| Abdomen 1 View (74018) |
$227.20 |
$284 |
2.6× |
| Abdomen 2 views (74019) |
$280.80 |
$351 |
2.6× |
| Acute Gastrointestinal Blood Loss Imaging (78278) |
$1,544.80 |
$1,931 |
3.8× |
| Ankle 2 views (73600) |
$252 |
$315 |
2.8× |
| Bone age studies (77072) |
$232.80 |
$291 |
2.2× |
| Bone Imaging 3 Phase (78315) |
$2,034.40 |
$2,543 |
5.0× |
| Bone Imaging Limited Area (78300) |
$1,254.40 |
$1,568 |
3.1× |
| Bone Imaging Whole Body (78306) |
$1,626.40 |
$2,033 |
4.0× |
| Brain Imaging Min 4 Static Views W Vascular Flow (78606) |
$1,376.80 |
$1,721 |
2.5× |
| Chest 1 view (71045) |
$210.40 |
$263 |
2.4× |
| Chest 2 views (71046) |
$279.20 |
$349 |
3.1× |
| Chest 3 views (71047) |
$320.80 |
$401 |
3.6× |
| Chest 4 or more views (71048) |
$344 |
$430 |
3.2× |
| Clavicle complete (73000) |
$291.20 |
$364 |
3.3× |
| Computed Tomography Thorax Lw Dose Lng Ca Scr C- (71271) |
$2,054.40 |
$2,568 |
19.2× |
| CT abdomen and pelvis without and with contrast (74178) |
$4,253.60 |
$5,317 |
11.9× |
| CT abdomen and pelvis without contrast (74176) |
$3,254.40 |
$4,068 |
13.4× |
| CT abdomen w contrast (74160) |
$2,384 |
$2,980 |
13.3× |
| CT abdomen w wo contrast (74170) |
$2,209.60 |
$2,762 |
12.3× |
| CT abdomen w/o contrast (74150) |
$1,718.40 |
$2,148 |
16.1× |
| CT Angio Abdomen and Pelvis (74174) |
$3,712 |
$4,640 |
10.4× |
| CT Angio Chest (71275) |
$2,650.40 |
$3,313 |
14.8× |
| CT Angio Head (70496) |
$2,454.40 |
$3,068 |
13.7× |
| CT Angio Neck (70498) |
$2,642.40 |
$3,303 |
14.7× |
| Ct Angio Upr Extrm W/O&W/Dye (73206) |
$2,326.40 |
$2,908 |
13.0× |
| CT cervical spine w/ contrast (72126) |
$2,361.60 |
$2,952 |
6.6× |
| CT cervical spine w/o contrast (72125) |
$1,997.60 |
$2,497 |
18.7× |
| CT chest w contrast (71260) |
$2,216 |
$2,770 |
12.4× |
| CT chest w/wo contrast (71270) |
$2,678.40 |
$3,348 |
14.9× |
| CT head/brain with contrast (70460) |
$2,008 |
$2,510 |
11.2× |
| CT head/brain without and with contrast (70470) |
$2,231.20 |
$2,789 |
12.5× |
| CT iac w contrast (70481) |
$2,138.40 |
$2,673 |
11.9× |
| CT lower ext w/o (73700) |
$1,941.60 |
$2,427 |
18.2× |
| CT lower extremity w/contrast material (73701) |
$2,088 |
$2,610 |
11.7× |
| CT lumbar spine w contrast (72132) |
$2,199.20 |
$2,749 |
6.2× |
| CT lumbar spine w/o contrast (72131) |
$1,950.40 |
$2,438 |
18.3× |
| CT maxillofacial w contrast (70487) |
$2,045.60 |
$2,557 |
11.4× |
| CT maxillofacial wo contrast (70486) |
$1,618.40 |
$2,023 |
15.2× |
| CT neck tissue combo (70492) |
$2,654.40 |
$3,318 |
14.8× |
| Ct Orbit/Ear/Fossa W/O&W/Dye (70482) |
$2,475.20 |
$3,094 |
13.8× |
| CT orbits w/o contrast (70480) |
$1,682.40 |
$2,103 |
15.8× |
| CT pelvis w&w/o contrast (72194) |
$2,004 |
$2,505 |
11.2× |
| CT pelvis w/o contrast (72192) |
$1,815.20 |
$2,269 |
17.0× |
| CT scan of leg combo (73702) |
$2,392.80 |
$2,991 |
13.4× |
| CT scans face/jaw combo (70488) |
$2,388 |
$2,985 |
13.3× |
| CT soft tissue neck w contrast (70491) |
$2,157.60 |
$2,697 |
12.0× |
| CT soft tissue neck w/o contrast (70490) |
$2,102.40 |
$2,628 |
19.7× |
| CT thoracic spine w contrast (72129) |
$2,263.20 |
$2,829 |
12.6× |
| CT thoracic spine w/o contrast (72128) |
$1,902.40 |
$2,378 |
17.8× |
| CT thorax w/o contrast (71250) |
$2,054.40 |
$2,568 |
19.2× |
| CT upper ext wo (73200) |
$1,943.20 |
$2,429 |
18.2× |
| CT upper extremity w/o & w/contrast material (73202) |
$2,390.40 |
$2,988 |
13.3× |
| CT upper extremity with contrast (73201) |
$2,503.20 |
$3,129 |
7.0× |
| Cta Abdomen (74175) |
$3,639.20 |
$4,549 |
20.3× |
| CTA head&neck c+ w/noncontrast img&post-pxessing (70471) |
$3,008 |
$3,760 |
8.4× |
| Dxa Bone Density Axial (77080) |
$472.80 |
$591 |
4.4× |
| Esophageal Motility Study (78258) |
$1,008.80 |
$1,261 |
2.5× |
| Fetal Biophysical Profile W/O Non-Stress Testing (76819) |
$647.20 |
$809 |
6.1× |
| Foot 2 views (73620) |
$231.20 |
$289 |
2.6× |
| Forearm 2 views (73090) |
$279.20 |
$349 |
3.1× |
| Gastric emptying imaging study (78264) |
$1,649.60 |
$2,062 |
4.0× |
| Gated Heart Planar Single (78472) |
$1,934.40 |
$2,418 |
4.7× |
| Hand 2 views (73120) |
$227.20 |
$284 |
2.1× |
| Hepatobil Syst Image W/Drug (78227) |
$2,037.60 |
$2,547 |
3.7× |
| Hepatobiliary System Imaging (78226) |
$1,780.80 |
$2,226 |
4.4× |
| Ht Muscle Image Spect Sing (78451) |
$3,508.80 |
$4,386 |
2.7× |
| Joint Survey Single View (77077) |
$240.80 |
$301 |
2.3× |
| K Flow/Funct Image W/Drug (78708) |
$1,824.80 |
$2,281 |
3.3× |
| K Flow/Funct Image W/O Drug (78707) |
$1,692 |
$2,115 |
3.1× |
| Knee 3 Views (73562) |
$331.20 |
$414 |
3.7× |
| Liver & Spleen Imaging Static Only (78215) |
$1,610.40 |
$2,013 |
3.9× |
| Liver imaging static only (78201) |
$1,578.40 |
$1,973 |
2.8× |
| Lung Ventilat&Perfus Imaging (78582) |
$1,704.80 |
$2,131 |
3.1× |
| Meckels Divert Exam (78290) |
$1,444.80 |
$1,806 |
3.5× |
| Mra Head W/O & W/Contrast Material (70546) |
$3,671.20 |
$4,589 |
10.3× |
| MRA head w/o contrast (70544) |
$2,637.60 |
$3,297 |
10.8× |
| MRA head with contrast (70545) |
$2,993.60 |
$3,742 |
8.4× |
| MRA neck w contrast (70548) |
$2,823.20 |
$3,529 |
7.9× |
| Mra Neck W/O &W/Contrast Material (70549) |
$3,511.20 |
$4,389 |
9.9× |
| MRA neck w/o contrast (70547) |
$2,470.40 |
$3,088 |
10.1× |
| MRI abdomen w/o contrast (74181) |
$2,850.40 |
$3,563 |
11.7× |
| MRI any jt lower extrem w/o & w/contrast matrl (73723) |
$3,582.40 |
$4,478 |
10.1× |
| MRI cervical spine w/o cont (72141) |
$2,884.80 |
$3,606 |
11.8× |
| MRI chest w/o contrast (71550) |
$2,736 |
$3,420 |
11.2× |
| MRI chest wo w contrast (71552) |
$3,756 |
$4,695 |
10.5× |
| MRI lower extrem oth/thn jt w/o & w/contr matr (73720) |
$3,608 |
$4,510 |
10.1× |
| MRI lower extrem oth/thn jt w/o contr matrl (73718) |
$2,609.60 |
$3,262 |
10.7× |
| Mri Neck Spine W/O & W/Dye (72156) |
$4,217.60 |
$5,272 |
11.8× |
| MRI orbit face &/neck w/o contrast (70540) |
$2,892.80 |
$3,616 |
11.9× |
| Mri Orbt/Fac/Nck W/O &W/Dye (70543) |
$4,122.40 |
$5,153 |
11.6× |
| MRI pelvis w/o & w contrast (72197) |
$3,956.80 |
$4,946 |
11.1× |
| MRI pelvis w/o contrast (72195) |
$2,768.80 |
$3,461 |
11.4× |
| MRI thoracic spine w/o contrast (72146) |
$2,735.20 |
$3,419 |
11.2× |
| MRI upper extremity oth than jt w/o contr matrl (73218) |
$2,580 |
$3,225 |
10.6× |
| Mri Uppr Extremity W/O&W/Dye (73220) |
$3,564.80 |
$4,456 |
10.0× |
| MRI, abdomen, combo (74183) |
$3,804 |
$4,755 |
10.7× |
| MRI, dorsal spine combo (72157) |
$4,056 |
$5,070 |
11.4× |
| MRI, joint upper extrem (73221) |
$2,675.20 |
$3,344 |
11.0× |
| MRI, joint upper extrem combo (73223) |
$3,819.20 |
$4,774 |
10.7× |
| MRI, lumbar spine combo (72158) |
$3,938.40 |
$4,923 |
11.0× |
| Myocardial Spect Multiple Studies (78452) |
$4,260.80 |
$5,326 |
3.2× |
| Neck soft tissue (70360) |
$280.80 |
$351 |
3.2× |
| Parathyroid imaging w/tomographic spect & CT (78072) |
$1,899.20 |
$2,374 |
3.4× |
| Pelvis 1 or 2 views (72170) |
$275.20 |
$344 |
2.6× |
| Pulmonary Perfusion Imaging Particulate (78580) |
$1,348 |
$1,685 |
3.3× |
| Radex Ankle Complete Minimum 3 Views (73610) |
$272 |
$340 |
3.1× |
| Radex Calcaneus Minimum 2 Views (73650) |
$231.20 |
$289 |
2.6× |
| Radex elbow complete minimum 3 views (73080) |
$272 |
$340 |
3.1× |
| Radex Facial Bones Complete Minimum 3 Views (70150) |
$345.60 |
$432 |
3.2× |
| Radex fingr minimum 2 views (73140) |
$231.20 |
$289 |
2.6× |
| Radex foot complete minimum 3 views (73630) |
$252 |
$315 |
2.8× |
| Radex Hand Minimum 3 Views (73130) |
$252 |
$315 |
2.8× |
| Radex lower extremity infant minimum 2 views (73592) |
$214.40 |
$268 |
2.4× |
| Radex Nasal Bones Complete Minimum 3 Views (70160) |
$331.20 |
$414 |
3.7× |
| Radex Ribs Unilateral 2 Views (71100) |
$334.40 |
$418 |
3.8× |
| Radex shoulder complete minimum 2 views (73030) |
$320.80 |
$401 |
3.6× |
| Radex Sinuses Paransl < 3 Views (70210) |
$227.20 |
$284 |
2.6× |
| Radex Spine 1 View Specify Level (72020) |
$240.80 |
$301 |
2.7× |
| Radex Sternum Minimum 2 Views (71120) |
$296 |
$370 |
3.3× |
| Radex Temporomandble Jt Opn & Clsd Mouth Bilat (70330) |
$382.40 |
$478 |
4.3× |
| Radex Toe Minimum 2 Views (73660) |
$231.20 |
$289 |
2.6× |
| Radex upper extremity infant minimum 2 views (73092) |
$204 |
$255 |
1.9× |
| Radex Wrist Complete Minimum 3 Views (73110) |
$252 |
$315 |
2.8× |
| Radiolog exam mandible compl minimum 4 views (70110) |
$356.80 |
$446 |
3.3× |
| Radiologic Exam Abdomen 3+ Views - Xr Abdomen 3+ Views (74021) |
$354.40 |
$443 |
3.3× |
| Radiologic exam knee complete 4/more views (73564) |
$384 |
$480 |
3.6× |
| Radiologic exam pelvis compl minimum 3 views (72190) |
$405.60 |
$507 |
3.8× |
| Radiologic examination femur 1 view (73551) |
$259.20 |
$324 |
2.9× |
| Radiologic examination femur minimum 2 views (73552) |
$316 |
$395 |
3.6× |
| Radiologic examination knee 1/2 views (73560) |
$291.20 |
$364 |
3.3× |
| Radiologic Examination Osseous Survey Limited (77074) |
$532.80 |
$666 |
5.0× |
| Radiologic examination tibia & fibula 2 views (73590) |
$309.60 |
$387 |
3.5× |
| Ribs bilateral 3 views (71110) |
$400 |
$500 |
3.7× |
| Rp Loclzj Tum Spect 1 Area Single Day Imaging (78803) |
$2,688.80 |
$3,361 |
4.8× |
| Scapula (73010) |
$276.80 |
$346 |
2.6× |
| Screening Digital Breast Tomosynthesis Bi (77063) |
$68 |
$85 |
2.9× |
| Sella turcica (70240) |
$186.40 |
$233 |
2.1× |
| Shoulder 1 view (73020) |
$227.20 |
$284 |
2.6× |
| Skull less than 4 views (70250) |
$377.60 |
$472 |
3.5× |
| Sternoclavicular joints (71130) |
$296 |
$370 |
3.3× |
| Thoracic spine 2 views (72070) |
$331.20 |
$414 |
3.1× |
| Thoracic spine 3 views (72072) |
$375.20 |
$469 |
3.5× |
| Thoracolumbar 2 views (72080) |
$313.60 |
$392 |
3.5× |
| Thyroid Imaging With Vascular Flow (78013) |
$956.80 |
$1,196 |
2.3× |
| Thyroid Uptake W/Blood Flow Sngle/Mult Quan Meas (78014) |
$1,368 |
$1,710 |
3.3× |
| Ultrasound Exam Aaa Screen (76706) |
$500 |
$625 |
4.7× |
| Ultrasound, abdomen limited (76705) |
$720.80 |
$901 |
6.7× |
| Ureteral Reflux Study (78740) |
$1,225.60 |
$1,532 |
3.0× |
| Us chest (76604) |
$568 |
$710 |
5.3× |
| Us complete joint (76881) |
$623.20 |
$779 |
5.8× |
| Us exam, pelvic, limited (76857) |
$638.40 |
$798 |
6.0× |
| Us lmtd joint/oth nonvasc xtr strux r-t w/img (76882) |
$544 |
$680 |
5.1× |
| Us ob limited 1 or more fetuses (76815) |
$538.40 |
$673 |
5.0× |
| Us ob transvaginal (76817) |
$654.40 |
$818 |
6.1× |
| Us pelvic non ob complete (76856) |
$779.20 |
$974 |
7.3× |
| Us pg uter img f&mat 14 wk tabdl 1/1st gestation (76801) |
$721.60 |
$902 |
6.8× |
| Us preg uterus real time f/u trnsabdl per fetus (76816) |
$496 |
$620 |
4.6× |
| Us retroperitoneal complete (76770) |
$778.40 |
$973 |
7.3× |
| Us retroperitoneal limited (76775) |
$635.20 |
$794 |
5.9× |
| Us scrotum and contents (76870) |
$715.20 |
$894 |
6.7× |
| Us thyroid (76536) |
$680 |
$850 |
6.4× |
| Us transrectal (76872) |
$687.20 |
$859 |
6.4× |
| Wrist 2 views (73100) |
$231.20 |
$289 |
2.6× |
| X-Ray Ac Jts - Xr Acromioclavicular Joints Bilateral (73050) |
$337.60 |
$422 |
3.8× |
| X-Ray Bend Only L-S Spine (72120) |
$320.80 |
$401 |
3.0× |
| X-Ray Elbow 2 Vw - Xr Elbow 1-2 Views Right (73070) |
$239.20 |
$299 |
2.7× |
| X-Ray Exam Hip Uni 1 View (73501) |
$239.20 |
$299 |
2.7× |
| X-Ray Exam Hip Uni 2-3 Views (73502) |
$289.60 |
$362 |
3.3× |
| X-Ray Exam Hip Uni 4/> Views (73503) |
$331.20 |
$414 |
3.1× |
| X-Ray Exam Hips Bi 2 Views (73521) |
$320 |
$400 |
3.0× |
| X-Ray Exam Hips Bi 3-4 Views (73522) |
$495.20 |
$619 |
4.6× |
| X-Ray Exam Hips Bi 5/> Views (73523) |
$492.80 |
$616 |
4.6× |
| X-Ray Exam L-S Spine Bending (72114) |
$364 |
$455 |
3.4× |
| X-Ray Exam Neck Spine 2-3 Vw (72040) |
$312 |
$390 |
3.5× |
| X-Ray Exam Neck Spine 6/>Vws (72052) |
$463.20 |
$579 |
4.3× |
| X-Ray Exam Unilat Ribs/Chest (71101) |
$398.40 |
$498 |
3.7× |
| X-ray eye for foreign body (70030) |
$236 |
$295 |
2.7× |
| X-ray humerus (73060) |
$312 |
$390 |
3.5× |
| X-Ray Jaw <4 Vw - Xr Mandible < 4 Views (70100) |
$302.40 |
$378 |
3.4× |
| X-Ray Knee Bilat Standing - Xr Knees Anteroposterior Standing Bilat (73565) |
$251.20 |
$314 |
2.8× |
| X-Ray Lumbar Spine 2/3 Vw - Xr Lumbar Spine 2-3 Views (72100) |
$331.20 |
$414 |
3.1× |
| X-ray nose-rectum child f.b. (76010) |
$232.80 |
$291 |
2.6× |
| X-Ray Ribs, Chest 4+ Vw - Xr Ribs 3 Vws Bil W/ Chest Posteroanterior (71111) |
$510.40 |
$638 |
4.8× |
| X-Ray Sacroiliac Jts 3+ Vw - Xr Sacroiliac Joints 3+ Views (72202) |
$296 |
$370 |
2.8× |
| X-Ray Sacrum/Coccyx 2+ Vw - Xr Sacrum Coccyx 2+ Views (72220) |
$291.20 |
$364 |
3.3× |
| X-Ray Sinuses 3+ Vw - Xr Paranasal Sinuses 3+ Views (70220) |
$404 |
$505 |
4.5× |
| X-Ray Skull 4+ Vw - Xr Skull Complete 4+ Views (70260) |
$492.80 |
$616 |
4.6× |
| X-ray thoracic spine 4 vw (72074) |
$345.60 |
$432 |
3.2× |
| X-Rays Bone Survey Complete (77075) |
$783.20 |
$979 |
7.3× |
| Xr c-spine 4 or 5 views (72050) |
$463.20 |
$579 |
4.3× |
| Xr facial bones less than 3 views (70140) |
$250.40 |
$313 |
2.8× |
| Xr orbits complete 4 views (70200) |
$363.20 |
$454 |
3.4× |