| Acute gi blood loss imaging (78278) |
$5,796.35 |
$5,796.35 |
13.7× |
| Angiography internal mammary rs&i (75756) |
$10,923.56 |
$10,923.56 |
3.3× |
| Angiography pulmonary bilateral slctv rs&i (75743) |
$22,648.04 |
$22,648.04 |
6.8× |
| Angiography visceral slctv/supraslctv rs&i (75726) |
$18,797.72 |
$18,797.72 |
3.2× |
| Angiography, adrenal, bilateral, selective, radiological supervision and interpretation Age Under 21 (75733) |
$15,502.74 |
$15,502.74 |
4.7× |
| Angiography, adrenal, unilateral, selective, radiological supervision and interpretation Age Under 21 (75731) |
$6,418.37 |
$6,418.37 |
1.9× |
| Angiography, extremity, bilateral, radiological supervision and interpretation Age Under 21 (75716) |
$12,224.26 |
$12,224.26 |
3.7× |
| Angiography, extremity, unilateral, radiological supervision and interpretation Age Under 21 (75710) |
$11,963.61 |
$11,963.61 |
3.6× |
| Angiography, pelvic, selective or supraselective, radiological supervision and interpretation Age Under 21 (75736) |
$11,863.84 |
$11,863.84 |
2.0× |
| Angiography, pulmonary, unilateral, selective, radiological supervision and interpretation Age Under 21 (75741) |
$13,357.84 |
$13,357.84 |
4.0× |
| Angiography, spinal, selective, radiological supervision and interpretation Age Under 21 (75705) |
$10,006.22 |
$10,006.22 |
1.7× |
| Angrph cath f-up std tcat other than thrombylsis (75898) |
$10,942.35 |
$10,942.35 |
3.3× |
| Angrph pulmonary nonslctv cath/ven njx rs&i (75746) |
$11,368.24 |
$11,368.24 |
3.4× |
| Ankle 2 views (73600) |
$2,084.43 |
$2,084.43 |
22.7× |
| Aortography, abdominal plus bilateral iliofemoral lower extremity, catheter, by serialography, radiological supervision… (75630) |
$11,703.48 |
$11,703.48 |
3.5× |
| Aortography, abdominal, by serialography, radiological supervision and interpretation Age Under 21 (75625) |
$11,184.31 |
$11,184.31 |
3.4× |
| Aortography, thoracic, by serialography, radiological supervision and interpretation Age Under 21 (75605) |
$11,863.84 |
$11,863.84 |
2.0× |
| Basic radiation dosimetry calculation (77300) |
$1,090.41 |
$1,090.41 |
7.7× |
| Brain flow imaging only - nm brain flow only brain death (78610) |
$4,273.56 |
$4,273.56 |
7.5× |
| Brain imaging, minimum 4 static views; with vascular flow Age Under 21 (78606) |
$8,925.49 |
$8,925.49 |
15.6× |
| Cardiac blood pool imaging (planar), first pass technique; single study, at rest or with stress (exercise and/or… (78481) |
$6,561.10 |
$6,561.10 |
11.5× |
| Cardiac MRI morphology & function w/o contrast (75557) |
$11,399 |
$11,399 |
45.3× |
| Cardiac MRI w/wo contrast & further seq (75561) |
$13,206.02 |
$13,206.02 |
35.9× |
| Clavicle complete (73000) |
$1,272.11 |
$1,272.11 |
13.9× |
| Complex dynamic pharyngeal and speech evaluation by cine or video recording Age Under 21 (70371) |
$3,937.65 |
$3,937.65 |
15.6× |
| Computed tomographic angiography, abdomen and pelvis, with contrast material(s), including noncontrast images, if… (74174) |
$25,052.82 |
$25,052.82 |
68.1× |
| Computed tomographic angiography, abdomen, with contrast material(s), including noncontrast images, if performed, and… (74175) |
$19,951.07 |
$19,951.07 |
107.8× |
| Computed tomographic angiography, abdominal aorta and bilateral iliofemoral lower extremity runoff, with contrast… (75635) |
$20,608.69 |
$20,608.69 |
111.4× |
| Computed tomographic angiography, chest (noncoronary), with contrast material(s), including noncontrast images, if… (71275) |
$23,716.46 |
$23,716.46 |
128.2× |
| Computed tomographic angiography, lower extremity, with contrast material(s), including noncontrast images, if… (73706) |
$19,633.81 |
$19,633.81 |
106.1× |
| Computed tomographic angiography, neck, with contrast material(s), including noncontrast images, if performed, and… (70498) |
$17,195.30 |
$17,195.30 |
92.9× |
| Computed tomographic angiography, pelvis, with contrast material(s), including noncontrast images, if performed, and… (72191) |
$26,123.36 |
$26,123.36 |
141.2× |
| Computed tomographic angiography, upper extremity, with contrast material(s), including noncontrast images, if… (73206) |
$19,675.06 |
$19,675.06 |
106.3× |
| Computed tomography, cervical spine; without contrast material, followed by contrast material(s) and further sections… (72127) |
$15,925.51 |
$15,925.51 |
86.1× |
| Computed tomography, lower extremity; without contrast material Age Under 21 (73700) |
$7,353.07 |
$7,353.07 |
66.7× |
| Computed tomography, lower extremity; without contrast material, followed by contrast material(s) and further sections… (73702) |
$11,303.75 |
$11,303.75 |
61.1× |
| Computed tomography, lumbar spine; without contrast material, followed by contrast material(s) and further sections Age… (72133) |
$17,013.51 |
$17,013.51 |
92.0× |
| Computed tomography, maxillofacial area; with contrast material(s) Age Under 21 (70487) |
$9,496.91 |
$9,496.91 |
51.3× |
| Computed tomography, maxillofacial area; without contrast material Age Under 21 (70486) |
$7,425.62 |
$7,425.62 |
67.3× |
| Computed tomography, orbit, sella, or posterior fossa or outer, middle, or inner ear; with contrast material(s) Age… (70481) |
$9,496.91 |
$9,496.91 |
51.3× |
| Computed tomography, orbit, sella, or posterior fossa or outer, middle, or inner ear; without contrast material Age… (70480) |
$7,425.62 |
$7,425.62 |
67.3× |
| Computed tomography, orbit, sella, or posterior fossa or outer, middle, or inner ear; without contrast material,… (70482) |
$14,296.33 |
$14,296.33 |
77.3× |
| Computed tomography, soft tissue neck; without contrast material followed by contrast material(s) and further sections… (70492) |
$15,604.20 |
$15,604.20 |
84.3× |
| Computed tomography, thoracic spine; without contrast material, followed by contrast material(s) and further sections… (72130) |
$31,121.93 |
$31,121.93 |
168.2× |
| Computed tomography, thorax, diagnostic; without contrast material, followed by contrast material(s) and further… (71270) |
$16,598.60 |
$16,598.60 |
89.7× |
| Corpora cavernosography, radiological supervision and interpretation Age Under 21 (74445) |
$13,051.68 |
$13,051.68 |
118.4× |
| CT abdomen and pelvis without and with contrast (74178) |
$31,409.96 |
$31,409.96 |
85.3× |
| CT abdomen and pelvis without contrast (74176) |
$22,073.59 |
$22,073.59 |
87.7× |
| CT abdomen w & w/o contrast (74170) |
$15,954.21 |
$15,954.21 |
86.2× |
| CT abdomen w/contrast (74160) |
$14,802.76 |
$14,802.76 |
80.0× |
| CT abdomen w/o contrast (74150) |
$11,838.93 |
$11,838.93 |
107.4× |
| CT angio hrt w/3d image (75574) |
$14,177.35 |
$14,177.35 |
38.5× |
| CT cervical spine w/contrast (72126) |
$14,147.06 |
$14,147.06 |
38.4× |
| CT cervical spine w/o contrast (72125) |
$12,999.28 |
$12,999.28 |
117.9× |
| CT chest w/contrast (71260) |
$12,712.61 |
$12,712.61 |
68.7× |
| CT extremity upper w & w/o contrast (73202) |
$11,303.75 |
$11,303.75 |
61.1× |
| CT extremity upper w/o contrast (73200) |
$7,353.07 |
$7,353.07 |
66.7× |
| CT head/brain with contrast (70460) |
$17,042.36 |
$17,042.36 |
92.1× |
| CT head/brain without and with contrast (70470) |
$18,905.82 |
$18,905.82 |
102.2× |
| CT heart c+ cardiac strux&morph cgen hrt ds (75573) |
$11,341.85 |
$11,341.85 |
30.8× |
| CT heart contrast eval cardiac structure&morph (75572) |
$20,982.46 |
$20,982.46 |
57.0× |
| CT heart no contrast quant eval coronry calcium (75571) |
$891.48 |
$891.48 |
9.7× |
| CT l-spine w/contrast (72132) |
$14,147.06 |
$14,147.06 |
38.4× |
| CT limited/localized follow up study (76380) |
$6,312.13 |
$6,312.13 |
68.8× |
| CT lower extremity w/dye (73701) |
$8,730.49 |
$8,730.49 |
47.2× |
| CT lumbar spine w/o contrast (72131) |
$12,999.28 |
$12,999.28 |
117.9× |
| CT maxillofacial w/wo contrast (70488) |
$17,709.46 |
$17,709.46 |
95.7× |
| CT neck w/contrast (70491) |
$13,028.42 |
$13,028.42 |
70.4× |
| CT neck w/o contrast (70490) |
$11,656.25 |
$11,656.25 |
105.7× |
| CT pelvis w & w/o contrast (72194) |
$16,739.82 |
$16,739.82 |
90.5× |
| CT pelvis w/o contrast (72192) |
$10,141.43 |
$10,141.43 |
92.0× |
| CT thoracic spine w/contrast (72129) |
$21,604.61 |
$21,604.61 |
116.8× |
| CT thoracic spine w/o contrast (72128) |
$12,999.28 |
$12,999.28 |
117.9× |
| CT thorax lung cancer scr c- (71271) |
$285.32 |
$285.32 |
2.6× |
| CT thorax w/o contrast (71250) |
$11,081.44 |
$11,081.44 |
100.5× |
| CT upper extremity w/dye (73201) |
$8,945.46 |
$8,945.46 |
24.3× |
| CTA head w contrast (70496) |
$12,921.55 |
$12,921.55 |
69.8× |
| Cystography, minimum of 3 views, radiological supervision and interpretation Age Under 21 (74430) |
$4,066.04 |
$4,066.04 |
11.0× |
| Dilation ureters/urethra rs&i (74485) |
$7,661.61 |
$7,661.61 |
3.5× |
| Discography, cervical or thoracic, radiological supervision and interpretation Age Under 21 (72285) |
$6,675.21 |
$6,675.21 |
3.2× |
| Diskography lumbar s&i (72295) |
$7,415.68 |
$7,415.68 |
3.6× |
| Doppler echocardiography, fetal, pulsed wave and/or continuous wave with spectral display; complete Age Under 21 (76827) |
$958.64 |
$958.64 |
8.7× |
| Doppler echocardiography, fetal, pulsed wave and/or continuous wave with spectral display; follow-up or repeat study… (76828) |
$2,280.97 |
$2,280.97 |
20.7× |
| Doppler fetal mid cerebral artery (76821) |
$483.89 |
$483.89 |
4.4× |
| Dual-energy X-ray absorptiometry (DXA), bone density study, 1 or more sites; axial skeleton (eg, hips, pelvis, spine)… (77080) |
$3,707.84 |
$3,707.84 |
33.6× |
| Echocardiography, fetal, cardiovascular system, real time with image documentation (2D), with or without M-mode… (76825) |
$4,736.34 |
$4,736.34 |
8.2× |
| Fetal biophys profile w/o nst (76819) |
$1,851.58 |
$1,851.58 |
16.8× |
| Fetal biophysical profile non-stress testing (76818) |
$3,791.21 |
$3,791.21 |
34.4× |
| Fluoroscopy up to 1 hour physician/qhp time (76000) |
$3,311.08 |
$3,311.08 |
13.2× |
| Gastroesophageal reflux study (78262) |
$11,193.06 |
$11,193.06 |
26.5× |
| Gated heart planar single (78472) |
$12,575.08 |
$12,575.08 |
29.8× |
| Hepatc vngrph wdg/fr w/o hemodyn eval rs&i (75891) |
$10,278.39 |
$10,278.39 |
3.1× |
| Hepatic venography, wedged or free, with hemodynamic evaluation, radiological supervision and interpretation Age Under… (75889) |
$9,646.45 |
$9,646.45 |
2.9× |
| Hepatobil syst imag inc gb w/pharma intervenj (78227) |
$13,035.36 |
$13,035.36 |
22.8× |
| Hepatobiliary syst imaging including gallbladder (78226) |
$10,428.31 |
$10,428.31 |
24.7× |
| Ht muscle image spect sing (78451) |
$23,557.05 |
$23,557.05 |
17.2× |
| Intestine imaging (eg, ectopic gastric mucosa, Meckel's localization, volvulus) Age Under 21 (78290) |
$9,702.10 |
$9,702.10 |
23.0× |
| Kidney imaging morphology; with vascular flow Age Under 21 (78701) |
$8,083.76 |
$8,083.76 |
19.2× |
| Kidney imaging morphology; with vascular flow and function, multiple studies, with and without pharmacological… (78709) |
$10,733.73 |
$10,733.73 |
18.7× |
| Kidney imaging morphology; with vascular flow and function, single study without pharmacological intervention Age Under… (78707) |
$11,900.65 |
$11,900.65 |
20.8× |
| Kidney imaging morphology; with vascular flow and function, single study, with pharmacological intervention (eg,… (78708) |
$8,937.43 |
$8,937.43 |
15.6× |
| Leveen/shunt patency exam (78291) |
$2,866.31 |
$2,866.31 |
6.8× |
| Liver and spleen imaging (78215) |
$9,984.95 |
$9,984.95 |
23.7× |
| Liver and spleen imaging; with vascular flow Age Under 21 (78216) |
$8,482.15 |
$8,482.15 |
20.1× |
| Liver imaging (78201) |
$5,642.33 |
$5,642.33 |
9.9× |
| Lung perf&ventilat diferentl (78598) |
$24,648.28 |
$24,648.28 |
43.0× |
| Lung perfusion imaging (78580) |
$10,280.95 |
$10,280.95 |
24.4× |
| Lymphangiography, pelvic/abdominal, unilateral, radiological supervision and interpretation Age Under 21 (75805) |
$6,839.09 |
$6,839.09 |
2.1× |
| Magnetic resonance (eg, proton) imaging, any joint of lower extremity; without contrast material(s), followed by… (73723) |
$13,993.52 |
$13,993.52 |
38.0× |
| Magnetic resonance (eg, proton) imaging, lower extremity other than joint; with contrast material(s) Age Under 21 (73719) |
$13,327.16 |
$13,327.16 |
36.2× |
| Magnetic resonance (eg, proton) imaging, lower extremity other than joint; without contrast material(s) Age Under 21 (73718) |
$12,856.08 |
$12,856.08 |
51.1× |
| Magnetic resonance (eg, proton) imaging, lower extremity other than joint; without contrast material(s), followed by… (73720) |
$15,073.85 |
$15,073.85 |
41.0× |
| Magnetic resonance (eg, proton) imaging, orbit, face, and/or neck; with contrast material(s) Age Under 21 (70542) |
$10,547.89 |
$10,547.89 |
28.7× |
| Magnetic resonance (eg, proton) imaging, orbit, face, and/or neck; without contrast material(s) Age Under 21 (70540) |
$10,256.84 |
$10,256.84 |
40.8× |
| Magnetic resonance (eg, proton) imaging, upper extremity, other than joint; with contrast material(s) Age Under 21 (73219) |
$14,739.76 |
$14,739.76 |
40.1× |
| Magnetic resonance (eg, proton) imaging, upper extremity, other than joint; without contrast material(s), followed by… (73220) |
$15,073.85 |
$15,073.85 |
41.0× |
| Magnetic resonance angiography, head; with contrast material(s) Age Under 21 (70545) |
$14,105.36 |
$14,105.36 |
38.3× |
| Magnetic resonance angiography, head; without contrast material(s), followed by contrast material(s) and further… (70546) |
$15,082.81 |
$15,082.81 |
41.0× |
| Magnetic resonance angiography, neck; without contrast material(s), followed by contrast material(s) and further… (70549) |
$15,832.24 |
$15,832.24 |
43.0× |
| Mammary ductogram or galactogram, multiple ducts, radiological supervision and interpretation Age Under 21 (77054) |
$3,884.58 |
$3,884.58 |
15.4× |
| Mammary ductogram single (77053) |
$3,053.52 |
$3,053.52 |
12.1× |
| Mandible min 4v (70110) |
$3,027.63 |
$3,027.63 |
27.5× |
| Mr safety implant&/fb assmt clin staf 1st 15 min (76014) |
$80.82 |
$80.82 |
2.6× |
| MRA head w/o contrast (70544) |
$13,352.35 |
$13,352.35 |
53.0× |
| MRA neck w/ contrast (70548) |
$14,104.48 |
$14,104.48 |
38.3× |
| MRA neck w/o contrast (70547) |
$13,120.85 |
$13,120.85 |
52.1× |
| MRI abdomen w/contrast (74182) |
$14,820.49 |
$14,820.49 |
40.3× |
| MRI abdomen w/o contrast (74181) |
$14,504.56 |
$14,504.56 |
57.6× |
| MRI abdomen w/wo contrast (74183) |
$17,412.44 |
$17,412.44 |
47.3× |
| MRI any jt lower extrem w/contrast material (73722) |
$13,200.54 |
$13,200.54 |
16.0× |
| MRI bone marrow (77084) |
$17,351.43 |
$17,351.43 |
68.9× |
| MRI breast c- bilateral (77047) |
$16,521.25 |
$16,521.25 |
65.6× |
| MRI c-spine w&w/o cont (72156) |
$16,679.82 |
$16,679.82 |
45.3× |
| MRI cervical spine w/contrast (72142) |
$13,576.58 |
$13,576.58 |
36.9× |
| MRI chest w/contrast (71551) |
$12,282.72 |
$12,282.72 |
14.9× |
| MRI chest w/o contrast (71550) |
$14,967.24 |
$14,967.24 |
59.5× |
| MRI chest w/wo contrast (71552) |
$17,933.84 |
$17,933.84 |
48.7× |
| MRI joint upr extr w/o&w/dye (73223) |
$10,683.77 |
$10,683.77 |
29.0× |
| MRI joint upr extrem w/dye (73222) |
$13,392.64 |
$13,392.64 |
16.2× |
| MRI joint upr extrem w/o dye (73221) |
$12,012.27 |
$12,012.27 |
47.7× |
| MRI lumbar spine w/contrast (72149) |
$13,733.71 |
$13,733.71 |
37.3× |
| MRI lumbar spine w/wo contrast (72158) |
$16,679.78 |
$16,679.78 |
45.3× |
| MRI orbit/face/neck w&w/o cont (70543) |
$13,218.22 |
$13,218.22 |
35.9× |
| MRI pelvis w & w/o contrast (72197) |
$11,880.36 |
$11,880.36 |
32.3× |
| MRI pelvis w/contrast (72196) |
$10,181.50 |
$10,181.50 |
27.7× |
| MRI pelvis w/o contrast (72195) |
$9,071.84 |
$9,071.84 |
36.0× |
| MRI spine cervical w/o contrast (72141) |
$11,357.11 |
$11,357.11 |
45.1× |
| MRI t-spine w&w/o cont (72157) |
$16,679.72 |
$16,679.72 |
45.3× |
| MRI thoracic spine w/contrast (72147) |
$11,796.74 |
$11,796.74 |
32.1× |
| MRI thoracic spine w/o contrst (72146) |
$10,893.70 |
$10,893.70 |
43.3× |
| MRI tmj (70336) |
$11,224.94 |
$11,224.94 |
44.6× |
| MRI upper extremity oth than jt w/o contr matrl (73218) |
$13,772.89 |
$13,772.89 |
54.7× |
| Myelography, 2 or more regions (eg, lumbar/thoracic, cervical/thoracic, lumbar/cervical, lumbar/thoracic/cervical),… (72270) |
$9,491.08 |
$9,491.08 |
11.5× |
| Myocardial perfusion imaging, planar (including qualitative or quantitative wall motion, ejection fraction by first… (78453) |
$20,016.33 |
$20,016.33 |
14.7× |
| Myocardial perfusion imaging, planar (including qualitative or quantitative wall motion, ejection fraction by first… (78454) |
$29,115.70 |
$29,115.70 |
21.3× |
| Myocardial spect multiple studies (78452) |
$30,914.62 |
$30,914.62 |
22.6× |
| N-invas est c ffr augmnt sw alys CTA i&r phy/qhp (75580) |
$3,649.01 |
$3,649.01 |
4.0× |
| Nm bone 3 phase (78315) |
$13,294.66 |
$13,294.66 |
31.5× |
| Nm bone imaging whole body (78306) |
$13,242.86 |
$13,242.86 |
31.4× |
| Nm csf cisternogram (78630) |
$8,762.20 |
$8,762.20 |
15.3× |
| Nm gastric emptying (78264) |
$9,735.35 |
$9,735.35 |
23.1× |
| Nm lung ventilation imaging (78579) |
$12,620.20 |
$12,620.20 |
29.9× |
| Nm lymph system (78195) |
$10,210.62 |
$10,210.62 |
17.8× |
| Nm myocard infarct spect (78469) |
$9,735.35 |
$9,735.35 |
17.0× |
| Non-cardiac vascular flow imaging (ie, angiography, venography) Age Under 21 (78445) |
$2,866.31 |
$2,866.31 |
6.8× |
| Nuclear medicine study of bone and/or joint limited area (78300) |
$13,552.17 |
$13,552.17 |
32.1× |
| Nuclear medicine study of bone and/or joint multiple areas (78305) |
$8,577.71 |
$8,577.71 |
20.3× |
| Nuclear medicine study of brain, 4 static views or more (78605) |
$8,925.49 |
$8,925.49 |
15.6× |
| Ob us limited fetus(s) (76815) |
$3,692.50 |
$3,692.50 |
33.5× |
| Parathyroid planar imaging (78070) |
$11,636.46 |
$11,636.46 |
27.6× |
| Parathyroid planar imaging w/wo subtraction (78071) |
$24,333.71 |
$24,333.71 |
57.7× |
| Percutaneous transhepatic portography with hemodynamic evaluation, radiological supervision and interpretation Age… (75885) |
$10,387.20 |
$10,387.20 |
3.1× |
| Prq transhepatc portograpy w/o hemodyn evl intrp (75887) |
$9,860.09 |
$9,860.09 |
3.0× |
| Pulmonary ventilation & perfusion imaging (78582) |
$22,901.15 |
$22,901.15 |
40.0× |
| Quant differential pulm perfusion w/wo imaging (78597) |
$12,028.06 |
$12,028.06 |
28.5× |
| Radex abscess/fistula/sinus tract rs&i (76080) |
$3,544.78 |
$3,544.78 |
6.1× |
| Radex entir thrc lmbr crv sac spi w/skull 1 vw (72081) |
$1,323.64 |
$1,323.64 |
14.4× |
| Radex entir thrc lmbr crv sac spi w/skull 2/3 vw (72082) |
$4,213.31 |
$4,213.31 |
38.2× |
| Radex entir thrc lmbr crv sac spi w/skull 4/5 vw (72083) |
$3,298.34 |
$3,298.34 |
29.9× |
| Radex entir thrc lmbr crv sac spi w/skull 6/> vw (72084) |
$7,511.66 |
$7,511.66 |
68.1× |
| Radex hip unilateral with pelvis 1 view (73501) |
$1,631.74 |
$1,631.74 |
17.8× |
| Radex hip unilateral with pelvis 2-3 views (73502) |
$4,612.23 |
$4,612.23 |
50.2× |
| Radex hip unilateral with pelvis minimum 4 views (73503) |
$4,213.31 |
$4,213.31 |
38.2× |
| Radex hips bilateral with pelvis 2 views (73521) |
$3,298.34 |
$3,298.34 |
29.9× |
| Radex hips bilateral with pelvis minimum 5 views (73523) |
$5,834.57 |
$5,834.57 |
52.9× |
| Radex spine cervical 2 or 3 views (72040) |
$3,184.74 |
$3,184.74 |
34.7× |
| Radex spine cervical 4 or 5 views (72050) |
$4,061.90 |
$4,061.90 |
36.8× |
| Radex spine cervical 6 or more views (72052) |
$4,647.34 |
$4,647.34 |
42.1× |
| Radex spine thoracolumbar junction min 2 views (72080) |
$2,548.11 |
$2,548.11 |
27.8× |
| Radiologic exam abdomen 3+ views (74021) |
$3,342.38 |
$3,342.38 |
30.3× |
| Radiologic exam chest 3 views (71047) |
$3,672.15 |
$3,672.15 |
40.0× |
| Radiologic exam chest 4+ views (71048) |
$4,590.23 |
$4,590.23 |
41.6× |
| Radiologic exam colon double contrast study (74280) |
$6,519.51 |
$6,519.51 |
35.2× |
| Radiologic exam colon single contrast study (74270) |
$5,504.31 |
$5,504.31 |
29.7× |
| Radiologic exam esophagus double contrast study (74221) |
$3,667.91 |
$3,667.91 |
19.8× |
| Radiologic exam esophagus single contrast study (74220) |
$3,568.64 |
$3,568.64 |
19.3× |
| Radiologic exam small int single contrast study (74250) |
$2,535.83 |
$2,535.83 |
13.7× |
| Radiologic exam swallow function contrast study (74230) |
$3,437.49 |
$3,437.49 |
18.6× |
| Radiologic exam upr gi trc double contrast study (74246) |
$8,644.36 |
$8,644.36 |
46.7× |
| Radiologic exam upr gi trc single contrast study (74240) |
$5,342.07 |
$5,342.07 |
28.9× |
| Radiologic examination femur 1 view (73551) |
$1,245.29 |
$1,245.29 |
13.6× |
| Radiologic examination femur minimum 2 views (73552) |
$2,535.83 |
$2,535.83 |
27.6× |
| Radiologic examination from nose to rectum for foreign body, single view, child Age Under 21 (76010) |
$2,212.82 |
$2,212.82 |
24.1× |
| Radiologic examination, ankle; complete, minimum of 3 views Age Under 21 (73610) |
$3,159.54 |
$3,159.54 |
34.4× |
| Radiologic examination, complete acute abdomen series, including 2 or more views of the abdomen (eg, supine, erect,… (74022) |
$3,221.25 |
$3,221.25 |
29.2× |
| Radiologic examination, elbow; 2 views Age Under 21 (73070) |
$1,635.65 |
$1,635.65 |
17.8× |
| Radiologic examination, elbow; complete, minimum of 3 views Age Under 21 (73080) |
$3,349.17 |
$3,349.17 |
36.5× |
| Radiologic examination, facial bones; less than 3 views Age Under 21 (70140) |
$2,635.15 |
$2,635.15 |
28.7× |
| Radiologic examination, foot; complete, minimum of 3 views Age Under 21 (73630) |
$3,494.74 |
$3,494.74 |
38.1× |
| Radiologic examination, hand; minimum of 3 views Age Under 21 (73130) |
$3,705.80 |
$3,705.80 |
40.4× |
| Radiologic examination, knee; both knees, standing, anteroposterior Age Under 21 (73565) |
$1,422.76 |
$1,422.76 |
15.5× |
| Radiologic examination, knee; complete, 4 or more views Age Under 21 (73564) |
$5,191.70 |
$5,191.70 |
47.1× |
| Radiologic examination, mandible; partial, less than 4 views Age Under 21 (70100) |
$2,756.25 |
$2,756.25 |
30.0× |
| Radiologic examination, nasal bones, complete, minimum of 3 views Age Under 21 (70160) |
$2,781.90 |
$2,781.90 |
30.3× |
| Radiologic examination, renal cyst study, translumbar, contrast visualization, radiological supervision and… (74470) |
$5,805.61 |
$5,805.61 |
10.1× |
| Radiologic examination, ribs, bilateral; including posteroanterior chest, minimum of 4 views Age Under 21 (71111) |
$4,445.07 |
$4,445.07 |
40.3× |
| Radiologic examination, ribs, unilateral; including posteroanterior chest, minimum of 3 views Age Under 21 (71101) |
$3,009.01 |
$3,009.01 |
27.3× |
| Radiologic examination, sacroiliac joints; less than 3 views Age Under 21 (72200) |
$2,083.03 |
$2,083.03 |
18.9× |
| Radiologic examination, shoulder, arthrography, radiological supervision and interpretation Age Under 21 (73040) |
$5,302.42 |
$5,302.42 |
14.4× |
| Radiologic examination, shoulder; complete, minimum of 2 views Age Under 21 (73030) |
$3,819.97 |
$3,819.97 |
41.6× |
| Radiologic examination, single plane body section (eg, tomography), other than with urography Age Under 21 (76100) |
$5,135.22 |
$5,135.22 |
46.6× |
| Radiologic examination, sinuses, paranasal, less than 3 views Age Under 21 (70210) |
$1,434.80 |
$1,434.80 |
15.6× |
| Radiologic examination, skull; less than 4 views Age Under 21 (70250) |
$2,570.86 |
$2,570.86 |
23.3× |
| Radiologic examination, spine, lumbosacral; 2 or 3 views Age Under 21 (72100) |
$3,009.01 |
$3,009.01 |
27.3× |
| Radiologic examination, spine, lumbosacral; bending views only, 2 or 3 views Age Under 21 (72120) |
$2,286.14 |
$2,286.14 |
20.7× |
| Radiologic examination, spine, lumbosacral; complete, including bending views, minimum of 6 views Age Under 21 (72114) |
$4,323.14 |
$4,323.14 |
39.2× |
| Radiologic examination, spine; thoracic, minimum of 4 views Age Under 21 (72074) |
$3,516.88 |
$3,516.88 |
31.9× |
| Radiologic examination, wrist; complete, minimum of 3 views Age Under 21 (73110) |
$3,169.54 |
$3,169.54 |
34.5× |
| Radiologic examination; acromioclavicular joints, bilateral, with or without weighted distraction Age Under 21 (73050) |
$2,212.82 |
$2,212.82 |
24.1× |
| Radiologic examination; humerus, minimum of 2 views Age Under 21 (73060) |
$2,976.50 |
$2,976.50 |
32.4× |
| Radiologic examination; lower extremity, infant, minimum of 2 views Age Under 21 (73592) |
$1,864.07 |
$1,864.07 |
20.3× |
| Radiologic examination; orbits, complete, minimum of 4 views Age Under 21 (70200) |
$3,420.22 |
$3,420.22 |
31.0× |
| Radiologic examination; sternoclavicular joint or joints, minimum of 3 views Age Under 21 (71130) |
$1,875.93 |
$1,875.93 |
20.4× |
| Radiologic examination; toe(s), minimum of 2 views Age Under 21 (73660) |
$1,767.74 |
$1,767.74 |
19.3× |
| Radiologic examination; upper extremity, infant, minimum of 2 views Age Under 21 (73092) |
$1,962.73 |
$1,962.73 |
17.8× |
| Radiopharmaceutical localization of tumor, inflammatory process or distribution of radiopharmaceutical agent(s)… (78803) |
$12,697.20 |
$12,697.20 |
22.2× |
| Radiopharmaceutical therapy, by intravenous administration Age Under 21 (79101) |
$3,334.96 |
$3,334.96 |
13.5× |
| Radiopharmaceutical therapy, by oral administration Age Under 21 (79005) |
$18,088.64 |
$18,088.64 |
73.5× |
| Review by radiologist of urinary bladder and urethra images with contrast and after passing urine (74455) |
$2,529.28 |
$2,529.28 |
10.0× |
| Rp loclzj tum plnr 1 area single day imaging (78800) |
$5,635.72 |
$5,635.72 |
13.4× |
| Rp loclzj tum plnr 2+area 1+d img/1 area img>2+d (78801) |
$1,741.02 |
$1,741.02 |
4.1× |
| Rp loclzj tum plnr whole body 2+ days imaging (78804) |
$13,519.01 |
$13,519.01 |
23.6× |
| Rp loclzj tum plnr whole body single day imaging (78802) |
$14,034.11 |
$14,034.11 |
24.5× |
| Rp loclzj tum spect 2 areas (78831) |
$12,697.20 |
$12,697.20 |
9.3× |
| Rp loclzj tum spect w/CT 1 (78830) |
$12,697.20 |
$12,697.20 |
9.3× |
| Rp loclzj tum spect w/CT 2 (78832) |
$12,697.20 |
$12,697.20 |
8.4× |
| Saline infusion sonohysterography (SIS), including color flow Doppler, when performed Age Under 21 (76831) |
$10,385.35 |
$10,385.35 |
41.3× |
| Scapula complete (73010) |
$1,570.79 |
$1,570.79 |
14.2× |
| Screening digital breast tomosynthesis bi (77063) |
$180.08 |
$180.08 |
— |
| Shuntogram indwelling nonvascular shunt rs&i (75809) |
$7,122.98 |
$7,122.98 |
64.6× |
| Splenoportography, radiological supervision and interpretation Age Under 21 (75810) |
$10,923.56 |
$10,923.56 |
3.3× |
| Ther rad simulaj-aided field setting complex (77290) |
$3,271.20 |
$3,271.20 |
8.3× |
| Therapeutic enema, contrast or air, for reduction of intussusception or other intraluminal obstruction (eg, meconium… (74283) |
$4,002.70 |
$4,002.70 |
21.6× |
| Thyroid imaging with vascular flow (78013) |
$7,331.05 |
$7,331.05 |
17.4× |
| Thyroid met imaging body (78018) |
$10,274.36 |
$10,274.36 |
17.9× |
| Thyroid uptake single/multiple quant measurement (78012) |
$4,466.07 |
$4,466.07 |
10.6× |
| Thyroid uptake w/blood flow sngle/mult quan meas (78014) |
$11,193.06 |
$11,193.06 |
26.5× |
| Treatment device complex (77334) |
$1,775.68 |
$1,775.68 |
4.5× |
| Ultrasound breast limited (76642) |
$5,637.62 |
$5,637.62 |
61.4× |
| Ultrasound, abdomen limited (76705) |
$2,500.72 |
$2,500.72 |
22.7× |
| Ultrasound, limited, joint or focal evaluation of other nonvascular extremity structure(s) (eg, joint space,… (76882) |
$1,726.94 |
$1,726.94 |
15.7× |
| Ultrasound, pelvic (nonobstetric), real time with image documentation; complete Age Under 21 (76856) |
$3,526.91 |
$3,526.91 |
32.0× |
| Ultrasound, pregnant uterus, real time with image documentation, fetal and maternal evaluation, first trimester (< 14… (76801) |
$3,765.38 |
$3,765.38 |
34.1× |
| Ultrasound, transplanted kidney, real time and duplex Doppler with image documentation Age Under 21 (76776) |
$4,540.32 |
$4,540.32 |
41.2× |
| Umbilical-artery Doppler (OB) (76820) |
$483.89 |
$483.89 |
4.4× |
| Ureteral reflux study (78740) |
$7,106.71 |
$7,106.71 |
16.9× |
| Urethrocystography retrograde rs&i (74450) |
$8,210.49 |
$8,210.49 |
32.6× |
| Urography (pyelography), intravenous, with or without KUB, with or without tomography Age Under 21 (74400) |
$6,154.78 |
$6,154.78 |
33.3× |
| Urography antegrade rs&i (74425) |
$4,145.86 |
$4,145.86 |
11.3× |
| Urography, infusion, drip technique and/or bolus technique; with nephrotomography Age Under 21 (74415) |
$9,448.59 |
$9,448.59 |
51.1× |
| Us breast uni real time with image complete (76641) |
$8,792.94 |
$8,792.94 |
79.7× |
| Us chest (76604) |
$3,256.76 |
$3,256.76 |
29.5× |
| Us compl joint r-t w/image documentation (76881) |
$3,518.83 |
$3,518.83 |
31.9× |
| Us encephalogram (76506) |
$2,430.74 |
$2,430.74 |
22.0× |
| Us exam, pelvic, limited (76857) |
$3,035.84 |
$3,035.84 |
27.5× |
| Us guided compression repair (76936) |
$11,293.97 |
$11,293.97 |
49.6× |
| Us inft hips r-t img dynamic req phys/qhp manj (76885) |
$2,145.30 |
$2,145.30 |
23.4× |
| US OB Follow-Up/Repeat (76816) |
$1,784.74 |
$1,784.74 |
16.2× |
| Us ob transvaginal (76817) |
$5,220.39 |
$5,220.39 |
47.3× |
| Us retroperitoneal complete (76770) |
$2,916.76 |
$2,916.76 |
26.4× |
| Us retroperitoneal ltd (76775) |
$3,515.43 |
$3,515.43 |
31.9× |
| Us scrotum (76870) |
$2,202.34 |
$2,202.34 |
20.0× |
| Us soft tissue head/neck (76536) |
$2,760.40 |
$2,760.40 |
25.0× |
| Us spinal canal (76800) |
$2,061.95 |
$2,061.95 |
18.7× |
| Us transrectal (76872) |
$4,836.47 |
$4,836.47 |
43.9× |
| Venogram sinus/jugular (75860) |
$6,217.18 |
$6,217.18 |
1.9× |
| Venography renal unilateral selective rs&i (75831) |
$10,713.78 |
$10,713.78 |
3.2× |
| Venography, caval, inferior, with serialography, radiological supervision and interpretation Age Under 21 (75825) |
$6,330.23 |
$6,330.23 |
1.9× |
| Venography, caval, superior, with serialography, radiological supervision and interpretation Age Under 21 (75827) |
$9,849.26 |
$9,849.26 |
5.9× |
| Venography, extremity, bilateral, radiological supervision and interpretation Age Under 21 (75822) |
$4,612.78 |
$4,612.78 |
2.8× |
| Venography, extremity, unilateral, radiological supervision and interpretation Age Under 21 (75820) |
$4,272.90 |
$4,272.90 |
2.6× |
| Venous sampling thru cath w/wo angiography rs& (75893) |
$11,246.17 |
$11,246.17 |
1.9× |
| X-ray exam hips bi 3-4 views (73522) |
$2,612.61 |
$2,612.61 |
23.7× |
| X-ray exam of finger(s) (73140) |
$1,655.86 |
$1,655.86 |
18.0× |
| X-ray exam of knee 1 or 2 (73560) |
$1,823.56 |
$1,823.56 |
19.9× |
| X-ray exam of small bowel - fl small bowel series enteroclysis tube (74251) |
$3,504.88 |
$3,504.88 |
18.9× |
| X-ray exam ribs bil 3 views (71110) |
$3,854.28 |
$3,854.28 |
34.9× |
| X-ray exam ribs uni 2 views (71100) |
$2,415.60 |
$2,415.60 |
26.3× |
| X-ray heel (73650) |
$1,580.21 |
$1,580.21 |
17.2× |
| X-ray of joint between lower spine and hip bone 3 or more views|PROFESSIONAL COMPONENT (72202) |
$2,400.71 |
$2,400.71 |
21.8× |
| X-ray retrograde pyelogram (74420) |
$3,312.36 |
$3,312.36 |
9.0× |
| Xr abdomen 1 view (74018) |
$1,987.15 |
$1,987.15 |
21.6× |
| Xr abdomen 2 views (74019) |
$2,571.07 |
$2,571.07 |
23.3× |
| Xr arthrogram ankle (73615) |
$8,098.39 |
$8,098.39 |
22.0× |
| Xr arthrogram elbow (73085) |
$8,928.19 |
$8,928.19 |
24.3× |
| Xr arthrogram hip (73525) |
$5,350.17 |
$5,350.17 |
14.5× |
| Xr arthrogram knee (73580) |
$8,239.11 |
$8,239.11 |
22.4× |
| Xr arthrogram wrist (73115) |
$8,107.70 |
$8,107.70 |
22.0× |
| Xr bone age studies (77072) |
$1,847.41 |
$1,847.41 |
16.8× |
| Xr bone length study (77073) |
$4,269.59 |
$4,269.59 |
38.7× |
| Xr bone survey infant (77076) |
$6,516.22 |
$6,516.22 |
59.1× |
| Xr bone survey ltd (77074) |
$6,801.33 |
$6,801.33 |
61.7× |
| Xr chest 1 view (71045) |
$1,269.31 |
$1,269.31 |
13.8× |
| Xr chest 2 views (71046) |
$2,160.09 |
$2,160.09 |
23.5× |
| Xr eye foreign body (70030) |
$1,596.44 |
$1,596.44 |
17.4× |
| Xr facial bones 3+ views (70150) |
$2,731.62 |
$2,731.62 |
24.8× |
| Xr foot arthritis pa only bilateral - report(ortho pro) (73620) |
$1,841.06 |
$1,841.06 |
20.1× |
| Xr forearm 2 views (73090) |
$2,976.50 |
$2,976.50 |
32.4× |
| Xr hand 2v (73120) |
$1,412.55 |
$1,412.55 |
12.8× |
| Xr hysterosalpingogram (74740) |
$2,867.10 |
$2,867.10 |
11.4× |
| Xr myelogram c-spine (72240) |
$9,918.52 |
$9,918.52 |
12.0× |
| Xr myelogram l-spine (72265) |
$9,003.84 |
$9,003.84 |
10.9× |
| Xr myelogram t-spine (72255) |
$8,711.82 |
$8,711.82 |
10.5× |
| Xr neck soft tissue (70360) |
$2,039.82 |
$2,039.82 |
22.2× |
| Xr o knee w/ merchant view bilat - report(ortho pro) (73562) |
$2,658.88 |
$2,658.88 |
29.0× |
| Xr osseous survey complete (77075) |
$10,058.24 |
$10,058.24 |
91.2× |
| Xr pelvis 1-2 views (72170) |
$2,196.61 |
$2,196.61 |
19.9× |
| Xr pelvis min 3 view (72190) |
$2,589.28 |
$2,589.28 |
23.5× |
| Xr peritoneogram (74190) |
$3,514.18 |
$3,514.18 |
6.1× |
| Xr sacrum/coccyx 2+ views (72220) |
$2,342.59 |
$2,342.59 |
25.5× |
| Xr shoulder 1 view (73020) |
$1,777.60 |
$1,777.60 |
19.4× |
| Xr sialogram (70390) |
$2,640.62 |
$2,640.62 |
10.5× |
| Xr sinuses 3+ views (70220) |
$2,742.34 |
$2,742.34 |
29.9× |
| Xr skull min 4 view (70260) |
$3,690.80 |
$3,690.80 |
33.5× |
| Xr spine 1 view (72020) |
$1,335.66 |
$1,335.66 |
14.5× |
| Xr spine thoracic 3v (72072) |
$2,492.62 |
$2,492.62 |
22.6× |
| Xr sternum 2+ views (71120) |
$2,173.61 |
$2,173.61 |
23.7× |
| Xr stress view joint (77071) |
$1,958.90 |
$1,958.90 |
21.3× |
| Xr surgical specimen (76098) |
$1,852.72 |
$1,852.72 |
3.2× |
| Xr t-spine 2 views (72070) |
$1,680.24 |
$1,680.24 |
15.2× |
| Xr tibia/fibula 2 views (73590) |
$2,383.11 |
$2,383.11 |
26.0× |
| Xr tmj bilateral (70330) |
$2,935.24 |
$2,935.24 |
32.0× |
| Xr tmj unilateral (70328) |
$3,528.81 |
$3,528.81 |
38.4× |
| Xr venogram renal bilat (75833) |
$10,967.42 |
$10,967.42 |
3.3× |
| Xr wrist 2 views (73100) |
$1,689.67 |
$1,689.67 |
18.4× |