| 3-D radiotherapy plan dose-volume histograms (77295) |
$4,712 |
$9,424 |
3.7× |
| Abdomen 1 View (74018) |
$206 |
$412 |
2.5× |
| Abdomen 2 views (74019) |
$327 |
$654 |
3.4× |
| Acute Gastrointestinal Blood Loss Imaging (78278) |
$958.50 |
$1,917 |
2.6× |
| Adrenal Cortex & Medulla Img (78075) |
$1,860 |
$3,720 |
1.5× |
| Angio internal mammary (75756) |
$2,508.50 |
$5,017 |
0.9× |
| Angio pulmonary bilat (75743) |
$3,515.50 |
$7,031 |
1.2× |
| Angiography Adrenal Bilateral Slctv Rs&I (75733) |
$3,705 |
$7,410 |
1.3× |
| Angiography extremity bilateral rs&i (75716) |
$4,044 |
$8,088 |
1.4× |
| Angiography extremity unilateral rs&i (75710) |
$4,044 |
$8,088 |
1.4× |
| Angiography pulmonary unilateral slctv rs&i (75741) |
$2,338 |
$4,676 |
0.8× |
| Angrph pulmonary nonslctv cath/ven njx rs&i (75746) |
$2,785 |
$5,570 |
0.9× |
| Ankle 2 views (73600) |
$147.50 |
$295 |
1.8× |
| Aortography thoracic serialography rs&i (75605) |
$3,455.50 |
$6,911 |
0.7× |
| Artery X-Rays Abdomen (75726) |
$3,455.50 |
$6,911 |
0.7× |
| Artery X-Rays Adrenal Gland (75731) |
$2,785 |
$5,570 |
0.9× |
| Artery X-Rays Pelvis (75736) |
$4,196.50 |
$8,393 |
0.8× |
| Artery X-Rays Spine (75705) |
$3,455.50 |
$6,911 |
0.7× |
| Arthrogram ankle (73615) |
$661.50 |
$1,323 |
2.0× |
| Arthrogram hip (73525) |
$1,126 |
$2,252 |
3.5× |
| Arthrogram Wrist (73115) |
$759 |
$1,518 |
2.3× |
| Basic radiation dosimetry calculation (77300) |
$502.50 |
$1,005 |
4.0× |
| Bone age studies (77072) |
$147.50 |
$295 |
1.5× |
| Bone Imaging 3 Phase (78315) |
$1,356 |
$2,712 |
3.6× |
| Bone Imaging Limited Area (78300) |
$742 |
$1,484 |
2.0× |
| Bone Imaging Whole Body (78306) |
$1,356 |
$2,712 |
3.6× |
| Bone marrow imaging; whole body (78104) |
$465.50 |
$931 |
1.3× |
| Bone survey infant (77076) |
$134.50 |
$269 |
1.4× |
| Brachytx isodose complex (77318) |
$1,210 |
$2,420 |
3.5× |
| Brachytx isodose intermed (77317) |
$824 |
$1,648 |
2.4× |
| Brachytx Isodose Plan Simple (77316) |
$631.50 |
$1,263 |
1.8× |
| Brain Flow Imaging Only (78610) |
$721.50 |
$1,443 |
1.4× |
| Brain imaging < 4 static views (78600) |
$480.50 |
$961 |
1.3× |
| Brain Imaging Min 4 Static Views W Vascular Flow (78606) |
$587 |
$1,174 |
1.2× |
| Brain Imaging Pet Metabolic Evaluation (78608) |
$4,386 |
$8,772 |
3.3× |
| Cardiac MRI w/w/o contrast & further seq (75561) |
$512.50 |
$1,025 |
1.6× |
| Cardiac MRI w/w/o contrast w/stress (75563) |
$496 |
$992 |
0.7× |
| Cardiac Shunt Detection (78428) |
$425.50 |
$851 |
1.1× |
| Cat Scan Follow-Up Study (76380) |
$370 |
$740 |
4.6× |
| Cerebrospinal Fluid Flow W/O Matl Shunt Evaltj (78645) |
$892 |
$1,784 |
1.8× |
| Cerebrospinal Fluid Scan (78630) |
$1,146 |
$2,292 |
2.3× |
| 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 |
$131.50–$147 |
$263–$294 |
varies |
| Cholecystography Oral Contrast (74290) |
$163 |
$326 |
1.0× |
| Cineradiograpy/vidradiograpy xcpt where spec (76120) |
$130 |
$260 |
1.3× |
| Cisternography Positive Contrast Rs&I (70015) |
$838.50 |
$1,677 |
1.2× |
| Clavicle complete (73000) |
$144.50 |
$289 |
1.8× |
| Computed Tomography Thorax Lw Dose Lng Ca Scr C- (71271) |
$52.50 |
$105 |
0.5× |
| Continuing medical physics consltj pr wk (77336) |
$622.50 |
$1,245 |
5.0× |
| Contrast Exam Abdominl Aorta (75625) |
$3,239 |
$6,478 |
1.1× |
| Contrast X-Ray Bladder (74430) |
$391.50 |
$783 |
1.2× |
| Contrast X-Ray Of Elbow (73085) |
$1,098 |
$2,196 |
3.4× |
| Contrast X-Ray Of Knee Joint (73580) |
$777 |
$1,554 |
2.4× |
| Contrast Xray Throat/Cerv Esopha (74210) |
$306 |
$612 |
1.9× |
| CT abdomen and pelvis without and with contrast (74178) |
$2,278 |
$4,556 |
7.0× |
| CT abdomen and pelvis without contrast (74176) |
$1,278 |
$2,556 |
5.8× |
| CT abdomen w contrast (74160) |
$850.50 |
$1,701 |
5.2× |
| CT abdomen w wo contrast (74170) |
$1,177 |
$2,354 |
7.2× |
| CT abdomen w/o contrast (74150) |
$604 |
$1,208 |
6.2× |
| CT Angio Abdomen and Pelvis (74174) |
$332 |
$664 |
1.0× |
| CT Angio Chest (71275) |
$1,072.50 |
$2,145 |
6.6× |
| CT Angio Head (70496) |
$1,587.50 |
$3,175 |
9.7× |
| CT angio hrt w/3d image (75574) |
$1,286.50 |
$2,573 |
4.0× |
| Ct Angio Lwr Extr W/O&W/Dye (73706) |
$879 |
$1,758 |
5.4× |
| CT Angio Neck (70498) |
$986 |
$1,972 |
6.0× |
| Ct Angio Upr Extrm W/O&W/Dye (73206) |
$813 |
$1,626 |
5.0× |
| CT Cere Prfuj Alys C+ W/O CT/Cta Same Anatomy (70473) |
$163 |
$326 |
1.0× |
| CT cervical spine w/ contrast (72126) |
$827.50 |
$1,655 |
2.6× |
| CT cervical spine w/o contrast (72125) |
$765 |
$1,530 |
7.9× |
| CT cervical spine w/wo cont (72127) |
$861.50 |
$1,723 |
5.3× |
| CT chest w contrast (71260) |
$779 |
$1,558 |
4.8× |
| CT chest w/wo contrast (71270) |
$948.50 |
$1,897 |
5.8× |
| CT colonography screening (74263) |
$224 |
$448 |
1.0× |
| CT Colonogrphy Dx Image Postprocess W/Contrast (74262) |
$187.50 |
$375 |
1.1× |
| CT colonogrphy dx image postprocess w/o contrast (74261) |
$123.50 |
$247 |
1.3× |
| CT head/brain with contrast (70460) |
$804 |
$1,608 |
4.9× |
| CT head/brain without and with contrast (70470) |
$1,065.50 |
$2,131 |
6.5× |
| CT heart contrast eval cardiac structure&morph (75572) |
$1,179 |
$2,358 |
3.6× |
| CT heart no contrast quant eval coronry calcium (75571) |
$65 |
$130 |
0.8× |
| CT hrt w/3d image congen (75573) |
$1,179 |
$2,358 |
3.6× |
| CT iac w contrast (70481) |
$1,140 |
$2,280 |
7.0× |
| CT l-spine w&w/o contrast (72133) |
$1,034.50 |
$2,069 |
6.3× |
| CT lower ext w/o (73700) |
$571 |
$1,142 |
5.9× |
| CT lower extremity w/contrast material (73701) |
$709 |
$1,418 |
4.3× |
| CT lumbar spine w contrast (72132) |
$827.50 |
$1,655 |
2.6× |
| CT lumbar spine w/o contrast (72131) |
$765 |
$1,530 |
7.9× |
| CT maxillofacial w contrast (70487) |
$1,102 |
$2,204 |
6.8× |
| CT maxillofacial wo contrast (70486) |
$918.50 |
$1,837 |
9.4× |
| CT neck tissue combo (70492) |
$1,517 |
$3,034 |
9.3× |
| Ct Orbit/Ear/Fossa W/O&W/Dye (70482) |
$1,321.50 |
$2,643 |
8.1× |
| CT orbits w/o contrast (70480) |
$951 |
$1,902 |
9.8× |
| CT pelvis w&w/o contrast (72194) |
$1,101 |
$2,202 |
6.7× |
| CT pelvis w/o contrast (72192) |
$675.50 |
$1,351 |
6.9× |
| CT scan of leg combo (73702) |
$902 |
$1,804 |
5.5× |
| CT scans face/jaw combo (70488) |
$1,456.50 |
$2,913 |
8.9× |
| CT soft tissue neck w contrast (70491) |
$1,137.50 |
$2,275 |
7.0× |
| CT soft tissue neck w/o contrast (70490) |
$984 |
$1,968 |
10.1× |
| CT thoracic spine w contrast (72129) |
$824 |
$1,648 |
5.1× |
| CT thoracic spine w/o contrast (72128) |
$760.50 |
$1,521 |
7.8× |
| CT thoracic spine w/wo cont (72130) |
$859 |
$1,718 |
5.3× |
| CT thorax w/o contrast (71250) |
$733 |
$1,466 |
7.5× |
CT unlisted procedure (76497)
range across 2 matching MRF lines |
$55.50–$460 |
$111–$920 |
varies |
| CT upper ext wo (73200) |
$579 |
$1,158 |
6.0× |
| CT upper extremity w/o & w/contrast material (73202) |
$757 |
$1,514 |
4.6× |
| CT upper extremity with contrast (73201) |
$716 |
$1,432 |
2.2× |
| Cta Abdl Aorta&Bi Iliofem W/Contrast&Postp (75635) |
$250.50 |
$501 |
1.5× |
| Cta Abdomen (74175) |
$887 |
$1,774 |
5.4× |
| CTA head&neck c+ w/noncontrast img&post-pxessing (70471) |
$324.50 |
$649 |
1.0× |
| CTA pelvis (72191) |
$756 |
$1,512 |
4.6× |
| Dacryocystography, nasolacrimal duct, radiological supervision and interpretation Non-Facility (70170) |
$271.50 |
$543 |
1.2× |
| Dilation ureters/urethra rs&i (74485) |
$1,380 |
$2,760 |
0.7× |
| Discography Cerv/Thor Spine (72285) |
$1,244.50 |
$2,489 |
0.7× |
| Diskography lumbar (72295) |
$1,244.50 |
$2,489 |
0.7× |
| Doppler Echo Fetal Puls Spectral F/U/Repeat (76828) |
$354 |
$708 |
3.6× |
| Doppler Echo Fetal Spectral Display Complete (76827) |
$464 |
$928 |
4.8× |
| Doppler Fetal Mid Cerebral Artery (76821) |
$434.50 |
$869 |
4.5× |
| Dxa Bone Density Axial (77080) |
$182.50 |
$365 |
1.9× |
| Dxa bone density study (77085) |
$582.50 |
$1,165 |
6.0× |
| Dxa bone density study 1/>sites appendiclr skel (77081) |
$50.50 |
$101 |
0.6× |
| Echo exam of fetal heart (76825) |
$408 |
$816 |
0.8× |
| Echo exam uterus (76831) |
$368.50 |
$737 |
1.7× |
| Echo Guide For Artery Repair (76936) |
$203.50 |
$407 |
1.0× |
| Echocardiography, fetal, cardiovascular system, real time with image documentation (2D), with or without M-mode… (76826) |
$298.50 |
$597 |
1.3× |
| Esophagram (74220) |
$452.50 |
$905 |
2.8× |
| Fetal Biophys Profile W/Nst (76818) |
$371 |
$742 |
3.8× |
| Fetal Biophysical Profile W/O Non-Stress Testing (76819) |
$250.50 |
$501 |
2.6× |
| Fetal MRI w/placntl matrnl plvc img sing/1st ges (74712) |
$237.50 |
$475 |
1.1× |
| Fluoroscopy up to 1 hr (76000) |
$676 |
$1,352 |
3.0× |
| Follow-Up Angiography (75898) |
$867 |
$1,734 |
0.3× |
| Foot 2 views (73620) |
$143 |
$286 |
1.8× |
| Forearm 2 views (73090) |
$147.50 |
$295 |
1.8× |
| Gastric emptying imaging study (78264) |
$1,131 |
$2,262 |
3.0× |
| Gastric Emptyng Imag Std W/Sm Bwl Transit (78265) |
$1,131 |
$2,262 |
3.0× |
| Gastroesophageal Reflux Exam (78262) |
$837.50 |
$1,675 |
2.3× |
| Gastrointestinal Protein Loss (78282) |
$373 |
$746 |
1.0× |
| Gated Heart Planar Single (78472) |
$1,150 |
$2,300 |
3.1× |
| GI Endoscopic US S&I (76975) |
$311.50 |
$623 |
1.4× |
| Gstrc Emptng Imag Std W/Sm Bwl Col Trnst Mlt Day (78266) |
$1,198 |
$2,396 |
2.4× |
| Hand 2 views (73120) |
$134.50 |
$269 |
1.4× |
| Hdr Rdncl Ntrstl/Icav Brchtx (77772) |
$2,075.50 |
$4,151 |
3.2× |
| Hdr Rdncl Ntrstl/Icav Brchtx (77771) |
$1,990.50 |
$3,981 |
3.1× |
| Hdr Rdncl Ntrstl/Icav Brchtx 1 Channel (77770) |
$1,905 |
$3,810 |
2.9× |
| Heart Image (Pet) Multiple (78492) |
$4,083.50 |
$8,167 |
3.1× |
| Hepatc Vngrph Wdg/Fr Hemodyn Eval Rs&I (75889) |
$3,694.50 |
$7,389 |
1.3× |
| Hepatc Vngrph Wdg/Fr W/O Hemodyn Eval Rs&I (75891) |
$2,367.50 |
$4,735 |
0.8× |
| Hepatobil Syst Image W/Drug (78227) |
$613 |
$1,226 |
1.2× |
| Hepatobiliary System Imaging (78226) |
$613 |
$1,226 |
1.6× |
| Ht Musc Image Planar Mult (78454) |
$1,787.50 |
$3,575 |
1.5× |
| Ht Muscle Image Spect Sing (78451) |
$1,106.50 |
$2,213 |
0.9× |
| Hysterosalpingogram (74740) |
$530 |
$1,060 |
2.4× |
| Infant hip ultrasound with hip movement (dynamic) (76885) |
$197 |
$394 |
2.4× |
| Infant hip ultrasound, limited static exam (76886) |
$172 |
$344 |
2.1× |
| Interstitial radiation source applic complex (77778) |
$2,501.50 |
$5,003 |
3.9× |
| Intracavitary Radiation Source Applic Complex (77763) |
$954.50 |
$1,909 |
1.5× |
| Intracavitary Radiation Source Applic Intermed (77762) |
$876 |
$1,752 |
1.7× |
| Intracavitary radiation source applic simple (77761) |
$818 |
$1,636 |
1.6× |
| Joint Survey Single View (77077) |
$84 |
$168 |
0.9× |
| K Flow/Funct Image Multiple (78709) |
$1,353.50 |
$2,707 |
2.7× |
| K Flow/Funct Image W/Drug (78708) |
$1,084.50 |
$2,169 |
2.1× |
| K Flow/Funct Image W/O Drug (78707) |
$1,084.50 |
$2,169 |
2.1× |
| Kidney Imaging Morphol (78700) |
$422 |
$844 |
1.1× |
| Kidney Imaging Morphoogy W/Vascular Flow (78701) |
$586.50 |
$1,173 |
1.6× |
| Knee 3 Views (73562) |
$158 |
$316 |
2.0× |
| Labeled RBC Sequestration Differntl Organ/Tissue (78140) |
$1,208.50 |
$2,417 |
3.3× |
| Leveen/Shunt Patency Exam (78291) |
$805 |
$1,610 |
2.2× |
| Liver & Spleen Imaging Static Only (78215) |
$1,223.50 |
$2,447 |
3.3× |
| Lung Perf&Ventilat Diferentl (78598) |
$662 |
$1,324 |
1.3× |
| Lung perfusion differential (78597) |
$424 |
$848 |
1.1× |
| Lung Ventilat&Perfus Imaging (78582) |
$662 |
$1,324 |
1.3× |
| Lung Ventilation Imaging (78579) |
$424 |
$848 |
1.1× |
| Lymph System Imaging (78195) |
$931.50 |
$1,863 |
1.8× |
| Lymphangiography Extremity Only Bilateral Rs&I (75803) |
$1,319.50 |
$2,639 |
0.9× |
| Lymphangiography extremity only unilateral rs&i (75801) |
$574 |
$1,148 |
1.0× |
| Lymphangiography Pelvic/Abdominal Bilateral Rs&I (75807) |
$2,087.50 |
$4,175 |
0.7× |
| Lymphangiography, pelvic/abdominal, unilateral (75805) |
$1,060 |
$2,120 |
0.4× |
| Magnetic Image Jaw Joint (70336) |
$1,329 |
$2,658 |
6.0× |
| Magnetic resonance (eg, proton) imaging, brain (including brain stem andskull base), during open intracranial procedure… (70557) |
$274 |
$548 |
0.5× |
| Magnetic Resonance Elastography (76391) |
$283.50 |
$567 |
1.3× |
| 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) |
$750.50 |
$1,501 |
2.0× |
| Mlc imrt design & construction per imrt plan (77338) |
$1,753 |
$3,506 |
5.0× |
| Mr safety determination physician/other qhp (76016) |
$25 |
$50 |
0.3× |
| Mr safety implant&/fb assmt clin staf 1st 15 min (76014) |
$25 |
$50 |
0.9× |
| Mr safety implt electronics prepj supvj phys/qhp (76018) |
$25 |
$50 |
0.3× |
| Mr safety implt pos&/immoblj (76019) |
$25 |
$50 |
0.5× |
| Mr safety med physics xm customization plng&mntr (76017) |
$25 |
$50 |
0.1× |
| Mra Head W/O & W/Contrast Material (70546) |
$1,442 |
$2,884 |
4.4× |
| MRA head w/o contrast (70544) |
$786.50 |
$1,573 |
3.5× |
| MRA head with contrast (70545) |
$935.50 |
$1,871 |
2.9× |
| MRA neck w contrast (70548) |
$808 |
$1,616 |
2.5× |
| Mra Neck W/O &W/Contrast Material (70549) |
$888 |
$1,776 |
2.7× |
| MRA neck w/o contrast (70547) |
$734.50 |
$1,469 |
3.3× |
| MRI abdomen w contrast (74182) |
$829 |
$1,658 |
2.6× |
| MRI abdomen w/o contrast (74181) |
$699 |
$1,398 |
3.1× |
| MRI any jt lower extrem w/contrast material (73722) |
$1,028.50 |
$2,057 |
1.4× |
| MRI any jt lower extrem w/o & w/contrast matrl (73723) |
$1,782 |
$3,564 |
5.5× |
| MRI any jt upper extremity w/contrast matrl (73222) |
$997.50 |
$1,995 |
1.4× |
| MRI brain functional w/o physician admnistration (70554) |
$296 |
$592 |
1.3× |
| MRI brain functional w/physician admnistration (70555) |
$296 |
$592 |
1.3× |
| MRI Breast W/O Contrast Bilateral (77047) |
$913 |
$1,826 |
4.1× |
| MRI Breast Without Contrast Material Unilateral (77046) |
$684 |
$1,368 |
3.1× |
| MRI cardiac w/o contrast (75557) |
$335.50 |
$671 |
1.5× |
| MRI cervical spine w contrast (72142) |
$957.50 |
$1,915 |
3.0× |
| MRI cervical spine w/o cont (72141) |
$851 |
$1,702 |
3.8× |
| MRI chest w/o contrast (71550) |
$770.50 |
$1,541 |
3.5× |
| MRI chest with contrast (71551) |
$980 |
$1,960 |
1.3× |
| MRI chest wo w contrast (71552) |
$1,670.50 |
$3,341 |
5.1× |
| MRI lower extrem oth/thn jt w/contrast matrl (73719) |
$912 |
$1,824 |
2.8× |
| MRI lower extrem oth/thn jt w/o & w/contr matr (73720) |
$1,603 |
$3,206 |
4.9× |
| MRI lower extrem oth/thn jt w/o contr matrl (73718) |
$772 |
$1,544 |
3.5× |
| MRI lumbar spine w contrast (72149) |
$1,004.50 |
$2,009 |
3.1× |
| Mri Neck Spine W/O & W/Dye (72156) |
$1,215 |
$2,430 |
3.7× |
| MRI orbit face &/neck w/o contrast (70540) |
$882.50 |
$1,765 |
4.0× |
| MRI orbit face neck w contrast (70542) |
$970 |
$1,940 |
3.0× |
| Mri Orbt/Fac/Nck W/O &W/Dye (70543) |
$1,067 |
$2,134 |
3.3× |
| MRI pelvis w contrast (72196) |
$836 |
$1,672 |
2.6× |
| MRI pelvis w/o & w contrast (72197) |
$1,916 |
$3,832 |
5.9× |
| MRI pelvis w/o contrast (72195) |
$622.50 |
$1,245 |
2.8× |
| MRI spectroscopy (76390) |
$1,110.50 |
$2,221 |
13.7× |
| MRI thoracic spine w/o contrast (72146) |
$892.50 |
$1,785 |
4.0× |
| MRI upper extremity oth than jt w/contr matrl (73219) |
$976 |
$1,952 |
3.0× |
| MRI upper extremity oth than jt w/o contr matrl (73218) |
$858 |
$1,716 |
3.9× |
| Mri Uppr Extremity W/O&W/Dye (73220) |
$1,658.50 |
$3,317 |
5.1× |
| MRI, abdomen, combo (74183) |
$1,585 |
$3,170 |
4.9× |
| MRI, dorsal spine combo (72157) |
$1,275.50 |
$2,551 |
3.9× |
| MRI, dorsal spine contrast (72147) |
$1,004.50 |
$2,009 |
3.1× |
| MRI, joint upper extrem (73221) |
$869.50 |
$1,739 |
3.9× |
| MRI, joint upper extrem combo (73223) |
$1,782 |
$3,564 |
5.5× |
| MRI, lumbar spine combo (72158) |
$1,275.50 |
$2,551 |
3.9× |
| Myelogram cervical (72240) |
$2,374.50 |
$4,749 |
3.3× |
| Myelogram Lumbar (72265) |
$2,328 |
$4,656 |
3.2× |
| Myelography thoracic (72255) |
$1,889 |
$3,778 |
2.6× |
| Myelograpy 2/more regions rs&i (72270) |
$3,115 |
$6,230 |
4.3× |
| Myocardial Imaging Pet Metabolic Evaluation (78459) |
$3,781.50 |
$7,563 |
3.1× |
| Myocardial Perfusion Planar 1 Study Rest/Stress (78453) |
$1,787.50 |
$3,575 |
1.5× |
| Myocardial Spect Multiple Studies (78452) |
$2,044 |
$4,088 |
1.7× |
| Myocrd Img Pet Metab Eval Single Study Cncrnt CT (78429) |
$1,921.50 |
$3,843 |
1.4× |
| Myocrd img PET prfuj 1std rest/stress cncrnt CT (78430) |
$1,921.50 |
$3,843 |
1.4× |
| Myocrd Img Pet Prfuj Mlt Std Rst&Strs Cncrnt CT (78431) |
$2,996.50 |
$5,993 |
1.5× |
| Myocrd Img Pet Prfuj W/Metab 2rtracer Cncrnt CT (78433) |
$3,662.50 |
$7,325 |
1.8× |
| Myocrd Img Pet Prfuj W/Metab Dual Radiotracer (78432) |
$3,662.50 |
$7,325 |
2.6× |
| N-invas est c ffr sw aly CTA (75580) |
$871 |
$1,742 |
1.1× |
| Neck soft tissue (70360) |
$218.50 |
$437 |
2.7× |
| Nfs/Instlj Radioelmnt Sln 3 Mo Follow-Up Care (77750) |
$216.50 |
$433 |
0.6× |
| Nm whole blood volume (78122) |
$2,012 |
$4,024 |
4.0× |
| Nonvascular Shunt X-Ray (75809) |
$424 |
$848 |
4.4× |
| Ntsty modul radthx pln dose-vol histos (77301) |
$6,516.50 |
$13,033 |
5.1× |
| Nuclear medicine study of endocrine organs (78099) |
$328 |
$656 |
0.9× |
| Nuclear Rx Intra-Arterial (79445) |
$521 |
$1,042 |
2.4× |
| Nuclear Rx Oral Admin (79005) |
$941.50 |
$1,883 |
4.3× |
| Ob us nuchal meas 1 gest (76813) |
$191.50 |
$383 |
2.0× |
| Oph bmtry us echograpy a-scan io lens pwr cal (76519) |
$338 |
$676 |
3.5× |
| Oph us dx ant sgm us immersion b-scan/hr biom (76513) |
$233 |
$466 |
2.4× |
| Oph US Dx B-Scan&Quan a-Scan Sm Pt Enctr (76510) |
$140.50 |
$281 |
1.1× |
| Ophthalmic Biometry US Echograpy a-Scan (76516) |
$338 |
$676 |
3.5× |
| Ophthalmic Ultrasonic Foreign Body Localization (76529) |
$95.50 |
$191 |
1.2× |
| Ophthalmic ultrasound dx b-scan w/wo a-scan (76512) |
$233 |
$466 |
2.4× |
| Ophthalmic US Dx Corneal Pachymetry Uni/Bi (76514) |
$102 |
$204 |
3.8× |
| Ophthalmic us dx quantitative a-scan only (76511) |
$206 |
$412 |
2.1× |
| Panoramic X-ray of jaws (70355) |
$69 |
$138 |
0.9× |
| Parathyroid imaging w/tomographic spect & CT (78072) |
$1,334.50 |
$2,669 |
2.6× |
| Parathyroid Planar Imaging (78070) |
$963 |
$1,926 |
2.6× |
| Parathyroid planar imaging w/wo subtraction (78071) |
$1,057 |
$2,114 |
2.8× |
| Pelvis 1 or 2 views (72170) |
$121 |
$242 |
1.2× |
| Perineogram (74775) |
$391.50 |
$783 |
1.8× |
| Peritoneogram Rs&I (74190) |
$650 |
$1,300 |
1.3× |
| Pet Image Skull-Thigh (78812) |
$1,627 |
$3,254 |
1.2× |
| Pet Image W/Ct Lmtd (78814) |
$1,111.50 |
$2,223 |
0.8× |
| PET image w/CT, full body (78816) |
$1,289 |
$2,578 |
1.0× |
| PET imaging CT attenuation skull base mid-thigh (78815) |
$1,289 |
$2,578 |
1.0× |
| Pet Imaging Limited Area Chest Head/Neck (78811) |
$1,481.50 |
$2,963 |
1.2× |
| Pet Myocardial Sngl Study (78491) |
$3,781.50 |
$7,563 |
2.8× |
| PET whole body (78813) |
$1,627 |
$3,254 |
1.2× |
| Prq Transhepatc Portograpy Hemodyn Eval Rs&I (75885) |
$4,044 |
$8,088 |
1.4× |
| Pulmonary Perfusion Imaging Particulate (78580) |
$748.50 |
$1,497 |
2.0× |
| Radex Abd Compl Aqt Abd W/S/E/D Views 1 View Ch (74022) |
$374 |
$748 |
3.8× |
| Radex abscess/fistula/sinus tract rs&i (76080) |
$398 |
$796 |
0.8× |
| Radex Ankle Complete Minimum 3 Views (73610) |
$163 |
$326 |
2.0× |
| Radex Calcaneus Minimum 2 Views (73650) |
$145 |
$290 |
1.8× |
| Radex elbow complete minimum 3 views (73080) |
$208.50 |
$417 |
2.6× |
| Radex Facial Bones Complete Minimum 3 Views (70150) |
$155.50 |
$311 |
1.6× |
| Radex fingr minimum 2 views (73140) |
$113.50 |
$227 |
1.4× |
| Radex foot complete minimum 3 views (73630) |
$165 |
$330 |
2.0× |
| Radex Hand Minimum 3 Views (73130) |
$147.50 |
$295 |
1.8× |
| Radex lower extremity infant minimum 2 views (73592) |
$80.50 |
$161 |
1.0× |
| Radex Mastoids Compl Minimum 3 Views PR Side (70130) |
$84 |
$168 |
0.9× |
| Radex Nasal Bones Complete Minimum 3 Views (70160) |
$147.50 |
$295 |
1.8× |
| Radex Pharynx/Larx W/Fluor&/Magnification Tq (70370) |
$291 |
$582 |
3.6× |
| Radex Ribs Unilateral 2 Views (71100) |
$142 |
$284 |
1.8× |
| Radex shoulder complete minimum 2 views (73030) |
$175.50 |
$351 |
2.2× |
| Radex Sinuses Paransl < 3 Views (70210) |
$147.50 |
$295 |
1.8× |
| Radex sm int w/mlt srl imges via enteroclss tube (74251) |
$257 |
$514 |
1.6× |
| Radex Spine 1 View Specify Level (72020) |
$97.50 |
$195 |
1.2× |
| Radex Sternum Minimum 2 Views (71120) |
$117.50 |
$235 |
1.5× |
| Radex Temporomandble Jt Opn & Clsd Mouth Bilat (70330) |
$101 |
$202 |
1.2× |
| Radex Toe Minimum 2 Views (73660) |
$111.50 |
$223 |
1.4× |
| Radex upper extremity infant minimum 2 views (73092) |
$60.50 |
$121 |
0.6× |
| Radex Wrist Complete Minimum 3 Views (73110) |
$159 |
$318 |
2.0× |
| Radex X-Ray Exam Entire Spi 6/> Vw - Xr Entire Spine 6+ Vw (72084) |
$393 |
$786 |
4.0× |
| Radiation Delivery Stereotactic Cranial Linear (77372) |
$10,149.50 |
$20,299 |
1.5× |
Radiation treatment delivery level 1 (77402)
range across 2 matching MRF lines |
$105–$482 |
$210–$964 |
varies |
Radiation treatment delivery level 2 (77407)
range across 2 matching MRF lines |
$394–$631.50 |
$788–$1,263 |
varies |
Radiation treatment delivery level 3 (77412)
range across 2 matching MRF lines |
$614–$854 |
$1,228–$1,708 |
varies |
| Radiolog exam mandible compl minimum 4 views (70110) |
$191 |
$382 |
2.0× |
| Radiologic Exam Abdomen 3+ Views - Xr Abdomen 3+ Views (74021) |
$404 |
$808 |
4.2× |
| Radiologic exam colon double contrast study (74280) |
$698 |
$1,396 |
4.3× |
| Radiologic exam colon single contrast study (74270) |
$577 |
$1,154 |
3.5× |
| Radiologic Exam Esophagus Double Contrast Study (74221) |
$452.50 |
$905 |
2.8× |
| Radiologic exam knee complete 4/more views (73564) |
$183 |
$366 |
1.9× |
| Radiologic exam pelvis compl minimum 3 views (72190) |
$175.50 |
$351 |
1.8× |
| Radiologic Exam Small Int Single Contrast Study (74250) |
$505.50 |
$1,011 |
3.1× |
| Radiologic exam swallow function contrast study (74230) |
$452.50 |
$905 |
2.8× |
| Radiologic exam teeth complete full mouth (70320) |
$130 |
$260 |
0.6× |
| Radiologic Exam Teeth Prtl Exam < Full Mouth (70310) |
$202.50 |
$405 |
0.9× |
Radiologic exam upr gi trc double contrast study (74246)
range across 2 matching MRF lines |
$551–$620 |
$1,102–$1,240 |
varies |
| Radiologic examination femur 1 view (73551) |
$50.50 |
$101 |
0.6× |
| Radiologic examination femur minimum 2 views (73552) |
$99 |
$198 |
1.2× |
| Radiologic examination knee 1/2 views (73560) |
$130.50 |
$261 |
1.6× |
| Radiologic Examination Osseous Survey Limited (77074) |
$153 |
$306 |
1.6× |
| Radiologic Examination Salivary Gland Calculus (70380) |
$107 |
$214 |
1.3× |
| Radiologic examination tibia & fibula 2 views (73590) |
$156.50 |
$313 |
1.9× |
| Radiologic examination, teeth; single view Non-Facility (70300) |
$55 |
$110 |
0.7× |
| Radiopharm Dacryocystography (78660) |
$465.50 |
$931 |
1.3× |
| Radiopharmaceutical therapy, by intracavitary administration Non-Facility (79200) |
$308.50 |
$617 |
1.4× |
| Remote afterloading high dose rate radionuclide skin surface brachytherapy, includes basic dosimetry, when performed;… (77768) |
$2,226 |
$4,452 |
6.2× |
| Remote afterloading high dose rate radionuclide skin surface brachytherapy, includes basic dosimetry, when performed;… (77767) |
$2,080 |
$4,160 |
5.8× |
| Renal Cyst Study (74470) |
$564 |
$1,128 |
1.1× |
| Ribs bilateral 3 views (71110) |
$159 |
$318 |
1.6× |
| Rp loclzj tum plnr 1 area single day imaging (78800) |
$478 |
$956 |
1.3× |
| Rp loclzj tum plnr 2+area 1+d img/1 area img>2+d (78801) |
$877 |
$1,754 |
2.4× |
| Rp Loclzj Tum Plnr Whole Body 2+ Days Imaging (78804) |
$1,124 |
$2,248 |
2.2× |
| Rp Loclzj Tum Plnr Whole Body Single Day Imaging (78802) |
$1,059.50 |
$2,119 |
2.1× |
| Rp Loclzj Tum Spect 1 Area Single Day Imaging (78803) |
$1,302 |
$2,604 |
2.6× |
| Rp loclzj tum spect 2 area/sep acquisj img (78831) |
$1,525 |
$3,050 |
1.3× |
| Rp loclzj tum spect CT 2area 1d img/1 ar img>2+d (78832) |
$1,729 |
$3,458 |
1.3× |
| Rp loclzj tum spect w/CT 1 area/acquisj 1day img (78830) |
$1,525 |
$3,050 |
1.3× |
| Rp Ther Radiolbld Monoclonal Antibody IV Infus (79403) |
$515 |
$1,030 |
2.4× |
| Rp Therapy Intravenous Administration (79101) |
$864.50 |
$1,729 |
4.0× |
| Salivary Gland Function Study (78232) |
$324 |
$648 |
0.9× |
| Salivary Gland Imaging Serial Images (78231) |
$478.50 |
$957 |
1.3× |
| Scapula (73010) |
$147 |
$294 |
1.5× |
| Screening Digital Breast Tomosynthesis Bi (77063) |
$358.50 |
$717 |
15.3× |
| Shoulder 1 view (73020) |
$126.50 |
$253 |
1.6× |
| Shoulder Arthrography (73040) |
$1,316 |
$2,632 |
4.1× |
| Sialogram (70390) |
$271.50 |
$543 |
1.2× |
| Skull less than 4 views (70250) |
$110 |
$220 |
1.1× |
| Special dosimetry (77331) |
$446 |
$892 |
3.6× |
| Special Physics Consult (77370) |
$1,470 |
$2,940 |
11.8× |
| Special teletherapy port plan (77321) |
$1,100 |
$2,200 |
3.2× |
| Special treatment procedure (77470) |
$2,172.50 |
$4,345 |
4.2× |
| Srs Multisource (77371) |
$37,601.50 |
$75,203 |
5.5× |
| Stereotactic Body Radiation Delivery (77373) |
$3,385 |
$6,770 |
2.0× |
| Sternoclavicular joints (71130) |
$137.50 |
$275 |
1.7× |
| Superior sagittal sinus venogram (75870) |
$2,141 |
$4,282 |
0.7× |
| Surface Applic Low Dose Rate Radionuclide Source (77789) |
$315.50 |
$631 |
3.3× |
| Telethx isodose pln cplx w/basic dosimetry (77307) |
$418.50 |
$837 |
1.2× |
| Telethx isodose pln smpl w/dosimetry calculation (77306) |
$418.50 |
$837 |
1.2× |
| Ther Rad Simulaj-Aided Field Setting Complex (77290) |
$1,888 |
$3,776 |
5.4× |
| Ther Rad Simulaj-Aided Field Setting Intermed (77285) |
$1,092.50 |
$2,185 |
3.1× |
| Ther rad simulaj-aided field setting simple (77280) |
$834 |
$1,668 |
6.7× |
| Therapeutic Enema Rdctj Intussusception/Obstrcj (74283) |
$1,188.50 |
$2,377 |
7.3× |
| Thoracic spine 2 views (72070) |
$155 |
$310 |
1.6× |
| Thoracic spine 3 views (72072) |
$191 |
$382 |
2.0× |
| Thoracolumbar 2 views (72080) |
$155 |
$310 |
1.9× |
| Thyroid Imaging With Vascular Flow (78013) |
$837.50 |
$1,675 |
2.3× |
| Thyroid Met Imaging Body (78018) |
$1,460 |
$2,920 |
2.9× |
| Thyroid Uptake Measurement (78012) |
$728 |
$1,456 |
2.0× |
| Thyroid Uptake W/Blood Flow Sngle/Mult Quan Meas (78014) |
$1,388 |
$2,776 |
3.7× |
| Tx Devices Design & Construction Complex (77334) |
$1,265.50 |
$2,531 |
3.6× |
| Tx devices design & construction intermediate (77333) |
$655.50 |
$1,311 |
5.2× |
| Tx devices design & construction simple (77332) |
$447 |
$894 |
3.6× |
| Ultrasound Breast Limited (76642) |
$471 |
$942 |
5.8× |
| Ultrasound elastography first target lesion (76982) |
$124.50 |
$249 |
1.3× |
| Ultrasound Elastography Parenchyma (76981) |
$124.50 |
$249 |
1.3× |
| Ultrasound Exam Aaa Screen (76706) |
$127 |
$254 |
1.3× |
| Ultrasound trgt dynamic microbubble 1st lesion (76978) |
$223 |
$446 |
0.7× |
| Ultrasound, abdomen limited (76705) |
$467 |
$934 |
4.8× |
| Umbilical-artery Doppler (OB) (76820) |
$434.50 |
$869 |
4.5× |
| Unlisted Dx Radiographic Procedure (76499) |
$574.50 |
$1,149 |
7.1× |
Unlisted fluoroscopic procedure (76496)
range across 3 matching MRF lines |
$251.50–$2,139 |
$503–$4,278 |
varies |
| Unlisted magnetic resonance procedure (76498) |
$482 |
$964 |
6.0× |
| Unlisted Miscellaneous Px Dx Nuclear Medicine (78999) |
$328 |
$656 |
0.9× |
| Unlisted respiratory px dx nuclear medicine (78599) |
$532 |
$1,064 |
1.4× |
Upper gi w/o kub (74240)
range across 2 matching MRF lines |
$577–$586.50 |
$1,154–$1,173 |
varies |
| Urea Breath Test C-14 Isotopic Acquisj Analysis (78267) |
$112 |
$224 |
10.1× |
| Urea breath test c-14 isotopic analysis (78268) |
$112 |
$224 |
1.2× |
| Ureteral Reflux Study (78740) |
$1,078 |
$2,156 |
2.9× |
| Urethrocystogram voiding (74455) |
$464.50 |
$929 |
2.1× |
| Urethrocystography retrograde (74450) |
$475 |
$950 |
2.1× |
| Us breast unilateral complete (76641) |
$498 |
$996 |
5.1× |
| Us chest (76604) |
$326.50 |
$653 |
3.4× |
| Us complete joint (76881) |
$140.50 |
$281 |
1.4× |
| Us exam, pelvic, limited (76857) |
$242 |
$484 |
2.5× |
| Us head (76506) |
$405 |
$810 |
4.2× |
| Us kidney transplant (76776) |
$259 |
$518 |
2.7× |
| Us lmtd joint/oth nonvasc xtr strux r-t w/img (76882) |
$91.50 |
$183 |
0.9× |
| Us ob detailed single fetus (76811) |
$332 |
$664 |
1.5× |
| Us ob limited 1 or more fetuses (76815) |
$257 |
$514 |
2.6× |
| Us ob transvaginal (76817) |
$225 |
$450 |
2.3× |
| Us pelvic non ob complete (76856) |
$414 |
$828 |
4.3× |
| Us pg uter img f&mat 14 wk tabdl 1/1st gestation (76801) |
$225 |
$450 |
2.3× |
| Us preg uterus real time f/u trnsabdl per fetus (76816) |
$313.50 |
$627 |
3.2× |
| Us retroperitoneal complete (76770) |
$400 |
$800 |
4.1× |
| Us retroperitoneal limited (76775) |
$256 |
$512 |
2.6× |
| Us scrotum and contents (76870) |
$431 |
$862 |
4.4× |
| Us spinal canal and contents (76800) |
$292.50 |
$585 |
3.0× |
| Us thyroid (76536) |
$392 |
$784 |
4.0× |
| Us transrectal (76872) |
$240 |
$480 |
2.5× |
| Vein X-Ray Chest (75827) |
$2,671.50 |
$5,343 |
1.8× |
| Vein X-Ray Liver W/O Hemodyn (75887) |
$2,775 |
$5,550 |
0.9× |
| Vein X-Ray Spleen/Liver (75810) |
$1,861.50 |
$3,723 |
0.6× |
| Venogram Sinus/Jugular (75860) |
$2,416.50 |
$4,833 |
0.8× |
| Venography Adrenal Unilateral (75840) |
$4,237.50 |
$8,475 |
1.4× |
| Venography caval inferior serialography rs&i (75825) |
$2,583.50 |
$5,167 |
0.9× |
| Venography extremity bilateral rs&i (75822) |
$1,797.50 |
$3,595 |
1.2× |
| Venography extremity unilateral rs&i (75820) |
$1,261.50 |
$2,523 |
0.9× |
| Venography Orbital Rs&I (75880) |
$1,409 |
$2,818 |
2.4× |
| Venography Renal Bilateral (75833) |
$3,241 |
$6,482 |
1.1× |
| Venography Renal Unilateral (75831) |
$2,570 |
$5,140 |
0.9× |
| Venous sampling by catheter (75893) |
$3,455.50 |
$6,911 |
0.7× |
| Venous Thrombosis Imaging Venogram Bilateral (78458) |
$465.50 |
$931 |
1.3× |
| Vertebral fracture assessment via dxa (77086) |
$170 |
$340 |
2.1× |
| Wrist 2 views (73100) |
$115.50 |
$231 |
1.4× |
| X-Ray Ac Jts - Xr Acromioclavicular Joints Bilateral (73050) |
$121 |
$242 |
1.5× |
| X-ray antegrade pyelogram tube (74425) |
$391.50 |
$783 |
1.2× |
| X-Ray Aorta Leg Arteries (75630) |
$3,239 |
$6,478 |
1.1× |
| X-Ray Bend Only L-S Spine (72120) |
$188.50 |
$377 |
1.9× |
| X-Ray Elbow 2 Vw - Xr Elbow 1-2 Views Right (73070) |
$142 |
$284 |
1.8× |
| X-Ray Exam Breast Specimen (76098) |
$496.50 |
$993 |
1.0× |
| X-Ray Exam Entire Spi 1 Vw (72081) |
$155 |
$310 |
1.9× |
| X-Ray Exam Entire Spi 2/3 Vw (72082) |
$393 |
$786 |
4.0× |
| X-Ray Exam Entire Spi 4/5 Vw (72083) |
$393 |
$786 |
4.0× |
| X-Ray Exam Hip Uni 1 View (73501) |
$133 |
$266 |
1.6× |
| X-Ray Exam Hip Uni 2-3 Views (73502) |
$152 |
$304 |
1.9× |
| X-Ray Exam Hip Uni 4/> Views (73503) |
$227.50 |
$455 |
2.3× |
| X-Ray Exam Hips Bi 2 Views (73521) |
$203 |
$406 |
2.1× |
| X-Ray Exam Hips Bi 3-4 Views (73522) |
$252.50 |
$505 |
2.6× |
| X-Ray Exam Hips Bi 5/> Views (73523) |
$297 |
$594 |
3.1× |
| X-Ray Exam L-S Spine Bending (72114) |
$243 |
$486 |
2.5× |
| X-Ray Exam Neck Spine 2-3 Vw (72040) |
$163 |
$326 |
2.0× |
| X-Ray Exam Neck Spine 6/>Vws (72052) |
$339.50 |
$679 |
3.5× |
| X-Ray Exam Unilat Ribs/Chest (71101) |
$178.50 |
$357 |
1.8× |
| X-ray eye for foreign body (70030) |
$75 |
$150 |
0.9× |
| X-ray head for orthodontia (70350) |
$69 |
$138 |
0.9× |
| X-ray humerus (73060) |
$148.50 |
$297 |
1.8× |
| X-ray IV pyelogram (ivp) (74400) |
$663 |
$1,326 |
4.1× |
| X-ray IV pyelogram+tomography (74415) |
$729 |
$1,458 |
4.5× |
| X-Ray Jaw <4 Vw - Xr Mandible < 4 Views (70100) |
$175.50 |
$351 |
2.2× |
| X-Ray Knee Bilat Standing - Xr Knees Anteroposterior Standing Bilat (73565) |
$130.50 |
$261 |
1.6× |
| X-Ray Lumbar Spine 2/3 Vw - Xr Lumbar Spine 2-3 Views (72100) |
$200.50 |
$401 |
2.1× |
| X-Ray Ribs, Chest 4+ Vw - Xr Ribs 3 Vws Bil W/ Chest Posteroanterior (71111) |
$240.50 |
$481 |
2.5× |
| X-Ray Sacroiliac Jts 3+ Vw - Xr Sacroiliac Joints 3+ Views (72202) |
$163 |
$326 |
1.7× |
| X-Ray Sacroiliac Jts <3 Vw - Xr Sacroiliac Joints 1-2 Views (72200) |
$136 |
$272 |
1.4× |
| X-Ray Sacrum/Coccyx 2+ Vw - Xr Sacrum Coccyx 2+ Views (72220) |
$148.50 |
$297 |
1.8× |
| X-Ray Sinuses 3+ Vw - Xr Paranasal Sinuses 3+ Views (70220) |
$182.50 |
$365 |
2.3× |
| X-Ray Skull 4+ Vw - Xr Skull Complete 4+ Views (70260) |
$182.50 |
$365 |
1.9× |
| X-ray thoracic spine 4 vw (72074) |
$226.50 |
$453 |
2.3× |
| X-Ray Tmj Unilat (70328) |
$49.50 |
$99 |
0.6× |
| X-Ray Urinary Tract Exam With Contrast Material (74420) |
$391.50 |
$783 |
1.2× |
| X-Rays Bone Length Studies (77073) |
$137.50 |
$275 |
1.4× |
| X-Rays Bone Survey Complete (77075) |
$153 |
$306 |
1.6× |
| Xr c-spine 4 or 5 views (72050) |
$243 |
$486 |
2.5× |
| Xr facial bones less than 3 views (70140) |
$133 |
$266 |
1.6× |
| XR Mastoids < 3 Views Bilateral (70120) |
$52 |
$104 |
0.5× |
| Xr orbits complete 4 views (70200) |
$147 |
$294 |
1.5× |
| Xr Tomogram Single Plane (76100) |
$212.50 |
$425 |
2.2× |