| Acute gi blood loss imaging (78278) |
$1,325.77 |
$1,325.77 |
3.1× |
| Angiography internal mammary rs&i (75756) |
$22,247.86 |
$22,247.86 |
6.7× |
| Angiography pulmonary bilateral slctv rs&i (75743) |
$38,670.15 |
$38,670.15 |
11.6× |
| Angiography visceral slctv/supraslctv rs&i (75726) |
$26,050.90 |
$26,050.90 |
4.4× |
| Angiography, adrenal, bilateral, selective, radiological supervision and interpretation Age Under 21 (75733) |
$50,550.14 |
$50,550.14 |
15.2× |
| Angiography, adrenal, unilateral, selective, radiological supervision and interpretation Age Under 21 (75731) |
$25,275.10 |
$25,275.10 |
7.6× |
| Angiography, extremity, bilateral, radiological supervision and interpretation Age Under 21 (75716) |
$28,493.64 |
$28,493.64 |
8.6× |
| Angiography, extremity, unilateral, radiological supervision and interpretation Age Under 21 (75710) |
$24,016.41 |
$24,016.41 |
7.2× |
| Angiography, pelvic, selective or supraselective, radiological supervision and interpretation Age Under 21 (75736) |
$23,405.37 |
$23,405.37 |
4.0× |
| Angiography, pulmonary, unilateral, selective, radiological supervision and interpretation Age Under 21 (75741) |
$19,335.07 |
$19,335.07 |
5.8× |
| Angiography, spinal, selective, radiological supervision and interpretation Age Under 21 (75705) |
$15,180.45 |
$15,180.45 |
2.6× |
| Angrph cath f-up std tcat other than thrombylsis (75898) |
$12,212.34 |
$12,212.34 |
3.7× |
| Angrph pulmonary nonslctv cath/ven njx rs&i (75746) |
$18,410.64 |
$18,410.64 |
5.5× |
| Ankle 2 views (73600) |
$1,290.50 |
$1,290.50 |
14.1× |
| Aortography, abdominal plus bilateral iliofemoral lower extremity, catheter, by serialography, radiological supervision… (75630) |
$23,217.06 |
$23,217.06 |
7.0× |
| Aortography, abdominal, by serialography, radiological supervision and interpretation Age Under 21 (75625) |
$24,772.26 |
$24,772.26 |
7.4× |
| Aortography, thoracic, by serialography, radiological supervision and interpretation Age Under 21 (75605) |
$22,387.53 |
$22,387.53 |
3.8× |
| Brain flow imaging only - nm brain flow only brain death (78610) |
$1,699.78 |
$1,699.78 |
3.0× |
| Brain imaging, minimum 4 static views; with vascular flow Age Under 21 (78606) |
$1,699.78 |
$1,699.78 |
3.0× |
| Brain imaging, positron emission tomography (PET); metabolic evaluation Age Under 21 (78608) |
$5,353.01 |
$5,353.01 |
3.5× |
| Cardiac blood pool imaging (planar), first pass technique; single study, at rest or with stress (exercise and/or… (78481) |
$1,699.78 |
$1,699.78 |
3.0× |
| Cardiac blood pool imaging, gated equilibrium; multiple studies, wall motion study plus ejection fraction, at rest and… (78473) |
$1,325.77 |
$1,325.77 |
3.1× |
| Cardiac MRI morphology & function w/o contrast (75557) |
$10,226.92 |
$10,226.92 |
40.6× |
| Cardiac MRI w/wo contrast & further seq (75561) |
$10,820.31 |
$10,820.31 |
29.4× |
| Cholecystography, oral contrast Age Under 21 (74290) |
$3,589.69 |
$3,589.69 |
19.4× |
| Cineradiography/videoradiography (76120) |
$323.72 |
$323.72 |
2.9× |
| Cisternography, positive contrast, radiological supervision and interpretation Age Under 21 (70015) |
$7,608 |
$7,608 |
9.2× |
| Clavicle complete (73000) |
$2,218.87 |
$2,218.87 |
24.2× |
| Complex dynamic pharyngeal and speech evaluation by cine or video recording Age Under 21 (70371) |
$4,807.74 |
$4,807.74 |
19.1× |
| Computed tomographic angiography, abdomen and pelvis, with contrast material(s), including noncontrast images, if… (74174) |
$4,627.02 |
$4,627.02 |
12.6× |
| Computed tomographic angiography, abdomen, with contrast material(s), including noncontrast images, if performed, and… (74175) |
$14,035.65 |
$14,035.65 |
75.9× |
| Computed tomographic angiography, abdominal aorta and bilateral iliofemoral lower extremity runoff, with contrast… (75635) |
$14,035.65 |
$14,035.65 |
75.9× |
| Computed tomographic angiography, chest (noncoronary), with contrast material(s), including noncontrast images, if… (71275) |
$14,035.65 |
$14,035.65 |
75.9× |
| Computed tomographic angiography, lower extremity, with contrast material(s), including noncontrast images, if… (73706) |
$11,417.73 |
$11,417.73 |
61.7× |
| Computed tomographic angiography, neck, with contrast material(s), including noncontrast images, if performed, and… (70498) |
$11,417.73 |
$11,417.73 |
61.7× |
| Computed tomographic angiography, pelvis, with contrast material(s), including noncontrast images, if performed, and… (72191) |
$14,035.65 |
$14,035.65 |
75.9× |
| Computed tomographic angiography, upper extremity, with contrast material(s), including noncontrast images, if… (73206) |
$11,417.73 |
$11,417.73 |
61.7× |
| Computed tomography, cervical spine; without contrast material, followed by contrast material(s) and further sections… (72127) |
$10,803.63 |
$10,803.63 |
58.4× |
| Computed tomography, lower extremity; without contrast material Age Under 21 (73700) |
$7,804.10 |
$7,804.10 |
70.8× |
| Computed tomography, lower extremity; without contrast material, followed by contrast material(s) and further sections… (73702) |
$10,803.63 |
$10,803.63 |
58.4× |
| Computed tomography, lumbar spine; without contrast material, followed by contrast material(s) and further sections Age… (72133) |
$10,803.63 |
$10,803.63 |
58.4× |
| Computed tomography, maxillofacial area; with contrast material(s) Age Under 21 (70487) |
$9,476.43 |
$9,476.43 |
51.2× |
| Computed tomography, maxillofacial area; without contrast material Age Under 21 (70486) |
$5,295.64 |
$5,295.64 |
48.0× |
| Computed tomography, orbit, sella, or posterior fossa or outer, middle, or inner ear; with contrast material(s) Age… (70481) |
$9,927.66 |
$9,927.66 |
53.7× |
| Computed tomography, orbit, sella, or posterior fossa or outer, middle, or inner ear; without contrast material Age… (70480) |
$7,804.10 |
$7,804.10 |
70.8× |
| Computed tomography, orbit, sella, or posterior fossa or outer, middle, or inner ear; without contrast material,… (70482) |
$10,803.63 |
$10,803.63 |
58.4× |
| Computed tomography, soft tissue neck; without contrast material followed by contrast material(s) and further sections… (70492) |
$10,451.91 |
$10,451.91 |
56.5× |
| Computed tomography, thoracic spine; without contrast material, followed by contrast material(s) and further sections… (72130) |
$10,803.63 |
$10,803.63 |
58.4× |
| Computed tomography, thorax, diagnostic; without contrast material, followed by contrast material(s) and further… (71270) |
$15,677.87 |
$15,677.87 |
84.7× |
| Corpora cavernosography, radiological supervision and interpretation Age Under 21 (74445) |
$7,977.42 |
$7,977.42 |
72.3× |
| Csf shunt evaluation (78645) |
$1,699.78 |
$1,699.78 |
3.0× |
| CT abdomen and pelvis without and with contrast (74178) |
$15,677.87 |
$15,677.87 |
42.6× |
| CT abdomen and pelvis without contrast (74176) |
$8,420.60 |
$8,420.60 |
33.5× |
| CT abdomen w & w/o contrast (74170) |
$10,451.91 |
$10,451.91 |
56.5× |
| CT abdomen w/contrast (74160) |
$9,476.43 |
$9,476.43 |
51.2× |
| CT abdomen w/o contrast (74150) |
$7,804.10 |
$7,804.10 |
70.8× |
| CT angio hrt w/3d image (75574) |
$817.24 |
$817.24 |
2.2× |
| CT cervical spine w/contrast (72126) |
$9,927.66 |
$9,927.66 |
27.0× |
| CT cervical spine w/o contrast (72125) |
$7,804.10 |
$7,804.10 |
70.8× |
| CT chest w/contrast (71260) |
$11,079.02 |
$11,079.02 |
59.9× |
| CT extremity upper w & w/o contrast (73202) |
$10,803.63 |
$10,803.63 |
58.4× |
| CT extremity upper w/o contrast (73200) |
$7,804.10 |
$7,804.10 |
70.8× |
| CT head/brain with contrast (70460) |
$9,476.43 |
$9,476.43 |
51.2× |
| CT head/brain without and with contrast (70470) |
$10,451.91 |
$10,451.91 |
56.5× |
| CT heart c+ cardiac strux&morph cgen hrt ds (75573) |
$2,475.53 |
$2,475.53 |
6.7× |
| CT heart contrast eval cardiac structure&morph (75572) |
$2,475.53 |
$2,475.53 |
6.7× |
| CT heart no contrast quant eval coronry calcium (75571) |
$252.37 |
$252.37 |
2.7× |
| CT l-spine w/contrast (72132) |
$9,476.43 |
$9,476.43 |
25.7× |
| CT limited/localized follow up study (76380) |
$5,124.74 |
$5,124.74 |
55.8× |
| CT lower extremity w/dye (73701) |
$9,927.66 |
$9,927.66 |
53.7× |
| CT lumbar spine w/o contrast (72131) |
$7,804.10 |
$7,804.10 |
70.8× |
| CT maxillofacial w/wo contrast (70488) |
$10,803.63 |
$10,803.63 |
58.4× |
| CT neck w/contrast (70491) |
$9,476.43 |
$9,476.43 |
51.2× |
| CT neck w/o contrast (70490) |
$7,804.10 |
$7,804.10 |
70.8× |
| CT pelvis w & w/o contrast (72194) |
$10,451.91 |
$10,451.91 |
56.5× |
| CT pelvis w/o contrast (72192) |
$7,804.10 |
$7,804.10 |
70.8× |
| CT thoracic spine w/contrast (72129) |
$9,476.43 |
$9,476.43 |
51.2× |
| CT thoracic spine w/o contrast (72128) |
$7,804.10 |
$7,804.10 |
70.8× |
| CT thorax lung cancer scr c- (71271) |
$252.37 |
$252.37 |
2.3× |
| CT thorax w/o contrast (71250) |
$7,943.45 |
$7,943.45 |
72.0× |
| CT upper extremity w/dye (73201) |
$9,927.66 |
$9,927.66 |
27.0× |
| CTA head w contrast (70496) |
$11,417.73 |
$11,417.73 |
61.7× |
| Cystography, minimum of 3 views, radiological supervision and interpretation Age Under 21 (74430) |
$3,498.02 |
$3,498.02 |
9.5× |
| Dilation ureters/urethra rs&i (74485) |
$13,839.95 |
$13,839.95 |
6.3× |
| Discography, cervical or thoracic, radiological supervision and interpretation Age Under 21 (72285) |
$7,785.12 |
$7,785.12 |
3.8× |
| Diskography lumbar s&i (72295) |
$6,131.20 |
$6,131.20 |
3.0× |
| Doppler fetal mid cerebral artery (76821) |
$1,727.20 |
$1,727.20 |
15.7× |
| Dual-energy X-ray absorptiometry (DXA), bone density study, 1 or more sites; axial skeleton (eg, hips, pelvis, spine)… (77080) |
$1,767.17 |
$1,767.17 |
16.0× |
| Dxa bone density study axial skeleton (77085) |
$2,997.10 |
$2,997.10 |
27.2× |
| Dxa bone density/peripheral (77081) |
$1,767.17 |
$1,767.17 |
19.3× |
| Echocardiography, fetal, cardiovascular system, real time with image documentation (2D), with or without M-mode… (76825) |
$5,155.47 |
$5,155.47 |
8.9× |
| Esophageal motility (78258) |
$1,325.77 |
$1,325.77 |
3.1× |
| Fetal biophys profile w/o nst (76819) |
$1,843.44 |
$1,843.44 |
16.7× |
| Fetal biophysical profile non-stress testing (76818) |
$2,401.05 |
$2,401.05 |
21.8× |
| Fluoroscopy up to 1 hour physician/qhp time (76000) |
$3,209.16 |
$3,209.16 |
12.7× |
| Gastroesophageal reflux study (78262) |
$1,325.77 |
$1,325.77 |
3.1× |
| Gated heart planar single (78472) |
$4,387.40 |
$4,387.40 |
10.4× |
| Heart infarct image (78466) |
$4,429.26 |
$4,429.26 |
10.5× |
| Hepatc vngrph wdg/fr w/o hemodyn eval rs&i (75891) |
$8,539.68 |
$8,539.68 |
2.6× |
| Hepatic venography, wedged or free, with hemodynamic evaluation, radiological supervision and interpretation Age Under… (75889) |
$9,191.54 |
$9,191.54 |
2.8× |
| Hepatobil syst imag inc gb w/pharma intervenj (78227) |
$1,699.78 |
$1,699.78 |
3.0× |
| Hepatobiliary syst imaging including gallbladder (78226) |
$1,325.77 |
$1,325.77 |
3.1× |
| Ht muscle image spect sing (78451) |
$4,581.63 |
$4,581.63 |
3.4× |
| Injection procedure for radiopharmaceutical localization by non-imaging probe study, intravenous (eg, parathyroid… (78808) |
$1,325.77 |
$1,325.77 |
3.1× |
| Intestine imaging (eg, ectopic gastric mucosa, Meckel's localization, volvulus) Age Under 21 (78290) |
$1,325.77 |
$1,325.77 |
3.1× |
| Kidney function study, non-imaging radioisotopic study Age Under 21 (78725) |
$1,325.77 |
$1,325.77 |
3.1× |
| Kidney imaging morphol - nm kidney cortex (78700) |
$1,325.77 |
$1,325.77 |
3.1× |
| Kidney imaging morphology; with vascular flow Age Under 21 (78701) |
$1,325.77 |
$1,325.77 |
3.1× |
| Kidney imaging morphology; with vascular flow and function, single study without pharmacological intervention Age Under… (78707) |
$1,699.78 |
$1,699.78 |
3.0× |
| Kidney imaging morphology; with vascular flow and function, single study, with pharmacological intervention (eg,… (78708) |
$1,699.78 |
$1,699.78 |
3.0× |
| Leveen/shunt patency exam (78291) |
$2,664.60 |
$2,664.60 |
6.3× |
| Liver and spleen imaging (78215) |
$1,325.77 |
$1,325.77 |
3.1× |
| Liver and spleen imaging; with vascular flow Age Under 21 (78216) |
$1,325.77 |
$1,325.77 |
3.1× |
| Liver imaging (78201) |
$4,581.63 |
$4,581.63 |
8.0× |
| Liver imaging with flow (78202) |
$4,581.63 |
$4,581.63 |
8.0× |
| Lung perf&ventilat diferentl (78598) |
$1,699.78 |
$1,699.78 |
3.0× |
| Lung perfusion imaging (78580) |
$1,325.77 |
$1,325.77 |
3.1× |
| Lymphangiography, pelvic/abdominal, unilateral, radiological supervision and interpretation Age Under 21 (75805) |
$6,522.28 |
$6,522.28 |
2.0× |
| Magnetic resonance (eg, proton) imaging, any joint of lower extremity; without contrast material(s), followed by… (73723) |
$12,701.58 |
$12,701.58 |
34.5× |
| Magnetic resonance (eg, proton) imaging, lower extremity other than joint; with contrast material(s) Age Under 21 (73719) |
$11,538.12 |
$11,538.12 |
31.4× |
| Magnetic resonance (eg, proton) imaging, lower extremity other than joint; without contrast material(s) Age Under 21 (73718) |
$10,211.07 |
$10,211.07 |
40.6× |
| Magnetic resonance (eg, proton) imaging, lower extremity other than joint; without contrast material(s), followed by… (73720) |
$12,701.58 |
$12,701.58 |
34.5× |
| Magnetic resonance (eg, proton) imaging, orbit, face, and/or neck; with contrast material(s) Age Under 21 (70542) |
$11,480.42 |
$11,480.42 |
31.2× |
| Magnetic resonance (eg, proton) imaging, orbit, face, and/or neck; without contrast material(s) Age Under 21 (70540) |
$9,810.74 |
$9,810.74 |
39.0× |
| Magnetic resonance (eg, proton) imaging, upper extremity, other than joint; with contrast material(s) Age Under 21 (73219) |
$11,422.73 |
$11,422.73 |
31.0× |
| Magnetic resonance (eg, proton) imaging, upper extremity, other than joint; without contrast material(s), followed by… (73220) |
$12,574.59 |
$12,574.59 |
34.2× |
| Magnetic resonance angiography, head; with contrast material(s) Age Under 21 (70545) |
$8,274.44 |
$8,274.44 |
22.5× |
| Magnetic resonance angiography, head; without contrast material(s), followed by contrast material(s) and further… (70546) |
$10,081.72 |
$10,081.72 |
27.4× |
| Magnetic resonance angiography, neck; without contrast material(s), followed by contrast material(s) and further… (70549) |
$10,081.72 |
$10,081.72 |
27.4× |
| Mammary ductogram or galactogram, multiple ducts, radiological supervision and interpretation Age Under 21 (77054) |
$5,018.43 |
$5,018.43 |
19.9× |
| Mammary ductogram single (77053) |
$3,718.73 |
$3,718.73 |
14.8× |
| Mandible min 4v (70110) |
$3,527.78 |
$3,527.78 |
32.0× |
| Mr safety implant&/fb assmt clin staf 1st 15 min (76014) |
$79.35 |
$79.35 |
2.6× |
| MRA head w/o contrast (70544) |
$6,633.72 |
$6,633.72 |
26.4× |
| MRA neck w/ contrast (70548) |
$8,274.44 |
$8,274.44 |
22.5× |
| MRA neck w/o contrast (70547) |
$6,957.24 |
$6,957.24 |
27.6× |
| MRI abdomen w/contrast (74182) |
$11,120.27 |
$11,120.27 |
30.2× |
| MRI abdomen w/o contrast (74181) |
$9,810.74 |
$9,810.74 |
39.0× |
| MRI abdomen w/wo contrast (74183) |
$12,364.96 |
$12,364.96 |
33.6× |
| MRI any jt lower extrem w/contrast material (73722) |
$11,538.12 |
$11,538.12 |
14.0× |
| MRI breast c- bilateral (77047) |
$6,922.28 |
$6,922.28 |
27.5× |
| MRI breast without contrast material unilateral (77046) |
$6,922.28 |
$6,922.28 |
27.5× |
| MRI c-spine w&w/o cont (72156) |
$12,269.48 |
$12,269.48 |
33.3× |
| MRI cervical spine w/contrast (72142) |
$11,480.42 |
$11,480.42 |
31.2× |
| MRI chest w/contrast (71551) |
$11,482.06 |
$11,482.06 |
13.9× |
| MRI chest w/o contrast (71550) |
$10,567.29 |
$10,567.29 |
42.0× |
| MRI chest w/wo contrast (71552) |
$12,636.50 |
$12,636.50 |
34.3× |
| MRI fetal sngl/1st gestation (74712) |
$10,107.37 |
$10,107.37 |
40.2× |
| MRI joint upr extr w/o&w/dye (73223) |
$12,638.08 |
$12,638.08 |
34.3× |
| MRI joint upr extrem w/dye (73222) |
$11,480.42 |
$11,480.42 |
13.9× |
| MRI joint upr extrem w/o dye (73221) |
$10,108.98 |
$10,108.98 |
40.2× |
| MRI lumbar spine w/contrast (72149) |
$11,207.29 |
$11,207.29 |
30.5× |
| MRI lumbar spine w/wo contrast (72158) |
$12,269.48 |
$12,269.48 |
33.3× |
| MRI orbit/face/neck w&w/o cont (70543) |
$12,269.48 |
$12,269.48 |
33.3× |
| MRI pelvis w & w/o contrast (72197) |
$12,364.16 |
$12,364.16 |
33.6× |
| MRI pelvis w/contrast (72196) |
$11,120.66 |
$11,120.66 |
30.2× |
| MRI pelvis w/o contrast (72195) |
$9,809.94 |
$9,809.94 |
39.0× |
| MRI spectroscopy (76390) |
$5,172.14 |
$5,172.14 |
56.3× |
| MRI spine cervical w/o contrast (72141) |
$9,810.74 |
$9,810.74 |
39.0× |
| MRI t-spine w&w/o cont (72157) |
$12,269.48 |
$12,269.48 |
33.3× |
| MRI thoracic spine w/contrast (72147) |
$11,480.42 |
$11,480.42 |
31.2× |
| MRI thoracic spine w/o contrst (72146) |
$9,810.74 |
$9,810.74 |
39.0× |
| MRI tmj (70336) |
$10,805.40 |
$10,805.40 |
42.9× |
| MRI upper extremity oth than jt w/o contr matrl (73218) |
$10,160.02 |
$10,160.02 |
40.4× |
| Myelography, 2 or more regions (eg, lumbar/thoracic, cervical/thoracic, lumbar/cervical, lumbar/thoracic/cervical),… (72270) |
$15,368.77 |
$15,368.77 |
18.6× |
| Myocardial imaging, positron emission tomography (PET), combined perfusion with metabolic evaluation study (including… (78432) |
$10,202.74 |
$10,202.74 |
6.4× |
| Myocardial imaging, positron emission tomography (PET), perfusion study (including ventricular wall motionºs» and/or… (78491) |
$5,353.01 |
$5,353.01 |
3.5× |
| Myocardial imaging, positron emission tomography (PET), perfusion study (including ventricular wall motionºs» and/or… (78492) |
$5,353.01 |
$5,353.01 |
3.5× |
| Myocardial imaging, positron emission tomography (PET), perfusion study (including ventricular wall motionºs» and/or… (78430) |
$5,353.01 |
$5,353.01 |
3.5× |
| Myocardial perfusion imaging, planar (including qualitative or quantitative wall motion, ejection fraction by first… (78453) |
$4,581.63 |
$4,581.63 |
3.4× |
| Myocardial perfusion imaging, planar (including qualitative or quantitative wall motion, ejection fraction by first… (78454) |
$4,581.63 |
$4,581.63 |
3.4× |
| Myocardial spect multiple studies (78452) |
$4,581.63 |
$4,581.63 |
3.4× |
| Myocrd img PET 2rtracer CT (78433) |
$10,202.74 |
$10,202.74 |
4.4× |
| Myocrd img PET metab eval single study (78459) |
$4,719.08 |
$4,719.08 |
3.5× |
| Myocrd img PET metab eval single study cncrnt CT (78429) |
$5,353.01 |
$5,353.01 |
3.5× |
| Myocrd img PET rst&strs CT (78431) |
$8,348.04 |
$8,348.04 |
3.6× |
| N-invas est c ffr augmnt sw alys CTA i&r phy/qhp (75580) |
$3,230.99 |
$3,230.99 |
3.6× |
| Nm bone 3 phase (78315) |
$1,325.77 |
$1,325.77 |
3.1× |
| Nm bone imaging whole body (78306) |
$1,325.77 |
$1,325.77 |
3.1× |
| Nm bone marrow ltd (78102) |
$1,325.77 |
$1,325.77 |
3.1× |
| Nm bone marrow wb (78104) |
$1,325.77 |
$1,325.77 |
3.1× |
| Nm csf cisternogram (78630) |
$1,699.78 |
$1,699.78 |
3.0× |
| Nm csf leak detection (78650) |
$4,581.63 |
$4,581.63 |
3.4× |
| Nm gastric emptying (78264) |
$1,325.77 |
$1,325.77 |
3.1× |
| Nm lung ventilation imaging (78579) |
$1,325.77 |
$1,325.77 |
3.1× |
| Nm lymph system (78195) |
$4,135.10 |
$4,135.10 |
7.2× |
| Nm myocard infarct spect (78469) |
$5,086.66 |
$5,086.66 |
8.9× |
| Non-cardiac vascular flow imaging (ie, angiography, venography) Age Under 21 (78445) |
$1,325.77 |
$1,325.77 |
3.1× |
| Nuclear medicine study for detecting heart shunt (78428) |
$1,325.77 |
$1,325.77 |
3.1× |
| Nuclear medicine study of bone and/or joint limited area (78300) |
$1,325.77 |
$1,325.77 |
3.1× |
| Nuclear medicine study of bone and/or joint multiple areas (78305) |
$1,325.77 |
$1,325.77 |
3.1× |
| Nuclear medicine study of brain, 4 static views or more (78605) |
$1,699.78 |
$1,699.78 |
3.0× |
| Nuclear medicine study of platelet survival (78191) |
$1,325.77 |
$1,325.77 |
3.1× |
| Nuclear medicine study to assess blood clot in vein of both sides (78458) |
$1,325.77 |
$1,325.77 |
3.1× |
| Ob us limited fetus(s) (76815) |
$1,621.09 |
$1,621.09 |
14.7× |
| Panoramic X-ray of jaws (70355) |
$3,105.05 |
$3,105.05 |
33.8× |
| Parathyrd planar w/spect&CT (78072) |
$1,699.78 |
$1,699.78 |
3.0× |
| Parathyroid planar imaging (78070) |
$1,325.77 |
$1,325.77 |
3.1× |
| Parathyroid planar imaging w/wo subtraction (78071) |
$1,325.77 |
$1,325.77 |
3.1× |
| Percutaneous transhepatic portography with hemodynamic evaluation, radiological supervision and interpretation Age… (75885) |
$10,583.40 |
$10,583.40 |
3.2× |
| PET imaging CT attenuation skull base mid-thigh (78815) |
$5,353.01 |
$5,353.01 |
3.5× |
| PET imaging CT for attenuation limited area (78814) |
$5,353.01 |
$5,353.01 |
3.5× |
| PET imaging for CT attenuation whole body (78816) |
$5,353.01 |
$5,353.01 |
3.5× |
| PET imaging whole body (78813) |
$5,353.01 |
$5,353.01 |
3.5× |
| Positron emission tomography (PET) imaging; limited area (eg, chest, head/neck) Age Under 21 (78811) |
$4,719.08 |
$4,719.08 |
3.5× |
| Positron emission tomography (PET) imaging; skull base to mid-thigh Age Under 21 (78812) |
$5,353.01 |
$5,353.01 |
3.5× |
| Prq transhepatc portograpy w/o hemodyn evl intrp (75887) |
$5,359.49 |
$5,359.49 |
1.6× |
| Pulmonary ventilation & perfusion imaging (78582) |
$1,699.78 |
$1,699.78 |
3.0× |
| Quant differential pulm perfusion w/wo imaging (78597) |
$1,325.77 |
$1,325.77 |
3.1× |
| Radex abscess/fistula/sinus tract rs&i (76080) |
$5,302.89 |
$5,302.89 |
9.2× |
| Radex entir thrc lmbr crv sac spi w/skull 1 vw (72081) |
$3,281.58 |
$3,281.58 |
35.7× |
| Radex entir thrc lmbr crv sac spi w/skull 2/3 vw (72082) |
$9,844.73 |
$9,844.73 |
89.3× |
| Radex entir thrc lmbr crv sac spi w/skull 4/5 vw (72083) |
$16,407.82 |
$16,407.82 |
148.8× |
| Radex entir thrc lmbr crv sac spi w/skull 6/> vw (72084) |
$19,689.39 |
$19,689.39 |
178.5× |
| Radex hip unilateral with pelvis 1 view (73501) |
$3,809.63 |
$3,809.63 |
41.5× |
| Radex hip unilateral with pelvis 2-3 views (73502) |
$3,809.63 |
$3,809.63 |
41.5× |
| Radex hip unilateral with pelvis minimum 4 views (73503) |
$4,437.74 |
$4,437.74 |
40.2× |
| Radex hips bilateral with pelvis 2 views (73521) |
$3,847.87 |
$3,847.87 |
34.9× |
| Radex hips bilateral with pelvis minimum 5 views (73523) |
$9,619.61 |
$9,619.61 |
87.2× |
| Radex spine cervical 2 or 3 views (72040) |
$2,528.31 |
$2,528.31 |
27.5× |
| Radex spine cervical 4 or 5 views (72050) |
$3,859.64 |
$3,859.64 |
35.0× |
| Radex spine cervical 6 or more views (72052) |
$4,683.97 |
$4,683.97 |
42.5× |
| Radex spine thoracolumbar junction min 2 views (72080) |
$2,889.16 |
$2,889.16 |
31.5× |
| Radiation treatment delivery, stereotactic radiosurgery (SRS), complete course of treatment of cranial lesion(s)… (77371) |
$21,916.79 |
$21,916.79 |
2.8× |
| Radiologic exam abdomen 3+ views (74021) |
$3,056.34 |
$3,056.34 |
27.7× |
| Radiologic exam chest 3 views (71047) |
$2,991.80 |
$2,991.80 |
32.6× |
| Radiologic exam chest 4+ views (71048) |
$3,343.48 |
$3,343.48 |
30.3× |
| Radiologic exam colon double contrast study (74280) |
$6,086.42 |
$6,086.42 |
32.9× |
| Radiologic exam colon single contrast study (74270) |
$5,766.45 |
$5,766.45 |
31.2× |
| Radiologic exam esophagus double contrast study (74221) |
$774.69 |
$774.69 |
4.2× |
| Radiologic exam esophagus single contrast study (74220) |
$774.69 |
$774.69 |
4.2× |
| Radiologic exam small int single contrast study (74250) |
$3,527.78 |
$3,527.78 |
19.1× |
| Radiologic exam swallow function contrast study (74230) |
$4,807.74 |
$4,807.74 |
26.0× |
| Radiologic exam upr gi trc double contrast study (74246) |
$5,117.26 |
$5,117.26 |
27.7× |
| Radiologic exam upr gi trc single contrast study (74240) |
$4,807.74 |
$4,807.74 |
26.0× |
| Radiologic examination femur 1 view (73551) |
$1,702.70 |
$1,702.70 |
18.5× |
| Radiologic examination femur minimum 2 views (73552) |
$3,405.35 |
$3,405.35 |
37.1× |
| Radiologic examination from nose to rectum for foreign body, single view, child Age Under 21 (76010) |
$2,095.08 |
$2,095.08 |
22.8× |
| Radiologic examination, ankle; complete, minimum of 3 views Age Under 21 (73610) |
$2,673.20 |
$2,673.20 |
29.1× |
| Radiologic examination, complete acute abdomen series, including 2 or more views of the abdomen (eg, supine, erect,… (74022) |
$3,209.16 |
$3,209.16 |
29.1× |
| Radiologic examination, elbow; 2 views Age Under 21 (73070) |
$1,868.56 |
$1,868.56 |
20.4× |
| Radiologic examination, elbow; complete, minimum of 3 views Age Under 21 (73080) |
$2,156.98 |
$2,156.98 |
23.5× |
| Radiologic examination, facial bones; less than 3 views Age Under 21 (70140) |
$2,249.22 |
$2,249.22 |
24.5× |
| Radiologic examination, foot; complete, minimum of 3 views Age Under 21 (73630) |
$3,096.54 |
$3,096.54 |
33.7× |
| Radiologic examination, hand; minimum of 3 views Age Under 21 (73130) |
$1,930.53 |
$1,930.53 |
21.0× |
| Radiologic examination, knee; both knees, standing, anteroposterior Age Under 21 (73565) |
$1,253.32 |
$1,253.32 |
13.7× |
| Radiologic examination, knee; complete, 4 or more views Age Under 21 (73564) |
$3,363.20 |
$3,363.20 |
30.5× |
| Radiologic examination, mandible; partial, less than 4 views Age Under 21 (70100) |
$2,466.41 |
$2,466.41 |
26.9× |
| Radiologic examination, mastoids; complete, minimum of 3 views per side Age Under 21 (70130) |
$4,487.74 |
$4,487.74 |
40.7× |
| Radiologic examination, nasal bones, complete, minimum of 3 views Age Under 21 (70160) |
$2,558.59 |
$2,558.59 |
27.9× |
| Radiologic examination, renal cyst study, translumbar, contrast visualization, radiological supervision and… (74470) |
$7,897.05 |
$7,897.05 |
13.7× |
| Radiologic examination, ribs, bilateral; including posteroanterior chest, minimum of 4 views Age Under 21 (71111) |
$6,086.42 |
$6,086.42 |
55.2× |
| Radiologic examination, ribs, unilateral; including posteroanterior chest, minimum of 3 views Age Under 21 (71101) |
$4,942.09 |
$4,942.09 |
44.8× |
| Radiologic examination, sacroiliac joints; less than 3 views Age Under 21 (72200) |
$2,558.59 |
$2,558.59 |
23.2× |
| Radiologic examination, shoulder, arthrography, radiological supervision and interpretation Age Under 21 (73040) |
$4,953.95 |
$4,953.95 |
13.5× |
| Radiologic examination, shoulder; complete, minimum of 2 views Age Under 21 (73030) |
$2,496.73 |
$2,496.73 |
27.2× |
| Radiologic examination, single plane body section (eg, tomography), other than with urography Age Under 21 (76100) |
$6,086.42 |
$6,086.42 |
55.2× |
| Radiologic examination, sinuses, paranasal, less than 3 views Age Under 21 (70210) |
$1,166.72 |
$1,166.72 |
12.7× |
| Radiologic examination, skull; less than 4 views Age Under 21 (70250) |
$2,249.22 |
$2,249.22 |
20.4× |
| Radiologic examination, spine, lumbosacral; 2 or 3 views Age Under 21 (72100) |
$3,847.87 |
$3,847.87 |
34.9× |
| Radiologic examination, spine, lumbosacral; bending views only, 2 or 3 views Age Under 21 (72120) |
$4,477.24 |
$4,477.24 |
40.6× |
| Radiologic examination, spine, lumbosacral; complete, including bending views, minimum of 6 views Age Under 21 (72114) |
$7,034.58 |
$7,034.58 |
63.8× |
| Radiologic examination, spine; thoracic, minimum of 4 views Age Under 21 (72074) |
$3,292.12 |
$3,292.12 |
29.9× |
| Radiologic examination, wrist; complete, minimum of 3 views Age Under 21 (73110) |
$3,009.66 |
$3,009.66 |
32.8× |
| Radiologic examination; acromioclavicular joints, bilateral, with or without weighted distraction Age Under 21 (73050) |
$2,558.59 |
$2,558.59 |
27.9× |
| Radiologic examination; humerus, minimum of 2 views Age Under 21 (73060) |
$2,249.22 |
$2,249.22 |
24.5× |
| Radiologic examination; lower extremity, infant, minimum of 2 views Age Under 21 (73592) |
$1,775.04 |
$1,775.04 |
19.3× |
| Radiologic examination; orbits, complete, minimum of 4 views Age Under 21 (70200) |
$3,209.16 |
$3,209.16 |
29.1× |
| Radiologic examination; sternoclavicular joint or joints, minimum of 3 views Age Under 21 (71130) |
$2,558.59 |
$2,558.59 |
27.9× |
| Radiologic examination; toe(s), minimum of 2 views Age Under 21 (73660) |
$1,806.72 |
$1,806.72 |
19.7× |
| Radiologic examination; upper extremity, infant, minimum of 2 views Age Under 21 (73092) |
$1,930.53 |
$1,930.53 |
17.5× |
| Radiopharmaceutical localization of tumor, inflammatory process or distribution of radiopharmaceutical agent(s)… (78803) |
$4,581.63 |
$4,581.63 |
8.0× |
| Radiopharmaceutical therapy, by intracavitary administration Age Under 21 (79200) |
$854.96 |
$854.96 |
3.5× |
| Radiopharmaceutical therapy, by intravenous administration Age Under 21 (79101) |
$854.96 |
$854.96 |
3.5× |
| Radiopharmaceutical therapy, by oral administration Age Under 21 (79005) |
$854.96 |
$854.96 |
3.5× |
| Radiopharmaceutical therapy, radiolabeled monoclonal antibody by intravenous infusion (79403) |
$854.96 |
$854.96 |
3.5× |
| Red cell volume determination (separate procedure); single sampling Age Under 21 (78120) |
$1,325.77 |
$1,325.77 |
3.1× |
| Review by radiologist of urinary bladder and urethra images with contrast and after passing urine (74455) |
$3,126.18 |
$3,126.18 |
12.4× |
| Rp loclzj tum plnr 1 area single day imaging (78800) |
$1,325.77 |
$1,325.77 |
3.1× |
| Rp loclzj tum plnr 2+area 1+d img/1 area img>2+d (78801) |
$1,325.77 |
$1,325.77 |
3.1× |
| Rp loclzj tum plnr whole body 2+ days imaging (78804) |
$4,581.63 |
$4,581.63 |
8.0× |
| Rp loclzj tum plnr whole body single day imaging (78802) |
$4,581.63 |
$4,581.63 |
8.0× |
| Rp loclzj tum spect 2 areas (78831) |
$4,581.63 |
$4,581.63 |
3.4× |
| Rp loclzj tum spect w/CT 1 (78830) |
$4,581.63 |
$4,581.63 |
3.4× |
| Rp loclzj tum spect w/CT 2 (78832) |
$5,197.10 |
$5,197.10 |
3.4× |
| Rp therapy intra-arterial particulate admn (79445) |
$854.96 |
$854.96 |
3.5× |
| Saline infusion sonohysterography (SIS), including color flow Doppler, when performed Age Under 21 (76831) |
$4,643.01 |
$4,643.01 |
18.4× |
| Scapula complete (73010) |
$2,383.52 |
$2,383.52 |
21.6× |
| Screening digital breast tomosynthesis bi (77063) |
$69.79 |
$69.79 |
— |
| Shuntogram indwelling nonvascular shunt rs&i (75809) |
$1,628.93 |
$1,628.93 |
14.8× |
| Splenoportography, radiological supervision and interpretation Age Under 21 (75810) |
$19,835.43 |
$19,835.43 |
6.0× |
| Testicular imaging with vascular flow Age Under 21 (78761) |
$1,325.77 |
$1,325.77 |
3.1× |
| Ther rad simulaj-aided field setting complex (77290) |
$1,535.75 |
$1,535.75 |
3.9× |
| Therapeutic enema, contrast or air, for reduction of intussusception or other intraluminal obstruction (eg, meconium… (74283) |
$3,847.87 |
$3,847.87 |
20.8× |
| Thyroid imaging with vascular flow (78013) |
$1,325.77 |
$1,325.77 |
3.1× |
| Thyroid met imaging body (78018) |
$1,699.78 |
$1,699.78 |
3.0× |
| Thyroid uptake single/multiple quant measurement (78012) |
$1,325.77 |
$1,325.77 |
3.1× |
| Thyroid uptake w/blood flow sngle/mult quan meas (78014) |
$1,325.77 |
$1,325.77 |
3.1× |
| Ultrasound breast limited (76642) |
$4,003.58 |
$4,003.58 |
43.6× |
| Ultrasound, abdomen limited (76705) |
$3,219.55 |
$3,219.55 |
29.2× |
| Ultrasound, limited, joint or focal evaluation of other nonvascular extremity structure(s) (eg, joint space,… (76882) |
$2,258.33 |
$2,258.33 |
20.5× |
| Ultrasound, pelvic (nonobstetric), real time with image documentation; complete Age Under 21 (76856) |
$5,085.53 |
$5,085.53 |
46.1× |
| Ultrasound, pregnant uterus, real time with image documentation, fetal and maternal evaluation plus detailed fetal… (76811) |
$3,604.46 |
$3,604.46 |
14.3× |
| Ultrasound, pregnant uterus, real time with image documentation, fetal and maternal evaluation, first trimester (< 14… (76801) |
$1,466.40 |
$1,466.40 |
13.3× |
| Ultrasound, transplanted kidney, real time and duplex Doppler with image documentation Age Under 21 (76776) |
$3,281.60 |
$3,281.60 |
29.8× |
| Umbilical-artery Doppler (OB) (76820) |
$1,727.20 |
$1,727.20 |
15.7× |
| Ureteral reflux study (78740) |
$1,325.77 |
$1,325.77 |
3.1× |
| Urethrocystography retrograde rs&i (74450) |
$4,807.74 |
$4,807.74 |
19.1× |
| Urography (pyelography), intravenous, with or without KUB, with or without tomography Age Under 21 (74400) |
$9,098.04 |
$9,098.04 |
49.2× |
| Urography antegrade rs&i (74425) |
$13,228.92 |
$13,228.92 |
35.9× |
| Urography, infusion, drip technique and/or bolus technique; with nephrotomography Age Under 21 (74415) |
$9,170.48 |
$9,170.48 |
49.6× |
| Us abdominal aorta real time screen study aaa (76706) |
$540.09 |
$540.09 |
4.9× |
| Us breast uni real time with image complete (76641) |
$4,876.17 |
$4,876.17 |
44.2× |
| Us chest (76604) |
$2,588.82 |
$2,588.82 |
23.5× |
| Us compl joint r-t w/image documentation (76881) |
$2,582.85 |
$2,582.85 |
23.4× |
| Us encephalogram (76506) |
$1,875.02 |
$1,875.02 |
17.0× |
| Us exam, pelvic, limited (76857) |
$1,291.39 |
$1,291.39 |
11.7× |
| Us guided compression repair (76936) |
$3,386.59 |
$3,386.59 |
14.9× |
| Us inft hips r-t img lmtd static phys/qhp manj (76886) |
$2,617.83 |
$2,617.83 |
28.5× |
| US OB Follow-Up/Repeat (76816) |
$2,299.42 |
$2,299.42 |
20.9× |
| Us ob transvaginal (76817) |
$932.47 |
$932.47 |
8.5× |
| Us retroperitoneal complete (76770) |
$3,609.01 |
$3,609.01 |
32.7× |
| Us retroperitoneal ltd (76775) |
$1,221.62 |
$1,221.62 |
11.1× |
| Us scrotum (76870) |
$2,892.16 |
$2,892.16 |
26.2× |
| Us soft tissue head/neck (76536) |
$3,266.36 |
$3,266.36 |
29.6× |
| Us spinal canal (76800) |
$1,645.91 |
$1,645.91 |
14.9× |
| Us transrectal (76872) |
$3,325.68 |
$3,325.68 |
30.2× |
| Venogram sinus/jugular (75860) |
$6,431.43 |
$6,431.43 |
1.9× |
| Venography adrenal unilateral selective rs&i (75840) |
$19,835.43 |
$19,835.43 |
6.0× |
| Venography renal unilateral selective rs&i (75831) |
$19,835.43 |
$19,835.43 |
6.0× |
| Venography, caval, inferior, with serialography, radiological supervision and interpretation Age Under 21 (75825) |
$16,133.87 |
$16,133.87 |
4.8× |
| Venography, caval, superior, with serialography, radiological supervision and interpretation Age Under 21 (75827) |
$17,758.85 |
$17,758.85 |
10.7× |
| Venography, extremity, bilateral, radiological supervision and interpretation Age Under 21 (75822) |
$8,548.92 |
$8,548.92 |
5.1× |
| Venography, extremity, unilateral, radiological supervision and interpretation Age Under 21 (75820) |
$7,394.05 |
$7,394.05 |
4.5× |
| Venography, superior sagittal sinus, radiological supervision and interpretation Age Under 21 (75870) |
$6,431.43 |
$6,431.43 |
1.9× |
| Venous sampling thru cath w/wo angiography rs& (75893) |
$18,281.60 |
$18,281.60 |
3.1× |
| Venous thrombosis imaging - nm extremity veins thrombosis right (78457) |
$4,581.63 |
$4,581.63 |
8.0× |
| Vertebral fracture assessment via dxa (77086) |
$1,229.93 |
$1,229.93 |
13.4× |
| X-ray exam hips bi 3-4 views (73522) |
$7,695.67 |
$7,695.67 |
69.8× |
| X-ray exam of finger(s) (73140) |
$2,002.90 |
$2,002.90 |
21.8× |
| X-ray exam of knee 1 or 2 (73560) |
$1,971.32 |
$1,971.32 |
21.5× |
| X-ray exam of small bowel - fl small bowel series enteroclysis tube (74251) |
$3,847.87 |
$3,847.87 |
20.8× |
| X-ray exam ribs bil 3 views (71110) |
$3,847.87 |
$3,847.87 |
34.9× |
| X-ray exam ribs uni 2 views (71100) |
$3,209.16 |
$3,209.16 |
35.0× |
| X-ray heel (73650) |
$2,064.80 |
$2,064.80 |
22.5× |
| X-ray of joint between lower spine and hip bone 3 or more views|PROFESSIONAL COMPONENT (72202) |
$2,558.59 |
$2,558.59 |
23.2× |
| X-ray retrograde pyelogram (74420) |
$4,807.74 |
$4,807.74 |
13.1× |
| Xr abdomen 1 view (74018) |
$1,887.48 |
$1,887.48 |
20.6× |
| Xr abdomen 2 views (74019) |
$2,938.42 |
$2,938.42 |
26.6× |
| Xr arthrogram ankle (73615) |
$5,674.22 |
$5,674.22 |
15.4× |
| Xr arthrogram elbow (73085) |
$7,540.19 |
$7,540.19 |
20.5× |
| Xr arthrogram hip (73525) |
$7,781.17 |
$7,781.17 |
21.1× |
| Xr arthrogram knee (73580) |
$5,674.22 |
$5,674.22 |
15.4× |
| Xr arthrogram wrist (73115) |
$8,066.95 |
$8,066.95 |
21.9× |
| Xr bone age studies (77072) |
$1,290.50 |
$1,290.50 |
11.7× |
| Xr bone length study (77073) |
$2,558.59 |
$2,558.59 |
23.2× |
| Xr bone survey infant (77076) |
$5,117.26 |
$5,117.26 |
46.4× |
| Xr bone survey ltd (77074) |
$3,527.78 |
$3,527.78 |
32.0× |
| Xr chest 1 view (71045) |
$1,424.88 |
$1,424.88 |
15.5× |
| Xr chest 2 views (71046) |
$2,208.35 |
$2,208.35 |
24.1× |
| Xr eye foreign body (70030) |
$3,683.22 |
$3,683.22 |
40.1× |
| Xr facial bones 3+ views (70150) |
$3,209.16 |
$3,209.16 |
29.1× |
| Xr foot arthritis pa only bilateral - report(ortho pro) (73620) |
$2,895.08 |
$2,895.08 |
31.5× |
| Xr forearm 2 views (73090) |
$1,868.56 |
$1,868.56 |
20.4× |
| Xr hand 2v (73120) |
$1,573.63 |
$1,573.63 |
14.3× |
| Xr hysterosalpingogram (74740) |
$4,807.74 |
$4,807.74 |
19.1× |
| Xr joint survey 1 view (77077) |
$1,879.14 |
$1,879.14 |
17.0× |
| Xr myelogram c-spine (72240) |
$12,182.03 |
$12,182.03 |
14.7× |
| Xr myelogram l-spine (72265) |
$10,903.38 |
$10,903.38 |
13.2× |
| Xr myelogram t-spine (72255) |
$10,263.47 |
$10,263.47 |
12.4× |
| Xr neck soft tissue (70360) |
$2,114.87 |
$2,114.87 |
23.0× |
| Xr o knee w/ merchant view bilat - report(ortho pro) (73562) |
$2,249.22 |
$2,249.22 |
24.5× |
| Xr osseous survey complete (77075) |
$11,501.22 |
$11,501.22 |
104.3× |
| Xr pelvis 1-2 views (72170) |
$1,930.53 |
$1,930.53 |
17.5× |
| Xr pelvis min 3 view (72190) |
$2,558.59 |
$2,558.59 |
23.2× |
| Xr peritoneogram (74190) |
$3,573.92 |
$3,573.92 |
6.2× |
| Xr sacrum/coccyx 2+ views (72220) |
$2,156.98 |
$2,156.98 |
23.5× |
| Xr shoulder 1 view (73020) |
$1,879.14 |
$1,879.14 |
20.5× |
| Xr sialogram (70390) |
$5,034.24 |
$5,034.24 |
20.0× |
| Xr sinuses 3+ views (70220) |
$3,209.16 |
$3,209.16 |
35.0× |
| Xr skull min 4 view (70260) |
$3,847.87 |
$3,847.87 |
34.9× |
| Xr spine 1 view (72020) |
$1,229.93 |
$1,229.93 |
13.4× |
| Xr spine thoracic 3v (72072) |
$3,085.33 |
$3,085.33 |
28.0× |
| Xr sternum 2+ views (71120) |
$2,600.76 |
$2,600.76 |
28.3× |
| Xr surgical specimen (76098) |
$846.06 |
$846.06 |
1.5× |
| Xr t-spine 2 views (72070) |
$3,085.33 |
$3,085.33 |
28.0× |
| Xr tibia/fibula 2 views (73590) |
$2,864.12 |
$2,864.12 |
31.2× |
| Xr tmj bilateral (70330) |
$3,527.78 |
$3,527.78 |
38.4× |
| Xr tmj unilateral (70328) |
$2,889.16 |
$2,889.16 |
31.5× |
| Xr venogram renal bilat (75833) |
$21,776.46 |
$21,776.46 |
6.5× |
| Xr wrist 2 views (73100) |
$1,559.16 |
$1,559.16 |
17.0× |