| 3-D radiotherapy plan dose-volume histograms (77295) |
$8,531.04 |
$15,234 |
5.8× |
| Acute gi blood loss imaging (78278) |
$1,976.24 |
$3,529 |
4.7× |
| Angiography pulmonary bilateral slctv rs&i (75743) |
$13,582.80 |
$24,255 |
4.1× |
| Angiography visceral slctv/supraslctv rs&i (75726) |
$12,697.44 |
$22,674 |
2.2× |
| Angiography, extremity, bilateral, radiological supervision and interpretation Age Under 21 (75716) |
$9,870 |
$17,625 |
3.0× |
| Angiography, extremity, unilateral, radiological supervision and interpretation Age Under 21 (75710) |
$9,055.20 |
$16,170 |
2.7× |
| Angiography, pelvic, selective or supraselective, radiological supervision and interpretation Age Under 21 (75736) |
$13,840.40 |
$24,715 |
2.4× |
| Ankle 2 views (73600) |
$239.12 |
$427 |
2.6× |
| Aortography, abdominal plus bilateral iliofemoral lower extremity, catheter, by serialography, radiological supervision… (75630) |
$8,342.32 |
$14,897 |
2.5× |
| Aortography, abdominal, by serialography, radiological supervision and interpretation Age Under 21 (75625) |
$5,050.36 |
$9,018.50 |
1.5× |
| Aortography, thoracic, by serialography, radiological supervision and interpretation Age Under 21 (75605) |
$12,697.44 |
$22,674 |
2.2× |
| Basic radiation dosimetry calculation (77300) |
$1,151.36 |
$2,056 |
8.1× |
| Cholecystography, oral contrast Age Under 21 (74290) |
$666.40 |
$1,190 |
3.6× |
| Clavicle complete (73000) |
$275.52 |
$492 |
3.0× |
| Computed tomographic (CT) colonography, diagnostic, including image postprocessing; without contrast material Age Under… (74261) |
$1,358.28 |
$2,425.50 |
12.3× |
| Computed tomographic (CT) colonography, screening, including image postprocessing (74263) |
$1,416.80 |
$2,530 |
5.6× |
| Computed tomographic angiography, abdomen and pelvis, with contrast material(s), including noncontrast images, if… (74174) |
$3,496.64 |
$6,244 |
9.5× |
| Computed tomographic angiography, abdomen, with contrast material(s), including noncontrast images, if performed, and… (74175) |
$1,972.32 |
$3,522 |
10.7× |
| Computed tomographic angiography, abdominal aorta and bilateral iliofemoral lower extremity runoff, with contrast… (75635) |
$2,663.36 |
$4,756 |
14.4× |
| Computed tomographic angiography, chest (noncoronary), with contrast material(s), including noncontrast images, if… (71275) |
$2,063.04 |
$3,684 |
11.1× |
| Computed tomographic angiography, lower extremity, with contrast material(s), including noncontrast images, if… (73706) |
$2,591.12 |
$4,627 |
14.0× |
| Computed tomographic angiography, neck, with contrast material(s), including noncontrast images, if performed, and… (70498) |
$2,063.04 |
$3,684 |
11.1× |
| Computed tomographic angiography, pelvis, with contrast material(s), including noncontrast images, if performed, and… (72191) |
$1,975.12 |
$3,527 |
10.7× |
| Computed tomographic angiography, upper extremity, with contrast material(s), including noncontrast images, if… (73206) |
$3,335.92 |
$5,957 |
18.0× |
| Computed tomography, cervical spine; without contrast material, followed by contrast material(s) and further sections… (72127) |
$2,150.40 |
$3,840 |
11.6× |
| Computed tomography, lower extremity; without contrast material Age Under 21 (73700) |
$1,488.20 |
$2,657.50 |
13.5× |
| Computed tomography, lower extremity; without contrast material, followed by contrast material(s) and further sections… (73702) |
$2,039.52 |
$3,642 |
11.0× |
| Computed tomography, lumbar spine; without contrast material, followed by contrast material(s) and further sections Age… (72133) |
$2,150.40 |
$3,840 |
11.6× |
| Computed tomography, maxillofacial area; with contrast material(s) Age Under 21 (70487) |
$1,678.32 |
$2,997 |
9.1× |
| Computed tomography, maxillofacial area; without contrast material Age Under 21 (70486) |
$1,379.28 |
$2,463 |
12.5× |
| Computed tomography, orbit, sella, or posterior fossa or outer, middle, or inner ear; with contrast material(s) Age… (70481) |
$1,818.88 |
$3,248 |
9.8× |
| Computed tomography, orbit, sella, or posterior fossa or outer, middle, or inner ear; without contrast material Age… (70480) |
$2,349.76 |
$4,196 |
21.3× |
| Computed tomography, orbit, sella, or posterior fossa or outer, middle, or inner ear; without contrast material,… (70482) |
$2,329.60 |
$4,160 |
12.6× |
| Computed tomography, soft tissue neck; without contrast material followed by contrast material(s) and further sections… (70492) |
$2,042.32 |
$3,647 |
11.0× |
| Computed tomography, thoracic spine; without contrast material, followed by contrast material(s) and further sections… (72130) |
$2,150.40 |
$3,840 |
11.6× |
| Computed tomography, thorax, diagnostic; without contrast material, followed by contrast material(s) and further… (71270) |
$2,071.44 |
$3,699 |
11.2× |
| Continuing medical physics consultation, including assessment of treatment parameters, quality assurance of dose… (77336) |
$839.44 |
$1,499 |
5.9× |
| CT abdomen and pelvis without and with contrast (74178) |
$3,596.32 |
$6,422 |
9.8× |
| CT abdomen and pelvis without contrast (74176) |
$2,139.20 |
$3,820 |
8.5× |
| CT abdomen w & w/o contrast (74170) |
$1,972.88 |
$3,523 |
10.7× |
| CT abdomen w/contrast (74160) |
$1,667.12 |
$2,977 |
9.0× |
| CT abdomen w/o contrast (74150) |
$1,190.56 |
$2,126 |
10.8× |
| CT angio hrt w/3d image (75574) |
$2,577.68 |
$4,603 |
7.0× |
| CT cervical spine w/contrast (72126) |
$1,678.32 |
$2,997 |
4.6× |
| CT cervical spine w/o contrast (72125) |
$1,197.84 |
$2,139 |
10.9× |
| CT chest w/contrast (71260) |
$2,316.72 |
$4,137 |
12.5× |
| CT extremity upper w & w/o contrast (73202) |
$2,226 |
$3,975 |
12.0× |
| CT extremity upper w/o contrast (73200) |
$1,595.44 |
$2,849 |
14.5× |
| CT head/brain with contrast (70460) |
$1,674.40 |
$2,990 |
9.0× |
| CT head/brain without and with contrast (70470) |
$1,972.88 |
$3,523 |
10.7× |
| CT heart no contrast quant eval coronry calcium (75571) |
$729.12 |
$1,302 |
7.9× |
| CT l-spine w/contrast (72132) |
$1,678.32 |
$2,997 |
4.6× |
| CT limited/localized follow up study (76380) |
$1,190.56 |
$2,126 |
13.0× |
| CT lower extremity w/dye (73701) |
$2,273.60 |
$4,060 |
12.3× |
| CT lumbar spine w/o contrast (72131) |
$1,197.84 |
$2,139 |
10.9× |
| CT maxillofacial w/wo contrast (70488) |
$1,972.88 |
$3,523 |
10.7× |
| CT neck w/contrast (70491) |
$2,316.72 |
$4,137 |
12.5× |
| CT neck w/o contrast (70490) |
$1,190.56 |
$2,126 |
10.8× |
| CT pelvis w & w/o contrast (72194) |
$2,472.96 |
$4,416 |
13.4× |
| CT pelvis w/o contrast (72192) |
$1,197.84 |
$2,139 |
10.9× |
| CT thoracic spine w/contrast (72129) |
$1,678.32 |
$2,997 |
9.1× |
| CT thoracic spine w/o contrast (72128) |
$1,190.56 |
$2,126 |
10.8× |
| CT thorax lung cancer scr c- (71271) |
$729.12 |
$1,302 |
6.6× |
| CT thorax w/o contrast (71250) |
$1,197.84 |
$2,139 |
10.9× |
| CT upper extremity w/dye (73201) |
$1,818.88 |
$3,248 |
4.9× |
| CTA head w contrast (70496) |
$2,063.04 |
$3,684 |
11.1× |
| Cystography, minimum of 3 views, radiological supervision and interpretation Age Under 21 (74430) |
$1,184.40 |
$2,115 |
3.2× |
| Diskography lumbar s&i (72295) |
$5,645.92 |
$10,082 |
2.7× |
| Dual-energy X-ray absorptiometry (DXA), bone density study, 1 or more sites; axial skeleton (eg, hips, pelvis, spine)… (77080) |
$72.24 |
$129 |
0.7× |
| Dxa bone density/peripheral (77081) |
$59.92 |
$107 |
0.7× |
| Fetal biophys profile w/o nst (76819) |
$691.04 |
$1,234 |
6.3× |
| Fetal biophysical profile non-stress testing (76818) |
$753.20 |
$1,345 |
6.8× |
| Fluoroscopy up to 1 hour physician/qhp time (76000) |
$801.36 |
$1,431 |
3.2× |
| Gated heart planar single (78472) |
$1,976.24 |
$3,529 |
4.7× |
| Hdr rdncl ntrstl/intrcav brachytx 1 channel (77770) |
$2,946.72 |
$5,262 |
4.0× |
| Hdr rdncl ntrstl/intrcav brachytx 2-12 channel (77771) |
$5,480.16 |
$9,786 |
7.5× |
| Hdr rdncl ntrstl/intrcav brachytx >12 channels (77772) |
$6,926.08 |
$12,368 |
9.4× |
| Hepatc vngrph wdg/fr w/o hemodyn eval rs&i (75891) |
$8,531.60 |
$15,235 |
2.6× |
| Hepatic venography, wedged or free, with hemodynamic evaluation, radiological supervision and interpretation Age Under… (75889) |
$9,055.20 |
$16,170 |
2.7× |
| Hepatobil syst imag inc gb w/pharma intervenj (78227) |
$1,976.24 |
$3,529 |
3.5× |
| Hepatobiliary syst imaging including gallbladder (78226) |
$1,976.24 |
$3,529 |
4.7× |
| Ht muscle image spect sing (78451) |
$3,796.24 |
$6,779 |
2.8× |
| Infusion or instillation of radioelement solution (includes 3-month follow-up care) (77750) |
$614.32 |
$1,097 |
1.5× |
| Intensity modulated radiotherapy plan, including dose-volume histograms for target and critical structure partial… (77301) |
$6,713.56 |
$11,988.50 |
4.6× |
| Interstitial radiation source application, complex, includes supervision, handling, loading of radiation source, when… (77778) |
$2,234.96 |
$3,991 |
3.0× |
| Intestine imaging (eg, ectopic gastric mucosa, Meckel's localization, volvulus) Age Under 21 (78290) |
$2,065.28 |
$3,688 |
4.9× |
| Intracavitary radiation source application - complex (77763) |
$3,530.80 |
$6,305 |
4.8× |
| Intracavitary radiation source application - intermediate (77762) |
$2,825.20 |
$5,045 |
4.8× |
| Intracavitary radiation source application - simple (77761) |
$2,825.20 |
$5,045 |
4.8× |
| Isodose brachytherapy complex 10+ sources (77318) |
$2,611.84 |
$4,664 |
6.6× |
| Isodose brachytherapy intermed 5 to 10 sources (77317) |
$2,015.44 |
$3,599 |
5.1× |
| Isodose brachytherapy plan simple 1 to 4 source (77316) |
$1,331.96 |
$2,378.50 |
3.4× |
| Isodose teletherapy plan complex multi tx w/cal (77307) |
$3,310.16 |
$5,911 |
8.4× |
| Isodose teletherapy plan simple 1 or 2 port w/cal (77306) |
$3,147.76 |
$5,621 |
8.0× |
| Kidney imaging morphology; with vascular flow and function, single study without pharmacological intervention Age Under… (78707) |
$2,892.96 |
$5,166 |
5.1× |
| Kidney imaging morphology; with vascular flow and function, single study, with pharmacological intervention (eg,… (78708) |
$2,653.84 |
$4,739 |
4.6× |
| Liver and spleen imaging (78215) |
$2,263.52 |
$4,042 |
5.4× |
| Liver imaging (78201) |
$2,154.32 |
$3,847 |
3.8× |
| Liver imaging with flow (78202) |
$2,154.32 |
$3,847 |
3.8× |
| Lung perfusion imaging (78580) |
$2,011.52 |
$3,592 |
4.8× |
| Lymphangiography, pelvic/abdominal, bilateral, radiological supervision and interpretation Age Under 21 (75807) |
$8,342.32 |
$14,897 |
2.5× |
| Magnetic resonance (eg, proton) imaging, any joint of lower extremity; without contrast material(s), followed by… (73723) |
$3,416.56 |
$6,101 |
9.3× |
| Magnetic resonance (eg, proton) imaging, lower extremity other than joint; with contrast material(s) Age Under 21 (73719) |
$2,805.04 |
$5,009 |
7.6× |
| Magnetic resonance (eg, proton) imaging, lower extremity other than joint; without contrast material(s) Age Under 21 (73718) |
$2,352.56 |
$4,201 |
9.3× |
| Magnetic resonance (eg, proton) imaging, lower extremity other than joint; without contrast material(s), followed by… (73720) |
$3,416.56 |
$6,101 |
9.3× |
| Magnetic resonance (eg, proton) imaging, orbit, face, and/or neck; with contrast material(s) Age Under 21 (70542) |
$2,760.24 |
$4,929 |
7.5× |
| Magnetic resonance (eg, proton) imaging, orbit, face, and/or neck; without contrast material(s) Age Under 21 (70540) |
$2,352.56 |
$4,201 |
9.3× |
| Magnetic resonance (eg, proton) imaging, upper extremity, other than joint; without contrast material(s), followed by… (73220) |
$3,416.56 |
$6,101 |
9.3× |
| Magnetic resonance angiography, head; without contrast material(s), followed by contrast material(s) and further… (70546) |
$3,861.76 |
$6,896 |
10.5× |
| Magnetic resonance angiography, neck; without contrast material(s), followed by contrast material(s) and further… (70549) |
$3,416.56 |
$6,101 |
9.3× |
| Mammary ductogram or galactogram, multiple ducts, radiological supervision and interpretation Age Under 21 (77054) |
$1,534.68 |
$2,740.50 |
6.1× |
| Mandible min 4v (70110) |
$413.28 |
$738 |
3.7× |
| Mr safety determination physician/other qhp (76016) |
$62.16 |
$111 |
0.7× |
| Mr safety med physics xm customization plng&mntr (76017) |
$170.24 |
$304 |
0.7× |
| MRA head w/o contrast (70544) |
$2,352.56 |
$4,201 |
9.3× |
| MRA neck w/ contrast (70548) |
$2,924.32 |
$5,222 |
7.9× |
| MRA neck w/o contrast (70547) |
$2,450.56 |
$4,376 |
9.7× |
| MRI abdomen w/contrast (74182) |
$3,198.72 |
$5,712 |
8.7× |
| MRI abdomen w/o contrast (74181) |
$2,352.56 |
$4,201 |
9.3× |
| MRI abdomen w/wo contrast (74183) |
$3,416.56 |
$6,101 |
9.3× |
| MRI any jt lower extrem w/contrast material (73722) |
$2,573.20 |
$4,595 |
3.1× |
| MRI bone marrow (77084) |
$3,416 |
$6,100 |
13.6× |
| MRI breast c- bilateral (77047) |
$2,667.28 |
$4,763 |
10.6× |
| MRI breast without contrast material unilateral (77046) |
$2,182.88 |
$3,898 |
8.7× |
| MRI c-spine w&w/o cont (72156) |
$2,831.92 |
$5,057 |
7.7× |
| MRI cervical spine w/contrast (72142) |
$2,805.04 |
$5,009 |
7.6× |
| MRI chest w/contrast (71551) |
$3,377.92 |
$6,032 |
4.1× |
| MRI chest w/o contrast (71550) |
$2,871.12 |
$5,127 |
11.4× |
| MRI chest w/wo contrast (71552) |
$4,158.56 |
$7,426 |
11.3× |
| MRI joint upr extr w/o&w/dye (73223) |
$3,416.56 |
$6,101 |
9.3× |
| MRI joint upr extrem w/dye (73222) |
$2,532.32 |
$4,522 |
3.1× |
| MRI joint upr extrem w/o dye (73221) |
$2,352.56 |
$4,201 |
9.3× |
| MRI lumbar spine w/contrast (72149) |
$2,805.04 |
$5,009 |
7.6× |
| MRI lumbar spine w/wo contrast (72158) |
$3,416.56 |
$6,101 |
9.3× |
| MRI orbit/face/neck w&w/o cont (70543) |
$3,416.56 |
$6,101 |
9.3× |
| MRI pelvis w & w/o contrast (72197) |
$3,416.56 |
$6,101 |
9.3× |
| MRI pelvis w/o contrast (72195) |
$2,352.56 |
$4,201 |
9.3× |
| MRI spine cervical w/o contrast (72141) |
$2,136.68 |
$3,815.50 |
8.5× |
| MRI t-spine w&w/o cont (72157) |
$3,416.56 |
$6,101 |
9.3× |
| MRI thoracic spine w/contrast (72147) |
$2,805.04 |
$5,009 |
7.6× |
| MRI thoracic spine w/o contrst (72146) |
$2,352.56 |
$4,201 |
9.3× |
| MRI tmj (70336) |
$3,531.64 |
$6,306.50 |
14.0× |
| MRI upper extremity oth than jt w/o contr matrl (73218) |
$2,352.56 |
$4,201 |
9.3× |
| Multi-leaf collimator (MLC) device(s) for intensity modulated radiation therapy (IMRT), design and construction per… (77338) |
$3,229.52 |
$5,767 |
8.2× |
| Myocardial spect multiple studies (78452) |
$3,540.32 |
$6,322 |
2.6× |
| Nm bone 3 phase (78315) |
$1,976.24 |
$3,529 |
4.7× |
| Nm bone imaging whole body (78306) |
$1,677.20 |
$2,995 |
4.0× |
| Nm gastric emptying (78264) |
$1,976.24 |
$3,529 |
4.7× |
| Nm lymph system (78195) |
$1,968.40 |
$3,515 |
3.4× |
| Nuclear medicine study for detecting heart shunt (78428) |
$1,687.28 |
$3,013 |
4.0× |
| Nuclear medicine study of bone and/or joint limited area (78300) |
$1,237.04 |
$2,209 |
2.9× |
| Ob us limited fetus(s) (76815) |
$374.08 |
$668 |
3.4× |
| Parathyrd planar w/spect&CT (78072) |
$2,630.88 |
$4,698 |
4.6× |
| Parathyroid planar imaging (78070) |
$1,976.24 |
$3,529 |
4.7× |
| Parathyroid planar imaging w/wo subtraction (78071) |
$1,984.64 |
$3,544 |
4.7× |
| PET imaging CT attenuation skull base mid-thigh (78815) |
$7,817.04 |
$13,959 |
5.2× |
| PET imaging CT for attenuation limited area (78814) |
$3,625.44 |
$6,474 |
2.4× |
| PET imaging for CT attenuation whole body (78816) |
$8,289.12 |
$14,802 |
5.5× |
| Prq transhepatc portograpy w/o hemodyn evl intrp (75887) |
$6,097.84 |
$10,889 |
1.8× |
| Pulmonary ventilation & perfusion imaging (78582) |
$4,249.84 |
$7,589 |
7.4× |
| Quant differential pulm perfusion w/wo imaging (78597) |
$2,318.40 |
$4,140 |
5.5× |
| Radex abscess/fistula/sinus tract rs&i (76080) |
$1,415.68 |
$2,528 |
2.5× |
| Radex hip unilateral with pelvis 1 view (73501) |
$256.48 |
$458 |
2.8× |
| Radex hip unilateral with pelvis 2-3 views (73502) |
$260.40 |
$465 |
2.8× |
| Radex hips bilateral with pelvis 2 views (73521) |
$489.44 |
$874 |
4.4× |
| Radex hips bilateral with pelvis minimum 5 views (73523) |
$454.16 |
$811 |
4.1× |
| Radex spine cervical 2 or 3 views (72040) |
$304.64 |
$544 |
3.3× |
| Radex spine cervical 4 or 5 views (72050) |
$472.08 |
$843 |
4.3× |
| Radex spine cervical 6 or more views (72052) |
$599.20 |
$1,070 |
5.4× |
| Radex spine thoracolumbar junction min 2 views (72080) |
$355.04 |
$634 |
3.9× |
| Radiation treatment delivery, stereotactic radiosurgery (SRS), complete course of treatment of cranial lesion(s)… (77372) |
$20,708.80 |
$36,980 |
2.7× |
| Radiation tx delivery lvl 1 (77402) |
$1,095.08 |
$1,955.50 |
10.2× |
| Radiation tx delivery lvl 2 (77407) |
$2,804.48 |
$5,008 |
6.9× |
| Radiation tx delivery lvl 3 (77412) |
$2,617.72 |
$4,674.50 |
4.5× |
| Radiologic exam chest 4+ views (71048) |
$380.24 |
$679 |
3.4× |
| Radiologic exam colon single contrast study (74270) |
$823.20 |
$1,470 |
4.4× |
| Radiologic exam esophagus single contrast study (74220) |
$687.12 |
$1,227 |
3.7× |
| Radiologic exam small int single contrast study (74250) |
$827.68 |
$1,478 |
4.5× |
| Radiologic exam swallow function contrast study (74230) |
$554.96 |
$991 |
3.0× |
| Radiologic exam upr gi trc double contrast study (74246) |
$858.48 |
$1,533 |
4.6× |
| Radiologic exam upr gi trc single contrast study (74240) |
$858.48 |
$1,533 |
4.6× |
| Radiologic examination femur 1 view (73551) |
$275.52 |
$492 |
3.0× |
| Radiologic examination femur minimum 2 views (73552) |
$260.40 |
$465 |
2.8× |
| Radiologic examination from nose to rectum for foreign body, single view, child Age Under 21 (76010) |
$282.24 |
$504 |
3.1× |
| Radiologic examination, ankle; complete, minimum of 3 views Age Under 21 (73610) |
$281.68 |
$503 |
3.1× |
| Radiologic examination, complete acute abdomen series, including 2 or more views of the abdomen (eg, supine, erect,… (74022) |
$472.08 |
$843 |
4.3× |
| Radiologic examination, elbow; 2 views Age Under 21 (73070) |
$275.52 |
$492 |
3.0× |
| Radiologic examination, elbow; complete, minimum of 3 views Age Under 21 (73080) |
$275.52 |
$492 |
3.0× |
| Radiologic examination, foot; complete, minimum of 3 views Age Under 21 (73630) |
$325.36 |
$581 |
3.5× |
| Radiologic examination, hand; minimum of 3 views Age Under 21 (73130) |
$343.84 |
$614 |
3.7× |
| Radiologic examination, knee; both knees, standing, anteroposterior Age Under 21 (73565) |
$314.72 |
$562 |
3.4× |
| Radiologic examination, knee; complete, 4 or more views Age Under 21 (73564) |
$350.56 |
$626 |
3.2× |
| Radiologic examination, nasal bones, complete, minimum of 3 views Age Under 21 (70160) |
$355.04 |
$634 |
3.9× |
| Radiologic examination, ribs, bilateral; including posteroanterior chest, minimum of 4 views Age Under 21 (71111) |
$540.96 |
$966 |
4.9× |
| Radiologic examination, ribs, unilateral; including posteroanterior chest, minimum of 3 views Age Under 21 (71101) |
$304.64 |
$544 |
2.8× |
| Radiologic examination, shoulder; complete, minimum of 2 views Age Under 21 (73030) |
$281.68 |
$503 |
3.1× |
| Radiologic examination, sinuses, paranasal, less than 3 views Age Under 21 (70210) |
$351.68 |
$628 |
3.8× |
| Radiologic examination, skull; less than 4 views Age Under 21 (70250) |
$389.76 |
$696 |
3.5× |
| Radiologic examination, spine, lumbosacral; 2 or 3 views Age Under 21 (72100) |
$308.56 |
$551 |
2.8× |
| Radiologic examination, spine, lumbosacral; bending views only, 2 or 3 views Age Under 21 (72120) |
$324.80 |
$580 |
2.9× |
| Radiologic examination, spine, lumbosacral; complete, including bending views, minimum of 6 views Age Under 21 (72114) |
$522.48 |
$933 |
4.7× |
| Radiologic examination, wrist; complete, minimum of 3 views Age Under 21 (73110) |
$336 |
$600 |
3.7× |
| Radiologic examination; acromioclavicular joints, bilateral, with or without weighted distraction Age Under 21 (73050) |
$275.52 |
$492 |
3.0× |
| Radiologic examination; humerus, minimum of 2 views Age Under 21 (73060) |
$275.52 |
$492 |
3.0× |
| Radiologic examination; lower extremity, infant, minimum of 2 views Age Under 21 (73592) |
$341.60 |
$610 |
3.7× |
| Radiologic examination; sternoclavicular joint or joints, minimum of 3 views Age Under 21 (71130) |
$347.20 |
$620 |
3.8× |
| Radiologic examination; toe(s), minimum of 2 views Age Under 21 (73660) |
$275.52 |
$492 |
3.0× |
| Radiologic examination; upper extremity, infant, minimum of 2 views Age Under 21 (73092) |
$540.40 |
$965 |
4.9× |
| Radiopharmaceutical localization of tumor, inflammatory process or distribution of radiopharmaceutical agent(s)… (78803) |
$3,966.48 |
$7,083 |
6.9× |
| Radiopharmaceutical therapy, by intravenous administration Age Under 21 (79101) |
$8,328.32 |
$14,872 |
33.8× |
| Radiopharmaceutical therapy, by oral administration Age Under 21 (79005) |
$2,150.40 |
$3,840 |
8.7× |
| Review by radiologist of urinary bladder and urethra images with contrast and after passing urine (74455) |
$1,056.72 |
$1,887 |
4.2× |
| Rp loclzj tum plnr whole body 2+ days imaging (78804) |
$5,137.44 |
$9,174 |
9.0× |
| Rp loclzj tum plnr whole body single day imaging (78802) |
$4,175.36 |
$7,456 |
7.3× |
| Rp loclzj tum spect w/CT 1 (78830) |
$4,175.36 |
$7,456 |
3.1× |
| Rp therapy intra-arterial particulate admn (79445) |
$1,778.56 |
$3,176 |
7.2× |
| Saline infusion sonohysterography (SIS), including color flow Doppler, when performed Age Under 21 (76831) |
$1,039.36 |
$1,856 |
4.1× |
| Scapula complete (73010) |
$350.56 |
$626 |
3.2× |
| Screening digital breast tomosynthesis bi (77063) |
$183.68 |
$328 |
— |
| Shuntogram indwelling nonvascular shunt rs&i (75809) |
$673.68 |
$1,203 |
6.1× |
| Simulation intermediate (77285) |
$2,058 |
$3,675 |
5.2× |
| Special dosimetry (77331) |
$839.44 |
$1,499 |
5.9× |
| Special physics consult (77370) |
$839.44 |
$1,499 |
5.9× |
| Special teletherapy port plan (77321) |
$1,658.72 |
$2,962 |
4.2× |
| Special treatment procedure (77470) |
$2,712.64 |
$4,844 |
4.7× |
| Spleen imaging only, with or without vascular flow Age Under 21 (78185) |
$2,263.52 |
$4,042 |
5.4× |
| Stereotactic body radiation therapy, treatment delivery, per fraction to 1 or more lesions, including image guidance,… (77373) |
$16,564.24 |
$29,579 |
8.8× |
| Ther rad simulaj-aided field setting complex (77290) |
$3,701.60 |
$6,610 |
9.4× |
| Therapeutic enema, contrast or air, for reduction of intussusception or other intraluminal obstruction (eg, meconium… (74283) |
$1,140.72 |
$2,037 |
6.2× |
| Thyroid imaging with vascular flow (78013) |
$2,154.32 |
$3,847 |
5.1× |
| Thyroid met imaging body (78018) |
$2,286.48 |
$4,083 |
4.0× |
| Thyroid uptake w/blood flow sngle/mult quan meas (78014) |
$1,976.24 |
$3,529 |
4.7× |
| Tr simulation simple (77280) |
$964.32 |
$1,722 |
6.8× |
| Treatment device complex (77334) |
$1,603.28 |
$2,863 |
4.1× |
| Treatment device intermediate (77333) |
$1,090.32 |
$1,947 |
7.7× |
| Treatment device simple (77332) |
$839.44 |
$1,499 |
5.9× |
| Ultrasound breast limited (76642) |
$388.64 |
$694 |
4.2× |
| Ultrasound, abdomen limited (76705) |
$535.92 |
$957 |
4.9× |
| Ultrasound, limited, joint or focal evaluation of other nonvascular extremity structure(s) (eg, joint space,… (76882) |
$323.68 |
$578 |
2.9× |
| Ultrasound, pelvic (nonobstetric), real time with image documentation; complete Age Under 21 (76856) |
$575.68 |
$1,028 |
5.2× |
| Ultrasound, pregnant uterus, real time with image documentation, fetal and maternal evaluation plus detailed fetal… (76811) |
$847.28 |
$1,513 |
3.4× |
| Ultrasound, pregnant uterus, real time with image documentation, fetal and maternal evaluation, first trimester (< 14… (76801) |
$575.68 |
$1,028 |
5.2× |
| Ultrasound, transrectal; prostate volume study for brachytherapy treatment planning (separate procedure) Age Under 21 (76873) |
$946.40 |
$1,690 |
8.6× |
| Unlisted CT procedure (76497) |
$2,427.60 |
$4,335 |
26.4× |
| Urethrocystography retrograde rs&i (74450) |
$980.56 |
$1,751 |
3.9× |
| Urography antegrade rs&i (74425) |
$1,290.80 |
$2,305 |
3.5× |
| Us abdominal aorta real time screen study aaa (76706) |
$606.48 |
$1,083 |
5.5× |
| Us breast uni real time with image complete (76641) |
$374.08 |
$668 |
3.4× |
| Us chest (76604) |
$427.28 |
$763 |
3.9× |
| Us compl joint r-t w/image documentation (76881) |
$921.76 |
$1,646 |
8.4× |
| Us elastography organ (76981) |
$413.84 |
$739 |
3.8× |
| Us encephalogram (76506) |
$761.04 |
$1,359 |
6.9× |
| Us exam, pelvic, limited (76857) |
$374.08 |
$668 |
3.4× |
| Us guided compression repair (76936) |
$1,120 |
$2,000 |
4.9× |
| Us inft hips r-t img dynamic req phys/qhp manj (76885) |
$747.04 |
$1,334 |
8.1× |
| US OB Follow-Up/Repeat (76816) |
$449.12 |
$802 |
4.1× |
| Us ob transvaginal (76817) |
$575.68 |
$1,028 |
5.2× |
| Us retroperitoneal complete (76770) |
$681.52 |
$1,217 |
6.2× |
| Us retroperitoneal ltd (76775) |
$575.68 |
$1,028 |
5.2× |
| Us scrotum (76870) |
$696.64 |
$1,244 |
6.3× |
| Us soft tissue head/neck (76536) |
$627.76 |
$1,121 |
5.7× |
| Us spinal canal (76800) |
$725.20 |
$1,295 |
6.6× |
| Us transrectal (76872) |
$425.04 |
$759 |
3.9× |
| Us unlstd proc (76999) |
$340.48 |
$608 |
3.7× |
| Venogram sinus/jugular (75860) |
$9,870 |
$17,625 |
3.0× |
| Venography deep dorsal vein penis radiolgicl supervision interpretation (76499) |
$1,135.68 |
$2,028 |
12.4× |
| Venography renal unilateral selective rs&i (75831) |
$9,870 |
$17,625 |
3.0× |
| Venography, caval, inferior, with serialography, radiological supervision and interpretation Age Under 21 (75825) |
$9,462.60 |
$16,897.50 |
2.8× |
| Venography, caval, superior, with serialography, radiological supervision and interpretation Age Under 21 (75827) |
$4,081.84 |
$7,289 |
2.5× |
| Venography, extremity, bilateral, radiological supervision and interpretation Age Under 21 (75822) |
$4,089.68 |
$7,303 |
2.5× |
| Venography, extremity, unilateral, radiological supervision and interpretation Age Under 21 (75820) |
$3,744.72 |
$6,687 |
2.3× |
| X-ray exam hips bi 3-4 views (73522) |
$535.92 |
$957 |
4.9× |
| X-ray exam of finger(s) (73140) |
$281.68 |
$503 |
3.1× |
| X-ray exam of knee 1 or 2 (73560) |
$275.52 |
$492 |
3.0× |
| X-ray heel (73650) |
$275.52 |
$492 |
3.0× |
| X-ray of joint between lower spine and hip bone 3 or more views|PROFESSIONAL COMPONENT (72202) |
$402.36 |
$718.50 |
3.6× |
| X-ray retrograde pyelogram (74420) |
$1,090.32 |
$1,947 |
3.0× |
| Xr abdomen 1 view (74018) |
$281.68 |
$503 |
3.1× |
| Xr abdomen 2 views (74019) |
$350.56 |
$626 |
3.2× |
| Xr bone age studies (77072) |
$360.08 |
$643 |
3.3× |
| Xr bone length study (77073) |
$333.76 |
$596 |
3.0× |
| Xr bone survey ltd (77074) |
$594.44 |
$1,061.50 |
5.4× |
| Xr chest 1 view (71045) |
$258.16 |
$461 |
2.8× |
| Xr chest 2 views (71046) |
$266.56 |
$476 |
2.9× |
| Xr eye foreign body (70030) |
$275.52 |
$492 |
3.0× |
| Xr facial bones 3+ views (70150) |
$362.32 |
$647 |
3.3× |
| Xr foot arthritis pa only bilateral - report(ortho pro) (73620) |
$239.12 |
$427 |
2.6× |
| Xr forearm 2 views (73090) |
$278.60 |
$497.50 |
3.0× |
| Xr hand 2v (73120) |
$304.64 |
$544 |
2.8× |
| Xr hysterosalpingogram (74740) |
$1,196.72 |
$2,137 |
4.8× |
| Xr myelogram l-spine (72265) |
$2,408 |
$4,300 |
2.9× |
| Xr myelogram t-spine (72255) |
$2,408 |
$4,300 |
2.9× |
| Xr neck soft tissue (70360) |
$322.56 |
$576 |
3.5× |
| Xr o knee w/ merchant view bilat - report(ortho pro) (73562) |
$260.40 |
$465 |
2.8× |
| Xr osseous survey complete (77075) |
$621.04 |
$1,109 |
5.6× |
| Xr pelvis 1-2 views (72170) |
$304.64 |
$544 |
2.8× |
| Xr pelvis min 3 view (72190) |
$386.96 |
$691 |
3.5× |
| Xr sacrum/coccyx 2+ views (72220) |
$390.88 |
$698 |
4.3× |
| Xr shoulder 1 view (73020) |
$275.52 |
$492 |
3.0× |
| Xr sinuses 3+ views (70220) |
$362.32 |
$647 |
3.9× |
| Xr skull min 4 view (70260) |
$646.80 |
$1,155 |
5.9× |
| Xr spine 1 view (72020) |
$362.32 |
$647 |
3.9× |
| Xr spine thoracic 3v (72072) |
$433.44 |
$774 |
3.9× |
| Xr sternum 2+ views (71120) |
$313.04 |
$559 |
3.4× |
| Xr surgical specimen (76098) |
$1,286.88 |
$2,298 |
2.2× |
| Xr t-spine 2 views (72070) |
$304.64 |
$544 |
2.8× |
| Xr tibia/fibula 2 views (73590) |
$275.52 |
$492 |
3.0× |
| Xr tmj bilateral (70330) |
$492.80 |
$880 |
5.4× |
| Xr tmj unilateral (70328) |
$316.40 |
$565 |
3.4× |
| Xr wrist 2 views (73100) |
$275.52 |
$492 |
3.0× |