| Abdomen 1 View (74018) |
$360 |
$375 |
4.0× |
| Abdomen 2 views (74019) |
$456 |
$475 |
4.2× |
| Ankle 2 views (73600) |
$336 |
$350 |
3.7× |
| Bone age studies (77072) |
$384 |
$400 |
3.5× |
| Bone Imaging 3 Phase (78315) |
$2,208 |
$2,300 |
5.3× |
| Bone Imaging Limited Area (78300) |
$1,200 |
$1,250 |
2.9× |
| Bone Imaging Whole Body (78306) |
$1,920 |
$2,000 |
4.6× |
| Chest 1 view (71045) |
$312 |
$325 |
3.5× |
| Chest 2 views (71046) |
$360 |
$375 |
4.0× |
| Clavicle complete (73000) |
$336 |
$350 |
3.7× |
| Computed Tomography Thorax Lw Dose Lng Ca Scr C- (71271) |
$1,068.48 |
$1,113 |
9.8× |
| CT abdomen and pelvis without and with contrast (74178) |
$5,280 |
$5,500 |
14.6× |
| CT abdomen and pelvis without contrast (74176) |
$3,456 |
$3,600 |
13.9× |
| CT abdomen w contrast (74160) |
$2,496 |
$2,600 |
13.7× |
| CT abdomen w wo contrast (74170) |
$3,168 |
$3,300 |
17.4× |
| CT abdomen w/o contrast (74150) |
$2,208 |
$2,300 |
20.3× |
| CT Angio Abdomen and Pelvis (74174) |
$4,933.44 |
$5,139 |
13.6× |
| CT Angio Chest (71275) |
$3,072 |
$3,200 |
16.9× |
| CT Angio Head (70496) |
$2,472 |
$2,575 |
13.6× |
| CT Angio Neck (70498) |
$2,880 |
$3,000 |
15.8× |
| CT cervical spine w/o contrast (72125) |
$2,208 |
$2,300 |
20.3× |
| CT chest w contrast (71260) |
$2,496 |
$2,600 |
13.7× |
| CT chest w/wo contrast (71270) |
$3,072 |
$3,200 |
16.9× |
| CT head/brain with contrast (70460) |
$2,352 |
$2,450 |
12.9× |
| CT head/brain without and with contrast (70470) |
$2,400 |
$2,500 |
13.2× |
| CT lower ext w/o (73700) |
$1,968 |
$2,050 |
18.1× |
| CT lower extremity w/contrast material (73701) |
$2,256 |
$2,350 |
12.4× |
| CT lumbar spine w/o contrast (72131) |
$2,208 |
$2,300 |
20.3× |
| CT maxillofacial w contrast (70487) |
$2,064 |
$2,150 |
11.3× |
| CT maxillofacial wo contrast (70486) |
$1,824 |
$1,900 |
16.8× |
| CT neck tissue combo (70492) |
$2,496 |
$2,600 |
13.7× |
| CT orbits w/o contrast (70480) |
$2,016 |
$2,100 |
18.6× |
| CT pelvis w&w/o contrast (72194) |
$2,880 |
$3,000 |
15.8× |
| CT pelvis w/o contrast (72192) |
$2,208 |
$2,300 |
20.3× |
| CT scan of leg combo (73702) |
$2,832 |
$2,950 |
15.5× |
| CT soft tissue neck w contrast (70491) |
$2,400 |
$2,500 |
13.2× |
| CT soft tissue neck w/o contrast (70490) |
$2,016 |
$2,100 |
18.6× |
| CT thoracic spine w/o contrast (72128) |
$2,208 |
$2,300 |
20.3× |
| CT thorax w/o contrast (71250) |
$2,208 |
$2,300 |
20.3× |
| CT upper ext wo (73200) |
$1,920 |
$2,000 |
17.7× |
| Cta Abdomen (74175) |
$3,264 |
$3,400 |
17.9× |
| CTA pelvis (72191) |
$2,688 |
$2,800 |
14.8× |
| Dxa Bone Density Axial (77080) |
$480 |
$500 |
4.4× |
| Foot 2 views (73620) |
$312 |
$325 |
3.5× |
| Forearm 2 views (73090) |
$384 |
$400 |
4.2× |
| Gated Heart Planar Single (78472) |
$2,016 |
$2,100 |
4.9× |
| Hand 2 views (73120) |
$336 |
$350 |
3.1× |
| Hepatobil Syst Image W/Drug (78227) |
$2,280 |
$2,375 |
4.0× |
| Hepatobiliary System Imaging (78226) |
$1,920 |
$2,000 |
4.6× |
| K Flow/Funct Image W/Drug (78708) |
$2,304 |
$2,400 |
4.1× |
| Knee 3 Views (73562) |
$432 |
$450 |
4.8× |
| Magnetic Image Jaw Joint (70336) |
$2,184 |
$2,275 |
8.8× |
| Mra Head W/O & W/Contrast Material (70546) |
$3,360 |
$3,500 |
9.3× |
| MRA head w/o contrast (70544) |
$3,264 |
$3,400 |
13.2× |
| Mra Neck W/O &W/Contrast Material (70549) |
$3,648 |
$3,800 |
10.1× |
| MRA neck w/o contrast (70547) |
$2,880 |
$3,000 |
11.6× |
| MRI abdomen w/o contrast (74181) |
$3,264 |
$3,400 |
13.2× |
| MRI any jt lower extrem w/o & w/contrast matrl (73723) |
$3,936 |
$4,100 |
10.9× |
| MRI cervical spine w/o cont (72141) |
$3,264 |
$3,400 |
13.2× |
| MRI chest wo w contrast (71552) |
$4,032 |
$4,200 |
11.1× |
| MRI lower extrem oth/thn jt w/contrast matrl (73719) |
$3,072 |
$3,200 |
8.5× |
| MRI lower extrem oth/thn jt w/o & w/contr matr (73720) |
$3,240 |
$3,375 |
8.9× |
| MRI lower extrem oth/thn jt w/o contr matrl (73718) |
$2,640 |
$2,750 |
10.7× |
| MRI lumbar spine w contrast (72149) |
$3,840 |
$4,000 |
10.6× |
| Mri Neck Spine W/O & W/Dye (72156) |
$3,936 |
$4,100 |
10.9× |
| MRI orbit face &/neck w/o contrast (70540) |
$3,648 |
$3,800 |
14.7× |
| Mri Orbt/Fac/Nck W/O &W/Dye (70543) |
$3,840 |
$4,000 |
10.6× |
| MRI pelvis w contrast (72196) |
$3,360 |
$3,500 |
9.3× |
| MRI pelvis w/o & w contrast (72197) |
$3,811.20 |
$3,970 |
10.5× |
| MRI pelvis w/o contrast (72195) |
$3,264 |
$3,400 |
13.2× |
| MRI thoracic spine w/o contrast (72146) |
$3,264 |
$3,400 |
13.2× |
| MRI upper extremity oth than jt w/o contr matrl (73218) |
$2,688 |
$2,800 |
10.8× |
| Mri Uppr Extremity W/O&W/Dye (73220) |
$3,312 |
$3,450 |
9.1× |
| MRI, abdomen, combo (74183) |
$3,600 |
$3,750 |
9.9× |
| MRI, dorsal spine combo (72157) |
$3,648 |
$3,800 |
10.1× |
| MRI, joint upper extrem (73221) |
$2,568 |
$2,675 |
10.4× |
| MRI, joint upper extrem combo (73223) |
$3,408 |
$3,550 |
9.4× |
| MRI, lumbar spine combo (72158) |
$3,936 |
$4,100 |
10.9× |
| Myocardial Spect Multiple Studies (78452) |
$4,800 |
$5,000 |
3.6× |
| Neck soft tissue (70360) |
$360 |
$375 |
4.0× |
| Parathyroid Planar Imaging (78070) |
$1,584 |
$1,650 |
3.8× |
| Pelvis 1 or 2 views (72170) |
$336 |
$350 |
3.1× |
| PET image w/CT, full body (78816) |
$7,200 |
$7,500 |
4.8× |
| PET imaging CT attenuation skull base mid-thigh (78815) |
$6,720 |
$7,000 |
4.5× |
| Radex Ankle Complete Minimum 3 Views (73610) |
$384 |
$400 |
4.2× |
| Radex Calcaneus Minimum 2 Views (73650) |
$264 |
$275 |
2.9× |
| Radex elbow complete minimum 3 views (73080) |
$384 |
$400 |
4.2× |
| Radex Facial Bones Complete Minimum 3 Views (70150) |
$480 |
$500 |
4.4× |
| Radex fingr minimum 2 views (73140) |
$312 |
$325 |
3.5× |
| Radex foot complete minimum 3 views (73630) |
$384 |
$400 |
4.2× |
| Radex Hand Minimum 3 Views (73130) |
$408 |
$425 |
4.5× |
| Radex lower extremity infant minimum 2 views (73592) |
$312 |
$325 |
3.5× |
| Radex Nasal Bones Complete Minimum 3 Views (70160) |
$384 |
$400 |
4.2× |
| Radex Ribs Unilateral 2 Views (71100) |
$336 |
$350 |
3.7× |
| Radex shoulder complete minimum 2 views (73030) |
$408 |
$425 |
4.5× |
| Radex Spine 1 View Specify Level (72020) |
$336 |
$350 |
3.7× |
| Radex Sternum Minimum 2 Views (71120) |
$312 |
$325 |
3.5× |
| Radex Toe Minimum 2 Views (73660) |
$288 |
$300 |
3.2× |
| Radex upper extremity infant minimum 2 views (73092) |
$336 |
$350 |
3.1× |
| Radex Wrist Complete Minimum 3 Views (73110) |
$384 |
$400 |
4.2× |
| Radiologic Exam Abdomen 3+ Views - Xr Abdomen 3+ Views (74021) |
$504 |
$525 |
4.6× |
| Radiologic exam knee complete 4/more views (73564) |
$480 |
$500 |
4.4× |
| Radiologic examination femur 1 view (73551) |
$288 |
$300 |
3.2× |
| Radiologic examination femur minimum 2 views (73552) |
$384 |
$400 |
4.2× |
| Radiologic examination knee 1/2 views (73560) |
$408 |
$425 |
4.5× |
| Radiologic examination tibia & fibula 2 views (73590) |
$384 |
$400 |
4.2× |
| Scapula (73010) |
$360 |
$375 |
3.3× |
| Screening Digital Breast Tomosynthesis Bi (77063) |
$72 |
$75 |
3.1× |
| Shoulder 1 view (73020) |
$288 |
$300 |
3.2× |
| Skull less than 4 views (70250) |
$384 |
$400 |
3.5× |
| Sternoclavicular joints (71130) |
$312 |
$325 |
3.5× |
| Thoracic spine 2 views (72070) |
$384 |
$400 |
3.5× |
| Thoracic spine 3 views (72072) |
$460.80 |
$480 |
4.2× |
| Ultrasound Breast Limited (76642) |
$432 |
$450 |
4.8× |
| Ultrasound Exam Aaa Screen (76706) |
$552 |
$575 |
5.1× |
| Ultrasound, abdomen limited (76705) |
$696 |
$725 |
6.4× |
| Us breast unilateral complete (76641) |
$600 |
$625 |
5.5× |
| Us exam, pelvic, limited (76857) |
$312 |
$325 |
2.9× |
| Us lmtd joint/oth nonvasc xtr strux r-t w/img (76882) |
$576 |
$600 |
5.3× |
| Us ob limited 1 or more fetuses (76815) |
$432 |
$450 |
4.0× |
| Us ob transvaginal (76817) |
$528 |
$550 |
4.9× |
| Us pelvic non ob complete (76856) |
$768 |
$800 |
7.1× |
| Us pg uter img f&mat 14 wk tabdl 1/1st gestation (76801) |
$624 |
$650 |
5.7× |
| Us preg uterus real time f/u trnsabdl per fetus (76816) |
$336 |
$350 |
3.1× |
| Us retroperitoneal complete (76770) |
$912 |
$950 |
8.4× |
| Us retroperitoneal limited (76775) |
$624 |
$650 |
5.7× |
| Us scrotum and contents (76870) |
$768 |
$800 |
7.1× |
| Us thyroid (76536) |
$672 |
$700 |
6.2× |
| Wrist 2 views (73100) |
$336 |
$350 |
3.7× |
| X-Ray Ac Jts - Xr Acromioclavicular Joints Bilateral (73050) |
$360 |
$375 |
4.0× |
| X-Ray Elbow 2 Vw - Xr Elbow 1-2 Views Right (73070) |
$345.60 |
$360 |
3.8× |
| X-Ray Exam Hip Uni 1 View (73501) |
$240 |
$250 |
2.7× |
| X-Ray Exam Hip Uni 2-3 Views (73502) |
$288 |
$300 |
3.2× |
| X-Ray Exam Hips Bi 2 Views (73521) |
$528 |
$550 |
4.9× |
| X-Ray Exam L-S Spine Bending (72114) |
$720 |
$750 |
6.6× |
| X-Ray Exam Neck Spine 2-3 Vw (72040) |
$360 |
$375 |
4.0× |
| X-Ray Exam Neck Spine 6/>Vws (72052) |
$748.80 |
$780 |
6.9× |
| X-Ray Exam Unilat Ribs/Chest (71101) |
$432 |
$450 |
4.0× |
| X-ray eye for foreign body (70030) |
$268.80 |
$280 |
3.0× |
| X-ray humerus (73060) |
$384 |
$400 |
4.2× |
| X-Ray Knee Bilat Standing - Xr Knees Anteroposterior Standing Bilat (73565) |
$288 |
$300 |
3.2× |
| X-Ray Lumbar Spine 2/3 Vw - Xr Lumbar Spine 2-3 Views (72100) |
$456 |
$475 |
4.2× |
| X-ray nose-rectum child f.b. (76010) |
$408 |
$425 |
4.5× |
| X-Ray Ribs, Chest 4+ Vw - Xr Ribs 3 Vws Bil W/ Chest Posteroanterior (71111) |
$552 |
$575 |
5.1× |
| X-Ray Sacroiliac Jts 3+ Vw - Xr Sacroiliac Joints 3+ Views (72202) |
$408 |
$425 |
3.8× |
| X-Ray Sacrum/Coccyx 2+ Vw - Xr Sacrum Coccyx 2+ Views (72220) |
$288 |
$300 |
3.2× |
| X-Ray Sinuses 3+ Vw - Xr Paranasal Sinuses 3+ Views (70220) |
$480 |
$500 |
5.3× |
| X-Rays Bone Survey Complete (77075) |
$1,104 |
$1,150 |
10.2× |
| Xr c-spine 4 or 5 views (72050) |
$528 |
$550 |
4.9× |
| Xr orbits complete 4 views (70200) |
$480 |
$500 |
4.4× |