| 3-D radiotherapy plan dose-volume histograms (77295) |
$1,850.40 |
$11,565 |
1.4× |
| Abdomen 1 View (74018) |
$84.80 |
$530 |
1.0× |
| Abdomen 2 views (74019) |
$169.44 |
$1,059 |
1.7× |
| Acute Gastrointestinal Blood Loss Imaging (78278) |
$544.32 |
$3,402 |
1.5× |
| Adrenal Cortex & Medulla Img (78075) |
$506.88 |
$3,168 |
0.4× |
| Angio internal mammary (75756) |
$1,539.68 |
$9,623 |
0.5× |
| Angio pulmonary bilat (75743) |
$1,420.48 |
$8,878 |
0.5× |
| Angiography Adrenal Bilateral Slctv Rs&I (75733) |
$2,518.08 |
$15,738 |
0.8× |
| Angiography extremity bilateral rs&i (75716) |
$1,955.84 |
$12,224 |
0.7× |
| Angiography extremity unilateral rs&i (75710) |
$1,476.48 |
$9,228 |
0.5× |
| Angiography pulmonary unilateral slctv rs&i (75741) |
$1,169.12 |
$7,307 |
0.4× |
| Angrph pulmonary nonslctv cath/ven njx rs&i (75746) |
$1,539.68 |
$9,623 |
0.5× |
| Ankle 2 views (73600) |
$110.56 |
$691 |
1.4× |
Aortography thoracic serialography rs&i (75605)
likely a partial charge, not the full procedure |
$1,328.64 |
$8,304 |
0.3× |
| Aortography thoracic w/o serialography rs&i (75600) |
$2,518.08 |
$15,738 |
0.8× |
Artery X-Rays Abdomen (75726)
unusually low: confirm this is the full procedure |
$1,825.44 |
$11,409 |
0.3× |
| Artery X-Rays Adrenal Gland (75731) |
$824.32 |
$5,152 |
0.3× |
Artery X-Rays Pelvis (75736)
unusually low: confirm this is the full procedure |
$1,766.40 |
$11,040 |
0.3× |
Artery X-Rays Spine (75705)
unusually low: confirm this is the full procedure |
$1,823.68 |
$11,398 |
0.3× |
| Arthrogram ankle (73615) |
$202.56 |
$1,266 |
0.6× |
| Arthrogram hip (73525) |
$191.68 |
$1,198 |
0.6× |
| Arthrogram Wrist (73115) |
$195.04 |
$1,219 |
0.6× |
| Basic radiation dosimetry calculation (77300) |
$80.96 |
$506 |
0.6× |
| Bone age studies (77072) |
$105.28 |
$658 |
1.1× |
| Bone Imaging 3 Phase (78315) |
$799.68 |
$4,998 |
2.1× |
| Bone Imaging Limited Area (78300) |
$335.20 |
$2,095 |
0.9× |
| Bone Imaging Multiple Areas (78305) |
$294.72 |
$1,842 |
0.8× |
| Bone Imaging Whole Body (78306) |
$607.20 |
$3,795 |
1.6× |
| Bone marrow imaging limited area (78102) |
$463.68 |
$2,898 |
1.2× |
| Bone marrow imaging; multiple areas (78103) |
$317.76 |
$1,986 |
0.8× |
| Bone marrow imaging; whole body (78104) |
$430.88 |
$2,693 |
1.1× |
| Bone survey infant (77076) |
$51.84 |
$324 |
0.5× |
| Brachytx isodose complex (77318) |
$276 |
$1,725 |
0.8× |
| Brachytx isodose intermed (77317) |
$363.20 |
$2,270 |
1.0× |
| Brachytx Isodose Plan Simple (77316) |
$173.92 |
$1,087 |
0.5× |
| Brain Flow Imaging Only (78610) |
$268.96 |
$1,681 |
0.5× |
| Brain Image W/Flow < 4 Views (78601) |
$194.88 |
$1,218 |
0.5× |
| Brain imaging < 4 static views (78600) |
$299.68 |
$1,873 |
0.8× |
| Brain Imaging Min 4 Static Views W Vascular Flow (78606) |
$317.60 |
$1,985 |
0.6× |
| Brain Imaging Minimum 4 Static Views (78605) |
$299.68 |
$1,873 |
0.6× |
| Brain Imaging Pet Metabolic Evaluation (78608) |
$2,160.96 |
$13,506 |
1.6× |
| Card Bl Pool Gated Spect Rest Wal Motn Ejct Frct (78494) |
$350.88 |
$2,193 |
0.9× |
| Cardiac blood pool imaging, first pass technique; multiple studies, resting and with stress (exercise and/or… (78483) |
$350.88 |
$2,193 |
0.7× |
| Cardiac MRI w/w/o contrast & further seq (75561) |
$758.56 |
$4,741 |
2.3× |
| Cardiac MRI w/w/o contrast w/stress (75563) |
$623.52 |
$3,897 |
0.8× |
| Cardiac Shunt Detection (78428) |
$350.88 |
$2,193 |
0.9× |
| Cat Scan Follow-Up Study (76380) |
$288.64 |
$1,804 |
3.5× |
| Cerebrospinal Fluid Flow W/O Matl Shunt Evaltj (78645) |
$427.04 |
$2,669 |
0.8× |
| Cerebrospinal fluid flow, imaging (not including introduction of material); ventriculography Non-Facility (78635) |
$520 |
$3,250 |
1.0× |
| Cerebrospinal Fluid Scan (78630) |
$286.24 |
$1,789 |
0.6× |
| Chest 1 view (71045) |
$91.84 |
$574 |
1.1× |
| Chest 2 views (71046) |
$103.20 |
$645 |
1.3× |
| Chest 3 views (71047) |
$107.04 |
$669 |
1.3× |
| Chest 4 or more views (71048) |
$99.20 |
$620 |
1.0× |
| Cholecystography Oral Contrast (74290) |
$135.04 |
$844 |
0.8× |
| Cineradiograpy/vidradiograpy xcpt where spec (76120) |
$63.68 |
$398 |
0.6× |
| Cisternography Positive Contrast Rs&I (70015) |
$389.12 |
$2,432 |
0.5× |
| Clavicle complete (73000) |
$88.80 |
$555 |
1.1× |
| Computed Tomography Thorax Lw Dose Lng Ca Scr C- (71271) |
$48.16 |
$301 |
0.5× |
| Continuing medical physics consltj pr wk (77336) |
$185.76 |
$1,161 |
1.5× |
| Contrast Exam Abdominl Aorta (75625) |
$1,764.32 |
$11,027 |
0.6× |
| Contrast X-Ray Bladder (74430) |
$176.96 |
$1,106 |
0.5× |
| Contrast X-Ray Of Elbow (73085) |
$203.52 |
$1,272 |
0.6× |
| Contrast X-Ray Of Knee Joint (73580) |
$196.48 |
$1,228 |
0.6× |
| Contrast Xray Throat/Cerv Esopha (74210) |
$211.20 |
$1,320 |
1.3× |
| Corpora cavernosography (74445) |
$122.88 |
$768 |
1.3× |
| CT abdomen and pelvis without and with contrast (74178) |
$738.56 |
$4,616 |
2.3× |
| CT abdomen and pelvis without contrast (74176) |
$710.56 |
$4,441 |
3.2× |
| CT abdomen w contrast (74160) |
$797.44 |
$4,984 |
4.8× |
| CT abdomen w wo contrast (74170) |
$929.76 |
$5,811 |
5.6× |
| CT abdomen w/o contrast (74150) |
$792 |
$4,950 |
8.1× |
CT Angio Abdomen and Pelvis (74174)
range across 2 matching MRF lines |
$835.84–$1,497.92 |
$5,224–$9,362 |
varies |
| CT Angio Chest (71275) |
$811.04 |
$5,069 |
4.9× |
| CT Angio Head (70496) |
$849.12 |
$5,307 |
5.2× |
| CT angio hrt w/3d image (75574) |
$905.12 |
$5,657 |
2.8× |
| Ct Angio Lwr Extr W/O&W/Dye (73706) |
$573.60 |
$3,585 |
3.5× |
| CT Angio Neck (70498) |
$569.92 |
$3,562 |
3.5× |
| Ct Angio Upr Extrm W/O&W/Dye (73206) |
$526.40 |
$3,290 |
3.2× |
| CT cervical spine w/ contrast (72126) |
$777.76 |
$4,861 |
2.4× |
| CT cervical spine w/o contrast (72125) |
$624.64 |
$3,904 |
6.4× |
| CT cervical spine w/wo cont (72127) |
$903.68 |
$5,648 |
5.5× |
| CT chest w contrast (71260) |
$916.48 |
$5,728 |
5.6× |
| CT chest w/wo contrast (71270) |
$1,029.12 |
$6,432 |
6.3× |
| CT colonography screening (74263) |
$625.92 |
$3,912 |
2.8× |
| CT Colonogrphy Dx Image Postprocess W/Contrast (74262) |
$301.92 |
$1,887 |
1.8× |
| CT colonogrphy dx image postprocess w/o contrast (74261) |
$475.68 |
$2,973 |
4.8× |
| CT head/brain with contrast (70460) |
$705.92 |
$4,412 |
4.3× |
| CT head/brain without and with contrast (70470) |
$776.96 |
$4,856 |
4.7× |
| CT heart contrast eval cardiac structure&morph (75572) |
$409.76 |
$2,561 |
1.3× |
| CT heart no contrast quant eval coronry calcium (75571) |
$310.56 |
$1,941 |
3.8× |
| CT hrt w/3d image congen (75573) |
$486.56 |
$3,041 |
1.5× |
| CT iac w contrast (70481) |
$513.92 |
$3,212 |
3.1× |
| CT l-spine w&w/o contrast (72133) |
$913.44 |
$5,709 |
5.5× |
| CT lower ext w/o (73700) |
$570.56 |
$3,566 |
5.8× |
| CT lower extremity w/contrast material (73701) |
$717.28 |
$4,483 |
4.4× |
| CT lumbar spine w contrast (72132) |
$908 |
$5,675 |
2.8× |
| CT lumbar spine w/o contrast (72131) |
$671.36 |
$4,196 |
6.8× |
| CT maxillofacial w contrast (70487) |
$443.04 |
$2,769 |
2.7× |
| CT maxillofacial wo contrast (70486) |
$500 |
$3,125 |
5.1× |
| CT neck tissue combo (70492) |
$857.92 |
$5,362 |
5.2× |
| Ct Orbit/Ear/Fossa W/O&W/Dye (70482) |
$543.52 |
$3,397 |
3.3× |
| CT orbits w/o contrast (70480) |
$484.48 |
$3,028 |
4.9× |
| CT pelvis w&w/o contrast (72194) |
$880.48 |
$5,503 |
5.3× |
| CT pelvis w/o contrast (72192) |
$530.56 |
$3,316 |
5.4× |
| CT scan of leg combo (73702) |
$780.32 |
$4,877 |
4.7× |
| CT scans face/jaw combo (70488) |
$827.68 |
$5,173 |
5.0× |
| CT soft tissue neck w contrast (70491) |
$593.44 |
$3,709 |
3.6× |
| CT soft tissue neck w/o contrast (70490) |
$614.56 |
$3,841 |
6.3× |
| CT thoracic spine w contrast (72129) |
$764.80 |
$4,780 |
4.6× |
| CT thoracic spine w/o contrast (72128) |
$683.04 |
$4,269 |
7.0× |
| CT thoracic spine w/wo cont (72130) |
$547.52 |
$3,422 |
3.3× |
| CT thorax w/o contrast (71250) |
$667.36 |
$4,171 |
6.8× |
CT unlisted procedure (76497)
range across 2 matching MRF lines |
$98.24–$145.92 |
$614–$912 |
varies |
| CT upper ext wo (73200) |
$416.32 |
$2,602 |
4.2× |
| CT upper extremity w/o & w/contrast material (73202) |
$816.96 |
$5,106 |
5.0× |
| CT upper extremity with contrast (73201) |
$518.56 |
$3,241 |
1.6× |
| Cta Abdl Aorta&Bi Iliofem W/Contrast&Postp (75635) |
$957.12 |
$5,982 |
5.8× |
| Cta Abdomen (74175) |
$902.24 |
$5,639 |
5.5× |
| CTA pelvis (72191) |
$772.64 |
$4,829 |
4.7× |
| Dacryocystography, nasolacrimal duct, radiological supervision and interpretation Non-Facility (70170) |
$171.20 |
$1,070 |
0.8× |
| Determination of central c-v hemodynamics (non-imaging) (eg, ejection fraction with probe technique) with or without… (78414) |
$350.88 |
$2,193 |
0.7× |
| Dilation ureters/urethra rs&i (74485) |
$736.48 |
$4,603 |
0.4× |
| Discography Cerv/Thor Spine (72285) |
$871.20 |
$5,445 |
0.5× |
| Diskography lumbar (72295) |
$545.12 |
$3,407 |
0.3× |
| Doppler Echo Fetal Puls Spectral F/U/Repeat (76828) |
$50.24 |
$314 |
0.5× |
| Doppler Echo Fetal Spectral Display Complete (76827) |
$235.36 |
$1,471 |
2.4× |
| Doppler Fetal Mid Cerebral Artery (76821) |
$191.68 |
$1,198 |
2.0× |
| Dxa Bone Density Axial (77080) |
$207.20 |
$1,295 |
2.1× |
| Dxa bone density study (77085) |
$109.92 |
$687 |
1.1× |
| Dxa bone density study 1/>sites appendiclr skel (77081) |
$104.96 |
$656 |
1.3× |
| Echo exam of fetal heart (76825) |
$338.40 |
$2,115 |
0.7× |
| Echo exam uterus (76831) |
$289.28 |
$1,808 |
1.3× |
| Echo Guide For Artery Repair (76936) |
$340.48 |
$2,128 |
1.7× |
| Echocardiography, fetal, cardiovascular system, real time with image documentation (2D), with or without M-mode… (76826) |
$170.72 |
$1,067 |
0.8× |
| Echograp Trans R Pros Study (76873) |
$135.04 |
$844 |
1.4× |
| Esophageal Motility Study (78258) |
$392.80 |
$2,455 |
1.0× |
| Esophagram (74220) |
$178.08 |
$1,113 |
1.1× |
| Fetal Biophys Profile W/Nst (76818) |
$171.84 |
$1,074 |
1.8× |
| Fetal Biophysical Profile W/O Non-Stress Testing (76819) |
$203.04 |
$1,269 |
2.1× |
| Fetal MRI w/placntl matrnl plvc img sing/1st ges (74712) |
$244.48 |
$1,528 |
1.1× |
| Fluoroscopy up to 1 hr (76000) |
$173.92 |
$1,087 |
0.8× |
| Follow-Up Angiography (75898) |
$1,693.76 |
$10,586 |
0.6× |
| Foot 2 views (73620) |
$106.08 |
$663 |
1.3× |
| Forearm 2 views (73090) |
$104.16 |
$651 |
1.3× |
| Gastric emptying imaging study (78264) |
$407.04 |
$2,544 |
1.1× |
| Gastric Mucosa Imaging (78261) |
$292.32 |
$1,827 |
0.8× |
| Gastroesophageal Reflux Exam (78262) |
$471.36 |
$2,946 |
1.3× |
| Gastrointestinal Protein Loss (78282) |
$291.52 |
$1,822 |
0.8× |
| Gated Heart Planar Single (78472) |
$490.24 |
$3,064 |
1.3× |
| Gated Heart, Multiple (78473) |
$236.96 |
$1,481 |
0.6× |
| Gstrc Emptng Imag Std W/Sm Bwl Col Trnst Mlt Day (78266) |
$223.20 |
$1,395 |
0.4× |
| Hand 2 views (73120) |
$77.92 |
$487 |
0.8× |
| Hdr Rdncl Ntrstl/Icav Brchtx (77772) |
$641.44 |
$4,009 |
1.0× |
| Hdr Rdncl Ntrstl/Icav Brchtx (77771) |
$641.44 |
$4,009 |
1.0× |
| Hdr Rdncl Ntrstl/Icav Brchtx 1 Channel (77770) |
$641.44 |
$4,009 |
1.0× |
| Heart first pass single,planar (78481) |
$350.88 |
$2,193 |
0.7× |
| Heart Image (Pet) Multiple (78492) |
$1,198.40 |
$7,490 |
0.9× |
| Hepatc Vngrph Wdg/Fr Hemodyn Eval Rs&I (75889) |
$1,227.68 |
$7,673 |
0.4× |
| Hepatc Vngrph Wdg/Fr W/O Hemodyn Eval Rs&I (75891) |
$824.64 |
$5,154 |
0.3× |
| Hepatobil Syst Image W/Drug (78227) |
$282.56 |
$1,766 |
0.6× |
| Hepatobiliary System Imaging (78226) |
$583.36 |
$3,646 |
1.6× |
| Ht Musc Image Planar Mult (78454) |
$1,109.12 |
$6,932 |
0.9× |
| Ht Muscle Image Spect Sing (78451) |
$731.04 |
$4,569 |
0.6× |
| Hyperthermia generated by interstitial probe(s); more than 5 interstitial applicators Non-Facility (77615) |
$445.28 |
$2,783 |
0.9× |
| Hyperthermia generated by intracavitary probe(s) Non-Facility (77620) |
$445.28 |
$2,783 |
0.9× |
| Hyperthermia, externally generated; deep (ie, heating to depths greater than 4 cm) Non-Facility (77605) |
$445.28 |
$2,783 |
0.7× |
| Hysterosalpingogram (74740) |
$260.96 |
$1,631 |
1.2× |
| Infant hip ultrasound with hip movement (dynamic) (76885) |
$192.32 |
$1,202 |
2.4× |
| Infant hip ultrasound, limited static exam (76886) |
$82.56 |
$516 |
1.0× |
| Infusion Ivp (74410) |
$129.12 |
$807 |
0.8× |
| Interstitial radiation source applic complex (77778) |
$1,413.60 |
$8,835 |
2.2× |
| Intracavitary Radiation Source Applic Complex (77763) |
$744.32 |
$4,652 |
1.1× |
| Intracavitary Radiation Source Applic Intermed (77762) |
$180.80 |
$1,130 |
0.3× |
| Intracavitary radiation source applic simple (77761) |
$629.28 |
$3,933 |
1.2× |
| Joint Survey Single View (77077) |
$52.48 |
$328 |
0.5× |
| K Flow/Funct Image Multiple (78709) |
$432 |
$2,700 |
0.8× |
| K Flow/Funct Image W/Drug (78708) |
$516.96 |
$3,231 |
1.0× |
| K Flow/Funct Image W/O Drug (78707) |
$680.32 |
$4,252 |
1.3× |
| Kidney Funcj Study Non-Img Radioisotopic Study (78725) |
$326.72 |
$2,042 |
0.9× |
| Kidney Imaging Morphol (78700) |
$255.84 |
$1,599 |
0.7× |
| Kidney Imaging Morphoogy W/Vascular Flow (78701) |
$383.04 |
$2,394 |
1.0× |
| Knee 3 Views (73562) |
$93.92 |
$587 |
1.1× |
| Labeled RBC Sequestration Differntl Organ/Tissue (78140) |
$494.40 |
$3,090 |
1.3× |
| Leveen/Shunt Patency Exam (78291) |
$393.60 |
$2,460 |
1.0× |
| Liver & Spleen Imaging Static Only (78215) |
$425.28 |
$2,658 |
1.1× |
| Liver & Spleen Imaging W/Vascular Flow (78216) |
$548.80 |
$3,430 |
1.5× |
| Liver imaging static only (78201) |
$591.36 |
$3,696 |
1.2× |
| Liver imaging w/vascular flow (78202) |
$596.16 |
$3,726 |
1.2× |
| Lung Perf&Ventilat Diferentl (78598) |
$276.80 |
$1,730 |
0.5× |
| Lung perfusion differential (78597) |
$487.04 |
$3,044 |
1.3× |
| Lung Ventilat&Perfus Imaging (78582) |
$633.28 |
$3,958 |
1.2× |
| Lung Ventilation Imaging (78579) |
$376.64 |
$2,354 |
1.0× |
| Lymph System Imaging (78195) |
$458.24 |
$2,864 |
0.9× |
| Lymphangiography Extremity Only Bilateral Rs&I (75803) |
$756.64 |
$4,729 |
0.5× |
| Lymphangiography extremity only unilateral rs&i (75801) |
$365.28 |
$2,283 |
0.6× |
| Magnetic Image Jaw Joint (70336) |
$548.16 |
$3,426 |
2.4× |
| Magnetic Resonance Elastography (76391) |
$540.96 |
$3,381 |
2.4× |
| Mammary ductogram or galactogram multiple (77054) |
$139.04 |
$869 |
0.6× |
| Mammary ductogram or galactogram single (77053) |
$160.64 |
$1,004 |
0.7× |
| Meckels Divert Exam (78290) |
$380.64 |
$2,379 |
1.0× |
| Mlc imrt design & construction per imrt plan (77338) |
$258.08 |
$1,613 |
0.7× |
| Mr safety determination physician/other qhp (76016) |
$38.72 |
$242 |
0.5× |
| Mr safety implant&/fb assmt clin staf 1st 15 min (76014) |
$10.72 |
$67 |
0.4× |
| Mr safety implt electronics prepj supvj phys/qhp (76018) |
$40.32 |
$252 |
0.5× |
| Mr safety implt pos&/immoblj (76019) |
$26.08 |
$163 |
0.5× |
| Mr safety med physics xm customization plng&mntr (76017) |
$106.40 |
$665 |
0.5× |
| Mra Head W/O & W/Contrast Material (70546) |
$1,182.56 |
$7,391 |
3.6× |
| MRA head w/o contrast (70544) |
$785.76 |
$4,911 |
3.5× |
| MRA head with contrast (70545) |
$944.96 |
$5,906 |
2.9× |
| MRA neck w contrast (70548) |
$947.04 |
$5,919 |
2.9× |
| Mra Neck W/O &W/Contrast Material (70549) |
$911.36 |
$5,696 |
2.8× |
| MRA neck w/o contrast (70547) |
$737.60 |
$4,610 |
3.3× |
| MRI abdomen w contrast (74182) |
$542.56 |
$3,391 |
1.7× |
| MRI abdomen w/o contrast (74181) |
$779.52 |
$4,872 |
3.5× |
| MRI any jt lower extrem w/contrast material (73722) |
$848 |
$5,300 |
1.2× |
| MRI any jt lower extrem w/o & w/contrast matrl (73723) |
$1,205.28 |
$7,533 |
3.7× |
| MRI any jt upper extremity w/contrast matrl (73222) |
$1,080.48 |
$6,753 |
1.5× |
| MRI bone marrow blood supply (77084) |
$1,536.64 |
$9,604 |
6.9× |
| MRI brain functional w/o physician admnistration (70554) |
$383.84 |
$2,399 |
1.7× |
| MRI Breast W/O Contrast Bilateral (77047) |
$309.44 |
$1,934 |
1.4× |
| MRI Breast Without Contrast Material Unilateral (77046) |
$1,234.56 |
$7,716 |
5.5× |
| MRI cardiac w/o contrast (75557) |
$713.92 |
$4,462 |
3.2× |
| MRI cervical spine w contrast (72142) |
$1,033.92 |
$6,462 |
3.2× |
| MRI cervical spine w/o cont (72141) |
$923.52 |
$5,772 |
4.1× |
| MRI chest w/o contrast (71550) |
$882.24 |
$5,514 |
3.9× |
| MRI chest with contrast (71551) |
$537.76 |
$3,361 |
0.7× |
| MRI chest wo w contrast (71552) |
$1,004.64 |
$6,279 |
3.1× |
| MRI lower extrem oth/thn jt w/contrast matrl (73719) |
$913.44 |
$5,709 |
2.8× |
| MRI lower extrem oth/thn jt w/o & w/contr matr (73720) |
$1,033.60 |
$6,460 |
3.2× |
| MRI lower extrem oth/thn jt w/o contr matrl (73718) |
$889.28 |
$5,558 |
4.0× |
| MRI lumbar spine w contrast (72149) |
$869.92 |
$5,437 |
2.7× |
| Mri Neck Spine W/O & W/Dye (72156) |
$1,196.64 |
$7,479 |
3.7× |
| MRI orbit face &/neck w/o contrast (70540) |
$875.04 |
$5,469 |
3.9× |
| MRI orbit face neck w contrast (70542) |
$670.72 |
$4,192 |
2.0× |
| Mri Orbt/Fac/Nck W/O &W/Dye (70543) |
$1,008.48 |
$6,303 |
3.1× |
| MRI pelvis w contrast (72196) |
$547.36 |
$3,421 |
1.7× |
| MRI pelvis w/o & w contrast (72197) |
$1,028.96 |
$6,431 |
3.1× |
| MRI pelvis w/o contrast (72195) |
$875.52 |
$5,472 |
3.9× |
| MRI spectroscopy (76390) |
$455.68 |
$2,848 |
5.6× |
| MRI thoracic spine w/o contrast (72146) |
$767.52 |
$4,797 |
3.4× |
| MRI upper extremity oth than jt w/contr matrl (73219) |
$852.80 |
$5,330 |
2.6× |
| MRI upper extremity oth than jt w/o contr matrl (73218) |
$852.48 |
$5,328 |
3.8× |
| Mri Uppr Extremity W/O&W/Dye (73220) |
$1,068.64 |
$6,679 |
3.3× |
| MRI, abdomen, combo (74183) |
$1,004.16 |
$6,276 |
3.1× |
| MRI, dorsal spine combo (72157) |
$1,178.72 |
$7,367 |
3.6× |
| MRI, dorsal spine contrast (72147) |
$909.60 |
$5,685 |
2.8× |
| MRI, joint upper extrem (73221) |
$1,080.48 |
$6,753 |
4.8× |
| MRI, joint upper extrem combo (73223) |
$1,163.04 |
$7,269 |
3.6× |
| MRI, lumbar spine combo (72158) |
$1,223.84 |
$7,649 |
3.7× |
| Musculoskeletal Nuclear Exam (78399) |
$289.44 |
$1,809 |
0.8× |
| Myelogram cervical (72240) |
$328.48 |
$2,053 |
0.4× |
| Myelogram Lumbar (72265) |
$306.08 |
$1,913 |
0.4× |
| Myelography thoracic (72255) |
$297.92 |
$1,862 |
0.4× |
| Myelograpy 2/more regions rs&i (72270) |
$385.44 |
$2,409 |
0.5× |
| Myocardial Imaging Infarct Avid Planar Qual/Quan (78466) |
$350.88 |
$2,193 |
0.9× |
| Myocardial Imaging Pet Metabolic Evaluation (78459) |
$1,448.32 |
$9,052 |
1.2× |
| Myocardial imaging, infarct avid, planar; with ejection fraction by first pass technique Non-Facility (78468) |
$187.68 |
$1,173 |
0.4× |
| Myocardial Perfusion Planar 1 Study Rest/Stress (78453) |
$771.20 |
$4,820 |
0.6× |
| Myocardial Spect Multiple Studies (78452) |
$1,193.60 |
$7,460 |
1.0× |
| Myocrd img PET prfuj 1std rest/stress cncrnt CT (78430) |
$834.40 |
$5,215 |
0.6× |
| Neck soft tissue (70360) |
$65.60 |
$410 |
0.8× |
| Nfs/Instlj Radioelmnt Sln 3 Mo Follow-Up Care (77750) |
$169.28 |
$1,058 |
0.5× |
| Njx Rp Loclzj Non-Img Probe Study Intravenous (78808) |
$109.28 |
$683 |
0.3× |
| Nm csf leak detection (78650) |
$451.68 |
$2,823 |
0.4× |
| Nm myocard infarct spect (78469) |
$350.88 |
$2,193 |
0.7× |
| Nm red cell survival study (78130) |
$414.08 |
$2,588 |
1.1× |
| Nm whole blood volume (78122) |
$494.40 |
$3,090 |
1.0× |
| Nonvascular Shunt X-Ray (75809) |
$220 |
$1,375 |
2.2× |
| Ntsty modul radthx pln dose-vol histos (77301) |
$1,823.84 |
$11,399 |
1.4× |
| Nuclear Rx Intra-Arterial (79445) |
$541.60 |
$3,385 |
2.5× |
| Nuclear Rx Oral Admin (79005) |
$432 |
$2,700 |
2.0× |
| Ob us nuchal meas 1 gest (76813) |
$202.88 |
$1,268 |
2.1× |
| Oph bmtry us echograpy a-scan io lens pwr cal (76519) |
$112.48 |
$703 |
1.1× |
| Oph us dx ant sgm us immersion b-scan/hr biom (76513) |
$122.24 |
$764 |
1.2× |
| Oph US Dx B-Scan&Quan a-Scan Sm Pt Enctr (76510) |
$164.32 |
$1,027 |
1.3× |
| Ophthalmic Biometry US Echograpy a-Scan (76516) |
$73.28 |
$458 |
0.7× |
| Ophthalmic ultrasound dx b-scan w/wo a-scan (76512) |
$112.48 |
$703 |
1.1× |
| Ophthalmic US Dx Corneal Pachymetry Uni/Bi (76514) |
$32.16 |
$201 |
1.2× |
| Ophthalmic us dx quantitative a-scan only (76511) |
$112.48 |
$703 |
1.1× |
| Optic foramina (70190) |
$67.20 |
$420 |
0.8× |
| Panoramic X-ray of jaws (70355) |
$40.96 |
$256 |
0.5× |
| Parathyroid imaging w/tomographic spect & CT (78072) |
$365.28 |
$2,283 |
0.7× |
| Parathyroid Planar Imaging (78070) |
$448.96 |
$2,806 |
1.2× |
| Parathyroid planar imaging w/wo subtraction (78071) |
$366.56 |
$2,291 |
1.0× |
| Pelvis 1 or 2 views (72170) |
$106.24 |
$664 |
1.1× |
| Perineogram (74775) |
$237.76 |
$1,486 |
1.1× |
| Peritoneogram Rs&I (74190) |
$289.92 |
$1,812 |
0.6× |
| Pet Image Skull-Thigh (78812) |
$1,484 |
$9,275 |
1.1× |
| Pet Image W/Ct Lmtd (78814) |
$1,694.56 |
$10,591 |
1.3× |
| PET image w/CT, full body (78816) |
$2,155.52 |
$13,472 |
1.6× |
| PET imaging CT attenuation skull base mid-thigh (78815) |
$2,351.36 |
$14,696 |
1.8× |
| Pet Imaging Limited Area Chest Head/Neck (78811) |
$1,379.20 |
$8,620 |
1.1× |
| Pet Myocardial Sngl Study (78491) |
$1,198.40 |
$7,490 |
0.9× |
| PET whole body (78813) |
$1,484 |
$9,275 |
1.1× |
| Platelet survival study Non-Facility (78191) |
$223.20 |
$1,395 |
0.6× |
| Prq Transhepatc Portograpy Hemodyn Eval Rs&I (75885) |
$1,102.40 |
$6,890 |
0.4× |
| Pulmonary Perfusion Imaging Particulate (78580) |
$450.40 |
$2,815 |
1.2× |
| Radex Abd Compl Aqt Abd W/S/E/D Views 1 View Ch (74022) |
$187.68 |
$1,173 |
1.9× |
| Radex abscess/fistula/sinus tract rs&i (76080) |
$175.68 |
$1,098 |
0.3× |
| Radex Ankle Complete Minimum 3 Views (73610) |
$77.12 |
$482 |
0.9× |
| Radex Calcaneus Minimum 2 Views (73650) |
$76.48 |
$478 |
0.9× |
| Radex elbow complete minimum 3 views (73080) |
$96.96 |
$606 |
1.2× |
| Radex Facial Bones Complete Minimum 3 Views (70150) |
$117.76 |
$736 |
1.2× |
| Radex fingr minimum 2 views (73140) |
$68.48 |
$428 |
0.8× |
| Radex foot complete minimum 3 views (73630) |
$106.40 |
$665 |
1.3× |
| Radex Hand Minimum 3 Views (73130) |
$83.04 |
$519 |
1.0× |
| Radex lower extremity infant minimum 2 views (73592) |
$62.72 |
$392 |
0.8× |
| Radex Mastoids Compl Minimum 3 Views PR Side (70130) |
$132 |
$825 |
1.3× |
| Radex Nasal Bones Complete Minimum 3 Views (70160) |
$83.04 |
$519 |
1.0× |
| Radex Pharynx/Larx W/Fluor&/Magnification Tq (70370) |
$94.24 |
$589 |
1.2× |
| Radex Ribs Unilateral 2 Views (71100) |
$132.64 |
$829 |
1.6× |
| Radex shoulder complete minimum 2 views (73030) |
$120.80 |
$755 |
1.5× |
| Radex Sinuses Paransl < 3 Views (70210) |
$80.96 |
$506 |
1.0× |
| Radex sm int w/mlt srl imges via enteroclss tube (74251) |
$405.92 |
$2,537 |
2.5× |
| Radex Spine 1 View Specify Level (72020) |
$71.84 |
$449 |
0.9× |
| Radex Sternum Minimum 2 Views (71120) |
$93.92 |
$587 |
1.1× |
| Radex Temporomandble Jt Opn & Clsd Mouth Bilat (70330) |
$90.24 |
$564 |
1.1× |
| Radex Toe Minimum 2 Views (73660) |
$90.40 |
$565 |
1.1× |
| Radex upper extremity infant minimum 2 views (73092) |
$81.92 |
$512 |
0.8× |
| Radex Wrist Complete Minimum 3 Views (73110) |
$84.96 |
$531 |
1.0× |
| Radex X-Ray Exam Entire Spi 6/> Vw - Xr Entire Spine 6+ Vw (72084) |
$140.80 |
$880 |
1.4× |
| Radiation Delivery Stereotactic Cranial Linear (77372) |
$8,283.20 |
$51,770 |
1.2× |
| Radiation treatment delivery level 1 (77402) |
$114.24 |
$714 |
1.2× |
| Radiation treatment delivery level 2 (77407) |
$177.60 |
$1,110 |
0.5× |
| Radiation treatment delivery level 3 (77412) |
$277.76 |
$1,736 |
0.5× |
| Radiolog exam mandible compl minimum 4 views (70110) |
$126.88 |
$793 |
1.3× |
| Radiologic Exam Abdomen 3+ Views - Xr Abdomen 3+ Views (74021) |
$231.04 |
$1,444 |
2.4× |
| Radiologic exam colon double contrast study (74280) |
$227.36 |
$1,421 |
1.4× |
| Radiologic exam colon single contrast study (74270) |
$177.44 |
$1,109 |
1.1× |
| Radiologic Exam Esophagus Double Contrast Study (74221) |
$121.92 |
$762 |
0.7× |
| Radiologic exam knee complete 4/more views (73564) |
$107.68 |
$673 |
1.1× |
| Radiologic exam pelvis compl minimum 3 views (72190) |
$144.32 |
$902 |
1.5× |
| Radiologic Exam Small Int Single Contrast Study (74250) |
$246.88 |
$1,543 |
1.5× |
| Radiologic exam swallow function contrast study (74230) |
$239.68 |
$1,498 |
1.5× |
| Radiologic exam upr gi trc double contrast study (74246) |
$236.96 |
$1,481 |
1.4× |
| Radiologic examination femur 1 view (73551) |
$154.88 |
$968 |
1.9× |
| Radiologic examination femur minimum 2 views (73552) |
$92.96 |
$581 |
1.1× |
| Radiologic examination knee 1/2 views (73560) |
$81.12 |
$507 |
1.0× |
| Radiologic Examination Osseous Survey Limited (77074) |
$211.84 |
$1,324 |
2.2× |
| Radiologic Examination Salivary Gland Calculus (70380) |
$61.60 |
$385 |
0.8× |
| Radiologic examination tibia & fibula 2 views (73590) |
$93.12 |
$582 |
1.1× |
| Radiologic examination, internal auditory meati, complete Non-Facility (70134) |
$164.80 |
$1,030 |
0.3× |
| Radiologic examination, teeth; single view Non-Facility (70300) |
$40.16 |
$251 |
0.5× |
| Radiopharm Dacryocystography (78660) |
$299.68 |
$1,873 |
0.8× |
| Radiopharmaceutical therapy, by interstitial radioactive colloid administration Facility (79300) |
$201.60 |
$1,260 |
0.9× |
| Radiopharmaceutical therapy, by intra-articular administration Non-Facility (79440) |
$299.20 |
$1,870 |
1.4× |
| Red Cell Volume Determination Spx 1 Sampling (78120) |
$427.04 |
$2,669 |
1.1× |
| Red Cell Volume Determination Spx Mult Samplings (78121) |
$494.40 |
$3,090 |
1.0× |
| Renal Cyst Study (74470) |
$289.92 |
$1,812 |
0.6× |
| Ribs bilateral 3 views (71110) |
$184.16 |
$1,151 |
1.9× |
| Rp loclzj tum plnr 1 area single day imaging (78800) |
$350.40 |
$2,190 |
0.9× |
| Rp loclzj tum plnr 2+area 1+d img/1 area img>2+d (78801) |
$528.64 |
$3,304 |
1.4× |
| Rp Loclzj Tum Plnr Whole Body 2+ Days Imaging (78804) |
$629.60 |
$3,935 |
1.2× |
| Rp Loclzj Tum Plnr Whole Body Single Day Imaging (78802) |
$644.80 |
$4,030 |
1.3× |
| Rp Loclzj Tum Spect 1 Area Single Day Imaging (78803) |
$527.52 |
$3,297 |
1.0× |
| Rp loclzj tum spect 2 area/sep acquisj img (78831) |
$569.92 |
$3,562 |
0.5× |
| Rp Ther Radiolbld Monoclonal Antibody IV Infus (79403) |
$139.04 |
$869 |
0.6× |
| Rp Therapy Intravenous Administration (79101) |
$502.72 |
$3,142 |
2.3× |
| Salivary Gland Function Study (78232) |
$291.52 |
$1,822 |
0.8× |
| Salivary Gland Imaging (78230) |
$291.52 |
$1,822 |
0.8× |
| Salivary Gland Imaging Serial Images (78231) |
$257.28 |
$1,608 |
0.7× |
| Scapula (73010) |
$72.80 |
$455 |
0.7× |
| Screening Digital Breast Tomosynthesis Bi (77063) |
$30.08 |
$188 |
1.3× |
| Sella turcica (70240) |
$45.12 |
$282 |
0.6× |
| Shoulder 1 view (73020) |
$120.48 |
$753 |
1.5× |
| Shoulder Arthrography (73040) |
$195.04 |
$1,219 |
0.6× |
| Sialogram (70390) |
$119.84 |
$749 |
0.5× |
| Skull less than 4 views (70250) |
$109.76 |
$686 |
1.1× |
| Special dosimetry (77331) |
$120.80 |
$755 |
1.0× |
| Special Physics Consult (77370) |
$409.44 |
$2,559 |
3.2× |
| Special teletherapy port plan (77321) |
$244.64 |
$1,529 |
0.7× |
| Special treatment procedure (77470) |
$599.68 |
$3,748 |
1.2× |
| Speech evaluation, complex (70371) |
$129.76 |
$811 |
0.6× |
| Spleen Imaging (78185) |
$317.76 |
$1,986 |
0.8× |
| Stereotactic Body Radiation Delivery (77373) |
$5,190.40 |
$32,440 |
3.1× |
| Sternoclavicular joints (71130) |
$54.88 |
$343 |
0.7× |
| Superior sagittal sinus venogram (75870) |
$893.60 |
$5,585 |
0.3× |
| Telethx isodose pln cplx w/basic dosimetry (77307) |
$425.28 |
$2,658 |
1.2× |
| Telethx isodose pln smpl w/dosimetry calculation (77306) |
$397.28 |
$2,483 |
1.1× |
| Temporomandble Jt Arthrography Rs&I (70332) |
$338.88 |
$2,118 |
1.5× |
| Testicular Imaging W/Flow (78761) |
$248 |
$1,550 |
0.7× |
| Ther Rad Simulaj-Aided Field Setting Complex (77290) |
$568.16 |
$3,551 |
1.6× |
| Ther Rad Simulaj-Aided Field Setting Intermed (77285) |
$197.92 |
$1,237 |
0.6× |
| Ther rad simulaj-aided field setting simple (77280) |
$267.52 |
$1,672 |
2.1× |
| Therapeutic Enema Rdctj Intussusception/Obstrcj (74283) |
$116.48 |
$728 |
0.7× |
| Thoracic spine 2 views (72070) |
$114.56 |
$716 |
1.2× |
| Thoracic spine 3 views (72072) |
$170.08 |
$1,063 |
1.7× |
| Thoracolumbar 2 views (72080) |
$114.56 |
$716 |
1.4× |
| Thyroid carcinoma metastases imaging; with additional studies (eg, urinary recovery) Non-Facility (78016) |
$340.48 |
$2,128 |
0.9× |
| Thyroid Carcinoma Metastases Img Lmtd Area (78015) |
$374.40 |
$2,340 |
1.0× |
| Thyroid Imaging With Vascular Flow (78013) |
$148.16 |
$926 |
0.4× |
| Thyroid Met Imaging Body (78018) |
$647.20 |
$4,045 |
1.3× |
| Thyroid Uptake Measurement (78012) |
$330.72 |
$2,067 |
0.9× |
| Thyroid Uptake W/Blood Flow Sngle/Mult Quan Meas (78014) |
$372.80 |
$2,330 |
1.0× |
| Tx Devices Design & Construction Complex (77334) |
$525.60 |
$3,285 |
1.5× |
| Tx devices design & construction intermediate (77333) |
$184.16 |
$1,151 |
1.5× |
| Tx devices design & construction simple (77332) |
$145.60 |
$910 |
1.2× |
| Ultrasound Breast Limited (76642) |
$165.12 |
$1,032 |
2.0× |
| Ultrasound elastography first target lesion (76982) |
$181.76 |
$1,136 |
1.9× |
| Ultrasound Elastography Parenchyma (76981) |
$75.52 |
$472 |
0.8× |
| Ultrasound Exam Aaa Screen (76706) |
$108.96 |
$681 |
1.1× |
| Ultrasound trgt dynamic microbubble 1st lesion (76978) |
$89.60 |
$560 |
0.3× |
| Ultrasound, abdomen limited (76705) |
$201.12 |
$1,257 |
2.0× |
| Umbilical-artery Doppler (OB) (76820) |
$170.56 |
$1,066 |
1.7× |
Unlisted Dx Radiographic Procedure (76499)
range across 3 matching MRF lines |
$30.40–$165.76 |
$190–$1,036 |
varies |
| Unlisted Procedure Clinical Brachytherapy (77799) |
$500.96 |
$3,131 |
5.2× |
| Upper gi w/o kub (74240) |
$164.96 |
$1,031 |
1.0× |
| Ureteral Reflux Study (78740) |
$235.52 |
$1,472 |
0.6× |
| Urethrocystogram voiding (74455) |
$208.64 |
$1,304 |
0.9× |
| Urethrocystography retrograde (74450) |
$206.40 |
$1,290 |
0.9× |
| Us bone density measurement (76977) |
$136.96 |
$856 |
1.4× |
| Us breast unilateral complete (76641) |
$168 |
$1,050 |
1.7× |
| Us chest (76604) |
$132.80 |
$830 |
1.4× |
| Us complete joint (76881) |
$202.88 |
$1,268 |
2.1× |
| Us exam, pelvic, limited (76857) |
$219.68 |
$1,373 |
2.2× |
| Us head (76506) |
$154.24 |
$964 |
1.6× |
| Us kidney transplant (76776) |
$124.32 |
$777 |
1.3× |
| Us lmtd joint/oth nonvasc xtr strux r-t w/img (76882) |
$259.52 |
$1,622 |
2.6× |
| Us ob detailed single fetus (76811) |
$285.44 |
$1,784 |
1.3× |
| Us ob limited 1 or more fetuses (76815) |
$112.16 |
$701 |
1.1× |
| Us ob transvaginal (76817) |
$235.52 |
$1,472 |
2.4× |
| Us pelvic non ob complete (76856) |
$242.72 |
$1,517 |
2.5× |
| Us pg uter img f&mat 14 wk tabdl 1/1st gestation (76801) |
$245.76 |
$1,536 |
2.5× |
| Us preg uterus real time f/u trnsabdl per fetus (76816) |
$191.04 |
$1,194 |
1.9× |
| Us retroperitoneal complete (76770) |
$184.16 |
$1,151 |
1.9× |
| Us retroperitoneal limited (76775) |
$241.60 |
$1,510 |
2.5× |
| Us scrotum and contents (76870) |
$213.12 |
$1,332 |
2.2× |
| Us spinal canal and contents (76800) |
$147.68 |
$923 |
1.5× |
| Us thyroid (76536) |
$212.32 |
$1,327 |
2.2× |
| Us transrectal (76872) |
$250.40 |
$1,565 |
2.6× |
| Vascular Flow Imaging (78445) |
$184.48 |
$1,153 |
0.5× |
| Vein X-Ray Chest (75827) |
$444.96 |
$2,781 |
0.3× |
| Vein X-Ray Liver W/O Hemodyn (75887) |
$1,539.68 |
$9,623 |
0.5× |
| Vein X-Ray Skull Epidural (75872) |
$812.32 |
$5,077 |
1.4× |
| Vein X-Ray Spleen/Liver (75810) |
$820.32 |
$5,127 |
0.3× |
| Venogram Sinus/Jugular (75860) |
$1,693.76 |
$10,586 |
0.6× |
| Venography Adrenal Unilateral (75840) |
$2,518.08 |
$15,738 |
0.8× |
| Venography caval inferior serialography rs&i (75825) |
$1,389.60 |
$8,685 |
0.5× |
| Venography extremity bilateral rs&i (75822) |
$686.88 |
$4,293 |
0.5× |
| Venography extremity unilateral rs&i (75820) |
$562.88 |
$3,518 |
0.4× |
| Venography Orbital Rs&I (75880) |
$812.32 |
$5,077 |
1.4× |
| Venography Renal Bilateral (75833) |
$1,415.84 |
$8,849 |
0.5× |
| Venography Renal Unilateral (75831) |
$1,126.08 |
$7,038 |
0.4× |
| Venous sampling by catheter (75893) |
$2,823.20 |
$17,645 |
0.5× |
| Venous thrombosis imaging (78457) |
$174.56 |
$1,091 |
0.3× |
| Venous Thrombosis Imaging Venogram Bilateral (78458) |
$235.84 |
$1,474 |
0.6× |
| Wrist 2 views (73100) |
$78.88 |
$493 |
1.0× |
| X-Ray Ac Jts - Xr Acromioclavicular Joints Bilateral (73050) |
$59.68 |
$373 |
0.7× |
| X-ray antegrade pyelogram tube (74425) |
$220.48 |
$1,378 |
0.7× |
| X-Ray Aorta Leg Arteries (75630) |
$1,961.44 |
$12,259 |
0.7× |
| X-Ray Bend Only L-S Spine (72120) |
$87.36 |
$546 |
0.9× |
| X-Ray Elbow 2 Vw - Xr Elbow 1-2 Views Right (73070) |
$96.16 |
$601 |
1.2× |
X-Ray Exam Breast Specimen (76098)
range across 12 matching MRF lines |
$200.80–$220.80 |
$1,255–$1,380 |
varies |
| X-Ray Exam Entire Spi 1 Vw (72081) |
$89.92 |
$562 |
1.1× |
| X-Ray Exam Entire Spi 2/3 Vw (72082) |
$105.44 |
$659 |
1.1× |
| X-Ray Exam Entire Spi 4/5 Vw (72083) |
$206.24 |
$1,289 |
2.1× |
| X-Ray Exam Hip Uni 1 View (73501) |
$137.76 |
$861 |
1.7× |
| X-Ray Exam Hip Uni 2-3 Views (73502) |
$104.16 |
$651 |
1.3× |
| X-Ray Exam Hip Uni 4/> Views (73503) |
$116.64 |
$729 |
1.2× |
| X-Ray Exam Hips Bi 2 Views (73521) |
$211.04 |
$1,319 |
2.2× |
| X-Ray Exam Hips Bi 3-4 Views (73522) |
$211.04 |
$1,319 |
2.2× |
| X-Ray Exam Hips Bi 5/> Views (73523) |
$226.08 |
$1,413 |
2.3× |
| X-Ray Exam L-S Spine Bending (72114) |
$152.16 |
$951 |
1.6× |
| X-Ray Exam Neck Spine 2-3 Vw (72040) |
$100.80 |
$630 |
1.2× |
| X-Ray Exam Neck Spine 6/>Vws (72052) |
$197.92 |
$1,237 |
2.0× |
| X-Ray Exam Unilat Ribs/Chest (71101) |
$174.72 |
$1,092 |
1.8× |
| X-ray eye for foreign body (70030) |
$56.64 |
$354 |
0.7× |
| X-ray head for orthodontia (70350) |
$52.48 |
$328 |
0.6× |
| X-ray humerus (73060) |
$90.08 |
$563 |
1.1× |
| X-ray IV pyelogram (ivp) (74400) |
$370.24 |
$2,314 |
2.2× |
| X-ray IV pyelogram+tomography (74415) |
$161.28 |
$1,008 |
1.0× |
| X-Ray Jaw <4 Vw - Xr Mandible < 4 Views (70100) |
$97.76 |
$611 |
1.2× |
| X-Ray Knee Bilat Standing - Xr Knees Anteroposterior Standing Bilat (73565) |
$89.60 |
$560 |
1.1× |
| X-Ray Lumbar Spine 2/3 Vw - Xr Lumbar Spine 2-3 Views (72100) |
$103.68 |
$648 |
1.1× |
| X-ray nose-rectum child f.b. (76010) |
$92.48 |
$578 |
1.1× |
| X-Ray Ribs, Chest 4+ Vw - Xr Ribs 3 Vws Bil W/ Chest Posteroanterior (71111) |
$262.08 |
$1,638 |
2.7× |
| X-Ray Sacroiliac Jts 3+ Vw - Xr Sacroiliac Joints 3+ Views (72202) |
$126.88 |
$793 |
1.3× |
| X-Ray Sacroiliac Jts <3 Vw - Xr Sacroiliac Joints 1-2 Views (72200) |
$57.76 |
$361 |
0.6× |
| X-Ray Sacrum/Coccyx 2+ Vw - Xr Sacrum Coccyx 2+ Views (72220) |
$90.08 |
$563 |
1.1× |
| X-Ray Sinuses 3+ Vw - Xr Paranasal Sinuses 3+ Views (70220) |
$159.36 |
$996 |
2.0× |
| X-Ray Skull 4+ Vw - Xr Skull Complete 4+ Views (70260) |
$134.56 |
$841 |
1.4× |
| X-Ray Stress View (77071) |
$52.48 |
$328 |
0.6× |
| X-ray thoracic spine 4 vw (72074) |
$174.24 |
$1,089 |
1.8× |
| X-Ray Tmj Unilat (70328) |
$57.76 |
$361 |
0.7× |
| X-Ray Urinary Tract Exam With Contrast Material (74420) |
$229.60 |
$1,435 |
0.7× |
X-Rays Bone Length Studies (77073)
range across 2 matching MRF lines |
$128.80–$259.84 |
$805–$1,624 |
varies |
| X-Rays Bone Survey Complete (77075) |
$279.52 |
$1,747 |
2.8× |
| Xr c-spine 4 or 5 views (72050) |
$211.84 |
$1,324 |
2.2× |
| Xr facial bones less than 3 views (70140) |
$67.68 |
$423 |
0.8× |
| XR Mastoids < 3 Views Bilateral (70120) |
$80.80 |
$505 |
0.8× |
| Xr myelogram posterior fossa (70010) |
$385.28 |
$2,408 |
1.2× |
| Xr orbits complete 4 views (70200) |
$144.64 |
$904 |
1.5× |
| Xr Tomogram Single Plane (76100) |
$134.88 |
$843 |
1.4× |