| Abdomen 1 View (74018) |
$86.70 |
$289 |
0.9× |
| Abdomen 2 views (74019) |
$115.80 |
$386 |
1.0× |
| Acute Gastrointestinal Blood Loss Imaging (78278) |
$467.40 |
$1,558 |
1.1× |
| Angio pulmonary bilat (75743) |
$3,100.50 |
$10,335 |
0.9× |
| Angiography Adrenal Bilateral Slctv Rs&I (75733) |
$3,100.50 |
$10,335 |
0.9× |
| Angiography extremity bilateral rs&i (75716) |
$3,100.50 |
$10,335 |
0.9× |
| Angiography extremity unilateral rs&i (75710) |
$3,100.50 |
$10,335 |
0.9× |
| Ankle 2 views (73600) |
$120.90 |
$403 |
1.3× |
| Aortography thoracic w/o serialography rs&i (75600) |
$3,100.50 |
$10,335 |
0.9× |
| Artery X-Rays Abdomen (75726) |
$5,324.70 |
$17,749 |
0.9× |
| Artery X-Rays Pelvis (75736) |
$5,324.70 |
$17,749 |
0.9× |
| Artery X-Rays Spine (75705) |
$5,324.70 |
$17,749 |
0.9× |
| Arthrogram ankle (73615) |
$351.90 |
$1,173 |
0.9× |
| Arthrogram Wrist (73115) |
$351.90 |
$1,173 |
0.9× |
| Bone age studies (77072) |
$105 |
$350 |
0.9× |
| Bone Imaging 3 Phase (78315) |
$395.70 |
$1,319 |
0.9× |
| Bone Imaging Multiple Areas (78305) |
$720.60 |
$2,402 |
1.7× |
| Bone Imaging Whole Body (78306) |
$720.60 |
$2,402 |
1.7× |
| Bone survey infant (77076) |
$232.20 |
$774 |
2.1× |
| Brain Flow Imaging Only (78610) |
$507.60 |
$1,692 |
0.9× |
| Chest 1 view (71045) |
$143.70 |
$479 |
1.5× |
| Chest 2 views (71046) |
$86.70 |
$289 |
0.9× |
| Chest 3 views (71047) |
$86.70 |
$289 |
0.9× |
| Chest 4 or more views (71048) |
$115.80 |
$386 |
1.0× |
| Clavicle complete (73000) |
$87.90 |
$293 |
0.9× |
| Computed Tomography Thorax Lw Dose Lng Ca Scr C- (71271) |
$78.30 |
$261 |
0.7× |
| Contrast Exam Abdominl Aorta (75625) |
$3,100.50 |
$10,335 |
0.9× |
| Contrast X-Ray Bladder (74430) |
$351.90 |
$1,173 |
0.9× |
| Contrast X-Ray Of Elbow (73085) |
$351.90 |
$1,173 |
0.9× |
| Contrast X-Ray Of Knee Joint (73580) |
$355.50 |
$1,185 |
1.0× |
| CT abdomen and pelvis without and with contrast (74178) |
$1,439.10 |
$4,797 |
3.8× |
| CT abdomen and pelvis without contrast (74176) |
$1,287.60 |
$4,292 |
5.0× |
| CT abdomen w contrast (74160) |
$679.20 |
$2,264 |
3.6× |
| CT abdomen w wo contrast (74170) |
$679.20 |
$2,264 |
3.6× |
| CT abdomen w/o contrast (74150) |
$608.40 |
$2,028 |
5.4× |
| CT Angio Abdomen and Pelvis (74174) |
$1,520.10 |
$5,067 |
4.1× |
| CT Angio Chest (71275) |
$759.90 |
$2,533 |
4.0× |
| CT Angio Head (70496) |
$759.90 |
$2,533 |
4.0× |
| Ct Angio Lwr Extr W/O&W/Dye (73706) |
$759.90 |
$2,533 |
4.0× |
| CT Angio Neck (70498) |
$759.90 |
$2,533 |
4.0× |
| Ct Angio Upr Extrm W/O&W/Dye (73206) |
$759.90 |
$2,533 |
4.0× |
| CT bone density (77078) |
$179.70 |
$599 |
1.9× |
| CT cervical spine w/ contrast (72126) |
$402.60 |
$1,342 |
1.1× |
| CT cervical spine w/o contrast (72125) |
$608.40 |
$2,028 |
5.4× |
| CT cervical spine w/wo cont (72127) |
$750.90 |
$2,503 |
4.0× |
| CT chest w contrast (71260) |
$644.70 |
$2,149 |
3.4× |
| CT chest w/wo contrast (71270) |
$715.20 |
$2,384 |
3.8× |
| CT head/brain with contrast (70460) |
$572.70 |
$1,909 |
3.0× |
| CT head/brain without and with contrast (70470) |
$644.70 |
$2,149 |
3.4× |
| CT iac w contrast (70481) |
$644.70 |
$2,149 |
3.4× |
| CT l-spine w&w/o contrast (72133) |
$750.90 |
$2,503 |
4.0× |
| CT lower ext w/o (73700) |
$644.70 |
$2,149 |
5.8× |
| CT lower extremity w/contrast material (73701) |
$715.20 |
$2,384 |
3.8× |
| CT lumbar spine w contrast (72132) |
$965.40 |
$3,218 |
2.6× |
| CT lumbar spine w/o contrast (72131) |
$608.40 |
$2,028 |
5.4× |
| CT maxillofacial w contrast (70487) |
$750.90 |
$2,503 |
4.0× |
| CT maxillofacial wo contrast (70486) |
$679.20 |
$2,264 |
6.1× |
| CT neck tissue combo (70492) |
$823.20 |
$2,744 |
4.4× |
| Ct Orbit/Ear/Fossa W/O&W/Dye (70482) |
$788.10 |
$2,627 |
4.2× |
| CT orbits w/o contrast (70480) |
$572.70 |
$1,909 |
5.1× |
| CT pelvis w&w/o contrast (72194) |
$823.20 |
$2,744 |
4.4× |
| CT pelvis w/o contrast (72192) |
$679.20 |
$2,264 |
6.1× |
| CT scan of leg combo (73702) |
$429.90 |
$1,433 |
2.3× |
| CT scans face/jaw combo (70488) |
$823.20 |
$2,744 |
4.4× |
| CT soft tissue neck w contrast (70491) |
$750.90 |
$2,503 |
4.0× |
| CT soft tissue neck w/o contrast (70490) |
$679.20 |
$2,264 |
6.1× |
| CT thoracic spine w contrast (72129) |
$644.70 |
$2,149 |
3.4× |
| CT thoracic spine w/o contrast (72128) |
$608.40 |
$2,028 |
5.4× |
| CT thorax w/o contrast (71250) |
$572.70 |
$1,909 |
5.1× |
| CT upper ext wo (73200) |
$644.70 |
$2,149 |
5.8× |
| CT upper extremity w/o & w/contrast material (73202) |
$788.10 |
$2,627 |
4.2× |
| CT upper extremity with contrast (73201) |
$715.20 |
$2,384 |
1.9× |
| Cta Abdl Aorta&Bi Iliofem W/Contrast&Postp (75635) |
$759.90 |
$2,533 |
4.0× |
| Cta Abdomen (74175) |
$759.90 |
$2,533 |
4.0× |
| CTA pelvis (72191) |
$175.50 |
$585 |
0.9× |
| Doppler Echo Fetal Spectral Display Complete (76827) |
$108.60 |
$362 |
1.0× |
| Doppler Fetal Mid Cerebral Artery (76821) |
$125.70 |
$419 |
1.1× |
| Echo exam of fetal heart (76825) |
$540 |
$1,800 |
0.9× |
| Echo exam uterus (76831) |
$223.50 |
$745 |
0.9× |
| Echo Guide For Artery Repair (76936) |
$306.90 |
$1,023 |
1.3× |
| Echocardiography, fetal, cardiovascular system, real time with image documentation (2D), with or without M-mode… (76826) |
$238.20 |
$794 |
0.9× |
| Fetal Biophys Profile W/Nst (76818) |
$105 |
$350 |
0.9× |
| Fetal Biophysical Profile W/O Non-Stress Testing (76819) |
$288 |
$960 |
2.6× |
| Fluoroscopy up to 1 hr (76000) |
$238.20 |
$794 |
0.9× |
| Foot 2 views (73620) |
$86.70 |
$289 |
0.9× |
| Forearm 2 views (73090) |
$87.90 |
$293 |
0.9× |
| Gastric emptying imaging study (78264) |
$395.70 |
$1,319 |
0.9× |
| Hand 2 views (73120) |
$106.50 |
$355 |
1.0× |
| Hepatc Vngrph Wdg/Fr Hemodyn Eval Rs&I (75889) |
$3,100.50 |
$10,335 |
0.9× |
| Hepatobil Syst Image W/Drug (78227) |
$514.20 |
$1,714 |
0.9× |
| Hepatobiliary System Imaging (78226) |
$514.20 |
$1,714 |
1.2× |
| Ht Muscle Image Spect Sing (78451) |
$1,286.10 |
$4,287 |
0.9× |
| Infant hip ultrasound with hip movement (dynamic) (76885) |
$86.70 |
$289 |
0.9× |
| Infant hip ultrasound, limited static exam (76886) |
$86.70 |
$289 |
0.9× |
| K Flow/Funct Image W/Drug (78708) |
$523.80 |
$1,746 |
0.9× |
| K Flow/Funct Image W/O Drug (78707) |
$523.80 |
$1,746 |
0.9× |
| Knee 3 Views (73562) |
$108.60 |
$362 |
1.2× |
| Liver & Spleen Imaging Static Only (78215) |
$510 |
$1,700 |
1.2× |
| Lung Ventilat&Perfus Imaging (78582) |
$555 |
$1,850 |
1.0× |
| Lung Ventilation Imaging (78579) |
$555 |
$1,850 |
1.3× |
| Lymph System Imaging (78195) |
$526.80 |
$1,756 |
0.9× |
| Mra Head W/O & W/Contrast Material (70546) |
$388.80 |
$1,296 |
1.0× |
| MRA head w/o contrast (70544) |
$388.80 |
$1,296 |
1.5× |
| MRA head with contrast (70545) |
$351.90 |
$1,173 |
0.9× |
| MRA neck w contrast (70548) |
$612.30 |
$2,041 |
1.6× |
| Mra Neck W/O &W/Contrast Material (70549) |
$612.30 |
$2,041 |
1.6× |
| MRA neck w/o contrast (70547) |
$612.30 |
$2,041 |
2.4× |
| MRI abdomen w/o contrast (74181) |
$651.30 |
$2,171 |
2.5× |
| MRI any jt lower extrem w/o & w/contrast matrl (73723) |
$651.30 |
$2,171 |
1.7× |
| MRI Breast W/O Contrast Bilateral (77047) |
$226.80 |
$756 |
0.9× |
| MRI cervical spine w/o cont (72141) |
$232.20 |
$774 |
0.9× |
| MRI chest w/o contrast (71550) |
$651.30 |
$2,171 |
2.5× |
| MRI chest wo w contrast (71552) |
$651.30 |
$2,171 |
1.7× |
| MRI lower extrem oth/thn jt w/o & w/contr matr (73720) |
$651.30 |
$2,171 |
1.7× |
| MRI lower extrem oth/thn jt w/o contr matrl (73718) |
$651.30 |
$2,171 |
2.5× |
| Mri Neck Spine W/O & W/Dye (72156) |
$1,285.20 |
$4,284 |
3.4× |
| MRI orbit face &/neck w/o contrast (70540) |
$651.30 |
$2,171 |
2.5× |
| MRI orbit face neck w contrast (70542) |
$651.30 |
$2,171 |
1.7× |
| Mri Orbt/Fac/Nck W/O &W/Dye (70543) |
$651.30 |
$2,171 |
1.7× |
| MRI pelvis w/o & w contrast (72197) |
$608.40 |
$2,028 |
1.6× |
| MRI pelvis w/o contrast (72195) |
$608.40 |
$2,028 |
2.4× |
| MRI thoracic spine w/o contrast (72146) |
$651.30 |
$2,171 |
2.5× |
| MRI upper extremity oth than jt w/o contr matrl (73218) |
$651.30 |
$2,171 |
2.5× |
| Mri Uppr Extremity W/O&W/Dye (73220) |
$651.30 |
$2,171 |
1.7× |
| MRI, abdomen, combo (74183) |
$651.30 |
$2,171 |
1.7× |
| MRI, dorsal spine combo (72157) |
$1,285.20 |
$4,284 |
3.4× |
| MRI, joint upper extrem (73221) |
$651.30 |
$2,171 |
2.5× |
| MRI, joint upper extrem combo (73223) |
$651.30 |
$2,171 |
1.7× |
| MRI, lumbar spine combo (72158) |
$1,273.80 |
$4,246 |
3.4× |
| Myocardial Imaging Infarct Avid Planar Qual/Quan (78466) |
$395.70 |
$1,319 |
0.9× |
| Myocardial Spect Multiple Studies (78452) |
$1,286.10 |
$4,287 |
0.9× |
| Neck soft tissue (70360) |
$98.70 |
$329 |
1.1× |
| Nonvascular Shunt X-Ray (75809) |
$104.70 |
$349 |
0.9× |
| Ob us nuchal meas 1 gest (76813) |
$109.20 |
$364 |
1.0× |
| Oph bmtry us echograpy a-scan io lens pwr cal (76519) |
$107.10 |
$357 |
1.0× |
| Ophthalmic ultrasound dx b-scan w/wo a-scan (76512) |
$107.10 |
$357 |
1.0× |
| Ophthalmic US Dx Corneal Pachymetry Uni/Bi (76514) |
$24.30 |
$81 |
0.8× |
| Parathyroid Planar Imaging (78070) |
$513 |
$1,710 |
1.2× |
| Parathyroid planar imaging w/wo subtraction (78071) |
$830.10 |
$2,767 |
1.9× |
| Pelvis 1 or 2 views (72170) |
$106.50 |
$355 |
1.0× |
| Peritoneogram Rs&I (74190) |
$540 |
$1,800 |
0.9× |
| Pulmonary Perfusion Imaging Particulate (78580) |
$555 |
$1,850 |
1.3× |
| Radex Abd Compl Aqt Abd W/S/E/D Views 1 View Ch (74022) |
$143.70 |
$479 |
1.3× |
| Radex abscess/fistula/sinus tract rs&i (76080) |
$540 |
$1,800 |
0.9× |
| Radex Ankle Complete Minimum 3 Views (73610) |
$120.90 |
$403 |
1.3× |
| Radex Calcaneus Minimum 2 Views (73650) |
$98.70 |
$329 |
1.1× |
| Radex elbow complete minimum 3 views (73080) |
$98.70 |
$329 |
1.1× |
| Radex Facial Bones Complete Minimum 3 Views (70150) |
$152.40 |
$508 |
1.4× |
| Radex fingr minimum 2 views (73140) |
$88.20 |
$294 |
0.9× |
| Radex foot complete minimum 3 views (73630) |
$86.70 |
$289 |
0.9× |
| Radex Hand Minimum 3 Views (73130) |
$88.20 |
$294 |
0.9× |
| Radex lower extremity infant minimum 2 views (73592) |
$98.70 |
$329 |
1.1× |
| Radex Nasal Bones Complete Minimum 3 Views (70160) |
$86.70 |
$289 |
0.9× |
| Radex Ribs Unilateral 2 Views (71100) |
$201.60 |
$672 |
2.2× |
| Radex shoulder complete minimum 2 views (73030) |
$98.70 |
$329 |
1.1× |
| Radex Sinuses Paransl < 3 Views (70210) |
$86.70 |
$289 |
0.9× |
| Radex sm int w/mlt srl imges via enteroclss tube (74251) |
$175.50 |
$585 |
0.9× |
| Radex Spine 1 View Specify Level (72020) |
$86.70 |
$289 |
0.9× |
| Radex Sternum Minimum 2 Views (71120) |
$86.70 |
$289 |
0.9× |
| Radex Temporomandble Jt Opn & Clsd Mouth Bilat (70330) |
$82.80 |
$276 |
0.9× |
| Radex Toe Minimum 2 Views (73660) |
$86.70 |
$289 |
0.9× |
| Radex upper extremity infant minimum 2 views (73092) |
$106.50 |
$355 |
1.0× |
| Radex Wrist Complete Minimum 3 Views (73110) |
$86.70 |
$289 |
0.9× |
| Radiolog exam mandible compl minimum 4 views (70110) |
$143.70 |
$479 |
1.3× |
| Radiologic Exam Abdomen 3+ Views - Xr Abdomen 3+ Views (74021) |
$115.80 |
$386 |
1.0× |
| Radiologic exam colon double contrast study (74280) |
$175.50 |
$585 |
0.9× |
| Radiologic exam colon single contrast study (74270) |
$175.50 |
$585 |
0.9× |
| Radiologic exam knee complete 4/more views (73564) |
$128.10 |
$427 |
1.1× |
| Radiologic Exam Small Int Single Contrast Study (74250) |
$282.60 |
$942 |
1.5× |
| Radiologic exam swallow function contrast study (74230) |
$183.60 |
$612 |
1.0× |
| Radiologic examination femur minimum 2 views (73552) |
$98.70 |
$329 |
1.1× |
| Radiologic examination knee 1/2 views (73560) |
$86.70 |
$289 |
0.9× |
| Radiologic Examination Osseous Survey Limited (77074) |
$395.40 |
$1,318 |
3.5× |
| Radiologic examination tibia & fibula 2 views (73590) |
$108.60 |
$362 |
1.2× |
| Ribs bilateral 3 views (71110) |
$211.50 |
$705 |
1.9× |
| Scapula (73010) |
$105.30 |
$351 |
0.9× |
| Screening Digital Breast Tomosynthesis Bi (77063) |
$30.30 |
$101 |
1.3× |
| Shoulder 1 view (73020) |
$86.70 |
$289 |
0.9× |
| Shoulder Arthrography (73040) |
$351.90 |
$1,173 |
0.9× |
| Skull less than 4 views (70250) |
$106.50 |
$355 |
1.0× |
| Sternoclavicular joints (71130) |
$91.50 |
$305 |
1.0× |
| Thoracic spine 2 views (72070) |
$117.90 |
$393 |
1.1× |
| Thoracic spine 3 views (72072) |
$118.80 |
$396 |
1.1× |
| Thyroid Imaging With Vascular Flow (78013) |
$544.20 |
$1,814 |
1.3× |
| Thyroid Uptake Measurement (78012) |
$395.70 |
$1,319 |
0.9× |
| Thyroid Uptake W/Blood Flow Sngle/Mult Quan Meas (78014) |
$714.30 |
$2,381 |
1.7× |
| Ultrasound Breast Limited (76642) |
$225.60 |
$752 |
2.4× |
| Ultrasound Exam Aaa Screen (76706) |
$106.20 |
$354 |
0.9× |
| Ultrasound, abdomen limited (76705) |
$104.70 |
$349 |
0.9× |
| Umbilical-artery Doppler (OB) (76820) |
$125.70 |
$419 |
1.1× |
| Unlisted us procedure (76999) |
$219 |
$730 |
2.3× |
| Upper gi w/o kub (74240) |
$175.50 |
$585 |
0.9× |
| Urethrocystogram voiding (74455) |
$303 |
$1,010 |
1.2× |
| Urethrocystography retrograde (74450) |
$238.20 |
$794 |
0.9× |
| Us breast unilateral complete (76641) |
$230.70 |
$769 |
2.1× |
| Us chest (76604) |
$105 |
$350 |
0.9× |
| Us exam, pelvic, limited (76857) |
$109.20 |
$364 |
1.0× |
| Us head (76506) |
$178.80 |
$596 |
1.6× |
| Us kidney transplant (76776) |
$100.20 |
$334 |
0.9× |
| Us lmtd joint/oth nonvasc xtr strux r-t w/img (76882) |
$196.80 |
$656 |
1.8× |
| Us ob detailed single fetus (76811) |
$223.50 |
$745 |
0.9× |
| Us ob limited 1 or more fetuses (76815) |
$168 |
$560 |
1.5× |
| Us ob transvaginal (76817) |
$109.20 |
$364 |
1.0× |
| Us pelvic non ob complete (76856) |
$247.20 |
$824 |
2.2× |
| Us pg uter img f&mat 14 wk tabdl 1/1st gestation (76801) |
$204.30 |
$681 |
1.8× |
| Us preg uterus real time f/u trnsabdl per fetus (76816) |
$172.20 |
$574 |
1.5× |
| Us retroperitoneal complete (76770) |
$299.70 |
$999 |
2.7× |
| Us retroperitoneal limited (76775) |
$199.50 |
$665 |
1.8× |
| Us scrotum and contents (76870) |
$179.40 |
$598 |
1.6× |
| Us spinal canal and contents (76800) |
$105 |
$350 |
0.9× |
| Us thyroid (76536) |
$142.80 |
$476 |
1.3× |
| Us transrectal (76872) |
$238.50 |
$795 |
2.1× |
| Vein X-Ray Chest (75827) |
$1,530 |
$5,100 |
0.9× |
| Wrist 2 views (73100) |
$86.70 |
$289 |
0.9× |
| X-Ray Ac Jts - Xr Acromioclavicular Joints Bilateral (73050) |
$177.30 |
$591 |
1.9× |
| X-Ray Bend Only L-S Spine (72120) |
$133.80 |
$446 |
1.2× |
| X-Ray Elbow 2 Vw - Xr Elbow 1-2 Views Right (73070) |
$99 |
$330 |
1.1× |
| X-Ray Exam Breast Specimen (76098) |
$540 |
$1,800 |
0.9× |
| X-Ray Exam Entire Spi 1 Vw (72081) |
$109.50 |
$365 |
1.2× |
| X-Ray Exam Entire Spi 2/3 Vw (72082) |
$143.70 |
$479 |
1.3× |
| X-Ray Exam Hip Uni 1 View (73501) |
$86.70 |
$289 |
0.9× |
| X-Ray Exam Hip Uni 2-3 Views (73502) |
$90.60 |
$302 |
1.0× |
| X-Ray Exam Hips Bi 2 Views (73521) |
$100.20 |
$334 |
0.9× |
| X-Ray Exam Hips Bi 3-4 Views (73522) |
$103.50 |
$345 |
0.9× |
| X-Ray Exam Hips Bi 5/> Views (73523) |
$100.20 |
$334 |
0.9× |
| X-Ray Exam L-S Spine Bending (72114) |
$159 |
$530 |
1.4× |
| X-Ray Exam Neck Spine 2-3 Vw (72040) |
$193.80 |
$646 |
2.1× |
| X-Ray Exam Neck Spine 6/>Vws (72052) |
$137.40 |
$458 |
1.2× |
| X-Ray Exam Unilat Ribs/Chest (71101) |
$280.50 |
$935 |
2.5× |
| X-ray eye for foreign body (70030) |
$86.70 |
$289 |
0.9× |
| X-ray humerus (73060) |
$108.60 |
$362 |
1.2× |
| X-Ray Jaw <4 Vw - Xr Mandible < 4 Views (70100) |
$107.70 |
$359 |
1.2× |
| X-Ray Knee Bilat Standing - Xr Knees Anteroposterior Standing Bilat (73565) |
$86.70 |
$289 |
0.9× |
| X-Ray Lumbar Spine 2/3 Vw - Xr Lumbar Spine 2-3 Views (72100) |
$185.40 |
$618 |
1.7× |
| X-Ray Ribs, Chest 4+ Vw - Xr Ribs 3 Vws Bil W/ Chest Posteroanterior (71111) |
$280.50 |
$935 |
2.5× |
| X-Ray Sacroiliac Jts 3+ Vw - Xr Sacroiliac Joints 3+ Views (72202) |
$106.50 |
$355 |
1.0× |
| X-Ray Sacroiliac Jts <3 Vw - Xr Sacroiliac Joints 1-2 Views (72200) |
$106.50 |
$355 |
1.0× |
| X-Ray Sacrum/Coccyx 2+ Vw - Xr Sacrum Coccyx 2+ Views (72220) |
$86.70 |
$289 |
0.9× |
| X-Ray Sinuses 3+ Vw - Xr Paranasal Sinuses 3+ Views (70220) |
$152.40 |
$508 |
1.6× |
| X-Ray Skull 4+ Vw - Xr Skull Complete 4+ Views (70260) |
$106.50 |
$355 |
1.0× |
| X-Ray Tmj Unilat (70328) |
$82.80 |
$276 |
0.9× |
| X-Ray Urinary Tract Exam With Contrast Material (74420) |
$374.10 |
$1,247 |
1.0× |
| X-Rays Bone Length Studies (77073) |
$105.30 |
$351 |
0.9× |
| Xr c-spine 4 or 5 views (72050) |
$160.80 |
$536 |
1.4× |
| Xr facial bones less than 3 views (70140) |
$86.70 |
$289 |
0.9× |
| Xr orbits complete 4 views (70200) |
$106.50 |
$355 |
1.0× |