| Acute gi blood loss imaging (78278) |
$1,009.38 |
$1,187.50 |
2.4× |
| Angiography, extremity, unilateral, radiological supervision and interpretation Age Under 21 (75710) |
$187 |
$220 |
0.1× |
| Ankle 2 views (73600) |
$164.90 |
$194 |
1.8× |
| Brain imaging, minimum 4 static views; with vascular flow Age Under 21 (78606) |
$913.32 |
$1,074.50 |
1.6× |
| Brain imaging, positron emission tomography (PET); metabolic evaluation Age Under 21 (78608) |
$5,538.60 |
$6,516 |
3.7× |
| Cholecystography, oral contrast Age Under 21 (74290) |
$233.32 |
$274.50 |
1.3× |
| Clavicle complete (73000) |
$167.45 |
$197 |
1.8× |
| Computed tomographic angiography, abdomen and pelvis, with contrast material(s), including noncontrast images, if… (74174) |
$2,834.75 |
$3,335 |
7.7× |
| Computed tomographic angiography, abdomen, with contrast material(s), including noncontrast images, if performed, and… (74175) |
$302.60 |
$356 |
1.6× |
| Computed tomographic angiography, abdominal aorta and bilateral iliofemoral lower extremity runoff, with contrast… (75635) |
$1,537.65 |
$1,809 |
8.3× |
| Computed tomographic angiography, chest (noncoronary), with contrast material(s), including noncontrast images, if… (71275) |
$196.78 |
$231.50 |
1.1× |
| Computed tomographic angiography, lower extremity, with contrast material(s), including noncontrast images, if… (73706) |
$1,678.75 |
$1,975 |
9.1× |
| Computed tomographic angiography, neck, with contrast material(s), including noncontrast images, if performed, and… (70498) |
$2,012.80 |
$2,368 |
10.9× |
| Computed tomographic angiography, upper extremity, with contrast material(s), including noncontrast images, if… (73206) |
$1,218.48 |
$1,433.50 |
6.6× |
| Computed tomography, cervical spine; without contrast material, followed by contrast material(s) and further sections… (72127) |
$1,655.80 |
$1,948 |
8.9× |
| Computed tomography, lower extremity; without contrast material Age Under 21 (73700) |
$148.75 |
$175 |
1.3× |
| Computed tomography, lower extremity; without contrast material, followed by contrast material(s) and further sections… (73702) |
$1,517.68 |
$1,785.50 |
8.2× |
| Computed tomography, lumbar spine; without contrast material, followed by contrast material(s) and further sections Age… (72133) |
$1,886.58 |
$2,219.50 |
10.2× |
| Computed tomography, maxillofacial area; with contrast material(s) Age Under 21 (70487) |
$1,349.80 |
$1,588 |
7.3× |
| Computed tomography, maxillofacial area; without contrast material Age Under 21 (70486) |
$153.85 |
$181 |
1.4× |
| Computed tomography, orbit, sella, or posterior fossa or outer, middle, or inner ear; with contrast material(s) Age… (70481) |
$1,524.05 |
$1,793 |
8.2× |
| Computed tomography, orbit, sella, or posterior fossa or outer, middle, or inner ear; without contrast material Age… (70480) |
$1,098.62 |
$1,292.50 |
10.0× |
| Computed tomography, orbit, sella, or posterior fossa or outer, middle, or inner ear; without contrast material,… (70482) |
$195.50 |
$230 |
1.1× |
| Computed tomography, soft tissue neck; without contrast material followed by contrast material(s) and further sections… (70492) |
$1,415.25 |
$1,665 |
7.6× |
| Computed tomography, thoracic spine; without contrast material, followed by contrast material(s) and further sections… (72130) |
$1,322.60 |
$1,556 |
7.1× |
| Computed tomography, thorax, diagnostic; without contrast material, followed by contrast material(s) and further… (71270) |
$188.70 |
$222 |
1.0× |
| CT abdomen and pelvis without and with contrast (74178) |
$2,293.72 |
$2,698.50 |
6.2× |
| CT abdomen and pelvis without contrast (74176) |
$1,784.58 |
$2,099.50 |
7.1× |
| CT abdomen w & w/o contrast (74170) |
$1,273.30 |
$1,498 |
6.9× |
| CT abdomen w/contrast (74160) |
$1,572.50 |
$1,850 |
8.5× |
| CT abdomen w/o contrast (74150) |
$147.05 |
$173 |
1.3× |
| CT angio hrt w/3d image (75574) |
$842.35 |
$991 |
2.3× |
| CT cervical spine w/contrast (72126) |
$1,527.88 |
$1,797.50 |
4.2× |
| CT cervical spine w/o contrast (72125) |
$1,509.60 |
$1,776 |
13.7× |
| CT chest w/contrast (71260) |
$169.15 |
$199 |
0.9× |
| CT extremity upper w & w/o contrast (73202) |
$1,485.80 |
$1,748 |
8.0× |
| CT extremity upper w/o contrast (73200) |
$926.08 |
$1,089.50 |
8.4× |
| CT head/brain with contrast (70460) |
$1,436.50 |
$1,690 |
7.8× |
| CT head/brain without and with contrast (70470) |
$1,595.45 |
$1,877 |
8.6× |
| CT heart c+ cardiac strux&morph cgen hrt ds (75573) |
$289 |
$340 |
0.8× |
| CT heart no contrast quant eval coronry calcium (75571) |
$102.85 |
$121 |
1.1× |
| CT l-spine w/contrast (72132) |
$1,527.88 |
$1,797.50 |
4.2× |
| CT limited/localized follow up study (76380) |
$525.72 |
$618.50 |
5.7× |
| CT lower extremity w/dye (73701) |
$1,405.90 |
$1,654 |
7.6× |
| CT lumbar spine w/o contrast (72131) |
$1,350.65 |
$1,589 |
12.2× |
| CT maxillofacial w/wo contrast (70488) |
$1,811.35 |
$2,131 |
9.8× |
| CT neck w/contrast (70491) |
$1,311.55 |
$1,543 |
7.1× |
| CT neck w/o contrast (70490) |
$1,088 |
$1,280 |
9.9× |
| CT pelvis w & w/o contrast (72194) |
$1,442.88 |
$1,697.50 |
7.8× |
| CT pelvis w/o contrast (72192) |
$987.70 |
$1,162 |
9.0× |
| CT thoracic spine w/contrast (72129) |
$1,235.05 |
$1,453 |
6.7× |
| CT thoracic spine w/o contrast (72128) |
$1,142.40 |
$1,344 |
10.4× |
| CT thorax lung cancer scr c- (71271) |
$332.35 |
$391 |
3.0× |
| CT thorax w/o contrast (71250) |
$138.55 |
$163 |
1.3× |
| CT upper extremity w/dye (73201) |
$1,377 |
$1,620 |
3.7× |
| CTA h&n c+ w/noncontrast img (70471) |
$3,944 |
$4,640 |
10.7× |
| CTA head w contrast (70496) |
$214.20 |
$252 |
1.2× |
| Cystography, minimum of 3 views, radiological supervision and interpretation Age Under 21 (74430) |
$350.20 |
$412 |
1.0× |
| Dual-energy X-ray absorptiometry (DXA), bone density study, 1 or more sites; axial skeleton (eg, hips, pelvis, spine)… (77080) |
$336.18 |
$395.50 |
3.0× |
| Dxa bone density/peripheral (77081) |
$202.72 |
$238.50 |
2.2× |
| Fetal biophys profile w/o nst (76819) |
$419.48 |
$493.50 |
3.8× |
| Fetal biophysical profile non-stress testing (76818) |
$419.48 |
$493.50 |
3.8× |
| Fluoroscopy up to 1 hour physician/qhp time (76000) |
$345.52 |
$406.50 |
1.4× |
| Gastroesophageal reflux study (78262) |
$85.85 |
$101 |
0.2× |
| Gated heart planar single (78472) |
$1,456.05 |
$1,713 |
3.5× |
| Hepatobil syst imag inc gb w/pharma intervenj (78227) |
$1,181.92 |
$1,390.50 |
2.1× |
| Ht muscle image spect sing (78451) |
$1,786.70 |
$2,102 |
1.3× |
| Interstitial radiation source application, complex, includes supervision, handling, loading of radiation source, when… (77778) |
$1,011.08 |
$1,189.50 |
1.4× |
| Intestine imaging (eg, ectopic gastric mucosa, Meckel's localization, volvulus) Age Under 21 (78290) |
$935.42 |
$1,100.50 |
2.2× |
| Kidney imaging morphol - nm kidney cortex (78700) |
$725.90 |
$854 |
1.7× |
| Kidney imaging morphology; with vascular flow Age Under 21 (78701) |
$255.42 |
$300.50 |
0.6× |
| Kidney imaging morphology; with vascular flow and function, single study without pharmacological intervention Age Under… (78707) |
$1,058.68 |
$1,245.50 |
1.8× |
| Kidney imaging morphology; with vascular flow and function, single study, with pharmacological intervention (eg,… (78708) |
$1,072.70 |
$1,262 |
1.9× |
| Liver and spleen imaging (78215) |
$1,198.50 |
$1,410 |
2.8× |
| Liver and spleen imaging; with vascular flow Age Under 21 (78216) |
$337.02 |
$396.50 |
0.8× |
| Lung perfusion imaging (78580) |
$1,081.20 |
$1,272 |
2.6× |
| Magnetic resonance (eg, proton) imaging, any joint of lower extremity; without contrast material(s), followed by… (73723) |
$1,801.15 |
$2,119 |
4.9× |
| Magnetic resonance (eg, proton) imaging, lower extremity other than joint; with contrast material(s) Age Under 21 (73719) |
$294.10 |
$346 |
0.8× |
| Magnetic resonance (eg, proton) imaging, lower extremity other than joint; without contrast material(s) Age Under 21 (73718) |
$1,288.18 |
$1,515.50 |
5.1× |
| Magnetic resonance (eg, proton) imaging, lower extremity other than joint; without contrast material(s), followed by… (73720) |
$1,864.05 |
$2,193 |
5.1× |
| Magnetic resonance (eg, proton) imaging, orbit, face, and/or neck; with contrast material(s) Age Under 21 (70542) |
$3,660.95 |
$4,307 |
9.9× |
| Magnetic resonance (eg, proton) imaging, orbit, face, and/or neck; without contrast material(s) Age Under 21 (70540) |
$366.35 |
$431 |
1.5× |
| Magnetic resonance (eg, proton) imaging, upper extremity, other than joint; with contrast material(s) Age Under 21 (73219) |
$1,514.28 |
$1,781.50 |
4.1× |
| Magnetic resonance (eg, proton) imaging, upper extremity, other than joint; without contrast material(s), followed by… (73220) |
$1,807.52 |
$2,126.50 |
4.9× |
| Magnetic resonance angiography, head; with contrast material(s) Age Under 21 (70545) |
$1,670.25 |
$1,965 |
4.5× |
| Magnetic resonance angiography, head; without contrast material(s), followed by contrast material(s) and further… (70546) |
$2,132.22 |
$2,508.50 |
5.8× |
| Magnetic resonance angiography, neck; without contrast material(s), followed by contrast material(s) and further… (70549) |
$2,089.72 |
$2,458.50 |
5.7× |
| Mammary ductogram single (77053) |
$456.45 |
$537 |
1.8× |
| Mandible min 4v (70110) |
$268.18 |
$315.50 |
2.4× |
| MRA head w/o contrast (70544) |
$222.70 |
$262 |
0.9× |
| MRA neck w/ contrast (70548) |
$1,861.50 |
$2,190 |
5.1× |
| MRA neck w/o contrast (70547) |
$366.35 |
$431 |
1.5× |
| MRI abdomen w/contrast (74182) |
$1,687.25 |
$1,985 |
4.6× |
| MRI abdomen w/o contrast (74181) |
$241.40 |
$284 |
1.0× |
| MRI abdomen w/wo contrast (74183) |
$1,818.58 |
$2,139.50 |
4.9× |
| MRI any jt lower extrem w/contrast material (73722) |
$1,420.35 |
$1,671 |
1.7× |
| MRI bone marrow (77084) |
$1,248.65 |
$1,469 |
5.0× |
| MRI breast c- bilateral (77047) |
$2,739.55 |
$3,223 |
10.9× |
| MRI c-spine w&w/o cont (72156) |
$1,947.35 |
$2,291 |
5.3× |
| MRI cervical spine w/contrast (72142) |
$1,674.50 |
$1,970 |
4.6× |
| MRI chest w/o contrast (71550) |
$1,648.15 |
$1,939 |
6.5× |
| MRI chest w/wo contrast (71552) |
$2,137.75 |
$2,515 |
5.8× |
| MRI joint upr extr w/o&w/dye (73223) |
$1,798.18 |
$2,115.50 |
4.9× |
| MRI joint upr extrem w/dye (73222) |
$1,479.42 |
$1,740.50 |
1.8× |
| MRI joint upr extrem w/o dye (73221) |
$1,275.42 |
$1,500.50 |
5.1× |
| MRI lumbar spine w/contrast (72149) |
$303.45 |
$357 |
0.8× |
| MRI lumbar spine w/wo contrast (72158) |
$2,025.12 |
$2,382.50 |
5.5× |
| MRI orbit/face/neck w&w/o cont (70543) |
$1,991.98 |
$2,343.50 |
5.4× |
| MRI pelvis w & w/o contrast (72197) |
$341.70 |
$402 |
0.9× |
| MRI pelvis w/contrast (72196) |
$303.45 |
$357 |
0.8× |
| MRI pelvis w/o contrast (72195) |
$282.20 |
$332 |
1.1× |
| MRI spine cervical w/o contrast (72141) |
$1,609.05 |
$1,893 |
6.4× |
| MRI t-spine w&w/o cont (72157) |
$1,976.25 |
$2,325 |
5.4× |
| MRI thoracic spine w/contrast (72147) |
$1,717 |
$2,020 |
4.7× |
| MRI thoracic spine w/o contrst (72146) |
$261.80 |
$308 |
1.0× |
| MRI tmj (70336) |
$1,048.48 |
$1,233.50 |
4.2× |
| MRI upper extremity oth than jt w/o contr matrl (73218) |
$1,366.80 |
$1,608 |
5.4× |
| Myelography, 2 or more regions (eg, lumbar/thoracic, cervical/thoracic, lumbar/cervical, lumbar/thoracic/cervical),… (72270) |
$154.70 |
$182 |
0.2× |
| Myocardial spect multiple studies (78452) |
$2,054.02 |
$2,416.50 |
1.5× |
| N-invas est c ffr augmnt sw alys CTA i&r phy/qhp (75580) |
$1,584.40 |
$1,864 |
1.7× |
| Nm bone 3 phase (78315) |
$1,153.02 |
$1,356.50 |
2.7× |
| Nm bone imaging whole body (78306) |
$1,076.95 |
$1,267 |
2.6× |
| Nm gastric emptying (78264) |
$1,175.98 |
$1,383.50 |
2.8× |
| Nm lung ventilation imaging (78579) |
$827.48 |
$973.50 |
2.0× |
| Nm lymph system (78195) |
$147.90 |
$174 |
0.3× |
| Nuclear medicine study of bone and/or joint limited area (78300) |
$969.42 |
$1,140.50 |
2.3× |
| Nuclear medicine study of salivary gland function (78232) |
$1,024.25 |
$1,205 |
2.4× |
| Nuclear medicine study to assess blood clot in vein of both sides (78458) |
$1,228.25 |
$1,445 |
2.9× |
| Ob us limited fetus(s) (76815) |
$266.48 |
$313.50 |
2.4× |
| Ob us nuchal meas 1 gest (76813) |
$158.10 |
$186 |
1.4× |
| Parathyroid planar imaging (78070) |
$825.78 |
$971.50 |
2.0× |
| Parathyroid planar imaging w/wo subtraction (78071) |
$947.75 |
$1,115 |
2.2× |
| PET imaging CT attenuation skull base mid-thigh (78815) |
$2,311.15 |
$2,719 |
1.5× |
| PET imaging CT for attenuation limited area (78814) |
$261.80 |
$308 |
0.2× |
| PET imaging for CT attenuation whole body (78816) |
$2,312.42 |
$2,720.50 |
1.5× |
| Pulmonary ventilation & perfusion imaging (78582) |
$1,710.62 |
$2,012.50 |
3.0× |
| Radex abscess/fistula/sinus tract rs&i (76080) |
$517.22 |
$608.50 |
0.9× |
| Radex entir thrc lmbr crv sac spi w/skull 1 vw (72081) |
$233.75 |
$275 |
2.5× |
| Radex entir thrc lmbr crv sac spi w/skull 2/3 vw (72082) |
$302.18 |
$355.50 |
2.7× |
| Radex hip unilateral with pelvis 1 view (73501) |
$167.45 |
$197 |
1.8× |
| Radex hip unilateral with pelvis 2-3 views (73502) |
$207.82 |
$244.50 |
2.3× |
| Radex hips bilateral with pelvis 2 views (73521) |
$289 |
$340 |
2.6× |
| Radex spine cervical 2 or 3 views (72040) |
$192.10 |
$226 |
2.1× |
| Radex spine cervical 4 or 5 views (72050) |
$51 |
$60 |
0.5× |
| Radex spine thoracolumbar junction min 2 views (72080) |
$263.50 |
$310 |
2.9× |
| Radiologic exam abdomen 3+ views (74021) |
$38.25 |
$45 |
0.3× |
| Radiologic exam chest 3 views (71047) |
$242.25 |
$285 |
2.6× |
| Radiologic exam chest 4+ views (71048) |
$34.85 |
$41 |
0.3× |
| Radiologic exam colon double contrast study (74280) |
$575.45 |
$677 |
3.1× |
| Radiologic exam colon single contrast study (74270) |
$423.30 |
$498 |
2.3× |
| Radiologic exam esophagus single contrast study (74220) |
$272 |
$320 |
1.5× |
| Radiologic exam small int single contrast study (74250) |
$439.45 |
$517 |
2.4× |
| Radiologic exam swallow function contrast study (74230) |
$388.88 |
$457.50 |
2.1× |
| Radiologic exam upr gi trc double contrast study (74246) |
$485.78 |
$571.50 |
2.6× |
| Radiologic exam upr gi trc single contrast study (74240) |
$480.25 |
$565 |
2.6× |
| Radiologic examination femur minimum 2 views (73552) |
$207.82 |
$244.50 |
2.3× |
| Radiologic examination, ankle; complete, minimum of 3 views Age Under 21 (73610) |
$194.65 |
$229 |
2.1× |
| Radiologic examination, complete acute abdomen series, including 2 or more views of the abdomen (eg, supine, erect,… (74022) |
$279.65 |
$329 |
2.5× |
| Radiologic examination, elbow; 2 views Age Under 21 (73070) |
$171.28 |
$201.50 |
1.9× |
| Radiologic examination, elbow; complete, minimum of 3 views Age Under 21 (73080) |
$190.82 |
$224.50 |
2.1× |
| Radiologic examination, foot; complete, minimum of 3 views Age Under 21 (73630) |
$191.25 |
$225 |
2.1× |
| Radiologic examination, hand; minimum of 3 views Age Under 21 (73130) |
$192.10 |
$226 |
2.1× |
| Radiologic examination, knee; complete, 4 or more views Age Under 21 (73564) |
$294.52 |
$346.50 |
2.7× |
| Radiologic examination, mandible; partial, less than 4 views Age Under 21 (70100) |
$193.80 |
$228 |
2.1× |
| Radiologic examination, mastoids; less than 3 views per side Age Under 21 (70120) |
$276.68 |
$325.50 |
2.5× |
| Radiologic examination, nasal bones, complete, minimum of 3 views Age Under 21 (70160) |
$245.65 |
$289 |
2.7× |
| Radiologic examination, pharynx and/or cervical esophagus, including scout neck radiograph(s) and delayed image(s),… (74210) |
$349.35 |
$411 |
1.9× |
| Radiologic examination, ribs, bilateral; including posteroanterior chest, minimum of 4 views Age Under 21 (71111) |
$313.22 |
$368.50 |
2.8× |
| Radiologic examination, ribs, unilateral; including posteroanterior chest, minimum of 3 views Age Under 21 (71101) |
$258.40 |
$304 |
2.3× |
| Radiologic examination, sacroiliac joints; less than 3 views Age Under 21 (72200) |
$211.22 |
$248.50 |
1.9× |
| Radiologic examination, shoulder; complete, minimum of 2 views Age Under 21 (73030) |
$199.32 |
$234.50 |
2.2× |
| Radiologic examination, single plane body section (eg, tomography), other than with urography Age Under 21 (76100) |
$385.48 |
$453.50 |
3.5× |
| Radiologic examination, sinuses, paranasal, less than 3 views Age Under 21 (70210) |
$144.50 |
$170 |
1.6× |
| Radiologic examination, skull; less than 4 views Age Under 21 (70250) |
$224.40 |
$264 |
2.0× |
| Radiologic examination, spine, lumbosacral; 2 or 3 views Age Under 21 (72100) |
$267.32 |
$314.50 |
2.4× |
| Radiologic examination, spine, lumbosacral; bending views only, 2 or 3 views Age Under 21 (72120) |
$264.35 |
$311 |
2.4× |
| Radiologic examination, spine, lumbosacral; complete, including bending views, minimum of 6 views Age Under 21 (72114) |
$370.18 |
$435.50 |
3.4× |
| Radiologic examination, wrist; complete, minimum of 3 views Age Under 21 (73110) |
$23.38 |
$27.50 |
0.3× |
| Radiologic examination; acromioclavicular joints, bilateral, with or without weighted distraction Age Under 21 (73050) |
$295.80 |
$348 |
3.2× |
| Radiologic examination; humerus, minimum of 2 views Age Under 21 (73060) |
$195.92 |
$230.50 |
2.1× |
| Radiologic examination; orbits, complete, minimum of 4 views Age Under 21 (70200) |
$243.95 |
$287 |
2.2× |
| Radiologic examination; sternoclavicular joint or joints, minimum of 3 views Age Under 21 (71130) |
$182.32 |
$214.50 |
2.0× |
| Radiologic examination; toe(s), minimum of 2 views Age Under 21 (73660) |
$153.42 |
$180.50 |
1.7× |
| Radiopharmaceutical localization of tumor, inflammatory process or distribution of radiopharmaceutical agent(s)… (78803) |
$2,775.25 |
$3,265 |
4.8× |
| Review by radiologist of urinary bladder and urethra images with contrast and after passing urine (74455) |
$476 |
$560 |
1.9× |
| Rp loclzj tum plnr 1 area single day imaging (78800) |
$600.95 |
$707 |
1.4× |
| Rp loclzj tum plnr whole body single day imaging (78802) |
$1,120.30 |
$1,318 |
2.0× |
| Saline infusion sonohysterography (SIS), including color flow Doppler, when performed Age Under 21 (76831) |
$560.58 |
$659.50 |
2.2× |
| Scapula complete (73010) |
$232.48 |
$273.50 |
2.1× |
| Screening digital breast tomosynthesis bi (77063) |
$77.35 |
$91 |
— |
| Testicular imaging with vascular flow Age Under 21 (78761) |
$744.18 |
$875.50 |
1.8× |
| Thyroid met imaging body (78018) |
$1,025.52 |
$1,206.50 |
1.8× |
| Thyroid uptake w/blood flow sngle/mult quan meas (78014) |
$950.72 |
$1,118.50 |
2.3× |
| Ultrasound breast limited (76642) |
$222.70 |
$262 |
2.4× |
| Ultrasound, abdomen limited (76705) |
$371.88 |
$437.50 |
3.4× |
| Ultrasound, limited, joint or focal evaluation of other nonvascular extremity structure(s) (eg, joint space,… (76882) |
$350.20 |
$412 |
3.2× |
| Ultrasound, pelvic (nonobstetric), real time with image documentation; complete Age Under 21 (76856) |
$406.30 |
$478 |
3.7× |
| Ultrasound, pregnant uterus, real time with image documentation, fetal and maternal evaluation plus detailed fetal… (76811) |
$551.65 |
$649 |
2.2× |
| Ultrasound, pregnant uterus, real time with image documentation, fetal and maternal evaluation, first trimester (< 14… (76801) |
$468.35 |
$551 |
4.2× |
| Umbilical-artery Doppler (OB) (76820) |
$176.80 |
$208 |
1.6× |
| Ureteral reflux study (78740) |
$882.72 |
$1,038.50 |
2.1× |
| Urethrocystography retrograde rs&i (74450) |
$541.45 |
$637 |
2.2× |
| Urography (pyelography), intravenous, with or without KUB, with or without tomography Age Under 21 (74400) |
$68 |
$80 |
0.4× |
| Urography, infusion, drip technique and/or bolus technique; with nephrotomography Age Under 21 (74415) |
$53.55 |
$63 |
0.3× |
| Us abdominal aorta real time screen study aaa (76706) |
$64.60 |
$76 |
0.6× |
| Us breast uni real time with image complete (76641) |
$486.20 |
$572 |
4.4× |
| Us chest (76604) |
$346.80 |
$408 |
3.1× |
| Us compl joint r-t w/image documentation (76881) |
$108.80 |
$128 |
1.0× |
| Us elastography organ (76981) |
$381.65 |
$449 |
3.5× |
| Us encephalogram (76506) |
$217.18 |
$255.50 |
2.0× |
| Us exam, pelvic, limited (76857) |
$276.25 |
$325 |
2.5× |
| Us inft hips r-t img dynamic req phys/qhp manj (76885) |
$363.80 |
$428 |
4.0× |
| Us inft hips r-t img lmtd static phys/qhp manj (76886) |
$303.88 |
$357.50 |
3.3× |
| US OB Follow-Up/Repeat (76816) |
$406.72 |
$478.50 |
3.7× |
| Us ob transvaginal (76817) |
$411.40 |
$484 |
3.7× |
| Us retroperitoneal complete (76770) |
$134.30 |
$158 |
1.2× |
| Us retroperitoneal ltd (76775) |
$376.12 |
$442.50 |
3.4× |
| Us scrotum (76870) |
$384.62 |
$452.50 |
3.5× |
| Us soft tissue head/neck (76536) |
$359.55 |
$423 |
3.3× |
| Us unlstd proc (76999) |
$660.45 |
$777 |
7.2× |
| Use 1st target lesion (76982) |
$381.65 |
$449 |
3.5× |
| Venogram sinus/jugular (75860) |
$1,439.48 |
$1,693.50 |
0.4× |
| Venography, extremity, bilateral, radiological supervision and interpretation Age Under 21 (75822) |
$789.22 |
$928.50 |
0.5× |
| Venography, extremity, unilateral, radiological supervision and interpretation Age Under 21 (75820) |
$114.75 |
$135 |
0.1× |
| Whole blood volume determination, including separate measurement of plasma volume and red cell volume… (78122) |
$894.20 |
$1,052 |
1.6× |
| X-ray exam of finger(s) (73140) |
$20.40 |
$24 |
0.2× |
| X-ray exam of knee 1 or 2 (73560) |
$23.80 |
$28 |
0.3× |
| X-ray exam ribs uni 2 views (71100) |
$220.15 |
$259 |
2.4× |
| X-ray heel (73650) |
$163.62 |
$192.50 |
1.8× |
| X-ray of joint between lower spine and hip bone 3 or more views|PROFESSIONAL COMPONENT (72202) |
$260.52 |
$306.50 |
2.4× |
| X-ray retrograde pyelogram (74420) |
$694.88 |
$817.50 |
1.9× |
| Xr abdomen 1 view (74018) |
$185.72 |
$218.50 |
2.0× |
| Xr abdomen 2 views (74019) |
$231.62 |
$272.50 |
2.1× |
| Xr arthrogram elbow (73085) |
$395.68 |
$465.50 |
1.1× |
| Xr arthrogram knee (73580) |
$598.82 |
$704.50 |
1.6× |
| Xr bone age studies (77072) |
$170 |
$200 |
1.5× |
| Xr bone length study (77073) |
$224.82 |
$264.50 |
2.0× |
| Xr bone survey infant (77076) |
$283.48 |
$333.50 |
2.6× |
| Xr bone survey ltd (77074) |
$242.25 |
$285 |
2.2× |
| Xr chest 1 view (71045) |
$25.50 |
$30 |
0.3× |
| Xr chest 2 views (71046) |
$51.85 |
$61 |
0.6× |
| Xr facial bones 3+ views (70150) |
$249.48 |
$293.50 |
2.3× |
| Xr foot arthritis pa only bilateral - report(ortho pro) (73620) |
$160.22 |
$188.50 |
1.7× |
| Xr forearm 2 views (73090) |
$181.05 |
$213 |
2.0× |
| Xr hand 2v (73120) |
$176.38 |
$207.50 |
1.6× |
| Xr hysterosalpingogram (74740) |
$526.15 |
$619 |
2.1× |
| Xr myelogram c-spine (72240) |
$102 |
$120 |
0.1× |
| Xr myelogram t-spine (72255) |
$104.55 |
$123 |
0.1× |
| Xr neck soft tissue (70360) |
$201.02 |
$236.50 |
2.2× |
| Xr o knee w/ merchant view bilat - report(ortho pro) (73562) |
$188.28 |
$221.50 |
2.1× |
| Xr osseous survey complete (77075) |
$73.95 |
$87 |
0.7× |
| Xr pelvis 1-2 views (72170) |
$190.82 |
$224.50 |
1.7× |
| Xr pelvis min 3 view (72190) |
$291.98 |
$343.50 |
2.6× |
| Xr sacrum/coccyx 2+ views (72220) |
$242.68 |
$285.50 |
2.6× |
| Xr shoulder 1 view (73020) |
$169.58 |
$199.50 |
1.8× |
| Xr sialogram (70390) |
$305.58 |
$359.50 |
1.2× |
| Xr sinuses 3+ views (70220) |
$248.62 |
$292.50 |
2.7× |
| Xr skull min 4 view (70260) |
$368.05 |
$433 |
3.3× |
| Xr spine 1 view (72020) |
$167.88 |
$197.50 |
1.8× |
| Xr spine thoracic 3v (72072) |
$343.82 |
$404.50 |
3.1× |
| Xr sternum 2+ views (71120) |
$178.92 |
$210.50 |
1.9× |
| Xr surgical specimen (76098) |
$34 |
$40 |
0.1× |
| Xr t-spine 2 views (72070) |
$235.02 |
$276.50 |
2.1× |
| Xr tibia/fibula 2 views (73590) |
$136.85 |
$161 |
1.5× |
| Xr tmj bilateral (70330) |
$243.10 |
$286 |
2.6× |
| Xr wrist 2 views (73100) |
$165.32 |
$194.50 |
1.8× |