| 3-D radiotherapy plan dose-volume histograms (77295) |
$4,232 |
$10,580 |
3.1× |
| Abdomen 1 View (74018) |
$70.40 |
$176 |
0.8× |
| Abdomen 2 views (74019) |
$222 |
$555 |
2.1× |
| Acute Gastrointestinal Blood Loss Imaging (78278) |
$828.40 |
$2,071 |
2.1× |
| Angio internal mammary (75756) |
$2,717.60 |
$6,794 |
0.9× |
| Angio pulmonary bilat (75743) |
$2,509.20 |
$6,273 |
0.8× |
| Angiography extremity bilateral rs&i (75716) |
$2,520 |
$6,300 |
0.8× |
| Angiography extremity unilateral rs&i (75710) |
$1,632.80 |
$4,082 |
0.5× |
| Angiography pulmonary unilateral slctv rs&i (75741) |
$2,647.20 |
$6,618 |
0.8× |
| Angrph pulmonary nonslctv cath/ven njx rs&i (75746) |
$1,495.60 |
$3,739 |
0.5× |
| Ankle 2 views (73600) |
$169.20 |
$423 |
2.0× |
| Aortography thoracic serialography rs&i (75605) |
$3,579.20 |
$8,948 |
0.6× |
| Artery X-Rays Abdomen (75726) |
$2,916 |
$7,290 |
0.5× |
| Artery X-Rays Pelvis (75736) |
$3,152 |
$7,880 |
0.6× |
| Artery X-Rays Spine (75705) |
$2,945.20 |
$7,363 |
0.5× |
| Arthrogram ankle (73615) |
$523.60 |
$1,309 |
1.5× |
| Arthrogram hip (73525) |
$570 |
$1,425 |
1.6× |
Basic radiation dosimetry calculation (77300)
range across 2 matching MRF lines |
$352.80–$418.40 |
$882–$1,046 |
varies |
| Bone age studies (77072) |
$246.80 |
$617 |
2.4× |
| Bone Imaging 3 Phase (78315) |
$1,086 |
$2,715 |
2.7× |
| Bone Imaging Multiple Areas (78305) |
$697.60 |
$1,744 |
1.8× |
| Bone Imaging Whole Body (78306) |
$860.40 |
$2,151 |
2.2× |
| Bone marrow imaging limited area (78102) |
$506.40 |
$1,266 |
1.3× |
| Bone marrow imaging; whole body (78104) |
$678.80 |
$1,697 |
1.7× |
| Bone survey infant (77076) |
$319.20 |
$798 |
3.1× |
| Brachytx isodose complex (77318) |
$2,162.80 |
$5,407 |
5.8× |
| Brachytx isodose intermed (77317) |
$2,050.40 |
$5,126 |
5.5× |
| Brachytx Isodose Plan Simple (77316) |
$2,480 |
$6,200 |
6.6× |
| Brain Image W/Flow < 4 Views (78601) |
$1,186 |
$2,965 |
3.0× |
| Brain Imaging Pet Metabolic Evaluation (78608) |
$3,965.60 |
$9,914 |
2.8× |
| Card Bl Pool Gated Spect Rest Wal Motn Ejct Frct (78494) |
$780.40 |
$1,951 |
2.0× |
| Cardiac MRI w/w/o contrast & further seq (75561) |
$1,769.60 |
$4,424 |
5.1× |
| Cardiac MRI w/w/o contrast w/stress (75563) |
$2,250.40 |
$5,626 |
2.9× |
| Cardiac Shunt Detection (78428) |
$502.80 |
$1,257 |
1.3× |
| Cat Scan Follow-Up Study (76380) |
$453.20 |
$1,133 |
5.2× |
| Chest 1 view (71045) |
$83.20 |
$208 |
1.0× |
| Chest 2 views (71046) |
$124.80 |
$312 |
1.4× |
| Chest 3 views (71047) |
$158 |
$395 |
1.8× |
| Chest 4 or more views (71048) |
$319.20 |
$798 |
3.1× |
| Chg us nrv&acc strux 1 xtr compre w/img pr extremity (76883) |
$62.80 |
$157 |
0.6× |
| Cisternography Positive Contrast Rs&I (70015) |
$520 |
$1,300 |
0.7× |
| Clavicle complete (73000) |
$259.60 |
$649 |
3.0× |
| Computed Tomography Thorax Lw Dose Lng Ca Scr C- (71271) |
$504.80 |
$1,262 |
4.8× |
| Continuing medical physics consltj pr wk (77336) |
$438.80 |
$1,097 |
3.3× |
| Contrast Exam Abdominl Aorta (75625) |
$3,256.40 |
$8,141 |
1.0× |
| Contrast X-Ray Bladder (74430) |
$289.20 |
$723 |
0.8× |
| Contrast X-Ray Of Elbow (73085) |
$249.20 |
$623 |
0.7× |
| Contrast X-Ray Of Knee Joint (73580) |
$456.40 |
$1,141 |
1.3× |
| Contrast Xray Throat/Cerv Esopha (74210) |
$322.40 |
$806 |
1.8× |
| CT abdomen and pelvis without and with contrast (74178) |
$2,388.40 |
$5,971 |
6.9× |
| CT abdomen and pelvis without contrast (74176) |
$1,728.40 |
$4,321 |
7.3× |
| CT abdomen w contrast (74160) |
$1,022 |
$2,555 |
5.8× |
| CT abdomen w wo contrast (74170) |
$1,232 |
$3,080 |
7.0× |
| CT abdomen w/o contrast (74150) |
$873.20 |
$2,183 |
8.4× |
| CT Angio Abdomen and Pelvis (74174) |
$2,403.60 |
$6,009 |
6.9× |
| CT Angio Chest (71275) |
$1,300 |
$3,250 |
7.4× |
| CT Angio Head (70496) |
$1,292.40 |
$3,231 |
7.4× |
| CT angio hrt w/3d image (75574) |
$1,170.40 |
$2,926 |
3.4× |
| Ct Angio Lwr Extr W/O&W/Dye (73706) |
$1,086 |
$2,715 |
6.2× |
| CT Angio Neck (70498) |
$1,278 |
$3,195 |
7.3× |
| Ct Angio Upr Extrm W/O&W/Dye (73206) |
$1,358.80 |
$3,397 |
7.8× |
| CT cervical spine w/ contrast (72126) |
$1,464 |
$3,660 |
4.2× |
| CT cervical spine w/o contrast (72125) |
$965.60 |
$2,414 |
9.3× |
| CT cervical spine w/wo cont (72127) |
$1,316.80 |
$3,292 |
7.5× |
| CT chest w contrast (71260) |
$1,023.20 |
$2,558 |
5.9× |
| CT chest w/wo contrast (71270) |
$1,348.80 |
$3,372 |
7.7× |
| CT head/brain with contrast (70460) |
$1,238 |
$3,095 |
7.1× |
| CT head/brain without and with contrast (70470) |
$1,590 |
$3,975 |
9.1× |
| CT heart contrast eval cardiac structure&morph (75572) |
$677.20 |
$1,693 |
1.9× |
CT heart no contrast quant eval coronry calcium (75571)
range across 2 matching MRF lines |
$43.20–$320.40 |
$108–$801 |
varies |
| CT hrt w/3d image congen (75573) |
$625.20 |
$1,563 |
1.8× |
| CT iac w contrast (70481) |
$1,290.40 |
$3,226 |
7.4× |
| CT l-spine w&w/o contrast (72133) |
$1,421.60 |
$3,554 |
8.1× |
| CT lower ext w/o (73700) |
$954 |
$2,385 |
9.2× |
| CT lower extremity w/contrast material (73701) |
$986.40 |
$2,466 |
5.6× |
| CT lumbar spine w contrast (72132) |
$1,422 |
$3,555 |
4.1× |
| CT lumbar spine w/o contrast (72131) |
$871.60 |
$2,179 |
8.4× |
| CT maxillofacial w contrast (70487) |
$1,232 |
$3,080 |
7.0× |
| CT maxillofacial wo contrast (70486) |
$1,129.20 |
$2,823 |
10.8× |
| CT neck tissue combo (70492) |
$1,450 |
$3,625 |
8.3× |
| Ct Orbit/Ear/Fossa W/O&W/Dye (70482) |
$1,476.40 |
$3,691 |
8.4× |
| CT orbits w/o contrast (70480) |
$992 |
$2,480 |
9.5× |
| CT pelvis w&w/o contrast (72194) |
$1,407.60 |
$3,519 |
8.1× |
| CT pelvis w/o contrast (72192) |
$946.80 |
$2,367 |
9.1× |
| CT scan of leg combo (73702) |
$1,280.80 |
$3,202 |
7.3× |
| CT scans face/jaw combo (70488) |
$1,309.60 |
$3,274 |
7.5× |
| CT soft tissue neck w contrast (70491) |
$991.60 |
$2,479 |
5.7× |
| CT soft tissue neck w/o contrast (70490) |
$750.40 |
$1,876 |
7.2× |
| CT thoracic spine w contrast (72129) |
$1,222.80 |
$3,057 |
7.0× |
| CT thoracic spine w/o contrast (72128) |
$929.60 |
$2,324 |
8.9× |
| CT thoracic spine w/wo cont (72130) |
$1,393.60 |
$3,484 |
8.0× |
| CT thorax w/o contrast (71250) |
$773.20 |
$1,933 |
7.4× |
| CT upper ext wo (73200) |
$1,068.80 |
$2,672 |
10.3× |
| CT upper extremity w/o & w/contrast material (73202) |
$1,363.60 |
$3,409 |
7.8× |
| CT upper extremity with contrast (73201) |
$923.60 |
$2,309 |
2.7× |
| Cta Abdl Aorta&Bi Iliofem W/Contrast&Postp (75635) |
$1,447.60 |
$3,619 |
8.3× |
| Cta Abdomen (74175) |
$1,245.60 |
$3,114 |
7.1× |
| CTA pelvis (72191) |
$1,710 |
$4,275 |
9.8× |
| Diskography lumbar (72295) |
$1,416.40 |
$3,541 |
0.7× |
| Doppler Echo Fetal Puls Spectral F/U/Repeat (76828) |
$367.20 |
$918 |
3.5× |
| Doppler Echo Fetal Spectral Display Complete (76827) |
$530.80 |
$1,327 |
5.1× |
| Doppler Fetal Mid Cerebral Artery (76821) |
$332.40 |
$831 |
3.2× |
| Dxa Bone Density Axial (77080) |
$287.20 |
$718 |
2.8× |
| Dxa bone density study (77085) |
$119.60 |
$299 |
1.1× |
| Dxa bone density study 1/>sites appendiclr skel (77081) |
$173.60 |
$434 |
2.0× |
| Echo exam of fetal heart (76825) |
$1,053.60 |
$2,634 |
1.9× |
| Echo exam uterus (76831) |
$514 |
$1,285 |
2.2× |
| Echo Guide For Artery Repair (76936) |
$577.60 |
$1,444 |
2.7× |
| Echocardiography, fetal, cardiovascular system, real time with image documentation (2D), with or without M-mode… (76826) |
$510 |
$1,275 |
2.1× |
| Echograp Trans R Pros Study (76873) |
$483.20 |
$1,208 |
4.6× |
| Esophagram (74220) |
$262.40 |
$656 |
1.5× |
| Fetal Biophys Profile W/Nst (76818) |
$430.80 |
$1,077 |
4.1× |
| Fetal Biophysical Profile W/O Non-Stress Testing (76819) |
$452.40 |
$1,131 |
4.3× |
| Fetal MRI w/placntl matrnl plvc img sing/1st ges (74712) |
$1,292 |
$3,230 |
5.4× |
| Fluoroscopy up to 1 hr (76000) |
$406 |
$1,015 |
1.7× |
| Follow-Up Angiography (75898) |
$1,720 |
$4,300 |
0.5× |
| Foot 2 views (73620) |
$136.40 |
$341 |
1.6× |
| Forearm 2 views (73090) |
$236 |
$590 |
2.7× |
| Gastric emptying imaging study (78264) |
$1,118.40 |
$2,796 |
2.8× |
| Gated Heart Planar Single (78472) |
$570.40 |
$1,426 |
1.4× |
| Hand 2 views (73120) |
$137.20 |
$343 |
1.3× |
| Hdr Rdncl Ntrstl/Icav Brchtx (77772) |
$3,375.20 |
$8,438 |
4.9× |
| Hdr Rdncl Ntrstl/Icav Brchtx (77771) |
$1,707.20 |
$4,268 |
2.5× |
| Hdr Rdncl Ntrstl/Icav Brchtx 1 Channel (77770) |
$2,077.20 |
$5,193 |
3.0× |
| Heart Image (Pet) Multiple (78492) |
$2,363.20 |
$5,908 |
1.7× |
| Hepatc Vngrph Wdg/Fr Hemodyn Eval Rs&I (75889) |
$2,627.20 |
$6,568 |
0.8× |
| Hepatc Vngrph Wdg/Fr W/O Hemodyn Eval Rs&I (75891) |
$1,965.60 |
$4,914 |
0.6× |
| Hepatobil Syst Image W/Drug (78227) |
$1,333.20 |
$3,333 |
2.5× |
| Hepatobiliary System Imaging (78226) |
$1,014.40 |
$2,536 |
2.5× |
| Ht Musc Image Planar Mult (78454) |
$1,039.20 |
$2,598 |
0.8× |
| Ht Muscle Image Spect Sing (78451) |
$1,405.60 |
$3,514 |
1.1× |
| Hysterosalpingogram (74740) |
$630.40 |
$1,576 |
2.7× |
| Infant hip ultrasound with hip movement (dynamic) (76885) |
$426.40 |
$1,066 |
4.9× |
| Interstitial radiation source applic complex (77778) |
$2,896.40 |
$7,241 |
4.2× |
| K Flow/Funct Image Multiple (78709) |
$924.80 |
$2,312 |
1.7× |
| K Flow/Funct Image W/Drug (78708) |
$1,122.40 |
$2,806 |
2.1× |
K Flow/Funct Image W/O Drug (78707)
range across 2 matching MRF lines |
$897.20–$1,274.40 |
$2,243–$3,186 |
varies |
| Knee 3 Views (73562) |
$154 |
$385 |
1.8× |
| Liver & Spleen Imaging Static Only (78215) |
$456 |
$1,140 |
1.1× |
| Lung Perf&Ventilat Diferentl (78598) |
$765.20 |
$1,913 |
1.4× |
| Lung perfusion differential (78597) |
$811.20 |
$2,028 |
2.0× |
| Lung Ventilat&Perfus Imaging (78582) |
$900.40 |
$2,251 |
1.7× |
| Lung Ventilation Imaging (78579) |
$507.60 |
$1,269 |
1.3× |
| Lymph System Imaging (78195) |
$1,220 |
$3,050 |
2.3× |
| Lymphangiography Extremity Only Bilateral Rs&I (75803) |
$2,714 |
$6,785 |
1.7× |
| Lymphangiography extremity only unilateral rs&i (75801) |
$1,107.20 |
$2,768 |
1.8× |
| Lymphangiography Pelvic/Abdominal Bilateral Rs&I (75807) |
$5,429.60 |
$13,574 |
1.7× |
| Lymphangiography, pelvic/abdominal, unilateral (75805) |
$5,429.60 |
$13,574 |
1.7× |
| Magnetic Image Jaw Joint (70336) |
$1,655.20 |
$4,138 |
7.0× |
| Magnetic resonance (eg, proton) imaging, brain (including brain stem andskull base), during open intracranial procedure… (70558) |
$2,839.20 |
$7,098 |
16.2× |
| Magnetic resonance (eg, proton) imaging, brain (including brain stem andskull base), during open intracranial procedure… (70557) |
$3,102 |
$7,755 |
5.7× |
| Magnetic resonance (eg, proton) imaging, brain (including brain stem andskull base), during open intracranial procedure… (70559) |
$3,791.20 |
$9,478 |
21.7× |
| Magnetic Resonance Elastography (76391) |
$581.20 |
$1,453 |
2.4× |
| Mammary ductogram or galactogram single (77053) |
$279.60 |
$699 |
1.2× |
| Meckels Divert Exam (78290) |
$1,143.20 |
$2,858 |
2.9× |
| Mlc imrt design & construction per imrt plan (77338) |
$1,346.40 |
$3,366 |
3.6× |
| Mra Head W/O & W/Contrast Material (70546) |
$2,034.80 |
$5,087 |
5.9× |
| MRA head w/o contrast (70544) |
$1,287.60 |
$3,219 |
5.4× |
| MRA head with contrast (70545) |
$1,625.60 |
$4,064 |
4.7× |
| MRA neck w contrast (70548) |
$1,506.80 |
$3,767 |
4.3× |
| Mra Neck W/O &W/Contrast Material (70549) |
$1,921.60 |
$4,804 |
5.5× |
| MRA neck w/o contrast (70547) |
$1,155.60 |
$2,889 |
4.9× |
| MRI abdomen w contrast (74182) |
$1,496 |
$3,740 |
4.3× |
| MRI abdomen w/o contrast (74181) |
$1,500.80 |
$3,752 |
6.3× |
| MRI any jt lower extrem w/contrast material (73722) |
$2,267.60 |
$5,669 |
2.9× |
| MRI any jt lower extrem w/o & w/contrast matrl (73723) |
$1,696.40 |
$4,241 |
4.9× |
| MRI any jt upper extremity w/contrast matrl (73222) |
$2,720.80 |
$6,802 |
3.5× |
| MRI brain functional w/o physician admnistration (70554) |
$866.80 |
$2,167 |
3.6× |
| MRI brain functional w/physician admnistration (70555) |
$1,542.80 |
$3,857 |
6.5× |
| MRI Breast W/O Contrast Bilateral (77047) |
$755.60 |
$1,889 |
3.2× |
| MRI Breast Without Contrast Material Unilateral (77046) |
$476 |
$1,190 |
2.0× |
| MRI cardiac w/o cont stress (75559) |
$1,350 |
$3,375 |
2.5× |
| MRI cardiac w/o contrast (75557) |
$1,942.40 |
$4,856 |
8.2× |
| MRI cervical spine w contrast (72142) |
$2,014 |
$5,035 |
5.8× |
| MRI cervical spine w/o cont (72141) |
$1,410.80 |
$3,527 |
5.9× |
| MRI chest w/o contrast (71550) |
$1,919.60 |
$4,799 |
8.1× |
| MRI chest with contrast (71551) |
$1,380.80 |
$3,452 |
1.8× |
| MRI chest wo w contrast (71552) |
$2,984 |
$7,460 |
8.6× |
| MRI lower extrem oth/thn jt w/contrast matrl (73719) |
$1,786.40 |
$4,466 |
5.1× |
| MRI lower extrem oth/thn jt w/o & w/contr matr (73720) |
$1,472.80 |
$3,682 |
4.2× |
| MRI lower extrem oth/thn jt w/o contr matrl (73718) |
$1,596 |
$3,990 |
6.7× |
| MRI lumbar spine w contrast (72149) |
$2,339.60 |
$5,849 |
6.7× |
| Mri Neck Spine W/O & W/Dye (72156) |
$2,526 |
$6,315 |
7.3× |
| MRI orbit face &/neck w/o contrast (70540) |
$1,410 |
$3,525 |
5.9× |
| MRI orbit face neck w contrast (70542) |
$2,167.20 |
$5,418 |
6.2× |
| Mri Orbt/Fac/Nck W/O &W/Dye (70543) |
$2,718.40 |
$6,796 |
7.8× |
| MRI pelvis w contrast (72196) |
$2,071.20 |
$5,178 |
6.0× |
| MRI pelvis w/o & w contrast (72197) |
$2,151.60 |
$5,379 |
6.2× |
| MRI pelvis w/o contrast (72195) |
$1,574.40 |
$3,936 |
6.6× |
| MRI spectroscopy (76390) |
$1,385.60 |
$3,464 |
16.0× |
| MRI thoracic spine w/o contrast (72146) |
$1,514.40 |
$3,786 |
6.4× |
| MRI upper extremity oth than jt w/contr matrl (73219) |
$1,616.40 |
$4,041 |
4.6× |
| MRI upper extremity oth than jt w/o contr matrl (73218) |
$1,355.20 |
$3,388 |
5.7× |
| Mri Uppr Extremity W/O&W/Dye (73220) |
$2,037.20 |
$5,093 |
5.9× |
| MRI, abdomen, combo (74183) |
$2,176 |
$5,440 |
6.3× |
| MRI, dorsal spine combo (72157) |
$2,375.20 |
$5,938 |
6.8× |
| MRI, dorsal spine contrast (72147) |
$1,649.20 |
$4,123 |
4.7× |
| MRI, joint upper extrem (73221) |
$1,399.60 |
$3,499 |
5.9× |
| MRI, joint upper extrem combo (73223) |
$2,319.60 |
$5,799 |
6.7× |
| MRI, lumbar spine combo (72158) |
$2,296 |
$5,740 |
6.6× |
| Myelogram Lumbar (72265) |
$749.60 |
$1,874 |
1.0× |
| Myelography thoracic (72255) |
$742.40 |
$1,856 |
1.0× |
| Myelograpy 2/more regions rs&i (72270) |
$589.20 |
$1,473 |
0.8× |
| Myocardial Spect Multiple Studies (78452) |
$2,049.20 |
$5,123 |
1.6× |
| Myocrd Img Pet Metab Eval Single Study Cncrnt CT (78429) |
$1,786.80 |
$4,467 |
1.3× |
| Myocrd img PET prfuj 1std rest/stress cncrnt CT (78430) |
$1,426.80 |
$3,567 |
1.0× |
| Myocrd Img Pet Prfuj Mlt Std Rst&Strs Cncrnt CT (78431) |
$3,182.80 |
$7,957 |
1.5× |
| Myocrd Img Pet Prfuj W/Metab 2rtracer Cncrnt CT (78433) |
$3,273.60 |
$8,184 |
1.5× |
| N-invas est c ffr sw aly CTA (75580) |
$2,798.80 |
$6,997 |
3.3× |
| Neck soft tissue (70360) |
$164.80 |
$412 |
1.9× |
| Nm csf leak detection (78650) |
$900.40 |
$2,251 |
0.7× |
| Nm myocard infarct spect (78469) |
$714.40 |
$1,786 |
1.3× |
| Nm whole blood volume (78122) |
$267.60 |
$669 |
0.5× |
| Nonvascular Shunt X-Ray (75809) |
$260 |
$650 |
2.5× |
| Ntsty modul radthx pln dose-vol histos (77301) |
$5,167.20 |
$12,918 |
3.7× |
| Nuclear Rx Oral Admin (79005) |
$940 |
$2,350 |
4.0× |
| Ob us nuchal meas 1 gest (76813) |
$351.20 |
$878 |
3.4× |
| Oph bmtry us echograpy a-scan io lens pwr cal (76519) |
$230.40 |
$576 |
2.2× |
| Oph us dx ant sgm us immersion b-scan/hr biom (76513) |
$208.80 |
$522 |
2.0× |
| Oph US Dx B-Scan&Quan a-Scan Sm Pt Enctr (76510) |
$414.40 |
$1,036 |
3.1× |
| Ophthalmic Biometry US Echograpy a-Scan (76516) |
$143.20 |
$358 |
1.4× |
| Ophthalmic ultrasound dx b-scan w/wo a-scan (76512) |
$237.60 |
$594 |
2.3× |
| Ophthalmic US Dx Corneal Pachymetry Uni/Bi (76514) |
$59.60 |
$149 |
2.1× |
| Ophthalmic us dx quantitative a-scan only (76511) |
$292 |
$730 |
2.8× |
| Optic foramina (70190) |
$82 |
$205 |
0.9× |
| Panoramic X-ray of jaws (70355) |
$76 |
$190 |
0.9× |
| Parathyroid imaging w/tomographic spect & CT (78072) |
$1,157.60 |
$2,894 |
2.1× |
| Parathyroid Planar Imaging (78070) |
$881.20 |
$2,203 |
2.2× |
| Pelvis 1 or 2 views (72170) |
$162.80 |
$407 |
1.6× |
| Perineogram (74775) |
$426 |
$1,065 |
1.8× |
| Pet Image W/Ct Lmtd (78814) |
$3,644.80 |
$9,112 |
2.6× |
| PET image w/CT, full body (78816) |
$3,364.80 |
$8,412 |
2.4× |
| PET imaging CT attenuation skull base mid-thigh (78815) |
$3,345.60 |
$8,364 |
2.3× |
| Plasma Vol Radiopharm Vol Dilute Spx Mult Smples (78111) |
$704 |
$1,760 |
0.5× |
| Prq Transhepatc Portograpy Hemodyn Eval Rs&I (75885) |
$2,613.60 |
$6,534 |
0.8× |
| Pulmonary Perfusion Imaging Particulate (78580) |
$808.40 |
$2,021 |
2.0× |
| Radex Abd Compl Aqt Abd W/S/E/D Views 1 View Ch (74022) |
$232.40 |
$581 |
2.2× |
| Radex abscess/fistula/sinus tract rs&i (76080) |
$400 |
$1,000 |
0.7× |
| Radex Ankle Complete Minimum 3 Views (73610) |
$202 |
$505 |
2.3× |
| Radex Calcaneus Minimum 2 Views (73650) |
$145.20 |
$363 |
1.7× |
| Radex elbow complete minimum 3 views (73080) |
$241.60 |
$604 |
2.8× |
| Radex Facial Bones Complete Minimum 3 Views (70150) |
$196.80 |
$492 |
1.9× |
| Radex fingr minimum 2 views (73140) |
$212.80 |
$532 |
2.5× |
| Radex foot complete minimum 3 views (73630) |
$179.60 |
$449 |
2.1× |
| Radex Hand Minimum 3 Views (73130) |
$196 |
$490 |
2.3× |
| Radex lower extremity infant minimum 2 views (73592) |
$198.80 |
$497 |
2.3× |
| Radex Mastoids Compl Minimum 3 Views PR Side (70130) |
$183.20 |
$458 |
1.8× |
| Radex Nasal Bones Complete Minimum 3 Views (70160) |
$224.40 |
$561 |
2.6× |
| Radex Pharynx/Larx W/Fluor&/Magnification Tq (70370) |
$258.40 |
$646 |
3.0× |
| Radex Ribs Unilateral 2 Views (71100) |
$188.40 |
$471 |
2.2× |
| Radex shoulder complete minimum 2 views (73030) |
$156.40 |
$391 |
1.8× |
| Radex Sinuses Paransl < 3 Views (70210) |
$73.20 |
$183 |
0.8× |
| Radex Spine 1 View Specify Level (72020) |
$186 |
$465 |
2.1× |
| Radex Sternum Minimum 2 Views (71120) |
$275.20 |
$688 |
3.2× |
| Radex Temporomandble Jt Opn & Clsd Mouth Bilat (70330) |
$186.80 |
$467 |
2.2× |
| Radex Toe Minimum 2 Views (73660) |
$149.60 |
$374 |
1.7× |
| Radex upper extremity infant minimum 2 views (73092) |
$174.40 |
$436 |
1.7× |
| Radex Wrist Complete Minimum 3 Views (73110) |
$208.40 |
$521 |
2.4× |
Radex X-Ray Exam Entire Spi 6/> Vw - Xr Entire Spine 6+ Vw (72084)
range across 2 matching MRF lines |
$240.40–$245.20 |
$601–$613 |
varies |
| Radiation Delivery Stereotactic Cranial Linear (77372) |
$6,135.60 |
$15,339 |
0.8× |
| Radiation treatment delivery level 1 (77402) |
$314.40 |
$786 |
3.1× |
| Radiation treatment delivery level 2 (77407) |
$445.60 |
$1,114 |
1.2× |
| Radiation treatment delivery level 3 (77412) |
$676.40 |
$1,691 |
1.2× |
| Radiolog exam mandible compl minimum 4 views (70110) |
$250.80 |
$627 |
2.4× |
| Radiologic Exam Abdomen 3+ Views - Xr Abdomen 3+ Views (74021) |
$284 |
$710 |
2.7× |
| Radiologic exam colon double contrast study (74280) |
$748.80 |
$1,872 |
4.3× |
| Radiologic exam colon single contrast study (74270) |
$468.40 |
$1,171 |
2.7× |
| Radiologic Exam Esophagus Double Contrast Study (74221) |
$308 |
$770 |
1.8× |
| Radiologic exam knee complete 4/more views (73564) |
$204.80 |
$512 |
2.0× |
| Radiologic exam pelvis compl minimum 3 views (72190) |
$269.60 |
$674 |
2.6× |
| Radiologic Exam Small Int Single Contrast Study (74250) |
$388.80 |
$972 |
2.2× |
| Radiologic exam swallow function contrast study (74230) |
$352.80 |
$882 |
2.0× |
| Radiologic exam upr gi trc double contrast study (74246) |
$468 |
$1,170 |
2.7× |
| Radiologic examination femur 1 view (73551) |
$78.80 |
$197 |
0.9× |
| Radiologic examination femur minimum 2 views (73552) |
$114.80 |
$287 |
1.3× |
| Radiologic examination knee 1/2 views (73560) |
$154 |
$385 |
1.8× |
| Radiologic Examination Osseous Survey Limited (77074) |
$260.80 |
$652 |
2.5× |
| Radiologic examination tibia & fibula 2 views (73590) |
$188 |
$470 |
2.2× |
| Radiologic examination, teeth; single view Non-Facility (70300) |
$84 |
$210 |
1.0× |
| Radiopharm Dacryocystography (78660) |
$572 |
$1,430 |
1.4× |
| Red Cell Volume Determination Spx Mult Samplings (78121) |
$267.60 |
$669 |
0.5× |
| Ribs bilateral 3 views (71110) |
$197.20 |
$493 |
1.9× |
| Rp loclzj tum plnr 1 area single day imaging (78800) |
$694.40 |
$1,736 |
1.7× |
| Rp Loclzj Tum Plnr Whole Body 2+ Days Imaging (78804) |
$1,843.60 |
$4,609 |
3.4× |
| Rp Loclzj Tum Plnr Whole Body Single Day Imaging (78802) |
$1,368.40 |
$3,421 |
2.5× |
| Rp Loclzj Tum Spect 1 Area Single Day Imaging (78803) |
$1,087.20 |
$2,718 |
2.0× |
| Rp loclzj tum spect 2 area/sep acquisj img (78831) |
$1,074 |
$2,685 |
0.8× |
| Rp loclzj tum spect CT 2area 1d img/1 ar img>2+d (78832) |
$1,432 |
$3,580 |
1.0× |
| Rp loclzj tum spect w/CT 1 area/acquisj 1day img (78830) |
$1,305.20 |
$3,263 |
1.0× |
| Rp Ther Radiolbld Monoclonal Antibody IV Infus (79403) |
$837.60 |
$2,094 |
3.6× |
| Rp Therapy Intravenous Administration (79101) |
$409.20 |
$1,023 |
1.8× |
| Salivary Gland Imaging Serial Images (78231) |
$910.80 |
$2,277 |
2.3× |
| Scapula (73010) |
$228 |
$570 |
2.2× |
| Screening Digital Breast Tomosynthesis Bi (77063) |
$74.80 |
$187 |
3.2× |
| Shoulder 1 view (73020) |
$110.40 |
$276 |
1.3× |
| Shoulder Arthrography (73040) |
$402.80 |
$1,007 |
1.2× |
| Sialogram (70390) |
$298.40 |
$746 |
1.3× |
| Skull less than 4 views (70250) |
$166.40 |
$416 |
1.6× |
| Special dosimetry (77331) |
$341.20 |
$853 |
2.5× |
| Special Physics Consult (77370) |
$440.40 |
$1,101 |
3.3× |
| Special teletherapy port plan (77321) |
$829.20 |
$2,073 |
2.2× |
| Special treatment procedure (77470) |
$1,140 |
$2,850 |
2.1× |
| Spleen Imaging (78185) |
$358.40 |
$896 |
0.9× |
| Stereotactic Body Radiation Delivery (77373) |
$3,429.20 |
$8,573 |
1.9× |
| Sternoclavicular joints (71130) |
$237.20 |
$593 |
2.7× |
| Superior sagittal sinus venogram (75870) |
$2,764 |
$6,910 |
0.9× |
| Surface Applic Low Dose Rate Radionuclide Source (77789) |
$650.80 |
$1,627 |
6.4× |
| Telethx isodose pln cplx w/basic dosimetry (77307) |
$1,858.40 |
$4,646 |
5.0× |
| Telethx isodose pln smpl w/dosimetry calculation (77306) |
$1,058.80 |
$2,647 |
2.8× |
| Ther Rad Simulaj-Aided Field Setting Complex (77290) |
$1,344.40 |
$3,361 |
3.6× |
| Ther Rad Simulaj-Aided Field Setting Intermed (77285) |
$1,171.20 |
$2,928 |
3.1× |
| Ther rad simulaj-aided field setting simple (77280) |
$711.60 |
$1,779 |
5.3× |
| Therapeutic Enema Rdctj Intussusception/Obstrcj (74283) |
$657.20 |
$1,643 |
3.8× |
| Thoracic spine 2 views (72070) |
$188.80 |
$472 |
1.8× |
| Thoracic spine 3 views (72072) |
$198.80 |
$497 |
1.9× |
| Thoracolumbar 2 views (72080) |
$152.40 |
$381 |
1.8× |
| Thyroid Imaging With Vascular Flow (78013) |
$606 |
$1,515 |
1.5× |
| Thyroid Met Imaging Body (78018) |
$1,460.40 |
$3,651 |
2.7× |
| Thyroid Uptake Measurement (78012) |
$542 |
$1,355 |
1.4× |
| Thyroid Uptake W/Blood Flow Sngle/Mult Quan Meas (78014) |
$601.20 |
$1,503 |
1.5× |
Tx Devices Design & Construction Complex (77334)
range across 3 matching MRF lines |
$841.60–$925.60 |
$2,104–$2,314 |
varies |
Tx devices design & construction intermediate (77333)
range across 3 matching MRF lines |
$340–$663.20 |
$850–$1,658 |
varies |
| Tx devices design & construction simple (77332) |
$330.40 |
$826 |
2.5× |
| Ultrasound Breast Limited (76642) |
$382 |
$955 |
4.4× |
| Ultrasound elastography first target lesion (76982) |
$188.80 |
$472 |
1.8× |
| Ultrasound Elastography Parenchyma (76981) |
$300.80 |
$752 |
2.9× |
| Ultrasound Exam Aaa Screen (76706) |
$289.60 |
$724 |
2.8× |
| Ultrasound trgt dynamic microbubble 1st lesion (76978) |
$416.80 |
$1,042 |
1.2× |
| Ultrasound, abdomen limited (76705) |
$355.20 |
$888 |
3.4× |
| Umbilical-artery Doppler (OB) (76820) |
$307.20 |
$768 |
2.9× |
Unlisted Dx Radiographic Procedure (76499)
range across 5 matching MRF lines |
$48.40–$336.80 |
$121–$842 |
varies |
| Unlisted fluoroscopic procedure (76496) |
$705.20 |
$1,763 |
8.1× |
| Unlisted hematopoietic, reticuloendothelial and lymphatic procedure, diagnostic nuclear medicine (78199) |
$160.40 |
$401 |
0.4× |
Unlisted magnetic resonance procedure (76498)
range across 3 matching MRF lines |
$220.80–$3,006 |
$552–$7,515 |
varies |
| Upper gi w/o kub (74240) |
$397.60 |
$994 |
2.3× |
| Ureteral Reflux Study (78740) |
$856 |
$2,140 |
2.1× |
| Urethrocystogram voiding (74455) |
$542 |
$1,355 |
2.3× |
| Urethrocystography retrograde (74450) |
$704 |
$1,760 |
3.0× |
| Us breast unilateral complete (76641) |
$483.20 |
$1,208 |
4.6× |
| Us chest (76604) |
$309.60 |
$774 |
3.0× |
| Us complete joint (76881) |
$462.40 |
$1,156 |
4.4× |
| Us exam, pelvic, limited (76857) |
$436.80 |
$1,092 |
4.2× |
| Us head (76506) |
$469.20 |
$1,173 |
4.5× |
| Us kidney transplant (76776) |
$377.20 |
$943 |
3.6× |
| Us lmtd joint/oth nonvasc xtr strux r-t w/img (76882) |
$345.60 |
$864 |
3.3× |
| Us ob detailed single fetus (76811) |
$674 |
$1,685 |
2.8× |
| Us ob limited 1 or more fetuses (76815) |
$432.40 |
$1,081 |
4.2× |
| Us ob transvaginal (76817) |
$455.60 |
$1,139 |
4.4× |
| Us pelvic non ob complete (76856) |
$618.40 |
$1,546 |
5.9× |
| Us pg uter img f&mat 14 wk tabdl 1/1st gestation (76801) |
$457.60 |
$1,144 |
4.4× |
| Us preg uterus real time f/u trnsabdl per fetus (76816) |
$378.40 |
$946 |
3.6× |
| Us retroperitoneal complete (76770) |
$435.60 |
$1,089 |
4.2× |
| Us retroperitoneal limited (76775) |
$294 |
$735 |
2.8× |
| Us scrotum and contents (76870) |
$464 |
$1,160 |
4.5× |
| Us spinal canal and contents (76800) |
$388 |
$970 |
3.7× |
| Us thyroid (76536) |
$444.40 |
$1,111 |
4.3× |
| Us transrectal (76872) |
$513.60 |
$1,284 |
4.9× |
| Vasogram (74440) |
$242.80 |
$607 |
1.0× |
| Vein X-Ray Chest (75827) |
$1,119.60 |
$2,799 |
0.7× |
| Vein X-Ray Liver W/O Hemodyn (75887) |
$1,759.60 |
$4,399 |
0.6× |
| Vein X-Ray Skull Epidural (75872) |
$311.20 |
$778 |
0.5× |
| Vein X-Ray Spleen/Liver (75810) |
$5,429.60 |
$13,574 |
1.7× |
| Venogram Sinus/Jugular (75860) |
$2,263.60 |
$5,659 |
0.7× |
| Venography caval inferior serialography rs&i (75825) |
$2,931.60 |
$7,329 |
0.9× |
| Venography extremity bilateral rs&i (75822) |
$916.40 |
$2,291 |
0.6× |
| Venography extremity unilateral rs&i (75820) |
$1,220 |
$3,050 |
0.8× |
| Venography Renal Bilateral (75833) |
$2,637.60 |
$6,594 |
0.8× |
| Venography Renal Unilateral (75831) |
$3,056.80 |
$7,642 |
1.0× |
| Venous sampling by catheter (75893) |
$3,969.60 |
$9,924 |
0.7× |
| Wrist 2 views (73100) |
$223.60 |
$559 |
2.6× |
| X-Ray Ac Jts - Xr Acromioclavicular Joints Bilateral (73050) |
$258.40 |
$646 |
3.0× |
| X-ray antegrade pyelogram tube (74425) |
$522.40 |
$1,306 |
1.5× |
| X-Ray Aorta Leg Arteries (75630) |
$1,952.80 |
$4,882 |
0.6× |
| X-Ray Elbow 2 Vw - Xr Elbow 1-2 Views Right (73070) |
$192.80 |
$482 |
2.2× |
| X-Ray Exam Breast Specimen (76098) |
$388.40 |
$971 |
0.7× |
X-Ray Exam Entire Spi 1 Vw (72081)
range across 2 matching MRF lines |
$158.80–$258 |
$397–$645 |
varies |
X-Ray Exam Entire Spi 2/3 Vw (72082)
range across 2 matching MRF lines |
$187.20–$216 |
$468–$540 |
varies |
X-Ray Exam Entire Spi 4/5 Vw (72083)
range across 2 matching MRF lines |
$224.40–$364 |
$561–$910 |
varies |
| X-Ray Exam Hip Uni 1 View (73501) |
$112.80 |
$282 |
1.3× |
| X-Ray Exam Hip Uni 2-3 Views (73502) |
$117.60 |
$294 |
1.4× |
| X-Ray Exam Hip Uni 4/> Views (73503) |
$245.20 |
$613 |
2.4× |
| X-Ray Exam Hips Bi 2 Views (73521) |
$261.20 |
$653 |
2.5× |
| X-Ray Exam Hips Bi 3-4 Views (73522) |
$195.20 |
$488 |
1.9× |
| X-Ray Exam Hips Bi 5/> Views (73523) |
$190.80 |
$477 |
1.8× |
| X-Ray Exam L-S Spine Bending (72114) |
$231.20 |
$578 |
2.2× |
| X-Ray Exam Neck Spine 2-3 Vw (72040) |
$183.60 |
$459 |
2.1× |
| X-Ray Exam Neck Spine 6/>Vws (72052) |
$297.20 |
$743 |
2.9× |
| X-Ray Exam Unilat Ribs/Chest (71101) |
$223.20 |
$558 |
2.1× |
| X-ray eye for foreign body (70030) |
$162.80 |
$407 |
1.9× |
| X-ray head for orthodontia (70350) |
$104.40 |
$261 |
1.2× |
| X-ray humerus (73060) |
$154 |
$385 |
1.8× |
| X-ray IV pyelogram (ivp) (74400) |
$371.60 |
$929 |
2.1× |
| X-ray IV pyelogram+tomography (74415) |
$563.20 |
$1,408 |
3.2× |
| X-Ray Jaw <4 Vw - Xr Mandible < 4 Views (70100) |
$221.20 |
$553 |
2.6× |
| X-Ray Knee Bilat Standing - Xr Knees Anteroposterior Standing Bilat (73565) |
$185.60 |
$464 |
2.1× |
| X-Ray Lumbar Spine 2/3 Vw - Xr Lumbar Spine 2-3 Views (72100) |
$153.20 |
$383 |
1.5× |
| X-ray nose-rectum child f.b. (76010) |
$153.20 |
$383 |
1.8× |
| X-Ray Ribs, Chest 4+ Vw - Xr Ribs 3 Vws Bil W/ Chest Posteroanterior (71111) |
$236.40 |
$591 |
2.3× |
| X-Ray Sacroiliac Jts 3+ Vw - Xr Sacroiliac Joints 3+ Views (72202) |
$189.60 |
$474 |
1.8× |
| X-Ray Sacroiliac Jts <3 Vw - Xr Sacroiliac Joints 1-2 Views (72200) |
$168 |
$420 |
1.6× |
| X-Ray Sacrum/Coccyx 2+ Vw - Xr Sacrum Coccyx 2+ Views (72220) |
$174.40 |
$436 |
2.0× |
| X-Ray Sinuses 3+ Vw - Xr Paranasal Sinuses 3+ Views (70220) |
$229.20 |
$573 |
2.6× |
| X-Ray Skull 4+ Vw - Xr Skull Complete 4+ Views (70260) |
$299.60 |
$749 |
2.9× |
| X-Ray Stress View (77071) |
$166 |
$415 |
1.9× |
| X-ray thoracic spine 4 vw (72074) |
$235.20 |
$588 |
2.3× |
| X-Ray Urinary Tract Exam With Contrast Material (74420) |
$402.40 |
$1,006 |
1.2× |
X-Rays Bone Length Studies (77073)
range across 2 matching MRF lines |
$176.80–$235.60 |
$442–$589 |
varies |
| X-Rays Bone Survey Complete (77075) |
$531.20 |
$1,328 |
5.1× |
| Xr c-spine 4 or 5 views (72050) |
$275.60 |
$689 |
2.6× |
| Xr facial bones less than 3 views (70140) |
$130.80 |
$327 |
1.5× |
| Xr orbits complete 4 views (70200) |
$193.20 |
$483 |
1.9× |
| Xr Tomogram Single Plane (76100) |
$515.60 |
$1,289 |
4.9× |