| 3-D radiotherapy plan dose-volume histograms (77295) |
$7,459.60 |
$8,776 |
5.1× |
| Acute gi blood loss imaging (78278) |
$2,737.85 |
$3,221 |
6.5× |
| Angiography pulmonary bilateral slctv rs&i (75743) |
$5,506.30 |
$6,478 |
1.7× |
| Angiography visceral slctv/supraslctv rs&i (75726) |
$18,401.65 |
$21,649 |
3.1× |
| Angiography, extremity, bilateral, radiological supervision and interpretation Age Under 21 (75716) |
$4,562.80 |
$5,368 |
1.4× |
| Angiography, extremity, unilateral, radiological supervision and interpretation Age Under 21 (75710) |
$4,515.20 |
$5,312 |
1.4× |
| Angiography, pelvic, selective or supraselective, radiological supervision and interpretation Age Under 21 (75736) |
$4,683.50 |
$5,510 |
0.8× |
| Angiography, pulmonary, unilateral, selective, radiological supervision and interpretation Age Under 21 (75741) |
$8,664.05 |
$10,193 |
2.6× |
| Ankle 2 views (73600) |
$231.20 |
$272 |
2.5× |
| Aortography, abdominal plus bilateral iliofemoral lower extremity, catheter, by serialography, radiological supervision… (75630) |
$8,455.38 |
$9,947.50 |
2.5× |
| Aortography, abdominal, by serialography, radiological supervision and interpretation Age Under 21 (75625) |
$4,625.28 |
$5,441.50 |
1.4× |
| Aortography, thoracic, by serialography, radiological supervision and interpretation Age Under 21 (75605) |
$4,794.85 |
$5,641 |
0.8× |
| Aortography, thoracic, without serialography, radiological supervision and interpretation Age Under 21 (75600) |
$8,770.30 |
$10,318 |
2.6× |
| Basic radiation dosimetry calculation (77300) |
$1,615 |
$1,900 |
11.4× |
| Brain imaging, positron emission tomography (PET); metabolic evaluation Age Under 21 (78608) |
$5,247.05 |
$6,173 |
3.5× |
| Cholecystography, oral contrast Age Under 21 (74290) |
$629 |
$740 |
3.4× |
| Clavicle complete (73000) |
$238 |
$280 |
2.6× |
| Computed tomographic (CT) colonography, diagnostic, including image postprocessing; without contrast material Age Under… (74261) |
$752.25 |
$885 |
6.8× |
| Computed tomographic angiography, abdomen and pelvis, with contrast material(s), including noncontrast images, if… (74174) |
$752.25 |
$885 |
2.0× |
| Computed tomographic angiography, abdomen, with contrast material(s), including noncontrast images, if performed, and… (74175) |
$752.25 |
$885 |
4.1× |
| Computed tomographic angiography, abdominal aorta and bilateral iliofemoral lower extremity runoff, with contrast… (75635) |
$752.25 |
$885 |
4.1× |
| Computed tomographic angiography, chest (noncoronary), with contrast material(s), including noncontrast images, if… (71275) |
$752.25 |
$885 |
4.1× |
| Computed tomographic angiography, lower extremity, with contrast material(s), including noncontrast images, if… (73706) |
$752.25 |
$885 |
4.1× |
| Computed tomographic angiography, neck, with contrast material(s), including noncontrast images, if performed, and… (70498) |
$752.25 |
$885 |
4.1× |
| Computed tomographic angiography, pelvis, with contrast material(s), including noncontrast images, if performed, and… (72191) |
$752.25 |
$885 |
4.1× |
| Computed tomographic angiography, upper extremity, with contrast material(s), including noncontrast images, if… (73206) |
$752.25 |
$885 |
4.1× |
| Computed tomography, cervical spine; without contrast material, followed by contrast material(s) and further sections… (72127) |
$404.60 |
$476 |
2.2× |
| Computed tomography, lower extremity; without contrast material Age Under 21 (73700) |
$752.25 |
$885 |
6.8× |
| Computed tomography, lower extremity; without contrast material, followed by contrast material(s) and further sections… (73702) |
$752.25 |
$885 |
4.1× |
| Computed tomography, lumbar spine; without contrast material, followed by contrast material(s) and further sections Age… (72133) |
$404.60 |
$476 |
2.2× |
| Computed tomography, maxillofacial area; with contrast material(s) Age Under 21 (70487) |
$752.25 |
$885 |
4.1× |
| Computed tomography, maxillofacial area; without contrast material Age Under 21 (70486) |
$752.25 |
$885 |
6.8× |
| Computed tomography, orbit, sella, or posterior fossa or outer, middle, or inner ear; with contrast material(s) Age… (70481) |
$752.25 |
$885 |
4.1× |
| Computed tomography, orbit, sella, or posterior fossa or outer, middle, or inner ear; without contrast material Age… (70480) |
$752.25 |
$885 |
6.8× |
| Computed tomography, orbit, sella, or posterior fossa or outer, middle, or inner ear; without contrast material,… (70482) |
$752.25 |
$885 |
4.1× |
| Computed tomography, soft tissue neck; without contrast material followed by contrast material(s) and further sections… (70492) |
$752.25 |
$885 |
4.1× |
| Computed tomography, thoracic spine; without contrast material, followed by contrast material(s) and further sections… (72130) |
$752.25 |
$885 |
4.1× |
| Computed tomography, thorax, diagnostic; without contrast material, followed by contrast material(s) and further… (71270) |
$752.25 |
$885 |
4.1× |
| Continuing medical physics consultation, including assessment of treatment parameters, quality assurance of dose… (77336) |
$822.80 |
$968 |
5.8× |
| CT abdomen and pelvis without and with contrast (74178) |
$752.25 |
$885 |
2.0× |
| CT abdomen and pelvis without contrast (74176) |
$752.25 |
$885 |
3.0× |
| CT abdomen w & w/o contrast (74170) |
$752.25 |
$885 |
4.1× |
| CT abdomen w/contrast (74160) |
$752.25 |
$885 |
4.1× |
| CT abdomen w/o contrast (74150) |
$752.25 |
$885 |
6.8× |
| CT angio hrt w/3d image (75574) |
$752.25 |
$885 |
2.0× |
| CT cervical spine w/contrast (72126) |
$752.25 |
$885 |
2.0× |
| CT cervical spine w/o contrast (72125) |
$752.25 |
$885 |
6.8× |
| CT chest w/contrast (71260) |
$752.25 |
$885 |
4.1× |
| CT extremity upper w & w/o contrast (73202) |
$413.95 |
$487 |
2.2× |
| CT extremity upper w/o contrast (73200) |
$752.25 |
$885 |
6.8× |
| CT head/brain with contrast (70460) |
$752.25 |
$885 |
4.1× |
| CT head/brain without and with contrast (70470) |
$752.25 |
$885 |
4.1× |
| CT heart contrast eval cardiac structure&morph (75572) |
$752.25 |
$885 |
2.0× |
| CT heart no contrast quant eval coronry calcium (75571) |
$101.15 |
$119 |
1.1× |
| CT l-spine w/contrast (72132) |
$752.25 |
$885 |
2.0× |
| CT lower extremity w/dye (73701) |
$752.25 |
$885 |
4.1× |
| CT lumbar spine w/o contrast (72131) |
$752.25 |
$885 |
6.8× |
| CT maxillofacial w/wo contrast (70488) |
$752.25 |
$885 |
4.1× |
| CT neck w/contrast (70491) |
$752.25 |
$885 |
4.1× |
| CT neck w/o contrast (70490) |
$752.25 |
$885 |
6.8× |
| CT pelvis w & w/o contrast (72194) |
$752.25 |
$885 |
4.1× |
| CT pelvis w/o contrast (72192) |
$752.25 |
$885 |
6.8× |
| CT thoracic spine w/contrast (72129) |
$752.25 |
$885 |
4.1× |
| CT thoracic spine w/o contrast (72128) |
$752.25 |
$885 |
6.8× |
| CT thorax lung cancer scr c- (71271) |
$249.90 |
$294 |
2.3× |
| CT thorax w/o contrast (71250) |
$752.25 |
$885 |
6.8× |
| CT upper extremity w/dye (73201) |
$752.25 |
$885 |
2.0× |
| CTA h&n c+ w/noncontrast img (70471) |
$837.25 |
$985 |
2.3× |
| CTA head w contrast (70496) |
$752.25 |
$885 |
4.1× |
| Cystography, minimum of 3 views, radiological supervision and interpretation Age Under 21 (74430) |
$1,272.02 |
$1,496.50 |
3.5× |
| Diskography lumbar s&i (72295) |
$5,936.40 |
$6,984 |
2.9× |
| Dual-energy X-ray absorptiometry (DXA), bone density study, 1 or more sites; axial skeleton (eg, hips, pelvis, spine)… (77080) |
$306 |
$360 |
2.8× |
| Dxa bone density study axial skeleton (77085) |
$329.80 |
$388 |
3.0× |
| Dxa bone density/peripheral (77081) |
$164.90 |
$194 |
1.8× |
| Fetal biophys profile w/o nst (76819) |
$358.70 |
$422 |
3.3× |
| Fluoroscopy up to 1 hour physician/qhp time (76000) |
$783.70 |
$922 |
3.1× |
| Gated heart planar single (78472) |
$4,162.02 |
$4,896.50 |
9.9× |
| Hdr rdncl ntrstl/intrcav brachytx 1 channel (77770) |
$5,362.65 |
$6,309 |
7.3× |
| Hdr rdncl ntrstl/intrcav brachytx 2-12 channel (77771) |
$5,170.12 |
$6,082.50 |
7.0× |
| Hdr rdncl ntrstl/intrcav brachytx >12 channels (77772) |
$5,170.12 |
$6,082.50 |
7.0× |
| Hepatobil syst imag inc gb w/pharma intervenj (78227) |
$2,703.42 |
$3,180.50 |
4.7× |
| Hepatobiliary syst imaging including gallbladder (78226) |
$2,703.42 |
$3,180.50 |
6.4× |
| Ht muscle image spect sing (78451) |
$2,744.65 |
$3,229 |
2.0× |
| Image fusion (77399) |
$853.40 |
$1,004 |
6.0× |
| Infusion or instillation of radioelement solution (includes 3-month follow-up care) (77750) |
$1,484.10 |
$1,746 |
3.6× |
| Intensity modulated radiotherapy plan, including dose-volume histograms for target and critical structure partial… (77301) |
$7,459.60 |
$8,776 |
5.1× |
| Interstitial radiation source application, complex, includes supervision, handling, loading of radiation source, when… (77778) |
$5,170.12 |
$6,082.50 |
7.0× |
| Intestine imaging (eg, ectopic gastric mucosa, Meckel's localization, volvulus) Age Under 21 (78290) |
$2,791.40 |
$3,284 |
6.6× |
| Isodose brachytherapy complex 10+ sources (77318) |
$2,181.52 |
$2,566.50 |
5.5× |
| Isodose brachytherapy plan simple 1 to 4 source (77316) |
$853.40 |
$1,004 |
2.2× |
| Isodose teletherapy plan complex multi tx w/cal (77307) |
$2,181.52 |
$2,566.50 |
5.5× |
| Isodose teletherapy plan simple 1 or 2 port w/cal (77306) |
$939.25 |
$1,105 |
2.4× |
| Kidney imaging morphology; with vascular flow and function, single study without pharmacological intervention Age Under… (78707) |
$2,066.78 |
$2,431.50 |
3.6× |
| Kidney imaging morphology; with vascular flow and function, single study, with pharmacological intervention (eg,… (78708) |
$2,374.90 |
$2,794 |
4.1× |
| Liver and spleen imaging (78215) |
$2,411.45 |
$2,837 |
5.7× |
| Liver imaging (78201) |
$2,119.05 |
$2,493 |
3.7× |
| Lung perfusion imaging (78580) |
$2,028.10 |
$2,386 |
4.8× |
| Magnetic resonance (eg, proton) imaging, any joint of lower extremity; without contrast material(s), followed by… (73723) |
$752.25 |
$885 |
2.0× |
| Magnetic resonance (eg, proton) imaging, lower extremity other than joint; with contrast material(s) Age Under 21 (73719) |
$752.25 |
$885 |
2.0× |
| Magnetic resonance (eg, proton) imaging, lower extremity other than joint; without contrast material(s) Age Under 21 (73718) |
$752.25 |
$885 |
3.0× |
| Magnetic resonance (eg, proton) imaging, lower extremity other than joint; without contrast material(s), followed by… (73720) |
$752.25 |
$885 |
2.0× |
| Magnetic resonance (eg, proton) imaging, orbit, face, and/or neck; with contrast material(s) Age Under 21 (70542) |
$752.25 |
$885 |
2.0× |
| Magnetic resonance (eg, proton) imaging, orbit, face, and/or neck; without contrast material(s) Age Under 21 (70540) |
$752.25 |
$885 |
3.0× |
| Magnetic resonance (eg, proton) imaging, upper extremity, other than joint; with contrast material(s) Age Under 21 (73219) |
$752.25 |
$885 |
2.0× |
| Magnetic resonance (eg, proton) imaging, upper extremity, other than joint; without contrast material(s), followed by… (73220) |
$752.25 |
$885 |
2.0× |
| Magnetic resonance angiography, head; with contrast material(s) Age Under 21 (70545) |
$752.25 |
$885 |
2.0× |
| Magnetic resonance angiography, head; without contrast material(s), followed by contrast material(s) and further… (70546) |
$752.25 |
$885 |
2.0× |
| Magnetic resonance angiography, neck; without contrast material(s), followed by contrast material(s) and further… (70549) |
$752.25 |
$885 |
2.0× |
| Mandible min 4v (70110) |
$260.10 |
$306 |
2.4× |
| MRA head w/o contrast (70544) |
$752.25 |
$885 |
3.0× |
| MRA neck w/ contrast (70548) |
$752.25 |
$885 |
2.0× |
| MRA neck w/o contrast (70547) |
$752.25 |
$885 |
3.0× |
| MRI abdomen w/o contrast (74181) |
$752.25 |
$885 |
3.0× |
| MRI abdomen w/wo contrast (74183) |
$752.25 |
$885 |
2.0× |
| MRI any jt lower extrem w/contrast material (73722) |
$752.25 |
$885 |
0.9× |
| MRI breast c- bilateral (77047) |
$752.25 |
$885 |
3.0× |
| MRI breast without contrast material unilateral (77046) |
$752.25 |
$885 |
3.0× |
| MRI c-spine w&w/o cont (72156) |
$752.25 |
$885 |
2.0× |
| MRI chest w/contrast (71551) |
$752.25 |
$885 |
0.9× |
| MRI chest w/o contrast (71550) |
$752.25 |
$885 |
3.0× |
| MRI chest w/wo contrast (71552) |
$752.25 |
$885 |
2.0× |
| MRI joint upr extr w/o&w/dye (73223) |
$752.25 |
$885 |
2.0× |
| MRI joint upr extrem w/dye (73222) |
$752.25 |
$885 |
0.9× |
| MRI joint upr extrem w/o dye (73221) |
$752.25 |
$885 |
3.0× |
| MRI lumbar spine w/contrast (72149) |
$752.25 |
$885 |
2.0× |
| MRI lumbar spine w/wo contrast (72158) |
$752.25 |
$885 |
2.0× |
| MRI orbit/face/neck w&w/o cont (70543) |
$752.25 |
$885 |
2.0× |
| MRI pelvis w & w/o contrast (72197) |
$752.25 |
$885 |
2.0× |
| MRI pelvis w/contrast (72196) |
$752.25 |
$885 |
2.0× |
| MRI pelvis w/o contrast (72195) |
$752.25 |
$885 |
3.0× |
| MRI spine cervical w/o contrast (72141) |
$752.25 |
$885 |
3.0× |
| MRI t-spine w&w/o cont (72157) |
$752.25 |
$885 |
2.0× |
| MRI thoracic spine w/o contrst (72146) |
$752.25 |
$885 |
3.0× |
| MRI tmj (70336) |
$752.25 |
$885 |
3.0× |
| MRI upper extremity oth than jt w/o contr matrl (73218) |
$752.25 |
$885 |
3.0× |
| Multi-leaf collimator (MLC) device(s) for intensity modulated radiation therapy (IMRT), design and construction per… (77338) |
$2,181.52 |
$2,566.50 |
5.5× |
| Myelography, 2 or more regions (eg, lumbar/thoracic, cervical/thoracic, lumbar/cervical, lumbar/thoracic/cervical),… (72270) |
$2,351.10 |
$2,766 |
2.8× |
| Myocardial spect multiple studies (78452) |
$5,286.58 |
$6,219.50 |
3.9× |
| Nm bone 3 phase (78315) |
$3,834.35 |
$4,511 |
9.1× |
| Nm bone imaging whole body (78306) |
$3,176.45 |
$3,737 |
7.5× |
| Nm csf leak detection (78650) |
$2,202.35 |
$2,591 |
1.6× |
| Nm gastric emptying (78264) |
$2,703.42 |
$3,180.50 |
6.4× |
| Nm lung ventilation imaging (78579) |
$3,029.40 |
$3,564 |
7.2× |
| Nm lymph system (78195) |
$2,368.95 |
$2,787 |
4.1× |
| Nm myocard infarct spect (78469) |
$1,802.85 |
$2,121 |
3.1× |
| Nuclear medicine study of bone and/or joint limited area (78300) |
$2,622.25 |
$3,085 |
6.2× |
| Ob us limited fetus(s) (76815) |
$642.60 |
$756 |
5.8× |
| Ophthalmic ultrasound, diagnostic; anterior segment ultrasound, immersion (water bath) B-scan or high resolution… (76513) |
$311.10 |
$366 |
2.8× |
| Ophthalmic ultrasound, diagnostic; B-scan (with or without superimposed non-quantitative A-scan) Age Under 21 (76512) |
$363.80 |
$428 |
3.3× |
| Ophthalmic us dx quantitative a-scan only (76511) |
$402.90 |
$474 |
3.7× |
| Parathyrd planar w/spect&CT (78072) |
$1,413.55 |
$1,663 |
2.5× |
| Parathyroid planar imaging (78070) |
$2,169.20 |
$2,552 |
5.1× |
| Parathyroid planar imaging w/wo subtraction (78071) |
$1,067.60 |
$1,256 |
2.5× |
| PET imaging CT attenuation skull base mid-thigh (78815) |
$10,171.52 |
$11,966.50 |
6.7× |
| PET imaging CT for attenuation limited area (78814) |
$7,864.20 |
$9,252 |
5.2× |
| PET imaging for CT attenuation whole body (78816) |
$10,115 |
$11,900 |
6.7× |
| PET imaging whole body (78813) |
$4,236.40 |
$4,984 |
2.8× |
| Positron emission tomography (PET) imaging; limited area (eg, chest, head/neck) Age Under 21 (78811) |
$5,099.15 |
$5,999 |
3.7× |
| Pulmonary ventilation & perfusion imaging (78582) |
$5,060.48 |
$5,953.50 |
8.8× |
| Quan&char c athrosclrtc plaq (75577) |
$2,020.45 |
$2,377 |
2.1× |
| Radex entir thrc lmbr crv sac spi w/skull 1 vw (72081) |
$149.18 |
$175.50 |
1.6× |
| Radex entir thrc lmbr crv sac spi w/skull 2/3 vw (72082) |
$308.12 |
$362.50 |
2.8× |
| Radex entir thrc lmbr crv sac spi w/skull 4/5 vw (72083) |
$372.72 |
$438.50 |
3.4× |
| Radex hip unilateral with pelvis 1 view (73501) |
$266.48 |
$313.50 |
2.9× |
| Radex hip unilateral with pelvis 2-3 views (73502) |
$214.62 |
$252.50 |
2.3× |
| Radex hips bilateral with pelvis 2 views (73521) |
$255 |
$300 |
2.3× |
| Radex spine cervical 2 or 3 views (72040) |
$201.02 |
$236.50 |
2.2× |
| Radex spine cervical 4 or 5 views (72050) |
$275.82 |
$324.50 |
2.5× |
| Radex spine cervical 6 or more views (72052) |
$291.98 |
$343.50 |
2.6× |
| Radiation treatment delivery, stereotactic radiosurgery (SRS), complete course of treatment of cranial lesion(s)… (77372) |
$18,322.18 |
$21,555.50 |
2.4× |
| Radiation tx delivery lvl 1 (77402) |
$828.75 |
$975 |
7.7× |
| Radiation tx delivery lvl 2 (77407) |
$828.75 |
$975 |
2.0× |
| Radiation tx delivery lvl 3 (77412) |
$1,430.98 |
$1,683.50 |
2.5× |
| Radiologic exam chest 4+ views (71048) |
$224.82 |
$264.50 |
2.0× |
| Radiologic exam colon double contrast study (74280) |
$629 |
$740 |
3.4× |
| Radiologic exam colon single contrast study (74270) |
$606.48 |
$713.50 |
3.3× |
| Radiologic exam esophagus single contrast study (74220) |
$606.48 |
$713.50 |
3.3× |
| Radiologic exam small int single contrast study (74250) |
$606.48 |
$713.50 |
3.3× |
| Radiologic exam swallow function contrast study (74230) |
$606.48 |
$713.50 |
3.3× |
| Radiologic exam upr gi trc double contrast study (74246) |
$606.48 |
$713.50 |
3.3× |
| Radiologic exam upr gi trc single contrast study (74240) |
$606.48 |
$713.50 |
3.3× |
| Radiologic examination femur 1 view (73551) |
$209.10 |
$246 |
2.3× |
| Radiologic examination femur minimum 2 views (73552) |
$244.38 |
$287.50 |
2.7× |
| Radiologic examination from nose to rectum for foreign body, single view, child Age Under 21 (76010) |
$183.18 |
$215.50 |
2.0× |
| Radiologic examination, ankle; complete, minimum of 3 views Age Under 21 (73610) |
$245.22 |
$288.50 |
2.7× |
| Radiologic examination, complete acute abdomen series, including 2 or more views of the abdomen (eg, supine, erect,… (74022) |
$270.72 |
$318.50 |
2.5× |
| Radiologic examination, elbow; 2 views Age Under 21 (73070) |
$203.58 |
$239.50 |
2.2× |
| Radiologic examination, elbow; complete, minimum of 3 views Age Under 21 (73080) |
$234.60 |
$276 |
2.6× |
| Radiologic examination, facial bones; less than 3 views Age Under 21 (70140) |
$187 |
$220 |
2.0× |
| Radiologic examination, foot; complete, minimum of 3 views Age Under 21 (73630) |
$248.20 |
$292 |
2.7× |
| Radiologic examination, hand; minimum of 3 views Age Under 21 (73130) |
$260.10 |
$306 |
2.8× |
| Radiologic examination, knee; both knees, standing, anteroposterior Age Under 21 (73565) |
$266.48 |
$313.50 |
2.9× |
| Radiologic examination, knee; complete, 4 or more views Age Under 21 (73564) |
$313.22 |
$368.50 |
2.8× |
| Radiologic examination, mandible; partial, less than 4 views Age Under 21 (70100) |
$131.32 |
$154.50 |
1.4× |
| Radiologic examination, nasal bones, complete, minimum of 3 views Age Under 21 (70160) |
$197.62 |
$232.50 |
2.2× |
| Radiologic examination, ribs, bilateral; including posteroanterior chest, minimum of 4 views Age Under 21 (71111) |
$386.75 |
$455 |
3.5× |
| Radiologic examination, ribs, unilateral; including posteroanterior chest, minimum of 3 views Age Under 21 (71101) |
$256.70 |
$302 |
2.3× |
| Radiologic examination, sacroiliac joints; less than 3 views Age Under 21 (72200) |
$240.55 |
$283 |
2.2× |
| Radiologic examination, shoulder, arthrography, radiological supervision and interpretation Age Under 21 (73040) |
$1,319.20 |
$1,552 |
3.6× |
| Radiologic examination, shoulder; complete, minimum of 2 views Age Under 21 (73030) |
$251.60 |
$296 |
2.7× |
| Radiologic examination, sinuses, paranasal, less than 3 views Age Under 21 (70210) |
$116.45 |
$137 |
1.3× |
| Radiologic examination, skull; less than 4 views Age Under 21 (70250) |
$247.78 |
$291.50 |
2.2× |
| Radiologic examination, spine, lumbosacral; 2 or 3 views Age Under 21 (72100) |
$252.02 |
$296.50 |
2.3× |
| Radiologic examination, wrist; complete, minimum of 3 views Age Under 21 (73110) |
$266.48 |
$313.50 |
2.9× |
| Radiologic examination; acromioclavicular joints, bilateral, with or without weighted distraction Age Under 21 (73050) |
$188.28 |
$221.50 |
2.1× |
| Radiologic examination; humerus, minimum of 2 views Age Under 21 (73060) |
$238 |
$280 |
2.6× |
| Radiologic examination; lower extremity, infant, minimum of 2 views Age Under 21 (73592) |
$228.65 |
$269 |
2.5× |
| Radiologic examination; orbits, complete, minimum of 4 views Age Under 21 (70200) |
$268.18 |
$315.50 |
2.4× |
| Radiologic examination; sternoclavicular joint or joints, minimum of 3 views Age Under 21 (71130) |
$204 |
$240 |
2.2× |
| Radiologic examination; toe(s), minimum of 2 views Age Under 21 (73660) |
$161.08 |
$189.50 |
1.8× |
| Radiologic examination; upper extremity, infant, minimum of 2 views Age Under 21 (73092) |
$236.30 |
$278 |
2.1× |
| Radiopharmaceutical localization of tumor, inflammatory process or distribution of radiopharmaceutical agent(s)… (78803) |
$3,323.08 |
$3,909.50 |
5.8× |
| Radiopharmaceutical therapy, by intravenous administration Age Under 21 (79101) |
$518.08 |
$609.50 |
2.1× |
| Radiopharmaceutical therapy, by oral administration Age Under 21 (79005) |
$2,380.42 |
$2,800.50 |
9.7× |
| Remote afterloading high dose rate radionuclide skin surface brachytherapy, includes basic dosimetry, when performed;… (77767) |
$1,430.98 |
$1,683.50 |
3.5× |
| Remote afterloading high dose rate radionuclide skin surface brachytherapy, includes basic dosimetry, when performed;… (77768) |
$1,430.98 |
$1,683.50 |
3.5× |
| Review by radiologist of urinary bladder and urethra images with contrast and after passing urine (74455) |
$804.10 |
$946 |
3.2× |
| Rp loclzj tum plnr 1 area single day imaging (78800) |
$3,100.80 |
$3,648 |
7.4× |
| Rp loclzj tum plnr 2+area 1+d img/1 area img>2+d (78801) |
$2,603.55 |
$3,063 |
6.2× |
| Rp loclzj tum plnr whole body 2+ days imaging (78804) |
$9,014.25 |
$10,605 |
15.7× |
| Rp loclzj tum plnr whole body single day imaging (78802) |
$2,603.55 |
$3,063 |
4.5× |
| Rp loclzj tum spect w/CT 1 (78830) |
$3,586.15 |
$4,219 |
2.6× |
| Scapula complete (73010) |
$198.90 |
$234 |
1.8× |
| Screening digital breast tomosynthesis bi (77063) |
$68.85 |
$81 |
— |
| Simulation intermediate (77285) |
$2,262.70 |
$2,662 |
5.7× |
| Special dosimetry (77331) |
$853.40 |
$1,004 |
6.0× |
| Special physics consult (77370) |
$822.80 |
$968 |
5.8× |
| Special teletherapy port plan (77321) |
$2,262.70 |
$2,662 |
5.7× |
| Special treatment procedure (77470) |
$3,462.48 |
$4,073.50 |
5.9× |
| Spleen imaging only, with or without vascular flow Age Under 21 (78185) |
$2,270.35 |
$2,671 |
5.4× |
| Stereotactic body radiation therapy, treatment delivery, per fraction to 1 or more lesions, including image guidance,… (77373) |
$6,496.98 |
$7,643.50 |
3.4× |
| Surface radiation therapy; orthovoltage, delivery, >150-500 kV, per fraction (77438) |
$769.25 |
$905 |
7.1× |
| Surface radiation therapy; superficial or orthovoltage, treatment planning and simulation-aided field setting (77436) |
$769.25 |
$905 |
19.5× |
| Surface radiation therapy; superficial, delivery, </=150 kV, per fraction (eg, electronic brachytherapy) (77437) |
$769.25 |
$905 |
7.1× |
| Tbs technical calculation only (77091) |
$233.75 |
$275 |
2.5× |
| Ther rad simulaj-aided field setting complex (77290) |
$2,181.52 |
$2,566.50 |
5.5× |
| Therapeutic enema, contrast or air, for reduction of intussusception or other intraluminal obstruction (eg, meconium… (74283) |
$629 |
$740 |
3.4× |
| Thyroid imaging with vascular flow (78013) |
$1,174.70 |
$1,382 |
2.8× |
| Thyroid met imaging body (78018) |
$2,445.45 |
$2,877 |
4.3× |
| Thyroid uptake single/multiple quant measurement (78012) |
$733.55 |
$863 |
1.7× |
| Thyroid uptake w/blood flow sngle/mult quan meas (78014) |
$1,823.25 |
$2,145 |
4.3× |
| Tr simulation simple (77280) |
$822.80 |
$968 |
5.8× |
| Trabecular bone score (TBS), structural condition of the bone microarchitecture; technical preparation and transmission… (77090) |
$242.25 |
$285 |
2.6× |
| Treatment device complex (77334) |
$3,231.70 |
$3,802 |
8.2× |
| Treatment device intermediate (77333) |
$822.80 |
$968 |
5.8× |
| Treatment device simple (77332) |
$822.80 |
$968 |
5.8× |
| Ultrasound breast limited (76642) |
$303.02 |
$356.50 |
3.3× |
| Ultrasound, abdomen limited (76705) |
$358.70 |
$422 |
3.3× |
| Ultrasound, limited, joint or focal evaluation of other nonvascular extremity structure(s) (eg, joint space,… (76882) |
$234.60 |
$276 |
2.1× |
| Ultrasound, pelvic (nonobstetric), real time with image documentation; complete Age Under 21 (76856) |
$358.70 |
$422 |
3.3× |
| Ultrasound, pregnant uterus, real time with image documentation, fetal and maternal evaluation, first trimester (< 14… (76801) |
$358.70 |
$422 |
3.3× |
| Ultrasound, transrectal; prostate volume study for brachytherapy treatment planning (separate procedure) Age Under 21 (76873) |
$765.42 |
$900.50 |
6.9× |
| Unlisted magnetic resonance procedure (eg, diagnostic, interventional) Age Under 21 (76498) |
$335.75 |
$395 |
3.7× |
| Urethrocystography retrograde rs&i (74450) |
$804.10 |
$946 |
3.2× |
| Urography (pyelography), intravenous, with or without KUB, with or without tomography Age Under 21 (74400) |
$629 |
$740 |
3.4× |
| Urography antegrade rs&i (74425) |
$1,319.20 |
$1,552 |
3.6× |
| Us abdominal aorta real time screen study aaa (76706) |
$315.78 |
$371.50 |
2.9× |
| Us breast uni real time with image complete (76641) |
$370.60 |
$436 |
3.4× |
| Us chest (76604) |
$502.35 |
$591 |
4.6× |
| Us compl joint r-t w/image documentation (76881) |
$358.70 |
$422 |
3.3× |
| Us elastography organ (76981) |
$255 |
$300 |
2.3× |
| Us encephalogram (76506) |
$358.70 |
$422 |
3.3× |
| Us exam, pelvic, limited (76857) |
$358.70 |
$422 |
3.3× |
| Us guided compression repair (76936) |
$774.35 |
$911 |
3.4× |
| Us inft hips r-t img dynamic req phys/qhp manj (76885) |
$190.40 |
$224 |
2.1× |
| US OB Follow-Up/Repeat (76816) |
$358.70 |
$422 |
3.3× |
| Us ob transvaginal (76817) |
$358.70 |
$422 |
3.3× |
| Us retroperitoneal complete (76770) |
$358.70 |
$422 |
3.3× |
| Us retroperitoneal ltd (76775) |
$358.70 |
$422 |
3.3× |
| Us scrotum (76870) |
$358.70 |
$422 |
3.3× |
| Us soft tissue head/neck (76536) |
$358.70 |
$422 |
3.3× |
| Us spinal canal (76800) |
$190.40 |
$224 |
1.7× |
| Us transrectal (76872) |
$317.90 |
$374 |
2.9× |
| Us unlstd proc (76999) |
$225.25 |
$265 |
2.5× |
| Use 1st target lesion (76982) |
$255 |
$300 |
2.3× |
| Venogram sinus/jugular (75860) |
$2,211.70 |
$2,602 |
0.7× |
| Venography deep dorsal vein penis radiolgicl supervision interpretation (76499) |
$52.28 |
$61.50 |
0.6× |
| Venography, caval, inferior, with serialography, radiological supervision and interpretation Age Under 21 (75825) |
$4,718.35 |
$5,551 |
1.4× |
| Venography, caval, superior, with serialography, radiological supervision and interpretation Age Under 21 (75827) |
$2,222.75 |
$2,615 |
1.3× |
| Venography, extremity, bilateral, radiological supervision and interpretation Age Under 21 (75822) |
$1,597.15 |
$1,879 |
1.0× |
| Venography, extremity, unilateral, radiological supervision and interpretation Age Under 21 (75820) |
$3,045.12 |
$3,582.50 |
1.8× |
| Vertebral fracture assessment via dxa (77086) |
$209.10 |
$246 |
2.3× |
| X-ray exam of finger(s) (73140) |
$239.70 |
$282 |
2.6× |
| X-ray exam of knee 1 or 2 (73560) |
$255.85 |
$301 |
2.8× |
| X-ray exam of small bowel - fl small bowel series enteroclysis tube (74251) |
$629 |
$740 |
3.4× |
| X-ray exam ribs bil 3 views (71110) |
$260.95 |
$307 |
2.4× |
| X-ray exam ribs uni 2 views (71100) |
$196.78 |
$231.50 |
2.1× |
| X-ray heel (73650) |
$214.20 |
$252 |
2.3× |
| X-ray retrograde pyelogram (74420) |
$3,025.58 |
$3,559.50 |
8.2× |
| Xr abdomen 1 view (74018) |
$245.65 |
$289 |
2.7× |
| Xr abdomen 2 views (74019) |
$248.20 |
$292 |
2.3× |
| Xr arthrogram hip (73525) |
$1,319.20 |
$1,552 |
3.6× |
| Xr arthrogram wrist (73115) |
$1,319.20 |
$1,552 |
3.6× |
| Xr bone age studies (77072) |
$226.52 |
$266.50 |
2.1× |
| Xr bone length study (77073) |
$263.08 |
$309.50 |
2.4× |
| Xr bone survey infant (77076) |
$372.72 |
$438.50 |
3.4× |
| Xr chest 1 view (71045) |
$226.10 |
$266 |
2.5× |
| Xr chest 2 views (71046) |
$226.10 |
$266 |
2.5× |
| Xr eye foreign body (70030) |
$373.15 |
$439 |
4.1× |
| Xr facial bones 3+ views (70150) |
$266.48 |
$313.50 |
2.4× |
| Xr foot arthritis pa only bilateral - report(ortho pro) (73620) |
$233.75 |
$275 |
2.5× |
| Xr forearm 2 views (73090) |
$217.60 |
$256 |
2.4× |
| Xr hand 2v (73120) |
$220.58 |
$259.50 |
2.0× |
| Xr hysterosalpingogram (74740) |
$775.20 |
$912 |
3.1× |
| Xr joint survey 1 view (77077) |
$174.25 |
$205 |
1.6× |
| Xr myelogram c-spine (72240) |
$2,351.10 |
$2,766 |
2.8× |
| Xr myelogram t-spine (72255) |
$2,351.10 |
$2,766 |
2.8× |
| Xr neck soft tissue (70360) |
$186.15 |
$219 |
2.0× |
| Xr o knee w/ merchant view bilat - report(ortho pro) (73562) |
$269.02 |
$316.50 |
2.9× |
| Xr osseous survey complete (77075) |
$360.82 |
$424.50 |
3.3× |
| Xr pelvis 1-2 views (72170) |
$233.75 |
$275 |
2.1× |
| Xr pelvis min 3 view (72190) |
$277.10 |
$326 |
2.5× |
| Xr sacrum/coccyx 2+ views (72220) |
$188.28 |
$221.50 |
2.1× |
| Xr shoulder 1 view (73020) |
$162.35 |
$191 |
1.8× |
| Xr sinuses 3+ views (70220) |
$198.05 |
$233 |
2.2× |
| Xr skull min 4 view (70260) |
$263.08 |
$309.50 |
2.4× |
| Xr spine 1 view (72020) |
$174.25 |
$205 |
1.9× |
| Xr sternum 2+ views (71120) |
$190.82 |
$224.50 |
2.1× |
| Xr surgical specimen (76098) |
$1,144.95 |
$1,347 |
2.0× |
| Xr t-spine 2 views (72070) |
$240.12 |
$282.50 |
2.2× |
| Xr tibia/fibula 2 views (73590) |
$230.78 |
$271.50 |
2.5× |
| Xr tmj bilateral (70330) |
$226.95 |
$267 |
2.5× |
| Xr tmj unilateral (70328) |
$193.80 |
$228 |
2.1× |
| Xr wrist 2 views (73100) |
$239.28 |
$281.50 |
2.6× |