| 3-D radiotherapy plan dose-volume histograms (77295) |
$5,249.75 |
$9,545 |
3.8× |
| Abdomen 1 View (74018) |
$310.20 |
$564 |
3.6× |
| Abdomen 2 views (74019) |
$328.35 |
$597 |
3.2× |
| Acute Gastrointestinal Blood Loss Imaging (78278) |
$992.20 |
$1,804 |
2.5× |
| Adrenal Cortex & Medulla Img (78075) |
$1,823.25 |
$3,315 |
1.4× |
| Angio internal mammary (75756) |
$2,955.70 |
$5,374 |
0.9× |
| Angiography extremity unilateral rs&i (75710) |
$3,864.30 |
$7,026 |
1.2× |
| Ankle 2 views (73600) |
$268.95 |
$489 |
3.1× |
| Artery X-Rays Abdomen (75726) |
$5,849.80 |
$10,636 |
1.1× |
| Artery X-Rays Adrenal Gland (75731) |
$5,182.65 |
$9,423 |
1.6× |
| Artery X-Rays Pelvis (75736) |
$3,648.70 |
$6,634 |
0.7× |
| Arthrogram hip (73525) |
$750.75 |
$1,365 |
2.2× |
| Arthrogram Wrist (73115) |
$745.80 |
$1,356 |
2.1× |
| Basic radiation dosimetry calculation (77300) |
$553.30 |
$1,006 |
4.1× |
| Bone age studies (77072) |
$246.40 |
$448 |
2.4× |
| Bone Imaging 3 Phase (78315) |
$2,041.60 |
$3,712 |
5.1× |
| Bone Imaging Limited Area (78300) |
$894.30 |
$1,626 |
2.2× |
| Bone Imaging Whole Body (78306) |
$1,824.35 |
$3,317 |
4.6× |
| Bone marrow imaging; multiple areas (78103) |
$542.85 |
$987 |
1.4× |
| Bone survey infant (77076) |
$622.05 |
$1,131 |
6.0× |
| Brain Image W/Flow < 4 Views (78601) |
$720.50 |
$1,310 |
1.8× |
| Brain Imaging Pet Metabolic Evaluation (78608) |
$3,496.35 |
$6,357 |
2.5× |
| Cardiac MRI w/w/o contrast & further seq (75561) |
$3,882.45 |
$7,059 |
11.2× |
| Cardiac Shunt Detection (78428) |
$720.50 |
$1,310 |
1.8× |
| Cat Scan Follow-Up Study (76380) |
$911.35 |
$1,657 |
10.5× |
| Chest 1 view (71045) |
$181.50 |
$330 |
2.1× |
| Chest 2 views (71046) |
$227.15 |
$413 |
2.6× |
| Chest 3 views (71047) |
$257.40 |
$468 |
3.0× |
| Chest 4 or more views (71048) |
$302.50 |
$550 |
2.9× |
| Clavicle complete (73000) |
$280.50 |
$510 |
3.2× |
| Computed Tomography Thorax Lw Dose Lng Ca Scr C- (71271) |
$599.50 |
$1,090 |
5.8× |
| Continuing medical physics consltj pr wk (77336) |
$1,769.90 |
$3,218 |
13.2× |
| Contrast X-Ray Bladder (74430) |
$594 |
$1,080 |
1.7× |
| Contrast X-Ray Of Elbow (73085) |
$757.90 |
$1,378 |
2.2× |
| Contrast X-Ray Of Knee Joint (73580) |
$757.90 |
$1,378 |
2.2× |
| Contrast Xray Throat/Cerv Esopha (74210) |
$331.65 |
$603 |
1.9× |
| CT abdomen and pelvis without and with contrast (74178) |
$3,835.70 |
$6,974 |
11.0× |
| CT abdomen and pelvis without contrast (74176) |
$2,424.40 |
$4,408 |
10.2× |
| CT abdomen w contrast (74160) |
$1,799.60 |
$3,272 |
10.3× |
| CT abdomen w wo contrast (74170) |
$2,382.05 |
$4,331 |
13.6× |
| CT abdomen w/o contrast (74150) |
$1,580.70 |
$2,874 |
15.2× |
| CT Angio Abdomen and Pelvis (74174) |
$2,537.15 |
$4,613 |
7.3× |
| CT Angio Chest (71275) |
$2,114.20 |
$3,844 |
12.1× |
| CT Angio Head (70496) |
$1,973.40 |
$3,588 |
11.3× |
| CT angio hrt w/3d image (75574) |
$2,439.80 |
$4,436 |
7.0× |
| Ct Angio Lwr Extr W/O&W/Dye (73706) |
$2,441.45 |
$4,439 |
14.0× |
| CT Angio Neck (70498) |
$1,973.40 |
$3,588 |
11.3× |
| Ct Angio Upr Extrm W/O&W/Dye (73206) |
$2,169.75 |
$3,945 |
12.4× |
| CT cervical spine w/ contrast (72126) |
$1,725.35 |
$3,137 |
5.0× |
| CT cervical spine w/o contrast (72125) |
$1,650 |
$3,000 |
15.8× |
| CT chest w contrast (71260) |
$1,749.55 |
$3,181 |
10.0× |
| CT chest w/wo contrast (71270) |
$2,352.35 |
$4,277 |
13.5× |
| CT head/brain with contrast (70460) |
$1,465.75 |
$2,665 |
8.4× |
| CT head/brain without and with contrast (70470) |
$1,994.30 |
$3,626 |
11.4× |
| CT heart contrast eval cardiac structure&morph (75572) |
$2,252.80 |
$4,096 |
6.5× |
CT heart no contrast quant eval coronry calcium (75571)
range across 2 matching MRF lines |
$27.50–$80.30 |
$50–$146 |
varies |
| CT iac w contrast (70481) |
$1,848.55 |
$3,361 |
10.6× |
| CT l-spine w&w/o contrast (72133) |
$1,983.30 |
$3,606 |
11.4× |
| CT lower ext w/o (73700) |
$1,553.20 |
$2,824 |
14.9× |
| CT lower extremity w/contrast material (73701) |
$1,731.95 |
$3,149 |
9.9× |
| CT lumbar spine w contrast (72132) |
$1,703.35 |
$3,097 |
4.9× |
| CT lumbar spine w/o contrast (72131) |
$1,661.55 |
$3,021 |
16.0× |
| CT maxillofacial w contrast (70487) |
$1,749 |
$3,180 |
10.0× |
| CT maxillofacial wo contrast (70486) |
$1,488.85 |
$2,707 |
14.3× |
| CT neck tissue combo (70492) |
$2,513.50 |
$4,570 |
14.4× |
| Ct Orbit/Ear/Fossa W/O&W/Dye (70482) |
$2,434.85 |
$4,427 |
13.9× |
| CT orbits w/o contrast (70480) |
$1,598.30 |
$2,906 |
15.3× |
| CT pelvis w&w/o contrast (72194) |
$2,122.45 |
$3,859 |
12.1× |
| CT pelvis w/o contrast (72192) |
$1,538.90 |
$2,798 |
14.8× |
| CT scan of leg combo (73702) |
$2,135.10 |
$3,882 |
12.2× |
| CT scans face/jaw combo (70488) |
$1,830.95 |
$3,329 |
10.5× |
| CT soft tissue neck w contrast (70491) |
$1,945.90 |
$3,538 |
11.1× |
| CT soft tissue neck w/o contrast (70490) |
$1,543.85 |
$2,807 |
14.8× |
| CT thoracic spine w contrast (72129) |
$1,655.50 |
$3,010 |
9.5× |
| CT thoracic spine w/o contrast (72128) |
$1,583.45 |
$2,879 |
15.2× |
| CT thoracic spine w/wo cont (72130) |
$1,926.10 |
$3,502 |
11.0× |
| CT thorax w/o contrast (71250) |
$1,570.25 |
$2,855 |
15.1× |
| CT upper ext wo (73200) |
$1,530.65 |
$2,783 |
14.7× |
| CT upper extremity w/o & w/contrast material (73202) |
$2,039.40 |
$3,708 |
11.7× |
| CT upper extremity with contrast (73201) |
$1,797.40 |
$3,268 |
5.2× |
| Cta Abdl Aorta&Bi Iliofem W/Contrast&Postp (75635) |
$2,223.10 |
$4,042 |
12.7× |
| Cta Abdomen (74175) |
$2,280.85 |
$4,147 |
13.1× |
| CTA pelvis (72191) |
$1,961.30 |
$3,566 |
11.2× |
| Doppler Echo Fetal Puls Spectral F/U/Repeat (76828) |
$272.25 |
$495 |
2.6× |
| Doppler Echo Fetal Spectral Display Complete (76827) |
$348.70 |
$634 |
3.3× |
| Doppler Fetal Mid Cerebral Artery (76821) |
$342.65 |
$623 |
3.3× |
| Echo exam of fetal heart (76825) |
$614.35 |
$1,117 |
1.1× |
| Echo exam uterus (76831) |
$518.10 |
$942 |
2.2× |
| Echo Guide For Artery Repair (76936) |
$1,376.10 |
$2,502 |
6.4× |
| Echocardiography, fetal, cardiovascular system, real time with image documentation (2D), with or without M-mode… (76826) |
$796.95 |
$1,449 |
3.4× |
| Esophagram (74220) |
$463.10 |
$842 |
2.7× |
| Fetal Biophys Profile W/Nst (76818) |
$629.20 |
$1,144 |
6.0× |
| Fetal Biophysical Profile W/O Non-Stress Testing (76819) |
$411.40 |
$748 |
4.0× |
| Fetal MRI w/placntl matrnl plvc img sing/1st ges (74712) |
$508.20 |
$924 |
2.1× |
| Fluoroscopy up to 1 hr (76000) |
$488.40 |
$888 |
2.1× |
| Foot 2 views (73620) |
$354.75 |
$645 |
4.1× |
| Forearm 2 views (73090) |
$277.75 |
$505 |
3.2× |
| Gastric emptying imaging study (78264) |
$1,615.35 |
$2,937 |
4.1× |
| Gated Heart Planar Single (78472) |
$1,508.10 |
$2,742 |
3.8× |
| Hand 2 views (73120) |
$342.10 |
$622 |
3.3× |
| Hepatc Vngrph Wdg/Fr Hemodyn Eval Rs&I (75889) |
$3,449.60 |
$6,272 |
1.1× |
| Hepatobil Syst Image W/Drug (78227) |
$1,586.75 |
$2,885 |
2.9× |
| Hepatobiliary System Imaging (78226) |
$1,485 |
$2,700 |
3.7× |
| Ht Muscle Image Spect Sing (78451) |
$2,805 |
$5,100 |
2.2× |
| Hysterosalpingogram (74740) |
$655.60 |
$1,192 |
2.8× |
| K Flow/Funct Image W/Drug (78708) |
$1,675.85 |
$3,047 |
3.1× |
| K Flow/Funct Image W/O Drug (78707) |
$1,292.50 |
$2,350 |
2.4× |
| Kidney Imaging Morphoogy W/Vascular Flow (78701) |
$947.10 |
$1,722 |
2.4× |
| Knee 3 Views (73562) |
$353.10 |
$642 |
4.1× |
| Lung Perf&Ventilat Diferentl (78598) |
$1,634.05 |
$2,971 |
3.0× |
| Lung perfusion differential (78597) |
$943.25 |
$1,715 |
2.4× |
| Lung Ventilat&Perfus Imaging (78582) |
$1,719.85 |
$3,127 |
3.2× |
| Lung Ventilation Imaging (78579) |
$625.35 |
$1,137 |
1.6× |
| Lymph System Imaging (78195) |
$1,516.35 |
$2,757 |
2.8× |
| Lymphangiography Extremity Only Bilateral Rs&I (75803) |
$1,566.40 |
$2,848 |
1.0× |
| Lymphangiography extremity only unilateral rs&i (75801) |
$1,115.40 |
$2,028 |
1.8× |
| Lymphangiography, pelvic/abdominal, unilateral (75805) |
$2,565.20 |
$4,664 |
0.8× |
| Magnetic Image Jaw Joint (70336) |
$2,384.25 |
$4,335 |
10.0× |
| Mammary ductogram or galactogram multiple (77054) |
$931.15 |
$1,693 |
3.9× |
| Mammary ductogram or galactogram single (77053) |
$587.40 |
$1,068 |
2.5× |
| Meckels Divert Exam (78290) |
$723.25 |
$1,315 |
1.8× |
| Mlc imrt design & construction per imrt plan (77338) |
$1,503.70 |
$2,734 |
4.0× |
| Mr safety determination physician/other qhp (76016) |
$135.30 |
$246 |
1.6× |
| Mr safety implant&/fb assmt clin staf 1st 15 min (76014) |
$37.40 |
$68 |
1.3× |
| Mr safety implt electronics prepj supvj phys/qhp (76018) |
$140.80 |
$256 |
1.5× |
| Mr safety implt pos&/immoblj (76019) |
$91.30 |
$166 |
1.6× |
| Mr safety med physics xm customization plng&mntr (76017) |
$371.25 |
$675 |
1.6× |
| Mra Head W/O & W/Contrast Material (70546) |
$4,211.35 |
$7,657 |
12.1× |
| MRA head w/o contrast (70544) |
$2,727.45 |
$4,959 |
11.5× |
| MRA head with contrast (70545) |
$3,131.70 |
$5,694 |
9.0× |
| MRA neck w contrast (70548) |
$2,237.40 |
$4,068 |
6.4× |
| Mra Neck W/O &W/Contrast Material (70549) |
$3,268.65 |
$5,943 |
9.4× |
| MRA neck w/o contrast (70547) |
$1,942.05 |
$3,531 |
8.2× |
| MRI abdomen w contrast (74182) |
$3,026.65 |
$5,503 |
8.7× |
| MRI abdomen w/o contrast (74181) |
$2,479.95 |
$4,509 |
10.4× |
| MRI any jt lower extrem w/contrast material (73722) |
$2,928.75 |
$5,325 |
3.8× |
| MRI any jt lower extrem w/o & w/contrast matrl (73723) |
$3,791.70 |
$6,894 |
10.9× |
| MRI any jt upper extremity w/contrast matrl (73222) |
$3,015.10 |
$5,482 |
3.9× |
| MRI Breast W/O Contrast Bilateral (77047) |
$2,920.50 |
$5,310 |
12.3× |
| MRI Breast Without Contrast Material Unilateral (77046) |
$2,806.65 |
$5,103 |
11.8× |
| MRI cardiac w/o contrast (75557) |
$2,520.65 |
$4,583 |
10.6× |
| MRI cervical spine w contrast (72142) |
$2,649.90 |
$4,818 |
7.6× |
| MRI cervical spine w/o cont (72141) |
$2,555.30 |
$4,646 |
10.8× |
| MRI chest w/o contrast (71550) |
$2,598.20 |
$4,724 |
10.9× |
| MRI chest wo w contrast (71552) |
$3,131.70 |
$5,694 |
9.0× |
| MRI lower extrem oth/thn jt w/contrast matrl (73719) |
$2,844.60 |
$5,172 |
8.2× |
| MRI lower extrem oth/thn jt w/o & w/contr matr (73720) |
$4,303.75 |
$7,825 |
12.4× |
| MRI lower extrem oth/thn jt w/o contr matrl (73718) |
$2,505.25 |
$4,555 |
10.5× |
| MRI lumbar spine w contrast (72149) |
$2,873.75 |
$5,225 |
8.3× |
| Mri Neck Spine W/O & W/Dye (72156) |
$3,518.35 |
$6,397 |
10.1× |
| MRI orbit face &/neck w/o contrast (70540) |
$3,358.85 |
$6,107 |
14.1× |
| Mri Orbt/Fac/Nck W/O &W/Dye (70543) |
$4,045.80 |
$7,356 |
11.6× |
| MRI pelvis w contrast (72196) |
$3,011.80 |
$5,476 |
8.7× |
| MRI pelvis w/o & w contrast (72197) |
$3,851.65 |
$7,003 |
11.1× |
| MRI pelvis w/o contrast (72195) |
$2,813.80 |
$5,116 |
11.8× |
| MRI thoracic spine w/o contrast (72146) |
$2,512.40 |
$4,568 |
10.6× |
| MRI upper extremity oth than jt w/contr matrl (73219) |
$3,049.75 |
$5,545 |
8.8× |
| MRI upper extremity oth than jt w/o contr matrl (73218) |
$2,410.65 |
$4,383 |
10.1× |
| Mri Uppr Extremity W/O&W/Dye (73220) |
$3,898.40 |
$7,088 |
11.2× |
| MRI, abdomen, combo (74183) |
$3,257.65 |
$5,923 |
9.4× |
| MRI, dorsal spine combo (72157) |
$3,940.75 |
$7,165 |
11.3× |
| MRI, dorsal spine contrast (72147) |
$3,099.80 |
$5,636 |
8.9× |
| MRI, joint upper extrem (73221) |
$2,734.60 |
$4,972 |
11.5× |
| MRI, joint upper extrem combo (73223) |
$3,939.65 |
$7,163 |
11.3× |
| MRI, lumbar spine combo (72158) |
$3,462.80 |
$6,296 |
10.0× |
| Myocardial Spect Multiple Studies (78452) |
$3,309.90 |
$6,018 |
2.6× |
| Myocrd img PET prfuj 1std rest/stress cncrnt CT (78430) |
$2,797.85 |
$5,087 |
2.0× |
| Myocrd Img Pet Prfuj Mlt Std Rst&Strs Cncrnt CT (78431) |
$4,019.40 |
$7,308 |
1.8× |
| Myocrd Img Pet Prfuj W/Metab 2rtracer Cncrnt CT (78433) |
$4,912.05 |
$8,931 |
2.2× |
| N-invas est c ffr sw aly CTA (75580) |
$1,495.45 |
$2,719 |
1.7× |
| Neck soft tissue (70360) |
$277.20 |
$504 |
3.2× |
| Njx Rp Loclzj Non-Img Probe Study Intravenous (78808) |
$648.45 |
$1,179 |
1.6× |
| Nm myocard infarct spect (78469) |
$1,300.20 |
$2,364 |
2.4× |
| Ntsty modul radthx pln dose-vol histos (77301) |
$8,222.50 |
$14,950 |
6.0× |
| Nuclear Rx Oral Admin (79005) |
$705.10 |
$1,282 |
3.0× |
| Ob us nuchal meas 1 gest (76813) |
$290.40 |
$528 |
2.8× |
| Ophthalmic ultrasound dx b-scan w/wo a-scan (76512) |
$325.60 |
$592 |
3.1× |
| Parathyroid imaging w/tomographic spect & CT (78072) |
$1,198.45 |
$2,179 |
2.2× |
| Parathyroid Planar Imaging (78070) |
$848.10 |
$1,542 |
2.1× |
| Parathyroid planar imaging w/wo subtraction (78071) |
$1,511.40 |
$2,748 |
3.8× |
| Pelvis 1 or 2 views (72170) |
$272.80 |
$496 |
2.6× |
| Perineogram (74775) |
$473.55 |
$861 |
2.0× |
| Pet Image W/Ct Lmtd (78814) |
$3,411.10 |
$6,202 |
2.4× |
| PET image w/CT, full body (78816) |
$3,927 |
$7,140 |
2.8× |
| PET imaging CT attenuation skull base mid-thigh (78815) |
$3,646.50 |
$6,630 |
2.6× |
| Pulmonary Perfusion Imaging Particulate (78580) |
$1,178.10 |
$2,142 |
3.0× |
| Radex Abd Compl Aqt Abd W/S/E/D Views 1 View Ch (74022) |
$471.90 |
$858 |
4.5× |
| Radex abscess/fistula/sinus tract rs&i (76080) |
$550 |
$1,000 |
1.0× |
| Radex Ankle Complete Minimum 3 Views (73610) |
$316.80 |
$576 |
3.7× |
| Radex Calcaneus Minimum 2 Views (73650) |
$265.10 |
$482 |
3.1× |
| Radex elbow complete minimum 3 views (73080) |
$303.05 |
$551 |
3.5× |
| Radex Facial Bones Complete Minimum 3 Views (70150) |
$321.20 |
$584 |
3.1× |
| Radex fingr minimum 2 views (73140) |
$259.60 |
$472 |
3.0× |
| Radex foot complete minimum 3 views (73630) |
$385 |
$700 |
4.4× |
| Radex Hand Minimum 3 Views (73130) |
$376.20 |
$684 |
4.3× |
| Radex lower extremity infant minimum 2 views (73592) |
$169.40 |
$308 |
2.0× |
| Radex Nasal Bones Complete Minimum 3 Views (70160) |
$316.80 |
$576 |
3.7× |
| Radex Ribs Unilateral 2 Views (71100) |
$342.10 |
$622 |
3.9× |
| Radex shoulder complete minimum 2 views (73030) |
$326.70 |
$594 |
3.8× |
| Radex Sinuses Paransl < 3 Views (70210) |
$162.25 |
$295 |
1.9× |
| Radex Spine 1 View Specify Level (72020) |
$221.65 |
$403 |
2.6× |
| Radex Sternum Minimum 2 Views (71120) |
$296.45 |
$539 |
3.4× |
| Radex Temporomandble Jt Opn & Clsd Mouth Bilat (70330) |
$331.65 |
$603 |
3.8× |
| Radex Toe Minimum 2 Views (73660) |
$241.45 |
$439 |
2.8× |
| Radex upper extremity infant minimum 2 views (73092) |
$206.25 |
$375 |
2.0× |
| Radex Wrist Complete Minimum 3 Views (73110) |
$282.70 |
$514 |
3.3× |
| Radex X-Ray Exam Entire Spi 6/> Vw - Xr Entire Spine 6+ Vw (72084) |
$488.95 |
$889 |
4.7× |
| Radiation treatment delivery level 1 (77402) |
$717.75 |
$1,305 |
7.1× |
| Radiation treatment delivery level 2 (77407) |
$923.45 |
$1,679 |
2.4× |
| Radiation treatment delivery level 3 (77412) |
$1,706.10 |
$3,102 |
3.1× |
| Radiolog exam mandible compl minimum 4 views (70110) |
$349.25 |
$635 |
3.4× |
| Radiologic Exam Abdomen 3+ Views - Xr Abdomen 3+ Views (74021) |
$353.10 |
$642 |
3.4× |
| Radiologic exam colon double contrast study (74280) |
$989.45 |
$1,799 |
5.7× |
| Radiologic exam colon single contrast study (74270) |
$448.80 |
$816 |
2.6× |
| Radiologic Exam Esophagus Double Contrast Study (74221) |
$539 |
$980 |
3.1× |
| Radiologic exam knee complete 4/more views (73564) |
$363 |
$660 |
3.5× |
| Radiologic exam pelvis compl minimum 3 views (72190) |
$294.80 |
$536 |
2.8× |
| Radiologic Exam Small Int Single Contrast Study (74250) |
$543.95 |
$989 |
3.1× |
| Radiologic exam swallow function contrast study (74230) |
$576.40 |
$1,048 |
3.3× |
| Radiologic exam upr gi trc double contrast study (74246) |
$663.30 |
$1,206 |
3.8× |
| Radiologic examination femur 1 view (73551) |
$376.20 |
$684 |
4.3× |
| Radiologic examination femur minimum 2 views (73552) |
$413.60 |
$752 |
4.8× |
| Radiologic examination knee 1/2 views (73560) |
$322.30 |
$586 |
3.7× |
| Radiologic Examination Osseous Survey Limited (77074) |
$414.70 |
$754 |
4.0× |
| Radiologic examination tibia & fibula 2 views (73590) |
$332.20 |
$604 |
3.8× |
| Ribs bilateral 3 views (71110) |
$401.50 |
$730 |
3.9× |
| Rp loclzj tum plnr 1 area single day imaging (78800) |
$806.85 |
$1,467 |
2.0× |
| Rp loclzj tum plnr 2+area 1+d img/1 area img>2+d (78801) |
$1,419 |
$2,580 |
3.6× |
| Rp Loclzj Tum Plnr Whole Body 2+ Days Imaging (78804) |
$2,495.35 |
$4,537 |
4.6× |
| Rp Loclzj Tum Plnr Whole Body Single Day Imaging (78802) |
$1,462.45 |
$2,659 |
2.7× |
| Rp Loclzj Tum Spect 1 Area Single Day Imaging (78803) |
$2,417.80 |
$4,396 |
4.5× |
| Rp loclzj tum spect 2 area/sep acquisj img (78831) |
$2,317.70 |
$4,214 |
1.8× |
| Rp loclzj tum spect CT 2area 1d img/1 ar img>2+d (78832) |
$2,628.45 |
$4,779 |
1.8× |
| Rp loclzj tum spect w/CT 1 area/acquisj 1day img (78830) |
$2,567.40 |
$4,668 |
2.0× |
| Rp Therapy Intravenous Administration (79101) |
$760.65 |
$1,383 |
3.3× |
| Scapula (73010) |
$294.80 |
$536 |
2.8× |
| Screening Digital Breast Tomosynthesis Bi (77063) |
$104.50 |
$190 |
4.5× |
| Shoulder 1 view (73020) |
$233.20 |
$424 |
2.7× |
| Shoulder Arthrography (73040) |
$757.90 |
$1,378 |
2.2× |
| Sialogram (70390) |
$554.40 |
$1,008 |
2.3× |
| Skull less than 4 views (70250) |
$301.95 |
$549 |
2.9× |
| Special dosimetry (77331) |
$499.95 |
$909 |
3.7× |
| Special Physics Consult (77370) |
$814 |
$1,480 |
6.1× |
| Special teletherapy port plan (77321) |
$1,359.05 |
$2,471 |
3.6× |
| Special treatment procedure (77470) |
$2,334.75 |
$4,245 |
4.2× |
| Stereotactic Body Radiation Delivery (77373) |
$6,501.55 |
$11,821 |
3.7× |
| Sternoclavicular joints (71130) |
$399.30 |
$726 |
4.6× |
| Telethx isodose pln cplx w/basic dosimetry (77307) |
$2,630.10 |
$4,782 |
7.1× |
| Telethx isodose pln smpl w/dosimetry calculation (77306) |
$2,264.90 |
$4,118 |
6.1× |
Ther Rad Simulaj-Aided Field Setting Complex (77290)
range across 2 matching MRF lines |
$1,039.50–$2,846.80 |
$1,890–$5,176 |
varies |
| Ther Rad Simulaj-Aided Field Setting Intermed (77285) |
$2,719.75 |
$4,945 |
7.3× |
| Ther rad simulaj-aided field setting simple (77280) |
$1,264.45 |
$2,299 |
9.4× |
| Thoracic spine 2 views (72070) |
$279.40 |
$508 |
2.7× |
| Thoracic spine 3 views (72072) |
$302.50 |
$550 |
2.9× |
| Thoracolumbar 2 views (72080) |
$312.40 |
$568 |
3.6× |
| Thyroid Imaging With Vascular Flow (78013) |
$537.35 |
$977 |
1.3× |
| Thyroid Met Imaging Body (78018) |
$1,597.75 |
$2,905 |
3.0× |
| Thyroid Uptake Measurement (78012) |
$741.40 |
$1,348 |
1.9× |
| Thyroid Uptake W/Blood Flow Sngle/Mult Quan Meas (78014) |
$1,186.35 |
$2,157 |
3.0× |
| Tx Devices Design & Construction Complex (77334) |
$1,311.20 |
$2,384 |
3.5× |
| Tx devices design & construction intermediate (77333) |
$419.10 |
$762 |
3.1× |
| Tx devices design & construction simple (77332) |
$373.45 |
$679 |
2.8× |
Ultrasound Breast Limited (76642)
range across 3 matching MRF lines |
$473.55–$502.15 |
$861–$913 |
varies |
| Ultrasound Exam Aaa Screen (76706) |
$641.85 |
$1,167 |
6.2× |
| Ultrasound, abdomen limited (76705) |
$573.10 |
$1,042 |
5.5× |
| Umbilical-artery Doppler (OB) (76820) |
$298.10 |
$542 |
2.9× |
| Unlisted Dx Radiographic Procedure (76499) |
$1,970.65 |
$3,583 |
22.7× |
Unlisted magnetic resonance procedure (76498)
range across 3 matching MRF lines |
$391.05–$3,023.35 |
$711–$5,497 |
varies |
| Unlisted us procedure (76999) |
$374 |
$680 |
4.3× |
| Upper gi w/o kub (74240) |
$563.20 |
$1,024 |
3.2× |
| Urethrocystogram voiding (74455) |
$602.80 |
$1,096 |
2.5× |
| Urethrocystography retrograde (74450) |
$473.55 |
$861 |
2.0× |
Us breast unilateral complete (76641)
range across 2 matching MRF lines |
$642.95–$761.75 |
$1,169–$1,385 |
varies |
| Us chest (76604) |
$506.55 |
$921 |
4.9× |
| Us complete joint (76881) |
$362.45 |
$659 |
3.5× |
| Us exam, pelvic, limited (76857) |
$534.05 |
$971 |
5.1× |
| Us kidney transplant (76776) |
$805.20 |
$1,464 |
7.7× |
| Us lmtd joint/oth nonvasc xtr strux r-t w/img (76882) |
$344.30 |
$626 |
3.3× |
| Us ob detailed single fetus (76811) |
$596.75 |
$1,085 |
2.5× |
| Us ob limited 1 or more fetuses (76815) |
$448.80 |
$816 |
4.3× |
| Us ob transvaginal (76817) |
$469.15 |
$853 |
4.5× |
| Us pelvic non ob complete (76856) |
$660 |
$1,200 |
6.3× |
| Us pg uter img f&mat 14 wk tabdl 1/1st gestation (76801) |
$465.30 |
$846 |
4.5× |
| Us preg uterus real time f/u trnsabdl per fetus (76816) |
$422.95 |
$769 |
4.1× |
| Us retroperitoneal complete (76770) |
$651.20 |
$1,184 |
6.3× |
| Us retroperitoneal limited (76775) |
$556.60 |
$1,012 |
5.3× |
| Us scrotum and contents (76870) |
$506.55 |
$921 |
4.9× |
| Us spinal canal and contents (76800) |
$227.70 |
$414 |
2.2× |
| Us thyroid (76536) |
$595.65 |
$1,083 |
5.7× |
| Us transrectal (76872) |
$725.45 |
$1,319 |
7.0× |
| Vein X-Ray Chest (75827) |
$1,326.05 |
$2,411 |
0.8× |
| Vein X-Ray Liver W/O Hemodyn (75887) |
$2,373.80 |
$4,316 |
0.8× |
| Vein X-Ray Skull Epidural (75872) |
$2,334.20 |
$4,244 |
3.7× |
| Vein X-Ray Spleen/Liver (75810) |
$3,357.75 |
$6,105 |
1.1× |
| Venogram Sinus/Jugular (75860) |
$2,861.10 |
$5,202 |
0.9× |
| Venography Adrenal Unilateral (75840) |
$5,182.65 |
$9,423 |
1.6× |
| Venography extremity bilateral rs&i (75822) |
$1,498.75 |
$2,725 |
1.0× |
| Venography extremity unilateral rs&i (75820) |
$1,181.95 |
$2,149 |
0.8× |
| Venography Renal Bilateral (75833) |
$5,182.65 |
$9,423 |
1.6× |
| Venography Renal Unilateral (75831) |
$5,182.65 |
$9,423 |
1.6× |
| Wrist 2 views (73100) |
$273.35 |
$497 |
3.2× |
| X-Ray Ac Jts - Xr Acromioclavicular Joints Bilateral (73050) |
$239.80 |
$436 |
2.8× |
| X-ray antegrade pyelogram tube (74425) |
$667.15 |
$1,213 |
1.9× |
| X-Ray Bend Only L-S Spine (72120) |
$324.50 |
$590 |
3.1× |
| X-Ray Elbow 2 Vw - Xr Elbow 1-2 Views Right (73070) |
$274.45 |
$499 |
3.2× |
X-Ray Exam Breast Specimen (76098)
range across 2 matching MRF lines |
$337.15–$370.98 |
$613–$674.50 |
varies |
| X-Ray Exam Entire Spi 1 Vw (72081) |
$307.45 |
$559 |
3.5× |
| X-Ray Exam Entire Spi 2/3 Vw (72082) |
$412.50 |
$750 |
4.0× |
| X-Ray Exam Entire Spi 4/5 Vw (72083) |
$407 |
$740 |
3.9× |
| X-Ray Exam Hip Uni 1 View (73501) |
$350.90 |
$638 |
4.0× |
| X-Ray Exam Hip Uni 2-3 Views (73502) |
$423.50 |
$770 |
4.9× |
| X-Ray Exam Hip Uni 4/> Views (73503) |
$465.85 |
$847 |
4.5× |
| X-Ray Exam Hips Bi 2 Views (73521) |
$370.70 |
$674 |
3.6× |
| X-Ray Exam Hips Bi 3-4 Views (73522) |
$430.10 |
$782 |
4.1× |
| X-Ray Exam Hips Bi 5/> Views (73523) |
$262.35 |
$477 |
2.5× |
| X-Ray Exam L-S Spine Bending (72114) |
$481.80 |
$876 |
4.6× |
| X-Ray Exam Neck Spine 2-3 Vw (72040) |
$315.70 |
$574 |
3.6× |
| X-Ray Exam Neck Spine 6/>Vws (72052) |
$379.50 |
$690 |
3.6× |
| X-Ray Exam Unilat Ribs/Chest (71101) |
$370.15 |
$673 |
3.6× |
| X-ray eye for foreign body (70030) |
$206.80 |
$376 |
2.4× |
| X-ray humerus (73060) |
$303.60 |
$552 |
3.5× |
| X-Ray Jaw <4 Vw - Xr Mandible < 4 Views (70100) |
$282.70 |
$514 |
3.3× |
| X-Ray Knee Bilat Standing - Xr Knees Anteroposterior Standing Bilat (73565) |
$258.50 |
$470 |
3.0× |
| X-Ray Lumbar Spine 2/3 Vw - Xr Lumbar Spine 2-3 Views (72100) |
$337.15 |
$613 |
3.2× |
| X-ray nose-rectum child f.b. (76010) |
$174.35 |
$317 |
2.0× |
| X-Ray Ribs, Chest 4+ Vw - Xr Ribs 3 Vws Bil W/ Chest Posteroanterior (71111) |
$408.65 |
$743 |
3.9× |
| X-Ray Sacroiliac Jts 3+ Vw - Xr Sacroiliac Joints 3+ Views (72202) |
$308 |
$560 |
3.0× |
| X-Ray Sacrum/Coccyx 2+ Vw - Xr Sacrum Coccyx 2+ Views (72220) |
$322.85 |
$587 |
3.7× |
| X-Ray Sinuses 3+ Vw - Xr Paranasal Sinuses 3+ Views (70220) |
$387.20 |
$704 |
4.5× |
| X-Ray Skull 4+ Vw - Xr Skull Complete 4+ Views (70260) |
$332.20 |
$604 |
3.2× |
| X-ray thoracic spine 4 vw (72074) |
$332.75 |
$605 |
3.2× |
| X-Ray Urinary Tract Exam With Contrast Material (74420) |
$631.40 |
$1,148 |
1.8× |
| X-Rays Bone Length Studies (77073) |
$308.55 |
$561 |
3.0× |
| X-Rays Bone Survey Complete (77075) |
$614.35 |
$1,117 |
5.9× |
| Xr c-spine 4 or 5 views (72050) |
$356.40 |
$648 |
3.4× |
| Xr facial bones less than 3 views (70140) |
$293.70 |
$534 |
3.4× |
| Xr orbits complete 4 views (70200) |
$224.40 |
$408 |
2.2× |