| 3-D radiotherapy plan dose-volume histograms (77295) |
$2,715.71 |
$7,759.15 |
1.9× |
| Acute gi blood loss imaging (78278) |
$412.84 |
$1,179.54 |
1.0× |
| Angiography internal mammary rs&i (75756) |
$2,269.89 |
$6,485.38 |
0.7× |
| Angiography pulmonary bilateral slctv rs&i (75743) |
$2,094.49 |
$5,984.25 |
0.6× |
| Angiography visceral slctv/supraslctv rs&i (75726) |
$4,236.94 |
$12,105.54 |
0.7× |
| Angiography, adrenal, unilateral, selective, radiological supervision and interpretation Age Under 21 (75731) |
$3,640.28 |
$10,400.79 |
1.1× |
| Angiography, extremity, bilateral, radiological supervision and interpretation Age Under 21 (75716) |
$1,881.85 |
$5,376.69 |
0.6× |
| Angiography, extremity, unilateral, radiological supervision and interpretation Age Under 21 (75710) |
$1,881.85 |
$5,376.69 |
0.6× |
| Angiography, pelvic, selective or supraselective, radiological supervision and interpretation Age Under 21 (75736) |
$3,208.49 |
$9,167.10 |
0.5× |
| Angiography, pulmonary, unilateral, selective, radiological supervision and interpretation Age Under 21 (75741) |
$2,094.49 |
$5,984.25 |
0.6× |
| Angiography, spinal, selective, radiological supervision and interpretation Age Under 21 (75705) |
$4,093.59 |
$11,695.96 |
0.7× |
| Angrph cath f-up std tcat other than thrombylsis (75898) |
$7,586.23 |
$21,674.94 |
2.3× |
| Angrph pulmonary nonslctv cath/ven njx rs&i (75746) |
$1,924.72 |
$5,499.19 |
0.6× |
| Ankle 2 views (73600) |
$124.16 |
$354.73 |
1.4× |
| Aortography, abdominal plus bilateral iliofemoral lower extremity, catheter, by serialography, radiological supervision… (75630) |
$2,094.49 |
$5,984.25 |
0.6× |
| Aortography, abdominal, by serialography, radiological supervision and interpretation Age Under 21 (75625) |
$1,881.85 |
$5,376.69 |
0.6× |
| Aortography, thoracic, by serialography, radiological supervision and interpretation Age Under 21 (75605) |
$4,247.37 |
$12,135.33 |
0.7× |
| Aortography, thoracic, without serialography, radiological supervision and interpretation Age Under 21 (75600) |
$2,094.49 |
$5,984.25 |
0.6× |
| Basic radiation dosimetry calculation (77300) |
$275.75 |
$787.84 |
1.9× |
| Brain flow imaging only - nm brain flow only brain death (78610) |
$402.64 |
$1,150.39 |
0.7× |
| Brain imaging, less than 4 static views; with vascular flow Age Under 21 (78601) |
$470.60 |
$1,344.57 |
1.1× |
| Brain imaging, minimum 4 static views; with vascular flow Age Under 21 (78606) |
$457.89 |
$1,308.25 |
0.8× |
| Brain imaging, positron emission tomography (PET); metabolic evaluation Age Under 21 (78608) |
$1,705.79 |
$4,873.68 |
1.1× |
| Cardiac blood pool imaging (planar), first pass technique; single study, at rest or with stress (exercise and/or… (78481) |
$390.91 |
$1,116.87 |
0.7× |
| Cardiac MRI morphology & function w/o contrast (75557) |
$687.30 |
$1,963.71 |
2.7× |
| Cardiac MRI w/wo contrast & further seq (75561) |
$827.47 |
$2,364.20 |
2.2× |
| Cerebrospinal fluid flow, imaging (not including introduction of material); ventriculography Age Under 21 (78635) |
$367.68 |
$1,050.51 |
0.6× |
| Clavicle complete (73000) |
$130.17 |
$371.90 |
1.4× |
| Computed tomographic angiography, abdomen and pelvis, with contrast material(s), including noncontrast images, if… (74174) |
$1,851.50 |
$5,289.98 |
5.0× |
| Computed tomographic angiography, abdomen, with contrast material(s), including noncontrast images, if performed, and… (74175) |
$1,061.48 |
$3,032.79 |
5.7× |
| Computed tomographic angiography, abdominal aorta and bilateral iliofemoral lower extremity runoff, with contrast… (75635) |
$1,119.42 |
$3,198.34 |
6.0× |
| Computed tomographic angiography, chest (noncoronary), with contrast material(s), including noncontrast images, if… (71275) |
$458.02 |
$1,308.62 |
2.5× |
| Computed tomographic angiography, lower extremity, with contrast material(s), including noncontrast images, if… (73706) |
$714.80 |
$2,042.27 |
3.9× |
| Computed tomographic angiography, neck, with contrast material(s), including noncontrast images, if performed, and… (70498) |
$1,567.12 |
$4,477.47 |
8.5× |
| Computed tomographic angiography, pelvis, with contrast material(s), including noncontrast images, if performed, and… (72191) |
$848.46 |
$2,424.17 |
4.6× |
| Computed tomographic angiography, upper extremity, with contrast material(s), including noncontrast images, if… (73206) |
$790.21 |
$2,257.72 |
4.3× |
| Computed tomography, lower extremity; without contrast material Age Under 21 (73700) |
$1,044.32 |
$2,983.77 |
9.5× |
| Computed tomography, lower extremity; without contrast material, followed by contrast material(s) and further sections… (73702) |
$676.92 |
$1,934.05 |
3.7× |
| Computed tomography, maxillofacial area; with contrast material(s) Age Under 21 (70487) |
$638.15 |
$1,823.28 |
3.4× |
| Computed tomography, maxillofacial area; without contrast material Age Under 21 (70486) |
$566 |
$1,617.14 |
5.1× |
| Computed tomography, orbit, sella, or posterior fossa or outer, middle, or inner ear; with contrast material(s) Age… (70481) |
$806.50 |
$2,304.27 |
4.4× |
| Computed tomography, orbit, sella, or posterior fossa or outer, middle, or inner ear; without contrast material Age… (70480) |
$634.24 |
$1,812.11 |
5.8× |
| Computed tomography, soft tissue neck; without contrast material followed by contrast material(s) and further sections… (70492) |
$1,030.03 |
$2,942.94 |
5.6× |
| Computed tomography, thorax, diagnostic; without contrast material, followed by contrast material(s) and further… (71270) |
$965.26 |
$2,757.88 |
5.2× |
| Corpora cavernosography, radiological supervision and interpretation Age Under 21 (74445) |
$249.32 |
$712.34 |
2.3× |
| Csf shunt evaluation (78645) |
$402.64 |
$1,150.39 |
0.7× |
| CT abdomen and pelvis without and with contrast (74178) |
$2,579.89 |
$7,371.10 |
7.0× |
| CT abdomen and pelvis without contrast (74176) |
$2,052.71 |
$5,864.86 |
8.2× |
| CT abdomen w & w/o contrast (74170) |
$921.05 |
$2,631.55 |
5.0× |
| CT abdomen w/contrast (74160) |
$1,474.31 |
$4,212.29 |
8.0× |
| CT abdomen w/o contrast (74150) |
$691.70 |
$1,976.28 |
6.3× |
| CT angio hrt w/3d image (75574) |
$944.70 |
$2,699.13 |
2.6× |
| CT cervical spine w/contrast (72126) |
$869.13 |
$2,483.21 |
2.4× |
| CT cervical spine w/o contrast (72125) |
$1,158.22 |
$3,309.20 |
10.5× |
| CT chest w/contrast (71260) |
$1,211.70 |
$3,462 |
6.5× |
| CT extremity upper w/o contrast (73200) |
$592.52 |
$1,692.91 |
5.4× |
| CT head/brain with contrast (70460) |
$698.88 |
$1,996.80 |
3.8× |
| CT head/brain without and with contrast (70470) |
$800.26 |
$2,286.44 |
4.3× |
| CT heart c+ cardiac strux&morph cgen hrt ds (75573) |
$881.59 |
$2,518.82 |
2.4× |
| CT heart contrast eval cardiac structure&morph (75572) |
$756.94 |
$2,162.66 |
2.1× |
| CT heart no contrast quant eval coronry calcium (75571) |
$103.64 |
$296.10 |
1.1× |
| CT l-spine w/contrast (72132) |
$935.78 |
$2,673.64 |
2.5× |
| CT limited/localized follow up study (76380) |
$271.07 |
$774.47 |
3.0× |
| CT lower extremity w/dye (73701) |
$675.68 |
$1,930.51 |
3.7× |
| CT lumbar spine w/o contrast (72131) |
$754.01 |
$2,154.30 |
6.8× |
| CT maxillofacial w/wo contrast (70488) |
$727.08 |
$2,077.37 |
3.9× |
| CT neck w/contrast (70491) |
$1,112.95 |
$3,179.84 |
6.0× |
| CT neck w/o contrast (70490) |
$642.01 |
$1,834.29 |
5.8× |
| CT pelvis w & w/o contrast (72194) |
$919.59 |
$2,627.39 |
5.0× |
| CT pelvis w/o contrast (72192) |
$717.61 |
$2,050.30 |
6.5× |
| CT thoracic spine w/contrast (72129) |
$815.87 |
$2,331.03 |
4.4× |
| CT thoracic spine w/o contrast (72128) |
$669.29 |
$1,912.23 |
6.1× |
| CT thorax lung cancer scr c- (71271) |
$65.19 |
$186.23 |
0.6× |
| CT thorax w/o contrast (71250) |
$1,054.09 |
$3,011.67 |
9.6× |
| CT upper extremity w/dye (73201) |
$727.62 |
$2,078.90 |
2.0× |
| CTA head w contrast (70496) |
$1,543.92 |
$4,411.18 |
8.3× |
| Cystography, minimum of 3 views, radiological supervision and interpretation Age Under 21 (74430) |
$241.81 |
$690.88 |
0.7× |
| Doppler echocardiography, fetal, pulsed wave and/or continuous wave with spectral display; complete Age Under 21 (76827) |
$124.23 |
$354.94 |
1.1× |
| Doppler echocardiography, fetal, pulsed wave and/or continuous wave with spectral display; follow-up or repeat study… (76828) |
$81.90 |
$234 |
0.7× |
| Doppler fetal mid cerebral artery (76821) |
$212.06 |
$605.87 |
1.9× |
| Dual-energy X-ray absorptiometry (DXA), bone density study, 1 or more sites; axial skeleton (eg, hips, pelvis, spine)… (77080) |
$178.82 |
$510.90 |
1.6× |
| Dxa bone density/peripheral (77081) |
$89.20 |
$254.84 |
1.0× |
| Echo exam of eye (76529) |
$54.74 |
$156.39 |
0.6× |
| Echo exam of eye (76516) |
$86.93 |
$248.37 |
0.8× |
| Echo exam of eye thickness (76514) |
$27.82 |
$79.48 |
0.9× |
| Echocardiography, fetal, cardiovascular system, real time with image documentation (2D), with or without M-mode… (76825) |
$403.43 |
$1,152.65 |
0.7× |
| Echocardiography, fetal, cardiovascular system, real time with image documentation (2D), with or without M-mode… (76826) |
$180.29 |
$515.10 |
0.7× |
| Esophageal motility (78258) |
$273.09 |
$780.23 |
0.6× |
| Fetal biophys profile w/o nst (76819) |
$226.56 |
$647.31 |
2.1× |
| Fetal biophysical profile non-stress testing (76818) |
$180.42 |
$515.48 |
1.6× |
| Gastric emptying imaging study (eg, solid, liquid, or both); with small bowel transit Age Under 21 (78265) |
$277.12 |
$791.77 |
0.7× |
| Gastroesophageal reflux study (78262) |
$334.61 |
$956.01 |
0.8× |
| Gated heart planar single (78472) |
$659.67 |
$1,884.75 |
1.6× |
| Heart infarct image (78466) |
$323.11 |
$923.15 |
0.8× |
| Hepatc vngrph wdg/fr w/o hemodyn eval rs&i (75891) |
$2,540.53 |
$7,258.65 |
0.8× |
| Hepatic venography, wedged or free, with hemodynamic evaluation, radiological supervision and interpretation Age Under… (75889) |
$2,384.09 |
$6,811.68 |
0.7× |
| Hepatobil syst imag inc gb w/pharma intervenj (78227) |
$402.64 |
$1,150.39 |
0.7× |
| Hepatobiliary syst imaging including gallbladder (78226) |
$266.53 |
$761.50 |
0.6× |
| Ht muscle image spect sing (78451) |
$1,057.76 |
$3,022.16 |
0.8× |
| Intestine imaging (eg, ectopic gastric mucosa, Meckel's localization, volvulus) Age Under 21 (78290) |
$358.16 |
$1,023.29 |
0.8× |
| Isodose brachytherapy intermed 5 to 10 sources (77317) |
$691.15 |
$1,974.71 |
1.7× |
| Isodose brachytherapy plan simple 1 to 4 source (77316) |
$499.66 |
$1,427.58 |
1.3× |
| Kidney function study, non-imaging radioisotopic study Age Under 21 (78725) |
$295.54 |
$844.40 |
0.7× |
| Kidney imaging morphol - nm kidney cortex (78700) |
$351.72 |
$1,004.89 |
0.8× |
| Kidney imaging morphology; with vascular flow Age Under 21 (78701) |
$377.76 |
$1,079.29 |
0.9× |
| Kidney imaging morphology; with vascular flow and function, multiple studies, with and without pharmacological… (78709) |
$553.85 |
$1,582.41 |
1.0× |
| Kidney imaging morphology; with vascular flow and function, single study without pharmacological intervention Age Under… (78707) |
$470.89 |
$1,345.39 |
0.8× |
| Kidney imaging morphology; with vascular flow and function, single study, with pharmacological intervention (eg,… (78708) |
$427.67 |
$1,221.89 |
0.7× |
| Leveen/shunt patency exam (78291) |
$290.94 |
$831.24 |
0.7× |
| Liver and spleen imaging (78215) |
$346.27 |
$989.32 |
0.8× |
| Liver and spleen imaging; with vascular flow Age Under 21 (78216) |
$483.29 |
$1,380.82 |
1.1× |
| Liver imaging (78201) |
$996.95 |
$2,848.41 |
1.7× |
| Liver imaging with flow (78202) |
$996.95 |
$2,848.41 |
1.7× |
| Lung perf&ventilat diferentl (78598) |
$415.05 |
$1,185.84 |
0.7× |
| Lung perfusion imaging (78580) |
$432.56 |
$1,235.86 |
1.0× |
| Lymphangiography, extremity only, bilateral, radiological supervision and interpretation Age Under 21 (75803) |
$1,451.68 |
$4,147.63 |
0.9× |
| Lymphangiography, pelvic/abdominal, bilateral, radiological supervision and interpretation Age Under 21 (75807) |
$2,496.91 |
$7,134.02 |
0.7× |
| Lymphangiography, pelvic/abdominal, unilateral, radiological supervision and interpretation Age Under 21 (75805) |
$2,603.08 |
$7,437.36 |
0.8× |
| Magnetic resonance (eg, proton) imaging, any joint of lower extremity; without contrast material(s), followed by… (73723) |
$1,044.08 |
$2,983.06 |
2.8× |
| Magnetic resonance (eg, proton) imaging, lower extremity other than joint; without contrast material(s) Age Under 21 (73718) |
$723.37 |
$2,066.77 |
2.9× |
| Magnetic resonance (eg, proton) imaging, lower extremity other than joint; without contrast material(s), followed by… (73720) |
$987.77 |
$2,822.20 |
2.7× |
| Magnetic resonance (eg, proton) imaging, orbit, face, and/or neck; with contrast material(s) Age Under 21 (70542) |
$1,073.32 |
$3,066.62 |
2.9× |
| Magnetic resonance (eg, proton) imaging, orbit, face, and/or neck; without contrast material(s) Age Under 21 (70540) |
$939.47 |
$2,684.19 |
3.7× |
| Magnetic resonance (eg, proton) imaging, upper extremity, other than joint; without contrast material(s), followed by… (73220) |
$1,004.57 |
$2,870.19 |
2.7× |
| Magnetic resonance angiography, head; with contrast material(s) Age Under 21 (70545) |
$965.41 |
$2,758.31 |
2.6× |
| Magnetic resonance angiography, head; without contrast material(s), followed by contrast material(s) and further… (70546) |
$1,370.67 |
$3,916.20 |
3.7× |
| Magnetic resonance angiography, neck; without contrast material(s), followed by contrast material(s) and further… (70549) |
$1,073.32 |
$3,066.62 |
2.9× |
| Magnetic resonance elastography (76391) |
$441.33 |
$1,260.92 |
1.8× |
| Mammary ductogram or galactogram, multiple ducts, radiological supervision and interpretation Age Under 21 (77054) |
$216.57 |
$618.76 |
0.9× |
| Mammary ductogram single (77053) |
$237.53 |
$678.64 |
0.9× |
| Mandible min 4v (70110) |
$210.72 |
$602.04 |
1.9× |
| Med physic dos eval rad exps (76145) |
$590.75 |
$1,687.85 |
1.5× |
| Mr safety determination physician/other qhp (76016) |
$184.91 |
$528.30 |
2.0× |
| Mr safety implant pos&/immoblj supvj phys/qhp (76019) |
$124.74 |
$356.40 |
2.0× |
| Mr safety implant&/fb assmt clin staf 1st 15 min (76014) |
$51.43 |
$146.94 |
1.7× |
| Mr safety implt electronics prepj supvj phys/qhp (76018) |
$192.76 |
$550.74 |
1.9× |
| Mr safety med physics xm customization plng&mntr (76017) |
$507.62 |
$1,450.32 |
2.0× |
| MRA head w/o contrast (70544) |
$685.66 |
$1,959.02 |
2.7× |
| MRA neck w/ contrast (70548) |
$761.89 |
$2,176.81 |
2.1× |
| MRA neck w/o contrast (70547) |
$679.50 |
$1,941.42 |
2.7× |
| MRI abdomen w/contrast (74182) |
$923.65 |
$2,639 |
2.5× |
| MRI abdomen w/o contrast (74181) |
$774.52 |
$2,212.89 |
3.1× |
| MRI abdomen w/wo contrast (74183) |
$1,069.97 |
$3,057.04 |
2.9× |
| MRI any jt lower extrem w/contrast material (73722) |
$1,011.83 |
$2,890.94 |
1.2× |
| MRI bone marrow (77084) |
$729.55 |
$2,084.41 |
2.9× |
| MRI breast c- bilateral (77047) |
$441.33 |
$1,260.92 |
1.8× |
| MRI breast without contrast material unilateral (77046) |
$441.33 |
$1,260.92 |
1.8× |
| MRI c-spine w&w/o cont (72156) |
$1,282.18 |
$3,663.37 |
3.5× |
| MRI cervical spine w/contrast (72142) |
$1,041.94 |
$2,976.97 |
2.8× |
| MRI chest w/contrast (71551) |
$831.96 |
$2,377.01 |
1.0× |
| MRI chest w/o contrast (71550) |
$776.60 |
$2,218.83 |
3.1× |
| MRI chest w/wo contrast (71552) |
$1,059.57 |
$3,027.33 |
2.9× |
| MRI fetal sngl/1st gestation (74712) |
$227.88 |
$651.08 |
0.9× |
| MRI joint upr extr w/o&w/dye (73223) |
$1,042.28 |
$2,977.94 |
2.8× |
| MRI joint upr extrem w/dye (73222) |
$935.69 |
$2,673.39 |
1.1× |
| MRI joint upr extrem w/o dye (73221) |
$909.57 |
$2,598.77 |
3.6× |
| MRI lumbar spine w/contrast (72149) |
$1,072.43 |
$3,064.06 |
2.9× |
| MRI lumbar spine w/wo contrast (72158) |
$1,278.35 |
$3,652.41 |
3.5× |
| MRI orbit/face/neck w&w/o cont (70543) |
$1,223.53 |
$3,495.80 |
3.3× |
| MRI pelvis w & w/o contrast (72197) |
$1,092.27 |
$3,120.76 |
3.0× |
| MRI pelvis w/contrast (72196) |
$914.91 |
$2,614.02 |
2.5× |
| MRI pelvis w/o contrast (72195) |
$747.03 |
$2,134.35 |
3.0× |
| MRI spectroscopy (76390) |
$928.97 |
$2,654.19 |
10.1× |
| MRI spine cervical w/o contrast (72141) |
$1,459.59 |
$4,170.24 |
5.8× |
| MRI t-spine w&w/o cont (72157) |
$1,282.79 |
$3,665.09 |
3.5× |
| MRI thoracic spine w/contrast (72147) |
$1,079.44 |
$3,084.11 |
2.9× |
| MRI thoracic spine w/o contrst (72146) |
$990.10 |
$2,828.85 |
3.9× |
| MRI tmj (70336) |
$712.08 |
$2,034.51 |
2.8× |
| MRI upper extremity oth than jt w/o contr matrl (73218) |
$596.69 |
$1,704.81 |
2.4× |
| Myelography, 2 or more regions (eg, lumbar/thoracic, cervical/thoracic, lumbar/cervical, lumbar/thoracic/cervical),… (72270) |
$503.22 |
$1,437.77 |
0.6× |
| Myocardial imaging, positron emission tomography (PET), combined perfusion with metabolic evaluation study (including… (78432) |
$2,226.59 |
$6,361.67 |
1.4× |
| Myocardial imaging, positron emission tomography (PET), perfusion study (including ventricular wall motionºs» and/or… (78430) |
$1,168.14 |
$3,337.53 |
0.8× |
| Myocardial perfusion imaging, planar (including qualitative or quantitative wall motion, ejection fraction by first… (78453) |
$996.94 |
$2,848.40 |
0.7× |
| Myocardial perfusion imaging, planar (including qualitative or quantitative wall motion, ejection fraction by first… (78454) |
$1,057.76 |
$3,022.16 |
0.8× |
| Myocardial spect multiple studies (78452) |
$1,918.01 |
$5,480.01 |
1.4× |
| Myocrd img PET 2rtracer CT (78433) |
$2,226.59 |
$6,361.67 |
1.0× |
| Myocrd img PET metab eval single study (78459) |
$1,597.40 |
$4,563.99 |
1.2× |
| Myocrd img PET metab eval single study cncrnt CT (78429) |
$1,168.14 |
$3,337.53 |
0.8× |
| Myocrd img PET rst&strs CT (78431) |
$3,072.98 |
$8,779.94 |
1.3× |
| Nm adrenal imaging (78075) |
$810.11 |
$2,314.59 |
0.6× |
| Nm bone 3 phase (78315) |
$471.87 |
$1,348.18 |
1.1× |
| Nm bone imaging whole body (78306) |
$479.24 |
$1,369.23 |
1.1× |
| Nm bone marrow ltd (78102) |
$292.11 |
$834.58 |
0.7× |
| Nm bone marrow multi (78103) |
$292.11 |
$834.58 |
0.7× |
| Nm bone marrow wb (78104) |
$300.21 |
$857.74 |
0.7× |
| Nm csf cisternogram (78630) |
$449.69 |
$1,284.81 |
0.8× |
| Nm csf leak detection (78650) |
$1,044.72 |
$2,984.89 |
0.8× |
| Nm gastric emptying (78264) |
$379.49 |
$1,084.24 |
0.9× |
| Nm lung ventilation imaging (78579) |
$307.24 |
$877.82 |
0.7× |
| Nm lymph system (78195) |
$566.84 |
$1,619.53 |
1.0× |
| Nm myocard infarct spect (78469) |
$983.97 |
$2,811.33 |
1.7× |
| Nuclear medicine study for detecting heart shunt (78428) |
$323.11 |
$923.15 |
0.8× |
| Nuclear medicine study of bone and/or joint limited area (78300) |
$321.87 |
$919.62 |
0.8× |
| Nuclear medicine study of bone and/or joint multiple areas (78305) |
$340.47 |
$972.75 |
0.8× |
| Nuclear medicine study of brain, 4 static views or more (78605) |
$402.64 |
$1,150.39 |
0.7× |
| Nuclear medicine study of brain, less than 4 static views (78600) |
$301.68 |
$861.94 |
0.7× |
| Nuclear medicine study of heart muscle following heart attack with measurement of internal blood volume ejected with… (78468) |
$315.48 |
$901.35 |
0.6× |
| Nuclear medicine study of salivary gland with serial images (78231) |
$273.09 |
$780.23 |
0.6× |
| Ob us limited fetus(s) (76815) |
$149.11 |
$426.01 |
1.4× |
| Ob us nuchal meas 1 gest (76813) |
$81.90 |
$234 |
0.7× |
| Ophthalmic biometry by ultrasound echography, A-scan; with intraocular lens power calculation Age Under 21 (76519) |
$84.20 |
$240.57 |
0.8× |
| Ophthalmic ultrasound, diagnostic; anterior segment ultrasound, immersion (water bath) B-scan or high resolution… (76513) |
$119.51 |
$341.43 |
1.1× |
| Ophthalmic ultrasound, diagnostic; B-scan (with or without superimposed non-quantitative A-scan) Age Under 21 (76512) |
$84.20 |
$240.57 |
0.8× |
| Ophthalmic ultrasound, diagnostic; B-scan and quantitative A-scan performed during the same patient encounter Age Under… (76510) |
$122.75 |
$350.70 |
0.9× |
| Ophthalmic us dx quantitative a-scan only (76511) |
$118.16 |
$337.58 |
1.1× |
| Panoramic X-ray of jaws (70355) |
$72.03 |
$205.80 |
0.8× |
| Parathyrd planar w/spect&CT (78072) |
$452.65 |
$1,293.27 |
0.8× |
| Parathyroid planar imaging (78070) |
$376.24 |
$1,074.96 |
0.9× |
| Parathyroid planar imaging w/wo subtraction (78071) |
$404.85 |
$1,156.69 |
1.0× |
| Percutaneous transhepatic portography with hemodynamic evaluation, radiological supervision and interpretation Age… (75885) |
$2,384.13 |
$6,811.78 |
0.7× |
| PET imaging CT attenuation skull base mid-thigh (78815) |
$1,882.41 |
$5,378.31 |
1.2× |
| PET imaging for CT attenuation whole body (78816) |
$1,914.05 |
$5,468.69 |
1.3× |
| Prq transhepatc portograpy w/o hemodyn evl intrp (75887) |
$2,374.42 |
$6,784.05 |
0.7× |
| Pulmonary ventilation & perfusion imaging (78582) |
$433.32 |
$1,238.03 |
0.8× |
| Quant differential pulm perfusion w/wo imaging (78597) |
$307.24 |
$877.82 |
0.7× |
| Radex abscess/fistula/sinus tract rs&i (76080) |
$410.96 |
$1,174.15 |
0.7× |
| Radex entir thrc lmbr crv sac spi w/skull 1 vw (72081) |
$56.38 |
$161.06 |
0.6× |
| Radex entir thrc lmbr crv sac spi w/skull 2/3 vw (72082) |
$93.37 |
$266.75 |
0.8× |
| Radex entir thrc lmbr crv sac spi w/skull 4/5 vw (72083) |
$178 |
$508.55 |
1.6× |
| Radex entir thrc lmbr crv sac spi w/skull 6/> vw (72084) |
$178 |
$508.55 |
1.6× |
| Radex hip unilateral with pelvis 1 view (73501) |
$56.38 |
$161.06 |
0.6× |
| Radex hip unilateral with pelvis 2-3 views (73502) |
$56.38 |
$161.06 |
0.6× |
| Radex hip unilateral with pelvis minimum 4 views (73503) |
$93.37 |
$266.75 |
0.8× |
| Radex hips bilateral with pelvis 2 views (73521) |
$93.37 |
$266.75 |
0.8× |
| Radex hips bilateral with pelvis minimum 5 views (73523) |
$178 |
$508.55 |
1.6× |
| Radex spine cervical 2 or 3 views (72040) |
$139.93 |
$399.80 |
1.5× |
| Radex spine cervical 4 or 5 views (72050) |
$181.67 |
$519.04 |
1.6× |
| Radex spine cervical 6 or more views (72052) |
$217.35 |
$620.99 |
2.0× |
| Radex spine thoracolumbar junction min 2 views (72080) |
$179.33 |
$512.35 |
2.0× |
| Radiologic exam abdomen 3+ views (74021) |
$108.13 |
$308.94 |
1.0× |
| Radiologic exam chest 3 views (71047) |
$56.57 |
$161.62 |
0.6× |
| Radiologic exam chest 4+ views (71048) |
$108.13 |
$308.94 |
1.0× |
| Radiologic exam colon double contrast study (74280) |
$379.53 |
$1,084.36 |
2.1× |
| Radiologic exam colon single contrast study (74270) |
$318.93 |
$911.21 |
1.7× |
| Radiologic exam esophagus double contrast study (74221) |
$164.17 |
$469.03 |
0.9× |
| Radiologic exam esophagus single contrast study (74220) |
$134.04 |
$382.97 |
0.7× |
| Radiologic exam small int single contrast study (74250) |
$194.31 |
$555.16 |
1.1× |
| Radiologic exam swallow function contrast study (74230) |
$125.48 |
$358.51 |
0.7× |
| Radiologic exam upr gi trc double contrast study (74246) |
$211.43 |
$604.08 |
1.1× |
| Radiologic exam upr gi trc single contrast study (74240) |
$222.48 |
$635.64 |
1.2× |
| Radiologic examination femur 1 view (73551) |
$56.38 |
$161.06 |
0.6× |
| Radiologic examination femur minimum 2 views (73552) |
$56.38 |
$161.06 |
0.6× |
| Radiologic examination from nose to rectum for foreign body, single view, child Age Under 21 (76010) |
$92.79 |
$265.09 |
1.0× |
| Radiologic examination, ankle; complete, minimum of 3 views Age Under 21 (73610) |
$125.74 |
$359.23 |
1.4× |
| Radiologic examination, complete acute abdomen series, including 2 or more views of the abdomen (eg, supine, erect,… (74022) |
$229.15 |
$654.70 |
2.1× |
| Radiologic examination, elbow; 2 views Age Under 21 (73070) |
$95.94 |
$274.10 |
1.0× |
| Radiologic examination, elbow; complete, minimum of 3 views Age Under 21 (73080) |
$137.40 |
$392.55 |
1.5× |
| Radiologic examination, facial bones; less than 3 views Age Under 21 (70140) |
$149.96 |
$428.45 |
1.6× |
| Radiologic examination, foot; complete, minimum of 3 views Age Under 21 (73630) |
$118.69 |
$339.10 |
1.3× |
| Radiologic examination, hand; minimum of 3 views Age Under 21 (73130) |
$122.41 |
$349.72 |
1.3× |
| Radiologic examination, knee; both knees, standing, anteroposterior Age Under 21 (73565) |
$143.83 |
$410.93 |
1.6× |
| Radiologic examination, knee; complete, 4 or more views Age Under 21 (73564) |
$149.16 |
$426.15 |
1.4× |
| Radiologic examination, mandible; partial, less than 4 views Age Under 21 (70100) |
$145.94 |
$416.96 |
1.6× |
| Radiologic examination, mastoids; complete, minimum of 3 views per side Age Under 21 (70130) |
$89.57 |
$255.89 |
0.8× |
| Radiologic examination, nasal bones, complete, minimum of 3 views Age Under 21 (70160) |
$138.52 |
$395.75 |
1.5× |
| Radiologic examination, pharynx and/or cervical esophagus, including scout neck radiograph(s) and delayed image(s),… (74210) |
$230.15 |
$657.56 |
1.2× |
| Radiologic examination, renal cyst study, translumbar, contrast visualization, radiological supervision and… (74470) |
$592.16 |
$1,691.86 |
1.0× |
| Radiologic examination, ribs, bilateral; including posteroanterior chest, minimum of 4 views Age Under 21 (71111) |
$229 |
$654.26 |
2.1× |
| Radiologic examination, ribs, unilateral; including posteroanterior chest, minimum of 3 views Age Under 21 (71101) |
$173.75 |
$496.42 |
1.6× |
| Radiologic examination, sacroiliac joints; less than 3 views Age Under 21 (72200) |
$77.39 |
$221.11 |
0.7× |
| Radiologic examination, shoulder, arthrography, radiological supervision and interpretation Age Under 21 (73040) |
$281.81 |
$805.17 |
0.8× |
| Radiologic examination, shoulder; complete, minimum of 2 views Age Under 21 (73030) |
$135.83 |
$388.06 |
1.5× |
| Radiologic examination, sinuses, paranasal, less than 3 views Age Under 21 (70210) |
$74.76 |
$213.58 |
0.8× |
| Radiologic examination, skull; less than 4 views Age Under 21 (70250) |
$146.16 |
$417.59 |
1.3× |
| Radiologic examination, spine, lumbosacral; 2 or 3 views Age Under 21 (72100) |
$161.32 |
$460.91 |
1.5× |
| Radiologic examination, spine, lumbosacral; bending views only, 2 or 3 views Age Under 21 (72120) |
$125.55 |
$358.70 |
1.1× |
| Radiologic examination, spine, lumbosacral; complete, including bending views, minimum of 6 views Age Under 21 (72114) |
$172.15 |
$491.84 |
1.6× |
| Radiologic examination, wrist; complete, minimum of 3 views Age Under 21 (73110) |
$121.22 |
$346.32 |
1.3× |
| Radiologic examination; acromioclavicular joints, bilateral, with or without weighted distraction Age Under 21 (73050) |
$126.21 |
$360.59 |
1.4× |
| Radiologic examination; humerus, minimum of 2 views Age Under 21 (73060) |
$97.40 |
$278.26 |
1.1× |
| Radiologic examination; lower extremity, infant, minimum of 2 views Age Under 21 (73592) |
$60.27 |
$172.19 |
0.7× |
| Radiologic examination; orbits, complete, minimum of 4 views Age Under 21 (70200) |
$178.72 |
$510.61 |
1.6× |
| Radiologic examination; sternoclavicular joint or joints, minimum of 3 views Age Under 21 (71130) |
$117.55 |
$335.85 |
1.3× |
| Radiologic examination; toe(s), minimum of 2 views Age Under 21 (73660) |
$87.36 |
$249.60 |
1.0× |
| Radiologic examination; upper extremity, infant, minimum of 2 views Age Under 21 (73092) |
$81.90 |
$234 |
0.7× |
| Radiopharmaceutical dacryocystography Age Under 21 (78660) |
$307.24 |
$877.82 |
0.7× |
| Radiopharmaceutical localization of tumor, inflammatory process or distribution of radiopharmaceutical agent(s)… (78803) |
$1,057.76 |
$3,022.16 |
1.8× |
| Radiopharmaceutical therapy, by oral administration Age Under 21 (79005) |
$315.05 |
$900.14 |
1.3× |
| Review by radiologist of urinary bladder and urethra images with contrast and after passing urine (74455) |
$241.81 |
$690.88 |
1.0× |
| Rp loclzj tum plnr 1 area single day imaging (78800) |
$454.99 |
$1,299.97 |
1.1× |
| Rp loclzj tum plnr 2+area 1+d img/1 area img>2+d (78801) |
$501.90 |
$1,433.99 |
1.2× |
| Rp loclzj tum plnr whole body 2+ days imaging (78804) |
$1,003.89 |
$2,868.25 |
1.8× |
| Rp loclzj tum plnr whole body single day imaging (78802) |
$980.72 |
$2,802.05 |
1.7× |
| Rp loclzj tum spect 2 areas (78831) |
$1,029.75 |
$2,942.14 |
0.8× |
| Rp loclzj tum spect w/CT 1 (78830) |
$1,029.75 |
$2,942.14 |
0.8× |
| Rp loclzj tum spect w/CT 2 (78832) |
$1,168.14 |
$3,337.53 |
0.8× |
| Rp therapy intra-arterial particulate admn (79445) |
$456.40 |
$1,304 |
1.9× |
| Saline infusion sonohysterography (SIS), including color flow Doppler, when performed Age Under 21 (76831) |
$213.63 |
$610.37 |
0.8× |
| Scapula complete (73010) |
$141.99 |
$405.67 |
1.3× |
| Screening digital breast tomosynthesis bi (77063) |
$23.21 |
$66.31 |
— |
| Special physics consult (77370) |
$415.70 |
$1,187.71 |
2.9× |
| Special treatment procedure (77470) |
$1,124.42 |
$3,212.62 |
1.9× |
| Spleen imaging only, with or without vascular flow Age Under 21 (78185) |
$237.33 |
$678.07 |
0.6× |
| Tbs technical calculation only (77091) |
$73.56 |
$210.16 |
0.8× |
| Testicular imaging with vascular flow Age Under 21 (78761) |
$351.72 |
$1,004.89 |
0.8× |
| Ther rad simulaj-aided field setting complex (77290) |
$934.08 |
$2,668.80 |
2.4× |
| Therapeutic enema, contrast or air, for reduction of intussusception or other intraluminal obstruction (eg, meconium… (74283) |
$429.28 |
$1,226.50 |
2.3× |
| Thyroid carcinoma metastases imaging; limited area (eg, neck and chest only) Age Under 21 (78015) |
$322.83 |
$922.36 |
0.8× |
| Thyroid carcinoma metastases imaging; with additional studies (eg, urinary recovery) Age Under 21 (78016) |
$318.66 |
$910.44 |
0.8× |
| Thyroid imaging with vascular flow (78013) |
$474.97 |
$1,357.05 |
1.1× |
| Thyroid met imaging body (78018) |
$599.52 |
$1,712.89 |
1.0× |
| Thyroid uptake single/multiple quant measurement (78012) |
$285.90 |
$816.84 |
0.7× |
| Thyroid uptake w/blood flow sngle/mult quan meas (78014) |
$242.01 |
$691.44 |
0.6× |
| Trabecular bone score (TBS), structural condition of the bone microarchitecture; technical preparation and transmission… (77090) |
$73.56 |
$210.16 |
0.8× |
| Ultrasound bone density measurement and interpretation, peripheral site(s), any method Age Under 21 (76977) |
$81.90 |
$234 |
0.7× |
| Ultrasound breast limited (76642) |
$77.41 |
$221.16 |
0.8× |
| Ultrasound, abdomen limited (76705) |
$177.77 |
$507.90 |
1.6× |
| Ultrasound, limited, joint or focal evaluation of other nonvascular extremity structure(s) (eg, joint space,… (76882) |
$111.34 |
$318.11 |
1.0× |
| Ultrasound, pelvic (nonobstetric), real time with image documentation; complete Age Under 21 (76856) |
$253.31 |
$723.72 |
2.3× |
| Ultrasound, pregnant uterus, real time with image documentation, fetal and maternal evaluation plus detailed fetal… (76811) |
$231.80 |
$662.26 |
0.9× |
| Ultrasound, pregnant uterus, real time with image documentation, fetal and maternal evaluation, first trimester (< 14… (76801) |
$155.57 |
$444.48 |
1.4× |
| Ultrasound, transplanted kidney, real time and duplex Doppler with image documentation Age Under 21 (76776) |
$166.68 |
$476.22 |
1.5× |
| Ultrasound, transrectal; prostate volume study for brachytherapy treatment planning (separate procedure) Age Under 21 (76873) |
$277.63 |
$793.22 |
2.5× |
| Umbilical-artery Doppler (OB) (76820) |
$212.06 |
$605.87 |
1.9× |
| Unlisted CT procedure (76497) |
$93.29 |
$266.54 |
1.0× |
| Unlisted endocrine procedure, diagnostic nuclear medicine (78099) |
$307.24 |
$877.82 |
0.7× |
| Unlisted fluoroscopic procedure (76496) |
$107.81 |
$308.02 |
1.2× |
| Unlisted magnetic resonance procedure (eg, diagnostic, interventional) Age Under 21 (76498) |
$3,479.68 |
$9,941.95 |
37.9× |
| Unlisted respiratory procedure, diagnostic nuclear medicine (78599) |
$307.24 |
$877.82 |
0.7× |
| Ureteral reflux study (78740) |
$351.72 |
$1,004.89 |
0.8× |
| Urethrocystography retrograde rs&i (74450) |
$241.81 |
$690.88 |
1.0× |
| Urography antegrade rs&i (74425) |
$241.81 |
$690.88 |
0.7× |
| Us abdominal aorta real time screen study aaa (76706) |
$92.05 |
$263 |
0.8× |
| Us breast uni real time with image complete (76641) |
$77.41 |
$221.16 |
0.7× |
| Us chest (76604) |
$145.73 |
$416.36 |
1.3× |
| Us compl joint r-t w/image documentation (76881) |
$156.14 |
$446.11 |
1.4× |
| Us elastography organ (76981) |
$242.97 |
$694.20 |
2.2× |
| Us encephalogram (76506) |
$134.94 |
$385.54 |
1.2× |
| Us exam, pelvic, limited (76857) |
$245.97 |
$702.75 |
2.2× |
| Us guided compression repair (76936) |
$215.41 |
$615.45 |
0.9× |
| Us inft hips r-t img dynamic req phys/qhp manj (76885) |
$139.82 |
$399.47 |
1.5× |
| Us inft hips r-t img lmtd static phys/qhp manj (76886) |
$109.17 |
$311.91 |
1.2× |
| Us nrv&acc strux 1 xtr compre w/img pr extremity (76883) |
$129.62 |
$370.34 |
1.2× |
| US OB Follow-Up/Repeat (76816) |
$134.92 |
$385.46 |
1.2× |
| Us ob transvaginal (76817) |
$150.59 |
$430.25 |
1.4× |
| Us retroperitoneal complete (76770) |
$166.68 |
$476.22 |
1.5× |
| Us retroperitoneal ltd (76775) |
$225.08 |
$643.08 |
2.0× |
| Us scrotum (76870) |
$208.65 |
$596.12 |
1.9× |
| Us soft tissue head/neck (76536) |
$124.77 |
$356.47 |
1.1× |
| Us spinal canal (76800) |
$121.42 |
$346.89 |
1.1× |
| Us transrectal (76872) |
$277.63 |
$793.22 |
2.5× |
| Us trgt dyn mbubb 1st les (76978) |
$163.61 |
$467.43 |
0.4× |
| Us unlstd proc (76999) |
$54.74 |
$156.39 |
0.6× |
| Use 1st target lesion (76982) |
$242.97 |
$694.20 |
2.2× |
| Venogram sinus/jugular (75860) |
$2,269.89 |
$6,485.38 |
0.7× |
| Venography deep dorsal vein penis radiolgicl supervision interpretation (76499) |
$176.77 |
$505.03 |
1.9× |
| Venography renal unilateral selective rs&i (75831) |
$2,496.91 |
$7,134.02 |
0.7× |
| Venography, caval, inferior, with serialography, radiological supervision and interpretation Age Under 21 (75825) |
$2,094.49 |
$5,984.25 |
0.6× |
| Venography, caval, superior, with serialography, radiological supervision and interpretation Age Under 21 (75827) |
$1,193.03 |
$3,408.63 |
0.7× |
| Venography, extremity, bilateral, radiological supervision and interpretation Age Under 21 (75822) |
$1,193.03 |
$3,408.63 |
0.7× |
| Venography, extremity, unilateral, radiological supervision and interpretation Age Under 21 (75820) |
$1,193.03 |
$3,408.63 |
0.7× |
| Venous sampling thru cath w/wo angiography rs& (75893) |
$4,247.37 |
$12,135.33 |
0.7× |
| Vertebral fracture assessment via dxa (77086) |
$55.78 |
$159.37 |
0.6× |
| X-ray exam hips bi 3-4 views (73522) |
$93.37 |
$266.75 |
0.8× |
| X-ray exam of finger(s) (73140) |
$89.28 |
$255.06 |
1.0× |
| X-ray exam of knee 1 or 2 (73560) |
$140.78 |
$402.22 |
1.5× |
| X-ray exam of small bowel - fl small bowel series enteroclysis tube (74251) |
$214.57 |
$613.03 |
1.2× |
| X-ray exam ribs bil 3 views (71110) |
$133.17 |
$380.46 |
1.2× |
| X-ray exam ribs uni 2 views (71100) |
$55.81 |
$159.45 |
0.6× |
| X-ray heel (73650) |
$94.54 |
$270.11 |
1.0× |
| X-ray of joint between lower spine and hip bone 3 or more views|PROFESSIONAL COMPONENT (72202) |
$144.51 |
$412.86 |
1.3× |
| X-ray retrograde pyelogram (74420) |
$249.32 |
$712.34 |
0.7× |
| Xr abdomen 1 view (74018) |
$56.57 |
$161.62 |
0.6× |
| Xr abdomen 2 views (74019) |
$108.13 |
$308.94 |
1.0× |
| Xr arthrogram elbow (73085) |
$281.81 |
$805.17 |
0.8× |
| Xr arthrogram hip (73525) |
$281.81 |
$805.17 |
0.8× |
| Xr arthrogram knee (73580) |
$281.81 |
$805.17 |
0.8× |
| Xr arthrogram wrist (73115) |
$281.81 |
$805.17 |
0.8× |
| Xr bone age studies (77072) |
$120.58 |
$344.49 |
1.1× |
| Xr bone length study (77073) |
$157.48 |
$449.93 |
1.4× |
| Xr bone survey infant (77076) |
$305.48 |
$872.80 |
2.8× |
| Xr chest 1 view (71045) |
$56.57 |
$161.62 |
0.6× |
| Xr chest 2 views (71046) |
$56.57 |
$161.62 |
0.6× |
| Xr eye foreign body (70030) |
$139.32 |
$398.05 |
1.5× |
| Xr facial bones 3+ views (70150) |
$170.42 |
$486.89 |
1.5× |
| Xr foot arthritis pa only bilateral - report(ortho pro) (73620) |
$109.02 |
$311.47 |
1.2× |
| Xr forearm 2 views (73090) |
$111.32 |
$318.05 |
1.2× |
| Xr hand 2v (73120) |
$101.70 |
$290.57 |
0.9× |
| Xr hysterosalpingogram (74740) |
$299.46 |
$855.60 |
1.2× |
| Xr myelogram c-spine (72240) |
$611.64 |
$1,747.53 |
0.7× |
| Xr myelogram l-spine (72265) |
$561.52 |
$1,604.34 |
0.7× |
| Xr myelogram t-spine (72255) |
$563.06 |
$1,608.73 |
0.7× |
| Xr neck soft tissue (70360) |
$124.82 |
$356.61 |
1.4× |
| Xr o knee w/ merchant view bilat - report(ortho pro) (73562) |
$160 |
$457.13 |
1.7× |
| Xr osseous survey complete (77075) |
$284.03 |
$811.50 |
2.6× |
| Xr pelvis 1-2 views (72170) |
$119.42 |
$341.19 |
1.1× |
| Xr pelvis min 3 view (72190) |
$119.42 |
$341.19 |
1.1× |
| Xr peritoneogram (74190) |
$433.91 |
$1,239.72 |
0.8× |
| Xr sacrum/coccyx 2+ views (72220) |
$130.59 |
$373.10 |
1.4× |
| Xr shoulder 1 view (73020) |
$100.71 |
$287.73 |
1.1× |
| Xr sialogram (70390) |
$241.04 |
$688.68 |
1.0× |
| Xr sinuses 3+ views (70220) |
$160.51 |
$458.59 |
1.7× |
| Xr skull min 4 view (70260) |
$220.69 |
$630.54 |
2.0× |
| Xr spine 1 view (72020) |
$119.45 |
$341.26 |
1.3× |
| Xr spine thoracic 3v (72072) |
$165.88 |
$473.92 |
1.5× |
| Xr sternum 2+ views (71120) |
$117.93 |
$336.92 |
1.3× |
| Xr stress view joint (77071) |
$69.88 |
$199.64 |
0.8× |
| Xr surgical specimen (76098) |
$344 |
$982.86 |
0.6× |
| Xr t-spine 2 views (72070) |
$111.89 |
$319.68 |
1.0× |
| Xr tibia/fibula 2 views (73590) |
$114.20 |
$326.28 |
1.2× |
| Xr tmj bilateral (70330) |
$155.98 |
$445.64 |
1.7× |
| Xr tmj unilateral (70328) |
$80.13 |
$228.93 |
0.9× |
| Xr venogram renal bilat (75833) |
$5,936.05 |
$16,960.13 |
1.8× |
| Xr wrist 2 views (73100) |
$113.85 |
$325.26 |
1.2× |