| 3-D radiotherapy plan dose-volume histograms (77295) |
$2,239.73 |
$4,666.10 |
1.5× |
| Abdomen 2 views (74019) |
$173.11 |
$360.65 |
1.6× |
| Acute gi blood loss imaging (78278) |
$1,785.46 |
$3,719.70 |
4.3× |
| Acute venous thrombosis imaging, peptide Non-Facility (78456) |
$683.38 |
$1,423.70 |
0.5× |
| Angiography extremity bilateral rs&i (75716) |
$3,099.65 |
$6,457.60 |
0.9× |
| Angiography extremity unilateral rs&i (75710) |
$2,515.20 |
$5,240 |
0.8× |
| Angiography internal mammary rs&i (75756) |
$2,785.15 |
$5,802.40 |
0.8× |
Angiography pelvic slctv/supraslctv rs&i (75736)
unusually low: confirm this is the full procedure |
$2,789.57 |
$5,811.60 |
0.5× |
| Angiography pulmonary bilateral slctv rs&i (75743) |
$2,802.62 |
$5,838.80 |
0.8× |
| Angiography pulmonary unilateral slctv rs&i (75741) |
$2,746.66 |
$5,722.20 |
0.8× |
| Angiography Spinal Selective Rs&I (75705) |
$3,597.50 |
$7,494.80 |
0.6× |
| Angiography visceral slctv/supraslctv rs&i (75726) |
$3,050.98 |
$6,356.20 |
0.5× |
| Angrph Cath F-Up Std Tcat Other Than Thrombylsis (75898) |
$1,310.26 |
$2,729.70 |
0.4× |
| Angrph pulmonary nonslctv cath/ven njx rs&i (75746) |
$2,346.43 |
$4,888.40 |
0.7× |
| Ankle 2 views (73600) |
$173.11 |
$360.65 |
1.9× |
Aortogram thoracic (75605)
unusually low: confirm this is the full procedure |
$2,124.67 |
$4,426.40 |
0.4× |
| Aortography abdl bi iliofem low extrem cath rs&i (75630) |
$3,629.42 |
$7,561.30 |
1.1× |
| Aortography abdominal serialography rs&i (75625) |
$3,103.92 |
$6,466.50 |
0.9× |
| Aortography Thoracic W/O Serialography Rs&I (75600) |
$1,577.18 |
$3,285.80 |
0.5× |
| Artery X-Rays Adrenal Gland (75731) |
$2,000.78 |
$4,168.30 |
0.6× |
| Arthrogram ankle (73615) |
$277.34 |
$577.80 |
0.8× |
| Arthrogram elbow (73085) |
$298.22 |
$621.30 |
0.8× |
| Arthrogram hip (73525) |
$277.06 |
$577.20 |
0.8× |
| Arthrogram knee (73580) |
$277.06 |
$577.20 |
0.8× |
| Arthrogram shoulder (73040) |
$277.20 |
$577.50 |
0.8× |
| Arthrogram wrist (73115) |
$277.06 |
$577.20 |
0.8× |
| Basic dosimetry (77300) |
$279.98 |
$583.30 |
2.0× |
| Bone &/Joint Imaging Limited Area (78300) |
$595.10 |
$1,239.80 |
1.4× |
| Bone &/Joint Imaging Multiple Areas (78305) |
$896.16 |
$1,867 |
2.1× |
| Bone &/joint imaging whole body (78306) |
$595.10 |
$1,239.80 |
1.4× |
| Bone age studies (77072) |
$138.43 |
$288.40 |
1.3× |
| Bone Imaging 3 Phase (78315) |
$744 |
$1,550 |
1.8× |
| Bone Marrow Imaging Limited Area (78102) |
$509.04 |
$1,060.50 |
1.2× |
| Bone survey complete (77075) |
$207.79 |
$432.90 |
1.9× |
| Bone survey infant (77076) |
$277.06 |
$577.20 |
2.5× |
| Bowel imaging (78290) |
$595.10 |
$1,239.80 |
1.4× |
| Brachytx isodose complex (77318) |
$4,759.39 |
$9,915.40 |
12.1× |
| Brachytx isodose intermed (77317) |
$3,639.60 |
$7,582.50 |
9.3× |
| Brachytx isodose pln smpl w/dosimetry cal (77316) |
$2,519.71 |
$5,249.40 |
6.4× |
| Brain imaging < 4 static views (78600) |
$597.46 |
$1,244.70 |
1.4× |
| Brain Imaging < 4 Static Views W Vascular Flow (78601) |
$597.46 |
$1,244.70 |
1.4× |
| Brain Imaging Min 4 Static Views W Vascular Flow (78606) |
$892.80 |
$1,860 |
1.6× |
| Brain Imaging Pet Metabolic Evaluation (78608) |
$2,851.58 |
$5,940.80 |
1.9× |
| Brain Imaging Vascular Flow Only (78610) |
$597.46 |
$1,244.70 |
1.1× |
| Brain imaging, minimum 4 static views; Non-Facility (78605) |
$597.46 |
$1,244.70 |
1.1× |
| Card Bl Pool Gated Spect Rest Wal Motn Ejct Frct (78494) |
$896.16 |
$1,867 |
2.1× |
| Card Bpi Gtd =Brm Plnr 1 Std Rest/Strs (78472) |
$892.80 |
$1,860 |
2.1× |
| Cardiac blood pool imaging (planar), first pass technique; multiple studies, at rest and with stress (exercise and/or… (78483) |
$448.22 |
$933.80 |
0.8× |
| Cardiac magnetic resonance imaging for morphology and function without contrast material(s), followed by contrast… (75563) |
$1,553.76 |
$3,237 |
1.9× |
| Cardiac MRI w/w/o contrast & further seq (75561) |
$1,276.99 |
$2,660.40 |
3.5× |
| Cerebrospinal Fluid Flow W/O Matl Shunt Evaltj (78645) |
$1,190.40 |
$2,480 |
2.1× |
| Cerebrospinal fluid flow, imaging (not including introduction of material); ventriculography Non-Facility (78635) |
$425.18 |
$885.80 |
0.7× |
| Cervical spine 2 or 3 views (72040) |
$173.11 |
$360.65 |
1.9× |
| Chest 1 view (71045) |
$173.11 |
$360.65 |
1.9× |
| Chest xray 3 views (71047) |
$138.43 |
$288.40 |
1.5× |
| Cholecystography, oral contrast Non-Facility (74290) |
$190.42 |
$396.70 |
1.0× |
| Cine/Vid X-Ray Throat/Esoph - Fl Esoph Barium Swlw W/ Video & Speech (74230) |
$207.79 |
$432.90 |
1.1× |
| Clavicle complete (73000) |
$173.20 |
$360.85 |
1.9× |
| Computed Tomography Thorax Lw Dose Lng Ca Scr C- (71271) |
$431.81 |
$899.60 |
3.9× |
| Continuing medical physics consltj pr wk (77336) |
$279.98 |
$583.30 |
2.0× |
| Contrast Xray Throat/Cerv Esopha (74210) |
$160.80 |
$335 |
0.9× |
| CT abdomen and pelvis without and with contrast (74178) |
$1,079.57 |
$2,249.10 |
3.0× |
| CT abdomen and pelvis without contrast (74176) |
$647.76 |
$1,349.50 |
2.6× |
| CT abdomen w contrast (74160) |
$647.76 |
$1,349.50 |
3.5× |
| CT abdomen w wo contrast (74170) |
$863.71 |
$1,799.40 |
4.7× |
| CT abdomen w/o contrast (74150) |
$381.46 |
$794.70 |
3.5× |
| CT angio hrt w/3d image (75574) |
$2,159.28 |
$4,498.50 |
5.9× |
| CT angio lwr extr w/o&w/dye (73706) |
$1,079.57 |
$2,249.10 |
5.9× |
| CT angiography upper extremity lt (73206) |
$863.71 |
$1,799.40 |
4.7× |
| CT c-spine w/contrast (72126) |
$647.76 |
$1,349.50 |
1.8× |
| CT c-spine w/o contrast (72125) |
$431.81 |
$899.60 |
3.9× |
| CT cervical spine w&w/o contrast (72127) |
$863.71 |
$1,799.40 |
4.7× |
| CT chest w contrast (71260) |
$323.86 |
$674.70 |
1.8× |
| CT chest w/wo contrast (71270) |
$431.83 |
$899.65 |
2.4× |
| CT colonography screening (74263) |
$1,079.57 |
$2,249.10 |
4.3× |
| CT colonography w/dye (74262) |
$1,079.57 |
$2,249.10 |
5.9× |
| CT colonography w/o cntrst (74261) |
$1,079.57 |
$2,249.10 |
9.9× |
| CT head/brain with contrast (70460) |
$647.76 |
$1,349.50 |
3.5× |
| CT head/brain without and with contrast (70470) |
$863.71 |
$1,799.40 |
4.7× |
| CT heart contrast eval cardiac structure&morph (75572) |
$359.86 |
$749.70 |
1.0× |
| CT heart w/o contrast quant eval coronary calcium (75571) |
$431.81 |
$899.60 |
4.7× |
| CT hrt w/3d image congen (75573) |
$2,159.28 |
$4,498.50 |
5.9× |
| CT iac w contrast (70481) |
$647.76 |
$1,349.50 |
3.5× |
| CT limited/localized follow up study (76380) |
$430.75 |
$897.40 |
4.7× |
| CT lower ext w/o (73700) |
$719.86 |
$1,499.70 |
6.6× |
| CT lower extremity w wo contrast (73702) |
$1,151.62 |
$2,399.20 |
6.3× |
| CT lower extremity w/contrast material (73701) |
$935.71 |
$1,949.40 |
5.1× |
| CT lumbar spine w & w/o contrast (72133) |
$861.41 |
$1,794.60 |
4.7× |
| CT lumbar spine w/contrast (72132) |
$647.76 |
$1,349.50 |
1.8× |
| CT lumbar spine w/o contrast (72131) |
$431.81 |
$899.60 |
3.9× |
| CT maxillofacial w contrast (70487) |
$647.76 |
$1,349.50 |
3.5× |
| CT maxillofacial w/wo contrast (70488) |
$863.71 |
$1,799.40 |
4.7× |
| CT maxillofacial wo contrast (70486) |
$647.76 |
$1,349.50 |
5.9× |
| CT orbit sella/post fossa/ear w/o & w/contr matr (70482) |
$863.71 |
$1,799.40 |
4.7× |
| CT orbits w/o contrast (70480) |
$377.88 |
$787.25 |
3.5× |
| CT pelvis w/o contrast (72192) |
$647.76 |
$1,349.50 |
5.9× |
| CT pelvis w/wo contrast (72194) |
$863.71 |
$1,799.40 |
4.7× |
| CT scan of arm combo (73202) |
$1,079.71 |
$2,249.40 |
5.9× |
| CT soft tissue neck w contrast (70491) |
$431.81 |
$899.60 |
2.4× |
| CT soft tissue neck w/o & w/contrast material (70492) |
$647.76 |
$1,349.50 |
3.5× |
| CT soft tissue neck w/o contrast (70490) |
$287.90 |
$599.80 |
2.6× |
| CT thoracic spine w/contrast (72129) |
$647.76 |
$1,349.50 |
3.5× |
| CT thoracic spine w/o contrast (72128) |
$431.81 |
$899.60 |
3.9× |
| CT thoracic spine w/wo contrast (72130) |
$861.41 |
$1,794.60 |
4.7× |
| CT thorax w/o contrast (71250) |
$233.98 |
$487.45 |
2.1× |
| CT upper ext wo (73200) |
$647.76 |
$1,349.50 |
5.9× |
| CT upper extremity with contrast (73201) |
$863.71 |
$1,799.40 |
2.4× |
| Cta Aa&Bi Iliofem Lxtr Rs&I C-/C+ Post-Pxessing (75635) |
$863.71 |
$1,799.40 |
4.7× |
| Cta Abdomen (74175) |
$863.71 |
$1,799.40 |
4.7× |
| CTA abdomen pelvis (74174) |
$1,511.52 |
$3,149 |
4.1× |
| CTA chest (71275) |
$431.81 |
$899.60 |
2.4× |
| Cta Head (70496) |
$863.71 |
$1,799.40 |
4.7× |
| CTA head&neck c+ w/noncontrast img&post-pxessing (70471) |
$863.71 |
$1,799.40 |
2.4× |
| Cta Neck (70498) |
$647.76 |
$1,349.50 |
3.5× |
| Cta Pelvis (72191) |
$647.76 |
$1,349.50 |
3.5× |
| Cystography minimum 3 views rs&i (74430) |
$696.43 |
$1,450.90 |
1.9× |
| Dacryocystography, nasolacrimal duct, radiological supervision and interpretation Non-Facility (70170) |
$350.69 |
$730.60 |
1.4× |
| Dilation of ureter(s) or urethra, radiological supervision and interpretation Non-Facility (74485) |
$431.38 |
$898.70 |
0.2× |
| Diskogram cervical (72285) |
$546.96 |
$1,139.50 |
0.3× |
| Diskography lumbar (72295) |
$568.03 |
$1,183.40 |
0.3× |
| Doppler Echo Fetal Puls Spectral F/U/Repeat (76828) |
$455.28 |
$948.50 |
4.2× |
| Doppler Echo Fetal Spectral Display Complete (76827) |
$671.30 |
$1,398.55 |
6.1× |
| Doppler Fetal Mid Cerebral Artery (76821) |
$120.34 |
$250.70 |
1.1× |
| Dxa bone density study 1/> sites axial skel (77080) |
$144.43 |
$300.90 |
1.3× |
| Dxa bone density study 1/>sites appendiclr skel (77081) |
$92.50 |
$192.70 |
1.0× |
| Dxa bone density study axial skeleton (77085) |
$288.24 |
$600.50 |
2.6× |
| Echocardiography, fetal, cardiovascular system, real time with image documentation (2D), with or without M-mode… (76826) |
$470.26 |
$979.70 |
1.9× |
| Esophageal motility (78258) |
$259.15 |
$539.90 |
0.6× |
| Esophagus (74220) |
$207.79 |
$432.90 |
1.1× |
| Facial bones min 3 views (70150) |
$138.43 |
$288.40 |
1.3× |
| Fetal biophysical profile non-stress testing (76818) |
$341.47 |
$711.40 |
3.1× |
| Fetal Biophysical Profile W/O Non-Stress Testing (76819) |
$341.47 |
$711.40 |
3.1× |
| Fetal Echo (76825) |
$142.30 |
$296.45 |
0.2× |
| Fluoroscopy up to 1 hr (76000) |
$1,380.62 |
$2,876.30 |
5.5× |
| Foot 2 views (73620) |
$147.14 |
$306.55 |
1.6× |
| Forearm 2 views (73090) |
$138.43 |
$288.40 |
1.5× |
| Functional MRI brain by phys/psych (70555) |
$2,193.55 |
$4,569.90 |
8.8× |
| Functional MRI brain by tech (70554) |
$2,189.04 |
$4,560.50 |
8.8× |
| Gastric mucosa imaging (78261) |
$609.94 |
$1,270.70 |
1.5× |
| Gastrointestinal protein loss Facility (78282) |
$486.72 |
$1,014 |
1.2× |
| Hand 2 views (73120) |
$138.43 |
$288.40 |
1.3× |
| Hdr rdncl ntrstl/intrcav brachytx 1 channel (77770) |
$332.35 |
$692.40 |
0.5× |
| Hdr rdncl ntrstl/intrcav brachytx 2-12 channel (77771) |
$332.35 |
$692.40 |
0.5× |
| Hdr rdncl ntrstl/intrcav brachytx >12 channels (77772) |
$331.68 |
$691 |
0.5× |
| Heart first pass single,planar (78481) |
$448.22 |
$933.80 |
0.8× |
| Heart Infarct Image (78466) |
$597.46 |
$1,244.70 |
1.4× |
| Hepatc Vngrph Wdg/Fr Hemodyn Eval Rs&I (75889) |
$862.85 |
$1,797.60 |
0.3× |
| Hepatc vngrph wdg/fr w/o hemodyn eval rs&i (75891) |
$862.85 |
$1,797.60 |
0.3× |
| Hepatobil Syst Imag Inc Gb W/Pharma Intervenj (78227) |
$1,190.40 |
$2,480 |
2.1× |
| Hepatobiliary syst imaging including gallbladder (78226) |
$1,041.46 |
$2,169.70 |
2.5× |
| Hysterosalpingogram (74740) |
$209.38 |
$436.20 |
0.8× |
| Image fusion (77399) |
$3,359.66 |
$6,999.30 |
23.9× |
| Interstitial radiation source applic complex (77778) |
$878.83 |
$1,830.90 |
1.2× |
| Intracavitary Radiation Source Applic Complex (77763) |
$832.22 |
$1,733.80 |
1.1× |
| Intracavitary Radiation Source Applic Intermed (77762) |
$680.83 |
$1,418.40 |
1.2× |
| Intracavitary Radiation Source Applic Simple (77761) |
$529.63 |
$1,103.40 |
0.9× |
| Joint Survey, Single View - Xr Joint Anteroposterior 2+ Joints (77077) |
$138.62 |
$288.80 |
1.3× |
| Kidney imaging morphology (78700) |
$746.88 |
$1,556 |
1.8× |
| Kidney Img Morphology Vascular Flow 1 W/O Rx (78707) |
$892.80 |
$1,860 |
1.6× |
| Kidney img morphology vascular flow 1 w/rx (78708) |
$892.80 |
$1,860 |
1.6× |
| Kidney Img Morphology Vascular Flow Multiple (78709) |
$744 |
$1,550 |
1.3× |
| Knee 3 views (73562) |
$173.11 |
$360.65 |
1.9× |
| Liver & spleen imaging static only (78215) |
$597.46 |
$1,244.70 |
1.4× |
| Liver & Spleen Imaging W/Vascular Flow (78216) |
$746.88 |
$1,556 |
1.8× |
| Liver imaging static only (78201) |
$597.46 |
$1,244.70 |
1.1× |
| Liver imaging w/vascular flow (78202) |
$611.81 |
$1,274.60 |
1.1× |
| Lung perf&ventilat diferentl (78598) |
$595.10 |
$1,239.80 |
1.0× |
| Lung perfusion differential (78597) |
$1,074.14 |
$2,237.80 |
2.6× |
| Lung ventilation imaging (78579) |
$597.46 |
$1,244.70 |
1.4× |
| Lymphangiography Pelvic/Abdominal Bilateral Rs&I (75807) |
$1,104.43 |
$2,300.90 |
0.3× |
| Lymphangiography Pelvic/Abdominal Unilat Rs&I (75805) |
$950.16 |
$1,979.50 |
0.3× |
| Lymphangiography, extremity only, bilateral, radiological supervision and interpretation Facility (75803) |
$1,006.18 |
$2,096.20 |
0.6× |
| Lymphangiography, extremity only, unilateral, radiological supervision and interpretation Facility (75801) |
$921.98 |
$1,920.80 |
1.4× |
| Lymphoscintigraphy (78195) |
$1,487.90 |
$3,099.80 |
2.6× |
| Magnetic resonance (eg, proton) imaging, any joint of upper extremity; with contrast material(s) Non-Facility (73222) |
$1,276.99 |
$2,660.40 |
1.6× |
| Magnetic resonance (eg, proton) imaging, brain (including brain stem and skull base), during open intracranial… (70558) |
$4,387.20 |
$9,140 |
23.9× |
| Magnetic resonance (eg, proton) imaging, brain (including brain stem and skull base), during open intracranial… (70557) |
$4,378.18 |
$9,121.20 |
7.7× |
| Magnetic resonance (eg, proton) imaging, brain (including brain stem and skull base), during open intracranial… (70559) |
$4,378.18 |
$9,121.20 |
23.8× |
| Magnetic resonance (eg, proton) imaging, upper extremity, other than joint; without contrast material(s), followed by… (73220) |
$1,459.39 |
$3,040.40 |
4.0× |
| Magnetic Resonance Elastography (76391) |
$969.07 |
$2,018.90 |
3.9× |
| Mammary ductogram or galactogram single (77053) |
$277.34 |
$577.80 |
1.1× |
| Manual Appl Stress Pfrmd Phys/Qhp Joint Films (77071) |
$138.62 |
$288.80 |
1.5× |
| Mlc imrt design & construction per imrt plan (77338) |
$2,490.56 |
$5,188.65 |
6.4× |
| MRA head w & w/o contrast (70546) |
$1,094.50 |
$2,280.20 |
3.0× |
| MRA head w/o contrast (70544) |
$729.74 |
$1,520.30 |
2.9× |
| MRA head with contrast (70545) |
$912 |
$1,900 |
2.5× |
| MRA neck w contrast (70548) |
$731.28 |
$1,523.50 |
2.0× |
| Mra Neck W/O &W/Contrast Material (70549) |
$912 |
$1,900 |
2.5× |
| MRA neck w/o contrast (70547) |
$547.30 |
$1,140.20 |
2.2× |
| MRI abdomen w contrast (74182) |
$1,231.34 |
$2,565.30 |
3.4× |
| MRI abdomen w/o & w/contrast material (74183) |
$1,368.19 |
$2,850.40 |
3.7× |
| MRI abdomen w/o contrast (74181) |
$1,094.50 |
$2,280.20 |
4.4× |
| MRI any jt lower extrem w/contrast material (73722) |
$1,641.79 |
$3,420.40 |
2.0× |
| MRI any jt lower extrem w/o & w/contrast matrl (73723) |
$1,276.99 |
$2,660.40 |
3.5× |
| MRI breast w/o contrast bilateral (77047) |
$456.05 |
$950.10 |
1.8× |
| MRI breast wo contrast unilateral (77046) |
$364.85 |
$760.10 |
1.5× |
| MRI c-spine with contrast (72142) |
$638.52 |
$1,330.25 |
1.7× |
| MRI cardiac w/o cont stress (75559) |
$1,327.97 |
$2,766.60 |
2.3× |
| MRI cardiac w/o contrast (75557) |
$1,094.50 |
$2,280.20 |
4.4× |
| MRI cervical spine w/o contrast (72141) |
$478.90 |
$997.70 |
1.9× |
| MRI chest w/o & w/contrast material (71552) |
$1,185.79 |
$2,470.40 |
3.2× |
| MRI chest w/o contrast (71550) |
$820.99 |
$1,710.40 |
3.3× |
| MRI chest with contrast (71551) |
$1,003.30 |
$2,090.20 |
1.2× |
| MRI fetal sngl/1st gestation (74712) |
$1,094.50 |
$2,280.20 |
4.4× |
| MRI lower extrem oth/thn jt w/contrast matrl (73719) |
$751.39 |
$1,565.40 |
2.1× |
| MRI lower extrem oth/thn jt w/o & w/contr matr (73720) |
$1,368.19 |
$2,850.40 |
3.7× |
| MRI lower extrem oth/thn jt w/o contr matrl (73718) |
$1,094.50 |
$2,280.20 |
4.4× |
| MRI orbit face &/neck w/o contrast (70540) |
$729.74 |
$1,520.30 |
2.9× |
| MRI orbit face neck w contrast (70542) |
$912 |
$1,900 |
2.5× |
| MRI orbit/face/neck w&w/o cont (70543) |
$1,459.39 |
$3,040.40 |
4.0× |
| MRI pelvis w/contrast (72196) |
$1,003.30 |
$2,090.20 |
2.7× |
| MRI pelvis w/o & w/contrast material (72197) |
$1,276.99 |
$2,660.40 |
3.5× |
| MRI pelvis w/o contrast (72195) |
$912 |
$1,900 |
3.6× |
| MRI spectroscopy (76390) |
$1,096.80 |
$2,285 |
12.0× |
| MRI spinal canal cervical w/o & w/contr matrl (72156) |
$798.74 |
$1,664.05 |
2.2× |
| MRI spinal canal lumbar w/contrast material (72149) |
$729.74 |
$1,520.30 |
2.0× |
| MRI spinal canal lumbar w/o & w/contr matrl (72158) |
$798.74 |
$1,664.05 |
2.2× |
| MRI spinal canal thoracic w/contrast matrl (72147) |
$638.52 |
$1,330.25 |
1.7× |
| MRI spinal canal thoracic w/o & w/contr matrl (72157) |
$798.74 |
$1,664.05 |
2.2× |
| MRI temporomandibular joint (70336) |
$820.99 |
$1,710.40 |
3.3× |
| MRI thoracic spine w/o contrast (72146) |
$479.28 |
$998.50 |
1.9× |
| MRI up ext w/o contrast (73218) |
$1,094.50 |
$2,280.20 |
4.4× |
| MRI upper ext joint w/o contrast (73221) |
$912 |
$1,900 |
3.6× |
| MRI, joint upper extrem combo (73223) |
$1,276.99 |
$2,660.40 |
3.5× |
| Myelogram Cervical (72240) |
$277.34 |
$577.80 |
0.3× |
| Myelogram Lumbar (72265) |
$282.67 |
$588.90 |
0.3× |
| Myelogram thoracic (72255) |
$277.34 |
$577.80 |
0.3× |
| Myocardial imaging, infarct avid, planar; with ejection fraction by first pass technique Non-Facility (78468) |
$597.46 |
$1,244.70 |
1.1× |
| Myocardial imaging, positron emission tomography (PET), combined perfusion with metabolic evaluation study (including… (78433) |
$8,201.42 |
$17,086.30 |
3.6× |
| Myocardial imaging, positron emission tomography (PET), metabolic evaluation study (including ventricular wall… (78429) |
$4,399.30 |
$9,165.20 |
2.9× |
| Myocardial imaging, positron emission tomography (PET), perfusion study (including ventricular wall motionºs» and/or… (78431) |
$5,256.72 |
$10,951.50 |
2.3× |
| Myocardial infarct spect (78469) |
$896.16 |
$1,867 |
1.6× |
| Myocardial Perfusion Planar 1 Study Rest/Stress (78453) |
$2,091.02 |
$4,356.30 |
1.5× |
| Myocardial Perfusion Planar Multiple Studies (78454) |
$1,653.12 |
$3,444 |
1.2× |
| Myocardial Spect Multiple Studies (78452) |
$1,785.55 |
$3,719.90 |
1.3× |
| Myocardial spect single study at rest or stress (78451) |
$1,785.46 |
$3,719.70 |
1.3× |
| Myocrd img PET prfuj 1std rest/stress cncrnt CT (78430) |
$2,830.51 |
$5,896.90 |
1.9× |
| Myocrd Img Pet Prfuj W/Metab Dual Radiotracer (78432) |
$7,229.90 |
$15,062.30 |
4.5× |
| N-invas est c ffr sw aly CTA (75580) |
$3,630.10 |
$7,562.70 |
4.0× |
| Neck soft tissue (70360) |
$173.11 |
$360.65 |
1.9× |
| Nfs/Instlj Radioelmnt Sln 3 Mo Follow-Up Care (77750) |
$264.58 |
$551.20 |
0.7× |
| Nm adrenal scan (78075) |
$1,190.40 |
$2,480 |
0.9× |
| Nm bone marrow multi (78103) |
$553.39 |
$1,152.90 |
1.3× |
| Nm bone marrow wb (78104) |
$600.96 |
$1,252 |
1.4× |
| Nm cardiac blood pool multiple (78473) |
$896.16 |
$1,867 |
2.1× |
| Nm cisternogram (78630) |
$2,380.75 |
$4,959.90 |
4.2× |
| Nm csf leak detection (78650) |
$1,785.46 |
$3,719.70 |
1.3× |
| Nm gastric emptying study (78264) |
$1,339.15 |
$2,789.90 |
3.2× |
| Nm gastroesophageal reflux study (78262) |
$1,792.32 |
$3,734 |
4.3× |
| Nm kidney scan w/flow (78701) |
$746.88 |
$1,556 |
1.8× |
| Nm peritoneal-venous shunt patency (78291) |
$1,190.40 |
$2,480 |
2.8× |
| Noncardiac Vascular Flow Imaging (78445) |
$298.66 |
$622.20 |
0.7× |
| Nonvascular shunt X-ray (75809) |
$862.85 |
$1,797.60 |
7.9× |
| Ntsty modul radthx pln dose-vol histos (77301) |
$12,885.79 |
$26,845.40 |
8.9× |
| Nuclear medicine study to assess blood clot in vein of both sides (78458) |
$740.21 |
$1,542.10 |
1.8× |
| Nuclear Rx Oral Admin (79005) |
$55.63 |
$115.90 |
0.2× |
| Ob us nuchal meas 1 gest (76813) |
$303.50 |
$632.30 |
2.8× |
| Ophthalmic biometry by ultrasound echography, A-scan; with intraocular lens power calculation Non-Facility (76519) |
$415.20 |
$865 |
3.8× |
| Ophthalmic ultrasound, diagnostic; quantitative A-scan only Non-Facility (76511) |
$158.74 |
$330.70 |
1.4× |
| Orthopantogram (70355) |
$203.32 |
$423.60 |
2.2× |
| Osseous survey limited (77074) |
$207.79 |
$432.90 |
1.9× |
| Parathyrd planar w/spect&CT (78072) |
$2,182.27 |
$4,546.40 |
3.8× |
| Parathyroid Planar Imaging (78070) |
$1,785.46 |
$3,719.70 |
4.3× |
| Parathyroid planar imaging w/wo subtraction (78071) |
$2,190.62 |
$4,563.80 |
5.2× |
| Pelvis 1 or 2 views (72170) |
$173.11 |
$360.65 |
1.6× |
| Perineogram (74775) |
$207.98 |
$433.30 |
0.8× |
| Peritoneogram after injection (74190) |
$647.18 |
$1,348.30 |
1.1× |
| PET image w/CT, skull-thigh (78815) |
$2,851.58 |
$5,940.80 |
1.9× |
| PET imaging CT for attenuation limited area (78814) |
$2,851.58 |
$5,940.80 |
1.9× |
| PET imaging for CT attenuation whole body (78816) |
$2,851.58 |
$5,940.80 |
1.9× |
| Plasma Vol Radiopharm Vol Dilute Spx Mult Smples (78111) |
$1,140.77 |
$2,376.60 |
0.8× |
| Prq Transhepatc Portograpy Hemodyn Eval Rs&I (75885) |
$903.41 |
$1,882.10 |
0.3× |
| Prq transhepatc portograpy w/o hemodyn evl intrp (75887) |
$862.85 |
$1,797.60 |
0.3× |
| Pulmonary Perfusion Imaging Particulate (78580) |
$446.45 |
$930.10 |
1.1× |
| Pulmonary Ventilation & Perfusion Imaging (78582) |
$595.10 |
$1,239.80 |
1.0× |
| Quan&charac c atherosclerotc plaq asses sev c ds (75577) |
$1,596.86 |
$3,326.80 |
1.6× |
| Radex abscess/fistula/sinus tract rs&i (76080) |
$553.97 |
$1,154.10 |
1.0× |
| Radex Ankle Compl Minimum 3 Views (73610) |
$173.11 |
$360.65 |
1.9× |
| Radex Calcaneus Minimum 2 Views (73650) |
$120.04 |
$250.10 |
1.3× |
| Radex Elbw Compl Minimum 3 Views (73080) |
$138.43 |
$288.40 |
1.5× |
| Radex Entir Thrc Lmbr Crv Sac Spi W/Skull 1 Vw - Xr Scoliosis 1 Vw (72081) |
$207.79 |
$432.90 |
2.3× |
| Radex entir thrc lmbr crv sac spi w/skull 2/3 vw (72082) |
$251.47 |
$523.90 |
2.3× |
| Radex Entir Thrc Lmbr Crv Sac Spi W/Skull 4/5 Vw (72083) |
$273.65 |
$570.10 |
2.5× |
| Radex fingr minimum 2 views (73140) |
$173.11 |
$360.65 |
1.9× |
| Radex Foot Compl Minimum 3 Views (73630) |
$173.11 |
$360.65 |
1.9× |
| Radex Hand Minimum 3 Views (73130) |
$138.43 |
$288.40 |
1.5× |
| Radex Hip Unilateral With Pelvis 1 View (73501) |
$346.28 |
$721.40 |
3.8× |
| Radex Hip Unilateral With Pelvis Minimum 4 Views (73503) |
$354.86 |
$739.30 |
3.2× |
| Radex Hips Bilateral With Pelvis 2 Views (73521) |
$286.03 |
$595.90 |
2.6× |
| Radex Hips Bilateral With Pelvis Minimum 5 Views (73523) |
$597.36 |
$1,244.50 |
5.5× |
| Radex Humerus Minimum 2 Views (73060) |
$138.43 |
$288.40 |
1.5× |
| Radex Kne 1/2 Views (73560) |
$173.11 |
$360.65 |
1.9× |
| Radex Kne Compl 4/More Views (73564) |
$138.43 |
$288.40 |
1.3× |
| Radex Mndbl Compl Minimum 4 Views (70110) |
$138.43 |
$288.40 |
1.3× |
| Radex Nasal Bones Complete Minimum 3 Views (70160) |
$138.43 |
$288.40 |
1.5× |
| Radex Pelvis Compl Minimum 3 Views (72190) |
$138.43 |
$288.40 |
1.3× |
| Radex Sho Compl Minimum 2 Views (73030) |
$173.11 |
$360.65 |
1.9× |
| Radex Sinuses Paransl < 3 Views (70210) |
$138.43 |
$288.40 |
1.5× |
| Radex Spine Lumbosacral Only Bending 2/3 Views (72120) |
$138.43 |
$288.40 |
1.3× |
| Radex Temporomandble Jt Opn & Clsd Mouth Bilat (70330) |
$138.43 |
$288.40 |
1.5× |
| Radex Toe Minimum 2 Views (73660) |
$173.11 |
$360.65 |
1.9× |
| Radex upper extremity infant minimum 2 views (73092) |
$138.52 |
$288.60 |
1.3× |
| Radex Wrst Compl Minimum 3 Views (73110) |
$173.11 |
$360.65 |
1.9× |
| Radex X-Ray Exam Entire Spi 6/> Vw - Xr Entire Spine 6+ Vw (72084) |
$317.42 |
$661.30 |
2.9× |
| Radiation Delivery Stereotactic Cranial Linear (77372) |
$4,479.55 |
$9,332.40 |
0.6× |
| Radiation treatment delivery level 1 (77402) |
$512.26 |
$1,067.20 |
4.8× |
| Radiation treatment delivery level 2 (77407) |
$4,262.35 |
$8,879.90 |
10.6× |
| Radiation treatment delivery level 3 (77412) |
$748.13 |
$1,558.60 |
1.3× |
| Radiologic Exam Abdomen 1 View - Xr Abdomen 1 View (74018) |
$207.79 |
$432.90 |
2.3× |
| Radiologic Exam Abdomen 3+ Views - Xr Abdomen 3+ Views (74021) |
$138.43 |
$288.40 |
1.3× |
| Radiologic exam chest 2 views (71046) |
$173.11 |
$360.65 |
1.9× |
| Radiologic exam colon single contrast study (74270) |
$286.66 |
$597.20 |
1.6× |
| Radiologic Exam Esophagus Double Contrast Study (74221) |
$207.79 |
$432.90 |
1.1× |
| Radiologic exam upr gi trc double contrast study (74246) |
$207.79 |
$432.90 |
1.1× |
| Radiologic exam upr gi trc single contrast study (74240) |
$207.88 |
$433.10 |
1.1× |
| Radiologic examination femur 1 view (73551) |
$173.11 |
$360.65 |
1.9× |
| Radiologic examination tibia & fibula 2 views (73590) |
$138.43 |
$288.40 |
1.5× |
| Radiologic examination, mastoids; complete, minimum of 3 views per side Non-Facility (70130) |
$135.70 |
$282.70 |
1.2× |
| Radiological examination surgical specimen (76098) |
$69.26 |
$144.30 |
0.1× |
| Radiopharm Dacryocystography (78660) |
$268.99 |
$560.40 |
0.6× |
| Radiopharmaceutical therapy, by intracavitary administration Non-Facility (79200) |
$597.46 |
$1,244.70 |
2.4× |
| Radiopharmaceutical therapy, radiolabeled monoclonal antibody by intravenous infusion Non-Facility (79403) |
$1,140.72 |
$2,376.50 |
4.7× |
| Red cell volume determination (separate procedure); multiple samplings Non-Facility (78121) |
$1,140.77 |
$2,376.60 |
2.0× |
| Renal Cyst Study (74470) |
$791.52 |
$1,649 |
1.4× |
| Ribs bilateral 3 views (71110) |
$138.43 |
$288.40 |
1.3× |
| Rp Loclzj Tum Plnr 1 Area Single Day Imaging (78800) |
$287.16 |
$598.25 |
0.7× |
| Rp loclzj tum plnr 2+area 1+d img/1 area img>2+d (78801) |
$597.46 |
$1,244.70 |
1.4× |
| Rp Loclzj Tum Plnr Whole Body 2+ Days Imaging (78804) |
$1,884.77 |
$3,926.60 |
3.3× |
| Rp loclzj tum plnr whole body single day imaging (78802) |
$1,587.12 |
$3,306.50 |
2.8× |
| Rp loclzj tum spect 1 area single day imaging (78803) |
$744 |
$1,550 |
1.3× |
| Rp loclzj tum spect CT 2area 1d img/1 ar img>2+d (78832) |
$3,125.23 |
$6,510.90 |
2.1× |
| Rp loclzj tum spect w/CT 1 area 1 day imaging (78830) |
$892.80 |
$1,860 |
0.7× |
| Rp therapy intra-arterial particulate admn (79445) |
$1,007.04 |
$2,098 |
4.1× |
| Rp Therapy Intravenous Administration (79101) |
$595.10 |
$1,239.80 |
2.4× |
| Sacroiliac Joints < 3 Views (72200) |
$135.50 |
$282.30 |
1.2× |
| Saline Infus Sonohysterography W/Color Doppler (76831) |
$455.28 |
$948.50 |
1.8× |
| Salivary gland imaging (78230) |
$597.46 |
$1,244.70 |
1.4× |
| Scapula (73010) |
$138.43 |
$288.40 |
1.3× |
| Screening Digital Breast Tomosynthesis Bi (77063) |
$34.54 |
$71.95 |
1.5× |
| Shoulder 1 view (73020) |
$173.11 |
$360.65 |
1.9× |
| Sialogram (70390) |
$862.85 |
$1,797.60 |
3.5× |
| Simulation intermediate (77285) |
$2,230.56 |
$4,647 |
5.7× |
| Small bowel series (74250) |
$415.54 |
$865.70 |
2.3× |
| Spec telethx port pln parts hemibdy tot bdy (77321) |
$335.04 |
$698 |
0.9× |
| Special dosimetry (77331) |
$286.22 |
$596.30 |
2.0× |
| Special Physics Consult (77370) |
$1,679.86 |
$3,499.70 |
11.9× |
| Special treatment procedure (77470) |
$1,200.14 |
$2,500.30 |
2.1× |
| Spine thoracic 3 views (72072) |
$138.43 |
$288.40 |
1.3× |
| Spleen imaging only (78185) |
$537.79 |
$1,120.40 |
1.3× |
| Splenoportograpy rs&i (75810) |
$1,727.52 |
$3,599 |
0.5× |
| Stereotactic Body Radiation Delivery (77373) |
$1,119.94 |
$2,333.20 |
0.6× |
| Superior sagittal sinus venogram (75870) |
$1,294.22 |
$2,696.30 |
0.4× |
| Surface Applic Low Dose Rate Radionuclide Source (77789) |
$339.31 |
$706.90 |
3.2× |
| Telethx isodose pln cplx w/basic dosimetry (77307) |
$1,399.82 |
$2,916.30 |
3.6× |
| Telethx isodose pln smpl w/dosimetry calculation (77306) |
$839.90 |
$1,749.80 |
2.1× |
| Testicular Imaging With Vascular Flow (78761) |
$448.22 |
$933.80 |
1.1× |
| Ther rad simulaj-aided field setting complex (77290) |
$2,239.73 |
$4,666.10 |
5.7× |
| Ther rad simulaj-aided field setting simple (77280) |
$2,239.73 |
$4,666.10 |
15.9× |
| Thoracolumbar 2 views (72080) |
$173.11 |
$360.65 |
1.9× |
| Thyroid carcinoma metastases imaging; limited area (eg, neck and chest only) Non-Facility (78015) |
$509.04 |
$1,060.50 |
1.2× |
| Thyroid carcinoma metastases img whole body (78018) |
$595.10 |
$1,239.80 |
1.0× |
| Thyroid imaging w/blood flow (78013) |
$448.22 |
$933.80 |
1.1× |
| Thyroid uptake measurement (78012) |
$896.16 |
$1,867 |
2.1× |
| Thyroid Uptake W/Blood Flow Sngle/Mult Quan Meas (78014) |
$595.10 |
$1,239.80 |
1.4× |
| Tmj unilateral (70328) |
$138.62 |
$288.80 |
1.5× |
| Tomogram (76100) |
$207.79 |
$432.90 |
1.9× |
| Treatment device complex (77334) |
$559.97 |
$1,166.60 |
1.4× |
| Treatment device intermediate (77333) |
$365.47 |
$761.40 |
2.6× |
| Treatment devices simple (77332) |
$279.98 |
$583.30 |
2.0× |
| Ultrasound breast complete (76641) |
$229.44 |
$478 |
2.1× |
| Ultrasound elastography first target lesion (76982) |
$238.70 |
$497.30 |
2.2× |
| Ultrasound Exam Aaa Screen (76706) |
$151.73 |
$316.10 |
1.4× |
| Ultrasound trgt dynamic microbubble 1st lesion (76978) |
$249.22 |
$519.20 |
0.7× |
| Ultrasound, abdomen limited (76705) |
$170.69 |
$355.60 |
1.6× |
| Umbilical-artery Doppler (OB) (76820) |
$120.34 |
$250.70 |
1.1× |
| Unlisted Diagnostic Radiographic Procedure (76499) |
$277.20 |
$577.50 |
3.0× |
| Unlisted gastrointestinal px dx nuclear medicine (78299) |
$412.18 |
$858.70 |
1.0× |
| Unlisted magnetic resonance procedure (76498) |
$1,094.50 |
$2,280.20 |
12.0× |
| Unlisted Procedure Clinical Brachytherapy (77799) |
$479.83 |
$999.65 |
4.5× |
| Unlisted ultrasound procedure (76999) |
$535.99 |
$1,116.65 |
5.9× |
| Ureteral reflux study (78740) |
$597.46 |
$1,244.70 |
1.4× |
| Urethrocystogram voiding (74455) |
$416.02 |
$866.70 |
1.7× |
| Urography, infusion, drip technique and/or bolus technique; Non-Facility (74410) |
$277.34 |
$577.80 |
1.5× |
| Urography, infusion, drip technique and/or bolus technique; with nephrotomography Non-Facility (74415) |
$277.34 |
$577.80 |
1.5× |
| Us breast unilateral limited (76642) |
$172.08 |
$358.50 |
1.9× |
| Us chest (76604) |
$227.57 |
$474.10 |
2.1× |
| Us Cmprn Rpr Artl Pseudoarysm/Arven Fstl (76936) |
$417.31 |
$869.40 |
1.8× |
| Us compl joint r-t w/image documentation (76881) |
$341.47 |
$711.40 |
3.1× |
| Us elastography parenchyma (76981) |
$238.70 |
$497.30 |
2.2× |
| Us encephalogram (76506) |
$227.57 |
$474.10 |
2.1× |
| Us hips infant static (76886) |
$455.57 |
$949.10 |
5.0× |
| Us infant hips w manipulation (76885) |
$341.47 |
$711.40 |
3.7× |
| Us lmtd joint/oth nonvasc xtr strux r-t w/img (76882) |
$227.18 |
$473.30 |
2.1× |
| Us ob detailed single fetus (76811) |
$341.47 |
$711.40 |
1.4× |
| Us ob limited (76815) |
$362.88 |
$756 |
3.3× |
| Us ob transvaginal (76817) |
$227.57 |
$474.10 |
2.1× |
| Us pelvic non ob complete (76856) |
$303.50 |
$632.30 |
2.8× |
| Us pelvic nonobstetric image dcmtn limited/f/u (76857) |
$227.57 |
$474.10 |
2.1× |
| Us pg uter img f&mat 14 wk tabdl 1/1st gestation (76801) |
$341.42 |
$711.30 |
3.1× |
| Us pg uter r-t img f-up tabdl appr pr fetus (76816) |
$341.42 |
$711.30 |
3.1× |
| Us retroperitoneal complete (76770) |
$227.57 |
$474.10 |
2.1× |
| Us retroperitoneal limited (76775) |
$215.71 |
$449.40 |
2.0× |
| Us scrotum and contents (76870) |
$466.08 |
$971 |
4.3× |
| Us soft tissue head/neck (76536) |
$341.47 |
$711.40 |
3.1× |
| Us spinal canal and contents (76800) |
$349.44 |
$728 |
3.2× |
| Us transrectal (76872) |
$455.28 |
$948.50 |
4.2× |
| Us transrectal prostate volume (76873) |
$227.57 |
$474.10 |
2.1× |
| Us,transplanted kidney, real time/ doppler (76776) |
$605.57 |
$1,261.60 |
5.5× |
| Venogram adrenal unilat (75840) |
$2,947.68 |
$6,141 |
0.9× |
| Venogram extremity bilateral (75822) |
$1,291.92 |
$2,691.50 |
0.8× |
| Venogram Extremity Unilateral (75820) |
$767.62 |
$1,599.20 |
0.5× |
| Venography caval inferior serialography rs&i (75825) |
$1,293.94 |
$2,695.70 |
0.4× |
| Venography caval superior serialography rs&i (75827) |
$1,291.06 |
$2,689.70 |
0.8× |
| Venography Orbital Rs&I (75880) |
$364.32 |
$759 |
0.6× |
| Venography Renal Bilateral (75833) |
$863.33 |
$1,798.60 |
0.3× |
| Venography renal unilateral selective rs&i (75831) |
$862.85 |
$1,797.60 |
0.3× |
| Venography venous sinus/jugular cath rs&i (75860) |
$1,285.63 |
$2,678.40 |
0.4× |
| Venography, epidural, radiological supervision and interpretation Non-Facility (75872) |
$1,219.06 |
$2,539.70 |
1.9× |
Venous sampling by catheter (75893)
likely a partial charge, not the full procedure |
$860.90 |
$1,793.55 |
0.1× |
| Venous thrombosis imaging, venogram; unilateral Non-Facility (78457) |
$369.55 |
$769.90 |
0.6× |
| Vertebral fracture assessment via dxa (77086) |
$144.19 |
$300.40 |
1.6× |
| Whole blood volume determination, including separate measurement of plasma volume and red cell volume… (78122) |
$1,487.90 |
$3,099.80 |
2.6× |
| Wrist 2 views (73100) |
$173.11 |
$360.65 |
1.9× |
| X-Ray Abdomen,Comp Acute Series - Xr Abdomen 2 Vws With Chest 1 View (74022) |
$138.62 |
$288.80 |
1.3× |
| X-Ray Ac Jts - Xr Acromioclavicular Joints Bilateral (73050) |
$138.43 |
$288.40 |
1.5× |
| X-ray b.e. reductn intuss (74283) |
$277.06 |
$577.20 |
1.5× |
| X-Ray Colon Air Contrast - Fl Barium Enema Air Contrast (74280) |
$277.06 |
$577.20 |
1.5× |
| X-Ray Elbow 2 Vw - Xr Elbow 1-2 Views Right (73070) |
$147.16 |
$306.60 |
1.6× |
| X-Ray Exam Hip Uni 2-3 Views (73502) |
$277.01 |
$577.10 |
3.0× |
| X-Ray Exam Hips Bi 3-4 Views (73522) |
$372.67 |
$776.40 |
3.4× |
| X-ray exam of femur 2/> (73552) |
$138.43 |
$288.40 |
1.5× |
| X-ray eye for foreign body (70030) |
$138.43 |
$288.40 |
1.5× |
| X-Ray Facial Bones <3 Vw - Xr Facial Bones 1-2 Views (70140) |
$138.43 |
$288.40 |
1.5× |
| X-ray IV pyelogram (ivp) (74400) |
$207.98 |
$433.30 |
1.1× |
| X-Ray Jaw <4 Vw - Xr Mandible < 4 Views (70100) |
$138.43 |
$288.40 |
1.5× |
| X-Ray Knee Bilat Standing - Xr Knees Anteroposterior Standing Bilat (73565) |
$138.43 |
$288.40 |
1.5× |
| X-ray leg, infant (73592) |
$138.43 |
$288.40 |
1.5× |
| X-Ray Lumbar Spine 2/3 Vw - Xr Lumbar Spine 2-3 Views (72100) |
$173.11 |
$360.65 |
1.6× |
| X-Ray Lumbar Spine 6+ Vw - Xr Lumbar Spine 6+ Vws Including Bending (72114) |
$138.43 |
$288.40 |
1.3× |
| X-ray nose-rectum child f.b. (76010) |
$138.43 |
$288.40 |
1.5× |
| X-Ray Orbits - Xr Orbits Complete 4+ Views (70200) |
$121.18 |
$252.45 |
1.1× |
| X-ray retrograde pyelogram (74420) |
$277.06 |
$577.20 |
0.8× |
| X-Ray Ribs 2 Vw Unilat - Xr Ribs 2 Views Right (71100) |
$138.43 |
$288.40 |
1.5× |
| X-Ray Ribs, Chest 3+ Vw - Xr Ribs 2 Vws Lt W/ Chest Anteroposterior (71101) |
$138.43 |
$288.40 |
1.3× |
| X-Ray Ribs, Chest 4+ Vw - Xr Ribs 3 Vws Bil W/ Chest Posteroanterior (71111) |
$138.43 |
$288.40 |
1.3× |
| X-Ray Sacroiliac Jts 3+ Vw - Xr Sacroiliac Joints 3+ Views (72202) |
$138.43 |
$288.40 |
1.3× |
| X-Ray Sacrum/Coccyx 2+ Vw - Xr Sacrum Coccyx 2+ Views (72220) |
$138.43 |
$288.40 |
1.5× |
| X-Ray Sinuses 3+ Vw - Xr Paranasal Sinuses 3+ Views (70220) |
$138.43 |
$288.40 |
1.5× |
| X-Ray Skull 4+ Vw - Xr Skull Complete 4+ Views (70260) |
$138.43 |
$288.40 |
1.3× |
| X-Ray Skull <4 Vw - Xr Skull 1-3 Views (70250) |
$173.11 |
$360.65 |
1.6× |
| X-Ray Small Bowel Enteroclysis (74251) |
$571.15 |
$1,189.90 |
3.1× |
| X-Ray Spine One View - Xr Spine (72020) |
$138.62 |
$288.80 |
1.5× |
| X-Ray Sterno-Clavicluar Jt - Xr Sternoclavicular Joints 3+ Views (71130) |
$138.43 |
$288.40 |
1.5× |
| X-Ray Sternum 2+ Vw - Xr Sternum 2+ Views (71120) |
$138.43 |
$288.40 |
1.5× |
| X-Ray Thoracic Spine 2 Vw - Xr Thoracic Spine 2 Views (72070) |
$173.11 |
$360.65 |
1.6× |
| X-Ray Thoracic Spine 4 Vw - Xr Thoracic Spine Complete 4+ Views (72074) |
$138.62 |
$288.80 |
1.3× |
| Xr bone length studies (77073) |
$231.79 |
$482.90 |
2.1× |
| Xr c-spine 4 or 5 views (72050) |
$138.43 |
$288.40 |
1.3× |
| Xr c-spine 6 or more views (72052) |
$207.79 |
$432.90 |
1.9× |
| Xr chest 4+ views (71048) |
$138.43 |
$288.40 |
1.3× |
| Xr urogram antegrade (74425) |
$831.70 |
$1,732.70 |
2.3× |