| 3-D radiotherapy plan dose-volume histograms (77295) |
$6,629.02 |
$16,572.55 |
4.5× |
| Acute gi blood loss imaging (78278) |
$719.82 |
$1,799.53 |
1.7× |
| Angiography pulmonary bilateral slctv rs&i (75743) |
$2,563.76 |
$6,409.39 |
0.8× |
Angiography visceral slctv/supraslctv rs&i (75726)
unusually low — confirm this is the full procedure |
$2,795.64 |
$6,989.10 |
0.5× |
| Angiography, extremity, bilateral, radiological supervision and interpretation Age Under 21 (75716) |
$4,590.14 |
$11,475.34 |
1.4× |
| Angiography, extremity, unilateral, radiological supervision and interpretation Age Under 21 (75710) |
$2,295.08 |
$5,737.69 |
0.7× |
| Angiography, pulmonary, unilateral, selective, radiological supervision and interpretation Age Under 21 (75741) |
$1,608.06 |
$4,020.15 |
0.5× |
| Angrph cath f-up std tcat other than thrombylsis (75898) |
$976.83 |
$2,442.06 |
0.3× |
| Ankle 2 views (73600) |
$282.68 |
$706.68 |
3.1× |
| Aortography, abdominal plus bilateral iliofemoral lower extremity, catheter, by serialography, radiological supervision… (75630) |
$2,563.76 |
$6,409.39 |
0.8× |
| Aortography, abdominal, by serialography, radiological supervision and interpretation Age Under 21 (75625) |
$2,563.76 |
$6,409.39 |
0.8× |
Aortography, thoracic, by serialography, radiological supervision and interpretation Age Under 21 (75605)
unusually low — confirm this is the full procedure |
$2,795.64 |
$6,989.10 |
0.5× |
| Basic radiation dosimetry calculation (77300) |
$287.06 |
$717.64 |
2.0× |
| Brain imaging, less than 4 static views; with vascular flow Age Under 21 (78601) |
$545.67 |
$1,364.16 |
1.3× |
| Brain imaging, minimum 4 static views; with vascular flow Age Under 21 (78606) |
$660.17 |
$1,650.42 |
1.2× |
| Brain imaging, positron emission tomography (PET); metabolic evaluation Age Under 21 (78608) |
$4,169.52 |
$10,423.80 |
2.8× |
| Cardiac MRI morphology & function w/o contrast (75557) |
$2,177.48 |
$5,443.68 |
8.7× |
| Cineradiography/videoradiography (76120) |
$199.05 |
$497.62 |
1.8× |
| Clavicle complete (73000) |
$281.90 |
$704.76 |
3.1× |
| Computed tomographic angiography, abdomen and pelvis, with contrast material(s), including noncontrast images, if… (74174) |
$5,913.57 |
$14,783.92 |
16.1× |
| Computed tomographic angiography, abdomen, with contrast material(s), including noncontrast images, if performed, and… (74175) |
$2,956.79 |
$7,391.97 |
16.0× |
| Computed tomographic angiography, abdominal aorta and bilateral iliofemoral lower extremity runoff, with contrast… (75635) |
$2,956.79 |
$7,391.97 |
16.0× |
| Computed tomographic angiography, chest (noncoronary), with contrast material(s), including noncontrast images, if… (71275) |
$2,956.79 |
$7,391.97 |
16.0× |
| Computed tomographic angiography, lower extremity, with contrast material(s), including noncontrast images, if… (73706) |
$3,400.30 |
$8,500.76 |
18.4× |
| Computed tomographic angiography, neck, with contrast material(s), including noncontrast images, if performed, and… (70498) |
$2,075.24 |
$5,188.08 |
11.2× |
| Computed tomographic angiography, pelvis, with contrast material(s), including noncontrast images, if performed, and… (72191) |
$2,956.79 |
$7,391.97 |
16.0× |
| Computed tomographic angiography, upper extremity, with contrast material(s), including noncontrast images, if… (73206) |
$2,956.79 |
$7,391.97 |
16.0× |
| Computed tomography, cervical spine; without contrast material, followed by contrast material(s) and further sections… (72127) |
$2,896.21 |
$7,240.52 |
15.7× |
| Computed tomography, lower extremity; without contrast material Age Under 21 (73700) |
$1,950.65 |
$4,876.61 |
17.7× |
| Computed tomography, lower extremity; without contrast material, followed by contrast material(s) and further sections… (73702) |
$3,449.70 |
$8,624.23 |
18.6× |
| Computed tomography, lumbar spine; without contrast material, followed by contrast material(s) and further sections Age… (72133) |
$2,896.21 |
$7,240.52 |
15.7× |
| Computed tomography, maxillofacial area; with contrast material(s) Age Under 21 (70487) |
$1,811.08 |
$4,527.70 |
9.8× |
| Computed tomography, maxillofacial area; without contrast material Age Under 21 (70486) |
$1,190.50 |
$2,976.25 |
10.8× |
| Computed tomography, orbit, sella, or posterior fossa or outer, middle, or inner ear; with contrast material(s) Age… (70481) |
$1,811.08 |
$4,527.70 |
9.8× |
| Computed tomography, orbit, sella, or posterior fossa or outer, middle, or inner ear; without contrast material Age… (70480) |
$1,190.50 |
$2,976.25 |
10.8× |
| Computed tomography, orbit, sella, or posterior fossa or outer, middle, or inner ear; without contrast material,… (70482) |
$1,608.25 |
$4,020.61 |
8.7× |
| Computed tomography, soft tissue neck; without contrast material followed by contrast material(s) and further sections… (70492) |
$2,032.72 |
$5,081.78 |
11.0× |
| Computed tomography, thoracic spine; without contrast material, followed by contrast material(s) and further sections… (72130) |
$2,896.21 |
$7,240.52 |
15.7× |
| Computed tomography, thorax, diagnostic; without contrast material, followed by contrast material(s) and further… (71270) |
$2,078.69 |
$5,196.72 |
11.2× |
| Continuing medical physics consultation, including assessment of treatment parameters, quality assurance of dose… (77336) |
$586.41 |
$1,466.01 |
4.1× |
| Csf shunt evaluation (78645) |
$666.70 |
$1,666.73 |
1.2× |
| CT abdomen and pelvis without and with contrast (74178) |
$2,732.50 |
$6,831.25 |
7.4× |
| CT abdomen and pelvis without contrast (74176) |
$1,639.51 |
$4,098.76 |
6.5× |
| CT abdomen w & w/o contrast (74170) |
$2,595.89 |
$6,489.71 |
14.0× |
| CT abdomen w/contrast (74160) |
$2,494.08 |
$6,235.18 |
13.5× |
| CT abdomen w/o contrast (74150) |
$1,592.14 |
$3,980.33 |
14.4× |
| CT angio hrt w/3d image (75574) |
$2,338.10 |
$5,845.23 |
6.4× |
| CT cervical spine w/contrast (72126) |
$2,580.42 |
$6,451.04 |
7.0× |
| CT cervical spine w/o contrast (72125) |
$1,696.22 |
$4,240.53 |
15.4× |
| CT chest w/contrast (71260) |
$2,580.42 |
$6,451.04 |
13.9× |
| CT extremity upper w & w/o contrast (73202) |
$3,202.54 |
$8,006.36 |
17.3× |
| CT extremity upper w/o contrast (73200) |
$1,950.65 |
$4,876.61 |
17.7× |
| CT head/brain with contrast (70460) |
$1,811.08 |
$4,527.70 |
9.8× |
| CT head/brain without and with contrast (70470) |
$2,032.72 |
$5,081.78 |
11.0× |
| CT heart contrast eval cardiac structure&morph (75572) |
$1,281.62 |
$3,204.03 |
3.5× |
| CT heart no contrast quant eval coronry calcium (75571) |
$515.01 |
$1,287.52 |
5.6× |
| CT l-spine w/contrast (72132) |
$2,580.42 |
$6,451.04 |
7.0× |
| CT limited/localized follow up study (76380) |
$1,696.22 |
$4,240.53 |
18.5× |
| CT lower extremity w/dye (73701) |
$2,378.44 |
$5,946.10 |
12.9× |
| CT lumbar spine w/o contrast (72131) |
$1,696.22 |
$4,240.53 |
15.4× |
| CT maxillofacial w/wo contrast (70488) |
$1,458.63 |
$3,646.57 |
7.9× |
| CT neck w/contrast (70491) |
$1,811.08 |
$4,527.70 |
9.8× |
| CT neck w/o contrast (70490) |
$1,190.50 |
$2,976.25 |
10.8× |
| CT pelvis w & w/o contrast (72194) |
$2,896.21 |
$7,240.52 |
15.7× |
| CT pelvis w/o contrast (72192) |
$1,613.23 |
$4,033.07 |
14.6× |
| CT thoracic spine w/contrast (72129) |
$2,723.48 |
$6,808.68 |
14.7× |
| CT thoracic spine w/o contrast (72128) |
$1,696.22 |
$4,240.53 |
15.4× |
| CT thorax lung cancer scr c- (71271) |
$266.46 |
$666.13 |
2.4× |
| CT thorax w/o contrast (71250) |
$1,696.22 |
$4,240.53 |
15.4× |
| CT upper extremity w/dye (73201) |
$2,967.48 |
$7,418.70 |
8.1× |
| CTA head w contrast (70496) |
$2,075.24 |
$5,188.08 |
11.2× |
| Cystography, minimum of 3 views, radiological supervision and interpretation Age Under 21 (74430) |
$797.26 |
$1,993.14 |
2.2× |
| Dilation ureters/urethra rs&i (74485) |
$1,343.20 |
$3,358 |
0.6× |
| Diskography lumbar s&i (72295) |
$1,071.71 |
$2,679.26 |
0.5× |
| Doppler fetal mid cerebral artery (76821) |
$400.90 |
$1,002.25 |
3.6× |
| Dual-energy X-ray absorptiometry (DXA), bone density study, 1 or more sites; axial skeleton (eg, hips, pelvis, spine)… (77080) |
$411.73 |
$1,029.31 |
3.7× |
| Dxa bone density study axial skeleton (77085) |
$495.58 |
$1,238.94 |
4.5× |
| Dxa bone density/peripheral (77081) |
$344.53 |
$861.31 |
3.8× |
| Fetal biophys profile w/o nst (76819) |
$607.09 |
$1,517.71 |
5.5× |
| Fetal biophysical profile non-stress testing (76818) |
$185.56 |
$463.89 |
1.7× |
| Fluoroscopy up to 1 hour physician/qhp time (76000) |
$262.28 |
$655.70 |
1.0× |
| Gastric emptying imaging study (eg, solid, liquid, or both); with small bowel and colon transit, multiple days Age… (78266) |
$1,047.74 |
$2,619.33 |
1.8× |
| Gastric emptying imaging study (eg, solid, liquid, or both); with small bowel transit Age Under 21 (78265) |
$838.19 |
$2,095.46 |
2.0× |
| Gated heart planar single (78472) |
$1,199.11 |
$2,997.76 |
2.8× |
| Hdr rdncl ntrstl/intrcav brachytx 1 channel (77770) |
$1,014.08 |
$2,535.18 |
1.4× |
| Hdr rdncl ntrstl/intrcav brachytx 2-12 channel (77771) |
$1,387.57 |
$3,468.91 |
1.9× |
| Hdr rdncl ntrstl/intrcav brachytx >12 channels (77772) |
$2,341.10 |
$5,852.75 |
3.2× |
| Hepatobil syst imag inc gb w/pharma intervenj (78227) |
$1,056.55 |
$2,641.37 |
1.8× |
| Hepatobiliary syst imaging including gallbladder (78226) |
$960.49 |
$2,401.22 |
2.3× |
| Ht muscle image spect sing (78451) |
$2,402.15 |
$6,005.37 |
1.8× |
| Intensity modulated radiotherapy plan, including dose-volume histograms for target and critical structure partial… (77301) |
$5,471.87 |
$13,679.67 |
3.7× |
| Interstitial radiation source application, complex, includes supervision, handling, loading of radiation source, when… (77778) |
$877.08 |
$2,192.70 |
1.2× |
| Intestine imaging (eg, ectopic gastric mucosa, Meckel's localization, volvulus) Age Under 21 (78290) |
$698.50 |
$1,746.23 |
1.7× |
| Isodose brachytherapy complex 10+ sources (77318) |
$984.04 |
$2,460.08 |
2.5× |
| Isodose brachytherapy intermed 5 to 10 sources (77317) |
$774.04 |
$1,935.08 |
2.0× |
| Isodose brachytherapy plan simple 1 to 4 source (77316) |
$487 |
$1,217.48 |
1.2× |
| Isodose teletherapy plan complex multi tx w/cal (77307) |
$524.97 |
$1,312.42 |
1.3× |
| Isodose teletherapy plan simple 1 or 2 port w/cal (77306) |
$336.28 |
$840.70 |
0.9× |
| Kidney imaging morphology; with vascular flow Age Under 21 (78701) |
$583.32 |
$1,458.28 |
1.4× |
| Kidney imaging morphology; with vascular flow and function, single study without pharmacological intervention Age Under… (78707) |
$1,090.06 |
$2,725.13 |
1.9× |
| Kidney imaging morphology; with vascular flow and function, single study, with pharmacological intervention (eg,… (78708) |
$963.38 |
$2,408.44 |
1.7× |
| Liver and spleen imaging (78215) |
$648.40 |
$1,620.98 |
1.5× |
| Lung perf&ventilat diferentl (78598) |
$1,166.53 |
$2,916.32 |
2.0× |
| Lung perfusion imaging (78580) |
$644.37 |
$1,610.92 |
1.5× |
| Magnetic resonance (eg, proton) imaging, any joint of lower extremity; without contrast material(s), followed by… (73723) |
$5,008.70 |
$12,521.75 |
13.6× |
| Magnetic resonance (eg, proton) imaging, lower extremity other than joint; with contrast material(s) Age Under 21 (73719) |
$4,549.53 |
$11,373.80 |
12.4× |
| Magnetic resonance (eg, proton) imaging, lower extremity other than joint; without contrast material(s) Age Under 21 (73718) |
$4,097.12 |
$10,242.80 |
16.3× |
| Magnetic resonance (eg, proton) imaging, lower extremity other than joint; without contrast material(s), followed by… (73720) |
$4,971.90 |
$12,429.72 |
13.5× |
| Magnetic resonance (eg, proton) imaging, orbit, face, and/or neck; with contrast material(s) Age Under 21 (70542) |
$2,591.40 |
$6,478.48 |
7.0× |
| Magnetic resonance (eg, proton) imaging, orbit, face, and/or neck; without contrast material(s) Age Under 21 (70540) |
$2,518.24 |
$6,295.59 |
10.0× |
| Magnetic resonance (eg, proton) imaging, upper extremity, other than joint; with contrast material(s) Age Under 21 (73219) |
$3,390.46 |
$8,476.14 |
9.2× |
| Magnetic resonance (eg, proton) imaging, upper extremity, other than joint; without contrast material(s), followed by… (73220) |
$4,971.90 |
$12,429.72 |
13.5× |
| Magnetic resonance angiography, head; with contrast material(s) Age Under 21 (70545) |
$2,591.40 |
$6,478.48 |
7.0× |
| Magnetic resonance angiography, head; without contrast material(s), followed by contrast material(s) and further… (70546) |
$3,682.49 |
$9,206.22 |
10.0× |
| Magnetic resonance angiography, neck; without contrast material(s), followed by contrast material(s) and further… (70549) |
$3,578.74 |
$8,946.83 |
9.7× |
| Mammary ductogram or galactogram, multiple ducts, radiological supervision and interpretation Age Under 21 (77054) |
$593.71 |
$1,484.26 |
2.4× |
| Mammary ductogram single (77053) |
$516.37 |
$1,290.91 |
2.1× |
| Mandible min 4v (70110) |
$432.62 |
$1,081.54 |
3.9× |
| Med physic dos eval rad exps (76145) |
$474.12 |
$1,185.28 |
1.2× |
| Mr safety determination physician/other qhp (76016) |
$551.20 |
$1,378 |
6.0× |
| Mr safety implant pos&/immoblj supvj phys/qhp (76019) |
$551.20 |
$1,378 |
8.9× |
| Mr safety implant&/fb assmt clin staf 1st 15 min (76014) |
$551.20 |
$1,378 |
18.1× |
| Mr safety implt electronics prepj supvj phys/qhp (76018) |
$551.20 |
$1,378 |
5.5× |
| Mr safety med physics xm customization plng&mntr (76017) |
$551.20 |
$1,378 |
2.2× |
| MRA head w/o contrast (70544) |
$2,927.40 |
$7,318.50 |
11.6× |
| MRA neck w/ contrast (70548) |
$3,250.65 |
$8,126.62 |
8.8× |
| MRA neck w/o contrast (70547) |
$1,853.34 |
$4,633.33 |
7.4× |
| MRI abdomen w/contrast (74182) |
$3,033.02 |
$7,582.53 |
8.2× |
| MRI abdomen w/o contrast (74181) |
$2,731.42 |
$6,828.53 |
10.9× |
| MRI abdomen w/wo contrast (74183) |
$3,339.14 |
$8,347.84 |
9.1× |
| MRI any jt lower extrem w/contrast material (73722) |
$4,549.53 |
$11,373.80 |
5.5× |
| MRI breast c- bilateral (77047) |
$2,390.83 |
$5,977.07 |
9.5× |
| MRI c-spine w&w/o cont (72156) |
$3,339.14 |
$8,347.84 |
9.1× |
| MRI cervical spine w/contrast (72142) |
$2,702.68 |
$6,756.70 |
7.3× |
| MRI chest w/contrast (71551) |
$3,033.02 |
$7,582.53 |
3.7× |
| MRI chest w/o contrast (71550) |
$2,731.42 |
$6,828.53 |
10.9× |
| MRI chest w/wo contrast (71552) |
$3,339.14 |
$8,347.84 |
9.1× |
| MRI joint upr extr w/o&w/dye (73223) |
$5,008.70 |
$12,521.75 |
13.6× |
| MRI joint upr extrem w/dye (73222) |
$4,549.53 |
$11,373.80 |
5.5× |
| MRI joint upr extrem w/o dye (73221) |
$3,669.18 |
$9,172.94 |
14.6× |
| MRI lumbar spine w/contrast (72149) |
$3,033.02 |
$7,582.53 |
8.2× |
| MRI lumbar spine w/wo contrast (72158) |
$3,339.14 |
$8,347.84 |
9.1× |
| MRI orbit/face/neck w&w/o cont (70543) |
$2,906.84 |
$7,267.10 |
7.9× |
| MRI pelvis w & w/o contrast (72197) |
$3,339.14 |
$8,347.84 |
9.1× |
| MRI pelvis w/contrast (72196) |
$3,033.02 |
$7,582.53 |
8.2× |
| MRI pelvis w/o contrast (72195) |
$2,731.42 |
$6,828.53 |
10.9× |
| MRI spine cervical w/o contrast (72141) |
$2,731.42 |
$6,828.53 |
10.9× |
| MRI t-spine w&w/o cont (72157) |
$3,339.14 |
$8,347.84 |
9.1× |
| MRI thoracic spine w/contrast (72147) |
$2,417.91 |
$6,044.77 |
6.6× |
| MRI thoracic spine w/o contrst (72146) |
$2,731.42 |
$6,828.53 |
10.9× |
| MRI tmj (70336) |
$4,097.12 |
$10,242.80 |
16.3× |
| MRI upper extremity oth than jt w/o contr matrl (73218) |
$4,097.12 |
$10,242.80 |
16.3× |
| Multi-leaf collimator (MLC) device(s) for intensity modulated radiation therapy (IMRT), design and construction per… (77338) |
$1,628.51 |
$4,071.26 |
4.1× |
| Myelography, 2 or more regions (eg, lumbar/thoracic, cervical/thoracic, lumbar/cervical, lumbar/thoracic/cervical),… (72270) |
$843.24 |
$2,108.10 |
1.0× |
| Myocardial spect multiple studies (78452) |
$2,115.62 |
$5,289.03 |
1.5× |
| N-invas est c ffr augmnt sw alys CTA i&r phy/qhp (75580) |
$6,757.89 |
$16,894.71 |
7.5× |
| Nm bone 3 phase (78315) |
$973.17 |
$2,432.91 |
2.3× |
| Nm bone imaging whole body (78306) |
$853.97 |
$2,134.92 |
2.0× |
| Nm csf cisternogram (78630) |
$712.30 |
$1,780.73 |
1.2× |
| Nm csf leak detection (78650) |
$712.30 |
$1,780.73 |
0.5× |
| Nm gastric emptying (78264) |
$698.50 |
$1,746.23 |
1.7× |
| Nm lung ventilation imaging (78579) |
$729.25 |
$1,823.12 |
1.7× |
| Nm lymph system (78195) |
$698.50 |
$1,746.23 |
1.2× |
| Nuclear medicine study of bone and/or joint limited area (78300) |
$753.78 |
$1,884.44 |
1.8× |
| Nuclear medicine study of bone and/or joint multiple areas (78305) |
$733.81 |
$1,834.52 |
1.7× |
| Nuclear medicine study of heart pumping function by labeling red blood cells with measurement of internal blood volume… (78494) |
$921.92 |
$2,304.78 |
2.2× |
| Ob us limited fetus(s) (76815) |
$376.37 |
$940.91 |
3.4× |
| Ob us nuchal meas 1 gest (76813) |
$381.53 |
$953.81 |
3.5× |
| Ophthalmic ultrasound, diagnostic; B-scan (with or without superimposed non-quantitative A-scan) Age Under 21 (76512) |
$785.41 |
$1,963.52 |
7.1× |
| Parathyrd planar w/spect&CT (78072) |
$1,949.34 |
$4,873.33 |
3.4× |
| Parathyroid planar imaging (78070) |
$553.96 |
$1,384.88 |
1.3× |
| Parathyroid planar imaging w/wo subtraction (78071) |
$2,136.22 |
$5,340.54 |
5.1× |
| PET imaging CT attenuation skull base mid-thigh (78815) |
$4,928.82 |
$12,322.05 |
3.3× |
| PET imaging for CT attenuation whole body (78816) |
$5,273.84 |
$13,184.59 |
3.5× |
| Pulmonary ventilation & perfusion imaging (78582) |
$1,030.76 |
$2,576.88 |
1.8× |
| Quant differential pulm perfusion w/wo imaging (78597) |
$1,030.76 |
$2,576.88 |
2.4× |
| Radex abscess/fistula/sinus tract rs&i (76080) |
$511.68 |
$1,279.19 |
0.9× |
| Radex entir thrc lmbr crv sac spi w/skull 1 vw (72081) |
$204.84 |
$512.09 |
2.2× |
| Radex entir thrc lmbr crv sac spi w/skull 2/3 vw (72082) |
$245.81 |
$614.51 |
2.2× |
| Radex entir thrc lmbr crv sac spi w/skull 4/5 vw (72083) |
$341.44 |
$853.60 |
3.1× |
| Radex entir thrc lmbr crv sac spi w/skull 6/> vw (72084) |
$484.96 |
$1,212.39 |
4.4× |
| Radex hip unilateral with pelvis 1 view (73501) |
$245.81 |
$614.51 |
2.7× |
| Radex hip unilateral with pelvis 2-3 views (73502) |
$307.27 |
$768.17 |
3.3× |
| Radex hip unilateral with pelvis minimum 4 views (73503) |
$360.52 |
$901.29 |
3.3× |
| Radex hips bilateral with pelvis 2 views (73521) |
$471.72 |
$1,179.29 |
4.3× |
| Radex hips bilateral with pelvis minimum 5 views (73523) |
$679.27 |
$1,698.17 |
6.2× |
| Radex spine cervical 2 or 3 views (72040) |
$310.62 |
$776.53 |
3.4× |
| Radex spine cervical 4 or 5 views (72050) |
$360.52 |
$901.29 |
3.3× |
| Radex spine cervical 6 or more views (72052) |
$377.98 |
$944.94 |
3.4× |
| Radex spine thoracolumbar junction min 2 views (72080) |
$245.81 |
$614.51 |
2.7× |
| Radiation treatment delivery, stereotactic radiosurgery (SRS), complete course of treatment of cranial lesion(s)… (77372) |
$11,065.01 |
$27,662.51 |
1.4× |
| Radiation tx delivery lvl 1 (77402) |
$361.32 |
$903.29 |
3.4× |
| Radiation tx delivery lvl 2 (77407) |
$475.94 |
$1,189.83 |
1.2× |
| Radiation tx delivery lvl 3 (77412) |
$551.68 |
$1,379.19 |
0.9× |
| Radiologic exam abdomen 3+ views (74021) |
$235.05 |
$587.61 |
2.1× |
| Radiologic exam chest 3 views (71047) |
$266.32 |
$665.79 |
2.9× |
| Radiologic exam chest 4+ views (71048) |
$337.15 |
$842.86 |
3.1× |
| Radiologic exam colon double contrast study (74280) |
$743.20 |
$1,857.98 |
4.0× |
| Radiologic exam colon single contrast study (74270) |
$508.44 |
$1,271.10 |
2.7× |
| Radiologic exam esophagus double contrast study (74221) |
$485.04 |
$1,212.59 |
2.6× |
| Radiologic exam esophagus single contrast study (74220) |
$508.44 |
$1,271.10 |
2.7× |
| Radiologic exam small int single contrast study (74250) |
$629.94 |
$1,574.83 |
3.4× |
| Radiologic exam swallow function contrast study (74230) |
$508.44 |
$1,271.10 |
2.7× |
| Radiologic exam upr gi trc double contrast study (74246) |
$508.44 |
$1,271.10 |
2.7× |
| Radiologic exam upr gi trc single contrast study (74240) |
$457.60 |
$1,143.98 |
2.5× |
| Radiologic examination femur 1 view (73551) |
$189.67 |
$474.16 |
2.1× |
| Radiologic examination femur minimum 2 views (73552) |
$262.73 |
$656.80 |
2.9× |
| Radiologic examination from nose to rectum for foreign body, single view, child Age Under 21 (76010) |
$247.73 |
$619.32 |
2.7× |
| Radiologic examination, ankle; complete, minimum of 3 views Age Under 21 (73610) |
$282.68 |
$706.68 |
3.1× |
| Radiologic examination, complete acute abdomen series, including 2 or more views of the abdomen (eg, supine, erect,… (74022) |
$414.33 |
$1,035.81 |
3.8× |
| Radiologic examination, elbow; 2 views Age Under 21 (73070) |
$242.28 |
$605.69 |
2.6× |
| Radiologic examination, elbow; complete, minimum of 3 views Age Under 21 (73080) |
$282.68 |
$706.68 |
3.1× |
| Radiologic examination, facial bones; less than 3 views Age Under 21 (70140) |
$227.62 |
$569.04 |
2.5× |
| Radiologic examination, foot; complete, minimum of 3 views Age Under 21 (73630) |
$282.68 |
$706.68 |
3.1× |
| Radiologic examination, hand; minimum of 3 views Age Under 21 (73130) |
$282.68 |
$706.68 |
3.1× |
| Radiologic examination, knee; both knees, standing, anteroposterior Age Under 21 (73565) |
$368.72 |
$921.78 |
4.0× |
| Radiologic examination, knee; complete, 4 or more views Age Under 21 (73564) |
$408.48 |
$1,021.20 |
3.7× |
| Radiologic examination, mandible; partial, less than 4 views Age Under 21 (70100) |
$245.81 |
$614.51 |
2.7× |
| Radiologic examination, mastoids; complete, minimum of 3 views per side Age Under 21 (70130) |
$245.81 |
$614.51 |
2.2× |
| Radiologic examination, nasal bones, complete, minimum of 3 views Age Under 21 (70160) |
$245.81 |
$614.51 |
2.7× |
| Radiologic examination, renal cyst study, translumbar, contrast visualization, radiological supervision and… (74470) |
$799.43 |
$1,998.57 |
1.4× |
| Radiologic examination, ribs, bilateral; including posteroanterior chest, minimum of 4 views Age Under 21 (71111) |
$540.77 |
$1,351.92 |
4.9× |
| Radiologic examination, ribs, unilateral; including posteroanterior chest, minimum of 3 views Age Under 21 (71101) |
$245.81 |
$614.51 |
2.2× |
| Radiologic examination, sacroiliac joints; less than 3 views Age Under 21 (72200) |
$245.81 |
$614.51 |
2.2× |
| Radiologic examination, shoulder, arthrography, radiological supervision and interpretation Age Under 21 (73040) |
$660.35 |
$1,650.87 |
1.8× |
| Radiologic examination, shoulder; complete, minimum of 2 views Age Under 21 (73030) |
$282.68 |
$706.68 |
3.1× |
| Radiologic examination, sinuses, paranasal, less than 3 views Age Under 21 (70210) |
$245.81 |
$614.51 |
2.7× |
| Radiologic examination, skull; less than 4 views Age Under 21 (70250) |
$245.81 |
$614.51 |
2.2× |
| Radiologic examination, spine, lumbosacral; 2 or 3 views Age Under 21 (72100) |
$342.32 |
$855.80 |
3.1× |
| Radiologic examination, spine, lumbosacral; bending views only, 2 or 3 views Age Under 21 (72120) |
$385.56 |
$963.89 |
3.5× |
| Radiologic examination, spine, lumbosacral; complete, including bending views, minimum of 6 views Age Under 21 (72114) |
$425.65 |
$1,064.11 |
3.9× |
| Radiologic examination, spine; thoracic, minimum of 4 views Age Under 21 (72074) |
$411.48 |
$1,028.70 |
3.7× |
| Radiologic examination, wrist; complete, minimum of 3 views Age Under 21 (73110) |
$282.68 |
$706.68 |
3.1× |
| Radiologic examination; acromioclavicular joints, bilateral, with or without weighted distraction Age Under 21 (73050) |
$487.62 |
$1,219.05 |
5.3× |
| Radiologic examination; humerus, minimum of 2 views Age Under 21 (73060) |
$294.25 |
$735.62 |
3.2× |
| Radiologic examination; lower extremity, infant, minimum of 2 views Age Under 21 (73592) |
$340.81 |
$852.02 |
3.7× |
| Radiologic examination; orbits, complete, minimum of 4 views Age Under 21 (70200) |
$369.90 |
$924.74 |
3.4× |
| Radiologic examination; sternoclavicular joint or joints, minimum of 3 views Age Under 21 (71130) |
$245.81 |
$614.51 |
2.7× |
| Radiologic examination; toe(s), minimum of 2 views Age Under 21 (73660) |
$282.68 |
$706.68 |
3.1× |
| Radiologic examination; upper extremity, infant, minimum of 2 views Age Under 21 (73092) |
$282.09 |
$705.21 |
2.6× |
| Radiopharmaceutical localization of tumor, inflammatory process or distribution of radiopharmaceutical agent(s)… (78803) |
$1,148.50 |
$2,871.24 |
2.0× |
| Radiopharmaceutical therapy, by intravenous administration Age Under 21 (79101) |
$769.53 |
$1,923.81 |
3.1× |
| Radiopharmaceutical therapy, by oral administration Age Under 21 (79005) |
$1,235.28 |
$3,088.19 |
5.0× |
| Remote afterloading high dose rate radionuclide skin surface brachytherapy, includes basic dosimetry, when performed;… (77767) |
$1,014.08 |
$2,535.18 |
2.5× |
| Remote afterloading high dose rate radionuclide skin surface brachytherapy, includes basic dosimetry, when performed;… (77768) |
$1,387.57 |
$3,468.91 |
3.4× |
| Review by radiologist of urinary bladder and urethra images with contrast and after passing urine (74455) |
$797.26 |
$1,993.14 |
3.2× |
| Rp loclzj tum plnr 1 area single day imaging (78800) |
$850.74 |
$2,126.84 |
2.0× |
| Rp loclzj tum plnr 2+area 1+d img/1 area img>2+d (78801) |
$1,122.98 |
$2,807.44 |
2.7× |
| Rp loclzj tum plnr whole body 2+ days imaging (78804) |
$1,814.46 |
$4,536.14 |
3.2× |
| Rp loclzj tum plnr whole body single day imaging (78802) |
$1,805.19 |
$4,512.97 |
3.2× |
| Rp loclzj tum spect 2 areas (78831) |
$1,516.02 |
$3,790.04 |
1.1× |
| Rp loclzj tum spect w/CT 1 (78830) |
$1,263.34 |
$3,158.35 |
0.9× |
| Rp loclzj tum spect w/CT 2 (78832) |
$1,667.62 |
$4,169.04 |
1.1× |
| Saline infusion sonohysterography (SIS), including color flow Doppler, when performed Age Under 21 (76831) |
$605.80 |
$1,514.48 |
2.4× |
| Scapula complete (73010) |
$282.68 |
$706.68 |
2.6× |
| Screening digital breast tomosynthesis bi (77063) |
$16 |
$40 |
— |
| Shuntogram indwelling nonvascular shunt rs&i (75809) |
$514.79 |
$1,286.96 |
4.7× |
| Simulation intermediate (77285) |
$1,979.23 |
$4,948.06 |
5.0× |
| Special dosimetry (77331) |
$112.72 |
$281.80 |
0.8× |
| Special physics consult (77370) |
$636.35 |
$1,590.87 |
4.5× |
| Special teletherapy port plan (77321) |
$877.44 |
$2,193.58 |
2.2× |
| Special treatment procedure (77470) |
$1,949.06 |
$4,872.64 |
3.3× |
| Stereotactic body radiation therapy, treatment delivery, per fraction to 1 or more lesions, including image guidance,… (77373) |
$11,065.01 |
$27,662.51 |
5.9× |
| Surface application of low dose rate radionuclide source (77789) |
$104.82 |
$262.03 |
1.0× |
| Ther rad simulaj-aided field setting complex (77290) |
$2,296.44 |
$5,741.10 |
5.8× |
| Therapeutic enema, contrast or air, for reduction of intussusception or other intraluminal obstruction (eg, meconium… (74283) |
$204.83 |
$512.07 |
1.1× |
| Thyroid imaging with vascular flow (78013) |
$697.20 |
$1,742.99 |
1.7× |
| Thyroid met imaging body (78018) |
$1,218.82 |
$3,047.04 |
2.1× |
| Thyroid uptake single/multiple quant measurement (78012) |
$305.26 |
$763.15 |
0.7× |
| Thyroid uptake w/blood flow sngle/mult quan meas (78014) |
$782.04 |
$1,955.08 |
1.9× |
| Tr simulation simple (77280) |
$1,195.12 |
$2,987.78 |
8.4× |
| Treatment device complex (77334) |
$733.84 |
$1,834.59 |
1.9× |
| Treatment device intermediate (77333) |
$407.70 |
$1,019.23 |
2.9× |
| Treatment device simple (77332) |
$265.83 |
$664.57 |
1.9× |
| Ultrasound breast limited (76642) |
$656.14 |
$1,640.33 |
7.1× |
| Ultrasound, abdomen limited (76705) |
$606.92 |
$1,517.30 |
5.5× |
| Ultrasound, limited, joint or focal evaluation of other nonvascular extremity structure(s) (eg, joint space,… (76882) |
$547.56 |
$1,368.90 |
5.0× |
| Ultrasound, pelvic (nonobstetric), real time with image documentation; complete Age Under 21 (76856) |
$790.10 |
$1,975.25 |
7.2× |
| Ultrasound, pregnant uterus, real time with image documentation, fetal and maternal evaluation plus detailed fetal… (76811) |
$577.06 |
$1,442.64 |
2.3× |
| Ultrasound, pregnant uterus, real time with image documentation, fetal and maternal evaluation, first trimester (< 14… (76801) |
$376.37 |
$940.91 |
3.4× |
| Ultrasound, transplanted kidney, real time and duplex Doppler with image documentation Age Under 21 (76776) |
$607.09 |
$1,517.71 |
5.5× |
| Ultrasound, transrectal; prostate volume study for brachytherapy treatment planning (separate procedure) Age Under 21 (76873) |
$261.47 |
$653.67 |
2.4× |
| Umbilical-artery Doppler (OB) (76820) |
$400.90 |
$1,002.25 |
3.6× |
| Unlisted cardiovascular procedure, diagnostic nuclear medicine (78499) |
$694.93 |
$1,737.32 |
1.6× |
| Unlisted gastrointestinal procedure, diagnostic nuclear medicine (78299) |
$694.93 |
$1,737.32 |
1.6× |
| Unlisted genitourinary procedure, diagnostic nuclear medicine (78799) |
$694.93 |
$1,737.32 |
1.6× |
| Unlisted hematopoietic, reticuloendothelial and lymphatic procedure, diagnostic nuclear medicine (78199) |
$694.93 |
$1,737.32 |
1.6× |
| Unlisted miscellaneous procedure, diagnostic nuclear medicine (78999) |
$694.93 |
$1,737.32 |
1.6× |
| Unlisted musculoskeletal procedure, diagnostic nuclear medicine (78399) |
$694.93 |
$1,737.32 |
1.6× |
| Unlisted nervous system procedure, diagnostic nuclear medicine (78699) |
$694.93 |
$1,737.32 |
1.6× |
| Unlisted procedure, clinical brachytherapy (77799) |
$1,608.76 |
$4,021.90 |
14.9× |
| Unlisted respiratory procedure, diagnostic nuclear medicine (78599) |
$694.93 |
$1,737.32 |
1.6× |
| Ureteral reflux study (78740) |
$600.22 |
$1,500.55 |
1.4× |
| Urethrocystography retrograde rs&i (74450) |
$797.26 |
$1,993.14 |
3.2× |
| Urography (pyelography), intravenous, with or without KUB, with or without tomography Age Under 21 (74400) |
$797.26 |
$1,993.14 |
4.3× |
| Urography antegrade rs&i (74425) |
$750.75 |
$1,876.86 |
2.0× |
| Us abdominal aorta real time screen study aaa (76706) |
$238.16 |
$595.38 |
2.2× |
| Us breast uni real time with image complete (76641) |
$436.18 |
$1,090.46 |
4.0× |
| Us chest (76604) |
$605.80 |
$1,514.48 |
5.5× |
| Us encephalogram (76506) |
$605.80 |
$1,514.48 |
5.5× |
| Us exam, pelvic, limited (76857) |
$376.37 |
$940.91 |
3.4× |
| Us guided compression repair (76936) |
$763.14 |
$1,907.84 |
3.4× |
| Us inft hips r-t img dynamic req phys/qhp manj (76885) |
$545.22 |
$1,363.03 |
5.9× |
| US OB Follow-Up/Repeat (76816) |
$376.37 |
$940.91 |
3.4× |
| Us ob transvaginal (76817) |
$511.33 |
$1,278.32 |
4.6× |
| Us retroperitoneal complete (76770) |
$698.61 |
$1,746.52 |
6.3× |
| Us retroperitoneal ltd (76775) |
$607.09 |
$1,517.71 |
5.5× |
| Us scrotum (76870) |
$607.09 |
$1,517.71 |
5.5× |
| Us soft tissue head/neck (76536) |
$757.89 |
$1,894.71 |
6.9× |
| Us spinal canal (76800) |
$576.15 |
$1,440.37 |
5.2× |
| Us transrectal (76872) |
$1,280.30 |
$3,200.73 |
11.6× |
| Us unlstd proc (76999) |
$467.90 |
$1,169.73 |
5.1× |
| Use 1st target lesion (76982) |
$140.68 |
$351.68 |
1.3× |
| Venography deep dorsal vein penis radiolgicl supervision interpretation (76499) |
$2,081.05 |
$5,202.62 |
22.7× |
| Venography, caval, inferior, with serialography, radiological supervision and interpretation Age Under 21 (75825) |
$1,681.68 |
$4,204.19 |
0.5× |
| Venography, caval, superior, with serialography, radiological supervision and interpretation Age Under 21 (75827) |
$1,400.11 |
$3,500.26 |
0.8× |
| Venography, extremity, bilateral, radiological supervision and interpretation Age Under 21 (75822) |
$902.72 |
$2,256.79 |
0.5× |
| Venography, extremity, unilateral, radiological supervision and interpretation Age Under 21 (75820) |
$849.74 |
$2,124.33 |
0.5× |
| Vertebral fracture assessment via dxa (77086) |
$177.91 |
$444.77 |
1.9× |
| X-ray exam hips bi 3-4 views (73522) |
$335.08 |
$837.68 |
3.0× |
| X-ray exam of finger(s) (73140) |
$276.54 |
$691.34 |
3.0× |
| X-ray exam of knee 1 or 2 (73560) |
$262.19 |
$655.46 |
2.9× |
| X-ray exam ribs bil 3 views (71110) |
$368.72 |
$921.78 |
3.3× |
| X-ray exam ribs uni 2 views (71100) |
$294.25 |
$735.62 |
3.2× |
| X-ray heel (73650) |
$282.68 |
$706.68 |
3.1× |
| X-ray of joint between lower spine and hip bone 3 or more views|PROFESSIONAL COMPONENT (72202) |
$245.81 |
$614.51 |
2.2× |
| X-ray retrograde pyelogram (74420) |
$797.26 |
$1,993.14 |
2.2× |
| Xr abdomen 1 view (74018) |
$235.05 |
$587.61 |
2.6× |
| Xr abdomen 2 views (74019) |
$225.01 |
$562.51 |
2.0× |
| Xr arthrogram hip (73525) |
$660.35 |
$1,650.87 |
1.8× |
| Xr bone age studies (77072) |
$189.93 |
$474.81 |
1.7× |
| Xr bone length study (77073) |
$165.85 |
$414.61 |
1.5× |
| Xr bone survey infant (77076) |
$316.57 |
$791.42 |
2.9× |
| Xr bone survey ltd (77074) |
$316.57 |
$791.42 |
2.9× |
| Xr chest 1 view (71045) |
$255.78 |
$639.43 |
2.8× |
| Xr chest 2 views (71046) |
$218.41 |
$546.02 |
2.4× |
| Xr eye foreign body (70030) |
$285.86 |
$714.64 |
3.1× |
| Xr facial bones 3+ views (70150) |
$245.81 |
$614.51 |
2.2× |
| Xr foot arthritis pa only bilateral - report(ortho pro) (73620) |
$282.68 |
$706.68 |
3.1× |
| Xr forearm 2 views (73090) |
$282.68 |
$706.68 |
3.1× |
| Xr hand 2v (73120) |
$282.68 |
$706.68 |
2.6× |
| Xr hysterosalpingogram (74740) |
$555.49 |
$1,388.71 |
2.2× |
| Xr joint survey 1 view (77077) |
$165.85 |
$414.61 |
1.5× |
| Xr myelogram c-spine (72240) |
$759.30 |
$1,898.24 |
0.9× |
| Xr myelogram l-spine (72265) |
$759.30 |
$1,898.24 |
0.9× |
| Xr myelogram t-spine (72255) |
$759.30 |
$1,898.24 |
0.9× |
| Xr neck soft tissue (70360) |
$297.28 |
$743.20 |
3.2× |
| Xr o knee w/ merchant view bilat - report(ortho pro) (73562) |
$282.68 |
$706.68 |
3.1× |
| Xr osseous survey complete (77075) |
$443.03 |
$1,107.56 |
4.0× |
| Xr pelvis 1-2 views (72170) |
$245.81 |
$614.51 |
2.2× |
| Xr pelvis min 3 view (72190) |
$245.81 |
$614.51 |
2.2× |
| Xr peritoneogram (74190) |
$565.74 |
$1,414.34 |
1.0× |
| Xr sacrum/coccyx 2+ views (72220) |
$245.81 |
$614.51 |
2.7× |
| Xr shoulder 1 view (73020) |
$193.75 |
$484.36 |
2.1× |
| Xr sialogram (70390) |
$799.43 |
$1,998.57 |
3.2× |
| Xr sinuses 3+ views (70220) |
$245.81 |
$614.51 |
2.7× |
| Xr skull min 4 view (70260) |
$432.62 |
$1,081.54 |
3.9× |
| Xr spine 1 view (72020) |
$245.81 |
$614.51 |
2.7× |
| Xr spine thoracic 3v (72072) |
$245.81 |
$614.51 |
2.2× |
| Xr sternum 2+ views (71120) |
$230.04 |
$575.10 |
2.5× |
| Xr stress view joint (77071) |
$165.85 |
$414.61 |
1.8× |
| Xr surgical specimen (76098) |
$467.90 |
$1,169.73 |
0.8× |
| Xr t-spine 2 views (72070) |
$245.81 |
$614.51 |
2.2× |
| Xr tibia/fibula 2 views (73590) |
$282.68 |
$706.68 |
3.1× |
| Xr tmj bilateral (70330) |
$223.46 |
$558.65 |
2.4× |
| Xr tmj unilateral (70328) |
$162.24 |
$405.59 |
1.8× |
| Xr venogram renal bilat (75833) |
$1,608.06 |
$4,020.15 |
0.5× |
| Xr wrist 2 views (73100) |
$282.68 |
$706.68 |
3.1× |