| Abdomen 1 View (74018) |
$311.35 |
$479 |
3.8× |
| Abdomen 2 views (74019) |
$366.60 |
$564 |
3.7× |
| Acute Gastrointestinal Blood Loss Imaging (78278) |
$2,555.15 |
$3,931 |
6.8× |
| Ankle 2 views (73600) |
$245.70 |
$378 |
3.0× |
| Arthrogram hip (73525) |
$1,062.75 |
$1,635 |
3.2× |
| Bone age studies (77072) |
$256.10 |
$394 |
2.6× |
| Bone Imaging 3 Phase (78315) |
$2,000.70 |
$3,078 |
5.3× |
| Bone Imaging Whole Body (78306) |
$1,736.80 |
$2,672 |
4.6× |
| Bone survey infant (77076) |
$425.75 |
$655 |
4.3× |
| Cerebrospinal Fluid Scan (78630) |
$2,575.30 |
$3,962 |
5.0× |
| Chest 1 view (71045) |
$188.50 |
$290 |
2.3× |
| Chest 2 views (71046) |
$258.70 |
$398 |
3.1× |
| Chest 3 views (71047) |
$278.20 |
$428 |
3.4× |
| Chest 4 or more views (71048) |
$350.35 |
$539 |
3.5× |
| Clavicle complete (73000) |
$250.90 |
$386 |
3.0× |
| Computed Tomography Thorax Lw Dose Lng Ca Scr C- (71271) |
$486.20 |
$748 |
4.9× |
| CT abdomen and pelvis without and with contrast (74178) |
$2,876.25 |
$4,425 |
8.7× |
| CT abdomen and pelvis without contrast (74176) |
$2,353 |
$3,620 |
10.4× |
| CT abdomen w contrast (74160) |
$1,179.10 |
$1,814 |
7.1× |
| CT abdomen w wo contrast (74170) |
$1,437.80 |
$2,212 |
8.7× |
| CT abdomen w/o contrast (74150) |
$1,179.10 |
$1,814 |
11.9× |
| CT Angio Abdomen and Pelvis (74174) |
$2,876.90 |
$4,426 |
8.7× |
| CT Angio Chest (71275) |
$1,437.80 |
$2,212 |
8.7× |
| CT Angio Head (70496) |
$1,740.70 |
$2,678 |
10.5× |
| Ct Angio Lwr Extr W/O&W/Dye (73706) |
$1,437.80 |
$2,212 |
8.7× |
| CT Angio Neck (70498) |
$1,740.70 |
$2,678 |
10.5× |
| Ct Angio Upr Extrm W/O&W/Dye (73206) |
$1,437.80 |
$2,212 |
8.7× |
| CT cervical spine w/ contrast (72126) |
$1,179.10 |
$1,814 |
3.6× |
| CT cervical spine w/o contrast (72125) |
$1,179.10 |
$1,814 |
11.9× |
| CT chest w contrast (71260) |
$1,179.10 |
$1,814 |
7.1× |
| CT chest w/wo contrast (71270) |
$1,437.80 |
$2,212 |
8.7× |
| CT colonography screening (74263) |
$549.25 |
$845 |
2.4× |
| CT head/brain with contrast (70460) |
$1,426.10 |
$2,194 |
8.6× |
| CT head/brain without and with contrast (70470) |
$1,740.70 |
$2,678 |
10.5× |
| CT iac w contrast (70481) |
$1,426.10 |
$2,194 |
8.6× |
| CT l-spine w&w/o contrast (72133) |
$1,437.80 |
$2,212 |
8.7× |
| CT lower ext w/o (73700) |
$1,179.10 |
$1,814 |
11.9× |
| CT lower extremity w/contrast material (73701) |
$1,179.10 |
$1,814 |
7.1× |
| CT lumbar spine w contrast (72132) |
$1,179.10 |
$1,814 |
3.6× |
| CT lumbar spine w/o contrast (72131) |
$1,179.10 |
$1,814 |
11.9× |
| CT maxillofacial w contrast (70487) |
$1,426.10 |
$2,194 |
8.6× |
| CT maxillofacial wo contrast (70486) |
$1,426.10 |
$2,194 |
14.4× |
| CT neck tissue combo (70492) |
$1,740.70 |
$2,678 |
10.5× |
| Ct Orbit/Ear/Fossa W/O&W/Dye (70482) |
$1,740.70 |
$2,678 |
10.5× |
| CT orbits w/o contrast (70480) |
$1,426.10 |
$2,194 |
14.4× |
| CT pelvis w&w/o contrast (72194) |
$1,437.80 |
$2,212 |
8.7× |
| CT pelvis w/o contrast (72192) |
$1,179.10 |
$1,814 |
11.9× |
| CT scan of leg combo (73702) |
$1,437.80 |
$2,212 |
8.7× |
| CT scans face/jaw combo (70488) |
$1,740.70 |
$2,678 |
10.5× |
| CT soft tissue neck w contrast (70491) |
$1,426.10 |
$2,194 |
8.6× |
| CT soft tissue neck w/o contrast (70490) |
$1,426.10 |
$2,194 |
14.4× |
| CT thoracic spine w contrast (72129) |
$1,179.10 |
$1,814 |
7.1× |
| CT thoracic spine w/o contrast (72128) |
$1,179.10 |
$1,814 |
11.9× |
| CT thorax w/o contrast (71250) |
$1,179.10 |
$1,814 |
11.9× |
| CT unlisted procedure (76497) |
$247 |
$380 |
3.0× |
| CT upper ext wo (73200) |
$1,179.10 |
$1,814 |
11.9× |
| CT upper extremity with contrast (73201) |
$1,179.10 |
$1,814 |
3.6× |
| Cta Abdl Aorta&Bi Iliofem W/Contrast&Postp (75635) |
$1,608.10 |
$2,474 |
9.7× |
| Cta Abdomen (74175) |
$1,437.80 |
$2,212 |
8.7× |
| CTA head&neck c+ w/noncontrast img&post-pxessing (70471) |
$579.15 |
$891 |
1.8× |
| CTA pelvis (72191) |
$1,437.80 |
$2,212 |
8.7× |
| Dxa Bone Density Axial (77080) |
$619.45 |
$953 |
6.3× |
| Dxa bone density study 1/>sites appendiclr skel (77081) |
$375.05 |
$577 |
4.6× |
| Esophagram (74220) |
$505.05 |
$777 |
3.0× |
| Fetal Biophysical Profile W/O Non-Stress Testing (76819) |
$634.40 |
$976 |
6.4× |
| Fluoroscopy up to 1 hr (76000) |
$411.45 |
$633 |
1.8× |
| Foot 2 views (73620) |
$230.10 |
$354 |
2.8× |
| Forearm 2 views (73090) |
$230.10 |
$354 |
2.8× |
| Gastric emptying imaging study (78264) |
$1,704.95 |
$2,623 |
4.5× |
| Gated Heart Planar Single (78472) |
$1,892.15 |
$2,911 |
5.0× |
| Hand 2 views (73120) |
$230.10 |
$354 |
2.3× |
| Hepatobil Syst Image W/Drug (78227) |
$2,011.75 |
$3,095 |
3.9× |
| Hepatobiliary System Imaging (78226) |
$1,714.70 |
$2,638 |
4.5× |
| Ht Muscle Image Spect Sing (78451) |
$4,070.30 |
$6,262 |
3.3× |
| Hysterosalpingogram (74740) |
$699.40 |
$1,076 |
3.1× |
| K Flow/Funct Image W/Drug (78708) |
$2,096.90 |
$3,226 |
4.1× |
| K Flow/Funct Image W/O Drug (78707) |
$2,096.90 |
$3,226 |
4.1× |
| Knee 3 Views (73562) |
$261.30 |
$402 |
3.2× |
| Lung perfusion differential (78597) |
$1,299.35 |
$1,999 |
3.4× |
| Lung Ventilat&Perfus Imaging (78582) |
$1,945.45 |
$2,993 |
3.8× |
| Lung Ventilation Imaging (78579) |
$1,305.85 |
$2,009 |
3.5× |
| Lymph System Imaging (78195) |
$1,032.85 |
$1,589 |
2.0× |
| Meckels Divert Exam (78290) |
$887.25 |
$1,365 |
2.3× |
| Mr safety determination physician/other qhp (76016) |
$120.90 |
$186 |
1.5× |
| Mr safety implant&/fb assmt clin staf 1st 15 min (76014) |
$34.45 |
$53 |
1.3× |
| Mr safety implt electronics prepj supvj phys/qhp (76018) |
$126.10 |
$194 |
1.4× |
| Mr safety implt pos&/immoblj (76019) |
$81.25 |
$125 |
1.5× |
| Mr safety med physics xm customization plng&mntr (76017) |
$330.85 |
$509 |
1.5× |
| Mra Head W/O & W/Contrast Material (70546) |
$3,151.85 |
$4,849 |
9.5× |
| MRA head w/o contrast (70544) |
$2,193.75 |
$3,375 |
9.7× |
| Mra Neck W/O &W/Contrast Material (70549) |
$3,097.90 |
$4,766 |
9.4× |
| MRA neck w/o contrast (70547) |
$2,193.75 |
$3,375 |
9.7× |
| MRI abdomen w contrast (74182) |
$2,193.75 |
$3,375 |
6.6× |
| MRI abdomen w/o contrast (74181) |
$2,193.75 |
$3,375 |
9.7× |
| MRI any jt lower extrem w/contrast material (73722) |
$2,193.75 |
$3,375 |
3.0× |
| MRI any jt lower extrem w/o & w/contrast matrl (73723) |
$3,097.90 |
$4,766 |
9.4× |
| MRI any jt upper extremity w/contrast matrl (73222) |
$2,193.75 |
$3,375 |
3.0× |
| MRI cervical spine w contrast (72142) |
$2,193.75 |
$3,375 |
6.6× |
| MRI cervical spine w/o cont (72141) |
$2,193.75 |
$3,375 |
9.7× |
| MRI chest w/o contrast (71550) |
$2,193.75 |
$3,375 |
9.7× |
| MRI chest wo w contrast (71552) |
$3,097.90 |
$4,766 |
9.4× |
| MRI lower extrem oth/thn jt w/contrast matrl (73719) |
$908.05 |
$1,397 |
2.8× |
| MRI lower extrem oth/thn jt w/o & w/contr matr (73720) |
$3,097.90 |
$4,766 |
9.4× |
| MRI lower extrem oth/thn jt w/o contr matrl (73718) |
$2,193.75 |
$3,375 |
9.7× |
| MRI lumbar spine w contrast (72149) |
$2,050.75 |
$3,155 |
6.2× |
| Mri Neck Spine W/O & W/Dye (72156) |
$3,097.90 |
$4,766 |
9.4× |
| MRI orbit face &/neck w/o contrast (70540) |
$2,193.75 |
$3,375 |
9.7× |
| Mri Orbt/Fac/Nck W/O &W/Dye (70543) |
$3,097.90 |
$4,766 |
9.4× |
| MRI pelvis w/o & w contrast (72197) |
$3,097.90 |
$4,766 |
9.4× |
| MRI pelvis w/o contrast (72195) |
$2,193.75 |
$3,375 |
9.7× |
| MRI thoracic spine w/o contrast (72146) |
$2,193.75 |
$3,375 |
9.7× |
| MRI upper extremity oth than jt w/contr matrl (73219) |
$2,050.75 |
$3,155 |
6.2× |
| MRI upper extremity oth than jt w/o contr matrl (73218) |
$2,193.75 |
$3,375 |
9.7× |
| Mri Uppr Extremity W/O&W/Dye (73220) |
$3,097.90 |
$4,766 |
9.4× |
| MRI, abdomen, combo (74183) |
$3,097.90 |
$4,766 |
9.4× |
| MRI, dorsal spine combo (72157) |
$3,097.90 |
$4,766 |
9.4× |
| MRI, joint upper extrem (73221) |
$2,193.75 |
$3,375 |
9.7× |
| MRI, joint upper extrem combo (73223) |
$3,097.90 |
$4,766 |
9.4× |
| MRI, lumbar spine combo (72158) |
$3,097.90 |
$4,766 |
9.4× |
| Myocardial Spect Multiple Studies (78452) |
$5,795.40 |
$8,916 |
4.7× |
| Neck soft tissue (70360) |
$250.90 |
$386 |
3.0× |
| Parathyroid planar imaging w/wo subtraction (78071) |
$3,779.75 |
$5,815 |
10.0× |
| Pelvis 1 or 2 views (72170) |
$230.10 |
$354 |
2.3× |
| PET image w/CT, full body (78816) |
$5,989.10 |
$9,214 |
4.4× |
| PET imaging CT attenuation skull base mid-thigh (78815) |
$5,989.10 |
$9,214 |
4.4× |
| Pulmonary Perfusion Imaging Particulate (78580) |
$1,299.35 |
$1,999 |
3.4× |
| Radex Abd Compl Aqt Abd W/S/E/D Views 1 View Ch (74022) |
$635.70 |
$978 |
6.4× |
| Radex Ankle Complete Minimum 3 Views (73610) |
$350.35 |
$539 |
4.3× |
| Radex Calcaneus Minimum 2 Views (73650) |
$261.30 |
$402 |
3.2× |
| Radex elbow complete minimum 3 views (73080) |
$325.65 |
$501 |
4.0× |
| Radex Facial Bones Complete Minimum 3 Views (70150) |
$350.35 |
$539 |
3.5× |
| Radex fingr minimum 2 views (73140) |
$261.30 |
$402 |
3.2× |
| Radex foot complete minimum 3 views (73630) |
$350.35 |
$539 |
4.3× |
| Radex Hand Minimum 3 Views (73130) |
$350.35 |
$539 |
4.3× |
| Radex lower extremity infant minimum 2 views (73592) |
$241.80 |
$372 |
2.9× |
| Radex Mastoids Compl Minimum 3 Views PR Side (70130) |
$350.35 |
$539 |
3.5× |
| Radex Nasal Bones Complete Minimum 3 Views (70160) |
$261.30 |
$402 |
3.2× |
| Radex Ribs Unilateral 2 Views (71100) |
$245.70 |
$378 |
3.0× |
| Radex shoulder complete minimum 2 views (73030) |
$261.30 |
$402 |
3.2× |
| Radex Sinuses Paransl < 3 Views (70210) |
$228.15 |
$351 |
2.8× |
| Radex Spine 1 View Specify Level (72020) |
$176.80 |
$272 |
2.1× |
| Radex Sternum Minimum 2 Views (71120) |
$261.30 |
$402 |
3.2× |
| Radex Temporomandble Jt Opn & Clsd Mouth Bilat (70330) |
$522.60 |
$804 |
6.3× |
| Radex Toe Minimum 2 Views (73660) |
$261.30 |
$402 |
3.2× |
| Radex Wrist Complete Minimum 3 Views (73110) |
$350.35 |
$539 |
4.3× |
| Radiolog exam mandible compl minimum 4 views (70110) |
$350.35 |
$539 |
3.5× |
| Radiologic Exam Abdomen 3+ Views - Xr Abdomen 3+ Views (74021) |
$547.30 |
$842 |
5.5× |
| Radiologic exam colon double contrast study (74280) |
$1,155.70 |
$1,778 |
7.0× |
| Radiologic exam colon single contrast study (74270) |
$809.90 |
$1,246 |
4.9× |
| Radiologic exam knee complete 4/more views (73564) |
$350.35 |
$539 |
3.5× |
| Radiologic exam pelvis compl minimum 3 views (72190) |
$325.65 |
$501 |
3.3× |
| Radiologic Exam Small Int Single Contrast Study (74250) |
$635.70 |
$978 |
3.8× |
| Radiologic exam swallow function contrast study (74230) |
$505.05 |
$777 |
3.0× |
| Radiologic exam upr gi trc double contrast study (74246) |
$997.10 |
$1,534 |
6.0× |
| Radiologic examination femur 1 view (73551) |
$176.80 |
$272 |
2.1× |
| Radiologic examination femur minimum 2 views (73552) |
$494.65 |
$761 |
6.0× |
| Radiologic examination knee 1/2 views (73560) |
$230.10 |
$354 |
2.8× |
| Radiologic Examination Osseous Survey Limited (77074) |
$619.45 |
$953 |
6.3× |
| Radiologic examination tibia & fibula 2 views (73590) |
$245.70 |
$378 |
3.0× |
| Ribs bilateral 3 views (71110) |
$261.30 |
$402 |
2.6× |
| Rp loclzj tum plnr 1 area single day imaging (78800) |
$1,647.75 |
$2,535 |
4.4× |
| Rp Loclzj Tum Spect 1 Area Single Day Imaging (78803) |
$2,106 |
$3,240 |
4.1× |
| Scapula (73010) |
$250.90 |
$386 |
2.5× |
| Screening Digital Breast Tomosynthesis Bi (77063) |
$43.55 |
$67 |
1.9× |
| Shoulder 1 view (73020) |
$176.80 |
$272 |
2.1× |
| Shoulder Arthrography (73040) |
$1,062.75 |
$1,635 |
3.2× |
| Skull less than 4 views (70250) |
$230.10 |
$354 |
2.3× |
| Thoracic spine 2 views (72070) |
$230.10 |
$354 |
2.3× |
| Thoracic spine 3 views (72072) |
$278.85 |
$429 |
2.8× |
| Thoracolumbar 2 views (72080) |
$213.85 |
$329 |
2.6× |
| Thyroid Uptake W/Blood Flow Sngle/Mult Quan Meas (78014) |
$1,876.55 |
$2,887 |
5.0× |
| Ultrasound Breast Limited (76642) |
$434.20 |
$668 |
5.3× |
| Ultrasound Exam Aaa Screen (76706) |
$315.90 |
$486 |
3.2× |
| Ultrasound, abdomen limited (76705) |
$759.20 |
$1,168 |
7.7× |
| Upper gi w/o kub (74240) |
$781.95 |
$1,203 |
4.7× |
| Urethrocystogram voiding (74455) |
$1,025.05 |
$1,577 |
4.5× |
| Urethrocystography retrograde (74450) |
$1,025.05 |
$1,577 |
4.5× |
| Us breast unilateral complete (76641) |
$455 |
$700 |
4.6× |
| Us chest (76604) |
$479.70 |
$738 |
4.8× |
| Us exam, pelvic, limited (76857) |
$567.45 |
$873 |
5.7× |
| Us kidney transplant (76776) |
$803.40 |
$1,236 |
8.1× |
| Us lmtd joint/oth nonvasc xtr strux r-t w/img (76882) |
$507 |
$780 |
5.1× |
| Us ob detailed single fetus (76811) |
$438.75 |
$675 |
1.9× |
| Us ob limited 1 or more fetuses (76815) |
$507 |
$780 |
5.1× |
| Us ob transvaginal (76817) |
$507 |
$780 |
5.1× |
| Us pelvic non ob complete (76856) |
$731.90 |
$1,126 |
7.4× |
| Us pg uter img f&mat 14 wk tabdl 1/1st gestation (76801) |
$591.50 |
$910 |
6.0× |
| Us preg uterus real time f/u trnsabdl per fetus (76816) |
$507 |
$780 |
5.1× |
| Us retroperitoneal complete (76770) |
$759.20 |
$1,168 |
7.7× |
| Us retroperitoneal limited (76775) |
$759.20 |
$1,168 |
7.7× |
| Us scrotum and contents (76870) |
$609.70 |
$938 |
6.2× |
| Us spinal canal and contents (76800) |
$269.10 |
$414 |
2.7× |
| Us thyroid (76536) |
$497.25 |
$765 |
5.0× |
| Us transrectal (76872) |
$464.10 |
$714 |
4.7× |
| Wrist 2 views (73100) |
$230.10 |
$354 |
2.8× |
| X-Ray Bend Only L-S Spine (72120) |
$650.65 |
$1,001 |
6.6× |
| X-Ray Elbow 2 Vw - Xr Elbow 1-2 Views Right (73070) |
$245.70 |
$378 |
3.0× |
| X-Ray Exam Breast Specimen (76098) |
$312.65 |
$481 |
0.6× |
| X-Ray Exam Hip Uni 1 View (73501) |
$244.40 |
$376 |
3.0× |
| X-Ray Exam Hip Uni 2-3 Views (73502) |
$380.25 |
$585 |
4.6× |
| X-Ray Exam Hip Uni 4/> Views (73503) |
$515.45 |
$793 |
5.2× |
| X-Ray Exam Hips Bi 2 Views (73521) |
$380.25 |
$585 |
3.8× |
| X-Ray Exam Hips Bi 3-4 Views (73522) |
$494.65 |
$761 |
5.0× |
| X-Ray Exam Hips Bi 5/> Views (73523) |
$757.25 |
$1,165 |
7.7× |
| X-Ray Exam L-S Spine Bending (72114) |
$456.30 |
$702 |
4.6× |
| X-Ray Exam Neck Spine 2-3 Vw (72040) |
$261.30 |
$402 |
3.2× |
| X-Ray Exam Neck Spine 6/>Vws (72052) |
$525.85 |
$809 |
5.3× |
| X-Ray Exam Unilat Ribs/Chest (71101) |
$261.30 |
$402 |
2.6× |
| X-ray eye for foreign body (70030) |
$406.90 |
$626 |
4.9× |
| X-ray humerus (73060) |
$261.30 |
$402 |
3.2× |
| X-ray IV pyelogram (ivp) (74400) |
$822.25 |
$1,265 |
5.0× |
| X-Ray Jaw <4 Vw - Xr Mandible < 4 Views (70100) |
$228.15 |
$351 |
2.8× |
| X-Ray Knee Bilat Standing - Xr Knees Anteroposterior Standing Bilat (73565) |
$261.30 |
$402 |
3.2× |
| X-Ray Lumbar Spine 2/3 Vw - Xr Lumbar Spine 2-3 Views (72100) |
$278.85 |
$429 |
2.8× |
| X-ray nose-rectum child f.b. (76010) |
$274.95 |
$423 |
3.3× |
| X-Ray Ribs, Chest 4+ Vw - Xr Ribs 3 Vws Bil W/ Chest Posteroanterior (71111) |
$350.35 |
$539 |
3.5× |
| X-Ray Sacroiliac Jts 3+ Vw - Xr Sacroiliac Joints 3+ Views (72202) |
$350.35 |
$539 |
3.5× |
| X-Ray Sacroiliac Jts <3 Vw - Xr Sacroiliac Joints 1-2 Views (72200) |
$213.85 |
$329 |
2.2× |
| X-Ray Sacrum/Coccyx 2+ Vw - Xr Sacrum Coccyx 2+ Views (72220) |
$261.30 |
$402 |
3.2× |
| X-Ray Sinuses 3+ Vw - Xr Paranasal Sinuses 3+ Views (70220) |
$350.35 |
$539 |
4.3× |
| X-Ray Skull 4+ Vw - Xr Skull Complete 4+ Views (70260) |
$350.35 |
$539 |
3.5× |
| X-ray thoracic spine 4 vw (72074) |
$350.35 |
$539 |
3.5× |
| X-Ray Tmj Unilat (70328) |
$259.35 |
$399 |
3.2× |
| X-Ray Urinary Tract Exam With Contrast Material (74420) |
$1,095.90 |
$1,686 |
3.3× |
| X-Rays Bone Survey Complete (77075) |
$802.75 |
$1,235 |
8.1× |
| Xr c-spine 4 or 5 views (72050) |
$350.35 |
$539 |
3.5× |
| Xr facial bones less than 3 views (70140) |
$228.15 |
$351 |
2.8× |
| Xr orbits complete 4 views (70200) |
$350.35 |
$539 |
3.5× |