| 3-D radiotherapy plan dose-volume histograms (77295) |
$2,002 |
$3,500 |
1.4× |
| Acute gi blood loss imaging (78278) |
$710.83 |
$1,786 |
1.7× |
| Ankle 2 views (73600) |
$119.25 |
$265 |
1.3× |
| Basic radiation dosimetry calculation (77300) |
$212.21 |
$371 |
1.5× |
| Brain flow imaging only - nm brain flow only brain death (78610) |
$295.32 |
$742 |
0.5× |
| Brain imaging, minimum 4 static views; with vascular flow Age Under 21 (78606) |
$464.07 |
$1,166 |
0.8× |
| Brain imaging, positron emission tomography (PET); metabolic evaluation Age Under 21 (78608) |
$2,075.02 |
$5,578 |
1.4× |
| Cardiac blood pool imaging, gated equilibrium; multiple studies, wall motion study plus ejection fraction, at rest and… (78473) |
$765.75 |
$1,924 |
1.8× |
| Cholecystography, oral contrast Age Under 21 (74290) |
$198.90 |
$442 |
1.1× |
| Clavicle complete (73000) |
$159.30 |
$354 |
1.7× |
| Computed tomographic (CT) colonography, diagnostic, including image postprocessing; with contrast material(s) including… (74262) |
$940.46 |
$2,177 |
5.1× |
| Computed tomographic (CT) colonography, diagnostic, including image postprocessing; without contrast material Age Under… (74261) |
$752.11 |
$1,741 |
6.8× |
| Computed tomographic angiography, abdomen and pelvis, with contrast material(s), including noncontrast images, if… (74174) |
$903.42 |
$3,346 |
2.5× |
| Computed tomographic angiography, abdomen, with contrast material(s), including noncontrast images, if performed, and… (74175) |
$579.96 |
$2,148 |
3.1× |
| Computed tomographic angiography, abdominal aorta and bilateral iliofemoral lower extremity runoff, with contrast… (75635) |
$1,290.38 |
$2,987 |
7.0× |
| Computed tomographic angiography, chest (noncoronary), with contrast material(s), including noncontrast images, if… (71275) |
$646.11 |
$2,393 |
3.5× |
| Computed tomographic angiography, lower extremity, with contrast material(s), including noncontrast images, if… (73706) |
$697.14 |
$2,582 |
3.8× |
| Computed tomographic angiography, neck, with contrast material(s), including noncontrast images, if performed, and… (70498) |
$700.65 |
$2,595 |
3.8× |
| Computed tomographic angiography, pelvis, with contrast material(s), including noncontrast images, if performed, and… (72191) |
$1,268.73 |
$4,699 |
6.9× |
| Computed tomographic angiography, upper extremity, with contrast material(s), including noncontrast images, if… (73206) |
$962.82 |
$3,566 |
5.2× |
| Computed tomography, cervical spine; without contrast material, followed by contrast material(s) and further sections… (72127) |
$1,199.61 |
$4,443 |
6.5× |
| Computed tomography, lower extremity; without contrast material Age Under 21 (73700) |
$442.53 |
$1,639 |
4.0× |
| Computed tomography, lower extremity; without contrast material, followed by contrast material(s) and further sections… (73702) |
$663.93 |
$2,459 |
3.6× |
| Computed tomography, lumbar spine; without contrast material, followed by contrast material(s) and further sections Age… (72133) |
$1,266.03 |
$4,689 |
6.8× |
| Computed tomography, maxillofacial area; with contrast material(s) Age Under 21 (70487) |
$828.90 |
$3,070 |
4.5× |
| Computed tomography, maxillofacial area; without contrast material Age Under 21 (70486) |
$663.12 |
$2,456 |
6.0× |
| Computed tomography, orbit, sella, or posterior fossa or outer, middle, or inner ear; with contrast material(s) Age… (70481) |
$825.39 |
$3,057 |
4.5× |
| Computed tomography, orbit, sella, or posterior fossa or outer, middle, or inner ear; without contrast material Age… (70480) |
$660.15 |
$2,445 |
6.0× |
| Computed tomography, orbit, sella, or posterior fossa or outer, middle, or inner ear; without contrast material,… (70482) |
$990.36 |
$3,668 |
5.4× |
| Computed tomography, soft tissue neck; without contrast material followed by contrast material(s) and further sections… (70492) |
$667.17 |
$2,471 |
3.6× |
| Computed tomography, thoracic spine; without contrast material, followed by contrast material(s) and further sections… (72130) |
$1,275.75 |
$4,725 |
6.9× |
| Computed tomography, thorax, diagnostic; without contrast material, followed by contrast material(s) and further… (71270) |
$615.33 |
$2,279 |
3.3× |
| Continuing medical physics consultation, including assessment of treatment parameters, quality assurance of dose… (77336) |
$394.68 |
$690 |
2.8× |
| CT abdomen and pelvis without and with contrast (74178) |
$860.22 |
$3,186 |
2.3× |
| CT abdomen and pelvis without contrast (74176) |
$573.48 |
$2,124 |
2.3× |
| CT abdomen w & w/o contrast (74170) |
$552.15 |
$2,045 |
3.0× |
| CT abdomen w/contrast (74160) |
$460.08 |
$1,704 |
2.5× |
| CT abdomen w/o contrast (74150) |
$368.01 |
$1,363 |
3.3× |
| CT angio hrt w/3d image (75574) |
$1,400.54 |
$3,242 |
3.8× |
| CT cervical spine w/contrast (72126) |
$999.81 |
$3,703 |
2.7× |
| CT cervical spine w/o contrast (72125) |
$799.74 |
$2,962 |
7.3× |
| CT chest w/contrast (71260) |
$512.73 |
$1,899 |
2.8× |
| CT extremity upper w & w/o contrast (73202) |
$916.92 |
$3,396 |
5.0× |
| CT extremity upper w/o contrast (73200) |
$611.28 |
$2,264 |
5.5× |
| CT head/brain with contrast (70460) |
$505.98 |
$1,874 |
2.7× |
| CT head/brain without and with contrast (70470) |
$607.23 |
$2,249 |
3.3× |
| CT heart no contrast quant eval coronry calcium (75571) |
$71.71 |
$166 |
0.8× |
| CT l-spine w/contrast (72132) |
$1,055.16 |
$3,908 |
2.9× |
| CT limited/localized follow up study (76380) |
$428.98 |
$993 |
4.7× |
| CT lower extremity w/dye (73701) |
$553.23 |
$2,049 |
3.0× |
| CT lumbar spine w/o contrast (72131) |
$844.02 |
$3,126 |
7.7× |
| CT maxillofacial w/wo contrast (70488) |
$994.68 |
$3,684 |
5.4× |
| CT neck w/contrast (70491) |
$555.93 |
$2,059 |
3.0× |
| CT neck w/o contrast (70490) |
$444.69 |
$1,647 |
4.0× |
| CT pelvis w & w/o contrast (72194) |
$1,208.25 |
$4,475 |
6.5× |
| CT pelvis w/o contrast (72192) |
$805.41 |
$2,983 |
7.3× |
| CT thoracic spine w/contrast (72129) |
$1,063.26 |
$3,938 |
5.7× |
| CT thoracic spine w/o contrast (72128) |
$850.50 |
$3,150 |
7.7× |
| CT thorax w/o contrast (71250) |
$410.13 |
$1,519 |
3.7× |
| CT upper extremity w/dye (73201) |
$764.10 |
$2,830 |
2.1× |
| CTA head w contrast (70496) |
$637.74 |
$2,362 |
3.4× |
| Cystography, minimum of 3 views, radiological supervision and interpretation Age Under 21 (74430) |
$242.55 |
$539 |
0.7× |
| Dual-energy X-ray absorptiometry (DXA), bone density study, 1 or more sites; axial skeleton (eg, hips, pelvis, spine)… (77080) |
$204.30 |
$454 |
1.9× |
| Dxa bone density study axial skeleton (77085) |
$228.15 |
$507 |
2.1× |
| Fetal biophys profile w/o nst (76819) |
$443.61 |
$781 |
4.0× |
| Fetal biophysical profile non-stress testing (76818) |
$481.66 |
$848 |
4.4× |
| Fluoroscopy up to 1 hour physician/qhp time (76000) |
$337.50 |
$750 |
1.3× |
| Gastric emptying imaging study (eg, solid, liquid, or both); with small bowel and colon transit, multiple days Age… (78266) |
$1,035.99 |
$2,603 |
1.8× |
| Gastric emptying imaging study (eg, solid, liquid, or both); with small bowel transit Age Under 21 (78265) |
$1,014.50 |
$2,549 |
2.4× |
| Gastroesophageal reflux study (78262) |
$487.95 |
$1,226 |
1.2× |
| Gated heart planar single (78472) |
$756.20 |
$1,900 |
1.8× |
| Heart infarct image (78466) |
$403.97 |
$1,015 |
1.0× |
| Hepatobil syst imag inc gb w/pharma intervenj (78227) |
$1,031.22 |
$2,591 |
1.8× |
| Hepatobiliary syst imaging including gallbladder (78226) |
$753.02 |
$1,892 |
1.8× |
| Ht muscle image spect sing (78451) |
$1,641.75 |
$4,125 |
1.2× |
| Injection procedure for radiopharmaceutical localization by non-imaging probe study, intravenous (eg, parathyroid… (78808) |
$209.75 |
$527 |
0.5× |
| Intensity modulated radiotherapy plan, including dose-volume histograms for target and critical structure partial… (77301) |
$4,247.10 |
$7,425 |
2.9× |
| Intestine imaging (eg, ectopic gastric mucosa, Meckel's localization, volvulus) Age Under 21 (78290) |
$675.41 |
$1,697 |
1.6× |
| Isodose teletherapy plan complex multi tx w/cal (77307) |
$491.35 |
$859 |
1.2× |
| Isodose teletherapy plan simple 1 or 2 port w/cal (77306) |
$326.61 |
$571 |
0.8× |
| Kidney imaging morphology; with vascular flow and function, multiple studies, with and without pharmacological… (78709) |
$660.68 |
$1,660 |
1.2× |
| Kidney imaging morphology; with vascular flow and function, single study without pharmacological intervention Age Under… (78707) |
$416.71 |
$1,047 |
0.7× |
| Kidney imaging morphology; with vascular flow and function, single study, with pharmacological intervention (eg,… (78708) |
$317.21 |
$797 |
0.6× |
| Leveen/shunt patency exam (78291) |
$336.71 |
$846 |
0.8× |
| Liver and spleen imaging; with vascular flow Age Under 21 (78216) |
$272.63 |
$685 |
0.6× |
| Lung perf&ventilat diferentl (78598) |
$618.49 |
$1,554 |
1.1× |
| Lung perfusion imaging (78580) |
$458.10 |
$1,151 |
1.1× |
| Magnetic resonance (eg, proton) imaging, any joint of lower extremity; without contrast material(s), followed by… (73723) |
$1,652.69 |
$3,585 |
4.5× |
| Magnetic resonance (eg, proton) imaging, lower extremity other than joint; with contrast material(s) Age Under 21 (73719) |
$1,024.34 |
$2,222 |
2.8× |
| Magnetic resonance (eg, proton) imaging, lower extremity other than joint; without contrast material(s) Age Under 21 (73718) |
$819.20 |
$1,777 |
3.3× |
| Magnetic resonance (eg, proton) imaging, lower extremity other than joint; without contrast material(s), followed by… (73720) |
$1,229.03 |
$2,666 |
3.3× |
| Magnetic resonance (eg, proton) imaging, orbit, face, and/or neck; with contrast material(s) Age Under 21 (70542) |
$1,264.80 |
$3,720 |
3.4× |
| Magnetic resonance (eg, proton) imaging, orbit, face, and/or neck; without contrast material(s) Age Under 21 (70540) |
$1,011.84 |
$2,976 |
4.0× |
| Magnetic resonance (eg, proton) imaging, upper extremity, other than joint; with contrast material(s) Age Under 21 (73219) |
$1,336.90 |
$2,900 |
3.6× |
| Magnetic resonance (eg, proton) imaging, upper extremity, other than joint; without contrast material(s), followed by… (73220) |
$1,604.28 |
$3,480 |
4.4× |
| Magnetic resonance angiography, head; with contrast material(s) Age Under 21 (70545) |
$484.77 |
$2,649 |
1.3× |
| Magnetic resonance angiography, head; without contrast material(s), followed by contrast material(s) and further… (70546) |
$581.76 |
$3,179 |
1.6× |
| Magnetic resonance angiography, neck; without contrast material(s), followed by contrast material(s) and further… (70549) |
$1,008.51 |
$5,511 |
2.7× |
| Mammary ductogram or galactogram, multiple ducts, radiological supervision and interpretation Age Under 21 (77054) |
$243.90 |
$542 |
1.0× |
| Mammary ductogram single (77053) |
$185.40 |
$412 |
0.7× |
| Mandible min 4v (70110) |
$223.65 |
$497 |
2.0× |
| Mr safety determination physician/other qhp (76016) |
$59.85 |
$133 |
0.7× |
| Mr safety implant pos&/immoblj supvj phys/qhp (76019) |
$140.85 |
$313 |
2.3× |
| Mr safety implant&/fb assmt clin staf 1st 15 min (76014) |
$17.10 |
$38 |
0.6× |
| Mr safety implt electronics prepj supvj phys/qhp (76018) |
$92.25 |
$205 |
0.9× |
| Mr safety med physics xm customization plng&mntr (76017) |
$219.15 |
$487 |
0.9× |
| MRA head w/o contrast (70544) |
$387.78 |
$2,119 |
1.5× |
| MRA neck w/ contrast (70548) |
$840.52 |
$4,593 |
2.3× |
| MRA neck w/o contrast (70547) |
$672.34 |
$3,674 |
2.7× |
| MRI abdomen w/contrast (74182) |
$1,834.78 |
$3,980 |
5.0× |
| MRI abdomen w/o contrast (74181) |
$1,467.82 |
$3,184 |
5.8× |
| MRI abdomen w/wo contrast (74183) |
$2,201.74 |
$4,776 |
6.0× |
| MRI any jt lower extrem w/contrast material (73722) |
$1,377.47 |
$2,988 |
1.7× |
| MRI breast c- bilateral (77047) |
$828.88 |
$1,798 |
3.3× |
| MRI breast without contrast material unilateral (77046) |
$526.46 |
$1,142 |
2.1× |
| MRI c-spine w&w/o cont (72156) |
$682.25 |
$2,604 |
1.9× |
| MRI cervical spine w/contrast (72142) |
$568.54 |
$2,170 |
1.5× |
| MRI chest w/contrast (71551) |
$1,663.29 |
$3,608 |
2.0× |
| MRI chest w/o contrast (71550) |
$1,330.45 |
$2,886 |
5.3× |
| MRI chest w/wo contrast (71552) |
$1,995.67 |
$4,329 |
5.4× |
| MRI joint upr extr w/o&w/dye (73223) |
$1,313.39 |
$2,849 |
3.6× |
| MRI joint upr extrem w/dye (73222) |
$1,094.41 |
$2,374 |
1.3× |
| MRI joint upr extrem w/o dye (73221) |
$875.44 |
$1,899 |
3.5× |
| MRI lumbar spine w/contrast (72149) |
$568.54 |
$2,170 |
1.5× |
| MRI lumbar spine w/wo contrast (72158) |
$682.25 |
$2,604 |
1.9× |
| MRI orbit/face/neck w&w/o cont (70543) |
$1,517.76 |
$4,464 |
4.1× |
| MRI pelvis w & w/o contrast (72197) |
$1,429.56 |
$3,101 |
3.9× |
| MRI pelvis w/contrast (72196) |
$1,191.22 |
$2,584 |
3.2× |
| MRI pelvis w/o contrast (72195) |
$952.89 |
$2,067 |
3.8× |
| MRI spine cervical w/o contrast (72141) |
$454.83 |
$1,736 |
1.8× |
| MRI t-spine w&w/o cont (72157) |
$682.25 |
$2,604 |
1.9× |
| MRI thoracic spine w/contrast (72147) |
$568.54 |
$2,170 |
1.5× |
| MRI thoracic spine w/o contrst (72146) |
$454.83 |
$1,736 |
1.8× |
| MRI tmj (70336) |
$1,427.72 |
$3,097 |
5.7× |
| MRI upper extremity oth than jt w/o contr matrl (73218) |
$1,069.52 |
$2,320 |
4.2× |
| Multi-leaf collimator (MLC) device(s) for intensity modulated radiation therapy (IMRT), design and construction per… (77338) |
$224.22 |
$392 |
0.6× |
| Myelography, 2 or more regions (eg, lumbar/thoracic, cervical/thoracic, lumbar/cervical, lumbar/thoracic/cervical),… (72270) |
$1,254.60 |
$2,788 |
1.5× |
| Myocardial spect multiple studies (78452) |
$2,120.94 |
$5,329 |
1.6× |
| N-invas est c ffr augmnt sw alys CTA i&r phy/qhp (75580) |
$3,290.38 |
$6,416 |
3.6× |
| Nm adrenal imaging (78075) |
$920.97 |
$2,314 |
0.7× |
| Nm bone 3 phase (78315) |
$1,103.65 |
$2,773 |
2.6× |
| Nm bone imaging whole body (78306) |
$959.98 |
$2,412 |
2.3× |
| Nm csf cisternogram (78630) |
$467.65 |
$1,175 |
0.8× |
| Nm gastric emptying (78264) |
$854.90 |
$2,148 |
2.0× |
| Nm lung ventilation imaging (78579) |
$324.77 |
$816 |
0.8× |
| Nm lymph system (78195) |
$674.61 |
$1,695 |
1.2× |
| Nuclear medicine study of bone and/or joint limited area (78300) |
$446.56 |
$1,122 |
1.1× |
| Nuclear medicine study of bone and/or joint multiple areas (78305) |
$530.14 |
$1,332 |
1.3× |
| Ob us limited fetus(s) (76815) |
$303.31 |
$534 |
2.8× |
| Ob us nuchal meas 1 gest (76813) |
$239.13 |
$421 |
2.2× |
| Optic foramina (70190) |
$126 |
$280 |
1.4× |
| Parathyrd planar w/spect&CT (78072) |
$569.54 |
$1,431 |
1.0× |
| Parathyroid planar imaging (78070) |
$458.10 |
$1,151 |
1.1× |
| Parathyroid planar imaging w/wo subtraction (78071) |
$522.97 |
$1,314 |
1.2× |
| PET imaging CT attenuation skull base mid-thigh (78815) |
$3,188.04 |
$8,570 |
2.1× |
| PET imaging CT for attenuation limited area (78814) |
$1,867.44 |
$5,020 |
1.2× |
| PET imaging for CT attenuation whole body (78816) |
$3,207.01 |
$8,621 |
2.1× |
| Pulmonary ventilation & perfusion imaging (78582) |
$725.16 |
$1,822 |
1.3× |
| Quant differential pulm perfusion w/wo imaging (78597) |
$378.10 |
$950 |
0.9× |
| Radex abscess/fistula/sinus tract rs&i (76080) |
$321.75 |
$715 |
0.6× |
| Radex entir thrc lmbr crv sac spi w/skull 1 vw (72081) |
$156.15 |
$347 |
1.7× |
| Radex entir thrc lmbr crv sac spi w/skull 2/3 vw (72082) |
$224.10 |
$498 |
2.0× |
| Radex entir thrc lmbr crv sac spi w/skull 4/5 vw (72083) |
$254.70 |
$566 |
2.3× |
| Radex entir thrc lmbr crv sac spi w/skull 6/> vw (72084) |
$264.15 |
$587 |
2.4× |
| Radex hip unilateral with pelvis 1 view (73501) |
$99.45 |
$221 |
1.1× |
| Radex hip unilateral with pelvis 2-3 views (73502) |
$186.75 |
$415 |
2.0× |
| Radex hip unilateral with pelvis minimum 4 views (73503) |
$233.55 |
$519 |
2.1× |
| Radex hips bilateral with pelvis 2 views (73521) |
$122.85 |
$273 |
1.1× |
| Radex hips bilateral with pelvis minimum 5 views (73523) |
$316.80 |
$704 |
2.9× |
| Radex spine cervical 2 or 3 views (72040) |
$211.50 |
$470 |
2.3× |
| Radex spine cervical 4 or 5 views (72050) |
$291.15 |
$647 |
2.6× |
| Radex spine cervical 6 or more views (72052) |
$343.35 |
$763 |
3.1× |
| Radex spine thoracolumbar junction min 2 views (72080) |
$117.90 |
$262 |
1.3× |
| Radiation tx delivery lvl 1 (77402) |
$255.11 |
$446 |
2.4× |
| Radiation tx delivery lvl 2 (77407) |
$316.89 |
$554 |
0.8× |
| Radiation tx delivery lvl 3 (77412) |
$475.33 |
$831 |
0.8× |
| Radiologic exam abdomen 3+ views (74021) |
$191.70 |
$426 |
1.7× |
| Radiologic exam chest 3 views (71047) |
$234.67 |
$476 |
2.6× |
| Radiologic exam chest 4+ views (71048) |
$265.23 |
$538 |
2.4× |
| Radiologic exam colon double contrast study (74280) |
$455.85 |
$1,013 |
2.5× |
| Radiologic exam colon single contrast study (74270) |
$410.85 |
$913 |
2.2× |
| Radiologic exam esophagus single contrast study (74220) |
$196.65 |
$437 |
1.1× |
| Radiologic exam small int single contrast study (74250) |
$271.35 |
$603 |
1.5× |
| Radiologic exam swallow function contrast study (74230) |
$276.75 |
$615 |
1.5× |
| Radiologic exam upr gi trc double contrast study (74246) |
$397.80 |
$884 |
2.1× |
| Radiologic exam upr gi trc single contrast study (74240) |
$299.70 |
$666 |
1.6× |
| Radiologic examination femur 1 view (73551) |
$83.70 |
$186 |
0.9× |
| Radiologic examination femur minimum 2 views (73552) |
$124.20 |
$276 |
1.4× |
| Radiologic examination from nose to rectum for foreign body, single view, child Age Under 21 (76010) |
$61.20 |
$136 |
0.7× |
| Radiologic examination, ankle; complete, minimum of 3 views Age Under 21 (73610) |
$211.95 |
$471 |
2.3× |
| Radiologic examination, complete acute abdomen series, including 2 or more views of the abdomen (eg, supine, erect,… (74022) |
$221.85 |
$493 |
2.0× |
| Radiologic examination, elbow; 2 views Age Under 21 (73070) |
$175.50 |
$390 |
1.9× |
| Radiologic examination, elbow; complete, minimum of 3 views Age Under 21 (73080) |
$216.45 |
$481 |
2.4× |
| Radiologic examination, facial bones; less than 3 views Age Under 21 (70140) |
$176.40 |
$392 |
1.9× |
| Radiologic examination, foot; complete, minimum of 3 views Age Under 21 (73630) |
$199.80 |
$444 |
2.2× |
| Radiologic examination, hand; minimum of 3 views Age Under 21 (73130) |
$160.20 |
$356 |
1.7× |
| Radiologic examination, knee; both knees, standing, anteroposterior Age Under 21 (73565) |
$236.70 |
$526 |
2.6× |
| Radiologic examination, knee; complete, 4 or more views Age Under 21 (73564) |
$263.25 |
$585 |
2.4× |
| Radiologic examination, mastoids; complete, minimum of 3 views per side Age Under 21 (70130) |
$147.60 |
$328 |
1.3× |
| Radiologic examination, nasal bones, complete, minimum of 3 views Age Under 21 (70160) |
$154.80 |
$344 |
1.7× |
| Radiologic examination, ribs, bilateral; including posteroanterior chest, minimum of 4 views Age Under 21 (71111) |
$252.45 |
$561 |
2.3× |
| Radiologic examination, ribs, unilateral; including posteroanterior chest, minimum of 3 views Age Under 21 (71101) |
$200.70 |
$446 |
1.8× |
| Radiologic examination, shoulder, arthrography, radiological supervision and interpretation Age Under 21 (73040) |
$470.79 |
$918 |
1.3× |
| Radiologic examination, shoulder; complete, minimum of 2 views Age Under 21 (73030) |
$199.80 |
$444 |
2.2× |
| Radiologic examination, single plane body section (eg, tomography), other than with urography Age Under 21 (76100) |
$221.85 |
$493 |
2.0× |
| Radiologic examination, sinuses, paranasal, less than 3 views Age Under 21 (70210) |
$124.65 |
$277 |
1.4× |
| Radiologic examination, skull; less than 4 views Age Under 21 (70250) |
$184.95 |
$411 |
1.7× |
| Radiologic examination, spine, lumbosacral; 2 or 3 views Age Under 21 (72100) |
$168.75 |
$375 |
1.5× |
| Radiologic examination, spine, lumbosacral; complete, including bending views, minimum of 6 views Age Under 21 (72114) |
$383.40 |
$852 |
3.5× |
| Radiologic examination, spine; thoracic, minimum of 4 views Age Under 21 (72074) |
$264.60 |
$588 |
2.4× |
| Radiologic examination, wrist; complete, minimum of 3 views Age Under 21 (73110) |
$198.90 |
$442 |
2.2× |
| Radiologic examination; acromioclavicular joints, bilateral, with or without weighted distraction Age Under 21 (73050) |
$169.65 |
$377 |
1.8× |
| Radiologic examination; humerus, minimum of 2 views Age Under 21 (73060) |
$192.60 |
$428 |
2.1× |
| Radiologic examination; lower extremity, infant, minimum of 2 views Age Under 21 (73592) |
$83.70 |
$186 |
0.9× |
| Radiologic examination; orbits, complete, minimum of 4 views Age Under 21 (70200) |
$234 |
$520 |
2.1× |
| Radiologic examination; sternoclavicular joint or joints, minimum of 3 views Age Under 21 (71130) |
$165.60 |
$368 |
1.8× |
| Radiologic examination; toe(s), minimum of 2 views Age Under 21 (73660) |
$115.65 |
$257 |
1.3× |
| Radiologic examination; upper extremity, infant, minimum of 2 views Age Under 21 (73092) |
$158.40 |
$352 |
1.4× |
| Radiopharmaceutical localization of tumor, inflammatory process or distribution of radiopharmaceutical agent(s)… (78803) |
$653.12 |
$1,641 |
1.1× |
| Radiopharmaceutical therapy, by intravenous administration Age Under 21 (79101) |
$348.73 |
$680 |
1.4× |
| Radiopharmaceutical therapy, by oral administration Age Under 21 (79005) |
$509.76 |
$994 |
2.1× |
| Review by radiologist of urinary bladder and urethra images with contrast and after passing urine (74455) |
$362.25 |
$805 |
1.4× |
| Rp loclzj tum plnr 2+area 1+d img/1 area img>2+d (78801) |
$345.86 |
$869 |
0.8× |
| Rp loclzj tum plnr whole body 2+ days imaging (78804) |
$959.18 |
$2,410 |
1.7× |
| Rp loclzj tum plnr whole body single day imaging (78802) |
$547.25 |
$1,375 |
1.0× |
| Rp loclzj tum spect 2 areas (78831) |
$653.12 |
$1,641 |
0.5× |
| Rp loclzj tum spect w/CT 1 (78830) |
$424.67 |
$1,067 |
0.3× |
| Rp loclzj tum spect w/CT 2 (78832) |
$716.80 |
$1,801 |
0.5× |
| Saline infusion sonohysterography (SIS), including color flow Doppler, when performed Age Under 21 (76831) |
$354.43 |
$624 |
1.4× |
| Scapula complete (73010) |
$120.60 |
$268 |
1.1× |
| Screening digital breast tomosynthesis bi (77063) |
$37.24 |
$49 |
— |
| Shuntogram indwelling nonvascular shunt rs&i (75809) |
$228.60 |
$508 |
2.1× |
| Simulation intermediate (77285) |
$821.96 |
$1,437 |
2.1× |
| Special dosimetry (77331) |
$191.62 |
$335 |
1.4× |
| Special physics consult (77370) |
$518.23 |
$906 |
3.7× |
| Special teletherapy port plan (77321) |
$318.03 |
$556 |
0.8× |
| Special treatment procedure (77470) |
$566.28 |
$990 |
1.0× |
| Ther rad simulaj-aided field setting complex (77290) |
$915.20 |
$1,600 |
2.3× |
| Thyroid imaging with vascular flow (78013) |
$386.86 |
$972 |
0.9× |
| Thyroid met imaging body (78018) |
$885.55 |
$2,225 |
1.5× |
| Thyroid uptake single/multiple quant measurement (78012) |
$241.19 |
$606 |
0.6× |
| Thyroid uptake w/blood flow sngle/mult quan meas (78014) |
$526.55 |
$1,323 |
1.2× |
| Tr simulation simple (77280) |
$482.20 |
$843 |
3.4× |
| Treatment device complex (77334) |
$545.69 |
$954 |
1.4× |
| Treatment device intermediate (77333) |
$464.46 |
$812 |
3.3× |
| Treatment device simple (77332) |
$207.06 |
$362 |
1.5× |
| Ultrasound breast limited (76642) |
$330.01 |
$581 |
3.6× |
| Ultrasound, abdomen limited (76705) |
$506.09 |
$891 |
4.6× |
| Ultrasound, limited, joint or focal evaluation of other nonvascular extremity structure(s) (eg, joint space,… (76882) |
$332.85 |
$586 |
3.0× |
| Ultrasound, pelvic (nonobstetric), real time with image documentation; complete Age Under 21 (76856) |
$593.56 |
$1,045 |
5.4× |
| Ultrasound, pregnant uterus, real time with image documentation, fetal and maternal evaluation plus detailed fetal… (76811) |
$354.43 |
$624 |
1.4× |
| Ultrasound, pregnant uterus, real time with image documentation, fetal and maternal evaluation, first trimester (< 14… (76801) |
$507.22 |
$893 |
4.6× |
| Ultrasound, transplanted kidney, real time and duplex Doppler with image documentation Age Under 21 (76776) |
$268.66 |
$473 |
2.4× |
| Umbilical-artery Doppler (OB) (76820) |
$169.83 |
$299 |
1.5× |
| Urea breath test, C-14 (isotopic); acquisition for analysis Other Outpatient (78267) |
$13.53 |
$34 |
1.2× |
| Urea breath test, C-14 (isotopic); analysis Other Outpatient (78268) |
$113.03 |
$284 |
1.2× |
| Ureteral reflux study (78740) |
$335.51 |
$843 |
0.8× |
| Urethrocystography retrograde rs&i (74450) |
$319.95 |
$711 |
1.3× |
| Urography (pyelography), intravenous, with or without KUB, with or without tomography Age Under 21 (74400) |
$693.90 |
$1,542 |
3.8× |
| Urography antegrade rs&i (74425) |
$319.05 |
$709 |
0.9× |
| Urography, infusion, drip technique and/or bolus technique; with nephrotomography Age Under 21 (74415) |
$626.85 |
$1,393 |
3.4× |
| Us abdominal aorta real time screen study aaa (76706) |
$218.11 |
$384 |
2.0× |
| Us breast uni real time with image complete (76641) |
$402.14 |
$708 |
3.6× |
| Us chest (76604) |
$337.39 |
$594 |
3.1× |
| Us compl joint r-t w/image documentation (76881) |
$516.31 |
$909 |
4.7× |
| Us encephalogram (76506) |
$294.79 |
$519 |
2.7× |
| Us exam, pelvic, limited (76857) |
$435.09 |
$766 |
3.9× |
| Us inft hips r-t img dynamic req phys/qhp manj (76885) |
$224.36 |
$395 |
2.4× |
| Us inft hips r-t img lmtd static phys/qhp manj (76886) |
$163.58 |
$288 |
1.8× |
| US OB Follow-Up/Repeat (76816) |
$308.42 |
$543 |
2.8× |
| Us ob transvaginal (76817) |
$391.35 |
$689 |
3.5× |
| Us retroperitoneal complete (76770) |
$583.34 |
$1,027 |
5.3× |
| Us retroperitoneal ltd (76775) |
$191.42 |
$337 |
1.7× |
| Us scrotum (76870) |
$546.42 |
$962 |
5.0× |
| Us soft tissue head/neck (76536) |
$528.81 |
$931 |
4.8× |
| Us spinal canal (76800) |
$231.18 |
$407 |
2.1× |
| Us transrectal (76872) |
$341.37 |
$601 |
3.1× |
| Venography, extremity, unilateral, radiological supervision and interpretation Age Under 21 (75820) |
$303.75 |
$675 |
0.2× |
| Vertebral fracture assessment via dxa (77086) |
$158.85 |
$353 |
1.7× |
| X-ray exam hips bi 3-4 views (73522) |
$200.25 |
$445 |
1.8× |
| X-ray exam of finger(s) (73140) |
$117.90 |
$262 |
1.3× |
| X-ray exam of knee 1 or 2 (73560) |
$141.75 |
$315 |
1.5× |
| X-ray exam ribs bil 3 views (71110) |
$205.65 |
$457 |
1.9× |
| X-ray exam ribs uni 2 views (71100) |
$176.85 |
$393 |
1.9× |
| X-ray heel (73650) |
$105.30 |
$234 |
1.1× |
| X-ray of joint between lower spine and hip bone 3 or more views|PROFESSIONAL COMPONENT (72202) |
$236.70 |
$526 |
2.1× |
| X-ray retrograde pyelogram (74420) |
$386.55 |
$859 |
1.1× |
| Xr abdomen 1 view (74018) |
$101.25 |
$225 |
1.1× |
| Xr abdomen 2 views (74019) |
$183.15 |
$407 |
1.7× |
| Xr arthrogram hip (73525) |
$495.92 |
$967 |
1.3× |
| Xr arthrogram knee (73580) |
$286.16 |
$558 |
0.8× |
| Xr arthrogram wrist (73115) |
$350.78 |
$684 |
1.0× |
| Xr bone age studies (77072) |
$108 |
$240 |
1.0× |
| Xr bone length study (77073) |
$256.05 |
$569 |
2.3× |
| Xr bone survey infant (77076) |
$223.65 |
$497 |
2.0× |
| Xr chest 1 view (71045) |
$108.46 |
$220 |
1.2× |
| Xr chest 2 views (71046) |
$227.77 |
$462 |
2.5× |
| Xr eye foreign body (70030) |
$75.60 |
$168 |
0.8× |
| Xr facial bones 3+ views (70150) |
$206.10 |
$458 |
1.9× |
| Xr foot arthritis pa only bilateral - report(ortho pro) (73620) |
$139.50 |
$310 |
1.5× |
| Xr forearm 2 views (73090) |
$144.90 |
$322 |
1.6× |
| Xr hand 2v (73120) |
$103.05 |
$229 |
0.9× |
| Xr hysterosalpingogram (74740) |
$238.05 |
$529 |
0.9× |
| Xr joint survey 1 view (77077) |
$87.30 |
$194 |
0.8× |
| Xr myelogram c-spine (72240) |
$976.05 |
$2,169 |
1.2× |
| Xr myelogram l-spine (72265) |
$989.55 |
$2,199 |
1.2× |
| Xr myelogram t-spine (72255) |
$778.05 |
$1,729 |
0.9× |
| Xr neck soft tissue (70360) |
$139.95 |
$311 |
1.5× |
| Xr o knee w/ merchant view bilat - report(ortho pro) (73562) |
$172.80 |
$384 |
1.9× |
| Xr osseous survey complete (77075) |
$221.85 |
$493 |
2.0× |
| Xr pelvis 1-2 views (72170) |
$111.15 |
$247 |
1.0× |
| Xr pelvis min 3 view (72190) |
$166.50 |
$370 |
1.5× |
| Xr sacrum/coccyx 2+ views (72220) |
$143.10 |
$318 |
1.6× |
| Xr sella turcica (70240) |
$81 |
$180 |
0.9× |
| Xr shoulder 1 view (73020) |
$144.90 |
$322 |
1.6× |
| Xr sialogram (70390) |
$278.10 |
$618 |
1.1× |
| Xr sinuses 3+ views (70220) |
$195.75 |
$435 |
2.1× |
| Xr skull min 4 view (70260) |
$212.40 |
$472 |
1.9× |
| Xr spine 1 view (72020) |
$148.50 |
$330 |
1.6× |
| Xr spine thoracic 3v (72072) |
$229.95 |
$511 |
2.1× |
| Xr sternum 2+ views (71120) |
$104.40 |
$232 |
1.1× |
| Xr surgical specimen (76098) |
$116.10 |
$258 |
0.2× |
| Xr t-spine 2 views (72070) |
$221.85 |
$493 |
2.0× |
| Xr tibia/fibula 2 views (73590) |
$119.70 |
$266 |
1.3× |
| Xr tmj bilateral (70330) |
$175.50 |
$390 |
1.9× |
| Xr wrist 2 views (73100) |
$139.50 |
$310 |
1.5× |