| Abdomen 1 View (74018) |
$225.45 |
$501 |
2.7× |
| Abdomen 2 views (74019) |
$263.25 |
$585 |
2.7× |
| Acute Gastrointestinal Blood Loss Imaging (78278) |
$1,351.35 |
$3,003 |
3.6× |
| Ankle 2 views (73600) |
$139.05 |
$309 |
1.7× |
| Bone age studies (77072) |
$186.30 |
$414 |
1.9× |
| Bone Imaging 3 Phase (78315) |
$1,567.80 |
$3,484 |
4.1× |
| Bone Imaging Whole Body (78306) |
$1,095.30 |
$2,434 |
2.9× |
| Bone survey infant (77076) |
$529.65 |
$1,177 |
5.4× |
| Cat Scan Follow-Up Study (76380) |
$315.45 |
$701 |
3.8× |
| Chest 1 view (71045) |
$149.85 |
$333 |
1.8× |
| Chest 2 views (71046) |
$159.30 |
$354 |
1.9× |
| Chest 3 views (71047) |
$172.80 |
$384 |
2.1× |
| Chest 4 or more views (71048) |
$185.40 |
$412 |
1.9× |
| Clavicle complete (73000) |
$218.25 |
$485 |
2.7× |
| Computed Tomography Thorax Lw Dose Lng Ca Scr C- (71271) |
$96.75 |
$215 |
1.0× |
| Contrast X-Ray Bladder (74430) |
$404.10 |
$898 |
1.2× |
| CT abdomen and pelvis without and with contrast (74178) |
$1,541.70 |
$3,426 |
4.7× |
| CT abdomen and pelvis without contrast (74176) |
$955.80 |
$2,124 |
4.2× |
| CT abdomen w contrast (74160) |
$593.55 |
$1,319 |
3.6× |
| CT abdomen w wo contrast (74170) |
$675.45 |
$1,501 |
4.1× |
| CT abdomen w/o contrast (74150) |
$550.35 |
$1,223 |
5.6× |
| CT Angio Abdomen and Pelvis (74174) |
$1,170 |
$2,600 |
3.5× |
| CT Angio Chest (71275) |
$957.60 |
$2,128 |
5.8× |
| CT Angio Head (70496) |
$1,010.70 |
$2,246 |
6.1× |
| CT Angio Neck (70498) |
$1,010.70 |
$2,246 |
6.1× |
| Ct Angio Upr Extrm W/O&W/Dye (73206) |
$1,073.25 |
$2,385 |
6.5× |
| CT cervical spine w/ contrast (72126) |
$1,290.60 |
$2,868 |
3.9× |
| CT cervical spine w/o contrast (72125) |
$842.85 |
$1,873 |
8.5× |
| CT cervical spine w/wo cont (72127) |
$1,289.25 |
$2,865 |
7.8× |
| CT chest w contrast (71260) |
$698.85 |
$1,553 |
4.2× |
| CT chest w/wo contrast (71270) |
$983.70 |
$2,186 |
5.9× |
| CT head/brain with contrast (70460) |
$787.05 |
$1,749 |
4.7× |
| CT head/brain without and with contrast (70470) |
$1,224.45 |
$2,721 |
7.4× |
| CT iac w contrast (70481) |
$1,003.05 |
$2,229 |
6.0× |
| CT l-spine w&w/o contrast (72133) |
$1,007.10 |
$2,238 |
6.1× |
| CT lower ext w/o (73700) |
$590.40 |
$1,312 |
6.0× |
| CT lower extremity w/contrast material (73701) |
$665.55 |
$1,479 |
4.0× |
| CT lumbar spine w contrast (72132) |
$828.90 |
$1,842 |
2.5× |
| CT lumbar spine w/o contrast (72131) |
$657 |
$1,460 |
6.6× |
| CT maxillofacial w contrast (70487) |
$977.85 |
$2,173 |
5.9× |
| CT maxillofacial wo contrast (70486) |
$837.45 |
$1,861 |
8.5× |
| CT neck tissue combo (70492) |
$1,242.45 |
$2,761 |
7.5× |
| Ct Orbit/Ear/Fossa W/O&W/Dye (70482) |
$1,111.05 |
$2,469 |
6.7× |
| CT orbits w/o contrast (70480) |
$698.85 |
$1,553 |
7.1× |
| CT pelvis w/o contrast (72192) |
$582.30 |
$1,294 |
5.9× |
| CT scan of leg combo (73702) |
$906.30 |
$2,014 |
5.5× |
| CT scans face/jaw combo (70488) |
$1,228.50 |
$2,730 |
7.4× |
| CT soft tissue neck w contrast (70491) |
$922.95 |
$2,051 |
5.6× |
| CT soft tissue neck w/o contrast (70490) |
$648.45 |
$1,441 |
6.6× |
| CT thoracic spine w contrast (72129) |
$945 |
$2,100 |
5.7× |
| CT thoracic spine w/o contrast (72128) |
$613.80 |
$1,364 |
6.2× |
| CT thoracic spine w/wo cont (72130) |
$1,007.10 |
$2,238 |
6.1× |
| CT thorax w/o contrast (71250) |
$678.60 |
$1,508 |
6.9× |
| CT upper ext wo (73200) |
$585.45 |
$1,301 |
5.9× |
| CT upper extremity with contrast (73201) |
$595.35 |
$1,323 |
1.8× |
| Cta Abdl Aorta&Bi Iliofem W/Contrast&Postp (75635) |
$965.25 |
$2,145 |
5.8× |
| Cta Abdomen (74175) |
$1,073.25 |
$2,385 |
6.5× |
| Dxa Bone Density Axial (77080) |
$190.80 |
$424 |
1.9× |
| Dxa bone density study 1/>sites appendiclr skel (77081) |
$79.65 |
$177 |
1.0× |
| Echo exam uterus (76831) |
$290.70 |
$646 |
1.3× |
| Esophagram (74220) |
$404.10 |
$898 |
2.4× |
| Fetal Biophysical Profile W/O Non-Stress Testing (76819) |
$380.70 |
$846 |
3.8× |
| Fluoroscopy up to 1 hr (76000) |
$200.25 |
$445 |
0.9× |
| Foot 2 views (73620) |
$135.45 |
$301 |
1.6× |
| Forearm 2 views (73090) |
$236.25 |
$525 |
2.9× |
| Gastric emptying imaging study (78264) |
$841.05 |
$1,869 |
2.2× |
| Gated Heart Planar Single (78472) |
$1,067.85 |
$2,373 |
2.8× |
| Hand 2 views (73120) |
$139.50 |
$310 |
1.4× |
| Hepatobil Syst Image W/Drug (78227) |
$995.40 |
$2,212 |
1.9× |
| Hepatobiliary System Imaging (78226) |
$995.40 |
$2,212 |
2.6× |
| Ht Musc Image Planar Mult (78454) |
$1,067.85 |
$2,373 |
0.9× |
| Ht Muscle Image Spect Sing (78451) |
$1,092.15 |
$2,427 |
0.9× |
| Hysterosalpingogram (74740) |
$384.30 |
$854 |
1.7× |
| Infant hip ultrasound with hip movement (dynamic) (76885) |
$378.45 |
$841 |
4.6× |
| Infant hip ultrasound, limited static exam (76886) |
$252 |
$560 |
3.1× |
| K Flow/Funct Image W/Drug (78708) |
$1,117.80 |
$2,484 |
2.2× |
| K Flow/Funct Image W/O Drug (78707) |
$944.55 |
$2,099 |
1.8× |
| Knee 3 Views (73562) |
$194.85 |
$433 |
2.4× |
| Liver & Spleen Imaging Static Only (78215) |
$1,105.20 |
$2,456 |
2.9× |
| Liver & Spleen Imaging W/Vascular Flow (78216) |
$1,143.45 |
$2,541 |
3.0× |
| Lung Ventilat&Perfus Imaging (78582) |
$1,321.20 |
$2,936 |
2.6× |
| Lung Ventilation Imaging (78579) |
$1,363.05 |
$3,029 |
3.6× |
| Mammary ductogram or galactogram single (77053) |
$316.80 |
$704 |
1.4× |
| Meckels Divert Exam (78290) |
$782.10 |
$1,738 |
2.1× |
| Mr safety determination physician/other qhp (76016) |
$70.20 |
$156 |
0.9× |
| Mr safety implant&/fb assmt clin staf 1st 15 min (76014) |
$19.80 |
$44 |
0.7× |
| Mr safety implt electronics prepj supvj phys/qhp (76018) |
$73.35 |
$163 |
0.8× |
| Mr safety implt pos&/immoblj (76019) |
$47.25 |
$105 |
0.8× |
| Mr safety med physics xm customization plng&mntr (76017) |
$192.60 |
$428 |
0.9× |
| Mra Head W/O & W/Contrast Material (70546) |
$2,454.75 |
$5,455 |
7.4× |
| MRA head w/o contrast (70544) |
$1,258.65 |
$2,797 |
5.6× |
| MRA head with contrast (70545) |
$1,709.10 |
$3,798 |
5.2× |
| MRA neck w contrast (70548) |
$2,259 |
$5,020 |
6.8× |
| Mra Neck W/O &W/Contrast Material (70549) |
$2,485.35 |
$5,523 |
7.5× |
| MRA neck w/o contrast (70547) |
$1,258.65 |
$2,797 |
5.6× |
| MRI abdomen w contrast (74182) |
$3,007.80 |
$6,684 |
9.1× |
| MRI abdomen w/o contrast (74181) |
$1,837.35 |
$4,083 |
8.1× |
| MRI any jt lower extrem w/contrast material (73722) |
$2,035.35 |
$4,523 |
2.7× |
| MRI any jt lower extrem w/o & w/contrast matrl (73723) |
$2,125.80 |
$4,724 |
6.4× |
| MRI any jt upper extremity w/contrast matrl (73222) |
$2,035.35 |
$4,523 |
2.7× |
| MRI cervical spine w contrast (72142) |
$2,278.80 |
$5,064 |
6.9× |
| MRI cervical spine w/o cont (72141) |
$2,078.55 |
$4,619 |
9.2× |
| MRI chest w/o contrast (71550) |
$1,296.45 |
$2,881 |
5.7× |
| MRI chest wo w contrast (71552) |
$1,675.80 |
$3,724 |
5.1× |
| MRI lower extrem oth/thn jt w/contrast matrl (73719) |
$2,035.35 |
$4,523 |
6.2× |
| MRI lower extrem oth/thn jt w/o & w/contr matr (73720) |
$2,239.20 |
$4,976 |
6.8× |
| MRI lower extrem oth/thn jt w/o contr matrl (73718) |
$1,850.40 |
$4,112 |
8.2× |
| MRI lumbar spine w contrast (72149) |
$1,754.55 |
$3,899 |
5.3× |
| Mri Neck Spine W/O & W/Dye (72156) |
$2,506.50 |
$5,570 |
7.6× |
| MRI orbit face &/neck w/o contrast (70540) |
$1,364.40 |
$3,032 |
6.0× |
| MRI orbit face neck w contrast (70542) |
$2,150.10 |
$4,778 |
6.5× |
| Mri Orbt/Fac/Nck W/O &W/Dye (70543) |
$2,821.95 |
$6,271 |
8.5× |
| MRI pelvis w contrast (72196) |
$2,299.95 |
$5,111 |
7.0× |
| MRI pelvis w/o & w contrast (72197) |
$2,529.90 |
$5,622 |
7.7× |
| MRI pelvis w/o contrast (72195) |
$1,514.25 |
$3,365 |
6.7× |
| MRI thoracic spine w/o contrast (72146) |
$1,771.65 |
$3,937 |
7.8× |
| MRI upper extremity oth than jt w/contr matrl (73219) |
$1,769.85 |
$3,933 |
5.4× |
| MRI upper extremity oth than jt w/o contr matrl (73218) |
$1,608.30 |
$3,574 |
7.1× |
| Mri Uppr Extremity W/O&W/Dye (73220) |
$1,946.25 |
$4,325 |
5.9× |
| MRI, abdomen, combo (74183) |
$3,308.40 |
$7,352 |
10.0× |
| MRI, dorsal spine combo (72157) |
$2,455.20 |
$5,456 |
7.4× |
| MRI, dorsal spine contrast (72147) |
$1,948.50 |
$4,330 |
5.9× |
| MRI, joint upper extrem (73221) |
$1,850.40 |
$4,112 |
8.2× |
| MRI, joint upper extrem combo (73223) |
$2,239.20 |
$4,976 |
6.8× |
| MRI, lumbar spine combo (72158) |
$1,826.55 |
$4,059 |
5.5× |
| Myocardial Spect Multiple Studies (78452) |
$2,324.70 |
$5,166 |
1.9× |
| Neck soft tissue (70360) |
$203.40 |
$452 |
2.5× |
| Ob us nuchal meas 1 gest (76813) |
$403.20 |
$896 |
4.1× |
| Parathyroid Planar Imaging (78070) |
$678.60 |
$1,508 |
1.8× |
| Pelvis 1 or 2 views (72170) |
$183.15 |
$407 |
1.9× |
| Pulmonary Perfusion Imaging Particulate (78580) |
$841.95 |
$1,871 |
2.2× |
| Radex Abd Compl Aqt Abd W/S/E/D Views 1 View Ch (74022) |
$322.65 |
$717 |
3.3× |
| Radex abscess/fistula/sinus tract rs&i (76080) |
$723.60 |
$1,608 |
1.4× |
| Radex Ankle Complete Minimum 3 Views (73610) |
$222.75 |
$495 |
2.7× |
| Radex Calcaneus Minimum 2 Views (73650) |
$236.25 |
$525 |
2.9× |
| Radex elbow complete minimum 3 views (73080) |
$230.40 |
$512 |
2.8× |
| Radex Facial Bones Complete Minimum 3 Views (70150) |
$272.25 |
$605 |
2.8× |
| Radex fingr minimum 2 views (73140) |
$177.30 |
$394 |
2.2× |
| Radex foot complete minimum 3 views (73630) |
$236.25 |
$525 |
2.9× |
| Radex Hand Minimum 3 Views (73130) |
$236.25 |
$525 |
2.9× |
| Radex lower extremity infant minimum 2 views (73592) |
$184.50 |
$410 |
2.2× |
| Radex Mastoids Compl Minimum 3 Views PR Side (70130) |
$318.15 |
$707 |
3.2× |
| Radex Nasal Bones Complete Minimum 3 Views (70160) |
$204.30 |
$454 |
2.5× |
| Radex Ribs Unilateral 2 Views (71100) |
$221.40 |
$492 |
2.7× |
| Radex shoulder complete minimum 2 views (73030) |
$227.70 |
$506 |
2.8× |
| Radex Sinuses Paransl < 3 Views (70210) |
$81.45 |
$181 |
1.0× |
| Radex Spine 1 View Specify Level (72020) |
$200.25 |
$445 |
2.4× |
| Radex Sternum Minimum 2 Views (71120) |
$166.95 |
$371 |
2.0× |
| Radex Toe Minimum 2 Views (73660) |
$194.85 |
$433 |
2.4× |
| Radex upper extremity infant minimum 2 views (73092) |
$187.65 |
$417 |
1.9× |
| Radex Wrist Complete Minimum 3 Views (73110) |
$229.50 |
$510 |
2.8× |
| Radiolog exam mandible compl minimum 4 views (70110) |
$276.75 |
$615 |
2.8× |
| Radiologic Exam Abdomen 3+ Views - Xr Abdomen 3+ Views (74021) |
$308.70 |
$686 |
3.1× |
| Radiologic exam colon double contrast study (74280) |
$512.55 |
$1,139 |
3.1× |
| Radiologic exam colon single contrast study (74270) |
$420.30 |
$934 |
2.5× |
| Radiologic Exam Esophagus Double Contrast Study (74221) |
$291.15 |
$647 |
1.8× |
| Radiologic exam knee complete 4/more views (73564) |
$294.75 |
$655 |
3.0× |
| Radiologic exam pelvis compl minimum 3 views (72190) |
$202.05 |
$449 |
2.0× |
| Radiologic Exam Small Int Single Contrast Study (74250) |
$409.95 |
$911 |
2.5× |
| Radiologic exam upr gi trc double contrast study (74246) |
$750.15 |
$1,667 |
4.5× |
| Radiologic examination femur minimum 2 views (73552) |
$214.20 |
$476 |
2.6× |
| Radiologic examination knee 1/2 views (73560) |
$183.15 |
$407 |
2.2× |
| Radiologic Examination Osseous Survey Limited (77074) |
$357.30 |
$794 |
3.6× |
| Radiologic examination tibia & fibula 2 views (73590) |
$207 |
$460 |
2.5× |
| Ribs bilateral 3 views (71110) |
$283.95 |
$631 |
2.9× |
| Rp Loclzj Tum Spect 1 Area Single Day Imaging (78803) |
$1,188.90 |
$2,642 |
2.3× |
| Rp loclzj tum spect w/CT 1 area/acquisj 1day img (78830) |
$1,308.15 |
$2,907 |
1.1× |
| Scapula (73010) |
$157.50 |
$350 |
1.6× |
| Screening Digital Breast Tomosynthesis Bi (77063) |
$48.15 |
$107 |
2.1× |
| Shoulder 1 view (73020) |
$122.85 |
$273 |
1.5× |
| Sialogram (70390) |
$325.35 |
$723 |
1.4× |
| Skull less than 4 views (70250) |
$189 |
$420 |
1.9× |
| Sternoclavicular joints (71130) |
$193.50 |
$430 |
2.4× |
| Thoracic spine 2 views (72070) |
$171.90 |
$382 |
1.7× |
| Thoracic spine 3 views (72072) |
$276.30 |
$614 |
2.8× |
| Thoracolumbar 2 views (72080) |
$171.45 |
$381 |
2.1× |
| Thyroid Imaging With Vascular Flow (78013) |
$958.50 |
$2,130 |
2.5× |
| Thyroid Uptake Measurement (78012) |
$174.60 |
$388 |
0.5× |
| Thyroid Uptake W/Blood Flow Sngle/Mult Quan Meas (78014) |
$1,246.05 |
$2,769 |
3.3× |
| Ultrasound Breast Limited (76642) |
$337.50 |
$750 |
4.1× |
| Ultrasound Elastography Parenchyma (76981) |
$434.25 |
$965 |
4.4× |
| Ultrasound Exam Aaa Screen (76706) |
$180 |
$400 |
1.8× |
| Ultrasound, abdomen limited (76705) |
$364.05 |
$809 |
3.7× |
| Umbilical-artery Doppler (OB) (76820) |
$235.80 |
$524 |
2.4× |
| Upper gi w/o kub (74240) |
$240.75 |
$535 |
1.5× |
| Urethrocystography retrograde (74450) |
$416.70 |
$926 |
1.8× |
| Us breast unilateral complete (76641) |
$337.50 |
$750 |
3.4× |
| Us chest (76604) |
$285.30 |
$634 |
2.9× |
| Us exam, pelvic, limited (76857) |
$275.40 |
$612 |
2.8× |
| Us lmtd joint/oth nonvasc xtr strux r-t w/img (76882) |
$167.40 |
$372 |
1.7× |
| Us ob detailed single fetus (76811) |
$467.10 |
$1,038 |
2.1× |
| Us ob limited 1 or more fetuses (76815) |
$193.05 |
$429 |
2.0× |
| Us ob transvaginal (76817) |
$252.45 |
$561 |
2.6× |
| Us pelvic non ob complete (76856) |
$450 |
$1,000 |
4.5× |
| Us pg uter img f&mat 14 wk tabdl 1/1st gestation (76801) |
$306.90 |
$682 |
3.1× |
| Us preg uterus real time f/u trnsabdl per fetus (76816) |
$252.45 |
$561 |
2.6× |
| Us retroperitoneal complete (76770) |
$406.35 |
$903 |
4.1× |
| Us retroperitoneal limited (76775) |
$364.50 |
$810 |
3.7× |
| Us scrotum and contents (76870) |
$450 |
$1,000 |
4.5× |
| Us spinal canal and contents (76800) |
$396.90 |
$882 |
4.0× |
| Us thyroid (76536) |
$471.15 |
$1,047 |
4.8× |
| Vascular Flow Imaging (78445) |
$680.40 |
$1,512 |
1.8× |
| Wrist 2 views (73100) |
$139.50 |
$310 |
1.7× |
| X-Ray Ac Jts - Xr Acromioclavicular Joints Bilateral (73050) |
$333 |
$740 |
4.0× |
| X-Ray Bend Only L-S Spine (72120) |
$139.50 |
$310 |
1.4× |
| X-Ray Elbow 2 Vw - Xr Elbow 1-2 Views Right (73070) |
$139.95 |
$311 |
1.7× |
| X-Ray Exam Breast Specimen (76098) |
$284.40 |
$632 |
0.6× |
| X-Ray Exam Entire Spi 2/3 Vw (72082) |
$207.45 |
$461 |
2.1× |
| X-Ray Exam Hip Uni 1 View (73501) |
$117.90 |
$262 |
1.4× |
| X-Ray Exam Hip Uni 2-3 Views (73502) |
$211.95 |
$471 |
2.6× |
| X-Ray Exam Hip Uni 4/> Views (73503) |
$283.95 |
$631 |
2.9× |
| X-Ray Exam Hips Bi 3-4 Views (73522) |
$426.15 |
$947 |
4.3× |
| X-Ray Exam Hips Bi 5/> Views (73523) |
$546.30 |
$1,214 |
5.5× |
| X-Ray Exam Neck Spine 2-3 Vw (72040) |
$274.50 |
$610 |
3.3× |
| X-Ray Exam Neck Spine 6/>Vws (72052) |
$426.15 |
$947 |
4.3× |
| X-Ray Exam Unilat Ribs/Chest (71101) |
$276.30 |
$614 |
2.8× |
| X-ray eye for foreign body (70030) |
$206.55 |
$459 |
2.5× |
| X-ray humerus (73060) |
$202.05 |
$449 |
2.5× |
| X-ray IV pyelogram (ivp) (74400) |
$597.15 |
$1,327 |
3.6× |
| X-ray IV pyelogram+tomography (74415) |
$612.45 |
$1,361 |
3.7× |
| X-Ray Lumbar Spine 2/3 Vw - Xr Lumbar Spine 2-3 Views (72100) |
$284.40 |
$632 |
2.9× |
| X-Ray Ribs, Chest 4+ Vw - Xr Ribs 3 Vws Bil W/ Chest Posteroanterior (71111) |
$302.40 |
$672 |
3.1× |
| X-Ray Sacroiliac Jts 3+ Vw - Xr Sacroiliac Joints 3+ Views (72202) |
$234.90 |
$522 |
2.4× |
| X-Ray Sacroiliac Jts <3 Vw - Xr Sacroiliac Joints 1-2 Views (72200) |
$156.60 |
$348 |
1.6× |
| X-Ray Sacrum/Coccyx 2+ Vw - Xr Sacrum Coccyx 2+ Views (72220) |
$229.95 |
$511 |
2.8× |
| X-Ray Sinuses 3+ Vw - Xr Paranasal Sinuses 3+ Views (70220) |
$285.30 |
$634 |
3.5× |
| X-Ray Skull 4+ Vw - Xr Skull Complete 4+ Views (70260) |
$281.25 |
$625 |
2.8× |
| X-ray thoracic spine 4 vw (72074) |
$302.85 |
$673 |
3.1× |
| X-Ray Tmj Unilat (70328) |
$214.20 |
$476 |
2.6× |
| X-Ray Urinary Tract Exam With Contrast Material (74420) |
$531.90 |
$1,182 |
1.6× |
| X-Rays Bone Survey Complete (77075) |
$535.05 |
$1,189 |
5.4× |
| Xr c-spine 4 or 5 views (72050) |
$353.25 |
$785 |
3.6× |
| Xr facial bones less than 3 views (70140) |
$165.15 |
$367 |
2.0× |
| Xr orbits complete 4 views (70200) |
$295.65 |
$657 |
3.0× |