| Acute gi blood loss imaging (78278) |
$828.46 |
$1,104.61 |
2.0× |
| Ankle 2 views (73600) |
$177.56 |
$236.75 |
1.9× |
| Clavicle complete (73000) |
$209.63 |
$279.51 |
2.3× |
| Computed tomographic angiography, abdomen and pelvis, with contrast material(s), including noncontrast images, if… (74174) |
$3,085.85 |
$4,114.47 |
8.4× |
| Computed tomographic angiography, abdomen, with contrast material(s), including noncontrast images, if performed, and… (74175) |
$1,829.36 |
$2,439.15 |
9.9× |
| Computed tomographic angiography, abdominal aorta and bilateral iliofemoral lower extremity runoff, with contrast… (75635) |
$2,704.27 |
$3,605.70 |
14.6× |
| Computed tomographic angiography, chest (noncoronary), with contrast material(s), including noncontrast images, if… (71275) |
$1,829.36 |
$2,439.15 |
9.9× |
| Computed tomographic angiography, lower extremity, with contrast material(s), including noncontrast images, if… (73706) |
$1,510.07 |
$2,013.43 |
8.2× |
| Computed tomographic angiography, neck, with contrast material(s), including noncontrast images, if performed, and… (70498) |
$2,051.93 |
$2,735.90 |
11.1× |
| Computed tomographic angiography, pelvis, with contrast material(s), including noncontrast images, if performed, and… (72191) |
$1,846.73 |
$2,462.31 |
10.0× |
| Computed tomography, cervical spine; without contrast material, followed by contrast material(s) and further sections… (72127) |
$2,025.58 |
$2,700.78 |
10.9× |
| Computed tomography, lower extremity; without contrast material Age Under 21 (73700) |
$1,105.11 |
$1,473.48 |
10.0× |
| Computed tomography, lower extremity; without contrast material, followed by contrast material(s) and further sections… (73702) |
$1,497.17 |
$1,996.23 |
8.1× |
| Computed tomography, lumbar spine; without contrast material, followed by contrast material(s) and further sections Age… (72133) |
$1,497.17 |
$1,996.23 |
8.1× |
| Computed tomography, maxillofacial area; with contrast material(s) Age Under 21 (70487) |
$1,495.15 |
$1,993.53 |
8.1× |
| Computed tomography, maxillofacial area; without contrast material Age Under 21 (70486) |
$1,105.11 |
$1,473.48 |
10.0× |
| Computed tomography, orbit, sella, or posterior fossa or outer, middle, or inner ear; with contrast material(s) Age… (70481) |
$1,105.11 |
$1,473.48 |
6.0× |
| Computed tomography, orbit, sella, or posterior fossa or outer, middle, or inner ear; without contrast material Age… (70480) |
$1,300.12 |
$1,733.50 |
11.8× |
| Computed tomography, orbit, sella, or posterior fossa or outer, middle, or inner ear; without contrast material,… (70482) |
$1,497.17 |
$1,996.23 |
8.1× |
| Computed tomography, soft tissue neck; without contrast material followed by contrast material(s) and further sections… (70492) |
$1,761.38 |
$2,348.50 |
9.5× |
| Computed tomography, thoracic spine; without contrast material, followed by contrast material(s) and further sections… (72130) |
$1,585.24 |
$2,113.65 |
8.6× |
| Computed tomography, thorax, diagnostic; without contrast material, followed by contrast material(s) and further… (71270) |
$1,760.36 |
$2,347.16 |
9.5× |
| CT abdomen and pelvis without and with contrast (74178) |
$3,061.42 |
$4,081.90 |
8.3× |
| CT abdomen and pelvis without contrast (74176) |
$2,210.15 |
$2,946.87 |
8.8× |
| CT abdomen w & w/o contrast (74170) |
$1,496.16 |
$1,994.88 |
8.1× |
| CT abdomen w/contrast (74160) |
$1,495.15 |
$1,993.53 |
8.1× |
| CT abdomen w/o contrast (74150) |
$1,300.12 |
$1,733.50 |
11.8× |
| CT cervical spine w/contrast (72126) |
$1,495.15 |
$1,993.53 |
4.1× |
| CT cervical spine w/o contrast (72125) |
$1,495.15 |
$1,993.53 |
13.6× |
| CT chest w/contrast (71260) |
$1,495.15 |
$1,993.53 |
8.1× |
| CT extremity upper w & w/o contrast (73202) |
$1,585.24 |
$2,113.65 |
8.6× |
| CT extremity upper w/o contrast (73200) |
$1,300.12 |
$1,733.50 |
11.8× |
| CT head/brain with contrast (70460) |
$1,495.15 |
$1,993.53 |
8.1× |
| CT head/brain without and with contrast (70470) |
$1,761.38 |
$2,348.50 |
9.5× |
| CT l-spine w/contrast (72132) |
$1,495.15 |
$1,993.53 |
4.1× |
| CT lower extremity w/dye (73701) |
$1,300.12 |
$1,733.50 |
7.0× |
| CT lumbar spine w/o contrast (72131) |
$1,495.15 |
$1,993.53 |
13.6× |
| CT maxillofacial w/wo contrast (70488) |
$1,497.17 |
$1,996.23 |
8.1× |
| CT neck w/contrast (70491) |
$1,350.55 |
$1,800.73 |
7.3× |
| CT neck w/o contrast (70490) |
$1,300.12 |
$1,733.50 |
11.8× |
| CT pelvis w & w/o contrast (72194) |
$1,760.36 |
$2,347.16 |
9.5× |
| CT pelvis w/o contrast (72192) |
$1,495.15 |
$1,993.53 |
13.6× |
| CT thoracic spine w/contrast (72129) |
$1,495.15 |
$1,993.53 |
8.1× |
| CT thoracic spine w/o contrast (72128) |
$1,495.15 |
$1,993.53 |
13.6× |
| CT thorax lung cancer scr c- (71271) |
$1,170.11 |
$1,560.15 |
10.6× |
| CT thorax w/o contrast (71250) |
$1,495.15 |
$1,993.53 |
13.6× |
| CT upper extremity w/dye (73201) |
$1,495.15 |
$1,993.53 |
4.1× |
| CTA head w contrast (70496) |
$1,829.36 |
$2,439.15 |
9.9× |
| Cystography, minimum of 3 views, radiological supervision and interpretation Age Under 21 (74430) |
$532.95 |
$710.60 |
1.4× |
| Fetal biophysical profile non-stress testing (76818) |
$767.40 |
$1,023.20 |
7.0× |
| Fluoroscopy up to 1 hour physician/qhp time (76000) |
$622.12 |
$829.50 |
2.5× |
| Gated heart planar single (78472) |
$1,462.50 |
$1,950 |
3.5× |
| Heart infarct image (78466) |
$684.26 |
$912.34 |
1.6× |
| Hepatobil syst imag inc gb w/pharma intervenj (78227) |
$932.30 |
$1,243.06 |
1.6× |
| Hepatobiliary syst imaging including gallbladder (78226) |
$932.30 |
$1,243.06 |
2.2× |
| Ht muscle image spect sing (78451) |
$1,119.88 |
$1,493.18 |
0.8× |
| Intestine imaging (eg, ectopic gastric mucosa, Meckel's localization, volvulus) Age Under 21 (78290) |
$778.15 |
$1,037.53 |
1.8× |
| Kidney imaging morphol - nm kidney cortex (78700) |
$804.08 |
$1,072.11 |
1.9× |
| Kidney imaging morphology; with vascular flow Age Under 21 (78701) |
$932.30 |
$1,243.06 |
2.2× |
| Kidney imaging morphology; with vascular flow and function, multiple studies, with and without pharmacological… (78709) |
$1,258.43 |
$1,677.91 |
2.2× |
| Kidney imaging morphology; with vascular flow and function, single study without pharmacological intervention Age Under… (78707) |
$1,471.18 |
$1,961.57 |
2.6× |
| Kidney imaging morphology; with vascular flow and function, single study, with pharmacological intervention (eg,… (78708) |
$1,208.03 |
$1,610.70 |
2.1× |
| Liver and spleen imaging (78215) |
$725.01 |
$966.68 |
1.7× |
| Liver and spleen imaging; with vascular flow Age Under 21 (78216) |
$881.20 |
$1,174.94 |
2.1× |
| Lung perfusion imaging (78580) |
$838.30 |
$1,117.74 |
2.0× |
| Magnetic resonance (eg, proton) imaging, any joint of lower extremity; without contrast material(s), followed by… (73723) |
$1,643.25 |
$2,191 |
4.5× |
| Magnetic resonance (eg, proton) imaging, lower extremity other than joint; with contrast material(s) Age Under 21 (73719) |
$1,320.38 |
$1,760.50 |
3.6× |
| Magnetic resonance (eg, proton) imaging, lower extremity other than joint; without contrast material(s) Age Under 21 (73718) |
$1,320.38 |
$1,760.50 |
5.2× |
| Magnetic resonance (eg, proton) imaging, lower extremity other than joint; without contrast material(s), followed by… (73720) |
$1,643.25 |
$2,191 |
4.5× |
| Magnetic resonance (eg, proton) imaging, orbit, face, and/or neck; with contrast material(s) Age Under 21 (70542) |
$1,320.38 |
$1,760.50 |
3.6× |
| Magnetic resonance (eg, proton) imaging, orbit, face, and/or neck; without contrast material(s) Age Under 21 (70540) |
$1,320.38 |
$1,760.50 |
5.2× |
| Magnetic resonance (eg, proton) imaging, upper extremity, other than joint; with contrast material(s) Age Under 21 (73219) |
$1,320.38 |
$1,760.50 |
3.6× |
| Magnetic resonance (eg, proton) imaging, upper extremity, other than joint; without contrast material(s), followed by… (73220) |
$1,643.25 |
$2,191 |
4.5× |
| Magnetic resonance angiography, head; with contrast material(s) Age Under 21 (70545) |
$1,320.11 |
$1,760.15 |
3.6× |
| Magnetic resonance angiography, head; without contrast material(s), followed by contrast material(s) and further… (70546) |
$1,642.94 |
$2,190.58 |
4.5× |
| Magnetic resonance angiography, neck; without contrast material(s), followed by contrast material(s) and further… (70549) |
$1,643.25 |
$2,191 |
4.5× |
| MRA head w/o contrast (70544) |
$1,320.38 |
$1,760.50 |
5.2× |
| MRI abdomen w/contrast (74182) |
$1,320.38 |
$1,760.50 |
3.6× |
| MRI abdomen w/o contrast (74181) |
$1,320.38 |
$1,760.50 |
5.2× |
| MRI abdomen w/wo contrast (74183) |
$1,643.25 |
$2,191 |
4.5× |
| MRI any jt lower extrem w/contrast material (73722) |
$1,320.38 |
$1,760.50 |
1.6× |
| MRI c-spine w&w/o cont (72156) |
$1,643.25 |
$2,191 |
4.5× |
| MRI cervical spine w/contrast (72142) |
$1,320.38 |
$1,760.50 |
3.6× |
| MRI chest w/contrast (71551) |
$1,320.38 |
$1,760.50 |
1.6× |
| MRI chest w/o contrast (71550) |
$1,320.38 |
$1,760.50 |
5.2× |
| MRI chest w/wo contrast (71552) |
$1,643.25 |
$2,191 |
4.5× |
| MRI joint upr extr w/o&w/dye (73223) |
$1,643.25 |
$2,191 |
4.5× |
| MRI joint upr extrem w/dye (73222) |
$1,320.38 |
$1,760.50 |
1.6× |
| MRI joint upr extrem w/o dye (73221) |
$1,320.38 |
$1,760.50 |
5.2× |
| MRI lumbar spine w/contrast (72149) |
$1,320.38 |
$1,760.50 |
3.6× |
| MRI lumbar spine w/wo contrast (72158) |
$1,643.25 |
$2,191 |
4.5× |
| MRI orbit/face/neck w&w/o cont (70543) |
$1,643.25 |
$2,191 |
4.5× |
| MRI pelvis w & w/o contrast (72197) |
$1,643.25 |
$2,191 |
4.5× |
| MRI pelvis w/contrast (72196) |
$1,320.38 |
$1,760.50 |
3.6× |
| MRI pelvis w/o contrast (72195) |
$1,320.38 |
$1,760.50 |
5.2× |
| MRI spine cervical w/o contrast (72141) |
$1,320.38 |
$1,760.50 |
5.2× |
| MRI t-spine w&w/o cont (72157) |
$1,643.25 |
$2,191 |
4.5× |
| MRI thoracic spine w/contrast (72147) |
$1,320.38 |
$1,760.50 |
3.6× |
| MRI thoracic spine w/o contrst (72146) |
$1,320.38 |
$1,760.50 |
5.2× |
| MRI upper extremity oth than jt w/o contr matrl (73218) |
$1,320.38 |
$1,760.50 |
5.2× |
| Myocardial spect multiple studies (78452) |
$2,466.65 |
$3,288.87 |
1.8× |
| Nm bone 3 phase (78315) |
$956.47 |
$1,275.30 |
2.3× |
| Nm bone imaging whole body (78306) |
$915.14 |
$1,220.18 |
2.2× |
| Nm gastric emptying (78264) |
$1,043.44 |
$1,391.26 |
2.5× |
| Nm lymph system (78195) |
$853.61 |
$1,138.15 |
1.5× |
| Nm salivary gland (78230) |
$752.60 |
$1,003.47 |
1.8× |
| Nuclear medicine study of bone and/or joint limited area (78300) |
$778.73 |
$1,038.31 |
1.8× |
| Nuclear medicine study of bone and/or joint multiple areas (78305) |
$872.53 |
$1,163.37 |
2.1× |
| Nuclear medicine study to assess blood clot in vein of both sides (78458) |
$1,197.40 |
$1,596.53 |
2.8× |
| Ob us limited fetus(s) (76815) |
$429.90 |
$573.20 |
3.9× |
| Parathyroid planar imaging (78070) |
$992.16 |
$1,322.88 |
2.4× |
| Pulmonary ventilation & perfusion imaging (78582) |
$1,796.14 |
$2,394.86 |
3.1× |
| Radex entir thrc lmbr crv sac spi w/skull 1 vw (72081) |
$370.54 |
$494.06 |
4.0× |
| Radex hip unilateral with pelvis 1 view (73501) |
$351.68 |
$468.91 |
3.8× |
| Radex hip unilateral with pelvis 2-3 views (73502) |
$328.10 |
$437.47 |
3.6× |
| Radex hips bilateral with pelvis 2 views (73521) |
$432.44 |
$576.58 |
3.9× |
| Radex spine cervical 2 or 3 views (72040) |
$296.59 |
$395.45 |
3.2× |
| Radex spine cervical 4 or 5 views (72050) |
$434.78 |
$579.70 |
3.9× |
| Radex spine cervical 6 or more views (72052) |
$651.97 |
$869.29 |
5.9× |
| Radiologic exam abdomen 3+ views (74021) |
$361.05 |
$481.40 |
3.3× |
| Radiologic exam chest 3 views (71047) |
$273.58 |
$364.78 |
3.0× |
| Radiologic exam chest 4+ views (71048) |
$356.95 |
$475.93 |
3.2× |
| Radiologic examination femur 1 view (73551) |
$244.61 |
$326.15 |
2.7× |
| Radiologic examination femur minimum 2 views (73552) |
$335.72 |
$447.63 |
3.7× |
| Radiologic examination, ankle; complete, minimum of 3 views Age Under 21 (73610) |
$201.54 |
$268.72 |
2.2× |
| Radiologic examination, complete acute abdomen series, including 2 or more views of the abdomen (eg, supine, erect,… (74022) |
$361.05 |
$481.40 |
3.3× |
| Radiologic examination, elbow; 2 views Age Under 21 (73070) |
$177.56 |
$236.75 |
1.9× |
| Radiologic examination, elbow; complete, minimum of 3 views Age Under 21 (73080) |
$300.36 |
$400.48 |
3.3× |
| Radiologic examination, foot; complete, minimum of 3 views Age Under 21 (73630) |
$209.63 |
$279.51 |
2.3× |
| Radiologic examination, hand; minimum of 3 views Age Under 21 (73130) |
$209.63 |
$279.51 |
2.3× |
| Radiologic examination, knee; complete, 4 or more views Age Under 21 (73564) |
$434.78 |
$579.70 |
3.9× |
| Radiologic examination, nasal bones, complete, minimum of 3 views Age Under 21 (70160) |
$335.72 |
$447.63 |
3.7× |
| Radiologic examination, ribs, bilateral; including posteroanterior chest, minimum of 4 views Age Under 21 (71111) |
$514.51 |
$686.01 |
4.7× |
| Radiologic examination, ribs, unilateral; including posteroanterior chest, minimum of 3 views Age Under 21 (71101) |
$451.42 |
$601.90 |
4.1× |
| Radiologic examination, shoulder, arthrography, radiological supervision and interpretation Age Under 21 (73040) |
$582.26 |
$776.35 |
1.6× |
| Radiologic examination, shoulder; complete, minimum of 2 views Age Under 21 (73030) |
$205.59 |
$274.12 |
2.2× |
| Radiologic examination, sinuses, paranasal, less than 3 views Age Under 21 (70210) |
$181.91 |
$242.55 |
2.0× |
| Radiologic examination, skull; less than 4 views Age Under 21 (70250) |
$296.32 |
$395.09 |
2.7× |
| Radiologic examination, spine, lumbosacral; 2 or 3 views Age Under 21 (72100) |
$324.04 |
$432.05 |
2.9× |
| Radiologic examination, spine, lumbosacral; bending views only, 2 or 3 views Age Under 21 (72120) |
$354.20 |
$472.27 |
3.2× |
| Radiologic examination, spine, lumbosacral; complete, including bending views, minimum of 6 views Age Under 21 (72114) |
$651.97 |
$869.29 |
5.9× |
| Radiologic examination, wrist; complete, minimum of 3 views Age Under 21 (73110) |
$209.63 |
$279.51 |
2.3× |
| Radiologic examination; acromioclavicular joints, bilateral, with or without weighted distraction Age Under 21 (73050) |
$231.10 |
$308.13 |
2.5× |
| Radiologic examination; humerus, minimum of 2 views Age Under 21 (73060) |
$205.59 |
$274.12 |
2.2× |
| Radiologic examination; lower extremity, infant, minimum of 2 views Age Under 21 (73592) |
$229.88 |
$306.50 |
2.5× |
| Radiologic examination; orbits, complete, minimum of 4 views Age Under 21 (70200) |
$268.59 |
$358.12 |
2.4× |
| Radiologic examination; toe(s), minimum of 2 views Age Under 21 (73660) |
$158.01 |
$210.68 |
1.7× |
| Radiologic examination; upper extremity, infant, minimum of 2 views Age Under 21 (73092) |
$229.88 |
$306.50 |
2.1× |
| Radiopharmaceutical localization of tumor, inflammatory process or distribution of radiopharmaceutical agent(s)… (78803) |
$1,026.38 |
$1,368.51 |
1.8× |
| Rp loclzj tum plnr 1 area single day imaging (78800) |
$1,283.10 |
$1,710.80 |
3.0× |
| Rp loclzj tum plnr 2+area 1+d img/1 area img>2+d (78801) |
$2,058.32 |
$2,744.43 |
4.9× |
| Rp loclzj tum plnr whole body single day imaging (78802) |
$1,385.67 |
$1,847.56 |
2.4× |
| Scapula complete (73010) |
$241.10 |
$321.47 |
2.2× |
| Screening digital breast tomosynthesis bi (77063) |
$45.24 |
$60.32 |
— |
| Testicular imaging with vascular flow Age Under 21 (78761) |
$736.32 |
$981.76 |
1.7× |
| Ultrasound breast limited (76642) |
$353.96 |
$471.95 |
3.9× |
| Ultrasound, abdomen limited (76705) |
$465.64 |
$620.86 |
4.2× |
| Ultrasound, limited, joint or focal evaluation of other nonvascular extremity structure(s) (eg, joint space,… (76882) |
$330.53 |
$440.71 |
3.0× |
| Ultrasound, pelvic (nonobstetric), real time with image documentation; complete Age Under 21 (76856) |
$503.36 |
$671.15 |
4.6× |
| Ultrasound, pregnant uterus, real time with image documentation, fetal and maternal evaluation, first trimester (< 14… (76801) |
$233.10 |
$310.80 |
2.1× |
| Ureteral reflux study (78740) |
$1,034.86 |
$1,379.82 |
2.5× |
| Urethrocystography retrograde rs&i (74450) |
$659.85 |
$879.80 |
2.6× |
| Urography (pyelography), intravenous, with or without KUB, with or without tomography Age Under 21 (74400) |
$659.78 |
$879.70 |
3.6× |
| Us abdominal aorta real time screen study aaa (76706) |
$252.88 |
$337.17 |
2.3× |
| Us breast uni real time with image complete (76641) |
$295.48 |
$393.97 |
2.7× |
| Us chest (76604) |
$323.49 |
$431.32 |
2.9× |
| US OB Follow-Up/Repeat (76816) |
$487.12 |
$649.50 |
4.4× |
| Us ob transvaginal (76817) |
$723.97 |
$965.30 |
6.6× |
| Us retroperitoneal complete (76770) |
$531.12 |
$708.16 |
4.8× |
| Us retroperitoneal ltd (76775) |
$347.17 |
$462.89 |
3.1× |
| Us scrotum (76870) |
$453.86 |
$605.14 |
4.1× |
| Us soft tissue head/neck (76536) |
$519.79 |
$693.05 |
4.7× |
| Us transrectal (76872) |
$767.40 |
$1,023.20 |
7.0× |
| Venous thrombosis imaging - nm extremity veins thrombosis right (78457) |
$1,197.40 |
$1,596.53 |
2.1× |
| X-ray exam of finger(s) (73140) |
$158.01 |
$210.68 |
1.7× |
| X-ray exam of knee 1 or 2 (73560) |
$197.57 |
$263.43 |
2.2× |
| X-ray exam ribs bil 3 views (71110) |
$339.92 |
$453.23 |
3.1× |
| X-ray exam ribs uni 2 views (71100) |
$276.84 |
$369.12 |
3.0× |
| X-ray heel (73650) |
$209.63 |
$279.51 |
2.3× |
| X-ray retrograde pyelogram (74420) |
$667.58 |
$890.10 |
1.8× |
| Xr abdomen 1 view (74018) |
$221.10 |
$294.80 |
2.4× |
| Xr abdomen 2 views (74019) |
$361.05 |
$481.40 |
3.3× |
| Xr bone survey infant (77076) |
$739.79 |
$986.39 |
6.7× |
| Xr chest 1 view (71045) |
$222.98 |
$297.31 |
2.4× |
| Xr chest 2 views (71046) |
$273.58 |
$364.78 |
3.0× |
| Xr facial bones 3+ views (70150) |
$335.72 |
$447.63 |
3.0× |
| Xr foot arthritis pa only bilateral - report(ortho pro) (73620) |
$177.56 |
$236.75 |
1.9× |
| Xr forearm 2 views (73090) |
$209.63 |
$279.51 |
2.3× |
| Xr hand 2v (73120) |
$177.56 |
$236.75 |
1.6× |
| Xr neck soft tissue (70360) |
$190.27 |
$253.70 |
2.1× |
| Xr o knee w/ merchant view bilat - report(ortho pro) (73562) |
$248.96 |
$331.95 |
2.7× |
| Xr osseous survey complete (77075) |
$739.79 |
$986.39 |
6.7× |
| Xr pelvis 1-2 views (72170) |
$217.50 |
$290 |
2.0× |
| Xr sacrum/coccyx 2+ views (72220) |
$268.59 |
$358.12 |
2.9× |
| Xr shoulder 1 view (73020) |
$174.66 |
$232.88 |
1.9× |
| Xr sinuses 3+ views (70220) |
$335.72 |
$447.63 |
3.7× |
| Xr skull min 4 view (70260) |
$434.78 |
$579.70 |
3.9× |
| Xr spine 1 view (72020) |
$174.35 |
$232.47 |
1.9× |
| Xr sternum 2+ views (71120) |
$268.59 |
$358.12 |
2.9× |
| Xr surgical specimen (76098) |
$76.24 |
$101.66 |
0.1× |
| Xr t-spine 2 views (72070) |
$252.94 |
$337.25 |
2.3× |
| Xr tibia/fibula 2 views (73590) |
$268.59 |
$358.12 |
2.9× |
| Xr wrist 2 views (73100) |
$177.56 |
$236.75 |
1.9× |