| 3-D radiotherapy plan dose-volume histograms (77295) |
$6,548.30 |
$11,906 |
4.7× |
| Abdomen 1 View (74018) |
$203.50 |
$370 |
2.3× |
| Abdomen 2 views (74019) |
$242 |
$440 |
2.3× |
| Acute Gastrointestinal Blood Loss Imaging (78278) |
$806.30 |
$1,466 |
2.0× |
| Angio internal mammary (75756) |
$1,384.35 |
$2,517 |
0.4× |
| Angio pulmonary bilat (75743) |
$4,762.45 |
$8,659 |
1.5× |
| Angiography extremity bilateral rs&i (75716) |
$4,401.65 |
$8,003 |
1.4× |
| Angiography extremity unilateral rs&i (75710) |
$2,673 |
$4,860 |
0.8× |
| Angiography pulmonary unilateral slctv rs&i (75741) |
$3,841.20 |
$6,984 |
1.2× |
| Angrph pulmonary nonslctv cath/ven njx rs&i (75746) |
$2,381.50 |
$4,330 |
0.8× |
Ankle 2 views (73600)
range across 2 matching MRF lines |
$139.15–$231 |
$253–$420 |
varies |
| Aortography thoracic serialography rs&i (75605) |
$4,105.75 |
$7,465 |
0.7× |
| Aortography thoracic w/o serialography rs&i (75600) |
$3,734.50 |
$6,790 |
1.2× |
| Artery X-Rays Abdomen (75726) |
$3,309.35 |
$6,017 |
0.6× |
| Artery X-Rays Pelvis (75736) |
$4,378.55 |
$7,961 |
0.8× |
| Artery X-Rays Spine (75705) |
$4,022.70 |
$7,314 |
0.7× |
| Arthrogram hip (73525) |
$921.80 |
$1,676 |
2.6× |
| Arthrogram Wrist (73115) |
$561 |
$1,020 |
1.6× |
| Basic radiation dosimetry calculation (77300) |
$744.15 |
$1,353 |
5.5× |
| Bone age studies (77072) |
$189.20 |
$344 |
1.8× |
| Bone Imaging 3 Phase (78315) |
$1,375 |
$2,500 |
3.4× |
| Bone Imaging Limited Area (78300) |
$550 |
$1,000 |
1.4× |
| Bone Imaging Multiple Areas (78305) |
$825 |
$1,500 |
2.1× |
| Bone Imaging Whole Body (78306) |
$1,045 |
$1,900 |
2.6× |
| Bone marrow imaging limited area (78102) |
$964.70 |
$1,754 |
2.4× |
| Brain Flow Imaging Only (78610) |
$398.20 |
$724 |
0.7× |
| Brain Image W/Flow < 4 Views (78601) |
$385 |
$700 |
1.0× |
| Brain Imaging Min 4 Static Views W Vascular Flow (78606) |
$1,182.50 |
$2,150 |
2.2× |
| Brain Imaging Pet Metabolic Evaluation (78608) |
$3,655.85 |
$6,647 |
2.6× |
| Cardiac MRI w/w/o contrast & further seq (75561) |
$1,612.60 |
$2,932 |
4.6× |
| Cardiac Shunt Detection (78428) |
$537.90 |
$978 |
1.3× |
| Cat Scan Follow-Up Study (76380) |
$563.20 |
$1,024 |
6.5× |
| Cerebrospinal Fluid Flow W/O Matl Shunt Evaltj (78645) |
$381.70 |
$694 |
0.7× |
| Cerebrospinal Fluid Scan (78630) |
$879.45 |
$1,599 |
1.6× |
| Chest 1 view (71045) |
$197.45 |
$359 |
2.3× |
| Chest 2 views (71046) |
$281.60 |
$512 |
3.2× |
| Chest 3 views (71047) |
$363 |
$660 |
4.2× |
| Chest 4 or more views (71048) |
$562.10 |
$1,022 |
5.4× |
| Cisternography Positive Contrast Rs&I (70015) |
$614.35 |
$1,117 |
0.8× |
| Clavicle complete (73000) |
$220 |
$400 |
2.5× |
| Computed Tomography Thorax Lw Dose Lng Ca Scr C- (71271) |
$101.20 |
$184 |
1.0× |
| Continuing medical physics consltj pr wk (77336) |
$1,046.65 |
$1,903 |
7.8× |
| Contrast Exam Abdominl Aorta (75625) |
$4,105.75 |
$7,465 |
1.3× |
| Contrast X-Ray Bladder (74430) |
$631.40 |
$1,148 |
1.8× |
| Contrast X-Ray Of Elbow (73085) |
$686.95 |
$1,249 |
2.0× |
| Contrast X-Ray Of Knee Joint (73580) |
$1,065.35 |
$1,937 |
3.0× |
| CT abdomen and pelvis without and with contrast (74178) |
$2,090 |
$3,800 |
6.0× |
| CT abdomen and pelvis without contrast (74176) |
$1,650 |
$3,000 |
6.9× |
| CT abdomen w contrast (74160) |
$1,375 |
$2,500 |
7.8× |
| CT abdomen w wo contrast (74170) |
$1,595 |
$2,900 |
9.1× |
| CT abdomen w/o contrast (74150) |
$1,155 |
$2,100 |
11.0× |
| CT Angio Abdomen and Pelvis (74174) |
$1,980 |
$3,600 |
5.7× |
| CT Angio Chest (71275) |
$1,210 |
$2,200 |
6.9× |
| CT Angio Head (70496) |
$1,705 |
$3,100 |
9.7× |
| CT angio hrt w/3d image (75574) |
$788.70 |
$1,434 |
2.3× |
| Ct Angio Lwr Extr W/O&W/Dye (73706) |
$1,633.50 |
$2,970 |
9.3× |
| CT Angio Neck (70498) |
$1,320 |
$2,400 |
7.5× |
| Ct Angio Upr Extrm W/O&W/Dye (73206) |
$1,746.25 |
$3,175 |
9.9× |
| CT bone density (77078) |
$895.40 |
$1,628 |
10.3× |
| CT cervical spine w/ contrast (72126) |
$1,571.90 |
$2,858 |
4.5× |
| CT cervical spine w/o contrast (72125) |
$1,045 |
$1,900 |
10.0× |
| CT cervical spine w/wo cont (72127) |
$2,076.80 |
$3,776 |
11.8× |
| CT chest w contrast (71260) |
$1,430 |
$2,600 |
8.1× |
| CT chest w/wo contrast (71270) |
$1,802.35 |
$3,277 |
10.3× |
| CT colonography screening (74263) |
$216.49 |
$393.62 |
0.9× |
| CT Colonogrphy Dx Image Postprocess W/Contrast (74262) |
$462.55 |
$841 |
2.6× |
| CT head/brain with contrast (70460) |
$1,346.95 |
$2,449 |
7.7× |
| CT head/brain without and with contrast (70470) |
$1,684.10 |
$3,062 |
9.6× |
| CT heart contrast eval cardiac structure&morph (75572) |
$512.60 |
$932 |
1.5× |
| CT heart no contrast quant eval coronry calcium (75571) |
$1,295.25 |
$2,355 |
14.9× |
| CT hrt w/3d image congen (75573) |
$440 |
$800 |
1.3× |
| CT iac w contrast (70481) |
$1,234.75 |
$2,245 |
7.0× |
| CT l-spine w&w/o contrast (72133) |
$1,596.10 |
$2,902 |
9.1× |
| CT lower ext w/o (73700) |
$1,100 |
$2,000 |
10.5× |
| CT lower extremity w/contrast material (73701) |
$1,430 |
$2,600 |
8.1× |
| CT lumbar spine w contrast (72132) |
$1,408 |
$2,560 |
4.0× |
| CT lumbar spine w/o contrast (72131) |
$880 |
$1,600 |
8.4× |
| CT maxillofacial w contrast (70487) |
$1,290.85 |
$2,347 |
7.3× |
| CT maxillofacial wo contrast (70486) |
$880 |
$1,600 |
8.4× |
| CT neck tissue combo (70492) |
$1,346.95 |
$2,449 |
7.7× |
| Ct Orbit/Ear/Fossa W/O&W/Dye (70482) |
$1,413.50 |
$2,570 |
8.0× |
| CT orbits w/o contrast (70480) |
$770 |
$1,400 |
7.4× |
| CT pelvis w&w/o contrast (72194) |
$1,668.70 |
$3,034 |
9.5× |
| CT pelvis w/o contrast (72192) |
$1,126.40 |
$2,048 |
10.8× |
| CT scan of leg combo (73702) |
$1,854.05 |
$3,371 |
10.6× |
| CT scans face/jaw combo (70488) |
$1,796.30 |
$3,266 |
10.2× |
| CT soft tissue neck w contrast (70491) |
$1,100 |
$2,000 |
6.3× |
| CT soft tissue neck w/o contrast (70490) |
$898.15 |
$1,633 |
8.6× |
| CT thoracic spine w contrast (72129) |
$1,576.85 |
$2,867 |
9.0× |
| CT thoracic spine w/o contrast (72128) |
$935 |
$1,700 |
8.9× |
| CT thoracic spine w/wo cont (72130) |
$1,858.45 |
$3,379 |
10.6× |
| CT thorax w/o contrast (71250) |
$1,100 |
$2,000 |
10.5× |
| CT upper ext wo (73200) |
$990 |
$1,800 |
9.5× |
| CT upper extremity w/o & w/contrast material (73202) |
$1,493.80 |
$2,716 |
8.5× |
| CT upper extremity with contrast (73201) |
$1,265 |
$2,300 |
3.6× |
| Cta Abdl Aorta&Bi Iliofem W/Contrast&Postp (75635) |
$1,320 |
$2,400 |
7.5× |
| Cta Abdomen (74175) |
$1,351.90 |
$2,458 |
7.7× |
| CTA pelvis (72191) |
$1,802.35 |
$3,277 |
10.3× |
| Dilation ureters/urethra rs&i (74485) |
$1,262.80 |
$2,296 |
0.6× |
| Diskography lumbar (72295) |
$1,026.30 |
$1,866 |
0.5× |
| Dxa Bone Density Axial (77080) |
$291.50 |
$530 |
2.8× |
| Dxa bone density study (77085) |
$1,032.35 |
$1,877 |
9.9× |
| Dxa bone density study 1/>sites appendiclr skel (77081) |
$67.10 |
$122 |
0.8× |
| Echograp Trans R Pros Study (76873) |
$1,521.30 |
$2,766 |
14.5× |
| Esophageal Motility Study (78258) |
$539.55 |
$981 |
1.3× |
| Esophagram (74220) |
$275 |
$500 |
1.6× |
| Fetal MRI w/placntl matrnl plvc img sing/1st ges (74712) |
$3,026.65 |
$5,503 |
12.7× |
Fluoroscopy up to 1 hr (76000)
range across 2 matching MRF lines |
$817.85–$921.80 |
$1,487–$1,676 |
varies |
| Follow-Up Angiography (75898) |
$1,172.60 |
$2,132 |
0.4× |
Foot 2 views (73620)
range across 2 matching MRF lines |
$136.95–$176 |
$249–$320 |
varies |
Forearm 2 views (73090)
range across 2 matching MRF lines |
$121–$220 |
$220–$400 |
varies |
| Gastric emptying imaging study (78264) |
$1,035.10 |
$1,882 |
2.6× |
| Gastric Emptyng Imag Std W/Sm Bwl Transit (78265) |
$1,035.10 |
$1,882 |
2.6× |
| Gastroesophageal Reflux Exam (78262) |
$1,522.95 |
$2,769 |
3.8× |
| Gated Heart Planar Single (78472) |
$860.20 |
$1,564 |
2.1× |
| Gated Heart, Multiple (78473) |
$2,371.60 |
$4,312 |
5.9× |
| Gstrc Emptng Imag Std W/Sm Bwl Col Trnst Mlt Day (78266) |
$1,236.40 |
$2,248 |
2.3× |
Hand 2 views (73120)
range across 2 matching MRF lines |
$63.25–$190.85 |
$115–$347 |
varies |
| Heart Image (Pet) Multiple (78492) |
$2,312.20 |
$4,204 |
1.6× |
| Hepatc Vngrph Wdg/Fr Hemodyn Eval Rs&I (75889) |
$4,692.60 |
$8,532 |
1.5× |
| Hepatc Vngrph Wdg/Fr W/O Hemodyn Eval Rs&I (75891) |
$3,854.40 |
$7,008 |
1.2× |
| Hepatobil Syst Image W/Drug (78227) |
$2,150.50 |
$3,910 |
4.0× |
| Hepatobiliary System Imaging (78226) |
$1,881.55 |
$3,421 |
4.7× |
| Ht Musc Image Planar Mult (78454) |
$2,174.70 |
$3,954 |
1.7× |
| Ht Muscle Image Spect Sing (78451) |
$2,035 |
$3,700 |
1.6× |
| Image fusion (77399) |
$314.05 |
$571 |
2.3× |
| Joint Survey Single View (77077) |
$151.25 |
$275 |
1.4× |
| K Flow/Funct Image W/Drug (78708) |
$1,666.50 |
$3,030 |
3.1× |
| K Flow/Funct Image W/O Drug (78707) |
$1,344.20 |
$2,444 |
2.5× |
| Kidney Funcj Study Non-Img Radioisotopic Study (78725) |
$645.15 |
$1,173 |
1.6× |
| Kidney Imaging Morphol (78700) |
$539.55 |
$981 |
1.3× |
| Knee 3 Views (73562) |
$269.50 |
$490 |
3.1× |
| Leveen/Shunt Patency Exam (78291) |
$515.90 |
$938 |
1.3× |
| Liver & Spleen Imaging Static Only (78215) |
$591.25 |
$1,075 |
1.5× |
| Liver imaging static only (78201) |
$1,876.60 |
$3,412 |
3.5× |
| Lung Perf&Ventilat Diferentl (78598) |
$789.80 |
$1,436 |
1.5× |
| Lung perfusion differential (78597) |
$752.40 |
$1,368 |
1.9× |
| Lung Ventilat&Perfus Imaging (78582) |
$1,129.15 |
$2,053 |
2.1× |
| Lung Ventilation Imaging (78579) |
$766.15 |
$1,393 |
1.9× |
| Lymph System Imaging (78195) |
$1,045 |
$1,900 |
1.9× |
| Lymphangiography Extremity Only Bilateral Rs&I (75803) |
$975.70 |
$1,774 |
0.6× |
| Lymphangiography Pelvic/Abdominal Bilateral Rs&I (75807) |
$4,441.80 |
$8,076 |
1.4× |
| Magnetic Image Jaw Joint (70336) |
$1,774.30 |
$3,226 |
7.4× |
| Magnetic resonance (eg, proton) imaging, brain (including brain stem andskull base), during open intracranial procedure… (70558) |
$591.25 |
$1,075 |
3.4× |
| Magnetic resonance (eg, proton) imaging, brain (including brain stem andskull base), during open intracranial procedure… (70557) |
$422.40 |
$768 |
0.8× |
| Magnetic resonance (eg, proton) imaging, brain (including brain stem andskull base), during open intracranial procedure… (70559) |
$645.15 |
$1,173 |
3.7× |
| Magnetic Resonance Elastography (76391) |
$182.05 |
$331 |
0.8× |
| Mammary ductogram or galactogram single (77053) |
$891.55 |
$1,621 |
3.7× |
| Meckels Divert Exam (78290) |
$1,505.35 |
$2,737 |
3.8× |
| Medical physics dose eval radiation expos w/rprt (76145) |
$283.25 |
$515 |
0.8× |
| Mlc imrt design & construction per imrt plan (77338) |
$1,570.25 |
$2,855 |
4.2× |
| Mra Head W/O & W/Contrast Material (70546) |
$2,530 |
$4,600 |
7.2× |
| MRA head w/o contrast (70544) |
$1,375 |
$2,500 |
5.8× |
| MRA head with contrast (70545) |
$1,889.25 |
$3,435 |
5.4× |
| MRA neck w contrast (70548) |
$1,935.45 |
$3,519 |
5.5× |
| Mra Neck W/O &W/Contrast Material (70549) |
$2,204.40 |
$4,008 |
6.3× |
| MRA neck w/o contrast (70547) |
$1,666.50 |
$3,030 |
7.0× |
| MRI abdomen w contrast (74182) |
$1,935.45 |
$3,519 |
5.5× |
| MRI abdomen w/o contrast (74181) |
$1,398.10 |
$2,542 |
5.9× |
| MRI any jt lower extrem w/contrast material (73722) |
$1,666.50 |
$3,030 |
2.1× |
| MRI any jt lower extrem w/o & w/contrast matrl (73723) |
$1,935.45 |
$3,519 |
5.5× |
| MRI any jt upper extremity w/contrast matrl (73222) |
$1,980 |
$3,600 |
2.5× |
| MRI bone marrow blood supply (77084) |
$354.75 |
$645 |
1.5× |
| MRI brain functional w/o physician admnistration (70554) |
$1,559.25 |
$2,835 |
6.5× |
| MRI Breast W/O Contrast Bilateral (77047) |
$366.85 |
$667 |
1.5× |
| MRI Breast Without Contrast Material Unilateral (77046) |
$183.15 |
$333 |
0.8× |
| MRI cardiac w/o contrast (75557) |
$699.05 |
$1,271 |
2.9× |
| MRI cervical spine w contrast (72142) |
$2,200 |
$4,000 |
6.3× |
| MRI cervical spine w/o cont (72141) |
$1,430 |
$2,600 |
6.0× |
| MRI chest w/o contrast (71550) |
$1,666.50 |
$3,030 |
7.0× |
| MRI chest with contrast (71551) |
$2,221.45 |
$4,039 |
2.8× |
| MRI chest wo w contrast (71552) |
$2,795.65 |
$5,083 |
8.0× |
| MRI lower extrem oth/thn jt w/contrast matrl (73719) |
$2,035 |
$3,700 |
5.8× |
| MRI lower extrem oth/thn jt w/o & w/contr matr (73720) |
$2,207.15 |
$4,013 |
6.3× |
| MRI lower extrem oth/thn jt w/o contr matrl (73718) |
$1,485 |
$2,700 |
6.2× |
| MRI lumbar spine w contrast (72149) |
$1,791.90 |
$3,258 |
5.1× |
| Mri Neck Spine W/O & W/Dye (72156) |
$2,530 |
$4,600 |
7.2× |
| MRI orbit face &/neck w/o contrast (70540) |
$1,720.40 |
$3,128 |
7.2× |
| MRI orbit face neck w contrast (70542) |
$1,989.35 |
$3,617 |
5.7× |
| Mri Orbt/Fac/Nck W/O &W/Dye (70543) |
$2,311.65 |
$4,203 |
6.6× |
| MRI pelvis w contrast (72196) |
$1,989.35 |
$3,617 |
5.7× |
| MRI pelvis w/o & w contrast (72197) |
$2,311.65 |
$4,203 |
6.6× |
MRI pelvis w/o contrast (72195)
range across 2 matching MRF lines |
$880–$1,720.40 |
$1,600–$3,128 |
varies |
| MRI spectroscopy (76390) |
$1,720.40 |
$3,128 |
19.7× |
| MRI thoracic spine w/o contrast (72146) |
$1,398.10 |
$2,542 |
5.9× |
| MRI upper extremity oth than jt w/contr matrl (73219) |
$1,989.35 |
$3,617 |
5.7× |
| MRI upper extremity oth than jt w/o contr matrl (73218) |
$1,666.50 |
$3,030 |
7.0× |
| Mri Uppr Extremity W/O&W/Dye (73220) |
$2,204.40 |
$4,008 |
6.3× |
| MRI, abdomen, combo (74183) |
$2,849.55 |
$5,181 |
8.2× |
| MRI, dorsal spine combo (72157) |
$2,472.80 |
$4,496 |
7.1× |
| MRI, dorsal spine contrast (72147) |
$1,935.45 |
$3,519 |
5.5× |
| MRI, joint upper extrem (73221) |
$1,430 |
$2,600 |
6.0× |
| MRI, joint upper extrem combo (73223) |
$2,310 |
$4,200 |
6.6× |
| MRI, lumbar spine combo (72158) |
$2,530 |
$4,600 |
7.2× |
| Myelogram cervical (72240) |
$1,739.65 |
$3,163 |
2.2× |
| Myelogram Lumbar (72265) |
$1,739.65 |
$3,163 |
2.2× |
| Myelography thoracic (72255) |
$1,391.50 |
$2,530 |
1.8× |
| Myelograpy 2/more regions rs&i (72270) |
$2,659.25 |
$4,835 |
3.4× |
| Myocardial Imaging Infarct Avid Planar Qual/Quan (78466) |
$460.90 |
$838 |
1.2× |
| Myocardial Imaging Pet Metabolic Evaluation (78459) |
$2,979.90 |
$5,418 |
2.3× |
| Myocardial Perfusion Planar 1 Study Rest/Stress (78453) |
$2,045.45 |
$3,719 |
1.6× |
| Myocardial Spect Multiple Studies (78452) |
$3,245 |
$5,900 |
2.5× |
| Myocrd Img Pet Metab Eval Single Study Cncrnt CT (78429) |
$3,408.35 |
$6,197 |
2.4× |
| Myocrd img PET prfuj 1std rest/stress cncrnt CT (78430) |
$1,856.25 |
$3,375 |
1.3× |
| Myocrd Img Pet Prfuj Mlt Std Rst&Strs Cncrnt CT (78431) |
$3,055.25 |
$5,555 |
1.4× |
| Myocrd Img Pet Prfuj W/Metab 2rtracer Cncrnt CT (78433) |
$2,826.45 |
$5,139 |
1.3× |
| Myocrd Img Pet Prfuj W/Metab Dual Radiotracer (78432) |
$2,826.45 |
$5,139 |
1.9× |
| N-invas est c ffr sw aly CTA (75580) |
$1,631.85 |
$2,967 |
1.9× |
| Neck soft tissue (70360) |
$212.30 |
$386 |
2.4× |
| Nm myocard infarct spect (78469) |
$494.45 |
$899 |
0.9× |
| Nonvascular Shunt X-Ray (75809) |
$179.30 |
$326 |
1.7× |
| Ntsty modul radthx pln dose-vol histos (77301) |
$7,722 |
$14,040 |
5.6× |
| Nuclear Rx Intra-Arterial (79445) |
$537.90 |
$978 |
2.3× |
| Nuclear Rx Oral Admin (79005) |
$1,505.35 |
$2,737 |
6.4× |
| Oph bmtry us echograpy a-scan io lens pwr cal (76519) |
$81.18 |
$147.60 |
0.8× |
| Oph us dx ant sgm us immersion b-scan/hr biom (76513) |
$112.86 |
$205.20 |
1.1× |
| Ophthalmic ultrasound dx b-scan w/wo a-scan (76512) |
$105.60 |
$192 |
1.0× |
| Ophthalmic US Dx Corneal Pachymetry Uni/Bi (76514) |
$3.30 |
$6 |
0.1× |
| Ophthalmic us dx quantitative a-scan only (76511) |
$86.61 |
$157.47 |
0.8× |
| Panoramic X-ray of jaws (70355) |
$212.85 |
$387 |
2.4× |
| Parathyroid imaging w/tomographic spect & CT (78072) |
$1,021.35 |
$1,857 |
1.9× |
| Parathyroid Planar Imaging (78070) |
$806.30 |
$1,466 |
2.0× |
| Parathyroid planar imaging w/wo subtraction (78071) |
$860.20 |
$1,564 |
2.1× |
| Pelvis 1 or 2 views (72170) |
$236.50 |
$430 |
2.3× |
| Peritoneogram Rs&I (74190) |
$239.25 |
$435 |
0.4× |
| Pet Image Skull-Thigh (78812) |
$5,732.65 |
$10,423 |
4.0× |
| Pet Image W/Ct Lmtd (78814) |
$3,025 |
$5,500 |
2.1× |
| PET image w/CT, full body (78816) |
$4,070 |
$7,400 |
2.8× |
| PET imaging CT attenuation skull base mid-thigh (78815) |
$3,740 |
$6,800 |
2.6× |
| Pet Myocardial Sngl Study (78491) |
$1,482.80 |
$2,696 |
1.0× |
| PET whole body (78813) |
$5,732.65 |
$10,423 |
4.0× |
| Prq Transhepatc Portograpy Hemodyn Eval Rs&I (75885) |
$3,267.55 |
$5,941 |
1.0× |
| Pulmonary Perfusion Imaging Particulate (78580) |
$1,075.25 |
$1,955 |
2.7× |
| Radex Abd Compl Aqt Abd W/S/E/D Views 1 View Ch (74022) |
$338.80 |
$616 |
3.2× |
| Radex abscess/fistula/sinus tract rs&i (76080) |
$660 |
$1,200 |
1.2× |
| Radex Ankle Complete Minimum 3 Views (73610) |
$304.70 |
$554 |
3.5× |
| Radex Calcaneus Minimum 2 Views (73650) |
$192.50 |
$350 |
2.2× |
| Radex elbow complete minimum 3 views (73080) |
$298.10 |
$542 |
3.4× |
| Radex Facial Bones Complete Minimum 3 Views (70150) |
$437.25 |
$795 |
4.2× |
| Radex fingr minimum 2 views (73140) |
$187 |
$340 |
2.1× |
| Radex foot complete minimum 3 views (73630) |
$242 |
$440 |
2.8× |
| Radex Hand Minimum 3 Views (73130) |
$253 |
$460 |
2.9× |
| Radex Mastoids Compl Minimum 3 Views PR Side (70130) |
$336.60 |
$612 |
3.2× |
| Radex Nasal Bones Complete Minimum 3 Views (70160) |
$291.50 |
$530 |
3.3× |
| Radex Ribs Unilateral 2 Views (71100) |
$229.90 |
$418 |
2.6× |
| Radex shoulder complete minimum 2 views (73030) |
$247.50 |
$450 |
2.8× |
| Radex Sinuses Paransl < 3 Views (70210) |
$268.95 |
$489 |
3.1× |
| Radex sm int w/mlt srl imges via enteroclss tube (74251) |
$376.20 |
$684 |
2.1× |
| Radex Spine 1 View Specify Level (72020) |
$263.45 |
$479 |
3.0× |
| Radex Sternum Minimum 2 Views (71120) |
$151.25 |
$275 |
1.7× |
| Radex Temporomandble Jt Opn & Clsd Mouth Bilat (70330) |
$268.95 |
$489 |
3.1× |
| Radex Toe Minimum 2 Views (73660) |
$212.85 |
$387 |
2.4× |
| Radex Wrist Complete Minimum 3 Views (73110) |
$275 |
$500 |
3.2× |
| Radex X-Ray Exam Entire Spi 6/> Vw - Xr Entire Spine 6+ Vw (72084) |
$448.80 |
$816 |
4.3× |
| Radiation Delivery Stereotactic Cranial Linear (77372) |
$21,459.90 |
$39,018 |
2.9× |
| Radiation treatment delivery level 1 (77402) |
$475.20 |
$864 |
4.7× |
| Radiation treatment delivery level 2 (77407) |
$926.75 |
$1,685 |
2.4× |
| Radiation treatment delivery level 3 (77412) |
$1,069.20 |
$1,944 |
1.9× |
| Radiolog exam mandible compl minimum 4 views (70110) |
$448.80 |
$816 |
4.3× |
| Radiologic Exam Abdomen 3+ Views - Xr Abdomen 3+ Views (74021) |
$312.40 |
$568 |
3.0× |
| Radiologic exam colon double contrast study (74280) |
$459.25 |
$835 |
2.6× |
| Radiologic exam colon single contrast study (74270) |
$413.05 |
$751 |
2.4× |
| Radiologic Exam Esophagus Double Contrast Study (74221) |
$574.20 |
$1,044 |
3.3× |
| Radiologic exam knee complete 4/more views (73564) |
$335.50 |
$610 |
3.2× |
| Radiologic exam pelvis compl minimum 3 views (72190) |
$342.10 |
$622 |
3.3× |
| Radiologic Exam Small Int Single Contrast Study (74250) |
$310.20 |
$564 |
1.8× |
| Radiologic exam swallow function contrast study (74230) |
$368.50 |
$670 |
2.1× |
| Radiologic exam upr gi trc double contrast study (74246) |
$574.20 |
$1,044 |
3.3× |
| Radiologic examination femur 1 view (73551) |
$220 |
$400 |
2.5× |
| Radiologic examination femur minimum 2 views (73552) |
$247.50 |
$450 |
2.8× |
| Radiologic examination knee 1/2 views (73560) |
$220 |
$400 |
2.5× |
| Radiologic examination tibia & fibula 2 views (73590) |
$231 |
$420 |
2.6× |
| Radiopharm Dacryocystography (78660) |
$248.60 |
$452 |
0.6× |
| Radiopharmaceutical therapy, by interstitial radioactive colloid administration Facility (79300) |
$315.15 |
$573 |
1.3× |
| Radiopharmaceutical therapy, by intracavitary administration Non-Facility (79200) |
$315.15 |
$573 |
1.3× |
| Renal Cyst Study (74470) |
$338.80 |
$616 |
0.6× |
| Ribs bilateral 3 views (71110) |
$240.90 |
$438 |
2.3× |
| Rp loclzj tum plnr 1 area single day imaging (78800) |
$484 |
$880 |
1.2× |
| Rp loclzj tum plnr 2+area 1+d img/1 area img>2+d (78801) |
$1,182.50 |
$2,150 |
3.0× |
| Rp Loclzj Tum Plnr Whole Body 2+ Days Imaging (78804) |
$1,290.30 |
$2,346 |
2.4× |
| Rp Loclzj Tum Plnr Whole Body Single Day Imaging (78802) |
$1,236.40 |
$2,248 |
2.3× |
| Rp Loclzj Tum Spect 1 Area Single Day Imaging (78803) |
$1,344.20 |
$2,444 |
2.5× |
| Rp loclzj tum spect 2 area/sep acquisj img (78831) |
$2,150.50 |
$3,910 |
1.7× |
| Rp loclzj tum spect CT 2area 1d img/1 ar img>2+d (78832) |
$2,419.45 |
$4,399 |
1.7× |
| Rp loclzj tum spect w/CT 1 area/acquisj 1day img (78830) |
$1,774.30 |
$3,226 |
1.4× |
| Rp Ther Radiolbld Monoclonal Antibody IV Infus (79403) |
$1,627.45 |
$2,959 |
7.0× |
| Rp Therapy Intravenous Administration (79101) |
$806.30 |
$1,466 |
3.5× |
| Scapula (73010) |
$286 |
$520 |
2.7× |
Screening Digital Breast Tomosynthesis Bi (77063)
range across 2 matching MRF lines |
$55–$109.45 |
$100–$199 |
varies |
| Shoulder 1 view (73020) |
$145.75 |
$265 |
1.7× |
| Shoulder Arthrography (73040) |
$831.60 |
$1,512 |
2.4× |
| Skull less than 4 views (70250) |
$286 |
$520 |
2.7× |
| Special dosimetry (77331) |
$379.50 |
$690 |
2.8× |
| Special Physics Consult (77370) |
$1,830.95 |
$3,329 |
13.6× |
| Special teletherapy port plan (77321) |
$1,046.65 |
$1,903 |
2.8× |
| Special treatment procedure (77470) |
$4,187.15 |
$7,613 |
7.6× |
| Speech evaluation, complex (70371) |
$314.60 |
$572 |
1.3× |
| Spleen Imaging (78185) |
$494.45 |
$899 |
1.2× |
| Stereotactic Body Radiation Delivery (77373) |
$26,168.45 |
$47,579 |
14.6× |
| Sternoclavicular joints (71130) |
$123.20 |
$224 |
1.4× |
| Superior sagittal sinus venogram (75870) |
$2,010.80 |
$3,656 |
0.6× |
| Telethx isodose pln cplx w/basic dosimetry (77307) |
$2,268.20 |
$4,124 |
6.0× |
| Telethx isodose pln smpl w/dosimetry calculation (77306) |
$796.40 |
$1,448 |
2.1× |
| Ther Rad Simulaj-Aided Field Setting Complex (77290) |
$3,837.90 |
$6,978 |
10.2× |
| Ther Rad Simulaj-Aided Field Setting Intermed (77285) |
$1,744.60 |
$3,172 |
4.7× |
| Ther rad simulaj-aided field setting simple (77280) |
$1,046.65 |
$1,903 |
7.8× |
| Thoracic spine 2 views (72070) |
$258.50 |
$470 |
2.5× |
| Thoracic spine 3 views (72072) |
$330 |
$600 |
3.2× |
| Thoracolumbar 2 views (72080) |
$231 |
$420 |
2.6× |
| Thyroid Imaging With Vascular Flow (78013) |
$649 |
$1,180 |
1.6× |
| Thyroid Met Imaging Body (78018) |
$1,828.20 |
$3,324 |
3.4× |
| Thyroid Uptake Measurement (78012) |
$228.25 |
$415 |
0.6× |
| Thyroid Uptake W/Blood Flow Sngle/Mult Quan Meas (78014) |
$537.90 |
$978 |
1.3× |
| Tx Devices Design & Construction Complex (77334) |
$2,093.30 |
$3,806 |
5.6× |
| Tx devices design & construction intermediate (77333) |
$806.30 |
$1,466 |
6.0× |
| Tx devices design & construction simple (77332) |
$723.80 |
$1,316 |
5.4× |
| Ultrasound Breast Limited (76642) |
$388.30 |
$706 |
4.5× |
| Ultrasound elastography first target lesion (76982) |
$117.70 |
$214 |
1.1× |
| Ultrasound Elastography Parenchyma (76981) |
$155.65 |
$283 |
1.5× |
| Ultrasound Exam Aaa Screen (76706) |
$209 |
$380 |
2.0× |
| Ultrasound trgt dynamic microbubble 1st lesion (76978) |
$211.20 |
$384 |
0.6× |
| Ultrasound, abdomen limited (76705) |
$456.50 |
$830 |
4.4× |
| Unlisted Dx Radiographic Procedure (76499) |
$359.70 |
$654 |
4.1× |
| Unlisted magnetic resonance procedure (76498) |
$3,870.90 |
$7,038 |
44.4× |
| Unlisted Miscellaneous Px Dx Nuclear Medicine (78999) |
$4,132.15 |
$7,513 |
10.3× |
| Unlisted us procedure (76999) |
$223.30 |
$406 |
2.6× |
| Upper gi w/o kub (74240) |
$482.35 |
$877 |
2.7× |
| Urea Breath Test C-14 Isotopic Acquisj Analysis (78267) |
$155.65 |
$283 |
14.1× |
| Urea breath test c-14 isotopic analysis (78268) |
$166.65 |
$303 |
1.8× |
| Ureteral Reflux Study (78740) |
$1,060.95 |
$1,929 |
2.6× |
| Urethrocystogram voiding (74455) |
$631.40 |
$1,148 |
2.6× |
| Urethrocystography retrograde (74450) |
$528 |
$960 |
2.2× |
| Us breast unilateral complete (76641) |
$528.55 |
$961 |
5.0× |
| Us chest (76604) |
$382.25 |
$695 |
3.7× |
| Us complete joint (76881) |
$565.95 |
$1,029 |
5.4× |
| Us exam, pelvic, limited (76857) |
$407 |
$740 |
3.9× |
| Us kidney transplant (76776) |
$1,850.20 |
$3,364 |
17.7× |
| Us lmtd joint/oth nonvasc xtr strux r-t w/img (76882) |
$509.85 |
$927 |
4.9× |
| Us ob limited 1 or more fetuses (76815) |
$431.75 |
$785 |
4.1× |
| Us ob transvaginal (76817) |
$332.75 |
$605 |
3.2× |
| Us pelvic non ob complete (76856) |
$550 |
$1,000 |
5.3× |
| Us pg uter img f&mat 14 wk tabdl 1/1st gestation (76801) |
$587.40 |
$1,068 |
5.6× |
| Us retroperitoneal complete (76770) |
$556.60 |
$1,012 |
5.3× |
| Us retroperitoneal limited (76775) |
$496.10 |
$902 |
4.7× |
| Us scrotum and contents (76870) |
$550 |
$1,000 |
5.3× |
| Us thyroid (76536) |
$517 |
$940 |
4.9× |
| Us transrectal (76872) |
$637.45 |
$1,159 |
6.1× |
| Vein X-Ray Chest (75827) |
$2,681.25 |
$4,875 |
1.7× |
| Vein X-Ray Liver W/O Hemodyn (75887) |
$3,267.55 |
$5,941 |
1.0× |
| Vein X-Ray Spleen/Liver (75810) |
$4,656.85 |
$8,467 |
1.5× |
| Venogram Sinus/Jugular (75860) |
$1,782.55 |
$3,241 |
0.6× |
| Venography Adrenal Unilateral (75840) |
$2,514.05 |
$4,571 |
0.8× |
| Venography caval inferior serialography rs&i (75825) |
$5,865.20 |
$10,664 |
1.9× |
| Venography extremity bilateral rs&i (75822) |
$1,340.90 |
$2,438 |
0.9× |
| Venography extremity unilateral rs&i (75820) |
$1,282.05 |
$2,331 |
0.8× |
| Venography Renal Bilateral (75833) |
$3,603.60 |
$6,552 |
1.1× |
| Venography Renal Unilateral (75831) |
$2,514.05 |
$4,571 |
0.8× |
| Venous sampling by catheter (75893) |
$3,162.50 |
$5,750 |
0.6× |
| Vertebral fracture assessment via dxa (77086) |
$85.25 |
$155 |
1.0× |
Wrist 2 views (73100)
range across 2 matching MRF lines |
$110–$214.50 |
$200–$390 |
varies |
| X-Ray Ac Jts - Xr Acromioclavicular Joints Bilateral (73050) |
$465.30 |
$846 |
5.3× |
| X-ray antegrade pyelogram tube (74425) |
$562.65 |
$1,023 |
1.6× |
| X-Ray Aorta Leg Arteries (75630) |
$4,776.20 |
$8,684 |
1.5× |
| X-Ray Bend Only L-S Spine (72120) |
$101.20 |
$184 |
1.0× |
X-Ray Elbow 2 Vw - Xr Elbow 1-2 Views Right (73070)
range across 2 matching MRF lines |
$126.50–$231 |
$230–$420 |
varies |
| X-Ray Exam Breast Specimen (76098) |
$743.60 |
$1,352 |
1.4× |
| X-Ray Exam Entire Spi 1 Vw (72081) |
$280.50 |
$510 |
3.2× |
| X-Ray Exam Entire Spi 2/3 Vw (72082) |
$336.60 |
$612 |
3.2× |
| X-Ray Exam Entire Spi 4/5 Vw (72083) |
$392.70 |
$714 |
3.8× |
| X-Ray Exam Hip Uni 1 View (73501) |
$212.30 |
$386 |
2.4× |
| X-Ray Exam Hip Uni 2-3 Views (73502) |
$288.20 |
$524 |
3.3× |
| X-Ray Exam Hip Uni 4/> Views (73503) |
$491.70 |
$894 |
4.7× |
| X-Ray Exam Hips Bi 2 Views (73521) |
$353.10 |
$642 |
3.4× |
| X-Ray Exam Hips Bi 3-4 Views (73522) |
$392.70 |
$714 |
3.8× |
| X-Ray Exam Hips Bi 5/> Views (73523) |
$478.50 |
$870 |
4.6× |
| X-Ray Exam L-S Spine Bending (72114) |
$518.65 |
$943 |
5.0× |
| X-Ray Exam Neck Spine 2-3 Vw (72040) |
$275 |
$500 |
3.2× |
| X-Ray Exam Neck Spine 6/>Vws (72052) |
$719.40 |
$1,308 |
6.9× |
| X-Ray Exam Unilat Ribs/Chest (71101) |
$336.60 |
$612 |
3.2× |
| X-ray eye for foreign body (70030) |
$126.50 |
$230 |
1.5× |
X-ray humerus (73060)
range across 2 matching MRF lines |
$104.50–$214.50 |
$190–$390 |
varies |
| X-ray IV pyelogram (ivp) (74400) |
$729.85 |
$1,327 |
4.2× |
| X-Ray Jaw <4 Vw - Xr Mandible < 4 Views (70100) |
$392.70 |
$714 |
4.5× |
| X-Ray Knee Bilat Standing - Xr Knees Anteroposterior Standing Bilat (73565) |
$275 |
$500 |
3.2× |
| X-Ray Lumbar Spine 2/3 Vw - Xr Lumbar Spine 2-3 Views (72100) |
$308 |
$560 |
2.9× |
| X-Ray Ribs, Chest 4+ Vw - Xr Ribs 3 Vws Bil W/ Chest Posteroanterior (71111) |
$398.20 |
$724 |
3.8× |
| X-Ray Sacroiliac Jts 3+ Vw - Xr Sacroiliac Joints 3+ Views (72202) |
$258.50 |
$470 |
2.5× |
| X-Ray Sacroiliac Jts <3 Vw - Xr Sacroiliac Joints 1-2 Views (72200) |
$200.20 |
$364 |
1.9× |
| X-Ray Sacrum/Coccyx 2+ Vw - Xr Sacrum Coccyx 2+ Views (72220) |
$268.95 |
$489 |
3.1× |
| X-Ray Sinuses 3+ Vw - Xr Paranasal Sinuses 3+ Views (70220) |
$286 |
$520 |
3.3× |
| X-Ray Skull 4+ Vw - Xr Skull Complete 4+ Views (70260) |
$359.15 |
$653 |
3.4× |
| X-Ray Stress View (77071) |
$454.30 |
$826 |
5.2× |
| X-ray thoracic spine 4 vw (72074) |
$360.25 |
$655 |
3.4× |
| X-Ray Tmj Unilat (70328) |
$134.75 |
$245 |
1.5× |
| X-Ray Urinary Tract Exam With Contrast Material (74420) |
$499.40 |
$908 |
1.4× |
| X-Rays Bone Length Studies (77073) |
$617.10 |
$1,122 |
5.9× |
| X-Rays Bone Survey Complete (77075) |
$437.25 |
$795 |
4.2× |
| Xr c-spine 4 or 5 views (72050) |
$363 |
$660 |
3.5× |
| Xr facial bones less than 3 views (70140) |
$319.55 |
$581 |
3.7× |
| XR Mastoids < 3 Views Bilateral (70120) |
$280.50 |
$510 |
2.7× |
| Xr orbits complete 4 views (70200) |
$162.80 |
$296 |
1.6× |
| Xr Tomogram Single Plane (76100) |
$398.75 |
$725 |
3.8× |