| Ankle 2 views (73600) |
$228.60 |
$304.80 |
2.6× |
| Clavicle complete (73000) |
$153.52 |
$204.70 |
1.7× |
| Computed tomographic angiography, abdomen and pelvis, with contrast material(s), including noncontrast images, if… (74174) |
$4,136.55 |
$5,515.40 |
11.6× |
| Computed tomographic angiography, abdomen, with contrast material(s), including noncontrast images, if performed, and… (74175) |
$4,226.25 |
$5,635 |
23.6× |
| Computed tomographic angiography, abdominal aorta and bilateral iliofemoral lower extremity runoff, with contrast… (75635) |
$3,455.18 |
$4,606.90 |
19.3× |
| Computed tomographic angiography, chest (noncoronary), with contrast material(s), including noncontrast images, if… (71275) |
$2,415.90 |
$3,221.20 |
13.5× |
| Computed tomographic angiography, lower extremity, with contrast material(s), including noncontrast images, if… (73706) |
$1,487.85 |
$1,983.80 |
8.3× |
| Computed tomographic angiography, neck, with contrast material(s), including noncontrast images, if performed, and… (70498) |
$2,111.40 |
$2,815.20 |
11.8× |
| Computed tomographic angiography, pelvis, with contrast material(s), including noncontrast images, if performed, and… (72191) |
$2,156.25 |
$2,875 |
12.0× |
| Computed tomographic angiography, upper extremity, with contrast material(s), including noncontrast images, if… (73206) |
$1,967.40 |
$2,623.20 |
11.0× |
| Computed tomography, cervical spine; without contrast material, followed by contrast material(s) and further sections… (72127) |
$2,203.72 |
$2,938.30 |
12.3× |
| Computed tomography, lower extremity; without contrast material Age Under 21 (73700) |
$1,493.85 |
$1,991.80 |
14.0× |
| Computed tomography, lower extremity; without contrast material, followed by contrast material(s) and further sections… (73702) |
$1,914.75 |
$2,553 |
10.7× |
| Computed tomography, lumbar spine; without contrast material, followed by contrast material(s) and further sections Age… (72133) |
$2,107.95 |
$2,810.60 |
11.8× |
| Computed tomography, maxillofacial area; with contrast material(s) Age Under 21 (70487) |
$1,805.25 |
$2,407 |
10.1× |
| Computed tomography, maxillofacial area; without contrast material Age Under 21 (70486) |
$1,417.95 |
$1,890.60 |
13.3× |
| Computed tomography, orbit, sella, or posterior fossa or outer, middle, or inner ear; with contrast material(s) Age… (70481) |
$1,823.32 |
$2,431.10 |
10.2× |
| Computed tomography, orbit, sella, or posterior fossa or outer, middle, or inner ear; without contrast material Age… (70480) |
$1,631.85 |
$2,175.80 |
15.3× |
| Computed tomography, orbit, sella, or posterior fossa or outer, middle, or inner ear; without contrast material,… (70482) |
$2,236.50 |
$2,982 |
12.5× |
| Computed tomography, soft tissue neck; without contrast material followed by contrast material(s) and further sections… (70492) |
$2,082.98 |
$2,777.30 |
11.6× |
| Computed tomography, thoracic spine; without contrast material, followed by contrast material(s) and further sections… (72130) |
$2,105.40 |
$2,807.20 |
11.7× |
| Computed tomography, thorax, diagnostic; without contrast material, followed by contrast material(s) and further… (71270) |
$2,116.16 |
$2,821.55 |
11.8× |
| CT abdomen and pelvis without and with contrast (74178) |
$3,735.52 |
$4,980.70 |
10.5× |
| CT abdomen and pelvis without contrast (74176) |
$2,548.72 |
$3,398.30 |
10.5× |
| CT abdomen w & w/o contrast (74170) |
$2,070 |
$2,760 |
11.6× |
| CT abdomen w/contrast (74160) |
$1,716.38 |
$2,288.50 |
9.6× |
| CT abdomen w/o contrast (74150) |
$1,398.15 |
$1,864.20 |
13.1× |
| CT cervical spine w/contrast (72126) |
$1,938.08 |
$2,584.10 |
5.4× |
| CT cervical spine w/o contrast (72125) |
$1,919.92 |
$2,559.90 |
18.0× |
| CT chest w/contrast (71260) |
$2,023.88 |
$2,698.50 |
11.3× |
| CT extremity upper w & w/o contrast (73202) |
$2,015.70 |
$2,687.60 |
11.2× |
| CT extremity upper w/o contrast (73200) |
$1,083.30 |
$1,444.40 |
10.1× |
| CT head/brain with contrast (70460) |
$1,643.10 |
$2,190.80 |
9.2× |
| CT head/brain without and with contrast (70470) |
$1,756.95 |
$2,342.60 |
9.8× |
| CT l-spine w/contrast (72132) |
$1,983.75 |
$2,645 |
5.6× |
| CT limited/localized follow up study (76380) |
$950.48 |
$1,267.30 |
10.7× |
| CT lower extremity w/dye (73701) |
$1,679.32 |
$2,239.10 |
9.4× |
| CT lumbar spine w/o contrast (72131) |
$1,938.08 |
$2,584.10 |
18.1× |
| CT maxillofacial w/wo contrast (70488) |
$2,032.05 |
$2,709.40 |
11.3× |
| CT neck w/contrast (70491) |
$1,764.68 |
$2,352.90 |
9.8× |
| CT neck w/o contrast (70490) |
$1,646.55 |
$2,195.40 |
15.4× |
| CT pelvis w & w/o contrast (72194) |
$1,914.75 |
$2,553 |
10.7× |
| CT pelvis w/o contrast (72192) |
$1,622.40 |
$2,163.20 |
15.2× |
| CT thoracic spine w/contrast (72129) |
$1,945.80 |
$2,594.40 |
10.9× |
| CT thoracic spine w/o contrast (72128) |
$1,823.32 |
$2,431.10 |
17.1× |
| CT thorax w/o contrast (71250) |
$1,666.35 |
$2,221.80 |
15.6× |
| CT upper extremity w/dye (73201) |
$1,343.78 |
$1,791.70 |
3.8× |
| CTA head w contrast (70496) |
$2,252.85 |
$3,003.80 |
12.6× |
| Dual-energy X-ray absorptiometry (DXA), bone density study, 1 or more sites; axial skeleton (eg, hips, pelvis, spine)… (77080) |
$400.20 |
$533.60 |
3.7× |
| Dxa bone density study axial skeleton (77085) |
$419.18 |
$558.90 |
3.9× |
| Dxa bone density/peripheral (77081) |
$363.15 |
$484.20 |
4.1× |
| Fetal biophys profile w/o nst (76819) |
$273.45 |
$364.60 |
2.6× |
| Magnetic resonance (eg, proton) imaging, any joint of lower extremity; without contrast material(s), followed by… (73723) |
$2,214.90 |
$2,953.20 |
6.2× |
| Magnetic resonance (eg, proton) imaging, lower extremity other than joint; without contrast material(s) Age Under 21 (73718) |
$1,778.48 |
$2,371.30 |
7.3× |
| Magnetic resonance (eg, proton) imaging, lower extremity other than joint; without contrast material(s), followed by… (73720) |
$2,258.02 |
$3,010.70 |
6.3× |
| Magnetic resonance (eg, proton) imaging, orbit, face, and/or neck; without contrast material(s) Age Under 21 (70540) |
$2,072.62 |
$2,763.50 |
8.5× |
| Magnetic resonance (eg, proton) imaging, upper extremity, other than joint; without contrast material(s), followed by… (73220) |
$2,303.78 |
$3,071.70 |
6.5× |
| Magnetic resonance angiography, head; without contrast material(s), followed by contrast material(s) and further… (70546) |
$2,975.62 |
$3,967.50 |
8.3× |
| Magnetic resonance angiography, neck; without contrast material(s), followed by contrast material(s) and further… (70549) |
$2,735.02 |
$3,646.70 |
7.7× |
| Mandible min 4v (70110) |
$297.60 |
$396.80 |
2.8× |
| MRA head w/o contrast (70544) |
$2,203.72 |
$2,938.30 |
9.0× |
| MRA neck w/ contrast (70548) |
$2,495.25 |
$3,327 |
7.0× |
| MRA neck w/o contrast (70547) |
$1,914.75 |
$2,553 |
7.9× |
| MRI abdomen w/o contrast (74181) |
$1,743.98 |
$2,325.30 |
7.2× |
| MRI abdomen w/wo contrast (74183) |
$2,207.18 |
$2,942.90 |
6.2× |
| MRI c-spine w&w/o cont (72156) |
$2,588.40 |
$3,451.20 |
7.3× |
| MRI chest w/o contrast (71550) |
$1,843.20 |
$2,457.60 |
7.6× |
| MRI chest w/wo contrast (71552) |
$2,610.82 |
$3,481.10 |
7.3× |
| MRI joint upr extr w/o&w/dye (73223) |
$2,351.18 |
$3,134.90 |
6.6× |
| MRI joint upr extrem w/o dye (73221) |
$1,753.50 |
$2,338 |
7.2× |
| MRI lumbar spine w/wo contrast (72158) |
$2,760 |
$3,680 |
7.7× |
| MRI orbit/face/neck w&w/o cont (70543) |
$2,543.55 |
$3,391.40 |
7.1× |
| MRI pelvis w & w/o contrast (72197) |
$2,015.70 |
$2,687.60 |
5.7× |
| MRI pelvis w/o contrast (72195) |
$1,743.98 |
$2,325.30 |
7.2× |
| MRI spine cervical w/o contrast (72141) |
$2,220.08 |
$2,960.10 |
9.1× |
| MRI t-spine w&w/o cont (72157) |
$3,105 |
$4,140 |
8.7× |
| MRI thoracic spine w/o contrst (72146) |
$2,712.60 |
$3,616.80 |
11.1× |
| MRI tmj (70336) |
$1,754.32 |
$2,339.10 |
7.2× |
| MRI upper extremity oth than jt w/o contr matrl (73218) |
$1,727.62 |
$2,303.50 |
7.1× |
| Ob us limited fetus(s) (76815) |
$282.90 |
$377.20 |
2.6× |
| Optic foramina (70190) |
$197.55 |
$263.40 |
2.2× |
| Radex entir thrc lmbr crv sac spi w/skull 2/3 vw (72082) |
$414 |
$552 |
3.9× |
| Radex hip unilateral with pelvis 1 view (73501) |
$171.68 |
$228.90 |
1.9× |
| Radex hip unilateral with pelvis 2-3 views (73502) |
$221.70 |
$295.60 |
2.5× |
| Radex hips bilateral with pelvis 2 views (73521) |
$382.95 |
$510.60 |
3.6× |
| Radex spine cervical 2 or 3 views (72040) |
$220.80 |
$294.40 |
2.5× |
| Radex spine cervical 4 or 5 views (72050) |
$263.10 |
$350.80 |
2.5× |
| Radex spine cervical 6 or more views (72052) |
$280.35 |
$373.80 |
2.6× |
| Radex spine thoracolumbar junction min 2 views (72080) |
$235.50 |
$314 |
2.6× |
| Radiologic exam chest 3 views (71047) |
$361.42 |
$481.90 |
4.1× |
| Radiologic exam chest 4+ views (71048) |
$429.52 |
$572.70 |
4.0× |
| Radiologic examination femur 1 view (73551) |
$163.05 |
$217.40 |
1.8× |
| Radiologic examination femur minimum 2 views (73552) |
$196.65 |
$262.20 |
2.2× |
| Radiologic examination from nose to rectum for foreign body, single view, child Age Under 21 (76010) |
$240.68 |
$320.90 |
2.7× |
| Radiologic examination, ankle; complete, minimum of 3 views Age Under 21 (73610) |
$250.12 |
$333.50 |
2.8× |
| Radiologic examination, complete acute abdomen series, including 2 or more views of the abdomen (eg, supine, erect,… (74022) |
$385.58 |
$514.10 |
3.6× |
| Radiologic examination, elbow; 2 views Age Under 21 (73070) |
$186.30 |
$248.40 |
2.1× |
| Radiologic examination, elbow; complete, minimum of 3 views Age Under 21 (73080) |
$229.42 |
$305.90 |
2.6× |
| Radiologic examination, facial bones; less than 3 views Age Under 21 (70140) |
$263.10 |
$350.80 |
3.0× |
| Radiologic examination, foot; complete, minimum of 3 views Age Under 21 (73630) |
$199.28 |
$265.70 |
2.2× |
| Radiologic examination, hand; minimum of 3 views Age Under 21 (73130) |
$179.40 |
$239.20 |
2.0× |
| Radiologic examination, knee; both knees, standing, anteroposterior Age Under 21 (73565) |
$182.85 |
$243.80 |
2.1× |
| Radiologic examination, knee; complete, 4 or more views Age Under 21 (73564) |
$316.58 |
$422.10 |
3.0× |
| Radiologic examination, mandible; partial, less than 4 views Age Under 21 (70100) |
$231.15 |
$308.20 |
2.6× |
| Radiologic examination, mastoids; complete, minimum of 3 views per side Age Under 21 (70130) |
$278.62 |
$371.50 |
2.6× |
| Radiologic examination, nasal bones, complete, minimum of 3 views Age Under 21 (70160) |
$263.92 |
$351.90 |
3.0× |
| Radiologic examination, ribs, bilateral; including posteroanterior chest, minimum of 4 views Age Under 21 (71111) |
$381.22 |
$508.30 |
3.6× |
| Radiologic examination, ribs, unilateral; including posteroanterior chest, minimum of 3 views Age Under 21 (71101) |
$248.40 |
$331.20 |
2.3× |
| Radiologic examination, shoulder; complete, minimum of 2 views Age Under 21 (73030) |
$278.62 |
$371.50 |
3.1× |
| Radiologic examination, sinuses, paranasal, less than 3 views Age Under 21 (70210) |
$187.20 |
$249.60 |
2.1× |
| Radiologic examination, skull; less than 4 views Age Under 21 (70250) |
$224.25 |
$299 |
2.1× |
| Radiologic examination, spine, lumbosacral; 2 or 3 views Age Under 21 (72100) |
$377.78 |
$503.70 |
3.5× |
| Radiologic examination, spine, lumbosacral; bending views only, 2 or 3 views Age Under 21 (72120) |
$286.35 |
$381.80 |
2.7× |
| Radiologic examination, spine, lumbosacral; complete, including bending views, minimum of 6 views Age Under 21 (72114) |
$312.22 |
$416.30 |
2.9× |
| Radiologic examination, wrist; complete, minimum of 3 views Age Under 21 (73110) |
$201 |
$268 |
2.3× |
| Radiologic examination; acromioclavicular joints, bilateral, with or without weighted distraction Age Under 21 (73050) |
$211.35 |
$281.80 |
2.4× |
| Radiologic examination; humerus, minimum of 2 views Age Under 21 (73060) |
$201 |
$268 |
2.3× |
| Radiologic examination; lower extremity, infant, minimum of 2 views Age Under 21 (73592) |
$172.50 |
$230 |
1.9× |
| Radiologic examination; orbits, complete, minimum of 4 views Age Under 21 (70200) |
$297.60 |
$396.80 |
2.8× |
| Radiologic examination; sternoclavicular joint or joints, minimum of 3 views Age Under 21 (71130) |
$220.80 |
$294.40 |
2.5× |
| Radiologic examination; toe(s), minimum of 2 views Age Under 21 (73660) |
$160.42 |
$213.90 |
1.8× |
| Saline infusion sonohysterography (SIS), including color flow Doppler, when performed Age Under 21 (76831) |
$378.68 |
$504.90 |
1.6× |
| Scapula complete (73010) |
$187.20 |
$249.60 |
1.8× |
| Ultrasound, abdomen limited (76705) |
$720.22 |
$960.30 |
6.7× |
| Ultrasound, limited, joint or focal evaluation of other nonvascular extremity structure(s) (eg, joint space,… (76882) |
$307.05 |
$409.40 |
2.9× |
| Ultrasound, pelvic (nonobstetric), real time with image documentation; complete Age Under 21 (76856) |
$476.10 |
$634.80 |
4.5× |
| Ultrasound, pregnant uterus, real time with image documentation, fetal and maternal evaluation plus detailed fetal… (76811) |
$643.42 |
$857.90 |
2.6× |
| Ultrasound, pregnant uterus, real time with image documentation, fetal and maternal evaluation, first trimester (< 14… (76801) |
$401.10 |
$534.80 |
3.8× |
| Us abdominal aorta real time screen study aaa (76706) |
$432.15 |
$576.20 |
4.0× |
| Us chest (76604) |
$368.32 |
$491.10 |
3.4× |
| Us compl joint r-t w/image documentation (76881) |
$345 |
$460 |
3.2× |
| Us exam, pelvic, limited (76857) |
$343.28 |
$457.70 |
3.2× |
| US OB Follow-Up/Repeat (76816) |
$220.80 |
$294.40 |
2.1× |
| Us ob transvaginal (76817) |
$403.65 |
$538.20 |
3.8× |
| Us retroperitoneal complete (76770) |
$637.42 |
$849.90 |
6.0× |
| Us retroperitoneal ltd (76775) |
$389.85 |
$519.80 |
3.6× |
| Us scrotum (76870) |
$383.85 |
$511.80 |
3.6× |
| Us soft tissue head/neck (76536) |
$563.25 |
$751 |
5.3× |
| Us unlstd proc (76999) |
$464.92 |
$619.90 |
5.2× |
| X-ray exam hips bi 3-4 views (73522) |
$388.12 |
$517.50 |
3.6× |
| X-ray exam of finger(s) (73140) |
$160.42 |
$213.90 |
1.8× |
| X-ray exam of knee 1 or 2 (73560) |
$201 |
$268 |
2.3× |
| X-ray exam ribs bil 3 views (71110) |
$259.65 |
$346.20 |
2.4× |
| X-ray exam ribs uni 2 views (71100) |
$182.85 |
$243.80 |
2.1× |
| X-ray heel (73650) |
$172.50 |
$230 |
1.9× |
| X-ray of joint between lower spine and hip bone 3 or more views|PROFESSIONAL COMPONENT (72202) |
$268.28 |
$357.70 |
2.5× |
| Xr abdomen 1 view (74018) |
$197.55 |
$263.40 |
2.2× |
| Xr abdomen 2 views (74019) |
$329.48 |
$439.30 |
3.1× |
| Xr bone age studies (77072) |
$131.10 |
$174.80 |
1.2× |
| Xr bone length study (77073) |
$239.78 |
$319.70 |
2.2× |
| Xr bone survey infant (77076) |
$410.55 |
$547.40 |
3.8× |
| Xr bone survey ltd (77074) |
$566.70 |
$755.60 |
5.3× |
| Xr chest 1 view (71045) |
$225.15 |
$300.20 |
2.5× |
| Xr chest 2 views (71046) |
$293.25 |
$391 |
3.3× |
| Xr eye foreign body (70030) |
$188.02 |
$250.70 |
2.1× |
| Xr facial bones 3+ views (70150) |
$307.05 |
$409.40 |
2.9× |
| Xr foot arthritis pa only bilateral - report(ortho pro) (73620) |
$160.42 |
$213.90 |
1.8× |
| Xr forearm 2 views (73090) |
$201 |
$268 |
2.3× |
| Xr hand 2v (73120) |
$166.50 |
$222 |
1.6× |
| Xr joint survey 1 view (77077) |
$172.50 |
$230 |
1.6× |
| Xr neck soft tissue (70360) |
$232.05 |
$309.40 |
2.6× |
| Xr o knee w/ merchant view bilat - report(ortho pro) (73562) |
$239.78 |
$319.70 |
2.7× |
| Xr osseous survey complete (77075) |
$584.78 |
$779.70 |
5.5× |
| Xr pelvis 1-2 views (72170) |
$225.98 |
$301.30 |
2.1× |
| Xr pelvis min 3 view (72190) |
$265.65 |
$354.20 |
2.5× |
| Xr sacrum/coccyx 2+ views (72220) |
$163.05 |
$217.40 |
1.8× |
| Xr sella turcica (70240) |
$197.55 |
$263.40 |
2.2× |
| Xr shoulder 1 view (73020) |
$228.60 |
$304.80 |
2.6× |
| Xr sinuses 3+ views (70220) |
$282.90 |
$377.20 |
3.2× |
| Xr skull min 4 view (70260) |
$297.60 |
$396.80 |
2.8× |
| Xr spine 1 view (72020) |
$148.35 |
$197.80 |
1.7× |
| Xr spine thoracic 3v (72072) |
$264.82 |
$353.10 |
2.5× |
| Xr sternum 2+ views (71120) |
$231.15 |
$308.20 |
2.6× |
| Xr t-spine 2 views (72070) |
$235.50 |
$314 |
2.2× |
| Xr tibia/fibula 2 views (73590) |
$201 |
$268 |
2.3× |
| Xr tmj bilateral (70330) |
$297.60 |
$396.80 |
3.3× |
| Xr wrist 2 views (73100) |
$163.05 |
$217.40 |
1.8× |