| Acute gi blood loss imaging (78278) |
$1,290 |
$1,290 |
3.1× |
| Ankle 2 views (73600) |
$275 |
$275 |
3.0× |
| Clavicle complete (73000) |
$275 |
$275 |
3.0× |
| Computed tomographic angiography, abdomen, with contrast material(s), including noncontrast images, if performed, and… (74175) |
$2,138 |
$2,138 |
11.6× |
| Computed tomographic angiography, abdominal aorta and bilateral iliofemoral lower extremity runoff, with contrast… (75635) |
$2,380 |
$2,380 |
12.9× |
| Computed tomographic angiography, chest (noncoronary), with contrast material(s), including noncontrast images, if… (71275) |
$2,466 |
$2,466 |
13.3× |
| Computed tomographic angiography, neck, with contrast material(s), including noncontrast images, if performed, and… (70498) |
$2,138 |
$2,138 |
11.6× |
| Computed tomography, lower extremity; without contrast material Age Under 21 (73700) |
$2,019 |
$2,019 |
18.3× |
| Computed tomography, lower extremity; without contrast material, followed by contrast material(s) and further sections… (73702) |
$2,506 |
$2,506 |
13.5× |
| Computed tomography, maxillofacial area; with contrast material(s) Age Under 21 (70487) |
$1,537 |
$1,537 |
8.3× |
| Computed tomography, maxillofacial area; without contrast material Age Under 21 (70486) |
$2,019 |
$2,019 |
18.3× |
| Computed tomography, orbit, sella, or posterior fossa or outer, middle, or inner ear; with contrast material(s) Age… (70481) |
$1,140 |
$1,140 |
6.2× |
| Computed tomography, orbit, sella, or posterior fossa or outer, middle, or inner ear; without contrast material Age… (70480) |
$1,115 |
$1,115 |
10.1× |
| Computed tomography, orbit, sella, or posterior fossa or outer, middle, or inner ear; without contrast material,… (70482) |
$1,285 |
$1,285 |
6.9× |
| Computed tomography, soft tissue neck; without contrast material followed by contrast material(s) and further sections… (70492) |
$1,537 |
$1,537 |
8.3× |
| Computed tomography, thorax, diagnostic; without contrast material, followed by contrast material(s) and further… (71270) |
$1,507 |
$1,507 |
8.1× |
| CT abdomen and pelvis without and with contrast (74178) |
$2,019 |
$2,019 |
5.5× |
| CT abdomen and pelvis without contrast (74176) |
$2,224 |
$2,224 |
8.8× |
| CT abdomen w & w/o contrast (74170) |
$2,260 |
$2,260 |
12.2× |
| CT abdomen w/contrast (74160) |
$2,138 |
$2,138 |
11.6× |
| CT abdomen w/o contrast (74150) |
$2,019 |
$2,019 |
18.3× |
| CT cervical spine w/o contrast (72125) |
$2,204 |
$2,204 |
20.0× |
| CT chest w/contrast (71260) |
$2,408 |
$2,408 |
13.0× |
| CT extremity upper w & w/o contrast (73202) |
$2,506 |
$2,506 |
13.5× |
| CT extremity upper w/o contrast (73200) |
$4,038 |
$4,038 |
36.6× |
| CT head/brain with contrast (70460) |
$2,019 |
$2,019 |
10.9× |
| CT head/brain without and with contrast (70470) |
$2,260 |
$2,260 |
12.2× |
| CT lower extremity w/dye (73701) |
$2,506 |
$2,506 |
13.5× |
| CT lumbar spine w/o contrast (72131) |
$2,019 |
$2,019 |
18.3× |
| CT maxillofacial w/wo contrast (70488) |
$1,537 |
$1,537 |
8.3× |
| CT neck w/contrast (70491) |
$2,138 |
$2,138 |
11.6× |
| CT neck w/o contrast (70490) |
$1,537 |
$1,537 |
13.9× |
| CT pelvis w & w/o contrast (72194) |
$2,138 |
$2,138 |
11.6× |
| CT pelvis w/o contrast (72192) |
$2,019 |
$2,019 |
18.3× |
| CT thoracic spine w/o contrast (72128) |
$2,019 |
$2,019 |
18.3× |
| CT thorax lung cancer scr c- (71271) |
$397 |
$397 |
3.6× |
| CT thorax w/o contrast (71250) |
$2,099 |
$2,099 |
19.0× |
| CT upper extremity w/dye (73201) |
$2,631 |
$2,631 |
7.1× |
| CTA head w contrast (70496) |
$2,138 |
$2,138 |
11.6× |
| Cystography, minimum of 3 views, radiological supervision and interpretation Age Under 21 (74430) |
$1,078 |
$1,078 |
2.9× |
| Dual-energy X-ray absorptiometry (DXA), bone density study, 1 or more sites; axial skeleton (eg, hips, pelvis, spine)… (77080) |
$597 |
$597 |
5.4× |
| Fluoroscopy up to 1 hour physician/qhp time (76000) |
$802 |
$802 |
3.2× |
| Gated heart planar single (78472) |
$1,880 |
$1,880 |
4.5× |
| Hepatobil syst imag inc gb w/pharma intervenj (78227) |
$1,898 |
$1,898 |
3.3× |
| Hepatobiliary syst imaging including gallbladder (78226) |
$2,019 |
$2,019 |
4.8× |
| Ht muscle image spect sing (78451) |
$4,380 |
$4,380 |
3.2× |
| Intestine imaging (eg, ectopic gastric mucosa, Meckel's localization, volvulus) Age Under 21 (78290) |
$1,267 |
$1,267 |
3.0× |
| Kidney imaging morphol - nm kidney cortex (78700) |
$1,267 |
$1,267 |
3.0× |
| Kidney imaging morphology; with vascular flow and function, multiple studies, with and without pharmacological… (78709) |
$1,693 |
$1,693 |
3.0× |
| Kidney imaging morphology; with vascular flow and function, single study without pharmacological intervention Age Under… (78707) |
$1,625 |
$1,625 |
2.8× |
| Kidney imaging morphology; with vascular flow and function, single study, with pharmacological intervention (eg,… (78708) |
$1,625 |
$1,625 |
2.8× |
| Liver and spleen imaging (78215) |
$1,267 |
$1,267 |
3.0× |
| Liver and spleen imaging; with vascular flow Age Under 21 (78216) |
$1,267 |
$1,267 |
3.0× |
| Lung perfusion imaging (78580) |
$1,267 |
$1,267 |
3.0× |
| Magnetic resonance (eg, proton) imaging, any joint of lower extremity; without contrast material(s), followed by… (73723) |
$3,344 |
$3,344 |
9.1× |
| Magnetic resonance (eg, proton) imaging, lower extremity other than joint; without contrast material(s) Age Under 21 (73718) |
$3,464 |
$3,464 |
13.8× |
| Magnetic resonance (eg, proton) imaging, lower extremity other than joint; without contrast material(s), followed by… (73720) |
$3,464 |
$3,464 |
9.4× |
| Magnetic resonance (eg, proton) imaging, orbit, face, and/or neck; without contrast material(s) Age Under 21 (70540) |
$2,251 |
$2,251 |
8.9× |
| Magnetic resonance (eg, proton) imaging, upper extremity, other than joint; without contrast material(s), followed by… (73220) |
$3,344 |
$3,344 |
9.1× |
| Magnetic resonance angiography, head; with contrast material(s) Age Under 21 (70545) |
$3,368 |
$3,368 |
9.2× |
| Magnetic resonance angiography, head; without contrast material(s), followed by contrast material(s) and further… (70546) |
$3,796 |
$3,796 |
10.3× |
| Magnetic resonance angiography, neck; without contrast material(s), followed by contrast material(s) and further… (70549) |
$3,796 |
$3,796 |
10.3× |
| Mandible min 4v (70110) |
$386 |
$386 |
3.5× |
| MRA head w/o contrast (70544) |
$3,164 |
$3,164 |
12.6× |
| MRA neck w/ contrast (70548) |
$3,164 |
$3,164 |
8.6× |
| MRA neck w/o contrast (70547) |
$3,344 |
$3,344 |
13.3× |
| MRI abdomen w/contrast (74182) |
$2,544 |
$2,544 |
6.9× |
| MRI abdomen w/o contrast (74181) |
$2,251 |
$2,251 |
8.9× |
| MRI abdomen w/wo contrast (74183) |
$2,911 |
$2,911 |
7.9× |
| MRI any jt lower extrem w/contrast material (73722) |
$3,003 |
$3,003 |
3.6× |
| MRI c-spine w&w/o cont (72156) |
$3,224 |
$3,224 |
8.8× |
| MRI chest w/o contrast (71550) |
$2,251 |
$2,251 |
8.9× |
| MRI chest w/wo contrast (71552) |
$3,796 |
$3,796 |
10.3× |
| MRI joint upr extr w/o&w/dye (73223) |
$3,102 |
$3,102 |
8.4× |
| MRI joint upr extrem w/dye (73222) |
$2,358 |
$2,358 |
2.9× |
| MRI joint upr extrem w/o dye (73221) |
$3,586 |
$3,586 |
14.2× |
| MRI lumbar spine w/wo contrast (72158) |
$3,344 |
$3,344 |
9.1× |
| MRI orbit/face/neck w&w/o cont (70543) |
$3,102 |
$3,102 |
8.4× |
| MRI pelvis w & w/o contrast (72197) |
$3,344 |
$3,344 |
9.1× |
| MRI pelvis w/o contrast (72195) |
$3,224 |
$3,224 |
12.8× |
| MRI spine cervical w/o contrast (72141) |
$3,603 |
$3,603 |
14.3× |
| MRI t-spine w&w/o cont (72157) |
$3,344 |
$3,344 |
9.1× |
| MRI thoracic spine w/o contrst (72146) |
$2,544 |
$2,544 |
10.1× |
| MRI tmj (70336) |
$2,929 |
$2,929 |
11.6× |
| MRI upper extremity oth than jt w/o contr matrl (73218) |
$3,464 |
$3,464 |
13.8× |
| Myocardial spect multiple studies (78452) |
$4,380 |
$4,380 |
3.2× |
| Nm bone 3 phase (78315) |
$1,887 |
$1,887 |
4.5× |
| Nm bone imaging whole body (78306) |
$1,657 |
$1,657 |
3.9× |
| Nm gastric emptying (78264) |
$1,341 |
$1,341 |
3.2× |
| Nm lung ventilation imaging (78579) |
$1,330 |
$1,330 |
3.2× |
| Nm lymph system (78195) |
$1,663 |
$1,663 |
2.9× |
| Nuclear medicine study of bone and/or joint limited area (78300) |
$1,267 |
$1,267 |
3.0× |
| Nuclear medicine study of bone and/or joint multiple areas (78305) |
$1,416 |
$1,416 |
3.4× |
| Ob us limited fetus(s) (76815) |
$393 |
$393 |
3.6× |
| Ophthalmic ultrasound, diagnostic; B-scan (with or without superimposed non-quantitative A-scan) Age Under 21 (76512) |
$376 |
$376 |
3.4× |
| Parathyroid planar imaging (78070) |
$1,537 |
$1,537 |
3.6× |
| Pulmonary ventilation & perfusion imaging (78582) |
$2,315 |
$2,315 |
4.0× |
| Radex entir thrc lmbr crv sac spi w/skull 1 vw (72081) |
$335 |
$335 |
3.6× |
| Radex entir thrc lmbr crv sac spi w/skull 2/3 vw (72082) |
$446 |
$446 |
4.0× |
| Radex hip unilateral with pelvis 1 view (73501) |
$275 |
$275 |
3.0× |
| Radex hip unilateral with pelvis 2-3 views (73502) |
$457 |
$457 |
5.0× |
| Radex hips bilateral with pelvis minimum 5 views (73523) |
$334 |
$334 |
3.0× |
| Radex spine cervical 2 or 3 views (72040) |
$393 |
$393 |
4.3× |
| Radex spine cervical 4 or 5 views (72050) |
$426 |
$426 |
3.9× |
| Radiologic exam abdomen 3+ views (74021) |
$399 |
$399 |
3.6× |
| Radiologic exam chest 3 views (71047) |
$370 |
$370 |
4.0× |
| Radiologic exam colon double contrast study (74280) |
$824 |
$824 |
4.5× |
| Radiologic exam colon single contrast study (74270) |
$865 |
$865 |
4.7× |
| Radiologic exam esophagus single contrast study (74220) |
$865 |
$865 |
4.7× |
| Radiologic exam small int single contrast study (74250) |
$511 |
$511 |
2.8× |
| Radiologic exam swallow function contrast study (74230) |
$511 |
$511 |
2.8× |
| Radiologic exam upr gi trc double contrast study (74246) |
$865 |
$865 |
4.7× |
| Radiologic exam upr gi trc single contrast study (74240) |
$795 |
$795 |
4.3× |
| Radiologic examination femur minimum 2 views (73552) |
$297 |
$297 |
3.2× |
| Radiologic examination, ankle; complete, minimum of 3 views Age Under 21 (73610) |
$351 |
$351 |
3.8× |
| Radiologic examination, complete acute abdomen series, including 2 or more views of the abdomen (eg, supine, erect,… (74022) |
$480 |
$480 |
4.4× |
| Radiologic examination, elbow; 2 views Age Under 21 (73070) |
$275 |
$275 |
3.0× |
| Radiologic examination, elbow; complete, minimum of 3 views Age Under 21 (73080) |
$297 |
$297 |
3.2× |
| Radiologic examination, facial bones; less than 3 views Age Under 21 (70140) |
$275 |
$275 |
3.0× |
| Radiologic examination, foot; complete, minimum of 3 views Age Under 21 (73630) |
$430 |
$430 |
4.7× |
| Radiologic examination, hand; minimum of 3 views Age Under 21 (73130) |
$310 |
$310 |
3.4× |
| Radiologic examination, knee; both knees, standing, anteroposterior Age Under 21 (73565) |
$785 |
$785 |
8.6× |
| Radiologic examination, knee; complete, 4 or more views Age Under 21 (73564) |
$393 |
$393 |
3.6× |
| Radiologic examination, mandible; partial, less than 4 views Age Under 21 (70100) |
$275 |
$275 |
3.0× |
| Radiologic examination, nasal bones, complete, minimum of 3 views Age Under 21 (70160) |
$275 |
$275 |
3.0× |
| Radiologic examination, ribs, unilateral; including posteroanterior chest, minimum of 3 views Age Under 21 (71101) |
$393 |
$393 |
3.6× |
| Radiologic examination, shoulder; complete, minimum of 2 views Age Under 21 (73030) |
$341 |
$341 |
3.7× |
| Radiologic examination, sinuses, paranasal, less than 3 views Age Under 21 (70210) |
$275 |
$275 |
3.0× |
| Radiologic examination, skull; less than 4 views Age Under 21 (70250) |
$393 |
$393 |
3.6× |
| Radiologic examination, spine, lumbosacral; 2 or 3 views Age Under 21 (72100) |
$450 |
$450 |
4.1× |
| Radiologic examination, wrist; complete, minimum of 3 views Age Under 21 (73110) |
$341 |
$341 |
3.7× |
| Radiologic examination; acromioclavicular joints, bilateral, with or without weighted distraction Age Under 21 (73050) |
$243 |
$243 |
2.6× |
| Radiologic examination; humerus, minimum of 2 views Age Under 21 (73060) |
$275 |
$275 |
3.0× |
| Radiologic examination; orbits, complete, minimum of 4 views Age Under 21 (70200) |
$393 |
$393 |
3.6× |
| Radiologic examination; toe(s), minimum of 2 views Age Under 21 (73660) |
$275 |
$275 |
3.0× |
| Review by radiologist of urinary bladder and urethra images with contrast and after passing urine (74455) |
$802 |
$802 |
3.2× |
| Rp loclzj tum plnr 1 area single day imaging (78800) |
$1,267 |
$1,267 |
3.0× |
| Rp loclzj tum plnr 2+area 1+d img/1 area img>2+d (78801) |
$1,791 |
$1,791 |
4.2× |
| Scapula complete (73010) |
$393 |
$393 |
3.6× |
| Screening digital breast tomosynthesis bi (77063) |
$145 |
$145 |
— |
| Testicular imaging with vascular flow Age Under 21 (78761) |
$1,267 |
$1,267 |
3.0× |
| Thyroid uptake single/multiple quant measurement (78012) |
$1,267 |
$1,267 |
3.0× |
| Ultrasound, abdomen limited (76705) |
$776 |
$776 |
7.0× |
| Ultrasound, limited, joint or focal evaluation of other nonvascular extremity structure(s) (eg, joint space,… (76882) |
$345 |
$345 |
3.1× |
| Ultrasound, pelvic (nonobstetric), real time with image documentation; complete Age Under 21 (76856) |
$513 |
$513 |
4.7× |
| Ultrasound, pregnant uterus, real time with image documentation, fetal and maternal evaluation, first trimester (< 14… (76801) |
$513 |
$513 |
4.7× |
| Ureteral reflux study (78740) |
$1,267 |
$1,267 |
3.0× |
| Urography, infusion, drip technique and/or bolus technique; Age Under 21 (74410) |
$865 |
$865 |
4.7× |
| Us breast uni real time with image complete (76641) |
$345 |
$345 |
3.1× |
| Us compl joint r-t w/image documentation (76881) |
$393 |
$393 |
3.6× |
| Us exam, pelvic, limited (76857) |
$393 |
$393 |
3.6× |
| US OB Follow-Up/Repeat (76816) |
$393 |
$393 |
3.6× |
| Us retroperitoneal complete (76770) |
$769 |
$769 |
7.0× |
| Us retroperitoneal ltd (76775) |
$393 |
$393 |
3.6× |
| Us scrotum (76870) |
$452 |
$452 |
4.1× |
| Us soft tissue head/neck (76536) |
$637 |
$637 |
5.8× |
| X-ray exam of finger(s) (73140) |
$275 |
$275 |
3.0× |
| X-ray exam of knee 1 or 2 (73560) |
$344 |
$344 |
3.7× |
| X-ray exam ribs bil 3 views (71110) |
$419 |
$419 |
3.8× |
| X-ray exam ribs uni 2 views (71100) |
$275 |
$275 |
3.0× |
| X-ray heel (73650) |
$275 |
$275 |
3.0× |
| X-ray of joint between lower spine and hip bone 3 or more views|PROFESSIONAL COMPONENT (72202) |
$393 |
$393 |
3.6× |
| Xr abdomen 1 view (74018) |
$236 |
$236 |
2.6× |
| Xr abdomen 2 views (74019) |
$356 |
$356 |
3.2× |
| Xr bone length study (77073) |
$491 |
$491 |
4.5× |
| Xr chest 1 view (71045) |
$299 |
$299 |
3.3× |
| Xr chest 2 views (71046) |
$308 |
$308 |
3.4× |
| Xr facial bones 3+ views (70150) |
$393 |
$393 |
3.6× |
| Xr foot arthritis pa only bilateral - report(ortho pro) (73620) |
$275 |
$275 |
3.0× |
| Xr forearm 2 views (73090) |
$260 |
$260 |
2.8× |
| Xr neck soft tissue (70360) |
$277 |
$277 |
3.0× |
| Xr o knee w/ merchant view bilat - report(ortho pro) (73562) |
$357 |
$357 |
3.9× |
| Xr osseous survey complete (77075) |
$393 |
$393 |
3.6× |
| Xr pelvis 1-2 views (72170) |
$386 |
$386 |
3.5× |
| Xr pelvis min 3 view (72190) |
$393 |
$393 |
3.6× |
| Xr sacrum/coccyx 2+ views (72220) |
$275 |
$275 |
3.0× |
| Xr shoulder 1 view (73020) |
$275 |
$275 |
3.0× |
| Xr sinuses 3+ views (70220) |
$393 |
$393 |
4.3× |
| Xr skull min 4 view (70260) |
$393 |
$393 |
3.6× |
| Xr spine thoracic 3v (72072) |
$393 |
$393 |
3.6× |
| Xr sternum 2+ views (71120) |
$243 |
$243 |
2.6× |
| Xr t-spine 2 views (72070) |
$445 |
$445 |
4.0× |
| Xr tibia/fibula 2 views (73590) |
$320 |
$320 |
3.5× |
| Xr wrist 2 views (73100) |
$275 |
$275 |
3.0× |