| 3-D radiotherapy plan dose-volume histograms (77295) |
$3,297.80 |
$5,996 |
2.3× |
| Abdomen 1 View (74018) |
$204.05 |
$371 |
2.2× |
| Abdomen 2 views (74019) |
$265.65 |
$483 |
2.4× |
| Acute Gastrointestinal Blood Loss Imaging (78278) |
$1,261.15 |
$2,293 |
3.0× |
| Adrenal Cortex & Medulla Img (78075) |
$3,239.50 |
$5,890 |
2.4× |
Angio internal mammary (75756)
range across 2 matching MRF lines |
$6,817.25–$6,881.60 |
$12,395–$12,512 |
varies |
| Angio pulmonary bilat (75743) |
$12,312.85 |
$22,387 |
3.7× |
| Angiography Adrenal Bilateral Slctv Rs&I (75733) |
$6,264.50 |
$11,390 |
1.9× |
| Angiography extremity bilateral rs&i (75716) |
$9,234.50 |
$16,790 |
2.8× |
| Angiography extremity unilateral rs&i (75710) |
$4,617.25 |
$8,395 |
1.4× |
| Angiography pulmonary unilateral slctv rs&i (75741) |
$6,156.70 |
$11,194 |
1.9× |
| Angrph pulmonary nonslctv cath/ven njx rs&i (75746) |
$6,316.75 |
$11,485 |
1.9× |
| Ankle 2 views (73600) |
$244.75 |
$445 |
2.7× |
| Aortography thoracic serialography rs&i (75605) |
$6,194.65 |
$11,263 |
1.1× |
| Aortography thoracic w/o serialography rs&i (75600) |
$4,710.75 |
$8,565 |
1.4× |
| Artery X-Rays Abdomen (75726) |
$4,645.85 |
$8,447 |
0.8× |
| Artery X-Rays Adrenal Gland (75731) |
$5,369.65 |
$9,763 |
1.6× |
| Artery X-Rays Pelvis (75736) |
$6,194.65 |
$11,263 |
1.1× |
| Artery X-Rays Spine (75705) |
$3,873.65 |
$7,043 |
0.7× |
| Arthrogram ankle (73615) |
$999.90 |
$1,818 |
2.7× |
| Arthrogram hip (73525) |
$993.85 |
$1,807 |
2.7× |
| Arthrogram Wrist (73115) |
$589.05 |
$1,071 |
1.6× |
| Basic radiation dosimetry calculation (77300) |
$354.75 |
$645 |
2.5× |
| Bone age studies (77072) |
$282.70 |
$514 |
2.6× |
| Bone Imaging 3 Phase (78315) |
$1,530.65 |
$2,783 |
3.7× |
| Bone Imaging Limited Area (78300) |
$942.70 |
$1,714 |
2.3× |
| Bone Imaging Multiple Areas (78305) |
$849.20 |
$1,544 |
2.0× |
| Bone Imaging Whole Body (78306) |
$1,414.05 |
$2,571 |
3.4× |
| Bone marrow imaging; multiple areas (78103) |
$849.20 |
$1,544 |
2.0× |
| Bone marrow imaging; whole body (78104) |
$942.70 |
$1,714 |
2.3× |
| Bone survey infant (77076) |
$282.70 |
$514 |
2.6× |
| Brachytx isodose complex (77318) |
$844.25 |
$1,535 |
2.2× |
| Brachytx isodose intermed (77317) |
$844.25 |
$1,535 |
2.2× |
| Brachytx Isodose Plan Simple (77316) |
$430.10 |
$782 |
1.1× |
| Brain Flow Imaging Only (78610) |
$1,104.95 |
$2,009 |
1.9× |
| Brain Image W/Flow < 4 Views (78601) |
$783.75 |
$1,425 |
1.9× |
| Brain Imaging Min 4 Static Views W Vascular Flow (78606) |
$1,357.40 |
$2,468 |
2.4× |
| Brain Imaging Pet Metabolic Evaluation (78608) |
$4,334 |
$7,880 |
2.9× |
| Card Bl Pool Gated Spect Rest Wal Motn Ejct Frct (78494) |
$849.20 |
$1,544 |
2.0× |
| Cardiac blood pool imaging, first pass technique; multiple studies, resting and with stress (exercise and/or… (78483) |
$1,104.95 |
$2,009 |
1.9× |
| Cardiac MRI w/w/o contrast & further seq (75561) |
$1,645.05 |
$2,991 |
4.5× |
| Cardiac MRI w/w/o contrast w/stress (75563) |
$3,333 |
$6,060 |
4.1× |
| Cardiac Shunt Detection (78428) |
$942.70 |
$1,714 |
2.3× |
| Cat Scan Follow-Up Study (76380) |
$182.05 |
$331 |
2.0× |
| Cerebrospinal Fluid Flow W/O Matl Shunt Evaltj (78645) |
$1,261.15 |
$2,293 |
2.2× |
| Cerebrospinal Fluid Scan (78630) |
$1,104.95 |
$2,009 |
1.9× |
| Chest 1 view (71045) |
$163.35 |
$297 |
1.8× |
| Chest 2 views (71046) |
$198 |
$360 |
2.2× |
| Chest 3 views (71047) |
$242 |
$440 |
2.7× |
| Chest 4 or more views (71048) |
$282.70 |
$514 |
2.6× |
| Chg us nrv&acc strux 1 xtr compre w/img pr extremity (76883) |
$239.25 |
$435 |
2.2× |
| Cholecystography Oral Contrast (74290) |
$390.50 |
$710 |
2.1× |
| Clavicle complete (73000) |
$204.05 |
$371 |
2.2× |
| Computed Tomography Thorax Lw Dose Lng Ca Scr C- (71271) |
$1,201.75 |
$2,185 |
11.0× |
| Continuing medical physics consltj pr wk (77336) |
$367.95 |
$669 |
2.6× |
| Contrast Exam Abdominl Aorta (75625) |
$6,156.70 |
$11,194 |
1.9× |
| Contrast X-Ray Bladder (74430) |
$619.85 |
$1,127 |
1.7× |
| Contrast X-Ray Of Elbow (73085) |
$993.85 |
$1,807 |
2.7× |
| Contrast X-Ray Of Knee Joint (73580) |
$993.85 |
$1,807 |
2.7× |
| CT abdomen and pelvis without and with contrast (74178) |
$1,408 |
$2,560 |
3.9× |
| CT abdomen and pelvis without contrast (74176) |
$1,260.05 |
$2,291 |
5.1× |
| CT abdomen w contrast (74160) |
$1,201.75 |
$2,185 |
6.6× |
CT abdomen w wo contrast (74170)
range across 2 matching MRF lines |
$1,201.75–$1,381.60 |
$2,185–$2,512 |
varies |
| CT abdomen w/o contrast (74150) |
$1,085.15 |
$1,973 |
9.9× |
| CT Angio Abdomen and Pelvis (74174) |
$1,408 |
$2,560 |
3.9× |
| CT Angio Chest (71275) |
$1,201.75 |
$2,185 |
6.6× |
| CT Angio Head (70496) |
$1,699.50 |
$3,090 |
9.3× |
| CT angio hrt w/3d image (75574) |
$1,201.75 |
$2,185 |
3.3× |
| Ct Angio Lwr Extr W/O&W/Dye (73706) |
$1,201.75 |
$2,185 |
6.6× |
| CT Angio Neck (70498) |
$1,201.75 |
$2,185 |
6.6× |
| Ct Angio Upr Extrm W/O&W/Dye (73206) |
$952.05 |
$1,731 |
5.2× |
| CT cervical spine w/ contrast (72126) |
$1,198.45 |
$2,179 |
3.3× |
| CT cervical spine w/o contrast (72125) |
$1,141.25 |
$2,075 |
10.5× |
| CT cervical spine w/wo cont (72127) |
$1,258.95 |
$2,289 |
6.9× |
CT chest w contrast (71260)
range across 2 matching MRF lines |
$1,201.75–$1,321.65 |
$2,185–$2,403 |
varies |
| CT chest w/wo contrast (71270) |
$1,381.60 |
$2,512 |
7.5× |
| CT colonography screening (74263) |
$1,849.10 |
$3,362 |
7.4× |
| CT Colonogrphy Dx Image Postprocess W/Contrast (74262) |
$952.05 |
$1,731 |
5.2× |
| CT colonogrphy dx image postprocess w/o contrast (74261) |
$952.05 |
$1,731 |
8.7× |
CT head/brain with contrast (70460)
range across 3 matching MRF lines |
$1,201.75–$1,609.85 |
$2,185–$2,927 |
varies |
CT head/brain without and with contrast (70470)
range across 2 matching MRF lines |
$1,201.75–$1,699.50 |
$2,185–$3,090 |
varies |
| CT heart contrast eval cardiac structure&morph (75572) |
$1,201.75 |
$2,185 |
3.3× |
| CT heart no contrast quant eval coronry calcium (75571) |
$952.05 |
$1,731 |
10.5× |
| CT hrt w/3d image congen (75573) |
$952.05 |
$1,731 |
2.6× |
CT iac w contrast (70481)
range across 3 matching MRF lines |
$1,201.75–$1,261.70 |
$2,185–$2,294 |
varies |
| CT l-spine w&w/o contrast (72133) |
$1,444.30 |
$2,626 |
7.9× |
| CT lower ext w/o (73700) |
$1,201.75 |
$2,185 |
11.0× |
CT lower extremity w/contrast material (73701)
range across 7 matching MRF lines |
$1,201.75–$1,261.70 |
$2,185–$2,294 |
varies |
| CT lumbar spine w contrast (72132) |
$1,375.55 |
$2,501 |
3.8× |
| CT lumbar spine w/o contrast (72131) |
$1,285.35 |
$2,337 |
11.8× |
| CT maxillofacial w contrast (70487) |
$1,261.70 |
$2,294 |
6.9× |
| CT maxillofacial wo contrast (70486) |
$1,201.75 |
$2,185 |
11.0× |
| CT neck tissue combo (70492) |
$1,324.40 |
$2,408 |
7.2× |
Ct Orbit/Ear/Fossa W/O&W/Dye (70482)
range across 3 matching MRF lines |
$952.05–$1,324.40 |
$1,731–$2,408 |
varies |
| CT orbits w/o contrast (70480) |
$1,201.75 |
$2,185 |
11.0× |
CT pelvis w&w/o contrast (72194)
range across 2 matching MRF lines |
$952.05–$1,324.40 |
$1,731–$2,408 |
varies |
| CT pelvis w/o contrast (72192) |
$1,201.75 |
$2,185 |
11.0× |
| CT scan of leg combo (73702) |
$952.05 |
$1,731 |
5.2× |
| CT scans face/jaw combo (70488) |
$1,324.40 |
$2,408 |
7.2× |
| CT soft tissue neck w contrast (70491) |
$1,261.70 |
$2,294 |
6.9× |
| CT soft tissue neck w/o contrast (70490) |
$1,201.75 |
$2,185 |
11.0× |
| CT thoracic spine w contrast (72129) |
$1,285.35 |
$2,337 |
7.0× |
| CT thoracic spine w/o contrast (72128) |
$1,201.75 |
$2,185 |
11.0× |
| CT thoracic spine w/wo cont (72130) |
$1,349.70 |
$2,454 |
7.4× |
| CT thorax w/o contrast (71250) |
$1,201.75 |
$2,185 |
11.0× |
CT upper ext wo (73200)
range across 8 matching MRF lines |
$1,085.15–$1,201.75 |
$1,973–$2,185 |
varies |
CT upper extremity w/o & w/contrast material (73202)
range across 7 matching MRF lines |
$952.05–$1,218.80 |
$1,731–$2,216 |
varies |
CT upper extremity with contrast (73201)
range across 7 matching MRF lines |
$1,160.50–$1,201.75 |
$2,110–$2,185 |
varies |
| Cta Abdl Aorta&Bi Iliofem W/Contrast&Postp (75635) |
$1,201.75 |
$2,185 |
6.6× |
| Cta Abdomen (74175) |
$1,201.75 |
$2,185 |
6.6× |
| CTA head&neck c+ w/noncontrast img&post-pxessing (70471) |
$686.40 |
$1,248 |
1.9× |
| CTA pelvis (72191) |
$952.05 |
$1,731 |
5.2× |
| Dilation ureters/urethra rs&i (74485) |
$3,917.65 |
$7,123 |
1.8× |
| Discography Cerv/Thor Spine (72285) |
$3,841.75 |
$6,985 |
1.9× |
| Diskography lumbar (72295) |
$7,943.65 |
$14,443 |
3.9× |
| Doppler Echo Fetal Puls Spectral F/U/Repeat (76828) |
$376.20 |
$684 |
3.4× |
| Doppler Echo Fetal Spectral Display Complete (76827) |
$376.20 |
$684 |
3.4× |
| Doppler Fetal Mid Cerebral Artery (76821) |
$245.30 |
$446 |
2.2× |
| Dxa Bone Density Axial (77080) |
$353.10 |
$642 |
3.2× |
| Dxa bone density study 1/>sites appendiclr skel (77081) |
$163.35 |
$297 |
1.8× |
| Echo exam of fetal heart (76825) |
$1,054.35 |
$1,917 |
1.8× |
| Echo exam uterus (76831) |
$457.60 |
$832 |
1.8× |
| Echo Guide For Artery Repair (76936) |
$606.10 |
$1,102 |
2.7× |
| Echocardiography, fetal, cardiovascular system, real time with image documentation (2D), with or without M-mode… (76826) |
$1,006.50 |
$1,830 |
4.0× |
| Esophageal Motility Study (78258) |
$1,261.15 |
$2,293 |
3.0× |
| Esophagram (74220) |
$367.95 |
$669 |
2.0× |
| Fetal Biophys Profile W/Nst (76818) |
$363.55 |
$661 |
3.3× |
| Fetal Biophysical Profile W/O Non-Stress Testing (76819) |
$376.20 |
$684 |
3.4× |
| Fetal MRI w/placntl matrnl plvc img sing/1st ges (74712) |
$1,323.85 |
$2,407 |
5.3× |
| Fluoroscopy up to 1 hr (76000) |
$671.55 |
$1,221 |
2.7× |
| Follow-Up Angiography (75898) |
$1,571.35 |
$2,857 |
0.5× |
| Foot 2 views (73620) |
$218.90 |
$398 |
2.4× |
| Forearm 2 views (73090) |
$188.65 |
$343 |
2.1× |
| Gastric emptying imaging study (78264) |
$1,497.65 |
$2,723 |
3.6× |
| Gastric Emptyng Imag Std W/Sm Bwl Transit (78265) |
$849.20 |
$1,544 |
2.0× |
| Gastroesophageal Reflux Exam (78262) |
$1,261.15 |
$2,293 |
3.0× |
| Gated Heart Planar Single (78472) |
$1,261.15 |
$2,293 |
3.0× |
| Gated Heart, Multiple (78473) |
$942.70 |
$1,714 |
2.3× |
| GI Endoscopic US S&I (76975) |
$524.15 |
$953 |
2.1× |
| Hand 2 views (73120) |
$329.45 |
$599 |
3.0× |
| Hdr Rdncl Ntrstl/Icav Brchtx (77772) |
$1,925 |
$3,500 |
2.6× |
| Hdr Rdncl Ntrstl/Icav Brchtx (77771) |
$2,406.25 |
$4,375 |
3.3× |
| Hdr Rdncl Ntrstl/Icav Brchtx 1 Channel (77770) |
$1,492.70 |
$2,714 |
2.1× |
| Heart first pass single,planar (78481) |
$1,104.95 |
$2,009 |
1.9× |
| Hepatc Vngrph Wdg/Fr Hemodyn Eval Rs&I (75889) |
$4,617.25 |
$8,395 |
1.4× |
| Hepatc Vngrph Wdg/Fr W/O Hemodyn Eval Rs&I (75891) |
$6,156.70 |
$11,194 |
1.9× |
| Hepatobil Syst Image W/Drug (78227) |
$1,530.65 |
$2,783 |
2.7× |
| Hepatobiliary System Imaging (78226) |
$1,493.25 |
$2,715 |
3.6× |
| Ht Musc Image Planar Mult (78454) |
$3,239.50 |
$5,890 |
2.4× |
| Ht Muscle Image Spect Sing (78451) |
$3,239.50 |
$5,890 |
2.4× |
| Hysterosalpingogram (74740) |
$405.35 |
$737 |
1.6× |
| Infant hip ultrasound with hip movement (dynamic) (76885) |
$278.85 |
$507 |
3.1× |
| Interstitial radiation source applic complex (77778) |
$1,925 |
$3,500 |
2.6× |
| Intracavitary Radiation Source Applic Intermed (77762) |
$1,259.50 |
$2,290 |
2.2× |
| Intracavitary radiation source applic simple (77761) |
$1,259.50 |
$2,290 |
2.2× |
| Intraop radiaj tx deliver xray single tx session (77424) |
$19,817.60 |
$36,032 |
2.6× |
| Joint Survey Single View (77077) |
$242 |
$440 |
2.2× |
| K Flow/Funct Image Multiple (78709) |
$1,261.15 |
$2,293 |
2.2× |
| K Flow/Funct Image W/Drug (78708) |
$1,415.70 |
$2,574 |
2.5× |
| K Flow/Funct Image W/O Drug (78707) |
$1,240.80 |
$2,256 |
2.2× |
| Kidney Funcj Study Non-Img Radioisotopic Study (78725) |
$1,261.15 |
$2,293 |
3.0× |
| Kidney Imaging Morphoogy W/Vascular Flow (78701) |
$849.20 |
$1,544 |
2.0× |
| Knee 3 Views (73562) |
$262.35 |
$477 |
2.9× |
| Labeled RBC Sequestration Differntl Organ/Tissue (78140) |
$1,261.15 |
$2,293 |
3.0× |
| Leveen/Shunt Patency Exam (78291) |
$1,261.15 |
$2,293 |
3.0× |
| Liver & Spleen Imaging Static Only (78215) |
$741.40 |
$1,348 |
1.8× |
| Liver & Spleen Imaging W/Vascular Flow (78216) |
$741.40 |
$1,348 |
1.8× |
| Liver imaging static only (78201) |
$1,104.95 |
$2,009 |
1.9× |
| Liver imaging w/vascular flow (78202) |
$2,578.95 |
$4,689 |
4.5× |
| Lung Perf&Ventilat Diferentl (78598) |
$1,647.25 |
$2,995 |
2.9× |
| Lung perfusion differential (78597) |
$1,338.15 |
$2,433 |
3.2× |
| Lung Ventilat&Perfus Imaging (78582) |
$1,530.65 |
$2,783 |
2.7× |
| Lung Ventilation Imaging (78579) |
$849.20 |
$1,544 |
2.0× |
| Lymph System Imaging (78195) |
$1,530.65 |
$2,783 |
2.7× |
| Lymphangiography Extremity Only Bilateral Rs&I (75803) |
$1,571.35 |
$2,857 |
1.0× |
| Lymphangiography extremity only unilateral rs&i (75801) |
$533.50 |
$970 |
0.8× |
| Lymphangiography Pelvic/Abdominal Bilateral Rs&I (75807) |
$6,130.30 |
$11,146 |
1.9× |
| Lymphangiography, pelvic/abdominal, unilateral (75805) |
$6,264.50 |
$11,390 |
1.9× |
| Magnetic Image Jaw Joint (70336) |
$1,323.85 |
$2,407 |
5.3× |
| Magnetic Resonance Elastography (76391) |
$1,323.85 |
$2,407 |
5.3× |
| Mammary ductogram or galactogram multiple (77054) |
$437.25 |
$795 |
1.8× |
| Mammary ductogram or galactogram single (77053) |
$437.25 |
$795 |
1.8× |
| Meckels Divert Exam (78290) |
$1,261.15 |
$2,293 |
3.0× |
| Mlc imrt design & construction per imrt plan (77338) |
$986.70 |
$1,794 |
2.5× |
| Mr safety determination physician/other qhp (76016) |
$179.67 |
$326.67 |
2.0× |
| Mr safety implant&/fb assmt clin staf 1st 15 min (76014) |
$49.97 |
$90.86 |
1.7× |
| Mr safety implt electronics prepj supvj phys/qhp (76018) |
$187.30 |
$340.55 |
1.9× |
| Mr safety implt pos&/immoblj (76019) |
$121.20 |
$220.37 |
2.0× |
| Mr safety med physics xm customization plng&mntr (76017) |
$554.44 |
$1,008.08 |
2.2× |
| Mra Head W/O & W/Contrast Material (70546) |
$1,590.60 |
$2,892 |
4.4× |
| MRA head w/o contrast (70544) |
$1,368.95 |
$2,489 |
5.5× |
| MRA head with contrast (70545) |
$1,485.55 |
$2,701 |
4.1× |
| MRA neck w contrast (70548) |
$1,368.95 |
$2,489 |
3.8× |
| Mra Neck W/O &W/Contrast Material (70549) |
$1,658.25 |
$3,015 |
4.6× |
| MRA neck w/o contrast (70547) |
$1,323.85 |
$2,407 |
5.3× |
| MRI abdomen w contrast (74182) |
$1,366.20 |
$2,484 |
3.8× |
| MRI abdomen w/o contrast (74181) |
$1,584 |
$2,880 |
6.4× |
MRI any jt lower extrem w/contrast material (73722)
range across 6 matching MRF lines |
$1,584–$1,659.90 |
$2,880–$3,018 |
varies |
MRI any jt lower extrem w/o & w/contrast matrl (73723)
range across 6 matching MRF lines |
$1,658.25–$1,742.40 |
$3,015–$3,168 |
varies |
| MRI any jt upper extremity w/contrast matrl (73222) |
$1,610.95 |
$2,929 |
2.0× |
| MRI bone marrow blood supply (77084) |
$519.20 |
$944 |
2.1× |
| MRI brain functional w/o physician admnistration (70554) |
$1,323.85 |
$2,407 |
5.3× |
| MRI brain functional w/physician admnistration (70555) |
$1,323.85 |
$2,407 |
5.3× |
| MRI Breast W/O Contrast Bilateral (77047) |
$1,323.85 |
$2,407 |
5.3× |
| MRI Breast Without Contrast Material Unilateral (77046) |
$519.20 |
$944 |
2.1× |
| MRI cardiac w/o contrast (75557) |
$1,323.85 |
$2,407 |
5.3× |
| MRI cervical spine w contrast (72142) |
$1,366.20 |
$2,484 |
3.8× |
| MRI cervical spine w/o cont (72141) |
$1,606.55 |
$2,921 |
6.4× |
| MRI chest w/o contrast (71550) |
$1,323.85 |
$2,407 |
5.3× |
| MRI chest with contrast (71551) |
$1,327.15 |
$2,413 |
1.6× |
| MRI chest wo w contrast (71552) |
$1,366.20 |
$2,484 |
3.8× |
| MRI lower extrem oth/thn jt w/contrast matrl (73719) |
$1,323.85 |
$2,407 |
3.6× |
| MRI lower extrem oth/thn jt w/o & w/contr matr (73720) |
$1,658.25 |
$3,015 |
4.6× |
| MRI lower extrem oth/thn jt w/o contr matrl (73718) |
$1,513.05 |
$2,751 |
6.1× |
| MRI lumbar spine w contrast (72149) |
$1,366.20 |
$2,484 |
3.8× |
| Mri Neck Spine W/O & W/Dye (72156) |
$1,658.25 |
$3,015 |
4.6× |
| MRI orbit face &/neck w/o contrast (70540) |
$1,323.85 |
$2,407 |
5.3× |
| MRI orbit face neck w contrast (70542) |
$1,366.20 |
$2,484 |
3.8× |
| Mri Orbt/Fac/Nck W/O &W/Dye (70543) |
$1,658.25 |
$3,015 |
4.6× |
| MRI pelvis w contrast (72196) |
$1,366.20 |
$2,484 |
3.8× |
| MRI pelvis w/o & w contrast (72197) |
$1,658.25 |
$3,015 |
4.6× |
| MRI pelvis w/o contrast (72195) |
$1,330.45 |
$2,419 |
5.3× |
| MRI spectroscopy (76390) |
$1,323.85 |
$2,407 |
14.6× |
| MRI thoracic spine w/o contrast (72146) |
$1,606.55 |
$2,921 |
6.4× |
| MRI upper extremity oth than jt w/contr matrl (73219) |
$1,323.85 |
$2,407 |
3.6× |
| MRI upper extremity oth than jt w/o contr matrl (73218) |
$1,451.45 |
$2,639 |
5.8× |
| Mri Uppr Extremity W/O&W/Dye (73220) |
$1,658.25 |
$3,015 |
4.6× |
| MRI, abdomen, combo (74183) |
$1,658.25 |
$3,015 |
4.6× |
| MRI, dorsal spine combo (72157) |
$1,658.25 |
$3,015 |
4.6× |
| MRI, dorsal spine contrast (72147) |
$1,366.20 |
$2,484 |
3.8× |
| MRI, joint upper extrem (73221) |
$1,507 |
$2,740 |
6.0× |
| MRI, joint upper extrem combo (73223) |
$1,658.25 |
$3,015 |
4.6× |
| MRI, lumbar spine combo (72158) |
$1,658.25 |
$3,015 |
4.6× |
| Myelogram Lumbar (72265) |
$1,892 |
$3,440 |
2.3× |
| Myelograpy 2/more regions rs&i (72270) |
$1,892 |
$3,440 |
2.3× |
| Myocardial Imaging Pet Metabolic Evaluation (78459) |
$3,135 |
$5,700 |
2.3× |
| Myocardial Perfusion Planar 1 Study Rest/Stress (78453) |
$3,239.50 |
$5,890 |
2.4× |
| Myocardial Spect Multiple Studies (78452) |
$3,239.50 |
$5,890 |
2.4× |
| Myocrd Img Pet Metab Eval Single Study Cncrnt CT (78429) |
$3,135 |
$5,700 |
2.1× |
| Myocrd img PET prfuj 1std rest/stress cncrnt CT (78430) |
$3,135 |
$5,700 |
2.1× |
| Myocrd Img Pet Prfuj Mlt Std Rst&Strs Cncrnt CT (78431) |
$3,802.70 |
$6,914 |
1.7× |
| Myocrd Img Pet Prfuj W/Metab 2rtracer Cncrnt CT (78433) |
$3,295.60 |
$5,992 |
1.4× |
| Myocrd Img Pet Prfuj W/Metab Dual Radiotracer (78432) |
$3,135 |
$5,700 |
2.0× |
| N-invas est c ffr sw aly CTA (75580) |
$2,201.10 |
$4,002 |
2.5× |
| Neck soft tissue (70360) |
$204.05 |
$371 |
2.2× |
| Nfs/Instlj Radioelmnt Sln 3 Mo Follow-Up Care (77750) |
$623.15 |
$1,133 |
1.5× |
| Njx Rp Loclzj Non-Img Probe Study Intravenous (78808) |
$849.20 |
$1,544 |
2.0× |
| Nm csf leak detection (78650) |
$2,339.15 |
$4,253 |
1.7× |
| Nm unlisted gi procedure (78299) |
$849.20 |
$1,544 |
2.0× |
| Nonvascular Shunt X-Ray (75809) |
$248.05 |
$451 |
2.3× |
| Ntsty modul radthx pln dose-vol histos (77301) |
$3,379.20 |
$6,144 |
2.3× |
| Nuclear Rx Intra-Arterial (79445) |
$506.55 |
$921 |
2.1× |
| Nuclear Rx Oral Admin (79005) |
$1,261.15 |
$2,293 |
5.2× |
| Ob us nuchal meas 1 gest (76813) |
$245.30 |
$446 |
2.2× |
| Oph US Dx B-Scan&Quan a-Scan Sm Pt Enctr (76510) |
$257.95 |
$469 |
1.9× |
| Ophthalmic ultrasound dx b-scan w/wo a-scan (76512) |
$239.25 |
$435 |
2.2× |
| Optic foramina (70190) |
$163.35 |
$297 |
1.8× |
| Panoramic X-ray of jaws (70355) |
$163.35 |
$297 |
1.8× |
| Parathyroid imaging w/tomographic spect & CT (78072) |
$1,261.15 |
$2,293 |
2.2× |
| Parathyroid Planar Imaging (78070) |
$1,261.15 |
$2,293 |
3.0× |
| Parathyroid planar imaging w/wo subtraction (78071) |
$942.70 |
$1,714 |
2.3× |
| Pelvis 1 or 2 views (72170) |
$353.10 |
$642 |
3.2× |
| Peritoneogram Rs&I (74190) |
$991.10 |
$1,802 |
1.7× |
| Pet Image Skull-Thigh (78812) |
$3,915.45 |
$7,119 |
2.6× |
| Pet Image W/Ct Lmtd (78814) |
$3,407.80 |
$6,196 |
2.3× |
| PET image w/CT, full body (78816) |
$4,334 |
$7,880 |
2.9× |
| PET imaging CT attenuation skull base mid-thigh (78815) |
$4,117.30 |
$7,486 |
2.8× |
| Pet Imaging Limited Area Chest Head/Neck (78811) |
$3,135 |
$5,700 |
2.3× |
| PET whole body (78813) |
$3,915.45 |
$7,119 |
2.6× |
| Prq Transhepatc Portograpy Hemodyn Eval Rs&I (75885) |
$6,156.70 |
$11,194 |
1.9× |
| Pulmonary Perfusion Imaging Particulate (78580) |
$1,297.45 |
$2,359 |
3.1× |
| Quan&Charac C Atherosclerotc Plaq Asses Sev C Ds (75577) |
$1,829.85 |
$3,327 |
1.9× |
| Radex Abd Compl Aqt Abd W/S/E/D Views 1 View Ch (74022) |
$557.15 |
$1,013 |
5.1× |
| Radex abscess/fistula/sinus tract rs&i (76080) |
$658.35 |
$1,197 |
1.2× |
| Radex Ankle Complete Minimum 3 Views (73610) |
$303.05 |
$551 |
3.3× |
| Radex Calcaneus Minimum 2 Views (73650) |
$189.75 |
$345 |
2.1× |
| Radex elbow complete minimum 3 views (73080) |
$204.05 |
$371 |
2.2× |
| Radex Facial Bones Complete Minimum 3 Views (70150) |
$282.70 |
$514 |
2.6× |
| Radex fingr minimum 2 views (73140) |
$171.05 |
$311 |
1.9× |
| Radex foot complete minimum 3 views (73630) |
$229.90 |
$418 |
2.5× |
| Radex Hand Minimum 3 Views (73130) |
$345.95 |
$629 |
3.8× |
| Radex lower extremity infant minimum 2 views (73592) |
$163.35 |
$297 |
1.8× |
| Radex Mastoids Compl Minimum 3 Views PR Side (70130) |
$282.70 |
$514 |
2.6× |
| Radex Nasal Bones Complete Minimum 3 Views (70160) |
$163.35 |
$297 |
1.8× |
| Radex Pharynx/Larx W/Fluor&/Magnification Tq (70370) |
$168.30 |
$306 |
1.9× |
| Radex Ribs Unilateral 2 Views (71100) |
$204.05 |
$371 |
2.2× |
| Radex shoulder complete minimum 2 views (73030) |
$204.05 |
$371 |
2.2× |
| Radex Sinuses Paransl < 3 Views (70210) |
$163.35 |
$297 |
1.8× |
| Radex sm int w/mlt srl imges via enteroclss tube (74251) |
$488.40 |
$888 |
2.7× |
| Radex Spine 1 View Specify Level (72020) |
$204.05 |
$371 |
2.2× |
| Radex Sternum Minimum 2 Views (71120) |
$163.35 |
$297 |
1.8× |
| Radex Temporomandble Jt Opn & Clsd Mouth Bilat (70330) |
$163.35 |
$297 |
1.8× |
| Radex Toe Minimum 2 Views (73660) |
$189.75 |
$345 |
2.1× |
| Radex upper extremity infant minimum 2 views (73092) |
$282.70 |
$514 |
2.6× |
| Radex Wrist Complete Minimum 3 Views (73110) |
$204.05 |
$371 |
2.2× |
| Radex X-Ray Exam Entire Spi 6/> Vw - Xr Entire Spine 6+ Vw (72084) |
$513.15 |
$933 |
4.7× |
| Radiation Delivery Stereotactic Cranial Linear (77372) |
$18,521.25 |
$33,675 |
2.4× |
| Radiation treatment delivery level 1 (77402) |
$375.65 |
$683 |
3.5× |
| Radiation treatment delivery level 2 (77407) |
$367.95 |
$669 |
0.9× |
| Radiation treatment delivery level 3 (77412) |
$646.25 |
$1,175 |
1.1× |
| Radiolog exam mandible compl minimum 4 views (70110) |
$282.70 |
$514 |
2.6× |
| Radiologic Exam Abdomen 3+ Views - Xr Abdomen 3+ Views (74021) |
$440.55 |
$801 |
4.0× |
| Radiologic exam colon double contrast study (74280) |
$513.15 |
$933 |
2.8× |
| Radiologic exam colon single contrast study (74270) |
$367.95 |
$669 |
2.0× |
| Radiologic Exam Esophagus Double Contrast Study (74221) |
$294.25 |
$535 |
1.6× |
| Radiologic exam knee complete 4/more views (73564) |
$315.15 |
$573 |
2.9× |
| Radiologic exam pelvis compl minimum 3 views (72190) |
$353.10 |
$642 |
3.2× |
| Radiologic Exam Small Int Single Contrast Study (74250) |
$282.70 |
$514 |
1.5× |
| Radiologic exam swallow function contrast study (74230) |
$353.10 |
$642 |
1.9× |
| Radiologic exam upr gi trc double contrast study (74246) |
$367.95 |
$669 |
2.0× |
| Radiologic examination femur 1 view (73551) |
$134.75 |
$245 |
1.5× |
| Radiologic examination femur minimum 2 views (73552) |
$168.30 |
$306 |
1.9× |
| Radiologic examination knee 1/2 views (73560) |
$204.05 |
$371 |
2.2× |
| Radiologic Examination Osseous Survey Limited (77074) |
$282.70 |
$514 |
2.6× |
| Radiologic Examination Salivary Gland Calculus (70380) |
$177.65 |
$323 |
2.0× |
| Radiologic examination tibia & fibula 2 views (73590) |
$204.05 |
$371 |
2.2× |
| Radiologic examination, internal auditory meati, complete Non-Facility (70134) |
$1,058.20 |
$1,924 |
1.9× |
| Radiologic examination, teeth; single view Non-Facility (70300) |
$177.65 |
$323 |
2.0× |
| Radiopharm Dacryocystography (78660) |
$681.45 |
$1,239 |
1.6× |
| Radiopharmaceutical therapy, by intra-articular administration Non-Facility (79440) |
$621.50 |
$1,130 |
2.6× |
| Remote afterloading high dose rate radionuclide skin surface brachytherapy, includes basic dosimetry, when performed;… (77768) |
$566.50 |
$1,030 |
1.4× |
| Remote afterloading high dose rate radionuclide skin surface brachytherapy, includes basic dosimetry, when performed;… (77767) |
$517 |
$940 |
1.3× |
| Renal Cyst Study (74470) |
$1,058.20 |
$1,924 |
1.9× |
| Ribs bilateral 3 views (71110) |
$353.10 |
$642 |
3.2× |
| Rp loclzj tum plnr 1 area single day imaging (78800) |
$783.75 |
$1,425 |
1.9× |
| Rp loclzj tum plnr 2+area 1+d img/1 area img>2+d (78801) |
$849.20 |
$1,544 |
2.0× |
| Rp Loclzj Tum Plnr Whole Body 2+ Days Imaging (78804) |
$3,239.50 |
$5,890 |
5.7× |
| Rp Loclzj Tum Plnr Whole Body Single Day Imaging (78802) |
$1,967.90 |
$3,578 |
3.5× |
| Rp Loclzj Tum Spect 1 Area Single Day Imaging (78803) |
$2,813.25 |
$5,115 |
5.0× |
| Rp loclzj tum spect 2 area/sep acquisj img (78831) |
$1,647.25 |
$2,995 |
1.2× |
| Rp loclzj tum spect CT 2area 1d img/1 ar img>2+d (78832) |
$1,647.25 |
$2,995 |
1.1× |
| Rp loclzj tum spect w/CT 1 area/acquisj 1day img (78830) |
$1,647.25 |
$2,995 |
1.2× |
| Rp Ther Radiolbld Monoclonal Antibody IV Infus (79403) |
$588.50 |
$1,070 |
2.4× |
| Rp Therapy Intravenous Administration (79101) |
$605 |
$1,100 |
2.5× |
| Salivary Gland Function Study (78232) |
$732.60 |
$1,332 |
1.8× |
| Scapula (73010) |
$207.35 |
$377 |
1.9× |
| Screening Digital Breast Tomosynthesis Bi (77063) |
$136.40 |
$248 |
5.8× |
| Sella turcica (70240) |
$177.65 |
$323 |
2.0× |
| Shoulder 1 view (73020) |
$161.70 |
$294 |
1.8× |
| Shoulder Arthrography (73040) |
$993.85 |
$1,807 |
2.7× |
| Sialogram (70390) |
$472.45 |
$859 |
1.9× |
| Skull less than 4 views (70250) |
$353.10 |
$642 |
3.2× |
| Special dosimetry (77331) |
$294.25 |
$535 |
2.1× |
| Special Physics Consult (77370) |
$489.50 |
$890 |
3.5× |
| Special teletherapy port plan (77321) |
$789.25 |
$1,435 |
2.0× |
| Special treatment procedure (77470) |
$1,259.50 |
$2,290 |
2.2× |
| Speech evaluation, complex (70371) |
$303.05 |
$551 |
1.2× |
| Spleen Imaging (78185) |
$783.75 |
$1,425 |
1.9× |
| Stereotactic Body Radiation Delivery (77373) |
$5,145.80 |
$9,356 |
2.8× |
| Sternoclavicular joints (71130) |
$163.35 |
$297 |
1.8× |
| Superior sagittal sinus venogram (75870) |
$6,506.50 |
$11,830 |
2.0× |
| Telethx isodose pln cplx w/basic dosimetry (77307) |
$1,056 |
$1,920 |
2.7× |
| Telethx isodose pln smpl w/dosimetry calculation (77306) |
$600.05 |
$1,091 |
1.5× |
| Temporomandble Jt Arthrography Rs&I (70332) |
$504.35 |
$917 |
2.0× |
| Testicular Imaging W/Flow (78761) |
$849.20 |
$1,544 |
2.0× |
| Ther Rad Simulaj-Aided Field Setting Complex (77290) |
$986.70 |
$1,794 |
2.5× |
| Ther Rad Simulaj-Aided Field Setting Intermed (77285) |
$789.25 |
$1,435 |
2.0× |
| Ther rad simulaj-aided field setting simple (77280) |
$515.90 |
$938 |
3.7× |
| Therapeutic Enema Rdctj Intussusception/Obstrcj (74283) |
$513.15 |
$933 |
2.8× |
| Thoracic spine 2 views (72070) |
$294.25 |
$535 |
2.7× |
| Thoracic spine 3 views (72072) |
$265.65 |
$483 |
2.4× |
| Thoracolumbar 2 views (72080) |
$204.05 |
$371 |
2.2× |
| Thyroid Imaging With Vascular Flow (78013) |
$783.75 |
$1,425 |
1.9× |
| Thyroid Met Imaging Body (78018) |
$1,552.65 |
$2,823 |
2.7× |
| Thyroid Uptake Measurement (78012) |
$888.25 |
$1,615 |
2.1× |
| Thyroid Uptake W/Blood Flow Sngle/Mult Quan Meas (78014) |
$1,144.55 |
$2,081 |
2.7× |
| Tx Devices Design & Construction Complex (77334) |
$828.30 |
$1,506 |
2.1× |
| Tx devices design & construction intermediate (77333) |
$402.05 |
$731 |
2.9× |
| Tx devices design & construction simple (77332) |
$231.55 |
$421 |
1.6× |
| Ultrasound Breast Limited (76642) |
$332.75 |
$605 |
3.7× |
| Ultrasound elastography first target lesion (76982) |
$266.75 |
$485 |
2.4× |
| Ultrasound Elastography Parenchyma (76981) |
$266.75 |
$485 |
2.4× |
| Ultrasound Exam Aaa Screen (76706) |
$290.40 |
$528 |
2.7× |
| Ultrasound, abdomen limited (76705) |
$455.95 |
$829 |
4.2× |
| Umbilical-artery Doppler (OB) (76820) |
$245.30 |
$446 |
2.2× |
| Unlisted Dx Radiographic Procedure (76499) |
$177.65 |
$323 |
2.0× |
| Unlisted fluoroscopic procedure (76496) |
$134.75 |
$245 |
1.5× |
| Unlisted magnetic resonance procedure (76498) |
$153.45 |
$279 |
1.7× |
| Unlisted Procedure Clinical Brachytherapy (77799) |
$264 |
$480 |
2.5× |
| Unlisted us procedure (76999) |
$184.80 |
$336 |
2.0× |
| Upper gi w/o kub (74240) |
$320.65 |
$583 |
1.8× |
| Ureteral Reflux Study (78740) |
$849.20 |
$1,544 |
2.0× |
| Urethrocystogram voiding (74455) |
$699.60 |
$1,272 |
2.8× |
| Urethrocystography retrograde (74450) |
$574.20 |
$1,044 |
2.3× |
| Us breast unilateral complete (76641) |
$450.45 |
$819 |
4.1× |
| Us chest (76604) |
$323.95 |
$589 |
3.0× |
| Us complete joint (76881) |
$566.50 |
$1,030 |
5.2× |
| Us exam, pelvic, limited (76857) |
$239.25 |
$435 |
2.2× |
| Us head (76506) |
$266.75 |
$485 |
2.4× |
| Us kidney transplant (76776) |
$466.95 |
$849 |
4.3× |
| Us lmtd joint/oth nonvasc xtr strux r-t w/img (76882) |
$290.95 |
$529 |
2.7× |
| Us ob detailed single fetus (76811) |
$398.20 |
$724 |
1.6× |
| Us ob limited 1 or more fetuses (76815) |
$376.20 |
$684 |
3.4× |
| Us ob transvaginal (76817) |
$466.95 |
$849 |
4.3× |
| Us pelvic non ob complete (76856) |
$566.50 |
$1,030 |
5.2× |
| Us pg uter img f&mat 14 wk tabdl 1/1st gestation (76801) |
$245.30 |
$446 |
2.2× |
| Us preg uterus real time f/u trnsabdl per fetus (76816) |
$239.25 |
$435 |
2.2× |
| Us retroperitoneal complete (76770) |
$546.70 |
$994 |
5.0× |
| Us retroperitoneal limited (76775) |
$455.95 |
$829 |
4.2× |
| Us scrotum and contents (76870) |
$566.50 |
$1,030 |
5.2× |
| Us spinal canal and contents (76800) |
$292.05 |
$531 |
2.7× |
| Us thyroid (76536) |
$566.50 |
$1,030 |
5.2× |
| Us transrectal (76872) |
$301.95 |
$549 |
2.8× |
| Vein X-Ray Chest (75827) |
$1,513.05 |
$2,751 |
0.9× |
| Vein X-Ray Liver W/O Hemodyn (75887) |
$1,999.80 |
$3,636 |
0.6× |
| Vein X-Ray Spleen/Liver (75810) |
$5,419.15 |
$9,853 |
1.6× |
| Venogram Sinus/Jugular (75860) |
$3,258.75 |
$5,925 |
1.0× |
| Venography Adrenal Unilateral (75840) |
$6,156.70 |
$11,194 |
1.9× |
| Venography caval inferior serialography rs&i (75825) |
$4,074.95 |
$7,409 |
1.2× |
| Venography extremity bilateral rs&i (75822) |
$2,670.25 |
$4,855 |
1.6× |
| Venography extremity unilateral rs&i (75820) |
$1,669.25 |
$3,035 |
1.0× |
| Venography Renal Bilateral (75833) |
$6,156.70 |
$11,194 |
1.9× |
| Venography Renal Unilateral (75831) |
$6,156.70 |
$11,194 |
1.9× |
| Venous sampling by catheter (75893) |
$6,194.65 |
$11,263 |
1.1× |
| Venous thrombosis imaging (78457) |
$1,261.15 |
$2,293 |
2.2× |
| Venous Thrombosis Imaging Venogram Bilateral (78458) |
$1,261.15 |
$2,293 |
3.0× |
| Vertebral fracture assessment via dxa (77086) |
$177.65 |
$323 |
2.0× |
| Wrist 2 views (73100) |
$189.75 |
$345 |
2.1× |
| X-Ray Ac Jts - Xr Acromioclavicular Joints Bilateral (73050) |
$163.35 |
$297 |
1.8× |
| X-ray antegrade pyelogram tube (74425) |
$1,144.55 |
$2,081 |
3.1× |
| X-Ray Aorta Leg Arteries (75630) |
$6,215 |
$11,300 |
1.9× |
| X-Ray Bend Only L-S Spine (72120) |
$408.65 |
$743 |
3.7× |
| X-Ray Elbow 2 Vw - Xr Elbow 1-2 Views Right (73070) |
$204.05 |
$371 |
2.2× |
| X-Ray Exam Breast Specimen (76098) |
$707.30 |
$1,286 |
1.2× |
| X-Ray Exam Entire Spi 1 Vw (72081) |
$134.75 |
$245 |
1.5× |
| X-Ray Exam Entire Spi 2/3 Vw (72082) |
$309.65 |
$563 |
2.8× |
| X-Ray Exam Entire Spi 4/5 Vw (72083) |
$513.15 |
$933 |
4.7× |
| X-Ray Exam Hip Uni 1 View (73501) |
$168.30 |
$306 |
1.9× |
| X-Ray Exam Hip Uni 2-3 Views (73502) |
$226.60 |
$412 |
2.5× |
| X-Ray Exam Hip Uni 4/> Views (73503) |
$248.05 |
$451 |
2.3× |
| X-Ray Exam Hips Bi 2 Views (73521) |
$309.65 |
$563 |
2.8× |
| X-Ray Exam Hips Bi 3-4 Views (73522) |
$309.65 |
$563 |
2.8× |
| X-Ray Exam Hips Bi 5/> Views (73523) |
$641.30 |
$1,166 |
5.9× |
| X-Ray Exam L-S Spine Bending (72114) |
$389.40 |
$708 |
3.6× |
| X-Ray Exam Neck Spine 2-3 Vw (72040) |
$367.95 |
$669 |
4.0× |
| X-Ray Exam Neck Spine 6/>Vws (72052) |
$353.10 |
$642 |
3.2× |
| X-Ray Exam Unilat Ribs/Chest (71101) |
$341 |
$620 |
3.1× |
| X-ray eye for foreign body (70030) |
$163.35 |
$297 |
1.8× |
| X-ray humerus (73060) |
$204.05 |
$371 |
2.2× |
| X-ray IV pyelogram (ivp) (74400) |
$390.50 |
$710 |
2.1× |
| X-Ray Jaw <4 Vw - Xr Mandible < 4 Views (70100) |
$221.65 |
$403 |
2.4× |
| X-Ray Knee Bilat Standing - Xr Knees Anteroposterior Standing Bilat (73565) |
$331.10 |
$602 |
3.6× |
| X-Ray Lumbar Spine 2/3 Vw - Xr Lumbar Spine 2-3 Views (72100) |
$353.10 |
$642 |
3.2× |
| X-ray nose-rectum child f.b. (76010) |
$443.30 |
$806 |
4.9× |
| X-Ray Ribs, Chest 4+ Vw - Xr Ribs 3 Vws Bil W/ Chest Posteroanterior (71111) |
$341 |
$620 |
3.1× |
| X-Ray Sacroiliac Jts 3+ Vw - Xr Sacroiliac Joints 3+ Views (72202) |
$353.10 |
$642 |
3.2× |
| X-Ray Sacroiliac Jts <3 Vw - Xr Sacroiliac Joints 1-2 Views (72200) |
$309.65 |
$563 |
2.8× |
| X-Ray Sacrum/Coccyx 2+ Vw - Xr Sacrum Coccyx 2+ Views (72220) |
$204.05 |
$371 |
2.2× |
| X-Ray Sinuses 3+ Vw - Xr Paranasal Sinuses 3+ Views (70220) |
$171.60 |
$312 |
1.9× |
| X-Ray Skull 4+ Vw - Xr Skull Complete 4+ Views (70260) |
$370.70 |
$674 |
3.4× |
| X-Ray Stress View (77071) |
$134.75 |
$245 |
1.5× |
| X-ray thoracic spine 4 vw (72074) |
$282.70 |
$514 |
2.6× |
| X-Ray Tmj Unilat (70328) |
$163.35 |
$297 |
1.8× |
| X-Ray Urinary Tract Exam With Contrast Material (74420) |
$1,086.25 |
$1,975 |
3.0× |
| X-Rays Bone Length Studies (77073) |
$166.10 |
$302 |
1.5× |
| X-Rays Bone Survey Complete (77075) |
$353.10 |
$642 |
3.2× |
| Xr c-spine 4 or 5 views (72050) |
$353.10 |
$642 |
3.2× |
| Xr facial bones less than 3 views (70140) |
$134.75 |
$245 |
1.5× |
| Xr orbits complete 4 views (70200) |
$353.10 |
$642 |
3.2× |