| Ankle 2 views (73600) |
$170.06 |
$226.74 |
1.9× |
| Clavicle complete (73000) |
$254.42 |
$339.23 |
2.8× |
| Computed tomographic angiography, abdomen and pelvis, with contrast material(s), including noncontrast images, if… (74174) |
$803.25 |
$1,071 |
2.2× |
| Computed tomographic angiography, abdomen, with contrast material(s), including noncontrast images, if performed, and… (74175) |
$1,543.23 |
$2,057.64 |
8.3× |
| Computed tomographic angiography, chest (noncoronary), with contrast material(s), including noncontrast images, if… (71275) |
$2,024.80 |
$2,699.74 |
10.9× |
| Computed tomographic angiography, lower extremity, with contrast material(s), including noncontrast images, if… (73706) |
$928.05 |
$1,237.40 |
5.0× |
| Computed tomographic angiography, neck, with contrast material(s), including noncontrast images, if performed, and… (70498) |
$1,481.72 |
$1,975.62 |
8.0× |
| Computed tomographic angiography, pelvis, with contrast material(s), including noncontrast images, if performed, and… (72191) |
$1,148.63 |
$1,531.51 |
6.2× |
| Computed tomographic angiography, upper extremity, with contrast material(s), including noncontrast images, if… (73206) |
$1,167.08 |
$1,556.11 |
6.3× |
| Computed tomography, lower extremity; without contrast material Age Under 21 (73700) |
$529.94 |
$706.58 |
4.8× |
| Computed tomography, maxillofacial area; with contrast material(s) Age Under 21 (70487) |
$1,180.28 |
$1,573.70 |
6.4× |
| Computed tomography, maxillofacial area; without contrast material Age Under 21 (70486) |
$1,045.81 |
$1,394.41 |
9.5× |
| Computed tomography, orbit, sella, or posterior fossa or outer, middle, or inner ear; with contrast material(s) Age… (70481) |
$1,214.54 |
$1,619.39 |
6.6× |
| Computed tomography, orbit, sella, or posterior fossa or outer, middle, or inner ear; without contrast material Age… (70480) |
$959.69 |
$1,279.58 |
8.7× |
| Computed tomography, orbit, sella, or posterior fossa or outer, middle, or inner ear; without contrast material,… (70482) |
$1,137.22 |
$1,516.29 |
6.1× |
| Computed tomography, soft tissue neck; without contrast material followed by contrast material(s) and further sections… (70492) |
$1,454.48 |
$1,939.30 |
7.9× |
| Computed tomography, thorax, diagnostic; without contrast material, followed by contrast material(s) and further… (71270) |
$1,982.65 |
$2,643.53 |
10.7× |
| CT abdomen and pelvis without and with contrast (74178) |
$2,849.94 |
$3,799.92 |
7.7× |
| CT abdomen and pelvis without contrast (74176) |
$1,920.25 |
$2,560.33 |
7.6× |
| CT abdomen w & w/o contrast (74170) |
$2,313.08 |
$3,084.10 |
12.5× |
| CT abdomen w/contrast (74160) |
$1,275.19 |
$1,700.25 |
6.9× |
| CT abdomen w/o contrast (74150) |
$1,107.34 |
$1,476.45 |
10.0× |
| CT cervical spine w/o contrast (72125) |
$1,038.79 |
$1,385.05 |
9.4× |
| CT chest w/contrast (71260) |
$1,924.64 |
$2,566.18 |
10.4× |
| CT extremity upper w/o contrast (73200) |
$744.38 |
$992.50 |
6.7× |
| CT head/brain with contrast (70460) |
$1,116.13 |
$1,488.17 |
6.0× |
| CT head/brain without and with contrast (70470) |
$1,340.22 |
$1,786.96 |
7.2× |
| CT heart no contrast quant eval coronry calcium (75571) |
$81.18 |
$108.24 |
0.9× |
| CT lower extremity w/dye (73701) |
$853.34 |
$1,137.79 |
4.6× |
| CT lumbar spine w/o contrast (72131) |
$1,038.79 |
$1,385.05 |
9.4× |
| CT maxillofacial w/wo contrast (70488) |
$1,415.81 |
$1,887.74 |
7.7× |
| CT neck w/contrast (70491) |
$1,214.54 |
$1,619.39 |
6.6× |
| CT neck w/o contrast (70490) |
$1,057.24 |
$1,409.65 |
9.6× |
| CT pelvis w/o contrast (72192) |
$871.81 |
$1,162.41 |
7.9× |
| CT thoracic spine w/o contrast (72128) |
$1,038.79 |
$1,385.05 |
9.4× |
| CT thorax lung cancer scr c- (71271) |
$844.62 |
$1,126.16 |
7.7× |
| CT thorax w/o contrast (71250) |
$1,513.91 |
$2,018.54 |
13.7× |
| CT upper extremity w/dye (73201) |
$855.98 |
$1,141.31 |
2.3× |
| CTA head w contrast (70496) |
$1,385.91 |
$1,847.88 |
7.5× |
| Lung perfusion imaging (78580) |
$3,724.49 |
$4,965.99 |
8.8× |
| Magnetic resonance (eg, proton) imaging, any joint of lower extremity; without contrast material(s), followed by… (73723) |
$2,412.25 |
$3,216.33 |
6.6× |
| Magnetic resonance (eg, proton) imaging, lower extremity other than joint; without contrast material(s) Age Under 21 (73718) |
$2,973.96 |
$3,965.28 |
11.8× |
| Magnetic resonance (eg, proton) imaging, lower extremity other than joint; without contrast material(s), followed by… (73720) |
$3,218.29 |
$4,291.05 |
8.7× |
| Magnetic resonance (eg, proton) imaging, orbit, face, and/or neck; with contrast material(s) Age Under 21 (70542) |
$2,218.16 |
$2,957.54 |
6.0× |
| Magnetic resonance (eg, proton) imaging, orbit, face, and/or neck; without contrast material(s) Age Under 21 (70540) |
$1,994.07 |
$2,658.76 |
7.9× |
| Magnetic resonance (eg, proton) imaging, upper extremity, other than joint; without contrast material(s), followed by… (73220) |
$2,518.73 |
$3,358.30 |
6.8× |
| Magnetic resonance angiography, head; with contrast material(s) Age Under 21 (70545) |
$2,638.25 |
$3,517.67 |
7.2× |
| Magnetic resonance angiography, neck; without contrast material(s), followed by contrast material(s) and further… (70549) |
$3,084.68 |
$4,112.91 |
8.4× |
| Mandible min 4v (70110) |
$241.67 |
$322.23 |
2.2× |
| MRA head w/o contrast (70544) |
$2,263.88 |
$3,018.51 |
9.0× |
| MRA neck w/ contrast (70548) |
$2,460.72 |
$3,280.96 |
6.7× |
| MRA neck w/o contrast (70547) |
$2,016.92 |
$2,689.22 |
8.0× |
| MRI abdomen w/contrast (74182) |
$2,596.07 |
$3,461.43 |
7.1× |
| MRI abdomen w/o contrast (74181) |
$2,418.54 |
$3,224.72 |
9.6× |
| MRI abdomen w/wo contrast (74183) |
$3,224.45 |
$4,299.26 |
8.8× |
| MRI any jt lower extrem w/contrast material (73722) |
$2,326.09 |
$3,101.45 |
2.8× |
| MRI c-spine w&w/o cont (72156) |
$3,495.12 |
$4,660.16 |
9.5× |
| MRI cervical spine w/contrast (72142) |
$2,346.47 |
$3,128.63 |
6.4× |
| MRI chest w/contrast (71551) |
$2,132.93 |
$2,843.91 |
2.6× |
| MRI chest w/o contrast (71550) |
$1,911.45 |
$2,548.60 |
7.6× |
| MRI chest w/wo contrast (71552) |
$3,428.32 |
$4,571.09 |
9.3× |
| MRI joint upr extr w/o&w/dye (73223) |
$1,550.72 |
$2,067.63 |
4.2× |
| MRI joint upr extrem w/dye (73222) |
$1,449.92 |
$1,933.23 |
1.8× |
| MRI joint upr extrem w/o dye (73221) |
$2,175.11 |
$2,900.14 |
8.6× |
| MRI lumbar spine w/contrast (72149) |
$2,400.96 |
$3,201.28 |
6.5× |
| MRI lumbar spine w/wo contrast (72158) |
$4,391.96 |
$5,855.94 |
11.9× |
| MRI orbit/face/neck w&w/o cont (70543) |
$3,443.25 |
$4,591 |
9.4× |
| MRI pelvis w & w/o contrast (72197) |
$3,452.05 |
$4,602.73 |
9.4× |
| MRI pelvis w/contrast (72196) |
$2,310.44 |
$3,080.59 |
6.3× |
| MRI pelvis w/o contrast (72195) |
$2,001.98 |
$2,669.31 |
8.0× |
| MRI spine cervical w/o contrast (72141) |
$2,019.55 |
$2,692.73 |
8.0× |
| MRI t-spine w&w/o cont (72157) |
$3,495.12 |
$4,660.16 |
9.5× |
| MRI thoracic spine w/contrast (72147) |
$2,417.67 |
$3,223.56 |
6.6× |
| MRI thoracic spine w/o contrst (72146) |
$2,011.64 |
$2,682.19 |
8.0× |
| MRI tmj (70336) |
$1,573.12 |
$2,097.49 |
6.2× |
| MRI upper extremity oth than jt w/o contr matrl (73218) |
$2,175.11 |
$2,900.14 |
8.6× |
| Ob us limited fetus(s) (76815) |
$285.62 |
$380.83 |
2.6× |
| Pulmonary ventilation & perfusion imaging (78582) |
$1,182.83 |
$1,577.10 |
2.1× |
| Radex entir thrc lmbr crv sac spi w/skull 1 vw (72081) |
$168.81 |
$225.08 |
1.8× |
| Radex entir thrc lmbr crv sac spi w/skull 2/3 vw (72082) |
$174.02 |
$232.03 |
1.6× |
| Radex hip unilateral with pelvis 1 view (73501) |
$147.92 |
$197.22 |
1.6× |
| Radex hip unilateral with pelvis 2-3 views (73502) |
$189.84 |
$253.12 |
2.1× |
| Radex hips bilateral with pelvis 2 views (73521) |
$255.76 |
$341.01 |
2.3× |
| Radex spine cervical 2 or 3 views (72040) |
$186.32 |
$248.42 |
2.0× |
| Radex spine cervical 4 or 5 views (72050) |
$244.32 |
$325.76 |
2.2× |
| Radex spine cervical 6 or more views (72052) |
$275.95 |
$367.93 |
2.5× |
| Radex spine thoracolumbar junction min 2 views (72080) |
$203 |
$270.67 |
2.2× |
| Radiologic exam swallow function contrast study (74230) |
$892.90 |
$1,190.53 |
4.8× |
| Radiologic examination femur 1 view (73551) |
$182.72 |
$243.62 |
2.0× |
| Radiologic examination femur minimum 2 views (73552) |
$253.21 |
$337.61 |
2.8× |
| Radiologic examination, ankle; complete, minimum of 3 views Age Under 21 (73610) |
$255.74 |
$340.99 |
2.8× |
| Radiologic examination, complete acute abdomen series, including 2 or more views of the abdomen (eg, supine, erect,… (74022) |
$258.38 |
$344.51 |
2.3× |
| Radiologic examination, elbow; 2 views Age Under 21 (73070) |
$212.24 |
$282.98 |
2.3× |
| Radiologic examination, elbow; complete, minimum of 3 views Age Under 21 (73080) |
$230.69 |
$307.58 |
2.5× |
| Radiologic examination, facial bones; less than 3 views Age Under 21 (70140) |
$184.56 |
$246.08 |
2.0× |
| Radiologic examination, foot; complete, minimum of 3 views Age Under 21 (73630) |
$253.10 |
$337.48 |
2.8× |
| Radiologic examination, hand; minimum of 3 views Age Under 21 (73130) |
$230.69 |
$307.58 |
2.5× |
| Radiologic examination, knee; both knees, standing, anteroposterior Age Under 21 (73565) |
$149.41 |
$199.21 |
1.6× |
| Radiologic examination, knee; complete, 4 or more views Age Under 21 (73564) |
$297.92 |
$397.23 |
2.7× |
| Radiologic examination, mastoids; complete, minimum of 3 views per side Age Under 21 (70130) |
$241.67 |
$322.23 |
2.2× |
| Radiologic examination, nasal bones, complete, minimum of 3 views Age Under 21 (70160) |
$175.78 |
$234.37 |
1.9× |
| Radiologic examination, ribs, bilateral; including posteroanterior chest, minimum of 4 views Age Under 21 (71111) |
$321.65 |
$428.87 |
2.9× |
| Radiologic examination, ribs, unilateral; including posteroanterior chest, minimum of 3 views Age Under 21 (71101) |
$241.67 |
$322.23 |
2.2× |
| Radiologic examination, shoulder; complete, minimum of 2 views Age Under 21 (73030) |
$199.50 |
$265.99 |
2.2× |
| Radiologic examination, sinuses, paranasal, less than 3 views Age Under 21 (70210) |
$146.33 |
$195.10 |
1.6× |
| Radiologic examination, skull; less than 4 views Age Under 21 (70250) |
$212.68 |
$283.57 |
1.9× |
| Radiologic examination, spine, lumbosacral; 2 or 3 views Age Under 21 (72100) |
$207.40 |
$276.53 |
1.9× |
| Radiologic examination, spine, lumbosacral; complete, including bending views, minimum of 6 views Age Under 21 (72114) |
$326.05 |
$434.73 |
3.0× |
| Radiologic examination, wrist; complete, minimum of 3 views Age Under 21 (73110) |
$242.56 |
$323.42 |
2.6× |
| Radiologic examination; acromioclavicular joints, bilateral, with or without weighted distraction Age Under 21 (73050) |
$174.88 |
$233.17 |
1.9× |
| Radiologic examination; humerus, minimum of 2 views Age Under 21 (73060) |
$259.70 |
$346.26 |
2.8× |
| Radiologic examination; lower extremity, infant, minimum of 2 views Age Under 21 (73592) |
$121.27 |
$161.70 |
1.3× |
| Radiologic examination; orbits, complete, minimum of 4 views Age Under 21 (70200) |
$241.67 |
$322.23 |
2.2× |
| Radiologic examination; sternoclavicular joint or joints, minimum of 3 views Age Under 21 (71130) |
$161.70 |
$215.60 |
1.8× |
| Radiologic examination; toe(s), minimum of 2 views Age Under 21 (73660) |
$137.10 |
$182.80 |
1.5× |
| Radiologic examination; upper extremity, infant, minimum of 2 views Age Under 21 (73092) |
$118.65 |
$158.20 |
1.1× |
| Scapula complete (73010) |
$239.93 |
$319.90 |
2.2× |
| Ultrasound bone density measurement and interpretation, peripheral site(s), any method Age Under 21 (76977) |
$108.97 |
$145.29 |
1.0× |
| Ultrasound, abdomen limited (76705) |
$181.91 |
$242.55 |
1.6× |
| Ultrasound, limited, joint or focal evaluation of other nonvascular extremity structure(s) (eg, joint space,… (76882) |
$340.11 |
$453.48 |
3.1× |
| Ultrasound, pelvic (nonobstetric), real time with image documentation; complete Age Under 21 (76856) |
$406.03 |
$541.37 |
3.7× |
| Ultrasound, pregnant uterus, real time with image documentation, fetal and maternal evaluation plus detailed fetal… (76811) |
$402.50 |
$536.67 |
1.6× |
| Ultrasound, pregnant uterus, real time with image documentation, fetal and maternal evaluation, first trimester (< 14… (76801) |
$394.59 |
$526.12 |
3.6× |
| Ultrasound, transrectal; prostate volume study for brachytherapy treatment planning (separate procedure) Age Under 21 (76873) |
$443.81 |
$591.74 |
4.0× |
| Urography (pyelography), intravenous, with or without KUB, with or without tomography Age Under 21 (74400) |
$312 |
$416 |
1.7× |
| Us abdominal aorta real time screen study aaa (76706) |
$350.37 |
$467.16 |
3.2× |
| Us breast uni real time with image complete (76641) |
$354.17 |
$472.23 |
3.2× |
| Us chest (76604) |
$209.96 |
$279.95 |
1.9× |
| Us exam, pelvic, limited (76857) |
$257.49 |
$343.32 |
2.3× |
| US OB Follow-Up/Repeat (76816) |
$318.14 |
$424.18 |
2.9× |
| Us ob transvaginal (76817) |
$335.72 |
$447.62 |
3.0× |
| Us retroperitoneal complete (76770) |
$428.88 |
$571.84 |
3.9× |
| Us retroperitoneal ltd (76775) |
$181.04 |
$241.38 |
1.6× |
| Us scrotum (76870) |
$299.24 |
$398.99 |
2.7× |
| Us soft tissue head/neck (76536) |
$298.82 |
$398.42 |
2.7× |
| X-ray exam hips bi 3-4 views (73522) |
$304.55 |
$406.06 |
2.8× |
| X-ray exam of finger(s) (73140) |
$230.69 |
$307.58 |
2.5× |
| X-ray exam of knee 1 or 2 (73560) |
$230.69 |
$307.58 |
2.5× |
| X-ray exam ribs bil 3 views (71110) |
$238.16 |
$317.55 |
2.2× |
| X-ray exam ribs uni 2 views (71100) |
$198.61 |
$264.81 |
2.2× |
| X-ray heel (73650) |
$89.64 |
$119.51 |
1.0× |
| X-ray of joint between lower spine and hip bone 3 or more views|PROFESSIONAL COMPONENT (72202) |
$203 |
$270.67 |
1.8× |
| Xr abdomen 1 view (74018) |
$149.41 |
$199.21 |
1.6× |
| Xr abdomen 2 views (74019) |
$191.59 |
$255.45 |
1.7× |
| Xr bone survey ltd (77074) |
$278.59 |
$371.45 |
2.5× |
| Xr chest 1 view (71045) |
$103.18 |
$137.58 |
1.1× |
| Xr chest 2 views (71046) |
$109.80 |
$146.40 |
1.2× |
| Xr eye foreign body (70030) |
$51.86 |
$69.14 |
0.6× |
| Xr facial bones 3+ views (70150) |
$247.84 |
$330.45 |
2.2× |
| Xr foot arthritis pa only bilateral - report(ortho pro) (73620) |
$217.50 |
$290 |
2.4× |
| Xr forearm 2 views (73090) |
$233.33 |
$311.10 |
2.5× |
| Xr hand 2v (73120) |
$187.19 |
$249.59 |
1.7× |
| Xr neck soft tissue (70360) |
$124.79 |
$166.39 |
1.4× |
| Xr pelvis 1-2 views (72170) |
$169.62 |
$226.16 |
1.5× |
| Xr pelvis min 3 view (72190) |
$202.13 |
$269.50 |
1.8× |
| Xr sacrum/coccyx 2+ views (72220) |
$195.10 |
$260.13 |
2.1× |
| Xr shoulder 1 view (73020) |
$187.19 |
$249.59 |
2.0× |
| Xr sinuses 3+ views (70220) |
$215.31 |
$287.08 |
2.3× |
| Xr skull min 4 view (70260) |
$275.95 |
$367.93 |
2.5× |
| Xr spine thoracic 3v (72072) |
$255.76 |
$341.01 |
2.3× |
| Xr sternum 2+ views (71120) |
$173.14 |
$230.85 |
1.9× |
| Xr t-spine 2 views (72070) |
$203 |
$270.67 |
1.8× |
| Xr tibia/fibula 2 views (73590) |
$254.42 |
$339.23 |
2.8× |
| Xr tmj bilateral (70330) |
$227.62 |
$303.49 |
2.5× |
| Xr wrist 2 views (73100) |
$214.88 |
$286.50 |
2.3× |