| Ankle 2 views (73600) |
$123.82 |
$165.10 |
1.4× |
| Clavicle complete (73000) |
$109.28 |
$145.70 |
1.2× |
| Computed tomographic angiography, abdomen and pelvis, with contrast material(s), including noncontrast images, if… (74174) |
$1,716.98 |
$2,289.30 |
4.8× |
| Computed tomographic angiography, abdomen, with contrast material(s), including noncontrast images, if performed, and… (74175) |
$1,435.57 |
$1,914.10 |
8.0× |
| Computed tomographic angiography, abdominal aorta and bilateral iliofemoral lower extremity runoff, with contrast… (75635) |
$1,964.25 |
$2,619 |
11.0× |
| Computed tomographic angiography, chest (noncoronary), with contrast material(s), including noncontrast images, if… (71275) |
$1,435.57 |
$1,914.10 |
8.0× |
| Computed tomographic angiography, lower extremity, with contrast material(s), including noncontrast images, if… (73706) |
$1,556.32 |
$2,075.10 |
8.7× |
| Computed tomographic angiography, neck, with contrast material(s), including noncontrast images, if performed, and… (70498) |
$1,325.32 |
$1,767.10 |
7.4× |
| Computed tomographic angiography, pelvis, with contrast material(s), including noncontrast images, if performed, and… (72191) |
$1,815.68 |
$2,420.90 |
10.1× |
| Computed tomographic angiography, upper extremity, with contrast material(s), including noncontrast images, if… (73206) |
$1,336.95 |
$1,782.60 |
7.5× |
| Computed tomography, bone mineral density study, 1 or more sites, axial skeleton (eg, hips, pelvis, spine) Age Under 21 (77078) |
$385.72 |
$514.30 |
4.3× |
| Computed tomography, cervical spine; without contrast material, followed by contrast material(s) and further sections… (72127) |
$1,485.15 |
$1,980.20 |
8.3× |
| Computed tomography, lower extremity; without contrast material Age Under 21 (73700) |
$964.50 |
$1,286 |
9.0× |
| Computed tomography, lower extremity; without contrast material, followed by contrast material(s) and further sections… (73702) |
$1,271.70 |
$1,695.60 |
7.1× |
| Computed tomography, lumbar spine; without contrast material, followed by contrast material(s) and further sections Age… (72133) |
$1,935.75 |
$2,581 |
10.8× |
| Computed tomography, maxillofacial area; with contrast material(s) Age Under 21 (70487) |
$1,059.60 |
$1,412.80 |
5.9× |
| Computed tomography, maxillofacial area; without contrast material Age Under 21 (70486) |
$1,022.62 |
$1,363.50 |
9.6× |
| Computed tomography, orbit, sella, or posterior fossa or outer, middle, or inner ear; with contrast material(s) Age… (70481) |
$988.20 |
$1,317.60 |
5.5× |
| Computed tomography, orbit, sella, or posterior fossa or outer, middle, or inner ear; without contrast material Age… (70480) |
$855.82 |
$1,141.10 |
8.0× |
| Computed tomography, orbit, sella, or posterior fossa or outer, middle, or inner ear; without contrast material,… (70482) |
$1,141.28 |
$1,521.70 |
6.4× |
| Computed tomography, soft tissue neck; without contrast material followed by contrast material(s) and further sections… (70492) |
$1,281.07 |
$1,708.10 |
7.1× |
| Computed tomography, thoracic spine; without contrast material, followed by contrast material(s) and further sections… (72130) |
$1,692.15 |
$2,256.20 |
9.4× |
| Computed tomography, thorax, diagnostic; without contrast material, followed by contrast material(s) and further… (71270) |
$1,783.35 |
$2,377.80 |
10.0× |
| CT abdomen and pelvis without and with contrast (74178) |
$2,765.18 |
$3,686.90 |
7.8× |
| CT abdomen and pelvis without contrast (74176) |
$1,161.90 |
$1,549.20 |
4.8× |
| CT abdomen w & w/o contrast (74170) |
$1,881.90 |
$2,509.20 |
10.5× |
| CT abdomen w/contrast (74160) |
$1,271.55 |
$1,695.40 |
7.1× |
| CT abdomen w/o contrast (74150) |
$735 |
$980 |
6.9× |
| CT cervical spine w/contrast (72126) |
$1,386.22 |
$1,848.30 |
3.9× |
| CT cervical spine w/o contrast (72125) |
$1,110 |
$1,480 |
10.4× |
| CT chest w/contrast (71260) |
$1,459.88 |
$1,946.50 |
8.1× |
| CT extremity upper w & w/o contrast (73202) |
$1,475.25 |
$1,967 |
8.2× |
| CT extremity upper w/o contrast (73200) |
$1,029.68 |
$1,372.90 |
9.6× |
| CT head/brain with contrast (70460) |
$1,420.80 |
$1,894.40 |
7.9× |
| CT head/brain without and with contrast (70470) |
$1,296.82 |
$1,729.10 |
7.2× |
| CT heart no contrast quant eval coronry calcium (75571) |
$141.98 |
$189.30 |
1.6× |
| CT l-spine w/contrast (72132) |
$1,565.93 |
$2,087.90 |
4.4× |
| CT limited/localized follow up study (76380) |
$519.38 |
$692.50 |
5.8× |
| CT lower extremity w/dye (73701) |
$976.58 |
$1,302.10 |
5.4× |
| CT lumbar spine w/o contrast (72131) |
$1,327.05 |
$1,769.40 |
12.4× |
| CT maxillofacial w/wo contrast (70488) |
$1,141.28 |
$1,521.70 |
6.4× |
| CT neck w/contrast (70491) |
$1,179.60 |
$1,572.80 |
6.6× |
| CT neck w/o contrast (70490) |
$1,001.40 |
$1,335.20 |
9.4× |
| CT pelvis w & w/o contrast (72194) |
$2,157.68 |
$2,876.90 |
12.0× |
| CT pelvis w/o contrast (72192) |
$848.78 |
$1,131.70 |
7.9× |
| CT thoracic spine w/contrast (72129) |
$1,565.93 |
$2,087.90 |
8.7× |
| CT thoracic spine w/o contrast (72128) |
$1,327.05 |
$1,769.40 |
12.4× |
| CT thorax lung cancer scr c- (71271) |
$871.65 |
$1,162.20 |
8.2× |
| CT thorax w/o contrast (71250) |
$1,144.43 |
$1,525.90 |
10.7× |
| CT upper extremity w/dye (73201) |
$1,175.18 |
$1,566.90 |
3.3× |
| CTA head w contrast (70496) |
$1,180.57 |
$1,574.10 |
6.6× |
| Doppler echocardiography, fetal, pulsed wave and/or continuous wave with spectral display; complete Age Under 21 (76827) |
$208.65 |
$278.20 |
2.0× |
| Fetal biophys profile w/o nst (76819) |
$254.18 |
$338.90 |
2.4× |
| Fetal biophysical profile non-stress testing (76818) |
$378.22 |
$504.30 |
3.5× |
| Magnetic resonance (eg, proton) imaging, lower extremity other than joint; with contrast material(s) Age Under 21 (73719) |
$1,052.78 |
$1,403.70 |
3.0× |
| Magnetic resonance (eg, proton) imaging, lower extremity other than joint; without contrast material(s) Age Under 21 (73718) |
$1,035.38 |
$1,380.50 |
4.2× |
| Magnetic resonance (eg, proton) imaging, orbit, face, and/or neck; with contrast material(s) Age Under 21 (70542) |
$1,112.40 |
$1,483.20 |
3.1× |
| Magnetic resonance (eg, proton) imaging, orbit, face, and/or neck; without contrast material(s) Age Under 21 (70540) |
$923.70 |
$1,231.60 |
3.8× |
| Magnetic resonance (eg, proton) imaging, upper extremity, other than joint; with contrast material(s) Age Under 21 (73219) |
$1,112.40 |
$1,483.20 |
3.1× |
| Magnetic resonance (eg, proton) imaging, upper extremity, other than joint; without contrast material(s), followed by… (73220) |
$1,317.30 |
$1,756.40 |
3.7× |
| Mandible min 4v (70110) |
$159.38 |
$212.50 |
1.5× |
| MRA head w/o contrast (70544) |
$1,125 |
$1,500 |
4.6× |
| MRI abdomen w/contrast (74182) |
$1,224.97 |
$1,633.30 |
3.4× |
| MRI abdomen w/o contrast (74181) |
$962.18 |
$1,282.90 |
3.9× |
| MRI abdomen w/wo contrast (74183) |
$1,707.82 |
$2,277.10 |
4.8× |
| MRI any jt lower extrem w/contrast material (73722) |
$1,052.78 |
$1,403.70 |
1.3× |
| MRI c-spine w&w/o cont (72156) |
$1,572.60 |
$2,096.80 |
4.4× |
| MRI cervical spine w/contrast (72142) |
$1,359.60 |
$1,812.80 |
3.8× |
| MRI chest w/contrast (71551) |
$1,010.32 |
$1,347.10 |
1.3× |
| MRI chest w/o contrast (71550) |
$1,114.57 |
$1,486.10 |
4.6× |
| MRI chest w/wo contrast (71552) |
$1,578 |
$2,104 |
4.4× |
| MRI joint upr extr w/o&w/dye (73223) |
$1,464.07 |
$1,952.10 |
4.1× |
| MRI joint upr extrem w/o dye (73221) |
$1,027.65 |
$1,370.20 |
4.2× |
| MRI lumbar spine w/contrast (72149) |
$1,050.60 |
$1,400.80 |
2.9× |
| MRI lumbar spine w/wo contrast (72158) |
$1,603.50 |
$2,138 |
4.5× |
| MRI orbit/face/neck w&w/o cont (70543) |
$1,579.31 |
$2,105.75 |
4.4× |
| MRI pelvis w & w/o contrast (72197) |
$1,661.25 |
$2,215 |
4.7× |
| MRI pelvis w/contrast (72196) |
$1,378.95 |
$1,838.60 |
3.9× |
| MRI pelvis w/o contrast (72195) |
$950.55 |
$1,267.40 |
3.9× |
| MRI spine cervical w/o contrast (72141) |
$1,011.75 |
$1,349 |
4.2× |
| MRI t-spine w&w/o cont (72157) |
$1,603.50 |
$2,138 |
4.5× |
| MRI thoracic spine w/contrast (72147) |
$990.97 |
$1,321.30 |
2.8× |
| MRI thoracic spine w/o contrst (72146) |
$1,106.85 |
$1,475.80 |
4.5× |
| MRI upper extremity oth than jt w/o contr matrl (73218) |
$904.05 |
$1,205.40 |
3.7× |
| Ob us limited fetus(s) (76815) |
$308.02 |
$410.70 |
2.9× |
| Ob us nuchal meas 1 gest (76813) |
$234.08 |
$312.10 |
2.2× |
| Radex entir thrc lmbr crv sac spi w/skull 1 vw (72081) |
$131.85 |
$175.80 |
1.5× |
| Radex entir thrc lmbr crv sac spi w/skull 2/3 vw (72082) |
$119.25 |
$159 |
1.1× |
| Radex entir thrc lmbr crv sac spi w/skull 4/5 vw (72083) |
$379.80 |
$506.40 |
3.6× |
| Radex entir thrc lmbr crv sac spi w/skull 6/> vw (72084) |
$484.12 |
$645.50 |
4.5× |
| Radex hip unilateral with pelvis 1 view (73501) |
$118.80 |
$158.40 |
1.3× |
| Radex hip unilateral with pelvis 2-3 views (73502) |
$262.12 |
$349.50 |
2.9× |
| Radex hip unilateral with pelvis minimum 4 views (73503) |
$152.02 |
$202.70 |
1.4× |
| Radex hips bilateral with pelvis 2 views (73521) |
$281.77 |
$375.70 |
2.6× |
| Radex hips bilateral with pelvis minimum 5 views (73523) |
$286.20 |
$381.60 |
2.7× |
| Radex spine cervical 2 or 3 views (72040) |
$108.98 |
$145.30 |
1.2× |
| Radex spine cervical 4 or 5 views (72050) |
$298.95 |
$398.60 |
2.8× |
| Radex spine cervical 6 or more views (72052) |
$388.28 |
$517.70 |
3.6× |
| Radex spine thoracolumbar junction min 2 views (72080) |
$144.38 |
$192.50 |
1.6× |
| Radiologic exam abdomen 3+ views (74021) |
$287.17 |
$382.90 |
2.7× |
| Radiologic exam chest 3 views (71047) |
$178.27 |
$237.70 |
2.0× |
| Radiologic exam chest 4+ views (71048) |
$151.50 |
$202 |
1.4× |
| Radiologic examination femur 1 view (73551) |
$123.82 |
$165.10 |
1.4× |
| Radiologic examination femur minimum 2 views (73552) |
$163.73 |
$218.30 |
1.8× |
| Radiologic examination from nose to rectum for foreign body, single view, child Age Under 21 (76010) |
$117.75 |
$157 |
1.3× |
| Radiologic examination, ankle; complete, minimum of 3 views Age Under 21 (73610) |
$132.90 |
$177.20 |
1.5× |
| Radiologic examination, complete acute abdomen series, including 2 or more views of the abdomen (eg, supine, erect,… (74022) |
$281.33 |
$375.10 |
2.6× |
| Radiologic examination, elbow; 2 views Age Under 21 (73070) |
$123.82 |
$165.10 |
1.4× |
| Radiologic examination, elbow; complete, minimum of 3 views Age Under 21 (73080) |
$132.90 |
$177.20 |
1.5× |
| Radiologic examination, facial bones; less than 3 views Age Under 21 (70140) |
$108.82 |
$145.10 |
1.2× |
| Radiologic examination, foot; complete, minimum of 3 views Age Under 21 (73630) |
$132.90 |
$177.20 |
1.5× |
| Radiologic examination, hand; minimum of 3 views Age Under 21 (73130) |
$132.90 |
$177.20 |
1.5× |
| Radiologic examination, knee; both knees, standing, anteroposterior Age Under 21 (73565) |
$126 |
$168 |
1.4× |
| Radiologic examination, knee; complete, 4 or more views Age Under 21 (73564) |
$166.12 |
$221.50 |
1.6× |
| Radiologic examination, mandible; partial, less than 4 views Age Under 21 (70100) |
$183.60 |
$244.80 |
2.1× |
| Radiologic examination, mastoids; complete, minimum of 3 views per side Age Under 21 (70130) |
$180.75 |
$241 |
1.7× |
| Radiologic examination, mastoids; less than 3 views per side Age Under 21 (70120) |
$166.12 |
$221.50 |
1.6× |
| Radiologic examination, nasal bones, complete, minimum of 3 views Age Under 21 (70160) |
$179.70 |
$239.60 |
2.0× |
| Radiologic examination, ribs, bilateral; including posteroanterior chest, minimum of 4 views Age Under 21 (71111) |
$245.02 |
$326.70 |
2.3× |
| Radiologic examination, ribs, unilateral; including posteroanterior chest, minimum of 3 views Age Under 21 (71101) |
$154.35 |
$205.80 |
1.4× |
| Radiologic examination, sacroiliac joints; less than 3 views Age Under 21 (72200) |
$152.32 |
$203.10 |
1.4× |
| Radiologic examination, shoulder; complete, minimum of 2 views Age Under 21 (73030) |
$272.25 |
$363 |
3.1× |
| Radiologic examination, sinuses, paranasal, less than 3 views Age Under 21 (70210) |
$121.35 |
$161.80 |
1.4× |
| Radiologic examination, skull; less than 4 views Age Under 21 (70250) |
$177.15 |
$236.20 |
1.7× |
| Radiologic examination, spine, lumbosacral; 2 or 3 views Age Under 21 (72100) |
$214.05 |
$285.40 |
2.0× |
| Radiologic examination, spine, lumbosacral; bending views only, 2 or 3 views Age Under 21 (72120) |
$187.50 |
$250 |
1.8× |
| Radiologic examination, spine, lumbosacral; complete, including bending views, minimum of 6 views Age Under 21 (72114) |
$310.05 |
$413.40 |
2.9× |
| Radiologic examination, spine; thoracic, minimum of 4 views Age Under 21 (72074) |
$253.27 |
$337.70 |
2.4× |
| Radiologic examination, wrist; complete, minimum of 3 views Age Under 21 (73110) |
$152.62 |
$203.50 |
1.7× |
| Radiologic examination; acromioclavicular joints, bilateral, with or without weighted distraction Age Under 21 (73050) |
$227.70 |
$303.60 |
2.6× |
| Radiologic examination; humerus, minimum of 2 views Age Under 21 (73060) |
$135.38 |
$180.50 |
1.5× |
| Radiologic examination; lower extremity, infant, minimum of 2 views Age Under 21 (73592) |
$123.82 |
$165.10 |
1.4× |
| Radiologic examination; orbits, complete, minimum of 4 views Age Under 21 (70200) |
$124.88 |
$166.50 |
1.2× |
| Radiologic examination; sternoclavicular joint or joints, minimum of 3 views Age Under 21 (71130) |
$191.48 |
$255.30 |
2.2× |
| Radiologic examination; toe(s), minimum of 2 views Age Under 21 (73660) |
$105.98 |
$141.30 |
1.2× |
| Radiologic examination; upper extremity, infant, minimum of 2 views Age Under 21 (73092) |
$98.40 |
$131.20 |
0.9× |
| Scapula complete (73010) |
$123.45 |
$164.60 |
1.2× |
| Screening digital breast tomosynthesis bi (77063) |
$105.45 |
$140.60 |
— |
| Ultrasound breast limited (76642) |
$40.80 |
$54.40 |
0.5× |
| Ultrasound, abdomen limited (76705) |
$368.85 |
$491.80 |
3.5× |
| Ultrasound, limited, joint or focal evaluation of other nonvascular extremity structure(s) (eg, joint space,… (76882) |
$368.85 |
$491.80 |
3.5× |
| Ultrasound, pelvic (nonobstetric), real time with image documentation; complete Age Under 21 (76856) |
$458.62 |
$611.50 |
4.3× |
| Ultrasound, pregnant uterus, real time with image documentation, fetal and maternal evaluation plus detailed fetal… (76811) |
$148.12 |
$197.50 |
0.6× |
| Ultrasound, pregnant uterus, real time with image documentation, fetal and maternal evaluation, first trimester (< 14… (76801) |
$185.62 |
$247.50 |
1.7× |
| Ultrasound, transplanted kidney, real time and duplex Doppler with image documentation Age Under 21 (76776) |
$555.45 |
$740.60 |
5.2× |
| Us abdominal aorta real time screen study aaa (76706) |
$243.38 |
$324.50 |
2.3× |
| Us breast uni real time with image complete (76641) |
$292.65 |
$390.20 |
2.7× |
| Us chest (76604) |
$266.70 |
$355.60 |
2.5× |
| Us compl joint r-t w/image documentation (76881) |
$276.38 |
$368.50 |
2.6× |
| Us exam, pelvic, limited (76857) |
$382.80 |
$510.40 |
3.6× |
| US OB Follow-Up/Repeat (76816) |
$151.73 |
$202.30 |
1.4× |
| Us ob transvaginal (76817) |
$176.85 |
$235.80 |
1.7× |
| Us retroperitoneal complete (76770) |
$510.60 |
$680.80 |
4.8× |
| Us retroperitoneal ltd (76775) |
$302.77 |
$403.70 |
2.8× |
| Us scrotum (76870) |
$293.92 |
$391.90 |
2.8× |
| Us soft tissue head/neck (76536) |
$470.10 |
$626.80 |
4.4× |
| Us spinal canal (76800) |
$482.78 |
$643.70 |
4.5× |
| X-ray exam hips bi 3-4 views (73522) |
$245.40 |
$327.20 |
2.3× |
| X-ray exam of finger(s) (73140) |
$105.98 |
$141.30 |
1.2× |
| X-ray exam of knee 1 or 2 (73560) |
$126 |
$168 |
1.4× |
| X-ray exam ribs bil 3 views (71110) |
$244.35 |
$325.80 |
2.3× |
| X-ray exam ribs uni 2 views (71100) |
$141.82 |
$189.10 |
1.6× |
| X-ray heel (73650) |
$123.82 |
$165.10 |
1.4× |
| X-ray of joint between lower spine and hip bone 3 or more views|PROFESSIONAL COMPONENT (72202) |
$259.58 |
$346.10 |
2.4× |
| Xr abdomen 1 view (74018) |
$223.88 |
$298.50 |
2.5× |
| Xr abdomen 2 views (74019) |
$194.92 |
$259.90 |
1.8× |
| Xr bone age studies (77072) |
$58.20 |
$77.60 |
0.5× |
| Xr bone length study (77073) |
$203.18 |
$270.90 |
1.9× |
| Xr bone survey infant (77076) |
$333 |
$444 |
3.1× |
| Xr bone survey ltd (77074) |
$277.27 |
$369.70 |
2.6× |
| Xr chest 1 view (71045) |
$165 |
$220 |
1.9× |
| Xr chest 2 views (71046) |
$185.85 |
$247.80 |
2.1× |
| Xr eye foreign body (70030) |
$166.12 |
$221.50 |
1.9× |
| Xr facial bones 3+ views (70150) |
$237.75 |
$317 |
2.2× |
| Xr foot arthritis pa only bilateral - report(ortho pro) (73620) |
$123.82 |
$165.10 |
1.4× |
| Xr forearm 2 views (73090) |
$123.82 |
$165.10 |
1.4× |
| Xr hand 2v (73120) |
$123.82 |
$165.10 |
1.2× |
| Xr joint survey 1 view (77077) |
$195.38 |
$260.50 |
1.8× |
| Xr neck soft tissue (70360) |
$110.10 |
$146.80 |
1.2× |
| Xr o knee w/ merchant view bilat - report(ortho pro) (73562) |
$161.02 |
$214.70 |
1.8× |
| Xr osseous survey complete (77075) |
$549.75 |
$733 |
5.1× |
| Xr pelvis 1-2 views (72170) |
$176.40 |
$235.20 |
1.7× |
| Xr pelvis min 3 view (72190) |
$333.15 |
$444.20 |
3.1× |
| Xr sacrum/coccyx 2+ views (72220) |
$274.73 |
$366.30 |
3.1× |
| Xr sella turcica (70240) |
$149.18 |
$198.90 |
1.7× |
| Xr shoulder 1 view (73020) |
$111.82 |
$149.10 |
1.3× |
| Xr sinuses 3+ views (70220) |
$146.55 |
$195.40 |
1.6× |
| Xr skull min 4 view (70260) |
$195.98 |
$261.30 |
1.8× |
| Xr spine 1 view (72020) |
$124.20 |
$165.60 |
1.4× |
| Xr spine thoracic 3v (72072) |
$258.38 |
$344.50 |
2.4× |
| Xr sternum 2+ views (71120) |
$125.25 |
$167 |
1.4× |
| Xr t-spine 2 views (72070) |
$169.65 |
$226.20 |
1.6× |
| Xr tibia/fibula 2 views (73590) |
$123.82 |
$165.10 |
1.4× |
| Xr tmj bilateral (70330) |
$206.10 |
$274.80 |
2.3× |
| Xr tmj unilateral (70328) |
$177.15 |
$236.20 |
2.0× |
| Xr wrist 2 views (73100) |
$123.82 |
$165.10 |
1.4× |