| 3-D radiotherapy plan dose-volume histograms (77295) |
$4,340 |
$8,680 |
3.2× |
| Abdomen 1 View (74018) |
$277 |
$554 |
3.3× |
| Abdomen 2 views (74019) |
$400.50 |
$801 |
3.9× |
| Acute Gastrointestinal Blood Loss Imaging (78278) |
$974.50 |
$1,949 |
2.5× |
| Adrenal Cortex & Medulla Img (78075) |
$1,261.50 |
$2,523 |
1.0× |
| Angio internal mammary (75756) |
$1,736 |
$3,472 |
0.6× |
| Angio pulmonary bilat (75743) |
$4,898.50 |
$9,797 |
1.6× |
| Angiography Adrenal Bilateral Slctv Rs&I (75733) |
$3,919 |
$7,838 |
1.3× |
| Angiography extremity bilateral rs&i (75716) |
$2,905.50 |
$5,811 |
0.9× |
| Angiography extremity unilateral rs&i (75710) |
$2,325.50 |
$4,651 |
0.8× |
| Angiography pulmonary unilateral slctv rs&i (75741) |
$4,898.50 |
$9,797 |
1.6× |
| Angrph pulmonary nonslctv cath/ven njx rs&i (75746) |
$2,427.50 |
$4,855 |
0.8× |
| Ankle 2 views (73600) |
$269 |
$538 |
3.2× |
| Aortography thoracic serialography rs&i (75605) |
$3,051 |
$6,102 |
0.6× |
| Aortography thoracic w/o serialography rs&i (75600) |
$2,939 |
$5,878 |
1.0× |
| Artery X-Rays Abdomen (75726) |
$4,898.50 |
$9,797 |
0.9× |
| Artery X-Rays Adrenal Gland (75731) |
$2,798.50 |
$5,597 |
0.9× |
| Artery X-Rays Pelvis (75736) |
$4,898.50 |
$9,797 |
0.9× |
| Artery X-Rays Spine (75705) |
$3,051 |
$6,102 |
0.6× |
| Arthrogram ankle (73615) |
$790.50 |
$1,581 |
2.3× |
| Arthrogram hip (73525) |
$798 |
$1,596 |
2.3× |
| Arthrogram Wrist (73115) |
$1,036 |
$2,072 |
3.0× |
| Basic radiation dosimetry calculation (77300) |
$413.50 |
$827 |
3.2× |
| Bone age studies (77072) |
$91.50 |
$183 |
0.9× |
| Bone Imaging 3 Phase (78315) |
$1,885 |
$3,770 |
4.8× |
| Bone Imaging Limited Area (78300) |
$827.50 |
$1,655 |
2.1× |
| Bone Imaging Multiple Areas (78305) |
$974.50 |
$1,949 |
2.5× |
| Bone Imaging Whole Body (78306) |
$1,392.50 |
$2,785 |
3.6× |
| Bone marrow imaging limited area (78102) |
$811 |
$1,622 |
2.1× |
| Bone marrow imaging; multiple areas (78103) |
$934 |
$1,868 |
2.4× |
| Bone marrow imaging; whole body (78104) |
$1,165.50 |
$2,331 |
3.0× |
| Bone survey infant (77076) |
$226.50 |
$453 |
2.2× |
| Brachytx isodose complex (77318) |
$2,544.50 |
$5,089 |
7.0× |
| Brachytx isodose intermed (77317) |
$2,105 |
$4,210 |
5.8× |
| Brachytx Isodose Plan Simple (77316) |
$1,664 |
$3,328 |
4.6× |
| Brain Flow Imaging Only (78610) |
$436.50 |
$873 |
0.8× |
| Brain Image W/Flow < 4 Views (78601) |
$2,254 |
$4,508 |
5.8× |
| Brain Imaging Min 4 Static Views W Vascular Flow (78606) |
$3,833.50 |
$7,667 |
7.2× |
| Brain Imaging Minimum 4 Static Views (78605) |
$2,671.50 |
$5,343 |
5.0× |
| Brain Imaging Pet Metabolic Evaluation (78608) |
$2,530.50 |
$5,061 |
1.8× |
| Cardiac MRI w/w/o contrast & further seq (75561) |
$2,148 |
$4,296 |
6.3× |
| Cardiac MRI w/w/o contrast w/stress (75563) |
$2,444 |
$4,888 |
3.2× |
| Cardiac Shunt Detection (78428) |
$670 |
$1,340 |
1.7× |
| Cat Scan Follow-Up Study (76380) |
$650 |
$1,300 |
7.7× |
| Cerebrospinal Fluid Flow W/O Matl Shunt Evaltj (78645) |
$938.50 |
$1,877 |
1.8× |
| Cerebrospinal Fluid Scan (78630) |
$856 |
$1,712 |
1.6× |
| Chest 1 view (71045) |
$234 |
$468 |
2.8× |
| Chest 2 views (71046) |
$281.50 |
$563 |
3.3× |
| Chest 3 views (71047) |
$406.50 |
$813 |
4.8× |
| Chest 4 or more views (71048) |
$508 |
$1,016 |
5.0× |
| Chg us nrv&acc strux 1 xtr compre w/img pr extremity (76883) |
$392 |
$784 |
3.8× |
| Cisternography Positive Contrast Rs&I (70015) |
$1,217.50 |
$2,435 |
1.6× |
| Clavicle complete (73000) |
$296.50 |
$593 |
3.5× |
Computed Tomography Thorax Lw Dose Lng Ca Scr C- (71271)
range across 2 matching MRF lines |
$175.50–$421 |
$351–$842 |
varies |
Continuing medical physics consltj pr wk (77336)
range across 2 matching MRF lines |
$555.50–$639 |
$1,111–$1,278 |
varies |
| Contrast Exam Abdominl Aorta (75625) |
$2,939 |
$5,878 |
1.0× |
| Contrast X-Ray Bladder (74430) |
$654 |
$1,308 |
1.9× |
| Contrast X-Ray Of Elbow (73085) |
$798 |
$1,596 |
2.3× |
| Contrast X-Ray Of Knee Joint (73580) |
$790.50 |
$1,581 |
2.3× |
| CT abdomen and pelvis without and with contrast (74178) |
$3,834.50 |
$7,669 |
11.3× |
| CT abdomen and pelvis without contrast (74176) |
$2,900.50 |
$5,801 |
12.5× |
| CT abdomen w contrast (74160) |
$1,642.50 |
$3,285 |
9.6× |
| CT abdomen w wo contrast (74170) |
$1,890.50 |
$3,781 |
11.0× |
| CT abdomen w/o contrast (74150) |
$1,427.50 |
$2,855 |
14.0× |
| CT Angio Abdomen and Pelvis (74174) |
$4,441 |
$8,882 |
13.0× |
| CT Angio Chest (71275) |
$2,328 |
$4,656 |
13.6× |
| CT Angio Head (70496) |
$2,221 |
$4,442 |
13.0× |
| CT angio hrt w/3d image (75574) |
$375 |
$750 |
1.1× |
| Ct Angio Lwr Extr W/O&W/Dye (73706) |
$1,984 |
$3,968 |
11.6× |
| CT Angio Neck (70498) |
$2,231 |
$4,462 |
13.0× |
| Ct Angio Upr Extrm W/O&W/Dye (73206) |
$1,274.50 |
$2,549 |
7.4× |
| CT cervical spine w/ contrast (72126) |
$1,839 |
$3,678 |
5.4× |
| CT cervical spine w/o contrast (72125) |
$1,600 |
$3,200 |
15.7× |
| CT cervical spine w/wo cont (72127) |
$2,113.50 |
$4,227 |
12.3× |
| CT chest w contrast (71260) |
$1,779.50 |
$3,559 |
10.4× |
| CT chest w/wo contrast (71270) |
$1,947 |
$3,894 |
11.4× |
| CT colonography screening (74263) |
$408 |
$816 |
1.8× |
| CT Colonogrphy Dx Image Postprocess W/Contrast (74262) |
$452.50 |
$905 |
2.6× |
| CT colonogrphy dx image postprocess w/o contrast (74261) |
$408 |
$816 |
4.0× |
| CT head/brain with contrast (70460) |
$1,526.50 |
$3,053 |
8.9× |
| CT head/brain without and with contrast (70470) |
$1,755.50 |
$3,511 |
10.3× |
| CT heart contrast eval cardiac structure&morph (75572) |
$1,007 |
$2,014 |
3.0× |
CT heart no contrast quant eval coronry calcium (75571)
range across 2 matching MRF lines |
$45–$293 |
$90–$586 |
varies |
| CT hrt w/3d image congen (75573) |
$1,007 |
$2,014 |
3.0× |
| CT iac w contrast (70481) |
$1,620.50 |
$3,241 |
9.5× |
| CT l-spine w&w/o contrast (72133) |
$2,140 |
$4,280 |
12.5× |
| CT lower ext w/o (73700) |
$1,296 |
$2,592 |
12.7× |
| CT lower extremity w/contrast material (73701) |
$1,500 |
$3,000 |
8.8× |
| CT lumbar spine w contrast (72132) |
$1,862 |
$3,724 |
5.5× |
| CT lumbar spine w/o contrast (72131) |
$1,608.50 |
$3,217 |
15.8× |
| CT maxillofacial w contrast (70487) |
$1,562.50 |
$3,125 |
9.1× |
| CT maxillofacial wo contrast (70486) |
$1,359.50 |
$2,719 |
13.3× |
| CT neck tissue combo (70492) |
$1,940 |
$3,880 |
11.3× |
| Ct Orbit/Ear/Fossa W/O&W/Dye (70482) |
$1,863 |
$3,726 |
10.9× |
| CT orbits w/o contrast (70480) |
$1,360 |
$2,720 |
13.3× |
| CT pelvis w&w/o contrast (72194) |
$1,753.50 |
$3,507 |
10.2× |
| CT pelvis w/o contrast (72192) |
$1,474 |
$2,948 |
14.5× |
| CT scan of leg combo (73702) |
$1,723.50 |
$3,447 |
10.1× |
| CT scans face/jaw combo (70488) |
$1,796.50 |
$3,593 |
10.5× |
| CT soft tissue neck w contrast (70491) |
$1,678 |
$3,356 |
9.8× |
| CT soft tissue neck w/o contrast (70490) |
$642.50 |
$1,285 |
6.3× |
| CT thoracic spine w contrast (72129) |
$1,862 |
$3,724 |
10.9× |
| CT thoracic spine w/o contrast (72128) |
$1,608.50 |
$3,217 |
15.8× |
| CT thoracic spine w/wo cont (72130) |
$2,140 |
$4,280 |
12.5× |
| CT thorax w/o contrast (71250) |
$1,372.50 |
$2,745 |
13.5× |
| CT upper ext wo (73200) |
$1,296 |
$2,592 |
12.7× |
| CT upper extremity w/o & w/contrast material (73202) |
$1,723.50 |
$3,447 |
10.1× |
| CT upper extremity with contrast (73201) |
$1,500 |
$3,000 |
4.4× |
| Cta Abdl Aorta&Bi Iliofem W/Contrast&Postp (75635) |
$1,708 |
$3,416 |
10.0× |
| Cta Abdomen (74175) |
$2,188 |
$4,376 |
12.8× |
| CTA pelvis (72191) |
$2,257.50 |
$4,515 |
13.2× |
| Dacryocystography, nasolacrimal duct, radiological supervision and interpretation Non-Facility (70170) |
$367.50 |
$735 |
1.6× |
| Dilation ureters/urethra rs&i (74485) |
$2,295.50 |
$4,591 |
1.1× |
| Discography Cerv/Thor Spine (72285) |
$1,989 |
$3,978 |
1.0× |
| Diskography lumbar (72295) |
$2,089.50 |
$4,179 |
1.1× |
| Doppler Echo Fetal Puls Spectral F/U/Repeat (76828) |
$150.50 |
$301 |
1.5× |
Doppler Echo Fetal Spectral Display Complete (76827)
range across 2 matching MRF lines |
$150.50–$815 |
$301–$1,630 |
varies |
Doppler Fetal Mid Cerebral Artery (76821)
range across 2 matching MRF lines |
$370–$396 |
$740–$792 |
varies |
| Dxa Bone Density Axial (77080) |
$588 |
$1,176 |
5.8× |
| Dxa bone density study (77085) |
$834.50 |
$1,669 |
8.2× |
| Dxa bone density study 1/>sites appendiclr skel (77081) |
$331.50 |
$663 |
3.9× |
Echo exam of fetal heart (76825)
range across 3 matching MRF lines |
$1,027.50–$1,142.50 |
$2,055–$2,285 |
varies |
| Echo exam uterus (76831) |
$655 |
$1,310 |
2.8× |
| Echo Guide For Artery Repair (76936) |
$437 |
$874 |
2.1× |
| Echocardiography, fetal, cardiovascular system, real time with image documentation (2D), with or without M-mode… (76826) |
$319 |
$638 |
1.4× |
| Echograp Trans R Pros Study (76873) |
$581 |
$1,162 |
5.7× |
Esophagram (74220)
range across 2 matching MRF lines |
$436.50–$587.50 |
$873–$1,175 |
varies |
Fetal Biophys Profile W/Nst (76818)
range across 2 matching MRF lines |
$425.50–$455 |
$851–$910 |
varies |
Fetal Biophysical Profile W/O Non-Stress Testing (76819)
range across 2 matching MRF lines |
$378.50–$405.50 |
$757–$811 |
varies |
| Fetal MRI w/placntl matrnl plvc img sing/1st ges (74712) |
$538 |
$1,076 |
2.3× |
| Fluoroscopy up to 1 hr (76000) |
$948 |
$1,896 |
4.1× |
| Follow-Up Angiography (75898) |
$1,619.50 |
$3,239 |
0.5× |
| Foot 2 views (73620) |
$296 |
$592 |
3.5× |
| Forearm 2 views (73090) |
$329.50 |
$659 |
3.9× |
| Gastric emptying imaging study (78264) |
$1,364 |
$2,728 |
3.5× |
| Gastric Emptyng Imag Std W/Sm Bwl Transit (78265) |
$1,364 |
$2,728 |
3.5× |
| Gastroesophageal Reflux Exam (78262) |
$651 |
$1,302 |
1.7× |
| Gated Heart Planar Single (78472) |
$1,348 |
$2,696 |
3.5× |
| Gstrc Emptng Imag Std W/Sm Bwl Col Trnst Mlt Day (78266) |
$1,544 |
$3,088 |
2.9× |
| Hand 2 views (73120) |
$244 |
$488 |
2.4× |
| Hdr Rdncl Ntrstl/Icav Brchtx (77772) |
$2,957 |
$5,914 |
4.4× |
| Hdr Rdncl Ntrstl/Icav Brchtx (77771) |
$2,729 |
$5,458 |
4.0× |
| Hdr Rdncl Ntrstl/Icav Brchtx 1 Channel (77770) |
$2,374 |
$4,748 |
3.5× |
| Hepatc Vngrph Wdg/Fr Hemodyn Eval Rs&I (75889) |
$3,919 |
$7,838 |
1.3× |
| Hepatc Vngrph Wdg/Fr W/O Hemodyn Eval Rs&I (75891) |
$2,939 |
$5,878 |
1.0× |
| Hepatobil Syst Image W/Drug (78227) |
$1,555 |
$3,110 |
2.9× |
| Hepatobiliary System Imaging (78226) |
$1,122 |
$2,244 |
2.9× |
| Ht Musc Image Planar Mult (78454) |
$1,693 |
$3,386 |
1.3× |
| Ht Muscle Image Spect Sing (78451) |
$1,693 |
$3,386 |
1.3× |
| Hysterosalpingogram (74740) |
$825.50 |
$1,651 |
3.5× |
| Infant hip ultrasound with hip movement (dynamic) (76885) |
$269.50 |
$539 |
3.2× |
| Infant hip ultrasound, limited static exam (76886) |
$163.50 |
$327 |
1.9× |
| Interstitial radiation source applic complex (77778) |
$2,957 |
$5,914 |
4.4× |
| Intracavitary Radiation Source Applic Complex (77763) |
$1,813.50 |
$3,627 |
2.7× |
| Intracavitary Radiation Source Applic Intermed (77762) |
$1,592 |
$3,184 |
3.0× |
| Intracavitary radiation source applic simple (77761) |
$1,376 |
$2,752 |
2.6× |
| Intraop radiaj tx deliver xray single tx session (77424) |
$3,906.50 |
$7,813 |
0.5× |
| Joint Survey Single View (77077) |
$386.50 |
$773 |
3.8× |
| K Flow/Funct Image Multiple (78709) |
$1,031.50 |
$2,063 |
1.9× |
| K Flow/Funct Image W/Drug (78708) |
$1,031.50 |
$2,063 |
1.9× |
| K Flow/Funct Image W/O Drug (78707) |
$1,031.50 |
$2,063 |
1.9× |
| Kidney Imaging Morphol (78700) |
$776 |
$1,552 |
2.0× |
| Kidney Imaging Morphoogy W/Vascular Flow (78701) |
$776 |
$1,552 |
2.0× |
| Knee 3 Views (73562) |
$335 |
$670 |
3.9× |
| Leveen/Shunt Patency Exam (78291) |
$651 |
$1,302 |
1.7× |
| Liver & Spleen Imaging Static Only (78215) |
$1,123 |
$2,246 |
2.9× |
| Liver & Spleen Imaging W/Vascular Flow (78216) |
$1,208 |
$2,416 |
3.1× |
| Liver imaging static only (78201) |
$1,143 |
$2,286 |
2.2× |
| Liver imaging w/vascular flow (78202) |
$1,143 |
$2,286 |
2.2× |
| Lung Perf&Ventilat Diferentl (78598) |
$1,268 |
$2,536 |
2.4× |
| Lung perfusion differential (78597) |
$1,268 |
$2,536 |
3.3× |
| Lung Ventilat&Perfus Imaging (78582) |
$1,415 |
$2,830 |
2.7× |
| Lymph System Imaging (78195) |
$1,392.50 |
$2,785 |
2.6× |
| Lymphangiography Extremity Only Bilateral Rs&I (75803) |
$1,096 |
$2,192 |
0.7× |
| Lymphangiography extremity only unilateral rs&i (75801) |
$1,096 |
$2,192 |
1.8× |
| Lymphangiography Pelvic/Abdominal Bilateral Rs&I (75807) |
$1,782.50 |
$3,565 |
0.6× |
| Lymphangiography, pelvic/abdominal, unilateral (75805) |
$1,782.50 |
$3,565 |
0.6× |
| Magnetic Image Jaw Joint (70336) |
$2,272.50 |
$4,545 |
9.8× |
| Magnetic resonance (eg, proton) imaging, brain (including brain stem andskull base), during open intracranial procedure… (70558) |
$989 |
$1,978 |
5.8× |
| Magnetic resonance (eg, proton) imaging, brain (including brain stem andskull base), during open intracranial procedure… (70557) |
$937 |
$1,874 |
1.8× |
| Magnetic resonance (eg, proton) imaging, brain (including brain stem andskull base), during open intracranial procedure… (70559) |
$1,041 |
$2,082 |
6.1× |
| Magnetic Resonance Elastography (76391) |
$1,128 |
$2,256 |
4.8× |
| Mammary ductogram or galactogram multiple (77054) |
$715 |
$1,430 |
3.1× |
| Mammary ductogram or galactogram single (77053) |
$452.50 |
$905 |
1.9× |
| Meckels Divert Exam (78290) |
$974.50 |
$1,949 |
2.5× |
| Mlc imrt design & construction per imrt plan (77338) |
$7,911.50 |
$15,823 |
21.7× |
| Mra Head W/O & W/Contrast Material (70546) |
$3,323 |
$6,646 |
9.8× |
| MRA head w/o contrast (70544) |
$2,513.50 |
$5,027 |
10.8× |
| MRA head with contrast (70545) |
$2,890.50 |
$5,781 |
8.5× |
| MRA neck w contrast (70548) |
$2,431.50 |
$4,863 |
7.1× |
| Mra Neck W/O &W/Contrast Material (70549) |
$3,242.50 |
$6,485 |
9.5× |
| MRA neck w/o contrast (70547) |
$2,115.50 |
$4,231 |
9.1× |
| MRI abdomen w contrast (74182) |
$2,150 |
$4,300 |
6.3× |
| MRI abdomen w/o contrast (74181) |
$1,625.50 |
$3,251 |
7.0× |
| MRI any jt lower extrem w/contrast material (73722) |
$2,555.50 |
$5,111 |
3.3× |
| MRI any jt lower extrem w/o & w/contrast matrl (73723) |
$3,433.50 |
$6,867 |
10.1× |
| MRI any jt upper extremity w/contrast matrl (73222) |
$2,555.50 |
$5,111 |
3.3× |
| MRI brain functional w/o physician admnistration (70554) |
$2,496.50 |
$4,993 |
10.7× |
| MRI brain functional w/physician admnistration (70555) |
$2,011 |
$4,022 |
8.6× |
| MRI Breast W/O Contrast Bilateral (77047) |
$3,075 |
$6,150 |
13.2× |
| MRI Breast Without Contrast Material Unilateral (77046) |
$2,753 |
$5,506 |
11.8× |
| MRI cardiac w/o contrast (75557) |
$1,522 |
$3,044 |
6.5× |
| MRI cervical spine w contrast (72142) |
$2,636.50 |
$5,273 |
7.7× |
| MRI cervical spine w/o cont (72141) |
$2,000 |
$4,000 |
8.6× |
| MRI chest w/o contrast (71550) |
$1,818 |
$3,636 |
7.8× |
| MRI chest with contrast (71551) |
$2,091.50 |
$4,183 |
2.7× |
| MRI chest wo w contrast (71552) |
$2,691.50 |
$5,383 |
7.9× |
| MRI lower extrem oth/thn jt w/contrast matrl (73719) |
$2,555.50 |
$5,111 |
7.5× |
| MRI lower extrem oth/thn jt w/o & w/contr matr (73720) |
$2,940 |
$5,880 |
8.6× |
| MRI lower extrem oth/thn jt w/o contr matrl (73718) |
$1,932.50 |
$3,865 |
8.3× |
| MRI lumbar spine w contrast (72149) |
$2,644 |
$5,288 |
7.8× |
| Mri Neck Spine W/O & W/Dye (72156) |
$3,272.50 |
$6,545 |
9.6× |
| MRI orbit face &/neck w/o contrast (70540) |
$2,467 |
$4,934 |
10.6× |
| MRI orbit face neck w contrast (70542) |
$2,838.50 |
$5,677 |
8.3× |
| Mri Orbt/Fac/Nck W/O &W/Dye (70543) |
$3,546.50 |
$7,093 |
10.4× |
| MRI pelvis w contrast (72196) |
$2,891 |
$5,782 |
8.5× |
| MRI pelvis w/o & w contrast (72197) |
$3,166 |
$6,332 |
9.3× |
| MRI pelvis w/o contrast (72195) |
$1,862 |
$3,724 |
8.0× |
| MRI spectroscopy (76390) |
$1,920.50 |
$3,841 |
22.6× |
| MRI thoracic spine w/o contrast (72146) |
$2,000 |
$4,000 |
8.6× |
| MRI upper extremity oth than jt w/contr matrl (73219) |
$2,207.50 |
$4,415 |
6.5× |
| MRI upper extremity oth than jt w/o contr matrl (73218) |
$1,920.50 |
$3,841 |
8.2× |
| Mri Uppr Extremity W/O&W/Dye (73220) |
$2,539 |
$5,078 |
7.5× |
| MRI, abdomen, combo (74183) |
$2,853.50 |
$5,707 |
8.4× |
| MRI, dorsal spine combo (72157) |
$3,315.50 |
$6,631 |
9.7× |
| MRI, dorsal spine contrast (72147) |
$2,644 |
$5,288 |
7.8× |
| MRI, joint upper extrem (73221) |
$1,932.50 |
$3,865 |
8.3× |
| MRI, joint upper extrem combo (73223) |
$3,585.50 |
$7,171 |
10.5× |
| MRI, lumbar spine combo (72158) |
$3,315.50 |
$6,631 |
9.7× |
| Myelogram cervical (72240) |
$1,241.50 |
$2,483 |
1.6× |
| Myelogram Lumbar (72265) |
$1,539 |
$3,078 |
2.0× |
| Myocardial Perfusion Planar 1 Study Rest/Stress (78453) |
$1,354 |
$2,708 |
1.1× |
| Myocardial Spect Multiple Studies (78452) |
$3,168 |
$6,336 |
2.5× |
| Myocrd Img Pet Prfuj W/Metab 2rtracer Cncrnt CT (78433) |
$2,263 |
$4,526 |
1.1× |
| Neck soft tissue (70360) |
$438.50 |
$877 |
5.2× |
| Nfs/Instlj Radioelmnt Sln 3 Mo Follow-Up Care (77750) |
$931 |
$1,862 |
2.5× |
| Njx Rp Loclzj Non-Img Probe Study Intravenous (78808) |
$197.50 |
$395 |
0.5× |
| Nonvascular Shunt X-Ray (75809) |
$206 |
$412 |
2.0× |
| Ntsty modul radthx pln dose-vol histos (77301) |
$4,123.50 |
$8,247 |
3.1× |
| Nuclear Rx Intra-Arterial (79445) |
$874.50 |
$1,749 |
3.8× |
| Nuclear Rx Oral Admin (79005) |
$1,187 |
$2,374 |
5.2× |
Ob us nuchal meas 1 gest (76813)
range across 2 matching MRF lines |
$522–$558.50 |
$1,044–$1,117 |
varies |
| Oph bmtry us echograpy a-scan io lens pwr cal (76519) |
$407 |
$814 |
4.0× |
| Ophthalmic Ultrasonic Foreign Body Localization (76529) |
$247.50 |
$495 |
2.9× |
| Ophthalmic ultrasound dx b-scan w/wo a-scan (76512) |
$337 |
$674 |
3.3× |
| Ophthalmic US Dx Corneal Pachymetry Uni/Bi (76514) |
$96.50 |
$193 |
3.4× |
| Panoramic X-ray of jaws (70355) |
$375.50 |
$751 |
4.4× |
| Parathyroid imaging w/tomographic spect & CT (78072) |
$1,811 |
$3,622 |
3.4× |
| Parathyroid Planar Imaging (78070) |
$1,369 |
$2,738 |
3.5× |
| Parathyroid planar imaging w/wo subtraction (78071) |
$1,582 |
$3,164 |
4.1× |
| Pelvis 1 or 2 views (72170) |
$328 |
$656 |
3.2× |
| Pet Image Skull-Thigh (78812) |
$5,070.50 |
$10,141 |
3.6× |
| Pet Image W/Ct Lmtd (78814) |
$4,409 |
$8,818 |
3.2× |
| PET image w/CT, full body (78816) |
$4,409 |
$8,818 |
3.2× |
| PET imaging CT attenuation skull base mid-thigh (78815) |
$4,409 |
$8,818 |
3.2× |
| Pet Imaging Limited Area Chest Head/Neck (78811) |
$5,070.50 |
$10,141 |
4.0× |
| PET whole body (78813) |
$5,070.50 |
$10,141 |
3.6× |
| Prq Transhepatc Portograpy Hemodyn Eval Rs&I (75885) |
$3,919 |
$7,838 |
1.3× |
| Pulmonary Perfusion Imaging Particulate (78580) |
$494 |
$988 |
1.3× |
| Radex Abd Compl Aqt Abd W/S/E/D Views 1 View Ch (74022) |
$494.50 |
$989 |
4.8× |
| Radex abscess/fistula/sinus tract rs&i (76080) |
$326.50 |
$653 |
0.6× |
| Radex Ankle Complete Minimum 3 Views (73610) |
$315.50 |
$631 |
3.7× |
| Radex Calcaneus Minimum 2 Views (73650) |
$280 |
$560 |
3.3× |
| Radex elbow complete minimum 3 views (73080) |
$451 |
$902 |
5.3× |
| Radex Facial Bones Complete Minimum 3 Views (70150) |
$534 |
$1,068 |
5.2× |
| Radex fingr minimum 2 views (73140) |
$202 |
$404 |
2.4× |
| Radex foot complete minimum 3 views (73630) |
$316.50 |
$633 |
3.7× |
| Radex Hand Minimum 3 Views (73130) |
$281.50 |
$563 |
3.3× |
| Radex lower extremity infant minimum 2 views (73592) |
$238.50 |
$477 |
2.8× |
| Radex Mastoids Compl Minimum 3 Views PR Side (70130) |
$299.50 |
$599 |
2.9× |
| Radex Nasal Bones Complete Minimum 3 Views (70160) |
$298 |
$596 |
3.5× |
| Radex Ribs Unilateral 2 Views (71100) |
$336.50 |
$673 |
4.0× |
| Radex shoulder complete minimum 2 views (73030) |
$319 |
$638 |
3.8× |
| Radex Sinuses Paransl < 3 Views (70210) |
$476.50 |
$953 |
5.6× |
| Radex sm int w/mlt srl imges via enteroclss tube (74251) |
$1,117 |
$2,234 |
6.5× |
| Radex Spine 1 View Specify Level (72020) |
$281 |
$562 |
3.3× |
| Radex Sternum Minimum 2 Views (71120) |
$347 |
$694 |
4.1× |
| Radex Temporomandble Jt Opn & Clsd Mouth Bilat (70330) |
$365.50 |
$731 |
4.3× |
| Radex Toe Minimum 2 Views (73660) |
$251 |
$502 |
3.0× |
| Radex upper extremity infant minimum 2 views (73092) |
$163 |
$326 |
1.6× |
| Radex Wrist Complete Minimum 3 Views (73110) |
$299 |
$598 |
3.5× |
| Radex X-Ray Exam Entire Spi 6/> Vw - Xr Entire Spine 6+ Vw (72084) |
$322 |
$644 |
3.2× |
| Radiation Delivery Stereotactic Cranial Linear (77372) |
$10,508.50 |
$21,017 |
1.5× |
| Radiation treatment delivery level 1 (77402) |
$371 |
$742 |
3.7× |
| Radiation treatment delivery level 2 (77407) |
$371 |
$742 |
1.0× |
| Radiation treatment delivery level 3 (77412) |
$564.50 |
$1,129 |
1.0× |
| Radiolog exam mandible compl minimum 4 views (70110) |
$411 |
$822 |
4.0× |
| Radiologic Exam Abdomen 3+ Views - Xr Abdomen 3+ Views (74021) |
$455 |
$910 |
4.5× |
| Radiologic exam colon double contrast study (74280) |
$1,120.50 |
$2,241 |
6.5× |
| Radiologic exam colon single contrast study (74270) |
$975 |
$1,950 |
5.7× |
| Radiologic Exam Esophagus Double Contrast Study (74221) |
$587.50 |
$1,175 |
3.4× |
| Radiologic exam knee complete 4/more views (73564) |
$434.50 |
$869 |
4.3× |
| Radiologic exam pelvis compl minimum 3 views (72190) |
$434 |
$868 |
4.3× |
| Radiologic Exam Small Int Single Contrast Study (74250) |
$788.50 |
$1,577 |
4.6× |
| Radiologic exam swallow function contrast study (74230) |
$486 |
$972 |
2.8× |
| Radiologic exam teeth complete full mouth (70320) |
$165.50 |
$331 |
0.7× |
| Radiologic Exam Teeth Prtl Exam < Full Mouth (70310) |
$165.50 |
$331 |
0.7× |
| Radiologic exam upr gi trc double contrast study (74246) |
$852.50 |
$1,705 |
5.0× |
Radiologic examination femur 1 view (73551)
range across 2 matching MRF lines |
$276.50–$380 |
$553–$760 |
varies |
| Radiologic examination femur minimum 2 views (73552) |
$334 |
$668 |
3.9× |
| Radiologic examination knee 1/2 views (73560) |
$262 |
$524 |
3.1× |
| Radiologic Examination Osseous Survey Limited (77074) |
$762 |
$1,524 |
7.5× |
| Radiologic examination tibia & fibula 2 views (73590) |
$311 |
$622 |
3.7× |
| Radiologic examination, teeth; single view Non-Facility (70300) |
$74 |
$148 |
0.9× |
| Remote afterloading high dose rate radionuclide skin surface brachytherapy, includes basic dosimetry, when performed;… (77768) |
$2,729 |
$5,458 |
7.3× |
| Remote afterloading high dose rate radionuclide skin surface brachytherapy, includes basic dosimetry, when performed;… (77767) |
$2,374 |
$4,748 |
6.3× |
| Renal Cyst Study (74470) |
$378 |
$756 |
0.7× |
| Ribs bilateral 3 views (71110) |
$612.50 |
$1,225 |
6.0× |
| Rp loclzj tum plnr 1 area single day imaging (78800) |
$1,127.50 |
$2,255 |
2.9× |
| Rp loclzj tum plnr 2+area 1+d img/1 area img>2+d (78801) |
$1,127.50 |
$2,255 |
2.9× |
| Rp Loclzj Tum Plnr Whole Body 2+ Days Imaging (78804) |
$2,289.50 |
$4,579 |
4.3× |
| Rp Loclzj Tum Spect 1 Area Single Day Imaging (78803) |
$2,289.50 |
$4,579 |
4.3× |
| Rp loclzj tum spect 2 area/sep acquisj img (78831) |
$2,385.50 |
$4,771 |
1.9× |
| Rp loclzj tum spect CT 2area 1d img/1 ar img>2+d (78832) |
$2,790 |
$5,580 |
2.0× |
| Rp loclzj tum spect w/CT 1 area/acquisj 1day img (78830) |
$2,385.50 |
$4,771 |
1.9× |
| Rp Ther Radiolbld Monoclonal Antibody IV Infus (79403) |
$874.50 |
$1,749 |
3.8× |
| Rp Therapy Intravenous Administration (79101) |
$615 |
$1,230 |
2.7× |
| Salivary Gland Imaging Serial Images (78231) |
$651 |
$1,302 |
1.7× |
| Scapula (73010) |
$388 |
$776 |
3.8× |
Screening Digital Breast Tomosynthesis Bi (77063)
range across 5 matching MRF lines |
$13.50–$18.50 |
$27–$37 |
varies |
| Sella turcica (70240) |
$158.50 |
$317 |
1.9× |
| Shoulder 1 view (73020) |
$222.50 |
$445 |
2.6× |
| Shoulder Arthrography (73040) |
$917 |
$1,834 |
2.7× |
| Sialogram (70390) |
$628.50 |
$1,257 |
2.7× |
| Skull less than 4 views (70250) |
$529 |
$1,058 |
5.2× |
| Special dosimetry (77331) |
$378.50 |
$757 |
2.9× |
| Special Physics Consult (77370) |
$575.50 |
$1,151 |
4.4× |
| Special teletherapy port plan (77321) |
$919 |
$1,838 |
2.5× |
| Special treatment procedure (77470) |
$1,850 |
$3,700 |
3.4× |
| Spleen Imaging (78185) |
$679 |
$1,358 |
1.7× |
| Srs Multisource (77371) |
$14,869 |
$29,738 |
2.1× |
| Stereotactic Body Radiation Delivery (77373) |
$10,508.50 |
$21,017 |
6.0× |
| Sternoclavicular joints (71130) |
$399.50 |
$799 |
4.7× |
| Superior sagittal sinus venogram (75870) |
$1,619.50 |
$3,239 |
0.5× |
| Surface Applic Low Dose Rate Radionuclide Source (77789) |
$246 |
$492 |
2.5× |
| Telethx isodose pln cplx w/basic dosimetry (77307) |
$905.50 |
$1,811 |
2.5× |
| Telethx isodose pln smpl w/dosimetry calculation (77306) |
$788 |
$1,576 |
2.2× |
| Testicular Imaging W/Flow (78761) |
$774 |
$1,548 |
2.0× |
| Ther Rad Simulaj-Aided Field Setting Complex (77290) |
$1,275.50 |
$2,551 |
3.5× |
| Ther Rad Simulaj-Aided Field Setting Intermed (77285) |
$946 |
$1,892 |
2.6× |
| Ther rad simulaj-aided field setting simple (77280) |
$636 |
$1,272 |
4.8× |
Thoracic spine 2 views (72070)
range across 2 matching MRF lines |
$337–$362.50 |
$674–$725 |
varies |
| Thoracic spine 3 views (72072) |
$360.50 |
$721 |
3.5× |
| Thoracolumbar 2 views (72080) |
$480 |
$960 |
5.7× |
| Thyroid Carcinoma Metastases Img Lmtd Area (78015) |
$760 |
$1,520 |
1.9× |
| Thyroid Imaging With Vascular Flow (78013) |
$573.50 |
$1,147 |
1.5× |
| Thyroid Met Imaging Body (78018) |
$1,747 |
$3,494 |
3.3× |
| Thyroid Uptake Measurement (78012) |
$347 |
$694 |
0.9× |
| Thyroid Uptake W/Blood Flow Sngle/Mult Quan Meas (78014) |
$1,091 |
$2,182 |
2.8× |
| Tx Devices Design & Construction Complex (77334) |
$514 |
$1,028 |
1.4× |
| Tx devices design & construction intermediate (77333) |
$448 |
$896 |
3.4× |
| Tx devices design & construction simple (77332) |
$389.50 |
$779 |
3.0× |
| Ultrasound Breast Limited (76642) |
$548 |
$1,096 |
6.5× |
| Ultrasound elastography first target lesion (76982) |
$332 |
$664 |
3.3× |
| Ultrasound Elastography Parenchyma (76981) |
$332 |
$664 |
3.3× |
| Ultrasound Exam Aaa Screen (76706) |
$691.50 |
$1,383 |
6.8× |
| Ultrasound trgt dynamic microbubble 1st lesion (76978) |
$677.50 |
$1,355 |
2.0× |
| Ultrasound, abdomen limited (76705) |
$722.50 |
$1,445 |
7.1× |
| Umbilical-artery Doppler (OB) (76820) |
$417 |
$834 |
4.1× |
| Unlisted magnetic resonance procedure (76498) |
$1,163 |
$2,326 |
13.7× |
| Unlisted us procedure (76999) |
$119 |
$238 |
1.4× |
| Upper gi w/o kub (74240) |
$852.50 |
$1,705 |
5.0× |
| Urea Breath Test C-14 Isotopic Acquisj Analysis (78267) |
$108.50 |
$217 |
9.8× |
| Ureteral Reflux Study (78740) |
$854 |
$1,708 |
2.2× |
| Urethrocystogram voiding (74455) |
$513.50 |
$1,027 |
2.2× |
| Urethrocystography retrograde (74450) |
$513.50 |
$1,027 |
2.2× |
| Us breast unilateral complete (76641) |
$561 |
$1,122 |
5.5× |
| Us chest (76604) |
$389 |
$778 |
3.8× |
| Us complete joint (76881) |
$784 |
$1,568 |
7.7× |
| Us exam, pelvic, limited (76857) |
$430 |
$860 |
4.2× |
| Us head (76506) |
$771.50 |
$1,543 |
7.6× |
| Us kidney transplant (76776) |
$595.50 |
$1,191 |
5.8× |
| Us lmtd joint/oth nonvasc xtr strux r-t w/img (76882) |
$306.50 |
$613 |
3.0× |
Us ob detailed single fetus (76811)
range across 2 matching MRF lines |
$664–$710 |
$1,328–$1,420 |
varies |
Us ob limited 1 or more fetuses (76815)
range across 4 matching MRF lines |
$474.50–$499.50 |
$949–$999 |
varies |
| Us ob transvaginal (76817) |
$423.50 |
$847 |
4.2× |
| Us pelvic non ob complete (76856) |
$737 |
$1,474 |
7.2× |
Us pg uter img f&mat 14 wk tabdl 1/1st gestation (76801)
range across 2 matching MRF lines |
$480–$514 |
$960–$1,028 |
varies |
Us preg uterus real time f/u trnsabdl per fetus (76816)
range across 2 matching MRF lines |
$189–$223.50 |
$378–$447 |
varies |
| Us retroperitoneal complete (76770) |
$758.50 |
$1,517 |
7.4× |
| Us retroperitoneal limited (76775) |
$559 |
$1,118 |
5.5× |
| Us scrotum and contents (76870) |
$708.50 |
$1,417 |
6.9× |
| Us spinal canal and contents (76800) |
$546 |
$1,092 |
5.4× |
| Us thyroid (76536) |
$588.50 |
$1,177 |
5.8× |
| Us transrectal (76872) |
$662 |
$1,324 |
6.5× |
| Vascular Flow Imaging (78445) |
$438 |
$876 |
1.1× |
| Vasogram (74440) |
$603.50 |
$1,207 |
2.6× |
| Vein X-Ray Chest (75827) |
$1,736 |
$3,472 |
1.1× |
| Vein X-Ray Liver W/O Hemodyn (75887) |
$1,619.50 |
$3,239 |
0.5× |
| Vein X-Ray Spleen/Liver (75810) |
$2,798.50 |
$5,597 |
0.9× |
| Venogram Sinus/Jugular (75860) |
$1,782.50 |
$3,565 |
0.6× |
| Venography Adrenal Unilateral (75840) |
$3,919 |
$7,838 |
1.3× |
| Venography caval inferior serialography rs&i (75825) |
$3,919 |
$7,838 |
1.3× |
| Venography extremity bilateral rs&i (75822) |
$2,079.50 |
$4,159 |
1.4× |
| Venography extremity unilateral rs&i (75820) |
$1,388 |
$2,776 |
0.9× |
| Venography Orbital Rs&I (75880) |
$2,427.50 |
$4,855 |
4.0× |
| Venography Renal Bilateral (75833) |
$3,919 |
$7,838 |
1.3× |
| Venography Renal Unilateral (75831) |
$3,919 |
$7,838 |
1.3× |
| Venous sampling by catheter (75893) |
$3,919 |
$7,838 |
0.7× |
| Venous thrombosis imaging (78457) |
$796.50 |
$1,593 |
1.5× |
| Venous Thrombosis Imaging Venogram Bilateral (78458) |
$796.50 |
$1,593 |
2.0× |
| Vertebral fracture assessment via dxa (77086) |
$160 |
$320 |
1.9× |
| Wrist 2 views (73100) |
$254.50 |
$509 |
3.0× |
| X-Ray Ac Jts - Xr Acromioclavicular Joints Bilateral (73050) |
$308.50 |
$617 |
3.6× |
| X-ray antegrade pyelogram tube (74425) |
$518 |
$1,036 |
1.5× |
| X-Ray Aorta Leg Arteries (75630) |
$2,939 |
$5,878 |
1.0× |
| X-Ray Bend Only L-S Spine (72120) |
$570.50 |
$1,141 |
5.6× |
| X-Ray Elbow 2 Vw - Xr Elbow 1-2 Views Right (73070) |
$268.50 |
$537 |
3.2× |
| X-Ray Exam Breast Specimen (76098) |
$610 |
$1,220 |
1.1× |
| X-Ray Exam Entire Spi 1 Vw (72081) |
$134.50 |
$269 |
1.6× |
| X-Ray Exam Entire Spi 2/3 Vw (72082) |
$169.50 |
$339 |
1.7× |
| X-Ray Exam Entire Spi 4/5 Vw (72083) |
$322 |
$644 |
3.2× |
| X-Ray Exam Hip Uni 1 View (73501) |
$219.50 |
$439 |
2.6× |
| X-Ray Exam Hip Uni 2-3 Views (73502) |
$250.50 |
$501 |
3.0× |
| X-Ray Exam Hip Uni 4/> Views (73503) |
$340.50 |
$681 |
3.3× |
| X-Ray Exam Hips Bi 2 Views (73521) |
$352 |
$704 |
3.5× |
| X-Ray Exam Hips Bi 3-4 Views (73522) |
$357.50 |
$715 |
3.5× |
| X-Ray Exam Hips Bi 5/> Views (73523) |
$417.50 |
$835 |
4.1× |
| X-Ray Exam L-S Spine Bending (72114) |
$779.50 |
$1,559 |
7.6× |
X-Ray Exam Neck Spine 2-3 Vw (72040)
range across 2 matching MRF lines |
$374–$402 |
$748–$804 |
varies |
| X-Ray Exam Neck Spine 6/>Vws (72052) |
$597.50 |
$1,195 |
5.9× |
| X-Ray Exam Unilat Ribs/Chest (71101) |
$446.50 |
$893 |
4.4× |
| X-ray eye for foreign body (70030) |
$181.50 |
$363 |
2.1× |
| X-ray head for orthodontia (70350) |
$158.50 |
$317 |
1.9× |
| X-ray humerus (73060) |
$337 |
$674 |
4.0× |
| X-ray IV pyelogram (ivp) (74400) |
$1,198.50 |
$2,397 |
7.0× |
| X-ray IV pyelogram+tomography (74415) |
$1,350 |
$2,700 |
7.9× |
| X-Ray Jaw <4 Vw - Xr Mandible < 4 Views (70100) |
$193.50 |
$387 |
2.3× |
| X-Ray Knee Bilat Standing - Xr Knees Anteroposterior Standing Bilat (73565) |
$216 |
$432 |
2.5× |
| X-Ray Lumbar Spine 2/3 Vw - Xr Lumbar Spine 2-3 Views (72100) |
$366.50 |
$733 |
3.6× |
| X-ray nose-rectum child f.b. (76010) |
$165.50 |
$331 |
1.9× |
| X-Ray Ribs, Chest 4+ Vw - Xr Ribs 3 Vws Bil W/ Chest Posteroanterior (71111) |
$705 |
$1,410 |
6.9× |
| X-Ray Sacroiliac Jts 3+ Vw - Xr Sacroiliac Joints 3+ Views (72202) |
$420.50 |
$841 |
4.1× |
| X-Ray Sacroiliac Jts <3 Vw - Xr Sacroiliac Joints 1-2 Views (72200) |
$244.50 |
$489 |
2.4× |
| X-Ray Sacrum/Coccyx 2+ Vw - Xr Sacrum Coccyx 2+ Views (72220) |
$419.50 |
$839 |
4.9× |
| X-Ray Sinuses 3+ Vw - Xr Paranasal Sinuses 3+ Views (70220) |
$803.50 |
$1,607 |
9.5× |
| X-Ray Skull 4+ Vw - Xr Skull Complete 4+ Views (70260) |
$704.50 |
$1,409 |
6.9× |
| X-ray thoracic spine 4 vw (72074) |
$588.50 |
$1,177 |
5.8× |
| X-Ray Tmj Unilat (70328) |
$341.50 |
$683 |
4.0× |
| X-Ray Urinary Tract Exam With Contrast Material (74420) |
$965 |
$1,930 |
2.8× |
| X-Rays Bone Length Studies (77073) |
$130 |
$260 |
1.3× |
| X-Rays Bone Survey Complete (77075) |
$897 |
$1,794 |
8.8× |
| Xr c-spine 4 or 5 views (72050) |
$444 |
$888 |
4.4× |
| Xr facial bones less than 3 views (70140) |
$314.50 |
$629 |
3.7× |
| XR Mastoids < 3 Views Bilateral (70120) |
$140 |
$280 |
1.4× |
| Xr orbits complete 4 views (70200) |
$533.50 |
$1,067 |
5.2× |
| Xr Tomogram Single Plane (76100) |
$154.50 |
$309 |
1.5× |