| 3-D radiotherapy plan dose-volume histograms (77295) |
$4,408.50 |
$5,878 |
3.1× |
| Abdomen 1 View (74018) |
$135.75 |
$181 |
1.5× |
| Abdomen 2 views (74019) |
$127.50 |
$170 |
1.2× |
| Acute Gastrointestinal Blood Loss Imaging (78278) |
$993 |
$1,324 |
2.4× |
| Angio internal mammary (75756) |
$2,507.25 |
$3,343 |
0.8× |
| Angio pulmonary bilat (75743) |
$2,814.75 |
$3,753 |
0.9× |
| Angiography extremity bilateral rs&i (75716) |
$3,474.75 |
$4,633 |
1.1× |
| Angiography extremity unilateral rs&i (75710) |
$4,002.75 |
$5,337 |
1.2× |
| Angiography pulmonary unilateral slctv rs&i (75741) |
$2,680.50 |
$3,574 |
0.8× |
| Angrph pulmonary nonslctv cath/ven njx rs&i (75746) |
$1,230.75 |
$1,641 |
0.4× |
| Ankle 2 views (73600) |
$106.50 |
$142 |
1.2× |
| Aortography thoracic serialography rs&i (75605) |
$5,541 |
$7,388 |
1.0× |
| Artery X-Rays Abdomen (75726) |
$4,623.75 |
$6,165 |
0.8× |
| Artery X-Rays Pelvis (75736) |
$4,098 |
$5,464 |
0.7× |
| Arthrogram hip (73525) |
$388.50 |
$518 |
1.1× |
| Basic radiation dosimetry calculation (77300) |
$381 |
$508 |
2.8× |
| Bone age studies (77072) |
$159.75 |
$213 |
1.5× |
| Bone Imaging 3 Phase (78315) |
$1,471.50 |
$1,962 |
3.6× |
| Bone Imaging Limited Area (78300) |
$739.50 |
$986 |
1.8× |
| Bone Imaging Whole Body (78306) |
$1,261.50 |
$1,682 |
3.1× |
| Bone marrow imaging limited area (78102) |
$375.75 |
$501 |
0.9× |
| Bone survey infant (77076) |
$160.50 |
$214 |
1.5× |
| Brain Imaging Min 4 Static Views W Vascular Flow (78606) |
$617.25 |
$823 |
1.1× |
| Cardiac MRI w/w/o contrast & further seq (75561) |
$1,346.25 |
$1,795 |
3.8× |
| Cardiac MRI w/w/o contrast w/stress (75563) |
$1,616.25 |
$2,155 |
2.0× |
| Cat Scan Follow-Up Study (76380) |
$588.75 |
$785 |
6.6× |
| Cerebrospinal Fluid Scan (78630) |
$684.75 |
$913 |
1.2× |
| Chest 1 view (71045) |
$277.50 |
$370 |
3.1× |
| Chest 2 views (71046) |
$288.75 |
$385 |
3.2× |
| Chest 3 views (71047) |
$176.25 |
$235 |
2.0× |
| Cineradiograpy/vidradiograpy xcpt where spec (76120) |
$225.75 |
$301 |
2.1× |
| Clavicle complete (73000) |
$233.25 |
$311 |
2.6× |
| Computed Tomography Thorax Lw Dose Lng Ca Scr C- (71271) |
$1,197 |
$1,596 |
11.2× |
Continuing medical physics consltj pr wk (77336)
range across 2 matching MRF lines |
$238.50–$546 |
$318–$728 |
varies |
| Contrast Exam Abdominl Aorta (75625) |
$3,720 |
$4,960 |
1.2× |
| Contrast X-Ray Bladder (74430) |
$456.75 |
$609 |
1.3× |
| Contrast X-Ray Of Elbow (73085) |
$210 |
$280 |
0.6× |
| Contrast X-Ray Of Knee Joint (73580) |
$306 |
$408 |
0.9× |
| CT abdomen and pelvis without and with contrast (74178) |
$3,027.75 |
$4,037 |
8.5× |
| CT abdomen and pelvis without contrast (74176) |
$2,289.75 |
$3,053 |
9.4× |
| CT abdomen w contrast (74160) |
$1,534.50 |
$2,046 |
8.6× |
| CT abdomen w wo contrast (74170) |
$1,867.50 |
$2,490 |
10.4× |
| CT abdomen w/o contrast (74150) |
$1,242.75 |
$1,657 |
11.6× |
| CT Angio Abdomen and Pelvis (74174) |
$3,307.50 |
$4,410 |
9.3× |
| CT Angio Chest (71275) |
$2,052 |
$2,736 |
11.5× |
| CT Angio Head (70496) |
$1,960.50 |
$2,614 |
10.9× |
| CT angio hrt w/3d image (75574) |
$1,888.50 |
$2,518 |
5.3× |
| Ct Angio Lwr Extr W/O&W/Dye (73706) |
$1,887.75 |
$2,517 |
10.5× |
| CT Angio Neck (70498) |
$1,997.25 |
$2,663 |
11.1× |
| Ct Angio Upr Extrm W/O&W/Dye (73206) |
$1,673.25 |
$2,231 |
9.3× |
| CT cervical spine w/ contrast (72126) |
$1,682.25 |
$2,243 |
4.7× |
| CT cervical spine w/o contrast (72125) |
$1,644.75 |
$2,193 |
15.4× |
| CT cervical spine w/wo cont (72127) |
$1,808.25 |
$2,411 |
10.1× |
| CT chest w contrast (71260) |
$1,602.75 |
$2,137 |
8.9× |
| CT chest w/wo contrast (71270) |
$1,698 |
$2,264 |
9.5× |
| CT colonography screening (74263) |
$1,232.25 |
$1,643 |
5.1× |
| CT colonogrphy dx image postprocess w/o contrast (74261) |
$622.50 |
$830 |
5.8× |
| CT head/brain with contrast (70460) |
$1,378.50 |
$1,838 |
7.7× |
| CT head/brain without and with contrast (70470) |
$1,659 |
$2,212 |
9.3× |
| CT heart contrast eval cardiac structure&morph (75572) |
$795.75 |
$1,061 |
2.2× |
| CT heart no contrast quant eval coronry calcium (75571) |
$15.75 |
$21 |
0.2× |
| CT hrt w/3d image congen (75573) |
$1,251 |
$1,668 |
3.5× |
| CT iac w contrast (70481) |
$1,512 |
$2,016 |
8.4× |
| CT l-spine w&w/o contrast (72133) |
$1,950.75 |
$2,601 |
10.9× |
| CT lower ext w/o (73700) |
$1,503 |
$2,004 |
14.1× |
| CT lower extremity w/contrast material (73701) |
$1,563.75 |
$2,085 |
8.7× |
| CT lumbar spine w contrast (72132) |
$1,569.75 |
$2,093 |
4.4× |
| CT lumbar spine w/o contrast (72131) |
$1,515 |
$2,020 |
14.2× |
| CT maxillofacial w contrast (70487) |
$1,467.75 |
$1,957 |
8.2× |
| CT maxillofacial wo contrast (70486) |
$1,429.50 |
$1,906 |
13.4× |
| CT neck tissue combo (70492) |
$1,590 |
$2,120 |
8.9× |
| Ct Orbit/Ear/Fossa W/O&W/Dye (70482) |
$1,614 |
$2,152 |
9.0× |
| CT orbits w/o contrast (70480) |
$1,316.25 |
$1,755 |
12.3× |
| CT pelvis w&w/o contrast (72194) |
$1,719.75 |
$2,293 |
9.6× |
| CT pelvis w/o contrast (72192) |
$1,415.25 |
$1,887 |
13.3× |
| CT scan of leg combo (73702) |
$2,161.50 |
$2,882 |
12.1× |
| CT scans face/jaw combo (70488) |
$1,732.50 |
$2,310 |
9.7× |
| CT soft tissue neck w contrast (70491) |
$1,494 |
$1,992 |
8.3× |
| CT soft tissue neck w/o contrast (70490) |
$1,227 |
$1,636 |
11.5× |
| CT thoracic spine w contrast (72129) |
$1,448.25 |
$1,931 |
8.1× |
| CT thoracic spine w/o contrast (72128) |
$1,427.25 |
$1,903 |
13.4× |
| CT thoracic spine w/wo cont (72130) |
$1,689.75 |
$2,253 |
9.4× |
| CT thorax w/o contrast (71250) |
$1,414.50 |
$1,886 |
13.2× |
| CT unlisted procedure (76497) |
$6,939 |
$9,252 |
78.0× |
| CT upper ext wo (73200) |
$1,310.25 |
$1,747 |
12.3× |
| CT upper extremity w/o & w/contrast material (73202) |
$1,366.50 |
$1,822 |
7.6× |
| CT upper extremity with contrast (73201) |
$1,542.75 |
$2,057 |
4.3× |
| Cta Abdl Aorta&Bi Iliofem W/Contrast&Postp (75635) |
$2,327.25 |
$3,103 |
13.0× |
| Cta Abdomen (74175) |
$2,061.75 |
$2,749 |
11.5× |
| CTA pelvis (72191) |
$1,719.75 |
$2,293 |
9.6× |
| Dilation ureters/urethra rs&i (74485) |
$1,462.50 |
$1,950 |
0.7× |
| Doppler Echo Fetal Puls Spectral F/U/Repeat (76828) |
$72 |
$96 |
0.7× |
| Doppler Echo Fetal Spectral Display Complete (76827) |
$184.50 |
$246 |
1.7× |
| Doppler Fetal Mid Cerebral Artery (76821) |
$266.25 |
$355 |
2.5× |
| Dxa Bone Density Axial (77080) |
$291 |
$388 |
2.7× |
| Echo exam of fetal heart (76825) |
$468 |
$624 |
0.8× |
| Echo exam uterus (76831) |
$567 |
$756 |
2.3× |
| Echocardiography, fetal, cardiovascular system, real time with image documentation (2D), with or without M-mode… (76826) |
$227.25 |
$303 |
0.9× |
| Esophagram (74220) |
$467.25 |
$623 |
2.6× |
| Fetal Biophys Profile W/Nst (76818) |
$168.75 |
$225 |
1.6× |
| Fetal Biophysical Profile W/O Non-Stress Testing (76819) |
$503.25 |
$671 |
4.7× |
| Fluoroscopy up to 1 hr (76000) |
$360.75 |
$481 |
1.5× |
| Follow-Up Angiography (75898) |
$1,251.75 |
$1,669 |
0.4× |
| Foot 2 views (73620) |
$140.25 |
$187 |
1.6× |
| Forearm 2 views (73090) |
$240 |
$320 |
2.7× |
| Gastric emptying imaging study (78264) |
$1,362.75 |
$1,817 |
3.3× |
| Gated Heart Planar Single (78472) |
$1,309.50 |
$1,746 |
3.2× |
| Hand 2 views (73120) |
$221.25 |
$295 |
2.1× |
| Hepatc Vngrph Wdg/Fr Hemodyn Eval Rs&I (75889) |
$2,869.50 |
$3,826 |
0.9× |
| Hepatobil Syst Image W/Drug (78227) |
$1,568.25 |
$2,091 |
2.8× |
| Hepatobiliary System Imaging (78226) |
$1,387.50 |
$1,850 |
3.4× |
| Hysterosalpingogram (74740) |
$601.50 |
$802 |
2.5× |
| Image fusion (77399) |
$408.75 |
$545 |
3.0× |
| Infant hip ultrasound with hip movement (dynamic) (76885) |
$229.50 |
$306 |
2.6× |
| Infant hip ultrasound, limited static exam (76886) |
$162.75 |
$217 |
1.8× |
| Interstitial radiation source applic complex (77778) |
$1,024.50 |
$1,366 |
1.4× |
| Joint Survey Single View (77077) |
$195 |
$260 |
1.8× |
| K Flow/Funct Image Multiple (78709) |
$662.25 |
$883 |
1.2× |
| K Flow/Funct Image W/Drug (78708) |
$1,329 |
$1,772 |
2.4× |
| K Flow/Funct Image W/O Drug (78707) |
$892.50 |
$1,190 |
1.6× |
| Kidney Imaging Morphoogy W/Vascular Flow (78701) |
$470.25 |
$627 |
1.2× |
| Knee 3 Views (73562) |
$163.50 |
$218 |
1.8× |
| Liver & Spleen Imaging Static Only (78215) |
$415.50 |
$554 |
1.0× |
| Lung Perf&Ventilat Diferentl (78598) |
$663.75 |
$885 |
1.2× |
| Lung Ventilat&Perfus Imaging (78582) |
$1,275.75 |
$1,701 |
2.3× |
| Lung Ventilation Imaging (78579) |
$338.25 |
$451 |
0.8× |
| Lymph System Imaging (78195) |
$1,656 |
$2,208 |
3.0× |
| Magnetic Image Jaw Joint (70336) |
$1,899.75 |
$2,533 |
7.8× |
| Mammary ductogram or galactogram single (77053) |
$241.50 |
$322 |
1.0× |
| Meckels Divert Exam (78290) |
$900 |
$1,200 |
2.2× |
| Mlc imrt design & construction per imrt plan (77338) |
$1,347.75 |
$1,797 |
3.5× |
| Mr safety implant&/fb assmt clin staf 1st 15 min (76014) |
$37.50 |
$50 |
1.3× |
| Mra Head W/O & W/Contrast Material (70546) |
$2,603.25 |
$3,471 |
7.3× |
| MRA head w/o contrast (70544) |
$2,201.25 |
$2,935 |
9.0× |
| MRA head with contrast (70545) |
$1,242 |
$1,656 |
3.5× |
| MRA neck w contrast (70548) |
$2,073.75 |
$2,765 |
5.8× |
| Mra Neck W/O &W/Contrast Material (70549) |
$2,780.25 |
$3,707 |
7.8× |
| MRA neck w/o contrast (70547) |
$1,969.50 |
$2,626 |
8.1× |
| MRI abdomen w contrast (74182) |
$2,332.50 |
$3,110 |
6.5× |
| MRI abdomen w/o contrast (74181) |
$2,244 |
$2,992 |
9.2× |
| MRI any jt lower extrem w/contrast material (73722) |
$2,498.25 |
$3,331 |
3.1× |
| MRI any jt lower extrem w/o & w/contrast matrl (73723) |
$2,682.75 |
$3,577 |
7.5× |
| MRI any jt upper extremity w/contrast matrl (73222) |
$2,405.25 |
$3,207 |
3.0× |
| MRI Breast W/O Contrast Bilateral (77047) |
$2,362.50 |
$3,150 |
9.7× |
| MRI Breast Without Contrast Material Unilateral (77046) |
$1,725 |
$2,300 |
7.1× |
| MRI cardiac w/o contrast (75557) |
$1,242 |
$1,656 |
5.1× |
| MRI cervical spine w contrast (72142) |
$1,743 |
$2,324 |
4.9× |
| MRI cervical spine w/o cont (72141) |
$2,205 |
$2,940 |
9.0× |
| MRI chest w/o contrast (71550) |
$1,905.75 |
$2,541 |
7.8× |
| MRI chest wo w contrast (71552) |
$2,427.75 |
$3,237 |
6.8× |
| MRI lower extrem oth/thn jt w/contrast matrl (73719) |
$1,567.50 |
$2,090 |
4.4× |
| MRI lower extrem oth/thn jt w/o & w/contr matr (73720) |
$2,737.50 |
$3,650 |
7.7× |
| MRI lower extrem oth/thn jt w/o contr matrl (73718) |
$2,200.50 |
$2,934 |
9.0× |
| MRI lumbar spine w contrast (72149) |
$2,339.25 |
$3,119 |
6.6× |
| Mri Neck Spine W/O & W/Dye (72156) |
$2,854.50 |
$3,806 |
8.0× |
| MRI orbit face &/neck w/o contrast (70540) |
$1,566.75 |
$2,089 |
6.4× |
| MRI orbit face neck w contrast (70542) |
$2,081.25 |
$2,775 |
5.8× |
| Mri Orbt/Fac/Nck W/O &W/Dye (70543) |
$2,781 |
$3,708 |
7.8× |
| MRI pelvis w contrast (72196) |
$1,303.50 |
$1,738 |
3.7× |
| MRI pelvis w/o & w contrast (72197) |
$2,898 |
$3,864 |
8.1× |
| MRI pelvis w/o contrast (72195) |
$2,174.25 |
$2,899 |
8.9× |
| MRI thoracic spine w/o contrast (72146) |
$2,208 |
$2,944 |
9.1× |
| MRI upper extremity oth than jt w/contr matrl (73219) |
$1,447.50 |
$1,930 |
4.1× |
| MRI upper extremity oth than jt w/o contr matrl (73218) |
$2,217 |
$2,956 |
9.1× |
| Mri Uppr Extremity W/O&W/Dye (73220) |
$2,725.50 |
$3,634 |
7.6× |
| MRI, abdomen, combo (74183) |
$3,006 |
$4,008 |
8.4× |
| MRI, dorsal spine combo (72157) |
$2,807.25 |
$3,743 |
7.9× |
| MRI, dorsal spine contrast (72147) |
$2,373 |
$3,164 |
6.7× |
| MRI, joint upper extrem (73221) |
$2,180.25 |
$2,907 |
8.9× |
| MRI, joint upper extrem combo (73223) |
$2,783.25 |
$3,711 |
7.8× |
| MRI, lumbar spine combo (72158) |
$2,913 |
$3,884 |
8.2× |
| Myocardial Spect Multiple Studies (78452) |
$2,911.50 |
$3,882 |
2.2× |
| Myocrd Img Pet Metab Eval Single Study Cncrnt CT (78429) |
$1,422.75 |
$1,897 |
1.0× |
| Myocrd Img Pet Prfuj W/Metab 2rtracer Cncrnt CT (78433) |
$4,641 |
$6,188 |
2.1× |
| Neck soft tissue (70360) |
$165 |
$220 |
1.9× |
| Nfs/Instlj Radioelmnt Sln 3 Mo Follow-Up Care (77750) |
$478.50 |
$638 |
1.2× |
| Nonvascular Shunt X-Ray (75809) |
$280.50 |
$374 |
2.6× |
| Ntsty modul radthx pln dose-vol histos (77301) |
$5,709 |
$7,612 |
4.0× |
| Nuclear Rx Intra-Arterial (79445) |
$318.75 |
$425 |
1.3× |
| Nuclear Rx Oral Admin (79005) |
$695.25 |
$927 |
2.9× |
| Ob us nuchal meas 1 gest (76813) |
$190.50 |
$254 |
1.8× |
| Oph US Dx B-Scan&Quan a-Scan Sm Pt Enctr (76510) |
$112.50 |
$150 |
0.8× |
| Optic foramina (70190) |
$118.50 |
$158 |
1.3× |
| Panoramic X-ray of jaws (70355) |
$176.25 |
$235 |
2.0× |
| Parathyroid imaging w/tomographic spect & CT (78072) |
$984 |
$1,312 |
1.8× |
| Parathyroid Planar Imaging (78070) |
$509.25 |
$679 |
1.2× |
| Parathyroid planar imaging w/wo subtraction (78071) |
$1,153.50 |
$1,538 |
2.8× |
| Pelvis 1 or 2 views (72170) |
$200.25 |
$267 |
1.9× |
| Peritoneogram Rs&I (74190) |
$477.75 |
$637 |
0.9× |
| Pet Image W/Ct Lmtd (78814) |
$3,218.25 |
$4,291 |
2.2× |
| PET image w/CT, full body (78816) |
$4,218.75 |
$5,625 |
2.9× |
| PET imaging CT attenuation skull base mid-thigh (78815) |
$4,414.50 |
$5,886 |
3.0× |
| Prq Transhepatc Portograpy Hemodyn Eval Rs&I (75885) |
$2,080.50 |
$2,774 |
0.6× |
| Pulmonary Perfusion Imaging Particulate (78580) |
$686.25 |
$915 |
1.7× |
| Radex Abd Compl Aqt Abd W/S/E/D Views 1 View Ch (74022) |
$174 |
$232 |
1.6× |
| Radex abscess/fistula/sinus tract rs&i (76080) |
$427.50 |
$570 |
0.8× |
| Radex Ankle Complete Minimum 3 Views (73610) |
$147 |
$196 |
1.7× |
| Radex Calcaneus Minimum 2 Views (73650) |
$135.75 |
$181 |
1.5× |
| Radex elbow complete minimum 3 views (73080) |
$270.75 |
$361 |
3.0× |
| Radex Facial Bones Complete Minimum 3 Views (70150) |
$111.75 |
$149 |
1.0× |
| Radex fingr minimum 2 views (73140) |
$173.25 |
$231 |
1.9× |
| Radex foot complete minimum 3 views (73630) |
$149.25 |
$199 |
1.7× |
| Radex Hand Minimum 3 Views (73130) |
$251.25 |
$335 |
2.8× |
| Radex lower extremity infant minimum 2 views (73592) |
$96 |
$128 |
1.1× |
| Radex Mastoids Compl Minimum 3 Views PR Side (70130) |
$107.25 |
$143 |
1.0× |
| Radex Nasal Bones Complete Minimum 3 Views (70160) |
$102.75 |
$137 |
1.2× |
| Radex Ribs Unilateral 2 Views (71100) |
$116.25 |
$155 |
1.3× |
| Radex shoulder complete minimum 2 views (73030) |
$264.75 |
$353 |
3.0× |
| Radex Sinuses Paransl < 3 Views (70210) |
$75 |
$100 |
0.8× |
| Radex Spine 1 View Specify Level (72020) |
$154.50 |
$206 |
1.7× |
| Radex Sternum Minimum 2 Views (71120) |
$170.25 |
$227 |
1.9× |
| Radex Temporomandble Jt Opn & Clsd Mouth Bilat (70330) |
$119.25 |
$159 |
1.3× |
| Radex Toe Minimum 2 Views (73660) |
$129 |
$172 |
1.5× |
| Radex upper extremity infant minimum 2 views (73092) |
$104.25 |
$139 |
1.0× |
| Radex Wrist Complete Minimum 3 Views (73110) |
$259.50 |
$346 |
2.9× |
| Radiation treatment delivery level 1 (77402) |
$280.50 |
$374 |
2.7× |
| Radiation treatment delivery level 3 (77412) |
$764.25 |
$1,019 |
1.4× |
| Radiolog exam mandible compl minimum 4 views (70110) |
$110.25 |
$147 |
1.0× |
| Radiologic Exam Abdomen 3+ Views - Xr Abdomen 3+ Views (74021) |
$160.50 |
$214 |
1.5× |
| Radiologic exam colon double contrast study (74280) |
$384.75 |
$513 |
2.1× |
| Radiologic exam colon single contrast study (74270) |
$444 |
$592 |
2.5× |
| Radiologic Exam Esophagus Double Contrast Study (74221) |
$329.25 |
$439 |
1.8× |
| Radiologic exam knee complete 4/more views (73564) |
$187.50 |
$250 |
1.8× |
| Radiologic exam pelvis compl minimum 3 views (72190) |
$225.75 |
$301 |
2.1× |
| Radiologic Exam Small Int Single Contrast Study (74250) |
$525 |
$700 |
2.9× |
| Radiologic exam swallow function contrast study (74230) |
$386.25 |
$515 |
2.2× |
| Radiologic exam upr gi trc double contrast study (74246) |
$580.50 |
$774 |
3.2× |
| Radiologic examination femur 1 view (73551) |
$116.25 |
$155 |
1.3× |
| Radiologic examination femur minimum 2 views (73552) |
$144 |
$192 |
1.6× |
| Radiologic examination knee 1/2 views (73560) |
$142.50 |
$190 |
1.6× |
| Radiologic Examination Osseous Survey Limited (77074) |
$145.50 |
$194 |
1.4× |
| Radiologic examination tibia & fibula 2 views (73590) |
$142.50 |
$190 |
1.6× |
| Renal Cyst Study (74470) |
$207.75 |
$277 |
0.4× |
| Ribs bilateral 3 views (71110) |
$270 |
$360 |
2.5× |
| Rp Loclzj Tum Plnr Whole Body 2+ Days Imaging (78804) |
$1,738.50 |
$2,318 |
3.1× |
| Rp Loclzj Tum Spect 1 Area Single Day Imaging (78803) |
$1,498.50 |
$1,998 |
2.7× |
| Rp loclzj tum spect 2 area/sep acquisj img (78831) |
$1,440 |
$1,920 |
1.1× |
| Rp loclzj tum spect w/CT 1 area/acquisj 1day img (78830) |
$1,440 |
$1,920 |
1.1× |
| Rp Therapy Intravenous Administration (79101) |
$251.25 |
$335 |
1.1× |
| Scapula (73010) |
$256.50 |
$342 |
2.4× |
| Screening Digital Breast Tomosynthesis Bi (77063) |
$72 |
$96 |
3.1× |
| Shoulder 1 view (73020) |
$189.75 |
$253 |
2.1× |
| Shoulder Arthrography (73040) |
$615.75 |
$821 |
1.7× |
| Skull less than 4 views (70250) |
$194.25 |
$259 |
1.8× |
| Special dosimetry (77331) |
$57 |
$76 |
0.4× |
Special Physics Consult (77370)
range across 2 matching MRF lines |
$324.75–$799.50 |
$433–$1,066 |
varies |
| Special teletherapy port plan (77321) |
$315 |
$420 |
0.8× |
| Special treatment procedure (77470) |
$1,422.75 |
$1,897 |
2.5× |
| Stereotactic Body Radiation Delivery (77373) |
$5,013 |
$6,684 |
2.7× |
| Sternoclavicular joints (71130) |
$66.75 |
$89 |
0.8× |
| Telethx isodose pln cplx w/basic dosimetry (77307) |
$384.75 |
$513 |
1.0× |
| Telethx isodose pln smpl w/dosimetry calculation (77306) |
$315.75 |
$421 |
0.8× |
| Ther Rad Simulaj-Aided Field Setting Complex (77290) |
$1,825.50 |
$2,434 |
4.8× |
| Ther Rad Simulaj-Aided Field Setting Intermed (77285) |
$1,035 |
$1,380 |
2.7× |
| Ther rad simulaj-aided field setting simple (77280) |
$426.75 |
$569 |
3.1× |
| Therapeutic Enema Rdctj Intussusception/Obstrcj (74283) |
$493.50 |
$658 |
2.8× |
| Thoracic spine 2 views (72070) |
$151.50 |
$202 |
1.4× |
| Thoracic spine 3 views (72072) |
$241.50 |
$322 |
2.3× |
| Thoracolumbar 2 views (72080) |
$174.75 |
$233 |
2.0× |
| Thyroid Imaging With Vascular Flow (78013) |
$921.75 |
$1,229 |
2.3× |
| Thyroid Met Imaging Body (78018) |
$1,419 |
$1,892 |
2.6× |
| Thyroid Uptake Measurement (78012) |
$921.75 |
$1,229 |
2.3× |
| Thyroid Uptake W/Blood Flow Sngle/Mult Quan Meas (78014) |
$961.50 |
$1,282 |
2.4× |
| Tx Devices Design & Construction Complex (77334) |
$891.75 |
$1,189 |
2.3× |
| Tx devices design & construction intermediate (77333) |
$395.25 |
$527 |
2.9× |
| Tx devices design & construction simple (77332) |
$353.25 |
$471 |
2.6× |
| Ultrasound Breast Limited (76642) |
$281.25 |
$375 |
3.2× |
| Ultrasound Exam Aaa Screen (76706) |
$420 |
$560 |
3.9× |
| Ultrasound, abdomen limited (76705) |
$545.25 |
$727 |
5.1× |
| Umbilical-artery Doppler (OB) (76820) |
$256.50 |
$342 |
2.4× |
| Upper gi w/o kub (74240) |
$498 |
$664 |
2.8× |
| Urethrocystogram voiding (74455) |
$585.75 |
$781 |
2.4× |
| Urethrocystography retrograde (74450) |
$382.50 |
$510 |
1.6× |
| Us breast unilateral complete (76641) |
$324.75 |
$433 |
3.0× |
| Us chest (76604) |
$334.50 |
$446 |
3.1× |
Us complete joint (76881)
range across 2 matching MRF lines |
$231–$445.50 |
$308–$594 |
varies |
| Us exam, pelvic, limited (76857) |
$384 |
$512 |
3.6× |
| Us head (76506) |
$312 |
$416 |
2.9× |
| Us kidney transplant (76776) |
$418.50 |
$558 |
3.9× |
Us lmtd joint/oth nonvasc xtr strux r-t w/img (76882)
range across 2 matching MRF lines |
$311.25–$401.25 |
$415–$535 |
varies |
| Us ob detailed single fetus (76811) |
$526.50 |
$702 |
2.2× |
Us ob limited 1 or more fetuses (76815)
range across 2 matching MRF lines |
$324–$408 |
$432–$544 |
varies |
| Us ob transvaginal (76817) |
$304.50 |
$406 |
2.9× |
| Us pelvic non ob complete (76856) |
$571.50 |
$762 |
5.4× |
| Us pg uter img f&mat 14 wk tabdl 1/1st gestation (76801) |
$402 |
$536 |
3.8× |
| Us preg uterus real time f/u trnsabdl per fetus (76816) |
$474 |
$632 |
4.4× |
| Us retroperitoneal complete (76770) |
$435.75 |
$581 |
4.1× |
| Us retroperitoneal limited (76775) |
$425.25 |
$567 |
4.0× |
| Us scrotum and contents (76870) |
$501 |
$668 |
4.7× |
| Us spinal canal and contents (76800) |
$230.25 |
$307 |
2.2× |
| Us thyroid (76536) |
$407.25 |
$543 |
3.8× |
| Us transrectal (76872) |
$216 |
$288 |
2.0× |
| Vein X-Ray Chest (75827) |
$1,949.25 |
$2,599 |
1.2× |
| Vein X-Ray Liver W/O Hemodyn (75887) |
$1,182 |
$1,576 |
0.4× |
| Venogram Sinus/Jugular (75860) |
$2,550 |
$3,400 |
0.8× |
| Venography caval inferior serialography rs&i (75825) |
$3,535.50 |
$4,714 |
1.1× |
| Venography extremity bilateral rs&i (75822) |
$1,227.75 |
$1,637 |
0.8× |
| Venography extremity unilateral rs&i (75820) |
$1,456.50 |
$1,942 |
0.9× |
| Venography Renal Bilateral (75833) |
$2,040.75 |
$2,721 |
0.6× |
| Venography Renal Unilateral (75831) |
$2,208 |
$2,944 |
0.7× |
Venous sampling by catheter (75893)
unusually low: confirm this is the full procedure |
$1,981.50 |
$2,642 |
0.3× |
| Wrist 2 views (73100) |
$234.75 |
$313 |
2.6× |
| X-Ray Ac Jts - Xr Acromioclavicular Joints Bilateral (73050) |
$106.50 |
$142 |
1.2× |
| X-ray antegrade pyelogram tube (74425) |
$369 |
$492 |
1.0× |
| X-Ray Aorta Leg Arteries (75630) |
$3,775.50 |
$5,034 |
1.2× |
| X-Ray Bend Only L-S Spine (72120) |
$212.25 |
$283 |
2.0× |
| X-Ray Elbow 2 Vw - Xr Elbow 1-2 Views Right (73070) |
$229.50 |
$306 |
2.6× |
| X-Ray Exam Breast Specimen (76098) |
$432 |
$576 |
0.8× |
| X-Ray Exam Entire Spi 1 Vw (72081) |
$60.75 |
$81 |
0.7× |
| X-Ray Exam Entire Spi 2/3 Vw (72082) |
$145.50 |
$194 |
1.4× |
| X-Ray Exam Entire Spi 4/5 Vw (72083) |
$148.50 |
$198 |
1.4× |
| X-Ray Exam Hip Uni 1 View (73501) |
$108.75 |
$145 |
1.2× |
| X-Ray Exam Hip Uni 2-3 Views (73502) |
$280.50 |
$374 |
3.2× |
| X-Ray Exam Hip Uni 4/> Views (73503) |
$169.50 |
$226 |
1.6× |
| X-Ray Exam Hips Bi 2 Views (73521) |
$114.75 |
$153 |
1.1× |
| X-Ray Exam Hips Bi 3-4 Views (73522) |
$167.25 |
$223 |
1.6× |
| X-Ray Exam Hips Bi 5/> Views (73523) |
$183.75 |
$245 |
1.7× |
| X-Ray Exam L-S Spine Bending (72114) |
$399.75 |
$533 |
3.7× |
| X-Ray Exam Neck Spine 2-3 Vw (72040) |
$180.75 |
$241 |
2.0× |
| X-Ray Exam Neck Spine 6/>Vws (72052) |
$392.25 |
$523 |
3.7× |
| X-Ray Exam Unilat Ribs/Chest (71101) |
$159.75 |
$213 |
1.5× |
| X-ray eye for foreign body (70030) |
$115.50 |
$154 |
1.3× |
| X-ray humerus (73060) |
$255 |
$340 |
2.9× |
| X-ray IV pyelogram (ivp) (74400) |
$405 |
$540 |
2.3× |
| X-Ray Jaw <4 Vw - Xr Mandible < 4 Views (70100) |
$79.50 |
$106 |
0.9× |
| X-Ray Knee Bilat Standing - Xr Knees Anteroposterior Standing Bilat (73565) |
$108 |
$144 |
1.2× |
| X-Ray Lumbar Spine 2/3 Vw - Xr Lumbar Spine 2-3 Views (72100) |
$219 |
$292 |
2.1× |
| X-ray nose-rectum child f.b. (76010) |
$100.50 |
$134 |
1.1× |
| X-Ray Ribs, Chest 4+ Vw - Xr Ribs 3 Vws Bil W/ Chest Posteroanterior (71111) |
$150 |
$200 |
1.4× |
| X-Ray Sacroiliac Jts 3+ Vw - Xr Sacroiliac Joints 3+ Views (72202) |
$176.25 |
$235 |
1.7× |
| X-Ray Sacroiliac Jts <3 Vw - Xr Sacroiliac Joints 1-2 Views (72200) |
$155.25 |
$207 |
1.5× |
| X-Ray Sacrum/Coccyx 2+ Vw - Xr Sacrum Coccyx 2+ Views (72220) |
$111.75 |
$149 |
1.3× |
| X-Ray Sinuses 3+ Vw - Xr Paranasal Sinuses 3+ Views (70220) |
$120.75 |
$161 |
1.4× |
| X-Ray Skull 4+ Vw - Xr Skull Complete 4+ Views (70260) |
$121.50 |
$162 |
1.1× |
| X-ray thoracic spine 4 vw (72074) |
$92.25 |
$123 |
0.9× |
| X-Ray Tmj Unilat (70328) |
$75.75 |
$101 |
0.9× |
| X-Ray Urinary Tract Exam With Contrast Material (74420) |
$728.25 |
$971 |
2.0× |
| X-Rays Bone Length Studies (77073) |
$119.25 |
$159 |
1.1× |
| X-Rays Bone Survey Complete (77075) |
$249.75 |
$333 |
2.3× |
| Xr c-spine 4 or 5 views (72050) |
$230.25 |
$307 |
2.2× |
| Xr facial bones less than 3 views (70140) |
$78 |
$104 |
0.9× |
| XR Mastoids < 3 Views Bilateral (70120) |
$107.25 |
$143 |
1.0× |
| Xr orbits complete 4 views (70200) |
$94.50 |
$126 |
0.9× |