| 3-D radiotherapy plan dose-volume histograms (77295) |
$4,744.50 |
$9,489 |
3.5× |
| Abdomen 1 View (74018) |
$190.50 |
$381 |
2.2× |
| Abdomen 2 views (74019) |
$330 |
$660 |
3.2× |
| Acute Gastrointestinal Blood Loss Imaging (78278) |
$1,059.50 |
$2,119 |
2.7× |
| Acute venous thrombosis imaging, peptide Non-Facility (78456) |
$638 |
$1,276 |
0.5× |
| Adrenal Cortex & Medulla Img (78075) |
$872.50 |
$1,745 |
0.7× |
| Angio internal mammary (75756) |
$1,622.50 |
$3,245 |
0.5× |
| Angio pulmonary bilat (75743) |
$3,421.50 |
$6,843 |
1.1× |
| Angiography Adrenal Bilateral Slctv Rs&I (75733) |
$3,421.50 |
$6,843 |
1.1× |
| Angiography extremity bilateral rs&i (75716) |
$1,819.50 |
$3,639 |
0.6× |
| Angiography extremity unilateral rs&i (75710) |
$1,819.50 |
$3,639 |
0.6× |
| Angiography pulmonary unilateral slctv rs&i (75741) |
$3,421.50 |
$6,843 |
1.1× |
| Angrph pulmonary nonslctv cath/ven njx rs&i (75746) |
$2,268.50 |
$4,537 |
0.7× |
| Ankle 2 views (73600) |
$171 |
$342 |
2.0× |
| Aortography thoracic serialography rs&i (75605) |
$3,745 |
$7,490 |
0.7× |
| Aortography thoracic w/o serialography rs&i (75600) |
$2,746.50 |
$5,493 |
0.9× |
| Artery X-Rays Abdomen (75726) |
$3,421.50 |
$6,843 |
0.6× |
| Artery X-Rays Adrenal Gland (75731) |
$2,615.50 |
$5,231 |
0.8× |
| Artery X-Rays Pelvis (75736) |
$3,421.50 |
$6,843 |
0.6× |
| Artery X-Rays Spine (75705) |
$2,851.50 |
$5,703 |
0.5× |
| Arthrogram ankle (73615) |
$349 |
$698 |
1.0× |
| Arthrogram hip (73525) |
$304.50 |
$609 |
0.9× |
| Arthrogram Wrist (73115) |
$262.50 |
$525 |
0.8× |
| Basic radiation dosimetry calculation (77300) |
$265 |
$530 |
2.0× |
| Bone age studies (77072) |
$212 |
$424 |
2.1× |
| Bone Imaging 3 Phase (78315) |
$909 |
$1,818 |
2.3× |
| Bone Imaging Limited Area (78300) |
$836.50 |
$1,673 |
2.1× |
| Bone Imaging Multiple Areas (78305) |
$837.50 |
$1,675 |
2.1× |
| Bone Imaging Whole Body (78306) |
$909.50 |
$1,819 |
2.3× |
| Bone marrow imaging limited area (78102) |
$837.50 |
$1,675 |
2.1× |
| Bone marrow imaging; multiple areas (78103) |
$837.50 |
$1,675 |
2.1× |
| Bone marrow imaging; whole body (78104) |
$909.50 |
$1,819 |
2.3× |
| Bone survey infant (77076) |
$591.50 |
$1,183 |
5.8× |
| Brachytx isodose complex (77318) |
$1,107 |
$2,214 |
3.0× |
| Brachytx isodose intermed (77317) |
$856 |
$1,712 |
2.3× |
| Brachytx Isodose Plan Simple (77316) |
$708.50 |
$1,417 |
1.9× |
| Brain Flow Imaging Only (78610) |
$255.50 |
$511 |
0.5× |
| Brain Image W/Flow < 4 Views (78601) |
$547 |
$1,094 |
1.4× |
| Brain Imaging Min 4 Static Views W Vascular Flow (78606) |
$621.50 |
$1,243 |
1.2× |
| Brain Imaging Minimum 4 Static Views (78605) |
$547 |
$1,094 |
1.0× |
| Brain Imaging Pet Metabolic Evaluation (78608) |
$4,816 |
$9,632 |
3.5× |
| Cardiac MRI w/w/o contrast & further seq (75561) |
$2,357 |
$4,714 |
6.9× |
| Cardiac MRI w/w/o contrast w/stress (75563) |
$2,935.50 |
$5,871 |
3.8× |
| Cardiac Shunt Detection (78428) |
$365 |
$730 |
0.9× |
| Cat Scan Follow-Up Study (76380) |
$675.50 |
$1,351 |
8.0× |
| Cerebrospinal Fluid Flow W/O Matl Shunt Evaltj (78645) |
$489.50 |
$979 |
0.9× |
| Cerebrospinal Fluid Scan (78630) |
$809.50 |
$1,619 |
1.5× |
| Chest 1 view (71045) |
$126.50 |
$253 |
1.5× |
| Chest 2 views (71046) |
$154 |
$308 |
1.8× |
| Chest 3 views (71047) |
$198.50 |
$397 |
2.3× |
| Chest 4 or more views (71048) |
$245 |
$490 |
2.4× |
| Chg us nrv&acc strux 1 xtr compre w/img pr extremity (76883) |
$404 |
$808 |
4.0× |
| Cisternography Positive Contrast Rs&I (70015) |
$426.50 |
$853 |
0.6× |
| Clavicle complete (73000) |
$203 |
$406 |
2.4× |
Computed Tomography Thorax Lw Dose Lng Ca Scr C- (71271)
range across 2 matching MRF lines |
$175.50–$478.50 |
$351–$957 |
varies |
| Continuing medical physics consltj pr wk (77336) |
$478 |
$956 |
3.6× |
| Contrast Exam Abdominl Aorta (75625) |
$1,819.50 |
$3,639 |
0.6× |
| Contrast X-Ray Bladder (74430) |
$306 |
$612 |
0.9× |
| Contrast X-Ray Of Elbow (73085) |
$330.50 |
$661 |
1.0× |
| Contrast X-Ray Of Knee Joint (73580) |
$432.50 |
$865 |
1.3× |
| CT abdomen and pelvis without and with contrast (74178) |
$3,108 |
$6,216 |
9.1× |
| CT abdomen and pelvis without contrast (74176) |
$1,625.50 |
$3,251 |
7.0× |
| CT abdomen w contrast (74160) |
$1,189 |
$2,378 |
6.9× |
| CT abdomen w wo contrast (74170) |
$1,474 |
$2,948 |
8.6× |
| CT abdomen w/o contrast (74150) |
$821 |
$1,642 |
8.0× |
| CT Angio Abdomen and Pelvis (74174) |
$2,598 |
$5,196 |
7.6× |
| CT Angio Chest (71275) |
$1,252.50 |
$2,505 |
7.3× |
| CT Angio Head (70496) |
$1,137 |
$2,274 |
6.6× |
CT angio hrt w/3d image (75574)
range across 2 matching MRF lines |
$225–$412.50 |
$450–$825 |
varies |
| Ct Angio Lwr Extr W/O&W/Dye (73706) |
$1,330.50 |
$2,661 |
7.8× |
| CT Angio Neck (70498) |
$1,101.50 |
$2,203 |
6.4× |
| Ct Angio Upr Extrm W/O&W/Dye (73206) |
$1,330.50 |
$2,661 |
7.8× |
| CT cervical spine w/ contrast (72126) |
$1,358.50 |
$2,717 |
4.0× |
| CT cervical spine w/o contrast (72125) |
$1,046.50 |
$2,093 |
10.3× |
| CT cervical spine w/wo cont (72127) |
$1,705 |
$3,410 |
10.0× |
| CT chest w contrast (71260) |
$1,240.50 |
$2,481 |
7.2× |
| CT chest w/wo contrast (71270) |
$1,485 |
$2,970 |
8.7× |
| CT colonography screening (74263) |
$322 |
$644 |
1.4× |
| CT Colonogrphy Dx Image Postprocess W/Contrast (74262) |
$375 |
$750 |
2.2× |
| CT colonogrphy dx image postprocess w/o contrast (74261) |
$322 |
$644 |
3.2× |
| CT head/brain with contrast (70460) |
$1,124.50 |
$2,249 |
6.6× |
| CT head/brain without and with contrast (70470) |
$1,383.50 |
$2,767 |
8.1× |
| CT heart contrast eval cardiac structure&morph (75572) |
$545 |
$1,090 |
1.6× |
| CT heart no contrast quant eval coronry calcium (75571) |
$75 |
$150 |
0.9× |
| CT hrt w/3d image congen (75573) |
$963 |
$1,926 |
2.8× |
| CT iac w contrast (70481) |
$1,154 |
$2,308 |
6.7× |
| CT l-spine w&w/o contrast (72133) |
$1,705 |
$3,410 |
10.0× |
| CT lower ext w/o (73700) |
$974 |
$1,948 |
9.5× |
| CT lower extremity w/contrast material (73701) |
$1,330.50 |
$2,661 |
7.8× |
| CT lumbar spine w contrast (72132) |
$1,349 |
$2,698 |
4.0× |
| CT lumbar spine w/o contrast (72131) |
$1,046.50 |
$2,093 |
10.3× |
| CT maxillofacial w contrast (70487) |
$909.50 |
$1,819 |
5.3× |
| CT maxillofacial wo contrast (70486) |
$885 |
$1,770 |
8.7× |
| CT neck tissue combo (70492) |
$1,321 |
$2,642 |
7.7× |
| Ct Orbit/Ear/Fossa W/O&W/Dye (70482) |
$1,460 |
$2,920 |
8.5× |
| CT orbits w/o contrast (70480) |
$923 |
$1,846 |
9.0× |
| CT pelvis w&w/o contrast (72194) |
$1,544 |
$3,088 |
9.0× |
| CT pelvis w/o contrast (72192) |
$807 |
$1,614 |
7.9× |
| CT scan of leg combo (73702) |
$1,431 |
$2,862 |
8.4× |
| CT scans face/jaw combo (70488) |
$1,293 |
$2,586 |
7.6× |
| CT soft tissue neck w contrast (70491) |
$946 |
$1,892 |
5.5× |
| CT soft tissue neck w/o contrast (70490) |
$932 |
$1,864 |
9.1× |
| CT thoracic spine w contrast (72129) |
$1,241.50 |
$2,483 |
7.3× |
| CT thoracic spine w/o contrast (72128) |
$1,010.50 |
$2,021 |
9.9× |
| CT thoracic spine w/wo cont (72130) |
$1,705 |
$3,410 |
10.0× |
| CT thorax w/o contrast (71250) |
$982.50 |
$1,965 |
9.6× |
| CT upper ext wo (73200) |
$974 |
$1,948 |
9.5× |
| CT upper extremity w/o & w/contrast material (73202) |
$1,431 |
$2,862 |
8.4× |
| CT upper extremity with contrast (73201) |
$1,330.50 |
$2,661 |
3.9× |
| Cta Abdl Aorta&Bi Iliofem W/Contrast&Postp (75635) |
$2,072.50 |
$4,145 |
12.1× |
| Cta Abdomen (74175) |
$1,407.50 |
$2,815 |
8.2× |
| CTA pelvis (72191) |
$1,354 |
$2,708 |
7.9× |
| Dacryocystography, nasolacrimal duct, radiological supervision and interpretation Non-Facility (70170) |
$299.50 |
$599 |
1.3× |
| Dilation ureters/urethra rs&i (74485) |
$1,021 |
$2,042 |
0.5× |
| Discography Cerv/Thor Spine (72285) |
$2,149 |
$4,298 |
1.1× |
| Diskography lumbar (72295) |
$1,650.50 |
$3,301 |
0.9× |
| Doppler Echo Fetal Puls Spectral F/U/Repeat (76828) |
$152 |
$304 |
1.5× |
| Doppler Echo Fetal Spectral Display Complete (76827) |
$152 |
$304 |
1.5× |
| Doppler Fetal Mid Cerebral Artery (76821) |
$370 |
$740 |
3.6× |
| Dxa Bone Density Axial (77080) |
$392 |
$784 |
3.8× |
| Dxa bone density study (77085) |
$267 |
$534 |
2.6× |
| Dxa bone density study 1/>sites appendiclr skel (77081) |
$247.50 |
$495 |
2.9× |
Echo exam of fetal heart (76825)
range across 2 matching MRF lines |
$1,041.50–$1,114.50 |
$2,083–$2,229 |
varies |
| Echo exam uterus (76831) |
$347 |
$694 |
1.5× |
| Echo Guide For Artery Repair (76936) |
$1,052 |
$2,104 |
5.0× |
| Echocardiography, fetal, cardiovascular system, real time with image documentation (2D), with or without M-mode… (76826) |
$320.50 |
$641 |
1.4× |
Esophagram (74220)
range across 2 matching MRF lines |
$467–$479 |
$934–$958 |
varies |
Fetal Biophys Profile W/Nst (76818)
range across 2 matching MRF lines |
$362–$387.50 |
$724–$775 |
varies |
Fetal Biophysical Profile W/O Non-Stress Testing (76819)
range across 2 matching MRF lines |
$400–$428 |
$800–$856 |
varies |
| Fetal MRI w/placntl matrnl plvc img sing/1st ges (74712) |
$539 |
$1,078 |
2.3× |
| Fluoroscopy up to 1 hr (76000) |
$189.50 |
$379 |
0.8× |
| Follow-Up Angiography (75898) |
$1,619.50 |
$3,239 |
0.5× |
| Foot 2 views (73620) |
$175.50 |
$351 |
2.1× |
| Forearm 2 views (73090) |
$186.50 |
$373 |
2.2× |
| Gastric emptying imaging study (78264) |
$917.50 |
$1,835 |
2.4× |
| Gastric Emptyng Imag Std W/Sm Bwl Transit (78265) |
$1,098.50 |
$2,197 |
2.8× |
| Gastroesophageal Reflux Exam (78262) |
$1,504.50 |
$3,009 |
3.9× |
| Gated Heart Planar Single (78472) |
$952 |
$1,904 |
2.4× |
| Gstrc Emptng Imag Std W/Sm Bwl Col Trnst Mlt Day (78266) |
$1,313.50 |
$2,627 |
2.5× |
| Hand 2 views (73120) |
$161 |
$322 |
1.6× |
| Hdr Rdncl Ntrstl/Icav Brchtx (77772) |
$3,400.50 |
$6,801 |
5.0× |
| Hdr Rdncl Ntrstl/Icav Brchtx (77771) |
$2,177.50 |
$4,355 |
3.2× |
| Hdr Rdncl Ntrstl/Icav Brchtx 1 Channel (77770) |
$1,197.50 |
$2,395 |
1.8× |
| Hepatc Vngrph Wdg/Fr Hemodyn Eval Rs&I (75889) |
$3,421.50 |
$6,843 |
1.1× |
| Hepatc Vngrph Wdg/Fr W/O Hemodyn Eval Rs&I (75891) |
$2,746.50 |
$5,493 |
0.9× |
| Hepatobil Syst Image W/Drug (78227) |
$1,906 |
$3,812 |
3.6× |
| Hepatobiliary System Imaging (78226) |
$1,374 |
$2,748 |
3.5× |
| Ht Musc Image Planar Mult (78454) |
$759 |
$1,518 |
0.6× |
| Ht Muscle Image Spect Sing (78451) |
$1,664.50 |
$3,329 |
1.3× |
| Hysterosalpingogram (74740) |
$219.50 |
$439 |
0.9× |
| Infant hip ultrasound with hip movement (dynamic) (76885) |
$492 |
$984 |
5.8× |
| Infant hip ultrasound, limited static exam (76886) |
$171 |
$342 |
2.0× |
| Infusion Ivp (74410) |
$642.50 |
$1,285 |
3.8× |
| Interstitial radiation source applic complex (77778) |
$1,164 |
$2,328 |
1.7× |
| Intracavitary Radiation Source Applic Complex (77763) |
$1,018 |
$2,036 |
1.5× |
| Intracavitary Radiation Source Applic Intermed (77762) |
$816.50 |
$1,633 |
1.5× |
| Intracavitary radiation source applic simple (77761) |
$682.50 |
$1,365 |
1.3× |
| Intraop radiaj tx deliver xray single tx session (77424) |
$4,492.50 |
$8,985 |
0.6× |
| Joint Survey Single View (77077) |
$417.50 |
$835 |
4.1× |
| K Flow/Funct Image Multiple (78709) |
$717.50 |
$1,435 |
1.4× |
| K Flow/Funct Image W/Drug (78708) |
$694.50 |
$1,389 |
1.3× |
| K Flow/Funct Image W/O Drug (78707) |
$512.50 |
$1,025 |
1.0× |
| Kidney Imaging Morphol (78700) |
$489.50 |
$979 |
1.3× |
| Kidney Imaging Morphoogy W/Vascular Flow (78701) |
$512.50 |
$1,025 |
1.3× |
| Knee 3 Views (73562) |
$238.50 |
$477 |
2.8× |
| Leveen/Shunt Patency Exam (78291) |
$493.50 |
$987 |
1.3× |
| Liver & Spleen Imaging Static Only (78215) |
$472 |
$944 |
1.2× |
| Liver imaging static only (78201) |
$381.50 |
$763 |
0.7× |
| Liver imaging w/vascular flow (78202) |
$381.50 |
$763 |
0.7× |
| Lung Perf&Ventilat Diferentl (78598) |
$1,174 |
$2,348 |
2.2× |
| Lung perfusion differential (78597) |
$785 |
$1,570 |
2.0× |
| Lung Ventilat&Perfus Imaging (78582) |
$1,242.50 |
$2,485 |
2.3× |
| Lymph System Imaging (78195) |
$1,005.50 |
$2,011 |
1.9× |
| Lymphangiography Extremity Only Bilateral Rs&I (75803) |
$1,024.50 |
$2,049 |
0.7× |
| Lymphangiography extremity only unilateral rs&i (75801) |
$1,024.50 |
$2,049 |
1.7× |
| Lymphangiography Pelvic/Abdominal Bilateral Rs&I (75807) |
$1,666 |
$3,332 |
0.5× |
| Lymphangiography, pelvic/abdominal, unilateral (75805) |
$1,666 |
$3,332 |
0.5× |
| Magnetic Image Jaw Joint (70336) |
$1,895.50 |
$3,791 |
8.1× |
| Magnetic Resonance Elastography (76391) |
$1,204.50 |
$2,409 |
5.2× |
| 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) |
$778.50 |
$1,557 |
2.0× |
| Mlc imrt design & construction per imrt plan (77338) |
$1,130.50 |
$2,261 |
3.1× |
| Mra Head W/O & W/Contrast Material (70546) |
$2,753.50 |
$5,507 |
8.1× |
| MRA head w/o contrast (70544) |
$1,675 |
$3,350 |
7.2× |
| MRA head with contrast (70545) |
$1,868.50 |
$3,737 |
5.5× |
| MRA neck w contrast (70548) |
$1,845 |
$3,690 |
5.4× |
| Mra Neck W/O &W/Contrast Material (70549) |
$2,753.50 |
$5,507 |
8.1× |
| MRA neck w/o contrast (70547) |
$1,692.50 |
$3,385 |
7.3× |
| MRI abdomen w contrast (74182) |
$2,056.50 |
$4,113 |
6.0× |
| MRI abdomen w/o contrast (74181) |
$1,906.50 |
$3,813 |
8.2× |
| MRI any jt lower extrem w/contrast material (73722) |
$2,088 |
$4,176 |
2.7× |
| MRI any jt lower extrem w/o & w/contrast matrl (73723) |
$3,790.50 |
$7,581 |
11.1× |
| MRI any jt upper extremity w/contrast matrl (73222) |
$2,088 |
$4,176 |
2.7× |
| MRI brain functional w/o physician admnistration (70554) |
$2,034.50 |
$4,069 |
8.7× |
| MRI brain functional w/physician admnistration (70555) |
$1,639 |
$3,278 |
7.0× |
| MRI Breast W/O Contrast Bilateral (77047) |
$3,079.50 |
$6,159 |
13.2× |
| MRI Breast Without Contrast Material Unilateral (77046) |
$2,757.50 |
$5,515 |
11.8× |
| MRI cardiac w/o contrast (75557) |
$1,659 |
$3,318 |
7.1× |
| MRI cervical spine w contrast (72142) |
$1,812 |
$3,624 |
5.3× |
| MRI cervical spine w/o cont (72141) |
$1,629 |
$3,258 |
7.0× |
| MRI chest w/o contrast (71550) |
$2,029 |
$4,058 |
8.7× |
| MRI chest with contrast (71551) |
$2,241 |
$4,482 |
2.9× |
| MRI chest wo w contrast (71552) |
$3,771.50 |
$7,543 |
11.1× |
| MRI lower extrem oth/thn jt w/contrast matrl (73719) |
$2,092.50 |
$4,185 |
6.1× |
| MRI lower extrem oth/thn jt w/o & w/contr matr (73720) |
$2,279.50 |
$4,559 |
6.7× |
| MRI lower extrem oth/thn jt w/o contr matrl (73718) |
$1,567 |
$3,134 |
6.7× |
| MRI lumbar spine w contrast (72149) |
$2,233.50 |
$4,467 |
6.6× |
| Mri Neck Spine W/O & W/Dye (72156) |
$3,208.50 |
$6,417 |
9.4× |
| MRI orbit face &/neck w/o contrast (70540) |
$1,634.50 |
$3,269 |
7.0× |
| MRI orbit face neck w contrast (70542) |
$1,708 |
$3,416 |
5.0× |
| Mri Orbt/Fac/Nck W/O &W/Dye (70543) |
$3,075.50 |
$6,151 |
9.0× |
| MRI pelvis w contrast (72196) |
$2,092.50 |
$4,185 |
6.1× |
| MRI pelvis w/o & w contrast (72197) |
$3,012 |
$6,024 |
8.8× |
| MRI pelvis w/o contrast (72195) |
$1,691 |
$3,382 |
7.3× |
| MRI spectroscopy (76390) |
$1,830.50 |
$3,661 |
21.6× |
| MRI thoracic spine w/o contrast (72146) |
$1,855 |
$3,710 |
8.0× |
| MRI upper extremity oth than jt w/contr matrl (73219) |
$2,105.50 |
$4,211 |
6.2× |
| MRI upper extremity oth than jt w/o contr matrl (73218) |
$1,895.50 |
$3,791 |
8.1× |
| Mri Uppr Extremity W/O&W/Dye (73220) |
$2,490.50 |
$4,981 |
7.3× |
| MRI, abdomen, combo (74183) |
$3,194.50 |
$6,389 |
9.4× |
| MRI, dorsal spine combo (72157) |
$3,112 |
$6,224 |
9.1× |
| MRI, dorsal spine contrast (72147) |
$2,233.50 |
$4,467 |
6.6× |
| MRI, joint upper extrem (73221) |
$1,757 |
$3,514 |
7.5× |
| MRI, joint upper extrem combo (73223) |
$3,790.50 |
$7,581 |
11.1× |
| MRI, lumbar spine combo (72158) |
$3,187 |
$6,374 |
9.4× |
| Myelogram cervical (72240) |
$909.50 |
$1,819 |
1.2× |
| Myelogram Lumbar (72265) |
$992.50 |
$1,985 |
1.3× |
| Myocardial Perfusion Planar 1 Study Rest/Stress (78453) |
$638 |
$1,276 |
0.5× |
| Myocardial Spect Multiple Studies (78452) |
$1,908 |
$3,816 |
1.5× |
| Myocrd Img Pet Prfuj W/Metab 2rtracer Cncrnt CT (78433) |
$2,263 |
$4,526 |
1.1× |
| Neck soft tissue (70360) |
$184.50 |
$369 |
2.2× |
| Nfs/Instlj Radioelmnt Sln 3 Mo Follow-Up Care (77750) |
$303 |
$606 |
0.8× |
| Njx Rp Loclzj Non-Img Probe Study Intravenous (78808) |
$197.50 |
$395 |
0.5× |
| Ntsty modul radthx pln dose-vol histos (77301) |
$4,080 |
$8,160 |
3.0× |
| Nuclear Rx Intra-Arterial (79445) |
$651 |
$1,302 |
2.9× |
| Nuclear Rx Oral Admin (79005) |
$411.50 |
$823 |
1.8× |
Ob us nuchal meas 1 gest (76813)
range across 2 matching MRF lines |
$407.50–$436 |
$815–$872 |
varies |
| Ophthalmic Ultrasonic Foreign Body Localization (76529) |
$262.50 |
$525 |
3.1× |
| Ophthalmic ultrasound dx b-scan w/wo a-scan (76512) |
$275 |
$550 |
2.7× |
| Panoramic X-ray of jaws (70355) |
$180 |
$360 |
2.1× |
| Parathyroid imaging w/tomographic spect & CT (78072) |
$1,216.50 |
$2,433 |
2.3× |
| Parathyroid Planar Imaging (78070) |
$870 |
$1,740 |
2.2× |
| Parathyroid planar imaging w/wo subtraction (78071) |
$870 |
$1,740 |
2.2× |
| Pelvis 1 or 2 views (72170) |
$193 |
$386 |
1.9× |
| Pet Image Skull-Thigh (78812) |
$5,425.50 |
$10,851 |
3.9× |
| 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) |
$5,425.50 |
$10,851 |
4.3× |
| PET whole body (78813) |
$5,425.50 |
$10,851 |
3.9× |
| Prq Transhepatc Portograpy Hemodyn Eval Rs&I (75885) |
$3,421.50 |
$6,843 |
1.1× |
| Pulmonary Perfusion Imaging Particulate (78580) |
$521.50 |
$1,043 |
1.3× |
| Radex Abd Compl Aqt Abd W/S/E/D Views 1 View Ch (74022) |
$404.50 |
$809 |
4.0× |
| Radex abscess/fistula/sinus tract rs&i (76080) |
$333 |
$666 |
0.6× |
| Radex Ankle Complete Minimum 3 Views (73610) |
$213 |
$426 |
2.5× |
| Radex Calcaneus Minimum 2 Views (73650) |
$194 |
$388 |
2.3× |
| Radex elbow complete minimum 3 views (73080) |
$207.50 |
$415 |
2.4× |
| Radex Facial Bones Complete Minimum 3 Views (70150) |
$410.50 |
$821 |
4.0× |
| Radex fingr minimum 2 views (73140) |
$98.50 |
$197 |
1.2× |
| Radex foot complete minimum 3 views (73630) |
$221 |
$442 |
2.6× |
| Radex Hand Minimum 3 Views (73130) |
$203 |
$406 |
2.4× |
| Radex lower extremity infant minimum 2 views (73592) |
$176.50 |
$353 |
2.1× |
| Radex Mastoids Compl Minimum 3 Views PR Side (70130) |
$413.50 |
$827 |
4.1× |
| Radex Nasal Bones Complete Minimum 3 Views (70160) |
$243 |
$486 |
2.9× |
| Radex Ribs Unilateral 2 Views (71100) |
$261.50 |
$523 |
3.1× |
| Radex shoulder complete minimum 2 views (73030) |
$237 |
$474 |
2.8× |
| Radex Sinuses Paransl < 3 Views (70210) |
$189 |
$378 |
2.2× |
| Radex sm int w/mlt srl imges via enteroclss tube (74251) |
$407.50 |
$815 |
2.4× |
| Radex Spine 1 View Specify Level (72020) |
$169 |
$338 |
2.0× |
| Radex Sternum Minimum 2 Views (71120) |
$258 |
$516 |
3.0× |
| Radex Temporomandble Jt Opn & Clsd Mouth Bilat (70330) |
$265.50 |
$531 |
3.1× |
| Radex Toe Minimum 2 Views (73660) |
$102 |
$204 |
1.2× |
| Radex upper extremity infant minimum 2 views (73092) |
$154.50 |
$309 |
1.5× |
| Radex Wrist Complete Minimum 3 Views (73110) |
$201 |
$402 |
2.4× |
| Radex X-Ray Exam Entire Spi 6/> Vw - Xr Entire Spine 6+ Vw (72084) |
$348.50 |
$697 |
3.4× |
| Radiation Delivery Stereotactic Cranial Linear (77372) |
$10,508.50 |
$21,017 |
1.5× |
| Radiation treatment delivery level 1 (77402) |
$316 |
$632 |
3.2× |
| Radiation treatment delivery level 2 (77407) |
$405 |
$810 |
1.1× |
| Radiation treatment delivery level 3 (77412) |
$493 |
$986 |
0.9× |
| Radiolog exam mandible compl minimum 4 views (70110) |
$258 |
$516 |
2.5× |
| Radiologic Exam Abdomen 3+ Views - Xr Abdomen 3+ Views (74021) |
$330 |
$660 |
3.2× |
| Radiologic exam colon double contrast study (74280) |
$812.50 |
$1,625 |
4.7× |
| Radiologic exam colon single contrast study (74270) |
$697 |
$1,394 |
4.1× |
| Radiologic Exam Esophagus Double Contrast Study (74221) |
$479 |
$958 |
2.8× |
| Radiologic exam knee complete 4/more views (73564) |
$275 |
$550 |
2.7× |
| Radiologic exam pelvis compl minimum 3 views (72190) |
$315.50 |
$631 |
3.1× |
| Radiologic Exam Small Int Single Contrast Study (74250) |
$407.50 |
$815 |
2.4× |
| Radiologic exam swallow function contrast study (74230) |
$600.50 |
$1,201 |
3.5× |
| Radiologic exam teeth complete full mouth (70320) |
$265.50 |
$531 |
1.1× |
| Radiologic Exam Teeth Prtl Exam < Full Mouth (70310) |
$265.50 |
$531 |
1.1× |
| Radiologic exam upr gi trc double contrast study (74246) |
$678 |
$1,356 |
4.0× |
| Radiologic examination femur 1 view (73551) |
$241 |
$482 |
2.8× |
| Radiologic examination femur minimum 2 views (73552) |
$306 |
$612 |
3.6× |
| Radiologic examination knee 1/2 views (73560) |
$191.50 |
$383 |
2.3× |
| Radiologic Examination Osseous Survey Limited (77074) |
$355 |
$710 |
3.5× |
| Radiologic examination tibia & fibula 2 views (73590) |
$208 |
$416 |
2.4× |
| Radiologic examination, teeth; single view Non-Facility (70300) |
$153.50 |
$307 |
1.8× |
| Remote afterloading high dose rate radionuclide skin surface brachytherapy, includes basic dosimetry, when performed;… (77768) |
$1,520.50 |
$3,041 |
4.0× |
| Remote afterloading high dose rate radionuclide skin surface brachytherapy, includes basic dosimetry, when performed;… (77767) |
$925 |
$1,850 |
2.5× |
| Renal Cyst Study (74470) |
$390.50 |
$781 |
0.7× |
| Ribs bilateral 3 views (71110) |
$264 |
$528 |
2.6× |
| Rp loclzj tum plnr 1 area single day imaging (78800) |
$544.50 |
$1,089 |
1.4× |
| Rp loclzj tum plnr 2+area 1+d img/1 area img>2+d (78801) |
$655.50 |
$1,311 |
1.7× |
| Rp Loclzj Tum Plnr Whole Body 2+ Days Imaging (78804) |
$2,450 |
$4,900 |
4.6× |
| Rp Loclzj Tum Spect 1 Area Single Day Imaging (78803) |
$2,450 |
$4,900 |
4.6× |
| Rp loclzj tum spect 2 area/sep acquisj img (78831) |
$1,670.50 |
$3,341 |
1.3× |
| Rp loclzj tum spect CT 2area 1d img/1 ar img>2+d (78832) |
$1,670.50 |
$3,341 |
1.2× |
| Rp loclzj tum spect w/CT 1 area/acquisj 1day img (78830) |
$1,670.50 |
$3,341 |
1.3× |
| Rp Ther Radiolbld Monoclonal Antibody IV Infus (79403) |
$700 |
$1,400 |
3.1× |
| Rp Therapy Intravenous Administration (79101) |
$411.50 |
$823 |
1.8× |
| Salivary Gland Imaging Serial Images (78231) |
$510.50 |
$1,021 |
1.3× |
| Scapula (73010) |
$243 |
$486 |
2.4× |
Screening Digital Breast Tomosynthesis Bi (77063)
range across 4 matching MRF lines |
$50–$82.50 |
$100–$165 |
varies |
| Sella turcica (70240) |
$132.50 |
$265 |
1.6× |
| Shoulder 1 view (73020) |
$186.50 |
$373 |
2.2× |
| Shoulder Arthrography (73040) |
$304.50 |
$609 |
0.9× |
| Sialogram (70390) |
$560.50 |
$1,121 |
2.4× |
| Skull less than 4 views (70250) |
$258 |
$516 |
2.5× |
| Special dosimetry (77331) |
$222 |
$444 |
1.7× |
| Special Physics Consult (77370) |
$673.50 |
$1,347 |
5.1× |
| Special teletherapy port plan (77321) |
$713.50 |
$1,427 |
2.0× |
| Special treatment procedure (77470) |
$1,894.50 |
$3,789 |
3.5× |
| Spleen Imaging (78185) |
$381.50 |
$763 |
1.0× |
| Srs Multisource (77371) |
$17,099.50 |
$34,199 |
2.4× |
| Stereotactic Body Radiation Delivery (77373) |
$7,462 |
$14,924 |
4.3× |
| Sternoclavicular joints (71130) |
$297 |
$594 |
3.5× |
| Superior sagittal sinus venogram (75870) |
$1,619.50 |
$3,239 |
0.5× |
| Surface Applic Low Dose Rate Radionuclide Source (77789) |
$107 |
$214 |
1.1× |
| Telethx isodose pln cplx w/basic dosimetry (77307) |
$847 |
$1,694 |
2.3× |
| Telethx isodose pln smpl w/dosimetry calculation (77306) |
$608 |
$1,216 |
1.7× |
| Testicular Imaging W/Flow (78761) |
$828 |
$1,656 |
2.1× |
| Ther Rad Simulaj-Aided Field Setting Complex (77290) |
$1,123 |
$2,246 |
3.1× |
| Ther Rad Simulaj-Aided Field Setting Intermed (77285) |
$956 |
$1,912 |
2.6× |
| Ther rad simulaj-aided field setting simple (77280) |
$590 |
$1,180 |
4.5× |
| Thoracic spine 2 views (72070) |
$178 |
$356 |
1.7× |
| Thoracic spine 3 views (72072) |
$223.50 |
$447 |
2.2× |
| Thoracolumbar 2 views (72080) |
$112.50 |
$225 |
1.3× |
| Thyroid Carcinoma Metastases Img Lmtd Area (78015) |
$413.50 |
$827 |
1.1× |
| Thyroid Imaging With Vascular Flow (78013) |
$903.50 |
$1,807 |
2.3× |
| Thyroid Met Imaging Body (78018) |
$864.50 |
$1,729 |
1.6× |
| Thyroid Uptake Measurement (78012) |
$703.50 |
$1,407 |
1.8× |
| Thyroid Uptake W/Blood Flow Sngle/Mult Quan Meas (78014) |
$926 |
$1,852 |
2.4× |
| Tx Devices Design & Construction Complex (77334) |
$587 |
$1,174 |
1.6× |
| Tx devices design & construction intermediate (77333) |
$432 |
$864 |
3.3× |
| Tx devices design & construction simple (77332) |
$246.50 |
$493 |
1.9× |
| Ultrasound Breast Limited (76642) |
$351.50 |
$703 |
4.1× |
| Ultrasound elastography first target lesion (76982) |
$336.50 |
$673 |
3.3× |
| Ultrasound Elastography Parenchyma (76981) |
$336.50 |
$673 |
3.3× |
| Ultrasound Exam Aaa Screen (76706) |
$302.50 |
$605 |
3.0× |
| Ultrasound trgt dynamic microbubble 1st lesion (76978) |
$687.50 |
$1,375 |
2.0× |
| Ultrasound, abdomen limited (76705) |
$500 |
$1,000 |
4.9× |
| Umbilical-artery Doppler (OB) (76820) |
$411 |
$822 |
4.0× |
| Unlisted magnetic resonance procedure (76498) |
$1,165 |
$2,330 |
13.7× |
| Unlisted us procedure (76999) |
$121 |
$242 |
1.4× |
| Upper gi w/o kub (74240) |
$458.50 |
$917 |
2.7× |
| Urea Breath Test C-14 Isotopic Acquisj Analysis (78267) |
$348.50 |
$697 |
31.5× |
| Ureteral Reflux Study (78740) |
$341.50 |
$683 |
0.9× |
| Urethrocystogram voiding (74455) |
$301 |
$602 |
1.3× |
| Urethrocystography retrograde (74450) |
$313.50 |
$627 |
1.3× |
| Us breast unilateral complete (76641) |
$387 |
$774 |
3.8× |
| Us chest (76604) |
$488 |
$976 |
4.8× |
| Us complete joint (76881) |
$488 |
$976 |
4.8× |
| Us exam, pelvic, limited (76857) |
$322.50 |
$645 |
3.2× |
| Us head (76506) |
$375 |
$750 |
3.7× |
| Us kidney transplant (76776) |
$496.50 |
$993 |
4.9× |
| Us lmtd joint/oth nonvasc xtr strux r-t w/img (76882) |
$90.50 |
$181 |
0.9× |
| Us ob detailed single fetus (76811) |
$551 |
$1,102 |
2.4× |
Us ob limited 1 or more fetuses (76815)
range across 4 matching MRF lines |
$400–$428 |
$800–$856 |
varies |
| Us ob transvaginal (76817) |
$428 |
$856 |
4.2× |
| Us pelvic non ob complete (76856) |
$491.50 |
$983 |
4.8× |
Us pg uter img f&mat 14 wk tabdl 1/1st gestation (76801)
range across 2 matching MRF lines |
$352.50–$377 |
$705–$754 |
varies |
Us preg uterus real time f/u trnsabdl per fetus (76816)
range across 2 matching MRF lines |
$204–$218.50 |
$408–$437 |
varies |
| Us retroperitoneal complete (76770) |
$500 |
$1,000 |
4.9× |
| Us retroperitoneal limited (76775) |
$383 |
$766 |
3.8× |
| Us scrotum and contents (76870) |
$495 |
$990 |
4.9× |
| Us spinal canal and contents (76800) |
$375 |
$750 |
3.7× |
| Us thyroid (76536) |
$454 |
$908 |
4.5× |
| Us transrectal (76872) |
$392 |
$784 |
3.8× |
| Vascular Flow Imaging (78445) |
$303 |
$606 |
0.8× |
| Vasogram (74440) |
$353.50 |
$707 |
1.5× |
| Vein X-Ray Chest (75827) |
$1,622.50 |
$3,245 |
1.1× |
| Vein X-Ray Liver W/O Hemodyn (75887) |
$1,619.50 |
$3,239 |
0.5× |
| Vein X-Ray Spleen/Liver (75810) |
$2,615.50 |
$5,231 |
0.8× |
| Venogram Sinus/Jugular (75860) |
$1,666 |
$3,332 |
0.5× |
| Venography Adrenal Unilateral (75840) |
$3,421.50 |
$6,843 |
1.1× |
| Venography caval inferior serialography rs&i (75825) |
$3,421.50 |
$6,843 |
1.1× |
| Venography extremity bilateral rs&i (75822) |
$765 |
$1,530 |
0.5× |
| Venography extremity unilateral rs&i (75820) |
$765 |
$1,530 |
0.5× |
| Venography Orbital Rs&I (75880) |
$297.50 |
$595 |
0.5× |
| Venography Renal Bilateral (75833) |
$3,421.50 |
$6,843 |
1.1× |
| Venography Renal Unilateral (75831) |
$3,421.50 |
$6,843 |
1.1× |
Venous sampling by catheter (75893)
unusually low: confirm this is the full procedure |
$2,643 |
$5,286 |
0.5× |
| Venous thrombosis imaging (78457) |
$434.50 |
$869 |
0.8× |
| Venous Thrombosis Imaging Venogram Bilateral (78458) |
$645 |
$1,290 |
1.7× |
| Vertebral fracture assessment via dxa (77086) |
$149.50 |
$299 |
1.8× |
| Wrist 2 views (73100) |
$171 |
$342 |
2.0× |
| X-Ray Ac Jts - Xr Acromioclavicular Joints Bilateral (73050) |
$258 |
$516 |
3.0× |
| X-ray antegrade pyelogram tube (74425) |
$375.50 |
$751 |
1.1× |
| X-Ray Aorta Leg Arteries (75630) |
$1,896 |
$3,792 |
0.6× |
| X-Ray Bend Only L-S Spine (72120) |
$283.50 |
$567 |
2.8× |
| X-Ray Elbow 2 Vw - Xr Elbow 1-2 Views Right (73070) |
$162 |
$324 |
1.9× |
| X-Ray Exam Breast Specimen (76098) |
$277 |
$554 |
0.5× |
| X-Ray Exam Entire Spi 1 Vw (72081) |
$145.50 |
$291 |
1.7× |
| X-Ray Exam Entire Spi 2/3 Vw (72082) |
$183 |
$366 |
1.8× |
| X-Ray Exam Entire Spi 4/5 Vw (72083) |
$348.50 |
$697 |
3.4× |
| X-Ray Exam Hip Uni 1 View (73501) |
$154 |
$308 |
1.8× |
| X-Ray Exam Hip Uni 2-3 Views (73502) |
$196 |
$392 |
2.3× |
| X-Ray Exam Hip Uni 4/> Views (73503) |
$277 |
$554 |
2.7× |
| X-Ray Exam Hips Bi 2 Views (73521) |
$214.50 |
$429 |
2.1× |
| X-Ray Exam Hips Bi 3-4 Views (73522) |
$251 |
$502 |
2.5× |
| X-Ray Exam Hips Bi 5/> Views (73523) |
$301 |
$602 |
3.0× |
| X-Ray Exam L-S Spine Bending (72114) |
$353.50 |
$707 |
3.5× |
| X-Ray Exam Neck Spine 2-3 Vw (72040) |
$221 |
$442 |
2.6× |
| X-Ray Exam Neck Spine 6/>Vws (72052) |
$385.50 |
$771 |
3.8× |
| X-Ray Exam Unilat Ribs/Chest (71101) |
$306 |
$612 |
3.0× |
| X-ray eye for foreign body (70030) |
$221 |
$442 |
2.6× |
| X-ray head for orthodontia (70350) |
$121 |
$242 |
1.4× |
| X-ray humerus (73060) |
$198 |
$396 |
2.3× |
| X-ray IV pyelogram (ivp) (74400) |
$531.50 |
$1,063 |
3.1× |
| X-ray IV pyelogram+tomography (74415) |
$662 |
$1,324 |
3.9× |
| X-Ray Jaw <4 Vw - Xr Mandible < 4 Views (70100) |
$161 |
$322 |
1.9× |
| X-Ray Knee Bilat Standing - Xr Knees Anteroposterior Standing Bilat (73565) |
$203 |
$406 |
2.4× |
| X-Ray Lumbar Spine 2/3 Vw - Xr Lumbar Spine 2-3 Views (72100) |
$241 |
$482 |
2.4× |
| X-ray nose-rectum child f.b. (76010) |
$206 |
$412 |
2.4× |
| X-Ray Ribs, Chest 4+ Vw - Xr Ribs 3 Vws Bil W/ Chest Posteroanterior (71111) |
$406.50 |
$813 |
4.0× |
| X-Ray Sacroiliac Jts 3+ Vw - Xr Sacroiliac Joints 3+ Views (72202) |
$264 |
$528 |
2.6× |
X-Ray Sacroiliac Jts <3 Vw - Xr Sacroiliac Joints 1-2 Views (72200)
range across 2 matching MRF lines |
$246.50–$264 |
$493–$528 |
varies |
| X-Ray Sacrum/Coccyx 2+ Vw - Xr Sacrum Coccyx 2+ Views (72220) |
$264 |
$528 |
3.1× |
| X-Ray Sinuses 3+ Vw - Xr Paranasal Sinuses 3+ Views (70220) |
$382.50 |
$765 |
4.5× |
| X-Ray Skull 4+ Vw - Xr Skull Complete 4+ Views (70260) |
$357 |
$714 |
3.5× |
| X-ray thoracic spine 4 vw (72074) |
$270.50 |
$541 |
2.7× |
| X-Ray Tmj Unilat (70328) |
$158.50 |
$317 |
1.9× |
| X-Ray Urinary Tract Exam With Contrast Material (74420) |
$517 |
$1,034 |
1.5× |
| X-Rays Bone Length Studies (77073) |
$140 |
$280 |
1.4× |
| X-Rays Bone Survey Complete (77075) |
$889.50 |
$1,779 |
8.7× |
| Xr c-spine 4 or 5 views (72050) |
$348.50 |
$697 |
3.4× |
| Xr facial bones less than 3 views (70140) |
$221.50 |
$443 |
2.6× |
| XR Mastoids < 3 Views Bilateral (70120) |
$100 |
$200 |
1.0× |
| Xr orbits complete 4 views (70200) |
$350.50 |
$701 |
3.4× |
| Xr Tomogram Single Plane (76100) |
$165.50 |
$331 |
1.6× |