| Abdomen 1 View (74018) |
$111 |
$771.31 |
1.0× |
| Abdomen 2 views (74019) |
$133 |
$945.26 |
1.0× |
| Acute Gastrointestinal Blood Loss Imaging (78278) |
$511 |
$3,298.40 |
1.0× |
| Angio internal mammary (75756) |
$4,041 |
$10,698.50 |
1.0× |
| Angiography extremity unilateral rs&i (75710) |
$4,041 |
$17,830.90 |
1.0× |
| Ankle 2 views (73600) |
$111 |
$799.59 |
1.0× |
| Aortography thoracic serialography rs&i (75605) |
$7,121 |
$18,444.70 |
1.0× |
| Artery X-Rays Abdomen (75726) |
$7,121 |
$27,028.50 |
1.0× |
| Arthrogram ankle (73615) |
$446 |
$1,369.02 |
1.0× |
| Bone age studies (77072) |
$133 |
$648.66 |
1.0× |
| Bone Imaging 3 Phase (78315) |
$511 |
$4,712.50 |
1.0× |
| Bone Imaging Limited Area (78300) |
$511 |
$2,383.94 |
1.0× |
| Bone Imaging Multiple Areas (78305) |
$511 |
$2,675 |
1.0× |
| Bone Imaging Whole Body (78306) |
$511 |
$3,378 |
1.0× |
| Bone survey infant (77076) |
$133 |
$470.47 |
1.0× |
| Brain Flow Imaging Only (78610) |
$694 |
$2,915.61 |
1.0× |
| Brain Imaging Min 4 Static Views W Vascular Flow (78606) |
$694 |
$3,015 |
1.0× |
| Cat Scan Follow-Up Study (76380) |
$111 |
$2,056.25 |
1.0× |
| Chest 1 view (71045) |
$111 |
$745.25 |
1.0× |
| Chest 2 views (71046) |
$111 |
$1,036.75 |
1.0× |
| Chest 4 or more views (71048) |
$133 |
$1,066.30 |
1.0× |
| Clavicle complete (73000) |
$111 |
$813.75 |
1.0× |
| Computed Tomography Thorax Lw Dose Lng Ca Scr C- (71271) |
$133 |
$531.70 |
1.0× |
| Contrast X-Ray Bladder (74430) |
$446 |
$2,194.03 |
1.0× |
| Contrast X-Ray Of Knee Joint (73580) |
$446 |
$2,148.09 |
1.0× |
| CT abdomen and pelvis without and with contrast (74178) |
$446 |
$10,297.50 |
1.0× |
| CT abdomen and pelvis without contrast (74176) |
$305 |
$7,926.11 |
1.0× |
| CT abdomen w contrast (74160) |
$224 |
$5,759.30 |
1.0× |
| CT abdomen w wo contrast (74170) |
$224 |
$6,717.50 |
1.0× |
| CT abdomen w/o contrast (74150) |
$133 |
$6,743 |
1.0× |
| CT Angio Abdomen and Pelvis (74174) |
$446 |
$9,527.50 |
1.0× |
| CT Angio Chest (71275) |
$224 |
$6,227.38 |
1.0× |
| CT Angio Head (70496) |
$224 |
$7,088.13 |
1.0× |
| Ct Angio Lwr Extr W/O&W/Dye (73706) |
$224 |
$5,602.50 |
1.0× |
| CT Angio Neck (70498) |
$224 |
$6,986.38 |
1.0× |
| Ct Angio Upr Extrm W/O&W/Dye (73206) |
$224 |
$4,470 |
1.0× |
| CT cervical spine w/ contrast (72126) |
$446 |
$5,639.26 |
1.0× |
| CT cervical spine w/o contrast (72125) |
$133 |
$5,885 |
1.0× |
| CT cervical spine w/wo cont (72127) |
$224 |
$3,274 |
1.0× |
| CT chest w contrast (71260) |
$224 |
$5,910.70 |
1.0× |
| CT chest w/wo contrast (71270) |
$224 |
$5,614.11 |
1.0× |
| CT head/brain with contrast (70460) |
$224 |
$3,855.50 |
1.0× |
| CT head/brain without and with contrast (70470) |
$224 |
$5,598.75 |
1.0× |
| CT iac w contrast (70481) |
$224 |
$4,716.88 |
1.0× |
| CT l-spine w&w/o contrast (72133) |
$224 |
$5,027 |
1.0× |
| CT lower ext w/o (73700) |
$133 |
$5,841 |
1.0× |
| CT lower extremity w/contrast material (73701) |
$224 |
$5,500.34 |
1.0× |
| CT lumbar spine w contrast (72132) |
$446 |
$5,802.50 |
1.0× |
| CT lumbar spine w/o contrast (72131) |
$133 |
$5,260 |
1.0× |
| CT maxillofacial w contrast (70487) |
$224 |
$4,517.50 |
1.0× |
| CT maxillofacial wo contrast (70486) |
$133 |
$6,183.38 |
1.0× |
| CT neck tissue combo (70492) |
$224 |
$6,061.25 |
1.0× |
| Ct Orbit/Ear/Fossa W/O&W/Dye (70482) |
$224 |
$5,684.88 |
1.0× |
| CT orbits w/o contrast (70480) |
$133 |
$5,350 |
1.0× |
| CT pelvis w&w/o contrast (72194) |
$224 |
$5,764.44 |
1.0× |
| CT pelvis w/o contrast (72192) |
$133 |
$5,617.50 |
1.0× |
| CT scan of leg combo (73702) |
$224 |
$5,500.34 |
1.0× |
| CT scans face/jaw combo (70488) |
$224 |
$5,749.40 |
1.0× |
| CT soft tissue neck w contrast (70491) |
$224 |
$4,639.75 |
1.0× |
| CT soft tissue neck w/o contrast (70490) |
$133 |
$5,350 |
1.0× |
| CT thoracic spine w contrast (72129) |
$224 |
$5,176.25 |
1.0× |
| CT thoracic spine w/o contrast (72128) |
$133 |
$5,260 |
1.0× |
| CT thoracic spine w/wo cont (72130) |
$224 |
$5,330.19 |
1.0× |
| CT thorax w/o contrast (71250) |
$133 |
$6,179.25 |
1.0× |
| CT upper ext wo (73200) |
$133 |
$5,310 |
1.0× |
| CT upper extremity w/o & w/contrast material (73202) |
$224 |
$4,400.27 |
1.0× |
| CT upper extremity with contrast (73201) |
$446 |
$4,400.27 |
1.0× |
| Cta Abdl Aorta&Bi Iliofem W/Contrast&Postp (75635) |
$224 |
$6,326.25 |
1.0× |
| Cta Abdomen (74175) |
$224 |
$5,775 |
1.0× |
| CTA pelvis (72191) |
$224 |
$5,613.75 |
1.0× |
| Esophagram (74220) |
$224 |
$1,376.34 |
1.0× |
| Fetal Biophys Profile W/Nst (76818) |
$133 |
$531.70 |
1.0× |
| Fetal Biophysical Profile W/O Non-Stress Testing (76819) |
$133 |
$1,147.37 |
1.0× |
| Fluoroscopy up to 1 hr (76000) |
$305 |
$1,885.03 |
1.0× |
| Foot 2 views (73620) |
$111 |
$832.50 |
1.0× |
| Forearm 2 views (73090) |
$111 |
$832.19 |
1.0× |
| Gastric emptying imaging study (78264) |
$511 |
$4,130 |
1.0× |
| Gastric Mucosa Imaging (78261) |
$511 |
$1,571.64 |
1.0× |
| Hand 2 views (73120) |
$133 |
$669 |
1.0× |
| Hepatobil Syst Image W/Drug (78227) |
$694 |
$3,535.09 |
1.0× |
| Hepatobiliary System Imaging (78226) |
$511 |
$3,725.56 |
1.0× |
| Hysterosalpingogram (74740) |
$305 |
$1,674 |
1.0× |
| K Flow/Funct Image Multiple (78709) |
$694 |
$2,206.80 |
1.0× |
| K Flow/Funct Image W/Drug (78708) |
$694 |
$3,339.70 |
1.0× |
| K Flow/Funct Image W/O Drug (78707) |
$694 |
$3,070 |
1.0× |
| Knee 3 Views (73562) |
$111 |
$1,113.75 |
1.0× |
| Liver & Spleen Imaging Static Only (78215) |
$511 |
$2,479 |
1.0× |
| Liver imaging static only (78201) |
$694 |
$3,608.04 |
1.0× |
| Lung Perf&Ventilat Diferentl (78598) |
$694 |
$3,760.38 |
1.0× |
| Lung Ventilat&Perfus Imaging (78582) |
$694 |
$7,836.50 |
1.0× |
| Lung Ventilation Imaging (78579) |
$511 |
$2,245.98 |
1.0× |
| Lymph System Imaging (78195) |
$694 |
$3,470.09 |
1.0× |
| Magnetic Image Jaw Joint (70336) |
$305 |
$4,738 |
1.0× |
| MRA head w/o contrast (70544) |
$305 |
$5,095 |
1.0× |
| MRA neck w/o contrast (70547) |
$305 |
$5,095 |
1.0× |
| MRI abdomen w contrast (74182) |
$446 |
$4,157.25 |
1.0× |
| MRI abdomen w/o contrast (74181) |
$305 |
$5,095 |
1.0× |
| MRI any jt lower extrem w/o & w/contrast matrl (73723) |
$446 |
$3,491.88 |
1.0× |
| MRI any jt upper extremity w/contrast matrl (73222) |
$1,003 |
$2,687.41 |
1.0× |
| MRI cardiac w/o contrast (75557) |
$305 |
$2,613.50 |
1.0× |
| MRI cervical spine w contrast (72142) |
$446 |
$6,091.71 |
1.0× |
| MRI cervical spine w/o cont (72141) |
$305 |
$6,197.50 |
1.0× |
| MRI chest w/o contrast (71550) |
$305 |
$5,103 |
1.0× |
| MRI chest wo w contrast (71552) |
$446 |
$3,491.88 |
1.0× |
| MRI lower extrem oth/thn jt w/contrast matrl (73719) |
$446 |
$5,984 |
1.0× |
| MRI lower extrem oth/thn jt w/o & w/contr matr (73720) |
$446 |
$6,326 |
1.0× |
| MRI lower extrem oth/thn jt w/o contr matrl (73718) |
$305 |
$3,294.81 |
1.0× |
| MRI lumbar spine w contrast (72149) |
$446 |
$1,785.65 |
1.0× |
| Mri Neck Spine W/O & W/Dye (72156) |
$446 |
$6,821.37 |
1.0× |
| MRI orbit face &/neck w/o contrast (70540) |
$305 |
$4,611.35 |
1.0× |
| Mri Orbt/Fac/Nck W/O &W/Dye (70543) |
$446 |
$5,677.13 |
1.0× |
| MRI pelvis w contrast (72196) |
$446 |
$5,888.80 |
1.0× |
| MRI pelvis w/o & w contrast (72197) |
$446 |
$8,270.40 |
1.0× |
| MRI pelvis w/o contrast (72195) |
$305 |
$4,611.95 |
1.0× |
| MRI thoracic spine w/o contrast (72146) |
$305 |
$6,197.50 |
1.0× |
| MRI upper extremity oth than jt w/contr matrl (73219) |
$446 |
$1,785.65 |
1.0× |
| MRI upper extremity oth than jt w/o contr matrl (73218) |
$305 |
$2,441.60 |
1.0× |
| MRI, abdomen, combo (74183) |
$446 |
$6,358.26 |
1.0× |
| MRI, dorsal spine combo (72157) |
$446 |
$6,606 |
1.0× |
| MRI, joint upper extrem (73221) |
$305 |
$6,378.75 |
1.0× |
| MRI, joint upper extrem combo (73223) |
$446 |
$1,785.65 |
1.0× |
| MRI, lumbar spine combo (72158) |
$446 |
$8,359.59 |
1.0× |
| Myocardial Spect Multiple Studies (78452) |
$1,656 |
$10,855.60 |
1.0× |
| Neck soft tissue (70360) |
$111 |
$737.50 |
1.0× |
| Ophthalmic Ultrasonic Foreign Body Localization (76529) |
$111 |
$440.25 |
1.0× |
| Ophthalmic ultrasound dx b-scan w/wo a-scan (76512) |
$133 |
$715 |
1.0× |
| Optic foramina (70190) |
$111 |
$481.94 |
1.0× |
| Pelvis 1 or 2 views (72170) |
$133 |
$917.13 |
1.0× |
| Pulmonary Perfusion Imaging Particulate (78580) |
$511 |
$4,456.38 |
1.0× |
| Radex Abd Compl Aqt Abd W/S/E/D Views 1 View Ch (74022) |
$133 |
$1,297.50 |
1.0× |
| Radex Ankle Complete Minimum 3 Views (73610) |
$111 |
$948.44 |
1.0× |
| Radex Calcaneus Minimum 2 Views (73650) |
$111 |
$798.19 |
1.0× |
| Radex elbow complete minimum 3 views (73080) |
$111 |
$1,016.13 |
1.0× |
| Radex Facial Bones Complete Minimum 3 Views (70150) |
$133 |
$1,084.64 |
1.0× |
| Radex fingr minimum 2 views (73140) |
$111 |
$782.86 |
1.0× |
| Radex foot complete minimum 3 views (73630) |
$111 |
$1,914.38 |
1.0× |
| Radex Hand Minimum 3 Views (73130) |
$111 |
$1,092.15 |
1.0× |
| Radex lower extremity infant minimum 2 views (73592) |
$111 |
$610.20 |
1.0× |
| Radex Nasal Bones Complete Minimum 3 Views (70160) |
$111 |
$821.25 |
1.0× |
| Radex Pharynx/Larx W/Fluor&/Magnification Tq (70370) |
$111 |
$704.56 |
1.0× |
| Radex Ribs Unilateral 2 Views (71100) |
$111 |
$773.43 |
1.0× |
| Radex shoulder complete minimum 2 views (73030) |
$111 |
$1,068.38 |
1.0× |
| Radex Sinuses Paransl < 3 Views (70210) |
$111 |
$663.85 |
1.0× |
| Radex sm int w/mlt srl imges via enteroclss tube (74251) |
$224 |
$1,027.81 |
1.0× |
| Radex Spine 1 View Specify Level (72020) |
$111 |
$710 |
1.0× |
| Radex Sternum Minimum 2 Views (71120) |
$111 |
$812.56 |
1.0× |
| Radex Temporomandble Jt Opn & Clsd Mouth Bilat (70330) |
$111 |
$754 |
1.0× |
| Radex Toe Minimum 2 Views (73660) |
$111 |
$727.16 |
1.0× |
| Radex upper extremity infant minimum 2 views (73092) |
$133 |
$648.66 |
1.0× |
| Radex Wrist Complete Minimum 3 Views (73110) |
$111 |
$1,123.53 |
1.0× |
| Radiolog exam mandible compl minimum 4 views (70110) |
$133 |
$1,026.94 |
1.0× |
| Radiologic Exam Abdomen 3+ Views - Xr Abdomen 3+ Views (74021) |
$133 |
$1,178.79 |
1.0× |
| Radiologic exam colon double contrast study (74280) |
$224 |
$1,953.36 |
1.0× |
| Radiologic exam colon single contrast study (74270) |
$224 |
$890.10 |
1.0× |
| Radiologic exam knee complete 4/more views (73564) |
$133 |
$1,250.41 |
1.0× |
| Radiologic exam pelvis compl minimum 3 views (72190) |
$133 |
$1,072.50 |
1.0× |
| Radiologic Exam Small Int Single Contrast Study (74250) |
$224 |
$1,721.25 |
1.0× |
| Radiologic exam swallow function contrast study (74230) |
$224 |
$1,984.13 |
1.0× |
| Radiologic Exam Teeth Prtl Exam < Full Mouth (70310) |
$305 |
$822.45 |
1.0× |
| Radiologic exam upr gi trc double contrast study (74246) |
$224 |
$1,508.57 |
1.0× |
| Radiologic examination femur 1 view (73551) |
$111 |
$559.16 |
1.0× |
| Radiologic examination femur minimum 2 views (73552) |
$111 |
$1,067.32 |
1.0× |
| Radiologic examination knee 1/2 views (73560) |
$111 |
$838.24 |
1.0× |
| Radiologic Examination Osseous Survey Limited (77074) |
$133 |
$1,111.46 |
1.0× |
| Radiologic examination tibia & fibula 2 views (73590) |
$111 |
$900 |
1.0× |
| Ribs bilateral 3 views (71110) |
$133 |
$1,200.53 |
1.0× |
| Rp loclzj tum spect CT 2area 1d img/1 ar img>2+d (78832) |
$1,830 |
$7,453 |
1.0× |
| Scapula (73010) |
$133 |
$675.06 |
1.0× |
| Shoulder 1 view (73020) |
$111 |
$914.58 |
1.0× |
| Shoulder Arthrography (73040) |
$446 |
$1,602.23 |
1.0× |
| Skull less than 4 views (70250) |
$133 |
$913.39 |
1.0× |
| Sternoclavicular joints (71130) |
$111 |
$334.67 |
1.0× |
| Thoracic spine 2 views (72070) |
$133 |
$615.01 |
1.0× |
| Thoracic spine 3 views (72072) |
$133 |
$1,111.50 |
1.0× |
| Thoracolumbar 2 views (72080) |
$111 |
$690 |
1.0× |
| Thyroid Uptake W/Blood Flow Sngle/Mult Quan Meas (78014) |
$511 |
$1,630.58 |
1.0× |
| Ultrasound Breast Limited (76642) |
$111 |
$856 |
1.0× |
| Ultrasound, abdomen limited (76705) |
$133 |
$2,051.09 |
1.0× |
| Unlisted us procedure (76999) |
$111 |
$508.33 |
1.0× |
| Upper gi w/o kub (74240) |
$224 |
$1,722.50 |
1.0× |
| Urethrocystography retrograde (74450) |
$305 |
$1,394.50 |
1.0× |
| Us breast unilateral complete (76641) |
$133 |
$2,117.50 |
1.0× |
| Us chest (76604) |
$133 |
$1,716 |
1.0× |
| Us complete joint (76881) |
$133 |
$1,842.75 |
1.0× |
| Us exam, pelvic, limited (76857) |
$133 |
$2,051.09 |
1.0× |
| Us head (76506) |
$133 |
$646.80 |
1.0× |
| Us kidney transplant (76776) |
$133 |
$1,092.62 |
1.0× |
| Us lmtd joint/oth nonvasc xtr strux r-t w/img (76882) |
$133 |
$1,055 |
1.0× |
| Us ob limited 1 or more fetuses (76815) |
$133 |
$984 |
1.0× |
| Us ob transvaginal (76817) |
$133 |
$1,173.21 |
1.0× |
| Us pelvic non ob complete (76856) |
$133 |
$2,142.15 |
1.0× |
| Us pg uter img f&mat 14 wk tabdl 1/1st gestation (76801) |
$133 |
$1,235 |
1.0× |
| Us preg uterus real time f/u trnsabdl per fetus (76816) |
$133 |
$930 |
1.0× |
| Us retroperitoneal complete (76770) |
$133 |
$2,103.49 |
1.0× |
| Us retroperitoneal limited (76775) |
$133 |
$1,431.25 |
1.0× |
| Us scrotum and contents (76870) |
$133 |
$1,599.75 |
1.0× |
| Us spinal canal and contents (76800) |
$133 |
$1,018.48 |
1.0× |
| Us thyroid (76536) |
$133 |
$1,690.39 |
1.0× |
| Vascular Flow Imaging (78445) |
$511 |
$2,819.41 |
1.0× |
| Venography caval inferior serialography rs&i (75825) |
$4,041 |
$17,830.90 |
1.0× |
| Venography extremity unilateral rs&i (75820) |
$2,014 |
$8,959.04 |
1.0× |
| Wrist 2 views (73100) |
$111 |
$803.95 |
1.0× |
| X-Ray Ac Jts - Xr Acromioclavicular Joints Bilateral (73050) |
$111 |
$620.23 |
1.0× |
| X-ray antegrade pyelogram tube (74425) |
$446 |
$1,785.65 |
1.0× |
| X-Ray Aorta Leg Arteries (75630) |
$4,041 |
$15,737.50 |
1.0× |
| X-Ray Elbow 2 Vw - Xr Elbow 1-2 Views Right (73070) |
$111 |
$826.64 |
1.0× |
| X-Ray Exam Breast Specimen (76098) |
$699 |
$2,878.88 |
1.0× |
| X-Ray Exam Entire Spi 1 Vw (72081) |
$111 |
$806.37 |
1.0× |
| X-Ray Exam Entire Spi 2/3 Vw (72082) |
$133 |
$531.70 |
1.0× |
| X-Ray Exam Hip Uni 1 View (73501) |
$111 |
$749 |
1.0× |
| X-Ray Exam Hip Uni 2-3 Views (73502) |
$111 |
$934.02 |
1.0× |
| X-Ray Exam Hips Bi 2 Views (73521) |
$133 |
$1,180.09 |
1.0× |
| X-Ray Exam Hips Bi 3-4 Views (73522) |
$133 |
$615.01 |
1.0× |
| X-Ray Exam L-S Spine Bending (72114) |
$133 |
$1,362 |
1.0× |
| X-Ray Exam Neck Spine 2-3 Vw (72040) |
$111 |
$983.90 |
1.0× |
| X-Ray Exam Neck Spine 6/>Vws (72052) |
$133 |
$1,266.65 |
1.0× |
| X-Ray Exam Unilat Ribs/Chest (71101) |
$133 |
$1,073.41 |
1.0× |
| X-ray eye for foreign body (70030) |
$111 |
$495.84 |
1.0× |
| X-ray humerus (73060) |
$111 |
$882.06 |
1.0× |
| X-ray IV pyelogram (ivp) (74400) |
$224 |
$2,572.81 |
1.0× |
| X-ray IV pyelogram+tomography (74415) |
$224 |
$1,711.75 |
1.0× |
| X-Ray Jaw <4 Vw - Xr Mandible < 4 Views (70100) |
$111 |
$602.50 |
1.0× |
| X-Ray Knee Bilat Standing - Xr Knees Anteroposterior Standing Bilat (73565) |
$111 |
$711.08 |
1.0× |
| X-Ray Lumbar Spine 2/3 Vw - Xr Lumbar Spine 2-3 Views (72100) |
$133 |
$1,105.02 |
1.0× |
| X-ray nose-rectum child f.b. (76010) |
$111 |
$487 |
1.0× |
| X-Ray Ribs, Chest 4+ Vw - Xr Ribs 3 Vws Bil W/ Chest Posteroanterior (71111) |
$133 |
$1,574.57 |
1.0× |
| X-Ray Sacroiliac Jts 3+ Vw - Xr Sacroiliac Joints 3+ Views (72202) |
$133 |
$719 |
1.0× |
| X-Ray Sacrum/Coccyx 2+ Vw - Xr Sacrum Coccyx 2+ Views (72220) |
$111 |
$926.75 |
1.0× |
| X-Ray Sinuses 3+ Vw - Xr Paranasal Sinuses 3+ Views (70220) |
$111 |
$924.99 |
1.0× |
| X-Ray Skull 4+ Vw - Xr Skull Complete 4+ Views (70260) |
$133 |
$1,157.36 |
1.0× |
| X-ray thoracic spine 4 vw (72074) |
$133 |
$1,090 |
1.0× |
| X-Ray Tmj Unilat (70328) |
$111 |
$440.25 |
1.0× |
| X-Ray Urinary Tract Exam With Contrast Material (74420) |
$446 |
$2,742.54 |
1.0× |
| X-Rays Bone Length Studies (77073) |
$133 |
$369 |
1.0× |
| X-Rays Bone Survey Complete (77075) |
$133 |
$1,563.73 |
1.0× |
| Xr c-spine 4 or 5 views (72050) |
$133 |
$1,351.25 |
1.0× |
| Xr facial bones less than 3 views (70140) |
$111 |
$604 |
1.0× |
| Xr myelogram posterior fossa (70010) |
$446 |
$1,832.10 |
1.0× |
| Xr orbits complete 4 views (70200) |
$133 |
$817.69 |
1.0× |