| Abdomen 1 View (74018) |
$218.40 |
$273 |
2.5× |
| Abdomen 2 views (74019) |
$324 |
$405 |
3.1× |
| Acute Gastrointestinal Blood Loss Imaging (78278) |
$1,572.80 |
$1,966 |
3.9× |
| Ankle 2 views (73600) |
$200 |
$250 |
2.3× |
| Bone age studies (77072) |
$261.60 |
$327 |
2.5× |
| Bone Imaging 3 Phase (78315) |
$1,941.60 |
$2,427 |
4.9× |
| Bone Imaging Limited Area (78300) |
$779.20 |
$974 |
2.0× |
| Bone Imaging Multiple Areas (78305) |
$950.40 |
$1,188 |
2.4× |
| Bone Imaging Whole Body (78306) |
$1,505.60 |
$1,882 |
3.8× |
| Bone survey infant (77076) |
$270.40 |
$338 |
2.6× |
| Chest 1 view (71045) |
$178.40 |
$223 |
2.1× |
| Chest 2 views (71046) |
$281.60 |
$352 |
3.2× |
| Chest 3 views (71047) |
$334.40 |
$418 |
3.9× |
| Chest 4 or more views (71048) |
$439.20 |
$549 |
4.2× |
| Clavicle complete (73000) |
$240.80 |
$301 |
2.8× |
| Computed Tomography Thorax Lw Dose Lng Ca Scr C- (71271) |
$481.60 |
$602 |
4.6× |
| Contrast X-Ray Bladder (74430) |
$618.40 |
$773 |
1.8× |
| Contrast X-Ray Of Knee Joint (73580) |
$1,092.80 |
$1,366 |
3.1× |
| CT abdomen and pelvis without and with contrast (74178) |
$3,844.80 |
$4,806 |
11.1× |
| CT abdomen and pelvis without contrast (74176) |
$1,916.80 |
$2,396 |
8.1× |
| CT abdomen w contrast (74160) |
$2,039.20 |
$2,549 |
11.7× |
| CT abdomen w wo contrast (74170) |
$2,576 |
$3,220 |
14.7× |
| CT abdomen w/o contrast (74150) |
$1,441.60 |
$1,802 |
13.8× |
| CT Angio Abdomen and Pelvis (74174) |
$2,169.60 |
$2,712 |
6.2× |
| CT Angio Chest (71275) |
$2,231.20 |
$2,789 |
12.8× |
| CT Angio Head (70496) |
$2,363.20 |
$2,954 |
13.5× |
| Ct Angio Lwr Extr W/O&W/Dye (73706) |
$2,488 |
$3,110 |
14.2× |
| CT Angio Neck (70498) |
$2,332.80 |
$2,916 |
13.3× |
| Ct Angio Upr Extrm W/O&W/Dye (73206) |
$2,488 |
$3,110 |
14.2× |
| CT cervical spine w/ contrast (72126) |
$1,724 |
$2,155 |
5.0× |
| CT cervical spine w/o contrast (72125) |
$1,724 |
$2,155 |
16.5× |
| CT chest w contrast (71260) |
$2,120 |
$2,650 |
12.1× |
| CT chest w/wo contrast (71270) |
$2,638.40 |
$3,298 |
15.1× |
| CT head/brain with contrast (70460) |
$1,816 |
$2,270 |
10.4× |
| CT head/brain without and with contrast (70470) |
$2,231.20 |
$2,789 |
12.8× |
| CT iac w contrast (70481) |
$1,816 |
$2,270 |
10.4× |
| CT l-spine w&w/o contrast (72133) |
$2,231.20 |
$2,789 |
12.8× |
| CT lower ext w/o (73700) |
$1,641.60 |
$2,052 |
15.8× |
| CT lower extremity w/contrast material (73701) |
$1,835.20 |
$2,294 |
10.5× |
| CT lumbar spine w contrast (72132) |
$1,998.40 |
$2,498 |
5.7× |
| CT lumbar spine w/o contrast (72131) |
$1,486.40 |
$1,858 |
14.3× |
| CT maxillofacial w contrast (70487) |
$1,816 |
$2,270 |
10.4× |
| CT maxillofacial wo contrast (70486) |
$1,512 |
$1,890 |
14.5× |
| CT neck tissue combo (70492) |
$2,231.20 |
$2,789 |
12.8× |
| Ct Orbit/Ear/Fossa W/O&W/Dye (70482) |
$2,231.20 |
$2,789 |
12.8× |
| CT orbits w/o contrast (70480) |
$1,410.40 |
$1,763 |
13.5× |
| CT pelvis w&w/o contrast (72194) |
$2,717.60 |
$3,397 |
15.5× |
| CT pelvis w/o contrast (72192) |
$1,643.20 |
$2,054 |
15.8× |
| CT scan of leg combo (73702) |
$2,124 |
$2,655 |
12.2× |
| CT scans face/jaw combo (70488) |
$2,231.20 |
$2,789 |
12.8× |
| CT soft tissue neck w contrast (70491) |
$1,988 |
$2,485 |
11.4× |
| CT soft tissue neck w/o contrast (70490) |
$1,614.40 |
$2,018 |
15.5× |
| CT thoracic spine w contrast (72129) |
$1,836 |
$2,295 |
10.5× |
| CT thoracic spine w/o contrast (72128) |
$1,836 |
$2,295 |
17.6× |
| CT thorax w/o contrast (71250) |
$1,480.80 |
$1,851 |
14.2× |
| CT unlisted procedure (76497) |
$288.80 |
$361 |
3.3× |
| CT upper ext wo (73200) |
$1,641.60 |
$2,052 |
15.8× |
| CT upper extremity w/o & w/contrast material (73202) |
$2,124 |
$2,655 |
12.2× |
| CT upper extremity with contrast (73201) |
$1,835.20 |
$2,294 |
5.3× |
| Cta Abdl Aorta&Bi Iliofem W/Contrast&Postp (75635) |
$1,296.80 |
$1,621 |
7.4× |
| Cta Abdomen (74175) |
$2,332.80 |
$2,916 |
13.3× |
| Dxa Bone Density Axial (77080) |
$543.20 |
$679 |
5.2× |
| Esophagram (74220) |
$439.20 |
$549 |
2.5× |
| Fetal Biophysical Profile W/O Non-Stress Testing (76819) |
$379.20 |
$474 |
3.6× |
| Fluoroscopy up to 1 hr (76000) |
$466.40 |
$583 |
2.0× |
| Foot 2 views (73620) |
$218.40 |
$273 |
2.5× |
| Forearm 2 views (73090) |
$230.40 |
$288 |
2.7× |
| Gastric emptying imaging study (78264) |
$1,250.40 |
$1,563 |
3.1× |
| Gated Heart Planar Single (78472) |
$1,416 |
$1,770 |
3.6× |
| Hand 2 views (73120) |
$216.80 |
$271 |
2.1× |
| Hepatobil Syst Image W/Drug (78227) |
$1,480.80 |
$1,851 |
2.7× |
| Hepatobiliary System Imaging (78226) |
$1,105.60 |
$1,382 |
2.8× |
| Hysterosalpingogram (74740) |
$574.40 |
$718 |
2.4× |
| Infant hip ultrasound with hip movement (dynamic) (76885) |
$573.60 |
$717 |
6.6× |
| Infant hip ultrasound, limited static exam (76886) |
$573.60 |
$717 |
6.6× |
| Joint Survey Single View (77077) |
$302.40 |
$378 |
2.9× |
| K Flow/Funct Image W/Drug (78708) |
$1,226.40 |
$1,533 |
2.3× |
| K Flow/Funct Image W/O Drug (78707) |
$965.60 |
$1,207 |
1.8× |
| Knee 3 Views (73562) |
$324 |
$405 |
3.7× |
| Lung Ventilat&Perfus Imaging (78582) |
$1,284 |
$1,605 |
2.4× |
| Lung Ventilation Imaging (78579) |
$815.20 |
$1,019 |
2.0× |
| Lymph System Imaging (78195) |
$1,440.80 |
$1,801 |
2.7× |
| Magnetic Image Jaw Joint (70336) |
$2,508 |
$3,135 |
10.5× |
| Meckels Divert Exam (78290) |
$1,050.40 |
$1,313 |
2.6× |
| Mr safety determination physician/other qhp (76016) |
$140.80 |
$176 |
1.6× |
| Mr safety implant&/fb assmt clin staf 1st 15 min (76014) |
$40 |
$50 |
1.4× |
| Mr safety implt electronics prepj supvj phys/qhp (76018) |
$147.20 |
$184 |
1.6× |
| Mr safety implt pos&/immoblj (76019) |
$95.20 |
$119 |
1.6× |
| Mr safety med physics xm customization plng&mntr (76017) |
$386.40 |
$483 |
1.6× |
| Mra Head W/O & W/Contrast Material (70546) |
$3,091.20 |
$3,864 |
8.9× |
| MRA head w/o contrast (70544) |
$2,231.20 |
$2,789 |
9.4× |
| Mra Neck W/O &W/Contrast Material (70549) |
$3,245.60 |
$4,057 |
9.3× |
| MRA neck w/o contrast (70547) |
$1,968.80 |
$2,461 |
8.3× |
| MRI abdomen w contrast (74182) |
$2,454.40 |
$3,068 |
7.1× |
| MRI abdomen w/o contrast (74181) |
$2,404.80 |
$3,006 |
10.1× |
| MRI any jt lower extrem w/contrast material (73722) |
$2,231.20 |
$2,789 |
2.9× |
| MRI any jt lower extrem w/o & w/contrast matrl (73723) |
$2,892 |
$3,615 |
8.3× |
| MRI any jt upper extremity w/contrast matrl (73222) |
$2,598.40 |
$3,248 |
3.3× |
| MRI cervical spine w contrast (72142) |
$2,830.40 |
$3,538 |
8.1× |
| MRI cervical spine w/o cont (72141) |
$2,506.40 |
$3,133 |
10.5× |
| MRI chest w/o contrast (71550) |
$2,404.80 |
$3,006 |
10.1× |
| MRI chest wo w contrast (71552) |
$3,380 |
$4,225 |
9.7× |
| MRI lower extrem oth/thn jt w/o & w/contr matr (73720) |
$3,439.20 |
$4,299 |
9.9× |
| MRI lower extrem oth/thn jt w/o contr matrl (73718) |
$2,475.20 |
$3,094 |
10.4× |
| MRI lumbar spine w contrast (72149) |
$3,286.40 |
$4,108 |
9.5× |
| Mri Neck Spine W/O & W/Dye (72156) |
$3,985.60 |
$4,982 |
11.5× |
| MRI orbit face &/neck w/o contrast (70540) |
$2,496 |
$3,120 |
10.5× |
| MRI orbit face neck w contrast (70542) |
$3,286.40 |
$4,108 |
9.5× |
| Mri Orbt/Fac/Nck W/O &W/Dye (70543) |
$3,763.20 |
$4,704 |
10.8× |
| MRI pelvis w contrast (72196) |
$2,454.40 |
$3,068 |
7.1× |
| MRI pelvis w/o & w contrast (72197) |
$3,540 |
$4,425 |
10.2× |
| MRI pelvis w/o contrast (72195) |
$2,353.60 |
$2,942 |
9.9× |
| MRI thoracic spine w/o contrast (72146) |
$2,496 |
$3,120 |
10.5× |
| MRI upper extremity oth than jt w/o contr matrl (73218) |
$2,151.20 |
$2,689 |
9.0× |
| Mri Uppr Extremity W/O&W/Dye (73220) |
$3,439.20 |
$4,299 |
9.9× |
| MRI, abdomen, combo (74183) |
$3,399.20 |
$4,249 |
9.8× |
| MRI, dorsal spine combo (72157) |
$4,036.80 |
$5,046 |
11.6× |
| MRI, dorsal spine contrast (72147) |
$2,830.40 |
$3,538 |
8.1× |
| MRI, joint upper extrem (73221) |
$2,576 |
$3,220 |
10.8× |
| MRI, joint upper extrem combo (73223) |
$3,537.60 |
$4,422 |
10.2× |
| MRI, lumbar spine combo (72158) |
$4,077.60 |
$5,097 |
11.7× |
| Myocardial Spect Multiple Studies (78452) |
$3,448 |
$4,310 |
2.7× |
| Neck soft tissue (70360) |
$218.40 |
$273 |
2.5× |
| Parathyroid Planar Imaging (78070) |
$1,447.20 |
$1,809 |
3.6× |
| Parathyroid planar imaging w/wo subtraction (78071) |
$1,913.60 |
$2,392 |
4.8× |
| Pelvis 1 or 2 views (72170) |
$227.20 |
$284 |
2.2× |
| PET image w/CT, full body (78816) |
$6,200.80 |
$7,751 |
4.4× |
| PET imaging CT attenuation skull base mid-thigh (78815) |
$6,077.60 |
$7,597 |
4.3× |
| Pulmonary Perfusion Imaging Particulate (78580) |
$815.20 |
$1,019 |
2.0× |
| Radex Abd Compl Aqt Abd W/S/E/D Views 1 View Ch (74022) |
$475.20 |
$594 |
4.6× |
| Radex abscess/fistula/sinus tract rs&i (76080) |
$672.80 |
$841 |
1.2× |
| Radex Ankle Complete Minimum 3 Views (73610) |
$313.60 |
$392 |
3.6× |
| Radex Calcaneus Minimum 2 Views (73650) |
$240.80 |
$301 |
2.8× |
| Radex elbow complete minimum 3 views (73080) |
$230.40 |
$288 |
2.7× |
| Radex Facial Bones Complete Minimum 3 Views (70150) |
$313.60 |
$392 |
3.0× |
| Radex fingr minimum 2 views (73140) |
$187.20 |
$234 |
2.2× |
| Radex foot complete minimum 3 views (73630) |
$313.60 |
$392 |
3.6× |
| Radex Hand Minimum 3 Views (73130) |
$302.40 |
$378 |
3.5× |
| Radex lower extremity infant minimum 2 views (73592) |
$175.20 |
$219 |
2.0× |
| Radex Nasal Bones Complete Minimum 3 Views (70160) |
$302.40 |
$378 |
3.5× |
| Radex Ribs Unilateral 2 Views (71100) |
$187.20 |
$234 |
2.2× |
| Radex shoulder complete minimum 2 views (73030) |
$313.60 |
$392 |
3.6× |
| Radex Sinuses Paransl < 3 Views (70210) |
$302.40 |
$378 |
3.5× |
| Radex Spine 1 View Specify Level (72020) |
$218.40 |
$273 |
2.5× |
| Radex Sternum Minimum 2 Views (71120) |
$249.60 |
$312 |
2.9× |
| Radex Temporomandble Jt Opn & Clsd Mouth Bilat (70330) |
$416.80 |
$521 |
4.8× |
| Radex Toe Minimum 2 Views (73660) |
$108.80 |
$136 |
1.3× |
| Radex upper extremity infant minimum 2 views (73092) |
$167.20 |
$209 |
1.6× |
| Radex Wrist Complete Minimum 3 Views (73110) |
$308 |
$385 |
3.6× |
| Radiolog exam mandible compl minimum 4 views (70110) |
$334.40 |
$418 |
3.2× |
| Radiologic Exam Abdomen 3+ Views - Xr Abdomen 3+ Views (74021) |
$386.40 |
$483 |
3.7× |
| Radiologic exam colon double contrast study (74280) |
$751.20 |
$939 |
4.3× |
| Radiologic exam colon single contrast study (74270) |
$564 |
$705 |
3.2× |
| Radiologic exam knee complete 4/more views (73564) |
$344.80 |
$431 |
3.3× |
| Radiologic exam pelvis compl minimum 3 views (72190) |
$386.40 |
$483 |
3.7× |
| Radiologic Exam Small Int Single Contrast Study (74250) |
$469.60 |
$587 |
2.7× |
| Radiologic exam swallow function contrast study (74230) |
$408.80 |
$511 |
2.3× |
| Radiologic exam upr gi trc double contrast study (74246) |
$695.20 |
$869 |
4.0× |
| Radiologic examination femur 1 view (73551) |
$218.40 |
$273 |
2.5× |
| Radiologic examination femur minimum 2 views (73552) |
$230.40 |
$288 |
2.7× |
| Radiologic examination knee 1/2 views (73560) |
$261.60 |
$327 |
3.0× |
| Radiologic examination tibia & fibula 2 views (73590) |
$249.60 |
$312 |
2.9× |
| Ribs bilateral 3 views (71110) |
$249.60 |
$312 |
2.4× |
| Rp loclzj tum plnr 1 area single day imaging (78800) |
$918.40 |
$1,148 |
2.3× |
| Rp loclzj tum plnr 2+area 1+d img/1 area img>2+d (78801) |
$1,104.80 |
$1,381 |
2.8× |
| Rp Loclzj Tum Spect 1 Area Single Day Imaging (78803) |
$1,551.20 |
$1,939 |
2.9× |
| Rp loclzj tum spect 2 area/sep acquisj img (78831) |
$1,551.20 |
$1,939 |
1.2× |
| Scapula (73010) |
$249.60 |
$312 |
2.4× |
| Screening Digital Breast Tomosynthesis Bi (77063) |
$51.20 |
$64 |
2.2× |
| Shoulder 1 view (73020) |
$178.40 |
$223 |
2.1× |
| Skull less than 4 views (70250) |
$249.60 |
$312 |
2.4× |
| Sternoclavicular joints (71130) |
$218.40 |
$273 |
2.5× |
| Thoracic spine 2 views (72070) |
$230.40 |
$288 |
2.2× |
| Thoracic spine 3 views (72072) |
$292.80 |
$366 |
2.8× |
| Thoracolumbar 2 views (72080) |
$178.40 |
$223 |
2.1× |
| Thyroid Imaging With Vascular Flow (78013) |
$792 |
$990 |
2.0× |
| Ultrasound Breast Limited (76642) |
$316.80 |
$396 |
3.7× |
| Ultrasound Exam Aaa Screen (76706) |
$460.80 |
$576 |
4.4× |
| Ultrasound, abdomen limited (76705) |
$614.40 |
$768 |
5.9× |
| Upper gi w/o kub (74240) |
$656 |
$820 |
3.8× |
| Urethrocystogram voiding (74455) |
$648 |
$810 |
2.7× |
| Us breast unilateral complete (76641) |
$368 |
$460 |
3.5× |
| Us chest (76604) |
$482.40 |
$603 |
4.6× |
| Us exam, pelvic, limited (76857) |
$470.40 |
$588 |
4.5× |
| Us head (76506) |
$564.80 |
$706 |
5.4× |
| Us kidney transplant (76776) |
$748 |
$935 |
7.2× |
| Us lmtd joint/oth nonvasc xtr strux r-t w/img (76882) |
$432 |
$540 |
4.1× |
| Us ob detailed single fetus (76811) |
$841.60 |
$1,052 |
3.5× |
| Us ob limited 1 or more fetuses (76815) |
$470.40 |
$588 |
4.5× |
| Us ob transvaginal (76817) |
$460.80 |
$576 |
4.4× |
| Us pelvic non ob complete (76856) |
$738.40 |
$923 |
7.1× |
| Us pg uter img f&mat 14 wk tabdl 1/1st gestation (76801) |
$757.60 |
$947 |
7.3× |
| Us preg uterus real time f/u trnsabdl per fetus (76816) |
$460.80 |
$576 |
4.4× |
| Us retroperitoneal complete (76770) |
$707.20 |
$884 |
6.8× |
| Us retroperitoneal limited (76775) |
$501.60 |
$627 |
4.8× |
| Us scrotum and contents (76870) |
$696 |
$870 |
6.7× |
| Us spinal canal and contents (76800) |
$707.20 |
$884 |
6.8× |
| Us thyroid (76536) |
$490.40 |
$613 |
4.7× |
| Wrist 2 views (73100) |
$218.40 |
$273 |
2.5× |
| X-Ray Ac Jts - Xr Acromioclavicular Joints Bilateral (73050) |
$261.60 |
$327 |
3.0× |
| X-Ray Bend Only L-S Spine (72120) |
$446.40 |
$558 |
4.3× |
| X-Ray Elbow 2 Vw - Xr Elbow 1-2 Views Right (73070) |
$240.80 |
$301 |
2.8× |
| X-Ray Exam Breast Specimen (76098) |
$672.80 |
$841 |
1.2× |
| X-Ray Exam Entire Spi 1 Vw (72081) |
$270.40 |
$338 |
3.1× |
| X-Ray Exam Entire Spi 2/3 Vw (72082) |
$446.40 |
$558 |
4.3× |
| X-Ray Exam Entire Spi 4/5 Vw (72083) |
$439.20 |
$549 |
4.2× |
| X-Ray Exam Hip Uni 1 View (73501) |
$108.80 |
$136 |
1.3× |
| X-Ray Exam Hip Uni 2-3 Views (73502) |
$194.40 |
$243 |
2.2× |
| X-Ray Exam Hips Bi 2 Views (73521) |
$365.60 |
$457 |
3.5× |
| X-Ray Exam Hips Bi 3-4 Views (73522) |
$569.60 |
$712 |
5.5× |
| X-Ray Exam Hips Bi 5/> Views (73523) |
$628.80 |
$786 |
6.0× |
| X-Ray Exam L-S Spine Bending (72114) |
$491.20 |
$614 |
4.7× |
| X-Ray Exam Neck Spine 2-3 Vw (72040) |
$302.40 |
$378 |
3.5× |
| X-Ray Exam Neck Spine 6/>Vws (72052) |
$460 |
$575 |
4.4× |
| X-Ray Exam Unilat Ribs/Chest (71101) |
$344.80 |
$431 |
3.3× |
| X-ray eye for foreign body (70030) |
$313.60 |
$392 |
3.6× |
| X-ray humerus (73060) |
$270.40 |
$338 |
3.1× |
| X-ray IV pyelogram (ivp) (74400) |
$876.80 |
$1,096 |
5.0× |
| X-Ray Jaw <4 Vw - Xr Mandible < 4 Views (70100) |
$213.60 |
$267 |
2.5× |
| X-Ray Knee Bilat Standing - Xr Knees Anteroposterior Standing Bilat (73565) |
$281.60 |
$352 |
3.2× |
| X-Ray Lumbar Spine 2/3 Vw - Xr Lumbar Spine 2-3 Views (72100) |
$344.80 |
$431 |
3.3× |
| X-ray nose-rectum child f.b. (76010) |
$200 |
$250 |
2.3× |
| X-Ray Ribs, Chest 4+ Vw - Xr Ribs 3 Vws Bil W/ Chest Posteroanterior (71111) |
$439.20 |
$549 |
4.2× |
| X-Ray Sacroiliac Jts 3+ Vw - Xr Sacroiliac Joints 3+ Views (72202) |
$313.60 |
$392 |
3.0× |
| X-Ray Sacroiliac Jts <3 Vw - Xr Sacroiliac Joints 1-2 Views (72200) |
$209.60 |
$262 |
2.0× |
| X-Ray Sacrum/Coccyx 2+ Vw - Xr Sacrum Coccyx 2+ Views (72220) |
$281.60 |
$352 |
3.2× |
| X-Ray Sinuses 3+ Vw - Xr Paranasal Sinuses 3+ Views (70220) |
$324 |
$405 |
3.7× |
| X-Ray Skull 4+ Vw - Xr Skull Complete 4+ Views (70260) |
$376.80 |
$471 |
3.6× |
| X-Ray Stress View (77071) |
$152.80 |
$191 |
1.8× |
| X-ray thoracic spine 4 vw (72074) |
$416.80 |
$521 |
4.0× |
| X-Ray Tmj Unilat (70328) |
$240.80 |
$301 |
2.8× |
| X-Rays Bone Length Studies (77073) |
$313.60 |
$392 |
3.0× |
| X-Rays Bone Survey Complete (77075) |
$469.60 |
$587 |
4.5× |
| Xr c-spine 4 or 5 views (72050) |
$439.20 |
$549 |
4.2× |
| Xr facial bones less than 3 views (70140) |
$239.20 |
$299 |
2.8× |
| Xr orbits complete 4 views (70200) |
$184.80 |
$231 |
1.8× |