| 3-D radiotherapy plan dose-volume histograms (77295) |
$3,885 |
$6,475 |
2.7× |
| Abdomen 1 View (74018) |
$214.80 |
$358 |
2.3× |
| Abdomen 2 views (74019) |
$261.60 |
$436 |
2.4× |
| Acute Gastrointestinal Blood Loss Imaging (78278) |
$3,115.20 |
$5,192 |
7.4× |
| Angio internal mammary (75756) |
$1,197.60 |
$1,996 |
0.4× |
| Angio pulmonary bilat (75743) |
$809.40 |
$1,349 |
0.2× |
| Angiography extremity bilateral rs&i (75716) |
$802.20 |
$1,337 |
0.2× |
| Angiography extremity unilateral rs&i (75710) |
$772.20 |
$1,287 |
0.2× |
| Angiography pulmonary unilateral slctv rs&i (75741) |
$794.40 |
$1,324 |
0.2× |
| Ankle 2 views (73600) |
$267.60 |
$446 |
2.9× |
Aortography thoracic serialography rs&i (75605)
likely a partial charge, not the full procedure |
$760.80 |
$1,268 |
0.1× |
| Aortography thoracic w/o serialography rs&i (75600) |
$1,805.40 |
$3,009 |
0.5× |
Artery X-Rays Abdomen (75726)
likely a partial charge, not the full procedure |
$869.40 |
$1,449 |
0.1× |
Artery X-Rays Pelvis (75736)
likely a partial charge, not the full procedure |
$1,018.80 |
$1,698 |
0.2× |
| Arthrogram hip (73525) |
$1,156.80 |
$1,928 |
3.1× |
| Arthrogram Wrist (73115) |
$1,183.80 |
$1,973 |
3.2× |
| Basic radiation dosimetry calculation (77300) |
$387 |
$645 |
2.7× |
| Bone age studies (77072) |
$184.20 |
$307 |
1.7× |
| Bone Imaging 3 Phase (78315) |
$3,078 |
$5,130 |
7.3× |
| Bone Imaging Limited Area (78300) |
$2,041.20 |
$3,402 |
4.8× |
| Bone Imaging Whole Body (78306) |
$2,634 |
$4,390 |
6.2× |
| Bone marrow imaging limited area (78102) |
$1,537.20 |
$2,562 |
3.6× |
| Bone marrow imaging; whole body (78104) |
$2,167.80 |
$3,613 |
5.1× |
| Bone survey infant (77076) |
$807 |
$1,345 |
7.3× |
| Brain Flow Imaging Only (78610) |
$1,660.80 |
$2,768 |
2.9× |
| Brain Image W/Flow < 4 Views (78601) |
$1,981.20 |
$3,302 |
4.7× |
| Brain Imaging Min 4 Static Views W Vascular Flow (78606) |
$3,070.80 |
$5,118 |
5.3× |
| Brain Imaging Pet Metabolic Evaluation (78608) |
$3,453 |
$5,755 |
2.3× |
| Cardiac MRI w/w/o contrast & further seq (75561) |
$2,602.80 |
$4,338 |
7.1× |
| Cat Scan Follow-Up Study (76380) |
$593.40 |
$989 |
6.4× |
| Cerebrospinal Fluid Scan (78630) |
$3,153 |
$5,255 |
5.5× |
| Chest 1 view (71045) |
$178.20 |
$297 |
1.9× |
| Chest 2 views (71046) |
$240.60 |
$401 |
2.6× |
| Chest 3 views (71047) |
$301.80 |
$503 |
3.3× |
| Chest 4 or more views (71048) |
$326.40 |
$544 |
3.0× |
| Clavicle complete (73000) |
$264 |
$440 |
2.9× |
| Computed Tomography Thorax Lw Dose Lng Ca Scr C- (71271) |
$595.20 |
$992 |
5.4× |
| Continuing medical physics consltj pr wk (77336) |
$387 |
$645 |
2.7× |
| Contrast Exam Abdominl Aorta (75625) |
$671.40 |
$1,119 |
0.2× |
| Contrast X-Ray Bladder (74430) |
$265.20 |
$442 |
0.7× |
| Contrast X-Ray Of Knee Joint (73580) |
$1,063.80 |
$1,773 |
2.9× |
| CT abdomen and pelvis without and with contrast (74178) |
$1,701.60 |
$2,836 |
4.6× |
| CT abdomen and pelvis without contrast (74176) |
$697.20 |
$1,162 |
2.8× |
| CT abdomen w contrast (74160) |
$1,199.40 |
$1,999 |
6.5× |
| CT abdomen w wo contrast (74170) |
$1,356.60 |
$2,261 |
7.3× |
| CT abdomen w/o contrast (74150) |
$556.20 |
$927 |
5.0× |
| CT Angio Abdomen and Pelvis (74174) |
$1,906.20 |
$3,177 |
5.2× |
| CT Angio Chest (71275) |
$1,343.40 |
$2,239 |
7.2× |
| CT Angio Head (70496) |
$1,327.80 |
$2,213 |
7.2× |
| CT angio hrt w/3d image (75574) |
$1,428 |
$2,380 |
3.9× |
Ct Angio Lwr Extr W/O&W/Dye (73706)
range across 3 matching MRF lines |
$1,638–$2,419.20 |
$2,730–$4,032 |
varies |
| CT Angio Neck (70498) |
$1,326 |
$2,210 |
7.1× |
| Ct Angio Upr Extrm W/O&W/Dye (73206) |
$1,464.60 |
$2,441 |
7.9× |
| CT cervical spine w/ contrast (72126) |
$765 |
$1,275 |
2.1× |
| CT cervical spine w/o contrast (72125) |
$569.40 |
$949 |
5.1× |
| CT cervical spine w/wo cont (72127) |
$945.60 |
$1,576 |
5.1× |
| CT chest w contrast (71260) |
$767.40 |
$1,279 |
4.1× |
| CT chest w/wo contrast (71270) |
$945.60 |
$1,576 |
5.1× |
| CT colonogrphy dx image postprocess w/o contrast (74261) |
$2,100 |
$3,500 |
19.0× |
| CT head/brain with contrast (70460) |
$649.80 |
$1,083 |
3.5× |
| CT head/brain without and with contrast (70470) |
$782.40 |
$1,304 |
4.2× |
| CT heart contrast eval cardiac structure&morph (75572) |
$995.40 |
$1,659 |
2.7× |
| CT heart no contrast quant eval coronry calcium (75571) |
$491.40 |
$819 |
5.3× |
| CT hrt w/3d image congen (75573) |
$1,256.40 |
$2,094 |
3.4× |
| CT iac w contrast (70481) |
$873.60 |
$1,456 |
4.7× |
| CT l-spine w&w/o contrast (72133) |
$947.40 |
$1,579 |
5.1× |
| CT lower ext w/o (73700) |
$567 |
$945 |
5.1× |
| CT lower extremity w/contrast material (73701) |
$769.20 |
$1,282 |
4.1× |
| CT lumbar spine w contrast (72132) |
$767.40 |
$1,279 |
2.1× |
| CT lumbar spine w/o contrast (72131) |
$565.20 |
$942 |
5.1× |
| CT maxillofacial w contrast (70487) |
$678 |
$1,130 |
3.7× |
| CT maxillofacial wo contrast (70486) |
$602.40 |
$1,004 |
5.4× |
| CT neck tissue combo (70492) |
$1,067.40 |
$1,779 |
5.8× |
| Ct Orbit/Ear/Fossa W/O&W/Dye (70482) |
$1,036.80 |
$1,728 |
5.6× |
| CT orbits w/o contrast (70480) |
$674.40 |
$1,124 |
6.1× |
| CT pelvis w&w/o contrast (72194) |
$1,349.40 |
$2,249 |
7.3× |
| CT pelvis w/o contrast (72192) |
$563.40 |
$939 |
5.1× |
| CT scan of leg combo (73702) |
$947.40 |
$1,579 |
5.1× |
| CT scans face/jaw combo (70488) |
$858.60 |
$1,431 |
4.6× |
| CT soft tissue neck w contrast (70491) |
$821.40 |
$1,369 |
4.4× |
| CT soft tissue neck w/o contrast (70490) |
$617.40 |
$1,029 |
5.6× |
| CT thoracic spine w contrast (72129) |
$771.60 |
$1,286 |
4.2× |
| CT thoracic spine w/o contrast (72128) |
$569.40 |
$949 |
5.1× |
| CT thoracic spine w/wo cont (72130) |
$956.40 |
$1,594 |
5.2× |
| CT thorax w/o contrast (71250) |
$565.20 |
$942 |
5.1× |
| CT upper ext wo (73200) |
$789 |
$1,315 |
7.1× |
| CT upper extremity w/o & w/contrast material (73202) |
$1,319.40 |
$2,199 |
7.1× |
| CT upper extremity with contrast (73201) |
$1,008.60 |
$1,681 |
2.7× |
| Cta Abdl Aorta&Bi Iliofem W/Contrast&Postp (75635) |
$2,043 |
$3,405 |
11.0× |
| Cta Abdomen (74175) |
$1,521.60 |
$2,536 |
8.2× |
| CTA head&neck c+ w/noncontrast img&post-pxessing (70471) |
$1,645.80 |
$2,743 |
4.5× |
| CTA pelvis (72191) |
$1,516.80 |
$2,528 |
8.2× |
| Discography Cerv/Thor Spine (72285) |
$799.80 |
$1,333 |
0.4× |
| Diskography lumbar (72295) |
$778.20 |
$1,297 |
0.4× |
| Dxa Bone Density Axial (77080) |
$310.80 |
$518 |
2.8× |
| Dxa bone density study (77085) |
$417.60 |
$696 |
3.8× |
| Dxa bone density study 1/>sites appendiclr skel (77081) |
$235.20 |
$392 |
2.6× |
| Echo exam uterus (76831) |
$492.60 |
$821 |
2.0× |
| Echo Guide For Artery Repair (76936) |
$993.60 |
$1,656 |
4.3× |
| Esophagram (74220) |
$715.20 |
$1,192 |
3.9× |
| Fetal Biophys Profile W/Nst (76818) |
$397.80 |
$663 |
3.6× |
| Fetal Biophysical Profile W/O Non-Stress Testing (76819) |
$286.20 |
$477 |
2.6× |
| Fluoroscopy up to 1 hr (76000) |
$313.20 |
$522 |
1.2× |
| Follow-Up Angiography (75898) |
$6,906.60 |
$11,511 |
2.1× |
| Foot 2 views (73620) |
$228 |
$380 |
2.5× |
| Forearm 2 views (73090) |
$235.20 |
$392 |
2.6× |
| Gastric emptying imaging study (78264) |
$3,029.40 |
$5,049 |
7.2× |
| Gated Heart Planar Single (78472) |
$1,873.20 |
$3,122 |
4.4× |
| Hand 2 views (73120) |
$253.80 |
$423 |
2.3× |
| Hepatc Vngrph Wdg/Fr Hemodyn Eval Rs&I (75889) |
$813.60 |
$1,356 |
0.2× |
| Hepatobil Syst Image W/Drug (78227) |
$4,081.80 |
$6,803 |
7.1× |
| Hepatobiliary System Imaging (78226) |
$3,000 |
$5,000 |
7.1× |
| Ht Muscle Image Spect Sing (78451) |
$2,820.60 |
$4,701 |
2.1× |
| Hysterosalpingogram (74740) |
$786 |
$1,310 |
3.1× |
| Infant hip ultrasound with hip movement (dynamic) (76885) |
$609.60 |
$1,016 |
6.6× |
| Infant hip ultrasound, limited static exam (76886) |
$427.20 |
$712 |
4.6× |
| Infusion Ivp (74410) |
$1,198.80 |
$1,998 |
6.5× |
| Joint Survey Single View (77077) |
$333 |
$555 |
3.0× |
| K Flow/Funct Image W/Drug (78708) |
$1,324.20 |
$2,207 |
2.3× |
| K Flow/Funct Image W/O Drug (78707) |
$1,951.20 |
$3,252 |
3.4× |
| Kidney Imaging Morphol (78700) |
$1,563.60 |
$2,606 |
3.7× |
| Kidney Imaging Morphoogy W/Vascular Flow (78701) |
$2,100.60 |
$3,501 |
5.0× |
| Knee 3 Views (73562) |
$343.80 |
$573 |
3.7× |
| Lung Perf&Ventilat Diferentl (78598) |
$2,716.80 |
$4,528 |
4.7× |
| Lung perfusion differential (78597) |
$1,723.80 |
$2,873 |
4.1× |
| Lung Ventilat&Perfus Imaging (78582) |
$2,907 |
$4,845 |
5.1× |
| Lymph System Imaging (78195) |
$3,066.60 |
$5,111 |
5.3× |
| Magnetic Image Jaw Joint (70336) |
$2,092.80 |
$3,488 |
8.3× |
| Mammary ductogram or galactogram single (77053) |
$123.60 |
$206 |
0.5× |
| Meckels Divert Exam (78290) |
$3,085.80 |
$5,143 |
7.3× |
| Mlc imrt design & construction per imrt plan (77338) |
$1,039.80 |
$1,733 |
2.6× |
| Mr safety determination physician/other qhp (76016) |
$434.40 |
$724 |
4.7× |
| Mr safety implant&/fb assmt clin staf 1st 15 min (76014) |
$105.60 |
$176 |
3.5× |
| Mr safety implt electronics prepj supvj phys/qhp (76018) |
$767.40 |
$1,279 |
7.6× |
| Mr safety implt pos&/immoblj (76019) |
$1,174.20 |
$1,957 |
18.8× |
| Mr safety med physics xm customization plng&mntr (76017) |
$1,829.40 |
$3,049 |
7.2× |
| Mra Head W/O & W/Contrast Material (70546) |
$2,753.40 |
$4,589 |
7.5× |
| MRA head w/o contrast (70544) |
$1,686 |
$2,810 |
6.7× |
| MRA head with contrast (70545) |
$1,816.80 |
$3,028 |
4.9× |
| MRA neck w contrast (70548) |
$1,867.20 |
$3,112 |
5.1× |
| Mra Neck W/O &W/Contrast Material (70549) |
$2,767.20 |
$4,612 |
7.5× |
| MRA neck w/o contrast (70547) |
$1,689 |
$2,815 |
6.7× |
| MRI abdomen w contrast (74182) |
$2,367.60 |
$3,946 |
6.4× |
| MRI abdomen w/o contrast (74181) |
$1,363.20 |
$2,272 |
5.4× |
| MRI any jt lower extrem w/contrast material (73722) |
$2,532 |
$4,220 |
3.1× |
| MRI any jt lower extrem w/o & w/contrast matrl (73723) |
$3,052.80 |
$5,088 |
8.3× |
| MRI any jt upper extremity w/contrast matrl (73222) |
$2,532 |
$4,220 |
3.1× |
| MRI Breast W/O Contrast Bilateral (77047) |
$1,548 |
$2,580 |
6.1× |
| MRI Breast Without Contrast Material Unilateral (77046) |
$1,541.40 |
$2,569 |
6.1× |
| MRI cardiac w/o cont stress (75559) |
$2,551.80 |
$4,253 |
4.4× |
| MRI cardiac w/o contrast (75557) |
$1,816.80 |
$3,028 |
7.2× |
| MRI cervical spine w contrast (72142) |
$2,038.80 |
$3,398 |
5.5× |
| MRI cervical spine w/o cont (72141) |
$1,289.40 |
$2,149 |
5.1× |
| MRI chest w/o contrast (71550) |
$2,875.20 |
$4,792 |
11.4× |
| MRI chest with contrast (71551) |
$3,123 |
$5,205 |
3.8× |
| MRI chest wo w contrast (71552) |
$3,909 |
$6,515 |
10.6× |
| MRI lower extrem oth/thn jt w/o & w/contr matr (73720) |
$2,532 |
$4,220 |
6.9× |
| MRI lower extrem oth/thn jt w/o contr matrl (73718) |
$1,709.40 |
$2,849 |
6.8× |
| MRI lumbar spine w contrast (72149) |
$1,991.40 |
$3,319 |
5.4× |
| Mri Neck Spine W/O & W/Dye (72156) |
$2,274 |
$3,790 |
6.2× |
| MRI orbit face &/neck w/o contrast (70540) |
$1,739.40 |
$2,899 |
6.9× |
| MRI orbit face neck w contrast (70542) |
$2,055 |
$3,425 |
5.6× |
| Mri Orbt/Fac/Nck W/O &W/Dye (70543) |
$2,548.80 |
$4,248 |
6.9× |
| MRI pelvis w contrast (72196) |
$2,001.60 |
$3,336 |
5.4× |
| MRI pelvis w/o & w contrast (72197) |
$2,508 |
$4,180 |
6.8× |
| MRI pelvis w/o contrast (72195) |
$1,712.40 |
$2,854 |
6.8× |
| MRI thoracic spine w/o contrast (72146) |
$1,289.40 |
$2,149 |
5.1× |
| MRI upper extremity oth than jt w/contr matrl (73219) |
$2,733.60 |
$4,556 |
7.4× |
| MRI upper extremity oth than jt w/o contr matrl (73218) |
$2,562 |
$4,270 |
10.1× |
| Mri Uppr Extremity W/O&W/Dye (73220) |
$3,307.80 |
$5,513 |
9.0× |
| MRI, abdomen, combo (74183) |
$2,521.80 |
$4,203 |
6.8× |
| MRI, dorsal spine combo (72157) |
$2,280 |
$3,800 |
6.2× |
| MRI, dorsal spine contrast (72147) |
$2,017.80 |
$3,363 |
5.5× |
| MRI, joint upper extrem (73221) |
$1,474.20 |
$2,457 |
5.8× |
| MRI, joint upper extrem combo (73223) |
$3,062.40 |
$5,104 |
8.3× |
| MRI, lumbar spine combo (72158) |
$2,266.80 |
$3,778 |
6.1× |
| Myocardial Imaging Infarct Avid Planar Qual/Quan (78466) |
$1,578 |
$2,630 |
3.7× |
| Myocardial Spect Multiple Studies (78452) |
$4,056 |
$6,760 |
3.0× |
| N-invas est c ffr sw aly CTA (75580) |
$4,747.80 |
$7,913 |
5.2× |
| Neck soft tissue (70360) |
$231.60 |
$386 |
2.5× |
| Njx Rp Loclzj Non-Img Probe Study Intravenous (78808) |
$901.20 |
$1,502 |
2.1× |
| Nm myocard infarct spect (78469) |
$1,851 |
$3,085 |
3.2× |
| Nonvascular Shunt X-Ray (75809) |
$597.60 |
$996 |
5.4× |
| Ntsty modul radthx pln dose-vol histos (77301) |
$3,885 |
$6,475 |
2.7× |
| Nuclear Rx Oral Admin (79005) |
$570.60 |
$951 |
2.3× |
| Ob us nuchal meas 1 gest (76813) |
$365.40 |
$609 |
3.3× |
| Ophthalmic US Dx Corneal Pachymetry Uni/Bi (76514) |
$22.20 |
$37 |
0.7× |
| Parathyroid Planar Imaging (78070) |
$2,641.80 |
$4,403 |
6.2× |
| Parathyroid planar imaging w/wo subtraction (78071) |
$3,029.40 |
$5,049 |
7.2× |
| Pelvis 1 or 2 views (72170) |
$213 |
$355 |
1.9× |
| Peritoneogram Rs&I (74190) |
$1,050 |
$1,750 |
1.8× |
| Pet Image W/Ct Lmtd (78814) |
$3,453 |
$5,755 |
2.3× |
| PET image w/CT, full body (78816) |
$3,453 |
$5,755 |
2.3× |
| PET imaging CT attenuation skull base mid-thigh (78815) |
$3,453 |
$5,755 |
2.3× |
| Pulmonary Perfusion Imaging Particulate (78580) |
$2,086.20 |
$3,477 |
4.9× |
| Radex Abd Compl Aqt Abd W/S/E/D Views 1 View Ch (74022) |
$349.20 |
$582 |
3.2× |
| Radex abscess/fistula/sinus tract rs&i (76080) |
$355.80 |
$593 |
0.6× |
| Radex Ankle Complete Minimum 3 Views (73610) |
$310.80 |
$518 |
3.4× |
| Radex Calcaneus Minimum 2 Views (73650) |
$228 |
$380 |
2.5× |
| Radex elbow complete minimum 3 views (73080) |
$264 |
$440 |
2.9× |
| Radex Facial Bones Complete Minimum 3 Views (70150) |
$376.80 |
$628 |
3.4× |
| Radex fingr minimum 2 views (73140) |
$340.20 |
$567 |
3.7× |
| Radex foot complete minimum 3 views (73630) |
$285.60 |
$476 |
3.1× |
| Radex Hand Minimum 3 Views (73130) |
$310.80 |
$518 |
3.4× |
| Radex lower extremity infant minimum 2 views (73592) |
$260.40 |
$434 |
2.8× |
| Radex Mastoids Compl Minimum 3 Views PR Side (70130) |
$502.80 |
$838 |
4.5× |
| Radex Nasal Bones Complete Minimum 3 Views (70160) |
$325.80 |
$543 |
3.5× |
| Radex Ribs Unilateral 2 Views (71100) |
$285.60 |
$476 |
3.1× |
| Radex shoulder complete minimum 2 views (73030) |
$279 |
$465 |
3.0× |
| Radex Sinuses Paransl < 3 Views (70210) |
$260.40 |
$434 |
2.8× |
| Radex sm int w/mlt srl imges via enteroclss tube (74251) |
$3,213.60 |
$5,356 |
17.3× |
| Radex Spine 1 View Specify Level (72020) |
$184.20 |
$307 |
2.0× |
| Radex Sternum Minimum 2 Views (71120) |
$264 |
$440 |
2.9× |
| Radex Temporomandble Jt Opn & Clsd Mouth Bilat (70330) |
$452.40 |
$754 |
4.9× |
| Radex Toe Minimum 2 Views (73660) |
$249.60 |
$416 |
2.7× |
| Radex upper extremity infant minimum 2 views (73092) |
$260.40 |
$434 |
2.4× |
| Radex Wrist Complete Minimum 3 Views (73110) |
$354.60 |
$591 |
3.9× |
| Radiation Delivery Stereotactic Cranial Linear (77372) |
$22,287.60 |
$37,146 |
2.9× |
| Radiation treatment delivery level 1 (77402) |
$439.80 |
$733 |
4.1× |
| Radiation treatment delivery level 2 (77407) |
$685.20 |
$1,142 |
1.7× |
| Radiation treatment delivery level 3 (77412) |
$875.40 |
$1,459 |
1.5× |
| Radiolog exam mandible compl minimum 4 views (70110) |
$343.80 |
$573 |
3.1× |
| Radiologic Exam Abdomen 3+ Views - Xr Abdomen 3+ Views (74021) |
$305.40 |
$509 |
2.8× |
| Radiologic exam colon double contrast study (74280) |
$1,662.60 |
$2,771 |
9.0× |
| Radiologic exam colon single contrast study (74270) |
$1,077.60 |
$1,796 |
5.8× |
| Radiologic Exam Esophagus Double Contrast Study (74221) |
$796.20 |
$1,327 |
4.3× |
| Radiologic exam knee complete 4/more views (73564) |
$387.60 |
$646 |
3.5× |
| Radiologic exam pelvis compl minimum 3 views (72190) |
$329.40 |
$549 |
3.0× |
| Radiologic Exam Small Int Single Contrast Study (74250) |
$866.40 |
$1,444 |
4.7× |
| Radiologic exam swallow function contrast study (74230) |
$1,027.80 |
$1,713 |
5.5× |
| Radiologic exam upr gi trc double contrast study (74246) |
$1,000.80 |
$1,668 |
5.4× |
| Radiologic examination femur 1 view (73551) |
$231.60 |
$386 |
2.5× |
| Radiologic examination femur minimum 2 views (73552) |
$293.40 |
$489 |
3.2× |
| Radiologic examination knee 1/2 views (73560) |
$285.60 |
$476 |
3.1× |
| Radiologic Examination Osseous Survey Limited (77074) |
$481.20 |
$802 |
4.4× |
| Radiologic examination tibia & fibula 2 views (73590) |
$260.40 |
$434 |
2.8× |
| Ribs bilateral 3 views (71110) |
$329.40 |
$549 |
3.0× |
| Rp loclzj tum plnr 1 area single day imaging (78800) |
$2,294.40 |
$3,824 |
5.4× |
| Rp Loclzj Tum Plnr Whole Body 2+ Days Imaging (78804) |
$6,212.40 |
$10,354 |
10.8× |
| Rp Loclzj Tum Plnr Whole Body Single Day Imaging (78802) |
$2,813.40 |
$4,689 |
4.9× |
| Rp Loclzj Tum Spect 1 Area Single Day Imaging (78803) |
$3,414 |
$5,690 |
5.9× |
| Rp loclzj tum spect 2 area/sep acquisj img (78831) |
$6,451.20 |
$10,752 |
4.7× |
| Scapula (73010) |
$163.20 |
$272 |
1.5× |
| Screening Digital Breast Tomosynthesis Bi (77063) |
$131.40 |
$219 |
5.6× |
| Sella turcica (70240) |
$260.40 |
$434 |
2.8× |
| Shoulder 1 view (73020) |
$156 |
$260 |
1.7× |
| Shoulder Arthrography (73040) |
$1,179.60 |
$1,966 |
3.2× |
| Skull less than 4 views (70250) |
$297 |
$495 |
2.7× |
| Special dosimetry (77331) |
$387 |
$645 |
2.7× |
| Special Physics Consult (77370) |
$387 |
$645 |
2.7× |
| Special teletherapy port plan (77321) |
$1,039.80 |
$1,733 |
2.6× |
| Special treatment procedure (77470) |
$1,659 |
$2,765 |
2.8× |
| Stereotactic Body Radiation Delivery (77373) |
$5,122.20 |
$8,537 |
2.7× |
| Sternoclavicular joints (71130) |
$337.20 |
$562 |
3.7× |
| Surf radj ther orthvlt dlvr>150-500 kv per fxj (77438) |
$294 |
$490 |
2.7× |
| Surf radj ther supfc dlvr<=150 kv per fraction (77437) |
$288 |
$480 |
2.7× |
| Surf radj ther supfc/orthvlt treatment planning (77436) |
$105.60 |
$176 |
2.7× |
| Telethx isodose pln cplx w/basic dosimetry (77307) |
$1,039.80 |
$1,733 |
2.6× |
| Telethx isodose pln smpl w/dosimetry calculation (77306) |
$1,039.80 |
$1,733 |
2.6× |
| Ther Rad Simulaj-Aided Field Setting Complex (77290) |
$1,039.80 |
$1,733 |
2.6× |
| Ther Rad Simulaj-Aided Field Setting Intermed (77285) |
$1,039.80 |
$1,733 |
2.6× |
| Ther rad simulaj-aided field setting simple (77280) |
$387 |
$645 |
2.7× |
| Thoracic spine 2 views (72070) |
$253.80 |
$423 |
2.3× |
| Thoracic spine 3 views (72072) |
$310.80 |
$518 |
2.8× |
| Thoracolumbar 2 views (72080) |
$267.60 |
$446 |
2.9× |
| Thyroid Met Imaging Body (78018) |
$2,813.40 |
$4,689 |
4.9× |
| Thyroid Uptake W/Blood Flow Sngle/Mult Quan Meas (78014) |
$2,227.80 |
$3,713 |
5.3× |
| Tx Devices Design & Construction Complex (77334) |
$1,039.80 |
$1,733 |
2.6× |
| Tx devices design & construction intermediate (77333) |
$387 |
$645 |
2.7× |
| Tx devices design & construction simple (77332) |
$387 |
$645 |
2.7× |
Ultrasound Breast Limited (76642)
range across 3 matching MRF lines |
$315.60–$451.20 |
$526–$752 |
varies |
| Ultrasound Exam Aaa Screen (76706) |
$482.40 |
$804 |
4.4× |
| Ultrasound, abdomen limited (76705) |
$360 |
$600 |
3.3× |
| Umbilical-artery Doppler (OB) (76820) |
$127.20 |
$212 |
1.1× |
| Unlisted us procedure (76999) |
$201.60 |
$336 |
2.2× |
| Upper gi w/o kub (74240) |
$873 |
$1,455 |
4.7× |
| Urethrocystogram voiding (74455) |
$903.60 |
$1,506 |
3.6× |
| Urethrocystography retrograde (74450) |
$487.20 |
$812 |
1.9× |
| Us bone density measurement (76977) |
$25.80 |
$43 |
0.2× |
Us breast unilateral complete (76641)
range across 3 matching MRF lines |
$411.60–$587.40 |
$686–$979 |
varies |
| Us chest (76604) |
$174.60 |
$291 |
1.6× |
Us complete joint (76881)
range across 3 matching MRF lines |
$65.40–$93.60 |
$109–$156 |
varies |
| Us exam, pelvic, limited (76857) |
$151.20 |
$252 |
1.4× |
| Us head (76506) |
$498.60 |
$831 |
4.5× |
| Us kidney transplant (76776) |
$673.20 |
$1,122 |
6.1× |
Us lmtd joint/oth nonvasc xtr strux r-t w/img (76882)
range across 3 matching MRF lines |
$55.20–$79.20 |
$92–$132 |
varies |
| Us ob detailed single fetus (76811) |
$514.80 |
$858 |
2.0× |
| Us ob limited 1 or more fetuses (76815) |
$301.80 |
$503 |
2.7× |
| Us ob transvaginal (76817) |
$341.40 |
$569 |
3.1× |
| Us pelvic non ob complete (76856) |
$437.40 |
$729 |
4.0× |
| Us pg uter img f&mat 14 wk tabdl 1/1st gestation (76801) |
$425.40 |
$709 |
3.8× |
| Us preg uterus real time f/u trnsabdl per fetus (76816) |
$415.20 |
$692 |
3.8× |
| Us retroperitoneal complete (76770) |
$442.80 |
$738 |
4.0× |
| Us retroperitoneal limited (76775) |
$189 |
$315 |
1.7× |
| Us scrotum and contents (76870) |
$423.60 |
$706 |
3.8× |
| Us spinal canal and contents (76800) |
$576 |
$960 |
5.2× |
| Us thyroid (76536) |
$504.60 |
$841 |
4.6× |
| Us transrectal (76872) |
$1,009.20 |
$1,682 |
9.1× |
| Vein X-Ray Chest (75827) |
$742.80 |
$1,238 |
0.4× |
| Venography caval inferior serialography rs&i (75825) |
$690.60 |
$1,151 |
0.2× |
| Venography extremity bilateral rs&i (75822) |
$731.40 |
$1,219 |
0.4× |
| Venography extremity unilateral rs&i (75820) |
$675.60 |
$1,126 |
0.4× |
| Venography Renal Bilateral (75833) |
$873 |
$1,455 |
0.3× |
| Venography Renal Unilateral (75831) |
$772.20 |
$1,287 |
0.2× |
| Vertebral fracture assessment via dxa (77086) |
$279.60 |
$466 |
3.0× |
| Wrist 2 views (73100) |
$282 |
$470 |
3.1× |
| X-Ray Ac Jts - Xr Acromioclavicular Joints Bilateral (73050) |
$213 |
$355 |
2.3× |
| X-ray antegrade pyelogram tube (74425) |
$1,145.40 |
$1,909 |
3.1× |
| X-Ray Aorta Leg Arteries (75630) |
$720 |
$1,200 |
0.2× |
| X-Ray Bend Only L-S Spine (72120) |
$325.80 |
$543 |
2.9× |
| X-Ray Elbow 2 Vw - Xr Elbow 1-2 Views Right (73070) |
$231.60 |
$386 |
2.5× |
| X-Ray Exam Breast Specimen (76098) |
$278.40 |
$464 |
0.5× |
| X-Ray Exam Entire Spi 1 Vw (72081) |
$329.40 |
$549 |
3.6× |
| X-Ray Exam Entire Spi 2/3 Vw (72082) |
$600.60 |
$1,001 |
5.4× |
| X-Ray Exam Hip Uni 1 View (73501) |
$260.40 |
$434 |
2.8× |
| X-Ray Exam Hip Uni 2-3 Views (73502) |
$394.80 |
$658 |
4.3× |
| X-Ray Exam Hips Bi 2 Views (73521) |
$333 |
$555 |
3.0× |
| X-Ray Exam Hips Bi 3-4 Views (73522) |
$430.80 |
$718 |
3.9× |
| X-Ray Exam Hips Bi 5/> Views (73523) |
$510.60 |
$851 |
4.6× |
| X-Ray Exam L-S Spine Bending (72114) |
$514.20 |
$857 |
4.6× |
| X-Ray Exam Neck Spine 2-3 Vw (72040) |
$315 |
$525 |
3.4× |
| X-Ray Exam Neck Spine 6/>Vws (72052) |
$521.40 |
$869 |
4.7× |
| X-Ray Exam Unilat Ribs/Chest (71101) |
$321.60 |
$536 |
2.9× |
X-ray eye for foreign body (70030)
range across 3 matching MRF lines |
$241.20–$363 |
$402–$605 |
varies |
| X-ray humerus (73060) |
$264 |
$440 |
2.9× |
| X-ray IV pyelogram (ivp) (74400) |
$1,142.40 |
$1,904 |
6.2× |
| X-ray IV pyelogram+tomography (74415) |
$1,336.80 |
$2,228 |
7.2× |
| X-Ray Jaw <4 Vw - Xr Mandible < 4 Views (70100) |
$325.80 |
$543 |
3.5× |
| X-Ray Knee Bilat Standing - Xr Knees Anteroposterior Standing Bilat (73565) |
$343.80 |
$573 |
3.7× |
| X-Ray Lumbar Spine 2/3 Vw - Xr Lumbar Spine 2-3 Views (72100) |
$318.60 |
$531 |
2.9× |
| X-ray nose-rectum child f.b. (76010) |
$214.80 |
$358 |
2.3× |
| X-Ray Ribs, Chest 4+ Vw - Xr Ribs 3 Vws Bil W/ Chest Posteroanterior (71111) |
$405 |
$675 |
3.7× |
| X-Ray Sacroiliac Jts 3+ Vw - Xr Sacroiliac Joints 3+ Views (72202) |
$310.80 |
$518 |
2.8× |
| X-Ray Sacroiliac Jts <3 Vw - Xr Sacroiliac Joints 1-2 Views (72200) |
$271.20 |
$452 |
2.5× |
| X-Ray Sacrum/Coccyx 2+ Vw - Xr Sacrum Coccyx 2+ Views (72220) |
$264 |
$440 |
2.9× |
| X-Ray Sinuses 3+ Vw - Xr Paranasal Sinuses 3+ Views (70220) |
$297 |
$495 |
3.2× |
| X-Ray Skull 4+ Vw - Xr Skull Complete 4+ Views (70260) |
$340.20 |
$567 |
3.1× |
| X-ray thoracic spine 4 vw (72074) |
$354.60 |
$591 |
3.2× |
| X-Ray Tmj Unilat (70328) |
$282 |
$470 |
3.1× |
| X-Ray Urinary Tract Exam With Contrast Material (74420) |
$534 |
$890 |
1.4× |
| X-Rays Bone Length Studies (77073) |
$347.40 |
$579 |
3.1× |
| X-Rays Bone Survey Complete (77075) |
$799.80 |
$1,333 |
7.2× |
| Xr c-spine 4 or 5 views (72050) |
$438 |
$730 |
4.0× |
| Xr facial bones less than 3 views (70140) |
$238.20 |
$397 |
2.6× |
| Xr orbits complete 4 views (70200) |
$376.80 |
$628 |
3.4× |