| 3-D radiotherapy plan dose-volume histograms (77295) |
$1,654 |
$3,308 |
1.2× |
| Abdomen 1 View (74018) |
$179 |
$358 |
2.0× |
| Abdomen 2 views (74019) |
$342 |
$684 |
3.3× |
| Acute Gastrointestinal Blood Loss Imaging (78278) |
$1,059 |
$2,118 |
2.6× |
| Angio internal mammary (75756) |
$1,543.50 |
$3,087 |
0.5× |
| Angio pulmonary bilat (75743) |
$4,784 |
$9,568 |
1.5× |
| Angiography extremity bilateral rs&i (75716) |
$4,784 |
$9,568 |
1.5× |
| Angiography extremity unilateral rs&i (75710) |
$4,784 |
$9,568 |
1.5× |
| Angiography pulmonary unilateral slctv rs&i (75741) |
$4,784 |
$9,568 |
1.5× |
| Angrph pulmonary nonslctv cath/ven njx rs&i (75746) |
$1,531 |
$3,062 |
0.5× |
| Ankle 2 views (73600) |
$153.50 |
$307 |
1.8× |
| Aortography thoracic serialography rs&i (75605) |
$4,784 |
$9,568 |
0.9× |
| Aortography thoracic w/o serialography rs&i (75600) |
$4,784 |
$9,568 |
1.5× |
| Artery X-Rays Abdomen (75726) |
$7,486 |
$14,972 |
1.3× |
| Artery X-Rays Pelvis (75736) |
$6,657.50 |
$13,315 |
1.2× |
| Artery X-Rays Spine (75705) |
$5,600.50 |
$11,201 |
1.0× |
| Arthrogram ankle (73615) |
$644 |
$1,288 |
1.8× |
| Arthrogram hip (73525) |
$745.50 |
$1,491 |
2.1× |
| Arthrogram Wrist (73115) |
$644 |
$1,288 |
1.8× |
| Basic radiation dosimetry calculation (77300) |
$386 |
$772 |
2.9× |
| Bone age studies (77072) |
$99.50 |
$199 |
0.9× |
| Bone Imaging 3 Phase (78315) |
$1,249.50 |
$2,499 |
3.1× |
| Bone Imaging Limited Area (78300) |
$619.50 |
$1,239 |
1.5× |
| Bone Imaging Multiple Areas (78305) |
$818.50 |
$1,637 |
2.0× |
| Bone Imaging Whole Body (78306) |
$1,105.50 |
$2,211 |
2.8× |
| Bone marrow imaging limited area (78102) |
$384.50 |
$769 |
1.0× |
| Bone marrow imaging; multiple areas (78103) |
$477 |
$954 |
1.2× |
| Bone marrow imaging; whole body (78104) |
$573 |
$1,146 |
1.4× |
| Bone survey infant (77076) |
$297 |
$594 |
2.8× |
| Brachytx isodose complex (77318) |
$2,572 |
$5,144 |
6.8× |
| Brachytx isodose intermed (77317) |
$2,572 |
$5,144 |
6.8× |
| Brachytx Isodose Plan Simple (77316) |
$2,572 |
$5,144 |
6.8× |
| Brain Image W/Flow < 4 Views (78601) |
$431.50 |
$863 |
1.1× |
| Brain Imaging Min 4 Static Views W Vascular Flow (78606) |
$679 |
$1,358 |
1.2× |
| Brain Imaging Pet Metabolic Evaluation (78608) |
$6,328 |
$12,656 |
4.4× |
| Cardiac MRI w/w/o contrast & further seq (75561) |
$1,688 |
$3,376 |
4.8× |
| Cardiac MRI w/w/o contrast w/stress (75563) |
$1,688 |
$3,376 |
2.1× |
| Cat Scan Follow-Up Study (76380) |
$404 |
$808 |
4.6× |
| Cerebrospinal Fluid Flow W/O Matl Shunt Evaltj (78645) |
$728 |
$1,456 |
1.3× |
| Cerebrospinal Fluid Scan (78630) |
$701.50 |
$1,403 |
1.3× |
| Chest 1 view (71045) |
$251 |
$502 |
2.9× |
| Chest 2 views (71046) |
$333.50 |
$667 |
3.8× |
| Chest 3 views (71047) |
$355.50 |
$711 |
4.1× |
| Chest 4 or more views (71048) |
$409.50 |
$819 |
3.9× |
| Chg us nrv&acc strux 1 xtr compre w/img pr extremity (76883) |
$185 |
$370 |
1.8× |
| Cisternography Positive Contrast Rs&I (70015) |
$1,094 |
$2,188 |
1.4× |
| Clavicle complete (73000) |
$133 |
$266 |
1.5× |
| Computed Tomography Thorax Lw Dose Lng Ca Scr C- (71271) |
$151.50 |
$303 |
1.4× |
| Continuing medical physics consltj pr wk (77336) |
$314 |
$628 |
2.3× |
| Contrast Exam Abdominl Aorta (75625) |
$4,784 |
$9,568 |
1.5× |
| Contrast X-Ray Bladder (74430) |
$452 |
$904 |
1.3× |
| Contrast X-Ray Of Elbow (73085) |
$644 |
$1,288 |
1.8× |
| Contrast X-Ray Of Knee Joint (73580) |
$644 |
$1,288 |
1.8× |
| Contrast Xray Throat/Cerv Esopha (74210) |
$138 |
$276 |
0.8× |
| CT abdomen and pelvis without and with contrast (74178) |
$1,795.50 |
$3,591 |
5.1× |
| CT abdomen and pelvis without contrast (74176) |
$1,243 |
$2,486 |
5.2× |
| CT abdomen w contrast (74160) |
$1,372.50 |
$2,745 |
7.8× |
| CT abdomen w wo contrast (74170) |
$1,167 |
$2,334 |
6.6× |
| CT abdomen w/o contrast (74150) |
$618 |
$1,236 |
5.9× |
| CT Angio Abdomen and Pelvis (74174) |
$1,695.50 |
$3,391 |
4.8× |
| CT Angio Chest (71275) |
$1,388.50 |
$2,777 |
7.9× |
| CT Angio Head (70496) |
$1,597 |
$3,194 |
9.1× |
| CT angio hrt w/3d image (75574) |
$933.50 |
$1,867 |
2.7× |
| Ct Angio Lwr Extr W/O&W/Dye (73706) |
$906 |
$1,812 |
5.1× |
| CT Angio Neck (70498) |
$1,597 |
$3,194 |
9.1× |
| Ct Angio Upr Extrm W/O&W/Dye (73206) |
$1,319.50 |
$2,639 |
7.5× |
| CT bone density (77078) |
$269 |
$538 |
3.1× |
| CT cervical spine w/ contrast (72126) |
$1,373.50 |
$2,747 |
3.9× |
| CT cervical spine w/o contrast (72125) |
$803 |
$1,606 |
7.6× |
| CT cervical spine w/wo cont (72127) |
$1,172.50 |
$2,345 |
6.7× |
| CT chest w contrast (71260) |
$1,374.50 |
$2,749 |
7.8× |
| CT chest w/wo contrast (71270) |
$1,168.50 |
$2,337 |
6.6× |
| CT colonography screening (74263) |
$3,572 |
$7,144 |
14.9× |
| CT Colonogrphy Dx Image Postprocess W/Contrast (74262) |
$775.50 |
$1,551 |
4.4× |
| CT colonogrphy dx image postprocess w/o contrast (74261) |
$453.50 |
$907 |
4.3× |
| CT head/brain with contrast (70460) |
$1,817 |
$3,634 |
10.3× |
| CT head/brain without and with contrast (70470) |
$1,551.50 |
$3,103 |
8.8× |
| CT heart contrast eval cardiac structure&morph (75572) |
$616.50 |
$1,233 |
1.8× |
| CT heart no contrast quant eval coronry calcium (75571) |
$190 |
$380 |
2.2× |
| CT hrt w/3d image congen (75573) |
$821.50 |
$1,643 |
2.3× |
| CT iac w contrast (70481) |
$1,579.50 |
$3,159 |
9.0× |
| CT l-spine w&w/o contrast (72133) |
$1,348.50 |
$2,697 |
7.7× |
| CT lower ext w/o (73700) |
$710.50 |
$1,421 |
6.8× |
| CT lower extremity w/contrast material (73701) |
$1,584.50 |
$3,169 |
9.0× |
| CT lumbar spine w contrast (72132) |
$1,219.50 |
$2,439 |
3.5× |
| CT lumbar spine w/o contrast (72131) |
$923.50 |
$1,847 |
8.8× |
| CT maxillofacial w contrast (70487) |
$1,402.50 |
$2,805 |
8.0× |
| CT maxillofacial wo contrast (70486) |
$1,062.50 |
$2,125 |
10.1× |
| CT neck tissue combo (70492) |
$1,545.50 |
$3,091 |
8.8× |
| Ct Orbit/Ear/Fossa W/O&W/Dye (70482) |
$1,348.50 |
$2,697 |
7.7× |
| CT orbits w/o contrast (70480) |
$923.50 |
$1,847 |
8.8× |
| CT pelvis w&w/o contrast (72194) |
$1,173.50 |
$2,347 |
6.7× |
| CT pelvis w/o contrast (72192) |
$617.50 |
$1,235 |
5.9× |
| CT scan of leg combo (73702) |
$1,350 |
$2,700 |
7.7× |
| CT scans face/jaw combo (70488) |
$1,551.50 |
$3,103 |
8.8× |
| CT soft tissue neck w contrast (70491) |
$1,818.50 |
$3,637 |
10.3× |
| CT soft tissue neck w/o contrast (70490) |
$818.50 |
$1,637 |
7.8× |
| CT thoracic spine w contrast (72129) |
$1,219.50 |
$2,439 |
6.9× |
| CT thoracic spine w/o contrast (72128) |
$923.50 |
$1,847 |
8.8× |
| CT thoracic spine w/wo cont (72130) |
$1,348.50 |
$2,697 |
7.7× |
| CT thorax w/o contrast (71250) |
$797.50 |
$1,595 |
7.6× |
CT unlisted procedure (76497)
range across 2 matching MRF lines |
$85.50–$289.50 |
$171–$579 |
varies |
| CT upper ext wo (73200) |
$645.50 |
$1,291 |
6.1× |
| CT upper extremity w/o & w/contrast material (73202) |
$1,226.50 |
$2,453 |
7.0× |
| CT upper extremity with contrast (73201) |
$1,439.50 |
$2,879 |
4.1× |
| Cta Abdl Aorta&Bi Iliofem W/Contrast&Postp (75635) |
$1,097 |
$2,194 |
6.2× |
| Cta Abdomen (74175) |
$1,102.50 |
$2,205 |
6.3× |
| CTA pelvis (72191) |
$1,042 |
$2,084 |
5.9× |
| Dilation ureters/urethra rs&i (74485) |
$2,438 |
$4,876 |
1.2× |
| Discography Cerv/Thor Spine (72285) |
$3,730.50 |
$7,461 |
1.9× |
| Diskography lumbar (72295) |
$3,730.50 |
$7,461 |
1.9× |
| Doppler Echo Fetal Puls Spectral F/U/Repeat (76828) |
$56 |
$112 |
0.5× |
| Doppler Echo Fetal Spectral Display Complete (76827) |
$112 |
$224 |
1.1× |
| Dxa Bone Density Axial (77080) |
$152.50 |
$305 |
1.5× |
| Dxa bone density study (77085) |
$274.50 |
$549 |
2.6× |
| Dxa bone density study 1/>sites appendiclr skel (77081) |
$52 |
$104 |
0.6× |
| Echo exam of fetal heart (76825) |
$303.50 |
$607 |
0.6× |
| Echo exam uterus (76831) |
$333.50 |
$667 |
1.4× |
| Echo Guide For Artery Repair (76936) |
$372 |
$744 |
1.7× |
| Echocardiography, fetal, cardiovascular system, real time with image documentation (2D), with or without M-mode… (76826) |
$201 |
$402 |
0.8× |
| Echograp Trans R Pros Study (76873) |
$261 |
$522 |
2.5× |
| Esophageal Motility Study (78258) |
$425.50 |
$851 |
1.1× |
| Esophagram (74220) |
$270.50 |
$541 |
1.5× |
| Fetal Biophysical Profile W/O Non-Stress Testing (76819) |
$116 |
$232 |
1.1× |
| Fetal MRI w/placntl matrnl plvc img sing/1st ges (74712) |
$1,280 |
$2,560 |
5.3× |
| Fluoroscopy up to 1 hr (76000) |
$235 |
$470 |
1.0× |
| Follow-Up Angiography (75898) |
$1,149.50 |
$2,299 |
0.4× |
| Foot 2 views (73620) |
$176.50 |
$353 |
2.0× |
| Forearm 2 views (73090) |
$229 |
$458 |
2.6× |
| Gastric emptying imaging study (78264) |
$1,299.50 |
$2,599 |
3.2× |
| Gastric Emptyng Imag Std W/Sm Bwl Transit (78265) |
$788 |
$1,576 |
2.0× |
| Gastroesophageal Reflux Exam (78262) |
$490 |
$980 |
1.2× |
| Gated Heart Planar Single (78472) |
$956.50 |
$1,913 |
2.4× |
| Gstrc Emptng Imag Std W/Sm Bwl Col Trnst Mlt Day (78266) |
$943 |
$1,886 |
1.7× |
| Hand 2 views (73120) |
$176.50 |
$353 |
1.7× |
| Hdr Rdncl Ntrstl/Icav Brchtx (77772) |
$2,338 |
$4,676 |
3.3× |
| Hdr Rdncl Ntrstl/Icav Brchtx (77771) |
$1,695 |
$3,390 |
2.4× |
| Hdr Rdncl Ntrstl/Icav Brchtx 1 Channel (77770) |
$1,705 |
$3,410 |
2.4× |
| Heart Image (Pet) Multiple (78492) |
$4,052.50 |
$8,105 |
2.8× |
| Hepatc Vngrph Wdg/Fr Hemodyn Eval Rs&I (75889) |
$4,784 |
$9,568 |
1.5× |
| Hepatc Vngrph Wdg/Fr W/O Hemodyn Eval Rs&I (75891) |
$4,784 |
$9,568 |
1.5× |
| Hepatobil Syst Image W/Drug (78227) |
$1,731 |
$3,462 |
3.2× |
| Hepatobiliary System Imaging (78226) |
$1,086.50 |
$2,173 |
2.7× |
| Ht Muscle Image Spect Sing (78451) |
$1,225 |
$2,450 |
0.9× |
| Hysterosalpingogram (74740) |
$768 |
$1,536 |
3.2× |
| Infant hip ultrasound, limited static exam (76886) |
$309.50 |
$619 |
3.5× |
| Interstitial radiation source applic complex (77778) |
$2,485 |
$4,970 |
3.6× |
| Intracavitary Radiation Source Applic Complex (77763) |
$2,338 |
$4,676 |
3.3× |
| Intracavitary radiation source applic simple (77761) |
$2,338 |
$4,676 |
4.2× |
| Joint Survey Single View (77077) |
$99.50 |
$199 |
0.9× |
| K Flow/Funct Image W/Drug (78708) |
$631 |
$1,262 |
1.2× |
| K Flow/Funct Image W/O Drug (78707) |
$1,022.50 |
$2,045 |
1.9× |
| Knee 3 Views (73562) |
$226.50 |
$453 |
2.6× |
| Leveen/Shunt Patency Exam (78291) |
$481.50 |
$963 |
1.2× |
| Liver & Spleen Imaging Static Only (78215) |
$753.50 |
$1,507 |
1.9× |
| Liver imaging static only (78201) |
$750 |
$1,500 |
1.4× |
| Liver imaging w/vascular flow (78202) |
$750 |
$1,500 |
1.4× |
| Lung Perf&Ventilat Diferentl (78598) |
$1,164.50 |
$2,329 |
2.1× |
| Lung perfusion differential (78597) |
$745.50 |
$1,491 |
1.9× |
| Lung Ventilat&Perfus Imaging (78582) |
$1,424.50 |
$2,849 |
2.6× |
| Lung Ventilation Imaging (78579) |
$826 |
$1,652 |
2.1× |
| Lymph System Imaging (78195) |
$1,426 |
$2,852 |
2.6× |
| Lymphangiography Pelvic/Abdominal Bilateral Rs&I (75807) |
$6,706.50 |
$13,413 |
2.1× |
| Magnetic Image Jaw Joint (70336) |
$994.50 |
$1,989 |
4.1× |
| Magnetic Resonance Elastography (76391) |
$1,070.50 |
$2,141 |
4.5× |
| Mammary ductogram or galactogram multiple (77054) |
$579 |
$1,158 |
2.4× |
| Mammary ductogram or galactogram single (77053) |
$551 |
$1,102 |
2.3× |
| Meckels Divert Exam (78290) |
$679.50 |
$1,359 |
1.7× |
| Mlc imrt design & construction per imrt plan (77338) |
$1,435.50 |
$2,871 |
3.8× |
| Mr safety determination physician/other qhp (76016) |
$1,159.50 |
$2,319 |
13.3× |
| Mr safety implant&/fb assmt clin staf 1st 15 min (76014) |
$1,159.50 |
$2,319 |
39.9× |
| Mr safety implt electronics prepj supvj phys/qhp (76018) |
$493.50 |
$987 |
5.2× |
| Mr safety implt pos&/immoblj (76019) |
$1,159.50 |
$2,319 |
19.6× |
| Mr safety med physics xm customization plng&mntr (76017) |
$1,678.59 |
$3,357.18 |
7.0× |
| Mra Head W/O & W/Contrast Material (70546) |
$2,071.50 |
$4,143 |
5.9× |
| MRA head w/o contrast (70544) |
$1,657 |
$3,314 |
6.9× |
| MRA head with contrast (70545) |
$2,216.50 |
$4,433 |
6.3× |
| MRA neck w contrast (70548) |
$1,622 |
$3,244 |
4.6× |
| Mra Neck W/O &W/Contrast Material (70549) |
$1,954 |
$3,908 |
5.6× |
| MRA neck w/o contrast (70547) |
$1,563.50 |
$3,127 |
6.5× |
| MRI abdomen w contrast (74182) |
$1,622 |
$3,244 |
4.6× |
| MRI abdomen w/o contrast (74181) |
$1,563.50 |
$3,127 |
6.5× |
| MRI any jt lower extrem w/contrast material (73722) |
$1,855 |
$3,710 |
2.4× |
| MRI any jt lower extrem w/o & w/contrast matrl (73723) |
$2,243 |
$4,486 |
6.4× |
| MRI any jt upper extremity w/contrast matrl (73222) |
$3,427.50 |
$6,855 |
4.4× |
| MRI bone marrow blood supply (77084) |
$1,138 |
$2,276 |
4.7× |
| MRI brain functional w/o physician admnistration (70554) |
$903 |
$1,806 |
3.8× |
| MRI brain functional w/physician admnistration (70555) |
$371.50 |
$743 |
1.5× |
| MRI Breast W/O Contrast Bilateral (77047) |
$2,053.50 |
$4,107 |
8.6× |
| MRI Breast Without Contrast Material Unilateral (77046) |
$1,869 |
$3,738 |
7.8× |
| MRI cardiac w/o cont stress (75559) |
$1,046.50 |
$2,093 |
1.9× |
| MRI cardiac w/o contrast (75557) |
$1,046.50 |
$2,093 |
4.4× |
| MRI cervical spine w contrast (72142) |
$2,428 |
$4,856 |
6.9× |
| MRI cervical spine w/o cont (72141) |
$1,798.50 |
$3,597 |
7.5× |
| MRI chest w/o contrast (71550) |
$1,211.50 |
$2,423 |
5.1× |
| MRI chest with contrast (71551) |
$1,622 |
$3,244 |
2.1× |
| MRI chest wo w contrast (71552) |
$1,954 |
$3,908 |
5.6× |
| MRI lower extrem oth/thn jt w/contrast matrl (73719) |
$1,695.50 |
$3,391 |
4.8× |
| MRI lower extrem oth/thn jt w/o & w/contr matr (73720) |
$2,042.50 |
$4,085 |
5.8× |
| MRI lower extrem oth/thn jt w/o contr matrl (73718) |
$1,634 |
$3,268 |
6.8× |
| MRI lumbar spine w contrast (72149) |
$1,466 |
$2,932 |
4.2× |
| Mri Neck Spine W/O & W/Dye (72156) |
$2,248 |
$4,496 |
6.4× |
| MRI orbit face &/neck w/o contrast (70540) |
$1,602.50 |
$3,205 |
6.7× |
| MRI orbit face neck w contrast (70542) |
$2,145.50 |
$4,291 |
6.1× |
| Mri Orbt/Fac/Nck W/O &W/Dye (70543) |
$2,585 |
$5,170 |
7.4× |
| MRI pelvis w contrast (72196) |
$1,865.50 |
$3,731 |
5.3× |
| MRI pelvis w/o & w contrast (72197) |
$2,054.50 |
$4,109 |
5.9× |
| MRI pelvis w/o contrast (72195) |
$1,274.50 |
$2,549 |
5.3× |
| MRI spectroscopy (76390) |
$1,080 |
$2,160 |
12.4× |
| MRI thoracic spine w/o contrast (72146) |
$1,811 |
$3,622 |
7.6× |
| MRI upper extremity oth than jt w/contr matrl (73219) |
$1,695.50 |
$3,391 |
4.8× |
| MRI upper extremity oth than jt w/o contr matrl (73218) |
$1,266.50 |
$2,533 |
5.3× |
| Mri Uppr Extremity W/O&W/Dye (73220) |
$2,042.50 |
$4,085 |
5.8× |
| MRI, abdomen, combo (74183) |
$1,954 |
$3,908 |
5.6× |
| MRI, dorsal spine combo (72157) |
$2,264 |
$4,528 |
6.5× |
| MRI, dorsal spine contrast (72147) |
$1,879 |
$3,758 |
5.4× |
| MRI, joint upper extrem (73221) |
$1,094 |
$2,188 |
4.6× |
| MRI, joint upper extrem combo (73223) |
$1,772.50 |
$3,545 |
5.1× |
| MRI, lumbar spine combo (72158) |
$1,779 |
$3,558 |
5.1× |
| Myelogram cervical (72240) |
$1,094 |
$2,188 |
1.4× |
| Myelogram Lumbar (72265) |
$1,094 |
$2,188 |
1.4× |
| Myelography thoracic (72255) |
$1,094 |
$2,188 |
1.4× |
| Myelograpy 2/more regions rs&i (72270) |
$1,203.50 |
$2,407 |
1.5× |
| Myocardial Imaging Infarct Avid Planar Qual/Quan (78466) |
$450 |
$900 |
1.1× |
| Myocardial Imaging Pet Metabolic Evaluation (78459) |
— |
$100 |
— |
| Myocardial Spect Multiple Studies (78452) |
$1,775 |
$3,550 |
1.4× |
| Myocrd Img Pet Metab Eval Single Study Cncrnt CT (78429) |
$2,267.50 |
$4,535 |
1.6× |
| Myocrd img PET prfuj 1std rest/stress cncrnt CT (78430) |
$3,794.50 |
$7,589 |
2.6× |
| Myocrd Img Pet Prfuj Mlt Std Rst&Strs Cncrnt CT (78431) |
$4,036.50 |
$8,073 |
1.8× |
| Myocrd Img Pet Prfuj W/Metab 2rtracer Cncrnt CT (78433) |
$4,331 |
$8,662 |
2.0× |
| Myocrd Img Pet Prfuj W/Metab Dual Radiotracer (78432) |
$3,794.50 |
$7,589 |
2.5× |
| N-invas est c ffr sw aly CTA (75580) |
$2,882.50 |
$5,765 |
3.3× |
| Neck soft tissue (70360) |
$160.50 |
$321 |
1.8× |
| Nfs/Instlj Radioelmnt Sln 3 Mo Follow-Up Care (77750) |
$360.50 |
$721 |
0.9× |
| Nm csf leak detection (78650) |
$682.50 |
$1,365 |
0.5× |
| Nm myocard infarct spect (78469) |
$562.50 |
$1,125 |
1.0× |
| Nonvascular Shunt X-Ray (75809) |
$153 |
$306 |
1.5× |
| Ntsty modul radthx pln dose-vol histos (77301) |
$5,755.50 |
$11,511 |
4.1× |
| Nuclear Rx Intra-Arterial (79445) |
$381.50 |
$763 |
1.6× |
| Nuclear Rx Oral Admin (79005) |
$211.50 |
$423 |
0.9× |
| Optic foramina (70190) |
$99.50 |
$199 |
1.1× |
| Parathyroid imaging w/tomographic spect & CT (78072) |
$1,371 |
$2,742 |
2.5× |
| Parathyroid Planar Imaging (78070) |
$584.50 |
$1,169 |
1.5× |
| Parathyroid planar imaging w/wo subtraction (78071) |
$1,426 |
$2,852 |
3.6× |
| Pelvis 1 or 2 views (72170) |
$199 |
$398 |
1.9× |
| Peritoneogram Rs&I (74190) |
$551 |
$1,102 |
1.0× |
| Pet Image Skull-Thigh (78812) |
$6,190.50 |
$12,381 |
4.3× |
| Pet Image W/Ct Lmtd (78814) |
$6,319.50 |
$12,639 |
4.4× |
| PET image w/CT, full body (78816) |
$6,104 |
$12,208 |
4.2× |
| PET imaging CT attenuation skull base mid-thigh (78815) |
$6,108.50 |
$12,217 |
4.3× |
| Pet Imaging Limited Area Chest Head/Neck (78811) |
$6,000 |
$12,000 |
4.6× |
| Pet Myocardial Sngl Study (78491) |
$4,052.50 |
$8,105 |
2.8× |
| PET whole body (78813) |
$6,190.50 |
$12,381 |
4.3× |
| Prq Transhepatc Portograpy Hemodyn Eval Rs&I (75885) |
$4,784 |
$9,568 |
1.5× |
| Pulmonary Perfusion Imaging Particulate (78580) |
$883 |
$1,766 |
2.2× |
| Radex Abd Compl Aqt Abd W/S/E/D Views 1 View Ch (74022) |
$354.50 |
$709 |
3.4× |
| Radex abscess/fistula/sinus tract rs&i (76080) |
$551 |
$1,102 |
1.0× |
| Radex Ankle Complete Minimum 3 Views (73610) |
$225.50 |
$451 |
2.6× |
| Radex Calcaneus Minimum 2 Views (73650) |
$260 |
$520 |
3.0× |
| Radex elbow complete minimum 3 views (73080) |
$153 |
$306 |
1.8× |
| Radex Facial Bones Complete Minimum 3 Views (70150) |
$153 |
$306 |
1.5× |
| Radex fingr minimum 2 views (73140) |
$176 |
$352 |
2.0× |
| Radex foot complete minimum 3 views (73630) |
$259.50 |
$519 |
3.0× |
| Radex Hand Minimum 3 Views (73130) |
$229 |
$458 |
2.6× |
| Radex lower extremity infant minimum 2 views (73592) |
$99.50 |
$199 |
1.1× |
| Radex Mastoids Compl Minimum 3 Views PR Side (70130) |
$99.50 |
$199 |
0.9× |
| Radex Nasal Bones Complete Minimum 3 Views (70160) |
$99.50 |
$199 |
1.1× |
| Radex Pharynx/Larx W/Fluor&/Magnification Tq (70370) |
$246.50 |
$493 |
2.8× |
| Radex Ribs Unilateral 2 Views (71100) |
$150.50 |
$301 |
1.7× |
| Radex shoulder complete minimum 2 views (73030) |
$173 |
$346 |
2.0× |
| Radex Sinuses Paransl < 3 Views (70210) |
$99.50 |
$199 |
1.1× |
| Radex Spine 1 View Specify Level (72020) |
$181 |
$362 |
2.1× |
| Radex Sternum Minimum 2 Views (71120) |
$109.50 |
$219 |
1.3× |
| Radex Temporomandble Jt Opn & Clsd Mouth Bilat (70330) |
$114.50 |
$229 |
1.3× |
| Radex Toe Minimum 2 Views (73660) |
$160 |
$320 |
1.8× |
| Radex upper extremity infant minimum 2 views (73092) |
$99.50 |
$199 |
0.9× |
| Radex Wrist Complete Minimum 3 Views (73110) |
$153 |
$306 |
1.8× |
| Radex X-Ray Exam Entire Spi 6/> Vw - Xr Entire Spine 6+ Vw (72084) |
$172 |
$344 |
1.6× |
| Radiation Delivery Stereotactic Cranial Linear (77372) |
$4,389.50 |
$8,779 |
0.6× |
| Radiation treatment delivery level 1 (77402) |
$1,575 |
$3,150 |
15.4× |
| Radiation treatment delivery level 2 (77407) |
$2,338 |
$4,676 |
6.0× |
| Radiation treatment delivery level 3 (77412) |
$2,109.50 |
$4,219 |
3.8× |
| Radiolog exam mandible compl minimum 4 views (70110) |
$194 |
$388 |
1.8× |
| Radiologic Exam Abdomen 3+ Views - Xr Abdomen 3+ Views (74021) |
$386.50 |
$773 |
3.7× |
| Radiologic exam colon double contrast study (74280) |
$497.50 |
$995 |
2.8× |
| Radiologic exam colon single contrast study (74270) |
$502.50 |
$1,005 |
2.9× |
| Radiologic Exam Esophagus Double Contrast Study (74221) |
$410 |
$820 |
2.3× |
| Radiologic exam knee complete 4/more views (73564) |
$306 |
$612 |
2.9× |
| Radiologic exam pelvis compl minimum 3 views (72190) |
$153.50 |
$307 |
1.5× |
| Radiologic Exam Small Int Single Contrast Study (74250) |
$194 |
$388 |
1.1× |
| Radiologic exam swallow function contrast study (74230) |
$295 |
$590 |
1.7× |
| Radiologic exam upr gi trc double contrast study (74246) |
$427 |
$854 |
2.4× |
| Radiologic examination femur 1 view (73551) |
$161 |
$322 |
1.8× |
| Radiologic examination femur minimum 2 views (73552) |
$247 |
$494 |
2.8× |
| Radiologic examination knee 1/2 views (73560) |
$198.50 |
$397 |
2.3× |
| Radiologic Examination Osseous Survey Limited (77074) |
$204.50 |
$409 |
1.9× |
| Radiologic examination tibia & fibula 2 views (73590) |
$153 |
$306 |
1.8× |
| Radiopharmaceutical therapy, by intracavitary administration Non-Facility (79200) |
$122.50 |
$245 |
0.5× |
| Remote afterloading high dose rate radionuclide skin surface brachytherapy, includes basic dosimetry, when performed;… (77768) |
$2,338 |
$4,676 |
6.0× |
| Remote afterloading high dose rate radionuclide skin surface brachytherapy, includes basic dosimetry, when performed;… (77767) |
$2,338 |
$4,676 |
6.0× |
| Ribs bilateral 3 views (71110) |
$178.50 |
$357 |
1.7× |
| Rp loclzj tum plnr 1 area single day imaging (78800) |
$631.50 |
$1,263 |
1.6× |
| Rp loclzj tum plnr 2+area 1+d img/1 area img>2+d (78801) |
$831 |
$1,662 |
2.1× |
| Rp Loclzj Tum Plnr Whole Body 2+ Days Imaging (78804) |
$2,060.50 |
$4,121 |
3.8× |
| Rp Loclzj Tum Plnr Whole Body Single Day Imaging (78802) |
$1,230 |
$2,460 |
2.3× |
| Rp Loclzj Tum Spect 1 Area Single Day Imaging (78803) |
$1,329.50 |
$2,659 |
2.4× |
| Rp loclzj tum spect 2 area/sep acquisj img (78831) |
$2,095 |
$4,190 |
1.6× |
| Rp loclzj tum spect CT 2area 1d img/1 ar img>2+d (78832) |
$2,503.50 |
$5,007 |
1.7× |
| Rp loclzj tum spect w/CT 1 area/acquisj 1day img (78830) |
$3,323 |
$6,646 |
2.6× |
| Rp Ther Radiolbld Monoclonal Antibody IV Infus (79403) |
$177.50 |
$355 |
0.8× |
| Rp Therapy Intravenous Administration (79101) |
$139.50 |
$279 |
0.6× |
| Salivary Gland Imaging (78230) |
$340 |
$680 |
0.8× |
| Salivary Gland Imaging Serial Images (78231) |
$234 |
$468 |
0.6× |
| Scapula (73010) |
$133 |
$266 |
1.3× |
| Screening Digital Breast Tomosynthesis Bi (77063) |
$70 |
$140 |
3.0× |
| Sella turcica (70240) |
$99.50 |
$199 |
1.1× |
| Shoulder 1 view (73020) |
$133.50 |
$267 |
1.5× |
| Shoulder Arthrography (73040) |
$815 |
$1,630 |
2.3× |
| Skull less than 4 views (70250) |
$229 |
$458 |
2.2× |
| Special dosimetry (77331) |
$386 |
$772 |
2.9× |
| Special Physics Consult (77370) |
$386.50 |
$773 |
2.9× |
| Special teletherapy port plan (77321) |
$400 |
$800 |
1.1× |
| Special treatment procedure (77470) |
$1,284 |
$2,568 |
2.3× |
| Srs Multisource (77371) |
$20,655 |
$41,310 |
2.8× |
| Stereotactic Body Radiation Delivery (77373) |
$14,720 |
$29,440 |
8.2× |
| Sternoclavicular joints (71130) |
$109.50 |
$219 |
1.3× |
| Superior sagittal sinus venogram (75870) |
$2,246 |
$4,492 |
0.7× |
| Surface Applic Low Dose Rate Radionuclide Source (77789) |
$316 |
$632 |
3.1× |
| Tbs techl prep&transmis data alys pfrmd elsewhr (77090) |
$182.50 |
$365 |
2.1× |
| Tbs technical calculation only (77091) |
$182.50 |
$365 |
2.1× |
| Telethx isodose pln cplx w/basic dosimetry (77307) |
$1,417.50 |
$2,835 |
3.8× |
| Telethx isodose pln smpl w/dosimetry calculation (77306) |
$1,625 |
$3,250 |
4.3× |
| Ther Rad Simulaj-Aided Field Setting Complex (77290) |
$2,273.50 |
$4,547 |
6.0× |
| Ther Rad Simulaj-Aided Field Setting Intermed (77285) |
$2,568 |
$5,136 |
6.8× |
| Ther rad simulaj-aided field setting simple (77280) |
$1,339.50 |
$2,679 |
9.9× |
| Thoracic spine 2 views (72070) |
$199 |
$398 |
1.9× |
| Thoracic spine 3 views (72072) |
$235 |
$470 |
2.2× |
| Thoracolumbar 2 views (72080) |
$164 |
$328 |
1.9× |
| Thyroid Met Imaging Body (78018) |
$1,197 |
$2,394 |
2.2× |
| Thyroid Uptake W/Blood Flow Sngle/Mult Quan Meas (78014) |
$764.50 |
$1,529 |
1.9× |
| Tx Devices Design & Construction Complex (77334) |
$912.50 |
$1,825 |
2.4× |
| Tx devices design & construction intermediate (77333) |
$684.50 |
$1,369 |
5.1× |
| Tx devices design & construction simple (77332) |
$541 |
$1,082 |
4.0× |
| Ultrasound Breast Limited (76642) |
$280.50 |
$561 |
3.2× |
| Ultrasound elastography first target lesion (76982) |
$267 |
$534 |
2.5× |
| Ultrasound Elastography Parenchyma (76981) |
$267 |
$534 |
2.5× |
| Ultrasound Exam Aaa Screen (76706) |
$252.50 |
$505 |
2.4× |
| Ultrasound trgt dynamic microbubble 1st lesion (76978) |
$298 |
$596 |
0.9× |
| Ultrasound, abdomen limited (76705) |
$435.50 |
$871 |
4.1× |
| Unlisted Dx Radiographic Procedure (76499) |
$99.50 |
$199 |
1.1× |
| Unlisted fluoroscopic procedure (76496) |
$246.50 |
$493 |
2.8× |
Unlisted magnetic resonance procedure (76498)
range across 5 matching MRF lines |
$116–$1,325 |
$232–$2,650 |
varies |
| Unlisted us procedure (76999) |
$139.50 |
$279 |
1.6× |
| Upper gi w/o kub (74240) |
$252 |
$504 |
1.4× |
| Urethrocystogram voiding (74455) |
$467.50 |
$935 |
2.0× |
| Urethrocystography retrograde (74450) |
$467.50 |
$935 |
2.0× |
| Us breast unilateral complete (76641) |
$356 |
$712 |
3.4× |
| Us chest (76604) |
$220 |
$440 |
2.1× |
| Us complete joint (76881) |
$362.50 |
$725 |
3.5× |
| Us exam, pelvic, limited (76857) |
$328 |
$656 |
3.1× |
| Us head (76506) |
$208 |
$416 |
2.0× |
| Us kidney transplant (76776) |
$338 |
$676 |
3.2× |
| Us lmtd joint/oth nonvasc xtr strux r-t w/img (76882) |
$221.50 |
$443 |
2.1× |
| Us ob detailed single fetus (76811) |
$207.50 |
$415 |
0.9× |
| Us ob limited 1 or more fetuses (76815) |
$233 |
$466 |
2.2× |
| Us ob transvaginal (76817) |
$259 |
$518 |
2.5× |
| Us pelvic non ob complete (76856) |
$495.50 |
$991 |
4.7× |
| Us pg uter img f&mat 14 wk tabdl 1/1st gestation (76801) |
$311.50 |
$623 |
3.0× |
| Us preg uterus real time f/u trnsabdl per fetus (76816) |
$300.50 |
$601 |
2.9× |
| Us retroperitoneal complete (76770) |
$428 |
$856 |
4.1× |
| Us retroperitoneal limited (76775) |
$330 |
$660 |
3.1× |
| Us scrotum and contents (76870) |
$491 |
$982 |
4.7× |
| Us spinal canal and contents (76800) |
$188.50 |
$377 |
1.8× |
| Us thyroid (76536) |
$440.50 |
$881 |
4.2× |
| Us transrectal (76872) |
$154 |
$308 |
1.5× |
| Vein X-Ray Chest (75827) |
$1,531 |
$3,062 |
1.0× |
| Vein X-Ray Liver W/O Hemodyn (75887) |
$1,531 |
$3,062 |
0.5× |
| Vein X-Ray Spleen/Liver (75810) |
$2,802.50 |
$5,605 |
0.9× |
| Venogram Sinus/Jugular (75860) |
$2,246 |
$4,492 |
0.7× |
| Venography Adrenal Unilateral (75840) |
$4,472.50 |
$8,945 |
1.4× |
| Venography caval inferior serialography rs&i (75825) |
$4,784 |
$9,568 |
1.5× |
| Venography extremity bilateral rs&i (75822) |
$1,543.50 |
$3,087 |
1.0× |
| Venography extremity unilateral rs&i (75820) |
$1,543.50 |
$3,087 |
1.0× |
| Venography Renal Bilateral (75833) |
$4,841.50 |
$9,683 |
1.5× |
| Venography Renal Unilateral (75831) |
$4,784 |
$9,568 |
1.5× |
| Venous sampling by catheter (75893) |
$11,587 |
$23,174 |
2.1× |
| Vertebral fracture assessment via dxa (77086) |
$128 |
$256 |
1.5× |
| Wrist 2 views (73100) |
$153 |
$306 |
1.8× |
| X-Ray Ac Jts - Xr Acromioclavicular Joints Bilateral (73050) |
$99.50 |
$199 |
1.1× |
| X-ray antegrade pyelogram tube (74425) |
$695.50 |
$1,391 |
2.0× |
| X-Ray Aorta Leg Arteries (75630) |
$4,784 |
$9,568 |
1.5× |
| X-Ray Bend Only L-S Spine (72120) |
$235 |
$470 |
2.2× |
| X-Ray Elbow 2 Vw - Xr Elbow 1-2 Views Right (73070) |
$153 |
$306 |
1.8× |
| X-Ray Exam Breast Specimen (76098) |
$694 |
$1,388 |
1.3× |
| X-Ray Exam Entire Spi 1 Vw (72081) |
$175.50 |
$351 |
2.0× |
| X-Ray Exam Entire Spi 2/3 Vw (72082) |
$365.50 |
$731 |
3.5× |
| X-Ray Exam Entire Spi 4/5 Vw (72083) |
$149.50 |
$299 |
1.4× |
| X-Ray Exam Hip Uni 1 View (73501) |
$159.50 |
$319 |
1.8× |
| X-Ray Exam Hip Uni 2-3 Views (73502) |
$256.50 |
$513 |
2.9× |
| X-Ray Exam Hip Uni 4/> Views (73503) |
$264.50 |
$529 |
2.5× |
| X-Ray Exam Hips Bi 2 Views (73521) |
$264.50 |
$529 |
2.5× |
| X-Ray Exam Hips Bi 3-4 Views (73522) |
$351.50 |
$703 |
3.3× |
| X-Ray Exam Hips Bi 5/> Views (73523) |
$364.50 |
$729 |
3.5× |
| X-Ray Exam L-S Spine Bending (72114) |
$235 |
$470 |
2.2× |
| X-Ray Exam Neck Spine 2-3 Vw (72040) |
$199 |
$398 |
2.3× |
| X-Ray Exam Neck Spine 6/>Vws (72052) |
$235 |
$470 |
2.2× |
| X-Ray Exam Unilat Ribs/Chest (71101) |
$231.50 |
$463 |
2.2× |
| X-ray eye for foreign body (70030) |
$109.50 |
$219 |
1.3× |
| X-ray humerus (73060) |
$181 |
$362 |
2.1× |
| X-ray IV pyelogram (ivp) (74400) |
$309 |
$618 |
1.8× |
| X-Ray Jaw <4 Vw - Xr Mandible < 4 Views (70100) |
$126.50 |
$253 |
1.4× |
| X-Ray Knee Bilat Standing - Xr Knees Anteroposterior Standing Bilat (73565) |
$154 |
$308 |
1.8× |
| X-Ray Lumbar Spine 2/3 Vw - Xr Lumbar Spine 2-3 Views (72100) |
$248.50 |
$497 |
2.4× |
| X-Ray Ribs, Chest 4+ Vw - Xr Ribs 3 Vws Bil W/ Chest Posteroanterior (71111) |
$178.50 |
$357 |
1.7× |
| X-Ray Sacroiliac Jts 3+ Vw - Xr Sacroiliac Joints 3+ Views (72202) |
$246.50 |
$493 |
2.3× |
| X-Ray Sacroiliac Jts <3 Vw - Xr Sacroiliac Joints 1-2 Views (72200) |
$176 |
$352 |
1.7× |
| X-Ray Sacrum/Coccyx 2+ Vw - Xr Sacrum Coccyx 2+ Views (72220) |
$176 |
$352 |
2.0× |
| X-Ray Sinuses 3+ Vw - Xr Paranasal Sinuses 3+ Views (70220) |
$153 |
$306 |
1.8× |
| X-Ray Skull 4+ Vw - Xr Skull Complete 4+ Views (70260) |
$352.50 |
$705 |
3.4× |
| X-Ray Stress View (77071) |
$99.50 |
$199 |
1.1× |
| X-ray thoracic spine 4 vw (72074) |
$153.50 |
$307 |
1.5× |
| X-Ray Tmj Unilat (70328) |
$114.50 |
$229 |
1.3× |
| X-Ray Urinary Tract Exam With Contrast Material (74420) |
$942.50 |
$1,885 |
2.7× |
| X-Rays Bone Length Studies (77073) |
$246 |
$492 |
2.3× |
| X-Rays Bone Survey Complete (77075) |
$204.50 |
$409 |
1.9× |
| Xr c-spine 4 or 5 views (72050) |
$306.50 |
$613 |
2.9× |
| Xr facial bones less than 3 views (70140) |
$99.50 |
$199 |
1.1× |
| XR Mastoids < 3 Views Bilateral (70120) |
$153 |
$306 |
1.5× |
| Xr myelogram posterior fossa (70010) |
$1,094 |
$2,188 |
3.1× |
| Xr orbits complete 4 views (70200) |
$153 |
$306 |
1.5× |