| 3-D radiotherapy plan dose-volume histograms (77295) |
$7,767.20 |
$13,870 |
4.0× |
| Abdomen 1 View (74018) |
$442.40 |
$790 |
3.6× |
| Abdomen 2 views (74019) |
$504 |
$900 |
3.4× |
| Acute Gastrointestinal Blood Loss Imaging (78278) |
$2,727.20 |
$4,870 |
4.8× |
| Acute venous thrombosis imaging, peptide Non-Facility (78456) |
$4,390.40 |
$7,840 |
2.4× |
| Adrenal Cortex & Medulla Img (78075) |
$4,300.80 |
$7,680 |
2.3× |
| Angio internal mammary (75756) |
$9,643.20 |
$17,220 |
2.2× |
| Angio pulmonary bilat (75743) |
$11,121.60 |
$19,860 |
2.5× |
| Angiography Adrenal Bilateral Slctv Rs&I (75733) |
$11,715.20 |
$20,920 |
2.6× |
| Angiography extremity bilateral rs&i (75716) |
$8,853.60 |
$15,810 |
2.0× |
| Angiography extremity unilateral rs&i (75710) |
$8,853.60 |
$15,810 |
2.0× |
| Angiography pulmonary unilateral slctv rs&i (75741) |
$8,853.60 |
$15,810 |
2.0× |
| Angrph pulmonary nonslctv cath/ven njx rs&i (75746) |
$8,853.60 |
$15,810 |
2.0× |
| Ankle 2 views (73600) |
$560 |
$1,000 |
4.5× |
| Aortography thoracic serialography rs&i (75605) |
$15,271.20 |
$27,270 |
1.9× |
| Aortography thoracic w/o serialography rs&i (75600) |
$8,853.60 |
$15,810 |
2.0× |
| Artery X-Rays Abdomen (75726) |
$14,140 |
$25,250 |
1.8× |
| Artery X-Rays Adrenal Gland (75731) |
$8,853.60 |
$15,810 |
2.0× |
| Artery X-Rays Pelvis (75736) |
$15,271.20 |
$27,270 |
1.9× |
| Artery X-Rays Spine (75705) |
$15,271.20 |
$27,270 |
1.9× |
| Arthrogram ankle (73615) |
$1,472.80 |
$2,630 |
3.0× |
| Arthrogram hip (73525) |
$1,394.40 |
$2,490 |
2.8× |
| Arthrogram Wrist (73115) |
$1,405.60 |
$2,510 |
2.8× |
| Basic radiation dosimetry calculation (77300) |
$1,153.60 |
$2,060 |
6.1× |
| Bone age studies (77072) |
$716.80 |
$1,280 |
4.8× |
| Bone Imaging 3 Phase (78315) |
$3,578.40 |
$6,390 |
6.3× |
| Bone Imaging Limited Area (78300) |
$1,540 |
$2,750 |
2.7× |
| Bone Imaging Multiple Areas (78305) |
$1,696.80 |
$3,030 |
3.0× |
| Bone Imaging Whole Body (78306) |
$2,592.80 |
$4,630 |
4.6× |
| Bone marrow imaging limited area (78102) |
$1,243.20 |
$2,220 |
2.2× |
| Bone marrow imaging; multiple areas (78103) |
$1,243.20 |
$2,220 |
2.2× |
| Bone marrow imaging; whole body (78104) |
$1,243.20 |
$2,220 |
2.2× |
| Bone survey infant (77076) |
$1,024.80 |
$1,830 |
6.9× |
| Brachytx isodose complex (77318) |
$3,920 |
$7,000 |
7.4× |
| Brachytx isodose intermed (77317) |
$2,167.20 |
$3,870 |
4.1× |
| Brachytx Isodose Plan Simple (77316) |
$1,058.40 |
$1,890 |
2.0× |
| Brain Flow Imaging Only (78610) |
$3,253.60 |
$5,810 |
4.2× |
| Brain Image W/Flow < 4 Views (78601) |
$3,550.40 |
$6,340 |
6.3× |
| Brain imaging < 4 static views (78600) |
$2,268 |
$4,050 |
4.0× |
| Brain Imaging Min 4 Static Views W Vascular Flow (78606) |
$4,373.60 |
$7,810 |
5.7× |
| Brain Imaging Minimum 4 Static Views (78605) |
$3,124.80 |
$5,580 |
4.1× |
| Brain Imaging Pet Metabolic Evaluation (78608) |
$4,407.20 |
$7,870 |
2.2× |
| Card Bl Pool Gated Spect Rest Wal Motn Ejct Frct (78494) |
$2,150.40 |
$3,840 |
3.8× |
| Cardiac blood pool imaging, first pass technique; multiple studies, resting and with stress (exercise and/or… (78483) |
$4,015.20 |
$7,170 |
5.2× |
| Cardiac MRI w/w/o contrast & further seq (75561) |
$6,087.20 |
$10,870 |
12.3× |
| Cardiac MRI w/w/o contrast w/stress (75563) |
$6,182.40 |
$11,040 |
5.6× |
| Cardiac Shunt Detection (78428) |
$3,259.20 |
$5,820 |
5.7× |
Cardiovasc nucl exam unlisted (78499)
range across 2 matching MRF lines |
$182–$2,536.80 |
$325–$4,530 |
varies |
| Cat Scan Follow-Up Study (76380) |
$879.20 |
$1,570 |
7.1× |
| Cerebrospinal Fluid Flow W/O Matl Shunt Evaltj (78645) |
$1,612.80 |
$2,880 |
2.1× |
| Cerebrospinal fluid flow, imaging (not including introduction of material); ventriculography Non-Facility (78635) |
$3,472 |
$6,200 |
4.5× |
| Cerebrospinal Fluid Scan (78630) |
$2,385.60 |
$4,260 |
3.1× |
| Chest 1 view (71045) |
$476 |
$850 |
3.9× |
| Chest 2 views (71046) |
$504 |
$900 |
4.1× |
| Chest 3 views (71047) |
$582.40 |
$1,040 |
4.7× |
| Chest 4 or more views (71048) |
$604.80 |
$1,080 |
4.1× |
| Chg us nrv&acc strux 1 xtr compre w/img pr extremity (76883) |
$296.80 |
$530 |
2.0× |
| Cholecystography Oral Contrast (74290) |
$1,024.80 |
$1,830 |
4.1× |
| Cineradiograpy/vidradiograpy xcpt where spec (76120) |
$784 |
$1,400 |
5.3× |
| Cisternography Positive Contrast Rs&I (70015) |
$2,200.80 |
$3,930 |
2.0× |
| Clavicle complete (73000) |
$610.40 |
$1,090 |
4.9× |
| Computed Tomography Thorax Lw Dose Lng Ca Scr C- (71271) |
$397.60 |
$710 |
2.7× |
| Continuing medical physics consltj pr wk (77336) |
$1,226.40 |
$2,190 |
6.4× |
| Contrast Exam Abdominl Aorta (75625) |
$8,853.60 |
$15,810 |
2.0× |
| Contrast X-Ray Bladder (74430) |
$1,428 |
$2,550 |
2.9× |
| Contrast X-Ray Of Elbow (73085) |
$3,696 |
$6,600 |
7.5× |
| Contrast X-Ray Of Knee Joint (73580) |
$1,495.20 |
$2,670 |
3.0× |
| Contrast Xray Throat/Cerv Esopha (74210) |
$968.80 |
$1,730 |
3.9× |
| Corpora cavernosography (74445) |
$1,629.60 |
$2,910 |
11.0× |
| CT abdomen and pelvis without and with contrast (74178) |
$6,602.40 |
$11,790 |
13.3× |
| CT abdomen and pelvis without contrast (74176) |
$4,351.20 |
$7,770 |
12.9× |
| CT abdomen w contrast (74160) |
$2,520 |
$4,500 |
10.1× |
| CT abdomen w wo contrast (74170) |
$2,833.60 |
$5,060 |
11.4× |
| CT abdomen w/o contrast (74150) |
$2,206.40 |
$3,940 |
14.9× |
| CT Angio Abdomen and Pelvis (74174) |
$6,529.60 |
$11,660 |
13.2× |
| CT Angio Chest (71275) |
$4,872 |
$8,700 |
19.6× |
| CT Angio Head (70496) |
$4,989.60 |
$8,910 |
20.1× |
| CT angio hrt w/3d image (75574) |
$4,222.40 |
$7,540 |
8.5× |
| Ct Angio Lwr Extr W/O&W/Dye (73706) |
$4,356.80 |
$7,780 |
17.5× |
| CT Angio Neck (70498) |
$5,062.40 |
$9,040 |
20.3× |
| Ct Angio Upr Extrm W/O&W/Dye (73206) |
$4,872 |
$8,700 |
19.6× |
| CT bone density (77078) |
$812 |
$1,450 |
6.6× |
| CT Cere Prfuj Alys C+ W/O CT/Cta Same Anatomy (70473) |
$2,288.16 |
$4,086 |
9.2× |
| CT cervical spine w/ contrast (72126) |
$3,948 |
$7,050 |
8.0× |
| CT cervical spine w/o contrast (72125) |
$3,231.20 |
$5,770 |
21.8× |
| CT cervical spine w/wo cont (72127) |
$4,664.80 |
$8,330 |
18.7× |
| CT chest w contrast (71260) |
$3,763.20 |
$6,720 |
15.1× |
| CT chest w/wo contrast (71270) |
$4,379.20 |
$7,820 |
17.6× |
| CT colonography screening (74263) |
$3,589.60 |
$6,410 |
10.6× |
| CT Colonogrphy Dx Image Postprocess W/Contrast (74262) |
$3,231.20 |
$5,770 |
13.0× |
| CT colonogrphy dx image postprocess w/o contrast (74261) |
$1,814.40 |
$3,240 |
12.2× |
| CT head/brain with contrast (70460) |
$2,945.60 |
$5,260 |
11.8× |
| CT head/brain without and with contrast (70470) |
$3,550.40 |
$6,340 |
14.3× |
| CT heart contrast eval cardiac structure&morph (75572) |
$4,317.60 |
$7,710 |
8.7× |
| CT heart no contrast quant eval coronry calcium (75571) |
$313.60 |
$560 |
2.5× |
| CT hrt w/3d image congen (75573) |
$2,648.80 |
$4,730 |
5.4× |
| CT iac w contrast (70481) |
$3,774.40 |
$6,740 |
15.2× |
| CT l-spine w&w/o contrast (72133) |
$4,664.80 |
$8,330 |
18.7× |
| CT lower ext w/o (73700) |
$2,867.20 |
$5,120 |
19.3× |
| CT lower extremity w/contrast material (73701) |
$3,248 |
$5,800 |
13.1× |
| CT lumbar spine w contrast (72132) |
$3,948 |
$7,050 |
8.0× |
| CT lumbar spine w/o contrast (72131) |
$3,231.20 |
$5,770 |
21.8× |
| CT maxillofacial w contrast (70487) |
$3,281.60 |
$5,860 |
13.2× |
| CT maxillofacial wo contrast (70486) |
$2,934.40 |
$5,240 |
19.8× |
| CT neck tissue combo (70492) |
$4,788 |
$8,550 |
19.2× |
| Ct Orbit/Ear/Fossa W/O&W/Dye (70482) |
$4,121.60 |
$7,360 |
16.6× |
| CT orbits w/o contrast (70480) |
$3,483.20 |
$6,220 |
23.5× |
| CT pelvis w&w/o contrast (72194) |
$5,023.20 |
$8,970 |
20.2× |
| CT pelvis w/o contrast (72192) |
$3,589.60 |
$6,410 |
24.2× |
| CT scan of leg combo (73702) |
$3,656.80 |
$6,530 |
14.7× |
| CT scans face/jaw combo (70488) |
$3,572.80 |
$6,380 |
14.4× |
| CT soft tissue neck w contrast (70491) |
$3,264.80 |
$5,830 |
13.1× |
| CT soft tissue neck w/o contrast (70490) |
$2,424.80 |
$4,330 |
16.4× |
| CT thoracic spine w contrast (72129) |
$3,948 |
$7,050 |
15.9× |
| CT thoracic spine w/o contrast (72128) |
$3,231.20 |
$5,770 |
21.8× |
| CT thoracic spine w/wo cont (72130) |
$4,306.40 |
$7,690 |
17.3× |
| CT thorax w/o contrast (71250) |
$2,844.80 |
$5,080 |
19.2× |
CT unlisted procedure (76497)
range across 3 matching MRF lines |
$385.84–$571.20 |
$689–$1,020 |
varies |
| CT upper ext wo (73200) |
$2,514.40 |
$4,490 |
17.0× |
| CT upper extremity w/o & w/contrast material (73202) |
$3,589.60 |
$6,410 |
14.4× |
| CT upper extremity with contrast (73201) |
$2,872.80 |
$5,130 |
5.8× |
| Cta Abdl Aorta&Bi Iliofem W/Contrast&Postp (75635) |
$5,336.80 |
$9,530 |
21.5× |
| Cta Abdomen (74175) |
$3,561.60 |
$6,360 |
14.3× |
| CTA head&neck c+ w/noncontrast img&post-pxessing (70471) |
$4,551.12 |
$8,127 |
9.2× |
| CTA pelvis (72191) |
$5,712 |
$10,200 |
23.0× |
| Dacryocystography, nasolacrimal duct, radiological supervision and interpretation Non-Facility (70170) |
$2,161.60 |
$3,860 |
6.4× |
| Determination of central c-v hemodynamics (non-imaging) (eg, ejection fraction with probe technique) with or without… (78414) |
$4,015.20 |
$7,170 |
5.2× |
| Dilation ureters/urethra rs&i (74485) |
$5,510.40 |
$9,840 |
1.9× |
| Discography Cerv/Thor Spine (72285) |
$5,342.40 |
$9,540 |
1.9× |
| Diskography lumbar (72295) |
$6,434.40 |
$11,490 |
2.3× |
| Doppler Echo Fetal Puls Spectral F/U/Repeat (76828) |
$420 |
$750 |
2.8× |
| Doppler Echo Fetal Spectral Display Complete (76827) |
$744.80 |
$1,330 |
5.0× |
| Doppler Fetal Mid Cerebral Artery (76821) |
$823.20 |
$1,470 |
5.6× |
| Dxa Bone Density Axial (77080) |
$504 |
$900 |
3.4× |
| Dxa bone density study (77085) |
$683.20 |
$1,220 |
4.6× |
| Dxa bone density study 1/>sites appendiclr skel (77081) |
$276.64 |
$494 |
2.2× |
| Echo exam of fetal heart (76825) |
$1,646.40 |
$2,940 |
2.1× |
| Echo exam uterus (76831) |
$1,080.80 |
$1,930 |
3.2× |
| Echo Guide For Artery Repair (76936) |
$1,456 |
$2,600 |
4.8× |
| Echocardiography, fetal, cardiovascular system, real time with image documentation (2D), with or without M-mode… (76826) |
$756 |
$1,350 |
2.2× |
| Echograp Trans R Pros Study (76873) |
$694.40 |
$1,240 |
4.7× |
| Esophageal Motility Study (78258) |
$2,620.80 |
$4,680 |
4.6× |
| Esophagram (74220) |
$1,047.20 |
$1,870 |
4.2× |
| Fetal Biophys Profile W/Nst (76818) |
$1,030.40 |
$1,840 |
6.9× |
| Fetal Biophysical Profile W/O Non-Stress Testing (76819) |
$1,030.40 |
$1,840 |
6.9× |
| Fetal MRI w/placntl matrnl plvc img sing/1st ges (74712) |
$2,391.20 |
$4,270 |
7.1× |
| Fluoroscopy up to 1 hr (76000) |
$1,355.20 |
$2,420 |
4.0× |
| Follow-Up Angiography (75898) |
$8,853.60 |
$15,810 |
2.0× |
| Foot 2 views (73620) |
$470.40 |
$840 |
3.8× |
| Forearm 2 views (73090) |
$588 |
$1,050 |
4.8× |
| Gastric emptying imaging study (78264) |
$2,945.60 |
$5,260 |
5.2× |
| Gastric Emptyng Imag Std W/Sm Bwl Transit (78265) |
$2,727.20 |
$4,870 |
4.8× |
| Gastric Mucosa Imaging (78261) |
$2,727.20 |
$4,870 |
4.8× |
| Gastroesophageal Reflux Exam (78262) |
$1,383.20 |
$2,470 |
2.4× |
| Gastrointestinal Protein Loss (78282) |
$2,620.80 |
$4,680 |
4.6× |
| Gated Heart Planar Single (78472) |
$1,349.60 |
$2,410 |
2.4× |
| Gated Heart, Multiple (78473) |
$2,234.40 |
$3,990 |
3.9× |
| GI Endoscopic US S&I (76975) |
$1,685.60 |
$3,010 |
5.0× |
| Gstrc Emptng Imag Std W/Sm Bwl Col Trnst Mlt Day (78266) |
$3,164 |
$5,650 |
4.1× |
| Hand 2 views (73120) |
$431.20 |
$770 |
2.9× |
| Hdr Rdncl Ntrstl/Icav Brchtx (77772) |
$15,792 |
$28,200 |
16.0× |
| Hdr Rdncl Ntrstl/Icav Brchtx (77771) |
$5,975.20 |
$10,670 |
6.0× |
| Hdr Rdncl Ntrstl/Icav Brchtx 1 Channel (77770) |
$3,998.40 |
$7,140 |
4.0× |
| Heart first pass single,planar (78481) |
$3,808 |
$6,800 |
4.9× |
| Heart Image (Pet) Multiple (78492) |
$5,476.80 |
$9,780 |
2.7× |
| Hepatc Vngrph Wdg/Fr Hemodyn Eval Rs&I (75889) |
$8,198.40 |
$14,640 |
1.8× |
| Hepatc Vngrph Wdg/Fr W/O Hemodyn Eval Rs&I (75891) |
$10,326.40 |
$18,440 |
2.3× |
| Hepatobil Syst Image W/Drug (78227) |
$2,094.40 |
$3,740 |
2.7× |
| Hepatobiliary System Imaging (78226) |
$1,836.80 |
$3,280 |
3.2× |
| High energy neutron radj tx dlvr 1/> isocenter (77423) |
$2,195.20 |
$3,920 |
2.8× |
| Ht Musc Image Planar Mult (78454) |
$5,342.40 |
$9,540 |
2.9× |
| Ht Muscle Image Spect Sing (78451) |
$3,925.60 |
$7,010 |
2.1× |
| Hyperthermia external generated superficial (77600) |
$2,049.60 |
$3,660 |
3.7× |
| Hyperthermia generated by interstitial probe(s); 5 or fewer interstitial applicators Non-Facility (77610) |
$4,407.20 |
$7,870 |
5.6× |
| Hyperthermia generated by interstitial probe(s); more than 5 interstitial applicators Non-Facility (77615) |
$4,407.20 |
$7,870 |
5.6× |
| Hyperthermia generated by intracavitary probe(s) Non-Facility (77620) |
$4,407.20 |
$7,870 |
5.6× |
| Hyperthermia, externally generated; deep (ie, heating to depths greater than 4 cm) Non-Facility (77605) |
$4,407.20 |
$7,870 |
4.5× |
| Hysterosalpingogram (74740) |
$1,685.60 |
$3,010 |
5.0× |
Image fusion (77399)
range across 3 matching MRF lines |
$182–$526.40 |
$325–$940 |
varies |
| Infant hip ultrasound with hip movement (dynamic) (76885) |
$610.40 |
$1,090 |
4.9× |
| Infant hip ultrasound, limited static exam (76886) |
$610.40 |
$1,090 |
4.9× |
| Infusion Ivp (74410) |
$1,920.80 |
$3,430 |
7.7× |
| Interstitial radiation source applic complex (77778) |
$3,880.80 |
$6,930 |
3.9× |
| Intracavitary Radiation Source Applic Complex (77763) |
$4,328.80 |
$7,730 |
4.4× |
| Intracavitary Radiation Source Applic Intermed (77762) |
$4,328.80 |
$7,730 |
5.5× |
| Intracavitary radiation source applic simple (77761) |
$4,502.40 |
$8,040 |
5.7× |
| Intraop radiaj tx deliver electrons sngl tx sess (77425) |
$10,500 |
$18,750 |
1.0× |
| Intraop radiaj tx deliver xray single tx session (77424) |
$6,221.60 |
$11,110 |
0.6× |
| Joint Survey Single View (77077) |
$375.20 |
$670 |
2.5× |
| K Flow/Funct Image Multiple (78709) |
$1,646.40 |
$2,940 |
2.1× |
| K Flow/Funct Image W/Drug (78708) |
$3,046.40 |
$5,440 |
4.0× |
| K Flow/Funct Image W/O Drug (78707) |
$2,144.80 |
$3,830 |
2.8× |
| Kidney Funcj Study Non-Img Radioisotopic Study (78725) |
$1,248.80 |
$2,230 |
2.2× |
| Kidney Imaging Morphol (78700) |
$1,825.60 |
$3,260 |
3.2× |
| Kidney Imaging Morphoogy W/Vascular Flow (78701) |
$2,620.80 |
$4,680 |
4.6× |
| Knee 3 Views (73562) |
$459.20 |
$820 |
3.7× |
| Labeled RBC Sequestration Differntl Organ/Tissue (78140) |
$3,253.60 |
$5,810 |
5.7× |
| Leveen/Shunt Patency Exam (78291) |
$2,620.80 |
$4,680 |
4.6× |
| Liver & Spleen Imaging Static Only (78215) |
$2,727.20 |
$4,870 |
4.8× |
| Liver & Spleen Imaging W/Vascular Flow (78216) |
$1,243.20 |
$2,220 |
2.2× |
| Liver imaging static only (78201) |
$2,749.60 |
$4,910 |
3.6× |
| Liver imaging w/vascular flow (78202) |
$4,160.80 |
$7,430 |
5.4× |
| Lung Perf&Ventilat Diferentl (78598) |
$3,175.20 |
$5,670 |
4.1× |
| Lung perfusion differential (78597) |
$1,836.80 |
$3,280 |
3.2× |
| Lung Ventilat&Perfus Imaging (78582) |
$2,749.60 |
$4,910 |
3.6× |
| Lung Ventilation Imaging (78579) |
$1,159.20 |
$2,070 |
2.0× |
| Lymph System Imaging (78195) |
$3,393.60 |
$6,060 |
4.4× |
| Lymphangiography Extremity Only Bilateral Rs&I (75803) |
$4,424 |
$7,900 |
2.0× |
| Lymphangiography extremity only unilateral rs&i (75801) |
$2,564.80 |
$4,580 |
2.9× |
| Lymphangiography Pelvic/Abdominal Bilateral Rs&I (75807) |
$8,853.60 |
$15,810 |
2.0× |
| Lymphangiography, pelvic/abdominal, unilateral (75805) |
$8,853.60 |
$15,810 |
2.0× |
| Magnetic Image Jaw Joint (70336) |
$3,522.40 |
$6,290 |
10.4× |
| Magnetic resonance (eg, proton) imaging, brain (including brain stem andskull base), during open intracranial procedure… (70558) |
$5,824 |
$10,400 |
23.4× |
| Magnetic resonance (eg, proton) imaging, brain (including brain stem andskull base), during open intracranial procedure… (70557) |
$4,995.20 |
$8,920 |
6.4× |
| Magnetic resonance (eg, proton) imaging, brain (including brain stem andskull base), during open intracranial procedure… (70559) |
$6,658.40 |
$11,890 |
26.8× |
| Magnetic Resonance Elastography (76391) |
$1,148 |
$2,050 |
3.4× |
| Mammary ductogram or galactogram multiple (77054) |
$694.40 |
$1,240 |
2.1× |
| Mammary ductogram or galactogram single (77053) |
$716.80 |
$1,280 |
2.1× |
| Meckels Divert Exam (78290) |
$2,727.20 |
$4,870 |
4.8× |
| Mlc imrt design & construction per imrt plan (77338) |
$4,188.80 |
$7,480 |
7.9× |
| Mr safety determination physician/other qhp (76016) |
$269.36 |
$481 |
2.2× |
| Mr safety implant&/fb assmt clin staf 1st 15 min (76014) |
$72.80 |
$130 |
1.8× |
| Mr safety implt electronics prepj supvj phys/qhp (76018) |
$280.56 |
$501 |
2.1× |
| Mr safety implt pos&/immoblj (76019) |
$400.40 |
$715 |
4.8× |
| Mr safety med physics xm customization plng&mntr (76017) |
$735.28 |
$1,313 |
2.2× |
| Mra Head W/O & W/Contrast Material (70546) |
$7,072.80 |
$12,630 |
14.3× |
| MRA head w/o contrast (70544) |
$3,768.80 |
$6,730 |
11.1× |
| MRA head with contrast (70545) |
$6,238.40 |
$11,140 |
12.6× |
| MRA neck w contrast (70548) |
$3,091.20 |
$5,520 |
6.2× |
| Mra Neck W/O &W/Contrast Material (70549) |
$4,732 |
$8,450 |
9.6× |
| MRA neck w/o contrast (70547) |
$4,004 |
$7,150 |
11.8× |
| MRI abdomen w contrast (74182) |
$4,390.40 |
$7,840 |
8.9× |
| MRI abdomen w/o contrast (74181) |
$3,449.60 |
$6,160 |
10.2× |
| MRI any jt lower extrem w/contrast material (73722) |
$4,160.80 |
$7,430 |
3.7× |
| MRI any jt lower extrem w/o & w/contrast matrl (73723) |
$6,199.20 |
$11,070 |
12.5× |
| MRI any jt upper extremity w/contrast matrl (73222) |
$4,160.80 |
$7,430 |
3.7× |
| MRI bone marrow blood supply (77084) |
$3,959.20 |
$7,070 |
11.7× |
| MRI brain functional w/o physician admnistration (70554) |
$3,332 |
$5,950 |
9.8× |
| MRI brain functional w/physician admnistration (70555) |
$3,595.20 |
$6,420 |
10.6× |
| MRI Breast W/O Contrast Bilateral (77047) |
$3,298.40 |
$5,890 |
9.7× |
| MRI Breast Without Contrast Material Unilateral (77046) |
$4,160.80 |
$7,430 |
12.3× |
| MRI cardiac w/o cont stress (75559) |
$3,029.60 |
$5,410 |
3.9× |
| MRI cardiac w/o contrast (75557) |
$7,772.80 |
$13,880 |
23.0× |
| MRI cervical spine w contrast (72142) |
$4,995.20 |
$8,920 |
10.1× |
| MRI cervical spine w/o cont (72141) |
$3,735.20 |
$6,670 |
11.0× |
| MRI chest w/o contrast (71550) |
$4,995.20 |
$8,920 |
14.8× |
| MRI chest with contrast (71551) |
$5,824 |
$10,400 |
5.2× |
| MRI chest wo w contrast (71552) |
$8,136.80 |
$14,530 |
16.4× |
| MRI lower extrem oth/thn jt w/contrast matrl (73719) |
$4,575.20 |
$8,170 |
9.2× |
| MRI lower extrem oth/thn jt w/o & w/contr matr (73720) |
$5,224.80 |
$9,330 |
10.6× |
| MRI lower extrem oth/thn jt w/o contr matrl (73718) |
$3,589.60 |
$6,410 |
10.6× |
| MRI lumbar spine w contrast (72149) |
$4,995.20 |
$8,920 |
10.1× |
| Mri Neck Spine W/O & W/Dye (72156) |
$5,930.40 |
$10,590 |
12.0× |
| MRI orbit face &/neck w/o contrast (70540) |
$6,563.20 |
$11,720 |
19.4× |
| MRI orbit face neck w contrast (70542) |
$6,272 |
$11,200 |
12.7× |
| Mri Orbt/Fac/Nck W/O &W/Dye (70543) |
$6,630.40 |
$11,840 |
13.4× |
| MRI pelvis w contrast (72196) |
$4,995.20 |
$8,920 |
10.1× |
| MRI pelvis w/o & w contrast (72197) |
$6,714.40 |
$11,990 |
13.6× |
| MRI pelvis w/o contrast (72195) |
$3,612 |
$6,450 |
10.7× |
| MRI spectroscopy (76390) |
$2,912 |
$5,200 |
23.6× |
| MRI thoracic spine w/o contrast (72146) |
$3,645.60 |
$6,510 |
10.8× |
| MRI upper extremity oth than jt w/contr matrl (73219) |
$4,670.40 |
$8,340 |
9.4× |
| MRI upper extremity oth than jt w/o contr matrl (73218) |
$3,152.80 |
$5,630 |
9.3× |
| Mri Uppr Extremity W/O&W/Dye (73220) |
$5,017.60 |
$8,960 |
10.1× |
| MRI, abdomen, combo (74183) |
$5,969.60 |
$10,660 |
12.1× |
| MRI, dorsal spine combo (72157) |
$6,837.60 |
$12,210 |
13.8× |
| MRI, dorsal spine contrast (72147) |
$4,995.20 |
$8,920 |
10.1× |
| MRI, joint upper extrem (73221) |
$3,304 |
$5,900 |
9.8× |
| MRI, joint upper extrem combo (73223) |
$7,582.40 |
$13,540 |
15.3× |
| MRI, lumbar spine combo (72158) |
$6,182.40 |
$11,040 |
12.5× |
Musculoskeletal Nuclear Exam (78399)
range across 2 matching MRF lines |
$182–$2,536.80 |
$325–$4,530 |
varies |
| Myelogram cervical (72240) |
$2,419.20 |
$4,320 |
2.2× |
| Myelogram Lumbar (72265) |
$2,419.20 |
$4,320 |
2.2× |
| Myelography thoracic (72255) |
$2,419.20 |
$4,320 |
2.2× |
| Myelograpy 2/more regions rs&i (72270) |
$4,032 |
$7,200 |
3.6× |
| Myocardial Imaging Infarct Avid Planar Qual/Quan (78466) |
$2,150.40 |
$3,840 |
3.8× |
| Myocardial Imaging Pet Metabolic Evaluation (78459) |
$3,959.20 |
$7,070 |
2.2× |
| Myocardial imaging, infarct avid, planar; with ejection fraction by first pass technique Non-Facility (78468) |
$4,009.60 |
$7,160 |
5.2× |
| Myocardial Perfusion Planar 1 Study Rest/Stress (78453) |
$7,907.20 |
$14,120 |
4.3× |
| Myocardial Spect Multiple Studies (78452) |
$5,146.40 |
$9,190 |
2.8× |
| Myocrd Img Pet Metab Eval Single Study Cncrnt CT (78429) |
$7,476 |
$13,350 |
3.7× |
| Myocrd img PET prfuj 1std rest/stress cncrnt CT (78430) |
$9,861.60 |
$17,610 |
4.9× |
| Myocrd Img Pet Prfuj Mlt Std Rst&Strs Cncrnt CT (78431) |
$6,003.20 |
$10,720 |
1.9× |
| Myocrd Img Pet Prfuj W/Metab 2rtracer Cncrnt CT (78433) |
$9,861.60 |
$17,610 |
3.2× |
| Myocrd Img Pet Prfuj W/Metab Dual Radiotracer (78432) |
$9,861.60 |
$17,610 |
4.6× |
| N-invas est c ffr sw aly CTA (75580) |
$4,062.24 |
$7,254 |
3.3× |
| Neck soft tissue (70360) |
$464.80 |
$830 |
3.8× |
Nervous system nuclear exam (78699)
range across 2 matching MRF lines |
$182–$1,764 |
$325–$3,150 |
varies |
| Nfs/Instlj Radioelmnt Sln 3 Mo Follow-Up Care (77750) |
$2,049.60 |
$3,660 |
3.7× |
| Njx Rp Loclzj Non-Img Probe Study Intravenous (78808) |
$1,092 |
$1,950 |
1.9× |
| Nm csf leak detection (78650) |
$6,048 |
$10,800 |
3.3× |
| Nm myocard infarct spect (78469) |
$4,160.80 |
$7,430 |
5.4× |
| Nm red cell survival study (78130) |
$3,136 |
$5,600 |
5.5× |
Nm unlisted gi procedure (78299)
range across 2 matching MRF lines |
$182–$2,536.80 |
$325–$4,530 |
varies |
| Nm whole blood volume (78122) |
$4,015.20 |
$7,170 |
5.2× |
| Nonvascular Shunt X-Ray (75809) |
$1,024.80 |
$1,830 |
6.9× |
| Ntsty modul radthx pln dose-vol histos (77301) |
$14,526.40 |
$25,940 |
7.4× |
Nuclear medicine study of endocrine organs (78099)
range across 2 matching MRF lines |
$182–$1,400 |
$325–$2,500 |
varies |
| Nuclear Rx Intra-Arterial (79445) |
$1,108.80 |
$1,980 |
3.4× |
| Nuclear Rx Oral Admin (79005) |
$2,861.60 |
$5,110 |
8.6× |
| Ob us nuchal meas 1 gest (76813) |
$761.60 |
$1,360 |
5.1× |
| Oph bmtry us echograpy a-scan io lens pwr cal (76519) |
$336 |
$600 |
2.3× |
| Oph us dx ant sgm us immersion b-scan/hr biom (76513) |
$420 |
$750 |
2.8× |
| Oph US Dx B-Scan&Quan a-Scan Sm Pt Enctr (76510) |
$733.60 |
$1,310 |
3.9× |
| Ophthalmic Biometry US Echograpy a-Scan (76516) |
$296.80 |
$530 |
2.0× |
| Ophthalmic Ultrasonic Foreign Body Localization (76529) |
$610.40 |
$1,090 |
4.9× |
| Ophthalmic ultrasound dx b-scan w/wo a-scan (76512) |
$296.80 |
$530 |
2.0× |
| Ophthalmic US Dx Corneal Pachymetry Uni/Bi (76514) |
$71.12 |
$127 |
1.7× |
| Ophthalmic us dx quantitative a-scan only (76511) |
$336 |
$600 |
2.3× |
| Optic foramina (70190) |
$604.80 |
$1,080 |
4.9× |
| Panoramic X-ray of jaws (70355) |
$364 |
$650 |
2.9× |
| Parathyroid imaging w/tomographic spect & CT (78072) |
$2,480.80 |
$4,430 |
3.2× |
| Parathyroid Planar Imaging (78070) |
$1,948.80 |
$3,480 |
3.4× |
| Parathyroid planar imaging w/wo subtraction (78071) |
$1,517.60 |
$2,710 |
2.7× |
| Pelvis 1 or 2 views (72170) |
$526.40 |
$940 |
3.5× |
| Perineogram (74775) |
$1,758.40 |
$3,140 |
5.2× |
| Peritoneogram Rs&I (74190) |
$1,758.40 |
$3,140 |
2.3× |
| Pet Image Skull-Thigh (78812) |
$4,872 |
$8,700 |
2.4× |
| Pet Image W/Ct Lmtd (78814) |
$5,706.40 |
$10,190 |
2.8× |
| PET image w/CT, full body (78816) |
$9,296 |
$16,600 |
4.6× |
| PET imaging CT attenuation skull base mid-thigh (78815) |
$7,218.40 |
$12,890 |
3.6× |
| Pet Imaging Limited Area Chest Head/Neck (78811) |
$7,935.20 |
$14,170 |
4.3× |
| Pet Myocardial Sngl Study (78491) |
$9,861.60 |
$17,610 |
4.9× |
| PET whole body (78813) |
$6,921.60 |
$12,360 |
3.4× |
| Plasma Vol Radiopharm Vol Dilute Spx Mult Smples (78111) |
$4,300.80 |
$7,680 |
2.3× |
| Plasma volume, radiopharmaceutical volume-dilution technique (separate procedure); single sampling Non-Facility (78110) |
$4,300.80 |
$7,680 |
2.3× |
| Platelet survival study Non-Facility (78191) |
$2,643.20 |
$4,720 |
4.7× |
| Proton trmt simple w/comp (77522) |
$7,935.20 |
$14,170 |
4.5× |
| Proton tx delivery complex (77525) |
$7,935.20 |
$14,170 |
4.5× |
| Proton tx delivery intermediate (77523) |
$7,935.20 |
$14,170 |
4.5× |
| Proton tx delivery simple w/o compensation (77520) |
$4,894.40 |
$8,740 |
6.2× |
| Prq Transhepatc Portograpy Hemodyn Eval Rs&I (75885) |
$8,853.60 |
$15,810 |
2.0× |
| Pulmonary Perfusion Imaging Particulate (78580) |
$991.20 |
$1,770 |
1.7× |
| Quan&Charac C Atherosclerotc Plaq Asses Sev C Ds (75577) |
$4,381.44 |
$7,824 |
3.3× |
| Radex Abd Compl Aqt Abd W/S/E/D Views 1 View Ch (74022) |
$896 |
$1,600 |
6.0× |
| Radex abscess/fistula/sinus tract rs&i (76080) |
$1,383.20 |
$2,470 |
1.8× |
| Radex Ankle Complete Minimum 3 Views (73610) |
$604.80 |
$1,080 |
4.9× |
| Radex Calcaneus Minimum 2 Views (73650) |
$532 |
$950 |
4.3× |
| Radex elbow complete minimum 3 views (73080) |
$616 |
$1,100 |
5.0× |
| Radex Facial Bones Complete Minimum 3 Views (70150) |
$492.80 |
$880 |
3.3× |
| Radex fingr minimum 2 views (73140) |
$492.80 |
$880 |
4.0× |
| Radex foot complete minimum 3 views (73630) |
$565.60 |
$1,010 |
4.6× |
| Radex Hand Minimum 3 Views (73130) |
$565.60 |
$1,010 |
4.6× |
| Radex lower extremity infant minimum 2 views (73592) |
$604.80 |
$1,080 |
4.9× |
| Radex Mastoids Compl Minimum 3 Views PR Side (70130) |
$862.40 |
$1,540 |
5.8× |
| Radex Nasal Bones Complete Minimum 3 Views (70160) |
$604.80 |
$1,080 |
4.9× |
| Radex Pharynx/Larx W/Fluor&/Magnification Tq (70370) |
$817.60 |
$1,460 |
6.6× |
| Radex Ribs Unilateral 2 Views (71100) |
$431.20 |
$770 |
3.5× |
| Radex shoulder complete minimum 2 views (73030) |
$655.20 |
$1,170 |
5.3× |
| Radex Sinuses Paransl < 3 Views (70210) |
$257.04 |
$459 |
2.1× |
| Radex sm int w/mlt srl imges via enteroclss tube (74251) |
$2,464 |
$4,400 |
9.9× |
| Radex Spine 1 View Specify Level (72020) |
$498.40 |
$890 |
4.0× |
| Radex Sternum Minimum 2 Views (71120) |
$560 |
$1,000 |
4.5× |
| Radex Temporomandble Jt Opn & Clsd Mouth Bilat (70330) |
$565.60 |
$1,010 |
4.6× |
| Radex Toe Minimum 2 Views (73660) |
$330.40 |
$590 |
2.7× |
| Radex upper extremity infant minimum 2 views (73092) |
$716.80 |
$1,280 |
4.8× |
| Radex Wrist Complete Minimum 3 Views (73110) |
$632.80 |
$1,130 |
5.1× |
| Radex X-Ray Exam Entire Spi 6/> Vw - Xr Entire Spine 6+ Vw (72084) |
$1,092 |
$1,950 |
7.4× |
| Radiation Delivery Stereotactic Cranial Linear (77372) |
$30,144.80 |
$53,830 |
2.9× |
Radiation treatment delivery level 1 (77402)
range across 5 matching MRF lines |
$873.60–$1,069.60 |
$1,560–$1,910 |
varies |
Radiation treatment delivery level 2 (77407)
range across 5 matching MRF lines |
$1,047.20–$1,237.60 |
$1,870–$2,210 |
varies |
Radiation treatment delivery level 3 (77412)
range across 5 matching MRF lines |
$1,411.20–$1,556.80 |
$2,520–$2,780 |
varies |
| Radiolog exam mandible compl minimum 4 views (70110) |
$968.80 |
$1,730 |
6.5× |
| Radiologic Exam Abdomen 3+ Views - Xr Abdomen 3+ Views (74021) |
$772.80 |
$1,380 |
5.2× |
| Radiologic exam colon double contrast study (74280) |
$1,355.20 |
$2,420 |
5.4× |
| Radiologic exam colon single contrast study (74270) |
$1,232 |
$2,200 |
5.0× |
| Radiologic Exam Esophagus Double Contrast Study (74221) |
$1,108.80 |
$1,980 |
4.5× |
| Radiologic exam knee complete 4/more views (73564) |
$672 |
$1,200 |
4.5× |
| Radiologic exam pelvis compl minimum 3 views (72190) |
$554.40 |
$990 |
3.7× |
| Radiologic Exam Small Int Single Contrast Study (74250) |
$481.60 |
$860 |
1.9× |
| Radiologic exam swallow function contrast study (74230) |
$1,170.40 |
$2,090 |
4.7× |
| Radiologic exam teeth complete full mouth (70320) |
$1,540 |
$2,750 |
4.6× |
| Radiologic Exam Teeth Prtl Exam < Full Mouth (70310) |
$1,232 |
$2,200 |
3.6× |
| Radiologic exam upr gi trc double contrast study (74246) |
$739.20 |
$1,320 |
3.0× |
| Radiologic examination femur 1 view (73551) |
$464.80 |
$830 |
3.8× |
| Radiologic examination femur minimum 2 views (73552) |
$492.80 |
$880 |
4.0× |
| Radiologic examination knee 1/2 views (73560) |
$403.20 |
$720 |
3.3× |
| Radiologic Examination Osseous Survey Limited (77074) |
$1,024.80 |
$1,830 |
6.9× |
| Radiologic Examination Salivary Gland Calculus (70380) |
$319.20 |
$570 |
2.6× |
| Radiologic examination tibia & fibula 2 views (73590) |
$576.80 |
$1,030 |
4.7× |
| Radiologic examination, internal auditory meati, complete Non-Facility (70134) |
$1,495.20 |
$2,670 |
1.9× |
| Radiologic examination, teeth; single view Non-Facility (70300) |
$616 |
$1,100 |
5.0× |
| Radiopharm Dacryocystography (78660) |
$2,184 |
$3,900 |
3.9× |
| Radiopharmaceutical therapy, by interstitial radioactive colloid administration Facility (79300) |
$2,273.60 |
$4,060 |
6.9× |
| Radiopharmaceutical therapy, by intra-articular administration Non-Facility (79440) |
$2,363.20 |
$4,220 |
7.1× |
| Radiopharmaceutical therapy, by intracavitary administration Non-Facility (79200) |
$2,273.60 |
$4,060 |
6.9× |
| Red Cell Volume Determination Spx 1 Sampling (78120) |
$3,136 |
$5,600 |
5.5× |
| Red Cell Volume Determination Spx Mult Samplings (78121) |
$4,009.60 |
$7,160 |
5.2× |
| Remote afterloading high dose rate radionuclide skin surface brachytherapy, includes basic dosimetry, when performed;… (77768) |
$1,825.60 |
$3,260 |
3.3× |
| Remote afterloading high dose rate radionuclide skin surface brachytherapy, includes basic dosimetry, when performed;… (77767) |
$4,071.20 |
$7,270 |
7.4× |
| Renal Cyst Study (74470) |
$1,495.20 |
$2,670 |
1.9× |
| Ribs bilateral 3 views (71110) |
$616 |
$1,100 |
4.2× |
| Rp loclzj tum plnr 1 area single day imaging (78800) |
$1,204 |
$2,150 |
2.1× |
| Rp loclzj tum plnr 2+area 1+d img/1 area img>2+d (78801) |
$3,175.20 |
$5,670 |
5.6× |
| Rp Loclzj Tum Plnr Whole Body 2+ Days Imaging (78804) |
$5,555.20 |
$9,920 |
7.2× |
| Rp Loclzj Tum Plnr Whole Body Single Day Imaging (78802) |
$5,269.60 |
$9,410 |
6.8× |
| Rp Loclzj Tum Spect 1 Area Single Day Imaging (78803) |
$3,746.40 |
$6,690 |
4.9× |
| Rp loclzj tum spect 2 area/sep acquisj img (78831) |
$3,998.40 |
$7,140 |
2.2× |
| Rp loclzj tum spect CT 2area 1d img/1 ar img>2+d (78832) |
$4,726.40 |
$8,440 |
2.3× |
| Rp loclzj tum spect w/CT 1 area/acquisj 1day img (78830) |
$4,597.60 |
$8,210 |
2.5× |
| Rp Ther Radiolbld Monoclonal Antibody IV Infus (79403) |
$2,200.80 |
$3,930 |
6.6× |
| Rp Therapy Intravenous Administration (79101) |
$1,064 |
$1,900 |
3.2× |
Rp Therapy Unlisted Procedure (79999)
range across 3 matching MRF lines |
$182–$1,596 |
$325–$2,850 |
varies |
| Salivary Gland Function Study (78232) |
$3,136 |
$5,600 |
5.5× |
| Salivary Gland Imaging (78230) |
$2,620.80 |
$4,680 |
4.6× |
| Salivary Gland Imaging Serial Images (78231) |
$1,377.60 |
$2,460 |
2.4× |
| Scapula (73010) |
$879.20 |
$1,570 |
5.9× |
| Screening Digital Breast Tomosynthesis Bi (77063) |
$115.36 |
$206 |
4.9× |
| Sella turcica (70240) |
$604.80 |
$1,080 |
4.9× |
| Shoulder 1 view (73020) |
$599.20 |
$1,070 |
4.9× |
| Shoulder Arthrography (73040) |
$1,366.40 |
$2,440 |
2.8× |
| Sialogram (70390) |
$1,965.60 |
$3,510 |
5.8× |
| Skull less than 4 views (70250) |
$683.20 |
$1,220 |
4.6× |
| Special dosimetry (77331) |
$616 |
$1,100 |
3.2× |
| Special Physics Consult (77370) |
$1,999.20 |
$3,570 |
10.5× |
| Special teletherapy port plan (77321) |
$1,153.60 |
$2,060 |
2.2× |
| Special treatment procedure (77470) |
$3,270.40 |
$5,840 |
4.2× |
| Speech evaluation, complex (70371) |
$1,069.60 |
$1,910 |
3.2× |
| Spleen Imaging (78185) |
$2,620.80 |
$4,680 |
4.6× |
| Srs Multisource (77371) |
$36,601.60 |
$65,360 |
3.5× |
| Stereotactic Body Radiation Delivery (77373) |
$13,826.40 |
$24,690 |
5.5× |
| Sternoclavicular joints (71130) |
$644 |
$1,150 |
5.2× |
| Superior sagittal sinus venogram (75870) |
$8,853.60 |
$15,810 |
2.0× |
| Surf radj ther orthvlt dlvr>150-500 kv per fxj (77438) |
$560.56 |
$1,001 |
3.9× |
| Surf radj ther supfc dlvr<=150 kv per fraction (77437) |
$560.56 |
$1,001 |
3.9× |
| Surf radj ther supfc/orthvlt treatment planning (77436) |
$204.96 |
$366 |
3.9× |
| Surface Applic Low Dose Rate Radionuclide Source (77789) |
$1,108.80 |
$1,980 |
7.7× |
| Tbs techl prep&transmis data alys pfrmd elsewhr (77090) |
$268.80 |
$480 |
2.2× |
| Tbs technical calculation only (77091) |
$268.80 |
$480 |
2.2× |
| Telethx isodose pln cplx w/basic dosimetry (77307) |
$4,866.40 |
$8,690 |
9.2× |
| Telethx isodose pln smpl w/dosimetry calculation (77306) |
$1,394.40 |
$2,490 |
2.6× |
| Temporomandble Jt Arthrography Rs&I (70332) |
$1,758.40 |
$3,140 |
5.2× |
| Testicular Imaging W/Flow (78761) |
$1,243.20 |
$2,220 |
2.2× |
| Ther Rad Simulaj-Aided Field Setting Complex (77290) |
$3,970.40 |
$7,090 |
7.5× |
| Ther Rad Simulaj-Aided Field Setting Intermed (77285) |
$2,340.80 |
$4,180 |
4.4× |
| Ther rad simulaj-aided field setting simple (77280) |
$1,887.20 |
$3,370 |
9.9× |
| Therapeutic Enema Rdctj Intussusception/Obstrcj (74283) |
$1,064 |
$1,900 |
4.3× |
| Thoracic spine 2 views (72070) |
$554.40 |
$990 |
3.7× |
| Thoracic spine 3 views (72072) |
$588 |
$1,050 |
4.0× |
| Thoracolumbar 2 views (72080) |
$352.80 |
$630 |
2.9× |
| Thyroid carcinoma metastases imaging; with additional studies (eg, urinary recovery) Non-Facility (78016) |
$2,727.20 |
$4,870 |
4.8× |
| Thyroid Carcinoma Metastases Img Lmtd Area (78015) |
$2,620.80 |
$4,680 |
4.6× |
| Thyroid Imaging With Vascular Flow (78013) |
$1,349.60 |
$2,410 |
2.4× |
| Thyroid Met Imaging Body (78018) |
$2,413.60 |
$4,310 |
3.1× |
| Thyroid Uptake Measurement (78012) |
$1,344 |
$2,400 |
2.4× |
| Thyroid Uptake W/Blood Flow Sngle/Mult Quan Meas (78014) |
$1,204 |
$2,150 |
2.1× |
| Tx Devices Design & Construction Complex (77334) |
$2,072 |
$3,700 |
3.9× |
| Tx devices design & construction intermediate (77333) |
$929.60 |
$1,660 |
4.9× |
| Tx devices design & construction simple (77332) |
$935.20 |
$1,670 |
4.9× |
| Ultrasound Breast Limited (76642) |
$560 |
$1,000 |
4.5× |
| Ultrasound elastography first target lesion (76982) |
$341.60 |
$610 |
2.3× |
| Ultrasound Elastography Parenchyma (76981) |
$425.60 |
$760 |
2.9× |
| Ultrasound Exam Aaa Screen (76706) |
$901.60 |
$1,610 |
6.1× |
| Ultrasound trgt dynamic microbubble 1st lesion (76978) |
$644 |
$1,150 |
1.3× |
| Ultrasound, abdomen limited (76705) |
$828.80 |
$1,480 |
5.6× |
| Umbilical-artery Doppler (OB) (76820) |
$397.60 |
$710 |
2.7× |
| Unlis px ther radiol clinical tx planning (77299) |
$182 |
$325 |
1.0× |
Unlisted Dx Radiographic Procedure (76499)
range across 11 matching MRF lines |
$154–$498.40 |
$275–$890 |
varies |
| Unlisted fluoroscopic procedure (76496) |
$305.76 |
$546 |
2.5× |
Unlisted genitourinary px dx nuclear medicine (78799)
range across 2 matching MRF lines |
$182–$2,536.80 |
$325–$4,530 |
varies |
| Unlisted hematopoietic, reticuloendothelial and lymphatic procedure, diagnostic nuclear medicine (78199) |
$182 |
$325 |
0.3× |
| Unlisted magnetic resonance procedure (76498) |
$367.92 |
$657 |
3.0× |
Unlisted Miscellaneous Px Dx Nuclear Medicine (78999)
range across 3 matching MRF lines |
$182–$369.60 |
$325–$660 |
varies |
| Unlisted Procedure Clinical Brachytherapy (77799) |
$182 |
$325 |
1.3× |
Unlisted respiratory px dx nuclear medicine (78599)
range across 2 matching MRF lines |
$182–$2,133.60 |
$325–$3,810 |
varies |
Unlisted us procedure (76999)
range across 4 matching MRF lines |
$151.20–$532 |
$270–$950 |
varies |
| Upper gi w/o kub (74240) |
$616 |
$1,100 |
2.5× |
| Urea Breath Test C-14 Isotopic Acquisj Analysis (78267) |
$86.24 |
$154 |
7.8× |
| Urea breath test c-14 isotopic analysis (78268) |
$237.44 |
$424 |
2.5× |
| Ureteral Reflux Study (78740) |
$2,727.20 |
$4,870 |
4.8× |
| Urethrocystogram voiding (74455) |
$2,021.60 |
$3,610 |
6.0× |
| Urethrocystography retrograde (74450) |
$856.80 |
$1,530 |
2.5× |
| Us bone density measurement (76977) |
$442.40 |
$790 |
3.0× |
| Us breast unilateral complete (76641) |
$1,164.80 |
$2,080 |
7.9× |
| Us chest (76604) |
$980 |
$1,750 |
6.6× |
| Us complete joint (76881) |
$868 |
$1,550 |
5.9× |
| Us exam, pelvic, limited (76857) |
$616 |
$1,100 |
4.2× |
| Us head (76506) |
$862.40 |
$1,540 |
5.8× |
| Us kidney transplant (76776) |
$1,388.80 |
$2,480 |
9.4× |
| Us lmtd joint/oth nonvasc xtr strux r-t w/img (76882) |
$767.20 |
$1,370 |
5.2× |
| Us ob detailed single fetus (76811) |
$901.60 |
$1,610 |
2.7× |
| Us ob limited 1 or more fetuses (76815) |
$604.80 |
$1,080 |
4.1× |
| Us ob transvaginal (76817) |
$806.40 |
$1,440 |
5.4× |
| Us pelvic non ob complete (76856) |
$940.80 |
$1,680 |
6.3× |
| Us pg uter img f&mat 14 wk tabdl 1/1st gestation (76801) |
$1,299.20 |
$2,320 |
8.8× |
| Us preg uterus real time f/u trnsabdl per fetus (76816) |
$543.20 |
$970 |
3.7× |
| Us retroperitoneal complete (76770) |
$901.60 |
$1,610 |
6.1× |
| Us retroperitoneal limited (76775) |
$795.20 |
$1,420 |
5.4× |
| Us scrotum and contents (76870) |
$890.40 |
$1,590 |
6.0× |
| Us spinal canal and contents (76800) |
$666.40 |
$1,190 |
4.5× |
| Us thyroid (76536) |
$907.20 |
$1,620 |
6.1× |
| Us transrectal (76872) |
$750.40 |
$1,340 |
5.1× |
| Vascular Flow Imaging (78445) |
$3,259.20 |
$5,820 |
5.7× |
| Vasogram (74440) |
$2,083.20 |
$3,720 |
6.2× |
| Vein X-Ray Chest (75827) |
$4,424 |
$7,900 |
2.0× |
| Vein X-Ray Liver W/O Hemodyn (75887) |
$8,853.60 |
$15,810 |
2.0× |
| Vein X-Ray Skull Epidural (75872) |
$5,829.60 |
$10,410 |
6.6× |
| Vein X-Ray Spleen/Liver (75810) |
$8,853.60 |
$15,810 |
2.0× |
| Venogram Sinus/Jugular (75860) |
$8,853.60 |
$15,810 |
2.0× |
| Venography Adrenal Unilateral (75840) |
$12,796 |
$22,850 |
2.9× |
| Venography caval inferior serialography rs&i (75825) |
$8,853.60 |
$15,810 |
2.0× |
| Venography extremity bilateral rs&i (75822) |
$4,424 |
$7,900 |
2.0× |
| Venography extremity unilateral rs&i (75820) |
$4,424 |
$7,900 |
2.0× |
| Venography Orbital Rs&I (75880) |
$5,829.60 |
$10,410 |
6.6× |
| Venography Renal Bilateral (75833) |
$11,121.60 |
$19,860 |
2.5× |
| Venography Renal Unilateral (75831) |
$8,853.60 |
$15,810 |
2.0× |
| Venous sampling by catheter (75893) |
$15,271.20 |
$27,270 |
1.9× |
| Venous thrombosis imaging (78457) |
$4,205.60 |
$7,510 |
5.5× |
| Venous Thrombosis Imaging Venogram Bilateral (78458) |
$3,136 |
$5,600 |
5.5× |
| Vertebral fracture assessment via dxa (77086) |
$257.04 |
$459 |
2.1× |
| Wrist 2 views (73100) |
$509.60 |
$910 |
4.1× |
| X-Ray Ac Jts - Xr Acromioclavicular Joints Bilateral (73050) |
$576.80 |
$1,030 |
4.7× |
| X-ray antegrade pyelogram tube (74425) |
$1,372 |
$2,450 |
2.8× |
| X-Ray Aorta Leg Arteries (75630) |
$8,853.60 |
$15,810 |
2.0× |
| X-Ray Bend Only L-S Spine (72120) |
$996.80 |
$1,780 |
6.7× |
| X-Ray Elbow 2 Vw - Xr Elbow 1-2 Views Right (73070) |
$532 |
$950 |
4.3× |
| X-Ray Exam Breast Specimen (76098) |
$1,383.20 |
$2,470 |
1.8× |
| X-Ray Exam Entire Spi 1 Vw (72081) |
$257.04 |
$459 |
2.1× |
| X-Ray Exam Entire Spi 2/3 Vw (72082) |
$341.60 |
$610 |
2.3× |
| X-Ray Exam Entire Spi 4/5 Vw (72083) |
$733.60 |
$1,310 |
4.9× |
| X-Ray Exam Hip Uni 1 View (73501) |
$352.80 |
$630 |
2.9× |
| X-Ray Exam Hip Uni 2-3 Views (73502) |
$380.80 |
$680 |
3.1× |
| X-Ray Exam Hip Uni 4/> Views (73503) |
$492.80 |
$880 |
3.3× |
| X-Ray Exam Hips Bi 2 Views (73521) |
$526.40 |
$940 |
3.5× |
| X-Ray Exam Hips Bi 3-4 Views (73522) |
$571.20 |
$1,020 |
3.9× |
| X-Ray Exam Hips Bi 5/> Views (73523) |
$739.20 |
$1,320 |
5.0× |
| X-Ray Exam L-S Spine Bending (72114) |
$677.60 |
$1,210 |
4.6× |
| X-Ray Exam Neck Spine 2-3 Vw (72040) |
$537.60 |
$960 |
4.4× |
| X-Ray Exam Neck Spine 6/>Vws (72052) |
$739.20 |
$1,320 |
5.0× |
| X-Ray Exam Unilat Ribs/Chest (71101) |
$616 |
$1,100 |
4.2× |
| X-ray eye for foreign body (70030) |
$257.04 |
$459 |
2.1× |
| X-ray head for orthodontia (70350) |
$554.40 |
$990 |
4.5× |
| X-ray humerus (73060) |
$604.80 |
$1,080 |
4.9× |
| X-ray IV pyelogram (ivp) (74400) |
$1,920.80 |
$3,430 |
7.7× |
| X-ray IV pyelogram+tomography (74415) |
$1,887.20 |
$3,370 |
7.6× |
| X-Ray Jaw <4 Vw - Xr Mandible < 4 Views (70100) |
$604.80 |
$1,080 |
4.9× |
| X-Ray Knee Bilat Standing - Xr Knees Anteroposterior Standing Bilat (73565) |
$238.56 |
$426 |
1.9× |
| X-Ray Lumbar Spine 2/3 Vw - Xr Lumbar Spine 2-3 Views (72100) |
$554.40 |
$990 |
3.7× |
| X-ray nose-rectum child f.b. (76010) |
$604.80 |
$1,080 |
4.9× |
| X-Ray Ribs, Chest 4+ Vw - Xr Ribs 3 Vws Bil W/ Chest Posteroanterior (71111) |
$739.20 |
$1,320 |
5.0× |
| X-Ray Sacroiliac Jts 3+ Vw - Xr Sacroiliac Joints 3+ Views (72202) |
$728 |
$1,300 |
4.9× |
| X-Ray Sacroiliac Jts <3 Vw - Xr Sacroiliac Joints 1-2 Views (72200) |
$347.20 |
$620 |
2.3× |
| X-Ray Sacrum/Coccyx 2+ Vw - Xr Sacrum Coccyx 2+ Views (72220) |
$515.20 |
$920 |
4.2× |
| X-Ray Sinuses 3+ Vw - Xr Paranasal Sinuses 3+ Views (70220) |
$308 |
$550 |
2.5× |
| X-Ray Skull 4+ Vw - Xr Skull Complete 4+ Views (70260) |
$1,002.40 |
$1,790 |
6.8× |
| X-Ray Stress View (77071) |
$716.80 |
$1,280 |
5.8× |
| X-ray thoracic spine 4 vw (72074) |
$677.60 |
$1,210 |
4.6× |
| X-Ray Tmj Unilat (70328) |
$380.80 |
$680 |
3.1× |
| X-Ray Urinary Tract Exam With Contrast Material (74420) |
$1,052.80 |
$1,880 |
2.1× |
| X-Rays Bone Length Studies (77073) |
$532 |
$950 |
3.6× |
| X-Rays Bone Survey Complete (77075) |
$1,444.80 |
$2,580 |
9.7× |
| Xr c-spine 4 or 5 views (72050) |
$677.60 |
$1,210 |
4.6× |
| Xr facial bones less than 3 views (70140) |
$476 |
$850 |
3.9× |
| XR Mastoids < 3 Views Bilateral (70120) |
$739.20 |
$1,320 |
5.0× |
| Xr myelogram posterior fossa (70010) |
$3,382.40 |
$6,040 |
6.8× |
| Xr orbits complete 4 views (70200) |
$784 |
$1,400 |
5.3× |
| Xr Tomogram Single Plane (76100) |
$974.40 |
$1,740 |
6.6× |