| 3-D radiotherapy plan dose-volume histograms (77295) |
$3,679.50 |
$7,359 |
2.6× |
| Abdomen 1 View (74018) |
$303.50 |
$607 |
3.5× |
| Abdomen 2 views (74019) |
$391 |
$782 |
3.7× |
| Acute Gastrointestinal Blood Loss Imaging (78278) |
$655.50 |
$1,311 |
1.6× |
| Angio internal mammary (75756) |
$1,749.50 |
$3,499 |
0.6× |
| Angio pulmonary bilat (75743) |
$1,998.50 |
$3,997 |
0.6× |
| Angiography Adrenal Bilateral Slctv Rs&I (75733) |
$1,827 |
$3,654 |
0.6× |
| Angiography extremity bilateral rs&i (75716) |
$3,583 |
$7,166 |
1.1× |
| Angiography extremity unilateral rs&i (75710) |
$4,886.50 |
$9,773 |
1.5× |
| Angiography pulmonary unilateral slctv rs&i (75741) |
$1,831.50 |
$3,663 |
0.6× |
| Angrph pulmonary nonslctv cath/ven njx rs&i (75746) |
$2,104 |
$4,208 |
0.7× |
| Ankle 2 views (73600) |
$282.50 |
$565 |
3.2× |
| Aortography thoracic serialography rs&i (75605) |
$3,490 |
$6,980 |
0.6× |
Artery X-Rays Abdomen (75726)
range across 2 matching MRF lines |
$1,749.50–$4,515.50 |
$3,499–$9,031 |
varies |
| Artery X-Rays Adrenal Gland (75731) |
$1,749.50 |
$3,499 |
0.6× |
| Artery X-Rays Pelvis (75736) |
$3,607.50 |
$7,215 |
0.6× |
Artery X-Rays Spine (75705)
range across 2 matching MRF lines |
$2,246–$4,136.50 |
$4,492–$8,273 |
varies |
| Arthrogram ankle (73615) |
$452 |
$904 |
1.3× |
| Arthrogram hip (73525) |
$416 |
$832 |
1.2× |
| Arthrogram Wrist (73115) |
$375.50 |
$751 |
1.1× |
| Basic radiation dosimetry calculation (77300) |
$3,679.50 |
$7,359 |
27.2× |
| Bone age studies (77072) |
$269 |
$538 |
2.6× |
| Bone Imaging 3 Phase (78315) |
$1,514.50 |
$3,029 |
3.8× |
| Bone Imaging Limited Area (78300) |
$255.50 |
$511 |
0.6× |
| Bone Imaging Whole Body (78306) |
$1,213 |
$2,426 |
3.0× |
| Bone marrow imaging limited area (78102) |
$460.50 |
$921 |
1.1× |
| Bone marrow imaging; whole body (78104) |
$703 |
$1,406 |
1.7× |
| Bone survey infant (77076) |
$629.50 |
$1,259 |
6.0× |
| Brain Image W/Flow < 4 Views (78601) |
$603 |
$1,206 |
1.5× |
| Brain Imaging Min 4 Static Views W Vascular Flow (78606) |
$780 |
$1,560 |
1.4× |
| Brain Imaging Minimum 4 Static Views (78605) |
$651 |
$1,302 |
1.2× |
| Brain Imaging Pet Metabolic Evaluation (78608) |
$7,898 |
$15,796 |
5.5× |
| Cardiac MRI w/w/o contrast & further seq (75561) |
$2,683 |
$5,366 |
7.6× |
| Cardiac MRI w/w/o contrast w/stress (75563) |
$2,193 |
$4,386 |
2.8× |
| Cat Scan Follow-Up Study (76380) |
$1,422.50 |
$2,845 |
16.2× |
| Cerebrospinal Fluid Flow W/O Matl Shunt Evaltj (78645) |
$692 |
$1,384 |
1.3× |
| Cerebrospinal fluid flow, imaging (not including introduction of material); ventriculography Non-Facility (78635) |
$877 |
$1,754 |
1.6× |
| Cerebrospinal Fluid Scan (78630) |
$878 |
$1,756 |
1.6× |
| Chest 1 view (71045) |
$300.50 |
$601 |
3.4× |
| Chest 2 views (71046) |
$324.50 |
$649 |
3.7× |
| Chest 3 views (71047) |
$348.50 |
$697 |
4.0× |
| Chest 4 or more views (71048) |
$373 |
$746 |
3.5× |
| Cisternography Positive Contrast Rs&I (70015) |
$564 |
$1,128 |
0.7× |
| Clavicle complete (73000) |
$269 |
$538 |
3.1× |
| Computed Tomography Thorax Lw Dose Lng Ca Scr C- (71271) |
$170.50 |
$341 |
1.6× |
| Continuing medical physics consltj pr wk (77336) |
$3,679.50 |
$7,359 |
27.2× |
| Contrast Exam Abdominl Aorta (75625) |
$3,583 |
$7,166 |
1.1× |
| Contrast X-Ray Bladder (74430) |
$536 |
$1,072 |
1.5× |
| Contrast X-Ray Of Elbow (73085) |
$415.50 |
$831 |
1.2× |
| Contrast X-Ray Of Knee Joint (73580) |
$526 |
$1,052 |
1.5× |
| Corpora cavernosography (74445) |
$386 |
$772 |
3.7× |
| CT abdomen and pelvis without and with contrast (74178) |
$5,006 |
$10,012 |
14.3× |
| CT abdomen and pelvis without contrast (74176) |
$3,769.50 |
$7,539 |
15.7× |
| CT abdomen w contrast (74160) |
$2,273 |
$4,546 |
12.9× |
| CT abdomen w wo contrast (74170) |
$2,569 |
$5,138 |
14.6× |
| CT abdomen w/o contrast (74150) |
$1,977 |
$3,954 |
18.8× |
| CT Angio Abdomen and Pelvis (74174) |
$4,607.50 |
$9,215 |
13.1× |
| CT Angio Chest (71275) |
$2,835.50 |
$5,671 |
16.1× |
| CT Angio Head (70496) |
$2,824.50 |
$5,649 |
16.0× |
| CT angio hrt w/3d image (75574) |
$1,130 |
$2,260 |
3.2× |
| Ct Angio Lwr Extr W/O&W/Dye (73706) |
$3,210 |
$6,420 |
18.2× |
| CT Angio Neck (70498) |
$2,883 |
$5,766 |
16.3× |
| Ct Angio Upr Extrm W/O&W/Dye (73206) |
$3,730.50 |
$7,461 |
21.1× |
| CT Cere Prfuj Alys C+ W/O CT/Cta Same Anatomy (70473) |
$1,783 |
$3,566 |
10.1× |
| CT cervical spine w/ contrast (72126) |
$2,429 |
$4,858 |
6.9× |
| CT cervical spine w/o contrast (72125) |
$2,112.50 |
$4,225 |
20.1× |
| CT cervical spine w/wo cont (72127) |
$2,745.50 |
$5,491 |
15.6× |
| CT chest w contrast (71260) |
$2,252.50 |
$4,505 |
12.8× |
| CT chest w/wo contrast (71270) |
$2,547.50 |
$5,095 |
14.4× |
| CT head/brain with contrast (70460) |
$2,057.50 |
$4,115 |
11.7× |
| CT head/brain without and with contrast (70470) |
$2,325.50 |
$4,651 |
13.2× |
| CT heart contrast eval cardiac structure&morph (75572) |
$1,130 |
$2,260 |
3.2× |
| CT heart no contrast quant eval coronry calcium (75571) |
$129 |
$258 |
1.5× |
| CT hrt w/3d image congen (75573) |
$1,130 |
$2,260 |
3.2× |
| CT iac w contrast (70481) |
$2,049.50 |
$4,099 |
11.6× |
| CT l-spine w&w/o contrast (72133) |
$2,943 |
$5,886 |
16.7× |
| CT lower ext w/o (73700) |
$1,819.50 |
$3,639 |
17.3× |
| CT lower extremity w/contrast material (73701) |
$2,092.50 |
$4,185 |
11.9× |
| CT lumbar spine w contrast (72132) |
$2,602 |
$5,204 |
7.4× |
| CT lumbar spine w/o contrast (72131) |
$2,263 |
$4,526 |
21.5× |
| CT maxillofacial w contrast (70487) |
$1,952.50 |
$3,905 |
11.1× |
| CT maxillofacial wo contrast (70486) |
$1,698.50 |
$3,397 |
16.1× |
| CT neck tissue combo (70492) |
$2,552 |
$5,104 |
14.5× |
| Ct Orbit/Ear/Fossa W/O&W/Dye (70482) |
$2,316.50 |
$4,633 |
13.1× |
| CT orbits w/o contrast (70480) |
$1,782 |
$3,564 |
16.9× |
| CT pelvis w&w/o contrast (72194) |
$2,545 |
$5,090 |
14.4× |
| CT pelvis w/o contrast (72192) |
$1,958 |
$3,916 |
18.6× |
| CT scan of leg combo (73702) |
$2,365 |
$4,730 |
13.4× |
| CT scans face/jaw combo (70488) |
$2,208 |
$4,416 |
12.5× |
| CT soft tissue neck w contrast (70491) |
$2,257 |
$4,514 |
12.8× |
| CT soft tissue neck w/o contrast (70490) |
$1,962.50 |
$3,925 |
18.7× |
| CT thoracic spine w contrast (72129) |
$2,577 |
$5,154 |
14.6× |
| CT thoracic spine w/o contrast (72128) |
$2,240.50 |
$4,481 |
21.3× |
| CT thoracic spine w/wo cont (72130) |
$2,912.50 |
$5,825 |
16.5× |
| CT thorax w/o contrast (71250) |
$1,959.50 |
$3,919 |
18.6× |
| CT upper ext wo (73200) |
$1,675 |
$3,350 |
15.9× |
| CT upper extremity w/o & w/contrast material (73202) |
$2,177 |
$4,354 |
12.3× |
| CT upper extremity with contrast (73201) |
$1,925.50 |
$3,851 |
5.5× |
| Cta Abdl Aorta&Bi Iliofem W/Contrast&Postp (75635) |
$2,431 |
$4,862 |
13.8× |
| Cta Abdomen (74175) |
$3,111.50 |
$6,223 |
17.6× |
| CTA head&neck c+ w/noncontrast img&post-pxessing (70471) |
$1,783 |
$3,566 |
5.1× |
| CTA pelvis (72191) |
$2,808.50 |
$5,617 |
15.9× |
| Dacryocystography, nasolacrimal duct, radiological supervision and interpretation Non-Facility (70170) |
$181 |
$362 |
0.8× |
| Dilation ureters/urethra rs&i (74485) |
$730 |
$1,460 |
0.3× |
| Discography Cerv/Thor Spine (72285) |
$1,718 |
$3,436 |
0.9× |
| Diskography lumbar (72295) |
$1,718 |
$3,436 |
0.9× |
| Dxa Bone Density Axial (77080) |
$757 |
$1,514 |
7.2× |
| Echo exam uterus (76831) |
$705.50 |
$1,411 |
2.9× |
| Echo Guide For Artery Repair (76936) |
$825 |
$1,650 |
3.8× |
| Esophagram (74220) |
$442.50 |
$885 |
2.5× |
| Fetal Biophys Profile W/Nst (76818) |
$754 |
$1,508 |
7.2× |
| Fetal Biophysical Profile W/O Non-Stress Testing (76819) |
$426.50 |
$853 |
4.1× |
| Fluoroscopy up to 1 hr (76000) |
$216.50 |
$433 |
0.9× |
| Follow-Up Angiography (75898) |
$1,265 |
$2,530 |
0.4× |
| Foot 2 views (73620) |
$243 |
$486 |
2.8× |
| Forearm 2 views (73090) |
$324 |
$648 |
3.7× |
| Gastric emptying imaging study (78264) |
$888.50 |
$1,777 |
2.2× |
| Gated Heart Planar Single (78472) |
$914 |
$1,828 |
2.3× |
| Hand 2 views (73120) |
$277 |
$554 |
2.6× |
| Hdr Rdncl Ntrstl/Icav Brchtx (77772) |
$2,754 |
$5,508 |
3.9× |
| Hdr Rdncl Ntrstl/Icav Brchtx (77771) |
$2,759 |
$5,518 |
3.9× |
| Hdr Rdncl Ntrstl/Icav Brchtx 1 Channel (77770) |
$2,759 |
$5,518 |
3.9× |
| Heart Image (Pet) Multiple (78492) |
$1,680 |
$3,360 |
1.2× |
| Hepatc Vngrph Wdg/Fr Hemodyn Eval Rs&I (75889) |
$3,468.50 |
$6,937 |
1.1× |
| Hepatc Vngrph Wdg/Fr W/O Hemodyn Eval Rs&I (75891) |
$3,083 |
$6,166 |
1.0× |
| Hepatobil Syst Image W/Drug (78227) |
$1,162.50 |
$2,325 |
2.1× |
| Hepatobiliary System Imaging (78226) |
$1,162.50 |
$2,325 |
2.9× |
| Ht Muscle Image Spect Sing (78451) |
$3,524.50 |
$7,049 |
2.7× |
| Hysterosalpingogram (74740) |
$673 |
$1,346 |
2.8× |
| Infant hip ultrasound with hip movement (dynamic) (76885) |
$406 |
$812 |
4.6× |
| Infant hip ultrasound, limited static exam (76886) |
$364 |
$728 |
4.2× |
| Interstitial radiation source applic complex (77778) |
$867 |
$1,734 |
1.2× |
| K Flow/Funct Image Multiple (78709) |
$1,047 |
$2,094 |
1.9× |
| K Flow/Funct Image W/Drug (78708) |
$1,098 |
$2,196 |
2.0× |
| K Flow/Funct Image W/O Drug (78707) |
$920 |
$1,840 |
1.7× |
| Kidney Funcj Study Non-Img Radioisotopic Study (78725) |
$863 |
$1,726 |
2.1× |
| Kidney Imaging Morphol (78700) |
$602.50 |
$1,205 |
1.5× |
| Kidney Imaging Morphoogy W/Vascular Flow (78701) |
$657.50 |
$1,315 |
1.6× |
| Knee 3 Views (73562) |
$204 |
$408 |
2.3× |
| Leveen/Shunt Patency Exam (78291) |
$703 |
$1,406 |
1.7× |
| Liver & Spleen Imaging Static Only (78215) |
$892.50 |
$1,785 |
2.2× |
| Liver & Spleen Imaging W/Vascular Flow (78216) |
$1,200.50 |
$2,401 |
3.0× |
| Liver imaging static only (78201) |
$1,391.50 |
$2,783 |
2.5× |
| Lung Perf&Ventilat Diferentl (78598) |
$1,890 |
$3,780 |
3.5× |
| Lung perfusion differential (78597) |
$824.50 |
$1,649 |
2.0× |
| Lung Ventilat&Perfus Imaging (78582) |
$1,932 |
$3,864 |
3.5× |
| Lung Ventilation Imaging (78579) |
$1,108 |
$2,216 |
2.8× |
| Lymph System Imaging (78195) |
$2,071.50 |
$4,143 |
3.8× |
| Lymphangiography Extremity Only Bilateral Rs&I (75803) |
$946 |
$1,892 |
0.6× |
| Lymphangiography extremity only unilateral rs&i (75801) |
$800.50 |
$1,601 |
1.3× |
| Lymphangiography Pelvic/Abdominal Bilateral Rs&I (75807) |
$2,516.50 |
$5,033 |
0.8× |
| Lymphangiography, pelvic/abdominal, unilateral (75805) |
$849 |
$1,698 |
0.3× |
| Magnetic Image Jaw Joint (70336) |
$1,890 |
$3,780 |
7.9× |
| Magnetic Resonance Elastography (76391) |
$604 |
$1,208 |
2.5× |
| Mammary ductogram or galactogram single (77053) |
$534 |
$1,068 |
2.2× |
| Meckels Divert Exam (78290) |
$888.50 |
$1,777 |
2.2× |
| Mlc imrt design & construction per imrt plan (77338) |
$3,679.50 |
$7,359 |
9.8× |
| Mr safety determination physician/other qhp (76016) |
$81 |
$162 |
0.9× |
| Mr safety implant&/fb assmt clin staf 1st 15 min (76014) |
$22.50 |
$45 |
0.8× |
| Mra Head W/O & W/Contrast Material (70546) |
$2,644 |
$5,288 |
7.5× |
| MRA head w/o contrast (70544) |
$1,977.50 |
$3,955 |
8.2× |
| MRA head with contrast (70545) |
$2,273.50 |
$4,547 |
6.5× |
| MRA neck w contrast (70548) |
$2,338.50 |
$4,677 |
6.7× |
| Mra Neck W/O &W/Contrast Material (70549) |
$2,644 |
$5,288 |
7.5× |
| MRA neck w/o contrast (70547) |
$2,034 |
$4,068 |
8.5× |
| MRI abdomen w contrast (74182) |
$2,625 |
$5,250 |
7.5× |
| MRI abdomen w/o contrast (74181) |
$2,282.50 |
$4,565 |
9.5× |
| MRI any jt lower extrem w/contrast material (73722) |
$2,805.50 |
$5,611 |
3.6× |
| MRI any jt lower extrem w/o & w/contrast matrl (73723) |
$3,171.50 |
$6,343 |
9.0× |
| MRI any jt upper extremity w/contrast matrl (73222) |
$2,751.50 |
$5,503 |
3.5× |
| MRI Breast W/O Contrast Bilateral (77047) |
$1,880 |
$3,760 |
7.8× |
| MRI Breast Without Contrast Material Unilateral (77046) |
$1,880 |
$3,760 |
7.8× |
| MRI cardiac w/o cont stress (75559) |
$1,436.50 |
$2,873 |
2.6× |
| MRI cardiac w/o contrast (75557) |
$1,880 |
$3,760 |
7.8× |
| MRI cervical spine w contrast (72142) |
$2,783 |
$5,566 |
7.9× |
| MRI cervical spine w/o cont (72141) |
$2,419 |
$4,838 |
10.1× |
| MRI chest w/o contrast (71550) |
$2,095 |
$4,190 |
8.7× |
| MRI chest with contrast (71551) |
$2,408.50 |
$4,817 |
3.1× |
| MRI chest wo w contrast (71552) |
$2,723.50 |
$5,447 |
7.8× |
| MRI lower extrem oth/thn jt w/contrast matrl (73719) |
$2,645.50 |
$5,291 |
7.5× |
| MRI lower extrem oth/thn jt w/o & w/contr matr (73720) |
$2,753.50 |
$5,507 |
7.8× |
| MRI lower extrem oth/thn jt w/o contr matrl (73718) |
$2,300.50 |
$4,601 |
9.6× |
| MRI lumbar spine w contrast (72149) |
$2,824 |
$5,648 |
8.0× |
| Mri Neck Spine W/O & W/Dye (72156) |
$3,146 |
$6,292 |
9.0× |
| MRI orbit face &/neck w/o contrast (70540) |
$2,091 |
$4,182 |
8.7× |
| MRI orbit face neck w contrast (70542) |
$2,404 |
$4,808 |
6.8× |
| Mri Orbt/Fac/Nck W/O &W/Dye (70543) |
$2,717.50 |
$5,435 |
7.7× |
| MRI pelvis w contrast (72196) |
$2,337.50 |
$4,675 |
6.7× |
| MRI pelvis w/o & w contrast (72197) |
$2,642 |
$5,284 |
7.5× |
| MRI pelvis w/o contrast (72195) |
$2,032.50 |
$4,065 |
8.5× |
| MRI spectroscopy (76390) |
$1,880 |
$3,760 |
21.5× |
| MRI thoracic spine w/o contrast (72146) |
$2,307 |
$4,614 |
9.6× |
| MRI upper extremity oth than jt w/contr matrl (73219) |
$2,192 |
$4,384 |
6.2× |
| MRI upper extremity oth than jt w/o contr matrl (73218) |
$1,906 |
$3,812 |
7.9× |
| Mri Uppr Extremity W/O&W/Dye (73220) |
$2,478.50 |
$4,957 |
7.1× |
| MRI, abdomen, combo (74183) |
$2,967 |
$5,934 |
8.5× |
| MRI, dorsal spine combo (72157) |
$2,998 |
$5,996 |
8.5× |
| MRI, dorsal spine contrast (72147) |
$2,652.50 |
$5,305 |
7.6× |
| MRI, joint upper extrem (73221) |
$2,392 |
$4,784 |
10.0× |
| MRI, joint upper extrem combo (73223) |
$3,110 |
$6,220 |
8.9× |
| MRI, lumbar spine combo (72158) |
$3,191.50 |
$6,383 |
9.1× |
| Myocardial Imaging Infarct Avid Planar Qual/Quan (78466) |
$980 |
$1,960 |
2.4× |
| Myocardial Spect Multiple Studies (78452) |
$4,548.50 |
$9,097 |
3.5× |
| N-invas est c ffr sw aly CTA (75580) |
$983.50 |
$1,967 |
1.1× |
| Neck soft tissue (70360) |
$187 |
$374 |
2.1× |
| Njx Rp Loclzj Non-Img Probe Study Intravenous (78808) |
$2,071.50 |
$4,143 |
5.1× |
| Nm csf leak detection (78650) |
$850 |
$1,700 |
0.7× |
| Nm myocard infarct spect (78469) |
$930.50 |
$1,861 |
1.7× |
| Nonvascular Shunt X-Ray (75809) |
$235 |
$470 |
2.2× |
| Ntsty modul radthx pln dose-vol histos (77301) |
$5,117 |
$10,234 |
3.7× |
Nuclear Rx Intra-Arterial (79445)
range across 2 matching MRF lines |
$1,906–$1,910 |
$3,812–$3,820 |
varies |
| Nuclear Rx Oral Admin (79005) |
$1,672.50 |
$3,345 |
7.1× |
| Ophthalmic ultrasound dx b-scan w/wo a-scan (76512) |
$145.50 |
$291 |
1.4× |
| Parathyroid imaging w/tomographic spect & CT (78072) |
$1,317.50 |
$2,635 |
2.4× |
| Parathyroid Planar Imaging (78070) |
$1,400.50 |
$2,801 |
3.5× |
| Parathyroid planar imaging w/wo subtraction (78071) |
$2,100 |
$4,200 |
5.2× |
| Pelvis 1 or 2 views (72170) |
$334 |
$668 |
3.2× |
| Peritoneogram Rs&I (74190) |
$600.50 |
$1,201 |
1.1× |
| Pet Image W/Ct Lmtd (78814) |
$1,410 |
$2,820 |
1.0× |
| PET image w/CT, full body (78816) |
$7,898 |
$15,796 |
5.5× |
| PET imaging CT attenuation skull base mid-thigh (78815) |
$7,898 |
$15,796 |
5.5× |
| Pet Myocardial Sngl Study (78491) |
$1,680 |
$3,360 |
1.2× |
| Prq Transhepatc Portograpy Hemodyn Eval Rs&I (75885) |
$1,895 |
$3,790 |
0.6× |
| Pulmonary Perfusion Imaging Particulate (78580) |
$825.50 |
$1,651 |
2.1× |
| Radex Abd Compl Aqt Abd W/S/E/D Views 1 View Ch (74022) |
$478.50 |
$957 |
4.5× |
| Radex abscess/fistula/sinus tract rs&i (76080) |
$442.50 |
$885 |
0.8× |
| Radex Ankle Complete Minimum 3 Views (73610) |
$377.50 |
$755 |
4.3× |
| Radex Calcaneus Minimum 2 Views (73650) |
$258.50 |
$517 |
3.0× |
| Radex elbow complete minimum 3 views (73080) |
$154.50 |
$309 |
1.8× |
| Radex Facial Bones Complete Minimum 3 Views (70150) |
$442 |
$884 |
4.2× |
| Radex fingr minimum 2 views (73140) |
$214 |
$428 |
2.4× |
| Radex foot complete minimum 3 views (73630) |
$324 |
$648 |
3.7× |
| Radex Hand Minimum 3 Views (73130) |
$283.50 |
$567 |
3.2× |
| Radex lower extremity infant minimum 2 views (73592) |
$410 |
$820 |
4.7× |
| Radex Mastoids Compl Minimum 3 Views PR Side (70130) |
$524.50 |
$1,049 |
5.0× |
| Radex Nasal Bones Complete Minimum 3 Views (70160) |
$283.50 |
$567 |
3.2× |
| Radex Ribs Unilateral 2 Views (71100) |
$334.50 |
$669 |
3.8× |
| Radex shoulder complete minimum 2 views (73030) |
$339.50 |
$679 |
3.9× |
| Radex Sinuses Paransl < 3 Views (70210) |
$263 |
$526 |
3.0× |
| Radex sm int w/mlt srl imges via enteroclss tube (74251) |
$584 |
$1,168 |
3.3× |
| Radex Spine 1 View Specify Level (72020) |
$251 |
$502 |
2.9× |
| Radex Sternum Minimum 2 Views (71120) |
$334.50 |
$669 |
3.8× |
| Radex Temporomandble Jt Opn & Clsd Mouth Bilat (70330) |
$442 |
$884 |
5.0× |
| Radex Toe Minimum 2 Views (73660) |
$258.50 |
$517 |
3.0× |
| Radex upper extremity infant minimum 2 views (73092) |
$324 |
$648 |
3.1× |
| Radex Wrist Complete Minimum 3 Views (73110) |
$311 |
$622 |
3.6× |
| Radex X-Ray Exam Entire Spi 6/> Vw - Xr Entire Spine 6+ Vw (72084) |
$706 |
$1,412 |
6.7× |
| Radiation Delivery Stereotactic Cranial Linear (77372) |
$11,659 |
$23,318 |
1.6× |
| Radiation treatment delivery level 1 (77402) |
$775 |
$1,550 |
7.5× |
| Radiation treatment delivery level 2 (77407) |
$1,052.50 |
$2,105 |
2.7× |
| Radiation treatment delivery level 3 (77412) |
$3,679.50 |
$7,359 |
6.6× |
| Radiolog exam mandible compl minimum 4 views (70110) |
$364 |
$728 |
3.5× |
| Radiologic Exam Abdomen 3+ Views - Xr Abdomen 3+ Views (74021) |
$478.50 |
$957 |
4.5× |
| Radiologic exam colon double contrast study (74280) |
$814 |
$1,628 |
4.6× |
| Radiologic exam colon single contrast study (74270) |
$588.50 |
$1,177 |
3.3× |
| Radiologic Exam Esophagus Double Contrast Study (74221) |
$442.50 |
$885 |
2.5× |
| Radiologic exam knee complete 4/more views (73564) |
$242.50 |
$485 |
2.3× |
| Radiologic exam pelvis compl minimum 3 views (72190) |
$574 |
$1,148 |
5.5× |
| Radiologic Exam Small Int Single Contrast Study (74250) |
$584 |
$1,168 |
3.3× |
| Radiologic exam swallow function contrast study (74230) |
$524.50 |
$1,049 |
3.0× |
| Radiologic exam upr gi trc double contrast study (74246) |
$707.50 |
$1,415 |
4.0× |
| Radiologic examination femur 1 view (73551) |
$251 |
$502 |
2.9× |
| Radiologic examination femur minimum 2 views (73552) |
$355.50 |
$711 |
4.1× |
| Radiologic examination knee 1/2 views (73560) |
$135 |
$270 |
1.5× |
| Radiologic Examination Osseous Survey Limited (77074) |
$1,203.50 |
$2,407 |
11.4× |
| Radiologic examination tibia & fibula 2 views (73590) |
$410 |
$820 |
4.7× |
| Radiopharmaceutical therapy, by interstitial radioactive colloid administration Facility (79300) |
$1,669 |
$3,338 |
7.1× |
| Radiopharmaceutical therapy, by intra-articular administration Non-Facility (79440) |
$1,669 |
$3,338 |
7.1× |
| Radiopharmaceutical therapy, by intracavitary administration Non-Facility (79200) |
$1,669 |
$3,338 |
7.1× |
| Remote afterloading high dose rate radionuclide skin surface brachytherapy, includes basic dosimetry, when performed;… (77768) |
$2,754 |
$5,508 |
7.1× |
| Remote afterloading high dose rate radionuclide skin surface brachytherapy, includes basic dosimetry, when performed;… (77767) |
$2,754 |
$5,508 |
7.1× |
| Renal Cyst Study (74470) |
$534.50 |
$1,069 |
1.0× |
| Ribs bilateral 3 views (71110) |
$493.50 |
$987 |
4.7× |
| Rp loclzj tum plnr 1 area single day imaging (78800) |
$1,181.50 |
$2,363 |
2.9× |
| Rp loclzj tum plnr 2+area 1+d img/1 area img>2+d (78801) |
$816 |
$1,632 |
2.0× |
| Rp Loclzj Tum Plnr Whole Body 2+ Days Imaging (78804) |
$1,632.50 |
$3,265 |
3.0× |
| Rp Loclzj Tum Plnr Whole Body Single Day Imaging (78802) |
$1,717.50 |
$3,435 |
3.1× |
| Rp Loclzj Tum Spect 1 Area Single Day Imaging (78803) |
$1,717.50 |
$3,435 |
3.1× |
| Rp loclzj tum spect 2 area/sep acquisj img (78831) |
$1,717.50 |
$3,435 |
1.3× |
| Rp loclzj tum spect CT 2area 1d img/1 ar img>2+d (78832) |
$1,831.50 |
$3,663 |
1.3× |
| Rp loclzj tum spect w/CT 1 area/acquisj 1day img (78830) |
$1,717.50 |
$3,435 |
1.3× |
| Rp Ther Radiolbld Monoclonal Antibody IV Infus (79403) |
$1,565 |
$3,130 |
6.7× |
| Rp Therapy Intravenous Administration (79101) |
$1,672.50 |
$3,345 |
7.1× |
| Salivary Gland Function Study (78232) |
$780 |
$1,560 |
1.9× |
| Scapula (73010) |
$263.50 |
$527 |
2.5× |
| Screening Digital Breast Tomosynthesis Bi (77063) |
$135 |
$270 |
5.8× |
| Sella turcica (70240) |
$501.50 |
$1,003 |
5.7× |
| Shoulder 1 view (73020) |
$324 |
$648 |
3.7× |
| Shoulder Arthrography (73040) |
$416 |
$832 |
1.2× |
| Sialogram (70390) |
$300.50 |
$601 |
1.3× |
| Skull less than 4 views (70250) |
$501.50 |
$1,003 |
4.8× |
| Special dosimetry (77331) |
$346.50 |
$693 |
2.6× |
| Special Physics Consult (77370) |
$812.50 |
$1,625 |
6.0× |
| Special teletherapy port plan (77321) |
$1,166 |
$2,332 |
3.1× |
| Special treatment procedure (77470) |
$2,966 |
$5,932 |
5.3× |
| Stereotactic Body Radiation Delivery (77373) |
$2,921 |
$5,842 |
1.6× |
| Sternoclavicular joints (71130) |
$347.50 |
$695 |
4.0× |
| Superior sagittal sinus venogram (75870) |
$1,749.50 |
$3,499 |
0.6× |
| Tbs technical calculation only (77091) |
$89.50 |
$179 |
1.0× |
| Telethx isodose pln cplx w/basic dosimetry (77307) |
$2,335.50 |
$4,671 |
6.2× |
| Telethx isodose pln smpl w/dosimetry calculation (77306) |
$1,606.50 |
$3,213 |
4.3× |
| Temporomandble Jt Arthrography Rs&I (70332) |
$452 |
$904 |
1.9× |
| Testicular Imaging W/Flow (78761) |
$837.50 |
$1,675 |
2.1× |
| Ther Rad Simulaj-Aided Field Setting Complex (77290) |
$3,679.50 |
$7,359 |
9.8× |
| Ther rad simulaj-aided field setting simple (77280) |
$3,679.50 |
$7,359 |
27.2× |
| Therapeutic Enema Rdctj Intussusception/Obstrcj (74283) |
$981.50 |
$1,963 |
5.6× |
| Thoracic spine 2 views (72070) |
$373 |
$746 |
3.5× |
| Thoracic spine 3 views (72072) |
$467 |
$934 |
4.4× |
| Thoracolumbar 2 views (72080) |
$373 |
$746 |
4.3× |
| Thyroid Imaging With Vascular Flow (78013) |
$816 |
$1,632 |
2.0× |
| Thyroid Met Imaging Body (78018) |
$816 |
$1,632 |
1.5× |
| Thyroid Uptake Measurement (78012) |
$816 |
$1,632 |
2.0× |
| Thyroid Uptake W/Blood Flow Sngle/Mult Quan Meas (78014) |
$816 |
$1,632 |
2.0× |
| Tx Devices Design & Construction Complex (77334) |
$3,679.50 |
$7,359 |
9.8× |
| Tx devices design & construction intermediate (77333) |
$1,226.50 |
$2,453 |
9.1× |
| Tx devices design & construction simple (77332) |
$820 |
$1,640 |
6.1× |
Ultrasound Breast Limited (76642)
range across 8 matching MRF lines |
$180–$288.50 |
$360–$577 |
varies |
| Ultrasound Elastography Parenchyma (76981) |
$387 |
$774 |
3.7× |
| Ultrasound Exam Aaa Screen (76706) |
$506.50 |
$1,013 |
4.8× |
| Ultrasound, abdomen limited (76705) |
$506.50 |
$1,013 |
4.8× |
| Umbilical-artery Doppler (OB) (76820) |
$357 |
$714 |
3.4× |
| Upper gi w/o kub (74240) |
$707.50 |
$1,415 |
4.0× |
| Ureteral Reflux Study (78740) |
$475.50 |
$951 |
1.2× |
| Urethrocystogram voiding (74455) |
$547.50 |
$1,095 |
2.3× |
| Urethrocystography retrograde (74450) |
$442.50 |
$885 |
1.8× |
Us breast unilateral complete (76641)
range across 2 matching MRF lines |
$277.50–$499.50 |
$555–$999 |
varies |
| Us chest (76604) |
$188 |
$376 |
1.8× |
| Us exam, pelvic, limited (76857) |
$330.50 |
$661 |
3.1× |
| Us head (76506) |
$715.50 |
$1,431 |
6.8× |
| Us kidney transplant (76776) |
$595.50 |
$1,191 |
5.7× |
| Us lmtd joint/oth nonvasc xtr strux r-t w/img (76882) |
$506.50 |
$1,013 |
4.8× |
| Us ob detailed single fetus (76811) |
$1,023 |
$2,046 |
4.3× |
| Us ob limited 1 or more fetuses (76815) |
$478.50 |
$957 |
4.5× |
| Us ob transvaginal (76817) |
$414.50 |
$829 |
3.9× |
| Us pelvic non ob complete (76856) |
$629.50 |
$1,259 |
6.0× |
| Us pg uter img f&mat 14 wk tabdl 1/1st gestation (76801) |
$531.50 |
$1,063 |
5.1× |
| Us preg uterus real time f/u trnsabdl per fetus (76816) |
$363 |
$726 |
3.5× |
| Us retroperitoneal complete (76770) |
$708 |
$1,416 |
6.7× |
| Us retroperitoneal limited (76775) |
$549.50 |
$1,099 |
5.2× |
| Us scrotum and contents (76870) |
$573.50 |
$1,147 |
5.5× |
| Us spinal canal and contents (76800) |
$463 |
$926 |
4.4× |
| Us thyroid (76536) |
$497 |
$994 |
4.7× |
| Us transrectal (76872) |
$661.50 |
$1,323 |
6.3× |
| Vein X-Ray Chest (75827) |
$1,749.50 |
$3,499 |
1.1× |
| Vein X-Ray Liver W/O Hemodyn (75887) |
$1,895 |
$3,790 |
0.6× |
| Vein X-Ray Skull Epidural (75872) |
$1,746.50 |
$3,493 |
2.8× |
| Vein X-Ray Spleen/Liver (75810) |
$1,749.50 |
$3,499 |
0.6× |
| Venogram Sinus/Jugular (75860) |
$1,810.50 |
$3,621 |
0.6× |
| Venography Adrenal Unilateral (75840) |
$1,749.50 |
$3,499 |
0.6× |
| Venography caval inferior serialography rs&i (75825) |
$3,066 |
$6,132 |
1.0× |
| Venography extremity bilateral rs&i (75822) |
$1,441.50 |
$2,883 |
0.9× |
| Venography extremity unilateral rs&i (75820) |
$1,163 |
$2,326 |
0.7× |
| Venography Orbital Rs&I (75880) |
$629.50 |
$1,259 |
1.0× |
| Venography Renal Bilateral (75833) |
$1,917 |
$3,834 |
0.6× |
| Venography Renal Unilateral (75831) |
$2,583.50 |
$5,167 |
0.8× |
| Venous sampling by catheter (75893) |
$3,738.50 |
$7,477 |
0.7× |
| Wrist 2 views (73100) |
$318.50 |
$637 |
3.6× |
| X-Ray Ac Jts - Xr Acromioclavicular Joints Bilateral (73050) |
$351.50 |
$703 |
4.0× |
| X-ray antegrade pyelogram tube (74425) |
$505 |
$1,010 |
1.4× |
| X-Ray Aorta Leg Arteries (75630) |
$3,583 |
$7,166 |
1.1× |
| X-Ray Bend Only L-S Spine (72120) |
$467 |
$934 |
4.4× |
| X-Ray Elbow 2 Vw - Xr Elbow 1-2 Views Right (73070) |
$324 |
$648 |
3.7× |
| X-Ray Exam Breast Specimen (76098) |
$434.50 |
$869 |
0.8× |
| X-Ray Exam Entire Spi 1 Vw (72081) |
$251 |
$502 |
2.9× |
| X-Ray Exam Entire Spi 2/3 Vw (72082) |
$467 |
$934 |
4.4× |
| X-Ray Exam Entire Spi 4/5 Vw (72083) |
$531 |
$1,062 |
5.0× |
| X-Ray Exam Hip Uni 1 View (73501) |
$250.50 |
$501 |
2.9× |
| X-Ray Exam Hip Uni 2-3 Views (73502) |
$418 |
$836 |
4.8× |
| X-Ray Exam Hip Uni 4/> Views (73503) |
$574 |
$1,148 |
5.5× |
| X-Ray Exam Hips Bi 2 Views (73521) |
$501.50 |
$1,003 |
4.8× |
| X-Ray Exam Hips Bi 3-4 Views (73522) |
$574 |
$1,148 |
5.5× |
| X-Ray Exam Hips Bi 5/> Views (73523) |
$752 |
$1,504 |
7.1× |
| X-Ray Exam L-S Spine Bending (72114) |
$428.50 |
$857 |
4.1× |
X-Ray Exam Neck Spine 2-3 Vw (72040)
range across 2 matching MRF lines |
$373–$467 |
$746–$934 |
varies |
| X-Ray Exam Neck Spine 6/>Vws (72052) |
$1,080 |
$2,160 |
10.3× |
| X-Ray Exam Unilat Ribs/Chest (71101) |
$300.50 |
$601 |
2.9× |
| X-ray eye for foreign body (70030) |
$293.50 |
$587 |
3.4× |
| X-ray humerus (73060) |
$283.50 |
$567 |
3.2× |
| X-ray IV pyelogram (ivp) (74400) |
$756.50 |
$1,513 |
4.3× |
| X-Ray Knee Bilat Standing - Xr Knees Anteroposterior Standing Bilat (73565) |
$204 |
$408 |
2.3× |
X-Ray Lumbar Spine 2/3 Vw - Xr Lumbar Spine 2-3 Views (72100)
range across 2 matching MRF lines |
$373–$467 |
$746–$934 |
varies |
| X-ray nose-rectum child f.b. (76010) |
$60.50 |
$121 |
0.7× |
| X-Ray Ribs, Chest 4+ Vw - Xr Ribs 3 Vws Bil W/ Chest Posteroanterior (71111) |
$589.50 |
$1,179 |
5.6× |
| X-Ray Sacroiliac Jts 3+ Vw - Xr Sacroiliac Joints 3+ Views (72202) |
$353 |
$706 |
3.4× |
| X-Ray Sacrum/Coccyx 2+ Vw - Xr Sacrum Coccyx 2+ Views (72220) |
$353 |
$706 |
4.0× |
| X-Ray Sinuses 3+ Vw - Xr Paranasal Sinuses 3+ Views (70220) |
$422 |
$844 |
4.8× |
| X-Ray Skull 4+ Vw - Xr Skull Complete 4+ Views (70260) |
$547.50 |
$1,095 |
5.2× |
| X-Ray Urinary Tract Exam With Contrast Material (74420) |
$505 |
$1,010 |
1.4× |
| X-Rays Bone Length Studies (77073) |
$491 |
$982 |
4.7× |
| X-Rays Bone Survey Complete (77075) |
$1,170.50 |
$2,341 |
11.1× |
| Xr c-spine 4 or 5 views (72050) |
$706 |
$1,412 |
6.7× |
| Xr facial bones less than 3 views (70140) |
$353 |
$706 |
4.0× |
| Xr orbits complete 4 views (70200) |
$442 |
$884 |
4.2× |