| Acute gi blood loss imaging (78278) |
$1,041.73 |
$2,604.31 |
2.5× |
| Ankle 2 views (73600) |
$264.76 |
$661.90 |
2.9× |
| Brain imaging, less than 4 static views; with vascular flow Age Under 21 (78601) |
$534.53 |
$1,336.31 |
1.3× |
| Brain imaging, minimum 4 static views; with vascular flow Age Under 21 (78606) |
$838.82 |
$2,097.04 |
1.5× |
| Cholecystography, oral contrast Age Under 21 (74290) |
$194.77 |
$486.92 |
1.1× |
| Clavicle complete (73000) |
$286.66 |
$716.62 |
3.1× |
| Computed tomographic angiography, abdomen and pelvis, with contrast material(s), including noncontrast images, if… (74174) |
$3,419.01 |
$8,547.52 |
9.3× |
| Computed tomographic angiography, abdomen, with contrast material(s), including noncontrast images, if performed, and… (74175) |
$1,880.45 |
$4,701.12 |
10.2× |
| Computed tomographic angiography, abdominal aorta and bilateral iliofemoral lower extremity runoff, with contrast… (75635) |
$2,383.94 |
$5,959.83 |
12.9× |
| Computed tomographic angiography, chest (noncoronary), with contrast material(s), including noncontrast images, if… (71275) |
$2,167.22 |
$5,418.05 |
11.7× |
| Computed tomographic angiography, lower extremity, with contrast material(s), including noncontrast images, if… (73706) |
$919.74 |
$2,299.36 |
5.0× |
| Computed tomographic angiography, neck, with contrast material(s), including noncontrast images, if performed, and… (70498) |
$2,331.05 |
$5,827.61 |
12.6× |
| Computed tomographic angiography, pelvis, with contrast material(s), including noncontrast images, if performed, and… (72191) |
$1,880.45 |
$4,701.12 |
10.2× |
| Computed tomographic angiography, upper extremity, with contrast material(s), including noncontrast images, if… (73206) |
$1,880.45 |
$4,701.12 |
10.2× |
| Computed tomography, cervical spine; without contrast material, followed by contrast material(s) and further sections… (72127) |
$1,601.60 |
$4,003.99 |
8.7× |
| Computed tomography, lower extremity; without contrast material Age Under 21 (73700) |
$1,199.63 |
$2,999.07 |
10.9× |
| Computed tomography, lower extremity; without contrast material, followed by contrast material(s) and further sections… (73702) |
$2,049.50 |
$5,123.74 |
11.1× |
| Computed tomography, lumbar spine; without contrast material, followed by contrast material(s) and further sections Age… (72133) |
$1,770.20 |
$4,425.50 |
9.6× |
| Computed tomography, maxillofacial area; with contrast material(s) Age Under 21 (70487) |
$1,186 |
$2,964.98 |
6.4× |
| Computed tomography, maxillofacial area; without contrast material Age Under 21 (70486) |
$936.28 |
$2,340.70 |
8.5× |
| Computed tomography, orbit, sella, or posterior fossa or outer, middle, or inner ear; with contrast material(s) Age… (70481) |
$1,534.80 |
$3,837 |
8.3× |
| Computed tomography, orbit, sella, or posterior fossa or outer, middle, or inner ear; without contrast material Age… (70480) |
$1,232.50 |
$3,081.25 |
11.2× |
| Computed tomography, orbit, sella, or posterior fossa or outer, middle, or inner ear; without contrast material,… (70482) |
$1,849.22 |
$4,623.04 |
10.0× |
| Computed tomography, soft tissue neck; without contrast material followed by contrast material(s) and further sections… (70492) |
$2,232.45 |
$5,581.12 |
12.1× |
| Computed tomography, thoracic spine; without contrast material, followed by contrast material(s) and further sections… (72130) |
$1,685.90 |
$4,214.74 |
9.1× |
| Computed tomography, thorax, diagnostic; without contrast material, followed by contrast material(s) and further… (71270) |
$2,285.67 |
$5,714.17 |
12.4× |
| Csf shunt evaluation (78645) |
$1,148.85 |
$2,872.12 |
2.0× |
| CT abdomen and pelvis without and with contrast (74178) |
$3,992.05 |
$9,980.12 |
10.8× |
| CT abdomen and pelvis without contrast (74176) |
$1,570.64 |
$3,926.58 |
6.2× |
| CT abdomen w & w/o contrast (74170) |
$1,682.32 |
$4,205.78 |
9.1× |
| CT abdomen w/contrast (74160) |
$1,214.53 |
$3,036.32 |
6.6× |
| CT abdomen w/o contrast (74150) |
$1,104.12 |
$2,760.30 |
10.0× |
| CT cervical spine w/contrast (72126) |
$1,504.70 |
$3,761.73 |
4.1× |
| CT cervical spine w/o contrast (72125) |
$1,423.87 |
$3,559.66 |
12.9× |
| CT chest w/contrast (71260) |
$1,529.95 |
$3,824.86 |
8.3× |
| CT extremity upper w & w/o contrast (73202) |
$2,049.50 |
$5,123.74 |
11.1× |
| CT extremity upper w/o contrast (73200) |
$1,243.93 |
$3,109.82 |
11.3× |
| CT head/brain with contrast (70460) |
$1,458.54 |
$3,646.33 |
7.9× |
| CT head/brain without and with contrast (70470) |
$2,002.35 |
$5,005.87 |
10.8× |
| CT heart no contrast quant eval coronry calcium (75571) |
$915.92 |
$2,289.79 |
10.0× |
| CT l-spine w/contrast (72132) |
$1,608.03 |
$4,020.06 |
4.4× |
| CT limited/localized follow up study (76380) |
$672.26 |
$1,680.65 |
7.3× |
| CT lower extremity w/dye (73701) |
$1,539.53 |
$3,848.82 |
8.3× |
| CT lumbar spine w/o contrast (72131) |
$1,473.16 |
$3,682.90 |
13.4× |
| CT maxillofacial w/wo contrast (70488) |
$1,901.30 |
$4,753.24 |
10.3× |
| CT neck w/contrast (70491) |
$1,277.67 |
$3,194.16 |
6.9× |
| CT neck w/o contrast (70490) |
$951.93 |
$2,379.82 |
8.6× |
| CT pelvis w & w/o contrast (72194) |
$1,320.77 |
$3,301.91 |
7.1× |
| CT pelvis w/o contrast (72192) |
$1,119.84 |
$2,799.58 |
10.2× |
| CT thoracic spine w/contrast (72129) |
$1,576.31 |
$3,940.77 |
8.5× |
| CT thoracic spine w/o contrast (72128) |
$1,431.47 |
$3,578.66 |
13.0× |
| CT thorax lung cancer scr c- (71271) |
$214.50 |
$536.25 |
1.9× |
| CT thorax w/o contrast (71250) |
$1,159.05 |
$2,897.61 |
10.5× |
| CT upper extremity w/dye (73201) |
$1,670.40 |
$4,176 |
4.5× |
| CTA head w contrast (70496) |
$1,886.43 |
$4,716.06 |
10.2× |
| Cystography, minimum of 3 views, radiological supervision and interpretation Age Under 21 (74430) |
$501.41 |
$1,253.52 |
1.4× |
| Dual-energy X-ray absorptiometry (DXA), bone density study, 1 or more sites; axial skeleton (eg, hips, pelvis, spine)… (77080) |
$333.79 |
$834.47 |
3.0× |
| Dxa bone density study axial skeleton (77085) |
$533.57 |
$1,333.91 |
4.8× |
| Fetal biophys profile w/o nst (76819) |
$325.53 |
$813.82 |
3.0× |
| Fetal biophysical profile non-stress testing (76818) |
$203.64 |
$509.10 |
1.8× |
| Fluoroscopy up to 1 hour physician/qhp time (76000) |
$239.81 |
$599.51 |
1.0× |
| Gastric emptying imaging study (eg, solid, liquid, or both); with small bowel and colon transit, multiple days Age… (78266) |
$1,356.14 |
$3,390.35 |
2.4× |
| Gastric emptying imaging study (eg, solid, liquid, or both); with small bowel transit Age Under 21 (78265) |
$1,084.92 |
$2,712.28 |
2.6× |
| Gated heart planar single (78472) |
$1,846.08 |
$4,615.18 |
4.4× |
| Hepatobil syst imag inc gb w/pharma intervenj (78227) |
$1,234.68 |
$3,086.68 |
2.2× |
| Hepatobiliary syst imaging including gallbladder (78226) |
$1,122.44 |
$2,806.09 |
2.7× |
| Ht muscle image spect sing (78451) |
$1,010.36 |
$2,525.89 |
0.7× |
| Intestine imaging (eg, ectopic gastric mucosa, Meckel's localization, volvulus) Age Under 21 (78290) |
$995.13 |
$2,487.82 |
2.4× |
| Kidney imaging morphology; with vascular flow and function, multiple studies, with and without pharmacological… (78709) |
$1,071.29 |
$2,678.21 |
1.9× |
| Kidney imaging morphology; with vascular flow and function, single study without pharmacological intervention Age Under… (78707) |
$852.10 |
$2,130.25 |
1.5× |
| Kidney imaging morphology; with vascular flow and function, single study, with pharmacological intervention (eg,… (78708) |
$1,014.47 |
$2,536.17 |
1.8× |
| Leveen/shunt patency exam (78291) |
$876.70 |
$2,191.73 |
2.1× |
| Liver and spleen imaging (78215) |
$1,011.90 |
$2,529.74 |
2.4× |
| Liver imaging (78201) |
$758.45 |
$1,896.11 |
1.3× |
| Lung perf&ventilat diferentl (78598) |
$1,804.86 |
$4,512.13 |
3.2× |
| Lung perfusion imaging (78580) |
$1,254.43 |
$3,136.07 |
3.0× |
| Magnetic resonance (eg, proton) imaging, any joint of lower extremity; without contrast material(s), followed by… (73723) |
$2,397.90 |
$5,994.74 |
6.5× |
| Magnetic resonance (eg, proton) imaging, lower extremity other than joint; with contrast material(s) Age Under 21 (73719) |
$2,072.10 |
$5,180.23 |
5.6× |
| Magnetic resonance (eg, proton) imaging, lower extremity other than joint; without contrast material(s) Age Under 21 (73718) |
$1,919.89 |
$4,799.72 |
7.6× |
| Magnetic resonance (eg, proton) imaging, lower extremity other than joint; without contrast material(s), followed by… (73720) |
$2,527.50 |
$6,318.72 |
6.9× |
| Magnetic resonance (eg, proton) imaging, orbit, face, and/or neck; with contrast material(s) Age Under 21 (70542) |
$2,130.26 |
$5,325.64 |
5.8× |
| Magnetic resonance (eg, proton) imaging, orbit, face, and/or neck; without contrast material(s) Age Under 21 (70540) |
$1,439.80 |
$3,599.48 |
5.7× |
| Magnetic resonance (eg, proton) imaging, upper extremity, other than joint; with contrast material(s) Age Under 21 (73219) |
$2,315.96 |
$5,789.88 |
6.3× |
| Magnetic resonance (eg, proton) imaging, upper extremity, other than joint; without contrast material(s), followed by… (73220) |
$2,580.75 |
$6,451.86 |
7.0× |
| Magnetic resonance angiography, head; without contrast material(s), followed by contrast material(s) and further… (70546) |
$3,222.24 |
$8,055.60 |
8.8× |
| Magnetic resonance angiography, neck; without contrast material(s), followed by contrast material(s) and further… (70549) |
$3,039.56 |
$7,598.90 |
8.3× |
| Mandible min 4v (70110) |
$412.56 |
$1,031.38 |
3.7× |
| 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) |
$1,210.07 |
$3,025.16 |
4.8× |
| MRA neck w/o contrast (70547) |
$1,210.07 |
$3,025.16 |
4.8× |
| MRI abdomen w/contrast (74182) |
$1,697.99 |
$4,244.97 |
4.6× |
| MRI abdomen w/o contrast (74181) |
$1,442.40 |
$3,605.99 |
5.7× |
| MRI abdomen w/wo contrast (74183) |
$2,222.58 |
$5,556.43 |
6.0× |
| MRI any jt lower extrem w/contrast material (73722) |
$2,177.38 |
$5,443.42 |
2.6× |
| MRI c-spine w&w/o cont (72156) |
$2,173.77 |
$5,434.41 |
5.9× |
| MRI cervical spine w/contrast (72142) |
$1,700.35 |
$4,250.87 |
4.6× |
| MRI chest w/o contrast (71550) |
$1,613.28 |
$4,033.20 |
6.4× |
| MRI chest w/wo contrast (71552) |
$2,092.38 |
$5,230.95 |
5.7× |
| MRI joint upr extr w/o&w/dye (73223) |
$2,704.58 |
$6,761.42 |
7.3× |
| MRI joint upr extrem w/dye (73222) |
$2,294.25 |
$5,735.61 |
2.8× |
| MRI joint upr extrem w/o dye (73221) |
$2,197.84 |
$5,494.61 |
8.7× |
| MRI lumbar spine w/contrast (72149) |
$1,775.74 |
$4,439.35 |
4.8× |
| MRI lumbar spine w/wo contrast (72158) |
$2,173.77 |
$5,434.41 |
5.9× |
| MRI orbit/face/neck w&w/o cont (70543) |
$2,820.72 |
$7,051.78 |
7.7× |
| MRI pelvis w & w/o contrast (72197) |
$1,854.94 |
$4,637.33 |
5.0× |
| MRI pelvis w/contrast (72196) |
$1,538.11 |
$3,845.27 |
4.2× |
| MRI pelvis w/o contrast (72195) |
$1,356.72 |
$3,391.80 |
5.4× |
| MRI spine cervical w/o contrast (72141) |
$1,280.41 |
$3,201.02 |
5.1× |
| MRI t-spine w&w/o cont (72157) |
$2,173.77 |
$5,434.41 |
5.9× |
| MRI thoracic spine w/contrast (72147) |
$1,775.74 |
$4,439.35 |
4.8× |
| MRI thoracic spine w/o contrst (72146) |
$1,415.66 |
$3,539.14 |
5.6× |
| MRI tmj (70336) |
$2,729.71 |
$6,824.27 |
10.8× |
| MRI upper extremity oth than jt w/o contr matrl (73218) |
$2,073.88 |
$5,184.68 |
8.2× |
| Myelography, 2 or more regions (eg, lumbar/thoracic, cervical/thoracic, lumbar/cervical, lumbar/thoracic/cervical),… (72270) |
$1,151.03 |
$2,877.56 |
1.4× |
| Myocardial spect multiple studies (78452) |
$1,434.77 |
$3,586.92 |
1.1× |
| N-invas est c ffr augmnt sw alys CTA i&r phy/qhp (75580) |
$6,748.04 |
$16,870.10 |
7.4× |
| Nm bone 3 phase (78315) |
$1,789.35 |
$4,473.37 |
4.2× |
| Nm bone imaging whole body (78306) |
$1,466.72 |
$3,666.80 |
3.5× |
| Nm csf cisternogram (78630) |
$1,455.87 |
$3,639.66 |
2.5× |
| Nm gastric emptying (78264) |
$944.16 |
$2,360.40 |
2.2× |
| Nm lung ventilation imaging (78579) |
$1,254.43 |
$3,136.07 |
3.0× |
| Nm lymph system (78195) |
$961.28 |
$2,403.20 |
1.7× |
| Nuclear medicine study of bone and/or joint limited area (78300) |
$854.35 |
$2,135.86 |
2.0× |
| Nuclear medicine study of bone and/or joint multiple areas (78305) |
$1,231.34 |
$3,078.34 |
2.9× |
| Ob us limited fetus(s) (76815) |
$278.20 |
$695.48 |
2.5× |
| Ophthalmic ultrasound, diagnostic; B-scan (with or without superimposed non-quantitative A-scan) Age Under 21 (76512) |
$649.36 |
$1,623.38 |
5.9× |
| Parathyrd planar w/spect&CT (78072) |
$2,229.99 |
$5,574.96 |
3.9× |
| Parathyroid planar imaging (78070) |
$994.49 |
$2,486.22 |
2.4× |
| Parathyroid planar imaging w/wo subtraction (78071) |
$1,833.30 |
$4,583.25 |
4.3× |
| Pulmonary ventilation & perfusion imaging (78582) |
$2,043.83 |
$5,109.57 |
3.6× |
| Quant differential pulm perfusion w/wo imaging (78597) |
$1,254.43 |
$3,136.07 |
3.0× |
| Radex abscess/fistula/sinus tract rs&i (76080) |
$335.75 |
$839.37 |
0.6× |
| Radex entir thrc lmbr crv sac spi w/skull 1 vw (72081) |
$274.18 |
$685.44 |
3.0× |
| Radex entir thrc lmbr crv sac spi w/skull 2/3 vw (72082) |
$328.12 |
$820.30 |
3.0× |
| Radex entir thrc lmbr crv sac spi w/skull 4/5 vw (72083) |
$384.08 |
$960.18 |
3.5× |
| Radex entir thrc lmbr crv sac spi w/skull 6/> vw (72084) |
$425.88 |
$1,064.68 |
3.9× |
| Radex hip unilateral with pelvis 1 view (73501) |
$159.12 |
$397.80 |
1.7× |
| Radex hip unilateral with pelvis 2-3 views (73502) |
$301.13 |
$752.81 |
3.3× |
| Radex hip unilateral with pelvis minimum 4 views (73503) |
$384.08 |
$960.18 |
3.5× |
| Radex hips bilateral with pelvis 2 views (73521) |
$377.34 |
$943.33 |
3.4× |
| Radex hips bilateral with pelvis minimum 5 views (73523) |
$485.87 |
$1,214.66 |
4.4× |
| Radex spine cervical 2 or 3 views (72040) |
$342.65 |
$856.62 |
3.7× |
| Radex spine cervical 4 or 5 views (72050) |
$426.32 |
$1,065.78 |
3.9× |
| Radex spine cervical 6 or more views (72052) |
$465.27 |
$1,163.16 |
4.2× |
| Radex spine thoracolumbar junction min 2 views (72080) |
$114.04 |
$285.09 |
1.2× |
| Radiologic exam abdomen 3+ views (74021) |
$382.31 |
$955.76 |
3.5× |
| Radiologic exam chest 3 views (71047) |
$373.91 |
$934.77 |
4.1× |
| Radiologic exam chest 4+ views (71048) |
$373.91 |
$934.77 |
3.4× |
| Radiologic exam colon double contrast study (74280) |
$811.42 |
$2,028.54 |
4.4× |
| Radiologic exam colon single contrast study (74270) |
$811.42 |
$2,028.54 |
4.4× |
| Radiologic exam esophagus double contrast study (74221) |
$414.20 |
$1,035.50 |
2.2× |
| Radiologic exam esophagus single contrast study (74220) |
$433.13 |
$1,082.81 |
2.3× |
| Radiologic exam small int single contrast study (74250) |
$486.85 |
$1,217.12 |
2.6× |
| Radiologic exam swallow function contrast study (74230) |
$413.26 |
$1,033.15 |
2.2× |
| Radiologic exam upr gi trc double contrast study (74246) |
$597.66 |
$1,494.14 |
3.2× |
| Radiologic exam upr gi trc single contrast study (74240) |
$203.33 |
$508.32 |
1.1× |
| Radiologic examination femur 1 view (73551) |
$219.33 |
$548.32 |
2.4× |
| Radiologic examination femur minimum 2 views (73552) |
$333.16 |
$832.90 |
3.6× |
| Radiologic examination from nose to rectum for foreign body, single view, child Age Under 21 (76010) |
$324.57 |
$811.41 |
3.5× |
| Radiologic examination, ankle; complete, minimum of 3 views Age Under 21 (73610) |
$277.76 |
$694.39 |
3.0× |
| Radiologic examination, complete acute abdomen series, including 2 or more views of the abdomen (eg, supine, erect,… (74022) |
$508.11 |
$1,270.27 |
4.6× |
| Radiologic examination, elbow; 2 views Age Under 21 (73070) |
$296.53 |
$741.32 |
3.2× |
| Radiologic examination, elbow; complete, minimum of 3 views Age Under 21 (73080) |
$321.04 |
$802.60 |
3.5× |
| Radiologic examination, facial bones; less than 3 views Age Under 21 (70140) |
$249.27 |
$623.16 |
2.7× |
| Radiologic examination, foot; complete, minimum of 3 views Age Under 21 (73630) |
$299.16 |
$747.90 |
3.3× |
| Radiologic examination, hand; minimum of 3 views Age Under 21 (73130) |
$239.86 |
$599.64 |
2.6× |
| Radiologic examination, knee; both knees, standing, anteroposterior Age Under 21 (73565) |
$108.08 |
$270.19 |
1.2× |
| Radiologic examination, knee; complete, 4 or more views Age Under 21 (73564) |
$291.74 |
$729.34 |
2.6× |
| Radiologic examination, mandible; partial, less than 4 views Age Under 21 (70100) |
$108.14 |
$270.33 |
1.2× |
| Radiologic examination, mastoids; complete, minimum of 3 views per side Age Under 21 (70130) |
$514.49 |
$1,286.21 |
4.7× |
| Radiologic examination, nasal bones, complete, minimum of 3 views Age Under 21 (70160) |
$332.34 |
$830.85 |
3.6× |
| Radiologic examination, ribs, bilateral; including posteroanterior chest, minimum of 4 views Age Under 21 (71111) |
$519.28 |
$1,298.19 |
4.7× |
| Radiologic examination, ribs, unilateral; including posteroanterior chest, minimum of 3 views Age Under 21 (71101) |
$457.27 |
$1,143.16 |
4.1× |
| Radiologic examination, sacroiliac joints; less than 3 views Age Under 21 (72200) |
$203.64 |
$509.10 |
1.8× |
| Radiologic examination, shoulder, arthrography, radiological supervision and interpretation Age Under 21 (73040) |
$599.77 |
$1,499.42 |
1.6× |
| Radiologic examination, shoulder; complete, minimum of 2 views Age Under 21 (73030) |
$288.48 |
$721.20 |
3.1× |
| Radiologic examination, single plane body section (eg, tomography), other than with urography Age Under 21 (76100) |
$486.85 |
$1,217.12 |
4.4× |
| Radiologic examination, sinuses, paranasal, less than 3 views Age Under 21 (70210) |
$166.18 |
$415.43 |
1.8× |
| Radiologic examination, skull; less than 4 views Age Under 21 (70250) |
$332.34 |
$830.85 |
3.0× |
| Radiologic examination, spine, lumbosacral; 2 or 3 views Age Under 21 (72100) |
$312.79 |
$781.96 |
2.8× |
| Radiologic examination, spine, lumbosacral; bending views only, 2 or 3 views Age Under 21 (72120) |
$401.34 |
$1,003.33 |
3.6× |
| Radiologic examination, spine, lumbosacral; complete, including bending views, minimum of 6 views Age Under 21 (72114) |
$444.75 |
$1,111.86 |
4.0× |
| Radiologic examination, spine; thoracic, minimum of 4 views Age Under 21 (72074) |
$797.53 |
$1,993.82 |
7.2× |
| Radiologic examination, wrist; complete, minimum of 3 views Age Under 21 (73110) |
$264.76 |
$661.90 |
2.9× |
| Radiologic examination; acromioclavicular joints, bilateral, with or without weighted distraction Age Under 21 (73050) |
$309.42 |
$773.53 |
3.4× |
| Radiologic examination; humerus, minimum of 2 views Age Under 21 (73060) |
$296.53 |
$741.32 |
3.2× |
| Radiologic examination; lower extremity, infant, minimum of 2 views Age Under 21 (73592) |
$286.66 |
$716.62 |
3.1× |
| Radiologic examination; orbits, complete, minimum of 4 views Age Under 21 (70200) |
$408 |
$1,020 |
3.7× |
| Radiologic examination; sternoclavicular joint or joints, minimum of 3 views Age Under 21 (71130) |
$332.34 |
$830.85 |
3.6× |
| Radiologic examination; toe(s), minimum of 2 views Age Under 21 (73660) |
$239.86 |
$599.64 |
2.6× |
| Radiologic examination; upper extremity, infant, minimum of 2 views Age Under 21 (73092) |
$329.65 |
$824.12 |
3.0× |
| Radiopharmaceutical localization of tumor, inflammatory process or distribution of radiopharmaceutical agent(s)… (78803) |
$1,728.46 |
$4,321.14 |
3.0× |
| Review by radiologist of urinary bladder and urethra images with contrast and after passing urine (74455) |
$399.71 |
$999.27 |
1.6× |
| Rp loclzj tum plnr 1 area single day imaging (78800) |
$1,280.34 |
$3,200.85 |
3.0× |
| Rp loclzj tum plnr 2+area 1+d img/1 area img>2+d (78801) |
$1,687.78 |
$4,219.44 |
4.0× |
| Rp loclzj tum plnr whole body 2+ days imaging (78804) |
$3,272.23 |
$8,180.56 |
5.7× |
| Rp loclzj tum plnr whole body single day imaging (78802) |
$2,055.87 |
$5,139.66 |
3.6× |
| Rp loclzj tum spect 2 areas (78831) |
$2,311.09 |
$5,777.72 |
1.7× |
| Rp loclzj tum spect w/CT 1 (78830) |
$1,901.31 |
$4,753.26 |
1.4× |
| Rp loclzj tum spect w/CT 2 (78832) |
$2,542.20 |
$6,355.49 |
1.7× |
| Saline infusion sonohysterography (SIS), including color flow Doppler, when performed Age Under 21 (76831) |
$386.19 |
$965.47 |
1.5× |
| Scapula complete (73010) |
$334.42 |
$836.06 |
3.0× |
| Screening digital breast tomosynthesis bi (77063) |
$16 |
$40 |
— |
| Testicular imaging with vascular flow Age Under 21 (78761) |
$651.67 |
$1,629.16 |
1.5× |
| Thyroid imaging with vascular flow (78013) |
$889.28 |
$2,223.18 |
2.1× |
| Thyroid met imaging body (78018) |
$2,749.50 |
$6,873.74 |
4.8× |
| Thyroid uptake single/multiple quant measurement (78012) |
$634.84 |
$1,587.10 |
1.5× |
| Thyroid uptake w/blood flow sngle/mult quan meas (78014) |
$1,199.94 |
$2,999.83 |
2.8× |
| Ultrasound breast limited (76642) |
$407.94 |
$1,019.84 |
4.4× |
| Ultrasound, abdomen limited (76705) |
$439.98 |
$1,099.95 |
4.0× |
| Ultrasound, limited, joint or focal evaluation of other nonvascular extremity structure(s) (eg, joint space,… (76882) |
$347.24 |
$868.10 |
3.1× |
| Ultrasound, pelvic (nonobstetric), real time with image documentation; complete Age Under 21 (76856) |
$543.32 |
$1,358.30 |
4.9× |
| Ultrasound, pregnant uterus, real time with image documentation, fetal and maternal evaluation plus detailed fetal… (76811) |
$695.53 |
$1,738.81 |
2.8× |
| Ultrasound, pregnant uterus, real time with image documentation, fetal and maternal evaluation, first trimester (< 14… (76801) |
$455.82 |
$1,139.54 |
4.1× |
| Umbilical-artery Doppler (OB) (76820) |
$176.46 |
$441.14 |
1.6× |
| Urethrocystography retrograde rs&i (74450) |
$1,353.63 |
$3,384.06 |
5.4× |
| Urography (pyelography), intravenous, with or without KUB, with or without tomography Age Under 21 (74400) |
$537.23 |
$1,343.06 |
2.9× |
| Urography antegrade rs&i (74425) |
$579.59 |
$1,448.97 |
1.6× |
| Us abdominal aorta real time screen study aaa (76706) |
$239.29 |
$598.22 |
2.2× |
| Us breast uni real time with image complete (76641) |
$448.74 |
$1,121.84 |
4.1× |
| Us chest (76604) |
$370.92 |
$927.29 |
3.4× |
| Us compl joint r-t w/image documentation (76881) |
$520.85 |
$1,302.12 |
4.7× |
| Us encephalogram (76506) |
$415.42 |
$1,038.53 |
3.8× |
| Us exam, pelvic, limited (76857) |
$255.80 |
$639.49 |
2.3× |
| Us inft hips r-t img dynamic req phys/qhp manj (76885) |
$498.51 |
$1,246.26 |
5.4× |
| US OB Follow-Up/Repeat (76816) |
$407.71 |
$1,019.27 |
3.7× |
| Us ob transvaginal (76817) |
$352.39 |
$880.96 |
3.2× |
| Us retroperitoneal complete (76770) |
$658.45 |
$1,646.11 |
6.0× |
| Us retroperitoneal ltd (76775) |
$506.48 |
$1,266.19 |
4.6× |
| Us scrotum (76870) |
$408.25 |
$1,020.62 |
3.7× |
| Us soft tissue head/neck (76536) |
$395.62 |
$989.03 |
3.6× |
| Us spinal canal (76800) |
$445.10 |
$1,112.74 |
4.0× |
| Venography deep dorsal vein penis radiolgicl supervision interpretation (76499) |
$4,385.03 |
$10,962.57 |
47.8× |
| X-ray exam hips bi 3-4 views (73522) |
$441.70 |
$1,104.24 |
4.0× |
| X-ray exam of finger(s) (73140) |
$239.86 |
$599.64 |
2.6× |
| X-ray exam of knee 1 or 2 (73560) |
$249.32 |
$623.31 |
2.7× |
| X-ray exam ribs bil 3 views (71110) |
$726.76 |
$1,816.90 |
6.6× |
| X-ray exam ribs uni 2 views (71100) |
$239.46 |
$598.63 |
2.6× |
| X-ray heel (73650) |
$262.27 |
$655.66 |
2.9× |
| X-ray of joint between lower spine and hip bone 3 or more views|PROFESSIONAL COMPONENT (72202) |
$343.80 |
$859.49 |
3.1× |
| X-ray retrograde pyelogram (74420) |
$294.80 |
$736.99 |
0.8× |
| Xr abdomen 1 view (74018) |
$239.14 |
$597.83 |
2.6× |
| Xr abdomen 2 views (74019) |
$486.19 |
$1,215.47 |
4.4× |
| Xr arthrogram hip (73525) |
$599.77 |
$1,499.42 |
1.6× |
| Xr arthrogram knee (73580) |
$441.23 |
$1,103.07 |
1.2× |
| Xr bone age studies (77072) |
$291.08 |
$727.69 |
2.6× |
| Xr bone length study (77073) |
$358.13 |
$895.32 |
3.2× |
| Xr bone survey infant (77076) |
$498.51 |
$1,246.26 |
4.5× |
| Xr bone survey ltd (77074) |
$575.86 |
$1,439.63 |
5.2× |
| Xr chest 1 view (71045) |
$172.70 |
$431.74 |
1.9× |
| Xr chest 2 views (71046) |
$184.23 |
$460.56 |
2.0× |
| Xr eye foreign body (70030) |
$168.36 |
$420.90 |
1.8× |
| Xr facial bones 3+ views (70150) |
$456.97 |
$1,142.42 |
4.1× |
| Xr foot arthritis pa only bilateral - report(ortho pro) (73620) |
$117.75 |
$294.36 |
1.3× |
| Xr forearm 2 views (73090) |
$305.75 |
$764.37 |
3.3× |
| Xr hand 2v (73120) |
$359.79 |
$899.46 |
3.3× |
| Xr hysterosalpingogram (74740) |
$498.27 |
$1,245.67 |
2.0× |
| Xr myelogram c-spine (72240) |
$1,019.31 |
$2,548.27 |
1.2× |
| Xr myelogram l-spine (72265) |
$1,019.31 |
$2,548.27 |
1.2× |
| Xr myelogram t-spine (72255) |
$1,019.31 |
$2,548.27 |
1.2× |
| Xr neck soft tissue (70360) |
$284 |
$709.99 |
3.1× |
| Xr o knee w/ merchant view bilat - report(ortho pro) (73562) |
$262.26 |
$655.65 |
2.9× |
| Xr osseous survey complete (77075) |
$700.45 |
$1,751.12 |
6.4× |
| Xr pelvis 1-2 views (72170) |
$239.46 |
$598.63 |
2.2× |
| Xr pelvis min 3 view (72190) |
$342.65 |
$856.62 |
3.1× |
| Xr sacrum/coccyx 2+ views (72220) |
$286.51 |
$716.26 |
3.1× |
| Xr shoulder 1 view (73020) |
$229.05 |
$572.62 |
2.5× |
| Xr sinuses 3+ views (70220) |
$415.42 |
$1,038.53 |
4.5× |
| Xr skull min 4 view (70260) |
$498.51 |
$1,246.26 |
4.5× |
| Xr spine 1 view (72020) |
$249.27 |
$623.16 |
2.7× |
| Xr spine thoracic 3v (72072) |
$342.65 |
$856.62 |
3.1× |
| Xr sternum 2+ views (71120) |
$309.42 |
$773.53 |
3.4× |
| Xr stress view joint (77071) |
$166.18 |
$415.43 |
1.8× |
| Xr surgical specimen (76098) |
$363.83 |
$909.56 |
0.6× |
| Xr t-spine 2 views (72070) |
$503.51 |
$1,258.77 |
4.6× |
| Xr tibia/fibula 2 views (73590) |
$288.62 |
$721.52 |
3.1× |
| Xr tmj bilateral (70330) |
$343.80 |
$859.49 |
3.7× |
| Xr tmj unilateral (70328) |
$108.14 |
$270.33 |
1.2× |
| Xr wrist 2 views (73100) |
$230.34 |
$575.84 |
2.5× |