| Acute gi blood loss imaging (78278) |
$666.70 |
$1,666.74 |
1.6× |
| Ankle 2 views (73600) |
$255.60 |
$639.01 |
2.8× |
| Brain imaging, less than 4 static views; with vascular flow Age Under 21 (78601) |
$544.10 |
$1,360.24 |
1.3× |
| Brain imaging, minimum 4 static views; with vascular flow Age Under 21 (78606) |
$611.46 |
$1,528.65 |
1.1× |
| Cholecystography, oral contrast Age Under 21 (74290) |
$429.53 |
$1,073.82 |
2.3× |
| Clavicle complete (73000) |
$254.92 |
$637.28 |
2.8× |
| Computed tomographic angiography, abdomen and pelvis, with contrast material(s), including noncontrast images, if… (74174) |
$5,347.22 |
$13,368.03 |
14.5× |
| Computed tomographic angiography, abdomen, with contrast material(s), including noncontrast images, if performed, and… (74175) |
$2,673.62 |
$6,684.04 |
14.4× |
| Computed tomographic angiography, abdominal aorta and bilateral iliofemoral lower extremity runoff, with contrast… (75635) |
$2,673.62 |
$6,684.04 |
14.4× |
| Computed tomographic angiography, chest (noncoronary), with contrast material(s), including noncontrast images, if… (71275) |
$2,673.62 |
$6,684.04 |
14.4× |
| Computed tomographic angiography, lower extremity, with contrast material(s), including noncontrast images, if… (73706) |
$3,074.66 |
$7,686.63 |
16.6× |
| Computed tomographic angiography, neck, with contrast material(s), including noncontrast images, if performed, and… (70498) |
$1,876.49 |
$4,691.22 |
10.1× |
| Computed tomographic angiography, pelvis, with contrast material(s), including noncontrast images, if performed, and… (72191) |
$2,673.62 |
$6,684.04 |
14.4× |
| Computed tomographic angiography, upper extremity, with contrast material(s), including noncontrast images, if… (73206) |
$2,673.62 |
$6,684.04 |
14.4× |
| Computed tomography, cervical spine; without contrast material, followed by contrast material(s) and further sections… (72127) |
$2,618.84 |
$6,547.09 |
14.2× |
| Computed tomography, lower extremity; without contrast material Age Under 21 (73700) |
$1,763.84 |
$4,409.57 |
16.0× |
| Computed tomography, lower extremity; without contrast material, followed by contrast material(s) and further sections… (73702) |
$1,238.65 |
$3,096.61 |
6.7× |
| Computed tomography, lumbar spine; without contrast material, followed by contrast material(s) and further sections Age… (72133) |
$2,618.84 |
$6,547.09 |
14.2× |
| Computed tomography, maxillofacial area; with contrast material(s) Age Under 21 (70487) |
$1,637.63 |
$4,094.06 |
8.9× |
| Computed tomography, maxillofacial area; without contrast material Age Under 21 (70486) |
$1,076.48 |
$2,691.20 |
9.8× |
| Computed tomography, orbit, sella, or posterior fossa or outer, middle, or inner ear; with contrast material(s) Age… (70481) |
$1,637.63 |
$4,094.06 |
8.9× |
| Computed tomography, orbit, sella, or posterior fossa or outer, middle, or inner ear; without contrast material Age… (70480) |
$1,076.48 |
$2,691.20 |
9.8× |
| Computed tomography, orbit, sella, or posterior fossa or outer, middle, or inner ear; without contrast material,… (70482) |
$1,642.20 |
$4,105.48 |
8.9× |
| Computed tomography, soft tissue neck; without contrast material followed by contrast material(s) and further sections… (70492) |
$1,838.04 |
$4,595.08 |
9.9× |
| Computed tomography, thoracic spine; without contrast material, followed by contrast material(s) and further sections… (72130) |
$2,618.84 |
$6,547.09 |
14.2× |
| Computed tomography, thorax, diagnostic; without contrast material, followed by contrast material(s) and further… (71270) |
$1,879.61 |
$4,699.01 |
10.2× |
| Csf shunt evaluation (78645) |
$617.50 |
$1,543.74 |
1.1× |
| CT abdomen and pelvis without and with contrast (74178) |
$2,470.81 |
$6,177.01 |
6.7× |
| CT abdomen and pelvis without contrast (74176) |
$1,482.49 |
$3,706.21 |
5.9× |
| CT abdomen w & w/o contrast (74170) |
$2,347.28 |
$5,868.18 |
12.7× |
| CT abdomen w/contrast (74160) |
$2,255.22 |
$5,638.04 |
12.2× |
| CT abdomen w/o contrast (74150) |
$1,439.65 |
$3,599.11 |
13.1× |
| CT angio hrt w/3d image (75574) |
$2,335.07 |
$5,837.66 |
6.3× |
| CT cervical spine w/contrast (72126) |
$2,333.29 |
$5,833.21 |
6.3× |
| CT cervical spine w/o contrast (72125) |
$1,533.77 |
$3,834.41 |
13.9× |
| CT chest w/contrast (71260) |
$2,333.29 |
$5,833.21 |
12.6× |
| CT extremity upper w & w/o contrast (73202) |
$2,781.22 |
$6,953.04 |
15.0× |
| CT extremity upper w/o contrast (73200) |
$1,763.84 |
$4,409.57 |
16.0× |
| CT head/brain with contrast (70460) |
$1,637.63 |
$4,094.06 |
8.9× |
| CT head/brain without and with contrast (70470) |
$1,838.04 |
$4,595.08 |
9.9× |
| CT heart contrast eval cardiac structure&morph (75572) |
$1,279.96 |
$3,199.89 |
3.5× |
| CT heart no contrast quant eval coronry calcium (75571) |
$465.68 |
$1,164.20 |
5.1× |
| CT l-spine w/contrast (72132) |
$2,333.29 |
$5,833.21 |
6.3× |
| CT limited/localized follow up study (76380) |
$1,533.77 |
$3,834.41 |
16.7× |
| CT lower extremity w/dye (73701) |
$2,150.66 |
$5,376.64 |
11.6× |
| CT lumbar spine w/o contrast (72131) |
$1,533.77 |
$3,834.41 |
13.9× |
| CT maxillofacial w/wo contrast (70488) |
$1,318.94 |
$3,297.34 |
7.1× |
| CT neck w/contrast (70491) |
$1,637.63 |
$4,094.06 |
8.9× |
| CT neck w/o contrast (70490) |
$1,076.48 |
$2,691.20 |
9.8× |
| CT pelvis w & w/o contrast (72194) |
$2,618.84 |
$6,547.09 |
14.2× |
| CT pelvis w/o contrast (72192) |
$1,458.74 |
$3,646.83 |
13.2× |
| CT thoracic spine w/contrast (72129) |
$2,462.64 |
$6,156.60 |
13.3× |
| CT thoracic spine w/o contrast (72128) |
$1,533.77 |
$3,834.41 |
13.9× |
| CT thorax lung cancer scr c- (71271) |
$256.25 |
$640.61 |
2.3× |
| CT thorax w/o contrast (71250) |
$1,533.77 |
$3,834.41 |
13.9× |
| CT upper extremity w/dye (73201) |
$2,683.28 |
$6,708.20 |
7.3× |
| CTA head w contrast (70496) |
$1,876.49 |
$4,691.22 |
10.1× |
| Cystography, minimum of 3 views, radiological supervision and interpretation Age Under 21 (74430) |
$720.91 |
$1,802.26 |
2.0× |
| Diskography lumbar s&i (72295) |
$969.08 |
$2,422.68 |
0.5× |
| Doppler fetal mid cerebral artery (76821) |
$362.52 |
$906.29 |
3.3× |
| Dual-energy X-ray absorptiometry (DXA), bone density study, 1 or more sites; axial skeleton (eg, hips, pelvis, spine)… (77080) |
$411.20 |
$1,027.98 |
3.7× |
| Dxa bone density study axial skeleton (77085) |
$494.94 |
$1,237.34 |
4.5× |
| Dxa bone density/peripheral (77081) |
$344.08 |
$860.20 |
3.7× |
| Fetal biophys profile w/o nst (76819) |
$548.95 |
$1,372.36 |
5.0× |
| Fetal biophysical profile non-stress testing (76818) |
$167.79 |
$419.47 |
1.5× |
| Fluoroscopy up to 1 hour physician/qhp time (76000) |
$237.17 |
$592.91 |
0.9× |
| Gastric emptying imaging study (eg, solid, liquid, or both); with small bowel and colon transit, multiple days Age… (78266) |
$970.43 |
$2,426.07 |
1.7× |
| Gastric emptying imaging study (eg, solid, liquid, or both); with small bowel transit Age Under 21 (78265) |
$776.35 |
$1,940.86 |
1.8× |
| Gated heart planar single (78472) |
$1,110.64 |
$2,776.58 |
2.6× |
| Hepatobil syst imag inc gb w/pharma intervenj (78227) |
$978.59 |
$2,446.46 |
1.7× |
| Hepatobiliary syst imaging including gallbladder (78226) |
$889.63 |
$2,224.06 |
2.1× |
| Ht muscle image spect sing (78451) |
$2,224.92 |
$5,562.28 |
1.6× |
| Injection procedure for radiopharmaceutical localization by non-imaging probe study, intravenous (eg, parathyroid… (78808) |
$388.61 |
$971.52 |
0.9× |
| Intestine imaging (eg, ectopic gastric mucosa, Meckel's localization, volvulus) Age Under 21 (78290) |
$646.95 |
$1,617.37 |
1.5× |
| Kidney imaging morphology; with vascular flow Age Under 21 (78701) |
$540.29 |
$1,350.71 |
1.3× |
| Kidney imaging morphology; with vascular flow and function, multiple studies, with and without pharmacological… (78709) |
$552.24 |
$1,380.58 |
1.0× |
| Kidney imaging morphology; with vascular flow and function, single study without pharmacological intervention Age Under… (78707) |
$1,009.63 |
$2,524.06 |
1.8× |
| Kidney imaging morphology; with vascular flow and function, single study, with pharmacological intervention (eg,… (78708) |
$892.30 |
$2,230.74 |
1.6× |
| Leveen/shunt patency exam (78291) |
$680.64 |
$1,701.59 |
1.6× |
| Liver and spleen imaging (78215) |
$600.55 |
$1,501.37 |
1.4× |
| Liver imaging (78201) |
$696.47 |
$1,741.17 |
1.2× |
| Lung perf&ventilat diferentl (78598) |
$1,080.47 |
$2,701.16 |
1.9× |
| Lung perfusion imaging (78580) |
$596.82 |
$1,492.05 |
1.4× |
| Magnetic resonance (eg, proton) imaging, any joint of lower extremity; without contrast material(s), followed by… (73723) |
$4,529.01 |
$11,322.51 |
12.3× |
| Magnetic resonance (eg, proton) imaging, lower extremity other than joint; with contrast material(s) Age Under 21 (73719) |
$2,952.77 |
$7,381.91 |
8.0× |
| Magnetic resonance (eg, proton) imaging, lower extremity other than joint; without contrast material(s) Age Under 21 (73718) |
$3,704.73 |
$9,261.82 |
14.7× |
| Magnetic resonance (eg, proton) imaging, lower extremity other than joint; without contrast material(s), followed by… (73720) |
$4,495.72 |
$11,239.30 |
12.2× |
| Magnetic resonance (eg, proton) imaging, orbit, face, and/or neck; with contrast material(s) Age Under 21 (70542) |
$2,343.21 |
$5,858.01 |
6.4× |
| Magnetic resonance (eg, proton) imaging, orbit, face, and/or neck; without contrast material(s) Age Under 21 (70540) |
$2,277.06 |
$5,692.65 |
9.0× |
| Magnetic resonance (eg, proton) imaging, upper extremity, other than joint; with contrast material(s) Age Under 21 (73219) |
$646.42 |
$1,616.03 |
1.8× |
| Magnetic resonance (eg, proton) imaging, upper extremity, other than joint; without contrast material(s), followed by… (73220) |
$4,495.72 |
$11,239.30 |
12.2× |
| Magnetic resonance angiography, head; with contrast material(s) Age Under 21 (70545) |
$2,343.21 |
$5,858.01 |
6.4× |
| Magnetic resonance angiography, head; without contrast material(s), followed by contrast material(s) and further… (70546) |
$3,329.81 |
$8,324.52 |
9.0× |
| Magnetic resonance angiography, neck; without contrast material(s), followed by contrast material(s) and further… (70549) |
$3,235.99 |
$8,089.96 |
8.8× |
| Mammary ductogram or galactogram, multiple ducts, radiological supervision and interpretation Age Under 21 (77054) |
$536.85 |
$1,342.11 |
2.1× |
| Mammary ductogram single (77053) |
$466.92 |
$1,167.28 |
1.9× |
| Mandible min 4v (70110) |
$391.19 |
$977.96 |
3.5× |
| Mr safety determination physician/other qhp (76016) |
$551.20 |
$1,378 |
6.0× |
| Mr safety implant pos&/immoblj supvj phys/qhp (76019) |
$551.20 |
$1,378 |
8.9× |
| Mr safety implant&/fb assmt clin staf 1st 15 min (76014) |
$551.20 |
$1,378 |
18.1× |
| Mr safety implt electronics prepj supvj phys/qhp (76018) |
$551.20 |
$1,378 |
5.5× |
| Mr safety med physics xm customization plng&mntr (76017) |
$551.20 |
$1,378 |
2.2× |
| MRA head w/o contrast (70544) |
$2,647.03 |
$6,617.57 |
10.5× |
| MRA neck w/ contrast (70548) |
$2,939.34 |
$7,348.33 |
8.0× |
| MRA neck w/o contrast (70547) |
$1,675.84 |
$4,189.59 |
6.7× |
| MRI abdomen w/contrast (74182) |
$2,742.54 |
$6,856.33 |
7.5× |
| MRI abdomen w/o contrast (74181) |
$2,469.82 |
$6,174.55 |
9.8× |
| MRI abdomen w/wo contrast (74183) |
$3,019.34 |
$7,548.34 |
8.2× |
| MRI any jt lower extrem w/contrast material (73722) |
$4,113.80 |
$10,284.50 |
5.0× |
| MRI breast c- bilateral (77047) |
$2,589.93 |
$6,474.82 |
10.3× |
| MRI breast without contrast material unilateral (77046) |
$458.86 |
$1,147.14 |
1.8× |
| MRI c-spine w&w/o cont (72156) |
$3,019.34 |
$7,548.34 |
8.2× |
| MRI cervical spine w/contrast (72142) |
$2,443.84 |
$6,109.59 |
6.6× |
| MRI chest w/contrast (71551) |
$2,742.54 |
$6,856.33 |
3.3× |
| MRI chest w/o contrast (71550) |
$2,469.82 |
$6,174.55 |
9.8× |
| MRI chest w/wo contrast (71552) |
$3,019.34 |
$7,548.34 |
8.2× |
| MRI joint upr extr w/o&w/dye (73223) |
$4,529.01 |
$11,322.51 |
12.3× |
| MRI joint upr extrem w/dye (73222) |
$4,113.80 |
$10,284.50 |
5.0× |
| MRI joint upr extrem w/o dye (73221) |
$3,317.77 |
$8,294.42 |
13.2× |
| MRI lumbar spine w/contrast (72149) |
$2,742.54 |
$6,856.33 |
7.5× |
| MRI lumbar spine w/wo contrast (72158) |
$3,019.34 |
$7,548.34 |
8.2× |
| MRI orbit/face/neck w&w/o cont (70543) |
$2,628.45 |
$6,571.12 |
7.1× |
| MRI pelvis w & w/o contrast (72197) |
$3,019.34 |
$7,548.34 |
8.2× |
| MRI pelvis w/contrast (72196) |
$2,742.54 |
$6,856.33 |
7.5× |
| MRI pelvis w/o contrast (72195) |
$2,469.82 |
$6,174.55 |
9.8× |
| MRI spine cervical w/o contrast (72141) |
$2,469.82 |
$6,174.55 |
9.8× |
| MRI t-spine w&w/o cont (72157) |
$3,019.34 |
$7,548.34 |
8.2× |
| MRI thoracic spine w/contrast (72147) |
$2,186.34 |
$5,465.85 |
5.9× |
| MRI thoracic spine w/o contrst (72146) |
$2,469.82 |
$6,174.55 |
9.8× |
| MRI tmj (70336) |
$3,704.73 |
$9,261.82 |
14.7× |
| MRI upper extremity oth than jt w/o contr matrl (73218) |
$3,704.73 |
$9,261.82 |
14.7× |
| Myelography, 2 or more regions (eg, lumbar/thoracic, cervical/thoracic, lumbar/cervical, lumbar/thoracic/cervical),… (72270) |
$762.49 |
$1,906.21 |
0.9× |
| Myocardial spect multiple studies (78452) |
$1,959.52 |
$4,898.79 |
1.4× |
| N-invas est c ffr augmnt sw alys CTA i&r phy/qhp (75580) |
$6,749.14 |
$16,872.83 |
7.5× |
| Nm bone 3 phase (78315) |
$901.36 |
$2,253.40 |
2.1× |
| Nm bone imaging whole body (78306) |
$790.96 |
$1,977.40 |
1.9× |
| Nm bone marrow ltd (78102) |
$534.36 |
$1,335.90 |
1.3× |
| Nm csf cisternogram (78630) |
$659.74 |
$1,649.33 |
1.2× |
| Nm csf leak detection (78650) |
$728.66 |
$1,821.63 |
0.5× |
| Nm gastric emptying (78264) |
$646.95 |
$1,617.37 |
1.5× |
| Nm lung ventilation imaging (78579) |
$675.44 |
$1,688.59 |
1.6× |
| Nm lymph system (78195) |
$646.95 |
$1,617.37 |
1.1× |
| Nuclear medicine study of bone and/or joint limited area (78300) |
$698.16 |
$1,745.40 |
1.7× |
| Nuclear medicine study of bone and/or joint multiple areas (78305) |
$679.67 |
$1,699.16 |
1.6× |
| Ob us limited fetus(s) (76815) |
$340.33 |
$850.81 |
3.1× |
| Ob us nuchal meas 1 gest (76813) |
$345 |
$862.49 |
3.1× |
| Ophthalmic ultrasound, diagnostic; B-scan (with or without superimposed non-quantitative A-scan) Age Under 21 (76512) |
$710.19 |
$1,775.46 |
6.4× |
| Parathyrd planar w/spect&CT (78072) |
$1,805.51 |
$4,513.77 |
3.2× |
| Parathyroid planar imaging (78070) |
$513.08 |
$1,282.69 |
1.2× |
| Parathyroid planar imaging w/wo subtraction (78071) |
$1,978.59 |
$4,946.47 |
4.7× |
| Pulmonary ventilation & perfusion imaging (78582) |
$954.70 |
$2,386.75 |
1.7× |
| Quant differential pulm perfusion w/wo imaging (78597) |
$954.70 |
$2,386.75 |
2.3× |
| Radex abscess/fistula/sinus tract rs&i (76080) |
$462.68 |
$1,156.69 |
0.8× |
| Radex entir thrc lmbr crv sac spi w/skull 1 vw (72081) |
$185.23 |
$463.06 |
2.0× |
| Radex entir thrc lmbr crv sac spi w/skull 2/3 vw (72082) |
$222.27 |
$555.67 |
2.0× |
| Radex entir thrc lmbr crv sac spi w/skull 4/5 vw (72083) |
$308.74 |
$771.84 |
2.8× |
| Radex entir thrc lmbr crv sac spi w/skull 6/> vw (72084) |
$438.52 |
$1,096.28 |
4.0× |
| Radex hip unilateral with pelvis 1 view (73501) |
$222.27 |
$555.67 |
2.4× |
| Radex hip unilateral with pelvis 2-3 views (73502) |
$277.84 |
$694.58 |
3.0× |
| Radex hip unilateral with pelvis minimum 4 views (73503) |
$325.99 |
$814.97 |
3.0× |
| Radex hips bilateral with pelvis 2 views (73521) |
$426.54 |
$1,066.35 |
3.9× |
| Radex hips bilateral with pelvis minimum 5 views (73523) |
$614.21 |
$1,535.52 |
5.6× |
| Radex spine cervical 2 or 3 views (72040) |
$280.87 |
$702.16 |
3.1× |
| Radex spine cervical 4 or 5 views (72050) |
$325.99 |
$814.97 |
3.0× |
| Radex spine cervical 6 or more views (72052) |
$341.78 |
$854.43 |
3.1× |
| Radex spine thoracolumbar junction min 2 views (72080) |
$222.27 |
$555.67 |
2.4× |
| Radiologic exam abdomen 3+ views (74021) |
$212.53 |
$531.32 |
1.9× |
| Radiologic exam chest 3 views (71047) |
$240.82 |
$602.03 |
2.6× |
| Radiologic exam chest 4+ views (71048) |
$336.18 |
$840.43 |
3.0× |
| Radiologic exam colon double contrast study (74280) |
$672.02 |
$1,680.03 |
3.6× |
| Radiologic exam colon single contrast study (74270) |
$459.75 |
$1,149.36 |
2.5× |
| Radiologic exam esophagus double contrast study (74221) |
$449.25 |
$1,123.12 |
2.4× |
| Radiologic exam esophagus single contrast study (74220) |
$459.75 |
$1,149.36 |
2.5× |
| Radiologic exam small int single contrast study (74250) |
$569.61 |
$1,424.02 |
3.1× |
| Radiologic exam swallow function contrast study (74230) |
$459.75 |
$1,149.36 |
2.5× |
| Radiologic exam upr gi trc double contrast study (74246) |
$459.75 |
$1,149.36 |
2.5× |
| Radiologic exam upr gi trc single contrast study (74240) |
$413.77 |
$1,034.42 |
2.2× |
| Radiologic examination femur 1 view (73551) |
$171.50 |
$428.74 |
1.9× |
| Radiologic examination femur minimum 2 views (73552) |
$237.56 |
$593.90 |
2.6× |
| Radiologic examination from nose to rectum for foreign body, single view, child Age Under 21 (76010) |
$246.61 |
$616.51 |
2.7× |
| Radiologic examination, ankle; complete, minimum of 3 views Age Under 21 (73610) |
$255.60 |
$639.01 |
2.8× |
| Radiologic examination, complete acute abdomen series, including 2 or more views of the abdomen (eg, supine, erect,… (74022) |
$374.64 |
$936.59 |
3.4× |
| Radiologic examination, elbow; 2 views Age Under 21 (73070) |
$219.08 |
$547.68 |
2.4× |
| Radiologic examination, elbow; complete, minimum of 3 views Age Under 21 (73080) |
$255.60 |
$639.01 |
2.8× |
| Radiologic examination, facial bones; less than 3 views Age Under 21 (70140) |
$205.82 |
$514.55 |
2.2× |
| Radiologic examination, foot; complete, minimum of 3 views Age Under 21 (73630) |
$255.60 |
$639.01 |
2.8× |
| Radiologic examination, hand; minimum of 3 views Age Under 21 (73130) |
$255.60 |
$639.01 |
2.8× |
| Radiologic examination, knee; both knees, standing, anteroposterior Age Under 21 (73565) |
$333.41 |
$833.52 |
3.6× |
| Radiologic examination, knee; complete, 4 or more views Age Under 21 (73564) |
$369.36 |
$923.40 |
3.3× |
| Radiologic examination, mandible; partial, less than 4 views Age Under 21 (70100) |
$222.27 |
$555.67 |
2.4× |
| Radiologic examination, mastoids; complete, minimum of 3 views per side Age Under 21 (70130) |
$245.81 |
$614.51 |
2.2× |
| Radiologic examination, nasal bones, complete, minimum of 3 views Age Under 21 (70160) |
$222.27 |
$555.67 |
2.4× |
| Radiologic examination, ribs, bilateral; including posteroanterior chest, minimum of 4 views Age Under 21 (71111) |
$488.99 |
$1,222.46 |
4.4× |
| Radiologic examination, ribs, unilateral; including posteroanterior chest, minimum of 3 views Age Under 21 (71101) |
$222.27 |
$555.67 |
2.0× |
| Radiologic examination, sacroiliac joints; less than 3 views Age Under 21 (72200) |
$222.27 |
$555.67 |
2.0× |
| Radiologic examination, shoulder, arthrography, radiological supervision and interpretation Age Under 21 (73040) |
$597.12 |
$1,492.78 |
1.6× |
| Radiologic examination, shoulder; complete, minimum of 2 views Age Under 21 (73030) |
$255.60 |
$639.01 |
2.8× |
| Radiologic examination, sinuses, paranasal, less than 3 views Age Under 21 (70210) |
$222.27 |
$555.67 |
2.4× |
| Radiologic examination, skull; less than 4 views Age Under 21 (70250) |
$222.27 |
$555.67 |
2.0× |
| Radiologic examination, spine, lumbosacral; 2 or 3 views Age Under 21 (72100) |
$309.53 |
$773.82 |
2.8× |
| Radiologic examination, spine, lumbosacral; bending views only, 2 or 3 views Age Under 21 (72120) |
$348.64 |
$871.58 |
3.2× |
| Radiologic examination, spine, lumbosacral; complete, including bending views, minimum of 6 views Age Under 21 (72114) |
$384.89 |
$962.22 |
3.5× |
| Radiologic examination, spine; thoracic, minimum of 4 views Age Under 21 (72074) |
$372.07 |
$930.17 |
3.4× |
| Radiologic examination, wrist; complete, minimum of 3 views Age Under 21 (73110) |
$255.60 |
$639.01 |
2.8× |
| Radiologic examination; acromioclavicular joints, bilateral, with or without weighted distraction Age Under 21 (73050) |
$440.92 |
$1,102.30 |
4.8× |
| Radiologic examination; humerus, minimum of 2 views Age Under 21 (73060) |
$222.27 |
$555.67 |
2.4× |
| Radiologic examination; lower extremity, infant, minimum of 2 views Age Under 21 (73592) |
$308.16 |
$770.40 |
3.4× |
| Radiologic examination; orbits, complete, minimum of 4 views Age Under 21 (70200) |
$334.47 |
$836.16 |
3.0× |
| Radiologic examination; sternoclavicular joint or joints, minimum of 3 views Age Under 21 (71130) |
$222.27 |
$555.67 |
2.4× |
| Radiologic examination; toe(s), minimum of 2 views Age Under 21 (73660) |
$255.60 |
$639.01 |
2.8× |
| Radiologic examination; upper extremity, infant, minimum of 2 views Age Under 21 (73092) |
$255.07 |
$637.66 |
2.3× |
| Radiopharmaceutical localization of tumor, inflammatory process or distribution of radiopharmaceutical agent(s)… (78803) |
$1,136.67 |
$2,841.67 |
2.0× |
| Radiopharmaceutical therapy, by intravenous administration Age Under 21 (79101) |
$712.75 |
$1,781.86 |
2.9× |
| Radiopharmaceutical therapy, by oral administration Age Under 21 (79005) |
$1,144.14 |
$2,860.34 |
4.6× |
| Radiopharmaceutical therapy, radiolabeled monoclonal antibody by intravenous infusion (79403) |
$724.26 |
$1,810.65 |
2.9× |
| Review by radiologist of urinary bladder and urethra images with contrast and after passing urine (74455) |
$720.91 |
$1,802.26 |
2.9× |
| Rp loclzj tum plnr 1 area single day imaging (78800) |
$841.98 |
$2,104.94 |
2.0× |
| Rp loclzj tum plnr 2+area 1+d img/1 area img>2+d (78801) |
$1,111.41 |
$2,778.51 |
2.6× |
| Rp loclzj tum plnr whole body 2+ days imaging (78804) |
$1,680.59 |
$4,201.46 |
2.9× |
| Rp loclzj tum plnr whole body single day imaging (78802) |
$1,672 |
$4,179.98 |
2.9× |
| Rp loclzj tum spect 2 areas (78831) |
$1,500.41 |
$3,751.01 |
1.1× |
| Rp loclzj tum spect w/CT 1 (78830) |
$1,250.34 |
$3,125.84 |
0.9× |
| Rp loclzj tum spect w/CT 2 (78832) |
$1,650.44 |
$4,126.09 |
1.1× |
| Rp therapy intra-arterial particulate admn (79445) |
$1,183.08 |
$2,957.70 |
4.8× |
| Scapula complete (73010) |
$255.60 |
$639.01 |
2.3× |
| Screening digital breast tomosynthesis bi (77063) |
$16 |
$40 |
— |
| Shuntogram indwelling nonvascular shunt rs&i (75809) |
$465.48 |
$1,163.70 |
4.2× |
| Testicular imaging with vascular flow Age Under 21 (78761) |
$480.17 |
$1,200.42 |
1.1× |
| Thyroid imaging with vascular flow (78013) |
$645.76 |
$1,614.40 |
1.5× |
| Thyroid met imaging body (78018) |
$1,128.90 |
$2,822.23 |
2.0× |
| Thyroid uptake single/multiple quant measurement (78012) |
$282.74 |
$706.83 |
0.7× |
| Thyroid uptake w/blood flow sngle/mult quan meas (78014) |
$724.33 |
$1,810.82 |
1.7× |
| Ultrasound breast limited (76642) |
$593.30 |
$1,483.24 |
6.5× |
| Ultrasound, abdomen limited (76705) |
$548.80 |
$1,371.99 |
5.0× |
| Ultrasound, limited, joint or focal evaluation of other nonvascular extremity structure(s) (eg, joint space,… (76882) |
$355.47 |
$888.66 |
3.2× |
| Ultrasound, pelvic (nonobstetric), real time with image documentation; complete Age Under 21 (76856) |
$714.44 |
$1,786.08 |
6.5× |
| Ultrasound, pregnant uterus, real time with image documentation, fetal and maternal evaluation plus detailed fetal… (76811) |
$521.80 |
$1,304.49 |
2.1× |
| Ultrasound, pregnant uterus, real time with image documentation, fetal and maternal evaluation, first trimester (< 14… (76801) |
$340.33 |
$850.81 |
3.1× |
| Ultrasound, transplanted kidney, real time and duplex Doppler with image documentation Age Under 21 (76776) |
$604.34 |
$1,510.84 |
5.5× |
| Umbilical-artery Doppler (OB) (76820) |
$362.52 |
$906.29 |
3.3× |
| Ureteral reflux study (78740) |
$555.94 |
$1,389.83 |
1.3× |
| Urethrocystography retrograde rs&i (74450) |
$720.91 |
$1,802.26 |
2.9× |
| Urography (pyelography), intravenous, with or without KUB, with or without tomography Age Under 21 (74400) |
$720.91 |
$1,802.26 |
3.9× |
| Urography antegrade rs&i (74425) |
$678.84 |
$1,697.10 |
1.8× |
| Us abdominal aorta real time screen study aaa (76706) |
$215.35 |
$538.37 |
2.0× |
| Us breast uni real time with image complete (76641) |
$394.41 |
$986.02 |
3.6× |
| Us chest (76604) |
$547.78 |
$1,369.44 |
5.0× |
| Us compl joint r-t w/image documentation (76881) |
$497.72 |
$1,244.30 |
4.5× |
| Us encephalogram (76506) |
$547.78 |
$1,369.44 |
5.0× |
| Us exam, pelvic, limited (76857) |
$340.33 |
$850.81 |
3.1× |
| US OB Follow-Up/Repeat (76816) |
$340.33 |
$850.81 |
3.1× |
| Us ob transvaginal (76817) |
$462.36 |
$1,155.89 |
4.2× |
| Us retroperitoneal complete (76770) |
$631.70 |
$1,579.25 |
5.7× |
| Us retroperitoneal ltd (76775) |
$548.95 |
$1,372.36 |
5.0× |
| Us scrotum (76870) |
$548.95 |
$1,372.36 |
5.0× |
| Us soft tissue head/neck (76536) |
$685.30 |
$1,713.24 |
6.2× |
| Venography deep dorsal vein penis radiolgicl supervision interpretation (76499) |
$3,717.26 |
$9,293.15 |
40.5× |
| Venography, extremity, bilateral, radiological supervision and interpretation Age Under 21 (75822) |
$966.77 |
$2,416.91 |
0.6× |
| Venography, extremity, unilateral, radiological supervision and interpretation Age Under 21 (75820) |
$768.35 |
$1,920.87 |
0.5× |
| X-ray exam hips bi 3-4 views (73522) |
$302.99 |
$757.46 |
2.7× |
| X-ray exam of finger(s) (73140) |
$250.06 |
$625.12 |
2.7× |
| X-ray exam of knee 1 or 2 (73560) |
$237.08 |
$592.68 |
2.6× |
| X-ray exam of small bowel - fl small bowel series enteroclysis tube (74251) |
$354.10 |
$885.24 |
1.9× |
| X-ray exam ribs bil 3 views (71110) |
$333.41 |
$833.52 |
3.0× |
| X-ray exam ribs uni 2 views (71100) |
$266.07 |
$665.17 |
2.9× |
| X-ray heel (73650) |
$255.60 |
$639.01 |
2.8× |
| X-ray of joint between lower spine and hip bone 3 or more views|PROFESSIONAL COMPONENT (72202) |
$222.27 |
$555.67 |
2.0× |
| X-ray retrograde pyelogram (74420) |
$720.91 |
$1,802.26 |
2.0× |
| Xr abdomen 1 view (74018) |
$212.53 |
$531.32 |
2.3× |
| Xr abdomen 2 views (74019) |
$203.46 |
$508.64 |
1.8× |
| Xr arthrogram hip (73525) |
$659.50 |
$1,648.74 |
1.8× |
| Xr bone age studies (77072) |
$171.74 |
$429.33 |
1.6× |
| Xr bone length study (77073) |
$149.96 |
$374.90 |
1.4× |
| Xr bone survey infant (77076) |
$286.26 |
$715.63 |
2.6× |
| Xr chest 1 view (71045) |
$213.32 |
$533.29 |
2.3× |
| Xr chest 2 views (71046) |
$197.50 |
$493.73 |
2.2× |
| Xr eye foreign body (70030) |
$258.48 |
$646.20 |
2.8× |
| Xr facial bones 3+ views (70150) |
$222.27 |
$555.67 |
2.0× |
| Xr foot arthritis pa only bilateral - report(ortho pro) (73620) |
$255.60 |
$639.01 |
2.8× |
| Xr forearm 2 views (73090) |
$255.60 |
$639.01 |
2.8× |
| Xr hand 2v (73120) |
$255.60 |
$639.01 |
2.3× |
| Xr hysterosalpingogram (74740) |
$502.29 |
$1,255.71 |
2.0× |
| Xr myelogram c-spine (72240) |
$686.58 |
$1,716.44 |
0.8× |
| Xr myelogram l-spine (72265) |
$686.58 |
$1,716.44 |
0.8× |
| Xr myelogram t-spine (72255) |
$686.58 |
$1,716.44 |
0.8× |
| Xr neck soft tissue (70360) |
$268.81 |
$672.02 |
2.9× |
| Xr o knee w/ merchant view bilat - report(ortho pro) (73562) |
$255.60 |
$639.01 |
2.8× |
| Xr osseous survey complete (77075) |
$400.59 |
$1,001.46 |
3.6× |
| Xr pelvis 1-2 views (72170) |
$222.27 |
$555.67 |
2.0× |
| Xr pelvis min 3 view (72190) |
$222.27 |
$555.67 |
2.0× |
| Xr peritoneogram (74190) |
$511.56 |
$1,278.89 |
0.9× |
| Xr sacrum/coccyx 2+ views (72220) |
$222.27 |
$555.67 |
2.4× |
| Xr shoulder 1 view (73020) |
$175.20 |
$437.98 |
1.9× |
| Xr sialogram (70390) |
$722.87 |
$1,807.17 |
2.9× |
| Xr sinuses 3+ views (70220) |
$222.27 |
$555.67 |
2.4× |
| Xr skull min 4 view (70260) |
$391.19 |
$977.96 |
3.5× |
| Xr spine 1 view (72020) |
$222.27 |
$555.67 |
2.4× |
| Xr spine thoracic 3v (72072) |
$222.27 |
$555.67 |
2.0× |
| Xr sternum 2+ views (71120) |
$208.01 |
$520.02 |
2.3× |
| Xr stress view joint (77071) |
$165.63 |
$414.07 |
1.8× |
| Xr surgical specimen (76098) |
$423.08 |
$1,057.69 |
0.7× |
| Xr t-spine 2 views (72070) |
$222.27 |
$555.67 |
2.0× |
| Xr tibia/fibula 2 views (73590) |
$255.60 |
$639.01 |
2.8× |
| Xr tmj bilateral (70330) |
$202.06 |
$505.14 |
2.2× |
| Xr tmj unilateral (70328) |
$146.70 |
$366.73 |
1.6× |
| Xr wrist 2 views (73100) |
$255.60 |
$639.01 |
2.8× |