| Acute gi blood loss imaging (78278) |
$1,805 |
$1,805 |
4.4× |
| Ankle 2 views (73600) |
$325 |
$325 |
3.7× |
| Basic radiation dosimetry calculation (77300) |
$903 |
$903 |
6.6× |
| Brain imaging, minimum 4 static views; with vascular flow Age Under 21 (78606) |
$2,292 |
$2,292 |
4.1× |
| Clavicle complete (73000) |
$325 |
$325 |
3.7× |
| Computed tomographic angiography, abdomen and pelvis, with contrast material(s), including noncontrast images, if… (74174) |
$5,646 |
$5,646 |
15.8× |
| Computed tomographic angiography, abdomen, with contrast material(s), including noncontrast images, if performed, and… (74175) |
$2,373 |
$2,373 |
13.2× |
| Computed tomographic angiography, abdominal aorta and bilateral iliofemoral lower extremity runoff, with contrast… (75635) |
$2,396 |
$2,396 |
13.4× |
| Computed tomographic angiography, chest (noncoronary), with contrast material(s), including noncontrast images, if… (71275) |
$3,150 |
$3,150 |
17.6× |
| Computed tomographic angiography, lower extremity, with contrast material(s), including noncontrast images, if… (73706) |
$2,546 |
$2,546 |
14.2× |
| Computed tomographic angiography, neck, with contrast material(s), including noncontrast images, if performed, and… (70498) |
$2,414 |
$2,414 |
13.5× |
| Computed tomographic angiography, pelvis, with contrast material(s), including noncontrast images, if performed, and… (72191) |
$2,472 |
$2,472 |
13.8× |
| Computed tomographic angiography, upper extremity, with contrast material(s), including noncontrast images, if… (73206) |
$2,546 |
$2,546 |
14.2× |
| Computed tomography, cervical spine; without contrast material, followed by contrast material(s) and further sections… (72127) |
$3,445 |
$3,445 |
19.2× |
| Computed tomography, lower extremity; without contrast material Age Under 21 (73700) |
$1,858 |
$1,858 |
17.4× |
| Computed tomography, lower extremity; without contrast material, followed by contrast material(s) and further sections… (73702) |
$2,072 |
$2,072 |
11.6× |
| Computed tomography, lumbar spine; without contrast material, followed by contrast material(s) and further sections Age… (72133) |
$3,067 |
$3,067 |
17.1× |
| Computed tomography, maxillofacial area; with contrast material(s) Age Under 21 (70487) |
$2,422 |
$2,422 |
13.5× |
| Computed tomography, maxillofacial area; without contrast material Age Under 21 (70486) |
$2,119 |
$2,119 |
19.8× |
| Computed tomography, orbit, sella, or posterior fossa or outer, middle, or inner ear; with contrast material(s) Age… (70481) |
$2,090 |
$2,090 |
11.7× |
| Computed tomography, orbit, sella, or posterior fossa or outer, middle, or inner ear; without contrast material Age… (70480) |
$1,701 |
$1,701 |
15.9× |
| Computed tomography, orbit, sella, or posterior fossa or outer, middle, or inner ear; without contrast material,… (70482) |
$2,616 |
$2,616 |
14.6× |
| Computed tomography, soft tissue neck; without contrast material followed by contrast material(s) and further sections… (70492) |
$2,725 |
$2,725 |
15.2× |
| Computed tomography, thoracic spine; without contrast material, followed by contrast material(s) and further sections… (72130) |
$3,067 |
$3,067 |
17.1× |
| Computed tomography, thorax, diagnostic; without contrast material, followed by contrast material(s) and further… (71270) |
$3,392 |
$3,392 |
18.9× |
| Continuing medical physics consultation, including assessment of treatment parameters, quality assurance of dose… (77336) |
$1,435 |
$1,435 |
10.5× |
| Csf shunt evaluation (78645) |
$1,370 |
$1,370 |
2.5× |
| CT abdomen and pelvis without and with contrast (74178) |
$6,531 |
$6,531 |
18.3× |
| CT abdomen and pelvis without contrast (74176) |
$4,989 |
$4,989 |
20.5× |
| CT abdomen w & w/o contrast (74170) |
$3,336 |
$3,336 |
18.6× |
| CT abdomen w/contrast (74160) |
$2,766 |
$2,766 |
15.4× |
| CT abdomen w/o contrast (74150) |
$2,114 |
$2,114 |
19.8× |
| CT cervical spine w/contrast (72126) |
$2,456 |
$2,456 |
6.9× |
| CT cervical spine w/o contrast (72125) |
$2,037 |
$2,037 |
19.1× |
| CT chest w/contrast (71260) |
$2,864 |
$2,864 |
16.0× |
| CT extremity upper w & w/o contrast (73202) |
$2,758 |
$2,758 |
15.4× |
| CT extremity upper w/o contrast (73200) |
$1,999 |
$1,999 |
18.7× |
| CT head/brain with contrast (70460) |
$2,119 |
$2,119 |
11.8× |
| CT head/brain without and with contrast (70470) |
$2,928 |
$2,928 |
16.3× |
| CT l-spine w/contrast (72132) |
$2,928 |
$2,928 |
8.2× |
| CT lower extremity w/dye (73701) |
$2,202 |
$2,202 |
12.3× |
| CT lumbar spine w/o contrast (72131) |
$2,161 |
$2,161 |
20.2× |
| CT maxillofacial w/wo contrast (70488) |
$2,928 |
$2,928 |
16.3× |
| CT neck w/contrast (70491) |
$2,130 |
$2,130 |
11.9× |
| CT neck w/o contrast (70490) |
$1,916 |
$1,916 |
17.9× |
| CT pelvis w & w/o contrast (72194) |
$3,300 |
$3,300 |
18.4× |
| CT pelvis w/o contrast (72192) |
$2,198 |
$2,198 |
20.6× |
| CT thoracic spine w/contrast (72129) |
$2,463 |
$2,463 |
13.7× |
| CT thoracic spine w/o contrast (72128) |
$1,955 |
$1,955 |
18.3× |
| CT thorax lung cancer scr c- (71271) |
$935 |
$935 |
8.8× |
| CT thorax w/o contrast (71250) |
$1,557 |
$1,557 |
14.6× |
| CT upper extremity w/dye (73201) |
$2,028 |
$2,028 |
5.7× |
| CTA head w contrast (70496) |
$2,514 |
$2,514 |
14.0× |
| Cystography, minimum of 3 views, radiological supervision and interpretation Age Under 21 (74430) |
$1,191 |
$1,191 |
3.3× |
| Dilation ureters/urethra rs&i (74485) |
$1,578 |
$1,578 |
0.7× |
| Doppler fetal mid cerebral artery (76821) |
$299 |
$299 |
2.8× |
| Dual-energy X-ray absorptiometry (DXA), bone density study, 1 or more sites; axial skeleton (eg, hips, pelvis, spine)… (77080) |
$677 |
$677 |
6.3× |
| Dxa bone density/peripheral (77081) |
$593 |
$593 |
6.7× |
| Fetal biophys profile w/o nst (76819) |
$482 |
$482 |
4.5× |
| Fetal biophysical profile non-stress testing (76818) |
$537 |
$537 |
5.0× |
| Fluoroscopy up to 1 hour physician/qhp time (76000) |
$1,003 |
$1,003 |
4.1× |
| Gastric emptying imaging study (eg, solid, liquid, or both); with small bowel and colon transit, multiple days Age… (78266) |
$2,928 |
$2,928 |
5.3× |
| Gastroesophageal reflux study (78262) |
$1,707 |
$1,707 |
4.2× |
| Gated heart planar single (78472) |
$2,657 |
$2,657 |
6.5× |
| Hepatobil syst imag inc gb w/pharma intervenj (78227) |
$2,127 |
$2,127 |
3.8× |
| Hepatobiliary syst imaging including gallbladder (78226) |
$1,744 |
$1,744 |
4.3× |
| Ht muscle image spect sing (78451) |
$4,842 |
$4,842 |
3.7× |
| Intensity modulated radiotherapy plan, including dose-volume histograms for target and critical structure partial… (77301) |
$11,719 |
$11,719 |
8.3× |
| Intestine imaging (eg, ectopic gastric mucosa, Meckel's localization, volvulus) Age Under 21 (78290) |
$1,423 |
$1,423 |
3.5× |
| Isodose teletherapy plan complex multi tx w/cal (77307) |
$4,464 |
$4,464 |
11.7× |
| Kidney imaging morphology; with vascular flow and function, single study without pharmacological intervention Age Under… (78707) |
$2,213 |
$2,213 |
4.0× |
| Kidney imaging morphology; with vascular flow and function, single study, with pharmacological intervention (eg,… (78708) |
$2,213 |
$2,213 |
4.0× |
| Labeled red cell sequestration, differential organ/tissue (eg, splenic and/or hepatic) Age Under 21 (78140) |
$2,439 |
$2,439 |
6.0× |
| Liver and spleen imaging (78215) |
$1,347 |
$1,347 |
3.3× |
| Lung perfusion imaging (78580) |
$1,486 |
$1,486 |
3.6× |
| Magnetic resonance (eg, proton) imaging, any joint of lower extremity; without contrast material(s), followed by… (73723) |
$5,193 |
$5,193 |
14.6× |
| Magnetic resonance (eg, proton) imaging, lower extremity other than joint; with contrast material(s) Age Under 21 (73719) |
$3,662 |
$3,662 |
10.3× |
| Magnetic resonance (eg, proton) imaging, lower extremity other than joint; without contrast material(s) Age Under 21 (73718) |
$3,678 |
$3,678 |
15.1× |
| Magnetic resonance (eg, proton) imaging, lower extremity other than joint; without contrast material(s), followed by… (73720) |
$5,393 |
$5,393 |
15.1× |
| Magnetic resonance (eg, proton) imaging, orbit, face, and/or neck; with contrast material(s) Age Under 21 (70542) |
$3,662 |
$3,662 |
10.3× |
| Magnetic resonance (eg, proton) imaging, orbit, face, and/or neck; without contrast material(s) Age Under 21 (70540) |
$3,530 |
$3,530 |
14.5× |
| Magnetic resonance (eg, proton) imaging, upper extremity, other than joint; with contrast material(s) Age Under 21 (73219) |
$4,141 |
$4,141 |
11.6× |
| Magnetic resonance (eg, proton) imaging, upper extremity, other than joint; without contrast material(s), followed by… (73220) |
$5,193 |
$5,193 |
14.6× |
| Magnetic resonance angiography, head; with contrast material(s) Age Under 21 (70545) |
$4,145.50 |
$4,145.50 |
11.6× |
| Magnetic resonance angiography, head; without contrast material(s), followed by contrast material(s) and further… (70546) |
$5,232.50 |
$5,232.50 |
14.7× |
| Magnetic resonance angiography, neck; without contrast material(s), followed by contrast material(s) and further… (70549) |
$5,353.50 |
$5,353.50 |
15.0× |
| Mammary ductogram or galactogram, multiple ducts, radiological supervision and interpretation Age Under 21 (77054) |
$1,454 |
$1,454 |
6.0× |
| Mammary ductogram single (77053) |
$1,454 |
$1,454 |
6.0× |
| Mandible min 4v (70110) |
$437 |
$437 |
4.1× |
| MRA head w/o contrast (70544) |
$3,470 |
$3,470 |
14.2× |
| MRA neck w/ contrast (70548) |
$4,773.50 |
$4,773.50 |
13.4× |
| MRA neck w/o contrast (70547) |
$3,002 |
$3,002 |
12.3× |
| MRI abdomen w/contrast (74182) |
$4,242 |
$4,242 |
11.9× |
| MRI abdomen w/o contrast (74181) |
$3,530 |
$3,530 |
14.5× |
| MRI abdomen w/wo contrast (74183) |
$5,393 |
$5,393 |
15.1× |
| MRI any jt lower extrem w/contrast material (73722) |
$4,592.50 |
$4,592.50 |
5.7× |
| MRI breast c- bilateral (77047) |
$5,072 |
$5,072 |
20.8× |
| MRI breast without contrast material unilateral (77046) |
$3,725 |
$3,725 |
15.3× |
| MRI c-spine w&w/o cont (72156) |
$5,393 |
$5,393 |
15.1× |
| MRI cervical spine w/contrast (72142) |
$4,240 |
$4,240 |
11.9× |
| MRI chest w/contrast (71551) |
$3,662 |
$3,662 |
4.6× |
| MRI chest w/o contrast (71550) |
$3,530 |
$3,530 |
14.5× |
| MRI chest w/wo contrast (71552) |
$5,393 |
$5,393 |
15.1× |
| MRI joint upr extr w/o&w/dye (73223) |
$5,193 |
$5,193 |
14.6× |
| MRI joint upr extrem w/dye (73222) |
$4,934 |
$4,934 |
6.2× |
| MRI joint upr extrem w/o dye (73221) |
$4,152 |
$4,152 |
17.0× |
| MRI lumbar spine w/contrast (72149) |
$4,753 |
$4,753 |
13.3× |
| MRI lumbar spine w/wo contrast (72158) |
$5,393 |
$5,393 |
15.1× |
| MRI orbit/face/neck w&w/o cont (70543) |
$5,393 |
$5,393 |
15.1× |
| MRI pelvis w & w/o contrast (72197) |
$5,393 |
$5,393 |
15.1× |
| MRI pelvis w/contrast (72196) |
$3,662 |
$3,662 |
10.3× |
| MRI pelvis w/o contrast (72195) |
$3,530 |
$3,530 |
14.5× |
| MRI spine cervical w/o contrast (72141) |
$3,678 |
$3,678 |
15.1× |
| MRI t-spine w&w/o cont (72157) |
$4,753 |
$4,753 |
13.3× |
| MRI thoracic spine w/contrast (72147) |
$4,306 |
$4,306 |
12.1× |
| MRI thoracic spine w/o contrst (72146) |
$3,822 |
$3,822 |
15.7× |
| MRI tmj (70336) |
$3,985 |
$3,985 |
16.3× |
| MRI upper extremity oth than jt w/o contr matrl (73218) |
$3,985 |
$3,985 |
16.3× |
| Myelography, 2 or more regions (eg, lumbar/thoracic, cervical/thoracic, lumbar/cervical, lumbar/thoracic/cervical),… (72270) |
$2,597 |
$2,597 |
3.2× |
| Myocardial spect multiple studies (78452) |
$7,409 |
$7,409 |
5.6× |
| Nm bone 3 phase (78315) |
$2,310 |
$2,310 |
5.7× |
| Nm bone imaging whole body (78306) |
$1,576 |
$1,576 |
3.9× |
| Nm bone marrow ltd (78102) |
$1,040 |
$1,040 |
2.5× |
| Nm bone marrow wb (78104) |
$1,613 |
$1,613 |
3.9× |
| Nm csf cisternogram (78630) |
$2,190 |
$2,190 |
3.9× |
| Nm csf leak detection (78650) |
$2,292 |
$2,292 |
1.7× |
| Nm gastric emptying (78264) |
$1,991 |
$1,991 |
4.9× |
| Nm lung ventilation imaging (78579) |
$1,154 |
$1,154 |
2.8× |
| Nm lymph system (78195) |
$1,693 |
$1,693 |
3.1× |
| Nuclear medicine study of bone and/or joint limited area (78300) |
$1,343 |
$1,343 |
3.3× |
| Nuclear medicine study of bone and/or joint multiple areas (78305) |
$1,534 |
$1,534 |
3.8× |
| Ob us limited fetus(s) (76815) |
$703 |
$703 |
6.6× |
| Optic foramina (70190) |
$336 |
$336 |
3.8× |
| Panoramic X-ray of jaws (70355) |
$491 |
$491 |
5.5× |
| Parathyrd planar w/spect&CT (78072) |
$3,181 |
$3,181 |
5.7× |
| Parathyroid planar imaging (78070) |
$2,000 |
$2,000 |
4.9× |
| Parathyroid planar imaging w/wo subtraction (78071) |
$3,181 |
$3,181 |
7.8× |
| PET imaging CT attenuation skull base mid-thigh (78815) |
$8,162 |
$8,162 |
5.6× |
| PET imaging CT for attenuation limited area (78814) |
$7,737 |
$7,737 |
5.3× |
| PET imaging for CT attenuation whole body (78816) |
$8,936 |
$8,936 |
6.1× |
| Pulmonary ventilation & perfusion imaging (78582) |
$1,679 |
$1,679 |
3.0× |
| Radex abscess/fistula/sinus tract rs&i (76080) |
$1,524 |
$1,524 |
2.7× |
| Radex entir thrc lmbr crv sac spi w/skull 1 vw (72081) |
$668 |
$668 |
7.5× |
| Radex entir thrc lmbr crv sac spi w/skull 2/3 vw (72082) |
$531 |
$531 |
5.0× |
| Radex entir thrc lmbr crv sac spi w/skull 4/5 vw (72083) |
$668 |
$668 |
6.3× |
| Radex entir thrc lmbr crv sac spi w/skull 6/> vw (72084) |
$803 |
$803 |
7.5× |
| Radex hip unilateral with pelvis 1 view (73501) |
$326 |
$326 |
3.7× |
| Radex hip unilateral with pelvis 2-3 views (73502) |
$411 |
$411 |
4.6× |
| Radex hip unilateral with pelvis minimum 4 views (73503) |
$540 |
$540 |
5.1× |
| Radex hips bilateral with pelvis 2 views (73521) |
$459 |
$459 |
4.3× |
| Radex hips bilateral with pelvis minimum 5 views (73523) |
$663 |
$663 |
6.2× |
| Radex spine cervical 2 or 3 views (72040) |
$430 |
$430 |
4.8× |
| Radex spine cervical 4 or 5 views (72050) |
$661 |
$661 |
6.2× |
| Radex spine cervical 6 or more views (72052) |
$341 |
$341 |
3.2× |
| Radex spine thoracolumbar junction min 2 views (72080) |
$310 |
$310 |
3.5× |
| Radiation treatment delivery, stereotactic radiosurgery (SRS), complete course of treatment of cranial lesion(s)… (77372) |
$33,845 |
$33,845 |
4.5× |
| Radiation tx delivery lvl 3 (77412) |
$1,453 |
$1,453 |
2.6× |
| Radiologic exam abdomen 3+ views (74021) |
$391 |
$391 |
3.7× |
| Radiologic exam chest 3 views (71047) |
$532 |
$532 |
6.0× |
| Radiologic exam chest 4+ views (71048) |
$708 |
$708 |
6.6× |
| Radiologic exam colon double contrast study (74280) |
$1,304 |
$1,304 |
7.3× |
| Radiologic exam colon single contrast study (74270) |
$1,007 |
$1,007 |
5.6× |
| Radiologic exam esophagus single contrast study (74220) |
$720 |
$720 |
4.0× |
| Radiologic exam small int single contrast study (74250) |
$805 |
$805 |
4.5× |
| Radiologic exam swallow function contrast study (74230) |
$596 |
$596 |
3.3× |
| Radiologic exam upr gi trc double contrast study (74246) |
$1,514 |
$1,514 |
8.4× |
| Radiologic exam upr gi trc single contrast study (74240) |
$886 |
$886 |
4.9× |
| Radiologic examination femur 1 view (73551) |
$346 |
$346 |
3.9× |
| Radiologic examination femur minimum 2 views (73552) |
$411 |
$411 |
4.6× |
| Radiologic examination from nose to rectum for foreign body, single view, child Age Under 21 (76010) |
$325 |
$325 |
3.7× |
| Radiologic examination, ankle; complete, minimum of 3 views Age Under 21 (73610) |
$391 |
$391 |
4.4× |
| Radiologic examination, complete acute abdomen series, including 2 or more views of the abdomen (eg, supine, erect,… (74022) |
$533 |
$533 |
5.0× |
| Radiologic examination, elbow; 2 views Age Under 21 (73070) |
$347 |
$347 |
3.9× |
| Radiologic examination, elbow; complete, minimum of 3 views Age Under 21 (73080) |
$391 |
$391 |
4.4× |
| Radiologic examination, facial bones; less than 3 views Age Under 21 (70140) |
$371 |
$371 |
4.2× |
| Radiologic examination, foot; complete, minimum of 3 views Age Under 21 (73630) |
$351 |
$351 |
3.9× |
| Radiologic examination, hand; minimum of 3 views Age Under 21 (73130) |
$391 |
$391 |
4.4× |
| Radiologic examination, knee; both knees, standing, anteroposterior Age Under 21 (73565) |
$333 |
$333 |
3.7× |
| Radiologic examination, knee; complete, 4 or more views Age Under 21 (73564) |
$409 |
$409 |
3.8× |
| Radiologic examination, mandible; partial, less than 4 views Age Under 21 (70100) |
$411 |
$411 |
4.6× |
| Radiologic examination, mastoids; complete, minimum of 3 views per side Age Under 21 (70130) |
$421 |
$421 |
3.9× |
| Radiologic examination, mastoids; less than 3 views per side Age Under 21 (70120) |
$326 |
$326 |
3.1× |
| Radiologic examination, nasal bones, complete, minimum of 3 views Age Under 21 (70160) |
$470 |
$470 |
5.3× |
| Radiologic examination, ribs, bilateral; including posteroanterior chest, minimum of 4 views Age Under 21 (71111) |
$591 |
$591 |
5.5× |
| Radiologic examination, ribs, unilateral; including posteroanterior chest, minimum of 3 views Age Under 21 (71101) |
$467 |
$467 |
4.4× |
| Radiologic examination, sacroiliac joints; less than 3 views Age Under 21 (72200) |
$372 |
$372 |
3.5× |
| Radiologic examination, shoulder, arthrography, radiological supervision and interpretation Age Under 21 (73040) |
$1,571 |
$1,571 |
4.4× |
| Radiologic examination, shoulder; complete, minimum of 2 views Age Under 21 (73030) |
$333 |
$333 |
3.7× |
| Radiologic examination, single plane body section (eg, tomography), other than with urography Age Under 21 (76100) |
$737 |
$737 |
6.9× |
| Radiologic examination, sinuses, paranasal, less than 3 views Age Under 21 (70210) |
$411 |
$411 |
4.6× |
| Radiologic examination, skull; less than 4 views Age Under 21 (70250) |
$391 |
$391 |
3.7× |
| Radiologic examination, spine, lumbosacral; 2 or 3 views Age Under 21 (72100) |
$472 |
$472 |
4.4× |
| Radiologic examination, spine, lumbosacral; bending views only, 2 or 3 views Age Under 21 (72120) |
$509 |
$509 |
4.8× |
| Radiologic examination, spine, lumbosacral; complete, including bending views, minimum of 6 views Age Under 21 (72114) |
$720 |
$720 |
6.7× |
| Radiologic examination, spine; thoracic, minimum of 4 views Age Under 21 (72074) |
$607 |
$607 |
5.7× |
| Radiologic examination, wrist; complete, minimum of 3 views Age Under 21 (73110) |
$351 |
$351 |
3.9× |
| Radiologic examination; acromioclavicular joints, bilateral, with or without weighted distraction Age Under 21 (73050) |
$411 |
$411 |
4.6× |
| Radiologic examination; humerus, minimum of 2 views Age Under 21 (73060) |
$346 |
$346 |
3.9× |
| Radiologic examination; lower extremity, infant, minimum of 2 views Age Under 21 (73592) |
$310 |
$310 |
3.5× |
| Radiologic examination; orbits, complete, minimum of 4 views Age Under 21 (70200) |
$560 |
$560 |
5.2× |
| Radiologic examination; pharynx or larynx, including fluoroscopy and/or magnification technique Age Under 21 (70370) |
$714 |
$714 |
8.0× |
| Radiologic examination; sternoclavicular joint or joints, minimum of 3 views Age Under 21 (71130) |
$361 |
$361 |
4.1× |
| Radiologic examination; toe(s), minimum of 2 views Age Under 21 (73660) |
$271 |
$271 |
3.0× |
| Radiologic examination; upper extremity, infant, minimum of 2 views Age Under 21 (73092) |
$325 |
$325 |
3.0× |
| Radiopharmaceutical localization of tumor, inflammatory process or distribution of radiopharmaceutical agent(s)… (78803) |
$2,829 |
$2,829 |
5.1× |
| Radiopharmaceutical therapy, by oral administration Age Under 21 (79005) |
$1,264 |
$1,264 |
5.3× |
| Review by radiologist of urinary bladder and urethra images with contrast and after passing urine (74455) |
$932 |
$932 |
3.8× |
| Rp loclzj tum plnr whole body single day imaging (78802) |
$2,228 |
$2,228 |
4.0× |
| Rp loclzj tum spect w/CT 2 (78832) |
$3,222 |
$3,222 |
2.2× |
| Saline infusion sonohysterography (SIS), including color flow Doppler, when performed Age Under 21 (76831) |
$935 |
$935 |
3.8× |
| Scapula complete (73010) |
$372 |
$372 |
3.5× |
| Screening digital breast tomosynthesis bi (77063) |
$156 |
$156 |
— |
| Shuntogram indwelling nonvascular shunt rs&i (75809) |
$894 |
$894 |
8.4× |
| Simulation intermediate (77285) |
$1,693 |
$1,693 |
4.4× |
| Special dosimetry (77331) |
$558 |
$558 |
4.1× |
| Special physics consult (77370) |
$979 |
$979 |
7.1× |
| Special treatment procedure (77470) |
$3,205 |
$3,205 |
5.7× |
| Stereotactic body radiation therapy, treatment delivery, per fraction to 1 or more lesions, including image guidance,… (77373) |
$15,677 |
$15,677 |
8.6× |
| Testicular imaging with vascular flow Age Under 21 (78761) |
$1,299 |
$1,299 |
3.2× |
| Ther rad simulaj-aided field setting complex (77290) |
$4,557 |
$4,557 |
11.9× |
| Therapeutic enema, contrast or air, for reduction of intussusception or other intraluminal obstruction (eg, meconium… (74283) |
$1,038 |
$1,038 |
5.8× |
| Thyroid imaging with vascular flow (78013) |
$700 |
$700 |
1.7× |
| Thyroid met imaging body (78018) |
$2,194 |
$2,194 |
4.0× |
| Thyroid uptake w/blood flow sngle/mult quan meas (78014) |
$1,810 |
$1,810 |
4.4× |
| Tr simulation simple (77280) |
$1,718 |
$1,718 |
12.5× |
| Treatment device complex (77334) |
$2,142 |
$2,142 |
5.6× |
| Treatment device intermediate (77333) |
$1,037 |
$1,037 |
7.6× |
| Treatment device simple (77332) |
$498 |
$498 |
3.6× |
| Ultrasound breast limited (76642) |
$584 |
$584 |
6.6× |
| Ultrasound, abdomen limited (76705) |
$1,060 |
$1,060 |
9.9× |
| Ultrasound, limited, joint or focal evaluation of other nonvascular extremity structure(s) (eg, joint space,… (76882) |
$480 |
$480 |
4.5× |
| Ultrasound, pelvic (nonobstetric), real time with image documentation; complete Age Under 21 (76856) |
$841 |
$841 |
7.9× |
| Ultrasound, pregnant uterus, real time with image documentation, fetal and maternal evaluation plus detailed fetal… (76811) |
$1,445 |
$1,445 |
5.9× |
| Ultrasound, pregnant uterus, real time with image documentation, fetal and maternal evaluation, first trimester (< 14… (76801) |
$841 |
$841 |
7.9× |
| Ultrasound, transplanted kidney, real time and duplex Doppler with image documentation Age Under 21 (76776) |
$654 |
$654 |
6.1× |
| Umbilical-artery Doppler (OB) (76820) |
$158 |
$158 |
1.5× |
| Unlisted magnetic resonance procedure (eg, diagnostic, interventional) Age Under 21 (76498) |
$10,228 |
$10,228 |
115.0× |
| Ureteral reflux study (78740) |
$1,299 |
$1,299 |
3.2× |
| Urethrocystography retrograde rs&i (74450) |
$1,191 |
$1,191 |
4.9× |
| Urography (pyelography), intravenous, with or without KUB, with or without tomography Age Under 21 (74400) |
$1,197 |
$1,197 |
6.7× |
| Urography antegrade rs&i (74425) |
$810 |
$810 |
2.3× |
| Us abdominal aorta real time screen study aaa (76706) |
$729 |
$729 |
6.8× |
| Us breast uni real time with image complete (76641) |
$584 |
$584 |
5.5× |
| Us chest (76604) |
$660 |
$660 |
6.2× |
| Us compl joint r-t w/image documentation (76881) |
$565 |
$565 |
5.3× |
| Us elastography organ (76981) |
$294 |
$294 |
2.8× |
| Us encephalogram (76506) |
$660 |
$660 |
6.2× |
| Us exam, pelvic, limited (76857) |
$684 |
$684 |
6.4× |
| Us inft hips r-t img dynamic req phys/qhp manj (76885) |
$950 |
$950 |
10.7× |
| US OB Follow-Up/Repeat (76816) |
$531 |
$531 |
5.0× |
| Us ob transvaginal (76817) |
$935 |
$935 |
8.8× |
| Us retroperitoneal complete (76770) |
$921 |
$921 |
8.6× |
| Us retroperitoneal ltd (76775) |
$697 |
$697 |
6.5× |
| Us scrotum (76870) |
$741 |
$741 |
6.9× |
| Us soft tissue head/neck (76536) |
$660 |
$660 |
6.2× |
| Us spinal canal (76800) |
$872 |
$872 |
8.2× |
| Us transrectal (76872) |
$760 |
$760 |
7.1× |
| Us unlstd proc (76999) |
$629 |
$629 |
7.1× |
| Venography deep dorsal vein penis radiolgicl supervision interpretation (76499) |
$293 |
$293 |
3.3× |
| Venography, caval, inferior, with serialography, radiological supervision and interpretation Age Under 21 (75825) |
$6,353 |
$6,353 |
2.0× |
| Venography, extremity, bilateral, radiological supervision and interpretation Age Under 21 (75822) |
$2,232 |
$2,232 |
1.4× |
| Venography, extremity, unilateral, radiological supervision and interpretation Age Under 21 (75820) |
$2,141 |
$2,141 |
1.3× |
| X-ray exam hips bi 3-4 views (73522) |
$547 |
$547 |
5.1× |
| X-ray exam of finger(s) (73140) |
$422 |
$422 |
4.7× |
| X-ray exam of knee 1 or 2 (73560) |
$351 |
$351 |
3.9× |
| X-ray exam of small bowel - fl small bowel series enteroclysis tube (74251) |
$1,273 |
$1,273 |
7.1× |
| X-ray exam ribs bil 3 views (71110) |
$467 |
$467 |
4.4× |
| X-ray exam ribs uni 2 views (71100) |
$411 |
$411 |
4.6× |
| X-ray heel (73650) |
$304 |
$304 |
3.4× |
| X-ray of joint between lower spine and hip bone 3 or more views|PROFESSIONAL COMPONENT (72202) |
$391 |
$391 |
3.7× |
| X-ray retrograde pyelogram (74420) |
$1,578 |
$1,578 |
4.4× |
| Xr abdomen 1 view (74018) |
$333 |
$333 |
3.7× |
| Xr abdomen 2 views (74019) |
$509 |
$509 |
4.8× |
| Xr arthrogram ankle (73615) |
$1,246 |
$1,246 |
3.5× |
| Xr arthrogram elbow (73085) |
$1,246 |
$1,246 |
3.5× |
| Xr arthrogram hip (73525) |
$1,638 |
$1,638 |
4.6× |
| Xr arthrogram knee (73580) |
$1,428 |
$1,428 |
4.0× |
| Xr arthrogram wrist (73115) |
$1,638 |
$1,638 |
4.6× |
| Xr bone age studies (77072) |
$472 |
$472 |
4.4× |
| Xr bone length study (77073) |
$420 |
$420 |
3.9× |
| Xr bone survey infant (77076) |
$548 |
$548 |
5.1× |
| Xr bone survey ltd (77074) |
$492 |
$492 |
4.6× |
| Xr chest 1 view (71045) |
$302 |
$302 |
3.4× |
| Xr chest 2 views (71046) |
$376 |
$376 |
4.2× |
| Xr eye foreign body (70030) |
$381 |
$381 |
4.3× |
| Xr facial bones 3+ views (70150) |
$560 |
$560 |
5.2× |
| Xr foot arthritis pa only bilateral - report(ortho pro) (73620) |
$284 |
$284 |
3.2× |
| Xr forearm 2 views (73090) |
$304 |
$304 |
3.4× |
| Xr hand 2v (73120) |
$304 |
$304 |
2.8× |
| Xr hysterosalpingogram (74740) |
$1,532 |
$1,532 |
6.3× |
| Xr myelogram c-spine (72240) |
$2,869 |
$2,869 |
3.6× |
| Xr myelogram l-spine (72265) |
$2,869 |
$2,869 |
3.6× |
| Xr myelogram t-spine (72255) |
$2,753 |
$2,753 |
3.4× |
| Xr neck soft tissue (70360) |
$304 |
$304 |
3.4× |
| Xr o knee w/ merchant view bilat - report(ortho pro) (73562) |
$391 |
$391 |
4.4× |
| Xr osseous survey complete (77075) |
$687 |
$687 |
6.4× |
| Xr pelvis 1-2 views (72170) |
$411 |
$411 |
3.8× |
| Xr pelvis min 3 view (72190) |
$467 |
$467 |
4.4× |
| Xr sacrum/coccyx 2+ views (72220) |
$353 |
$353 |
4.0× |
| Xr shoulder 1 view (73020) |
$289 |
$289 |
3.3× |
| Xr sinuses 3+ views (70220) |
$491 |
$491 |
5.5× |
| Xr skull min 4 view (70260) |
$459 |
$459 |
4.3× |
| Xr spine 1 view (72020) |
$252 |
$252 |
2.8× |
| Xr spine thoracic 3v (72072) |
$509 |
$509 |
4.8× |
| Xr sternum 2+ views (71120) |
$411 |
$411 |
4.6× |
| Xr surgical specimen (76098) |
$1,564 |
$1,564 |
2.8× |
| Xr t-spine 2 views (72070) |
$411 |
$411 |
3.8× |
| Xr tibia/fibula 2 views (73590) |
$347 |
$347 |
3.9× |
| Xr tmj bilateral (70330) |
$403 |
$403 |
4.5× |
| Xr wrist 2 views (73100) |
$325 |
$325 |
3.7× |