| 3-D radiotherapy plan dose-volume histograms (77295) |
$11,554.50 |
$11,554.50 |
7.9× |
| Acute gi blood loss imaging (78278) |
$6,177 |
$6,177 |
14.6× |
| Angiography internal mammary rs&i (75756) |
$8,198.88 |
$8,198.88 |
2.5× |
| Angiography pulmonary bilateral slctv rs&i (75743) |
$15,453 |
$15,453 |
4.6× |
| Angiography visceral slctv/supraslctv rs&i (75726) |
$14,520.50 |
$14,520.50 |
2.5× |
| Angiography, adrenal, bilateral, selective, radiological supervision and interpretation Age Under 21 (75733) |
$10,810.50 |
$10,810.50 |
3.2× |
| Angiography, adrenal, unilateral, selective, radiological supervision and interpretation Age Under 21 (75731) |
$2,657.25 |
$2,657.25 |
0.8× |
| Angiography, extremity, bilateral, radiological supervision and interpretation Age Under 21 (75716) |
$14,520.50 |
$14,520.50 |
4.4× |
| Angiography, extremity, unilateral, radiological supervision and interpretation Age Under 21 (75710) |
$14,656 |
$14,656 |
4.4× |
| Angiography, pelvic, selective or supraselective, radiological supervision and interpretation Age Under 21 (75736) |
$9,048.25 |
$9,048.25 |
1.5× |
| Angiography, pulmonary, unilateral, selective, radiological supervision and interpretation Age Under 21 (75741) |
$13,175.75 |
$13,175.75 |
4.0× |
| Angiography, spinal, selective, radiological supervision and interpretation Age Under 21 (75705) |
$9,729.25 |
$9,729.25 |
1.7× |
| Angrph cath f-up std tcat other than thrombylsis (75898) |
$2,524.25 |
$2,524.25 |
0.8× |
| Angrph pulmonary nonslctv cath/ven njx rs&i (75746) |
$4,925.38 |
$4,925.38 |
1.5× |
| Ankle 2 views (73600) |
$976.50 |
$976.50 |
10.6× |
| Aortography, abdominal plus bilateral iliofemoral lower extremity, catheter, by serialography, radiological supervision… (75630) |
$16,347.88 |
$16,347.88 |
4.9× |
| Aortography, abdominal, by serialography, radiological supervision and interpretation Age Under 21 (75625) |
$14,520.50 |
$14,520.50 |
4.4× |
| Aortography, thoracic, by serialography, radiological supervision and interpretation Age Under 21 (75605) |
$14,520.50 |
$14,520.50 |
2.5× |
| Aortography, thoracic, without serialography, radiological supervision and interpretation Age Under 21 (75600) |
$10,024 |
$10,024 |
3.0× |
| Basic radiation dosimetry calculation (77300) |
$2,396 |
$2,396 |
16.9× |
| Brain imaging, minimum 4 static views; with vascular flow Age Under 21 (78606) |
$4,919.75 |
$4,919.75 |
8.6× |
| Brain imaging, positron emission tomography (PET); metabolic evaluation Age Under 21 (78608) |
$15,654.25 |
$15,654.25 |
10.4× |
| Card MRI w/stress img & dye (75563) |
$8,664.25 |
$8,664.25 |
10.5× |
| Cardiac MRI morphology & function w/o contrast (75557) |
$15,173.50 |
$15,173.50 |
60.3× |
| Cardiac MRI w/stress img (75559) |
$2,175.25 |
$2,175.25 |
3.8× |
| Cardiac MRI w/wo contrast & further seq (75561) |
$21,902.75 |
$21,902.75 |
59.5× |
| Clavicle complete (73000) |
$914.50 |
$914.50 |
10.0× |
| Complex dynamic pharyngeal and speech evaluation by cine or video recording Age Under 21 (70371) |
$825.50 |
$825.50 |
3.3× |
| Computed tomographic angiography, abdomen and pelvis, with contrast material(s), including noncontrast images, if… (74174) |
$15,599.88 |
$15,599.88 |
42.4× |
| Computed tomographic angiography, abdomen, with contrast material(s), including noncontrast images, if performed, and… (74175) |
$10,966.38 |
$10,966.38 |
59.3× |
| Computed tomographic angiography, abdominal aorta and bilateral iliofemoral lower extremity runoff, with contrast… (75635) |
$10,862.12 |
$10,862.12 |
58.7× |
| Computed tomographic angiography, chest (noncoronary), with contrast material(s), including noncontrast images, if… (71275) |
$13,160.88 |
$13,160.88 |
71.1× |
| Computed tomographic angiography, lower extremity, with contrast material(s), including noncontrast images, if… (73706) |
$9,155.25 |
$9,155.25 |
49.5× |
| Computed tomographic angiography, neck, with contrast material(s), including noncontrast images, if performed, and… (70498) |
$9,155.25 |
$9,155.25 |
49.5× |
| Computed tomographic angiography, pelvis, with contrast material(s), including noncontrast images, if performed, and… (72191) |
$9,986.75 |
$9,986.75 |
54.0× |
| Computed tomographic angiography, upper extremity, with contrast material(s), including noncontrast images, if… (73206) |
$9,682 |
$9,682 |
52.3× |
| Computed tomography, cervical spine; without contrast material, followed by contrast material(s) and further sections… (72127) |
$17,900.50 |
$17,900.50 |
96.7× |
| Computed tomography, lower extremity; without contrast material Age Under 21 (73700) |
$4,686.25 |
$4,686.25 |
42.5× |
| Computed tomography, lower extremity; without contrast material, followed by contrast material(s) and further sections… (73702) |
$17,900.50 |
$17,900.50 |
96.7× |
| Computed tomography, lumbar spine; without contrast material, followed by contrast material(s) and further sections Age… (72133) |
$17,900.50 |
$17,900.50 |
96.7× |
| Computed tomography, maxillofacial area; with contrast material(s) Age Under 21 (70487) |
$8,021.50 |
$8,021.50 |
43.4× |
| Computed tomography, maxillofacial area; without contrast material Age Under 21 (70486) |
$4,686.25 |
$4,686.25 |
42.5× |
| Computed tomography, orbit, sella, or posterior fossa or outer, middle, or inner ear; with contrast material(s) Age… (70481) |
$8,021.50 |
$8,021.50 |
43.4× |
| Computed tomography, orbit, sella, or posterior fossa or outer, middle, or inner ear; without contrast material Age… (70480) |
$4,686.25 |
$4,686.25 |
42.5× |
| Computed tomography, orbit, sella, or posterior fossa or outer, middle, or inner ear; without contrast material,… (70482) |
$17,900.50 |
$17,900.50 |
96.7× |
| Computed tomography, soft tissue neck; without contrast material followed by contrast material(s) and further sections… (70492) |
$10,186.75 |
$10,186.75 |
55.1× |
| Computed tomography, thoracic spine; without contrast material, followed by contrast material(s) and further sections… (72130) |
$12,589.50 |
$12,589.50 |
68.0× |
| Computed tomography, thorax, diagnostic; without contrast material, followed by contrast material(s) and further… (71270) |
$8,888 |
$8,888 |
48.0× |
| Continuing medical physics consultation, including assessment of treatment parameters, quality assurance of dose… (77336) |
$3,317.75 |
$3,317.75 |
23.4× |
| CT abdomen and pelvis without and with contrast (74178) |
$13,024.50 |
$13,024.50 |
35.4× |
| CT abdomen and pelvis without contrast (74176) |
$8,262 |
$8,262 |
32.8× |
| CT abdomen w & w/o contrast (74170) |
$8,888.75 |
$8,888.75 |
48.0× |
| CT abdomen w/contrast (74160) |
$6,416.75 |
$6,416.75 |
34.7× |
| CT abdomen w/o contrast (74150) |
$4,686.25 |
$4,686.25 |
42.5× |
| CT angio hrt w/3d image (75574) |
$2,567.25 |
$2,567.25 |
7.0× |
| CT cervical spine w/contrast (72126) |
$8,021.50 |
$8,021.50 |
21.8× |
| CT cervical spine w/o contrast (72125) |
$2,603.75 |
$2,603.75 |
23.6× |
| CT chest w/contrast (71260) |
$8,021.50 |
$8,021.50 |
43.4× |
| CT extremity upper w & w/o contrast (73202) |
$17,900.50 |
$17,900.50 |
96.7× |
| CT extremity upper w/o contrast (73200) |
$9,070.50 |
$9,070.50 |
82.2× |
| CT head/brain with contrast (70460) |
$8,021.50 |
$8,021.50 |
43.4× |
| CT head/brain without and with contrast (70470) |
$8,888 |
$8,888 |
48.0× |
| CT heart c+ cardiac strux&morph cgen hrt ds (75573) |
$2,567.25 |
$2,567.25 |
7.0× |
| CT heart contrast eval cardiac structure&morph (75572) |
$2,567.25 |
$2,567.25 |
7.0× |
| CT heart no contrast quant eval coronry calcium (75571) |
$300.75 |
$300.75 |
3.3× |
| CT l-spine w/contrast (72132) |
$8,021.50 |
$8,021.50 |
21.8× |
| CT limited/localized follow up study (76380) |
$2,754.62 |
$2,754.62 |
30.0× |
| CT lower extremity w/dye (73701) |
$8,021.50 |
$8,021.50 |
43.4× |
| CT lumbar spine w/o contrast (72131) |
$2,603.75 |
$2,603.75 |
23.6× |
| CT maxillofacial w/wo contrast (70488) |
$8,888 |
$8,888 |
48.0× |
| CT neck w/contrast (70491) |
$8,021.50 |
$8,021.50 |
43.4× |
| CT neck w/o contrast (70490) |
$4,686.25 |
$4,686.25 |
42.5× |
| CT pelvis w & w/o contrast (72194) |
$8,888 |
$8,888 |
48.0× |
| CT pelvis w/o contrast (72192) |
$4,686.25 |
$4,686.25 |
42.5× |
| CT thoracic spine w/contrast (72129) |
$8,021.50 |
$8,021.50 |
43.4× |
| CT thoracic spine w/o contrast (72128) |
$2,603.75 |
$2,603.75 |
23.6× |
| CT thorax lung cancer scr c- (71271) |
$610 |
$610 |
5.5× |
| CT thorax w/o contrast (71250) |
$4,686.25 |
$4,686.25 |
42.5× |
| CT upper extremity w/dye (73201) |
$12,649.50 |
$12,649.50 |
34.4× |
| CTA head w contrast (70496) |
$9,155.25 |
$9,155.25 |
49.5× |
| Cystography, minimum of 3 views, radiological supervision and interpretation Age Under 21 (74430) |
$1,702 |
$1,702 |
4.6× |
| Dacryocystography, nasolacrimal duct, radiological supervision and interpretation Age Under 21 (70170) |
$1,669.50 |
$1,669.50 |
6.6× |
| Dilation ureters/urethra rs&i (74485) |
$7,331.50 |
$7,331.50 |
3.3× |
| Diskography lumbar s&i (72295) |
$4,814.75 |
$4,814.75 |
2.3× |
| Doppler echocardiography, fetal, pulsed wave and/or continuous wave with spectral display; complete Age Under 21 (76827) |
$1,318.50 |
$1,318.50 |
12.0× |
| Doppler echocardiography, fetal, pulsed wave and/or continuous wave with spectral display; follow-up or repeat study… (76828) |
$453.75 |
$453.75 |
4.1× |
| Doppler fetal mid cerebral artery (76821) |
$1,456.50 |
$1,456.50 |
13.2× |
| Echocardiography, fetal, cardiovascular system, real time with image documentation (2D), with or without M-mode… (76825) |
$1,318.50 |
$1,318.50 |
2.3× |
| Echocardiography, fetal, cardiovascular system, real time with image documentation (2D), with or without M-mode… (76826) |
$957 |
$957 |
3.8× |
| Fetal biophys profile w/o nst (76819) |
$1,855.50 |
$1,855.50 |
16.8× |
| Fetal biophysical profile non-stress testing (76818) |
$2,960.25 |
$2,960.25 |
26.8× |
| Fluoroscopy up to 1 hour physician/qhp time (76000) |
$1,269.75 |
$1,269.75 |
5.0× |
| Gastric emptying imaging study (eg, solid, liquid, or both); with small bowel transit Age Under 21 (78265) |
$2,028 |
$2,028 |
4.8× |
| Gated heart planar single (78472) |
$8,725 |
$8,725 |
20.7× |
| Hepatc vngrph wdg/fr w/o hemodyn eval rs&i (75891) |
$10,810.50 |
$10,810.50 |
3.2× |
| Hepatic venography, wedged or free, with hemodynamic evaluation, radiological supervision and interpretation Age Under… (75889) |
$8,800.38 |
$8,800.38 |
2.6× |
| Hepatobil syst imag inc gb w/pharma intervenj (78227) |
$7,199.50 |
$7,199.50 |
12.6× |
| Hepatobiliary syst imaging including gallbladder (78226) |
$7,199.50 |
$7,199.50 |
17.1× |
| Ht muscle image spect sing (78451) |
$13,094 |
$13,094 |
9.6× |
| Intensity modulated radiotherapy plan, including dose-volume histograms for target and critical structure partial… (77301) |
$29,364.25 |
$29,364.25 |
20.1× |
| Interstitial radiation source application, complex, includes supervision, handling, loading of radiation source, when… (77778) |
$40,217 |
$40,217 |
54.7× |
| Intestine imaging (eg, ectopic gastric mucosa, Meckel's localization, volvulus) Age Under 21 (78290) |
$3,128.75 |
$3,128.75 |
7.4× |
| Intracavitary radiation source application - complex (77763) |
$17,600 |
$17,600 |
24.0× |
| Intracavitary radiation source application - intermediate (77762) |
$14,105.75 |
$14,105.75 |
24.2× |
| Intracavitary radiation source application - simple (77761) |
$10,571.75 |
$10,571.75 |
18.1× |
| Intraoperative radiation treatment delivery, electrons, single treatment session (77425) |
$21,935.50 |
$21,935.50 |
2.8× |
| Intraoperative radiation treatment delivery, x-ray, single treatment session (77424) |
$21,935.50 |
$21,935.50 |
2.8× |
| Isodose teletherapy plan complex multi tx w/cal (77307) |
$39,759 |
$39,759 |
100.7× |
| Isodose teletherapy plan simple 1 or 2 port w/cal (77306) |
$22,935.75 |
$22,935.75 |
58.1× |
| Kidney function study, non-imaging radioisotopic study Age Under 21 (78725) |
$5,692.25 |
$5,692.25 |
13.5× |
| Kidney imaging morphol - nm kidney cortex (78700) |
$7,003.75 |
$7,003.75 |
16.6× |
| Kidney imaging morphology; with vascular flow and function, multiple studies, with and without pharmacological… (78709) |
$10,609.25 |
$10,609.25 |
18.5× |
| Kidney imaging morphology; with vascular flow and function, single study without pharmacological intervention Age Under… (78707) |
$9,111.50 |
$9,111.50 |
15.9× |
| Kidney imaging morphology; with vascular flow and function, single study, with pharmacological intervention (eg,… (78708) |
$9,642 |
$9,642 |
16.8× |
| Leveen/shunt patency exam (78291) |
$2,156.50 |
$2,156.50 |
5.1× |
| Liver and spleen imaging (78215) |
$5,087.50 |
$5,087.50 |
12.1× |
| Liver imaging (78201) |
$3,147 |
$3,147 |
5.5× |
| Liver imaging with flow (78202) |
$4,919.75 |
$4,919.75 |
8.6× |
| Lung perf&ventilat diferentl (78598) |
$15,516.50 |
$15,516.50 |
27.1× |
| Lung perfusion imaging (78580) |
$4,185.25 |
$4,185.25 |
9.9× |
| Lymphangiography, extremity only, unilateral, radiological supervision and interpretation Age Under 21 (75801) |
$1,800.75 |
$1,800.75 |
2.7× |
| Lymphangiography, pelvic/abdominal, bilateral, radiological supervision and interpretation Age Under 21 (75807) |
$4,345 |
$4,345 |
1.3× |
| Lymphangiography, pelvic/abdominal, unilateral, radiological supervision and interpretation Age Under 21 (75805) |
$4,561.75 |
$4,561.75 |
1.4× |
| Magnetic resonance (eg, proton) imaging, any joint of lower extremity; without contrast material(s), followed by… (73723) |
$21,902.75 |
$21,902.75 |
59.5× |
| Magnetic resonance (eg, proton) imaging, lower extremity other than joint; with contrast material(s) Age Under 21 (73719) |
$16,251.75 |
$16,251.75 |
44.2× |
| Magnetic resonance (eg, proton) imaging, lower extremity other than joint; without contrast material(s) Age Under 21 (73718) |
$13,494.25 |
$13,494.25 |
53.6× |
| Magnetic resonance (eg, proton) imaging, lower extremity other than joint; without contrast material(s), followed by… (73720) |
$21,902.75 |
$21,902.75 |
59.5× |
| Magnetic resonance (eg, proton) imaging, orbit, face, and/or neck; with contrast material(s) Age Under 21 (70542) |
$18,119.75 |
$18,119.75 |
49.2× |
| Magnetic resonance (eg, proton) imaging, orbit, face, and/or neck; without contrast material(s) Age Under 21 (70540) |
$13,494.25 |
$13,494.25 |
53.6× |
| Magnetic resonance (eg, proton) imaging, upper extremity, other than joint; with contrast material(s) Age Under 21 (73219) |
$16,251.75 |
$16,251.75 |
44.2× |
| Magnetic resonance (eg, proton) imaging, upper extremity, other than joint; without contrast material(s), followed by… (73220) |
$21,902.75 |
$21,902.75 |
59.5× |
| Magnetic resonance angiography, head; with contrast material(s) Age Under 21 (70545) |
$12,041.50 |
$12,041.50 |
32.7× |
| Magnetic resonance angiography, head; without contrast material(s), followed by contrast material(s) and further… (70546) |
$21,902.75 |
$21,902.75 |
59.5× |
| Magnetic resonance angiography, neck; without contrast material(s), followed by contrast material(s) and further… (70549) |
$21,902.75 |
$21,902.75 |
59.5× |
| Magnetic resonance elastography (76391) |
$1,276.75 |
$1,276.75 |
5.1× |
| Mandible min 4v (70110) |
$836.50 |
$836.50 |
7.6× |
| Mr safety implant&/fb assmt clin staf 1st 15 min (76014) |
$81 |
$81 |
2.7× |
| MRA head w/o contrast (70544) |
$10,795.50 |
$10,795.50 |
42.9× |
| MRA neck w/ contrast (70548) |
$18,119.75 |
$18,119.75 |
49.2× |
| MRA neck w/o contrast (70547) |
$10,795.50 |
$10,795.50 |
42.9× |
| MRI abdomen w/contrast (74182) |
$16,755.75 |
$16,755.75 |
45.5× |
| MRI abdomen w/o contrast (74181) |
$10,795.50 |
$10,795.50 |
42.9× |
| MRI abdomen w/wo contrast (74183) |
$21,902.75 |
$21,902.75 |
59.5× |
| MRI any jt lower extrem w/contrast material (73722) |
$18,119.75 |
$18,119.75 |
21.9× |
| MRI breast c- bilateral (77047) |
$1,276.75 |
$1,276.75 |
5.1× |
| MRI breast without contrast material unilateral (77046) |
$1,276.75 |
$1,276.75 |
5.1× |
| MRI c-spine w&w/o cont (72156) |
$21,902.75 |
$21,902.75 |
59.5× |
| MRI cervical spine w/contrast (72142) |
$18,119.75 |
$18,119.75 |
49.2× |
| MRI chest w/contrast (71551) |
$15,530 |
$15,530 |
18.8× |
| MRI chest w/o contrast (71550) |
$13,494.25 |
$13,494.25 |
53.6× |
| MRI chest w/wo contrast (71552) |
$21,902.75 |
$21,902.75 |
59.5× |
| MRI fetal sngl/1st gestation (74712) |
$1,979.75 |
$1,979.75 |
7.9× |
| MRI joint upr extr w/o&w/dye (73223) |
$21,902.75 |
$21,902.75 |
59.5× |
| MRI joint upr extrem w/dye (73222) |
$17,185.75 |
$17,185.75 |
20.8× |
| MRI joint upr extrem w/o dye (73221) |
$13,494.25 |
$13,494.25 |
53.6× |
| MRI lumbar spine w/contrast (72149) |
$18,119.75 |
$18,119.75 |
49.2× |
| MRI lumbar spine w/wo contrast (72158) |
$17,521.75 |
$17,521.75 |
47.6× |
| MRI orbit/face/neck w&w/o cont (70543) |
$17,521.75 |
$17,521.75 |
47.6× |
| MRI pelvis w & w/o contrast (72197) |
$17,521.75 |
$17,521.75 |
47.6× |
| MRI pelvis w/contrast (72196) |
$19,411.75 |
$19,411.75 |
52.7× |
| MRI pelvis w/o contrast (72195) |
$13,494.25 |
$13,494.25 |
53.6× |
| MRI spectroscopy (76390) |
$7,116.75 |
$7,116.75 |
77.5× |
| MRI spine cervical w/o contrast (72141) |
$13,494.25 |
$13,494.25 |
53.6× |
| MRI t-spine w&w/o cont (72157) |
$17,521.75 |
$17,521.75 |
47.6× |
| MRI thoracic spine w/contrast (72147) |
$18,119.75 |
$18,119.75 |
49.2× |
| MRI thoracic spine w/o contrst (72146) |
$13,494.25 |
$13,494.25 |
53.6× |
| MRI tmj (70336) |
$13,494.25 |
$13,494.25 |
53.6× |
| MRI upper extremity oth than jt w/o contr matrl (73218) |
$13,494.25 |
$13,494.25 |
53.6× |
| Multi-leaf collimator (MLC) device(s) for intensity modulated radiation therapy (IMRT), design and construction per… (77338) |
$11,039.75 |
$11,039.75 |
28.0× |
| Myelography, 2 or more regions (eg, lumbar/thoracic, cervical/thoracic, lumbar/cervical, lumbar/thoracic/cervical),… (72270) |
$3,384.25 |
$3,384.25 |
4.1× |
| Myocardial spect multiple studies (78452) |
$13,094 |
$13,094 |
9.6× |
| Myocrd img PET metab eval single study (78459) |
$21,633.50 |
$21,633.50 |
15.8× |
| Myocrd img PET rst&strs CT (78431) |
$21,633.50 |
$21,633.50 |
9.3× |
| N-invas est c ffr augmnt sw alys CTA i&r phy/qhp (75580) |
$3,456.75 |
$3,456.75 |
3.8× |
| Nm bone 3 phase (78315) |
$8,198.75 |
$8,198.75 |
19.4× |
| Nm bone imaging whole body (78306) |
$11,716.75 |
$11,716.75 |
27.8× |
| Nm bone marrow ltd (78102) |
$2,157.50 |
$2,157.50 |
5.1× |
| Nm bone marrow wb (78104) |
$2,157.50 |
$2,157.50 |
5.1× |
| Nm csf cisternogram (78630) |
$10,842.50 |
$10,842.50 |
18.9× |
| Nm csf leak detection (78650) |
$4,827.25 |
$4,827.25 |
3.5× |
| Nm gastric emptying (78264) |
$7,645.75 |
$7,645.75 |
18.1× |
| Nm lung ventilation imaging (78579) |
$3,789 |
$3,789 |
9.0× |
| Nm lymph system (78195) |
$10,684.25 |
$10,684.25 |
18.7× |
| Nm myocard infarct spect (78469) |
$8,283.50 |
$8,283.50 |
14.5× |
| Non-cardiac vascular flow imaging (ie, angiography, venography) Age Under 21 (78445) |
$8,247 |
$8,247 |
19.6× |
| Nuclear medicine study of bone and/or joint limited area (78300) |
$2,181.50 |
$2,181.50 |
5.2× |
| Nuclear medicine study of bone and/or joint multiple areas (78305) |
$8,198.75 |
$8,198.75 |
19.4× |
| Nuclear medicine study of platelet survival (78191) |
$2,260.25 |
$2,260.25 |
5.4× |
| Nuclear medicine study of salivary gland with serial images (78231) |
$2,028 |
$2,028 |
4.8× |
| Ob us limited fetus(s) (76815) |
$978 |
$978 |
8.9× |
| Ob us nuchal meas 1 gest (76813) |
$1,086.25 |
$1,086.25 |
9.8× |
| Parathyrd planar w/spect&CT (78072) |
$17,264 |
$17,264 |
30.1× |
| Parathyroid planar imaging (78070) |
$8,645.50 |
$8,645.50 |
20.5× |
| Parathyroid planar imaging w/wo subtraction (78071) |
$17,264 |
$17,264 |
40.9× |
| Percutaneous transhepatic portography with hemodynamic evaluation, radiological supervision and interpretation Age… (75885) |
$10,810.50 |
$10,810.50 |
3.2× |
| Perineogram (eg, vaginogram, for sex determination or extent of anomalies) Age Under 21 (74775) |
$801 |
$801 |
3.2× |
| PET imaging CT attenuation skull base mid-thigh (78815) |
$15,654.25 |
$15,654.25 |
10.4× |
| PET imaging CT for attenuation limited area (78814) |
$15,654.25 |
$15,654.25 |
10.4× |
| PET imaging for CT attenuation whole body (78816) |
$15,654.25 |
$15,654.25 |
10.4× |
| PET imaging whole body (78813) |
$15,654.25 |
$15,654.25 |
10.4× |
| Positron emission tomography (PET) imaging; limited area (eg, chest, head/neck) Age Under 21 (78811) |
$15,654.25 |
$15,654.25 |
11.5× |
| Positron emission tomography (PET) imaging; skull base to mid-thigh Age Under 21 (78812) |
$15,654.25 |
$15,654.25 |
10.4× |
| Prq transhepatc portograpy w/o hemodyn evl intrp (75887) |
$4,263.50 |
$4,263.50 |
1.3× |
| Pulmonary ventilation & perfusion imaging (78582) |
$7,944 |
$7,944 |
13.9× |
| Quant differential pulm perfusion w/wo imaging (78597) |
$11,731 |
$11,731 |
27.8× |
| Radex abscess/fistula/sinus tract rs&i (76080) |
$2,306 |
$2,306 |
4.0× |
| Radex entir thrc lmbr crv sac spi w/skull 1 vw (72081) |
$258.50 |
$258.50 |
2.8× |
| Radex entir thrc lmbr crv sac spi w/skull 2/3 vw (72082) |
$427.25 |
$427.25 |
3.9× |
| Radex entir thrc lmbr crv sac spi w/skull 4/5 vw (72083) |
$920.50 |
$920.50 |
8.3× |
| Radex entir thrc lmbr crv sac spi w/skull 6/> vw (72084) |
$407.75 |
$407.75 |
3.7× |
| Radex hip unilateral with pelvis 1 view (73501) |
$258.50 |
$258.50 |
2.8× |
| Radex hip unilateral with pelvis 2-3 views (73502) |
$258.50 |
$258.50 |
2.8× |
| Radex hip unilateral with pelvis minimum 4 views (73503) |
$427.25 |
$427.25 |
3.9× |
| Radex hips bilateral with pelvis 2 views (73521) |
$427.25 |
$427.25 |
3.9× |
| Radex hips bilateral with pelvis minimum 5 views (73523) |
$813 |
$813 |
7.4× |
| Radex spine cervical 2 or 3 views (72040) |
$1,344.25 |
$1,344.25 |
14.6× |
| Radex spine cervical 4 or 5 views (72050) |
$1,658 |
$1,658 |
15.0× |
| Radex spine cervical 6 or more views (72052) |
$1,923 |
$1,923 |
17.4× |
| Radex spine thoracolumbar junction min 2 views (72080) |
$1,052 |
$1,052 |
11.5× |
| Radiation tx delivery lvl 1 (77402) |
$2,938 |
$2,938 |
27.3× |
| Radiation tx delivery lvl 2 (77407) |
$3,746.75 |
$3,746.75 |
9.2× |
| Radiation tx delivery lvl 3 (77412) |
$5,728.75 |
$5,728.75 |
9.8× |
| Radiologic exam abdomen 3+ views (74021) |
$465.50 |
$465.50 |
4.2× |
| Radiologic exam chest 3 views (71047) |
$1,148.50 |
$1,148.50 |
12.5× |
| Radiologic exam chest 4+ views (71048) |
$2,036.25 |
$2,036.25 |
18.5× |
| Radiologic exam colon double contrast study (74280) |
$2,496.75 |
$2,496.75 |
13.5× |
| Radiologic exam colon single contrast study (74270) |
$2,409.75 |
$2,409.75 |
13.0× |
| Radiologic exam esophagus double contrast study (74221) |
$659.75 |
$659.75 |
3.6× |
| Radiologic exam esophagus single contrast study (74220) |
$802.25 |
$802.25 |
4.3× |
| Radiologic exam small int single contrast study (74250) |
$1,224.25 |
$1,224.25 |
6.6× |
| Radiologic exam swallow function contrast study (74230) |
$1,545.50 |
$1,545.50 |
8.4× |
| Radiologic exam upr gi trc double contrast study (74246) |
$2,161.75 |
$2,161.75 |
11.7× |
| Radiologic exam upr gi trc single contrast study (74240) |
$1,892.75 |
$1,892.75 |
10.2× |
| Radiologic examination femur 1 view (73551) |
$258.50 |
$258.50 |
2.8× |
| Radiologic examination femur minimum 2 views (73552) |
$258.50 |
$258.50 |
2.8× |
| Radiologic examination from nose to rectum for foreign body, single view, child Age Under 21 (76010) |
$711 |
$711 |
7.7× |
| Radiologic examination, ankle; complete, minimum of 3 views Age Under 21 (73610) |
$1,026.50 |
$1,026.50 |
11.2× |
| Radiologic examination, complete acute abdomen series, including 2 or more views of the abdomen (eg, supine, erect,… (74022) |
$1,300.50 |
$1,300.50 |
11.8× |
| Radiologic examination, elbow; 2 views Age Under 21 (73070) |
$917 |
$917 |
10.0× |
| Radiologic examination, elbow; complete, minimum of 3 views Age Under 21 (73080) |
$1,037.25 |
$1,037.25 |
11.3× |
| Radiologic examination, facial bones; less than 3 views Age Under 21 (70140) |
$1,276.75 |
$1,276.75 |
13.9× |
| Radiologic examination, foot; complete, minimum of 3 views Age Under 21 (73630) |
$1,094.50 |
$1,094.50 |
11.9× |
| Radiologic examination, hand; minimum of 3 views Age Under 21 (73130) |
$986.25 |
$986.25 |
10.7× |
| Radiologic examination, knee; complete, 4 or more views Age Under 21 (73564) |
$1,024.25 |
$1,024.25 |
9.3× |
| Radiologic examination, mandible; partial, less than 4 views Age Under 21 (70100) |
$762.25 |
$762.25 |
8.3× |
| Radiologic examination, mastoids; complete, minimum of 3 views per side Age Under 21 (70130) |
$1,449.75 |
$1,449.75 |
13.1× |
| Radiologic examination, nasal bones, complete, minimum of 3 views Age Under 21 (70160) |
$1,138.75 |
$1,138.75 |
12.4× |
| Radiologic examination, renal cyst study, translumbar, contrast visualization, radiological supervision and… (74470) |
$3,224.75 |
$3,224.75 |
5.6× |
| Radiologic examination, ribs, bilateral; including posteroanterior chest, minimum of 4 views Age Under 21 (71111) |
$1,890.75 |
$1,890.75 |
17.1× |
| Radiologic examination, ribs, unilateral; including posteroanterior chest, minimum of 3 views Age Under 21 (71101) |
$1,809.75 |
$1,809.75 |
16.4× |
| Radiologic examination, sacroiliac joints; less than 3 views Age Under 21 (72200) |
$646 |
$646 |
5.9× |
| Radiologic examination, shoulder, arthrography, radiological supervision and interpretation Age Under 21 (73040) |
$2,435 |
$2,435 |
6.6× |
| Radiologic examination, shoulder; complete, minimum of 2 views Age Under 21 (73030) |
$1,128.25 |
$1,128.25 |
12.3× |
| Radiologic examination, sinuses, paranasal, less than 3 views Age Under 21 (70210) |
$800.50 |
$800.50 |
8.7× |
| Radiologic examination, skull; less than 4 views Age Under 21 (70250) |
$950.50 |
$950.50 |
8.6× |
| Radiologic examination, spine, lumbosacral; 2 or 3 views Age Under 21 (72100) |
$1,052 |
$1,052 |
9.5× |
| Radiologic examination, spine, lumbosacral; bending views only, 2 or 3 views Age Under 21 (72120) |
$1,128.25 |
$1,128.25 |
10.2× |
| Radiologic examination, spine, lumbosacral; complete, including bending views, minimum of 6 views Age Under 21 (72114) |
$2,913.50 |
$2,913.50 |
26.4× |
| Radiologic examination, wrist; complete, minimum of 3 views Age Under 21 (73110) |
$1,037.25 |
$1,037.25 |
11.3× |
| Radiologic examination; acromioclavicular joints, bilateral, with or without weighted distraction Age Under 21 (73050) |
$1,147.25 |
$1,147.25 |
12.5× |
| Radiologic examination; humerus, minimum of 2 views Age Under 21 (73060) |
$976.50 |
$976.50 |
10.6× |
| Radiologic examination; lower extremity, infant, minimum of 2 views Age Under 21 (73592) |
$873.50 |
$873.50 |
9.5× |
| Radiologic examination; orbits, complete, minimum of 4 views Age Under 21 (70200) |
$1,441.50 |
$1,441.50 |
13.1× |
| Radiologic examination; sternoclavicular joint or joints, minimum of 3 views Age Under 21 (71130) |
$1,128.25 |
$1,128.25 |
12.3× |
| Radiologic examination; toe(s), minimum of 2 views Age Under 21 (73660) |
$762.25 |
$762.25 |
8.3× |
| Radiologic examination; upper extremity, infant, minimum of 2 views Age Under 21 (73092) |
$873.50 |
$873.50 |
7.9× |
| Radiopharmaceutical dacryocystography Age Under 21 (78660) |
$3,319.75 |
$3,319.75 |
7.9× |
| Radiopharmaceutical localization of tumor, inflammatory process or distribution of radiopharmaceutical agent(s)… (78803) |
$12,940.75 |
$12,940.75 |
22.6× |
| Radiopharmaceutical therapy, by intravenous administration Age Under 21 (79101) |
$2,715 |
$2,715 |
11.0× |
| Radiopharmaceutical therapy, by oral administration Age Under 21 (79005) |
$2,715 |
$2,715 |
11.0× |
| Radiopharmaceutical therapy, radiolabeled monoclonal antibody by intravenous infusion (79403) |
$5,418 |
$5,418 |
22.0× |
| Review by radiologist of urinary bladder and urethra images with contrast and after passing urine (74455) |
$1,005.75 |
$1,005.75 |
4.0× |
| Rp loclzj tum plnr 1 area single day imaging (78800) |
$2,036.50 |
$2,036.50 |
4.8× |
| Rp loclzj tum plnr whole body 2+ days imaging (78804) |
$14,763.50 |
$14,763.50 |
25.8× |
| Rp loclzj tum plnr whole body single day imaging (78802) |
$10,888.25 |
$10,888.25 |
19.0× |
| Rp loclzj tum spect 2 areas (78831) |
$7,006.75 |
$7,006.75 |
5.1× |
| Rp loclzj tum spect w/CT 1 (78830) |
$7,006.75 |
$7,006.75 |
5.1× |
| Rp loclzj tum spect w/CT 2 (78832) |
$7,948.50 |
$7,948.50 |
5.3× |
| Rp therapy intra-arterial particulate admn (79445) |
$2,366.50 |
$2,366.50 |
9.6× |
| Saline infusion sonohysterography (SIS), including color flow Doppler, when performed Age Under 21 (76831) |
$3,459 |
$3,459 |
13.7× |
| Scapula complete (73010) |
$1,024.25 |
$1,024.25 |
9.3× |
| Shuntogram indwelling nonvascular shunt rs&i (75809) |
$845 |
$845 |
7.7× |
| Simulation intermediate (77285) |
$7,431.50 |
$7,431.50 |
18.8× |
| Special dosimetry (77331) |
$5,728.75 |
$5,728.75 |
40.4× |
| Special physics consult (77370) |
$6,536.25 |
$6,536.25 |
46.1× |
| Special teletherapy port plan (77321) |
$10,725 |
$10,725 |
27.2× |
| Special treatment procedure (77470) |
$11,315 |
$11,315 |
19.4× |
| Splenoportography, radiological supervision and interpretation Age Under 21 (75810) |
$4,263.50 |
$4,263.50 |
1.3× |
| Stereotactic body radiation therapy, treatment delivery, per fraction to 1 or more lesions, including image guidance,… (77373) |
$9,528.25 |
$9,528.25 |
5.1× |
| Testicular imaging with vascular flow Age Under 21 (78761) |
$5,542.50 |
$5,542.50 |
13.1× |
| Ther rad simulaj-aided field setting complex (77290) |
$5,312.12 |
$5,312.12 |
13.4× |
| Therapeutic enema, contrast or air, for reduction of intussusception or other intraluminal obstruction (eg, meconium… (74283) |
$874 |
$874 |
4.7× |
| Thyroid imaging with vascular flow (78013) |
$5,957.50 |
$5,957.50 |
14.1× |
| Thyroid met imaging body (78018) |
$5,840.50 |
$5,840.50 |
10.2× |
| Thyroid uptake single/multiple quant measurement (78012) |
$3,005 |
$3,005 |
7.1× |
| Thyroid uptake w/blood flow sngle/mult quan meas (78014) |
$5,459.50 |
$5,459.50 |
12.9× |
| Tr simulation simple (77280) |
$3,788.75 |
$3,788.75 |
26.7× |
| Treatment device complex (77334) |
$6,653.75 |
$6,653.75 |
16.8× |
| Treatment device intermediate (77333) |
$5,174.25 |
$5,174.25 |
36.5× |
| Treatment device simple (77332) |
$3,037.75 |
$3,037.75 |
21.4× |
| Ultrasound breast limited (76642) |
$2,173.25 |
$2,173.25 |
23.7× |
| Ultrasound, abdomen limited (76705) |
$2,300.50 |
$2,300.50 |
20.9× |
| Ultrasound, limited, joint or focal evaluation of other nonvascular extremity structure(s) (eg, joint space,… (76882) |
$1,269 |
$1,269 |
11.5× |
| Ultrasound, pelvic (nonobstetric), real time with image documentation; complete Age Under 21 (76856) |
$1,885.12 |
$1,885.12 |
17.1× |
| Ultrasound, pregnant uterus, real time with image documentation, fetal and maternal evaluation plus detailed fetal… (76811) |
$3,016 |
$3,016 |
12.0× |
| Ultrasound, pregnant uterus, real time with image documentation, fetal and maternal evaluation, first trimester (< 14… (76801) |
$1,271.88 |
$1,271.88 |
11.5× |
| Ultrasound, transplanted kidney, real time and duplex Doppler with image documentation Age Under 21 (76776) |
$3,556.25 |
$3,556.25 |
32.2× |
| Ultrasound, transrectal; prostate volume study for brachytherapy treatment planning (separate procedure) Age Under 21 (76873) |
$2,677.25 |
$2,677.25 |
24.3× |
| Umbilical-artery Doppler (OB) (76820) |
$1,466.50 |
$1,466.50 |
13.3× |
| Unlisted magnetic resonance procedure (eg, diagnostic, interventional) Age Under 21 (76498) |
$17,159.75 |
$17,159.75 |
186.9× |
| Urethrocystography retrograde rs&i (74450) |
$2,443.50 |
$2,443.50 |
9.7× |
| Urography (pyelography), intravenous, with or without KUB, with or without tomography Age Under 21 (74400) |
$2,424.75 |
$2,424.75 |
13.1× |
| Urography antegrade rs&i (74425) |
$2,456 |
$2,456 |
6.7× |
| Us abdominal aorta real time screen study aaa (76706) |
$499.25 |
$499.25 |
4.5× |
| Us breast uni real time with image complete (76641) |
$2,173.25 |
$2,173.25 |
19.7× |
| Us chest (76604) |
$1,633.50 |
$1,633.50 |
14.8× |
| Us compl joint r-t w/image documentation (76881) |
$1,931.50 |
$1,931.50 |
17.5× |
| Us elastography organ (76981) |
$513.25 |
$513.25 |
4.7× |
| Us encephalogram (76506) |
$2,995.75 |
$2,995.75 |
27.2× |
| Us exam, pelvic, limited (76857) |
$1,869.12 |
$1,869.12 |
16.9× |
| Us inft hips r-t img dynamic req phys/qhp manj (76885) |
$1,926 |
$1,926 |
21.0× |
| Us inft hips r-t img lmtd static phys/qhp manj (76886) |
$1,707.25 |
$1,707.25 |
18.6× |
| US OB Follow-Up/Repeat (76816) |
$1,114.50 |
$1,114.50 |
10.1× |
| Us ob transvaginal (76817) |
$3,459 |
$3,459 |
31.4× |
| Us retroperitoneal complete (76770) |
$3,019 |
$3,019 |
27.4× |
| Us retroperitoneal ltd (76775) |
$2,274.12 |
$2,274.12 |
20.6× |
| Us scrotum (76870) |
$1,781.50 |
$1,781.50 |
16.2× |
| Us soft tissue head/neck (76536) |
$2,984.62 |
$2,984.62 |
27.1× |
| Us spinal canal (76800) |
$1,372.75 |
$1,372.75 |
12.4× |
| Us transrectal (76872) |
$2,677.25 |
$2,677.25 |
24.3× |
| Use 1st target lesion (76982) |
$513.25 |
$513.25 |
4.7× |
| Venogram sinus/jugular (75860) |
$10,810.50 |
$10,810.50 |
3.2× |
| Venography adrenal unilateral selective rs&i (75840) |
$10,810.50 |
$10,810.50 |
3.2× |
| Venography renal unilateral selective rs&i (75831) |
$4,021.75 |
$4,021.75 |
1.2× |
| Venography, caval, inferior, with serialography, radiological supervision and interpretation Age Under 21 (75825) |
$14,520.50 |
$14,520.50 |
4.4× |
| Venography, caval, superior, with serialography, radiological supervision and interpretation Age Under 21 (75827) |
$4,684.88 |
$4,684.88 |
2.8× |
| Venography, extremity, bilateral, radiological supervision and interpretation Age Under 21 (75822) |
$5,741.25 |
$5,741.25 |
3.5× |
| Venography, extremity, unilateral, radiological supervision and interpretation Age Under 21 (75820) |
$4,733.25 |
$4,733.25 |
2.9× |
| Venography, superior sagittal sinus, radiological supervision and interpretation Age Under 21 (75870) |
$4,351.50 |
$4,351.50 |
1.3× |
| Venous sampling thru cath w/wo angiography rs& (75893) |
$10,343.75 |
$10,343.75 |
1.8× |
| Vertebral fracture assessment via dxa (77086) |
$710.50 |
$710.50 |
7.7× |
| Whole blood volume determination, including separate measurement of plasma volume and red cell volume… (78122) |
$8,738.75 |
$8,738.75 |
15.3× |
| X-ray exam hips bi 3-4 views (73522) |
$427.25 |
$427.25 |
3.9× |
| X-ray exam of finger(s) (73140) |
$624.50 |
$624.50 |
6.8× |
| X-ray exam of knee 1 or 2 (73560) |
$960.75 |
$960.75 |
10.5× |
| X-ray exam of small bowel - fl small bowel series enteroclysis tube (74251) |
$1,224.25 |
$1,224.25 |
6.6× |
| X-ray exam ribs bil 3 views (71110) |
$1,429.25 |
$1,429.25 |
13.0× |
| X-ray exam ribs uni 2 views (71100) |
$868.25 |
$868.25 |
9.5× |
| X-ray heel (73650) |
$814.50 |
$814.50 |
8.9× |
| X-ray retrograde pyelogram (74420) |
$2,443.50 |
$2,443.50 |
6.6× |
| Xr abdomen 1 view (74018) |
$240 |
$240 |
2.6× |
| Xr abdomen 2 views (74019) |
$465.50 |
$465.50 |
4.2× |
| Xr arthrogram ankle (73615) |
$1,716.50 |
$1,716.50 |
4.7× |
| Xr arthrogram elbow (73085) |
$1,605 |
$1,605 |
4.4× |
| Xr arthrogram hip (73525) |
$1,147.25 |
$1,147.25 |
3.1× |
| Xr arthrogram knee (73580) |
$914.50 |
$914.50 |
2.5× |
| Xr arthrogram wrist (73115) |
$1,958.50 |
$1,958.50 |
5.3× |
| Xr bone age studies (77072) |
$1,073.50 |
$1,073.50 |
9.7× |
| Xr bone length study (77073) |
$1,233 |
$1,233 |
11.2× |
| Xr bone survey infant (77076) |
$1,727.50 |
$1,727.50 |
15.7× |
| Xr bone survey ltd (77074) |
$2,830.75 |
$2,830.75 |
25.7× |
| Xr chest 1 view (71045) |
$954.75 |
$954.75 |
10.4× |
| Xr chest 2 views (71046) |
$1,018 |
$1,018 |
11.1× |
| Xr eye foreign body (70030) |
$467.75 |
$467.75 |
5.1× |
| Xr facial bones 3+ views (70150) |
$1,441.50 |
$1,441.50 |
13.1× |
| Xr foot arthritis pa only bilateral - report(ortho pro) (73620) |
$976.50 |
$976.50 |
10.6× |
| Xr forearm 2 views (73090) |
$976.50 |
$976.50 |
10.6× |
| Xr hand 2v (73120) |
$909.75 |
$909.75 |
8.2× |
| Xr hysterosalpingogram (74740) |
$1,543.25 |
$1,543.25 |
6.1× |
| Xr myelogram c-spine (72240) |
$2,305.75 |
$2,305.75 |
2.8× |
| Xr myelogram l-spine (72265) |
$3,371.50 |
$3,371.50 |
4.1× |
| Xr myelogram t-spine (72255) |
$3,004.50 |
$3,004.50 |
3.6× |
| Xr neck soft tissue (70360) |
$1,260 |
$1,260 |
13.7× |
| Xr o knee w/ merchant view bilat - report(ortho pro) (73562) |
$1,024.25 |
$1,024.25 |
11.2× |
| Xr osseous survey complete (77075) |
$4,936.50 |
$4,936.50 |
44.8× |
| Xr pelvis 1-2 views (72170) |
$762.25 |
$762.25 |
6.9× |
| Xr pelvis min 3 view (72190) |
$960.75 |
$960.75 |
8.7× |
| Xr peritoneogram (74190) |
$1,980 |
$1,980 |
3.4× |
| Xr sacrum/coccyx 2+ views (72220) |
$696.75 |
$696.75 |
7.6× |
| Xr shoulder 1 view (73020) |
$762.25 |
$762.25 |
8.3× |
| Xr sialogram (70390) |
$1,429.25 |
$1,429.25 |
5.7× |
| Xr sinuses 3+ views (70220) |
$1,545.50 |
$1,545.50 |
16.8× |
| Xr skull min 4 view (70260) |
$1,497 |
$1,497 |
13.6× |
| Xr spine 1 view (72020) |
$940.25 |
$940.25 |
10.2× |
| Xr spine thoracic 3v (72072) |
$940.25 |
$940.25 |
8.5× |
| Xr sternum 2+ views (71120) |
$960.75 |
$960.75 |
10.5× |
| Xr stress view joint (77071) |
$579.75 |
$579.75 |
6.3× |
| Xr surgical specimen (76098) |
$598.75 |
$598.75 |
1.0× |
| Xr t-spine 2 views (72070) |
$859.50 |
$859.50 |
7.8× |
| Xr tibia/fibula 2 views (73590) |
$960.75 |
$960.75 |
10.5× |
| Xr tmj bilateral (70330) |
$1,170.25 |
$1,170.25 |
12.7× |
| Xr venogram renal bilat (75833) |
$7,425.25 |
$7,425.25 |
2.2× |
| Xr wrist 2 views (73100) |
$960.75 |
$960.75 |
10.5× |