| 3-D radiotherapy plan dose-volume histograms (77295) |
$4,673.20 |
$11,683 |
3.2× |
| Acute gi blood loss imaging (78278) |
$1,054 |
$2,635 |
2.5× |
| Angiography pulmonary bilateral slctv rs&i (75743) |
$2,156.40 |
$5,391 |
0.6× |
| Angiography visceral slctv/supraslctv rs&i (75726) |
$4,403.20 |
$11,008 |
0.8× |
| Angiography, extremity, bilateral, radiological supervision and interpretation Age Under 21 (75716) |
$3,100.80 |
$7,752 |
0.9× |
| Angiography, extremity, unilateral, radiological supervision and interpretation Age Under 21 (75710) |
$2,837.60 |
$7,094 |
0.9× |
| Angiography, pelvic, selective or supraselective, radiological supervision and interpretation Age Under 21 (75736) |
$3,709.20 |
$9,273 |
0.6× |
| Angiography, spinal, selective, radiological supervision and interpretation Age Under 21 (75705) |
$3,538.40 |
$8,846 |
0.6× |
| Angrph cath f-up std tcat other than thrombylsis (75898) |
$1,758 |
$4,395 |
0.5× |
| Ankle 2 views (73600) |
$209.76 |
$524.40 |
2.3× |
| Aortography, abdominal plus bilateral iliofemoral lower extremity, catheter, by serialography, radiological supervision… (75630) |
$2,644 |
$6,610 |
0.8× |
| Aortography, abdominal, by serialography, radiological supervision and interpretation Age Under 21 (75625) |
$2,479.20 |
$6,198 |
0.7× |
| Basic radiation dosimetry calculation (77300) |
$416.40 |
$1,041 |
2.9× |
| Brain imaging, positron emission tomography (PET); metabolic evaluation Age Under 21 (78608) |
$4,667.49 |
$11,668.72 |
3.1× |
| Clavicle complete (73000) |
$222.48 |
$556.20 |
2.4× |
| Computed tomographic angiography, abdomen and pelvis, with contrast material(s), including noncontrast images, if… (74174) |
$3,781.20 |
$9,453 |
10.3× |
| Computed tomographic angiography, abdomen, with contrast material(s), including noncontrast images, if performed, and… (74175) |
$1,984.80 |
$4,962 |
10.7× |
| Computed tomographic angiography, abdominal aorta and bilateral iliofemoral lower extremity runoff, with contrast… (75635) |
$2,165.20 |
$5,413 |
11.7× |
| Computed tomographic angiography, chest (noncoronary), with contrast material(s), including noncontrast images, if… (71275) |
$1,988 |
$4,970 |
10.7× |
| Computed tomographic angiography, lower extremity, with contrast material(s), including noncontrast images, if… (73706) |
$2,003.60 |
$5,009 |
10.8× |
| Computed tomographic angiography, neck, with contrast material(s), including noncontrast images, if performed, and… (70498) |
$1,713.60 |
$4,284 |
9.3× |
| Computed tomographic angiography, pelvis, with contrast material(s), including noncontrast images, if performed, and… (72191) |
$1,983.60 |
$4,959 |
10.7× |
| Computed tomographic angiography, upper extremity, with contrast material(s), including noncontrast images, if… (73206) |
$1,463.20 |
$3,658 |
7.9× |
| Computed tomography, cervical spine; without contrast material, followed by contrast material(s) and further sections… (72127) |
$1,299.55 |
$3,248.87 |
7.0× |
| Computed tomography, lower extremity; without contrast material Age Under 21 (73700) |
$1,933.20 |
$4,833 |
17.5× |
| Computed tomography, lower extremity; without contrast material, followed by contrast material(s) and further sections… (73702) |
$1,588 |
$3,970 |
8.6× |
| Computed tomography, maxillofacial area; with contrast material(s) Age Under 21 (70487) |
$1,587.20 |
$3,968 |
8.6× |
| Computed tomography, maxillofacial area; without contrast material Age Under 21 (70486) |
$1,238.40 |
$3,096 |
11.2× |
| Computed tomography, orbit, sella, or posterior fossa or outer, middle, or inner ear; with contrast material(s) Age… (70481) |
$1,718 |
$4,295 |
9.3× |
| Computed tomography, orbit, sella, or posterior fossa or outer, middle, or inner ear; without contrast material Age… (70480) |
$1,442.80 |
$3,607 |
13.1× |
| Computed tomography, orbit, sella, or posterior fossa or outer, middle, or inner ear; without contrast material,… (70482) |
$1,729.76 |
$4,324.40 |
9.3× |
| Computed tomography, soft tissue neck; without contrast material followed by contrast material(s) and further sections… (70492) |
$1,687.60 |
$4,219 |
9.1× |
| Computed tomography, thorax, diagnostic; without contrast material, followed by contrast material(s) and further… (71270) |
$1,703.20 |
$4,258 |
9.2× |
| Continuing medical physics consultation, including assessment of treatment parameters, quality assurance of dose… (77336) |
$578.40 |
$1,446 |
4.1× |
| Csf shunt evaluation (78645) |
$1,113.84 |
$2,784.60 |
1.9× |
| CT abdomen and pelvis without and with contrast (74178) |
$3,322.40 |
$8,306 |
9.0× |
| CT abdomen and pelvis without contrast (74176) |
$2,502.40 |
$6,256 |
9.9× |
| CT abdomen w & w/o contrast (74170) |
$2,159.60 |
$5,399 |
11.7× |
| CT abdomen w/contrast (74160) |
$1,733.60 |
$4,334 |
9.4× |
| CT abdomen w/o contrast (74150) |
$1,526.80 |
$3,817 |
13.8× |
| CT angio hrt w/3d image (75574) |
$1,481.20 |
$3,703 |
4.0× |
| CT cervical spine w/contrast (72126) |
$1,652.80 |
$4,132 |
4.5× |
| CT cervical spine w/o contrast (72125) |
$1,472.80 |
$3,682 |
13.4× |
| CT chest w/contrast (71260) |
$1,581.20 |
$3,953 |
8.5× |
| CT extremity upper w & w/o contrast (73202) |
$1,618 |
$4,045 |
8.7× |
| CT extremity upper w/o contrast (73200) |
$1,182.40 |
$2,956 |
10.7× |
| CT head/brain with contrast (70460) |
$1,378.40 |
$3,446 |
7.4× |
| CT head/brain without and with contrast (70470) |
$1,647.60 |
$4,119 |
8.9× |
| CT heart no contrast quant eval coronry calcium (75571) |
$254.92 |
$637.30 |
2.8× |
| CT l-spine w/contrast (72132) |
$1,689.60 |
$4,224 |
4.6× |
| CT lower extremity w/dye (73701) |
$1,456 |
$3,640 |
7.9× |
| CT lumbar spine w/o contrast (72131) |
$1,514.80 |
$3,787 |
13.7× |
| CT maxillofacial w/wo contrast (70488) |
$1,299.55 |
$3,248.87 |
7.0× |
| CT neck w/contrast (70491) |
$1,524.80 |
$3,812 |
8.2× |
| CT neck w/o contrast (70490) |
$1,461.60 |
$3,654 |
13.3× |
| CT pelvis w & w/o contrast (72194) |
$1,806.56 |
$4,516.40 |
9.8× |
| CT pelvis w/o contrast (72192) |
$1,558.44 |
$3,896.10 |
14.1× |
| CT thoracic spine w/contrast (72129) |
$1,550.16 |
$3,875.40 |
8.4× |
| CT thoracic spine w/o contrast (72128) |
$1,527.20 |
$3,818 |
13.8× |
| CT thorax lung cancer scr c- (71271) |
$412 |
$1,030 |
3.7× |
| CT thorax w/o contrast (71250) |
$1,411.20 |
$3,528 |
12.8× |
| CT upper extremity w/dye (73201) |
$1,480 |
$3,700 |
4.0× |
| CTA head w contrast (70496) |
$1,716.80 |
$4,292 |
9.3× |
| Cystography, minimum of 3 views, radiological supervision and interpretation Age Under 21 (74430) |
$613.92 |
$1,534.80 |
1.7× |
| Dual-energy X-ray absorptiometry (DXA), bone density study, 1 or more sites; axial skeleton (eg, hips, pelvis, spine)… (77080) |
$340.36 |
$850.90 |
3.1× |
| Dxa bone density/peripheral (77081) |
$119.17 |
$297.92 |
1.3× |
| Fetal biophys profile w/o nst (76819) |
$366.80 |
$917 |
3.3× |
| Fetal biophysical profile non-stress testing (76818) |
$335.20 |
$838 |
3.0× |
| Fluoroscopy up to 1 hour physician/qhp time (76000) |
$429.20 |
$1,073 |
1.7× |
| Gated heart planar single (78472) |
$1,214.71 |
$3,036.77 |
2.9× |
| Hdr rdncl ntrstl/intrcav brachytx >12 channels (77772) |
$1,643.04 |
$4,107.60 |
2.2× |
| Hepatc vngrph wdg/fr w/o hemodyn eval rs&i (75891) |
$2,050.80 |
$5,127 |
0.6× |
| Hepatic venography, wedged or free, with hemodynamic evaluation, radiological supervision and interpretation Age Under… (75889) |
$3,740.80 |
$9,352 |
1.1× |
| Hepatobil syst imag inc gb w/pharma intervenj (78227) |
$1,526.40 |
$3,816 |
2.7× |
| Hepatobiliary syst imaging including gallbladder (78226) |
$1,352.60 |
$3,381.50 |
3.2× |
| Ht muscle image spect sing (78451) |
$2,741.51 |
$6,853.77 |
2.0× |
| Injection procedure for radiopharmaceutical localization by non-imaging probe study, intravenous (eg, parathyroid… (78808) |
$843.85 |
$2,109.61 |
2.0× |
| Intensity modulated radiotherapy plan, including dose-volume histograms for target and critical structure partial… (77301) |
$4,224 |
$10,560 |
2.9× |
| Isodose teletherapy plan complex multi tx w/cal (77307) |
$1,124.80 |
$2,812 |
2.8× |
| Kidney imaging morphology; with vascular flow and function, multiple studies, with and without pharmacological… (78709) |
$1,251.12 |
$3,127.80 |
2.2× |
| Kidney imaging morphology; with vascular flow and function, single study without pharmacological intervention Age Under… (78707) |
$833.20 |
$2,083 |
1.5× |
| Kidney imaging morphology; with vascular flow and function, single study, with pharmacological intervention (eg,… (78708) |
$1,264.80 |
$3,162 |
2.2× |
| Liver and spleen imaging (78215) |
$836.20 |
$2,090.50 |
2.0× |
| Lung perf&ventilat diferentl (78598) |
$1,898.44 |
$4,746.10 |
3.3× |
| Lung perfusion imaging (78580) |
$914.40 |
$2,286 |
2.2× |
| Magnetic resonance (eg, proton) imaging, any joint of lower extremity; without contrast material(s), followed by… (73723) |
$1,911.20 |
$4,778 |
5.2× |
| Magnetic resonance (eg, proton) imaging, lower extremity other than joint; with contrast material(s) Age Under 21 (73719) |
$2,025.36 |
$5,063.40 |
5.5× |
| Magnetic resonance (eg, proton) imaging, lower extremity other than joint; without contrast material(s) Age Under 21 (73718) |
$1,563.20 |
$3,908 |
6.2× |
| Magnetic resonance (eg, proton) imaging, lower extremity other than joint; without contrast material(s), followed by… (73720) |
$2,386 |
$5,965 |
6.5× |
| Magnetic resonance (eg, proton) imaging, orbit, face, and/or neck; without contrast material(s) Age Under 21 (70540) |
$1,768.80 |
$4,422 |
7.0× |
| Magnetic resonance (eg, proton) imaging, upper extremity, other than joint; with contrast material(s) Age Under 21 (73219) |
$1,710.47 |
$4,276.17 |
4.6× |
| Magnetic resonance (eg, proton) imaging, upper extremity, other than joint; without contrast material(s), followed by… (73220) |
$2,386 |
$5,965 |
6.5× |
| Magnetic resonance angiography, head; with contrast material(s) Age Under 21 (70545) |
$2,372 |
$5,930 |
6.4× |
| Magnetic resonance angiography, head; without contrast material(s), followed by contrast material(s) and further… (70546) |
$2,773.60 |
$6,934 |
7.5× |
| Magnetic resonance angiography, neck; without contrast material(s), followed by contrast material(s) and further… (70549) |
$3,294.80 |
$8,237 |
9.0× |
| Mammary ductogram or galactogram, multiple ducts, radiological supervision and interpretation Age Under 21 (77054) |
$96.26 |
$240.65 |
0.4× |
| Mandible min 4v (70110) |
$310.36 |
$775.90 |
2.8× |
| MRA head w/o contrast (70544) |
$2,241.20 |
$5,603 |
8.9× |
| MRA neck w/o contrast (70547) |
$1,958 |
$4,895 |
7.8× |
| MRI abdomen w/contrast (74182) |
$1,924 |
$4,810 |
5.2× |
| MRI abdomen w/o contrast (74181) |
$1,740.40 |
$4,351 |
6.9× |
| MRI abdomen w/wo contrast (74183) |
$2,519.60 |
$6,299 |
6.8× |
| MRI any jt lower extrem w/contrast material (73722) |
$1,789.20 |
$4,473 |
2.2× |
| MRI breast c- bilateral (77047) |
$1,529.32 |
$3,823.30 |
6.1× |
| MRI c-spine w&w/o cont (72156) |
$2,552.40 |
$6,381 |
6.9× |
| MRI cervical spine w/contrast (72142) |
$2,264.40 |
$5,661 |
6.2× |
| MRI chest w/o contrast (71550) |
$1,600 |
$4,000 |
6.4× |
| MRI chest w/wo contrast (71552) |
$2,930 |
$7,325 |
8.0× |
| MRI joint upr extr w/o&w/dye (73223) |
$1,982.40 |
$4,956 |
5.4× |
| MRI joint upr extrem w/dye (73222) |
$1,700.40 |
$4,251 |
2.1× |
| MRI joint upr extrem w/o dye (73221) |
$1,400.40 |
$3,501 |
5.6× |
| MRI lumbar spine w/contrast (72149) |
$2,377.60 |
$5,944 |
6.5× |
| MRI lumbar spine w/wo contrast (72158) |
$2,672.80 |
$6,682 |
7.3× |
| MRI orbit/face/neck w&w/o cont (70543) |
$2,724.40 |
$6,811 |
7.4× |
| MRI pelvis w & w/o contrast (72197) |
$2,930 |
$7,325 |
8.0× |
| MRI pelvis w/contrast (72196) |
$2,330.84 |
$5,827.10 |
6.3× |
| MRI pelvis w/o contrast (72195) |
$2,175.60 |
$5,439 |
8.6× |
| MRI spectroscopy (76390) |
$1,793.20 |
$4,483 |
19.5× |
| MRI spine cervical w/o contrast (72141) |
$1,960 |
$4,900 |
7.8× |
| MRI t-spine w&w/o cont (72157) |
$2,648 |
$6,620 |
7.2× |
| MRI thoracic spine w/contrast (72147) |
$2,243.60 |
$5,609 |
6.1× |
| MRI thoracic spine w/o contrst (72146) |
$2,095.60 |
$5,239 |
8.3× |
| MRI tmj (70336) |
$1,985.76 |
$4,964.40 |
7.9× |
| MRI upper extremity oth than jt w/o contr matrl (73218) |
$1,563.20 |
$3,908 |
6.2× |
| Multi-leaf collimator (MLC) device(s) for intensity modulated radiation therapy (IMRT), design and construction per… (77338) |
$1,546.40 |
$3,866 |
3.9× |
| Myelography, 2 or more regions (eg, lumbar/thoracic, cervical/thoracic, lumbar/cervical, lumbar/thoracic/cervical),… (72270) |
$1,580.12 |
$3,950.30 |
1.9× |
| Myocardial spect multiple studies (78452) |
$3,175.84 |
$7,939.60 |
2.3× |
| Nm bone 3 phase (78315) |
$1,353.60 |
$3,384 |
3.2× |
| Nm bone imaging whole body (78306) |
$1,212.40 |
$3,031 |
2.9× |
| Nm gastric emptying (78264) |
$1,263.52 |
$3,158.80 |
3.0× |
| Nm lymph system (78195) |
$1,270.76 |
$3,176.90 |
2.2× |
| Nuclear medicine study of bone and/or joint limited area (78300) |
$843.85 |
$2,109.61 |
2.0× |
| Ob us limited fetus(s) (76815) |
$339.22 |
$848.05 |
3.1× |
| Ophthalmic ultrasound, diagnostic; B-scan (with or without superimposed non-quantitative A-scan) Age Under 21 (76512) |
$335.20 |
$838 |
3.0× |
| Parathyrd planar w/spect&CT (78072) |
$589.68 |
$1,474.20 |
1.0× |
| Parathyroid planar imaging (78070) |
$937.16 |
$2,342.90 |
2.2× |
| Parathyroid planar imaging w/wo subtraction (78071) |
$816.44 |
$2,041.10 |
1.9× |
| PET imaging CT attenuation skull base mid-thigh (78815) |
$3,993.20 |
$9,983 |
2.6× |
| PET imaging for CT attenuation whole body (78816) |
$4,608 |
$11,520 |
3.1× |
| Pulmonary ventilation & perfusion imaging (78582) |
$1,625.48 |
$4,063.70 |
2.8× |
| Radex abscess/fistula/sinus tract rs&i (76080) |
$1,035.42 |
$2,588.53 |
1.8× |
| Radex entir thrc lmbr crv sac spi w/skull 1 vw (72081) |
$52.40 |
$131 |
0.6× |
| Radex entir thrc lmbr crv sac spi w/skull 2/3 vw (72082) |
$381.28 |
$953.20 |
3.5× |
| Radex entir thrc lmbr crv sac spi w/skull 4/5 vw (72083) |
$418.88 |
$1,047.20 |
3.8× |
| Radex entir thrc lmbr crv sac spi w/skull 6/> vw (72084) |
$212.68 |
$531.70 |
1.9× |
| Radex hip unilateral with pelvis 1 view (73501) |
$184.40 |
$461 |
2.0× |
| Radex hip unilateral with pelvis 2-3 views (73502) |
$210.40 |
$526 |
2.3× |
| Radex hip unilateral with pelvis minimum 4 views (73503) |
$274.44 |
$686.10 |
2.5× |
| Radex hips bilateral with pelvis 2 views (73521) |
$224 |
$560 |
2.0× |
| Radex hips bilateral with pelvis minimum 5 views (73523) |
$343.20 |
$858 |
3.1× |
| Radex spine cervical 2 or 3 views (72040) |
$231.84 |
$579.60 |
2.5× |
| Radex spine cervical 4 or 5 views (72050) |
$294.24 |
$735.60 |
2.7× |
| Radex spine cervical 6 or more views (72052) |
$408.36 |
$1,020.90 |
3.7× |
| Radex spine thoracolumbar junction min 2 views (72080) |
$230 |
$575 |
2.5× |
| Radiation tx delivery lvl 1 (77402) |
$433.04 |
$1,082.60 |
4.0× |
| Radiation tx delivery lvl 2 (77407) |
$1,529.32 |
$3,823.30 |
3.8× |
| Radiation tx delivery lvl 3 (77412) |
$762.80 |
$1,907 |
1.3× |
| Radiologic exam abdomen 3+ views (74021) |
$26.99 |
$67.47 |
0.2× |
| Radiologic exam chest 3 views (71047) |
$267.08 |
$667.70 |
2.9× |
| Radiologic exam colon double contrast study (74280) |
$695.04 |
$1,737.60 |
3.8× |
| Radiologic exam colon single contrast study (74270) |
$538.40 |
$1,346 |
2.9× |
| Radiologic exam esophagus single contrast study (74220) |
$487.60 |
$1,219 |
2.6× |
| Radiologic exam small int single contrast study (74250) |
$477.64 |
$1,194.10 |
2.6× |
| Radiologic exam swallow function contrast study (74230) |
$406.80 |
$1,017 |
2.2× |
| Radiologic exam upr gi trc double contrast study (74246) |
$555.76 |
$1,389.40 |
3.0× |
| Radiologic exam upr gi trc single contrast study (74240) |
$468 |
$1,170 |
2.5× |
| Radiologic examination femur 1 view (73551) |
$170.48 |
$426.20 |
1.9× |
| Radiologic examination femur minimum 2 views (73552) |
$205.20 |
$513 |
2.2× |
| Radiologic examination from nose to rectum for foreign body, single view, child Age Under 21 (76010) |
$199.20 |
$498 |
2.2× |
| Radiologic examination, ankle; complete, minimum of 3 views Age Under 21 (73610) |
$234.12 |
$585.30 |
2.6× |
| Radiologic examination, complete acute abdomen series, including 2 or more views of the abdomen (eg, supine, erect,… (74022) |
$372.12 |
$930.30 |
3.4× |
| Radiologic examination, elbow; 2 views Age Under 21 (73070) |
$210.24 |
$525.60 |
2.3× |
| Radiologic examination, elbow; complete, minimum of 3 views Age Under 21 (73080) |
$247.44 |
$618.60 |
2.7× |
| Radiologic examination, facial bones; less than 3 views Age Under 21 (70140) |
$232.16 |
$580.40 |
2.5× |
| Radiologic examination, foot; complete, minimum of 3 views Age Under 21 (73630) |
$233.60 |
$584 |
2.5× |
| Radiologic examination, hand; minimum of 3 views Age Under 21 (73130) |
$241.64 |
$604.10 |
2.6× |
| Radiologic examination, knee; both knees, standing, anteroposterior Age Under 21 (73565) |
$204.36 |
$510.90 |
2.2× |
| Radiologic examination, knee; complete, 4 or more views Age Under 21 (73564) |
$260 |
$650 |
2.4× |
| Radiologic examination, nasal bones, complete, minimum of 3 views Age Under 21 (70160) |
$222.48 |
$556.20 |
2.4× |
| Radiologic examination, ribs, bilateral; including posteroanterior chest, minimum of 4 views Age Under 21 (71111) |
$409.64 |
$1,024.10 |
3.7× |
| Radiologic examination, ribs, unilateral; including posteroanterior chest, minimum of 3 views Age Under 21 (71101) |
$340.56 |
$851.40 |
3.1× |
| Radiologic examination, sacroiliac joints; less than 3 views Age Under 21 (72200) |
$180.80 |
$452 |
1.6× |
| Radiologic examination, shoulder; complete, minimum of 2 views Age Under 21 (73030) |
$245.44 |
$613.60 |
2.7× |
| Radiologic examination, single plane body section (eg, tomography), other than with urography Age Under 21 (76100) |
$366.12 |
$915.30 |
3.3× |
| Radiologic examination, sinuses, paranasal, less than 3 views Age Under 21 (70210) |
$191.36 |
$478.40 |
2.1× |
| Radiologic examination, skull; less than 4 views Age Under 21 (70250) |
$229.20 |
$573 |
2.1× |
| Radiologic examination, spine, lumbosacral; 2 or 3 views Age Under 21 (72100) |
$277.36 |
$693.40 |
2.5× |
| Radiologic examination, spine, lumbosacral; bending views only, 2 or 3 views Age Under 21 (72120) |
$317.56 |
$793.90 |
2.9× |
| Radiologic examination, spine, lumbosacral; complete, including bending views, minimum of 6 views Age Under 21 (72114) |
$436 |
$1,090 |
4.0× |
| Radiologic examination, spine; thoracic, minimum of 4 views Age Under 21 (72074) |
$209.50 |
$523.75 |
1.9× |
| Radiologic examination, wrist; complete, minimum of 3 views Age Under 21 (73110) |
$243.08 |
$607.70 |
2.6× |
| Radiologic examination; acromioclavicular joints, bilateral, with or without weighted distraction Age Under 21 (73050) |
$224.44 |
$561.10 |
2.4× |
| Radiologic examination; humerus, minimum of 2 views Age Under 21 (73060) |
$224.56 |
$561.40 |
2.4× |
| Radiologic examination; lower extremity, infant, minimum of 2 views Age Under 21 (73592) |
$125.08 |
$312.70 |
1.4× |
| Radiologic examination; orbits, complete, minimum of 4 views Age Under 21 (70200) |
$303.92 |
$759.80 |
2.8× |
| Radiologic examination; sternoclavicular joint or joints, minimum of 3 views Age Under 21 (71130) |
$173.16 |
$432.90 |
1.9× |
| Radiologic examination; toe(s), minimum of 2 views Age Under 21 (73660) |
$201.40 |
$503.50 |
2.2× |
| Radiologic examination; upper extremity, infant, minimum of 2 views Age Under 21 (73092) |
$47.58 |
$118.95 |
0.4× |
| Radiopharmaceutical localization of tumor, inflammatory process or distribution of radiopharmaceutical agent(s)… (78803) |
$1,414.40 |
$3,536 |
2.5× |
| Radiopharmaceutical therapy, by intravenous administration Age Under 21 (79101) |
$470.68 |
$1,176.68 |
1.9× |
| Radiopharmaceutical therapy, by oral administration Age Under 21 (79005) |
$1,253.16 |
$3,132.90 |
5.1× |
| Review by radiologist of urinary bladder and urethra images with contrast and after passing urine (74455) |
$722 |
$1,805 |
2.9× |
| Rp loclzj tum plnr whole body 2+ days imaging (78804) |
$2,443.88 |
$6,109.70 |
4.3× |
| Rp loclzj tum spect 2 areas (78831) |
$2,741.51 |
$6,853.77 |
2.0× |
| Scapula complete (73010) |
$224.44 |
$561.10 |
2.0× |
| Screening digital breast tomosynthesis bi (77063) |
$117.88 |
$294.70 |
— |
| Special dosimetry (77331) |
$554.80 |
$1,387 |
3.9× |
| Special physics consult (77370) |
$573.20 |
$1,433 |
4.0× |
| Ther rad simulaj-aided field setting complex (77290) |
$1,580.40 |
$3,951 |
4.0× |
| Thyroid imaging with vascular flow (78013) |
$461.04 |
$1,152.60 |
1.1× |
| Thyroid met imaging body (78018) |
$1,272 |
$3,180 |
2.2× |
| Thyroid uptake w/blood flow sngle/mult quan meas (78014) |
$881 |
$2,202.50 |
2.1× |
| Tr simulation simple (77280) |
$874 |
$2,185 |
6.2× |
| Treatment device complex (77334) |
$944.40 |
$2,361 |
2.4× |
| Treatment device intermediate (77333) |
$451.42 |
$1,128.55 |
3.2× |
| Treatment device simple (77332) |
$440.40 |
$1,101 |
3.1× |
| Ultrasound breast limited (76642) |
$319.44 |
$798.60 |
3.5× |
| Ultrasound, abdomen limited (76705) |
$383 |
$957.50 |
3.5× |
| Ultrasound, limited, joint or focal evaluation of other nonvascular extremity structure(s) (eg, joint space,… (76882) |
$254.28 |
$635.70 |
2.3× |
| Ultrasound, pelvic (nonobstetric), real time with image documentation; complete Age Under 21 (76856) |
$547.12 |
$1,367.80 |
5.0× |
| Ultrasound, pregnant uterus, real time with image documentation, fetal and maternal evaluation, first trimester (< 14… (76801) |
$376.08 |
$940.20 |
3.4× |
| Ultrasound, transplanted kidney, real time and duplex Doppler with image documentation Age Under 21 (76776) |
$485.60 |
$1,214 |
4.4× |
| Umbilical-artery Doppler (OB) (76820) |
$188.60 |
$471.50 |
1.7× |
| Unlisted magnetic resonance procedure (eg, diagnostic, interventional) Age Under 21 (76498) |
$2,664.56 |
$6,661.38 |
29.0× |
| Urethrocystography retrograde rs&i (74450) |
$69.22 |
$173.05 |
0.3× |
| Urography (pyelography), intravenous, with or without KUB, with or without tomography Age Under 21 (74400) |
$65.58 |
$163.95 |
0.4× |
| Urography antegrade rs&i (74425) |
$713.52 |
$1,783.80 |
1.9× |
| Us abdominal aorta real time screen study aaa (76706) |
$366.88 |
$917.20 |
3.3× |
| Us breast uni real time with image complete (76641) |
$447.28 |
$1,118.20 |
4.1× |
| Us chest (76604) |
$420 |
$1,050 |
3.8× |
| Us compl joint r-t w/image documentation (76881) |
$532.80 |
$1,332 |
4.8× |
| Us encephalogram (76506) |
$333.72 |
$834.30 |
3.0× |
| Us exam, pelvic, limited (76857) |
$325.74 |
$814.36 |
3.0× |
| Us inft hips r-t img dynamic req phys/qhp manj (76885) |
$259.92 |
$649.80 |
2.8× |
| Us inft hips r-t img lmtd static phys/qhp manj (76886) |
$281.76 |
$704.40 |
3.1× |
| US OB Follow-Up/Repeat (76816) |
$287.68 |
$719.20 |
2.6× |
| Us ob transvaginal (76817) |
$346.40 |
$866 |
3.1× |
| Us retroperitoneal complete (76770) |
$572.24 |
$1,430.60 |
5.2× |
| Us retroperitoneal ltd (76775) |
$366.64 |
$916.60 |
3.3× |
| Us scrotum (76870) |
$444 |
$1,110 |
4.0× |
| Us soft tissue head/neck (76536) |
$445.16 |
$1,112.90 |
4.0× |
| Us spinal canal (76800) |
$436.96 |
$1,092.40 |
4.0× |
| Venography renal unilateral selective rs&i (75831) |
$2,630.56 |
$6,576.40 |
0.8× |
| Venography, caval, inferior, with serialography, radiological supervision and interpretation Age Under 21 (75825) |
$2,630.56 |
$6,576.40 |
0.8× |
| Venography, caval, superior, with serialography, radiological supervision and interpretation Age Under 21 (75827) |
$1,676.40 |
$4,191 |
1.0× |
| Venography, extremity, bilateral, radiological supervision and interpretation Age Under 21 (75822) |
$1,576.24 |
$3,940.60 |
0.9× |
| Venography, extremity, unilateral, radiological supervision and interpretation Age Under 21 (75820) |
$1,252.80 |
$3,132 |
0.8× |
| X-ray exam hips bi 3-4 views (73522) |
$310.80 |
$777 |
2.8× |
| X-ray exam of finger(s) (73140) |
$181.08 |
$452.70 |
2.0× |
| X-ray exam of knee 1 or 2 (73560) |
$213.80 |
$534.50 |
2.3× |
| X-ray exam ribs bil 3 views (71110) |
$302.08 |
$755.20 |
2.7× |
| X-ray exam ribs uni 2 views (71100) |
$288.20 |
$720.50 |
3.1× |
| X-ray heel (73650) |
$225.24 |
$563.10 |
2.5× |
| X-ray of joint between lower spine and hip bone 3 or more views|PROFESSIONAL COMPONENT (72202) |
$270.52 |
$676.30 |
2.5× |
| X-ray retrograde pyelogram (74420) |
$652.33 |
$1,630.82 |
1.8× |
| Xr abdomen 1 view (74018) |
$205.28 |
$513.20 |
2.2× |
| Xr abdomen 2 views (74019) |
$258.80 |
$647 |
2.3× |
| Xr bone age studies (77072) |
$130.96 |
$327.40 |
1.2× |
| Xr bone length study (77073) |
$228.72 |
$571.80 |
2.1× |
| Xr bone survey infant (77076) |
$186.20 |
$465.50 |
1.7× |
| Xr chest 1 view (71045) |
$128 |
$320 |
1.4× |
| Xr chest 2 views (71046) |
$204 |
$510 |
2.2× |
| Xr eye foreign body (70030) |
$170 |
$425 |
1.9× |
| Xr facial bones 3+ views (70150) |
$307.68 |
$769.20 |
2.8× |
| Xr foot arthritis pa only bilateral - report(ortho pro) (73620) |
$199.56 |
$498.90 |
2.2× |
| Xr forearm 2 views (73090) |
$223.76 |
$559.40 |
2.4× |
| Xr hand 2v (73120) |
$194 |
$485 |
1.8× |
| Xr hysterosalpingogram (74740) |
$464.52 |
$1,161.30 |
1.8× |
| Xr myelogram c-spine (72240) |
$1,580.12 |
$3,950.30 |
1.9× |
| Xr myelogram l-spine (72265) |
$1,580.12 |
$3,950.30 |
1.9× |
| Xr myelogram t-spine (72255) |
$1,580.12 |
$3,950.30 |
1.9× |
| Xr neck soft tissue (70360) |
$216.32 |
$540.80 |
2.4× |
| Xr o knee w/ merchant view bilat - report(ortho pro) (73562) |
$255.32 |
$638.30 |
2.8× |
| Xr osseous survey complete (77075) |
$589.48 |
$1,473.70 |
5.3× |
| Xr pelvis 1-2 views (72170) |
$199.52 |
$498.80 |
1.8× |
| Xr pelvis min 3 view (72190) |
$283.72 |
$709.30 |
2.6× |
| Xr sacrum/coccyx 2+ views (72220) |
$231.12 |
$577.80 |
2.5× |
| Xr shoulder 1 view (73020) |
$195.84 |
$489.60 |
2.1× |
| Xr sinuses 3+ views (70220) |
$274.84 |
$687.10 |
3.0× |
| Xr skull min 4 view (70260) |
$367.60 |
$919 |
3.3× |
| Xr spine 1 view (72020) |
$214.24 |
$535.60 |
2.3× |
| Xr spine thoracic 3v (72072) |
$268.80 |
$672 |
2.4× |
| Xr sternum 2+ views (71120) |
$246.12 |
$615.30 |
2.7× |
| Xr surgical specimen (76098) |
$410.80 |
$1,027 |
0.7× |
| Xr t-spine 2 views (72070) |
$241.60 |
$604 |
2.2× |
| Xr tibia/fibula 2 views (73590) |
$231.36 |
$578.40 |
2.5× |
| Xr tmj bilateral (70330) |
$309.48 |
$773.70 |
3.4× |
| Xr wrist 2 views (73100) |
$209.68 |
$524.20 |
2.3× |