| Abdomen 1 View (74018) |
$142.50 |
$285 |
1.7× |
| Abdomen 2 views (74019) |
$199.50 |
$399 |
2.0× |
| Ankle 2 views (73600) |
$189.50 |
$379 |
2.3× |
| Bone age studies (77072) |
$131 |
$262 |
1.3× |
| Bone Imaging 3 Phase (78315) |
$1,343 |
$2,686 |
3.5× |
| Bone Imaging Limited Area (78300) |
$1,343 |
$2,686 |
3.5× |
| Bone Imaging Whole Body (78306) |
$1,343 |
$2,686 |
3.5× |
| Bone survey infant (77076) |
$127.50 |
$255 |
1.3× |
| Chest 1 view (71045) |
$174.50 |
$349 |
2.1× |
| Chest 2 views (71046) |
$220.50 |
$441 |
2.7× |
| Chest 3 views (71047) |
$220.50 |
$441 |
2.7× |
| Clavicle complete (73000) |
$182 |
$364 |
2.2× |
| Computed Tomography Thorax Lw Dose Lng Ca Scr C- (71271) |
$178.50 |
$357 |
1.8× |
| Contrast X-Ray Bladder (74430) |
$333.50 |
$667 |
1.0× |
| CT abdomen and pelvis without and with contrast (74178) |
$3,367.50 |
$6,735 |
10.1× |
| CT abdomen and pelvis without contrast (74176) |
$2,091 |
$4,182 |
9.2× |
| CT abdomen w contrast (74160) |
$1,452 |
$2,904 |
8.7× |
| CT abdomen w wo contrast (74170) |
$1,626.50 |
$3,253 |
9.7× |
| CT abdomen w/o contrast (74150) |
$1,046 |
$2,092 |
10.5× |
| CT Angio Abdomen and Pelvis (74174) |
$1,880 |
$3,760 |
5.6× |
| CT Angio Chest (71275) |
$2,030.50 |
$4,061 |
12.1× |
| CT Angio Head (70496) |
$1,482.50 |
$2,965 |
8.8× |
| Ct Angio Lwr Extr W/O&W/Dye (73706) |
$1,916.50 |
$3,833 |
11.4× |
| CT Angio Neck (70498) |
$2,034.50 |
$4,069 |
12.1× |
| Ct Angio Upr Extrm W/O&W/Dye (73206) |
$1,879 |
$3,758 |
11.2× |
| CT cervical spine w/ contrast (72126) |
$4,305 |
$8,610 |
12.9× |
| CT cervical spine w/o contrast (72125) |
$1,090 |
$2,180 |
10.9× |
| CT cervical spine w/wo cont (72127) |
$4,305.50 |
$8,611 |
25.7× |
| CT chest w contrast (71260) |
$1,274.50 |
$2,549 |
7.6× |
| CT chest w/wo contrast (71270) |
$1,504.50 |
$3,009 |
9.0× |
| CT colonogrphy dx image postprocess w/o contrast (74261) |
$952 |
$1,904 |
9.5× |
| CT head/brain with contrast (70460) |
$1,209.50 |
$2,419 |
7.2× |
| CT head/brain without and with contrast (70470) |
$1,562 |
$3,124 |
9.3× |
| CT iac w contrast (70481) |
$1,718.50 |
$3,437 |
10.3× |
| CT l-spine w&w/o contrast (72133) |
$1,165.50 |
$2,331 |
7.0× |
| CT lower ext w/o (73700) |
$827 |
$1,654 |
8.3× |
| CT lower extremity w/contrast material (73701) |
$1,084 |
$2,168 |
6.5× |
| CT lumbar spine w contrast (72132) |
$992.50 |
$1,985 |
3.0× |
| CT lumbar spine w/o contrast (72131) |
$752.50 |
$1,505 |
7.5× |
| CT maxillofacial w contrast (70487) |
$1,478 |
$2,956 |
8.8× |
| CT maxillofacial wo contrast (70486) |
$1,119.50 |
$2,239 |
11.2× |
| CT neck tissue combo (70492) |
$1,814 |
$3,628 |
10.8× |
| Ct Orbit/Ear/Fossa W/O&W/Dye (70482) |
$1,718.50 |
$3,437 |
10.3× |
| CT orbits w/o contrast (70480) |
$1,245 |
$2,490 |
12.5× |
| CT pelvis w&w/o contrast (72194) |
$1,731.50 |
$3,463 |
10.3× |
| CT pelvis w/o contrast (72192) |
$1,042.50 |
$2,085 |
10.4× |
| CT scan of leg combo (73702) |
$1,282 |
$2,564 |
7.6× |
| CT scans face/jaw combo (70488) |
$1,735.50 |
$3,471 |
10.4× |
| CT soft tissue neck w contrast (70491) |
$1,537.50 |
$3,075 |
9.2× |
| CT soft tissue neck w/o contrast (70490) |
$1,168.50 |
$2,337 |
11.7× |
| CT thoracic spine w contrast (72129) |
$2,991 |
$5,982 |
17.8× |
| CT thoracic spine w/o contrast (72128) |
$731.50 |
$1,463 |
7.3× |
| CT thoracic spine w/wo cont (72130) |
$2,426 |
$4,852 |
14.5× |
| CT thorax w/o contrast (71250) |
$970 |
$1,940 |
9.7× |
| CT upper ext wo (73200) |
$828.50 |
$1,657 |
8.3× |
| CT upper extremity w/o & w/contrast material (73202) |
$2,161 |
$4,322 |
12.9× |
| CT upper extremity with contrast (73201) |
$1,090 |
$2,180 |
3.3× |
| Cta Abdl Aorta&Bi Iliofem W/Contrast&Postp (75635) |
$921.50 |
$1,843 |
5.5× |
| Cta Abdomen (74175) |
$1,880 |
$3,760 |
11.2× |
| CTA pelvis (72191) |
$781.50 |
$1,563 |
4.7× |
| Dxa Bone Density Axial (77080) |
$336.50 |
$673 |
3.4× |
| Esophagram (74220) |
$373.50 |
$747 |
2.2× |
| Fetal Biophys Profile W/Nst (76818) |
$367.50 |
$735 |
3.7× |
| Fetal Biophysical Profile W/O Non-Stress Testing (76819) |
$269.50 |
$539 |
2.7× |
| Fluoroscopy up to 1 hr (76000) |
$316 |
$632 |
1.4× |
| Foot 2 views (73620) |
$188.50 |
$377 |
2.3× |
| Forearm 2 views (73090) |
$193.50 |
$387 |
2.3× |
| Gastric emptying imaging study (78264) |
$974 |
$1,948 |
2.5× |
| Hand 2 views (73120) |
$199 |
$398 |
2.0× |
| Hepatobil Syst Image W/Drug (78227) |
$1,235.50 |
$2,471 |
2.4× |
| Hepatobiliary System Imaging (78226) |
$1,235.50 |
$2,471 |
3.2× |
| Ht Muscle Image Spect Sing (78451) |
$2,825.50 |
$5,651 |
2.3× |
| Hysterosalpingogram (74740) |
$475.50 |
$951 |
2.1× |
| Infant hip ultrasound with hip movement (dynamic) (76885) |
$192.50 |
$385 |
2.3× |
| Joint Survey Single View (77077) |
$341.50 |
$683 |
3.4× |
| K Flow/Funct Image W/Drug (78708) |
$2,670.50 |
$5,341 |
5.1× |
| K Flow/Funct Image W/O Drug (78707) |
$1,114.50 |
$2,229 |
2.1× |
| Knee 3 Views (73562) |
$204 |
$408 |
2.5× |
| Lung perfusion differential (78597) |
$729.50 |
$1,459 |
1.9× |
| Lung Ventilat&Perfus Imaging (78582) |
$524.50 |
$1,049 |
1.0× |
| Lymph System Imaging (78195) |
$1,110 |
$2,220 |
2.1× |
| Meckels Divert Exam (78290) |
$979.50 |
$1,959 |
2.6× |
| Mr safety determination physician/other qhp (76016) |
$105 |
$210 |
1.3× |
| Mr safety implant&/fb assmt clin staf 1st 15 min (76014) |
$29.50 |
$59 |
1.1× |
| Mr safety implt electronics prepj supvj phys/qhp (76018) |
$109.50 |
$219 |
1.2× |
| Mr safety implt pos&/immoblj (76019) |
$71 |
$142 |
1.3× |
| Mr safety med physics xm customization plng&mntr (76017) |
$287.50 |
$575 |
1.3× |
| Mra Head W/O & W/Contrast Material (70546) |
$1,613 |
$3,226 |
4.8× |
| MRA head w/o contrast (70544) |
$1,160.50 |
$2,321 |
5.1× |
| Mra Neck W/O &W/Contrast Material (70549) |
$1,689 |
$3,378 |
5.1× |
| MRA neck w/o contrast (70547) |
$1,048.50 |
$2,097 |
4.6× |
| MRI abdomen w contrast (74182) |
$2,036.50 |
$4,073 |
6.1× |
| MRI abdomen w/o contrast (74181) |
$1,584 |
$3,168 |
6.9× |
| MRI any jt lower extrem w/contrast material (73722) |
$2,066.50 |
$4,133 |
2.8× |
| MRI any jt lower extrem w/o & w/contrast matrl (73723) |
$2,802.50 |
$5,605 |
8.4× |
| MRI any jt upper extremity w/contrast matrl (73222) |
$2,075 |
$4,150 |
2.8× |
| MRI cervical spine w contrast (72142) |
$2,419.50 |
$4,839 |
7.3× |
| MRI cervical spine w/o cont (72141) |
$1,861 |
$3,722 |
8.2× |
| MRI chest w/o contrast (71550) |
$1,338.50 |
$2,677 |
5.9× |
| MRI lower extrem oth/thn jt w/contrast matrl (73719) |
$1,320 |
$2,640 |
4.0× |
| MRI lower extrem oth/thn jt w/o & w/contr matr (73720) |
$1,811.50 |
$3,623 |
5.4× |
| MRI lower extrem oth/thn jt w/o contr matrl (73718) |
$1,139 |
$2,278 |
5.0× |
| MRI lumbar spine w contrast (72149) |
$1,868.50 |
$3,737 |
5.6× |
| Mri Neck Spine W/O & W/Dye (72156) |
$2,233.50 |
$4,467 |
6.7× |
| MRI orbit face &/neck w/o contrast (70540) |
$1,240 |
$2,480 |
5.4× |
| MRI orbit face neck w contrast (70542) |
$1,255 |
$2,510 |
3.8× |
| Mri Orbt/Fac/Nck W/O &W/Dye (70543) |
$1,549 |
$3,098 |
4.6× |
| MRI pelvis w/o & w contrast (72197) |
$2,406.50 |
$4,813 |
7.2× |
| MRI pelvis w/o contrast (72195) |
$1,492.50 |
$2,985 |
6.5× |
| MRI thoracic spine w/o contrast (72146) |
$1,372 |
$2,744 |
6.0× |
| MRI upper extremity oth than jt w/contr matrl (73219) |
$1,676.50 |
$3,353 |
5.0× |
| MRI upper extremity oth than jt w/o contr matrl (73218) |
$1,111 |
$2,222 |
4.9× |
| Mri Uppr Extremity W/O&W/Dye (73220) |
$1,356 |
$2,712 |
4.1× |
| MRI, abdomen, combo (74183) |
$2,514 |
$5,028 |
7.5× |
| MRI, dorsal spine combo (72157) |
$2,194.50 |
$4,389 |
6.6× |
| MRI, dorsal spine contrast (72147) |
$1,783.50 |
$3,567 |
5.3× |
| MRI, joint upper extrem (73221) |
$1,758.50 |
$3,517 |
7.7× |
| MRI, joint upper extrem combo (73223) |
$2,093 |
$4,186 |
6.3× |
| MRI, lumbar spine combo (72158) |
$2,308.50 |
$4,617 |
6.9× |
| Myocardial Spect Multiple Studies (78452) |
$3,071 |
$6,142 |
2.5× |
| N-invas est c ffr sw aly CTA (75580) |
$3,122 |
$6,244 |
3.8× |
| Neck soft tissue (70360) |
$137.50 |
$275 |
1.7× |
| Ophthalmic ultrasound dx b-scan w/wo a-scan (76512) |
$173 |
$346 |
1.7× |
| Parathyroid planar imaging w/wo subtraction (78071) |
$4,059 |
$8,118 |
10.6× |
| Pelvis 1 or 2 views (72170) |
$175.50 |
$351 |
1.8× |
| PET image w/CT, full body (78816) |
$2,886.50 |
$5,773 |
2.1× |
| PET imaging CT attenuation skull base mid-thigh (78815) |
$3,520.50 |
$7,041 |
2.6× |
| Radex Abd Compl Aqt Abd W/S/E/D Views 1 View Ch (74022) |
$272.50 |
$545 |
2.7× |
| Radex abscess/fistula/sinus tract rs&i (76080) |
$230.50 |
$461 |
0.4× |
| Radex Ankle Complete Minimum 3 Views (73610) |
$210 |
$420 |
2.5× |
| Radex Calcaneus Minimum 2 Views (73650) |
$119.50 |
$239 |
1.4× |
| Radex elbow complete minimum 3 views (73080) |
$214.50 |
$429 |
2.6× |
| Radex Facial Bones Complete Minimum 3 Views (70150) |
$118 |
$236 |
1.2× |
| Radex fingr minimum 2 views (73140) |
$151 |
$302 |
1.8× |
| Radex foot complete minimum 3 views (73630) |
$213 |
$426 |
2.6× |
| Radex Hand Minimum 3 Views (73130) |
$228.50 |
$457 |
2.7× |
| Radex lower extremity infant minimum 2 views (73592) |
$82.50 |
$165 |
1.0× |
| Radex Nasal Bones Complete Minimum 3 Views (70160) |
$299.50 |
$599 |
3.6× |
| Radex Ribs Unilateral 2 Views (71100) |
$202 |
$404 |
2.4× |
| Radex shoulder complete minimum 2 views (73030) |
$228.50 |
$457 |
2.7× |
| Radex Sinuses Paransl < 3 Views (70210) |
$245.50 |
$491 |
3.0× |
| Radex Spine 1 View Specify Level (72020) |
$156 |
$312 |
1.9× |
| Radex Sternum Minimum 2 Views (71120) |
$170 |
$340 |
2.0× |
| Radex Temporomandble Jt Opn & Clsd Mouth Bilat (70330) |
$199.50 |
$399 |
2.4× |
| Radex Toe Minimum 2 Views (73660) |
$111.50 |
$223 |
1.3× |
| Radex upper extremity infant minimum 2 views (73092) |
$79 |
$158 |
0.8× |
| Radex Wrist Complete Minimum 3 Views (73110) |
$203.50 |
$407 |
2.4× |
| Radiolog exam mandible compl minimum 4 views (70110) |
$79 |
$158 |
0.8× |
| Radiologic Exam Abdomen 3+ Views - Xr Abdomen 3+ Views (74021) |
$248.50 |
$497 |
2.5× |
| Radiologic exam colon single contrast study (74270) |
$461 |
$922 |
2.7× |
| Radiologic exam knee complete 4/more views (73564) |
$248 |
$496 |
2.5× |
| Radiologic exam pelvis compl minimum 3 views (72190) |
$263 |
$526 |
2.6× |
| Radiologic Exam Small Int Single Contrast Study (74250) |
$324 |
$648 |
1.9× |
| Radiologic exam swallow function contrast study (74230) |
$116.50 |
$233 |
0.7× |
| Radiologic exam upr gi trc double contrast study (74246) |
$354 |
$708 |
2.1× |
| Radiologic examination femur 1 view (73551) |
$79 |
$158 |
0.9× |
| Radiologic examination femur minimum 2 views (73552) |
$96.50 |
$193 |
1.2× |
| Radiologic examination knee 1/2 views (73560) |
$204 |
$408 |
2.5× |
| Radiologic examination tibia & fibula 2 views (73590) |
$191 |
$382 |
2.3× |
| Ribs bilateral 3 views (71110) |
$291.50 |
$583 |
2.9× |
| Scapula (73010) |
$132.50 |
$265 |
1.3× |
| Screening Digital Breast Tomosynthesis Bi (77063) |
$67 |
$134 |
2.9× |
| Shoulder 1 view (73020) |
$176.50 |
$353 |
2.1× |
| Skull less than 4 views (70250) |
$116 |
$232 |
1.2× |
| Sternoclavicular joints (71130) |
$65 |
$130 |
0.8× |
| Thoracic spine 2 views (72070) |
$199.50 |
$399 |
2.0× |
| Thoracic spine 3 views (72072) |
$280.50 |
$561 |
2.8× |
| Thoracolumbar 2 views (72080) |
$206 |
$412 |
2.5× |
| Thyroid Uptake W/Blood Flow Sngle/Mult Quan Meas (78014) |
$2,414 |
$4,828 |
6.3× |
| Ultrasound Breast Limited (76642) |
$220.50 |
$441 |
2.7× |
| Ultrasound Exam Aaa Screen (76706) |
$116 |
$232 |
1.2× |
| Ultrasound, abdomen limited (76705) |
$567 |
$1,134 |
5.7× |
| Umbilical-artery Doppler (OB) (76820) |
$178.50 |
$357 |
1.8× |
| Upper gi w/o kub (74240) |
$397 |
$794 |
2.4× |
| Urethrocystogram voiding (74455) |
$419.50 |
$839 |
1.8× |
| Urethrocystography retrograde (74450) |
$419.50 |
$839 |
1.8× |
| Us breast unilateral complete (76641) |
$337.50 |
$675 |
3.4× |
| Us chest (76604) |
$188.50 |
$377 |
1.9× |
| Us complete joint (76881) |
$292 |
$584 |
2.9× |
| Us exam, pelvic, limited (76857) |
$352 |
$704 |
3.5× |
| Us head (76506) |
$320 |
$640 |
3.2× |
| Us kidney transplant (76776) |
$403 |
$806 |
4.0× |
| Us lmtd joint/oth nonvasc xtr strux r-t w/img (76882) |
$172.50 |
$345 |
1.7× |
| Us ob limited 1 or more fetuses (76815) |
$230 |
$460 |
2.3× |
| Us ob transvaginal (76817) |
$353.50 |
$707 |
3.5× |
| Us pelvic non ob complete (76856) |
$539.50 |
$1,079 |
5.4× |
| Us pg uter img f&mat 14 wk tabdl 1/1st gestation (76801) |
$176.50 |
$353 |
1.8× |
| Us retroperitoneal complete (76770) |
$466 |
$932 |
4.7× |
| Us retroperitoneal limited (76775) |
$466 |
$932 |
4.7× |
| Us scrotum and contents (76870) |
$423 |
$846 |
4.2× |
| Us spinal canal and contents (76800) |
$210 |
$420 |
2.1× |
| Us thyroid (76536) |
$438.50 |
$877 |
4.4× |
| Wrist 2 views (73100) |
$183.50 |
$367 |
2.2× |
| X-Ray Ac Jts - Xr Acromioclavicular Joints Bilateral (73050) |
$87.50 |
$175 |
1.1× |
| X-ray antegrade pyelogram tube (74425) |
$538.50 |
$1,077 |
1.6× |
| X-Ray Bend Only L-S Spine (72120) |
$203.50 |
$407 |
2.0× |
| X-Ray Elbow 2 Vw - Xr Elbow 1-2 Views Right (73070) |
$214.50 |
$429 |
2.6× |
| X-Ray Exam Breast Specimen (76098) |
$330.50 |
$661 |
0.6× |
| X-Ray Exam Entire Spi 1 Vw (72081) |
$56 |
$112 |
0.7× |
| X-Ray Exam Entire Spi 2/3 Vw (72082) |
$327 |
$654 |
3.3× |
| X-Ray Exam Entire Spi 4/5 Vw (72083) |
$500.50 |
$1,001 |
5.0× |
| X-Ray Exam Hip Uni 1 View (73501) |
$114.50 |
$229 |
1.4× |
| X-Ray Exam Hip Uni 2-3 Views (73502) |
$231.50 |
$463 |
2.8× |
| X-Ray Exam Hip Uni 4/> Views (73503) |
$212 |
$424 |
2.1× |
| X-Ray Exam Hips Bi 2 Views (73521) |
$231.50 |
$463 |
2.3× |
| X-Ray Exam Hips Bi 3-4 Views (73522) |
$279 |
$558 |
2.8× |
| X-Ray Exam L-S Spine Bending (72114) |
$252.50 |
$505 |
2.5× |
| X-Ray Exam Neck Spine 2-3 Vw (72040) |
$250 |
$500 |
3.0× |
| X-Ray Exam Neck Spine 6/>Vws (72052) |
$518.50 |
$1,037 |
5.2× |
| X-Ray Exam Unilat Ribs/Chest (71101) |
$225 |
$450 |
2.3× |
| X-ray eye for foreign body (70030) |
$128.50 |
$257 |
1.5× |
| X-ray humerus (73060) |
$181 |
$362 |
2.2× |
| X-ray IV pyelogram (ivp) (74400) |
$488.50 |
$977 |
2.9× |
| X-Ray Jaw <4 Vw - Xr Mandible < 4 Views (70100) |
$79 |
$158 |
0.9× |
| X-Ray Knee Bilat Standing - Xr Knees Anteroposterior Standing Bilat (73565) |
$248 |
$496 |
3.0× |
| X-Ray Lumbar Spine 2/3 Vw - Xr Lumbar Spine 2-3 Views (72100) |
$255.50 |
$511 |
2.6× |
| X-ray nose-rectum child f.b. (76010) |
$79 |
$158 |
0.9× |
| X-Ray Ribs, Chest 4+ Vw - Xr Ribs 3 Vws Bil W/ Chest Posteroanterior (71111) |
$376 |
$752 |
3.8× |
| X-Ray Sacroiliac Jts 3+ Vw - Xr Sacroiliac Joints 3+ Views (72202) |
$151 |
$302 |
1.5× |
| X-Ray Sacroiliac Jts <3 Vw - Xr Sacroiliac Joints 1-2 Views (72200) |
$352 |
$704 |
3.5× |
| X-Ray Sacrum/Coccyx 2+ Vw - Xr Sacrum Coccyx 2+ Views (72220) |
$146 |
$292 |
1.8× |
| X-Ray Sinuses 3+ Vw - Xr Paranasal Sinuses 3+ Views (70220) |
$288 |
$576 |
3.5× |
| X-Ray Skull 4+ Vw - Xr Skull Complete 4+ Views (70260) |
$202.50 |
$405 |
2.0× |
| X-ray thoracic spine 4 vw (72074) |
$216 |
$432 |
2.2× |
| X-Ray Urinary Tract Exam With Contrast Material (74420) |
$588.50 |
$1,177 |
1.8× |
| X-Rays Bone Length Studies (77073) |
$122.50 |
$245 |
1.2× |
| X-Rays Bone Survey Complete (77075) |
$127.50 |
$255 |
1.3× |
| Xr c-spine 4 or 5 views (72050) |
$316 |
$632 |
3.2× |
| Xr facial bones less than 3 views (70140) |
$118 |
$236 |
1.4× |
| Xr orbits complete 4 views (70200) |
$167 |
$334 |
1.7× |