| 3-D radiotherapy plan dose-volume histograms (77295) |
$3,384.50 |
$9,670 |
2.3× |
| Acute gi blood loss imaging (78278) |
$2,411.85 |
$6,891 |
5.7× |
| Angiography internal mammary rs&i (75756) |
$2,031.75 |
$5,805 |
0.6× |
| Angiography pulmonary bilateral slctv rs&i (75743) |
$4,014.15 |
$11,469 |
1.2× |
| Angiography visceral slctv/supraslctv rs&i (75726) |
$4,014.15 |
$11,469 |
0.7× |
| Angiography, adrenal, bilateral, selective, radiological supervision and interpretation Age Under 21 (75733) |
$3,362.45 |
$9,607 |
1.0× |
| Angiography, adrenal, unilateral, selective, radiological supervision and interpretation Age Under 21 (75731) |
$2,029.30 |
$5,798 |
0.6× |
| Angiography, extremity, bilateral, radiological supervision and interpretation Age Under 21 (75716) |
$4,040.40 |
$11,544 |
1.2× |
| Angiography, extremity, unilateral, radiological supervision and interpretation Age Under 21 (75710) |
$3,813.95 |
$10,897 |
1.1× |
| Angiography, pelvic, selective or supraselective, radiological supervision and interpretation Age Under 21 (75736) |
$4,014.15 |
$11,469 |
0.7× |
| Angiography, pulmonary, unilateral, selective, radiological supervision and interpretation Age Under 21 (75741) |
$3,722.95 |
$10,637 |
1.1× |
| Angiography, spinal, selective, radiological supervision and interpretation Age Under 21 (75705) |
$3,184.65 |
$9,099 |
0.5× |
| Angrph cath f-up std tcat other than thrombylsis (75898) |
$3,471.65 |
$9,919 |
1.0× |
| Angrph pulmonary nonslctv cath/ven njx rs&i (75746) |
$1,533.70 |
$4,382 |
0.5× |
| Ankle 2 views (73600) |
$225.05 |
$643 |
2.5× |
| Aortography, abdominal plus bilateral iliofemoral lower extremity, catheter, by serialography, radiological supervision… (75630) |
$2,269.05 |
$6,483 |
0.7× |
| Aortography, abdominal, by serialography, radiological supervision and interpretation Age Under 21 (75625) |
$2,465.75 |
$7,045 |
0.7× |
| Aortography, thoracic, by serialography, radiological supervision and interpretation Age Under 21 (75605) |
$3,454.50 |
$9,870 |
0.6× |
| Basic radiation dosimetry calculation (77300) |
$551.60 |
$1,576 |
3.9× |
| Brain flow imaging only - nm brain flow only brain death (78610) |
$1,027.25 |
$2,935 |
1.8× |
| Brain imaging, minimum 4 static views; with vascular flow Age Under 21 (78606) |
$1,019.90 |
$2,914 |
1.8× |
| Brain imaging, positron emission tomography (PET); metabolic evaluation Age Under 21 (78608) |
$2,771.65 |
$7,919 |
1.8× |
| Card MRI w/stress img & dye (75563) |
$2,399.95 |
$6,857 |
2.9× |
| Cardiac blood pool imaging (planar), first pass technique; single study, at rest or with stress (exercise and/or… (78481) |
$2,133.60 |
$6,096 |
3.7× |
| Cardiac blood pool imaging, gated equilibrium; multiple studies, wall motion study plus ejection fraction, at rest and… (78473) |
$1,164.10 |
$3,326 |
2.8× |
| Cardiac MRI morphology & function w/o contrast (75557) |
$1,954.05 |
$5,583 |
7.8× |
| Cardiac MRI w/wo contrast & further seq (75561) |
$2,193.10 |
$6,266 |
6.0× |
| Cineradiography/videoradiography (76120) |
$964.95 |
$2,757 |
8.8× |
| Cisternography, positive contrast, radiological supervision and interpretation Age Under 21 (70015) |
$673.05 |
$1,923 |
0.8× |
| Clavicle complete (73000) |
$240.80 |
$688 |
2.6× |
| Complex dynamic pharyngeal and speech evaluation by cine or video recording Age Under 21 (70371) |
$628.60 |
$1,796 |
2.5× |
| Computed tomographic (CT) colonography, diagnostic, including image postprocessing; without contrast material Age Under… (74261) |
$686 |
$1,960 |
6.2× |
| Computed tomographic (CT) colonography, screening, including image postprocessing (74263) |
$1,213.45 |
$3,467 |
4.8× |
| Computed tomographic angiography, abdomen and pelvis, with contrast material(s), including noncontrast images, if… (74174) |
$5,792.85 |
$16,551 |
15.7× |
| Computed tomographic angiography, abdomen, with contrast material(s), including noncontrast images, if performed, and… (74175) |
$2,487.10 |
$7,106 |
13.4× |
| Computed tomographic angiography, abdominal aorta and bilateral iliofemoral lower extremity runoff, with contrast… (75635) |
$1,881.60 |
$5,376 |
10.2× |
| Computed tomographic angiography, chest (noncoronary), with contrast material(s), including noncontrast images, if… (71275) |
$2,975.70 |
$8,502 |
16.1× |
| Computed tomographic angiography, lower extremity, with contrast material(s), including noncontrast images, if… (73706) |
$2,458.40 |
$7,024 |
13.3× |
| Computed tomographic angiography, neck, with contrast material(s), including noncontrast images, if performed, and… (70498) |
$3,131.45 |
$8,947 |
16.9× |
| Computed tomographic angiography, pelvis, with contrast material(s), including noncontrast images, if performed, and… (72191) |
$2,220.05 |
$6,343 |
12.0× |
| Computed tomographic angiography, upper extremity, with contrast material(s), including noncontrast images, if… (73206) |
$2,226 |
$6,360 |
12.0× |
| Computed tomography, cervical spine; without contrast material, followed by contrast material(s) and further sections… (72127) |
$2,536.80 |
$7,248 |
13.7× |
| Computed tomography, lower extremity; without contrast material Age Under 21 (73700) |
$1,746.85 |
$4,991 |
15.8× |
| Computed tomography, lower extremity; without contrast material, followed by contrast material(s) and further sections… (73702) |
$2,066.05 |
$5,903 |
11.2× |
| Computed tomography, lumbar spine; without contrast material, followed by contrast material(s) and further sections Age… (72133) |
$1,462.30 |
$4,178 |
7.9× |
| Computed tomography, maxillofacial area; with contrast material(s) Age Under 21 (70487) |
$1,845.55 |
$5,273 |
10.0× |
| Computed tomography, maxillofacial area; without contrast material Age Under 21 (70486) |
$1,487.85 |
$4,251 |
13.5× |
| Computed tomography, orbit, sella, or posterior fossa or outer, middle, or inner ear; with contrast material(s) Age… (70481) |
$1,113.70 |
$3,182 |
6.0× |
| Computed tomography, orbit, sella, or posterior fossa or outer, middle, or inner ear; without contrast material Age… (70480) |
$1,060.50 |
$3,030 |
9.6× |
| Computed tomography, orbit, sella, or posterior fossa or outer, middle, or inner ear; without contrast material,… (70482) |
$1,225 |
$3,500 |
6.6× |
| Computed tomography, soft tissue neck; without contrast material followed by contrast material(s) and further sections… (70492) |
$1,956.50 |
$5,590 |
10.6× |
| Computed tomography, thoracic spine; without contrast material, followed by contrast material(s) and further sections… (72130) |
$1,429.75 |
$4,085 |
7.7× |
| Computed tomography, thorax, diagnostic; without contrast material, followed by contrast material(s) and further… (71270) |
$2,846.90 |
$8,134 |
15.4× |
| Continuing medical physics consultation, including assessment of treatment parameters, quality assurance of dose… (77336) |
$931 |
$2,660 |
6.6× |
| Csf shunt evaluation (78645) |
$1,198.75 |
$3,425 |
2.1× |
| CT abdomen and pelvis without and with contrast (74178) |
$5,517.05 |
$15,763 |
15.0× |
| CT abdomen and pelvis without contrast (74176) |
$4,569.60 |
$13,056 |
18.2× |
| CT abdomen w & w/o contrast (74170) |
$2,368.80 |
$6,768 |
12.8× |
| CT abdomen w/contrast (74160) |
$1,975.75 |
$5,645 |
10.7× |
| CT abdomen w/o contrast (74150) |
$1,716.40 |
$4,904 |
15.6× |
| CT angio hrt w/3d image (75574) |
$1,598.45 |
$4,567 |
4.3× |
| CT cervical spine w/contrast (72126) |
$2,306.15 |
$6,589 |
6.3× |
| CT cervical spine w/o contrast (72125) |
$2,259.25 |
$6,455 |
20.5× |
| CT chest w/contrast (71260) |
$2,719.50 |
$7,770 |
14.7× |
| CT extremity upper w & w/o contrast (73202) |
$2,119.95 |
$6,057 |
11.5× |
| CT extremity upper w/o contrast (73200) |
$1,558.55 |
$4,453 |
14.1× |
| CT head/brain with contrast (70460) |
$2,152.50 |
$6,150 |
11.6× |
| CT head/brain without and with contrast (70470) |
$2,367.75 |
$6,765 |
12.8× |
| CT heart c+ cardiac strux&morph cgen hrt ds (75573) |
$556.50 |
$1,590 |
1.5× |
| CT heart contrast eval cardiac structure&morph (75572) |
$910.70 |
$2,602 |
2.5× |
| CT heart no contrast quant eval coronry calcium (75571) |
$189.35 |
$541 |
2.1× |
| CT l-spine w/contrast (72132) |
$1,243.20 |
$3,552 |
3.4× |
| CT limited/localized follow up study (76380) |
$91.35 |
$261 |
1.0× |
| CT lower extremity w/dye (73701) |
$1,920.10 |
$5,486 |
10.4× |
| CT lumbar spine w/o contrast (72131) |
$1,093.40 |
$3,124 |
9.9× |
| CT maxillofacial w/wo contrast (70488) |
$2,030 |
$5,800 |
11.0× |
| CT neck w/contrast (70491) |
$1,609.30 |
$4,598 |
8.7× |
| CT neck w/o contrast (70490) |
$1,069.95 |
$3,057 |
9.7× |
| CT pelvis w & w/o contrast (72194) |
$2,220.05 |
$6,343 |
12.0× |
| CT pelvis w/o contrast (72192) |
$2,072 |
$5,920 |
18.8× |
| CT thoracic spine w/contrast (72129) |
$1,277.15 |
$3,649 |
6.9× |
| CT thoracic spine w/o contrast (72128) |
$1,257.20 |
$3,592 |
11.4× |
| CT thorax lung cancer scr c- (71271) |
$1,894.55 |
$5,413 |
17.2× |
| CT thorax w/o contrast (71250) |
$1,894.55 |
$5,413 |
17.2× |
| CT upper extremity w/dye (73201) |
$2,026.15 |
$5,789 |
5.5× |
| CTA head w contrast (70496) |
$2,954.70 |
$8,442 |
16.0× |
| Cystography, minimum of 3 views, radiological supervision and interpretation Age Under 21 (74430) |
$662.90 |
$1,894 |
1.8× |
| Dilation ureters/urethra rs&i (74485) |
$1,071 |
$3,060 |
0.5× |
| Discography, cervical or thoracic, radiological supervision and interpretation Age Under 21 (72285) |
$1,701.35 |
$4,861 |
0.8× |
| Diskography lumbar s&i (72295) |
$1,792.70 |
$5,122 |
0.9× |
| Doppler echocardiography, fetal, pulsed wave and/or continuous wave with spectral display; complete Age Under 21 (76827) |
$387.80 |
$1,108 |
3.5× |
| Doppler echocardiography, fetal, pulsed wave and/or continuous wave with spectral display; follow-up or repeat study… (76828) |
$207.90 |
$594 |
1.9× |
| Doppler fetal mid cerebral artery (76821) |
$220.50 |
$630 |
2.0× |
| Dual-energy X-ray absorptiometry (DXA), bone density study, 1 or more sites; axial skeleton (eg, hips, pelvis, spine)… (77080) |
$114.45 |
$327 |
1.0× |
| Echo exam of eye (76529) |
$111.65 |
$319 |
1.2× |
| Echo exam of eye (76516) |
$139.30 |
$398 |
1.3× |
| Echo exam of eye thickness (76514) |
$24.50 |
$70 |
0.8× |
| Echocardiography, fetal, cardiovascular system, real time with image documentation (2D), with or without M-mode… (76825) |
$378.35 |
$1,081 |
0.7× |
| Esophageal motility (78258) |
$942.90 |
$2,694 |
2.2× |
| Fetal biophys profile w/o nst (76819) |
$403.90 |
$1,154 |
3.7× |
| Fetal biophysical profile non-stress testing (76818) |
$485.80 |
$1,388 |
4.4× |
| Fluoroscopy up to 1 hour physician/qhp time (76000) |
$1,339.45 |
$3,827 |
5.3× |
| Gastroesophageal reflux study (78262) |
$864.85 |
$2,471 |
2.1× |
| Gastrointestinal endoscopic ultrasound, supervision and interpretation Age Under 21 (76975) |
$398.30 |
$1,138 |
1.6× |
| Gated heart planar single (78472) |
$1,005.55 |
$2,873 |
2.4× |
| Hdr rdncl ntrstl/intrcav brachytx 1 channel (77770) |
$5,388.25 |
$15,395 |
7.3× |
| Hdr rdncl ntrstl/intrcav brachytx 2-12 channel (77771) |
$6,196.40 |
$17,704 |
8.4× |
| Hdr rdncl ntrstl/intrcav brachytx >12 channels (77772) |
$6,618.50 |
$18,910 |
9.0× |
| Heart infarct image (78466) |
$637.70 |
$1,822 |
1.5× |
| Hepatc vngrph wdg/fr w/o hemodyn eval rs&i (75891) |
$2,269.05 |
$6,483 |
0.7× |
| Hepatic venography, wedged or free, with hemodynamic evaluation, radiological supervision and interpretation Age Under… (75889) |
$2,269.05 |
$6,483 |
0.7× |
| Hepatobil syst imag inc gb w/pharma intervenj (78227) |
$3,155.60 |
$9,016 |
5.5× |
| Hepatobiliary syst imaging including gallbladder (78226) |
$3,005.45 |
$8,587 |
7.1× |
| Ht muscle image spect sing (78451) |
$2,271.85 |
$6,491 |
1.7× |
| Injection procedure for radiopharmaceutical localization by non-imaging probe study, intravenous (eg, parathyroid… (78808) |
$483 |
$1,380 |
1.1× |
| Intensity modulated radiotherapy plan, including dose-volume histograms for target and critical structure partial… (77301) |
$2,852.85 |
$8,151 |
2.0× |
| Interstitial radiation source application, complex, includes supervision, handling, loading of radiation source, when… (77778) |
$1,489.25 |
$4,255 |
2.0× |
| Intestine imaging (eg, ectopic gastric mucosa, Meckel's localization, volvulus) Age Under 21 (78290) |
$1,013.25 |
$2,895 |
2.4× |
| Intracavitary radiation source application - complex (77763) |
$1,092.70 |
$3,122 |
1.5× |
| Intracavitary radiation source application - intermediate (77762) |
$1,040.90 |
$2,974 |
1.8× |
| Intracavitary radiation source application - simple (77761) |
$991.20 |
$2,832 |
1.7× |
| Isodose brachytherapy complex 10+ sources (77318) |
$1,779.05 |
$5,083 |
4.5× |
| Isodose brachytherapy intermed 5 to 10 sources (77317) |
$1,061.90 |
$3,034 |
2.7× |
| Isodose brachytherapy plan simple 1 to 4 source (77316) |
$974.75 |
$2,785 |
2.5× |
| Isodose teletherapy plan complex multi tx w/cal (77307) |
$1,602.65 |
$4,579 |
4.1× |
| Isodose teletherapy plan simple 1 or 2 port w/cal (77306) |
$769.30 |
$2,198 |
1.9× |
| Kidney function study, non-imaging radioisotopic study Age Under 21 (78725) |
$905.45 |
$2,587 |
2.1× |
| Kidney imaging morphol - nm kidney cortex (78700) |
$381.85 |
$1,091 |
0.9× |
| Kidney imaging morphology; with vascular flow Age Under 21 (78701) |
$1,024.45 |
$2,927 |
2.4× |
| Kidney imaging morphology; with vascular flow and function, multiple studies, with and without pharmacological… (78709) |
$991.55 |
$2,833 |
1.7× |
| Kidney imaging morphology; with vascular flow and function, single study without pharmacological intervention Age Under… (78707) |
$1,906.10 |
$5,446 |
3.3× |
| Kidney imaging morphology; with vascular flow and function, single study, with pharmacological intervention (eg,… (78708) |
$1,906.10 |
$5,446 |
3.3× |
| Leveen/shunt patency exam (78291) |
$659.05 |
$1,883 |
1.6× |
| Liver and spleen imaging (78215) |
$861.70 |
$2,462 |
2.0× |
| Liver imaging (78201) |
$1,127 |
$3,220 |
2.0× |
| Liver imaging with flow (78202) |
$1,240.75 |
$3,545 |
2.2× |
| Lung perf&ventilat diferentl (78598) |
$3,015.95 |
$8,617 |
5.3× |
| Lung perfusion imaging (78580) |
$1,345.05 |
$3,843 |
3.2× |
| Lymphangiography, extremity only, bilateral, radiological supervision and interpretation Age Under 21 (75803) |
$1,001 |
$2,860 |
0.6× |
| Lymphangiography, extremity only, unilateral, radiological supervision and interpretation Age Under 21 (75801) |
$913.85 |
$2,611 |
1.4× |
| Lymphangiography, pelvic/abdominal, bilateral, radiological supervision and interpretation Age Under 21 (75807) |
$1,366.75 |
$3,905 |
0.4× |
| Lymphangiography, pelvic/abdominal, unilateral, radiological supervision and interpretation Age Under 21 (75805) |
$3,445.40 |
$9,844 |
1.0× |
| Magnetic resonance (eg, proton) imaging, any joint of lower extremity; without contrast material(s), followed by… (73723) |
$3,110.80 |
$8,888 |
8.5× |
| Magnetic resonance (eg, proton) imaging, lower extremity other than joint; with contrast material(s) Age Under 21 (73719) |
$1,874.60 |
$5,356 |
5.1× |
| Magnetic resonance (eg, proton) imaging, lower extremity other than joint; without contrast material(s) Age Under 21 (73718) |
$1,598.80 |
$4,568 |
6.4× |
| Magnetic resonance (eg, proton) imaging, lower extremity other than joint; without contrast material(s), followed by… (73720) |
$2,363.90 |
$6,754 |
6.4× |
| Magnetic resonance (eg, proton) imaging, orbit, face, and/or neck; with contrast material(s) Age Under 21 (70542) |
$2,736.65 |
$7,819 |
7.4× |
| Magnetic resonance (eg, proton) imaging, orbit, face, and/or neck; without contrast material(s) Age Under 21 (70540) |
$2,329.60 |
$6,656 |
9.3× |
| Magnetic resonance (eg, proton) imaging, upper extremity, other than joint; with contrast material(s) Age Under 21 (73219) |
$2,107 |
$6,020 |
5.7× |
| Magnetic resonance (eg, proton) imaging, upper extremity, other than joint; without contrast material(s), followed by… (73220) |
$2,399.25 |
$6,855 |
6.5× |
| Magnetic resonance angiography, head; with contrast material(s) Age Under 21 (70545) |
$2,731.40 |
$7,804 |
7.4× |
| Magnetic resonance angiography, head; without contrast material(s), followed by contrast material(s) and further… (70546) |
$4,141.20 |
$11,832 |
11.3× |
| Magnetic resonance angiography, neck; without contrast material(s), followed by contrast material(s) and further… (70549) |
$4,148.55 |
$11,853 |
11.3× |
| Magnetic resonance elastography (76391) |
$371.70 |
$1,062 |
1.5× |
| Magnetic resonance imaging, brain, functional MRI; requiring physician or psychologist administration of entire… (70555) |
$2,000.60 |
$5,716 |
7.9× |
| Mammary ductogram or galactogram, multiple ducts, radiological supervision and interpretation Age Under 21 (77054) |
$575.05 |
$1,643 |
2.3× |
| Mammary ductogram single (77053) |
$390.25 |
$1,115 |
1.6× |
| Mandible min 4v (70110) |
$359.10 |
$1,026 |
3.3× |
| MRA head w/o contrast (70544) |
$2,538.90 |
$7,254 |
10.1× |
| MRA neck w/ contrast (70548) |
$2,798.60 |
$7,996 |
7.6× |
| MRA neck w/o contrast (70547) |
$2,538.90 |
$7,254 |
10.1× |
| MRI abdomen w/contrast (74182) |
$2,088.45 |
$5,967 |
5.7× |
| MRI abdomen w/o contrast (74181) |
$1,506.05 |
$4,303 |
6.0× |
| MRI abdomen w/wo contrast (74183) |
$3,091.90 |
$8,834 |
8.4× |
| MRI any jt lower extrem w/contrast material (73722) |
$2,369.50 |
$6,770 |
2.9× |
| MRI bone marrow (77084) |
$1,310.05 |
$3,743 |
5.2× |
| MRI brain w/dye (70558) |
$2,747.85 |
$7,851 |
14.9× |
| MRI brain w/o & w/dye (70559) |
$2,885.05 |
$8,243 |
15.6× |
| MRI brain w/o dye (70557) |
$2,482.90 |
$7,094 |
4.3× |
| MRI breast c- bilateral (77047) |
$2,396.45 |
$6,847 |
9.5× |
| MRI breast without contrast material unilateral (77046) |
$2,332.75 |
$6,665 |
9.3× |
| MRI c-spine w&w/o cont (72156) |
$2,906.75 |
$8,305 |
7.9× |
| MRI cervical spine w/contrast (72142) |
$2,594.90 |
$7,414 |
7.1× |
| MRI chest w/contrast (71551) |
$2,748.55 |
$7,853 |
3.3× |
| MRI chest w/o contrast (71550) |
$2,418.50 |
$6,910 |
9.6× |
| MRI chest w/wo contrast (71552) |
$3,293.15 |
$9,409 |
8.9× |
| MRI fetal sngl/1st gestation (74712) |
$2,132.20 |
$6,092 |
8.5× |
| MRI joint upr extr w/o&w/dye (73223) |
$2,982.70 |
$8,522 |
8.1× |
| MRI joint upr extrem w/dye (73222) |
$2,719.50 |
$7,770 |
3.3× |
| MRI joint upr extrem w/o dye (73221) |
$2,266.95 |
$6,477 |
9.0× |
| MRI lumbar spine w/contrast (72149) |
$3,117.80 |
$8,908 |
8.5× |
| MRI lumbar spine w/wo contrast (72158) |
$3,094.35 |
$8,841 |
8.4× |
| MRI orbit/face/neck w&w/o cont (70543) |
$3,400.95 |
$9,717 |
9.2× |
| MRI pelvis w & w/o contrast (72197) |
$3,735.55 |
$10,673 |
10.2× |
| MRI pelvis w/contrast (72196) |
$2,026.50 |
$5,790 |
5.5× |
| MRI pelvis w/o contrast (72195) |
$1,723.05 |
$4,923 |
6.8× |
| MRI spectroscopy (76390) |
$978.60 |
$2,796 |
10.7× |
| MRI spine cervical w/o contrast (72141) |
$2,422.35 |
$6,921 |
9.6× |
| MRI t-spine w&w/o cont (72157) |
$3,003.35 |
$8,581 |
8.2× |
| MRI thoracic spine w/contrast (72147) |
$2,833.60 |
$8,096 |
7.7× |
| MRI thoracic spine w/o contrst (72146) |
$2,566.90 |
$7,334 |
10.2× |
| MRI tmj (70336) |
$1,705.20 |
$4,872 |
6.8× |
| MRI upper extremity oth than jt w/o contr matrl (73218) |
$1,971.20 |
$5,632 |
7.8× |
| Multi-leaf collimator (MLC) device(s) for intensity modulated radiation therapy (IMRT), design and construction per… (77338) |
$3,614.10 |
$10,326 |
9.2× |
| Myelography, 2 or more regions (eg, lumbar/thoracic, cervical/thoracic, lumbar/cervical, lumbar/thoracic/cervical),… (72270) |
$790.65 |
$2,259 |
1.0× |
| Myocardial imaging, positron emission tomography (PET), combined perfusion with metabolic evaluation study (including… (78432) |
$2,886.10 |
$8,246 |
1.8× |
| Myocardial imaging, positron emission tomography (PET), perfusion study (including ventricular wall motionºs» and/or… (78491) |
$3,787.35 |
$10,821 |
2.5× |
| Myocardial imaging, positron emission tomography (PET), perfusion study (including ventricular wall motionºs» and/or… (78492) |
$4,391.80 |
$12,548 |
2.9× |
| Myocardial imaging, positron emission tomography (PET), perfusion study (including ventricular wall motionºs» and/or… (78430) |
$1,741.25 |
$4,975 |
1.2× |
| Myocardial perfusion imaging, planar (including qualitative or quantitative wall motion, ejection fraction by first… (78453) |
$1,512.70 |
$4,322 |
1.1× |
| Myocardial perfusion imaging, planar (including qualitative or quantitative wall motion, ejection fraction by first… (78454) |
$1,588.30 |
$4,538 |
1.2× |
| Myocardial spect multiple studies (78452) |
$4,835.60 |
$13,816 |
3.5× |
| Myocrd img PET 2rtracer CT (78433) |
$2,604 |
$7,440 |
1.1× |
| Myocrd img PET metab eval single study (78459) |
$3,723.65 |
$10,639 |
2.7× |
| Myocrd img PET metab eval single study cncrnt CT (78429) |
$3,580.50 |
$10,230 |
2.4× |
| Myocrd img PET rst&strs CT (78431) |
$2,604 |
$7,440 |
1.1× |
| N-invas est c ffr augmnt sw alys CTA i&r phy/qhp (75580) |
$1,083.60 |
$3,096 |
1.2× |
| Nm adrenal imaging (78075) |
$1,136.80 |
$3,248 |
0.8× |
| Nm bone 3 phase (78315) |
$2,841.65 |
$8,119 |
6.7× |
| Nm bone imaging whole body (78306) |
$2,716.70 |
$7,762 |
6.4× |
| Nm bone marrow wb (78104) |
$1,125.60 |
$3,216 |
2.7× |
| Nm csf cisternogram (78630) |
$927.50 |
$2,650 |
1.6× |
| Nm csf leak detection (78650) |
$1,616.30 |
$4,618 |
1.2× |
| Nm gastric emptying (78264) |
$3,351.95 |
$9,577 |
7.9× |
| Nm lung ventilation imaging (78579) |
$974.05 |
$2,783 |
2.3× |
| Nm lymph system (78195) |
$1,852.90 |
$5,294 |
3.2× |
| Nuclear medicine study for detecting heart shunt (78428) |
$764.40 |
$2,184 |
1.8× |
| Nuclear medicine study of bone and/or joint limited area (78300) |
$1,374.10 |
$3,926 |
3.3× |
| Nuclear medicine study of heart pumping function by labeling red blood cells with measurement of internal blood volume… (78494) |
$1,345.05 |
$3,843 |
3.2× |
| Nuclear medicine study to assess blood clot in vein of both sides (78458) |
$751.45 |
$2,147 |
1.8× |
| Ob us limited fetus(s) (76815) |
$364.35 |
$1,041 |
3.3× |
| Ob us nuchal meas 1 gest (76813) |
$278.60 |
$796 |
2.5× |
| Ophthalmic biometry by ultrasound echography, A-scan; with intraocular lens power calculation Age Under 21 (76519) |
$171.15 |
$489 |
1.6× |
| Ophthalmic ultrasound, diagnostic; anterior segment ultrasound, immersion (water bath) B-scan or high resolution… (76513) |
$278.95 |
$797 |
2.5× |
| Ophthalmic ultrasound, diagnostic; B-scan (with or without superimposed non-quantitative A-scan) Age Under 21 (76512) |
$265.65 |
$759 |
2.4× |
| Ophthalmic ultrasound, diagnostic; B-scan and quantitative A-scan performed during the same patient encounter Age Under… (76510) |
$416.85 |
$1,191 |
3.0× |
| Ophthalmic us dx quantitative a-scan only (76511) |
$158.90 |
$454 |
1.4× |
| Parathyrd planar w/spect&CT (78072) |
$4,779.60 |
$13,656 |
8.3× |
| Parathyroid planar imaging w/wo subtraction (78071) |
$2,594.55 |
$7,413 |
6.2× |
| Percutaneous transhepatic portography with hemodynamic evaluation, radiological supervision and interpretation Age… (75885) |
$2,269.05 |
$6,483 |
0.7× |
| PET imaging CT attenuation skull base mid-thigh (78815) |
$5,718.30 |
$16,338 |
3.8× |
| PET imaging CT for attenuation limited area (78814) |
$5,322.10 |
$15,206 |
3.5× |
| PET imaging for CT attenuation whole body (78816) |
$5,958.75 |
$17,025 |
4.0× |
| PET imaging whole body (78813) |
$5,332.95 |
$15,237 |
3.5× |
| Positron emission tomography (PET) imaging; limited area (eg, chest, head/neck) Age Under 21 (78811) |
$3,926.30 |
$11,218 |
2.9× |
| Positron emission tomography (PET) imaging; skull base to mid-thigh Age Under 21 (78812) |
$5,078.85 |
$14,511 |
3.4× |
| Prq transhepatc portograpy w/o hemodyn evl intrp (75887) |
$2,031.75 |
$5,805 |
0.6× |
| Pulmonary ventilation & perfusion imaging (78582) |
$2,847.25 |
$8,135 |
5.0× |
| Quant differential pulm perfusion w/wo imaging (78597) |
$1,850.10 |
$5,286 |
4.4× |
| Radex abscess/fistula/sinus tract rs&i (76080) |
$421.40 |
$1,204 |
0.7× |
| Radex entir thrc lmbr crv sac spi w/skull 1 vw (72081) |
$250.60 |
$716 |
2.7× |
| Radex entir thrc lmbr crv sac spi w/skull 2/3 vw (72082) |
$480.20 |
$1,372 |
4.4× |
| Radex entir thrc lmbr crv sac spi w/skull 4/5 vw (72083) |
$491.05 |
$1,403 |
4.5× |
| Radex entir thrc lmbr crv sac spi w/skull 6/> vw (72084) |
$515.55 |
$1,473 |
4.7× |
| Radex hip unilateral with pelvis 1 view (73501) |
$222.95 |
$637 |
2.4× |
| Radex hip unilateral with pelvis 2-3 views (73502) |
$460.60 |
$1,316 |
5.0× |
| Radex hip unilateral with pelvis minimum 4 views (73503) |
$483.70 |
$1,382 |
4.4× |
| Radex hips bilateral with pelvis 2 views (73521) |
$283.15 |
$809 |
2.6× |
| Radex hips bilateral with pelvis minimum 5 views (73523) |
$501.55 |
$1,433 |
4.5× |
| Radex spine cervical 2 or 3 views (72040) |
$331.45 |
$947 |
3.6× |
| Radex spine cervical 4 or 5 views (72050) |
$456.75 |
$1,305 |
4.1× |
| Radex spine cervical 6 or more views (72052) |
$471.10 |
$1,346 |
4.3× |
| Radex spine thoracolumbar junction min 2 views (72080) |
$236.25 |
$675 |
2.6× |
| Radiation treatment delivery, stereotactic radiosurgery (SRS), complete course of treatment of cranial lesion(s)… (77371) |
$31,191.65 |
$89,119 |
4.0× |
| Radiation treatment delivery, stereotactic radiosurgery (SRS), complete course of treatment of cranial lesion(s)… (77372) |
$16,302.65 |
$46,579 |
2.1× |
| Radiation tx delivery lvl 1 (77402) |
$542.85 |
$1,551 |
5.0× |
| Radiation tx delivery lvl 2 (77407) |
$662.90 |
$1,894 |
1.6× |
| Radiation tx delivery lvl 3 (77412) |
$962.50 |
$2,750 |
1.7× |
| Radiologic exam abdomen 3+ views (74021) |
$339.50 |
$970 |
3.1× |
| Radiologic exam chest 3 views (71047) |
$443.10 |
$1,266 |
4.8× |
| Radiologic exam chest 4+ views (71048) |
$518 |
$1,480 |
4.7× |
| Radiologic exam colon double contrast study (74280) |
$791 |
$2,260 |
4.3× |
| Radiologic exam colon single contrast study (74270) |
$584.85 |
$1,671 |
3.2× |
| Radiologic exam esophagus double contrast study (74221) |
$745.50 |
$2,130 |
4.0× |
| Radiologic exam esophagus single contrast study (74220) |
$706.65 |
$2,019 |
3.8× |
| Radiologic exam small int single contrast study (74250) |
$796.25 |
$2,275 |
4.3× |
| Radiologic exam swallow function contrast study (74230) |
$468.65 |
$1,339 |
2.5× |
| Radiologic exam upr gi trc double contrast study (74246) |
$814.45 |
$2,327 |
4.4× |
| Radiologic exam upr gi trc single contrast study (74240) |
$713.65 |
$2,039 |
3.9× |
| Radiologic examination femur 1 view (73551) |
$240.10 |
$686 |
2.6× |
| Radiologic examination femur minimum 2 views (73552) |
$276.15 |
$789 |
3.0× |
| Radiologic examination from nose to rectum for foreign body, single view, child Age Under 21 (76010) |
$440.30 |
$1,258 |
4.8× |
| Radiologic examination, ankle; complete, minimum of 3 views Age Under 21 (73610) |
$406.35 |
$1,161 |
4.4× |
| Radiologic examination, complete acute abdomen series, including 2 or more views of the abdomen (eg, supine, erect,… (74022) |
$340.55 |
$973 |
3.1× |
| Radiologic examination, elbow; 2 views Age Under 21 (73070) |
$225.05 |
$643 |
2.5× |
| Radiologic examination, elbow; complete, minimum of 3 views Age Under 21 (73080) |
$361.20 |
$1,032 |
3.9× |
| Radiologic examination, facial bones; less than 3 views Age Under 21 (70140) |
$243.60 |
$696 |
2.7× |
| Radiologic examination, foot; complete, minimum of 3 views Age Under 21 (73630) |
$430.85 |
$1,231 |
4.7× |
| Radiologic examination, hand; minimum of 3 views Age Under 21 (73130) |
$415.10 |
$1,186 |
4.5× |
| Radiologic examination, knee; both knees, standing, anteroposterior Age Under 21 (73565) |
$225.40 |
$644 |
2.5× |
| Radiologic examination, knee; complete, 4 or more views Age Under 21 (73564) |
$483 |
$1,380 |
4.4× |
| Radiologic examination, mandible; partial, less than 4 views Age Under 21 (70100) |
$166.25 |
$475 |
1.8× |
| Radiologic examination, mastoids; complete, minimum of 3 views per side Age Under 21 (70130) |
$108.15 |
$309 |
1.0× |
| Radiologic examination, nasal bones, complete, minimum of 3 views Age Under 21 (70160) |
$260.40 |
$744 |
2.8× |
| Radiologic examination, pharynx and/or cervical esophagus, including scout neck radiograph(s) and delayed image(s),… (74210) |
$532.35 |
$1,521 |
2.9× |
| Radiologic examination, renal cyst study, translumbar, contrast visualization, radiological supervision and… (74470) |
$1,048.95 |
$2,997 |
1.8× |
| Radiologic examination, ribs, bilateral; including posteroanterior chest, minimum of 4 views Age Under 21 (71111) |
$328.30 |
$938 |
3.0× |
| Radiologic examination, ribs, unilateral; including posteroanterior chest, minimum of 3 views Age Under 21 (71101) |
$308.70 |
$882 |
2.8× |
| Radiologic examination, sacroiliac joints; less than 3 views Age Under 21 (72200) |
$264.25 |
$755 |
2.4× |
| Radiologic examination, shoulder, arthrography, radiological supervision and interpretation Age Under 21 (73040) |
$1,029.35 |
$2,941 |
2.8× |
| Radiologic examination, shoulder; complete, minimum of 2 views Age Under 21 (73030) |
$321.30 |
$918 |
3.5× |
| Radiologic examination, single plane body section (eg, tomography), other than with urography Age Under 21 (76100) |
$468.30 |
$1,338 |
4.2× |
| Radiologic examination, sinuses, paranasal, less than 3 views Age Under 21 (70210) |
$138.25 |
$395 |
1.5× |
| Radiologic examination, skull; less than 4 views Age Under 21 (70250) |
$295.75 |
$845 |
2.7× |
| Radiologic examination, spine, lumbosacral; 2 or 3 views Age Under 21 (72100) |
$500.50 |
$1,430 |
4.5× |
| Radiologic examination, spine, lumbosacral; bending views only, 2 or 3 views Age Under 21 (72120) |
$284.90 |
$814 |
2.6× |
| Radiologic examination, spine, lumbosacral; complete, including bending views, minimum of 6 views Age Under 21 (72114) |
$588.70 |
$1,682 |
5.3× |
| Radiologic examination, spine; thoracic, minimum of 4 views Age Under 21 (72074) |
$288.05 |
$823 |
2.6× |
| Radiologic examination, wrist; complete, minimum of 3 views Age Under 21 (73110) |
$415.10 |
$1,186 |
4.5× |
| Radiologic examination; acromioclavicular joints, bilateral, with or without weighted distraction Age Under 21 (73050) |
$173.95 |
$497 |
1.9× |
| Radiologic examination; humerus, minimum of 2 views Age Under 21 (73060) |
$211.75 |
$605 |
2.3× |
| Radiologic examination; lower extremity, infant, minimum of 2 views Age Under 21 (73592) |
$205.80 |
$588 |
2.2× |
| Radiologic examination; orbits, complete, minimum of 4 views Age Under 21 (70200) |
$339.85 |
$971 |
3.1× |
| Radiologic examination; pharynx or larynx, including fluoroscopy and/or magnification technique Age Under 21 (70370) |
$571.90 |
$1,634 |
6.2× |
| Radiologic examination; sternoclavicular joint or joints, minimum of 3 views Age Under 21 (71130) |
$240.80 |
$688 |
2.6× |
| Radiologic examination; toe(s), minimum of 2 views Age Under 21 (73660) |
$220.85 |
$631 |
2.4× |
| Radiologic examination; upper extremity, infant, minimum of 2 views Age Under 21 (73092) |
$155.75 |
$445 |
1.4× |
| Radiopharmaceutical localization of tumor, inflammatory process or distribution of radiopharmaceutical agent(s)… (78803) |
$1,210.30 |
$3,458 |
2.1× |
| Radiopharmaceutical therapy, by intravenous administration Age Under 21 (79101) |
$2,075.50 |
$5,930 |
8.4× |
| Radiopharmaceutical therapy, by oral administration Age Under 21 (79005) |
$2,801.75 |
$8,005 |
11.4× |
| Radiopharmaceutical therapy, radiolabeled monoclonal antibody by intravenous infusion (79403) |
$558.95 |
$1,597 |
2.3× |
| Red cell mass multiple (78121) |
$2,486.40 |
$7,104 |
4.3× |
| Review by radiologist of urinary bladder and urethra images with contrast and after passing urine (74455) |
$623 |
$1,780 |
2.5× |
| Rp loclzj tum plnr 2+area 1+d img/1 area img>2+d (78801) |
$1,076.95 |
$3,077 |
2.6× |
| Rp loclzj tum plnr whole body 2+ days imaging (78804) |
$2,629.55 |
$7,513 |
4.6× |
| Rp loclzj tum plnr whole body single day imaging (78802) |
$1,939 |
$5,540 |
3.4× |
| Rp loclzj tum spect 2 areas (78831) |
$2,866.15 |
$8,189 |
2.1× |
| Rp loclzj tum spect w/CT 1 (78830) |
$4,340.35 |
$12,401 |
3.2× |
| Rp loclzj tum spect w/CT 2 (78832) |
$4,496.80 |
$12,848 |
3.0× |
| Rp therapy intra-arterial particulate admn (79445) |
$1,271.20 |
$3,632 |
5.2× |
| Saline infusion sonohysterography (SIS), including color flow Doppler, when performed Age Under 21 (76831) |
$330.40 |
$944 |
1.3× |
| Scapula complete (73010) |
$256.55 |
$733 |
2.3× |
| Screening digital breast tomosynthesis bi (77063) |
$32.20 |
$92 |
— |
| Shuntogram indwelling nonvascular shunt rs&i (75809) |
$310.80 |
$888 |
2.8× |
| Simulation intermediate (77285) |
$1,961.75 |
$5,605 |
5.0× |
| Special dosimetry (77331) |
$355.95 |
$1,017 |
2.5× |
| Special physics consult (77370) |
$1,400.70 |
$4,002 |
9.9× |
| Special teletherapy port plan (77321) |
$1,663.20 |
$4,752 |
4.2× |
| Special treatment procedure (77470) |
$4,587.45 |
$13,107 |
7.9× |
| Spleen imaging only, with or without vascular flow Age Under 21 (78185) |
$671.65 |
$1,919 |
1.6× |
| Splenoportography, radiological supervision and interpretation Age Under 21 (75810) |
$3,421.60 |
$9,776 |
1.0× |
| Stereotactic body radiation therapy, treatment delivery, per fraction to 1 or more lesions, including image guidance,… (77373) |
$16,158.45 |
$46,167 |
8.6× |
| Surface application of low dose rate radionuclide source (77789) |
$2,691.15 |
$7,689 |
25.0× |
| Testicular imaging with vascular flow Age Under 21 (78761) |
$807.45 |
$2,307 |
1.9× |
| Ther rad simulaj-aided field setting complex (77290) |
$2,682.40 |
$7,664 |
6.8× |
| Therapeutic enema, contrast or air, for reduction of intussusception or other intraluminal obstruction (eg, meconium… (74283) |
$415.45 |
$1,187 |
2.2× |
| Thyroid imaging with vascular flow (78013) |
$956.90 |
$2,734 |
2.3× |
| Thyroid met imaging body (78018) |
$3,319.05 |
$9,483 |
5.8× |
| Thyroid uptake single/multiple quant measurement (78012) |
$752.50 |
$2,150 |
1.8× |
| Thyroid uptake w/blood flow sngle/mult quan meas (78014) |
$1,733.20 |
$4,952 |
4.1× |
| Tr simulation simple (77280) |
$1,428.70 |
$4,082 |
10.1× |
| Treatment device complex (77334) |
$1,337 |
$3,820 |
3.4× |
| Treatment device intermediate (77333) |
$740.60 |
$2,116 |
5.2× |
| Treatment device simple (77332) |
$580.30 |
$1,658 |
4.1× |
| Ultrasound bone density measurement and interpretation, peripheral site(s), any method Age Under 21 (76977) |
$94.85 |
$271 |
0.9× |
| Ultrasound breast limited (76642) |
$471.10 |
$1,346 |
5.1× |
| Ultrasound, abdomen limited (76705) |
$587.65 |
$1,679 |
5.3× |
| Ultrasound, limited, joint or focal evaluation of other nonvascular extremity structure(s) (eg, joint space,… (76882) |
$301 |
$860 |
2.7× |
| Ultrasound, pelvic (nonobstetric), real time with image documentation; complete Age Under 21 (76856) |
$757.40 |
$2,164 |
6.9× |
| Ultrasound, pregnant uterus, real time with image documentation, fetal and maternal evaluation plus detailed fetal… (76811) |
$716.80 |
$2,048 |
2.8× |
| Ultrasound, pregnant uterus, real time with image documentation, fetal and maternal evaluation, first trimester (< 14… (76801) |
$477.40 |
$1,364 |
4.3× |
| Ultrasound, transplanted kidney, real time and duplex Doppler with image documentation Age Under 21 (76776) |
$472.50 |
$1,350 |
4.3× |
| Ultrasound, transrectal; prostate volume study for brachytherapy treatment planning (separate procedure) Age Under 21 (76873) |
$268.80 |
$768 |
2.4× |
| Umbilical-artery Doppler (OB) (76820) |
$210 |
$600 |
1.9× |
| Unlisted cardiovascular procedure, diagnostic nuclear medicine (78499) |
$314.76 |
$899.31 |
0.7× |
| Unlisted endocrine procedure, diagnostic nuclear medicine (78099) |
$574.88 |
$1,642.50 |
1.4× |
| Unlisted fluoroscopic procedure (76496) |
$474.10 |
$1,354.56 |
5.2× |
| Unlisted gastrointestinal procedure, diagnostic nuclear medicine (78299) |
$303.46 |
$867 |
0.7× |
| Unlisted genitourinary procedure, diagnostic nuclear medicine (78799) |
$591.76 |
$1,690.74 |
1.4× |
| Unlisted magnetic resonance procedure (eg, diagnostic, interventional) Age Under 21 (76498) |
$2,482.86 |
$7,093.87 |
27.0× |
| Unlisted miscellaneous procedure, diagnostic nuclear medicine (78999) |
$319.18 |
$911.94 |
0.8× |
| Unlisted nervous system procedure, diagnostic nuclear medicine (78699) |
$307.25 |
$877.83 |
0.7× |
| Unlisted respiratory procedure, diagnostic nuclear medicine (78599) |
$733.69 |
$2,096.25 |
1.7× |
| Ureteral reflux study (78740) |
$1,207.15 |
$3,449 |
2.9× |
| Urethrocystography retrograde rs&i (74450) |
$1,055.95 |
$3,017 |
4.2× |
| Urography (pyelography), intravenous, with or without KUB, with or without tomography Age Under 21 (74400) |
$742.35 |
$2,121 |
4.0× |
| Urography antegrade rs&i (74425) |
$422.10 |
$1,206 |
1.1× |
| Us abdominal aorta real time screen study aaa (76706) |
$405.30 |
$1,158 |
3.7× |
| Us breast uni real time with image complete (76641) |
$484.40 |
$1,384 |
4.4× |
| Us chest (76604) |
$379.40 |
$1,084 |
3.4× |
| Us compl joint r-t w/image documentation (76881) |
$756 |
$2,160 |
6.9× |
| Us elastography organ (76981) |
$153.65 |
$439 |
1.4× |
| Us encephalogram (76506) |
$433.30 |
$1,238 |
3.9× |
| Us exam, pelvic, limited (76857) |
$498.40 |
$1,424 |
4.5× |
| Us guided compression repair (76936) |
$1,224.30 |
$3,498 |
5.4× |
| Us inft hips r-t img dynamic req phys/qhp manj (76885) |
$581.35 |
$1,661 |
6.3× |
| Us nrv&acc strux 1 xtr compre w/img pr extremity (76883) |
$258.65 |
$739 |
2.3× |
| US OB Follow-Up/Repeat (76816) |
$232.75 |
$665 |
2.1× |
| Us ob transvaginal (76817) |
$478.80 |
$1,368 |
4.3× |
| Us retroperitoneal complete (76770) |
$506.80 |
$1,448 |
4.6× |
| Us retroperitoneal ltd (76775) |
$484.75 |
$1,385 |
4.4× |
| Us scrotum (76870) |
$682.50 |
$1,950 |
6.2× |
| Us soft tissue head/neck (76536) |
$633.50 |
$1,810 |
5.7× |
| Us spinal canal (76800) |
$618.80 |
$1,768 |
5.6× |
| Us transrectal (76872) |
$298.55 |
$853 |
2.7× |
| Us unlstd proc (76999) |
$93.07 |
$265.91 |
1.0× |
| Use 1st target lesion (76982) |
$152.60 |
$436 |
1.4× |
| Venogram sinus/jugular (75860) |
$2,077.95 |
$5,937 |
0.6× |
| Venography adrenal unilateral selective rs&i (75840) |
$2,669.80 |
$7,628 |
0.8× |
| Venography deep dorsal vein penis radiolgicl supervision interpretation (76499) |
$783.42 |
$2,238.34 |
8.5× |
| Venography renal unilateral selective rs&i (75831) |
$2,269.05 |
$6,483 |
0.7× |
| Venography, caval, inferior, with serialography, radiological supervision and interpretation Age Under 21 (75825) |
$2,269.05 |
$6,483 |
0.7× |
| Venography, caval, superior, with serialography, radiological supervision and interpretation Age Under 21 (75827) |
$2,208.15 |
$6,309 |
1.3× |
| Venography, extremity, bilateral, radiological supervision and interpretation Age Under 21 (75822) |
$1,126.65 |
$3,219 |
0.7× |
| Venography, extremity, unilateral, radiological supervision and interpretation Age Under 21 (75820) |
$1,010.45 |
$2,887 |
0.6× |
| Venography, superior sagittal sinus, radiological supervision and interpretation Age Under 21 (75870) |
$1,641.50 |
$4,690 |
0.5× |
| Venous sampling thru cath w/wo angiography rs& (75893) |
$4,014.15 |
$11,469 |
0.7× |
| Venous thrombosis imaging - nm extremity veins thrombosis right (78457) |
$517.65 |
$1,479 |
0.9× |
| Whole blood volume determination, including separate measurement of plasma volume and red cell volume… (78122) |
$2,161.95 |
$6,177 |
3.8× |
| X-ray exam hips bi 3-4 views (73522) |
$479.85 |
$1,371 |
4.4× |
| X-ray exam of finger(s) (73140) |
$244.65 |
$699 |
2.7× |
| X-ray exam of knee 1 or 2 (73560) |
$276.15 |
$789 |
3.0× |
| X-ray exam ribs bil 3 views (71110) |
$324.80 |
$928 |
2.9× |
| X-ray exam ribs uni 2 views (71100) |
$284.90 |
$814 |
3.1× |
| X-ray heel (73650) |
$201.25 |
$575 |
2.2× |
| X-ray of joint between lower spine and hip bone 3 or more views|PROFESSIONAL COMPONENT (72202) |
$361.20 |
$1,032 |
3.3× |
| X-ray retrograde pyelogram (74420) |
$392.35 |
$1,121 |
1.1× |
| Xr abdomen 1 view (74018) |
$313.25 |
$895 |
3.4× |
| Xr abdomen 2 views (74019) |
$329 |
$940 |
3.0× |
| Xr arthrogram ankle (73615) |
$476 |
$1,360 |
1.3× |
| Xr arthrogram elbow (73085) |
$837.55 |
$2,393 |
2.3× |
| Xr arthrogram hip (73525) |
$505.75 |
$1,445 |
1.4× |
| Xr arthrogram knee (73580) |
$778.40 |
$2,224 |
2.1× |
| Xr arthrogram wrist (73115) |
$581.70 |
$1,662 |
1.6× |
| Xr bone age studies (77072) |
$175.70 |
$502 |
1.6× |
| Xr bone length study (77073) |
$438.90 |
$1,254 |
4.0× |
| Xr bone survey infant (77076) |
$311.50 |
$890 |
2.8× |
| Xr bone survey ltd (77074) |
$486.15 |
$1,389 |
4.4× |
| Xr chest 1 view (71045) |
$316.05 |
$903 |
3.4× |
| Xr chest 2 views (71046) |
$435.75 |
$1,245 |
4.7× |
| Xr eye foreign body (70030) |
$303.80 |
$868 |
3.3× |
| Xr facial bones 3+ views (70150) |
$254.80 |
$728 |
2.3× |
| Xr foot arthritis pa only bilateral - report(ortho pro) (73620) |
$225.05 |
$643 |
2.5× |
| Xr forearm 2 views (73090) |
$142.45 |
$407 |
1.6× |
| Xr hand 2v (73120) |
$225.05 |
$643 |
2.0× |
| Xr hysterosalpingogram (74740) |
$607.60 |
$1,736 |
2.4× |
| Xr joint survey 1 view (77077) |
$355.95 |
$1,017 |
3.2× |
| Xr myelogram c-spine (72240) |
$669.20 |
$1,912 |
0.8× |
| Xr myelogram l-spine (72265) |
$711.20 |
$2,032 |
0.9× |
| Xr neck soft tissue (70360) |
$260.40 |
$744 |
2.8× |
| Xr o knee w/ merchant view bilat - report(ortho pro) (73562) |
$409.15 |
$1,169 |
4.5× |
| Xr osseous survey complete (77075) |
$551.25 |
$1,575 |
5.0× |
| Xr pelvis 1-2 views (72170) |
$256.55 |
$733 |
2.3× |
| Xr pelvis min 3 view (72190) |
$501.55 |
$1,433 |
4.5× |
| Xr peritoneogram (74190) |
$1,157.80 |
$3,308 |
2.0× |
| Xr sacrum/coccyx 2+ views (72220) |
$264.25 |
$755 |
2.9× |
| Xr shoulder 1 view (73020) |
$96.95 |
$277 |
1.1× |
| Xr sialogram (70390) |
$419.65 |
$1,199 |
1.7× |
| Xr sinuses 3+ views (70220) |
$158.20 |
$452 |
1.7× |
| Xr skull min 4 view (70260) |
$339.15 |
$969 |
3.1× |
| Xr spine 1 view (72020) |
$276.15 |
$789 |
3.0× |
| Xr spine thoracic 3v (72072) |
$275.45 |
$787 |
2.5× |
| Xr sternum 2+ views (71120) |
$213.50 |
$610 |
2.3× |
| Xr stress view joint (77071) |
$96.95 |
$277 |
1.1× |
| Xr surgical specimen (76098) |
$291.20 |
$832 |
0.5× |
| Xr t-spine 2 views (72070) |
$262.85 |
$751 |
2.4× |
| Xr tibia/fibula 2 views (73590) |
$264.25 |
$755 |
2.9× |
| Xr tmj bilateral (70330) |
$159.25 |
$455 |
1.7× |
| Xr tmj unilateral (70328) |
$104.65 |
$299 |
1.1× |
| Xr venogram renal bilat (75833) |
$2,465.05 |
$7,043 |
0.7× |
| Xr wrist 2 views (73100) |
$217 |
$620 |
2.4× |