| Abdomen 1 View (74018) |
$212.40 |
$354 |
2.6× |
| Abdomen 2 views (74019) |
$270 |
$450 |
2.7× |
| Acute Gastrointestinal Blood Loss Imaging (78278) |
$930.60 |
$1,551 |
2.4× |
| Ankle 2 views (73600) |
$211.80 |
$353 |
2.5× |
| Bone age studies (77072) |
$225.60 |
$376 |
2.3× |
| Bone Imaging 3 Phase (78315) |
$1,207.20 |
$2,012 |
3.2× |
| Bone Imaging Limited Area (78300) |
$693.60 |
$1,156 |
1.8× |
| Bone Imaging Whole Body (78306) |
$1,284 |
$2,140 |
3.4× |
| Bone survey infant (77076) |
$442.20 |
$737 |
4.4× |
| Cat Scan Follow-Up Study (76380) |
$208.80 |
$348 |
2.5× |
| Chest 1 view (71045) |
$150.60 |
$251 |
1.8× |
| Chest 2 views (71046) |
$227.40 |
$379 |
2.7× |
| Chest 3 views (71047) |
$233.40 |
$389 |
2.8× |
| Clavicle complete (73000) |
$221.40 |
$369 |
2.7× |
| Computed Tomography Thorax Lw Dose Lng Ca Scr C- (71271) |
$111.60 |
$186 |
1.1× |
| CT abdomen and pelvis without and with contrast (74178) |
$3,995.40 |
$6,659 |
12.0× |
| CT abdomen and pelvis without contrast (74176) |
$2,492.40 |
$4,154 |
10.9× |
| CT abdomen w contrast (74160) |
$2,304 |
$3,840 |
13.7× |
| CT abdomen w wo contrast (74170) |
$2,511.60 |
$4,186 |
15.0× |
| CT abdomen w/o contrast (74150) |
$1,636.20 |
$2,727 |
16.4× |
| CT Angio Abdomen and Pelvis (74174) |
$2,872.20 |
$4,787 |
8.6× |
| CT Angio Chest (71275) |
$2,569.80 |
$4,283 |
15.3× |
| CT Angio Head (70496) |
$2,329.20 |
$3,882 |
13.9× |
| CT angio hrt w/3d image (75574) |
$1,902 |
$3,170 |
5.7× |
| Ct Angio Lwr Extr W/O&W/Dye (73706) |
$1,944.60 |
$3,241 |
11.6× |
| CT Angio Neck (70498) |
$2,367.60 |
$3,946 |
14.1× |
| Ct Angio Upr Extrm W/O&W/Dye (73206) |
$1,416 |
$2,360 |
8.4× |
| CT cervical spine w/ contrast (72126) |
$1,803.60 |
$3,006 |
5.4× |
| CT cervical spine w/o contrast (72125) |
$1,582.20 |
$2,637 |
15.8× |
| CT cervical spine w/wo cont (72127) |
$1,977.60 |
$3,296 |
11.8× |
| CT chest w contrast (71260) |
$1,716 |
$2,860 |
10.2× |
| CT chest w/wo contrast (71270) |
$2,145 |
$3,575 |
12.8× |
| CT head/brain with contrast (70460) |
$1,755.60 |
$2,926 |
10.5× |
| CT head/brain without and with contrast (70470) |
$2,313 |
$3,855 |
13.8× |
| CT heart contrast eval cardiac structure&morph (75572) |
$522.60 |
$871 |
1.6× |
| CT hrt w/3d image congen (75573) |
$522.60 |
$871 |
1.6× |
| CT iac w contrast (70481) |
$1,397.40 |
$2,329 |
8.3× |
| CT l-spine w&w/o contrast (72133) |
$1,777.80 |
$2,963 |
10.6× |
| CT lower ext w/o (73700) |
$1,843.80 |
$3,073 |
18.5× |
| CT lower extremity w/contrast material (73701) |
$1,530.60 |
$2,551 |
9.1× |
| CT lumbar spine w contrast (72132) |
$1,564.80 |
$2,608 |
4.7× |
| CT lumbar spine w/o contrast (72131) |
$1,422 |
$2,370 |
14.2× |
| CT maxillofacial w contrast (70487) |
$1,876.20 |
$3,127 |
11.2× |
| CT maxillofacial wo contrast (70486) |
$1,339.80 |
$2,233 |
13.4× |
| Ct Orbit/Ear/Fossa W/O&W/Dye (70482) |
$2,389.20 |
$3,982 |
14.3× |
| CT orbits w/o contrast (70480) |
$1,020 |
$1,700 |
10.2× |
| CT pelvis w/o contrast (72192) |
$1,155.60 |
$1,926 |
11.6× |
| CT scan of leg combo (73702) |
$1,954.80 |
$3,258 |
11.7× |
| CT scans face/jaw combo (70488) |
$1,983 |
$3,305 |
11.8× |
| CT soft tissue neck w contrast (70491) |
$2,038.20 |
$3,397 |
12.2× |
| CT soft tissue neck w/o contrast (70490) |
$1,080 |
$1,800 |
10.8× |
| CT thoracic spine w contrast (72129) |
$1,687.20 |
$2,812 |
10.1× |
| CT thoracic spine w/o contrast (72128) |
$1,739.40 |
$2,899 |
17.4× |
| CT thoracic spine w/wo cont (72130) |
$1,913.40 |
$3,189 |
11.4× |
| CT thorax w/o contrast (71250) |
$961.20 |
$1,602 |
9.6× |
| CT upper ext wo (73200) |
$1,435.80 |
$2,393 |
14.4× |
| CT upper extremity w/o & w/contrast material (73202) |
$2,168.40 |
$3,614 |
12.9× |
| CT upper extremity with contrast (73201) |
$1,651.20 |
$2,752 |
5.0× |
| Cta Abdl Aorta&Bi Iliofem W/Contrast&Postp (75635) |
$1,516.80 |
$2,528 |
9.0× |
| Cta Abdomen (74175) |
$2,068.20 |
$3,447 |
12.3× |
| CTA pelvis (72191) |
$1,416 |
$2,360 |
8.4× |
| Dxa Bone Density Axial (77080) |
$359.40 |
$599 |
3.6× |
| Dxa bone density study 1/>sites appendiclr skel (77081) |
$79.20 |
$132 |
1.0× |
| Fluoroscopy up to 1 hr (76000) |
$414 |
$690 |
1.8× |
| Foot 2 views (73620) |
$207 |
$345 |
2.5× |
| Forearm 2 views (73090) |
$237.60 |
$396 |
2.9× |
| Gastric emptying imaging study (78264) |
$1,188 |
$1,980 |
3.1× |
| Gated Heart Planar Single (78472) |
$1,045.80 |
$1,743 |
2.7× |
| Gated Heart, Multiple (78473) |
$1,394.40 |
$2,324 |
3.6× |
| Hand 2 views (73120) |
$222.60 |
$371 |
2.2× |
| Hepatobil Syst Image W/Drug (78227) |
$1,323.60 |
$2,206 |
2.6× |
| Hepatobiliary System Imaging (78226) |
$1,243.80 |
$2,073 |
3.3× |
| Ht Muscle Image Spect Sing (78451) |
$2,863.20 |
$4,772 |
2.3× |
| K Flow/Funct Image W/Drug (78708) |
$1,089 |
$1,815 |
2.1× |
| K Flow/Funct Image W/O Drug (78707) |
$792 |
$1,320 |
1.5× |
| Knee 3 Views (73562) |
$259.20 |
$432 |
3.1× |
| Lung Ventilat&Perfus Imaging (78582) |
$800.40 |
$1,334 |
1.5× |
| Lymph System Imaging (78195) |
$1,364.40 |
$2,274 |
2.6× |
| Meckels Divert Exam (78290) |
$562.80 |
$938 |
1.5× |
| Myocardial Spect Multiple Studies (78452) |
$3,112.20 |
$5,187 |
2.5× |
| Neck soft tissue (70360) |
$258.60 |
$431 |
3.1× |
| Nuclear Rx Oral Admin (79005) |
$652.80 |
$1,088 |
2.9× |
| Parathyroid Planar Imaging (78070) |
$588 |
$980 |
1.5× |
| Pelvis 1 or 2 views (72170) |
$223.80 |
$373 |
2.2× |
| Pulmonary Perfusion Imaging Particulate (78580) |
$576 |
$960 |
1.5× |
| Radex Abd Compl Aqt Abd W/S/E/D Views 1 View Ch (74022) |
$348.60 |
$581 |
3.5× |
| Radex Ankle Complete Minimum 3 Views (73610) |
$271.80 |
$453 |
3.3× |
| Radex Calcaneus Minimum 2 Views (73650) |
$238.80 |
$398 |
2.9× |
| Radex elbow complete minimum 3 views (73080) |
$238.80 |
$398 |
2.9× |
| Radex Facial Bones Complete Minimum 3 Views (70150) |
$225.60 |
$376 |
2.3× |
| Radex fingr minimum 2 views (73140) |
$216.60 |
$361 |
2.6× |
| Radex foot complete minimum 3 views (73630) |
$238.20 |
$397 |
2.9× |
| Radex Hand Minimum 3 Views (73130) |
$236.40 |
$394 |
2.8× |
| Radex lower extremity infant minimum 2 views (73592) |
$225.60 |
$376 |
2.7× |
| Radex Mastoids Compl Minimum 3 Views PR Side (70130) |
$277.20 |
$462 |
2.8× |
| Radex Nasal Bones Complete Minimum 3 Views (70160) |
$145.80 |
$243 |
1.8× |
| Radex Ribs Unilateral 2 Views (71100) |
$207.60 |
$346 |
2.5× |
| Radex shoulder complete minimum 2 views (73030) |
$279.60 |
$466 |
3.4× |
| Radex Sinuses Paransl < 3 Views (70210) |
$138.60 |
$231 |
1.7× |
| Radex Spine 1 View Specify Level (72020) |
$228.60 |
$381 |
2.7× |
| Radex Sternum Minimum 2 Views (71120) |
$145.80 |
$243 |
1.8× |
| Radex Toe Minimum 2 Views (73660) |
$174 |
$290 |
2.1× |
| Radex upper extremity infant minimum 2 views (73092) |
$225.60 |
$376 |
2.3× |
| Radex Wrist Complete Minimum 3 Views (73110) |
$246.60 |
$411 |
3.0× |
| Radiolog exam mandible compl minimum 4 views (70110) |
$232.80 |
$388 |
2.3× |
| Radiologic exam knee complete 4/more views (73564) |
$316.80 |
$528 |
3.2× |
| Radiologic exam pelvis compl minimum 3 views (72190) |
$259.20 |
$432 |
2.6× |
| Radiologic Exam Small Int Single Contrast Study (74250) |
$425.40 |
$709 |
2.5× |
| Radiologic examination femur minimum 2 views (73552) |
$207 |
$345 |
2.5× |
| Radiologic examination knee 1/2 views (73560) |
$205.80 |
$343 |
2.5× |
| Radiologic Examination Osseous Survey Limited (77074) |
$202.20 |
$337 |
2.0× |
| Radiologic examination tibia & fibula 2 views (73590) |
$273 |
$455 |
3.3× |
| Ribs bilateral 3 views (71110) |
$232.20 |
$387 |
2.3× |
| Rp loclzj tum plnr 1 area single day imaging (78800) |
$532.20 |
$887 |
1.4× |
| Rp Loclzj Tum Spect 1 Area Single Day Imaging (78803) |
$2,173.80 |
$3,623 |
4.2× |
| Scapula (73010) |
$238.20 |
$397 |
2.4× |
| Screening Digital Breast Tomosynthesis Bi (77063) |
$45.60 |
$76 |
2.0× |
| Shoulder 1 view (73020) |
$145.20 |
$242 |
1.7× |
| Skull less than 4 views (70250) |
$160.20 |
$267 |
1.6× |
| Sternoclavicular joints (71130) |
$209.40 |
$349 |
2.5× |
| Thoracic spine 2 views (72070) |
$274.80 |
$458 |
2.7× |
| Thoracic spine 3 views (72072) |
$337.80 |
$563 |
3.4× |
| Thoracolumbar 2 views (72080) |
$145.80 |
$243 |
1.8× |
| Thyroid Imaging With Vascular Flow (78013) |
$520.20 |
$867 |
1.4× |
| Thyroid Met Imaging Body (78018) |
$1,315.80 |
$2,193 |
2.5× |
| Thyroid Uptake W/Blood Flow Sngle/Mult Quan Meas (78014) |
$1,040.40 |
$1,734 |
2.7× |
| Ultrasound Breast Limited (76642) |
$247.80 |
$413 |
3.0× |
| Ultrasound Exam Aaa Screen (76706) |
$215.40 |
$359 |
2.2× |
| Ultrasound, abdomen limited (76705) |
$279.60 |
$466 |
2.8× |
| Unlisted us procedure (76999) |
$353.40 |
$589 |
4.2× |
| Upper gi w/o kub (74240) |
$409.80 |
$683 |
2.4× |
| Urethrocystography retrograde (74450) |
$624.60 |
$1,041 |
2.7× |
| Us breast unilateral complete (76641) |
$247.80 |
$413 |
2.5× |
| Us chest (76604) |
$426 |
$710 |
4.3× |
| Us complete joint (76881) |
$367.20 |
$612 |
3.7× |
| Us exam, pelvic, limited (76857) |
$232.80 |
$388 |
2.3× |
| Us head (76506) |
$155.40 |
$259 |
1.6× |
| Us lmtd joint/oth nonvasc xtr strux r-t w/img (76882) |
$277.80 |
$463 |
2.8× |
| Us ob limited 1 or more fetuses (76815) |
$366.60 |
$611 |
3.7× |
| Us ob transvaginal (76817) |
$366.60 |
$611 |
3.7× |
| Us pelvic non ob complete (76856) |
$506.40 |
$844 |
5.1× |
| Us pg uter img f&mat 14 wk tabdl 1/1st gestation (76801) |
$366.60 |
$611 |
3.7× |
| Us retroperitoneal complete (76770) |
$745.20 |
$1,242 |
7.5× |
| Us retroperitoneal limited (76775) |
$462 |
$770 |
4.6× |
| Us scrotum and contents (76870) |
$526.20 |
$877 |
5.3× |
| Us thyroid (76536) |
$553.80 |
$923 |
5.5× |
| Wrist 2 views (73100) |
$133.20 |
$222 |
1.6× |
| X-Ray Ac Jts - Xr Acromioclavicular Joints Bilateral (73050) |
$336.60 |
$561 |
4.0× |
| X-Ray Bend Only L-S Spine (72120) |
$172.20 |
$287 |
1.7× |
| X-Ray Elbow 2 Vw - Xr Elbow 1-2 Views Right (73070) |
$205.20 |
$342 |
2.5× |
| X-Ray Exam Breast Specimen (76098) |
$331.20 |
$552 |
0.6× |
| X-Ray Exam Entire Spi 1 Vw (72081) |
$139.20 |
$232 |
1.7× |
| X-Ray Exam Entire Spi 2/3 Vw (72082) |
$229.80 |
$383 |
2.3× |
| X-Ray Exam Hip Uni 1 View (73501) |
$139.80 |
$233 |
1.7× |
| X-Ray Exam Hip Uni 2-3 Views (73502) |
$139.80 |
$233 |
1.7× |
| X-Ray Exam Hips Bi 2 Views (73521) |
$229.80 |
$383 |
2.3× |
| X-Ray Exam Hips Bi 3-4 Views (73522) |
$229.80 |
$383 |
2.3× |
| X-Ray Exam L-S Spine Bending (72114) |
$521.40 |
$869 |
5.2× |
| X-Ray Exam Neck Spine 2-3 Vw (72040) |
$309.60 |
$516 |
3.7× |
| X-Ray Exam Neck Spine 6/>Vws (72052) |
$408.60 |
$681 |
4.1× |
| X-Ray Exam Unilat Ribs/Chest (71101) |
$305.40 |
$509 |
3.1× |
| X-ray eye for foreign body (70030) |
$120.60 |
$201 |
1.4× |
| X-ray humerus (73060) |
$298.20 |
$497 |
3.6× |
| X-Ray Jaw <4 Vw - Xr Mandible < 4 Views (70100) |
$138.60 |
$231 |
1.7× |
| X-Ray Knee Bilat Standing - Xr Knees Anteroposterior Standing Bilat (73565) |
$138 |
$230 |
1.7× |
| X-Ray Lumbar Spine 2/3 Vw - Xr Lumbar Spine 2-3 Views (72100) |
$391.80 |
$653 |
3.9× |
| X-ray nose-rectum child f.b. (76010) |
$120.60 |
$201 |
1.4× |
| X-Ray Ribs, Chest 4+ Vw - Xr Ribs 3 Vws Bil W/ Chest Posteroanterior (71111) |
$318 |
$530 |
3.2× |
| X-Ray Sacroiliac Jts 3+ Vw - Xr Sacroiliac Joints 3+ Views (72202) |
$346.80 |
$578 |
3.5× |
| X-Ray Sacroiliac Jts <3 Vw - Xr Sacroiliac Joints 1-2 Views (72200) |
$230.40 |
$384 |
2.3× |
| X-Ray Sacrum/Coccyx 2+ Vw - Xr Sacrum Coccyx 2+ Views (72220) |
$247.80 |
$413 |
3.0× |
| X-Ray Sinuses 3+ Vw - Xr Paranasal Sinuses 3+ Views (70220) |
$354.60 |
$591 |
4.3× |
| X-Ray Skull 4+ Vw - Xr Skull Complete 4+ Views (70260) |
$232.80 |
$388 |
2.3× |
| X-Ray Stress View (77071) |
$161.40 |
$269 |
1.9× |
| X-ray thoracic spine 4 vw (72074) |
$258 |
$430 |
2.6× |
| X-Ray Tmj Unilat (70328) |
$161.40 |
$269 |
1.9× |
| X-Rays Bone Survey Complete (77075) |
$376.80 |
$628 |
3.8× |
| Xr c-spine 4 or 5 views (72050) |
$429.60 |
$716 |
4.3× |
| Xr facial bones less than 3 views (70140) |
$126.60 |
$211 |
1.5× |
| Xr orbits complete 4 views (70200) |
$225.60 |
$376 |
2.3× |