| 3-D radiotherapy plan dose-volume histograms (77295) |
$2,473.60 |
$3,092 |
1.7× |
| Acute gi blood loss imaging (78278) |
$540 |
$675 |
1.3× |
| Angiography pulmonary bilateral slctv rs&i (75743) |
$2,100.40 |
$2,625.50 |
0.7× |
| Angiography visceral slctv/supraslctv rs&i (75726) |
$3,351.20 |
$4,189 |
0.6× |
| Angiography, extremity, bilateral, radiological supervision and interpretation Age Under 21 (75716) |
$2,754 |
$3,442.50 |
0.9× |
| Angiography, extremity, unilateral, radiological supervision and interpretation Age Under 21 (75710) |
$2,189.60 |
$2,737 |
0.7× |
| Angiography, pelvic, selective or supraselective, radiological supervision and interpretation Age Under 21 (75736) |
$3,380 |
$4,225 |
0.6× |
| Angiography, pulmonary, unilateral, selective, radiological supervision and interpretation Age Under 21 (75741) |
$1,838.40 |
$2,298 |
0.6× |
| Angrph cath f-up std tcat other than thrombylsis (75898) |
$1,004 |
$1,255 |
0.3× |
| Ankle 2 views (73600) |
$103.20 |
$129 |
1.2× |
| Aortography, abdominal plus bilateral iliofemoral lower extremity, catheter, by serialography, radiological supervision… (75630) |
$947.20 |
$1,184 |
0.3× |
| Aortography, abdominal, by serialography, radiological supervision and interpretation Age Under 21 (75625) |
$512 |
$640 |
0.2× |
Aortography, thoracic, by serialography, radiological supervision and interpretation Age Under 21 (75605)
likely a partial charge — not the full procedure |
$530.40 |
$663 |
0.1× |
| Basic radiation dosimetry calculation (77300) |
$197.60 |
$247 |
1.4× |
| Brain imaging, positron emission tomography (PET); metabolic evaluation Age Under 21 (78608) |
$1,643.20 |
$2,054 |
1.1× |
| Cholecystography, oral contrast Age Under 21 (74290) |
$209.60 |
$262 |
1.2× |
| Clavicle complete (73000) |
$97.60 |
$122 |
1.1× |
| Computed tomographic (CT) colonography, diagnostic, including image postprocessing; without contrast material Age Under… (74261) |
$676.40 |
$845.50 |
6.3× |
| Computed tomographic (CT) colonography, screening, including image postprocessing (74263) |
$1,132.80 |
$1,416 |
4.6× |
| Computed tomographic angiography, abdomen and pelvis, with contrast material(s), including noncontrast images, if… (74174) |
$1,700.80 |
$2,126 |
4.8× |
| Computed tomographic angiography, abdomen, with contrast material(s), including noncontrast images, if performed, and… (74175) |
$972.40 |
$1,215.50 |
5.4× |
| Computed tomographic angiography, abdominal aorta and bilateral iliofemoral lower extremity runoff, with contrast… (75635) |
$1,010.40 |
$1,263 |
5.6× |
| Computed tomographic angiography, chest (noncoronary), with contrast material(s), including noncontrast images, if… (71275) |
$984 |
$1,230 |
5.5× |
| Computed tomographic angiography, lower extremity, with contrast material(s), including noncontrast images, if… (73706) |
$947.60 |
$1,184.50 |
5.3× |
| Computed tomographic angiography, neck, with contrast material(s), including noncontrast images, if performed, and… (70498) |
$918.40 |
$1,148 |
5.1× |
| Computed tomographic angiography, pelvis, with contrast material(s), including noncontrast images, if performed, and… (72191) |
$945.20 |
$1,181.50 |
5.3× |
| Computed tomographic angiography, upper extremity, with contrast material(s), including noncontrast images, if… (73206) |
$932.80 |
$1,166 |
5.2× |
| Computed tomography, cervical spine; without contrast material, followed by contrast material(s) and further sections… (72127) |
$908.80 |
$1,136 |
5.1× |
| Computed tomography, lower extremity; without contrast material Age Under 21 (73700) |
$671.60 |
$839.50 |
6.3× |
| Computed tomography, lower extremity; without contrast material, followed by contrast material(s) and further sections… (73702) |
$816.80 |
$1,021 |
4.6× |
| Computed tomography, lumbar spine; without contrast material, followed by contrast material(s) and further sections Age… (72133) |
$908.80 |
$1,136 |
5.1× |
| Computed tomography, maxillofacial area; with contrast material(s) Age Under 21 (70487) |
$699.60 |
$874.50 |
3.9× |
| Computed tomography, maxillofacial area; without contrast material Age Under 21 (70486) |
$612.40 |
$765.50 |
5.7× |
| Computed tomography, orbit, sella, or posterior fossa or outer, middle, or inner ear; with contrast material(s) Age… (70481) |
$728.80 |
$911 |
4.1× |
| Computed tomography, orbit, sella, or posterior fossa or outer, middle, or inner ear; without contrast material Age… (70480) |
$660.40 |
$825.50 |
6.2× |
| Computed tomography, orbit, sella, or posterior fossa or outer, middle, or inner ear; without contrast material,… (70482) |
$821.20 |
$1,026.50 |
4.6× |
| Computed tomography, soft tissue neck; without contrast material followed by contrast material(s) and further sections… (70492) |
$822.40 |
$1,028 |
4.6× |
| Computed tomography, thoracic spine; without contrast material, followed by contrast material(s) and further sections… (72130) |
$908.80 |
$1,136 |
5.1× |
| Computed tomography, thorax, diagnostic; without contrast material, followed by contrast material(s) and further… (71270) |
$922 |
$1,152.50 |
5.1× |
| Continuing medical physics consultation, including assessment of treatment parameters, quality assurance of dose… (77336) |
$425.60 |
$532 |
3.1× |
| Csf shunt evaluation (78645) |
$416 |
$520 |
0.7× |
| CT abdomen and pelvis without and with contrast (74178) |
$1,354.40 |
$1,693 |
3.8× |
| CT abdomen and pelvis without contrast (74176) |
$1,123.60 |
$1,404.50 |
4.6× |
| CT abdomen w & w/o contrast (74170) |
$902.80 |
$1,128.50 |
5.0× |
| CT abdomen w/contrast (74160) |
$789.20 |
$986.50 |
4.4× |
| CT abdomen w/o contrast (74150) |
$706.80 |
$883.50 |
6.6× |
| CT angio hrt w/3d image (75574) |
$536 |
$670 |
1.5× |
| CT cervical spine w/contrast (72126) |
$795.60 |
$994.50 |
2.2× |
| CT cervical spine w/o contrast (72125) |
$709.20 |
$886.50 |
6.6× |
| CT chest w/contrast (71260) |
$813.20 |
$1,016.50 |
4.5× |
| CT extremity upper w & w/o contrast (73202) |
$851.60 |
$1,064.50 |
4.8× |
| CT extremity upper w/o contrast (73200) |
$671.60 |
$839.50 |
6.3× |
| CT head/brain with contrast (70460) |
$699.60 |
$874.50 |
3.9× |
| CT head/brain without and with contrast (70470) |
$802.40 |
$1,003 |
4.5× |
| CT heart c+ cardiac strux&morph cgen hrt ds (75573) |
$1,350 |
$1,687.50 |
3.8× |
| CT heart contrast eval cardiac structure&morph (75572) |
$1,070.40 |
$1,338 |
3.0× |
| CT heart no contrast quant eval coronry calcium (75571) |
$97.60 |
$122 |
1.1× |
| CT l-spine w/contrast (72132) |
$795.60 |
$994.50 |
2.2× |
| CT limited/localized follow up study (76380) |
$516.80 |
$646 |
5.8× |
| CT lower extremity w/dye (73701) |
$753.20 |
$941.50 |
4.2× |
| CT lumbar spine w/o contrast (72131) |
$702 |
$877.50 |
6.6× |
| CT maxillofacial w/wo contrast (70488) |
$801.60 |
$1,002 |
4.5× |
| CT neck w/contrast (70491) |
$781.60 |
$977 |
4.4× |
| CT neck w/o contrast (70490) |
$660.40 |
$825.50 |
6.2× |
| CT pelvis w & w/o contrast (72194) |
$881.20 |
$1,101.50 |
4.9× |
| CT pelvis w/o contrast (72192) |
$712 |
$890 |
6.7× |
| CT thoracic spine w/contrast (72129) |
$795.60 |
$994.50 |
4.4× |
| CT thoracic spine w/o contrast (72128) |
$702 |
$877.50 |
6.6× |
| CT thorax lung cancer scr c- (71271) |
$241.60 |
$302 |
2.3× |
| CT thorax w/o contrast (71250) |
$704 |
$880 |
6.6× |
| CT upper extremity w/dye (73201) |
$720 |
$900 |
2.0× |
| CTA head w contrast (70496) |
$918.40 |
$1,148 |
5.1× |
| Cystography, minimum of 3 views, radiological supervision and interpretation Age Under 21 (74430) |
$387.20 |
$484 |
1.1× |
| Dacryocystography, nasolacrimal duct, radiological supervision and interpretation Age Under 21 (70170) |
$230.40 |
$288 |
0.9× |
| Dilation ureters/urethra rs&i (74485) |
$421.20 |
$526.50 |
0.2× |
| Discography, cervical or thoracic, radiological supervision and interpretation Age Under 21 (72285) |
$1,256 |
$1,570 |
0.6× |
| Diskography lumbar s&i (72295) |
$1,227.20 |
$1,534 |
0.6× |
| Doppler echocardiography, fetal, pulsed wave and/or continuous wave with spectral display; complete Age Under 21 (76827) |
$233.60 |
$292 |
2.2× |
| Doppler echocardiography, fetal, pulsed wave and/or continuous wave with spectral display; follow-up or repeat study… (76828) |
$111.20 |
$139 |
1.0× |
| Doppler fetal mid cerebral artery (76821) |
$262 |
$327.50 |
2.5× |
| Dxa bone density study axial skeleton (77085) |
$212 |
$265 |
2.0× |
| Dxa bone density/peripheral (77081) |
$131.20 |
$164 |
1.5× |
| Echocardiography, fetal, cardiovascular system, real time with image documentation (2D), with or without M-mode… (76825) |
$476.80 |
$596 |
0.9× |
| Fetal biophys profile w/o nst (76819) |
$267.60 |
$334.50 |
2.5× |
| Fetal biophysical profile non-stress testing (76818) |
$407.20 |
$509 |
3.8× |
| Fluoroscopy up to 1 hour physician/qhp time (76000) |
$334.40 |
$418 |
1.4× |
| Gastroesophageal reflux study (78262) |
$471.60 |
$589.50 |
1.2× |
| Gated heart planar single (78472) |
$217.60 |
$272 |
0.5× |
| Hepatc vngrph wdg/fr w/o hemodyn eval rs&i (75891) |
$990.80 |
$1,238.50 |
0.3× |
| Hepatobil syst imag inc gb w/pharma intervenj (78227) |
$865.60 |
$1,082 |
1.6× |
| Hepatobiliary syst imaging including gallbladder (78226) |
$652.40 |
$815.50 |
1.6× |
| Ht muscle image spect sing (78451) |
$538.40 |
$673 |
0.4× |
| Intensity modulated radiotherapy plan, including dose-volume histograms for target and critical structure partial… (77301) |
$3,170 |
$3,962.50 |
2.2× |
| Intestine imaging (eg, ectopic gastric mucosa, Meckel's localization, volvulus) Age Under 21 (78290) |
$407.60 |
$509.50 |
1.0× |
| Isodose teletherapy plan complex multi tx w/cal (77307) |
$500 |
$625 |
1.3× |
| Isodose teletherapy plan simple 1 or 2 port w/cal (77306) |
$499.20 |
$624 |
1.3× |
| Kidney imaging morphology; with vascular flow and function, multiple studies, with and without pharmacological… (78709) |
$609.60 |
$762 |
1.1× |
| Kidney imaging morphology; with vascular flow and function, single study, with pharmacological intervention (eg,… (78708) |
$506.80 |
$633.50 |
0.9× |
| Labeled red cell sequestration, differential organ/tissue (eg, splenic and/or hepatic) Age Under 21 (78140) |
$384.40 |
$480.50 |
0.9× |
| Liver and spleen imaging (78215) |
$343.20 |
$429 |
0.8× |
| Liver and spleen imaging; with vascular flow Age Under 21 (78216) |
$343.20 |
$429 |
0.8× |
| Lung perfusion imaging (78580) |
$413.20 |
$516.50 |
1.0× |
| Magnetic resonance (eg, proton) imaging, any joint of lower extremity; without contrast material(s), followed by… (73723) |
$487.20 |
$609 |
1.4× |
| Magnetic resonance (eg, proton) imaging, lower extremity other than joint; without contrast material(s) Age Under 21 (73718) |
$906.80 |
$1,133.50 |
3.7× |
| Magnetic resonance (eg, proton) imaging, lower extremity other than joint; without contrast material(s), followed by… (73720) |
$487.20 |
$609 |
1.4× |
| Magnetic resonance (eg, proton) imaging, orbit, face, and/or neck; without contrast material(s) Age Under 21 (70540) |
$305.60 |
$382 |
1.3× |
| Magnetic resonance (eg, proton) imaging, upper extremity, other than joint; without contrast material(s), followed by… (73220) |
$1,233.20 |
$1,541.50 |
3.5× |
| Magnetic resonance angiography, head; without contrast material(s), followed by contrast material(s) and further… (70546) |
$1,311.20 |
$1,639 |
3.7× |
| Magnetic resonance angiography, neck; without contrast material(s), followed by contrast material(s) and further… (70549) |
$408 |
$510 |
1.1× |
| Mammary ductogram or galactogram, multiple ducts, radiological supervision and interpretation Age Under 21 (77054) |
$335.20 |
$419 |
1.4× |
| Mammary ductogram single (77053) |
$266 |
$332.50 |
1.1× |
| Mandible min 4v (70110) |
$113.60 |
$142 |
1.1× |
| MRA head w/o contrast (70544) |
$273.60 |
$342 |
1.1× |
| MRI abdomen w/contrast (74182) |
$1,062.40 |
$1,328 |
3.0× |
| MRI abdomen w/o contrast (74181) |
$836.40 |
$1,045.50 |
3.4× |
| MRI abdomen w/wo contrast (74183) |
$1,249.60 |
$1,562 |
3.5× |
| MRI any jt lower extrem w/contrast material (73722) |
$981.20 |
$1,226.50 |
1.2× |
| MRI c-spine w&w/o cont (72156) |
$519.20 |
$649 |
1.5× |
| MRI cervical spine w/contrast (72142) |
$930.80 |
$1,163.50 |
2.6× |
| MRI chest w/o contrast (71550) |
$214 |
$267.50 |
0.9× |
| MRI chest w/wo contrast (71552) |
$1,185.20 |
$1,481.50 |
3.3× |
| MRI joint upr extr w/o&w/dye (73223) |
$488.80 |
$611 |
1.4× |
| MRI joint upr extrem w/dye (73222) |
$961.60 |
$1,202 |
1.2× |
| MRI joint upr extrem w/o dye (73221) |
$308 |
$385 |
1.3× |
| MRI lumbar spine w/contrast (72149) |
$932 |
$1,165 |
2.6× |
| MRI lumbar spine w/wo contrast (72158) |
$520.80 |
$651 |
1.5× |
| MRI orbit/face/neck w&w/o cont (70543) |
$486.40 |
$608 |
1.4× |
| MRI pelvis w & w/o contrast (72197) |
$513.60 |
$642 |
1.4× |
| MRI pelvis w/contrast (72196) |
$925.20 |
$1,156.50 |
2.6× |
| MRI pelvis w/o contrast (72195) |
$332 |
$415 |
1.4× |
| MRI spine cervical w/o contrast (72141) |
$337.60 |
$422 |
1.4× |
| MRI t-spine w&w/o cont (72157) |
$519.20 |
$649 |
1.5× |
| MRI thoracic spine w/contrast (72147) |
$849.20 |
$1,061.50 |
2.4× |
| MRI thoracic spine w/o contrst (72146) |
$337.60 |
$422 |
1.4× |
| MRI upper extremity oth than jt w/o contr matrl (73218) |
$308 |
$385 |
1.3× |
| Multi-leaf collimator (MLC) device(s) for intensity modulated radiation therapy (IMRT), design and construction per… (77338) |
$858 |
$1,072.50 |
2.2× |
| Myocardial spect multiple studies (78452) |
$353.60 |
$442 |
0.3× |
| Nm bone 3 phase (78315) |
$604.40 |
$755.50 |
1.5× |
| Nm bone imaging whole body (78306) |
$592 |
$740 |
1.4× |
| Nm csf cisternogram (78630) |
$623.60 |
$779.50 |
1.1× |
| Nm gastric emptying (78264) |
$574.40 |
$718 |
1.4× |
| Nm lymph system (78195) |
$617.60 |
$772 |
1.1× |
| Nm myocard infarct spect (78469) |
$794 |
$992.50 |
1.4× |
| Nuclear medicine study of bone and/or joint limited area (78300) |
$358 |
$447.50 |
0.9× |
| Nuclear medicine study of brain, 4 static views or more (78605) |
$275.60 |
$344.50 |
0.5× |
| Nuclear medicine study of heart pumping function by labeling red blood cells with measurement of internal blood volume… (78494) |
$318.80 |
$398.50 |
0.8× |
| Nuclear medicine study of salivary gland with serial images (78231) |
$431.20 |
$539 |
1.1× |
| Ob us limited fetus(s) (76815) |
$266.80 |
$333.50 |
2.5× |
| Ob us nuchal meas 1 gest (76813) |
$279.20 |
$349 |
2.6× |
| Parathyroid planar imaging (78070) |
$648.80 |
$811 |
1.6× |
| Perineogram (eg, vaginogram, for sex determination or extent of anomalies) Age Under 21 (74775) |
$389.20 |
$486.50 |
1.6× |
| PET imaging CT attenuation skull base mid-thigh (78815) |
$2,364.40 |
$2,955.50 |
1.6× |
| PET imaging for CT attenuation whole body (78816) |
$2,396.80 |
$2,996 |
1.6× |
| Pulmonary ventilation & perfusion imaging (78582) |
$580 |
$725 |
1.0× |
| Radex abscess/fistula/sinus tract rs&i (76080) |
$196.40 |
$245.50 |
0.4× |
| Radex entir thrc lmbr crv sac spi w/skull 1 vw (72081) |
$106.40 |
$133 |
1.2× |
| Radex entir thrc lmbr crv sac spi w/skull 2/3 vw (72082) |
$136.80 |
$171 |
1.3× |
| Radex hip unilateral with pelvis 1 view (73501) |
$100.40 |
$125.50 |
1.1× |
| Radex hip unilateral with pelvis 2-3 views (73502) |
$108.40 |
$135.50 |
1.2× |
| Radex hips bilateral with pelvis 2 views (73521) |
$138.80 |
$173.50 |
1.3× |
| Radex hips bilateral with pelvis minimum 5 views (73523) |
$172.80 |
$216 |
1.6× |
| Radex spine cervical 2 or 3 views (72040) |
$48 |
$60 |
0.5× |
| Radex spine cervical 4 or 5 views (72050) |
$72 |
$90 |
0.7× |
| Radex spine cervical 6 or more views (72052) |
$156 |
$195 |
1.5× |
| Radex spine thoracolumbar junction min 2 views (72080) |
$113.60 |
$142 |
1.3× |
| Radiation tx delivery lvl 1 (77402) |
$577.60 |
$722 |
5.5× |
| Radiation tx delivery lvl 2 (77407) |
$616.80 |
$771 |
1.6× |
| Radiation tx delivery lvl 3 (77412) |
$778.40 |
$973 |
1.4× |
| Radiologic exam chest 3 views (71047) |
$124.40 |
$155.50 |
1.4× |
| Radiologic exam chest 4+ views (71048) |
$127.60 |
$159.50 |
1.2× |
| Radiologic exam colon double contrast study (74280) |
$304.80 |
$381 |
1.7× |
| Radiologic exam colon single contrast study (74270) |
$242.80 |
$303.50 |
1.4× |
| Radiologic exam esophagus double contrast study (74221) |
$197.60 |
$247 |
1.1× |
| Radiologic exam esophagus single contrast study (74220) |
$268.80 |
$336 |
1.5× |
| Radiologic exam small int single contrast study (74250) |
$194 |
$242.50 |
1.1× |
| Radiologic exam swallow function contrast study (74230) |
$201.20 |
$251.50 |
1.1× |
| Radiologic exam upr gi trc single contrast study (74240) |
$254 |
$317.50 |
1.4× |
| Radiologic examination femur minimum 2 views (73552) |
$50.40 |
$63 |
0.6× |
| Radiologic examination from nose to rectum for foreign body, single view, child Age Under 21 (76010) |
$103.20 |
$129 |
1.2× |
| Radiologic examination, ankle; complete, minimum of 3 views Age Under 21 (73610) |
$50.40 |
$63 |
0.6× |
| Radiologic examination, complete acute abdomen series, including 2 or more views of the abdomen (eg, supine, erect,… (74022) |
$128.40 |
$160.50 |
1.2× |
| Radiologic examination, elbow; 2 views Age Under 21 (73070) |
$29.60 |
$37 |
0.3× |
| Radiologic examination, elbow; complete, minimum of 3 views Age Under 21 (73080) |
$40 |
$50 |
0.4× |
| Radiologic examination, facial bones; less than 3 views Age Under 21 (70140) |
$108.40 |
$135.50 |
1.2× |
| Radiologic examination, foot; complete, minimum of 3 views Age Under 21 (73630) |
$48 |
$60 |
0.5× |
| Radiologic examination, hand; minimum of 3 views Age Under 21 (73130) |
$50.40 |
$63 |
0.6× |
| Radiologic examination, knee; both knees, standing, anteroposterior Age Under 21 (73565) |
$124.80 |
$156 |
1.4× |
| Radiologic examination, knee; complete, 4 or more views Age Under 21 (73564) |
$63.20 |
$79 |
0.6× |
| Radiologic examination, mandible; partial, less than 4 views Age Under 21 (70100) |
$91.60 |
$114.50 |
1.0× |
| Radiologic examination, mastoids; complete, minimum of 3 views per side Age Under 21 (70130) |
$126.80 |
$158.50 |
1.2× |
| Radiologic examination, mastoids; less than 3 views per side Age Under 21 (70120) |
$104.40 |
$130.50 |
1.0× |
| Radiologic examination, nasal bones, complete, minimum of 3 views Age Under 21 (70160) |
$98.80 |
$123.50 |
1.1× |
| Radiologic examination, ribs, bilateral; including posteroanterior chest, minimum of 4 views Age Under 21 (71111) |
$93.60 |
$117 |
0.9× |
| Radiologic examination, ribs, unilateral; including posteroanterior chest, minimum of 3 views Age Under 21 (71101) |
$62.40 |
$78 |
0.6× |
| Radiologic examination, sacroiliac joints; less than 3 views Age Under 21 (72200) |
$98.80 |
$123.50 |
0.9× |
| Radiologic examination, shoulder, arthrography, radiological supervision and interpretation Age Under 21 (73040) |
$750.80 |
$938.50 |
2.1× |
| Radiologic examination, shoulder; complete, minimum of 2 views Age Under 21 (73030) |
$110 |
$137.50 |
1.2× |
| Radiologic examination, sinuses, paranasal, less than 3 views Age Under 21 (70210) |
$105.20 |
$131.50 |
1.2× |
| Radiologic examination, skull; less than 4 views Age Under 21 (70250) |
$56.80 |
$71 |
0.5× |
| Radiologic examination, spine, lumbosacral; 2 or 3 views Age Under 21 (72100) |
$50.40 |
$63 |
0.5× |
| Radiologic examination, spine, lumbosacral; bending views only, 2 or 3 views Age Under 21 (72120) |
$126.40 |
$158 |
1.2× |
| Radiologic examination, spine, lumbosacral; complete, including bending views, minimum of 6 views Age Under 21 (72114) |
$154.80 |
$193.50 |
1.4× |
| Radiologic examination, wrist; complete, minimum of 3 views Age Under 21 (73110) |
$40 |
$50 |
0.4× |
| Radiologic examination; acromioclavicular joints, bilateral, with or without weighted distraction Age Under 21 (73050) |
$138.40 |
$173 |
1.6× |
| Radiologic examination; humerus, minimum of 2 views Age Under 21 (73060) |
$102 |
$127.50 |
1.1× |
| Radiologic examination; lower extremity, infant, minimum of 2 views Age Under 21 (73592) |
$96.80 |
$121 |
1.1× |
| Radiologic examination; orbits, complete, minimum of 4 views Age Under 21 (70200) |
$124 |
$155 |
1.2× |
| Radiologic examination; pharynx or larynx, including fluoroscopy and/or magnification technique Age Under 21 (70370) |
$111.60 |
$139.50 |
1.3× |
| Radiologic examination; sternoclavicular joint or joints, minimum of 3 views Age Under 21 (71130) |
$120.40 |
$150.50 |
1.4× |
| Radiologic examination; toe(s), minimum of 2 views Age Under 21 (73660) |
$28 |
$35 |
0.3× |
| Radiologic examination; upper extremity, infant, minimum of 2 views Age Under 21 (73092) |
$96.80 |
$121 |
0.9× |
| Radiopharmaceutical localization of tumor, inflammatory process or distribution of radiopharmaceutical agent(s)… (78803) |
$766.80 |
$958.50 |
1.4× |
| Radiopharmaceutical therapy, by intravenous administration Age Under 21 (79101) |
$525.60 |
$657 |
2.2× |
| Radiopharmaceutical therapy, by oral administration Age Under 21 (79005) |
$508 |
$635 |
2.1× |
| Radiopharmaceutical therapy, radiolabeled monoclonal antibody by intravenous infusion (79403) |
$936 |
$1,170 |
3.9× |
| Review by radiologist of urinary bladder and urethra images with contrast and after passing urine (74455) |
$193.60 |
$242 |
0.8× |
| Rp loclzj tum plnr 1 area single day imaging (78800) |
$153.60 |
$192 |
0.4× |
| Rp loclzj tum plnr 2+area 1+d img/1 area img>2+d (78801) |
$590.40 |
$738 |
1.4× |
| Rp loclzj tum plnr whole body 2+ days imaging (78804) |
$643.20 |
$804 |
1.2× |
| Rp loclzj tum plnr whole body single day imaging (78802) |
$634 |
$792.50 |
1.1× |
| Saline infusion sonohysterography (SIS), including color flow Doppler, when performed Age Under 21 (76831) |
$265.60 |
$332 |
1.1× |
| Scapula complete (73010) |
$98.80 |
$123.50 |
0.9× |
| Screening digital breast tomosynthesis bi (77063) |
$99.20 |
$124 |
— |
| Shuntogram indwelling nonvascular shunt rs&i (75809) |
$198.80 |
$248.50 |
1.9× |
| Simulation intermediate (77285) |
$976 |
$1,220 |
2.6× |
| Special dosimetry (77331) |
$354 |
$442.50 |
2.6× |
| Special physics consult (77370) |
$810.40 |
$1,013 |
5.9× |
| Special teletherapy port plan (77321) |
$507.20 |
$634 |
1.3× |
| Special treatment procedure (77470) |
$1,354.80 |
$1,693.50 |
2.4× |
| Spleen imaging only, with or without vascular flow Age Under 21 (78185) |
$342.80 |
$428.50 |
0.8× |
| Testicular imaging with vascular flow Age Under 21 (78761) |
$457.20 |
$571.50 |
1.1× |
| Ther rad simulaj-aided field setting complex (77290) |
$897.20 |
$1,121.50 |
2.3× |
| Thyroid carcinoma metastases imaging; limited area (eg, neck and chest only) Age Under 21 (78015) |
$361.20 |
$451.50 |
0.9× |
| Thyroid imaging with vascular flow (78013) |
$336 |
$420 |
0.8× |
| Thyroid met imaging body (78018) |
$666 |
$832.50 |
1.2× |
| Thyroid uptake single/multiple quant measurement (78012) |
$282.40 |
$353 |
0.7× |
| Thyroid uptake w/blood flow sngle/mult quan meas (78014) |
$538.40 |
$673 |
1.3× |
| Tr simulation simple (77280) |
$440.80 |
$551 |
3.2× |
| Treatment device complex (77334) |
$538 |
$672.50 |
1.4× |
| Treatment device intermediate (77333) |
$529.20 |
$661.50 |
3.9× |
| Treatment device simple (77332) |
$391.20 |
$489 |
2.8× |
| Ultrasound bone density measurement and interpretation, peripheral site(s), any method Age Under 21 (76977) |
$255.20 |
$319 |
2.4× |
| Ultrasound breast limited (76642) |
$272.80 |
$341 |
3.1× |
| Ultrasound, abdomen limited (76705) |
$376 |
$470 |
3.5× |
| Ultrasound, limited, joint or focal evaluation of other nonvascular extremity structure(s) (eg, joint space,… (76882) |
$140.80 |
$176 |
1.3× |
| Ultrasound, pelvic (nonobstetric), real time with image documentation; complete Age Under 21 (76856) |
$345.60 |
$432 |
3.2× |
| Ultrasound, pregnant uterus, real time with image documentation, fetal and maternal evaluation plus detailed fetal… (76811) |
$543.60 |
$679.50 |
2.2× |
| Ultrasound, pregnant uterus, real time with image documentation, fetal and maternal evaluation, first trimester (< 14… (76801) |
$261.20 |
$326.50 |
2.4× |
| Ultrasound, transplanted kidney, real time and duplex Doppler with image documentation Age Under 21 (76776) |
$277.20 |
$346.50 |
2.6× |
| Umbilical-artery Doppler (OB) (76820) |
$290 |
$362.50 |
2.7× |
| Unlisted fluoroscopic procedure (76496) |
$178.40 |
$223 |
2.0× |
| Urethrocystography retrograde rs&i (74450) |
$187.60 |
$234.50 |
0.8× |
| Urography (pyelography), intravenous, with or without KUB, with or without tomography Age Under 21 (74400) |
$218.80 |
$273.50 |
1.2× |
| Urography antegrade rs&i (74425) |
$368.40 |
$460.50 |
1.0× |
| Us abdominal aorta real time screen study aaa (76706) |
$251.60 |
$314.50 |
2.4× |
| Us breast uni real time with image complete (76641) |
$272.40 |
$340.50 |
2.6× |
| Us chest (76604) |
$234 |
$292.50 |
2.2× |
| Us encephalogram (76506) |
$239.20 |
$299 |
2.2× |
| Us exam, pelvic, limited (76857) |
$276.40 |
$345.50 |
2.6× |
| Us guided compression repair (76936) |
$501.20 |
$626.50 |
2.3× |
| Us inft hips r-t img lmtd static phys/qhp manj (76886) |
$158 |
$197.50 |
1.8× |
| US OB Follow-Up/Repeat (76816) |
$286.40 |
$358 |
2.7× |
| Us ob transvaginal (76817) |
$328.80 |
$411 |
3.1× |
| Us retroperitoneal complete (76770) |
$308.80 |
$386 |
2.9× |
| Us retroperitoneal ltd (76775) |
$234 |
$292.50 |
2.2× |
| Us scrotum (76870) |
$268.80 |
$336 |
2.5× |
| Us soft tissue head/neck (76536) |
$420 |
$525 |
3.9× |
| Us spinal canal (76800) |
$334.80 |
$418.50 |
3.1× |
| Us transrectal (76872) |
$222.40 |
$278 |
2.1× |
| Venogram sinus/jugular (75860) |
$1,953.60 |
$2,442 |
0.6× |
| Venography deep dorsal vein penis radiolgicl supervision interpretation (76499) |
$80 |
$100 |
0.9× |
| Venography, caval, inferior, with serialography, radiological supervision and interpretation Age Under 21 (75825) |
$1,957.20 |
$2,446.50 |
0.6× |
| Venography, caval, superior, with serialography, radiological supervision and interpretation Age Under 21 (75827) |
$214.40 |
$268 |
0.1× |
| Venography, extremity, bilateral, radiological supervision and interpretation Age Under 21 (75822) |
$909.60 |
$1,137 |
0.6× |
| Venography, extremity, unilateral, radiological supervision and interpretation Age Under 21 (75820) |
$239.20 |
$299 |
0.1× |
| X-ray exam hips bi 3-4 views (73522) |
$149.60 |
$187 |
1.4× |
| X-ray exam of finger(s) (73140) |
$92.40 |
$115.50 |
1.0× |
| X-ray exam of knee 1 or 2 (73560) |
$44 |
$55 |
0.5× |
| X-ray exam of small bowel - fl small bowel series enteroclysis tube (74251) |
$409.60 |
$512 |
2.3× |
| X-ray exam ribs bil 3 views (71110) |
$144.40 |
$180.50 |
1.4× |
| X-ray exam ribs uni 2 views (71100) |
$50.40 |
$63 |
0.6× |
| X-ray heel (73650) |
$97.20 |
$121.50 |
1.1× |
| X-ray of joint between lower spine and hip bone 3 or more views|PROFESSIONAL COMPONENT (72202) |
$106.80 |
$133.50 |
1.0× |
| X-ray retrograde pyelogram (74420) |
$313.60 |
$392 |
0.9× |
| Xr abdomen 1 view (74018) |
$102.80 |
$128.50 |
1.2× |
| Xr abdomen 2 views (74019) |
$116.40 |
$145.50 |
1.1× |
| Xr arthrogram ankle (73615) |
$331.20 |
$414 |
0.9× |
| Xr arthrogram elbow (73085) |
$361.20 |
$451.50 |
1.0× |
| Xr arthrogram hip (73525) |
$514.80 |
$643.50 |
1.4× |
| Xr arthrogram knee (73580) |
$503.20 |
$629 |
1.4× |
| Xr arthrogram wrist (73115) |
$522.80 |
$653.50 |
1.5× |
| Xr bone age studies (77072) |
$42.40 |
$53 |
0.4× |
| Xr bone length study (77073) |
$125.20 |
$156.50 |
1.2× |
| Xr bone survey infant (77076) |
$172.40 |
$215.50 |
1.6× |
| Xr bone survey ltd (77074) |
$141.60 |
$177 |
1.3× |
| Xr chest 1 view (71045) |
$55.20 |
$69 |
0.6× |
| Xr chest 2 views (71046) |
$49.60 |
$62 |
0.6× |
| Xr eye foreign body (70030) |
$37.60 |
$47 |
0.4× |
| Xr facial bones 3+ views (70150) |
$124.40 |
$155.50 |
1.2× |
| Xr foot arthritis pa only bilateral - report(ortho pro) (73620) |
$44.80 |
$56 |
0.5× |
| Xr forearm 2 views (73090) |
$98.40 |
$123 |
1.1× |
| Xr hand 2v (73120) |
$103.20 |
$129 |
1.0× |
| Xr hysterosalpingogram (74740) |
$359.60 |
$449.50 |
1.5× |
| Xr neck soft tissue (70360) |
$93.60 |
$117 |
1.1× |
| Xr osseous survey complete (77075) |
$192 |
$240 |
1.8× |
| Xr pelvis 1-2 views (72170) |
$34.40 |
$43 |
0.3× |
| Xr pelvis min 3 view (72190) |
$113.60 |
$142 |
1.1× |
| Xr peritoneogram (74190) |
$222.80 |
$278.50 |
0.4× |
| Xr sacrum/coccyx 2+ views (72220) |
$103.20 |
$129 |
1.2× |
| Xr shoulder 1 view (73020) |
$96.80 |
$121 |
1.1× |
| Xr sialogram (70390) |
$220.80 |
$276 |
0.9× |
| Xr sinuses 3+ views (70220) |
$124 |
$155 |
1.4× |
| Xr skull min 4 view (70260) |
$141.20 |
$176.50 |
1.3× |
| Xr spine 1 view (72020) |
$35.20 |
$44 |
0.4× |
| Xr spine thoracic 3v (72072) |
$47.20 |
$59 |
0.4× |
| Xr sternum 2+ views (71120) |
$110.40 |
$138 |
1.2× |
| Xr surgical specimen (76098) |
$97.20 |
$121.50 |
0.2× |
| Xr t-spine 2 views (72070) |
$50.40 |
$63 |
0.5× |
| Xr tibia/fibula 2 views (73590) |
$98.80 |
$123.50 |
1.1× |
| Xr tmj bilateral (70330) |
$150.80 |
$188.50 |
1.7× |
| Xr tmj unilateral (70328) |
$101.20 |
$126.50 |
1.1× |
| Xr venogram renal bilat (75833) |
$1,985.60 |
$2,482 |
0.6× |
| Xr wrist 2 views (73100) |
$103.20 |
$129 |
1.2× |