| Abdomen 1 View (74018) |
$128.70 |
$143 |
1.5× |
| Abdomen 2 views (74019) |
$136.80 |
$152 |
1.4× |
| Ankle 2 views (73600) |
$116.10 |
$129 |
1.4× |
| Arthrogram hip (73525) |
$502.20 |
$558 |
1.5× |
| Bone age studies (77072) |
$132.30 |
$147 |
1.3× |
| Bone Imaging 3 Phase (78315) |
$1,147.50 |
$1,275 |
3.0× |
| Bone Imaging Whole Body (78306) |
$1,035.90 |
$1,151 |
2.7× |
| Chest 1 view (71045) |
$103.50 |
$115 |
1.2× |
| Chest 2 views (71046) |
$145.80 |
$162 |
1.7× |
| Chest 3 views (71047) |
$158.40 |
$176 |
1.9× |
| Chest 4 or more views (71048) |
$162.90 |
$181 |
1.6× |
| Clavicle complete (73000) |
$113.40 |
$126 |
1.4× |
| Computed Tomography Thorax Lw Dose Lng Ca Scr C- (71271) |
$563.40 |
$626 |
5.6× |
| Contrast X-Ray Bladder (74430) |
$210.60 |
$234 |
0.6× |
| Contrast X-Ray Of Knee Joint (73580) |
$380.70 |
$423 |
1.1× |
| CT abdomen and pelvis without and with contrast (74178) |
$4,191.30 |
$4,657 |
12.5× |
| CT abdomen and pelvis without contrast (74176) |
$3,166.20 |
$3,518 |
13.8× |
| CT abdomen w contrast (74160) |
$1,186.20 |
$1,318 |
7.0× |
| CT abdomen w wo contrast (74170) |
$1,410.30 |
$1,567 |
8.4× |
| CT abdomen w/o contrast (74150) |
$1,048.50 |
$1,165 |
10.4× |
| CT Angio Abdomen and Pelvis (74174) |
$2,769.30 |
$3,077 |
8.3× |
| CT Angio Chest (71275) |
$1,908.90 |
$2,121 |
11.3× |
| CT Angio Head (70496) |
$1,718.10 |
$1,909 |
10.2× |
| Ct Angio Lwr Extr W/O&W/Dye (73706) |
$1,478.70 |
$1,643 |
8.8× |
| CT Angio Neck (70498) |
$1,874.70 |
$2,083 |
11.1× |
| Ct Angio Upr Extrm W/O&W/Dye (73206) |
$1,785.60 |
$1,984 |
10.6× |
| CT cervical spine w/ contrast (72126) |
$703.80 |
$782 |
2.1× |
| CT cervical spine w/o contrast (72125) |
$1,027.80 |
$1,142 |
10.2× |
| CT cervical spine w/wo cont (72127) |
$1,702.80 |
$1,892 |
10.1× |
| CT chest w contrast (71260) |
$1,282.50 |
$1,425 |
7.6× |
| CT chest w/wo contrast (71270) |
$1,540.80 |
$1,712 |
9.1× |
| CT head/brain with contrast (70460) |
$1,052.10 |
$1,169 |
6.2× |
| CT head/brain without and with contrast (70470) |
$1,260 |
$1,400 |
7.5× |
| CT iac w contrast (70481) |
$1,234.80 |
$1,372 |
7.3× |
| CT l-spine w&w/o contrast (72133) |
$1,745.10 |
$1,939 |
10.3× |
| CT lower ext w/o (73700) |
$732.60 |
$814 |
7.3× |
| CT lower extremity w/contrast material (73701) |
$1,017.90 |
$1,131 |
6.0× |
| CT lumbar spine w/o contrast (72131) |
$1,107 |
$1,230 |
11.0× |
| CT maxillofacial w contrast (70487) |
$1,285.20 |
$1,428 |
7.6× |
| CT maxillofacial wo contrast (70486) |
$985.50 |
$1,095 |
9.8× |
| CT neck tissue combo (70492) |
$1,482.30 |
$1,647 |
8.8× |
| Ct Orbit/Ear/Fossa W/O&W/Dye (70482) |
$1,411.20 |
$1,568 |
8.4× |
| CT orbits w/o contrast (70480) |
$991.80 |
$1,102 |
9.9× |
| CT pelvis w&w/o contrast (72194) |
$2,376 |
$2,640 |
14.1× |
| CT pelvis w/o contrast (72192) |
$929.70 |
$1,033 |
9.3× |
| CT scan of leg combo (73702) |
$1,872.90 |
$2,081 |
11.1× |
| CT scans face/jaw combo (70488) |
$1,440 |
$1,600 |
8.5× |
| CT soft tissue neck w contrast (70491) |
$1,234.80 |
$1,372 |
7.3× |
| CT soft tissue neck w/o contrast (70490) |
$1,076.40 |
$1,196 |
10.7× |
| CT thoracic spine w/o contrast (72128) |
$1,026 |
$1,140 |
10.2× |
| CT thorax w/o contrast (71250) |
$1,115.10 |
$1,239 |
11.1× |
| CT upper ext wo (73200) |
$828.90 |
$921 |
8.2× |
| CT upper extremity w/o & w/contrast material (73202) |
$1,872.90 |
$2,081 |
11.1× |
| CT upper extremity with contrast (73201) |
$1,547.10 |
$1,719 |
4.6× |
| Cta Abdl Aorta&Bi Iliofem W/Contrast&Postp (75635) |
$3,204 |
$3,560 |
19.0× |
| Cta Abdomen (74175) |
$1,845 |
$2,050 |
10.9× |
| CTA head&neck c+ w/noncontrast img&post-pxessing (70471) |
$2,149.20 |
$2,388 |
6.4× |
| CTA pelvis (72191) |
$885.60 |
$984 |
5.3× |
| Dxa Bone Density Axial (77080) |
$396 |
$440 |
3.9× |
| Dxa bone density study (77085) |
$191.70 |
$213 |
1.9× |
| Esophagram (74220) |
$254.70 |
$283 |
1.5× |
| Fetal Biophysical Profile W/O Non-Stress Testing (76819) |
$391.50 |
$435 |
3.9× |
| Fluoroscopy up to 1 hr (76000) |
$207.90 |
$231 |
0.9× |
| Foot 2 views (73620) |
$99.90 |
$111 |
1.2× |
| Forearm 2 views (73090) |
$110.70 |
$123 |
1.3× |
| Gastric emptying imaging study (78264) |
$998.10 |
$1,109 |
2.6× |
| Gated Heart Planar Single (78472) |
$1,107 |
$1,230 |
2.9× |
| Gated Heart, Multiple (78473) |
$1,259.10 |
$1,399 |
3.3× |
| Hand 2 views (73120) |
$99.90 |
$111 |
1.0× |
| Hepatobil Syst Image W/Drug (78227) |
$1,090.80 |
$1,212 |
2.1× |
| Hepatobiliary System Imaging (78226) |
$753.30 |
$837 |
2.0× |
| Hysterosalpingogram (74740) |
$254.70 |
$283 |
1.1× |
| K Flow/Funct Image W/Drug (78708) |
$1,038.60 |
$1,154 |
2.0× |
| K Flow/Funct Image W/O Drug (78707) |
$975.60 |
$1,084 |
1.9× |
| Kidney Imaging Morphoogy W/Vascular Flow (78701) |
$616.50 |
$685 |
1.6× |
| Knee 3 Views (73562) |
$135 |
$150 |
1.6× |
| Lung Perf&Ventilat Diferentl (78598) |
$1,300.50 |
$1,445 |
2.5× |
| Lung Ventilat&Perfus Imaging (78582) |
$1,204.20 |
$1,338 |
2.3× |
| Lymph System Imaging (78195) |
$1,432.80 |
$1,592 |
2.7× |
| Mra Head W/O & W/Contrast Material (70546) |
$1,900.80 |
$2,112 |
5.7× |
| MRA head w/o contrast (70544) |
$1,715.40 |
$1,906 |
7.5× |
| MRA head with contrast (70545) |
$2,017.80 |
$2,242 |
6.0× |
| Mra Neck W/O &W/Contrast Material (70549) |
$3,732.30 |
$4,147 |
11.1× |
| MRA neck w/o contrast (70547) |
$1,715.40 |
$1,906 |
7.5× |
| MRI abdomen w/o contrast (74181) |
$1,917 |
$2,130 |
8.4× |
| MRI any jt lower extrem w/contrast material (73722) |
$1,905.30 |
$2,117 |
2.5× |
| MRI any jt lower extrem w/o & w/contrast matrl (73723) |
$3,471.30 |
$3,857 |
10.4× |
| MRI any jt upper extremity w/contrast matrl (73222) |
$2,439.90 |
$2,711 |
3.2× |
| MRI Breast W/O Contrast Bilateral (77047) |
$1,278.90 |
$1,421 |
5.6× |
| MRI cervical spine w contrast (72142) |
$1,870.20 |
$2,078 |
5.6× |
| MRI cervical spine w/o cont (72141) |
$1,624.50 |
$1,805 |
7.1× |
| MRI chest w/o contrast (71550) |
$2,383.20 |
$2,648 |
10.4× |
| MRI chest wo w contrast (71552) |
$3,321.90 |
$3,691 |
9.9× |
| MRI lower extrem oth/thn jt w/o & w/contr matr (73720) |
$3,657.60 |
$4,064 |
10.9× |
| MRI lower extrem oth/thn jt w/o contr matrl (73718) |
$1,529.10 |
$1,699 |
6.7× |
| MRI lumbar spine w contrast (72149) |
$1,899.90 |
$2,111 |
5.7× |
| Mri Neck Spine W/O & W/Dye (72156) |
$2,828.70 |
$3,143 |
8.4× |
| MRI orbit face &/neck w/o contrast (70540) |
$2,437.20 |
$2,708 |
10.6× |
| Mri Orbt/Fac/Nck W/O &W/Dye (70543) |
$2,804.40 |
$3,116 |
8.4× |
| MRI pelvis w/o & w contrast (72197) |
$3,839.40 |
$4,266 |
11.4× |
| MRI pelvis w/o contrast (72195) |
$1,564.20 |
$1,738 |
6.8× |
| MRI thoracic spine w/o contrast (72146) |
$1,772.10 |
$1,969 |
7.7× |
| MRI upper extremity oth than jt w/o contr matrl (73218) |
$1,341 |
$1,490 |
5.8× |
| Mri Uppr Extremity W/O&W/Dye (73220) |
$3,589.20 |
$3,988 |
10.7× |
| MRI, abdomen, combo (74183) |
$3,941.10 |
$4,379 |
11.8× |
| MRI, dorsal spine combo (72157) |
$3,948.30 |
$4,387 |
11.8× |
| MRI, dorsal spine contrast (72147) |
$1,144.80 |
$1,272 |
3.4× |
| MRI, joint upper extrem (73221) |
$1,540.80 |
$1,712 |
6.7× |
| MRI, joint upper extrem combo (73223) |
$3,142.80 |
$3,492 |
9.4× |
| MRI, lumbar spine combo (72158) |
$4,089.60 |
$4,544 |
12.2× |
| Myocardial Spect Multiple Studies (78452) |
$3,753 |
$4,170 |
3.0× |
| Neck soft tissue (70360) |
$113.40 |
$126 |
1.4× |
| Optic foramina (70190) |
$140.40 |
$156 |
1.7× |
| Parathyroid Planar Imaging (78070) |
$582.30 |
$647 |
1.5× |
| Parathyroid planar imaging w/wo subtraction (78071) |
$1,067.40 |
$1,186 |
2.8× |
| Pelvis 1 or 2 views (72170) |
$113.40 |
$126 |
1.1× |
| PET image w/CT, full body (78816) |
$4,923 |
$5,470 |
3.6× |
| PET imaging CT attenuation skull base mid-thigh (78815) |
$4,923 |
$5,470 |
3.6× |
| Radex Abd Compl Aqt Abd W/S/E/D Views 1 View Ch (74022) |
$232.20 |
$258 |
2.3× |
| Radex abscess/fistula/sinus tract rs&i (76080) |
$107.10 |
$119 |
0.2× |
| Radex Ankle Complete Minimum 3 Views (73610) |
$127.80 |
$142 |
1.5× |
| Radex Calcaneus Minimum 2 Views (73650) |
$110.70 |
$123 |
1.3× |
| Radex elbow complete minimum 3 views (73080) |
$135.90 |
$151 |
1.6× |
| Radex Facial Bones Complete Minimum 3 Views (70150) |
$157.50 |
$175 |
1.6× |
| Radex fingr minimum 2 views (73140) |
$97.20 |
$108 |
1.2× |
| Radex foot complete minimum 3 views (73630) |
$126 |
$140 |
1.5× |
| Radex Hand Minimum 3 Views (73130) |
$144 |
$160 |
1.7× |
| Radex lower extremity infant minimum 2 views (73592) |
$139.50 |
$155 |
1.7× |
| Radex Nasal Bones Complete Minimum 3 Views (70160) |
$126 |
$140 |
1.5× |
| Radex Ribs Unilateral 2 Views (71100) |
$144 |
$160 |
1.7× |
| Radex shoulder complete minimum 2 views (73030) |
$128.70 |
$143 |
1.5× |
| Radex Spine 1 View Specify Level (72020) |
$92.70 |
$103 |
1.1× |
| Radex Sternum Minimum 2 Views (71120) |
$130.50 |
$145 |
1.6× |
| Radex Temporomandble Jt Opn & Clsd Mouth Bilat (70330) |
$114.30 |
$127 |
1.4× |
| Radex Toe Minimum 2 Views (73660) |
$108.90 |
$121 |
1.3× |
| Radex upper extremity infant minimum 2 views (73092) |
$113.40 |
$126 |
1.1× |
| Radex Wrist Complete Minimum 3 Views (73110) |
$144 |
$160 |
1.7× |
| Radiolog exam mandible compl minimum 4 views (70110) |
$158.40 |
$176 |
1.6× |
| Radiologic Exam Abdomen 3+ Views - Xr Abdomen 3+ Views (74021) |
$162 |
$180 |
1.6× |
| Radiologic exam colon double contrast study (74280) |
$438.30 |
$487 |
2.6× |
| Radiologic exam colon single contrast study (74270) |
$373.50 |
$415 |
2.2× |
| Radiologic Exam Esophagus Double Contrast Study (74221) |
$391.50 |
$435 |
2.3× |
| Radiologic exam knee complete 4/more views (73564) |
$158.40 |
$176 |
1.6× |
| Radiologic exam pelvis compl minimum 3 views (72190) |
$191.70 |
$213 |
1.9× |
| Radiologic Exam Small Int Single Contrast Study (74250) |
$270 |
$300 |
1.6× |
| Radiologic exam swallow function contrast study (74230) |
$285.30 |
$317 |
1.7× |
| Radiologic exam teeth complete full mouth (70320) |
$252.90 |
$281 |
1.1× |
| Radiologic exam upr gi trc double contrast study (74246) |
$341.10 |
$379 |
2.0× |
| Radiologic examination femur 1 view (73551) |
$107.10 |
$119 |
1.3× |
| Radiologic examination femur minimum 2 views (73552) |
$126 |
$140 |
1.5× |
| Radiologic examination knee 1/2 views (73560) |
$75.60 |
$84 |
0.9× |
| Radiologic Examination Osseous Survey Limited (77074) |
$149.40 |
$166 |
1.5× |
| Radiologic examination tibia & fibula 2 views (73590) |
$113.40 |
$126 |
1.4× |
| Ribs bilateral 3 views (71110) |
$222.30 |
$247 |
2.2× |
| Rp Loclzj Tum Spect 1 Area Single Day Imaging (78803) |
$821.70 |
$913 |
1.6× |
| Scapula (73010) |
$126 |
$140 |
1.3× |
| Screening Digital Breast Tomosynthesis Bi (77063) |
$45.90 |
$51 |
2.0× |
| Shoulder 1 view (73020) |
$98.10 |
$109 |
1.2× |
| Shoulder Arthrography (73040) |
$477 |
$530 |
1.4× |
| Skull less than 4 views (70250) |
$205.20 |
$228 |
2.0× |
| Sternoclavicular joints (71130) |
$252 |
$280 |
3.0× |
| Thoracic spine 2 views (72070) |
$148.50 |
$165 |
1.5× |
| Thoracic spine 3 views (72072) |
$167.40 |
$186 |
1.7× |
| Thoracolumbar 2 views (72080) |
$139.50 |
$155 |
1.7× |
| Thyroid Imaging With Vascular Flow (78013) |
$565.20 |
$628 |
1.5× |
| Thyroid Uptake W/Blood Flow Sngle/Mult Quan Meas (78014) |
$790.20 |
$878 |
2.1× |
| Ultrasound Breast Limited (76642) |
$347.40 |
$386 |
4.2× |
| Ultrasound Exam Aaa Screen (76706) |
$245.70 |
$273 |
2.4× |
| Ultrasound, abdomen limited (76705) |
$428.40 |
$476 |
4.3× |
| Umbilical-artery Doppler (OB) (76820) |
$239.40 |
$266 |
2.4× |
| Upper gi w/o kub (74240) |
$361.80 |
$402 |
2.1× |
| Urethrocystogram voiding (74455) |
$274.50 |
$305 |
1.2× |
| Us breast unilateral complete (76641) |
$471.60 |
$524 |
4.7× |
| Us chest (76604) |
$277.20 |
$308 |
2.8× |
| Us exam, pelvic, limited (76857) |
$286.20 |
$318 |
2.8× |
| Us head (76506) |
$242.10 |
$269 |
2.4× |
| Us kidney transplant (76776) |
$379.80 |
$422 |
3.8× |
| Us lmtd joint/oth nonvasc xtr strux r-t w/img (76882) |
$313.20 |
$348 |
3.1× |
| Us ob limited 1 or more fetuses (76815) |
$318.60 |
$354 |
3.2× |
| Us ob transvaginal (76817) |
$342 |
$380 |
3.4× |
| Us pelvic non ob complete (76856) |
$379.80 |
$422 |
3.8× |
| Us pg uter img f&mat 14 wk tabdl 1/1st gestation (76801) |
$382.50 |
$425 |
3.8× |
| Us preg uterus real time f/u trnsabdl per fetus (76816) |
$299.70 |
$333 |
3.0× |
| Us retroperitoneal complete (76770) |
$382.50 |
$425 |
3.8× |
| Us retroperitoneal limited (76775) |
$330.30 |
$367 |
3.3× |
| Us scrotum and contents (76870) |
$334.80 |
$372 |
3.3× |
| Us spinal canal and contents (76800) |
$311.40 |
$346 |
3.1× |
| Us thyroid (76536) |
$347.40 |
$386 |
3.5× |
| Wrist 2 views (73100) |
$76.50 |
$85 |
0.9× |
| X-Ray Ac Jts - Xr Acromioclavicular Joints Bilateral (73050) |
$150.30 |
$167 |
1.8× |
| X-Ray Bend Only L-S Spine (72120) |
$222.30 |
$247 |
2.2× |
| X-Ray Elbow 2 Vw - Xr Elbow 1-2 Views Right (73070) |
$108 |
$120 |
1.3× |
| X-Ray Exam Breast Specimen (76098) |
$127.80 |
$142 |
0.2× |
| X-Ray Exam Entire Spi 2/3 Vw (72082) |
$155.70 |
$173 |
1.5× |
| X-Ray Exam Hip Uni 1 View (73501) |
$92.70 |
$103 |
1.1× |
| X-Ray Exam Hip Uni 2-3 Views (73502) |
$130.50 |
$145 |
1.6× |
| X-Ray Exam Hips Bi 2 Views (73521) |
$162 |
$180 |
1.6× |
| X-Ray Exam Hips Bi 3-4 Views (73522) |
$230.40 |
$256 |
2.3× |
| X-Ray Exam L-S Spine Bending (72114) |
$232.20 |
$258 |
2.3× |
| X-Ray Exam Neck Spine 2-3 Vw (72040) |
$132.30 |
$147 |
1.6× |
| X-Ray Exam Neck Spine 6/>Vws (72052) |
$268.20 |
$298 |
2.7× |
| X-Ray Exam Unilat Ribs/Chest (71101) |
$151.20 |
$168 |
1.5× |
| X-ray eye for foreign body (70030) |
$128.70 |
$143 |
1.5× |
| X-ray humerus (73060) |
$113.40 |
$126 |
1.4× |
| X-ray IV pyelogram (ivp) (74400) |
$440.10 |
$489 |
2.6× |
| X-Ray Jaw <4 Vw - Xr Mandible < 4 Views (70100) |
$128.70 |
$143 |
1.5× |
| X-Ray Knee Bilat Standing - Xr Knees Anteroposterior Standing Bilat (73565) |
$90.90 |
$101 |
1.1× |
| X-Ray Lumbar Spine 2/3 Vw - Xr Lumbar Spine 2-3 Views (72100) |
$135 |
$150 |
1.3× |
| X-ray nose-rectum child f.b. (76010) |
$113.40 |
$126 |
1.4× |
| X-Ray Ribs, Chest 4+ Vw - Xr Ribs 3 Vws Bil W/ Chest Posteroanterior (71111) |
$194.40 |
$216 |
1.9× |
| X-Ray Sacroiliac Jts 3+ Vw - Xr Sacroiliac Joints 3+ Views (72202) |
$139.50 |
$155 |
1.4× |
| X-Ray Sacroiliac Jts <3 Vw - Xr Sacroiliac Joints 1-2 Views (72200) |
$108.90 |
$121 |
1.1× |
| X-Ray Sacrum/Coccyx 2+ Vw - Xr Sacrum Coccyx 2+ Views (72220) |
$138.60 |
$154 |
1.7× |
| X-Ray Sinuses 3+ Vw - Xr Paranasal Sinuses 3+ Views (70220) |
$194.40 |
$216 |
2.3× |
| X-Ray Skull 4+ Vw - Xr Skull Complete 4+ Views (70260) |
$212.40 |
$236 |
2.1× |
| X-ray thoracic spine 4 vw (72074) |
$190.80 |
$212 |
1.9× |
| X-Ray Tmj Unilat (70328) |
$150.30 |
$167 |
1.8× |
| X-Rays Bone Length Studies (77073) |
$95.40 |
$106 |
0.9× |
| X-Rays Bone Survey Complete (77075) |
$256.50 |
$285 |
2.6× |
| Xr c-spine 4 or 5 views (72050) |
$215.10 |
$239 |
2.1× |
| Xr orbits complete 4 views (70200) |
$165.60 |
$184 |
1.6× |