| 3-D radiotherapy plan dose-volume histograms (77295) |
$4,554.55 |
$7,007 |
3.4× |
| Abdomen 1 View (74018) |
$309.40 |
$476 |
3.7× |
| Abdomen 2 views (74019) |
$353.60 |
$544 |
3.5× |
| Acute Gastrointestinal Blood Loss Imaging (78278) |
$921.05 |
$1,417 |
2.4× |
| Angio internal mammary (75756) |
$2,575.95 |
$3,963 |
0.9× |
| Angio pulmonary bilat (75743) |
$4,756.05 |
$7,317 |
1.6× |
| Angiography extremity bilateral rs&i (75716) |
$6,680.05 |
$10,277 |
2.2× |
| Angiography extremity unilateral rs&i (75710) |
$6,295.90 |
$9,686 |
2.1× |
| Angiography pulmonary unilateral slctv rs&i (75741) |
$4,529.85 |
$6,969 |
1.5× |
| Ankle 2 views (73600) |
$284.70 |
$438 |
3.4× |
| Aortography thoracic serialography rs&i (75605) |
$3,788.85 |
$5,829 |
0.7× |
| Artery X-Rays Abdomen (75726) |
$6,126.25 |
$9,425 |
1.1× |
| Artery X-Rays Pelvis (75736) |
$6,739.20 |
$10,368 |
1.3× |
| Artery X-Rays Spine (75705) |
$3,968.90 |
$6,106 |
0.7× |
| Arthrogram ankle (73615) |
$580.45 |
$893 |
1.7× |
| Arthrogram hip (73525) |
$892.45 |
$1,373 |
2.7× |
| Arthrogram Wrist (73115) |
$714.35 |
$1,099 |
2.1× |
| Basic radiation dosimetry calculation (77300) |
$381.55 |
$587 |
3.0× |
| Bone age studies (77072) |
$226.20 |
$348 |
2.3× |
| Bone Imaging 3 Phase (78315) |
$1,702.35 |
$2,619 |
4.4× |
| Bone Imaging Limited Area (78300) |
$802.75 |
$1,235 |
2.1× |
| Bone Imaging Whole Body (78306) |
$1,543.10 |
$2,374 |
4.0× |
| Bone survey infant (77076) |
$263.90 |
$406 |
2.6× |
| Brachytx isodose complex (77318) |
$1,053.65 |
$1,621 |
2.9× |
| Brain Flow Imaging Only (78610) |
$639.60 |
$984 |
1.2× |
| Brain Image W/Flow < 4 Views (78601) |
$653.25 |
$1,005 |
1.7× |
| Brain Imaging Pet Metabolic Evaluation (78608) |
$4,616.30 |
$7,102 |
3.4× |
| Cardiac MRI w/w/o contrast & further seq (75561) |
$2,624.70 |
$4,038 |
7.9× |
| Cat Scan Follow-Up Study (76380) |
$666.25 |
$1,025 |
8.0× |
| Cerebrospinal Fluid Flow W/O Matl Shunt Evaltj (78645) |
$967.85 |
$1,489 |
1.9× |
| Cerebrospinal Fluid Scan (78630) |
$1,494.35 |
$2,299 |
2.9× |
| Chest 1 view (71045) |
$262.60 |
$404 |
3.2× |
| Chest 2 views (71046) |
$313.95 |
$483 |
3.8× |
| Chest 3 views (71047) |
$376.35 |
$579 |
4.5× |
| Chest 4 or more views (71048) |
$449.80 |
$692 |
4.5× |
| Clavicle complete (73000) |
$297.70 |
$458 |
3.6× |
| Computed Tomography Thorax Lw Dose Lng Ca Scr C- (71271) |
$345.80 |
$532 |
3.5× |
| Continuing medical physics consltj pr wk (77336) |
$559.65 |
$861 |
4.3× |
| Contrast Exam Abdominl Aorta (75625) |
$6,126.25 |
$9,425 |
2.0× |
| Contrast X-Ray Bladder (74430) |
$605.15 |
$931 |
1.8× |
| Contrast X-Ray Of Elbow (73085) |
$952.25 |
$1,465 |
2.8× |
| Contrast X-Ray Of Knee Joint (73580) |
$714.35 |
$1,099 |
2.1× |
| CT abdomen and pelvis without and with contrast (74178) |
$4,319.25 |
$6,645 |
12.9× |
| CT abdomen and pelvis without contrast (74176) |
$2,937.35 |
$4,519 |
12.9× |
| CT abdomen w contrast (74160) |
$1,771.90 |
$2,726 |
10.5× |
| CT abdomen w wo contrast (74170) |
$2,122.90 |
$3,266 |
12.6× |
| CT abdomen w/o contrast (74150) |
$1,563.25 |
$2,405 |
15.6× |
| CT Angio Abdomen and Pelvis (74174) |
$4,120.35 |
$6,339 |
12.3× |
| CT Angio Chest (71275) |
$2,007.20 |
$3,088 |
11.9× |
| CT Angio Head (70496) |
$2,104.05 |
$3,237 |
12.5× |
| CT angio hrt w/3d image (75574) |
$1,825.85 |
$2,809 |
5.5× |
| Ct Angio Lwr Extr W/O&W/Dye (73706) |
$2,032.55 |
$3,127 |
12.1× |
| CT Angio Neck (70498) |
$2,060.50 |
$3,170 |
12.3× |
| Ct Angio Upr Extrm W/O&W/Dye (73206) |
$2,215.85 |
$3,409 |
13.2× |
| CT Cere Prfuj Alys C+ W/O CT/Cta Same Anatomy (70473) |
$2,035.15 |
$3,131 |
12.1× |
| CT cervical spine w/ contrast (72126) |
$1,807.65 |
$2,781 |
5.4× |
| CT cervical spine w/o contrast (72125) |
$1,721.85 |
$2,649 |
17.2× |
| CT cervical spine w/wo cont (72127) |
$2,045.55 |
$3,147 |
12.2× |
| CT chest w contrast (71260) |
$1,895.40 |
$2,916 |
11.3× |
| CT chest w/wo contrast (71270) |
$2,124.85 |
$3,269 |
12.6× |
| CT colonography screening (74263) |
$928.20 |
$1,428 |
4.1× |
| CT colonogrphy dx image postprocess w/o contrast (74261) |
$1,423.50 |
$2,190 |
14.2× |
| CT head/brain with contrast (70460) |
$1,722.50 |
$2,650 |
10.3× |
| CT head/brain without and with contrast (70470) |
$1,968.85 |
$3,029 |
11.7× |
| CT heart contrast eval cardiac structure&morph (75572) |
$2,066.35 |
$3,179 |
6.2× |
| CT heart no contrast quant eval coronry calcium (75571) |
$91.65 |
$141 |
1.1× |
| CT hrt w/3d image congen (75573) |
$1,968.20 |
$3,028 |
5.9× |
| CT iac w contrast (70481) |
$1,951.30 |
$3,002 |
11.6× |
| CT l-spine w&w/o contrast (72133) |
$2,405.65 |
$3,701 |
14.3× |
| CT lower ext w/o (73700) |
$1,213.55 |
$1,867 |
12.1× |
| CT lower extremity w/contrast material (73701) |
$1,690.65 |
$2,601 |
10.1× |
| CT lumbar spine w contrast (72132) |
$2,056.60 |
$3,164 |
6.2× |
| CT lumbar spine w/o contrast (72131) |
$1,790.10 |
$2,754 |
17.9× |
| CT maxillofacial w contrast (70487) |
$1,688.05 |
$2,597 |
10.0× |
| CT maxillofacial wo contrast (70486) |
$1,378.65 |
$2,121 |
13.8× |
| CT neck tissue combo (70492) |
$2,323.10 |
$3,574 |
13.8× |
| Ct Orbit/Ear/Fossa W/O&W/Dye (70482) |
$2,125.50 |
$3,270 |
12.7× |
| CT orbits w/o contrast (70480) |
$1,442.35 |
$2,219 |
14.4× |
| CT pelvis w&w/o contrast (72194) |
$1,918.80 |
$2,952 |
11.4× |
| CT pelvis w/o contrast (72192) |
$1,543.10 |
$2,374 |
15.4× |
| CT scan of leg combo (73702) |
$2,210.65 |
$3,401 |
13.2× |
| CT scans face/jaw combo (70488) |
$1,901.25 |
$2,925 |
11.3× |
| CT soft tissue neck w contrast (70491) |
$1,730.30 |
$2,662 |
10.3× |
| CT soft tissue neck w/o contrast (70490) |
$1,546.35 |
$2,379 |
15.4× |
| CT thoracic spine w contrast (72129) |
$1,610.05 |
$2,477 |
9.6× |
| CT thoracic spine w/o contrast (72128) |
$1,580.80 |
$2,432 |
15.8× |
| CT thoracic spine w/wo cont (72130) |
$2,208.70 |
$3,398 |
13.1× |
| CT thorax w/o contrast (71250) |
$1,513.20 |
$2,328 |
15.1× |
| CT unlisted procedure (76497) |
$1,706.25 |
$2,625 |
20.5× |
| CT upper ext wo (73200) |
$1,554.15 |
$2,391 |
15.5× |
| CT upper extremity w/o & w/contrast material (73202) |
$2,409.55 |
$3,707 |
14.3× |
| CT upper extremity with contrast (73201) |
$1,707.55 |
$2,627 |
5.1× |
| Cta Abdl Aorta&Bi Iliofem W/Contrast&Postp (75635) |
$2,635.10 |
$4,054 |
15.7× |
| Cta Abdomen (74175) |
$1,879.80 |
$2,892 |
11.2× |
| CTA head&neck c+ w/noncontrast img&post-pxessing (70471) |
$4,160 |
$6,400 |
12.4× |
| CTA pelvis (72191) |
$3,169.40 |
$4,876 |
18.9× |
| Diskography lumbar (72295) |
$1,651.65 |
$2,541 |
0.9× |
| Doppler Echo Fetal Puls Spectral F/U/Repeat (76828) |
$273 |
$420 |
2.7× |
Doppler Echo Fetal Spectral Display Complete (76827)
range across 2 matching MRF lines |
$312–$469.30 |
$480–$722 |
varies |
| Doppler Fetal Mid Cerebral Artery (76821) |
$383.50 |
$590 |
3.8× |
| Dxa Bone Density Axial (77080) |
$397.15 |
$611 |
4.0× |
Echo exam of fetal heart (76825)
range across 2 matching MRF lines |
$754.65–$776.10 |
$1,161–$1,194 |
varies |
| Echo exam uterus (76831) |
$611.65 |
$941 |
2.7× |
| Echo Guide For Artery Repair (76936) |
$621.40 |
$956 |
3.0× |
| Echocardiography, fetal, cardiovascular system, real time with image documentation (2D), with or without M-mode… (76826) |
$583.70 |
$898 |
2.6× |
| Echograp Trans R Pros Study (76873) |
$172.90 |
$266 |
1.7× |
| Esophagram (74220) |
$477.75 |
$735 |
2.8× |
| Fetal Biophys Profile W/Nst (76818) |
$598 |
$920 |
6.0× |
| Fetal Biophysical Profile W/O Non-Stress Testing (76819) |
$570.05 |
$877 |
5.7× |
| Fetal MRI w/placntl matrnl plvc img sing/1st ges (74712) |
$590.20 |
$908 |
2.6× |
| Fluoroscopy up to 1 hr (76000) |
$640.25 |
$985 |
2.8× |
| Follow-Up Angiography (75898) |
$2,300.35 |
$3,539 |
0.8× |
| Foot 2 views (73620) |
$287.30 |
$442 |
3.4× |
| Forearm 2 views (73090) |
$331.50 |
$510 |
4.0× |
| Gastric emptying imaging study (78264) |
$1,409.85 |
$2,169 |
3.7× |
| Gastroesophageal Reflux Exam (78262) |
$1,942.85 |
$2,989 |
5.1× |
| Gated Heart Planar Single (78472) |
$1,335.75 |
$2,055 |
3.5× |
| Hand 2 views (73120) |
$263.25 |
$405 |
2.6× |
| Hdr Rdncl Ntrstl/Icav Brchtx (77771) |
$3,079.05 |
$4,737 |
4.6× |
| Hdr Rdncl Ntrstl/Icav Brchtx 1 Channel (77770) |
$2,200.90 |
$3,386 |
3.3× |
| Hepatc Vngrph Wdg/Fr Hemodyn Eval Rs&I (75889) |
$6,601.40 |
$10,156 |
2.2× |
| Hepatc Vngrph Wdg/Fr W/O Hemodyn Eval Rs&I (75891) |
$5,902 |
$9,080 |
2.0× |
| Hepatobil Syst Image W/Drug (78227) |
$1,735.50 |
$2,670 |
3.3× |
| Hepatobiliary System Imaging (78226) |
$1,407.90 |
$2,166 |
3.7× |
| Ht Muscle Image Spect Sing (78451) |
$2,186.60 |
$3,364 |
1.8× |
| Hyperthermia, externally generated; deep (ie, heating to depths greater than 4 cm) Non-Facility (77605) |
$1,062.75 |
$1,635 |
1.6× |
| Hysterosalpingogram (74740) |
$570.70 |
$878 |
2.5× |
| Infant hip ultrasound with hip movement (dynamic) (76885) |
$574.60 |
$884 |
6.9× |
| Infant hip ultrasound, limited static exam (76886) |
$559.65 |
$861 |
6.7× |
| Interstitial radiation source applic complex (77778) |
$5,501.60 |
$8,464 |
8.2× |
| Joint Survey Single View (77077) |
$140.40 |
$216 |
1.4× |
| K Flow/Funct Image Multiple (78709) |
$1,994.20 |
$3,068 |
3.8× |
| K Flow/Funct Image W/Drug (78708) |
$1,348.75 |
$2,075 |
2.6× |
| K Flow/Funct Image W/O Drug (78707) |
$1,285.70 |
$1,978 |
2.5× |
| Kidney Imaging Morphol (78700) |
$968.50 |
$1,490 |
2.5× |
| Knee 3 Views (73562) |
$400.40 |
$616 |
4.8× |
| Liver & Spleen Imaging Static Only (78215) |
$1,343.55 |
$2,067 |
3.5× |
| Lung perfusion differential (78597) |
$645.45 |
$993 |
1.7× |
| Lung Ventilat&Perfus Imaging (78582) |
$1,351.35 |
$2,079 |
2.6× |
| Lymph System Imaging (78195) |
$1,080.95 |
$1,663 |
2.1× |
| Lymphangiography Pelvic/Abdominal Bilateral Rs&I (75807) |
$3,166.80 |
$4,872 |
1.0× |
| Magnetic Image Jaw Joint (70336) |
$2,924.35 |
$4,499 |
12.8× |
| Magnetic Resonance Elastography (76391) |
$1,345.50 |
$2,070 |
5.9× |
| Meckels Divert Exam (78290) |
$1,162.20 |
$1,788 |
3.0× |
| Mlc imrt design & construction per imrt plan (77338) |
$3,138.20 |
$4,828 |
8.8× |
| Mr safety determination physician/other qhp (76016) |
$143 |
$220 |
1.7× |
| Mr safety implant&/fb assmt clin staf 1st 15 min (76014) |
$39.65 |
$61 |
1.4× |
| Mr safety implt electronics prepj supvj phys/qhp (76018) |
$148.85 |
$229 |
1.6× |
| Mr safety implt pos&/immoblj (76019) |
$96.85 |
$149 |
1.7× |
| Mr safety med physics xm customization plng&mntr (76017) |
$392.60 |
$604 |
1.7× |
| Mra Head W/O & W/Contrast Material (70546) |
$2,609.75 |
$4,015 |
7.8× |
| MRA head w/o contrast (70544) |
$2,152.15 |
$3,311 |
9.4× |
| MRA head with contrast (70545) |
$2,434.90 |
$3,746 |
7.3× |
| MRA neck w contrast (70548) |
$2,314 |
$3,560 |
6.9× |
| Mra Neck W/O &W/Contrast Material (70549) |
$2,648.10 |
$4,074 |
7.9× |
| MRA neck w/o contrast (70547) |
$1,829.75 |
$2,815 |
8.0× |
| MRI abdomen w contrast (74182) |
$3,073.20 |
$4,728 |
9.2× |
| MRI abdomen w/o contrast (74181) |
$2,237.95 |
$3,443 |
9.8× |
| MRI any jt lower extrem w/contrast material (73722) |
$2,390.05 |
$3,677 |
3.2× |
| MRI any jt lower extrem w/o & w/contrast matrl (73723) |
$2,561.65 |
$3,941 |
7.7× |
| MRI any jt upper extremity w/contrast matrl (73222) |
$2,425.15 |
$3,731 |
3.2× |
| MRI bone marrow blood supply (77084) |
$1,810.25 |
$2,785 |
7.9× |
| MRI brain functional w/o physician admnistration (70554) |
$1,996.80 |
$3,072 |
8.7× |
| MRI Breast W/O Contrast Bilateral (77047) |
$3,230.50 |
$4,970 |
14.1× |
| MRI cardiac w/o cont stress (75559) |
$2,052.70 |
$3,158 |
3.9× |
| MRI cardiac w/o contrast (75557) |
$1,448.20 |
$2,228 |
6.3× |
| MRI cervical spine w contrast (72142) |
$2,349.75 |
$3,615 |
7.0× |
| MRI cervical spine w/o cont (72141) |
$2,076.10 |
$3,194 |
9.1× |
| MRI chest w/o contrast (71550) |
$2,026.05 |
$3,117 |
8.9× |
| MRI chest wo w contrast (71552) |
$2,997.80 |
$4,612 |
9.0× |
| MRI lower extrem oth/thn jt w/contrast matrl (73719) |
$2,414.10 |
$3,714 |
7.2× |
| MRI lower extrem oth/thn jt w/o & w/contr matr (73720) |
$2,946.45 |
$4,533 |
8.8× |
| MRI lower extrem oth/thn jt w/o contr matrl (73718) |
$2,178.15 |
$3,351 |
9.5× |
| MRI lumbar spine w contrast (72149) |
$2,631.20 |
$4,048 |
7.9× |
| Mri Neck Spine W/O & W/Dye (72156) |
$2,517.45 |
$3,873 |
7.5× |
| MRI orbit face &/neck w/o contrast (70540) |
$2,117.05 |
$3,257 |
9.3× |
| Mri Orbt/Fac/Nck W/O &W/Dye (70543) |
$2,794.35 |
$4,299 |
8.4× |
| MRI pelvis w/o & w contrast (72197) |
$2,710.50 |
$4,170 |
8.1× |
| MRI pelvis w/o contrast (72195) |
$2,011.10 |
$3,094 |
8.8× |
| MRI spectroscopy (76390) |
$1,698.45 |
$2,613 |
20.4× |
| MRI thoracic spine w/o contrast (72146) |
$2,310.10 |
$3,554 |
10.1× |
| MRI upper extremity oth than jt w/contr matrl (73219) |
$2,401.75 |
$3,695 |
7.2× |
| MRI upper extremity oth than jt w/o contr matrl (73218) |
$2,125.50 |
$3,270 |
9.3× |
| Mri Uppr Extremity W/O&W/Dye (73220) |
$2,997.80 |
$4,612 |
9.0× |
| MRI, abdomen, combo (74183) |
$3,014.70 |
$4,638 |
9.0× |
| MRI, dorsal spine combo (72157) |
$3,047.20 |
$4,688 |
9.1× |
| MRI, dorsal spine contrast (72147) |
$2,660.45 |
$4,093 |
8.0× |
| MRI, joint upper extrem (73221) |
$2,227.55 |
$3,427 |
9.7× |
| MRI, joint upper extrem combo (73223) |
$2,939.30 |
$4,522 |
8.8× |
| MRI, lumbar spine combo (72158) |
$2,821 |
$4,340 |
8.4× |
| Myelogram cervical (72240) |
$1,262.95 |
$1,943 |
1.7× |
| Myelogram Lumbar (72265) |
$980.85 |
$1,509 |
1.3× |
| Myelography thoracic (72255) |
$1,301.30 |
$2,002 |
1.7× |
| Myelograpy 2/more regions rs&i (72270) |
$1,509.30 |
$2,322 |
2.0× |
| Myocardial Imaging Pet Metabolic Evaluation (78459) |
$2,458.30 |
$3,782 |
2.0× |
| Myocardial Spect Multiple Studies (78452) |
$3,610.75 |
$5,555 |
2.9× |
| Myocrd Img Pet Prfuj Mlt Std Rst&Strs Cncrnt CT (78431) |
$5,558.80 |
$8,552 |
2.6× |
| N-invas est c ffr sw aly CTA (75580) |
$1,618.50 |
$2,490 |
2.0× |
| Neck soft tissue (70360) |
$299 |
$460 |
3.6× |
| Nonvascular Shunt X-Ray (75809) |
$172.90 |
$266 |
1.7× |
| Ntsty modul radthx pln dose-vol histos (77301) |
$5,938.40 |
$9,136 |
4.5× |
| Nuclear Rx Intra-Arterial (79445) |
$857.35 |
$1,319 |
3.8× |
| Nuclear Rx Oral Admin (79005) |
$1,227.85 |
$1,889 |
5.5× |
| Ophthalmic ultrasound dx b-scan w/wo a-scan (76512) |
$423.80 |
$652 |
4.2× |
| Panoramic X-ray of jaws (70355) |
$271.05 |
$417 |
3.3× |
| Parathyroid imaging w/tomographic spect & CT (78072) |
$1,580.15 |
$2,431 |
3.0× |
| Parathyroid Planar Imaging (78070) |
$1,203.80 |
$1,852 |
3.1× |
| Pelvis 1 or 2 views (72170) |
$255.45 |
$393 |
2.6× |
| Peritoneogram Rs&I (74190) |
$388.05 |
$597 |
0.7× |
| Pet Image W/Ct Lmtd (78814) |
$3,758.95 |
$5,783 |
2.7× |
| PET image w/CT, full body (78816) |
$3,845.40 |
$5,916 |
2.8× |
| PET imaging CT attenuation skull base mid-thigh (78815) |
$3,757 |
$5,780 |
2.7× |
| Plasma Vol Radiopharm Vol Dilute Spx Mult Smples (78111) |
$2,639.65 |
$4,061 |
2.1× |
| Prq Transhepatc Portograpy Hemodyn Eval Rs&I (75885) |
$2,735.20 |
$4,208 |
0.9× |
| Pulmonary Perfusion Imaging Particulate (78580) |
$1,842.75 |
$2,835 |
4.8× |
| Quan&Charac C Atherosclerotc Plaq Asses Sev C Ds (75577) |
$3,575 |
$5,500 |
4.0× |
| Radex Abd Compl Aqt Abd W/S/E/D Views 1 View Ch (74022) |
$543.40 |
$836 |
5.4× |
| Radex abscess/fistula/sinus tract rs&i (76080) |
$603.85 |
$929 |
1.2× |
| Radex Ankle Complete Minimum 3 Views (73610) |
$367.90 |
$566 |
4.4× |
| Radex Calcaneus Minimum 2 Views (73650) |
$335.40 |
$516 |
4.0× |
| Radex elbow complete minimum 3 views (73080) |
$366.60 |
$564 |
4.4× |
| Radex Facial Bones Complete Minimum 3 Views (70150) |
$325 |
$500 |
3.2× |
| Radex fingr minimum 2 views (73140) |
$252.85 |
$389 |
3.0× |
| Radex foot complete minimum 3 views (73630) |
$364.65 |
$561 |
4.4× |
| Radex Hand Minimum 3 Views (73130) |
$354.90 |
$546 |
4.3× |
| Radex lower extremity infant minimum 2 views (73592) |
$176.15 |
$271 |
2.1× |
| Radex Nasal Bones Complete Minimum 3 Views (70160) |
$312.65 |
$481 |
3.8× |
| Radex Ribs Unilateral 2 Views (71100) |
$336.70 |
$518 |
4.0× |
| Radex shoulder complete minimum 2 views (73030) |
$386.75 |
$595 |
4.6× |
| Radex Sinuses Paransl < 3 Views (70210) |
$203.45 |
$313 |
2.4× |
| Radex Spine 1 View Specify Level (72020) |
$330.20 |
$508 |
4.0× |
| Radex Sternum Minimum 2 Views (71120) |
$332.80 |
$512 |
4.0× |
| Radex Temporomandble Jt Opn & Clsd Mouth Bilat (70330) |
$206.05 |
$317 |
2.5× |
| Radex Toe Minimum 2 Views (73660) |
$276.25 |
$425 |
3.3× |
| Radex upper extremity infant minimum 2 views (73092) |
$174.85 |
$269 |
1.7× |
| Radex Wrist Complete Minimum 3 Views (73110) |
$362.05 |
$557 |
4.3× |
| Radex X-Ray Exam Entire Spi 6/> Vw - Xr Entire Spine 6+ Vw (72084) |
$417.95 |
$643 |
4.2× |
| Radiation Delivery Stereotactic Cranial Linear (77372) |
$16,889.60 |
$25,984 |
2.4× |
| Radiation treatment delivery level 1 (77402) |
$1,990.95 |
$3,063 |
20.4× |
| Radiation treatment delivery level 2 (77407) |
$2,280.85 |
$3,509 |
6.2× |
| Radiation treatment delivery level 3 (77412) |
$2,280.85 |
$3,509 |
4.3× |
| Radiolog exam mandible compl minimum 4 views (70110) |
$486.20 |
$748 |
4.9× |
| Radiologic Exam Abdomen 3+ Views - Xr Abdomen 3+ Views (74021) |
$427.70 |
$658 |
4.3× |
| Radiologic exam colon double contrast study (74280) |
$930.80 |
$1,432 |
5.5× |
| Radiologic exam colon single contrast study (74270) |
$755.30 |
$1,162 |
4.5× |
| Radiologic Exam Esophagus Double Contrast Study (74221) |
$2,572.05 |
$3,957 |
15.3× |
| Radiologic exam knee complete 4/more views (73564) |
$456.30 |
$702 |
4.6× |
| Radiologic exam pelvis compl minimum 3 views (72190) |
$395.20 |
$608 |
3.9× |
| Radiologic Exam Small Int Single Contrast Study (74250) |
$582.40 |
$896 |
3.5× |
| Radiologic exam swallow function contrast study (74230) |
$458.25 |
$705 |
2.7× |
| Radiologic exam upr gi trc double contrast study (74246) |
$758.55 |
$1,167 |
4.5× |
| Radiologic examination femur 1 view (73551) |
$193.05 |
$297 |
2.3× |
| Radiologic examination femur minimum 2 views (73552) |
$284.70 |
$438 |
3.4× |
| Radiologic examination knee 1/2 views (73560) |
$310.05 |
$477 |
3.7× |
| Radiologic examination tibia & fibula 2 views (73590) |
$322.40 |
$496 |
3.9× |
| Radiopharm Dacryocystography (78660) |
$286 |
$440 |
0.7× |
| Remote afterloading high dose rate radionuclide skin surface brachytherapy, includes basic dosimetry, when performed;… (77768) |
$427.70 |
$658 |
1.2× |
| Remote afterloading high dose rate radionuclide skin surface brachytherapy, includes basic dosimetry, when performed;… (77767) |
$427.70 |
$658 |
1.2× |
| Ribs bilateral 3 views (71110) |
$419.90 |
$646 |
4.2× |
| Rp loclzj tum plnr 1 area single day imaging (78800) |
$886.60 |
$1,364 |
2.3× |
| Rp Loclzj Tum Plnr Whole Body Single Day Imaging (78802) |
$977.60 |
$1,504 |
1.9× |
| Rp Loclzj Tum Spect 1 Area Single Day Imaging (78803) |
$1,048.45 |
$1,613 |
2.0× |
| Rp loclzj tum spect CT 2area 1d img/1 ar img>2+d (78832) |
$1,187.55 |
$1,827 |
0.9× |
| Rp loclzj tum spect w/CT 1 area/acquisj 1day img (78830) |
$1,100.45 |
$1,693 |
0.9× |
| Rp Therapy Intravenous Administration (79101) |
$857.35 |
$1,319 |
3.8× |
| Scapula (73010) |
$339.95 |
$523 |
3.4× |
| Screening Digital Breast Tomosynthesis Bi (77063) |
$85.15 |
$131 |
3.6× |
| Shoulder 1 view (73020) |
$233.35 |
$359 |
2.8× |
| Shoulder Arthrography (73040) |
$935.35 |
$1,439 |
2.8× |
| Skull less than 4 views (70250) |
$364 |
$560 |
3.6× |
| Special dosimetry (77331) |
$310.70 |
$478 |
2.4× |
| Special Physics Consult (77370) |
$574.60 |
$884 |
4.5× |
| Special teletherapy port plan (77321) |
$788.45 |
$1,213 |
2.2× |
| Special treatment procedure (77470) |
$1,781.65 |
$2,741 |
3.4× |
| Speech evaluation, complex (70371) |
$342.55 |
$527 |
1.5× |
| Srs Multisource (77371) |
$48,360 |
$74,400 |
6.9× |
| Stereotactic Body Radiation Delivery (77373) |
$8,262.80 |
$12,712 |
4.8× |
| Sternoclavicular joints (71130) |
$215.15 |
$331 |
2.6× |
| Superior sagittal sinus venogram (75870) |
$2,334.80 |
$3,592 |
0.8× |
| Surf radj ther orthvlt dlvr>150-500 kv per fxj (77438) |
$169.65 |
$261 |
1.7× |
| Surf radj ther supfc dlvr<=150 kv per fraction (77437) |
$169.65 |
$261 |
1.7× |
| Surf radj ther supfc/orthvlt treatment planning (77436) |
$61.75 |
$95 |
1.7× |
| Tbs technical calculation only (77091) |
$143 |
$220 |
1.7× |
| Telethx isodose pln cplx w/basic dosimetry (77307) |
$1,385.15 |
$2,131 |
3.9× |
| Telethx isodose pln smpl w/dosimetry calculation (77306) |
$1,051.70 |
$1,618 |
2.9× |
| Ther Rad Simulaj-Aided Field Setting Complex (77290) |
$1,238.90 |
$1,906 |
3.5× |
| Ther Rad Simulaj-Aided Field Setting Intermed (77285) |
$880.10 |
$1,354 |
2.5× |
| Ther rad simulaj-aided field setting simple (77280) |
$730.60 |
$1,124 |
5.7× |
| Therapeutic Enema Rdctj Intussusception/Obstrcj (74283) |
$780.65 |
$1,201 |
4.6× |
| Thoracic spine 2 views (72070) |
$378.30 |
$582 |
3.8× |
| Thoracic spine 3 views (72072) |
$582.40 |
$896 |
5.8× |
| Thoracolumbar 2 views (72080) |
$356.85 |
$549 |
4.3× |
| Thyroid Imaging With Vascular Flow (78013) |
$599.95 |
$923 |
1.6× |
| Thyroid Met Imaging Body (78018) |
$1,300.65 |
$2,001 |
2.5× |
| Thyroid Uptake Measurement (78012) |
$378.95 |
$583 |
1.0× |
| Thyroid Uptake W/Blood Flow Sngle/Mult Quan Meas (78014) |
$802.10 |
$1,234 |
2.1× |
| Tx Devices Design & Construction Complex (77334) |
$1,014 |
$1,560 |
2.8× |
Tx devices design & construction intermediate (77333)
range across 2 matching MRF lines |
$456.95–$492.05 |
$703–$757 |
varies |
Tx devices design & construction simple (77332)
range across 2 matching MRF lines |
$457.60–$579.15 |
$704–$891 |
varies |
| Ultrasound Breast Limited (76642) |
$500.50 |
$770 |
6.0× |
| Ultrasound Elastography Parenchyma (76981) |
$358.15 |
$551 |
3.6× |
| Ultrasound Exam Aaa Screen (76706) |
$464.75 |
$715 |
4.6× |
| Ultrasound, abdomen limited (76705) |
$709.80 |
$1,092 |
7.1× |
| Umbilical-artery Doppler (OB) (76820) |
$362.70 |
$558 |
3.6× |
| Unlisted Dx Radiographic Procedure (76499) |
$534.30 |
$822 |
6.4× |
| Unlisted fluoroscopic procedure (76496) |
$146.25 |
$225 |
1.8× |
| Unlisted magnetic resonance procedure (76498) |
$1,654.25 |
$2,545 |
19.8× |
| Unlisted Miscellaneous Px Dx Nuclear Medicine (78999) |
$653.25 |
$1,005 |
1.7× |
| Upper gi w/o kub (74240) |
$711.10 |
$1,094 |
4.2× |
| Urethrocystogram voiding (74455) |
$670.80 |
$1,032 |
2.9× |
| Urethrocystography retrograde (74450) |
$611 |
$940 |
2.7× |
| Us breast unilateral complete (76641) |
$815.75 |
$1,255 |
8.1× |
| Us chest (76604) |
$512.85 |
$789 |
5.1× |
| Us complete joint (76881) |
$727.35 |
$1,119 |
7.3× |
| Us exam, pelvic, limited (76857) |
$536.90 |
$826 |
5.4× |
| Us head (76506) |
$482.30 |
$742 |
4.8× |
| Us kidney transplant (76776) |
$481.65 |
$741 |
4.8× |
| Us lmtd joint/oth nonvasc xtr strux r-t w/img (76882) |
$527.15 |
$811 |
5.3× |
| Us ob detailed single fetus (76811) |
$1,008.80 |
$1,552 |
4.4× |
| Us ob limited 1 or more fetuses (76815) |
$452.40 |
$696 |
4.5× |
| Us ob transvaginal (76817) |
$821.60 |
$1,264 |
8.2× |
| Us pelvic non ob complete (76856) |
$759.85 |
$1,169 |
7.6× |
| Us pg uter img f&mat 14 wk tabdl 1/1st gestation (76801) |
$761.80 |
$1,172 |
7.6× |
| Us preg uterus real time f/u trnsabdl per fetus (76816) |
$856.05 |
$1,317 |
8.5× |
| Us retroperitoneal complete (76770) |
$722.80 |
$1,112 |
7.2× |
| Us retroperitoneal limited (76775) |
$618.80 |
$952 |
6.2× |
| Us scrotum and contents (76870) |
$702 |
$1,080 |
7.0× |
| Us spinal canal and contents (76800) |
$475.80 |
$732 |
4.8× |
| Us thyroid (76536) |
$677.30 |
$1,042 |
6.8× |
| Us transrectal (76872) |
$1,041.95 |
$1,603 |
10.4× |
| Vein X-Ray Chest (75827) |
$2,334.80 |
$3,592 |
1.5× |
| Vein X-Ray Liver W/O Hemodyn (75887) |
$5,114.85 |
$7,869 |
1.7× |
| Vein X-Ray Spleen/Liver (75810) |
$5,012.80 |
$7,712 |
1.7× |
| Venogram Sinus/Jugular (75860) |
$5,114.85 |
$7,869 |
1.7× |
| Venography caval inferior serialography rs&i (75825) |
$6,601.40 |
$10,156 |
2.2× |
| Venography extremity bilateral rs&i (75822) |
$2,167.10 |
$3,334 |
1.4× |
| Venography extremity unilateral rs&i (75820) |
$2,167.10 |
$3,334 |
1.4× |
| Venography Renal Bilateral (75833) |
$6,930.95 |
$10,663 |
2.3× |
| Venography Renal Unilateral (75831) |
$6,601.40 |
$10,156 |
2.2× |
| Venous sampling by catheter (75893) |
$7,041.45 |
$10,833 |
1.3× |
| Vertebral fracture assessment via dxa (77086) |
$169 |
$260 |
2.0× |
| Wrist 2 views (73100) |
$261.95 |
$403 |
3.1× |
| X-Ray Ac Jts - Xr Acromioclavicular Joints Bilateral (73050) |
$173.55 |
$267 |
2.1× |
| X-ray antegrade pyelogram tube (74425) |
$534.30 |
$822 |
1.6× |
| X-Ray Aorta Leg Arteries (75630) |
$7,041.45 |
$10,833 |
2.3× |
| X-Ray Bend Only L-S Spine (72120) |
$181.35 |
$279 |
1.8× |
| X-Ray Elbow 2 Vw - Xr Elbow 1-2 Views Right (73070) |
$267.80 |
$412 |
3.2× |
| X-Ray Exam Breast Specimen (76098) |
$1,006.20 |
$1,548 |
1.9× |
| X-Ray Exam Entire Spi 1 Vw (72081) |
$360.75 |
$555 |
4.3× |
| X-Ray Exam Entire Spi 2/3 Vw (72082) |
$378.95 |
$583 |
3.8× |
| X-Ray Exam Entire Spi 4/5 Vw (72083) |
$397.80 |
$612 |
4.0× |
| X-Ray Exam Hip Uni 1 View (73501) |
$225.55 |
$347 |
2.7× |
| X-Ray Exam Hip Uni 2-3 Views (73502) |
$281.45 |
$433 |
3.4× |
| X-Ray Exam Hip Uni 4/> Views (73503) |
$360.75 |
$555 |
3.6× |
| X-Ray Exam Hips Bi 2 Views (73521) |
$455.65 |
$701 |
4.6× |
| X-Ray Exam Hips Bi 3-4 Views (73522) |
$468.65 |
$721 |
4.7× |
| X-Ray Exam Hips Bi 5/> Views (73523) |
$492.05 |
$757 |
4.9× |
| X-Ray Exam L-S Spine Bending (72114) |
$831.35 |
$1,279 |
8.3× |
| X-Ray Exam Neck Spine 2-3 Vw (72040) |
$377 |
$580 |
4.5× |
| X-Ray Exam Neck Spine 6/>Vws (72052) |
$642.20 |
$988 |
6.4× |
| X-Ray Exam Unilat Ribs/Chest (71101) |
$440.05 |
$677 |
4.4× |
| X-ray eye for foreign body (70030) |
$274.95 |
$423 |
3.3× |
| X-ray humerus (73060) |
$316.55 |
$487 |
3.8× |
| X-ray IV pyelogram (ivp) (74400) |
$958.75 |
$1,475 |
5.7× |
| X-Ray Jaw <4 Vw - Xr Mandible < 4 Views (70100) |
$192.40 |
$296 |
2.3× |
| X-Ray Knee Bilat Standing - Xr Knees Anteroposterior Standing Bilat (73565) |
$303.55 |
$467 |
3.6× |
| X-Ray Lumbar Spine 2/3 Vw - Xr Lumbar Spine 2-3 Views (72100) |
$469.95 |
$723 |
4.7× |
| X-ray nose-rectum child f.b. (76010) |
$176.80 |
$272 |
2.1× |
| X-Ray Ribs, Chest 4+ Vw - Xr Ribs 3 Vws Bil W/ Chest Posteroanterior (71111) |
$624.65 |
$961 |
6.2× |
| X-Ray Sacroiliac Jts 3+ Vw - Xr Sacroiliac Joints 3+ Views (72202) |
$390.65 |
$601 |
3.9× |
| X-Ray Sacroiliac Jts <3 Vw - Xr Sacroiliac Joints 1-2 Views (72200) |
$161.20 |
$248 |
1.6× |
| X-Ray Sacrum/Coccyx 2+ Vw - Xr Sacrum Coccyx 2+ Views (72220) |
$334.75 |
$515 |
4.0× |
| X-Ray Sinuses 3+ Vw - Xr Paranasal Sinuses 3+ Views (70220) |
$456.30 |
$702 |
5.5× |
| X-Ray Skull 4+ Vw - Xr Skull Complete 4+ Views (70260) |
$385.45 |
$593 |
3.8× |
| X-Ray Stress View (77071) |
$221.65 |
$341 |
2.7× |
| X-ray thoracic spine 4 vw (72074) |
$638.30 |
$982 |
6.4× |
| X-Ray Urinary Tract Exam With Contrast Material (74420) |
$744.25 |
$1,145 |
2.2× |
| X-Rays Bone Length Studies (77073) |
$208.65 |
$321 |
2.1× |
| X-Rays Bone Survey Complete (77075) |
$608.40 |
$936 |
6.1× |
| Xr c-spine 4 or 5 views (72050) |
$494 |
$760 |
4.9× |
| Xr facial bones less than 3 views (70140) |
$233.35 |
$359 |
2.8× |
| Xr orbits complete 4 views (70200) |
$468.65 |
$721 |
4.7× |