| 3-D radiotherapy plan dose-volume histograms (77295) |
$4,048.80 |
$6,748 |
2.9× |
| Acute gi blood loss imaging (78278) |
$1,099.65 |
$1,832.75 |
2.7× |
| Angiography internal mammary rs&i (75756) |
$4,833.30 |
$8,055.50 |
1.5× |
| Angiography pulmonary bilateral slctv rs&i (75743) |
$3,480 |
$5,800 |
1.1× |
| Angiography visceral slctv/supraslctv rs&i (75726) |
$3,267.30 |
$5,445.50 |
0.6× |
| Angiography, adrenal, bilateral, selective, radiological supervision and interpretation Age Under 21 (75733) |
$6,385.35 |
$10,642.25 |
2.0× |
| Angiography, adrenal, unilateral, selective, radiological supervision and interpretation Age Under 21 (75731) |
$6,385.35 |
$10,642.25 |
2.0× |
| Angiography, extremity, bilateral, radiological supervision and interpretation Age Under 21 (75716) |
$3,232.20 |
$5,387 |
1.0× |
| Angiography, extremity, unilateral, radiological supervision and interpretation Age Under 21 (75710) |
$3,480 |
$5,800 |
1.1× |
| Angiography, pelvic, selective or supraselective, radiological supervision and interpretation Age Under 21 (75736) |
$3,267.30 |
$5,445.50 |
0.6× |
| Angiography, pulmonary, unilateral, selective, radiological supervision and interpretation Age Under 21 (75741) |
$3,480 |
$5,800 |
1.1× |
| Angiography, spinal, selective, radiological supervision and interpretation Age Under 21 (75705) |
$3,267.30 |
$5,445.50 |
0.6× |
| Angrph cath f-up std tcat other than thrombylsis (75898) |
$2,416.65 |
$4,027.75 |
0.8× |
| Angrph pulmonary nonslctv cath/ven njx rs&i (75746) |
$1,895.25 |
$3,158.75 |
0.6× |
| Ankle 2 views (73600) |
$317.85 |
$529.75 |
3.6× |
| Aortography, abdominal plus bilateral iliofemoral lower extremity, catheter, by serialography, radiological supervision… (75630) |
$3,232.20 |
$5,387 |
1.0× |
| Aortography, abdominal, by serialography, radiological supervision and interpretation Age Under 21 (75625) |
$3,480 |
$5,800 |
1.1× |
| Aortography, thoracic, by serialography, radiological supervision and interpretation Age Under 21 (75605) |
$3,267.30 |
$5,445.50 |
0.6× |
| Basic radiation dosimetry calculation (77300) |
$306.75 |
$511.25 |
2.3× |
| Brain flow imaging only - nm brain flow only brain death (78610) |
$1,956.60 |
$3,261 |
3.6× |
| Brain imaging, less than 4 static views; with vascular flow Age Under 21 (78601) |
$479.10 |
$798.50 |
1.2× |
| Brain imaging, minimum 4 static views; with vascular flow Age Under 21 (78606) |
$1,132.80 |
$1,888 |
2.1× |
| Brain imaging, positron emission tomography (PET); metabolic evaluation Age Under 21 (78608) |
$5,005.80 |
$8,343 |
3.5× |
| Cardiac blood pool imaging (planar), first pass technique; multiple studies, at rest and with stress (exercise and/or… (78483) |
$1,663.35 |
$2,772.25 |
3.0× |
| Cardiac blood pool imaging (planar), first pass technique; single study, at rest or with stress (exercise and/or… (78481) |
$1,381.05 |
$2,301.75 |
2.5× |
| Cardiac MRI morphology & function w/o contrast (75557) |
$1,244.85 |
$2,074.75 |
5.2× |
| Cardiac MRI w/stress img (75559) |
$1,137.15 |
$1,895.25 |
2.1× |
| Cardiac MRI w/wo contrast & further seq (75561) |
$1,902 |
$3,170 |
5.4× |
| Clavicle complete (73000) |
$371.85 |
$619.75 |
4.3× |
| Computed tomographic (CT) colonography, diagnostic, including image postprocessing; with contrast material(s) including… (74262) |
$922.35 |
$1,537.25 |
5.2× |
| Computed tomographic (CT) colonography, diagnostic, including image postprocessing; without contrast material Age Under… (74261) |
$606.30 |
$1,010.50 |
5.8× |
| Computed tomographic angiography, abdomen and pelvis, with contrast material(s), including noncontrast images, if… (74174) |
$5,878.20 |
$9,797 |
16.8× |
| Computed tomographic angiography, abdomen, with contrast material(s), including noncontrast images, if performed, and… (74175) |
$3,264.90 |
$5,441.50 |
18.5× |
| Computed tomographic angiography, abdominal aorta and bilateral iliofemoral lower extremity runoff, with contrast… (75635) |
$1,229.10 |
$2,048.50 |
7.0× |
| Computed tomographic angiography, chest (noncoronary), with contrast material(s), including noncontrast images, if… (71275) |
$3,264.90 |
$5,441.50 |
18.5× |
| Computed tomographic angiography, lower extremity, with contrast material(s), including noncontrast images, if… (73706) |
$4,135.20 |
$6,892 |
23.5× |
| Computed tomographic angiography, neck, with contrast material(s), including noncontrast images, if performed, and… (70498) |
$2,830.05 |
$4,716.75 |
16.1× |
| Computed tomographic angiography, pelvis, with contrast material(s), including noncontrast images, if performed, and… (72191) |
$2,612.85 |
$4,354.75 |
14.8× |
| Computed tomographic angiography, upper extremity, with contrast material(s), including noncontrast images, if… (73206) |
$4,135.20 |
$6,892 |
23.5× |
| Computed tomography, cervical spine; without contrast material, followed by contrast material(s) and further sections… (72127) |
$3,264.90 |
$5,441.50 |
18.5× |
| Computed tomography, lower extremity; without contrast material Age Under 21 (73700) |
$2,394.15 |
$3,990.25 |
22.8× |
| Computed tomography, lower extremity; without contrast material, followed by contrast material(s) and further sections… (73702) |
$3,264.90 |
$5,441.50 |
18.5× |
| Computed tomography, lumbar spine; without contrast material, followed by contrast material(s) and further sections Age… (72133) |
$3,264.90 |
$5,441.50 |
18.5× |
| Computed tomography, maxillofacial area; with contrast material(s) Age Under 21 (70487) |
$1,767.90 |
$2,946.50 |
10.0× |
| Computed tomography, maxillofacial area; without contrast material Age Under 21 (70486) |
$1,666.95 |
$2,778.25 |
15.9× |
| Computed tomography, orbit, sella, or posterior fossa or outer, middle, or inner ear; with contrast material(s) Age… (70481) |
$2,046.60 |
$3,411 |
11.6× |
| Computed tomography, orbit, sella, or posterior fossa or outer, middle, or inner ear; without contrast material Age… (70480) |
$2,046.60 |
$3,411 |
19.5× |
| Computed tomography, orbit, sella, or posterior fossa or outer, middle, or inner ear; without contrast material,… (70482) |
$2,264.55 |
$3,774.25 |
12.9× |
| Computed tomography, soft tissue neck; without contrast material followed by contrast material(s) and further sections… (70492) |
$2,927.85 |
$4,879.75 |
16.6× |
| Computed tomography, thoracic spine; without contrast material, followed by contrast material(s) and further sections… (72130) |
$3,264.90 |
$5,441.50 |
18.5× |
| Computed tomography, thorax, diagnostic; without contrast material, followed by contrast material(s) and further… (71270) |
$3,264.90 |
$5,441.50 |
18.5× |
| Continuing medical physics consultation, including assessment of treatment parameters, quality assurance of dose… (77336) |
$310.05 |
$516.75 |
2.3× |
| Csf shunt evaluation (78645) |
$1,132.80 |
$1,888 |
2.1× |
| CT abdomen and pelvis without and with contrast (74178) |
$4,407.45 |
$7,345.75 |
12.6× |
| CT abdomen and pelvis without contrast (74176) |
$3,356.10 |
$5,593.50 |
14.0× |
| CT abdomen w & w/o contrast (74170) |
$3,264.90 |
$5,441.50 |
18.5× |
| CT abdomen w/contrast (74160) |
$2,612.85 |
$4,354.75 |
14.8× |
| CT abdomen w/o contrast (74150) |
$2,394.15 |
$3,990.25 |
22.8× |
| CT angio hrt w/3d image (75574) |
$835.65 |
$1,392.75 |
2.4× |
| CT cervical spine w/contrast (72126) |
$2,612.85 |
$4,354.75 |
7.5× |
| CT cervical spine w/o contrast (72125) |
$2,394.15 |
$3,990.25 |
22.8× |
| CT chest w/contrast (71260) |
$2,656.20 |
$4,427 |
15.1× |
| CT extremity upper w & w/o contrast (73202) |
$3,264.90 |
$5,441.50 |
18.5× |
| CT extremity upper w/o contrast (73200) |
$1,991.85 |
$3,319.75 |
19.0× |
| CT head/brain with contrast (70460) |
$2,275.80 |
$3,793 |
12.9× |
| CT head/brain without and with contrast (70470) |
$2,720.70 |
$4,534.50 |
15.4× |
| CT heart c+ cardiac strux&morph cgen hrt ds (75573) |
$835.65 |
$1,392.75 |
2.4× |
| CT heart contrast eval cardiac structure&morph (75572) |
$835.65 |
$1,392.75 |
2.4× |
| CT heart no contrast quant eval coronry calcium (75571) |
$136.50 |
$227.50 |
1.6× |
| CT l-spine w/contrast (72132) |
$2,612.85 |
$4,354.75 |
7.5× |
| CT limited/localized follow up study (76380) |
$789.60 |
$1,316 |
9.0× |
| CT lower extremity w/dye (73701) |
$2,612.85 |
$4,354.75 |
14.8× |
| CT lumbar spine w/o contrast (72131) |
$2,394.15 |
$3,990.25 |
22.8× |
| CT maxillofacial w/wo contrast (70488) |
$2,312.25 |
$3,853.75 |
13.1× |
| CT neck w/contrast (70491) |
$2,394.15 |
$3,990.25 |
13.6× |
| CT neck w/o contrast (70490) |
$2,068.50 |
$3,447.50 |
19.7× |
| CT pelvis w & w/o contrast (72194) |
$2,612.85 |
$4,354.75 |
14.8× |
| CT pelvis w/o contrast (72192) |
$2,081.55 |
$3,469.25 |
19.8× |
| CT thoracic spine w/contrast (72129) |
$2,612.85 |
$4,354.75 |
14.8× |
| CT thoracic spine w/o contrast (72128) |
$2,394.15 |
$3,990.25 |
22.8× |
| CT thorax lung cancer scr c- (71271) |
$231 |
$385 |
2.2× |
| CT thorax w/o contrast (71250) |
$2,383.80 |
$3,973 |
22.7× |
| CT upper extremity w/dye (73201) |
$1,991.85 |
$3,319.75 |
5.7× |
| CTA head w contrast (70496) |
$2,830.05 |
$4,716.75 |
16.1× |
| Cystography, minimum of 3 views, radiological supervision and interpretation Age Under 21 (74430) |
$622.35 |
$1,037.25 |
1.8× |
| Dilation ureters/urethra rs&i (74485) |
$3,009.45 |
$5,015.75 |
1.4× |
| Doppler echocardiography, fetal, pulsed wave and/or continuous wave with spectral display; complete Age Under 21 (76827) |
$446.70 |
$744.50 |
4.3× |
| Doppler echocardiography, fetal, pulsed wave and/or continuous wave with spectral display; follow-up or repeat study… (76828) |
$214.35 |
$357.25 |
2.0× |
| Doppler fetal mid cerebral artery (76821) |
$223.05 |
$371.75 |
2.1× |
| Dual-energy X-ray absorptiometry (DXA), bone density study, 1 or more sites; axial skeleton (eg, hips, pelvis, spine)… (77080) |
$415.80 |
$693 |
4.0× |
| Dxa bone density/peripheral (77081) |
$143.25 |
$238.75 |
1.6× |
| Echocardiography, fetal, cardiovascular system, real time with image documentation (2D), with or without M-mode… (76825) |
$888.15 |
$1,480.25 |
1.6× |
| Echocardiography, fetal, cardiovascular system, real time with image documentation (2D), with or without M-mode… (76826) |
$429.45 |
$715.75 |
1.8× |
| Fetal biophys profile w/o nst (76819) |
$469.50 |
$782.50 |
4.5× |
| Fetal biophysical profile non-stress testing (76818) |
$381.75 |
$636.25 |
3.6× |
| Fluoroscopy up to 1 hour physician/qhp time (76000) |
$417.15 |
$695.25 |
1.7× |
| Gated heart planar single (78472) |
$1,518.75 |
$2,531.25 |
3.8× |
| Hepatc vngrph wdg/fr w/o hemodyn eval rs&i (75891) |
$2,502.15 |
$4,170.25 |
0.8× |
| Hepatic venography, wedged or free, with hemodynamic evaluation, radiological supervision and interpretation Age Under… (75889) |
$2,634.90 |
$4,391.50 |
0.8× |
| Hepatobil syst imag inc gb w/pharma intervenj (78227) |
$1,602.75 |
$2,671.25 |
2.9× |
| Hepatobiliary syst imaging including gallbladder (78226) |
$1,602.75 |
$2,671.25 |
4.0× |
| Ht muscle image spect sing (78451) |
$3,905.10 |
$6,508.50 |
3.0× |
| Injection procedure for radiopharmaceutical localization by non-imaging probe study, intravenous (eg, parathyroid… (78808) |
$510.45 |
$850.75 |
1.3× |
| Intensity modulated radiotherapy plan, including dose-volume histograms for target and critical structure partial… (77301) |
$2,658.45 |
$4,430.75 |
1.9× |
| Interstitial radiation source application, complex, includes supervision, handling, loading of radiation source, when… (77778) |
$3,177.60 |
$5,296 |
4.5× |
| Intestine imaging (eg, ectopic gastric mucosa, Meckel's localization, volvulus) Age Under 21 (78290) |
$820.20 |
$1,367 |
2.0× |
| Isodose teletherapy plan complex multi tx w/cal (77307) |
$872.85 |
$1,454.75 |
2.3× |
| Kidney imaging morphol - nm kidney cortex (78700) |
$747.90 |
$1,246.50 |
1.9× |
| Kidney imaging morphology; with vascular flow Age Under 21 (78701) |
$747.90 |
$1,246.50 |
1.9× |
| Kidney imaging morphology; with vascular flow and function, multiple studies, with and without pharmacological… (78709) |
$1,570.65 |
$2,617.75 |
2.9× |
| Kidney imaging morphology; with vascular flow and function, single study without pharmacological intervention Age Under… (78707) |
$1,320.15 |
$2,200.25 |
2.4× |
| Kidney imaging morphology; with vascular flow and function, single study, with pharmacological intervention (eg,… (78708) |
$1,491.60 |
$2,486 |
2.7× |
| Leveen/shunt patency exam (78291) |
$1,076.40 |
$1,794 |
2.7× |
| Liver and spleen imaging (78215) |
$1,069.20 |
$1,782 |
2.7× |
| Liver and spleen imaging; with vascular flow Age Under 21 (78216) |
$1,069.20 |
$1,782 |
2.7× |
| Liver imaging (78201) |
$777.90 |
$1,296.50 |
1.4× |
| Liver imaging with flow (78202) |
$820.20 |
$1,367 |
1.5× |
| Lung perf&ventilat diferentl (78598) |
$3,479.55 |
$5,799.25 |
6.4× |
| Lung perfusion imaging (78580) |
$1,257.45 |
$2,095.75 |
3.1× |
| Lymphangiography, extremity only, unilateral, radiological supervision and interpretation Age Under 21 (75801) |
$373.65 |
$622.75 |
0.6× |
| Lymphangiography, pelvic/abdominal, bilateral, radiological supervision and interpretation Age Under 21 (75807) |
$5,479.20 |
$9,132 |
1.7× |
| Magnetic resonance (eg, proton) imaging, any joint of lower extremity; without contrast material(s), followed by… (73723) |
$3,700.05 |
$6,166.75 |
10.6× |
| Magnetic resonance (eg, proton) imaging, lower extremity other than joint; with contrast material(s) Age Under 21 (73719) |
$3,482.70 |
$5,804.50 |
9.9× |
| Magnetic resonance (eg, proton) imaging, lower extremity other than joint; without contrast material(s) Age Under 21 (73718) |
$3,264.90 |
$5,441.50 |
13.6× |
| Magnetic resonance (eg, proton) imaging, lower extremity other than joint; without contrast material(s), followed by… (73720) |
$3,700.05 |
$6,166.75 |
10.6× |
| Magnetic resonance (eg, proton) imaging, orbit, face, and/or neck; with contrast material(s) Age Under 21 (70542) |
$3,156.60 |
$5,261 |
9.0× |
| Magnetic resonance (eg, proton) imaging, orbit, face, and/or neck; without contrast material(s) Age Under 21 (70540) |
$2,830.05 |
$4,716.75 |
11.8× |
| Magnetic resonance (eg, proton) imaging, upper extremity, other than joint; with contrast material(s) Age Under 21 (73219) |
$2,687.10 |
$4,478.50 |
7.7× |
| Magnetic resonance (eg, proton) imaging, upper extremity, other than joint; without contrast material(s), followed by… (73220) |
$3,264.90 |
$5,441.50 |
9.3× |
| Magnetic resonance angiography, head; with contrast material(s) Age Under 21 (70545) |
$2,612.85 |
$4,354.75 |
7.5× |
| Magnetic resonance angiography, head; without contrast material(s), followed by contrast material(s) and further… (70546) |
$2,830.05 |
$4,716.75 |
8.1× |
| Magnetic resonance angiography, neck; without contrast material(s), followed by contrast material(s) and further… (70549) |
$2,830.05 |
$4,716.75 |
8.1× |
| Magnetic resonance imaging, brain, functional MRI; including test selection and administration of repetitive body part… (70554) |
$1,351.95 |
$2,253.25 |
5.6× |
| Magnetic resonance imaging, brain, functional MRI; requiring physician or psychologist administration of entire… (70555) |
$1,283.70 |
$2,139.50 |
5.4× |
| Mammary ductogram or galactogram, multiple ducts, radiological supervision and interpretation Age Under 21 (77054) |
$621.75 |
$1,036.25 |
2.6× |
| Mammary ductogram single (77053) |
$646.65 |
$1,077.75 |
2.7× |
| Mandible min 4v (70110) |
$411.30 |
$685.50 |
3.9× |
| Mr safety implant&/fb assmt clin staf 1st 15 min (76014) |
$51.45 |
$85.75 |
1.8× |
| Mr safety implt electronics prepj supvj phys/qhp (76018) |
$192.90 |
$321.50 |
2.0× |
| Mr safety med physics xm customization plng&mntr (76017) |
$507.75 |
$846.25 |
2.1× |
| MRA head w/o contrast (70544) |
$2,394.15 |
$3,990.25 |
10.0× |
| MRA neck w/ contrast (70548) |
$2,612.85 |
$4,354.75 |
7.5× |
| MRA neck w/o contrast (70547) |
$2,394.15 |
$3,990.25 |
10.0× |
| MRI abdomen w/contrast (74182) |
$2,482.20 |
$4,137 |
7.1× |
| MRI abdomen w/o contrast (74181) |
$2,394.15 |
$3,990.25 |
10.0× |
| MRI abdomen w/wo contrast (74183) |
$3,264.90 |
$5,441.50 |
9.3× |
| MRI any jt lower extrem w/contrast material (73722) |
$3,482.70 |
$5,804.50 |
4.4× |
| MRI breast c- bilateral (77047) |
$2,610.75 |
$4,351.25 |
10.9× |
| MRI c-spine w&w/o cont (72156) |
$3,264.90 |
$5,441.50 |
9.3× |
| MRI cervical spine w/contrast (72142) |
$2,612.85 |
$4,354.75 |
7.5× |
| MRI chest w/contrast (71551) |
$2,997.75 |
$4,996.25 |
3.8× |
| MRI chest w/o contrast (71550) |
$2,830.05 |
$4,716.75 |
11.8× |
| MRI chest w/wo contrast (71552) |
$3,482.70 |
$5,804.50 |
9.9× |
| MRI joint upr extr w/o&w/dye (73223) |
$3,700.05 |
$6,166.75 |
10.6× |
| MRI joint upr extrem w/dye (73222) |
$3,482.70 |
$5,804.50 |
4.4× |
| MRI joint upr extrem w/o dye (73221) |
$3,264.90 |
$5,441.50 |
13.6× |
| MRI lumbar spine w/contrast (72149) |
$2,612.85 |
$4,354.75 |
7.5× |
| MRI lumbar spine w/wo contrast (72158) |
$3,264.90 |
$5,441.50 |
9.3× |
| MRI orbit/face/neck w&w/o cont (70543) |
$3,482.70 |
$5,804.50 |
9.9× |
| MRI pelvis w & w/o contrast (72197) |
$3,482.70 |
$5,804.50 |
9.9× |
| MRI pelvis w/contrast (72196) |
$2,997.75 |
$4,996.25 |
8.6× |
| MRI pelvis w/o contrast (72195) |
$2,830.05 |
$4,716.75 |
11.8× |
| MRI spectroscopy (76390) |
$1,742.10 |
$2,903.50 |
19.9× |
| MRI spine cervical w/o contrast (72141) |
$2,394.15 |
$3,990.25 |
10.0× |
| MRI t-spine w&w/o cont (72157) |
$3,264.90 |
$5,441.50 |
9.3× |
| MRI thoracic spine w/contrast (72147) |
$2,612.85 |
$4,354.75 |
7.5× |
| MRI thoracic spine w/o contrst (72146) |
$2,394.15 |
$3,990.25 |
10.0× |
| MRI tmj (70336) |
$1,731.30 |
$2,885.50 |
7.2× |
| MRI upper extremity oth than jt w/o contr matrl (73218) |
$2,394.15 |
$3,990.25 |
10.0× |
| Multi-leaf collimator (MLC) device(s) for intensity modulated radiation therapy (IMRT), design and construction per… (77338) |
$670.35 |
$1,117.25 |
1.8× |
| Myelography, 2 or more regions (eg, lumbar/thoracic, cervical/thoracic, lumbar/cervical, lumbar/thoracic/cervical),… (72270) |
$1,459.50 |
$2,432.50 |
1.9× |
| Myocardial perfusion imaging, planar (including qualitative or quantitative wall motion, ejection fraction by first… (78453) |
$2,788.05 |
$4,646.75 |
2.1× |
| Myocardial perfusion imaging, planar (including qualitative or quantitative wall motion, ejection fraction by first… (78454) |
$3,231.15 |
$5,385.25 |
2.5× |
| Myocardial spect multiple studies (78452) |
$4,138.95 |
$6,898.25 |
3.2× |
| N-invas est c ffr augmnt sw alys CTA i&r phy/qhp (75580) |
$3,535.65 |
$5,892.75 |
4.1× |
| Nm adrenal imaging (78075) |
$1,193.40 |
$1,989 |
0.9× |
| Nm bone 3 phase (78315) |
$1,570.65 |
$2,617.75 |
3.9× |
| Nm bone imaging whole body (78306) |
$1,570.65 |
$2,617.75 |
3.9× |
| Nm bone marrow ltd (78102) |
$820.20 |
$1,367 |
2.0× |
| Nm bone marrow wb (78104) |
$1,076.40 |
$1,794 |
2.7× |
| Nm csf cisternogram (78630) |
$1,132.80 |
$1,888 |
2.1× |
| Nm gastric emptying (78264) |
$995.40 |
$1,659 |
2.5× |
| Nm lung ventilation imaging (78579) |
$1,203.45 |
$2,005.75 |
3.0× |
| Nm lymph system (78195) |
$1,654.65 |
$2,757.75 |
3.0× |
| Nm myocard infarct spect (78469) |
$1,076.40 |
$1,794 |
2.0× |
| Nuclear medicine study of bone and/or joint limited area (78300) |
$820.20 |
$1,367 |
2.0× |
| Nuclear medicine study of bone and/or joint multiple areas (78305) |
$1,194 |
$1,990 |
3.0× |
| Nuclear medicine study of salivary gland with serial images (78231) |
$747.90 |
$1,246.50 |
1.9× |
| Ob us limited fetus(s) (76815) |
$381.75 |
$636.25 |
3.6× |
| Ob us nuchal meas 1 gest (76813) |
$214.35 |
$357.25 |
2.0× |
| Ophthalmic ultrasound, diagnostic; B-scan (with or without superimposed non-quantitative A-scan) Age Under 21 (76512) |
$305.10 |
$508.50 |
2.9× |
| Panoramic X-ray of jaws (70355) |
$285.15 |
$475.25 |
3.3× |
| Parathyrd planar w/spect&CT (78072) |
$2,634.30 |
$4,390.50 |
4.8× |
| Parathyroid planar imaging (78070) |
$1,132.80 |
$1,888 |
2.8× |
| Parathyroid planar imaging w/wo subtraction (78071) |
$1,883.70 |
$3,139.50 |
4.7× |
| Percutaneous transhepatic portography with hemodynamic evaluation, radiological supervision and interpretation Age… (75885) |
$2,502.15 |
$4,170.25 |
0.8× |
| PET imaging CT attenuation skull base mid-thigh (78815) |
$6,093.75 |
$10,156.25 |
4.2× |
| PET imaging CT for attenuation limited area (78814) |
$6,261 |
$10,435 |
4.4× |
| PET imaging for CT attenuation whole body (78816) |
$6,592.50 |
$10,987.50 |
4.6× |
| PET imaging whole body (78813) |
$6,020.10 |
$10,033.50 |
4.2× |
| Positron emission tomography (PET) imaging; skull base to mid-thigh Age Under 21 (78812) |
$6,338.85 |
$10,564.75 |
4.4× |
| Prq transhepatc portograpy w/o hemodyn evl intrp (75887) |
$3,837.30 |
$6,395.50 |
1.2× |
| Pulmonary ventilation & perfusion imaging (78582) |
$2,199.15 |
$3,665.25 |
4.0× |
| Quant differential pulm perfusion w/wo imaging (78597) |
$2,029.05 |
$3,381.75 |
5.1× |
| Radex abscess/fistula/sinus tract rs&i (76080) |
$404.40 |
$674 |
0.7× |
| Radex entir thrc lmbr crv sac spi w/skull 1 vw (72081) |
$264 |
$440 |
3.0× |
| Radex entir thrc lmbr crv sac spi w/skull 2/3 vw (72082) |
$300.60 |
$501 |
2.9× |
| Radex entir thrc lmbr crv sac spi w/skull 4/5 vw (72083) |
$362.55 |
$604.25 |
3.5× |
| Radex entir thrc lmbr crv sac spi w/skull 6/> vw (72084) |
$383.10 |
$638.50 |
3.6× |
| Radex hip unilateral with pelvis 1 view (73501) |
$360.30 |
$600.50 |
4.1× |
| Radex hip unilateral with pelvis 2-3 views (73502) |
$404.40 |
$674 |
4.6× |
| Radex hip unilateral with pelvis minimum 4 views (73503) |
$491.70 |
$819.50 |
4.7× |
| Radex hips bilateral with pelvis 2 views (73521) |
$491.70 |
$819.50 |
4.7× |
| Radex hips bilateral with pelvis minimum 5 views (73523) |
$515.25 |
$858.75 |
4.9× |
| Radex spine cervical 2 or 3 views (72040) |
$364.80 |
$608 |
4.2× |
| Radex spine cervical 4 or 5 views (72050) |
$545.55 |
$909.25 |
5.2× |
| Radex spine cervical 6 or more views (72052) |
$508.50 |
$847.50 |
4.8× |
| Radex spine thoracolumbar junction min 2 views (72080) |
$371.85 |
$619.75 |
4.3× |
| Radiation tx delivery lvl 1 (77402) |
$503.70 |
$839.50 |
4.9× |
| Radiation tx delivery lvl 3 (77412) |
$682.80 |
$1,138 |
1.2× |
| Radiologic exam abdomen 3+ views (74021) |
$404.40 |
$674 |
3.9× |
| Radiologic exam chest 3 views (71047) |
$464.10 |
$773.50 |
5.3× |
| Radiologic exam chest 4+ views (71048) |
$490.20 |
$817 |
4.7× |
| Radiologic exam colon double contrast study (74280) |
$785.55 |
$1,309.25 |
4.5× |
| Radiologic exam colon single contrast study (74270) |
$742.20 |
$1,237 |
4.2× |
| Radiologic exam esophagus single contrast study (74220) |
$425.55 |
$709.25 |
2.4× |
| Radiologic exam small int single contrast study (74250) |
$639.60 |
$1,066 |
3.6× |
| Radiologic exam swallow function contrast study (74230) |
$601.05 |
$1,001.75 |
3.4× |
| Radiologic exam upr gi trc double contrast study (74246) |
$643.95 |
$1,073.25 |
3.7× |
| Radiologic exam upr gi trc single contrast study (74240) |
$643.95 |
$1,073.25 |
3.7× |
| Radiologic examination femur 1 view (73551) |
$317.85 |
$529.75 |
3.6× |
| Radiologic examination femur minimum 2 views (73552) |
$351 |
$585 |
4.0× |
| Radiologic examination from nose to rectum for foreign body, single view, child Age Under 21 (76010) |
$415.80 |
$693 |
4.8× |
| Radiologic examination, ankle; complete, minimum of 3 views Age Under 21 (73610) |
$404.40 |
$674 |
4.6× |
| Radiologic examination, complete acute abdomen series, including 2 or more views of the abdomen (eg, supine, erect,… (74022) |
$339.15 |
$565.25 |
3.2× |
| Radiologic examination, elbow; 2 views Age Under 21 (73070) |
$351 |
$585 |
4.0× |
| Radiologic examination, elbow; complete, minimum of 3 views Age Under 21 (73080) |
$383.10 |
$638.50 |
4.4× |
| Radiologic examination, facial bones; less than 3 views Age Under 21 (70140) |
$252.60 |
$421 |
2.9× |
| Radiologic examination, foot; complete, minimum of 3 views Age Under 21 (73630) |
$371.85 |
$619.75 |
4.3× |
| Radiologic examination, hand; minimum of 3 views Age Under 21 (73130) |
$404.40 |
$674 |
4.6× |
| Radiologic examination, internal auditory meati, complete Age Under 21 (70134) |
$328.20 |
$547 |
0.6× |
| Radiologic examination, knee; both knees, standing, anteroposterior Age Under 21 (73565) |
$491.70 |
$819.50 |
5.6× |
| Radiologic examination, knee; complete, 4 or more views Age Under 21 (73564) |
$425.55 |
$709.25 |
4.1× |
| Radiologic examination, mastoids; complete, minimum of 3 views per side Age Under 21 (70130) |
$300.60 |
$501 |
2.9× |
| Radiologic examination, nasal bones, complete, minimum of 3 views Age Under 21 (70160) |
$274.65 |
$457.75 |
3.1× |
| Radiologic examination, renal cyst study, translumbar, contrast visualization, radiological supervision and… (74470) |
$787.65 |
$1,312.75 |
1.4× |
| Radiologic examination, ribs, bilateral; including posteroanterior chest, minimum of 4 views Age Under 21 (71111) |
$491.70 |
$819.50 |
4.7× |
| Radiologic examination, ribs, unilateral; including posteroanterior chest, minimum of 3 views Age Under 21 (71101) |
$294.90 |
$491.50 |
2.8× |
| Radiologic examination, shoulder, arthrography, radiological supervision and interpretation Age Under 21 (73040) |
$594.30 |
$990.50 |
1.7× |
| Radiologic examination, shoulder; complete, minimum of 2 views Age Under 21 (73030) |
$282.15 |
$470.25 |
3.2× |
| Radiologic examination, sinuses, paranasal, less than 3 views Age Under 21 (70210) |
$208.50 |
$347.50 |
2.4× |
| Radiologic examination, skull; less than 4 views Age Under 21 (70250) |
$351 |
$585 |
3.3× |
| Radiologic examination, spine, lumbosacral; 2 or 3 views Age Under 21 (72100) |
$524.40 |
$874 |
5.0× |
| Radiologic examination, spine, lumbosacral; bending views only, 2 or 3 views Age Under 21 (72120) |
$425.55 |
$709.25 |
4.1× |
| Radiologic examination, spine, lumbosacral; complete, including bending views, minimum of 6 views Age Under 21 (72114) |
$425.55 |
$709.25 |
4.1× |
| Radiologic examination, wrist; complete, minimum of 3 views Age Under 21 (73110) |
$502.05 |
$836.75 |
5.7× |
| Radiologic examination; acromioclavicular joints, bilateral, with or without weighted distraction Age Under 21 (73050) |
$257.10 |
$428.50 |
2.9× |
| Radiologic examination; humerus, minimum of 2 views Age Under 21 (73060) |
$351 |
$585 |
4.0× |
| Radiologic examination; lower extremity, infant, minimum of 2 views Age Under 21 (73592) |
$302.55 |
$504.25 |
3.5× |
| Radiologic examination; orbits, complete, minimum of 4 views Age Under 21 (70200) |
$328.35 |
$547.25 |
3.1× |
| Radiologic examination; sternoclavicular joint or joints, minimum of 3 views Age Under 21 (71130) |
$285.15 |
$475.25 |
3.3× |
| Radiologic examination; toe(s), minimum of 2 views Age Under 21 (73660) |
$313.35 |
$522.25 |
3.6× |
| Radiologic examination; upper extremity, infant, minimum of 2 views Age Under 21 (73092) |
$215.70 |
$359.50 |
2.1× |
| Radiopharmaceutical localization of tumor, inflammatory process or distribution of radiopharmaceutical agent(s)… (78803) |
$1,795.35 |
$2,992.25 |
3.3× |
| Radiopharmaceutical therapy, by oral administration Age Under 21 (79005) |
$1,305.90 |
$2,176.50 |
5.6× |
| Review by radiologist of urinary bladder and urethra images with contrast and after passing urine (74455) |
$622.35 |
$1,037.25 |
2.6× |
| Rp loclzj tum plnr 1 area single day imaging (78800) |
$1,132.80 |
$1,888 |
2.8× |
| Rp loclzj tum plnr 2+area 1+d img/1 area img>2+d (78801) |
$1,125.30 |
$1,875.50 |
2.8× |
| Rp loclzj tum plnr whole body 2+ days imaging (78804) |
$2,912.25 |
$4,853.75 |
5.3× |
| Rp loclzj tum plnr whole body single day imaging (78802) |
$2,051.70 |
$3,419.50 |
3.8× |
| Rp loclzj tum spect w/CT 1 (78830) |
$3,199.20 |
$5,332 |
2.5× |
| Rp loclzj tum spect w/CT 2 (78832) |
$3,199.20 |
$5,332 |
2.2× |
| Rp therapy intra-arterial particulate admn (79445) |
$863.85 |
$1,439.75 |
3.7× |
| Scapula complete (73010) |
$270 |
$450 |
2.6× |
| Screening digital breast tomosynthesis bi (77063) |
$66.15 |
$110.25 |
— |
| Shuntogram indwelling nonvascular shunt rs&i (75809) |
$453.15 |
$755.25 |
4.3× |
| Special physics consult (77370) |
$298.05 |
$496.75 |
2.2× |
| Special treatment procedure (77470) |
$2,228.55 |
$3,714.25 |
4.0× |
| Splenoportography, radiological supervision and interpretation Age Under 21 (75810) |
$2,405.85 |
$4,009.75 |
0.8× |
| Stereotactic body radiation therapy, treatment delivery, per fraction to 1 or more lesions, including image guidance,… (77373) |
$4,261.35 |
$7,102.25 |
2.4× |
| Ther rad simulaj-aided field setting complex (77290) |
$1,084.65 |
$1,807.75 |
2.9× |
| Thyroid imaging with vascular flow (78013) |
$696.75 |
$1,161.25 |
1.7× |
| Thyroid met imaging body (78018) |
$1,132.80 |
$1,888 |
2.1× |
| Thyroid uptake single/multiple quant measurement (78012) |
$382.95 |
$638.25 |
1.0× |
| Thyroid uptake w/blood flow sngle/mult quan meas (78014) |
$1,044.15 |
$1,740.25 |
2.6× |
| Tr simulation simple (77280) |
$549.30 |
$915.50 |
4.1× |
| Treatment device complex (77334) |
$863.25 |
$1,438.75 |
2.3× |
| Treatment device simple (77332) |
$569.10 |
$948.50 |
4.2× |
| Ultrasound breast limited (76642) |
$383.10 |
$638.50 |
4.4× |
| Ultrasound, abdomen limited (76705) |
$545.55 |
$909.25 |
5.2× |
| Ultrasound, limited, joint or focal evaluation of other nonvascular extremity structure(s) (eg, joint space,… (76882) |
$277.80 |
$463 |
2.6× |
| Ultrasound, pelvic (nonobstetric), real time with image documentation; complete Age Under 21 (76856) |
$861.45 |
$1,435.75 |
8.2× |
| Ultrasound, pregnant uterus, real time with image documentation, fetal and maternal evaluation plus detailed fetal… (76811) |
$641.40 |
$1,069 |
2.7× |
| Ultrasound, pregnant uterus, real time with image documentation, fetal and maternal evaluation, first trimester (< 14… (76801) |
$393 |
$655 |
3.7× |
| Ultrasound, transplanted kidney, real time and duplex Doppler with image documentation Age Under 21 (76776) |
$545.55 |
$909.25 |
5.2× |
| Umbilical-artery Doppler (OB) (76820) |
$188.70 |
$314.50 |
1.8× |
| Unlisted fluoroscopic procedure (76496) |
$329.25 |
$548.75 |
3.8× |
| Unlisted magnetic resonance procedure (eg, diagnostic, interventional) Age Under 21 (76498) |
$2,504.25 |
$4,173.75 |
28.6× |
| Ureteral reflux study (78740) |
$820.20 |
$1,367 |
2.0× |
| Urethrocystography retrograde rs&i (74450) |
$622.35 |
$1,037.25 |
2.6× |
| Urography (pyelography), intravenous, with or without KUB, with or without tomography Age Under 21 (74400) |
$622.35 |
$1,037.25 |
3.5× |
| Urography antegrade rs&i (74425) |
$622.35 |
$1,037.25 |
1.8× |
| Urography, infusion, drip technique and/or bolus technique; Age Under 21 (74410) |
$591.75 |
$986.25 |
3.4× |
| Urography, infusion, drip technique and/or bolus technique; with nephrotomography Age Under 21 (74415) |
$622.35 |
$1,037.25 |
3.5× |
| Us abdominal aorta real time screen study aaa (76706) |
$356.70 |
$594.50 |
3.4× |
| Us breast uni real time with image complete (76641) |
$383.10 |
$638.50 |
3.6× |
| Us chest (76604) |
$484.95 |
$808.25 |
4.6× |
| Us compl joint r-t w/image documentation (76881) |
$484.95 |
$808.25 |
4.6× |
| Us elastography organ (76981) |
$545.55 |
$909.25 |
5.2× |
| Us encephalogram (76506) |
$762.60 |
$1,271 |
7.3× |
| Us exam, pelvic, limited (76857) |
$383.10 |
$638.50 |
3.6× |
| Us guided compression repair (76936) |
$610.80 |
$1,018 |
2.8× |
| Us inft hips r-t img dynamic req phys/qhp manj (76885) |
$484.95 |
$808.25 |
5.5× |
| Us nrv&acc strux 1 xtr compre w/img pr extremity (76883) |
$277.80 |
$463 |
2.6× |
| US OB Follow-Up/Repeat (76816) |
$254.70 |
$424.50 |
2.4× |
| Us ob transvaginal (76817) |
$589.80 |
$983 |
5.6× |
| Us retroperitoneal complete (76770) |
$742.20 |
$1,237 |
7.1× |
| Us retroperitoneal ltd (76775) |
$381.75 |
$636.25 |
3.6× |
| Us scrotum (76870) |
$568.35 |
$947.25 |
5.4× |
| Us soft tissue head/neck (76536) |
$601.05 |
$1,001.75 |
5.7× |
| Us spinal canal (76800) |
$545.55 |
$909.25 |
5.2× |
| Us transrectal (76872) |
$557.40 |
$929 |
5.3× |
| Us unlstd proc (76999) |
$333.75 |
$556.25 |
3.8× |
| Venogram sinus/jugular (75860) |
$4,833.30 |
$8,055.50 |
1.5× |
| Venography adrenal unilateral selective rs&i (75840) |
$2,405.85 |
$4,009.75 |
0.8× |
| Venography deep dorsal vein penis radiolgicl supervision interpretation (76499) |
$99.90 |
$166.50 |
1.1× |
| Venography renal unilateral selective rs&i (75831) |
$2,634.90 |
$4,391.50 |
0.8× |
| Venography, caval, inferior, with serialography, radiological supervision and interpretation Age Under 21 (75825) |
$2,899.95 |
$4,833.25 |
0.9× |
| Venography, caval, superior, with serialography, radiological supervision and interpretation Age Under 21 (75827) |
$1,633.50 |
$2,722.50 |
1.0× |
| Venography, epidural, radiological supervision and interpretation Age Under 21 (75872) |
$1,491.60 |
$2,486 |
2.4× |
| Venography, extremity, bilateral, radiological supervision and interpretation Age Under 21 (75822) |
$1,931.40 |
$3,219 |
1.2× |
| Venography, extremity, unilateral, radiological supervision and interpretation Age Under 21 (75820) |
$1,448.70 |
$2,414.50 |
0.9× |
| Venography, orbital, radiological supervision and interpretation Age Under 21 (75880) |
$1,242.90 |
$2,071.50 |
2.0× |
| Venography, superior sagittal sinus, radiological supervision and interpretation Age Under 21 (75870) |
$3,866.70 |
$6,444.50 |
1.2× |
| Venous sampling thru cath w/wo angiography rs& (75893) |
$3,267.30 |
$5,445.50 |
0.6× |
| X-ray exam hips bi 3-4 views (73522) |
$507.75 |
$846.25 |
4.8× |
| X-ray exam of finger(s) (73140) |
$241.05 |
$401.75 |
2.8× |
| X-ray exam of knee 1 or 2 (73560) |
$383.10 |
$638.50 |
4.4× |
| X-ray exam of small bowel - fl small bowel series enteroclysis tube (74251) |
$488.85 |
$814.75 |
2.8× |
| X-ray exam ribs bil 3 views (71110) |
$436.80 |
$728 |
4.2× |
| X-ray exam ribs uni 2 views (71100) |
$280.65 |
$467.75 |
3.2× |
| X-ray heel (73650) |
$289.65 |
$482.75 |
3.3× |
| X-ray of joint between lower spine and hip bone 3 or more views|PROFESSIONAL COMPONENT (72202) |
$230.55 |
$384.25 |
2.2× |
| X-ray retrograde pyelogram (74420) |
$622.35 |
$1,037.25 |
1.8× |
| Xr abdomen 1 view (74018) |
$339.15 |
$565.25 |
3.9× |
| Xr abdomen 2 views (74019) |
$404.40 |
$674 |
3.9× |
| Xr arthrogram ankle (73615) |
$571.35 |
$952.25 |
1.6× |
| Xr arthrogram elbow (73085) |
$594.30 |
$990.50 |
1.7× |
| Xr arthrogram hip (73525) |
$468 |
$780 |
1.3× |
| Xr arthrogram knee (73580) |
$564.45 |
$940.75 |
1.6× |
| Xr arthrogram wrist (73115) |
$564.45 |
$940.75 |
1.6× |
| Xr bone age studies (77072) |
$376.35 |
$627.25 |
3.6× |
| Xr bone length study (77073) |
$285.30 |
$475.50 |
2.7× |
| Xr bone survey infant (77076) |
$374.85 |
$624.75 |
3.6× |
| Xr chest 1 view (71045) |
$383.10 |
$638.50 |
4.4× |
| Xr chest 2 views (71046) |
$267.30 |
$445.50 |
3.1× |
| Xr facial bones 3+ views (70150) |
$381.75 |
$636.25 |
3.6× |
| Xr foot arthritis pa only bilateral - report(ortho pro) (73620) |
$333 |
$555 |
3.8× |
| Xr forearm 2 views (73090) |
$404.40 |
$674 |
4.6× |
| Xr hand 2v (73120) |
$294.90 |
$491.50 |
2.8× |
| Xr hysterosalpingogram (74740) |
$828.75 |
$1,381.25 |
3.5× |
| Xr myelogram c-spine (72240) |
$1,198.65 |
$1,997.75 |
1.5× |
| Xr myelogram l-spine (72265) |
$1,305.60 |
$2,176 |
1.7× |
| Xr myelogram t-spine (72255) |
$1,255.35 |
$2,092.25 |
1.6× |
| Xr neck soft tissue (70360) |
$175.80 |
$293 |
2.0× |
| Xr o knee w/ merchant view bilat - report(ortho pro) (73562) |
$404.40 |
$674 |
4.6× |
| Xr osseous survey complete (77075) |
$578.10 |
$963.50 |
5.5× |
| Xr pelvis 1-2 views (72170) |
$371.85 |
$619.75 |
3.5× |
| Xr pelvis min 3 view (72190) |
$404.40 |
$674 |
3.9× |
| Xr sacrum/coccyx 2+ views (72220) |
$307.05 |
$511.75 |
3.5× |
| Xr sella turcica (70240) |
$156.75 |
$261.25 |
1.8× |
| Xr shoulder 1 view (73020) |
$307.05 |
$511.75 |
3.5× |
| Xr sinuses 3+ views (70220) |
$404.40 |
$674 |
4.6× |
| Xr skull min 4 view (70260) |
$525 |
$875 |
5.0× |
| Xr spine 1 view (72020) |
$328.35 |
$547.25 |
3.8× |
| Xr spine thoracic 3v (72072) |
$371.85 |
$619.75 |
3.5× |
| Xr sternum 2+ views (71120) |
$274.65 |
$457.75 |
3.1× |
| Xr surgical specimen (76098) |
$653.40 |
$1,089 |
1.2× |
| Xr t-spine 2 views (72070) |
$404.40 |
$674 |
3.9× |
| Xr tibia/fibula 2 views (73590) |
$345.75 |
$576.25 |
4.0× |
| Xr tmj bilateral (70330) |
$406.80 |
$678 |
4.7× |
| Xr venogram renal bilat (75833) |
$2,502.15 |
$4,170.25 |
0.8× |
| Xr wrist 2 views (73100) |
$328.35 |
$547.25 |
3.8× |