| 3-D radiotherapy plan dose-volume histograms (77295) |
$4,687.10 |
$8,522 |
3.4× |
Abdomen 1 View (74018)
range across 2 matching MRF lines |
$40.92–$189.75 |
$74.40–$345 |
varies |
| Abdomen 2 views (74019) |
$242 |
$440 |
2.3× |
| Acute Gastrointestinal Blood Loss Imaging (78278) |
$591.25 |
$1,075 |
1.5× |
| Adrenal Cortex & Medulla Img (78075) |
$1,286.45 |
$2,339 |
1.0× |
| Angio internal mammary (75756) |
$1,732.50 |
$3,150 |
0.5× |
| Angio pulmonary bilat (75743) |
$2,633.40 |
$4,788 |
0.8× |
| Angiography Adrenal Bilateral Slctv Rs&I (75733) |
$3,396.25 |
$6,175 |
1.1× |
| Angiography extremity bilateral rs&i (75716) |
$2,771.45 |
$5,039 |
0.9× |
| Angiography extremity unilateral rs&i (75710) |
$2,356.20 |
$4,284 |
0.7× |
| Angiography pulmonary unilateral slctv rs&i (75741) |
$2,633.40 |
$4,788 |
0.8× |
| Angrph pulmonary nonslctv cath/ven njx rs&i (75746) |
$1,663.20 |
$3,024 |
0.5× |
Ankle 2 views (73600)
range across 2 matching MRF lines |
$105.05–$195.25 |
$191–$355 |
varies |
| Aortography thoracic serialography rs&i (75605) |
$2,910.05 |
$5,291 |
0.5× |
| Aortography thoracic w/o serialography rs&i (75600) |
$2,633.40 |
$4,788 |
0.8× |
| Artery X-Rays Abdomen (75726) |
$4,088.15 |
$7,433 |
0.7× |
| Artery X-Rays Adrenal Gland (75731) |
$3,320.35 |
$6,037 |
1.0× |
| Artery X-Rays Pelvis (75736) |
$2,910.05 |
$5,291 |
0.5× |
| Artery X-Rays Spine (75705) |
$4,156.90 |
$7,558 |
0.7× |
| Arthrogram ankle (73615) |
$879.45 |
$1,599 |
2.5× |
| Arthrogram hip (73525) |
$693 |
$1,260 |
2.0× |
| Arthrogram Wrist (73115) |
$527.45 |
$959 |
1.5× |
| Basic radiation dosimetry calculation (77300) |
$572 |
$1,040 |
4.2× |
| Bone age studies (77072) |
$223.30 |
$406 |
2.1× |
| Bone Imaging 3 Phase (78315) |
$845.90 |
$1,538 |
2.1× |
| Bone Imaging Limited Area (78300) |
$591.25 |
$1,075 |
1.5× |
| Bone Imaging Multiple Areas (78305) |
$617.65 |
$1,123 |
1.5× |
| Bone Imaging Whole Body (78306) |
$783.75 |
$1,425 |
2.0× |
| Bone marrow imaging; whole body (78104) |
$451 |
$820 |
1.1× |
| Bone survey infant (77076) |
$242.55 |
$441 |
2.3× |
| Brachytx isodose complex (77318) |
$1,776.50 |
$3,230 |
4.7× |
| Brachytx isodose intermed (77317) |
$1,567.50 |
$2,850 |
4.2× |
| Brachytx Isodose Plan Simple (77316) |
$1,463 |
$2,660 |
3.9× |
| Brain Flow Imaging Only (78610) |
$557.70 |
$1,014 |
1.0× |
| Brain Image W/Flow < 4 Views (78601) |
$574.75 |
$1,045 |
1.4× |
| Brain Imaging Min 4 Static Views W Vascular Flow (78606) |
$767.25 |
$1,395 |
1.4× |
| Brain Imaging Minimum 4 Static Views (78605) |
$616.55 |
$1,121 |
1.1× |
| Brain Imaging Pet Metabolic Evaluation (78608) |
$2,455.75 |
$4,465 |
1.7× |
| Cardiac blood pool imaging, first pass technique; multiple studies, resting and with stress (exercise and/or… (78483) |
$1,100 |
$2,000 |
2.0× |
| Cardiac MRI w/w/o contrast & further seq (75561) |
$1,737.45 |
$3,159 |
5.0× |
| Cardiac MRI w/w/o contrast w/stress (75563) |
$1,295.25 |
$2,355 |
1.6× |
| Cat Scan Follow-Up Study (76380) |
$457.60 |
$832 |
5.2× |
| Cerebrospinal Fluid Flow W/O Matl Shunt Evaltj (78645) |
$731.50 |
$1,330 |
1.3× |
| Cerebrospinal fluid flow, imaging (not including introduction of material); ventriculography Non-Facility (78635) |
$714.45 |
$1,299 |
1.3× |
| Cerebrospinal Fluid Scan (78630) |
$767.25 |
$1,395 |
1.4× |
| Chest 1 view (71045) |
$138.60 |
$252 |
1.6× |
| Chest 2 views (71046) |
$201.85 |
$367 |
2.3× |
| Chest 3 views (71047) |
$203.50 |
$370 |
2.3× |
| Chest 4 or more views (71048) |
$211.20 |
$384 |
2.0× |
| Cholecystography Oral Contrast (74290) |
$444.95 |
$809 |
2.5× |
| Cisternography Positive Contrast Rs&I (70015) |
$981.75 |
$1,785 |
1.3× |
| Clavicle complete (73000) |
$223.30 |
$406 |
2.6× |
| Computed Tomography Thorax Lw Dose Lng Ca Scr C- (71271) |
$771.65 |
$1,403 |
7.4× |
| Continuing medical physics consltj pr wk (77336) |
$574.75 |
$1,045 |
4.3× |
| Contrast Exam Abdominl Aorta (75625) |
$2,425.50 |
$4,410 |
0.8× |
Contrast X-Ray Bladder (74430)
range across 2 matching MRF lines |
$253–$395.45 |
$460–$719 |
varies |
| Contrast X-Ray Of Elbow (73085) |
$985.05 |
$1,791 |
2.8× |
| Contrast X-Ray Of Knee Joint (73580) |
$655.05 |
$1,191 |
1.9× |
| Corpora cavernosography (74445) |
$634.15 |
$1,153 |
6.1× |
| CT abdomen and pelvis without and with contrast (74178) |
$2,581.15 |
$4,693 |
7.4× |
| CT abdomen and pelvis without contrast (74176) |
$2,037.75 |
$3,705 |
8.5× |
| CT abdomen w contrast (74160) |
$1,018.60 |
$1,852 |
5.8× |
| CT abdomen w wo contrast (74170) |
$1,222.65 |
$2,223 |
7.0× |
| CT abdomen w/o contrast (74150) |
$815.10 |
$1,482 |
7.8× |
| CT Angio Abdomen and Pelvis (74174) |
$1,222.65 |
$2,223 |
3.5× |
| CT Angio Chest (71275) |
$1,222.65 |
$2,223 |
7.0× |
| CT Angio Head (70496) |
$1,222.65 |
$2,223 |
7.0× |
| CT angio hrt w/3d image (75574) |
$536.80 |
$976 |
1.5× |
| Ct Angio Lwr Extr W/O&W/Dye (73706) |
$1,222.65 |
$2,223 |
7.0× |
| CT Angio Neck (70498) |
$1,018.60 |
$1,852 |
5.8× |
| Ct Angio Upr Extrm W/O&W/Dye (73206) |
$1,222.65 |
$2,223 |
7.0× |
| CT cervical spine w/ contrast (72126) |
$1,018.60 |
$1,852 |
2.9× |
| CT cervical spine w/o contrast (72125) |
$815.10 |
$1,482 |
7.8× |
| CT cervical spine w/wo cont (72127) |
$1,222.65 |
$2,223 |
7.0× |
| CT chest w contrast (71260) |
$1,018.60 |
$1,852 |
5.8× |
| CT chest w/wo contrast (71270) |
$1,222.65 |
$2,223 |
7.0× |
| CT colonography screening (74263) |
$672.65 |
$1,223 |
2.8× |
| CT Colonogrphy Dx Image Postprocess W/Contrast (74262) |
$1,018.60 |
$1,852 |
5.8× |
| CT colonogrphy dx image postprocess w/o contrast (74261) |
$672.65 |
$1,223 |
6.4× |
| CT head/brain with contrast (70460) |
$1,222.65 |
$2,223 |
7.0× |
| CT head/brain without and with contrast (70470) |
$1,426.70 |
$2,594 |
8.1× |
| CT heart contrast eval cardiac structure&morph (75572) |
$624.80 |
$1,136 |
1.8× |
| CT heart no contrast quant eval coronry calcium (75571) |
$88.55 |
$161 |
1.0× |
| CT hrt w/3d image congen (75573) |
$343.20 |
$624 |
1.0× |
| CT iac w contrast (70481) |
$1,018.60 |
$1,852 |
5.8× |
| CT l-spine w&w/o contrast (72133) |
$1,222.65 |
$2,223 |
7.0× |
| CT lower ext w/o (73700) |
$815.10 |
$1,482 |
7.8× |
| CT lower extremity w/contrast material (73701) |
$1,018.60 |
$1,852 |
5.8× |
| CT lumbar spine w contrast (72132) |
$1,018.60 |
$1,852 |
2.9× |
| CT lumbar spine w/o contrast (72131) |
$815.10 |
$1,482 |
7.8× |
| CT maxillofacial w contrast (70487) |
$1,018.60 |
$1,852 |
5.8× |
| CT maxillofacial wo contrast (70486) |
$883.30 |
$1,606 |
8.4× |
| CT neck tissue combo (70492) |
$1,222.65 |
$2,223 |
7.0× |
| Ct Orbit/Ear/Fossa W/O&W/Dye (70482) |
$1,222.65 |
$2,223 |
7.0× |
| CT orbits w/o contrast (70480) |
$883.30 |
$1,606 |
8.4× |
| CT pelvis w&w/o contrast (72194) |
$1,222.65 |
$2,223 |
7.0× |
| CT pelvis w/o contrast (72192) |
$815.10 |
$1,482 |
7.8× |
| CT scan of leg combo (73702) |
$1,562 |
$2,840 |
8.9× |
| CT scans face/jaw combo (70488) |
$1,222.65 |
$2,223 |
7.0× |
| CT soft tissue neck w contrast (70491) |
$1,018.60 |
$1,852 |
5.8× |
| CT soft tissue neck w/o contrast (70490) |
$883.30 |
$1,606 |
8.4× |
| CT thoracic spine w contrast (72129) |
$1,018.60 |
$1,852 |
5.8× |
| CT thoracic spine w/o contrast (72128) |
$815.10 |
$1,482 |
7.8× |
| CT thoracic spine w/wo cont (72130) |
$1,222.65 |
$2,223 |
7.0× |
| CT thorax w/o contrast (71250) |
$815.10 |
$1,482 |
7.8× |
| CT unlisted procedure (76497) |
$407.55 |
$741 |
4.7× |
| CT upper ext wo (73200) |
$815.10 |
$1,482 |
7.8× |
| CT upper extremity w/o & w/contrast material (73202) |
$1,222.65 |
$2,223 |
7.0× |
| CT upper extremity with contrast (73201) |
$1,018.60 |
$1,852 |
2.9× |
| Cta Abdl Aorta&Bi Iliofem W/Contrast&Postp (75635) |
$1,222.65 |
$2,223 |
7.0× |
| Cta Abdomen (74175) |
$1,222.65 |
$2,223 |
7.0× |
| CTA pelvis (72191) |
$1,018.60 |
$1,852 |
5.8× |
| Dacryocystography, nasolacrimal duct, radiological supervision and interpretation Non-Facility (70170) |
$313.50 |
$570 |
1.3× |
| Dilation ureters/urethra rs&i (74485) |
$1,650 |
$3,000 |
0.8× |
| Discography Cerv/Thor Spine (72285) |
$3,406.70 |
$6,194 |
1.7× |
| Diskography lumbar (72295) |
$3,406.70 |
$6,194 |
1.7× |
| Doppler Echo Fetal Puls Spectral F/U/Repeat (76828) |
$323.40 |
$588 |
3.1× |
| Doppler Echo Fetal Spectral Display Complete (76827) |
$431.75 |
$785 |
4.1× |
| Doppler Fetal Mid Cerebral Artery (76821) |
$278.85 |
$507 |
2.7× |
| Dxa Bone Density Axial (77080) |
$256.30 |
$466 |
2.4× |
| Dxa bone density study (77085) |
$147.40 |
$268 |
1.4× |
| Dxa bone density study 1/>sites appendiclr skel (77081) |
$157.30 |
$286 |
1.8× |
| Echo exam of fetal heart (76825) |
$1,007.60 |
$1,832 |
1.8× |
| Echo exam uterus (76831) |
$561 |
$1,020 |
2.3× |
| Echo Guide For Artery Repair (76936) |
$557.70 |
$1,014 |
2.6× |
| Echocardiography, fetal, cardiovascular system, real time with image documentation (2D), with or without M-mode… (76826) |
$503.80 |
$916 |
2.1× |
| Echograp Trans R Pros Study (76873) |
$605 |
$1,100 |
5.8× |
| Esophageal Motility Study (78258) |
$398.75 |
$725 |
1.0× |
| Esophagram (74220) |
$254.10 |
$462 |
1.4× |
| Fetal Biophys Profile W/Nst (76818) |
$371.80 |
$676 |
3.6× |
| Fetal Biophysical Profile W/O Non-Stress Testing (76819) |
$391.60 |
$712 |
3.7× |
| Fetal MRI w/placntl matrnl plvc img sing/1st ges (74712) |
$956.45 |
$1,739 |
4.0× |
| Fluoroscopy up to 1 hr (76000) |
$485.65 |
$883 |
2.0× |
| Follow-Up Angiography (75898) |
$1,385.45 |
$2,519 |
0.4× |
Foot 2 views (73620)
range across 2 matching MRF lines |
$89.65–$179.30 |
$163–$326 |
varies |
Forearm 2 views (73090)
range across 2 matching MRF lines |
$91.85–$183.70 |
$167–$334 |
varies |
| Gastric emptying imaging study (78264) |
$812.90 |
$1,478 |
2.0× |
| Gastric Emptyng Imag Std W/Sm Bwl Transit (78265) |
$880 |
$1,600 |
2.2× |
| Gastroesophageal Reflux Exam (78262) |
$553.85 |
$1,007 |
1.4× |
| Gated Heart Planar Single (78472) |
$1,001 |
$1,820 |
2.5× |
| Gated Heart, Multiple (78473) |
$1,100 |
$2,000 |
2.7× |
| Gstrc Emptng Imag Std W/Sm Bwl Col Trnst Mlt Day (78266) |
$990 |
$1,800 |
1.8× |
Hand 2 views (73120)
range across 2 matching MRF lines |
$91.30–$189.20 |
$166–$344 |
varies |
| Hdr Rdncl Ntrstl/Icav Brchtx (77772) |
$3,787.85 |
$6,887 |
5.4× |
| Hdr Rdncl Ntrstl/Icav Brchtx (77771) |
$3,879.15 |
$7,053 |
5.6× |
| Hdr Rdncl Ntrstl/Icav Brchtx 1 Channel (77770) |
$3,501.85 |
$6,367 |
5.0× |
| Heart first pass single,planar (78481) |
$1,001 |
$1,820 |
1.8× |
| Hepatc Vngrph Wdg/Fr Hemodyn Eval Rs&I (75889) |
$3,048.65 |
$5,543 |
1.0× |
| Hepatc Vngrph Wdg/Fr W/O Hemodyn Eval Rs&I (75891) |
$2,590.50 |
$4,710 |
0.8× |
| Hepatobil Syst Image W/Drug (78227) |
$888.25 |
$1,615 |
1.6× |
| Hepatobiliary System Imaging (78226) |
$815.10 |
$1,482 |
2.0× |
| Ht Musc Image Planar Mult (78454) |
$2,047.65 |
$3,723 |
1.6× |
| Ht Muscle Image Spect Sing (78451) |
$1,923.90 |
$3,498 |
1.5× |
| Hysterosalpingogram (74740) |
$531.30 |
$966 |
2.2× |
| Image fusion (77399) |
$199.10 |
$362 |
1.5× |
| Infant hip ultrasound with hip movement (dynamic) (76885) |
$532.95 |
$969 |
6.1× |
| Infant hip ultrasound, limited static exam (76886) |
$532.95 |
$969 |
6.1× |
| Interstitial radiation source applic complex (77778) |
$2,901.80 |
$5,276 |
4.2× |
| Joint Survey Single View (77077) |
$111.65 |
$203 |
1.1× |
| K Flow/Funct Image Multiple (78709) |
$940.50 |
$1,710 |
1.7× |
| K Flow/Funct Image W/Drug (78708) |
$778.80 |
$1,416 |
1.4× |
| K Flow/Funct Image W/O Drug (78707) |
$767.25 |
$1,395 |
1.4× |
| Kidney Funcj Study Non-Img Radioisotopic Study (78725) |
$349.25 |
$635 |
0.9× |
| Kidney Imaging Morphol (78700) |
$553.85 |
$1,007 |
1.4× |
| Kidney Imaging Morphoogy W/Vascular Flow (78701) |
$563.75 |
$1,025 |
1.4× |
| Knee 3 Views (73562) |
$223.30 |
$406 |
2.6× |
| Leveen/Shunt Patency Exam (78291) |
$459.80 |
$836 |
1.1× |
| Liver & Spleen Imaging Static Only (78215) |
$774.40 |
$1,408 |
1.9× |
| Liver & Spleen Imaging W/Vascular Flow (78216) |
$892.65 |
$1,623 |
2.2× |
| Liver imaging w/vascular flow (78202) |
$1,227.60 |
$2,232 |
2.3× |
| Lung Perf&Ventilat Diferentl (78598) |
$1,014.75 |
$1,845 |
1.9× |
| Lung perfusion differential (78597) |
$950.95 |
$1,729 |
2.4× |
| Lung Ventilat&Perfus Imaging (78582) |
$815.65 |
$1,483 |
1.5× |
| Lung Ventilation Imaging (78579) |
$574.75 |
$1,045 |
1.4× |
| Lymph System Imaging (78195) |
$821.70 |
$1,494 |
1.5× |
| Lymphangiography Extremity Only Bilateral Rs&I (75803) |
$1,205.60 |
$2,192 |
0.8× |
| Lymphangiography extremity only unilateral rs&i (75801) |
$602.80 |
$1,096 |
1.0× |
| Lymphangiography Pelvic/Abdominal Bilateral Rs&I (75807) |
$3,600.30 |
$6,546 |
1.1× |
| Lymphangiography, pelvic/abdominal, unilateral (75805) |
$1,800.15 |
$3,273 |
0.6× |
| Magnetic Image Jaw Joint (70336) |
$1,463 |
$2,660 |
6.1× |
| Mammary ductogram or galactogram multiple (77054) |
$536.25 |
$975 |
2.2× |
| Mammary ductogram or galactogram single (77053) |
$463.10 |
$842 |
1.9× |
| Meckels Divert Exam (78290) |
$591.25 |
$1,075 |
1.5× |
| Mlc imrt design & construction per imrt plan (77338) |
$3,011.80 |
$5,476 |
8.0× |
| Mr safety determination physician/other qhp (76016) |
$97.35 |
$177 |
1.1× |
| Mr safety implant&/fb assmt clin staf 1st 15 min (76014) |
$26.95 |
$49 |
0.9× |
| Mr safety implt electronics prepj supvj phys/qhp (76018) |
$143 |
$260 |
1.5× |
| Mr safety implt pos&/immoblj (76019) |
$143 |
$260 |
2.4× |
| Mr safety med physics xm customization plng&mntr (76017) |
$266.20 |
$484 |
1.1× |
| Mra Head W/O & W/Contrast Material (70546) |
$1,828.75 |
$3,325 |
5.2× |
| MRA head w/o contrast (70544) |
$1,310.65 |
$2,383 |
5.5× |
| MRA head with contrast (70545) |
$1,619.75 |
$2,945 |
4.6× |
| MRA neck w contrast (70548) |
$1,619.75 |
$2,945 |
4.6× |
| Mra Neck W/O &W/Contrast Material (70549) |
$1,725.90 |
$3,138 |
4.9× |
| MRA neck w/o contrast (70547) |
$1,410.75 |
$2,565 |
5.9× |
| MRI abdomen w contrast (74182) |
$1,705 |
$3,100 |
4.9× |
MRI abdomen w/o contrast (74181)
range across 2 matching MRF lines |
$742.50–$1,485 |
$1,350–$2,700 |
varies |
| MRI any jt lower extrem w/contrast material (73722) |
$1,921.70 |
$3,494 |
2.4× |
| MRI any jt lower extrem w/o & w/contrast matrl (73723) |
$1,882.10 |
$3,422 |
5.4× |
| MRI any jt upper extremity w/contrast matrl (73222) |
$1,946.45 |
$3,539 |
2.5× |
| MRI bone marrow blood supply (77084) |
$1,152.80 |
$2,096 |
4.8× |
| MRI brain functional w/o physician admnistration (70554) |
$469.15 |
$853 |
2.0× |
| MRI brain functional w/physician admnistration (70555) |
$361.90 |
$658 |
1.5× |
| MRI Breast W/O Contrast Bilateral (77047) |
$1,567.50 |
$2,850 |
6.6× |
| MRI Breast Without Contrast Material Unilateral (77046) |
$783.75 |
$1,425 |
3.3× |
| MRI cardiac w/o cont stress (75559) |
$1,245.75 |
$2,265 |
2.3× |
| MRI cardiac w/o contrast (75557) |
$987.80 |
$1,796 |
4.1× |
MRI cervical spine w contrast (72142)
range across 2 matching MRF lines |
$1,705–$1,815 |
$3,100–$3,300 |
varies |
| MRI cervical spine w/o cont (72141) |
$1,569.70 |
$2,854 |
6.6× |
MRI chest w/o contrast (71550)
range across 2 matching MRF lines |
$705.65–$1,411.30 |
$1,283–$2,566 |
varies |
| MRI chest with contrast (71551) |
$1,415.15 |
$2,573 |
1.8× |
| MRI chest wo w contrast (71552) |
$2,377.65 |
$4,323 |
6.8× |
| MRI lower extrem oth/thn jt w/contrast matrl (73719) |
$1,705 |
$3,100 |
4.9× |
| MRI lower extrem oth/thn jt w/o & w/contr matr (73720) |
$1,913.45 |
$3,479 |
5.5× |
| MRI lower extrem oth/thn jt w/o contr matrl (73718) |
$1,500.95 |
$2,729 |
6.3× |
| MRI lumbar spine w contrast (72149) |
$1,670.35 |
$3,037 |
4.8× |
| Mri Neck Spine W/O & W/Dye (72156) |
$2,550.90 |
$4,638 |
7.3× |
| MRI orbit face &/neck w/o contrast (70540) |
$1,410.75 |
$2,565 |
5.9× |
| MRI orbit face neck w contrast (70542) |
$1,619.75 |
$2,945 |
4.6× |
| Mri Orbt/Fac/Nck W/O &W/Dye (70543) |
$2,070.20 |
$3,764 |
5.9× |
| MRI pelvis w contrast (72196) |
$1,619.75 |
$2,945 |
4.6× |
| MRI pelvis w/o & w contrast (72197) |
$2,277.55 |
$4,141 |
6.5× |
MRI pelvis w/o contrast (72195)
range across 2 matching MRF lines |
$731.50–$1,410.75 |
$1,330–$2,565 |
varies |
| MRI spectroscopy (76390) |
$1,515.25 |
$2,755 |
17.4× |
| MRI thoracic spine w/o contrast (72146) |
$1,485 |
$2,700 |
6.2× |
| MRI upper extremity oth than jt w/contr matrl (73219) |
$1,705 |
$3,100 |
4.9× |
| MRI upper extremity oth than jt w/o contr matrl (73218) |
$1,608.75 |
$2,925 |
6.7× |
| Mri Uppr Extremity W/O&W/Dye (73220) |
$1,883.75 |
$3,425 |
5.4× |
| MRI, abdomen, combo (74183) |
$2,442 |
$4,440 |
7.0× |
| MRI, dorsal spine combo (72157) |
$2,560.80 |
$4,656 |
7.3× |
| MRI, dorsal spine contrast (72147) |
$1,705 |
$3,100 |
4.9× |
| MRI, joint upper extrem (73221) |
$1,700.05 |
$3,091 |
7.1× |
| MRI, joint upper extrem combo (73223) |
$1,828.75 |
$3,325 |
5.2× |
| MRI, lumbar spine combo (72158) |
$2,474.45 |
$4,499 |
7.1× |
| Myelogram cervical (72240) |
$943.80 |
$1,716 |
1.2× |
| Myelogram Lumbar (72265) |
$943.80 |
$1,716 |
1.2× |
| Myelography thoracic (72255) |
$943.80 |
$1,716 |
1.2× |
| Myelograpy 2/more regions rs&i (72270) |
$1,018.60 |
$1,852 |
1.3× |
| Myocardial Imaging Infarct Avid Planar Qual/Quan (78466) |
$415.25 |
$755 |
1.0× |
| Myocardial Imaging Pet Metabolic Evaluation (78459) |
$1,985.50 |
$3,610 |
1.5× |
| Myocardial imaging, infarct avid, planar; with ejection fraction by first pass technique Non-Facility (78468) |
$569.25 |
$1,035 |
1.0× |
| Myocardial Perfusion Planar 1 Study Rest/Stress (78453) |
$1,353.55 |
$2,461 |
1.0× |
| Myocardial Spect Multiple Studies (78452) |
$2,154.90 |
$3,918 |
1.7× |
| Neck soft tissue (70360) |
$219.45 |
$399 |
2.5× |
| Njx Rp Loclzj Non-Img Probe Study Intravenous (78808) |
$235.40 |
$428 |
0.6× |
| Nm csf leak detection (78650) |
$844.25 |
$1,535 |
0.7× |
| Nm myocard infarct spect (78469) |
$844.25 |
$1,535 |
1.6× |
| Nonvascular Shunt X-Ray (75809) |
$138.05 |
$251 |
1.3× |
| Ntsty modul radthx pln dose-vol histos (77301) |
$7,043.85 |
$12,807 |
5.1× |
| Nuclear Rx Intra-Arterial (79445) |
$261.25 |
$475 |
1.1× |
| Nuclear Rx Oral Admin (79005) |
$731.50 |
$1,330 |
3.1× |
| Ob us nuchal meas 1 gest (76813) |
$262.90 |
$478 |
2.5× |
| Optic foramina (70190) |
$150.70 |
$274 |
1.7× |
| Panoramic X-ray of jaws (70355) |
$157.30 |
$286 |
1.8× |
| Parathyroid imaging w/tomographic spect & CT (78072) |
$767.25 |
$1,395 |
1.4× |
| Parathyroid Planar Imaging (78070) |
$591.25 |
$1,075 |
1.5× |
| Parathyroid planar imaging w/wo subtraction (78071) |
$747.45 |
$1,359 |
1.9× |
| Pelvis 1 or 2 views (72170) |
$183.70 |
$334 |
1.8× |
| Peritoneogram Rs&I (74190) |
$1,023.55 |
$1,861 |
1.9× |
| Pet Image W/Ct Lmtd (78814) |
$2,320.45 |
$4,219 |
1.6× |
| PET image w/CT, full body (78816) |
$2,861.65 |
$5,203 |
2.0× |
| PET imaging CT attenuation skull base mid-thigh (78815) |
$2,535.50 |
$4,610 |
1.8× |
| Prq Transhepatc Portograpy Hemodyn Eval Rs&I (75885) |
$2,590.50 |
$4,710 |
0.8× |
| Pulmonary Perfusion Imaging Particulate (78580) |
$591.25 |
$1,075 |
1.5× |
| Radex Abd Compl Aqt Abd W/S/E/D Views 1 View Ch (74022) |
$316.25 |
$575 |
3.0× |
| Radex abscess/fistula/sinus tract rs&i (76080) |
$594.55 |
$1,081 |
1.1× |
| Radex Ankle Complete Minimum 3 Views (73610) |
$216.15 |
$393 |
2.5× |
| Radex Calcaneus Minimum 2 Views (73650) |
$178.20 |
$324 |
2.0× |
| Radex elbow complete minimum 3 views (73080) |
$229.90 |
$418 |
2.6× |
| Radex Facial Bones Complete Minimum 3 Views (70150) |
$327.80 |
$596 |
3.1× |
Radex fingr minimum 2 views (73140)
range across 2 matching MRF lines |
$85.80–$175.45 |
$156–$319 |
varies |
| Radex foot complete minimum 3 views (73630) |
$215.60 |
$392 |
2.5× |
| Radex Hand Minimum 3 Views (73130) |
$206.25 |
$375 |
2.4× |
| Radex lower extremity infant minimum 2 views (73592) |
$170.50 |
$310 |
2.0× |
| Radex Mastoids Compl Minimum 3 Views PR Side (70130) |
$374 |
$680 |
3.6× |
| Radex Nasal Bones Complete Minimum 3 Views (70160) |
$177.10 |
$322 |
2.0× |
| Radex Pharynx/Larx W/Fluor&/Magnification Tq (70370) |
$259.60 |
$472 |
3.0× |
| Radex Ribs Unilateral 2 Views (71100) |
$229.90 |
$418 |
2.6× |
| Radex shoulder complete minimum 2 views (73030) |
$223.30 |
$406 |
2.6× |
| Radex Sinuses Paransl < 3 Views (70210) |
$193.60 |
$352 |
2.2× |
| Radex sm int w/mlt srl imges via enteroclss tube (74251) |
$672.10 |
$1,222 |
3.8× |
| Radex Spine 1 View Specify Level (72020) |
$144.10 |
$262 |
1.7× |
| Radex Sternum Minimum 2 Views (71120) |
$256.30 |
$466 |
2.9× |
| Radex Temporomandble Jt Opn & Clsd Mouth Bilat (70330) |
$327.80 |
$596 |
3.8× |
Radex Toe Minimum 2 Views (73660)
range across 2 matching MRF lines |
$98.45–$174.90 |
$179–$318 |
varies |
| Radex upper extremity infant minimum 2 views (73092) |
$262.35 |
$477 |
2.5× |
| Radex Wrist Complete Minimum 3 Views (73110) |
$216.70 |
$394 |
2.5× |
| Radex X-Ray Exam Entire Spi 6/> Vw - Xr Entire Spine 6+ Vw (72084) |
$418 |
$760 |
4.0× |
| Radiation Delivery Stereotactic Cranial Linear (77372) |
$13,585 |
$24,700 |
1.8× |
| Radiation treatment delivery level 1 (77402) |
$366.30 |
$666 |
3.6× |
| Radiation treatment delivery level 2 (77407) |
$577.50 |
$1,050 |
1.5× |
| Radiation treatment delivery level 3 (77412) |
$745.25 |
$1,355 |
1.3× |
| Radiolog exam mandible compl minimum 4 views (70110) |
$308.55 |
$561 |
2.9× |
| Radiologic Exam Abdomen 3+ Views - Xr Abdomen 3+ Views (74021) |
$314.60 |
$572 |
3.0× |
| Radiologic exam colon double contrast study (74280) |
$804.65 |
$1,463 |
4.6× |
| Radiologic exam colon single contrast study (74270) |
$460.35 |
$837 |
2.6× |
| Radiologic Exam Esophagus Double Contrast Study (74221) |
$314.60 |
$572 |
1.8× |
| Radiologic exam knee complete 4/more views (73564) |
$256.30 |
$466 |
2.4× |
| Radiologic exam pelvis compl minimum 3 views (72190) |
$282.70 |
$514 |
2.7× |
| Radiologic Exam Small Int Single Contrast Study (74250) |
$336.60 |
$612 |
1.9× |
| Radiologic exam swallow function contrast study (74230) |
$380.05 |
$691 |
2.2× |
| Radiologic exam upr gi trc double contrast study (74246) |
$570.90 |
$1,038 |
3.2× |
| Radiologic examination femur 1 view (73551) |
$135.30 |
$246 |
1.6× |
| Radiologic examination femur minimum 2 views (73552) |
$143 |
$260 |
1.6× |
| Radiologic examination knee 1/2 views (73560) |
$189.75 |
$345 |
2.2× |
| Radiologic Examination Osseous Survey Limited (77074) |
$288.75 |
$525 |
2.8× |
| Radiologic Examination Salivary Gland Calculus (70380) |
$108.90 |
$198 |
1.2× |
Radiologic examination tibia & fibula 2 views (73590)
range across 2 matching MRF lines |
$118.25–$235.95 |
$215–$429 |
varies |
| Renal Cyst Study (74470) |
$1,004.85 |
$1,827 |
1.8× |
| Ribs bilateral 3 views (71110) |
$229.90 |
$418 |
2.2× |
| Rp loclzj tum plnr 1 area single day imaging (78800) |
$711.70 |
$1,294 |
1.8× |
| Rp loclzj tum plnr 2+area 1+d img/1 area img>2+d (78801) |
$783.75 |
$1,425 |
2.0× |
| Rp Loclzj Tum Plnr Whole Body 2+ Days Imaging (78804) |
$1,250.15 |
$2,273 |
2.3× |
| Rp Loclzj Tum Plnr Whole Body Single Day Imaging (78802) |
$1,222.65 |
$2,223 |
2.2× |
| Rp Loclzj Tum Spect 1 Area Single Day Imaging (78803) |
$1,494.35 |
$2,717 |
2.7× |
| Rp loclzj tum spect 2 area/sep acquisj img (78831) |
$2,047.65 |
$3,723 |
1.6× |
| Rp loclzj tum spect CT 2area 1d img/1 ar img>2+d (78832) |
$2,092.20 |
$3,804 |
1.5× |
| Rp loclzj tum spect w/CT 1 area/acquisj 1day img (78830) |
$2,047.65 |
$3,723 |
1.6× |
| Rp Ther Radiolbld Monoclonal Antibody IV Infus (79403) |
$812.90 |
$1,478 |
3.5× |
| Rp Therapy Intravenous Administration (79101) |
$611.05 |
$1,111 |
2.6× |
| Salivary Gland Imaging (78230) |
$303.05 |
$551 |
0.8× |
| Scapula (73010) |
$288.75 |
$525 |
2.8× |
Screening Digital Breast Tomosynthesis Bi (77063)
range across 2 matching MRF lines |
$54.45–$116.05 |
$99–$211 |
varies |
| Sella turcica (70240) |
$179.85 |
$327 |
2.1× |
| Shoulder 1 view (73020) |
$91.85 |
$167 |
1.1× |
| Shoulder Arthrography (73040) |
$672.10 |
$1,222 |
1.9× |
| Sialogram (70390) |
$393.25 |
$715 |
1.6× |
| Skull less than 4 views (70250) |
$249.70 |
$454 |
2.4× |
| Special dosimetry (77331) |
$219.45 |
$399 |
1.6× |
| Special Physics Consult (77370) |
$1,077.45 |
$1,959 |
8.0× |
| Special teletherapy port plan (77321) |
$646.25 |
$1,175 |
1.7× |
| Special treatment procedure (77470) |
$1,829.30 |
$3,326 |
3.3× |
| Spleen Imaging (78185) |
$495.55 |
$901 |
1.2× |
| Stereotactic Body Radiation Delivery (77373) |
$12,148.40 |
$22,088 |
6.8× |
| Sternoclavicular joints (71130) |
$282.70 |
$514 |
3.2× |
| Superior sagittal sinus venogram (75870) |
$1,334.85 |
$2,427 |
0.4× |
| Tbs technical calculation only (77091) |
$110.55 |
$201 |
1.3× |
| Telethx isodose pln cplx w/basic dosimetry (77307) |
$2,083.40 |
$3,788 |
5.6× |
| Telethx isodose pln smpl w/dosimetry calculation (77306) |
$1,463 |
$2,660 |
3.9× |
| Temporomandble Jt Arthrography Rs&I (70332) |
$332.20 |
$604 |
1.4× |
| Testicular Imaging W/Flow (78761) |
$489.50 |
$890 |
1.2× |
| Ther Rad Simulaj-Aided Field Setting Complex (77290) |
$1,881 |
$3,420 |
5.0× |
| Ther Rad Simulaj-Aided Field Setting Intermed (77285) |
$1,149.50 |
$2,090 |
3.1× |
| Ther rad simulaj-aided field setting simple (77280) |
$731.50 |
$1,330 |
5.4× |
| Therapeutic Enema Rdctj Intussusception/Obstrcj (74283) |
$475.20 |
$864 |
2.7× |
| Thoracic spine 2 views (72070) |
$217.25 |
$395 |
2.1× |
| Thoracic spine 3 views (72072) |
$275 |
$500 |
2.6× |
| Thoracolumbar 2 views (72080) |
$209.55 |
$381 |
2.4× |
| Thyroid Carcinoma Metastases Img Lmtd Area (78015) |
$553.85 |
$1,007 |
1.4× |
| Thyroid Imaging With Vascular Flow (78013) |
$448.80 |
$816 |
1.1× |
| Thyroid Met Imaging Body (78018) |
$1,630.20 |
$2,964 |
3.0× |
| Thyroid Uptake Measurement (78012) |
$591.25 |
$1,075 |
1.5× |
| Thyroid Uptake W/Blood Flow Sngle/Mult Quan Meas (78014) |
$679.25 |
$1,235 |
1.7× |
| Tx Devices Design & Construction Complex (77334) |
$1,045 |
$1,900 |
2.8× |
| Tx devices design & construction intermediate (77333) |
$745.80 |
$1,356 |
5.5× |
| Tx devices design & construction simple (77332) |
$482.90 |
$878 |
3.6× |
Ultrasound Breast Limited (76642)
range across 2 matching MRF lines |
$50.82–$518.10 |
$92.40–$942 |
varies |
| Ultrasound elastography first target lesion (76982) |
$245.30 |
$446 |
2.3× |
| Ultrasound Elastography Parenchyma (76981) |
$318.45 |
$579 |
3.0× |
| Ultrasound Exam Aaa Screen (76706) |
$212.30 |
$386 |
2.0× |
| Ultrasound trgt dynamic microbubble 1st lesion (76978) |
$438.90 |
$798 |
1.3× |
| Ultrasound, abdomen limited (76705) |
$567.05 |
$1,031 |
5.4× |
| Umbilical-artery Doppler (OB) (76820) |
$326.15 |
$593 |
3.1× |
Unlisted magnetic resonance procedure (76498)
range across 2 matching MRF lines |
$522.50–$627 |
$950–$1,140 |
varies |
| Unlisted Miscellaneous Px Dx Nuclear Medicine (78999) |
$247.50 |
$450 |
0.6× |
| Unlisted Procedure Clinical Brachytherapy (77799) |
$481.25 |
$875 |
4.7× |
| Unlisted us procedure (76999) |
$321.20 |
$584 |
3.7× |
| Upper gi w/o kub (74240) |
$482.35 |
$877 |
2.7× |
| Urea Breath Test C-14 Isotopic Acquisj Analysis (78267) |
$298.10 |
$542 |
27.0× |
| Urea breath test c-14 isotopic analysis (78268) |
$397.10 |
$722 |
4.2× |
| Urethrocystogram voiding (74455) |
$577.50 |
$1,050 |
2.4× |
| Urethrocystography retrograde (74450) |
$570.90 |
$1,038 |
2.4× |
| Us breast unilateral complete (76641) |
$814 |
$1,480 |
7.8× |
| Us chest (76604) |
$402.05 |
$731 |
3.8× |
| Us complete joint (76881) |
$436.70 |
$794 |
4.2× |
| Us exam, pelvic, limited (76857) |
$405.90 |
$738 |
3.9× |
| Us head (76506) |
$446.60 |
$812 |
4.3× |
| Us kidney transplant (76776) |
$523.05 |
$951 |
5.0× |
| Us lmtd joint/oth nonvasc xtr strux r-t w/img (76882) |
$229.90 |
$418 |
2.2× |
| Us ob detailed single fetus (76811) |
$698.50 |
$1,270 |
2.9× |
| Us ob limited 1 or more fetuses (76815) |
$271.70 |
$494 |
2.6× |
| Us ob transvaginal (76817) |
$401.50 |
$730 |
3.8× |
| Us pelvic non ob complete (76856) |
$604.45 |
$1,099 |
5.8× |
| Us pg uter img f&mat 14 wk tabdl 1/1st gestation (76801) |
$484 |
$880 |
4.6× |
| Us preg uterus real time f/u trnsabdl per fetus (76816) |
$361.35 |
$657 |
3.5× |
| Us retroperitoneal complete (76770) |
$668.25 |
$1,215 |
6.4× |
| Us retroperitoneal limited (76775) |
$471.35 |
$857 |
4.5× |
| Us scrotum and contents (76870) |
$632.50 |
$1,150 |
6.0× |
| Us spinal canal and contents (76800) |
$496.65 |
$903 |
4.7× |
| Us thyroid (76536) |
$526.35 |
$957 |
5.0× |
| Us transrectal (76872) |
$590.70 |
$1,074 |
5.6× |
| Vascular Flow Imaging (78445) |
$553.85 |
$1,007 |
1.4× |
| Vein X-Ray Chest (75827) |
$1,317.25 |
$2,395 |
0.8× |
| Vein X-Ray Liver W/O Hemodyn (75887) |
$1,731.95 |
$3,149 |
0.5× |
| Vein X-Ray Spleen/Liver (75810) |
$2,590.50 |
$4,710 |
0.8× |
| Venogram Sinus/Jugular (75860) |
$1,801.80 |
$3,276 |
0.6× |
| Venography Adrenal Unilateral (75840) |
$1,999.80 |
$3,636 |
0.6× |
| Venography caval inferior serialography rs&i (75825) |
$2,494.80 |
$4,536 |
0.8× |
| Venography extremity bilateral rs&i (75822) |
$2,078.45 |
$3,779 |
1.3× |
| Venography extremity unilateral rs&i (75820) |
$1,039.50 |
$1,890 |
0.7× |
| Venography Renal Bilateral (75833) |
$3,328.60 |
$6,052 |
1.1× |
| Venography Renal Unilateral (75831) |
$2,633.40 |
$4,788 |
0.8× |
| Venous sampling by catheter (75893) |
$3,386.90 |
$6,158 |
0.6× |
| Vertebral fracture assessment via dxa (77086) |
$92.40 |
$168 |
1.1× |
Wrist 2 views (73100)
range across 2 matching MRF lines |
$82.50–$165.55 |
$150–$301 |
varies |
| X-Ray Ac Jts - Xr Acromioclavicular Joints Bilateral (73050) |
$315.15 |
$573 |
3.6× |
| X-ray antegrade pyelogram tube (74425) |
$470.80 |
$856 |
1.3× |
| X-Ray Aorta Leg Arteries (75630) |
$2,633.40 |
$4,788 |
0.8× |
| X-Ray Bend Only L-S Spine (72120) |
$241.45 |
$439 |
2.3× |
X-Ray Elbow 2 Vw - Xr Elbow 1-2 Views Right (73070)
range across 2 matching MRF lines |
$94.05–$188.10 |
$171–$342 |
varies |
| X-Ray Exam Breast Specimen (76098) |
$471.90 |
$858 |
0.9× |
| X-Ray Exam Entire Spi 1 Vw (72081) |
$256.85 |
$467 |
2.9× |
| X-Ray Exam Entire Spi 2/3 Vw (72082) |
$321.20 |
$584 |
3.1× |
| X-Ray Exam Entire Spi 4/5 Vw (72083) |
$385.55 |
$701 |
3.7× |
| X-Ray Exam Hip Uni 1 View (73501) |
$127.60 |
$232 |
1.5× |
| X-Ray Exam Hip Uni 2-3 Views (73502) |
$173.25 |
$315 |
2.0× |
| X-Ray Exam Hip Uni 4/> Views (73503) |
$339.35 |
$617 |
3.2× |
| X-Ray Exam Hips Bi 2 Views (73521) |
$230.45 |
$419 |
2.2× |
| X-Ray Exam Hips Bi 3-4 Views (73522) |
$331.10 |
$602 |
3.2× |
| X-Ray Exam Hips Bi 5/> Views (73523) |
$407 |
$740 |
3.9× |
| X-Ray Exam L-S Spine Bending (72114) |
$482.90 |
$878 |
4.6× |
| X-Ray Exam Neck Spine 2-3 Vw (72040) |
$283.25 |
$515 |
3.2× |
| X-Ray Exam Neck Spine 6/>Vws (72052) |
$504.90 |
$918 |
4.8× |
| X-Ray Exam Unilat Ribs/Chest (71101) |
$235.95 |
$429 |
2.3× |
| X-ray eye for foreign body (70030) |
$197.45 |
$359 |
2.3× |
X-ray humerus (73060)
range across 2 matching MRF lines |
$98.45–$196.90 |
$179–$358 |
varies |
| X-ray IV pyelogram (ivp) (74400) |
$618.75 |
$1,125 |
3.5× |
| X-Ray Jaw <4 Vw - Xr Mandible < 4 Views (70100) |
$268.95 |
$489 |
3.1× |
| X-Ray Knee Bilat Standing - Xr Knees Anteroposterior Standing Bilat (73565) |
$203.50 |
$370 |
2.3× |
| X-Ray Lumbar Spine 2/3 Vw - Xr Lumbar Spine 2-3 Views (72100) |
$276.10 |
$502 |
2.6× |
| X-ray nose-rectum child f.b. (76010) |
$242 |
$440 |
2.8× |
| X-Ray Ribs, Chest 4+ Vw - Xr Ribs 3 Vws Bil W/ Chest Posteroanterior (71111) |
$471.90 |
$858 |
4.5× |
| X-Ray Sacroiliac Jts 3+ Vw - Xr Sacroiliac Joints 3+ Views (72202) |
$218.35 |
$397 |
2.1× |
| X-Ray Sacroiliac Jts <3 Vw - Xr Sacroiliac Joints 1-2 Views (72200) |
$162.25 |
$295 |
1.5× |
| X-Ray Sacrum/Coccyx 2+ Vw - Xr Sacrum Coccyx 2+ Views (72220) |
$229.90 |
$418 |
2.6× |
| X-Ray Sinuses 3+ Vw - Xr Paranasal Sinuses 3+ Views (70220) |
$273.35 |
$497 |
3.1× |
| X-Ray Skull 4+ Vw - Xr Skull Complete 4+ Views (70260) |
$308.55 |
$561 |
2.9× |
| X-ray thoracic spine 4 vw (72074) |
$289.30 |
$526 |
2.8× |
| X-Ray Tmj Unilat (70328) |
$164.45 |
$299 |
1.9× |
| X-Ray Urinary Tract Exam With Contrast Material (74420) |
$600.60 |
$1,092 |
1.7× |
| X-Rays Bone Length Studies (77073) |
$209 |
$380 |
2.0× |
| X-Rays Bone Survey Complete (77075) |
$373.45 |
$679 |
3.6× |
| Xr c-spine 4 or 5 views (72050) |
$411.95 |
$749 |
3.9× |
| Xr facial bones less than 3 views (70140) |
$295.35 |
$537 |
3.4× |
| XR Mastoids < 3 Views Bilateral (70120) |
$338.80 |
$616 |
3.2× |
| Xr myelogram posterior fossa (70010) |
$679.80 |
$1,236 |
1.9× |
| Xr orbits complete 4 views (70200) |
$268.95 |
$489 |
2.6× |
| Xr Tomogram Single Plane (76100) |
$339.90 |
$618 |
3.2× |