| Abdomen 1 View (74018) |
$140 |
$175 |
1.7× |
| Abdomen 2 views (74019) |
$140 |
$175 |
1.4× |
| Ankle 2 views (73600) |
$129.60 |
$162 |
1.5× |
| Bone age studies (77072) |
$129.60 |
$162 |
1.3× |
| Bone Imaging 3 Phase (78315) |
$963.20 |
$1,204 |
2.5× |
| Bone Imaging Limited Area (78300) |
$704.80 |
$881 |
1.8× |
| Bone Imaging Multiple Areas (78305) |
$722.40 |
$903 |
1.9× |
| Bone Imaging Whole Body (78306) |
$726.40 |
$908 |
1.9× |
| Cat Scan Follow-Up Study (76380) |
$465.60 |
$582 |
5.6× |
| Chest 1 view (71045) |
$131.20 |
$164 |
1.6× |
| Chest 2 views (71046) |
$196.80 |
$246 |
2.4× |
| Chest 3 views (71047) |
$140 |
$175 |
1.7× |
| Chest 4 or more views (71048) |
$140 |
$175 |
1.4× |
| Clavicle complete (73000) |
$129.60 |
$162 |
1.5× |
| Computed Tomography Thorax Lw Dose Lng Ca Scr C- (71271) |
$236 |
$295 |
2.3× |
| Contrast X-Ray Bladder (74430) |
$453.60 |
$567 |
1.4× |
| CT abdomen and pelvis without and with contrast (74178) |
$2,743.20 |
$3,429 |
8.2× |
| CT abdomen and pelvis without contrast (74176) |
$2,718.40 |
$3,398 |
11.9× |
| CT abdomen w contrast (74160) |
$1,459.20 |
$1,824 |
8.7× |
| CT abdomen w wo contrast (74170) |
$1,370.40 |
$1,713 |
8.1× |
| CT abdomen w/o contrast (74150) |
$1,358.40 |
$1,698 |
13.5× |
| CT Angio Abdomen and Pelvis (74174) |
$2,358.40 |
$2,948 |
7.0× |
| CT Angio Chest (71275) |
$1,900.80 |
$2,376 |
11.3× |
| CT Angio Head (70496) |
$1,713.60 |
$2,142 |
10.2× |
| CT Angio Neck (70498) |
$1,713.60 |
$2,142 |
10.2× |
| CT cervical spine w/ contrast (72126) |
$1,204 |
$1,505 |
3.6× |
| CT cervical spine w/o contrast (72125) |
$1,420 |
$1,775 |
14.1× |
| CT cervical spine w/wo cont (72127) |
$1,370.40 |
$1,713 |
8.1× |
| CT chest w contrast (71260) |
$1,737.60 |
$2,172 |
10.3× |
| CT chest w/wo contrast (71270) |
$1,370.40 |
$1,713 |
8.1× |
| CT head/brain with contrast (70460) |
$1,278.40 |
$1,598 |
7.6× |
| CT head/brain without and with contrast (70470) |
$1,692 |
$2,115 |
10.0× |
| CT iac w contrast (70481) |
$1,278.40 |
$1,598 |
7.6× |
| CT l-spine w&w/o contrast (72133) |
$1,370.40 |
$1,713 |
8.1× |
| CT lower ext w/o (73700) |
$1,370.40 |
$1,713 |
13.6× |
| CT lower extremity w/contrast material (73701) |
$1,517.60 |
$1,897 |
9.0× |
| CT lumbar spine w contrast (72132) |
$1,204 |
$1,505 |
3.6× |
| CT lumbar spine w/o contrast (72131) |
$1,410.40 |
$1,763 |
14.0× |
| CT maxillofacial w contrast (70487) |
$1,460 |
$1,825 |
8.7× |
| CT maxillofacial wo contrast (70486) |
$1,388 |
$1,735 |
13.8× |
| CT neck tissue combo (70492) |
$1,488 |
$1,860 |
8.8× |
| Ct Orbit/Ear/Fossa W/O&W/Dye (70482) |
$1,424.80 |
$1,781 |
8.4× |
| CT orbits w/o contrast (70480) |
$1,392.80 |
$1,741 |
13.9× |
| CT pelvis w&w/o contrast (72194) |
$1,370.40 |
$1,713 |
8.1× |
| CT pelvis w/o contrast (72192) |
$1,358.40 |
$1,698 |
13.5× |
| CT scan of leg combo (73702) |
$1,370.40 |
$1,713 |
8.1× |
| CT scans face/jaw combo (70488) |
$1,424.80 |
$1,781 |
8.4× |
| CT soft tissue neck w contrast (70491) |
$1,526.40 |
$1,908 |
9.1× |
| CT soft tissue neck w/o contrast (70490) |
$1,452 |
$1,815 |
14.4× |
| CT thoracic spine w contrast (72129) |
$1,204 |
$1,505 |
7.1× |
| CT thoracic spine w/o contrast (72128) |
$1,410.40 |
$1,763 |
14.0× |
| CT thoracic spine w/wo cont (72130) |
$1,370.40 |
$1,713 |
8.1× |
| CT thorax w/o contrast (71250) |
$1,632.80 |
$2,041 |
16.2× |
| CT upper ext wo (73200) |
$1,358.40 |
$1,698 |
13.5× |
| CT upper extremity w/o & w/contrast material (73202) |
$1,370.40 |
$1,713 |
8.1× |
| CT upper extremity with contrast (73201) |
$1,204 |
$1,505 |
3.6× |
| Cta Abdl Aorta&Bi Iliofem W/Contrast&Postp (75635) |
$2,178.40 |
$2,723 |
12.9× |
| Cta Abdomen (74175) |
$2,000 |
$2,500 |
11.9× |
| Dxa Bone Density Axial (77080) |
$297.60 |
$372 |
3.0× |
| Dxa bone density study (77085) |
$240.80 |
$301 |
2.4× |
| Dxa bone density study 1/>sites appendiclr skel (77081) |
$201.60 |
$252 |
2.4× |
| Fetal Biophysical Profile W/O Non-Stress Testing (76819) |
$269.60 |
$337 |
2.7× |
| Fluoroscopy up to 1 hr (76000) |
$236.80 |
$296 |
1.0× |
| Foot 2 views (73620) |
$129.60 |
$162 |
1.5× |
| Forearm 2 views (73090) |
$129.60 |
$162 |
1.5× |
| Gated Heart Planar Single (78472) |
$705.60 |
$882 |
1.8× |
| Gated Heart, Multiple (78473) |
$690.40 |
$863 |
1.8× |
| Hand 2 views (73120) |
$129.60 |
$162 |
1.3× |
| Hepatobil Syst Image W/Drug (78227) |
$963.20 |
$1,204 |
1.8× |
| Hepatobiliary System Imaging (78226) |
$731.20 |
$914 |
1.9× |
| Joint Survey Single View (77077) |
$129.60 |
$162 |
1.3× |
| K Flow/Funct Image W/Drug (78708) |
$722.40 |
$903 |
1.4× |
| K Flow/Funct Image W/O Drug (78707) |
$704.80 |
$881 |
1.4× |
| Knee 3 Views (73562) |
$185.60 |
$232 |
2.2× |
| Magnetic Image Jaw Joint (70336) |
$1,260 |
$1,575 |
5.5× |
| Mra Head W/O & W/Contrast Material (70546) |
$2,322.40 |
$2,903 |
6.9× |
| MRA head w/o contrast (70544) |
$1,282.40 |
$1,603 |
5.6× |
| MRA head with contrast (70545) |
$1,759.20 |
$2,199 |
5.2× |
| MRA neck w contrast (70548) |
$1,759.20 |
$2,199 |
5.2× |
| Mra Neck W/O &W/Contrast Material (70549) |
$2,322.40 |
$2,903 |
6.9× |
| MRA neck w/o contrast (70547) |
$1,220.80 |
$1,526 |
5.3× |
| MRI abdomen w contrast (74182) |
$1,494.40 |
$1,868 |
4.5× |
| MRI abdomen w/o contrast (74181) |
$1,246.40 |
$1,558 |
5.4× |
| MRI any jt lower extrem w/contrast material (73722) |
$1,475.20 |
$1,844 |
2.0× |
| MRI any jt lower extrem w/o & w/contrast matrl (73723) |
$2,612 |
$3,265 |
7.8× |
| MRI any jt upper extremity w/contrast matrl (73222) |
$1,475.20 |
$1,844 |
2.0× |
| MRI cervical spine w contrast (72142) |
$1,530.40 |
$1,913 |
4.6× |
| MRI cervical spine w/o cont (72141) |
$1,416 |
$1,770 |
6.2× |
| MRI chest w/o contrast (71550) |
$1,246.40 |
$1,558 |
5.4× |
| MRI chest with contrast (71551) |
$1,494.40 |
$1,868 |
2.0× |
| MRI chest wo w contrast (71552) |
$2,616.80 |
$3,271 |
7.8× |
| MRI lower extrem oth/thn jt w/contrast matrl (73719) |
$1,475.20 |
$1,844 |
4.4× |
| MRI lower extrem oth/thn jt w/o & w/contr matr (73720) |
$2,612 |
$3,265 |
7.8× |
| MRI lower extrem oth/thn jt w/o contr matrl (73718) |
$1,230.40 |
$1,538 |
5.4× |
| MRI lumbar spine w contrast (72149) |
$1,513.60 |
$1,892 |
4.5× |
| Mri Neck Spine W/O & W/Dye (72156) |
$2,696.80 |
$3,371 |
8.0× |
| MRI orbit face &/neck w/o contrast (70540) |
$1,230.40 |
$1,538 |
5.4× |
| MRI orbit face neck w contrast (70542) |
$1,746.40 |
$2,183 |
5.2× |
| Mri Orbt/Fac/Nck W/O &W/Dye (70543) |
$2,612 |
$3,265 |
7.8× |
| MRI pelvis w contrast (72196) |
$1,494.40 |
$1,868 |
4.5× |
| MRI pelvis w/o & w contrast (72197) |
$2,631.20 |
$3,289 |
7.8× |
| MRI pelvis w/o contrast (72195) |
$1,246.40 |
$1,558 |
5.4× |
| MRI thoracic spine w/o contrast (72146) |
$1,392.80 |
$1,741 |
6.1× |
| MRI upper extremity oth than jt w/o contr matrl (73218) |
$1,230.40 |
$1,538 |
5.4× |
| Mri Uppr Extremity W/O&W/Dye (73220) |
$2,612 |
$3,265 |
7.8× |
| MRI, abdomen, combo (74183) |
$2,631.20 |
$3,289 |
7.8× |
| MRI, dorsal spine combo (72157) |
$2,696.80 |
$3,371 |
8.0× |
| MRI, dorsal spine contrast (72147) |
$1,530.40 |
$1,913 |
4.6× |
| MRI, joint upper extrem (73221) |
$1,291.20 |
$1,614 |
5.6× |
| MRI, joint upper extrem combo (73223) |
$2,612 |
$3,265 |
7.8× |
| MRI, lumbar spine combo (72158) |
$2,669.60 |
$3,337 |
8.0× |
| Neck soft tissue (70360) |
$129.60 |
$162 |
1.5× |
| Parathyroid Planar Imaging (78070) |
$530.40 |
$663 |
1.4× |
| Parathyroid planar imaging w/wo subtraction (78071) |
$381.60 |
$477 |
1.0× |
| Pelvis 1 or 2 views (72170) |
$129.60 |
$162 |
1.3× |
| Pulmonary Perfusion Imaging Particulate (78580) |
$872.80 |
$1,091 |
2.3× |
| Radex Abd Compl Aqt Abd W/S/E/D Views 1 View Ch (74022) |
$275.20 |
$344 |
2.7× |
| Radex Ankle Complete Minimum 3 Views (73610) |
$134.40 |
$168 |
1.6× |
| Radex Calcaneus Minimum 2 Views (73650) |
$129.60 |
$162 |
1.5× |
| Radex elbow complete minimum 3 views (73080) |
$134.40 |
$168 |
1.6× |
| Radex Facial Bones Complete Minimum 3 Views (70150) |
$188.80 |
$236 |
1.9× |
| Radex fingr minimum 2 views (73140) |
$134.40 |
$168 |
1.6× |
| Radex foot complete minimum 3 views (73630) |
$134.40 |
$168 |
1.6× |
| Radex Hand Minimum 3 Views (73130) |
$134.40 |
$168 |
1.6× |
| Radex lower extremity infant minimum 2 views (73592) |
$129.60 |
$162 |
1.5× |
| Radex Mastoids Compl Minimum 3 Views PR Side (70130) |
$129.60 |
$162 |
1.3× |
| Radex Nasal Bones Complete Minimum 3 Views (70160) |
$188.80 |
$236 |
2.3× |
| Radex Ribs Unilateral 2 Views (71100) |
$129.60 |
$162 |
1.5× |
| Radex shoulder complete minimum 2 views (73030) |
$134.40 |
$168 |
1.6× |
| Radex Sinuses Paransl < 3 Views (70210) |
$144.80 |
$181 |
1.7× |
| Radex Spine 1 View Specify Level (72020) |
$129.60 |
$162 |
1.5× |
| Radex Sternum Minimum 2 Views (71120) |
$173.60 |
$217 |
2.1× |
| Radex Temporomandble Jt Opn & Clsd Mouth Bilat (70330) |
$129.60 |
$162 |
1.5× |
| Radex Toe Minimum 2 Views (73660) |
$134.40 |
$168 |
1.6× |
| Radex upper extremity infant minimum 2 views (73092) |
$129.60 |
$162 |
1.3× |
| Radex Wrist Complete Minimum 3 Views (73110) |
$134.40 |
$168 |
1.6× |
| Radiolog exam mandible compl minimum 4 views (70110) |
$129.60 |
$162 |
1.3× |
| Radiologic Exam Abdomen 3+ Views - Xr Abdomen 3+ Views (74021) |
$140 |
$175 |
1.4× |
| Radiologic exam knee complete 4/more views (73564) |
$144 |
$180 |
1.4× |
| Radiologic exam pelvis compl minimum 3 views (72190) |
$134.40 |
$168 |
1.3× |
| Radiologic Exam Small Int Single Contrast Study (74250) |
$263.20 |
$329 |
1.6× |
| Radiologic examination femur 1 view (73551) |
$129.60 |
$162 |
1.5× |
| Radiologic examination femur minimum 2 views (73552) |
$134.40 |
$168 |
1.6× |
| Radiologic examination knee 1/2 views (73560) |
$129.60 |
$162 |
1.5× |
| Radiologic Examination Osseous Survey Limited (77074) |
$222.40 |
$278 |
2.2× |
| Radiologic examination tibia & fibula 2 views (73590) |
$129.60 |
$162 |
1.5× |
| Ribs bilateral 3 views (71110) |
$173.60 |
$217 |
1.7× |
| Scapula (73010) |
$134.40 |
$168 |
1.3× |
| Screening Digital Breast Tomosynthesis Bi (77063) |
$23.20 |
$29 |
1.0× |
| Shoulder 1 view (73020) |
$129.60 |
$162 |
1.5× |
| Skull less than 4 views (70250) |
$144.80 |
$181 |
1.4× |
| Sternoclavicular joints (71130) |
$134.40 |
$168 |
1.6× |
| Thoracic spine 2 views (72070) |
$129.60 |
$162 |
1.3× |
| Thoracic spine 3 views (72072) |
$134.40 |
$168 |
1.3× |
| Thoracolumbar 2 views (72080) |
$129.60 |
$162 |
1.5× |
| Thyroid Imaging With Vascular Flow (78013) |
$402.40 |
$503 |
1.0× |
| Thyroid Uptake Measurement (78012) |
$412 |
$515 |
1.1× |
| Thyroid Uptake W/Blood Flow Sngle/Mult Quan Meas (78014) |
$437.60 |
$547 |
1.1× |
| Ultrasound Breast Limited (76642) |
$284.80 |
$356 |
3.4× |
| Ultrasound Exam Aaa Screen (76706) |
$276.80 |
$346 |
2.8× |
| Ultrasound, abdomen limited (76705) |
$300 |
$375 |
3.0× |
| Unlisted us procedure (76999) |
$168 |
$210 |
2.0× |
| Us breast unilateral complete (76641) |
$328 |
$410 |
3.3× |
| Us chest (76604) |
$269.60 |
$337 |
2.7× |
| Us complete joint (76881) |
$269.60 |
$337 |
2.7× |
| Us exam, pelvic, limited (76857) |
$280 |
$350 |
2.8× |
| Us kidney transplant (76776) |
$665.60 |
$832 |
6.6× |
| Us lmtd joint/oth nonvasc xtr strux r-t w/img (76882) |
$240 |
$300 |
2.4× |
| Us ob detailed single fetus (76811) |
$616 |
$770 |
2.7× |
| Us ob limited 1 or more fetuses (76815) |
$225.60 |
$282 |
2.2× |
| Us ob transvaginal (76817) |
$269.60 |
$337 |
2.7× |
| Us pelvic non ob complete (76856) |
$302.40 |
$378 |
3.0× |
| Us pg uter img f&mat 14 wk tabdl 1/1st gestation (76801) |
$336.80 |
$421 |
3.4× |
| Us preg uterus real time f/u trnsabdl per fetus (76816) |
$225.60 |
$282 |
2.2× |
| Us retroperitoneal complete (76770) |
$355.20 |
$444 |
3.5× |
| Us retroperitoneal limited (76775) |
$300 |
$375 |
3.0× |
| Us scrotum and contents (76870) |
$380.80 |
$476 |
3.8× |
| Us thyroid (76536) |
$269.60 |
$337 |
2.7× |
| Us transrectal (76872) |
$286.40 |
$358 |
2.8× |
| Wrist 2 views (73100) |
$129.60 |
$162 |
1.5× |
| X-Ray Ac Jts - Xr Acromioclavicular Joints Bilateral (73050) |
$129.60 |
$162 |
1.5× |
| X-Ray Bend Only L-S Spine (72120) |
$134.40 |
$168 |
1.3× |
| X-Ray Elbow 2 Vw - Xr Elbow 1-2 Views Right (73070) |
$129.60 |
$162 |
1.5× |
| X-Ray Exam Breast Specimen (76098) |
$124 |
$155 |
0.2× |
| X-Ray Exam Entire Spi 1 Vw (72081) |
$129.60 |
$162 |
1.5× |
| X-Ray Exam Entire Spi 2/3 Vw (72082) |
$129.60 |
$162 |
1.3× |
| X-Ray Exam Entire Spi 4/5 Vw (72083) |
$222.40 |
$278 |
2.2× |
| X-Ray Exam Hip Uni 1 View (73501) |
$129.60 |
$162 |
1.5× |
| X-Ray Exam Hip Uni 2-3 Views (73502) |
$134.40 |
$168 |
1.6× |
| X-Ray Exam Hips Bi 2 Views (73521) |
$264.80 |
$331 |
2.6× |
| X-Ray Exam Hips Bi 3-4 Views (73522) |
$267.20 |
$334 |
2.7× |
| X-Ray Exam L-S Spine Bending (72114) |
$222.40 |
$278 |
2.2× |
| X-Ray Exam Neck Spine 2-3 Vw (72040) |
$134.40 |
$168 |
1.6× |
| X-Ray Exam Neck Spine 6/>Vws (72052) |
$222.40 |
$278 |
2.2× |
| X-Ray Exam Unilat Ribs/Chest (71101) |
$129.60 |
$162 |
1.3× |
| X-ray eye for foreign body (70030) |
$129.60 |
$162 |
1.5× |
| X-ray humerus (73060) |
$129.60 |
$162 |
1.5× |
| X-ray IV pyelogram (ivp) (74400) |
$453.60 |
$567 |
2.7× |
| X-Ray Jaw <4 Vw - Xr Mandible < 4 Views (70100) |
$129.60 |
$162 |
1.5× |
| X-Ray Knee Bilat Standing - Xr Knees Anteroposterior Standing Bilat (73565) |
$129.60 |
$162 |
1.5× |
| X-Ray Lumbar Spine 2/3 Vw - Xr Lumbar Spine 2-3 Views (72100) |
$203.20 |
$254 |
2.0× |
| X-ray nose-rectum child f.b. (76010) |
$129.60 |
$162 |
1.5× |
| X-Ray Ribs, Chest 4+ Vw - Xr Ribs 3 Vws Bil W/ Chest Posteroanterior (71111) |
$179.20 |
$224 |
1.8× |
| X-Ray Sacroiliac Jts 3+ Vw - Xr Sacroiliac Joints 3+ Views (72202) |
$134.40 |
$168 |
1.3× |
| X-Ray Sacrum/Coccyx 2+ Vw - Xr Sacrum Coccyx 2+ Views (72220) |
$134.40 |
$168 |
1.6× |
| X-Ray Sinuses 3+ Vw - Xr Paranasal Sinuses 3+ Views (70220) |
$188.80 |
$236 |
2.3× |
| X-Ray Skull 4+ Vw - Xr Skull Complete 4+ Views (70260) |
$222.40 |
$278 |
2.2× |
| X-Ray Stress View (77071) |
$129.60 |
$162 |
1.5× |
| X-Ray Tmj Unilat (70328) |
$129.60 |
$162 |
1.5× |
| X-Ray Urinary Tract Exam With Contrast Material (74420) |
$453.60 |
$567 |
1.4× |
| Xr c-spine 4 or 5 views (72050) |
$222.40 |
$278 |
2.2× |
| Xr facial bones less than 3 views (70140) |
$144.80 |
$181 |
1.7× |