| Abdomen 1 View (74018) |
$313.60 |
$392 |
3.7× |
| Abdomen 2 views (74019) |
$376.80 |
$471 |
3.7× |
| Acute Gastrointestinal Blood Loss Imaging (78278) |
$1,712 |
$2,140 |
4.5× |
| Ankle 2 views (73600) |
$302.40 |
$378 |
3.6× |
| Arthrogram hip (73525) |
$1,037.60 |
$1,297 |
3.1× |
| Bone age studies (77072) |
$224 |
$280 |
2.2× |
| Bone Imaging 3 Phase (78315) |
$2,139.20 |
$2,674 |
5.6× |
| Bone Imaging Limited Area (78300) |
$1,337.60 |
$1,672 |
3.5× |
| Bone Imaging Whole Body (78306) |
$1,916 |
$2,395 |
5.0× |
| Cat Scan Follow-Up Study (76380) |
$1,032 |
$1,290 |
12.3× |
| Chest 1 view (71045) |
$253.60 |
$317 |
3.0× |
| Chest 2 views (71046) |
$340 |
$425 |
4.1× |
| Chest 3 views (71047) |
$247.20 |
$309 |
3.0× |
| Chest 4 or more views (71048) |
$260.80 |
$326 |
2.6× |
| Clavicle complete (73000) |
$317.60 |
$397 |
3.8× |
| Contrast X-Ray Bladder (74430) |
$838.40 |
$1,048 |
2.5× |
| Contrast X-Ray Of Knee Joint (73580) |
$1,105.60 |
$1,382 |
3.3× |
| CT abdomen and pelvis without and with contrast (74178) |
$5,248.80 |
$6,561 |
15.6× |
| CT abdomen and pelvis without contrast (74176) |
$3,804.80 |
$4,756 |
16.6× |
| CT abdomen w contrast (74160) |
$2,761.60 |
$3,452 |
16.4× |
| CT abdomen w wo contrast (74170) |
$2,880.80 |
$3,601 |
17.1× |
| CT abdomen w/o contrast (74150) |
$2,223.20 |
$2,779 |
22.1× |
| CT Angio Abdomen and Pelvis (74174) |
$4,990.40 |
$6,238 |
14.9× |
| CT Angio Chest (71275) |
$2,847.20 |
$3,559 |
16.9× |
| CT Angio Head (70496) |
$2,859.20 |
$3,574 |
17.0× |
| CT Angio Neck (70498) |
$2,859.20 |
$3,574 |
17.0× |
| CT cervical spine w/ contrast (72126) |
$2,577.60 |
$3,222 |
7.7× |
| CT cervical spine w/o contrast (72125) |
$2,473.60 |
$3,092 |
24.6× |
| CT cervical spine w/wo cont (72127) |
$1,867.20 |
$2,334 |
11.1× |
| CT chest w contrast (71260) |
$2,748.80 |
$3,436 |
16.3× |
| CT chest w/wo contrast (71270) |
$3,041.60 |
$3,802 |
18.0× |
| CT head/brain with contrast (70460) |
$2,536 |
$3,170 |
15.0× |
| CT head/brain without and with contrast (70470) |
$2,455.20 |
$3,069 |
14.6× |
| CT iac w contrast (70481) |
$2,556.80 |
$3,196 |
15.2× |
| CT l-spine w&w/o contrast (72133) |
$3,097.60 |
$3,872 |
18.4× |
| CT lower ext w/o (73700) |
$2,018.40 |
$2,523 |
20.1× |
| CT lower extremity w/contrast material (73701) |
$2,360.80 |
$2,951 |
14.0× |
| CT lumbar spine w contrast (72132) |
$2,491.20 |
$3,114 |
7.4× |
| CT lumbar spine w/o contrast (72131) |
$2,508 |
$3,135 |
25.0× |
| CT maxillofacial w contrast (70487) |
$2,528 |
$3,160 |
15.0× |
| CT maxillofacial wo contrast (70486) |
$2,112 |
$2,640 |
21.0× |
| CT neck tissue combo (70492) |
$2,835.20 |
$3,544 |
16.8× |
| Ct Orbit/Ear/Fossa W/O&W/Dye (70482) |
$2,783.20 |
$3,479 |
16.5× |
| CT orbits w/o contrast (70480) |
$2,129.60 |
$2,662 |
21.2× |
| CT pelvis w&w/o contrast (72194) |
$2,769.60 |
$3,462 |
16.4× |
| CT pelvis w/o contrast (72192) |
$2,004 |
$2,505 |
19.9× |
| CT scan of leg combo (73702) |
$2,696 |
$3,370 |
16.0× |
| CT scans face/jaw combo (70488) |
$2,947.20 |
$3,684 |
17.5× |
| CT soft tissue neck w contrast (70491) |
$2,381.60 |
$2,977 |
14.1× |
| CT soft tissue neck w/o contrast (70490) |
$1,920.80 |
$2,401 |
19.1× |
| CT thoracic spine w contrast (72129) |
$2,577.60 |
$3,222 |
15.3× |
| CT thoracic spine w/o contrast (72128) |
$2,491.20 |
$3,114 |
24.8× |
| CT thorax w/o contrast (71250) |
$2,108 |
$2,635 |
21.0× |
| CT upper ext wo (73200) |
$1,920.80 |
$2,401 |
19.1× |
| CT upper extremity w/o & w/contrast material (73202) |
$2,664 |
$3,330 |
15.8× |
| CT upper extremity with contrast (73201) |
$2,224.80 |
$2,781 |
6.6× |
| Cta Abdomen (74175) |
$3,057.60 |
$3,822 |
18.1× |
| CTA head&neck c+ w/noncontrast img&post-pxessing (70471) |
$3,008 |
$3,760 |
9.0× |
| CTA pelvis (72191) |
$3,117.60 |
$3,897 |
18.5× |
| Doppler Echo Fetal Puls Spectral F/U/Repeat (76828) |
$571.20 |
$714 |
5.7× |
| Doppler Echo Fetal Spectral Display Complete (76827) |
$750.40 |
$938 |
7.5× |
| Doppler Fetal Mid Cerebral Artery (76821) |
$488 |
$610 |
4.9× |
| Dxa Bone Density Axial (77080) |
$472 |
$590 |
4.7× |
| Echo exam of fetal heart (76825) |
$1,549.60 |
$1,937 |
2.9× |
| Echo exam uterus (76831) |
$887.20 |
$1,109 |
3.9× |
| Echocardiography, fetal, cardiovascular system, real time with image documentation (2D), with or without M-mode… (76826) |
$1,096.80 |
$1,371 |
4.8× |
| Esophagram (74220) |
$744 |
$930 |
4.4× |
| Fetal Biophys Profile W/Nst (76818) |
$898.40 |
$1,123 |
8.9× |
| Fetal Biophysical Profile W/O Non-Stress Testing (76819) |
$696.80 |
$871 |
6.9× |
| Fluoroscopy up to 1 hr (76000) |
$636.80 |
$796 |
2.8× |
| Foot 2 views (73620) |
$282.40 |
$353 |
3.4× |
| Forearm 2 views (73090) |
$317.60 |
$397 |
3.8× |
| Gastric emptying imaging study (78264) |
$1,791.20 |
$2,239 |
4.7× |
| Gated Heart Planar Single (78472) |
$2,076.80 |
$2,596 |
5.4× |
| Gated Heart, Multiple (78473) |
$2,422.40 |
$3,028 |
6.3× |
| Hand 2 views (73120) |
$312 |
$390 |
3.1× |
| Hepatobil Syst Image W/Drug (78227) |
$2,092.80 |
$2,616 |
4.0× |
| Hepatobiliary System Imaging (78226) |
$1,784 |
$2,230 |
4.6× |
| Ht Muscle Image Spect Sing (78451) |
$3,348.80 |
$4,186 |
2.7× |
| Hysterosalpingogram (74740) |
$897.60 |
$1,122 |
3.9× |
| Infant hip ultrasound with hip movement (dynamic) (76885) |
$603.20 |
$754 |
7.2× |
| Joint Survey Single View (77077) |
$322.40 |
$403 |
3.2× |
| K Flow/Funct Image W/Drug (78708) |
$2,182.40 |
$2,728 |
4.2× |
| K Flow/Funct Image W/O Drug (78707) |
$1,980.80 |
$2,476 |
3.8× |
| Knee 3 Views (73562) |
$363.20 |
$454 |
4.3× |
| Lung Ventilat&Perfus Imaging (78582) |
$2,011.20 |
$2,514 |
3.9× |
| Magnetic Image Jaw Joint (70336) |
$2,824.80 |
$3,531 |
12.3× |
| Meckels Divert Exam (78290) |
$1,536.80 |
$1,921 |
4.0× |
| Mra Head W/O & W/Contrast Material (70546) |
$3,977.60 |
$4,972 |
11.9× |
| MRA head w/o contrast (70544) |
$2,816.80 |
$3,521 |
12.3× |
| MRA head with contrast (70545) |
$3,096 |
$3,870 |
9.2× |
| MRA neck w contrast (70548) |
$2,907.20 |
$3,634 |
8.7× |
| Mra Neck W/O &W/Contrast Material (70549) |
$3,804 |
$4,755 |
11.3× |
| MRA neck w/o contrast (70547) |
$2,597.60 |
$3,247 |
11.3× |
| MRI abdomen w contrast (74182) |
$3,222.40 |
$4,028 |
9.6× |
| MRI abdomen w/o contrast (74181) |
$2,896.80 |
$3,621 |
12.6× |
| MRI any jt lower extrem w/contrast material (73722) |
$3,324 |
$4,155 |
4.4× |
| MRI any jt lower extrem w/o & w/contrast matrl (73723) |
$4,069.60 |
$5,087 |
12.1× |
| MRI any jt upper extremity w/contrast matrl (73222) |
$3,332 |
$4,165 |
4.4× |
| MRI cervical spine w contrast (72142) |
$3,444 |
$4,305 |
10.3× |
| MRI cervical spine w/o cont (72141) |
$2,987.20 |
$3,734 |
13.0× |
| MRI chest wo w contrast (71552) |
$4,069.60 |
$5,087 |
12.1× |
| MRI lower extrem oth/thn jt w/contrast matrl (73719) |
$3,683.20 |
$4,604 |
11.0× |
| MRI lower extrem oth/thn jt w/o & w/contr matr (73720) |
$4,060 |
$5,075 |
12.1× |
| MRI lower extrem oth/thn jt w/o contr matrl (73718) |
$2,810.40 |
$3,513 |
12.3× |
| MRI lumbar spine w contrast (72149) |
$3,452.80 |
$4,316 |
10.3× |
| Mri Neck Spine W/O & W/Dye (72156) |
$4,445.60 |
$5,557 |
13.3× |
| MRI orbit face &/neck w/o contrast (70540) |
$3,165.60 |
$3,957 |
13.8× |
| MRI orbit face neck w contrast (70542) |
$3,648.80 |
$4,561 |
10.9× |
| Mri Orbt/Fac/Nck W/O &W/Dye (70543) |
$4,310.40 |
$5,388 |
12.9× |
| MRI pelvis w/o & w contrast (72197) |
$4,138.40 |
$5,173 |
12.3× |
| MRI pelvis w/o contrast (72195) |
$2,972.80 |
$3,716 |
13.0× |
| MRI thoracic spine w/o contrast (72146) |
$3,044.80 |
$3,806 |
13.3× |
| MRI upper extremity oth than jt w/o contr matrl (73218) |
$2,645.60 |
$3,307 |
11.5× |
| Mri Uppr Extremity W/O&W/Dye (73220) |
$4,012.80 |
$5,016 |
12.0× |
| MRI, abdomen, combo (74183) |
$4,155.20 |
$5,194 |
12.4× |
| MRI, dorsal spine combo (72157) |
$4,425.60 |
$5,532 |
13.2× |
| MRI, dorsal spine contrast (72147) |
$3,452.80 |
$4,316 |
10.3× |
| MRI, joint upper extrem (73221) |
$2,874.40 |
$3,593 |
12.5× |
| MRI, joint upper extrem combo (73223) |
$3,989.60 |
$4,987 |
11.9× |
| MRI, lumbar spine combo (72158) |
$4,326.40 |
$5,408 |
12.9× |
| Myocardial Spect Multiple Studies (78452) |
$4,600 |
$5,750 |
3.7× |
| Neck soft tissue (70360) |
$314.40 |
$393 |
3.8× |
| Ob us nuchal meas 1 gest (76813) |
$599.20 |
$749 |
6.0× |
| Parathyroid imaging w/tomographic spect & CT (78072) |
$2,063.20 |
$2,579 |
4.0× |
| Parathyroid planar imaging w/wo subtraction (78071) |
$1,761.60 |
$2,202 |
4.6× |
| Pelvis 1 or 2 views (72170) |
$327.20 |
$409 |
3.3× |
| Radex Abd Compl Aqt Abd W/S/E/D Views 1 View Ch (74022) |
$520.80 |
$651 |
5.2× |
| Radex Ankle Complete Minimum 3 Views (73610) |
$353.60 |
$442 |
4.2× |
| Radex Calcaneus Minimum 2 Views (73650) |
$284.80 |
$356 |
3.4× |
| Radex elbow complete minimum 3 views (73080) |
$360.80 |
$451 |
4.3× |
| Radex Facial Bones Complete Minimum 3 Views (70150) |
$413.60 |
$517 |
4.1× |
| Radex fingr minimum 2 views (73140) |
$284 |
$355 |
3.4× |
| Radex foot complete minimum 3 views (73630) |
$348.80 |
$436 |
4.2× |
| Radex Hand Minimum 3 Views (73130) |
$346.40 |
$433 |
4.1× |
| Radex lower extremity infant minimum 2 views (73592) |
$253.60 |
$317 |
3.0× |
| Radex Nasal Bones Complete Minimum 3 Views (70160) |
$341.60 |
$427 |
4.1× |
| Radex Ribs Unilateral 2 Views (71100) |
$336 |
$420 |
4.0× |
| Radex shoulder complete minimum 2 views (73030) |
$360.80 |
$451 |
4.3× |
| Radex Sinuses Paransl < 3 Views (70210) |
$268 |
$335 |
3.2× |
| Radex Spine 1 View Specify Level (72020) |
$323.20 |
$404 |
3.9× |
| Radex Sternum Minimum 2 Views (71120) |
$288 |
$360 |
3.4× |
| Radex Temporomandble Jt Opn & Clsd Mouth Bilat (70330) |
$426.40 |
$533 |
5.1× |
| Radex Toe Minimum 2 Views (73660) |
$284 |
$355 |
3.4× |
| Radex upper extremity infant minimum 2 views (73092) |
$244.80 |
$306 |
2.4× |
| Radex Wrist Complete Minimum 3 Views (73110) |
$350.40 |
$438 |
4.2× |
| Radex X-Ray Exam Entire Spi 6/> Vw - Xr Entire Spine 6+ Vw (72084) |
$728.80 |
$911 |
7.3× |
| Radiolog exam mandible compl minimum 4 views (70110) |
$363.20 |
$454 |
3.6× |
| Radiologic Exam Abdomen 3+ Views - Xr Abdomen 3+ Views (74021) |
$423.20 |
$529 |
4.2× |
| Radiologic exam colon double contrast study (74280) |
$1,442.40 |
$1,803 |
8.6× |
| Radiologic exam colon single contrast study (74270) |
$1,168 |
$1,460 |
6.9× |
| Radiologic exam knee complete 4/more views (73564) |
$413.60 |
$517 |
4.1× |
| Radiologic exam pelvis compl minimum 3 views (72190) |
$406.40 |
$508 |
4.0× |
| Radiologic Exam Small Int Single Contrast Study (74250) |
$924 |
$1,155 |
5.5× |
| Radiologic exam swallow function contrast study (74230) |
$720.80 |
$901 |
4.3× |
| Radiologic exam upr gi trc double contrast study (74246) |
$1,021.60 |
$1,277 |
6.1× |
| Radiologic examination femur 1 view (73551) |
$280 |
$350 |
3.3× |
| Radiologic examination femur minimum 2 views (73552) |
$317.60 |
$397 |
3.8× |
| Radiologic examination knee 1/2 views (73560) |
$309.60 |
$387 |
3.7× |
| Radiologic examination tibia & fibula 2 views (73590) |
$332 |
$415 |
4.0× |
| Ribs bilateral 3 views (71110) |
$449.60 |
$562 |
4.5× |
| Scapula (73010) |
$351.20 |
$439 |
3.5× |
| Screening Digital Breast Tomosynthesis Bi (77063) |
$121.60 |
$152 |
5.2× |
| Shoulder 1 view (73020) |
$284 |
$355 |
3.4× |
| Shoulder Arthrography (73040) |
$1,065.60 |
$1,332 |
3.2× |
| Skull less than 4 views (70250) |
$390.40 |
$488 |
3.9× |
| Sternoclavicular joints (71130) |
$333.60 |
$417 |
4.0× |
| Thoracic spine 2 views (72070) |
$372 |
$465 |
3.7× |
| Thoracic spine 3 views (72072) |
$446.40 |
$558 |
4.4× |
| Thoracolumbar 2 views (72080) |
$371.20 |
$464 |
4.4× |
| Thyroid Uptake Measurement (78012) |
$900.80 |
$1,126 |
2.3× |
| Thyroid Uptake W/Blood Flow Sngle/Mult Quan Meas (78014) |
$1,384.80 |
$1,731 |
3.6× |
| Ultrasound Breast Limited (76642) |
$446.40 |
$558 |
5.3× |
| Ultrasound Exam Aaa Screen (76706) |
$482.40 |
$603 |
4.8× |
| Ultrasound, abdomen limited (76705) |
$756 |
$945 |
7.5× |
| Umbilical-artery Doppler (OB) (76820) |
$448 |
$560 |
4.5× |
| Unlisted us procedure (76999) |
$464.80 |
$581 |
5.6× |
| Upper gi w/o kub (74240) |
$946.40 |
$1,183 |
5.6× |
| Us breast unilateral complete (76641) |
$519.20 |
$649 |
5.2× |
| Us chest (76604) |
$594.40 |
$743 |
5.9× |
| Us exam, pelvic, limited (76857) |
$514.40 |
$643 |
5.1× |
| Us head (76506) |
$620.80 |
$776 |
6.2× |
| Us kidney transplant (76776) |
$800 |
$1,000 |
8.0× |
| Us lmtd joint/oth nonvasc xtr strux r-t w/img (76882) |
$462.40 |
$578 |
4.6× |
| Us ob detailed single fetus (76811) |
$1,128.80 |
$1,411 |
4.9× |
| Us ob limited 1 or more fetuses (76815) |
$538.40 |
$673 |
5.4× |
| Us ob transvaginal (76817) |
$699.20 |
$874 |
7.0× |
| Us pelvic non ob complete (76856) |
$956.80 |
$1,196 |
9.5× |
| Us pg uter img f&mat 14 wk tabdl 1/1st gestation (76801) |
$788.80 |
$986 |
7.8× |
| Us preg uterus real time f/u trnsabdl per fetus (76816) |
$494.40 |
$618 |
4.9× |
| Us retroperitoneal complete (76770) |
$820 |
$1,025 |
8.2× |
| Us retroperitoneal limited (76775) |
$700 |
$875 |
7.0× |
| Us scrotum and contents (76870) |
$793.60 |
$992 |
7.9× |
| Us spinal canal and contents (76800) |
$642.40 |
$803 |
6.4× |
| Us thyroid (76536) |
$728.80 |
$911 |
7.3× |
| Wrist 2 views (73100) |
$298.40 |
$373 |
3.6× |
| X-Ray Ac Jts - Xr Acromioclavicular Joints Bilateral (73050) |
$360 |
$450 |
4.3× |
| X-Ray Elbow 2 Vw - Xr Elbow 1-2 Views Right (73070) |
$300 |
$375 |
3.6× |
| X-Ray Exam Breast Specimen (76098) |
$267.20 |
$334 |
0.5× |
| X-Ray Exam Entire Spi 1 Vw (72081) |
$326.40 |
$408 |
3.9× |
| X-Ray Exam Entire Spi 2/3 Vw (72082) |
$557.60 |
$697 |
5.5× |
| X-Ray Exam Entire Spi 4/5 Vw (72083) |
$608 |
$760 |
6.0× |
| X-Ray Exam Hip Uni 1 View (73501) |
$272.80 |
$341 |
3.3× |
| X-Ray Exam Hip Uni 2-3 Views (73502) |
$352 |
$440 |
4.2× |
| X-Ray Exam Hip Uni 4/> Views (73503) |
$455.20 |
$569 |
4.5× |
| X-Ray Exam Hips Bi 2 Views (73521) |
$439.20 |
$549 |
4.4× |
| X-Ray Exam Hips Bi 3-4 Views (73522) |
$499.20 |
$624 |
5.0× |
| X-Ray Exam Hips Bi 5/> Views (73523) |
$618.40 |
$773 |
6.2× |
| X-Ray Exam L-S Spine Bending (72114) |
$652.80 |
$816 |
6.5× |
| X-Ray Exam Neck Spine 2-3 Vw (72040) |
$372 |
$465 |
4.4× |
| X-Ray Exam Neck Spine 6/>Vws (72052) |
$620.80 |
$776 |
6.2× |
| X-Ray Exam Unilat Ribs/Chest (71101) |
$441.60 |
$552 |
4.4× |
| X-ray eye for foreign body (70030) |
$263.20 |
$329 |
3.1× |
| X-ray humerus (73060) |
$324 |
$405 |
3.9× |
| X-ray IV pyelogram (ivp) (74400) |
$1,008.80 |
$1,261 |
6.0× |
| X-Ray Jaw <4 Vw - Xr Mandible < 4 Views (70100) |
$311.20 |
$389 |
3.7× |
| X-Ray Knee Bilat Standing - Xr Knees Anteroposterior Standing Bilat (73565) |
$316 |
$395 |
3.8× |
| X-Ray Lumbar Spine 2/3 Vw - Xr Lumbar Spine 2-3 Views (72100) |
$414.40 |
$518 |
4.1× |
| X-Ray Ribs, Chest 4+ Vw - Xr Ribs 3 Vws Bil W/ Chest Posteroanterior (71111) |
$512 |
$640 |
5.1× |
| X-Ray Sacroiliac Jts 3+ Vw - Xr Sacroiliac Joints 3+ Views (72202) |
$387.20 |
$484 |
3.9× |
| X-Ray Sacrum/Coccyx 2+ Vw - Xr Sacrum Coccyx 2+ Views (72220) |
$346.40 |
$433 |
4.1× |
| X-Ray Sinuses 3+ Vw - Xr Paranasal Sinuses 3+ Views (70220) |
$383.20 |
$479 |
4.6× |
| X-Ray Skull 4+ Vw - Xr Skull Complete 4+ Views (70260) |
$416.80 |
$521 |
4.1× |
| X-Ray Urinary Tract Exam With Contrast Material (74420) |
$1,060 |
$1,325 |
3.2× |
| X-Rays Bone Length Studies (77073) |
$532.80 |
$666 |
5.3× |
| X-Rays Bone Survey Complete (77075) |
$774.40 |
$968 |
7.7× |
| Xr c-spine 4 or 5 views (72050) |
$530.40 |
$663 |
5.3× |
| Xr facial bones less than 3 views (70140) |
$284.80 |
$356 |
3.4× |
| Xr orbits complete 4 views (70200) |
$416.80 |
$521 |
4.1× |
| Xr Tomogram Single Plane (76100) |
$828.80 |
$1,036 |
8.2× |