| 3-D radiotherapy plan dose-volume histograms (77295) |
$3,824.40 |
$12,748 |
2.6× |
| Acute gi blood loss imaging (78278) |
$856.20 |
$2,854 |
2.0× |
| Angiography internal mammary rs&i (75756) |
$1,382.70 |
$4,609 |
0.4× |
| Angiography pulmonary bilateral slctv rs&i (75743) |
$3,041.70 |
$10,139 |
0.9× |
Angiography visceral slctv/supraslctv rs&i (75726)
unusually low — confirm this is the full procedure |
$2,729.70 |
$9,099 |
0.5× |
| Angiography, adrenal, bilateral, selective, radiological supervision and interpretation Age Under 21 (75733) |
$3,205.20 |
$10,684 |
1.0× |
| Angiography, adrenal, unilateral, selective, radiological supervision and interpretation Age Under 21 (75731) |
$2,982.30 |
$9,941 |
0.9× |
| Angiography, extremity, bilateral, radiological supervision and interpretation Age Under 21 (75716) |
$3,083.10 |
$10,277 |
0.9× |
| Angiography, extremity, unilateral, radiological supervision and interpretation Age Under 21 (75710) |
$2,097.30 |
$6,991 |
0.6× |
Angiography, pelvic, selective or supraselective, radiological supervision and interpretation Age Under 21 (75736)
unusually low — confirm this is the full procedure |
$2,464.20 |
$8,214 |
0.4× |
| Angiography, pulmonary, unilateral, selective, radiological supervision and interpretation Age Under 21 (75741) |
$2,232 |
$7,440 |
0.7× |
Angiography, spinal, selective, radiological supervision and interpretation Age Under 21 (75705)
unusually low — confirm this is the full procedure |
$2,729.70 |
$9,099 |
0.5× |
| Angrph cath f-up std tcat other than thrombylsis (75898) |
$1,163.70 |
$3,879 |
0.3× |
| Angrph pulmonary nonslctv cath/ven njx rs&i (75746) |
$1,236 |
$4,120 |
0.4× |
| Ankle 2 views (73600) |
$194.40 |
$648 |
2.1× |
| Aortography, abdominal plus bilateral iliofemoral lower extremity, catheter, by serialography, radiological supervision… (75630) |
$3,104.10 |
$10,347 |
0.9× |
| Aortography, abdominal, by serialography, radiological supervision and interpretation Age Under 21 (75625) |
$2,860.20 |
$9,534 |
0.9× |
Aortography, thoracic, by serialography, radiological supervision and interpretation Age Under 21 (75605)
unusually low — confirm this is the full procedure |
$2,213.40 |
$7,378 |
0.4× |
| Basic radiation dosimetry calculation (77300) |
$429.30 |
$1,431 |
3.0× |
| Brain flow imaging only - nm brain flow only brain death (78610) |
$693.30 |
$2,311 |
1.2× |
| Brain imaging, minimum 4 static views; with vascular flow Age Under 21 (78606) |
$836.70 |
$2,789 |
1.5× |
| Brain imaging, positron emission tomography (PET); metabolic evaluation Age Under 21 (78608) |
$2,722.80 |
$9,076 |
1.8× |
| Cardiac MRI morphology & function w/o contrast (75557) |
$1,178.10 |
$3,927 |
4.7× |
| Cardiac MRI w/wo contrast & further seq (75561) |
$1,490.10 |
$4,967 |
4.0× |
| Clavicle complete (73000) |
$192.90 |
$643 |
2.1× |
| Computed tomographic angiography, abdomen and pelvis, with contrast material(s), including noncontrast images, if… (74174) |
$4,639.50 |
$15,465 |
12.6× |
| Computed tomographic angiography, abdomen, with contrast material(s), including noncontrast images, if performed, and… (74175) |
$2,560.20 |
$8,534 |
13.8× |
| Computed tomographic angiography, abdominal aorta and bilateral iliofemoral lower extremity runoff, with contrast… (75635) |
$2,228.70 |
$7,429 |
12.0× |
| Computed tomographic angiography, chest (noncoronary), with contrast material(s), including noncontrast images, if… (71275) |
$2,311.80 |
$7,706 |
12.5× |
| Computed tomographic angiography, lower extremity, with contrast material(s), including noncontrast images, if… (73706) |
$2,130.30 |
$7,101 |
11.5× |
| Computed tomographic angiography, neck, with contrast material(s), including noncontrast images, if performed, and… (70498) |
$2,016.90 |
$6,723 |
10.9× |
| Computed tomographic angiography, pelvis, with contrast material(s), including noncontrast images, if performed, and… (72191) |
$1,684.80 |
$5,616 |
9.1× |
| Computed tomographic angiography, upper extremity, with contrast material(s), including noncontrast images, if… (73206) |
$1,441.20 |
$4,804 |
7.8× |
| Computed tomography, cervical spine; without contrast material, followed by contrast material(s) and further sections… (72127) |
$2,092.50 |
$6,975 |
11.3× |
| Computed tomography, lower extremity; without contrast material Age Under 21 (73700) |
$812.10 |
$2,707 |
7.4× |
| Computed tomography, lower extremity; without contrast material, followed by contrast material(s) and further sections… (73702) |
$1,259.70 |
$4,199 |
6.8× |
| Computed tomography, lumbar spine; without contrast material, followed by contrast material(s) and further sections Age… (72133) |
$1,812.30 |
$6,041 |
9.8× |
| Computed tomography, maxillofacial area; with contrast material(s) Age Under 21 (70487) |
$1,316.70 |
$4,389 |
7.1× |
| Computed tomography, maxillofacial area; without contrast material Age Under 21 (70486) |
$1,165.20 |
$3,884 |
10.6× |
| Computed tomography, orbit, sella, or posterior fossa or outer, middle, or inner ear; with contrast material(s) Age… (70481) |
$1,485 |
$4,950 |
8.0× |
| Computed tomography, orbit, sella, or posterior fossa or outer, middle, or inner ear; without contrast material Age… (70480) |
$1,140.30 |
$3,801 |
10.3× |
| Computed tomography, orbit, sella, or posterior fossa or outer, middle, or inner ear; without contrast material,… (70482) |
$1,755.30 |
$5,851 |
9.5× |
| Computed tomography, soft tissue neck; without contrast material followed by contrast material(s) and further sections… (70492) |
$1,307.10 |
$4,357 |
7.1× |
| Computed tomography, thoracic spine; without contrast material, followed by contrast material(s) and further sections… (72130) |
$1,993.50 |
$6,645 |
10.8× |
| Computed tomography, thorax, diagnostic; without contrast material, followed by contrast material(s) and further… (71270) |
$1,616.70 |
$5,389 |
8.7× |
| Continuing medical physics consultation, including assessment of treatment parameters, quality assurance of dose… (77336) |
$539.70 |
$1,799 |
3.8× |
| Csf shunt evaluation (78645) |
$1,199.10 |
$3,997 |
2.1× |
| CT abdomen and pelvis without and with contrast (74178) |
$4,418.70 |
$14,729 |
12.0× |
| CT abdomen and pelvis without contrast (74176) |
$3,334.50 |
$11,115 |
13.2× |
| CT abdomen w & w/o contrast (74170) |
$2,438.40 |
$8,128 |
13.2× |
| CT abdomen w/contrast (74160) |
$2,245.50 |
$7,485 |
12.1× |
| CT abdomen w/o contrast (74150) |
$1,561.80 |
$5,206 |
14.2× |
| CT angio hrt w/3d image (75574) |
$950.70 |
$3,169 |
2.6× |
| CT cervical spine w/contrast (72126) |
$1,916.40 |
$6,388 |
5.2× |
| CT cervical spine w/o contrast (72125) |
$1,710.90 |
$5,703 |
15.5× |
| CT chest w/contrast (71260) |
$1,260.60 |
$4,202 |
6.8× |
| CT extremity upper w & w/o contrast (73202) |
$1,098.60 |
$3,662 |
5.9× |
| CT extremity upper w/o contrast (73200) |
$858.60 |
$2,862 |
7.8× |
| CT head/brain with contrast (70460) |
$1,770.30 |
$5,901 |
9.6× |
| CT head/brain without and with contrast (70470) |
$2,022.30 |
$6,741 |
10.9× |
| CT heart c+ cardiac strux&morph cgen hrt ds (75573) |
$594.90 |
$1,983 |
1.6× |
| CT heart contrast eval cardiac structure&morph (75572) |
$537.30 |
$1,791 |
1.5× |
| CT heart no contrast quant eval coronry calcium (75571) |
$181.80 |
$606 |
2.0× |
| CT l-spine w/contrast (72132) |
$1,517.40 |
$5,058 |
4.1× |
| CT limited/localized follow up study (76380) |
$543.30 |
$1,811 |
5.9× |
| CT lower extremity w/dye (73701) |
$1,022.10 |
$3,407 |
5.5× |
| CT lumbar spine w/o contrast (72131) |
$1,120.50 |
$3,735 |
10.2× |
| CT maxillofacial w/wo contrast (70488) |
$1,654.80 |
$5,516 |
8.9× |
| CT neck w/contrast (70491) |
$921.60 |
$3,072 |
5.0× |
| CT neck w/o contrast (70490) |
$573.30 |
$1,911 |
5.2× |
| CT pelvis w & w/o contrast (72194) |
$1,604.70 |
$5,349 |
8.7× |
| CT pelvis w/o contrast (72192) |
$976.50 |
$3,255 |
8.9× |
| CT thoracic spine w/contrast (72129) |
$1,789.20 |
$5,964 |
9.7× |
| CT thoracic spine w/o contrast (72128) |
$1,654.80 |
$5,516 |
15.0× |
| CT thorax lung cancer scr c- (71271) |
$1,025.40 |
$3,418 |
9.3× |
| CT thorax w/o contrast (71250) |
$1,074.90 |
$3,583 |
9.7× |
| CT upper extremity w/dye (73201) |
$968.40 |
$3,228 |
2.6× |
| CTA head w contrast (70496) |
$2,323.20 |
$7,744 |
12.6× |
| Cystography, minimum of 3 views, radiological supervision and interpretation Age Under 21 (74430) |
$572.70 |
$1,909 |
1.6× |
| Dilation ureters/urethra rs&i (74485) |
$1,616.40 |
$5,388 |
0.7× |
| Discography, cervical or thoracic, radiological supervision and interpretation Age Under 21 (72285) |
$2,889.90 |
$9,633 |
1.4× |
| Diskography lumbar s&i (72295) |
$2,454 |
$8,180 |
1.2× |
| Doppler echocardiography, fetal, pulsed wave and/or continuous wave with spectral display; complete Age Under 21 (76827) |
$103.80 |
$346 |
0.9× |
| Doppler fetal mid cerebral artery (76821) |
$119.70 |
$399 |
1.1× |
| Dual-energy X-ray absorptiometry (DXA), bone density study, 1 or more sites; axial skeleton (eg, hips, pelvis, spine)… (77080) |
$282.30 |
$941 |
2.6× |
| Dxa bone density/peripheral (77081) |
$117.60 |
$392 |
1.3× |
| Esophageal motility (78258) |
$842.40 |
$2,808 |
2.0× |
| Fetal biophys profile w/o nst (76819) |
$178.20 |
$594 |
1.6× |
| Fetal biophysical profile non-stress testing (76818) |
$281.10 |
$937 |
2.5× |
| Fluoroscopy up to 1 hour physician/qhp time (76000) |
$485.10 |
$1,617 |
1.9× |
| Gastroesophageal reflux study (78262) |
$748.20 |
$2,494 |
1.8× |
| Gated heart planar single (78472) |
$1,083.60 |
$3,612 |
2.6× |
| Hepatc vngrph wdg/fr w/o hemodyn eval rs&i (75891) |
$1,577.70 |
$5,259 |
0.5× |
| Hepatic venography, wedged or free, with hemodynamic evaluation, radiological supervision and interpretation Age Under… (75889) |
$1,999.80 |
$6,666 |
0.6× |
| Hepatobil syst imag inc gb w/pharma intervenj (78227) |
$1,801.50 |
$6,005 |
3.1× |
| Hepatobiliary syst imaging including gallbladder (78226) |
$1,620.30 |
$5,401 |
3.8× |
| Ht muscle image spect sing (78451) |
$2,541.30 |
$8,471 |
1.9× |
| Image fusion (77399) |
$308.11 |
$1,027.01 |
2.2× |
| Intensity modulated radiotherapy plan, including dose-volume histograms for target and critical structure partial… (77301) |
$4,573.20 |
$15,244 |
3.1× |
| Interstitial radiation source application, complex, includes supervision, handling, loading of radiation source, when… (77778) |
$2,376.60 |
$7,922 |
3.2× |
| Intestine imaging (eg, ectopic gastric mucosa, Meckel's localization, volvulus) Age Under 21 (78290) |
$529.50 |
$1,765 |
1.3× |
| Intracavitary radiation source application - complex (77763) |
$1,129.80 |
$3,766 |
1.5× |
| Intracavitary radiation source application - intermediate (77762) |
$819.30 |
$2,731 |
1.4× |
| Intracavitary radiation source application - simple (77761) |
$552.90 |
$1,843 |
0.9× |
| Isodose brachytherapy complex 10+ sources (77318) |
$1,772.70 |
$5,909 |
4.5× |
| Isodose brachytherapy intermed 5 to 10 sources (77317) |
$1,211.10 |
$4,037 |
3.1× |
| Isodose brachytherapy plan simple 1 to 4 source (77316) |
$990.60 |
$3,302 |
2.5× |
| Isodose teletherapy plan complex multi tx w/cal (77307) |
$1,503.60 |
$5,012 |
3.8× |
| Isodose teletherapy plan simple 1 or 2 port w/cal (77306) |
$828 |
$2,760 |
2.1× |
| Kidney imaging morphol - nm kidney cortex (78700) |
$846 |
$2,820 |
2.0× |
| Kidney imaging morphology; with vascular flow and function, multiple studies, with and without pharmacological… (78709) |
$1,578.60 |
$5,262 |
2.8× |
| Kidney imaging morphology; with vascular flow and function, single study without pharmacological intervention Age Under… (78707) |
$1,564.20 |
$5,214 |
2.7× |
| Kidney imaging morphology; with vascular flow and function, single study, with pharmacological intervention (eg,… (78708) |
$1,554.30 |
$5,181 |
2.7× |
| Liver and spleen imaging (78215) |
$714.30 |
$2,381 |
1.7× |
| Liver and spleen imaging; with vascular flow Age Under 21 (78216) |
$547.50 |
$1,825 |
1.3× |
| Liver imaging (78201) |
$648.30 |
$2,161 |
1.1× |
| Lung perf&ventilat diferentl (78598) |
$974.40 |
$3,248 |
1.7× |
| Lung perfusion imaging (78580) |
$1,074 |
$3,580 |
2.5× |
| Lymphangiography, extremity only, unilateral, radiological supervision and interpretation Age Under 21 (75801) |
$504.30 |
$1,681 |
0.8× |
| Lymphangiography, pelvic/abdominal, bilateral, radiological supervision and interpretation Age Under 21 (75807) |
$2,684.10 |
$8,947 |
0.8× |
| Lymphangiography, pelvic/abdominal, unilateral, radiological supervision and interpretation Age Under 21 (75805) |
$2,556.30 |
$8,521 |
0.8× |
| Magnetic resonance (eg, proton) imaging, any joint of lower extremity; without contrast material(s), followed by… (73723) |
$2,751.60 |
$9,172 |
7.5× |
| Magnetic resonance (eg, proton) imaging, lower extremity other than joint; with contrast material(s) Age Under 21 (73719) |
$1,992.30 |
$6,641 |
5.4× |
| Magnetic resonance (eg, proton) imaging, lower extremity other than joint; without contrast material(s) Age Under 21 (73718) |
$1,897.50 |
$6,325 |
7.5× |
| Magnetic resonance (eg, proton) imaging, lower extremity other than joint; without contrast material(s), followed by… (73720) |
$2,961.60 |
$9,872 |
8.0× |
| Magnetic resonance (eg, proton) imaging, orbit, face, and/or neck; with contrast material(s) Age Under 21 (70542) |
$1,335 |
$4,450 |
3.6× |
| Magnetic resonance (eg, proton) imaging, orbit, face, and/or neck; without contrast material(s) Age Under 21 (70540) |
$1,213.50 |
$4,045 |
4.8× |
| Magnetic resonance (eg, proton) imaging, upper extremity, other than joint; with contrast material(s) Age Under 21 (73219) |
$1,316.40 |
$4,388 |
3.6× |
| Magnetic resonance (eg, proton) imaging, upper extremity, other than joint; without contrast material(s), followed by… (73220) |
$1,530.60 |
$5,102 |
4.2× |
| Magnetic resonance angiography, head; with contrast material(s) Age Under 21 (70545) |
$2,132.40 |
$7,108 |
5.8× |
| Magnetic resonance angiography, head; without contrast material(s), followed by contrast material(s) and further… (70546) |
$2,974.50 |
$9,915 |
8.1× |
| Magnetic resonance angiography, neck; without contrast material(s), followed by contrast material(s) and further… (70549) |
$1,647.90 |
$5,493 |
4.5× |
| Mammary ductogram or galactogram, multiple ducts, radiological supervision and interpretation Age Under 21 (77054) |
$687.30 |
$2,291 |
2.7× |
| Mammary ductogram single (77053) |
$455.10 |
$1,517 |
1.8× |
| Mandible min 4v (70110) |
$233.70 |
$779 |
2.1× |
| Mr safety determination physician/other qhp (76016) |
$86.70 |
$289 |
0.9× |
| Mr safety implant pos&/immoblj supvj phys/qhp (76019) |
$62.10 |
$207 |
1.0× |
| Mr safety implant&/fb assmt clin staf 1st 15 min (76014) |
$22.20 |
$74 |
0.7× |
| Mr safety implt electronics prepj supvj phys/qhp (76018) |
$95.40 |
$318 |
1.0× |
| Mr safety med physics xm customization plng&mntr (76017) |
$251.40 |
$838 |
1.0× |
| MRA head w/o contrast (70544) |
$1,982.10 |
$6,607 |
7.9× |
| MRA neck w/ contrast (70548) |
$1,463.70 |
$4,879 |
4.0× |
| MRA neck w/o contrast (70547) |
$1,190.70 |
$3,969 |
4.7× |
| MRI abdomen w/contrast (74182) |
$2,158.50 |
$7,195 |
5.9× |
| MRI abdomen w/o contrast (74181) |
$1,971.90 |
$6,573 |
7.8× |
| MRI abdomen w/wo contrast (74183) |
$2,532.60 |
$8,442 |
6.9× |
| MRI any jt lower extrem w/contrast material (73722) |
$2,170.50 |
$7,235 |
2.6× |
| MRI bone marrow (77084) |
$1,129.80 |
$3,766 |
4.5× |
| MRI breast c- bilateral (77047) |
$543 |
$1,810 |
2.2× |
| MRI breast without contrast material unilateral (77046) |
$528 |
$1,760 |
2.1× |
| MRI c-spine w&w/o cont (72156) |
$2,598.30 |
$8,661 |
7.1× |
| MRI cervical spine w/contrast (72142) |
$2,235.90 |
$7,453 |
6.1× |
| MRI chest w/contrast (71551) |
$1,520.10 |
$5,067 |
1.8× |
| MRI chest w/o contrast (71550) |
$1,385.40 |
$4,618 |
5.5× |
| MRI chest w/wo contrast (71552) |
$1,722.90 |
$5,743 |
4.7× |
| MRI fetal sngl/1st gestation (74712) |
$1,114.50 |
$3,715 |
4.4× |
| MRI joint upr extr w/o&w/dye (73223) |
$2,373 |
$7,910 |
6.4× |
| MRI joint upr extrem w/dye (73222) |
$1,964.10 |
$6,547 |
2.4× |
| MRI joint upr extrem w/o dye (73221) |
$1,698.30 |
$5,661 |
6.7× |
| MRI lumbar spine w/contrast (72149) |
$2,140.50 |
$7,135 |
5.8× |
| MRI lumbar spine w/wo contrast (72158) |
$2,466 |
$8,220 |
6.7× |
| MRI orbit/face/neck w&w/o cont (70543) |
$1,549.20 |
$5,164 |
4.2× |
| MRI pelvis w & w/o contrast (72197) |
$2,879.70 |
$9,599 |
7.8× |
| MRI pelvis w/contrast (72196) |
$2,321.70 |
$7,739 |
6.3× |
| MRI pelvis w/o contrast (72195) |
$2,050.20 |
$6,834 |
8.1× |
| MRI spectroscopy (76390) |
$1,014 |
$3,380 |
11.0× |
| MRI spine cervical w/o contrast (72141) |
$1,987.80 |
$6,626 |
7.9× |
| MRI t-spine w&w/o cont (72157) |
$2,884.50 |
$9,615 |
7.8× |
| MRI thoracic spine w/contrast (72147) |
$2,125.50 |
$7,085 |
5.8× |
| MRI thoracic spine w/o contrst (72146) |
$1,840.50 |
$6,135 |
7.3× |
| MRI tmj (70336) |
$1,717.20 |
$5,724 |
6.8× |
| MRI upper extremity oth than jt w/o contr matrl (73218) |
$1,231.50 |
$4,105 |
4.9× |
| Multi-leaf collimator (MLC) device(s) for intensity modulated radiation therapy (IMRT), design and construction per… (77338) |
$972.90 |
$3,243 |
2.5× |
| Myelography, 2 or more regions (eg, lumbar/thoracic, cervical/thoracic, lumbar/cervical, lumbar/thoracic/cervical),… (72270) |
$900.90 |
$3,003 |
1.1× |
| Myocardial imaging, positron emission tomography (PET), combined perfusion with metabolic evaluation study (including… (78432) |
$3,555.60 |
$11,852 |
2.2× |
| Myocardial imaging, positron emission tomography (PET), perfusion study (including ventricular wall motionºs» and/or… (78491) |
$2,305.50 |
$7,685 |
1.5× |
| Myocardial imaging, positron emission tomography (PET), perfusion study (including ventricular wall motionºs» and/or… (78492) |
$4,206.60 |
$14,022 |
2.8× |
| Myocardial imaging, positron emission tomography (PET), perfusion study (including ventricular wall motionºs» and/or… (78430) |
$3,085.20 |
$10,284 |
2.0× |
| Myocardial perfusion imaging, planar (including qualitative or quantitative wall motion, ejection fraction by first… (78453) |
$1,989.30 |
$6,631 |
1.5× |
| Myocardial spect multiple studies (78452) |
$3,557.70 |
$11,859 |
2.6× |
| Myocrd img PET 2rtracer CT (78433) |
$4,416.60 |
$14,722 |
1.9× |
| Myocrd img PET metab eval single study (78459) |
$1,417.20 |
$4,724 |
1.0× |
| Myocrd img PET metab eval single study cncrnt CT (78429) |
$2,682.90 |
$8,943 |
1.8× |
| Myocrd img PET rst&strs CT (78431) |
$3,381 |
$11,270 |
1.5× |
| N-invas est c ffr augmnt sw alys CTA i&r phy/qhp (75580) |
$925.80 |
$3,086 |
1.0× |
| Nm adrenal imaging (78075) |
$809.10 |
$2,697 |
0.6× |
| Nm bone 3 phase (78315) |
$1,218.30 |
$4,061 |
2.9× |
| Nm bone imaging whole body (78306) |
$1,021.20 |
$3,404 |
2.4× |
| Nm bone marrow ltd (78102) |
$1,161 |
$3,870 |
2.8× |
| Nm csf cisternogram (78630) |
$1,253.10 |
$4,177 |
2.2× |
| Nm csf leak detection (78650) |
$1,278.60 |
$4,262 |
0.9× |
| Nm gastric emptying (78264) |
$1,398 |
$4,660 |
3.3× |
| Nm lung ventilation imaging (78579) |
$537.60 |
$1,792 |
1.3× |
| Nm lymph system (78195) |
$1,194.90 |
$3,983 |
2.1× |
| Nuclear medicine study for detecting heart shunt (78428) |
$948.90 |
$3,163 |
2.3× |
| Nuclear medicine study of bone and/or joint limited area (78300) |
$572.40 |
$1,908 |
1.4× |
| Nuclear medicine study of bone and/or joint multiple areas (78305) |
$800.70 |
$2,669 |
1.9× |
| Nuclear medicine study of heart pumping function by labeling red blood cells with measurement of internal blood volume… (78494) |
$1,782.30 |
$5,941 |
4.2× |
| Ob us limited fetus(s) (76815) |
$335.70 |
$1,119 |
3.0× |
| Ob us nuchal meas 1 gest (76813) |
$255.30 |
$851 |
2.3× |
| Ophthalmic ultrasound, diagnostic; B-scan (with or without superimposed non-quantitative A-scan) Age Under 21 (76512) |
$159.90 |
$533 |
1.4× |
| Panoramic X-ray of jaws (70355) |
$158.70 |
$529 |
1.7× |
| Parathyrd planar w/spect&CT (78072) |
$670.80 |
$2,236 |
1.2× |
| Parathyroid planar imaging (78070) |
$985.80 |
$3,286 |
2.3× |
| Parathyroid planar imaging w/wo subtraction (78071) |
$1,077.60 |
$3,592 |
2.6× |
| Percutaneous transhepatic portography with hemodynamic evaluation, radiological supervision and interpretation Age… (75885) |
$1,580.10 |
$5,267 |
0.5× |
| Perineogram (eg, vaginogram, for sex determination or extent of anomalies) Age Under 21 (74775) |
$450.60 |
$1,502 |
1.8× |
| PET imaging CT attenuation skull base mid-thigh (78815) |
$3,326.10 |
$11,087 |
2.2× |
| PET imaging CT for attenuation limited area (78814) |
$2,626.80 |
$8,756 |
1.7× |
| PET imaging for CT attenuation whole body (78816) |
$3,485.40 |
$11,618 |
2.3× |
| Prq transhepatc portograpy w/o hemodyn evl intrp (75887) |
$1,296 |
$4,320 |
0.4× |
| Pulmonary ventilation & perfusion imaging (78582) |
$1,120.80 |
$3,736 |
2.0× |
| Radex abscess/fistula/sinus tract rs&i (76080) |
$523.50 |
$1,745 |
0.9× |
| Radex entir thrc lmbr crv sac spi w/skull 1 vw (72081) |
$207 |
$690 |
2.3× |
| Radex entir thrc lmbr crv sac spi w/skull 2/3 vw (72082) |
$384.90 |
$1,283 |
3.5× |
| Radex entir thrc lmbr crv sac spi w/skull 4/5 vw (72083) |
$438.30 |
$1,461 |
4.0× |
| Radex entir thrc lmbr crv sac spi w/skull 6/> vw (72084) |
$466.50 |
$1,555 |
4.2× |
| Radex hip unilateral with pelvis 1 view (73501) |
$154.80 |
$516 |
1.7× |
| Radex hip unilateral with pelvis 2-3 views (73502) |
$283.20 |
$944 |
3.1× |
| Radex hip unilateral with pelvis minimum 4 views (73503) |
$297.30 |
$991 |
2.7× |
| Radex hips bilateral with pelvis 2 views (73521) |
$230.10 |
$767 |
2.1× |
| Radex hips bilateral with pelvis minimum 5 views (73523) |
$572.70 |
$1,909 |
5.2× |
| Radex spine cervical 2 or 3 views (72040) |
$283.80 |
$946 |
3.1× |
| Radex spine cervical 4 or 5 views (72050) |
$399 |
$1,330 |
3.6× |
| Radex spine cervical 6 or more views (72052) |
$674.10 |
$2,247 |
6.1× |
| Radex spine thoracolumbar junction min 2 views (72080) |
$258.90 |
$863 |
2.8× |
| Radiation treatment delivery, stereotactic radiosurgery (SRS), complete course of treatment of cranial lesion(s)… (77372) |
$11,086.80 |
$36,956 |
1.4× |
| Radiation tx delivery lvl 1 (77402) |
$475.20 |
$1,584 |
4.4× |
| Radiation tx delivery lvl 2 (77407) |
$504 |
$1,680 |
1.2× |
| Radiation tx delivery lvl 3 (77412) |
$832.50 |
$2,775 |
1.4× |
| Radiologic exam abdomen 3+ views (74021) |
$272.10 |
$907 |
2.5× |
| Radiologic exam chest 3 views (71047) |
$228.90 |
$763 |
2.5× |
| Radiologic exam chest 4+ views (71048) |
$244.80 |
$816 |
2.2× |
| Radiologic exam colon double contrast study (74280) |
$745.20 |
$2,484 |
4.0× |
| Radiologic exam colon single contrast study (74270) |
$614.40 |
$2,048 |
3.3× |
| Radiologic exam esophagus double contrast study (74221) |
$498.90 |
$1,663 |
2.7× |
| Radiologic exam esophagus single contrast study (74220) |
$450 |
$1,500 |
2.4× |
| Radiologic exam small int single contrast study (74250) |
$456.90 |
$1,523 |
2.5× |
| Radiologic exam swallow function contrast study (74230) |
$394.20 |
$1,314 |
2.1× |
| Radiologic exam upr gi trc double contrast study (74246) |
$447.90 |
$1,493 |
2.4× |
| Radiologic exam upr gi trc single contrast study (74240) |
$392.40 |
$1,308 |
2.1× |
| Radiologic examination femur 1 view (73551) |
$117.90 |
$393 |
1.3× |
| Radiologic examination femur minimum 2 views (73552) |
$120.90 |
$403 |
1.3× |
| Radiologic examination from nose to rectum for foreign body, single view, child Age Under 21 (76010) |
$334.20 |
$1,114 |
3.6× |
| Radiologic examination, ankle; complete, minimum of 3 views Age Under 21 (73610) |
$333.90 |
$1,113 |
3.6× |
| Radiologic examination, complete acute abdomen series, including 2 or more views of the abdomen (eg, supine, erect,… (74022) |
$314.40 |
$1,048 |
2.9× |
| Radiologic examination, elbow; 2 views Age Under 21 (73070) |
$194.40 |
$648 |
2.1× |
| Radiologic examination, elbow; complete, minimum of 3 views Age Under 21 (73080) |
$326.40 |
$1,088 |
3.6× |
| Radiologic examination, facial bones; less than 3 views Age Under 21 (70140) |
$219.60 |
$732 |
2.4× |
| Radiologic examination, foot; complete, minimum of 3 views Age Under 21 (73630) |
$329.70 |
$1,099 |
3.6× |
| Radiologic examination, hand; minimum of 3 views Age Under 21 (73130) |
$323.40 |
$1,078 |
3.5× |
| Radiologic examination, knee; both knees, standing, anteroposterior Age Under 21 (73565) |
$215.10 |
$717 |
2.3× |
| Radiologic examination, knee; complete, 4 or more views Age Under 21 (73564) |
$381.30 |
$1,271 |
3.5× |
| Radiologic examination, mandible; partial, less than 4 views Age Under 21 (70100) |
$115.20 |
$384 |
1.3× |
| Radiologic examination, mastoids; complete, minimum of 3 views per side Age Under 21 (70130) |
$284.70 |
$949 |
2.6× |
| Radiologic examination, mastoids; less than 3 views per side Age Under 21 (70120) |
$225 |
$750 |
2.0× |
| Radiologic examination, nasal bones, complete, minimum of 3 views Age Under 21 (70160) |
$183.30 |
$611 |
2.0× |
| Radiologic examination, ribs, bilateral; including posteroanterior chest, minimum of 4 views Age Under 21 (71111) |
$418.80 |
$1,396 |
3.8× |
| Radiologic examination, ribs, unilateral; including posteroanterior chest, minimum of 3 views Age Under 21 (71101) |
$295.80 |
$986 |
2.7× |
| Radiologic examination, sacroiliac joints; less than 3 views Age Under 21 (72200) |
$213.90 |
$713 |
1.9× |
| Radiologic examination, shoulder, arthrography, radiological supervision and interpretation Age Under 21 (73040) |
$391.50 |
$1,305 |
1.1× |
| Radiologic examination, shoulder; complete, minimum of 2 views Age Under 21 (73030) |
$277.20 |
$924 |
3.0× |
| Radiologic examination, single plane body section (eg, tomography), other than with urography Age Under 21 (76100) |
$173.70 |
$579 |
1.6× |
| Radiologic examination, sinuses, paranasal, less than 3 views Age Under 21 (70210) |
$122.40 |
$408 |
1.3× |
| Radiologic examination, skull; less than 4 views Age Under 21 (70250) |
$290.10 |
$967 |
2.6× |
| Radiologic examination, spine, lumbosacral; 2 or 3 views Age Under 21 (72100) |
$397.80 |
$1,326 |
3.6× |
| Radiologic examination, spine, lumbosacral; bending views only, 2 or 3 views Age Under 21 (72120) |
$273.60 |
$912 |
2.5× |
| Radiologic examination, spine, lumbosacral; complete, including bending views, minimum of 6 views Age Under 21 (72114) |
$604.50 |
$2,015 |
5.5× |
| Radiologic examination, spine; thoracic, minimum of 4 views Age Under 21 (72074) |
$238.50 |
$795 |
2.2× |
| Radiologic examination, wrist; complete, minimum of 3 views Age Under 21 (73110) |
$327.60 |
$1,092 |
3.6× |
| Radiologic examination; acromioclavicular joints, bilateral, with or without weighted distraction Age Under 21 (73050) |
$202.20 |
$674 |
2.2× |
| Radiologic examination; humerus, minimum of 2 views Age Under 21 (73060) |
$230.70 |
$769 |
2.5× |
| Radiologic examination; lower extremity, infant, minimum of 2 views Age Under 21 (73592) |
$183 |
$610 |
2.0× |
| Radiologic examination; orbits, complete, minimum of 4 views Age Under 21 (70200) |
$194.70 |
$649 |
1.8× |
| Radiologic examination; sternoclavicular joint or joints, minimum of 3 views Age Under 21 (71130) |
$241.50 |
$805 |
2.6× |
| Radiologic examination; toe(s), minimum of 2 views Age Under 21 (73660) |
$182.10 |
$607 |
2.0× |
| Radiologic examination; upper extremity, infant, minimum of 2 views Age Under 21 (73092) |
$157.50 |
$525 |
1.4× |
| Radiopharmaceutical localization of tumor, inflammatory process or distribution of radiopharmaceutical agent(s)… (78803) |
$1,634.70 |
$5,449 |
2.9× |
| Radiopharmaceutical therapy, by intravenous administration Age Under 21 (79101) |
$991.20 |
$3,304 |
4.0× |
| Radiopharmaceutical therapy, by oral administration Age Under 21 (79005) |
$1,161.30 |
$3,871 |
4.7× |
| Radiopharmaceutical therapy, radiolabeled monoclonal antibody by intravenous infusion (79403) |
$912.90 |
$3,043 |
3.7× |
| Review by radiologist of urinary bladder and urethra images with contrast and after passing urine (74455) |
$577.20 |
$1,924 |
2.3× |
| Rp loclzj tum plnr 2+area 1+d img/1 area img>2+d (78801) |
$1,193.10 |
$3,977 |
2.8× |
| Rp loclzj tum plnr whole body 2+ days imaging (78804) |
$2,190.90 |
$7,303 |
3.8× |
| Rp loclzj tum plnr whole body single day imaging (78802) |
$1,349.70 |
$4,499 |
2.4× |
| Rp loclzj tum spect 2 areas (78831) |
$2,420.70 |
$8,069 |
1.8× |
| Rp loclzj tum spect w/CT 1 (78830) |
$2,031.30 |
$6,771 |
1.5× |
| Rp loclzj tum spect w/CT 2 (78832) |
$2,471.70 |
$8,239 |
1.6× |
| Rp therapy intra-arterial particulate admn (79445) |
$432.90 |
$1,443 |
1.8× |
| Saline infusion sonohysterography (SIS), including color flow Doppler, when performed Age Under 21 (76831) |
$335.10 |
$1,117 |
1.3× |
| Scapula complete (73010) |
$216.90 |
$723 |
2.0× |
| Screening digital breast tomosynthesis bi (77063) |
$29.10 |
$97 |
— |
| Shuntogram indwelling nonvascular shunt rs&i (75809) |
$491.10 |
$1,637 |
4.5× |
| Simulation intermediate (77285) |
$828.90 |
$2,763 |
2.1× |
| Special dosimetry (77331) |
$358.80 |
$1,196 |
2.5× |
| Special physics consult (77370) |
$1,126.20 |
$3,754 |
7.9× |
| Special teletherapy port plan (77321) |
$1,040.70 |
$3,469 |
2.6× |
| Special treatment procedure (77470) |
$1,767.30 |
$5,891 |
3.0× |
| Splenoportography, radiological supervision and interpretation Age Under 21 (75810) |
$2,501.70 |
$8,339 |
0.8× |
| Stereotactic body radiation therapy, treatment delivery, per fraction to 1 or more lesions, including image guidance,… (77373) |
$11,742 |
$39,140 |
6.2× |
| Testicular imaging with vascular flow Age Under 21 (78761) |
$846 |
$2,820 |
2.0× |
| Ther rad simulaj-aided field setting complex (77290) |
$1,621.80 |
$5,406 |
4.1× |
| Therapeutic enema, contrast or air, for reduction of intussusception or other intraluminal obstruction (eg, meconium… (74283) |
$568.20 |
$1,894 |
3.1× |
| Thyroid imaging with vascular flow (78013) |
$602.70 |
$2,009 |
1.4× |
| Thyroid met imaging body (78018) |
$1,614.90 |
$5,383 |
2.8× |
| Thyroid uptake single/multiple quant measurement (78012) |
$560.70 |
$1,869 |
1.3× |
| Thyroid uptake w/blood flow sngle/mult quan meas (78014) |
$1,113.30 |
$3,711 |
2.6× |
| Tr simulation simple (77280) |
$807.60 |
$2,692 |
5.7× |
| Treatment device complex (77334) |
$982.20 |
$3,274 |
2.5× |
| Treatment device intermediate (77333) |
$619.80 |
$2,066 |
4.4× |
| Treatment device simple (77332) |
$331.20 |
$1,104 |
2.3× |
| Ultrasound breast limited (76642) |
$120.90 |
$403 |
1.3× |
| Ultrasound, abdomen limited (76705) |
$471 |
$1,570 |
4.3× |
| Ultrasound, limited, joint or focal evaluation of other nonvascular extremity structure(s) (eg, joint space,… (76882) |
$335.70 |
$1,119 |
3.0× |
| Ultrasound, pelvic (nonobstetric), real time with image documentation; complete Age Under 21 (76856) |
$554.10 |
$1,847 |
5.0× |
| Ultrasound, pregnant uterus, real time with image documentation, fetal and maternal evaluation plus detailed fetal… (76811) |
$534.30 |
$1,781 |
2.1× |
| Ultrasound, pregnant uterus, real time with image documentation, fetal and maternal evaluation, first trimester (< 14… (76801) |
$437.40 |
$1,458 |
4.0× |
| Ultrasound, transplanted kidney, real time and duplex Doppler with image documentation Age Under 21 (76776) |
$636.90 |
$2,123 |
5.8× |
| Ultrasound, transrectal; prostate volume study for brachytherapy treatment planning (separate procedure) Age Under 21 (76873) |
$267.90 |
$893 |
2.4× |
| Umbilical-artery Doppler (OB) (76820) |
$231.90 |
$773 |
2.1× |
| Unlisted cardiovascular procedure, diagnostic nuclear medicine (78499) |
$359.18 |
$1,197.24 |
0.9× |
| Unlisted CT procedure (76497) |
$538.32 |
$1,794.40 |
5.9× |
| Unlisted endocrine procedure, diagnostic nuclear medicine (78099) |
$409.66 |
$1,365.52 |
1.0× |
| Unlisted gastrointestinal procedure, diagnostic nuclear medicine (78299) |
$354.79 |
$1,182.63 |
0.8× |
| Unlisted hematopoietic, reticuloendothelial and lymphatic procedure, diagnostic nuclear medicine (78199) |
$359.18 |
$1,197.24 |
0.9× |
| Unlisted magnetic resonance procedure (eg, diagnostic, interventional) Age Under 21 (76498) |
$234.88 |
$782.94 |
2.6× |
| Unlisted musculoskeletal procedure, diagnostic nuclear medicine (78399) |
$355.86 |
$1,186.17 |
0.8× |
| Urea breath test, C-14 (isotopic); acquisition for analysis Other Outpatient (78267) |
$50.10 |
$167 |
4.5× |
| Urea breath test, C-14 (isotopic); analysis Other Outpatient (78268) |
$291.90 |
$973 |
3.1× |
| Ureteral reflux study (78740) |
$846 |
$2,820 |
2.0× |
| Urethrocystography retrograde rs&i (74450) |
$662.40 |
$2,208 |
2.6× |
| Urography (pyelography), intravenous, with or without KUB, with or without tomography Age Under 21 (74400) |
$592.80 |
$1,976 |
3.2× |
| Urography antegrade rs&i (74425) |
$512.40 |
$1,708 |
1.4× |
| Urography, infusion, drip technique and/or bolus technique; with nephrotomography Age Under 21 (74415) |
$641.10 |
$2,137 |
3.5× |
| Us abdominal aorta real time screen study aaa (76706) |
$369.30 |
$1,231 |
3.3× |
| Us breast uni real time with image complete (76641) |
$122.70 |
$409 |
1.1× |
| Us chest (76604) |
$393.60 |
$1,312 |
3.6× |
| Us compl joint r-t w/image documentation (76881) |
$249.30 |
$831 |
2.3× |
| Us elastography organ (76981) |
$118.80 |
$396 |
1.1× |
| Us encephalogram (76506) |
$456.30 |
$1,521 |
4.1× |
| Us exam, pelvic, limited (76857) |
$354.30 |
$1,181 |
3.2× |
| Us guided compression repair (76936) |
$858.60 |
$2,862 |
3.8× |
| Us inft hips r-t img dynamic req phys/qhp manj (76885) |
$340.20 |
$1,134 |
3.7× |
| Us inft hips r-t img lmtd static phys/qhp manj (76886) |
$226.80 |
$756 |
2.5× |
| US OB Follow-Up/Repeat (76816) |
$239.40 |
$798 |
2.2× |
| Us ob transvaginal (76817) |
$405.30 |
$1,351 |
3.7× |
| Us retroperitoneal complete (76770) |
$630.90 |
$2,103 |
5.7× |
| Us retroperitoneal ltd (76775) |
$419.40 |
$1,398 |
3.8× |
| Us scrotum (76870) |
$395.40 |
$1,318 |
3.6× |
| Us soft tissue head/neck (76536) |
$395.40 |
$1,318 |
3.6× |
| Us spinal canal (76800) |
$222.90 |
$743 |
2.0× |
| Us unlstd proc (76999) |
$159.62 |
$532.03 |
1.7× |
| Venogram sinus/jugular (75860) |
$1,608.60 |
$5,362 |
0.5× |
| Venography adrenal unilateral selective rs&i (75840) |
$1,577.70 |
$5,259 |
0.5× |
| Venography deep dorsal vein penis radiolgicl supervision interpretation (76499) |
$340.43 |
$1,134.75 |
3.7× |
| Venography renal unilateral selective rs&i (75831) |
$1,517.40 |
$5,058 |
0.5× |
| Venography, caval, inferior, with serialography, radiological supervision and interpretation Age Under 21 (75825) |
$2,097.30 |
$6,991 |
0.6× |
| Venography, caval, superior, with serialography, radiological supervision and interpretation Age Under 21 (75827) |
$2,223.30 |
$7,411 |
1.3× |
| Venography, extremity, bilateral, radiological supervision and interpretation Age Under 21 (75822) |
$1,179.90 |
$3,933 |
0.7× |
| Venography, extremity, unilateral, radiological supervision and interpretation Age Under 21 (75820) |
$1,126.80 |
$3,756 |
0.7× |
| Venography, superior sagittal sinus, radiological supervision and interpretation Age Under 21 (75870) |
$1,163.70 |
$3,879 |
0.3× |
Venous sampling thru cath w/wo angiography rs& (75893)
unusually low — confirm this is the full procedure |
$2,729.70 |
$9,099 |
0.5× |
| X-ray exam hips bi 3-4 views (73522) |
$286.20 |
$954 |
2.6× |
| X-ray exam of finger(s) (73140) |
$199.80 |
$666 |
2.2× |
| X-ray exam of knee 1 or 2 (73560) |
$237.60 |
$792 |
2.6× |
| X-ray exam of small bowel - fl small bowel series enteroclysis tube (74251) |
$695.40 |
$2,318 |
3.8× |
| X-ray exam ribs bil 3 views (71110) |
$339.60 |
$1,132 |
3.1× |
| X-ray exam ribs uni 2 views (71100) |
$230.40 |
$768 |
2.5× |
| X-ray heel (73650) |
$188.40 |
$628 |
2.1× |
| X-ray of joint between lower spine and hip bone 3 or more views|PROFESSIONAL COMPONENT (72202) |
$299.70 |
$999 |
2.7× |
| X-ray retrograde pyelogram (74420) |
$335.70 |
$1,119 |
0.9× |
| Xr abdomen 1 view (74018) |
$247.80 |
$826 |
2.7× |
| Xr abdomen 2 views (74019) |
$259.20 |
$864 |
2.4× |
| Xr arthrogram ankle (73615) |
$448.80 |
$1,496 |
1.2× |
| Xr arthrogram elbow (73085) |
$690.60 |
$2,302 |
1.9× |
| Xr arthrogram hip (73525) |
$651.30 |
$2,171 |
1.8× |
| Xr arthrogram knee (73580) |
$719.40 |
$2,398 |
2.0× |
| Xr arthrogram wrist (73115) |
$574.20 |
$1,914 |
1.6× |
| Xr bone age studies (77072) |
$124.50 |
$415 |
1.1× |
| Xr bone length study (77073) |
$476.40 |
$1,588 |
4.3× |
| Xr bone survey infant (77076) |
$665.40 |
$2,218 |
6.0× |
| Xr bone survey ltd (77074) |
$432.30 |
$1,441 |
3.9× |
| Xr chest 1 view (71045) |
$209.70 |
$699 |
2.3× |
| Xr chest 2 views (71046) |
$219.30 |
$731 |
2.4× |
| Xr eye foreign body (70030) |
$216.30 |
$721 |
2.4× |
| Xr facial bones 3+ views (70150) |
$329.40 |
$1,098 |
3.0× |
| Xr foot arthritis pa only bilateral - report(ortho pro) (73620) |
$207.60 |
$692 |
2.3× |
| Xr forearm 2 views (73090) |
$219.90 |
$733 |
2.4× |
| Xr hand 2v (73120) |
$181.80 |
$606 |
1.6× |
| Xr hysterosalpingogram (74740) |
$531 |
$1,770 |
2.1× |
| Xr myelogram c-spine (72240) |
$709.50 |
$2,365 |
0.9× |
| Xr myelogram l-spine (72265) |
$713.10 |
$2,377 |
0.9× |
| Xr myelogram t-spine (72255) |
$660.90 |
$2,203 |
0.8× |
| Xr neck soft tissue (70360) |
$220.80 |
$736 |
2.4× |
| Xr o knee w/ merchant view bilat - report(ortho pro) (73562) |
$330.30 |
$1,101 |
3.6× |
| Xr osseous survey complete (77075) |
$808.20 |
$2,694 |
7.3× |
| Xr pelvis 1-2 views (72170) |
$158.10 |
$527 |
1.4× |
| Xr pelvis min 3 view (72190) |
$318 |
$1,060 |
2.9× |
| Xr peritoneogram (74190) |
$352.20 |
$1,174 |
0.6× |
| Xr sacrum/coccyx 2+ views (72220) |
$232.50 |
$775 |
2.5× |
| Xr shoulder 1 view (73020) |
$120.60 |
$402 |
1.3× |
| Xr sialogram (70390) |
$465 |
$1,550 |
1.8× |
| Xr sinuses 3+ views (70220) |
$211.80 |
$706 |
2.3× |
| Xr skull min 4 view (70260) |
$504.30 |
$1,681 |
4.6× |
| Xr spine 1 view (72020) |
$225.60 |
$752 |
2.5× |
| Xr spine thoracic 3v (72072) |
$227.10 |
$757 |
2.1× |
| Xr sternum 2+ views (71120) |
$210.60 |
$702 |
2.3× |
| Xr surgical specimen (76098) |
$818.10 |
$2,727 |
1.4× |
| Xr t-spine 2 views (72070) |
$210.60 |
$702 |
1.9× |
| Xr tibia/fibula 2 views (73590) |
$224.70 |
$749 |
2.4× |
| Xr tmj bilateral (70330) |
$300 |
$1,000 |
3.3× |
| Xr tmj unilateral (70328) |
$172.20 |
$574 |
1.9× |
| Xr venogram renal bilat (75833) |
$1,612.80 |
$5,376 |
0.5× |
| Xr wrist 2 views (73100) |
$186 |
$620 |
2.0× |