| Abdomen 1 View (74018) |
$307.20 |
$384 |
3.5× |
| Abdomen 2 views (74019) |
$387.20 |
$484 |
3.6× |
| Acute Gastrointestinal Blood Loss Imaging (78278) |
$1,955.20 |
$2,444 |
4.8× |
| Ankle 2 views (73600) |
$308 |
$385 |
3.5× |
| Bone Imaging 3 Phase (78315) |
$2,268 |
$2,835 |
5.6× |
| Bone Imaging Whole Body (78306) |
$2,068.80 |
$2,586 |
5.1× |
| Chest 1 view (71045) |
$309.60 |
$387 |
3.5× |
| Chest 2 views (71046) |
$352.80 |
$441 |
4.0× |
| Chest 3 views (71047) |
$385.60 |
$482 |
4.3× |
| Chest 4 or more views (71048) |
$502.40 |
$628 |
4.7× |
| Clavicle complete (73000) |
$337.60 |
$422 |
3.8× |
| Computed Tomography Thorax Lw Dose Lng Ca Scr C- (71271) |
$1,058.40 |
$1,323 |
9.9× |
| CT abdomen and pelvis without and with contrast (74178) |
$5,310.40 |
$6,638 |
14.9× |
| CT abdomen and pelvis without contrast (74176) |
$4,067.20 |
$5,084 |
16.7× |
| CT abdomen w contrast (74160) |
$2,666.40 |
$3,333 |
14.9× |
| CT abdomen w wo contrast (74170) |
$3,052.80 |
$3,816 |
17.0× |
| CT abdomen w/o contrast (74150) |
$2,214.40 |
$2,768 |
20.7× |
| CT Angio Chest (71275) |
$2,990.40 |
$3,738 |
16.7× |
| CT Angio Head (70496) |
$2,946.40 |
$3,683 |
16.4× |
| CT Angio Neck (70498) |
$2,946.40 |
$3,683 |
16.4× |
| CT cervical spine w/o contrast (72125) |
$2,472.80 |
$3,091 |
23.2× |
| CT chest w contrast (71260) |
$2,666.40 |
$3,333 |
14.9× |
| CT chest w/wo contrast (71270) |
$3,286.40 |
$4,108 |
18.3× |
| CT head/brain with contrast (70460) |
$2,457.60 |
$3,072 |
13.7× |
| CT head/brain without and with contrast (70470) |
$2,618.40 |
$3,273 |
14.6× |
| CT iac w contrast (70481) |
$2,409.60 |
$3,012 |
13.4× |
| CT l-spine w&w/o contrast (72133) |
$2,624.80 |
$3,281 |
14.6× |
| CT lower ext w/o (73700) |
$2,195.20 |
$2,744 |
20.6× |
| CT lower extremity w/contrast material (73701) |
$1,866.40 |
$2,333 |
10.4× |
| CT lumbar spine w/o contrast (72131) |
$2,539.20 |
$3,174 |
23.8× |
| CT maxillofacial w contrast (70487) |
$2,228 |
$2,785 |
12.4× |
| CT maxillofacial wo contrast (70486) |
$2,128 |
$2,660 |
19.9× |
| CT neck tissue combo (70492) |
$3,061.60 |
$3,827 |
17.1× |
| Ct Orbit/Ear/Fossa W/O&W/Dye (70482) |
$2,815.20 |
$3,519 |
15.7× |
| CT orbits w/o contrast (70480) |
$2,154.40 |
$2,693 |
20.2× |
| CT pelvis w&w/o contrast (72194) |
$2,741.60 |
$3,427 |
15.3× |
| CT pelvis w/o contrast (72192) |
$1,944 |
$2,430 |
18.2× |
| CT scan of leg combo (73702) |
$2,727.20 |
$3,409 |
15.2× |
| CT scans face/jaw combo (70488) |
$2,929.60 |
$3,662 |
16.3× |
| CT soft tissue neck w contrast (70491) |
$2,409.60 |
$3,012 |
13.4× |
| CT soft tissue neck w/o contrast (70490) |
$2,136.80 |
$2,671 |
20.0× |
| CT thoracic spine w/o contrast (72128) |
$2,539.20 |
$3,174 |
23.8× |
| CT thorax w/o contrast (71250) |
$2,188.80 |
$2,736 |
20.5× |
| CT upper ext wo (73200) |
$2,022.40 |
$2,528 |
18.9× |
| Dxa Bone Density Axial (77080) |
$591.20 |
$739 |
5.5× |
| Fetal Biophys Profile W/Nst (76818) |
$732.80 |
$916 |
6.9× |
| Foot 2 views (73620) |
$260 |
$325 |
2.9× |
| Forearm 2 views (73090) |
$337.60 |
$422 |
3.8× |
| Gastric emptying imaging study (78264) |
$1,841.60 |
$2,302 |
4.5× |
| Hand 2 views (73120) |
$245.60 |
$307 |
2.3× |
| Hepatobil Syst Image W/Drug (78227) |
$1,691.20 |
$2,114 |
3.0× |
| Hepatobiliary System Imaging (78226) |
$1,928 |
$2,410 |
4.7× |
| Ht Muscle Image Spect Sing (78451) |
$3,508 |
$4,385 |
2.7× |
| Joint Survey Single View (77077) |
$322.40 |
$403 |
3.0× |
| K Flow/Funct Image W/Drug (78708) |
$2,236 |
$2,795 |
4.0× |
| Knee 3 Views (73562) |
$376.80 |
$471 |
4.2× |
| Lung Ventilat&Perfus Imaging (78582) |
$1,959.20 |
$2,449 |
3.5× |
| Magnetic Image Jaw Joint (70336) |
$2,857.60 |
$3,572 |
11.7× |
| Mra Head W/O & W/Contrast Material (70546) |
$3,832.80 |
$4,791 |
10.8× |
| MRA head w/o contrast (70544) |
$2,849.60 |
$3,562 |
11.7× |
| MRA head with contrast (70545) |
$3,071.20 |
$3,839 |
8.6× |
| MRA neck w contrast (70548) |
$2,960.80 |
$3,701 |
8.3× |
| Mra Neck W/O &W/Contrast Material (70549) |
$3,848 |
$4,810 |
10.8× |
| MRA neck w/o contrast (70547) |
$2,622.40 |
$3,278 |
10.8× |
| MRI abdomen w contrast (74182) |
$3,372.80 |
$4,216 |
9.5× |
| MRI abdomen w/o contrast (74181) |
$2,994.40 |
$3,743 |
12.3× |
| MRI any jt lower extrem w/contrast material (73722) |
$3,369.60 |
$4,212 |
4.2× |
| MRI any jt lower extrem w/o & w/contrast matrl (73723) |
$4,055.20 |
$5,069 |
11.4× |
| MRI any jt upper extremity w/contrast matrl (73222) |
$3,597.60 |
$4,497 |
4.5× |
| MRI cervical spine w contrast (72142) |
$3,369.60 |
$4,212 |
9.5× |
| MRI cervical spine w/o cont (72141) |
$3,225.60 |
$4,032 |
13.2× |
| MRI chest w/o contrast (71550) |
$2,946.40 |
$3,683 |
12.1× |
| MRI chest with contrast (71551) |
$3,288 |
$4,110 |
4.1× |
| MRI chest wo w contrast (71552) |
$4,185.60 |
$5,232 |
11.7× |
| MRI lower extrem oth/thn jt w/contrast matrl (73719) |
$3,652.80 |
$4,566 |
10.2× |
| MRI lower extrem oth/thn jt w/o & w/contr matr (73720) |
$3,926.40 |
$4,908 |
11.0× |
| MRI lower extrem oth/thn jt w/o contr matrl (73718) |
$2,995.20 |
$3,744 |
12.3× |
| MRI lumbar spine w contrast (72149) |
$3,362.40 |
$4,203 |
9.4× |
| Mri Neck Spine W/O & W/Dye (72156) |
$4,723.20 |
$5,904 |
13.3× |
| MRI orbit face &/neck w/o contrast (70540) |
$3,123.20 |
$3,904 |
12.8× |
| MRI orbit face neck w contrast (70542) |
$3,799.20 |
$4,749 |
10.7× |
| Mri Orbt/Fac/Nck W/O &W/Dye (70543) |
$4,656.80 |
$5,821 |
13.1× |
| MRI pelvis w contrast (72196) |
$4,011.20 |
$5,014 |
11.3× |
| MRI pelvis w/o & w contrast (72197) |
$4,042.40 |
$5,053 |
11.3× |
| MRI pelvis w/o contrast (72195) |
$3,064 |
$3,830 |
12.6× |
| MRI thoracic spine w/o contrast (72146) |
$3,372 |
$4,215 |
13.8× |
| MRI upper extremity oth than jt w/contr matrl (73219) |
$3,563.20 |
$4,454 |
10.0× |
| MRI upper extremity oth than jt w/o contr matrl (73218) |
$2,829.60 |
$3,537 |
11.6× |
| Mri Uppr Extremity W/O&W/Dye (73220) |
$3,820.80 |
$4,776 |
10.7× |
| MRI, abdomen, combo (74183) |
$4,211.20 |
$5,264 |
11.8× |
| MRI, dorsal spine combo (72157) |
$4,424 |
$5,530 |
12.4× |
| MRI, dorsal spine contrast (72147) |
$3,414.40 |
$4,268 |
9.6× |
| MRI, joint upper extrem (73221) |
$2,979.20 |
$3,724 |
12.2× |
| MRI, joint upper extrem combo (73223) |
$4,104 |
$5,130 |
11.5× |
| MRI, lumbar spine combo (72158) |
$4,430.40 |
$5,538 |
12.4× |
| Myocardial Spect Multiple Studies (78452) |
$4,746.40 |
$5,933 |
3.6× |
| Neck soft tissue (70360) |
$289.60 |
$362 |
3.3× |
| Pelvis 1 or 2 views (72170) |
$337.60 |
$422 |
3.2× |
| Pulmonary Perfusion Imaging Particulate (78580) |
$1,431.20 |
$1,789 |
3.5× |
| Radex Ankle Complete Minimum 3 Views (73610) |
$376.80 |
$471 |
4.2× |
| Radex Calcaneus Minimum 2 Views (73650) |
$319.20 |
$399 |
3.6× |
| Radex elbow complete minimum 3 views (73080) |
$368 |
$460 |
4.1× |
| Radex Facial Bones Complete Minimum 3 Views (70150) |
$581.60 |
$727 |
5.4× |
| Radex fingr minimum 2 views (73140) |
$240.80 |
$301 |
2.7× |
| Radex foot complete minimum 3 views (73630) |
$351.20 |
$439 |
4.0× |
| Radex Hand Minimum 3 Views (73130) |
$356 |
$445 |
4.0× |
| Radex lower extremity infant minimum 2 views (73592) |
$287.20 |
$359 |
3.2× |
| Radex Nasal Bones Complete Minimum 3 Views (70160) |
$403.20 |
$504 |
4.5× |
| Radex Ribs Unilateral 2 Views (71100) |
$365.60 |
$457 |
4.1× |
| Radex shoulder complete minimum 2 views (73030) |
$365.60 |
$457 |
4.1× |
| Radex Sinuses Paransl < 3 Views (70210) |
$324 |
$405 |
3.6× |
| Radex Spine 1 View Specify Level (72020) |
$248.80 |
$311 |
2.8× |
| Radex Sternum Minimum 2 Views (71120) |
$396 |
$495 |
4.5× |
| Radex Temporomandble Jt Opn & Clsd Mouth Bilat (70330) |
$465.60 |
$582 |
5.2× |
| Radex Toe Minimum 2 Views (73660) |
$240.80 |
$301 |
2.7× |
| Radex upper extremity infant minimum 2 views (73092) |
$307.20 |
$384 |
2.9× |
| Radex Wrist Complete Minimum 3 Views (73110) |
$351.20 |
$439 |
4.0× |
| Radex X-Ray Exam Entire Spi 6/> Vw - Xr Entire Spine 6+ Vw (72084) |
$768.80 |
$961 |
7.2× |
| Radiolog exam mandible compl minimum 4 views (70110) |
$514.40 |
$643 |
4.8× |
| Radiologic Exam Abdomen 3+ Views - Xr Abdomen 3+ Views (74021) |
$434.40 |
$543 |
4.1× |
| Radiologic exam knee complete 4/more views (73564) |
$533.60 |
$667 |
5.0× |
| Radiologic exam pelvis compl minimum 3 views (72190) |
$440.80 |
$551 |
4.1× |
| Radiologic exam swallow function contrast study (74230) |
$728 |
$910 |
4.1× |
| Radiologic examination femur 1 view (73551) |
$362.40 |
$453 |
4.1× |
| Radiologic examination femur minimum 2 views (73552) |
$321.60 |
$402 |
3.6× |
| Radiologic examination knee 1/2 views (73560) |
$322.40 |
$403 |
3.6× |
| Radiologic Examination Osseous Survey Limited (77074) |
$612 |
$765 |
5.7× |
| Radiologic examination tibia & fibula 2 views (73590) |
$337.60 |
$422 |
3.8× |
| Ribs bilateral 3 views (71110) |
$627.20 |
$784 |
5.9× |
| Scapula (73010) |
$408.80 |
$511 |
3.8× |
| Screening Digital Breast Tomosynthesis Bi (77063) |
$90.40 |
$113 |
3.9× |
| Shoulder 1 view (73020) |
$296.80 |
$371 |
3.3× |
| Skull less than 4 views (70250) |
$427.20 |
$534 |
4.0× |
| Thoracic spine 2 views (72070) |
$404 |
$505 |
3.8× |
| Thoracic spine 3 views (72072) |
$483.20 |
$604 |
4.5× |
| Thyroid Uptake W/Blood Flow Sngle/Mult Quan Meas (78014) |
$1,479.20 |
$1,849 |
3.6× |
| Ultrasound Exam Aaa Screen (76706) |
$565.60 |
$707 |
5.3× |
| Ultrasound, abdomen limited (76705) |
$764.80 |
$956 |
7.2× |
| Unlisted us procedure (76999) |
$628.80 |
$786 |
7.1× |
| Us exam, pelvic, limited (76857) |
$712 |
$890 |
6.7× |
| Us lmtd joint/oth nonvasc xtr strux r-t w/img (76882) |
$601.60 |
$752 |
5.6× |
| Us ob limited 1 or more fetuses (76815) |
$567.20 |
$709 |
5.3× |
| Us ob transvaginal (76817) |
$812.80 |
$1,016 |
7.6× |
| Us pelvic non ob complete (76856) |
$921.60 |
$1,152 |
8.6× |
| Us preg uterus real time f/u trnsabdl per fetus (76816) |
$531.20 |
$664 |
5.0× |
| Us retroperitoneal complete (76770) |
$921.60 |
$1,152 |
8.6× |
| Us retroperitoneal limited (76775) |
$720 |
$900 |
6.7× |
| Us scrotum and contents (76870) |
$824.80 |
$1,031 |
7.7× |
| Us thyroid (76536) |
$807.20 |
$1,009 |
7.6× |
| Wrist 2 views (73100) |
$289.60 |
$362 |
3.3× |
| X-Ray Ac Jts - Xr Acromioclavicular Joints Bilateral (73050) |
$356 |
$445 |
4.0× |
| X-Ray Bend Only L-S Spine (72120) |
$307.20 |
$384 |
2.9× |
| X-Ray Elbow 2 Vw - Xr Elbow 1-2 Views Right (73070) |
$289.60 |
$362 |
3.3× |
| X-Ray Exam Entire Spi 1 Vw (72081) |
$428.80 |
$536 |
4.8× |
| X-Ray Exam Entire Spi 2/3 Vw (72082) |
$604 |
$755 |
5.7× |
| X-Ray Exam Entire Spi 4/5 Vw (72083) |
$673.60 |
$842 |
6.3× |
| X-Ray Exam Hip Uni 1 View (73501) |
$297.60 |
$372 |
3.3× |
| X-Ray Exam Hip Uni 2-3 Views (73502) |
$269.60 |
$337 |
3.0× |
| X-Ray Exam Hip Uni 4/> Views (73503) |
$526.40 |
$658 |
4.9× |
| X-Ray Exam Hips Bi 2 Views (73521) |
$532 |
$665 |
5.0× |
| X-Ray Exam Hips Bi 3-4 Views (73522) |
$424.80 |
$531 |
4.0× |
| X-Ray Exam Hips Bi 5/> Views (73523) |
$639.20 |
$799 |
6.0× |
| X-Ray Exam Neck Spine 2-3 Vw (72040) |
$368 |
$460 |
4.1× |
| X-Ray Exam Neck Spine 6/>Vws (72052) |
$796 |
$995 |
7.5× |
| X-Ray Exam Unilat Ribs/Chest (71101) |
$509.60 |
$637 |
4.8× |
| X-ray eye for foreign body (70030) |
$343.20 |
$429 |
3.9× |
| X-ray humerus (73060) |
$337.60 |
$422 |
3.8× |
| X-ray IV pyelogram (ivp) (74400) |
$1,095.20 |
$1,369 |
6.1× |
| X-ray IV pyelogram+tomography (74415) |
$1,183.20 |
$1,479 |
6.6× |
| X-Ray Jaw <4 Vw - Xr Mandible < 4 Views (70100) |
$356.80 |
$446 |
4.0× |
| X-Ray Knee Bilat Standing - Xr Knees Anteroposterior Standing Bilat (73565) |
$328.80 |
$411 |
3.7× |
| X-Ray Lumbar Spine 2/3 Vw - Xr Lumbar Spine 2-3 Views (72100) |
$425.60 |
$532 |
4.0× |
| X-Ray Ribs, Chest 4+ Vw - Xr Ribs 3 Vws Bil W/ Chest Posteroanterior (71111) |
$672 |
$840 |
6.3× |
| X-Ray Sacroiliac Jts 3+ Vw - Xr Sacroiliac Joints 3+ Views (72202) |
$430.40 |
$538 |
4.0× |
| X-Ray Sacroiliac Jts <3 Vw - Xr Sacroiliac Joints 1-2 Views (72200) |
$340 |
$425 |
3.2× |
| X-Ray Sacrum/Coccyx 2+ Vw - Xr Sacrum Coccyx 2+ Views (72220) |
$351.20 |
$439 |
4.0× |
| X-Ray Sinuses 3+ Vw - Xr Paranasal Sinuses 3+ Views (70220) |
$536 |
$670 |
6.0× |
| X-Ray Skull 4+ Vw - Xr Skull Complete 4+ Views (70260) |
$621.60 |
$777 |
5.8× |
| X-Rays Bone Survey Complete (77075) |
$1,128 |
$1,410 |
10.6× |
| Xr c-spine 4 or 5 views (72050) |
$636.80 |
$796 |
6.0× |
| Xr facial bones less than 3 views (70140) |
$357.60 |
$447 |
4.0× |
| Xr orbits complete 4 views (70200) |
$415.20 |
$519 |
3.9× |