Diagnostic radiology · Pennsylvania
Diagnostic radiology commercial reimbursement in Pennsylvania
How Pennsylvania diagnostic radiology rates compare with the national market.
Diagnostic radiology in Pennsylvania
49 codes · 120 sampled providers
Index vs national
96
4% below
Rank among states
32 of 51
1 = highest
Codes above national
10 of 49
median code at 96%
Providers
120
sampled
What the data shows
1
Diagnostic radiology ranks 32nd of 51 states in Pennsylvania with an index of 96 (100 = the specialty's national median), across 49 codes and 120 sampled providers.
2
Of the 49 diagnostic radiology codes with enough data in Pennsylvania, 10 pay above the national median and 39 below; the typical code sits at 96% of the national median.
3
Largest premium over the national median: CPT 99214 (Office o/p est mod 30 min) at 107%; largest discount: CPT 72131 (Ct lumbar spine w/o dye) at 91%.
4
Measured against Medicare, Pennsylvania diagnostic radiology rates have a median of 149% of the Medicare rate across these codes.
Codes above and below the national median
The five largest gaps in each direction
Highest vs national
All diagnostic radiology codes in Pennsylvania
Median across payers vs the specialty's national median and the Medicare rate; sorted by premium
| Code | Pennsylvania | National | Gap | % of Medicare | Providers | TINs | Level |
|---|---|---|---|---|---|---|---|
| CPT 99214 Office o/p est mod 30 min | $137 | $128 | +7% | 101% | 119 | 394 | |
| CPT 99215 Office o/p est hi 40 min | $191 | $182 | +5% | 99% | 119 | 397 | |
| CPT 99204 Office o/p new mod 45 min | $195 | $187 | +5% | 110% | 119 | 395 | |
| CPT 99212 Office o/p est sf 10 min | $53 | $50 | +4% | 88% | 119 | 418 | |
| CPT 93971 Extremity study | $179 | $172 | +4% | 154% | 120 | 427 | |
| CPT 99203 Office o/p new low 30 min | $125 | $121 | +4% | 107% | 119 | 411 | |
| CPT 99205 Office o/p new hi 60 min | $253 | $244 | +4% | 107% | 119 | 414 | |
| CPT 99213 Office o/p est low 20 min | $90 | $88 | +2% | 94% | 119 | 399 | |
| CPT 93880 Extracranial bilat study | $280 | $277 | +1% | 148% | 119 | 418 | |
| CPT 93970 Extremity study | $272 | $270 | +1% | 148% | 120 | 426 | |
| CPT 74178 Ct abd&plv wo cntr flwd cntr | $515 | $520 | -1% | 152% | 119 | 417 | |
| CPT 77067 Scr mammo bi incl cad | $178 | $182 | -2% | 141% | 120 | 420 | |
| CPT 73721 Mri jnt of lwr extre w/o dye | $396 | $407 | -3% | 194% | 120 | 423 | |
| CPT 77080 Dxa bone density axial | $64 | $66 | -3% | 164% | 120 | 419 | |
| CPT 76641 Ultrasound breast complete | $141 | $145 | -3% | 141% | 119 | 420 | |
| CPT 76700 Us exam abdom complete | $163 | $168 | -3% | 143% | 119 | 419 | |
| CPT 71045 X-ray exam chest 1 view | $32 | $33 | -3% | 125% | 120 | 415 | |
| CPT 70551 Mri brain stem w/o dye | $389 | $402 | -3% | 199% | 119 | 421 | |
| CPT 72148 Mri lumbar spine w/o dye | $379 | $392 | -3% | 198% | 119 | 421 | |
| CPT 73502 X-ray exam hip uni 2-3 views | $59 | $61 | -3% | 122% | 120 | 420 | |
| CPT 76705 Echo exam of abdomen | $122 | $126 | -3% | 141% | 120 | 422 | |
| CPT 77066 Dx mammo incl cad bi | $217 | $225 | -4% | 138% | 119 | 424 | |
| CPT 93000 Electrocardiogram complete | $24 | $25 | -4% | 156% | 118 | 406 | |
| CPT 76770 Us exam abdo back wall comp | $152 | $158 | -4% | 143% | 119 | 410 | |
| CPT 74174 Cta abd&plvs w/contrast | $577 | $601 | -4% | 152% | 119 | 415 | |
| CPT 77065 Dx mammo incl cad uni | $171 | $179 | -4% | 138% | 120 | 419 | |
| CPT 76642 Ultrasound breast limited | $115 | $120 | -4% | 138% | 120 | 419 | |
| CPT 77049 Mri breast c-+ w/cad bi | $533 | $558 | -5% | 157% | 119 | 424 | |
| CPT 74177 Ct abd & pelvis w/contrast | $428 | $448 | -5% | 142% | 120 | 421 | |
| CPT 72158 Mri lumbar spine w/o & w/dye | $565 | $593 | -5% | 178% | 118 | 420 | |
| CPT 70496 Ct angiography head | $434 | $457 | -5% | 158% | 119 | 417 | |
| CPT 74176 Ct abd & pelvis w/o contrast | $272 | $287 | -5% | 149% | 120 | 420 | |
| CPT 72141 Mri neck spine w/o dye | $369 | $390 | -5% | 194% | 118 | 420 | |
| CPT 70553 Mri brain stem w/o & w/dye | $568 | $600 | -5% | 179% | 120 | 422 | |
| CPT 71260 Ct thorax dx c+ | $295 | $312 | -5% | 177% | 119 | 400 | |
| CPT 37243 Vasc embolize/occlude organ | $809 | $858 | -6% | 168% | 119 | 398 | |
| CPT 73221 Mri joint upr extrem w/o dye | $384 | $407 | -6% | 187% | 119 | 421 | |
| CPT 74183 Mri abd w/o cntr flwd cntr | $598 | $634 | -6% | 178% | 119 | 420 | |
| CPT 72197 Mri pelvis w/o & w/dye | $597 | $634 | -6% | 178% | 119 | 421 | |
| CPT 71271 Ct thorax lung cancer scr c- | $196 | $208 | -6% | 144% | 119 | 422 | |
| CPT 72125 Ct neck spine w/o dye | $234 | $249 | -6% | 179% | 120 | 392 | |
| CPT 71275 Ct angiography chest | $433 | $462 | -6% | 155% | 119 | 405 | |
| CPT 20610 Drain/inj joint/bursa w/o us | $78 | $83 | -6% | 113% | 119 | 429 | |
| CPT 70450 Ct head/brain w/o dye | $182 | $194 | -7% | 171% | 120 | 420 | |
| CPT 71250 Ct thorax dx c- | $233 | $250 | -7% | 175% | 120 | 397 | |
| CPT 70498 Ct angiography neck | $426 | $459 | -7% | 156% | 119 | 417 | |
| CPT 71046 X-ray exam chest 2 views | $42 | $45 | -7% | 126% | 120 | 421 | |
| CPT 76536 Us exam of head and neck | $142 | $154 | -8% | 131% | 120 | 420 | |
| CPT 72131 Ct lumbar spine w/o dye | $226 | $248 | -9% | 174% | 119 | 413 |
Frequently asked questions
How do Pennsylvania diagnostic radiology rates compare with the rest of the country?
Pennsylvania ranks 32nd of 51 states with an index of 96; 10 of 49 codes are above the national median.
Which diagnostic radiology code has the biggest premium in Pennsylvania?
CPT 99214 (Office o/p est mod 30 min), at 107% of the national median.
Are these Medicare or commercial rates?
Commercial in-network negotiated rates from four national payers' published files; the Medicare comparison column uses the CY2026 Medicare physician fee schedule.
Methodology
How these numbers are calculated
- Source: in-network negotiated-rate files published under the federal Transparency in Coverage rule, August 2026 snapshot: UnitedHealthcare Choice plans (74 files); Aetna commercial plans (70 files); Cigna national PPO (1 files); BCBS licensees' own-network files (5,387 files). Payer comparisons describe these files, not each payer's entire book of business.
- Sample: rates come from a random sample of up to 150 providers per state and specialty. Counts on this page are sampled providers and TINs, not totals.
- Which providers count: only providers in a specialty relevant to the code, because a rate in a payer file attaches to a provider group and is listed under every provider in that group.
- Filters: fee-for-service, professional billing class, no modifier, negotiated or fee-schedule dollar rates. Rates outside 1% to 1,000% of the Medicare rate are excluded.
- Statistic: one median rate per provider, then percentiles across providers. A cell is shown only with at least 15 sampled providers and 4 TINs.
- Medicare benchmark: CY2026 national physician fee schedule, non-QPP conversion factor, unadjusted for locality. Where the non-facility rate is more than twice the facility rate (office rates that include device or supply cost), the facility rate is used so comparisons are like for like.
Benchmark your Pennsylvania diagnostic radiology contracts
Compare your rates with these medians.