| 3-D radiotherapy plan dose-volume histograms (77295) |
$6,975.75 |
$9,301 |
4.8× |
| Acute gi blood loss imaging (78278) |
$1,534.50 |
$2,046 |
3.6× |
| Ankle 2 views (73600) |
$306.75 |
$409 |
3.3× |
| Basic radiation dosimetry calculation (77300) |
$470.25 |
$627 |
3.3× |
| Brain imaging, less than 4 static views; with vascular flow Age Under 21 (78601) |
$1,905 |
$2,540 |
4.5× |
| Brain imaging, positron emission tomography (PET); metabolic evaluation Age Under 21 (78608) |
$4,239 |
$5,652 |
2.8× |
| Clavicle complete (73000) |
$243.75 |
$325 |
2.7× |
| Computed tomographic (CT) colonography, diagnostic, including image postprocessing; without contrast material Age Under… (74261) |
$891 |
$1,188 |
8.1× |
| Computed tomographic (CT) colonography, screening, including image postprocessing (74263) |
$1,101.75 |
$1,469 |
4.4× |
| Computed tomographic angiography, abdomen and pelvis, with contrast material(s), including noncontrast images, if… (74174) |
$1,122.75 |
$1,497 |
3.1× |
| Computed tomographic angiography, abdomen, with contrast material(s), including noncontrast images, if performed, and… (74175) |
$2,920.50 |
$3,894 |
15.8× |
| Computed tomographic angiography, abdominal aorta and bilateral iliofemoral lower extremity runoff, with contrast… (75635) |
$3,516 |
$4,688 |
19.0× |
| Computed tomographic angiography, chest (noncoronary), with contrast material(s), including noncontrast images, if… (71275) |
$2,798.25 |
$3,731 |
15.1× |
| Computed tomographic angiography, lower extremity, with contrast material(s), including noncontrast images, if… (73706) |
$3,297 |
$4,396 |
17.8× |
| Computed tomographic angiography, neck, with contrast material(s), including noncontrast images, if performed, and… (70498) |
$2,514.75 |
$3,353 |
13.6× |
| Computed tomographic angiography, pelvis, with contrast material(s), including noncontrast images, if performed, and… (72191) |
$3,027 |
$4,036 |
16.4× |
| Computed tomographic angiography, upper extremity, with contrast material(s), including noncontrast images, if… (73206) |
$3,272.25 |
$4,363 |
17.7× |
| Computed tomography, cervical spine; without contrast material, followed by contrast material(s) and further sections… (72127) |
$2,613 |
$3,484 |
14.1× |
| Computed tomography, lower extremity; without contrast material Age Under 21 (73700) |
$917.88 |
$1,223.84 |
8.3× |
| Computed tomography, lumbar spine; without contrast material, followed by contrast material(s) and further sections Age… (72133) |
$2,618.25 |
$3,491 |
14.2× |
| Computed tomography, maxillofacial area; with contrast material(s) Age Under 21 (70487) |
$1,833.75 |
$2,445 |
9.9× |
| Computed tomography, maxillofacial area; without contrast material Age Under 21 (70486) |
$964.12 |
$1,285.50 |
8.7× |
| Computed tomography, orbit, sella, or posterior fossa or outer, middle, or inner ear; with contrast material(s) Age… (70481) |
$1,860 |
$2,480 |
10.1× |
| Computed tomography, orbit, sella, or posterior fossa or outer, middle, or inner ear; without contrast material Age… (70480) |
$1,590.75 |
$2,121 |
14.4× |
| Computed tomography, orbit, sella, or posterior fossa or outer, middle, or inner ear; without contrast material,… (70482) |
$2,232 |
$2,976 |
12.1× |
| Computed tomography, soft tissue neck; without contrast material followed by contrast material(s) and further sections… (70492) |
$1,868.25 |
$2,491 |
10.1× |
| Computed tomography, thoracic spine; without contrast material, followed by contrast material(s) and further sections… (72130) |
$2,611.50 |
$3,482 |
14.1× |
| Computed tomography, thorax, diagnostic; without contrast material, followed by contrast material(s) and further… (71270) |
$2,037.75 |
$2,717 |
11.0× |
| Continuing medical physics consultation, including assessment of treatment parameters, quality assurance of dose… (77336) |
$850.50 |
$1,134 |
6.0× |
| CT abdomen and pelvis without and with contrast (74178) |
$4,206.75 |
$5,609 |
11.4× |
| CT abdomen and pelvis without contrast (74176) |
$3,003.75 |
$4,005 |
11.9× |
| CT abdomen w & w/o contrast (74170) |
$2,106.75 |
$2,809 |
11.4× |
| CT abdomen w/contrast (74160) |
$1,699.50 |
$2,266 |
9.2× |
| CT abdomen w/o contrast (74150) |
$1,404.75 |
$1,873 |
12.7× |
| CT angio hrt w/3d image (75574) |
$2,207.25 |
$2,943 |
6.0× |
| CT cervical spine w/contrast (72126) |
$2,154 |
$2,872 |
5.9× |
| CT cervical spine w/o contrast (72125) |
$1,842 |
$2,456 |
16.7× |
| CT chest w/contrast (71260) |
$1,665 |
$2,220 |
9.0× |
| CT extremity upper w/o contrast (73200) |
$253.25 |
$337.67 |
2.3× |
| CT head/brain with contrast (70460) |
$1,803.75 |
$2,405 |
9.7× |
| CT head/brain without and with contrast (70470) |
$2,204.25 |
$2,939 |
11.9× |
| CT heart c+ cardiac strux&morph cgen hrt ds (75573) |
$1,538.25 |
$2,051 |
4.2× |
| CT heart contrast eval cardiac structure&morph (75572) |
$1,306.50 |
$1,742 |
3.6× |
| CT heart no contrast quant eval coronry calcium (75571) |
$212.25 |
$283 |
2.3× |
| CT l-spine w/contrast (72132) |
$2,157.75 |
$2,877 |
5.9× |
| CT lower extremity w/dye (73701) |
$1,230.75 |
$1,641 |
6.7× |
| CT lumbar spine w/o contrast (72131) |
$1,842 |
$2,456 |
16.7× |
| CT maxillofacial w/wo contrast (70488) |
$2,212.50 |
$2,950 |
12.0× |
| CT neck w/contrast (70491) |
$1,557 |
$2,076 |
8.4× |
| CT neck w/o contrast (70490) |
$1,370.25 |
$1,827 |
12.4× |
| CT pelvis w & w/o contrast (72194) |
$2,154.75 |
$2,873 |
11.6× |
| CT pelvis w/o contrast (72192) |
$2,094.75 |
$2,793 |
19.0× |
| CT thoracic spine w/contrast (72129) |
$2,220 |
$2,960 |
12.0× |
| CT thoracic spine w/o contrast (72128) |
$1,842 |
$2,456 |
16.7× |
| CT thorax lung cancer scr c- (71271) |
$224.25 |
$299 |
2.0× |
| CT thorax w/o contrast (71250) |
$799.50 |
$1,066 |
7.2× |
| CT upper extremity w/dye (73201) |
$1,722.75 |
$2,297 |
4.7× |
| CTA head w contrast (70496) |
$2,691.75 |
$3,589 |
14.5× |
| Cystography, minimum of 3 views, radiological supervision and interpretation Age Under 21 (74430) |
$549.75 |
$733 |
1.5× |
| Discography, cervical or thoracic, radiological supervision and interpretation Age Under 21 (72285) |
$2,933.25 |
$3,911 |
1.4× |
| Diskography lumbar s&i (72295) |
$2,933.25 |
$3,911 |
1.4× |
| Doppler echocardiography, fetal, pulsed wave and/or continuous wave with spectral display; complete Age Under 21 (76827) |
$624.75 |
$833 |
5.7× |
| Doppler echocardiography, fetal, pulsed wave and/or continuous wave with spectral display; follow-up or repeat study… (76828) |
$377.25 |
$503 |
3.4× |
| Doppler fetal mid cerebral artery (76821) |
$391.50 |
$522 |
3.6× |
| Dual-energy X-ray absorptiometry (DXA), bone density study, 1 or more sites; axial skeleton (eg, hips, pelvis, spine)… (77080) |
$469.50 |
$626 |
4.3× |
| Dxa bone density study axial skeleton (77085) |
$296.25 |
$395 |
2.7× |
| Dxa bone density/peripheral (77081) |
$135 |
$180 |
1.5× |
| Echocardiography, fetal, cardiovascular system, real time with image documentation (2D), with or without M-mode… (76825) |
$807 |
$1,076 |
1.4× |
| Echocardiography, fetal, cardiovascular system, real time with image documentation (2D), with or without M-mode… (76826) |
$562.50 |
$750 |
2.2× |
| Fetal biophys profile w/o nst (76819) |
$487.50 |
$650 |
4.4× |
| Fetal biophysical profile non-stress testing (76818) |
$531 |
$708 |
4.8× |
| Fluoroscopy up to 1 hour physician/qhp time (76000) |
$528 |
$704 |
2.1× |
| Gated heart planar single (78472) |
$1,645.50 |
$2,194 |
3.9× |
| Hdr rdncl ntrstl/intrcav brachytx 1 channel (77770) |
$4,458.75 |
$5,945 |
6.1× |
| Hdr rdncl ntrstl/intrcav brachytx 2-12 channel (77771) |
$4,557 |
$6,076 |
6.2× |
| Hdr rdncl ntrstl/intrcav brachytx >12 channels (77772) |
$4,816.50 |
$6,422 |
6.6× |
| Hepatobil syst imag inc gb w/pharma intervenj (78227) |
$1,545 |
$2,060 |
2.7× |
| Hepatobiliary syst imaging including gallbladder (78226) |
$1,112.25 |
$1,483 |
2.6× |
| Image fusion (77399) |
$404.62 |
$539.50 |
2.9× |
| Intensity modulated radiotherapy plan, including dose-volume histograms for target and critical structure partial… (77301) |
$6,842.25 |
$9,123 |
4.7× |
| Interstitial radiation source application, complex, includes supervision, handling, loading of radiation source, when… (77778) |
$1,688.25 |
$2,251 |
2.3× |
| Intestine imaging (eg, ectopic gastric mucosa, Meckel's localization, volvulus) Age Under 21 (78290) |
$1,100.25 |
$1,467 |
2.6× |
| Isodose brachytherapy complex 10+ sources (77318) |
$2,100.75 |
$2,801 |
5.3× |
| Isodose brachytherapy intermed 5 to 10 sources (77317) |
$885 |
$1,180 |
2.2× |
| Isodose brachytherapy plan simple 1 to 4 source (77316) |
$319.50 |
$426 |
0.8× |
| Isodose teletherapy plan complex multi tx w/cal (77307) |
$1,423.50 |
$1,898 |
3.6× |
| Isodose teletherapy plan simple 1 or 2 port w/cal (77306) |
$967.50 |
$1,290 |
2.4× |
| Kidney imaging morphology; with vascular flow Age Under 21 (78701) |
$1,062.75 |
$1,417 |
2.5× |
| Kidney imaging morphology; with vascular flow and function, single study, with pharmacological intervention (eg,… (78708) |
$1,271.25 |
$1,695 |
2.2× |
| Labeled red cell sequestration, differential organ/tissue (eg, splenic and/or hepatic) Age Under 21 (78140) |
$822 |
$1,096 |
1.9× |
| Liver and spleen imaging (78215) |
$1,157.25 |
$1,543 |
2.7× |
| Lung perf&ventilat diferentl (78598) |
$758.25 |
$1,011 |
1.3× |
| Lung perfusion imaging (78580) |
$686.25 |
$915 |
1.6× |
| Magnetic resonance (eg, proton) imaging, any joint of lower extremity; without contrast material(s), followed by… (73723) |
$1,431.75 |
$1,909 |
3.9× |
| Magnetic resonance (eg, proton) imaging, lower extremity other than joint; with contrast material(s) Age Under 21 (73719) |
$1,282.12 |
$1,709.50 |
3.5× |
| Magnetic resonance (eg, proton) imaging, lower extremity other than joint; without contrast material(s) Age Under 21 (73718) |
$1,199.25 |
$1,599 |
4.8× |
| Magnetic resonance (eg, proton) imaging, lower extremity other than joint; without contrast material(s), followed by… (73720) |
$1,411.12 |
$1,881.50 |
3.8× |
| Magnetic resonance (eg, proton) imaging, orbit, face, and/or neck; with contrast material(s) Age Under 21 (70542) |
$1,074 |
$1,432 |
2.9× |
| Magnetic resonance (eg, proton) imaging, orbit, face, and/or neck; without contrast material(s) Age Under 21 (70540) |
$926.25 |
$1,235 |
3.7× |
| Magnetic resonance (eg, proton) imaging, upper extremity, other than joint; with contrast material(s) Age Under 21 (73219) |
$978.75 |
$1,305 |
2.7× |
| Magnetic resonance (eg, proton) imaging, upper extremity, other than joint; without contrast material(s), followed by… (73220) |
$1,390.88 |
$1,854.50 |
3.8× |
| Magnetic resonance angiography, head; with contrast material(s) Age Under 21 (70545) |
$1,012.50 |
$1,350 |
2.8× |
| Magnetic resonance angiography, head; without contrast material(s), followed by contrast material(s) and further… (70546) |
$1,195.50 |
$1,594 |
3.2× |
| Magnetic resonance angiography, neck; without contrast material(s), followed by contrast material(s) and further… (70549) |
$1,628.25 |
$2,171 |
4.4× |
| Mammary ductogram or galactogram, multiple ducts, radiological supervision and interpretation Age Under 21 (77054) |
$612 |
$816 |
2.4× |
| Mammary ductogram single (77053) |
$738.75 |
$985 |
2.9× |
| Mandible min 4v (70110) |
$393.75 |
$525 |
3.6× |
| MRA head w/o contrast (70544) |
$1,217.25 |
$1,623 |
4.8× |
| MRA neck w/ contrast (70548) |
$998.25 |
$1,331 |
2.7× |
| MRA neck w/o contrast (70547) |
$934.50 |
$1,246 |
3.7× |
| MRI abdomen w/contrast (74182) |
$1,503.75 |
$2,005 |
4.1× |
| MRI abdomen w/o contrast (74181) |
$1,281 |
$1,708 |
5.1× |
| MRI abdomen w/wo contrast (74183) |
$1,730.25 |
$2,307 |
4.7× |
| MRI any jt lower extrem w/contrast material (73722) |
$1,216.88 |
$1,622.50 |
1.5× |
| MRI breast c- bilateral (77047) |
$1,179 |
$1,572 |
4.7× |
| MRI c-spine w&w/o cont (72156) |
$1,493.25 |
$1,991 |
4.1× |
| MRI cervical spine w/contrast (72142) |
$1,407 |
$1,876 |
3.8× |
| MRI chest w/contrast (71551) |
$954 |
$1,272 |
1.2× |
| MRI chest w/o contrast (71550) |
$1,161.75 |
$1,549 |
4.6× |
| MRI chest w/wo contrast (71552) |
$1,710.75 |
$2,281 |
4.6× |
| MRI joint upr extr w/o&w/dye (73223) |
$1,396.12 |
$1,861.50 |
3.8× |
| MRI joint upr extrem w/dye (73222) |
$1,248 |
$1,664 |
1.5× |
| MRI joint upr extrem w/o dye (73221) |
$1,203.75 |
$1,605 |
4.8× |
| MRI lumbar spine w/contrast (72149) |
$1,347.75 |
$1,797 |
3.7× |
| MRI lumbar spine w/wo contrast (72158) |
$1,767.75 |
$2,357 |
4.8× |
| MRI orbit/face/neck w&w/o cont (70543) |
$1,678.50 |
$2,238 |
4.6× |
| MRI pelvis w & w/o contrast (72197) |
$1,708.50 |
$2,278 |
4.6× |
| MRI pelvis w/contrast (72196) |
$1,079.25 |
$1,439 |
2.9× |
| MRI pelvis w/o contrast (72195) |
$1,233.75 |
$1,645 |
4.9× |
| MRI spine cervical w/o contrast (72141) |
$1,248.75 |
$1,665 |
5.0× |
| MRI t-spine w&w/o cont (72157) |
$1,779.75 |
$2,373 |
4.8× |
| MRI thoracic spine w/contrast (72147) |
$1,485 |
$1,980 |
4.0× |
| MRI thoracic spine w/o contrst (72146) |
$1,265.25 |
$1,687 |
5.0× |
| MRI tmj (70336) |
$1,098 |
$1,464 |
4.4× |
| MRI upper extremity oth than jt w/o contr matrl (73218) |
$1,068 |
$1,424 |
4.2× |
| Multi-leaf collimator (MLC) device(s) for intensity modulated radiation therapy (IMRT), design and construction per… (77338) |
$1,004.25 |
$1,339 |
2.5× |
| Myelography, 2 or more regions (eg, lumbar/thoracic, cervical/thoracic, lumbar/cervical, lumbar/thoracic/cervical),… (72270) |
$2,117.25 |
$2,823 |
2.6× |
| Myocardial spect multiple studies (78452) |
$3,077.25 |
$4,103 |
2.3× |
| Myocrd img PET metab eval single study (78459) |
$4,013.25 |
$5,351 |
2.9× |
| N-invas est c ffr augmnt sw alys CTA i&r phy/qhp (75580) |
$2,850.75 |
$3,801 |
3.1× |
| Nm bone 3 phase (78315) |
$1,762.50 |
$2,350 |
4.2× |
| Nm bone imaging whole body (78306) |
$1,580.25 |
$2,107 |
3.7× |
| Nm gastric emptying (78264) |
$1,271.25 |
$1,695 |
3.0× |
| Nm lung ventilation imaging (78579) |
$437.25 |
$583 |
1.0× |
| Nm lymph system (78195) |
$1,878 |
$2,504 |
3.3× |
| Nuclear medicine study for detecting heart shunt (78428) |
$684 |
$912 |
1.6× |
| Nuclear medicine study of bone and/or joint limited area (78300) |
$1,149 |
$1,532 |
2.7× |
| Nuclear medicine study of bone and/or joint multiple areas (78305) |
$1,350 |
$1,800 |
3.2× |
| Ob us limited fetus(s) (76815) |
$402.75 |
$537 |
3.7× |
| Ob us nuchal meas 1 gest (76813) |
$391.50 |
$522 |
3.6× |
| Ophthalmic ultrasound, diagnostic; B-scan (with or without superimposed non-quantitative A-scan) Age Under 21 (76512) |
$285.75 |
$381 |
2.6× |
| Parathyrd planar w/spect&CT (78072) |
$1,389.75 |
$1,853 |
2.4× |
| Parathyroid planar imaging (78070) |
$1,221 |
$1,628 |
2.9× |
| PET imaging CT attenuation skull base mid-thigh (78815) |
$5,739 |
$7,652 |
3.8× |
| PET imaging CT for attenuation limited area (78814) |
$4,013.25 |
$5,351 |
2.7× |
| PET imaging for CT attenuation whole body (78816) |
$5,939.25 |
$7,919 |
3.9× |
| PET imaging whole body (78813) |
$11,042.25 |
$14,723 |
7.3× |
| Pulmonary ventilation & perfusion imaging (78582) |
$783.75 |
$1,045 |
1.4× |
| Quant differential pulm perfusion w/wo imaging (78597) |
$469.50 |
$626 |
1.1× |
| Radex abscess/fistula/sinus tract rs&i (76080) |
$540.75 |
$721 |
0.9× |
| Radex entir thrc lmbr crv sac spi w/skull 2/3 vw (72082) |
$336.75 |
$449 |
3.1× |
| Radex entir thrc lmbr crv sac spi w/skull 4/5 vw (72083) |
$554.25 |
$739 |
5.0× |
| Radex entir thrc lmbr crv sac spi w/skull 6/> vw (72084) |
$588.75 |
$785 |
5.3× |
| Radex hip unilateral with pelvis 1 view (73501) |
$169.50 |
$226 |
1.8× |
| Radex hip unilateral with pelvis 2-3 views (73502) |
$278.25 |
$371 |
3.0× |
| Radex hip unilateral with pelvis minimum 4 views (73503) |
$460.50 |
$614 |
4.2× |
| Radex hips bilateral with pelvis 2 views (73521) |
$354.75 |
$473 |
3.2× |
| Radex hips bilateral with pelvis minimum 5 views (73523) |
$672.75 |
$897 |
6.1× |
| Radex spine cervical 2 or 3 views (72040) |
$286.50 |
$382 |
3.1× |
| Radex spine cervical 4 or 5 views (72050) |
$501.75 |
$669 |
4.5× |
| Radex spine cervical 6 or more views (72052) |
$480 |
$640 |
4.4× |
| Radex spine thoracolumbar junction min 2 views (72080) |
$300.75 |
$401 |
3.3× |
| Radiation tx delivery lvl 3 (77412) |
$3,826.51 |
$5,102.01 |
6.6× |
| Radiologic exam abdomen 3+ views (74021) |
$298.50 |
$398 |
2.7× |
| Radiologic exam chest 3 views (71047) |
$308.25 |
$411 |
3.4× |
| Radiologic exam chest 4+ views (71048) |
$346.50 |
$462 |
3.1× |
| Radiologic exam colon double contrast study (74280) |
$528.75 |
$705 |
2.9× |
| Radiologic exam colon single contrast study (74270) |
$382.50 |
$510 |
2.1× |
| Radiologic exam esophagus single contrast study (74220) |
$430.50 |
$574 |
2.3× |
| Radiologic exam small int single contrast study (74250) |
$446.25 |
$595 |
2.4× |
| Radiologic exam swallow function contrast study (74230) |
$477 |
$636 |
2.6× |
| Radiologic exam upr gi trc double contrast study (74246) |
$579.75 |
$773 |
3.1× |
| Radiologic exam upr gi trc single contrast study (74240) |
$565.50 |
$754 |
3.1× |
| Radiologic examination femur 1 view (73551) |
$257.25 |
$343 |
2.8× |
| Radiologic examination femur minimum 2 views (73552) |
$257.25 |
$343 |
2.8× |
| Radiologic examination from nose to rectum for foreign body, single view, child Age Under 21 (76010) |
$198 |
$264 |
2.2× |
| Radiologic examination, ankle; complete, minimum of 3 views Age Under 21 (73610) |
$247.50 |
$330 |
2.7× |
| Radiologic examination, complete acute abdomen series, including 2 or more views of the abdomen (eg, supine, erect,… (74022) |
$399 |
$532 |
3.6× |
| Radiologic examination, elbow; 2 views Age Under 21 (73070) |
$396 |
$528 |
4.3× |
| Radiologic examination, elbow; complete, minimum of 3 views Age Under 21 (73080) |
$259.50 |
$346 |
2.8× |
| Radiologic examination, foot; complete, minimum of 3 views Age Under 21 (73630) |
$258 |
$344 |
2.8× |
| Radiologic examination, hand; minimum of 3 views Age Under 21 (73130) |
$255.75 |
$341 |
2.8× |
| Radiologic examination, knee; both knees, standing, anteroposterior Age Under 21 (73565) |
$152.25 |
$203 |
1.7× |
| Radiologic examination, knee; complete, 4 or more views Age Under 21 (73564) |
$322.50 |
$430 |
2.9× |
| Radiologic examination, mandible; partial, less than 4 views Age Under 21 (70100) |
$147 |
$196 |
1.6× |
| Radiologic examination, mastoids; complete, minimum of 3 views per side Age Under 21 (70130) |
$228.75 |
$305 |
2.1× |
| Radiologic examination, nasal bones, complete, minimum of 3 views Age Under 21 (70160) |
$313.50 |
$418 |
3.4× |
| Radiologic examination, ribs, bilateral; including posteroanterior chest, minimum of 4 views Age Under 21 (71111) |
$595.50 |
$794 |
5.4× |
| Radiologic examination, ribs, unilateral; including posteroanterior chest, minimum of 3 views Age Under 21 (71101) |
$342.75 |
$457 |
3.1× |
| Radiologic examination, shoulder, arthrography, radiological supervision and interpretation Age Under 21 (73040) |
$922.50 |
$1,230 |
2.5× |
| Radiologic examination, shoulder; complete, minimum of 2 views Age Under 21 (73030) |
$287.25 |
$383 |
3.1× |
| Radiologic examination, sinuses, paranasal, less than 3 views Age Under 21 (70210) |
$161.25 |
$215 |
1.8× |
| Radiologic examination, skull; less than 4 views Age Under 21 (70250) |
$282.75 |
$377 |
2.6× |
| Radiologic examination, spine, lumbosacral; 2 or 3 views Age Under 21 (72100) |
$330 |
$440 |
3.0× |
| Radiologic examination, spine, lumbosacral; bending views only, 2 or 3 views Age Under 21 (72120) |
$758.25 |
$1,011 |
6.9× |
| Radiologic examination, spine, lumbosacral; complete, including bending views, minimum of 6 views Age Under 21 (72114) |
$696.75 |
$929 |
6.3× |
| Radiologic examination, wrist; complete, minimum of 3 views Age Under 21 (73110) |
$248.25 |
$331 |
2.7× |
| Radiologic examination; acromioclavicular joints, bilateral, with or without weighted distraction Age Under 21 (73050) |
$312.75 |
$417 |
3.4× |
| Radiologic examination; humerus, minimum of 2 views Age Under 21 (73060) |
$279.75 |
$373 |
3.0× |
| Radiologic examination; lower extremity, infant, minimum of 2 views Age Under 21 (73592) |
$303.75 |
$405 |
3.3× |
| Radiologic examination; orbits, complete, minimum of 4 views Age Under 21 (70200) |
$271.50 |
$362 |
2.5× |
| Radiologic examination; sternoclavicular joint or joints, minimum of 3 views Age Under 21 (71130) |
$279.75 |
$373 |
3.0× |
| Radiologic examination; toe(s), minimum of 2 views Age Under 21 (73660) |
$196.50 |
$262 |
2.1× |
| Radiologic examination; upper extremity, infant, minimum of 2 views Age Under 21 (73092) |
$195.75 |
$261 |
1.8× |
| Radiopharmaceutical localization of tumor, inflammatory process or distribution of radiopharmaceutical agent(s)… (78803) |
$2,176.50 |
$2,902 |
3.8× |
| Radiopharmaceutical therapy, by intravenous administration Age Under 21 (79101) |
$13,734.38 |
$18,312.50 |
55.8× |
| Radiopharmaceutical therapy, by oral administration Age Under 21 (79005) |
$1,043.62 |
$1,391.50 |
4.2× |
| Review by radiologist of urinary bladder and urethra images with contrast and after passing urine (74455) |
$361.50 |
$482 |
1.4× |
| Rp loclzj tum plnr 1 area single day imaging (78800) |
$1,034.25 |
$1,379 |
2.5× |
| Rp loclzj tum plnr 2+area 1+d img/1 area img>2+d (78801) |
$1,347.75 |
$1,797 |
3.2× |
| Rp loclzj tum plnr whole body 2+ days imaging (78804) |
$3,396 |
$4,528 |
5.9× |
| Rp loclzj tum plnr whole body single day imaging (78802) |
$1,687.50 |
$2,250 |
2.9× |
| Saline infusion sonohysterography (SIS), including color flow Doppler, when performed Age Under 21 (76831) |
$435.75 |
$581 |
1.7× |
| Scapula complete (73010) |
$315 |
$420 |
2.9× |
| Screening digital breast tomosynthesis bi (77063) |
$42 |
$56 |
— |
| Special dosimetry (77331) |
$336.75 |
$449 |
2.4× |
| Special physics consult (77370) |
$996 |
$1,328 |
7.0× |
| Special teletherapy port plan (77321) |
$830.25 |
$1,107 |
2.1× |
| Special treatment procedure (77470) |
$4,079.25 |
$5,439 |
7.0× |
| Stereotactic body radiation therapy, treatment delivery, per fraction to 1 or more lesions, including image guidance,… (77373) |
$6,594.75 |
$8,793 |
3.5× |
| Surface application of low dose rate radionuclide source (77789) |
$348.75 |
$465 |
3.2× |
| Testicular imaging with vascular flow Age Under 21 (78761) |
$423 |
$564 |
1.0× |
| Ther rad simulaj-aided field setting complex (77290) |
$2,370 |
$3,160 |
6.0× |
| Therapeutic enema, contrast or air, for reduction of intussusception or other intraluminal obstruction (eg, meconium… (74283) |
$570 |
$760 |
3.1× |
| Thyroid met imaging body (78018) |
$2,022.75 |
$2,697 |
3.5× |
| Thyroid uptake w/blood flow sngle/mult quan meas (78014) |
$1,685.25 |
$2,247 |
4.0× |
| Tr simulation simple (77280) |
$1,320 |
$1,760 |
9.3× |
| Treatment device complex (77334) |
$1,079.25 |
$1,439 |
2.7× |
| Treatment device intermediate (77333) |
$564 |
$752 |
4.0× |
| Treatment device simple (77332) |
$484.50 |
$646 |
3.4× |
| Ultrasound breast limited (76642) |
$377.62 |
$503.50 |
4.1× |
| Ultrasound, abdomen limited (76705) |
$442.50 |
$590 |
4.0× |
| Ultrasound, limited, joint or focal evaluation of other nonvascular extremity structure(s) (eg, joint space,… (76882) |
$373.50 |
$498 |
3.4× |
| Ultrasound, pelvic (nonobstetric), real time with image documentation; complete Age Under 21 (76856) |
$494.25 |
$659 |
4.5× |
| Ultrasound, pregnant uterus, real time with image documentation, fetal and maternal evaluation plus detailed fetal… (76811) |
$735 |
$980 |
2.9× |
| Ultrasound, pregnant uterus, real time with image documentation, fetal and maternal evaluation, first trimester (< 14… (76801) |
$726.75 |
$969 |
6.6× |
| Ultrasound, transplanted kidney, real time and duplex Doppler with image documentation Age Under 21 (76776) |
$501 |
$668 |
4.5× |
| Umbilical-artery Doppler (OB) (76820) |
$463.50 |
$618 |
4.2× |
| Unlisted procedure, clinical brachytherapy (77799) |
$965.25 |
$1,287 |
9.0× |
| Urethrocystography retrograde rs&i (74450) |
$314.25 |
$419 |
1.2× |
| Urography (pyelography), intravenous, with or without KUB, with or without tomography Age Under 21 (74400) |
$368.25 |
$491 |
2.0× |
| Us breast uni real time with image complete (76641) |
$370.88 |
$494.50 |
3.4× |
| Us chest (76604) |
$427.50 |
$570 |
3.9× |
| Us compl joint r-t w/image documentation (76881) |
$329.62 |
$439.50 |
3.0× |
| Us elastography organ (76981) |
$282 |
$376 |
2.6× |
| Us encephalogram (76506) |
$264 |
$352 |
2.4× |
| Us exam, pelvic, limited (76857) |
$374.25 |
$499 |
3.4× |
| Us inft hips r-t img dynamic req phys/qhp manj (76885) |
$449.25 |
$599 |
4.9× |
| US OB Follow-Up/Repeat (76816) |
$484.50 |
$646 |
4.4× |
| Us ob transvaginal (76817) |
$477 |
$636 |
4.3× |
| Us retroperitoneal complete (76770) |
$641.25 |
$855 |
5.8× |
| Us retroperitoneal ltd (76775) |
$428.25 |
$571 |
3.9× |
| Us scrotum (76870) |
$459.75 |
$613 |
4.2× |
| Us soft tissue head/neck (76536) |
$423 |
$564 |
3.8× |
| Us spinal canal (76800) |
$375.75 |
$501 |
3.4× |
| Use 1st target lesion (76982) |
$282 |
$376 |
2.6× |
| Venography, extremity, unilateral, radiological supervision and interpretation Age Under 21 (75820) |
$1,312.50 |
$1,750 |
0.8× |
| Vertebral fracture assessment via dxa (77086) |
$132 |
$176 |
1.4× |
| X-ray exam hips bi 3-4 views (73522) |
$354.75 |
$473 |
3.2× |
| X-ray exam of finger(s) (73140) |
$193.50 |
$258 |
2.1× |
| X-ray exam of knee 1 or 2 (73560) |
$206.25 |
$275 |
2.2× |
| X-ray exam of small bowel - fl small bowel series enteroclysis tube (74251) |
$523.50 |
$698 |
2.8× |
| X-ray exam ribs bil 3 views (71110) |
$401.25 |
$535 |
3.6× |
| X-ray exam ribs uni 2 views (71100) |
$351.75 |
$469 |
3.8× |
| X-ray heel (73650) |
$216.75 |
$289 |
2.4× |
| X-ray of joint between lower spine and hip bone 3 or more views|PROFESSIONAL COMPONENT (72202) |
$345 |
$460 |
3.1× |
| Xr abdomen 1 view (74018) |
$213 |
$284 |
2.3× |
| Xr abdomen 2 views (74019) |
$301.50 |
$402 |
2.7× |
| Xr arthrogram ankle (73615) |
$917.25 |
$1,223 |
2.5× |
| Xr arthrogram elbow (73085) |
$785.25 |
$1,047 |
2.1× |
| Xr arthrogram hip (73525) |
$744.75 |
$993 |
2.0× |
| Xr arthrogram knee (73580) |
$1,074.75 |
$1,433 |
2.9× |
| Xr arthrogram wrist (73115) |
$754.50 |
$1,006 |
2.1× |
| Xr bone age studies (77072) |
$266.25 |
$355 |
2.4× |
| Xr bone length study (77073) |
$240.75 |
$321 |
2.2× |
| Xr bone survey ltd (77074) |
$282.75 |
$377 |
2.6× |
| Xr chest 1 view (71045) |
$162.75 |
$217 |
1.8× |
| Xr chest 2 views (71046) |
$248.25 |
$331 |
2.7× |
| Xr eye foreign body (70030) |
$162.75 |
$217 |
1.8× |
| Xr facial bones 3+ views (70150) |
$378 |
$504 |
3.4× |
| Xr foot arthritis pa only bilateral - report(ortho pro) (73620) |
$465.75 |
$621 |
5.1× |
| Xr forearm 2 views (73090) |
$272.25 |
$363 |
3.0× |
| Xr hand 2v (73120) |
$222.75 |
$297 |
2.0× |
| Xr hysterosalpingogram (74740) |
$645.75 |
$861 |
2.6× |
| Xr joint survey 1 view (77077) |
$222 |
$296 |
2.0× |
| Xr myelogram c-spine (72240) |
$1,488.75 |
$1,985 |
1.8× |
| Xr myelogram l-spine (72265) |
$1,215 |
$1,620 |
1.5× |
| Xr myelogram t-spine (72255) |
$1,408.50 |
$1,878 |
1.7× |
| Xr neck soft tissue (70360) |
$222 |
$296 |
2.4× |
| Xr o knee w/ merchant view bilat - report(ortho pro) (73562) |
$541.50 |
$722 |
5.9× |
| Xr osseous survey complete (77075) |
$582 |
$776 |
5.3× |
| Xr pelvis 1-2 views (72170) |
$257.25 |
$343 |
2.3× |
| Xr pelvis min 3 view (72190) |
$283.50 |
$378 |
2.6× |
| Xr sacrum/coccyx 2+ views (72220) |
$266.25 |
$355 |
2.9× |
| Xr sella turcica (70240) |
$126 |
$168 |
1.4× |
| Xr shoulder 1 view (73020) |
$192 |
$256 |
2.1× |
| Xr sialogram (70390) |
$426.75 |
$569 |
1.7× |
| Xr sinuses 3+ views (70220) |
$210 |
$280 |
2.3× |
| Xr skull min 4 view (70260) |
$475.50 |
$634 |
4.3× |
| Xr spine 1 view (72020) |
$262.50 |
$350 |
2.9× |
| Xr spine thoracic 3v (72072) |
$291 |
$388 |
2.6× |
| Xr sternum 2+ views (71120) |
$312.75 |
$417 |
3.4× |
| Xr stress view joint (77071) |
$138.75 |
$185 |
1.5× |
| Xr surgical specimen (76098) |
$450.75 |
$601 |
0.8× |
| Xr t-spine 2 views (72070) |
$309.75 |
$413 |
2.8× |
| Xr tibia/fibula 2 views (73590) |
$275.25 |
$367 |
3.0× |
| Xr tmj bilateral (70330) |
$321.75 |
$429 |
3.5× |
| Xr wrist 2 views (73100) |
$242.25 |
$323 |
2.6× |