| Acute gi blood loss imaging (78278) |
$1,690.80 |
$2,818 |
4.1× |
| Angio adrenal bilat select (75733) |
$5,027.40 |
$8,379 |
1.5× |
| Angio adrenal unilat select (75731) |
$2,059.20 |
$3,432 |
0.6× |
| Angio extremity unilateral (75710) |
$4,930.20 |
$8,217 |
1.5× |
| Angio pulmonary unilateral (75741) |
$2,749.20 |
$4,582 |
0.8× |
| Angiogram extremity bilateral (75716) |
$5,244.60 |
$8,741 |
1.6× |
Angiogram pelvic (75736)
unusually low: confirm this is the full procedure |
$2,698.20 |
$4,497 |
0.5× |
| Angiography internal mammary rs&i (75756) |
$665.40 |
$1,109 |
0.2× |
| Angiography pulmonary bilateral slctv rs&i (75743) |
$3,088.80 |
$5,148 |
0.9× |
| Angiography visceral slctv/supraslctv rs&i (75726) |
$3,771 |
$6,285 |
0.6× |
| Angrph cath f-up std tcat other than thrombylsis (75898) |
$924.60 |
$1,541 |
0.3× |
| Angrph pulmonary nonslctv cath/ven njx rs&i (75746) |
$2,779.80 |
$4,633 |
0.8× |
| Ankle 2 views (73600) |
$551.40 |
$919 |
6.1× |
| Aortography thoracic w/o serialography rs&i (75600) |
$4,656 |
$7,760 |
1.4× |
| Arthrography knee lt (73580) |
$886.80 |
$1,478 |
2.4× |
| Arthrography wrist lt (73115) |
$886.80 |
$1,478 |
2.4× |
| Barium enema (74270) |
$853.20 |
$1,422 |
4.7× |
| Bilat selctv renal venogram (75833) |
$5,494.20 |
$9,157 |
1.7× |
| Bone age studies (77072) |
$282.60 |
$471 |
2.6× |
| Bone imaging limited area (78300) |
$1,657.80 |
$2,763 |
4.0× |
| Bone marrow imaging whole body (78104) |
$1,617 |
$2,695 |
3.9× |
| Bone survey complete (77075) |
$866.40 |
$1,444 |
7.9× |
| Bowel imaging (78290) |
$1,486.20 |
$2,477 |
3.6× |
| Brain image w/flow 4 + views (78606) |
$1,800 |
$3,000 |
3.2× |
| Brain imaging, less than 4 static views; with vascular flow Age Under 21 (78601) |
$1,184.40 |
$1,974 |
2.8× |
| Card MRI w/stress img & dye (75563) |
$1,709.40 |
$2,849 |
2.1× |
| Cardiac blood pool imaging (planar), first pass technique; single study, at rest or with stress (exercise and/or… (78481) |
$430.80 |
$718 |
0.8× |
| Cardiac blood pool imaging, gated equilibrium; multiple studies, wall motion study plus ejection fraction, at rest and… (78473) |
$3,551.40 |
$5,919 |
8.5× |
| Cardiac MRI w/stress img (75559) |
$1,487.40 |
$2,479 |
2.6× |
| Cardiac MRI w/wo contrast & further seq (75561) |
$1,709.40 |
$2,849 |
4.7× |
| Cerebrospinal fluid leakage (78650) |
$1,249.80 |
$2,083 |
0.9× |
| Cholecystography, oral contrast Other Diagnostic Radiology FS (74290) |
$199.80 |
$333 |
1.1× |
| Cine/Vid X-Ray Throat/Esoph - Fl Esoph Barium Swlw W/ Video & Speech (74230) |
$786 |
$1,310 |
4.3× |
| Cineradiography/videoradiography (76120) |
$201.60 |
$336 |
1.8× |
| Cisternogram (78630) |
$1,263.60 |
$2,106 |
2.2× |
| Clavicle complete (73000) |
$477.90 |
$796.50 |
5.3× |
| Computed tomographic (CT) colonography, screening, including image postprocessing UNSCHEDULED (74263) |
$391.20 |
$652 |
1.6× |
| Computed tomography, orbit, sella, or posterior fossa or outer, middle, or inner ear; with contrast material(s) Age… (70481) |
$3,060 |
$5,100 |
16.7× |
| Contrast exam abdominl aorta (75625) |
$5,027.40 |
$8,379 |
1.5× |
| Contrast exam thoracic aorta (75605) |
$4,642.80 |
$7,738 |
0.8× |
| Corpora cavernosography (74445) |
$177.60 |
$296 |
1.6× |
| Csf shunt evaluation (78645) |
$1,532.40 |
$2,554 |
2.7× |
| CT - st neck w&wo contr (70492) |
$3,616.20 |
$6,027 |
19.7× |
| CT abdomen and pelvis without and with contrast (74178) |
$5,664.75 |
$9,441.25 |
15.5× |
| CT abdomen and pelvis without contrast (74176) |
$3,398.85 |
$5,664.75 |
13.6× |
| CT abdomen w wo contrast (74170) |
$3,852 |
$6,420 |
21.0× |
| CT abdomen w/contrast (74160) |
$3,172.20 |
$5,287 |
17.3× |
| CT abdomen w/o contrast (74150) |
$2,266.20 |
$3,777 |
20.8× |
| CT angio abd&plvis cntrst mtrl w/wo cntrst imges (74174) |
$4,906.80 |
$8,178 |
13.5× |
| CT angio abdom w/o & w/dye (74175) |
$3,876.60 |
$6,461 |
21.2× |
| CT angio abdominal arteries (75635) |
$3,345 |
$5,575 |
18.3× |
| CT angio hrt w/3d image (75574) |
$1,641.60 |
$2,736 |
4.5× |
| CT angiograph pelv w/o&w/dye (72191) |
$3,151.20 |
$5,252 |
17.2× |
| CT cervical spine w/contrast (72126) |
$3,725.40 |
$6,209 |
10.2× |
| CT cervical spine w/o contrast (72125) |
$3,004.20 |
$5,007 |
27.5× |
| CT chest w/contrast (71260) |
$3,348.60 |
$5,581 |
18.3× |
| CT colonography diag w cont (74262) |
$1,621.80 |
$2,703 |
8.9× |
| CT colonography w/o cntrst (74261) |
$1,787.40 |
$2,979 |
16.4× |
| CT extremity upper w & w/o contrast (73202) |
$3,210 |
$5,350 |
17.5× |
| CT head/brain with contrast (70460) |
$3,743.40 |
$6,239 |
20.4× |
| CT head/brain without and with contrast (70470) |
$4,407.60 |
$7,346 |
24.1× |
| CT heart contrast eval cardiac structure&morph (75572) |
$1,641.60 |
$2,736 |
4.5× |
| CT heart w/o contrast quant eval coronary calcium (75571) |
$1,395.60 |
$2,326 |
15.4× |
| CT hrt w/3d image congen (75573) |
$1,641.60 |
$2,736 |
4.5× |
| CT limited/localized follow up study (76380) |
$1,108.20 |
$1,847 |
12.2× |
| CT lower ext w/wo contrast (73702) |
$5,191.20 |
$8,652 |
28.3× |
| CT lower extremity w contrast (73701) |
$4,428.60 |
$7,381 |
24.2× |
| CT lower extremity w/o contrast unilateral (73700) |
$3,666 |
$6,110 |
33.6× |
| CT lumbar spine w/contrast (72132) |
$4,116.60 |
$6,861 |
11.3× |
| CT lumbar spine w/o contrast (72131) |
$3,241.20 |
$5,402 |
29.7× |
| CT lumbar spine w/o then w/ con (72133) |
$4,861.80 |
$8,103 |
26.5× |
| CT maxillofacial area w/o contrast (70486) |
$2,631.60 |
$4,386 |
24.1× |
| CT maxillofacial w/contrast (70487) |
$3,157.80 |
$5,263 |
17.2× |
| CT maxillofacial w/o then w/ con (70488) |
$3,842.40 |
$6,404 |
21.0× |
| CT orbit sella ear w/o con (70480) |
$2,571.60 |
$4,286 |
23.6× |
| CT orbit/ear/fossa w/o then w/ con (70482) |
$3,317.40 |
$5,529 |
18.1× |
| CT pelvis w & w/o contrast (72194) |
$5,367 |
$8,945 |
29.3× |
| CT pelvis w/o contrast (72192) |
$2,932.80 |
$4,888 |
26.9× |
| CT soft tissue neck w/contrast (70491) |
$2,988.60 |
$4,981 |
16.3× |
| CT soft tissue neck w/o contrast (70490) |
$2,421 |
$4,035 |
22.2× |
| CT spine cervical w/wo contrast (72127) |
$4,416 |
$7,360 |
24.1× |
| CT thoracic spine w/contrast (72129) |
$4,288.20 |
$7,147 |
23.4× |
| CT thoracic spine w/o contrast (72128) |
$2,395.80 |
$3,993 |
21.9× |
| CT thoracic spine w/o then w/ con (72130) |
$4,288.20 |
$7,147 |
23.4× |
| CT thorax lung cancer scr c- (71271) |
$158.40 |
$264 |
1.5× |
| CT thorax w/o contrast (71250) |
$2,712.60 |
$4,521 |
24.8× |
| CT thorax w/o then w/ contrast (71270) |
$3,984.60 |
$6,641 |
21.8× |
| CT upper extremity w/dye (73201) |
$2,656.80 |
$4,428 |
7.3× |
| CT upper extremity w/o contrast rt (73200) |
$2,229 |
$3,715 |
20.4× |
| CTA chest w/wo contrast (71275) |
$3,283.80 |
$5,473 |
17.9× |
| CTA head w contrast (70496) |
$3,536.40 |
$5,894 |
19.3× |
| CTA lower extremity w/wo contrast unilateral (73706) |
$2,833.50 |
$4,722.50 |
15.5× |
| Cta Neck (70498) |
$3,579 |
$5,965 |
19.5× |
| CTA upper extremity w/wo contrast unilateral (73206) |
$2,756.40 |
$4,594 |
15.0× |
| Dacryocystography, nasolacrimal duct, radiological supervision and interpretation Other Diagnostic Radiology FS (70170) |
$454.20 |
$757 |
1.8× |
| Dilation ureters/urethra rs&i (74485) |
$3,244.20 |
$5,407 |
1.5× |
| Discography, cervical or thoracic, radiological supervision and interpretation Other Diagnostic Radiology FS (72285) |
$3,084 |
$5,140 |
1.5× |
| Diskography lumbar (72295) |
$1,659.60 |
$2,766 |
0.8× |
| Doppler echo fetal spectral display complete (76827) |
$707.40 |
$1,179 |
6.5× |
| Doppler echocardiography, fetal, pulsed wave and/or continuous wave with spectral display; follow-up or repeat study… (76828) |
$502.20 |
$837 |
4.6× |
| Doppler fetal mid cerebral artery (76821) |
$88.50 |
$147.50 |
0.8× |
| Dxa bone density study axial skeleton (77085) |
$175.20 |
$292 |
1.6× |
| Echocardiography, fetal, cardiovascular system, real time with image documentation (2D), with or without M-mode… (76826) |
$423 |
$705 |
1.7× |
| Esophageal motility (78258) |
$930 |
$1,550 |
2.2× |
| Esophogram (74220) |
$628.80 |
$1,048 |
3.4× |
| Fetal biophysical profile non-stress testing (76818) |
$386.10 |
$643.50 |
3.5× |
| Fetal biophysical profile w/o nst (76819) |
$516.60 |
$861 |
4.7× |
| Fetal echo complete (76825) |
$919.80 |
$1,533 |
1.6× |
| Fluoroscopy up to 1 hour physician/qhp time (76000) |
$672 |
$1,120 |
2.7× |
| Functional MRI brain by phys/psych (70555) |
$793.20 |
$1,322 |
3.2× |
| Functional MRI brain by tech (70554) |
$1,908 |
$3,180 |
7.7× |
| Gastric emptying imaging study (eg, solid, liquid, or both); with small bowel and colon transit, multiple days Age… (78266) |
$866.40 |
$1,444 |
1.5× |
| Gastric emptying imaging study (eg, solid, liquid, or both); with small bowel transit Age Under 21 (78265) |
$653.40 |
$1,089 |
1.6× |
| Gastric emptying study (78264) |
$2,036.40 |
$3,394 |
4.9× |
| Gastroesophageal reflux study (78262) |
$1,126.80 |
$1,878 |
2.7× |
| Gated heart planar single (78472) |
$2,818.80 |
$4,698 |
6.8× |
| Heart infarct image (78466) |
$685.80 |
$1,143 |
1.6× |
| Hepatc vngrph wdg/fr w/o hemodyn eval rs&i (75891) |
$1,483.80 |
$2,473 |
0.5× |
| Hepatic venography, wedged or free, with hemodynamic evaluation, radiological supervision and interpretation Other… (75889) |
$4,918.20 |
$8,197 |
1.5× |
| Hepatobil syst image w/drug (78227) |
$2,709.60 |
$4,516 |
4.8× |
| Hepatobiliary system imaging (78226) |
$1,977.60 |
$3,296 |
4.7× |
| Humerus min 2 views (73060) |
$500.40 |
$834 |
5.5× |
| Hysterosalpingography (74740) |
$865.80 |
$1,443 |
3.5× |
| Infusion of radioelement (77750) |
$556.80 |
$928 |
1.4× |
| Injection procedure for radiopharmaceutical localization by non-imaging probe study, intravenous (eg, parathyroid… (78808) |
$657 |
$1,095 |
1.6× |
| Interstitial radiation source application, complex, includes supervision, handling, loading of radiation source, when… (77778) |
$3,618 |
$6,030 |
5.0× |
| Ivp (74400) |
$2,203.20 |
$3,672 |
12.0× |
| Ivp w tomography (74415) |
$2,688 |
$4,480 |
14.7× |
| Kidney imaging morphology; with vascular flow and function, multiple studies, with and without pharmacological… (78709) |
$1,525.80 |
$2,543 |
2.7× |
| Kidney imaging morphology; with vascular flow and function, single study without pharmacological intervention Age Under… (78707) |
$961.20 |
$1,602 |
1.7× |
| Kidney imaging morphology; with vascular flow and function, single study, with pharmacological intervention (eg,… (78708) |
$732.60 |
$1,221 |
1.3× |
| Kidney w vascular flow (78701) |
$900 |
$1,500 |
2.2× |
| Liver & spleen; static only (78215) |
$1,472.40 |
$2,454 |
3.5× |
| Liver & spleen; w vasc flow (78216) |
$957 |
$1,595 |
2.3× |
| Liver imaging w/vascular flow (78202) |
$1,280.40 |
$2,134 |
2.3× |
| Lung perf&ventilat diferentl (78598) |
$1,812 |
$3,020 |
3.2× |
| Lung perfusion differential (78597) |
$1,177.80 |
$1,963 |
2.8× |
| Lung ventilat&perfus imaging (78582) |
$1,477.20 |
$2,462 |
2.6× |
| Lung ventilation imaging (78579) |
$827.40 |
$1,379 |
2.0× |
| Lymphangiography, extremity only, bilateral, radiological supervision and interpretation Other Diagnostic Radiology FS (75803) |
$768 |
$1,280 |
0.5× |
| Lymphangiography, extremity only, unilateral, radiological supervision and interpretation Other Diagnostic Radiology FS (75801) |
$768 |
$1,280 |
1.2× |
| Lymphangiography, pelvic/abdominal, bilateral, radiological supervision and interpretation Other Diagnostic Radiology FS (75807) |
$768 |
$1,280 |
0.2× |
| Lymphangiography, pelvic/abdominal, unilateral (75805) |
$1,349.40 |
$2,249 |
0.4× |
| Magnetic resonance (eg, proton) imaging, any joint of lower extremity; without contrast material(s), followed by… (73723) |
$5,611.50 |
$9,352.50 |
15.4× |
| Magnetic resonance (eg, proton) imaging, lower extremity other than joint; without contrast material(s), followed by… (73720) |
$5,494.80 |
$9,158 |
15.1× |
| Mammary ductogram multiple ducts (77054) |
$70.20 |
$117 |
0.3× |
| Mammary ductogram single (77053) |
$53.40 |
$89 |
0.2× |
| Mr safety determination physician/other qhp (76016) |
$185.40 |
$309 |
2.0× |
| Mr safety implant pos&/immoblj supvj phys/qhp (76019) |
$125.40 |
$209 |
2.0× |
| Mr safety implant&/fb assmt clin staf 1st 15 min (76014) |
$51.60 |
$86 |
1.7× |
| Mr safety implt electronics prepj supvj phys/qhp (76018) |
$193.20 |
$322 |
1.9× |
| Mr safety med physics xm customization plng&mntr (76017) |
$509.40 |
$849 |
2.0× |
| MRA head w & w/o contrast (70546) |
$4,425 |
$7,375 |
12.1× |
| MRA head w/contrast (70545) |
$4,425 |
$7,375 |
12.1× |
| MRA head w/o contrast (70544) |
$2,649.60 |
$4,416 |
10.6× |
| MRA neck w/contrast (70548) |
$3,028.80 |
$5,048 |
8.3× |
| MRA neck w/o contrast (70547) |
$1,817.40 |
$3,029 |
7.3× |
| MRA neck w/wo contrast (70549) |
$3,028.80 |
$5,048 |
8.3× |
| MRI abdomen w/contrast (74182) |
$3,396.60 |
$5,661 |
9.3× |
| MRI abdomen w/o & w/contrast material (74183) |
$3,396.60 |
$5,661 |
9.3× |
| MRI abdomen w/o contrast (74181) |
$2,038.20 |
$3,397 |
8.2× |
| MRI any jnt lwr ext with con lt (73722) |
$9,498.60 |
$15,831 |
11.6× |
| MRI bone marrow (77084) |
$419.40 |
$699 |
1.7× |
| MRI brain w/dye (70558) |
$375 |
$625 |
2.0× |
| MRI brain w/o & w/dye (70559) |
$375 |
$625 |
2.0× |
| MRI brain w/o dye (70557) |
$1,155.60 |
$1,926 |
2.0× |
| MRI breast without contrast bilateral (77047) |
$1,543.20 |
$2,572 |
6.2× |
| MRI breast without contrast material unilateral (77046) |
$1,543.20 |
$2,572 |
6.2× |
| MRI cardiac w/o contrast (75557) |
$1,487.40 |
$2,479 |
6.0× |
| MRI cervical spine w/o contrast (72141) |
$1,839 |
$3,065 |
7.4× |
| MRI cervical spine with contrast (72142) |
$3,064.80 |
$5,108 |
8.4× |
| MRI chest w & w/o contrast (71552) |
$2,643.60 |
$4,406 |
7.3× |
| MRI chest w/contrast (71551) |
$4,732.20 |
$7,887 |
5.8× |
| MRI chest w/o contrast (71550) |
$1,586.40 |
$2,644 |
6.4× |
| MRI elastography (76391) |
$452.40 |
$754 |
1.8× |
| MRI fetal sngl/1st gestation (74712) |
$537 |
$895 |
2.2× |
| MRI joint upper ext w/contrast (73222) |
$7,989.30 |
$13,315.50 |
9.8× |
| MRI joint upr extr w/o&w/dye (73223) |
$4,719.60 |
$7,866 |
13.0× |
| MRI joint upr extrem w/o dye (73221) |
$3,072.90 |
$5,121.50 |
12.3× |
| Mri Lower Extremity W/O Dye (73718) |
$3,451.50 |
$5,752.50 |
13.9× |
| MRI lumbar spine with contrast (72149) |
$4,185 |
$6,975 |
11.5× |
| MRI lumbar w/wo contrast (72158) |
$4,185 |
$6,975 |
11.5× |
| MRI lwr ext w/o jnts with con rt (73719) |
$4,141.80 |
$6,903 |
11.4× |
| MRI orbit/face/neck w/contrast (70542) |
$2,894.40 |
$4,824 |
7.9× |
| MRI orbit/face/neck w/o & w/contrast (70543) |
$2,894.40 |
$4,824 |
7.9× |
| MRI orbit/face/neck w/o contrast (70540) |
$1,736.40 |
$2,894 |
7.0× |
| MRI pelvis w/ contrast (72196) |
$3,090.60 |
$5,151 |
8.5× |
| MRI pelvis w/o contrast (72195) |
$1,854.60 |
$3,091 |
7.4× |
| MRI pelvis w/wo contrast (72197) |
$3,090.60 |
$5,151 |
8.5× |
| MRI spectroscopy (76390) |
$1,859.40 |
$3,099 |
20.5× |
| MRI spine cervical wo/w contrast (72156) |
$3,064.80 |
$5,108 |
8.4× |
| MRI spine thoracic w/contrast (72147) |
$3,665.40 |
$6,109 |
10.1× |
| MRI thoracic spine w wo contrast (72157) |
$3,665.40 |
$6,109 |
10.1× |
| MRI thoracic spine w/o contrast (72146) |
$2,199 |
$3,665 |
8.8× |
| MRI tmj (70336) |
$1,858.80 |
$3,098 |
7.5× |
| MRI upper extremity oth than jt w/o contr matrl (73218) |
$2,545.50 |
$4,242.50 |
10.2× |
| Mri Upper Extremity W/Dye (73219) |
$3,743.40 |
$6,239 |
10.3× |
| MRI upr ext w/o jnts w/o-w/con rt (73220) |
$3,743.40 |
$6,239 |
10.3× |
| Myelogram thoracic (72255) |
$1,299 |
$2,165 |
1.6× |
| Myelography 2 or more regions (72270) |
$1,946.40 |
$3,244 |
2.4× |
| Myelography lumbosacral (72265) |
$1,845 |
$3,075 |
2.3× |
| Myocardial perfusion planar 1 study rest/stress (78453) |
$4,457.40 |
$7,429 |
3.3× |
| Myocardial perfusion planar multiple studies (78454) |
$5,370 |
$8,950 |
4.0× |
| Myocardial spect single study at rest or stress (78451) |
$4,457.40 |
$7,429 |
3.3× |
| Myocrd img PET metab eval single study cncrnt CT (78429) |
$2,814.60 |
$4,691 |
1.9× |
| Myocrd img PET prfuj 1std rest/stress cncrnt CT (78430) |
$2,814.60 |
$4,691 |
1.9× |
| Myocrd img PET prfuj mlt std rst&strs cncrnt CT (78431) |
$4,389.60 |
$7,316 |
1.9× |
| Myocrd img PET prfuj w/metab 2rtracer cncrnt CT (78433) |
$5,365.20 |
$8,942 |
2.3× |
| Myocrd img PET prfuj w/metab dual radiotracer (78432) |
$5,365.20 |
$8,942 |
3.4× |
| Nm bone 3 phase (78315) |
$2,508 |
$4,180 |
6.0× |
| Nm bone imaging whole body (78306) |
$2,181 |
$3,635 |
5.2× |
| Nm bone marrow scan limited (78102) |
$1,106.40 |
$1,844 |
2.7× |
| Nm bone marrow scan multiple (78103) |
$1,418.40 |
$2,364 |
3.4× |
| Nm bone multi (78305) |
$2,028.60 |
$3,381 |
4.9× |
| Nm heart perfusion spect stress rest (78452) |
$5,370 |
$8,950 |
4.0× |
| Nm kidney imaging morphology (78700) |
$702 |
$1,170 |
1.7× |
| Nm liver image static only (78201) |
$1,200.60 |
$2,001 |
2.1× |
| Nm lymph system (78195) |
$2,008.80 |
$3,348 |
3.5× |
| Nm myocard infarct spect (78469) |
$2,481.60 |
$4,136 |
4.4× |
| Nm thyroid ca mets limited (78015) |
$1,207.20 |
$2,012 |
2.9× |
| Nm thyroid imaging only (78013) |
$525.60 |
$876 |
1.3× |
| Nose to rectum for fb child (76010) |
$211.80 |
$353 |
2.3× |
| Nuclear medicine study of salivary gland with serial images (78231) |
$553.80 |
$923 |
1.3× |
| Nuclear medicine study to assess blood clot in vein using radiolabeled peptide (78456) |
$425.40 |
$709 |
0.3× |
| Nuclear rx IV admin (79101) |
$2,480.40 |
$4,134 |
10.2× |
| Ob us < 14 wks single fetus (76801) |
$312.90 |
$521.50 |
2.9× |
| Ob us nuchal meas 1 gest (76813) |
$178.50 |
$297.50 |
1.6× |
| Ophthalmic ultrasound, diagnostic; B-scan (with or without superimposed non-quantitative A-scan) Age Under 21 (76512) |
$947.70 |
$1,579.50 |
8.7× |
| Oral radiopharm rx (79005) |
$1,457.40 |
$2,429 |
6.0× |
| Orthopantogram (70355) |
$324 |
$540 |
3.6× |
| Parathyrd planar w/spect&CT (78072) |
$807.60 |
$1,346 |
1.4× |
| Parathyroid imaging (78070) |
$1,292.40 |
$2,154 |
3.1× |
| Parathyroid planar imaging w/wo subtraction (78071) |
$741 |
$1,235 |
1.8× |
| Peritoneal-venous shunt patency test (78291) |
$1,017.60 |
$1,696 |
2.4× |
| Peritoneogram rs&i (74190) |
$661.80 |
$1,103 |
1.2× |
| PET brain metabolic eval (78608) |
$4,019.40 |
$6,699 |
2.7× |
| PET imaging CT attenuation skull base mid-thigh (78815) |
$5,149.20 |
$8,582 |
3.4× |
| PET imaging CT for attenuation limited area (78814) |
$4,634.40 |
$7,724 |
3.1× |
| PET imaging for CT attenuation whole body (78816) |
$5,252.40 |
$8,754 |
3.5× |
| Plasma volume multiple (78111) |
$2,841 |
$4,735 |
2.1× |
| Prq transhepatc portograpy w/o hemodyn evl intrp (75887) |
$1,386 |
$2,310 |
0.4× |
| Pulmonary perfusion imaging particulate (78580) |
$1,048.80 |
$1,748 |
2.5× |
| Radex abscess/fistula/sinus tract rs&i (76080) |
$477.60 |
$796 |
0.8× |
| Radex Entir Thrc Lmbr Crv Sac Spi W/Skull 1 Vw - Xr Scoliosis 1 Vw (72081) |
$119.40 |
$199 |
1.3× |
| Radex entir thrc lmbr crv sac spi w/skull 2/3 vw (72082) |
$192 |
$320 |
1.8× |
| Radex entir thrc lmbr crv sac spi w/skull 4/5 vw (72083) |
$226.80 |
$378 |
2.1× |
| Radex entir thrc lmbr crv sac spi w/skull 6/> vw (72084) |
$265.20 |
$442 |
2.4× |
| Radex hip unilateral with pelvis 1 view (73501) |
$419.40 |
$699 |
4.6× |
| Radex hip unilateral with pelvis 2-3 views (73502) |
$582.60 |
$971 |
6.4× |
| Radex hip unilateral with pelvis minimum 4 views (73503) |
$728.40 |
$1,214 |
6.7× |
| Radex hips bilateral with pelvis 2 views (73521) |
$518.40 |
$864 |
4.7× |
| Radex hips bilateral with pelvis minimum 5 views (73523) |
$792.60 |
$1,321 |
7.3× |
| Radex spine cervical 2 or 3 views (72040) |
$594.60 |
$991 |
6.5× |
| Radex spine cervical 4 or 5 views (72050) |
$820.80 |
$1,368 |
7.5× |
| Radex spine cervical 6 or more views (72052) |
$975 |
$1,625 |
8.9× |
| Radex X-Ray Exam Thoracolmb 2+ Vw - Xr Thoracolumbar Spine 2 Views (72080) |
$521.40 |
$869 |
5.7× |
| Radiologic Exam Chest 4+ Views - Xr Chest 4+ Views (71048) |
$621 |
$1,035 |
5.7× |
| Radiologic exam esophagus double contrast study (74221) |
$355.20 |
$592 |
1.9× |
| Radiologic exam phrnx&/crv esoph contrast study (74210) |
$693.60 |
$1,156 |
3.8× |
| Radiologic exam upr gi trc double contrast study (74246) |
$796.20 |
$1,327 |
4.3× |
| Radiologic exam upr gi trc single contrast study (74240) |
$706.80 |
$1,178 |
3.9× |
| Radiologic Examination Femur 1 View - Xr Femur 1 Vw Right (73551) |
$445.80 |
$743 |
4.9× |
| Radiologic Examination Femur Minimum 2 Views - Xr Femur 2+ Vw Lt (73552) |
$655.50 |
$1,092.50 |
7.2× |
| Radiologic examination, complete acute abdomen series, including 2 or more views of the abdomen (eg, supine, erect,… (74022) |
$638.40 |
$1,064 |
5.8× |
| Radiologic examination, single plane body section (eg, tomography), other than with urography Other Diagnostic… (76100) |
$780.60 |
$1,301 |
7.2× |
| Radiologic examination, spine; thoracic, minimum of 4 views Other Diagnostic Radiology FS (72074) |
$724.20 |
$1,207 |
6.6× |
| Radiologic examination; pharynx or larynx, including fluoroscopy and/or magnification technique Other Diagnostic… (70370) |
$189.60 |
$316 |
2.1× |
| Radiopharmaceutical dacryocystography Age Under 21 (78660) |
$645 |
$1,075 |
1.5× |
| Radiopharmaceutical therapy, by intra-articular administration Age Under 21 (79440) |
$824.40 |
$1,374 |
3.4× |
| Radiopharmaceutical therapy, by intracavitary administration Age Under 21 (79200) |
$824.40 |
$1,374 |
3.4× |
| Radiopharmaceutical therapy, radiolabeled monoclonal antibody by intravenous infusion UNSCHEDULED (79403) |
$1,486.80 |
$2,478 |
6.1× |
| Red cell mass multiple (78121) |
$1,081.20 |
$1,802 |
1.9× |
| Renal cyst study (74470) |
$1,645.20 |
$2,742 |
2.9× |
| Rp loclzj tum plnr 1 area single day imaging (78800) |
$763.80 |
$1,273 |
1.8× |
| Rp loclzj tum plnr 2+area 1+d img/1 area img>2+d (78801) |
$1,011 |
$1,685 |
2.4× |
| Rp loclzj tum plnr whole body 2+ days imaging (78804) |
$2,246.40 |
$3,744 |
4.0× |
| Rp loclzj tum plnr whole body single day imaging (78802) |
$1,280.40 |
$2,134 |
2.3× |
| Rp loclzj tum spect 1 area single day imaging (78803) |
$1,347.60 |
$2,246 |
2.4× |
| Rp loclzj tum spect 2 area/sep acquisj img (78831) |
$2,481 |
$4,135 |
1.8× |
| Rp loclzj tum spect CT 2area/sep acquisj img (78832) |
$2,814.60 |
$4,691 |
1.9× |
| Rp loclzj tum spect w/CT 1 area 1 day imaging (78830) |
$2,481 |
$4,135 |
1.8× |
| Rp therapy intra-arterial particulate admn (79445) |
$1,197 |
$1,995 |
4.9× |
| Saline infused sonohysterogram (76831) |
$611.40 |
$1,019 |
2.5× |
| Screening digital breast tomosynthesis; bilateral (77063) |
$66 |
$110 |
2.8× |
| Selective spinal angiogram (75705) |
$6,789 |
$11,315 |
1.2× |
| Shoulder arthrogram (73040) |
$1,241.40 |
$2,069 |
3.4× |
| Shuntogram indwelling nonvascular shunt rs&i (75809) |
$454.20 |
$757 |
4.2× |
| Small bowel series (74250) |
$907.20 |
$1,512 |
5.0× |
| Speech evaluation complex (70371) |
$727.80 |
$1,213 |
2.9× |
| Spleen imaging only (78185) |
$634.20 |
$1,057 |
1.5× |
| Splenoportography (75810) |
$1,698.60 |
$2,831 |
0.5× |
| Superior sagittal sinus venogram (75870) |
$1,573.80 |
$2,623 |
0.5× |
| Temporomandibular joint arthrography, radiological supervision and interpretation Other Diagnostic Radiology FS (70332) |
$691.80 |
$1,153 |
2.8× |
| Testicular imaging w/flow (78761) |
$987 |
$1,645 |
2.4× |
| Therapeutic enema barium or air (74283) |
$1,098.60 |
$1,831 |
6.0× |
| Thyroid met imaging body (78018) |
$1,677 |
$2,795 |
3.0× |
| Thyroid uptake single/multiple quant measurement (78012) |
$1,288.20 |
$2,147 |
3.1× |
| Thyroid uptake w/blood flow sngle/mult quan meas (78014) |
$657 |
$1,095 |
1.6× |
| Ultrasound breast limited (76642) |
$155.40 |
$259 |
1.7× |
| Ultrasound, abdomen limited (76705) |
$682.20 |
$1,137 |
6.2× |
| Ultrasound, elastography; first target lesion (76982) |
$220.80 |
$368 |
2.0× |
| Umbilical-artery Doppler (OB) (76820) |
$165 |
$275 |
1.5× |
| Unlisted diagnostic radiographic procedure (76499) |
$276.60 |
$461 |
3.0× |
| Unlisted fluoroscopic procedure (76496) |
$158.40 |
$264 |
1.7× |
| Unlisted gastrointestinal procedure, diagnostic nuclear medicine UNSCHEDULED (78299) |
$493.80 |
$823 |
1.2× |
| Unlisted magnetic resonance procedure (76498) |
$1,634.40 |
$2,724 |
18.0× |
| Urea breath test, C-14 (isotopic); acquisition for analysis Other Outpatient (78267) |
$591 |
$985 |
53.4× |
| Ureteral reflux study (78740) |
$900.60 |
$1,501 |
2.2× |
| Urethrocystography retrograde rs&i (74450) |
$805.20 |
$1,342 |
3.2× |
| Urethrocystography voiding (74455) |
$805.20 |
$1,342 |
3.2× |
| Urography antegrade (74425) |
$1,101.60 |
$1,836 |
3.0× |
| Urography retrograde w/wo kub (74420) |
$1,101.60 |
$1,836 |
3.0× |
| Us abdominal aorta real time screen study aaa (76706) |
$222.60 |
$371 |
2.0× |
| Us breast uni real time with image complete (76641) |
$204.60 |
$341 |
1.9× |
| Us chest (76604) |
$585.60 |
$976 |
5.4× |
| Us compl joint r-t w/image documentation (76881) |
$987.60 |
$1,646 |
9.0× |
| Us elastography parenchyma (76981) |
$220.80 |
$368 |
2.0× |
| Us encephalogram (76506) |
$469.80 |
$783 |
4.3× |
| Us guided compression repair (76936) |
$1,027.20 |
$1,712 |
4.6× |
| Us inft hips r-t img dynamic req phys/qhp manj (76885) |
$569.40 |
$949 |
6.3× |
| Us inft hips r-t img lmtd static phys/qhp manj (76886) |
$415.80 |
$693 |
4.6× |
| Us kidney transplanted (76776) |
$666 |
$1,110 |
6.1× |
| Us lmtd jt/fcl eval nonvasc xtr strux r-t w/img (76882) |
$637.20 |
$1,062 |
5.8× |
| Us nrv&acc strux 1 xtr compre w/img pr extremity (76883) |
$225 |
$375 |
2.1× |
| Us ob detailed single fetus (76811) |
$406.20 |
$677 |
1.6× |
| Us ob followup per fetus (76816) |
$680.40 |
$1,134 |
6.2× |
| Us ob limited 1 or more fetuses (76815) |
$501.60 |
$836 |
4.6× |
| Us obstetric transvaginal (76817) |
$576.60 |
$961 |
5.3× |
| Us pelvic limited or f/u non-ob (76857) |
$882 |
$1,470 |
8.1× |
| Us pelvis complete (76856) |
$464.10 |
$773.50 |
4.3× |
| Us retroperitoneal complete (76770) |
$898.20 |
$1,497 |
8.2× |
| Us retroperitoneal limited (76775) |
$466.80 |
$778 |
4.3× |
| Us scrotum (76870) |
$921.60 |
$1,536 |
8.4× |
| Us soft tissue head/neck (76536) |
$1,206 |
$2,010 |
11.0× |
| Us spinal canal (76800) |
$549 |
$915 |
5.0× |
| Us transrectal (76872) |
$1,167.60 |
$1,946 |
10.7× |
| Us transrectal prostate volume (76873) |
$1,576.20 |
$2,627 |
14.4× |
| Us trgt dyn mbubb 1st les (76978) |
$354 |
$590 |
1.0× |
| Vascular flow imaging (78445) |
$425.40 |
$709 |
1.0× |
| Vein X-ray liver w/hemodynam (75885) |
$3,379.80 |
$5,633 |
1.0× |
| Venogram epidural (75872) |
$1,554.60 |
$2,591 |
2.4× |
| Venogram extremity bilateral (75822) |
$1,906.20 |
$3,177 |
1.2× |
| Venogram ivc w serialography (75825) |
$6,162 |
$10,270 |
1.9× |
| Venogram svc w serialography (75827) |
$3,096 |
$5,160 |
1.9× |
| Venography adrenal unilateral selective rs&i (75840) |
$4,028.40 |
$6,714 |
1.2× |
| Venography ext unilateral (75820) |
$1,629 |
$2,715 |
1.0× |
| Venography renal unilateral selective rs&i (75831) |
$4,656 |
$7,760 |
1.4× |
| Venography venous sinus/jugular cath rs&i (75860) |
$1,101.60 |
$1,836 |
0.3× |
| Venography, orbital, radiological supervision and interpretation Other Diagnostic Radiology FS (75880) |
$918 |
$1,530 |
1.4× |
| Venous sampling by catheter (75893) |
$7,740 |
$12,900 |
1.3× |
| Vertebral fracture assessment via dxa (77086) |
$52.20 |
$87 |
0.6× |
| X-Ray Ac Jts - Xr Acromioclavicular Joints Bilateral (73050) |
$349.20 |
$582 |
3.8× |
| X-Ray Ankle 3+ Vw - Xr Ankle 3+ Views Right (73610) |
$584.40 |
$974 |
6.4× |
| X-ray aorta leg arteries (75630) |
$6,284.40 |
$10,474 |
1.9× |
| X-Ray Colon Air Contrast - Fl Barium Enema Air Contrast (74280) |
$1,194.60 |
$1,991 |
6.5× |
| X-Ray Elbow 3+ Vw - Xr Elbow 3+ Views Right (73080) |
$699 |
$1,165 |
7.7× |
| X-ray exam hips bi 3-4 views (73522) |
$675.60 |
$1,126 |
6.2× |
| X-ray exam of finger(s) (73140) |
$530.40 |
$884 |
5.8× |
| X-ray exam of small bowel - fl small bowel series enteroclysis tube (74251) |
$3,483.60 |
$5,806 |
19.0× |
| X-Ray Facial Bones <3 Vw - Xr Facial Bones 1-2 Views (70140) |
$515.40 |
$859 |
5.7× |
| X-Ray Foot 2 Vw - Xr Foot 1-2 Views Right (73620) |
$590.10 |
$983.50 |
6.5× |
| X-Ray Foot 3+ Vw - Xr Foot 3+ Views Right (73630) |
$664.50 |
$1,107.50 |
7.3× |
| X-Ray Hand 2 Vw - Xr Hand 1-2 Views Right (73120) |
$612.60 |
$1,021 |
5.6× |
| X-Ray Hand 3+ Vw - Xr Hand 3+ Views Right (73130) |
$684 |
$1,140 |
7.5× |
| X-Ray Heel - Xr Calcaneus 2 Views Right (73650) |
$412.50 |
$687.50 |
4.5× |
| X-Ray Jaw <4 Vw - Xr Mandible < 4 Views (70100) |
$655.80 |
$1,093 |
7.2× |
| X-Ray Knee 3 View - Xr Knee 3 Views Right (73562) |
$888.60 |
$1,481 |
9.8× |
| X-Ray Knee 4+ View - Xr Knee 4+ Views Right (73564) |
$966 |
$1,610 |
8.8× |
| X-Ray Knee Bilat Standing - Xr Knees Anteroposterior Standing Bilat (73565) |
$695.40 |
$1,159 |
7.7× |
| X-Ray Lumbar Spine 2/3 Vw - Xr Lumbar Spine 2-3 Views (72100) |
$630.60 |
$1,051 |
5.8× |
| X-Ray Lumbar Spine 6+ Vw - Xr Lumbar Spine 6+ Vws Including Bending (72114) |
$1,002.60 |
$1,671 |
9.2× |
| X-Ray Mastoids 3+ Vw - Xr Mastoids 3+ Views (70130) |
$595.80 |
$993 |
5.5× |
| X-ray perineogram (74775) |
$520.80 |
$868 |
2.1× |
| X-Ray Ribs 2 Vw Unilat - Xr Ribs 2 Views Right (71100) |
$583.20 |
$972 |
6.4× |
| X-Ray Ribs, Chest 4+ Vw - Xr Ribs 3 Vws Bil W/ Chest Posteroanterior (71111) |
$821.40 |
$1,369 |
7.5× |
| X-Ray Sacroiliac Jts 3+ Vw - Xr Sacroiliac Joints 3+ Views (72202) |
$610.80 |
$1,018 |
5.6× |
| X-Ray Sacroiliac Jts <3 Vw - Xr Sacroiliac Joints 1-2 Views (72200) |
$541.20 |
$902 |
5.0× |
| X-Ray Sacrum/Coccyx 2+ Vw - Xr Sacrum Coccyx 2+ Views (72220) |
$535.80 |
$893 |
5.9× |
| X-Ray Shoulder 2+ Vw - Xr Shoulder 2+ Views Right (73030) |
$655.50 |
$1,092.50 |
7.2× |
| X-Ray Sinuses 3+ Vw - Xr Paranasal Sinuses 3+ Views (70220) |
$610.20 |
$1,017 |
6.7× |
| X-Ray Skull 4+ Vw - Xr Skull Complete 4+ Views (70260) |
$670.80 |
$1,118 |
6.1× |
| X-Ray Skull <4 Vw - Xr Skull 1-3 Views (70250) |
$536.40 |
$894 |
4.9× |
| X-Ray Sterno-Clavicluar Jt - Xr Sternoclavicular Joints 3+ Views (71130) |
$717 |
$1,195 |
7.9× |
| X-Ray Toe(S) - Xr Toes 2+ Views Right (73660) |
$485.40 |
$809 |
5.3× |
| X-Ray Wrist 2 Vw - Xr Wrist 1-2 Views Right (73100) |
$794.10 |
$1,323.50 |
8.7× |
| X-Ray Wrist 3+ Vw - Xr Wrist 3+ Views Right (73110) |
$886.50 |
$1,477.50 |
9.8× |
| Xr abdomen 1 view (74018) |
$351 |
$585 |
3.9× |
| Xr abdomen 2 views (74019) |
$638.40 |
$1,064 |
5.8× |
| Xr abdomen 3 views (74021) |
$638.40 |
$1,064 |
5.8× |
| Xr arthrogram ankle (73615) |
$886.80 |
$1,478 |
2.4× |
| Xr arthrogram elbow (73085) |
$432.60 |
$721 |
1.2× |
| Xr arthrogram hip (73525) |
$886.80 |
$1,478 |
2.4× |
| Xr bone density appendicular (77081) |
$96.60 |
$161 |
1.1× |
| Xr bone density axial (77080) |
$175.20 |
$292 |
1.6× |
| Xr bone length study (77073) |
$215.40 |
$359 |
2.0× |
| Xr bone survey infant (77076) |
$944.40 |
$1,574 |
8.7× |
| Xr bone survey limited (77074) |
$632.40 |
$1,054 |
5.8× |
| Xr chest 1 view (71045) |
$358.80 |
$598 |
3.9× |
| Xr chest 2 views (71046) |
$455.40 |
$759 |
5.0× |
| Xr chest 3 views (71047) |
$574.20 |
$957 |
6.3× |
| Xr cystogram 3+ views (74430) |
$601.20 |
$1,002 |
1.7× |
| Xr eye foreign body (70030) |
$193.20 |
$322 |
2.1× |
| Xr facial bones 3 views (70150) |
$736.20 |
$1,227 |
6.7× |
| Xr lower extremity 2 views infant (73592) |
$285.60 |
$476 |
3.1× |
| Xr lumbar spine 4 views w/ flex ext (72120) |
$744 |
$1,240 |
6.8× |
| Xr mandible 4 views (70110) |
$762.60 |
$1,271 |
7.0× |
| Xr myelogram c-spine (72240) |
$1,875.60 |
$3,126 |
2.3× |
| Xr nasal bones (70160) |
$477 |
$795 |
5.2× |
| Xr pelvis 3 views (72190) |
$567.60 |
$946 |
5.2× |
| Xr sella turcica (70240) |
$96.60 |
$161 |
1.1× |
| Xr sialogram (70390) |
$921.60 |
$1,536 |
3.7× |
| Xr spine 1 view (72020) |
$366.60 |
$611 |
4.0× |
| Xr sternum 2 views (71120) |
$602.40 |
$1,004 |
6.6× |
| Xr stress view joint (77071) |
$102 |
$170 |
1.1× |
| Xr surgical specimen (76098) |
$77.40 |
$129 |
0.1× |
| Xr upper extremity 2 views infant (73092) |
$285 |
$475 |
2.6× |
| Xray elbow 2 views (73070) |
$643.20 |
$1,072 |
7.1× |
| Xray forearm 2 views (73090) |
$712.50 |
$1,187.50 |
7.8× |
| Xray knee 1 or 2 views rt (73560) |
$796.20 |
$1,327 |
8.8× |
| Xray neck soft tissue (70360) |
$382.80 |
$638 |
4.2× |
| Xray orbits complete min 4 views (70200) |
$630.60 |
$1,051 |
5.8× |
| Xray pelvis 1 or 2 views (72170) |
$472.80 |
$788 |
4.3× |
| Xray ribs bilateral 3 views (71110) |
$695.40 |
$1,159 |
6.4× |
| Xray ribs unilat w/ pa chest 3v rt (71101) |
$662.40 |
$1,104 |
6.1× |
| Xray scapula complete (73010) |
$566.40 |
$944 |
5.2× |
| Xray shoulder 1 view (73020) |
$545.10 |
$908.50 |
6.0× |
| Xray sinuses paranasal <3 views (70210) |
$492 |
$820 |
5.4× |
| Xray spine thoracic 2 views (72070) |
$618.60 |
$1,031 |
5.7× |
| Xray spine thoracic 3 views (72072) |
$658.20 |
$1,097 |
6.0× |
| Xray tibia-fibula 2 views bil (73590) |
$787.50 |
$1,312.50 |
8.7× |
| Xray tmj open - closed unilat (70328) |
$287.40 |
$479 |
3.2× |
| Xray tmj's bilateral open-clsc (70330) |
$449.40 |
$749 |
4.9× |