| 3-D radiotherapy plan dose-volume histograms (77295) |
$7,305.90 |
$10,437 |
4.7× |
| Abdomen 1 View (74018) |
$249.20 |
$356 |
2.6× |
| Abdomen 2 views (74019) |
$272.30 |
$389 |
2.3× |
| Acute Gastrointestinal Blood Loss Imaging (78278) |
$1,408.40 |
$2,012 |
3.2× |
| Adrenal Cortex & Medulla Img (78075) |
$2,116.10 |
$3,023 |
1.5× |
| Angio pulmonary bilat (75743) |
$8,597.40 |
$12,282 |
2.4× |
| Angiography Adrenal Bilateral Slctv Rs&I (75733) |
$8,597.40 |
$12,282 |
2.4× |
| Angiography extremity bilateral rs&i (75716) |
$6,876.80 |
$9,824 |
2.0× |
| Angiography extremity unilateral rs&i (75710) |
$6,876.80 |
$9,824 |
2.0× |
| Angiography pulmonary unilateral slctv rs&i (75741) |
$8,597.40 |
$12,282 |
2.4× |
| Angrph pulmonary nonslctv cath/ven njx rs&i (75746) |
$8,270.50 |
$11,815 |
2.4× |
| Ankle 2 views (73600) |
$277.90 |
$397 |
2.9× |
| Aortography thoracic serialography rs&i (75605) |
$8,597.40 |
$12,282 |
1.4× |
| Artery X-Rays Abdomen (75726) |
$7,614.60 |
$10,878 |
1.2× |
| Artery X-Rays Adrenal Gland (75731) |
$8,597.40 |
$12,282 |
2.4× |
| Artery X-Rays Pelvis (75736) |
$6,876.80 |
$9,824 |
1.1× |
| Artery X-Rays Spine (75705) |
$3,905.30 |
$5,579 |
0.6× |
| Arthrogram ankle (73615) |
$1,325.10 |
$1,893 |
3.4× |
| Arthrogram hip (73525) |
$1,357.30 |
$1,939 |
3.5× |
| Arthrogram Wrist (73115) |
$1,135.40 |
$1,622 |
2.9× |
| Basic radiation dosimetry calculation (77300) |
$425.60 |
$608 |
2.8× |
| Bone age studies (77072) |
$294.70 |
$421 |
2.5× |
| Bone Imaging 3 Phase (78315) |
$1,696.10 |
$2,423 |
3.8× |
| Bone Imaging Limited Area (78300) |
$815.50 |
$1,165 |
1.8× |
| Bone Imaging Multiple Areas (78305) |
$1,249.50 |
$1,785 |
2.8× |
| Bone Imaging Whole Body (78306) |
$1,382.50 |
$1,975 |
3.1× |
| Bone survey infant (77076) |
$769.30 |
$1,099 |
6.6× |
| Brachytx isodose complex (77318) |
$1,099 |
$1,570 |
2.6× |
| Brachytx isodose intermed (77317) |
$1,099 |
$1,570 |
2.6× |
| Brachytx Isodose Plan Simple (77316) |
$396.20 |
$566 |
0.9× |
| Brain Flow Imaging Only (78610) |
$1,137.50 |
$1,625 |
1.9× |
| Brain Image W/Flow < 4 Views (78601) |
$1,190 |
$1,700 |
2.7× |
| Brain imaging < 4 static views (78600) |
$1,190 |
$1,700 |
2.7× |
| Brain Imaging Min 4 Static Views W Vascular Flow (78606) |
$1,905.40 |
$2,722 |
3.1× |
| Brain Imaging Minimum 4 Static Views (78605) |
$1,190 |
$1,700 |
2.0× |
| Card Bl Pool Gated Spect Rest Wal Motn Ejct Frct (78494) |
$2,725.80 |
$3,894 |
6.1× |
| Cardiac MRI w/w/o contrast & further seq (75561) |
$2,880.50 |
$4,115 |
7.4× |
| Cardiac MRI w/w/o contrast w/stress (75563) |
$2,880.50 |
$4,115 |
3.3× |
| Cardiovasc nucl exam unlisted (78499) |
$2,181.20 |
$3,116 |
4.9× |
| Cat Scan Follow-Up Study (76380) |
$1,038.10 |
$1,483 |
10.7× |
| Cerebrospinal Fluid Flow W/O Matl Shunt Evaltj (78645) |
$1,192.10 |
$1,703 |
2.0× |
| Cerebrospinal fluid flow, imaging (not including introduction of material); ventriculography Non-Facility (78635) |
$2,071.30 |
$2,959 |
3.4× |
| Cerebrospinal Fluid Scan (78630) |
$1,905.40 |
$2,722 |
3.1× |
| Chest 1 view (71045) |
$237.30 |
$339 |
2.4× |
| Chest 2 views (71046) |
$312.90 |
$447 |
3.2× |
| Chest 3 views (71047) |
$368.90 |
$527 |
3.8× |
| Chest 4 or more views (71048) |
$578.90 |
$827 |
5.0× |
| Cholecystography Oral Contrast (74290) |
$548.80 |
$784 |
2.8× |
| Cisternography Positive Contrast Rs&I (70015) |
$2,843.40 |
$4,062 |
3.3× |
| Clavicle complete (73000) |
$294.70 |
$421 |
3.0× |
| Computed Tomography Thorax Lw Dose Lng Ca Scr C- (71271) |
$323.40 |
$462 |
2.8× |
| Continuing medical physics consltj pr wk (77336) |
$784.70 |
$1,121 |
5.2× |
| Contrast Exam Abdominl Aorta (75625) |
$6,876.80 |
$9,824 |
2.0× |
| Contrast X-Ray Bladder (74430) |
$548.10 |
$783 |
1.4× |
| Contrast X-Ray Of Elbow (73085) |
$1,357.30 |
$1,939 |
3.5× |
| Contrast X-Ray Of Knee Joint (73580) |
$1,330.70 |
$1,901 |
3.4× |
| Contrast Xray Throat/Cerv Esopha (74210) |
$876.40 |
$1,252 |
4.5× |
| CT abdomen and pelvis without and with contrast (74178) |
$3,444.70 |
$4,921 |
8.9× |
| CT abdomen and pelvis without contrast (74176) |
$2,234.40 |
$3,192 |
8.4× |
| CT abdomen w contrast (74160) |
$1,406.30 |
$2,009 |
7.2× |
| CT abdomen w wo contrast (74170) |
$1,722.70 |
$2,461 |
8.8× |
| CT abdomen w/o contrast (74150) |
$1,093.40 |
$1,562 |
9.4× |
| CT Angio Abdomen and Pelvis (74174) |
$3,770.90 |
$5,387 |
9.7× |
| CT Angio Chest (71275) |
$2,107 |
$3,010 |
10.8× |
| CT Angio Head (70496) |
$1,710.80 |
$2,444 |
8.8× |
| CT angio hrt w/3d image (75574) |
$2,316.30 |
$3,309 |
6.0× |
| Ct Angio Lwr Extr W/O&W/Dye (73706) |
$2,310.70 |
$3,301 |
11.8× |
| CT Angio Neck (70498) |
$1,710.80 |
$2,444 |
8.8× |
| Ct Angio Upr Extrm W/O&W/Dye (73206) |
$1,764 |
$2,520 |
9.0× |
| CT bone density (77078) |
$308 |
$440 |
3.2× |
| CT cervical spine w/ contrast (72126) |
$1,374.80 |
$1,964 |
3.5× |
| CT cervical spine w/o contrast (72125) |
$1,080.10 |
$1,543 |
9.3× |
| CT cervical spine w/wo cont (72127) |
$2,118.90 |
$3,027 |
10.8× |
| CT chest w contrast (71260) |
$1,451.80 |
$2,074 |
7.4× |
| CT chest w/wo contrast (71270) |
$1,790.60 |
$2,558 |
9.2× |
| CT head/brain with contrast (70460) |
$1,145.20 |
$1,636 |
5.9× |
| CT head/brain without and with contrast (70470) |
$1,407.70 |
$2,011 |
7.2× |
| CT heart contrast eval cardiac structure&morph (75572) |
$1,255.80 |
$1,794 |
3.2× |
| CT heart no contrast quant eval coronry calcium (75571) |
$131.60 |
$188 |
1.4× |
| CT hrt w/3d image congen (75573) |
$1,599.50 |
$2,285 |
4.1× |
| CT iac w contrast (70481) |
$1,145.20 |
$1,636 |
5.9× |
| CT l-spine w&w/o contrast (72133) |
$2,237.90 |
$3,197 |
11.4× |
| CT lower ext w/o (73700) |
$959.70 |
$1,371 |
8.2× |
| CT lower extremity w/contrast material (73701) |
$1,228.50 |
$1,755 |
6.3× |
| CT lumbar spine w contrast (72132) |
$1,451.80 |
$2,074 |
3.7× |
| CT lumbar spine w/o contrast (72131) |
$1,141 |
$1,630 |
9.8× |
| CT maxillofacial w contrast (70487) |
$1,145.20 |
$1,636 |
5.9× |
CT maxillofacial wo contrast (70486)
range across 2 matching MRF lines |
$442.40–$885.50 |
$632–$1,265 |
varies |
| CT neck tissue combo (70492) |
$1,407.70 |
$2,011 |
7.2× |
| Ct Orbit/Ear/Fossa W/O&W/Dye (70482) |
$1,407.70 |
$2,011 |
7.2× |
| CT orbits w/o contrast (70480) |
$885.50 |
$1,265 |
7.6× |
| CT pelvis w&w/o contrast (72194) |
$2,153.20 |
$3,076 |
11.0× |
| CT pelvis w/o contrast (72192) |
$1,141 |
$1,630 |
9.8× |
| CT scan of leg combo (73702) |
$1,902.60 |
$2,718 |
9.7× |
| CT scans face/jaw combo (70488) |
$1,759.80 |
$2,514 |
9.0× |
| CT soft tissue neck w contrast (70491) |
$1,145.20 |
$1,636 |
5.9× |
| CT soft tissue neck w/o contrast (70490) |
$885.50 |
$1,265 |
7.6× |
| CT thoracic spine w contrast (72129) |
$1,451.80 |
$2,074 |
7.4× |
| CT thoracic spine w/o contrast (72128) |
$1,141 |
$1,630 |
9.8× |
| CT thoracic spine w/wo cont (72130) |
$2,237.90 |
$3,197 |
11.4× |
CT thorax w/o contrast (71250)
range across 2 matching MRF lines |
$596.40–$1,141 |
$852–$1,630 |
varies |
| CT upper ext wo (73200) |
$959.70 |
$1,371 |
8.2× |
| CT upper extremity w/o & w/contrast material (73202) |
$1,521.80 |
$2,174 |
7.8× |
| CT upper extremity with contrast (73201) |
$1,228.50 |
$1,755 |
3.2× |
| Cta Abdl Aorta&Bi Iliofem W/Contrast&Postp (75635) |
$2,557.80 |
$3,654 |
13.1× |
| Cta Abdomen (74175) |
$2,007.60 |
$2,868 |
10.3× |
| CTA pelvis (72191) |
$2,205.70 |
$3,151 |
11.3× |
| Dilation ureters/urethra rs&i (74485) |
$5,737.90 |
$8,197 |
2.5× |
| Discography Cerv/Thor Spine (72285) |
$2,481.50 |
$3,545 |
1.1× |
| Diskography lumbar (72295) |
$1,850.10 |
$2,643 |
0.9× |
| Doppler Echo Fetal Puls Spectral F/U/Repeat (76828) |
$1,000.30 |
$1,429 |
8.6× |
| Doppler Echo Fetal Spectral Display Complete (76827) |
$1,000.30 |
$1,429 |
8.6× |
| Dxa Bone Density Axial (77080) |
$371 |
$530 |
3.2× |
| Dxa bone density study (77085) |
$283.50 |
$405 |
2.4× |
| Dxa bone density study 1/>sites appendiclr skel (77081) |
$401.10 |
$573 |
4.1× |
| Echo exam of fetal heart (76825) |
$3,188.50 |
$4,555 |
5.2× |
| Echo exam uterus (76831) |
$1,596.70 |
$2,281 |
6.0× |
| Echocardiography, fetal, cardiovascular system, real time with image documentation (2D), with or without M-mode… (76826) |
$850.50 |
$1,215 |
3.2× |
| Echograp Trans R Pros Study (76873) |
$521.50 |
$745 |
4.5× |
| Esophageal Motility Study (78258) |
$1,169 |
$1,670 |
2.6× |
| Esophagram (74220) |
$558.60 |
$798 |
2.9× |
| Fetal Biophys Profile W/Nst (76818) |
$532 |
$760 |
4.6× |
| Fetal Biophysical Profile W/O Non-Stress Testing (76819) |
$532 |
$760 |
4.6× |
| Fluoroscopy up to 1 hr (76000) |
$674.80 |
$964 |
2.5× |
| Follow-Up Angiography (75898) |
$5,171.60 |
$7,388 |
1.5× |
| Foot 2 views (73620) |
$277.90 |
$397 |
2.9× |
| Forearm 2 views (73090) |
$294.70 |
$421 |
3.0× |
| Gastric emptying imaging study (78264) |
$1,091.30 |
$1,559 |
2.4× |
| Gastric Emptyng Imag Std W/Sm Bwl Transit (78265) |
$1,091.30 |
$1,559 |
2.4× |
| Gastroesophageal Reflux Exam (78262) |
$1,211 |
$1,730 |
2.7× |
| Gated Heart Planar Single (78472) |
$1,577.80 |
$2,254 |
3.5× |
| Gated Heart, Multiple (78473) |
$2,298.10 |
$3,283 |
5.2× |
| Gstrc Emptng Imag Std W/Sm Bwl Col Trnst Mlt Day (78266) |
$1,161.30 |
$1,659 |
1.9× |
| Hand 2 views (73120) |
$277.90 |
$397 |
2.4× |
| Hdr Rdncl Ntrstl/Icav Brchtx (77772) |
$2,292.50 |
$3,275 |
3.0× |
| Hdr Rdncl Ntrstl/Icav Brchtx (77771) |
$2,292.50 |
$3,275 |
3.0× |
| Hdr Rdncl Ntrstl/Icav Brchtx 1 Channel (77770) |
$2,292.50 |
$3,275 |
3.0× |
| Hepatobil Syst Image W/Drug (78227) |
$1,157.10 |
$1,653 |
1.9× |
| Hepatobiliary System Imaging (78226) |
$751.10 |
$1,073 |
1.7× |
| Ht Muscle Image Spect Sing (78451) |
$2,552.20 |
$3,646 |
1.8× |
| Hysterosalpingogram (74740) |
$1,052.10 |
$1,503 |
4.0× |
| Infant hip ultrasound with hip movement (dynamic) (76885) |
$1,957.20 |
$2,796 |
20.2× |
| Infant hip ultrasound, limited static exam (76886) |
$1,003.10 |
$1,433 |
10.3× |
| Infusion Ivp (74410) |
$1,743.70 |
$2,491 |
8.9× |
| Interstitial radiation source applic complex (77778) |
$3,679.90 |
$5,257 |
4.7× |
| Intracavitary Radiation Source Applic Complex (77763) |
$2,639.70 |
$3,771 |
3.4× |
| Intracavitary Radiation Source Applic Intermed (77762) |
$2,375.80 |
$3,394 |
3.9× |
| Intracavitary radiation source applic simple (77761) |
$1,246.70 |
$1,781 |
2.0× |
| Joint Survey Single View (77077) |
$655.20 |
$936 |
5.6× |
| K Flow/Funct Image Multiple (78709) |
$1,362.20 |
$1,946 |
2.3× |
| K Flow/Funct Image W/Drug (78708) |
$1,260 |
$1,800 |
2.1× |
| K Flow/Funct Image W/O Drug (78707) |
$1,232 |
$1,760 |
2.0× |
| Kidney Imaging Morphol (78700) |
$1,009.40 |
$1,442 |
2.3× |
| Kidney Imaging Morphoogy W/Vascular Flow (78701) |
$1,167.60 |
$1,668 |
2.6× |
| Knee 3 Views (73562) |
$372.40 |
$532 |
3.8× |
| Leveen/Shunt Patency Exam (78291) |
$1,278.20 |
$1,826 |
2.9× |
| Liver & Spleen Imaging Static Only (78215) |
$1,041.60 |
$1,488 |
2.3× |
| Liver & Spleen Imaging W/Vascular Flow (78216) |
$1,481.90 |
$2,117 |
3.3× |
| Liver imaging static only (78201) |
$903 |
$1,290 |
1.5× |
| Liver imaging w/vascular flow (78202) |
$956.90 |
$1,367 |
1.6× |
| Lung Perf&Ventilat Diferentl (78598) |
$1,029 |
$1,470 |
1.7× |
| Lung perfusion differential (78597) |
$875.70 |
$1,251 |
2.0× |
| Lung Ventilat&Perfus Imaging (78582) |
$1,029 |
$1,470 |
1.7× |
| Lung Ventilation Imaging (78579) |
$581 |
$830 |
1.3× |
| Lymph System Imaging (78195) |
$2,851.10 |
$4,073 |
4.7× |
| Magnetic Image Jaw Joint (70336) |
$2,437.40 |
$3,482 |
9.2× |
| Mammary ductogram or galactogram multiple (77054) |
$1,419.60 |
$2,028 |
5.3× |
| Mammary ductogram or galactogram single (77053) |
$788.20 |
$1,126 |
3.0× |
| Meckels Divert Exam (78290) |
$923.30 |
$1,319 |
2.1× |
| Medical physics dose eval radiation expos w/rprt (76145) |
$264.60 |
$378 |
0.6× |
| Mlc imrt design & construction per imrt plan (77338) |
$7,305.90 |
$10,437 |
17.5× |
| Mr safety determination physician/other qhp (76016) |
$261.80 |
$374 |
2.7× |
| Mr safety implant&/fb assmt clin staf 1st 15 min (76014) |
$72.80 |
$104 |
2.3× |
| Mr safety implt electronics prepj supvj phys/qhp (76018) |
$256.90 |
$367 |
2.4× |
| Mr safety implt pos&/immoblj (76019) |
$166.60 |
$238 |
2.5× |
| Mr safety med physics xm customization plng&mntr (76017) |
$718.90 |
$1,027 |
2.7× |
| Mra Head W/O & W/Contrast Material (70546) |
$2,419.90 |
$3,457 |
6.2× |
| MRA head w/o contrast (70544) |
$2,004.10 |
$2,863 |
7.5× |
| MRA head with contrast (70545) |
$2,101.40 |
$3,002 |
5.4× |
| MRA neck w contrast (70548) |
$2,109.10 |
$3,013 |
5.4× |
| Mra Neck W/O &W/Contrast Material (70549) |
$2,260.30 |
$3,229 |
5.8× |
| MRA neck w/o contrast (70547) |
$2,004.10 |
$2,863 |
7.5× |
| MRI abdomen w contrast (74182) |
$2,564.10 |
$3,663 |
6.6× |
MRI abdomen w/o contrast (74181)
range across 3 matching MRF lines |
$2,437.40–$2,501.80 |
$3,482–$3,574 |
varies |
| MRI any jt lower extrem w/contrast material (73722) |
$3,126.90 |
$4,467 |
3.6× |
| MRI any jt lower extrem w/o & w/contrast matrl (73723) |
$4,088.70 |
$5,841 |
10.5× |
| MRI any jt upper extremity w/contrast matrl (73222) |
$2,258.90 |
$3,227 |
2.6× |
| MRI bone marrow blood supply (77084) |
$2,604 |
$3,720 |
9.8× |
| MRI Breast W/O Contrast Bilateral (77047) |
$1,345.40 |
$1,922 |
5.1× |
| MRI Breast Without Contrast Material Unilateral (77046) |
$1,344 |
$1,920 |
5.1× |
| MRI cardiac w/o cont stress (75559) |
$2,305.80 |
$3,294 |
3.8× |
| MRI cardiac w/o contrast (75557) |
$2,437.40 |
$3,482 |
9.2× |
MRI cervical spine w contrast (72142)
range across 2 matching MRF lines |
$1,779.40–$2,170 |
$2,542–$3,100 |
varies |
| MRI cervical spine w/o cont (72141) |
$1,733.20 |
$2,476 |
6.5× |
| MRI chest w/o contrast (71550) |
$2,193.10 |
$3,133 |
8.2× |
| MRI chest with contrast (71551) |
$2,437.40 |
$3,482 |
2.8× |
| MRI chest wo w contrast (71552) |
$2,564.10 |
$3,663 |
6.6× |
| MRI lower extrem oth/thn jt w/contrast matrl (73719) |
$2,756.60 |
$3,938 |
7.1× |
| MRI lower extrem oth/thn jt w/o & w/contr matr (73720) |
$3,126.90 |
$4,467 |
8.0× |
MRI lower extrem oth/thn jt w/o contr matrl (73718)
range across 2 matching MRF lines |
$1,233.40–$2,377.20 |
$1,762–$3,396 |
varies |
| MRI lumbar spine w contrast (72149) |
$3,052.70 |
$4,361 |
7.9× |
Mri Neck Spine W/O & W/Dye (72156)
range across 2 matching MRF lines |
$2,170–$3,332.70 |
$3,100–$4,761 |
varies |
| MRI orbit face &/neck w/o contrast (70540) |
$1,148.70 |
$1,641 |
4.3× |
| MRI orbit face neck w contrast (70542) |
$1,276.10 |
$1,823 |
3.3× |
| Mri Orbt/Fac/Nck W/O &W/Dye (70543) |
$1,418.20 |
$2,026 |
3.6× |
| MRI pelvis w contrast (72196) |
$2,564.10 |
$3,663 |
6.6× |
| MRI pelvis w/o & w contrast (72197) |
$3,213.70 |
$4,591 |
8.3× |
| MRI pelvis w/o contrast (72195) |
$2,437.40 |
$3,482 |
9.2× |
MRI thoracic spine w/o contrast (72146)
range across 2 matching MRF lines |
$2,501.80–$2,951.20 |
$3,574–$4,216 |
varies |
| MRI upper extremity oth than jt w/contr matrl (73219) |
$2,468.90 |
$3,527 |
6.4× |
MRI upper extremity oth than jt w/o contr matrl (73218)
range across 2 matching MRF lines |
$1,233.40–$2,814 |
$1,762–$4,020 |
varies |
| Mri Uppr Extremity W/O&W/Dye (73220) |
$3,126.90 |
$4,467 |
8.0× |
| MRI, abdomen, combo (74183) |
$3,213.70 |
$4,591 |
8.3× |
MRI, dorsal spine combo (72157)
range across 2 matching MRF lines |
$3,052.70–$4,686.50 |
$4,361–$6,695 |
varies |
MRI, dorsal spine contrast (72147)
range across 2 matching MRF lines |
$2,705.50–$3,052.70 |
$3,865–$4,361 |
varies |
MRI, joint upper extrem (73221)
range across 2 matching MRF lines |
$1,233.40–$2,032.10 |
$1,762–$2,903 |
varies |
| MRI, joint upper extrem combo (73223) |
$3,126.90 |
$4,467 |
8.0× |
| MRI, lumbar spine combo (72158) |
$4,686.50 |
$6,695 |
12.1× |
| Musculoskeletal Nuclear Exam (78399) |
$4,407.90 |
$6,297 |
9.9× |
| Myelogram cervical (72240) |
$3,060.40 |
$4,372 |
3.5× |
| Myelogram Lumbar (72265) |
$2,630.60 |
$3,758 |
3.0× |
| Myelography thoracic (72255) |
$2,793 |
$3,990 |
3.2× |
| Myelograpy 2/more regions rs&i (72270) |
$3,929.80 |
$5,614 |
4.5× |
| Myocardial Imaging Infarct Avid Planar Qual/Quan (78466) |
$1,264.20 |
$1,806 |
2.8× |
| Myocardial Spect Multiple Studies (78452) |
$3,550.40 |
$5,072 |
2.5× |
| Neck soft tissue (70360) |
$202.30 |
$289 |
2.1× |
| Nervous system nuclear exam (78699) |
$1,169 |
$1,670 |
2.6× |
| Nfs/Instlj Radioelmnt Sln 3 Mo Follow-Up Care (77750) |
$640.50 |
$915 |
1.5× |
| Njx Rp Loclzj Non-Img Probe Study Intravenous (78808) |
$1,099.70 |
$1,571 |
2.5× |
| Nm csf leak detection (78650) |
$1,905.40 |
$2,722 |
1.3× |
| Nm myocard infarct spect (78469) |
$1,275.40 |
$1,822 |
2.1× |
| Nm unlisted gi procedure (78299) |
$631.40 |
$902 |
1.4× |
| Ntsty modul radthx pln dose-vol histos (77301) |
$7,305.90 |
$10,437 |
4.7× |
| Nuclear medicine study of endocrine organs (78099) |
$991.20 |
$1,416 |
2.2× |
| Nuclear Rx Oral Admin (79005) |
$685.30 |
$979 |
2.6× |
| Ob us nuchal meas 1 gest (76813) |
$789.60 |
$1,128 |
6.8× |
Ophthalmic ultrasound dx b-scan w/wo a-scan (76512)
range across 3 matching MRF lines |
$60.20–$136.50 |
$86–$195 |
varies |
| Optic foramina (70190) |
$548.80 |
$784 |
5.7× |
| Panoramic X-ray of jaws (70355) |
$504.70 |
$721 |
5.2× |
| Parathyroid imaging w/tomographic spect & CT (78072) |
$1,412.60 |
$2,018 |
2.3× |
| Parathyroid Planar Imaging (78070) |
$664.30 |
$949 |
1.5× |
| Parathyroid planar imaging w/wo subtraction (78071) |
$730.80 |
$1,044 |
1.6× |
| Pelvis 1 or 2 views (72170) |
$294.70 |
$421 |
2.5× |
| Perineogram (74775) |
$868 |
$1,240 |
3.3× |
| Peritoneogram Rs&I (74190) |
$1,444.10 |
$2,063 |
2.4× |
| Pet Image W/Ct Lmtd (78814) |
$5,890.50 |
$8,415 |
3.7× |
| PET image w/CT, full body (78816) |
$5,890.50 |
$8,415 |
3.7× |
| PET imaging CT attenuation skull base mid-thigh (78815) |
$5,890.50 |
$8,415 |
3.7× |
| Pulmonary Perfusion Imaging Particulate (78580) |
$1,028.30 |
$1,469 |
2.3× |
| Radex Abd Compl Aqt Abd W/S/E/D Views 1 View Ch (74022) |
$349.30 |
$499 |
3.0× |
| Radex abscess/fistula/sinus tract rs&i (76080) |
$858.90 |
$1,227 |
1.4× |
| Radex Ankle Complete Minimum 3 Views (73610) |
$342.30 |
$489 |
3.5× |
| Radex Calcaneus Minimum 2 Views (73650) |
$267.40 |
$382 |
2.8× |
| Radex elbow complete minimum 3 views (73080) |
$321.30 |
$459 |
3.3× |
| Radex Facial Bones Complete Minimum 3 Views (70150) |
$442.40 |
$632 |
3.8× |
| Radex fingr minimum 2 views (73140) |
$237.30 |
$339 |
2.4× |
| Radex foot complete minimum 3 views (73630) |
$298.90 |
$427 |
3.1× |
| Radex Hand Minimum 3 Views (73130) |
$298.90 |
$427 |
3.1× |
| Radex lower extremity infant minimum 2 views (73592) |
$294.70 |
$421 |
3.0× |
| Radex Mastoids Compl Minimum 3 Views PR Side (70130) |
$693 |
$990 |
5.9× |
| Radex Nasal Bones Complete Minimum 3 Views (70160) |
$294.70 |
$421 |
3.0× |
| Radex Ribs Unilateral 2 Views (71100) |
$321.30 |
$459 |
3.3× |
| Radex shoulder complete minimum 2 views (73030) |
$362.60 |
$518 |
3.7× |
| Radex Sinuses Paransl < 3 Views (70210) |
$351.40 |
$502 |
3.6× |
| Radex sm int w/mlt srl imges via enteroclss tube (74251) |
$961.80 |
$1,374 |
4.9× |
| Radex Spine 1 View Specify Level (72020) |
$237.30 |
$339 |
2.4× |
| Radex Sternum Minimum 2 Views (71120) |
$364.70 |
$521 |
3.8× |
| Radex Temporomandble Jt Opn & Clsd Mouth Bilat (70330) |
$468.30 |
$669 |
4.8× |
| Radex Toe Minimum 2 Views (73660) |
$237.30 |
$339 |
2.4× |
| Radex upper extremity infant minimum 2 views (73092) |
$294.70 |
$421 |
2.5× |
| Radex Wrist Complete Minimum 3 Views (73110) |
$298.90 |
$427 |
3.1× |
| Radex X-Ray Exam Entire Spi 6/> Vw - Xr Entire Spine 6+ Vw (72084) |
$578.90 |
$827 |
5.0× |
| Radiation Delivery Stereotactic Cranial Linear (77372) |
$12,317.90 |
$17,597 |
1.5× |
| Radiation treatment delivery level 1 (77402) |
$533.40 |
$762 |
4.7× |
| Radiation treatment delivery level 3 (77412) |
$897.40 |
$1,282 |
1.5× |
| Radiolog exam mandible compl minimum 4 views (70110) |
$351.40 |
$502 |
3.0× |
| Radiologic Exam Abdomen 3+ Views - Xr Abdomen 3+ Views (74021) |
$427.70 |
$611 |
3.7× |
| Radiologic exam colon double contrast study (74280) |
$1,052.80 |
$1,504 |
5.4× |
| Radiologic exam colon single contrast study (74270) |
$802.90 |
$1,147 |
4.1× |
| Radiologic exam knee complete 4/more views (73564) |
$473.20 |
$676 |
4.1× |
| Radiologic exam pelvis compl minimum 3 views (72190) |
$402.50 |
$575 |
3.5× |
| Radiologic Exam Small Int Single Contrast Study (74250) |
$613.20 |
$876 |
3.1× |
| Radiologic exam swallow function contrast study (74230) |
$613.20 |
$876 |
3.1× |
| Radiologic exam upr gi trc double contrast study (74246) |
$792.40 |
$1,132 |
4.1× |
| Radiologic examination femur 1 view (73551) |
$287.70 |
$411 |
3.0× |
| Radiologic examination femur minimum 2 views (73552) |
$183.40 |
$262 |
1.9× |
| Radiologic examination knee 1/2 views (73560) |
$320.60 |
$458 |
3.3× |
| Radiologic Examination Osseous Survey Limited (77074) |
$556.50 |
$795 |
4.8× |
| Radiologic Examination Salivary Gland Calculus (70380) |
$820.40 |
$1,172 |
8.5× |
| Radiologic examination tibia & fibula 2 views (73590) |
$294.70 |
$421 |
3.0× |
| Renal Cyst Study (74470) |
$779.10 |
$1,113 |
1.3× |
| Ribs bilateral 3 views (71110) |
$501.20 |
$716 |
4.3× |
| Rp loclzj tum plnr 1 area single day imaging (78800) |
$1,411.90 |
$2,017 |
3.2× |
| Rp loclzj tum plnr 2+area 1+d img/1 area img>2+d (78801) |
$1,411.90 |
$2,017 |
3.2× |
| Rp Loclzj Tum Plnr Whole Body 2+ Days Imaging (78804) |
$3,169.60 |
$4,528 |
5.2× |
| Rp Loclzj Tum Plnr Whole Body Single Day Imaging (78802) |
$1,680.70 |
$2,401 |
2.8× |
| Rp Loclzj Tum Spect 1 Area Single Day Imaging (78803) |
$3,814.30 |
$5,449 |
6.3× |
| Rp loclzj tum spect CT 2area 1d img/1 ar img>2+d (78832) |
$4,654.30 |
$6,649 |
2.9× |
| Rp loclzj tum spect w/CT 1 area/acquisj 1day img (78830) |
$4,034.80 |
$5,764 |
2.8× |
| Rp Ther Radiolbld Monoclonal Antibody IV Infus (79403) |
$1,444.10 |
$2,063 |
5.6× |
| Rp Therapy Intravenous Administration (79101) |
$653.10 |
$933 |
2.5× |
| Scapula (73010) |
$294.70 |
$421 |
2.5× |
| Screening Digital Breast Tomosynthesis Bi (77063) |
$41.30 |
$59 |
1.8× |
| Sella turcica (70240) |
$373.10 |
$533 |
3.8× |
| Shoulder 1 view (73020) |
$267.40 |
$382 |
2.8× |
| Shoulder Arthrography (73040) |
$1,357.30 |
$1,939 |
3.5× |
| Sialogram (70390) |
$879.90 |
$1,257 |
3.3× |
| Skull less than 4 views (70250) |
$351.40 |
$502 |
3.0× |
| Special dosimetry (77331) |
$425.60 |
$608 |
2.8× |
| Special Physics Consult (77370) |
$917.70 |
$1,311 |
6.1× |
| Special teletherapy port plan (77321) |
$1,097.60 |
$1,568 |
2.6× |
| Special treatment procedure (77470) |
$1,908.90 |
$2,727 |
3.1× |
| Spleen Imaging (78185) |
$1,275.40 |
$1,822 |
2.9× |
| Srs Multisource (77371) |
$12,317.90 |
$17,597 |
1.5× |
| Stereotactic Body Radiation Delivery (77373) |
$6,590.50 |
$9,415 |
3.3× |
| Sternoclavicular joints (71130) |
$390.60 |
$558 |
4.0× |
| Telethx isodose pln cplx w/basic dosimetry (77307) |
$396.20 |
$566 |
0.9× |
| Telethx isodose pln smpl w/dosimetry calculation (77306) |
$396.20 |
$566 |
0.9× |
| Temporomandble Jt Arthrography Rs&I (70332) |
$1,293.60 |
$1,848 |
4.9× |
| Testicular Imaging W/Flow (78761) |
$1,465.10 |
$2,093 |
3.3× |
| Ther Rad Simulaj-Aided Field Setting Complex (77290) |
$1,955.10 |
$2,793 |
4.7× |
| Ther Rad Simulaj-Aided Field Setting Intermed (77285) |
$1,489.60 |
$2,128 |
3.6× |
| Ther rad simulaj-aided field setting simple (77280) |
$913.50 |
$1,305 |
6.1× |
| Therapeutic Enema Rdctj Intussusception/Obstrcj (74283) |
$1,657.60 |
$2,368 |
8.5× |
| Thoracic spine 2 views (72070) |
$331.10 |
$473 |
2.8× |
| Thoracic spine 3 views (72072) |
$412.30 |
$589 |
3.5× |
| Thoracolumbar 2 views (72080) |
$412.30 |
$589 |
4.3× |
| Thyroid Imaging With Vascular Flow (78013) |
$944.30 |
$1,349 |
2.1× |
| Thyroid Met Imaging Body (78018) |
$1,554 |
$2,220 |
2.6× |
| Thyroid Uptake Measurement (78012) |
$600.60 |
$858 |
1.3× |
| Thyroid Uptake W/Blood Flow Sngle/Mult Quan Meas (78014) |
$1,238.30 |
$1,769 |
2.8× |
| Tx Devices Design & Construction Complex (77334) |
$855.40 |
$1,222 |
2.1× |
| Tx devices design & construction intermediate (77333) |
$787.50 |
$1,125 |
5.3× |
| Tx devices design & construction simple (77332) |
$787.50 |
$1,125 |
5.3× |
| Ultrasound Breast Limited (76642) |
$291.90 |
$417 |
3.0× |
| Ultrasound Elastography Parenchyma (76981) |
$494.90 |
$707 |
4.2× |
| Ultrasound Exam Aaa Screen (76706) |
$290.50 |
$415 |
2.5× |
| Ultrasound, abdomen limited (76705) |
$451.50 |
$645 |
3.9× |
| Umbilical-artery Doppler (OB) (76820) |
$398.30 |
$569 |
3.4× |
| Unlisted Dx Radiographic Procedure (76499) |
$1,021.30 |
$1,459 |
10.5× |
Unlisted magnetic resonance procedure (76498)
range across 3 matching MRF lines |
$1,197–$2,275 |
$1,710–$3,250 |
varies |
| Unlisted Miscellaneous Px Dx Nuclear Medicine (78999) |
$1,152.90 |
$1,647 |
2.6× |
| Unlisted respiratory px dx nuclear medicine (78599) |
$725.90 |
$1,037 |
1.6× |
| Unlisted us procedure (76999) |
$702.80 |
$1,004 |
7.2× |
| Upper gi w/o kub (74240) |
$1,031.80 |
$1,474 |
5.3× |
| Urea Breath Test C-14 Isotopic Acquisj Analysis (78267) |
$434 |
$620 |
39.2× |
| Ureteral Reflux Study (78740) |
$1,071 |
$1,530 |
2.4× |
| Urethrocystogram voiding (74455) |
$742.70 |
$1,061 |
2.8× |
| Urethrocystography retrograde (74450) |
$548.10 |
$783 |
2.1× |
| Us breast unilateral complete (76641) |
$291.90 |
$417 |
2.5× |
| Us chest (76604) |
$422.80 |
$604 |
3.6× |
| Us complete joint (76881) |
$318.50 |
$455 |
2.7× |
| Us exam, pelvic, limited (76857) |
$496.30 |
$709 |
4.3× |
| Us head (76506) |
$393.40 |
$562 |
3.4× |
| Us kidney transplant (76776) |
$426.30 |
$609 |
3.7× |
| Us lmtd joint/oth nonvasc xtr strux r-t w/img (76882) |
$293.30 |
$419 |
2.5× |
| Us ob detailed single fetus (76811) |
$702.80 |
$1,004 |
2.6× |
| Us ob limited 1 or more fetuses (76815) |
$393.40 |
$562 |
3.4× |
| Us ob transvaginal (76817) |
$449.40 |
$642 |
3.9× |
| Us pelvic non ob complete (76856) |
$653.80 |
$934 |
5.6× |
| Us pg uter img f&mat 14 wk tabdl 1/1st gestation (76801) |
$525 |
$750 |
4.5× |
| Us preg uterus real time f/u trnsabdl per fetus (76816) |
$309.40 |
$442 |
2.7× |
| Us retroperitoneal complete (76770) |
$543.20 |
$776 |
4.7× |
| Us retroperitoneal limited (76775) |
$451.50 |
$645 |
3.9× |
| Us scrotum and contents (76870) |
$467.60 |
$668 |
4.0× |
| Us spinal canal and contents (76800) |
$529.20 |
$756 |
4.5× |
| Us thyroid (76536) |
$393.40 |
$562 |
3.4× |
| Vein X-Ray Chest (75827) |
$8,113 |
$11,590 |
4.6× |
| Venogram Sinus/Jugular (75860) |
$2,543.10 |
$3,633 |
0.7× |
| Venography caval inferior serialography rs&i (75825) |
$8,597.40 |
$12,282 |
2.4× |
| Venography extremity bilateral rs&i (75822) |
$3,082.80 |
$4,404 |
1.8× |
| Venography extremity unilateral rs&i (75820) |
$2,467.50 |
$3,525 |
1.4× |
| Venography Renal Unilateral (75831) |
$9,518.60 |
$13,598 |
2.7× |
| Venous sampling by catheter (75893) |
$8,597.40 |
$12,282 |
1.4× |
| Venous thrombosis imaging (78457) |
$1,165.50 |
$1,665 |
1.9× |
| Venous Thrombosis Imaging Venogram Bilateral (78458) |
$1,243.20 |
$1,776 |
2.8× |
| Vertebral fracture assessment via dxa (77086) |
$392.70 |
$561 |
4.0× |
| Wrist 2 views (73100) |
$277.90 |
$397 |
2.9× |
| X-Ray Ac Jts - Xr Acromioclavicular Joints Bilateral (73050) |
$375.20 |
$536 |
3.9× |
| X-ray antegrade pyelogram tube (74425) |
$628.60 |
$898 |
1.6× |
| X-Ray Aorta Leg Arteries (75630) |
$6,890.80 |
$9,844 |
2.0× |
| X-Ray Bend Only L-S Spine (72120) |
$786.80 |
$1,124 |
6.8× |
| X-Ray Elbow 2 Vw - Xr Elbow 1-2 Views Right (73070) |
$294.70 |
$421 |
3.0× |
| X-Ray Exam Breast Specimen (76098) |
$1,267.70 |
$1,811 |
2.1× |
| X-Ray Exam Entire Spi 1 Vw (72081) |
$183.40 |
$262 |
1.9× |
| X-Ray Exam Entire Spi 2/3 Vw (72082) |
$303.10 |
$433 |
2.6× |
| X-Ray Exam Entire Spi 4/5 Vw (72083) |
$578.90 |
$827 |
5.0× |
| X-Ray Exam Hip Uni 1 View (73501) |
$151.20 |
$216 |
1.6× |
| X-Ray Exam Hip Uni 2-3 Views (73502) |
$183.40 |
$262 |
1.9× |
| X-Ray Exam Hip Uni 4/> Views (73503) |
$476 |
$680 |
4.1× |
| X-Ray Exam Hips Bi 2 Views (73521) |
$303.10 |
$433 |
2.6× |
| X-Ray Exam Hips Bi 3-4 Views (73522) |
$303.10 |
$433 |
2.6× |
| X-Ray Exam Hips Bi 5/> Views (73523) |
$905.80 |
$1,294 |
7.8× |
| X-Ray Exam L-S Spine Bending (72114) |
$630.70 |
$901 |
5.4× |
| X-Ray Exam Neck Spine 2-3 Vw (72040) |
$336 |
$480 |
3.5× |
| X-Ray Exam Neck Spine 6/>Vws (72052) |
$630.70 |
$901 |
5.4× |
| X-Ray Exam Unilat Ribs/Chest (71101) |
$498.40 |
$712 |
4.3× |
| X-ray eye for foreign body (70030) |
$295.40 |
$422 |
3.0× |
| X-ray humerus (73060) |
$321.30 |
$459 |
3.3× |
| X-ray IV pyelogram (ivp) (74400) |
$1,246.70 |
$1,781 |
6.4× |
| X-ray IV pyelogram+tomography (74415) |
$3,388 |
$4,840 |
17.3× |
| X-Ray Jaw <4 Vw - Xr Mandible < 4 Views (70100) |
$294.70 |
$421 |
3.0× |
| X-Ray Knee Bilat Standing - Xr Knees Anteroposterior Standing Bilat (73565) |
$294.70 |
$421 |
3.0× |
| X-Ray Lumbar Spine 2/3 Vw - Xr Lumbar Spine 2-3 Views (72100) |
$375.20 |
$536 |
3.2× |
| X-ray nose-rectum child f.b. (76010) |
$538.30 |
$769 |
5.6× |
| X-Ray Ribs, Chest 4+ Vw - Xr Ribs 3 Vws Bil W/ Chest Posteroanterior (71111) |
$541.80 |
$774 |
4.7× |
| X-Ray Sacroiliac Jts 3+ Vw - Xr Sacroiliac Joints 3+ Views (72202) |
$351.40 |
$502 |
3.0× |
| X-Ray Sacroiliac Jts <3 Vw - Xr Sacroiliac Joints 1-2 Views (72200) |
$237.30 |
$339 |
2.0× |
| X-Ray Sacrum/Coccyx 2+ Vw - Xr Sacrum Coccyx 2+ Views (72220) |
$321.30 |
$459 |
3.3× |
| X-Ray Sinuses 3+ Vw - Xr Paranasal Sinuses 3+ Views (70220) |
$442.40 |
$632 |
4.6× |
| X-Ray Skull 4+ Vw - Xr Skull Complete 4+ Views (70260) |
$501.20 |
$716 |
4.3× |
| X-Ray Stress View (77071) |
$417.90 |
$597 |
4.3× |
| X-ray thoracic spine 4 vw (72074) |
$660.10 |
$943 |
5.7× |
| X-Ray Tmj Unilat (70328) |
$439.60 |
$628 |
4.5× |
| X-Ray Urinary Tract Exam With Contrast Material (74420) |
$1,238.30 |
$1,769 |
3.2× |
| X-Rays Bone Length Studies (77073) |
$442.40 |
$632 |
3.8× |
| X-Rays Bone Survey Complete (77075) |
$1,021.30 |
$1,459 |
8.8× |
| Xr c-spine 4 or 5 views (72050) |
$501.20 |
$716 |
4.3× |
| Xr facial bones less than 3 views (70140) |
$548.80 |
$784 |
5.7× |
| XR Mastoids < 3 Views Bilateral (70120) |
$351.40 |
$502 |
3.0× |
| Xr orbits complete 4 views (70200) |
$442.40 |
$632 |
3.8× |
| Xr Tomogram Single Plane (76100) |
$927.50 |
$1,325 |
8.0× |