| Ankle 2 views (73600) |
$190 |
$190 |
2.1× |
| Cholecystography, oral contrast Age Under 21 (74290) |
$158 |
$158 |
0.9× |
| Clavicle complete (73000) |
$200 |
$200 |
2.2× |
| Computed tomographic angiography, abdomen and pelvis, with contrast material(s), including noncontrast images, if… (74174) |
$2,418.50 |
$2,418.50 |
6.8× |
| Computed tomographic angiography, abdomen, with contrast material(s), including noncontrast images, if performed, and… (74175) |
$1,600.50 |
$1,600.50 |
8.9× |
| Computed tomographic angiography, abdominal aorta and bilateral iliofemoral lower extremity runoff, with contrast… (75635) |
$3,809 |
$3,809 |
21.3× |
| Computed tomographic angiography, chest (noncoronary), with contrast material(s), including noncontrast images, if… (71275) |
$3,101 |
$3,101 |
17.3× |
| Computed tomographic angiography, lower extremity, with contrast material(s), including noncontrast images, if… (73706) |
$2,919 |
$2,919 |
16.3× |
| Computed tomographic angiography, neck, with contrast material(s), including noncontrast images, if performed, and… (70498) |
$1,662 |
$1,662 |
9.3× |
| Computed tomographic angiography, pelvis, with contrast material(s), including noncontrast images, if performed, and… (72191) |
$1,520 |
$1,520 |
8.5× |
| Computed tomographic angiography, upper extremity, with contrast material(s), including noncontrast images, if… (73206) |
$1,647.50 |
$1,647.50 |
9.2× |
| Computed tomography, cervical spine; without contrast material, followed by contrast material(s) and further sections… (72127) |
$1,380 |
$1,380 |
7.7× |
| Computed tomography, lower extremity; without contrast material Age Under 21 (73700) |
$1,088 |
$1,088 |
10.2× |
| Computed tomography, lower extremity; without contrast material, followed by contrast material(s) and further sections… (73702) |
$2,603 |
$2,603 |
14.5× |
| Computed tomography, lumbar spine; without contrast material, followed by contrast material(s) and further sections Age… (72133) |
$1,452 |
$1,452 |
8.1× |
| Computed tomography, maxillofacial area; with contrast material(s) Age Under 21 (70487) |
$1,551.50 |
$1,551.50 |
8.7× |
| Computed tomography, maxillofacial area; without contrast material Age Under 21 (70486) |
$1,185.50 |
$1,185.50 |
11.1× |
| Computed tomography, orbit, sella, or posterior fossa or outer, middle, or inner ear; with contrast material(s) Age… (70481) |
$1,099 |
$1,099 |
6.1× |
| Computed tomography, orbit, sella, or posterior fossa or outer, middle, or inner ear; without contrast material Age… (70480) |
$835.50 |
$835.50 |
7.8× |
| Computed tomography, orbit, sella, or posterior fossa or outer, middle, or inner ear; without contrast material,… (70482) |
$1,353.50 |
$1,353.50 |
7.6× |
| Computed tomography, soft tissue neck; without contrast material followed by contrast material(s) and further sections… (70492) |
$1,548 |
$1,548 |
8.6× |
| Computed tomography, thoracic spine; without contrast material, followed by contrast material(s) and further sections… (72130) |
$1,499.50 |
$1,499.50 |
8.4× |
| Computed tomography, thorax, diagnostic; without contrast material, followed by contrast material(s) and further… (71270) |
$1,696 |
$1,696 |
9.5× |
| CT abdomen and pelvis without and with contrast (74178) |
$2,689.50 |
$2,689.50 |
7.5× |
| CT abdomen and pelvis without contrast (74176) |
$2,296 |
$2,296 |
9.4× |
| CT abdomen w & w/o contrast (74170) |
$1,449 |
$1,449 |
8.1× |
| CT abdomen w/contrast (74160) |
$1,533.50 |
$1,533.50 |
8.6× |
| CT abdomen w/o contrast (74150) |
$1,181 |
$1,181 |
11.1× |
| CT cervical spine w/contrast (72126) |
$1,242.50 |
$1,242.50 |
3.5× |
| CT cervical spine w/o contrast (72125) |
$1,326 |
$1,326 |
12.4× |
| CT chest w/contrast (71260) |
$1,617 |
$1,617 |
9.0× |
| CT extremity upper w & w/o contrast (73202) |
$2,461 |
$2,461 |
13.7× |
| CT extremity upper w/o contrast (73200) |
$1,040 |
$1,040 |
9.7× |
| CT head/brain with contrast (70460) |
$1,231 |
$1,231 |
6.9× |
| CT head/brain without and with contrast (70470) |
$1,382 |
$1,382 |
7.7× |
| CT l-spine w/contrast (72132) |
$1,471.50 |
$1,471.50 |
4.1× |
| CT limited/localized follow up study (76380) |
$750.50 |
$750.50 |
8.4× |
| CT lower extremity w/dye (73701) |
$1,287.50 |
$1,287.50 |
7.2× |
| CT lumbar spine w/o contrast (72131) |
$1,334 |
$1,334 |
12.5× |
| CT maxillofacial w/wo contrast (70488) |
$1,706 |
$1,706 |
9.5× |
| CT neck w/contrast (70491) |
$1,482.50 |
$1,482.50 |
8.3× |
| CT neck w/o contrast (70490) |
$1,232.50 |
$1,232.50 |
11.5× |
| CT pelvis w & w/o contrast (72194) |
$1,358.50 |
$1,358.50 |
7.6× |
| CT pelvis w/o contrast (72192) |
$1,160 |
$1,160 |
10.9× |
| CT thoracic spine w/contrast (72129) |
$1,474.50 |
$1,474.50 |
8.2× |
| CT thoracic spine w/o contrast (72128) |
$1,462 |
$1,462 |
13.7× |
| CT thorax lung cancer scr c- (71271) |
$323.50 |
$323.50 |
3.0× |
| CT thorax w/o contrast (71250) |
$1,899 |
$1,899 |
17.8× |
| CT upper extremity w/dye (73201) |
$1,131 |
$1,131 |
3.2× |
| CTA head w contrast (70496) |
$2,644 |
$2,644 |
14.8× |
| Cystography, minimum of 3 views, radiological supervision and interpretation Age Under 21 (74430) |
$428.50 |
$428.50 |
1.2× |
| Dual-energy X-ray absorptiometry (DXA), bone density study, 1 or more sites; axial skeleton (eg, hips, pelvis, spine)… (77080) |
$652 |
$652 |
6.1× |
| Fetal biophys profile w/o nst (76819) |
$472.50 |
$472.50 |
4.4× |
| Fluoroscopy up to 1 hour physician/qhp time (76000) |
$415.50 |
$415.50 |
1.7× |
| Magnetic resonance (eg, proton) imaging, any joint of lower extremity; without contrast material(s), followed by… (73723) |
$3,953 |
$3,953 |
11.1× |
| Magnetic resonance (eg, proton) imaging, lower extremity other than joint; without contrast material(s) Age Under 21 (73718) |
$2,469 |
$2,469 |
10.1× |
| Magnetic resonance (eg, proton) imaging, lower extremity other than joint; without contrast material(s), followed by… (73720) |
$3,758 |
$3,758 |
10.5× |
| Magnetic resonance (eg, proton) imaging, orbit, face, and/or neck; with contrast material(s) Age Under 21 (70542) |
$2,057 |
$2,057 |
5.8× |
| Magnetic resonance (eg, proton) imaging, orbit, face, and/or neck; without contrast material(s) Age Under 21 (70540) |
$2,058.50 |
$2,058.50 |
8.4× |
| Magnetic resonance (eg, proton) imaging, upper extremity, other than joint; without contrast material(s), followed by… (73220) |
$3,797 |
$3,797 |
10.7× |
| Magnetic resonance angiography, head; without contrast material(s), followed by contrast material(s) and further… (70546) |
$2,604 |
$2,604 |
7.3× |
| Magnetic resonance angiography, neck; without contrast material(s), followed by contrast material(s) and further… (70549) |
$2,421.50 |
$2,421.50 |
6.8× |
| Mammary ductogram single (77053) |
$671 |
$671 |
2.8× |
| Mandible min 4v (70110) |
$270 |
$270 |
2.5× |
| MRA head w/o contrast (70544) |
$1,888.50 |
$1,888.50 |
7.7× |
| MRA neck w/ contrast (70548) |
$4,058 |
$4,058 |
11.4× |
| MRA neck w/o contrast (70547) |
$2,003.50 |
$2,003.50 |
8.2× |
| MRI abdomen w/o contrast (74181) |
$1,617 |
$1,617 |
6.6× |
| MRI abdomen w/wo contrast (74183) |
$1,986.50 |
$1,986.50 |
5.6× |
| MRI c-spine w&w/o cont (72156) |
$2,159 |
$2,159 |
6.1× |
| MRI cervical spine w/contrast (72142) |
$1,814.50 |
$1,814.50 |
5.1× |
| MRI chest w/o contrast (71550) |
$2,172.50 |
$2,172.50 |
8.9× |
| MRI chest w/wo contrast (71552) |
$2,545.50 |
$2,545.50 |
7.1× |
| MRI joint upr extr w/o&w/dye (73223) |
$3,331 |
$3,331 |
9.3× |
| MRI joint upr extrem w/o dye (73221) |
$2,685 |
$2,685 |
11.0× |
| MRI lumbar spine w/contrast (72149) |
$1,999.50 |
$1,999.50 |
5.6× |
| MRI lumbar spine w/wo contrast (72158) |
$2,151.50 |
$2,151.50 |
6.0× |
| MRI orbit/face/neck w&w/o cont (70543) |
$2,261.50 |
$2,261.50 |
6.3× |
| MRI pelvis w & w/o contrast (72197) |
$2,188 |
$2,188 |
6.1× |
| MRI pelvis w/o contrast (72195) |
$1,689 |
$1,689 |
6.9× |
| MRI spine cervical w/o contrast (72141) |
$1,612.50 |
$1,612.50 |
6.6× |
| MRI t-spine w&w/o cont (72157) |
$2,173.50 |
$2,173.50 |
6.1× |
| MRI thoracic spine w/contrast (72147) |
$1,839.50 |
$1,839.50 |
5.2× |
| MRI thoracic spine w/o contrst (72146) |
$1,637 |
$1,637 |
6.7× |
| MRI tmj (70336) |
$1,445.50 |
$1,445.50 |
5.9× |
| MRI upper extremity oth than jt w/o contr matrl (73218) |
$2,469 |
$2,469 |
10.1× |
| Ob us limited fetus(s) (76815) |
$262 |
$262 |
2.5× |
| Optic foramina (70190) |
$360 |
$360 |
4.0× |
| Radex abscess/fistula/sinus tract rs&i (76080) |
$424 |
$424 |
0.8× |
| Radex entir thrc lmbr crv sac spi w/skull 1 vw (72081) |
$348 |
$348 |
3.9× |
| Radex entir thrc lmbr crv sac spi w/skull 2/3 vw (72082) |
$1,124 |
$1,124 |
10.5× |
| Radex hip unilateral with pelvis 1 view (73501) |
$183.50 |
$183.50 |
2.1× |
| Radex hip unilateral with pelvis 2-3 views (73502) |
$152 |
$152 |
1.7× |
| Radex hips bilateral with pelvis 2 views (73521) |
$240.50 |
$240.50 |
2.3× |
| Radex hips bilateral with pelvis minimum 5 views (73523) |
$300.50 |
$300.50 |
2.8× |
| Radex spine cervical 2 or 3 views (72040) |
$292 |
$292 |
3.3× |
| Radex spine cervical 4 or 5 views (72050) |
$443.50 |
$443.50 |
4.2× |
| Radex spine cervical 6 or more views (72052) |
$428.50 |
$428.50 |
4.0× |
| Radex spine thoracolumbar junction min 2 views (72080) |
$164.50 |
$164.50 |
1.9× |
| Radiologic exam abdomen 3+ views (74021) |
$306 |
$306 |
2.9× |
| Radiologic exam chest 3 views (71047) |
$341 |
$341 |
3.8× |
| Radiologic exam chest 4+ views (71048) |
$411.50 |
$411.50 |
3.9× |
| Radiologic exam colon double contrast study (74280) |
$706 |
$706 |
3.9× |
| Radiologic exam colon single contrast study (74270) |
$450 |
$450 |
2.5× |
| Radiologic exam esophagus double contrast study (74221) |
$421 |
$421 |
2.3× |
| Radiologic exam esophagus single contrast study (74220) |
$395 |
$395 |
2.2× |
| Radiologic exam small int single contrast study (74250) |
$204 |
$204 |
1.1× |
| Radiologic exam swallow function contrast study (74230) |
$343 |
$343 |
1.9× |
| Radiologic exam upr gi trc double contrast study (74246) |
$463.50 |
$463.50 |
2.6× |
| Radiologic exam upr gi trc single contrast study (74240) |
$505.50 |
$505.50 |
2.8× |
| Radiologic examination femur 1 view (73551) |
$194.50 |
$194.50 |
2.2× |
| Radiologic examination femur minimum 2 views (73552) |
$219 |
$219 |
2.5× |
| Radiologic examination from nose to rectum for foreign body, single view, child Age Under 21 (76010) |
$191.50 |
$191.50 |
2.2× |
| Radiologic examination, ankle; complete, minimum of 3 views Age Under 21 (73610) |
$262 |
$262 |
2.9× |
| Radiologic examination, complete acute abdomen series, including 2 or more views of the abdomen (eg, supine, erect,… (74022) |
$234 |
$234 |
2.2× |
| Radiologic examination, elbow; 2 views Age Under 21 (73070) |
$175 |
$175 |
2.0× |
| Radiologic examination, elbow; complete, minimum of 3 views Age Under 21 (73080) |
$239 |
$239 |
2.7× |
| Radiologic examination, facial bones; less than 3 views Age Under 21 (70140) |
$180 |
$180 |
2.0× |
| Radiologic examination, foot; complete, minimum of 3 views Age Under 21 (73630) |
$261.50 |
$261.50 |
2.9× |
| Radiologic examination, hand; minimum of 3 views Age Under 21 (73130) |
$205.50 |
$205.50 |
2.3× |
| Radiologic examination, knee; both knees, standing, anteroposterior Age Under 21 (73565) |
$196 |
$196 |
2.2× |
| Radiologic examination, knee; complete, 4 or more views Age Under 21 (73564) |
$534 |
$534 |
5.0× |
| Radiologic examination, mandible; partial, less than 4 views Age Under 21 (70100) |
$198.50 |
$198.50 |
2.2× |
| Radiologic examination, mastoids; complete, minimum of 3 views per side Age Under 21 (70130) |
$432.50 |
$432.50 |
4.0× |
| Radiologic examination, mastoids; less than 3 views per side Age Under 21 (70120) |
$217.50 |
$217.50 |
2.0× |
| Radiologic examination, nasal bones, complete, minimum of 3 views Age Under 21 (70160) |
$147.50 |
$147.50 |
1.7× |
| Radiologic examination, renal cyst study, translumbar, contrast visualization, radiological supervision and… (74470) |
$116 |
$116 |
0.2× |
| Radiologic examination, ribs, bilateral; including posteroanterior chest, minimum of 4 views Age Under 21 (71111) |
$476.50 |
$476.50 |
4.5× |
| Radiologic examination, ribs, unilateral; including posteroanterior chest, minimum of 3 views Age Under 21 (71101) |
$77 |
$77 |
0.7× |
| Radiologic examination, salivary gland for calculus Age Under 21 (70380) |
$287.50 |
$287.50 |
3.2× |
| Radiologic examination, shoulder, arthrography, radiological supervision and interpretation Age Under 21 (73040) |
$666.50 |
$666.50 |
1.9× |
| Radiologic examination, shoulder; complete, minimum of 2 views Age Under 21 (73030) |
$266.50 |
$266.50 |
3.0× |
| Radiologic examination, sinuses, paranasal, less than 3 views Age Under 21 (70210) |
$176 |
$176 |
2.0× |
| Radiologic examination, skull; less than 4 views Age Under 21 (70250) |
$255 |
$255 |
2.4× |
| Radiologic examination, spine, lumbosacral; 2 or 3 views Age Under 21 (72100) |
$173 |
$173 |
1.6× |
| Radiologic examination, spine, lumbosacral; complete, including bending views, minimum of 6 views Age Under 21 (72114) |
$427 |
$427 |
4.0× |
| Radiologic examination, wrist; complete, minimum of 3 views Age Under 21 (73110) |
$207.50 |
$207.50 |
2.3× |
| Radiologic examination; acromioclavicular joints, bilateral, with or without weighted distraction Age Under 21 (73050) |
$211 |
$211 |
2.4× |
| Radiologic examination; humerus, minimum of 2 views Age Under 21 (73060) |
$190.50 |
$190.50 |
2.1× |
| Radiologic examination; lower extremity, infant, minimum of 2 views Age Under 21 (73592) |
$174.50 |
$174.50 |
2.0× |
| Radiologic examination; orbits, complete, minimum of 4 views Age Under 21 (70200) |
$380 |
$380 |
3.6× |
| Radiologic examination; sternoclavicular joint or joints, minimum of 3 views Age Under 21 (71130) |
$239.50 |
$239.50 |
2.7× |
| Radiologic examination; toe(s), minimum of 2 views Age Under 21 (73660) |
$161 |
$161 |
1.8× |
| Radiologic examination; upper extremity, infant, minimum of 2 views Age Under 21 (73092) |
$176 |
$176 |
1.6× |
| Review by radiologist of urinary bladder and urethra images with contrast and after passing urine (74455) |
$419.50 |
$419.50 |
1.7× |
| Saline infusion sonohysterography (SIS), including color flow Doppler, when performed Age Under 21 (76831) |
$433 |
$433 |
1.8× |
| Scapula complete (73010) |
$193.50 |
$193.50 |
1.8× |
| Screening digital breast tomosynthesis bi (77063) |
$125 |
$125 |
— |
| Therapeutic enema, contrast or air, for reduction of intussusception or other intraluminal obstruction (eg, meconium… (74283) |
$520 |
$520 |
2.9× |
| Ultrasound breast limited (76642) |
$457 |
$457 |
5.1× |
| Ultrasound, abdomen limited (76705) |
$554 |
$554 |
5.2× |
| Ultrasound, limited, joint or focal evaluation of other nonvascular extremity structure(s) (eg, joint space,… (76882) |
$134 |
$134 |
1.3× |
| Ultrasound, pelvic (nonobstetric), real time with image documentation; complete Age Under 21 (76856) |
$448 |
$448 |
4.2× |
| Ultrasound, pregnant uterus, real time with image documentation, fetal and maternal evaluation, first trimester (< 14… (76801) |
$495 |
$495 |
4.6× |
| Urethrocystography retrograde rs&i (74450) |
$349 |
$349 |
1.4× |
| Urography (pyelography), intravenous, with or without KUB, with or without tomography Age Under 21 (74400) |
$513 |
$513 |
2.9× |
| Urography, infusion, drip technique and/or bolus technique; with nephrotomography Age Under 21 (74415) |
$1,149 |
$1,149 |
6.4× |
| Us abdominal aorta real time screen study aaa (76706) |
$638 |
$638 |
6.0× |
| Us breast uni real time with image complete (76641) |
$311 |
$311 |
2.9× |
| Us chest (76604) |
$405 |
$405 |
3.8× |
| Us encephalogram (76506) |
$583.50 |
$583.50 |
5.5× |
| Us exam, pelvic, limited (76857) |
$263 |
$263 |
2.5× |
| US OB Follow-Up/Repeat (76816) |
$134 |
$134 |
1.3× |
| Us ob transvaginal (76817) |
$413 |
$413 |
3.9× |
| Us retroperitoneal complete (76770) |
$480.50 |
$480.50 |
4.5× |
| Us retroperitoneal ltd (76775) |
$447 |
$447 |
4.2× |
| Us scrotum (76870) |
$410 |
$410 |
3.8× |
| Us soft tissue head/neck (76536) |
$433 |
$433 |
4.1× |
| Us spinal canal (76800) |
$358 |
$358 |
3.4× |
| Us unlstd proc (76999) |
$254.50 |
$254.50 |
2.9× |
| Venography deep dorsal vein penis radiolgicl supervision interpretation (76499) |
$12.10 |
$12.10 |
0.1× |
| X-ray exam hips bi 3-4 views (73522) |
$342 |
$342 |
3.2× |
| X-ray exam of finger(s) (73140) |
$43 |
$43 |
0.5× |
| X-ray exam of knee 1 or 2 (73560) |
$182.50 |
$182.50 |
2.1× |
| X-ray exam of small bowel - fl small bowel series enteroclysis tube (74251) |
$119 |
$119 |
0.7× |
| X-ray exam ribs bil 3 views (71110) |
$371 |
$371 |
3.5× |
| X-ray exam ribs uni 2 views (71100) |
$216 |
$216 |
2.4× |
| X-ray heel (73650) |
$172 |
$172 |
1.9× |
| X-ray of joint between lower spine and hip bone 3 or more views|PROFESSIONAL COMPONENT (72202) |
$279.50 |
$279.50 |
2.6× |
| X-ray retrograde pyelogram (74420) |
$1,017 |
$1,017 |
2.9× |
| Xr abdomen 1 view (74018) |
$196.50 |
$196.50 |
2.2× |
| Xr abdomen 2 views (74019) |
$280.50 |
$280.50 |
2.6× |
| Xr arthrogram hip (73525) |
$568.50 |
$568.50 |
1.6× |
| Xr bone age studies (77072) |
$215 |
$215 |
2.0× |
| Xr bone length study (77073) |
$116 |
$116 |
1.1× |
| Xr bone survey infant (77076) |
$218 |
$218 |
2.0× |
| Xr bone survey ltd (77074) |
$123.50 |
$123.50 |
1.2× |
| Xr chest 1 view (71045) |
$162 |
$162 |
1.8× |
| Xr chest 2 views (71046) |
$241 |
$241 |
2.7× |
| Xr eye foreign body (70030) |
$46 |
$46 |
0.5× |
| Xr facial bones 3+ views (70150) |
$245.50 |
$245.50 |
2.3× |
| Xr foot arthritis pa only bilateral - report(ortho pro) (73620) |
$173.50 |
$173.50 |
2.0× |
| Xr forearm 2 views (73090) |
$193 |
$193 |
2.2× |
| Xr hand 2v (73120) |
$203.50 |
$203.50 |
1.9× |
| Xr hysterosalpingogram (74740) |
$357.50 |
$357.50 |
1.5× |
| Xr neck soft tissue (70360) |
$180 |
$180 |
2.0× |
| Xr o knee w/ merchant view bilat - report(ortho pro) (73562) |
$221 |
$221 |
2.5× |
| Xr osseous survey complete (77075) |
$261.50 |
$261.50 |
2.4× |
| Xr pelvis 1-2 views (72170) |
$217.50 |
$217.50 |
2.0× |
| Xr pelvis min 3 view (72190) |
$259.50 |
$259.50 |
2.4× |
| Xr sacrum/coccyx 2+ views (72220) |
$203.50 |
$203.50 |
2.3× |
| Xr sella turcica (70240) |
$148 |
$148 |
1.7× |
| Xr shoulder 1 view (73020) |
$176.50 |
$176.50 |
2.0× |
| Xr sialogram (70390) |
$149 |
$149 |
0.6× |
| Xr sinuses 3+ views (70220) |
$324.50 |
$324.50 |
3.6× |
| Xr skull min 4 view (70260) |
$402 |
$402 |
3.8× |
| Xr spine 1 view (72020) |
$124.50 |
$124.50 |
1.4× |
| Xr spine thoracic 3v (72072) |
$277.50 |
$277.50 |
2.6× |
| Xr sternum 2+ views (71120) |
$228.50 |
$228.50 |
2.6× |
| Xr stress view joint (77071) |
$240 |
$240 |
2.7× |
| Xr surgical specimen (76098) |
$63 |
$63 |
0.1× |
| Xr t-spine 2 views (72070) |
$193 |
$193 |
1.8× |
| Xr tibia/fibula 2 views (73590) |
$204.50 |
$204.50 |
2.3× |
| Xr tmj bilateral (70330) |
$285 |
$285 |
3.2× |
| Xr wrist 2 views (73100) |
$147 |
$147 |
1.7× |