| Abdomen 1 View (74018) |
$260 |
$325 |
2.9× |
| Abdomen 2 views (74019) |
$319.20 |
$399 |
3.0× |
| Acute Gastrointestinal Blood Loss Imaging (78278) |
$1,782.40 |
$2,228 |
4.3× |
| Ankle 2 views (73600) |
$208.80 |
$261 |
2.3× |
| Bone Imaging 3 Phase (78315) |
$2,199.20 |
$2,749 |
5.3× |
| Bone Imaging Limited Area (78300) |
$1,280 |
$1,600 |
3.1× |
| Bone Imaging Whole Body (78306) |
$1,880 |
$2,350 |
4.6× |
| Bone survey infant (77076) |
$451.20 |
$564 |
4.2× |
| Cat Scan Follow-Up Study (76380) |
$1,361.60 |
$1,702 |
15.2× |
| Chest 1 view (71045) |
$121.60 |
$152 |
1.4× |
| Chest 2 views (71046) |
$196 |
$245 |
2.2× |
| Chest 3 views (71047) |
$164 |
$205 |
1.8× |
| Chest 4 or more views (71048) |
$332 |
$415 |
3.1× |
| Clavicle complete (73000) |
$184 |
$230 |
2.0× |
| Contrast X-Ray Bladder (74430) |
$478.40 |
$598 |
1.3× |
| CT abdomen and pelvis without and with contrast (74178) |
$5,067.20 |
$6,334 |
14.1× |
| CT abdomen and pelvis without contrast (74176) |
$3,158.40 |
$3,948 |
12.8× |
| CT abdomen w contrast (74160) |
$3,021.60 |
$3,777 |
16.7× |
| CT abdomen w wo contrast (74170) |
$3,138.40 |
$3,923 |
17.3× |
| CT abdomen w/o contrast (74150) |
$1,968.80 |
$2,461 |
18.2× |
| CT Angio Abdomen and Pelvis (74174) |
$4,839.20 |
$6,049 |
13.4× |
| CT Angio Chest (71275) |
$3,344 |
$4,180 |
18.5× |
| CT Angio Head (70496) |
$3,188.80 |
$3,986 |
17.6× |
| CT Angio Neck (70498) |
$3,288.80 |
$4,111 |
18.2× |
| CT cervical spine w/o contrast (72125) |
$2,522.40 |
$3,153 |
23.4× |
| CT chest w contrast (71260) |
$2,877.60 |
$3,597 |
15.9× |
| CT chest w/wo contrast (71270) |
$3,312.80 |
$4,141 |
18.3× |
| CT head/brain with contrast (70460) |
$2,248 |
$2,810 |
12.4× |
| CT head/brain without and with contrast (70470) |
$2,568.80 |
$3,211 |
14.2× |
| CT iac w contrast (70481) |
$3,057.60 |
$3,822 |
16.9× |
| CT lower ext w/o (73700) |
$2,235.20 |
$2,794 |
20.7× |
| CT lower extremity w/contrast material (73701) |
$2,700 |
$3,375 |
14.9× |
| CT lumbar spine w contrast (72132) |
$2,661.60 |
$3,327 |
7.4× |
| CT lumbar spine w/o contrast (72131) |
$2,495.20 |
$3,119 |
23.1× |
| CT maxillofacial w contrast (70487) |
$2,431.20 |
$3,039 |
13.4× |
| CT maxillofacial wo contrast (70486) |
$1,888 |
$2,360 |
17.5× |
| CT neck tissue combo (70492) |
$3,220.80 |
$4,026 |
17.8× |
| Ct Orbit/Ear/Fossa W/O&W/Dye (70482) |
$3,217.60 |
$4,022 |
17.8× |
| CT orbits w/o contrast (70480) |
$2,380 |
$2,975 |
22.1× |
| CT pelvis w&w/o contrast (72194) |
$3,093.60 |
$3,867 |
17.1× |
| CT pelvis w/o contrast (72192) |
$1,928.80 |
$2,411 |
17.9× |
| CT scan of leg combo (73702) |
$3,152.80 |
$3,941 |
17.4× |
| CT scans face/jaw combo (70488) |
$2,814.40 |
$3,518 |
15.5× |
| CT soft tissue neck w contrast (70491) |
$2,722.40 |
$3,403 |
15.0× |
| CT soft tissue neck w/o contrast (70490) |
$2,327.20 |
$2,909 |
21.6× |
| CT thoracic spine w/o contrast (72128) |
$2,507.20 |
$3,134 |
23.2× |
| CT thorax w/o contrast (71250) |
$2,341.60 |
$2,927 |
21.7× |
| CT upper ext wo (73200) |
$2,227.20 |
$2,784 |
20.6× |
| CT upper extremity w/o & w/contrast material (73202) |
$3,199.20 |
$3,999 |
17.7× |
| CT upper extremity with contrast (73201) |
$2,773.60 |
$3,467 |
7.7× |
| Cta Abdomen (74175) |
$3,443.20 |
$4,304 |
19.0× |
| CTA head&neck c+ w/noncontrast img&post-pxessing (70471) |
$3,008 |
$3,760 |
8.4× |
| Dxa Bone Density Axial (77080) |
$501.60 |
$627 |
4.6× |
| Esophagram (74220) |
$526.40 |
$658 |
2.9× |
| Fetal Biophys Profile W/Nst (76818) |
$689.60 |
$862 |
6.4× |
| Fetal Biophysical Profile W/O Non-Stress Testing (76819) |
$656 |
$820 |
6.1× |
| Fluoroscopy up to 1 hr (76000) |
$376.80 |
$471 |
1.5× |
| Foot 2 views (73620) |
$174.40 |
$218 |
1.9× |
| Forearm 2 views (73090) |
$166.40 |
$208 |
1.9× |
| Gastric emptying imaging study (78264) |
$1,857.60 |
$2,322 |
4.5× |
| Hand 2 views (73120) |
$172 |
$215 |
1.6× |
| Hepatobil Syst Image W/Drug (78227) |
$2,257.60 |
$2,822 |
4.0× |
| Hepatobiliary System Imaging (78226) |
$1,837.60 |
$2,297 |
4.5× |
| Ht Muscle Image Spect Sing (78451) |
$2,692 |
$3,365 |
2.0× |
| Hysterosalpingogram (74740) |
$539.20 |
$674 |
2.2× |
| Joint Survey Single View (77077) |
$199.20 |
$249 |
1.8× |
| K Flow/Funct Image W/Drug (78708) |
$1,272 |
$1,590 |
2.3× |
| K Flow/Funct Image W/O Drug (78707) |
$1,739.20 |
$2,174 |
3.1× |
| Knee 3 Views (73562) |
$359.20 |
$449 |
4.0× |
| Liver imaging w/vascular flow (78202) |
$1,436 |
$1,795 |
2.6× |
| Lung Ventilat&Perfus Imaging (78582) |
$2,070.40 |
$2,588 |
3.7× |
| Lymph System Imaging (78195) |
$2,056.80 |
$2,571 |
3.7× |
| Magnetic Image Jaw Joint (70336) |
$2,789.60 |
$3,487 |
11.3× |
| Meckels Divert Exam (78290) |
$1,667.20 |
$2,084 |
4.0× |
| Mra Head W/O & W/Contrast Material (70546) |
$3,812 |
$4,765 |
10.6× |
| MRA head w/o contrast (70544) |
$2,700 |
$3,375 |
11.0× |
| MRA head with contrast (70545) |
$2,888.80 |
$3,611 |
8.0× |
| MRA neck w contrast (70548) |
$2,765.60 |
$3,457 |
7.7× |
| Mra Neck W/O &W/Contrast Material (70549) |
$3,582.40 |
$4,478 |
9.9× |
| MRA neck w/o contrast (70547) |
$2,588 |
$3,235 |
10.5× |
| MRI abdomen w/o contrast (74181) |
$2,846.40 |
$3,558 |
11.6× |
| MRI any jt lower extrem w/o & w/contrast matrl (73723) |
$4,012 |
$5,015 |
11.1× |
| MRI cervical spine w/o cont (72141) |
$2,950.40 |
$3,688 |
12.0× |
| MRI chest w/o contrast (71550) |
$2,899.20 |
$3,624 |
11.8× |
| MRI lower extrem oth/thn jt w/o & w/contr matr (73720) |
$4,018.40 |
$5,023 |
11.2× |
| MRI lower extrem oth/thn jt w/o contr matrl (73718) |
$2,672.80 |
$3,341 |
10.9× |
| MRI lumbar spine w contrast (72149) |
$3,344 |
$4,180 |
9.3× |
| Mri Neck Spine W/O & W/Dye (72156) |
$4,279.20 |
$5,349 |
11.9× |
| MRI orbit face &/neck w/o contrast (70540) |
$3,072.80 |
$3,841 |
12.5× |
| Mri Orbt/Fac/Nck W/O &W/Dye (70543) |
$4,256.80 |
$5,321 |
11.8× |
| MRI pelvis w contrast (72196) |
$3,685.60 |
$4,607 |
10.2× |
| MRI pelvis w/o & w contrast (72197) |
$4,222.40 |
$5,278 |
11.7× |
| MRI pelvis w/o contrast (72195) |
$2,924 |
$3,655 |
11.9× |
| MRI thoracic spine w/o contrast (72146) |
$2,993.60 |
$3,742 |
12.2× |
| MRI upper extremity oth than jt w/o contr matrl (73218) |
$2,681.60 |
$3,352 |
10.9× |
| Mri Uppr Extremity W/O&W/Dye (73220) |
$4,018.40 |
$5,023 |
11.2× |
| MRI, abdomen, combo (74183) |
$4,222.40 |
$5,278 |
11.7× |
| MRI, dorsal spine combo (72157) |
$4,279.20 |
$5,349 |
11.9× |
| MRI, dorsal spine contrast (72147) |
$3,209.60 |
$4,012 |
8.9× |
| MRI, joint upper extrem (73221) |
$2,809.60 |
$3,512 |
11.4× |
| MRI, joint upper extrem combo (73223) |
$4,018.40 |
$5,023 |
11.2× |
| MRI, lumbar spine combo (72158) |
$4,279.20 |
$5,349 |
11.9× |
| Myocardial Spect Multiple Studies (78452) |
$3,588 |
$4,485 |
2.7× |
| Neck soft tissue (70360) |
$192.80 |
$241 |
2.1× |
| Parathyroid imaging w/tomographic spect & CT (78072) |
$2,179.20 |
$2,724 |
3.9× |
| Pelvis 1 or 2 views (72170) |
$216 |
$270 |
2.0× |
| Pet Image W/Ct Lmtd (78814) |
$6,043.20 |
$7,554 |
4.1× |
| PET image w/CT, full body (78816) |
$6,656 |
$8,320 |
4.5× |
| PET imaging CT attenuation skull base mid-thigh (78815) |
$7,007.20 |
$8,759 |
4.7× |
| Pulmonary Perfusion Imaging Particulate (78580) |
$1,439.20 |
$1,799 |
3.5× |
| Radex Abd Compl Aqt Abd W/S/E/D Views 1 View Ch (74022) |
$275.20 |
$344 |
2.6× |
| Radex abscess/fistula/sinus tract rs&i (76080) |
$570.40 |
$713 |
1.0× |
| Radex Ankle Complete Minimum 3 Views (73610) |
$352.80 |
$441 |
3.9× |
| Radex Calcaneus Minimum 2 Views (73650) |
$184 |
$230 |
2.0× |
| Radex elbow complete minimum 3 views (73080) |
$216 |
$270 |
2.4× |
| Radex Facial Bones Complete Minimum 3 Views (70150) |
$268.80 |
$336 |
2.5× |
| Radex fingr minimum 2 views (73140) |
$195.20 |
$244 |
2.2× |
| Radex foot complete minimum 3 views (73630) |
$334.40 |
$418 |
3.7× |
| Radex Hand Minimum 3 Views (73130) |
$218.40 |
$273 |
2.4× |
| Radex Mastoids Compl Minimum 3 Views PR Side (70130) |
$336.80 |
$421 |
3.1× |
| Radex Nasal Bones Complete Minimum 3 Views (70160) |
$223.20 |
$279 |
2.5× |
| Radex Ribs Unilateral 2 Views (71100) |
$208.80 |
$261 |
2.3× |
| Radex shoulder complete minimum 2 views (73030) |
$274.40 |
$343 |
3.1× |
| Radex Sinuses Paransl < 3 Views (70210) |
$200.80 |
$251 |
2.2× |
| Radex Sternum Minimum 2 Views (71120) |
$187.20 |
$234 |
2.1× |
| Radex Temporomandble Jt Opn & Clsd Mouth Bilat (70330) |
$284 |
$355 |
3.2× |
| Radex Toe Minimum 2 Views (73660) |
$200.80 |
$251 |
2.2× |
| Radex upper extremity infant minimum 2 views (73092) |
$239.20 |
$299 |
2.2× |
| Radex Wrist Complete Minimum 3 Views (73110) |
$215.20 |
$269 |
2.4× |
| Radiolog exam mandible compl minimum 4 views (70110) |
$235.20 |
$294 |
2.2× |
| Radiologic Exam Abdomen 3+ Views - Xr Abdomen 3+ Views (74021) |
$363.20 |
$454 |
3.4× |
| Radiologic exam colon double contrast study (74280) |
$1,113.60 |
$1,392 |
6.2× |
| Radiologic exam colon single contrast study (74270) |
$878.40 |
$1,098 |
4.9× |
| Radiologic exam knee complete 4/more views (73564) |
$268.80 |
$336 |
2.5× |
| Radiologic exam pelvis compl minimum 3 views (72190) |
$263.20 |
$329 |
2.4× |
| Radiologic Exam Small Int Single Contrast Study (74250) |
$646.40 |
$808 |
3.6× |
| Radiologic exam swallow function contrast study (74230) |
$664 |
$830 |
3.7× |
| Radiologic exam upr gi trc double contrast study (74246) |
$744.80 |
$931 |
4.1× |
| Radiologic examination femur minimum 2 views (73552) |
$304.80 |
$381 |
3.4× |
| Radiologic examination knee 1/2 views (73560) |
$181.60 |
$227 |
2.0× |
| Radiologic Examination Osseous Survey Limited (77074) |
$392 |
$490 |
3.6× |
| Radiologic examination tibia & fibula 2 views (73590) |
$195.20 |
$244 |
2.2× |
| Ribs bilateral 3 views (71110) |
$244 |
$305 |
2.3× |
| Rp Loclzj Tum Spect 1 Area Single Day Imaging (78803) |
$2,648 |
$3,310 |
4.7× |
| Scapula (73010) |
$208.80 |
$261 |
1.9× |
| Screening Digital Breast Tomosynthesis Bi (77063) |
$124 |
$155 |
5.3× |
| Shoulder 1 view (73020) |
$150.40 |
$188 |
1.7× |
| Skull less than 4 views (70250) |
$224.80 |
$281 |
2.1× |
| Sternoclavicular joints (71130) |
$204.80 |
$256 |
2.3× |
| Thoracic spine 2 views (72070) |
$218.40 |
$273 |
2.0× |
| Thoracic spine 3 views (72072) |
$230.40 |
$288 |
2.1× |
| Thyroid Imaging With Vascular Flow (78013) |
$1,077.60 |
$1,347 |
2.6× |
| Thyroid Uptake Measurement (78012) |
$754.40 |
$943 |
1.8× |
| Thyroid Uptake W/Blood Flow Sngle/Mult Quan Meas (78014) |
$1,479.20 |
$1,849 |
3.6× |
| Ultrasound Breast Limited (76642) |
$448.80 |
$561 |
5.0× |
| Ultrasound Exam Aaa Screen (76706) |
$520.80 |
$651 |
4.8× |
| Ultrasound, abdomen limited (76705) |
$604.80 |
$756 |
5.6× |
| Unlisted us procedure (76999) |
$368.80 |
$461 |
4.1× |
| Upper gi w/o kub (74240) |
$649.60 |
$812 |
3.6× |
| Ureteral Reflux Study (78740) |
$1,428 |
$1,785 |
3.5× |
| Urethrocystogram voiding (74455) |
$573.60 |
$717 |
2.3× |
| Us breast unilateral complete (76641) |
$560.80 |
$701 |
5.2× |
| Us chest (76604) |
$568 |
$710 |
5.3× |
| Us exam, pelvic, limited (76857) |
$564.80 |
$706 |
5.2× |
| Us lmtd joint/oth nonvasc xtr strux r-t w/img (76882) |
$464 |
$580 |
4.3× |
| Us ob limited 1 or more fetuses (76815) |
$550.40 |
$688 |
5.1× |
| Us ob transvaginal (76817) |
$568 |
$710 |
5.3× |
| Us pelvic non ob complete (76856) |
$741.60 |
$927 |
6.9× |
| Us pg uter img f&mat 14 wk tabdl 1/1st gestation (76801) |
$721.60 |
$902 |
6.7× |
| Us preg uterus real time f/u trnsabdl per fetus (76816) |
$511.20 |
$639 |
4.7× |
| Us retroperitoneal complete (76770) |
$745.60 |
$932 |
6.9× |
| Us retroperitoneal limited (76775) |
$336 |
$420 |
3.1× |
| Us spinal canal and contents (76800) |
$619.20 |
$774 |
5.7× |
| Us thyroid (76536) |
$736.80 |
$921 |
6.8× |
| Us transrectal (76872) |
$602.40 |
$753 |
5.6× |
| Venography extremity unilateral rs&i (75820) |
$1,236.80 |
$1,546 |
0.8× |
| Wrist 2 views (73100) |
$198.40 |
$248 |
2.2× |
| X-Ray Ac Jts - Xr Acromioclavicular Joints Bilateral (73050) |
$240.80 |
$301 |
2.7× |
| X-Ray Elbow 2 Vw - Xr Elbow 1-2 Views Right (73070) |
$184 |
$230 |
2.0× |
| X-Ray Exam Breast Specimen (76098) |
$372.80 |
$466 |
0.7× |
| X-Ray Exam Hip Uni 1 View (73501) |
$167.20 |
$209 |
1.9× |
| X-Ray Exam Hip Uni 2-3 Views (73502) |
$248 |
$310 |
2.8× |
| X-Ray Exam Hip Uni 4/> Views (73503) |
$320.80 |
$401 |
3.0× |
| X-Ray Exam Hips Bi 3-4 Views (73522) |
$327.20 |
$409 |
3.0× |
| X-Ray Exam Hips Bi 5/> Views (73523) |
$392 |
$490 |
3.6× |
| X-Ray Exam L-S Spine Bending (72114) |
$446.40 |
$558 |
4.1× |
| X-Ray Exam Neck Spine 2-3 Vw (72040) |
$210.40 |
$263 |
2.3× |
| X-Ray Exam Neck Spine 6/>Vws (72052) |
$370.40 |
$463 |
3.4× |
| X-Ray Exam Unilat Ribs/Chest (71101) |
$218.40 |
$273 |
2.0× |
| X-ray eye for foreign body (70030) |
$187.20 |
$234 |
2.1× |
| X-ray humerus (73060) |
$198.40 |
$248 |
2.2× |
| X-ray IV pyelogram (ivp) (74400) |
$688 |
$860 |
3.8× |
| X-Ray Knee Bilat Standing - Xr Knees Anteroposterior Standing Bilat (73565) |
$262.40 |
$328 |
2.9× |
| X-Ray Lumbar Spine 2/3 Vw - Xr Lumbar Spine 2-3 Views (72100) |
$274.40 |
$343 |
2.5× |
| X-Ray Ribs, Chest 4+ Vw - Xr Ribs 3 Vws Bil W/ Chest Posteroanterior (71111) |
$302.40 |
$378 |
2.8× |
| X-Ray Sacroiliac Jts 3+ Vw - Xr Sacroiliac Joints 3+ Views (72202) |
$228 |
$285 |
2.1× |
| X-Ray Sacrum/Coccyx 2+ Vw - Xr Sacrum Coccyx 2+ Views (72220) |
$192 |
$240 |
2.1× |
| X-Ray Sinuses 3+ Vw - Xr Paranasal Sinuses 3+ Views (70220) |
$240.80 |
$301 |
2.7× |
| X-Ray Skull 4+ Vw - Xr Skull Complete 4+ Views (70260) |
$290.40 |
$363 |
2.7× |
| X-ray thoracic spine 4 vw (72074) |
$288 |
$360 |
2.7× |
| X-Ray Urinary Tract Exam With Contrast Material (74420) |
$1,072 |
$1,340 |
3.0× |
| X-Rays Bone Survey Complete (77075) |
$749.60 |
$937 |
6.9× |
| Xr c-spine 4 or 5 views (72050) |
$278.40 |
$348 |
2.6× |
| Xr orbits complete 4 views (70200) |
$272.80 |
$341 |
2.5× |