| Abdomen 1 View (74018) |
$167 |
$238 |
1.9× |
| Abdomen 2 views (74019) |
$300 |
$429 |
2.9× |
| Ankle 2 views (73600) |
$416 |
$594 |
4.8× |
| Bone age studies (77072) |
$209 |
$298 |
2.0× |
| Bone Imaging 3 Phase (78315) |
$687 |
$982 |
1.7× |
| Bone Imaging Multiple Areas (78305) |
$687 |
$982 |
1.7× |
| Bone Imaging Whole Body (78306) |
$962 |
$1,374 |
2.4× |
| Bone survey infant (77076) |
$183 |
$262 |
1.7× |
| Cat Scan Follow-Up Study (76380) |
$408 |
$583 |
4.7× |
| Chest 1 view (71045) |
$170 |
$243 |
1.9× |
| Chest 2 views (71046) |
$194 |
$277 |
2.2× |
| Chest 4 or more views (71048) |
$224 |
$320 |
2.1× |
| Clavicle complete (73000) |
$260 |
$371 |
3.0× |
| Computed Tomography Thorax Lw Dose Lng Ca Scr C- (71271) |
$245 |
$350 |
2.3× |
| CT abdomen and pelvis without and with contrast (74178) |
$2,344 |
$3,348 |
6.7× |
| CT abdomen and pelvis without contrast (74176) |
$1,990 |
$2,843 |
8.3× |
| CT abdomen w contrast (74160) |
$1,117 |
$1,595 |
6.3× |
| CT abdomen w wo contrast (74170) |
$1,210 |
$1,728 |
6.9× |
| CT abdomen w/o contrast (74150) |
$977 |
$1,396 |
9.3× |
| CT Angio Abdomen and Pelvis (74174) |
$3,795 |
$5,421 |
10.8× |
| CT Angio Chest (71275) |
$2,844 |
$4,063 |
16.1× |
| CT Angio Head (70496) |
$1,735 |
$2,479 |
9.8× |
| Ct Angio Lwr Extr W/O&W/Dye (73706) |
$1,849 |
$2,641 |
10.5× |
| CT Angio Neck (70498) |
$1,735 |
$2,479 |
9.8× |
| Ct Angio Upr Extrm W/O&W/Dye (73206) |
$1,155 |
$1,650 |
6.6× |
| CT cervical spine w/ contrast (72126) |
$1,903 |
$2,718 |
5.4× |
| CT cervical spine w/o contrast (72125) |
$1,091 |
$1,559 |
10.4× |
| CT chest w contrast (71260) |
$1,722 |
$2,460 |
9.8× |
| CT chest w/wo contrast (71270) |
$1,890 |
$2,700 |
10.7× |
| CT head/brain with contrast (70460) |
$910 |
$1,300 |
5.2× |
| CT head/brain without and with contrast (70470) |
$1,359 |
$1,942 |
7.7× |
| CT iac w contrast (70481) |
$2,017 |
$2,881 |
11.4× |
| CT l-spine w&w/o contrast (72133) |
$1,007 |
$1,438 |
5.7× |
| CT lower ext w/o (73700) |
$967 |
$1,381 |
9.2× |
| CT lower extremity w/contrast material (73701) |
$1,184 |
$1,692 |
6.7× |
| CT lumbar spine w contrast (72132) |
$1,973 |
$2,818 |
5.6× |
| CT lumbar spine w/o contrast (72131) |
$1,101 |
$1,573 |
10.5× |
| CT maxillofacial w contrast (70487) |
$1,257 |
$1,795 |
7.1× |
| CT maxillofacial wo contrast (70486) |
$952 |
$1,360 |
9.1× |
| CT neck tissue combo (70492) |
$1,390 |
$1,986 |
7.9× |
| Ct Orbit/Ear/Fossa W/O&W/Dye (70482) |
$955 |
$1,364 |
5.4× |
| CT orbits w/o contrast (70480) |
$994 |
$1,420 |
9.5× |
| CT pelvis w&w/o contrast (72194) |
$1,040 |
$1,486 |
5.9× |
| CT pelvis w/o contrast (72192) |
$1,027 |
$1,467 |
9.8× |
| CT scan of leg combo (73702) |
$1,103 |
$1,575 |
6.3× |
| CT scans face/jaw combo (70488) |
$1,855 |
$2,650 |
10.5× |
| CT soft tissue neck w contrast (70491) |
$1,170 |
$1,671 |
6.6× |
| CT soft tissue neck w/o contrast (70490) |
$880 |
$1,257 |
8.4× |
| CT thoracic spine w contrast (72129) |
$1,796 |
$2,566 |
10.2× |
| CT thoracic spine w/o contrast (72128) |
$1,078 |
$1,540 |
10.3× |
| CT thorax w/o contrast (71250) |
$1,509 |
$2,155 |
14.4× |
| CT upper ext wo (73200) |
$893 |
$1,276 |
8.5× |
| CT upper extremity w/o & w/contrast material (73202) |
$1,230 |
$1,757 |
7.0× |
| CT upper extremity with contrast (73201) |
$906 |
$1,294 |
2.6× |
| Cta Abdl Aorta&Bi Iliofem W/Contrast&Postp (75635) |
$2,982 |
$4,260 |
16.9× |
| Cta Abdomen (74175) |
$1,542 |
$2,203 |
8.8× |
| Dxa Bone Density Axial (77080) |
$237 |
$338 |
2.3× |
| Dxa bone density study 1/>sites appendiclr skel (77081) |
$152 |
$217 |
1.7× |
| Esophagram (74220) |
$307 |
$438 |
1.7× |
| Fetal Biophysical Profile W/O Non-Stress Testing (76819) |
$288 |
$411 |
2.7× |
| Fluoroscopy up to 1 hr (76000) |
$420 |
$600 |
1.8× |
| Foot 2 views (73620) |
$260 |
$371 |
3.0× |
| Forearm 2 views (73090) |
$260 |
$371 |
3.0× |
| Gastric emptying imaging study (78264) |
$687 |
$982 |
1.7× |
| Hand 2 views (73120) |
$253 |
$362 |
2.4× |
| Hepatobil Syst Image W/Drug (78227) |
$1,118 |
$1,597 |
2.0× |
| Ht Muscle Image Spect Sing (78451) |
$2,367 |
$3,382 |
1.8× |
| Infant hip ultrasound with hip movement (dynamic) (76885) |
$454 |
$649 |
5.2× |
| K Flow/Funct Image W/O Drug (78707) |
$1,841 |
$2,630 |
3.4× |
| Knee 3 Views (73562) |
$416 |
$594 |
4.8× |
| Liver & Spleen Imaging Static Only (78215) |
$1,057 |
$1,510 |
2.6× |
| Magnetic Image Jaw Joint (70336) |
$1,367 |
$1,953 |
5.7× |
| Meckels Divert Exam (78290) |
$725 |
$1,036 |
1.8× |
| Mra Head W/O & W/Contrast Material (70546) |
$1,987 |
$2,839 |
5.7× |
| MRA head w/o contrast (70544) |
$1,521 |
$2,173 |
6.3× |
| MRA head with contrast (70545) |
$1,692 |
$2,417 |
4.8× |
| Mra Neck W/O &W/Contrast Material (70549) |
$1,865 |
$2,664 |
5.3× |
| MRA neck w/o contrast (70547) |
$1,546 |
$2,208 |
6.4× |
| MRI abdomen w contrast (74182) |
$1,539 |
$2,199 |
4.4× |
| MRI abdomen w/o contrast (74181) |
$1,367 |
$1,953 |
5.7× |
| MRI any jt lower extrem w/o & w/contrast matrl (73723) |
$2,801 |
$4,002 |
8.0× |
| MRI cervical spine w contrast (72142) |
$3,261 |
$4,658 |
9.3× |
| MRI cervical spine w/o cont (72141) |
$2,634 |
$3,763 |
11.0× |
| MRI chest w/o contrast (71550) |
$2,590 |
$3,700 |
10.8× |
| MRI chest wo w contrast (71552) |
$3,360 |
$4,800 |
9.6× |
| MRI lower extrem oth/thn jt w/o & w/contr matr (73720) |
$2,655 |
$3,793 |
7.6× |
| MRI lower extrem oth/thn jt w/o contr matrl (73718) |
$2,146 |
$3,065 |
9.0× |
| MRI lumbar spine w contrast (72149) |
$3,739 |
$5,341 |
10.7× |
| Mri Neck Spine W/O & W/Dye (72156) |
$3,337 |
$4,767 |
9.5× |
| MRI orbit face &/neck w/o contrast (70540) |
$1,544 |
$2,206 |
6.4× |
| Mri Orbt/Fac/Nck W/O &W/Dye (70543) |
$2,251 |
$3,215 |
6.4× |
| MRI pelvis w contrast (72196) |
$1,367 |
$1,953 |
3.9× |
| MRI pelvis w/o & w contrast (72197) |
$2,920 |
$4,172 |
8.3× |
| MRI pelvis w/o contrast (72195) |
$1,469 |
$2,098 |
6.1× |
| MRI thoracic spine w/o contrast (72146) |
$2,837 |
$4,053 |
11.8× |
| MRI upper extremity oth than jt w/o contr matrl (73218) |
$2,122 |
$3,031 |
8.9× |
| Mri Uppr Extremity W/O&W/Dye (73220) |
$2,870 |
$4,100 |
8.2× |
| MRI, abdomen, combo (74183) |
$3,185 |
$4,550 |
9.1× |
| MRI, dorsal spine combo (72157) |
$3,355 |
$4,793 |
9.6× |
| MRI, dorsal spine contrast (72147) |
$2,585 |
$3,693 |
7.4× |
| MRI, joint upper extrem (73221) |
$2,460 |
$3,514 |
10.3× |
| MRI, joint upper extrem combo (73223) |
$2,460 |
$3,514 |
7.0× |
| MRI, lumbar spine combo (72158) |
$3,177 |
$4,539 |
9.1× |
| Myocardial Spect Multiple Studies (78452) |
$2,367 |
$3,382 |
1.8× |
| Neck soft tissue (70360) |
$154 |
$220 |
1.8× |
| Parathyroid Planar Imaging (78070) |
$1,199 |
$1,713 |
3.0× |
| Pelvis 1 or 2 views (72170) |
$240 |
$343 |
2.3× |
| Radex Ankle Complete Minimum 3 Views (73610) |
$416 |
$594 |
4.8× |
| Radex Calcaneus Minimum 2 Views (73650) |
$260 |
$371 |
3.0× |
| Radex elbow complete minimum 3 views (73080) |
$152 |
$217 |
1.7× |
| Radex Facial Bones Complete Minimum 3 Views (70150) |
$248 |
$355 |
2.4× |
| Radex fingr minimum 2 views (73140) |
$260 |
$371 |
3.0× |
| Radex foot complete minimum 3 views (73630) |
$260 |
$371 |
3.0× |
| Radex Hand Minimum 3 Views (73130) |
$291 |
$415 |
3.3× |
| Radex lower extremity infant minimum 2 views (73592) |
$416 |
$594 |
4.8× |
| Radex Mastoids Compl Minimum 3 Views PR Side (70130) |
$183 |
$262 |
1.7× |
| Radex Nasal Bones Complete Minimum 3 Views (70160) |
$260 |
$371 |
3.0× |
| Radex Ribs Unilateral 2 Views (71100) |
$260 |
$371 |
3.0× |
| Radex shoulder complete minimum 2 views (73030) |
$416 |
$594 |
4.8× |
| Radex Sinuses Paransl < 3 Views (70210) |
$260 |
$372 |
3.0× |
| Radex Spine 1 View Specify Level (72020) |
$260 |
$371 |
3.0× |
| Radex Sternum Minimum 2 Views (71120) |
$183 |
$261 |
2.1× |
| Radex Temporomandble Jt Opn & Clsd Mouth Bilat (70330) |
$188 |
$268 |
2.2× |
| Radex Toe Minimum 2 Views (73660) |
$154 |
$220 |
1.8× |
| Radex upper extremity infant minimum 2 views (73092) |
$183 |
$262 |
1.7× |
| Radex Wrist Complete Minimum 3 Views (73110) |
$260 |
$371 |
3.0× |
| Radiolog exam mandible compl minimum 4 views (70110) |
$183 |
$262 |
1.7× |
| Radiologic exam colon double contrast study (74280) |
$317 |
$453 |
1.8× |
| Radiologic exam colon single contrast study (74270) |
$307 |
$438 |
1.7× |
| Radiologic Exam Esophagus Double Contrast Study (74221) |
$445 |
$636 |
2.5× |
| Radiologic exam knee complete 4/more views (73564) |
$416 |
$594 |
4.0× |
| Radiologic exam pelvis compl minimum 3 views (72190) |
$416 |
$594 |
4.0× |
| Radiologic exam swallow function contrast study (74230) |
$481 |
$687 |
2.7× |
| Radiologic exam upr gi trc double contrast study (74246) |
$662 |
$945 |
3.8× |
| Radiologic examination femur 1 view (73551) |
$176 |
$252 |
2.0× |
| Radiologic examination femur minimum 2 views (73552) |
$260 |
$371 |
3.0× |
| Radiologic examination knee 1/2 views (73560) |
$260 |
$371 |
3.0× |
| Radiologic Examination Osseous Survey Limited (77074) |
$416 |
$594 |
4.0× |
| Radiologic examination tibia & fibula 2 views (73590) |
$260 |
$371 |
3.0× |
| Ribs bilateral 3 views (71110) |
$186 |
$265 |
1.8× |
| Scapula (73010) |
$300 |
$429 |
2.9× |
| Screening Digital Breast Tomosynthesis Bi (77063) |
$119 |
$170 |
5.1× |
| Shoulder 1 view (73020) |
$260 |
$371 |
3.0× |
| Skull less than 4 views (70250) |
$240 |
$343 |
2.3× |
| Thoracic spine 2 views (72070) |
$240 |
$343 |
2.3× |
| Thyroid Uptake W/Blood Flow Sngle/Mult Quan Meas (78014) |
$827 |
$1,182 |
2.1× |
| Ultrasound Breast Limited (76642) |
$675 |
$964 |
7.7× |
| Ultrasound, abdomen limited (76705) |
$341 |
$487 |
3.2× |
| Unlisted Dx Radiographic Procedure (76499) |
$260 |
$371 |
3.0× |
| Unlisted us procedure (76999) |
$402 |
$574 |
4.6× |
| Urethrocystogram voiding (74455) |
$4 |
$5 |
0.0× |
| Us breast unilateral complete (76641) |
$490 |
$700 |
4.7× |
| Us chest (76604) |
$510 |
$729 |
4.9× |
| Us complete joint (76881) |
$591 |
$844 |
5.6× |
| Us exam, pelvic, limited (76857) |
$219 |
$313 |
2.1× |
| Us head (76506) |
$385 |
$550 |
3.7× |
| Us kidney transplant (76776) |
$458 |
$654 |
4.4× |
| Us lmtd joint/oth nonvasc xtr strux r-t w/img (76882) |
$419 |
$598 |
4.0× |
| Us ob limited 1 or more fetuses (76815) |
$249 |
$356 |
2.4× |
| Us ob transvaginal (76817) |
$591 |
$844 |
5.6× |
| Us pelvic non ob complete (76856) |
$400 |
$572 |
3.8× |
| Us pg uter img f&mat 14 wk tabdl 1/1st gestation (76801) |
$591 |
$844 |
5.6× |
| Us preg uterus real time f/u trnsabdl per fetus (76816) |
$328 |
$468 |
3.1× |
| Us retroperitoneal complete (76770) |
$458 |
$654 |
4.4× |
| Us retroperitoneal limited (76775) |
$298 |
$425 |
2.8× |
| Us scrotum and contents (76870) |
$591 |
$844 |
5.6× |
| Us spinal canal and contents (76800) |
$455 |
$650 |
4.3× |
| Us thyroid (76536) |
$337 |
$481 |
3.2× |
| Wrist 2 views (73100) |
$260 |
$371 |
3.0× |
| X-Ray Ac Jts - Xr Acromioclavicular Joints Bilateral (73050) |
$416 |
$594 |
4.8× |
| X-Ray Elbow 2 Vw - Xr Elbow 1-2 Views Right (73070) |
$260 |
$371 |
3.0× |
| X-Ray Exam Entire Spi 1 Vw (72081) |
$260 |
$371 |
3.0× |
| X-Ray Exam Hip Uni 1 View (73501) |
$260 |
$371 |
3.0× |
| X-Ray Exam Hip Uni 2-3 Views (73502) |
$260 |
$371 |
3.0× |
| X-Ray Exam Hips Bi 3-4 Views (73522) |
$183 |
$262 |
1.7× |
| X-Ray Exam Neck Spine 2-3 Vw (72040) |
$240 |
$343 |
2.7× |
| X-ray humerus (73060) |
$260 |
$371 |
3.0× |
| X-ray IV pyelogram (ivp) (74400) |
$307 |
$438 |
1.7× |
| X-Ray Jaw <4 Vw - Xr Mandible < 4 Views (70100) |
$158 |
$226 |
1.8× |
| X-Ray Knee Bilat Standing - Xr Knees Anteroposterior Standing Bilat (73565) |
$152 |
$217 |
1.7× |
| X-Ray Lumbar Spine 2/3 Vw - Xr Lumbar Spine 2-3 Views (72100) |
$300 |
$429 |
2.9× |
| X-ray nose-rectum child f.b. (76010) |
$165 |
$235 |
1.9× |
| X-Ray Sacroiliac Jts <3 Vw - Xr Sacroiliac Joints 1-2 Views (72200) |
$190 |
$271 |
1.8× |
| X-Ray Sacrum/Coccyx 2+ Vw - Xr Sacrum Coccyx 2+ Views (72220) |
$181 |
$258 |
2.1× |
| X-Ray Sinuses 3+ Vw - Xr Paranasal Sinuses 3+ Views (70220) |
$251 |
$359 |
2.9× |
| X-Ray Skull 4+ Vw - Xr Skull Complete 4+ Views (70260) |
$328 |
$468 |
3.1× |
| X-ray thoracic spine 4 vw (72074) |
$416 |
$594 |
4.0× |
| X-Rays Bone Length Studies (77073) |
$183 |
$262 |
1.7× |
| X-Rays Bone Survey Complete (77075) |
$183 |
$262 |
1.7× |
| Xr c-spine 4 or 5 views (72050) |
$356 |
$508 |
3.4× |
| Xr facial bones less than 3 views (70140) |
$168 |
$240 |
1.9× |
| XR Mastoids < 3 Views Bilateral (70120) |
$183 |
$262 |
1.7× |
| Xr orbits complete 4 views (70200) |
$416 |
$594 |
4.0× |