| Abdomen 1 View (74018) |
$275 |
$275 |
3.0× |
| Abdomen 2 views (74019) |
$437 |
$437 |
4.0× |
| Ankle 2 views (73600) |
$225 |
$225 |
2.5× |
| Bone age studies (77072) |
$265 |
$265 |
2.4× |
| Bone Imaging 3 Phase (78315) |
$2,500 |
$2,500 |
6.0× |
| Bone Imaging Limited Area (78300) |
$1,180 |
$1,180 |
2.8× |
| Bone Imaging Multiple Areas (78305) |
$1,193 |
$1,193 |
2.9× |
| Bone Imaging Whole Body (78306) |
$2,076 |
$2,076 |
5.0× |
| Bone survey infant (77076) |
$560 |
$560 |
5.2× |
| Chest 1 view (71045) |
$318 |
$318 |
3.5× |
| Chest 2 views (71046) |
$394 |
$394 |
4.4× |
| Chest 3 views (71047) |
$335 |
$335 |
3.7× |
| Clavicle complete (73000) |
$273 |
$273 |
3.0× |
| Computed Tomography Thorax Lw Dose Lng Ca Scr C- (71271) |
$300 |
$300 |
2.8× |
| Contrast X-Ray Bladder (74430) |
$980 |
$980 |
2.7× |
| CT abdomen and pelvis without and with contrast (74178) |
$5,600 |
$5,600 |
15.5× |
| CT abdomen and pelvis without contrast (74176) |
$4,100 |
$4,100 |
16.5× |
| CT abdomen w contrast (74160) |
$2,669 |
$2,669 |
14.7× |
| CT abdomen w wo contrast (74170) |
$3,087 |
$3,087 |
16.9× |
| CT abdomen w/o contrast (74150) |
$2,357 |
$2,357 |
21.7× |
| CT Angio Abdomen and Pelvis (74174) |
$6,298 |
$6,298 |
17.4× |
| CT Angio Chest (71275) |
$3,650 |
$3,650 |
20.0× |
| Ct Angio Lwr Extr W/O&W/Dye (73706) |
$2,400 |
$2,400 |
13.2× |
| Ct Angio Upr Extrm W/O&W/Dye (73206) |
$2,543 |
$2,543 |
14.0× |
| CT cervical spine w/ contrast (72126) |
$2,660 |
$2,660 |
7.3× |
| CT cervical spine w/o contrast (72125) |
$2,600 |
$2,600 |
23.9× |
| CT chest w contrast (71260) |
$2,750 |
$2,750 |
15.1× |
| CT chest w/wo contrast (71270) |
$3,355 |
$3,355 |
18.4× |
| CT head/brain with contrast (70460) |
$2,415 |
$2,415 |
13.3× |
| CT head/brain without and with contrast (70470) |
$2,704 |
$2,704 |
14.8× |
| CT heart no contrast quant eval coronry calcium (75571) |
$150 |
$150 |
1.7× |
| CT iac w contrast (70481) |
$2,291 |
$2,291 |
12.6× |
| CT l-spine w&w/o contrast (72133) |
$2,608 |
$2,608 |
14.3× |
| CT lower ext w/o (73700) |
$2,000 |
$2,000 |
18.4× |
| CT lower extremity w/contrast material (73701) |
$2,216 |
$2,216 |
12.2× |
| CT lumbar spine w contrast (72132) |
$2,486 |
$2,486 |
6.9× |
| CT lumbar spine w/o contrast (72131) |
$2,637 |
$2,637 |
24.3× |
| CT maxillofacial w contrast (70487) |
$2,079 |
$2,079 |
11.4× |
| CT maxillofacial wo contrast (70486) |
$2,100 |
$2,100 |
19.3× |
| CT neck tissue combo (70492) |
$2,777 |
$2,777 |
15.2× |
| Ct Orbit/Ear/Fossa W/O&W/Dye (70482) |
$2,734 |
$2,734 |
15.0× |
| CT orbits w/o contrast (70480) |
$2,048 |
$2,048 |
18.9× |
| CT pelvis w&w/o contrast (72194) |
$2,910 |
$2,910 |
16.0× |
| CT pelvis w/o contrast (72192) |
$2,184 |
$2,184 |
20.1× |
| CT scan of leg combo (73702) |
$2,100 |
$2,100 |
11.5× |
| CT scans face/jaw combo (70488) |
$2,261 |
$2,261 |
12.4× |
| CT soft tissue neck w contrast (70491) |
$2,415 |
$2,415 |
13.3× |
| CT soft tissue neck w/o contrast (70490) |
$1,850 |
$1,850 |
17.0× |
| CT thoracic spine w contrast (72129) |
$2,546 |
$2,546 |
14.0× |
| CT thoracic spine w/o contrast (72128) |
$2,068 |
$2,068 |
19.0× |
| CT thoracic spine w/wo cont (72130) |
$2,756 |
$2,756 |
15.1× |
| CT thorax w/o contrast (71250) |
$2,450 |
$2,450 |
22.6× |
| CT upper ext wo (73200) |
$2,383 |
$2,383 |
22.0× |
| CT upper extremity with contrast (73201) |
$2,436 |
$2,436 |
6.7× |
| Cta Abdl Aorta&Bi Iliofem W/Contrast&Postp (75635) |
$3,603 |
$3,603 |
19.8× |
| Cta Abdomen (74175) |
$3,570 |
$3,570 |
19.6× |
| CTA pelvis (72191) |
$2,985 |
$2,985 |
16.4× |
| Dxa Bone Density Axial (77080) |
$500 |
$500 |
4.6× |
| Esophagram (74220) |
$716 |
$716 |
3.9× |
| Fetal Biophysical Profile W/O Non-Stress Testing (76819) |
$484 |
$484 |
4.5× |
| Fluoroscopy up to 1 hr (76000) |
$700 |
$700 |
2.8× |
| Foot 2 views (73620) |
$295 |
$295 |
3.3× |
| Forearm 2 views (73090) |
$280 |
$280 |
3.1× |
| Gated Heart Planar Single (78472) |
$1,985 |
$1,985 |
4.8× |
| Hand 2 views (73120) |
$203 |
$203 |
1.9× |
| Hepatobil Syst Image W/Drug (78227) |
$2,157 |
$2,157 |
3.8× |
| Hepatobiliary System Imaging (78226) |
$2,243 |
$2,243 |
5.4× |
| Ht Muscle Image Spect Sing (78451) |
$3,115 |
$3,115 |
2.3× |
| Hysterosalpingogram (74740) |
$870 |
$870 |
3.5× |
| K Flow/Funct Image Multiple (78709) |
$1,796 |
$1,796 |
3.2× |
| K Flow/Funct Image W/Drug (78708) |
$1,562 |
$1,562 |
2.8× |
| K Flow/Funct Image W/O Drug (78707) |
$1,400 |
$1,400 |
2.5× |
| Kidney Imaging Morphol (78700) |
$1,558 |
$1,558 |
3.8× |
| Knee 3 Views (73562) |
$310 |
$310 |
3.4× |
| Liver & Spleen Imaging Static Only (78215) |
$1,500 |
$1,500 |
3.6× |
| Lung Ventilat&Perfus Imaging (78582) |
$1,117 |
$1,117 |
2.0× |
| Lung Ventilation Imaging (78579) |
$537 |
$537 |
1.3× |
| Meckels Divert Exam (78290) |
$1,355 |
$1,355 |
3.3× |
| Mra Head W/O & W/Contrast Material (70546) |
$3,450 |
$3,450 |
9.5× |
| MRA head w/o contrast (70544) |
$3,045 |
$3,045 |
12.3× |
| MRA neck w contrast (70548) |
$3,268 |
$3,268 |
9.0× |
| Mra Neck W/O &W/Contrast Material (70549) |
$3,549 |
$3,549 |
9.8× |
| MRA neck w/o contrast (70547) |
$2,740 |
$2,740 |
11.1× |
| MRI abdomen w/o contrast (74181) |
$2,700 |
$2,700 |
10.9× |
| MRI any jt lower extrem w/contrast material (73722) |
$3,602 |
$3,602 |
4.4× |
| MRI any jt lower extrem w/o & w/contrast matrl (73723) |
$3,675 |
$3,675 |
10.1× |
| MRI any jt upper extremity w/contrast matrl (73222) |
$3,150 |
$3,150 |
3.9× |
| MRI cervical spine w contrast (72142) |
$3,517 |
$3,517 |
9.7× |
| MRI cervical spine w/o cont (72141) |
$3,156 |
$3,156 |
12.7× |
| MRI chest w/o contrast (71550) |
$2,780 |
$2,780 |
11.2× |
| MRI chest wo w contrast (71552) |
$3,956 |
$3,956 |
10.9× |
| MRI lower extrem oth/thn jt w/contrast matrl (73719) |
$2,876 |
$2,876 |
7.9× |
| MRI lower extrem oth/thn jt w/o & w/contr matr (73720) |
$3,271 |
$3,271 |
9.0× |
| MRI lower extrem oth/thn jt w/o contr matrl (73718) |
$2,573 |
$2,573 |
10.4× |
| MRI lumbar spine w contrast (72149) |
$3,780 |
$3,780 |
10.4× |
| Mri Neck Spine W/O & W/Dye (72156) |
$4,148 |
$4,148 |
11.5× |
| MRI orbit face &/neck w/o contrast (70540) |
$2,859 |
$2,859 |
11.5× |
| Mri Orbt/Fac/Nck W/O &W/Dye (70543) |
$3,308 |
$3,308 |
9.1× |
| MRI pelvis w contrast (72196) |
$3,270 |
$3,270 |
9.0× |
| MRI pelvis w/o & w contrast (72197) |
$3,658 |
$3,658 |
10.1× |
| MRI pelvis w/o contrast (72195) |
$2,800 |
$2,800 |
11.3× |
| MRI thoracic spine w/o contrast (72146) |
$3,218 |
$3,218 |
13.0× |
| MRI upper extremity oth than jt w/contr matrl (73219) |
$2,964 |
$2,964 |
8.2× |
| MRI upper extremity oth than jt w/o contr matrl (73218) |
$2,869 |
$2,869 |
11.6× |
| Mri Uppr Extremity W/O&W/Dye (73220) |
$3,544 |
$3,544 |
9.8× |
| MRI, abdomen, combo (74183) |
$4,707 |
$4,707 |
13.0× |
| MRI, dorsal spine combo (72157) |
$3,554 |
$3,554 |
9.8× |
| MRI, dorsal spine contrast (72147) |
$3,683 |
$3,683 |
10.2× |
| MRI, joint upper extrem (73221) |
$2,850 |
$2,850 |
11.5× |
| MRI, joint upper extrem combo (73223) |
$3,817 |
$3,817 |
10.5× |
| MRI, lumbar spine combo (72158) |
$4,300 |
$4,300 |
11.9× |
| Myocardial Imaging Infarct Avid Planar Qual/Quan (78466) |
$1,408 |
$1,408 |
3.4× |
| Myocardial Spect Multiple Studies (78452) |
$4,760 |
$4,760 |
3.5× |
| Neck soft tissue (70360) |
$273 |
$273 |
3.0× |
| Parathyroid Planar Imaging (78070) |
$1,223 |
$1,223 |
2.9× |
| Pelvis 1 or 2 views (72170) |
$268 |
$268 |
2.5× |
| Pet Image W/Ct Lmtd (78814) |
$6,000 |
$6,000 |
4.0× |
| PET image w/CT, full body (78816) |
$6,250 |
$6,250 |
4.2× |
| PET imaging CT attenuation skull base mid-thigh (78815) |
$6,500 |
$6,500 |
4.4× |
| Radex Abd Compl Aqt Abd W/S/E/D Views 1 View Ch (74022) |
$487 |
$487 |
4.5× |
| Radex Ankle Complete Minimum 3 Views (73610) |
$378 |
$378 |
4.2× |
| Radex Calcaneus Minimum 2 Views (73650) |
$297 |
$297 |
3.3× |
| Radex elbow complete minimum 3 views (73080) |
$273 |
$273 |
3.0× |
| Radex Facial Bones Complete Minimum 3 Views (70150) |
$410 |
$410 |
3.8× |
| Radex fingr minimum 2 views (73140) |
$215 |
$215 |
2.4× |
| Radex foot complete minimum 3 views (73630) |
$384 |
$384 |
4.2× |
| Radex Hand Minimum 3 Views (73130) |
$370 |
$370 |
4.1× |
| Radex Nasal Bones Complete Minimum 3 Views (70160) |
$364 |
$364 |
4.0× |
| Radex Ribs Unilateral 2 Views (71100) |
$274 |
$274 |
3.0× |
| Radex shoulder complete minimum 2 views (73030) |
$396 |
$396 |
4.4× |
| Radex sm int w/mlt srl imges via enteroclss tube (74251) |
$650 |
$650 |
3.6× |
| Radex Spine 1 View Specify Level (72020) |
$368 |
$368 |
4.1× |
| Radex Sternum Minimum 2 Views (71120) |
$275 |
$275 |
3.0× |
| Radex Temporomandble Jt Opn & Clsd Mouth Bilat (70330) |
$305 |
$305 |
3.4× |
| Radex Toe Minimum 2 Views (73660) |
$210 |
$210 |
2.3× |
| Radex Wrist Complete Minimum 3 Views (73110) |
$373 |
$373 |
4.1× |
| Radiolog exam mandible compl minimum 4 views (70110) |
$446 |
$446 |
4.1× |
| Radiologic exam colon single contrast study (74270) |
$845 |
$845 |
4.6× |
| Radiologic Exam Esophagus Double Contrast Study (74221) |
$791 |
$791 |
4.3× |
| Radiologic exam knee complete 4/more views (73564) |
$500 |
$500 |
4.6× |
| Radiologic Exam Small Int Single Contrast Study (74250) |
$695 |
$695 |
3.8× |
| Radiologic exam swallow function contrast study (74230) |
$570 |
$570 |
3.1× |
| Radiologic exam upr gi trc double contrast study (74246) |
$750 |
$750 |
4.1× |
| Radiologic examination femur 1 view (73551) |
$258 |
$258 |
2.9× |
| Radiologic examination femur minimum 2 views (73552) |
$384 |
$384 |
4.2× |
| Radiologic examination knee 1/2 views (73560) |
$368 |
$368 |
4.1× |
| Radiologic Examination Osseous Survey Limited (77074) |
$632 |
$632 |
5.8× |
| Radiologic examination tibia & fibula 2 views (73590) |
$280 |
$280 |
3.1× |
| Ribs bilateral 3 views (71110) |
$524 |
$524 |
4.8× |
| Scapula (73010) |
$275 |
$275 |
2.5× |
| Screening Digital Breast Tomosynthesis Bi (77063) |
$105 |
$105 |
4.5× |
| Shoulder 1 view (73020) |
$212 |
$212 |
2.3× |
| Skull less than 4 views (70250) |
$368 |
$368 |
3.4× |
| Sternoclavicular joints (71130) |
$260 |
$260 |
2.9× |
| Thoracic spine 2 views (72070) |
$332 |
$332 |
3.1× |
| Thoracic spine 3 views (72072) |
$375 |
$375 |
3.5× |
| Thoracolumbar 2 views (72080) |
$340 |
$340 |
3.8× |
| Ultrasound Breast Limited (76642) |
$486 |
$486 |
5.4× |
| Ultrasound Exam Aaa Screen (76706) |
$620 |
$620 |
5.7× |
| Ultrasound, abdomen limited (76705) |
$779 |
$779 |
7.2× |
| Upper gi w/o kub (74240) |
$578 |
$578 |
3.2× |
| Urethrocystogram voiding (74455) |
$874 |
$874 |
3.5× |
| Us breast unilateral complete (76641) |
$462 |
$462 |
4.3× |
| Us exam, pelvic, limited (76857) |
$586 |
$586 |
5.4× |
| Us lmtd joint/oth nonvasc xtr strux r-t w/img (76882) |
$499 |
$499 |
4.6× |
| Us ob limited 1 or more fetuses (76815) |
$459 |
$459 |
4.2× |
| Us ob transvaginal (76817) |
$503 |
$503 |
4.6× |
| Us pelvic non ob complete (76856) |
$740 |
$740 |
6.8× |
| Us pg uter img f&mat 14 wk tabdl 1/1st gestation (76801) |
$570 |
$570 |
5.3× |
| Us preg uterus real time f/u trnsabdl per fetus (76816) |
$399 |
$399 |
3.7× |
| Us retroperitoneal complete (76770) |
$746 |
$746 |
6.9× |
| Us retroperitoneal limited (76775) |
$531 |
$531 |
4.9× |
| Us scrotum and contents (76870) |
$604 |
$604 |
5.6× |
| Us thyroid (76536) |
$690 |
$690 |
6.4× |
| Wrist 2 views (73100) |
$300 |
$300 |
3.3× |
| X-Ray Ac Jts - Xr Acromioclavicular Joints Bilateral (73050) |
$280 |
$280 |
3.1× |
| X-Ray Bend Only L-S Spine (72120) |
$525 |
$525 |
4.8× |
| X-Ray Elbow 2 Vw - Xr Elbow 1-2 Views Right (73070) |
$250 |
$250 |
2.8× |
| X-Ray Exam Breast Specimen (76098) |
$257 |
$257 |
0.5× |
| X-Ray Exam Hip Uni 1 View (73501) |
$255 |
$255 |
2.8× |
| X-Ray Exam Hip Uni 2-3 Views (73502) |
$379 |
$379 |
4.2× |
| X-Ray Exam Hips Bi 2 Views (73521) |
$546 |
$546 |
5.0× |
| X-Ray Exam Neck Spine 2-3 Vw (72040) |
$403 |
$403 |
4.5× |
| X-Ray Exam Unilat Ribs/Chest (71101) |
$387 |
$387 |
3.6× |
| X-ray eye for foreign body (70030) |
$221 |
$221 |
2.4× |
| X-ray humerus (73060) |
$290 |
$290 |
3.2× |
| X-Ray Knee Bilat Standing - Xr Knees Anteroposterior Standing Bilat (73565) |
$224 |
$224 |
2.5× |
| X-Ray Lumbar Spine 2/3 Vw - Xr Lumbar Spine 2-3 Views (72100) |
$520 |
$520 |
4.8× |
| X-ray nose-rectum child f.b. (76010) |
$377 |
$377 |
4.2× |
| X-Ray Ribs, Chest 4+ Vw - Xr Ribs 3 Vws Bil W/ Chest Posteroanterior (71111) |
$560 |
$560 |
5.2× |
| X-Ray Sacroiliac Jts <3 Vw - Xr Sacroiliac Joints 1-2 Views (72200) |
$416 |
$416 |
3.8× |
| X-Ray Sacrum/Coccyx 2+ Vw - Xr Sacrum Coccyx 2+ Views (72220) |
$281 |
$281 |
3.1× |
| X-Ray Sinuses 3+ Vw - Xr Paranasal Sinuses 3+ Views (70220) |
$346 |
$346 |
3.8× |
| X-Ray Skull 4+ Vw - Xr Skull Complete 4+ Views (70260) |
$520 |
$520 |
4.8× |
| X-Ray Urinary Tract Exam With Contrast Material (74420) |
$970 |
$970 |
2.7× |
| Xr c-spine 4 or 5 views (72050) |
$475 |
$475 |
4.4× |
| Xr facial bones less than 3 views (70140) |
$331 |
$331 |
3.7× |