| 3-D radiotherapy plan dose-volume histograms (77295) |
$2,831.64 |
$6,742 |
2.0× |
| Acute gi blood loss imaging (78278) |
$664.86 |
$1,583 |
1.6× |
| Angiography internal mammary rs&i (75756) |
$1,648.50 |
$3,925 |
0.5× |
| Angiography pulmonary bilateral slctv rs&i (75743) |
$5,677.14 |
$13,517 |
1.8× |
| Angiography visceral slctv/supraslctv rs&i (75726) |
$2,985.78 |
$7,109 |
0.5× |
| Angiography, adrenal, bilateral, selective, radiological supervision and interpretation Age Under 21 (75733) |
$3,682.56 |
$8,768 |
1.1× |
| Angiography, adrenal, unilateral, selective, radiological supervision and interpretation Age Under 21 (75731) |
$2,454.90 |
$5,845 |
0.8× |
| Angiography, extremity, bilateral, radiological supervision and interpretation Age Under 21 (75716) |
$2,436.42 |
$5,801 |
0.8× |
| Angiography, extremity, unilateral, radiological supervision and interpretation Age Under 21 (75710) |
$1,985.34 |
$4,727 |
0.6× |
| Angiography, pelvic, selective or supraselective, radiological supervision and interpretation Age Under 21 (75736) |
$2,852.22 |
$6,791 |
0.5× |
| Angiography, pulmonary, unilateral, selective, radiological supervision and interpretation Age Under 21 (75741) |
$3,368.40 |
$8,020 |
1.0× |
| Angiography, spinal, selective, radiological supervision and interpretation Age Under 21 (75705) |
$2,852.22 |
$6,791 |
0.5× |
| Angrph cath f-up std tcat other than thrombylsis (75898) |
$927.36 |
$2,208 |
0.3× |
| Angrph pulmonary nonslctv cath/ven njx rs&i (75746) |
$3,406.20 |
$8,110 |
1.1× |
| Ankle 2 views (73600) |
$73.50 |
$175 |
0.8× |
| Aortography, abdominal plus bilateral iliofemoral lower extremity, catheter, by serialography, radiological supervision… (75630) |
$2,342.34 |
$5,577 |
0.7× |
| Aortography, abdominal, by serialography, radiological supervision and interpretation Age Under 21 (75625) |
$1,921.92 |
$4,576 |
0.6× |
| Aortography, thoracic, by serialography, radiological supervision and interpretation Age Under 21 (75605) |
$3,202.92 |
$7,626 |
0.6× |
| Aortography, thoracic, without serialography, radiological supervision and interpretation Age Under 21 (75600) |
$2,978.64 |
$7,092 |
0.9× |
| Basic radiation dosimetry calculation (77300) |
$275.94 |
$657 |
2.0× |
| Brain imaging, less than 4 static views; with vascular flow Age Under 21 (78601) |
$385.14 |
$917 |
0.9× |
| Brain imaging, minimum 4 static views; with vascular flow Age Under 21 (78606) |
$583.80 |
$1,390 |
1.1× |
| Cardiac blood pool imaging (planar), first pass technique; single study, at rest or with stress (exercise and/or… (78481) |
$728.70 |
$1,735 |
1.3× |
| Cardiac MRI morphology & function w/o contrast (75557) |
$438.90 |
$1,045 |
1.8× |
| Cardiac MRI w/wo contrast & further seq (75561) |
$658.56 |
$1,568 |
1.8× |
| Clavicle complete (73000) |
$78.96 |
$188 |
0.9× |
| Complex dynamic pharyngeal and speech evaluation by cine or video recording Age Under 21 (70371) |
$152.46 |
$363 |
0.6× |
| Computed tomographic (CT) colonography, diagnostic, including image postprocessing; with contrast material(s) including… (74262) |
$430.50 |
$1,025 |
2.4× |
| Computed tomographic (CT) colonography, diagnostic, including image postprocessing; without contrast material Age Under… (74261) |
$344.40 |
$820 |
3.2× |
| Computed tomographic (CT) colonography, screening, including image postprocessing (74263) |
$576.24 |
$1,372 |
2.4× |
| Computed tomographic angiography, abdomen and pelvis, with contrast material(s), including noncontrast images, if… (74174) |
$1,339.80 |
$3,190 |
3.8× |
| Computed tomographic angiography, abdomen, with contrast material(s), including noncontrast images, if performed, and… (74175) |
$617.40 |
$1,470 |
3.4× |
| Computed tomographic angiography, abdominal aorta and bilateral iliofemoral lower extremity runoff, with contrast… (75635) |
$685.86 |
$1,633 |
3.8× |
| Computed tomographic angiography, chest (noncoronary), with contrast material(s), including noncontrast images, if… (71275) |
$729.12 |
$1,736 |
4.1× |
| Computed tomographic angiography, lower extremity, with contrast material(s), including noncontrast images, if… (73706) |
$1,022.70 |
$2,435 |
5.7× |
| Computed tomographic angiography, neck, with contrast material(s), including noncontrast images, if performed, and… (70498) |
$1,025.64 |
$2,442 |
5.7× |
| Computed tomographic angiography, pelvis, with contrast material(s), including noncontrast images, if performed, and… (72191) |
$606.90 |
$1,445 |
3.4× |
| Computed tomographic angiography, upper extremity, with contrast material(s), including noncontrast images, if… (73206) |
$727.44 |
$1,732 |
4.1× |
| Computed tomography, cervical spine; without contrast material, followed by contrast material(s) and further sections… (72127) |
$973.98 |
$2,319 |
5.4× |
| Computed tomography, lower extremity; without contrast material Age Under 21 (73700) |
$649.32 |
$1,546 |
6.1× |
| Computed tomography, lower extremity; without contrast material, followed by contrast material(s) and further sections… (73702) |
$973.98 |
$2,319 |
5.4× |
| Computed tomography, lumbar spine; without contrast material, followed by contrast material(s) and further sections Age… (72133) |
$963.48 |
$2,294 |
5.4× |
| Computed tomography, maxillofacial area; with contrast material(s) Age Under 21 (70487) |
$811.86 |
$1,933 |
4.5× |
| Computed tomography, maxillofacial area; without contrast material Age Under 21 (70486) |
$649.32 |
$1,546 |
6.1× |
| Computed tomography, orbit, sella, or posterior fossa or outer, middle, or inner ear; with contrast material(s) Age… (70481) |
$811.86 |
$1,933 |
4.5× |
| Computed tomography, orbit, sella, or posterior fossa or outer, middle, or inner ear; without contrast material Age… (70480) |
$649.32 |
$1,546 |
6.1× |
| Computed tomography, orbit, sella, or posterior fossa or outer, middle, or inner ear; without contrast material,… (70482) |
$973.98 |
$2,319 |
5.4× |
| Computed tomography, soft tissue neck; without contrast material followed by contrast material(s) and further sections… (70492) |
$976.50 |
$2,325 |
5.4× |
| Computed tomography, thoracic spine; without contrast material, followed by contrast material(s) and further sections… (72130) |
$971.04 |
$2,312 |
5.4× |
| Computed tomography, thorax, diagnostic; without contrast material, followed by contrast material(s) and further… (71270) |
$694.26 |
$1,653 |
3.9× |
| Continuing medical physics consultation, including assessment of treatment parameters, quality assurance of dose… (77336) |
$279.72 |
$666 |
2.0× |
| Csf shunt evaluation (78645) |
$514.50 |
$1,225 |
0.9× |
| CT abdomen and pelvis without and with contrast (74178) |
$1,275.96 |
$3,038 |
3.6× |
| CT abdomen and pelvis without contrast (74176) |
$850.50 |
$2,025 |
3.5× |
| CT abdomen w & w/o contrast (74170) |
$588 |
$1,400 |
3.3× |
| CT abdomen w/contrast (74160) |
$490.14 |
$1,167 |
2.7× |
| CT abdomen w/o contrast (74150) |
$391.86 |
$933 |
3.7× |
| CT angio hrt w/3d image (75574) |
$523.74 |
$1,247 |
1.5× |
| CT cervical spine w/contrast (72126) |
$811.86 |
$1,933 |
2.3× |
| CT cervical spine w/o contrast (72125) |
$649.32 |
$1,546 |
6.1× |
| CT chest w/contrast (71260) |
$578.76 |
$1,378 |
3.2× |
| CT extremity upper w & w/o contrast (73202) |
$692.58 |
$1,649 |
3.9× |
| CT extremity upper w/o contrast (73200) |
$461.58 |
$1,099 |
4.3× |
| CT head/brain with contrast (70460) |
$811.86 |
$1,933 |
4.5× |
| CT head/brain without and with contrast (70470) |
$973.98 |
$2,319 |
5.4× |
| CT heart c+ cardiac strux&morph cgen hrt ds (75573) |
$498.54 |
$1,187 |
1.4× |
| CT heart contrast eval cardiac structure&morph (75572) |
$415.38 |
$989 |
1.2× |
| CT heart no contrast quant eval coronry calcium (75571) |
$73.08 |
$174 |
0.8× |
| CT l-spine w/contrast (72132) |
$803.04 |
$1,912 |
2.3× |
| CT limited/localized follow up study (76380) |
$245.70 |
$585 |
2.8× |
| CT lower extremity w/dye (73701) |
$811.86 |
$1,933 |
4.5× |
| CT lumbar spine w/o contrast (72131) |
$642.18 |
$1,529 |
6.0× |
| CT maxillofacial w/wo contrast (70488) |
$973.98 |
$2,319 |
5.4× |
| CT neck w/contrast (70491) |
$813.96 |
$1,938 |
4.5× |
| CT neck w/o contrast (70490) |
$651 |
$1,550 |
6.1× |
| CT pelvis w & w/o contrast (72194) |
$577.92 |
$1,376 |
3.2× |
| CT pelvis w/o contrast (72192) |
$385.14 |
$917 |
3.6× |
| CT thoracic spine w/contrast (72129) |
$809.34 |
$1,927 |
4.5× |
| CT thoracic spine w/o contrast (72128) |
$647.22 |
$1,541 |
6.1× |
| CT thorax w/o contrast (71250) |
$462.84 |
$1,102 |
4.3× |
| CT upper extremity w/dye (73201) |
$577.08 |
$1,374 |
1.6× |
| CTA head w contrast (70496) |
$1,022.70 |
$2,435 |
5.7× |
| Cystography, minimum of 3 views, radiological supervision and interpretation Age Under 21 (74430) |
$315.42 |
$751 |
0.9× |
| Dilation ureters/urethra rs&i (74485) |
$644.28 |
$1,534 |
0.3× |
| Discography, cervical or thoracic, radiological supervision and interpretation Age Under 21 (72285) |
$2,344.44 |
$5,582 |
1.2× |
| Diskography lumbar s&i (72295) |
$1,344 |
$3,200 |
0.7× |
| Fetal biophys profile w/o nst (76819) |
$162.54 |
$387 |
1.5× |
| Fetal biophysical profile non-stress testing (76818) |
$226.80 |
$540 |
2.1× |
| Fluoroscopy up to 1 hour physician/qhp time (76000) |
$385.56 |
$918 |
1.6× |
| Gastroesophageal reflux study (78262) |
$590.10 |
$1,405 |
1.4× |
| Gated heart planar single (78472) |
$781.62 |
$1,861 |
1.9× |
| Hdr rdncl ntrstl/intrcav brachytx 1 channel (77770) |
$1,834.56 |
$4,368 |
2.6× |
| Hdr rdncl ntrstl/intrcav brachytx 2-12 channel (77771) |
$2,285.22 |
$5,441 |
3.2× |
| Hdr rdncl ntrstl/intrcav brachytx >12 channels (77772) |
$2,376.78 |
$5,659 |
3.3× |
| Heart infarct image (78466) |
$452.34 |
$1,077 |
1.1× |
| Hepatc vngrph wdg/fr w/o hemodyn eval rs&i (75891) |
$1,954.68 |
$4,654 |
0.6× |
| Hepatic venography, wedged or free, with hemodynamic evaluation, radiological supervision and interpretation Age Under… (75889) |
$2,171.82 |
$5,171 |
0.7× |
| Hepatobil syst imag inc gb w/pharma intervenj (78227) |
$1,071.84 |
$2,552 |
1.9× |
| Hepatobiliary syst imaging including gallbladder (78226) |
$758.10 |
$1,805 |
1.9× |
| Ht muscle image spect sing (78451) |
$556.50 |
$1,325 |
0.4× |
| Injection procedure for radiopharmaceutical localization by non-imaging probe study, intravenous (eg, parathyroid… (78808) |
$234.36 |
$558 |
0.6× |
| Intensity modulated radiotherapy plan, including dose-volume histograms for target and critical structure partial… (77301) |
$3,102.12 |
$7,386 |
2.2× |
| Interstitial radiation source application, complex, includes supervision, handling, loading of radiation source, when… (77778) |
$1,666.56 |
$3,968 |
2.3× |
| Intestine imaging (eg, ectopic gastric mucosa, Meckel's localization, volvulus) Age Under 21 (78290) |
$632.52 |
$1,506 |
1.5× |
| Intracavitary radiation source application - complex (77763) |
$1,125.18 |
$2,679 |
1.6× |
| Intracavitary radiation source application - intermediate (77762) |
$787.50 |
$1,875 |
1.4× |
| Intracavitary radiation source application - simple (77761) |
$596.40 |
$1,420 |
1.1× |
| Isodose brachytherapy complex 10+ sources (77318) |
$687.96 |
$1,638 |
1.8× |
| Isodose brachytherapy intermed 5 to 10 sources (77317) |
$651.84 |
$1,552 |
1.7× |
| Isodose brachytherapy plan simple 1 to 4 source (77316) |
$494.34 |
$1,177 |
1.3× |
| Isodose teletherapy plan complex multi tx w/cal (77307) |
$667.80 |
$1,590 |
1.7× |
| Isodose teletherapy plan simple 1 or 2 port w/cal (77306) |
$277.62 |
$661 |
0.7× |
| Kidney imaging morphology; with vascular flow and function, multiple studies, with and without pharmacological… (78709) |
$868.14 |
$2,067 |
1.6× |
| Kidney imaging morphology; with vascular flow and function, single study without pharmacological intervention Age Under… (78707) |
$837.48 |
$1,994 |
1.5× |
| Kidney imaging morphology; with vascular flow and function, single study, with pharmacological intervention (eg,… (78708) |
$790.44 |
$1,882 |
1.4× |
| Liver and spleen imaging (78215) |
$557.76 |
$1,328 |
1.4× |
| Liver and spleen imaging; with vascular flow Age Under 21 (78216) |
$362.88 |
$864 |
0.9× |
| Lung perf&ventilat diferentl (78598) |
$768.60 |
$1,830 |
1.4× |
| Lung perfusion imaging (78580) |
$594.30 |
$1,415 |
1.5× |
| Lymphangiography, extremity only, bilateral, radiological supervision and interpretation Age Under 21 (75803) |
$1,492.26 |
$3,553 |
0.9× |
| Lymphangiography, extremity only, unilateral, radiological supervision and interpretation Age Under 21 (75801) |
$705.60 |
$1,680 |
1.1× |
| Lymphangiography, pelvic/abdominal, bilateral, radiological supervision and interpretation Age Under 21 (75807) |
$1,648.50 |
$3,925 |
0.5× |
| Lymphangiography, pelvic/abdominal, unilateral, radiological supervision and interpretation Age Under 21 (75805) |
$952.56 |
$2,268 |
0.3× |
| Magnetic resonance (eg, proton) imaging, any joint of lower extremity; without contrast material(s), followed by… (73723) |
$1,200.78 |
$2,859 |
3.4× |
| Magnetic resonance (eg, proton) imaging, lower extremity other than joint; with contrast material(s) Age Under 21 (73719) |
$1,000.86 |
$2,383 |
2.8× |
| Magnetic resonance (eg, proton) imaging, lower extremity other than joint; without contrast material(s) Age Under 21 (73718) |
$800.52 |
$1,906 |
3.3× |
| Magnetic resonance (eg, proton) imaging, lower extremity other than joint; without contrast material(s), followed by… (73720) |
$1,200.78 |
$2,859 |
3.4× |
| Magnetic resonance (eg, proton) imaging, orbit, face, and/or neck; with contrast material(s) Age Under 21 (70542) |
$808.08 |
$1,924 |
2.3× |
| Magnetic resonance (eg, proton) imaging, orbit, face, and/or neck; without contrast material(s) Age Under 21 (70540) |
$646.38 |
$1,539 |
2.7× |
| Magnetic resonance (eg, proton) imaging, upper extremity, other than joint; with contrast material(s) Age Under 21 (73219) |
$771.96 |
$1,838 |
2.2× |
| Magnetic resonance (eg, proton) imaging, upper extremity, other than joint; without contrast material(s), followed by… (73220) |
$926.10 |
$2,205 |
2.6× |
| Magnetic resonance angiography, head; with contrast material(s) Age Under 21 (70545) |
$716.10 |
$1,705 |
2.0× |
| Magnetic resonance angiography, head; without contrast material(s), followed by contrast material(s) and further… (70546) |
$859.32 |
$2,046 |
2.4× |
| Magnetic resonance angiography, neck; without contrast material(s), followed by contrast material(s) and further… (70549) |
$933.24 |
$2,222 |
2.6× |
| Mammary ductogram or galactogram, multiple ducts, radiological supervision and interpretation Age Under 21 (77054) |
$231.42 |
$551 |
0.9× |
| Mammary ductogram single (77053) |
$175.98 |
$419 |
0.7× |
| Mandible min 4v (70110) |
$78.96 |
$188 |
0.7× |
| Mr safety determination physician/other qhp (76016) |
$55.44 |
$132 |
0.6× |
| Mr safety implant pos&/immoblj supvj phys/qhp (76019) |
$125.16 |
$298 |
2.1× |
| Mr safety implant&/fb assmt clin staf 1st 15 min (76014) |
$15.96 |
$38 |
0.5× |
| Mr safety implt electronics prepj supvj phys/qhp (76018) |
$81.90 |
$195 |
0.8× |
| Mr safety med physics xm customization plng&mntr (76017) |
$194.04 |
$462 |
0.8× |
| MRA head w/o contrast (70544) |
$572.88 |
$1,364 |
2.4× |
| MRA neck w/ contrast (70548) |
$777.84 |
$1,852 |
2.2× |
| MRA neck w/o contrast (70547) |
$622.02 |
$1,481 |
2.6× |
| MRI abdomen w/contrast (74182) |
$982.38 |
$2,339 |
2.8× |
| MRI abdomen w/o contrast (74181) |
$785.82 |
$1,871 |
3.2× |
| MRI abdomen w/wo contrast (74183) |
$1,178.94 |
$2,807 |
3.3× |
| MRI any jt lower extrem w/contrast material (73722) |
$1,000.86 |
$2,383 |
1.2× |
| MRI bone marrow (77084) |
$640.50 |
$1,525 |
2.6× |
| MRI breast c- bilateral (77047) |
$668.22 |
$1,591 |
2.7× |
| MRI breast without contrast material unilateral (77046) |
$445.62 |
$1,061 |
1.8× |
| MRI c-spine w&w/o cont (72156) |
$1,197.84 |
$2,852 |
3.4× |
| MRI cervical spine w/contrast (72142) |
$998.34 |
$2,377 |
2.8× |
| MRI chest w/contrast (71551) |
$1,001.28 |
$2,384 |
1.3× |
| MRI chest w/o contrast (71550) |
$800.94 |
$1,907 |
3.3× |
| MRI chest w/wo contrast (71552) |
$1,201.62 |
$2,861 |
3.4× |
| MRI joint upr extr w/o&w/dye (73223) |
$1,200.78 |
$2,859 |
3.4× |
| MRI joint upr extrem w/dye (73222) |
$1,000.86 |
$2,383 |
1.2× |
| MRI joint upr extrem w/o dye (73221) |
$800.52 |
$1,906 |
3.3× |
| MRI lumbar spine w/contrast (72149) |
$1,000.86 |
$2,383 |
2.8× |
| MRI lumbar spine w/wo contrast (72158) |
$1,200.78 |
$2,859 |
3.4× |
| MRI orbit/face/neck w&w/o cont (70543) |
$969.78 |
$2,309 |
2.7× |
| MRI pelvis w & w/o contrast (72197) |
$1,192.80 |
$2,840 |
3.3× |
| MRI pelvis w/contrast (72196) |
$994.14 |
$2,367 |
2.8× |
| MRI pelvis w/o contrast (72195) |
$795.06 |
$1,893 |
3.3× |
| MRI spine cervical w/o contrast (72141) |
$798.42 |
$1,901 |
3.3× |
| MRI t-spine w&w/o cont (72157) |
$1,194.48 |
$2,844 |
3.4× |
| MRI thoracic spine w/contrast (72147) |
$995.40 |
$2,370 |
2.8× |
| MRI thoracic spine w/o contrst (72146) |
$796.32 |
$1,896 |
3.3× |
| MRI tmj (70336) |
$602.70 |
$1,435 |
2.5× |
| MRI upper extremity oth than jt w/o contr matrl (73218) |
$617.40 |
$1,470 |
2.5× |
| Multi-leaf collimator (MLC) device(s) for intensity modulated radiation therapy (IMRT), design and construction per… (77338) |
$459.48 |
$1,094 |
1.2× |
| Myelography, 2 or more regions (eg, lumbar/thoracic, cervical/thoracic, lumbar/cervical, lumbar/thoracic/cervical),… (72270) |
$619.92 |
$1,476 |
0.8× |
| Myocardial perfusion imaging, planar (including qualitative or quantitative wall motion, ejection fraction by first… (78453) |
$556.50 |
$1,325 |
0.4× |
| Myocardial perfusion imaging, planar (including qualitative or quantitative wall motion, ejection fraction by first… (78454) |
$671.16 |
$1,598 |
0.5× |
| Myocardial spect multiple studies (78452) |
$671.16 |
$1,598 |
0.5× |
| Nm bone 3 phase (78315) |
$1,307.04 |
$3,112 |
3.2× |
| Nm bone imaging whole body (78306) |
$1,035.30 |
$2,465 |
2.5× |
| Nm bone marrow ltd (78102) |
$343.98 |
$819 |
0.8× |
| Nm bone marrow multi (78103) |
$440.16 |
$1,048 |
1.1× |
| Nm bone marrow wb (78104) |
$501.90 |
$1,195 |
1.2× |
| Nm csf cisternogram (78630) |
$550.62 |
$1,311 |
1.0× |
| Nm csf leak detection (78650) |
$900.06 |
$2,143 |
0.7× |
| Nm gastric emptying (78264) |
$956.34 |
$2,277 |
2.3× |
| Nm lung ventilation imaging (78579) |
$430.92 |
$1,026 |
1.1× |
| Nm lymph system (78195) |
$961.80 |
$2,290 |
1.7× |
| Nuclear medicine study for detecting heart shunt (78428) |
$636.30 |
$1,515 |
1.6× |
| Nuclear medicine study of bone and/or joint limited area (78300) |
$745.92 |
$1,776 |
1.8× |
| Nuclear medicine study of bone and/or joint multiple areas (78305) |
$760.20 |
$1,810 |
1.9× |
| Nuclear medicine study of brain, 4 static views or more (78605) |
$351.54 |
$837 |
0.6× |
| Nuclear medicine study of brain, less than 4 static views (78600) |
$328.02 |
$781 |
0.8× |
| Ob us limited fetus(s) (76815) |
$161.70 |
$385 |
1.5× |
| Optic foramina (70190) |
$55.44 |
$132 |
0.6× |
| Panoramic X-ray of jaws (70355) |
$53.34 |
$127 |
0.6× |
| Parathyrd planar w/spect&CT (78072) |
$801.78 |
$1,909 |
1.4× |
| Parathyroid planar imaging (78070) |
$538.44 |
$1,282 |
1.3× |
| Parathyroid planar imaging w/wo subtraction (78071) |
$484.26 |
$1,153 |
1.2× |
| Percutaneous transhepatic portography with hemodynamic evaluation, radiological supervision and interpretation Age… (75885) |
$2,669.10 |
$6,355 |
0.8× |
| PET imaging CT attenuation skull base mid-thigh (78815) |
$2,877 |
$6,850 |
2.0× |
| Prq transhepatc portograpy w/o hemodyn evl intrp (75887) |
$2,639.28 |
$6,284 |
0.8× |
| Pulmonary ventilation & perfusion imaging (78582) |
$1,298.22 |
$3,091 |
2.3× |
| Quant differential pulm perfusion w/wo imaging (78597) |
$499.38 |
$1,189 |
1.2× |
| Radex abscess/fistula/sinus tract rs&i (76080) |
$345.66 |
$823 |
0.6× |
| Radex entir thrc lmbr crv sac spi w/skull 1 vw (72081) |
$60.06 |
$143 |
0.7× |
| Radex entir thrc lmbr crv sac spi w/skull 2/3 vw (72082) |
$94.08 |
$224 |
0.9× |
| Radex entir thrc lmbr crv sac spi w/skull 4/5 vw (72083) |
$105.84 |
$252 |
1.0× |
| Radex entir thrc lmbr crv sac spi w/skull 6/> vw (72084) |
$106.26 |
$253 |
1.0× |
| Radex hip unilateral with pelvis 1 view (73501) |
$102.90 |
$245 |
1.2× |
| Radex hip unilateral with pelvis 2-3 views (73502) |
$111.30 |
$265 |
1.3× |
| Radex hip unilateral with pelvis minimum 4 views (73503) |
$166.32 |
$396 |
1.6× |
| Radex hips bilateral with pelvis 2 views (73521) |
$112.98 |
$269 |
1.1× |
| Radex hips bilateral with pelvis minimum 5 views (73523) |
$242.76 |
$578 |
2.3× |
| Radex spine cervical 2 or 3 views (72040) |
$78.96 |
$188 |
0.9× |
| Radex spine cervical 4 or 5 views (72050) |
$108.36 |
$258 |
1.0× |
| Radex spine cervical 6 or more views (72052) |
$129.36 |
$308 |
1.2× |
| Radex spine thoracolumbar junction min 2 views (72080) |
$78.96 |
$188 |
0.9× |
| Radiation treatment delivery, stereotactic radiosurgery (SRS), complete course of treatment of cranial lesion(s)… (77372) |
$6,318.48 |
$15,044 |
0.8× |
| Radiation tx delivery lvl 1 (77402) |
$236.04 |
$562 |
2.3× |
| Radiation tx delivery lvl 2 (77407) |
$294 |
$700 |
0.7× |
| Radiation tx delivery lvl 3 (77412) |
$329.70 |
$785 |
0.6× |
| Radiologic exam abdomen 3+ views (74021) |
$99.96 |
$238 |
0.9× |
| Radiologic exam chest 3 views (71047) |
$132.30 |
$315 |
1.5× |
| Radiologic exam chest 4+ views (71048) |
$141.54 |
$337 |
1.3× |
| Radiologic exam colon double contrast study (74280) |
$188.58 |
$449 |
1.1× |
| Radiologic exam colon single contrast study (74270) |
$181.44 |
$432 |
1.0× |
| Radiologic exam esophagus double contrast study (74221) |
$150.78 |
$359 |
0.8× |
| Radiologic exam esophagus single contrast study (74220) |
$143.22 |
$341 |
0.8× |
| Radiologic exam small int single contrast study (74250) |
$181.44 |
$432 |
1.0× |
| Radiologic exam swallow function contrast study (74230) |
$181.44 |
$432 |
1.0× |
| Radiologic exam upr gi trc double contrast study (74246) |
$229.32 |
$546 |
1.3× |
| Radiologic exam upr gi trc single contrast study (74240) |
$200.76 |
$478 |
1.1× |
| Radiologic examination femur 1 view (73551) |
$60.06 |
$143 |
0.7× |
| Radiologic examination femur minimum 2 views (73552) |
$78.96 |
$188 |
0.9× |
| Radiologic examination from nose to rectum for foreign body, single view, child Age Under 21 (76010) |
$55.44 |
$132 |
0.6× |
| Radiologic examination, ankle; complete, minimum of 3 views Age Under 21 (73610) |
$78.96 |
$188 |
0.9× |
| Radiologic examination, complete acute abdomen series, including 2 or more views of the abdomen (eg, supine, erect,… (74022) |
$130.62 |
$311 |
1.2× |
| Radiologic examination, elbow; 2 views Age Under 21 (73070) |
$70.98 |
$169 |
0.8× |
| Radiologic examination, elbow; complete, minimum of 3 views Age Under 21 (73080) |
$78.96 |
$188 |
0.9× |
| Radiologic examination, facial bones; less than 3 views Age Under 21 (70140) |
$55.44 |
$132 |
0.6× |
| Radiologic examination, foot; complete, minimum of 3 views Age Under 21 (73630) |
$78.96 |
$188 |
0.9× |
| Radiologic examination, hand; minimum of 3 views Age Under 21 (73130) |
$78.96 |
$188 |
0.9× |
| Radiologic examination, knee; both knees, standing, anteroposterior Age Under 21 (73565) |
$87.78 |
$209 |
1.0× |
| Radiologic examination, knee; complete, 4 or more views Age Under 21 (73564) |
$87.36 |
$208 |
0.8× |
| Radiologic examination, mandible; partial, less than 4 views Age Under 21 (70100) |
$55.44 |
$132 |
0.6× |
| Radiologic examination, mastoids; complete, minimum of 3 views per side Age Under 21 (70130) |
$73.92 |
$176 |
0.7× |
| Radiologic examination, nasal bones, complete, minimum of 3 views Age Under 21 (70160) |
$78.96 |
$188 |
0.9× |
| Radiologic examination, ribs, bilateral; including posteroanterior chest, minimum of 4 views Age Under 21 (71111) |
$112.56 |
$268 |
1.1× |
| Radiologic examination, ribs, unilateral; including posteroanterior chest, minimum of 3 views Age Under 21 (71101) |
$81.90 |
$195 |
0.8× |
| Radiologic examination, sacroiliac joints; less than 3 views Age Under 21 (72200) |
$67.20 |
$160 |
0.6× |
| Radiologic examination, shoulder, arthrography, radiological supervision and interpretation Age Under 21 (73040) |
$413.28 |
$984 |
1.2× |
| Radiologic examination, shoulder; complete, minimum of 2 views Age Under 21 (73030) |
$78.96 |
$188 |
0.9× |
| Radiologic examination, single plane body section (eg, tomography), other than with urography Age Under 21 (76100) |
$77.28 |
$184 |
0.7× |
| Radiologic examination, sinuses, paranasal, less than 3 views Age Under 21 (70210) |
$55.44 |
$132 |
0.6× |
| Radiologic examination, skull; less than 4 views Age Under 21 (70250) |
$78.96 |
$188 |
0.7× |
| Radiologic examination, spine, lumbosacral; 2 or 3 views Age Under 21 (72100) |
$78.96 |
$188 |
0.7× |
| Radiologic examination, spine, lumbosacral; bending views only, 2 or 3 views Age Under 21 (72120) |
$68.88 |
$164 |
0.6× |
| Radiologic examination, spine, lumbosacral; complete, including bending views, minimum of 6 views Age Under 21 (72114) |
$127.26 |
$303 |
1.2× |
| Radiologic examination, spine; thoracic, minimum of 4 views Age Under 21 (72074) |
$92.40 |
$220 |
0.9× |
| Radiologic examination, wrist; complete, minimum of 3 views Age Under 21 (73110) |
$78.96 |
$188 |
0.9× |
| Radiologic examination; acromioclavicular joints, bilateral, with or without weighted distraction Age Under 21 (73050) |
$55.44 |
$132 |
0.6× |
| Radiologic examination; humerus, minimum of 2 views Age Under 21 (73060) |
$78.96 |
$188 |
0.9× |
| Radiologic examination; lower extremity, infant, minimum of 2 views Age Under 21 (73592) |
$58.38 |
$139 |
0.7× |
| Radiologic examination; orbits, complete, minimum of 4 views Age Under 21 (70200) |
$78.96 |
$188 |
0.7× |
| Radiologic examination; sternoclavicular joint or joints, minimum of 3 views Age Under 21 (71130) |
$74.76 |
$178 |
0.8× |
| Radiologic examination; toe(s), minimum of 2 views Age Under 21 (73660) |
$78.96 |
$188 |
0.9× |
| Radiologic examination; upper extremity, infant, minimum of 2 views Age Under 21 (73092) |
$77.70 |
$185 |
0.7× |
| Radiopharmaceutical localization of tumor, inflammatory process or distribution of radiopharmaceutical agent(s)… (78803) |
$1,367.52 |
$3,256 |
2.5× |
| Radiopharmaceutical therapy, by intra-articular administration Age Under 21 (79440) |
$183.12 |
$436 |
0.8× |
| Radiopharmaceutical therapy, by oral administration Age Under 21 (79005) |
$1,077.72 |
$2,566 |
4.5× |
| Radiopharmaceutical therapy, radiolabeled monoclonal antibody by intravenous infusion (79403) |
$567 |
$1,350 |
2.4× |
| Review by radiologist of urinary bladder and urethra images with contrast and after passing urine (74455) |
$220.08 |
$524 |
0.9× |
| Rp loclzj tum plnr 1 area single day imaging (78800) |
$386.40 |
$920 |
0.9× |
| Rp loclzj tum plnr 2+area 1+d img/1 area img>2+d (78801) |
$515.34 |
$1,227 |
1.3× |
| Rp loclzj tum plnr whole body 2+ days imaging (78804) |
$1,504.44 |
$3,582 |
2.7× |
| Rp loclzj tum plnr whole body single day imaging (78802) |
$822.78 |
$1,959 |
1.5× |
| Rp loclzj tum spect 2 areas (78831) |
$1,178.52 |
$2,806 |
0.9× |
| Rp loclzj tum spect w/CT 1 (78830) |
$1,103.34 |
$2,627 |
0.8× |
| Rp loclzj tum spect w/CT 2 (78832) |
$1,220.52 |
$2,906 |
0.8× |
| Rp therapy intra-arterial particulate admn (79445) |
$257.46 |
$613 |
1.1× |
| Scapula complete (73010) |
$63 |
$150 |
0.6× |
| Shuntogram indwelling nonvascular shunt rs&i (75809) |
$285.60 |
$680 |
2.7× |
| Simulation intermediate (77285) |
$696.78 |
$1,659 |
1.8× |
| Special dosimetry (77331) |
$381.78 |
$909 |
2.8× |
| Special physics consult (77370) |
$480.06 |
$1,143 |
3.5× |
| Special teletherapy port plan (77321) |
$701.40 |
$1,670 |
1.8× |
| Special treatment procedure (77470) |
$813.96 |
$1,938 |
1.4× |
| Spleen imaging only, with or without vascular flow Age Under 21 (78185) |
$284.76 |
$678 |
0.7× |
| Splenoportography, radiological supervision and interpretation Age Under 21 (75810) |
$1,648.50 |
$3,925 |
0.5× |
| Stereotactic body radiation therapy, treatment delivery, per fraction to 1 or more lesions, including image guidance,… (77373) |
$3,062.22 |
$7,291 |
1.7× |
| Temporomandibular joint arthrography, radiological supervision and interpretation Age Under 21 (70332) |
$152.46 |
$363 |
0.6× |
| Testicular imaging with vascular flow Age Under 21 (78761) |
$253.26 |
$603 |
0.6× |
| Ther rad simulaj-aided field setting complex (77290) |
$807.66 |
$1,923 |
2.1× |
| Therapeutic enema, contrast or air, for reduction of intussusception or other intraluminal obstruction (eg, meconium… (74283) |
$172.20 |
$410 |
1.0× |
| Thyroid carcinoma metastases imaging; limited area (eg, neck and chest only) Age Under 21 (78015) |
$404.04 |
$962 |
1.0× |
| Thyroid imaging with vascular flow (78013) |
$480.48 |
$1,144 |
1.2× |
| Thyroid met imaging body (78018) |
$947.10 |
$2,255 |
1.7× |
| Thyroid uptake single/multiple quant measurement (78012) |
$278.46 |
$663 |
0.7× |
| Thyroid uptake w/blood flow sngle/mult quan meas (78014) |
$1,013.88 |
$2,414 |
2.5× |
| Tr simulation simple (77280) |
$464.52 |
$1,106 |
3.4× |
| Treatment device complex (77334) |
$547.68 |
$1,304 |
1.4× |
| Treatment device intermediate (77333) |
$362.88 |
$864 |
2.6× |
| Treatment device simple (77332) |
$232.68 |
$554 |
1.7× |
| Ultrasound breast limited (76642) |
$140.28 |
$334 |
1.6× |
| Ultrasound, abdomen limited (76705) |
$281.40 |
$670 |
2.6× |
| Ultrasound, limited, joint or focal evaluation of other nonvascular extremity structure(s) (eg, joint space,… (76882) |
$182.28 |
$434 |
1.7× |
| Ultrasound, pelvic (nonobstetric), real time with image documentation; complete Age Under 21 (76856) |
$281.40 |
$670 |
2.6× |
| Ultrasound, pregnant uterus, real time with image documentation, fetal and maternal evaluation plus detailed fetal… (76811) |
$265.02 |
$631 |
1.1× |
| Ultrasound, pregnant uterus, real time with image documentation, fetal and maternal evaluation, first trimester (< 14… (76801) |
$281.40 |
$670 |
2.6× |
| Ultrasound, transplanted kidney, real time and duplex Doppler with image documentation Age Under 21 (76776) |
$281.40 |
$670 |
2.6× |
| Ultrasound, transrectal; prostate volume study for brachytherapy treatment planning (separate procedure) Age Under 21 (76873) |
$228.48 |
$544 |
2.1× |
| Unlisted magnetic resonance procedure (eg, diagnostic, interventional) Age Under 21 (76498) |
$1,249.50 |
$2,975 |
14.1× |
| Urea breath test, C-14 (isotopic); acquisition for analysis Other Outpatient (78267) |
$251.16 |
$598 |
22.7× |
| Urea breath test, C-14 (isotopic); analysis Other Outpatient (78268) |
$2,089.50 |
$4,975 |
22.1× |
| Ureteral reflux study (78740) |
$253.26 |
$603 |
0.6× |
| Urethrocystography retrograde rs&i (74450) |
$206.22 |
$491 |
0.8× |
| Urography (pyelography), intravenous, with or without KUB, with or without tomography Age Under 21 (74400) |
$444.78 |
$1,059 |
2.5× |
| Urography antegrade rs&i (74425) |
$278.46 |
$663 |
0.8× |
| Urography, infusion, drip technique and/or bolus technique; Age Under 21 (74410) |
$464.94 |
$1,107 |
2.6× |
| Urography, infusion, drip technique and/or bolus technique; with nephrotomography Age Under 21 (74415) |
$542.64 |
$1,292 |
3.0× |
| Us breast uni real time with image complete (76641) |
$171.36 |
$408 |
1.6× |
| Us chest (76604) |
$171.36 |
$408 |
1.6× |
| Us compl joint r-t w/image documentation (76881) |
$282.66 |
$673 |
2.6× |
| Us encephalogram (76506) |
$107.94 |
$257 |
1.0× |
| Us exam, pelvic, limited (76857) |
$225.12 |
$536 |
2.1× |
| Us guided compression repair (76936) |
$328.02 |
$781 |
1.5× |
| Us inft hips r-t img dynamic req phys/qhp manj (76885) |
$107.94 |
$257 |
1.2× |
| Us inft hips r-t img lmtd static phys/qhp manj (76886) |
$78.96 |
$188 |
0.9× |
| US OB Follow-Up/Repeat (76816) |
$129.78 |
$309 |
1.2× |
| Us ob transvaginal (76817) |
$186.06 |
$443 |
1.7× |
| Us retroperitoneal complete (76770) |
$281.40 |
$670 |
2.6× |
| Us retroperitoneal ltd (76775) |
$147 |
$350 |
1.4× |
| Us scrotum (76870) |
$281.40 |
$670 |
2.6× |
| Us soft tissue head/neck (76536) |
$169.26 |
$403 |
1.6× |
| Us spinal canal (76800) |
$166.74 |
$397 |
1.6× |
| Us transrectal (76872) |
$269.64 |
$642 |
2.5× |
| Venogram sinus/jugular (75860) |
$1,575.84 |
$3,752 |
0.5× |
| Venography adrenal unilateral selective rs&i (75840) |
$2,441.88 |
$5,814 |
0.8× |
| Venography renal unilateral selective rs&i (75831) |
$2,168.46 |
$5,163 |
0.7× |
| Venography, caval, inferior, with serialography, radiological supervision and interpretation Age Under 21 (75825) |
$1,648.50 |
$3,925 |
0.5× |
| Venography, caval, superior, with serialography, radiological supervision and interpretation Age Under 21 (75827) |
$995.40 |
$2,370 |
0.6× |
| Venography, epidural, radiological supervision and interpretation Age Under 21 (75872) |
$2,441.88 |
$5,814 |
3.8× |
| Venography, extremity, bilateral, radiological supervision and interpretation Age Under 21 (75822) |
$1,171.38 |
$2,789 |
0.7× |
| Venography, extremity, unilateral, radiological supervision and interpretation Age Under 21 (75820) |
$1,020.60 |
$2,430 |
0.6× |
| Venography, orbital, radiological supervision and interpretation Age Under 21 (75880) |
$2,291.94 |
$5,457 |
3.6× |
| Venography, superior sagittal sinus, radiological supervision and interpretation Age Under 21 (75870) |
$1,575.84 |
$3,752 |
0.5× |
| Venous sampling thru cath w/wo angiography rs& (75893) |
$2,852.22 |
$6,791 |
0.5× |
| X-ray exam hips bi 3-4 views (73522) |
$150.78 |
$359 |
1.4× |
| X-ray exam of finger(s) (73140) |
$78.96 |
$188 |
0.9× |
| X-ray exam of knee 1 or 2 (73560) |
$55.44 |
$132 |
0.6× |
| X-ray exam of small bowel - fl small bowel series enteroclysis tube (74251) |
$412.86 |
$983 |
2.3× |
| X-ray exam ribs bil 3 views (71110) |
$94.92 |
$226 |
0.9× |
| X-ray exam ribs uni 2 views (71100) |
$71.82 |
$171 |
0.8× |
| X-ray heel (73650) |
$72.24 |
$172 |
0.8× |
| X-ray of joint between lower spine and hip bone 3 or more views|PROFESSIONAL COMPONENT (72202) |
$90.30 |
$215 |
0.8× |
| X-ray retrograde pyelogram (74420) |
$278.46 |
$663 |
0.8× |
| Xr abdomen 1 view (74018) |
$71.82 |
$171 |
0.8× |
| Xr abdomen 2 views (74019) |
$85.68 |
$204 |
0.8× |
| Xr arthrogram ankle (73615) |
$281.82 |
$671 |
0.8× |
| Xr arthrogram elbow (73085) |
$230.58 |
$549 |
0.6× |
| Xr arthrogram hip (73525) |
$230.58 |
$549 |
0.6× |
| Xr arthrogram knee (73580) |
$230.58 |
$549 |
0.6× |
| Xr arthrogram wrist (73115) |
$236.46 |
$563 |
0.7× |
| Xr bone age studies (77072) |
$67.20 |
$160 |
0.6× |
| Xr bone length study (77073) |
$67.20 |
$160 |
0.6× |
| Xr bone survey infant (77076) |
$97.44 |
$232 |
0.9× |
| Xr bone survey ltd (77074) |
$67.20 |
$160 |
0.6× |
| Xr chest 1 view (71045) |
$78.96 |
$188 |
0.9× |
| Xr chest 2 views (71046) |
$99.96 |
$238 |
1.1× |
| Xr eye foreign body (70030) |
$78.96 |
$188 |
0.9× |
| Xr facial bones 3+ views (70150) |
$67.20 |
$160 |
0.6× |
| Xr foot arthritis pa only bilateral - report(ortho pro) (73620) |
$68.04 |
$162 |
0.8× |
| Xr forearm 2 views (73090) |
$70.98 |
$169 |
0.8× |
| Xr hand 2v (73120) |
$68.88 |
$164 |
0.6× |
| Xr hysterosalpingogram (74740) |
$290.22 |
$691 |
1.2× |
| Xr joint survey 1 view (77077) |
$67.20 |
$160 |
0.6× |
| Xr myelogram c-spine (72240) |
$693.42 |
$1,651 |
0.9× |
| Xr myelogram l-spine (72265) |
$609.84 |
$1,452 |
0.8× |
| Xr myelogram t-spine (72255) |
$640.50 |
$1,525 |
0.8× |
| Xr neck soft tissue (70360) |
$78.96 |
$188 |
0.9× |
| Xr o knee w/ merchant view bilat - report(ortho pro) (73562) |
$78.96 |
$188 |
0.9× |
| Xr osseous survey complete (77075) |
$130.62 |
$311 |
1.2× |
| Xr pelvis 1-2 views (72170) |
$78.96 |
$188 |
0.7× |
| Xr pelvis min 3 view (72190) |
$94.50 |
$225 |
0.9× |
| Xr peritoneogram (74190) |
$345.66 |
$823 |
0.6× |
| Xr sacrum/coccyx 2+ views (72220) |
$78.96 |
$188 |
0.9× |
| Xr sella turcica (70240) |
$55.44 |
$132 |
0.6× |
| Xr shoulder 1 view (73020) |
$62.58 |
$149 |
0.7× |
| Xr sinuses 3+ views (70220) |
$67.20 |
$160 |
0.8× |
| Xr skull min 4 view (70260) |
$82.32 |
$196 |
0.8× |
| Xr spine 1 view (72020) |
$63 |
$150 |
0.7× |
| Xr spine thoracic 3v (72072) |
$84 |
$200 |
0.8× |
| Xr sternum 2+ views (71120) |
$58.38 |
$139 |
0.7× |
| Xr stress view joint (77071) |
$99.54 |
$237 |
1.1× |
| Xr surgical specimen (76098) |
$168 |
$400 |
0.3× |
| Xr t-spine 2 views (72070) |
$78.96 |
$188 |
0.7× |
| Xr tibia/fibula 2 views (73590) |
$78.96 |
$188 |
0.9× |
| Xr tmj bilateral (70330) |
$103.74 |
$247 |
1.2× |
| Xr tmj unilateral (70328) |
$55.44 |
$132 |
0.6× |
| Xr venogram renal bilat (75833) |
$3,837.96 |
$9,138 |
1.2× |
| Xr wrist 2 views (73100) |
$68.88 |
$164 |
0.8× |