| 3-D radiotherapy plan dose-volume histograms (77295) |
$3,649.50 |
$7,299 |
2.8× |
| Abdomen 1 View (74018) |
$124 |
$248 |
1.5× |
| Abdomen 2 views (74019) |
$197 |
$394 |
2.0× |
| Acute Gastrointestinal Blood Loss Imaging (78278) |
$729.50 |
$1,459 |
2.0× |
| Adrenal Cortex & Medulla Img (78075) |
$1,416 |
$2,832 |
1.2× |
| Angio internal mammary (75756) |
$1,513 |
$3,026 |
0.5× |
| Angio pulmonary bilat (75743) |
$2,120.50 |
$4,241 |
0.7× |
| Angiography Adrenal Bilateral Slctv Rs&I (75733) |
$2,234.50 |
$4,469 |
0.8× |
| Angiography extremity bilateral rs&i (75716) |
$2,439.50 |
$4,879 |
0.8× |
| Angiography extremity unilateral rs&i (75710) |
$2,439.50 |
$4,879 |
0.8× |
| Angiography pulmonary unilateral slctv rs&i (75741) |
$1,410.50 |
$2,821 |
0.5× |
| Angrph pulmonary nonslctv cath/ven njx rs&i (75746) |
$1,679.50 |
$3,359 |
0.6× |
| Ankle 2 views (73600) |
$178 |
$356 |
2.2× |
Aortography thoracic serialography rs&i (75605)
unusually low: confirm this is the full procedure |
$2,084 |
$4,168 |
0.4× |
Artery X-Rays Abdomen (75726)
unusually low: confirm this is the full procedure |
$2,084 |
$4,168 |
0.4× |
| Artery X-Rays Adrenal Gland (75731) |
$1,679.50 |
$3,359 |
0.6× |
Artery X-Rays Pelvis (75736)
unusually low: confirm this is the full procedure |
$2,531 |
$5,062 |
0.5× |
Artery X-Rays Spine (75705)
unusually low: confirm this is the full procedure |
$2,084 |
$4,168 |
0.4× |
| Arthrogram ankle (73615) |
$800 |
$1,600 |
2.5× |
| Arthrogram hip (73525) |
$679 |
$1,358 |
2.1× |
| Arthrogram Wrist (73115) |
$918.50 |
$1,837 |
2.8× |
| Basic radiation dosimetry calculation (77300) |
$389 |
$778 |
3.1× |
| Bone age studies (77072) |
$178 |
$356 |
1.8× |
| Bone Imaging 3 Phase (78315) |
$1,033 |
$2,066 |
2.8× |
| Bone Imaging Limited Area (78300) |
$565 |
$1,130 |
1.5× |
| Bone Imaging Whole Body (78306) |
$1,033 |
$2,066 |
2.8× |
| Bone marrow imaging; whole body (78104) |
$354.50 |
$709 |
1.0× |
| Bone survey infant (77076) |
$163 |
$326 |
1.7× |
| Brachytx isodose complex (77318) |
$937.50 |
$1,875 |
2.7× |
| Brachytx isodose intermed (77317) |
$638 |
$1,276 |
1.8× |
| Brachytx Isodose Plan Simple (77316) |
$488.50 |
$977 |
1.4× |
| Brain Flow Imaging Only (78610) |
$549.50 |
$1,099 |
1.1× |
| Brain imaging < 4 static views (78600) |
$366 |
$732 |
1.0× |
| Brain Imaging Min 4 Static Views W Vascular Flow (78606) |
$447 |
$894 |
0.9× |
| Brain Imaging Pet Metabolic Evaluation (78608) |
$3,340 |
$6,680 |
2.5× |
| Cardiac MRI w/w/o contrast & further seq (75561) |
$477 |
$954 |
1.5× |
| Cardiac MRI w/w/o contrast w/stress (75563) |
$461.50 |
$923 |
0.6× |
| Cardiac Shunt Detection (78428) |
$323.50 |
$647 |
0.9× |
| Cat Scan Follow-Up Study (76380) |
$453 |
$906 |
5.6× |
| Cerebrospinal Fluid Flow W/O Matl Shunt Evaltj (78645) |
$679 |
$1,358 |
1.3× |
| Cerebrospinal Fluid Scan (78630) |
$872.50 |
$1,745 |
1.7× |
| Chest 1 view (71045) |
$207 |
$414 |
2.6× |
| Chest 2 views (71046) |
$248 |
$496 |
3.1× |
| Chest 3 views (71047) |
$289.50 |
$579 |
3.6× |
| Chest 4 or more views (71048) |
$344.50 |
$689 |
3.5× |
Chg us nrv&acc strux 1 xtr compre w/img pr extremity (76883)
range across 2 matching MRF lines |
$108.50–$132.50 |
$217–$265 |
varies |
| Cholecystography Oral Contrast (74290) |
$98 |
$196 |
0.6× |
| Cineradiograpy/vidradiograpy xcpt where spec (76120) |
$78.50 |
$157 |
0.8× |
| Cisternography Positive Contrast Rs&I (70015) |
$505 |
$1,010 |
0.7× |
| Clavicle complete (73000) |
$175 |
$350 |
2.2× |
| Computed Tomography Thorax Lw Dose Lng Ca Scr C- (71271) |
$64 |
$128 |
0.7× |
| Continuing medical physics consltj pr wk (77336) |
$482 |
$964 |
3.9× |
| Contrast Exam Abdominl Aorta (75625) |
$1,954 |
$3,908 |
0.7× |
| Contrast X-Ray Bladder (74430) |
$236 |
$472 |
0.7× |
| Contrast X-Ray Of Elbow (73085) |
$662.50 |
$1,325 |
2.0× |
| Contrast X-Ray Of Knee Joint (73580) |
$940 |
$1,880 |
2.9× |
| Contrast Xray Throat/Cerv Esopha (74210) |
$184.50 |
$369 |
1.1× |
| CT abdomen and pelvis without and with contrast (74178) |
$2,790.50 |
$5,581 |
8.6× |
| CT abdomen and pelvis without contrast (74176) |
$1,565.50 |
$3,131 |
7.1× |
| CT abdomen w contrast (74160) |
$1,042 |
$2,084 |
6.4× |
| CT abdomen w wo contrast (74170) |
$1,442 |
$2,884 |
8.8× |
| CT abdomen w/o contrast (74150) |
$739.50 |
$1,479 |
7.6× |
| CT Angio Abdomen and Pelvis (74174) |
$406.50 |
$813 |
1.3× |
| CT Angio Chest (71275) |
$1,314 |
$2,628 |
8.1× |
| CT Angio Head (70496) |
$1,353.50 |
$2,707 |
8.3× |
| CT angio hrt w/3d image (75574) |
$1,576.50 |
$3,153 |
4.9× |
| Ct Angio Lwr Extr W/O&W/Dye (73706) |
$1,077 |
$2,154 |
6.6× |
| CT Angio Neck (70498) |
$840.50 |
$1,681 |
5.2× |
| Ct Angio Upr Extrm W/O&W/Dye (73206) |
$996 |
$1,992 |
6.1× |
| CT cervical spine w/ contrast (72126) |
$705.50 |
$1,411 |
2.2× |
| CT cervical spine w/o contrast (72125) |
$652 |
$1,304 |
6.7× |
| CT cervical spine w/wo cont (72127) |
$734.50 |
$1,469 |
4.5× |
| CT chest w contrast (71260) |
$954 |
$1,908 |
5.8× |
| CT chest w/wo contrast (71270) |
$1,162 |
$2,324 |
7.1× |
| CT Colonogrphy Dx Image Postprocess W/Contrast (74262) |
$229 |
$458 |
1.4× |
| CT colonogrphy dx image postprocess w/o contrast (74261) |
$151 |
$302 |
1.6× |
| CT head/brain with contrast (70460) |
$685.50 |
$1,371 |
4.2× |
| CT head/brain without and with contrast (70470) |
$908.50 |
$1,817 |
5.6× |
| CT heart contrast eval cardiac structure&morph (75572) |
$1,444.50 |
$2,889 |
4.5× |
| CT heart no contrast quant eval coronry calcium (75571) |
$65 |
$130 |
0.8× |
| CT hrt w/3d image congen (75573) |
$1,444.50 |
$2,889 |
4.5× |
| CT iac w contrast (70481) |
$972 |
$1,944 |
6.0× |
| CT l-spine w&w/o contrast (72133) |
$1,267.50 |
$2,535 |
7.8× |
| CT lower ext w/o (73700) |
$699.50 |
$1,399 |
7.2× |
| CT lower extremity w/contrast material (73701) |
$868.50 |
$1,737 |
5.3× |
| CT lumbar spine w contrast (72132) |
$1,014 |
$2,028 |
3.1× |
| CT lumbar spine w/o contrast (72131) |
$937 |
$1,874 |
9.6× |
| CT maxillofacial w contrast (70487) |
$939.50 |
$1,879 |
5.8× |
| CT maxillofacial wo contrast (70486) |
$783 |
$1,566 |
8.1× |
| CT neck tissue combo (70492) |
$1,293.50 |
$2,587 |
7.9× |
| Ct Orbit/Ear/Fossa W/O&W/Dye (70482) |
$1,127 |
$2,254 |
6.9× |
| CT orbits w/o contrast (70480) |
$811 |
$1,622 |
8.3× |
| CT pelvis w&w/o contrast (72194) |
$1,349 |
$2,698 |
8.3× |
| CT pelvis w/o contrast (72192) |
$827.50 |
$1,655 |
8.5× |
| CT scan of leg combo (73702) |
$1,105 |
$2,210 |
6.8× |
| CT scans face/jaw combo (70488) |
$1,241.50 |
$2,483 |
7.6× |
| CT soft tissue neck w contrast (70491) |
$970 |
$1,940 |
5.9× |
| CT soft tissue neck w/o contrast (70490) |
$839 |
$1,678 |
8.6× |
| CT thoracic spine w contrast (72129) |
$1,009 |
$2,018 |
6.2× |
| CT thoracic spine w/o contrast (72128) |
$932 |
$1,864 |
9.6× |
| CT thoracic spine w/wo cont (72130) |
$1,052.50 |
$2,105 |
6.5× |
| CT thorax w/o contrast (71250) |
$898 |
$1,796 |
9.2× |
CT unlisted procedure (76497)
range across 2 matching MRF lines |
$67.50–$563.50 |
$135–$1,127 |
varies |
| CT upper ext wo (73200) |
$709 |
$1,418 |
7.3× |
| CT upper extremity w/o & w/contrast material (73202) |
$927 |
$1,854 |
5.7× |
| CT upper extremity with contrast (73201) |
$877.50 |
$1,755 |
2.7× |
| Cta Abdl Aorta&Bi Iliofem W/Contrast&Postp (75635) |
$307 |
$614 |
1.9× |
| Cta Abdomen (74175) |
$1,087 |
$2,174 |
6.7× |
| CTA pelvis (72191) |
$926 |
$1,852 |
5.7× |
| Dacryocystography, nasolacrimal duct, radiological supervision and interpretation Non-Facility (70170) |
$164 |
$328 |
0.7× |
| Dilation ureters/urethra rs&i (74485) |
$832 |
$1,664 |
0.4× |
| Discography Cerv/Thor Spine (72285) |
$1,506 |
$3,012 |
0.8× |
| Diskography lumbar (72295) |
$1,506 |
$3,012 |
0.8× |
| Doppler Echo Fetal Puls Spectral F/U/Repeat (76828) |
$319 |
$638 |
3.3× |
| Doppler Echo Fetal Spectral Display Complete (76827) |
$417.50 |
$835 |
4.3× |
| Doppler Fetal Mid Cerebral Artery (76821) |
$261.50 |
$523 |
2.7× |
| Dxa Bone Density Axial (77080) |
$221 |
$442 |
2.3× |
| Dxa bone density study (77085) |
$351 |
$702 |
3.6× |
| Dxa bone density study 1/>sites appendiclr skel (77081) |
$61 |
$122 |
0.8× |
| Echo exam of fetal heart (76825) |
$367.50 |
$735 |
0.7× |
| Echo exam uterus (76831) |
$331.50 |
$663 |
1.5× |
| Echo Guide For Artery Repair (76936) |
$123 |
$246 |
0.6× |
| Echocardiography, fetal, cardiovascular system, real time with image documentation (2D), with or without M-mode… (76826) |
$268.50 |
$537 |
1.2× |
| Esophagram (74220) |
$272.50 |
$545 |
1.7× |
| Fetal Biophys Profile W/Nst (76818) |
$334 |
$668 |
3.4× |
| Fetal Biophysical Profile W/O Non-Stress Testing (76819) |
$225 |
$450 |
2.3× |
| Fetal MRI w/placntl matrnl plvc img sing/1st ges (74712) |
$221 |
$442 |
1.0× |
| Fluoroscopy up to 1 hr (76000) |
$407 |
$814 |
1.8× |
| Follow-Up Angiography (75898) |
$523 |
$1,046 |
0.2× |
| Foot 2 views (73620) |
$173 |
$346 |
2.1× |
| Forearm 2 views (73090) |
$178 |
$356 |
2.2× |
| Gastric emptying imaging study (78264) |
$861.50 |
$1,723 |
2.3× |
| Gastric Emptyng Imag Std W/Sm Bwl Transit (78265) |
$861.50 |
$1,723 |
2.3× |
| Gastroesophageal Reflux Exam (78262) |
$637.50 |
$1,275 |
1.7× |
| Gated Heart Planar Single (78472) |
$875.50 |
$1,751 |
2.4× |
| GI Endoscopic US S&I (76975) |
$280 |
$560 |
1.3× |
| Gstrc Emptng Imag Std W/Sm Bwl Col Trnst Mlt Day (78266) |
$912 |
$1,824 |
1.8× |
| Hand 2 views (73120) |
$163 |
$326 |
1.7× |
| Hdr Rdncl Ntrstl/Icav Brchtx (77772) |
$1,607.50 |
$3,215 |
2.5× |
| Hdr Rdncl Ntrstl/Icav Brchtx (77771) |
$1,541 |
$3,082 |
2.4× |
| Hdr Rdncl Ntrstl/Icav Brchtx 1 Channel (77770) |
$1,475.50 |
$2,951 |
2.3× |
| Heart Image (Pet) Multiple (78492) |
$3,109.50 |
$6,219 |
2.3× |
| Hepatc Vngrph Wdg/Fr Hemodyn Eval Rs&I (75889) |
$2,229 |
$4,458 |
0.8× |
| Hepatc Vngrph Wdg/Fr W/O Hemodyn Eval Rs&I (75891) |
$1,428 |
$2,856 |
0.5× |
| Hepatobil Syst Image W/Drug (78227) |
$466.50 |
$933 |
0.9× |
| Hepatobiliary System Imaging (78226) |
$466.50 |
$933 |
1.3× |
| Ht Musc Image Planar Mult (78454) |
$1,361 |
$2,722 |
1.1× |
| Ht Muscle Image Spect Sing (78451) |
$842.50 |
$1,685 |
0.7× |
| Hysterosalpingogram (74740) |
$319 |
$638 |
1.4× |
| Infant hip ultrasound with hip movement (dynamic) (76885) |
$177 |
$354 |
2.2× |
| Infant hip ultrasound, limited static exam (76886) |
$154 |
$308 |
1.9× |
| Interstitial radiation source applic complex (77778) |
$1,937.50 |
$3,875 |
3.0× |
| Intracavitary Radiation Source Applic Complex (77763) |
$739 |
$1,478 |
1.1× |
| Intracavitary Radiation Source Applic Intermed (77762) |
$678.50 |
$1,357 |
1.3× |
| Intracavitary radiation source applic simple (77761) |
$633.50 |
$1,267 |
1.2× |
| Joint Survey Single View (77077) |
$102 |
$204 |
1.0× |
| K Flow/Funct Image Multiple (78709) |
$1,030.50 |
$2,061 |
2.0× |
| K Flow/Funct Image W/Drug (78708) |
$826 |
$1,652 |
1.6× |
| K Flow/Funct Image W/O Drug (78707) |
$826 |
$1,652 |
1.6× |
| Kidney Imaging Morphol (78700) |
$321.50 |
$643 |
0.9× |
| Kidney Imaging Morphoogy W/Vascular Flow (78701) |
$446.50 |
$893 |
1.2× |
| Knee 3 Views (73562) |
$191.50 |
$383 |
2.4× |
| Labeled RBC Sequestration Differntl Organ/Tissue (78140) |
$920 |
$1,840 |
2.5× |
| Leveen/Shunt Patency Exam (78291) |
$613 |
$1,226 |
1.6× |
| Liver & Spleen Imaging Static Only (78215) |
$931.50 |
$1,863 |
2.5× |
| Lung Perf&Ventilat Diferentl (78598) |
$504 |
$1,008 |
1.0× |
| Lung perfusion differential (78597) |
$322.50 |
$645 |
0.9× |
| Lung Ventilat&Perfus Imaging (78582) |
$504 |
$1,008 |
1.0× |
| Lung Ventilation Imaging (78579) |
$322.50 |
$645 |
0.9× |
| Lymph System Imaging (78195) |
$709 |
$1,418 |
1.4× |
| Lymphangiography Extremity Only Bilateral Rs&I (75803) |
$795.50 |
$1,591 |
0.5× |
| Lymphangiography Pelvic/Abdominal Bilateral Rs&I (75807) |
$1,259 |
$2,518 |
0.4× |
| Lymphangiography, pelvic/abdominal, unilateral (75805) |
$639.50 |
$1,279 |
0.2× |
| Magnetic Image Jaw Joint (70336) |
$1,236.50 |
$2,473 |
5.6× |
| Magnetic resonance (eg, proton) imaging, brain (including brain stem andskull base), during open intracranial procedure… (70557) |
$207.50 |
$415 |
0.4× |
| Magnetic Resonance Elastography (76391) |
$264 |
$528 |
1.2× |
| Mammary ductogram or galactogram multiple (77054) |
$289.50 |
$579 |
1.3× |
| Mammary ductogram or galactogram single (77053) |
$248 |
$496 |
1.1× |
| Meckels Divert Exam (78290) |
$571 |
$1,142 |
1.5× |
| Mlc imrt design & construction per imrt plan (77338) |
$1,357.50 |
$2,715 |
3.9× |
| Mra Head W/O & W/Contrast Material (70546) |
$1,091.50 |
$2,183 |
3.4× |
| MRA head w/o contrast (70544) |
$595.50 |
$1,191 |
2.7× |
| MRA head with contrast (70545) |
$708 |
$1,416 |
2.2× |
| MRA neck w contrast (70548) |
$611.50 |
$1,223 |
1.9× |
| Mra Neck W/O &W/Contrast Material (70549) |
$672 |
$1,344 |
2.1× |
| MRA neck w/o contrast (70547) |
$556 |
$1,112 |
2.5× |
| MRI abdomen w contrast (74182) |
$771 |
$1,542 |
2.4× |
| MRI abdomen w/o contrast (74181) |
$650 |
$1,300 |
2.9× |
| MRI any jt lower extrem w/contrast material (73722) |
$957 |
$1,914 |
1.3× |
| MRI any jt lower extrem w/o & w/contrast matrl (73723) |
$1,658 |
$3,316 |
5.1× |
| MRI any jt upper extremity w/contrast matrl (73222) |
$928 |
$1,856 |
1.3× |
| MRI brain functional w/o physician admnistration (70554) |
$224 |
$448 |
1.0× |
| MRI brain functional w/physician admnistration (70555) |
$224 |
$448 |
1.0× |
| MRI Breast W/O Contrast Bilateral (77047) |
$849 |
$1,698 |
3.8× |
| MRI Breast Without Contrast Material Unilateral (77046) |
$636.50 |
$1,273 |
2.9× |
| MRI cardiac w/o contrast (75557) |
$312.50 |
$625 |
1.4× |
| MRI cervical spine w contrast (72142) |
$724.50 |
$1,449 |
2.2× |
| MRI cervical spine w/o cont (72141) |
$644 |
$1,288 |
2.9× |
| MRI chest w/o contrast (71550) |
$717 |
$1,434 |
3.2× |
| MRI chest with contrast (71551) |
$912 |
$1,824 |
1.3× |
| MRI chest wo w contrast (71552) |
$1,555 |
$3,110 |
4.8× |
| MRI lower extrem oth/thn jt w/contrast matrl (73719) |
$848.50 |
$1,697 |
2.6× |
| MRI lower extrem oth/thn jt w/o & w/contr matr (73720) |
$1,492 |
$2,984 |
4.6× |
| MRI lower extrem oth/thn jt w/o contr matrl (73718) |
$718.50 |
$1,437 |
3.2× |
| MRI lumbar spine w contrast (72149) |
$935 |
$1,870 |
2.9× |
| Mri Neck Spine W/O & W/Dye (72156) |
$920 |
$1,840 |
2.8× |
| MRI orbit face &/neck w/o contrast (70540) |
$668 |
$1,336 |
3.0× |
| MRI orbit face neck w contrast (70542) |
$734.50 |
$1,469 |
2.3× |
| Mri Orbt/Fac/Nck W/O &W/Dye (70543) |
$808 |
$1,616 |
2.5× |
| MRI pelvis w contrast (72196) |
$778 |
$1,556 |
2.4× |
| MRI pelvis w/o & w contrast (72197) |
$1,783 |
$3,566 |
5.5× |
| MRI pelvis w/o contrast (72195) |
$579 |
$1,158 |
2.6× |
| MRI spectroscopy (76390) |
$1,033.50 |
$2,067 |
12.8× |
| MRI thoracic spine w/o contrast (72146) |
$830.50 |
$1,661 |
3.7× |
| MRI upper extremity oth than jt w/contr matrl (73219) |
$908 |
$1,816 |
2.8× |
| MRI upper extremity oth than jt w/o contr matrl (73218) |
$798.50 |
$1,597 |
3.6× |
| Mri Uppr Extremity W/O&W/Dye (73220) |
$1,543.50 |
$3,087 |
4.8× |
| MRI, abdomen, combo (74183) |
$1,475 |
$2,950 |
4.5× |
| MRI, dorsal spine combo (72157) |
$1,187 |
$2,374 |
3.7× |
| MRI, dorsal spine contrast (72147) |
$935 |
$1,870 |
2.9× |
| MRI, joint upper extrem (73221) |
$809 |
$1,618 |
3.6× |
| MRI, joint upper extrem combo (73223) |
$1,658 |
$3,316 |
5.1× |
| MRI, lumbar spine combo (72158) |
$1,187 |
$2,374 |
3.7× |
| Myelogram cervical (72240) |
$1,432.50 |
$2,865 |
2.0× |
| Myelogram Lumbar (72265) |
$1,404 |
$2,808 |
1.9× |
| Myelography thoracic (72255) |
$1,139.50 |
$2,279 |
1.6× |
| Myelograpy 2/more regions rs&i (72270) |
$1,879 |
$3,758 |
2.6× |
| Myocardial Imaging Pet Metabolic Evaluation (78459) |
$2,879.50 |
$5,759 |
2.4× |
| Myocardial Perfusion Planar 1 Study Rest/Stress (78453) |
$1,361 |
$2,722 |
1.1× |
| Myocardial Spect Multiple Studies (78452) |
$1,556 |
$3,112 |
1.3× |
| Myocrd Img Pet Metab Eval Single Study Cncrnt CT (78429) |
$1,463.50 |
$2,927 |
1.1× |
| Myocrd img PET prfuj 1std rest/stress cncrnt CT (78430) |
$1,463.50 |
$2,927 |
1.1× |
| Myocrd Img Pet Prfuj Mlt Std Rst&Strs Cncrnt CT (78431) |
$2,282 |
$4,564 |
1.1× |
| Myocrd Img Pet Prfuj W/Metab 2rtracer Cncrnt CT (78433) |
$2,788.50 |
$5,577 |
1.4× |
| Myocrd Img Pet Prfuj W/Metab Dual Radiotracer (78432) |
$2,788.50 |
$5,577 |
2.0× |
| Neck soft tissue (70360) |
$131.50 |
$263 |
1.6× |
| Nfs/Instlj Radioelmnt Sln 3 Mo Follow-Up Care (77750) |
$167.50 |
$335 |
0.5× |
| Nm whole blood volume (78122) |
$1,532 |
$3,064 |
3.0× |
| Nonvascular Shunt X-Ray (75809) |
$255 |
$510 |
2.6× |
| Ntsty modul radthx pln dose-vol histos (77301) |
$5,047 |
$10,094 |
3.9× |
| Nuclear medicine study of endocrine organs (78099) |
$249.50 |
$499 |
0.7× |
| Nuclear Rx Intra-Arterial (79445) |
$396.50 |
$793 |
1.8× |
| Nuclear Rx Oral Admin (79005) |
$717 |
$1,434 |
3.3× |
| Ob us nuchal meas 1 gest (76813) |
$172.50 |
$345 |
1.8× |
| Oph bmtry us echograpy a-scan io lens pwr cal (76519) |
$304 |
$608 |
3.1× |
| Oph us dx ant sgm us immersion b-scan/hr biom (76513) |
$209.50 |
$419 |
2.2× |
| Oph US Dx B-Scan&Quan a-Scan Sm Pt Enctr (76510) |
$126.50 |
$253 |
1.0× |
| Ophthalmic Biometry US Echograpy a-Scan (76516) |
$304 |
$608 |
3.1× |
| Ophthalmic ultrasound dx b-scan w/wo a-scan (76512) |
$209.50 |
$419 |
2.2× |
| Ophthalmic US Dx Corneal Pachymetry Uni/Bi (76514) |
$92 |
$184 |
3.4× |
| Ophthalmic us dx quantitative a-scan only (76511) |
$185.50 |
$371 |
1.9× |
| Panoramic X-ray of jaws (70355) |
$83.50 |
$167 |
1.0× |
| Parathyroid imaging w/tomographic spect & CT (78072) |
$1,016 |
$2,032 |
2.0× |
| Parathyroid Planar Imaging (78070) |
$733 |
$1,466 |
2.0× |
| Parathyroid planar imaging w/wo subtraction (78071) |
$805 |
$1,610 |
2.2× |
| Pelvis 1 or 2 views (72170) |
$146.50 |
$293 |
1.5× |
| Perineogram (74775) |
$236 |
$472 |
1.1× |
| Pet Image Skull-Thigh (78812) |
$1,239 |
$2,478 |
0.9× |
| Pet Image W/Ct Lmtd (78814) |
$846.50 |
$1,693 |
0.6× |
| PET image w/CT, full body (78816) |
$981.50 |
$1,963 |
0.7× |
| PET imaging CT attenuation skull base mid-thigh (78815) |
$981.50 |
$1,963 |
0.7× |
| Pet Imaging Limited Area Chest Head/Neck (78811) |
$1,128 |
$2,256 |
0.9× |
| Pet Myocardial Sngl Study (78491) |
$2,879.50 |
$5,759 |
2.2× |
| PET whole body (78813) |
$1,239 |
$2,478 |
0.9× |
| Prq Transhepatc Portograpy Hemodyn Eval Rs&I (75885) |
$2,439.50 |
$4,879 |
0.8× |
| Pulmonary Perfusion Imaging Particulate (78580) |
$569.50 |
$1,139 |
1.5× |
| Radex Abd Compl Aqt Abd W/S/E/D Views 1 View Ch (74022) |
$225 |
$450 |
2.3× |
| Radex abscess/fistula/sinus tract rs&i (76080) |
$240 |
$480 |
0.5× |
| Radex Ankle Complete Minimum 3 Views (73610) |
$197.50 |
$395 |
2.4× |
| Radex Calcaneus Minimum 2 Views (73650) |
$175.50 |
$351 |
2.2× |
| Radex elbow complete minimum 3 views (73080) |
$252.50 |
$505 |
3.1× |
| Radex Facial Bones Complete Minimum 3 Views (70150) |
$188 |
$376 |
1.9× |
| Radex fingr minimum 2 views (73140) |
$137.50 |
$275 |
1.7× |
| Radex foot complete minimum 3 views (73630) |
$199.50 |
$399 |
2.5× |
| Radex Hand Minimum 3 Views (73130) |
$178 |
$356 |
2.2× |
| Radex lower extremity infant minimum 2 views (73592) |
$97.50 |
$195 |
1.2× |
| Radex Mastoids Compl Minimum 3 Views PR Side (70130) |
$102 |
$204 |
1.0× |
| Radex Nasal Bones Complete Minimum 3 Views (70160) |
$178 |
$356 |
2.2× |
| Radex Pharynx/Larx W/Fluor&/Magnification Tq (70370) |
$175.50 |
$351 |
2.2× |
| Radex Ribs Unilateral 2 Views (71100) |
$171.50 |
$343 |
2.1× |
| Radex shoulder complete minimum 2 views (73030) |
$212.50 |
$425 |
2.6× |
| Radex Sinuses Paransl < 3 Views (70210) |
$178 |
$356 |
2.2× |
| Radex sm int w/mlt srl imges via enteroclss tube (74251) |
$155 |
$310 |
1.0× |
| Radex Spine 1 View Specify Level (72020) |
$117.50 |
$235 |
1.5× |
| Radex Sternum Minimum 2 Views (71120) |
$142 |
$284 |
1.8× |
| Radex Temporomandble Jt Opn & Clsd Mouth Bilat (70330) |
$122 |
$244 |
1.5× |
| Radex Toe Minimum 2 Views (73660) |
$135 |
$270 |
1.7× |
| Radex upper extremity infant minimum 2 views (73092) |
$73 |
$146 |
0.8× |
| Radex Wrist Complete Minimum 3 Views (73110) |
$192.50 |
$385 |
2.4× |
| Radex X-Ray Exam Entire Spi 6/> Vw - Xr Entire Spine 6+ Vw (72084) |
$476 |
$952 |
4.9× |
| Radiation Delivery Stereotactic Cranial Linear (77372) |
$7,861 |
$15,722 |
1.1× |
| Radiation treatment delivery level 1 (77402) |
$373 |
$746 |
3.9× |
| Radiation treatment delivery level 2 (77407) |
$488.50 |
$977 |
1.4× |
| Radiation treatment delivery level 3 (77412) |
$661 |
$1,322 |
1.3× |
| Radiolog exam mandible compl minimum 4 views (70110) |
$231 |
$462 |
2.4× |
| Radiologic Exam Abdomen 3+ Views - Xr Abdomen 3+ Views (74021) |
$243.50 |
$487 |
2.5× |
| Radiologic exam colon double contrast study (74280) |
$420.50 |
$841 |
2.6× |
| Radiologic exam colon single contrast study (74270) |
$347.50 |
$695 |
2.1× |
| Radiologic Exam Esophagus Double Contrast Study (74221) |
$272.50 |
$545 |
1.7× |
| Radiologic exam knee complete 4/more views (73564) |
$221.50 |
$443 |
2.3× |
| Radiologic exam pelvis compl minimum 3 views (72190) |
$212.50 |
$425 |
2.2× |
| Radiologic Exam Small Int Single Contrast Study (74250) |
$304.50 |
$609 |
1.9× |
| Radiologic exam swallow function contrast study (74230) |
$272.50 |
$545 |
1.7× |
| Radiologic exam teeth complete full mouth (70320) |
$157.50 |
$315 |
0.7× |
| Radiologic Exam Teeth Prtl Exam < Full Mouth (70310) |
$245.50 |
$491 |
1.1× |
Radiologic exam upr gi trc double contrast study (74246)
range across 2 matching MRF lines |
$332–$373.50 |
$664–$747 |
varies |
| Radiologic examination femur 1 view (73551) |
$61 |
$122 |
0.8× |
| Radiologic examination femur minimum 2 views (73552) |
$120 |
$240 |
1.5× |
| Radiologic examination knee 1/2 views (73560) |
$158 |
$316 |
2.0× |
| Radiologic Examination Osseous Survey Limited (77074) |
$185.50 |
$371 |
1.9× |
| Radiologic Examination Salivary Gland Calculus (70380) |
$71.50 |
$143 |
0.9× |
| Radiologic examination tibia & fibula 2 views (73590) |
$189 |
$378 |
2.3× |
| Radiologic examination, teeth; single view Non-Facility (70300) |
$66.50 |
$133 |
0.8× |
| Radiopharm Dacryocystography (78660) |
$354.50 |
$709 |
1.0× |
| Radiopharmaceutical therapy, by intracavitary administration Non-Facility (79200) |
$234.50 |
$469 |
1.1× |
| Remote afterloading high dose rate radionuclide skin surface brachytherapy, includes basic dosimetry, when performed;… (77768) |
$1,724 |
$3,448 |
4.8× |
| Remote afterloading high dose rate radionuclide skin surface brachytherapy, includes basic dosimetry, when performed;… (77767) |
$1,610.50 |
$3,221 |
4.5× |
| Renal Cyst Study (74470) |
$340 |
$680 |
0.7× |
| Ribs bilateral 3 views (71110) |
$192.50 |
$385 |
2.0× |
| Rp loclzj tum plnr 1 area single day imaging (78800) |
$363.50 |
$727 |
1.0× |
| Rp loclzj tum plnr 2+area 1+d img/1 area img>2+d (78801) |
$668 |
$1,336 |
1.8× |
| Rp Loclzj Tum Plnr Whole Body 2+ Days Imaging (78804) |
$856 |
$1,712 |
1.7× |
| Rp Loclzj Tum Plnr Whole Body Single Day Imaging (78802) |
$807 |
$1,614 |
1.6× |
| Rp Loclzj Tum Spect 1 Area Single Day Imaging (78803) |
$991.50 |
$1,983 |
2.0× |
| Rp loclzj tum spect 2 area/sep acquisj img (78831) |
$1,161.50 |
$2,323 |
1.0× |
| Rp loclzj tum spect CT 2area 1d img/1 ar img>2+d (78832) |
$1,316.50 |
$2,633 |
1.0× |
| Rp loclzj tum spect w/CT 1 area/acquisj 1day img (78830) |
$1,161.50 |
$2,323 |
1.0× |
| Rp Ther Radiolbld Monoclonal Antibody IV Infus (79403) |
$398.50 |
$797 |
1.8× |
| Rp Therapy Intravenous Administration (79101) |
$658.50 |
$1,317 |
3.0× |
| Salivary Gland Function Study (78232) |
$246.50 |
$493 |
0.7× |
| Salivary Gland Imaging Serial Images (78231) |
$364.50 |
$729 |
1.0× |
| Scapula (73010) |
$177.50 |
$355 |
1.8× |
| Screening Digital Breast Tomosynthesis Bi (77063) |
$358 |
$716 |
15.3× |
| Shoulder 1 view (73020) |
$153 |
$306 |
1.9× |
| Shoulder Arthrography (73040) |
$794 |
$1,588 |
2.4× |
| Sialogram (70390) |
$164 |
$328 |
0.7× |
| Skull less than 4 views (70250) |
$133 |
$266 |
1.4× |
| Special dosimetry (77331) |
$345 |
$690 |
2.8× |
| Special Physics Consult (77370) |
$1,138.50 |
$2,277 |
9.1× |
| Special teletherapy port plan (77321) |
$852 |
$1,704 |
2.4× |
| Special treatment procedure (77470) |
$1,682.50 |
$3,365 |
3.3× |
| Srs Multisource (77371) |
$29,123 |
$58,246 |
4.3× |
| Stereotactic Body Radiation Delivery (77373) |
$2,621.50 |
$5,243 |
1.6× |
| Sternoclavicular joints (71130) |
$166 |
$332 |
2.1× |
| Superior sagittal sinus venogram (75870) |
$1,291 |
$2,582 |
0.4× |
| Surface Applic Low Dose Rate Radionuclide Source (77789) |
$244.50 |
$489 |
2.6× |
| Telethx isodose pln cplx w/basic dosimetry (77307) |
$324 |
$648 |
0.9× |
| Telethx isodose pln smpl w/dosimetry calculation (77306) |
$324 |
$648 |
0.9× |
| Ther Rad Simulaj-Aided Field Setting Complex (77290) |
$1,462 |
$2,924 |
4.2× |
| Ther Rad Simulaj-Aided Field Setting Intermed (77285) |
$845.50 |
$1,691 |
2.4× |
| Ther rad simulaj-aided field setting simple (77280) |
$646 |
$1,292 |
5.2× |
| Therapeutic Enema Rdctj Intussusception/Obstrcj (74283) |
$717 |
$1,434 |
4.4× |
| Thoracic spine 2 views (72070) |
$187.50 |
$375 |
1.9× |
| Thoracic spine 3 views (72072) |
$231 |
$462 |
2.4× |
| Thoracolumbar 2 views (72080) |
$187.50 |
$375 |
2.3× |
| Thyroid Imaging With Vascular Flow (78013) |
$637.50 |
$1,275 |
1.7× |
| Thyroid Met Imaging Body (78018) |
$1,112 |
$2,224 |
2.2× |
| Thyroid Uptake Measurement (78012) |
$554.50 |
$1,109 |
1.5× |
| Thyroid Uptake W/Blood Flow Sngle/Mult Quan Meas (78014) |
$1,056.50 |
$2,113 |
2.8× |
| Tx Devices Design & Construction Complex (77334) |
$980 |
$1,960 |
2.8× |
| Tx devices design & construction intermediate (77333) |
$508 |
$1,016 |
4.1× |
| Tx devices design & construction simple (77332) |
$346.50 |
$693 |
2.8× |
| Ultrasound Breast Limited (76642) |
$424 |
$848 |
5.2× |
| Ultrasound elastography first target lesion (76982) |
$112 |
$224 |
1.2× |
| Ultrasound Elastography Parenchyma (76981) |
$112 |
$224 |
1.2× |
| Ultrasound Exam Aaa Screen (76706) |
$114 |
$228 |
1.2× |
| Ultrasound trgt dynamic microbubble 1st lesion (76978) |
$200 |
$400 |
0.6× |
| Ultrasound, abdomen limited (76705) |
$420 |
$840 |
4.3× |
| Umbilical-artery Doppler (OB) (76820) |
$261.50 |
$523 |
2.7× |
| Unlisted Dx Radiographic Procedure (76499) |
$346.50 |
$693 |
4.3× |
Unlisted fluoroscopic procedure (76496)
range across 3 matching MRF lines |
$151.50–$1,290 |
$303–$2,580 |
varies |
| Unlisted magnetic resonance procedure (76498) |
$448 |
$896 |
5.5× |
| Unlisted Miscellaneous Px Dx Nuclear Medicine (78999) |
$249.50 |
$499 |
0.7× |
| Unlisted respiratory px dx nuclear medicine (78599) |
$405 |
$810 |
1.1× |
Upper gi w/o kub (74240)
range across 2 matching MRF lines |
$347.50–$353 |
$695–$706 |
varies |
| Urea Breath Test C-14 Isotopic Acquisj Analysis (78267) |
$85 |
$170 |
7.7× |
| Urea breath test c-14 isotopic analysis (78268) |
$85 |
$170 |
0.9× |
| Ureteral Reflux Study (78740) |
$821 |
$1,642 |
2.2× |
| Urethrocystogram voiding (74455) |
$280 |
$560 |
1.3× |
| Urethrocystography retrograde (74450) |
$286 |
$572 |
1.3× |
| Us breast unilateral complete (76641) |
$448 |
$896 |
4.6× |
| Us chest (76604) |
$294 |
$588 |
3.0× |
| Us complete joint (76881) |
$126.50 |
$253 |
1.3× |
| Us exam, pelvic, limited (76857) |
$218 |
$436 |
2.2× |
| Us head (76506) |
$364.50 |
$729 |
3.7× |
| Us kidney transplant (76776) |
$233 |
$466 |
2.4× |
| Us lmtd joint/oth nonvasc xtr strux r-t w/img (76882) |
$82.50 |
$165 |
0.8× |
| Us ob detailed single fetus (76811) |
$298.50 |
$597 |
1.3× |
| Us ob limited 1 or more fetuses (76815) |
$231 |
$462 |
2.4× |
| Us ob transvaginal (76817) |
$202.50 |
$405 |
2.1× |
| Us pelvic non ob complete (76856) |
$373 |
$746 |
3.8× |
| Us pg uter img f&mat 14 wk tabdl 1/1st gestation (76801) |
$202.50 |
$405 |
2.1× |
| Us preg uterus real time f/u trnsabdl per fetus (76816) |
$282 |
$564 |
2.9× |
| Us retroperitoneal complete (76770) |
$359.50 |
$719 |
3.7× |
| Us retroperitoneal limited (76775) |
$230 |
$460 |
2.4× |
| Us scrotum and contents (76870) |
$388 |
$776 |
4.0× |
| Us spinal canal and contents (76800) |
$263 |
$526 |
2.7× |
| Us thyroid (76536) |
$352.50 |
$705 |
3.6× |
| Us transrectal (76872) |
$216 |
$432 |
2.2× |
| Vein X-Ray Chest (75827) |
$1,611.50 |
$3,223 |
1.1× |
| Vein X-Ray Liver W/O Hemodyn (75887) |
$1,674 |
$3,348 |
0.6× |
| Vein X-Ray Spleen/Liver (75810) |
$1,123 |
$2,246 |
0.4× |
| Venogram Sinus/Jugular (75860) |
$1,457.50 |
$2,915 |
0.5× |
| Venography Adrenal Unilateral (75840) |
$2,556 |
$5,112 |
0.9× |
| Venography caval inferior serialography rs&i (75825) |
$1,558 |
$3,116 |
0.5× |
| Venography extremity bilateral rs&i (75822) |
$1,084 |
$2,168 |
0.7× |
| Venography extremity unilateral rs&i (75820) |
$761 |
$1,522 |
0.5× |
| Venography Orbital Rs&I (75880) |
$849.50 |
$1,699 |
1.5× |
| Venography Renal Bilateral (75833) |
$1,955 |
$3,910 |
0.7× |
| Venography Renal Unilateral (75831) |
$1,550 |
$3,100 |
0.5× |
Venous sampling by catheter (75893)
unusually low: confirm this is the full procedure |
$2,084 |
$4,168 |
0.4× |
| Venous Thrombosis Imaging Venogram Bilateral (78458) |
$354.50 |
$709 |
1.0× |
| Vertebral fracture assessment via dxa (77086) |
$102.50 |
$205 |
1.3× |
| Wrist 2 views (73100) |
$139.50 |
$279 |
1.7× |
| X-Ray Ac Jts - Xr Acromioclavicular Joints Bilateral (73050) |
$146.50 |
$293 |
1.8× |
| X-ray antegrade pyelogram tube (74425) |
$236 |
$472 |
0.7× |
| X-Ray Aorta Leg Arteries (75630) |
$1,954 |
$3,908 |
0.7× |
| X-Ray Bend Only L-S Spine (72120) |
$228 |
$456 |
2.3× |
| X-Ray Elbow 2 Vw - Xr Elbow 1-2 Views Right (73070) |
$171.50 |
$343 |
2.1× |
| X-Ray Exam Breast Specimen (76098) |
$496 |
$992 |
1.0× |
| X-Ray Exam Entire Spi 1 Vw (72081) |
$187.50 |
$375 |
2.3× |
| X-Ray Exam Entire Spi 2/3 Vw (72082) |
$476 |
$952 |
4.9× |
| X-Ray Exam Entire Spi 4/5 Vw (72083) |
$476 |
$952 |
4.9× |
| X-Ray Exam Hip Uni 1 View (73501) |
$161 |
$322 |
2.0× |
| X-Ray Exam Hip Uni 2-3 Views (73502) |
$183.50 |
$367 |
2.3× |
| X-Ray Exam Hip Uni 4/> Views (73503) |
$275 |
$550 |
2.8× |
| X-Ray Exam Hips Bi 2 Views (73521) |
$246 |
$492 |
2.5× |
| X-Ray Exam Hips Bi 3-4 Views (73522) |
$306 |
$612 |
3.1× |
| X-Ray Exam Hips Bi 5/> Views (73523) |
$359 |
$718 |
3.7× |
| X-Ray Exam L-S Spine Bending (72114) |
$294 |
$588 |
3.0× |
| X-Ray Exam Neck Spine 2-3 Vw (72040) |
$197.50 |
$395 |
2.4× |
| X-Ray Exam Neck Spine 6/>Vws (72052) |
$411 |
$822 |
4.2× |
| X-Ray Exam Unilat Ribs/Chest (71101) |
$216 |
$432 |
2.2× |
| X-ray eye for foreign body (70030) |
$45.50 |
$91 |
0.6× |
| X-ray head for orthodontia (70350) |
$83.50 |
$167 |
1.0× |
| X-ray humerus (73060) |
$180 |
$360 |
2.2× |
| X-ray IV pyelogram (ivp) (74400) |
$399.50 |
$799 |
2.4× |
| X-ray IV pyelogram+tomography (74415) |
$439 |
$878 |
2.7× |
| X-Ray Jaw <4 Vw - Xr Mandible < 4 Views (70100) |
$212.50 |
$425 |
2.6× |
| X-Ray Knee Bilat Standing - Xr Knees Anteroposterior Standing Bilat (73565) |
$158 |
$316 |
2.0× |
| X-Ray Lumbar Spine 2/3 Vw - Xr Lumbar Spine 2-3 Views (72100) |
$242.50 |
$485 |
2.5× |
| X-Ray Ribs, Chest 4+ Vw - Xr Ribs 3 Vws Bil W/ Chest Posteroanterior (71111) |
$291 |
$582 |
3.0× |
| X-Ray Sacroiliac Jts 3+ Vw - Xr Sacroiliac Joints 3+ Views (72202) |
$197.50 |
$395 |
2.0× |
| X-Ray Sacroiliac Jts <3 Vw - Xr Sacroiliac Joints 1-2 Views (72200) |
$164.50 |
$329 |
1.7× |
| X-Ray Sacrum/Coccyx 2+ Vw - Xr Sacrum Coccyx 2+ Views (72220) |
$180 |
$360 |
2.2× |
| X-Ray Sinuses 3+ Vw - Xr Paranasal Sinuses 3+ Views (70220) |
$221 |
$442 |
2.7× |
| X-Ray Skull 4+ Vw - Xr Skull Complete 4+ Views (70260) |
$221 |
$442 |
2.3× |
| X-ray thoracic spine 4 vw (72074) |
$274 |
$548 |
2.8× |
| X-Ray Tmj Unilat (70328) |
$60 |
$120 |
0.7× |
| X-Ray Urinary Tract Exam With Contrast Material (74420) |
$236 |
$472 |
0.7× |
| X-Rays Bone Length Studies (77073) |
$166 |
$332 |
1.7× |
| X-Rays Bone Survey Complete (77075) |
$185.50 |
$371 |
1.9× |
| Xr c-spine 4 or 5 views (72050) |
$294 |
$588 |
3.0× |
| Xr facial bones less than 3 views (70140) |
$161 |
$322 |
2.0× |
| XR Mastoids < 3 Views Bilateral (70120) |
$62.50 |
$125 |
0.6× |
| Xr orbits complete 4 views (70200) |
$177.50 |
$355 |
1.8× |
| Xr Tomogram Single Plane (76100) |
$128 |
$256 |
1.3× |