| Abdomen 1 View (74018) |
$40.94 |
$89 |
0.5× |
| Abdomen 2 views (74019) |
$50.14 |
$109 |
0.5× |
| Ankle 2 views (73600) |
$46.92 |
$102 |
0.5× |
| Bone age studies (77072) |
$32.20 |
$70 |
0.3× |
| Bone Imaging 3 Phase (78315) |
$1,660.60 |
$3,610 |
4.0× |
| Bone Imaging Limited Area (78300) |
$1,394.72 |
$3,032 |
3.4× |
| Bone Imaging Whole Body (78306) |
$1,818.84 |
$3,954 |
4.4× |
| Bone survey infant (77076) |
$141.68 |
$308 |
1.3× |
| Cat Scan Follow-Up Study (76380) |
$581.44 |
$1,264 |
6.4× |
| Chest 1 view (71045) |
$33.12 |
$72 |
0.4× |
| Chest 2 views (71046) |
$44.62 |
$97 |
0.5× |
| Clavicle complete (73000) |
$47.38 |
$103 |
0.5× |
| Computed Tomography Thorax Lw Dose Lng Ca Scr C- (71271) |
$581.44 |
$1,264 |
5.4× |
| Contrast X-Ray Bladder (74430) |
$348.22 |
$757 |
1.0× |
| CT abdomen and pelvis without and with contrast (74178) |
$844.56 |
$1,836 |
2.3× |
| CT abdomen and pelvis without contrast (74176) |
$603.98 |
$1,313 |
2.4× |
| CT abdomen w contrast (74160) |
$639.86 |
$1,391 |
3.5× |
| CT abdomen w wo contrast (74170) |
$814.66 |
$1,771 |
4.5× |
| CT abdomen w/o contrast (74150) |
$581.44 |
$1,264 |
5.4× |
| CT Angio Abdomen and Pelvis (74174) |
$828.46 |
$1,801 |
2.3× |
| CT Angio Chest (71275) |
$627.90 |
$1,365 |
3.4× |
| CT Angio Head (70496) |
$699.66 |
$1,521 |
3.8× |
| CT angio hrt w/3d image (75574) |
$660.10 |
$1,435 |
1.8× |
| Ct Angio Lwr Extr W/O&W/Dye (73706) |
$814.66 |
$1,771 |
4.5× |
| CT Angio Neck (70498) |
$719.90 |
$1,565 |
4.0× |
| Ct Angio Upr Extrm W/O&W/Dye (73206) |
$888.72 |
$1,932 |
4.9× |
| CT cervical spine w/o contrast (72125) |
$628.36 |
$1,366 |
5.8× |
| CT cervical spine w/wo cont (72127) |
$879.98 |
$1,913 |
4.8× |
| CT chest w contrast (71260) |
$639.86 |
$1,391 |
3.5× |
| CT chest w/wo contrast (71270) |
$814.66 |
$1,771 |
4.5× |
| CT head/brain with contrast (70460) |
$609.50 |
$1,325 |
3.3× |
| CT head/brain without and with contrast (70470) |
$814.66 |
$1,771 |
4.5× |
| CT heart contrast eval cardiac structure&morph (75572) |
$660.10 |
$1,435 |
1.8× |
| CT iac w contrast (70481) |
$639.86 |
$1,391 |
3.5× |
| CT l-spine w&w/o contrast (72133) |
$896.08 |
$1,948 |
4.9× |
| CT lower ext w/o (73700) |
$581.44 |
$1,264 |
5.4× |
| CT lower extremity w/contrast material (73701) |
$639.86 |
$1,391 |
3.5× |
| CT lumbar spine w contrast (72132) |
$706.10 |
$1,535 |
1.9× |
| CT lumbar spine w/o contrast (72131) |
$639.86 |
$1,391 |
5.9× |
| CT maxillofacial w contrast (70487) |
$639.86 |
$1,391 |
3.5× |
| CT maxillofacial wo contrast (70486) |
$581.44 |
$1,264 |
5.4× |
| CT neck tissue combo (70492) |
$814.66 |
$1,771 |
4.5× |
| CT orbits w/o contrast (70480) |
$581.44 |
$1,264 |
5.4× |
| CT pelvis w/o contrast (72192) |
$581.44 |
$1,264 |
5.4× |
| CT scans face/jaw combo (70488) |
$1,439.34 |
$3,129 |
7.9× |
| CT soft tissue neck w contrast (70491) |
$639.86 |
$1,391 |
3.5× |
| CT soft tissue neck w/o contrast (70490) |
$581.44 |
$1,264 |
5.4× |
| CT thoracic spine w contrast (72129) |
$713.46 |
$1,551 |
3.9× |
| CT thoracic spine w/o contrast (72128) |
$649.52 |
$1,412 |
6.0× |
| CT thoracic spine w/wo cont (72130) |
$909.42 |
$1,977 |
5.0× |
| CT thorax w/o contrast (71250) |
$581.44 |
$1,264 |
5.4× |
| CT unlisted procedure (76497) |
$327.06 |
$711 |
3.6× |
| CT upper ext wo (73200) |
$634.80 |
$1,380 |
5.8× |
| CT upper extremity with contrast (73201) |
$697.82 |
$1,517 |
1.9× |
| Cta Abdl Aorta&Bi Iliofem W/Contrast&Postp (75635) |
$660.10 |
$1,435 |
3.6× |
| Cta Abdomen (74175) |
$814.66 |
$1,771 |
4.5× |
| CTA head&neck c+ w/noncontrast img&post-pxessing (70471) |
$374.90 |
$815 |
1.0× |
| CTA pelvis (72191) |
$832.14 |
$1,809 |
4.6× |
| Dxa Bone Density Axial (77080) |
$57.50 |
$125 |
0.5× |
| Dxa bone density study 1/>sites appendiclr skel (77081) |
$46.92 |
$102 |
0.5× |
| Esophagram (74220) |
$291.64 |
$634 |
1.6× |
| Fetal Biophysical Profile W/O Non-Stress Testing (76819) |
$317.40 |
$690 |
2.9× |
| Fluoroscopy up to 1 hr (76000) |
$173.42 |
$377 |
0.7× |
| Foot 2 views (73620) |
$40.48 |
$88 |
0.4× |
| Forearm 2 views (73090) |
$41.86 |
$91 |
0.5× |
| Gastric emptying imaging study (78264) |
$1,429.22 |
$3,107 |
3.4× |
| Hand 2 views (73120) |
$44.62 |
$97 |
0.4× |
| Hepatobil Syst Image W/Drug (78227) |
$1,873.58 |
$4,073 |
3.3× |
| Hepatobiliary System Imaging (78226) |
$1,372.64 |
$2,984 |
3.3× |
| Ht Muscle Image Spect Sing (78451) |
$1,094.34 |
$2,379 |
0.8× |
| Hysterosalpingogram (74740) |
$250.24 |
$544 |
1.0× |
| Joint Survey Single View (77077) |
$57.50 |
$125 |
0.5× |
| K Flow/Funct Image W/Drug (78708) |
$1,818.84 |
$3,954 |
3.2× |
| Knee 3 Views (73562) |
$60.72 |
$132 |
0.7× |
| Lung Ventilat&Perfus Imaging (78582) |
$1,503.74 |
$3,269 |
2.7× |
| Lymph System Imaging (78195) |
$1,251.20 |
$2,720 |
2.2× |
| Meckels Divert Exam (78290) |
$2,094.84 |
$4,554 |
5.0× |
| Mra Head W/O & W/Contrast Material (70546) |
$2,077.82 |
$4,517 |
5.7× |
| MRA head w/o contrast (70544) |
$1,484.42 |
$3,227 |
6.0× |
| Mra Neck W/O &W/Contrast Material (70549) |
$1,416.34 |
$3,079 |
3.9× |
| MRA neck w/o contrast (70547) |
$1,012 |
$2,200 |
4.1× |
| MRI abdomen w/o contrast (74181) |
$1,237.40 |
$2,690 |
5.0× |
| MRI any jt lower extrem w/contrast material (73722) |
$1,649.56 |
$3,586 |
2.0× |
| MRI any jt lower extrem w/o & w/contrast matrl (73723) |
$2,099.44 |
$4,564 |
5.8× |
| MRI any jt upper extremity w/contrast matrl (73222) |
$1,647.72 |
$3,582 |
2.0× |
| MRI Breast W/O Contrast Bilateral (77047) |
$1,146.32 |
$2,492 |
4.6× |
| MRI cervical spine w contrast (72142) |
$1,636.22 |
$3,557 |
4.5× |
| MRI cervical spine w/o cont (72141) |
$1,488.10 |
$3,235 |
6.0× |
| MRI chest w/o contrast (71550) |
$934.72 |
$2,032 |
3.8× |
| MRI chest wo w contrast (71552) |
$1,307.32 |
$2,842 |
3.6× |
| MRI lower extrem oth/thn jt w/o & w/contr matr (73720) |
$1,432.90 |
$3,115 |
4.0× |
| MRI lower extrem oth/thn jt w/o contr matrl (73718) |
$1,023.96 |
$2,226 |
4.1× |
| Mri Neck Spine W/O & W/Dye (72156) |
$2,083.34 |
$4,529 |
5.7× |
| MRI orbit face &/neck w/o contrast (70540) |
$540.50 |
$1,175 |
2.2× |
| Mri Orbt/Fac/Nck W/O &W/Dye (70543) |
$1,280.64 |
$2,784 |
3.5× |
| MRI pelvis w/o & w contrast (72197) |
$2,115.08 |
$4,598 |
5.8× |
| MRI pelvis w/o contrast (72195) |
$1,510.64 |
$3,284 |
6.1× |
| MRI thoracic spine w/o contrast (72146) |
$1,245.22 |
$2,707 |
5.0× |
| MRI upper extremity oth than jt w/o contr matrl (73218) |
$1,599.42 |
$3,477 |
6.5× |
| Mri Uppr Extremity W/O&W/Dye (73220) |
$2,239.74 |
$4,869 |
6.2× |
| MRI, abdomen, combo (74183) |
$1,732.82 |
$3,767 |
4.8× |
| MRI, dorsal spine combo (72157) |
$1,742.48 |
$3,788 |
4.8× |
| MRI, dorsal spine contrast (72147) |
$1,369.42 |
$2,977 |
3.8× |
| MRI, joint upper extrem (73221) |
$1,498.68 |
$3,258 |
6.0× |
| MRI, joint upper extrem combo (73223) |
$2,097.14 |
$4,559 |
5.8× |
| MRI, lumbar spine combo (72158) |
$2,096.68 |
$4,558 |
5.8× |
| Myocardial Spect Multiple Studies (78452) |
$1,572.28 |
$3,418 |
1.2× |
| Neck soft tissue (70360) |
$43.70 |
$95 |
0.5× |
| Njx Rp Loclzj Non-Img Probe Study Intravenous (78808) |
$247.94 |
$539 |
0.6× |
| Ophthalmic ultrasound dx b-scan w/wo a-scan (76512) |
$200.56 |
$436 |
1.8× |
| Parathyroid Planar Imaging (78070) |
$628.82 |
$1,367 |
1.5× |
| Pelvis 1 or 2 views (72170) |
$37.72 |
$82 |
0.3× |
| PET image w/CT, full body (78816) |
$1,955.46 |
$4,251 |
1.3× |
| PET imaging CT attenuation skull base mid-thigh (78815) |
$1,955.46 |
$4,251 |
1.3× |
| Quan&Charac C Atherosclerotc Plaq Asses Sev C Ds (75577) |
$560.28 |
$1,218 |
0.6× |
| Radex Ankle Complete Minimum 3 Views (73610) |
$53.82 |
$117 |
0.6× |
| Radex Calcaneus Minimum 2 Views (73650) |
$39.56 |
$86 |
0.4× |
| Radex elbow complete minimum 3 views (73080) |
$46.92 |
$102 |
0.5× |
| Radex Facial Bones Complete Minimum 3 Views (70150) |
$65.78 |
$143 |
0.6× |
| Radex fingr minimum 2 views (73140) |
$60.72 |
$132 |
0.7× |
| Radex foot complete minimum 3 views (73630) |
$50.14 |
$109 |
0.6× |
| Radex Hand Minimum 3 Views (73130) |
$55.66 |
$121 |
0.6× |
| Radex lower extremity infant minimum 2 views (73592) |
$45.54 |
$99 |
0.5× |
| Radex Nasal Bones Complete Minimum 3 Views (70160) |
$56.58 |
$123 |
0.6× |
| Radex Ribs Unilateral 2 Views (71100) |
$50.14 |
$109 |
0.6× |
| Radex shoulder complete minimum 2 views (73030) |
$49.22 |
$107 |
0.5× |
| Radex Sinuses Paransl < 3 Views (70210) |
$46 |
$100 |
0.5× |
| Radex Spine 1 View Specify Level (72020) |
$32.20 |
$70 |
0.4× |
| Radex Sternum Minimum 2 Views (71120) |
$46 |
$100 |
0.5× |
| Radex Toe Minimum 2 Views (73660) |
$43.70 |
$95 |
0.5× |
| Radex upper extremity infant minimum 2 views (73092) |
$56.58 |
$123 |
0.5× |
| Radex Wrist Complete Minimum 3 Views (73110) |
$63.48 |
$138 |
0.7× |
| Radiolog exam mandible compl minimum 4 views (70110) |
$60.72 |
$132 |
0.6× |
| Radiologic exam knee complete 4/more views (73564) |
$69.92 |
$152 |
0.6× |
| Radiologic exam pelvis compl minimum 3 views (72190) |
$57.50 |
$125 |
0.5× |
| Radiologic Exam Small Int Single Contrast Study (74250) |
$358.34 |
$779 |
2.0× |
| Radiologic exam swallow function contrast study (74230) |
$454.02 |
$987 |
2.5× |
| Radiologic examination femur 1 view (73551) |
$41.86 |
$91 |
0.5× |
| Radiologic examination femur minimum 2 views (73552) |
$51.98 |
$113 |
0.6× |
| Radiologic examination knee 1/2 views (73560) |
$50.14 |
$109 |
0.6× |
| Radiologic examination tibia & fibula 2 views (73590) |
$46 |
$100 |
0.5× |
| Ribs bilateral 3 views (71110) |
$57.50 |
$125 |
0.5× |
| Rp loclzj tum spect w/CT 1 area/acquisj 1day img (78830) |
$1,075.48 |
$2,338 |
0.8× |
| Scapula (73010) |
$29.44 |
$64 |
0.3× |
| Screening Digital Breast Tomosynthesis Bi (77063) |
$68.54 |
$149 |
2.9× |
| Shoulder 1 view (73020) |
$27.60 |
$60 |
0.3× |
| Skull less than 4 views (70250) |
$52.44 |
$114 |
0.5× |
| Sternoclavicular joints (71130) |
$58.88 |
$128 |
0.7× |
| Thoracic spine 2 views (72070) |
$44.62 |
$97 |
0.4× |
| Thoracic spine 3 views (72072) |
$55.20 |
$120 |
0.5× |
| Thoracolumbar 2 views (72080) |
$47.38 |
$103 |
0.5× |
| Thyroid Uptake W/Blood Flow Sngle/Mult Quan Meas (78014) |
$628.82 |
$1,367 |
1.5× |
| Ultrasound Breast Limited (76642) |
$275.54 |
$599 |
3.0× |
| Ultrasound Exam Aaa Screen (76706) |
$275.54 |
$599 |
2.5× |
| Ultrasound, abdomen limited (76705) |
$275.54 |
$599 |
2.5× |
| Umbilical-artery Doppler (OB) (76820) |
$275.54 |
$599 |
2.5× |
| Unlisted us procedure (76999) |
$275.54 |
$599 |
3.0× |
| Upper gi w/o kub (74240) |
$348.22 |
$757 |
1.9× |
| Us chest (76604) |
$275.54 |
$599 |
2.5× |
| Us complete joint (76881) |
$317.40 |
$690 |
2.9× |
| Us exam, pelvic, limited (76857) |
$273.70 |
$595 |
2.5× |
| Us lmtd joint/oth nonvasc xtr strux r-t w/img (76882) |
$317.40 |
$690 |
2.9× |
| Us ob limited 1 or more fetuses (76815) |
$275.54 |
$599 |
2.5× |
| Us ob transvaginal (76817) |
$273.70 |
$595 |
2.5× |
| Us pelvic non ob complete (76856) |
$432.86 |
$941 |
4.0× |
| Us pg uter img f&mat 14 wk tabdl 1/1st gestation (76801) |
$275.54 |
$599 |
2.5× |
| Us preg uterus real time f/u trnsabdl per fetus (76816) |
$275.54 |
$599 |
2.5× |
| Us retroperitoneal complete (76770) |
$517.04 |
$1,124 |
4.8× |
| Us retroperitoneal limited (76775) |
$275.54 |
$599 |
2.5× |
| Us scrotum and contents (76870) |
$275.54 |
$599 |
2.5× |
| Us thyroid (76536) |
$275.54 |
$599 |
2.5× |
| Wrist 2 views (73100) |
$49.22 |
$107 |
0.5× |
| X-Ray Ac Jts - Xr Acromioclavicular Joints Bilateral (73050) |
$38.64 |
$84 |
0.4× |
| X-Ray Elbow 2 Vw - Xr Elbow 1-2 Views Right (73070) |
$40.94 |
$89 |
0.5× |
| X-Ray Exam Breast Specimen (76098) |
$291.64 |
$634 |
0.5× |
| X-Ray Exam Entire Spi 1 Vw (72081) |
$58.88 |
$128 |
0.7× |
| X-Ray Exam Hip Uni 1 View (73501) |
$46.92 |
$102 |
0.5× |
| X-Ray Exam Hip Uni 2-3 Views (73502) |
$71.30 |
$155 |
0.8× |
| X-Ray Exam Hips Bi 2 Views (73521) |
$58.88 |
$128 |
0.5× |
| X-Ray Exam Hips Bi 3-4 Views (73522) |
$76.82 |
$167 |
0.7× |
| X-Ray Exam Hips Bi 5/> Views (73523) |
$90.16 |
$196 |
0.8× |
| X-Ray Exam Neck Spine 2-3 Vw (72040) |
$55.66 |
$121 |
0.6× |
| X-Ray Exam Unilat Ribs/Chest (71101) |
$56.58 |
$123 |
0.5× |
| X-ray eye for foreign body (70030) |
$46.92 |
$102 |
0.5× |
| X-ray humerus (73060) |
$46.92 |
$102 |
0.5× |
| X-Ray Jaw <4 Vw - Xr Mandible < 4 Views (70100) |
$57.50 |
$125 |
0.6× |
| X-Ray Knee Bilat Standing - Xr Knees Anteroposterior Standing Bilat (73565) |
$60.72 |
$132 |
0.7× |
| X-Ray Lumbar Spine 2/3 Vw - Xr Lumbar Spine 2-3 Views (72100) |
$55.66 |
$121 |
0.5× |
| X-ray nose-rectum child f.b. (76010) |
$39.56 |
$86 |
0.4× |
| X-Ray Ribs, Chest 4+ Vw - Xr Ribs 3 Vws Bil W/ Chest Posteroanterior (71111) |
$71.30 |
$155 |
0.7× |
| X-Ray Sacroiliac Jts 3+ Vw - Xr Sacroiliac Joints 3+ Views (72202) |
$55.20 |
$120 |
0.5× |
| X-Ray Sacroiliac Jts <3 Vw - Xr Sacroiliac Joints 1-2 Views (72200) |
$48.76 |
$106 |
0.4× |
| X-Ray Sacrum/Coccyx 2+ Vw - Xr Sacrum Coccyx 2+ Views (72220) |
$46.92 |
$102 |
0.5× |
| X-Ray Sinuses 3+ Vw - Xr Paranasal Sinuses 3+ Views (70220) |
$52.44 |
$114 |
0.6× |
| X-Ray Tmj Unilat (70328) |
$49.22 |
$107 |
0.5× |
| X-Rays Bone Length Studies (77073) |
$62.10 |
$135 |
0.6× |
| X-Rays Bone Survey Complete (77075) |
$140.30 |
$305 |
1.3× |
| Xr c-spine 4 or 5 views (72050) |
$78.66 |
$171 |
0.7× |
| Xr facial bones less than 3 views (70140) |
$42.78 |
$93 |
0.5× |