| Card MRI w/stress img & dye (75563) |
$2,487.80 |
$3,554 |
3.0× |
| Cardiac MRI morphology & function w/o contrast (75557) |
$1,197.70 |
$1,711 |
4.8× |
| Cardiac MRI w/wo contrast & further seq (75561) |
$1,899.10 |
$2,713 |
5.2× |
| Clavicle complete (73000) |
$175.70 |
$251 |
1.9× |
| Computed tomographic angiography, abdomen and pelvis, with contrast material(s), including noncontrast images, if… (74174) |
$1,778 |
$2,540 |
4.8× |
| Computed tomographic angiography, abdomen, with contrast material(s), including noncontrast images, if performed, and… (74175) |
$1,486.80 |
$2,124 |
8.0× |
| Computed tomographic angiography, abdominal aorta and bilateral iliofemoral lower extremity runoff, with contrast… (75635) |
$1,278.90 |
$1,827 |
6.9× |
| Computed tomographic angiography, chest (noncoronary), with contrast material(s), including noncontrast images, if… (71275) |
$2,105.60 |
$3,008 |
11.4× |
| Computed tomographic angiography, lower extremity, with contrast material(s), including noncontrast images, if… (73706) |
$1,237.60 |
$1,768 |
6.7× |
| Computed tomographic angiography, neck, with contrast material(s), including noncontrast images, if performed, and… (70498) |
$2,331.70 |
$3,331 |
12.6× |
| Computed tomographic angiography, upper extremity, with contrast material(s), including noncontrast images, if… (73206) |
$1,263.50 |
$1,805 |
6.8× |
| Computed tomography, cervical spine; without contrast material, followed by contrast material(s) and further sections… (72127) |
$1,052.80 |
$1,504 |
5.7× |
| Computed tomography, lower extremity; without contrast material Age Under 21 (73700) |
$814.10 |
$1,163 |
7.4× |
| Computed tomography, maxillofacial area; with contrast material(s) Age Under 21 (70487) |
$1,215.20 |
$1,736 |
6.6× |
| Computed tomography, maxillofacial area; without contrast material Age Under 21 (70486) |
$1,133.30 |
$1,619 |
10.3× |
| Computed tomography, orbit, sella, or posterior fossa or outer, middle, or inner ear; with contrast material(s) Age… (70481) |
$1,153.60 |
$1,648 |
6.2× |
| Computed tomography, orbit, sella, or posterior fossa or outer, middle, or inner ear; without contrast material Age… (70480) |
$809.20 |
$1,156 |
7.3× |
| Computed tomography, orbit, sella, or posterior fossa or outer, middle, or inner ear; without contrast material,… (70482) |
$1,133.30 |
$1,619 |
6.1× |
| Computed tomography, thoracic spine; without contrast material, followed by contrast material(s) and further sections… (72130) |
$1,052.80 |
$1,504 |
5.7× |
| Computed tomography, thorax, diagnostic; without contrast material, followed by contrast material(s) and further… (71270) |
$1,616.30 |
$2,309 |
8.7× |
| CT abdomen and pelvis without and with contrast (74178) |
$1,806 |
$2,580 |
4.9× |
| CT abdomen and pelvis without contrast (74176) |
$1,295.70 |
$1,851 |
5.1× |
| CT abdomen w & w/o contrast (74170) |
$1,465.80 |
$2,094 |
7.9× |
| CT abdomen w/contrast (74160) |
$1,247.40 |
$1,782 |
6.7× |
| CT abdomen w/o contrast (74150) |
$842.10 |
$1,203 |
7.6× |
| CT angio hrt w/3d image (75574) |
$1,806 |
$2,580 |
4.9× |
| CT cervical spine w/contrast (72126) |
$845.60 |
$1,208 |
2.3× |
| CT cervical spine w/o contrast (72125) |
$830.20 |
$1,186 |
7.5× |
| CT chest w/contrast (71260) |
$1,477.70 |
$2,111 |
8.0× |
| CT extremity upper w/o contrast (73200) |
$814.10 |
$1,163 |
7.4× |
| CT head/brain with contrast (70460) |
$1,153.60 |
$1,648 |
6.2× |
| CT head/brain without and with contrast (70470) |
$1,255.80 |
$1,794 |
6.8× |
| CT heart c+ cardiac strux&morph cgen hrt ds (75573) |
$648.20 |
$926 |
1.8× |
| CT heart contrast eval cardiac structure&morph (75572) |
$1,437.10 |
$2,053 |
3.9× |
| CT heart no contrast quant eval coronry calcium (75571) |
$51.80 |
$74 |
0.6× |
| CT l-spine w/contrast (72132) |
$996.10 |
$1,423 |
2.7× |
| CT lower extremity w/dye (73701) |
$911.40 |
$1,302 |
4.9× |
| CT lumbar spine w/o contrast (72131) |
$805.70 |
$1,151 |
7.3× |
| CT maxillofacial w/wo contrast (70488) |
$1,080.80 |
$1,544 |
5.8× |
| CT neck w/contrast (70491) |
$1,231.30 |
$1,759 |
6.7× |
| CT neck w/o contrast (70490) |
$830.20 |
$1,186 |
7.5× |
| CT pelvis w & w/o contrast (72194) |
$1,060.50 |
$1,515 |
5.7× |
| CT pelvis w/o contrast (72192) |
$728.70 |
$1,041 |
6.6× |
| CT thoracic spine w/contrast (72129) |
$1,000.30 |
$1,429 |
5.4× |
| CT thoracic spine w/o contrast (72128) |
$805.70 |
$1,151 |
7.3× |
| CT thorax lung cancer scr c- (71271) |
$639.80 |
$914 |
5.8× |
| CT thorax w/o contrast (71250) |
$1,434.30 |
$2,049 |
13.0× |
| CT upper extremity w/dye (73201) |
$1,069.60 |
$1,528 |
2.9× |
| CTA head w contrast (70496) |
$1,960 |
$2,800 |
10.6× |
| Dual-energy X-ray absorptiometry (DXA), bone density study, 1 or more sites; axial skeleton (eg, hips, pelvis, spine)… (77080) |
$501.20 |
$716 |
4.5× |
| Dxa bone density study axial skeleton (77085) |
$501.20 |
$716 |
4.5× |
| Fluoroscopy up to 1 hour physician/qhp time (76000) |
$604.10 |
$863 |
2.4× |
| Gated heart planar single (78472) |
$1,241.80 |
$1,774 |
2.9× |
| Hepatobil syst imag inc gb w/pharma intervenj (78227) |
$1,775.20 |
$2,536 |
3.1× |
| Hepatobiliary syst imaging including gallbladder (78226) |
$627.90 |
$897 |
1.5× |
| Ht muscle image spect sing (78451) |
$2,905.70 |
$4,151 |
2.1× |
| Lung perf&ventilat diferentl (78598) |
$1,873.90 |
$2,677 |
3.3× |
| Lung perfusion imaging (78580) |
$1,241.80 |
$1,774 |
2.9× |
| Magnetic resonance (eg, proton) imaging, any joint of lower extremity; without contrast material(s), followed by… (73723) |
$1,953 |
$2,790 |
5.3× |
| Magnetic resonance (eg, proton) imaging, lower extremity other than joint; without contrast material(s) Age Under 21 (73718) |
$1,604.40 |
$2,292 |
6.4× |
| Magnetic resonance (eg, proton) imaging, lower extremity other than joint; without contrast material(s), followed by… (73720) |
$2,118.90 |
$3,027 |
5.8× |
| Magnetic resonance (eg, proton) imaging, orbit, face, and/or neck; with contrast material(s) Age Under 21 (70542) |
$1,708 |
$2,440 |
4.6× |
| Magnetic resonance (eg, proton) imaging, orbit, face, and/or neck; without contrast material(s) Age Under 21 (70540) |
$1,592.50 |
$2,275 |
6.3× |
| Magnetic resonance (eg, proton) imaging, upper extremity, other than joint; with contrast material(s) Age Under 21 (73219) |
$1,724.10 |
$2,463 |
4.7× |
| Magnetic resonance (eg, proton) imaging, upper extremity, other than joint; without contrast material(s), followed by… (73220) |
$2,126.60 |
$3,038 |
5.8× |
| Magnetic resonance angiography, head; without contrast material(s), followed by contrast material(s) and further… (70546) |
$2,715.30 |
$3,879 |
7.4× |
| Magnetic resonance angiography, neck; without contrast material(s), followed by contrast material(s) and further… (70549) |
$2,719.50 |
$3,885 |
7.4× |
| Magnetic resonance elastography (76391) |
$1,365 |
$1,950 |
5.4× |
| Mandible min 4v (70110) |
$282.80 |
$404 |
2.6× |
| Mr safety determination physician/other qhp (76016) |
$156.80 |
$224 |
1.7× |
| Mr safety implant pos&/immoblj supvj phys/qhp (76019) |
$105.70 |
$151 |
1.7× |
| Mr safety implant&/fb assmt clin staf 1st 15 min (76014) |
$43.40 |
$62 |
1.4× |
| Mr safety implt electronics prepj supvj phys/qhp (76018) |
$163.10 |
$233 |
1.6× |
| Mr safety med physics xm customization plng&mntr (76017) |
$429.80 |
$614 |
1.7× |
| MRA head w/o contrast (70544) |
$1,791.30 |
$2,559 |
7.1× |
| MRA neck w/o contrast (70547) |
$1,753.50 |
$2,505 |
7.0× |
| MRI abdomen w/o contrast (74181) |
$1,384.60 |
$1,978 |
5.5× |
| MRI abdomen w/wo contrast (74183) |
$2,114.70 |
$3,021 |
5.7× |
| MRI bone marrow (77084) |
$1,675.10 |
$2,393 |
6.7× |
| MRI c-spine w&w/o cont (72156) |
$1,960.70 |
$2,801 |
5.3× |
| MRI cervical spine w/contrast (72142) |
$1,737.40 |
$2,482 |
4.7× |
| MRI chest w/contrast (71551) |
$2,014.60 |
$2,878 |
2.4× |
| MRI chest w/o contrast (71550) |
$1,845.20 |
$2,636 |
7.3× |
| MRI chest w/wo contrast (71552) |
$2,524.20 |
$3,606 |
6.9× |
| MRI joint upr extr w/o&w/dye (73223) |
$1,957.20 |
$2,796 |
5.3× |
| MRI joint upr extrem w/dye (73222) |
$1,596 |
$2,280 |
1.9× |
| MRI joint upr extrem w/o dye (73221) |
$1,521.80 |
$2,174 |
6.0× |
| MRI lumbar spine w/contrast (72149) |
$1,729 |
$2,470 |
4.7× |
| MRI lumbar spine w/wo contrast (72158) |
$1,960.70 |
$2,801 |
5.3× |
| MRI orbit/face/neck w&w/o cont (70543) |
$2,093.70 |
$2,991 |
5.7× |
| MRI pelvis w & w/o contrast (72197) |
$2,109.80 |
$3,014 |
5.7× |
| MRI pelvis w/contrast (72196) |
$1,733.20 |
$2,476 |
4.7× |
| MRI pelvis w/o contrast (72195) |
$1,617 |
$2,310 |
6.4× |
| MRI spine cervical w/o contrast (72141) |
$1,380.40 |
$1,972 |
5.5× |
| MRI t-spine w&w/o cont (72157) |
$1,845.20 |
$2,636 |
5.0× |
| MRI thoracic spine w/contrast (72147) |
$1,496.60 |
$2,138 |
4.1× |
| MRI thoracic spine w/o contrst (72146) |
$1,384.60 |
$1,978 |
5.5× |
| MRI tmj (70336) |
$1,355.90 |
$1,937 |
5.4× |
| MRI upper extremity oth than jt w/o contr matrl (73218) |
$1,646.40 |
$2,352 |
6.5× |
| Myocardial perfusion imaging, planar (including qualitative or quantitative wall motion, ejection fraction by first… (78453) |
$2,686.60 |
$3,838 |
2.0× |
| Myocardial spect multiple studies (78452) |
$3,384.50 |
$4,835 |
2.5× |
| Myocrd img PET 2rtracer CT (78433) |
$6,076.70 |
$8,681 |
2.6× |
| Myocrd img PET metab eval single study cncrnt CT (78429) |
$3,173.10 |
$4,533 |
2.1× |
| N-invas est c ffr augmnt sw alys CTA i&r phy/qhp (75580) |
$2,592.10 |
$3,703 |
2.9× |
| Nm bone 3 phase (78315) |
$1,362.20 |
$1,946 |
3.2× |
| Nm bone imaging whole body (78306) |
$1,259.30 |
$1,799 |
3.0× |
| Nm gastric emptying (78264) |
$1,526.70 |
$2,181 |
3.6× |
| Nm lung ventilation imaging (78579) |
$784.70 |
$1,121 |
1.9× |
| Nuclear medicine study of bone and/or joint limited area (78300) |
$507.50 |
$725 |
1.2× |
| Parathyrd planar w/spect&CT (78072) |
$1,022 |
$1,460 |
1.8× |
| PET imaging CT attenuation skull base mid-thigh (78815) |
$4,834.20 |
$6,906 |
3.2× |
| PET imaging for CT attenuation whole body (78816) |
$4,834.20 |
$6,906 |
3.2× |
| Pulmonary ventilation & perfusion imaging (78582) |
$1,736.70 |
$2,481 |
3.0× |
| Quan&char c athrosclrtc plaq (75577) |
$3,066.70 |
$4,381 |
3.1× |
| Quant differential pulm perfusion w/wo imaging (78597) |
$998.20 |
$1,426 |
2.4× |
| Radex entir thrc lmbr crv sac spi w/skull 2/3 vw (72082) |
$163.10 |
$233 |
1.5× |
| Radex hip unilateral with pelvis 2-3 views (73502) |
$206.50 |
$295 |
2.2× |
| Radex hips bilateral with pelvis 2 views (73521) |
$329 |
$470 |
3.0× |
| Radex spine cervical 2 or 3 views (72040) |
$191.10 |
$273 |
2.1× |
| Radex spine cervical 4 or 5 views (72050) |
$347.90 |
$497 |
3.2× |
| Radex spine cervical 6 or more views (72052) |
$362.60 |
$518 |
3.3× |
| Radex spine thoracolumbar junction min 2 views (72080) |
$200.20 |
$286 |
2.2× |
| Radiologic exam chest 3 views (71047) |
$193.20 |
$276 |
2.1× |
| Radiologic exam chest 4+ views (71048) |
$207.90 |
$297 |
1.9× |
| Radiologic exam esophagus double contrast study (74221) |
$588.70 |
$841 |
3.2× |
| Radiologic exam esophagus single contrast study (74220) |
$527.80 |
$754 |
2.9× |
| Radiologic exam small int single contrast study (74250) |
$489.30 |
$699 |
2.6× |
| Radiologic exam swallow function contrast study (74230) |
$515.90 |
$737 |
2.8× |
| Radiologic exam upr gi trc double contrast study (74246) |
$527.10 |
$753 |
2.8× |
| Radiologic exam upr gi trc single contrast study (74240) |
$592.20 |
$846 |
3.2× |
| Radiologic examination femur minimum 2 views (73552) |
$347.90 |
$497 |
3.8× |
| Radiologic examination, ankle; complete, minimum of 3 views Age Under 21 (73610) |
$186.90 |
$267 |
2.0× |
| Radiologic examination, complete acute abdomen series, including 2 or more views of the abdomen (eg, supine, erect,… (74022) |
$319.20 |
$456 |
2.9× |
| Radiologic examination, elbow; 2 views Age Under 21 (73070) |
$186.90 |
$267 |
2.0× |
| Radiologic examination, elbow; complete, minimum of 3 views Age Under 21 (73080) |
$186.90 |
$267 |
2.0× |
| Radiologic examination, foot; complete, minimum of 3 views Age Under 21 (73630) |
$186.90 |
$267 |
2.0× |
| Radiologic examination, hand; minimum of 3 views Age Under 21 (73130) |
$186.90 |
$267 |
2.0× |
| Radiologic examination, knee; complete, 4 or more views Age Under 21 (73564) |
$336 |
$480 |
3.0× |
| Radiologic examination, mastoids; complete, minimum of 3 views per side Age Under 21 (70130) |
$206.50 |
$295 |
1.9× |
| Radiologic examination, nasal bones, complete, minimum of 3 views Age Under 21 (70160) |
$145.60 |
$208 |
1.6× |
| Radiologic examination, ribs, bilateral; including posteroanterior chest, minimum of 4 views Age Under 21 (71111) |
$408.10 |
$583 |
3.7× |
| Radiologic examination, ribs, unilateral; including posteroanterior chest, minimum of 3 views Age Under 21 (71101) |
$324.80 |
$464 |
2.9× |
| Radiologic examination, sacroiliac joints; less than 3 views Age Under 21 (72200) |
$312.90 |
$447 |
2.8× |
| Radiologic examination, shoulder; complete, minimum of 2 views Age Under 21 (73030) |
$191.10 |
$273 |
2.1× |
| Radiologic examination, sinuses, paranasal, less than 3 views Age Under 21 (70210) |
$183.40 |
$262 |
2.0× |
| Radiologic examination, spine, lumbosacral; 2 or 3 views Age Under 21 (72100) |
$321.30 |
$459 |
2.9× |
| Radiologic examination, wrist; complete, minimum of 3 views Age Under 21 (73110) |
$186.90 |
$267 |
2.0× |
| Radiologic examination; acromioclavicular joints, bilateral, with or without weighted distraction Age Under 21 (73050) |
$133.70 |
$191 |
1.5× |
| Radiologic examination; humerus, minimum of 2 views Age Under 21 (73060) |
$186.90 |
$267 |
2.0× |
| Radiologic examination; lower extremity, infant, minimum of 2 views Age Under 21 (73592) |
$155.40 |
$222 |
1.7× |
| Radiologic examination; sternoclavicular joint or joints, minimum of 3 views Age Under 21 (71130) |
$133.70 |
$191 |
1.5× |
| Radiologic examination; toe(s), minimum of 2 views Age Under 21 (73660) |
$183.40 |
$262 |
2.0× |
| Radiologic examination; upper extremity, infant, minimum of 2 views Age Under 21 (73092) |
$187.60 |
$268 |
1.7× |
| Radiopharmaceutical localization of tumor, inflammatory process or distribution of radiopharmaceutical agent(s)… (78803) |
$1,452.50 |
$2,075 |
2.5× |
| Radiopharmaceutical therapy, by intravenous administration Age Under 21 (79101) |
$581.70 |
$831 |
2.4× |
| Radiopharmaceutical therapy, radiolabeled monoclonal antibody by intravenous infusion (79403) |
$746.90 |
$1,067 |
3.0× |
| Rp loclzj tum plnr whole body 2+ days imaging (78804) |
$2,484.30 |
$3,549 |
4.3× |
| Rp loclzj tum spect w/CT 1 (78830) |
$2,629.20 |
$3,756 |
1.9× |
| Rp loclzj tum spect w/CT 2 (78832) |
$5,307.40 |
$7,582 |
3.5× |
| Scapula complete (73010) |
$186.90 |
$267 |
1.7× |
| Tbs technical calculation only (77091) |
$163.10 |
$233 |
1.8× |
| Therapeutic enema, contrast or air, for reduction of intussusception or other intraluminal obstruction (eg, meconium… (74283) |
$315 |
$450 |
1.7× |
| Thyroid imaging with vascular flow (78013) |
$1,040.20 |
$1,486 |
2.5× |
| Ultrasound, abdomen limited (76705) |
$473.20 |
$676 |
4.3× |
| Ultrasound, limited, joint or focal evaluation of other nonvascular extremity structure(s) (eg, joint space,… (76882) |
$280 |
$400 |
2.5× |
| Us abdominal aorta real time screen study aaa (76706) |
$473.20 |
$676 |
4.3× |
| Us chest (76604) |
$412.30 |
$589 |
3.7× |
| Us compl joint r-t w/image documentation (76881) |
$238 |
$340 |
2.2× |
| Us nrv&acc strux 1 xtr compre w/img pr extremity (76883) |
$189 |
$270 |
1.7× |
| Us retroperitoneal complete (76770) |
$435.40 |
$622 |
3.9× |
| Us retroperitoneal ltd (76775) |
$435.40 |
$622 |
3.9× |
| Us soft tissue head/neck (76536) |
$435.40 |
$622 |
3.9× |
| Venography deep dorsal vein penis radiolgicl supervision interpretation (76499) |
$501.20 |
$716 |
5.5× |
| Vertebral fracture assessment via dxa (77086) |
$309.40 |
$442 |
3.4× |
| X-ray exam hips bi 3-4 views (73522) |
$333.90 |
$477 |
3.0× |
| X-ray exam of finger(s) (73140) |
$191.10 |
$273 |
2.1× |
| X-ray exam of knee 1 or 2 (73560) |
$183.40 |
$262 |
2.0× |
| X-ray exam ribs bil 3 views (71110) |
$317.10 |
$453 |
2.9× |
| X-ray exam ribs uni 2 views (71100) |
$168.70 |
$241 |
1.8× |
| X-ray heel (73650) |
$183.40 |
$262 |
2.0× |
| X-ray of joint between lower spine and hip bone 3 or more views|PROFESSIONAL COMPONENT (72202) |
$333.90 |
$477 |
3.0× |
| Xr abdomen 1 view (74018) |
$186.90 |
$267 |
2.0× |
| Xr abdomen 2 views (74019) |
$317.10 |
$453 |
2.9× |
| Xr bone age studies (77072) |
$294.70 |
$421 |
2.7× |
| Xr bone survey ltd (77074) |
$374.50 |
$535 |
3.4× |
| Xr chest 1 view (71045) |
$186.90 |
$267 |
2.0× |
| Xr chest 2 views (71046) |
$191.10 |
$273 |
2.1× |
| Xr eye foreign body (70030) |
$179.90 |
$257 |
2.0× |
| Xr facial bones 3+ views (70150) |
$282.80 |
$404 |
2.6× |
| Xr forearm 2 views (73090) |
$186.90 |
$267 |
2.0× |
| Xr neck soft tissue (70360) |
$186.90 |
$267 |
2.0× |
| Xr o knee w/ merchant view bilat - report(ortho pro) (73562) |
$195.30 |
$279 |
2.1× |
| Xr osseous survey complete (77075) |
$189 |
$270 |
1.7× |
| Xr pelvis 1-2 views (72170) |
$321.30 |
$459 |
2.9× |
| Xr sacrum/coccyx 2+ views (72220) |
$312.90 |
$447 |
3.4× |
| Xr sinuses 3+ views (70220) |
$294.70 |
$421 |
3.2× |
| Xr skull min 4 view (70260) |
$294.70 |
$421 |
2.7× |
| Xr spine 1 view (72020) |
$163.10 |
$233 |
1.8× |
| Xr sternum 2+ views (71120) |
$191.10 |
$273 |
2.1× |
| Xr t-spine 2 views (72070) |
$317.10 |
$453 |
2.9× |
| Xr tibia/fibula 2 views (73590) |
$186.90 |
$267 |
2.0× |
| Xr tmj bilateral (70330) |
$218.40 |
$312 |
2.4× |
| Xr tmj unilateral (70328) |
$154 |
$220 |
1.7× |