| 3-D radiotherapy plan dose-volume histograms (77295) |
$1,495.36 |
$4,673 |
1.2× |
| Abdomen 2 views (74019) |
$60.48 |
$189 |
0.6× |
| Acute gastrointestinal blood loss imaging (78278) |
$273.28 |
$854 |
0.8× |
| Angiography extremity bilateral rs&i (75716) |
$1,053.12 |
$3,291 |
0.4× |
| Angiography extremity unilateral rs&i (75710) |
$1,053.12 |
$3,291 |
0.4× |
| Angiography internal mammary rs&i (75756) |
$1,053.12 |
$3,291 |
0.4× |
Angiography pelvic slctv/supraslctv rs&i (75736)
unusually low: confirm this is the full procedure |
$1,746.56 |
$5,458 |
0.3× |
| Angiography pulmonary bilateral slctv rs&i (75743) |
$1,053.12 |
$3,291 |
0.4× |
| Angiography pulmonary unilateral slctv rs&i (75741) |
$1,053.12 |
$3,291 |
0.4× |
Angiography Spinal Selective Rs&I (75705)
unusually low: confirm this is the full procedure |
$1,746.56 |
$5,458 |
0.3× |
Angiography visceral slctv/supraslctv rs&i (75726)
unusually low: confirm this is the full procedure |
$1,746.56 |
$5,458 |
0.3× |
| Angrph Cath F-Up Std Tcat Other Than Thrombylsis (75898) |
$620.16 |
$1,938 |
0.2× |
| Angrph pulmonary nonslctv cath/ven njx rs&i (75746) |
$677.44 |
$2,117 |
0.2× |
| Ankle 2 views (73600) |
$72 |
$225 |
0.9× |
| Antegrade urography radiological supvj & interpj (74425) |
$145.60 |
$455 |
0.5× |
Aortogram thoracic (75605)
unusually low: confirm this is the full procedure |
$1,746.56 |
$5,458 |
0.3× |
| Aortography abdl bi iliofem low extrem cath rs&i (75630) |
$1,053.12 |
$3,291 |
0.4× |
| Aortography abdominal serialography rs&i (75625) |
$1,053.12 |
$3,291 |
0.4× |
| Artery X-Rays Adrenal Gland (75731) |
$682.88 |
$2,134 |
0.2× |
| Arthrogram elbow (73085) |
$195.84 |
$612 |
0.6× |
| Arthrogram hip (73525) |
$130.88 |
$409 |
0.4× |
| Arthrogram shoulder (73040) |
$306.72 |
$958.50 |
1.0× |
| Arthrogram wrist (73115) |
$145.60 |
$455 |
0.5× |
| Arthrography knee lt (73580) |
$185.76 |
$580.50 |
0.6× |
| Basic radiation dosimetry calculation (77300) |
$82.56 |
$258 |
0.7× |
| Bone &/Joint Imaging Limited Area (78300) |
$137.60 |
$430 |
0.4× |
| Bone &/Joint Imaging Multiple Areas (78305) |
$194.56 |
$608 |
0.5× |
| Bone &/joint imaging whole body (78306) |
$223.68 |
$699 |
0.6× |
| Bone age studies (77072) |
$42.88 |
$134 |
0.5× |
| Bone Imaging 3 Phase (78315) |
$270.08 |
$844 |
0.7× |
| Bone Marrow Imaging Limited Area (78102) |
$121.28 |
$379 |
0.3× |
| Bone survey complete (77075) |
$103.68 |
$324 |
1.1× |
| Brachytx isodose complex (77318) |
$318.72 |
$996 |
0.9× |
| Brachytx isodose intermed (77317) |
$231.04 |
$722 |
0.7× |
| Brachytx isodose pln smpl w/dosimetry cal (77316) |
$160.32 |
$501 |
0.5× |
| Brain image w/flow 4 + views (78606) |
$237.44 |
$742 |
0.5× |
| Brain Imaging Pet Metabolic Evaluation (78608) |
$1,011.20 |
$3,160 |
0.8× |
| Brain Imaging Vascular Flow Only (78610) |
$179.52 |
$561 |
0.4× |
| Breath Test,Acquire/Analyze - Nm Breath Test Acquire Analyze (78267) |
$18.24 |
$57 |
1.6× |
| Card Bl Pool Gated Spect Rest Wal Motn Ejct Frct (78494) |
$437.12 |
$1,366 |
1.2× |
| Cardiac MRI w/w/o contrast & further seq (75561) |
$722.88 |
$2,259 |
2.3× |
| Cardiac shunt detection (78428) |
$142.08 |
$444 |
0.4× |
| Cerebrospinal Fluid Flow W/O Matl Shunt Evaltj (78645) |
$219.84 |
$687 |
0.4× |
| Cervical spine 2 or 3 views (72040) |
$62.08 |
$194 |
0.8× |
| Chest 1 view (71045) |
$43.20 |
$135 |
0.5× |
| Chest 3 views (71047) |
$59.52 |
$186 |
0.8× |
| Cine/Vid X-Ray Throat/Esoph - Fl Esoph Barium Swlw W/ Video & Speech (74230) |
$137.60 |
$430 |
0.9× |
| Cineradiography/videoradiography (76120) |
$79.36 |
$248 |
0.8× |
| Clavicle complete (73000) |
$74.40 |
$232.50 |
0.9× |
| Computed Tomography Thorax Lw Dose Lng Ca Scr C- (71271) |
$68.80 |
$215 |
0.7× |
| Continuing medical physics consltj pr wk (77336) |
$167.68 |
$524 |
1.4× |
| Contrast Xray Throat/Cerv Esopha - Fl Esophagus Pharynx (74210) |
$125.44 |
$392 |
0.8× |
| Corpora cavernosography (74445) |
$74.24 |
$232 |
0.8× |
| CT abdomen and pelvis without and with contrast (74178) |
$578.88 |
$1,809 |
1.8× |
| CT abdomen and pelvis without contrast (74176) |
$370.88 |
$1,159 |
1.7× |
| CT abdomen w contrast (74160) |
$326.08 |
$1,019 |
2.1× |
| CT abdomen w wo contrast (74170) |
$385.92 |
$1,206 |
2.4× |
| CT abdomen w/o contrast (74150) |
$247.36 |
$773 |
2.6× |
| CT angio hrt w/3d image (75574) |
$344.96 |
$1,078 |
1.1× |
| CT angiography upper extremity lt (73206) |
$386.56 |
$1,208 |
2.4× |
| CT c-spine w/o contrast (72125) |
$246.72 |
$771 |
2.6× |
| CT cervical spine w&w/o contrast (72127) |
$386.88 |
$1,209 |
2.4× |
| CT cervical spine with contrast (72126) |
$326.08 |
$1,019 |
1.0× |
| CT chest w/wo contrast (71270) |
$386.88 |
$1,209 |
2.4× |
| CT chest with contrast (71260) |
$326.08 |
$1,019 |
2.1× |
| CT colonography screening (74263) |
$755.20 |
$2,360 |
3.5× |
| CT colonography w/dye (74262) |
$380.48 |
$1,189 |
2.4× |
| CT colonography w/o cntrst (74261) |
$250.24 |
$782 |
2.6× |
| CT head/brain with contrast (70460) |
$280.64 |
$877 |
1.8× |
| CT head/brain without and with contrast (70470) |
$348.48 |
$1,089 |
2.2× |
| CT heart contrast eval cardiac structure&morph (75572) |
$228.16 |
$713 |
0.7× |
| CT heart no contrast quant eval coronry calcium (75571) |
$58.24 |
$182 |
0.7× |
| CT hrt w/3d image congen (75573) |
$322.56 |
$1,008 |
1.0× |
| CT iac w contrast (70481) |
$318.08 |
$994 |
2.0× |
| CT limited/localized follow up study (76380) |
$122.56 |
$383 |
1.6× |
| CT lower ext w/o (73700) |
$369.60 |
$1,155 |
3.9× |
| CT lower extremity w wo contrast (73702) |
$578.88 |
$1,809 |
3.6× |
| CT lower extremity with contrast (73701) |
$458.40 |
$1,432.50 |
2.9× |
| CT lumbar spine w & w/o contrast (72133) |
$386.24 |
$1,207 |
2.4× |
| CT lumbar spine w/o contrast (72131) |
$246.72 |
$771 |
2.6× |
| CT lumbar spine with contrast (72132) |
$326.08 |
$1,019 |
1.0× |
| CT maxillofacial w contrast (70487) |
$300.48 |
$939 |
1.9× |
| CT maxillofacial w/o contrast (70486) |
$247.04 |
$772 |
2.6× |
| CT maxillofacial w/wo contrast (70488) |
$375.36 |
$1,173 |
2.4× |
| CT neck soft tissue w contrast (70491) |
$296.64 |
$927 |
1.9× |
| CT orbit sella/post fossa/ear w/o & w/contr matr (70482) |
$385.92 |
$1,206 |
2.4× |
| CT orbits w/o contrast (70480) |
$246.72 |
$771 |
2.6× |
| CT pelvis w & w/o contrast (72194) |
$386.24 |
$1,207 |
2.4× |
| CT pelvis w/o contrast (72192) |
$247.36 |
$773 |
2.6× |
| CT scan for measuring calcium and other minerals in bone (77078) |
$94.08 |
$294 |
1.2× |
| CT soft tissue neck w/o & w/contrast material (70492) |
$371.52 |
$1,161 |
2.3× |
| CT soft tissue neck w/o contrast (70490) |
$244.48 |
$764 |
2.6× |
| CT thoracic spine w/contrast (72129) |
$326.08 |
$1,019 |
2.1× |
| CT thoracic spine w/o contrast (72128) |
$246.72 |
$771 |
2.6× |
| CT thoracic spine w/wo contrast (72130) |
$386.88 |
$1,209 |
2.4× |
| CT thorax w/o contrast (71250) |
$246.72 |
$771 |
2.6× |
| CT unlisted procedure (76497) |
$122.56 |
$383 |
1.6× |
| CT upper extremity w/o & w/contrast material (73202) |
$578.88 |
$1,809 |
3.6× |
| CT upper extremity w/o contrast rt (73200) |
$369.60 |
$1,155 |
3.9× |
| CT upper extremity with contrast (73201) |
$456.96 |
$1,428 |
1.4× |
| Cta Abdl Aorta&Bi Iliofem W/Contrast&Postp (75635) |
$385.60 |
$1,205 |
2.4× |
| Cta Abdomen (74175) |
$386.24 |
$1,207 |
2.4× |
| CTA abdomen pelvis (74174) |
$619.84 |
$1,937 |
2.0× |
| CTA chest (71275) |
$385.92 |
$1,206 |
2.4× |
| Cta Head (70496) |
$387.52 |
$1,211 |
2.4× |
| CTA lwr ext w&w/o contrast (73706) |
$579.36 |
$1,810.50 |
3.6× |
| Cta Neck (70498) |
$387.52 |
$1,211 |
2.4× |
| Cta Pelvis (72191) |
$386.24 |
$1,207 |
2.4× |
| Cystography minimum 3 views rs&i (74430) |
$145.60 |
$455 |
0.5× |
| Dacryocystography (70170) |
$88.96 |
$278 |
0.4× |
| Diskogram cervical (72285) |
$655.68 |
$2,049 |
0.4× |
| Diskography lumbar (72295) |
$616.96 |
$1,928 |
0.3× |
| Doppler Echo Fetal Puls Spectral F/U/Repeat (76828) |
$48.64 |
$152 |
0.5× |
| Doppler Echo Fetal Spectral Display Complete (76827) |
$77.12 |
$241 |
0.8× |
| Doppler Fetal Mid Cerebral Artery (76821) |
$81.92 |
$256 |
0.9× |
| Dx ophthalmic us ant segment immersion uni/bi (76513) |
$51.36 |
$160.50 |
0.5× |
| Dxa bone density study 1/> sites axial skel (77080) |
$96 |
$300 |
1.0× |
| Dxa bone density study 1/>sites appendiclr skel (77081) |
$52.16 |
$163 |
0.7× |
| Dxa bone density study axial skeleton (77085) |
$96 |
$300 |
1.0× |
| Echo exam of eye (76529) |
$55.04 |
$172 |
0.7× |
| Echo exam of fetal heart (76825) |
$183.04 |
$572 |
0.4× |
| Echo fetal cardiovasc w/wo m-mode repeat std (76826) |
$88.96 |
$278 |
0.4× |
| Echoencephalography real time imaging (76506) |
$106.24 |
$332 |
1.1× |
| Esophageal motility (78258) |
$169.60 |
$530 |
0.5× |
| Esophagus (74220) |
$129.92 |
$406 |
0.8× |
| Fetal biophysical profile non-stress testing (76818) |
$83.20 |
$260 |
0.9× |
| Fetal Biophysical Profile W/O Non-Stress Testing (76819) |
$77.76 |
$243 |
0.8× |
| Fluoroscopy up to 1 hr (76000) |
$105.92 |
$331 |
0.5× |
| Foot 2 views (73620) |
$72 |
$225 |
0.9× |
| Forearm 2 views (73090) |
$74.40 |
$232.50 |
0.9× |
| Functional MRI brain by phys/psych (70555) |
$290.88 |
$909 |
1.3× |
| Functional MRI brain by tech (70554) |
$642.56 |
$2,008 |
3.0× |
| Gastric emptying imaging study (eg, solid, liquid, or both); with small bowel and colon transit, multiple days Age… (78266) |
$575.04 |
$1,797 |
1.2× |
| Gated Heart Planar Single (78472) |
$272.64 |
$852 |
0.8× |
| Hand 2 views (73120) |
$72 |
$225 |
0.8× |
| Hand 3 views (73130) |
$78.72 |
$246 |
1.0× |
| Hdr rdncl ntrstl/intrcav brachytx 1 channel (77770) |
$389.12 |
$1,216 |
0.6× |
| Hdr rdncl ntrstl/intrcav brachytx 2-12 channel (77771) |
$708.48 |
$2,214 |
1.1× |
| Hdr rdncl ntrstl/intrcav brachytx >12 channels (77772) |
$1,118.40 |
$3,495 |
1.8× |
| Hdr rdncl sk srf brchytx les >2cm&2chan/mlt les (77768) |
$494.40 |
$1,545 |
1.4× |
| Hdr rdncl skn surf brachytx les </2cm/1 chan (77767) |
$300.80 |
$940 |
0.9× |
| Heart Infarct Image (78466) |
$128.64 |
$402 |
0.4× |
| Hepatc vngrph wdg/fr w/o hemodyn eval rs&i (75891) |
$1,053.12 |
$3,291 |
0.4× |
| Hepatobil Syst Imag Inc Gb W/Pharma Intervenj (78227) |
$549.76 |
$1,718 |
1.1× |
| Hepatobiliary syst imaging including gallbladder (78226) |
$398.72 |
$1,246 |
1.1× |
| Ht muscle image spect sing (78451) |
$483.84 |
$1,512 |
0.4× |
| Humerus Min 2 Views Left (73060) |
$55.68 |
$174 |
0.7× |
| Hysterosalpingogram (74740) |
$90.24 |
$282 |
0.4× |
| Interstitial radiation source applic complex (77778) |
$375.04 |
$1,172 |
0.6× |
| Intracavitary Radiation Source Applic Complex (77763) |
$341.12 |
$1,066 |
0.5× |
| Intracavitary Radiation Source Applic Intermed (77762) |
$270.40 |
$845 |
0.5× |
| Intracavitary radiation source applic simple (77761) |
$204.48 |
$639 |
0.4× |
| Joint Survey, Single View - Xr Joint Anteroposterior 2+ Joints (77077) |
$64.64 |
$202 |
0.7× |
| Kidney funcj study non-img radioisotopic study (78725) |
$140.16 |
$438 |
0.4× |
| Kidney imaging morphology (78700) |
$162.88 |
$509 |
0.4× |
| Kidney Img Morphology Vascular Flow 1 W/O Rx (78707) |
$224.64 |
$702 |
0.5× |
| Kidney img morphology vascular flow 1 w/rx (78708) |
$200.96 |
$628 |
0.4× |
| Kidney Img Morphology Vascular Flow Multiple (78709) |
$260.16 |
$813 |
0.5× |
| Knee 3 views (73562) |
$89.28 |
$279 |
1.1× |
| Liver & spleen imaging static only (78215) |
$160.64 |
$502 |
0.4× |
| Liver & Spleen Imaging W/Vascular Flow (78216) |
$159.68 |
$499 |
0.4× |
| Liver imaging static only (78201) |
$483.84 |
$1,512 |
1.0× |
| Liver imaging w/vascular flow (78202) |
$483.84 |
$1,512 |
1.0× |
| Lung perfusion differential (78597) |
$220.80 |
$690 |
0.6× |
| Lung Ventilation Imaging (78579) |
$206.08 |
$644 |
0.6× |
| Lymphangio Abd/Pelv Bilat - Ir Lymphangiogram Abdomen Pelvis Bilat (75807) |
$1,053.12 |
$3,291 |
0.4× |
| Lymphangio extrem unilat - ir lymphangiogram extremity (75801) |
$297.92 |
$931 |
0.5× |
| Lymphangiography extremity only bilateral rs&i (75803) |
$201.60 |
$630 |
0.1× |
| Lymphangiography Pelvic/Abdominal Unilat Rs&I (75805) |
$620.16 |
$1,938 |
0.2× |
| Lymphoscintigraphy (78195) |
$244.16 |
$763 |
0.5× |
| Mammary ductogram or galactogram multiple (77054) |
$181.44 |
$567 |
0.8× |
| Mammary ductogram or galactogram single (77053) |
$139.84 |
$437 |
0.6× |
| Manual appl stress pfrmd phys/qhp joint films (77071) |
$86.08 |
$269 |
1.1× |
| Meckels Diverticulum (78290) |
$204.80 |
$640 |
0.6× |
| Mlc imrt design & construction per imrt plan (77338) |
$431.04 |
$1,347 |
1.3× |
| Mr elastography (76391) |
$193.28 |
$604 |
0.9× |
| MRA head w & w/o contrast (70546) |
$644.48 |
$2,014 |
2.0× |
| MRA head w/o contrast (70544) |
$452.80 |
$1,415 |
2.1× |
| MRA head with contrast (70545) |
$488.96 |
$1,528 |
1.5× |
| MRA neck w contrast (70548) |
$488.32 |
$1,526 |
1.5× |
| Mra Neck W/O &W/Contrast Material (70549) |
$644.48 |
$2,014 |
2.0× |
| MRA neck w/o contrast (70547) |
$452.80 |
$1,415 |
2.1× |
| MRI abdomen w contrast (74182) |
$487.04 |
$1,522 |
1.5× |
| MRI abdomen w/o & w/contrast material (74183) |
$645.76 |
$2,018 |
2.0× |
| MRI abdomen w/o contrast (74181) |
$602.24 |
$1,882 |
2.8× |
| MRI any jnt lwr ext with con lt (73722) |
$730.08 |
$2,281.50 |
1.0× |
| MRI any jt upper extremity w/contrast matrl (73222) |
$731.04 |
$2,284.50 |
1.0× |
| MRI bone marrow blood supply (77084) |
$363.52 |
$1,136 |
1.7× |
| MRI breast w/o contrast bilateral (77047) |
$247.04 |
$772 |
1.1× |
| MRI breast w/o contrast unilat (77046) |
$248.64 |
$777 |
1.2× |
| MRI c-spine with contrast (72142) |
$488.64 |
$1,527 |
1.5× |
| MRI cardiac w/o cont stress (75559) |
$471.68 |
$1,474 |
1.0× |
| MRI cardiac w/o contrast (75557) |
$474.56 |
$1,483 |
2.2× |
| MRI cervical spine w/o contrast (72141) |
$453.12 |
$1,416 |
2.1× |
| MRI chest w/o & w/contrast material (71552) |
$644.16 |
$2,013 |
2.0× |
| MRI chest w/o contrast (71550) |
$451.20 |
$1,410 |
2.1× |
| MRI chest with contrast (71551) |
$487.04 |
$1,522 |
0.7× |
| MRI fetal sngl/1st gestation (74712) |
$358.08 |
$1,119 |
1.7× |
| MRI Forearm w/ Contrast Bilateral 73219 (73219) |
$730.56 |
$2,283 |
2.3× |
| MRI lower extrem oth/thn jt w/contrast matrl (73719) |
$730.08 |
$2,281.50 |
2.3× |
| MRI lower extrem oth/thn jt w/o contr matrl (73718) |
$676.80 |
$2,115 |
3.1× |
| MRI orbit face &/neck w/o contrast (70540) |
$451.20 |
$1,410 |
2.1× |
| MRI orbit/face/neck w&w/o cont (70543) |
$645.76 |
$2,018 |
2.0× |
| MRI orbit/face/neck w/contrast (70542) |
$486.72 |
$1,521 |
1.5× |
| MRI pelvis w contrast (72196) |
$487.04 |
$1,522 |
1.5× |
| MRI pelvis w/o & w/contrast material (72197) |
$645.76 |
$2,018 |
2.0× |
| MRI pelvis w/o contrast (72195) |
$451.84 |
$1,412 |
2.1× |
| MRI scan of arm joint before and after contrast (73223) |
$967.68 |
$3,024 |
3.1× |
| MRI scan of heart before and after contrast with stress imaging (75563) |
$720.96 |
$2,253 |
1.0× |
| MRI scan of leg joint before and after contrast (73723) |
$967.68 |
$3,024 |
3.1× |
| MRI spectroscopy (76390) |
$519.36 |
$1,623 |
6.6× |
| MRI spinal canal cervical w/o & w/contr matrl (72156) |
$648.96 |
$2,028 |
2.1× |
| MRI spinal canal lumbar w/contrast material (72149) |
$488.64 |
$1,527 |
1.5× |
| MRI spinal canal lumbar w/o & w/contr matrl (72158) |
$648.96 |
$2,028 |
2.1× |
| MRI spinal canal thoracic w/contrast matrl (72147) |
$489.28 |
$1,529 |
1.5× |
| MRI spinal canal thoracic w/o & w/contr matrl (72157) |
$648.96 |
$2,028 |
2.1× |
| MRI thoracic spine w/o contrast (72146) |
$452.80 |
$1,415 |
2.1× |
| MRI tmj (70336) |
$363.52 |
$1,136 |
1.7× |
| MRI upper ext joint w/o contrast (73221) |
$451.20 |
$1,410 |
2.1× |
| MRI upper extrem other than jt w/o & w/contras (73220) |
$645.76 |
$2,018 |
2.0× |
| MRI upper extremity oth than jt w/o contr matrl (73218) |
$676.80 |
$2,115 |
3.1× |
| Myelogram Cervical (72240) |
$407.04 |
$1,272 |
0.6× |
| Myelogram Lumbar (72265) |
$356.16 |
$1,113 |
0.5× |
| Myelogram thoracic (72255) |
$369.28 |
$1,154 |
0.5× |
| Myelography 2 or more regions (72270) |
$408.64 |
$1,277 |
0.6× |
| Myocardial Imaging Pet Metabolic Evaluation (78459) |
$2,640.32 |
$8,251 |
2.3× |
| Myocardial infarct spect (78469) |
$483.84 |
$1,512 |
1.0× |
| Myocardial Spect Multiple Studies (78452) |
$483.84 |
$1,512 |
0.4× |
| Myocrd img PET metab eval single study cncrnt CT (78429) |
$1,206.72 |
$3,771 |
0.9× |
| Myocrd img PET prfuj 1std rest/stress cncrnt CT (78430) |
$1,206.72 |
$3,771 |
0.9× |
| Myocrd img PET prfuj mlt std rst&strs cncrnt CT (78431) |
$1,881.60 |
$5,880 |
0.9× |
| Myocrd img PET prfuj w/metab 2rtracer cncrnt CT (78433) |
$2,299.52 |
$7,186 |
1.2× |
| Myocrd img PET prfuj w/metab dual radiotracer (78432) |
$2,299.52 |
$7,186 |
1.7× |
| Neck soft tissue (70360) |
$43.20 |
$135 |
0.5× |
| Njx Rp Loclzj Non-Img Probe Study Intravenous (78808) |
$140.16 |
$438 |
0.4× |
| Nm adrenal scan (78075) |
$483.84 |
$1,512 |
0.4× |
| Nm cisternogram (78630) |
$279.04 |
$872 |
0.6× |
| Nm csf leak detection (78650) |
$483.84 |
$1,512 |
0.4× |
| Nm gastric emptying study (78264) |
$231.36 |
$723 |
0.6× |
| Nm gastroesophageal reflux study (78262) |
$136.96 |
$428 |
0.4× |
| Nm peritoneal-venous shunt patency (78291) |
$179.84 |
$562 |
0.5× |
| Nm red cell sequestration (78140) |
$177.60 |
$555 |
0.5× |
| Ntsty modul radthx pln dose-vol histos (77301) |
$2,247.68 |
$7,024 |
1.8× |
| Nuclear medicine of blood flow in heart muscle at rest and with stress (78492) |
$2,640.32 |
$8,251 |
2.0× |
| Nuclear medicine of heart muscle at rest with stress (78454) |
$483.84 |
$1,512 |
0.4× |
| Nuclear medicine of heart pumping function (78473) |
$390.40 |
$1,220 |
1.1× |
| Nuclear medicine study from skull base to mid-thigh (78812) |
$2,375.68 |
$7,424 |
1.8× |
| Nuclear medicine study of blood flow in heart muscle at rest with stress (78491) |
$2,640.32 |
$8,251 |
2.0× |
| Nuclear medicine study of endocrine organs (78099) |
$135.68 |
$424 |
0.4× |
| Nuclear medicine study of heart muscle at rest with stress (78453) |
$483.84 |
$1,512 |
0.4× |
| Nuclear medicine study of kidney and blood flow (78701) |
$190.72 |
$596 |
0.5× |
| Nuclear medicine study of limited area for thyroid cancer (78015) |
$154.24 |
$482 |
0.4× |
| Nuclear medicine study of stomach to assess emptying small bowel movement (78265) |
$435.20 |
$1,360 |
1.2× |
| Nuclear medicine study to assess blood clot in vein of both sides (78458) |
$193.28 |
$604 |
0.5× |
| Nuclear Rx Oral Admin (79005) |
$113.28 |
$354 |
0.5× |
| Ob Us Follow-Up Per Fetus - Us Ob Follow Up Transabdominal Approach (76816) |
$66.56 |
$208 |
0.7× |
| Oph US Dx B-Scan&Quan a-Scan Sm Pt Enctr (76510) |
$132.48 |
$414 |
1.1× |
| Ophthalmic us dx quantitative a-scan only (76511) |
$91.20 |
$285 |
1.0× |
| Orthopantogram (70355) |
$49.92 |
$156 |
0.6× |
| Osseous survey infant (77076) |
$85.76 |
$268 |
0.9× |
| Osseous survey limited (77074) |
$69.44 |
$217 |
0.7× |
| Parathyrd planar w/spect&CT (78072) |
$634.56 |
$1,983 |
1.3× |
| Parathyrd planar w/wo subtrj (78071) |
$458.88 |
$1,434 |
1.3× |
| Parathyroid imaging (78070) |
$188.48 |
$589 |
0.5× |
| Pelvis 1 or 2 views (72170) |
$48.64 |
$152 |
0.5× |
| Perineogram (74775) |
$96.32 |
$301 |
0.4× |
| PET image w/CT, skull-thigh (78815) |
$1,100.16 |
$3,438 |
0.8× |
| PET imaging CT for attenuation limited area (78814) |
$1,100.16 |
$3,438 |
0.8× |
| PET imaging for CT attenuation whole body (78816) |
$1,100.16 |
$3,438 |
0.8× |
| PET imaging limited area chest head/neck (78811) |
$2,375.68 |
$7,424 |
2.0× |
| PET whole body (78813) |
$2,375.68 |
$7,424 |
1.8× |
| Plasma volume, radiopharmaceutical volume-dilution technique (separate procedure); single sampling Age Under 21 (78110) |
$139.84 |
$437 |
0.1× |
| Pr gi endoscopic ultrasound (76975) |
$101.76 |
$318 |
0.5× |
| Pr MRI, lower extr, w/o contrast f/u by contrast (73720) |
$968.64 |
$3,027 |
3.1× |
| Prq Transhepatc Portograpy Hemodyn Eval Rs&I (75885) |
$1,053.12 |
$3,291 |
0.4× |
| Prq transhepatc portograpy w/o hemodyn evl intrp (75887) |
$673.92 |
$2,106 |
0.2× |
| Pulmonary Perfusion Imaging Particulate (78580) |
$182.72 |
$571 |
0.5× |
| Pulmonary Ventilation & Perfusion Imaging (78582) |
$369.28 |
$1,154 |
0.8× |
| Radex abscess/fistula/sinus tract rs&i (76080) |
$183.04 |
$572 |
0.4× |
| Radex Entir Thrc Lmbr Crv Sac Spi W/Skull 1 Vw - Xr Scoliosis 1 Vw (72081) |
$66.88 |
$209 |
0.8× |
| Radex entir thrc lmbr crv sac spi w/skull 2/3 vw (72082) |
$121.60 |
$380 |
1.3× |
| Radex hips bilateral with pelvis 2 views (73521) |
$74.56 |
$233 |
0.8× |
| Radex mastoids compl minimum 3 views pr side (70130) |
$83.84 |
$262 |
0.9× |
| Radex X-Ray Exam Entire Spi 6/> Vw - Xr Entire Spine 6+ Vw (72084) |
$158.08 |
$494 |
1.7× |
| Radiation Delivery Stereotactic Cranial Linear (77372) |
$26,197.12 |
$81,866 |
3.9× |
| Radiation treatment delivery 1 mev >= complex (77412) |
$223.36 |
$698 |
0.4× |
| Radiation treatment delivery 1 mev >= simple (77402) |
$154.56 |
$483 |
1.7× |
| Radiation tx delivery 1 mev >= intermediate (77407) |
$189.76 |
$593 |
0.5× |
| Radiolog exam mandible compl minimum 4 views (70110) |
$64 |
$200 |
0.7× |
| Radiologic Exam Abdomen 1 View - Xr Abdomen 1 View (74018) |
$48 |
$150 |
0.6× |
| Radiologic Exam Abdomen 3+ Views - Xr Abdomen 3+ Views (74021) |
$63.04 |
$197 |
0.7× |
| Radiologic Exam Chest 2 Views - Xr Chest 2 Views (71046) |
$59.52 |
$186 |
0.8× |
| Radiologic exam colon single contrast study (74270) |
$102.40 |
$320 |
0.6× |
| Radiologic Exam Esophagus Double Contrast Study (74221) |
$152.64 |
$477 |
1.0× |
| Radiologic exam upr gi trc double contrast study (74246) |
$181.76 |
$568 |
1.1× |
| Radiologic exam upr gi trc single contrast study (74240) |
$155.52 |
$486 |
1.0× |
| Radiologic Examination Femur Minimum 2 Views - Xr Femur 2+ Vw Lt (73552) |
$91.20 |
$285 |
1.2× |
| Radiological examination surgical specimen (76098) |
$155.84 |
$487 |
0.3× |
| Radiopharm Dacryocystography (78660) |
$125.44 |
$392 |
0.3× |
| Red Cell Volume Determination Spx 1 Sampling (78120) |
$140.16 |
$438 |
0.4× |
| Review by radiologist of adrenal gland vein image (75840) |
$1,973.76 |
$6,168 |
0.7× |
| Review by radiologist of liver vein image with assessment of blood flow (75889) |
$1,053.12 |
$3,291 |
0.4× |
| Ribs bilateral 3 views (71110) |
$75.20 |
$235 |
0.8× |
| Rp loclzj tum plnr 2+area 1+d img/1 area img>2+d (78801) |
$223.04 |
$697 |
0.6× |
| Rp loclzj tum plnr whole body single day imaging (78802) |
$483.84 |
$1,512 |
1.0× |
| Rp loclzj tum spect 1 area single day imaging (78803) |
$483.84 |
$1,512 |
1.0× |
| Rp loclzj tum spect 2 area/sep acquisj img (78831) |
$1,064 |
$3,325 |
0.9× |
| Rp loclzj tum spect CT 2area 1d img/1 ar img>2+d (78832) |
$1,206.72 |
$3,771 |
0.9× |
| Rp loclzj tum spect w/CT 1 area 1 day imaging (78830) |
$1,064 |
$3,325 |
0.9× |
| Rp Ther Radiolbld Monoclonal Antibody IV Infus (79403) |
$180.80 |
$565 |
0.9× |
| Rp therapy intra-arterial particulate admn (79445) |
$127.04 |
$397 |
0.6× |
| Rp Therapy Intravenous Administration (79101) |
$115.20 |
$360 |
0.5× |
| Sacroiliac Joints < 3 Views (72200) |
$50.56 |
$158 |
0.5× |
| Saline Infus Sonohysterography W/Color Doppler (76831) |
$87.36 |
$273 |
0.4× |
| Salivary gland function study (78232) |
$161.60 |
$505 |
0.4× |
| Salivary gland imaging (78230) |
$78.72 |
$246 |
0.2× |
| Salivary gland imaging serial images (78231) |
$104.96 |
$328 |
0.3× |
| Scanogram (77073) |
$48.64 |
$152 |
0.5× |
| Scapula complete (73010) |
$75.84 |
$237 |
0.8× |
| Screening digital breast tomosynthesis (77063) |
$15.36 |
$48 |
0.7× |
| Sella turcica (70240) |
$44.16 |
$138 |
0.6× |
| Shuntogram indwelling nonvascular shunt rs&i (75809) |
$70.08 |
$219 |
0.7× |
| Sialogram (70390) |
$184.64 |
$577 |
0.9× |
| Simulation intermediate (77285) |
$399.68 |
$1,249 |
1.2× |
| Small bowel series (74250) |
$149.76 |
$468 |
0.9× |
| Spec medical radj physics consltj (77370) |
$222.08 |
$694 |
1.8× |
| Spec telethx port pln parts hemibdy tot bdy (77321) |
$221.44 |
$692 |
0.7× |
| Special dosimetry (77331) |
$48.64 |
$152 |
0.4× |
| Special treatment procedure (77470) |
$579.20 |
$1,810 |
1.2× |
| Speech evaluation complex (70371) |
$93.44 |
$292 |
0.4× |
| Spine thoracic 3 views (72072) |
$71.68 |
$224 |
0.8× |
| Spleen imaging only (78185) |
$144.96 |
$453 |
0.4× |
| Splenoportograpy rs&i (75810) |
$828.16 |
$2,588 |
0.3× |
| Stereotactic body radiation delivery (77373) |
$2,649.92 |
$8,281 |
1.6× |
| Superior sagittal sinus venogram (75870) |
$666.24 |
$2,082 |
0.2× |
| Surface Applic Low Dose Rate Radionuclide Source (77789) |
$48.64 |
$152 |
0.5× |
| Tbs Technical Calculation Only (77091) |
$33.28 |
$104 |
0.4× |
| Telethx isodose pln cplx w/basic dosimetry (77307) |
$158.08 |
$494 |
0.5× |
| Telethx isodose pln smpl w/dosimetry calculation (77306) |
$104.64 |
$327 |
0.3× |
| Testicular Imaging With Vascular Flow (78761) |
$171.52 |
$536 |
0.5× |
| Ther rad simulaj-aided field setting complex (77290) |
$527.04 |
$1,647 |
1.6× |
| Ther rad simulaj-aided field setting simple (77280) |
$239.36 |
$748 |
2.0× |
| Therapeutic Enema (74283) |
$114.88 |
$359 |
0.7× |
| Thoracolumbar 2 views (72080) |
$64.96 |
$203 |
0.8× |
| Thyroid carcinoma metastases img whole body (78018) |
$288 |
$900 |
0.6× |
| Thyroid Imaging With Vascular Flow (78013) |
$288.64 |
$902 |
0.8× |
| Thyroid uptake measurement (78012) |
$148.16 |
$463 |
0.4× |
| Thyroid Uptake W/Blood Flow Sngle/Mult Quan Meas (78014) |
$329.28 |
$1,029 |
0.9× |
| Tmj unilateral (70328) |
$48.64 |
$152 |
0.6× |
| Tomogram (76100) |
$112.96 |
$353 |
1.2× |
| Treatment device intermediate (77333) |
$99.84 |
$312 |
0.8× |
| Treatment devices simple (77332) |
$88.96 |
$278 |
0.7× |
| Tumor Imaging Whole Body - Nm Tumor Local Whole Body Mult Days (78804) |
$470.08 |
$1,469 |
1.0× |
| Tumor Imaging, Limited Area - Nm Tumor Localization Limited (78800) |
$173.12 |
$541 |
0.5× |
| Tx devices design & construction complex (77334) |
$199.36 |
$623 |
0.6× |
| Ultrasound elastography first target lesion (76982) |
$225.92 |
$706 |
2.4× |
| Ultrasound scan of cornea to determine thickness (76514) |
$8.96 |
$28 |
0.3× |
| Ultrasound scan to determine eye length and lens power (76519) |
$93.60 |
$292.50 |
1.0× |
| Ultrasound trgt dynamic microbubble 1st lesion (76978) |
$168.96 |
$528 |
0.5× |
| Ultrasound, abdomen limited (76705) |
$78.08 |
$244 |
0.8× |
| Umbilical-artery Doppler (OB) (76820) |
$67.52 |
$211 |
0.7× |
| Unlisted Diagnostic Radiographic Procedure (76499) |
$53.76 |
$168 |
0.7× |
| Unlisted fluoroscopic procedure (76496) |
$97.60 |
$305 |
1.2× |
| Unlisted magnetic resonance procedure (76498) |
$280.32 |
$876 |
3.6× |
| Unlisted miscellaneous px dx nuclear medicine (78999) |
$78.72 |
$246 |
0.2× |
| Unlisted Procedure Clinical Brachytherapy (77799) |
$953.92 |
$2,981 |
10.3× |
| Unlisted Ultrasound Procedure (76999) |
$72.96 |
$228 |
0.9× |
| Upper Extremity Infant (73092) |
$72.96 |
$228 |
0.8× |
| Urethrocystography retrograde rs&i (74450) |
$96.32 |
$301 |
0.4× |
| Urethrocystography voiding (74455) |
$111.36 |
$348 |
0.5× |
| Urography (pyelography), intravenous, with or without KUB, with or without tomography (74400) |
$121.92 |
$381 |
0.8× |
| Us abdl aorta screen aaa (76706) |
$88 |
$275 |
0.9× |
| Us breast unilateral complete (76641) |
$91.20 |
$285 |
1.0× |
| Us breast unilateral limited (76642) |
$91.20 |
$285 |
1.2× |
| Us chest (76604) |
$67.52 |
$211 |
0.7× |
| Us compl joint r-t w/image documentation (76881) |
$118.08 |
$369 |
1.2× |
| Us elastography parenchyma (76981) |
$225.92 |
$706 |
2.4× |
| Us fetal nuchal translucency 1st gestation (76813) |
$88.32 |
$276 |
0.9× |
| Us guided compression repair (76936) |
$224.32 |
$701 |
1.1× |
| Us infant hips dynamic (76885) |
$79.68 |
$249 |
1.0× |
| Us infant hips limited static (76886) |
$77.44 |
$242 |
1.0× |
| Us kidney transplant (76776) |
$109.12 |
$341 |
1.2× |
| Us ob detailed single fetus (76811) |
$175.68 |
$549 |
0.8× |
| Us ob transvaginal (76817) |
$76.16 |
$238 |
0.8× |
| Us pelvic non ob complete (76856) |
$87.36 |
$273 |
0.9× |
| Us pelvic nonobstetric image dcmtn limited/f/u (76857) |
$79.04 |
$247 |
0.8× |
| Us pregnancy ltd (76815) |
$72 |
$225 |
0.8× |
| Us pregnant uterus 14 wk transabdl 1/1st gestat (76801) |
$104 |
$325 |
1.1× |
| Us retroperitoneal complete (76770) |
$104.32 |
$326 |
1.1× |
| Us retroperitoneal limited (76775) |
$78.08 |
$244 |
0.8× |
| Us scrotum and contents (76870) |
$87.36 |
$273 |
0.9× |
| Us soft tissue head/neck (76536) |
$81.60 |
$255 |
0.9× |
| Us spinal canal and contents (76800) |
$77.12 |
$241 |
0.8× |
| Us transrectal (76872) |
$111.68 |
$349 |
1.2× |
| Us transrectal prostate volume (76873) |
$115.52 |
$361 |
1.2× |
| Us xtr non-vasc lmtd (76882) |
$42.88 |
$134 |
0.5× |
| Us, eye b-scan (76512) |
$118.08 |
$369 |
1.2× |
| Vascular flow imaging (78445) |
$119.36 |
$373 |
0.3× |
| Venogram extremity bilateral (75822) |
$620.16 |
$1,938 |
0.4× |
| Venogram orbital (75880) |
$195.84 |
$612 |
0.3× |
| Venography caval inferior serialography rs&i (75825) |
$1,053.12 |
$3,291 |
0.4× |
| Venography caval superior serialography rs&i (75827) |
$670.08 |
$2,094 |
0.5× |
| Venography extremity unilateral rs&i (75820) |
$195.84 |
$612 |
0.1× |
| Venography Renal Bilateral (75833) |
$1,053.12 |
$3,291 |
0.4× |
| Venography renal unilateral selective rs&i (75831) |
$1,053.12 |
$3,291 |
0.4× |
| Venography venous sinus/jugular cath rs&i (75860) |
$1,053.12 |
$3,291 |
0.4× |
Venous sampling thru cath w/wo angiography rs& (75893)
unusually low: confirm this is the full procedure |
$1,746.56 |
$5,458 |
0.3× |
| Vertebral fracture assessment via dxa (77086) |
$44.16 |
$138 |
0.6× |
| Wrist 2 views (73100) |
$72.96 |
$228 |
0.9× |
| X-Ray Abdomen,Comp Acute Series - Xr Abdomen 2 Vws With Chest 1 View (74022) |
$75.20 |
$235 |
0.8× |
| X-Ray Ac Jts - Xr Acromioclavicular Joints Bilateral (73050) |
$65.92 |
$206 |
0.8× |
| X-Ray Ankle 3+ Vw - Xr Ankle 3+ Views Right (73610) |
$80.16 |
$250.50 |
1.0× |
| X-Ray Colon Air Contrast - Fl Barium Enema Air Contrast (74280) |
$180.16 |
$563 |
1.1× |
| X-Ray Elbow 2 Vw - Xr Elbow 1-2 Views Right (73070) |
$74.40 |
$232.50 |
0.9× |
| X-Ray Elbow 3+ Vw - Xr Elbow 3+ Views Right (73080) |
$90.72 |
$283.50 |
1.2× |
| X-ray exam entire spi 4/5 vw (72083) |
$131.84 |
$412 |
1.4× |
| X-ray exam hip uni 1 view (73501) |
$54.08 |
$169 |
0.7× |
| X-Ray Exam Hip Uni 2-3 Views (73502) |
$79.04 |
$247 |
1.0× |
| X-ray exam hip uni 4/> views (73503) |
$97.92 |
$306 |
1.0× |
| X-Ray Exam Hips Bi 3-4 Views (73522) |
$88.64 |
$277 |
0.9× |
| X-Ray Exam Hips Bi 5/> Views (73523) |
$106.56 |
$333 |
1.1× |
| X-ray exam of femur 1 (73551) |
$51.20 |
$160 |
0.6× |
| X-ray eye for foreign body (70030) |
$66.24 |
$207 |
0.8× |
| X-Ray Facial Bones 3+ Vw - Xr Facial Bones 3+ Views (70150) |
$77.12 |
$241 |
0.8× |
| X-Ray Facial Bones <3 Vw - Xr Facial Bones 1-2 Views (70140) |
$58.56 |
$183 |
0.7× |
| X-Ray Foot 3+ Vw - Xr Foot 3+ Views Right (73630) |
$78.72 |
$246 |
1.0× |
| X-ray guide gu dilation - ir nephrostomy dilation (74485) |
$541.44 |
$1,692 |
0.3× |
| X-Ray Heel - Xr Calcaneus 2 Views Right (73650) |
$70.56 |
$220.50 |
0.9× |
| X-ray IV pyelogram+drip infusn (74410) |
$136 |
$425 |
0.9× |
| X-Ray Jaw <4 Vw - Xr Mandible < 4 Views (70100) |
$51.52 |
$161 |
0.7× |
| X-Ray Knee 4+ View - Xr Knee 4+ Views Right (73564) |
$98.88 |
$309 |
1.0× |
| X-Ray Knee Bilat Standing - Xr Knees Anteroposterior Standing Bilat (73565) |
$49.60 |
$155 |
0.6× |
| X-Ray Leg, Infant - Xr Lower Extremity 2+ Views Infant Left (73592) |
$72.96 |
$228 |
0.9× |
| X-Ray Lumbar Spine 2/3 Vw - Xr Lumbar Spine 2-3 Views (72100) |
$67.52 |
$211 |
0.7× |
| X-Ray Lumbar Spine 6+ Vw - Xr Lumbar Spine 6+ Vws Including Bending (72114) |
$121.60 |
$380 |
1.3× |
| X-Ray Lumbar Spine Flex/Exten - Xr Lumbar Spine 4+ Views W/ Flex Ext (72120) |
$91.20 |
$285 |
1.0× |
| X-Ray Nasal Bones - Xr Nasal Bones (70160) |
$52.48 |
$164 |
0.7× |
| X-Ray Nose-Rectum Child F.B. - Xr Nose to Rectum Foreign Body Peds (76010) |
$33.28 |
$104 |
0.4× |
| X-ray of voice box or throat (70370) |
$63.68 |
$199 |
0.8× |
| X-Ray Orbits - Xr Orbits Complete 4+ Views (70200) |
$77.12 |
$241 |
0.8× |
| X-Ray Pelvis 3+ Vw - Xr Pelvis 3+ Views (72190) |
$68.48 |
$214 |
0.7× |
| X-Ray Renal Cyst Xlumbar+Contrst - Xr Renal Cyst Lumbar W Contrast (74470) |
$72.32 |
$226 |
0.1× |
| X-Ray Retrograde Pyelogram - Fl Pyelogram Retrograde (74420) |
$172.80 |
$540 |
0.5× |
| X-Ray Ribs 2 Vw Unilat - Xr Ribs 2 Views Right (71100) |
$56.64 |
$177 |
0.7× |
| X-Ray Ribs, Chest 3+ Vw - Xr Ribs 2 Vws Lt W/ Chest Anteroposterior (71101) |
$65.92 |
$206 |
0.7× |
| X-Ray Ribs, Chest 4+ Vw - Xr Ribs 3 Vws Bil W/ Chest Posteroanterior (71111) |
$90.56 |
$283 |
1.0× |
| X-Ray Sacroiliac Jts 3+ Vw - Xr Sacroiliac Joints 3+ Views (72202) |
$63.04 |
$197 |
0.7× |
| X-Ray Sacrum/Coccyx 2+ Vw - Xr Sacrum Coccyx 2+ Views (72220) |
$55.68 |
$174 |
0.7× |
| X-Ray Shoulder 2+ Vw - Xr Shoulder 2+ Views Right (73030) |
$83.52 |
$261 |
1.1× |
| X-Ray Sinuses 3+ Vw - Xr Paranasal Sinuses 3+ Views (70220) |
$74.24 |
$232 |
0.9× |
| X-Ray Sinuses <3 Vw - Xr Paranasal Sinuses 1-2 Views (70210) |
$59.52 |
$186 |
0.8× |
| X-Ray Skull 4+ Vw - Xr Skull Complete 4+ Views (70260) |
$85.44 |
$267 |
0.9× |
| X-Ray Skull <4 Vw - Xr Skull 1-3 Views (70250) |
$62.08 |
$194 |
0.7× |
| X-Ray Spine One View - Xr Spine (72020) |
$40.64 |
$127 |
0.5× |
| X-Ray Sterno-Clavicluar Jt - Xr Sternoclavicular Joints 3+ Views (71130) |
$69.44 |
$217 |
0.9× |
| X-Ray Sternum 2+ Vw - Xr Sternum 2+ Views (71120) |
$62.08 |
$194 |
0.8× |
| X-Ray Thoracic Spine 2 Vw - Xr Thoracic Spine 2 Views (72070) |
$62.08 |
$194 |
0.7× |
| X-Ray Thoracic Spine 4 Vw - Xr Thoracic Spine Complete 4+ Views (72074) |
$89.60 |
$280 |
0.9× |
| X-Ray Toe(S) - Xr Toes 2+ Views Right (73660) |
$45.12 |
$141 |
0.6× |
| X-Ray Wrist 3+ Vw - Xr Wrist 3+ Views Right (73110) |
$82.56 |
$258 |
1.0× |
| Xr arthrogram ankle (73615) |
$145.60 |
$455 |
0.5× |
| Xr c-spine 6 or more views (72052) |
$113.60 |
$355 |
1.2× |
| Xr chest 4+ views (71048) |
$78.08 |
$244 |
0.8× |
| Xr Cholecystography Oral Contrast (74290) |
$45.12 |
$141 |
0.3× |
| Xr finger(s) 2+ views (73140) |
$46.08 |
$144 |
0.6× |
| Xr internal auditory meati complete (70134) |
$183.04 |
$572 |
0.4× |
| XR Mastoids < 3 Views Bilateral (70120) |
$62.08 |
$194 |
0.7× |
| Xr myelogram posterior fossa (70010) |
$378.24 |
$1,182 |
1.2× |
| Xr shoulder 1 view (73020) |
$66.24 |
$207 |
0.8× |
| Xr spine cervical 4 or 5 views (72050) |
$90.56 |
$283 |
1.0× |
| Xr tibia/fibula 2 views (73590) |
$74.40 |
$232.50 |
0.9× |
| Xr tmj bilateral (70330) |
$84.80 |
$265 |
1.1× |
| Xray knee 1 or 2 views rt (73560) |
$75.84 |
$237 |
1.0× |