| Abdomen 1 View (74018) |
$188 |
$235 |
2.2× |
| Abdomen 2 views (74019) |
$230 |
$288 |
2.3× |
| Acute Gastrointestinal Blood Loss Imaging (78278) |
$1,218 |
$1,523 |
3.2× |
| Ankle 2 views (73600) |
$200 |
$250 |
2.4× |
| Bone age studies (77072) |
$164 |
$205 |
1.6× |
| Bone Imaging 3 Phase (78315) |
$1,210 |
$1,513 |
3.1× |
| Bone Imaging Limited Area (78300) |
$797 |
$997 |
2.1× |
| Bone Imaging Multiple Areas (78305) |
$964 |
$1,205 |
2.5× |
| Bone Imaging Whole Body (78306) |
$1,036 |
$1,296 |
2.7× |
| Bone survey infant (77076) |
$671 |
$839 |
6.7× |
| Cat Scan Follow-Up Study (76380) |
$945 |
$1,182 |
11.3× |
| Chest 1 view (71045) |
$161 |
$202 |
1.9× |
| Chest 2 views (71046) |
$210 |
$263 |
2.5× |
| Chest 3 views (71047) |
$264 |
$331 |
3.2× |
| Chest 4 or more views (71048) |
$362 |
$453 |
3.6× |
| Cholecystography Oral Contrast (74290) |
$552 |
$691 |
3.3× |
| Clavicle complete (73000) |
$200 |
$250 |
2.4× |
| Computed Tomography Thorax Lw Dose Lng Ca Scr C- (71271) |
$420 |
$525 |
4.2× |
| Contrast X-Ray Bladder (74430) |
$255 |
$319 |
0.8× |
| Contrast X-Ray Of Knee Joint (73580) |
$928 |
$1,160 |
2.8× |
| Contrast Xray Throat/Cerv Esopha (74210) |
$624 |
$780 |
3.7× |
| CT abdomen and pelvis without and with contrast (74178) |
$3,858 |
$4,823 |
11.5× |
| CT abdomen and pelvis without contrast (74176) |
$2,368 |
$2,961 |
10.3× |
| CT abdomen w contrast (74160) |
$1,881 |
$2,352 |
11.2× |
| CT abdomen w wo contrast (74170) |
$2,069 |
$2,587 |
12.3× |
| CT abdomen w/o contrast (74150) |
$1,710 |
$2,138 |
17.0× |
| CT Angio Abdomen and Pelvis (74174) |
$2,220 |
$2,775 |
6.6× |
| CT Angio Chest (71275) |
$1,963 |
$2,454 |
11.6× |
| CT Angio Head (70496) |
$1,963 |
$2,454 |
11.6× |
| CT Angio Neck (70498) |
$1,963 |
$2,454 |
11.6× |
| CT cervical spine w/ contrast (72126) |
$1,900 |
$2,376 |
5.7× |
| CT cervical spine w/o contrast (72125) |
$1,728 |
$2,160 |
17.2× |
| CT cervical spine w/wo cont (72127) |
$2,091 |
$2,614 |
12.4× |
| CT chest w contrast (71260) |
$1,900 |
$2,376 |
11.3× |
| CT chest w/wo contrast (71270) |
$2,091 |
$2,614 |
12.4× |
| CT head/brain with contrast (70460) |
$1,840 |
$2,301 |
10.9× |
| CT head/brain without and with contrast (70470) |
$2,037 |
$2,547 |
12.1× |
| CT heart no contrast quant eval coronry calcium (75571) |
$79 |
$99 |
0.9× |
| CT iac w contrast (70481) |
$1,840 |
$2,301 |
10.9× |
| CT l-spine w&w/o contrast (72133) |
$2,112 |
$2,640 |
12.5× |
| CT lower ext w/o (73700) |
$1,543 |
$1,929 |
15.4× |
| CT lower extremity w/contrast material (73701) |
$1,840 |
$2,301 |
10.9× |
| CT lumbar spine w contrast (72132) |
$1,920 |
$2,400 |
5.7× |
| CT lumbar spine w/o contrast (72131) |
$1,745 |
$2,182 |
17.4× |
| CT maxillofacial w contrast (70487) |
$1,840 |
$2,301 |
10.9× |
| CT maxillofacial wo contrast (70486) |
$1,543 |
$1,929 |
15.4× |
| CT neck tissue combo (70492) |
$2,037 |
$2,547 |
12.1× |
| Ct Orbit/Ear/Fossa W/O&W/Dye (70482) |
$2,037 |
$2,547 |
12.1× |
| CT orbits w/o contrast (70480) |
$1,543 |
$1,929 |
15.4× |
| CT pelvis w&w/o contrast (72194) |
$2,069 |
$2,587 |
12.3× |
| CT pelvis w/o contrast (72192) |
$1,710 |
$2,138 |
17.0× |
| CT scan of leg combo (73702) |
$2,037 |
$2,547 |
12.1× |
| CT scans face/jaw combo (70488) |
$2,037 |
$2,547 |
12.1× |
| CT soft tissue neck w contrast (70491) |
$1,840 |
$2,301 |
10.9× |
| CT soft tissue neck w/o contrast (70490) |
$1,543 |
$1,929 |
15.4× |
| CT thoracic spine w contrast (72129) |
$1,920 |
$2,400 |
11.4× |
| CT thoracic spine w/o contrast (72128) |
$1,745 |
$2,182 |
17.4× |
| CT thoracic spine w/wo cont (72130) |
$2,112 |
$2,640 |
12.5× |
| CT thorax w/o contrast (71250) |
$1,728 |
$2,160 |
17.2× |
| CT upper ext wo (73200) |
$1,543 |
$1,929 |
15.4× |
| CT upper extremity w/o & w/contrast material (73202) |
$2,037 |
$2,547 |
12.1× |
| CT upper extremity with contrast (73201) |
$1,840 |
$2,301 |
5.5× |
| Cta Abdl Aorta&Bi Iliofem W/Contrast&Postp (75635) |
$2,358 |
$2,948 |
14.0× |
| Cta Abdomen (74175) |
$1,654 |
$2,068 |
9.8× |
| CTA pelvis (72191) |
$1,963 |
$2,454 |
11.6× |
| Dxa Bone Density Axial (77080) |
$402 |
$503 |
4.0× |
| Esophagram (74220) |
$630 |
$788 |
3.7× |
| Fetal Biophys Profile W/Nst (76818) |
$543 |
$679 |
5.4× |
| Fetal Biophysical Profile W/O Non-Stress Testing (76819) |
$396 |
$495 |
3.9× |
| Fluoroscopy up to 1 hr (76000) |
$266 |
$333 |
1.2× |
| Foot 2 views (73620) |
$175 |
$219 |
2.1× |
| Forearm 2 views (73090) |
$181 |
$227 |
2.2× |
| Gastric emptying imaging study (78264) |
$1,154 |
$1,443 |
3.0× |
| Gated Heart Planar Single (78472) |
$1,015 |
$1,269 |
2.6× |
| Hand 2 views (73120) |
$193 |
$242 |
1.9× |
| Heart first pass single,planar (78481) |
$928 |
$1,161 |
1.8× |
| Hepatobil Syst Image W/Drug (78227) |
$1,527 |
$1,909 |
2.9× |
| Ht Muscle Image Spect Sing (78451) |
$1,760 |
$2,200 |
1.4× |
| Hysterosalpingogram (74740) |
$612 |
$766 |
2.7× |
| Infant hip ultrasound with hip movement (dynamic) (76885) |
$541 |
$677 |
6.5× |
| Infant hip ultrasound, limited static exam (76886) |
$476 |
$595 |
5.7× |
| Infusion Ivp (74410) |
$890 |
$1,113 |
5.3× |
| Joint Survey Single View (77077) |
$293 |
$367 |
2.9× |
| K Flow/Funct Image W/Drug (78708) |
$1,223 |
$1,529 |
2.3× |
| K Flow/Funct Image W/O Drug (78707) |
$1,202 |
$1,503 |
2.3× |
| Kidney Imaging Morphoogy W/Vascular Flow (78701) |
$1,138 |
$1,423 |
3.0× |
| Knee 3 Views (73562) |
$254 |
$318 |
3.0× |
| Liver & Spleen Imaging Static Only (78215) |
$759 |
$949 |
2.0× |
| Liver imaging static only (78201) |
$946 |
$1,183 |
1.8× |
| Lung Ventilat&Perfus Imaging (78582) |
$1,286 |
$1,608 |
2.5× |
| Magnetic Image Jaw Joint (70336) |
$1,841 |
$2,302 |
8.0× |
| Mammary ductogram or galactogram multiple (77054) |
$484 |
$606 |
2.1× |
| Mammary ductogram or galactogram single (77053) |
$583 |
$729 |
2.5× |
| Meckels Divert Exam (78290) |
$1,149 |
$1,437 |
3.0× |
| Mra Head W/O & W/Contrast Material (70546) |
$2,421 |
$3,027 |
7.2× |
| MRA head w/o contrast (70544) |
$1,854 |
$2,318 |
8.1× |
| MRA head with contrast (70545) |
$2,048 |
$2,560 |
6.1× |
| MRA neck w contrast (70548) |
$2,222 |
$2,778 |
6.6× |
| Mra Neck W/O &W/Contrast Material (70549) |
$2,433 |
$3,042 |
7.3× |
| MRA neck w/o contrast (70547) |
$1,857 |
$2,322 |
8.1× |
| MRI abdomen w contrast (74182) |
$2,081 |
$2,602 |
6.2× |
| MRI abdomen w/o contrast (74181) |
$1,998 |
$2,498 |
8.7× |
| MRI any jt lower extrem w/contrast material (73722) |
$2,229 |
$2,787 |
3.0× |
| MRI any jt lower extrem w/o & w/contrast matrl (73723) |
$2,685 |
$3,357 |
8.0× |
| MRI any jt upper extremity w/contrast matrl (73222) |
$2,226 |
$2,783 |
3.0× |
| MRI cervical spine w contrast (72142) |
$2,093 |
$2,617 |
6.2× |
| MRI cervical spine w/o cont (72141) |
$1,889 |
$2,362 |
8.2× |
| MRI chest w/o contrast (71550) |
$2,035 |
$2,544 |
8.9× |
| MRI chest wo w contrast (71552) |
$2,806 |
$3,508 |
8.4× |
| MRI lower extrem oth/thn jt w/contrast matrl (73719) |
$2,044 |
$2,556 |
6.1× |
| MRI lower extrem oth/thn jt w/o & w/contr matr (73720) |
$2,783 |
$3,479 |
8.3× |
| MRI lower extrem oth/thn jt w/o contr matrl (73718) |
$1,880 |
$2,350 |
8.2× |
| MRI lumbar spine w contrast (72149) |
$2,236 |
$2,795 |
6.7× |
| Mri Neck Spine W/O & W/Dye (72156) |
$2,664 |
$3,331 |
7.9× |
| MRI orbit face &/neck w/o contrast (70540) |
$1,913 |
$2,392 |
8.3× |
| MRI orbit face neck w contrast (70542) |
$2,110 |
$2,638 |
6.3× |
| Mri Orbt/Fac/Nck W/O &W/Dye (70543) |
$2,241 |
$2,802 |
6.7× |
| MRI pelvis w contrast (72196) |
$2,055 |
$2,569 |
6.1× |
| MRI pelvis w/o & w contrast (72197) |
$2,801 |
$3,502 |
8.4× |
| MRI pelvis w/o contrast (72195) |
$1,884 |
$2,355 |
8.2× |
| MRI thoracic spine w/o contrast (72146) |
$1,889 |
$2,362 |
8.2× |
| MRI upper extremity oth than jt w/o contr matrl (73218) |
$2,036 |
$2,546 |
8.9× |
| Mri Uppr Extremity W/O&W/Dye (73220) |
$2,910 |
$3,638 |
8.7× |
| MRI, abdomen, combo (74183) |
$2,806 |
$3,508 |
8.4× |
| MRI, dorsal spine combo (72157) |
$2,672 |
$3,340 |
8.0× |
| MRI, dorsal spine contrast (72147) |
$2,072 |
$2,591 |
6.2× |
| MRI, joint upper extrem (73221) |
$1,837 |
$2,297 |
8.0× |
| MRI, joint upper extrem combo (73223) |
$2,694 |
$3,368 |
8.0× |
| MRI, lumbar spine combo (72158) |
$2,656 |
$3,321 |
7.9× |
| Myocardial Imaging Infarct Avid Planar Qual/Quan (78466) |
$1,042 |
$1,303 |
2.7× |
| Myocardial Spect Multiple Studies (78452) |
$2,445 |
$3,057 |
2.0× |
| Neck soft tissue (70360) |
$196 |
$245 |
2.3× |
| Nm unlisted gi procedure (78299) |
$791 |
$989 |
2.1× |
| Parathyroid Planar Imaging (78070) |
$1,023 |
$1,279 |
2.7× |
| Pelvis 1 or 2 views (72170) |
$173 |
$217 |
1.7× |
| Pet Image W/Ct Lmtd (78814) |
$4,427 |
$5,534 |
3.2× |
| PET image w/CT, full body (78816) |
$4,464 |
$5,581 |
3.2× |
| PET imaging CT attenuation skull base mid-thigh (78815) |
$4,460 |
$5,576 |
3.2× |
| Pulmonary Perfusion Imaging Particulate (78580) |
$1,045 |
$1,307 |
2.7× |
| Radex Abd Compl Aqt Abd W/S/E/D Views 1 View Ch (74022) |
$312 |
$391 |
3.1× |
| Radex abscess/fistula/sinus tract rs&i (76080) |
$380 |
$476 |
0.7× |
| Radex Ankle Complete Minimum 3 Views (73610) |
$228 |
$286 |
2.7× |
| Radex Calcaneus Minimum 2 Views (73650) |
$180 |
$225 |
2.2× |
| Radex elbow complete minimum 3 views (73080) |
$202 |
$253 |
2.4× |
| Radex Facial Bones Complete Minimum 3 Views (70150) |
$297 |
$372 |
3.0× |
| Radex fingr minimum 2 views (73140) |
$232 |
$290 |
2.8× |
| Radex foot complete minimum 3 views (73630) |
$215 |
$269 |
2.6× |
| Radex Hand Minimum 3 Views (73130) |
$227 |
$284 |
2.7× |
| Radex lower extremity infant minimum 2 views (73592) |
$197 |
$247 |
2.4× |
| Radex Mastoids Compl Minimum 3 Views PR Side (70130) |
$392 |
$491 |
3.9× |
| Radex Nasal Bones Complete Minimum 3 Views (70160) |
$237 |
$297 |
2.8× |
| Radex Ribs Unilateral 2 Views (71100) |
$230 |
$288 |
2.7× |
| Radex shoulder complete minimum 2 views (73030) |
$215 |
$269 |
2.6× |
| Radex Sinuses Paransl < 3 Views (70210) |
$202 |
$253 |
2.4× |
| Radex Spine 1 View Specify Level (72020) |
$152 |
$191 |
1.8× |
| Radex Sternum Minimum 2 Views (71120) |
$212 |
$265 |
2.5× |
| Radex Temporomandble Jt Opn & Clsd Mouth Bilat (70330) |
$334 |
$418 |
4.0× |
| Radex Toe Minimum 2 Views (73660) |
$181 |
$227 |
2.2× |
| Radex upper extremity infant minimum 2 views (73092) |
$197 |
$247 |
2.0× |
| Radex Wrist Complete Minimum 3 Views (73110) |
$254 |
$318 |
3.0× |
| Radex X-Ray Exam Entire Spi 6/> Vw - Xr Entire Spine 6+ Vw (72084) |
$616 |
$770 |
6.1× |
| Radiolog exam mandible compl minimum 4 views (70110) |
$274 |
$343 |
2.7× |
| Radiologic Exam Abdomen 3+ Views - Xr Abdomen 3+ Views (74021) |
$271 |
$339 |
2.7× |
| Radiologic exam colon single contrast study (74270) |
$994 |
$1,243 |
5.9× |
| Radiologic exam knee complete 4/more views (73564) |
$288 |
$361 |
2.9× |
| Radiologic exam pelvis compl minimum 3 views (72190) |
$264 |
$331 |
2.6× |
| Radiologic Exam Small Int Single Contrast Study (74250) |
$790 |
$988 |
4.7× |
| Radiologic exam swallow function contrast study (74230) |
$813 |
$1,017 |
4.8× |
| Radiologic exam upr gi trc double contrast study (74246) |
$904 |
$1,130 |
5.4× |
| Radiologic examination femur 1 view (73551) |
$181 |
$227 |
2.2× |
| Radiologic examination femur minimum 2 views (73552) |
$219 |
$274 |
2.6× |
| Radiologic examination knee 1/2 views (73560) |
$212 |
$266 |
2.5× |
| Radiologic Examination Osseous Survey Limited (77074) |
$409 |
$512 |
4.1× |
| Radiologic examination tibia & fibula 2 views (73590) |
$196 |
$245 |
2.3× |
| Ribs bilateral 3 views (71110) |
$275 |
$344 |
2.7× |
| Rp Loclzj Tum Spect 1 Area Single Day Imaging (78803) |
$1,836 |
$2,296 |
3.5× |
| Scapula (73010) |
$148 |
$185 |
1.5× |
| Screening Digital Breast Tomosynthesis Bi (77063) |
$44 |
$56 |
1.9× |
| Sella turcica (70240) |
$207 |
$259 |
2.5× |
| Shoulder 1 view (73020) |
$133 |
$167 |
1.6× |
| Shoulder Arthrography (73040) |
$829 |
$1,037 |
2.5× |
| Skull less than 4 views (70250) |
$223 |
$279 |
2.2× |
| Sternoclavicular joints (71130) |
$259 |
$324 |
3.1× |
| Testicular Imaging W/Flow (78761) |
$940 |
$1,176 |
2.4× |
| Thoracic spine 2 views (72070) |
$204 |
$256 |
2.0× |
| Thoracic spine 3 views (72072) |
$245 |
$307 |
2.4× |
| Thyroid Imaging With Vascular Flow (78013) |
$712 |
$891 |
1.9× |
| Thyroid Uptake Measurement (78012) |
$801 |
$1,002 |
2.1× |
| Ultrasound Breast Limited (76642) |
$384 |
$481 |
4.6× |
| Ultrasound Exam Aaa Screen (76706) |
$482 |
$603 |
4.8× |
| Ultrasound, abdomen limited (76705) |
$397 |
$497 |
4.0× |
| Umbilical-artery Doppler (OB) (76820) |
$215 |
$269 |
2.1× |
| Unlisted us procedure (76999) |
$428 |
$536 |
5.1× |
| Upper gi w/o kub (74240) |
$792 |
$990 |
4.7× |
| Ureteral Reflux Study (78740) |
$1,123 |
$1,404 |
2.9× |
| Urethrocystogram voiding (74455) |
$663 |
$829 |
2.9× |
| Us breast unilateral complete (76641) |
$468 |
$586 |
4.7× |
| Us chest (76604) |
$459 |
$574 |
4.6× |
| Us exam, pelvic, limited (76857) |
$376 |
$471 |
3.7× |
| Us head (76506) |
$521 |
$652 |
5.2× |
| Us kidney transplant (76776) |
$675 |
$844 |
6.7× |
| Us lmtd joint/oth nonvasc xtr strux r-t w/img (76882) |
$440 |
$551 |
4.4× |
| Us ob limited 1 or more fetuses (76815) |
$385 |
$482 |
3.8× |
| Us ob transvaginal (76817) |
$440 |
$551 |
4.4× |
| Us pelvic non ob complete (76856) |
$502 |
$628 |
5.0× |
| Us pg uter img f&mat 14 wk tabdl 1/1st gestation (76801) |
$558 |
$698 |
5.6× |
| Us preg uterus real time f/u trnsabdl per fetus (76816) |
$520 |
$651 |
5.2× |
| Us retroperitoneal complete (76770) |
$665 |
$832 |
6.6× |
| Us retroperitoneal limited (76775) |
$456 |
$571 |
4.5× |
| Us scrotum and contents (76870) |
$477 |
$597 |
4.7× |
| Us thyroid (76536) |
$505 |
$632 |
5.0× |
| Us transrectal (76872) |
$465 |
$582 |
4.6× |
| Venography extremity bilateral rs&i (75822) |
$844 |
$1,055 |
0.6× |
| Venography extremity unilateral rs&i (75820) |
$694 |
$868 |
0.5× |
| Wrist 2 views (73100) |
$211 |
$264 |
2.5× |
| X-Ray Ac Jts - Xr Acromioclavicular Joints Bilateral (73050) |
$177 |
$222 |
2.1× |
| X-ray antegrade pyelogram tube (74425) |
$868 |
$1,086 |
2.6× |
| X-Ray Bend Only L-S Spine (72120) |
$255 |
$319 |
2.5× |
| X-Ray Elbow 2 Vw - Xr Elbow 1-2 Views Right (73070) |
$181 |
$227 |
2.2× |
| X-Ray Exam Breast Specimen (76098) |
$253 |
$317 |
0.5× |
| X-Ray Exam Entire Spi 1 Vw (72081) |
$266 |
$333 |
3.2× |
| X-Ray Exam Entire Spi 2/3 Vw (72082) |
$438 |
$548 |
4.4× |
| X-Ray Exam Entire Spi 4/5 Vw (72083) |
$492 |
$615 |
4.9× |
| X-Ray Exam Hip Uni 1 View (73501) |
$202 |
$253 |
2.4× |
| X-Ray Exam Hip Uni 2-3 Views (73502) |
$292 |
$366 |
3.5× |
| X-Ray Exam Hip Uni 4/> Views (73503) |
$368 |
$460 |
3.7× |
| X-Ray Exam Hips Bi 2 Views (73521) |
$256 |
$321 |
2.5× |
| X-Ray Exam Hips Bi 3-4 Views (73522) |
$335 |
$419 |
3.3× |
| X-Ray Exam Hips Bi 5/> Views (73523) |
$383 |
$479 |
3.8× |
| X-Ray Exam L-S Spine Bending (72114) |
$387 |
$484 |
3.9× |
| X-Ray Exam Neck Spine 2-3 Vw (72040) |
$247 |
$309 |
3.0× |
| X-Ray Exam Neck Spine 6/>Vws (72052) |
$387 |
$484 |
3.9× |
| X-Ray Exam Unilat Ribs/Chest (71101) |
$264 |
$331 |
2.6× |
| X-ray eye for foreign body (70030) |
$95 |
$119 |
1.1× |
| X-ray humerus (73060) |
$197 |
$247 |
2.4× |
| X-ray IV pyelogram (ivp) (74400) |
$861 |
$1,077 |
5.1× |
| X-ray IV pyelogram+tomography (74415) |
$984 |
$1,230 |
5.8× |
| X-Ray Jaw <4 Vw - Xr Mandible < 4 Views (70100) |
$240 |
$300 |
2.9× |
| X-Ray Knee Bilat Standing - Xr Knees Anteroposterior Standing Bilat (73565) |
$252 |
$315 |
3.0× |
| X-Ray Lumbar Spine 2/3 Vw - Xr Lumbar Spine 2-3 Views (72100) |
$248 |
$311 |
2.5× |
| X-ray nose-rectum child f.b. (76010) |
$186 |
$233 |
2.2× |
| X-Ray Ribs, Chest 4+ Vw - Xr Ribs 3 Vws Bil W/ Chest Posteroanterior (71111) |
$329 |
$412 |
3.3× |
| X-Ray Sacroiliac Jts 3+ Vw - Xr Sacroiliac Joints 3+ Views (72202) |
$245 |
$307 |
2.4× |
| X-Ray Sacroiliac Jts <3 Vw - Xr Sacroiliac Joints 1-2 Views (72200) |
$204 |
$255 |
2.0× |
| X-Ray Sacrum/Coccyx 2+ Vw - Xr Sacrum Coccyx 2+ Views (72220) |
$202 |
$253 |
2.4× |
| X-Ray Sinuses 3+ Vw - Xr Paranasal Sinuses 3+ Views (70220) |
$236 |
$296 |
2.8× |
| X-Ray Skull 4+ Vw - Xr Skull Complete 4+ Views (70260) |
$281 |
$352 |
2.8× |
| X-Ray Stress View (77071) |
$341 |
$427 |
4.1× |
| X-Ray Urinary Tract Exam With Contrast Material (74420) |
$482 |
$603 |
1.4× |
| X-Rays Bone Length Studies (77073) |
$281 |
$352 |
2.8× |
| X-Rays Bone Survey Complete (77075) |
$623 |
$779 |
6.2× |
| Xr c-spine 4 or 5 views (72050) |
$332 |
$416 |
3.3× |
| Xr facial bones less than 3 views (70140) |
$200 |
$251 |
2.4× |
| Xr orbits complete 4 views (70200) |
$304 |
$380 |
3.0× |
| Xr Tomogram Single Plane (76100) |
$564 |
$705 |
5.6× |