| Acute gi blood loss imaging (78278) |
$1,989 |
$1,989 |
4.7× |
| Ankle 2 views (73600) |
$205 |
$205 |
2.2× |
| Clavicle complete (73000) |
$263 |
$263 |
2.9× |
| Computed tomographic angiography, abdomen and pelvis, with contrast material(s), including noncontrast images, if… (74174) |
$8,469 |
$8,469 |
23.0× |
| Computed tomographic angiography, abdomen, with contrast material(s), including noncontrast images, if performed, and… (74175) |
$7,049 |
$7,049 |
38.1× |
| Computed tomographic angiography, abdominal aorta and bilateral iliofemoral lower extremity runoff, with contrast… (75635) |
$3,811 |
$3,811 |
20.6× |
| Computed tomographic angiography, chest (noncoronary), with contrast material(s), including noncontrast images, if… (71275) |
$7,049 |
$7,049 |
38.1× |
| Computed tomographic angiography, lower extremity, with contrast material(s), including noncontrast images, if… (73706) |
$2,994 |
$2,994 |
16.2× |
| Computed tomographic angiography, neck, with contrast material(s), including noncontrast images, if performed, and… (70498) |
$7,049 |
$7,049 |
38.1× |
| Computed tomographic angiography, pelvis, with contrast material(s), including noncontrast images, if performed, and… (72191) |
$4,235 |
$4,235 |
22.9× |
| Computed tomographic angiography, upper extremity, with contrast material(s), including noncontrast images, if… (73206) |
$5,341 |
$5,341 |
28.9× |
| Computed tomography, bone mineral density study, 1 or more sites, axial skeleton (eg, hips, pelvis, spine) Age Under 21 (77078) |
$219 |
$219 |
2.4× |
| Computed tomography, cervical spine; without contrast material, followed by contrast material(s) and further sections… (72127) |
$4,235 |
$4,235 |
22.9× |
| Computed tomography, lower extremity; without contrast material Age Under 21 (73700) |
$2,304 |
$2,304 |
20.9× |
| Computed tomography, lower extremity; without contrast material, followed by contrast material(s) and further sections… (73702) |
$5,341 |
$5,341 |
28.9× |
| Computed tomography, lumbar spine; without contrast material, followed by contrast material(s) and further sections Age… (72133) |
$3,811 |
$3,811 |
20.6× |
| Computed tomography, maxillofacial area; with contrast material(s) Age Under 21 (70487) |
$3,624 |
$3,624 |
19.6× |
| Computed tomography, maxillofacial area; without contrast material Age Under 21 (70486) |
$2,304 |
$2,304 |
20.9× |
| Computed tomography, orbit, sella, or posterior fossa or outer, middle, or inner ear; with contrast material(s) Age… (70481) |
$2,994 |
$2,994 |
16.2× |
| Computed tomography, orbit, sella, or posterior fossa or outer, middle, or inner ear; without contrast material Age… (70480) |
$2,304 |
$2,304 |
20.9× |
| Computed tomography, orbit, sella, or posterior fossa or outer, middle, or inner ear; without contrast material,… (70482) |
$3,811 |
$3,811 |
20.6× |
| Computed tomography, soft tissue neck; without contrast material followed by contrast material(s) and further sections… (70492) |
$3,811 |
$3,811 |
20.6× |
| Computed tomography, thoracic spine; without contrast material, followed by contrast material(s) and further sections… (72130) |
$3,811 |
$3,811 |
20.6× |
| Computed tomography, thorax, diagnostic; without contrast material, followed by contrast material(s) and further… (71270) |
$4,235 |
$4,235 |
22.9× |
| CT abdomen and pelvis without and with contrast (74178) |
$7,151 |
$7,151 |
19.4× |
| CT abdomen and pelvis without contrast (74176) |
$4,604 |
$4,604 |
18.3× |
| CT abdomen w & w/o contrast (74170) |
$3,811 |
$3,811 |
20.6× |
| CT abdomen w/contrast (74160) |
$2,994 |
$2,994 |
16.2× |
| CT abdomen w/o contrast (74150) |
$2,304 |
$2,304 |
20.9× |
| CT cervical spine w/contrast (72126) |
$2,994 |
$2,994 |
8.1× |
| CT cervical spine w/o contrast (72125) |
$2,304 |
$2,304 |
20.9× |
| CT chest w/contrast (71260) |
$2,994 |
$2,994 |
16.2× |
| CT extremity upper w & w/o contrast (73202) |
$3,683 |
$3,683 |
19.9× |
| CT extremity upper w/o contrast (73200) |
$2,304 |
$2,304 |
20.9× |
| CT head/brain with contrast (70460) |
$5,419 |
$5,419 |
29.3× |
| CT head/brain without and with contrast (70470) |
$7,366 |
$7,366 |
39.8× |
| CT heart no contrast quant eval coronry calcium (75571) |
$174 |
$174 |
1.9× |
| CT l-spine w/contrast (72132) |
$2,994 |
$2,994 |
8.1× |
| CT lower extremity w/dye (73701) |
$2,428 |
$2,428 |
13.1× |
| CT lumbar spine w/o contrast (72131) |
$2,304 |
$2,304 |
20.9× |
| CT maxillofacial w/wo contrast (70488) |
$3,811 |
$3,811 |
20.6× |
| CT neck w/contrast (70491) |
$2,994 |
$2,994 |
16.2× |
| CT neck w/o contrast (70490) |
$2,304 |
$2,304 |
20.9× |
| CT pelvis w & w/o contrast (72194) |
$3,811 |
$3,811 |
20.6× |
| CT pelvis w/o contrast (72192) |
$2,304 |
$2,304 |
20.9× |
| CT thoracic spine w/contrast (72129) |
$3,683 |
$3,683 |
19.9× |
| CT thoracic spine w/o contrast (72128) |
$2,304 |
$2,304 |
20.9× |
| CT thorax lung cancer scr c- (71271) |
$2,092 |
$2,092 |
19.0× |
| CT thorax w/o contrast (71250) |
$2,304 |
$2,304 |
20.9× |
| CT upper extremity w/dye (73201) |
$2,994 |
$2,994 |
8.1× |
| CTA head w contrast (70496) |
$7,049 |
$7,049 |
38.1× |
| Fetal biophys profile w/o nst (76819) |
$732 |
$732 |
6.6× |
| Fluoroscopy up to 1 hour physician/qhp time (76000) |
$569 |
$569 |
2.3× |
| Gated heart planar single (78472) |
$3,187 |
$3,187 |
7.6× |
| Hepatobil syst imag inc gb w/pharma intervenj (78227) |
$2,826 |
$2,826 |
4.9× |
| Hepatobiliary syst imaging including gallbladder (78226) |
$2,532 |
$2,532 |
6.0× |
| Ht muscle image spect sing (78451) |
$2,652 |
$2,652 |
1.9× |
| Intestine imaging (eg, ectopic gastric mucosa, Meckel's localization, volvulus) Age Under 21 (78290) |
$3,444 |
$3,444 |
8.2× |
| Kidney imaging morphol - nm kidney cortex (78700) |
$2,377 |
$2,377 |
5.6× |
| Kidney imaging morphology; with vascular flow Age Under 21 (78701) |
$2,692 |
$2,692 |
6.4× |
| Kidney imaging morphology; with vascular flow and function, multiple studies, with and without pharmacological… (78709) |
$2,880 |
$2,880 |
5.0× |
| Kidney imaging morphology; with vascular flow and function, single study without pharmacological intervention Age Under… (78707) |
$2,826 |
$2,826 |
4.9× |
| Kidney imaging morphology; with vascular flow and function, single study, with pharmacological intervention (eg,… (78708) |
$2,857 |
$2,857 |
5.0× |
| Liver and spleen imaging (78215) |
$1,584 |
$1,584 |
3.8× |
| Liver and spleen imaging; with vascular flow Age Under 21 (78216) |
$2,470 |
$2,470 |
5.9× |
| Lung perf&ventilat diferentl (78598) |
$4,866 |
$4,866 |
8.5× |
| Lung perfusion imaging (78580) |
$3,756 |
$3,756 |
8.9× |
| Magnetic resonance (eg, proton) imaging, any joint of lower extremity; without contrast material(s), followed by… (73723) |
$5,400 |
$5,400 |
14.7× |
| Magnetic resonance (eg, proton) imaging, lower extremity other than joint; with contrast material(s) Age Under 21 (73719) |
$3,403 |
$3,403 |
9.2× |
| Magnetic resonance (eg, proton) imaging, lower extremity other than joint; without contrast material(s) Age Under 21 (73718) |
$3,328 |
$3,328 |
13.2× |
| Magnetic resonance (eg, proton) imaging, lower extremity other than joint; without contrast material(s), followed by… (73720) |
$5,400 |
$5,400 |
14.7× |
| Magnetic resonance (eg, proton) imaging, orbit, face, and/or neck; with contrast material(s) Age Under 21 (70542) |
$3,403 |
$3,403 |
9.2× |
| Magnetic resonance (eg, proton) imaging, orbit, face, and/or neck; without contrast material(s) Age Under 21 (70540) |
$3,328 |
$3,328 |
13.2× |
| Magnetic resonance (eg, proton) imaging, upper extremity, other than joint; with contrast material(s) Age Under 21 (73219) |
$3,403 |
$3,403 |
9.2× |
| Magnetic resonance (eg, proton) imaging, upper extremity, other than joint; without contrast material(s), followed by… (73220) |
$5,400 |
$5,400 |
14.7× |
| Magnetic resonance angiography, head; with contrast material(s) Age Under 21 (70545) |
$3,503 |
$3,503 |
9.5× |
| Magnetic resonance angiography, head; without contrast material(s), followed by contrast material(s) and further… (70546) |
$5,560 |
$5,560 |
15.1× |
| Magnetic resonance angiography, neck; without contrast material(s), followed by contrast material(s) and further… (70549) |
$5,560 |
$5,560 |
15.1× |
| Mandible min 4v (70110) |
$437 |
$437 |
4.0× |
| MRA head w/o contrast (70544) |
$3,428 |
$3,428 |
13.6× |
| MRA neck w/ contrast (70548) |
$3,503 |
$3,503 |
9.5× |
| MRA neck w/o contrast (70547) |
$3,428 |
$3,428 |
13.6× |
| MRI abdomen w/contrast (74182) |
$3,403 |
$3,403 |
9.2× |
| MRI abdomen w/o contrast (74181) |
$3,328 |
$3,328 |
13.2× |
| MRI abdomen w/wo contrast (74183) |
$5,400 |
$5,400 |
14.7× |
| MRI any jt lower extrem w/contrast material (73722) |
$3,403 |
$3,403 |
4.1× |
| MRI c-spine w&w/o cont (72156) |
$5,400 |
$5,400 |
14.7× |
| MRI cervical spine w/contrast (72142) |
$3,403 |
$3,403 |
9.2× |
| MRI chest w/contrast (71551) |
$3,403 |
$3,403 |
4.1× |
| MRI chest w/o contrast (71550) |
$3,328 |
$3,328 |
13.2× |
| MRI chest w/wo contrast (71552) |
$5,400 |
$5,400 |
14.7× |
| MRI joint upr extr w/o&w/dye (73223) |
$5,400 |
$5,400 |
14.7× |
| MRI joint upr extrem w/dye (73222) |
$3,403 |
$3,403 |
4.1× |
| MRI joint upr extrem w/o dye (73221) |
$3,328 |
$3,328 |
13.2× |
| MRI lumbar spine w/contrast (72149) |
$3,403 |
$3,403 |
9.2× |
| MRI lumbar spine w/wo contrast (72158) |
$5,400 |
$5,400 |
14.7× |
| MRI orbit/face/neck w&w/o cont (70543) |
$5,400 |
$5,400 |
14.7× |
| MRI pelvis w & w/o contrast (72197) |
$5,400 |
$5,400 |
14.7× |
| MRI pelvis w/contrast (72196) |
$3,403 |
$3,403 |
9.2× |
| MRI pelvis w/o contrast (72195) |
$3,328 |
$3,328 |
13.2× |
| MRI spine cervical w/o contrast (72141) |
$3,328 |
$3,328 |
13.2× |
| MRI t-spine w&w/o cont (72157) |
$5,400 |
$5,400 |
14.7× |
| MRI thoracic spine w/contrast (72147) |
$3,403 |
$3,403 |
9.2× |
| MRI thoracic spine w/o contrst (72146) |
$3,328 |
$3,328 |
13.2× |
| MRI tmj (70336) |
$3,328 |
$3,328 |
13.2× |
| MRI upper extremity oth than jt w/o contr matrl (73218) |
$3,328 |
$3,328 |
13.2× |
| Myocardial spect multiple studies (78452) |
$5,669 |
$5,669 |
4.2× |
| Nm bone 3 phase (78315) |
$1,904 |
$1,904 |
4.5× |
| Nm bone imaging whole body (78306) |
$1,838 |
$1,838 |
4.4× |
| Nm gastric emptying (78264) |
$1,838 |
$1,838 |
4.4× |
| Nm lung ventilation imaging (78579) |
$3,756 |
$3,756 |
8.9× |
| Nuclear medicine study of bone and/or joint limited area (78300) |
$1,546 |
$1,546 |
3.7× |
| Nuclear medicine study of bone and/or joint multiple areas (78305) |
$1,724 |
$1,724 |
4.1× |
| Ob us limited fetus(s) (76815) |
$732 |
$732 |
6.6× |
| Ophthalmic ultrasound, diagnostic; B-scan and quantitative A-scan performed during the same patient encounter Age Under… (76510) |
$252 |
$252 |
1.8× |
| Parathyroid planar imaging (78070) |
$1,311 |
$1,311 |
3.1× |
| Parathyroid planar imaging w/wo subtraction (78071) |
$1,515 |
$1,515 |
3.6× |
| Quant differential pulm perfusion w/wo imaging (78597) |
$3,927 |
$3,927 |
9.3× |
| Radex entir thrc lmbr crv sac spi w/skull 1 vw (72081) |
$410 |
$410 |
4.5× |
| Radex entir thrc lmbr crv sac spi w/skull 2/3 vw (72082) |
$844 |
$844 |
7.7× |
| Radex hip unilateral with pelvis 1 view (73501) |
$293 |
$293 |
3.2× |
| Radex hip unilateral with pelvis 2-3 views (73502) |
$410 |
$410 |
4.5× |
| Radex hips bilateral with pelvis 2 views (73521) |
$820 |
$820 |
7.4× |
| Radex spine cervical 2 or 3 views (72040) |
$366 |
$366 |
4.0× |
| Radex spine cervical 4 or 5 views (72050) |
$509 |
$509 |
4.6× |
| Radex spine cervical 6 or more views (72052) |
$554 |
$554 |
5.0× |
| Radex spine thoracolumbar junction min 2 views (72080) |
$410 |
$410 |
4.5× |
| Radiologic exam abdomen 3+ views (74021) |
$462 |
$462 |
4.2× |
| Radiologic exam chest 3 views (71047) |
$366 |
$366 |
4.0× |
| Radiologic exam swallow function contrast study (74230) |
$361 |
$361 |
2.0× |
| Radiologic exam upr gi trc single contrast study (74240) |
$554.50 |
$554.50 |
3.0× |
| Radiologic examination femur 1 view (73551) |
$240 |
$240 |
2.6× |
| Radiologic examination femur minimum 2 views (73552) |
$293 |
$293 |
3.2× |
| Radiologic examination from nose to rectum for foreign body, single view, child Age Under 21 (76010) |
$176 |
$176 |
1.9× |
| Radiologic examination, ankle; complete, minimum of 3 views Age Under 21 (73610) |
$263 |
$263 |
2.9× |
| Radiologic examination, complete acute abdomen series, including 2 or more views of the abdomen (eg, supine, erect,… (74022) |
$482 |
$482 |
4.4× |
| Radiologic examination, elbow; 2 views Age Under 21 (73070) |
$235 |
$235 |
2.6× |
| Radiologic examination, elbow; complete, minimum of 3 views Age Under 21 (73080) |
$293 |
$293 |
3.2× |
| Radiologic examination, facial bones; less than 3 views Age Under 21 (70140) |
$293 |
$293 |
3.2× |
| Radiologic examination, foot; complete, minimum of 3 views Age Under 21 (73630) |
$263 |
$263 |
2.9× |
| Radiologic examination, hand; minimum of 3 views Age Under 21 (73130) |
$263 |
$263 |
2.9× |
| Radiologic examination, knee; both knees, standing, anteroposterior Age Under 21 (73565) |
$235 |
$235 |
2.6× |
| Radiologic examination, knee; complete, 4 or more views Age Under 21 (73564) |
$366 |
$366 |
3.3× |
| Radiologic examination, mandible; partial, less than 4 views Age Under 21 (70100) |
$293 |
$293 |
3.2× |
| Radiologic examination, nasal bones, complete, minimum of 3 views Age Under 21 (70160) |
$293 |
$293 |
3.2× |
| Radiologic examination, ribs, bilateral; including posteroanterior chest, minimum of 4 views Age Under 21 (71111) |
$580 |
$580 |
5.3× |
| Radiologic examination, ribs, unilateral; including posteroanterior chest, minimum of 3 views Age Under 21 (71101) |
$494 |
$494 |
4.5× |
| Radiologic examination, shoulder; complete, minimum of 2 views Age Under 21 (73030) |
$235 |
$235 |
2.6× |
| Radiologic examination, sinuses, paranasal, less than 3 views Age Under 21 (70210) |
$235 |
$235 |
2.6× |
| Radiologic examination, skull; less than 4 views Age Under 21 (70250) |
$366 |
$366 |
3.3× |
| Radiologic examination, spine, lumbosacral; 2 or 3 views Age Under 21 (72100) |
$410 |
$410 |
3.7× |
| Radiologic examination, spine, lumbosacral; bending views only, 2 or 3 views Age Under 21 (72120) |
$410 |
$410 |
3.7× |
| Radiologic examination, spine, lumbosacral; complete, including bending views, minimum of 6 views Age Under 21 (72114) |
$524 |
$524 |
4.8× |
| Radiologic examination, spine; thoracic, minimum of 4 views Age Under 21 (72074) |
$784 |
$784 |
7.1× |
| Radiologic examination, wrist; complete, minimum of 3 views Age Under 21 (73110) |
$263 |
$263 |
2.9× |
| Radiologic examination; acromioclavicular joints, bilateral, with or without weighted distraction Age Under 21 (73050) |
$366 |
$366 |
4.0× |
| Radiologic examination; humerus, minimum of 2 views Age Under 21 (73060) |
$293 |
$293 |
3.2× |
| Radiologic examination; lower extremity, infant, minimum of 2 views Age Under 21 (73592) |
$321 |
$321 |
3.5× |
| Radiologic examination; sternoclavicular joint or joints, minimum of 3 views Age Under 21 (71130) |
$321 |
$321 |
3.5× |
| Radiologic examination; toe(s), minimum of 2 views Age Under 21 (73660) |
$205 |
$205 |
2.2× |
| Radiologic examination; upper extremity, infant, minimum of 2 views Age Under 21 (73092) |
$321 |
$321 |
2.9× |
| Scapula complete (73010) |
$293 |
$293 |
2.7× |
| Testicular imaging with vascular flow Age Under 21 (78761) |
$1,311 |
$1,311 |
3.1× |
| Thyroid imaging with vascular flow (78013) |
$1,311 |
$1,311 |
3.1× |
| Thyroid uptake w/blood flow sngle/mult quan meas (78014) |
$1,693 |
$1,693 |
4.0× |
| Ultrasound breast limited (76642) |
$732 |
$732 |
8.0× |
| Ultrasound, abdomen limited (76705) |
$216 |
$216 |
2.0× |
| Ultrasound, limited, joint or focal evaluation of other nonvascular extremity structure(s) (eg, joint space,… (76882) |
$732 |
$732 |
6.6× |
| Ultrasound, pelvic (nonobstetric), real time with image documentation; complete Age Under 21 (76856) |
$732 |
$732 |
6.6× |
| Ultrasound, pregnant uterus, real time with image documentation, fetal and maternal evaluation plus detailed fetal… (76811) |
$732 |
$732 |
2.9× |
| Ultrasound, pregnant uterus, real time with image documentation, fetal and maternal evaluation, first trimester (< 14… (76801) |
$732 |
$732 |
6.6× |
| Ureteral reflux study (78740) |
$1,408 |
$1,408 |
3.3× |
| Us breast uni real time with image complete (76641) |
$732 |
$732 |
6.6× |
| Us chest (76604) |
$216 |
$216 |
2.0× |
| Us compl joint r-t w/image documentation (76881) |
$732 |
$732 |
6.6× |
| Us exam, pelvic, limited (76857) |
$732 |
$732 |
6.6× |
| US OB Follow-Up/Repeat (76816) |
$732 |
$732 |
6.6× |
| Us ob transvaginal (76817) |
$732 |
$732 |
6.6× |
| Us retroperitoneal complete (76770) |
$732 |
$732 |
6.6× |
| Us retroperitoneal ltd (76775) |
$216 |
$216 |
2.0× |
| Us scrotum (76870) |
$732 |
$732 |
6.6× |
| Us soft tissue head/neck (76536) |
$732 |
$732 |
6.6× |
| Us unlstd proc (76999) |
$732 |
$732 |
8.0× |
| X-ray exam of finger(s) (73140) |
$205 |
$205 |
2.2× |
| X-ray exam of knee 1 or 2 (73560) |
$263 |
$263 |
2.9× |
| X-ray exam ribs bil 3 views (71110) |
$437 |
$437 |
4.0× |
| X-ray exam ribs uni 2 views (71100) |
$366 |
$366 |
4.0× |
| X-ray heel (73650) |
$263 |
$263 |
2.9× |
| X-ray of joint between lower spine and hip bone 3 or more views|PROFESSIONAL COMPONENT (72202) |
$366 |
$366 |
3.3× |
| Xr abdomen 1 view (74018) |
$235 |
$235 |
2.6× |
| Xr abdomen 2 views (74019) |
$393 |
$393 |
3.6× |
| Xr bone survey infant (77076) |
$550 |
$550 |
5.0× |
| Xr chest 1 view (71045) |
$235 |
$235 |
2.6× |
| Xr chest 2 views (71046) |
$293 |
$293 |
3.2× |
| Xr eye foreign body (70030) |
$294 |
$294 |
3.2× |
| Xr facial bones 3+ views (70150) |
$437 |
$437 |
4.0× |
| Xr foot arthritis pa only bilateral - report(ortho pro) (73620) |
$205 |
$205 |
2.2× |
| Xr forearm 2 views (73090) |
$235 |
$235 |
2.6× |
| Xr hand 2v (73120) |
$205 |
$205 |
1.9× |
| Xr neck soft tissue (70360) |
$366 |
$366 |
4.0× |
| Xr o knee w/ merchant view bilat - report(ortho pro) (73562) |
$321 |
$321 |
3.5× |
| Xr osseous survey complete (77075) |
$1,161 |
$1,161 |
10.5× |
| Xr pelvis 1-2 views (72170) |
$263 |
$263 |
2.4× |
| Xr pelvis min 3 view (72190) |
$263 |
$263 |
2.4× |
| Xr sacrum/coccyx 2+ views (72220) |
$366 |
$366 |
4.0× |
| Xr shoulder 1 view (73020) |
$235 |
$235 |
2.6× |
| Xr sinuses 3+ views (70220) |
$437 |
$437 |
4.8× |
| Xr skull min 4 view (70260) |
$509 |
$509 |
4.6× |
| Xr spine 1 view (72020) |
$263 |
$263 |
2.9× |
| Xr sternum 2+ views (71120) |
$321 |
$321 |
3.5× |
| Xr stress view joint (77071) |
$205 |
$205 |
2.2× |
| Xr t-spine 2 views (72070) |
$410 |
$410 |
3.7× |
| Xr tibia/fibula 2 views (73590) |
$293 |
$293 |
3.2× |
| Xr tmj bilateral (70330) |
$509 |
$509 |
5.5× |
| Xr tmj unilateral (70328) |
$437 |
$437 |
4.8× |
| Xr wrist 2 views (73100) |
$205 |
$205 |
2.2× |