| 3-D radiotherapy plan dose-volume histograms (77295) |
$7,676.25 |
$10,235 |
5.3× |
| Acute gi blood loss imaging (78278) |
$1,477.50 |
$1,970 |
3.5× |
| Angiography visceral slctv/supraslctv rs&i (75726) |
$9,528.75 |
$12,705 |
1.6× |
| Angiography, extremity, bilateral, radiological supervision and interpretation Age Under 21 (75716) |
$439.50 |
$586 |
0.1× |
| Angiography, extremity, unilateral, radiological supervision and interpretation Age Under 21 (75710) |
$3,541.88 |
$4,722.50 |
1.1× |
| Ankle 2 views (73600) |
$189.38 |
$252.50 |
2.1× |
| Aortography, abdominal plus bilateral iliofemoral lower extremity, catheter, by serialography, radiological supervision… (75630) |
$3,731.25 |
$4,975 |
1.1× |
| Aortography, abdominal, by serialography, radiological supervision and interpretation Age Under 21 (75625) |
$338.25 |
$451 |
0.1× |
| Aortography, thoracic, by serialography, radiological supervision and interpretation Age Under 21 (75605) |
$9,528.75 |
$12,705 |
1.6× |
| Basic radiation dosimetry calculation (77300) |
$804.75 |
$1,073 |
5.7× |
| Brain flow imaging only - nm brain flow only brain death (78610) |
$1,657.88 |
$2,210.50 |
2.9× |
| Cardiac blood pool imaging, gated equilibrium; multiple studies, wall motion study plus ejection fraction, at rest and… (78473) |
$2,093.25 |
$2,791 |
5.0× |
| Cineradiography/videoradiography (76120) |
$315 |
$420 |
2.9× |
| Cisternography, positive contrast, radiological supervision and interpretation Age Under 21 (70015) |
$294.75 |
$393 |
0.4× |
| Clavicle complete (73000) |
$228.75 |
$305 |
2.5× |
| Computed tomographic angiography, abdomen and pelvis, with contrast material(s), including noncontrast images, if… (74174) |
$1,401 |
$1,868 |
3.8× |
| Computed tomographic angiography, abdomen, with contrast material(s), including noncontrast images, if performed, and… (74175) |
$720.75 |
$961 |
3.9× |
| Computed tomographic angiography, abdominal aorta and bilateral iliofemoral lower extremity runoff, with contrast… (75635) |
$792 |
$1,056 |
4.3× |
| Computed tomographic angiography, chest (noncoronary), with contrast material(s), including noncontrast images, if… (71275) |
$723 |
$964 |
3.9× |
| Computed tomographic angiography, lower extremity, with contrast material(s), including noncontrast images, if… (73706) |
$2,702.62 |
$3,603.50 |
14.6× |
| Computed tomographic angiography, neck, with contrast material(s), including noncontrast images, if performed, and… (70498) |
$714 |
$952 |
3.9× |
| Computed tomographic angiography, pelvis, with contrast material(s), including noncontrast images, if performed, and… (72191) |
$1,111.88 |
$1,482.50 |
6.0× |
| Computed tomographic angiography, upper extremity, with contrast material(s), including noncontrast images, if… (73206) |
$929.62 |
$1,239.50 |
5.0× |
| Computed tomography, cervical spine; without contrast material, followed by contrast material(s) and further sections… (72127) |
$1,519.50 |
$2,026 |
8.2× |
| Computed tomography, lower extremity; without contrast material Age Under 21 (73700) |
$602.25 |
$803 |
5.5× |
| Computed tomography, lower extremity; without contrast material, followed by contrast material(s) and further sections… (73702) |
$2,166 |
$2,888 |
11.7× |
| Computed tomography, lumbar spine; without contrast material, followed by contrast material(s) and further sections Age… (72133) |
$1,939.88 |
$2,586.50 |
10.5× |
| Computed tomography, maxillofacial area; with contrast material(s) Age Under 21 (70487) |
$761.25 |
$1,015 |
4.1× |
| Computed tomography, maxillofacial area; without contrast material Age Under 21 (70486) |
$353.25 |
$471 |
3.2× |
| Computed tomography, orbit, sella, or posterior fossa or outer, middle, or inner ear; with contrast material(s) Age… (70481) |
$1,162.12 |
$1,549.50 |
6.3× |
| Computed tomography, orbit, sella, or posterior fossa or outer, middle, or inner ear; without contrast material Age… (70480) |
$696 |
$928 |
6.3× |
| Computed tomography, orbit, sella, or posterior fossa or outer, middle, or inner ear; without contrast material,… (70482) |
$1,099.50 |
$1,466 |
5.9× |
| Computed tomography, soft tissue neck; without contrast material followed by contrast material(s) and further sections… (70492) |
$1,133.25 |
$1,511 |
6.1× |
| Computed tomography, thoracic spine; without contrast material, followed by contrast material(s) and further sections… (72130) |
$3,163.50 |
$4,218 |
17.1× |
| Computed tomography, thorax, diagnostic; without contrast material, followed by contrast material(s) and further… (71270) |
$1,688.62 |
$2,251.50 |
9.1× |
| Continuing medical physics consultation, including assessment of treatment parameters, quality assurance of dose… (77336) |
$624.75 |
$833 |
4.4× |
| CT abdomen and pelvis without and with contrast (74178) |
$931.50 |
$1,242 |
2.5× |
| CT abdomen and pelvis without contrast (74176) |
$501 |
$668 |
2.0× |
| CT abdomen w & w/o contrast (74170) |
$1,281 |
$1,708 |
6.9× |
| CT abdomen w/contrast (74160) |
$1,136.25 |
$1,515 |
6.1× |
| CT abdomen w/o contrast (74150) |
$873 |
$1,164 |
7.9× |
| CT angio hrt w/3d image (75574) |
$1,992.75 |
$2,657 |
5.4× |
| CT cervical spine w/contrast (72126) |
$1,065 |
$1,420 |
2.9× |
| CT cervical spine w/o contrast (72125) |
$358.50 |
$478 |
3.3× |
| CT chest w/contrast (71260) |
$750 |
$1,000 |
4.1× |
| CT extremity upper w & w/o contrast (73202) |
$2,126.25 |
$2,835 |
11.5× |
| CT extremity upper w/o contrast (73200) |
$1,148.62 |
$1,531.50 |
10.4× |
| CT head/brain with contrast (70460) |
$1,038.75 |
$1,385 |
5.6× |
| CT head/brain without and with contrast (70470) |
$1,140 |
$1,520 |
6.2× |
| CT heart no contrast quant eval coronry calcium (75571) |
$274.50 |
$366 |
3.0× |
| CT l-spine w/contrast (72132) |
$1,217.25 |
$1,623 |
3.3× |
| CT limited/localized follow up study (76380) |
$733.12 |
$977.50 |
8.0× |
| CT lower extremity w/dye (73701) |
$1,397.25 |
$1,863 |
7.6× |
| CT lumbar spine w/o contrast (72131) |
$327.38 |
$436.50 |
3.0× |
| CT maxillofacial w/wo contrast (70488) |
$749.25 |
$999 |
4.0× |
| CT neck w/contrast (70491) |
$1,127.25 |
$1,503 |
6.1× |
| CT neck w/o contrast (70490) |
$968.25 |
$1,291 |
8.8× |
| CT pelvis w & w/o contrast (72194) |
$1,272 |
$1,696 |
6.9× |
| CT pelvis w/o contrast (72192) |
$854.25 |
$1,139 |
7.7× |
| CT thoracic spine w/contrast (72129) |
$1,149.75 |
$1,533 |
6.2× |
| CT thoracic spine w/o contrast (72128) |
$989.25 |
$1,319 |
9.0× |
| CT thorax lung cancer scr c- (71271) |
$242.25 |
$323 |
2.2× |
| CT thorax w/o contrast (71250) |
$363.75 |
$485 |
3.3× |
| CT upper extremity w/dye (73201) |
$1,353 |
$1,804 |
3.7× |
| CTA head w contrast (70496) |
$714 |
$952 |
3.9× |
| Cystography, minimum of 3 views, radiological supervision and interpretation Age Under 21 (74430) |
$560.25 |
$747 |
1.5× |
| Dilation ureters/urethra rs&i (74485) |
$4,063.50 |
$5,418 |
1.8× |
| Doppler echocardiography, fetal, pulsed wave and/or continuous wave with spectral display; follow-up or repeat study… (76828) |
$263.25 |
$351 |
2.4× |
| Doppler fetal mid cerebral artery (76821) |
$202.88 |
$270.50 |
1.8× |
| Dual-energy X-ray absorptiometry (DXA), bone density study, 1 or more sites; axial skeleton (eg, hips, pelvis, spine)… (77080) |
$96.38 |
$128.50 |
0.9× |
| Dxa bone density/peripheral (77081) |
$139.88 |
$186.50 |
1.5× |
| Fetal biophys profile w/o nst (76819) |
$191.62 |
$255.50 |
1.7× |
| Fetal biophysical profile non-stress testing (76818) |
$302.25 |
$403 |
2.7× |
| Fluoroscopy up to 1 hour physician/qhp time (76000) |
$120.75 |
$161 |
0.5× |
| Gated heart planar single (78472) |
$1,455.75 |
$1,941 |
3.5× |
| Hepatobil syst imag inc gb w/pharma intervenj (78227) |
$895.12 |
$1,193.50 |
1.6× |
| Hepatobiliary syst imaging including gallbladder (78226) |
$1,374 |
$1,832 |
3.3× |
| Ht muscle image spect sing (78451) |
$3,018.75 |
$4,025 |
2.2× |
| Image fusion (77399) |
$368.25 |
$491 |
2.6× |
| Intensity modulated radiotherapy plan, including dose-volume histograms for target and critical structure partial… (77301) |
$5,961 |
$7,948 |
4.1× |
| Isodose teletherapy plan complex multi tx w/cal (77307) |
$2,142 |
$2,856 |
5.4× |
| Kidney imaging morphology; with vascular flow and function, single study without pharmacological intervention Age Under… (78707) |
$1,031.25 |
$1,375 |
1.8× |
| Kidney imaging morphology; with vascular flow and function, single study, with pharmacological intervention (eg,… (78708) |
$1,007.62 |
$1,343.50 |
1.8× |
| Liver and spleen imaging (78215) |
$2,047.50 |
$2,730 |
4.9× |
| Liver and spleen imaging; with vascular flow Age Under 21 (78216) |
$1,959.75 |
$2,613 |
4.6× |
| Liver imaging with flow (78202) |
$1,520.25 |
$2,027 |
2.7× |
| Lung perf&ventilat diferentl (78598) |
$2,512.50 |
$3,350 |
4.4× |
| Lung perfusion imaging (78580) |
$1,153.50 |
$1,538 |
2.7× |
| Magnetic resonance (eg, proton) imaging, any joint of lower extremity; without contrast material(s), followed by… (73723) |
$2,216.25 |
$2,955 |
6.0× |
| Magnetic resonance (eg, proton) imaging, lower extremity other than joint; with contrast material(s) Age Under 21 (73719) |
$1,861.12 |
$2,481.50 |
5.1× |
| Magnetic resonance (eg, proton) imaging, lower extremity other than joint; without contrast material(s) Age Under 21 (73718) |
$1,261.50 |
$1,682 |
5.0× |
| Magnetic resonance (eg, proton) imaging, lower extremity other than joint; without contrast material(s), followed by… (73720) |
$1,786.50 |
$2,382 |
4.9× |
| Magnetic resonance (eg, proton) imaging, orbit, face, and/or neck; with contrast material(s) Age Under 21 (70542) |
$734.25 |
$979 |
2.0× |
| Magnetic resonance (eg, proton) imaging, orbit, face, and/or neck; without contrast material(s) Age Under 21 (70540) |
$618.75 |
$825 |
2.5× |
| Magnetic resonance (eg, proton) imaging, upper extremity, other than joint; with contrast material(s) Age Under 21 (73219) |
$1,394.25 |
$1,859 |
3.8× |
| Magnetic resonance (eg, proton) imaging, upper extremity, other than joint; without contrast material(s), followed by… (73220) |
$1,492.50 |
$1,990 |
4.1× |
| Magnetic resonance angiography, head; with contrast material(s) Age Under 21 (70545) |
$1,719.38 |
$2,292.50 |
4.7× |
| Magnetic resonance angiography, head; without contrast material(s), followed by contrast material(s) and further… (70546) |
$1,525.50 |
$2,034 |
4.1× |
| Magnetic resonance angiography, neck; without contrast material(s), followed by contrast material(s) and further… (70549) |
$826.50 |
$1,102 |
2.2× |
| Mandible min 4v (70110) |
$243 |
$324 |
2.2× |
| Mr safety implant&/fb assmt clin staf 1st 15 min (76014) |
$95.62 |
$127.50 |
3.1× |
| Mr safety implt electronics prepj supvj phys/qhp (76018) |
$223.12 |
$297.50 |
2.2× |
| MRA head w/o contrast (70544) |
$591.75 |
$789 |
2.4× |
| MRA neck w/ contrast (70548) |
$1,299.38 |
$1,732.50 |
3.5× |
| MRA neck w/o contrast (70547) |
$1,117.50 |
$1,490 |
4.4× |
| MRI abdomen w/contrast (74182) |
$1,439.62 |
$1,919.50 |
3.9× |
| MRI abdomen w/o contrast (74181) |
$1,042.50 |
$1,390 |
4.1× |
| MRI abdomen w/wo contrast (74183) |
$1,492.50 |
$1,990 |
4.1× |
| MRI any jt lower extrem w/contrast material (73722) |
$1,669.12 |
$2,225.50 |
2.0× |
| MRI brain w/o & w/dye (70559) |
$2,354.25 |
$3,139 |
12.7× |
| MRI c-spine w&w/o cont (72156) |
$873.75 |
$1,165 |
2.4× |
| MRI cervical spine w/contrast (72142) |
$1,710.38 |
$2,280.50 |
4.6× |
| MRI chest w/contrast (71551) |
$1,309.12 |
$1,745.50 |
1.6× |
| MRI chest w/o contrast (71550) |
$1,266.75 |
$1,689 |
5.0× |
| MRI chest w/wo contrast (71552) |
$1,813.12 |
$2,417.50 |
4.9× |
| MRI joint upr extr w/o&w/dye (73223) |
$1,492.50 |
$1,990 |
4.1× |
| MRI joint upr extrem w/dye (73222) |
$1,669.12 |
$2,225.50 |
2.0× |
| MRI joint upr extrem w/o dye (73221) |
$913.12 |
$1,217.50 |
3.6× |
| MRI lumbar spine w/contrast (72149) |
$1,860 |
$2,480 |
5.1× |
| MRI lumbar spine w/wo contrast (72158) |
$875.25 |
$1,167 |
2.4× |
| MRI orbit/face/neck w&w/o cont (70543) |
$927.75 |
$1,237 |
2.5× |
| MRI pelvis w & w/o contrast (72197) |
$1,803.75 |
$2,405 |
4.9× |
| MRI pelvis w/contrast (72196) |
$1,941.75 |
$2,589 |
5.3× |
| MRI pelvis w/o contrast (72195) |
$1,380 |
$1,840 |
5.5× |
| MRI spine cervical w/o contrast (72141) |
$523.50 |
$698 |
2.1× |
| MRI t-spine w&w/o cont (72157) |
$876 |
$1,168 |
2.4× |
| MRI thoracic spine w/contrast (72147) |
$1,712.62 |
$2,283.50 |
4.7× |
| MRI thoracic spine w/o contrst (72146) |
$522.75 |
$697 |
2.1× |
| MRI tmj (70336) |
$1,254.38 |
$1,672.50 |
5.0× |
| MRI upper extremity oth than jt w/o contr matrl (73218) |
$955.50 |
$1,274 |
3.8× |
| Multi-leaf collimator (MLC) device(s) for intensity modulated radiation therapy (IMRT), design and construction per… (77338) |
$1,695.75 |
$2,261 |
4.3× |
| Myocardial spect multiple studies (78452) |
$985.50 |
$1,314 |
0.7× |
| N-invas est c ffr augmnt sw alys CTA i&r phy/qhp (75580) |
$2,571.75 |
$3,429 |
2.8× |
| Nm bone 3 phase (78315) |
$840 |
$1,120 |
2.0× |
| Nm bone imaging whole body (78306) |
$653.62 |
$871.50 |
1.5× |
| Nm gastric emptying (78264) |
$633 |
$844 |
1.5× |
| Nm lymph system (78195) |
$1,852.50 |
$2,470 |
3.2× |
| Nuclear medicine study of bone and/or joint limited area (78300) |
$552.75 |
$737 |
1.3× |
| Nuclear medicine study of bone and/or joint multiple areas (78305) |
$672 |
$896 |
1.6× |
| Ob us limited fetus(s) (76815) |
$202.50 |
$270 |
1.8× |
| Ob us nuchal meas 1 gest (76813) |
$163.50 |
$218 |
1.5× |
| Parathyroid planar imaging (78070) |
$97.50 |
$130 |
0.2× |
| Parathyroid planar imaging w/wo subtraction (78071) |
$2,197.50 |
$2,930 |
5.2× |
| PET imaging CT attenuation skull base mid-thigh (78815) |
$4,341 |
$5,788 |
2.9× |
| PET imaging for CT attenuation whole body (78816) |
$4,452 |
$5,936 |
3.0× |
| Pulmonary ventilation & perfusion imaging (78582) |
$1,074.75 |
$1,433 |
1.9× |
| Quant differential pulm perfusion w/wo imaging (78597) |
$409.50 |
$546 |
1.0× |
| Radex abscess/fistula/sinus tract rs&i (76080) |
$795.75 |
$1,061 |
1.4× |
| Radex entir thrc lmbr crv sac spi w/skull 1 vw (72081) |
$243 |
$324 |
2.6× |
| Radex entir thrc lmbr crv sac spi w/skull 2/3 vw (72082) |
$203.25 |
$271 |
1.8× |
| Radex hip unilateral with pelvis 1 view (73501) |
$196.12 |
$261.50 |
2.1× |
| Radex hip unilateral with pelvis 2-3 views (73502) |
$249.75 |
$333 |
2.7× |
| Radex hip unilateral with pelvis minimum 4 views (73503) |
$417.38 |
$556.50 |
3.8× |
| Radex hips bilateral with pelvis 2 views (73521) |
$73.50 |
$98 |
0.7× |
| Radex hips bilateral with pelvis minimum 5 views (73523) |
$384 |
$512 |
3.5× |
| Radex spine cervical 2 or 3 views (72040) |
$166.50 |
$222 |
1.8× |
| Radex spine cervical 4 or 5 views (72050) |
$291.75 |
$389 |
2.6× |
| Radex spine cervical 6 or more views (72052) |
$360.75 |
$481 |
3.3× |
| Radex spine thoracolumbar junction min 2 views (72080) |
$219.75 |
$293 |
2.4× |
| Radiation tx delivery lvl 1 (77402) |
$375 |
$500 |
3.5× |
| Radiation tx delivery lvl 2 (77407) |
$429.75 |
$573 |
1.1× |
| Radiation tx delivery lvl 3 (77412) |
$1,236 |
$1,648 |
2.1× |
| Radiologic exam abdomen 3+ views (74021) |
$317.25 |
$423 |
2.9× |
| Radiologic exam chest 3 views (71047) |
$296.62 |
$395.50 |
3.2× |
| Radiologic exam chest 4+ views (71048) |
$402 |
$536 |
3.6× |
| Radiologic exam colon double contrast study (74280) |
$706.12 |
$941.50 |
3.8× |
| Radiologic exam colon single contrast study (74270) |
$429 |
$572 |
2.3× |
| Radiologic exam esophagus double contrast study (74221) |
$85.50 |
$114 |
0.5× |
| Radiologic exam esophagus single contrast study (74220) |
$405.75 |
$541 |
2.2× |
| Radiologic exam small int single contrast study (74250) |
$440.25 |
$587 |
2.4× |
| Radiologic exam swallow function contrast study (74230) |
$287.25 |
$383 |
1.6× |
| Radiologic exam upr gi trc double contrast study (74246) |
$471 |
$628 |
2.5× |
| Radiologic exam upr gi trc single contrast study (74240) |
$405 |
$540 |
2.2× |
| Radiologic examination femur 1 view (73551) |
$21.75 |
$29 |
0.2× |
| Radiologic examination femur minimum 2 views (73552) |
$180.75 |
$241 |
2.0× |
| Radiologic examination from nose to rectum for foreign body, single view, child Age Under 21 (76010) |
$134.25 |
$179 |
1.5× |
| Radiologic examination, ankle; complete, minimum of 3 views Age Under 21 (73610) |
$134.25 |
$179 |
1.5× |
| Radiologic examination, complete acute abdomen series, including 2 or more views of the abdomen (eg, supine, erect,… (74022) |
$337.50 |
$450 |
3.1× |
| Radiologic examination, elbow; 2 views Age Under 21 (73070) |
$228.75 |
$305 |
2.5× |
| Radiologic examination, elbow; complete, minimum of 3 views Age Under 21 (73080) |
$128.62 |
$171.50 |
1.4× |
| Radiologic examination, facial bones; less than 3 views Age Under 21 (70140) |
$185.25 |
$247 |
2.0× |
| Radiologic examination, foot; complete, minimum of 3 views Age Under 21 (73630) |
$130.12 |
$173.50 |
1.4× |
| Radiologic examination, hand; minimum of 3 views Age Under 21 (73130) |
$278.62 |
$371.50 |
3.0× |
| Radiologic examination, knee; complete, 4 or more views Age Under 21 (73564) |
$243 |
$324 |
2.2× |
| Radiologic examination, mandible; partial, less than 4 views Age Under 21 (70100) |
$185.25 |
$247 |
2.0× |
| Radiologic examination, nasal bones, complete, minimum of 3 views Age Under 21 (70160) |
$103.50 |
$138 |
1.1× |
| Radiologic examination, ribs, bilateral; including posteroanterior chest, minimum of 4 views Age Under 21 (71111) |
$304.50 |
$406 |
2.8× |
| Radiologic examination, ribs, unilateral; including posteroanterior chest, minimum of 3 views Age Under 21 (71101) |
$246 |
$328 |
2.2× |
| Radiologic examination, shoulder, arthrography, radiological supervision and interpretation Age Under 21 (73040) |
$937.50 |
$1,250 |
2.5× |
| Radiologic examination, shoulder; complete, minimum of 2 views Age Under 21 (73030) |
$166.50 |
$222 |
1.8× |
| Radiologic examination, sinuses, paranasal, less than 3 views Age Under 21 (70210) |
$187.88 |
$250.50 |
2.0× |
| Radiologic examination, skull; less than 4 views Age Under 21 (70250) |
$98.25 |
$131 |
0.9× |
| Radiologic examination, spine, lumbosacral; 2 or 3 views Age Under 21 (72100) |
$111.75 |
$149 |
1.0× |
| Radiologic examination, spine, lumbosacral; bending views only, 2 or 3 views Age Under 21 (72120) |
$338.25 |
$451 |
3.1× |
| Radiologic examination, spine, lumbosacral; complete, including bending views, minimum of 6 views Age Under 21 (72114) |
$407.25 |
$543 |
3.7× |
| Radiologic examination, spine; thoracic, minimum of 4 views Age Under 21 (72074) |
$333 |
$444 |
3.0× |
| Radiologic examination, wrist; complete, minimum of 3 views Age Under 21 (73110) |
$166.50 |
$222 |
1.8× |
| Radiologic examination; acromioclavicular joints, bilateral, with or without weighted distraction Age Under 21 (73050) |
$229.12 |
$305.50 |
2.5× |
| Radiologic examination; humerus, minimum of 2 views Age Under 21 (73060) |
$109.50 |
$146 |
1.2× |
| Radiologic examination; lower extremity, infant, minimum of 2 views Age Under 21 (73592) |
$287.25 |
$383 |
3.1× |
| Radiologic examination; orbits, complete, minimum of 4 views Age Under 21 (70200) |
$160.88 |
$214.50 |
1.5× |
| Radiologic examination; sternoclavicular joint or joints, minimum of 3 views Age Under 21 (71130) |
$216.75 |
$289 |
2.4× |
| Radiologic examination; toe(s), minimum of 2 views Age Under 21 (73660) |
$190.50 |
$254 |
2.1× |
| Radiologic examination; upper extremity, infant, minimum of 2 views Age Under 21 (73092) |
$221.25 |
$295 |
2.0× |
| Radiopharmaceutical localization of tumor, inflammatory process or distribution of radiopharmaceutical agent(s)… (78803) |
$1,838.62 |
$2,451.50 |
3.2× |
| Review by radiologist of urinary bladder and urethra images with contrast and after passing urine (74455) |
$661.88 |
$882.50 |
2.6× |
| Rp loclzj tum plnr 1 area single day imaging (78800) |
$642 |
$856 |
1.5× |
| Rp loclzj tum plnr 2+area 1+d img/1 area img>2+d (78801) |
$665.25 |
$887 |
1.6× |
| Rp loclzj tum spect 2 areas (78831) |
$1,728 |
$2,304 |
1.3× |
| Rp loclzj tum spect w/CT 1 (78830) |
$1,165.50 |
$1,554 |
0.9× |
| Rp loclzj tum spect w/CT 2 (78832) |
$2,195.25 |
$2,927 |
1.5× |
| Saline infusion sonohysterography (SIS), including color flow Doppler, when performed Age Under 21 (76831) |
$230.25 |
$307 |
0.9× |
| Scapula complete (73010) |
$277.50 |
$370 |
2.5× |
| Screening digital breast tomosynthesis bi (77063) |
$74.25 |
$99 |
— |
| Shuntogram indwelling nonvascular shunt rs&i (75809) |
$62.25 |
$83 |
0.6× |
| Simulation intermediate (77285) |
$1,946.25 |
$2,595 |
4.9× |
| Special dosimetry (77331) |
$534.75 |
$713 |
3.8× |
| Special teletherapy port plan (77321) |
$1,647.75 |
$2,197 |
4.2× |
| Special treatment procedure (77470) |
$2,532 |
$3,376 |
4.3× |
| Stereotactic body radiation therapy, treatment delivery, per fraction to 1 or more lesions, including image guidance,… (77373) |
$13,776.75 |
$18,369 |
7.3× |
| Ther rad simulaj-aided field setting complex (77290) |
$2,204.25 |
$2,939 |
5.6× |
| Therapeutic enema, contrast or air, for reduction of intussusception or other intraluminal obstruction (eg, meconium… (74283) |
$482.25 |
$643 |
2.6× |
| Thyroid uptake single/multiple quant measurement (78012) |
$902.25 |
$1,203 |
2.1× |
| Tr simulation simple (77280) |
$969.75 |
$1,293 |
6.8× |
| Treatment device complex (77334) |
$1,647.75 |
$2,197 |
4.2× |
| Treatment device intermediate (77333) |
$942 |
$1,256 |
6.6× |
| Treatment device simple (77332) |
$624.75 |
$833 |
4.4× |
| Ultrasound breast limited (76642) |
$145.50 |
$194 |
1.6× |
| Ultrasound, abdomen limited (76705) |
$237.75 |
$317 |
2.2× |
| Ultrasound, limited, joint or focal evaluation of other nonvascular extremity structure(s) (eg, joint space,… (76882) |
$174.75 |
$233 |
1.6× |
| Ultrasound, pelvic (nonobstetric), real time with image documentation; complete Age Under 21 (76856) |
$289.50 |
$386 |
2.6× |
| Ultrasound, pregnant uterus, real time with image documentation, fetal and maternal evaluation plus detailed fetal… (76811) |
$255 |
$340 |
1.0× |
| Ultrasound, pregnant uterus, real time with image documentation, fetal and maternal evaluation, first trimester (< 14… (76801) |
$264 |
$352 |
2.4× |
| Umbilical-artery Doppler (OB) (76820) |
$123 |
$164 |
1.1× |
| Unlisted magnetic resonance procedure (eg, diagnostic, interventional) Age Under 21 (76498) |
$533.25 |
$711 |
5.8× |
| Urethrocystography retrograde rs&i (74450) |
$592.88 |
$790.50 |
2.4× |
| Urography antegrade rs&i (74425) |
$794.25 |
$1,059 |
2.2× |
| Us abdominal aorta real time screen study aaa (76706) |
$266.25 |
$355 |
2.4× |
| Us breast uni real time with image complete (76641) |
$438.75 |
$585 |
4.0× |
| Us chest (76604) |
$166.50 |
$222 |
1.5× |
| Us compl joint r-t w/image documentation (76881) |
$129.75 |
$173 |
1.2× |
| Us encephalogram (76506) |
$238.50 |
$318 |
2.2× |
| Us exam, pelvic, limited (76857) |
$139.50 |
$186 |
1.3× |
| Us guided compression repair (76936) |
$591.75 |
$789 |
2.6× |
| US OB Follow-Up/Repeat (76816) |
$196.50 |
$262 |
1.8× |
| Us ob transvaginal (76817) |
$252.75 |
$337 |
2.3× |
| Us retroperitoneal complete (76770) |
$358.50 |
$478 |
3.3× |
| Us retroperitoneal ltd (76775) |
$299.25 |
$399 |
2.7× |
| Us scrotum (76870) |
$271.50 |
$362 |
2.5× |
| Us soft tissue head/neck (76536) |
$264.75 |
$353 |
2.4× |
| Us transrectal (76872) |
$391.12 |
$521.50 |
3.5× |
| Venography, caval, inferior, with serialography, radiological supervision and interpretation Age Under 21 (75825) |
$7,855.50 |
$10,474 |
2.4× |
| Venography, extremity, unilateral, radiological supervision and interpretation Age Under 21 (75820) |
$1,256.62 |
$1,675.50 |
0.8× |
| X-ray exam hips bi 3-4 views (73522) |
$281.25 |
$375 |
2.6× |
| X-ray exam of finger(s) (73140) |
$189.38 |
$252.50 |
2.1× |
| X-ray exam of knee 1 or 2 (73560) |
$120.75 |
$161 |
1.3× |
| X-ray exam of small bowel - fl small bowel series enteroclysis tube (74251) |
$644.25 |
$859 |
3.5× |
| X-ray heel (73650) |
$117.38 |
$156.50 |
1.3× |
| X-ray of joint between lower spine and hip bone 3 or more views|PROFESSIONAL COMPONENT (72202) |
$221.25 |
$295 |
2.0× |
| X-ray retrograde pyelogram (74420) |
$223.50 |
$298 |
0.6× |
| Xr abdomen 1 view (74018) |
$81.75 |
$109 |
0.9× |
| Xr abdomen 2 views (74019) |
$233.25 |
$311 |
2.1× |
| Xr bone age studies (77072) |
$168.75 |
$225 |
1.5× |
| Xr bone length study (77073) |
$255 |
$340 |
2.3× |
| Xr bone survey infant (77076) |
$233.25 |
$311 |
2.1× |
| Xr chest 1 view (71045) |
$69.75 |
$93 |
0.8× |
| Xr chest 2 views (71046) |
$90.75 |
$121 |
1.0× |
| Xr eye foreign body (70030) |
$90 |
$120 |
1.0× |
| Xr facial bones 3+ views (70150) |
$129 |
$172 |
1.2× |
| Xr foot arthritis pa only bilateral - report(ortho pro) (73620) |
$189.38 |
$252.50 |
2.1× |
| Xr forearm 2 views (73090) |
$118.50 |
$158 |
1.3× |
| Xr hand 2v (73120) |
$221.25 |
$295 |
2.0× |
| Xr hysterosalpingogram (74740) |
$429 |
$572 |
1.7× |
| Xr neck soft tissue (70360) |
$85.50 |
$114 |
0.9× |
| Xr o knee w/ merchant view bilat - report(ortho pro) (73562) |
$199.50 |
$265.99 |
2.2× |
| Xr osseous survey complete (77075) |
$615 |
$820 |
5.6× |
| Xr pelvis 1-2 views (72170) |
$200.25 |
$267 |
1.8× |
| Xr pelvis min 3 view (72190) |
$223.50 |
$298 |
2.0× |
| Xr sacrum/coccyx 2+ views (72220) |
$207.75 |
$277 |
2.3× |
| Xr shoulder 1 view (73020) |
$189.38 |
$252.50 |
2.1× |
| Xr sinuses 3+ views (70220) |
$241.12 |
$321.50 |
2.6× |
| Xr skull min 4 view (70260) |
$120.75 |
$161 |
1.1× |
| Xr spine 1 view (72020) |
$163.12 |
$217.50 |
1.8× |
| Xr spine thoracic 3v (72072) |
$258 |
$344 |
2.3× |
| Xr sternum 2+ views (71120) |
$171.75 |
$229 |
1.9× |
| Xr surgical specimen (76098) |
$932.25 |
$1,243 |
1.6× |
| Xr t-spine 2 views (72070) |
$219 |
$292 |
2.0× |
| Xr tibia/fibula 2 views (73590) |
$190.50 |
$254 |
2.1× |
| Xr tmj bilateral (70330) |
$39 |
$52 |
0.4× |
| Xr wrist 2 views (73100) |
$189.38 |
$252.50 |
2.1× |