| Ankle 2 views (73600) |
$280 |
$350 |
3.1× |
| Clavicle complete (73000) |
$280 |
$350 |
3.1× |
| Computed tomographic angiography, abdomen and pelvis, with contrast material(s), including noncontrast images, if… (74174) |
$3,969.60 |
$4,962 |
10.8× |
| Computed tomographic angiography, abdomen, with contrast material(s), including noncontrast images, if performed, and… (74175) |
$1,616 |
$2,020 |
8.7× |
| Computed tomographic angiography, abdominal aorta and bilateral iliofemoral lower extremity runoff, with contrast… (75635) |
$1,712.80 |
$2,141 |
9.3× |
| Computed tomographic angiography, chest (noncoronary), with contrast material(s), including noncontrast images, if… (71275) |
$2,935.20 |
$3,669 |
15.9× |
| Computed tomographic angiography, lower extremity, with contrast material(s), including noncontrast images, if… (73706) |
$2,118.40 |
$2,648 |
11.4× |
| Computed tomographic angiography, neck, with contrast material(s), including noncontrast images, if performed, and… (70498) |
$1,616 |
$2,020 |
8.7× |
| Computed tomographic angiography, pelvis, with contrast material(s), including noncontrast images, if performed, and… (72191) |
$2,622.40 |
$3,278 |
14.2× |
| Computed tomographic angiography, upper extremity, with contrast material(s), including noncontrast images, if… (73206) |
$1,616 |
$2,020 |
8.7× |
| Computed tomography, cervical spine; without contrast material, followed by contrast material(s) and further sections… (72127) |
$2,460.80 |
$3,076 |
13.3× |
| Computed tomography, lower extremity; without contrast material Age Under 21 (73700) |
$1,738.40 |
$2,173 |
15.8× |
| Computed tomography, lower extremity; without contrast material, followed by contrast material(s) and further sections… (73702) |
$2,017.60 |
$2,522 |
10.9× |
| Computed tomography, lumbar spine; without contrast material, followed by contrast material(s) and further sections Age… (72133) |
$3,164.80 |
$3,956 |
17.1× |
| Computed tomography, maxillofacial area; with contrast material(s) Age Under 21 (70487) |
$1,895.20 |
$2,369 |
10.2× |
| Computed tomography, maxillofacial area; without contrast material Age Under 21 (70486) |
$1,569.60 |
$1,962 |
14.2× |
| Computed tomography, orbit, sella, or posterior fossa or outer, middle, or inner ear; with contrast material(s) Age… (70481) |
$1,186.40 |
$1,483 |
6.4× |
| Computed tomography, orbit, sella, or posterior fossa or outer, middle, or inner ear; without contrast material Age… (70480) |
$1,021.60 |
$1,277 |
9.3× |
| Computed tomography, orbit, sella, or posterior fossa or outer, middle, or inner ear; without contrast material,… (70482) |
$1,336.80 |
$1,671 |
7.2× |
| Computed tomography, soft tissue neck; without contrast material followed by contrast material(s) and further sections… (70492) |
$1,336.80 |
$1,671 |
7.2× |
| Computed tomography, thoracic spine; without contrast material, followed by contrast material(s) and further sections… (72130) |
$1,045.60 |
$1,307 |
5.7× |
| Computed tomography, thorax, diagnostic; without contrast material, followed by contrast material(s) and further… (71270) |
$2,795.20 |
$3,494 |
15.1× |
| CT abdomen and pelvis without and with contrast (74178) |
$3,898.40 |
$4,873 |
10.6× |
| CT abdomen and pelvis without contrast (74176) |
$3,214.40 |
$4,018 |
12.8× |
| CT abdomen w & w/o contrast (74170) |
$1,257.60 |
$1,572 |
6.8× |
| CT abdomen w/contrast (74160) |
$1,100.80 |
$1,376 |
5.9× |
| CT abdomen w/o contrast (74150) |
$831.20 |
$1,039 |
7.5× |
| CT cervical spine w/contrast (72126) |
$2,174.40 |
$2,718 |
5.9× |
| CT cervical spine w/o contrast (72125) |
$1,951.20 |
$2,439 |
17.7× |
| CT chest w/contrast (71260) |
$2,607.20 |
$3,259 |
14.1× |
| CT extremity upper w & w/o contrast (73202) |
$1,336.80 |
$1,671 |
7.2× |
| CT extremity upper w/o contrast (73200) |
$1,082.40 |
$1,353 |
9.8× |
| CT head/brain with contrast (70460) |
$2,109.60 |
$2,637 |
11.4× |
| CT head/brain without and with contrast (70470) |
$2,215.20 |
$2,769 |
12.0× |
| CT heart no contrast quant eval coronry calcium (75571) |
$437.60 |
$547 |
4.8× |
| CT l-spine w/contrast (72132) |
$2,700.80 |
$3,376 |
7.3× |
| CT lower extremity w/dye (73701) |
$1,955.20 |
$2,444 |
10.6× |
| CT lumbar spine w/o contrast (72131) |
$2,496 |
$3,120 |
22.6× |
| CT maxillofacial w/wo contrast (70488) |
$1,989.60 |
$2,487 |
10.8× |
| CT neck w/contrast (70491) |
$1,186.40 |
$1,483 |
6.4× |
| CT neck w/o contrast (70490) |
$1,021.60 |
$1,277 |
9.3× |
| CT pelvis w & w/o contrast (72194) |
$1,977.60 |
$2,472 |
10.7× |
| CT pelvis w/o contrast (72192) |
$1,082.40 |
$1,353 |
9.8× |
| CT thoracic spine w/contrast (72129) |
$996 |
$1,245 |
5.4× |
| CT thoracic spine w/o contrast (72128) |
$948.80 |
$1,186 |
8.6× |
| CT thorax lung cancer scr c- (71271) |
$674.40 |
$843 |
6.1× |
| CT thorax w/o contrast (71250) |
$2,172.80 |
$2,716 |
19.7× |
| CT upper extremity w/dye (73201) |
$1,257.60 |
$1,572 |
3.4× |
| CTA head w contrast (70496) |
$2,325.60 |
$2,907 |
12.6× |
| Dual-energy X-ray absorptiometry (DXA), bone density study, 1 or more sites; axial skeleton (eg, hips, pelvis, spine)… (77080) |
$435.20 |
$544 |
3.9× |
| Dxa bone density/peripheral (77081) |
$187.20 |
$234 |
2.0× |
| Fetal biophys profile w/o nst (76819) |
$390.40 |
$488 |
3.5× |
| Fluoroscopy up to 1 hour physician/qhp time (76000) |
$408 |
$510 |
1.6× |
| Gated heart planar single (78472) |
$1,322.40 |
$1,653 |
3.1× |
| Ht muscle image spect sing (78451) |
$2,119.20 |
$2,649 |
1.6× |
| Magnetic resonance (eg, proton) imaging, any joint of lower extremity; without contrast material(s), followed by… (73723) |
$2,432 |
$3,040 |
6.6× |
| Magnetic resonance (eg, proton) imaging, lower extremity other than joint; without contrast material(s) Age Under 21 (73718) |
$1,552.80 |
$1,941 |
6.2× |
| Magnetic resonance (eg, proton) imaging, lower extremity other than joint; without contrast material(s), followed by… (73720) |
$2,432 |
$3,040 |
6.6× |
| Magnetic resonance (eg, proton) imaging, orbit, face, and/or neck; without contrast material(s) Age Under 21 (70540) |
$1,281.60 |
$1,602 |
5.1× |
| Magnetic resonance (eg, proton) imaging, upper extremity, other than joint; with contrast material(s) Age Under 21 (73219) |
$1,708 |
$2,135 |
4.6× |
| Magnetic resonance (eg, proton) imaging, upper extremity, other than joint; without contrast material(s), followed by… (73220) |
$2,432 |
$3,040 |
6.6× |
| Magnetic resonance angiography, head; without contrast material(s), followed by contrast material(s) and further… (70546) |
$2,503.20 |
$3,129 |
6.8× |
| Magnetic resonance angiography, neck; without contrast material(s), followed by contrast material(s) and further… (70549) |
$2,442.40 |
$3,053 |
6.6× |
| Mammary ductogram or galactogram, multiple ducts, radiological supervision and interpretation Age Under 21 (77054) |
$543.20 |
$679 |
2.2× |
| Mandible min 4v (70110) |
$310.40 |
$388 |
2.8× |
| Mr safety determination physician/other qhp (76016) |
$212.80 |
$266 |
2.3× |
| Mr safety implant pos&/immoblj supvj phys/qhp (76019) |
$165.60 |
$207 |
2.7× |
| Mr safety implant&/fb assmt clin staf 1st 15 min (76014) |
$59.20 |
$74 |
1.9× |
| Mr safety implt electronics prepj supvj phys/qhp (76018) |
$254.40 |
$318 |
2.5× |
| Mr safety med physics xm customization plng&mntr (76017) |
$670.40 |
$838 |
2.7× |
| MRA head w/o contrast (70544) |
$1,597.60 |
$1,997 |
6.3× |
| MRA neck w/o contrast (70547) |
$1,597.60 |
$1,997 |
6.3× |
| MRI abdomen w/contrast (74182) |
$1,659.20 |
$2,074 |
4.5× |
| MRI abdomen w/o contrast (74181) |
$1,597.60 |
$1,997 |
6.3× |
| MRI abdomen w/wo contrast (74183) |
$2,503.20 |
$3,129 |
6.8× |
| MRI any jt lower extrem w/contrast material (73722) |
$1,662.40 |
$2,078 |
2.0× |
| MRI bone marrow (77084) |
$1,492 |
$1,865 |
5.9× |
| MRI c-spine w&w/o cont (72156) |
$2,432 |
$3,040 |
6.6× |
| MRI cervical spine w/contrast (72142) |
$1,664.80 |
$2,081 |
4.5× |
| MRI chest w/o contrast (71550) |
$1,390.40 |
$1,738 |
5.5× |
| MRI chest w/wo contrast (71552) |
$2,503.20 |
$3,129 |
6.8× |
| MRI joint upr extr w/o&w/dye (73223) |
$2,432 |
$3,040 |
6.6× |
| MRI joint upr extrem w/dye (73222) |
$1,869.60 |
$2,337 |
2.3× |
| MRI joint upr extrem w/o dye (73221) |
$1,552.80 |
$1,941 |
6.2× |
| MRI lumbar spine w/contrast (72149) |
$2,240.80 |
$2,801 |
6.1× |
| MRI lumbar spine w/wo contrast (72158) |
$3,498.40 |
$4,373 |
9.5× |
| MRI orbit/face/neck w&w/o cont (70543) |
$2,432 |
$3,040 |
6.6× |
| MRI pelvis w & w/o contrast (72197) |
$2,432 |
$3,040 |
6.6× |
| MRI pelvis w/o contrast (72195) |
$1,597.60 |
$1,997 |
6.3× |
| MRI spine cervical w/o contrast (72141) |
$1,585.60 |
$1,982 |
6.3× |
| MRI t-spine w&w/o cont (72157) |
$2,432 |
$3,040 |
6.6× |
| MRI thoracic spine w/contrast (72147) |
$1,908 |
$2,385 |
5.2× |
| MRI thoracic spine w/o contrst (72146) |
$1,552.80 |
$1,941 |
6.2× |
| MRI tmj (70336) |
$1,350.40 |
$1,688 |
5.4× |
| MRI upper extremity oth than jt w/o contr matrl (73218) |
$1,597.60 |
$1,997 |
6.3× |
| Myocardial imaging, positron emission tomography (PET), perfusion study (including ventricular wall motionºs» and/or… (78491) |
$3,949.60 |
$4,937 |
2.6× |
| Myocardial imaging, positron emission tomography (PET), perfusion study (including ventricular wall motionºs» and/or… (78492) |
$7,205.60 |
$9,007 |
4.8× |
| Myocardial spect multiple studies (78452) |
$2,176.80 |
$2,721 |
1.6× |
| Ob us limited fetus(s) (76815) |
$350.40 |
$438 |
3.2× |
| Ob us nuchal meas 1 gest (76813) |
$211.20 |
$264 |
1.9× |
| Ophthalmic ultrasound, diagnostic; B-scan (with or without superimposed non-quantitative A-scan) Age Under 21 (76512) |
$292 |
$365 |
2.6× |
| Radex abscess/fistula/sinus tract rs&i (76080) |
$655.20 |
$819 |
1.1× |
| Radex entir thrc lmbr crv sac spi w/skull 1 vw (72081) |
$270.40 |
$338 |
2.9× |
| Radex entir thrc lmbr crv sac spi w/skull 2/3 vw (72082) |
$587.20 |
$734 |
5.3× |
| Radex entir thrc lmbr crv sac spi w/skull 4/5 vw (72083) |
$668.80 |
$836 |
6.1× |
| Radex entir thrc lmbr crv sac spi w/skull 6/> vw (72084) |
$731.20 |
$914 |
6.6× |
| Radex hip unilateral with pelvis 1 view (73501) |
$216 |
$270 |
2.4× |
| Radex hip unilateral with pelvis 2-3 views (73502) |
$356.80 |
$446 |
3.9× |
| Radex hip unilateral with pelvis minimum 4 views (73503) |
$400.80 |
$501 |
3.6× |
| Radex hips bilateral with pelvis 2 views (73521) |
$397.60 |
$497 |
3.6× |
| Radex hips bilateral with pelvis minimum 5 views (73523) |
$548.80 |
$686 |
5.0× |
| Radex spine cervical 2 or 3 views (72040) |
$310.40 |
$388 |
3.4× |
| Radex spine cervical 4 or 5 views (72050) |
$324 |
$405 |
2.9× |
| Radex spine cervical 6 or more views (72052) |
$364.80 |
$456 |
3.3× |
| Radex spine thoracolumbar junction min 2 views (72080) |
$310.40 |
$388 |
3.4× |
| Radiologic exam abdomen 3+ views (74021) |
$331.20 |
$414 |
3.0× |
| Radiologic exam chest 3 views (71047) |
$432.80 |
$541 |
4.7× |
| Radiologic exam colon double contrast study (74280) |
$669.60 |
$837 |
3.6× |
| Radiologic exam colon single contrast study (74270) |
$603.20 |
$754 |
3.3× |
| Radiologic exam esophagus double contrast study (74221) |
$582.40 |
$728 |
3.1× |
| Radiologic exam esophagus single contrast study (74220) |
$473.60 |
$592 |
2.6× |
| Radiologic exam small int single contrast study (74250) |
$411.20 |
$514 |
2.2× |
| Radiologic exam upr gi trc double contrast study (74246) |
$621.60 |
$777 |
3.4× |
| Radiologic exam upr gi trc single contrast study (74240) |
$415.20 |
$519 |
2.2× |
| Radiologic examination femur 1 view (73551) |
$188 |
$235 |
2.0× |
| Radiologic examination femur minimum 2 views (73552) |
$230.40 |
$288 |
2.5× |
| Radiologic examination from nose to rectum for foreign body, single view, child Age Under 21 (76010) |
$288 |
$360 |
3.1× |
| Radiologic examination, ankle; complete, minimum of 3 views Age Under 21 (73610) |
$343.20 |
$429 |
3.7× |
| Radiologic examination, complete acute abdomen series, including 2 or more views of the abdomen (eg, supine, erect,… (74022) |
$382.40 |
$478 |
3.5× |
| Radiologic examination, elbow; 2 views Age Under 21 (73070) |
$272 |
$340 |
3.0× |
| Radiologic examination, elbow; complete, minimum of 3 views Age Under 21 (73080) |
$310.40 |
$388 |
3.4× |
| Radiologic examination, facial bones; less than 3 views Age Under 21 (70140) |
$270.40 |
$338 |
2.9× |
| Radiologic examination, foot; complete, minimum of 3 views Age Under 21 (73630) |
$360 |
$450 |
3.9× |
| Radiologic examination, hand; minimum of 3 views Age Under 21 (73130) |
$360 |
$450 |
3.9× |
| Radiologic examination, knee; both knees, standing, anteroposterior Age Under 21 (73565) |
$292.80 |
$366 |
3.2× |
| Radiologic examination, knee; complete, 4 or more views Age Under 21 (73564) |
$403.20 |
$504 |
3.7× |
| Radiologic examination, mandible; partial, less than 4 views Age Under 21 (70100) |
$270.40 |
$338 |
2.9× |
| Radiologic examination, mastoids; complete, minimum of 3 views per side Age Under 21 (70130) |
$317.60 |
$397 |
2.9× |
| Radiologic examination, nasal bones, complete, minimum of 3 views Age Under 21 (70160) |
$243.20 |
$304 |
2.6× |
| Radiologic examination, ribs, bilateral; including posteroanterior chest, minimum of 4 views Age Under 21 (71111) |
$413.60 |
$517 |
3.8× |
| Radiologic examination, ribs, unilateral; including posteroanterior chest, minimum of 3 views Age Under 21 (71101) |
$350.40 |
$438 |
3.2× |
| Radiologic examination, sacroiliac joints; less than 3 views Age Under 21 (72200) |
$274.40 |
$343 |
2.5× |
| Radiologic examination, shoulder, arthrography, radiological supervision and interpretation Age Under 21 (73040) |
$464.80 |
$581 |
1.3× |
| Radiologic examination, shoulder; complete, minimum of 2 views Age Under 21 (73030) |
$344 |
$430 |
3.7× |
| Radiologic examination, sinuses, paranasal, less than 3 views Age Under 21 (70210) |
$200 |
$250 |
2.2× |
| Radiologic examination, skull; less than 4 views Age Under 21 (70250) |
$293.60 |
$367 |
2.7× |
| Radiologic examination, spine, lumbosacral; 2 or 3 views Age Under 21 (72100) |
$310.40 |
$388 |
2.8× |
| Radiologic examination, spine, lumbosacral; bending views only, 2 or 3 views Age Under 21 (72120) |
$259.20 |
$324 |
2.4× |
| Radiologic examination, spine, lumbosacral; complete, including bending views, minimum of 6 views Age Under 21 (72114) |
$310.40 |
$388 |
2.8× |
| Radiologic examination, wrist; complete, minimum of 3 views Age Under 21 (73110) |
$360 |
$450 |
3.9× |
| Radiologic examination; acromioclavicular joints, bilateral, with or without weighted distraction Age Under 21 (73050) |
$270.40 |
$338 |
2.9× |
| Radiologic examination; humerus, minimum of 2 views Age Under 21 (73060) |
$310.40 |
$388 |
3.4× |
| Radiologic examination; lower extremity, infant, minimum of 2 views Age Under 21 (73592) |
$270.40 |
$338 |
2.9× |
| Radiologic examination; orbits, complete, minimum of 4 views Age Under 21 (70200) |
$310.40 |
$388 |
2.8× |
| Radiologic examination; sternoclavicular joint or joints, minimum of 3 views Age Under 21 (71130) |
$270.40 |
$338 |
2.9× |
| Radiologic examination; toe(s), minimum of 2 views Age Under 21 (73660) |
$256 |
$320 |
2.8× |
| Radiologic examination; upper extremity, infant, minimum of 2 views Age Under 21 (73092) |
$270.40 |
$338 |
2.5× |
| Scapula complete (73010) |
$246.40 |
$308 |
2.2× |
| Screening digital breast tomosynthesis bi (77063) |
$52 |
$65 |
— |
| Ultrasound breast limited (76642) |
$262.40 |
$328 |
2.9× |
| Ultrasound, abdomen limited (76705) |
$632 |
$790 |
5.7× |
| Ultrasound, limited, joint or focal evaluation of other nonvascular extremity structure(s) (eg, joint space,… (76882) |
$486.40 |
$608 |
4.4× |
| Ultrasound, pelvic (nonobstetric), real time with image documentation; complete Age Under 21 (76856) |
$789.60 |
$987 |
7.2× |
| Ultrasound, pregnant uterus, real time with image documentation, fetal and maternal evaluation, first trimester (< 14… (76801) |
$476.80 |
$596 |
4.3× |
| Ultrasound, transplanted kidney, real time and duplex Doppler with image documentation Age Under 21 (76776) |
$824 |
$1,030 |
7.5× |
| Us abdominal aorta real time screen study aaa (76706) |
$366.40 |
$458 |
3.3× |
| Us breast uni real time with image complete (76641) |
$425.60 |
$532 |
3.9× |
| Us chest (76604) |
$440.80 |
$551 |
4.0× |
| Us compl joint r-t w/image documentation (76881) |
$563.20 |
$704 |
5.1× |
| Us exam, pelvic, limited (76857) |
$480.80 |
$601 |
4.4× |
| Us guided compression repair (76936) |
$1,863.20 |
$2,329 |
8.2× |
| US OB Follow-Up/Repeat (76816) |
$349.60 |
$437 |
3.2× |
| Us ob transvaginal (76817) |
$304 |
$380 |
2.8× |
| Us retroperitoneal complete (76770) |
$906.40 |
$1,133 |
8.2× |
| Us retroperitoneal ltd (76775) |
$482.40 |
$603 |
4.4× |
| Us scrotum (76870) |
$628 |
$785 |
5.7× |
| Us soft tissue head/neck (76536) |
$628 |
$785 |
5.7× |
| Us unlstd proc (76999) |
$361.40 |
$451.75 |
3.9× |
| X-ray exam hips bi 3-4 views (73522) |
$522.40 |
$653 |
4.7× |
| X-ray exam of finger(s) (73140) |
$280 |
$350 |
3.1× |
| X-ray exam of knee 1 or 2 (73560) |
$310.40 |
$388 |
3.4× |
| X-ray exam ribs bil 3 views (71110) |
$406.40 |
$508 |
3.7× |
| X-ray exam ribs uni 2 views (71100) |
$310.40 |
$388 |
3.4× |
| X-ray heel (73650) |
$184.80 |
$231 |
2.0× |
| X-ray of joint between lower spine and hip bone 3 or more views|PROFESSIONAL COMPONENT (72202) |
$310.40 |
$388 |
2.8× |
| Xr abdomen 1 view (74018) |
$248.80 |
$311 |
2.7× |
| Xr abdomen 2 views (74019) |
$310.40 |
$388 |
2.8× |
| Xr arthrogram hip (73525) |
$331.20 |
$414 |
0.9× |
| Xr arthrogram knee (73580) |
$881.60 |
$1,102 |
2.4× |
| Xr bone age studies (77072) |
$270.40 |
$338 |
2.5× |
| Xr bone length study (77073) |
$398.40 |
$498 |
3.6× |
| Xr chest 1 view (71045) |
$304 |
$380 |
3.3× |
| Xr chest 2 views (71046) |
$348 |
$435 |
3.8× |
| Xr eye foreign body (70030) |
$240 |
$300 |
2.6× |
| Xr facial bones 3+ views (70150) |
$289.60 |
$362 |
2.6× |
| Xr foot arthritis pa only bilateral - report(ortho pro) (73620) |
$282.40 |
$353 |
3.1× |
| Xr forearm 2 views (73090) |
$310.40 |
$388 |
3.4× |
| Xr hand 2v (73120) |
$288 |
$360 |
2.6× |
| Xr myelogram l-spine (72265) |
$1,320.80 |
$1,651 |
1.6× |
| Xr neck soft tissue (70360) |
$270.40 |
$338 |
2.9× |
| Xr o knee w/ merchant view bilat - report(ortho pro) (73562) |
$356.80 |
$446 |
3.9× |
| Xr osseous survey complete (77075) |
$500 |
$625 |
4.5× |
| Xr pelvis 1-2 views (72170) |
$310.40 |
$388 |
2.8× |
| Xr pelvis min 3 view (72190) |
$399.20 |
$499 |
3.6× |
| Xr sacrum/coccyx 2+ views (72220) |
$310.40 |
$388 |
3.4× |
| Xr shoulder 1 view (73020) |
$240 |
$300 |
2.6× |
| Xr sinuses 3+ views (70220) |
$310.40 |
$388 |
3.4× |
| Xr skull min 4 view (70260) |
$310.40 |
$388 |
2.8× |
| Xr spine 1 view (72020) |
$248 |
$310 |
2.7× |
| Xr spine thoracic 3v (72072) |
$339.20 |
$424 |
3.1× |
| Xr sternum 2+ views (71120) |
$175.20 |
$219 |
1.9× |
| Xr t-spine 2 views (72070) |
$310.40 |
$388 |
2.8× |
| Xr tibia/fibula 2 views (73590) |
$310.40 |
$388 |
3.4× |
| Xr tmj bilateral (70330) |
$426.40 |
$533 |
4.6× |
| Xr tmj unilateral (70328) |
$340 |
$425 |
3.7× |
| Xr wrist 2 views (73100) |
$310.40 |
$388 |
3.4× |