| 3-D radiotherapy plan dose-volume histograms (77295) |
$4,559.92 |
$9,325 |
3.1× |
| Acute gi blood loss imaging (78278) |
$912.91 |
$1,848 |
2.2× |
| Angiography internal mammary rs&i (75756) |
$1,102.05 |
$3,950 |
0.3× |
| Angiography pulmonary bilateral slctv rs&i (75743) |
$2,777.45 |
$9,955 |
0.8× |
Angiography visceral slctv/supraslctv rs&i (75726)
unusually low — confirm this is the full procedure |
$1,906.41 |
$6,833 |
0.3× |
| Angiography, extremity, bilateral, radiological supervision and interpretation Age Under 21 (75716) |
$1,618.48 |
$5,801 |
0.5× |
| Angiography, extremity, unilateral, radiological supervision and interpretation Age Under 21 (75710) |
$1,264.99 |
$4,534 |
0.4× |
Angiography, pelvic, selective or supraselective, radiological supervision and interpretation Age Under 21 (75736)
unusually low — confirm this is the full procedure |
$1,906.41 |
$6,833 |
0.3× |
| Angiography, pulmonary, unilateral, selective, radiological supervision and interpretation Age Under 21 (75741) |
$1,627.69 |
$5,834 |
0.5× |
Angiography, spinal, selective, radiological supervision and interpretation Age Under 21 (75705)
unusually low — confirm this is the full procedure |
$1,906.41 |
$6,833 |
0.3× |
| Angrph cath f-up std tcat other than thrombylsis (75898) |
$616.03 |
$2,208 |
0.2× |
| Angrph pulmonary nonslctv cath/ven njx rs&i (75746) |
$2,262.69 |
$8,110 |
0.7× |
| Ankle 2 views (73600) |
$46.82 |
$133 |
0.5× |
| Aortography, abdominal plus bilateral iliofemoral lower extremity, catheter, by serialography, radiological supervision… (75630) |
$3,191.48 |
$11,439 |
1.0× |
| Aortography, abdominal, by serialography, radiological supervision and interpretation Age Under 21 (75625) |
$1,102.05 |
$3,950 |
0.3× |
Aortography, thoracic, by serialography, radiological supervision and interpretation Age Under 21 (75605)
unusually low — confirm this is the full procedure |
$1,906.41 |
$6,833 |
0.3× |
| Basic radiation dosimetry calculation (77300) |
$434.72 |
$889 |
3.1× |
| Brain flow imaging only - nm brain flow only brain death (78610) |
$401.13 |
$812 |
0.7× |
| Brain imaging, minimum 4 static views; with vascular flow Age Under 21 (78606) |
$705.43 |
$1,428 |
1.2× |
| Brain imaging, positron emission tomography (PET); metabolic evaluation Age Under 21 (78608) |
$2,457.85 |
$6,088 |
1.6× |
| Card MRI w/stress img & dye (75563) |
$759.65 |
$1,968 |
0.9× |
| Cardiac blood pool imaging (planar), first pass technique; single study, at rest or with stress (exercise and/or… (78481) |
$857.09 |
$1,735 |
1.5× |
| Cardiac blood pool imaging, gated equilibrium; multiple studies, wall motion study plus ejection fraction, at rest and… (78473) |
$1,177.70 |
$2,384 |
2.8× |
| Cardiac MRI morphology & function w/o contrast (75557) |
$544.65 |
$1,411 |
2.2× |
| Cardiac MRI w/stress img (75559) |
$506.43 |
$1,312 |
0.9× |
| Cardiac MRI w/wo contrast & further seq (75561) |
$817.16 |
$2,117 |
2.2× |
| Cholecystography, oral contrast Age Under 21 (74290) |
$127.42 |
$362 |
0.7× |
| Cineradiography/videoradiography (76120) |
$233.02 |
$662 |
2.1× |
| Clavicle complete (73000) |
$53.86 |
$153 |
0.6× |
| Computed tomographic (CT) colonography, diagnostic, including image postprocessing; with contrast material(s) including… (74262) |
$804.45 |
$1,730 |
4.3× |
| Computed tomographic (CT) colonography, diagnostic, including image postprocessing; without contrast material Age Under… (74261) |
$643.56 |
$1,384 |
5.8× |
| Computed tomographic angiography, abdomen and pelvis, with contrast material(s), including noncontrast images, if… (74174) |
$569.14 |
$1,704 |
1.5× |
| Computed tomographic angiography, abdomen, with contrast material(s), including noncontrast images, if performed, and… (74175) |
$392.45 |
$1,175 |
2.1× |
| Computed tomographic angiography, abdominal aorta and bilateral iliofemoral lower extremity runoff, with contrast… (75635) |
$759.34 |
$1,633 |
4.1× |
| Computed tomographic angiography, chest (noncoronary), with contrast material(s), including noncontrast images, if… (71275) |
$482.96 |
$1,446 |
2.6× |
| Computed tomographic angiography, lower extremity, with contrast material(s), including noncontrast images, if… (73706) |
$466.26 |
$1,396 |
2.5× |
| Computed tomographic angiography, neck, with contrast material(s), including noncontrast images, if performed, and… (70498) |
$479.84 |
$1,481 |
2.6× |
| Computed tomographic angiography, pelvis, with contrast material(s), including noncontrast images, if performed, and… (72191) |
$536.74 |
$1,607 |
2.9× |
| Computed tomographic angiography, upper extremity, with contrast material(s), including noncontrast images, if… (73206) |
$481.96 |
$1,443 |
2.6× |
| Computed tomography, cervical spine; without contrast material, followed by contrast material(s) and further sections… (72127) |
$573.81 |
$1,718 |
3.1× |
| Computed tomography, lower extremity; without contrast material Age Under 21 (73700) |
$295.92 |
$886 |
2.7× |
| Computed tomography, lower extremity; without contrast material, followed by contrast material(s) and further sections… (73702) |
$443.89 |
$1,329 |
2.4× |
| Computed tomography, lumbar spine; without contrast material, followed by contrast material(s) and further sections Age… (72133) |
$458.92 |
$1,374 |
2.5× |
| Computed tomography, maxillofacial area; with contrast material(s) Age Under 21 (70487) |
$370.98 |
$1,145 |
2.0× |
| Computed tomography, maxillofacial area; without contrast material Age Under 21 (70486) |
$296.78 |
$916 |
2.7× |
| Computed tomography, orbit, sella, or posterior fossa or outer, middle, or inner ear; with contrast material(s) Age… (70481) |
$380.70 |
$1,175 |
2.1× |
| Computed tomography, orbit, sella, or posterior fossa or outer, middle, or inner ear; without contrast material Age… (70480) |
$304.56 |
$940 |
2.8× |
| Computed tomography, orbit, sella, or posterior fossa or outer, middle, or inner ear; without contrast material,… (70482) |
$456.84 |
$1,410 |
2.5× |
| Computed tomography, soft tissue neck; without contrast material followed by contrast material(s) and further sections… (70492) |
$456.84 |
$1,410 |
2.5× |
| Computed tomography, thorax, diagnostic; without contrast material, followed by contrast material(s) and further… (71270) |
$459.92 |
$1,377 |
2.5× |
| Continuing medical physics consultation, including assessment of treatment parameters, quality assurance of dose… (77336) |
$748.66 |
$1,531 |
5.3× |
| CT abdomen and pelvis without and with contrast (74178) |
$541.75 |
$1,622 |
1.5× |
| CT abdomen and pelvis without contrast (74176) |
$361.05 |
$1,081 |
1.4× |
| CT abdomen w & w/o contrast (74170) |
$373.75 |
$1,119 |
2.0× |
| CT abdomen w/contrast (74160) |
$311.62 |
$933 |
1.7× |
| CT abdomen w/o contrast (74150) |
$249.16 |
$746 |
2.3× |
| CT angio hrt w/3d image (75574) |
$611.94 |
$1,316 |
1.7× |
| CT cervical spine w/contrast (72126) |
$478.29 |
$1,432 |
1.3× |
| CT cervical spine w/o contrast (72125) |
$382.43 |
$1,145 |
3.5× |
| CT chest w/contrast (71260) |
$383.43 |
$1,148 |
2.1× |
| CT extremity upper w & w/o contrast (73202) |
$458.92 |
$1,374 |
2.5× |
| CT extremity upper w/o contrast (73200) |
$305.94 |
$916 |
2.8× |
| CT head/brain with contrast (70460) |
$456.19 |
$1,408 |
2.5× |
| CT head/brain without and with contrast (70470) |
$547.24 |
$1,689 |
3.0× |
| CT heart c+ cardiac strux&morph cgen hrt ds (75573) |
$582.64 |
$1,253 |
1.6× |
| CT heart contrast eval cardiac structure&morph (75572) |
$459.89 |
$989 |
1.2× |
| CT heart no contrast quant eval coronry calcium (75571) |
$55.80 |
$120 |
0.6× |
| CT l-spine w/contrast (72132) |
$382.43 |
$1,145 |
1.0× |
| CT limited/localized follow up study (76380) |
$218.55 |
$470 |
2.4× |
| CT lower extremity w/dye (73701) |
$370.07 |
$1,108 |
2.0× |
| CT lumbar spine w/o contrast (72131) |
$305.94 |
$916 |
2.8× |
| CT maxillofacial w/wo contrast (70488) |
$445.18 |
$1,374 |
2.4× |
| CT neck w/contrast (70491) |
$380.70 |
$1,175 |
2.1× |
| CT neck w/o contrast (70490) |
$304.56 |
$940 |
2.8× |
| CT pelvis w & w/o contrast (72194) |
$511.02 |
$1,530 |
2.8× |
| CT pelvis w/o contrast (72192) |
$340.68 |
$1,020 |
3.1× |
| CT thoracic spine w/contrast (72129) |
$476.62 |
$1,427 |
2.6× |
| CT thoracic spine w/o contrast (72128) |
$381.09 |
$1,141 |
3.5× |
| CT thorax lung cancer scr c- (71271) |
$158.32 |
$474 |
1.4× |
| CT thorax w/o contrast (71250) |
$306.61 |
$918 |
2.8× |
| CT upper extremity w/dye (73201) |
$382.43 |
$1,145 |
1.0× |
| CTA head w contrast (70496) |
$574.78 |
$1,774 |
3.1× |
| Cystography, minimum of 3 views, radiological supervision and interpretation Age Under 21 (74430) |
$206.62 |
$587 |
0.6× |
| Dilation ureters/urethra rs&i (74485) |
$539.97 |
$1,534 |
0.2× |
| Discography, cervical or thoracic, radiological supervision and interpretation Age Under 21 (72285) |
$1,964.86 |
$5,582 |
1.0× |
| Diskography lumbar s&i (72295) |
$1,963.10 |
$5,577 |
1.0× |
| Doppler echocardiography, fetal, pulsed wave and/or continuous wave with spectral display; complete Age Under 21 (76827) |
$192.44 |
$348 |
1.7× |
| Doppler fetal mid cerebral artery (76821) |
$163.14 |
$295 |
1.5× |
| Dual-energy X-ray absorptiometry (DXA), bone density study, 1 or more sites; axial skeleton (eg, hips, pelvis, spine)… (77080) |
$101.02 |
$287 |
0.9× |
| Dxa bone density study axial skeleton (77085) |
$170.72 |
$485 |
1.5× |
| Dxa bone density/peripheral (77081) |
$94.34 |
$268 |
1.0× |
| Echocardiography, fetal, cardiovascular system, real time with image documentation (2D), with or without M-mode… (76825) |
$624.89 |
$1,130 |
1.1× |
| Fetal biophys profile w/o nst (76819) |
$275.39 |
$498 |
2.5× |
| Fetal biophysical profile non-stress testing (76818) |
$320.19 |
$579 |
2.9× |
| Fluoroscopy up to 1 hour physician/qhp time (76000) |
$194.66 |
$553 |
0.8× |
| Gastric emptying imaging study (eg, solid, liquid, or both); with small bowel and colon transit, multiple days Age… (78266) |
$1,669.23 |
$3,379 |
2.9× |
| Gastric emptying imaging study (eg, solid, liquid, or both); with small bowel transit Age Under 21 (78265) |
$1,473.11 |
$2,982 |
3.5× |
| Gastroesophageal reflux study (78262) |
$694.07 |
$1,405 |
1.6× |
| Gated heart planar single (78472) |
$934.65 |
$1,892 |
2.2× |
| Hdr rdncl ntrstl/intrcav brachytx 1 channel (77770) |
$2,883.63 |
$5,897 |
3.9× |
| Hdr rdncl ntrstl/intrcav brachytx 2-12 channel (77771) |
$4,326.67 |
$8,848 |
5.9× |
| Hdr rdncl ntrstl/intrcav brachytx >12 channels (77772) |
$4,715.43 |
$9,643 |
6.4× |
| Heart infarct image (78466) |
$532.04 |
$1,077 |
1.3× |
| Hepatc vngrph wdg/fr w/o hemodyn eval rs&i (75891) |
$1,432.99 |
$4,071 |
0.4× |
| Hepatic venography, wedged or free, with hemodynamic evaluation, radiological supervision and interpretation Age Under… (75889) |
$1,576.61 |
$4,479 |
0.5× |
| Hepatobil syst imag inc gb w/pharma intervenj (78227) |
$2,036.76 |
$4,123 |
3.6× |
| Hepatobiliary syst imaging including gallbladder (78226) |
$1,189.55 |
$2,408 |
2.8× |
| Ht muscle image spect sing (78451) |
$654.55 |
$1,325 |
0.5× |
| Injection procedure for radiopharmaceutical localization by non-imaging probe study, intravenous (eg, parathyroid… (78808) |
$275.65 |
$558 |
0.7× |
| Intensity modulated radiotherapy plan, including dose-volume histograms for target and critical structure partial… (77301) |
$4,000.02 |
$8,180 |
2.7× |
| Interstitial radiation source application, complex, includes supervision, handling, loading of radiation source, when… (77778) |
$1,940.35 |
$3,968 |
2.6× |
| Intestine imaging (eg, ectopic gastric mucosa, Meckel's localization, volvulus) Age Under 21 (78290) |
$743.96 |
$1,506 |
1.8× |
| Intracavitary radiation source application - complex (77763) |
$1,310.03 |
$2,679 |
1.8× |
| Intracavitary radiation source application - intermediate (77762) |
$916.88 |
$1,875 |
1.6× |
| Intracavitary radiation source application - simple (77761) |
$694.38 |
$1,420 |
1.2× |
| Isodose brachytherapy complex 10+ sources (77318) |
$800.98 |
$1,638 |
2.0× |
| Isodose brachytherapy intermed 5 to 10 sources (77317) |
$742.30 |
$1,518 |
1.9× |
| Isodose brachytherapy plan simple 1 to 4 source (77316) |
$444.99 |
$910 |
1.1× |
| Isodose teletherapy plan complex multi tx w/cal (77307) |
$777.51 |
$1,590 |
2.0× |
| Isodose teletherapy plan simple 1 or 2 port w/cal (77306) |
$323.23 |
$661 |
0.8× |
| Kidney imaging morphology; with vascular flow and function, multiple studies, with and without pharmacological… (78709) |
$1,150.53 |
$2,329 |
2.0× |
| Kidney imaging morphology; with vascular flow and function, single study without pharmacological intervention Age Under… (78707) |
$883.27 |
$1,788 |
1.5× |
| Kidney imaging morphology; with vascular flow and function, single study, with pharmacological intervention (eg,… (78708) |
$743.96 |
$1,506 |
1.3× |
| Labeled red cell sequestration, differential organ/tissue (eg, splenic and/or hepatic) Age Under 21 (78140) |
$670.36 |
$1,357 |
1.6× |
| Leveen/shunt patency exam (78291) |
$644.67 |
$1,305 |
1.5× |
| Liver and spleen imaging; with vascular flow Age Under 21 (78216) |
$426.82 |
$864 |
1.0× |
| Liver imaging (78201) |
$680.24 |
$1,377 |
1.2× |
| Liver imaging with flow (78202) |
$749.40 |
$1,517 |
1.3× |
| Lung perf&ventilat diferentl (78598) |
$904.02 |
$1,830 |
1.6× |
| Lung perfusion imaging (78580) |
$866.97 |
$1,755 |
2.1× |
| Lymphangiography, extremity only, bilateral, radiological supervision and interpretation Age Under 21 (75803) |
$1,250.66 |
$3,553 |
0.8× |
| Lymphangiography, extremity only, unilateral, radiological supervision and interpretation Age Under 21 (75801) |
$591.36 |
$1,680 |
0.9× |
| Lymphangiography, pelvic/abdominal, bilateral, radiological supervision and interpretation Age Under 21 (75807) |
$1,390.40 |
$3,950 |
0.4× |
| Lymphangiography, pelvic/abdominal, unilateral, radiological supervision and interpretation Age Under 21 (75805) |
$997.92 |
$2,835 |
0.3× |
| Magnetic resonance (eg, proton) imaging, any joint of lower extremity; without contrast material(s), followed by… (73723) |
$617.99 |
$1,601 |
1.7× |
| Magnetic resonance (eg, proton) imaging, lower extremity other than joint; with contrast material(s) Age Under 21 (73719) |
$558.93 |
$1,448 |
1.5× |
| Magnetic resonance (eg, proton) imaging, lower extremity other than joint; without contrast material(s) Age Under 21 (73718) |
$446.99 |
$1,158 |
1.8× |
| Magnetic resonance (eg, proton) imaging, lower extremity other than joint; without contrast material(s), followed by… (73720) |
$670.48 |
$1,737 |
1.8× |
| Magnetic resonance (eg, proton) imaging, orbit, face, and/or neck; with contrast material(s) Age Under 21 (70542) |
$415.58 |
$1,448 |
1.1× |
| Magnetic resonance (eg, proton) imaging, orbit, face, and/or neck; without contrast material(s) Age Under 21 (70540) |
$332.35 |
$1,158 |
1.3× |
| Magnetic resonance (eg, proton) imaging, upper extremity, other than joint; with contrast material(s) Age Under 21 (73219) |
$630.72 |
$1,634 |
1.7× |
| Magnetic resonance (eg, proton) imaging, upper extremity, other than joint; without contrast material(s), followed by… (73220) |
$756.95 |
$1,961 |
2.1× |
| Magnetic resonance angiography, head; with contrast material(s) Age Under 21 (70545) |
$467.70 |
$1,448 |
1.3× |
| Magnetic resonance angiography, head; without contrast material(s), followed by contrast material(s) and further… (70546) |
$561.05 |
$1,737 |
1.5× |
| Magnetic resonance angiography, neck; without contrast material(s), followed by contrast material(s) and further… (70549) |
$847.55 |
$2,624 |
2.3× |
| Mammary ductogram or galactogram, multiple ducts, radiological supervision and interpretation Age Under 21 (77054) |
$193.95 |
$551 |
0.8× |
| Mammary ductogram single (77053) |
$147.49 |
$419 |
0.6× |
| Mandible min 4v (70110) |
$66.18 |
$188 |
0.6× |
| Mr safety determination physician/other qhp (76016) |
$46.82 |
$133 |
0.5× |
| Mr safety implant pos&/immoblj supvj phys/qhp (76019) |
$110.18 |
$313 |
1.8× |
| Mr safety implant&/fb assmt clin staf 1st 15 min (76014) |
$13.38 |
$38 |
0.4× |
| Mr safety implt electronics prepj supvj phys/qhp (76018) |
$72.16 |
$205 |
0.7× |
| Mr safety med physics xm customization plng&mntr (76017) |
$171.42 |
$487 |
0.7× |
| MRA head w/o contrast (70544) |
$374.03 |
$1,158 |
1.5× |
| MRA neck w/ contrast (70548) |
$706.40 |
$2,187 |
1.9× |
| MRA neck w/o contrast (70547) |
$564.93 |
$1,749 |
2.2× |
| MRI abdomen w/contrast (74182) |
$501.41 |
$1,299 |
1.4× |
| MRI abdomen w/o contrast (74181) |
$401.05 |
$1,039 |
1.6× |
| MRI abdomen w/wo contrast (74183) |
$601.77 |
$1,559 |
1.6× |
| MRI any jt lower extrem w/contrast material (73722) |
$514.92 |
$1,334 |
0.6× |
| MRI bone marrow (77084) |
$687.85 |
$1,782 |
2.7× |
| MRI breast c- bilateral (77047) |
$608.34 |
$1,576 |
2.4× |
| MRI breast without contrast material unilateral (77046) |
$409.55 |
$1,061 |
1.6× |
| MRI c-spine w&w/o cont (72156) |
$457.89 |
$1,601 |
1.2× |
| MRI cervical spine w/contrast (72142) |
$381.52 |
$1,334 |
1.0× |
| MRI chest w/contrast (71551) |
$998.97 |
$2,588 |
1.2× |
| MRI chest w/o contrast (71550) |
$799.02 |
$2,070 |
3.2× |
| MRI chest w/wo contrast (71552) |
$1,198.53 |
$3,105 |
3.3× |
| MRI fetal sngl/1st gestation (74712) |
$382.53 |
$991 |
1.5× |
| MRI joint upr extr w/o&w/dye (73223) |
$617.99 |
$1,601 |
1.7× |
| MRI joint upr extrem w/dye (73222) |
$514.92 |
$1,334 |
0.6× |
| MRI joint upr extrem w/o dye (73221) |
$411.86 |
$1,067 |
1.6× |
| MRI lumbar spine w/contrast (72149) |
$381.52 |
$1,334 |
1.0× |
| MRI lumbar spine w/wo contrast (72158) |
$457.89 |
$1,601 |
1.2× |
| MRI orbit/face/neck w&w/o cont (70543) |
$498.52 |
$1,737 |
1.4× |
| MRI pelvis w & w/o contrast (72197) |
$617.99 |
$1,601 |
1.7× |
| MRI pelvis w/contrast (72196) |
$514.92 |
$1,334 |
1.4× |
| MRI pelvis w/o contrast (72195) |
$411.86 |
$1,067 |
1.6× |
| MRI spine cervical w/o contrast (72141) |
$305.16 |
$1,067 |
1.2× |
| MRI t-spine w&w/o cont (72157) |
$445.30 |
$1,557 |
1.2× |
| MRI thoracic spine w/contrast (72147) |
$371.23 |
$1,298 |
1.0× |
| MRI thoracic spine w/o contrst (72146) |
$296.87 |
$1,038 |
1.2× |
| MRI tmj (70336) |
$411.09 |
$1,065 |
1.6× |
| MRI upper extremity oth than jt w/o contr matrl (73218) |
$504.50 |
$1,307 |
2.0× |
| Multi-leaf collimator (MLC) device(s) for intensity modulated radiation therapy (IMRT), design and construction per… (77338) |
$722.25 |
$1,477 |
1.8× |
| Myelography, 2 or more regions (eg, lumbar/thoracic, cervical/thoracic, lumbar/cervical, lumbar/thoracic/cervical),… (72270) |
$519.55 |
$1,476 |
0.6× |
| Myocardial spect multiple studies (78452) |
$789.41 |
$1,598 |
0.6× |
| N-invas est c ffr augmnt sw alys CTA i&r phy/qhp (75580) |
$1,370.70 |
$4,569 |
1.5× |
| Nm adrenal imaging (78075) |
$856.10 |
$1,733 |
0.6× |
| Nm bone 3 phase (78315) |
$1,508.18 |
$3,053 |
3.6× |
| Nm bone imaging whole body (78306) |
$1,371.84 |
$2,777 |
3.3× |
| Nm bone marrow ltd (78102) |
$404.59 |
$819 |
1.0× |
| Nm bone marrow multi (78103) |
$517.71 |
$1,048 |
1.2× |
| Nm bone marrow wb (78104) |
$590.33 |
$1,195 |
1.4× |
| Nm csf cisternogram (78630) |
$965.28 |
$1,954 |
1.7× |
| Nm gastric emptying (78264) |
$1,241.42 |
$2,513 |
2.9× |
| Nm lung ventilation imaging (78579) |
$506.84 |
$1,026 |
1.2× |
| Nm lymph system (78195) |
$905.01 |
$1,832 |
1.6× |
| Nm salivary gland (78230) |
$374.45 |
$758 |
0.9× |
| Non-cardiac vascular flow imaging (ie, angiography, venography) Age Under 21 (78445) |
$389.77 |
$789 |
0.9× |
| Nuclear medicine study of bone and/or joint limited area (78300) |
$977.13 |
$1,978 |
2.3× |
| Nuclear medicine study of bone and/or joint multiple areas (78305) |
$1,172.26 |
$2,373 |
2.8× |
| Nuclear medicine study to assess blood clot in vein of both sides (78458) |
$653.07 |
$1,322 |
1.5× |
| Ob us limited fetus(s) (76815) |
$168.67 |
$305 |
1.5× |
| Ob us nuchal meas 1 gest (76813) |
$220.65 |
$399 |
2.0× |
| Optic foramina (70190) |
$49.98 |
$142 |
0.5× |
| Panoramic X-ray of jaws (70355) |
$44.70 |
$127 |
0.5× |
| Parathyrd planar w/spect&CT (78072) |
$754.34 |
$1,527 |
1.3× |
| Parathyroid planar imaging (78070) |
$538.95 |
$1,091 |
1.3× |
| Parathyroid planar imaging w/wo subtraction (78071) |
$691.60 |
$1,400 |
1.6× |
| PET imaging CT attenuation skull base mid-thigh (78815) |
$2,368.22 |
$5,866 |
1.6× |
| PET imaging CT for attenuation limited area (78814) |
$2,131.24 |
$5,279 |
1.4× |
| PET imaging for CT attenuation whole body (78816) |
$2,415.46 |
$5,983 |
1.6× |
| Prq transhepatc portograpy w/o hemodyn evl intrp (75887) |
$1,434.75 |
$4,076 |
0.4× |
| Pulmonary ventilation & perfusion imaging (78582) |
$1,526.95 |
$3,091 |
2.7× |
| Quant differential pulm perfusion w/wo imaging (78597) |
$873.39 |
$1,768 |
2.1× |
| Radex abscess/fistula/sinus tract rs&i (76080) |
$318.56 |
$905 |
0.6× |
| Radex entir thrc lmbr crv sac spi w/skull 1 vw (72081) |
$67.23 |
$191 |
0.7× |
| Radex entir thrc lmbr crv sac spi w/skull 2/3 vw (72082) |
$87.65 |
$249 |
0.8× |
| Radex entir thrc lmbr crv sac spi w/skull 4/5 vw (72083) |
$103.14 |
$293 |
0.9× |
| Radex entir thrc lmbr crv sac spi w/skull 6/> vw (72084) |
$120.38 |
$342 |
1.1× |
| Radex hip unilateral with pelvis 1 view (73501) |
$90.46 |
$257 |
1.0× |
| Radex hip unilateral with pelvis 2-3 views (73502) |
$99.62 |
$283 |
1.1× |
| Radex hip unilateral with pelvis minimum 4 views (73503) |
$109.82 |
$312 |
1.0× |
| Radex hips bilateral with pelvis 2 views (73521) |
$114.05 |
$324 |
1.0× |
| Radex hips bilateral with pelvis minimum 5 views (73523) |
$172.83 |
$491 |
1.6× |
| Radex spine cervical 2 or 3 views (72040) |
$53.86 |
$153 |
0.6× |
| Radex spine cervical 4 or 5 views (72050) |
$76.03 |
$216 |
0.7× |
| Radex spine cervical 6 or more views (72052) |
$86.59 |
$246 |
0.8× |
| Radex spine thoracolumbar junction min 2 views (72080) |
$70.05 |
$199 |
0.8× |
| Radiation treatment delivery, stereotactic radiosurgery (SRS), complete course of treatment of cranial lesion(s)… (77372) |
$13,241.63 |
$27,079 |
1.7× |
| Radiation tx delivery lvl 1 (77402) |
$408.80 |
$836 |
3.8× |
| Radiation tx delivery lvl 2 (77407) |
$462.10 |
$945 |
1.1× |
| Radiation tx delivery lvl 3 (77412) |
$864.55 |
$1,768 |
1.5× |
| Radiologic exam abdomen 3+ views (74021) |
$109.47 |
$311 |
1.0× |
| Radiologic exam chest 3 views (71047) |
$96.40 |
$241 |
1.1× |
| Radiologic exam chest 4+ views (71048) |
$104 |
$260 |
0.9× |
| Radiologic exam colon double contrast study (74280) |
$200.64 |
$570 |
1.1× |
| Radiologic exam colon single contrast study (74270) |
$131.30 |
$373 |
0.7× |
| Radiologic exam esophagus single contrast study (74220) |
$127.42 |
$362 |
0.7× |
| Radiologic exam small int single contrast study (74250) |
$127.42 |
$362 |
0.7× |
| Radiologic exam swallow function contrast study (74230) |
$127.42 |
$362 |
0.7× |
| Radiologic exam upr gi trc double contrast study (74246) |
$145.73 |
$414 |
0.8× |
| Radiologic exam upr gi trc single contrast study (74240) |
$127.42 |
$362 |
0.7× |
| Radiologic examination femur 1 view (73551) |
$46.82 |
$133 |
0.5× |
| Radiologic examination femur minimum 2 views (73552) |
$49.98 |
$142 |
0.5× |
| Radiologic examination from nose to rectum for foreign body, single view, child Age Under 21 (76010) |
$46.82 |
$133 |
0.5× |
| Radiologic examination, ankle; complete, minimum of 3 views Age Under 21 (73610) |
$52.45 |
$149 |
0.6× |
| Radiologic examination, complete acute abdomen series, including 2 or more views of the abdomen (eg, supine, erect,… (74022) |
$87.65 |
$249 |
0.8× |
| Radiologic examination, elbow; 2 views Age Under 21 (73070) |
$55.26 |
$157 |
0.6× |
| Radiologic examination, elbow; complete, minimum of 3 views Age Under 21 (73080) |
$66.18 |
$188 |
0.7× |
| Radiologic examination, facial bones; less than 3 views Age Under 21 (70140) |
$46.82 |
$133 |
0.5× |
| Radiologic examination, foot; complete, minimum of 3 views Age Under 21 (73630) |
$48.93 |
$139 |
0.5× |
| Radiologic examination, hand; minimum of 3 views Age Under 21 (73130) |
$62.30 |
$177 |
0.7× |
| Radiologic examination, internal auditory meati, complete Age Under 21 (70134) |
$109.47 |
$311 |
0.2× |
| Radiologic examination, knee; both knees, standing, anteroposterior Age Under 21 (73565) |
$59.14 |
$168 |
0.6× |
| Radiologic examination, knee; complete, 4 or more views Age Under 21 (73564) |
$73.22 |
$208 |
0.7× |
| Radiologic examination, mandible; partial, less than 4 views Age Under 21 (70100) |
$57.02 |
$162 |
0.6× |
| Radiologic examination, mastoids; complete, minimum of 3 views per side Age Under 21 (70130) |
$68.64 |
$195 |
0.6× |
| Radiologic examination, mastoids; less than 3 views per side Age Under 21 (70120) |
$56.67 |
$161 |
0.5× |
| Radiologic examination, nasal bones, complete, minimum of 3 views Age Under 21 (70160) |
$54.91 |
$156 |
0.6× |
| Radiologic examination, renal cyst study, translumbar, contrast visualization, radiological supervision and… (74470) |
$291.46 |
$828 |
0.5× |
| Radiologic examination, ribs, bilateral; including posteroanterior chest, minimum of 4 views Age Under 21 (71111) |
$75.33 |
$214 |
0.7× |
| Radiologic examination, ribs, unilateral; including posteroanterior chest, minimum of 3 views Age Under 21 (71101) |
$68.64 |
$195 |
0.6× |
| Radiologic examination, sacroiliac joints; less than 3 views Age Under 21 (72200) |
$56.67 |
$161 |
0.5× |
| Radiologic examination, shoulder, arthrography, radiological supervision and interpretation Age Under 21 (73040) |
$317.73 |
$787 |
0.9× |
| Radiologic examination, shoulder; complete, minimum of 2 views Age Under 21 (73030) |
$57.73 |
$164 |
0.6× |
| Radiologic examination, single plane body section (eg, tomography), other than with urography Age Under 21 (76100) |
$87.65 |
$249 |
0.8× |
| Radiologic examination, sinuses, paranasal, less than 3 views Age Under 21 (70210) |
$46.82 |
$133 |
0.5× |
| Radiologic examination, skull; less than 4 views Age Under 21 (70250) |
$66.18 |
$188 |
0.6× |
| Radiologic examination, spine, lumbosacral; 2 or 3 views Age Under 21 (72100) |
$56.67 |
$161 |
0.5× |
| Radiologic examination, spine, lumbosacral; bending views only, 2 or 3 views Age Under 21 (72120) |
$58.78 |
$167 |
0.5× |
| Radiologic examination, spine, lumbosacral; complete, including bending views, minimum of 6 views Age Under 21 (72114) |
$84.13 |
$239 |
0.8× |
| Radiologic examination, spine; thoracic, minimum of 4 views Age Under 21 (72074) |
$80.26 |
$228 |
0.7× |
| Radiologic examination, wrist; complete, minimum of 3 views Age Under 21 (73110) |
$61.25 |
$174 |
0.7× |
| Radiologic examination; acromioclavicular joints, bilateral, with or without weighted distraction Age Under 21 (73050) |
$87.30 |
$248 |
1.0× |
| Radiologic examination; humerus, minimum of 2 views Age Under 21 (73060) |
$59.84 |
$170 |
0.7× |
| Radiologic examination; lower extremity, infant, minimum of 2 views Age Under 21 (73592) |
$63.71 |
$181 |
0.7× |
| Radiologic examination; orbits, complete, minimum of 4 views Age Under 21 (70200) |
$64.06 |
$182 |
0.6× |
| Radiologic examination; sternoclavicular joint or joints, minimum of 3 views Age Under 21 (71130) |
$59.14 |
$168 |
0.6× |
| Radiologic examination; toe(s), minimum of 2 views Age Under 21 (73660) |
$55.62 |
$158 |
0.6× |
| Radiologic examination; upper extremity, infant, minimum of 2 views Age Under 21 (73092) |
$64.42 |
$183 |
0.6× |
| Radiopharmaceutical localization of tumor, inflammatory process or distribution of radiopharmaceutical agent(s)… (78803) |
$1,386.16 |
$2,806 |
2.4× |
| Radiopharmaceutical therapy, by intravenous administration Age Under 21 (79101) |
$1,249.66 |
$3,049 |
5.1× |
| Radiopharmaceutical therapy, by oral administration Age Under 21 (79005) |
$1,428.54 |
$3,434 |
5.8× |
| Radiopharmaceutical therapy, radiolabeled monoclonal antibody by intravenous infusion (79403) |
$561.60 |
$1,350 |
2.3× |
| Remote afterloading high dose rate radionuclide skin surface brachytherapy, includes basic dosimetry, when performed;… (77767) |
$2,779.48 |
$5,684 |
6.8× |
| Remote afterloading high dose rate radionuclide skin surface brachytherapy, includes basic dosimetry, when performed;… (77768) |
$4,280.71 |
$8,754 |
10.5× |
| Review by radiologist of urinary bladder and urethra images with contrast and after passing urine (74455) |
$182.69 |
$519 |
0.7× |
| Rp loclzj tum plnr 1 area single day imaging (78800) |
$606.14 |
$1,227 |
1.4× |
| Rp loclzj tum plnr 2+area 1+d img/1 area img>2+d (78801) |
$646.15 |
$1,308 |
1.5× |
| Rp loclzj tum plnr whole body 2+ days imaging (78804) |
$1,742.34 |
$3,527 |
3.0× |
| Rp loclzj tum plnr whole body single day imaging (78802) |
$973.67 |
$1,971 |
1.7× |
| Rp loclzj tum spect 2 areas (78831) |
$1,871.77 |
$3,789 |
1.4× |
| Rp loclzj tum spect w/CT 1 (78830) |
$1,435.56 |
$2,906 |
1.1× |
| Rp loclzj tum spect w/CT 2 (78832) |
$1,887.08 |
$3,820 |
1.3× |
| Rp therapy intra-arterial particulate admn (79445) |
$344.45 |
$828 |
1.4× |
| Saline infusion sonohysterography (SIS), including color flow Doppler, when performed Age Under 21 (76831) |
$345.63 |
$625 |
1.4× |
| Scapula complete (73010) |
$66.18 |
$188 |
0.6× |
| Screening digital breast tomosynthesis bi (77063) |
$33.51 |
$83 |
— |
| Shuntogram indwelling nonvascular shunt rs&i (75809) |
$241.12 |
$685 |
2.2× |
| Simulation intermediate (77285) |
$876.29 |
$1,792 |
2.2× |
| Special dosimetry (77331) |
$368.22 |
$753 |
2.6× |
| Special physics consult (77370) |
$700.74 |
$1,433 |
4.9× |
| Special teletherapy port plan (77321) |
$802.45 |
$1,641 |
2.0× |
| Special treatment procedure (77470) |
$1,719.32 |
$3,516 |
2.9× |
| Stereotactic body radiation therapy, treatment delivery, per fraction to 1 or more lesions, including image guidance,… (77373) |
$4,753.57 |
$9,721 |
2.5× |
| Surface application of low dose rate radionuclide source (77789) |
$317.85 |
$650 |
3.0× |
| Temporomandibular joint arthrography, radiological supervision and interpretation Age Under 21 (70332) |
$147.36 |
$365 |
0.6× |
| Testicular imaging with vascular flow Age Under 21 (78761) |
$401.13 |
$812 |
1.0× |
| Ther rad simulaj-aided field setting complex (77290) |
$1,403.92 |
$2,871 |
3.6× |
| Thyroid imaging with vascular flow (78013) |
$565.14 |
$1,144 |
1.3× |
| Thyroid met imaging body (78018) |
$1,113.97 |
$2,255 |
1.9× |
| Thyroid uptake single/multiple quant measurement (78012) |
$327.52 |
$663 |
0.8× |
| Thyroid uptake w/blood flow sngle/mult quan meas (78014) |
$1,192.52 |
$2,414 |
2.8× |
| Tr simulation simple (77280) |
$730.57 |
$1,494 |
5.2× |
| Treatment device complex (77334) |
$1,076.78 |
$2,202 |
2.7× |
| Treatment device intermediate (77333) |
$916.39 |
$1,874 |
6.5× |
| Treatment device simple (77332) |
$442.06 |
$904 |
3.1× |
| Ultrasound breast limited (76642) |
$154.29 |
$279 |
1.7× |
| Ultrasound, abdomen limited (76705) |
$191.34 |
$346 |
1.7× |
| Ultrasound, limited, joint or focal evaluation of other nonvascular extremity structure(s) (eg, joint space,… (76882) |
$142.12 |
$257 |
1.3× |
| Ultrasound, pelvic (nonobstetric), real time with image documentation; complete Age Under 21 (76856) |
$219.54 |
$397 |
2.0× |
| Ultrasound, pregnant uterus, real time with image documentation, fetal and maternal evaluation plus detailed fetal… (76811) |
$565.72 |
$1,023 |
2.2× |
| Ultrasound, pregnant uterus, real time with image documentation, fetal and maternal evaluation, first trimester (< 14… (76801) |
$294.75 |
$533 |
2.7× |
| Ultrasound, transplanted kidney, real time and duplex Doppler with image documentation Age Under 21 (76776) |
$249.40 |
$451 |
2.3× |
| Ultrasound, transrectal; prostate volume study for brachytherapy treatment planning (separate procedure) Age Under 21 (76873) |
$291.43 |
$527 |
2.6× |
| Umbilical-artery Doppler (OB) (76820) |
$142.12 |
$257 |
1.3× |
| Ureteral reflux study (78740) |
$393.22 |
$796 |
0.9× |
| Urethrocystography retrograde rs&i (74450) |
$228.45 |
$649 |
0.9× |
| Urography (pyelography), intravenous, with or without KUB, with or without tomography Age Under 21 (74400) |
$372.77 |
$1,059 |
2.0× |
| Urography antegrade rs&i (74425) |
$315.39 |
$896 |
0.9× |
| Urography, infusion, drip technique and/or bolus technique; with nephrotomography Age Under 21 (74415) |
$454.78 |
$1,292 |
2.5× |
| Us abdominal aorta real time screen study aaa (76706) |
$235.58 |
$426 |
2.1× |
| Us breast uni real time with image complete (76641) |
$198.53 |
$359 |
1.8× |
| Us chest (76604) |
$142.12 |
$257 |
1.3× |
| Us compl joint r-t w/image documentation (76881) |
$275.39 |
$498 |
2.5× |
| Us elastography organ (76981) |
$221.75 |
$401 |
2.0× |
| Us encephalogram (76506) |
$191.89 |
$347 |
1.7× |
| Us exam, pelvic, limited (76857) |
$195.76 |
$354 |
1.8× |
| Us inft hips r-t img dynamic req phys/qhp manj (76885) |
$197.97 |
$358 |
2.2× |
| Us inft hips r-t img lmtd static phys/qhp manj (76886) |
$140.46 |
$254 |
1.5× |
| US OB Follow-Up/Repeat (76816) |
$203.50 |
$368 |
1.8× |
| Us ob transvaginal (76817) |
$244.98 |
$443 |
2.2× |
| Us retroperitoneal complete (76770) |
$214.01 |
$387 |
1.9× |
| Us retroperitoneal ltd (76775) |
$114.47 |
$207 |
1.0× |
| Us scrotum (76870) |
$204.61 |
$370 |
1.9× |
| Us soft tissue head/neck (76536) |
$244.43 |
$442 |
2.2× |
| Us spinal canal (76800) |
$296.41 |
$536 |
2.7× |
| Us transrectal (76872) |
$492.17 |
$890 |
4.5× |
| Use 1st target lesion (76982) |
$190.23 |
$344 |
1.7× |
| Venogram sinus/jugular (75860) |
$1,320.70 |
$3,752 |
0.4× |
| Venography renal unilateral selective rs&i (75831) |
$1,817.38 |
$5,163 |
0.5× |
| Venography, caval, inferior, with serialography, radiological supervision and interpretation Age Under 21 (75825) |
$1,390.40 |
$3,950 |
0.4× |
| Venography, caval, superior, with serialography, radiological supervision and interpretation Age Under 21 (75827) |
$1,474.18 |
$4,188 |
0.9× |
| Venography, extremity, bilateral, radiological supervision and interpretation Age Under 21 (75822) |
$1,312.26 |
$3,728 |
0.8× |
| Venography, extremity, unilateral, radiological supervision and interpretation Age Under 21 (75820) |
$680.42 |
$1,933 |
0.4× |
| Venography, superior sagittal sinus, radiological supervision and interpretation Age Under 21 (75870) |
$1,320.70 |
$3,752 |
0.4× |
Venous sampling thru cath w/wo angiography rs& (75893)
unusually low — confirm this is the full procedure |
$2,405.22 |
$6,833 |
0.4× |
| Vertebral fracture assessment via dxa (77086) |
$47.52 |
$135 |
0.5× |
| X-ray exam hips bi 3-4 views (73522) |
$107.71 |
$306 |
1.0× |
| X-ray exam of finger(s) (73140) |
$58.78 |
$167 |
0.6× |
| X-ray exam of knee 1 or 2 (73560) |
$57.73 |
$164 |
0.6× |
| X-ray exam of small bowel - fl small bowel series enteroclysis tube (74251) |
$467.46 |
$1,328 |
2.5× |
| X-ray exam ribs bil 3 views (71110) |
$63.71 |
$181 |
0.6× |
| X-ray exam ribs uni 2 views (71100) |
$48.93 |
$139 |
0.5× |
| X-ray heel (73650) |
$46.82 |
$133 |
0.5× |
| X-ray of joint between lower spine and hip bone 3 or more views|PROFESSIONAL COMPONENT (72202) |
$64.42 |
$183 |
0.6× |
| X-ray retrograde pyelogram (74420) |
$197.12 |
$560 |
0.5× |
| Xr abdomen 1 view (74018) |
$48.58 |
$138 |
0.5× |
| Xr abdomen 2 views (74019) |
$71.10 |
$202 |
0.6× |
| Xr arthrogram ankle (73615) |
$270.90 |
$671 |
0.7× |
| Xr arthrogram elbow (73085) |
$226.08 |
$560 |
0.6× |
| Xr arthrogram hip (73525) |
$226.08 |
$560 |
0.6× |
| Xr arthrogram knee (73580) |
$331.45 |
$821 |
0.9× |
| Xr arthrogram wrist (73115) |
$307.23 |
$761 |
0.8× |
| Xr bone age studies (77072) |
$56.67 |
$161 |
0.5× |
| Xr bone length study (77073) |
$59.84 |
$170 |
0.5× |
| Xr bone survey infant (77076) |
$95.04 |
$270 |
0.9× |
| Xr bone survey ltd (77074) |
$76.03 |
$216 |
0.7× |
| Xr chest 1 view (71045) |
$75.20 |
$188 |
0.8× |
| Xr chest 2 views (71046) |
$76.40 |
$191 |
0.8× |
| Xr eye foreign body (70030) |
$46.82 |
$133 |
0.5× |
| Xr facial bones 3+ views (70150) |
$64.77 |
$184 |
0.6× |
| Xr foot arthritis pa only bilateral - report(ortho pro) (73620) |
$46.82 |
$133 |
0.5× |
| Xr forearm 2 views (73090) |
$58.78 |
$167 |
0.6× |
| Xr hand 2v (73120) |
$56.67 |
$161 |
0.5× |
| Xr hysterosalpingogram (74740) |
$410.78 |
$1,167 |
1.6× |
| Xr joint survey 1 view (77077) |
$66.18 |
$188 |
0.6× |
| Xr myelogram c-spine (72240) |
$581.15 |
$1,651 |
0.7× |
| Xr myelogram l-spine (72265) |
$511.10 |
$1,452 |
0.6× |
| Xr myelogram t-spine (72255) |
$536.80 |
$1,525 |
0.6× |
| Xr neck soft tissue (70360) |
$61.60 |
$175 |
0.7× |
| Xr o knee w/ merchant view bilat - report(ortho pro) (73562) |
$59.14 |
$168 |
0.6× |
| Xr osseous survey complete (77075) |
$91.87 |
$261 |
0.8× |
| Xr pelvis 1-2 views (72170) |
$56.67 |
$161 |
0.5× |
| Xr pelvis min 3 view (72190) |
$62.66 |
$178 |
0.6× |
| Xr sacrum/coccyx 2+ views (72220) |
$48.93 |
$139 |
0.5× |
| Xr sella turcica (70240) |
$46.82 |
$133 |
0.5× |
| Xr shoulder 1 view (73020) |
$52.45 |
$149 |
0.6× |
| Xr sialogram (70390) |
$205.22 |
$583 |
0.8× |
| Xr sinuses 3+ views (70220) |
$63.01 |
$179 |
0.7× |
| Xr skull min 4 view (70260) |
$76.03 |
$216 |
0.7× |
| Xr spine 1 view (72020) |
$52.80 |
$150 |
0.6× |
| Xr spine thoracic 3v (72072) |
$69.70 |
$198 |
0.6× |
| Xr sternum 2+ views (71120) |
$46.82 |
$133 |
0.5× |
| Xr surgical specimen (76098) |
$140.80 |
$400 |
0.2× |
| Xr t-spine 2 views (72070) |
$56.67 |
$161 |
0.5× |
| Xr tibia/fibula 2 views (73590) |
$64.42 |
$183 |
0.7× |
| Xr tmj bilateral (70330) |
$114.40 |
$325 |
1.2× |
| Xr tmj unilateral (70328) |
$48.22 |
$137 |
0.5× |
| Xr venogram renal bilat (75833) |
$3,216.58 |
$9,138 |
1.0× |
| Xr wrist 2 views (73100) |
$48.22 |
$137 |
0.5× |