| 3-D radiotherapy plan dose-volume histograms (77295) |
$1,497.80 |
$3,744.50 |
1.1× |
| Acute gi blood loss imaging (78278) |
$902.80 |
$2,257 |
2.2× |
| Angiography internal mammary rs&i (75756) |
$2,318 |
$5,795 |
0.7× |
| Angiography pulmonary bilateral slctv rs&i (75743) |
$4,462 |
$11,155 |
1.4× |
Angiography visceral slctv/supraslctv rs&i (75726)
unusually low — confirm this is the full procedure |
$2,526 |
$6,315 |
0.5× |
| Angiography, adrenal, bilateral, selective, radiological supervision and interpretation Age Under 21 (75733) |
$2,528 |
$6,320 |
0.8× |
| Angiography, adrenal, unilateral, selective, radiological supervision and interpretation Age Under 21 (75731) |
$4,462 |
$11,155 |
1.4× |
| Angiography, extremity, bilateral, radiological supervision and interpretation Age Under 21 (75716) |
$3,028.40 |
$7,571 |
1.0× |
| Angiography, extremity, unilateral, radiological supervision and interpretation Age Under 21 (75710) |
$2,200.40 |
$5,501 |
0.7× |
| Angiography, pelvic, selective or supraselective, radiological supervision and interpretation Age Under 21 (75736) |
$2,960 |
$7,400 |
0.5× |
| Angiography, pulmonary, unilateral, selective, radiological supervision and interpretation Age Under 21 (75741) |
$1,968 |
$4,920 |
0.6× |
| Angiography, spinal, selective, radiological supervision and interpretation Age Under 21 (75705) |
$3,348 |
$8,370 |
0.6× |
| Angrph cath f-up std tcat other than thrombylsis (75898) |
$4,837.20 |
$12,093 |
1.5× |
| Angrph pulmonary nonslctv cath/ven njx rs&i (75746) |
$1,654.80 |
$4,137 |
0.5× |
| Ankle 2 views (73600) |
$328.80 |
$822 |
3.8× |
| Aortography, abdominal plus bilateral iliofemoral lower extremity, catheter, by serialography, radiological supervision… (75630) |
$2,536 |
$6,340 |
0.8× |
| Aortography, abdominal, by serialography, radiological supervision and interpretation Age Under 21 (75625) |
$2,542.80 |
$6,357 |
0.8× |
| Aortography, thoracic, by serialography, radiological supervision and interpretation Age Under 21 (75605) |
$2,849.60 |
$7,124 |
0.5× |
| Aortography, thoracic, without serialography, radiological supervision and interpretation Age Under 21 (75600) |
$3,048 |
$7,620 |
1.0× |
| Basic radiation dosimetry calculation (77300) |
$272.80 |
$682 |
2.0× |
| Brain imaging, less than 4 static views; with vascular flow Age Under 21 (78601) |
$534.80 |
$1,337 |
1.3× |
| Brain imaging, minimum 4 static views; with vascular flow Age Under 21 (78606) |
$1,711.60 |
$4,279 |
3.1× |
| Brain imaging, positron emission tomography (PET); metabolic evaluation Age Under 21 (78608) |
$3,544 |
$8,860 |
2.5× |
| Card MRI w/stress img & dye (75563) |
$1,561.60 |
$3,904 |
2.0× |
| Cardiac MRI morphology & function w/o contrast (75557) |
$1,189.20 |
$2,973 |
5.0× |
| Cardiac MRI w/stress img (75559) |
$1,716.80 |
$4,292 |
3.1× |
| Cardiac MRI w/wo contrast & further seq (75561) |
$1,274 |
$3,185 |
3.6× |
| Cephalogram, orthodontic Age Under 21 (70350) |
$206.80 |
$517 |
2.4× |
| Clavicle complete (73000) |
$373 |
$932.50 |
4.3× |
| Complex dynamic pharyngeal and speech evaluation by cine or video recording Age Under 21 (70371) |
$488.80 |
$1,222 |
2.0× |
| Computed tomographic (CT) colonography, diagnostic, including image postprocessing; with contrast material(s) including… (74262) |
$966.80 |
$2,417 |
5.5× |
| Computed tomographic (CT) colonography, diagnostic, including image postprocessing; without contrast material Age Under… (74261) |
$636.40 |
$1,591 |
6.1× |
| Computed tomographic (CT) colonography, screening, including image postprocessing (74263) |
$636.40 |
$1,591 |
2.7× |
| Computed tomographic angiography, abdomen and pelvis, with contrast material(s), including noncontrast images, if… (74174) |
$1,922.40 |
$4,806 |
5.5× |
| Computed tomographic angiography, abdomen, with contrast material(s), including noncontrast images, if performed, and… (74175) |
$1,335.60 |
$3,339 |
7.6× |
| Computed tomographic angiography, abdominal aorta and bilateral iliofemoral lower extremity runoff, with contrast… (75635) |
$1,429.20 |
$3,573 |
8.1× |
| Computed tomographic angiography, chest (noncoronary), with contrast material(s), including noncontrast images, if… (71275) |
$1,360.80 |
$3,402 |
7.7× |
| Computed tomographic angiography, lower extremity, with contrast material(s), including noncontrast images, if… (73706) |
$2,697.80 |
$6,744.50 |
15.3× |
| Computed tomographic angiography, neck, with contrast material(s), including noncontrast images, if performed, and… (70498) |
$1,295.60 |
$3,239 |
7.4× |
| Computed tomographic angiography, pelvis, with contrast material(s), including noncontrast images, if performed, and… (72191) |
$1,307.60 |
$3,269 |
7.4× |
| Computed tomographic angiography, upper extremity, with contrast material(s), including noncontrast images, if… (73206) |
$1,207.60 |
$3,019 |
6.9× |
| Computed tomography, cervical spine; without contrast material, followed by contrast material(s) and further sections… (72127) |
$3,113.60 |
$7,784 |
17.7× |
| Computed tomography, lower extremity; without contrast material Age Under 21 (73700) |
$2,425 |
$6,062.50 |
23.1× |
| Computed tomography, lower extremity; without contrast material, followed by contrast material(s) and further sections… (73702) |
$3,812 |
$9,530 |
21.6× |
| Computed tomography, lumbar spine; without contrast material, followed by contrast material(s) and further sections Age… (72133) |
$3,355.20 |
$8,388 |
19.0× |
| Computed tomography, maxillofacial area; with contrast material(s) Age Under 21 (70487) |
$1,483.60 |
$3,709 |
8.4× |
| Computed tomography, maxillofacial area; without contrast material Age Under 21 (70486) |
$1,533.20 |
$3,833 |
14.6× |
| Computed tomography, orbit, sella, or posterior fossa or outer, middle, or inner ear; with contrast material(s) Age… (70481) |
$2,162 |
$5,405 |
12.3× |
| Computed tomography, orbit, sella, or posterior fossa or outer, middle, or inner ear; without contrast material Age… (70480) |
$1,860.80 |
$4,652 |
17.7× |
| Computed tomography, orbit, sella, or posterior fossa or outer, middle, or inner ear; without contrast material,… (70482) |
$2,453.20 |
$6,133 |
13.9× |
| Computed tomography, soft tissue neck; without contrast material followed by contrast material(s) and further sections… (70492) |
$2,518 |
$6,295 |
14.3× |
| Computed tomography, thoracic spine; without contrast material, followed by contrast material(s) and further sections… (72130) |
$3,416 |
$8,540 |
19.4× |
| Computed tomography, thorax, diagnostic; without contrast material, followed by contrast material(s) and further… (71270) |
$2,437.60 |
$6,094 |
13.8× |
| Continuing medical physics consultation, including assessment of treatment parameters, quality assurance of dose… (77336) |
$86.80 |
$217 |
0.6× |
| Csf shunt evaluation (78645) |
$1,320.40 |
$3,301 |
2.4× |
| CT abdomen and pelvis without and with contrast (74178) |
$2,150.80 |
$5,377 |
6.1× |
| CT abdomen and pelvis without contrast (74176) |
$1,521.60 |
$3,804 |
6.3× |
| CT abdomen w & w/o contrast (74170) |
$1,322.80 |
$3,307 |
7.5× |
| CT abdomen w/contrast (74160) |
$1,955 |
$4,887.50 |
11.1× |
| CT abdomen w/o contrast (74150) |
$2,227.20 |
$5,568 |
21.2× |
| CT angio hrt w/3d image (75574) |
$1,098.80 |
$2,747 |
3.1× |
| CT cervical spine w/contrast (72126) |
$2,551.20 |
$6,378 |
7.3× |
| CT cervical spine w/o contrast (72125) |
$2,199.20 |
$5,498 |
20.9× |
| CT chest w/contrast (71260) |
$1,971.20 |
$4,928 |
11.2× |
| CT extremity upper w & w/o contrast (73202) |
$2,564.40 |
$6,411 |
14.6× |
| CT extremity upper w/o contrast (73200) |
$2,446.80 |
$6,117 |
23.3× |
| CT head/brain with contrast (70460) |
$1,748.40 |
$4,371 |
9.9× |
| CT head/brain without and with contrast (70470) |
$2,095.20 |
$5,238 |
11.9× |
| CT heart c+ cardiac strux&morph cgen hrt ds (75573) |
$877.60 |
$2,194 |
2.5× |
| CT heart contrast eval cardiac structure&morph (75572) |
$877.60 |
$2,194 |
2.5× |
| CT heart no contrast quant eval coronry calcium (75571) |
$146.40 |
$366 |
1.7× |
| CT l-spine w/contrast (72132) |
$2,740.80 |
$6,852 |
7.8× |
| CT limited/localized follow up study (76380) |
$934.80 |
$2,337 |
10.7× |
| CT lower extremity w/dye (73701) |
$2,952.80 |
$7,382 |
16.8× |
| CT lumbar spine w/o contrast (72131) |
$2,356.40 |
$5,891 |
22.4× |
| CT maxillofacial w/wo contrast (70488) |
$1,715.20 |
$4,288 |
9.7× |
| CT neck w/contrast (70491) |
$2,069.60 |
$5,174 |
11.7× |
| CT neck w/o contrast (70490) |
$1,542.80 |
$3,857 |
14.7× |
| CT pelvis w & w/o contrast (72194) |
$2,860 |
$7,150 |
16.2× |
| CT pelvis w/o contrast (72192) |
$1,809.60 |
$4,524 |
17.2× |
| CT thoracic spine w/contrast (72129) |
$2,792 |
$6,980 |
15.8× |
| CT thoracic spine w/o contrast (72128) |
$2,416.40 |
$6,041 |
23.0× |
| CT thorax lung cancer scr c- (71271) |
$292.40 |
$731 |
2.8× |
| CT thorax w/o contrast (71250) |
$1,630 |
$4,075 |
15.5× |
| CT upper extremity w/dye (73201) |
$2,965.40 |
$7,413.50 |
8.5× |
| CTA head w contrast (70496) |
$1,288 |
$3,220 |
7.3× |
| Cystography, minimum of 3 views, radiological supervision and interpretation Age Under 21 (74430) |
$501.60 |
$1,254 |
1.4× |
| Dilation ureters/urethra rs&i (74485) |
$1,137.60 |
$2,844 |
0.5× |
| Diskography lumbar s&i (72295) |
$1,726.40 |
$4,316 |
0.9× |
| Doppler echocardiography, fetal, pulsed wave and/or continuous wave with spectral display; complete Age Under 21 (76827) |
$668 |
$1,670 |
6.4× |
| Doppler echocardiography, fetal, pulsed wave and/or continuous wave with spectral display; follow-up or repeat study… (76828) |
$485.60 |
$1,214 |
4.6× |
| Doppler fetal mid cerebral artery (76821) |
$501.60 |
$1,254 |
4.8× |
| Dual-energy X-ray absorptiometry (DXA), bone density study, 1 or more sites; axial skeleton (eg, hips, pelvis, spine)… (77080) |
$425.60 |
$1,064 |
4.1× |
| Dxa bone density/peripheral (77081) |
$425.60 |
$1,064 |
4.9× |
| Echo exam of eye (76516) |
$163.20 |
$408 |
1.6× |
| Echo exam of eye thickness (76514) |
$34 |
$85 |
1.2× |
| Echocardiography, fetal, cardiovascular system, real time with image documentation (2D), with or without M-mode… (76825) |
$782.80 |
$1,957 |
1.4× |
| Echocardiography, fetal, cardiovascular system, real time with image documentation (2D), with or without M-mode… (76826) |
$455.60 |
$1,139 |
1.9× |
| Esophageal motility (78258) |
$1,278 |
$3,195 |
3.2× |
| Fetal biophysical profile non-stress testing (76818) |
$380 |
$950 |
3.6× |
| Fluoroscopy up to 1 hour physician/qhp time (76000) |
$407.20 |
$1,018 |
1.7× |
| Full mouth X-ray of teeth (70320) |
$423.20 |
$1,058 |
1.8× |
| Gastric emptying imaging study (eg, solid, liquid, or both); with small bowel and colon transit, multiple days Age… (78266) |
$1,244.40 |
$3,111 |
2.3× |
| Gastric emptying imaging study (eg, solid, liquid, or both); with small bowel transit Age Under 21 (78265) |
$938.40 |
$2,346 |
2.3× |
| Gated heart planar single (78472) |
$1,380.40 |
$3,451 |
3.4× |
| Hdr rdncl ntrstl/intrcav brachytx 1 channel (77770) |
$516.80 |
$1,292 |
0.7× |
| Hdr rdncl ntrstl/intrcav brachytx 2-12 channel (77771) |
$516.80 |
$1,292 |
0.7× |
| Hdr rdncl ntrstl/intrcav brachytx >12 channels (77772) |
$516.80 |
$1,292 |
0.7× |
| Hepatc vngrph wdg/fr w/o hemodyn eval rs&i (75891) |
$1,968 |
$4,920 |
0.6× |
| Hepatic venography, wedged or free, with hemodynamic evaluation, radiological supervision and interpretation Age Under… (75889) |
$1,968 |
$4,920 |
0.6× |
| Hepatobil syst imag inc gb w/pharma intervenj (78227) |
$1,077.20 |
$2,693 |
2.0× |
| Hepatobiliary syst imaging including gallbladder (78226) |
$836.80 |
$2,092 |
2.1× |
| Ht muscle image spect sing (78451) |
$2,526 |
$6,315 |
1.9× |
| Image fusion (77399) |
$211.60 |
$529 |
1.6× |
| Infusion or instillation of radioelement solution (includes 3-month follow-up care) (77750) |
$129.20 |
$323 |
0.3× |
| Injection procedure for radiopharmaceutical localization by non-imaging probe study, intravenous (eg, parathyroid… (78808) |
$1,366.80 |
$3,417 |
3.4× |
| Intensity modulated radiotherapy plan, including dose-volume histograms for target and critical structure partial… (77301) |
$1,897.20 |
$4,743 |
1.4× |
| Interstitial radiation source application, complex, includes supervision, handling, loading of radiation source, when… (77778) |
$1,724.20 |
$4,310.50 |
2.5× |
| Intestine imaging (eg, ectopic gastric mucosa, Meckel's localization, volvulus) Age Under 21 (78290) |
$556 |
$1,390 |
1.4× |
| Intracavitary radiation source application - complex (77763) |
$278 |
$695 |
0.4× |
| Intracavitary radiation source application - intermediate (77762) |
$278 |
$695 |
0.5× |
| Intracavitary radiation source application - simple (77761) |
$278 |
$695 |
0.5× |
| Isodose brachytherapy complex 10+ sources (77318) |
$329.20 |
$823 |
0.9× |
| Isodose brachytherapy intermed 5 to 10 sources (77317) |
$329.20 |
$823 |
0.9× |
| Isodose brachytherapy plan simple 1 to 4 source (77316) |
$118 |
$295 |
0.3× |
| Isodose teletherapy plan complex multi tx w/cal (77307) |
$118 |
$295 |
0.3× |
| Isodose teletherapy plan simple 1 or 2 port w/cal (77306) |
$118 |
$295 |
0.3× |
| Kidney imaging morphol - nm kidney cortex (78700) |
$784 |
$1,960 |
2.0× |
| Kidney imaging morphology; with vascular flow and function, single study without pharmacological intervention Age Under… (78707) |
$1,059.60 |
$2,649 |
1.9× |
| Kidney imaging morphology; with vascular flow and function, single study, with pharmacological intervention (eg,… (78708) |
$786.40 |
$1,966 |
1.4× |
| Leveen/shunt patency exam (78291) |
$784 |
$1,960 |
2.0× |
| Liver and spleen imaging (78215) |
$650.40 |
$1,626 |
1.6× |
| Liver and spleen imaging; with vascular flow Age Under 21 (78216) |
$510.40 |
$1,276 |
1.3× |
| Liver imaging (78201) |
$1,770 |
$4,425 |
3.2× |
| Liver imaging with flow (78202) |
$4,614 |
$11,535 |
8.5× |
| Lung perf&ventilat diferentl (78598) |
$902.40 |
$2,256 |
1.7× |
| Lung perfusion imaging (78580) |
$607.20 |
$1,518 |
1.5× |
| Lymphangiography, extremity only, unilateral, radiological supervision and interpretation Age Under 21 (75801) |
$933.60 |
$2,334 |
1.5× |
| Lymphangiography, pelvic/abdominal, bilateral, radiological supervision and interpretation Age Under 21 (75807) |
$1,582.80 |
$3,957 |
0.5× |
| Lymphangiography, pelvic/abdominal, unilateral, radiological supervision and interpretation Age Under 21 (75805) |
$4,796.40 |
$11,991 |
1.5× |
| Magnetic resonance (eg, proton) imaging, any joint of lower extremity; without contrast material(s), followed by… (73723) |
$4,803.40 |
$12,008.50 |
13.7× |
| Magnetic resonance (eg, proton) imaging, lower extremity other than joint; with contrast material(s) Age Under 21 (73719) |
$4,147.20 |
$10,368 |
11.8× |
| Magnetic resonance (eg, proton) imaging, lower extremity other than joint; without contrast material(s) Age Under 21 (73718) |
$2,556.80 |
$6,392 |
10.7× |
| Magnetic resonance (eg, proton) imaging, lower extremity other than joint; without contrast material(s), followed by… (73720) |
$5,276.60 |
$13,191.50 |
15.1× |
| Magnetic resonance (eg, proton) imaging, orbit, face, and/or neck; with contrast material(s) Age Under 21 (70542) |
$1,530 |
$3,825 |
4.4× |
| Magnetic resonance (eg, proton) imaging, orbit, face, and/or neck; without contrast material(s) Age Under 21 (70540) |
$2,219.60 |
$5,549 |
9.3× |
| Magnetic resonance (eg, proton) imaging, upper extremity, other than joint; with contrast material(s) Age Under 21 (73219) |
$2,239.20 |
$5,598 |
6.4× |
| Magnetic resonance (eg, proton) imaging, upper extremity, other than joint; without contrast material(s), followed by… (73220) |
$5,089.40 |
$12,723.50 |
14.5× |
| Magnetic resonance angiography, head; with contrast material(s) Age Under 21 (70545) |
$1,399.60 |
$3,499 |
4.0× |
| Magnetic resonance angiography, head; without contrast material(s), followed by contrast material(s) and further… (70546) |
$1,870 |
$4,675 |
5.3× |
| Magnetic resonance angiography, neck; without contrast material(s), followed by contrast material(s) and further… (70549) |
$1,335 |
$3,337.50 |
3.8× |
| Magnetic resonance elastography (76391) |
$892.40 |
$2,231 |
3.7× |
| Magnetic resonance imaging, brain, functional MRI; including test selection and administration of repetitive body part… (70554) |
$830.80 |
$2,077 |
3.5× |
| Magnetic resonance imaging, brain, functional MRI; requiring physician or psychologist administration of entire… (70555) |
$1,062.40 |
$2,656 |
4.4× |
| Mammary ductogram or galactogram, multiple ducts, radiological supervision and interpretation Age Under 21 (77054) |
$1,003.60 |
$2,509 |
4.2× |
| Mammary ductogram single (77053) |
$420.40 |
$1,051 |
1.8× |
| Mandible min 4v (70110) |
$314 |
$785 |
3.0× |
| MRA head w/o contrast (70544) |
$1,328 |
$3,320 |
5.5× |
| MRA neck w/ contrast (70548) |
$646.40 |
$1,616 |
1.8× |
| MRA neck w/o contrast (70547) |
$923.20 |
$2,308 |
3.9× |
| MRI abdomen w/contrast (74182) |
$2,285.20 |
$5,713 |
6.5× |
| MRI abdomen w/o contrast (74181) |
$1,844.80 |
$4,612 |
7.7× |
| MRI abdomen w/wo contrast (74183) |
$4,096.80 |
$10,242 |
11.7× |
| MRI any jt lower extrem w/contrast material (73722) |
$3,870 |
$9,675 |
4.9× |
| MRI bone marrow (77084) |
$2,110.80 |
$5,277 |
8.8× |
| MRI breast c- bilateral (77047) |
$892.40 |
$2,231 |
3.7× |
| MRI breast without contrast material unilateral (77046) |
$892.40 |
$2,231 |
3.7× |
| MRI c-spine w&w/o cont (72156) |
$4,184.80 |
$10,462 |
11.9× |
| MRI cervical spine w/contrast (72142) |
$2,780.40 |
$6,951 |
7.9× |
| MRI chest w/contrast (71551) |
$2,193.20 |
$5,483 |
2.8× |
| MRI chest w/o contrast (71550) |
$1,900 |
$4,750 |
7.9× |
| MRI chest w/wo contrast (71552) |
$2,668.40 |
$6,671 |
7.6× |
| MRI fetal sngl/1st gestation (74712) |
$771.60 |
$1,929 |
3.2× |
| MRI joint upr extr w/o&w/dye (73223) |
$5,223 |
$13,057.50 |
14.9× |
| MRI joint upr extrem w/dye (73222) |
$4,148.60 |
$10,371.50 |
5.3× |
| MRI joint upr extrem w/o dye (73221) |
$3,860.20 |
$9,650.50 |
16.1× |
| MRI lumbar spine w/contrast (72149) |
$3,558.80 |
$8,897 |
10.2× |
| MRI lumbar spine w/wo contrast (72158) |
$4,124.40 |
$10,311 |
11.8× |
| MRI orbit/face/neck w&w/o cont (70543) |
$3,037.20 |
$7,593 |
8.7× |
| MRI pelvis w & w/o contrast (72197) |
$3,031.20 |
$7,578 |
8.6× |
| MRI pelvis w/contrast (72196) |
$1,838.60 |
$4,596.50 |
5.2× |
| MRI pelvis w/o contrast (72195) |
$2,555.60 |
$6,389 |
10.7× |
| MRI spectroscopy (76390) |
$960.40 |
$2,401 |
11.0× |
| MRI spine cervical w/o contrast (72141) |
$2,805.20 |
$7,013 |
11.7× |
| MRI t-spine w&w/o cont (72157) |
$3,887.20 |
$9,718 |
11.1× |
| MRI thoracic spine w/contrast (72147) |
$2,931.20 |
$7,328 |
8.4× |
| MRI thoracic spine w/o contrst (72146) |
$2,658.80 |
$6,647 |
11.1× |
| MRI tmj (70336) |
$1,929.20 |
$4,823 |
8.0× |
| MRI upper extremity oth than jt w/o contr matrl (73218) |
$3,784.80 |
$9,462 |
15.8× |
| Multi-leaf collimator (MLC) device(s) for intensity modulated radiation therapy (IMRT), design and construction per… (77338) |
$725.60 |
$1,814 |
1.9× |
| Myelography, 2 or more regions (eg, lumbar/thoracic, cervical/thoracic, lumbar/cervical, lumbar/thoracic/cervical),… (72270) |
$1,992.40 |
$4,981 |
2.5× |
| Myocardial imaging, positron emission tomography (PET), combined perfusion with metabolic evaluation study (including… (78432) |
$9,974.80 |
$24,937 |
6.5× |
| Myocardial imaging, positron emission tomography (PET), perfusion study (including ventricular wall motionºs» and/or… (78491) |
$3,150.80 |
$7,877 |
2.2× |
| Myocardial imaging, positron emission tomography (PET), perfusion study (including ventricular wall motionºs» and/or… (78492) |
$3,957.60 |
$9,894 |
2.8× |
| Myocardial imaging, positron emission tomography (PET), perfusion study (including ventricular wall motionºs» and/or… (78430) |
$5,233.20 |
$13,083 |
3.6× |
| Myocardial perfusion imaging, planar (including qualitative or quantitative wall motion, ejection fraction by first… (78453) |
$1,644.40 |
$4,111 |
1.3× |
| Myocardial spect multiple studies (78452) |
$2,526 |
$6,315 |
1.9× |
| Myocrd img PET 2rtracer CT (78433) |
$9,974.80 |
$24,937 |
4.5× |
| Myocrd img PET metab eval single study (78459) |
$3,397.60 |
$8,494 |
2.6× |
| Myocrd img PET metab eval single study cncrnt CT (78429) |
$5,233.20 |
$13,083 |
3.6× |
| Myocrd img PET rst&strs CT (78431) |
$8,162.80 |
$20,407 |
3.7× |
| Nm adrenal imaging (78075) |
$2,378.40 |
$5,946 |
1.8× |
| Nm bone 3 phase (78315) |
$1,052.40 |
$2,631 |
2.6× |
| Nm bone imaging whole body (78306) |
$765.60 |
$1,914 |
1.9× |
| Nm bone marrow ltd (78102) |
$568.80 |
$1,422 |
1.4× |
| Nm bone marrow multi (78103) |
$748 |
$1,870 |
1.9× |
| Nm bone marrow wb (78104) |
$842 |
$2,105 |
2.1× |
| Nm csf cisternogram (78630) |
$1,365.60 |
$3,414 |
2.5× |
| Nm csf leak detection (78650) |
$1,363.60 |
$3,409 |
1.0× |
| Nm gastric emptying (78264) |
$1,202 |
$3,005 |
3.0× |
| Nm lung ventilation imaging (78579) |
$742.80 |
$1,857 |
1.8× |
| Nm lymph system (78195) |
$1,278.40 |
$3,196 |
2.3× |
| Nm myocard infarct spect (78469) |
$1,014.80 |
$2,537 |
1.9× |
| Nm salivary gland (78230) |
$671.20 |
$1,678 |
1.7× |
| Nuclear medicine study of bone and/or joint multiple areas (78305) |
$694.80 |
$1,737 |
1.7× |
| Ob us limited fetus(s) (76815) |
$304.80 |
$762 |
2.9× |
| Ophthalmic biometry by ultrasound echography, A-scan; with intraocular lens power calculation Age Under 21 (76519) |
$174.40 |
$436 |
1.7× |
| Ophthalmic ultrasound, diagnostic; B-scan (with or without superimposed non-quantitative A-scan) Age Under 21 (76512) |
$204.40 |
$511 |
1.9× |
| Ophthalmic ultrasound, diagnostic; B-scan and quantitative A-scan performed during the same patient encounter Age Under… (76510) |
$358.80 |
$897 |
2.7× |
| Ophthalmic us dx quantitative a-scan only (76511) |
$217.60 |
$544 |
2.1× |
| Panoramic X-ray of jaws (70355) |
$275.20 |
$688 |
3.1× |
| Parathyrd planar w/spect&CT (78072) |
$1,190.80 |
$2,977 |
2.2× |
| Parathyroid planar imaging (78070) |
$864 |
$2,160 |
2.2× |
| Parathyroid planar imaging w/wo subtraction (78071) |
$1,190.80 |
$2,977 |
3.0× |
| Percutaneous transhepatic portography with hemodynamic evaluation, radiological supervision and interpretation Age… (75885) |
$1,969.60 |
$4,924 |
0.6× |
| PET imaging CT attenuation skull base mid-thigh (78815) |
$5,580.40 |
$13,951 |
3.9× |
| PET imaging CT for attenuation limited area (78814) |
$3,581.20 |
$8,953 |
2.5× |
| PET imaging for CT attenuation whole body (78816) |
$5,738.40 |
$14,346 |
4.0× |
| PET imaging whole body (78813) |
$3,294.40 |
$8,236 |
2.3× |
| Positron emission tomography (PET) imaging; limited area (eg, chest, head/neck) Age Under 21 (78811) |
$2,564.40 |
$6,411 |
2.0× |
| Positron emission tomography (PET) imaging; skull base to mid-thigh Age Under 21 (78812) |
$4,672.80 |
$11,682 |
3.3× |
| Prq transhepatc portograpy w/o hemodyn evl intrp (75887) |
$1,445.20 |
$3,613 |
0.5× |
| Pulmonary ventilation & perfusion imaging (78582) |
$902.40 |
$2,256 |
1.7× |
| Quant differential pulm perfusion w/wo imaging (78597) |
$1,221.20 |
$3,053 |
3.0× |
| Radex abscess/fistula/sinus tract rs&i (76080) |
$465.60 |
$1,164 |
0.8× |
| Radex entir thrc lmbr crv sac spi w/skull 1 vw (72081) |
$170.80 |
$427 |
2.0× |
| Radex entir thrc lmbr crv sac spi w/skull 2/3 vw (72082) |
$284.80 |
$712 |
2.7× |
| Radex entir thrc lmbr crv sac spi w/skull 4/5 vw (72083) |
$541.60 |
$1,354 |
5.2× |
| Radex entir thrc lmbr crv sac spi w/skull 6/> vw (72084) |
$541.60 |
$1,354 |
5.2× |
| Radex hip unilateral with pelvis 1 view (73501) |
$170.80 |
$427 |
2.0× |
| Radex hip unilateral with pelvis 2-3 views (73502) |
$170.80 |
$427 |
2.0× |
| Radex hip unilateral with pelvis minimum 4 views (73503) |
$284.80 |
$712 |
2.7× |
| Radex hips bilateral with pelvis 2 views (73521) |
$284.80 |
$712 |
2.7× |
| Radex hips bilateral with pelvis minimum 5 views (73523) |
$541.60 |
$1,354 |
5.2× |
| Radex spine cervical 2 or 3 views (72040) |
$313.60 |
$784 |
3.6× |
| Radex spine cervical 4 or 5 views (72050) |
$440 |
$1,100 |
4.2× |
| Radex spine cervical 6 or more views (72052) |
$553.20 |
$1,383 |
5.3× |
| Radiation treatment delivery, stereotactic radiosurgery (SRS), complete course of treatment of cranial lesion(s)… (77371) |
$10,210.40 |
$25,526 |
1.4× |
| Radiation treatment delivery, stereotactic radiosurgery (SRS), complete course of treatment of cranial lesion(s)… (77372) |
$5,539.20 |
$13,848 |
0.7× |
| Radiation tx delivery lvl 1 (77402) |
$146 |
$365 |
1.4× |
| Radiation tx delivery lvl 2 (77407) |
$238.40 |
$596 |
0.6× |
| Radiation tx delivery lvl 3 (77412) |
$226.40 |
$566 |
0.4× |
| Radiologic exam abdomen 3+ views (74021) |
$519.60 |
$1,299 |
4.9× |
| Radiologic exam chest 3 views (71047) |
$271.60 |
$679 |
3.1× |
| Radiologic exam chest 4+ views (71048) |
$519.60 |
$1,299 |
4.9× |
| Radiologic exam colon double contrast study (74280) |
$904 |
$2,260 |
5.1× |
| Radiologic exam colon single contrast study (74270) |
$653.60 |
$1,634 |
3.7× |
| Radiologic exam esophagus double contrast study (74221) |
$661.20 |
$1,653 |
3.8× |
| Radiologic exam esophagus single contrast study (74220) |
$398 |
$995 |
2.3× |
| Radiologic exam small int single contrast study (74250) |
$448.40 |
$1,121 |
2.5× |
| Radiologic exam swallow function contrast study (74230) |
$422.40 |
$1,056 |
2.4× |
| Radiologic exam upr gi trc double contrast study (74246) |
$661.20 |
$1,653 |
3.8× |
| Radiologic exam upr gi trc single contrast study (74240) |
$648.40 |
$1,621 |
3.7× |
| Radiologic examination femur 1 view (73551) |
$256.40 |
$641 |
2.9× |
| Radiologic examination femur minimum 2 views (73552) |
$256.40 |
$641 |
2.9× |
| Radiologic examination, ankle; complete, minimum of 3 views Age Under 21 (73610) |
$382.80 |
$957 |
4.4× |
| Radiologic examination, complete acute abdomen series, including 2 or more views of the abdomen (eg, supine, erect,… (74022) |
$477.60 |
$1,194 |
4.5× |
| Radiologic examination, elbow; 2 views Age Under 21 (73070) |
$347.60 |
$869 |
4.0× |
| Radiologic examination, elbow; complete, minimum of 3 views Age Under 21 (73080) |
$462.60 |
$1,156.50 |
5.3× |
| Radiologic examination, foot; complete, minimum of 3 views Age Under 21 (73630) |
$417 |
$1,042.50 |
4.8× |
| Radiologic examination, hand; minimum of 3 views Age Under 21 (73130) |
$427.40 |
$1,068.50 |
4.9× |
| Radiologic examination, knee; both knees, standing, anteroposterior Age Under 21 (73565) |
$374.80 |
$937 |
4.3× |
| Radiologic examination, knee; complete, 4 or more views Age Under 21 (73564) |
$494.60 |
$1,236.50 |
4.7× |
| Radiologic examination, mandible; partial, less than 4 views Age Under 21 (70100) |
$240 |
$600 |
2.7× |
| Radiologic examination, nasal bones, complete, minimum of 3 views Age Under 21 (70160) |
$264 |
$660 |
3.0× |
| Radiologic examination, pharynx and/or cervical esophagus, including scout neck radiograph(s) and delayed image(s),… (74210) |
$457.60 |
$1,144 |
2.6× |
| Radiologic examination, ribs, bilateral; including posteroanterior chest, minimum of 4 views Age Under 21 (71111) |
$559.60 |
$1,399 |
5.3× |
| Radiologic examination, ribs, unilateral; including posteroanterior chest, minimum of 3 views Age Under 21 (71101) |
$266 |
$665 |
2.5× |
| Radiologic examination, shoulder, arthrography, radiological supervision and interpretation Age Under 21 (73040) |
$676.80 |
$1,692 |
1.9× |
| Radiologic examination, shoulder; complete, minimum of 2 views Age Under 21 (73030) |
$392.40 |
$981 |
4.5× |
| Radiologic examination, single plane body section (eg, tomography), other than with urography Age Under 21 (76100) |
$416 |
$1,040 |
4.0× |
| Radiologic examination, skull; less than 4 views Age Under 21 (70250) |
$278 |
$695 |
2.6× |
| Radiologic examination, spine, lumbosacral; 2 or 3 views Age Under 21 (72100) |
$360.40 |
$901 |
3.4× |
| Radiologic examination, spine, lumbosacral; bending views only, 2 or 3 views Age Under 21 (72120) |
$400 |
$1,000 |
3.8× |
| Radiologic examination, spine, lumbosacral; complete, including bending views, minimum of 6 views Age Under 21 (72114) |
$668.80 |
$1,672 |
6.4× |
| Radiologic examination, teeth; partial examination, less than full mouth Age Under 21 (70310) |
$313.60 |
$784 |
1.3× |
| Radiologic examination, teeth; single view Age Under 21 (70300) |
$113.20 |
$283 |
1.3× |
| Radiologic examination, wrist; complete, minimum of 3 views Age Under 21 (73110) |
$482.20 |
$1,205.50 |
5.5× |
| Radiologic examination; acromioclavicular joints, bilateral, with or without weighted distraction Age Under 21 (73050) |
$239.20 |
$598 |
2.7× |
| Radiologic examination; humerus, minimum of 2 views Age Under 21 (73060) |
$286 |
$715 |
3.3× |
| Radiologic examination; lower extremity, infant, minimum of 2 views Age Under 21 (73592) |
$257.60 |
$644 |
2.9× |
| Radiologic examination; orbits, complete, minimum of 4 views Age Under 21 (70200) |
$133.60 |
$334 |
1.3× |
| Radiologic examination; sternoclavicular joint or joints, minimum of 3 views Age Under 21 (71130) |
$424.80 |
$1,062 |
4.9× |
| Radiologic examination; toe(s), minimum of 2 views Age Under 21 (73660) |
$325.20 |
$813 |
3.7× |
| Radiologic examination; upper extremity, infant, minimum of 2 views Age Under 21 (73092) |
$410 |
$1,025 |
3.9× |
| Radiopharmaceutical localization of tumor, inflammatory process or distribution of radiopharmaceutical agent(s)… (78803) |
$2,943.20 |
$7,358 |
5.4× |
| Radiopharmaceutical therapy, by intravenous administration Age Under 21 (79101) |
$938.80 |
$2,347 |
4.0× |
| Radiopharmaceutical therapy, by oral administration Age Under 21 (79005) |
$928.80 |
$2,322 |
4.0× |
| Remote afterloading high dose rate radionuclide skin surface brachytherapy, includes basic dosimetry, when performed;… (77767) |
$144 |
$360 |
0.4× |
| Remote afterloading high dose rate radionuclide skin surface brachytherapy, includes basic dosimetry, when performed;… (77768) |
$144 |
$360 |
0.4× |
| Review by radiologist of urinary bladder and urethra images with contrast and after passing urine (74455) |
$700 |
$1,750 |
2.9× |
| Rp loclzj tum plnr 1 area single day imaging (78800) |
$1,513.20 |
$3,783 |
3.8× |
| Rp loclzj tum plnr 2+area 1+d img/1 area img>2+d (78801) |
$2,064.40 |
$5,161 |
5.1× |
| Rp loclzj tum plnr whole body 2+ days imaging (78804) |
$5,233.20 |
$13,083 |
9.6× |
| Rp loclzj tum plnr whole body single day imaging (78802) |
$2,723.60 |
$6,809 |
5.0× |
| Rp loclzj tum spect 2 areas (78831) |
$4,614 |
$11,535 |
3.5× |
| Rp loclzj tum spect w/CT 1 (78830) |
$4,614 |
$11,535 |
3.5× |
| Rp loclzj tum spect w/CT 2 (78832) |
$5,233.20 |
$13,083 |
3.6× |
| Rp therapy intra-arterial particulate admn (79445) |
$581.20 |
$1,453 |
2.5× |
| Saline infusion sonohysterography (SIS), including color flow Doppler, when performed Age Under 21 (76831) |
$579.60 |
$1,449 |
2.4× |
| Scapula complete (73010) |
$394.20 |
$985.50 |
3.8× |
| Screening digital breast tomosynthesis bi (77063) |
$46 |
$115 |
— |
| Shuntogram indwelling nonvascular shunt rs&i (75809) |
$463.60 |
$1,159 |
4.4× |
| Simulation intermediate (77285) |
$278 |
$695 |
0.7× |
| Special dosimetry (77331) |
$86.80 |
$217 |
0.6× |
| Special physics consult (77370) |
$289.20 |
$723 |
2.1× |
| Special teletherapy port plan (77321) |
$222.80 |
$557 |
0.6× |
| Special treatment procedure (77470) |
$1,140.60 |
$2,851.50 |
2.1× |
| Splenoportography, radiological supervision and interpretation Age Under 21 (75810) |
$4,462 |
$11,155 |
1.4× |
| Stereotactic body radiation therapy, treatment delivery, per fraction to 1 or more lesions, including image guidance,… (77373) |
$1,610.40 |
$4,026 |
0.9× |
| Surface application of low dose rate radionuclide source (77789) |
$78 |
$195 |
0.8× |
| Tbs technical calculation only (77091) |
$286.40 |
$716 |
3.3× |
| Ther rad simulaj-aided field setting complex (77290) |
$446 |
$1,115 |
1.2× |
| Thyroid carcinoma metastases imaging; limited area (eg, neck and chest only) Age Under 21 (78015) |
$783.20 |
$1,958 |
2.0× |
| Thyroid imaging with vascular flow (78013) |
$478.60 |
$1,196.50 |
1.2× |
| Thyroid met imaging body (78018) |
$1,148.40 |
$2,871 |
2.1× |
| Thyroid uptake single/multiple quant measurement (78012) |
$422 |
$1,055 |
1.1× |
| Thyroid uptake w/blood flow sngle/mult quan meas (78014) |
$861.20 |
$2,153 |
2.1× |
| Tr simulation simple (77280) |
$156.40 |
$391 |
1.2× |
| Treatment device complex (77334) |
$159.60 |
$399 |
0.4× |
| Treatment device intermediate (77333) |
$159.60 |
$399 |
1.2× |
| Treatment device simple (77332) |
$159.60 |
$399 |
1.2× |
| Ultrasound breast limited (76642) |
$382.20 |
$955.50 |
4.4× |
| Ultrasound, abdomen limited (76705) |
$588.80 |
$1,472 |
5.6× |
| Ultrasound, limited, joint or focal evaluation of other nonvascular extremity structure(s) (eg, joint space,… (76882) |
$305.40 |
$763.50 |
2.9× |
| Ultrasound, pelvic (nonobstetric), real time with image documentation; complete Age Under 21 (76856) |
$658.80 |
$1,647 |
6.3× |
| Ultrasound, pregnant uterus, real time with image documentation, fetal and maternal evaluation plus detailed fetal… (76811) |
$636.40 |
$1,591 |
2.7× |
| Ultrasound, pregnant uterus, real time with image documentation, fetal and maternal evaluation, first trimester (< 14… (76801) |
$302.40 |
$756 |
2.9× |
| Ultrasound, transplanted kidney, real time and duplex Doppler with image documentation Age Under 21 (76776) |
$606 |
$1,515 |
5.8× |
| Ultrasound, transrectal; prostate volume study for brachytherapy treatment planning (separate procedure) Age Under 21 (76873) |
$535.20 |
$1,338 |
5.1× |
| Umbilical-artery Doppler (OB) (76820) |
$226 |
$565 |
2.2× |
| Unlisted fluoroscopic procedure (76496) |
$437.60 |
$1,094 |
5.0× |
| Unlisted magnetic resonance procedure (eg, diagnostic, interventional) Age Under 21 (76498) |
$4,703.40 |
$11,758.50 |
53.8× |
| Unlisted musculoskeletal procedure, diagnostic nuclear medicine (78399) |
$588.40 |
$1,471 |
1.5× |
| Unlisted procedure, clinical brachytherapy (77799) |
$116.80 |
$292 |
1.1× |
| Urethrocystography retrograde rs&i (74450) |
$546.80 |
$1,367 |
2.3× |
| Urography (pyelography), intravenous, with or without KUB, with or without tomography Age Under 21 (74400) |
$540 |
$1,350 |
3.1× |
| Urography antegrade rs&i (74425) |
$434 |
$1,085 |
1.2× |
| Us abdominal aorta real time screen study aaa (76706) |
$413.20 |
$1,033 |
3.9× |
| Us breast uni real time with image complete (76641) |
$382.20 |
$955.50 |
3.6× |
| Us chest (76604) |
$480.40 |
$1,201 |
4.6× |
| Us compl joint r-t w/image documentation (76881) |
$365.20 |
$913 |
3.5× |
| Us elastography organ (76981) |
$434.80 |
$1,087 |
4.1× |
| Us encephalogram (76506) |
$325.20 |
$813 |
3.1× |
| Us exam, pelvic, limited (76857) |
$536.40 |
$1,341 |
5.1× |
| Us guided compression repair (76936) |
$956.40 |
$2,391 |
4.4× |
| Us inft hips r-t img dynamic req phys/qhp manj (76885) |
$508 |
$1,270 |
5.8× |
| Us inft hips r-t img lmtd static phys/qhp manj (76886) |
$452 |
$1,130 |
5.2× |
| Us nrv&acc strux 1 xtr compre w/img pr extremity (76883) |
$176.80 |
$442 |
1.7× |
| US OB Follow-Up/Repeat (76816) |
$302.40 |
$756 |
2.9× |
| Us ob transvaginal (76817) |
$300.40 |
$751 |
2.9× |
| Us retroperitoneal complete (76770) |
$559.60 |
$1,399 |
5.3× |
| Us retroperitoneal ltd (76775) |
$456 |
$1,140 |
4.3× |
| Us scrotum (76870) |
$502.80 |
$1,257 |
4.8× |
| Us soft tissue head/neck (76536) |
$558.40 |
$1,396 |
5.3× |
| Us spinal canal (76800) |
$701.20 |
$1,753 |
6.7× |
| Us transrectal (76872) |
$678.40 |
$1,696 |
6.5× |
| Us trgt dyn mbubb 1st les (76978) |
$780.40 |
$1,951 |
2.2× |
| Use 1st target lesion (76982) |
$434.80 |
$1,087 |
4.1× |
| Vasography, vesiculography, or epididymography, radiological supervision and interpretation Age Under 21 (74440) |
$418.80 |
$1,047 |
1.7× |
| Venogram sinus/jugular (75860) |
$1,622 |
$4,055 |
0.5× |
| Venography deep dorsal vein penis radiolgicl supervision interpretation (76499) |
$298.40 |
$746 |
3.4× |
| Venography renal unilateral selective rs&i (75831) |
$1,968 |
$4,920 |
0.6× |
| Venography, caval, inferior, with serialography, radiological supervision and interpretation Age Under 21 (75825) |
$2,326.80 |
$5,817 |
0.7× |
| Venography, caval, superior, with serialography, radiological supervision and interpretation Age Under 21 (75827) |
$2,318 |
$5,795 |
1.5× |
| Venography, extremity, bilateral, radiological supervision and interpretation Age Under 21 (75822) |
$1,070 |
$2,675 |
0.7× |
| Venography, extremity, unilateral, radiological supervision and interpretation Age Under 21 (75820) |
$1,003.20 |
$2,508 |
0.6× |
| Venography, superior sagittal sinus, radiological supervision and interpretation Age Under 21 (75870) |
$5,914.80 |
$14,787 |
1.9× |
| Venous sampling thru cath w/wo angiography rs& (75893) |
$2,926.80 |
$7,317 |
0.5× |
| X-ray exam hips bi 3-4 views (73522) |
$284.80 |
$712 |
2.7× |
| X-ray exam of finger(s) (73140) |
$311 |
$777.50 |
3.6× |
| X-ray exam of knee 1 or 2 (73560) |
$339.80 |
$849.50 |
3.9× |
| X-ray exam ribs bil 3 views (71110) |
$424.80 |
$1,062 |
4.0× |
| X-ray exam ribs uni 2 views (71100) |
$343.60 |
$859 |
3.9× |
| X-ray heel (73650) |
$306.60 |
$766.50 |
3.5× |
| X-ray of joint between lower spine and hip bone 3 or more views|PROFESSIONAL COMPONENT (72202) |
$252.40 |
$631 |
2.4× |
| X-ray retrograde pyelogram (74420) |
$556 |
$1,390 |
1.6× |
| Xr abdomen 1 view (74018) |
$271.60 |
$679 |
3.1× |
| Xr abdomen 2 views (74019) |
$519.60 |
$1,299 |
4.9× |
| Xr arthrogram ankle (73615) |
$690.80 |
$1,727 |
2.0× |
| Xr arthrogram elbow (73085) |
$617.60 |
$1,544 |
1.8× |
| Xr arthrogram hip (73525) |
$682 |
$1,705 |
1.9× |
| Xr arthrogram knee (73580) |
$784 |
$1,960 |
2.2× |
| Xr arthrogram wrist (73115) |
$337.60 |
$844 |
1.0× |
| Xr bone age studies (77072) |
$202 |
$505 |
1.9× |
| Xr bone length study (77073) |
$264.80 |
$662 |
2.5× |
| Xr bone survey infant (77076) |
$607.20 |
$1,518 |
5.8× |
| Xr bone survey ltd (77074) |
$502.80 |
$1,257 |
4.8× |
| Xr chest 1 view (71045) |
$271.60 |
$679 |
3.1× |
| Xr chest 2 views (71046) |
$271.60 |
$679 |
3.1× |
| Xr facial bones 3+ views (70150) |
$292.40 |
$731 |
2.8× |
| Xr foot arthritis pa only bilateral - report(ortho pro) (73620) |
$352 |
$880 |
4.0× |
| Xr forearm 2 views (73090) |
$394.20 |
$985.50 |
4.5× |
| Xr hand 2v (73120) |
$371.80 |
$929.50 |
3.5× |
| Xr hysterosalpingogram (74740) |
$570.80 |
$1,427 |
2.4× |
| Xr myelogram c-spine (72240) |
$1,260 |
$3,150 |
1.6× |
| Xr myelogram l-spine (72265) |
$1,353.60 |
$3,384 |
1.7× |
| Xr myelogram t-spine (72255) |
$1,199.60 |
$2,999 |
1.5× |
| Xr neck soft tissue (70360) |
$258 |
$645 |
3.0× |
| Xr o knee w/ merchant view bilat - report(ortho pro) (73562) |
$423 |
$1,057.50 |
4.8× |
| Xr osseous survey complete (77075) |
$748 |
$1,870 |
7.1× |
| Xr pelvis 1-2 views (72170) |
$253.20 |
$633 |
2.4× |
| Xr pelvis min 3 view (72190) |
$400 |
$1,000 |
3.8× |
| Xr peritoneogram (74190) |
$492.40 |
$1,231 |
0.9× |
| Xr sacrum/coccyx 2+ views (72220) |
$252.40 |
$631 |
2.9× |
| Xr shoulder 1 view (73020) |
$305.40 |
$763.50 |
3.5× |
| Xr sinuses 3+ views (70220) |
$370 |
$925 |
4.2× |
| Xr skull min 4 view (70260) |
$365.60 |
$914 |
3.5× |
| Xr spine 1 view (72020) |
$248 |
$620 |
2.8× |
| Xr sternum 2+ views (71120) |
$241.60 |
$604 |
2.8× |
| Xr surgical specimen (76098) |
$374.80 |
$937 |
0.7× |
| Xr t-spine 2 views (72070) |
$336 |
$840 |
3.2× |
| Xr tibia/fibula 2 views (73590) |
$366.60 |
$916.50 |
4.2× |
| Xr tmj bilateral (70330) |
$365.20 |
$913 |
4.2× |
| Xr tmj unilateral (70328) |
$240 |
$600 |
2.7× |
| Xr venogram renal bilat (75833) |
$10,050 |
$25,125 |
3.2× |
| Xr wrist 2 views (73100) |
$393 |
$982.50 |
4.5× |