| Acute gi blood loss imaging (78278) |
$913.60 |
$1,142 |
2.2× |
| Cardiac blood pool imaging (planar), first pass technique; single study, at rest or with stress (exercise and/or… (78481) |
$1,374.40 |
$1,718 |
2.4× |
| Cardiac blood pool imaging, gated equilibrium; multiple studies, wall motion study plus ejection fraction, at rest and… (78473) |
$1,904.80 |
$2,381 |
4.5× |
| Cardiac MRI morphology & function w/o contrast (75557) |
$2,340.80 |
$3,344 |
9.3× |
| Cardiac MRI w/wo contrast & further seq (75561) |
$2,340.80 |
$3,344 |
6.4× |
| Computed tomographic angiography, abdomen and pelvis, with contrast material(s), including noncontrast images, if… (74174) |
$2,519.30 |
$3,599 |
6.8× |
| Computed tomographic angiography, abdomen, with contrast material(s), including noncontrast images, if performed, and… (74175) |
$2,519.30 |
$3,599 |
13.6× |
| Computed tomographic angiography, abdominal aorta and bilateral iliofemoral lower extremity runoff, with contrast… (75635) |
$1,957.20 |
$2,796 |
10.6× |
| Computed tomographic angiography, chest (noncoronary), with contrast material(s), including noncontrast images, if… (71275) |
$2,856 |
$4,080 |
15.4× |
| Computed tomographic angiography, neck, with contrast material(s), including noncontrast images, if performed, and… (70498) |
$1,925.60 |
$2,407 |
10.4× |
| Computed tomographic angiography, upper extremity, with contrast material(s), including noncontrast images, if… (73206) |
$1,912.40 |
$2,732 |
10.3× |
| Computed tomography, bone mineral density study, 1 or more sites, axial skeleton (eg, hips, pelvis, spine) Age Under 21 (77078) |
$324 |
$324 |
3.5× |
| Computed tomography, maxillofacial area; with contrast material(s) Age Under 21 (70487) |
$1,532.80 |
$1,916 |
8.3× |
| Computed tomography, maxillofacial area; without contrast material Age Under 21 (70486) |
$1,337.60 |
$1,672 |
12.1× |
| Computed tomography, orbit, sella, or posterior fossa or outer, middle, or inner ear; with contrast material(s) Age… (70481) |
$1,756.80 |
$2,196 |
9.5× |
| Computed tomography, orbit, sella, or posterior fossa or outer, middle, or inner ear; without contrast material Age… (70480) |
$1,571.20 |
$1,964 |
14.2× |
| Computed tomography, orbit, sella, or posterior fossa or outer, middle, or inner ear; without contrast material,… (70482) |
$1,876.70 |
$2,681 |
10.1× |
| Computed tomography, soft tissue neck; without contrast material followed by contrast material(s) and further sections… (70492) |
$1,880.20 |
$2,686 |
10.2× |
| Computed tomography, thorax, diagnostic; without contrast material, followed by contrast material(s) and further… (71270) |
$2,374.40 |
$3,392 |
12.8× |
| CT abdomen and pelvis without and with contrast (74178) |
$3,395.40 |
$5,659 |
9.2× |
| CT abdomen and pelvis without contrast (74176) |
$3,055.50 |
$4,365 |
12.1× |
| CT abdomen w & w/o contrast (74170) |
$2,183.30 |
$3,119 |
11.8× |
| CT abdomen w/contrast (74160) |
$1,818.60 |
$2,598 |
9.8× |
| CT abdomen w/o contrast (74150) |
$1,850.40 |
$2,313 |
16.8× |
| CT cervical spine w/contrast (72126) |
$1,843.10 |
$2,633 |
5.0× |
| CT cervical spine w/o contrast (72125) |
$1,777.30 |
$2,539 |
16.1× |
| CT chest w/contrast (71260) |
$1,874.60 |
$2,678 |
10.1× |
| CT head/brain with contrast (70460) |
$1,935.20 |
$2,419 |
10.5× |
| CT head/brain without and with contrast (70470) |
$1,891.40 |
$2,702 |
10.2× |
| CT lumbar spine w/o contrast (72131) |
$1,723.20 |
$2,154 |
15.6× |
| CT maxillofacial w/wo contrast (70488) |
$1,684 |
$2,105 |
9.1× |
| CT neck w/contrast (70491) |
$1,785 |
$2,550 |
9.6× |
| CT neck w/o contrast (70490) |
$1,436 |
$1,795 |
13.0× |
| CT pelvis w & w/o contrast (72194) |
$2,183.30 |
$3,119 |
11.8× |
| CT pelvis w/o contrast (72192) |
$1,713.60 |
$2,142 |
15.5× |
| CT thoracic spine w/o contrast (72128) |
$1,701.60 |
$2,127 |
15.4× |
| CT thorax lung cancer scr c- (71271) |
$2,374.40 |
$3,392 |
21.5× |
| CT thorax w/o contrast (71250) |
$1,917.60 |
$2,397 |
17.4× |
| CTA head w contrast (70496) |
$1,925.60 |
$2,407 |
10.4× |
| Cystography, minimum of 3 views, radiological supervision and interpretation Age Under 21 (74430) |
$852 |
$852 |
2.3× |
| Dual-energy X-ray absorptiometry (DXA), bone density study, 1 or more sites; axial skeleton (eg, hips, pelvis, spine)… (77080) |
$536 |
$536 |
4.9× |
| Fetal biophysical profile non-stress testing (76818) |
$434 |
$434 |
3.9× |
| Gated heart planar single (78472) |
$1,300 |
$1,625 |
3.1× |
| Heart infarct image (78466) |
$1,055.20 |
$1,319 |
2.5× |
| Hepatobil syst imag inc gb w/pharma intervenj (78227) |
$1,833.60 |
$2,292 |
3.2× |
| Ht muscle image spect sing (78451) |
$2,889.60 |
$4,128 |
2.1× |
| Intestine imaging (eg, ectopic gastric mucosa, Meckel's localization, volvulus) Age Under 21 (78290) |
$930.40 |
$1,163 |
2.2× |
| Kidney imaging morphol - nm kidney cortex (78700) |
$813.60 |
$1,017 |
1.9× |
| Kidney imaging morphology; with vascular flow Age Under 21 (78701) |
$1,013.60 |
$1,267 |
2.4× |
| Kidney imaging morphology; with vascular flow and function, multiple studies, with and without pharmacological… (78709) |
$1,118.40 |
$1,398 |
2.0× |
| Kidney imaging morphology; with vascular flow and function, single study without pharmacological intervention Age Under… (78707) |
$1,178.40 |
$1,473 |
2.1× |
| Kidney imaging morphology; with vascular flow and function, single study, with pharmacological intervention (eg,… (78708) |
$1,176 |
$1,470 |
2.1× |
| Liver and spleen imaging (78215) |
$910.40 |
$1,138 |
2.2× |
| Liver and spleen imaging; with vascular flow Age Under 21 (78216) |
$1,326.40 |
$1,658 |
3.1× |
| Liver imaging (78201) |
$1,094.40 |
$1,368 |
1.9× |
| Liver imaging with flow (78202) |
$1,326.40 |
$1,658 |
2.3× |
| Lung perfusion imaging (78580) |
$1,028 |
$1,285 |
2.4× |
| Magnetic resonance (eg, proton) imaging, orbit, face, and/or neck; with contrast material(s) Age Under 21 (70542) |
$1,904 |
$2,720 |
5.2× |
| Magnetic resonance (eg, proton) imaging, orbit, face, and/or neck; without contrast material(s) Age Under 21 (70540) |
$1,878.10 |
$2,683 |
7.5× |
| Magnetic resonance angiography, head; with contrast material(s) Age Under 21 (70545) |
$1,992.80 |
$2,491 |
5.4× |
| Magnetic resonance angiography, head; without contrast material(s), followed by contrast material(s) and further… (70546) |
$2,394.70 |
$3,421 |
6.5× |
| Magnetic resonance angiography, neck; without contrast material(s), followed by contrast material(s) and further… (70549) |
$2,128.70 |
$3,041 |
5.8× |
| Mandible min 4v (70110) |
$367 |
$367 |
3.3× |
| MRA head w/o contrast (70544) |
$2,104.90 |
$3,007 |
8.4× |
| MRA neck w/ contrast (70548) |
$2,104.90 |
$3,007 |
5.7× |
| MRA neck w/o contrast (70547) |
$1,868.30 |
$2,669 |
7.4× |
| MRI abdomen w/contrast (74182) |
$2,135 |
$3,050 |
5.8× |
| MRI abdomen w/o contrast (74181) |
$2,088.10 |
$2,983 |
8.3× |
| MRI abdomen w/wo contrast (74183) |
$2,392.60 |
$3,418 |
6.5× |
| MRI bone marrow (77084) |
$2,027.90 |
$2,897 |
8.1× |
| MRI c-spine w&w/o cont (72156) |
$2,718.10 |
$3,883 |
7.4× |
| MRI cervical spine w/contrast (72142) |
$2,608.90 |
$3,727 |
7.1× |
| MRI chest w/contrast (71551) |
$2,474.50 |
$3,535 |
3.0× |
| MRI chest w/o contrast (71550) |
$2,474.50 |
$3,535 |
9.8× |
| MRI chest w/wo contrast (71552) |
$2,739.10 |
$3,913 |
7.4× |
| MRI lumbar spine w/contrast (72149) |
$2,503.20 |
$3,576 |
6.8× |
| MRI lumbar spine w/wo contrast (72158) |
$2,977.10 |
$4,253 |
8.1× |
| MRI orbit/face/neck w&w/o cont (70543) |
$2,121.70 |
$3,031 |
5.8× |
| MRI pelvis w & w/o contrast (72197) |
$2,410.80 |
$3,444 |
6.6× |
| MRI pelvis w/contrast (72196) |
$2,382.80 |
$3,404 |
6.5× |
| MRI pelvis w/o contrast (72195) |
$1,999.90 |
$2,857 |
7.9× |
| MRI spine cervical w/o contrast (72141) |
$2,405.90 |
$3,437 |
9.6× |
| MRI t-spine w&w/o cont (72157) |
$2,349.20 |
$3,356 |
6.4× |
| MRI thoracic spine w/contrast (72147) |
$2,280.60 |
$3,258 |
6.2× |
| MRI thoracic spine w/o contrst (72146) |
$2,036.30 |
$2,909 |
8.1× |
| MRI tmj (70336) |
$2,109.10 |
$3,013 |
8.4× |
| Myocardial perfusion imaging, planar (including qualitative or quantitative wall motion, ejection fraction by first… (78453) |
$2,237.20 |
$3,196 |
1.6× |
| Myocardial perfusion imaging, planar (including qualitative or quantitative wall motion, ejection fraction by first… (78454) |
$2,342.20 |
$3,346 |
1.7× |
| Myocardial spect multiple studies (78452) |
$3,005.80 |
$4,294 |
2.2× |
| Nm bone 3 phase (78315) |
$1,571.20 |
$1,964 |
3.7× |
| Nm bone imaging whole body (78306) |
$1,399.20 |
$1,749 |
3.3× |
| Nm gastric emptying (78264) |
$1,532.80 |
$1,916 |
3.6× |
| Nm lymph system (78195) |
$1,243.20 |
$1,554 |
2.2× |
| Nuclear medicine study of bone and/or joint limited area (78300) |
$908 |
$1,135 |
2.2× |
| Nuclear medicine study of bone and/or joint multiple areas (78305) |
$856 |
$1,070 |
2.0× |
| Ob us limited fetus(s) (76815) |
$497 |
$497 |
4.5× |
| Optic foramina (70190) |
$376 |
$376 |
4.1× |
| Parathyroid planar imaging (78070) |
$605 |
$605 |
1.4× |
| Radex abscess/fistula/sinus tract rs&i (76080) |
$724 |
$724 |
1.3× |
| Radex entir thrc lmbr crv sac spi w/skull 1 vw (72081) |
$264 |
$264 |
2.9× |
| Radex entir thrc lmbr crv sac spi w/skull 2/3 vw (72082) |
$587 |
$587 |
5.3× |
| Radex entir thrc lmbr crv sac spi w/skull 4/5 vw (72083) |
$723 |
$723 |
6.6× |
| Radex entir thrc lmbr crv sac spi w/skull 6/> vw (72084) |
$791 |
$791 |
7.2× |
| Radex spine cervical 2 or 3 views (72040) |
$406 |
$406 |
4.4× |
| Radex spine cervical 4 or 5 views (72050) |
$590 |
$590 |
5.4× |
| Radex spine cervical 6 or more views (72052) |
$723 |
$723 |
6.6× |
| Radiologic exam abdomen 3+ views (74021) |
$501 |
$501 |
4.5× |
| Radiologic exam chest 3 views (71047) |
$439 |
$439 |
4.8× |
| Radiologic exam chest 4+ views (71048) |
$492 |
$492 |
4.5× |
| Radiologic exam esophagus single contrast study (74220) |
$537 |
$537 |
2.9× |
| Radiologic examination, complete acute abdomen series, including 2 or more views of the abdomen (eg, supine, erect,… (74022) |
$546 |
$546 |
5.0× |
| Radiologic examination, facial bones; less than 3 views Age Under 21 (70140) |
$376 |
$376 |
4.1× |
| Radiologic examination, knee; both knees, standing, anteroposterior Age Under 21 (73565) |
$377 |
$377 |
4.1× |
| Radiologic examination, mandible; partial, less than 4 views Age Under 21 (70100) |
$290 |
$290 |
3.2× |
| Radiologic examination, mastoids; complete, minimum of 3 views per side Age Under 21 (70130) |
$376 |
$376 |
3.4× |
| Radiologic examination, nasal bones, complete, minimum of 3 views Age Under 21 (70160) |
$290 |
$290 |
3.2× |
| Radiologic examination, ribs, bilateral; including posteroanterior chest, minimum of 4 views Age Under 21 (71111) |
$544 |
$544 |
4.9× |
| Radiologic examination, sacroiliac joints; less than 3 views Age Under 21 (72200) |
$387 |
$387 |
3.5× |
| Radiologic examination, salivary gland for calculus Age Under 21 (70380) |
$290 |
$290 |
3.2× |
| Radiologic examination, sinuses, paranasal, less than 3 views Age Under 21 (70210) |
$271 |
$271 |
3.0× |
| Radiologic examination, skull; less than 4 views Age Under 21 (70250) |
$355 |
$355 |
3.2× |
| Radiologic examination, spine, lumbosacral; 2 or 3 views Age Under 21 (72100) |
$494 |
$494 |
4.5× |
| Radiologic examination, spine, lumbosacral; bending views only, 2 or 3 views Age Under 21 (72120) |
$489 |
$489 |
4.4× |
| Radiologic examination, spine, lumbosacral; complete, including bending views, minimum of 6 views Age Under 21 (72114) |
$663 |
$663 |
6.0× |
| Radiologic examination, spine; thoracic, minimum of 4 views Age Under 21 (72074) |
$668 |
$668 |
6.1× |
| Radiologic examination; acromioclavicular joints, bilateral, with or without weighted distraction Age Under 21 (73050) |
$300 |
$300 |
3.3× |
| Radiologic examination; orbits, complete, minimum of 4 views Age Under 21 (70200) |
$408 |
$408 |
3.7× |
| Radiologic examination; sternoclavicular joint or joints, minimum of 3 views Age Under 21 (71130) |
$253 |
$253 |
2.8× |
| Rp loclzj tum plnr 1 area single day imaging (78800) |
$915.20 |
$1,144 |
2.2× |
| Rp loclzj tum plnr 2+area 1+d img/1 area img>2+d (78801) |
$1,176 |
$1,470 |
2.8× |
| Scapula complete (73010) |
$349 |
$349 |
3.2× |
| Screening digital breast tomosynthesis bi (77063) |
$62 |
$62 |
— |
| Testicular imaging with vascular flow Age Under 21 (78761) |
$908 |
$1,135 |
2.2× |
| Ultrasound, abdomen limited (76705) |
$778 |
$778 |
7.1× |
| Ultrasound, limited, joint or focal evaluation of other nonvascular extremity structure(s) (eg, joint space,… (76882) |
$596 |
$596 |
5.4× |
| Ultrasound, pelvic (nonobstetric), real time with image documentation; complete Age Under 21 (76856) |
$698 |
$698 |
6.3× |
| Ultrasound, pregnant uterus, real time with image documentation, fetal and maternal evaluation, first trimester (< 14… (76801) |
$677 |
$677 |
6.1× |
| Ureteral reflux study (78740) |
$972.80 |
$1,216 |
2.3× |
| Urography, infusion, drip technique and/or bolus technique; Age Under 21 (74410) |
$552 |
$552 |
3.0× |
| Us abdominal aorta real time screen study aaa (76706) |
$660 |
$660 |
6.0× |
| Us compl joint r-t w/image documentation (76881) |
$709 |
$709 |
6.4× |
| Us encephalogram (76506) |
$472 |
$472 |
4.3× |
| Us exam, pelvic, limited (76857) |
$582 |
$582 |
5.3× |
| US OB Follow-Up/Repeat (76816) |
$425 |
$425 |
3.9× |
| Us ob transvaginal (76817) |
$577 |
$577 |
5.2× |
| Us retroperitoneal complete (76770) |
$759 |
$759 |
6.9× |
| Us retroperitoneal ltd (76775) |
$759 |
$759 |
6.9× |
| Us scrotum (76870) |
$559 |
$559 |
5.1× |
| Us soft tissue head/neck (76536) |
$652 |
$652 |
5.9× |
| Us spinal canal (76800) |
$715 |
$715 |
6.5× |
| X-ray exam hips bi 3-4 views (73522) |
$586 |
$586 |
5.3× |
| X-ray exam ribs bil 3 views (71110) |
$448 |
$448 |
4.1× |
| X-ray of joint between lower spine and hip bone 3 or more views|PROFESSIONAL COMPONENT (72202) |
$411 |
$411 |
3.7× |
| X-ray retrograde pyelogram (74420) |
$930 |
$930 |
2.5× |
| Xr abdomen 1 view (74018) |
$333 |
$333 |
3.6× |
| Xr abdomen 2 views (74019) |
$412 |
$412 |
3.7× |
| Xr bone age studies (77072) |
$277 |
$277 |
2.5× |
| Xr bone length study (77073) |
$380 |
$380 |
3.4× |
| Xr chest 1 view (71045) |
$298 |
$298 |
3.2× |
| Xr chest 2 views (71046) |
$364 |
$364 |
4.0× |
| Xr facial bones 3+ views (70150) |
$408 |
$408 |
3.7× |
| Xr neck soft tissue (70360) |
$348 |
$348 |
3.8× |
| Xr pelvis 1-2 views (72170) |
$428 |
$428 |
3.9× |
| Xr pelvis min 3 view (72190) |
$436 |
$436 |
4.0× |
| Xr sacrum/coccyx 2+ views (72220) |
$351 |
$351 |
3.8× |
| Xr sella turcica (70240) |
$229 |
$229 |
2.5× |
| Xr sinuses 3+ views (70220) |
$376 |
$376 |
4.1× |
| Xr skull min 4 view (70260) |
$439 |
$439 |
4.0× |
| Xr spine 1 view (72020) |
$274 |
$274 |
3.0× |
| Xr spine thoracic 3v (72072) |
$546 |
$546 |
5.0× |
| Xr sternum 2+ views (71120) |
$293 |
$293 |
3.2× |
| Xr t-spine 2 views (72070) |
$406 |
$406 |
3.7× |
| Xr tmj bilateral (70330) |
$408 |
$408 |
4.4× |