| 3-D radiotherapy plan dose-volume histograms (77295) |
$5,255 |
$10,510 |
3.7× |
| Abdomen 2 views (74019) |
$284 |
$568 |
2.6× |
| Acute gi blood loss imaging (78278) |
$2,319.50 |
$4,639 |
5.6× |
| Angiography extremity bilateral rs&i (75716) |
$2,274.50 |
$4,549 |
0.7× |
| Angiography extremity unilateral rs&i (75710) |
$2,244.50 |
$4,489 |
0.7× |
| Angiography internal mammary rs&i (75756) |
$1,728 |
$3,456 |
0.5× |
| Angiography pelvic slctv/supraslctv rs&i (75736) |
$14,411.44 |
$28,822.89 |
2.5× |
| Angiography pulmonary bilateral slctv rs&i (75743) |
$2,168.50 |
$4,337 |
0.7× |
| Angiography pulmonary unilateral slctv rs&i (75741) |
$1,741.50 |
$3,483 |
0.5× |
| Angiography Spinal Selective Rs&I (75705) |
$10,173.50 |
$20,347 |
1.8× |
| Angiography visceral slctv/supraslctv rs&i (75726) |
$7,257.52 |
$14,515.05 |
1.3× |
| Angrph Cath F-Up Std Tcat Other Than Thrombylsis (75898) |
$1,935 |
$3,870 |
0.6× |
| Angrph pulmonary nonslctv cath/ven njx rs&i (75746) |
$2,397 |
$4,794 |
0.7× |
| Ankle 2 views (73600) |
$390.75 |
$781.50 |
4.3× |
| Aortogram thoracic (75605) |
$3,460.50 |
$6,921 |
0.6× |
| Aortography abdl bi iliofem low extrem cath rs&i (75630) |
$2,460.50 |
$4,921 |
0.8× |
| Aortography abdominal serialography rs&i (75625) |
$1,738.50 |
$3,477 |
0.5× |
| Aortography Thoracic W/O Serialography Rs&I (75600) |
$1,282 |
$2,564 |
0.4× |
| Arthrogram ankle (73615) |
$664.50 |
$1,329 |
1.8× |
| Arthrogram elbow (73085) |
$989.50 |
$1,979 |
2.7× |
| Arthrogram hip (73525) |
$2,164.49 |
$4,328.99 |
6.0× |
| Arthrogram knee (73580) |
$534 |
$1,068 |
1.5× |
| Arthrogram shoulder (73040) |
$2,933.46 |
$5,866.92 |
8.1× |
| Arthrogram wrist (73115) |
$586 |
$1,172 |
1.6× |
| Basic dosimetry (77300) |
$567.50 |
$1,135 |
4.1× |
| Bone &/Joint Imaging Limited Area (78300) |
$1,122 |
$2,244 |
2.7× |
| Bone &/joint imaging whole body (78306) |
$1,482.50 |
$2,965 |
3.6× |
| Bone age studies (77072) |
$374 |
$748 |
3.5× |
| Bone Imaging 3 Phase (78315) |
$1,610 |
$3,220 |
3.9× |
| Bone Marrow Imaging Limited Area (78102) |
$548 |
$1,096 |
1.3× |
| Bone survey complete (77075) |
$777.50 |
$1,555 |
7.2× |
| Bone survey infant (77076) |
$741 |
$1,482 |
6.9× |
| Bowel imaging (78290) |
$434.50 |
$869 |
1.1× |
| Brachytx isodose complex (77318) |
$682.50 |
$1,365 |
1.8× |
| Brachytx isodose intermed (77317) |
$682 |
$1,364 |
1.8× |
| Brachytx isodose pln smpl w/dosimetry cal (77316) |
$290 |
$580 |
0.7× |
| Brain Imaging Min 4 Static Views W Vascular Flow (78606) |
$1,426 |
$2,852 |
2.5× |
| Brain Imaging Pet Metabolic Evaluation (78608) |
$4,029.50 |
$8,059 |
2.7× |
| Card Bpi Gtd =Brm Plnr 1 Std Rest/Strs (78472) |
$1,606.50 |
$3,213 |
3.9× |
| Cardiac magnetic resonance imaging for morphology and function without contrast material(s), followed by contrast… (75563) |
$1,148.50 |
$2,297 |
1.4× |
| Cardiac MRI w/w/o contrast & further seq (75561) |
$1,090.50 |
$2,181 |
3.0× |
| Cerebrospinal Fluid Flow W/O Matl Shunt Evaltj (78645) |
$1,217.50 |
$2,435 |
2.2× |
| Cervical spine 2 or 3 views (72040) |
$377 |
$754 |
4.2× |
| Chest 1 view (71045) |
$188 |
$376 |
2.1× |
| Chest xray 3 views (71047) |
$186.50 |
$373 |
2.1× |
| Cine/Vid X-Ray Throat/Esoph - Fl Esoph Barium Swlw W/ Video & Speech (74230) |
$388 |
$776 |
2.1× |
| Cineradiography/videoradiography (76120) |
$329.50 |
$659 |
3.0× |
| Cisternography Positive Contrast Rs&I (70015) |
$491 |
$982 |
0.6× |
| Clavicle complete (73000) |
$337.50 |
$675 |
3.7× |
| Computed Tomography Thorax Lw Dose Lng Ca Scr C- (71271) |
$386.50 |
$773 |
3.6× |
| Computed tomography, bone mineral density study, 1 or more sites, axial skeleton (eg, hips, pelvis, spine) Non-Facility (77078) |
$470.50 |
$941 |
5.2× |
| Continuing medical physics consltj pr wk (77336) |
$784.75 |
$1,569.50 |
5.6× |
| Contrast Xray Throat/Cerv Esopha (74210) |
$896 |
$1,792 |
4.9× |
| CT abdomen and pelvis without and with contrast (74178) |
$2,890.20 |
$5,780.40 |
8.0× |
| CT abdomen and pelvis without contrast (74176) |
$1,470 |
$2,940 |
6.0× |
| CT abdomen w contrast (74160) |
$1,483.50 |
$2,967 |
8.2× |
| CT abdomen w wo contrast (74170) |
$2,625.82 |
$5,251.63 |
14.5× |
| CT abdomen w/o contrast (74150) |
$1,327.50 |
$2,655 |
12.3× |
| CT angio hrt w/3d image (75574) |
$1,115.50 |
$2,231 |
3.1× |
| CT angio lwr extr w/o&w/dye (73706) |
$3,954.50 |
$7,909 |
21.8× |
| CT angiography upper extremity lt (73206) |
$1,941.50 |
$3,883 |
10.7× |
| CT c-spine w/contrast (72126) |
$1,764 |
$3,528 |
4.9× |
| CT c-spine w/o contrast (72125) |
$1,470 |
$2,940 |
13.6× |
| CT cere prfu aly c+wo CT/CTA (70473) |
$1,392.50 |
$2,785 |
7.7× |
| CT cervical spine w&w/o contrast (72127) |
$2,763.50 |
$5,527 |
15.2× |
| CT chest w contrast (71260) |
$1,669.50 |
$3,339 |
9.2× |
| CT chest w/wo contrast (71270) |
$2,615.50 |
$5,231 |
14.4× |
| CT colonography screening (74263) |
$277 |
$554 |
1.1× |
| CT colonography w/dye (74262) |
$264 |
$528 |
1.5× |
| CT colonography w/o cntrst (74261) |
$247.50 |
$495 |
2.3× |
| CT head/brain with contrast (70460) |
$1,237 |
$2,474 |
6.8× |
| CT head/brain without and with contrast (70470) |
$1,937.50 |
$3,875 |
10.7× |
| CT heart contrast eval cardiac structure&morph (75572) |
$1,090 |
$2,180 |
3.0× |
| CT heart w/o contrast quant eval coronary calcium (75571) |
$472 |
$944 |
5.2× |
| CT hrt w/3d image congen (75573) |
$3,110 |
$6,220 |
8.6× |
| CT iac w contrast (70481) |
$1,539.50 |
$3,079 |
8.5× |
| CT limited/localized follow up study (76380) |
$431.50 |
$863 |
4.8× |
| CT lower ext w/o (73700) |
$1,484.50 |
$2,969 |
13.7× |
| CT lower extremity w wo contrast (73702) |
$2,233 |
$4,466 |
12.3× |
| CT lower extremity w/contrast material (73701) |
$1,781.25 |
$3,562.50 |
9.8× |
| CT lumbar spine w & w/o contrast (72133) |
$2,763.50 |
$5,527 |
15.2× |
| CT lumbar spine w/contrast (72132) |
$1,764 |
$3,528 |
4.9× |
| CT lumbar spine w/o contrast (72131) |
$1,470 |
$2,940 |
13.6× |
| CT maxillofacial w contrast (70487) |
$1,634.50 |
$3,269 |
9.0× |
| CT maxillofacial w/wo contrast (70488) |
$2,560.50 |
$5,121 |
14.1× |
| CT maxillofacial wo contrast (70486) |
$1,362 |
$2,724 |
12.6× |
| CT orbit sella/post fossa/ear w/o & w/contr matr (70482) |
$2,411.50 |
$4,823 |
13.3× |
| CT orbits w/o contrast (70480) |
$1,282.50 |
$2,565 |
11.9× |
| CT pelvis w/o contrast (72192) |
$1,195.50 |
$2,391 |
11.1× |
| CT pelvis w/wo contrast (72194) |
$1,272 |
$2,544 |
7.0× |
| CT scan of arm combo (73202) |
$2,282 |
$4,564 |
12.6× |
| CT soft tissue neck w contrast (70491) |
$1,580.50 |
$3,161 |
8.7× |
| CT soft tissue neck w/o & w/contrast material (70492) |
$2,475.50 |
$4,951 |
13.6× |
| CT soft tissue neck w/o contrast (70490) |
$1,316.50 |
$2,633 |
12.2× |
| CT thoracic spine w/contrast (72129) |
$1,764 |
$3,528 |
9.7× |
| CT thoracic spine w/o contrast (72128) |
$1,470 |
$2,940 |
13.6× |
| CT thoracic spine w/wo contrast (72130) |
$2,763.50 |
$5,527 |
15.2× |
| CT thorax w/o contrast (71250) |
$1,391.50 |
$2,783 |
12.9× |
| CT upper ext wo (73200) |
$1,214 |
$2,428 |
11.2× |
| CT upper extremity with contrast (73201) |
$1,456.50 |
$2,913 |
4.0× |
| Cta Aa&Bi Iliofem Lxtr Rs&I C-/C+ Post-Pxessing (75635) |
$1,571.50 |
$3,143 |
8.7× |
| Cta Abdomen (74175) |
$2,559.50 |
$5,119 |
14.1× |
| CTA abdomen pelvis (74174) |
$3,315 |
$6,630 |
9.2× |
| CTA chest (71275) |
$1,908 |
$3,816 |
10.5× |
| Cta Head (70496) |
$1,543 |
$3,086 |
8.5× |
| CTA head&neck c+ w/noncontrast img&post-pxessing (70471) |
$1,392.50 |
$2,785 |
3.9× |
| Cta Neck (70498) |
$1,577 |
$3,154 |
8.7× |
| Cta Pelvis (72191) |
$3,403 |
$6,806 |
18.8× |
| Cystography minimum 3 views rs&i (74430) |
$624.30 |
$1,248.60 |
1.7× |
| Dilation of ureter(s) or urethra, radiological supervision and interpretation Non-Facility (74485) |
$1,207.50 |
$2,415 |
0.6× |
| Diskogram cervical (72285) |
$1,953.50 |
$3,907 |
1.0× |
| Diskography lumbar (72295) |
$1,848 |
$3,696 |
0.9× |
| Doppler Echo Fetal Puls Spectral F/U/Repeat (76828) |
$479.50 |
$959 |
4.4× |
| Doppler Echo Fetal Spectral Display Complete (76827) |
$1,164.50 |
$2,329 |
10.8× |
| Doppler Fetal Mid Cerebral Artery (76821) |
$488.50 |
$977 |
4.5× |
| Dxa bone density study 1/> sites axial skel (77080) |
$754 |
$1,508 |
7.0× |
| Dxa bone density study 1/>sites appendiclr skel (77081) |
$673 |
$1,346 |
7.5× |
| Dxa bone density study axial skeleton (77085) |
$453.50 |
$907 |
4.2× |
| Echocardiography, fetal, cardiovascular system, real time with image documentation (2D), with or without M-mode… (76826) |
$1,201 |
$2,402 |
4.9× |
| Esophageal motility (78258) |
$524.50 |
$1,049 |
1.3× |
| Esophagus (74220) |
$445 |
$890 |
2.5× |
| Facial bones min 3 views (70150) |
$483.50 |
$967 |
4.5× |
| Fetal biophysical profile non-stress testing (76818) |
$742.75 |
$1,485.50 |
6.9× |
| Fetal Biophysical Profile W/O Non-Stress Testing (76819) |
$652 |
$1,304 |
6.0× |
| Fetal Echo (76825) |
$1,361 |
$2,722 |
2.4× |
| Fluoroscopy up to 1 hr (76000) |
$6,746.26 |
$13,492.52 |
27.3× |
| Foot 2 views (73620) |
$389.50 |
$779 |
4.3× |
| Forearm 2 views (73090) |
$392 |
$784 |
4.4× |
| Functional MRI brain by phys/psych (70555) |
$439.50 |
$879 |
1.8× |
| Functional MRI brain by tech (70554) |
$756.50 |
$1,513 |
3.1× |
| Gastric Emptyng Imag Std W/Sm Bwl Transit (78265) |
$2,448 |
$4,896 |
5.9× |
| Gastric mucosa imaging (78261) |
$749.50 |
$1,499 |
1.8× |
| Gstrc Emptng Imag Std W/Sm Bwl Col Trnst Mlt Day (78266) |
$2,284.50 |
$4,569 |
4.1× |
| Hand 2 views (73120) |
$339.50 |
$679 |
3.1× |
| Hdr rdncl ntrstl/intrcav brachytx 1 channel (77770) |
$551.50 |
$1,103 |
0.8× |
| Hdr rdncl ntrstl/intrcav brachytx 2-12 channel (77771) |
$551.50 |
$1,103 |
0.8× |
| Hdr rdncl ntrstl/intrcav brachytx >12 channels (77772) |
$551.50 |
$1,103 |
0.8× |
| Heart Infarct Image (78466) |
$736.50 |
$1,473 |
1.8× |
| Hepatc Vngrph Wdg/Fr Hemodyn Eval Rs&I (75889) |
$1,794.50 |
$3,589 |
0.5× |
| Hepatc vngrph wdg/fr w/o hemodyn eval rs&i (75891) |
$1,185 |
$2,370 |
0.4× |
| Hepatobil Syst Imag Inc Gb W/Pharma Intervenj (78227) |
$1,360.50 |
$2,721 |
2.4× |
| Hepatobiliary syst imaging including gallbladder (78226) |
$835.50 |
$1,671 |
2.0× |
| Hysterosalpingogram (74740) |
$1,144.70 |
$2,289.40 |
4.6× |
| Interstitial radiation source applic complex (77778) |
$2,165 |
$4,330 |
3.0× |
| Intracavitary Radiation Source Applic Complex (77763) |
$2,407.50 |
$4,815 |
3.3× |
| Intracavitary Radiation Source Applic Intermed (77762) |
$2,008.50 |
$4,017 |
3.5× |
| Intracavitary Radiation Source Applic Simple (77761) |
$1,235 |
$2,470 |
2.2× |
| Joint Survey, Single View - Xr Joint Anteroposterior 2+ Joints (77077) |
$220.50 |
$441 |
2.0× |
| Kidney Img Morphology Vascular Flow 1 W/O Rx (78707) |
$1,752 |
$3,504 |
3.1× |
| Kidney img morphology vascular flow 1 w/rx (78708) |
$1,794.50 |
$3,589 |
3.2× |
| Kidney Img Morphology Vascular Flow Multiple (78709) |
$2,272 |
$4,544 |
4.0× |
| Knee 3 views (73562) |
$385 |
$770 |
4.3× |
| Liver & spleen imaging static only (78215) |
$760.50 |
$1,521 |
1.8× |
| Liver imaging w/vascular flow (78202) |
$482 |
$964 |
0.9× |
| Lung perf&ventilat diferentl (78598) |
$337.50 |
$675 |
0.6× |
| Lung perfusion differential (78597) |
$1,470 |
$2,940 |
3.6× |
| Lung ventilation imaging (78579) |
$355 |
$710 |
0.9× |
| Lymphangiography Pelvic/Abdominal Bilateral Rs&I (75807) |
$408.50 |
$817 |
0.1× |
| Lymphangiography Pelvic/Abdominal Unilat Rs&I (75805) |
$378.50 |
$757 |
0.1× |
| Lymphangiography, extremity only, bilateral, radiological supervision and interpretation Facility (75803) |
$752 |
$1,504 |
0.5× |
| Lymphoscintigraphy (78195) |
$1,457 |
$2,914 |
2.6× |
| Magnetic resonance (eg, proton) imaging, any joint of upper extremity; with contrast material(s) Non-Facility (73222) |
$2,915.37 |
$5,830.74 |
3.6× |
| Magnetic resonance (eg, proton) imaging, brain (including brain stem and skull base), during open intracranial… (70558) |
$2,173 |
$4,346 |
12.0× |
| Magnetic resonance (eg, proton) imaging, brain (including brain stem and skull base), during open intracranial… (70557) |
$1,810.50 |
$3,621 |
3.2× |
| Magnetic resonance (eg, proton) imaging, brain (including brain stem and skull base), during open intracranial… (70559) |
$3,404 |
$6,808 |
18.8× |
| Magnetic resonance (eg, proton) imaging, upper extremity, other than joint; with contrast material(s) Non-Facility (73219) |
$1,572 |
$3,144 |
4.4× |
| Magnetic resonance (eg, proton) imaging, upper extremity, other than joint; without contrast material(s), followed by… (73220) |
$2,463 |
$4,926 |
6.8× |
| Magnetic Resonance Elastography (76391) |
$455.50 |
$911 |
1.8× |
| Mammary ductogram or galactogram multiple (77054) |
$505 |
$1,010 |
2.0× |
| Mammary ductogram or galactogram single (77053) |
$201.50 |
$403 |
0.8× |
| Medical physics dose eval radiation expos w/rprt (76145) |
$157 |
$314 |
0.4× |
| Mlc imrt design & construction per imrt plan (77338) |
$1,531.50 |
$3,063 |
4.0× |
| Mr safety determination physician/other qhp (76016) |
$115.50 |
$231 |
1.3× |
| Mr safety implant&/fb assmt clin staf 1st 15 min (76014) |
$65.50 |
$131 |
2.2× |
| Mr safety implt electronics prepj supvj phys/qhp (76018) |
$121 |
$242 |
1.2× |
| Mr safety implt pos&/immoblj (76019) |
$78 |
$156 |
1.3× |
| Mr safety med physics xm customization plng&mntr (76017) |
$317 |
$634 |
1.3× |
| MRA head w & w/o contrast (70546) |
$3,323.50 |
$6,647 |
9.2× |
| MRA head w/o contrast (70544) |
$1,767.50 |
$3,535 |
7.2× |
| MRA head with contrast (70545) |
$2,121 |
$4,242 |
5.9× |
| MRA neck w contrast (70548) |
$1,530.50 |
$3,061 |
4.2× |
| Mra Neck W/O &W/Contrast Material (70549) |
$2,397.50 |
$4,795 |
6.6× |
| MRA neck w/o contrast (70547) |
$1,275 |
$2,550 |
5.2× |
| MRI abdomen w contrast (74182) |
$3,149.50 |
$6,299 |
8.7× |
| MRI abdomen w/o & w/contrast material (74183) |
$3,627.75 |
$7,255.50 |
10.1× |
| MRI abdomen w/o contrast (74181) |
$2,065.50 |
$4,131 |
8.4× |
| MRI any jt lower extrem w/contrast material (73722) |
$1,272.50 |
$2,545 |
1.6× |
| MRI any jt lower extrem w/o & w/contrast matrl (73723) |
$1,994 |
$3,988 |
5.5× |
| MRI bone marrow blood supply (77084) |
$992.50 |
$1,985 |
4.0× |
| MRI breast w/o contrast bilateral (77047) |
$1,421.50 |
$2,843 |
5.8× |
| MRI breast wo contrast unilateral (77046) |
$2,612.50 |
$5,225 |
10.6× |
| MRI c-spine with contrast (72142) |
$1,490 |
$2,980 |
4.1× |
| MRI cardiac w/o cont stress (75559) |
$548 |
$1,096 |
1.0× |
| MRI cardiac w/o contrast (75557) |
$924.50 |
$1,849 |
3.7× |
| MRI cervical spine w/o contrast (72141) |
$1,241.50 |
$2,483 |
5.0× |
| MRI chest w/o & w/contrast material (71552) |
$2,317.50 |
$4,635 |
6.4× |
| MRI chest w/o contrast (71550) |
$1,232.50 |
$2,465 |
5.0× |
| MRI chest with contrast (71551) |
$1,479.50 |
$2,959 |
1.8× |
| MRI fetal sngl/1st gestation (74712) |
$746.50 |
$1,493 |
3.0× |
| MRI lower extrem oth/thn jt w/contrast matrl (73719) |
$1,272.50 |
$2,545 |
3.5× |
| MRI lower extrem oth/thn jt w/o & w/contr matr (73720) |
$1,994 |
$3,988 |
5.5× |
| MRI lower extrem oth/thn jt w/o contr matrl (73718) |
$1,325.75 |
$2,651.50 |
5.4× |
| MRI orbit face &/neck w/o contrast (70540) |
$1,220.50 |
$2,441 |
4.9× |
| MRI orbit face neck w contrast (70542) |
$1,465 |
$2,930 |
4.1× |
| MRI orbit/face/neck w&w/o cont (70543) |
$2,295 |
$4,590 |
6.4× |
| MRI pelvis w/contrast (72196) |
$1,704.50 |
$3,409 |
4.7× |
| MRI pelvis w/o & w/contrast material (72197) |
$2,670.50 |
$5,341 |
7.4× |
| MRI pelvis w/o contrast (72195) |
$1,420.50 |
$2,841 |
5.8× |
| MRI spectroscopy (76390) |
$1,092.75 |
$2,185.50 |
12.1× |
| MRI spinal canal cervical w/o & w/contr matrl (72156) |
$2,334 |
$4,668 |
6.5× |
| MRI spinal canal lumbar w/contrast material (72149) |
$1,357.50 |
$2,715 |
3.8× |
| MRI spinal canal lumbar w/o & w/contr matrl (72158) |
$2,127 |
$4,254 |
5.9× |
| MRI spinal canal thoracic w/contrast matrl (72147) |
$1,496.50 |
$2,993 |
4.1× |
| MRI spinal canal thoracic w/o & w/contr matrl (72157) |
$2,344 |
$4,688 |
6.5× |
| MRI temporomandibular joint (70336) |
$748 |
$1,496 |
3.0× |
| MRI thoracic spine w/o contrast (72146) |
$1,247 |
$2,494 |
5.1× |
| MRI up ext w/o contrast (73218) |
$1,310 |
$2,620 |
5.3× |
| MRI upper ext joint w/o contrast (73221) |
$1,352 |
$2,704 |
5.5× |
| MRI, joint upper extrem combo (73223) |
$2,541.50 |
$5,083 |
7.0× |
| Myelogram Cervical (72240) |
$1,283.50 |
$2,567 |
1.6× |
| Myelogram Lumbar (72265) |
$1,226.50 |
$2,453 |
1.5× |
| Myelography 2 or more regions (72270) |
$1,536.50 |
$3,073 |
1.9× |
| Myocardial Imaging Pet Metabolic Evaluation (78459) |
$4,829 |
$9,658 |
3.6× |
| Myocardial imaging, positron emission tomography (PET), combined perfusion with metabolic evaluation study (including… (78433) |
$8,752 |
$17,504 |
3.8× |
| Myocardial imaging, positron emission tomography (PET), metabolic evaluation study (including ventricular wall… (78429) |
$3,341 |
$6,682 |
2.3× |
| Myocardial imaging, positron emission tomography (PET), perfusion study (including ventricular wall motionºs» and/or… (78491) |
$4,740 |
$9,480 |
3.2× |
| Myocardial imaging, positron emission tomography (PET), perfusion study (including ventricular wall motionºs» and/or… (78431) |
$9,377.50 |
$18,755 |
4.1× |
| Myocardial imaging, positron emission tomography (PET), perfusion study (including ventricular wall motionºs» and/or… (78492) |
$3,519 |
$7,038 |
2.4× |
| Myocardial infarct spect (78469) |
$1,019 |
$2,038 |
1.8× |
| Myocardial Spect Multiple Studies (78452) |
$3,065 |
$6,130 |
2.3× |
| Myocardial spect single study at rest or stress (78451) |
$2,299 |
$4,598 |
1.7× |
| Myocrd img PET prfuj 1std rest/stress cncrnt CT (78430) |
$6,515.50 |
$13,031 |
4.4× |
| Myocrd Img Pet Prfuj W/Metab Dual Radiotracer (78432) |
$5,209.50 |
$10,419 |
3.3× |
| N-invas est c ffr sw aly CTA (75580) |
$1,309 |
$2,618 |
1.5× |
| Neck soft tissue (70360) |
$282 |
$564 |
3.1× |
| Nfs/Instlj Radioelmnt Sln 3 Mo Follow-Up Care (77750) |
$637 |
$1,274 |
1.6× |
| Njx Rp Loclzj Non-Img Probe Study Intravenous (78808) |
$536.50 |
$1,073 |
1.3× |
| Nm bone marrow multi (78103) |
$798 |
$1,596 |
1.9× |
| Nm bone marrow wb (78104) |
$547 |
$1,094 |
1.3× |
| Nm cisternogram (78630) |
$418.50 |
$837 |
0.7× |
| Nm csf leak detection (78650) |
$1,183.50 |
$2,367 |
0.9× |
| Nm gastric emptying study (78264) |
$1,546 |
$3,092 |
3.7× |
| Nm gastroesophageal reflux study (78262) |
$885.50 |
$1,771 |
2.1× |
| Nm peritoneal-venous shunt patency (78291) |
$1,176 |
$2,352 |
2.8× |
| Noncardiac Vascular Flow Imaging (78445) |
$962.50 |
$1,925 |
2.3× |
| Nonvascular shunt X-ray (75809) |
$1,719.50 |
$3,439 |
15.9× |
| Ntsty modul radthx pln dose-vol histos (77301) |
$4,437.50 |
$8,875 |
3.1× |
| Nuclear Rx Oral Admin (79005) |
$1,869.50 |
$3,739 |
7.7× |
| Ob us nuchal meas 1 gest (76813) |
$1,806.50 |
$3,613 |
16.7× |
| Ophthalmic biometry by ultrasound echography, A-scan; with intraocular lens power calculation Non-Facility (76519) |
$143 |
$286 |
1.3× |
| Ophthalmic ultrasound, diagnostic; anterior segment ultrasound, immersion (water bath) B-scan or high resolution… (76513) |
$240.50 |
$481 |
2.2× |
| Ophthalmic ultrasound, diagnostic; corneal pachymetry, unilateral or bilateral (determination of corneal thickness)… (76514) |
$302.50 |
$605 |
10.1× |
| Ophthalmic ultrasound, diagnostic; quantitative A-scan only Non-Facility (76511) |
$134 |
$268 |
1.2× |
| Orthopantogram (70355) |
$619.50 |
$1,239 |
6.9× |
| Osseous survey limited (77074) |
$224 |
$448 |
2.1× |
| Parathyrd planar w/spect&CT (78072) |
$1,996.50 |
$3,993 |
3.6× |
| Parathyroid Planar Imaging (78070) |
$953 |
$1,906 |
2.3× |
| Parathyroid planar imaging w/wo subtraction (78071) |
$939 |
$1,878 |
2.3× |
| Pelvis 1 or 2 views (72170) |
$263.50 |
$527 |
2.4× |
| Perineogram (74775) |
$305.50 |
$611 |
1.2× |
| Peritoneogram after injection (74190) |
$371.50 |
$743 |
0.7× |
| PET image w/CT, skull-thigh (78815) |
$2,426.50 |
$4,853 |
1.6× |
| PET imaging CT for attenuation limited area (78814) |
$3,450 |
$6,900 |
2.3× |
| PET imaging for CT attenuation whole body (78816) |
$1,150 |
$2,300 |
0.8× |
| Prq Transhepatc Portograpy Hemodyn Eval Rs&I (75885) |
$1,167.50 |
$2,335 |
0.4× |
| Prq transhepatc portograpy w/o hemodyn evl intrp (75887) |
$1,483 |
$2,966 |
0.5× |
| Pulmonary Perfusion Imaging Particulate (78580) |
$1,033.50 |
$2,067 |
2.5× |
| Pulmonary Ventilation & Perfusion Imaging (78582) |
$1,123.50 |
$2,247 |
2.0× |
| Quan&charac c atherosclerotc plaq asses sev c ds (75577) |
$1,188 |
$2,376 |
1.2× |
| Radex abscess/fistula/sinus tract rs&i (76080) |
$1,103.14 |
$2,206.28 |
2.0× |
| Radex Ankle Compl Minimum 3 Views (73610) |
$388.75 |
$777.50 |
4.3× |
| Radex Calcaneus Minimum 2 Views (73650) |
$323.25 |
$646.50 |
3.6× |
| Radex Elbw Compl Minimum 3 Views (73080) |
$468.25 |
$936.50 |
5.2× |
| Radex Entir Thrc Lmbr Crv Sac Spi W/Skull 1 Vw - Xr Scoliosis 1 Vw (72081) |
$246 |
$492 |
2.7× |
| Radex entir thrc lmbr crv sac spi w/skull 2/3 vw (72082) |
$377 |
$754 |
3.5× |
| Radex Entir Thrc Lmbr Crv Sac Spi W/Skull 4/5 Vw (72083) |
$538 |
$1,076 |
5.0× |
| Radex fingr minimum 2 views (73140) |
$332.50 |
$665 |
3.7× |
| Radex Foot Compl Minimum 3 Views (73630) |
$388.75 |
$777.50 |
4.3× |
| Radex Hand Minimum 3 Views (73130) |
$432 |
$864 |
4.8× |
| Radex Hip Unilateral With Pelvis 1 View (73501) |
$188.50 |
$377 |
2.1× |
| Radex Hip Unilateral With Pelvis Minimum 4 Views (73503) |
$682 |
$1,364 |
6.3× |
| Radex Hips Bilateral With Pelvis 2 Views (73521) |
$388.50 |
$777 |
3.6× |
| Radex Hips Bilateral With Pelvis Minimum 5 Views (73523) |
$466.50 |
$933 |
4.3× |
| Radex Humerus Minimum 2 Views (73060) |
$262.50 |
$525 |
2.9× |
| Radex Kne 1/2 Views (73560) |
$342 |
$684 |
3.8× |
| Radex Kne Compl 4/More Views (73564) |
$438.75 |
$877.50 |
4.1× |
| Radex Mndbl Compl Minimum 4 Views (70110) |
$497 |
$994 |
4.6× |
| Radex Nasal Bones Complete Minimum 3 Views (70160) |
$439.50 |
$879 |
4.9× |
| Radex Pelvis Compl Minimum 3 Views (72190) |
$395 |
$790 |
3.7× |
| Radex Sho Compl Minimum 2 Views (73030) |
$475 |
$950 |
5.3× |
| Radex Sinuses Paransl < 3 Views (70210) |
$171 |
$342 |
1.9× |
| Radex Spine Lumbosacral Only Bending 2/3 Views (72120) |
$343 |
$686 |
3.2× |
| Radex Temporomandble Jt Opn & Clsd Mouth Bilat (70330) |
$746.50 |
$1,493 |
8.3× |
| Radex Toe Minimum 2 Views (73660) |
$332 |
$664 |
3.7× |
| Radex upper extremity infant minimum 2 views (73092) |
$357 |
$714 |
3.3× |
| Radex Wrst Compl Minimum 3 Views (73110) |
$415.75 |
$831.50 |
4.6× |
| Radex X-Ray Exam Entire Spi 6/> Vw - Xr Entire Spine 6+ Vw (72084) |
$551.50 |
$1,103 |
5.1× |
| Radiation Delivery Stereotactic Cranial Cobalt (77371) |
$64,303.50 |
$128,607 |
8.4× |
| Radiation Delivery Stereotactic Cranial Linear (77372) |
$13,762.50 |
$27,525 |
1.8× |
| Radiation treatment delivery level 1 (77402) |
$580 |
$1,160 |
5.5× |
| Radiation treatment delivery level 2 (77407) |
$511.50 |
$1,023 |
1.3× |
| Radiation treatment delivery level 3 (77412) |
$636.50 |
$1,273 |
1.1× |
| Radiologic Exam Abdomen 1 View - Xr Abdomen 1 View (74018) |
$233.50 |
$467 |
2.6× |
| Radiologic Exam Abdomen 3+ Views - Xr Abdomen 3+ Views (74021) |
$325.50 |
$651 |
3.0× |
| Radiologic exam chest 2 views (71046) |
$292.50 |
$585 |
3.2× |
| Radiologic exam colon single contrast study (74270) |
$612.50 |
$1,225 |
3.4× |
| Radiologic Exam Esophagus Double Contrast Study (74221) |
$464 |
$928 |
2.6× |
| Radiologic exam upr gi trc double contrast study (74246) |
$584 |
$1,168 |
3.2× |
| Radiologic exam upr gi trc single contrast study (74240) |
$827 |
$1,654 |
4.6× |
| Radiologic examination femur 1 view (73551) |
$201.25 |
$402.50 |
2.2× |
| Radiologic examination tibia & fibula 2 views (73590) |
$339.50 |
$679 |
3.8× |
| Radiologic examination, internal auditory meati, complete Non-Facility (70134) |
$168.50 |
$337 |
0.3× |
| Radiologic examination, mastoids; complete, minimum of 3 views per side Non-Facility (70130) |
$380.50 |
$761 |
3.5× |
| Radiologic examination, mastoids; less than 3 views per side Non-Facility (70120) |
$245.50 |
$491 |
2.3× |
| Radiologic examination, teeth; single view Non-Facility (70300) |
$86 |
$172 |
1.0× |
| Radiological examination surgical specimen (76098) |
$412 |
$824 |
0.7× |
| Radiopharmaceutical therapy, by intra-articular administration Non-Facility (79440) |
$3,282.50 |
$6,565 |
13.6× |
| Radiopharmaceutical therapy, radiolabeled monoclonal antibody by intravenous infusion Non-Facility (79403) |
$2,093 |
$4,186 |
8.7× |
| Remote afterloading high dose rate radionuclide skin surface brachytherapy, includes basic dosimetry, when performed;… (77768) |
$340.50 |
$681 |
0.9× |
| Remote afterloading high dose rate radionuclide skin surface brachytherapy, includes basic dosimetry, when performed;… (77767) |
$340.50 |
$681 |
0.9× |
| Renal Cyst Study (74470) |
$239.50 |
$479 |
0.4× |
| Ribs bilateral 3 views (71110) |
$371.50 |
$743 |
3.4× |
| Rp Loclzj Tum Plnr 1 Area Single Day Imaging (78800) |
$265 |
$530 |
0.6× |
| Rp loclzj tum plnr 2+area 1+d img/1 area img>2+d (78801) |
$253 |
$506 |
0.6× |
| Rp Loclzj Tum Plnr Whole Body 2+ Days Imaging (78804) |
$1,236 |
$2,472 |
2.2× |
| Rp loclzj tum plnr whole body single day imaging (78802) |
$2,127 |
$4,254 |
3.8× |
| Rp loclzj tum spect 1 area single day imaging (78803) |
$1,669.50 |
$3,339 |
3.0× |
| Rp loclzj tum spect 2 area/sep acquisj img (78831) |
$1,739.50 |
$3,479 |
1.3× |
| Rp loclzj tum spect CT 2area 1d img/1 ar img>2+d (78832) |
$3,664.50 |
$7,329 |
2.5× |
| Rp loclzj tum spect w/CT 1 area 1 day imaging (78830) |
$3,230.50 |
$6,461 |
2.4× |
| Rp Therapy Intravenous Administration (79101) |
$589.50 |
$1,179 |
2.4× |
| Sacroiliac Joints < 3 Views (72200) |
$495 |
$990 |
4.6× |
| Saline Infus Sonohysterography W/Color Doppler (76831) |
$612.50 |
$1,225 |
2.5× |
| Salivary gland imaging (78230) |
$829 |
$1,658 |
2.0× |
| Scapula (73010) |
$333.75 |
$667.50 |
3.1× |
| Screening Digital Breast Tomosynthesis Bi (77063) |
$354.50 |
$709 |
15.2× |
| Shoulder 1 view (73020) |
$205 |
$410 |
2.3× |
| Simulation intermediate (77285) |
$1,154 |
$2,308 |
3.0× |
| Small bowel series (74250) |
$563.50 |
$1,127 |
3.1× |
| Spec telethx port pln parts hemibdy tot bdy (77321) |
$1,013.50 |
$2,027 |
2.6× |
| Special dosimetry (77331) |
$135 |
$270 |
1.0× |
| Special Physics Consult (77370) |
$672.25 |
$1,344.50 |
4.8× |
| Special treatment procedure (77470) |
$1,784 |
$3,568 |
3.1× |
| Speech evaluation complex (70371) |
$459.50 |
$919 |
1.9× |
| Spine thoracic 3 views (72072) |
$377 |
$754 |
3.5× |
| Splenoportograpy rs&i (75810) |
$1,200.50 |
$2,401 |
0.4× |
| Stereotactic Body Radiation Delivery (77373) |
$22,977.25 |
$45,954.50 |
12.4× |
| Superior sagittal sinus venogram (75870) |
$2,286.50 |
$4,573 |
0.7× |
| Surface Applic Low Dose Rate Radionuclide Source (77789) |
$411.50 |
$823 |
3.9× |
| Telethx isodose pln cplx w/basic dosimetry (77307) |
$1,063 |
$2,126 |
2.7× |
| Telethx isodose pln smpl w/dosimetry calculation (77306) |
$1,057 |
$2,114 |
2.7× |
| Ther rad simulaj-aided field setting complex (77290) |
$1,515.75 |
$3,031.50 |
3.9× |
| Ther rad simulaj-aided field setting simple (77280) |
$709 |
$1,418 |
5.1× |
| Thoracolumbar 2 views (72080) |
$294 |
$588 |
3.3× |
| Thyroid carcinoma metastases imaging; limited area (eg, neck and chest only) Non-Facility (78015) |
$682 |
$1,364 |
1.6× |
| Thyroid carcinoma metastases img whole body (78018) |
$1,913.50 |
$3,827 |
3.4× |
| Thyroid imaging w/blood flow (78013) |
$678 |
$1,356 |
1.6× |
| Thyroid uptake measurement (78012) |
$931 |
$1,862 |
2.3× |
| Thyroid Uptake W/Blood Flow Sngle/Mult Quan Meas (78014) |
$839.50 |
$1,679 |
2.0× |
| Tmj unilateral (70328) |
$117 |
$234 |
1.3× |
| Tomogram (76100) |
$520 |
$1,040 |
4.8× |
| Treatment device complex (77334) |
$1,062.25 |
$2,124.50 |
2.7× |
| Treatment device intermediate (77333) |
$408 |
$816 |
2.9× |
| Treatment devices simple (77332) |
$340 |
$680 |
2.4× |
| Ultrasound breast complete (76641) |
$541.50 |
$1,083 |
5.0× |
| Ultrasound elastography first target lesion (76982) |
$621.50 |
$1,243 |
5.7× |
| Ultrasound Exam Aaa Screen (76706) |
$359.50 |
$719 |
3.3× |
| Ultrasound trgt dynamic microbubble 1st lesion (76978) |
$1,155 |
$2,310 |
3.2× |
| Ultrasound, abdomen limited (76705) |
$714 |
$1,428 |
6.6× |
| Umbilical-artery Doppler (OB) (76820) |
$613 |
$1,226 |
5.7× |
| Unlisted Diagnostic Radiographic Procedure (76499) |
$514.50 |
$1,029 |
5.7× |
| Unlisted fluoroscopic procedure (76496) |
$155 |
$310 |
1.7× |
| Unlisted hematopoietic, reticuloendothelial and lymphatic procedure, diagnostic nuclear medicine UNSCHEDULED (78199) |
$281.50 |
$563 |
0.7× |
| Unlisted magnetic resonance procedure (76498) |
$2,801.50 |
$5,603 |
31.1× |
| Unlisted Procedure Clinical Brachytherapy (77799) |
$1,634 |
$3,268 |
15.5× |
| Unlisted respiratory px dx nuclear medicine (78599) |
$1,173.50 |
$2,347 |
2.8× |
| Unlisted ultrasound procedure (76999) |
$1,008 |
$2,016 |
11.2× |
| Ureteral reflux study (78740) |
$957 |
$1,914 |
2.3× |
| Urethrocystogram voiding (74455) |
$307 |
$614 |
1.2× |
| Urethrocystography retrograde rs&i (74450) |
$426 |
$852 |
1.7× |
| Urography, infusion, drip technique and/or bolus technique; Non-Facility (74410) |
$732 |
$1,464 |
4.0× |
| Urography, infusion, drip technique and/or bolus technique; with nephrotomography Non-Facility (74415) |
$974.50 |
$1,949 |
5.4× |
| Us breast unilateral limited (76642) |
$195 |
$390 |
2.2× |
| Us chest (76604) |
$377 |
$754 |
3.5× |
| Us Cmprn Rpr Artl Pseudoarysm/Arven Fstl (76936) |
$1,054.50 |
$2,109 |
4.7× |
| Us compl joint r-t w/image documentation (76881) |
$571.50 |
$1,143 |
5.3× |
| Us elastography parenchyma (76981) |
$76 |
$152 |
0.7× |
| Us encephalogram (76506) |
$484.50 |
$969 |
4.5× |
| Us hips infant static (76886) |
$1,146 |
$2,292 |
12.7× |
| Us infant hips w manipulation (76885) |
$988 |
$1,976 |
11.0× |
| Us lmtd joint/oth nonvasc xtr strux r-t w/img (76882) |
$553.75 |
$1,107.50 |
5.1× |
| Us nrv&acc strux 1 xtr compre w/img pr extremity (76883) |
$131.50 |
$263 |
1.2× |
| Us ob detailed single fetus (76811) |
$513.50 |
$1,027 |
2.1× |
| Us ob limited (76815) |
$992.75 |
$1,985.50 |
9.2× |
| Us ob transvaginal (76817) |
$801.50 |
$1,603 |
7.4× |
| Us pelvic non ob complete (76856) |
$1,463 |
$2,926 |
13.5× |
| Us pelvic nonobstetric image dcmtn limited/f/u (76857) |
$494.50 |
$989 |
4.6× |
| Us pg uter img f&mat 14 wk tabdl 1/1st gestation (76801) |
$542 |
$1,084 |
5.0× |
| Us pg uter r-t img f-up tabdl appr pr fetus (76816) |
$747 |
$1,494 |
6.9× |
| Us retroperitoneal complete (76770) |
$807.50 |
$1,615 |
7.5× |
| Us retroperitoneal limited (76775) |
$407.50 |
$815 |
3.8× |
| Us scrotum and contents (76870) |
$618 |
$1,236 |
5.7× |
| Us soft tissue head/neck (76536) |
$620.50 |
$1,241 |
5.7× |
| Us spinal canal and contents (76800) |
$1,204 |
$2,408 |
11.1× |
| Us transrectal (76872) |
$5,423.76 |
$10,847.52 |
50.1× |
| Us transrectal prostate volume (76873) |
$1,060 |
$2,120 |
9.8× |
| Us, eye b-scan (76512) |
$519 |
$1,038 |
4.8× |
| Us,transplanted kidney, real time/ doppler (76776) |
$408.50 |
$817 |
3.8× |
| Venogram adrenal unilat (75840) |
$1,200.50 |
$2,401 |
0.4× |
| Venogram extremity bilateral (75822) |
$555.50 |
$1,111 |
0.3× |
| Venogram Extremity Unilateral (75820) |
$1,429 |
$2,858 |
0.9× |
| Venography caval inferior serialography rs&i (75825) |
$1,483 |
$2,966 |
0.5× |
| Venography caval superior serialography rs&i (75827) |
$1,130.50 |
$2,261 |
0.7× |
| Venography Orbital Rs&I (75880) |
$371 |
$742 |
0.6× |
| Venography Renal Bilateral (75833) |
$1,741.50 |
$3,483 |
0.5× |
| Venography renal unilateral selective rs&i (75831) |
$1,741.50 |
$3,483 |
0.5× |
| Venography venous sinus/jugular cath rs&i (75860) |
$2,118.50 |
$4,237 |
0.6× |
Venous sampling by catheter (75893)
likely a partial charge, not the full procedure |
$1,004 |
$2,008 |
0.2× |
| Vertebral fracture assessment via dxa (77086) |
$369.50 |
$739 |
4.1× |
| Wrist 2 views (73100) |
$390.75 |
$781.50 |
4.3× |
| X-Ray Abdomen,Comp Acute Series - Xr Abdomen 2 Vws With Chest 1 View (74022) |
$510 |
$1,020 |
4.7× |
| X-Ray Ac Jts - Xr Acromioclavicular Joints Bilateral (73050) |
$369.50 |
$739 |
4.1× |
| X-ray b.e. reductn intuss (74283) |
$302.50 |
$605 |
1.7× |
| X-Ray Colon Air Contrast - Fl Barium Enema Air Contrast (74280) |
$977 |
$1,954 |
5.4× |
| X-Ray Elbow 2 Vw - Xr Elbow 1-2 Views Right (73070) |
$379.50 |
$759 |
4.2× |
| X-Ray Exam Hip Uni 2-3 Views (73502) |
$264.50 |
$529 |
2.9× |
| X-Ray Exam Hips Bi 3-4 Views (73522) |
$484.50 |
$969 |
4.5× |
| X-ray exam of femur 2/> (73552) |
$308.75 |
$617.50 |
3.4× |
| X-ray eye for foreign body (70030) |
$201 |
$402 |
2.2× |
| X-Ray Facial Bones <3 Vw - Xr Facial Bones 1-2 Views (70140) |
$287.50 |
$575 |
3.2× |
| X-Ray Jaw <4 Vw - Xr Mandible < 4 Views (70100) |
$155.50 |
$311 |
1.7× |
| X-Ray Knee Bilat Standing - Xr Knees Anteroposterior Standing Bilat (73565) |
$182.50 |
$365 |
2.0× |
| X-ray leg, infant (73592) |
$532 |
$1,064 |
5.9× |
| X-Ray Lumbar Spine 2/3 Vw - Xr Lumbar Spine 2-3 Views (72100) |
$377 |
$754 |
3.5× |
| X-Ray Lumbar Spine 6+ Vw - Xr Lumbar Spine 6+ Vws Including Bending (72114) |
$468 |
$936 |
4.3× |
| X-ray nose-rectum child f.b. (76010) |
$417.50 |
$835 |
4.6× |
| X-ray optic foramen (70190) |
$138.50 |
$277 |
1.5× |
| X-Ray Orbits - Xr Orbits Complete 4+ Views (70200) |
$542 |
$1,084 |
5.0× |
| X-ray retrograde pyelogram (74420) |
$599.50 |
$1,199 |
1.7× |
| X-Ray Ribs 2 Vw Unilat - Xr Ribs 2 Views Right (71100) |
$270 |
$540 |
3.0× |
| X-Ray Ribs, Chest 3+ Vw - Xr Ribs 2 Vws Lt W/ Chest Anteroposterior (71101) |
$428.50 |
$857 |
4.0× |
| X-Ray Ribs, Chest 4+ Vw - Xr Ribs 3 Vws Bil W/ Chest Posteroanterior (71111) |
$450.50 |
$901 |
4.2× |
| X-Ray Sacroiliac Jts 3+ Vw - Xr Sacroiliac Joints 3+ Views (72202) |
$376.50 |
$753 |
3.5× |
| X-Ray Sacrum/Coccyx 2+ Vw - Xr Sacrum Coccyx 2+ Views (72220) |
$281.50 |
$563 |
3.1× |
| X-Ray Sinuses 3+ Vw - Xr Paranasal Sinuses 3+ Views (70220) |
$409.50 |
$819 |
4.5× |
| X-Ray Skull 4+ Vw - Xr Skull Complete 4+ Views (70260) |
$503.50 |
$1,007 |
4.7× |
| X-Ray Skull <4 Vw - Xr Skull 1-3 Views (70250) |
$326.50 |
$653 |
3.0× |
| X-Ray Small Bowel Enteroclysis (74251) |
$765 |
$1,530 |
4.2× |
| X-Ray Spine One View - Xr Spine (72020) |
$227.50 |
$455 |
2.5× |
| X-Ray Sterno-Clavicluar Jt - Xr Sternoclavicular Joints 3+ Views (71130) |
$55 |
$110 |
0.6× |
| X-Ray Sternum 2+ Vw - Xr Sternum 2+ Views (71120) |
$340.50 |
$681 |
3.8× |
| X-Ray Thoracic Spine 2 Vw - Xr Thoracic Spine 2 Views (72070) |
$315.50 |
$631 |
2.9× |
| X-Ray Thoracic Spine 4 Vw - Xr Thoracic Spine Complete 4+ Views (72074) |
$359.50 |
$719 |
3.3× |
| Xr bone length studies (77073) |
$511 |
$1,022 |
4.7× |
| Xr c-spine 4 or 5 views (72050) |
$509.50 |
$1,019 |
4.7× |
| Xr c-spine 6 or more views (72052) |
$343 |
$686 |
3.2× |
| Xr chest 4+ views (71048) |
$189 |
$378 |
1.7× |
| Xr urogram antegrade (74425) |
$183 |
$366 |
0.5× |