| Ankle 2 views (73600) |
$149 |
$248 |
1.6× |
| Cholecystography, oral contrast Age Under 21 (74290) |
$182 |
$303 |
1.0× |
| Clavicle complete (73000) |
$211 |
$352 |
2.3× |
| Computed tomographic (CT) colonography, diagnostic, including image postprocessing; with contrast material(s) including… (74262) |
$944 |
$1,574 |
5.1× |
| Computed tomographic (CT) colonography, diagnostic, including image postprocessing; without contrast material Age Under… (74261) |
$754 |
$1,257 |
6.8× |
| Computed tomographic (CT) colonography, screening, including image postprocessing (74263) |
$484 |
$806 |
1.9× |
| Computed tomographic angiography, abdomen and pelvis, with contrast material(s), including noncontrast images, if… (74174) |
$2,923 |
$4,871 |
7.9× |
| Computed tomographic angiography, abdomen, with contrast material(s), including noncontrast images, if performed, and… (74175) |
$1,236 |
$2,060 |
6.7× |
| Computed tomographic angiography, abdominal aorta and bilateral iliofemoral lower extremity runoff, with contrast… (75635) |
$1,688 |
$2,814 |
9.1× |
| Computed tomographic angiography, chest (noncoronary), with contrast material(s), including noncontrast images, if… (71275) |
$1,971 |
$3,285 |
10.7× |
| Computed tomographic angiography, lower extremity, with contrast material(s), including noncontrast images, if… (73706) |
$862 |
$1,436 |
4.7× |
| Computed tomographic angiography, neck, with contrast material(s), including noncontrast images, if performed, and… (70498) |
$1,573 |
$2,621 |
8.5× |
| Computed tomographic angiography, pelvis, with contrast material(s), including noncontrast images, if performed, and… (72191) |
$1,275 |
$2,125 |
6.9× |
| Computed tomographic angiography, upper extremity, with contrast material(s), including noncontrast images, if… (73206) |
$825 |
$1,375 |
4.5× |
| Computed tomography, bone mineral density study, 1 or more sites, axial skeleton (eg, hips, pelvis, spine) Age Under 21 (77078) |
$279 |
$465 |
3.0× |
| Computed tomography, cervical spine; without contrast material, followed by contrast material(s) and further sections… (72127) |
$1,601 |
$2,669 |
8.7× |
| Computed tomography, lumbar spine; without contrast material, followed by contrast material(s) and further sections Age… (72133) |
$2,015 |
$3,358 |
10.9× |
| Computed tomography, maxillofacial area; with contrast material(s) Age Under 21 (70487) |
$1,211 |
$2,019 |
6.5× |
| Computed tomography, maxillofacial area; without contrast material Age Under 21 (70486) |
$802 |
$1,336 |
7.3× |
| Computed tomography, orbit, sella, or posterior fossa or outer, middle, or inner ear; with contrast material(s) Age… (70481) |
$1,147 |
$1,912 |
6.2× |
| Computed tomography, orbit, sella, or posterior fossa or outer, middle, or inner ear; without contrast material Age… (70480) |
$1,073 |
$1,789 |
9.7× |
| Computed tomography, orbit, sella, or posterior fossa or outer, middle, or inner ear; without contrast material,… (70482) |
$1,368 |
$2,280 |
7.4× |
| Computed tomography, thoracic spine; without contrast material, followed by contrast material(s) and further sections… (72130) |
$2,015 |
$3,358 |
10.9× |
| CT abdomen and pelvis without and with contrast (74178) |
$3,070 |
$5,117 |
8.3× |
| CT abdomen and pelvis without contrast (74176) |
$2,182 |
$3,636 |
8.7× |
| CT cervical spine w/contrast (72126) |
$1,598 |
$2,663 |
4.3× |
| CT extremity upper w & w/o contrast (73202) |
$1,051 |
$1,751 |
5.7× |
| CT l-spine w/contrast (72132) |
$1,938 |
$3,230 |
5.3× |
| CT lower extremity w/dye (73701) |
$2,828 |
$4,714 |
15.3× |
| CT maxillofacial w/wo contrast (70488) |
$1,426 |
$2,377 |
7.7× |
| CT thoracic spine w/contrast (72129) |
$1,938 |
$3,230 |
10.5× |
| CT thoracic spine w/o contrast (72128) |
$1,057 |
$1,762 |
9.6× |
| CTA h&n c+ w/noncontrast img (70471) |
$2,292 |
$3,820 |
6.2× |
| CTA head w contrast (70496) |
$1,219 |
$2,032 |
6.6× |
| Cystography, minimum of 3 views, radiological supervision and interpretation Age Under 21 (74430) |
$496 |
$826 |
1.3× |
| Fetal biophys profile w/o nst (76819) |
$365 |
$609 |
3.3× |
| Fluoroscopy up to 1 hour physician/qhp time (76000) |
$227 |
$379 |
0.9× |
| Gastric emptying imaging study (eg, solid, liquid, or both); with small bowel and colon transit, multiple days Age… (78266) |
$785 |
$1,308 |
1.4× |
| Gastric emptying imaging study (eg, solid, liquid, or both); with small bowel transit Age Under 21 (78265) |
$785 |
$1,308 |
1.9× |
| Hepatobiliary syst imaging including gallbladder (78226) |
$960 |
$1,600 |
2.3× |
| Ht muscle image spect sing (78451) |
$2,109 |
$3,515 |
1.5× |
| Kidney imaging morphology; with vascular flow and function, multiple studies, with and without pharmacological… (78709) |
$875 |
$1,458 |
1.5× |
| Magnetic resonance (eg, proton) imaging, any joint of lower extremity; without contrast material(s), followed by… (73723) |
$2,137 |
$3,562 |
5.8× |
| Magnetic resonance (eg, proton) imaging, lower extremity other than joint; with contrast material(s) Age Under 21 (73719) |
$1,683 |
$2,805 |
4.6× |
| Magnetic resonance (eg, proton) imaging, lower extremity other than joint; without contrast material(s) Age Under 21 (73718) |
$1,354 |
$2,257 |
5.4× |
| Magnetic resonance (eg, proton) imaging, lower extremity other than joint; without contrast material(s), followed by… (73720) |
$1,822 |
$3,037 |
5.0× |
| Magnetic resonance (eg, proton) imaging, orbit, face, and/or neck; with contrast material(s) Age Under 21 (70542) |
$2,015 |
$3,358 |
5.5× |
| Magnetic resonance (eg, proton) imaging, orbit, face, and/or neck; without contrast material(s) Age Under 21 (70540) |
$1,611 |
$2,685 |
6.4× |
| Magnetic resonance (eg, proton) imaging, upper extremity, other than joint; with contrast material(s) Age Under 21 (73219) |
$1,611 |
$2,685 |
4.4× |
| Magnetic resonance (eg, proton) imaging, upper extremity, other than joint; without contrast material(s), followed by… (73220) |
$1,635 |
$2,725 |
4.4× |
| Magnetic resonance angiography, head; with contrast material(s) Age Under 21 (70545) |
$1,611 |
$2,685 |
4.4× |
| Magnetic resonance angiography, head; without contrast material(s), followed by contrast material(s) and further… (70546) |
$2,302 |
$3,836 |
6.3× |
| Magnetic resonance angiography, neck; without contrast material(s), followed by contrast material(s) and further… (70549) |
$1,776 |
$2,960 |
4.8× |
| Mandible min 4v (70110) |
$274 |
$457 |
2.5× |
| MRA head w/o contrast (70544) |
$1,504 |
$2,506 |
6.0× |
| MRA neck w/ contrast (70548) |
$1,693 |
$2,822 |
4.6× |
| MRA neck w/o contrast (70547) |
$1,611 |
$2,685 |
6.4× |
| MRI abdomen w/contrast (74182) |
$1,823 |
$3,038 |
5.0× |
| MRI abdomen w/o contrast (74181) |
$1,482 |
$2,470 |
5.9× |
| MRI abdomen w/wo contrast (74183) |
$2,309 |
$3,848 |
6.3× |
| MRI any jt lower extrem w/contrast material (73722) |
$1,891 |
$3,152 |
2.3× |
| MRI c-spine w&w/o cont (72156) |
$2,390 |
$3,984 |
6.5× |
| MRI cervical spine w/contrast (72142) |
$2,119 |
$3,532 |
5.8× |
| MRI chest w/contrast (71551) |
$1,611 |
$2,685 |
1.9× |
| MRI chest w/o contrast (71550) |
$1,504 |
$2,506 |
6.0× |
| MRI chest w/wo contrast (71552) |
$2,449 |
$4,082 |
6.7× |
| MRI joint upr extr w/o&w/dye (73223) |
$1,910 |
$3,183 |
5.2× |
| MRI joint upr extrem w/dye (73222) |
$1,760 |
$2,934 |
2.1× |
| MRI joint upr extrem w/o dye (73221) |
$1,611 |
$2,685 |
6.4× |
| MRI lumbar spine w/contrast (72149) |
$2,119 |
$3,532 |
5.8× |
| MRI lumbar spine w/wo contrast (72158) |
$2,390 |
$3,984 |
6.5× |
| MRI orbit/face/neck w&w/o cont (70543) |
$2,419 |
$4,031 |
6.6× |
| MRI pelvis w & w/o contrast (72197) |
$1,876 |
$3,127 |
5.1× |
| MRI pelvis w/contrast (72196) |
$1,773 |
$2,955 |
4.8× |
| MRI pelvis w/o contrast (72195) |
$1,670 |
$2,783 |
6.6× |
| MRI t-spine w&w/o cont (72157) |
$2,390 |
$3,984 |
6.5× |
| MRI thoracic spine w/contrast (72147) |
$2,119 |
$3,532 |
5.8× |
| MRI tmj (70336) |
$1,250 |
$2,084 |
5.0× |
| MRI upper extremity oth than jt w/o contr matrl (73218) |
$1,535 |
$2,558 |
6.1× |
| Myocardial spect multiple studies (78452) |
$2,734 |
$4,557 |
2.0× |
| Nm adrenal imaging (78075) |
$2,008 |
$3,346 |
1.5× |
| Nm bone imaging whole body (78306) |
$898 |
$1,497 |
2.1× |
| Nm lung ventilation imaging (78579) |
$655 |
$1,091 |
1.6× |
| Ob us limited fetus(s) (76815) |
$281 |
$468 |
2.5× |
| Optic foramina (70190) |
$148 |
$247 |
1.6× |
| Parathyroid planar imaging (78070) |
$682 |
$1,137 |
1.6× |
| Parathyroid planar imaging w/wo subtraction (78071) |
$682 |
$1,137 |
1.6× |
| Pulmonary ventilation & perfusion imaging (78582) |
$1,058 |
$1,763 |
1.8× |
| Radex abscess/fistula/sinus tract rs&i (76080) |
$496 |
$826 |
0.9× |
| Radex entir thrc lmbr crv sac spi w/skull 1 vw (72081) |
$271 |
$451 |
3.0× |
| Radex entir thrc lmbr crv sac spi w/skull 2/3 vw (72082) |
$325 |
$541 |
2.9× |
| Radex hip unilateral with pelvis 1 view (73501) |
$242 |
$404 |
2.6× |
| Radex hip unilateral with pelvis 2-3 views (73502) |
$286 |
$477 |
3.1× |
| Radex hips bilateral with pelvis 2 views (73521) |
$188 |
$314 |
1.7× |
| Radex spine cervical 2 or 3 views (72040) |
$151 |
$252 |
1.6× |
| Radex spine cervical 4 or 5 views (72050) |
$289 |
$482 |
2.6× |
| Radex spine cervical 6 or more views (72052) |
$343 |
$572 |
3.1× |
| Radex spine thoracolumbar junction min 2 views (72080) |
$202 |
$337 |
2.2× |
| Radiologic exam chest 3 views (71047) |
$191 |
$319 |
2.1× |
| Radiologic exam chest 4+ views (71048) |
$164 |
$274 |
1.5× |
| Radiologic exam colon double contrast study (74280) |
$644 |
$1,074 |
3.5× |
| Radiologic exam colon single contrast study (74270) |
$335 |
$559 |
1.8× |
| Radiologic exam esophagus single contrast study (74220) |
$329 |
$549 |
1.8× |
| Radiologic exam small int single contrast study (74250) |
$324 |
$540 |
1.8× |
| Radiologic exam swallow function contrast study (74230) |
$279 |
$465 |
1.5× |
| Radiologic exam upr gi trc double contrast study (74246) |
$457 |
$762 |
2.5× |
| Radiologic exam upr gi trc single contrast study (74240) |
$368 |
$613 |
2.0× |
| Radiologic examination femur 1 view (73551) |
$151 |
$251 |
1.6× |
| Radiologic examination femur minimum 2 views (73552) |
$178 |
$297 |
1.9× |
| Radiologic examination, ankle; complete, minimum of 3 views Age Under 21 (73610) |
$194 |
$323 |
2.1× |
| Radiologic examination, complete acute abdomen series, including 2 or more views of the abdomen (eg, supine, erect,… (74022) |
$323 |
$538 |
2.9× |
| Radiologic examination, elbow; 2 views Age Under 21 (73070) |
$157 |
$262 |
1.7× |
| Radiologic examination, elbow; complete, minimum of 3 views Age Under 21 (73080) |
$195 |
$325 |
2.1× |
| Radiologic examination, facial bones; less than 3 views Age Under 21 (70140) |
$172 |
$286 |
1.9× |
| Radiologic examination, foot; complete, minimum of 3 views Age Under 21 (73630) |
$188 |
$314 |
2.0× |
| Radiologic examination, hand; minimum of 3 views Age Under 21 (73130) |
$191 |
$318 |
2.1× |
| Radiologic examination, knee; both knees, standing, anteroposterior Age Under 21 (73565) |
$119 |
$199 |
1.3× |
| Radiologic examination, knee; complete, 4 or more views Age Under 21 (73564) |
$209 |
$349 |
1.9× |
| Radiologic examination, mandible; partial, less than 4 views Age Under 21 (70100) |
$131 |
$218 |
1.4× |
| Radiologic examination, mastoids; complete, minimum of 3 views per side Age Under 21 (70130) |
$367 |
$612 |
3.3× |
| Radiologic examination, mastoids; less than 3 views per side Age Under 21 (70120) |
$306 |
$510 |
2.8× |
| Radiologic examination, nasal bones, complete, minimum of 3 views Age Under 21 (70160) |
$161 |
$269 |
1.8× |
| Radiologic examination, pharynx and/or cervical esophagus, including scout neck radiograph(s) and delayed image(s),… (74210) |
$236 |
$393 |
1.3× |
| Radiologic examination, ribs, bilateral; including posteroanterior chest, minimum of 4 views Age Under 21 (71111) |
$304 |
$506 |
2.8× |
| Radiologic examination, ribs, unilateral; including posteroanterior chest, minimum of 3 views Age Under 21 (71101) |
$194 |
$323 |
1.8× |
| Radiologic examination, sacroiliac joints; less than 3 views Age Under 21 (72200) |
$173 |
$288 |
1.6× |
| Radiologic examination, shoulder, arthrography, radiological supervision and interpretation Age Under 21 (73040) |
$590 |
$984 |
1.6× |
| Radiologic examination, shoulder; complete, minimum of 2 views Age Under 21 (73030) |
$195 |
$325 |
2.1× |
| Radiologic examination, single plane body section (eg, tomography), other than with urography Age Under 21 (76100) |
$346 |
$576 |
3.1× |
| Radiologic examination, sinuses, paranasal, less than 3 views Age Under 21 (70210) |
$151 |
$251 |
1.6× |
| Radiologic examination, skull; less than 4 views Age Under 21 (70250) |
$215 |
$359 |
1.9× |
| Radiologic examination, spine, lumbosacral; 2 or 3 views Age Under 21 (72100) |
$191 |
$318 |
1.7× |
| Radiologic examination, spine, lumbosacral; complete, including bending views, minimum of 6 views Age Under 21 (72114) |
$414 |
$690 |
3.8× |
| Radiologic examination, spine; thoracic, minimum of 4 views Age Under 21 (72074) |
$340 |
$566 |
3.1× |
| Radiologic examination, wrist; complete, minimum of 3 views Age Under 21 (73110) |
$174 |
$290 |
1.9× |
| Radiologic examination; acromioclavicular joints, bilateral, with or without weighted distraction Age Under 21 (73050) |
$191 |
$319 |
2.1× |
| Radiologic examination; humerus, minimum of 2 views Age Under 21 (73060) |
$145 |
$242 |
1.6× |
| Radiologic examination; lower extremity, infant, minimum of 2 views Age Under 21 (73592) |
$185 |
$308 |
2.0× |
| Radiologic examination; orbits, complete, minimum of 4 views Age Under 21 (70200) |
$248 |
$414 |
2.2× |
| Radiologic examination; sternoclavicular joint or joints, minimum of 3 views Age Under 21 (71130) |
$197 |
$329 |
2.1× |
| Radiologic examination; toe(s), minimum of 2 views Age Under 21 (73660) |
$115 |
$191 |
1.3× |
| Radiologic examination; upper extremity, infant, minimum of 2 views Age Under 21 (73092) |
$112 |
$186 |
1.0× |
| Radiopharmaceutical localization of tumor, inflammatory process or distribution of radiopharmaceutical agent(s)… (78803) |
$1,302 |
$2,170 |
2.3× |
| Review by radiologist of urinary bladder and urethra images with contrast and after passing urine (74455) |
$424 |
$706 |
1.7× |
| Rp loclzj tum plnr 1 area single day imaging (78800) |
$705 |
$1,175 |
1.7× |
| Rp loclzj tum plnr 2+area 1+d img/1 area img>2+d (78801) |
$1,039 |
$1,731 |
2.5× |
| Rp loclzj tum plnr whole body 2+ days imaging (78804) |
$1,039 |
$1,731 |
1.8× |
| Rp loclzj tum plnr whole body single day imaging (78802) |
$1,039 |
$1,731 |
1.8× |
| Scapula complete (73010) |
$169 |
$281 |
1.5× |
| Screening digital breast tomosynthesis bi (77063) |
$360 |
$600 |
— |
| Testicular imaging with vascular flow Age Under 21 (78761) |
$631 |
$1,052 |
1.5× |
| Thyroid uptake single/multiple quant measurement (78012) |
$386 |
$643 |
0.9× |
| Thyroid uptake w/blood flow sngle/mult quan meas (78014) |
$739 |
$1,232 |
1.8× |
| Ultrasound breast limited (76642) |
$157 |
$261 |
1.7× |
| Ultrasound, abdomen limited (76705) |
$376 |
$627 |
3.4× |
| Ultrasound, limited, joint or focal evaluation of other nonvascular extremity structure(s) (eg, joint space,… (76882) |
$322 |
$536 |
2.9× |
| Ultrasound, pelvic (nonobstetric), real time with image documentation; complete Age Under 21 (76856) |
$548 |
$914 |
5.0× |
| Ultrasound, pregnant uterus, real time with image documentation, fetal and maternal evaluation plus detailed fetal… (76811) |
$685.50 |
$1,142 |
2.7× |
| Ultrasound, pregnant uterus, real time with image documentation, fetal and maternal evaluation, first trimester (< 14… (76801) |
$528 |
$880 |
4.8× |
| Ultrasound, transplanted kidney, real time and duplex Doppler with image documentation Age Under 21 (76776) |
$342 |
$570 |
3.1× |
| Unlisted genitourinary procedure, diagnostic nuclear medicine (78799) |
$670 |
$1,117 |
1.6× |
| Urethrocystography retrograde rs&i (74450) |
$386 |
$644 |
1.5× |
| Urography antegrade rs&i (74425) |
$386 |
$644 |
1.0× |
| Urography, infusion, drip technique and/or bolus technique; with nephrotomography Age Under 21 (74415) |
$661 |
$1,101 |
3.6× |
| Us abdominal aorta real time screen study aaa (76706) |
$448 |
$746 |
4.1× |
| Us breast uni real time with image complete (76641) |
$232 |
$386 |
2.1× |
| Us chest (76604) |
$239 |
$398 |
2.2× |
| Us compl joint r-t w/image documentation (76881) |
$353 |
$589 |
3.2× |
| Us elastography organ (76981) |
$131 |
$219 |
1.2× |
| Us exam, pelvic, limited (76857) |
$314 |
$524 |
2.8× |
| US OB Follow-Up/Repeat (76816) |
$449 |
$749 |
4.1× |
| Us ob transvaginal (76817) |
$321 |
$535 |
2.9× |
| Us retroperitoneal complete (76770) |
$411 |
$685 |
3.7× |
| Us retroperitoneal ltd (76775) |
$342 |
$570 |
3.1× |
| Us scrotum (76870) |
$329 |
$549 |
3.0× |
| Us soft tissue head/neck (76536) |
$352 |
$587 |
3.2× |
| Us unlstd proc (76999) |
$259 |
$432 |
2.8× |
| Use 1st target lesion (76982) |
$112 |
$186 |
1.0× |
| X-ray exam hips bi 3-4 views (73522) |
$371 |
$618 |
3.4× |
| X-ray exam of finger(s) (73140) |
$146 |
$243 |
1.6× |
| X-ray exam of knee 1 or 2 (73560) |
$136 |
$227 |
1.5× |
| X-ray exam of small bowel - fl small bowel series enteroclysis tube (74251) |
$324 |
$540 |
1.8× |
| X-ray exam ribs bil 3 views (71110) |
$218 |
$363 |
2.0× |
| X-ray exam ribs uni 2 views (71100) |
$191 |
$318 |
2.1× |
| X-ray heel (73650) |
$126 |
$210 |
1.4× |
| X-ray of joint between lower spine and hip bone 3 or more views|PROFESSIONAL COMPONENT (72202) |
$195 |
$325 |
1.8× |
| X-ray retrograde pyelogram (74420) |
$411 |
$685 |
1.1× |
| Xr abdomen 1 view (74018) |
$127 |
$211 |
1.4× |
| Xr abdomen 2 views (74019) |
$151 |
$251 |
1.4× |
| Xr arthrogram ankle (73615) |
$590 |
$984 |
1.6× |
| Xr arthrogram hip (73525) |
$590 |
$984 |
1.6× |
| Xr arthrogram knee (73580) |
$590 |
$984 |
1.6× |
| Xr arthrogram wrist (73115) |
$590 |
$984 |
1.6× |
| Xr bone age studies (77072) |
$107 |
$179 |
1.0× |
| Xr bone length study (77073) |
$326 |
$544 |
3.0× |
| Xr bone survey infant (77076) |
$252 |
$420 |
2.3× |
| Xr bone survey ltd (77074) |
$233 |
$389 |
2.1× |
| Xr chest 1 view (71045) |
$121 |
$202 |
1.3× |
| Xr chest 2 views (71046) |
$178 |
$297 |
1.9× |
| Xr eye foreign body (70030) |
$184 |
$306 |
2.0× |
| Xr facial bones 3+ views (70150) |
$229 |
$381 |
2.1× |
| Xr foot arthritis pa only bilateral - report(ortho pro) (73620) |
$180.50 |
$300.50 |
2.0× |
| Xr forearm 2 views (73090) |
$155 |
$258 |
1.7× |
| Xr hand 2v (73120) |
$140 |
$234 |
1.3× |
| Xr hysterosalpingogram (74740) |
$496 |
$826 |
2.0× |
| Xr neck soft tissue (70360) |
$185 |
$309 |
2.0× |
| Xr o knee w/ merchant view bilat - report(ortho pro) (73562) |
$208 |
$346 |
2.3× |
| Xr osseous survey complete (77075) |
$469 |
$781 |
4.3× |
| Xr pelvis 1-2 views (72170) |
$139 |
$231 |
1.3× |
| Xr pelvis min 3 view (72190) |
$176 |
$294 |
1.6× |
| Xr sacrum/coccyx 2+ views (72220) |
$201 |
$335 |
2.2× |
| Xr sella turcica (70240) |
$107 |
$179 |
1.2× |
| Xr shoulder 1 view (73020) |
$164 |
$274 |
1.8× |
| Xr sinuses 3+ views (70220) |
$287 |
$479 |
3.1× |
| Xr skull min 4 view (70260) |
$321 |
$535 |
2.9× |
| Xr spine 1 view (72020) |
$149 |
$248 |
1.6× |
| Xr spine thoracic 3v (72072) |
$283 |
$472 |
2.6× |
| Xr sternum 2+ views (71120) |
$166 |
$276 |
1.8× |
| Xr surgical specimen (76098) |
$842 |
$1,403 |
1.5× |
| Xr t-spine 2 views (72070) |
$181 |
$301 |
1.6× |
| Xr tibia/fibula 2 views (73590) |
$188 |
$314 |
2.0× |
| Xr tmj bilateral (70330) |
$245 |
$408 |
2.7× |
| Xr tmj unilateral (70328) |
$197 |
$328 |
2.1× |
| Xr wrist 2 views (73100) |
$174 |
$290 |
1.9× |