oth nonvasc xtr strux r-t w/img (76882) |
$486 |
$540 |
3.7× |
| Us ob detailed single fetus (76811) |
$1,314 |
$1,460 |
4.4× |
| Us ob limited 1 or more fetuses (76815) |
$729 |
$810 |
5.6× |
| Us ob transvaginal (76817) |
$720 |
$800 |
5.5× |
| Us pelvic non ob complete (76856) |
$1,336.50 |
$1,485 |
10.2× |
| Us pg uter img f&mat 14 wk tabdl 1/1st gestation (76801) |
$720 |
$800 |
5.5× |
| Us preg uterus real time f/u trnsabdl per fetus (76816) |
$720 |
$800 |
5.5× |
| Us retroperitoneal complete (76770) |
$1,215 |
$1,350 |
9.3× |
| Us retroperitoneal limited (76775) |
$1,057.50 |
$1,175 |
8.1× |
| Us scrotum and contents (76870) |
$1,336.50 |
$1,485 |
10.2× |
| Us spinal canal and contents (76800) |
$576 |
$640 |
4.4× |
| Us thyroid (76536) |
$1,449 |
$1,610 |
11.1× |
| Us transrectal (76872) |
$1,215 |
$1,350 |
9.3× |
| Vascular Flow Imaging (78445) |
$1,579.50 |
$1,755 |
3.2× |
| Vasogram (74440) |
$850.50 |
$945 |
2.9× |
| Vein X-Ray Chest (75827) |
$2,673 |
$2,970 |
1.4× |
| Vein X-Ray Liver W/O Hemodyn (75887) |
$5,589 |
$6,210 |
1.4× |
| Vein X-Ray Skull Epidural (75872) |
$2,187 |
$2,430 |
2.8× |
| Vein X-Ray Spleen/Liver (75810) |
$4,981.50 |
$5,535 |
1.3× |
| Venogram Sinus/Jugular (75860) |
$4,950 |
$5,500 |
1.3× |
| Venography Adrenal Unilateral (75840) |
$5,832 |
$6,480 |
1.5× |
| Venography caval inferior serialography rs&i (75825) |
$4,590 |
$5,100 |
1.2× |
| Venography extremity bilateral rs&i (75822) |
$3,240 |
$3,600 |
1.6× |
| Venography extremity unilateral rs&i (75820) |
$2,880 |
$3,200 |
1.5× |
| Venography Orbital Rs&I (75880) |
$2,187 |
$2,430 |
2.8× |
| Venography Renal Bilateral (75833) |
$6,300 |
$7,000 |
1.6× |
| Venography Renal Unilateral (75831) |
$5,832 |
$6,480 |
1.5× |
| Venous sampling by catheter (75893) |
$8,100 |
$9,000 |
1.2× |
| Venous thrombosis imaging (78457) |
$2,160 |
$2,400 |
3.2× |
| Venous Thrombosis Imaging Venogram Bilateral (78458) |
$2,430 |
$2,700 |
4.9× |
| Vertebral fracture assessment via dxa (77086) |
$355.50 |
$395 |
3.3× |
| Wrist 2 views (73100) |
$432 |
$480 |
4.0× |
| X-Ray Ac Jts - Xr Acromioclavicular Joints Bilateral (73050) |
$522 |
$580 |
4.8× |
| X-ray antegrade pyelogram tube (74425) |
$1,458 |
$1,620 |
3.3× |
| X-Ray Aorta Leg Arteries (75630) |
$4,770 |
$5,300 |
1.2× |
| X-Ray Bend Only L-S Spine (72120) |
$814.50 |
$905 |
6.2× |
| X-Ray Elbow 2 Vw - Xr Elbow 1-2 Views Right (73070) |
$360 |
$400 |
3.3× |
| X-Ray Exam Breast Specimen (76098) |
$1,170 |
$1,300 |
1.7× |
| X-Ray Exam Entire Spi 1 Vw (72081) |
$315 |
$350 |
2.9× |
| X-Ray Exam Entire Spi 2/3 Vw (72082) |
$477 |
$530 |
3.7× |
| X-Ray Exam Entire Spi 4/5 Vw (72083) |
$630 |
$700 |
4.8× |
| X-Ray Exam Hip Uni 1 View (73501) |
$355.50 |
$395 |
3.3× |
| X-Ray Exam Hip Uni 2-3 Views (73502) |
$391.50 |
$435 |
3.6× |
| X-Ray Exam Hip Uni 4/> Views (73503) |
$477 |
$530 |
3.7× |
| X-Ray Exam Hips Bi 2 Views (73521) |
$477 |
$530 |
3.7× |
| X-Ray Exam Hips Bi 3-4 Views (73522) |
$540 |
$600 |
4.1× |
| X-Ray Exam Hips Bi 5/> Views (73523) |
$720 |
$800 |
5.5× |
| X-Ray Exam L-S Spine Bending (72114) |
$1,044 |
$1,160 |
8.0× |
| X-Ray Exam Neck Spine 2-3 Vw (72040) |
$486 |
$540 |
4.5× |
| X-Ray Exam Neck Spine 6/>Vws (72052) |
$1,215 |
$1,350 |
9.3× |
| X-Ray Exam Unilat Ribs/Chest (71101) |
$477 |
$530 |
3.7× |
| X-ray eye for foreign body (70030) |
$306 |
$340 |
2.8× |
| X-ray head for orthodontia (70350) |
$355.50 |
$395 |
3.3× |
| X-ray humerus (73060) |
$409.50 |
$455 |
3.8× |
| X-ray IV pyelogram (ivp) (74400) |
$783 |
$870 |
3.6× |
| X-ray IV pyelogram+tomography (74415) |
$846 |
$940 |
3.9× |
| X-Ray Jaw <4 Vw - Xr Mandible < 4 Views (70100) |
$342 |
$380 |
3.1× |
| X-Ray Knee Bilat Standing - Xr Knees Anteroposterior Standing Bilat (73565) |
$675 |
$750 |
6.2× |
| X-Ray Lumbar Spine 2/3 Vw - Xr Lumbar Spine 2-3 Views (72100) |
$580.50 |
$645 |
4.4× |
| X-ray nose-rectum child f.b. (76010) |
$265.50 |
$295 |
2.4× |
| X-Ray Ribs, Chest 4+ Vw - Xr Ribs 3 Vws Bil W/ Chest Posteroanterior (71111) |
$715.50 |
$795 |
5.5× |
| X-Ray Sacroiliac Jts 3+ Vw - Xr Sacroiliac Joints 3+ Views (72202) |
$562.50 |
$625 |
4.3× |
| X-Ray Sacroiliac Jts <3 Vw - Xr Sacroiliac Joints 1-2 Views (72200) |
$481.50 |
$535 |
3.7× |
| X-Ray Sacrum/Coccyx 2+ Vw - Xr Sacrum Coccyx 2+ Views (72220) |
$405 |
$450 |
3.7× |
| X-Ray Sinuses 3+ Vw - Xr Paranasal Sinuses 3+ Views (70220) |
$396 |
$440 |
3.6× |
| X-Ray Skull 4+ Vw - Xr Skull Complete 4+ Views (70260) |
$670.50 |
$745 |
5.1× |
| X-Ray Stress View (77071) |
$306 |
$340 |
2.8× |
| X-ray thoracic spine 4 vw (72074) |
$787.50 |
$875 |
6.0× |
| X-Ray Tmj Unilat (70328) |
$360 |
$400 |
3.3× |
| X-Ray Urinary Tract Exam With Contrast Material (74420) |
$1,458 |
$1,620 |
3.3× |
| X-Rays Bone Length Studies (77073) |
$607.50 |
$675 |
4.7× |
| X-Rays Bone Survey Complete (77075) |
$1,071 |
$1,190 |
8.2× |
| Xr c-spine 4 or 5 views (72050) |
$1,093.50 |
$1,215 |
8.4× |
| Xr facial bones less than 3 views (70140) |
$342 |
$380 |
3.1× |
| XR Mastoids < 3 Views Bilateral (70120) |
$342 |
$380 |
2.6× |
| Xr myelogram posterior fossa (70010) |
$1,336.50 |
$1,485 |
3.1× |
| Xr orbits complete 4 views (70200) |
$400.50 |
$445 |
3.1× |
| Xr Tomogram Single Plane (76100) |
$387 |
$430 |
3.0× |