| Acute gi blood loss imaging (78278) |
$1,157.50 |
$2,315 |
2.7× |
| Ankle 2 views (73600) |
$177.75 |
$355.50 |
1.9× |
| Clavicle complete (73000) |
$177.75 |
$355.50 |
1.9× |
| Computed tomographic angiography, abdomen and pelvis, with contrast material(s), including noncontrast images, if… (74174) |
$2,811 |
$5,622 |
7.6× |
| Computed tomographic angiography, abdomen, with contrast material(s), including noncontrast images, if performed, and… (74175) |
$1,505.75 |
$3,011.50 |
8.1× |
| Computed tomographic angiography, abdominal aorta and bilateral iliofemoral lower extremity runoff, with contrast… (75635) |
$1,921.25 |
$3,842.50 |
10.4× |
| Computed tomographic angiography, chest (noncoronary), with contrast material(s), including noncontrast images, if… (71275) |
$1,713.25 |
$3,426.50 |
9.3× |
| Computed tomographic angiography, lower extremity, with contrast material(s), including noncontrast images, if… (73706) |
$1,743 |
$3,486 |
9.4× |
| Computed tomographic angiography, neck, with contrast material(s), including noncontrast images, if performed, and… (70498) |
$1,565.25 |
$3,130.50 |
8.5× |
| Computed tomographic angiography, upper extremity, with contrast material(s), including noncontrast images, if… (73206) |
$1,664.50 |
$3,329 |
9.0× |
| Computed tomography, lower extremity; without contrast material Age Under 21 (73700) |
$1,068 |
$2,136 |
9.7× |
| Computed tomography, lower extremity; without contrast material, followed by contrast material(s) and further sections… (73702) |
$1,512 |
$3,024 |
8.2× |
| Computed tomography, lumbar spine; without contrast material, followed by contrast material(s) and further sections Age… (72133) |
$1,585 |
$3,170 |
8.6× |
| Computed tomography, maxillofacial area; with contrast material(s) Age Under 21 (70487) |
$1,209 |
$2,418 |
6.5× |
| Computed tomography, maxillofacial area; without contrast material Age Under 21 (70486) |
$949.25 |
$1,898.50 |
8.6× |
| Computed tomography, orbit, sella, or posterior fossa or outer, middle, or inner ear; without contrast material Age… (70480) |
$1,127 |
$2,254 |
10.2× |
| Computed tomography, orbit, sella, or posterior fossa or outer, middle, or inner ear; without contrast material,… (70482) |
$1,473.50 |
$2,947 |
8.0× |
| Computed tomography, soft tissue neck; without contrast material followed by contrast material(s) and further sections… (70492) |
$1,624.75 |
$3,249.50 |
8.8× |
| Computed tomography, thorax, diagnostic; without contrast material, followed by contrast material(s) and further… (71270) |
$1,664.50 |
$3,329 |
9.0× |
| CT abdomen and pelvis without and with contrast (74178) |
$2,514.25 |
$5,028.50 |
6.8× |
| CT abdomen and pelvis without contrast (74176) |
$1,661 |
$3,322 |
6.6× |
| CT abdomen w & w/o contrast (74170) |
$1,683.50 |
$3,367 |
9.1× |
| CT abdomen w/contrast (74160) |
$1,476 |
$2,952 |
8.0× |
| CT abdomen w/o contrast (74150) |
$1,097.75 |
$2,195.50 |
10.0× |
| CT cervical spine w/contrast (72126) |
$1,481.50 |
$2,963 |
4.0× |
| CT cervical spine w/o contrast (72125) |
$1,127 |
$2,254 |
10.2× |
| CT chest w/contrast (71260) |
$1,446.25 |
$2,892.50 |
7.8× |
| CT extremity upper w & w/o contrast (73202) |
$1,512 |
$3,024 |
8.2× |
| CT extremity upper w/o contrast (73200) |
$1,068 |
$2,136 |
9.7× |
| CT head/brain with contrast (70460) |
$1,387.25 |
$2,774.50 |
7.5× |
| CT head/brain without and with contrast (70470) |
$1,603.50 |
$3,207 |
8.7× |
| CT heart no contrast quant eval coronry calcium (75571) |
$119 |
$238 |
1.3× |
| CT l-spine w/contrast (72132) |
$1,446.25 |
$2,892.50 |
3.9× |
| CT lower extremity w/dye (73701) |
$1,357.50 |
$2,715 |
7.3× |
| CT lumbar spine w/o contrast (72131) |
$1,127 |
$2,254 |
10.2× |
| CT maxillofacial w/wo contrast (70488) |
$1,360.50 |
$2,721 |
7.4× |
| CT neck w/contrast (70491) |
$1,446.25 |
$2,892.50 |
7.8× |
| CT neck w/o contrast (70490) |
$1,154.50 |
$2,309 |
10.5× |
| CT pelvis w & w/o contrast (72194) |
$1,566 |
$3,132 |
8.5× |
| CT pelvis w/o contrast (72192) |
$1,127 |
$2,254 |
10.2× |
| CT thoracic spine w/contrast (72129) |
$1,481.50 |
$2,963 |
8.0× |
| CT thoracic spine w/o contrast (72128) |
$1,127 |
$2,254 |
10.2× |
| CT thorax lung cancer scr c- (71271) |
$148 |
$296 |
1.3× |
| CT thorax w/o contrast (71250) |
$1,127 |
$2,254 |
10.2× |
| CT upper extremity w/dye (73201) |
$1,299.75 |
$2,599.50 |
3.5× |
| CTA head w contrast (70496) |
$1,565.25 |
$3,130.50 |
8.5× |
| Cystography, minimum of 3 views, radiological supervision and interpretation Age Under 21 (74430) |
$486 |
$972 |
1.3× |
| Dual-energy X-ray absorptiometry (DXA), bone density study, 1 or more sites; axial skeleton (eg, hips, pelvis, spine)… (77080) |
$237.25 |
$474.50 |
2.2× |
| Fetal biophysical profile non-stress testing (76818) |
$486 |
$972 |
4.4× |
| Fluoroscopy up to 1 hour physician/qhp time (76000) |
$334.50 |
$669 |
1.3× |
| Hepatobil syst imag inc gb w/pharma intervenj (78227) |
$1,423.75 |
$2,847.50 |
2.5× |
| Hepatobiliary syst imaging including gallbladder (78226) |
$1,299.75 |
$2,599.50 |
3.1× |
| Ht muscle image spect sing (78451) |
$1,582 |
$3,164 |
1.2× |
| Intestine imaging (eg, ectopic gastric mucosa, Meckel's localization, volvulus) Age Under 21 (78290) |
$881.50 |
$1,763 |
2.1× |
| Kidney imaging morphology; with vascular flow Age Under 21 (78701) |
$723.50 |
$1,447 |
1.7× |
| Kidney imaging morphology; with vascular flow and function, multiple studies, with and without pharmacological… (78709) |
$1,350 |
$2,700 |
2.4× |
| Lung perf&ventilat diferentl (78598) |
$2,218.50 |
$4,437 |
3.9× |
| Magnetic resonance (eg, proton) imaging, any joint of lower extremity; without contrast material(s), followed by… (73723) |
$2,336.50 |
$4,673 |
6.3× |
| Magnetic resonance (eg, proton) imaging, lower extremity other than joint; without contrast material(s) Age Under 21 (73718) |
$1,602 |
$3,204 |
6.4× |
| Magnetic resonance (eg, proton) imaging, lower extremity other than joint; without contrast material(s), followed by… (73720) |
$2,336.50 |
$4,673 |
6.3× |
| Magnetic resonance (eg, proton) imaging, orbit, face, and/or neck; with contrast material(s) Age Under 21 (70542) |
$1,500.50 |
$3,001 |
4.1× |
| Magnetic resonance (eg, proton) imaging, orbit, face, and/or neck; without contrast material(s) Age Under 21 (70540) |
$1,641 |
$3,282 |
6.5× |
| Magnetic resonance (eg, proton) imaging, upper extremity, other than joint; without contrast material(s), followed by… (73220) |
$2,336.50 |
$4,673 |
6.3× |
| Magnetic resonance angiography, neck; without contrast material(s), followed by contrast material(s) and further… (70549) |
$2,089.50 |
$4,179 |
5.7× |
| Mandible min 4v (70110) |
$356.25 |
$712.50 |
3.2× |
| Mr safety implant&/fb assmt clin staf 1st 15 min (76014) |
$38.50 |
$77 |
1.3× |
| MRA head w/o contrast (70544) |
$1,645.25 |
$3,290.50 |
6.5× |
| MRA neck w/ contrast (70548) |
$1,551 |
$3,102 |
4.2× |
| MRA neck w/o contrast (70547) |
$1,641 |
$3,282 |
6.5× |
| MRI abdomen w/contrast (74182) |
$2,332.50 |
$4,665 |
6.3× |
| MRI abdomen w/o contrast (74181) |
$1,957.75 |
$3,915.50 |
7.8× |
| MRI abdomen w/wo contrast (74183) |
$2,396 |
$4,792 |
6.5× |
| MRI any jt lower extrem w/contrast material (73722) |
$2,217.50 |
$4,435 |
2.7× |
| MRI breast c- bilateral (77047) |
$1,884 |
$3,768 |
7.5× |
| MRI c-spine w&w/o cont (72156) |
$2,336.50 |
$4,673 |
6.3× |
| MRI cervical spine w/contrast (72142) |
$1,943 |
$3,886 |
5.3× |
| MRI chest w/o contrast (71550) |
$1,641 |
$3,282 |
6.5× |
| MRI chest w/wo contrast (71552) |
$2,393.50 |
$4,787 |
6.5× |
| MRI joint upr extr w/o&w/dye (73223) |
$2,336.50 |
$4,673 |
6.3× |
| MRI joint upr extrem w/dye (73222) |
$2,039.75 |
$4,079.50 |
2.5× |
| MRI joint upr extrem w/o dye (73221) |
$1,602 |
$3,204 |
6.4× |
| MRI lumbar spine w/contrast (72149) |
$2,089.50 |
$4,179 |
5.7× |
| MRI lumbar spine w/wo contrast (72158) |
$2,336.50 |
$4,673 |
6.3× |
| MRI orbit/face/neck w&w/o cont (70543) |
$2,336.50 |
$4,673 |
6.3× |
| MRI pelvis w & w/o contrast (72197) |
$2,336.50 |
$4,673 |
6.3× |
| MRI pelvis w/o contrast (72195) |
$1,602 |
$3,204 |
6.4× |
| MRI spine cervical w/o contrast (72141) |
$1,602 |
$3,204 |
6.4× |
| MRI t-spine w&w/o cont (72157) |
$2,336.50 |
$4,673 |
6.3× |
| MRI thoracic spine w/o contrst (72146) |
$1,602 |
$3,204 |
6.4× |
| MRI tmj (70336) |
$1,641 |
$3,282 |
6.5× |
| MRI upper extremity oth than jt w/o contr matrl (73218) |
$1,602 |
$3,204 |
6.4× |
| Myocardial spect multiple studies (78452) |
$2,818.25 |
$5,636.50 |
2.1× |
| Nm bone 3 phase (78315) |
$1,453.50 |
$2,907 |
3.4× |
| Nm bone imaging whole body (78306) |
$1,305.25 |
$2,610.50 |
3.1× |
| Nm gastric emptying (78264) |
$1,290.50 |
$2,581 |
3.1× |
| Nm lung ventilation imaging (78579) |
$810.50 |
$1,621 |
1.9× |
| Ob us limited fetus(s) (76815) |
$296.75 |
$593.50 |
2.7× |
| Parathyroid planar imaging (78070) |
$1,186.50 |
$2,373 |
2.8× |
| Pulmonary ventilation & perfusion imaging (78582) |
$2,165.25 |
$4,330.50 |
3.8× |
| Radex entir thrc lmbr crv sac spi w/skull 1 vw (72081) |
$356.25 |
$712.50 |
3.9× |
| Radex hip unilateral with pelvis 1 view (73501) |
$148 |
$296 |
1.6× |
| Radex hip unilateral with pelvis 2-3 views (73502) |
$237.25 |
$474.50 |
2.6× |
| Radex spine cervical 2 or 3 views (72040) |
$237.25 |
$474.50 |
2.6× |
| Radex spine cervical 4 or 5 views (72050) |
$296.75 |
$593.50 |
2.7× |
| Radex spine cervical 6 or more views (72052) |
$296.75 |
$593.50 |
2.7× |
| Radex spine thoracolumbar junction min 2 views (72080) |
$237.25 |
$474.50 |
2.6× |
| Radiologic exam chest 4+ views (71048) |
$243 |
$486 |
2.2× |
| Radiologic exam colon double contrast study (74280) |
$790 |
$1,580 |
4.3× |
| Radiologic exam colon single contrast study (74270) |
$652.50 |
$1,305 |
3.5× |
| Radiologic exam esophagus single contrast study (74220) |
$534 |
$1,068 |
2.9× |
| Radiologic exam small int single contrast study (74250) |
$504.25 |
$1,008.50 |
2.7× |
| Radiologic exam swallow function contrast study (74230) |
$608 |
$1,216 |
3.3× |
| Radiologic exam upr gi trc double contrast study (74246) |
$593.50 |
$1,187 |
3.2× |
| Radiologic examination femur minimum 2 views (73552) |
$182 |
$364 |
2.0× |
| Radiologic examination from nose to rectum for foreign body, single view, child Age Under 21 (76010) |
$148 |
$296 |
1.6× |
| Radiologic examination, ankle; complete, minimum of 3 views Age Under 21 (73610) |
$237.25 |
$474.50 |
2.6× |
| Radiologic examination, complete acute abdomen series, including 2 or more views of the abdomen (eg, supine, erect,… (74022) |
$326.50 |
$653 |
3.0× |
| Radiologic examination, elbow; 2 views Age Under 21 (73070) |
$177.75 |
$355.50 |
1.9× |
| Radiologic examination, elbow; complete, minimum of 3 views Age Under 21 (73080) |
$237.25 |
$474.50 |
2.6× |
| Radiologic examination, facial bones; less than 3 views Age Under 21 (70140) |
$237.25 |
$474.50 |
2.6× |
| Radiologic examination, foot; complete, minimum of 3 views Age Under 21 (73630) |
$237.25 |
$474.50 |
2.6× |
| Radiologic examination, hand; minimum of 3 views Age Under 21 (73130) |
$251.75 |
$503.50 |
2.7× |
| Radiologic examination, knee; both knees, standing, anteroposterior Age Under 21 (73565) |
$148 |
$296 |
1.6× |
| Radiologic examination, knee; complete, 4 or more views Age Under 21 (73564) |
$267 |
$534 |
2.4× |
| Radiologic examination, mandible; partial, less than 4 views Age Under 21 (70100) |
$318 |
$636 |
3.5× |
| Radiologic examination, nasal bones, complete, minimum of 3 views Age Under 21 (70160) |
$326.50 |
$653 |
3.6× |
| Radiologic examination, ribs, bilateral; including posteroanterior chest, minimum of 4 views Age Under 21 (71111) |
$356.25 |
$712.50 |
3.2× |
| Radiologic examination, ribs, unilateral; including posteroanterior chest, minimum of 3 views Age Under 21 (71101) |
$326.50 |
$653 |
3.0× |
| Radiologic examination, sacroiliac joints; less than 3 views Age Under 21 (72200) |
$237.25 |
$474.50 |
2.2× |
| Radiologic examination, shoulder, arthrography, radiological supervision and interpretation Age Under 21 (73040) |
$972.50 |
$1,945 |
2.6× |
| Radiologic examination, shoulder; complete, minimum of 2 views Age Under 21 (73030) |
$237.25 |
$474.50 |
2.6× |
| Radiologic examination, skull; less than 4 views Age Under 21 (70250) |
$237.25 |
$474.50 |
2.2× |
| Radiologic examination, spine, lumbosacral; 2 or 3 views Age Under 21 (72100) |
$243 |
$486 |
2.2× |
| Radiologic examination, spine, lumbosacral; complete, including bending views, minimum of 6 views Age Under 21 (72114) |
$296.75 |
$593.50 |
2.7× |
| Radiologic examination, wrist; complete, minimum of 3 views Age Under 21 (73110) |
$251.75 |
$503.50 |
2.7× |
| Radiologic examination; acromioclavicular joints, bilateral, with or without weighted distraction Age Under 21 (73050) |
$237.25 |
$474.50 |
2.6× |
| Radiologic examination; humerus, minimum of 2 views Age Under 21 (73060) |
$177.75 |
$355.50 |
1.9× |
| Radiologic examination; lower extremity, infant, minimum of 2 views Age Under 21 (73592) |
$177.75 |
$355.50 |
1.9× |
| Radiologic examination; orbits, complete, minimum of 4 views Age Under 21 (70200) |
$243 |
$486 |
2.2× |
| Radiologic examination; toe(s), minimum of 2 views Age Under 21 (73660) |
$177.75 |
$355.50 |
1.9× |
| Radiologic examination; upper extremity, infant, minimum of 2 views Age Under 21 (73092) |
$182 |
$364 |
1.7× |
| Review by radiologist of urinary bladder and urethra images with contrast and after passing urine (74455) |
$547 |
$1,094 |
2.2× |
| Saline infusion sonohysterography (SIS), including color flow Doppler, when performed Age Under 21 (76831) |
$334.50 |
$669 |
1.3× |
| Scapula complete (73010) |
$177.75 |
$355.50 |
1.6× |
| Screening digital breast tomosynthesis bi (77063) |
$38.50 |
$77 |
— |
| Thyroid uptake w/blood flow sngle/mult quan meas (78014) |
$2,165.25 |
$4,330.50 |
5.1× |
| Ultrasound breast limited (76642) |
$198.50 |
$397 |
2.2× |
| Ultrasound, abdomen limited (76705) |
$415.25 |
$830.50 |
3.8× |
| Ultrasound, pelvic (nonobstetric), real time with image documentation; complete Age Under 21 (76856) |
$356.25 |
$712.50 |
3.2× |
| Ultrasound, pregnant uterus, real time with image documentation, fetal and maternal evaluation, first trimester (< 14… (76801) |
$385.50 |
$771 |
3.5× |
| Urography (pyelography), intravenous, with or without KUB, with or without tomography Age Under 21 (74400) |
$665.50 |
$1,331 |
3.6× |
| Us abdominal aorta real time screen study aaa (76706) |
$192.75 |
$385.50 |
1.7× |
| Us breast uni real time with image complete (76641) |
$608 |
$1,216 |
5.5× |
| Us chest (76604) |
$504.25 |
$1,008.50 |
4.6× |
| Us compl joint r-t w/image documentation (76881) |
$296.75 |
$593.50 |
2.7× |
| Us elastography organ (76981) |
$282 |
$564 |
2.6× |
| Us encephalogram (76506) |
$415.25 |
$830.50 |
3.8× |
| Us exam, pelvic, limited (76857) |
$296.75 |
$593.50 |
2.7× |
| Us inft hips r-t img dynamic req phys/qhp manj (76885) |
$296.75 |
$593.50 |
3.2× |
| US OB Follow-Up/Repeat (76816) |
$167 |
$334 |
1.5× |
| Us ob transvaginal (76817) |
$173.50 |
$347 |
1.6× |
| Us retroperitoneal complete (76770) |
$415.25 |
$830.50 |
3.8× |
| Us retroperitoneal ltd (76775) |
$415.25 |
$830.50 |
3.8× |
| Us scrotum (76870) |
$415.25 |
$830.50 |
3.8× |
| Us soft tissue head/neck (76536) |
$492 |
$984 |
4.5× |
| Us spinal canal (76800) |
$356.25 |
$712.50 |
3.2× |
| Venography deep dorsal vein penis radiolgicl supervision interpretation (76499) |
$66.50 |
$133 |
0.7× |
| X-ray exam of finger(s) (73140) |
$177.75 |
$355.50 |
1.9× |
| X-ray exam of knee 1 or 2 (73560) |
$177.75 |
$355.50 |
1.9× |
| X-ray exam ribs bil 3 views (71110) |
$296.75 |
$593.50 |
2.7× |
| X-ray exam ribs uni 2 views (71100) |
$273.50 |
$547 |
3.0× |
| X-ray heel (73650) |
$177.75 |
$355.50 |
1.9× |
| Xr abdomen 1 view (74018) |
$237.25 |
$474.50 |
2.6× |
| Xr abdomen 2 views (74019) |
$267 |
$534 |
2.4× |
| Xr arthrogram wrist (73115) |
$972.50 |
$1,945 |
2.6× |
| Xr bone age studies (77072) |
$148 |
$296 |
1.3× |
| Xr bone length study (77073) |
$267 |
$534 |
2.4× |
| Xr bone survey infant (77076) |
$661.50 |
$1,323 |
6.0× |
| Xr chest 1 view (71045) |
$148 |
$296 |
1.6× |
| Xr chest 2 views (71046) |
$173.50 |
$347 |
1.9× |
| Xr eye foreign body (70030) |
$135.25 |
$270.50 |
1.5× |
| Xr facial bones 3+ views (70150) |
$326.50 |
$653 |
3.0× |
| Xr foot arthritis pa only bilateral - report(ortho pro) (73620) |
$177.75 |
$355.50 |
1.9× |
| Xr forearm 2 views (73090) |
$177.75 |
$355.50 |
1.9× |
| Xr hand 2v (73120) |
$206.75 |
$413.50 |
1.9× |
| Xr hysterosalpingogram (74740) |
$711.75 |
$1,423.50 |
2.8× |
| Xr myelogram c-spine (72240) |
$972.50 |
$1,945 |
1.2× |
| Xr myelogram l-spine (72265) |
$949.25 |
$1,898.50 |
1.1× |
| Xr neck soft tissue (70360) |
$237.25 |
$474.50 |
2.6× |
| Xr o knee w/ merchant view bilat - report(ortho pro) (73562) |
$266.25 |
$532.50 |
2.9× |
| Xr osseous survey complete (77075) |
$949.25 |
$1,898.50 |
8.6× |
| Xr pelvis 1-2 views (72170) |
$237.25 |
$474.50 |
2.2× |
| Xr sacrum/coccyx 2+ views (72220) |
$237.25 |
$474.50 |
2.6× |
| Xr shoulder 1 view (73020) |
$148 |
$296 |
1.6× |
| Xr sinuses 3+ views (70220) |
$243 |
$486 |
2.6× |
| Xr skull min 4 view (70260) |
$385.50 |
$771 |
3.5× |
| Xr spine 1 view (72020) |
$207.50 |
$415 |
2.3× |
| Xr spine thoracic 3v (72072) |
$296.75 |
$593.50 |
2.7× |
| Xr sternum 2+ views (71120) |
$237.25 |
$474.50 |
2.6× |
| Xr surgical specimen (76098) |
$212.50 |
$425 |
0.4× |
| Xr t-spine 2 views (72070) |
$237.25 |
$474.50 |
2.2× |
| Xr tibia/fibula 2 views (73590) |
$177.75 |
$355.50 |
1.9× |
| Xr tmj bilateral (70330) |
$356.25 |
$712.50 |
3.9× |
| Xr wrist 2 views (73100) |
$206.75 |
$413.50 |
2.3× |