| 3-D radiotherapy plan dose-volume histograms (77295) |
$2,591 |
$5,182 |
1.8× |
| Acute gi blood loss imaging (78278) |
$2,629.50 |
$5,259 |
6.2× |
| Angiography internal mammary rs&i (75756) |
$4,462.50 |
$8,925 |
1.3× |
| Angiography pulmonary bilateral slctv rs&i (75743) |
$5,045 |
$10,090 |
1.5× |
Angiography visceral slctv/supraslctv rs&i (75726)
unusually low — confirm this is the full procedure |
$2,257 |
$4,514 |
0.4× |
| Angiography, adrenal, bilateral, selective, radiological supervision and interpretation Age Under 21 (75733) |
$4,462.50 |
$8,925 |
1.3× |
| Angiography, adrenal, unilateral, selective, radiological supervision and interpretation Age Under 21 (75731) |
$3,545 |
$7,090 |
1.1× |
| Angiography, extremity, bilateral, radiological supervision and interpretation Age Under 21 (75716) |
$9,837 |
$19,674 |
2.9× |
| Angiography, extremity, unilateral, radiological supervision and interpretation Age Under 21 (75710) |
$10,112.50 |
$20,225 |
3.0× |
| Angiography, pelvic, selective or supraselective, radiological supervision and interpretation Age Under 21 (75736) |
$4,422.50 |
$8,845 |
0.7× |
| Angiography, pulmonary, unilateral, selective, radiological supervision and interpretation Age Under 21 (75741) |
$4,212.50 |
$8,425 |
1.3× |
| Angiography, spinal, selective, radiological supervision and interpretation Age Under 21 (75705) |
$3,442.75 |
$6,885.50 |
0.6× |
| Angrph cath f-up std tcat other than thrombylsis (75898) |
$5,097.50 |
$10,195 |
1.5× |
| Ankle 2 views (73600) |
$599.50 |
$1,199 |
6.5× |
| Aortography, abdominal plus bilateral iliofemoral lower extremity, catheter, by serialography, radiological supervision… (75630) |
$5,533.50 |
$11,067 |
1.6× |
| Aortography, abdominal, by serialography, radiological supervision and interpretation Age Under 21 (75625) |
$4,070.50 |
$8,141 |
1.2× |
| Aortography, thoracic, by serialography, radiological supervision and interpretation Age Under 21 (75605) |
$4,070.50 |
$8,141 |
0.7× |
| Aortography, thoracic, without serialography, radiological supervision and interpretation Age Under 21 (75600) |
$32.50 |
$65 |
0.0× |
| Basic radiation dosimetry calculation (77300) |
$1,779 |
$3,558 |
12.4× |
| Brain flow imaging only - nm brain flow only brain death (78610) |
$2,070.50 |
$4,141 |
3.6× |
| Cardiac MRI morphology & function w/o contrast (75557) |
$2,542.50 |
$5,085 |
10.0× |
| Cardiac MRI w/wo contrast & further seq (75561) |
$2,542.50 |
$5,085 |
6.8× |
| Clavicle complete (73000) |
$642.50 |
$1,285 |
6.9× |
| Computed tomographic (CT) colonography, diagnostic, including image postprocessing; with contrast material(s) including… (74262) |
$286 |
$572 |
1.5× |
| Computed tomographic (CT) colonography, diagnostic, including image postprocessing; without contrast material Age Under… (74261) |
$1,944.50 |
$3,889 |
17.4× |
| Computed tomographic (CT) colonography, screening, including image postprocessing (74263) |
$622 |
$1,244 |
2.4× |
| Computed tomographic angiography, abdomen and pelvis, with contrast material(s), including noncontrast images, if… (74174) |
$2,102 |
$4,204 |
5.6× |
| Computed tomographic angiography, abdomen, with contrast material(s), including noncontrast images, if performed, and… (74175) |
$2,102 |
$4,204 |
11.2× |
| Computed tomographic angiography, abdominal aorta and bilateral iliofemoral lower extremity runoff, with contrast… (75635) |
$2,102 |
$4,204 |
11.2× |
| Computed tomographic angiography, chest (noncoronary), with contrast material(s), including noncontrast images, if… (71275) |
$2,102 |
$4,204 |
11.2× |
| Computed tomographic angiography, lower extremity, with contrast material(s), including noncontrast images, if… (73706) |
$2,102 |
$4,204 |
11.2× |
| Computed tomographic angiography, neck, with contrast material(s), including noncontrast images, if performed, and… (70498) |
$2,102 |
$4,204 |
11.2× |
| Computed tomographic angiography, pelvis, with contrast material(s), including noncontrast images, if performed, and… (72191) |
$2,102 |
$4,204 |
11.2× |
| Computed tomographic angiography, upper extremity, with contrast material(s), including noncontrast images, if… (73206) |
$2,102 |
$4,204 |
11.2× |
| Computed tomography, cervical spine; without contrast material, followed by contrast material(s) and further sections… (72127) |
$2,102 |
$4,204 |
11.2× |
| Computed tomography, lower extremity; without contrast material Age Under 21 (73700) |
$2,102 |
$4,204 |
18.9× |
| Computed tomography, lower extremity; without contrast material, followed by contrast material(s) and further sections… (73702) |
$2,102 |
$4,204 |
11.2× |
| Computed tomography, lumbar spine; without contrast material, followed by contrast material(s) and further sections Age… (72133) |
$2,102 |
$4,204 |
11.2× |
| Computed tomography, maxillofacial area; with contrast material(s) Age Under 21 (70487) |
$2,102 |
$4,204 |
11.2× |
| Computed tomography, maxillofacial area; without contrast material Age Under 21 (70486) |
$2,102 |
$4,204 |
18.9× |
| Computed tomography, orbit, sella, or posterior fossa or outer, middle, or inner ear; with contrast material(s) Age… (70481) |
$2,102 |
$4,204 |
11.2× |
| Computed tomography, orbit, sella, or posterior fossa or outer, middle, or inner ear; without contrast material Age… (70480) |
$2,102 |
$4,204 |
18.9× |
| Computed tomography, orbit, sella, or posterior fossa or outer, middle, or inner ear; without contrast material,… (70482) |
$2,102 |
$4,204 |
11.2× |
| Computed tomography, soft tissue neck; without contrast material followed by contrast material(s) and further sections… (70492) |
$2,102 |
$4,204 |
11.2× |
| Computed tomography, thoracic spine; without contrast material, followed by contrast material(s) and further sections… (72130) |
$2,102 |
$4,204 |
11.2× |
| Corpora cavernosography, radiological supervision and interpretation Age Under 21 (74445) |
$7,214.50 |
$14,429 |
64.7× |
| Csf shunt evaluation (78645) |
$3,042.50 |
$6,085 |
5.3× |
| CT abdomen and pelvis without and with contrast (74178) |
$2,102 |
$4,204 |
5.6× |
| CT abdomen and pelvis without contrast (74176) |
$2,102 |
$4,204 |
8.3× |
| CT abdomen w & w/o contrast (74170) |
$2,102 |
$4,204 |
11.2× |
| CT abdomen w/contrast (74160) |
$2,102 |
$4,204 |
11.2× |
| CT abdomen w/o contrast (74150) |
$2,102 |
$4,204 |
18.9× |
| CT angio hrt w/3d image (75574) |
$2,102 |
$4,204 |
5.6× |
| CT cervical spine w/contrast (72126) |
$2,102 |
$4,204 |
5.6× |
| CT cervical spine w/o contrast (72125) |
$2,102 |
$4,204 |
18.9× |
| CT chest w/contrast (71260) |
$2,102 |
$4,204 |
11.2× |
| CT extremity upper w & w/o contrast (73202) |
$2,102 |
$4,204 |
11.2× |
| CT extremity upper w/o contrast (73200) |
$2,102 |
$4,204 |
18.9× |
| CT head/brain with contrast (70460) |
$2,102 |
$4,204 |
11.2× |
| CT head/brain without and with contrast (70470) |
$2,102 |
$4,204 |
11.2× |
| CT heart contrast eval cardiac structure&morph (75572) |
$2,102 |
$4,204 |
5.6× |
| CT heart no contrast quant eval coronry calcium (75571) |
$622 |
$1,244 |
6.7× |
| CT l-spine w/contrast (72132) |
$2,102 |
$4,204 |
5.6× |
| CT lower extremity w/dye (73701) |
$2,102 |
$4,204 |
11.2× |
| CT lumbar spine w/o contrast (72131) |
$2,102 |
$4,204 |
18.9× |
| CT maxillofacial w/wo contrast (70488) |
$1,944.50 |
$3,889 |
10.4× |
| CT neck w/contrast (70491) |
$2,102 |
$4,204 |
11.2× |
| CT neck w/o contrast (70490) |
$2,102 |
$4,204 |
18.9× |
| CT pelvis w & w/o contrast (72194) |
$2,102 |
$4,204 |
11.2× |
| CT pelvis w/o contrast (72192) |
$2,102 |
$4,204 |
18.9× |
| CT thoracic spine w/contrast (72129) |
$2,102 |
$4,204 |
11.2× |
| CT thoracic spine w/o contrast (72128) |
$2,102 |
$4,204 |
18.9× |
| CT thorax lung cancer scr c- (71271) |
$622 |
$1,244 |
5.6× |
| CT thorax w/o contrast (71250) |
$1,944.50 |
$3,889 |
17.4× |
| CT upper extremity w/dye (73201) |
$2,102 |
$4,204 |
5.6× |
| CTA head w contrast (70496) |
$2,102 |
$4,204 |
11.2× |
| Cystography, minimum of 3 views, radiological supervision and interpretation Age Under 21 (74430) |
$1,468.50 |
$2,937 |
3.9× |
| Dilation ureters/urethra rs&i (74485) |
$2,082 |
$4,164 |
0.9× |
| Discography, cervical or thoracic, radiological supervision and interpretation Age Under 21 (72285) |
$3,995.50 |
$7,991 |
1.9× |
| Diskography lumbar s&i (72295) |
$2,772 |
$5,544 |
1.3× |
| Doppler echocardiography, fetal, pulsed wave and/or continuous wave with spectral display; complete Age Under 21 (76827) |
$263.50 |
$527 |
2.4× |
| Doppler echocardiography, fetal, pulsed wave and/or continuous wave with spectral display; follow-up or repeat study… (76828) |
$840.50 |
$1,681 |
7.5× |
| Doppler fetal mid cerebral artery (76821) |
$504 |
$1,008 |
4.5× |
| Dual-energy X-ray absorptiometry (DXA), bone density study, 1 or more sites; axial skeleton (eg, hips, pelvis, spine)… (77080) |
$503 |
$1,006 |
4.5× |
| Dxa bone density study axial skeleton (77085) |
$533.50 |
$1,067 |
4.8× |
| Echocardiography, fetal, cardiovascular system, real time with image documentation (2D), with or without M-mode… (76825) |
$792 |
$1,584 |
1.4× |
| Echocardiography, fetal, cardiovascular system, real time with image documentation (2D), with or without M-mode… (76826) |
$792 |
$1,584 |
3.1× |
| Fetal biophys profile w/o nst (76819) |
$414 |
$828 |
3.7× |
| Fetal biophysical profile non-stress testing (76818) |
$683.25 |
$1,366.50 |
6.1× |
| Fluoroscopy up to 1 hour physician/qhp time (76000) |
$895.50 |
$1,791 |
3.5× |
| Gated heart planar single (78472) |
$3,171 |
$6,342 |
7.4× |
| Hepatc vngrph wdg/fr w/o hemodyn eval rs&i (75891) |
$3,983 |
$7,966 |
1.2× |
| Hepatic venography, wedged or free, with hemodynamic evaluation, radiological supervision and interpretation Age Under… (75889) |
$3,688.50 |
$7,377 |
1.1× |
| Hepatobil syst imag inc gb w/pharma intervenj (78227) |
$3,136 |
$6,272 |
5.4× |
| Hepatobiliary syst imaging including gallbladder (78226) |
$2,737.50 |
$5,475 |
6.4× |
| Ht muscle image spect sing (78451) |
$6,526.50 |
$13,053 |
4.7× |
| Injection procedure for radiopharmaceutical localization by non-imaging probe study, intravenous (eg, parathyroid… (78808) |
$329 |
$658 |
0.8× |
| Intestine imaging (eg, ectopic gastric mucosa, Meckel's localization, volvulus) Age Under 21 (78290) |
$2,570.50 |
$5,141 |
6.0× |
| Isodose teletherapy plan complex multi tx w/cal (77307) |
$700.50 |
$1,401 |
1.8× |
| Kidney imaging morphol - nm kidney cortex (78700) |
$2,106.50 |
$4,213 |
4.9× |
| Kidney imaging morphology; with vascular flow and function, single study without pharmacological intervention Age Under… (78707) |
$3,097.50 |
$6,195 |
5.3× |
| Kidney imaging morphology; with vascular flow and function, single study, with pharmacological intervention (eg,… (78708) |
$3,172 |
$6,344 |
5.5× |
| Liver and spleen imaging (78215) |
$2,685.50 |
$5,371 |
6.3× |
| Liver imaging (78201) |
$2,383.50 |
$4,767 |
4.1× |
| Lung perf&ventilat diferentl (78598) |
$4,086.50 |
$8,173 |
7.1× |
| Lung perfusion imaging (78580) |
$2,629.50 |
$5,259 |
6.2× |
| Lymphangiography, extremity only, bilateral, radiological supervision and interpretation Age Under 21 (75803) |
$4,367 |
$8,734 |
2.6× |
| Lymphangiography, extremity only, unilateral, radiological supervision and interpretation Age Under 21 (75801) |
$1,188.50 |
$2,377 |
1.8× |
| Lymphangiography, pelvic/abdominal, bilateral, radiological supervision and interpretation Age Under 21 (75807) |
$5,062 |
$10,124 |
1.5× |
| Lymphangiography, pelvic/abdominal, unilateral, radiological supervision and interpretation Age Under 21 (75805) |
$4,367 |
$8,734 |
1.3× |
| Magnetic resonance (eg, proton) imaging, any joint of lower extremity; without contrast material(s), followed by… (73723) |
$2,542.50 |
$5,085 |
6.8× |
| Magnetic resonance (eg, proton) imaging, lower extremity other than joint; with contrast material(s) Age Under 21 (73719) |
$2,542.50 |
$5,085 |
6.8× |
| Magnetic resonance (eg, proton) imaging, lower extremity other than joint; without contrast material(s) Age Under 21 (73718) |
$2,542.50 |
$5,085 |
10.0× |
| Magnetic resonance (eg, proton) imaging, lower extremity other than joint; without contrast material(s), followed by… (73720) |
$2,542.50 |
$5,085 |
6.8× |
| Magnetic resonance (eg, proton) imaging, orbit, face, and/or neck; with contrast material(s) Age Under 21 (70542) |
$2,542.50 |
$5,085 |
6.8× |
| Magnetic resonance (eg, proton) imaging, orbit, face, and/or neck; without contrast material(s) Age Under 21 (70540) |
$2,542.50 |
$5,085 |
10.0× |
| Magnetic resonance (eg, proton) imaging, upper extremity, other than joint; with contrast material(s) Age Under 21 (73219) |
$2,542.50 |
$5,085 |
6.8× |
| Magnetic resonance (eg, proton) imaging, upper extremity, other than joint; without contrast material(s), followed by… (73220) |
$2,542.50 |
$5,085 |
6.8× |
| Magnetic resonance angiography, head; without contrast material(s), followed by contrast material(s) and further… (70546) |
$2,542.50 |
$5,085 |
6.8× |
| Magnetic resonance angiography, neck; without contrast material(s), followed by contrast material(s) and further… (70549) |
$2,542.50 |
$5,085 |
6.8× |
| Mammary ductogram or galactogram, multiple ducts, radiological supervision and interpretation Age Under 21 (77054) |
$861.50 |
$1,723 |
3.4× |
| Mammary ductogram single (77053) |
$654.50 |
$1,309 |
2.6× |
| Mandible min 4v (70110) |
$918.50 |
$1,837 |
8.2× |
| MRA head w/o contrast (70544) |
$2,542.50 |
$5,085 |
10.0× |
| MRA neck w/ contrast (70548) |
$2,542.50 |
$5,085 |
6.8× |
| MRA neck w/o contrast (70547) |
$2,542.50 |
$5,085 |
10.0× |
| MRI abdomen w/contrast (74182) |
$2,542.50 |
$5,085 |
6.8× |
| MRI abdomen w/o contrast (74181) |
$2,542.50 |
$5,085 |
10.0× |
| MRI abdomen w/wo contrast (74183) |
$2,542.50 |
$5,085 |
6.8× |
| MRI any jt lower extrem w/contrast material (73722) |
$2,542.50 |
$5,085 |
3.0× |
| MRI bone marrow (77084) |
$2,542.50 |
$5,085 |
10.0× |
| MRI brain w/o dye (70557) |
$2,542.50 |
$5,085 |
4.4× |
| MRI breast c- bilateral (77047) |
$1,647 |
$3,294 |
6.5× |
| MRI c-spine w&w/o cont (72156) |
$2,542.50 |
$5,085 |
6.8× |
| MRI cervical spine w/contrast (72142) |
$2,542.50 |
$5,085 |
6.8× |
| MRI chest w/contrast (71551) |
$2,542.50 |
$5,085 |
3.0× |
| MRI chest w/o contrast (71550) |
$2,542.50 |
$5,085 |
10.0× |
| MRI chest w/wo contrast (71552) |
$2,542.50 |
$5,085 |
6.8× |
| MRI joint upr extr w/o&w/dye (73223) |
$2,542.50 |
$5,085 |
6.8× |
| MRI joint upr extrem w/dye (73222) |
$2,542.50 |
$5,085 |
3.0× |
| MRI joint upr extrem w/o dye (73221) |
$2,542.50 |
$5,085 |
10.0× |
| MRI lumbar spine w/contrast (72149) |
$2,542.50 |
$5,085 |
6.8× |
| MRI lumbar spine w/wo contrast (72158) |
$2,542.50 |
$5,085 |
6.8× |
| MRI orbit/face/neck w&w/o cont (70543) |
$2,542.50 |
$5,085 |
6.8× |
| MRI pelvis w & w/o contrast (72197) |
$2,542.50 |
$5,085 |
6.8× |
| MRI pelvis w/contrast (72196) |
$2,542.50 |
$5,085 |
6.8× |
| MRI pelvis w/o contrast (72195) |
$2,542.50 |
$5,085 |
10.0× |
| MRI spectroscopy (76390) |
$2,542.50 |
$5,085 |
27.4× |
| MRI spine cervical w/o contrast (72141) |
$2,542.50 |
$5,085 |
10.0× |
| MRI t-spine w&w/o cont (72157) |
$2,542.50 |
$5,085 |
6.8× |
| MRI thoracic spine w/contrast (72147) |
$2,542.50 |
$5,085 |
6.8× |
| MRI thoracic spine w/o contrst (72146) |
$2,542.50 |
$5,085 |
10.0× |
| MRI tmj (70336) |
$2,542.50 |
$5,085 |
10.0× |
| MRI upper extremity oth than jt w/o contr matrl (73218) |
$2,542.50 |
$5,085 |
10.0× |
| Myelography, 2 or more regions (eg, lumbar/thoracic, cervical/thoracic, lumbar/cervical, lumbar/thoracic/cervical),… (72270) |
$3,760 |
$7,520 |
4.5× |
| Myocardial perfusion imaging, planar (including qualitative or quantitative wall motion, ejection fraction by first… (78453) |
$2,737.50 |
$5,475 |
2.0× |
| Myocardial spect multiple studies (78452) |
$8,193.50 |
$16,387 |
5.9× |
| Myocrd img PET metab eval single study (78459) |
$10,312.50 |
$20,625 |
7.5× |
| N-invas est c ffr augmnt sw alys CTA i&r phy/qhp (75580) |
$1,591.50 |
$3,183 |
1.7× |
| Nm bone 3 phase (78315) |
$3,772.50 |
$7,545 |
8.8× |
| Nm bone imaging whole body (78306) |
$3,136 |
$6,272 |
7.4× |
| Nm bone marrow wb (78104) |
$2,252 |
$4,504 |
5.3× |
| Nm csf cisternogram (78630) |
$3,415 |
$6,830 |
5.9× |
| Nm csf leak detection (78650) |
$2,721 |
$5,442 |
2.0× |
| Nm gastric emptying (78264) |
$2,947 |
$5,894 |
6.9× |
| Nm lymph system (78195) |
$2,311 |
$4,622 |
4.0× |
| Nm salivary gland (78230) |
$678 |
$1,356 |
1.6× |
| Nuclear medicine study for detecting heart shunt (78428) |
$3,378 |
$6,756 |
7.9× |
| Nuclear medicine study of bone and/or joint limited area (78300) |
$1,992 |
$3,984 |
4.7× |
| Nuclear medicine study of bone and/or joint multiple areas (78305) |
$2,404 |
$4,808 |
5.6× |
| Ob us limited fetus(s) (76815) |
$463 |
$926 |
4.2× |
| Ob us nuchal meas 1 gest (76813) |
$792 |
$1,584 |
7.1× |
| Optic foramina (70190) |
$167.50 |
$335 |
1.8× |
| Parathyrd planar w/spect&CT (78072) |
$2,649 |
$5,298 |
4.6× |
| Parathyroid planar imaging (78070) |
$2,421 |
$4,842 |
5.7× |
| Percutaneous transhepatic portography with hemodynamic evaluation, radiological supervision and interpretation Age… (75885) |
$4,726 |
$9,452 |
1.4× |
| Prq transhepatc portograpy w/o hemodyn evl intrp (75887) |
$4,047.50 |
$8,095 |
1.2× |
| Pulmonary ventilation & perfusion imaging (78582) |
$3,980.50 |
$7,961 |
6.9× |
| Radex abscess/fistula/sinus tract rs&i (76080) |
$1,077 |
$2,154 |
1.8× |
| Radex entir thrc lmbr crv sac spi w/skull 1 vw (72081) |
$167.50 |
$335 |
1.8× |
| Radex entir thrc lmbr crv sac spi w/skull 2/3 vw (72082) |
$1,155.50 |
$2,311 |
10.4× |
| Radex entir thrc lmbr crv sac spi w/skull 6/> vw (72084) |
$1,155.50 |
$2,311 |
10.4× |
| Radex hip unilateral with pelvis 1 view (73501) |
$599.50 |
$1,199 |
6.5× |
| Radex hip unilateral with pelvis 2-3 views (73502) |
$719.50 |
$1,439 |
7.8× |
| Radex hip unilateral with pelvis minimum 4 views (73503) |
$976.50 |
$1,953 |
8.8× |
| Radex hips bilateral with pelvis 2 views (73521) |
$785 |
$1,570 |
7.0× |
| Radex hips bilateral with pelvis minimum 5 views (73523) |
$978 |
$1,956 |
8.8× |
| Radex spine cervical 2 or 3 views (72040) |
$798 |
$1,596 |
8.6× |
| Radex spine cervical 4 or 5 views (72050) |
$1,293.50 |
$2,587 |
11.6× |
| Radex spine cervical 6 or more views (72052) |
$1,491 |
$2,982 |
13.4× |
| Radex spine thoracolumbar junction min 2 views (72080) |
$726.50 |
$1,453 |
7.8× |
| Radiologic exam chest 3 views (71047) |
$700 |
$1,400 |
7.5× |
| Radiologic exam chest 4+ views (71048) |
$680.50 |
$1,361 |
6.1× |
| Radiologic exam colon double contrast study (74280) |
$2,008.50 |
$4,017 |
10.7× |
| Radiologic exam colon single contrast study (74270) |
$1,575 |
$3,150 |
8.4× |
| Radiologic exam esophagus single contrast study (74220) |
$1,271 |
$2,542 |
6.8× |
| Radiologic exam small int single contrast study (74250) |
$1,576.50 |
$3,153 |
8.4× |
| Radiologic exam swallow function contrast study (74230) |
$1,623.50 |
$3,247 |
8.7× |
| Radiologic exam upr gi trc double contrast study (74246) |
$1,575 |
$3,150 |
8.4× |
| Radiologic exam upr gi trc single contrast study (74240) |
$1,642.50 |
$3,285 |
8.8× |
| Radiologic examination femur 1 view (73551) |
$700 |
$1,400 |
7.5× |
| Radiologic examination femur minimum 2 views (73552) |
$700 |
$1,400 |
7.5× |
| Radiologic examination from nose to rectum for foreign body, single view, child Age Under 21 (76010) |
$794 |
$1,588 |
8.6× |
| Radiologic examination, ankle; complete, minimum of 3 views Age Under 21 (73610) |
$680.50 |
$1,361 |
7.3× |
| Radiologic examination, complete acute abdomen series, including 2 or more views of the abdomen (eg, supine, erect,… (74022) |
$1,055.50 |
$2,111 |
9.5× |
| Radiologic examination, elbow; 2 views Age Under 21 (73070) |
$599.50 |
$1,199 |
6.5× |
| Radiologic examination, elbow; complete, minimum of 3 views Age Under 21 (73080) |
$719.50 |
$1,439 |
7.8× |
| Radiologic examination, facial bones; less than 3 views Age Under 21 (70140) |
$700 |
$1,400 |
7.5× |
| Radiologic examination, foot; complete, minimum of 3 views Age Under 21 (73630) |
$680.50 |
$1,361 |
7.3× |
| Radiologic examination, hand; minimum of 3 views Age Under 21 (73130) |
$719.50 |
$1,439 |
7.8× |
| Radiologic examination, knee; both knees, standing, anteroposterior Age Under 21 (73565) |
$599.50 |
$1,199 |
6.5× |
| Radiologic examination, knee; complete, 4 or more views Age Under 21 (73564) |
$878.50 |
$1,757 |
7.9× |
| Radiologic examination, mandible; partial, less than 4 views Age Under 21 (70100) |
$167.50 |
$335 |
1.8× |
| Radiologic examination, mastoids; complete, minimum of 3 views per side Age Under 21 (70130) |
$819 |
$1,638 |
7.3× |
| Radiologic examination, mastoids; less than 3 views per side Age Under 21 (70120) |
$301.50 |
$603 |
2.7× |
| Radiologic examination, nasal bones, complete, minimum of 3 views Age Under 21 (70160) |
$664 |
$1,328 |
7.2× |
| Radiologic examination, renal cyst study, translumbar, contrast visualization, radiological supervision and… (74470) |
$1,863 |
$3,726 |
3.2× |
| Radiologic examination, ribs, unilateral; including posteroanterior chest, minimum of 3 views Age Under 21 (71101) |
$878.50 |
$1,757 |
7.9× |
| Radiologic examination, sacroiliac joints; less than 3 views Age Under 21 (72200) |
$580.50 |
$1,161 |
5.2× |
| Radiologic examination, shoulder, arthrography, radiological supervision and interpretation Age Under 21 (73040) |
$1,709.50 |
$3,419 |
4.6× |
| Radiologic examination, shoulder; complete, minimum of 2 views Age Under 21 (73030) |
$741 |
$1,482 |
8.0× |
| Radiologic examination, single plane body section (eg, tomography), other than with urography Age Under 21 (76100) |
$1,316.50 |
$2,633 |
11.8× |
| Radiologic examination, sinuses, paranasal, less than 3 views Age Under 21 (70210) |
$642.50 |
$1,285 |
6.9× |
| Radiologic examination, skull; less than 4 views Age Under 21 (70250) |
$700 |
$1,400 |
6.3× |
| Radiologic examination, spine, lumbosacral; 2 or 3 views Age Under 21 (72100) |
$878.50 |
$1,757 |
7.9× |
| Radiologic examination, spine, lumbosacral; bending views only, 2 or 3 views Age Under 21 (72120) |
$301.50 |
$603 |
2.7× |
| Radiologic examination, spine, lumbosacral; complete, including bending views, minimum of 6 views Age Under 21 (72114) |
$1,393.50 |
$2,787 |
12.5× |
| Radiologic examination, spine; thoracic, minimum of 4 views Age Under 21 (72074) |
$998 |
$1,996 |
8.9× |
| Radiologic examination, wrist; complete, minimum of 3 views Age Under 21 (73110) |
$700 |
$1,400 |
7.5× |
| Radiologic examination; acromioclavicular joints, bilateral, with or without weighted distraction Age Under 21 (73050) |
$680.50 |
$1,361 |
7.3× |
| Radiologic examination; humerus, minimum of 2 views Age Under 21 (73060) |
$642.50 |
$1,285 |
6.9× |
| Radiologic examination; lower extremity, infant, minimum of 2 views Age Under 21 (73592) |
$621.50 |
$1,243 |
6.7× |
| Radiologic examination; orbits, complete, minimum of 4 views Age Under 21 (70200) |
$918.50 |
$1,837 |
8.2× |
| Radiologic examination; sternoclavicular joint or joints, minimum of 3 views Age Under 21 (71130) |
$680.50 |
$1,361 |
7.3× |
| Radiologic examination; toe(s), minimum of 2 views Age Under 21 (73660) |
$599.50 |
$1,199 |
6.5× |
| Radiologic examination; upper extremity, infant, minimum of 2 views Age Under 21 (73092) |
$478.50 |
$957 |
4.3× |
| Radiopharmaceutical localization of tumor, inflammatory process or distribution of radiopharmaceutical agent(s)… (78803) |
$3,695.50 |
$7,391 |
6.4× |
| Radiopharmaceutical therapy, by intravenous administration Age Under 21 (79101) |
$1,410.50 |
$2,821 |
5.7× |
| Radiopharmaceutical therapy, by oral administration Age Under 21 (79005) |
$2,385.50 |
$4,771 |
9.6× |
| Review by radiologist of urinary bladder and urethra images with contrast and after passing urine (74455) |
$1,448 |
$2,896 |
5.7× |
| Rp loclzj tum plnr 2+area 1+d img/1 area img>2+d (78801) |
$3,117.50 |
$6,235 |
7.3× |
| Rp loclzj tum plnr whole body 2+ days imaging (78804) |
$4,069.50 |
$8,139 |
7.0× |
| Rp loclzj tum plnr whole body single day imaging (78802) |
$3,269.50 |
$6,539 |
5.6× |
| Rp loclzj tum spect 2 areas (78831) |
$3,836 |
$7,672 |
2.8× |
| Rp loclzj tum spect w/CT 1 (78830) |
$4,956 |
$9,912 |
3.6× |
| Rp loclzj tum spect w/CT 2 (78832) |
$5,096.50 |
$10,193 |
3.3× |
| Rp therapy intra-arterial particulate admn (79445) |
$1,590.50 |
$3,181 |
6.4× |
| Saline infusion sonohysterography (SIS), including color flow Doppler, when performed Age Under 21 (76831) |
$718.50 |
$1,437 |
2.8× |
| Scapula complete (73010) |
$661 |
$1,322 |
5.9× |
| Screening digital breast tomosynthesis bi (77063) |
$26.50 |
$53 |
— |
| Shuntogram indwelling nonvascular shunt rs&i (75809) |
$216 |
$432 |
1.9× |
| Special physics consult (77370) |
$280.50 |
$561 |
2.0× |
| Tbs technical calculation only (77091) |
$110 |
$220 |
1.2× |
| Temporomandibular joint arthrography, radiological supervision and interpretation Age Under 21 (70332) |
$441.50 |
$883 |
1.7× |
| Testicular imaging with vascular flow Age Under 21 (78761) |
$1,954.50 |
$3,909 |
4.6× |
| Thyroid imaging with vascular flow (78013) |
$1,576.50 |
$3,153 |
3.7× |
| Thyroid met imaging body (78018) |
$3,415 |
$6,830 |
5.9× |
| Thyroid uptake single/multiple quant measurement (78012) |
$1,429 |
$2,858 |
3.4× |
| Thyroid uptake w/blood flow sngle/mult quan meas (78014) |
$2,703.50 |
$5,407 |
6.3× |
| Ultrasound bone density measurement and interpretation, peripheral site(s), any method Age Under 21 (76977) |
$3 |
$6 |
0.0× |
| Ultrasound breast limited (76642) |
$143 |
$286 |
1.5× |
| Ultrasound, abdomen limited (76705) |
$1,662.50 |
$3,325 |
14.9× |
| Ultrasound, limited, joint or focal evaluation of other nonvascular extremity structure(s) (eg, joint space,… (76882) |
$461.50 |
$923 |
4.1× |
| Ultrasound, pelvic (nonobstetric), real time with image documentation; complete Age Under 21 (76856) |
$943 |
$1,886 |
8.5× |
| Ultrasound, pregnant uterus, real time with image documentation, fetal and maternal evaluation plus detailed fetal… (76811) |
$547 |
$1,094 |
2.1× |
| Ultrasound, pregnant uterus, real time with image documentation, fetal and maternal evaluation, first trimester (< 14… (76801) |
$419.25 |
$838.50 |
3.8× |
| Ultrasound, transplanted kidney, real time and duplex Doppler with image documentation Age Under 21 (76776) |
$763.50 |
$1,527 |
6.8× |
| Ultrasound, transrectal; prostate volume study for brachytherapy treatment planning (separate procedure) Age Under 21 (76873) |
$398.50 |
$797 |
3.6× |
| Umbilical-artery Doppler (OB) (76820) |
$308.75 |
$617.50 |
2.8× |
| Urethrocystography retrograde rs&i (74450) |
$7,214.50 |
$14,429 |
28.3× |
| Urography (pyelography), intravenous, with or without KUB, with or without tomography Age Under 21 (74400) |
$1,831 |
$3,662 |
9.8× |
| Urography antegrade rs&i (74425) |
$2,516 |
$5,032 |
6.8× |
| Us abdominal aorta real time screen study aaa (76706) |
$63 |
$126 |
0.6× |
| Us breast uni real time with image complete (76641) |
$218.75 |
$437.50 |
2.0× |
| Us chest (76604) |
$1,281 |
$2,562 |
11.5× |
| Us compl joint r-t w/image documentation (76881) |
$43 |
$86 |
0.4× |
| Us encephalogram (76506) |
$1,453 |
$2,906 |
13.0× |
| Us exam, pelvic, limited (76857) |
$1,014.50 |
$2,029 |
9.1× |
| Us guided compression repair (76936) |
$2,311 |
$4,622 |
10.0× |
| Us inft hips r-t img dynamic req phys/qhp manj (76885) |
$1,692.50 |
$3,385 |
18.2× |
| US OB Follow-Up/Repeat (76816) |
$239.50 |
$479 |
2.1× |
| Us ob transvaginal (76817) |
$314.75 |
$629.50 |
2.8× |
| Us retroperitoneal complete (76770) |
$1,756 |
$3,512 |
15.7× |
| Us retroperitoneal ltd (76775) |
$1,318 |
$2,636 |
11.8× |
| Us scrotum (76870) |
$1,604 |
$3,208 |
14.4× |
| Us soft tissue head/neck (76536) |
$1,491 |
$2,982 |
13.4× |
| Us spinal canal (76800) |
$1,293.50 |
$2,587 |
11.6× |
| Us transrectal (76872) |
$1,642.50 |
$3,285 |
14.7× |
| Venogram sinus/jugular (75860) |
$1,774.75 |
$3,549.50 |
0.5× |
| Venography adrenal unilateral selective rs&i (75840) |
$3,348.50 |
$6,697 |
1.0× |
| Venography renal unilateral selective rs&i (75831) |
$4,120.75 |
$8,241.50 |
1.2× |
| Venography, caval, inferior, with serialography, radiological supervision and interpretation Age Under 21 (75825) |
$4,070.50 |
$8,141 |
1.2× |
| Venography, caval, superior, with serialography, radiological supervision and interpretation Age Under 21 (75827) |
$4,070.50 |
$8,141 |
2.4× |
| Venography, epidural, radiological supervision and interpretation Age Under 21 (75872) |
$1,188.50 |
$2,377 |
1.8× |
| Venography, extremity, bilateral, radiological supervision and interpretation Age Under 21 (75822) |
$3,328 |
$6,656 |
2.0× |
| Venography, extremity, unilateral, radiological supervision and interpretation Age Under 21 (75820) |
$1,142.50 |
$2,285 |
0.7× |
| Venography, orbital, radiological supervision and interpretation Age Under 21 (75880) |
$1,188.50 |
$2,377 |
1.8× |
| Venous sampling thru cath w/wo angiography rs& (75893) |
$4,047.50 |
$8,095 |
0.7× |
| Venous thrombosis imaging - nm extremity veins thrombosis right (78457) |
$3,028.50 |
$6,057 |
5.2× |
| X-ray exam hips bi 3-4 views (73522) |
$978 |
$1,956 |
8.8× |
| X-ray exam of finger(s) (73140) |
$599.50 |
$1,199 |
6.5× |
| X-ray exam of knee 1 or 2 (73560) |
$621.50 |
$1,243 |
6.7× |
| X-ray exam of small bowel - fl small bowel series enteroclysis tube (74251) |
$1,732.50 |
$3,465 |
9.3× |
| X-ray exam ribs bil 3 views (71110) |
$301.50 |
$603 |
2.7× |
| X-ray exam ribs uni 2 views (71100) |
$923 |
$1,846 |
9.9× |
| X-ray heel (73650) |
$661 |
$1,322 |
7.1× |
| X-ray of joint between lower spine and hip bone 3 or more views|PROFESSIONAL COMPONENT (72202) |
$719.50 |
$1,439 |
6.5× |
| X-ray retrograde pyelogram (74420) |
$1,613.50 |
$3,227 |
4.3× |
| Xr abdomen 1 view (74018) |
$621.50 |
$1,243 |
6.7× |
| Xr abdomen 2 views (74019) |
$819 |
$1,638 |
7.3× |
| Xr arthrogram ankle (73615) |
$1,754 |
$3,508 |
4.7× |
| Xr arthrogram elbow (73085) |
$2,037.50 |
$4,075 |
5.5× |
| Xr arthrogram hip (73525) |
$2,017 |
$4,034 |
5.4× |
| Xr arthrogram knee (73580) |
$1,681.50 |
$3,363 |
4.5× |
| Xr arthrogram wrist (73115) |
$1,643 |
$3,286 |
4.4× |
| Xr bone age studies (77072) |
$661 |
$1,322 |
5.9× |
| Xr bone length study (77073) |
$878.50 |
$1,757 |
7.9× |
| Xr bone survey infant (77076) |
$814 |
$1,628 |
7.3× |
| Xr chest 1 view (71045) |
$599.50 |
$1,199 |
6.5× |
| Xr chest 2 views (71046) |
$680.50 |
$1,361 |
7.3× |
| Xr eye foreign body (70030) |
$167.50 |
$335 |
1.8× |
| Xr facial bones 3+ views (70150) |
$959 |
$1,918 |
8.6× |
| Xr foot arthritis pa only bilateral - report(ortho pro) (73620) |
$599.50 |
$1,199 |
6.5× |
| Xr forearm 2 views (73090) |
$642.50 |
$1,285 |
6.9× |
| Xr hand 2v (73120) |
$680.50 |
$1,361 |
6.1× |
| Xr hysterosalpingogram (74740) |
$935 |
$1,870 |
3.7× |
| Xr myelogram c-spine (72240) |
$3,004 |
$6,008 |
3.6× |
| Xr myelogram l-spine (72265) |
$2,889.50 |
$5,779 |
3.5× |
| Xr myelogram t-spine (72255) |
$2,845.50 |
$5,691 |
3.4× |
| Xr neck soft tissue (70360) |
$621.50 |
$1,243 |
6.7× |
| Xr o knee w/ merchant view bilat - report(ortho pro) (73562) |
$760 |
$1,520 |
8.2× |
| Xr osseous survey complete (77075) |
$794 |
$1,588 |
7.1× |
| Xr pelvis 1-2 views (72170) |
$642.50 |
$1,285 |
5.8× |
| Xr pelvis min 3 view (72190) |
$798 |
$1,596 |
7.2× |
| Xr peritoneogram (74190) |
$1,050.50 |
$2,101 |
1.8× |
| Xr sacrum/coccyx 2+ views (72220) |
$741 |
$1,482 |
8.0× |
| Xr sella turcica (70240) |
$362.50 |
$725 |
3.9× |
| Xr shoulder 1 view (73020) |
$599.50 |
$1,199 |
6.5× |
| Xr sialogram (70390) |
$1,358 |
$2,716 |
5.3× |
| Xr sinuses 3+ views (70220) |
$903 |
$1,806 |
9.7× |
| Xr skull min 4 view (70260) |
$1,077.50 |
$2,155 |
9.7× |
| Xr spine 1 view (72020) |
$680.50 |
$1,361 |
7.3× |
| Xr spine thoracic 3v (72072) |
$878.50 |
$1,757 |
7.9× |
| Xr sternum 2+ views (71120) |
$719.50 |
$1,439 |
7.8× |
| Xr surgical specimen (76098) |
$399.50 |
$799 |
0.7× |
| Xr t-spine 2 views (72070) |
$798 |
$1,596 |
7.2× |
| Xr tibia/fibula 2 views (73590) |
$680.50 |
$1,361 |
7.3× |
| Xr tmj bilateral (70330) |
$918.50 |
$1,837 |
9.9× |
| Xr tmj unilateral (70328) |
$661 |
$1,322 |
7.1× |
| Xr venogram renal bilat (75833) |
$4,898.50 |
$9,797 |
1.5× |
| Xr wrist 2 views (73100) |
$661 |
$1,322 |
7.1× |