| Abdomen 1 View (74018) |
$260.08 |
$505 |
3.1× |
| Abdomen 2 views (74019) |
$287.37 |
$558 |
2.8× |
| Ankle 2 views (73600) |
$87.04 |
$169 |
1.0× |
| Bone age studies (77072) |
$91.16 |
$177 |
0.9× |
| Bone Imaging 3 Phase (78315) |
$1,150 |
$2,233 |
3.0× |
| Bone Imaging Limited Area (78300) |
$923.40 |
$1,793 |
2.4× |
| Bone Imaging Whole Body (78306) |
$1,234.97 |
$2,398 |
3.2× |
| Bone survey infant (77076) |
$80.86 |
$157 |
0.8× |
| Cat Scan Follow-Up Study (76380) |
$520.67 |
$1,011 |
6.2× |
| Chest 1 view (71045) |
$189.52 |
$368 |
2.2× |
| Chest 2 views (71046) |
$189.52 |
$368 |
2.2× |
| Chest 3 views (71047) |
$189.52 |
$368 |
2.2× |
| Clavicle complete (73000) |
$260.08 |
$505 |
3.1× |
| Computed Tomography Thorax Lw Dose Lng Ca Scr C- (71271) |
$168.92 |
$328 |
1.7× |
| Contrast X-Ray Bladder (74430) |
$284.80 |
$553 |
0.8× |
| CT abdomen and pelvis without and with contrast (74178) |
$2,713.54 |
$5,269 |
8.0× |
| CT abdomen and pelvis without contrast (74176) |
$1,621.22 |
$3,148 |
7.0× |
| CT abdomen w contrast (74160) |
$1,248.36 |
$2,424 |
7.3× |
| CT abdomen w wo contrast (74170) |
$1,267.93 |
$2,462 |
7.4× |
| CT abdomen w/o contrast (74150) |
$779.71 |
$1,514 |
7.7× |
| CT Angio Abdomen and Pelvis (74174) |
$2,339.13 |
$4,542 |
6.9× |
| CT Angio Chest (71275) |
$1,267.93 |
$2,462 |
7.4× |
| CT Angio Head (70496) |
$1,267.93 |
$2,462 |
7.4× |
| Ct Angio Lwr Extr W/O&W/Dye (73706) |
$968.72 |
$1,881 |
5.7× |
| CT Angio Neck (70498) |
$1,267.93 |
$2,462 |
7.4× |
| Ct Angio Upr Extrm W/O&W/Dye (73206) |
$824 |
$1,600 |
4.8× |
| CT cervical spine w/ contrast (72126) |
$2,064.12 |
$4,008 |
6.1× |
| CT cervical spine w/o contrast (72125) |
$779.71 |
$1,514 |
7.7× |
| CT cervical spine w/wo cont (72127) |
$138.02 |
$268 |
0.8× |
| CT chest w contrast (71260) |
$1,248.36 |
$2,424 |
7.3× |
| CT chest w/wo contrast (71270) |
$1,267.93 |
$2,462 |
7.4× |
| CT head/brain with contrast (70460) |
$1,187.08 |
$2,305 |
7.0× |
| CT head/brain without and with contrast (70470) |
$1,267.93 |
$2,462 |
7.4× |
| CT iac w contrast (70481) |
$1,267.93 |
$2,462 |
7.4× |
| CT lower ext w/o (73700) |
$779.71 |
$1,514 |
7.7× |
| CT lower extremity w/contrast material (73701) |
$1,072.75 |
$2,083 |
6.3× |
| CT lumbar spine w contrast (72132) |
$284.80 |
$553 |
0.8× |
| CT lumbar spine w/o contrast (72131) |
$779.71 |
$1,514 |
7.7× |
| CT maxillofacial w contrast (70487) |
$1,267.93 |
$2,462 |
7.4× |
| CT maxillofacial wo contrast (70486) |
$779.71 |
$1,514 |
7.7× |
| CT neck tissue combo (70492) |
$1,267.93 |
$2,462 |
7.4× |
| Ct Orbit/Ear/Fossa W/O&W/Dye (70482) |
$137.51 |
$267 |
0.8× |
| CT orbits w/o contrast (70480) |
$779.71 |
$1,514 |
7.7× |
| CT pelvis w/o contrast (72192) |
$779.71 |
$1,514 |
7.7× |
| CT soft tissue neck w contrast (70491) |
$1,153.60 |
$2,240 |
6.8× |
| CT soft tissue neck w/o contrast (70490) |
$779.71 |
$1,514 |
7.7× |
| CT thoracic spine w/o contrast (72128) |
$779.71 |
$1,514 |
7.7× |
| CT thorax w/o contrast (71250) |
$779.71 |
$1,514 |
7.7× |
| CT upper ext wo (73200) |
$779.71 |
$1,514 |
7.7× |
| CT upper extremity with contrast (73201) |
$1,076.35 |
$2,090 |
3.2× |
| Cta Abdl Aorta&Bi Iliofem W/Contrast&Postp (75635) |
$1,267.93 |
$2,462 |
7.4× |
| Cta Abdomen (74175) |
$1,267.93 |
$2,462 |
7.4× |
| CTA head&neck c+ w/noncontrast img&post-pxessing (70471) |
$2,180 |
$4,233 |
6.4× |
| CTA pelvis (72191) |
$1,267.93 |
$2,462 |
7.4× |
| Dxa Bone Density Axial (77080) |
$244.63 |
$475 |
2.4× |
| Dxa bone density study (77085) |
$84.46 |
$164 |
0.8× |
| Dxa bone density study 1/>sites appendiclr skel (77081) |
$116.39 |
$226 |
1.4× |
| Echo exam uterus (76831) |
$525.82 |
$1,021 |
2.3× |
| Esophagram (74220) |
$357.93 |
$695 |
2.1× |
| Fetal Biophysical Profile W/O Non-Stress Testing (76819) |
$366.68 |
$712 |
3.6× |
| Fluoroscopy up to 1 hr (76000) |
$401.70 |
$780 |
1.7× |
| Foot 2 views (73620) |
$232.78 |
$452 |
2.8× |
| Forearm 2 views (73090) |
$232.78 |
$452 |
2.8× |
| Gastric emptying imaging study (78264) |
$928.55 |
$1,803 |
2.4× |
| Hand 2 views (73120) |
$232.78 |
$452 |
2.3× |
| Hepatobil Syst Image W/Drug (78227) |
$1,578.99 |
$3,066 |
3.0× |
| Ht Muscle Image Spect Sing (78451) |
$1,114.46 |
$2,164 |
0.9× |
| K Flow/Funct Image W/Drug (78708) |
$412.52 |
$801 |
0.8× |
| Knee 3 Views (73562) |
$260.08 |
$505 |
3.1× |
| Lung Ventilat&Perfus Imaging (78582) |
$1,150 |
$2,233 |
2.2× |
| Magnetic Image Jaw Joint (70336) |
$180.25 |
$350 |
0.8× |
| Meckels Divert Exam (78290) |
$625.21 |
$1,214 |
1.6× |
| Mra Head W/O & W/Contrast Material (70546) |
$2,736.71 |
$5,314 |
8.1× |
| MRA head w/o contrast (70544) |
$1,617.62 |
$3,141 |
7.0× |
| MRA neck w contrast (70548) |
$1,526.46 |
$2,964 |
4.5× |
| Mra Neck W/O &W/Contrast Material (70549) |
$1,961.12 |
$3,808 |
5.8× |
| MRA neck w/o contrast (70547) |
$1,526.46 |
$2,964 |
6.6× |
| MRI abdomen w/o contrast (74181) |
$1,621.22 |
$3,148 |
7.0× |
| MRI any jt lower extrem w/contrast material (73722) |
$1,979.66 |
$3,844 |
2.6× |
| MRI any jt lower extrem w/o & w/contrast matrl (73723) |
$2,588.39 |
$5,026 |
7.6× |
| MRI cervical spine w/o cont (72141) |
$1,621.22 |
$3,148 |
7.0× |
| MRI chest wo w contrast (71552) |
$2,224.29 |
$4,319 |
6.6× |
| MRI lower extrem oth/thn jt w/o & w/contr matr (73720) |
$1,617.62 |
$3,141 |
4.8× |
| MRI lower extrem oth/thn jt w/o contr matrl (73718) |
$1,555.30 |
$3,020 |
6.7× |
| MRI lumbar spine w contrast (72149) |
$2,236.13 |
$4,342 |
6.6× |
| Mri Neck Spine W/O & W/Dye (72156) |
$1,886.45 |
$3,663 |
5.6× |
| Mri Orbt/Fac/Nck W/O &W/Dye (70543) |
$1,886.45 |
$3,663 |
5.6× |
| MRI pelvis w contrast (72196) |
$1,526.46 |
$2,964 |
4.5× |
| MRI pelvis w/o & w contrast (72197) |
$1,682.51 |
$3,267 |
5.0× |
| MRI pelvis w/o contrast (72195) |
$1,600.11 |
$3,107 |
6.9× |
| MRI thoracic spine w/o contrast (72146) |
$1,621.22 |
$3,148 |
7.0× |
| MRI upper extremity oth than jt w/o contr matrl (73218) |
$1,555.30 |
$3,020 |
6.7× |
| Mri Uppr Extremity W/O&W/Dye (73220) |
$1,526.46 |
$2,964 |
4.5× |
| MRI, abdomen, combo (74183) |
$1,961.12 |
$3,808 |
5.8× |
| MRI, dorsal spine combo (72157) |
$1,961.12 |
$3,808 |
5.8× |
| MRI, joint upper extrem (73221) |
$1,617.62 |
$3,141 |
7.0× |
| MRI, joint upper extrem combo (73223) |
$2,171.76 |
$4,217 |
6.4× |
| MRI, lumbar spine combo (72158) |
$1,961.12 |
$3,808 |
5.8× |
| Myocardial Spect Multiple Studies (78452) |
$2,485.91 |
$4,827 |
2.0× |
| Neck soft tissue (70360) |
$237.42 |
$461 |
2.8× |
| Pelvis 1 or 2 views (72170) |
$260.08 |
$505 |
2.6× |
| PET image w/CT, full body (78816) |
$2,495.18 |
$4,845 |
1.8× |
| PET imaging CT attenuation skull base mid-thigh (78815) |
$2,492.09 |
$4,839 |
1.8× |
| Radex Abd Compl Aqt Abd W/S/E/D Views 1 View Ch (74022) |
$357.41 |
$694 |
3.5× |
| Radex Ankle Complete Minimum 3 Views (73610) |
$260.08 |
$505 |
3.1× |
| Radex Calcaneus Minimum 2 Views (73650) |
$232.78 |
$452 |
2.8× |
| Radex elbow complete minimum 3 views (73080) |
$260.08 |
$505 |
3.1× |
| Radex Facial Bones Complete Minimum 3 Views (70150) |
$260.59 |
$506 |
2.6× |
| Radex fingr minimum 2 views (73140) |
$232.78 |
$452 |
2.8× |
| Radex foot complete minimum 3 views (73630) |
$260.08 |
$505 |
3.1× |
| Radex Hand Minimum 3 Views (73130) |
$255.44 |
$496 |
3.0× |
| Radex Nasal Bones Complete Minimum 3 Views (70160) |
$237.42 |
$461 |
2.8× |
| Radex Ribs Unilateral 2 Views (71100) |
$232.78 |
$452 |
2.8× |
| Radex shoulder complete minimum 2 views (73030) |
$232.78 |
$452 |
2.8× |
| Radex Sinuses Paransl < 3 Views (70210) |
$63.86 |
$124 |
0.8× |
| Radex Spine 1 View Specify Level (72020) |
$232.78 |
$452 |
2.8× |
| Radex Sternum Minimum 2 Views (71120) |
$90.64 |
$176 |
1.1× |
| Radex Toe Minimum 2 Views (73660) |
$232.78 |
$452 |
2.8× |
| Radex upper extremity infant minimum 2 views (73092) |
$109.70 |
$213 |
1.1× |
| Radex Wrist Complete Minimum 3 Views (73110) |
$260.08 |
$505 |
3.1× |
| Radex X-Ray Exam Entire Spi 6/> Vw - Xr Entire Spine 6+ Vw (72084) |
$86.52 |
$168 |
0.9× |
| Radiolog exam mandible compl minimum 4 views (70110) |
$260.59 |
$506 |
2.6× |
| Radiologic exam colon double contrast study (74280) |
$684.95 |
$1,330 |
4.0× |
| Radiologic exam colon single contrast study (74270) |
$1,137.64 |
$2,209 |
6.7× |
| Radiologic exam knee complete 4/more views (73564) |
$260.08 |
$505 |
2.6× |
| Radiologic exam pelvis compl minimum 3 views (72190) |
$293.04 |
$569 |
2.9× |
| Radiologic Exam Small Int Single Contrast Study (74250) |
$138.02 |
$268 |
0.8× |
| Radiologic exam upr gi trc double contrast study (74246) |
$397.07 |
$771 |
2.3× |
| Radiologic examination femur 1 view (73551) |
$193.64 |
$376 |
2.3× |
| Radiologic examination femur minimum 2 views (73552) |
$237.93 |
$462 |
2.8× |
| Radiologic examination knee 1/2 views (73560) |
$232.78 |
$452 |
2.8× |
| Radiologic examination tibia & fibula 2 views (73590) |
$232.78 |
$452 |
2.8× |
| Ribs bilateral 3 views (71110) |
$111.24 |
$216 |
1.1× |
| Rp loclzj tum spect w/CT 1 area/acquisj 1day img (78830) |
$1,127.85 |
$2,190 |
0.9× |
| Scapula (73010) |
$265.23 |
$515 |
2.6× |
| Screening Digital Breast Tomosynthesis Bi (77063) |
$23.18 |
$45 |
1.0× |
| Shoulder 1 view (73020) |
$204.97 |
$398 |
2.4× |
| Skull less than 4 views (70250) |
$265.23 |
$515 |
2.6× |
| Sternoclavicular joints (71130) |
$260.59 |
$506 |
3.1× |
| Thoracic spine 2 views (72070) |
$314.67 |
$611 |
3.1× |
| Thoracic spine 3 views (72072) |
$357.41 |
$694 |
3.5× |
| Thoracolumbar 2 views (72080) |
$293.04 |
$569 |
3.5× |
| Thyroid Uptake Measurement (78012) |
$339.39 |
$659 |
0.9× |
| Thyroid Uptake W/Blood Flow Sngle/Mult Quan Meas (78014) |
$730.27 |
$1,418 |
1.9× |
| Ultrasound Breast Limited (76642) |
$175.62 |
$341 |
2.1× |
| Ultrasound Exam Aaa Screen (76706) |
$221.45 |
$430 |
2.2× |
| Ultrasound, abdomen limited (76705) |
$359.47 |
$698 |
3.5× |
| Upper gi w/o kub (74240) |
$342.48 |
$665 |
2.0× |
| Us breast unilateral complete (76641) |
$195.19 |
$379 |
1.9× |
| Us chest (76604) |
$262.14 |
$509 |
2.6× |
| Us complete joint (76881) |
$359.99 |
$699 |
3.5× |
| Us exam, pelvic, limited (76857) |
$241.02 |
$468 |
2.4× |
| Us kidney transplant (76776) |
$83.95 |
$163 |
0.8× |
| Us lmtd joint/oth nonvasc xtr strux r-t w/img (76882) |
$247.72 |
$481 |
2.4× |
| Us ob limited 1 or more fetuses (76815) |
$238.45 |
$463 |
2.3× |
| Us ob transvaginal (76817) |
$243.08 |
$472 |
2.4× |
| Us pelvic non ob complete (76856) |
$349.69 |
$679 |
3.4× |
| Us pg uter img f&mat 14 wk tabdl 1/1st gestation (76801) |
$366.68 |
$712 |
3.6× |
| Us preg uterus real time f/u trnsabdl per fetus (76816) |
$238.45 |
$463 |
2.3× |
| Us retroperitoneal complete (76770) |
$291.49 |
$566 |
2.9× |
| Us retroperitoneal limited (76775) |
$247.72 |
$481 |
2.4× |
| Us scrotum and contents (76870) |
$359.47 |
$698 |
3.5× |
| Us thyroid (76536) |
$303.85 |
$590 |
3.0× |
| Us transrectal (76872) |
$359.99 |
$699 |
3.5× |
| Wrist 2 views (73100) |
$232.78 |
$452 |
2.8× |
| X-Ray Ac Jts - Xr Acromioclavicular Joints Bilateral (73050) |
$232.78 |
$452 |
2.8× |
| X-Ray Elbow 2 Vw - Xr Elbow 1-2 Views Right (73070) |
$232.78 |
$452 |
2.8× |
| X-Ray Exam Breast Specimen (76098) |
$358.96 |
$697 |
0.7× |
| X-Ray Exam Entire Spi 1 Vw (72081) |
$132.87 |
$258 |
1.6× |
| X-Ray Exam Entire Spi 2/3 Vw (72082) |
$117.42 |
$228 |
1.2× |
| X-Ray Exam Hip Uni 1 View (73501) |
$246.69 |
$479 |
2.9× |
| X-Ray Exam Hip Uni 2-3 Views (73502) |
$232.78 |
$452 |
2.8× |
| X-Ray Exam Hip Uni 4/> Views (73503) |
$232.78 |
$452 |
2.3× |
| X-Ray Exam Hips Bi 3-4 Views (73522) |
$287.37 |
$558 |
2.8× |
| X-Ray Exam L-S Spine Bending (72114) |
$205.49 |
$399 |
2.0× |
| X-Ray Exam Neck Spine 2-3 Vw (72040) |
$357.41 |
$694 |
4.2× |
| X-Ray Exam Neck Spine 6/>Vws (72052) |
$342.48 |
$665 |
3.4× |
| X-Ray Exam Unilat Ribs/Chest (71101) |
$357.93 |
$695 |
3.5× |
| X-ray eye for foreign body (70030) |
$237.42 |
$461 |
2.8× |
| X-ray humerus (73060) |
$144.20 |
$280 |
1.7× |
| X-Ray Jaw <4 Vw - Xr Mandible < 4 Views (70100) |
$237.42 |
$461 |
2.8× |
| X-Ray Knee Bilat Standing - Xr Knees Anteroposterior Standing Bilat (73565) |
$130.30 |
$253 |
1.5× |
| X-Ray Lumbar Spine 2/3 Vw - Xr Lumbar Spine 2-3 Views (72100) |
$314.67 |
$611 |
3.1× |
| X-ray nose-rectum child f.b. (76010) |
$357.93 |
$695 |
4.2× |
| X-Ray Ribs, Chest 4+ Vw - Xr Ribs 3 Vws Bil W/ Chest Posteroanterior (71111) |
$265.23 |
$515 |
2.6× |
| X-Ray Sacroiliac Jts 3+ Vw - Xr Sacroiliac Joints 3+ Views (72202) |
$265.23 |
$515 |
2.6× |
| X-Ray Sacrum/Coccyx 2+ Vw - Xr Sacrum Coccyx 2+ Views (72220) |
$260.08 |
$505 |
3.1× |
| X-Ray Sinuses 3+ Vw - Xr Paranasal Sinuses 3+ Views (70220) |
$237.42 |
$461 |
2.8× |
| X-Ray Skull 4+ Vw - Xr Skull Complete 4+ Views (70260) |
$301.79 |
$586 |
3.0× |
| X-Ray Tmj Unilat (70328) |
$103 |
$200 |
1.2× |
| X-Rays Bone Length Studies (77073) |
$288.40 |
$560 |
2.8× |
| X-Rays Bone Survey Complete (77075) |
$211.15 |
$410 |
2.1× |
| Xr c-spine 4 or 5 views (72050) |
$314.67 |
$611 |
3.1× |
| Xr facial bones less than 3 views (70140) |
$232.78 |
$452 |
2.8× |
| Xr orbits complete 4 views (70200) |
$83.43 |
$162 |
0.8× |