| Ankle 2 views (73600) |
$222.40 |
$278 |
2.5× |
| Clavicle complete (73000) |
$215.20 |
$269 |
2.4× |
| Computed tomographic angiography, abdomen, with contrast material(s), including noncontrast images, if performed, and… (74175) |
$2,017.60 |
$2,522 |
11.3× |
| Computed tomographic angiography, abdominal aorta and bilateral iliofemoral lower extremity runoff, with contrast… (75635) |
$2,783.20 |
$3,479 |
15.5× |
| Computed tomographic angiography, chest (noncoronary), with contrast material(s), including noncontrast images, if… (71275) |
$2,004.40 |
$2,505.50 |
11.2× |
| Computed tomographic angiography, lower extremity, with contrast material(s), including noncontrast images, if… (73706) |
$1,816.80 |
$2,271 |
10.1× |
| Computed tomographic angiography, neck, with contrast material(s), including noncontrast images, if performed, and… (70498) |
$1,997.60 |
$2,497 |
11.1× |
| Computed tomographic angiography, pelvis, with contrast material(s), including noncontrast images, if performed, and… (72191) |
$2,136 |
$2,670 |
11.9× |
| Computed tomographic angiography, upper extremity, with contrast material(s), including noncontrast images, if… (73206) |
$1,888 |
$2,360 |
10.5× |
| Computed tomography, cervical spine; without contrast material, followed by contrast material(s) and further sections… (72127) |
$2,269.60 |
$2,837 |
12.7× |
| Computed tomography, lower extremity; without contrast material Age Under 21 (73700) |
$1,860.80 |
$2,326 |
17.4× |
| Computed tomography, lower extremity; without contrast material, followed by contrast material(s) and further sections… (73702) |
$1,640 |
$2,050 |
9.2× |
| Computed tomography, lumbar spine; without contrast material, followed by contrast material(s) and further sections Age… (72133) |
$2,340.80 |
$2,926 |
13.1× |
| Computed tomography, maxillofacial area; with contrast material(s) Age Under 21 (70487) |
$1,616.80 |
$2,021 |
9.0× |
| Computed tomography, maxillofacial area; without contrast material Age Under 21 (70486) |
$1,489.60 |
$1,862 |
13.9× |
| Computed tomography, orbit, sella, or posterior fossa or outer, middle, or inner ear; with contrast material(s) Age… (70481) |
$1,964 |
$2,455 |
11.0× |
| Computed tomography, orbit, sella, or posterior fossa or outer, middle, or inner ear; without contrast material Age… (70480) |
$1,560 |
$1,950 |
14.6× |
| Computed tomography, orbit, sella, or posterior fossa or outer, middle, or inner ear; without contrast material,… (70482) |
$1,788 |
$2,235 |
10.0× |
| Computed tomography, soft tissue neck; without contrast material followed by contrast material(s) and further sections… (70492) |
$1,954.40 |
$2,443 |
10.9× |
| Computed tomography, thoracic spine; without contrast material, followed by contrast material(s) and further sections… (72130) |
$2,181.60 |
$2,727 |
12.2× |
| Computed tomography, thorax, diagnostic; without contrast material, followed by contrast material(s) and further… (71270) |
$2,248.80 |
$2,811 |
12.5× |
| CT abdomen and pelvis without and with contrast (74178) |
$3,363.20 |
$4,204 |
9.4× |
| CT abdomen and pelvis without contrast (74176) |
$2,884 |
$3,605 |
11.8× |
| CT abdomen w & w/o contrast (74170) |
$2,402.40 |
$3,003 |
13.4× |
| CT abdomen w/contrast (74160) |
$1,952 |
$2,440 |
10.9× |
| CT abdomen w/o contrast (74150) |
$1,500.80 |
$1,876 |
14.1× |
| CT cervical spine w/contrast (72126) |
$1,840.80 |
$2,301 |
5.2× |
| CT cervical spine w/o contrast (72125) |
$1,730.40 |
$2,163 |
16.2× |
| CT chest w/contrast (71260) |
$2,112.80 |
$2,641 |
11.8× |
| CT extremity upper w & w/o contrast (73202) |
$1,846.40 |
$2,308 |
10.3× |
| CT extremity upper w/o contrast (73200) |
$2,000 |
$2,500 |
18.7× |
| CT head/brain with contrast (70460) |
$1,440 |
$1,800 |
8.0× |
| CT head/brain without and with contrast (70470) |
$1,940 |
$2,425 |
10.8× |
| CT l-spine w/contrast (72132) |
$1,919.20 |
$2,399 |
5.4× |
| CT lower extremity w/dye (73701) |
$1,780.80 |
$2,226 |
9.9× |
| CT lumbar spine w/o contrast (72131) |
$1,632 |
$2,040 |
15.3× |
| CT maxillofacial w/wo contrast (70488) |
$2,096 |
$2,620 |
11.7× |
| CT neck w/contrast (70491) |
$1,820 |
$2,275 |
10.2× |
| CT neck w/o contrast (70490) |
$1,456.80 |
$1,821 |
13.6× |
| CT pelvis w & w/o contrast (72194) |
$2,223.20 |
$2,779 |
12.4× |
| CT pelvis w/o contrast (72192) |
$1,532 |
$1,915 |
14.3× |
| CT thoracic spine w/contrast (72129) |
$1,981.60 |
$2,477 |
11.1× |
| CT thoracic spine w/o contrast (72128) |
$1,769.60 |
$2,212 |
16.6× |
| CT thorax w/o contrast (71250) |
$1,460 |
$1,825 |
13.7× |
| CT upper extremity w/dye (73201) |
$1,554.40 |
$1,943 |
4.4× |
| CTA head w contrast (70496) |
$2,014.40 |
$2,518 |
11.2× |
| Mandible min 4v (70110) |
$239.20 |
$299 |
2.2× |
| Optic foramina (70190) |
$220 |
$275 |
2.5× |
| Radex entir thrc lmbr crv sac spi w/skull 1 vw (72081) |
$327.20 |
$409 |
3.7× |
| Radex entir thrc lmbr crv sac spi w/skull 2/3 vw (72082) |
$312.80 |
$391 |
2.9× |
| Radex hip unilateral with pelvis 1 view (73501) |
$264 |
$330 |
3.0× |
| Radex hip unilateral with pelvis 2-3 views (73502) |
$283.20 |
$354 |
3.2× |
| Radex hip unilateral with pelvis minimum 4 views (73503) |
$379.20 |
$474 |
3.6× |
| Radex hips bilateral with pelvis 2 views (73521) |
$283.20 |
$354 |
2.7× |
| Radex hips bilateral with pelvis minimum 5 views (73523) |
$474.40 |
$593 |
4.4× |
| Radex spine cervical 2 or 3 views (72040) |
$300 |
$375 |
3.4× |
| Radex spine cervical 4 or 5 views (72050) |
$396.80 |
$496 |
3.7× |
| Radex spine cervical 6 or more views (72052) |
$515.20 |
$644 |
4.8× |
| Radex spine thoracolumbar junction min 2 views (72080) |
$205.60 |
$257 |
2.3× |
| Radiologic exam abdomen 3+ views (74021) |
$360 |
$450 |
3.4× |
| Radiologic exam chest 3 views (71047) |
$318.40 |
$398 |
3.6× |
| Radiologic exam chest 4+ views (71048) |
$381.60 |
$477 |
3.6× |
| Radiologic examination femur 1 view (73551) |
$280.80 |
$351 |
3.2× |
| Radiologic examination femur minimum 2 views (73552) |
$256.80 |
$321 |
2.9× |
| Radiologic examination from nose to rectum for foreign body, single view, child Age Under 21 (76010) |
$521.60 |
$652 |
5.9× |
| Radiologic examination, ankle; complete, minimum of 3 views Age Under 21 (73610) |
$264.80 |
$331 |
3.0× |
| Radiologic examination, complete acute abdomen series, including 2 or more views of the abdomen (eg, supine, erect,… (74022) |
$412.80 |
$516 |
3.9× |
| Radiologic examination, elbow; 2 views Age Under 21 (73070) |
$254.40 |
$318 |
2.9× |
| Radiologic examination, elbow; complete, minimum of 3 views Age Under 21 (73080) |
$274.40 |
$343 |
3.1× |
| Radiologic examination, facial bones; less than 3 views Age Under 21 (70140) |
$203.20 |
$254 |
2.3× |
| Radiologic examination, foot; complete, minimum of 3 views Age Under 21 (73630) |
$309.60 |
$387 |
3.5× |
| Radiologic examination, hand; minimum of 3 views Age Under 21 (73130) |
$268 |
$335 |
3.0× |
| Radiologic examination, knee; both knees, standing, anteroposterior Age Under 21 (73565) |
$240 |
$300 |
2.7× |
| Radiologic examination, knee; complete, 4 or more views Age Under 21 (73564) |
$334.40 |
$418 |
3.1× |
| Radiologic examination, mandible; partial, less than 4 views Age Under 21 (70100) |
$269.20 |
$336.50 |
3.0× |
| Radiologic examination, mastoids; complete, minimum of 3 views per side Age Under 21 (70130) |
$304.80 |
$381 |
2.9× |
| Radiologic examination, mastoids; less than 3 views per side Age Under 21 (70120) |
$200 |
$250 |
1.9× |
| Radiologic examination, nasal bones, complete, minimum of 3 views Age Under 21 (70160) |
$248 |
$310 |
2.8× |
| Radiologic examination, ribs, bilateral; including posteroanterior chest, minimum of 4 views Age Under 21 (71111) |
$440 |
$550 |
4.1× |
| Radiologic examination, ribs, unilateral; including posteroanterior chest, minimum of 3 views Age Under 21 (71101) |
$316 |
$395 |
3.0× |
| Radiologic examination, sacroiliac joints; less than 3 views Age Under 21 (72200) |
$247.20 |
$309 |
2.3× |
| Radiologic examination, shoulder; complete, minimum of 2 views Age Under 21 (73030) |
$250.40 |
$313 |
2.8× |
| Radiologic examination, sinuses, paranasal, less than 3 views Age Under 21 (70210) |
$248 |
$310 |
2.8× |
| Radiologic examination, skull; less than 4 views Age Under 21 (70250) |
$288 |
$360 |
2.7× |
| Radiologic examination, spine, lumbosacral; 2 or 3 views Age Under 21 (72100) |
$301.60 |
$377 |
2.8× |
| Radiologic examination, spine, lumbosacral; bending views only, 2 or 3 views Age Under 21 (72120) |
$318.40 |
$398 |
3.0× |
| Radiologic examination, spine, lumbosacral; complete, including bending views, minimum of 6 views Age Under 21 (72114) |
$554.40 |
$693 |
5.2× |
| Radiologic examination, spine; thoracic, minimum of 4 views Age Under 21 (72074) |
$366.40 |
$458 |
3.4× |
| Radiologic examination, wrist; complete, minimum of 3 views Age Under 21 (73110) |
$254.40 |
$318 |
2.9× |
| Radiologic examination; acromioclavicular joints, bilateral, with or without weighted distraction Age Under 21 (73050) |
$270.40 |
$338 |
3.0× |
| Radiologic examination; humerus, minimum of 2 views Age Under 21 (73060) |
$264 |
$330 |
3.0× |
| Radiologic examination; lower extremity, infant, minimum of 2 views Age Under 21 (73592) |
$210.40 |
$263 |
2.4× |
| Radiologic examination; orbits, complete, minimum of 4 views Age Under 21 (70200) |
$359.20 |
$449 |
3.4× |
| Radiologic examination; sternoclavicular joint or joints, minimum of 3 views Age Under 21 (71130) |
$254.40 |
$318 |
2.9× |
| Radiologic examination; toe(s), minimum of 2 views Age Under 21 (73660) |
$210.40 |
$263 |
2.4× |
| Scapula complete (73010) |
$252 |
$315 |
2.4× |
| X-ray exam hips bi 3-4 views (73522) |
$340 |
$425 |
3.2× |
| X-ray exam of finger(s) (73140) |
$241.60 |
$302 |
2.7× |
| X-ray exam of knee 1 or 2 (73560) |
$290.40 |
$363 |
3.3× |
| X-ray exam ribs bil 3 views (71110) |
$385.60 |
$482 |
3.6× |
| X-ray exam ribs uni 2 views (71100) |
$277.60 |
$347 |
3.1× |
| X-ray heel (73650) |
$257.60 |
$322 |
2.9× |
| X-ray of joint between lower spine and hip bone 3 or more views|PROFESSIONAL COMPONENT (72202) |
$263.20 |
$329 |
2.5× |
| Xr abdomen 1 view (74018) |
$263.20 |
$329 |
3.0× |
| Xr abdomen 2 views (74019) |
$324.80 |
$406 |
3.0× |
| Xr bone survey infant (77076) |
$359.20 |
$449 |
3.4× |
| Xr chest 1 view (71045) |
$203.20 |
$254 |
2.3× |
| Xr chest 2 views (71046) |
$252.80 |
$316 |
2.8× |
| Xr eye foreign body (70030) |
$216 |
$270 |
2.4× |
| Xr facial bones 3+ views (70150) |
$280 |
$350 |
2.6× |
| Xr foot arthritis pa only bilateral - report(ortho pro) (73620) |
$193.60 |
$242 |
2.2× |
| Xr forearm 2 views (73090) |
$224.80 |
$281 |
2.5× |
| Xr hand 2v (73120) |
$234.40 |
$293 |
2.2× |
| Xr neck soft tissue (70360) |
$200 |
$250 |
2.2× |
| Xr o knee w/ merchant view bilat - report(ortho pro) (73562) |
$324.80 |
$406 |
3.7× |
| Xr osseous survey complete (77075) |
$566 |
$707.50 |
5.3× |
| Xr pelvis 1-2 views (72170) |
$252.80 |
$316 |
2.4× |
| Xr pelvis min 3 view (72190) |
$315.20 |
$394 |
3.0× |
| Xr sacrum/coccyx 2+ views (72220) |
$249.60 |
$312 |
2.8× |
| Xr sella turcica (70240) |
$240 |
$300 |
2.7× |
| Xr shoulder 1 view (73020) |
$217.60 |
$272 |
2.4× |
| Xr sinuses 3+ views (70220) |
$320 |
$400 |
3.6× |
| Xr skull min 4 view (70260) |
$360 |
$450 |
3.4× |
| Xr spine 1 view (72020) |
$189.60 |
$237 |
2.1× |
| Xr spine thoracic 3v (72072) |
$340 |
$425 |
3.2× |
| Xr sternum 2+ views (71120) |
$264 |
$330 |
3.0× |
| Xr t-spine 2 views (72070) |
$264 |
$330 |
2.5× |
| Xr tibia/fibula 2 views (73590) |
$274.40 |
$343 |
3.1× |
| Xr tmj bilateral (70330) |
$362.40 |
$453 |
4.1× |
| Xr tmj unilateral (70328) |
$188 |
$235 |
2.1× |
| Xr wrist 2 views (73100) |
$228 |
$285 |
2.6× |