| Abdomen 1 View (74018) |
$238.80 |
$398 |
2.8× |
| Abdomen 2 views (74019) |
$70.80 |
$118 |
0.7× |
| Ankle 2 views (73600) |
$120.60 |
$201 |
1.4× |
| Bone age studies (77072) |
$83.40 |
$139 |
0.8× |
| Bone Imaging 3 Phase (78315) |
$1,388.40 |
$2,314 |
3.6× |
| Bone Imaging Limited Area (78300) |
$675 |
$1,125 |
1.7× |
| Bone Imaging Whole Body (78306) |
$675 |
$1,125 |
1.7× |
| Bone survey infant (77076) |
$579 |
$965 |
5.7× |
| Chest 1 view (71045) |
$100.20 |
$167 |
1.2× |
| Chest 2 views (71046) |
$232.80 |
$388 |
2.7× |
| Chest 3 views (71047) |
$86.40 |
$144 |
1.0× |
| Clavicle complete (73000) |
$120.60 |
$201 |
1.4× |
| Computed Tomography Thorax Lw Dose Lng Ca Scr C- (71271) |
$283.80 |
$473 |
2.8× |
| CT abdomen and pelvis without and with contrast (74178) |
$2,065.80 |
$3,443 |
6.1× |
| CT abdomen and pelvis without contrast (74176) |
$1,409.40 |
$2,349 |
6.1× |
| CT abdomen w contrast (74160) |
$834 |
$1,390 |
4.9× |
| CT abdomen w wo contrast (74170) |
$1,033.20 |
$1,722 |
6.0× |
| CT abdomen w/o contrast (74150) |
$690 |
$1,150 |
6.8× |
| CT Angio Abdomen and Pelvis (74174) |
$1,464 |
$2,440 |
4.3× |
| CT Angio Chest (71275) |
$858.60 |
$1,431 |
5.0× |
| CT Angio Head (70496) |
$849 |
$1,415 |
5.0× |
| CT Angio Neck (70498) |
$708.60 |
$1,181 |
4.1× |
| CT cervical spine w/ contrast (72126) |
$862.20 |
$1,437 |
2.5× |
| CT cervical spine w/o contrast (72125) |
$721.20 |
$1,202 |
7.1× |
| CT chest w contrast (71260) |
$862.20 |
$1,437 |
5.0× |
| CT chest w/wo contrast (71270) |
$1,078.20 |
$1,797 |
6.3× |
| CT head/brain with contrast (70460) |
$690 |
$1,150 |
4.0× |
| CT head/brain without and with contrast (70470) |
$862.20 |
$1,437 |
5.0× |
| CT heart no contrast quant eval coronry calcium (75571) |
$129 |
$129 |
1.5× |
| CT l-spine w&w/o contrast (72133) |
$939 |
$1,565 |
5.5× |
| CT lower ext w/o (73700) |
$604.20 |
$1,007 |
5.9× |
| CT lower extremity w/contrast material (73701) |
$721.20 |
$1,202 |
4.2× |
| CT lumbar spine w contrast (72132) |
$862.20 |
$1,437 |
2.5× |
| CT lumbar spine w/o contrast (72131) |
$721.20 |
$1,202 |
7.1× |
| CT maxillofacial w contrast (70487) |
$781.20 |
$1,302 |
4.6× |
| CT maxillofacial wo contrast (70486) |
$576 |
$960 |
5.6× |
| CT neck tissue combo (70492) |
$862.20 |
$1,437 |
5.0× |
| Ct Orbit/Ear/Fossa W/O&W/Dye (70482) |
$3,117 |
$5,195 |
18.2× |
| CT orbits w/o contrast (70480) |
$576 |
$960 |
5.6× |
| CT pelvis w&w/o contrast (72194) |
$781.20 |
$1,302 |
4.6× |
| CT pelvis w/o contrast (72192) |
$721.20 |
$1,202 |
7.1× |
| CT scan of leg combo (73702) |
$1,698 |
$2,830 |
9.9× |
| CT scans face/jaw combo (70488) |
$862.20 |
$1,437 |
5.0× |
| CT soft tissue neck w contrast (70491) |
$690 |
$1,150 |
4.0× |
| CT soft tissue neck w/o contrast (70490) |
$576 |
$960 |
5.6× |
| CT thoracic spine w contrast (72129) |
$862.20 |
$1,437 |
5.0× |
| CT thoracic spine w/o contrast (72128) |
$721.20 |
$1,202 |
7.1× |
| CT thorax w/o contrast (71250) |
$721.20 |
$1,202 |
7.1× |
| CT upper ext wo (73200) |
$604.20 |
$1,007 |
5.9× |
| CT upper extremity with contrast (73201) |
$721.20 |
$1,202 |
2.1× |
| Cta Abdl Aorta&Bi Iliofem W/Contrast&Postp (75635) |
$2,991.60 |
$4,986 |
17.5× |
| Cta Abdomen (74175) |
$979.80 |
$1,633 |
5.7× |
| CTA pelvis (72191) |
$1,537.20 |
$2,562 |
9.0× |
| Dxa Bone Density Axial (77080) |
$338.40 |
$564 |
3.3× |
| Dxa bone density study 1/>sites appendiclr skel (77081) |
$133.80 |
$223 |
1.6× |
| Esophagram (74220) |
$409.20 |
$682 |
2.4× |
| Fluoroscopy up to 1 hr (76000) |
$665.40 |
$1,109 |
2.9× |
| Foot 2 views (73620) |
$120.60 |
$201 |
1.4× |
| Forearm 2 views (73090) |
$120.60 |
$201 |
1.4× |
| Gastric emptying imaging study (78264) |
$675 |
$1,125 |
1.7× |
| Gated Heart Planar Single (78472) |
$799.20 |
$1,332 |
2.0× |
| Hand 2 views (73120) |
$120.60 |
$201 |
1.2× |
| Hepatobil Syst Image W/Drug (78227) |
$908.40 |
$1,514 |
1.7× |
| Hepatobiliary System Imaging (78226) |
$1,173.60 |
$1,956 |
3.0× |
| Ht Muscle Image Spect Sing (78451) |
$2,073.60 |
$3,456 |
1.6× |
| K Flow/Funct Image Multiple (78709) |
$927 |
$1,545 |
1.7× |
| K Flow/Funct Image W/Drug (78708) |
$836.40 |
$1,394 |
1.6× |
| K Flow/Funct Image W/O Drug (78707) |
$908.40 |
$1,514 |
1.7× |
| Knee 3 Views (73562) |
$125.40 |
$209 |
1.5× |
| Lung Ventilat&Perfus Imaging (78582) |
$508.20 |
$847 |
1.0× |
| MRA head w/o contrast (70544) |
$1,353 |
$2,255 |
5.8× |
| MRA neck w contrast (70548) |
$696.60 |
$1,161 |
2.0× |
| Mra Neck W/O &W/Contrast Material (70549) |
$2,855.40 |
$4,759 |
8.4× |
| MRA neck w/o contrast (70547) |
$1,353 |
$2,255 |
5.8× |
| MRI abdomen w/o contrast (74181) |
$1,353 |
$2,255 |
5.8× |
| MRI any jt lower extrem w/o & w/contrast matrl (73723) |
$2,855.40 |
$4,759 |
8.4× |
| MRI cervical spine w/o cont (72141) |
$1,353 |
$2,255 |
5.8× |
| MRI lower extrem oth/thn jt w/o & w/contr matr (73720) |
$2,855.40 |
$4,759 |
8.4× |
| MRI lower extrem oth/thn jt w/o contr matrl (73718) |
$1,353 |
$2,255 |
5.8× |
| Mri Neck Spine W/O & W/Dye (72156) |
$2,855.40 |
$4,759 |
8.4× |
| MRI orbit face &/neck w/o contrast (70540) |
$949.20 |
$1,582 |
4.1× |
| Mri Orbt/Fac/Nck W/O &W/Dye (70543) |
$1,522.20 |
$2,537 |
4.5× |
| MRI pelvis w/o & w contrast (72197) |
$2,855.40 |
$4,759 |
8.4× |
| MRI pelvis w/o contrast (72195) |
$949.20 |
$1,582 |
4.1× |
| MRI thoracic spine w/o contrast (72146) |
$1,353 |
$2,255 |
5.8× |
| MRI upper extremity oth than jt w/o contr matrl (73218) |
$1,353 |
$2,255 |
5.8× |
| Mri Uppr Extremity W/O&W/Dye (73220) |
$1,522.20 |
$2,537 |
4.5× |
| MRI, abdomen, combo (74183) |
$2,855.40 |
$4,759 |
8.4× |
| MRI, dorsal spine combo (72157) |
$2,855.40 |
$4,759 |
8.4× |
| MRI, joint upper extrem (73221) |
$1,353 |
$2,255 |
5.8× |
| MRI, lumbar spine combo (72158) |
$2,855.40 |
$4,759 |
8.4× |
| Myocardial Spect Multiple Studies (78452) |
$2,404.20 |
$4,007 |
1.9× |
| Neck soft tissue (70360) |
$120.60 |
$201 |
1.4× |
| Parathyroid Planar Imaging (78070) |
$244.20 |
$407 |
0.6× |
| Pelvis 1 or 2 views (72170) |
$120.60 |
$201 |
1.2× |
| Pulmonary Perfusion Imaging Particulate (78580) |
$399 |
$665 |
1.0× |
| Radex Abd Compl Aqt Abd W/S/E/D Views 1 View Ch (74022) |
$240 |
$400 |
2.4× |
| Radex Ankle Complete Minimum 3 Views (73610) |
$240 |
$400 |
2.8× |
| Radex Calcaneus Minimum 2 Views (73650) |
$120.60 |
$201 |
1.4× |
| Radex elbow complete minimum 3 views (73080) |
$125.40 |
$209 |
1.5× |
| Radex Facial Bones Complete Minimum 3 Views (70150) |
$516 |
$860 |
5.1× |
| Radex fingr minimum 2 views (73140) |
$120.60 |
$201 |
1.4× |
| Radex foot complete minimum 3 views (73630) |
$240 |
$400 |
2.8× |
| Radex Hand Minimum 3 Views (73130) |
$120.60 |
$201 |
1.4× |
| Radex Nasal Bones Complete Minimum 3 Views (70160) |
$120.60 |
$201 |
1.4× |
| Radex Ribs Unilateral 2 Views (71100) |
$120.60 |
$201 |
1.4× |
| Radex shoulder complete minimum 2 views (73030) |
$240 |
$400 |
2.8× |
| Radex Sinuses Paransl < 3 Views (70210) |
$457.20 |
$762 |
5.4× |
| Radex Spine 1 View Specify Level (72020) |
$68.40 |
$114 |
0.8× |
| Radex Sternum Minimum 2 Views (71120) |
$79.80 |
$133 |
0.9× |
| Radex Temporomandble Jt Opn & Clsd Mouth Bilat (70330) |
$507 |
$845 |
6.0× |
| Radex Toe Minimum 2 Views (73660) |
$240 |
$400 |
2.8× |
| Radex Wrist Complete Minimum 3 Views (73110) |
$120.60 |
$201 |
1.4× |
| Radiologic exam colon double contrast study (74280) |
$1,514.40 |
$2,524 |
8.8× |
| Radiologic exam colon single contrast study (74270) |
$315 |
$525 |
1.8× |
| Radiologic exam knee complete 4/more views (73564) |
$229.20 |
$382 |
2.2× |
| Radiologic exam pelvis compl minimum 3 views (72190) |
$468.60 |
$781 |
4.6× |
| Radiologic Exam Small Int Single Contrast Study (74250) |
$213 |
$355 |
1.2× |
| Radiologic exam swallow function contrast study (74230) |
$213 |
$355 |
1.2× |
| Radiologic examination femur 1 view (73551) |
$470.40 |
$784 |
5.5× |
| Radiologic examination femur minimum 2 views (73552) |
$120.60 |
$201 |
1.4× |
| Radiologic examination knee 1/2 views (73560) |
$120.60 |
$201 |
1.4× |
| Radiologic Examination Osseous Survey Limited (77074) |
$144.60 |
$241 |
1.4× |
| Radiologic examination tibia & fibula 2 views (73590) |
$120.60 |
$201 |
1.4× |
| Ribs bilateral 3 views (71110) |
$190.20 |
$317 |
1.9× |
| Scapula (73010) |
$120.60 |
$201 |
1.2× |
| Screening Digital Breast Tomosynthesis Bi (77063) |
$18 |
$30 |
0.8× |
| Shoulder 1 view (73020) |
$120.60 |
$201 |
1.4× |
| Skull less than 4 views (70250) |
$83.40 |
$139 |
0.8× |
| Sternoclavicular joints (71130) |
$82.20 |
$137 |
1.0× |
| Thoracic spine 2 views (72070) |
$120.60 |
$201 |
1.2× |
| Thoracic spine 3 views (72072) |
$190.20 |
$317 |
1.9× |
| Thoracolumbar 2 views (72080) |
$82.20 |
$137 |
1.0× |
| Thyroid Imaging With Vascular Flow (78013) |
$486.60 |
$811 |
1.2× |
| Thyroid Uptake W/Blood Flow Sngle/Mult Quan Meas (78014) |
$729 |
$1,215 |
1.9× |
| Ultrasound Breast Limited (76642) |
$188.40 |
$314 |
2.2× |
| Ultrasound Exam Aaa Screen (76706) |
$232.20 |
$387 |
2.3× |
| Ultrasound, abdomen limited (76705) |
$342 |
$570 |
3.4× |
| Upper gi w/o kub (74240) |
$331.20 |
$552 |
1.9× |
| Us breast unilateral complete (76641) |
$235.80 |
$393 |
2.3× |
| Us chest (76604) |
$568.20 |
$947 |
5.6× |
| Us complete joint (76881) |
$340.20 |
$567 |
3.3× |
| Us exam, pelvic, limited (76857) |
$129.60 |
$216 |
1.3× |
| Us lmtd joint/oth nonvasc xtr strux r-t w/img (76882) |
$188.40 |
$314 |
1.8× |
| Us ob limited 1 or more fetuses (76815) |
$281.40 |
$469 |
2.8× |
| Us ob transvaginal (76817) |
$281.40 |
$469 |
2.8× |
| Us pelvic non ob complete (76856) |
$187.20 |
$312 |
1.8× |
| Us pg uter img f&mat 14 wk tabdl 1/1st gestation (76801) |
$281.40 |
$469 |
2.8× |
| Us retroperitoneal complete (76770) |
$241.80 |
$403 |
2.4× |
| Us retroperitoneal limited (76775) |
$174.60 |
$291 |
1.7× |
| Us scrotum and contents (76870) |
$187.20 |
$312 |
1.8× |
| Us spinal canal and contents (76800) |
$918 |
$1,530 |
9.0× |
| Us thyroid (76536) |
$281.40 |
$469 |
2.8× |
| Wrist 2 views (73100) |
$120.60 |
$201 |
1.4× |
| X-Ray Ac Jts - Xr Acromioclavicular Joints Bilateral (73050) |
$568.20 |
$947 |
6.7× |
| X-Ray Bend Only L-S Spine (72120) |
$192.60 |
$321 |
1.9× |
| X-Ray Elbow 2 Vw - Xr Elbow 1-2 Views Right (73070) |
$120.60 |
$201 |
1.4× |
| X-Ray Exam Entire Spi 1 Vw (72081) |
$342.60 |
$571 |
4.0× |
| X-Ray Exam Entire Spi 2/3 Vw (72082) |
$175.20 |
$292 |
1.7× |
| X-Ray Exam Hip Uni 1 View (73501) |
$120.60 |
$201 |
1.4× |
| X-Ray Exam Hip Uni 2-3 Views (73502) |
$120.60 |
$201 |
1.4× |
| X-Ray Exam Hip Uni 4/> Views (73503) |
$175.20 |
$292 |
1.7× |
| X-Ray Exam Hips Bi 2 Views (73521) |
$175.20 |
$292 |
1.7× |
| X-Ray Exam Hips Bi 3-4 Views (73522) |
$175.20 |
$292 |
1.7× |
| X-Ray Exam Hips Bi 5/> Views (73523) |
$642.60 |
$1,071 |
6.3× |
| X-Ray Exam L-S Spine Bending (72114) |
$708 |
$1,180 |
6.9× |
| X-Ray Exam Neck Spine 2-3 Vw (72040) |
$120.60 |
$201 |
1.4× |
| X-Ray Exam Unilat Ribs/Chest (71101) |
$190.20 |
$317 |
1.9× |
| X-ray eye for foreign body (70030) |
$120.60 |
$201 |
1.4× |
| X-ray humerus (73060) |
$120.60 |
$201 |
1.4× |
| X-Ray Jaw <4 Vw - Xr Mandible < 4 Views (70100) |
$144 |
$240 |
1.7× |
| X-Ray Knee Bilat Standing - Xr Knees Anteroposterior Standing Bilat (73565) |
$120.60 |
$201 |
1.4× |
| X-Ray Lumbar Spine 2/3 Vw - Xr Lumbar Spine 2-3 Views (72100) |
$232.80 |
$388 |
2.3× |
| X-Ray Ribs, Chest 4+ Vw - Xr Ribs 3 Vws Bil W/ Chest Posteroanterior (71111) |
$190.20 |
$317 |
1.9× |
| X-Ray Sacroiliac Jts 3+ Vw - Xr Sacroiliac Joints 3+ Views (72202) |
$120.60 |
$201 |
1.2× |
| X-Ray Sacrum/Coccyx 2+ Vw - Xr Sacrum Coccyx 2+ Views (72220) |
$120.60 |
$201 |
1.4× |
| X-Ray Sinuses 3+ Vw - Xr Paranasal Sinuses 3+ Views (70220) |
$120.60 |
$201 |
1.4× |
| X-Ray Skull 4+ Vw - Xr Skull Complete 4+ Views (70260) |
$628.80 |
$1,048 |
6.2× |
| X-Ray Tmj Unilat (70328) |
$156.60 |
$261 |
1.8× |
| X-Rays Bone Length Studies (77073) |
$200.40 |
$334 |
2.0× |
| X-Rays Bone Survey Complete (77075) |
$226.20 |
$377 |
2.2× |
| Xr c-spine 4 or 5 views (72050) |
$190.20 |
$317 |
1.9× |
| Xr facial bones less than 3 views (70140) |
$156 |
$260 |
1.8× |
| Xr orbits complete 4 views (70200) |
$114.60 |
$191 |
1.1× |