| Abdomen 1 View (74018) |
$267.60 |
$446 |
3.3× |
| Abdomen 2 views (74019) |
$291 |
$485 |
3.0× |
| Acute Gastrointestinal Blood Loss Imaging (78278) |
$1,170 |
$1,950 |
3.1× |
| Ankle 2 views (73600) |
$163.80 |
$273 |
2.0× |
| Bone age studies (77072) |
$202.20 |
$337 |
2.1× |
| Bone Imaging 3 Phase (78315) |
$1,949.40 |
$3,249 |
5.2× |
| Bone Imaging Limited Area (78300) |
$1,414.20 |
$2,357 |
3.8× |
| Bone Imaging Multiple Areas (78305) |
$1,668 |
$2,780 |
4.4× |
| Bone Imaging Whole Body (78306) |
$2,177.40 |
$3,629 |
5.8× |
| Bone marrow imaging limited area (78102) |
$991.80 |
$1,653 |
2.6× |
| Bone survey infant (77076) |
$378.60 |
$631 |
3.9× |
| Cerebrospinal Fluid Flow W/O Matl Shunt Evaltj (78645) |
$1,074 |
$1,790 |
2.1× |
| Chest 1 view (71045) |
$186.60 |
$311 |
2.3× |
| Chest 2 views (71046) |
$67.80 |
$113 |
0.8× |
| Chest 3 views (71047) |
$286.80 |
$478 |
3.5× |
| Chest 4 or more views (71048) |
$155.40 |
$259 |
1.6× |
| Cholecystography Oral Contrast (74290) |
$296.40 |
$494 |
1.8× |
| Clavicle complete (73000) |
$218.40 |
$364 |
2.7× |
| Computed Tomography Thorax Lw Dose Lng Ca Scr C- (71271) |
$127.80 |
$213 |
1.3× |
| CT abdomen and pelvis without and with contrast (74178) |
$2,491.20 |
$4,152 |
7.6× |
| CT abdomen and pelvis without contrast (74176) |
$1,407 |
$2,345 |
6.3× |
| CT abdomen w contrast (74160) |
$712.20 |
$1,187 |
4.3× |
| CT abdomen w wo contrast (74170) |
$1,245.60 |
$2,076 |
7.6× |
| CT abdomen w/o contrast (74150) |
$879 |
$1,465 |
9.0× |
| CT Angio Abdomen and Pelvis (74174) |
$1,245.60 |
$2,076 |
3.8× |
| CT Angio Chest (71275) |
$996.60 |
$1,661 |
6.1× |
| CT Angio Head (70496) |
$1,285.80 |
$2,143 |
7.8× |
| Ct Angio Lwr Extr W/O&W/Dye (73706) |
$1,602.60 |
$2,671 |
9.7× |
| CT Angio Neck (70498) |
$1,362 |
$2,270 |
8.3× |
| Ct Angio Upr Extrm W/O&W/Dye (73206) |
$1,197.60 |
$1,996 |
7.3× |
| CT cervical spine w/ contrast (72126) |
$1,135.80 |
$1,893 |
3.5× |
| CT cervical spine w/o contrast (72125) |
$907.80 |
$1,513 |
9.3× |
| CT cervical spine w/wo cont (72127) |
$1,549.80 |
$2,583 |
9.4× |
| CT chest w contrast (71260) |
$526.80 |
$878 |
3.2× |
| CT chest w/wo contrast (71270) |
$1,245.60 |
$2,076 |
7.6× |
| CT head/brain with contrast (70460) |
$1,135.80 |
$1,893 |
6.9× |
| CT head/brain without and with contrast (70470) |
$1,285.80 |
$2,143 |
7.8× |
| CT iac w contrast (70481) |
$1,464 |
$2,440 |
8.9× |
| CT l-spine w&w/o contrast (72133) |
$1,449 |
$2,415 |
8.8× |
| CT lower ext w/o (73700) |
$703.20 |
$1,172 |
7.2× |
| CT lower extremity w/contrast material (73701) |
$1,453.80 |
$2,423 |
8.8× |
| CT lumbar spine w contrast (72132) |
$1,098 |
$1,830 |
3.4× |
| CT lumbar spine w/o contrast (72131) |
$703.20 |
$1,172 |
7.2× |
| CT maxillofacial w contrast (70487) |
$1,135.80 |
$1,893 |
6.9× |
| CT maxillofacial wo contrast (70486) |
$726.60 |
$1,211 |
7.4× |
| CT neck tissue combo (70492) |
$1,285.80 |
$2,143 |
7.8× |
| Ct Orbit/Ear/Fossa W/O&W/Dye (70482) |
$1,285.80 |
$2,143 |
7.8× |
| CT orbits w/o contrast (70480) |
$907.80 |
$1,513 |
9.3× |
| CT pelvis w&w/o contrast (72194) |
$1,245.60 |
$2,076 |
7.6× |
| CT pelvis w/o contrast (72192) |
$879 |
$1,465 |
9.0× |
| CT scan of leg combo (73702) |
$1,477.80 |
$2,463 |
9.0× |
| CT soft tissue neck w contrast (70491) |
$1,135.80 |
$1,893 |
6.9× |
| CT soft tissue neck w/o contrast (70490) |
$907.80 |
$1,513 |
9.3× |
| CT thoracic spine w contrast (72129) |
$1,098 |
$1,830 |
6.7× |
| CT thoracic spine w/o contrast (72128) |
$879 |
$1,465 |
9.0× |
| CT thorax w/o contrast (71250) |
$703.20 |
$1,172 |
7.2× |
| CT upper ext wo (73200) |
$879 |
$1,465 |
9.0× |
| CT upper extremity w/o & w/contrast material (73202) |
$1,245.60 |
$2,076 |
7.6× |
| CT upper extremity with contrast (73201) |
$1,098 |
$1,830 |
3.4× |
| Cta Abdl Aorta&Bi Iliofem W/Contrast&Postp (75635) |
$2,296.20 |
$3,827 |
14.0× |
| Cta Abdomen (74175) |
$2,296.20 |
$3,827 |
14.0× |
| Dxa Bone Density Axial (77080) |
$150.60 |
$251 |
1.5× |
| Esophagram (74220) |
$753 |
$1,255 |
4.6× |
| Fluoroscopy up to 1 hr (76000) |
$754.20 |
$1,257 |
3.4× |
| Foot 2 views (73620) |
$163.80 |
$273 |
2.0× |
| Forearm 2 views (73090) |
$218.40 |
$364 |
2.7× |
| Gastric emptying imaging study (78264) |
$1,999.80 |
$3,333 |
5.3× |
| Gastric Mucosa Imaging (78261) |
$1,093.20 |
$1,822 |
2.9× |
| Gated Heart Planar Single (78472) |
$1,608.60 |
$2,681 |
4.3× |
| Hand 2 views (73120) |
$163.80 |
$273 |
1.7× |
| Hepatobil Syst Image W/Drug (78227) |
$1,828.80 |
$3,048 |
3.6× |
| Hepatobiliary System Imaging (78226) |
$1,828.80 |
$3,048 |
4.9× |
| Ht Muscle Image Spect Sing (78451) |
$2,098.20 |
$3,497 |
1.7× |
| K Flow/Funct Image Multiple (78709) |
$1,791.60 |
$2,986 |
3.5× |
| K Flow/Funct Image W/O Drug (78707) |
$1,671 |
$2,785 |
3.3× |
| Knee 3 Views (73562) |
$313.20 |
$522 |
3.8× |
| Leveen/Shunt Patency Exam (78291) |
$1,206 |
$2,010 |
3.2× |
| Liver & Spleen Imaging Static Only (78215) |
$1,371.60 |
$2,286 |
3.7× |
| Liver & Spleen Imaging W/Vascular Flow (78216) |
$1,500.60 |
$2,501 |
4.0× |
| Liver imaging static only (78201) |
$916.80 |
$1,528 |
1.8× |
| Lung Perf&Ventilat Diferentl (78598) |
$1,763.40 |
$2,939 |
3.5× |
| Meckels Divert Exam (78290) |
$1,500.60 |
$2,501 |
4.0× |
| Mr safety determination physician/other qhp (76016) |
$138.60 |
$231 |
1.7× |
| Mr safety implant&/fb assmt clin staf 1st 15 min (76014) |
$38.40 |
$64 |
1.4× |
| Mr safety implt electronics prepj supvj phys/qhp (76018) |
$144 |
$240 |
1.6× |
| Mr safety implt pos&/immoblj (76019) |
$93.60 |
$156 |
1.7× |
| Mr safety med physics xm customization plng&mntr (76017) |
$380.40 |
$634 |
1.7× |
| Mra Head W/O & W/Contrast Material (70546) |
$2,511.60 |
$4,186 |
7.7× |
| MRA head w/o contrast (70544) |
$1,729.80 |
$2,883 |
7.7× |
| MRA head with contrast (70545) |
$2,161.80 |
$3,603 |
6.6× |
| MRA neck w contrast (70548) |
$2,161.80 |
$3,603 |
6.6× |
| Mra Neck W/O &W/Contrast Material (70549) |
$2,511.60 |
$4,186 |
7.7× |
| MRA neck w/o contrast (70547) |
$1,729.80 |
$2,883 |
7.7× |
| MRI abdomen w contrast (74182) |
$2,724 |
$4,540 |
8.3× |
| MRI abdomen w/o contrast (74181) |
$2,179.80 |
$3,633 |
9.7× |
| MRI any jt lower extrem w/contrast material (73722) |
$2,724 |
$4,540 |
3.7× |
| MRI any jt lower extrem w/o & w/contrast matrl (73723) |
$3,166.80 |
$5,278 |
9.7× |
| MRI any jt upper extremity w/contrast matrl (73222) |
$2,433 |
$4,055 |
3.3× |
| MRI Breast W/O Contrast Bilateral (77047) |
$1,962 |
$3,270 |
8.8× |
| MRI Breast Without Contrast Material Unilateral (77046) |
$2,256.60 |
$3,761 |
10.1× |
| MRI cervical spine w contrast (72142) |
$2,335.20 |
$3,892 |
7.1× |
| MRI cervical spine w/o cont (72141) |
$1,867.20 |
$3,112 |
8.3× |
| MRI chest w/o contrast (71550) |
$2,179.80 |
$3,633 |
9.7× |
| MRI chest with contrast (71551) |
$2,724 |
$4,540 |
3.7× |
| MRI chest wo w contrast (71552) |
$3,166.80 |
$5,278 |
9.7× |
| MRI lower extrem oth/thn jt w/contrast matrl (73719) |
$2,724 |
$4,540 |
8.3× |
| MRI lower extrem oth/thn jt w/o & w/contr matr (73720) |
$2,956.20 |
$4,927 |
9.0× |
| MRI lower extrem oth/thn jt w/o contr matrl (73718) |
$2,179.80 |
$3,633 |
9.7× |
| MRI lumbar spine w contrast (72149) |
$2,616 |
$4,360 |
8.0× |
| Mri Neck Spine W/O & W/Dye (72156) |
$2,714.40 |
$4,524 |
8.3× |
| MRI orbit face &/neck w/o contrast (70540) |
$1,752 |
$2,920 |
7.8× |
| MRI orbit face neck w contrast (70542) |
$2,638.20 |
$4,397 |
8.1× |
| Mri Orbt/Fac/Nck W/O &W/Dye (70543) |
$3,166.20 |
$5,277 |
9.7× |
| MRI pelvis w contrast (72196) |
$2,477.40 |
$4,129 |
7.6× |
| MRI pelvis w/o & w contrast (72197) |
$2,879.40 |
$4,799 |
8.8× |
| MRI pelvis w/o contrast (72195) |
$1,768.80 |
$2,948 |
7.9× |
| MRI thoracic spine w/o contrast (72146) |
$2,091.60 |
$3,486 |
9.3× |
| MRI upper extremity oth than jt w/contr matrl (73219) |
$2,724 |
$4,540 |
8.3× |
| MRI upper extremity oth than jt w/o contr matrl (73218) |
$2,179.80 |
$3,633 |
9.7× |
| Mri Uppr Extremity W/O&W/Dye (73220) |
$3,439.80 |
$5,733 |
10.5× |
| MRI, abdomen, combo (74183) |
$3,166.80 |
$5,278 |
9.7× |
| MRI, dorsal spine combo (72157) |
$3,039.60 |
$5,066 |
9.3× |
| MRI, dorsal spine contrast (72147) |
$2,616 |
$4,360 |
8.0× |
| MRI, joint upper extrem (73221) |
$2,179.80 |
$3,633 |
9.7× |
| MRI, joint upper extrem combo (73223) |
$2,829.60 |
$4,716 |
8.6× |
| MRI, lumbar spine combo (72158) |
$3,039.60 |
$5,066 |
9.3× |
| Myelogram cervical (72240) |
$2,156.40 |
$3,594 |
2.9× |
| Myocardial Spect Multiple Studies (78452) |
$4,393.80 |
$7,323 |
3.6× |
| Neck soft tissue (70360) |
$235.80 |
$393 |
2.9× |
| Parathyroid Planar Imaging (78070) |
$1,526.40 |
$2,544 |
4.1× |
| Parathyroid planar imaging w/wo subtraction (78071) |
$723 |
$1,205 |
1.9× |
| Pelvis 1 or 2 views (72170) |
$250.20 |
$417 |
2.6× |
| Pulmonary Perfusion Imaging Particulate (78580) |
$1,600.80 |
$2,668 |
4.3× |
| Radex Abd Compl Aqt Abd W/S/E/D Views 1 View Ch (74022) |
$388.20 |
$647 |
4.0× |
| Radex Ankle Complete Minimum 3 Views (73610) |
$348.60 |
$581 |
4.3× |
| Radex Calcaneus Minimum 2 Views (73650) |
$194.40 |
$324 |
2.4× |
| Radex Facial Bones Complete Minimum 3 Views (70150) |
$223.20 |
$372 |
2.3× |
| Radex fingr minimum 2 views (73140) |
$163.80 |
$273 |
2.0× |
| Radex foot complete minimum 3 views (73630) |
$318 |
$530 |
3.9× |
| Radex Hand Minimum 3 Views (73130) |
$313.80 |
$523 |
3.8× |
| Radex lower extremity infant minimum 2 views (73592) |
$241.20 |
$402 |
3.0× |
| Radex Nasal Bones Complete Minimum 3 Views (70160) |
$249 |
$415 |
3.0× |
| Radex shoulder complete minimum 2 views (73030) |
$324.60 |
$541 |
4.0× |
| Radex Sinuses Paransl < 3 Views (70210) |
$147.60 |
$246 |
1.8× |
| Radex Spine 1 View Specify Level (72020) |
$166.20 |
$277 |
2.0× |
| Radex Sternum Minimum 2 Views (71120) |
$150 |
$250 |
1.8× |
| Radex Temporomandble Jt Opn & Clsd Mouth Bilat (70330) |
$277.80 |
$463 |
3.4× |
| Radex Toe Minimum 2 Views (73660) |
$163.80 |
$273 |
2.0× |
| Radex upper extremity infant minimum 2 views (73092) |
$220.80 |
$368 |
2.3× |
| Radex Wrist Complete Minimum 3 Views (73110) |
$313.80 |
$523 |
3.8× |
| Radex X-Ray Exam Entire Spi 6/> Vw - Xr Entire Spine 6+ Vw (72084) |
$516.60 |
$861 |
5.3× |
| Radiolog exam mandible compl minimum 4 views (70110) |
$250.80 |
$418 |
2.6× |
| Radiologic Exam Abdomen 3+ Views - Xr Abdomen 3+ Views (74021) |
$381 |
$635 |
3.9× |
| Radiologic exam colon double contrast study (74280) |
$801 |
$1,335 |
4.9× |
| Radiologic exam colon single contrast study (74270) |
$441 |
$735 |
2.7× |
| Radiologic exam knee complete 4/more views (73564) |
$391.20 |
$652 |
4.0× |
| Radiologic Exam Small Int Single Contrast Study (74250) |
$252.60 |
$421 |
1.5× |
| Radiologic exam swallow function contrast study (74230) |
$528.60 |
$881 |
3.2× |
| Radiologic exam upr gi trc double contrast study (74246) |
$356.40 |
$594 |
2.2× |
| Radiologic examination femur minimum 2 views (73552) |
$538.20 |
$897 |
6.6× |
| Radiologic examination knee 1/2 views (73560) |
$194.40 |
$324 |
2.4× |
| Radiologic examination tibia & fibula 2 views (73590) |
$354.60 |
$591 |
4.3× |
| Rp Loclzj Tum Plnr Whole Body 2+ Days Imaging (78804) |
$2,176.80 |
$3,628 |
4.3× |
| Rp Loclzj Tum Plnr Whole Body Single Day Imaging (78802) |
$2,018.40 |
$3,364 |
4.0× |
| Rp Loclzj Tum Spect 1 Area Single Day Imaging (78803) |
$1,869.60 |
$3,116 |
3.7× |
| Rp loclzj tum spect 2 area/sep acquisj img (78831) |
$2,218.80 |
$3,698 |
1.8× |
| Scapula (73010) |
$218.40 |
$364 |
2.2× |
| Screening Digital Breast Tomosynthesis Bi (77063) |
$24 |
$40 |
1.0× |
| Shoulder 1 view (73020) |
$145.20 |
$242 |
1.8× |
| Shoulder Arthrography (73040) |
$691.20 |
$1,152 |
2.1× |
| Skull less than 4 views (70250) |
$189.60 |
$316 |
1.9× |
| Temporomandble Jt Arthrography Rs&I (70332) |
$780.60 |
$1,301 |
3.5× |
| Thoracic spine 2 views (72070) |
$292.80 |
$488 |
3.0× |
| Thoracic spine 3 views (72072) |
$305.40 |
$509 |
3.1× |
| Thyroid Carcinoma Metastases Img Lmtd Area (78015) |
$1,121.40 |
$1,869 |
3.0× |
| Thyroid Imaging With Vascular Flow (78013) |
$842.40 |
$1,404 |
2.2× |
| Thyroid Met Imaging Body (78018) |
$2,317.80 |
$3,863 |
4.5× |
| Thyroid Uptake Measurement (78012) |
$820.80 |
$1,368 |
2.2× |
| Thyroid Uptake W/Blood Flow Sngle/Mult Quan Meas (78014) |
$1,570.80 |
$2,618 |
4.2× |
| Ultrasound Breast Limited (76642) |
$379.20 |
$632 |
4.6× |
| Ultrasound Exam Aaa Screen (76706) |
$789.60 |
$1,316 |
8.0× |
| Ultrasound, abdomen limited (76705) |
$646.20 |
$1,077 |
6.6× |
| Unlisted us procedure (76999) |
$468 |
$780 |
5.7× |
| Upper gi w/o kub (74240) |
$338.40 |
$564 |
2.1× |
| Ureteral Reflux Study (78740) |
$1,012.80 |
$1,688 |
2.7× |
| Urethrocystogram voiding (74455) |
$801 |
$1,335 |
3.6× |
| Us breast unilateral complete (76641) |
$379.20 |
$632 |
3.9× |
| Us chest (76604) |
$679.80 |
$1,133 |
6.9× |
| Us complete joint (76881) |
$642.60 |
$1,071 |
6.6× |
| Us exam, pelvic, limited (76857) |
$745.80 |
$1,243 |
7.6× |
| Us lmtd joint/oth nonvasc xtr strux r-t w/img (76882) |
$455.40 |
$759 |
4.6× |
| Us ob limited 1 or more fetuses (76815) |
$681.60 |
$1,136 |
6.9× |
| Us ob transvaginal (76817) |
$672 |
$1,120 |
6.9× |
| Us pelvic non ob complete (76856) |
$733.20 |
$1,222 |
7.5× |
| Us pg uter img f&mat 14 wk tabdl 1/1st gestation (76801) |
$1,137 |
$1,895 |
11.6× |
| Us preg uterus real time f/u trnsabdl per fetus (76816) |
$706.20 |
$1,177 |
7.2× |
| Us retroperitoneal complete (76770) |
$817.20 |
$1,362 |
8.3× |
| Us retroperitoneal limited (76775) |
$817.20 |
$1,362 |
8.3× |
| Us scrotum and contents (76870) |
$693 |
$1,155 |
7.1× |
| Us thyroid (76536) |
$776.40 |
$1,294 |
7.9× |
| Us transrectal (76872) |
$1,153.20 |
$1,922 |
11.8× |
| Wrist 2 views (73100) |
$163.80 |
$273 |
2.0× |
| X-Ray Ac Jts - Xr Acromioclavicular Joints Bilateral (73050) |
$150 |
$250 |
1.8× |
| X-Ray Elbow 2 Vw - Xr Elbow 1-2 Views Right (73070) |
$289.20 |
$482 |
3.5× |
| X-Ray Exam Entire Spi 1 Vw (72081) |
$172.80 |
$288 |
2.1× |
| X-Ray Exam Entire Spi 2/3 Vw (72082) |
$205.20 |
$342 |
2.1× |
| X-Ray Exam Entire Spi 4/5 Vw (72083) |
$205.20 |
$342 |
2.1× |
| X-Ray Exam Hip Uni 1 View (73501) |
$340.80 |
$568 |
4.2× |
| X-Ray Exam Hip Uni 2-3 Views (73502) |
$309.60 |
$516 |
3.8× |
| X-Ray Exam Hip Uni 4/> Views (73503) |
$385.20 |
$642 |
3.9× |
| X-Ray Exam Hips Bi 2 Views (73521) |
$304.20 |
$507 |
3.1× |
| X-Ray Exam Hips Bi 3-4 Views (73522) |
$385.20 |
$642 |
3.9× |
| X-Ray Exam Hips Bi 5/> Views (73523) |
$577.20 |
$962 |
5.9× |
| X-Ray Exam Neck Spine 2-3 Vw (72040) |
$293.40 |
$489 |
3.6× |
| X-Ray Exam Neck Spine 6/>Vws (72052) |
$457.20 |
$762 |
4.7× |
| X-Ray Exam Unilat Ribs/Chest (71101) |
$236.40 |
$394 |
2.4× |
| X-ray humerus (73060) |
$251.40 |
$419 |
3.1× |
| X-ray IV pyelogram (ivp) (74400) |
$700.20 |
$1,167 |
4.3× |
| X-Ray Jaw <4 Vw - Xr Mandible < 4 Views (70100) |
$222.60 |
$371 |
2.7× |
| X-Ray Lumbar Spine 2/3 Vw - Xr Lumbar Spine 2-3 Views (72100) |
$354.60 |
$591 |
3.6× |
| X-Ray Ribs, Chest 4+ Vw - Xr Ribs 3 Vws Bil W/ Chest Posteroanterior (71111) |
$286.80 |
$478 |
2.9× |
| X-Ray Sacroiliac Jts 3+ Vw - Xr Sacroiliac Joints 3+ Views (72202) |
$285.60 |
$476 |
2.9× |
| X-Ray Sacrum/Coccyx 2+ Vw - Xr Sacrum Coccyx 2+ Views (72220) |
$202.20 |
$337 |
2.5× |
| X-Ray Sinuses 3+ Vw - Xr Paranasal Sinuses 3+ Views (70220) |
$175.80 |
$293 |
2.2× |
| X-Ray Skull 4+ Vw - Xr Skull Complete 4+ Views (70260) |
$218.40 |
$364 |
2.2× |
| X-Rays Bone Survey Complete (77075) |
$591.60 |
$986 |
6.0× |
| Xr c-spine 4 or 5 views (72050) |
$325.80 |
$543 |
3.3× |
| Xr facial bones less than 3 views (70140) |
$207 |
$345 |
2.5× |
| Xr orbits complete 4 views (70200) |
$203.40 |
$339 |
2.1× |