| Abdomen 1 View (74018) |
$233.75 |
$275 |
2.7× |
| Abdomen 2 views (74019) |
$276.25 |
$325 |
2.6× |
| Ankle 2 views (73600) |
$255 |
$300 |
2.9× |
| Arthrogram hip (73525) |
$850 |
$1,000 |
2.4× |
| Bone age studies (77072) |
$255 |
$300 |
2.4× |
| Bone Imaging 3 Phase (78315) |
$1,870 |
$2,200 |
4.7× |
| Bone Imaging Whole Body (78306) |
$1,275 |
$1,500 |
3.2× |
| Chest 1 view (71045) |
$212.50 |
$250 |
2.4× |
| Chest 2 views (71046) |
$255 |
$300 |
2.9× |
| Chest 4 or more views (71048) |
$382.50 |
$450 |
3.7× |
| Clavicle complete (73000) |
$280.50 |
$330 |
3.2× |
| Computed Tomography Thorax Lw Dose Lng Ca Scr C- (71271) |
$170 |
$200 |
1.6× |
| CT abdomen and pelvis without and with contrast (74178) |
$3,400 |
$4,000 |
9.7× |
| CT abdomen and pelvis without contrast (74176) |
$1,275 |
$1,500 |
5.3× |
| CT abdomen w contrast (74160) |
$1,785 |
$2,100 |
10.2× |
| CT abdomen w wo contrast (74170) |
$2,125 |
$2,500 |
12.1× |
| CT abdomen w/o contrast (74150) |
$1,360 |
$1,600 |
13.0× |
| CT Angio Abdomen and Pelvis (74174) |
$2,380 |
$2,800 |
6.8× |
| CT Angio Chest (71275) |
$2,125 |
$2,500 |
12.1× |
| CT Angio Head (70496) |
$2,040 |
$2,400 |
11.6× |
| Ct Angio Lwr Extr W/O&W/Dye (73706) |
$2,040 |
$2,400 |
11.6× |
| CT Angio Neck (70498) |
$2,040 |
$2,400 |
11.6× |
| Ct Angio Upr Extrm W/O&W/Dye (73206) |
$2,975 |
$3,500 |
16.9× |
| CT cervical spine w/o contrast (72125) |
$1,615 |
$1,900 |
15.4× |
| CT cervical spine w/wo cont (72127) |
$2,635 |
$3,100 |
15.0× |
| CT chest w contrast (71260) |
$1,785 |
$2,100 |
10.2× |
| CT head/brain without and with contrast (70470) |
$1,836 |
$2,160 |
10.5× |
| CT heart no contrast quant eval coronry calcium (75571) |
$42.50 |
$50 |
0.5× |
| CT iac w contrast (70481) |
$1,742.50 |
$2,050 |
9.9× |
| CT l-spine w&w/o contrast (72133) |
$1,912.50 |
$2,250 |
10.9× |
| CT lower ext w/o (73700) |
$1,445 |
$1,700 |
13.8× |
| CT lower extremity w/contrast material (73701) |
$1,700 |
$2,000 |
9.7× |
| CT lumbar spine w contrast (72132) |
$1,700 |
$2,000 |
4.9× |
| CT lumbar spine w/o contrast (72131) |
$1,275 |
$1,500 |
12.2× |
| CT maxillofacial w contrast (70487) |
$1,742.50 |
$2,050 |
9.9× |
| CT maxillofacial wo contrast (70486) |
$1,615 |
$1,900 |
15.4× |
| CT neck tissue combo (70492) |
$1,870 |
$2,200 |
10.6× |
| Ct Orbit/Ear/Fossa W/O&W/Dye (70482) |
$1,836 |
$2,160 |
10.5× |
| CT orbits w/o contrast (70480) |
$1,530 |
$1,800 |
14.6× |
| CT pelvis w&w/o contrast (72194) |
$1,657.50 |
$1,950 |
9.4× |
| CT pelvis w/o contrast (72192) |
$1,700 |
$2,000 |
16.2× |
| CT scan of leg combo (73702) |
$2,516 |
$2,960 |
14.3× |
| CT scans face/jaw combo (70488) |
$2,690.25 |
$3,165 |
15.3× |
| CT soft tissue neck w contrast (70491) |
$1,700 |
$2,000 |
9.7× |
| CT soft tissue neck w/o contrast (70490) |
$1,530 |
$1,800 |
14.6× |
| CT thoracic spine w contrast (72129) |
$1,870 |
$2,200 |
10.6× |
| CT thoracic spine w/o contrast (72128) |
$1,700 |
$2,000 |
16.2× |
| CT thorax w/o contrast (71250) |
$1,275 |
$1,500 |
12.2× |
| CT upper ext wo (73200) |
$1,445 |
$1,700 |
13.8× |
| CT upper extremity w/o & w/contrast material (73202) |
$2,125 |
$2,500 |
12.1× |
| CT upper extremity with contrast (73201) |
$1,700 |
$2,000 |
4.9× |
| Cta Abdl Aorta&Bi Iliofem W/Contrast&Postp (75635) |
$2,125 |
$2,500 |
12.1× |
| Cta Abdomen (74175) |
$2,975 |
$3,500 |
16.9× |
| Doppler Echo Fetal Spectral Display Complete (76827) |
$510 |
$600 |
4.9× |
| Dxa Bone Density Axial (77080) |
$425 |
$500 |
4.1× |
| Fetal Biophysical Profile W/O Non-Stress Testing (76819) |
$765 |
$900 |
7.3× |
| Fluoroscopy up to 1 hr (76000) |
$663 |
$780 |
2.8× |
| Foot 2 views (73620) |
$255 |
$300 |
2.9× |
| Forearm 2 views (73090) |
$293.25 |
$345 |
3.4× |
| Gastric emptying imaging study (78264) |
$1,700 |
$2,000 |
4.2× |
| Hand 2 views (73120) |
$255 |
$300 |
2.4× |
| Hepatobil Syst Image W/Drug (78227) |
$1,955 |
$2,300 |
3.6× |
| Hepatobiliary System Imaging (78226) |
$1,785 |
$2,100 |
4.5× |
| Ht Muscle Image Spect Sing (78451) |
$1,041.25 |
$1,225 |
0.8× |
| Knee 3 Views (73562) |
$297.50 |
$350 |
3.4× |
| Magnetic Resonance Elastography (76391) |
$1,003 |
$1,180 |
4.2× |
| Meckels Divert Exam (78290) |
$1,365.95 |
$1,607 |
3.4× |
| Mr safety determination physician/other qhp (76016) |
$403.75 |
$475 |
4.6× |
| Mr safety implant&/fb assmt clin staf 1st 15 min (76014) |
$112.20 |
$132 |
3.9× |
| Mra Head W/O & W/Contrast Material (70546) |
$2,720 |
$3,200 |
7.8× |
| MRA head w/o contrast (70544) |
$2,125 |
$2,500 |
8.9× |
| MRA neck w contrast (70548) |
$2,210 |
$2,600 |
6.3× |
| Mra Neck W/O &W/Contrast Material (70549) |
$3,060 |
$3,600 |
8.8× |
| MRI abdomen w/o contrast (74181) |
$1,955 |
$2,300 |
8.2× |
| MRI any jt lower extrem w/contrast material (73722) |
$2,295 |
$2,700 |
2.9× |
| MRI any jt lower extrem w/o & w/contrast matrl (73723) |
$2,975 |
$3,500 |
8.5× |
| MRI any jt upper extremity w/contrast matrl (73222) |
$2,380 |
$2,800 |
3.0× |
| MRI brain functional w/o physician admnistration (70554) |
$1,003 |
$1,180 |
4.2× |
| MRI cervical spine w/o cont (72141) |
$1,955 |
$2,300 |
8.2× |
| MRI lower extrem oth/thn jt w/o & w/contr matr (73720) |
$2,975 |
$3,500 |
8.5× |
| MRI lower extrem oth/thn jt w/o contr matrl (73718) |
$2,210 |
$2,600 |
9.2× |
| Mri Neck Spine W/O & W/Dye (72156) |
$3,145 |
$3,700 |
9.0× |
| Mri Orbt/Fac/Nck W/O &W/Dye (70543) |
$3,655 |
$4,300 |
10.5× |
| MRI pelvis w contrast (72196) |
$1,916.75 |
$2,255 |
5.5× |
| MRI pelvis w/o & w contrast (72197) |
$2,975 |
$3,500 |
8.5× |
| MRI pelvis w/o contrast (72195) |
$1,955 |
$2,300 |
8.2× |
| MRI spectroscopy (76390) |
$374 |
$440 |
4.3× |
| MRI thoracic spine w/o contrast (72146) |
$1,946.50 |
$2,290 |
8.1× |
| MRI upper extremity oth than jt w/o contr matrl (73218) |
$2,125 |
$2,500 |
8.9× |
| Mri Uppr Extremity W/O&W/Dye (73220) |
$2,975 |
$3,500 |
8.5× |
| MRI, abdomen, combo (74183) |
$3,315 |
$3,900 |
9.5× |
| MRI, dorsal spine combo (72157) |
$3,145 |
$3,700 |
9.0× |
| MRI, joint upper extrem (73221) |
$2,125 |
$2,500 |
8.9× |
| MRI, joint upper extrem combo (73223) |
$2,805 |
$3,300 |
8.0× |
| MRI, lumbar spine combo (72158) |
$3,230 |
$3,800 |
9.2× |
| Myocardial Spect Multiple Studies (78452) |
$3,145 |
$3,700 |
2.4× |
| Neck soft tissue (70360) |
$289 |
$340 |
3.3× |
| Nonvascular Shunt X-Ray (75809) |
$467.50 |
$550 |
4.5× |
| Ophthalmic ultrasound dx b-scan w/wo a-scan (76512) |
$595 |
$700 |
5.7× |
| Parathyroid Planar Imaging (78070) |
$1,190 |
$1,400 |
3.0× |
| Pelvis 1 or 2 views (72170) |
$255 |
$300 |
2.4× |
| Radex Abd Compl Aqt Abd W/S/E/D Views 1 View Ch (74022) |
$382.50 |
$450 |
3.7× |
| Radex Ankle Complete Minimum 3 Views (73610) |
$340 |
$400 |
3.9× |
| Radex Calcaneus Minimum 2 Views (73650) |
$255 |
$300 |
2.9× |
| Radex elbow complete minimum 3 views (73080) |
$331.50 |
$390 |
3.8× |
| Radex Facial Bones Complete Minimum 3 Views (70150) |
$297.50 |
$350 |
2.8× |
| Radex fingr minimum 2 views (73140) |
$255 |
$300 |
2.9× |
| Radex foot complete minimum 3 views (73630) |
$340 |
$400 |
3.9× |
| Radex Hand Minimum 3 Views (73130) |
$340 |
$400 |
3.9× |
| Radex lower extremity infant minimum 2 views (73592) |
$297.50 |
$350 |
3.4× |
| Radex Mastoids Compl Minimum 3 Views PR Side (70130) |
$374 |
$440 |
3.6× |
| Radex Nasal Bones Complete Minimum 3 Views (70160) |
$280.50 |
$330 |
3.2× |
| Radex Ribs Unilateral 2 Views (71100) |
$289 |
$340 |
3.3× |
| Radex shoulder complete minimum 2 views (73030) |
$297.50 |
$350 |
3.4× |
| Radex Sternum Minimum 2 Views (71120) |
$297.50 |
$350 |
3.4× |
| Radex Temporomandble Jt Opn & Clsd Mouth Bilat (70330) |
$327.25 |
$385 |
3.8× |
| Radex Toe Minimum 2 Views (73660) |
$297.50 |
$350 |
3.4× |
| Radex Wrist Complete Minimum 3 Views (73110) |
$323 |
$380 |
3.7× |
| Radiolog exam mandible compl minimum 4 views (70110) |
$327.25 |
$385 |
3.1× |
| Radiologic exam knee complete 4/more views (73564) |
$340 |
$400 |
3.2× |
| Radiologic exam pelvis compl minimum 3 views (72190) |
$340 |
$400 |
3.2× |
| Radiologic exam swallow function contrast study (74230) |
$446.25 |
$525 |
2.5× |
| Radiologic examination femur minimum 2 views (73552) |
$297.50 |
$350 |
3.4× |
| Radiologic examination knee 1/2 views (73560) |
$255 |
$300 |
2.9× |
| Radiologic examination tibia & fibula 2 views (73590) |
$255 |
$300 |
2.9× |
| Ribs bilateral 3 views (71110) |
$340 |
$400 |
3.2× |
| Scapula (73010) |
$297.50 |
$350 |
2.8× |
| Screening Digital Breast Tomosynthesis Bi (77063) |
$68 |
$80 |
2.9× |
| Shoulder 1 view (73020) |
$246.50 |
$290 |
2.8× |
| Shoulder Arthrography (73040) |
$680 |
$800 |
1.9× |
| Skull less than 4 views (70250) |
$255 |
$300 |
2.4× |
| Thoracic spine 2 views (72070) |
$280.50 |
$330 |
2.7× |
| Thoracic spine 3 views (72072) |
$323 |
$380 |
3.1× |
| Ultrasound Breast Limited (76642) |
$510 |
$600 |
5.9× |
| Ultrasound Exam Aaa Screen (76706) |
$510 |
$600 |
4.9× |
| Ultrasound, abdomen limited (76705) |
$722.50 |
$850 |
6.9× |
| Unlisted fluoroscopic procedure (76496) |
$340 |
$400 |
3.9× |
| Us breast unilateral complete (76641) |
$722.50 |
$850 |
6.9× |
| Us chest (76604) |
$535.50 |
$630 |
5.1× |
| Us complete joint (76881) |
$680 |
$800 |
6.5× |
| Us exam, pelvic, limited (76857) |
$595 |
$700 |
5.7× |
| Us lmtd joint/oth nonvasc xtr strux r-t w/img (76882) |
$510 |
$600 |
4.9× |
| Us ob limited 1 or more fetuses (76815) |
$595 |
$700 |
5.7× |
| Us ob transvaginal (76817) |
$637.50 |
$750 |
6.1× |
| Us pelvic non ob complete (76856) |
$765 |
$900 |
7.3× |
| Us pg uter img f&mat 14 wk tabdl 1/1st gestation (76801) |
$765 |
$900 |
7.3× |
| Us preg uterus real time f/u trnsabdl per fetus (76816) |
$510 |
$600 |
4.9× |
| Us retroperitoneal limited (76775) |
$544 |
$640 |
5.2× |
| Us thyroid (76536) |
$680 |
$800 |
6.5× |
| Us transrectal (76872) |
$425 |
$500 |
4.1× |
| Wrist 2 views (73100) |
$255 |
$300 |
2.9× |
| X-Ray Ac Jts - Xr Acromioclavicular Joints Bilateral (73050) |
$221 |
$260 |
2.5× |
| X-Ray Elbow 2 Vw - Xr Elbow 1-2 Views Right (73070) |
$289 |
$340 |
3.3× |
| X-Ray Exam Hip Uni 1 View (73501) |
$255 |
$300 |
2.9× |
| X-Ray Exam Hip Uni 2-3 Views (73502) |
$297.50 |
$350 |
3.4× |
| X-Ray Exam Hip Uni 4/> Views (73503) |
$340 |
$400 |
3.2× |
| X-Ray Exam Hips Bi 5/> Views (73523) |
$595 |
$700 |
5.7× |
| X-Ray Exam L-S Spine Bending (72114) |
$539.75 |
$635 |
5.2× |
| X-Ray Exam Neck Spine 2-3 Vw (72040) |
$340 |
$400 |
3.9× |
| X-Ray Exam Neck Spine 6/>Vws (72052) |
$467.50 |
$550 |
4.5× |
| X-Ray Exam Unilat Ribs/Chest (71101) |
$318.75 |
$375 |
3.0× |
| X-ray eye for foreign body (70030) |
$327.25 |
$385 |
3.8× |
| X-ray humerus (73060) |
$289 |
$340 |
3.3× |
| X-Ray Lumbar Spine 2/3 Vw - Xr Lumbar Spine 2-3 Views (72100) |
$289 |
$340 |
2.8× |
| X-ray nose-rectum child f.b. (76010) |
$340 |
$400 |
3.9× |
| X-Ray Ribs, Chest 4+ Vw - Xr Ribs 3 Vws Bil W/ Chest Posteroanterior (71111) |
$361.25 |
$425 |
3.5× |
| X-Ray Sacroiliac Jts 3+ Vw - Xr Sacroiliac Joints 3+ Views (72202) |
$331.50 |
$390 |
3.2× |
| X-Ray Sacrum/Coccyx 2+ Vw - Xr Sacrum Coccyx 2+ Views (72220) |
$289 |
$340 |
3.3× |
| X-Ray Sinuses 3+ Vw - Xr Paranasal Sinuses 3+ Views (70220) |
$331.50 |
$390 |
3.8× |
| X-Ray Skull 4+ Vw - Xr Skull Complete 4+ Views (70260) |
$340 |
$400 |
3.2× |
| X-Rays Bone Survey Complete (77075) |
$467.50 |
$550 |
4.5× |
| Xr c-spine 4 or 5 views (72050) |
$361.25 |
$425 |
3.5× |
| Xr facial bones less than 3 views (70140) |
$255 |
$300 |
2.9× |
| Xr orbits complete 4 views (70200) |
$318.75 |
$375 |
3.0× |