| 3-D radiotherapy plan dose-volume histograms (77295) |
$5,529.50 |
$11,059 |
3.8× |
| Abdomen 1 View (74018) |
$294 |
$588 |
3.3× |
| Abdomen 2 views (74019) |
$294 |
$588 |
2.7× |
| Acute Gastrointestinal Blood Loss Imaging (78278) |
$958 |
$1,916 |
2.3× |
Angio internal mammary (75756)
range across 2 matching MRF lines |
$1,185.50–$2,916 |
$2,371–$5,832 |
varies |
| Angio pulmonary bilat (75743) |
$1,391 |
$2,782 |
0.4× |
| Angiography Adrenal Bilateral Slctv Rs&I (75733) |
$1,840.50 |
$3,681 |
0.6× |
| Angiography extremity bilateral rs&i (75716) |
$2,085 |
$4,170 |
0.6× |
Angiography extremity unilateral rs&i (75710)
range across 2 matching MRF lines |
$555–$1,912.50 |
$1,110–$3,825 |
varies |
| Angiography pulmonary unilateral slctv rs&i (75741) |
$1,160.50 |
$2,321 |
0.4× |
| Angrph pulmonary nonslctv cath/ven njx rs&i (75746) |
$1,129 |
$2,258 |
0.3× |
| Ankle 2 views (73600) |
$192.50 |
$385 |
2.1× |
Aortography thoracic serialography rs&i (75605)
unusually low: confirm this is the full procedure |
$2,219.50 |
$4,439 |
0.4× |
| Aortography thoracic w/o serialography rs&i (75600) |
$441 |
$882 |
0.1× |
Artery X-Rays Abdomen (75726)
unusually low: confirm this is the full procedure |
$2,739 |
$5,478 |
0.5× |
| Artery X-Rays Adrenal Gland (75731) |
$1,391 |
$2,782 |
0.4× |
Artery X-Rays Pelvis (75736)
unusually low: confirm this is the full procedure |
$2,510 |
$5,020 |
0.4× |
Artery X-Rays Spine (75705)
unusually low: confirm this is the full procedure |
$2,604 |
$5,208 |
0.5× |
| Arthrogram hip (73525) |
$759.50 |
$1,519 |
2.1× |
| Arthrogram Wrist (73115) |
$723.50 |
$1,447 |
2.0× |
| Basic radiation dosimetry calculation (77300) |
$495.50 |
$991 |
3.6× |
| Bone age studies (77072) |
$111.50 |
$223 |
1.0× |
| Bone Imaging 3 Phase (78315) |
$1,359 |
$2,718 |
3.3× |
| Bone Imaging Limited Area (78300) |
$613.50 |
$1,227 |
1.5× |
| Bone Imaging Whole Body (78306) |
$1,202.50 |
$2,405 |
2.9× |
| Bone marrow imaging limited area (78102) |
$320 |
$640 |
0.8× |
| Bone marrow imaging; multiple areas (78103) |
$400.50 |
$801 |
1.0× |
| Bone marrow imaging; whole body (78104) |
$1,627 |
$3,254 |
3.9× |
| Bone survey infant (77076) |
$249.50 |
$499 |
2.3× |
| Brachytx isodose complex (77318) |
$1,907.50 |
$3,815 |
4.9× |
| Brachytx isodose intermed (77317) |
$1,589.50 |
$3,179 |
4.1× |
| Brachytx Isodose Plan Simple (77316) |
$1,271.50 |
$2,543 |
3.3× |
| Brain Flow Imaging Only (78610) |
$407.50 |
$815 |
0.7× |
| Brain Image W/Flow < 4 Views (78601) |
$685 |
$1,370 |
1.7× |
| Brain Imaging Min 4 Static Views W Vascular Flow (78606) |
$630 |
$1,260 |
1.1× |
Brain Imaging Pet Metabolic Evaluation (78608)
range across 2 matching MRF lines |
$3,311.50–$3,510.50 |
$6,623–$7,021 |
varies |
| Cardiac MRI w/w/o contrast & further seq (75561) |
$1,370 |
$2,740 |
3.8× |
| Cat Scan Follow-Up Study (76380) |
$491.50 |
$983 |
5.4× |
| Cerebrospinal Fluid Flow W/O Matl Shunt Evaltj (78645) |
$620.50 |
$1,241 |
1.1× |
| Cerebrospinal Fluid Scan (78630) |
$1,296.50 |
$2,593 |
2.3× |
| Chest 1 view (71045) |
$226.50 |
$453 |
2.5× |
| Chest 2 views (71046) |
$226.50 |
$453 |
2.5× |
Chest 3 views (71047)
range across 2 matching MRF lines |
$201.50–$711.50 |
$403–$1,423 |
varies |
| Chest 4 or more views (71048) |
$233.50 |
$467 |
2.2× |
| Cineradiograpy/vidradiograpy xcpt where spec (76120) |
$2,899.50 |
$5,799 |
26.7× |
| Clavicle complete (73000) |
$220.50 |
$441 |
2.4× |
| Computed Tomography Thorax Lw Dose Lng Ca Scr C- (71271) |
$203 |
$406 |
1.9× |
| Continuing medical physics consltj pr wk (77336) |
$791.50 |
$1,583 |
5.7× |
| Contrast Exam Abdominl Aorta (75625) |
$1,808 |
$3,616 |
0.6× |
| Contrast X-Ray Bladder (74430) |
$412.50 |
$825 |
1.1× |
| Contrast X-Ray Of Elbow (73085) |
$484 |
$968 |
1.3× |
| Contrast X-Ray Of Knee Joint (73580) |
$760 |
$1,520 |
2.1× |
| Contrast Xray Throat/Cerv Esopha (74210) |
$1,262.50 |
$2,525 |
6.9× |
| CT abdomen and pelvis without and with contrast (74178) |
$3,408.50 |
$6,817 |
9.4× |
| CT abdomen and pelvis without contrast (74176) |
$1,811.50 |
$3,623 |
7.3× |
| CT abdomen w contrast (74160) |
$1,501.50 |
$3,003 |
8.2× |
| CT abdomen w wo contrast (74170) |
$1,666.50 |
$3,333 |
9.1× |
| CT abdomen w/o contrast (74150) |
$1,141 |
$2,282 |
10.5× |
| CT Angio Abdomen and Pelvis (74174) |
$1,352 |
$2,704 |
3.7× |
| CT Angio Chest (71275) |
$1,675 |
$3,350 |
9.2× |
| CT Angio Head (70496) |
$1,284.50 |
$2,569 |
7.1× |
| CT angio hrt w/3d image (75574) |
$156.50 |
$313 |
0.4× |
| Ct Angio Lwr Extr W/O&W/Dye (73706) |
$1,386.50 |
$2,773 |
7.6× |
| CT Angio Neck (70498) |
$1,442.50 |
$2,885 |
7.9× |
| Ct Angio Upr Extrm W/O&W/Dye (73206) |
$1,577.50 |
$3,155 |
8.7× |
| CT cervical spine w/ contrast (72126) |
$1,645 |
$3,290 |
4.5× |
| CT cervical spine w/o contrast (72125) |
$1,305.50 |
$2,611 |
12.0× |
| CT cervical spine w/wo cont (72127) |
$1,736.50 |
$3,473 |
9.5× |
| CT chest w contrast (71260) |
$1,191.50 |
$2,383 |
6.5× |
| CT chest w/wo contrast (71270) |
$1,358.50 |
$2,717 |
7.5× |
| CT colonogrphy dx image postprocess w/o contrast (74261) |
$1,002.50 |
$2,005 |
9.2× |
| CT head/brain with contrast (70460) |
$1,261 |
$2,522 |
6.9× |
| CT head/brain without and with contrast (70470) |
$1,513 |
$3,026 |
8.3× |
| CT heart contrast eval cardiac structure&morph (75572) |
$141 |
$282 |
0.4× |
| CT heart no contrast quant eval coronry calcium (75571) |
$120.50 |
$241 |
1.3× |
| CT hrt w/3d image congen (75573) |
$141 |
$282 |
0.4× |
| CT iac w contrast (70481) |
$1,520 |
$3,040 |
8.3× |
| CT l-spine w&w/o contrast (72133) |
$1,448.50 |
$2,897 |
8.0× |
| CT lower ext w/o (73700) |
$985.50 |
$1,971 |
9.1× |
| CT lower extremity w/contrast material (73701) |
$1,271 |
$2,542 |
7.0× |
| CT lumbar spine w contrast (72132) |
$1,389.50 |
$2,779 |
3.8× |
| CT lumbar spine w/o contrast (72131) |
$1,177.50 |
$2,355 |
10.8× |
| CT maxillofacial w contrast (70487) |
$1,401 |
$2,802 |
7.7× |
| CT maxillofacial wo contrast (70486) |
$1,094.50 |
$2,189 |
10.1× |
| CT neck tissue combo (70492) |
$1,765 |
$3,530 |
9.7× |
| Ct Orbit/Ear/Fossa W/O&W/Dye (70482) |
$1,659.50 |
$3,319 |
9.1× |
| CT orbits w/o contrast (70480) |
$1,394.50 |
$2,789 |
12.8× |
CT pelvis w&w/o contrast (72194)
range across 2 matching MRF lines |
$140.50–$1,565 |
$281–$3,130 |
varies |
| CT pelvis w/o contrast (72192) |
$1,036.50 |
$2,073 |
9.5× |
| CT scan of leg combo (73702) |
$1,428.50 |
$2,857 |
7.8× |
| CT scans face/jaw combo (70488) |
$1,423 |
$2,846 |
7.8× |
| CT soft tissue neck w contrast (70491) |
$1,435 |
$2,870 |
7.9× |
| CT soft tissue neck w/o contrast (70490) |
$1,105 |
$2,210 |
10.2× |
| CT thoracic spine w contrast (72129) |
$1,593.50 |
$3,187 |
8.7× |
| CT thoracic spine w/o contrast (72128) |
$1,386 |
$2,772 |
12.8× |
| CT thoracic spine w/wo cont (72130) |
$1,607.50 |
$3,215 |
8.8× |
| CT thorax w/o contrast (71250) |
$810.50 |
$1,621 |
7.5× |
| CT upper ext wo (73200) |
$1,212 |
$2,424 |
11.2× |
| CT upper extremity w/o & w/contrast material (73202) |
$1,527 |
$3,054 |
8.4× |
| CT upper extremity with contrast (73201) |
$1,272.50 |
$2,545 |
3.5× |
| Cta Abdl Aorta&Bi Iliofem W/Contrast&Postp (75635) |
$1,818 |
$3,636 |
10.0× |
| Cta Abdomen (74175) |
$1,595.50 |
$3,191 |
8.8× |
| CTA pelvis (72191) |
$785.50 |
$1,571 |
4.3× |
| Dilation ureters/urethra rs&i (74485) |
$1,115.50 |
$2,231 |
0.5× |
| Discography Cerv/Thor Spine (72285) |
$396.50 |
$793 |
0.2× |
| Diskography lumbar (72295) |
$1,723 |
$3,446 |
0.8× |
| Doppler Echo Fetal Puls Spectral F/U/Repeat (76828) |
$96.50 |
$193 |
0.9× |
| Doppler Echo Fetal Spectral Display Complete (76827) |
$132.50 |
$265 |
1.2× |
| Doppler Fetal Mid Cerebral Artery (76821) |
$162.50 |
$325 |
1.5× |
| Dxa Bone Density Axial (77080) |
$392 |
$784 |
3.6× |
| Dxa bone density study (77085) |
$349 |
$698 |
3.2× |
| Echo exam of fetal heart (76825) |
$475.50 |
$951 |
0.8× |
| Echo exam uterus (76831) |
$197.50 |
$395 |
0.8× |
| Echocardiography, fetal, cardiovascular system, real time with image documentation (2D), with or without M-mode… (76826) |
$683.50 |
$1,367 |
2.8× |
| Echograp Trans R Pros Study (76873) |
$370 |
$740 |
3.4× |
| Esophagram (74220) |
$479 |
$958 |
2.6× |
Fetal Biophys Profile W/Nst (76818)
range across 2 matching MRF lines |
$263–$535.50 |
$526–$1,071 |
varies |
| Fetal Biophysical Profile W/O Non-Stress Testing (76819) |
$194.50 |
$389 |
1.8× |
| Fluoroscopy up to 1 hr (76000) |
$426.50 |
$853 |
1.7× |
| Follow-Up Angiography (75898) |
$1,994 |
$3,988 |
0.6× |
| Foot 2 views (73620) |
$194.50 |
$389 |
2.2× |
| Forearm 2 views (73090) |
$210.50 |
$421 |
2.3× |
| Gastric emptying imaging study (78264) |
$1,189.50 |
$2,379 |
2.9× |
| Gated Heart Planar Single (78472) |
$1,264.50 |
$2,529 |
3.0× |
| Gated Heart, Multiple (78473) |
$1,423.50 |
$2,847 |
3.4× |
| Hand 2 views (73120) |
$216.50 |
$433 |
2.0× |
| Hdr Rdncl Ntrstl/Icav Brchtx (77772) |
$1,460 |
$2,920 |
2.0× |
| Hdr Rdncl Ntrstl/Icav Brchtx (77771) |
$1,460 |
$2,920 |
2.0× |
| Hdr Rdncl Ntrstl/Icav Brchtx 1 Channel (77770) |
$1,460 |
$2,920 |
2.0× |
| Hepatc Vngrph Wdg/Fr Hemodyn Eval Rs&I (75889) |
$1,285 |
$2,570 |
0.4× |
| Hepatc Vngrph Wdg/Fr W/O Hemodyn Eval Rs&I (75891) |
$860.50 |
$1,721 |
0.3× |
| Hepatobil Syst Image W/Drug (78227) |
$1,097.50 |
$2,195 |
1.9× |
| Hepatobiliary System Imaging (78226) |
$965.50 |
$1,931 |
2.3× |
| Ht Muscle Image Spect Sing (78451) |
$974 |
$1,948 |
0.7× |
| Hysterosalpingogram (74740) |
$668 |
$1,336 |
2.7× |
| Infant hip ultrasound with hip movement (dynamic) (76885) |
$299.50 |
$599 |
3.3× |
| Infant hip ultrasound, limited static exam (76886) |
$312 |
$624 |
3.5× |
| Joint Survey Single View (77077) |
$111.50 |
$223 |
1.0× |
| K Flow/Funct Image Multiple (78709) |
$1,320 |
$2,640 |
2.3× |
| K Flow/Funct Image W/Drug (78708) |
$1,056 |
$2,112 |
1.9× |
| K Flow/Funct Image W/O Drug (78707) |
$982 |
$1,964 |
1.7× |
| Kidney Funcj Study Non-Img Radioisotopic Study (78725) |
$434.50 |
$869 |
1.0× |
| Kidney Imaging Morphol (78700) |
$602 |
$1,204 |
1.5× |
| Kidney Imaging Morphoogy W/Vascular Flow (78701) |
$486 |
$972 |
1.2× |
| Knee 3 Views (73562) |
$309.50 |
$619 |
3.4× |
| Liver & Spleen Imaging Static Only (78215) |
$551.50 |
$1,103 |
1.3× |
| Liver imaging static only (78201) |
$445.50 |
$891 |
0.8× |
| Lung Perf&Ventilat Diferentl (78598) |
$1,212.50 |
$2,425 |
2.2× |
| Lung perfusion differential (78597) |
$641 |
$1,282 |
1.5× |
| Lung Ventilat&Perfus Imaging (78582) |
$1,034 |
$2,068 |
1.8× |
| Lung Ventilation Imaging (78579) |
$734 |
$1,468 |
1.8× |
| Lymph System Imaging (78195) |
$1,098.50 |
$2,197 |
1.9× |
| Magnetic Image Jaw Joint (70336) |
$1,386.50 |
$2,773 |
5.6× |
| Mammary ductogram or galactogram multiple (77054) |
$466.50 |
$933 |
1.9× |
| Mammary ductogram or galactogram single (77053) |
$442.50 |
$885 |
1.8× |
| Meckels Divert Exam (78290) |
$659.50 |
$1,319 |
1.6× |
| Mlc imrt design & construction per imrt plan (77338) |
$2,920 |
$5,840 |
7.5× |
| Mr safety determination physician/other qhp (76016) |
$61.50 |
$123 |
0.7× |
| Mr safety implant&/fb assmt clin staf 1st 15 min (76014) |
$17 |
$34 |
0.6× |
| Mr safety implt electronics prepj supvj phys/qhp (76018) |
$64.50 |
$129 |
0.7× |
| Mr safety implt pos&/immoblj (76019) |
$41.50 |
$83 |
0.7× |
| Mr safety med physics xm customization plng&mntr (76017) |
$169 |
$338 |
0.7× |
| Mra Head W/O & W/Contrast Material (70546) |
$2,591.50 |
$5,183 |
7.2× |
| MRA head w/o contrast (70544) |
$1,775 |
$3,550 |
7.2× |
| MRA head with contrast (70545) |
$1,828.50 |
$3,657 |
5.0× |
| MRA neck w contrast (70548) |
$1,594 |
$3,188 |
4.4× |
| Mra Neck W/O &W/Contrast Material (70549) |
$2,046 |
$4,092 |
5.6× |
| MRA neck w/o contrast (70547) |
$1,328.50 |
$2,657 |
5.4× |
| MRI abdomen w contrast (74182) |
$2,051 |
$4,102 |
5.7× |
| MRI abdomen w/o contrast (74181) |
$1,797.50 |
$3,595 |
7.3× |
| MRI any jt lower extrem w/contrast material (73722) |
$1,947 |
$3,894 |
2.4× |
| MRI any jt lower extrem w/o & w/contrast matrl (73723) |
$2,074 |
$4,148 |
5.7× |
| MRI any jt upper extremity w/contrast matrl (73222) |
$1,551.50 |
$3,103 |
1.9× |
| MRI brain functional w/o physician admnistration (70554) |
$1,253.50 |
$2,507 |
5.1× |
| MRI Breast W/O Contrast Bilateral (77047) |
$221 |
$442 |
0.9× |
| MRI cardiac w/o contrast (75557) |
$589 |
$1,178 |
2.4× |
| MRI cervical spine w contrast (72142) |
$2,325.50 |
$4,651 |
6.4× |
| MRI cervical spine w/o cont (72141) |
$1,757 |
$3,514 |
7.1× |
| MRI chest w/o contrast (71550) |
$1,951 |
$3,902 |
7.9× |
| MRI chest with contrast (71551) |
$2,136.50 |
$4,273 |
2.6× |
| MRI chest wo w contrast (71552) |
$2,322.50 |
$4,645 |
6.4× |
| MRI lower extrem oth/thn jt w/contrast matrl (73719) |
$1,521 |
$3,042 |
4.2× |
| MRI lower extrem oth/thn jt w/o & w/contr matr (73720) |
$1,635.50 |
$3,271 |
4.5× |
| MRI lower extrem oth/thn jt w/o contr matrl (73718) |
$1,423 |
$2,846 |
5.7× |
| MRI lumbar spine w contrast (72149) |
$1,884 |
$3,768 |
5.2× |
| Mri Neck Spine W/O & W/Dye (72156) |
$2,584 |
$5,168 |
7.1× |
| MRI orbit face &/neck w/o contrast (70540) |
$2,272.50 |
$4,545 |
9.2× |
| MRI orbit face neck w contrast (70542) |
$2,347.50 |
$4,695 |
6.5× |
| Mri Orbt/Fac/Nck W/O &W/Dye (70543) |
$2,497 |
$4,994 |
6.9× |
| MRI pelvis w contrast (72196) |
$1,936.50 |
$3,873 |
5.3× |
| MRI pelvis w/o & w contrast (72197) |
$2,017.50 |
$4,035 |
5.6× |
| MRI pelvis w/o contrast (72195) |
$1,714.50 |
$3,429 |
6.9× |
| MRI spectroscopy (76390) |
$663.50 |
$1,327 |
7.3× |
| MRI thoracic spine w/o contrast (72146) |
$1,843 |
$3,686 |
7.4× |
| MRI upper extremity oth than jt w/contr matrl (73219) |
$1,479 |
$2,958 |
4.1× |
| MRI upper extremity oth than jt w/o contr matrl (73218) |
$1,369.50 |
$2,739 |
5.5× |
| Mri Uppr Extremity W/O&W/Dye (73220) |
$1,643.50 |
$3,287 |
4.5× |
| MRI, abdomen, combo (74183) |
$2,304.50 |
$4,609 |
6.4× |
| MRI, dorsal spine combo (72157) |
$2,071 |
$4,142 |
5.7× |
| MRI, dorsal spine contrast (72147) |
$1,864 |
$3,728 |
5.1× |
| MRI, joint upper extrem (73221) |
$1,303.50 |
$2,607 |
5.3× |
| MRI, joint upper extrem combo (73223) |
$1,655.50 |
$3,311 |
4.6× |
| MRI, lumbar spine combo (72158) |
$2,185 |
$4,370 |
6.0× |
| Myelogram cervical (72240) |
$832 |
$1,664 |
1.0× |
| Myelogram Lumbar (72265) |
$1,062.50 |
$2,125 |
1.3× |
| Myelography thoracic (72255) |
$3,193 |
$6,386 |
3.9× |
| Myelograpy 2/more regions rs&i (72270) |
$4,892 |
$9,784 |
6.0× |
| Myocardial Spect Multiple Studies (78452) |
$2,319 |
$4,638 |
1.7× |
| Myocrd Img Pet Metab Eval Single Study Cncrnt CT (78429) |
$1,252.50 |
$2,505 |
0.8× |
| Neck soft tissue (70360) |
$234.50 |
$469 |
2.6× |
| Nfs/Instlj Radioelmnt Sln 3 Mo Follow-Up Care (77750) |
$625 |
$1,250 |
1.6× |
| Nm csf leak detection (78650) |
$1,054.50 |
$2,109 |
0.8× |
| Nonvascular Shunt X-Ray (75809) |
$570.50 |
$1,141 |
5.3× |
| Ntsty modul radthx pln dose-vol histos (77301) |
$6,316.50 |
$12,633 |
4.4× |
| Nuclear Rx Intra-Arterial (79445) |
$1,403.50 |
$2,807 |
5.8× |
| Nuclear Rx Oral Admin (79005) |
$481.50 |
$963 |
2.0× |
| Parathyroid imaging w/tomographic spect & CT (78072) |
$605.50 |
$1,211 |
1.1× |
| Parathyroid Planar Imaging (78070) |
$781.50 |
$1,563 |
1.9× |
| Parathyroid planar imaging w/wo subtraction (78071) |
$709 |
$1,418 |
1.7× |
| Pelvis 1 or 2 views (72170) |
$215.50 |
$431 |
2.0× |
| Peritoneogram Rs&I (74190) |
$817 |
$1,634 |
1.4× |
| Pet Image W/Ct Lmtd (78814) |
$3,659.50 |
$7,319 |
2.5× |
| PET image w/CT, full body (78816) |
$4,008 |
$8,016 |
2.7× |
| PET imaging CT attenuation skull base mid-thigh (78815) |
$4,356.50 |
$8,713 |
2.9× |
| Proton trmt simple w/comp (77522) |
$100 |
$200 |
0.1× |
| Proton tx delivery simple w/o compensation (77520) |
$1,270 |
$2,540 |
2.2× |
| Prq Transhepatc Portograpy Hemodyn Eval Rs&I (75885) |
$2,028 |
$4,056 |
0.6× |
| Pulmonary Perfusion Imaging Particulate (78580) |
$879 |
$1,758 |
2.1× |
| Radex Abd Compl Aqt Abd W/S/E/D Views 1 View Ch (74022) |
$385 |
$770 |
3.5× |
| Radex abscess/fistula/sinus tract rs&i (76080) |
$654 |
$1,308 |
1.2× |
Radex Ankle Complete Minimum 3 Views (73610)
range across 2 matching MRF lines |
$153–$253 |
$306–$506 |
varies |
| Radex Calcaneus Minimum 2 Views (73650) |
$121 |
$242 |
1.3× |
| Radex elbow complete minimum 3 views (73080) |
$270 |
$540 |
3.0× |
| Radex Facial Bones Complete Minimum 3 Views (70150) |
$346.50 |
$693 |
3.2× |
| Radex fingr minimum 2 views (73140) |
$171.50 |
$343 |
1.9× |
Radex foot complete minimum 3 views (73630)
range across 2 matching MRF lines |
$144–$255.50 |
$288–$511 |
varies |
| Radex Hand Minimum 3 Views (73130) |
$249 |
$498 |
2.8× |
| Radex lower extremity infant minimum 2 views (73592) |
$113.50 |
$227 |
1.3× |
| Radex Mastoids Compl Minimum 3 Views PR Side (70130) |
$211 |
$422 |
1.9× |
| Radex Nasal Bones Complete Minimum 3 Views (70160) |
$233 |
$466 |
2.6× |
| Radex Ribs Unilateral 2 Views (71100) |
$205.50 |
$411 |
2.3× |
| Radex shoulder complete minimum 2 views (73030) |
$310.50 |
$621 |
3.4× |
| Radex Sinuses Paransl < 3 Views (70210) |
$214.50 |
$429 |
2.4× |
| Radex sm int w/mlt srl imges via enteroclss tube (74251) |
$357 |
$714 |
2.0× |
| Radex Spine 1 View Specify Level (72020) |
$216 |
$432 |
2.4× |
| Radex Sternum Minimum 2 Views (71120) |
$96.50 |
$193 |
1.1× |
| Radex Temporomandble Jt Opn & Clsd Mouth Bilat (70330) |
$187.50 |
$375 |
2.1× |
| Radex Toe Minimum 2 Views (73660) |
$189.50 |
$379 |
2.1× |
| Radex upper extremity infant minimum 2 views (73092) |
$102.50 |
$205 |
0.9× |
| Radex Wrist Complete Minimum 3 Views (73110) |
$270.50 |
$541 |
3.0× |
| Radex X-Ray Exam Entire Spi 6/> Vw - Xr Entire Spine 6+ Vw (72084) |
$212.50 |
$425 |
2.0× |
| Radiation Delivery Stereotactic Cranial Linear (77372) |
$12,748 |
$25,496 |
1.7× |
| Radiation treatment delivery level 1 (77402) |
$376 |
$752 |
3.5× |
| Radiation treatment delivery level 2 (77407) |
$449.50 |
$899 |
1.1× |
| Radiation treatment delivery level 3 (77412) |
$1,026 |
$2,052 |
1.8× |
| Radiolog exam mandible compl minimum 4 views (70110) |
$315.50 |
$631 |
2.9× |
| Radiologic exam colon double contrast study (74280) |
$941 |
$1,882 |
5.2× |
| Radiologic exam colon single contrast study (74270) |
$741 |
$1,482 |
4.1× |
| Radiologic Exam Esophagus Double Contrast Study (74221) |
$166 |
$332 |
0.9× |
| Radiologic exam knee complete 4/more views (73564) |
$319 |
$638 |
2.9× |
| Radiologic exam pelvis compl minimum 3 views (72190) |
$241 |
$482 |
2.2× |
| Radiologic Exam Small Int Single Contrast Study (74250) |
$463 |
$926 |
2.5× |
| Radiologic exam swallow function contrast study (74230) |
$421 |
$842 |
2.3× |
| Radiologic Exam Teeth Prtl Exam < Full Mouth (70310) |
$1,203 |
$2,406 |
4.9× |
Radiologic exam upr gi trc double contrast study (74246)
range across 2 matching MRF lines |
$511.50–$578 |
$1,023–$1,156 |
varies |
| Radiologic examination femur 1 view (73551) |
$107.50 |
$215 |
1.2× |
| Radiologic examination femur minimum 2 views (73552) |
$168.50 |
$337 |
1.9× |
| Radiologic examination knee 1/2 views (73560) |
$288 |
$576 |
3.2× |
| Radiologic Examination Osseous Survey Limited (77074) |
$179 |
$358 |
1.6× |
| Radiologic Examination Salivary Gland Calculus (70380) |
$136.50 |
$273 |
1.5× |
| Radiologic examination tibia & fibula 2 views (73590) |
$266 |
$532 |
2.9× |
| Remote afterloading high dose rate radionuclide skin surface brachytherapy, includes basic dosimetry, when performed;… (77768) |
$992.50 |
$1,985 |
2.5× |
| Remote afterloading high dose rate radionuclide skin surface brachytherapy, includes basic dosimetry, when performed;… (77767) |
$446.50 |
$893 |
1.1× |
| Ribs bilateral 3 views (71110) |
$314 |
$628 |
2.9× |
| Rp loclzj tum plnr 1 area single day imaging (78800) |
$762.50 |
$1,525 |
1.8× |
| Rp Loclzj Tum Plnr Whole Body 2+ Days Imaging (78804) |
$1,759.50 |
$3,519 |
3.1× |
| Rp Loclzj Tum Plnr Whole Body Single Day Imaging (78802) |
$1,349 |
$2,698 |
2.4× |
Rp Loclzj Tum Spect 1 Area Single Day Imaging (78803)
range across 3 matching MRF lines |
$1,041–$1,466 |
$2,082–$2,932 |
varies |
| Rp Therapy Intravenous Administration (79101) |
$482.50 |
$965 |
2.0× |
| Scapula (73010) |
$244 |
$488 |
2.2× |
| Screening Digital Breast Tomosynthesis Bi (77063) |
$60.50 |
$121 |
2.6× |
| Shoulder 1 view (73020) |
$167.50 |
$335 |
1.9× |
| Shoulder Arthrography (73040) |
$622 |
$1,244 |
1.7× |
| Sialogram (70390) |
$388.50 |
$777 |
1.6× |
| Skull less than 4 views (70250) |
$139 |
$278 |
1.3× |
| Special dosimetry (77331) |
$444.50 |
$889 |
3.2× |
| Special Physics Consult (77370) |
$1,021.50 |
$2,043 |
7.3× |
| Special teletherapy port plan (77321) |
$1,240 |
$2,480 |
3.2× |
| Special treatment procedure (77470) |
$2,045.50 |
$4,091 |
3.6× |
| Speech evaluation, complex (70371) |
$196 |
$392 |
0.8× |
| Stereotactic Body Radiation Delivery (77373) |
$8,423.50 |
$16,847 |
4.5× |
| Sternoclavicular joints (71130) |
$175.50 |
$351 |
1.9× |
| Superior sagittal sinus venogram (75870) |
$1,688.50 |
$3,377 |
0.5× |
| Telethx isodose pln cplx w/basic dosimetry (77307) |
$1,702 |
$3,404 |
4.4× |
| Telethx isodose pln smpl w/dosimetry calculation (77306) |
$1,021.50 |
$2,043 |
2.6× |
| Temporomandble Jt Arthrography Rs&I (70332) |
$3,595 |
$7,190 |
14.5× |
| Testicular Imaging W/Flow (78761) |
$704 |
$1,408 |
1.7× |
| Ther Rad Simulaj-Aided Field Setting Complex (77290) |
$1,759.50 |
$3,519 |
4.5× |
| Ther Rad Simulaj-Aided Field Setting Intermed (77285) |
$1,231.50 |
$2,463 |
3.2× |
| Ther rad simulaj-aided field setting simple (77280) |
$1,003 |
$2,006 |
7.2× |
| Therapeutic Enema Rdctj Intussusception/Obstrcj (74283) |
$940.50 |
$1,881 |
5.2× |
| Thoracic spine 2 views (72070) |
$219 |
$438 |
2.0× |
| Thoracic spine 3 views (72072) |
$306.50 |
$613 |
2.8× |
| Thoracolumbar 2 views (72080) |
$200 |
$400 |
2.2× |
| Thyroid carcinoma metastases imaging; with additional studies (eg, urinary recovery) Non-Facility (78016) |
$1,139 |
$2,278 |
2.7× |
| Thyroid Carcinoma Metastases Img Lmtd Area (78015) |
$448.50 |
$897 |
1.1× |
| Thyroid Imaging With Vascular Flow (78013) |
$392 |
$784 |
0.9× |
| Thyroid Met Imaging Body (78018) |
$1,128 |
$2,256 |
2.0× |
| Thyroid Uptake Measurement (78012) |
$251.50 |
$503 |
0.6× |
| Thyroid Uptake W/Blood Flow Sngle/Mult Quan Meas (78014) |
$676 |
$1,352 |
1.6× |
| Tx Devices Design & Construction Complex (77334) |
$969.50 |
$1,939 |
2.5× |
| Tx devices design & construction intermediate (77333) |
$465.50 |
$931 |
3.3× |
| Tx devices design & construction simple (77332) |
$407.50 |
$815 |
2.9× |
| Ultrasound Breast Limited (76642) |
$743.50 |
$1,487 |
8.2× |
| Ultrasound Exam Aaa Screen (76706) |
$328 |
$656 |
3.0× |
| Ultrasound, abdomen limited (76705) |
$194 |
$388 |
1.8× |
| Umbilical-artery Doppler (OB) (76820) |
$90 |
$180 |
0.8× |
| Unlisted fluoroscopic procedure (76496) |
$764 |
$1,528 |
8.5× |
| Unlisted Procedure Clinical Brachytherapy (77799) |
$351 |
$702 |
3.3× |
Unlisted us procedure (76999)
range across 2 matching MRF lines |
$293.50–$312.50 |
$587–$625 |
varies |
| Upper gi w/o kub (74240) |
$495 |
$990 |
2.7× |
| Ureteral Reflux Study (78740) |
$1,403.50 |
$2,807 |
3.4× |
| Urethrocystogram voiding (74455) |
$579 |
$1,158 |
2.3× |
| Urethrocystography retrograde (74450) |
$568 |
$1,136 |
2.3× |
| Us breast unilateral complete (76641) |
$743.50 |
$1,487 |
6.8× |
| Us chest (76604) |
$275.50 |
$551 |
2.5× |
| Us complete joint (76881) |
$443.50 |
$887 |
4.1× |
| Us exam, pelvic, limited (76857) |
$112.50 |
$225 |
1.0× |
| Us head (76506) |
$396.50 |
$793 |
3.7× |
Us kidney transplant (76776)
range across 2 matching MRF lines |
$283.50–$877 |
$567–$1,754 |
varies |
| Us lmtd joint/oth nonvasc xtr strux r-t w/img (76882) |
$366.50 |
$733 |
3.4× |
| Us ob detailed single fetus (76811) |
$322.50 |
$645 |
1.3× |
| Us ob limited 1 or more fetuses (76815) |
$158 |
$316 |
1.5× |
| Us ob transvaginal (76817) |
$451 |
$902 |
4.2× |
| Us pelvic non ob complete (76856) |
$240 |
$480 |
2.2× |
| Us pg uter img f&mat 14 wk tabdl 1/1st gestation (76801) |
$270 |
$540 |
2.5× |
Us preg uterus real time f/u trnsabdl per fetus (76816)
range across 2 matching MRF lines |
$216.50–$297.50 |
$433–$595 |
varies |
| Us retroperitoneal complete (76770) |
$247.50 |
$495 |
2.3× |
| Us retroperitoneal limited (76775) |
$378.50 |
$757 |
3.5× |
| Us scrotum and contents (76870) |
$508.50 |
$1,017 |
4.7× |
| Us spinal canal and contents (76800) |
$343.50 |
$687 |
3.2× |
| Us thyroid (76536) |
$432 |
$864 |
4.0× |
| Us transrectal (76872) |
$370 |
$740 |
3.4× |
| Vein X-Ray Chest (75827) |
$1,152 |
$2,304 |
0.7× |
| Vein X-Ray Liver W/O Hemodyn (75887) |
$2,759 |
$5,518 |
0.8× |
| Venogram Sinus/Jugular (75860) |
$398 |
$796 |
0.1× |
| Venography Adrenal Unilateral (75840) |
$1,840.50 |
$3,681 |
0.6× |
| Venography caval inferior serialography rs&i (75825) |
$1,850 |
$3,700 |
0.6× |
| Venography extremity bilateral rs&i (75822) |
$976 |
$1,952 |
0.6× |
| Venography extremity unilateral rs&i (75820) |
$787 |
$1,574 |
0.5× |
| Venography Renal Bilateral (75833) |
$1,750 |
$3,500 |
0.5× |
| Venography Renal Unilateral (75831) |
$1,224 |
$2,448 |
0.4× |
Venous sampling by catheter (75893)
likely a partial charge, not the full procedure |
$1,500.50 |
$3,001 |
0.3× |
| Vertebral fracture assessment via dxa (77086) |
$121.50 |
$243 |
1.3× |
| Wrist 2 views (73100) |
$165 |
$330 |
1.8× |
| X-Ray Ac Jts - Xr Acromioclavicular Joints Bilateral (73050) |
$245.50 |
$491 |
2.7× |
| X-ray antegrade pyelogram tube (74425) |
$476.50 |
$953 |
1.3× |
| X-Ray Aorta Leg Arteries (75630) |
$1,529 |
$3,058 |
0.5× |
| X-Ray Bend Only L-S Spine (72120) |
$167.50 |
$335 |
1.5× |
| X-Ray Elbow 2 Vw - Xr Elbow 1-2 Views Right (73070) |
$212.50 |
$425 |
2.4× |
| X-Ray Exam Breast Specimen (76098) |
$277 |
$554 |
0.5× |
| X-Ray Exam Entire Spi 1 Vw (72081) |
$177.50 |
$355 |
2.0× |
| X-Ray Exam Entire Spi 2/3 Vw (72082) |
$394 |
$788 |
3.6× |
| X-Ray Exam Entire Spi 4/5 Vw (72083) |
$205 |
$410 |
1.9× |
| X-Ray Exam Hip Uni 1 View (73501) |
$116 |
$232 |
1.3× |
| X-Ray Exam Hip Uni 2-3 Views (73502) |
$116 |
$232 |
1.3× |
| X-Ray Exam Hip Uni 4/> Views (73503) |
$144 |
$288 |
1.3× |
| X-Ray Exam Hips Bi 2 Views (73521) |
$344.50 |
$689 |
3.2× |
| X-Ray Exam Hips Bi 3-4 Views (73522) |
$344.50 |
$689 |
3.2× |
| X-Ray Exam Hips Bi 5/> Views (73523) |
$313.50 |
$627 |
2.9× |
| X-Ray Exam L-S Spine Bending (72114) |
$458 |
$916 |
4.2× |
| X-Ray Exam Neck Spine 2-3 Vw (72040) |
$270.50 |
$541 |
3.0× |
| X-Ray Exam Neck Spine 6/>Vws (72052) |
$508.50 |
$1,017 |
4.7× |
| X-Ray Exam Unilat Ribs/Chest (71101) |
$277.50 |
$555 |
2.6× |
| X-ray eye for foreign body (70030) |
$176.50 |
$353 |
2.0× |
| X-ray humerus (73060) |
$217 |
$434 |
2.4× |
| X-ray IV pyelogram (ivp) (74400) |
$561.50 |
$1,123 |
3.1× |
| X-ray IV pyelogram+tomography (74415) |
$842 |
$1,684 |
4.6× |
| X-Ray Jaw <4 Vw - Xr Mandible < 4 Views (70100) |
$151.50 |
$303 |
1.7× |
| X-Ray Knee Bilat Standing - Xr Knees Anteroposterior Standing Bilat (73565) |
$155 |
$310 |
1.7× |
| X-Ray Lumbar Spine 2/3 Vw - Xr Lumbar Spine 2-3 Views (72100) |
$341.50 |
$683 |
3.1× |
| X-ray nose-rectum child f.b. (76010) |
$208 |
$416 |
2.3× |
| X-Ray Ribs, Chest 4+ Vw - Xr Ribs 3 Vws Bil W/ Chest Posteroanterior (71111) |
$366.50 |
$733 |
3.4× |
| X-Ray Sacroiliac Jts 3+ Vw - Xr Sacroiliac Joints 3+ Views (72202) |
$299 |
$598 |
2.8× |
| X-Ray Sacroiliac Jts <3 Vw - Xr Sacroiliac Joints 1-2 Views (72200) |
$177 |
$354 |
1.6× |
| X-Ray Sacrum/Coccyx 2+ Vw - Xr Sacrum Coccyx 2+ Views (72220) |
$179 |
$358 |
2.0× |
| X-Ray Sinuses 3+ Vw - Xr Paranasal Sinuses 3+ Views (70220) |
$282 |
$564 |
3.1× |
| X-Ray Skull 4+ Vw - Xr Skull Complete 4+ Views (70260) |
$343 |
$686 |
3.2× |
| X-Ray Stress View (77071) |
$136.50 |
$273 |
1.5× |
| X-ray thoracic spine 4 vw (72074) |
$245 |
$490 |
2.3× |
| X-Ray Urinary Tract Exam With Contrast Material (74420) |
$529.50 |
$1,059 |
1.5× |
| X-Rays Bone Length Studies (77073) |
$200 |
$400 |
1.8× |
| X-Rays Bone Survey Complete (77075) |
$640 |
$1,280 |
5.9× |
| Xr c-spine 4 or 5 views (72050) |
$373 |
$746 |
3.4× |
| Xr facial bones less than 3 views (70140) |
$83.50 |
$167 |
0.9× |
| Xr orbits complete 4 views (70200) |
$333.50 |
$667 |
3.1× |