| Acute gi blood loss imaging (78278) |
$2,216.80 |
$2,771 |
5.3× |
| Ankle 2 views (73600) |
$170.40 |
$213 |
1.9× |
| Clavicle complete (73000) |
$244.80 |
$306 |
2.7× |
| Computed tomographic angiography, abdomen and pelvis, with contrast material(s), including noncontrast images, if… (74174) |
$4,261.60 |
$5,327 |
11.6× |
| Computed tomographic angiography, abdomen, with contrast material(s), including noncontrast images, if performed, and… (74175) |
$2,547.20 |
$3,184 |
13.8× |
| Computed tomographic angiography, abdominal aorta and bilateral iliofemoral lower extremity runoff, with contrast… (75635) |
$2,726.40 |
$3,408 |
14.7× |
| Computed tomographic angiography, chest (noncoronary), with contrast material(s), including noncontrast images, if… (71275) |
$2,586.40 |
$3,233 |
14.0× |
| Computed tomographic angiography, lower extremity, with contrast material(s), including noncontrast images, if… (73706) |
$2,458.40 |
$3,073 |
13.3× |
| Computed tomographic angiography, neck, with contrast material(s), including noncontrast images, if performed, and… (70498) |
$2,224 |
$2,780 |
12.0× |
| Computed tomographic angiography, upper extremity, with contrast material(s), including noncontrast images, if… (73206) |
$2,288.80 |
$2,861 |
12.4× |
| Computed tomography, bone mineral density study, 1 or more sites, axial skeleton (eg, hips, pelvis, spine) Age Under 21 (77078) |
$320 |
$400 |
3.5× |
| Computed tomography, cervical spine; without contrast material, followed by contrast material(s) and further sections… (72127) |
$2,364 |
$2,955 |
12.8× |
| Computed tomography, lower extremity; without contrast material Age Under 21 (73700) |
$1,498.40 |
$1,873 |
13.6× |
| Computed tomography, lower extremity; without contrast material, followed by contrast material(s) and further sections… (73702) |
$2,361.60 |
$2,952 |
12.8× |
| Computed tomography, lumbar spine; without contrast material, followed by contrast material(s) and further sections Age… (72133) |
$2,547.20 |
$3,184 |
13.8× |
| Computed tomography, maxillofacial area; with contrast material(s) Age Under 21 (70487) |
$2,122.40 |
$2,653 |
11.5× |
| Computed tomography, maxillofacial area; without contrast material Age Under 21 (70486) |
$1,512 |
$1,890 |
13.7× |
| Computed tomography, orbit, sella, or posterior fossa or outer, middle, or inner ear; without contrast material Age… (70480) |
$1,599.20 |
$1,999 |
14.5× |
| Computed tomography, soft tissue neck; without contrast material followed by contrast material(s) and further sections… (70492) |
$2,164.80 |
$2,706 |
11.7× |
| Computed tomography, thoracic spine; without contrast material, followed by contrast material(s) and further sections… (72130) |
$2,547.20 |
$3,184 |
13.8× |
| CT abdomen and pelvis without and with contrast (74178) |
$3,982.40 |
$4,978 |
10.8× |
| CT abdomen and pelvis without contrast (74176) |
$3,188 |
$3,985 |
12.7× |
| CT abdomen w & w/o contrast (74170) |
$2,528 |
$3,160 |
13.7× |
| CT abdomen w/contrast (74160) |
$2,149.60 |
$2,687 |
11.6× |
| CT abdomen w/o contrast (74150) |
$1,895.20 |
$2,369 |
17.2× |
| CT angio hrt w/3d image (75574) |
$2,564.80 |
$3,206 |
7.0× |
| CT cervical spine w/contrast (72126) |
$2,164.80 |
$2,706 |
5.9× |
| CT cervical spine w/o contrast (72125) |
$1,883.20 |
$2,354 |
17.1× |
| CT chest w/contrast (71260) |
$2,052.80 |
$2,566 |
11.1× |
| CT extremity upper w & w/o contrast (73202) |
$2,136.80 |
$2,671 |
11.5× |
| CT extremity upper w/o contrast (73200) |
$1,866.40 |
$2,333 |
16.9× |
| CT head/brain with contrast (70460) |
$2,346.40 |
$2,933 |
12.7× |
| CT head/brain without and with contrast (70470) |
$2,497.60 |
$3,122 |
13.5× |
| CT heart no contrast quant eval coronry calcium (75571) |
$384 |
$480 |
4.2× |
| CT l-spine w/contrast (72132) |
$2,248 |
$2,810 |
6.1× |
| CT lower extremity w/dye (73701) |
$2,147.20 |
$2,684 |
11.6× |
| CT lumbar spine w/o contrast (72131) |
$1,965.60 |
$2,457 |
17.8× |
| CT maxillofacial w/wo contrast (70488) |
$2,431.60 |
$3,039.50 |
13.1× |
| CT neck w/contrast (70491) |
$1,932 |
$2,415 |
10.4× |
| CT neck w/o contrast (70490) |
$1,667.20 |
$2,084 |
15.1× |
| CT pelvis w & w/o contrast (72194) |
$2,852 |
$3,565 |
15.4× |
| CT pelvis w/o contrast (72192) |
$1,914.40 |
$2,393 |
17.4× |
| CT thoracic spine w/contrast (72129) |
$2,050.40 |
$2,563 |
11.1× |
| CT thoracic spine w/o contrast (72128) |
$1,864 |
$2,330 |
16.9× |
| CT thorax w/o contrast (71250) |
$1,866.40 |
$2,333 |
16.9× |
| CT upper extremity w/dye (73201) |
$2,052.80 |
$2,566 |
5.6× |
| CTA head w contrast (70496) |
$2,370.40 |
$2,963 |
12.8× |
| Dual-energy X-ray absorptiometry (DXA), bone density study, 1 or more sites; axial skeleton (eg, hips, pelvis, spine)… (77080) |
$468.80 |
$586 |
4.3× |
| Fetal biophys profile w/o nst (76819) |
$421.60 |
$527 |
3.8× |
| Fluoroscopy up to 1 hour physician/qhp time (76000) |
$584 |
$730 |
2.3× |
| Hepatobil syst imag inc gb w/pharma intervenj (78227) |
$2,316.80 |
$2,896 |
4.0× |
| Hepatobiliary syst imaging including gallbladder (78226) |
$2,106.40 |
$2,633 |
5.0× |
| Kidney imaging morphology; with vascular flow and function, multiple studies, with and without pharmacological… (78709) |
$1,432 |
$1,790 |
2.5× |
| Liver and spleen imaging (78215) |
$1,301.60 |
$1,627 |
3.1× |
| Liver and spleen imaging; with vascular flow Age Under 21 (78216) |
$2,106.40 |
$2,633 |
5.0× |
| Lung perf&ventilat diferentl (78598) |
$2,357.60 |
$2,947 |
4.1× |
| Magnetic resonance (eg, proton) imaging, any joint of lower extremity; without contrast material(s), followed by… (73723) |
$3,385.60 |
$4,232 |
9.2× |
| Magnetic resonance (eg, proton) imaging, lower extremity other than joint; with contrast material(s) Age Under 21 (73719) |
$2,616 |
$3,270 |
7.1× |
| Magnetic resonance (eg, proton) imaging, lower extremity other than joint; without contrast material(s) Age Under 21 (73718) |
$2,140 |
$2,675 |
8.5× |
| Magnetic resonance (eg, proton) imaging, lower extremity other than joint; without contrast material(s), followed by… (73720) |
$3,385.60 |
$4,232 |
9.2× |
| Magnetic resonance (eg, proton) imaging, orbit, face, and/or neck; without contrast material(s) Age Under 21 (70540) |
$2,297.60 |
$2,872 |
9.1× |
| Magnetic resonance (eg, proton) imaging, upper extremity, other than joint; with contrast material(s) Age Under 21 (73219) |
$2,595.20 |
$3,244 |
7.1× |
| Magnetic resonance (eg, proton) imaging, upper extremity, other than joint; without contrast material(s), followed by… (73220) |
$3,792 |
$4,740 |
10.3× |
| Magnetic resonance angiography, neck; without contrast material(s), followed by contrast material(s) and further… (70549) |
$4,126.40 |
$5,158 |
11.2× |
| Mandible min 4v (70110) |
$296 |
$370 |
2.7× |
| MRA head w/o contrast (70544) |
$2,394.40 |
$2,993 |
9.5× |
| MRA neck w/ contrast (70548) |
$2,888.80 |
$3,611 |
7.8× |
| MRA neck w/o contrast (70547) |
$2,751.20 |
$3,439 |
10.9× |
| MRI abdomen w/contrast (74182) |
$2,584 |
$3,230 |
7.0× |
| MRI abdomen w/o contrast (74181) |
$2,264.80 |
$2,831 |
9.0× |
| MRI abdomen w/wo contrast (74183) |
$3,385.60 |
$4,232 |
9.2× |
| MRI any jt lower extrem w/contrast material (73722) |
$2,808 |
$3,510 |
3.4× |
| MRI c-spine w&w/o cont (72156) |
$3,239.20 |
$4,049 |
8.8× |
| MRI cervical spine w/contrast (72142) |
$2,835.20 |
$3,544 |
7.7× |
| MRI chest w/contrast (71551) |
$3,182.40 |
$3,978 |
3.8× |
| MRI chest w/o contrast (71550) |
$2,048.80 |
$2,561 |
8.1× |
| MRI joint upr extr w/o&w/dye (73223) |
$3,385.60 |
$4,232 |
9.2× |
| MRI joint upr extrem w/dye (73222) |
$2,681.20 |
$3,351.50 |
3.2× |
| MRI joint upr extrem w/o dye (73221) |
$2,324.80 |
$2,906 |
9.2× |
| MRI lumbar spine w/contrast (72149) |
$3,980 |
$4,975 |
10.8× |
| MRI lumbar spine w/wo contrast (72158) |
$4,378.40 |
$5,473 |
11.9× |
| MRI orbit/face/neck w&w/o cont (70543) |
$1,757.60 |
$2,197 |
4.8× |
| MRI pelvis w & w/o contrast (72197) |
$3,385.60 |
$4,232 |
9.2× |
| MRI pelvis w/o contrast (72195) |
$2,439.20 |
$3,049 |
9.7× |
| MRI spine cervical w/o contrast (72141) |
$2,454.40 |
$3,068 |
9.8× |
| MRI t-spine w&w/o cont (72157) |
$3,896.80 |
$4,871 |
10.6× |
| MRI thoracic spine w/contrast (72147) |
$3,542.40 |
$4,428 |
9.6× |
| MRI thoracic spine w/o contrst (72146) |
$2,741.60 |
$3,427 |
10.9× |
| MRI tmj (70336) |
$2,409.60 |
$3,012 |
9.6× |
| MRI upper extremity oth than jt w/o contr matrl (73218) |
$2,242.40 |
$2,803 |
8.9× |
| Myocardial spect multiple studies (78452) |
$3,697.60 |
$4,622 |
2.7× |
| Nm bone 3 phase (78315) |
$2,037.60 |
$2,547 |
4.8× |
| Nm bone imaging whole body (78306) |
$1,611.20 |
$2,014 |
3.8× |
| Nm gastric emptying (78264) |
$783.20 |
$979 |
1.9× |
| Nm lymph system (78195) |
$1,262.40 |
$1,578 |
2.2× |
| Nuclear medicine study of bone and/or joint limited area (78300) |
$1,385.60 |
$1,732 |
3.3× |
| Nuclear medicine study of bone and/or joint multiple areas (78305) |
$1,520.80 |
$1,901 |
3.6× |
| Ob us limited fetus(s) (76815) |
$361.60 |
$452 |
3.3× |
| Parathyroid planar imaging (78070) |
$1,895.20 |
$2,369 |
4.5× |
| Pulmonary ventilation & perfusion imaging (78582) |
$2,357.60 |
$2,947 |
4.1× |
| Radex hip unilateral with pelvis 1 view (73501) |
$228.80 |
$286 |
2.5× |
| Radex hip unilateral with pelvis 2-3 views (73502) |
$340 |
$425 |
3.7× |
| Radex hips bilateral with pelvis 2 views (73521) |
$448.80 |
$561 |
4.1× |
| Radex spine cervical 2 or 3 views (72040) |
$317.60 |
$397 |
3.5× |
| Radex spine cervical 4 or 5 views (72050) |
$521.60 |
$652 |
4.7× |
| Radex spine cervical 6 or more views (72052) |
$459.20 |
$574 |
4.2× |
| Radiologic exam abdomen 3+ views (74021) |
$316 |
$395 |
2.9× |
| Radiologic exam chest 3 views (71047) |
$304 |
$380 |
3.3× |
| Radiologic exam chest 4+ views (71048) |
$349.60 |
$437 |
3.2× |
| Radiologic exam small int single contrast study (74250) |
$648 |
$810 |
3.5× |
| Radiologic examination femur minimum 2 views (73552) |
$332 |
$415 |
3.6× |
| Radiologic examination, ankle; complete, minimum of 3 views Age Under 21 (73610) |
$280.80 |
$351 |
3.1× |
| Radiologic examination, complete acute abdomen series, including 2 or more views of the abdomen (eg, supine, erect,… (74022) |
$443.20 |
$554 |
4.0× |
| Radiologic examination, elbow; 2 views Age Under 21 (73070) |
$268 |
$335 |
2.9× |
| Radiologic examination, elbow; complete, minimum of 3 views Age Under 21 (73080) |
$287.20 |
$359 |
3.1× |
| Radiologic examination, foot; complete, minimum of 3 views Age Under 21 (73630) |
$269.60 |
$337 |
2.9× |
| Radiologic examination, hand; minimum of 3 views Age Under 21 (73130) |
$265.60 |
$332 |
2.9× |
| Radiologic examination, knee; both knees, standing, anteroposterior Age Under 21 (73565) |
$184 |
$230 |
2.0× |
| Radiologic examination, knee; complete, 4 or more views Age Under 21 (73564) |
$373.60 |
$467 |
3.4× |
| Radiologic examination, mandible; partial, less than 4 views Age Under 21 (70100) |
$160 |
$200 |
1.7× |
| Radiologic examination, nasal bones, complete, minimum of 3 views Age Under 21 (70160) |
$202.40 |
$253 |
2.2× |
| Radiologic examination, ribs, unilateral; including posteroanterior chest, minimum of 3 views Age Under 21 (71101) |
$368 |
$460 |
3.3× |
| Radiologic examination, sacroiliac joints; less than 3 views Age Under 21 (72200) |
$306.40 |
$383 |
2.8× |
| Radiologic examination, shoulder; complete, minimum of 2 views Age Under 21 (73030) |
$287.20 |
$359 |
3.1× |
| Radiologic examination, sinuses, paranasal, less than 3 views Age Under 21 (70210) |
$232 |
$290 |
2.5× |
| Radiologic examination, skull; less than 4 views Age Under 21 (70250) |
$273.60 |
$342 |
2.5× |
| Radiologic examination, spine, lumbosacral; 2 or 3 views Age Under 21 (72100) |
$380 |
$475 |
3.4× |
| Radiologic examination, spine, lumbosacral; bending views only, 2 or 3 views Age Under 21 (72120) |
$349.60 |
$437 |
3.2× |
| Radiologic examination, spine, lumbosacral; complete, including bending views, minimum of 6 views Age Under 21 (72114) |
$768 |
$960 |
7.0× |
| Radiologic examination, wrist; complete, minimum of 3 views Age Under 21 (73110) |
$252.80 |
$316 |
2.8× |
| Radiologic examination; acromioclavicular joints, bilateral, with or without weighted distraction Age Under 21 (73050) |
$402.40 |
$503 |
4.4× |
| Radiologic examination; humerus, minimum of 2 views Age Under 21 (73060) |
$265.60 |
$332 |
2.9× |
| Radiologic examination; lower extremity, infant, minimum of 2 views Age Under 21 (73592) |
$282.40 |
$353 |
3.1× |
| Radiologic examination; orbits, complete, minimum of 4 views Age Under 21 (70200) |
$332.80 |
$416 |
3.0× |
| Radiologic examination; sternoclavicular joint or joints, minimum of 3 views Age Under 21 (71130) |
$275.20 |
$344 |
3.0× |
| Radiologic examination; toe(s), minimum of 2 views Age Under 21 (73660) |
$268 |
$335 |
2.9× |
| Radiologic examination; upper extremity, infant, minimum of 2 views Age Under 21 (73092) |
$242.40 |
$303 |
2.2× |
| Scapula complete (73010) |
$244.80 |
$306 |
2.2× |
| Screening digital breast tomosynthesis bi (77063) |
$48 |
$60 |
— |
| Thyroid imaging with vascular flow (78013) |
$1,280.80 |
$1,601 |
3.0× |
| Ultrasound breast limited (76642) |
$248.80 |
$311 |
2.7× |
| Ultrasound, abdomen limited (76705) |
$567.20 |
$709 |
5.1× |
| Ultrasound, limited, joint or focal evaluation of other nonvascular extremity structure(s) (eg, joint space,… (76882) |
$512 |
$640 |
4.6× |
| Ultrasound, pelvic (nonobstetric), real time with image documentation; complete Age Under 21 (76856) |
$627.20 |
$784 |
5.7× |
| Ultrasound, pregnant uterus, real time with image documentation, fetal and maternal evaluation, first trimester (< 14… (76801) |
$435.20 |
$544 |
3.9× |
| Ultrasound, transplanted kidney, real time and duplex Doppler with image documentation Age Under 21 (76776) |
$692 |
$865 |
6.3× |
| Umbilical-artery Doppler (OB) (76820) |
$240 |
$300 |
2.2× |
| Urography (pyelography), intravenous, with or without KUB, with or without tomography Age Under 21 (74400) |
$893.60 |
$1,117 |
4.8× |
| Us abdominal aorta real time screen study aaa (76706) |
$457.60 |
$572 |
4.1× |
| Us breast uni real time with image complete (76641) |
$307.20 |
$384 |
2.8× |
| Us chest (76604) |
$545.60 |
$682 |
4.9× |
| Us compl joint r-t w/image documentation (76881) |
$678.40 |
$848 |
6.2× |
| Us exam, pelvic, limited (76857) |
$479.60 |
$599.50 |
4.3× |
| US OB Follow-Up/Repeat (76816) |
$188.80 |
$236 |
1.7× |
| Us ob transvaginal (76817) |
$496.80 |
$621 |
4.5× |
| Us retroperitoneal complete (76770) |
$635.20 |
$794 |
5.8× |
| Us retroperitoneal ltd (76775) |
$448 |
$560 |
4.1× |
| Us scrotum (76870) |
$600 |
$750 |
5.4× |
| Us soft tissue head/neck (76536) |
$595.20 |
$744 |
5.4× |
| X-ray exam of finger(s) (73140) |
$208.80 |
$261 |
2.3× |
| X-ray exam of knee 1 or 2 (73560) |
$269.60 |
$337 |
2.9× |
| X-ray exam ribs bil 3 views (71110) |
$504 |
$630 |
4.6× |
| X-ray heel (73650) |
$211.60 |
$264.50 |
2.3× |
| Xr abdomen 1 view (74018) |
$245.60 |
$307 |
2.7× |
| Xr abdomen 2 views (74019) |
$331.60 |
$414.50 |
3.0× |
| Xr bone age studies (77072) |
$206.40 |
$258 |
1.9× |
| Xr bone length study (77073) |
$211.20 |
$264 |
1.9× |
| Xr chest 1 view (71045) |
$253.60 |
$317 |
2.8× |
| Xr chest 2 views (71046) |
$287.60 |
$359.50 |
3.1× |
| Xr eye foreign body (70030) |
$262.40 |
$328 |
2.9× |
| Xr facial bones 3+ views (70150) |
$283.20 |
$354 |
2.6× |
| Xr foot arthritis pa only bilateral - report(ortho pro) (73620) |
$211.60 |
$264.50 |
2.3× |
| Xr forearm 2 views (73090) |
$240.80 |
$301 |
2.6× |
| Xr hand 2v (73120) |
$211.20 |
$264 |
1.9× |
| Xr neck soft tissue (70360) |
$230.40 |
$288 |
2.5× |
| Xr o knee w/ merchant view bilat - report(ortho pro) (73562) |
$312.80 |
$391 |
3.4× |
| Xr osseous survey complete (77075) |
$570.40 |
$713 |
5.2× |
| Xr pelvis 1-2 views (72170) |
$260 |
$325 |
2.4× |
| Xr sacrum/coccyx 2+ views (72220) |
$306.40 |
$383 |
3.3× |
| Xr shoulder 1 view (73020) |
$176 |
$220 |
1.9× |
| Xr sinuses 3+ views (70220) |
$302.40 |
$378 |
3.3× |
| Xr skull min 4 view (70260) |
$362.40 |
$453 |
3.3× |
| Xr sternum 2+ views (71120) |
$267.20 |
$334 |
2.9× |
| Xr surgical specimen (76098) |
$575.20 |
$719 |
1.0× |
| Xr t-spine 2 views (72070) |
$334.40 |
$418 |
3.0× |
| Xr tibia/fibula 2 views (73590) |
$276.80 |
$346 |
3.0× |
| Xr tmj bilateral (70330) |
$334.40 |
$418 |
3.6× |
| Xr wrist 2 views (73100) |
$222.40 |
$278 |
2.4× |