| Ankle 2 views (73600) |
$190 |
$237 |
2.1× |
| Clavicle complete (73000) |
$238 |
$297 |
2.6× |
| Computed tomographic angiography, abdomen and pelvis, with contrast material(s), including noncontrast images, if… (74174) |
$2,106 |
$2,633 |
5.7× |
| Computed tomographic angiography, abdomen, with contrast material(s), including noncontrast images, if performed, and… (74175) |
$2,289 |
$2,861 |
12.4× |
| Computed tomographic angiography, abdominal aorta and bilateral iliofemoral lower extremity runoff, with contrast… (75635) |
$1,290 |
$1,613 |
7.0× |
| Computed tomographic angiography, chest (noncoronary), with contrast material(s), including noncontrast images, if… (71275) |
$1,699 |
$2,124 |
9.2× |
| Computed tomographic angiography, neck, with contrast material(s), including noncontrast images, if performed, and… (70498) |
$1,002 |
$1,252 |
5.4× |
| Computed tomographic angiography, pelvis, with contrast material(s), including noncontrast images, if performed, and… (72191) |
$1,732 |
$2,165 |
9.4× |
| Computed tomographic angiography, upper extremity, with contrast material(s), including noncontrast images, if… (73206) |
$691 |
$864 |
3.7× |
| Computed tomography, lower extremity; without contrast material Age Under 21 (73700) |
$851 |
$1,064 |
7.7× |
| Computed tomography, lower extremity; without contrast material, followed by contrast material(s) and further sections… (73702) |
$1,510 |
$1,888 |
8.2× |
| Computed tomography, maxillofacial area; with contrast material(s) Age Under 21 (70487) |
$1,564 |
$1,955 |
8.5× |
| Computed tomography, maxillofacial area; without contrast material Age Under 21 (70486) |
$1,002 |
$1,252 |
9.1× |
| Computed tomography, orbit, sella, or posterior fossa or outer, middle, or inner ear; with contrast material(s) Age… (70481) |
$1,039.50 |
$1,299.50 |
5.6× |
| Computed tomography, orbit, sella, or posterior fossa or outer, middle, or inner ear; without contrast material Age… (70480) |
$751 |
$939 |
6.8× |
| Computed tomography, soft tissue neck; without contrast material followed by contrast material(s) and further sections… (70492) |
$1,574 |
$1,967 |
8.5× |
| Computed tomography, thorax, diagnostic; without contrast material, followed by contrast material(s) and further… (71270) |
$2,082 |
$2,603 |
11.3× |
| CT abdomen and pelvis without and with contrast (74178) |
$1,988 |
$2,485 |
5.4× |
| CT abdomen and pelvis without contrast (74176) |
$1,503 |
$1,879 |
6.0× |
| CT abdomen w & w/o contrast (74170) |
$1,922 |
$2,402 |
10.4× |
| CT abdomen w/contrast (74160) |
$1,538 |
$1,922 |
8.3× |
| CT abdomen w/o contrast (74150) |
$1,230 |
$1,537 |
11.2× |
| CT cervical spine w/contrast (72126) |
$1,251 |
$1,564 |
3.4× |
| CT cervical spine w/o contrast (72125) |
$1,122 |
$1,403 |
10.2× |
| CT chest w/contrast (71260) |
$1,602 |
$2,002 |
8.7× |
| CT extremity upper w & w/o contrast (73202) |
$447.50 |
$559.50 |
2.4× |
| CT extremity upper w/o contrast (73200) |
$794 |
$993 |
7.2× |
| CT head/brain with contrast (70460) |
$1,002 |
$1,252 |
5.4× |
| CT head/brain without and with contrast (70470) |
$1,662 |
$2,078 |
9.0× |
| CT l-spine w/contrast (72132) |
$1,126 |
$1,407 |
3.1× |
| CT lower extremity w/dye (73701) |
$1,078 |
$1,348 |
5.8× |
| CT lumbar spine w/o contrast (72131) |
$1,001 |
$1,251 |
9.1× |
| CT maxillofacial w/wo contrast (70488) |
$441 |
$551 |
2.4× |
| CT neck w/contrast (70491) |
$1,002 |
$1,252 |
5.4× |
| CT neck w/o contrast (70490) |
$834 |
$1,042 |
7.6× |
| CT pelvis w & w/o contrast (72194) |
$1,715 |
$2,144 |
9.3× |
| CT pelvis w/o contrast (72192) |
$930 |
$1,163 |
8.4× |
| CT thoracic spine w/contrast (72129) |
$1,405 |
$1,756 |
7.6× |
| CT thoracic spine w/o contrast (72128) |
$1,201 |
$1,501 |
10.9× |
| CT thorax lung cancer scr c- (71271) |
$1,069 |
$1,336 |
9.7× |
| CT thorax w/o contrast (71250) |
$1,068 |
$1,335 |
9.7× |
| CT upper extremity w/dye (73201) |
$929 |
$1,161 |
2.5× |
| CTA head w contrast (70496) |
$1,165 |
$1,456 |
6.3× |
| Dual-energy X-ray absorptiometry (DXA), bone density study, 1 or more sites; axial skeleton (eg, hips, pelvis, spine)… (77080) |
$714 |
$893 |
6.5× |
| Dxa bone density/peripheral (77081) |
$218 |
$273 |
2.4× |
| Fetal biophys profile w/o nst (76819) |
$334 |
$417 |
3.0× |
| Fluoroscopy up to 1 hour physician/qhp time (76000) |
$588 |
$735 |
2.3× |
| Magnetic resonance (eg, proton) imaging, any joint of lower extremity; without contrast material(s), followed by… (73723) |
$923 |
$1,154 |
2.5× |
| Magnetic resonance (eg, proton) imaging, lower extremity other than joint; with contrast material(s) Age Under 21 (73719) |
$923 |
$1,154 |
2.5× |
| Magnetic resonance (eg, proton) imaging, lower extremity other than joint; without contrast material(s) Age Under 21 (73718) |
$2,052 |
$2,565 |
8.2× |
| Magnetic resonance (eg, proton) imaging, lower extremity other than joint; without contrast material(s), followed by… (73720) |
$3,186 |
$3,982 |
8.7× |
| Magnetic resonance (eg, proton) imaging, orbit, face, and/or neck; with contrast material(s) Age Under 21 (70542) |
$3,833 |
$4,791 |
10.4× |
| Magnetic resonance (eg, proton) imaging, orbit, face, and/or neck; without contrast material(s) Age Under 21 (70540) |
$3,015 |
$3,769 |
12.0× |
| Magnetic resonance (eg, proton) imaging, upper extremity, other than joint; with contrast material(s) Age Under 21 (73219) |
$923 |
$1,154 |
2.5× |
| Magnetic resonance (eg, proton) imaging, upper extremity, other than joint; without contrast material(s), followed by… (73220) |
$3,186 |
$3,982 |
8.7× |
| Magnetic resonance angiography, neck; without contrast material(s), followed by contrast material(s) and further… (70549) |
$3,806 |
$4,758 |
10.3× |
| MRA head w/o contrast (70544) |
$1,589 |
$1,986 |
6.3× |
| MRA neck w/ contrast (70548) |
$3,173 |
$3,966 |
8.6× |
| MRA neck w/o contrast (70547) |
$2,434 |
$3,043 |
9.7× |
| MRI abdomen w/contrast (74182) |
$2,715 |
$3,394 |
7.4× |
| MRI abdomen w/o contrast (74181) |
$1,769 |
$2,211 |
7.0× |
| MRI abdomen w/wo contrast (74183) |
$3,561 |
$4,451 |
9.7× |
| MRI any jt lower extrem w/contrast material (73722) |
$1,602 |
$2,003 |
1.9× |
| MRI c-spine w&w/o cont (72156) |
$4,107 |
$5,134 |
11.2× |
| MRI chest w/o contrast (71550) |
$835 |
$1,044 |
3.3× |
| MRI chest w/wo contrast (71552) |
$4,426 |
$5,533 |
12.0× |
| MRI joint upr extr w/o&w/dye (73223) |
$1,520.50 |
$1,900.50 |
4.1× |
| MRI joint upr extrem w/dye (73222) |
$1,602 |
$2,003 |
1.9× |
| MRI joint upr extrem w/o dye (73221) |
$1,954 |
$2,442 |
7.8× |
| MRI lumbar spine w/wo contrast (72158) |
$4,107 |
$5,134 |
11.2× |
| MRI orbit/face/neck w&w/o cont (70543) |
$4,410 |
$5,513 |
12.0× |
| MRI pelvis w & w/o contrast (72197) |
$1,946 |
$2,432 |
5.3× |
| MRI pelvis w/contrast (72196) |
$1,557 |
$1,946 |
4.2× |
| MRI pelvis w/o contrast (72195) |
$1,246 |
$1,557 |
5.0× |
| MRI spine cervical w/o contrast (72141) |
$1,979 |
$2,474 |
7.9× |
| MRI t-spine w&w/o cont (72157) |
$4,107 |
$5,134 |
11.2× |
| MRI thoracic spine w/o contrst (72146) |
$2,345 |
$2,931 |
9.3× |
| MRI upper extremity oth than jt w/o contr matrl (73218) |
$1,804.50 |
$2,255.50 |
7.2× |
| Ob us limited fetus(s) (76815) |
$334 |
$417 |
3.0× |
| Ob us nuchal meas 1 gest (76813) |
$334 |
$417 |
3.0× |
| Panoramic X-ray of jaws (70355) |
$240 |
$300 |
2.6× |
| Radex hip unilateral with pelvis 1 view (73501) |
$238 |
$297 |
2.6× |
| Radex hip unilateral with pelvis 2-3 views (73502) |
$285 |
$356 |
3.1× |
| Radex hips bilateral with pelvis 2 views (73521) |
$389 |
$486 |
3.5× |
| Radex spine cervical 2 or 3 views (72040) |
$262 |
$327 |
2.9× |
| Radex spine cervical 4 or 5 views (72050) |
$298 |
$372 |
2.7× |
| Radex spine cervical 6 or more views (72052) |
$334 |
$417 |
3.0× |
| Radiologic exam abdomen 3+ views (74021) |
$400 |
$500 |
3.6× |
| Radiologic examination femur minimum 2 views (73552) |
$238 |
$297 |
2.6× |
| Radiologic examination, ankle; complete, minimum of 3 views Age Under 21 (73610) |
$238 |
$297 |
2.6× |
| Radiologic examination, elbow; 2 views Age Under 21 (73070) |
$190 |
$237 |
2.1× |
| Radiologic examination, elbow; complete, minimum of 3 views Age Under 21 (73080) |
$238 |
$297 |
2.6× |
| Radiologic examination, foot; complete, minimum of 3 views Age Under 21 (73630) |
$238 |
$297 |
2.6× |
| Radiologic examination, hand; minimum of 3 views Age Under 21 (73130) |
$238 |
$297 |
2.6× |
| Radiologic examination, knee; both knees, standing, anteroposterior Age Under 21 (73565) |
$238 |
$297 |
2.6× |
| Radiologic examination, knee; complete, 4 or more views Age Under 21 (73564) |
$334 |
$417 |
3.0× |
| Radiologic examination, mandible; partial, less than 4 views Age Under 21 (70100) |
$238 |
$297 |
2.6× |
| Radiologic examination, nasal bones, complete, minimum of 3 views Age Under 21 (70160) |
$238 |
$297 |
2.6× |
| Radiologic examination, ribs, bilateral; including posteroanterior chest, minimum of 4 views Age Under 21 (71111) |
$400 |
$500 |
3.6× |
| Radiologic examination, ribs, unilateral; including posteroanterior chest, minimum of 3 views Age Under 21 (71101) |
$334 |
$417 |
3.0× |
| Radiologic examination, shoulder; complete, minimum of 2 views Age Under 21 (73030) |
$238 |
$297 |
2.6× |
| Radiologic examination, sinuses, paranasal, less than 3 views Age Under 21 (70210) |
$238 |
$297 |
2.6× |
| Radiologic examination, skull; less than 4 views Age Under 21 (70250) |
$334 |
$417 |
3.0× |
| Radiologic examination, spine, lumbosacral; 2 or 3 views Age Under 21 (72100) |
$334 |
$417 |
3.0× |
| Radiologic examination, spine, lumbosacral; complete, including bending views, minimum of 6 views Age Under 21 (72114) |
$480 |
$600 |
4.4× |
| Radiologic examination, wrist; complete, minimum of 3 views Age Under 21 (73110) |
$238 |
$297 |
2.6× |
| Radiologic examination; acromioclavicular joints, bilateral, with or without weighted distraction Age Under 21 (73050) |
$238 |
$297 |
2.6× |
| Radiologic examination; humerus, minimum of 2 views Age Under 21 (73060) |
$238 |
$297 |
2.6× |
| Radiologic examination; toe(s), minimum of 2 views Age Under 21 (73660) |
$238 |
$297 |
2.6× |
| Saline infusion sonohysterography (SIS), including color flow Doppler, when performed Age Under 21 (76831) |
$693 |
$866 |
2.8× |
| Scapula complete (73010) |
$299 |
$373.50 |
2.7× |
| Ultrasound breast limited (76642) |
$271 |
$339 |
3.0× |
| Ultrasound, abdomen limited (76705) |
$1,020 |
$1,275 |
9.2× |
| Ultrasound, limited, joint or focal evaluation of other nonvascular extremity structure(s) (eg, joint space,… (76882) |
$222 |
$278 |
2.0× |
| Ultrasound, pelvic (nonobstetric), real time with image documentation; complete Age Under 21 (76856) |
$647 |
$809 |
5.9× |
| Ultrasound, pregnant uterus, real time with image documentation, fetal and maternal evaluation, first trimester (< 14… (76801) |
$334 |
$417 |
3.0× |
| Ultrasound, transplanted kidney, real time and duplex Doppler with image documentation Age Under 21 (76776) |
$334 |
$417 |
3.0× |
| Umbilical-artery Doppler (OB) (76820) |
$334 |
$417 |
3.0× |
| Us abdominal aorta real time screen study aaa (76706) |
$334 |
$417 |
3.0× |
| Us breast uni real time with image complete (76641) |
$522 |
$652 |
4.7× |
| Us chest (76604) |
$500 |
$625 |
4.5× |
| Us compl joint r-t w/image documentation (76881) |
$499 |
$624 |
4.5× |
| Us exam, pelvic, limited (76857) |
$334 |
$417 |
3.0× |
| US OB Follow-Up/Repeat (76816) |
$334 |
$417 |
3.0× |
| Us ob transvaginal (76817) |
$334 |
$417 |
3.0× |
| Us retroperitoneal complete (76770) |
$947 |
$1,184 |
8.6× |
| Us retroperitoneal ltd (76775) |
$790 |
$987 |
7.2× |
| Us scrotum (76870) |
$569 |
$711 |
5.2× |
| Us soft tissue head/neck (76536) |
$609 |
$761 |
5.5× |
| Us spinal canal (76800) |
$334 |
$417 |
3.0× |
| X-ray exam hips bi 3-4 views (73522) |
$400 |
$500 |
3.6× |
| X-ray exam of finger(s) (73140) |
$238 |
$297 |
2.6× |
| X-ray exam of knee 1 or 2 (73560) |
$238 |
$297 |
2.6× |
| X-ray heel (73650) |
$238 |
$297 |
2.6× |
| X-ray of joint between lower spine and hip bone 3 or more views|PROFESSIONAL COMPONENT (72202) |
$334 |
$417 |
3.0× |
| Xr abdomen 1 view (74018) |
$238 |
$297 |
2.6× |
| Xr abdomen 2 views (74019) |
$334 |
$417 |
3.0× |
| Xr bone age studies (77072) |
$41 |
$51 |
0.4× |
| Xr chest 1 view (71045) |
$287 |
$359 |
3.1× |
| Xr chest 2 views (71046) |
$316 |
$395 |
3.4× |
| Xr eye foreign body (70030) |
$158 |
$198 |
1.7× |
| Xr facial bones 3+ views (70150) |
$334 |
$417 |
3.0× |
| Xr foot arthritis pa only bilateral - report(ortho pro) (73620) |
$190 |
$237 |
2.1× |
| Xr forearm 2 views (73090) |
$238 |
$297 |
2.6× |
| Xr hand 2v (73120) |
$190 |
$237 |
1.7× |
| Xr neck soft tissue (70360) |
$238 |
$297 |
2.6× |
| Xr o knee w/ merchant view bilat - report(ortho pro) (73562) |
$285 |
$356 |
3.1× |
| Xr pelvis 1-2 views (72170) |
$270 |
$337 |
2.4× |
| Xr pelvis min 3 view (72190) |
$324 |
$405 |
2.9× |
| Xr sacrum/coccyx 2+ views (72220) |
$238 |
$297 |
2.6× |
| Xr shoulder 1 view (73020) |
$190 |
$237 |
2.1× |
| Xr sinuses 3+ views (70220) |
$285 |
$356 |
3.1× |
| Xr skull min 4 view (70260) |
$264 |
$330 |
2.4× |
| Xr spine 1 view (72020) |
$238 |
$297 |
2.6× |
| Xr spine thoracic 3v (72072) |
$399 |
$499 |
3.6× |
| Xr sternum 2+ views (71120) |
$238 |
$297 |
2.6× |
| Xr t-spine 2 views (72070) |
$333 |
$416 |
3.0× |
| Xr tibia/fibula 2 views (73590) |
$238 |
$297 |
2.6× |
| Xr wrist 2 views (73100) |
$190 |
$237 |
2.1× |