| 3-D radiotherapy plan dose-volume histograms (77295) |
$8,677.90 |
$12,397 |
5.9× |
| Acute gi blood loss imaging (78278) |
$1,740.90 |
$2,487 |
4.1× |
| Angiography internal mammary rs&i (75756) |
$3,840.20 |
$5,486 |
1.2× |
| Angiography pulmonary bilateral slctv rs&i (75743) |
$7,097.30 |
$10,139 |
2.1× |
| Angiography visceral slctv/supraslctv rs&i (75726) |
$6,594 |
$9,420 |
1.1× |
| Angiography, adrenal, unilateral, selective, radiological supervision and interpretation Age Under 21 (75731) |
$5,694.50 |
$8,135 |
1.7× |
| Angiography, extremity, bilateral, radiological supervision and interpretation Age Under 21 (75716) |
$6,154.40 |
$8,792 |
1.8× |
| Angiography, extremity, unilateral, radiological supervision and interpretation Age Under 21 (75710) |
$3,686.20 |
$5,266 |
1.1× |
| Angiography, pelvic, selective or supraselective, radiological supervision and interpretation Age Under 21 (75736) |
$6,594.70 |
$9,421 |
1.1× |
| Angiography, pulmonary, unilateral, selective, radiological supervision and interpretation Age Under 21 (75741) |
$4,416.30 |
$6,309 |
1.3× |
| Angiography, spinal, selective, radiological supervision and interpretation Age Under 21 (75705) |
$4,507.30 |
$6,439 |
0.8× |
| Angrph cath f-up std tcat other than thrombylsis (75898) |
$2,685.90 |
$3,837 |
0.8× |
| Angrph pulmonary nonslctv cath/ven njx rs&i (75746) |
$5,838.70 |
$8,341 |
1.8× |
| Ankle 2 views (73600) |
$249.90 |
$357 |
2.7× |
| Aortography, abdominal plus bilateral iliofemoral lower extremity, catheter, by serialography, radiological supervision… (75630) |
$3,776.50 |
$5,395 |
1.1× |
| Aortography, abdominal, by serialography, radiological supervision and interpretation Age Under 21 (75625) |
$2,893.80 |
$4,134 |
0.9× |
| Aortography, thoracic, by serialography, radiological supervision and interpretation Age Under 21 (75605) |
$4,507.30 |
$6,439 |
0.8× |
| Basic radiation dosimetry calculation (77300) |
$595.70 |
$851 |
4.2× |
| Brain flow imaging only - nm brain flow only brain death (78610) |
$1,708 |
$2,440 |
3.0× |
| Brain imaging, positron emission tomography (PET); metabolic evaluation Age Under 21 (78608) |
$5,310.20 |
$7,586 |
3.5× |
| Card MRI w/stress img & dye (75563) |
$2,408.70 |
$3,441 |
2.9× |
| Cardiac MRI morphology & function w/o contrast (75557) |
$1,353.10 |
$1,933 |
5.4× |
| Cardiac MRI w/wo contrast & further seq (75561) |
$2,070.60 |
$2,958 |
5.6× |
| Clavicle complete (73000) |
$308 |
$440 |
3.4× |
| Computed tomographic angiography, abdomen and pelvis, with contrast material(s), including noncontrast images, if… (74174) |
$5,189.10 |
$7,413 |
14.1× |
| Computed tomographic angiography, abdomen, with contrast material(s), including noncontrast images, if performed, and… (74175) |
$2,332.40 |
$3,332 |
12.6× |
| Computed tomographic angiography, abdominal aorta and bilateral iliofemoral lower extremity runoff, with contrast… (75635) |
$1,775.90 |
$2,537 |
9.6× |
| Computed tomographic angiography, chest (noncoronary), with contrast material(s), including noncontrast images, if… (71275) |
$3,142.30 |
$4,489 |
17.0× |
| Computed tomographic angiography, lower extremity, with contrast material(s), including noncontrast images, if… (73706) |
$2,139.90 |
$3,057 |
11.6× |
| Computed tomographic angiography, neck, with contrast material(s), including noncontrast images, if performed, and… (70498) |
$2,151.10 |
$3,073 |
11.6× |
| Computed tomographic angiography, pelvis, with contrast material(s), including noncontrast images, if performed, and… (72191) |
$2,821.70 |
$4,031 |
15.2× |
| Computed tomographic angiography, upper extremity, with contrast material(s), including noncontrast images, if… (73206) |
$2,072 |
$2,960 |
11.2× |
| Computed tomography, bone mineral density study, 1 or more sites, axial skeleton (eg, hips, pelvis, spine) Age Under 21 (77078) |
$934.50 |
$1,335 |
10.2× |
| Computed tomography, cervical spine; without contrast material, followed by contrast material(s) and further sections… (72127) |
$2,615.20 |
$3,736 |
14.1× |
| Computed tomography, lower extremity; without contrast material Age Under 21 (73700) |
$1,225.70 |
$1,751 |
11.1× |
| Computed tomography, lower extremity; without contrast material, followed by contrast material(s) and further sections… (73702) |
$2,037.70 |
$2,911 |
11.0× |
| Computed tomography, lumbar spine; without contrast material, followed by contrast material(s) and further sections Age… (72133) |
$2,050.30 |
$2,929 |
11.1× |
| Computed tomography, maxillofacial area; with contrast material(s) Age Under 21 (70487) |
$1,733.20 |
$2,476 |
9.4× |
| Computed tomography, maxillofacial area; without contrast material Age Under 21 (70486) |
$1,225 |
$1,750 |
11.1× |
| Computed tomography, orbit, sella, or posterior fossa or outer, middle, or inner ear; with contrast material(s) Age… (70481) |
$2,763.60 |
$3,948 |
14.9× |
| Computed tomography, orbit, sella, or posterior fossa or outer, middle, or inner ear; without contrast material Age… (70480) |
$2,380 |
$3,400 |
21.6× |
| Computed tomography, orbit, sella, or posterior fossa or outer, middle, or inner ear; without contrast material,… (70482) |
$3,178 |
$4,540 |
17.2× |
| Computed tomography, soft tissue neck; without contrast material followed by contrast material(s) and further sections… (70492) |
$1,941.10 |
$2,773 |
10.5× |
| Computed tomography, thoracic spine; without contrast material, followed by contrast material(s) and further sections… (72130) |
$2,190.30 |
$3,129 |
11.8× |
| Computed tomography, thorax, diagnostic; without contrast material, followed by contrast material(s) and further… (71270) |
$2,634.10 |
$3,763 |
14.2× |
| Continuing medical physics consultation, including assessment of treatment parameters, quality assurance of dose… (77336) |
$1,106.70 |
$1,581 |
7.8× |
| Csf shunt evaluation (78645) |
$1,395.10 |
$1,993 |
2.4× |
| CT abdomen and pelvis without and with contrast (74178) |
$4,942 |
$7,060 |
13.4× |
| CT abdomen and pelvis without contrast (74176) |
$3,175.20 |
$4,536 |
12.6× |
| CT abdomen w & w/o contrast (74170) |
$2,221.10 |
$3,173 |
12.0× |
| CT abdomen w/contrast (74160) |
$1,852.90 |
$2,647 |
10.0× |
| CT abdomen w/o contrast (74150) |
$1,599.50 |
$2,285 |
14.5× |
| CT angio hrt w/3d image (75574) |
$1,420.30 |
$2,029 |
3.9× |
| CT cervical spine w/contrast (72126) |
$2,333.10 |
$3,333 |
6.3× |
| CT cervical spine w/o contrast (72125) |
$1,746.50 |
$2,495 |
15.8× |
| CT chest w/contrast (71260) |
$2,152.50 |
$3,075 |
11.6× |
| CT extremity upper w & w/o contrast (73202) |
$1,745.80 |
$2,494 |
9.4× |
| CT extremity upper w/o contrast (73200) |
$1,430.80 |
$2,044 |
13.0× |
| CT head/brain with contrast (70460) |
$2,283.40 |
$3,262 |
12.3× |
| CT head/brain without and with contrast (70470) |
$2,685.90 |
$3,837 |
14.5× |
| CT heart c+ cardiac strux&morph cgen hrt ds (75573) |
$1,343.30 |
$1,919 |
3.7× |
| CT heart contrast eval cardiac structure&morph (75572) |
$1,136.80 |
$1,624 |
3.1× |
| CT heart no contrast quant eval coronry calcium (75571) |
$208.60 |
$298 |
2.3× |
| CT l-spine w/contrast (72132) |
$1,709.40 |
$2,442 |
4.6× |
| CT limited/localized follow up study (76380) |
$996.10 |
$1,423 |
10.9× |
| CT lower extremity w/dye (73701) |
$1,653.40 |
$2,362 |
8.9× |
| CT lumbar spine w/o contrast (72131) |
$1,579.90 |
$2,257 |
14.3× |
| CT maxillofacial w/wo contrast (70488) |
$2,177.70 |
$3,111 |
11.8× |
| CT neck w/contrast (70491) |
$1,644.30 |
$2,349 |
8.9× |
| CT neck w/o contrast (70490) |
$1,579.90 |
$2,257 |
14.3× |
| CT pelvis w & w/o contrast (72194) |
$1,896.30 |
$2,709 |
10.2× |
| CT pelvis w/o contrast (72192) |
$1,664.60 |
$2,378 |
15.1× |
| CT thoracic spine w/contrast (72129) |
$1,866.90 |
$2,667 |
10.1× |
| CT thoracic spine w/o contrast (72128) |
$1,614.90 |
$2,307 |
14.6× |
| CT thorax lung cancer scr c- (71271) |
$1,225.70 |
$1,751 |
11.1× |
| CT thorax w/o contrast (71250) |
$1,228.50 |
$1,755 |
11.1× |
| CT upper extremity w/dye (73201) |
$1,644.30 |
$2,349 |
4.5× |
| CTA head w contrast (70496) |
$2,151.10 |
$3,073 |
11.6× |
| Cystography, minimum of 3 views, radiological supervision and interpretation Age Under 21 (74430) |
$1,433.60 |
$2,048 |
3.9× |
| Dacryocystography, nasolacrimal duct, radiological supervision and interpretation Age Under 21 (70170) |
$842.80 |
$1,204 |
3.3× |
| Dilation ureters/urethra rs&i (74485) |
$2,697.10 |
$3,853 |
1.2× |
| Discography, cervical or thoracic, radiological supervision and interpretation Age Under 21 (72285) |
$4,176.90 |
$5,967 |
2.0× |
| Diskography lumbar s&i (72295) |
$3,903.20 |
$5,576 |
1.9× |
| Doppler echocardiography, fetal, pulsed wave and/or continuous wave with spectral display; complete Age Under 21 (76827) |
$667.10 |
$953 |
6.0× |
| Doppler fetal mid cerebral artery (76821) |
$864.50 |
$1,235 |
7.8× |
| Dual-energy X-ray absorptiometry (DXA), bone density study, 1 or more sites; axial skeleton (eg, hips, pelvis, spine)… (77080) |
$607.60 |
$868 |
5.5× |
| Dxa bone density/peripheral (77081) |
$303.80 |
$434 |
3.3× |
| Echo exam of eye (76529) |
$177.10 |
$253 |
1.9× |
| Echocardiography, fetal, cardiovascular system, real time with image documentation (2D), with or without M-mode… (76825) |
$995.40 |
$1,422 |
1.7× |
| Fetal biophys profile w/o nst (76819) |
$536.20 |
$766 |
4.9× |
| Fetal biophysical profile non-stress testing (76818) |
$714.70 |
$1,021 |
6.5× |
| Fluoroscopy up to 1 hour physician/qhp time (76000) |
$702.10 |
$1,003 |
2.8× |
| Gated heart planar single (78472) |
$3,384.50 |
$4,835 |
8.0× |
| Hepatc vngrph wdg/fr w/o hemodyn eval rs&i (75891) |
$3,813.60 |
$5,448 |
1.1× |
| Hepatic venography, wedged or free, with hemodynamic evaluation, radiological supervision and interpretation Age Under… (75889) |
$4,286.80 |
$6,124 |
1.3× |
| Hepatobil syst imag inc gb w/pharma intervenj (78227) |
$2,358.30 |
$3,369 |
4.1× |
| Hepatobiliary syst imaging including gallbladder (78226) |
$2,303.70 |
$3,291 |
5.5× |
| Ht muscle image spect sing (78451) |
$4,037.60 |
$5,768 |
3.0× |
| Injection procedure for radiopharmaceutical localization by non-imaging probe study, intravenous (eg, parathyroid… (78808) |
$906.50 |
$1,295 |
2.1× |
| Intensity modulated radiotherapy plan, including dose-volume histograms for target and critical structure partial… (77301) |
$10,122.70 |
$14,461 |
6.9× |
| Intestine imaging (eg, ectopic gastric mucosa, Meckel's localization, volvulus) Age Under 21 (78290) |
$1,740.90 |
$2,487 |
4.1× |
| Isodose brachytherapy complex 10+ sources (77318) |
$1,760.50 |
$2,515 |
4.5× |
| Isodose brachytherapy plan simple 1 to 4 source (77316) |
$1,084.30 |
$1,549 |
2.7× |
| Isodose teletherapy plan complex multi tx w/cal (77307) |
$1,507.10 |
$2,153 |
3.8× |
| Isodose teletherapy plan simple 1 or 2 port w/cal (77306) |
$802.90 |
$1,147 |
2.0× |
| Kidney imaging morphology; with vascular flow Age Under 21 (78701) |
$1,724.10 |
$2,463 |
4.1× |
| Kidney imaging morphology; with vascular flow and function, single study without pharmacological intervention Age Under… (78707) |
$2,368.10 |
$3,383 |
4.1× |
| Kidney imaging morphology; with vascular flow and function, single study, with pharmacological intervention (eg,… (78708) |
$2,368.10 |
$3,383 |
4.1× |
| Leveen/shunt patency exam (78291) |
$837.90 |
$1,197 |
2.0× |
| Liver and spleen imaging (78215) |
$1,491.70 |
$2,131 |
3.5× |
| Liver imaging (78201) |
$1,383.90 |
$1,977 |
2.4× |
| Lung perf&ventilat diferentl (78598) |
$2,616.60 |
$3,738 |
4.6× |
| Lung perfusion imaging (78580) |
$1,400 |
$2,000 |
3.3× |
| Lymphangiography, pelvic/abdominal, unilateral, radiological supervision and interpretation Age Under 21 (75805) |
$2,685.90 |
$3,837 |
0.8× |
| Magnetic resonance (eg, proton) imaging, any joint of lower extremity; without contrast material(s), followed by… (73723) |
$2,599.10 |
$3,713 |
7.1× |
| Magnetic resonance (eg, proton) imaging, lower extremity other than joint; with contrast material(s) Age Under 21 (73719) |
$2,496.20 |
$3,566 |
6.8× |
| Magnetic resonance (eg, proton) imaging, lower extremity other than joint; without contrast material(s) Age Under 21 (73718) |
$1,606.50 |
$2,295 |
6.4× |
| Magnetic resonance (eg, proton) imaging, lower extremity other than joint; without contrast material(s), followed by… (73720) |
$2,843.40 |
$4,062 |
7.7× |
| Magnetic resonance (eg, proton) imaging, orbit, face, and/or neck; with contrast material(s) Age Under 21 (70542) |
$2,698.50 |
$3,855 |
7.3× |
| Magnetic resonance (eg, proton) imaging, orbit, face, and/or neck; without contrast material(s) Age Under 21 (70540) |
$2,297.40 |
$3,282 |
9.1× |
| Magnetic resonance (eg, proton) imaging, upper extremity, other than joint; with contrast material(s) Age Under 21 (73219) |
$1,676.50 |
$2,395 |
4.6× |
| Magnetic resonance (eg, proton) imaging, upper extremity, other than joint; without contrast material(s), followed by… (73220) |
$3,083.50 |
$4,405 |
8.4× |
| Magnetic resonance angiography, head; with contrast material(s) Age Under 21 (70545) |
$3,249.40 |
$4,642 |
8.8× |
| Magnetic resonance angiography, head; without contrast material(s), followed by contrast material(s) and further… (70546) |
$3,491.60 |
$4,988 |
9.5× |
| Magnetic resonance angiography, neck; without contrast material(s), followed by contrast material(s) and further… (70549) |
$4,029.20 |
$5,756 |
10.9× |
| Mammary ductogram single (77053) |
$722.40 |
$1,032 |
2.9× |
| Mandible min 4v (70110) |
$400.40 |
$572 |
3.6× |
| Med physic dos eval rad exps (76145) |
$506.10 |
$723 |
1.3× |
| MRA head w/o contrast (70544) |
$3,109.40 |
$4,442 |
12.4× |
| MRA neck w/ contrast (70548) |
$3,491.60 |
$4,988 |
9.5× |
| MRA neck w/o contrast (70547) |
$3,109.40 |
$4,442 |
12.4× |
| MRI abdomen w/contrast (74182) |
$2,774.10 |
$3,963 |
7.5× |
| MRI abdomen w/o contrast (74181) |
$2,154.60 |
$3,078 |
8.6× |
| MRI abdomen w/wo contrast (74183) |
$2,942.10 |
$4,203 |
8.0× |
| MRI any jt lower extrem w/contrast material (73722) |
$1,924.30 |
$2,749 |
2.3× |
| MRI bone marrow (77084) |
$2,522.10 |
$3,603 |
10.0× |
| MRI breast c- bilateral (77047) |
$1,390.20 |
$1,986 |
5.5× |
| MRI breast without contrast material unilateral (77046) |
$515.20 |
$736 |
2.0× |
| MRI c-spine w&w/o cont (72156) |
$2,878.40 |
$4,112 |
7.8× |
| MRI cervical spine w/contrast (72142) |
$2,741.20 |
$3,916 |
7.4× |
| MRI chest w/o contrast (71550) |
$2,297.40 |
$3,282 |
9.1× |
| MRI chest w/wo contrast (71552) |
$3,290.70 |
$4,701 |
8.9× |
| MRI fetal sngl/1st gestation (74712) |
$3,609.20 |
$5,156 |
14.3× |
| MRI joint upr extr w/o&w/dye (73223) |
$2,843.40 |
$4,062 |
7.7× |
| MRI joint upr extrem w/dye (73222) |
$2,353.40 |
$3,362 |
2.8× |
| MRI joint upr extrem w/o dye (73221) |
$1,836.80 |
$2,624 |
7.3× |
| MRI lumbar spine w/contrast (72149) |
$2,741.20 |
$3,916 |
7.4× |
| MRI lumbar spine w/wo contrast (72158) |
$2,878.40 |
$4,112 |
7.8× |
| MRI orbit/face/neck w&w/o cont (70543) |
$2,970.80 |
$4,244 |
8.1× |
| MRI pelvis w & w/o contrast (72197) |
$3,271.80 |
$4,674 |
8.9× |
| MRI pelvis w/contrast (72196) |
$2,869.30 |
$4,099 |
7.8× |
| MRI pelvis w/o contrast (72195) |
$2,439.50 |
$3,485 |
9.7× |
| MRI spectroscopy (76390) |
$1,096.20 |
$1,566 |
11.9× |
| MRI spine cervical w/o contrast (72141) |
$2,109.80 |
$3,014 |
8.4× |
| MRI t-spine w&w/o cont (72157) |
$2,878.40 |
$4,112 |
7.8× |
| MRI thoracic spine w/contrast (72147) |
$2,741.20 |
$3,916 |
7.4× |
| MRI thoracic spine w/o contrst (72146) |
$2,231.60 |
$3,188 |
8.9× |
| MRI tmj (70336) |
$2,077.60 |
$2,968 |
8.3× |
| MRI upper extremity oth than jt w/o contr matrl (73218) |
$1,568 |
$2,240 |
6.2× |
| Multi-leaf collimator (MLC) device(s) for intensity modulated radiation therapy (IMRT), design and construction per… (77338) |
$1,712.20 |
$2,446 |
4.3× |
| Myelography, 2 or more regions (eg, lumbar/thoracic, cervical/thoracic, lumbar/cervical, lumbar/thoracic/cervical),… (72270) |
$2,139.90 |
$3,057 |
2.6× |
| Myocardial imaging, positron emission tomography (PET), perfusion study (including ventricular wall motionºs» and/or… (78492) |
$6,349.70 |
$9,071 |
4.2× |
| Myocardial spect multiple studies (78452) |
$5,352.20 |
$7,646 |
3.9× |
| N-invas est c ffr augmnt sw alys CTA i&r phy/qhp (75580) |
$2,240.70 |
$3,201 |
2.5× |
| Nm adrenal imaging (78075) |
$1,887.90 |
$2,697 |
1.4× |
| Nm bone 3 phase (78315) |
$2,110.50 |
$3,015 |
5.0× |
| Nm bone imaging whole body (78306) |
$2,018.80 |
$2,884 |
4.8× |
| Nm csf cisternogram (78630) |
$1,807.40 |
$2,582 |
3.2× |
| Nm gastric emptying (78264) |
$2,358.30 |
$3,369 |
5.6× |
| Nm lymph system (78195) |
$1,602.30 |
$2,289 |
2.8× |
| Nuclear medicine study for detecting heart shunt (78428) |
$786.10 |
$1,123 |
1.9× |
| Nuclear medicine study of bone and/or joint limited area (78300) |
$1,330 |
$1,900 |
3.2× |
| Nuclear medicine study of bone and/or joint multiple areas (78305) |
$1,834 |
$2,620 |
4.3× |
| Ob us limited fetus(s) (76815) |
$415.80 |
$594 |
3.8× |
| Ob us nuchal meas 1 gest (76813) |
$761.60 |
$1,088 |
6.9× |
| Ophthalmic ultrasound, diagnostic; B-scan (with or without superimposed non-quantitative A-scan) Age Under 21 (76512) |
$295.40 |
$422 |
2.7× |
| Panoramic X-ray of jaws (70355) |
$228.20 |
$326 |
2.5× |
| Parathyroid planar imaging (78070) |
$1,095.50 |
$1,565 |
2.6× |
| Parathyroid planar imaging w/wo subtraction (78071) |
$1,098.30 |
$1,569 |
2.6× |
| Percutaneous transhepatic portography with hemodynamic evaluation, radiological supervision and interpretation Age… (75885) |
$4,286.80 |
$6,124 |
1.3× |
| PET imaging CT attenuation skull base mid-thigh (78815) |
$5,310.20 |
$7,586 |
3.5× |
| PET imaging CT for attenuation limited area (78814) |
$5,040.70 |
$7,201 |
3.3× |
| PET imaging for CT attenuation whole body (78816) |
$5,841.50 |
$8,345 |
3.9× |
| Prq transhepatc portograpy w/o hemodyn evl intrp (75887) |
$3,686.20 |
$5,266 |
1.1× |
| Pulmonary ventilation & perfusion imaging (78582) |
$2,805.60 |
$4,008 |
4.9× |
| Radex abscess/fistula/sinus tract rs&i (76080) |
$1,800.05 |
$2,571.50 |
3.1× |
| Radex entir thrc lmbr crv sac spi w/skull 1 vw (72081) |
$204.40 |
$292 |
2.2× |
| Radex entir thrc lmbr crv sac spi w/skull 2/3 vw (72082) |
$233.10 |
$333 |
2.1× |
| Radex entir thrc lmbr crv sac spi w/skull 4/5 vw (72083) |
$265.30 |
$379 |
2.4× |
| Radex entir thrc lmbr crv sac spi w/skull 6/> vw (72084) |
$277.90 |
$397 |
2.5× |
| Radex hip unilateral with pelvis 1 view (73501) |
$308 |
$440 |
3.4× |
| Radex hip unilateral with pelvis 2-3 views (73502) |
$468.30 |
$669 |
5.1× |
| Radex hip unilateral with pelvis minimum 4 views (73503) |
$599.20 |
$856 |
5.4× |
| Radex hips bilateral with pelvis 2 views (73521) |
$388.50 |
$555 |
3.5× |
| Radex hips bilateral with pelvis minimum 5 views (73523) |
$595 |
$850 |
5.4× |
| Radex spine cervical 2 or 3 views (72040) |
$403.90 |
$577 |
4.4× |
| Radex spine cervical 4 or 5 views (72050) |
$613.90 |
$877 |
5.6× |
| Radex spine cervical 6 or more views (72052) |
$700.70 |
$1,001 |
6.4× |
| Radex spine thoracolumbar junction min 2 views (72080) |
$335.30 |
$479 |
3.7× |
| Radiation treatment delivery, stereotactic radiosurgery (SRS), complete course of treatment of cranial lesion(s)… (77372) |
$16,931.60 |
$24,188 |
2.2× |
| Radiation tx delivery lvl 1 (77402) |
$433.30 |
$619 |
4.0× |
| Radiation tx delivery lvl 2 (77407) |
$442.40 |
$632 |
1.1× |
| Radiation tx delivery lvl 3 (77412) |
$1,311.10 |
$1,873 |
2.2× |
| Radiologic exam abdomen 3+ views (74021) |
$435.40 |
$622 |
3.9× |
| Radiologic exam chest 3 views (71047) |
$442.40 |
$632 |
4.8× |
| Radiologic exam chest 4+ views (71048) |
$461.30 |
$659 |
4.2× |
| Radiologic exam colon double contrast study (74280) |
$1,076.60 |
$1,538 |
5.8× |
| Radiologic exam colon single contrast study (74270) |
$903 |
$1,290 |
4.9× |
| Radiologic exam esophagus double contrast study (74221) |
$785.40 |
$1,122 |
4.2× |
| Radiologic exam esophagus single contrast study (74220) |
$611.10 |
$873 |
3.3× |
| Radiologic exam small int single contrast study (74250) |
$785.40 |
$1,122 |
4.2× |
| Radiologic exam swallow function contrast study (74230) |
$510.30 |
$729 |
2.8× |
| Radiologic exam upr gi trc double contrast study (74246) |
$903 |
$1,290 |
4.9× |
| Radiologic exam upr gi trc single contrast study (74240) |
$678.30 |
$969 |
3.7× |
| Radiologic examination femur 1 view (73551) |
$228.90 |
$327 |
2.5× |
| Radiologic examination femur minimum 2 views (73552) |
$284.90 |
$407 |
3.1× |
| Radiologic examination from nose to rectum for foreign body, single view, child Age Under 21 (76010) |
$338.80 |
$484 |
3.7× |
| Radiologic examination, ankle; complete, minimum of 3 views Age Under 21 (73610) |
$304.50 |
$435 |
3.3× |
| Radiologic examination, complete acute abdomen series, including 2 or more views of the abdomen (eg, supine, erect,… (74022) |
$499.10 |
$713 |
4.5× |
| Radiologic examination, elbow; 2 views Age Under 21 (73070) |
$242.20 |
$346 |
2.6× |
| Radiologic examination, elbow; complete, minimum of 3 views Age Under 21 (73080) |
$310.80 |
$444 |
3.4× |
| Radiologic examination, facial bones; less than 3 views Age Under 21 (70140) |
$271.60 |
$388 |
3.0× |
| Radiologic examination, foot; complete, minimum of 3 views Age Under 21 (73630) |
$322.70 |
$461 |
3.5× |
| Radiologic examination, hand; minimum of 3 views Age Under 21 (73130) |
$403.90 |
$577 |
4.4× |
| Radiologic examination, knee; both knees, standing, anteroposterior Age Under 21 (73565) |
$172.90 |
$247 |
1.9× |
| Radiologic examination, knee; complete, 4 or more views Age Under 21 (73564) |
$403.90 |
$577 |
3.7× |
| Radiologic examination, mandible; partial, less than 4 views Age Under 21 (70100) |
$379.40 |
$542 |
4.1× |
| Radiologic examination, mastoids; complete, minimum of 3 views per side Age Under 21 (70130) |
$435.40 |
$622 |
3.9× |
| Radiologic examination, nasal bones, complete, minimum of 3 views Age Under 21 (70160) |
$351.40 |
$502 |
3.8× |
| Radiologic examination, ribs, bilateral; including posteroanterior chest, minimum of 4 views Age Under 21 (71111) |
$609 |
$870 |
5.5× |
| Radiologic examination, ribs, unilateral; including posteroanterior chest, minimum of 3 views Age Under 21 (71101) |
$401.10 |
$573 |
3.6× |
| Radiologic examination, sacroiliac joints; less than 3 views Age Under 21 (72200) |
$284.90 |
$407 |
2.6× |
| Radiologic examination, shoulder, arthrography, radiological supervision and interpretation Age Under 21 (73040) |
$996.10 |
$1,423 |
2.7× |
| Radiologic examination, shoulder; complete, minimum of 2 views Age Under 21 (73030) |
$254.10 |
$363 |
2.8× |
| Radiologic examination, single plane body section (eg, tomography), other than with urography Age Under 21 (76100) |
$609 |
$870 |
5.5× |
| Radiologic examination, sinuses, paranasal, less than 3 views Age Under 21 (70210) |
$354.90 |
$507 |
3.9× |
| Radiologic examination, skull; less than 4 views Age Under 21 (70250) |
$351.40 |
$502 |
3.2× |
| Radiologic examination, spine, lumbosacral; 2 or 3 views Age Under 21 (72100) |
$375.20 |
$536 |
3.4× |
| Radiologic examination, spine, lumbosacral; bending views only, 2 or 3 views Age Under 21 (72120) |
$403.90 |
$577 |
3.7× |
| Radiologic examination, spine, lumbosacral; complete, including bending views, minimum of 6 views Age Under 21 (72114) |
$700.70 |
$1,001 |
6.4× |
| Radiologic examination, spine; thoracic, minimum of 4 views Age Under 21 (72074) |
$574 |
$820 |
5.2× |
| Radiologic examination, wrist; complete, minimum of 3 views Age Under 21 (73110) |
$310.80 |
$444 |
3.4× |
| Radiologic examination; acromioclavicular joints, bilateral, with or without weighted distraction Age Under 21 (73050) |
$403.90 |
$577 |
4.4× |
| Radiologic examination; humerus, minimum of 2 views Age Under 21 (73060) |
$254.10 |
$363 |
2.8× |
| Radiologic examination; lower extremity, infant, minimum of 2 views Age Under 21 (73592) |
$396.20 |
$566 |
4.3× |
| Radiologic examination; orbits, complete, minimum of 4 views Age Under 21 (70200) |
$403.90 |
$577 |
3.7× |
| Radiologic examination; sternoclavicular joint or joints, minimum of 3 views Age Under 21 (71130) |
$403.90 |
$577 |
4.4× |
| Radiologic examination; toe(s), minimum of 2 views Age Under 21 (73660) |
$288.40 |
$412 |
3.1× |
| Radiologic examination; upper extremity, infant, minimum of 2 views Age Under 21 (73092) |
$351.40 |
$502 |
3.2× |
| Radiopharmaceutical localization of tumor, inflammatory process or distribution of radiopharmaceutical agent(s)… (78803) |
$3,868.90 |
$5,527 |
6.8× |
| Radiopharmaceutical therapy, by intravenous administration Age Under 21 (79101) |
$4,967.20 |
$7,096 |
20.2× |
| Radiopharmaceutical therapy, by oral administration Age Under 21 (79005) |
$2,275 |
$3,250 |
9.2× |
| Review by radiologist of urinary bladder and urethra images with contrast and after passing urine (74455) |
$1,246.70 |
$1,781 |
5.0× |
| Rp loclzj tum plnr 1 area single day imaging (78800) |
$828.80 |
$1,184 |
2.0× |
| Rp loclzj tum plnr 2+area 1+d img/1 area img>2+d (78801) |
$1,821.40 |
$2,602 |
4.3× |
| Rp loclzj tum plnr whole body 2+ days imaging (78804) |
$4,042.50 |
$5,775 |
7.1× |
| Rp loclzj tum plnr whole body single day imaging (78802) |
$1,981.70 |
$2,831 |
3.5× |
| Rp loclzj tum spect 2 areas (78831) |
$3,922.10 |
$5,603 |
2.9× |
| Rp loclzj tum spect w/CT 1 (78830) |
$2,578.80 |
$3,684 |
1.9× |
| Rp therapy intra-arterial particulate admn (79445) |
$805 |
$1,150 |
3.3× |
| Saline infusion sonohysterography (SIS), including color flow Doppler, when performed Age Under 21 (76831) |
$714.70 |
$1,021 |
2.8× |
| Scapula complete (73010) |
$351.40 |
$502 |
3.2× |
| Screening digital breast tomosynthesis bi (77063) |
$59.50 |
$85 |
— |
| Shuntogram indwelling nonvascular shunt rs&i (75809) |
$1,087.10 |
$1,553 |
9.9× |
| Simulation intermediate (77285) |
$1,305.50 |
$1,865 |
3.3× |
| Special dosimetry (77331) |
$1,224.30 |
$1,749 |
8.6× |
| Special physics consult (77370) |
$522.90 |
$747 |
3.7× |
| Special teletherapy port plan (77321) |
$1,472.80 |
$2,104 |
3.7× |
| Special treatment procedure (77470) |
$2,056.60 |
$2,938 |
3.5× |
| Splenoportography, radiological supervision and interpretation Age Under 21 (75810) |
$3,845.10 |
$5,493 |
1.2× |
| Stereotactic body radiation therapy, treatment delivery, per fraction to 1 or more lesions, including image guidance,… (77373) |
$11,090.10 |
$15,843 |
5.9× |
| Ther rad simulaj-aided field setting complex (77290) |
$1,957.20 |
$2,796 |
5.0× |
| Therapeutic enema, contrast or air, for reduction of intussusception or other intraluminal obstruction (eg, meconium… (74283) |
$785.40 |
$1,122 |
4.2× |
| Thyroid met imaging body (78018) |
$2,278.50 |
$3,255 |
4.0× |
| Thyroid uptake single/multiple quant measurement (78012) |
$781.20 |
$1,116 |
1.9× |
| Thyroid uptake w/blood flow sngle/mult quan meas (78014) |
$1,460.20 |
$2,086 |
3.5× |
| Tr simulation simple (77280) |
$1,035.30 |
$1,479 |
7.3× |
| Treatment device complex (77334) |
$1,712.20 |
$2,446 |
4.3× |
| Treatment device intermediate (77333) |
$1,208.90 |
$1,727 |
8.5× |
| Treatment device simple (77332) |
$958.30 |
$1,369 |
6.8× |
| Ultrasound breast limited (76642) |
$454.30 |
$649 |
4.9× |
| Ultrasound, abdomen limited (76705) |
$616.70 |
$881 |
5.6× |
| Ultrasound, limited, joint or focal evaluation of other nonvascular extremity structure(s) (eg, joint space,… (76882) |
$642.60 |
$918 |
5.8× |
| Ultrasound, pelvic (nonobstetric), real time with image documentation; complete Age Under 21 (76856) |
$714.70 |
$1,021 |
6.5× |
| Ultrasound, pregnant uterus, real time with image documentation, fetal and maternal evaluation plus detailed fetal… (76811) |
$1,246.70 |
$1,781 |
5.0× |
| Ultrasound, pregnant uterus, real time with image documentation, fetal and maternal evaluation, first trimester (< 14… (76801) |
$822.50 |
$1,175 |
7.5× |
| Ultrasound, transplanted kidney, real time and duplex Doppler with image documentation Age Under 21 (76776) |
$822.50 |
$1,175 |
7.5× |
| Ultrasound, transrectal; prostate volume study for brachytherapy treatment planning (separate procedure) Age Under 21 (76873) |
$1,067.50 |
$1,525 |
9.7× |
| Umbilical-artery Doppler (OB) (76820) |
$864.50 |
$1,235 |
7.8× |
| Unlisted endocrine procedure, diagnostic nuclear medicine (78099) |
$822.82 |
$1,175.45 |
2.0× |
| Unlisted fluoroscopic procedure (76496) |
$560 |
$800 |
6.1× |
| Unlisted magnetic resonance procedure (eg, diagnostic, interventional) Age Under 21 (76498) |
$3,566.20 |
$5,094.56 |
38.8× |
| Unlisted miscellaneous procedure, diagnostic nuclear medicine (78999) |
$754.58 |
$1,077.96 |
1.8× |
| Urethrocystography retrograde rs&i (74450) |
$1,246.70 |
$1,781 |
5.0× |
| Urography (pyelography), intravenous, with or without KUB, with or without tomography Age Under 21 (74400) |
$810.60 |
$1,158 |
4.4× |
| Urography antegrade rs&i (74425) |
$810.60 |
$1,158 |
2.2× |
| Us abdominal aorta real time screen study aaa (76706) |
$735 |
$1,050 |
6.7× |
| Us breast uni real time with image complete (76641) |
$501.90 |
$717 |
4.6× |
| Us chest (76604) |
$822.50 |
$1,175 |
7.5× |
| Us compl joint r-t w/image documentation (76881) |
$822.50 |
$1,175 |
7.5× |
| Us elastography organ (76981) |
$256.20 |
$366 |
2.3× |
| Us encephalogram (76506) |
$714.70 |
$1,021 |
6.5× |
| Us exam, pelvic, limited (76857) |
$529.20 |
$756 |
4.8× |
| Us guided compression repair (76936) |
$1,679.30 |
$2,399 |
7.4× |
| Us inft hips r-t img dynamic req phys/qhp manj (76885) |
$714.70 |
$1,021 |
7.8× |
| Us inft hips r-t img lmtd static phys/qhp manj (76886) |
$379.40 |
$542 |
4.1× |
| US OB Follow-Up/Repeat (76816) |
$529.20 |
$756 |
4.8× |
| Us ob transvaginal (76817) |
$822.50 |
$1,175 |
7.5× |
| Us retroperitoneal complete (76770) |
$697.20 |
$996 |
6.3× |
| Us retroperitoneal ltd (76775) |
$619.50 |
$885 |
5.6× |
| Us scrotum (76870) |
$822.50 |
$1,175 |
7.5× |
| Us soft tissue head/neck (76536) |
$834.40 |
$1,192 |
7.6× |
| Us spinal canal (76800) |
$714.70 |
$1,021 |
6.5× |
| Us unlstd proc (76999) |
$206.72 |
$295.31 |
2.3× |
| Use 1st target lesion (76982) |
$238 |
$340 |
2.2× |
| Venogram sinus/jugular (75860) |
$3,813.60 |
$5,448 |
1.1× |
| Venography adrenal unilateral selective rs&i (75840) |
$3,686.20 |
$5,266 |
1.1× |
| Venography deep dorsal vein penis radiolgicl supervision interpretation (76499) |
$1,425.21 |
$2,036.01 |
15.5× |
| Venography renal unilateral selective rs&i (75831) |
$4,109.70 |
$5,871 |
1.2× |
| Venography, caval, inferior, with serialography, radiological supervision and interpretation Age Under 21 (75825) |
$3,318 |
$4,740 |
1.0× |
| Venography, caval, superior, with serialography, radiological supervision and interpretation Age Under 21 (75827) |
$3,517.50 |
$5,025 |
2.1× |
| Venography, extremity, bilateral, radiological supervision and interpretation Age Under 21 (75822) |
$2,268.70 |
$3,241 |
1.4× |
| Venography, extremity, unilateral, radiological supervision and interpretation Age Under 21 (75820) |
$1,881.60 |
$2,688 |
1.1× |
| Venous sampling thru cath w/wo angiography rs& (75893) |
$4,507.30 |
$6,439 |
0.8× |
| X-ray exam hips bi 3-4 views (73522) |
$506.10 |
$723 |
4.6× |
| X-ray exam of finger(s) (73140) |
$351.40 |
$502 |
3.8× |
| X-ray exam of knee 1 or 2 (73560) |
$275.80 |
$394 |
3.0× |
| X-ray exam ribs bil 3 views (71110) |
$430.50 |
$615 |
3.9× |
| X-ray exam ribs uni 2 views (71100) |
$351.40 |
$502 |
3.8× |
| X-ray heel (73650) |
$263.20 |
$376 |
2.9× |
| X-ray of joint between lower spine and hip bone 3 or more views|PROFESSIONAL COMPONENT (72202) |
$403.90 |
$577 |
3.7× |
| Xr abdomen 1 view (74018) |
$389.90 |
$557 |
4.2× |
| Xr abdomen 2 views (74019) |
$401.10 |
$573 |
3.6× |
| Xr arthrogram elbow (73085) |
$996.10 |
$1,423 |
2.7× |
| Xr arthrogram hip (73525) |
$996.10 |
$1,423 |
2.7× |
| Xr arthrogram knee (73580) |
$996.10 |
$1,423 |
2.7× |
| Xr arthrogram wrist (73115) |
$996.10 |
$1,423 |
2.7× |
| Xr bone age studies (77072) |
$207.20 |
$296 |
1.9× |
| Xr bone length study (77073) |
$403.90 |
$577 |
3.7× |
| Xr bone survey infant (77076) |
$609 |
$870 |
5.5× |
| Xr bone survey ltd (77074) |
$317.10 |
$453 |
2.9× |
| Xr chest 1 view (71045) |
$378.70 |
$541 |
4.1× |
| Xr chest 2 views (71046) |
$403.90 |
$577 |
4.4× |
| Xr eye foreign body (70030) |
$392 |
$560 |
4.3× |
| Xr facial bones 3+ views (70150) |
$282.80 |
$404 |
2.6× |
| Xr foot arthritis pa only bilateral - report(ortho pro) (73620) |
$251.30 |
$359 |
2.7× |
| Xr forearm 2 views (73090) |
$254.10 |
$363 |
2.8× |
| Xr hand 2v (73120) |
$336 |
$480 |
3.0× |
| Xr hysterosalpingogram (74740) |
$1,494.50 |
$2,135 |
5.9× |
| Xr joint survey 1 view (77077) |
$351.40 |
$502 |
3.2× |
| Xr myelogram c-spine (72240) |
$1,685.60 |
$2,408 |
2.0× |
| Xr myelogram l-spine (72265) |
$1,694 |
$2,420 |
2.0× |
| Xr myelogram t-spine (72255) |
$1,570.10 |
$2,243 |
1.9× |
| Xr neck soft tissue (70360) |
$256.20 |
$366 |
2.8× |
| Xr o knee w/ merchant view bilat - report(ortho pro) (73562) |
$322.70 |
$461 |
3.5× |
| Xr osseous survey complete (77075) |
$579.60 |
$828 |
5.3× |
| Xr pelvis 1-2 views (72170) |
$338.80 |
$484 |
3.1× |
| Xr pelvis min 3 view (72190) |
$349.30 |
$499 |
3.2× |
| Xr peritoneogram (74190) |
$1,666 |
$2,380 |
2.9× |
| Xr sacrum/coccyx 2+ views (72220) |
$261.10 |
$373 |
2.8× |
| Xr sella turcica (70240) |
$133 |
$190 |
1.4× |
| Xr shoulder 1 view (73020) |
$249.20 |
$356 |
2.7× |
| Xr sialogram (70390) |
$1,201.90 |
$1,717 |
4.8× |
| Xr sinuses 3+ views (70220) |
$403.90 |
$577 |
4.4× |
| Xr skull min 4 view (70260) |
$537.60 |
$768 |
4.9× |
| Xr spine 1 view (72020) |
$291.90 |
$417 |
3.2× |
| Xr spine thoracic 3v (72072) |
$401.10 |
$573 |
3.6× |
| Xr sternum 2+ views (71120) |
$351.40 |
$502 |
3.8× |
| Xr surgical specimen (76098) |
$452.90 |
$647 |
0.8× |
| Xr t-spine 2 views (72070) |
$361.90 |
$517 |
3.3× |
| Xr tibia/fibula 2 views (73590) |
$254.10 |
$363 |
2.8× |
| Xr tmj bilateral (70330) |
$500.50 |
$715 |
5.5× |
| Xr tmj unilateral (70328) |
$434.70 |
$621 |
4.7× |
| Xr venogram renal bilat (75833) |
$4,416.30 |
$6,309 |
1.3× |
| Xr wrist 2 views (73100) |
$242.20 |
$346 |
2.6× |