| 3-D radiotherapy plan dose-volume histograms (77295) |
$4,430.25 |
$9,845 |
3.0× |
| Acute gi blood loss imaging (78278) |
$1,338.30 |
$2,974 |
3.2× |
| Angiography internal mammary rs&i (75756) |
$3,788.10 |
$8,418 |
1.1× |
| Angiography pulmonary bilateral slctv rs&i (75743) |
$8,778.15 |
$19,507 |
2.6× |
| Angiography visceral slctv/supraslctv rs&i (75726) |
$8,790.30 |
$19,534 |
1.5× |
| Angiography, adrenal, bilateral, selective, radiological supervision and interpretation Age Under 21 (75733) |
$6,873.75 |
$15,275 |
2.1× |
| Angiography, adrenal, unilateral, selective, radiological supervision and interpretation Age Under 21 (75731) |
$4,582.35 |
$10,183 |
1.4× |
| Angiography, extremity, bilateral, radiological supervision and interpretation Age Under 21 (75716) |
$4,724.10 |
$10,498 |
1.4× |
| Angiography, extremity, unilateral, radiological supervision and interpretation Age Under 21 (75710) |
$3,094.20 |
$6,876 |
0.9× |
| Angiography, pelvic, selective or supraselective, radiological supervision and interpretation Age Under 21 (75736) |
$7,927.20 |
$17,616 |
1.4× |
| Angiography, pulmonary, unilateral, selective, radiological supervision and interpretation Age Under 21 (75741) |
$4,582.35 |
$10,183 |
1.4× |
| Angiography, spinal, selective, radiological supervision and interpretation Age Under 21 (75705) |
$7,643.70 |
$16,986 |
1.3× |
| Angrph cath f-up std tcat other than thrombylsis (75898) |
$5,273.10 |
$11,718 |
1.6× |
| Angrph pulmonary nonslctv cath/ven njx rs&i (75746) |
$5,348.25 |
$11,885 |
1.6× |
| Ankle 2 views (73600) |
$202.05 |
$449 |
2.2× |
| Aortography, abdominal plus bilateral iliofemoral lower extremity, catheter, by serialography, radiological supervision… (75630) |
$3,465 |
$7,700 |
1.0× |
| Aortography, abdominal, by serialography, radiological supervision and interpretation Age Under 21 (75625) |
$3,956.85 |
$8,793 |
1.2× |
| Aortography, thoracic, by serialography, radiological supervision and interpretation Age Under 21 (75605) |
$4,968.45 |
$11,041 |
0.8× |
| Basic radiation dosimetry calculation (77300) |
$789.30 |
$1,754 |
5.6× |
| Brain flow imaging only - nm brain flow only brain death (78610) |
$1,574.10 |
$3,498 |
2.7× |
| Brain imaging, positron emission tomography (PET); metabolic evaluation Age Under 21 (78608) |
$3,211.65 |
$7,137 |
2.1× |
| Card MRI w/stress img & dye (75563) |
$1,904.85 |
$4,233 |
2.3× |
| Cardiac MRI morphology & function w/o contrast (75557) |
$1,632.60 |
$3,628 |
6.5× |
| Cardiac MRI w/wo contrast & further seq (75561) |
$1,826.55 |
$4,059 |
5.0× |
| Clavicle complete (73000) |
$310.50 |
$690 |
3.4× |
| Computed tomographic angiography, abdomen and pelvis, with contrast material(s), including noncontrast images, if… (74174) |
$4,545 |
$10,100 |
12.3× |
| Computed tomographic angiography, abdomen, with contrast material(s), including noncontrast images, if performed, and… (74175) |
$1,654.20 |
$3,676 |
8.9× |
| Computed tomographic angiography, abdominal aorta and bilateral iliofemoral lower extremity runoff, with contrast… (75635) |
$1,534.50 |
$3,410 |
8.3× |
| Computed tomographic angiography, chest (noncoronary), with contrast material(s), including noncontrast images, if… (71275) |
$2,799.90 |
$6,222 |
15.1× |
| Computed tomographic angiography, lower extremity, with contrast material(s), including noncontrast images, if… (73706) |
$2,236.50 |
$4,970 |
12.1× |
| Computed tomographic angiography, neck, with contrast material(s), including noncontrast images, if performed, and… (70498) |
$2,110.05 |
$4,689 |
11.4× |
| Computed tomographic angiography, pelvis, with contrast material(s), including noncontrast images, if performed, and… (72191) |
$1,983.60 |
$4,408 |
10.7× |
| Computed tomographic angiography, upper extremity, with contrast material(s), including noncontrast images, if… (73206) |
$2,236.50 |
$4,970 |
12.1× |
| Computed tomography, cervical spine; without contrast material, followed by contrast material(s) and further sections… (72127) |
$2,009.25 |
$4,465 |
10.9× |
| Computed tomography, lower extremity; without contrast material Age Under 21 (73700) |
$1,045.80 |
$2,324 |
9.5× |
| Computed tomography, lower extremity; without contrast material, followed by contrast material(s) and further sections… (73702) |
$2,129.85 |
$4,733 |
11.5× |
| Computed tomography, lumbar spine; without contrast material, followed by contrast material(s) and further sections Age… (72133) |
$2,129.85 |
$4,733 |
11.5× |
| Computed tomography, maxillofacial area; with contrast material(s) Age Under 21 (70487) |
$1,941.30 |
$4,314 |
10.5× |
| Computed tomography, maxillofacial area; without contrast material Age Under 21 (70486) |
$1,377 |
$3,060 |
12.5× |
| Computed tomography, orbit, sella, or posterior fossa or outer, middle, or inner ear; with contrast material(s) Age… (70481) |
$1,941.30 |
$4,314 |
10.5× |
| Computed tomography, orbit, sella, or posterior fossa or outer, middle, or inner ear; without contrast material Age… (70480) |
$1,609.20 |
$3,576 |
14.6× |
| Computed tomography, orbit, sella, or posterior fossa or outer, middle, or inner ear; without contrast material,… (70482) |
$2,009.25 |
$4,465 |
10.9× |
| Computed tomography, soft tissue neck; without contrast material followed by contrast material(s) and further sections… (70492) |
$1,890.45 |
$4,201 |
10.2× |
| Computed tomography, thoracic spine; without contrast material, followed by contrast material(s) and further sections… (72130) |
$2,009.25 |
$4,465 |
10.9× |
| Computed tomography, thorax, diagnostic; without contrast material, followed by contrast material(s) and further… (71270) |
$1,730.25 |
$3,845 |
9.4× |
| Continuing medical physics consultation, including assessment of treatment parameters, quality assurance of dose… (77336) |
$787.05 |
$1,749 |
5.6× |
| Csf shunt evaluation (78645) |
$1,400.85 |
$3,113 |
2.4× |
| CT abdomen and pelvis without and with contrast (74178) |
$4,328.55 |
$9,619 |
11.8× |
| CT abdomen and pelvis without contrast (74176) |
$2,612.25 |
$5,805 |
10.4× |
| CT abdomen w & w/o contrast (74170) |
$1,465.65 |
$3,257 |
7.9× |
| CT abdomen w/contrast (74160) |
$1,299.60 |
$2,888 |
7.0× |
| CT abdomen w/o contrast (74150) |
$1,147.05 |
$2,549 |
10.4× |
| CT angio hrt w/3d image (75574) |
$1,357.65 |
$3,017 |
3.7× |
| CT cervical spine w/contrast (72126) |
$1,899 |
$4,220 |
5.2× |
| CT cervical spine w/o contrast (72125) |
$1,739.70 |
$3,866 |
15.8× |
| CT chest w/contrast (71260) |
$1,413.90 |
$3,142 |
7.6× |
| CT extremity upper w & w/o contrast (73202) |
$2,129.85 |
$4,733 |
11.5× |
| CT extremity upper w/o contrast (73200) |
$1,609.20 |
$3,576 |
14.6× |
| CT head/brain with contrast (70460) |
$1,941.30 |
$4,314 |
10.5× |
| CT head/brain without and with contrast (70470) |
$2,057.85 |
$4,573 |
11.1× |
| CT heart c+ cardiac strux&morph cgen hrt ds (75573) |
$1,292.85 |
$2,873 |
3.5× |
| CT heart contrast eval cardiac structure&morph (75572) |
$840.60 |
$1,868 |
2.3× |
| CT heart no contrast quant eval coronry calcium (75571) |
$271.80 |
$604 |
3.0× |
| CT l-spine w/contrast (72132) |
$1,807.20 |
$4,016 |
4.9× |
| CT limited/localized follow up study (76380) |
$552.15 |
$1,227 |
6.0× |
| CT lower extremity w/dye (73701) |
$1,941.30 |
$4,314 |
10.5× |
| CT lumbar spine w/o contrast (72131) |
$1,498.95 |
$3,331 |
13.6× |
| CT maxillofacial w/wo contrast (70488) |
$2,057.85 |
$4,573 |
11.1× |
| CT neck w/contrast (70491) |
$1,554.75 |
$3,455 |
8.4× |
| CT neck w/o contrast (70490) |
$1,121.85 |
$2,493 |
10.2× |
| CT pelvis w & w/o contrast (72194) |
$1,889.10 |
$4,198 |
10.2× |
| CT pelvis w/o contrast (72192) |
$1,453.05 |
$3,229 |
13.2× |
| CT thoracic spine w/contrast (72129) |
$1,234.35 |
$2,743 |
6.7× |
| CT thoracic spine w/o contrast (72128) |
$1,194.75 |
$2,655 |
10.8× |
| CT thorax lung cancer scr c- (71271) |
$429.75 |
$955 |
3.9× |
| CT thorax w/o contrast (71250) |
$1,256.40 |
$2,792 |
11.4× |
| CT upper extremity w/dye (73201) |
$1,941.30 |
$4,314 |
5.3× |
| CTA head w contrast (70496) |
$2,545.20 |
$5,656 |
13.8× |
| Cystography, minimum of 3 views, radiological supervision and interpretation Age Under 21 (74430) |
$782.55 |
$1,739 |
2.1× |
| Dilation ureters/urethra rs&i (74485) |
$2,873.25 |
$6,385 |
1.3× |
| Discography, cervical or thoracic, radiological supervision and interpretation Age Under 21 (72285) |
$2,811.15 |
$6,247 |
1.4× |
| Diskography lumbar s&i (72295) |
$2,490.75 |
$5,535 |
1.2× |
| Doppler echocardiography, fetal, pulsed wave and/or continuous wave with spectral display; complete Age Under 21 (76827) |
$189 |
$420 |
1.7× |
| Doppler fetal mid cerebral artery (76821) |
$304.65 |
$677 |
2.8× |
| Dual-energy X-ray absorptiometry (DXA), bone density study, 1 or more sites; axial skeleton (eg, hips, pelvis, spine)… (77080) |
$422.10 |
$938 |
3.8× |
| Dxa bone density/peripheral (77081) |
$199.80 |
$444 |
2.2× |
| Esophageal motility (78258) |
$993.60 |
$2,208 |
2.4× |
| Fetal biophys profile w/o nst (76819) |
$242.10 |
$538 |
2.2× |
| Fetal biophysical profile non-stress testing (76818) |
$279 |
$620 |
2.5× |
| Fluoroscopy up to 1 hour physician/qhp time (76000) |
$622.35 |
$1,383 |
2.5× |
| Gastroesophageal reflux study (78262) |
$993.60 |
$2,208 |
2.4× |
| Gated heart planar single (78472) |
$2,117.25 |
$4,705 |
5.0× |
| Hdr rdncl ntrstl/intrcav brachytx 1 channel (77770) |
$1,597.95 |
$3,551 |
2.2× |
| Hdr rdncl ntrstl/intrcav brachytx 2-12 channel (77771) |
$6,804.90 |
$15,122 |
9.3× |
| Hdr rdncl ntrstl/intrcav brachytx >12 channels (77772) |
$7,317 |
$16,260 |
10.0× |
| Hepatc vngrph wdg/fr w/o hemodyn eval rs&i (75891) |
$4,585.50 |
$10,190 |
1.4× |
| Hepatic venography, wedged or free, with hemodynamic evaluation, radiological supervision and interpretation Age Under… (75889) |
$3,370.50 |
$7,490 |
1.0× |
| Hepatobil syst imag inc gb w/pharma intervenj (78227) |
$2,657.70 |
$5,906 |
4.6× |
| Hepatobiliary syst imaging including gallbladder (78226) |
$1,696.95 |
$3,771 |
4.0× |
| Ht muscle image spect sing (78451) |
$2,421 |
$5,380 |
1.8× |
| Image fusion (77399) |
$481.84 |
$1,070.74 |
3.4× |
| Intensity modulated radiotherapy plan, including dose-volume histograms for target and critical structure partial… (77301) |
$7,151.85 |
$15,893 |
4.9× |
| Interstitial radiation source application, complex, includes supervision, handling, loading of radiation source, when… (77778) |
$7,521.75 |
$16,715 |
10.2× |
| Intestine imaging (eg, ectopic gastric mucosa, Meckel's localization, volvulus) Age Under 21 (78290) |
$1,072.80 |
$2,384 |
2.5× |
| Intracavitary radiation source application - complex (77763) |
$7,521.75 |
$16,715 |
10.2× |
| Intracavitary radiation source application - intermediate (77762) |
$6,354 |
$14,120 |
10.9× |
| Intracavitary radiation source application - simple (77761) |
$5,186.70 |
$11,526 |
8.9× |
| Isodose brachytherapy complex 10+ sources (77318) |
$2,556.45 |
$5,681 |
6.5× |
| Isodose brachytherapy intermed 5 to 10 sources (77317) |
$2,258.10 |
$5,018 |
5.7× |
| Isodose brachytherapy plan simple 1 to 4 source (77316) |
$2,091.60 |
$4,648 |
5.3× |
| Isodose teletherapy plan complex multi tx w/cal (77307) |
$2,351.25 |
$5,225 |
6.0× |
| Isodose teletherapy plan simple 1 or 2 port w/cal (77306) |
$2,218.05 |
$4,929 |
5.6× |
| Kidney imaging morphol - nm kidney cortex (78700) |
$1,323 |
$2,940 |
3.1× |
| Kidney imaging morphology; with vascular flow and function, multiple studies, with and without pharmacological… (78709) |
$1,965.60 |
$4,368 |
3.4× |
| Kidney imaging morphology; with vascular flow and function, single study without pharmacological intervention Age Under… (78707) |
$1,880.10 |
$4,178 |
3.3× |
| Kidney imaging morphology; with vascular flow and function, single study, with pharmacological intervention (eg,… (78708) |
$1,794.60 |
$3,988 |
3.1× |
| Liver and spleen imaging (78215) |
$1,621.80 |
$3,604 |
3.8× |
| Liver and spleen imaging; with vascular flow Age Under 21 (78216) |
$1,431 |
$3,180 |
3.4× |
| Lung perf&ventilat diferentl (78598) |
$1,524.15 |
$3,387 |
2.7× |
| Lung perfusion imaging (78580) |
$1,147.50 |
$2,550 |
2.7× |
| Lymphangiography, pelvic/abdominal, bilateral, radiological supervision and interpretation Age Under 21 (75807) |
$7,107.30 |
$15,794 |
2.1× |
| Lymphangiography, pelvic/abdominal, unilateral, radiological supervision and interpretation Age Under 21 (75805) |
$5,273.10 |
$11,718 |
1.6× |
| Magnetic resonance (eg, proton) imaging, any joint of lower extremity; without contrast material(s), followed by… (73723) |
$2,880 |
$6,400 |
7.8× |
| Magnetic resonance (eg, proton) imaging, lower extremity other than joint; with contrast material(s) Age Under 21 (73719) |
$2,061.90 |
$4,582 |
5.6× |
| Magnetic resonance (eg, proton) imaging, lower extremity other than joint; without contrast material(s) Age Under 21 (73718) |
$1,758.60 |
$3,908 |
7.0× |
| Magnetic resonance (eg, proton) imaging, lower extremity other than joint; without contrast material(s), followed by… (73720) |
$2,600.10 |
$5,778 |
7.1× |
| Magnetic resonance (eg, proton) imaging, orbit, face, and/or neck; with contrast material(s) Age Under 21 (70542) |
$2,043.45 |
$4,541 |
5.6× |
| Magnetic resonance (eg, proton) imaging, orbit, face, and/or neck; without contrast material(s) Age Under 21 (70540) |
$1,227.15 |
$2,727 |
4.9× |
| Magnetic resonance (eg, proton) imaging, upper extremity, other than joint; without contrast material(s), followed by… (73220) |
$1,627.65 |
$3,617 |
4.4× |
| Magnetic resonance angiography, head; with contrast material(s) Age Under 21 (70545) |
$1,685.25 |
$3,745 |
4.6× |
| Magnetic resonance angiography, head; without contrast material(s), followed by contrast material(s) and further… (70546) |
$1,946.70 |
$4,326 |
5.3× |
| Magnetic resonance angiography, neck; without contrast material(s), followed by contrast material(s) and further… (70549) |
$2,380.50 |
$5,290 |
6.5× |
| Magnetic resonance elastography (76391) |
$561.60 |
$1,248 |
2.2× |
| Mammary ductogram or galactogram, multiple ducts, radiological supervision and interpretation Age Under 21 (77054) |
$569.70 |
$1,266 |
2.3× |
| Mammary ductogram single (77053) |
$495.45 |
$1,101 |
2.0× |
| Mandible min 4v (70110) |
$357.30 |
$794 |
3.2× |
| Med physic dos eval rad exps (76145) |
$562.95 |
$1,251 |
1.4× |
| Mr safety determination physician/other qhp (76016) |
$119.70 |
$266 |
1.3× |
| Mr safety implant pos&/immoblj supvj phys/qhp (76019) |
$93.15 |
$207 |
1.5× |
| Mr safety implant&/fb assmt clin staf 1st 15 min (76014) |
$33.30 |
$74 |
1.1× |
| Mr safety implt electronics prepj supvj phys/qhp (76018) |
$143.10 |
$318 |
1.4× |
| Mr safety med physics xm customization plng&mntr (76017) |
$377.10 |
$838 |
1.5× |
| MRA head w/o contrast (70544) |
$1,566.45 |
$3,481 |
6.2× |
| MRA neck w/ contrast (70548) |
$1,632.60 |
$3,628 |
4.4× |
| MRA neck w/o contrast (70547) |
$1,480.95 |
$3,291 |
5.9× |
| MRI abdomen w/contrast (74182) |
$1,512.90 |
$3,362 |
4.1× |
| MRI abdomen w/o contrast (74181) |
$1,276.20 |
$2,836 |
5.1× |
| MRI abdomen w/wo contrast (74183) |
$1,604.70 |
$3,566 |
4.4× |
| MRI any jt lower extrem w/contrast material (73722) |
$2,159.10 |
$4,798 |
2.6× |
| MRI bone marrow (77084) |
$1,694.70 |
$3,766 |
6.7× |
| MRI breast c- bilateral (77047) |
$627.75 |
$1,395 |
2.5× |
| MRI breast without contrast material unilateral (77046) |
$511.20 |
$1,136 |
2.0× |
| MRI c-spine w&w/o cont (72156) |
$2,135.70 |
$4,746 |
5.8× |
| MRI cervical spine w/contrast (72142) |
$2,043.45 |
$4,541 |
5.6× |
| MRI chest w/contrast (71551) |
$2,200.05 |
$4,889 |
2.7× |
| MRI chest w/o contrast (71550) |
$1,854 |
$4,120 |
7.4× |
| MRI chest w/wo contrast (71552) |
$2,324.25 |
$5,165 |
6.3× |
| MRI fetal sngl/1st gestation (74712) |
$2,331 |
$5,180 |
9.3× |
| MRI joint upr extr w/o&w/dye (73223) |
$1,821.60 |
$4,048 |
4.9× |
| MRI joint upr extrem w/dye (73222) |
$1,507.95 |
$3,351 |
1.8× |
| MRI joint upr extrem w/o dye (73221) |
$1,178.10 |
$2,618 |
4.7× |
| MRI lumbar spine w/contrast (72149) |
$2,043.45 |
$4,541 |
5.6× |
| MRI lumbar spine w/wo contrast (72158) |
$2,128.95 |
$4,731 |
5.8× |
| MRI orbit/face/neck w&w/o cont (70543) |
$2,604.60 |
$5,788 |
7.1× |
| MRI pelvis w & w/o contrast (72197) |
$1,702.35 |
$3,783 |
4.6× |
| MRI pelvis w/contrast (72196) |
$1,385.55 |
$3,079 |
3.8× |
| MRI pelvis w/o contrast (72195) |
$1,178.10 |
$2,618 |
4.7× |
| MRI spectroscopy (76390) |
$2,171.70 |
$4,826 |
23.7× |
| MRI spine cervical w/o contrast (72141) |
$1,548 |
$3,440 |
6.2× |
| MRI t-spine w&w/o cont (72157) |
$2,118.15 |
$4,707 |
5.8× |
| MRI thoracic spine w/contrast (72147) |
$2,043.45 |
$4,541 |
5.6× |
| MRI thoracic spine w/o contrst (72146) |
$1,662.75 |
$3,695 |
6.6× |
| MRI tmj (70336) |
$1,629.45 |
$3,621 |
6.5× |
| MRI upper extremity oth than jt w/o contr matrl (73218) |
$1,178.10 |
$2,618 |
4.7× |
| Multi-leaf collimator (MLC) device(s) for intensity modulated radiation therapy (IMRT), design and construction per… (77338) |
$1,521.45 |
$3,381 |
3.9× |
| Myelography, 2 or more regions (eg, lumbar/thoracic, cervical/thoracic, lumbar/cervical, lumbar/thoracic/cervical),… (72270) |
$3,091.95 |
$6,871 |
3.7× |
| Myocardial imaging, positron emission tomography (PET), combined perfusion with metabolic evaluation study (including… (78432) |
$5,333.40 |
$11,852 |
3.3× |
| Myocardial imaging, positron emission tomography (PET), perfusion study (including ventricular wall motionºs» and/or… (78491) |
$3,720.60 |
$8,268 |
2.5× |
| Myocardial imaging, positron emission tomography (PET), perfusion study (including ventricular wall motionºs» and/or… (78492) |
$5,585.85 |
$12,413 |
3.7× |
| Myocardial imaging, positron emission tomography (PET), perfusion study (including ventricular wall motionºs» and/or… (78430) |
$4,135.50 |
$9,190 |
2.7× |
| Myocardial perfusion imaging, planar (including qualitative or quantitative wall motion, ejection fraction by first… (78453) |
$1,889.55 |
$4,199 |
1.4× |
| Myocardial spect multiple studies (78452) |
$4,150.35 |
$9,223 |
3.0× |
| Myocrd img PET 2rtracer CT (78433) |
$6,624.90 |
$14,722 |
2.9× |
| Myocrd img PET metab eval single study (78459) |
$3,791.25 |
$8,425 |
2.8× |
| Myocrd img PET metab eval single study cncrnt CT (78429) |
$4,024.35 |
$8,943 |
2.7× |
| Myocrd img PET rst&strs CT (78431) |
$4,846.95 |
$10,771 |
2.1× |
| N-invas est c ffr augmnt sw alys CTA i&r phy/qhp (75580) |
$1,555.20 |
$3,456 |
1.7× |
| Nm bone 3 phase (78315) |
$1,797.30 |
$3,994 |
4.3× |
| Nm bone imaging whole body (78306) |
$1,597.05 |
$3,549 |
3.8× |
| Nm bone marrow ltd (78102) |
$1,815.30 |
$4,034 |
4.3× |
| Nm bone marrow wb (78104) |
$2,549.25 |
$5,665 |
6.0× |
| Nm csf cisternogram (78630) |
$1,809.90 |
$4,022 |
3.2× |
| Nm csf leak detection (78650) |
$2,294.55 |
$5,099 |
1.7× |
| Nm gastric emptying (78264) |
$1,856.25 |
$4,125 |
4.4× |
| Nm lung ventilation imaging (78579) |
$841.05 |
$1,869 |
2.0× |
| Nm lymph system (78195) |
$1,682.10 |
$3,738 |
2.9× |
| Nuclear medicine study of bone and/or joint limited area (78300) |
$1,222.65 |
$2,717 |
2.9× |
| Nuclear medicine study of bone and/or joint multiple areas (78305) |
$1,440.45 |
$3,201 |
3.4× |
| Nuclear medicine study of heart pumping function by labeling red blood cells with measurement of internal blood volume… (78494) |
$1,912.05 |
$4,249 |
4.5× |
| Ob us limited fetus(s) (76815) |
$323.10 |
$718 |
2.9× |
| Ob us nuchal meas 1 gest (76813) |
$205.20 |
$456 |
1.9× |
| Ophthalmic ultrasound, diagnostic; B-scan (with or without superimposed non-quantitative A-scan) Age Under 21 (76512) |
$339.30 |
$754 |
3.1× |
| Panoramic X-ray of jaws (70355) |
$310.50 |
$690 |
3.4× |
| Parathyrd planar w/spect&CT (78072) |
$879.75 |
$1,955 |
1.5× |
| Parathyroid planar imaging (78070) |
$1,139.85 |
$2,533 |
2.7× |
| Parathyroid planar imaging w/wo subtraction (78071) |
$2,388.15 |
$5,307 |
5.7× |
| Percutaneous transhepatic portography with hemodynamic evaluation, radiological supervision and interpretation Age… (75885) |
$4,585.50 |
$10,190 |
1.4× |
| Perineogram (eg, vaginogram, for sex determination or extent of anomalies) Age Under 21 (74775) |
$767.25 |
$1,705 |
3.0× |
| PET imaging CT attenuation skull base mid-thigh (78815) |
$4,921.20 |
$10,936 |
3.3× |
| PET imaging CT for attenuation limited area (78814) |
$3,211.65 |
$7,137 |
2.1× |
| PET imaging for CT attenuation whole body (78816) |
$4,950.45 |
$11,001 |
3.3× |
| Prq transhepatc portograpy w/o hemodyn evl intrp (75887) |
$4,585.50 |
$10,190 |
1.4× |
| Pulmonary ventilation & perfusion imaging (78582) |
$1,524.15 |
$3,387 |
2.7× |
| Radex abscess/fistula/sinus tract rs&i (76080) |
$744.30 |
$1,654 |
1.3× |
| Radex entir thrc lmbr crv sac spi w/skull 1 vw (72081) |
$310.50 |
$690 |
3.4× |
| Radex entir thrc lmbr crv sac spi w/skull 2/3 vw (72082) |
$326.25 |
$725 |
3.0× |
| Radex entir thrc lmbr crv sac spi w/skull 4/5 vw (72083) |
$341.55 |
$759 |
3.1× |
| Radex entir thrc lmbr crv sac spi w/skull 6/> vw (72084) |
$357.30 |
$794 |
3.2× |
| Radex hip unilateral with pelvis 1 view (73501) |
$202.05 |
$449 |
2.2× |
| Radex hip unilateral with pelvis 2-3 views (73502) |
$281.25 |
$625 |
3.1× |
| Radex hip unilateral with pelvis minimum 4 views (73503) |
$341.55 |
$759 |
3.1× |
| Radex hips bilateral with pelvis 2 views (73521) |
$233.10 |
$518 |
2.1× |
| Radex hips bilateral with pelvis minimum 5 views (73523) |
$357.30 |
$794 |
3.2× |
| Radex spine cervical 2 or 3 views (72040) |
$288.45 |
$641 |
3.1× |
| Radex spine cervical 4 or 5 views (72050) |
$307.35 |
$683 |
2.8× |
| Radex spine cervical 6 or more views (72052) |
$357.30 |
$794 |
3.2× |
| Radex spine thoracolumbar junction min 2 views (72080) |
$226.35 |
$503 |
2.5× |
| Radiation treatment delivery, stereotactic radiosurgery (SRS), complete course of treatment of cranial lesion(s)… (77372) |
$11,269.80 |
$25,044 |
1.5× |
| Radiation tx delivery lvl 1 (77402) |
$561.15 |
$1,247 |
5.2× |
| Radiation tx delivery lvl 2 (77407) |
$862.65 |
$1,917 |
2.1× |
| Radiation tx delivery lvl 3 (77412) |
$1,302.30 |
$2,894 |
2.2× |
| Radiologic exam abdomen 3+ views (74021) |
$357.30 |
$794 |
3.2× |
| Radiologic exam chest 3 views (71047) |
$341.55 |
$759 |
3.7× |
| Radiologic exam chest 4+ views (71048) |
$357.30 |
$794 |
3.2× |
| Radiologic exam colon double contrast study (74280) |
$493.65 |
$1,097 |
2.7× |
| Radiologic exam colon single contrast study (74270) |
$357.30 |
$794 |
1.9× |
| Radiologic exam esophagus double contrast study (74221) |
$461.25 |
$1,025 |
2.5× |
| Radiologic exam esophagus single contrast study (74220) |
$279 |
$620 |
1.5× |
| Radiologic exam small int single contrast study (74250) |
$539.55 |
$1,199 |
2.9× |
| Radiologic exam swallow function contrast study (74230) |
$563.85 |
$1,253 |
3.0× |
| Radiologic exam upr gi trc double contrast study (74246) |
$493.65 |
$1,097 |
2.7× |
| Radiologic exam upr gi trc single contrast study (74240) |
$359.10 |
$798 |
1.9× |
| Radiologic examination femur 1 view (73551) |
$202.05 |
$449 |
2.2× |
| Radiologic examination femur minimum 2 views (73552) |
$252 |
$560 |
2.7× |
| Radiologic examination from nose to rectum for foreign body, single view, child Age Under 21 (76010) |
$310.50 |
$690 |
3.4× |
| Radiologic examination, ankle; complete, minimum of 3 views Age Under 21 (73610) |
$310.50 |
$690 |
3.4× |
| Radiologic examination, complete acute abdomen series, including 2 or more views of the abdomen (eg, supine, erect,… (74022) |
$372.60 |
$828 |
3.4× |
| Radiologic examination, elbow; 2 views Age Under 21 (73070) |
$279.90 |
$622 |
3.0× |
| Radiologic examination, elbow; complete, minimum of 3 views Age Under 21 (73080) |
$310.50 |
$690 |
3.4× |
| Radiologic examination, facial bones; less than 3 views Age Under 21 (70140) |
$209.25 |
$465 |
2.3× |
| Radiologic examination, foot; complete, minimum of 3 views Age Under 21 (73630) |
$334.80 |
$744 |
3.6× |
| Radiologic examination, hand; minimum of 3 views Age Under 21 (73130) |
$315 |
$700 |
3.4× |
| Radiologic examination, knee; both knees, standing, anteroposterior Age Under 21 (73565) |
$310.50 |
$690 |
3.4× |
| Radiologic examination, knee; complete, 4 or more views Age Under 21 (73564) |
$357.30 |
$794 |
3.2× |
| Radiologic examination, mandible; partial, less than 4 views Age Under 21 (70100) |
$310.50 |
$690 |
3.4× |
| Radiologic examination, mastoids; complete, minimum of 3 views per side Age Under 21 (70130) |
$357.30 |
$794 |
3.2× |
| Radiologic examination, mastoids; less than 3 views per side Age Under 21 (70120) |
$310.50 |
$690 |
2.8× |
| Radiologic examination, nasal bones, complete, minimum of 3 views Age Under 21 (70160) |
$310.50 |
$690 |
3.4× |
| Radiologic examination, ribs, bilateral; including posteroanterior chest, minimum of 4 views Age Under 21 (71111) |
$357.30 |
$794 |
3.2× |
| Radiologic examination, ribs, unilateral; including posteroanterior chest, minimum of 3 views Age Under 21 (71101) |
$333.45 |
$741 |
3.0× |
| Radiologic examination, sacroiliac joints; less than 3 views Age Under 21 (72200) |
$315.90 |
$702 |
2.9× |
| Radiologic examination, shoulder, arthrography, radiological supervision and interpretation Age Under 21 (73040) |
$1,021.95 |
$2,271 |
2.8× |
| Radiologic examination, shoulder; complete, minimum of 2 views Age Under 21 (73030) |
$310.50 |
$690 |
3.4× |
| Radiologic examination, single plane body section (eg, tomography), other than with urography Age Under 21 (76100) |
$380.70 |
$846 |
3.5× |
| Radiologic examination, sinuses, paranasal, less than 3 views Age Under 21 (70210) |
$310.50 |
$690 |
3.4× |
| Radiologic examination, skull; less than 4 views Age Under 21 (70250) |
$310.50 |
$690 |
2.8× |
| Radiologic examination, spine, lumbosacral; 2 or 3 views Age Under 21 (72100) |
$229.05 |
$509 |
2.1× |
| Radiologic examination, spine, lumbosacral; bending views only, 2 or 3 views Age Under 21 (72120) |
$236.70 |
$526 |
2.1× |
| Radiologic examination, spine, lumbosacral; complete, including bending views, minimum of 6 views Age Under 21 (72114) |
$357.30 |
$794 |
3.2× |
| Radiologic examination, spine; thoracic, minimum of 4 views Age Under 21 (72074) |
$302.85 |
$673 |
2.7× |
| Radiologic examination, wrist; complete, minimum of 3 views Age Under 21 (73110) |
$310.50 |
$690 |
3.4× |
| Radiologic examination; acromioclavicular joints, bilateral, with or without weighted distraction Age Under 21 (73050) |
$202.05 |
$449 |
2.2× |
| Radiologic examination; humerus, minimum of 2 views Age Under 21 (73060) |
$301.95 |
$671 |
3.3× |
| Radiologic examination; lower extremity, infant, minimum of 2 views Age Under 21 (73592) |
$310.50 |
$690 |
3.4× |
| Radiologic examination; orbits, complete, minimum of 4 views Age Under 21 (70200) |
$310.50 |
$690 |
2.8× |
| Radiologic examination; sternoclavicular joint or joints, minimum of 3 views Age Under 21 (71130) |
$357.30 |
$794 |
3.9× |
| Radiologic examination; toe(s), minimum of 2 views Age Under 21 (73660) |
$310.50 |
$690 |
3.4× |
| Radiologic examination; upper extremity, infant, minimum of 2 views Age Under 21 (73092) |
$310.50 |
$690 |
2.8× |
| Radiopharmaceutical localization of tumor, inflammatory process or distribution of radiopharmaceutical agent(s)… (78803) |
$2,333.25 |
$5,185 |
4.1× |
| Radiopharmaceutical therapy, by intravenous administration Age Under 21 (79101) |
$1,204.20 |
$2,676 |
4.9× |
| Radiopharmaceutical therapy, by oral administration Age Under 21 (79005) |
$1,229.40 |
$2,732 |
5.0× |
| Radiopharmaceutical therapy, radiolabeled monoclonal antibody by intravenous infusion (79403) |
$1,427.40 |
$3,172 |
5.8× |
| Review by radiologist of urinary bladder and urethra images with contrast and after passing urine (74455) |
$992.70 |
$2,206 |
3.9× |
| Rp loclzj tum plnr 1 area single day imaging (78800) |
$1,365.75 |
$3,035 |
3.2× |
| Rp loclzj tum plnr 2+area 1+d img/1 area img>2+d (78801) |
$1,630.80 |
$3,624 |
3.9× |
| Rp loclzj tum plnr whole body 2+ days imaging (78804) |
$2,741.85 |
$6,093 |
4.8× |
| Rp loclzj tum plnr whole body single day imaging (78802) |
$2,294.55 |
$5,099 |
4.0× |
| Rp loclzj tum spect 2 areas (78831) |
$2,895.75 |
$6,435 |
2.1× |
| Rp loclzj tum spect w/CT 1 (78830) |
$2,757.60 |
$6,128 |
2.0× |
| Rp loclzj tum spect w/CT 2 (78832) |
$3,132.45 |
$6,961 |
2.1× |
| Rp therapy intra-arterial particulate admn (79445) |
$645.75 |
$1,435 |
2.6× |
| Saline infusion sonohysterography (SIS), including color flow Doppler, when performed Age Under 21 (76831) |
$536.85 |
$1,193 |
2.1× |
| Scapula complete (73010) |
$233.10 |
$518 |
2.1× |
| Screening digital breast tomosynthesis bi (77063) |
$80.10 |
$178 |
— |
| Shuntogram indwelling nonvascular shunt rs&i (75809) |
$320.40 |
$712 |
2.9× |
| Simulation intermediate (77285) |
$1,407.15 |
$3,127 |
3.6× |
| Special dosimetry (77331) |
$863.55 |
$1,919 |
6.1× |
| Special physics consult (77370) |
$463.05 |
$1,029 |
3.3× |
| Special teletherapy port plan (77321) |
$1,627.65 |
$3,617 |
4.1× |
| Special treatment procedure (77470) |
$2,327.40 |
$5,172 |
4.0× |
| Stereotactic body radiation therapy, treatment delivery, per fraction to 1 or more lesions, including image guidance,… (77373) |
$8,852.85 |
$19,673 |
4.7× |
| Testicular imaging with vascular flow Age Under 21 (78761) |
$1,247.85 |
$2,773 |
3.0× |
| Ther rad simulaj-aided field setting complex (77290) |
$1,878.75 |
$4,175 |
4.8× |
| Therapeutic enema, contrast or air, for reduction of intussusception or other intraluminal obstruction (eg, meconium… (74283) |
$607.05 |
$1,349 |
3.3× |
| Thyroid imaging with vascular flow (78013) |
$698.85 |
$1,553 |
1.7× |
| Thyroid met imaging body (78018) |
$2,247.75 |
$4,995 |
3.9× |
| Thyroid uptake single/multiple quant measurement (78012) |
$617.40 |
$1,372 |
1.5× |
| Thyroid uptake w/blood flow sngle/mult quan meas (78014) |
$828 |
$1,840 |
2.0× |
| Tr simulation simple (77280) |
$1,061.55 |
$2,359 |
7.5× |
| Treatment device complex (77334) |
$1,449 |
$3,220 |
3.7× |
| Treatment device intermediate (77333) |
$930.15 |
$2,067 |
6.6× |
| Treatment device simple (77332) |
$517.50 |
$1,150 |
3.6× |
| Ultrasound breast limited (76642) |
$197.10 |
$438 |
2.1× |
| Ultrasound, abdomen limited (76705) |
$460.80 |
$1,024 |
4.2× |
| Ultrasound, limited, joint or focal evaluation of other nonvascular extremity structure(s) (eg, joint space,… (76882) |
$297.45 |
$661 |
2.7× |
| Ultrasound, pelvic (nonobstetric), real time with image documentation; complete Age Under 21 (76856) |
$688.95 |
$1,531 |
6.2× |
| Ultrasound, pregnant uterus, real time with image documentation, fetal and maternal evaluation plus detailed fetal… (76811) |
$551.70 |
$1,226 |
2.2× |
| Ultrasound, pregnant uterus, real time with image documentation, fetal and maternal evaluation, first trimester (< 14… (76801) |
$545.85 |
$1,213 |
4.9× |
| Ultrasound, transplanted kidney, real time and duplex Doppler with image documentation Age Under 21 (76776) |
$531 |
$1,180 |
4.8× |
| Ultrasound, transrectal; prostate volume study for brachytherapy treatment planning (separate procedure) Age Under 21 (76873) |
$531.90 |
$1,182 |
4.8× |
| Umbilical-artery Doppler (OB) (76820) |
$198 |
$440 |
1.8× |
| Unlisted CT procedure (76497) |
$794.23 |
$1,764.95 |
8.7× |
| Unlisted fluoroscopic procedure (76496) |
$247.25 |
$549.44 |
2.7× |
| Unlisted magnetic resonance procedure (eg, diagnostic, interventional) Age Under 21 (76498) |
$561.62 |
$1,248.04 |
6.1× |
| Urea breath test, C-14 (isotopic); acquisition for analysis Other Outpatient (78267) |
$135.90 |
$302 |
12.3× |
| Urea breath test, C-14 (isotopic); analysis Other Outpatient (78268) |
$430.65 |
$957 |
4.6× |
| Ureteral reflux study (78740) |
$1,247.85 |
$2,773 |
3.0× |
| Urethrocystography retrograde rs&i (74450) |
$767.25 |
$1,705 |
3.0× |
| Urography (pyelography), intravenous, with or without KUB, with or without tomography Age Under 21 (74400) |
$914.85 |
$2,033 |
4.9× |
| Urography antegrade rs&i (74425) |
$745.65 |
$1,657 |
2.0× |
| Urography, infusion, drip technique and/or bolus technique; with nephrotomography Age Under 21 (74415) |
$914.85 |
$2,033 |
4.9× |
| Us abdominal aorta real time screen study aaa (76706) |
$347.85 |
$773 |
3.2× |
| Us breast uni real time with image complete (76641) |
$230.40 |
$512 |
2.1× |
| Us chest (76604) |
$328.05 |
$729 |
3.0× |
| Us compl joint r-t w/image documentation (76881) |
$350.55 |
$779 |
3.2× |
| Us elastography organ (76981) |
$191.70 |
$426 |
1.7× |
| Us encephalogram (76506) |
$673.20 |
$1,496 |
6.1× |
| Us exam, pelvic, limited (76857) |
$481.95 |
$1,071 |
4.4× |
| Us guided compression repair (76936) |
$610.20 |
$1,356 |
2.7× |
| Us inft hips r-t img dynamic req phys/qhp manj (76885) |
$531.90 |
$1,182 |
5.8× |
| Us inft hips r-t img lmtd static phys/qhp manj (76886) |
$334.35 |
$743 |
3.6× |
| US OB Follow-Up/Repeat (76816) |
$255.60 |
$568 |
2.3× |
| Us ob transvaginal (76817) |
$390.15 |
$867 |
3.5× |
| Us retroperitoneal complete (76770) |
$667.35 |
$1,483 |
6.1× |
| Us retroperitoneal ltd (76775) |
$618.75 |
$1,375 |
5.6× |
| Us scrotum (76870) |
$537.75 |
$1,195 |
4.9× |
| Us soft tissue head/neck (76536) |
$310.95 |
$691 |
2.8× |
| Us spinal canal (76800) |
$511.65 |
$1,137 |
4.6× |
| Us transrectal (76872) |
$301.05 |
$669 |
2.7× |
| Us unlstd proc (76999) |
$339.33 |
$754.05 |
3.7× |
| Venogram sinus/jugular (75860) |
$4,585.50 |
$10,190 |
1.4× |
| Venography adrenal unilateral selective rs&i (75840) |
$4,582.35 |
$10,183 |
1.4× |
| Venography deep dorsal vein penis radiolgicl supervision interpretation (76499) |
$502.26 |
$1,116.13 |
5.5× |
| Venography renal unilateral selective rs&i (75831) |
$4,217.85 |
$9,373 |
1.3× |
| Venography, caval, inferior, with serialography, radiological supervision and interpretation Age Under 21 (75825) |
$2,980.35 |
$6,623 |
0.9× |
| Venography, caval, superior, with serialography, radiological supervision and interpretation Age Under 21 (75827) |
$2,591.10 |
$5,758 |
1.6× |
| Venography, extremity, bilateral, radiological supervision and interpretation Age Under 21 (75822) |
$2,591.10 |
$5,758 |
1.6× |
| Venography, extremity, unilateral, radiological supervision and interpretation Age Under 21 (75820) |
$2,253.15 |
$5,007 |
1.4× |
| Venography, superior sagittal sinus, radiological supervision and interpretation Age Under 21 (75870) |
$4,585.50 |
$10,190 |
1.4× |
| Venous sampling thru cath w/wo angiography rs& (75893) |
$6,269.40 |
$13,932 |
1.1× |
| X-ray exam hips bi 3-4 views (73522) |
$304.20 |
$676 |
2.8× |
| X-ray exam of finger(s) (73140) |
$222.75 |
$495 |
2.4× |
| X-ray exam of knee 1 or 2 (73560) |
$306.45 |
$681 |
3.3× |
| X-ray exam of small bowel - fl small bowel series enteroclysis tube (74251) |
$563.85 |
$1,253 |
3.0× |
| X-ray exam ribs bil 3 views (71110) |
$341.10 |
$758 |
3.1× |
| X-ray exam ribs uni 2 views (71100) |
$310.50 |
$690 |
3.4× |
| X-ray heel (73650) |
$305.55 |
$679 |
3.3× |
| X-ray of joint between lower spine and hip bone 3 or more views|PROFESSIONAL COMPONENT (72202) |
$357.30 |
$794 |
3.2× |
| X-ray retrograde pyelogram (74420) |
$743.85 |
$1,653 |
2.0× |
| Xr abdomen 1 view (74018) |
$328.95 |
$731 |
3.6× |
| Xr abdomen 2 views (74019) |
$341.55 |
$759 |
3.1× |
| Xr arthrogram ankle (73615) |
$888.75 |
$1,975 |
2.4× |
| Xr arthrogram elbow (73085) |
$888.75 |
$1,975 |
2.4× |
| Xr arthrogram hip (73525) |
$589.50 |
$1,310 |
1.6× |
| Xr arthrogram knee (73580) |
$888.75 |
$1,975 |
2.4× |
| Xr arthrogram wrist (73115) |
$611.55 |
$1,359 |
1.7× |
| Xr bone age studies (77072) |
$310.50 |
$690 |
2.8× |
| Xr bone length study (77073) |
$211.50 |
$470 |
1.9× |
| Xr bone survey infant (77076) |
$295.65 |
$657 |
2.7× |
| Xr bone survey ltd (77074) |
$221.85 |
$493 |
2.0× |
| Xr chest 1 view (71045) |
$282.15 |
$627 |
3.1× |
| Xr chest 2 views (71046) |
$310.50 |
$690 |
3.4× |
| Xr eye foreign body (70030) |
$310.50 |
$690 |
3.4× |
| Xr facial bones 3+ views (70150) |
$357.30 |
$794 |
3.2× |
| Xr foot arthritis pa only bilateral - report(ortho pro) (73620) |
$310.50 |
$690 |
3.4× |
| Xr forearm 2 views (73090) |
$283.05 |
$629 |
3.1× |
| Xr hand 2v (73120) |
$310.50 |
$690 |
2.8× |
| Xr hysterosalpingogram (74740) |
$636.30 |
$1,414 |
2.5× |
| Xr myelogram c-spine (72240) |
$2,009.70 |
$4,466 |
2.4× |
| Xr myelogram l-spine (72265) |
$1,895.85 |
$4,213 |
2.3× |
| Xr myelogram t-spine (72255) |
$1,318.05 |
$2,929 |
1.6× |
| Xr neck soft tissue (70360) |
$310.50 |
$690 |
3.4× |
| Xr o knee w/ merchant view bilat - report(ortho pro) (73562) |
$335.25 |
$745 |
3.7× |
| Xr osseous survey complete (77075) |
$245.70 |
$546 |
2.2× |
| Xr pelvis 1-2 views (72170) |
$282.15 |
$627 |
2.6× |
| Xr pelvis min 3 view (72190) |
$357.30 |
$794 |
3.2× |
| Xr peritoneogram (74190) |
$961.20 |
$2,136 |
1.7× |
| Xr sacrum/coccyx 2+ views (72220) |
$303.30 |
$674 |
3.3× |
| Xr shoulder 1 view (73020) |
$252 |
$560 |
2.7× |
| Xr sialogram (70390) |
$1,517.85 |
$3,373 |
6.0× |
| Xr sinuses 3+ views (70220) |
$357.30 |
$794 |
3.9× |
| Xr skull min 4 view (70260) |
$357.30 |
$794 |
3.2× |
| Xr spine 1 view (72020) |
$279.45 |
$621 |
3.0× |
| Xr spine thoracic 3v (72072) |
$263.25 |
$585 |
2.4× |
| Xr sternum 2+ views (71120) |
$310.50 |
$690 |
3.4× |
| Xr surgical specimen (76098) |
$503.10 |
$1,118 |
0.9× |
| Xr t-spine 2 views (72070) |
$202.05 |
$449 |
1.8× |
| Xr tibia/fibula 2 views (73590) |
$298.35 |
$663 |
3.3× |
| Xr tmj bilateral (70330) |
$357.30 |
$794 |
3.9× |
| Xr tmj unilateral (70328) |
$310.50 |
$690 |
3.4× |
| Xr venogram renal bilat (75833) |
$7,240.50 |
$16,090 |
2.2× |
| Xr wrist 2 views (73100) |
$288 |
$640 |
3.1× |