| 3-D radiotherapy plan dose-volume histograms (77295) |
$3,319.20 |
$11,064 |
2.2× |
| Abdomen 1 View (74018) |
$117.30 |
$391 |
1.3× |
| Abdomen 2 views (74019) |
$137.10 |
$457 |
1.2× |
| Acute Gastrointestinal Blood Loss Imaging (78278) |
$665.40 |
$2,218 |
1.6× |
| Acute venous thrombosis imaging, peptide Non-Facility (78456) |
$594.90 |
$1,983 |
0.4× |
| Adrenal Cortex & Medulla Img (78075) |
$423 |
$1,410 |
0.3× |
Angio internal mammary (75756)
range across 3 matching MRF lines |
$1,166.70–$1,690.80 |
$3,889–$5,636 |
varies |
| Angio pulmonary bilat (75743) |
$1,479.30 |
$4,931 |
0.4× |
| Angiography Adrenal Bilateral Slctv Rs&I (75733) |
$1,623 |
$5,410 |
0.5× |
| Angiography extremity bilateral rs&i (75716) |
$2,492.10 |
$8,307 |
0.7× |
| Angiography extremity unilateral rs&i (75710) |
$1,297.20 |
$4,324 |
0.4× |
| Angiography pulmonary unilateral slctv rs&i (75741) |
$1,166.70 |
$3,889 |
0.3× |
| Angrph pulmonary nonslctv cath/ven njx rs&i (75746) |
$1,203.30 |
$4,011 |
0.4× |
| Ankle 2 views (73600) |
$142.80 |
$476 |
1.5× |
Aortography thoracic serialography rs&i (75605)
likely a partial charge, not the full procedure |
$980.10 |
$3,267 |
0.2× |
| Aortography thoracic w/o serialography rs&i (75600) |
$1,602.30 |
$5,341 |
0.5× |
Artery X-Rays Abdomen (75726)
unusually low: confirm this is the full procedure |
$2,602.50 |
$8,675 |
0.4× |
| Artery X-Rays Adrenal Gland (75731) |
$1,623 |
$5,410 |
0.5× |
Artery X-Rays Pelvis (75736)
unusually low: confirm this is the full procedure |
$1,801.20 |
$6,004 |
0.3× |
Artery X-Rays Spine (75705)
likely a partial charge, not the full procedure |
$1,423.80 |
$4,746 |
0.2× |
| Arthrogram ankle (73615) |
$345 |
$1,150 |
0.9× |
| Arthrogram hip (73525) |
$548.40 |
$1,828 |
1.5× |
| Arthrogram Wrist (73115) |
$320.10 |
$1,067 |
0.9× |
| Basic radiation dosimetry calculation (77300) |
$272.40 |
$908 |
1.9× |
| Bone age studies (77072) |
$199.20 |
$664 |
1.8× |
| Bone Imaging 3 Phase (78315) |
$1,209 |
$4,030 |
2.8× |
| Bone Imaging Whole Body (78306) |
$1,054.50 |
$3,515 |
2.5× |
| Bone marrow imaging; multiple areas (78103) |
$911.10 |
$3,037 |
2.1× |
| Bone survey infant (77076) |
$345 |
$1,150 |
3.1× |
| Brachytx isodose complex (77318) |
$410.70 |
$1,369 |
1.0× |
| Brachytx isodose intermed (77317) |
$410.70 |
$1,369 |
1.0× |
| Brachytx Isodose Plan Simple (77316) |
$147.30 |
$491 |
0.4× |
| Brain Imaging Min 4 Static Views W Vascular Flow (78606) |
$726 |
$2,420 |
1.2× |
| Brain Imaging Pet Metabolic Evaluation (78608) |
$1,923 |
$6,410 |
1.3× |
| Card Bl Pool Gated Spect Rest Wal Motn Ejct Frct (78494) |
$728.40 |
$2,428 |
1.7× |
| Cardiac MRI w/w/o contrast & further seq (75561) |
$1,684.80 |
$5,616 |
4.5× |
| Cardiac MRI w/w/o contrast w/stress (75563) |
$2,144.40 |
$7,148 |
2.6× |
| Cardiac Shunt Detection (78428) |
$594.90 |
$1,983 |
1.4× |
| Cat Scan Follow-Up Study (76380) |
$199.20 |
$664 |
2.1× |
| Cerebrospinal Fluid Flow W/O Matl Shunt Evaltj (78645) |
$514.50 |
$1,715 |
0.9× |
| Cerebrospinal Fluid Scan (78630) |
$462.30 |
$1,541 |
0.8× |
| Chest 1 view (71045) |
$93.30 |
$311 |
1.0× |
| Chest 2 views (71046) |
$109.20 |
$364 |
1.2× |
| Chest 3 views (71047) |
$127.50 |
$425 |
1.4× |
| Chest 4 or more views (71048) |
$143.40 |
$478 |
1.3× |
| Cineradiograpy/vidradiograpy xcpt where spec (76120) |
$481.50 |
$1,605 |
4.3× |
| Cisternography Positive Contrast Rs&I (70015) |
$694.20 |
$2,314 |
0.8× |
| Clavicle complete (73000) |
$140.40 |
$468 |
1.5× |
Computed Tomography Thorax Lw Dose Lng Ca Scr C- (71271)
range across 2 matching MRF lines |
$268.20–$1,223.40 |
$894–$4,078 |
varies |
| Continuing medical physics consltj pr wk (77336) |
$381.30 |
$1,271 |
2.6× |
| Contrast Exam Abdominl Aorta (75625) |
$1,568.10 |
$5,227 |
0.5× |
| Contrast X-Ray Bladder (74430) |
$455.10 |
$1,517 |
1.2× |
| Contrast X-Ray Of Elbow (73085) |
$504.30 |
$1,681 |
1.3× |
| Contrast X-Ray Of Knee Joint (73580) |
$401.40 |
$1,338 |
1.1× |
| Corpora cavernosography (74445) |
$235.80 |
$786 |
2.1× |
| CT abdomen and pelvis without and with contrast (74178) |
$3,072 |
$10,240 |
8.2× |
| CT abdomen and pelvis without contrast (74176) |
$2,162.70 |
$7,209 |
8.5× |
| CT abdomen w contrast (74160) |
$1,300.50 |
$4,335 |
6.9× |
| CT abdomen w wo contrast (74170) |
$1,614.90 |
$5,383 |
8.6× |
| CT abdomen w/o contrast (74150) |
$1,087.80 |
$3,626 |
9.7× |
| CT Angio Abdomen and Pelvis (74174) |
$2,441.70 |
$8,139 |
6.5× |
| CT Angio Chest (71275) |
$1,505.70 |
$5,019 |
8.0× |
| CT Angio Head (70496) |
$1,254.30 |
$4,181 |
6.7× |
| CT angio hrt w/3d image (75574) |
$820.80 |
$2,736 |
2.2× |
| Ct Angio Lwr Extr W/O&W/Dye (73706) |
$843.60 |
$2,812 |
4.5× |
| CT Angio Neck (70498) |
$1,164.90 |
$3,883 |
6.2× |
| Ct Angio Upr Extrm W/O&W/Dye (73206) |
$1,143 |
$3,810 |
6.1× |
| CT Cere Prfuj Alys C+ W/O CT/Cta Same Anatomy (70473) |
$280.50 |
$935 |
1.5× |
| CT cervical spine w/ contrast (72126) |
$1,443.60 |
$4,812 |
3.9× |
| CT cervical spine w/o contrast (72125) |
$904.20 |
$3,014 |
8.1× |
| CT cervical spine w/wo cont (72127) |
$1,076.40 |
$3,588 |
5.7× |
| CT chest w contrast (71260) |
$1,391.10 |
$4,637 |
7.4× |
| CT chest w/wo contrast (71270) |
$1,133.10 |
$3,777 |
6.0× |
| CT colonography screening (74263) |
$467.40 |
$1,558 |
1.8× |
| CT Colonogrphy Dx Image Postprocess W/Contrast (74262) |
$642.90 |
$2,143 |
3.4× |
| CT colonogrphy dx image postprocess w/o contrast (74261) |
$558 |
$1,860 |
5.0× |
| CT head/brain with contrast (70460) |
$1,099.80 |
$3,666 |
5.9× |
| CT head/brain without and with contrast (70470) |
$1,138.80 |
$3,796 |
6.1× |
| CT heart contrast eval cardiac structure&morph (75572) |
$714.30 |
$2,381 |
1.9× |
| CT heart no contrast quant eval coronry calcium (75571) |
$407.70 |
$1,359 |
4.4× |
| CT hrt w/3d image congen (75573) |
$469.50 |
$1,565 |
1.3× |
| CT iac w contrast (70481) |
$1,087.50 |
$3,625 |
5.8× |
| CT l-spine w&w/o contrast (72133) |
$1,224 |
$4,080 |
6.5× |
| CT lower ext w/o (73700) |
$984.60 |
$3,282 |
8.8× |
| CT lower extremity w/contrast material (73701) |
$1,053.90 |
$3,513 |
5.6× |
| CT lumbar spine w contrast (72132) |
$1,517.10 |
$5,057 |
4.1× |
| CT lumbar spine w/o contrast (72131) |
$1,314 |
$4,380 |
11.7× |
| CT maxillofacial w contrast (70487) |
$1,317.90 |
$4,393 |
7.0× |
| CT maxillofacial wo contrast (70486) |
$1,185.30 |
$3,951 |
10.6× |
| CT neck tissue combo (70492) |
$1,033.50 |
$3,445 |
5.5× |
| Ct Orbit/Ear/Fossa W/O&W/Dye (70482) |
$1,544.70 |
$5,149 |
8.2× |
| CT orbits w/o contrast (70480) |
$1,140.30 |
$3,801 |
10.2× |
| CT pelvis w&w/o contrast (72194) |
$1,076.40 |
$3,588 |
5.7× |
| CT pelvis w/o contrast (72192) |
$817.80 |
$2,726 |
7.3× |
CT scan of leg combo (73702)
range across 3 matching MRF lines |
$1,053.90–$1,824.30 |
$3,513–$6,081 |
varies |
| CT scans face/jaw combo (70488) |
$1,563 |
$5,210 |
8.3× |
| CT soft tissue neck w contrast (70491) |
$1,226.70 |
$4,089 |
6.5× |
| CT soft tissue neck w/o contrast (70490) |
$728.70 |
$2,429 |
6.5× |
| CT thoracic spine w contrast (72129) |
$992.70 |
$3,309 |
5.3× |
| CT thoracic spine w/o contrast (72128) |
$879.30 |
$2,931 |
7.8× |
| CT thoracic spine w/wo cont (72130) |
$1,134 |
$3,780 |
6.0× |
| CT thorax w/o contrast (71250) |
$1,223.40 |
$4,078 |
10.9× |
| CT upper ext wo (73200) |
$1,025.10 |
$3,417 |
9.2× |
| CT upper extremity w/o & w/contrast material (73202) |
$1,053.90 |
$3,513 |
5.6× |
| CT upper extremity with contrast (73201) |
$1,113 |
$3,710 |
3.0× |
| Cta Abdl Aorta&Bi Iliofem W/Contrast&Postp (75635) |
$782.40 |
$2,608 |
4.2× |
| Cta Abdomen (74175) |
$958.50 |
$3,195 |
5.1× |
| CTA head&neck c+ w/noncontrast img&post-pxessing (70471) |
$280.50 |
$935 |
0.8× |
| CTA pelvis (72191) |
$845.70 |
$2,819 |
4.5× |
| Dacryocystography, nasolacrimal duct, radiological supervision and interpretation Non-Facility (70170) |
$252 |
$840 |
1.0× |
Dilation ureters/urethra rs&i (74485)
range across 3 matching MRF lines |
$939.90–$1,163.70 |
$3,133–$3,879 |
varies |
| Discography Cerv/Thor Spine (72285) |
$2,566.80 |
$8,556 |
1.2× |
| Diskography lumbar (72295) |
$2,566.80 |
$8,556 |
1.2× |
| Doppler Echo Fetal Puls Spectral F/U/Repeat (76828) |
$127.80 |
$426 |
1.1× |
| Doppler Echo Fetal Spectral Display Complete (76827) |
$257.10 |
$857 |
2.3× |
| Doppler Fetal Mid Cerebral Artery (76821) |
$114.90 |
$383 |
1.0× |
| Dxa Bone Density Axial (77080) |
$276.30 |
$921 |
2.5× |
| Dxa bone density study (77085) |
$109.80 |
$366 |
1.0× |
| Dxa bone density study 1/>sites appendiclr skel (77081) |
$207.30 |
$691 |
2.2× |
| Echo exam of fetal heart (76825) |
$511.80 |
$1,706 |
0.9× |
| Echo exam uterus (76831) |
$477.90 |
$1,593 |
1.9× |
| Echo Guide For Artery Repair (76936) |
$522.90 |
$1,743 |
2.3× |
| Echocardiography, fetal, cardiovascular system, real time with image documentation (2D), with or without M-mode… (76826) |
$257.10 |
$857 |
1.0× |
| Echograp Trans R Pros Study (76873) |
$101.40 |
$338 |
0.9× |
| Esophagram (74220) |
$340.20 |
$1,134 |
1.8× |
| Fetal Biophys Profile W/Nst (76818) |
$539.40 |
$1,798 |
4.8× |
| Fetal Biophysical Profile W/O Non-Stress Testing (76819) |
$127.80 |
$426 |
1.1× |
| Fetal MRI w/placntl matrnl plvc img sing/1st ges (74712) |
$1,796.40 |
$5,988 |
7.0× |
| Fluoroscopy up to 1 hr (76000) |
$270 |
$900 |
1.1× |
| Follow-Up Angiography (75898) |
$438.30 |
$1,461 |
0.1× |
| Foot 2 views (73620) |
$152.10 |
$507 |
1.6× |
| Forearm 2 views (73090) |
$111.90 |
$373 |
1.2× |
| Gastric emptying imaging study (78264) |
$976.20 |
$3,254 |
2.3× |
| Gastric Emptyng Imag Std W/Sm Bwl Transit (78265) |
$976.20 |
$3,254 |
2.3× |
| Gastroesophageal Reflux Exam (78262) |
$965.10 |
$3,217 |
2.3× |
| Gated Heart Planar Single (78472) |
$982.50 |
$3,275 |
2.3× |
| GI Endoscopic US S&I (76975) |
$618.60 |
$2,062 |
2.4× |
| Gstrc Emptng Imag Std W/Sm Bwl Col Trnst Mlt Day (78266) |
$1,092.60 |
$3,642 |
1.9× |
| Hand 2 views (73120) |
$142.80 |
$476 |
1.3× |
| Hdr Rdncl Ntrstl/Icav Brchtx (77772) |
$1,004.10 |
$3,347 |
1.3× |
| Hdr Rdncl Ntrstl/Icav Brchtx (77771) |
$1,228.50 |
$4,095 |
1.6× |
| Hdr Rdncl Ntrstl/Icav Brchtx 1 Channel (77770) |
$2,239.20 |
$7,464 |
3.0× |
| Heart first pass single,planar (78481) |
$786.30 |
$2,621 |
1.4× |
| Heart Image (Pet) Multiple (78492) |
$2,146.80 |
$7,156 |
1.4× |
| Hepatc Vngrph Wdg/Fr Hemodyn Eval Rs&I (75889) |
$2,465.70 |
$8,219 |
0.7× |
| Hepatc Vngrph Wdg/Fr W/O Hemodyn Eval Rs&I (75891) |
$1,769.10 |
$5,897 |
0.5× |
| Hepatobil Syst Image W/Drug (78227) |
$989.10 |
$3,297 |
1.7× |
| Hepatobiliary System Imaging (78226) |
$862.80 |
$2,876 |
2.0× |
| Ht Musc Image Planar Mult (78454) |
$995.70 |
$3,319 |
0.7× |
| Ht Muscle Image Spect Sing (78451) |
$1,258.80 |
$4,196 |
0.9× |
| Hysterosalpingogram (74740) |
$720 |
$2,400 |
2.8× |
| Infant hip ultrasound with hip movement (dynamic) (76885) |
$256.80 |
$856 |
2.8× |
| Infant hip ultrasound, limited static exam (76886) |
$256.80 |
$856 |
2.8× |
| Joint Survey Single View (77077) |
$118.20 |
$394 |
1.1× |
| K Flow/Funct Image W/Drug (78708) |
$919.80 |
$3,066 |
1.6× |
| K Flow/Funct Image W/O Drug (78707) |
$825.30 |
$2,751 |
1.4× |
| Knee 3 Views (73562) |
$201.90 |
$673 |
2.2× |
| Leveen/Shunt Patency Exam (78291) |
$726 |
$2,420 |
1.7× |
| Liver & Spleen Imaging Static Only (78215) |
$594.90 |
$1,983 |
1.4× |
| Liver imaging static only (78201) |
$548.40 |
$1,828 |
0.9× |
| Liver imaging w/vascular flow (78202) |
$796.50 |
$2,655 |
1.4× |
| Lung Perf&Ventilat Diferentl (78598) |
$680.70 |
$2,269 |
1.2× |
| Lung perfusion differential (78597) |
$594.90 |
$1,983 |
1.4× |
| Lung Ventilat&Perfus Imaging (78582) |
$618.60 |
$2,062 |
1.1× |
| Lymph System Imaging (78195) |
$890.10 |
$2,967 |
1.5× |
| Lymphangiography Extremity Only Bilateral Rs&I (75803) |
$1,138.80 |
$3,796 |
0.7× |
| Lymphangiography extremity only unilateral rs&i (75801) |
$719.40 |
$2,398 |
1.1× |
| Lymphangiography Pelvic/Abdominal Bilateral Rs&I (75807) |
$1,138.80 |
$3,796 |
0.3× |
| Lymphangiography, pelvic/abdominal, unilateral (75805) |
$719.40 |
$2,398 |
0.2× |
| Magnetic Image Jaw Joint (70336) |
$1,640.70 |
$5,469 |
6.4× |
| Magnetic Resonance Elastography (76391) |
$249.90 |
$833 |
1.0× |
| Mammary ductogram or galactogram multiple (77054) |
$224.70 |
$749 |
0.9× |
| Mammary ductogram or galactogram single (77053) |
$254.10 |
$847 |
1.0× |
| Meckels Divert Exam (78290) |
$1,054.50 |
$3,515 |
2.5× |
| Mlc imrt design & construction per imrt plan (77338) |
$369.90 |
$1,233 |
0.9× |
| Mra Head W/O & W/Contrast Material (70546) |
$1,302 |
$4,340 |
3.5× |
| MRA head w/o contrast (70544) |
$782.70 |
$2,609 |
3.1× |
| MRA head with contrast (70545) |
$1,341.90 |
$4,473 |
3.6× |
| MRA neck w contrast (70548) |
$1,424.10 |
$4,747 |
3.8× |
| Mra Neck W/O &W/Contrast Material (70549) |
$1,154.70 |
$3,849 |
3.1× |
| MRA neck w/o contrast (70547) |
$1,207.80 |
$4,026 |
4.7× |
| MRI abdomen w contrast (74182) |
$2,155.20 |
$7,184 |
5.8× |
| MRI abdomen w/o contrast (74181) |
$1,796.40 |
$5,988 |
7.0× |
| MRI any jt lower extrem w/contrast material (73722) |
$1,936.50 |
$6,455 |
2.3× |
| MRI any jt lower extrem w/o & w/contrast matrl (73723) |
$1,936.50 |
$6,455 |
5.2× |
| MRI any jt upper extremity w/contrast matrl (73222) |
$2,002.80 |
$6,676 |
2.4× |
| MRI bone marrow blood supply (77084) |
$332.70 |
$1,109 |
1.3× |
| MRI brain functional w/o physician admnistration (70554) |
$1,801.20 |
$6,004 |
7.0× |
| MRI brain functional w/physician admnistration (70555) |
$1,749 |
$5,830 |
6.8× |
| MRI Breast W/O Contrast Bilateral (77047) |
$249.90 |
$833 |
1.0× |
| MRI Breast Without Contrast Material Unilateral (77046) |
$249.90 |
$833 |
1.0× |
| MRI cardiac w/o cont stress (75559) |
$1,700.70 |
$5,669 |
2.9× |
| MRI cardiac w/o contrast (75557) |
$1,432.20 |
$4,774 |
5.6× |
| MRI cervical spine w contrast (72142) |
$1,410 |
$4,700 |
3.8× |
| MRI cervical spine w/o cont (72141) |
$1,801.20 |
$6,004 |
7.0× |
| MRI chest w/o contrast (71550) |
$1,521.60 |
$5,072 |
6.0× |
| MRI chest with contrast (71551) |
$1,410 |
$4,700 |
1.7× |
| MRI chest wo w contrast (71552) |
$2,445 |
$8,150 |
6.5× |
| MRI lower extrem oth/thn jt w/contrast matrl (73719) |
$1,391.70 |
$4,639 |
3.7× |
| MRI lower extrem oth/thn jt w/o & w/contr matr (73720) |
$2,137.20 |
$7,124 |
5.7× |
| MRI lower extrem oth/thn jt w/o contr matrl (73718) |
$1,606.20 |
$5,354 |
6.3× |
| MRI lumbar spine w contrast (72149) |
$1,391.70 |
$4,639 |
3.7× |
| Mri Neck Spine W/O & W/Dye (72156) |
$2,442 |
$8,140 |
6.5× |
| MRI orbit face &/neck w/o contrast (70540) |
$1,321.50 |
$4,405 |
5.2× |
| MRI orbit face neck w contrast (70542) |
$1,391.70 |
$4,639 |
3.7× |
| Mri Orbt/Fac/Nck W/O &W/Dye (70543) |
$2,455.80 |
$8,186 |
6.6× |
| MRI pelvis w contrast (72196) |
$1,391.70 |
$4,639 |
3.7× |
| MRI pelvis w/o & w contrast (72197) |
$2,455.80 |
$8,186 |
6.6× |
| MRI pelvis w/o contrast (72195) |
$1,801.20 |
$6,004 |
7.0× |
| MRI spectroscopy (76390) |
$883.50 |
$2,945 |
9.5× |
| MRI thoracic spine w/o contrast (72146) |
$1,693.20 |
$5,644 |
6.6× |
| MRI upper extremity oth than jt w/contr matrl (73219) |
$1,549.20 |
$5,164 |
4.1× |
| MRI upper extremity oth than jt w/o contr matrl (73218) |
$1,779.30 |
$5,931 |
7.0× |
| Mri Uppr Extremity W/O&W/Dye (73220) |
$1,982.40 |
$6,608 |
5.3× |
| MRI, abdomen, combo (74183) |
$2,445 |
$8,150 |
6.5× |
| MRI, dorsal spine combo (72157) |
$2,445 |
$8,150 |
6.5× |
| MRI, dorsal spine contrast (72147) |
$1,453.50 |
$4,845 |
3.9× |
| MRI, joint upper extrem (73221) |
$1,775.40 |
$5,918 |
6.9× |
| MRI, joint upper extrem combo (73223) |
$1,873.50 |
$6,245 |
5.0× |
| MRI, lumbar spine combo (72158) |
$2,455.80 |
$8,186 |
6.6× |
| Myocardial Imaging Infarct Avid Planar Qual/Quan (78466) |
$319.80 |
$1,066 |
0.7× |
| Myocardial Imaging Pet Metabolic Evaluation (78459) |
$2,146.80 |
$7,156 |
1.5× |
| Myocardial Perfusion Planar 1 Study Rest/Stress (78453) |
$995.70 |
$3,319 |
0.7× |
| Myocardial Spect Multiple Studies (78452) |
$1,414.80 |
$4,716 |
1.0× |
| N-invas est c ffr sw aly CTA (75580) |
$1,695.30 |
$5,651 |
1.8× |
| Neck soft tissue (70360) |
$186.60 |
$622 |
2.0× |
| Nm csf leak detection (78650) |
$564.30 |
$1,881 |
0.4× |
| Nonvascular Shunt X-Ray (75809) |
$1,616.40 |
$5,388 |
14.4× |
| Ntsty modul radthx pln dose-vol histos (77301) |
$3,751.20 |
$12,504 |
2.5× |
| Nuclear Rx Intra-Arterial (79445) |
$3,931.50 |
$13,105 |
15.7× |
| Nuclear Rx Oral Admin (79005) |
$828.90 |
$2,763 |
3.3× |
| Ob us nuchal meas 1 gest (76813) |
$89.40 |
$298 |
0.8× |
| Oph bmtry us echograpy a-scan io lens pwr cal (76519) |
$71.70 |
$239 |
0.6× |
| Oph us dx ant sgm us immersion b-scan/hr biom (76513) |
$134.10 |
$447 |
1.2× |
| Oph US Dx B-Scan&Quan a-Scan Sm Pt Enctr (76510) |
$315 |
$1,050 |
2.2× |
| Ophthalmic Biometry US Echograpy a-Scan (76516) |
$71.70 |
$239 |
0.6× |
| Ophthalmic ultrasound dx b-scan w/wo a-scan (76512) |
$134.10 |
$447 |
1.2× |
| Ophthalmic US Dx Corneal Pachymetry Uni/Bi (76514) |
$33.90 |
$113 |
1.1× |
| Ophthalmic us dx quantitative a-scan only (76511) |
$134.10 |
$447 |
1.2× |
| Optic foramina (70190) |
$78 |
$260 |
0.8× |
| Panoramic X-ray of jaws (70355) |
$135.90 |
$453 |
1.5× |
| Parathyroid imaging w/tomographic spect & CT (78072) |
$791.10 |
$2,637 |
1.4× |
| Parathyroid Planar Imaging (78070) |
$720 |
$2,400 |
1.7× |
| Parathyroid planar imaging w/wo subtraction (78071) |
$726 |
$2,420 |
1.7× |
| Pelvis 1 or 2 views (72170) |
$229.20 |
$764 |
2.0× |
| Peritoneogram Rs&I (74190) |
$414 |
$1,380 |
0.7× |
| Pet Image Skull-Thigh (78812) |
$1,643.40 |
$5,478 |
1.1× |
| Pet Image W/Ct Lmtd (78814) |
$1,554 |
$5,180 |
1.0× |
| PET image w/CT, full body (78816) |
$2,256.60 |
$7,522 |
1.5× |
| PET imaging CT attenuation skull base mid-thigh (78815) |
$2,296.80 |
$7,656 |
1.5× |
| Pet Imaging Limited Area Chest Head/Neck (78811) |
$1,554 |
$5,180 |
1.1× |
| Pet Myocardial Sngl Study (78491) |
$2,146.80 |
$7,156 |
1.4× |
| PET whole body (78813) |
$1,643.40 |
$5,478 |
1.1× |
| Plasma Vol Radiopharm Vol Dilute Spx Mult Smples (78111) |
$339.90 |
$1,133 |
0.2× |
| Prq Transhepatc Portograpy Hemodyn Eval Rs&I (75885) |
$1,924.20 |
$6,414 |
0.6× |
| Pulmonary Perfusion Imaging Particulate (78580) |
$410.40 |
$1,368 |
1.0× |
| Radex Abd Compl Aqt Abd W/S/E/D Views 1 View Ch (74022) |
$162.60 |
$542 |
1.5× |
| Radex abscess/fistula/sinus tract rs&i (76080) |
$445.20 |
$1,484 |
0.8× |
| Radex Ankle Complete Minimum 3 Views (73610) |
$182.70 |
$609 |
2.0× |
| Radex Calcaneus Minimum 2 Views (73650) |
$150.30 |
$501 |
1.6× |
| Radex elbow complete minimum 3 views (73080) |
$176.40 |
$588 |
1.9× |
| Radex Facial Bones Complete Minimum 3 Views (70150) |
$207.90 |
$693 |
1.9× |
| Radex fingr minimum 2 views (73140) |
$139.50 |
$465 |
1.5× |
| Radex foot complete minimum 3 views (73630) |
$192.30 |
$641 |
2.1× |
| Radex Hand Minimum 3 Views (73130) |
$182.70 |
$609 |
2.0× |
| Radex lower extremity infant minimum 2 views (73592) |
$211.50 |
$705 |
2.3× |
| Radex Mastoids Compl Minimum 3 Views PR Side (70130) |
$58.50 |
$195 |
0.5× |
| Radex Nasal Bones Complete Minimum 3 Views (70160) |
$189.60 |
$632 |
2.0× |
| Radex Ribs Unilateral 2 Views (71100) |
$169.20 |
$564 |
1.8× |
| Radex shoulder complete minimum 2 views (73030) |
$191.70 |
$639 |
2.1× |
| Radex Sinuses Paransl < 3 Views (70210) |
$96.30 |
$321 |
1.0× |
| Radex sm int w/mlt srl imges via enteroclss tube (74251) |
$687 |
$2,290 |
3.7× |
| Radex Spine 1 View Specify Level (72020) |
$129.90 |
$433 |
1.4× |
| Radex Sternum Minimum 2 Views (71120) |
$129.30 |
$431 |
1.4× |
| Radex Temporomandble Jt Opn & Clsd Mouth Bilat (70330) |
$186.30 |
$621 |
2.0× |
| Radex Toe Minimum 2 Views (73660) |
$139.50 |
$465 |
1.5× |
| Radex upper extremity infant minimum 2 views (73092) |
$176.40 |
$588 |
1.6× |
| Radex Wrist Complete Minimum 3 Views (73110) |
$201.90 |
$673 |
2.2× |
| Radex X-Ray Exam Entire Spi 6/> Vw - Xr Entire Spine 6+ Vw (72084) |
$263.70 |
$879 |
2.4× |
| Radiation Delivery Stereotactic Cranial Linear (77372) |
$4,910.40 |
$16,368 |
0.6× |
| Radiation treatment delivery level 1 (77402) |
$131.10 |
$437 |
1.2× |
| Radiation treatment delivery level 2 (77407) |
$309.90 |
$1,033 |
0.7× |
| Radiation treatment delivery level 3 (77412) |
$444 |
$1,480 |
0.7× |
| Radiolog exam mandible compl minimum 4 views (70110) |
$225 |
$750 |
2.0× |
| Radiologic Exam Abdomen 3+ Views - Xr Abdomen 3+ Views (74021) |
$121.50 |
$405 |
1.1× |
| Radiologic exam colon double contrast study (74280) |
$612.30 |
$2,041 |
3.3× |
| Radiologic exam colon single contrast study (74270) |
$453.60 |
$1,512 |
2.4× |
| Radiologic Exam Esophagus Double Contrast Study (74221) |
$187.20 |
$624 |
1.0× |
| Radiologic exam knee complete 4/more views (73564) |
$216.30 |
$721 |
1.9× |
| Radiologic exam pelvis compl minimum 3 views (72190) |
$272.70 |
$909 |
2.4× |
| Radiologic Exam Small Int Single Contrast Study (74250) |
$465.90 |
$1,553 |
2.5× |
| Radiologic exam swallow function contrast study (74230) |
$268.20 |
$894 |
1.4× |
| Radiologic exam upr gi trc double contrast study (74246) |
$656.70 |
$2,189 |
3.5× |
| Radiologic examination femur 1 view (73551) |
$191.40 |
$638 |
2.1× |
| Radiologic examination femur minimum 2 views (73552) |
$214.50 |
$715 |
2.3× |
| Radiologic examination knee 1/2 views (73560) |
$179.70 |
$599 |
1.9× |
| Radiologic Examination Osseous Survey Limited (77074) |
$364.80 |
$1,216 |
3.3× |
| Radiologic Examination Salivary Gland Calculus (70380) |
$75.60 |
$252 |
0.8× |
| Radiologic examination tibia & fibula 2 views (73590) |
$176.40 |
$588 |
1.9× |
| Radiologic examination, internal auditory meati, complete Non-Facility (70134) |
$129.30 |
$431 |
0.2× |
| Radiopharmaceutical therapy, by interstitial radioactive colloid administration Facility (79300) |
$1,515.90 |
$5,053 |
6.1× |
| Radiopharmaceutical therapy, by intracavitary administration Non-Facility (79200) |
$291.30 |
$971 |
1.2× |
| Red Cell Volume Determination Spx Mult Samplings (78121) |
$325.20 |
$1,084 |
0.6× |
| Ribs bilateral 3 views (71110) |
$145.50 |
$485 |
1.3× |
| Rp loclzj tum plnr 1 area single day imaging (78800) |
$594.90 |
$1,983 |
1.4× |
| Rp loclzj tum plnr 2+area 1+d img/1 area img>2+d (78801) |
$1,396.80 |
$4,656 |
3.3× |
| Rp Loclzj Tum Plnr Whole Body 2+ Days Imaging (78804) |
$1,641.90 |
$5,473 |
2.8× |
| Rp Loclzj Tum Plnr Whole Body Single Day Imaging (78802) |
$1,054.50 |
$3,515 |
1.8× |
Rp Loclzj Tum Spect 1 Area Single Day Imaging (78803)
range across 2 matching MRF lines |
$889.80–$1,309.50 |
$2,966–$4,365 |
varies |
| Rp loclzj tum spect 2 area/sep acquisj img (78831) |
$1,309.50 |
$4,365 |
0.9× |
| Rp loclzj tum spect CT 2area 1d img/1 ar img>2+d (78832) |
$1,485.30 |
$4,951 |
1.0× |
| Rp loclzj tum spect w/CT 1 area/acquisj 1day img (78830) |
$1,309.50 |
$4,365 |
0.9× |
| Rp Ther Radiolbld Monoclonal Antibody IV Infus (79403) |
$852.90 |
$2,843 |
3.4× |
| Rp Therapy Intravenous Administration (79101) |
$1,044.60 |
$3,482 |
4.2× |
| Salivary Gland Imaging (78230) |
$501.90 |
$1,673 |
1.2× |
| Scapula (73010) |
$176.10 |
$587 |
1.6× |
| Screening Digital Breast Tomosynthesis Bi (77063) |
$31.50 |
$105 |
1.3× |
| Sella turcica (70240) |
$96.60 |
$322 |
1.0× |
| Shoulder 1 view (73020) |
$130.20 |
$434 |
1.4× |
| Shoulder Arthrography (73040) |
$500.10 |
$1,667 |
1.3× |
| Sialogram (70390) |
$132.60 |
$442 |
0.5× |
| Skull less than 4 views (70250) |
$151.80 |
$506 |
1.4× |
| Special dosimetry (77331) |
$361.80 |
$1,206 |
2.5× |
| Special Physics Consult (77370) |
$402.60 |
$1,342 |
2.8× |
| Special treatment procedure (77470) |
$1,423.80 |
$4,746 |
2.4× |
| Stereotactic Body Radiation Delivery (77373) |
$2,626.50 |
$8,755 |
1.4× |
| Sternoclavicular joints (71130) |
$135.90 |
$453 |
1.5× |
| Superior sagittal sinus venogram (75870) |
$1,131.90 |
$3,773 |
0.3× |
| Surface Applic Low Dose Rate Radionuclide Source (77789) |
$2,050.20 |
$6,834 |
18.8× |
| Tbs technical calculation only (77091) |
$74.40 |
$248 |
0.8× |
| Telethx isodose pln cplx w/basic dosimetry (77307) |
$147.30 |
$491 |
0.4× |
| Telethx isodose pln smpl w/dosimetry calculation (77306) |
$147.30 |
$491 |
0.4× |
| Testicular Imaging W/Flow (78761) |
$449.70 |
$1,499 |
1.0× |
| Ther Rad Simulaj-Aided Field Setting Complex (77290) |
$1,393.50 |
$4,645 |
3.5× |
| Ther rad simulaj-aided field setting simple (77280) |
$698.70 |
$2,329 |
4.9× |
| Thoracic spine 2 views (72070) |
$176.40 |
$588 |
1.6× |
| Thoracic spine 3 views (72072) |
$175.80 |
$586 |
1.6× |
| Thoracolumbar 2 views (72080) |
$154.80 |
$516 |
1.7× |
| Thyroid Imaging With Vascular Flow (78013) |
$402.90 |
$1,343 |
0.9× |
| Thyroid Met Imaging Body (78018) |
$1,054.50 |
$3,515 |
1.8× |
| Thyroid Uptake Measurement (78012) |
$402.60 |
$1,342 |
0.9× |
| Thyroid Uptake W/Blood Flow Sngle/Mult Quan Meas (78014) |
$807 |
$2,690 |
1.9× |
| Tx Devices Design & Construction Complex (77334) |
$640.20 |
$2,134 |
1.6× |
| Tx devices design & construction intermediate (77333) |
$291.30 |
$971 |
2.0× |
| Tx devices design & construction simple (77332) |
$318.90 |
$1,063 |
2.2× |
Ultrasound Breast Limited (76642)
range across 3 matching MRF lines |
$74.40–$157.80 |
$248–$526 |
varies |
| Ultrasound elastography first target lesion (76982) |
$594.90 |
$1,983 |
5.3× |
| Ultrasound Elastography Parenchyma (76981) |
$594.90 |
$1,983 |
5.3× |
| Ultrasound Exam Aaa Screen (76706) |
$199.20 |
$664 |
1.8× |
| Ultrasound trgt dynamic microbubble 1st lesion (76978) |
$154.50 |
$515 |
0.4× |
| Ultrasound, abdomen limited (76705) |
$387 |
$1,290 |
3.5× |
| Umbilical-artery Doppler (OB) (76820) |
$132.90 |
$443 |
1.2× |
Unlisted Dx Radiographic Procedure (76499)
range across 12 matching MRF lines |
$17.70–$152.70 |
$59–$509 |
varies |
| Unlisted fluoroscopic procedure (76496) |
$335.70 |
$1,119 |
3.6× |
Unlisted magnetic resonance procedure (76498)
range across 2 matching MRF lines |
$660.60–$1,131.60 |
$2,202–$3,772 |
varies |
| Upper gi w/o kub (74240) |
$437.40 |
$1,458 |
2.3× |
| Ureteral Reflux Study (78740) |
$726 |
$2,420 |
1.7× |
| Urethrocystogram voiding (74455) |
$459.30 |
$1,531 |
1.8× |
| Urethrocystography retrograde (74450) |
$452.70 |
$1,509 |
1.8× |
Us breast unilateral complete (76641)
range across 3 matching MRF lines |
$91.80–$203.40 |
$306–$678 |
varies |
| Us chest (76604) |
$196.50 |
$655 |
1.8× |
Us complete joint (76881)
range across 2 matching MRF lines |
$144.60–$184.80 |
$482–$616 |
varies |
| Us exam, pelvic, limited (76857) |
$332.70 |
$1,109 |
3.0× |
| Us head (76506) |
$227.10 |
$757 |
2.0× |
| Us kidney transplant (76776) |
$309.60 |
$1,032 |
2.8× |
Us lmtd joint/oth nonvasc xtr strux r-t w/img (76882)
range across 4 matching MRF lines |
$89.40–$220.20 |
$298–$734 |
varies |
| Us ob detailed single fetus (76811) |
$250.80 |
$836 |
1.0× |
| Us ob limited 1 or more fetuses (76815) |
$351.30 |
$1,171 |
3.1× |
| Us ob transvaginal (76817) |
$117 |
$390 |
1.0× |
| Us pelvic non ob complete (76856) |
$413.70 |
$1,379 |
3.7× |
| Us pg uter img f&mat 14 wk tabdl 1/1st gestation (76801) |
$104.40 |
$348 |
0.9× |
| Us preg uterus real time f/u trnsabdl per fetus (76816) |
$226.50 |
$755 |
2.0× |
| Us retroperitoneal complete (76770) |
$358.50 |
$1,195 |
3.2× |
| Us retroperitoneal limited (76775) |
$243 |
$810 |
2.2× |
| Us scrotum and contents (76870) |
$430.20 |
$1,434 |
3.8× |
| Us spinal canal and contents (76800) |
$243.90 |
$813 |
2.2× |
| Us thyroid (76536) |
$388.20 |
$1,294 |
3.5× |
| Us transrectal (76872) |
$233.70 |
$779 |
2.1× |
| Vascular Flow Imaging (78445) |
$248.10 |
$827 |
0.6× |
| Vasogram (74440) |
$235.80 |
$786 |
0.9× |
| Vein X-Ray Chest (75827) |
$1,368.30 |
$4,561 |
0.8× |
| Vein X-Ray Liver W/O Hemodyn (75887) |
$1,736.70 |
$5,789 |
0.5× |
| Vein X-Ray Skull Epidural (75872) |
$967.50 |
$3,225 |
1.4× |
| Venogram Sinus/Jugular (75860) |
$1,461.60 |
$4,872 |
0.4× |
| Venography Adrenal Unilateral (75840) |
$1,131.90 |
$3,773 |
0.3× |
| Venography caval inferior serialography rs&i (75825) |
$1,010.70 |
$3,369 |
0.3× |
| Venography extremity bilateral rs&i (75822) |
$765.90 |
$2,553 |
0.5× |
| Venography extremity unilateral rs&i (75820) |
$396.60 |
$1,322 |
0.2× |
| Venography Orbital Rs&I (75880) |
$1,131.90 |
$3,773 |
1.7× |
| Venography Renal Bilateral (75833) |
$1,854.90 |
$6,183 |
0.5× |
| Venography Renal Unilateral (75831) |
$1,514.70 |
$5,049 |
0.4× |
Venous sampling by catheter (75893)
likely a partial charge, not the full procedure |
$924.30 |
$3,081 |
0.2× |
| Venous thrombosis imaging (78457) |
$248.10 |
$827 |
0.4× |
| Venous Thrombosis Imaging Venogram Bilateral (78458) |
$126.90 |
$423 |
0.3× |
| Vertebral fracture assessment via dxa (77086) |
$77.70 |
$259 |
0.8× |
| Wrist 2 views (73100) |
$139.50 |
$465 |
1.5× |
| X-Ray Ac Jts - Xr Acromioclavicular Joints Bilateral (73050) |
$186.30 |
$621 |
2.0× |
| X-ray antegrade pyelogram tube (74425) |
$411 |
$1,370 |
1.1× |
| X-Ray Aorta Leg Arteries (75630) |
$1,373.70 |
$4,579 |
0.4× |
| X-Ray Bend Only L-S Spine (72120) |
$138.60 |
$462 |
1.2× |
| X-Ray Elbow 2 Vw - Xr Elbow 1-2 Views Right (73070) |
$146.40 |
$488 |
1.6× |
| X-Ray Exam Breast Specimen (76098) |
$538.80 |
$1,796 |
0.9× |
| X-Ray Exam Entire Spi 1 Vw (72081) |
$191.40 |
$638 |
2.1× |
| X-Ray Exam Entire Spi 2/3 Vw (72082) |
$214.50 |
$715 |
1.9× |
| X-Ray Exam Entire Spi 4/5 Vw (72083) |
$239.70 |
$799 |
2.1× |
X-Ray Exam Hip Uni 1 View (73501)
range across 2 matching MRF lines |
$166.50–$191.40 |
$555–$638 |
varies |
| X-Ray Exam Hip Uni 2-3 Views (73502) |
$191.40 |
$638 |
2.1× |
X-Ray Exam Hip Uni 4/> Views (73503)
range across 2 matching MRF lines |
$214.50–$239.70 |
$715–$799 |
varies |
| X-Ray Exam Hips Bi 2 Views (73521) |
$239.70 |
$799 |
2.1× |
X-Ray Exam Hips Bi 3-4 Views (73522)
range across 2 matching MRF lines |
$239.70–$263.70 |
$799–$879 |
varies |
| X-Ray Exam L-S Spine Bending (72114) |
$340.20 |
$1,134 |
3.0× |
| X-Ray Exam Neck Spine 2-3 Vw (72040) |
$195.90 |
$653 |
2.1× |
| X-Ray Exam Neck Spine 6/>Vws (72052) |
$347.70 |
$1,159 |
3.1× |
| X-Ray Exam Unilat Ribs/Chest (71101) |
$263.40 |
$878 |
2.4× |
| X-ray eye for foreign body (70030) |
$120.60 |
$402 |
1.3× |
| X-ray head for orthodontia (70350) |
$81.30 |
$271 |
0.9× |
| X-ray humerus (73060) |
$195.90 |
$653 |
2.1× |
| X-ray IV pyelogram (ivp) (74400) |
$291.30 |
$971 |
1.5× |
| X-ray IV pyelogram+tomography (74415) |
$361.80 |
$1,206 |
1.9× |
| X-Ray Jaw <4 Vw - Xr Mandible < 4 Views (70100) |
$85.50 |
$285 |
0.9× |
| X-Ray Knee Bilat Standing - Xr Knees Anteroposterior Standing Bilat (73565) |
$158.10 |
$527 |
1.7× |
| X-Ray Lumbar Spine 2/3 Vw - Xr Lumbar Spine 2-3 Views (72100) |
$222 |
$740 |
2.0× |
| X-ray nose-rectum child f.b. (76010) |
$58.50 |
$195 |
0.6× |
| X-Ray Ribs, Chest 4+ Vw - Xr Ribs 3 Vws Bil W/ Chest Posteroanterior (71111) |
$226.50 |
$755 |
2.0× |
| X-Ray Sacroiliac Jts 3+ Vw - Xr Sacroiliac Joints 3+ Views (72202) |
$201.90 |
$673 |
1.8× |
| X-Ray Sacrum/Coccyx 2+ Vw - Xr Sacrum Coccyx 2+ Views (72220) |
$171.90 |
$573 |
1.8× |
| X-Ray Sinuses 3+ Vw - Xr Paranasal Sinuses 3+ Views (70220) |
$243 |
$810 |
2.6× |
| X-Ray Skull 4+ Vw - Xr Skull Complete 4+ Views (70260) |
$289.50 |
$965 |
2.6× |
| X-Ray Stress View (77071) |
$161.70 |
$539 |
1.7× |
| X-Ray Urinary Tract Exam With Contrast Material (74420) |
$555.60 |
$1,852 |
1.5× |
| X-Rays Bone Length Studies (77073) |
$90.60 |
$302 |
0.8× |
| X-Rays Bone Survey Complete (77075) |
$526.50 |
$1,755 |
4.7× |
| Xr c-spine 4 or 5 views (72050) |
$303.60 |
$1,012 |
2.7× |
| Xr facial bones less than 3 views (70140) |
$111.30 |
$371 |
1.2× |
| Xr myelogram posterior fossa (70010) |
$694.20 |
$2,314 |
1.9× |
| Xr orbits complete 4 views (70200) |
$253.80 |
$846 |
2.3× |
| Xr Tomogram Single Plane (76100) |
$119.10 |
$397 |
1.1× |