| 3-D radiotherapy plan dose-volume histograms (77295) |
$1,771 |
$9,863.87 |
1.0× |
| Abdomen 1 View (74018) |
$111 |
$560.70 |
1.0× |
| Abdomen 2 views (74019) |
$133 |
$1,012.60 |
1.0× |
| Acute Gastrointestinal Blood Loss Imaging (78278) |
$511 |
$2,054.75 |
1.0× |
| Acute venous thrombosis imaging, peptide Non-Facility (78456) |
$1,656 |
$1,932 |
1.0× |
| Adrenal Cortex & Medulla Img (78075) |
$1,656 |
$3,608.04 |
1.0× |
| Angio internal mammary (75756) |
$4,041 |
$7,478.22 |
1.0× |
Angio pulmonary bilat (75743)
range across 3 matching MRF lines |
$4,041 |
$7,478.22–$7,478.26 |
1.0× |
| Angiography Adrenal Bilateral Slctv Rs&I (75733) |
$4,041 |
$7,478.22 |
1.0× |
| Angiography extremity bilateral rs&i (75716) |
$4,041 |
$10,046.80 |
1.0× |
| Angiography extremity unilateral rs&i (75710) |
$4,041 |
$15,900.40 |
1.0× |
| Angiography pulmonary unilateral slctv rs&i (75741) |
$4,041 |
$7,478.22 |
1.0× |
| Angrph pulmonary nonslctv cath/ven njx rs&i (75746) |
$4,041 |
$2,940 |
1.0× |
| Ankle 2 views (73600) |
$111 |
$560.70 |
1.0× |
| Aortography thoracic serialography rs&i (75605) |
$7,121 |
$12,794.90 |
1.0× |
| Aortography thoracic w/o serialography rs&i (75600) |
$4,041 |
$7,478.22 |
1.0× |
| Artery X-Rays Abdomen (75726) |
$7,121 |
$13,129.60 |
1.0× |
| Artery X-Rays Adrenal Gland (75731) |
$4,041 |
$7,565 |
1.0× |
| Artery X-Rays Pelvis (75736) |
$7,121 |
$13,129.60 |
1.0× |
| Artery X-Rays Spine (75705) |
$7,121 |
$21,882.60 |
1.0× |
Arthrogram ankle (73615)
range across 3 matching MRF lines |
$446 |
$1,909.25–$1,918.50 |
1.0× |
| Arthrogram hip (73525) |
$446 |
$1,918.05 |
1.0× |
| Arthrogram Wrist (73115) |
$446 |
$1,584.89 |
1.0× |
| Basic radiation dosimetry calculation (77300) |
$172 |
$851 |
1.0× |
| Bone age studies (77072) |
$133 |
$424 |
1.0× |
| Bone Imaging 3 Phase (78315) |
$511 |
$1,801 |
1.0× |
| Bone Imaging Limited Area (78300) |
$511 |
$868 |
1.0× |
| Bone Imaging Multiple Areas (78305) |
$511 |
$1,006 |
1.0× |
| Bone Imaging Whole Body (78306) |
$511 |
$2,594 |
1.0× |
| Bone marrow imaging limited area (78102) |
$511 |
$1,519.54 |
1.0× |
| Bone marrow imaging; multiple areas (78103) |
$511 |
$1,586 |
1.0× |
| Bone marrow imaging; whole body (78104) |
$511 |
$2,634 |
1.0× |
| Bone survey infant (77076) |
$133 |
$1,049 |
1.0× |
| Brachytx isodose complex (77318) |
$479 |
$842 |
1.0× |
| Brachytx isodose intermed (77317) |
$479 |
$609 |
1.0× |
| Brachytx Isodose Plan Simple (77316) |
$479 |
$458 |
1.0× |
| Brain Flow Imaging Only (78610) |
$694 |
$1,040 |
1.0× |
| Brain Image W/Flow < 4 Views (78601) |
$511 |
$1,040 |
1.0× |
| Brain imaging < 4 static views (78600) |
$511 |
$1,076 |
1.0× |
| Brain Imaging Min 4 Static Views W Vascular Flow (78606) |
$694 |
$1,040 |
1.0× |
| Brain Imaging Minimum 4 Static Views (78605) |
$694 |
$1,921 |
1.0× |
| Brain Imaging Pet Metabolic Evaluation (78608) |
$1,830 |
$5,553 |
1.0× |
| Card Bl Pool Gated Spect Rest Wal Motn Ejct Frct (78494) |
$511 |
$924 |
1.0× |
| Cardiac MRI w/w/o contrast & further seq (75561) |
$446 |
$4,370 |
1.0× |
| Cardiac Shunt Detection (78428) |
$511 |
$1,450 |
1.0× |
| Cat Scan Follow-Up Study (76380) |
$111 |
$2,096 |
1.0× |
| Cerebrospinal Fluid Flow W/O Matl Shunt Evaltj (78645) |
$694 |
$806 |
1.0× |
| Cerebrospinal fluid flow, imaging (not including introduction of material); ventriculography Non-Facility (78635) |
$694 |
$735 |
1.0× |
| Cerebrospinal Fluid Scan (78630) |
$694 |
$2,258 |
1.0× |
| Chest 1 view (71045) |
$111 |
$560.70 |
1.0× |
| Chest 2 views (71046) |
$111 |
$782 |
1.0× |
| Chest 3 views (71047) |
$111 |
$837 |
1.0× |
| Chest 4 or more views (71048) |
$133 |
$837 |
1.0× |
| Cholecystography Oral Contrast (74290) |
$224 |
$1,049 |
1.0× |
| Cineradiograpy/vidradiograpy xcpt where spec (76120) |
$133 |
$707.54 |
1.0× |
| Clavicle complete (73000) |
$111 |
$560.70 |
1.0× |
| Computed Tomography Thorax Lw Dose Lng Ca Scr C- (71271) |
$133 |
$404.90 |
1.0× |
| Continuing medical physics consltj pr wk (77336) |
$172 |
$1,074.92 |
1.0× |
| Contrast Exam Abdominl Aorta (75625) |
$4,041 |
$9,631.53 |
1.0× |
| Contrast X-Ray Bladder (74430) |
$446 |
$1,157.65 |
1.0× |
| Contrast X-Ray Of Elbow (73085) |
$446 |
$1,369.11 |
1.0× |
| Contrast X-Ray Of Knee Joint (73580) |
$446 |
$1,802.44 |
1.0× |
| Contrast Xray Throat/Cerv Esopha (74210) |
$224 |
$315 |
1.0× |
| CT abdomen and pelvis without and with contrast (74178) |
$446 |
$6,059 |
1.0× |
| CT abdomen and pelvis without contrast (74176) |
$305 |
$4,542.73 |
1.0× |
| CT abdomen w contrast (74160) |
$224 |
$4,431 |
1.0× |
| CT abdomen w wo contrast (74170) |
$224 |
$5,018 |
1.0× |
| CT abdomen w/o contrast (74150) |
$133 |
$4,128 |
1.0× |
| CT Angio Abdomen and Pelvis (74174) |
$446 |
$4,543.14 |
1.0× |
| CT Angio Chest (71275) |
$224 |
$5,704 |
1.0× |
| CT Angio Head (70496) |
$224 |
$4,815 |
1.0× |
| CT angio hrt w/3d image (75574) |
$446 |
$1,884.05 |
1.0× |
| Ct Angio Lwr Extr W/O&W/Dye (73706) |
$224 |
$3,726.33 |
1.0× |
| CT Angio Neck (70498) |
$224 |
$4,253 |
1.0× |
| Ct Angio Upr Extrm W/O&W/Dye (73206) |
$224 |
$3,356 |
1.0× |
| CT bone density (77078) |
$111 |
$1,004 |
1.0× |
| CT cervical spine w/ contrast (72126) |
$446 |
$3,472 |
1.0× |
| CT cervical spine w/o contrast (72125) |
$133 |
$1,964 |
1.0× |
| CT cervical spine w/wo cont (72127) |
$224 |
$4,849 |
1.0× |
| CT chest w contrast (71260) |
$224 |
$4,945 |
1.0× |
| CT chest w/wo contrast (71270) |
$224 |
$5,530 |
1.0× |
| CT colonography screening (74263) |
$305 |
$676 |
1.0× |
| CT head/brain with contrast (70460) |
$224 |
$4,325 |
1.0× |
| CT head/brain without and with contrast (70470) |
$224 |
$4,643 |
1.0× |
| CT heart contrast eval cardiac structure&morph (75572) |
$446 |
$1,884.05 |
1.0× |
| CT heart no contrast quant eval coronry calcium (75571) |
$111 |
$432.90 |
1.0× |
| CT hrt w/3d image congen (75573) |
$446 |
$1,884.05 |
1.0× |
| CT iac w contrast (70481) |
$224 |
$3,745 |
1.0× |
| CT l-spine w&w/o contrast (72133) |
$224 |
$4,849 |
1.0× |
| CT lower ext w/o (73700) |
$133 |
$2,502.01 |
1.0× |
| CT lower extremity w/contrast material (73701) |
$224 |
$2,887 |
1.0× |
| CT lumbar spine w contrast (72132) |
$446 |
$5,117 |
1.0× |
CT lumbar spine w/o contrast (72131)
range across 2 matching MRF lines |
$133 |
$2,924–$4,711 |
1.0× |
| CT maxillofacial w contrast (70487) |
$224 |
$4,920 |
1.0× |
| CT maxillofacial wo contrast (70486) |
$133 |
$3,932 |
1.0× |
CT neck tissue combo (70492)
range across 2 matching MRF lines |
$224 |
$3,679.50–$4,082 |
1.0× |
| Ct Orbit/Ear/Fossa W/O&W/Dye (70482) |
$224 |
$3,887.18 |
1.0× |
| CT orbits w/o contrast (70480) |
$133 |
$3,218 |
1.0× |
| CT pelvis w&w/o contrast (72194) |
$224 |
$4,191 |
1.0× |
| CT pelvis w/o contrast (72192) |
$133 |
$3,081 |
1.0× |
| CT scan of leg combo (73702) |
$224 |
$3,210 |
1.0× |
| CT scans face/jaw combo (70488) |
$224 |
$5,117 |
1.0× |
| CT soft tissue neck w contrast (70491) |
$224 |
$3,679.50 |
1.0× |
| CT soft tissue neck w/o contrast (70490) |
$133 |
$3,532 |
1.0× |
CT thoracic spine w contrast (72129)
range across 2 matching MRF lines |
$224 |
$460–$3,335 |
1.0× |
| CT thoracic spine w/o contrast (72128) |
$133 |
$4,711 |
1.0× |
| CT thoracic spine w/wo cont (72130) |
$224 |
$4,849 |
1.0× |
| CT thorax w/o contrast (71250) |
$133 |
$4,643 |
1.0× |
| CT upper ext wo (73200) |
$133 |
$2,505 |
1.0× |
| CT upper extremity w/o & w/contrast material (73202) |
$224 |
$3,385.25 |
1.0× |
| CT upper extremity with contrast (73201) |
$446 |
$3,472.95 |
1.0× |
| Cta Abdl Aorta&Bi Iliofem W/Contrast&Postp (75635) |
$224 |
$7,565 |
1.0× |
| Cta Abdomen (74175) |
$224 |
$5,972 |
1.0× |
| CTA pelvis (72191) |
$224 |
$5,143 |
1.0× |
| Dilation ureters/urethra rs&i (74485) |
$2,675 |
$2,865 |
1.0× |
| Discography Cerv/Thor Spine (72285) |
$2,499 |
$6,440 |
1.0× |
| Diskography lumbar (72295) |
$2,499 |
$4,831.50 |
1.0× |
| Dxa Bone Density Axial (77080) |
$133 |
$766.79 |
1.0× |
| Dxa bone density study 1/>sites appendiclr skel (77081) |
$111 |
$448.85 |
1.0× |
| Echo exam uterus (76831) |
$305 |
$1,148.38 |
1.0× |
| Echo Guide For Artery Repair (76936) |
$276 |
$1,451.16 |
1.0× |
| Echograp Trans R Pros Study (76873) |
$133 |
$1,120 |
1.0× |
| Esophageal Motility Study (78258) |
$511 |
$1,268.72 |
1.0× |
| Esophagram (74220) |
$224 |
$1,815.70 |
1.0× |
| Fetal Biophys Profile W/Nst (76818) |
$133 |
$1,266 |
1.0× |
| Fetal Biophysical Profile W/O Non-Stress Testing (76819) |
$133 |
$875.52 |
1.0× |
Fluoroscopy up to 1 hr (76000)
range across 6 matching MRF lines |
$305 |
$2,075–$2,075.05 |
1.0× |
| Follow-Up Angiography (75898) |
$4,041 |
$2,069 |
1.0× |
| Foot 2 views (73620) |
$111 |
$560.70 |
1.0× |
| Forearm 2 views (73090) |
$111 |
$560.70 |
1.0× |
| Gastric emptying imaging study (78264) |
$511 |
$2,422 |
1.0× |
| Gastric Mucosa Imaging (78261) |
$511 |
$795 |
1.0× |
| Gastroesophageal Reflux Exam (78262) |
$511 |
$2,563.70 |
1.0× |
| Gated Heart Planar Single (78472) |
$511 |
$1,423 |
1.0× |
| Gated Heart, Multiple (78473) |
$511 |
$2,786 |
1.0× |
| Hand 2 views (73120) |
$133 |
$562.55 |
1.0× |
| Hdr Rdncl Ntrstl/Icav Brchtx (77772) |
$891 |
$4,427.50 |
1.0× |
| Hdr Rdncl Ntrstl/Icav Brchtx (77771) |
$891 |
$2,769 |
1.0× |
| Hdr Rdncl Ntrstl/Icav Brchtx 1 Channel (77770) |
$891 |
$2,769 |
1.0× |
| Heart first pass single,planar (78481) |
$694 |
$220 |
1.0× |
| Hepatc Vngrph Wdg/Fr Hemodyn Eval Rs&I (75889) |
$4,041 |
$10,274.20 |
1.0× |
| Hepatc Vngrph Wdg/Fr W/O Hemodyn Eval Rs&I (75891) |
$4,041 |
$7,478.22 |
1.0× |
Hepatobil Syst Image W/Drug (78227)
range across 4 matching MRF lines |
$694 |
$2,126–$2,294.32 |
1.0× |
| Hepatobiliary System Imaging (78226) |
$511 |
$2,294.32 |
1.0× |
| Ht Musc Image Planar Mult (78454) |
$1,656 |
$5,425.63 |
1.0× |
| Ht Muscle Image Spect Sing (78451) |
$1,656 |
$5,425.63 |
1.0× |
| Hysterosalpingogram (74740) |
$305 |
$1,357.71 |
1.0× |
| Infant hip ultrasound with hip movement (dynamic) (76885) |
$111 |
$935 |
1.0× |
| Infant hip ultrasound, limited static exam (76886) |
$111 |
$784.12 |
1.0× |
| Infusion Ivp (74410) |
$224 |
$1,661 |
1.0× |
| Interstitial radiation source applic complex (77778) |
$891 |
$6,438.57 |
1.0× |
| Intracavitary Radiation Source Applic Complex (77763) |
$891 |
$5,214 |
1.0× |
| Intracavitary Radiation Source Applic Intermed (77762) |
$707 |
$2,924.58 |
1.0× |
| Intracavitary radiation source applic simple (77761) |
$707 |
$4,600.93 |
1.0× |
| Joint Survey Single View (77077) |
$133 |
$402.22 |
1.0× |
| K Flow/Funct Image Multiple (78709) |
$694 |
$5,799 |
1.0× |
| K Flow/Funct Image W/Drug (78708) |
$694 |
$3,189 |
1.0× |
| K Flow/Funct Image W/O Drug (78707) |
$694 |
$3,189 |
1.0× |
| Kidney Funcj Study Non-Img Radioisotopic Study (78725) |
$511 |
$1,406 |
1.0× |
| Kidney Imaging Morphol (78700) |
$511 |
$1,454 |
1.0× |
| Kidney Imaging Morphoogy W/Vascular Flow (78701) |
$511 |
$788 |
1.0× |
| Knee 3 Views (73562) |
$111 |
$610.35 |
1.0× |
| Labeled RBC Sequestration Differntl Organ/Tissue (78140) |
$511 |
$2,649 |
1.0× |
| Leveen/Shunt Patency Exam (78291) |
$511 |
$1,524.41 |
1.0× |
| Liver & Spleen Imaging Static Only (78215) |
$511 |
$2,467.43 |
1.0× |
| Liver & Spleen Imaging W/Vascular Flow (78216) |
$511 |
$2,734.82 |
1.0× |
| Liver imaging static only (78201) |
$694 |
$3,608.04 |
1.0× |
| Liver imaging w/vascular flow (78202) |
$694 |
$3,608.04 |
1.0× |
| Lung Perf&Ventilat Diferentl (78598) |
$694 |
$2,474.08 |
1.0× |
| Lung perfusion differential (78597) |
$511 |
$1,582.98 |
1.0× |
Lung Ventilat&Perfus Imaging (78582)
range across 5 matching MRF lines |
$694 |
$2,474.08–$2,747.08 |
1.0× |
| Lung Ventilation Imaging (78579) |
$511 |
$1,582.98 |
1.0× |
| Lymph System Imaging (78195) |
$694 |
$2,300.51 |
1.0× |
| Lymphangiography Extremity Only Bilateral Rs&I (75803) |
$2,014 |
$2,575 |
1.0× |
| Lymphangiography extremity only unilateral rs&i (75801) |
$802 |
$2,126.34 |
1.0× |
Magnetic Image Jaw Joint (70336)
range across 2 matching MRF lines |
$305 |
$3,341–$4,500 |
1.0× |
| Meckels Divert Exam (78290) |
$511 |
$1,321 |
1.0× |
| Mra Head W/O & W/Contrast Material (70546) |
$446 |
$5,145.88 |
1.0× |
| MRA head w/o contrast (70544) |
$305 |
$3,324 |
1.0× |
| MRA head with contrast (70545) |
$446 |
$3,907 |
1.0× |
| MRA neck w contrast (70548) |
$446 |
$4,524 |
1.0× |
| Mra Neck W/O &W/Contrast Material (70549) |
$446 |
$4,524 |
1.0× |
| MRA neck w/o contrast (70547) |
$305 |
$3,324 |
1.0× |
| MRI abdomen w contrast (74182) |
$446 |
$4,656 |
1.0× |
| MRI abdomen w/o contrast (74181) |
$305 |
$3,893 |
1.0× |
| MRI any jt lower extrem w/contrast material (73722) |
$1,003 |
$4,423 |
1.0× |
| MRI any jt lower extrem w/o & w/contrast matrl (73723) |
$446 |
$4,949 |
1.0× |
| MRI any jt upper extremity w/contrast matrl (73222) |
$1,003 |
$6,225.75 |
1.0× |
| MRI bone marrow blood supply (77084) |
$305 |
$3,302 |
1.0× |
| MRI Breast W/O Contrast Bilateral (77047) |
$305 |
$2,613.50 |
1.0× |
| MRI Breast Without Contrast Material Unilateral (77046) |
$305 |
$2,613.50 |
1.0× |
| MRI cardiac w/o contrast (75557) |
$305 |
$3,570 |
1.0× |
| MRI cervical spine w contrast (72142) |
$446 |
$4,684.77 |
1.0× |
| MRI cervical spine w/o cont (72141) |
$305 |
$4,008.14 |
1.0× |
| MRI chest w/o contrast (71550) |
$305 |
$3,531 |
1.0× |
| MRI chest with contrast (71551) |
$1,003 |
$4,965.90 |
1.0× |
| MRI chest wo w contrast (71552) |
$446 |
$4,937.91 |
1.0× |
| MRI lower extrem oth/thn jt w/contrast matrl (73719) |
$446 |
$4,313 |
1.0× |
| MRI lower extrem oth/thn jt w/o & w/contr matr (73720) |
$446 |
$5,140.20 |
1.0× |
| MRI lower extrem oth/thn jt w/o contr matrl (73718) |
$305 |
$3,673 |
1.0× |
| MRI lumbar spine w contrast (72149) |
$446 |
$4,910.65 |
1.0× |
| Mri Neck Spine W/O & W/Dye (72156) |
$446 |
$5,372 |
1.0× |
| MRI orbit face &/neck w/o contrast (70540) |
$305 |
$3,901 |
1.0× |
| MRI orbit face neck w contrast (70542) |
$446 |
$4,673.95 |
1.0× |
| Mri Orbt/Fac/Nck W/O &W/Dye (70543) |
$446 |
$4,524 |
1.0× |
| MRI pelvis w contrast (72196) |
$446 |
$4,611 |
1.0× |
| MRI pelvis w/o & w contrast (72197) |
$446 |
$5,157.34 |
1.0× |
| MRI pelvis w/o contrast (72195) |
$305 |
$3,971.10 |
1.0× |
| MRI thoracic spine w/o contrast (72146) |
$305 |
$3,949.24 |
1.0× |
| MRI upper extremity oth than jt w/contr matrl (73219) |
$446 |
$4,365 |
1.0× |
| MRI upper extremity oth than jt w/o contr matrl (73218) |
$305 |
$3,537 |
1.0× |
| Mri Uppr Extremity W/O&W/Dye (73220) |
$446 |
$4,990.64 |
1.0× |
| MRI, abdomen, combo (74183) |
$446 |
$5,113 |
1.0× |
| MRI, dorsal spine combo (72157) |
$446 |
$5,298 |
1.0× |
| MRI, dorsal spine contrast (72147) |
$446 |
$4,751.89 |
1.0× |
| MRI, joint upper extrem (73221) |
$305 |
$3,324 |
1.0× |
| MRI, joint upper extrem combo (73223) |
$446 |
$5,132.71 |
1.0× |
| MRI, lumbar spine combo (72158) |
$446 |
$5,580 |
1.0× |
| Myelogram cervical (72240) |
$1,003 |
$2,874.65 |
1.0× |
| Myelogram Lumbar (72265) |
$1,003 |
$2,604.90 |
1.0× |
| Myelography thoracic (72255) |
$1,003 |
$3,309 |
1.0× |
| Myelograpy 2/more regions rs&i (72270) |
$1,003 |
$3,249.07 |
1.0× |
| Myocardial Imaging Infarct Avid Planar Qual/Quan (78466) |
$511 |
$1,626 |
1.0× |
| Myocardial Imaging Pet Metabolic Evaluation (78459) |
$1,656 |
$2,576 |
1.0× |
| Myocardial imaging, infarct avid, planar; with ejection fraction by first pass technique Non-Facility (78468) |
$694 |
$924 |
1.0× |
| Myocardial Perfusion Planar 1 Study Rest/Stress (78453) |
$1,656 |
$5,425.63 |
1.0× |
| Myocardial Spect Multiple Studies (78452) |
$1,656 |
$6,404 |
1.0× |
| Neck soft tissue (70360) |
$111 |
$560.70 |
1.0× |
| Nfs/Instlj Radioelmnt Sln 3 Mo Follow-Up Care (77750) |
$493 |
$305 |
1.0× |
| Njx Rp Loclzj Non-Img Probe Study Intravenous (78808) |
$511 |
$1,167.39 |
1.0× |
| Nm csf leak detection (78650) |
$1,656 |
$1,027 |
1.0× |
| Nm myocard infarct spect (78469) |
$694 |
$924 |
1.0× |
| Nm red cell survival study (78130) |
$511 |
$1,853 |
1.0× |
| Nm whole blood volume (78122) |
$694 |
$1,738 |
1.0× |
Nonvascular Shunt X-Ray (75809)
range across 2 matching MRF lines |
$133 |
$559.95–$806 |
1.0× |
| Ntsty modul radthx pln dose-vol histos (77301) |
$1,771 |
$11,115 |
1.0× |
| Nuclear Rx Oral Admin (79005) |
$298 |
$1,886 |
1.0× |
| Ophthalmic Ultrasonic Foreign Body Localization (76529) |
$111 |
$544.85 |
1.0× |
| Ophthalmic ultrasound dx b-scan w/wo a-scan (76512) |
$133 |
$544.85 |
1.0× |
| Optic foramina (70190) |
$111 |
$559.17 |
1.0× |
| Parathyroid Planar Imaging (78070) |
$511 |
$2,027.48 |
1.0× |
| Parathyroid planar imaging w/wo subtraction (78071) |
$511 |
$1,830.65 |
1.0× |
| Pelvis 1 or 2 views (72170) |
$133 |
$1,012.60 |
1.0× |
| Peritoneogram Rs&I (74190) |
$699 |
$1,460.07 |
1.0× |
| Pet Image W/Ct Lmtd (78814) |
$1,830 |
$6,092 |
1.0× |
| PET image w/CT, full body (78816) |
$1,830 |
$4,416 |
1.0× |
| PET imaging CT attenuation skull base mid-thigh (78815) |
$1,830 |
$6,219 |
1.0× |
| Plasma Vol Radiopharm Vol Dilute Spx Mult Smples (78111) |
$1,656 |
$844 |
1.0× |
| Plasma volume, radiopharmaceutical volume-dilution technique (separate procedure); single sampling Non-Facility (78110) |
$1,656 |
$741 |
1.0× |
| Prq Transhepatc Portograpy Hemodyn Eval Rs&I (75885) |
$4,041 |
$7,478.22 |
1.0× |
| Pulmonary Perfusion Imaging Particulate (78580) |
$511 |
$1,831 |
1.0× |
| Radex Abd Compl Aqt Abd W/S/E/D Views 1 View Ch (74022) |
$133 |
$1,012.60 |
1.0× |
| Radex abscess/fistula/sinus tract rs&i (76080) |
$699 |
$1,234.36 |
1.0× |
Radex Ankle Complete Minimum 3 Views (73610)
range across 4 matching MRF lines |
$111 |
$560.70–$632 |
1.0× |
| Radex Calcaneus Minimum 2 Views (73650) |
$111 |
$460.70 |
1.0× |
| Radex elbow complete minimum 3 views (73080) |
$111 |
$632 |
1.0× |
| Radex Facial Bones Complete Minimum 3 Views (70150) |
$133 |
$1,032 |
1.0× |
| Radex fingr minimum 2 views (73140) |
$111 |
$560.70 |
1.0× |
| Radex foot complete minimum 3 views (73630) |
$111 |
$632 |
1.0× |
| Radex Hand Minimum 3 Views (73130) |
$111 |
$632 |
1.0× |
| Radex lower extremity infant minimum 2 views (73592) |
$111 |
$560.70 |
1.0× |
| Radex Mastoids Compl Minimum 3 Views PR Side (70130) |
$133 |
$1,032 |
1.0× |
| Radex Nasal Bones Complete Minimum 3 Views (70160) |
$111 |
$632 |
1.0× |
| Radex Ribs Unilateral 2 Views (71100) |
$111 |
$733 |
1.0× |
| Radex shoulder complete minimum 2 views (73030) |
$111 |
$632 |
1.0× |
| Radex Sinuses Paransl < 3 Views (70210) |
$111 |
$560.70 |
1.0× |
| Radex sm int w/mlt srl imges via enteroclss tube (74251) |
$224 |
$1,412 |
1.0× |
| Radex Spine 1 View Specify Level (72020) |
$111 |
$560.70 |
1.0× |
| Radex Sternum Minimum 2 Views (71120) |
$111 |
$632 |
1.0× |
| Radex Temporomandble Jt Opn & Clsd Mouth Bilat (70330) |
$111 |
$637.65 |
1.0× |
| Radex Toe Minimum 2 Views (73660) |
$111 |
$560.70 |
1.0× |
| Radex upper extremity infant minimum 2 views (73092) |
$133 |
$787.60 |
1.0× |
| Radex Wrist Complete Minimum 3 Views (73110) |
$111 |
$632 |
1.0× |
| Radex X-Ray Exam Entire Spi 6/> Vw - Xr Entire Spine 6+ Vw (72084) |
$133 |
$837 |
1.0× |
| Radiation treatment delivery level 1 (77402) |
$130 |
$437 |
1.0× |
| Radiation treatment delivery level 2 (77407) |
$493 |
$404 |
1.0× |
| Radiation treatment delivery level 3 (77412) |
$707 |
$621 |
1.0× |
| Radiolog exam mandible compl minimum 4 views (70110) |
$133 |
$1,032 |
1.0× |
| Radiologic Exam Abdomen 3+ Views - Xr Abdomen 3+ Views (74021) |
$133 |
$898 |
1.0× |
| Radiologic exam colon double contrast study (74280) |
$224 |
$1,815.70 |
1.0× |
| Radiologic exam colon single contrast study (74270) |
$224 |
$1,815.70 |
1.0× |
| Radiologic exam knee complete 4/more views (73564) |
$133 |
$1,012.60 |
1.0× |
| Radiologic exam pelvis compl minimum 3 views (72190) |
$133 |
$1,012.60 |
1.0× |
| Radiologic Exam Small Int Single Contrast Study (74250) |
$224 |
$1,460 |
1.0× |
| Radiologic exam swallow function contrast study (74230) |
$224 |
$1,012.60 |
1.0× |
Radiologic exam upr gi trc double contrast study (74246)
range across 3 matching MRF lines |
$224 |
$1,209.47–$1,412.20 |
1.0× |
| Radiologic examination femur 1 view (73551) |
$111 |
$560.70 |
1.0× |
| Radiologic examination femur minimum 2 views (73552) |
$111 |
$560.70 |
1.0× |
| Radiologic examination knee 1/2 views (73560) |
$111 |
$560.70 |
1.0× |
| Radiologic Examination Osseous Survey Limited (77074) |
$133 |
$1,292 |
1.0× |
| Radiologic Examination Salivary Gland Calculus (70380) |
$111 |
$368.75 |
1.0× |
| Radiologic examination tibia & fibula 2 views (73590) |
$111 |
$605 |
1.0× |
| Radiologic examination, internal auditory meati, complete Non-Facility (70134) |
$699 |
$1,460 |
1.0× |
| Radiopharmaceutical therapy, by intracavitary administration Non-Facility (79200) |
$298 |
$816 |
1.0× |
| Red Cell Volume Determination Spx 1 Sampling (78120) |
$511 |
$671 |
1.0× |
| Red Cell Volume Determination Spx Mult Samplings (78121) |
$694 |
$844 |
1.0× |
| Renal Cyst Study (74470) |
$699 |
$1,134 |
1.0× |
| Ribs bilateral 3 views (71110) |
$133 |
$1,049 |
1.0× |
| Rp loclzj tum plnr 1 area single day imaging (78800) |
$511 |
$1,933 |
1.0× |
| Rp loclzj tum plnr 2+area 1+d img/1 area img>2+d (78801) |
$511 |
$1,933 |
1.0× |
| Rp Loclzj Tum Plnr Whole Body 2+ Days Imaging (78804) |
$694 |
$6,360.95 |
1.0× |
| Rp Loclzj Tum Plnr Whole Body Single Day Imaging (78802) |
$694 |
$6,360.92 |
1.0× |
| Rp Loclzj Tum Spect 1 Area Single Day Imaging (78803) |
$694 |
$3,608.04 |
1.0× |
| Rp loclzj tum spect 2 area/sep acquisj img (78831) |
$1,656 |
$6,360.95 |
1.0× |
| Rp Therapy Intravenous Administration (79101) |
$298 |
$1,715 |
1.0× |
| Salivary Gland Function Study (78232) |
$511 |
$2,163.04 |
1.0× |
| Salivary Gland Imaging (78230) |
$511 |
$2,126 |
1.0× |
| Salivary Gland Imaging Serial Images (78231) |
$511 |
$2,369 |
1.0× |
| Scapula (73010) |
$133 |
$1,012.60 |
1.0× |
| Sella turcica (70240) |
$111 |
$543 |
1.0× |
| Shoulder 1 view (73020) |
$111 |
$560.70 |
1.0× |
| Shoulder Arthrography (73040) |
$446 |
$1,809.24 |
1.0× |
| Sialogram (70390) |
$305 |
$1,123.47 |
1.0× |
| Skull less than 4 views (70250) |
$133 |
$1,012.60 |
1.0× |
| Special dosimetry (77331) |
$172 |
$882.14 |
1.0× |
| Special Physics Consult (77370) |
$172 |
$1,428.47 |
1.0× |
| Special teletherapy port plan (77321) |
$479 |
$1,842 |
1.0× |
| Special treatment procedure (77470) |
$707 |
$3,749.21 |
1.0× |
| Spleen Imaging (78185) |
$511 |
$1,048.32 |
1.0× |
| Sternoclavicular joints (71130) |
$111 |
$632 |
1.0× |
| Superior sagittal sinus venogram (75870) |
$4,041 |
$2,893.39 |
1.0× |
| Surface Applic Low Dose Rate Radionuclide Source (77789) |
$130 |
$1,016.22 |
1.0× |
| Telethx isodose pln cplx w/basic dosimetry (77307) |
$479 |
$911 |
1.0× |
| Telethx isodose pln smpl w/dosimetry calculation (77306) |
$479 |
$331 |
1.0× |
| Temporomandble Jt Arthrography Rs&I (70332) |
$305 |
$1,676.82 |
1.0× |
| Testicular Imaging W/Flow (78761) |
$511 |
$997 |
1.0× |
| Ther Rad Simulaj-Aided Field Setting Complex (77290) |
$479 |
$2,960.03 |
1.0× |
| Ther Rad Simulaj-Aided Field Setting Intermed (77285) |
$479 |
$2,217.50 |
1.0× |
| Ther rad simulaj-aided field setting simple (77280) |
$172 |
$1,592.66 |
1.0× |
| Therapeutic Enema Rdctj Intussusception/Obstrcj (74283) |
$224 |
$1,341.08 |
1.0× |
| Thoracic spine 2 views (72070) |
$133 |
$1,012.60 |
1.0× |
| Thoracic spine 3 views (72072) |
$133 |
$721.12 |
1.0× |
| Thoracolumbar 2 views (72080) |
$111 |
$837 |
1.0× |
| Thyroid carcinoma metastases imaging; with additional studies (eg, urinary recovery) Non-Facility (78016) |
$511 |
$903 |
1.0× |
| Thyroid Carcinoma Metastases Img Lmtd Area (78015) |
$511 |
$1,933 |
1.0× |
| Thyroid Imaging With Vascular Flow (78013) |
$511 |
$852.90 |
1.0× |
| Thyroid Met Imaging Body (78018) |
$694 |
$2,700.33 |
1.0× |
| Thyroid Uptake Measurement (78012) |
$511 |
$648.20 |
1.0× |
| Thyroid Uptake W/Blood Flow Sngle/Mult Quan Meas (78014) |
$511 |
$1,324.15 |
1.0× |
| Tx Devices Design & Construction Complex (77334) |
$479 |
$1,964 |
1.0× |
| Tx devices design & construction intermediate (77333) |
$172 |
$1,155.93 |
1.0× |
| Tx devices design & construction simple (77332) |
$172 |
$1,014 |
1.0× |
Ultrasound Breast Limited (76642)
range across 3 matching MRF lines |
$111 |
$404.50–$1,274 |
1.0× |
Ultrasound, abdomen limited (76705)
range across 3 matching MRF lines |
$133 |
$1,491.70–$1,952 |
1.0× |
| Umbilical-artery Doppler (OB) (76820) |
$133 |
$630 |
1.0× |
Unlisted Dx Radiographic Procedure (76499)
range across 5 matching MRF lines |
$111 |
$229–$3,077 |
1.0× |
| Unlisted fluoroscopic procedure (76496) |
$111 |
$277 |
1.0× |
| Unlisted Miscellaneous Px Dx Nuclear Medicine (78999) |
$511 |
$489 |
1.0× |
| Unlisted Procedure Clinical Brachytherapy (77799) |
$130 |
$1,930 |
1.0× |
| Unlisted respiratory px dx nuclear medicine (78599) |
$511 |
$1,699 |
1.0× |
| Upper gi w/o kub (74240) |
$224 |
$1,556 |
1.0× |
| Urea Breath Test C-14 Isotopic Acquisj Analysis (78267) |
$11 |
$481.03 |
1.0× |
| Urea breath test c-14 isotopic analysis (78268) |
$94 |
$473.11 |
1.0× |
| Ureteral Reflux Study (78740) |
$511 |
$1,310 |
1.0× |
| Urethrocystogram voiding (74455) |
$305 |
$1,216 |
1.0× |
| Urethrocystography retrograde (74450) |
$305 |
$1,613.95 |
1.0× |
| Us breast unilateral complete (76641) |
$133 |
$1,274 |
1.0× |
Us chest (76604)
range across 3 matching MRF lines |
$133 |
$544.85–$1,145 |
1.0× |
| Us complete joint (76881) |
$133 |
$776 |
1.0× |
Us exam, pelvic, limited (76857)
range across 3 matching MRF lines |
$133 |
$827–$1,491.70 |
1.0× |
| Us head (76506) |
$133 |
$1,168 |
1.0× |
| Us kidney transplant (76776) |
$133 |
$1,224 |
1.0× |
Us lmtd joint/oth nonvasc xtr strux r-t w/img (76882)
range across 3 matching MRF lines |
$133 |
$544.85–$796.39 |
1.0× |
| Us ob detailed single fetus (76811) |
$305 |
$1,409.75 |
1.0× |
Us ob limited 1 or more fetuses (76815)
range across 4 matching MRF lines |
$133 |
$544.85–$760 |
1.0× |
| Us ob transvaginal (76817) |
$133 |
$863 |
1.0× |
| Us pelvic non ob complete (76856) |
$133 |
$1,055 |
1.0× |
| Us pg uter img f&mat 14 wk tabdl 1/1st gestation (76801) |
$133 |
$929 |
1.0× |
| Us preg uterus real time f/u trnsabdl per fetus (76816) |
$133 |
$1,082 |
1.0× |
Us retroperitoneal complete (76770)
range across 3 matching MRF lines |
$133 |
$1,562–$1,632 |
1.0× |
Us retroperitoneal limited (76775)
range across 2 matching MRF lines |
$133 |
$544.85–$1,632 |
1.0× |
| Us scrotum and contents (76870) |
$133 |
$965 |
1.0× |
| Us spinal canal and contents (76800) |
$133 |
$871.50 |
1.0× |
Us thyroid (76536)
range across 3 matching MRF lines |
$133 |
$544.85–$1,055 |
1.0× |
| Us transrectal (76872) |
$133 |
$1,120 |
1.0× |
| Vascular Flow Imaging (78445) |
$511 |
$636 |
1.0× |
| Vein X-Ray Chest (75827) |
$2,014 |
$3,690.65 |
1.0× |
| Vein X-Ray Liver W/O Hemodyn (75887) |
$4,041 |
$3,882.06 |
1.0× |
| Vein X-Ray Skull Epidural (75872) |
$802 |
$3,412 |
1.0× |
| Vein X-Ray Spleen/Liver (75810) |
$4,041 |
$2,187.30 |
1.0× |
| Venogram Sinus/Jugular (75860) |
$4,041 |
$7,478.22 |
1.0× |
| Venography Adrenal Unilateral (75840) |
$4,041 |
$7,478.22 |
1.0× |
| Venography caval inferior serialography rs&i (75825) |
$4,041 |
$7,478.22 |
1.0× |
| Venography extremity bilateral rs&i (75822) |
$2,014 |
$2,948.91 |
1.0× |
| Venography extremity unilateral rs&i (75820) |
$2,014 |
$3,100.05 |
1.0× |
| Venography Orbital Rs&I (75880) |
$802 |
$1,659 |
1.0× |
| Venography Renal Bilateral (75833) |
$4,041 |
$7,478.22 |
1.0× |
| Venography Renal Unilateral (75831) |
$4,041 |
$7,478.22 |
1.0× |
| Venous sampling by catheter (75893) |
$7,121 |
$12,794.90 |
1.0× |
| Venous thrombosis imaging (78457) |
$694 |
$1,652 |
1.0× |
| Venous Thrombosis Imaging Venogram Bilateral (78458) |
$511 |
$603 |
1.0× |
| Vertebral fracture assessment via dxa (77086) |
$111 |
$154 |
1.0× |
| Wrist 2 views (73100) |
$111 |
$560.70 |
1.0× |
| X-Ray Ac Jts - Xr Acromioclavicular Joints Bilateral (73050) |
$111 |
$733 |
1.0× |
| X-ray antegrade pyelogram tube (74425) |
$446 |
$1,654 |
1.0× |
| X-Ray Aorta Leg Arteries (75630) |
$4,041 |
$9,818.61 |
1.0× |
| X-Ray Bend Only L-S Spine (72120) |
$133 |
$1,012.60 |
1.0× |
| X-Ray Elbow 2 Vw - Xr Elbow 1-2 Views Right (73070) |
$111 |
$560.70 |
1.0× |
X-Ray Exam Breast Specimen (76098)
range across 3 matching MRF lines |
$699 |
$1,460.07–$2,515.65 |
1.0× |
| X-Ray Exam Entire Spi 1 Vw (72081) |
$111 |
$955 |
1.0× |
| X-Ray Exam Entire Spi 2/3 Vw (72082) |
$133 |
$1,376 |
1.0× |
| X-Ray Exam Entire Spi 4/5 Vw (72083) |
$133 |
$837.52 |
1.0× |
| X-Ray Exam Hip Uni 1 View (73501) |
$111 |
$560.70 |
1.0× |
| X-Ray Exam Hip Uni 2-3 Views (73502) |
$111 |
$560.70 |
1.0× |
| X-Ray Exam Hip Uni 4/> Views (73503) |
$133 |
$1,012.60 |
1.0× |
| X-Ray Exam Hips Bi 2 Views (73521) |
$133 |
$1,012.60 |
1.0× |
| X-Ray Exam Hips Bi 3-4 Views (73522) |
$133 |
$1,012.60 |
1.0× |
| X-Ray Exam L-S Spine Bending (72114) |
$133 |
$1,661 |
1.0× |
| X-Ray Exam Neck Spine 2-3 Vw (72040) |
$111 |
$632 |
1.0× |
| X-Ray Exam Neck Spine 6/>Vws (72052) |
$133 |
$1,376 |
1.0× |
| X-Ray Exam Unilat Ribs/Chest (71101) |
$133 |
$1,012.60 |
1.0× |
| X-ray eye for foreign body (70030) |
$111 |
$632 |
1.0× |
| X-ray humerus (73060) |
$111 |
$560.70 |
1.0× |
| X-ray IV pyelogram (ivp) (74400) |
$224 |
$2,518 |
1.0× |
| X-ray IV pyelogram+tomography (74415) |
$224 |
$1,815.70 |
1.0× |
| X-Ray Jaw <4 Vw - Xr Mandible < 4 Views (70100) |
$111 |
$632 |
1.0× |
| X-Ray Knee Bilat Standing - Xr Knees Anteroposterior Standing Bilat (73565) |
$111 |
$560.70 |
1.0× |
| X-Ray Lumbar Spine 2/3 Vw - Xr Lumbar Spine 2-3 Views (72100) |
$133 |
$1,012.60 |
1.0× |
| X-ray nose-rectum child f.b. (76010) |
$111 |
$824 |
1.0× |
| X-Ray Ribs, Chest 4+ Vw - Xr Ribs 3 Vws Bil W/ Chest Posteroanterior (71111) |
$133 |
$562.55 |
1.0× |
| X-Ray Sacroiliac Jts 3+ Vw - Xr Sacroiliac Joints 3+ Views (72202) |
$133 |
$1,012.60 |
1.0× |
| X-Ray Sacroiliac Jts <3 Vw - Xr Sacroiliac Joints 1-2 Views (72200) |
$133 |
$1,012.60 |
1.0× |
| X-Ray Sacrum/Coccyx 2+ Vw - Xr Sacrum Coccyx 2+ Views (72220) |
$111 |
$632 |
1.0× |
| X-Ray Sinuses 3+ Vw - Xr Paranasal Sinuses 3+ Views (70220) |
$111 |
$560.70 |
1.0× |
| X-Ray Skull 4+ Vw - Xr Skull Complete 4+ Views (70260) |
$133 |
$1,254 |
1.0× |
| X-ray thoracic spine 4 vw (72074) |
$133 |
$1,012.60 |
1.0× |
| X-Ray Tmj Unilat (70328) |
$111 |
$560.70 |
1.0× |
| X-Ray Urinary Tract Exam With Contrast Material (74420) |
$446 |
$1,898.63 |
1.0× |
X-Rays Bone Length Studies (77073)
range across 3 matching MRF lines |
$133 |
$531.70–$1,032 |
1.0× |
| X-Rays Bone Survey Complete (77075) |
$133 |
$1,268.79 |
1.0× |
| Xr c-spine 4 or 5 views (72050) |
$133 |
$1,032 |
1.0× |
| Xr facial bones less than 3 views (70140) |
$111 |
$632 |
1.0× |
| XR Mastoids < 3 Views Bilateral (70120) |
$133 |
$632 |
1.0× |
| Xr myelogram posterior fossa (70010) |
$446 |
$1,562 |
1.0× |
| Xr orbits complete 4 views (70200) |
$133 |
$1,032 |
1.0× |
| Xr Tomogram Single Plane (76100) |
$133 |
$1,460 |
1.0× |