| Acute gi blood loss imaging (78278) |
$1,134.11 |
$1,786 |
2.8× |
| Ankle 2 views (73600) |
$186.56 |
$265 |
2.1× |
| Clavicle complete (73000) |
$249.22 |
$354 |
2.8× |
| Computed tomographic (CT) colonography, diagnostic, including image postprocessing; with contrast material(s) including… (74262) |
$1,081.97 |
$2,177 |
6.0× |
| Computed tomographic (CT) colonography, diagnostic, including image postprocessing; without contrast material Age Under… (74261) |
$865.28 |
$1,741 |
8.1× |
| Computed tomographic (CT) colonography, screening, including image postprocessing (74263) |
$873.23 |
$1,757 |
3.6× |
| Computed tomographic angiography, abdomen and pelvis, with contrast material(s), including noncontrast images, if… (74174) |
$2,007.60 |
$3,346 |
5.6× |
| Computed tomographic angiography, abdomen, with contrast material(s), including noncontrast images, if performed, and… (74175) |
$1,288.80 |
$2,148 |
7.2× |
| Computed tomographic angiography, abdominal aorta and bilateral iliofemoral lower extremity runoff, with contrast… (75635) |
$1,484.54 |
$2,987 |
8.3× |
| Computed tomographic angiography, chest (noncoronary), with contrast material(s), including noncontrast images, if… (71275) |
$1,435.80 |
$2,393 |
8.0× |
| Computed tomographic angiography, lower extremity, with contrast material(s), including noncontrast images, if… (73706) |
$1,549.20 |
$2,582 |
8.6× |
| Computed tomographic angiography, neck, with contrast material(s), including noncontrast images, if performed, and… (70498) |
$1,559.60 |
$2,595 |
8.7× |
| Computed tomographic angiography, pelvis, with contrast material(s), including noncontrast images, if performed, and… (72191) |
$2,819.40 |
$4,699 |
15.7× |
| Computed tomographic angiography, upper extremity, with contrast material(s), including noncontrast images, if… (73206) |
$2,139.60 |
$3,566 |
11.9× |
| Computed tomography, bone mineral density study, 1 or more sites, axial skeleton (eg, hips, pelvis, spine) Age Under 21 (77078) |
$390 |
$650 |
4.4× |
| Computed tomography, cervical spine; without contrast material, followed by contrast material(s) and further sections… (72127) |
$2,665.80 |
$4,443 |
14.9× |
| Computed tomography, lower extremity; without contrast material Age Under 21 (73700) |
$983.40 |
$1,639 |
9.2× |
| Computed tomography, lower extremity; without contrast material, followed by contrast material(s) and further sections… (73702) |
$1,475.40 |
$2,459 |
8.2× |
| Computed tomography, lumbar spine; without contrast material, followed by contrast material(s) and further sections Age… (72133) |
$2,813.40 |
$4,689 |
15.7× |
| Computed tomography, maxillofacial area; with contrast material(s) Age Under 21 (70487) |
$1,845.07 |
$3,070 |
10.3× |
| Computed tomography, maxillofacial area; without contrast material Age Under 21 (70486) |
$1,476.06 |
$2,456 |
13.8× |
| Computed tomography, orbit, sella, or posterior fossa or outer, middle, or inner ear; with contrast material(s) Age… (70481) |
$1,837.26 |
$3,057 |
10.3× |
| Computed tomography, orbit, sella, or posterior fossa or outer, middle, or inner ear; without contrast material Age… (70480) |
$1,469.44 |
$2,445 |
13.8× |
| Computed tomography, orbit, sella, or posterior fossa or outer, middle, or inner ear; without contrast material,… (70482) |
$2,204.47 |
$3,668 |
12.3× |
| Computed tomography, soft tissue neck; without contrast material followed by contrast material(s) and further sections… (70492) |
$1,485.07 |
$2,471 |
8.3× |
| Computed tomography, thoracic spine; without contrast material, followed by contrast material(s) and further sections… (72130) |
$2,835 |
$4,725 |
15.8× |
| Computed tomography, thorax, diagnostic; without contrast material, followed by contrast material(s) and further… (71270) |
$1,367.40 |
$2,279 |
7.6× |
| CT abdomen and pelvis without and with contrast (74178) |
$1,911.60 |
$3,186 |
5.4× |
| CT abdomen and pelvis without contrast (74176) |
$1,274.40 |
$2,124 |
5.2× |
| CT abdomen w & w/o contrast (74170) |
$1,227 |
$2,045 |
6.8× |
| CT abdomen w/contrast (74160) |
$1,022.40 |
$1,704 |
5.7× |
| CT abdomen w/o contrast (74150) |
$817.80 |
$1,363 |
7.7× |
| CT angio hrt w/3d image (75574) |
$1,611.27 |
$3,242 |
4.5× |
| CT cervical spine w/contrast (72126) |
$2,221.80 |
$3,703 |
6.2× |
| CT cervical spine w/o contrast (72125) |
$1,777.20 |
$2,962 |
16.6× |
| CT chest w/contrast (71260) |
$1,139.40 |
$1,899 |
6.4× |
| CT extremity upper w & w/o contrast (73202) |
$2,037.60 |
$3,396 |
11.4× |
| CT extremity upper w/o contrast (73200) |
$1,358.40 |
$2,264 |
12.7× |
| CT head/brain with contrast (70460) |
$1,126.27 |
$1,874 |
6.3× |
| CT head/brain without and with contrast (70470) |
$1,351.65 |
$2,249 |
7.5× |
| CT heart no contrast quant eval coronry calcium (75571) |
$82.50 |
$166 |
0.9× |
| CT l-spine w/contrast (72132) |
$2,344.80 |
$3,908 |
6.6× |
| CT limited/localized follow up study (76380) |
$493.52 |
$993 |
5.6× |
| CT lower extremity w/dye (73701) |
$1,229.40 |
$2,049 |
6.9× |
| CT lumbar spine w/o contrast (72131) |
$1,875.60 |
$3,126 |
17.6× |
| CT maxillofacial w/wo contrast (70488) |
$2,214.08 |
$3,684 |
12.4× |
| CT neck w/contrast (70491) |
$1,237.46 |
$2,059 |
6.9× |
| CT neck w/o contrast (70490) |
$989.85 |
$1,647 |
9.3× |
| CT pelvis w & w/o contrast (72194) |
$2,685 |
$4,475 |
15.0× |
| CT pelvis w/o contrast (72192) |
$1,789.80 |
$2,983 |
16.8× |
| CT thoracic spine w/contrast (72129) |
$2,362.80 |
$3,938 |
13.2× |
| CT thoracic spine w/o contrast (72128) |
$1,890 |
$3,150 |
17.7× |
| CT thorax lung cancer scr c- (71271) |
$329.40 |
$549 |
3.1× |
| CT thorax w/o contrast (71250) |
$911.40 |
$1,519 |
8.5× |
| CT upper extremity w/dye (73201) |
$1,698 |
$2,830 |
4.8× |
| CTA head w contrast (70496) |
$1,419.56 |
$2,362 |
7.9× |
| Cystography, minimum of 3 views, radiological supervision and interpretation Age Under 21 (74430) |
$379.46 |
$539 |
1.1× |
| Doppler echocardiography, fetal, pulsed wave and/or continuous wave with spectral display; complete Age Under 21 (76827) |
$426.87 |
$510 |
4.0× |
| Dual-energy X-ray absorptiometry (DXA), bone density study, 1 or more sites; axial skeleton (eg, hips, pelvis, spine)… (77080) |
$319.62 |
$454 |
3.0× |
| Dxa bone density study axial skeleton (77085) |
$356.93 |
$507 |
3.3× |
| Dxa bone density/peripheral (77081) |
$332.99 |
$473 |
3.7× |
| Echocardiography, fetal, cardiovascular system, real time with image documentation (2D), with or without M-mode… (76825) |
$903.96 |
$1,080 |
1.6× |
| Echocardiography, fetal, cardiovascular system, real time with image documentation (2D), with or without M-mode… (76826) |
$415.99 |
$497 |
1.7× |
| Fetal biophys profile w/o nst (76819) |
$653.70 |
$781 |
6.1× |
| Fetal biophysical profile non-stress testing (76818) |
$709.78 |
$848 |
6.6× |
| Fluoroscopy up to 1 hour physician/qhp time (76000) |
$528 |
$750 |
2.2× |
| Gated heart planar single (78472) |
$1,206.50 |
$1,900 |
3.0× |
| Hepatobil syst imag inc gb w/pharma intervenj (78227) |
$1,645.29 |
$2,591 |
3.0× |
| Hepatobiliary syst imaging including gallbladder (78226) |
$1,201.42 |
$1,892 |
2.9× |
| Ht muscle image spect sing (78451) |
$2,619.38 |
$4,125 |
2.0× |
| Intestine imaging (eg, ectopic gastric mucosa, Meckel's localization, volvulus) Age Under 21 (78290) |
$1,077.60 |
$1,697 |
2.6× |
| Kidney imaging morphol - nm kidney cortex (78700) |
$485.78 |
$765 |
1.2× |
| Kidney imaging morphology; with vascular flow Age Under 21 (78701) |
$513.08 |
$808 |
1.3× |
| Kidney imaging morphology; with vascular flow and function, multiple studies, with and without pharmacological… (78709) |
$1,054.10 |
$1,660 |
1.9× |
| Kidney imaging morphology; with vascular flow and function, single study without pharmacological intervention Age Under… (78707) |
$664.84 |
$1,047 |
1.2× |
| Kidney imaging morphology; with vascular flow and function, single study, with pharmacological intervention (eg,… (78708) |
$506.10 |
$797 |
0.9× |
| Liver and spleen imaging (78215) |
$916.94 |
$1,444 |
2.2× |
| Liver and spleen imaging; with vascular flow Age Under 21 (78216) |
$434.98 |
$685 |
1.1× |
| Lung perf&ventilat diferentl (78598) |
$986.79 |
$1,554 |
1.8× |
| Lung perfusion imaging (78580) |
$730.88 |
$1,151 |
1.8× |
| Magnetic resonance (eg, proton) imaging, any joint of lower extremity; without contrast material(s), followed by… (73723) |
$2,778.38 |
$3,585 |
7.8× |
| Magnetic resonance (eg, proton) imaging, lower extremity other than joint; with contrast material(s) Age Under 21 (73719) |
$1,722.05 |
$2,222 |
4.8× |
| Magnetic resonance (eg, proton) imaging, lower extremity other than joint; without contrast material(s) Age Under 21 (73718) |
$1,377.17 |
$1,777 |
5.6× |
| Magnetic resonance (eg, proton) imaging, lower extremity other than joint; without contrast material(s), followed by… (73720) |
$2,066.15 |
$2,666 |
5.8× |
| Magnetic resonance (eg, proton) imaging, orbit, face, and/or neck; with contrast material(s) Age Under 21 (70542) |
$2,555.64 |
$3,720 |
7.2× |
| Magnetic resonance (eg, proton) imaging, orbit, face, and/or neck; without contrast material(s) Age Under 21 (70540) |
$2,044.51 |
$2,976 |
8.4× |
| Magnetic resonance (eg, proton) imaging, upper extremity, other than joint; with contrast material(s) Age Under 21 (73219) |
$2,247.50 |
$2,900 |
6.3× |
| Magnetic resonance (eg, proton) imaging, upper extremity, other than joint; without contrast material(s), followed by… (73220) |
$2,697 |
$3,480 |
7.6× |
| Magnetic resonance angiography, head; with contrast material(s) Age Under 21 (70545) |
$2,026.49 |
$2,649 |
5.7× |
| Magnetic resonance angiography, head; without contrast material(s), followed by contrast material(s) and further… (70546) |
$2,431.94 |
$3,179 |
6.8× |
| Magnetic resonance angiography, neck; without contrast material(s), followed by contrast material(s) and further… (70549) |
$4,215.92 |
$5,511 |
11.8× |
| Mammary ductogram single (77053) |
$290.05 |
$412 |
1.2× |
| Mandible min 4v (70110) |
$349.89 |
$497 |
3.3× |
| Mr safety determination physician/other qhp (76016) |
$93.63 |
$133 |
1.1× |
| Mr safety implant pos&/immoblj supvj phys/qhp (76019) |
$220.35 |
$313 |
3.7× |
| Mr safety implant&/fb assmt clin staf 1st 15 min (76014) |
$26.75 |
$38 |
0.9× |
| Mr safety implt electronics prepj supvj phys/qhp (76018) |
$144.32 |
$205 |
1.5× |
| Mr safety med physics xm customization plng&mntr (76017) |
$342.85 |
$487 |
1.4× |
| MRA head w/o contrast (70544) |
$1,621.04 |
$2,119 |
6.6× |
| MRA neck w/ contrast (70548) |
$3,513.64 |
$4,593 |
9.9× |
| MRA neck w/o contrast (70547) |
$2,810.61 |
$3,674 |
11.5× |
| MRI abdomen w/contrast (74182) |
$3,084.50 |
$3,980 |
8.7× |
| MRI abdomen w/o contrast (74181) |
$2,467.60 |
$3,184 |
10.1× |
| MRI abdomen w/wo contrast (74183) |
$3,701.40 |
$4,776 |
10.4× |
| MRI any jt lower extrem w/contrast material (73722) |
$2,315.70 |
$2,988 |
2.9× |
| MRI bone marrow (77084) |
$1,818.92 |
$2,347 |
7.5× |
| MRI breast c- bilateral (77047) |
$1,393.45 |
$1,798 |
5.7× |
| MRI breast without contrast material unilateral (77046) |
$885.05 |
$1,142 |
3.6× |
| MRI c-spine w&w/o cont (72156) |
$1,841.03 |
$2,604 |
5.2× |
| MRI cervical spine w/contrast (72142) |
$1,534.19 |
$2,170 |
4.3× |
| MRI chest w/contrast (71551) |
$2,796.20 |
$3,608 |
3.5× |
| MRI chest w/o contrast (71550) |
$2,236.65 |
$2,886 |
9.2× |
| MRI chest w/wo contrast (71552) |
$3,354.98 |
$4,329 |
9.4× |
| MRI joint upr extr w/o&w/dye (73223) |
$2,207.98 |
$2,849 |
6.2× |
| MRI joint upr extrem w/dye (73222) |
$1,839.85 |
$2,374 |
2.3× |
| MRI joint upr extrem w/o dye (73221) |
$1,471.73 |
$1,899 |
6.0× |
| MRI lumbar spine w/contrast (72149) |
$1,534.19 |
$2,170 |
4.3× |
| MRI lumbar spine w/wo contrast (72158) |
$1,841.03 |
$2,604 |
5.2× |
| MRI orbit/face/neck w&w/o cont (70543) |
$3,066.77 |
$4,464 |
8.6× |
| MRI pelvis w & w/o contrast (72197) |
$2,403.28 |
$3,101 |
6.7× |
| MRI pelvis w/contrast (72196) |
$2,002.60 |
$2,584 |
5.6× |
| MRI pelvis w/o contrast (72195) |
$1,601.92 |
$2,067 |
6.6× |
| MRI spine cervical w/o contrast (72141) |
$1,227.35 |
$1,736 |
5.0× |
| MRI t-spine w&w/o cont (72157) |
$1,841.03 |
$2,604 |
5.2× |
| MRI thoracic spine w/contrast (72147) |
$1,534.19 |
$2,170 |
4.3× |
| MRI thoracic spine w/o contrst (72146) |
$1,227.35 |
$1,736 |
5.0× |
| MRI tmj (70336) |
$2,400.18 |
$3,097 |
9.8× |
| MRI upper extremity oth than jt w/o contr matrl (73218) |
$1,798 |
$2,320 |
7.4× |
| Myocardial spect multiple studies (78452) |
$3,383.92 |
$5,329 |
2.6× |
| N-invas est c ffr augmnt sw alys CTA i&r phy/qhp (75580) |
$4,604.51 |
$6,416 |
5.2× |
| Nm bone 3 phase (78315) |
$1,760.86 |
$2,773 |
4.3× |
| Nm bone imaging whole body (78306) |
$1,531.62 |
$2,412 |
3.8× |
| Nm gastric emptying (78264) |
$1,363.98 |
$2,148 |
3.3× |
| Nm lung ventilation imaging (78579) |
$518.16 |
$816 |
1.3× |
| Nuclear medicine study of bone and/or joint limited area (78300) |
$712.47 |
$1,122 |
1.7× |
| Nuclear medicine study of bone and/or joint multiple areas (78305) |
$845.82 |
$1,332 |
2.1× |
| Nuclear medicine study of stomach lining (78261) |
$513.08 |
$808 |
1.3× |
| Ob us limited fetus(s) (76815) |
$446.96 |
$534 |
4.2× |
| Optic foramina (70190) |
$197.12 |
$280 |
2.2× |
| Parathyroid planar imaging (78070) |
$730.88 |
$1,151 |
1.8× |
| Pulmonary ventilation & perfusion imaging (78582) |
$1,156.97 |
$1,822 |
2.1× |
| Quant differential pulm perfusion w/wo imaging (78597) |
$603.25 |
$950 |
1.5× |
| Radex abscess/fistula/sinus tract rs&i (76080) |
$503.36 |
$715 |
0.9× |
| Radex entir thrc lmbr crv sac spi w/skull 1 vw (72081) |
$244.29 |
$347 |
2.7× |
| Radex entir thrc lmbr crv sac spi w/skull 2/3 vw (72082) |
$350.59 |
$498 |
3.3× |
| Radex entir thrc lmbr crv sac spi w/skull 4/5 vw (72083) |
$398.46 |
$566 |
3.7× |
| Radex entir thrc lmbr crv sac spi w/skull 6/> vw (72084) |
$413.25 |
$587 |
3.9× |
| Radex hip unilateral with pelvis 1 view (73501) |
$155.58 |
$221 |
1.7× |
| Radex hip unilateral with pelvis 2-3 views (73502) |
$292.16 |
$415 |
3.3× |
| Radex hips bilateral with pelvis 2 views (73521) |
$192.19 |
$273 |
1.8× |
| Radex hips bilateral with pelvis minimum 5 views (73523) |
$495.62 |
$704 |
4.6× |
| Radex spine cervical 2 or 3 views (72040) |
$330.88 |
$470 |
3.7× |
| Radex spine cervical 4 or 5 views (72050) |
$455.49 |
$647 |
4.3× |
| Radex spine cervical 6 or more views (72052) |
$537.15 |
$763 |
5.0× |
| Radiologic exam abdomen 3+ views (74021) |
$299.90 |
$426 |
2.8× |
| Radiologic exam chest 3 views (71047) |
$290.36 |
$476 |
3.3× |
| Radiologic exam chest 4+ views (71048) |
$328.18 |
$538 |
3.1× |
| Radiologic exam colon double contrast study (74280) |
$713.15 |
$1,013 |
4.0× |
| Radiologic exam colon single contrast study (74270) |
$642.75 |
$913 |
3.6× |
| Radiologic exam esophagus single contrast study (74220) |
$307.65 |
$437 |
1.7× |
| Radiologic exam small int single contrast study (74250) |
$424.51 |
$603 |
2.4× |
| Radiologic exam swallow function contrast study (74230) |
$432.96 |
$615 |
2.4× |
| Radiologic exam upr gi trc double contrast study (74246) |
$622.34 |
$884 |
3.5× |
| Radiologic exam upr gi trc single contrast study (74240) |
$468.86 |
$666 |
2.6× |
| Radiologic examination femur 1 view (73551) |
$130.94 |
$186 |
1.5× |
| Radiologic examination femur minimum 2 views (73552) |
$194.30 |
$276 |
2.2× |
| Radiologic examination, ankle; complete, minimum of 3 views Age Under 21 (73610) |
$331.58 |
$471 |
3.7× |
| Radiologic examination, complete acute abdomen series, including 2 or more views of the abdomen (eg, supine, erect,… (74022) |
$347.07 |
$493 |
3.2× |
| Radiologic examination, elbow; 2 views Age Under 21 (73070) |
$274.56 |
$390 |
3.1× |
| Radiologic examination, elbow; complete, minimum of 3 views Age Under 21 (73080) |
$338.62 |
$481 |
3.8× |
| Radiologic examination, facial bones; less than 3 views Age Under 21 (70140) |
$275.97 |
$392 |
3.1× |
| Radiologic examination, foot; complete, minimum of 3 views Age Under 21 (73630) |
$312.58 |
$444 |
3.5× |
| Radiologic examination, hand; minimum of 3 views Age Under 21 (73130) |
$250.62 |
$356 |
2.8× |
| Radiologic examination, internal auditory meati, complete Age Under 21 (70134) |
$345.66 |
$491 |
0.6× |
| Radiologic examination, knee; complete, 4 or more views Age Under 21 (73564) |
$411.84 |
$585 |
3.9× |
| Radiologic examination, mandible; partial, less than 4 views Age Under 21 (70100) |
$330.88 |
$470 |
3.7× |
| Radiologic examination, mastoids; complete, minimum of 3 views per side Age Under 21 (70130) |
$230.91 |
$328 |
2.2× |
| Radiologic examination, nasal bones, complete, minimum of 3 views Age Under 21 (70160) |
$242.18 |
$344 |
2.7× |
| Radiologic examination, ribs, bilateral; including posteroanterior chest, minimum of 4 views Age Under 21 (71111) |
$394.94 |
$561 |
3.7× |
| Radiologic examination, ribs, unilateral; including posteroanterior chest, minimum of 3 views Age Under 21 (71101) |
$313.98 |
$446 |
2.9× |
| Radiologic examination, shoulder, arthrography, radiological supervision and interpretation Age Under 21 (73040) |
$658.81 |
$918 |
1.8× |
| Radiologic examination, shoulder; complete, minimum of 2 views Age Under 21 (73030) |
$312.58 |
$444 |
3.5× |
| Radiologic examination, sinuses, paranasal, less than 3 views Age Under 21 (70210) |
$195.01 |
$277 |
2.2× |
| Radiologic examination, skull; less than 4 views Age Under 21 (70250) |
$289.34 |
$411 |
2.7× |
| Radiologic examination, spine, lumbosacral; 2 or 3 views Age Under 21 (72100) |
$264 |
$375 |
2.5× |
| Radiologic examination, spine, lumbosacral; bending views only, 2 or 3 views Age Under 21 (72120) |
$516.74 |
$734 |
4.8× |
| Radiologic examination, spine, lumbosacral; complete, including bending views, minimum of 6 views Age Under 21 (72114) |
$599.81 |
$852 |
5.6× |
| Radiologic examination, wrist; complete, minimum of 3 views Age Under 21 (73110) |
$311.17 |
$442 |
3.5× |
| Radiologic examination; acromioclavicular joints, bilateral, with or without weighted distraction Age Under 21 (73050) |
$265.41 |
$377 |
3.0× |
| Radiologic examination; humerus, minimum of 2 views Age Under 21 (73060) |
$301.31 |
$428 |
3.4× |
| Radiologic examination; lower extremity, infant, minimum of 2 views Age Under 21 (73592) |
$130.94 |
$186 |
1.5× |
| Radiologic examination; orbits, complete, minimum of 4 views Age Under 21 (70200) |
$366.08 |
$520 |
3.4× |
| Radiologic examination; sternoclavicular joint or joints, minimum of 3 views Age Under 21 (71130) |
$259.07 |
$368 |
2.9× |
| Radiologic examination; toe(s), minimum of 2 views Age Under 21 (73660) |
$180.93 |
$257 |
2.0× |
| Radiologic examination; upper extremity, infant, minimum of 2 views Age Under 21 (73092) |
$247.81 |
$352 |
2.3× |
| Radiopharmaceutical localization of tumor, inflammatory process or distribution of radiopharmaceutical agent(s)… (78803) |
$1,042.04 |
$1,641 |
1.9× |
| Review by radiologist of urinary bladder and urethra images with contrast and after passing urine (74455) |
$566.72 |
$805 |
2.3× |
| Rp loclzj tum plnr 1 area single day imaging (78800) |
$521.34 |
$821 |
1.3× |
| Rp loclzj tum plnr whole body single day imaging (78802) |
$873.12 |
$1,375 |
1.6× |
| Scapula complete (73010) |
$188.67 |
$268 |
1.8× |
| Screening digital breast tomosynthesis bi (77063) |
$40.82 |
$49 |
— |
| Testicular imaging with vascular flow Age Under 21 (78761) |
$584.20 |
$920 |
1.4× |
| Thyroid imaging with vascular flow (78013) |
$617.22 |
$972 |
1.5× |
| Thyroid uptake w/blood flow sngle/mult quan meas (78014) |
$840.10 |
$1,323 |
2.1× |
| Ultrasound breast limited (76642) |
$486.30 |
$581 |
5.5× |
| Ultrasound, abdomen limited (76705) |
$745.77 |
$891 |
7.0× |
| Ultrasound, limited, joint or focal evaluation of other nonvascular extremity structure(s) (eg, joint space,… (76882) |
$490.48 |
$586 |
4.6× |
| Ultrasound, pelvic (nonobstetric), real time with image documentation; complete Age Under 21 (76856) |
$874.66 |
$1,045 |
8.2× |
| Ultrasound, pregnant uterus, real time with image documentation, fetal and maternal evaluation plus detailed fetal… (76811) |
$522.29 |
$624 |
2.1× |
| Ultrasound, pregnant uterus, real time with image documentation, fetal and maternal evaluation, first trimester (< 14… (76801) |
$747.44 |
$893 |
7.0× |
| Ureteral reflux study (78740) |
$535.31 |
$843 |
1.3× |
| Urethrocystography retrograde rs&i (74450) |
$500.54 |
$711 |
2.1× |
| Urography (pyelography), intravenous, with or without KUB, with or without tomography Age Under 21 (74400) |
$1,085.57 |
$1,542 |
6.1× |
| Urography antegrade rs&i (74425) |
$499.14 |
$709 |
1.4× |
| Urography, infusion, drip technique and/or bolus technique; with nephrotomography Age Under 21 (74415) |
$980.67 |
$1,393 |
5.5× |
| Us abdominal aorta real time screen study aaa (76706) |
$321.41 |
$384 |
3.0× |
| Us breast uni real time with image complete (76641) |
$592.60 |
$708 |
5.5× |
| Us chest (76604) |
$497.18 |
$594 |
4.7× |
| Us compl joint r-t w/image documentation (76881) |
$760.83 |
$909 |
7.1× |
| Us elastography organ (76981) |
$252.77 |
$302 |
2.4× |
| Us exam, pelvic, limited (76857) |
$641.14 |
$766 |
6.0× |
| US OB Follow-Up/Repeat (76816) |
$454.49 |
$543 |
4.3× |
| Us ob transvaginal (76817) |
$576.69 |
$689 |
5.4× |
| Us retroperitoneal complete (76770) |
$859.60 |
$1,027 |
8.0× |
| Us retroperitoneal ltd (76775) |
$282.07 |
$337 |
2.6× |
| Us scrotum (76870) |
$805.19 |
$962 |
7.5× |
| Us soft tissue head/neck (76536) |
$779.25 |
$931 |
7.3× |
| Use 1st target lesion (76982) |
$217.62 |
$260 |
2.0× |
| Venography, extremity, bilateral, radiological supervision and interpretation Age Under 21 (75822) |
$555.46 |
$789 |
0.3× |
| Venography, extremity, unilateral, radiological supervision and interpretation Age Under 21 (75820) |
$475.20 |
$675 |
0.3× |
| X-ray exam hips bi 3-4 views (73522) |
$313.28 |
$445 |
2.9× |
| X-ray exam of finger(s) (73140) |
$184.45 |
$262 |
2.1× |
| X-ray exam of knee 1 or 2 (73560) |
$221.76 |
$315 |
2.5× |
| X-ray exam ribs bil 3 views (71110) |
$321.73 |
$457 |
3.0× |
| X-ray exam ribs uni 2 views (71100) |
$276.67 |
$393 |
3.1× |
| X-ray heel (73650) |
$164.74 |
$234 |
1.9× |
| X-ray of joint between lower spine and hip bone 3 or more views|PROFESSIONAL COMPONENT (72202) |
$370.30 |
$526 |
3.5× |
| X-ray retrograde pyelogram (74420) |
$604.74 |
$859 |
1.7× |
| Xr abdomen 1 view (74018) |
$158.40 |
$225 |
1.8× |
| Xr abdomen 2 views (74019) |
$286.53 |
$407 |
2.7× |
| Xr arthrogram ankle (73615) |
$457.15 |
$637 |
1.3× |
| Xr arthrogram elbow (73085) |
$431.31 |
$601 |
1.2× |
| Xr arthrogram hip (73525) |
$693.98 |
$967 |
1.9× |
| Xr arthrogram knee (73580) |
$400.45 |
$558 |
1.1× |
| Xr arthrogram wrist (73115) |
$490.88 |
$684 |
1.4× |
| Xr bone age studies (77072) |
$168.96 |
$240 |
1.6× |
| Xr bone length study (77073) |
$400.58 |
$569 |
3.8× |
| Xr bone survey infant (77076) |
$349.89 |
$497 |
3.3× |
| Xr chest 1 view (71045) |
$134.20 |
$220 |
1.5× |
| Xr chest 2 views (71046) |
$281.82 |
$462 |
3.2× |
| Xr eye foreign body (70030) |
$118.27 |
$168 |
1.3× |
| Xr facial bones 3+ views (70150) |
$322.43 |
$458 |
3.0× |
| Xr foot arthritis pa only bilateral - report(ortho pro) (73620) |
$218.24 |
$310 |
2.5× |
| Xr forearm 2 views (73090) |
$226.69 |
$322 |
2.5× |
| Xr hand 2v (73120) |
$161.22 |
$229 |
1.5× |
| Xr myelogram c-spine (72240) |
$1,526.98 |
$2,169 |
1.9× |
| Xr myelogram l-spine (72265) |
$1,548.10 |
$2,199 |
1.9× |
| Xr myelogram t-spine (72255) |
$1,217.22 |
$1,729 |
1.5× |
| Xr neck soft tissue (70360) |
$218.94 |
$311 |
2.5× |
| Xr o knee w/ merchant view bilat - report(ortho pro) (73562) |
$270.34 |
$384 |
3.0× |
| Xr osseous survey complete (77075) |
$347.07 |
$493 |
3.2× |
| Xr pelvis 1-2 views (72170) |
$173.89 |
$247 |
1.6× |
| Xr pelvis min 3 view (72190) |
$260.48 |
$370 |
2.4× |
| Xr sacrum/coccyx 2+ views (72220) |
$223.87 |
$318 |
2.5× |
| Xr shoulder 1 view (73020) |
$226.69 |
$322 |
2.5× |
| Xr sinuses 3+ views (70220) |
$306.24 |
$435 |
3.4× |
| Xr skull min 4 view (70260) |
$332.29 |
$472 |
3.1× |
| Xr spine 1 view (72020) |
$232.32 |
$330 |
2.6× |
| Xr spine thoracic 3v (72072) |
$359.74 |
$511 |
3.4× |
| Xr sternum 2+ views (71120) |
$163.33 |
$232 |
1.8× |
| Xr surgical specimen (76098) |
$181.63 |
$258 |
0.3× |
| Xr t-spine 2 views (72070) |
$347.07 |
$493 |
3.2× |
| Xr tibia/fibula 2 views (73590) |
$187.26 |
$266 |
2.1× |
| Xr tmj bilateral (70330) |
$274.56 |
$390 |
3.1× |
| Xr wrist 2 views (73100) |
$218.24 |
$310 |
2.5× |