| Abdomen 1 View (74018) |
$308.80 |
$386 |
3.5× |
| Abdomen 2 views (74019) |
$392 |
$490 |
3.7× |
| Acute Gastrointestinal Blood Loss Imaging (78278) |
$1,736 |
$2,170 |
4.3× |
| Ankle 2 views (73600) |
$308.80 |
$386 |
3.5× |
| Bone age studies (77072) |
$369.60 |
$462 |
3.5× |
| Bone Imaging 3 Phase (78315) |
$2,248.80 |
$2,811 |
5.5× |
| Bone Imaging Limited Area (78300) |
$1,394.40 |
$1,743 |
3.4× |
| Bone Imaging Multiple Areas (78305) |
$1,662.40 |
$2,078 |
4.1× |
| Bone Imaging Whole Body (78306) |
$2,012 |
$2,515 |
4.9× |
| Bone survey infant (77076) |
$524 |
$655 |
4.9× |
| Brain Imaging Min 4 Static Views W Vascular Flow (78606) |
$1,602.40 |
$2,003 |
2.9× |
| Chest 1 view (71045) |
$276 |
$345 |
3.1× |
| Chest 2 views (71046) |
$350.40 |
$438 |
3.9× |
| Chest 3 views (71047) |
$411.20 |
$514 |
4.6× |
| Chest 4 or more views (71048) |
$531.20 |
$664 |
5.0× |
| Clavicle complete (73000) |
$308.80 |
$386 |
3.5× |
| Computed Tomography Thorax Lw Dose Lng Ca Scr C- (71271) |
$1,708 |
$2,135 |
16.0× |
| CT abdomen and pelvis without and with contrast (74178) |
$5,310.40 |
$6,638 |
14.9× |
| CT abdomen and pelvis without contrast (74176) |
$3,744 |
$4,680 |
15.4× |
| CT abdomen w contrast (74160) |
$2,656 |
$3,320 |
14.8× |
| CT abdomen w wo contrast (74170) |
$3,036.80 |
$3,796 |
16.9× |
| CT abdomen w/o contrast (74150) |
$2,140 |
$2,675 |
20.0× |
| CT Angio Abdomen and Pelvis (74174) |
$4,180 |
$5,225 |
11.7× |
| CT Angio Chest (71275) |
$2,992 |
$3,740 |
16.7× |
| CT Angio Head (70496) |
$2,936.80 |
$3,671 |
16.4× |
| CT Angio Neck (70498) |
$2,936.80 |
$3,671 |
16.4× |
| Ct Angio Upr Extrm W/O&W/Dye (73206) |
$2,544 |
$3,180 |
14.2× |
| CT cervical spine w/ contrast (72126) |
$2,708.80 |
$3,386 |
7.6× |
| CT cervical spine w/o contrast (72125) |
$2,253.60 |
$2,817 |
21.1× |
| CT cervical spine w/wo cont (72127) |
$3,067.20 |
$3,834 |
17.1× |
| CT chest w contrast (71260) |
$2,691.20 |
$3,364 |
15.0× |
| CT chest w/wo contrast (71270) |
$3,224 |
$4,030 |
18.0× |
| CT head/brain with contrast (70460) |
$2,447.20 |
$3,059 |
13.7× |
| CT head/brain without and with contrast (70470) |
$2,620.80 |
$3,276 |
14.6× |
| CT iac w contrast (70481) |
$2,625.60 |
$3,282 |
14.7× |
| CT l-spine w&w/o contrast (72133) |
$2,968 |
$3,710 |
16.6× |
| CT lower ext w/o (73700) |
$2,029.60 |
$2,537 |
19.0× |
| CT lower extremity w/contrast material (73701) |
$2,538.40 |
$3,173 |
14.2× |
| CT lumbar spine w contrast (72132) |
$2,680 |
$3,350 |
7.5× |
| CT lumbar spine w/o contrast (72131) |
$2,376 |
$2,970 |
22.2× |
| CT maxillofacial w contrast (70487) |
$2,598.40 |
$3,248 |
14.5× |
| CT maxillofacial wo contrast (70486) |
$2,034.40 |
$2,543 |
19.0× |
| CT neck tissue combo (70492) |
$2,992.80 |
$3,741 |
16.7× |
| Ct Orbit/Ear/Fossa W/O&W/Dye (70482) |
$2,924.80 |
$3,656 |
16.3× |
| CT orbits w/o contrast (70480) |
$2,168 |
$2,710 |
20.3× |
| CT pelvis w&w/o contrast (72194) |
$2,809.60 |
$3,512 |
15.7× |
| CT pelvis w/o contrast (72192) |
$1,926.40 |
$2,408 |
18.0× |
| CT scan of leg combo (73702) |
$2,832 |
$3,540 |
15.8× |
| CT scans face/jaw combo (70488) |
$3,063.20 |
$3,829 |
17.1× |
| CT soft tissue neck w contrast (70491) |
$2,501.60 |
$3,127 |
14.0× |
| CT soft tissue neck w/o contrast (70490) |
$2,064.80 |
$2,581 |
19.3× |
| CT thoracic spine w contrast (72129) |
$2,772 |
$3,465 |
15.5× |
| CT thoracic spine w/o contrast (72128) |
$2,376 |
$2,970 |
22.2× |
| CT thoracic spine w/wo cont (72130) |
$3,301.60 |
$4,127 |
18.4× |
| CT thorax w/o contrast (71250) |
$2,095.20 |
$2,619 |
19.6× |
| CT upper ext wo (73200) |
$1,955.20 |
$2,444 |
18.3× |
| CT upper extremity w/o & w/contrast material (73202) |
$2,586.40 |
$3,233 |
14.4× |
| CT upper extremity with contrast (73201) |
$2,285.60 |
$2,857 |
6.4× |
| Cta Abdl Aorta&Bi Iliofem W/Contrast&Postp (75635) |
$2,968 |
$3,710 |
16.6× |
| Cta Abdomen (74175) |
$3,272 |
$4,090 |
18.3× |
| CTA head&neck c+ w/noncontrast img&post-pxessing (70471) |
$3,008 |
$3,760 |
8.4× |
| Dxa Bone Density Axial (77080) |
$538.40 |
$673 |
5.0× |
| Dxa bone density study 1/>sites appendiclr skel (77081) |
$339.20 |
$424 |
3.8× |
| Esophageal Motility Study (78258) |
$1,246.40 |
$1,558 |
3.1× |
| Esophagram (74220) |
$672 |
$840 |
3.8× |
| Fetal Biophysical Profile W/O Non-Stress Testing (76819) |
$662.40 |
$828 |
6.2× |
| Foot 2 views (73620) |
$308.80 |
$386 |
3.5× |
| Forearm 2 views (73090) |
$308.80 |
$386 |
3.5× |
| Gastric emptying imaging study (78264) |
$1,882.40 |
$2,353 |
4.6× |
| Gastroesophageal Reflux Exam (78262) |
$1,802.40 |
$2,253 |
4.4× |
| Gated Heart Planar Single (78472) |
$2,072.80 |
$2,591 |
5.1× |
| Gated Heart, Multiple (78473) |
$2,263.20 |
$2,829 |
5.5× |
| Hand 2 views (73120) |
$266.40 |
$333 |
2.5× |
| Hepatobil Syst Image W/Drug (78227) |
$2,279.20 |
$2,849 |
4.1× |
| Hepatobiliary System Imaging (78226) |
$1,981.60 |
$2,477 |
4.9× |
| Ht Musc Image Planar Mult (78454) |
$2,768.80 |
$3,461 |
2.1× |
| Ht Muscle Image Spect Sing (78451) |
$2,980 |
$3,725 |
2.3× |
| Infant hip ultrasound with hip movement (dynamic) (76885) |
$558.40 |
$698 |
6.3× |
| Joint Survey Single View (77077) |
$324 |
$405 |
3.0× |
| K Flow/Funct Image W/Drug (78708) |
$2,226.40 |
$2,783 |
4.0× |
| K Flow/Funct Image W/O Drug (78707) |
$2,049.60 |
$2,562 |
3.7× |
| Knee 3 Views (73562) |
$407.20 |
$509 |
4.6× |
| Liver & Spleen Imaging Static Only (78215) |
$1,672.80 |
$2,091 |
4.1× |
| Liver & Spleen Imaging W/Vascular Flow (78216) |
$2,071.20 |
$2,589 |
5.1× |
| Liver imaging static only (78201) |
$1,848.80 |
$2,311 |
3.3× |
| Liver imaging w/vascular flow (78202) |
$1,690.40 |
$2,113 |
3.0× |
| Magnetic Image Jaw Joint (70336) |
$2,968.80 |
$3,711 |
12.2× |
| Meckels Divert Exam (78290) |
$1,458.40 |
$1,823 |
3.6× |
| Mra Head W/O & W/Contrast Material (70546) |
$4,208.80 |
$5,261 |
11.8× |
| MRA head w/o contrast (70544) |
$2,836 |
$3,545 |
11.6× |
| MRA head with contrast (70545) |
$3,430.40 |
$4,288 |
9.6× |
| MRA neck w contrast (70548) |
$3,220 |
$4,025 |
9.0× |
| Mra Neck W/O &W/Contrast Material (70549) |
$4,024.80 |
$5,031 |
11.3× |
| MRA neck w/o contrast (70547) |
$2,756 |
$3,445 |
11.3× |
| MRI abdomen w contrast (74182) |
$3,488.80 |
$4,361 |
9.8× |
| MRI abdomen w/o contrast (74181) |
$3,030.40 |
$3,788 |
12.4× |
| MRI any jt lower extrem w/contrast material (73722) |
$3,372.80 |
$4,216 |
4.2× |
| MRI any jt lower extrem w/o & w/contrast matrl (73723) |
$4,273.60 |
$5,342 |
12.0× |
| MRI any jt upper extremity w/contrast matrl (73222) |
$3,516 |
$4,395 |
4.4× |
| MRI cervical spine w contrast (72142) |
$3,585.60 |
$4,482 |
10.1× |
| MRI cervical spine w/o cont (72141) |
$3,250.40 |
$4,063 |
13.3× |
| MRI chest w/o contrast (71550) |
$2,800 |
$3,500 |
11.5× |
| MRI chest with contrast (71551) |
$3,504 |
$4,380 |
4.4× |
| MRI chest wo w contrast (71552) |
$4,276.80 |
$5,346 |
12.0× |
| MRI lower extrem oth/thn jt w/contrast matrl (73719) |
$3,620.80 |
$4,526 |
10.2× |
| MRI lower extrem oth/thn jt w/o & w/contr matr (73720) |
$3,785.60 |
$4,732 |
10.6× |
| MRI lower extrem oth/thn jt w/o contr matrl (73718) |
$2,830.40 |
$3,538 |
11.6× |
| MRI lumbar spine w contrast (72149) |
$3,616 |
$4,520 |
10.1× |
| Mri Neck Spine W/O & W/Dye (72156) |
$4,566.40 |
$5,708 |
12.8× |
| MRI orbit face &/neck w/o contrast (70540) |
$3,065.60 |
$3,832 |
12.6× |
| MRI orbit face neck w contrast (70542) |
$3,728 |
$4,660 |
10.5× |
| Mri Orbt/Fac/Nck W/O &W/Dye (70543) |
$4,530.40 |
$5,663 |
12.7× |
| MRI pelvis w contrast (72196) |
$3,974.40 |
$4,968 |
11.2× |
| MRI pelvis w/o & w contrast (72197) |
$4,349.60 |
$5,437 |
12.2× |
| MRI pelvis w/o contrast (72195) |
$3,053.60 |
$3,817 |
12.5× |
| MRI thoracic spine w/o contrast (72146) |
$3,200 |
$4,000 |
13.1× |
| 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) |
$2,815.20 |
$3,519 |
11.5× |
| Mri Uppr Extremity W/O&W/Dye (73220) |
$3,932.80 |
$4,916 |
11.0× |
| MRI, abdomen, combo (74183) |
$4,195.20 |
$5,244 |
11.8× |
| MRI, dorsal spine combo (72157) |
$4,324.80 |
$5,406 |
12.1× |
| MRI, dorsal spine contrast (72147) |
$3,603.20 |
$4,504 |
10.1× |
| MRI, joint upper extrem (73221) |
$2,931.20 |
$3,664 |
12.0× |
| MRI, joint upper extrem combo (73223) |
$3,925.60 |
$4,907 |
11.0× |
| MRI, lumbar spine combo (72158) |
$4,319.20 |
$5,399 |
12.1× |
| Myocardial Imaging Infarct Avid Planar Qual/Quan (78466) |
$1,516.80 |
$1,896 |
3.7× |
| Myocardial Spect Multiple Studies (78452) |
$4,810.40 |
$6,013 |
3.6× |
| Neck soft tissue (70360) |
$268.80 |
$336 |
3.0× |
| Nm unlisted gi procedure (78299) |
$643.20 |
$804 |
1.6× |
| Optic foramina (70190) |
$302.40 |
$378 |
3.4× |
| Parathyroid imaging w/tomographic spect & CT (78072) |
$1,774.40 |
$2,218 |
3.2× |
| Parathyroid planar imaging w/wo subtraction (78071) |
$2,033.60 |
$2,542 |
5.0× |
| Pelvis 1 or 2 views (72170) |
$360.80 |
$451 |
3.4× |
| Pulmonary Perfusion Imaging Particulate (78580) |
$1,503.20 |
$1,879 |
3.7× |
| Radex Abd Compl Aqt Abd W/S/E/D Views 1 View Ch (74022) |
$616.80 |
$771 |
5.8× |
| Radex Ankle Complete Minimum 3 Views (73610) |
$368 |
$460 |
4.1× |
| Radex Calcaneus Minimum 2 Views (73650) |
$308.80 |
$386 |
3.5× |
| Radex elbow complete minimum 3 views (73080) |
$407.20 |
$509 |
4.6× |
| Radex Facial Bones Complete Minimum 3 Views (70150) |
$514.40 |
$643 |
4.8× |
| Radex fingr minimum 2 views (73140) |
$211.20 |
$264 |
2.4× |
| Radex foot complete minimum 3 views (73630) |
$362.40 |
$453 |
4.1× |
| Radex Hand Minimum 3 Views (73130) |
$334.40 |
$418 |
3.8× |
| Radex lower extremity infant minimum 2 views (73592) |
$297.60 |
$372 |
3.3× |
| Radex Mastoids Compl Minimum 3 Views PR Side (70130) |
$428 |
$535 |
4.0× |
| Radex Nasal Bones Complete Minimum 3 Views (70160) |
$372 |
$465 |
4.2× |
| Radex Ribs Unilateral 2 Views (71100) |
$361.60 |
$452 |
4.1× |
| Radex shoulder complete minimum 2 views (73030) |
$382.40 |
$478 |
4.3× |
| Radex Sinuses Paransl < 3 Views (70210) |
$364.80 |
$456 |
4.1× |
| Radex Spine 1 View Specify Level (72020) |
$380.80 |
$476 |
4.3× |
| Radex Sternum Minimum 2 Views (71120) |
$386.40 |
$483 |
4.3× |
| Radex Temporomandble Jt Opn & Clsd Mouth Bilat (70330) |
$498.40 |
$623 |
5.6× |
| Radex Toe Minimum 2 Views (73660) |
$308.80 |
$386 |
3.5× |
| Radex upper extremity infant minimum 2 views (73092) |
$316 |
$395 |
3.0× |
| Radex Wrist Complete Minimum 3 Views (73110) |
$334.40 |
$418 |
3.8× |
| Radex X-Ray Exam Entire Spi 6/> Vw - Xr Entire Spine 6+ Vw (72084) |
$791.20 |
$989 |
7.4× |
| Radiolog exam mandible compl minimum 4 views (70110) |
$536 |
$670 |
5.0× |
| Radiologic Exam Abdomen 3+ Views - Xr Abdomen 3+ Views (74021) |
$478.40 |
$598 |
4.5× |
| Radiologic exam colon double contrast study (74280) |
$1,291.20 |
$1,614 |
7.2× |
| Radiologic exam colon single contrast study (74270) |
$988 |
$1,235 |
5.5× |
| Radiologic exam knee complete 4/more views (73564) |
$477.60 |
$597 |
4.5× |
| Radiologic exam pelvis compl minimum 3 views (72190) |
$428.80 |
$536 |
4.0× |
| Radiologic Exam Small Int Single Contrast Study (74250) |
$836 |
$1,045 |
4.7× |
| Radiologic exam swallow function contrast study (74230) |
$724 |
$905 |
4.0× |
| Radiologic exam upr gi trc double contrast study (74246) |
$928 |
$1,160 |
5.2× |
| Radiologic examination femur 1 view (73551) |
$276.80 |
$346 |
3.1× |
| Radiologic examination femur minimum 2 views (73552) |
$355.20 |
$444 |
4.0× |
| Radiologic examination knee 1/2 views (73560) |
$308.80 |
$386 |
3.5× |
| Radiologic examination tibia & fibula 2 views (73590) |
$308.80 |
$386 |
3.5× |
| Radiologic examination, internal auditory meati, complete Non-Facility (70134) |
$370.40 |
$463 |
0.7× |
| Ribs bilateral 3 views (71110) |
$437.60 |
$547 |
4.1× |
| Rp loclzj tum plnr 1 area single day imaging (78800) |
$1,584 |
$1,980 |
3.9× |
| Salivary Gland Imaging Serial Images (78231) |
$1,137.60 |
$1,422 |
2.8× |
| Scapula (73010) |
$308.80 |
$386 |
2.9× |
| Screening Digital Breast Tomosynthesis Bi (77063) |
$126.40 |
$158 |
5.4× |
| Sella turcica (70240) |
$283.20 |
$354 |
3.2× |
| Shoulder 1 view (73020) |
$316 |
$395 |
3.6× |
| Skull less than 4 views (70250) |
$417.60 |
$522 |
3.9× |
| Spleen Imaging (78185) |
$986.40 |
$1,233 |
2.4× |
| Sternoclavicular joints (71130) |
$392 |
$490 |
4.4× |
| Testicular Imaging W/Flow (78761) |
$1,587.20 |
$1,984 |
3.9× |
| Thoracic spine 2 views (72070) |
$400.80 |
$501 |
3.8× |
| Thoracic spine 3 views (72072) |
$488 |
$610 |
4.6× |
| Thoracolumbar 2 views (72080) |
$403.20 |
$504 |
4.5× |
| Thyroid Imaging With Vascular Flow (78013) |
$1,083.20 |
$1,354 |
2.7× |
| Thyroid Uptake Measurement (78012) |
$876.80 |
$1,096 |
2.1× |
| Thyroid Uptake W/Blood Flow Sngle/Mult Quan Meas (78014) |
$1,464 |
$1,830 |
3.6× |
| Ultrasound Exam Aaa Screen (76706) |
$512.80 |
$641 |
4.8× |
| Ultrasound, abdomen limited (76705) |
$750.40 |
$938 |
7.0× |
| Umbilical-artery Doppler (OB) (76820) |
$492 |
$615 |
4.6× |
| Ureteral Reflux Study (78740) |
$1,388 |
$1,735 |
3.4× |
| Urethrocystography retrograde (74450) |
$918.40 |
$1,148 |
3.8× |
| Us chest (76604) |
$623.20 |
$779 |
5.8× |
| Us complete joint (76881) |
$503.20 |
$629 |
4.7× |
| Us exam, pelvic, limited (76857) |
$548.80 |
$686 |
5.1× |
| Us lmtd joint/oth nonvasc xtr strux r-t w/img (76882) |
$505.60 |
$632 |
4.7× |
| Us ob limited 1 or more fetuses (76815) |
$604 |
$755 |
5.7× |
| Us ob transvaginal (76817) |
$748 |
$935 |
7.0× |
| Us pelvic non ob complete (76856) |
$720 |
$900 |
6.7× |
| Us pg uter img f&mat 14 wk tabdl 1/1st gestation (76801) |
$783.20 |
$979 |
7.3× |
| Us preg uterus real time f/u trnsabdl per fetus (76816) |
$568.80 |
$711 |
5.3× |
| Us retroperitoneal complete (76770) |
$830.40 |
$1,038 |
7.8× |
| Us retroperitoneal limited (76775) |
$700 |
$875 |
6.6× |
| Us scrotum and contents (76870) |
$693.60 |
$867 |
6.5× |
| Us thyroid (76536) |
$783.20 |
$979 |
7.3× |
| Venous Thrombosis Imaging Venogram Bilateral (78458) |
$1,593.60 |
$1,992 |
3.9× |
| Wrist 2 views (73100) |
$266.40 |
$333 |
3.0× |
| X-Ray Ac Jts - Xr Acromioclavicular Joints Bilateral (73050) |
$380.80 |
$476 |
4.3× |
| X-Ray Bend Only L-S Spine (72120) |
$591.20 |
$739 |
5.5× |
| X-Ray Elbow 2 Vw - Xr Elbow 1-2 Views Right (73070) |
$308.80 |
$386 |
3.5× |
| X-Ray Exam Hip Uni 1 View (73501) |
$312 |
$390 |
3.5× |
| X-Ray Exam Hip Uni 2-3 Views (73502) |
$448 |
$560 |
5.0× |
| X-Ray Exam Hip Uni 4/> Views (73503) |
$550.40 |
$688 |
5.2× |
| X-Ray Exam Hips Bi 3-4 Views (73522) |
$689.60 |
$862 |
6.5× |
| X-Ray Exam Hips Bi 5/> Views (73523) |
$764.80 |
$956 |
7.2× |
| X-Ray Exam Neck Spine 2-3 Vw (72040) |
$444 |
$555 |
5.0× |
| X-Ray Exam Neck Spine 6/>Vws (72052) |
$816.80 |
$1,021 |
7.6× |
| X-Ray Exam Unilat Ribs/Chest (71101) |
$444 |
$555 |
4.2× |
| X-ray eye for foreign body (70030) |
$318.40 |
$398 |
3.6× |
| X-ray humerus (73060) |
$308.80 |
$386 |
3.5× |
| X-ray IV pyelogram (ivp) (74400) |
$1,091.20 |
$1,364 |
6.1× |
| X-Ray Jaw <4 Vw - Xr Mandible < 4 Views (70100) |
$384.80 |
$481 |
4.3× |
| X-Ray Knee Bilat Standing - Xr Knees Anteroposterior Standing Bilat (73565) |
$295.20 |
$369 |
3.3× |
| X-Ray Lumbar Spine 2/3 Vw - Xr Lumbar Spine 2-3 Views (72100) |
$444 |
$555 |
4.2× |
| X-Ray Ribs, Chest 4+ Vw - Xr Ribs 3 Vws Bil W/ Chest Posteroanterior (71111) |
$653.60 |
$817 |
6.1× |
| X-Ray Sacroiliac Jts 3+ Vw - Xr Sacroiliac Joints 3+ Views (72202) |
$420 |
$525 |
3.9× |
| X-Ray Sacrum/Coccyx 2+ Vw - Xr Sacrum Coccyx 2+ Views (72220) |
$390.40 |
$488 |
4.4× |
| X-Ray Sinuses 3+ Vw - Xr Paranasal Sinuses 3+ Views (70220) |
$525.60 |
$657 |
5.9× |
| X-Ray Skull 4+ Vw - Xr Skull Complete 4+ Views (70260) |
$618.40 |
$773 |
5.8× |
| X-ray thoracic spine 4 vw (72074) |
$610.40 |
$763 |
5.7× |
| X-Ray Tmj Unilat (70328) |
$372 |
$465 |
4.2× |
| X-Ray Urinary Tract Exam With Contrast Material (74420) |
$1,169.60 |
$1,462 |
3.3× |
| X-Rays Bone Survey Complete (77075) |
$1,050.40 |
$1,313 |
9.8× |
| Xr c-spine 4 or 5 views (72050) |
$597.60 |
$747 |
5.6× |
| Xr facial bones less than 3 views (70140) |
$391.20 |
$489 |
4.4× |
| XR Mastoids < 3 Views Bilateral (70120) |
$252 |
$315 |
2.4× |
| Xr orbits complete 4 views (70200) |
$500.80 |
$626 |
4.7× |