| Abdomen 1 View (74018) |
$232.05 |
$357 |
2.1× |
| Abdomen 2 views (74019) |
$304.20 |
$468 |
2.3× |
| Acute Gastrointestinal Blood Loss Imaging (78278) |
$894.40 |
$1,376 |
1.8× |
| Ankle 2 views (73600) |
$232.05 |
$357 |
2.1× |
| Arthrogram hip (73525) |
$919.75 |
$1,415 |
2.1× |
| Bone age studies (77072) |
$312 |
$480 |
2.4× |
| Bone Imaging 3 Phase (78315) |
$917.80 |
$1,412 |
1.8× |
| Bone Imaging Whole Body (78306) |
$917.80 |
$1,412 |
1.8× |
| Bone survey infant (77076) |
$278.85 |
$429 |
2.1× |
| Cardiac MRI w/w/o contrast & further seq (75561) |
$1,683.50 |
$2,590 |
3.9× |
| Cardiac MRI w/w/o contrast w/stress (75563) |
$1,683.50 |
$2,590 |
1.7× |
| Chest 1 view (71045) |
$232.05 |
$357 |
2.1× |
| Chest 2 views (71046) |
$232.05 |
$357 |
2.1× |
| Chest 3 views (71047) |
$232.05 |
$357 |
2.1× |
| Clavicle complete (73000) |
$232.05 |
$357 |
2.1× |
| Computed Tomography Thorax Lw Dose Lng Ca Scr C- (71271) |
$1,196 |
$1,840 |
9.2× |
| CT abdomen and pelvis without and with contrast (74178) |
$3,287.70 |
$5,058 |
7.5× |
| CT abdomen and pelvis without contrast (74176) |
$2,774.85 |
$4,269 |
9.3× |
| CT abdomen w contrast (74160) |
$2,427.10 |
$3,734 |
11.1× |
| CT abdomen w wo contrast (74170) |
$2,964.65 |
$4,561 |
13.5× |
| CT abdomen w/o contrast (74150) |
$1,696.50 |
$2,610 |
13.0× |
| CT Angio Abdomen and Pelvis (74174) |
$1,056.90 |
$1,626 |
2.4× |
| CT Angio Chest (71275) |
$1,935.05 |
$2,977 |
8.8× |
| CT Angio Head (70496) |
$1,990.95 |
$3,063 |
9.1× |
| Ct Angio Lwr Extr W/O&W/Dye (73706) |
$987.35 |
$1,519 |
4.5× |
| CT Angio Neck (70498) |
$1,383.20 |
$2,128 |
6.3× |
| Ct Angio Upr Extrm W/O&W/Dye (73206) |
$512.20 |
$788 |
2.3× |
| CT bone density (77078) |
$923 |
$1,420 |
8.5× |
| CT cervical spine w/ contrast (72126) |
$1,125.80 |
$1,732 |
2.6× |
| CT cervical spine w/o contrast (72125) |
$1,153.75 |
$1,775 |
8.8× |
| CT chest w contrast (71260) |
$1,444.95 |
$2,223 |
6.6× |
| CT chest w/wo contrast (71270) |
$2,119.65 |
$3,261 |
9.7× |
| CT head/brain with contrast (70460) |
$1,393.60 |
$2,144 |
6.4× |
| CT head/brain without and with contrast (70470) |
$1,233.70 |
$1,898 |
5.6× |
| CT heart contrast eval cardiac structure&morph (75572) |
$358.80 |
$552 |
0.8× |
| CT heart no contrast quant eval coronry calcium (75571) |
$207.35 |
$319 |
1.9× |
| CT hrt w/3d image congen (75573) |
$358.80 |
$552 |
0.8× |
| CT iac w contrast (70481) |
$698.75 |
$1,075 |
3.2× |
| CT l-spine w&w/o contrast (72133) |
$624.65 |
$961 |
2.9× |
| CT lower ext w/o (73700) |
$312 |
$480 |
2.4× |
| CT lower extremity w/contrast material (73701) |
$512.20 |
$788 |
2.3× |
| CT lumbar spine w contrast (72132) |
$1,125.80 |
$1,732 |
2.6× |
| CT lumbar spine w/o contrast (72131) |
$1,227.85 |
$1,889 |
9.4× |
| CT maxillofacial w contrast (70487) |
$2,267.20 |
$3,488 |
10.4× |
| CT maxillofacial wo contrast (70486) |
$1,370.85 |
$2,109 |
10.5× |
| CT orbits w/o contrast (70480) |
$980.20 |
$1,508 |
7.5× |
| CT pelvis w&w/o contrast (72194) |
$1,528.80 |
$2,352 |
7.0× |
| CT pelvis w/o contrast (72192) |
$570.70 |
$878 |
4.4× |
| CT soft tissue neck w contrast (70491) |
$1,341.60 |
$2,064 |
6.1× |
| CT soft tissue neck w/o contrast (70490) |
$1,134.25 |
$1,745 |
8.7× |
| CT thoracic spine w/o contrast (72128) |
$1,339.65 |
$2,061 |
10.3× |
| CT thorax w/o contrast (71250) |
$1,120.60 |
$1,724 |
8.6× |
| CT unlisted procedure (76497) |
$207.35 |
$319 |
1.9× |
| CT upper ext wo (73200) |
$312 |
$480 |
2.4× |
| CT upper extremity w/o & w/contrast material (73202) |
$457.60 |
$704 |
2.1× |
| CT upper extremity with contrast (73201) |
$1,056.90 |
$1,626 |
2.4× |
| Cta Abdl Aorta&Bi Iliofem W/Contrast&Postp (75635) |
$1,662.05 |
$2,557 |
7.6× |
| Cta Abdomen (74175) |
$1,964.30 |
$3,022 |
9.0× |
| CTA pelvis (72191) |
$986.70 |
$1,518 |
4.5× |
| Doppler Echo Fetal Puls Spectral F/U/Repeat (76828) |
$304.20 |
$468 |
2.3× |
| Doppler Echo Fetal Spectral Display Complete (76827) |
$423.15 |
$651 |
3.2× |
| Dxa Bone Density Axial (77080) |
$204.75 |
$315 |
1.6× |
| Echo exam uterus (76831) |
$660.40 |
$1,016 |
2.2× |
| Esophagram (74220) |
$457.60 |
$704 |
2.1× |
| Fetal Biophys Profile W/Nst (76818) |
$312 |
$480 |
2.4× |
| Fetal Biophysical Profile W/O Non-Stress Testing (76819) |
$312 |
$480 |
2.4× |
| Fluoroscopy up to 1 hr (76000) |
$660.40 |
$1,016 |
2.2× |
| Foot 2 views (73620) |
$232.05 |
$357 |
2.1× |
| Forearm 2 views (73090) |
$232.05 |
$357 |
2.1× |
| Gastric emptying imaging study (78264) |
$917.80 |
$1,412 |
1.8× |
| Gated Heart Planar Single (78472) |
$965.90 |
$1,486 |
1.9× |
| Hand 2 views (73120) |
$312 |
$480 |
2.4× |
| Hepatobil Syst Image W/Drug (78227) |
$1,192.10 |
$1,834 |
1.8× |
| Infant hip ultrasound, limited static exam (76886) |
$232.05 |
$357 |
2.1× |
| K Flow/Funct Image W/Drug (78708) |
$1,254.50 |
$1,930 |
1.9× |
| Knee 3 Views (73562) |
$232.05 |
$357 |
2.1× |
| Lymph System Imaging (78195) |
$1,192.10 |
$1,834 |
1.8× |
| Magnetic Image Jaw Joint (70336) |
$589.55 |
$907 |
2.0× |
| Mr safety determination physician/other qhp (76016) |
$250.90 |
$386 |
2.3× |
| Mr safety implant&/fb assmt clin staf 1st 15 min (76014) |
$69.55 |
$107 |
1.9× |
| Mr safety implt electronics prepj supvj phys/qhp (76018) |
$261.95 |
$403 |
2.2× |
| Mr safety implt pos&/immoblj (76019) |
$169.65 |
$261 |
2.3× |
| Mr safety med physics xm customization plng&mntr (76017) |
$689.65 |
$1,061 |
2.3× |
| MRA head w/o contrast (70544) |
$3,040.05 |
$4,677 |
10.2× |
| MRA head with contrast (70545) |
$3,015.35 |
$4,639 |
6.9× |
| Mra Neck W/O &W/Contrast Material (70549) |
$4,147 |
$6,380 |
9.5× |
| MRA neck w/o contrast (70547) |
$2,671.50 |
$4,110 |
9.0× |
| MRI abdomen w/o contrast (74181) |
$2,382.90 |
$3,666 |
8.0× |
| MRI any jt lower extrem w/o & w/contrast matrl (73723) |
$943.80 |
$1,452 |
2.2× |
| MRI any jt upper extremity w/contrast matrl (73222) |
$1,833.65 |
$2,821 |
1.9× |
| MRI cardiac w/o cont stress (75559) |
$1,049.75 |
$1,615 |
1.5× |
| MRI cardiac w/o contrast (75557) |
$1,049.75 |
$1,615 |
3.5× |
| MRI cervical spine w contrast (72142) |
$943.80 |
$1,452 |
2.2× |
| MRI cervical spine w/o cont (72141) |
$2,403.70 |
$3,698 |
8.1× |
| MRI chest w/o contrast (71550) |
$692.90 |
$1,066 |
2.3× |
| MRI lower extrem oth/thn jt w/o & w/contr matr (73720) |
$1,862.90 |
$2,866 |
4.3× |
| MRI lower extrem oth/thn jt w/o contr matrl (73718) |
$660.40 |
$1,016 |
2.2× |
| MRI lumbar spine w contrast (72149) |
$943.80 |
$1,452 |
2.2× |
| Mri Neck Spine W/O & W/Dye (72156) |
$4,123.60 |
$6,344 |
9.5× |
| MRI orbit face &/neck w/o contrast (70540) |
$660.40 |
$1,016 |
2.2× |
| Mri Orbt/Fac/Nck W/O &W/Dye (70543) |
$3,485.95 |
$5,363 |
8.0× |
| MRI pelvis w/o & w contrast (72197) |
$4,037.80 |
$6,212 |
9.3× |
| MRI pelvis w/o contrast (72195) |
$2,437.50 |
$3,750 |
8.2× |
| MRI thoracic spine w/o contrast (72146) |
$2,636.40 |
$4,056 |
8.9× |
| MRI upper extremity oth than jt w/o contr matrl (73218) |
$660.40 |
$1,016 |
2.2× |
| Mri Uppr Extremity W/O&W/Dye (73220) |
$1,056.90 |
$1,626 |
2.4× |
| MRI, abdomen, combo (74183) |
$3,092.70 |
$4,758 |
7.1× |
| MRI, dorsal spine combo (72157) |
$4,100.85 |
$6,309 |
9.4× |
| MRI, dorsal spine contrast (72147) |
$1,056.90 |
$1,626 |
2.4× |
| MRI, joint upper extrem (73221) |
$660.40 |
$1,016 |
2.2× |
| MRI, joint upper extrem combo (73223) |
$943.80 |
$1,452 |
2.2× |
| MRI, lumbar spine combo (72158) |
$4,068.35 |
$6,259 |
9.3× |
| Myocardial Spect Multiple Studies (78452) |
$3,181.75 |
$4,895 |
2.0× |
| Neck soft tissue (70360) |
$311.35 |
$479 |
2.9× |
| Nonvascular Shunt X-Ray (75809) |
$312 |
$480 |
2.4× |
| Ob us nuchal meas 1 gest (76813) |
$312 |
$480 |
2.4× |
| Parathyroid Planar Imaging (78070) |
$917.80 |
$1,412 |
1.8× |
| Pelvis 1 or 2 views (72170) |
$312 |
$480 |
2.4× |
| Pulmonary Perfusion Imaging Particulate (78580) |
$917.80 |
$1,412 |
1.8× |
| Radex abscess/fistula/sinus tract rs&i (76080) |
$1,206.40 |
$1,856 |
1.8× |
| Radex Ankle Complete Minimum 3 Views (73610) |
$232.05 |
$357 |
2.1× |
| Radex Calcaneus Minimum 2 Views (73650) |
$232.05 |
$357 |
2.1× |
| Radex elbow complete minimum 3 views (73080) |
$232.05 |
$357 |
2.1× |
| Radex Facial Bones Complete Minimum 3 Views (70150) |
$347.10 |
$534 |
2.7× |
| Radex fingr minimum 2 views (73140) |
$232.05 |
$357 |
2.1× |
| Radex foot complete minimum 3 views (73630) |
$232.05 |
$357 |
2.1× |
| Radex Hand Minimum 3 Views (73130) |
$232.05 |
$357 |
2.1× |
| Radex lower extremity infant minimum 2 views (73592) |
$232.05 |
$357 |
2.1× |
| Radex Nasal Bones Complete Minimum 3 Views (70160) |
$309.40 |
$476 |
2.8× |
| Radex Ribs Unilateral 2 Views (71100) |
$232.05 |
$357 |
2.1× |
| Radex shoulder complete minimum 2 views (73030) |
$232.05 |
$357 |
2.1× |
| Radex Spine 1 View Specify Level (72020) |
$202.15 |
$311 |
1.9× |
| Radex Sternum Minimum 2 Views (71120) |
$226.20 |
$348 |
2.1× |
| Radex Toe Minimum 2 Views (73660) |
$232.05 |
$357 |
2.1× |
| Radex upper extremity infant minimum 2 views (73092) |
$278.85 |
$429 |
2.1× |
| Radex Wrist Complete Minimum 3 Views (73110) |
$232.05 |
$357 |
2.1× |
| Radiolog exam mandible compl minimum 4 views (70110) |
$304.20 |
$468 |
2.3× |
| Radiologic Exam Abdomen 3+ Views - Xr Abdomen 3+ Views (74021) |
$271.70 |
$418 |
2.1× |
| Radiologic exam colon single contrast study (74270) |
$627.25 |
$965 |
2.9× |
| Radiologic exam knee complete 4/more views (73564) |
$312 |
$480 |
2.4× |
| Radiologic exam pelvis compl minimum 3 views (72190) |
$312 |
$480 |
2.4× |
| Radiologic Exam Small Int Single Contrast Study (74250) |
$457.60 |
$704 |
2.1× |
| Radiologic exam swallow function contrast study (74230) |
$512.20 |
$788 |
2.3× |
| Radiologic examination femur 1 view (73551) |
$232.05 |
$357 |
2.1× |
| Radiologic examination femur minimum 2 views (73552) |
$232.05 |
$357 |
2.1× |
| Radiologic examination knee 1/2 views (73560) |
$232.05 |
$357 |
2.1× |
| Radiologic Examination Osseous Survey Limited (77074) |
$271.70 |
$418 |
2.1× |
| Radiologic examination tibia & fibula 2 views (73590) |
$232.05 |
$357 |
2.1× |
| Ribs bilateral 3 views (71110) |
$495.95 |
$763 |
3.8× |
| Rp Loclzj Tum Spect 1 Area Single Day Imaging (78803) |
$3,349.45 |
$5,153 |
4.9× |
| Scapula (73010) |
$312 |
$480 |
2.4× |
| Screening Digital Breast Tomosynthesis Bi (77063) |
$100.75 |
$155 |
4.3× |
| Shoulder 1 view (73020) |
$232.05 |
$357 |
2.1× |
| Shoulder Arthrography (73040) |
$1,030.25 |
$1,585 |
2.4× |
| Skull less than 4 views (70250) |
$329.55 |
$507 |
2.5× |
| Therapeutic Enema Rdctj Intussusception/Obstrcj (74283) |
$457.60 |
$704 |
2.1× |
| Thoracic spine 2 views (72070) |
$364.65 |
$561 |
2.8× |
| Thyroid Uptake W/Blood Flow Sngle/Mult Quan Meas (78014) |
$917.80 |
$1,412 |
1.8× |
| Ultrasound Breast Limited (76642) |
$207.35 |
$319 |
1.9× |
| Ultrasound, abdomen limited (76705) |
$733.85 |
$1,129 |
5.6× |
| Umbilical-artery Doppler (OB) (76820) |
$278.85 |
$429 |
2.1× |
| Unlisted fluoroscopic procedure (76496) |
$207.35 |
$319 |
1.9× |
| Unlisted magnetic resonance procedure (76498) |
$207.35 |
$319 |
1.9× |
| Unlisted us procedure (76999) |
$226.20 |
$348 |
2.1× |
| Upper gi w/o kub (74240) |
$744.90 |
$1,146 |
3.4× |
| Us breast unilateral complete (76641) |
$312 |
$480 |
2.4× |
| Us chest (76604) |
$602.55 |
$927 |
4.6× |
| Us complete joint (76881) |
$312 |
$480 |
2.4× |
| Us exam, pelvic, limited (76857) |
$536.25 |
$825 |
4.1× |
| Us head (76506) |
$312 |
$480 |
2.4× |
| Us lmtd joint/oth nonvasc xtr strux r-t w/img (76882) |
$347.75 |
$535 |
2.7× |
| Us ob detailed single fetus (76811) |
$660.40 |
$1,016 |
2.2× |
| Us ob limited 1 or more fetuses (76815) |
$312 |
$480 |
2.4× |
| Us ob transvaginal (76817) |
$312 |
$480 |
2.4× |
| Us pelvic non ob complete (76856) |
$776.10 |
$1,194 |
5.9× |
| Us pg uter img f&mat 14 wk tabdl 1/1st gestation (76801) |
$312 |
$480 |
2.4× |
| Us preg uterus real time f/u trnsabdl per fetus (76816) |
$312 |
$480 |
2.4× |
| Us retroperitoneal complete (76770) |
$550.55 |
$847 |
4.2× |
| Us retroperitoneal limited (76775) |
$755.95 |
$1,163 |
5.8× |
| Us scrotum and contents (76870) |
$941.20 |
$1,448 |
7.2× |
| Us spinal canal and contents (76800) |
$312 |
$480 |
2.4× |
| Us thyroid (76536) |
$638.30 |
$982 |
4.9× |
| Us transrectal (76872) |
$278.85 |
$429 |
2.1× |
| Vein X-Ray Chest (75827) |
$3,511.30 |
$5,402 |
1.8× |
| Venography extremity unilateral rs&i (75820) |
$3,511.30 |
$5,402 |
1.8× |
| Wrist 2 views (73100) |
$232.05 |
$357 |
2.1× |
| X-Ray Elbow 2 Vw - Xr Elbow 1-2 Views Right (73070) |
$232.05 |
$357 |
2.1× |
| X-Ray Exam Breast Specimen (76098) |
$1,387.10 |
$2,134 |
2.0× |
| X-Ray Exam Entire Spi 1 Vw (72081) |
$207.35 |
$319 |
1.9× |
| X-Ray Exam Entire Spi 2/3 Vw (72082) |
$488.80 |
$752 |
3.7× |
| X-Ray Exam Entire Spi 4/5 Vw (72083) |
$532.35 |
$819 |
4.1× |
| X-Ray Exam Hip Uni 1 View (73501) |
$232.05 |
$357 |
2.1× |
| X-Ray Exam Hip Uni 2-3 Views (73502) |
$232.05 |
$357 |
2.1× |
| X-Ray Exam Hip Uni 4/> Views (73503) |
$312 |
$480 |
2.4× |
| X-Ray Exam Hips Bi 2 Views (73521) |
$312 |
$480 |
2.4× |
| X-Ray Exam Hips Bi 3-4 Views (73522) |
$278.85 |
$429 |
2.1× |
| X-Ray Exam Hips Bi 5/> Views (73523) |
$406.90 |
$626 |
3.1× |
| X-Ray Exam L-S Spine Bending (72114) |
$646.75 |
$995 |
5.0× |
| X-Ray Exam Neck Spine 2-3 Vw (72040) |
$380.90 |
$586 |
3.5× |
| X-Ray Exam Neck Spine 6/>Vws (72052) |
$568.10 |
$874 |
4.4× |
| X-ray humerus (73060) |
$254.15 |
$391 |
2.3× |
| X-ray IV pyelogram (ivp) (74400) |
$494 |
$760 |
2.3× |
| X-Ray Lumbar Spine 2/3 Vw - Xr Lumbar Spine 2-3 Views (72100) |
$392.60 |
$604 |
3.0× |
| X-ray nose-rectum child f.b. (76010) |
$226.20 |
$348 |
2.1× |
| X-Ray Ribs, Chest 4+ Vw - Xr Ribs 3 Vws Bil W/ Chest Posteroanterior (71111) |
$278.85 |
$429 |
2.1× |
| X-Ray Sacroiliac Jts 3+ Vw - Xr Sacroiliac Joints 3+ Views (72202) |
$369.85 |
$569 |
2.8× |
| X-Ray Sacrum/Coccyx 2+ Vw - Xr Sacrum Coccyx 2+ Views (72220) |
$262.60 |
$404 |
2.4× |
| X-Ray Sinuses 3+ Vw - Xr Paranasal Sinuses 3+ Views (70220) |
$260.65 |
$401 |
2.4× |
| X-Ray Skull 4+ Vw - Xr Skull Complete 4+ Views (70260) |
$278.85 |
$429 |
2.1× |
| Xr c-spine 4 or 5 views (72050) |
$600.60 |
$924 |
4.6× |
| Xr orbits complete 4 views (70200) |
$312 |
$480 |
2.4× |