| 3-D radiotherapy plan dose-volume histograms (77295) |
$4,965.20 |
$12,413 |
3.6× |
| Abdomen 1 View (74018) |
$166.80 |
$417 |
1.9× |
| Abdomen 2 views (74019) |
$201.60 |
$504 |
2.0× |
| Acute Gastrointestinal Blood Loss Imaging (78278) |
$793.20 |
$1,983 |
2.0× |
| Adrenal Cortex & Medulla Img (78075) |
$1,869.20 |
$4,673 |
1.5× |
| Angio internal mammary (75756) |
$1,202 |
$3,005 |
0.4× |
| Angio pulmonary bilat (75743) |
$1,565.20 |
$3,913 |
0.5× |
| Angiography extremity bilateral rs&i (75716) |
$1,872.40 |
$4,681 |
0.6× |
| Angiography extremity unilateral rs&i (75710) |
$1,702 |
$4,255 |
0.5× |
| Angiography pulmonary unilateral slctv rs&i (75741) |
$1,404.80 |
$3,512 |
0.5× |
| Angrph pulmonary nonslctv cath/ven njx rs&i (75746) |
$1,586 |
$3,965 |
0.5× |
| Ankle 2 views (73600) |
$166.80 |
$417 |
1.9× |
Aortography thoracic serialography rs&i (75605)
unusually low: confirm this is the full procedure |
$2,003.60 |
$5,009 |
0.4× |
| Aortography thoracic w/o serialography rs&i (75600) |
$1,227.60 |
$3,069 |
0.4× |
Artery X-Rays Abdomen (75726)
unusually low: confirm this is the full procedure |
$2,255.20 |
$5,638 |
0.4× |
| Artery X-Rays Adrenal Gland (75731) |
$1,677.20 |
$4,193 |
0.5× |
Artery X-Rays Pelvis (75736)
unusually low: confirm this is the full procedure |
$2,003.60 |
$5,009 |
0.4× |
| Artery X-Rays Spine (75705) |
$3,624 |
$9,060 |
0.7× |
| Arthrogram ankle (73615) |
$676.80 |
$1,692 |
2.0× |
| Arthrogram hip (73525) |
$676.80 |
$1,692 |
2.0× |
| Arthrogram Wrist (73115) |
$676.80 |
$1,692 |
2.0× |
| Basic radiation dosimetry calculation (77300) |
$496.80 |
$1,242 |
3.8× |
| Bone age studies (77072) |
$201.60 |
$504 |
2.0× |
| Bone Imaging 3 Phase (78315) |
$1,518.40 |
$3,796 |
3.9× |
| Bone Imaging Limited Area (78300) |
$704.40 |
$1,761 |
1.8× |
| Bone Imaging Multiple Areas (78305) |
$767.20 |
$1,918 |
1.9× |
| Bone Imaging Whole Body (78306) |
$897.20 |
$2,243 |
2.3× |
| Bone marrow imaging limited area (78102) |
$329.20 |
$823 |
0.8× |
| Bone marrow imaging; multiple areas (78103) |
$432 |
$1,080 |
1.1× |
| Bone marrow imaging; whole body (78104) |
$657.60 |
$1,644 |
1.7× |
| Bone survey infant (77076) |
$201.60 |
$504 |
2.0× |
| Brachytx isodose complex (77318) |
$6,234.40 |
$15,586 |
16.9× |
Brachytx isodose intermed (77317)
range across 2 matching MRF lines |
$2,262–$6,234.40 |
$5,655–$15,586 |
varies |
| Brachytx Isodose Plan Simple (77316) |
$1,269.20 |
$3,173 |
3.4× |
| Brain Flow Imaging Only (78610) |
$364 |
$910 |
0.7× |
| Brain Image W/Flow < 4 Views (78601) |
$532 |
$1,330 |
1.4× |
| Brain Imaging Min 4 Static Views W Vascular Flow (78606) |
$1,047.60 |
$2,619 |
2.0× |
| Brain Imaging Pet Metabolic Evaluation (78608) |
$5,815.60 |
$14,539 |
4.1× |
| Cardiac MRI w/w/o contrast & further seq (75561) |
$1,333.60 |
$3,334 |
3.9× |
| Cardiac MRI w/w/o contrast w/stress (75563) |
$1,496 |
$3,740 |
1.9× |
| Cardiac Shunt Detection (78428) |
$1,265.60 |
$3,164 |
3.2× |
| Cat Scan Follow-Up Study (76380) |
$517.20 |
$1,293 |
6.0× |
| Cerebrospinal Fluid Flow W/O Matl Shunt Evaltj (78645) |
$809.20 |
$2,023 |
1.5× |
| Cerebrospinal Fluid Scan (78630) |
$1,100 |
$2,750 |
2.1× |
| Chest 1 view (71045) |
$166.80 |
$417 |
1.9× |
| Chest 2 views (71046) |
$183.60 |
$459 |
2.1× |
| Chest 3 views (71047) |
$202 |
$505 |
2.4× |
| Chg us nrv&acc strux 1 xtr compre w/img pr extremity (76883) |
$192 |
$480 |
1.9× |
| Cisternography Positive Contrast Rs&I (70015) |
$1,497.20 |
$3,743 |
1.9× |
| Clavicle complete (73000) |
$166.80 |
$417 |
1.9× |
| Computed Tomography Thorax Lw Dose Lng Ca Scr C- (71271) |
$708 |
$1,770 |
6.9× |
| Continuing medical physics consltj pr wk (77336) |
$540.40 |
$1,351 |
4.1× |
| Contrast Exam Abdominl Aorta (75625) |
$1,866.40 |
$4,666 |
0.6× |
| Contrast X-Ray Bladder (74430) |
$676.80 |
$1,692 |
2.0× |
| Contrast X-Ray Of Elbow (73085) |
$676.80 |
$1,692 |
2.0× |
| Contrast X-Ray Of Knee Joint (73580) |
$676.80 |
$1,692 |
2.0× |
| CT abdomen and pelvis without and with contrast (74178) |
$1,764.80 |
$4,412 |
5.1× |
| CT abdomen and pelvis without contrast (74176) |
$1,022.40 |
$2,556 |
4.3× |
| CT abdomen w contrast (74160) |
$1,078 |
$2,695 |
6.2× |
| CT abdomen w wo contrast (74170) |
$1,137.20 |
$2,843 |
6.6× |
| CT abdomen w/o contrast (74150) |
$1,049.60 |
$2,624 |
10.2× |
| CT Angio Abdomen and Pelvis (74174) |
$1,280.40 |
$3,201 |
3.7× |
| CT Angio Chest (71275) |
$1,414.40 |
$3,536 |
8.2× |
| CT Angio Head (70496) |
$1,596.40 |
$3,991 |
9.2× |
| CT angio hrt w/3d image (75574) |
$1,049.60 |
$2,624 |
3.1× |
| Ct Angio Lwr Extr W/O&W/Dye (73706) |
$1,414.40 |
$3,536 |
8.2× |
| CT Angio Neck (70498) |
$1,304.40 |
$3,261 |
7.5× |
| Ct Angio Upr Extrm W/O&W/Dye (73206) |
$1,414.40 |
$3,536 |
8.2× |
| CT cervical spine w/ contrast (72126) |
$948.80 |
$2,372 |
2.8× |
| CT cervical spine w/o contrast (72125) |
$790.80 |
$1,977 |
7.7× |
| CT cervical spine w/wo cont (72127) |
$992 |
$2,480 |
5.7× |
| CT chest w contrast (71260) |
$946 |
$2,365 |
5.5× |
| CT chest w/wo contrast (71270) |
$1,218 |
$3,045 |
7.0× |
| CT colonography screening (74263) |
$395.20 |
$988 |
1.7× |
| CT Colonogrphy Dx Image Postprocess W/Contrast (74262) |
$1,276.80 |
$3,192 |
7.4× |
| CT colonogrphy dx image postprocess w/o contrast (74261) |
$1,110.40 |
$2,776 |
10.8× |
| CT head/brain with contrast (70460) |
$795.20 |
$1,988 |
4.6× |
| CT head/brain without and with contrast (70470) |
$908.80 |
$2,272 |
5.3× |
| CT heart contrast eval cardiac structure&morph (75572) |
$1,140.80 |
$2,852 |
3.3× |
| CT heart no contrast quant eval coronry calcium (75571) |
$850.40 |
$2,126 |
9.9× |
| CT hrt w/3d image congen (75573) |
$1,140.80 |
$2,852 |
3.3× |
| CT iac w contrast (70481) |
$939.60 |
$2,349 |
5.4× |
| CT l-spine w&w/o contrast (72133) |
$1,340.80 |
$3,352 |
7.8× |
| CT lower ext w/o (73700) |
$944.40 |
$2,361 |
9.2× |
| CT lower extremity w/contrast material (73701) |
$948.40 |
$2,371 |
5.5× |
| CT lumbar spine w contrast (72132) |
$1,282.80 |
$3,207 |
3.7× |
| CT lumbar spine w/o contrast (72131) |
$1,166 |
$2,915 |
11.3× |
| CT maxillofacial w contrast (70487) |
$868.80 |
$2,172 |
5.0× |
| CT maxillofacial wo contrast (70486) |
$724.80 |
$1,812 |
7.0× |
| CT neck tissue combo (70492) |
$786 |
$1,965 |
4.5× |
| Ct Orbit/Ear/Fossa W/O&W/Dye (70482) |
$983.20 |
$2,458 |
5.7× |
| CT orbits w/o contrast (70480) |
$854 |
$2,135 |
8.3× |
| CT pelvis w&w/o contrast (72194) |
$1,406.40 |
$3,516 |
8.1× |
| CT pelvis w/o contrast (72192) |
$944.40 |
$2,361 |
9.2× |
| CT scan of leg combo (73702) |
$1,083.20 |
$2,708 |
6.3× |
| CT scans face/jaw combo (70488) |
$894 |
$2,235 |
5.2× |
| CT soft tissue neck w contrast (70491) |
$751.60 |
$1,879 |
4.3× |
| CT soft tissue neck w/o contrast (70490) |
$627.60 |
$1,569 |
6.1× |
| CT thoracic spine w contrast (72129) |
$965.60 |
$2,414 |
5.6× |
| CT thoracic spine w/o contrast (72128) |
$852.80 |
$2,132 |
8.3× |
| CT thoracic spine w/wo cont (72130) |
$979.60 |
$2,449 |
5.7× |
| CT thorax w/o contrast (71250) |
$708 |
$1,770 |
6.9× |
| CT upper ext wo (73200) |
$944.40 |
$2,361 |
9.2× |
| CT upper extremity w/o & w/contrast material (73202) |
$1,085.20 |
$2,713 |
6.3× |
| CT upper extremity with contrast (73201) |
$1,068.80 |
$2,672 |
3.1× |
| Cta Abdl Aorta&Bi Iliofem W/Contrast&Postp (75635) |
$1,570.80 |
$3,927 |
9.1× |
| Cta Abdomen (74175) |
$1,414.40 |
$3,536 |
8.2× |
| CTA pelvis (72191) |
$1,414.40 |
$3,536 |
8.2× |
| Dilation ureters/urethra rs&i (74485) |
$816 |
$2,040 |
0.4× |
| Discography Cerv/Thor Spine (72285) |
$1,360 |
$3,400 |
0.7× |
| Diskography lumbar (72295) |
$1,360 |
$3,400 |
0.7× |
| Doppler Echo Fetal Puls Spectral F/U/Repeat (76828) |
$202.80 |
$507 |
2.0× |
| Doppler Echo Fetal Spectral Display Complete (76827) |
$212.80 |
$532 |
2.1× |
| Doppler Fetal Mid Cerebral Artery (76821) |
$205.60 |
$514 |
2.0× |
| Dxa Bone Density Axial (77080) |
$452.80 |
$1,132 |
4.4× |
| Dxa bone density study (77085) |
$167.60 |
$419 |
1.6× |
| Dxa bone density study 1/>sites appendiclr skel (77081) |
$132 |
$330 |
1.5× |
| Echo exam of fetal heart (76825) |
$904.80 |
$2,262 |
1.7× |
| Echo exam uterus (76831) |
$538.80 |
$1,347 |
2.3× |
| Echo Guide For Artery Repair (76936) |
$1,700 |
$4,250 |
8.0× |
| Echocardiography, fetal, cardiovascular system, real time with image documentation (2D), with or without M-mode… (76826) |
$415.20 |
$1,038 |
1.8× |
| Esophageal Motility Study (78258) |
$624.80 |
$1,562 |
1.6× |
| Esophagram (74220) |
$337.20 |
$843 |
2.0× |
Fetal Biophys Profile W/Nst (76818)
range across 2 matching MRF lines |
$98.80–$596.80 |
$247–$1,492 |
varies |
| Fetal Biophysical Profile W/O Non-Stress Testing (76819) |
$240.80 |
$602 |
2.3× |
| Fluoroscopy up to 1 hr (76000) |
$300.80 |
$752 |
1.3× |
| Follow-Up Angiography (75898) |
$1,202 |
$3,005 |
0.4× |
| Foot 2 views (73620) |
$166.80 |
$417 |
1.9× |
| Forearm 2 views (73090) |
$166.80 |
$417 |
1.9× |
| Gastric emptying imaging study (78264) |
$741.60 |
$1,854 |
1.9× |
| Gastric Emptyng Imag Std W/Sm Bwl Transit (78265) |
$794 |
$1,985 |
2.0× |
| Gastroesophageal Reflux Exam (78262) |
$1,031.60 |
$2,579 |
2.6× |
| Gated Heart Planar Single (78472) |
$914.80 |
$2,287 |
2.3× |
| Gated Heart, Multiple (78473) |
$1,294.80 |
$3,237 |
3.3× |
| Gstrc Emptng Imag Std W/Sm Bwl Col Trnst Mlt Day (78266) |
$1,053.20 |
$2,633 |
2.0× |
| Hand 2 views (73120) |
$166.80 |
$417 |
1.6× |
| Hdr Rdncl Ntrstl/Icav Brchtx (77772) |
$3,694.80 |
$9,237 |
5.4× |
| Hdr Rdncl Ntrstl/Icav Brchtx (77771) |
$3,312.40 |
$8,281 |
4.8× |
| Hdr Rdncl Ntrstl/Icav Brchtx 1 Channel (77770) |
$2,931.20 |
$7,328 |
4.3× |
| Heart Image (Pet) Multiple (78492) |
$3,840.40 |
$9,601 |
2.7× |
| Hepatc Vngrph Wdg/Fr Hemodyn Eval Rs&I (75889) |
$1,454.80 |
$3,637 |
0.5× |
| Hepatc Vngrph Wdg/Fr W/O Hemodyn Eval Rs&I (75891) |
$1,454.80 |
$3,637 |
0.5× |
| Hepatobil Syst Image W/Drug (78227) |
$799.20 |
$1,998 |
1.5× |
| Hepatobiliary System Imaging (78226) |
$799.20 |
$1,998 |
2.0× |
| Ht Musc Image Planar Mult (78454) |
$2,920.40 |
$7,301 |
2.3× |
| Ht Muscle Image Spect Sing (78451) |
$2,920.40 |
$7,301 |
2.3× |
| Hysterosalpingogram (74740) |
$458 |
$1,145 |
1.9× |
| Infant hip ultrasound with hip movement (dynamic) (76885) |
$214.80 |
$537 |
2.5× |
| Infusion Ivp (74410) |
$337.20 |
$843 |
2.0× |
| Interstitial radiation source applic complex (77778) |
$7,488.80 |
$18,722 |
10.9× |
| Intracavitary Radiation Source Applic Complex (77763) |
$1,939.60 |
$4,849 |
2.8× |
| Intracavitary Radiation Source Applic Intermed (77762) |
$1,368.40 |
$3,421 |
2.5× |
| Intracavitary radiation source applic simple (77761) |
$923.20 |
$2,308 |
1.7× |
| Joint Survey Single View (77077) |
$106.40 |
$266 |
1.0× |
| K Flow/Funct Image Multiple (78709) |
$1,129.20 |
$2,823 |
2.1× |
| K Flow/Funct Image W/Drug (78708) |
$624 |
$1,560 |
1.2× |
| K Flow/Funct Image W/O Drug (78707) |
$1,001.60 |
$2,504 |
1.9× |
| Kidney Imaging Morphol (78700) |
$697.60 |
$1,744 |
1.8× |
| Knee 3 Views (73562) |
$183.60 |
$459 |
2.1× |
| Leveen/Shunt Patency Exam (78291) |
$603.20 |
$1,508 |
1.5× |
| Liver & Spleen Imaging Static Only (78215) |
$692.40 |
$1,731 |
1.8× |
| Liver imaging w/vascular flow (78202) |
$716.40 |
$1,791 |
1.3× |
| Lung Perf&Ventilat Diferentl (78598) |
$862.40 |
$2,156 |
1.6× |
| Lung perfusion differential (78597) |
$552.80 |
$1,382 |
1.4× |
| Lung Ventilat&Perfus Imaging (78582) |
$862.40 |
$2,156 |
1.6× |
| Lung Ventilation Imaging (78579) |
$552.80 |
$1,382 |
1.4× |
| Lymph System Imaging (78195) |
$791.20 |
$1,978 |
1.5× |
| Magnetic Image Jaw Joint (70336) |
$994 |
$2,485 |
4.2× |
| Mammary ductogram or galactogram multiple (77054) |
$504 |
$1,260 |
2.1× |
| Mammary ductogram or galactogram single (77053) |
$458 |
$1,145 |
1.9× |
| Meckels Divert Exam (78290) |
$452.40 |
$1,131 |
1.1× |
| Medical physics dose eval radiation expos w/rprt (76145) |
$203.20 |
$508 |
0.6× |
| Mlc imrt design & construction per imrt plan (77338) |
$472 |
$1,180 |
1.3× |
| Mr safety determination physician/other qhp (76016) |
$141.20 |
$353 |
1.6× |
| Mr safety implant&/fb assmt clin staf 1st 15 min (76014) |
$39.20 |
$98 |
1.4× |
| Mr safety implt electronics prepj supvj phys/qhp (76018) |
$147.20 |
$368 |
1.6× |
| Mr safety implt pos&/immoblj (76019) |
$95.20 |
$238 |
1.6× |
| Mr safety med physics xm customization plng&mntr (76017) |
$386.80 |
$967 |
1.6× |
| Mra Head W/O & W/Contrast Material (70546) |
$1,295.60 |
$3,239 |
3.8× |
| MRA head w/o contrast (70544) |
$1,033.20 |
$2,583 |
4.4× |
| MRA head with contrast (70545) |
$1,132 |
$2,830 |
3.3× |
| MRA neck w contrast (70548) |
$1,238.80 |
$3,097 |
3.6× |
| Mra Neck W/O &W/Contrast Material (70549) |
$1,326.40 |
$3,316 |
3.9× |
| MRA neck w/o contrast (70547) |
$1,033.20 |
$2,583 |
4.4× |
| MRI abdomen w contrast (74182) |
$1,136 |
$2,840 |
3.3× |
| MRI abdomen w/o contrast (74181) |
$1,032.80 |
$2,582 |
4.4× |
| MRI any jt lower extrem w/contrast material (73722) |
$1,215.20 |
$3,038 |
1.6× |
| MRI any jt lower extrem w/o & w/contrast matrl (73723) |
$1,325.60 |
$3,314 |
3.9× |
| MRI any jt upper extremity w/contrast matrl (73222) |
$1,146.80 |
$2,867 |
1.5× |
| MRI bone marrow blood supply (77084) |
$430.80 |
$1,077 |
1.8× |
| MRI brain functional w/o physician admnistration (70554) |
$1,033.20 |
$2,583 |
4.4× |
| MRI brain functional w/physician admnistration (70555) |
$1,064 |
$2,660 |
4.5× |
| MRI Breast W/O Contrast Bilateral (77047) |
$1,186.80 |
$2,967 |
5.0× |
| MRI Breast Without Contrast Material Unilateral (77046) |
$999.20 |
$2,498 |
4.3× |
| MRI cardiac w/o contrast (75557) |
$908.80 |
$2,272 |
3.9× |
| MRI cervical spine w contrast (72142) |
$1,216 |
$3,040 |
3.5× |
| MRI cervical spine w/o cont (72141) |
$1,033.20 |
$2,583 |
4.4× |
| MRI chest w/o contrast (71550) |
$965.20 |
$2,413 |
4.1× |
| MRI chest with contrast (71551) |
$1,093.60 |
$2,734 |
1.4× |
| MRI chest wo w contrast (71552) |
$1,239.60 |
$3,099 |
3.6× |
| MRI lower extrem oth/thn jt w/contrast matrl (73719) |
$1,258.40 |
$3,146 |
3.7× |
| MRI lower extrem oth/thn jt w/o & w/contr matr (73720) |
$1,452.40 |
$3,631 |
4.2× |
| MRI lower extrem oth/thn jt w/o contr matrl (73718) |
$1,110.40 |
$2,776 |
4.7× |
| MRI lumbar spine w contrast (72149) |
$1,062 |
$2,655 |
3.1× |
| Mri Neck Spine W/O & W/Dye (72156) |
$1,351.20 |
$3,378 |
3.9× |
| MRI orbit face &/neck w/o contrast (70540) |
$1,033.20 |
$2,583 |
4.4× |
| MRI orbit face neck w contrast (70542) |
$1,238.80 |
$3,097 |
3.6× |
| Mri Orbt/Fac/Nck W/O &W/Dye (70543) |
$1,351.20 |
$3,378 |
3.9× |
| MRI pelvis w contrast (72196) |
$1,061.60 |
$2,654 |
3.1× |
| MRI pelvis w/o & w contrast (72197) |
$1,262.80 |
$3,157 |
3.7× |
| MRI pelvis w/o contrast (72195) |
$1,013.60 |
$2,534 |
4.3× |
| MRI spectroscopy (76390) |
$860 |
$2,150 |
10.0× |
| MRI thoracic spine w/o contrast (72146) |
$1,032.80 |
$2,582 |
4.4× |
| MRI upper extremity oth than jt w/contr matrl (73219) |
$1,168.40 |
$2,921 |
3.4× |
| MRI upper extremity oth than jt w/o contr matrl (73218) |
$1,052 |
$2,630 |
4.5× |
| Mri Uppr Extremity W/O&W/Dye (73220) |
$1,502.80 |
$3,757 |
4.4× |
| MRI, abdomen, combo (74183) |
$1,238.40 |
$3,096 |
3.6× |
| MRI, dorsal spine combo (72157) |
$1,603.20 |
$4,008 |
4.7× |
| MRI, dorsal spine contrast (72147) |
$1,093.60 |
$2,734 |
3.2× |
| MRI, joint upper extrem (73221) |
$974 |
$2,435 |
4.1× |
| MRI, joint upper extrem combo (73223) |
$1,274.40 |
$3,186 |
3.7× |
| MRI, lumbar spine combo (72158) |
$1,496 |
$3,740 |
4.4× |
| Myelogram cervical (72240) |
$733.20 |
$1,833 |
0.9× |
| Myelogram Lumbar (72265) |
$640 |
$1,600 |
0.8× |
| Myelography thoracic (72255) |
$613.60 |
$1,534 |
0.8× |
| Myelograpy 2/more regions rs&i (72270) |
$959.20 |
$2,398 |
1.2× |
| Myocardial Imaging Infarct Avid Planar Qual/Quan (78466) |
$552 |
$1,380 |
1.4× |
| Myocardial Imaging Pet Metabolic Evaluation (78459) |
$3,840.40 |
$9,601 |
3.0× |
| Myocardial Perfusion Planar 1 Study Rest/Stress (78453) |
$2,776.40 |
$6,941 |
2.2× |
| Myocardial Spect Multiple Studies (78452) |
$3,528 |
$8,820 |
2.8× |
| Myocrd Img Pet Metab Eval Single Study Cncrnt CT (78429) |
$3,941.60 |
$9,854 |
2.8× |
| Myocrd img PET prfuj 1std rest/stress cncrnt CT (78430) |
$2,792 |
$6,980 |
2.0× |
| Myocrd Img Pet Prfuj Mlt Std Rst&Strs Cncrnt CT (78431) |
$4,055.60 |
$10,139 |
1.9× |
| Myocrd Img Pet Prfuj W/Metab 2rtracer Cncrnt CT (78433) |
$4,956 |
$12,390 |
2.3× |
| Myocrd Img Pet Prfuj W/Metab Dual Radiotracer (78432) |
$4,956 |
$12,390 |
3.3× |
| Neck soft tissue (70360) |
$166.80 |
$417 |
1.9× |
| Nm csf leak detection (78650) |
$976.40 |
$2,441 |
0.8× |
| Nm myocard infarct spect (78469) |
$820.40 |
$2,051 |
1.5× |
| Nm red cell survival study (78130) |
$1,263.60 |
$3,159 |
3.2× |
| Nonvascular Shunt X-Ray (75809) |
$201.60 |
$504 |
2.0× |
| Ntsty modul radthx pln dose-vol histos (77301) |
$1,390.40 |
$3,476 |
1.0× |
| Nuclear Rx Intra-Arterial (79445) |
$618.80 |
$1,547 |
2.7× |
| Nuclear Rx Oral Admin (79005) |
$995.20 |
$2,488 |
4.3× |
| Ob us nuchal meas 1 gest (76813) |
$202.80 |
$507 |
2.0× |
| Oph bmtry us echograpy a-scan io lens pwr cal (76519) |
$95.60 |
$239 |
0.9× |
| Oph us dx ant sgm us immersion b-scan/hr biom (76513) |
$98.80 |
$247 |
1.0× |
| Ophthalmic Biometry US Echograpy a-Scan (76516) |
$95.60 |
$239 |
0.9× |
| Ophthalmic ultrasound dx b-scan w/wo a-scan (76512) |
$88 |
$220 |
0.9× |
| Ophthalmic US Dx Corneal Pachymetry Uni/Bi (76514) |
$22.40 |
$56 |
0.8× |
| Parathyroid imaging w/tomographic spect & CT (78072) |
$1,490.40 |
$3,726 |
2.8× |
| Parathyroid Planar Imaging (78070) |
$707.60 |
$1,769 |
1.8× |
| Parathyroid planar imaging w/wo subtraction (78071) |
$868.40 |
$2,171 |
2.2× |
| Pelvis 1 or 2 views (72170) |
$201.60 |
$504 |
2.0× |
| Perineogram (74775) |
$458 |
$1,145 |
1.9× |
| Pet Image Skull-Thigh (78812) |
$3,175.60 |
$7,939 |
2.3× |
Pet Image W/Ct Lmtd (78814)
range across 2 matching MRF lines |
$2,080–$3,332 |
$5,200–$8,330 |
varies |
| PET image w/CT, full body (78816) |
$3,175.60 |
$7,939 |
2.3× |
| PET imaging CT attenuation skull base mid-thigh (78815) |
$3,175.60 |
$7,939 |
2.3× |
| Pet Myocardial Sngl Study (78491) |
$2,600.40 |
$6,501 |
1.8× |
| PET whole body (78813) |
$4,010 |
$10,025 |
2.8× |
| Prq Transhepatc Portograpy Hemodyn Eval Rs&I (75885) |
$4,766.40 |
$11,916 |
1.5× |
| Pulmonary Perfusion Imaging Particulate (78580) |
$796.80 |
$1,992 |
2.0× |
| Radex Abd Compl Aqt Abd W/S/E/D Views 1 View Ch (74022) |
$221.60 |
$554 |
2.2× |
| Radex abscess/fistula/sinus tract rs&i (76080) |
$1,096.40 |
$2,741 |
2.0× |
| Radex Ankle Complete Minimum 3 Views (73610) |
$183.60 |
$459 |
2.1× |
| Radex Calcaneus Minimum 2 Views (73650) |
$166.80 |
$417 |
1.9× |
| Radex elbow complete minimum 3 views (73080) |
$183.60 |
$459 |
2.1× |
| Radex Facial Bones Complete Minimum 3 Views (70150) |
$201.60 |
$504 |
2.0× |
| Radex fingr minimum 2 views (73140) |
$166.80 |
$417 |
1.9× |
| Radex foot complete minimum 3 views (73630) |
$183.60 |
$459 |
2.1× |
| Radex Hand Minimum 3 Views (73130) |
$201.60 |
$504 |
2.4× |
| Radex lower extremity infant minimum 2 views (73592) |
$166.80 |
$417 |
1.9× |
| Radex Nasal Bones Complete Minimum 3 Views (70160) |
$166.80 |
$417 |
1.9× |
| Radex Ribs Unilateral 2 Views (71100) |
$166.80 |
$417 |
1.9× |
| Radex shoulder complete minimum 2 views (73030) |
$183.60 |
$459 |
2.1× |
| Radex Sinuses Paransl < 3 Views (70210) |
$166.80 |
$417 |
1.9× |
| Radex Spine 1 View Specify Level (72020) |
$166.80 |
$417 |
1.9× |
| Radex Sternum Minimum 2 Views (71120) |
$166.80 |
$417 |
1.9× |
| Radex Temporomandble Jt Opn & Clsd Mouth Bilat (70330) |
$183.60 |
$459 |
2.1× |
| Radex Toe Minimum 2 Views (73660) |
$166.80 |
$417 |
1.9× |
| Radex upper extremity infant minimum 2 views (73092) |
$201.60 |
$504 |
2.0× |
| Radex Wrist Complete Minimum 3 Views (73110) |
$183.60 |
$459 |
2.1× |
| Radex X-Ray Exam Entire Spi 6/> Vw - Xr Entire Spine 6+ Vw (72084) |
$243.60 |
$609 |
2.4× |
| Radiation Delivery Stereotactic Cranial Linear (77372) |
$7,806 |
$19,515 |
1.1× |
| Radiation treatment delivery level 1 (77402) |
$437.20 |
$1,093 |
4.3× |
| Radiation treatment delivery level 2 (77407) |
$495.20 |
$1,238 |
1.3× |
| Radiation treatment delivery level 3 (77412) |
$877.20 |
$2,193 |
1.6× |
| Radiolog exam mandible compl minimum 4 views (70110) |
$201.60 |
$504 |
2.0× |
| Radiologic exam colon double contrast study (74280) |
$370.80 |
$927 |
2.1× |
| Radiologic exam colon single contrast study (74270) |
$337.20 |
$843 |
2.0× |
| Radiologic Exam Esophagus Double Contrast Study (74221) |
$370.80 |
$927 |
2.1× |
| Radiologic exam knee complete 4/more views (73564) |
$201.60 |
$504 |
2.0× |
| Radiologic exam pelvis compl minimum 3 views (72190) |
$221.60 |
$554 |
2.2× |
| Radiologic Exam Small Int Single Contrast Study (74250) |
$337.20 |
$843 |
2.0× |
| Radiologic exam swallow function contrast study (74230) |
$337.20 |
$843 |
2.0× |
| Radiologic exam upr gi trc double contrast study (74246) |
$370.80 |
$927 |
2.1× |
| Radiologic examination femur 1 view (73551) |
$166.80 |
$417 |
1.9× |
| Radiologic examination femur minimum 2 views (73552) |
$183.60 |
$459 |
2.1× |
| Radiologic examination knee 1/2 views (73560) |
$166.80 |
$417 |
1.9× |
| Radiologic Examination Osseous Survey Limited (77074) |
$201.60 |
$504 |
2.0× |
| Radiologic Examination Salivary Gland Calculus (70380) |
$166.80 |
$417 |
1.9× |
| Radiologic examination tibia & fibula 2 views (73590) |
$166.80 |
$417 |
1.9× |
| Radiopharm Dacryocystography (78660) |
$344 |
$860 |
0.9× |
| Radiopharmaceutical therapy, by interstitial radioactive colloid administration Facility (79300) |
$1,556.40 |
$3,891 |
6.8× |
| Radiopharmaceutical therapy, by intracavitary administration Non-Facility (79200) |
$1,193.20 |
$2,983 |
5.2× |
| Red Cell Volume Determination Spx Mult Samplings (78121) |
$635.60 |
$1,589 |
1.2× |
| Remote afterloading high dose rate radionuclide skin surface brachytherapy, includes basic dosimetry, when performed;… (77768) |
$3,694.80 |
$9,237 |
9.7× |
| Remote afterloading high dose rate radionuclide skin surface brachytherapy, includes basic dosimetry, when performed;… (77767) |
$2,931.20 |
$7,328 |
7.7× |
| Ribs bilateral 3 views (71110) |
$201.60 |
$504 |
2.0× |
| Rp loclzj tum plnr 1 area single day imaging (78800) |
$663.20 |
$1,658 |
1.7× |
| Rp loclzj tum plnr 2+area 1+d img/1 area img>2+d (78801) |
$1,118.40 |
$2,796 |
2.8× |
| Rp Loclzj Tum Plnr Whole Body 2+ Days Imaging (78804) |
$1,306 |
$3,265 |
2.4× |
| Rp Loclzj Tum Plnr Whole Body Single Day Imaging (78802) |
$1,278.40 |
$3,196 |
2.4× |
| Rp Loclzj Tum Spect 1 Area Single Day Imaging (78803) |
$1,338.80 |
$3,347 |
2.5× |
| Rp loclzj tum spect 2 area/sep acquisj img (78831) |
$2,292 |
$5,730 |
1.8× |
| Rp loclzj tum spect CT 2area 1d img/1 ar img>2+d (78832) |
$2,600.40 |
$6,501 |
1.8× |
| Rp loclzj tum spect w/CT 1 area/acquisj 1day img (78830) |
$1,623.20 |
$4,058 |
1.3× |
| Rp Ther Radiolbld Monoclonal Antibody IV Infus (79403) |
$688 |
$1,720 |
3.0× |
| Rp Therapy Intravenous Administration (79101) |
$841.20 |
$2,103 |
3.7× |
| Salivary Gland Imaging (78230) |
$455.60 |
$1,139 |
1.2× |
| Scapula (73010) |
$201.60 |
$504 |
2.0× |
| Screening Digital Breast Tomosynthesis Bi (77063) |
$90 |
$225 |
3.8× |
| Shoulder 1 view (73020) |
$166.80 |
$417 |
1.9× |
| Shoulder Arthrography (73040) |
$676.80 |
$1,692 |
2.0× |
| Sialogram (70390) |
$458 |
$1,145 |
1.9× |
| Skull less than 4 views (70250) |
$201.60 |
$504 |
2.0× |
| Special dosimetry (77331) |
$221.20 |
$553 |
1.7× |
| Special Physics Consult (77370) |
$1,733.60 |
$4,334 |
13.1× |
| Special teletherapy port plan (77321) |
$1,197.60 |
$2,994 |
3.2× |
| Special treatment procedure (77470) |
$2,562.80 |
$6,407 |
4.7× |
| Spleen Imaging (78185) |
$628.80 |
$1,572 |
1.6× |
| Srs Multisource (77371) |
$34,165.20 |
$85,413 |
4.7× |
| Stereotactic Body Radiation Delivery (77373) |
$5,736.80 |
$14,342 |
3.3× |
| Sternoclavicular joints (71130) |
$166.80 |
$417 |
1.9× |
| Superior sagittal sinus venogram (75870) |
$1,388.80 |
$3,472 |
0.4× |
| Tbs techl prep&transmis data alys pfrmd elsewhr (77090) |
$150.80 |
$377 |
1.8× |
| Tbs technical calculation only (77091) |
$150.80 |
$377 |
1.8× |
| Telethx isodose pln cplx w/basic dosimetry (77307) |
$4,149.20 |
$10,373 |
11.2× |
| Telethx isodose pln smpl w/dosimetry calculation (77306) |
$1,785.60 |
$4,464 |
4.8× |
| Testicular Imaging W/Flow (78761) |
$676.40 |
$1,691 |
1.7× |
| Ther Rad Simulaj-Aided Field Setting Complex (77290) |
$1,843.60 |
$4,609 |
5.0× |
| Ther Rad Simulaj-Aided Field Setting Intermed (77285) |
$1,749.60 |
$4,374 |
4.7× |
| Ther rad simulaj-aided field setting simple (77280) |
$726.80 |
$1,817 |
5.5× |
| Therapeutic Enema Rdctj Intussusception/Obstrcj (74283) |
$337.20 |
$843 |
2.0× |
| Thoracic spine 2 views (72070) |
$201.60 |
$504 |
2.0× |
| Thoracic spine 3 views (72072) |
$221.60 |
$554 |
2.2× |
| Thoracolumbar 2 views (72080) |
$166.80 |
$417 |
1.9× |
| Thyroid Carcinoma Metastases Img Lmtd Area (78015) |
$1,086 |
$2,715 |
2.8× |
| Thyroid Imaging With Vascular Flow (78013) |
$466.40 |
$1,166 |
1.2× |
| Thyroid Met Imaging Body (78018) |
$1,193.20 |
$2,983 |
2.2× |
| Thyroid Uptake Measurement (78012) |
$340 |
$850 |
0.9× |
| Thyroid Uptake W/Blood Flow Sngle/Mult Quan Meas (78014) |
$630 |
$1,575 |
1.6× |
| Tx Devices Design & Construction Complex (77334) |
$818.40 |
$2,046 |
2.2× |
| Tx devices design & construction intermediate (77333) |
$387.60 |
$969 |
2.9× |
| Tx devices design & construction simple (77332) |
$334.40 |
$836 |
2.5× |
| Ultrasound Breast Limited (76642) |
$224 |
$560 |
2.6× |
| Ultrasound elastography first target lesion (76982) |
$538.80 |
$1,347 |
5.2× |
| Ultrasound Elastography Parenchyma (76981) |
$538.80 |
$1,347 |
5.2× |
| Ultrasound Exam Aaa Screen (76706) |
$212.40 |
$531 |
2.1× |
| Ultrasound, abdomen limited (76705) |
$552 |
$1,380 |
5.4× |
| Umbilical-artery Doppler (OB) (76820) |
$205.60 |
$514 |
2.0× |
| Unlis px ther radiol clinical tx planning (77299) |
$588.40 |
$1,471 |
4.4× |
Unlisted Dx Radiographic Procedure (76499)
range across 3 matching MRF lines |
$39.60–$242.80 |
$99–$607 |
varies |
| Upper gi w/o kub (74240) |
$337.20 |
$843 |
2.0× |
| Urea Breath Test C-14 Isotopic Acquisj Analysis (78267) |
$224.80 |
$562 |
20.3× |
| Urea breath test c-14 isotopic analysis (78268) |
$435.60 |
$1,089 |
4.6× |
| Ureteral Reflux Study (78740) |
$940 |
$2,350 |
2.4× |
| Urethrocystogram voiding (74455) |
$458 |
$1,145 |
1.9× |
| Urethrocystography retrograde (74450) |
$458 |
$1,145 |
1.9× |
| Us breast unilateral complete (76641) |
$483.20 |
$1,208 |
4.7× |
| Us chest (76604) |
$790.40 |
$1,976 |
7.7× |
| Us complete joint (76881) |
$514.40 |
$1,286 |
5.0× |
Us exam, pelvic, limited (76857)
range across 2 matching MRF lines |
$94–$368.40 |
$235–$921 |
varies |
| Us head (76506) |
$340 |
$850 |
3.3× |
| Us kidney transplant (76776) |
$418.80 |
$1,047 |
4.1× |
| Us lmtd joint/oth nonvasc xtr strux r-t w/img (76882) |
$356.80 |
$892 |
3.5× |
| Us ob detailed single fetus (76811) |
$247.20 |
$618 |
1.1× |
| Us ob limited 1 or more fetuses (76815) |
$479.60 |
$1,199 |
4.7× |
| Us ob transvaginal (76817) |
$501.60 |
$1,254 |
4.9× |
| Us pelvic non ob complete (76856) |
$520 |
$1,300 |
5.0× |
| Us pg uter img f&mat 14 wk tabdl 1/1st gestation (76801) |
$550 |
$1,375 |
5.3× |
| Us preg uterus real time f/u trnsabdl per fetus (76816) |
$425.60 |
$1,064 |
4.1× |
| Us retroperitoneal complete (76770) |
$766.40 |
$1,916 |
7.4× |
| Us retroperitoneal limited (76775) |
$538 |
$1,345 |
5.2× |
| Us scrotum and contents (76870) |
$448 |
$1,120 |
4.3× |
| Us thyroid (76536) |
$436 |
$1,090 |
4.2× |
| Us transrectal (76872) |
$834.40 |
$2,086 |
8.1× |
| Vein X-Ray Chest (75827) |
$1,709.20 |
$4,273 |
1.1× |
| Vein X-Ray Liver W/O Hemodyn (75887) |
$1,269.20 |
$3,173 |
0.4× |
| Vein X-Ray Skull Epidural (75872) |
$1,282.40 |
$3,206 |
2.1× |
| Venogram Sinus/Jugular (75860) |
$1,454.80 |
$3,637 |
0.5× |
| Venography Adrenal Unilateral (75840) |
$1,517.20 |
$3,793 |
0.5× |
| Venography caval inferior serialography rs&i (75825) |
$1,354 |
$3,385 |
0.4× |
| Venography extremity bilateral rs&i (75822) |
$590.80 |
$1,477 |
0.4× |
| Venography extremity unilateral rs&i (75820) |
$590.80 |
$1,477 |
0.4× |
| Venography Renal Bilateral (75833) |
$1,938.80 |
$4,847 |
0.6× |
| Venography Renal Unilateral (75831) |
$1,683.20 |
$4,208 |
0.5× |
Venous sampling by catheter (75893)
unusually low: confirm this is the full procedure |
$2,003.60 |
$5,009 |
0.4× |
| Venous thrombosis imaging (78457) |
$716.40 |
$1,791 |
1.3× |
| Venous Thrombosis Imaging Venogram Bilateral (78458) |
$779.20 |
$1,948 |
2.0× |
| Vertebral fracture assessment via dxa (77086) |
$105.20 |
$263 |
1.2× |
| Wrist 2 views (73100) |
$166.80 |
$417 |
1.9× |
| X-Ray Ac Jts - Xr Acromioclavicular Joints Bilateral (73050) |
$166.80 |
$417 |
1.9× |
| X-ray antegrade pyelogram tube (74425) |
$676.80 |
$1,692 |
2.0× |
| X-Ray Aorta Leg Arteries (75630) |
$2,026.80 |
$5,067 |
0.7× |
| X-Ray Bend Only L-S Spine (72120) |
$201.60 |
$504 |
2.0× |
| X-Ray Elbow 2 Vw - Xr Elbow 1-2 Views Right (73070) |
$166.80 |
$417 |
1.9× |
| X-Ray Exam Breast Specimen (76098) |
$1,096.40 |
$2,741 |
2.0× |
| X-Ray Exam Entire Spi 1 Vw (72081) |
$166.80 |
$417 |
1.9× |
| X-Ray Exam Entire Spi 2/3 Vw (72082) |
$201.60 |
$504 |
2.0× |
| X-Ray Exam Entire Spi 4/5 Vw (72083) |
$221.60 |
$554 |
2.2× |
| X-Ray Exam Hip Uni 1 View (73501) |
$166.80 |
$417 |
1.9× |
| X-Ray Exam Hip Uni 2-3 Views (73502) |
$183.60 |
$459 |
2.1× |
| X-Ray Exam Hip Uni 4/> Views (73503) |
$202 |
$505 |
2.0× |
| X-Ray Exam Hips Bi 2 Views (73521) |
$201.60 |
$504 |
2.0× |
| X-Ray Exam Hips Bi 3-4 Views (73522) |
$221.60 |
$554 |
2.2× |
| X-Ray Exam Hips Bi 5/> Views (73523) |
$243.60 |
$609 |
2.4× |
| X-Ray Exam L-S Spine Bending (72114) |
$243.60 |
$609 |
2.4× |
| X-Ray Exam Neck Spine 2-3 Vw (72040) |
$166.80 |
$417 |
1.9× |
| X-Ray Exam Neck Spine 6/>Vws (72052) |
$221.60 |
$554 |
2.2× |
| X-Ray Exam Unilat Ribs/Chest (71101) |
$183.60 |
$459 |
1.8× |
| X-ray eye for foreign body (70030) |
$166.80 |
$417 |
1.9× |
| X-ray head for orthodontia (70350) |
$166.80 |
$417 |
1.9× |
| X-ray humerus (73060) |
$166.80 |
$417 |
1.9× |
| X-ray IV pyelogram+tomography (74415) |
$370.80 |
$927 |
2.1× |
| X-Ray Jaw <4 Vw - Xr Mandible < 4 Views (70100) |
$166.80 |
$417 |
1.9× |
| X-Ray Knee Bilat Standing - Xr Knees Anteroposterior Standing Bilat (73565) |
$166.80 |
$417 |
1.9× |
| X-Ray Lumbar Spine 2/3 Vw - Xr Lumbar Spine 2-3 Views (72100) |
$201.60 |
$504 |
2.0× |
| X-ray nose-rectum child f.b. (76010) |
$166.80 |
$417 |
1.9× |
| X-Ray Ribs, Chest 4+ Vw - Xr Ribs 3 Vws Bil W/ Chest Posteroanterior (71111) |
$221.60 |
$554 |
2.2× |
| X-Ray Sacroiliac Jts 3+ Vw - Xr Sacroiliac Joints 3+ Views (72202) |
$221.60 |
$554 |
2.2× |
| X-Ray Sacroiliac Jts <3 Vw - Xr Sacroiliac Joints 1-2 Views (72200) |
$201.60 |
$504 |
2.0× |
| X-Ray Sacrum/Coccyx 2+ Vw - Xr Sacrum Coccyx 2+ Views (72220) |
$166.80 |
$417 |
1.9× |
| X-Ray Sinuses 3+ Vw - Xr Paranasal Sinuses 3+ Views (70220) |
$183.60 |
$459 |
2.1× |
| X-Ray Skull 4+ Vw - Xr Skull Complete 4+ Views (70260) |
$221.60 |
$554 |
2.2× |
| X-Ray Stress View (77071) |
$166.80 |
$417 |
1.9× |
| X-ray thoracic spine 4 vw (72074) |
$243.60 |
$609 |
2.4× |
| X-Ray Tmj Unilat (70328) |
$166.80 |
$417 |
1.9× |
| X-Ray Urinary Tract Exam With Contrast Material (74420) |
$676.40 |
$1,691 |
2.0× |
| X-Rays Bone Length Studies (77073) |
$201.60 |
$504 |
2.0× |
| X-Rays Bone Survey Complete (77075) |
$221.60 |
$554 |
2.2× |
| Xr c-spine 4 or 5 views (72050) |
$201.60 |
$504 |
2.0× |
| Xr facial bones less than 3 views (70140) |
$166.80 |
$417 |
1.9× |
| Xr orbits complete 4 views (70200) |
$201.60 |
$504 |
2.0× |
| Xr Tomogram Single Plane (76100) |
$201.60 |
$504 |
2.0× |