| Ankle 2 views (73600) |
$161.15 |
$293 |
1.8× |
| Clavicle complete (73000) |
$161.15 |
$293 |
1.8× |
| Computed tomographic angiography, abdomen and pelvis, with contrast material(s), including noncontrast images, if… (74174) |
$2,230.80 |
$4,056 |
6.1× |
| Computed tomographic angiography, abdomen, with contrast material(s), including noncontrast images, if performed, and… (74175) |
$2,230.80 |
$4,056 |
12.1× |
| Computed tomographic angiography, abdominal aorta and bilateral iliofemoral lower extremity runoff, with contrast… (75635) |
$1,728.65 |
$3,143 |
9.3× |
| Computed tomographic angiography, chest (noncoronary), with contrast material(s), including noncontrast images, if… (71275) |
$2,341.90 |
$4,258 |
12.7× |
| Computed tomographic angiography, lower extremity, with contrast material(s), including noncontrast images, if… (73706) |
$2,230.80 |
$4,056 |
12.1× |
| Computed tomographic angiography, neck, with contrast material(s), including noncontrast images, if performed, and… (70498) |
$2,341.90 |
$4,258 |
12.7× |
| Computed tomographic angiography, upper extremity, with contrast material(s), including noncontrast images, if… (73206) |
$2,230.80 |
$4,056 |
12.1× |
| Computed tomography, cervical spine; without contrast material, followed by contrast material(s) and further sections… (72127) |
$933.35 |
$1,697 |
5.0× |
| Computed tomography, lower extremity; without contrast material Age Under 21 (73700) |
$665.50 |
$1,210 |
6.0× |
| Computed tomography, lower extremity; without contrast material, followed by contrast material(s) and further sections… (73702) |
$1,221 |
$2,220 |
6.6× |
| Computed tomography, lumbar spine; without contrast material, followed by contrast material(s) and further sections Age… (72133) |
$1,197.35 |
$2,177 |
6.5× |
| Computed tomography, maxillofacial area; with contrast material(s) Age Under 21 (70487) |
$1,112.10 |
$2,022 |
6.0× |
| Computed tomography, maxillofacial area; without contrast material Age Under 21 (70486) |
$810.15 |
$1,473 |
7.3× |
| Computed tomography, orbit, sella, or posterior fossa or outer, middle, or inner ear; with contrast material(s) Age… (70481) |
$1,147.30 |
$2,086 |
6.2× |
| Computed tomography, orbit, sella, or posterior fossa or outer, middle, or inner ear; without contrast material Age… (70480) |
$730.95 |
$1,329 |
6.6× |
| Computed tomography, thoracic spine; without contrast material, followed by contrast material(s) and further sections… (72130) |
$933.35 |
$1,697 |
5.0× |
| Computed tomography, thorax, diagnostic; without contrast material, followed by contrast material(s) and further… (71270) |
$1,255.65 |
$2,283 |
6.8× |
| CT abdomen and pelvis without and with contrast (74178) |
$2,387 |
$4,340 |
6.5× |
| CT abdomen and pelvis without contrast (74176) |
$1,758.35 |
$3,197 |
7.0× |
| CT abdomen w & w/o contrast (74170) |
$1,249.60 |
$2,272 |
6.8× |
| CT abdomen w/contrast (74160) |
$1,082.40 |
$1,968 |
5.8× |
| CT abdomen w/o contrast (74150) |
$618.75 |
$1,125 |
5.6× |
| CT angio hrt w/3d image (75574) |
$1,119.25 |
$2,035 |
3.0× |
| CT cervical spine w/o contrast (72125) |
$818.95 |
$1,489 |
7.4× |
| CT chest w/contrast (71260) |
$1,197.90 |
$2,178 |
6.5× |
| CT extremity upper w & w/o contrast (73202) |
$892.65 |
$1,623 |
4.8× |
| CT extremity upper w/o contrast (73200) |
$693 |
$1,260 |
6.3× |
| CT head/brain with contrast (70460) |
$1,333.75 |
$2,425 |
7.2× |
| CT head/brain without and with contrast (70470) |
$1,249.60 |
$2,272 |
6.8× |
| CT heart no contrast quant eval coronry calcium (75571) |
$567.60 |
$1,032 |
6.2× |
| CT l-spine w/contrast (72132) |
$1,073.60 |
$1,952 |
2.9× |
| CT lower extremity w/dye (73701) |
$944.90 |
$1,718 |
5.1× |
| CT lumbar spine w/o contrast (72131) |
$818.95 |
$1,489 |
7.4× |
| CT neck w/contrast (70491) |
$917.95 |
$1,669 |
5.0× |
| CT neck w/o contrast (70490) |
$618.75 |
$1,125 |
5.6× |
| CT pelvis w & w/o contrast (72194) |
$1,249.60 |
$2,272 |
6.8× |
| CT pelvis w/o contrast (72192) |
$730.95 |
$1,329 |
6.6× |
| CT thoracic spine w/contrast (72129) |
$871.20 |
$1,584 |
4.7× |
| CT thoracic spine w/o contrast (72128) |
$647.90 |
$1,178 |
5.9× |
| CT thorax w/o contrast (71250) |
$772.75 |
$1,405 |
7.0× |
| CT upper extremity w/dye (73201) |
$983.95 |
$1,789 |
2.7× |
| CTA head w contrast (70496) |
$2,339.70 |
$4,254 |
12.6× |
| Dual-energy X-ray absorptiometry (DXA), bone density study, 1 or more sites; axial skeleton (eg, hips, pelvis, spine)… (77080) |
$290.95 |
$529 |
2.6× |
| Dxa bone density/peripheral (77081) |
$290.95 |
$529 |
3.2× |
| Fetal biophys profile w/o nst (76819) |
$300.30 |
$546 |
2.7× |
| Fluoroscopy up to 1 hour physician/qhp time (76000) |
$391.05 |
$711 |
1.6× |
| Hepatobil syst imag inc gb w/pharma intervenj (78227) |
$1,503.15 |
$2,733 |
2.6× |
| Hepatobiliary syst imaging including gallbladder (78226) |
$883.85 |
$1,607 |
2.1× |
| Ht muscle image spect sing (78451) |
$2,129.05 |
$3,871 |
1.6× |
| Kidney imaging morphology; with vascular flow and function, multiple studies, with and without pharmacological… (78709) |
$858.55 |
$1,561 |
1.5× |
| Lung perfusion imaging (78580) |
$821.15 |
$1,493 |
1.9× |
| Magnetic resonance (eg, proton) imaging, any joint of lower extremity; without contrast material(s), followed by… (73723) |
$2,180.75 |
$3,965 |
5.9× |
| Magnetic resonance (eg, proton) imaging, lower extremity other than joint; without contrast material(s) Age Under 21 (73718) |
$1,614.25 |
$2,935 |
6.4× |
| Magnetic resonance (eg, proton) imaging, lower extremity other than joint; without contrast material(s), followed by… (73720) |
$2,333.10 |
$4,242 |
6.3× |
| Magnetic resonance (eg, proton) imaging, orbit, face, and/or neck; without contrast material(s) Age Under 21 (70540) |
$1,473.45 |
$2,679 |
5.9× |
| Magnetic resonance (eg, proton) imaging, upper extremity, other than joint; without contrast material(s), followed by… (73220) |
$1,911.80 |
$3,476 |
5.2× |
| Magnetic resonance angiography, neck; without contrast material(s), followed by contrast material(s) and further… (70549) |
$2,361.70 |
$4,294 |
6.4× |
| Mandible min 4v (70110) |
$161.15 |
$293 |
1.5× |
| MRA head w/o contrast (70544) |
$1,997.60 |
$3,632 |
7.9× |
| MRA neck w/o contrast (70547) |
$1,997.60 |
$3,632 |
7.9× |
| MRI abdomen w/o contrast (74181) |
$1,614.25 |
$2,935 |
6.4× |
| MRI abdomen w/wo contrast (74183) |
$2,060.85 |
$3,747 |
5.6× |
| MRI any jt lower extrem w/contrast material (73722) |
$1,593.90 |
$2,898 |
1.9× |
| MRI c-spine w&w/o cont (72156) |
$2,389.75 |
$4,345 |
6.5× |
| MRI cervical spine w/contrast (72142) |
$1,576.30 |
$2,866 |
4.3× |
| MRI joint upr extr w/o&w/dye (73223) |
$1,911.80 |
$3,476 |
5.2× |
| MRI joint upr extrem w/dye (73222) |
$1,668.70 |
$3,034 |
2.0× |
| MRI joint upr extrem w/o dye (73221) |
$1,437.15 |
$2,613 |
5.7× |
| MRI lumbar spine w/wo contrast (72158) |
$1,939.30 |
$3,526 |
5.3× |
| MRI orbit/face/neck w&w/o cont (70543) |
$2,266.55 |
$4,121 |
6.2× |
| MRI pelvis w & w/o contrast (72197) |
$2,389.75 |
$4,345 |
6.5× |
| MRI pelvis w/o contrast (72195) |
$1,614.25 |
$2,935 |
6.4× |
| MRI spine cervical w/o contrast (72141) |
$1,291.40 |
$2,348 |
5.1× |
| MRI t-spine w&w/o cont (72157) |
$2,237.95 |
$4,069 |
6.1× |
| MRI thoracic spine w/o contrst (72146) |
$1,291.40 |
$2,348 |
5.1× |
| MRI upper extremity oth than jt w/o contr matrl (73218) |
$1,471.80 |
$2,676 |
5.8× |
| Myocardial spect multiple studies (78452) |
$2,846.80 |
$5,176 |
2.1× |
| Nm bone 3 phase (78315) |
$883.85 |
$1,607 |
2.1× |
| Nm bone imaging whole body (78306) |
$1,885.40 |
$3,428 |
4.5× |
| Nm gastric emptying (78264) |
$883.85 |
$1,607 |
2.1× |
| Nuclear medicine study of bone and/or joint limited area (78300) |
$1,396.45 |
$2,539 |
3.3× |
| Ob us limited fetus(s) (76815) |
$175.45 |
$319 |
1.6× |
| Parathyroid planar imaging w/wo subtraction (78071) |
$883.85 |
$1,607 |
2.1× |
| PET imaging CT attenuation skull base mid-thigh (78815) |
$3,996.30 |
$7,266 |
2.6× |
| PET imaging for CT attenuation whole body (78816) |
$4,561.70 |
$8,294 |
3.0× |
| Pulmonary ventilation & perfusion imaging (78582) |
$883.85 |
$1,607 |
1.5× |
| Radex entir thrc lmbr crv sac spi w/skull 2/3 vw (72082) |
$435.05 |
$791 |
3.9× |
| Radex hip unilateral with pelvis 1 view (73501) |
$393.80 |
$716 |
4.3× |
| Radex hip unilateral with pelvis 2-3 views (73502) |
$312.95 |
$569 |
3.4× |
| Radex hips bilateral with pelvis 2 views (73521) |
$469.15 |
$853 |
4.3× |
| Radex spine cervical 2 or 3 views (72040) |
$199.10 |
$362 |
2.2× |
| Radex spine cervical 4 or 5 views (72050) |
$336.60 |
$612 |
3.1× |
| Radex spine cervical 6 or more views (72052) |
$394.35 |
$717 |
3.6× |
| Radex spine thoracolumbar junction min 2 views (72080) |
$161.15 |
$293 |
1.8× |
| Radiologic exam abdomen 3+ views (74021) |
$336.60 |
$612 |
3.1× |
| Radiologic exam chest 3 views (71047) |
$207.35 |
$377 |
2.3× |
| Radiologic exam colon double contrast study (74280) |
$485.10 |
$882 |
2.6× |
| Radiologic exam colon single contrast study (74270) |
$328.90 |
$598 |
1.8× |
| Radiologic exam esophagus single contrast study (74220) |
$328.90 |
$598 |
1.8× |
| Radiologic exam small int single contrast study (74250) |
$328.90 |
$598 |
1.8× |
| Radiologic exam swallow function contrast study (74230) |
$328.90 |
$598 |
1.8× |
| Radiologic exam upr gi trc double contrast study (74246) |
$328.90 |
$598 |
1.8× |
| Radiologic examination femur 1 view (73551) |
$141.35 |
$257 |
1.5× |
| Radiologic examination femur minimum 2 views (73552) |
$161.15 |
$293 |
1.8× |
| Radiologic examination from nose to rectum for foreign body, single view, child Age Under 21 (76010) |
$193.60 |
$352 |
2.1× |
| Radiologic examination, ankle; complete, minimum of 3 views Age Under 21 (73610) |
$201.85 |
$367 |
2.2× |
| Radiologic examination, complete acute abdomen series, including 2 or more views of the abdomen (eg, supine, erect,… (74022) |
$336.60 |
$612 |
3.1× |
| Radiologic examination, elbow; 2 views Age Under 21 (73070) |
$161.15 |
$293 |
1.8× |
| Radiologic examination, elbow; complete, minimum of 3 views Age Under 21 (73080) |
$201.85 |
$367 |
2.2× |
| Radiologic examination, foot; complete, minimum of 3 views Age Under 21 (73630) |
$196.35 |
$357 |
2.1× |
| Radiologic examination, hand; minimum of 3 views Age Under 21 (73130) |
$201.85 |
$367 |
2.2× |
| Radiologic examination, knee; both knees, standing, anteroposterior Age Under 21 (73565) |
$161.15 |
$293 |
1.8× |
| Radiologic examination, knee; complete, 4 or more views Age Under 21 (73564) |
$201.85 |
$367 |
1.8× |
| Radiologic examination, nasal bones, complete, minimum of 3 views Age Under 21 (70160) |
$161.15 |
$293 |
1.8× |
| Radiologic examination, ribs, bilateral; including posteroanterior chest, minimum of 4 views Age Under 21 (71111) |
$254.10 |
$462 |
2.3× |
| Radiologic examination, ribs, unilateral; including posteroanterior chest, minimum of 3 views Age Under 21 (71101) |
$240.90 |
$438 |
2.2× |
| Radiologic examination, shoulder, arthrography, radiological supervision and interpretation Age Under 21 (73040) |
$764.50 |
$1,390 |
2.1× |
| Radiologic examination, shoulder; complete, minimum of 2 views Age Under 21 (73030) |
$226.05 |
$411 |
2.5× |
| Radiologic examination, sinuses, paranasal, less than 3 views Age Under 21 (70210) |
$161.15 |
$293 |
1.8× |
| Radiologic examination, skull; less than 4 views Age Under 21 (70250) |
$161.15 |
$293 |
1.5× |
| Radiologic examination, spine, lumbosacral; 2 or 3 views Age Under 21 (72100) |
$201.85 |
$367 |
1.8× |
| Radiologic examination, spine, lumbosacral; bending views only, 2 or 3 views Age Under 21 (72120) |
$161.15 |
$293 |
1.5× |
| Radiologic examination, spine, lumbosacral; complete, including bending views, minimum of 6 views Age Under 21 (72114) |
$269.50 |
$490 |
2.4× |
| Radiologic examination, wrist; complete, minimum of 3 views Age Under 21 (73110) |
$215.60 |
$392 |
2.3× |
| Radiologic examination; acromioclavicular joints, bilateral, with or without weighted distraction Age Under 21 (73050) |
$161.15 |
$293 |
1.8× |
| Radiologic examination; humerus, minimum of 2 views Age Under 21 (73060) |
$161.15 |
$293 |
1.8× |
| Radiologic examination; orbits, complete, minimum of 4 views Age Under 21 (70200) |
$165 |
$300 |
1.5× |
| Radiologic examination; sternoclavicular joint or joints, minimum of 3 views Age Under 21 (71130) |
$161.15 |
$293 |
1.8× |
| Radiologic examination; toe(s), minimum of 2 views Age Under 21 (73660) |
$161.15 |
$293 |
1.8× |
| Review by radiologist of urinary bladder and urethra images with contrast and after passing urine (74455) |
$521.40 |
$948 |
2.1× |
| Scapula complete (73010) |
$161.15 |
$293 |
1.5× |
| Screening digital breast tomosynthesis bi (77063) |
$56.65 |
$103 |
— |
| Thyroid uptake w/blood flow sngle/mult quan meas (78014) |
$883.85 |
$1,607 |
2.1× |
| Ultrasound breast limited (76642) |
$232.10 |
$422 |
2.5× |
| Ultrasound, abdomen limited (76705) |
$233.20 |
$424 |
2.1× |
| Ultrasound, limited, joint or focal evaluation of other nonvascular extremity structure(s) (eg, joint space,… (76882) |
$198 |
$360 |
1.8× |
| Ultrasound, pelvic (nonobstetric), real time with image documentation; complete Age Under 21 (76856) |
$315.70 |
$574 |
2.9× |
| Ultrasound, pregnant uterus, real time with image documentation, fetal and maternal evaluation plus detailed fetal… (76811) |
$350.35 |
$637 |
1.4× |
| Ultrasound, pregnant uterus, real time with image documentation, fetal and maternal evaluation, first trimester (< 14… (76801) |
$253 |
$460 |
2.3× |
| Umbilical-artery Doppler (OB) (76820) |
$202.40 |
$368 |
1.8× |
| Urethrocystography retrograde rs&i (74450) |
$521.40 |
$948 |
2.1× |
| Us abdominal aorta real time screen study aaa (76706) |
$300.30 |
$546 |
2.7× |
| Us breast uni real time with image complete (76641) |
$266.20 |
$484 |
2.4× |
| Us exam, pelvic, limited (76857) |
$109.45 |
$199 |
1.0× |
| US OB Follow-Up/Repeat (76816) |
$218.90 |
$398 |
2.0× |
| Us ob transvaginal (76817) |
$202.40 |
$368 |
1.8× |
| Us retroperitoneal complete (76770) |
$272.25 |
$495 |
2.5× |
| Us scrotum (76870) |
$217.80 |
$396 |
2.0× |
| Us soft tissue head/neck (76536) |
$251.35 |
$457 |
2.3× |
| X-ray exam hips bi 3-4 views (73522) |
$534.60 |
$972 |
4.8× |
| X-ray exam of finger(s) (73140) |
$161.15 |
$293 |
1.8× |
| X-ray exam of knee 1 or 2 (73560) |
$201.85 |
$367 |
2.2× |
| X-ray heel (73650) |
$161.15 |
$293 |
1.8× |
| X-ray of joint between lower spine and hip bone 3 or more views|PROFESSIONAL COMPONENT (72202) |
$161.15 |
$293 |
1.5× |
| Xr abdomen 1 view (74018) |
$199.65 |
$363 |
2.2× |
| Xr abdomen 2 views (74019) |
$250.80 |
$456 |
2.3× |
| Xr arthrogram hip (73525) |
$611.60 |
$1,112 |
1.7× |
| Xr arthrogram knee (73580) |
$611.60 |
$1,112 |
1.7× |
| Xr arthrogram wrist (73115) |
$611.60 |
$1,112 |
1.7× |
| Xr bone age studies (77072) |
$161.15 |
$293 |
1.5× |
| Xr chest 1 view (71045) |
$161.15 |
$293 |
1.8× |
| Xr chest 2 views (71046) |
$184.80 |
$336 |
2.0× |
| Xr eye foreign body (70030) |
$161.15 |
$293 |
1.8× |
| Xr facial bones 3+ views (70150) |
$161.15 |
$293 |
1.5× |
| Xr foot arthritis pa only bilateral - report(ortho pro) (73620) |
$161.15 |
$293 |
1.8× |
| Xr forearm 2 views (73090) |
$161.15 |
$293 |
1.8× |
| Xr hand 2v (73120) |
$161.15 |
$293 |
1.5× |
| Xr hysterosalpingogram (74740) |
$590.70 |
$1,074 |
2.3× |
| Xr neck soft tissue (70360) |
$161.15 |
$293 |
1.8× |
| Xr o knee w/ merchant view bilat - report(ortho pro) (73562) |
$193.05 |
$351 |
2.1× |
| Xr osseous survey complete (77075) |
$435.05 |
$791 |
3.9× |
| Xr pelvis 1-2 views (72170) |
$201.85 |
$367 |
1.8× |
| Xr pelvis min 3 view (72190) |
$242 |
$440 |
2.2× |
| Xr sacrum/coccyx 2+ views (72220) |
$161.15 |
$293 |
1.8× |
| Xr shoulder 1 view (73020) |
$161.15 |
$293 |
1.8× |
| Xr sinuses 3+ views (70220) |
$217.25 |
$395 |
2.4× |
| Xr spine 1 view (72020) |
$161.15 |
$293 |
1.8× |
| Xr spine thoracic 3v (72072) |
$161.15 |
$293 |
1.5× |
| Xr sternum 2+ views (71120) |
$161.15 |
$293 |
1.8× |
| Xr surgical specimen (76098) |
$312.95 |
$569 |
0.5× |
| Xr t-spine 2 views (72070) |
$161.15 |
$293 |
1.5× |
| Xr tibia/fibula 2 views (73590) |
$201.85 |
$367 |
2.2× |
| Xr tmj bilateral (70330) |
$161.15 |
$293 |
1.8× |
| Xr wrist 2 views (73100) |
$201.85 |
$367 |
2.2× |