| 3-D radiotherapy plan dose-volume histograms (77295) |
$2,015 |
$6,500 |
1.5× |
| Abdomen 1 View (74018) |
$111.60 |
$360 |
1.3× |
| Abdomen 2 views (74019) |
$157.17 |
$507 |
1.6× |
| Acute Gastrointestinal Blood Loss Imaging (78278) |
$590.86 |
$1,906 |
1.5× |
| Angio internal mammary (75756) |
$1,228.53 |
$3,963 |
0.4× |
| Angio pulmonary bilat (75743) |
$2,268.27 |
$7,317 |
0.8× |
| Angiography extremity bilateral rs&i (75716) |
$2,006.94 |
$6,474 |
0.7× |
| Angiography extremity unilateral rs&i (75710) |
$2,792.17 |
$9,007 |
0.9× |
| Angiography pulmonary unilateral slctv rs&i (75741) |
$2,160.39 |
$6,969 |
0.7× |
| Ankle 2 views (73600) |
$82.15 |
$265 |
1.0× |
Aortography thoracic serialography rs&i (75605)
unusually low: confirm this is the full procedure |
$1,806.99 |
$5,829 |
0.3× |
| Artery X-Rays Abdomen (75726) |
$3,268.02 |
$10,542 |
0.6× |
| Artery X-Rays Pelvis (75736) |
$3,214.08 |
$10,368 |
0.6× |
Artery X-Rays Spine (75705)
unusually low: confirm this is the full procedure |
$1,892.86 |
$6,106 |
0.4× |
| Arthrogram ankle (73615) |
$276.83 |
$893 |
0.8× |
| Arthrogram hip (73525) |
$174.84 |
$564 |
0.5× |
| Arthrogram Wrist (73115) |
$279 |
$900 |
0.8× |
| Basic radiation dosimetry calculation (77300) |
$155 |
$500 |
1.2× |
| Bone age studies (77072) |
$196.85 |
$635 |
2.0× |
| Bone Imaging 3 Phase (78315) |
$572.57 |
$1,847 |
1.5× |
| Bone Imaging Limited Area (78300) |
$382.85 |
$1,235 |
1.0× |
| Bone Imaging Whole Body (78306) |
$466.24 |
$1,504 |
1.2× |
| Bone survey infant (77076) |
$125.86 |
$406 |
1.3× |
| Brachytx isodose complex (77318) |
$1,280.61 |
$4,131 |
3.6× |
| Brachytx Isodose Plan Simple (77316) |
$642.94 |
$2,074 |
1.8× |
| Brain Flow Imaging Only (78610) |
$305.04 |
$984 |
0.6× |
| Brain Imaging Pet Metabolic Evaluation (78608) |
$1,514.66 |
$4,886 |
1.1× |
| Cardiac MRI w/w/o contrast & further seq (75561) |
$1,251.78 |
$4,038 |
3.8× |
| Cat Scan Follow-Up Study (76380) |
$317.75 |
$1,025 |
3.8× |
| Cerebrospinal Fluid Flow W/O Matl Shunt Evaltj (78645) |
$461.59 |
$1,489 |
0.9× |
| Cerebrospinal Fluid Scan (78630) |
$712.69 |
$2,299 |
1.4× |
| Chest 1 view (71045) |
$125.24 |
$404 |
1.5× |
| Chest 2 views (71046) |
$116.25 |
$375 |
1.4× |
| Chest 3 views (71047) |
$179.49 |
$579 |
2.2× |
| Chest 4 or more views (71048) |
$214.52 |
$692 |
2.2× |
| Clavicle complete (73000) |
$120.90 |
$390 |
1.5× |
| Computed Tomography Thorax Lw Dose Lng Ca Scr C- (71271) |
$449.19 |
$1,449 |
4.5× |
| Continuing medical physics consltj pr wk (77336) |
$215.45 |
$695 |
1.7× |
| Contrast Exam Abdominl Aorta (75625) |
$2,001.36 |
$6,456 |
0.7× |
| Contrast X-Ray Bladder (74430) |
$266.60 |
$860 |
0.8× |
| Contrast X-Ray Of Elbow (73085) |
$399.59 |
$1,289 |
1.2× |
| Contrast X-Ray Of Knee Joint (73580) |
$266.60 |
$860 |
0.8× |
| CT abdomen and pelvis without and with contrast (74178) |
$2,059.02 |
$6,642 |
6.2× |
| CT abdomen and pelvis without contrast (74176) |
$1,611.38 |
$5,198 |
7.1× |
| CT abdomen w contrast (74160) |
$732.84 |
$2,364 |
4.4× |
| CT abdomen w wo contrast (74170) |
$1,145.14 |
$3,694 |
6.8× |
| CT abdomen w/o contrast (74150) |
$499.41 |
$1,611 |
5.0× |
| CT Angio Abdomen and Pelvis (74174) |
$2,008.49 |
$6,479 |
6.0× |
| CT Angio Chest (71275) |
$957.90 |
$3,090 |
5.7× |
CT Angio Head (70496)
range across 2 matching MRF lines |
$1,003.47–$1,265.11 |
$3,237–$4,081 |
varies |
| CT angio hrt w/3d image (75574) |
$870.79 |
$2,809 |
2.6× |
| Ct Angio Lwr Extr W/O&W/Dye (73706) |
$667.74 |
$2,154 |
4.0× |
CT Angio Neck (70498)
range across 2 matching MRF lines |
$982.70–$1,099.26 |
$3,170–$3,546 |
varies |
| Ct Angio Upr Extrm W/O&W/Dye (73206) |
$563.27 |
$1,817 |
3.4× |
| CT Cere Prfuj Alys C+ W/O CT/Cta Same Anatomy (70473) |
$970.61 |
$3,131 |
5.8× |
| CT cervical spine w/ contrast (72126) |
$562.34 |
$1,814 |
1.7× |
| CT cervical spine w/o contrast (72125) |
$851.57 |
$2,747 |
8.5× |
| CT cervical spine w/wo cont (72127) |
$1,318.74 |
$4,254 |
7.9× |
| CT chest w contrast (71260) |
$820.88 |
$2,648 |
4.9× |
| CT chest w/wo contrast (71270) |
$845.68 |
$2,728 |
5.1× |
| CT colonography screening (74263) |
$442.68 |
$1,428 |
1.9× |
| CT colonogrphy dx image postprocess w/o contrast (74261) |
$678.90 |
$2,190 |
6.8× |
| CT head/brain with contrast (70460) |
$506.85 |
$1,635 |
3.0× |
| CT head/brain without and with contrast (70470) |
$895.90 |
$2,890 |
5.4× |
| CT heart contrast eval cardiac structure&morph (75572) |
$985.49 |
$3,179 |
3.0× |
| CT heart no contrast quant eval coronry calcium (75571) |
$37.20 |
$120 |
0.4× |
| CT hrt w/3d image congen (75573) |
$938.68 |
$3,028 |
2.8× |
| CT iac w contrast (70481) |
$697.50 |
$2,250 |
4.2× |
| CT l-spine w&w/o contrast (72133) |
$1,089.03 |
$3,513 |
6.5× |
| CT lower ext w/o (73700) |
$662.78 |
$2,138 |
6.6× |
| CT lower extremity w/contrast material (73701) |
$568.85 |
$1,835 |
3.4× |
| CT lumbar spine w contrast (72132) |
$562.34 |
$1,814 |
1.7× |
| CT lumbar spine w/o contrast (72131) |
$811.27 |
$2,617 |
8.1× |
| CT maxillofacial w contrast (70487) |
$581.25 |
$1,875 |
3.5× |
| CT maxillofacial wo contrast (70486) |
$708.66 |
$2,286 |
7.1× |
| CT neck tissue combo (70492) |
$942.71 |
$3,041 |
5.6× |
| Ct Orbit/Ear/Fossa W/O&W/Dye (70482) |
$763.22 |
$2,462 |
4.6× |
| CT orbits w/o contrast (70480) |
$542.50 |
$1,750 |
5.4× |
| CT pelvis w&w/o contrast (72194) |
$708.04 |
$2,284 |
4.2× |
| CT pelvis w/o contrast (72192) |
$576.91 |
$1,861 |
5.8× |
| CT scan of leg combo (73702) |
$666.50 |
$2,150 |
4.0× |
| CT scans face/jaw combo (70488) |
$585.28 |
$1,888 |
3.5× |
| CT soft tissue neck w contrast (70491) |
$718.27 |
$2,317 |
4.3× |
| CT soft tissue neck w/o contrast (70490) |
$559.55 |
$1,805 |
5.6× |
| CT thoracic spine w contrast (72129) |
$555.83 |
$1,793 |
3.3× |
| CT thoracic spine w/o contrast (72128) |
$799.18 |
$2,578 |
8.0× |
| CT thoracic spine w/wo cont (72130) |
$1,138.01 |
$3,671 |
6.8× |
| CT thorax w/o contrast (71250) |
$779.96 |
$2,516 |
7.8× |
| CT unlisted procedure (76497) |
$813.75 |
$2,625 |
9.8× |
| CT upper ext wo (73200) |
$516.77 |
$1,667 |
5.2× |
| CT upper extremity w/o & w/contrast material (73202) |
$638.29 |
$2,059 |
3.8× |
| CT upper extremity with contrast (73201) |
$619.38 |
$1,998 |
1.9× |
| Cta Abdl Aorta&Bi Iliofem W/Contrast&Postp (75635) |
$1,109.49 |
$3,579 |
6.6× |
| Cta Abdomen (74175) |
$1,005.95 |
$3,245 |
6.0× |
| CTA head&neck c+ w/noncontrast img&post-pxessing (70471) |
$1,984 |
$6,400 |
6.0× |
| CTA pelvis (72191) |
$1,038.50 |
$3,350 |
6.2× |
| Diskography lumbar (72295) |
$787.71 |
$2,541 |
0.4× |
| Doppler Echo Fetal Puls Spectral F/U/Repeat (76828) |
$130.20 |
$420 |
1.3× |
Doppler Echo Fetal Spectral Display Complete (76827)
range across 2 matching MRF lines |
$148.80–$223.82 |
$480–$722 |
varies |
| Doppler Fetal Mid Cerebral Artery (76821) |
$182.90 |
$590 |
1.8× |
| Dxa Bone Density Axial (77080) |
$186 |
$600 |
1.9× |
Echo exam of fetal heart (76825)
range across 2 matching MRF lines |
$359.91–$370.14 |
$1,161–$1,194 |
varies |
| Echo exam uterus (76831) |
$291.71 |
$941 |
1.3× |
| Echo Guide For Artery Repair (76936) |
$296.36 |
$956 |
1.4× |
| Echocardiography, fetal, cardiovascular system, real time with image documentation (2D), with or without M-mode… (76826) |
$278.38 |
$898 |
1.2× |
| Echograp Trans R Pros Study (76873) |
$256.68 |
$828 |
2.6× |
| Esophagram (74220) |
$127.41 |
$411 |
0.8× |
| Fetal Biophys Profile W/Nst (76818) |
$285.20 |
$920 |
2.9× |
| Fetal Biophysical Profile W/O Non-Stress Testing (76819) |
$240.87 |
$777 |
2.4× |
| Fetal MRI w/placntl matrnl plvc img sing/1st ges (74712) |
$281.48 |
$908 |
1.2× |
| Fluoroscopy up to 1 hr (76000) |
$162.44 |
$524 |
0.7× |
| Follow-Up Angiography (75898) |
$1,097.09 |
$3,539 |
0.4× |
| Foot 2 views (73620) |
$96.10 |
$310 |
1.2× |
| Forearm 2 views (73090) |
$117.18 |
$378 |
1.4× |
| Gastric emptying imaging study (78264) |
$641.39 |
$2,069 |
1.7× |
| Gastroesophageal Reflux Exam (78262) |
$926.59 |
$2,989 |
2.4× |
| Gated Heart Planar Single (78472) |
$916.67 |
$2,957 |
2.4× |
| Hand 2 views (73120) |
$120.28 |
$388 |
1.2× |
| Hdr Rdncl Ntrstl/Icav Brchtx (77771) |
$1,468.47 |
$4,737 |
2.2× |
| Hdr Rdncl Ntrstl/Icav Brchtx 1 Channel (77770) |
$1,331.76 |
$4,296 |
2.0× |
| Hepatc Vngrph Wdg/Fr Hemodyn Eval Rs&I (75889) |
$3,148.36 |
$10,156 |
1.0× |
| Hepatc Vngrph Wdg/Fr W/O Hemodyn Eval Rs&I (75891) |
$2,814.80 |
$9,080 |
0.9× |
| Hepatobil Syst Image W/Drug (78227) |
$1,058.03 |
$3,413 |
2.0× |
| Hepatobiliary System Imaging (78226) |
$376.03 |
$1,213 |
1.0× |
| Ht Muscle Image Spect Sing (78451) |
$1,042.84 |
$3,364 |
0.8× |
| Hyperthermia, externally generated; deep (ie, heating to depths greater than 4 cm) Non-Facility (77605) |
$506.85 |
$1,635 |
0.8× |
| Hysterosalpingogram (74740) |
$540.33 |
$1,743 |
2.4× |
| Infant hip ultrasound with hip movement (dynamic) (76885) |
$274.04 |
$884 |
3.3× |
| Infant hip ultrasound, limited static exam (76886) |
$266.91 |
$861 |
3.2× |
| Interstitial radiation source applic complex (77778) |
$2,623.84 |
$8,464 |
3.9× |
| Joint Survey Single View (77077) |
$66.96 |
$216 |
0.7× |
| K Flow/Funct Image Multiple (78709) |
$609.77 |
$1,967 |
1.2× |
| K Flow/Funct Image W/Drug (78708) |
$643.25 |
$2,075 |
1.2× |
| K Flow/Funct Image W/O Drug (78707) |
$1,360.59 |
$4,389 |
2.6× |
| Kidney Imaging Morphol (78700) |
$461.90 |
$1,490 |
1.2× |
| Knee 3 Views (73562) |
$154.38 |
$498 |
1.9× |
| Liver & Spleen Imaging Static Only (78215) |
$446.09 |
$1,439 |
1.2× |
| Lung perfusion differential (78597) |
$307.83 |
$993 |
0.8× |
| Lung Ventilat&Perfus Imaging (78582) |
$644.49 |
$2,079 |
1.2× |
| Lymph System Imaging (78195) |
$548.70 |
$1,770 |
1.1× |
| Lymphangiography Pelvic/Abdominal Bilateral Rs&I (75807) |
$1,510.32 |
$4,872 |
0.5× |
| Magnetic Image Jaw Joint (70336) |
$1,108.87 |
$3,577 |
4.9× |
| Magnetic Resonance Elastography (76391) |
$641.70 |
$2,070 |
2.8× |
| Meckels Divert Exam (78290) |
$345.96 |
$1,116 |
0.9× |
| Mlc imrt design & construction per imrt plan (77338) |
$320.23 |
$1,033 |
0.9× |
| Mr safety determination physician/other qhp (76016) |
$68.20 |
$220 |
0.8× |
| Mr safety implant&/fb assmt clin staf 1st 15 min (76014) |
$18.91 |
$61 |
0.7× |
| Mr safety implt electronics prepj supvj phys/qhp (76018) |
$70.99 |
$229 |
0.8× |
| Mr safety implt pos&/immoblj (76019) |
$46.19 |
$149 |
0.8× |
| Mr safety med physics xm customization plng&mntr (76017) |
$187.24 |
$604 |
0.8× |
| Mra Head W/O & W/Contrast Material (70546) |
$931.86 |
$3,006 |
2.8× |
| MRA head w/o contrast (70544) |
$775 |
$2,500 |
3.4× |
| MRA head with contrast (70545) |
$361.77 |
$1,167 |
1.1× |
| MRA neck w contrast (70548) |
$1,103.60 |
$3,560 |
3.3× |
| Mra Neck W/O &W/Contrast Material (70549) |
$1,322.15 |
$4,265 |
4.0× |
| MRA neck w/o contrast (70547) |
$697.19 |
$2,249 |
3.1× |
| MRI abdomen w/o contrast (74181) |
$814.37 |
$2,627 |
3.6× |
| MRI any jt lower extrem w/contrast material (73722) |
$1,127.16 |
$3,636 |
1.5× |
| MRI any jt lower extrem w/o & w/contrast matrl (73723) |
$929.07 |
$2,997 |
2.8× |
| MRI any jt upper extremity w/contrast matrl (73222) |
$1,345.40 |
$4,340 |
1.8× |
| MRI bone marrow blood supply (77084) |
$863.35 |
$2,785 |
3.8× |
| MRI brain functional w/o physician admnistration (70554) |
$952.32 |
$3,072 |
4.2× |
| MRI Breast W/O Contrast Bilateral (77047) |
$861.18 |
$2,778 |
3.8× |
| MRI cardiac w/o contrast (75557) |
$690.68 |
$2,228 |
3.0× |
| MRI cervical spine w contrast (72142) |
$1,121.27 |
$3,617 |
3.4× |
| MRI cervical spine w/o cont (72141) |
$1,129.64 |
$3,644 |
5.0× |
| MRI chest w/o contrast (71550) |
$759.50 |
$2,450 |
3.3× |
| MRI chest wo w contrast (71552) |
$918.84 |
$2,964 |
2.8× |
| MRI lower extrem oth/thn jt w/contrast matrl (73719) |
$546.84 |
$1,764 |
1.6× |
| MRI lower extrem oth/thn jt w/o & w/contr matr (73720) |
$1,151.34 |
$3,714 |
3.5× |
| MRI lower extrem oth/thn jt w/o contr matrl (73718) |
$975.88 |
$3,148 |
4.3× |
| MRI lumbar spine w contrast (72149) |
$1,306.34 |
$4,214 |
3.9× |
| Mri Neck Spine W/O & W/Dye (72156) |
$1,458.24 |
$4,704 |
4.4× |
| MRI orbit face &/neck w/o contrast (70540) |
$1,066.40 |
$3,440 |
4.7× |
| Mri Orbt/Fac/Nck W/O &W/Dye (70543) |
$1,209 |
$3,900 |
3.6× |
| MRI pelvis w/o & w contrast (72197) |
$1,134.91 |
$3,661 |
3.4× |
| MRI pelvis w/o contrast (72195) |
$904.27 |
$2,917 |
4.0× |
| MRI spectroscopy (76390) |
$810.03 |
$2,613 |
9.8× |
| MRI thoracic spine w/o contrast (72146) |
$1,108.87 |
$3,577 |
4.9× |
| MRI upper extremity oth than jt w/contr matrl (73219) |
$1,243.10 |
$4,010 |
3.7× |
| MRI upper extremity oth than jt w/o contr matrl (73218) |
$970.61 |
$3,131 |
4.3× |
| Mri Uppr Extremity W/O&W/Dye (73220) |
$1,050.59 |
$3,389 |
3.2× |
| MRI, abdomen, combo (74183) |
$1,367.10 |
$4,410 |
4.1× |
| MRI, dorsal spine combo (72157) |
$1,483.04 |
$4,784 |
4.5× |
| MRI, dorsal spine contrast (72147) |
$409.20 |
$1,320 |
1.2× |
| MRI, joint upper extrem (73221) |
$984.25 |
$3,175 |
4.3× |
| MRI, joint upper extrem combo (73223) |
$1,162.19 |
$3,749 |
3.5× |
| MRI, lumbar spine combo (72158) |
$1,441.50 |
$4,650 |
4.3× |
| Myelogram cervical (72240) |
$602.33 |
$1,943 |
0.8× |
| Myelogram Lumbar (72265) |
$467.79 |
$1,509 |
0.6× |
| Myelography thoracic (72255) |
$620.62 |
$2,002 |
0.8× |
| Myelograpy 2/more regions rs&i (72270) |
$1,105.46 |
$3,566 |
1.5× |
| Myocardial Imaging Pet Metabolic Evaluation (78459) |
$1,172.42 |
$3,782 |
0.9× |
| Myocardial Spect Multiple Studies (78452) |
$1,498.85 |
$4,835 |
1.2× |
| Myocrd Img Pet Prfuj Mlt Std Rst&Strs Cncrnt CT (78431) |
$2,651.12 |
$8,552 |
1.3× |
| N-invas est c ffr sw aly CTA (75580) |
$1,550 |
$5,000 |
1.9× |
| Neck soft tissue (70360) |
$77.50 |
$250 |
0.9× |
| Nonvascular Shunt X-Ray (75809) |
$82.46 |
$266 |
0.8× |
| Ntsty modul radthx pln dose-vol histos (77301) |
$2,170 |
$7,000 |
1.6× |
| Nuclear Rx Intra-Arterial (79445) |
$408.89 |
$1,319 |
1.8× |
| Nuclear Rx Oral Admin (79005) |
$568.23 |
$1,833 |
2.6× |
| Ophthalmic ultrasound dx b-scan w/wo a-scan (76512) |
$202.12 |
$652 |
2.0× |
| Panoramic X-ray of jaws (70355) |
$129.27 |
$417 |
1.6× |
| Parathyroid imaging w/tomographic spect & CT (78072) |
$753.61 |
$2,431 |
1.5× |
| Parathyroid Planar Imaging (78070) |
$765.08 |
$2,468 |
2.0× |
| Pelvis 1 or 2 views (72170) |
$112.84 |
$364 |
1.1× |
| Peritoneogram Rs&I (74190) |
$185.07 |
$597 |
0.4× |
| Pet Image W/Ct Lmtd (78814) |
$1,792.73 |
$5,783 |
1.3× |
| PET image w/CT, full body (78816) |
$1,793.97 |
$5,787 |
1.3× |
| PET imaging CT attenuation skull base mid-thigh (78815) |
$2,262.38 |
$7,298 |
1.7× |
| Plasma Vol Radiopharm Vol Dilute Spx Mult Smples (78111) |
$1,258.91 |
$4,061 |
1.0× |
| Prq Transhepatc Portograpy Hemodyn Eval Rs&I (75885) |
$1,304.48 |
$4,208 |
0.4× |
| Pulmonary Perfusion Imaging Particulate (78580) |
$342.86 |
$1,106 |
0.9× |
| Quan&Charac C Atherosclerotc Plaq Asses Sev C Ds (75577) |
$1,705 |
$5,500 |
1.9× |
| Radex Abd Compl Aqt Abd W/S/E/D Views 1 View Ch (74022) |
$259.16 |
$836 |
2.6× |
| Radex abscess/fistula/sinus tract rs&i (76080) |
$336.35 |
$1,085 |
0.6× |
| Radex Ankle Complete Minimum 3 Views (73610) |
$145.08 |
$468 |
1.7× |
| Radex Calcaneus Minimum 2 Views (73650) |
$76.26 |
$246 |
0.9× |
| Radex elbow complete minimum 3 views (73080) |
$117.80 |
$380 |
1.4× |
| Radex Facial Bones Complete Minimum 3 Views (70150) |
$108.50 |
$350 |
1.1× |
| Radex fingr minimum 2 views (73140) |
$113.15 |
$365 |
1.4× |
| Radex foot complete minimum 3 views (73630) |
$142.29 |
$459 |
1.7× |
| Radex Hand Minimum 3 Views (73130) |
$124 |
$400 |
1.5× |
| Radex lower extremity infant minimum 2 views (73592) |
$84.01 |
$271 |
1.0× |
| Radex Nasal Bones Complete Minimum 3 Views (70160) |
$143.22 |
$462 |
1.7× |
| Radex Ribs Unilateral 2 Views (71100) |
$124 |
$400 |
1.5× |
| Radex shoulder complete minimum 2 views (73030) |
$130.82 |
$422 |
1.6× |
| Radex Sinuses Paransl < 3 Views (70210) |
$97.03 |
$313 |
1.2× |
| Radex Spine 1 View Specify Level (72020) |
$64.17 |
$207 |
0.8× |
| Radex Sternum Minimum 2 Views (71120) |
$158.41 |
$511 |
1.9× |
| Radex Temporomandble Jt Opn & Clsd Mouth Bilat (70330) |
$85.56 |
$276 |
1.0× |
| Radex Toe Minimum 2 Views (73660) |
$107.26 |
$346 |
1.3× |
| Radex upper extremity infant minimum 2 views (73092) |
$83.39 |
$269 |
0.8× |
| Radex Wrist Complete Minimum 3 Views (73110) |
$123.69 |
$399 |
1.5× |
| Radex X-Ray Exam Entire Spi 6/> Vw - Xr Entire Spine 6+ Vw (72084) |
$199.33 |
$643 |
2.0× |
| Radiation Delivery Stereotactic Cranial Linear (77372) |
$6,934.70 |
$22,370 |
1.0× |
| Radiation treatment delivery level 1 (77402) |
$949.53 |
$3,063 |
9.8× |
| Radiation treatment delivery level 2 (77407) |
$1,087.79 |
$3,509 |
3.0× |
| Radiation treatment delivery level 3 (77412) |
$1,087.79 |
$3,509 |
2.1× |
| Radiolog exam mandible compl minimum 4 views (70110) |
$88.35 |
$285 |
0.9× |
| Radiologic Exam Abdomen 3+ Views - Xr Abdomen 3+ Views (74021) |
$203.98 |
$658 |
2.0× |
| Radiologic exam colon double contrast study (74280) |
$443.92 |
$1,432 |
2.7× |
| Radiologic exam colon single contrast study (74270) |
$259.16 |
$836 |
1.5× |
| Radiologic Exam Esophagus Double Contrast Study (74221) |
$1,226.67 |
$3,957 |
7.3× |
| Radiologic exam knee complete 4/more views (73564) |
$147.56 |
$476 |
1.5× |
| Radiologic exam pelvis compl minimum 3 views (72190) |
$188.48 |
$608 |
1.9× |
| Radiologic Exam Small Int Single Contrast Study (74250) |
$168.02 |
$542 |
1.0× |
| Radiologic exam swallow function contrast study (74230) |
$118.11 |
$381 |
0.7× |
| Radiologic exam upr gi trc double contrast study (74246) |
$285.20 |
$920 |
1.7× |
| Radiologic examination femur 1 view (73551) |
$92.07 |
$297 |
1.1× |
| Radiologic examination femur minimum 2 views (73552) |
$112.22 |
$362 |
1.4× |
| Radiologic examination knee 1/2 views (73560) |
$75.95 |
$245 |
0.9× |
| Radiologic examination tibia & fibula 2 views (73590) |
$111.60 |
$360 |
1.3× |
| Radiopharm Dacryocystography (78660) |
$136.40 |
$440 |
0.4× |
| Remote afterloading high dose rate radionuclide skin surface brachytherapy, includes basic dosimetry, when performed;… (77768) |
$203.98 |
$658 |
0.6× |
| Remote afterloading high dose rate radionuclide skin surface brachytherapy, includes basic dosimetry, when performed;… (77767) |
$203.98 |
$658 |
0.6× |
| Ribs bilateral 3 views (71110) |
$230.33 |
$743 |
2.3× |
| Rp loclzj tum plnr 1 area single day imaging (78800) |
$422.84 |
$1,364 |
1.1× |
| Rp Loclzj Tum Plnr Whole Body Single Day Imaging (78802) |
$466.24 |
$1,504 |
0.9× |
| Rp Loclzj Tum Spect 1 Area Single Day Imaging (78803) |
$500.03 |
$1,613 |
1.0× |
| Rp loclzj tum spect CT 2area 1d img/1 ar img>2+d (78832) |
$566.37 |
$1,827 |
0.4× |
| Rp loclzj tum spect w/CT 1 area/acquisj 1day img (78830) |
$524.83 |
$1,693 |
0.4× |
| Rp Therapy Intravenous Administration (79101) |
$408.89 |
$1,319 |
1.8× |
| Scapula (73010) |
$78.12 |
$252 |
0.8× |
Screening Digital Breast Tomosynthesis Bi (77063)
range across 2 matching MRF lines |
$27.59–$40.61 |
$89–$131 |
varies |
| Shoulder 1 view (73020) |
$95.79 |
$309 |
1.2× |
| Shoulder Arthrography (73040) |
$266.60 |
$860 |
0.8× |
| Skull less than 4 views (70250) |
$111.91 |
$361 |
1.1× |
| Special dosimetry (77331) |
$128.96 |
$416 |
1.0× |
| Special Physics Consult (77370) |
$456.94 |
$1,474 |
3.6× |
| Special teletherapy port plan (77321) |
$376.03 |
$1,213 |
1.1× |
| Special treatment procedure (77470) |
$655.65 |
$2,115 |
1.2× |
| Speech evaluation, complex (70371) |
$163.37 |
$527 |
0.7× |
| Srs Multisource (77371) |
$23,064 |
$74,400 |
3.3× |
| Stereotactic Body Radiation Delivery (77373) |
$2,291.83 |
$7,393 |
1.3× |
| Sternoclavicular joints (71130) |
$83.39 |
$269 |
1.0× |
| Superior sagittal sinus venogram (75870) |
$1,113.52 |
$3,592 |
0.4× |
| Surf radj ther orthvlt dlvr>150-500 kv per fxj (77438) |
$80.91 |
$261 |
0.8× |
| Surf radj ther supfc dlvr<=150 kv per fraction (77437) |
$80.91 |
$261 |
0.8× |
| Surf radj ther supfc/orthvlt treatment planning (77436) |
$29.45 |
$95 |
0.8× |
| Tbs technical calculation only (77091) |
$68.20 |
$220 |
0.8× |
| Telethx isodose pln cplx w/basic dosimetry (77307) |
$713 |
$2,300 |
2.0× |
| Telethx isodose pln smpl w/dosimetry calculation (77306) |
$151.59 |
$489 |
0.4× |
| Ther Rad Simulaj-Aided Field Setting Complex (77290) |
$465 |
$1,500 |
1.3× |
| Ther Rad Simulaj-Aided Field Setting Intermed (77285) |
$419.74 |
$1,354 |
1.2× |
| Ther rad simulaj-aided field setting simple (77280) |
$200.88 |
$648 |
1.6× |
| Therapeutic Enema Rdctj Intussusception/Obstrcj (74283) |
$372.31 |
$1,201 |
2.2× |
| Thoracic spine 2 views (72070) |
$138.57 |
$447 |
1.4× |
| Thoracic spine 3 views (72072) |
$161.20 |
$520 |
1.6× |
| Thoracolumbar 2 views (72080) |
$115.32 |
$372 |
1.4× |
| Thyroid Imaging With Vascular Flow (78013) |
$286.13 |
$923 |
0.8× |
| Thyroid Met Imaging Body (78018) |
$686.96 |
$2,216 |
1.3× |
| Thyroid Uptake Measurement (78012) |
$180.73 |
$583 |
0.5× |
| Thyroid Uptake W/Blood Flow Sngle/Mult Quan Meas (78014) |
$235.29 |
$759 |
0.6× |
Tx Devices Design & Construction Complex (77334)
range across 2 matching MRF lines |
$367.35–$483.60 |
$1,185–$1,560 |
varies |
Tx devices design & construction intermediate (77333)
range across 2 matching MRF lines |
$217.93–$381.61 |
$703–$1,231 |
varies |
Tx devices design & construction simple (77332)
range across 2 matching MRF lines |
$274.97–$276.21 |
$887–$891 |
varies |
| Ultrasound Breast Limited (76642) |
$208.63 |
$673 |
2.5× |
| Ultrasound Elastography Parenchyma (76981) |
$170.81 |
$551 |
1.7× |
| Ultrasound Exam Aaa Screen (76706) |
$123.07 |
$397 |
1.2× |
| Ultrasound, abdomen limited (76705) |
$249.24 |
$804 |
2.5× |
| Umbilical-artery Doppler (OB) (76820) |
$172.98 |
$558 |
1.7× |
| Unlisted Dx Radiographic Procedure (76499) |
$254.82 |
$822 |
3.1× |
| Unlisted fluoroscopic procedure (76496) |
$69.75 |
$225 |
0.8× |
| Unlisted magnetic resonance procedure (76498) |
$788.95 |
$2,545 |
9.5× |
| Unlisted Miscellaneous Px Dx Nuclear Medicine (78999) |
$311.55 |
$1,005 |
0.8× |
| Upper gi w/o kub (74240) |
$216.38 |
$698 |
1.3× |
| Urethrocystogram voiding (74455) |
$319.92 |
$1,032 |
1.4× |
| Urethrocystography retrograde (74450) |
$291.40 |
$940 |
1.3× |
| Us breast unilateral complete (76641) |
$337.59 |
$1,089 |
3.4× |
| Us chest (76604) |
$170.81 |
$551 |
1.7× |
| Us complete joint (76881) |
$346.89 |
$1,119 |
3.5× |
| Us exam, pelvic, limited (76857) |
$108.19 |
$349 |
1.1× |
| Us head (76506) |
$230.02 |
$742 |
2.3× |
| Us kidney transplant (76776) |
$229.71 |
$741 |
2.3× |
| Us lmtd joint/oth nonvasc xtr strux r-t w/img (76882) |
$179.49 |
$579 |
1.8× |
| Us ob detailed single fetus (76811) |
$481.12 |
$1,552 |
2.1× |
| Us ob limited 1 or more fetuses (76815) |
$105.09 |
$339 |
1.1× |
| Us ob transvaginal (76817) |
$230.64 |
$744 |
2.3× |
| Us pelvic non ob complete (76856) |
$200.88 |
$648 |
2.0× |
| Us pg uter img f&mat 14 wk tabdl 1/1st gestation (76801) |
$218.55 |
$705 |
2.2× |
| Us preg uterus real time f/u trnsabdl per fetus (76816) |
$119.66 |
$386 |
1.2× |
| Us retroperitoneal complete (76770) |
$181.35 |
$585 |
1.8× |
| Us retroperitoneal limited (76775) |
$145.08 |
$468 |
1.5× |
| Us scrotum and contents (76870) |
$189.10 |
$610 |
1.9× |
| Us spinal canal and contents (76800) |
$226.92 |
$732 |
2.3× |
| Us thyroid (76536) |
$229.40 |
$740 |
2.3× |
| Us transrectal (76872) |
$496.93 |
$1,603 |
5.0× |
| Vein X-Ray Chest (75827) |
$1,113.52 |
$3,592 |
0.7× |
| Vein X-Ray Liver W/O Hemodyn (75887) |
$2,439.39 |
$7,869 |
0.8× |
| Venogram Sinus/Jugular (75860) |
$2,439.39 |
$7,869 |
0.8× |
| Venography caval inferior serialography rs&i (75825) |
$586.52 |
$1,892 |
0.2× |
| Venography extremity bilateral rs&i (75822) |
$1,033.54 |
$3,334 |
0.7× |
| Venography extremity unilateral rs&i (75820) |
$439.89 |
$1,419 |
0.3× |
| Venography Renal Bilateral (75833) |
$3,305.53 |
$10,663 |
1.1× |
| Venography Renal Unilateral (75831) |
$3,148.36 |
$10,156 |
1.0× |
| Venous sampling by catheter (75893) |
$3,358.23 |
$10,833 |
0.6× |
| Vertebral fracture assessment via dxa (77086) |
$80.60 |
$260 |
1.0× |
| Wrist 2 views (73100) |
$82.46 |
$266 |
1.0× |
| X-Ray Ac Jts - Xr Acromioclavicular Joints Bilateral (73050) |
$82.77 |
$267 |
1.0× |
| X-ray antegrade pyelogram tube (74425) |
$254.82 |
$822 |
0.8× |
| X-Ray Aorta Leg Arteries (75630) |
$3,358.23 |
$10,833 |
1.1× |
| X-Ray Bend Only L-S Spine (72120) |
$86.49 |
$279 |
0.9× |
| X-Ray Elbow 2 Vw - Xr Elbow 1-2 Views Right (73070) |
$84.94 |
$274 |
1.0× |
| X-Ray Exam Breast Specimen (76098) |
$305.66 |
$986 |
0.6× |
| X-Ray Exam Entire Spi 1 Vw (72081) |
$55.80 |
$180 |
0.7× |
| X-Ray Exam Entire Spi 2/3 Vw (72082) |
$180.73 |
$583 |
1.8× |
| X-Ray Exam Entire Spi 4/5 Vw (72083) |
$189.72 |
$612 |
1.9× |
| X-Ray Exam Hip Uni 1 View (73501) |
$163.68 |
$528 |
2.0× |
| X-Ray Exam Hip Uni 2-3 Views (73502) |
$266.29 |
$859 |
3.2× |
| X-Ray Exam Hip Uni 4/> Views (73503) |
$172.05 |
$555 |
1.7× |
| X-Ray Exam Hips Bi 2 Views (73521) |
$217.31 |
$701 |
2.2× |
| X-Ray Exam Hips Bi 3-4 Views (73522) |
$223.51 |
$721 |
2.2× |
| X-Ray Exam Hips Bi 5/> Views (73523) |
$234.67 |
$757 |
2.4× |
| X-Ray Exam L-S Spine Bending (72114) |
$190.03 |
$613 |
1.9× |
| X-Ray Exam Neck Spine 2-3 Vw (72040) |
$110.67 |
$357 |
1.3× |
| X-Ray Exam Neck Spine 6/>Vws (72052) |
$224.75 |
$725 |
2.3× |
| X-Ray Exam Unilat Ribs/Chest (71101) |
$130.51 |
$421 |
1.3× |
| X-ray eye for foreign body (70030) |
$131.13 |
$423 |
1.6× |
| X-ray humerus (73060) |
$114.70 |
$370 |
1.4× |
| X-ray IV pyelogram (ivp) (74400) |
$457.25 |
$1,475 |
2.7× |
| X-Ray Jaw <4 Vw - Xr Mandible < 4 Views (70100) |
$83.39 |
$269 |
1.0× |
| X-Ray Knee Bilat Standing - Xr Knees Anteroposterior Standing Bilat (73565) |
$144.77 |
$467 |
1.7× |
| X-Ray Lumbar Spine 2/3 Vw - Xr Lumbar Spine 2-3 Views (72100) |
$115.32 |
$372 |
1.2× |
| X-ray nose-rectum child f.b. (76010) |
$158.10 |
$510 |
1.9× |
| X-Ray Ribs, Chest 4+ Vw - Xr Ribs 3 Vws Bil W/ Chest Posteroanterior (71111) |
$187.55 |
$605 |
1.9× |
| X-Ray Sacroiliac Jts 3+ Vw - Xr Sacroiliac Joints 3+ Views (72202) |
$87.11 |
$281 |
0.9× |
| X-Ray Sacroiliac Jts <3 Vw - Xr Sacroiliac Joints 1-2 Views (72200) |
$76.88 |
$248 |
0.8× |
| X-Ray Sacrum/Coccyx 2+ Vw - Xr Sacrum Coccyx 2+ Views (72220) |
$108.50 |
$350 |
1.3× |
| X-Ray Sinuses 3+ Vw - Xr Paranasal Sinuses 3+ Views (70220) |
$81.22 |
$262 |
1.0× |
| X-Ray Skull 4+ Vw - Xr Skull Complete 4+ Views (70260) |
$188.48 |
$608 |
1.9× |
| X-Ray Stress View (77071) |
$105.71 |
$341 |
1.3× |
| X-ray thoracic spine 4 vw (72074) |
$304.42 |
$982 |
3.1× |
| X-Ray Urinary Tract Exam With Contrast Material (74420) |
$354.95 |
$1,145 |
1.1× |
| X-Rays Bone Length Studies (77073) |
$131.13 |
$423 |
1.3× |
| X-Rays Bone Survey Complete (77075) |
$290.16 |
$936 |
2.9× |
| Xr c-spine 4 or 5 views (72050) |
$217 |
$700 |
2.2× |
| Xr facial bones less than 3 views (70140) |
$64.17 |
$207 |
0.8× |
| Xr orbits complete 4 views (70200) |
$232.50 |
$750 |
2.3× |