| 3-D radiotherapy plan dose-volume histograms (77295) |
$5,746 |
$5,746 |
4.1× |
| Acute gi blood loss imaging (78278) |
$1,885 |
$1,885 |
4.6× |
| Angiography internal mammary rs&i (75756) |
$489 |
$489 |
0.2× |
| Angiography pulmonary bilateral slctv rs&i (75743) |
$481 |
$481 |
0.1× |
Angiography visceral slctv/supraslctv rs&i (75726)
likely a partial charge — not the full procedure |
$459 |
$459 |
0.1× |
| Angiography, adrenal, bilateral, selective, radiological supervision and interpretation Age Under 21 (75733) |
$528 |
$528 |
0.2× |
| Angiography, adrenal, unilateral, selective, radiological supervision and interpretation Age Under 21 (75731) |
$425 |
$425 |
0.1× |
| Angiography, extremity, bilateral, radiological supervision and interpretation Age Under 21 (75716) |
$549 |
$549 |
0.2× |
| Angiography, extremity, unilateral, radiological supervision and interpretation Age Under 21 (75710) |
$3,725 |
$3,725 |
1.2× |
Angiography, pelvic, selective or supraselective, radiological supervision and interpretation Age Under 21 (75736)
likely a partial charge — not the full procedure |
$444 |
$444 |
0.1× |
Angiography, spinal, selective, radiological supervision and interpretation Age Under 21 (75705)
likely a partial charge — not the full procedure |
$626 |
$626 |
0.1× |
| Angrph cath f-up std tcat other than thrombylsis (75898) |
$212 |
$212 |
0.1× |
| Ankle 2 views (73600) |
$200 |
$200 |
2.2× |
| Aortography, abdominal plus bilateral iliofemoral lower extremity, catheter, by serialography, radiological supervision… (75630) |
$468 |
$468 |
0.1× |
| Aortography, abdominal, by serialography, radiological supervision and interpretation Age Under 21 (75625) |
$6,153 |
$6,153 |
1.9× |
| Basic radiation dosimetry calculation (77300) |
$168 |
$168 |
1.2× |
| Brain flow imaging only - nm brain flow only brain death (78610) |
$456 |
$456 |
0.8× |
| Brain imaging, less than 4 static views; with vascular flow Age Under 21 (78601) |
$558 |
$558 |
1.4× |
| Brain imaging, minimum 4 static views; with vascular flow Age Under 21 (78606) |
$857 |
$857 |
1.5× |
| Brain imaging, positron emission tomography (PET); metabolic evaluation Age Under 21 (78608) |
$4,659 |
$4,659 |
3.2× |
| Card MRI w/stress img & dye (75563) |
$3,756.50 |
$3,756.50 |
4.7× |
| Cardiac blood pool imaging (planar), first pass technique; multiple studies, at rest and with stress (exercise and/or… (78483) |
$628 |
$628 |
1.1× |
| Cardiac blood pool imaging (planar), first pass technique; single study, at rest or with stress (exercise and/or… (78481) |
$470 |
$470 |
0.8× |
| Cardiac blood pool imaging, gated equilibrium; multiple studies, wall motion study plus ejection fraction, at rest and… (78473) |
$758 |
$758 |
1.9× |
| Cardiac MRI morphology & function w/o contrast (75557) |
$2,114 |
$2,114 |
8.7× |
| Cardiac MRI w/stress img (75559) |
$2,137 |
$2,137 |
3.8× |
| Cardiac MRI w/wo contrast & further seq (75561) |
$2,142 |
$2,142 |
6.0× |
| Cephalogram, orthodontic Age Under 21 (70350) |
$56 |
$56 |
0.6× |
| Cerebrospinal fluid flow, imaging (not including introduction of material); ventriculography Age Under 21 (78635) |
$873 |
$873 |
1.6× |
| Cholecystography, oral contrast Age Under 21 (74290) |
$180 |
$180 |
1.0× |
| Cineradiography/videoradiography (76120) |
$194 |
$194 |
1.8× |
| Clavicle complete (73000) |
$85 |
$85 |
1.0× |
| Complex dynamic pharyngeal and speech evaluation by cine or video recording Age Under 21 (70371) |
$235 |
$235 |
1.0× |
| Computed tomographic (CT) colonography, diagnostic, including image postprocessing; with contrast material(s) including… (74262) |
$1,140 |
$1,140 |
6.4× |
| Computed tomographic (CT) colonography, diagnostic, including image postprocessing; without contrast material Age Under… (74261) |
$1,358 |
$1,358 |
12.7× |
| Computed tomographic (CT) colonography, screening, including image postprocessing (74263) |
$777.50 |
$777.50 |
3.2× |
| Computed tomographic angiography, abdomen and pelvis, with contrast material(s), including noncontrast images, if… (74174) |
$3,355 |
$3,355 |
9.4× |
| Computed tomographic angiography, abdomen, with contrast material(s), including noncontrast images, if performed, and… (74175) |
$2,300 |
$2,300 |
12.8× |
| Computed tomographic angiography, abdominal aorta and bilateral iliofemoral lower extremity runoff, with contrast… (75635) |
$3,478 |
$3,478 |
19.4× |
| Computed tomographic angiography, chest (noncoronary), with contrast material(s), including noncontrast images, if… (71275) |
$2,715 |
$2,715 |
15.2× |
| Computed tomographic angiography, lower extremity, with contrast material(s), including noncontrast images, if… (73706) |
$2,444 |
$2,444 |
13.6× |
| Computed tomographic angiography, neck, with contrast material(s), including noncontrast images, if performed, and… (70498) |
$2,635 |
$2,635 |
14.7× |
| Computed tomographic angiography, pelvis, with contrast material(s), including noncontrast images, if performed, and… (72191) |
$2,322 |
$2,322 |
13.0× |
| Computed tomographic angiography, upper extremity, with contrast material(s), including noncontrast images, if… (73206) |
$2,504 |
$2,504 |
14.0× |
| Computed tomography, bone mineral density study, 1 or more sites, axial skeleton (eg, hips, pelvis, spine) Age Under 21 (77078) |
$335 |
$335 |
3.8× |
| Computed tomography, cervical spine; without contrast material, followed by contrast material(s) and further sections… (72127) |
$798 |
$798 |
4.5× |
| Computed tomography, lower extremity; without contrast material Age Under 21 (73700) |
$1,445 |
$1,445 |
13.5× |
| Computed tomography, lower extremity; without contrast material, followed by contrast material(s) and further sections… (73702) |
$2,490 |
$2,490 |
13.9× |
| Computed tomography, lumbar spine; without contrast material, followed by contrast material(s) and further sections Age… (72133) |
$798 |
$798 |
4.5× |
| Computed tomography, maxillofacial area; with contrast material(s) Age Under 21 (70487) |
$2,235 |
$2,235 |
12.5× |
| Computed tomography, maxillofacial area; without contrast material Age Under 21 (70486) |
$1,785 |
$1,785 |
16.7× |
| Computed tomography, orbit, sella, or posterior fossa or outer, middle, or inner ear; with contrast material(s) Age… (70481) |
$2,111 |
$2,111 |
11.8× |
| Computed tomography, orbit, sella, or posterior fossa or outer, middle, or inner ear; without contrast material Age… (70480) |
$1,765 |
$1,765 |
16.5× |
| Computed tomography, orbit, sella, or posterior fossa or outer, middle, or inner ear; without contrast material,… (70482) |
$904 |
$904 |
5.0× |
| Computed tomography, soft tissue neck; without contrast material followed by contrast material(s) and further sections… (70492) |
$2,210 |
$2,210 |
12.3× |
| Computed tomography, thoracic spine; without contrast material, followed by contrast material(s) and further sections… (72130) |
$802 |
$802 |
4.5× |
| Computed tomography, thorax, diagnostic; without contrast material, followed by contrast material(s) and further… (71270) |
$3,018 |
$3,018 |
16.8× |
| Continuing medical physics consultation, including assessment of treatment parameters, quality assurance of dose… (77336) |
$952 |
$952 |
6.9× |
| Corpora cavernosography, radiological supervision and interpretation Age Under 21 (74445) |
$141 |
$141 |
1.3× |
| Csf shunt evaluation (78645) |
$830 |
$830 |
1.5× |
| CT abdomen and pelvis without and with contrast (74178) |
$4,500 |
$4,500 |
12.6× |
| CT abdomen and pelvis without contrast (74176) |
$2,849 |
$2,849 |
11.7× |
| CT abdomen w & w/o contrast (74170) |
$2,603 |
$2,603 |
14.5× |
| CT abdomen w/contrast (74160) |
$2,262 |
$2,262 |
12.6× |
| CT abdomen w/o contrast (74150) |
$1,727 |
$1,727 |
16.2× |
| CT angio hrt w/3d image (75574) |
$2,683 |
$2,683 |
7.5× |
| CT cervical spine w/contrast (72126) |
$2,193 |
$2,193 |
6.2× |
| CT cervical spine w/o contrast (72125) |
$1,843 |
$1,843 |
17.3× |
| CT chest w/contrast (71260) |
$2,498 |
$2,498 |
13.9× |
| CT extremity upper w & w/o contrast (73202) |
$2,606.50 |
$2,606.50 |
14.5× |
| CT extremity upper w/o contrast (73200) |
$1,824 |
$1,824 |
17.1× |
| CT head/brain with contrast (70460) |
$1,944 |
$1,944 |
10.8× |
| CT head/brain without and with contrast (70470) |
$2,310 |
$2,310 |
12.9× |
| CT heart c+ cardiac strux&morph cgen hrt ds (75573) |
$2,429 |
$2,429 |
6.8× |
| CT heart contrast eval cardiac structure&morph (75572) |
$1,872 |
$1,872 |
5.3× |
| CT heart no contrast quant eval coronry calcium (75571) |
$299 |
$299 |
3.4× |
| CT l-spine w/contrast (72132) |
$2,231 |
$2,231 |
6.3× |
| CT limited/localized follow up study (76380) |
$614 |
$614 |
6.9× |
| CT lower extremity w/dye (73701) |
$1,800 |
$1,800 |
10.0× |
| CT lumbar spine w/o contrast (72131) |
$1,866 |
$1,866 |
17.5× |
| CT maxillofacial w/wo contrast (70488) |
$3,025 |
$3,025 |
16.9× |
| CT neck w/contrast (70491) |
$1,885 |
$1,885 |
10.5× |
| CT neck w/o contrast (70490) |
$1,790 |
$1,790 |
16.8× |
| CT pelvis w & w/o contrast (72194) |
$2,773 |
$2,773 |
15.5× |
| CT pelvis w/o contrast (72192) |
$1,878 |
$1,878 |
17.6× |
| CT thoracic spine w/contrast (72129) |
$2,377 |
$2,377 |
13.3× |
| CT thoracic spine w/o contrast (72128) |
$1,796 |
$1,796 |
16.8× |
| CT thorax lung cancer scr c- (71271) |
$1,051 |
$1,051 |
9.8× |
| CT thorax w/o contrast (71250) |
$1,990 |
$1,990 |
18.6× |
| CT upper extremity w/dye (73201) |
$2,285 |
$2,285 |
6.4× |
| CTA head w contrast (70496) |
$2,365 |
$2,365 |
13.2× |
| Cystography, minimum of 3 views, radiological supervision and interpretation Age Under 21 (74430) |
$427.50 |
$427.50 |
1.2× |
| Dacryocystography, nasolacrimal duct, radiological supervision and interpretation Age Under 21 (70170) |
$38 |
$38 |
0.2× |
| Determination of central c-v hemodynamics (non-imaging) (eg, ejection fraction with probe technique) with or without… (78414) |
$57 |
$57 |
0.1× |
| Dilation ureters/urethra rs&i (74485) |
$250 |
$250 |
0.1× |
| Discography, cervical or thoracic, radiological supervision and interpretation Age Under 21 (72285) |
$299 |
$299 |
0.1× |
| Diskography lumbar s&i (72295) |
$1,663.50 |
$1,663.50 |
0.8× |
| Doppler echocardiography, fetal, pulsed wave and/or continuous wave with spectral display; complete Age Under 21 (76827) |
$544.50 |
$544.50 |
5.1× |
| Doppler fetal mid cerebral artery (76821) |
$291.50 |
$291.50 |
2.7× |
| Dual-energy X-ray absorptiometry (DXA), bone density study, 1 or more sites; axial skeleton (eg, hips, pelvis, spine)… (77080) |
$482 |
$482 |
4.5× |
| Dxa bone density/peripheral (77081) |
$309 |
$309 |
3.5× |
| Echo exam of eye thickness (76514) |
$39 |
$39 |
1.3× |
| Echocardiography, fetal, cardiovascular system, real time with image documentation (2D), with or without M-mode… (76825) |
$940 |
$940 |
1.7× |
| Esophageal motility (78258) |
$579 |
$579 |
1.4× |
| Fetal biophys profile w/o nst (76819) |
$280 |
$280 |
2.6× |
| Fetal biophysical profile non-stress testing (76818) |
$572 |
$572 |
5.4× |
| Fluoroscopy up to 1 hour physician/qhp time (76000) |
$200 |
$200 |
0.8× |
| Full mouth X-ray of teeth (70320) |
$140 |
$140 |
0.6× |
| Gastroesophageal reflux study (78262) |
$646 |
$646 |
1.6× |
| Gastrointestinal endoscopic ultrasound, supervision and interpretation Age Under 21 (76975) |
$110 |
$110 |
0.5× |
| Gated heart planar single (78472) |
$4,171 |
$4,171 |
10.2× |
| Hdr rdncl ntrstl/intrcav brachytx 1 channel (77770) |
$6,172 |
$6,172 |
8.7× |
| Hdr rdncl ntrstl/intrcav brachytx 2-12 channel (77771) |
$8,080 |
$8,080 |
11.4× |
| Hdr rdncl ntrstl/intrcav brachytx >12 channels (77772) |
$5,723 |
$5,723 |
8.0× |
| Heart infarct image (78466) |
$507 |
$507 |
1.2× |
| Hepatobil syst imag inc gb w/pharma intervenj (78227) |
$2,594 |
$2,594 |
4.7× |
| Hepatobiliary syst imaging including gallbladder (78226) |
$2,304 |
$2,304 |
5.6× |
| High energy neutron radiation treatment delivery, 1 or more isocenter(s) with coplanar or non-coplanar geometry with… (77423) |
$721 |
$721 |
1.3× |
| Ht muscle image spect sing (78451) |
$2,552.50 |
$2,552.50 |
1.9× |
| Infusion or instillation of radioelement solution (includes 3-month follow-up care) (77750) |
$907 |
$907 |
2.3× |
| Injection procedure for radiopharmaceutical localization by non-imaging probe study, intravenous (eg, parathyroid… (78808) |
$115 |
$115 |
0.3× |
| Intensity modulated radiotherapy plan, including dose-volume histograms for target and critical structure partial… (77301) |
$4,988 |
$4,988 |
3.5× |
| Interstitial radiation source application, complex, includes supervision, handling, loading of radiation source, when… (77778) |
$5,700 |
$5,700 |
8.0× |
| Intestine imaging (eg, ectopic gastric mucosa, Meckel's localization, volvulus) Age Under 21 (78290) |
$981 |
$981 |
2.4× |
| Intracavitary radiation source application - complex (77763) |
$3,040 |
$3,040 |
4.3× |
| Intracavitary radiation source application - intermediate (77762) |
$2,130 |
$2,130 |
3.8× |
| Intracavitary radiation source application - simple (77761) |
$1,610 |
$1,610 |
2.9× |
| Isodose brachytherapy complex 10+ sources (77318) |
$2,759 |
$2,759 |
7.2× |
| Isodose brachytherapy intermed 5 to 10 sources (77317) |
$2,286 |
$2,286 |
6.0× |
| Isodose brachytherapy plan simple 1 to 4 source (77316) |
$1,664 |
$1,664 |
4.3× |
| Kidney function study, non-imaging radioisotopic study Age Under 21 (78725) |
$286 |
$286 |
0.7× |
| Kidney imaging morphol - nm kidney cortex (78700) |
$457 |
$457 |
1.1× |
| Kidney imaging morphology; with vascular flow Age Under 21 (78701) |
$551 |
$551 |
1.3× |
| Kidney imaging morphology; with vascular flow and function, single study without pharmacological intervention Age Under… (78707) |
$2,078 |
$2,078 |
3.7× |
| Labeled red cell sequestration, differential organ/tissue (eg, splenic and/or hepatic) Age Under 21 (78140) |
$348 |
$348 |
0.9× |
| Leveen/shunt patency exam (78291) |
$660 |
$660 |
1.6× |
| Liver and spleen imaging (78215) |
$1,355 |
$1,355 |
3.3× |
| Liver and spleen imaging; with vascular flow Age Under 21 (78216) |
$318 |
$318 |
0.8× |
| Liver imaging (78201) |
$481 |
$481 |
0.9× |
| Liver imaging with flow (78202) |
$568 |
$568 |
1.0× |
| Lung perf&ventilat diferentl (78598) |
$911 |
$911 |
1.6× |
| Lung perfusion imaging (78580) |
$1,795 |
$1,795 |
4.4× |
| Lymphangiography, extremity only, bilateral, radiological supervision and interpretation Age Under 21 (75803) |
$147 |
$147 |
0.1× |
| Lymphangiography, extremity only, unilateral, radiological supervision and interpretation Age Under 21 (75801) |
$115 |
$115 |
0.2× |
| Magnetic resonance (eg, proton) imaging, any joint of lower extremity; without contrast material(s), followed by… (73723) |
$2,720 |
$2,720 |
7.6× |
| Magnetic resonance (eg, proton) imaging, lower extremity other than joint; with contrast material(s) Age Under 21 (73719) |
$2,450 |
$2,450 |
6.9× |
| Magnetic resonance (eg, proton) imaging, lower extremity other than joint; without contrast material(s) Age Under 21 (73718) |
$2,175 |
$2,175 |
8.9× |
| Magnetic resonance (eg, proton) imaging, lower extremity other than joint; without contrast material(s), followed by… (73720) |
$2,952 |
$2,952 |
8.3× |
| Magnetic resonance (eg, proton) imaging, orbit, face, and/or neck; with contrast material(s) Age Under 21 (70542) |
$2,300 |
$2,300 |
6.5× |
| Magnetic resonance (eg, proton) imaging, orbit, face, and/or neck; without contrast material(s) Age Under 21 (70540) |
$2,025 |
$2,025 |
8.3× |
| Magnetic resonance (eg, proton) imaging, upper extremity, other than joint; with contrast material(s) Age Under 21 (73219) |
$2,570 |
$2,570 |
7.2× |
| Magnetic resonance (eg, proton) imaging, upper extremity, other than joint; without contrast material(s), followed by… (73220) |
$3,039 |
$3,039 |
8.5× |
| Magnetic resonance angiography, head; with contrast material(s) Age Under 21 (70545) |
$2,650 |
$2,650 |
7.4× |
| Magnetic resonance angiography, head; without contrast material(s), followed by contrast material(s) and further… (70546) |
$3,163 |
$3,163 |
8.9× |
| Magnetic resonance angiography, neck; without contrast material(s), followed by contrast material(s) and further… (70549) |
$3,509 |
$3,509 |
9.8× |
| Magnetic resonance imaging, brain, functional MRI; including test selection and administration of repetitive body part… (70554) |
$1,246 |
$1,246 |
5.1× |
| Magnetic resonance imaging, brain, functional MRI; requiring physician or psychologist administration of entire… (70555) |
$320 |
$320 |
1.3× |
| Mammary ductogram or galactogram, multiple ducts, radiological supervision and interpretation Age Under 21 (77054) |
$630 |
$630 |
2.6× |
| Mammary ductogram single (77053) |
$477 |
$477 |
2.0× |
| Mandible min 4v (70110) |
$291.50 |
$291.50 |
2.7× |
| Mr safety determination physician/other qhp (76016) |
$236 |
$236 |
2.7× |
| Mr safety implant&/fb assmt clin staf 1st 15 min (76014) |
$65 |
$65 |
2.2× |
| Mr safety implt electronics prepj supvj phys/qhp (76018) |
$246 |
$246 |
2.5× |
| Mr safety med physics xm customization plng&mntr (76017) |
$647 |
$647 |
2.7× |
| MRA head w/o contrast (70544) |
$2,299 |
$2,299 |
9.4× |
| MRA neck w/ contrast (70548) |
$2,950 |
$2,950 |
8.3× |
| MRA neck w/o contrast (70547) |
$2,489 |
$2,489 |
10.2× |
| MRI abdomen w/contrast (74182) |
$3,156 |
$3,156 |
8.9× |
| MRI abdomen w/o contrast (74181) |
$2,505 |
$2,505 |
10.3× |
| MRI abdomen w/wo contrast (74183) |
$3,075 |
$3,075 |
8.6× |
| MRI any jt lower extrem w/contrast material (73722) |
$1,556 |
$1,556 |
1.9× |
| MRI bone marrow (77084) |
$1,423.50 |
$1,423.50 |
5.8× |
| MRI brain w/dye (70558) |
$403 |
$403 |
2.2× |
| MRI brain w/o & w/dye (70559) |
$404 |
$404 |
2.3× |
| MRI breast c- bilateral (77047) |
$2,194 |
$2,194 |
9.0× |
| MRI c-spine w&w/o cont (72156) |
$3,565 |
$3,565 |
10.0× |
| MRI cervical spine w/contrast (72142) |
$3,000 |
$3,000 |
8.4× |
| MRI chest w/contrast (71551) |
$2,700 |
$2,700 |
3.4× |
| MRI chest w/o contrast (71550) |
$2,483 |
$2,483 |
10.2× |
| MRI chest w/wo contrast (71552) |
$3,529 |
$3,529 |
9.9× |
| MRI joint upr extr w/o&w/dye (73223) |
$2,905 |
$2,905 |
8.2× |
| MRI joint upr extrem w/dye (73222) |
$2,423 |
$2,423 |
3.0× |
| MRI joint upr extrem w/o dye (73221) |
$1,297 |
$1,297 |
5.3× |
| MRI lumbar spine w/contrast (72149) |
$3,000 |
$3,000 |
8.4× |
| MRI lumbar spine w/wo contrast (72158) |
$3,564 |
$3,564 |
10.0× |
| MRI orbit/face/neck w&w/o cont (70543) |
$2,922 |
$2,922 |
8.2× |
| MRI pelvis w & w/o contrast (72197) |
$3,444 |
$3,444 |
9.7× |
| MRI pelvis w/contrast (72196) |
$3,000 |
$3,000 |
8.4× |
| MRI pelvis w/o contrast (72195) |
$2,594 |
$2,594 |
10.6× |
| MRI spine cervical w/o contrast (72141) |
$2,521 |
$2,521 |
10.3× |
| MRI t-spine w&w/o cont (72157) |
$3,504 |
$3,504 |
9.8× |
| MRI thoracic spine w/contrast (72147) |
$2,950 |
$2,950 |
8.3× |
| MRI thoracic spine w/o contrst (72146) |
$2,426 |
$2,426 |
10.0× |
| MRI tmj (70336) |
$1,977 |
$1,977 |
8.1× |
| MRI upper extremity oth than jt w/o contr matrl (73218) |
$1,422.50 |
$1,422.50 |
5.8× |
| Multi-leaf collimator (MLC) device(s) for intensity modulated radiation therapy (IMRT), design and construction per… (77338) |
$1,258 |
$1,258 |
3.3× |
| Myelography, 2 or more regions (eg, lumbar/thoracic, cervical/thoracic, lumbar/cervical, lumbar/thoracic/cervical),… (72270) |
$503 |
$503 |
0.6× |
| Myocardial imaging, positron emission tomography (PET), perfusion study (including ventricular wall motionºs» and/or… (78491) |
$181 |
$181 |
0.1× |
| Myocardial imaging, positron emission tomography (PET), perfusion study (including ventricular wall motionºs» and/or… (78492) |
$224 |
$224 |
0.2× |
| Myocardial perfusion imaging, planar (including qualitative or quantitative wall motion, ejection fraction by first… (78453) |
$784 |
$784 |
0.6× |
| Myocardial perfusion imaging, planar (including qualitative or quantitative wall motion, ejection fraction by first… (78454) |
$1,127 |
$1,127 |
0.9× |
| Myocardial spect multiple studies (78452) |
$3,032 |
$3,032 |
2.3× |
| Myocrd img PET metab eval single study (78459) |
$177 |
$177 |
0.1× |
| Nm adrenal imaging (78075) |
$1,105 |
$1,105 |
0.8× |
| Nm bone 3 phase (78315) |
$2,694 |
$2,694 |
6.6× |
| Nm bone imaging whole body (78306) |
$2,442 |
$2,442 |
6.0× |
| Nm bone marrow ltd (78102) |
$438 |
$438 |
1.1× |
| Nm bone marrow multi (78103) |
$559 |
$559 |
1.4× |
| Nm bone marrow wb (78104) |
$640 |
$640 |
1.6× |
| Nm csf cisternogram (78630) |
$2,441 |
$2,441 |
4.4× |
| Nm csf leak detection (78650) |
$861 |
$861 |
0.7× |
| Nm gastric emptying (78264) |
$2,159 |
$2,159 |
5.3× |
| Nm lung ventilation imaging (78579) |
$785 |
$785 |
1.9× |
| Nm lymph system (78195) |
$1,810 |
$1,810 |
3.3× |
| Nm myocard infarct spect (78469) |
$586 |
$586 |
1.1× |
| Nm salivary gland (78230) |
$447 |
$447 |
1.1× |
| Non-cardiac vascular flow imaging (ie, angiography, venography) Age Under 21 (78445) |
$505 |
$505 |
1.2× |
| Nuclear medicine study for detecting heart shunt (78428) |
$475 |
$475 |
1.2× |
| Nuclear medicine study of bone and/or joint limited area (78300) |
$2,519 |
$2,519 |
6.2× |
| Nuclear medicine study of bone and/or joint multiple areas (78305) |
$855 |
$855 |
2.1× |
| Nuclear medicine study of brain, 4 static views or more (78605) |
$510 |
$510 |
0.9× |
| Nuclear medicine study of brain, less than 4 static views (78600) |
$473 |
$473 |
1.2× |
| Nuclear medicine study of heart muscle following heart attack with measurement of internal blood volume ejected with… (78468) |
$516 |
$516 |
0.9× |
| Nuclear medicine study of heart pumping function by labeling red blood cells with measurement of internal blood volume… (78494) |
$593 |
$593 |
1.5× |
| Nuclear medicine study of platelet survival (78191) |
$415 |
$415 |
1.0× |
| Nuclear medicine study of red blood cell survival (78130) |
$414 |
$414 |
1.0× |
| Nuclear medicine study of salivary gland function (78232) |
$250 |
$250 |
0.6× |
| Nuclear medicine study of salivary gland with serial images (78231) |
$332 |
$332 |
0.8× |
| Nuclear medicine study of stomach lining (78261) |
$652 |
$652 |
1.6× |
| Nuclear medicine study to assess blood clot in vein of both sides (78458) |
$483 |
$483 |
1.2× |
| Nuclear medicine study to assess blood clot in vein using radiolabeled peptide (78456) |
$915 |
$915 |
0.7× |
| Nuclear medicine study to assess protein loss into the digestive tract (78282) |
$47 |
$47 |
0.1× |
| Ob us limited fetus(s) (76815) |
$320 |
$320 |
3.0× |
| Ob us nuchal meas 1 gest (76813) |
$382.50 |
$382.50 |
3.6× |
| Ophthalmic biometry by ultrasound echography, A-scan; with intraocular lens power calculation Age Under 21 (76519) |
$220 |
$220 |
2.1× |
| Ophthalmic ultrasound, diagnostic; anterior segment ultrasound, immersion (water bath) B-scan or high resolution… (76513) |
$250 |
$250 |
2.3× |
| Ophthalmic ultrasound, diagnostic; B-scan (with or without superimposed non-quantitative A-scan) Age Under 21 (76512) |
$241 |
$241 |
2.3× |
| Ophthalmic ultrasound, diagnostic; B-scan and quantitative A-scan performed during the same patient encounter Age Under… (76510) |
$461 |
$461 |
3.4× |
| Panoramic X-ray of jaws (70355) |
$54 |
$54 |
0.6× |
| Parathyrd planar w/spect&CT (78072) |
$1,755 |
$1,755 |
3.2× |
| Parathyroid planar imaging (78070) |
$2,223 |
$2,223 |
5.4× |
| Parathyroid planar imaging w/wo subtraction (78071) |
$1,722 |
$1,722 |
4.2× |
| Perineogram (eg, vaginogram, for sex determination or extent of anomalies) Age Under 21 (74775) |
$78 |
$78 |
0.3× |
| PET imaging CT attenuation skull base mid-thigh (78815) |
$3,931.50 |
$3,931.50 |
2.7× |
| PET imaging CT for attenuation limited area (78814) |
$271 |
$271 |
0.2× |
| PET imaging for CT attenuation whole body (78816) |
$4,351.50 |
$4,351.50 |
3.0× |
| PET imaging whole body (78813) |
$245 |
$245 |
0.2× |
| Plasma volume multiple (78111) |
$218 |
$218 |
0.2× |
| Plasma volume, radiopharmaceutical volume-dilution technique (separate procedure); single sampling Age Under 21 (78110) |
$238 |
$238 |
0.2× |
| Positron emission tomography (PET) imaging; limited area (eg, chest, head/neck) Age Under 21 (78811) |
$195 |
$195 |
0.1× |
| Positron emission tomography (PET) imaging; skull base to mid-thigh Age Under 21 (78812) |
$235 |
$235 |
0.2× |
| Pulmonary ventilation & perfusion imaging (78582) |
$1,923.50 |
$1,923.50 |
3.5× |
| Quant differential pulm perfusion w/wo imaging (78597) |
$611 |
$611 |
1.5× |
| Radex abscess/fistula/sinus tract rs&i (76080) |
$148 |
$148 |
0.3× |
| Radex entir thrc lmbr crv sac spi w/skull 1 vw (72081) |
$355 |
$355 |
4.0× |
| Radex entir thrc lmbr crv sac spi w/skull 2/3 vw (72082) |
$526 |
$526 |
4.9× |
| Radex hip unilateral with pelvis 1 view (73501) |
$219 |
$219 |
2.5× |
| Radex hip unilateral with pelvis 2-3 views (73502) |
$282.50 |
$282.50 |
3.2× |
| Radex hips bilateral with pelvis 2 views (73521) |
$363 |
$363 |
3.4× |
| Radex spine cervical 2 or 3 views (72040) |
$231.50 |
$231.50 |
2.6× |
| Radex spine cervical 4 or 5 views (72050) |
$318.50 |
$318.50 |
3.0× |
| Radex spine cervical 6 or more views (72052) |
$424 |
$424 |
4.0× |
| Radex spine thoracolumbar junction min 2 views (72080) |
$281.50 |
$281.50 |
3.2× |
Radiation treatment delivery, stereotactic radiosurgery (SRS), complete course of treatment of cranial lesion(s)… (77372)
likely a partial charge — not the full procedure |
$1,963 |
$1,963 |
0.3× |
| Radiologic exam abdomen 3+ views (74021) |
$274.50 |
$274.50 |
2.6× |
| Radiologic exam chest 3 views (71047) |
$248.50 |
$248.50 |
2.8× |
| Radiologic exam chest 4+ views (71048) |
$316.50 |
$316.50 |
3.0× |
| Radiologic exam colon double contrast study (74280) |
$1,013 |
$1,013 |
5.7× |
| Radiologic exam colon single contrast study (74270) |
$920 |
$920 |
5.1× |
| Radiologic exam esophagus double contrast study (74221) |
$798 |
$798 |
4.5× |
| Radiologic exam esophagus single contrast study (74220) |
$761 |
$761 |
4.2× |
| Radiologic exam small int single contrast study (74250) |
$840 |
$840 |
4.7× |
| Radiologic exam swallow function contrast study (74230) |
$800 |
$800 |
4.5× |
| Radiologic exam upr gi trc double contrast study (74246) |
$1,279 |
$1,279 |
7.1× |
| Radiologic exam upr gi trc single contrast study (74240) |
$920 |
$920 |
5.1× |
| Radiologic examination femur minimum 2 views (73552) |
$198.50 |
$198.50 |
2.2× |
| Radiologic examination from nose to rectum for foreign body, single view, child Age Under 21 (76010) |
$120 |
$120 |
1.3× |
| Radiologic examination, ankle; complete, minimum of 3 views Age Under 21 (73610) |
$253.50 |
$253.50 |
2.9× |
| Radiologic examination, complete acute abdomen series, including 2 or more views of the abdomen (eg, supine, erect,… (74022) |
$315 |
$315 |
2.9× |
| Radiologic examination, elbow; 2 views Age Under 21 (73070) |
$201 |
$201 |
2.3× |
| Radiologic examination, elbow; complete, minimum of 3 views Age Under 21 (73080) |
$252.50 |
$252.50 |
2.8× |
| Radiologic examination, facial bones; less than 3 views Age Under 21 (70140) |
$192.50 |
$192.50 |
2.2× |
| Radiologic examination, foot; complete, minimum of 3 views Age Under 21 (73630) |
$387 |
$387 |
4.4× |
| Radiologic examination, hand; minimum of 3 views Age Under 21 (73130) |
$385 |
$385 |
4.3× |
| Radiologic examination, internal auditory meati, complete Age Under 21 (70134) |
$119 |
$119 |
0.2× |
| Radiologic examination, knee; both knees, standing, anteroposterior Age Under 21 (73565) |
$191.50 |
$191.50 |
2.2× |
| Radiologic examination, knee; complete, 4 or more views Age Under 21 (73564) |
$496 |
$496 |
4.6× |
| Radiologic examination, mandible; partial, less than 4 views Age Under 21 (70100) |
$250.50 |
$250.50 |
2.8× |
| Radiologic examination, mastoids; complete, minimum of 3 views per side Age Under 21 (70130) |
$171 |
$171 |
1.6× |
| Radiologic examination, nasal bones, complete, minimum of 3 views Age Under 21 (70160) |
$203 |
$203 |
2.3× |
| Radiologic examination, pharynx and/or cervical esophagus, including scout neck radiograph(s) and delayed image(s),… (74210) |
$201 |
$201 |
1.1× |
| Radiologic examination, renal cyst study, translumbar, contrast visualization, radiological supervision and… (74470) |
$66 |
$66 |
0.1× |
| Radiologic examination, ribs, bilateral; including posteroanterior chest, minimum of 4 views Age Under 21 (71111) |
$400.50 |
$400.50 |
3.7× |
| Radiologic examination, ribs, unilateral; including posteroanterior chest, minimum of 3 views Age Under 21 (71101) |
$290 |
$290 |
2.7× |
| Radiologic examination, salivary gland for calculus Age Under 21 (70380) |
$102 |
$102 |
1.1× |
| Radiologic examination, shoulder, arthrography, radiological supervision and interpretation Age Under 21 (73040) |
$1,335 |
$1,335 |
3.7× |
| Radiologic examination, shoulder; complete, minimum of 2 views Age Under 21 (73030) |
$256 |
$256 |
2.9× |
| Radiologic examination, single plane body section (eg, tomography), other than with urography Age Under 21 (76100) |
$310 |
$310 |
2.9× |
| Radiologic examination, sinuses, paranasal, less than 3 views Age Under 21 (70210) |
$184 |
$184 |
2.1× |
| Radiologic examination, skull; less than 4 views Age Under 21 (70250) |
$430 |
$430 |
4.0× |
| Radiologic examination, spine, lumbosacral; 2 or 3 views Age Under 21 (72100) |
$269.50 |
$269.50 |
2.5× |
| Radiologic examination, spine, lumbosacral; complete, including bending views, minimum of 6 views Age Under 21 (72114) |
$465.50 |
$465.50 |
4.4× |
| Radiologic examination, wrist; complete, minimum of 3 views Age Under 21 (73110) |
$250 |
$250 |
2.8× |
| Radiologic examination; acromioclavicular joints, bilateral, with or without weighted distraction Age Under 21 (73050) |
$299.50 |
$299.50 |
3.4× |
| Radiologic examination; humerus, minimum of 2 views Age Under 21 (73060) |
$218 |
$218 |
2.5× |
| Radiologic examination; lower extremity, infant, minimum of 2 views Age Under 21 (73592) |
$91.50 |
$91.50 |
1.0× |
| Radiologic examination; orbits, complete, minimum of 4 views Age Under 21 (70200) |
$354 |
$354 |
3.3× |
| Radiologic examination; pharynx or larynx, including fluoroscopy and/or magnification technique Age Under 21 (70370) |
$210 |
$210 |
2.4× |
| Radiologic examination; sternoclavicular joint or joints, minimum of 3 views Age Under 21 (71130) |
$251.50 |
$251.50 |
2.8× |
| Radiologic examination; toe(s), minimum of 2 views Age Under 21 (73660) |
$186.50 |
$186.50 |
2.1× |
| Radiologic examination; upper extremity, infant, minimum of 2 views Age Under 21 (73092) |
$116 |
$116 |
1.1× |
| Radiopharmaceutical dacryocystography Age Under 21 (78660) |
$488 |
$488 |
1.2× |
| Radiopharmaceutical localization of tumor, inflammatory process or distribution of radiopharmaceutical agent(s)… (78803) |
$1,945 |
$1,945 |
3.5× |
| Radiopharmaceutical therapy, by interstitial radioactive colloid administration (79300) |
$201 |
$201 |
0.8× |
| Radiopharmaceutical therapy, by intra-articular administration Age Under 21 (79440) |
$358 |
$358 |
1.5× |
| Radiopharmaceutical therapy, by intracavitary administration Age Under 21 (79200) |
$392 |
$392 |
1.6× |
| Radiopharmaceutical therapy, by intravenous administration Age Under 21 (79101) |
$1,150 |
$1,150 |
4.8× |
| Radiopharmaceutical therapy, by oral administration Age Under 21 (79005) |
$2,102 |
$2,102 |
8.8× |
| Radiopharmaceutical therapy, radiolabeled monoclonal antibody by intravenous infusion (79403) |
$477 |
$477 |
2.0× |
| Red cell mass multiple (78121) |
$199 |
$199 |
0.4× |
| Red cell volume determination (separate procedure); single sampling Age Under 21 (78120) |
$235 |
$235 |
0.6× |
| Remote afterloading high dose rate radionuclide skin surface brachytherapy, includes basic dosimetry, when performed;… (77767) |
$1,395 |
$1,395 |
3.5× |
| Remote afterloading high dose rate radionuclide skin surface brachytherapy, includes basic dosimetry, when performed;… (77768) |
$2,406 |
$2,406 |
6.1× |
| Review by radiologist of urinary bladder and urethra images with contrast and after passing urine (74455) |
$738 |
$738 |
3.0× |
| Rp loclzj tum plnr 1 area single day imaging (78800) |
$490 |
$490 |
1.2× |
| Rp loclzj tum plnr 2+area 1+d img/1 area img>2+d (78801) |
$1,835 |
$1,835 |
4.5× |
| Rp loclzj tum plnr whole body 2+ days imaging (78804) |
$4,711 |
$4,711 |
8.5× |
| Rp therapy intra-arterial particulate admn (79445) |
$286 |
$286 |
1.2× |
| Saline infusion sonohysterography (SIS), including color flow Doppler, when performed Age Under 21 (76831) |
$386.50 |
$386.50 |
1.6× |
| Scapula complete (73010) |
$242 |
$242 |
2.3× |
| Screening digital breast tomosynthesis bi (77063) |
$81 |
$81 |
— |
| Shuntogram indwelling nonvascular shunt rs&i (75809) |
$266 |
$266 |
2.5× |
| Special dosimetry (77331) |
$430.50 |
$430.50 |
3.1× |
| Special physics consult (77370) |
$1,531 |
$1,531 |
11.1× |
| Special teletherapy port plan (77321) |
$228 |
$228 |
0.6× |
| Special treatment procedure (77470) |
$2,288 |
$2,288 |
4.1× |
| Spleen imaging only, with or without vascular flow Age Under 21 (78185) |
$547 |
$547 |
1.3× |
| Splenoportography, radiological supervision and interpretation Age Under 21 (75810) |
$142 |
$142 |
0.0× |
| Stereotactic body radiation therapy, treatment delivery, per fraction to 1 or more lesions, including image guidance,… (77373) |
$3,173 |
$3,173 |
1.7× |
| Surface application of low dose rate radionuclide source (77789) |
$296 |
$296 |
2.8× |
| Testicular imaging with vascular flow Age Under 21 (78761) |
$557 |
$557 |
1.4× |
| Ther rad simulaj-aided field setting complex (77290) |
$2,974 |
$2,974 |
7.8× |
| Therapeutic enema, contrast or air, for reduction of intussusception or other intraluminal obstruction (eg, meconium… (74283) |
$880 |
$880 |
4.9× |
| Thyroid imaging with vascular flow (78013) |
$668 |
$668 |
1.6× |
| Thyroid met imaging body (78018) |
$2,368 |
$2,368 |
4.3× |
| Thyroid uptake single/multiple quant measurement (78012) |
$630 |
$630 |
1.5× |
| Thyroid uptake w/blood flow sngle/mult quan meas (78014) |
$1,933 |
$1,933 |
4.7× |
| Tr simulation simple (77280) |
$1,578 |
$1,578 |
11.5× |
| Treatment device complex (77334) |
$1,691 |
$1,691 |
4.4× |
| Treatment device simple (77332) |
$695 |
$695 |
5.1× |
| Ultrasound breast limited (76642) |
$456.50 |
$456.50 |
5.1× |
| Ultrasound, abdomen limited (76705) |
$601 |
$601 |
5.6× |
| Ultrasound, limited, joint or focal evaluation of other nonvascular extremity structure(s) (eg, joint space,… (76882) |
$445 |
$445 |
4.2× |
| Ultrasound, pelvic (nonobstetric), real time with image documentation; complete Age Under 21 (76856) |
$594 |
$594 |
5.6× |
| Ultrasound, pregnant uterus, real time with image documentation, fetal and maternal evaluation plus detailed fetal… (76811) |
$845 |
$845 |
3.5× |
| Ultrasound, pregnant uterus, real time with image documentation, fetal and maternal evaluation, first trimester (< 14… (76801) |
$450 |
$450 |
4.2× |
| Ultrasound, transplanted kidney, real time and duplex Doppler with image documentation Age Under 21 (76776) |
$779 |
$779 |
7.3× |
| Ultrasound, transrectal; prostate volume study for brachytherapy treatment planning (separate procedure) Age Under 21 (76873) |
$435 |
$435 |
4.1× |
| Umbilical-artery Doppler (OB) (76820) |
$267 |
$267 |
2.5× |
| Unlisted magnetic resonance procedure (eg, diagnostic, interventional) Age Under 21 (76498) |
$7,000 |
$7,000 |
78.7× |
| Unlisted procedure, clinical brachytherapy (77799) |
$1,081 |
$1,081 |
10.4× |
| Ureteral reflux study (78740) |
$520 |
$520 |
1.3× |
| Urethrocystography retrograde rs&i (74450) |
$796 |
$796 |
3.3× |
| Urography antegrade rs&i (74425) |
$989 |
$989 |
2.8× |
| Urography, infusion, drip technique and/or bolus technique; Age Under 21 (74410) |
$395 |
$395 |
2.2× |
| Urography, infusion, drip technique and/or bolus technique; with nephrotomography Age Under 21 (74415) |
$605 |
$605 |
3.4× |
| Us abdominal aorta real time screen study aaa (76706) |
$593 |
$593 |
5.6× |
| Us breast uni real time with image complete (76641) |
$623 |
$623 |
5.8× |
| Us chest (76604) |
$559 |
$559 |
5.2× |
| Us compl joint r-t w/image documentation (76881) |
$588 |
$588 |
5.5× |
| Us encephalogram (76506) |
$301 |
$301 |
2.8× |
| Us exam, pelvic, limited (76857) |
$210 |
$210 |
2.0× |
| Us guided compression repair (76936) |
$722 |
$722 |
3.3× |
| Us inft hips r-t img dynamic req phys/qhp manj (76885) |
$385 |
$385 |
4.3× |
| Us inft hips r-t img lmtd static phys/qhp manj (76886) |
$287.50 |
$287.50 |
3.2× |
| US OB Follow-Up/Repeat (76816) |
$420 |
$420 |
3.9× |
| Us ob transvaginal (76817) |
$300 |
$300 |
2.8× |
| Us retroperitoneal complete (76770) |
$832 |
$832 |
7.8× |
| Us retroperitoneal ltd (76775) |
$523 |
$523 |
4.9× |
| Us scrotum (76870) |
$651 |
$651 |
6.1× |
| Us soft tissue head/neck (76536) |
$663 |
$663 |
6.2× |
| Us spinal canal (76800) |
$385 |
$385 |
3.6× |
| Us transrectal (76872) |
$595 |
$595 |
5.6× |
| Vasography, vesiculography, or epididymography, radiological supervision and interpretation Age Under 21 (74440) |
$216 |
$216 |
0.9× |
| Venogram sinus/jugular (75860) |
$395 |
$395 |
0.1× |
| Venography adrenal unilateral selective rs&i (75840) |
$413 |
$413 |
0.1× |
| Venography renal unilateral selective rs&i (75831) |
$412 |
$412 |
0.1× |
| Venography, caval, inferior, with serialography, radiological supervision and interpretation Age Under 21 (75825) |
$380 |
$380 |
0.1× |
| Venography, caval, superior, with serialography, radiological supervision and interpretation Age Under 21 (75827) |
$389 |
$389 |
0.2× |
| Venography, extremity, bilateral, radiological supervision and interpretation Age Under 21 (75822) |
$1,349.50 |
$1,349.50 |
0.8× |
| Venography, extremity, unilateral, radiological supervision and interpretation Age Under 21 (75820) |
$1,683 |
$1,683 |
1.0× |
| Venography, orbital, radiological supervision and interpretation Age Under 21 (75880) |
$605 |
$605 |
0.9× |
Venous sampling thru cath w/wo angiography rs& (75893)
likely a partial charge — not the full procedure |
$322 |
$322 |
0.1× |
| Venous thrombosis imaging - nm extremity veins thrombosis right (78457) |
$526 |
$526 |
0.9× |
| Whole blood volume determination, including separate measurement of plasma volume and red cell volume… (78122) |
$253 |
$253 |
0.5× |
| X-ray exam hips bi 3-4 views (73522) |
$386 |
$386 |
3.6× |
| X-ray exam of finger(s) (73140) |
$185 |
$185 |
2.1× |
| X-ray exam of knee 1 or 2 (73560) |
$90 |
$90 |
1.0× |
| X-ray exam of small bowel - fl small bowel series enteroclysis tube (74251) |
$900 |
$900 |
5.0× |
| X-ray exam ribs bil 3 views (71110) |
$337.50 |
$337.50 |
3.2× |
| X-ray exam ribs uni 2 views (71100) |
$250 |
$250 |
2.8× |
| X-ray heel (73650) |
$196.50 |
$196.50 |
2.2× |
| X-ray of joint between lower spine and hip bone 3 or more views|PROFESSIONAL COMPONENT (72202) |
$276.50 |
$276.50 |
2.6× |
| X-ray retrograde pyelogram (74420) |
$1,273 |
$1,273 |
3.6× |
| Xr abdomen 1 view (74018) |
$196.50 |
$196.50 |
2.2× |
| Xr abdomen 2 views (74019) |
$100 |
$100 |
0.9× |
| Xr arthrogram ankle (73615) |
$452 |
$452 |
1.3× |
| Xr arthrogram elbow (73085) |
$470 |
$470 |
1.3× |
| Xr arthrogram hip (73525) |
$828 |
$828 |
2.3× |
| Xr arthrogram knee (73580) |
$795 |
$795 |
2.2× |
| Xr arthrogram wrist (73115) |
$643 |
$643 |
1.8× |
| Xr bone age studies (77072) |
$145 |
$145 |
1.4× |
| Xr bone length study (77073) |
$585 |
$585 |
5.5× |
| Xr bone survey infant (77076) |
$270 |
$270 |
2.5× |
| Xr bone survey ltd (77074) |
$450 |
$450 |
4.2× |
| Xr chest 1 view (71045) |
$82 |
$82 |
0.9× |
| Xr chest 2 views (71046) |
$120 |
$120 |
1.3× |
| Xr eye foreign body (70030) |
$161 |
$161 |
1.8× |
| Xr facial bones 3+ views (70150) |
$317.50 |
$317.50 |
3.0× |
| Xr foot arthritis pa only bilateral - report(ortho pro) (73620) |
$193 |
$193 |
2.2× |
| Xr forearm 2 views (73090) |
$223 |
$223 |
2.5× |
| Xr hand 2v (73120) |
$205.50 |
$205.50 |
1.9× |
| Xr hysterosalpingogram (74740) |
$649 |
$649 |
2.7× |
| Xr joint survey 1 view (77077) |
$619 |
$619 |
5.8× |
| Xr myelogram l-spine (72265) |
$323 |
$323 |
0.4× |
| Xr myelogram t-spine (72255) |
$314 |
$314 |
0.4× |
| Xr neck soft tissue (70360) |
$217 |
$217 |
2.4× |
| Xr o knee w/ merchant view bilat - report(ortho pro) (73562) |
$272 |
$272 |
3.1× |
| Xr osseous survey complete (77075) |
$1,020 |
$1,020 |
9.5× |
| Xr pelvis 1-2 views (72170) |
$220.50 |
$220.50 |
2.1× |
| Xr pelvis min 3 view (72190) |
$303.50 |
$303.50 |
2.8× |
| Xr peritoneogram (74190) |
$605 |
$605 |
1.1× |
| Xr sacrum/coccyx 2+ views (72220) |
$254.50 |
$254.50 |
2.9× |
| Xr sella turcica (70240) |
$100 |
$100 |
1.1× |
| Xr shoulder 1 view (73020) |
$172 |
$172 |
1.9× |
| Xr sialogram (70390) |
$480 |
$480 |
2.0× |
| Xr sinuses 3+ views (70220) |
$303.50 |
$303.50 |
3.4× |
| Xr skull min 4 view (70260) |
$370 |
$370 |
3.5× |
| Xr spine 1 view (72020) |
$190.50 |
$190.50 |
2.1× |
| Xr spine thoracic 3v (72072) |
$291 |
$291 |
2.7× |
| Xr sternum 2+ views (71120) |
$239 |
$239 |
2.7× |
| Xr stress view joint (77071) |
$132 |
$132 |
1.5× |
| Xr surgical specimen (76098) |
$605 |
$605 |
1.1× |
| Xr t-spine 2 views (72070) |
$269 |
$269 |
2.5× |
| Xr tibia/fibula 2 views (73590) |
$213.50 |
$213.50 |
2.4× |
| Xr tmj bilateral (70330) |
$285 |
$285 |
3.2× |
| Xr venogram renal bilat (75833) |
$475 |
$475 |
0.1× |
| Xr wrist 2 views (73100) |
$350 |
$350 |
3.9× |