| Ankle 2 views (73600) |
$117.20 |
$156.26 |
1.3× |
| Clavicle complete (73000) |
$144.56 |
$192.76 |
1.6× |
| Computed tomographic angiography, abdomen and pelvis, with contrast material(s), including noncontrast images, if… (74174) |
$2,647.12 |
$3,529.50 |
7.4× |
| Computed tomographic angiography, abdomen, with contrast material(s), including noncontrast images, if performed, and… (74175) |
$2,132.72 |
$2,843.62 |
11.9× |
| Computed tomographic angiography, abdominal aorta and bilateral iliofemoral lower extremity runoff, with contrast… (75635) |
$3,003 |
$4,004 |
16.8× |
| Computed tomographic angiography, lower extremity, with contrast material(s), including noncontrast images, if… (73706) |
$512.78 |
$683.71 |
2.9× |
| Computed tomographic angiography, neck, with contrast material(s), including noncontrast images, if performed, and… (70498) |
$1,997.83 |
$2,663.78 |
11.1× |
| Computed tomographic angiography, pelvis, with contrast material(s), including noncontrast images, if performed, and… (72191) |
$1,973.67 |
$2,631.56 |
11.0× |
| Computed tomography, cervical spine; without contrast material, followed by contrast material(s) and further sections… (72127) |
$1,831.16 |
$2,441.55 |
10.2× |
| Computed tomography, lower extremity; without contrast material Age Under 21 (73700) |
$1,139.68 |
$1,519.58 |
10.7× |
| Computed tomography, lower extremity; without contrast material, followed by contrast material(s) and further sections… (73702) |
$1,826.66 |
$2,435.54 |
10.2× |
| Computed tomography, lumbar spine; without contrast material, followed by contrast material(s) and further sections Age… (72133) |
$1,822.98 |
$2,430.63 |
10.2× |
| Computed tomography, maxillofacial area; with contrast material(s) Age Under 21 (70487) |
$1,055.58 |
$1,407.43 |
5.9× |
| Computed tomography, maxillofacial area; without contrast material Age Under 21 (70486) |
$916.26 |
$1,221.68 |
8.6× |
| Computed tomography, orbit, sella, or posterior fossa or outer, middle, or inner ear; with contrast material(s) Age… (70481) |
$3,385.20 |
$4,513.60 |
18.9× |
| Computed tomography, orbit, sella, or posterior fossa or outer, middle, or inner ear; without contrast material Age… (70480) |
$1,446.07 |
$1,928.10 |
13.5× |
| Computed tomography, orbit, sella, or posterior fossa or outer, middle, or inner ear; without contrast material,… (70482) |
$3,395.57 |
$4,527.43 |
18.9× |
| Computed tomography, soft tissue neck; without contrast material followed by contrast material(s) and further sections… (70492) |
$1,637.44 |
$2,183.25 |
9.1× |
| Computed tomography, thoracic spine; without contrast material, followed by contrast material(s) and further sections… (72130) |
$1,834.03 |
$2,445.37 |
10.2× |
| Computed tomography, thorax, diagnostic; without contrast material, followed by contrast material(s) and further… (71270) |
$1,505.33 |
$2,007.10 |
8.4× |
| CT abdomen and pelvis without and with contrast (74178) |
$2,499.78 |
$3,333.04 |
7.0× |
| CT abdomen and pelvis without contrast (74176) |
$1,612.58 |
$2,150.11 |
6.6× |
| CT abdomen w & w/o contrast (74170) |
$1,995.23 |
$2,660.30 |
11.1× |
| CT abdomen w/contrast (74160) |
$1,670.17 |
$2,226.90 |
9.3× |
| CT abdomen w/o contrast (74150) |
$865.56 |
$1,154.08 |
8.1× |
| CT cervical spine w/contrast (72126) |
$1,607.78 |
$2,143.72 |
4.5× |
| CT cervical spine w/o contrast (72125) |
$1,188.82 |
$1,585.10 |
11.1× |
| CT chest w/contrast (71260) |
$1,339.58 |
$1,786.11 |
7.5× |
| CT extremity upper w & w/o contrast (73202) |
$1,853.40 |
$2,471.20 |
10.3× |
| CT extremity upper w/o contrast (73200) |
$344.72 |
$459.63 |
3.2× |
| CT head/brain with contrast (70460) |
$1,087.50 |
$1,450 |
6.1× |
| CT head/brain without and with contrast (70470) |
$1,306.14 |
$1,741.52 |
7.3× |
| CT l-spine w/contrast (72132) |
$1,610.90 |
$2,147.88 |
4.5× |
| CT limited/localized follow up study (76380) |
$1,361.88 |
$1,815.84 |
15.3× |
| CT lower extremity w/dye (73701) |
$1,448.36 |
$1,931.15 |
8.1× |
| CT lumbar spine w/o contrast (72131) |
$1,277.45 |
$1,703.26 |
12.0× |
| CT maxillofacial w/wo contrast (70488) |
$1,384.24 |
$1,845.64 |
7.7× |
| CT neck w/contrast (70491) |
$1,333.74 |
$1,778.31 |
7.4× |
| CT neck w/o contrast (70490) |
$1,035.84 |
$1,381.12 |
9.7× |
| CT pelvis w & w/o contrast (72194) |
$1,776.13 |
$2,368.17 |
9.9× |
| CT pelvis w/o contrast (72192) |
$858.80 |
$1,145.07 |
8.0× |
| CT thoracic spine w/contrast (72129) |
$1,494.47 |
$1,992.63 |
8.3× |
| CT thoracic spine w/o contrast (72128) |
$1,283.30 |
$1,711.06 |
12.0× |
| CT thorax lung cancer scr c- (71271) |
$926.92 |
$1,235.90 |
8.7× |
| CT thorax w/o contrast (71250) |
$1,026.83 |
$1,369.10 |
9.6× |
| CT upper extremity w/dye (73201) |
$2,700.36 |
$3,600.48 |
7.6× |
| CTA head w contrast (70496) |
$2,003.68 |
$2,671.58 |
11.2× |
| Fetal biophysical profile non-stress testing (76818) |
$546 |
$728 |
5.1× |
| Fluoroscopy up to 1 hour physician/qhp time (76000) |
$262.90 |
$350.53 |
1.1× |
| Hepatobil syst imag inc gb w/pharma intervenj (78227) |
$1,458.32 |
$1,944.42 |
2.6× |
| Magnetic resonance (eg, proton) imaging, any joint of lower extremity; without contrast material(s), followed by… (73723) |
$837.94 |
$1,117.25 |
2.4× |
| Magnetic resonance (eg, proton) imaging, lower extremity other than joint; with contrast material(s) Age Under 21 (73719) |
$1,461.30 |
$1,948.40 |
4.1× |
| Magnetic resonance (eg, proton) imaging, lower extremity other than joint; without contrast material(s) Age Under 21 (73718) |
$577.57 |
$770.09 |
2.4× |
| Magnetic resonance (eg, proton) imaging, lower extremity other than joint; without contrast material(s), followed by… (73720) |
$2,028.50 |
$2,704.66 |
5.7× |
| Magnetic resonance (eg, proton) imaging, orbit, face, and/or neck; with contrast material(s) Age Under 21 (70542) |
$1,489.97 |
$1,986.62 |
4.2× |
| Magnetic resonance (eg, proton) imaging, upper extremity, other than joint; with contrast material(s) Age Under 21 (73219) |
$1,915.85 |
$2,554.46 |
5.4× |
| Magnetic resonance (eg, proton) imaging, upper extremity, other than joint; without contrast material(s), followed by… (73220) |
$2,280.72 |
$3,040.95 |
6.4× |
| Magnetic resonance angiography, neck; without contrast material(s), followed by contrast material(s) and further… (70549) |
$2,148.78 |
$2,865.03 |
6.0× |
| Mandible min 4v (70110) |
$153.78 |
$205.03 |
1.4× |
| MRA head w/o contrast (70544) |
$1,509.54 |
$2,012.72 |
6.2× |
| MRA neck w/ contrast (70548) |
$1,584.48 |
$2,112.64 |
4.4× |
| MRA neck w/o contrast (70547) |
$1,515.28 |
$2,020.36 |
6.2× |
| MRI abdomen w/o contrast (74181) |
$2,045.04 |
$2,726.72 |
8.4× |
| MRI abdomen w/wo contrast (74183) |
$1,786.61 |
$2,382.14 |
5.0× |
| MRI any jt lower extrem w/contrast material (73722) |
$1,800.78 |
$2,401.04 |
2.2× |
| MRI c-spine w&w/o cont (72156) |
$1,622.24 |
$2,162.98 |
4.6× |
| MRI cervical spine w/contrast (72142) |
$1,470.72 |
$1,960.96 |
4.1× |
| MRI chest w/wo contrast (71552) |
$2,671.78 |
$3,562.38 |
7.5× |
| MRI joint upr extr w/o&w/dye (73223) |
$1,873.28 |
$2,497.70 |
5.3× |
| MRI joint upr extrem w/dye (73222) |
$1,504.71 |
$2,006.28 |
1.9× |
| MRI joint upr extrem w/o dye (73221) |
$1,423.61 |
$1,898.14 |
5.8× |
| MRI lumbar spine w/contrast (72149) |
$1,449.84 |
$1,933.12 |
4.1× |
| MRI lumbar spine w/wo contrast (72158) |
$1,757.84 |
$2,343.78 |
4.9× |
| MRI orbit/face/neck w&w/o cont (70543) |
$1,787.26 |
$2,383.02 |
5.0× |
| MRI pelvis w & w/o contrast (72197) |
$1,988.04 |
$2,650.72 |
5.6× |
| MRI pelvis w/contrast (72196) |
$1,461.30 |
$1,948.40 |
4.1× |
| MRI pelvis w/o contrast (72195) |
$1,339.39 |
$1,785.86 |
5.5× |
| MRI spine cervical w/o contrast (72141) |
$1,408.40 |
$1,877.86 |
5.8× |
| MRI t-spine w&w/o cont (72157) |
$1,628.38 |
$2,171.17 |
4.6× |
| MRI thoracic spine w/contrast (72147) |
$1,463.36 |
$1,951.14 |
4.1× |
| MRI thoracic spine w/o contrst (72146) |
$1,410.74 |
$1,880.98 |
5.8× |
| MRI tmj (70336) |
$1,179.90 |
$1,573.19 |
4.8× |
| MRI upper extremity oth than jt w/o contr matrl (73218) |
$1,799.14 |
$2,398.86 |
7.4× |
| Ob us limited fetus(s) (76815) |
$257.82 |
$343.76 |
2.4× |
| Radex entir thrc lmbr crv sac spi w/skull 1 vw (72081) |
$105.82 |
$141.09 |
1.2× |
| Radex entir thrc lmbr crv sac spi w/skull 2/3 vw (72082) |
$341.64 |
$455.52 |
3.2× |
| Radex hip unilateral with pelvis 1 view (73501) |
$132.79 |
$177.06 |
1.5× |
| Radex hip unilateral with pelvis 2-3 views (73502) |
$184.38 |
$245.83 |
2.1× |
| Radex hips bilateral with pelvis minimum 5 views (73523) |
$249.53 |
$332.70 |
2.3× |
| Radex spine cervical 2 or 3 views (72040) |
$150.24 |
$200.32 |
1.7× |
| Radex spine cervical 4 or 5 views (72050) |
$252.39 |
$336.52 |
2.4× |
| Radex spine cervical 6 or more views (72052) |
$281.32 |
$375.08 |
2.6× |
| Radex spine thoracolumbar junction min 2 views (72080) |
$130.94 |
$174.60 |
1.5× |
| Radiologic exam chest 4+ views (71048) |
$155.36 |
$207.15 |
1.5× |
| Radiologic exam small int single contrast study (74250) |
$230.72 |
$307.62 |
1.3× |
| Radiologic examination femur 1 view (73551) |
$150.45 |
$200.60 |
1.7× |
| Radiologic examination femur minimum 2 views (73552) |
$161.65 |
$215.54 |
1.8× |
| Radiologic examination from nose to rectum for foreign body, single view, child Age Under 21 (76010) |
$154.50 |
$206 |
1.7× |
| Radiologic examination, ankle; complete, minimum of 3 views Age Under 21 (73610) |
$146.34 |
$195.12 |
1.6× |
| Radiologic examination, complete acute abdomen series, including 2 or more views of the abdomen (eg, supine, erect,… (74022) |
$166.38 |
$221.84 |
1.6× |
| Radiologic examination, elbow; 2 views Age Under 21 (73070) |
$139.88 |
$186.52 |
1.6× |
| Radiologic examination, elbow; complete, minimum of 3 views Age Under 21 (73080) |
$146.83 |
$195.78 |
1.7× |
| Radiologic examination, facial bones; less than 3 views Age Under 21 (70140) |
$115.24 |
$153.64 |
1.3× |
| Radiologic examination, foot; complete, minimum of 3 views Age Under 21 (73630) |
$141.24 |
$188.32 |
1.6× |
| Radiologic examination, hand; minimum of 3 views Age Under 21 (73130) |
$147.61 |
$196.82 |
1.7× |
| Radiologic examination, knee; both knees, standing, anteroposterior Age Under 21 (73565) |
$63.86 |
$85.16 |
0.7× |
| Radiologic examination, knee; complete, 4 or more views Age Under 21 (73564) |
$175.63 |
$234.18 |
1.6× |
| Radiologic examination, mandible; partial, less than 4 views Age Under 21 (70100) |
$133 |
$177.34 |
1.5× |
| Radiologic examination, nasal bones, complete, minimum of 3 views Age Under 21 (70160) |
$159.58 |
$212.77 |
1.8× |
| Radiologic examination, ribs, unilateral; including posteroanterior chest, minimum of 3 views Age Under 21 (71101) |
$202.42 |
$269.89 |
1.9× |
| Radiologic examination, sacroiliac joints; less than 3 views Age Under 21 (72200) |
$56.35 |
$75.13 |
0.5× |
| Radiologic examination, shoulder, arthrography, radiological supervision and interpretation Age Under 21 (73040) |
$454.96 |
$606.61 |
1.3× |
| Radiologic examination, shoulder; complete, minimum of 2 views Age Under 21 (73030) |
$131.50 |
$175.32 |
1.5× |
| Radiologic examination, sinuses, paranasal, less than 3 views Age Under 21 (70210) |
$142.42 |
$189.88 |
1.6× |
| Radiologic examination, skull; less than 4 views Age Under 21 (70250) |
$128.30 |
$171.06 |
1.2× |
| Radiologic examination, spine, lumbosacral; 2 or 3 views Age Under 21 (72100) |
$155.08 |
$206.78 |
1.5× |
| Radiologic examination, spine, lumbosacral; bending views only, 2 or 3 views Age Under 21 (72120) |
$182.60 |
$243.46 |
1.7× |
| Radiologic examination, spine, lumbosacral; complete, including bending views, minimum of 6 views Age Under 21 (72114) |
$243.12 |
$324.16 |
2.3× |
| Radiologic examination, wrist; complete, minimum of 3 views Age Under 21 (73110) |
$157.36 |
$209.82 |
1.8× |
| Radiologic examination; acromioclavicular joints, bilateral, with or without weighted distraction Age Under 21 (73050) |
$294.06 |
$392.08 |
3.3× |
| Radiologic examination; humerus, minimum of 2 views Age Under 21 (73060) |
$146.44 |
$195.26 |
1.6× |
| Radiologic examination; lower extremity, infant, minimum of 2 views Age Under 21 (73592) |
$48.02 |
$64.02 |
0.5× |
| Radiologic examination; sternoclavicular joint or joints, minimum of 3 views Age Under 21 (71130) |
$124.04 |
$165.38 |
1.4× |
| Radiologic examination; toe(s), minimum of 2 views Age Under 21 (73660) |
$124.48 |
$165.97 |
1.4× |
| Radiologic examination; upper extremity, infant, minimum of 2 views Age Under 21 (73092) |
$50.45 |
$67.27 |
0.5× |
| Scapula complete (73010) |
$165.84 |
$221.12 |
1.6× |
| Screening digital breast tomosynthesis bi (77063) |
$88.14 |
$117.52 |
— |
| Ultrasound breast limited (76642) |
$233.17 |
$310.89 |
2.6× |
| Ultrasound, abdomen limited (76705) |
$408.68 |
$544.91 |
3.8× |
| Ultrasound, limited, joint or focal evaluation of other nonvascular extremity structure(s) (eg, joint space,… (76882) |
$237.12 |
$316.16 |
2.2× |
| Ultrasound, pelvic (nonobstetric), real time with image documentation; complete Age Under 21 (76856) |
$390.03 |
$520.04 |
3.7× |
| Ultrasound, pregnant uterus, real time with image documentation, fetal and maternal evaluation, first trimester (< 14… (76801) |
$291.80 |
$389.06 |
2.7× |
| Urography (pyelography), intravenous, with or without KUB, with or without tomography Age Under 21 (74400) |
$459.10 |
$612.12 |
2.6× |
| Us breast uni real time with image complete (76641) |
$339.71 |
$452.94 |
3.2× |
| Us chest (76604) |
$66.50 |
$88.66 |
0.6× |
| Us compl joint r-t w/image documentation (76881) |
$361.92 |
$482.56 |
3.4× |
| Us exam, pelvic, limited (76857) |
$362.70 |
$483.60 |
3.4× |
| Us ob transvaginal (76817) |
$321.98 |
$429.30 |
3.0× |
| Us retroperitoneal complete (76770) |
$555.22 |
$740.29 |
5.2× |
| Us retroperitoneal ltd (76775) |
$324.39 |
$432.52 |
3.0× |
| Us scrotum (76870) |
$314.09 |
$418.78 |
2.9× |
| Us soft tissue head/neck (76536) |
$341.65 |
$455.53 |
3.2× |
| X-ray exam of finger(s) (73140) |
$153.14 |
$204.20 |
1.7× |
| X-ray exam of knee 1 or 2 (73560) |
$130.52 |
$174.04 |
1.5× |
| X-ray exam ribs bil 3 views (71110) |
$185.70 |
$247.60 |
1.7× |
| X-ray exam ribs uni 2 views (71100) |
$156.68 |
$208.92 |
1.8× |
| X-ray heel (73650) |
$124.22 |
$165.64 |
1.4× |
| X-ray of joint between lower spine and hip bone 3 or more views|PROFESSIONAL COMPONENT (72202) |
$81.33 |
$108.44 |
0.8× |
| Xr abdomen 1 view (74018) |
$125.26 |
$167 |
1.4× |
| Xr abdomen 2 views (74019) |
$141.90 |
$189.19 |
1.3× |
| Xr arthrogram elbow (73085) |
$307.13 |
$409.50 |
0.9× |
| Xr arthrogram hip (73525) |
$678.34 |
$904.45 |
1.9× |
| Xr arthrogram knee (73580) |
$307.13 |
$409.50 |
0.9× |
| Xr arthrogram wrist (73115) |
$410.94 |
$547.92 |
1.2× |
| Xr bone survey infant (77076) |
$343.45 |
$457.93 |
3.2× |
| Xr chest 1 view (71045) |
$111.60 |
$148.79 |
1.3× |
| Xr chest 2 views (71046) |
$155.63 |
$207.50 |
1.8× |
| Xr facial bones 3+ views (70150) |
$174.90 |
$233.20 |
1.6× |
| Xr foot arthritis pa only bilateral - report(ortho pro) (73620) |
$118.82 |
$158.44 |
1.3× |
| Xr forearm 2 views (73090) |
$120 |
$160 |
1.3× |
| Xr hand 2v (73120) |
$123.90 |
$165.20 |
1.2× |
| Xr neck soft tissue (70360) |
$115.51 |
$154.01 |
1.3× |
| Xr o knee w/ merchant view bilat - report(ortho pro) (73562) |
$166.70 |
$222.26 |
1.9× |
| Xr pelvis 1-2 views (72170) |
$150.64 |
$200.84 |
1.4× |
| Xr pelvis min 3 view (72190) |
$179.53 |
$239.38 |
1.7× |
| Xr sacrum/coccyx 2+ views (72220) |
$118.26 |
$157.68 |
1.3× |
| Xr shoulder 1 view (73020) |
$118.44 |
$157.92 |
1.3× |
| Xr skull min 4 view (70260) |
$169.74 |
$226.32 |
1.6× |
| Xr spine 1 view (72020) |
$86.94 |
$115.92 |
1.0× |
| Xr spine thoracic 3v (72072) |
$185.59 |
$247.45 |
1.7× |
| Xr sternum 2+ views (71120) |
$120.64 |
$160.86 |
1.4× |
| Xr stress view joint (77071) |
$67.41 |
$89.88 |
0.8× |
| Xr tibia/fibula 2 views (73590) |
$138.25 |
$184.34 |
1.6× |
| Xr tmj bilateral (70330) |
$381.04 |
$508.06 |
4.3× |
| Xr tmj unilateral (70328) |
$125.39 |
$167.18 |
1.4× |
| Xr wrist 2 views (73100) |
$137.54 |
$183.40 |
1.5× |