| Abdomen 1 View (74018) |
$248.80 |
$311 |
2.7× |
| Abdomen 2 views (74019) |
$310.40 |
$388 |
2.8× |
| Ankle 2 views (73600) |
$280 |
$350 |
3.1× |
| Arthrogram hip (73525) |
$331.20 |
$414 |
0.9× |
| Bone age studies (77072) |
$270.40 |
$338 |
2.5× |
| Chest 1 view (71045) |
$304 |
$380 |
3.3× |
| Chest 2 views (71046) |
$348 |
$435 |
3.8× |
| Chest 3 views (71047) |
$432.80 |
$541 |
4.7× |
| Clavicle complete (73000) |
$280 |
$350 |
3.1× |
| Computed Tomography Thorax Lw Dose Lng Ca Scr C- (71271) |
$674.40 |
$843 |
6.1× |
| Contrast X-Ray Of Knee Joint (73580) |
$881.60 |
$1,102 |
2.4× |
| CT abdomen and pelvis without and with contrast (74178) |
$3,898.40 |
$4,873 |
10.6× |
| CT abdomen and pelvis without contrast (74176) |
$3,214.40 |
$4,018 |
12.8× |
| CT abdomen w contrast (74160) |
$1,100.80 |
$1,376 |
5.9× |
| CT abdomen w wo contrast (74170) |
$1,257.60 |
$1,572 |
6.8× |
| CT abdomen w/o contrast (74150) |
$831.20 |
$1,039 |
7.5× |
| CT Angio Abdomen and Pelvis (74174) |
$3,969.60 |
$4,962 |
10.8× |
| CT Angio Chest (71275) |
$2,935.20 |
$3,669 |
15.9× |
| CT Angio Head (70496) |
$2,325.60 |
$2,907 |
12.6× |
| Ct Angio Lwr Extr W/O&W/Dye (73706) |
$2,118.40 |
$2,648 |
11.4× |
| CT Angio Neck (70498) |
$1,616 |
$2,020 |
8.7× |
| Ct Angio Upr Extrm W/O&W/Dye (73206) |
$1,616 |
$2,020 |
8.7× |
| CT cervical spine w/ contrast (72126) |
$2,174.40 |
$2,718 |
5.9× |
| CT cervical spine w/o contrast (72125) |
$1,951.20 |
$2,439 |
17.7× |
| CT cervical spine w/wo cont (72127) |
$2,460.80 |
$3,076 |
13.3× |
| CT chest w contrast (71260) |
$2,607.20 |
$3,259 |
14.1× |
| CT chest w/wo contrast (71270) |
$2,795.20 |
$3,494 |
15.1× |
| CT head/brain with contrast (70460) |
$2,109.60 |
$2,637 |
11.4× |
| CT head/brain without and with contrast (70470) |
$2,215.20 |
$2,769 |
12.0× |
| CT heart no contrast quant eval coronry calcium (75571) |
$437.60 |
$547 |
4.8× |
| CT iac w contrast (70481) |
$1,186.40 |
$1,483 |
6.4× |
| CT l-spine w&w/o contrast (72133) |
$3,164.80 |
$3,956 |
17.1× |
| CT lower ext w/o (73700) |
$1,738.40 |
$2,173 |
15.8× |
| CT lower extremity w/contrast material (73701) |
$1,955.20 |
$2,444 |
10.6× |
| CT lumbar spine w contrast (72132) |
$2,700.80 |
$3,376 |
7.3× |
| CT lumbar spine w/o contrast (72131) |
$2,496 |
$3,120 |
22.6× |
| CT maxillofacial w contrast (70487) |
$1,895.20 |
$2,369 |
10.2× |
| CT maxillofacial wo contrast (70486) |
$1,569.60 |
$1,962 |
14.2× |
| CT neck tissue combo (70492) |
$1,336.80 |
$1,671 |
7.2× |
| Ct Orbit/Ear/Fossa W/O&W/Dye (70482) |
$1,336.80 |
$1,671 |
7.2× |
| CT orbits w/o contrast (70480) |
$1,021.60 |
$1,277 |
9.3× |
| CT pelvis w&w/o contrast (72194) |
$1,977.60 |
$2,472 |
10.7× |
| CT pelvis w/o contrast (72192) |
$1,082.40 |
$1,353 |
9.8× |
| CT scan of leg combo (73702) |
$2,017.60 |
$2,522 |
10.9× |
| CT scans face/jaw combo (70488) |
$1,989.60 |
$2,487 |
10.8× |
| CT soft tissue neck w contrast (70491) |
$1,186.40 |
$1,483 |
6.4× |
| CT soft tissue neck w/o contrast (70490) |
$1,021.60 |
$1,277 |
9.3× |
| CT thoracic spine w contrast (72129) |
$996 |
$1,245 |
5.4× |
| CT thoracic spine w/o contrast (72128) |
$948.80 |
$1,186 |
8.6× |
| CT thoracic spine w/wo cont (72130) |
$1,045.60 |
$1,307 |
5.7× |
| CT thorax w/o contrast (71250) |
$2,172.80 |
$2,716 |
19.7× |
| CT upper ext wo (73200) |
$1,082.40 |
$1,353 |
9.8× |
| CT upper extremity w/o & w/contrast material (73202) |
$1,336.80 |
$1,671 |
7.2× |
| CT upper extremity with contrast (73201) |
$1,257.60 |
$1,572 |
3.4× |
| Cta Abdl Aorta&Bi Iliofem W/Contrast&Postp (75635) |
$1,712.80 |
$2,141 |
9.3× |
| Cta Abdomen (74175) |
$1,616 |
$2,020 |
8.7× |
| CTA pelvis (72191) |
$2,622.40 |
$3,278 |
14.2× |
| Dxa Bone Density Axial (77080) |
$435.20 |
$544 |
3.9× |
| Dxa bone density study 1/>sites appendiclr skel (77081) |
$187.20 |
$234 |
2.0× |
| Echo Guide For Artery Repair (76936) |
$1,863.20 |
$2,329 |
8.2× |
| Esophagram (74220) |
$473.60 |
$592 |
2.6× |
| Fetal Biophysical Profile W/O Non-Stress Testing (76819) |
$390.40 |
$488 |
3.5× |
| Fluoroscopy up to 1 hr (76000) |
$408 |
$510 |
1.6× |
| Foot 2 views (73620) |
$282.40 |
$353 |
3.1× |
| Forearm 2 views (73090) |
$310.40 |
$388 |
3.4× |
| Gated Heart Planar Single (78472) |
$1,322.40 |
$1,653 |
3.1× |
| Hand 2 views (73120) |
$288 |
$360 |
2.6× |
| Heart Image (Pet) Multiple (78492) |
$7,205.60 |
$9,007 |
4.8× |
| Ht Muscle Image Spect Sing (78451) |
$2,119.20 |
$2,649 |
1.6× |
| Knee 3 Views (73562) |
$356.80 |
$446 |
3.9× |
| Magnetic Image Jaw Joint (70336) |
$1,350.40 |
$1,688 |
5.4× |
| Mammary ductogram or galactogram multiple (77054) |
$543.20 |
$679 |
2.2× |
| Mr safety determination physician/other qhp (76016) |
$212.80 |
$266 |
2.3× |
| Mr safety implant&/fb assmt clin staf 1st 15 min (76014) |
$59.20 |
$74 |
1.9× |
| Mr safety implt electronics prepj supvj phys/qhp (76018) |
$254.40 |
$318 |
2.5× |
| Mr safety implt pos&/immoblj (76019) |
$165.60 |
$207 |
2.7× |
| Mr safety med physics xm customization plng&mntr (76017) |
$670.40 |
$838 |
2.7× |
| Mra Head W/O & W/Contrast Material (70546) |
$2,503.20 |
$3,129 |
6.8× |
| MRA head w/o contrast (70544) |
$1,597.60 |
$1,997 |
6.3× |
| Mra Neck W/O &W/Contrast Material (70549) |
$2,442.40 |
$3,053 |
6.6× |
| MRA neck w/o contrast (70547) |
$1,597.60 |
$1,997 |
6.3× |
| MRI abdomen w contrast (74182) |
$1,659.20 |
$2,074 |
4.5× |
| MRI abdomen w/o contrast (74181) |
$1,597.60 |
$1,997 |
6.3× |
| MRI any jt lower extrem w/contrast material (73722) |
$1,662.40 |
$2,078 |
2.0× |
| MRI any jt lower extrem w/o & w/contrast matrl (73723) |
$2,432 |
$3,040 |
6.6× |
| MRI any jt upper extremity w/contrast matrl (73222) |
$1,869.60 |
$2,337 |
2.3× |
| MRI bone marrow blood supply (77084) |
$1,492 |
$1,865 |
5.9× |
| MRI cervical spine w contrast (72142) |
$1,664.80 |
$2,081 |
4.5× |
| MRI cervical spine w/o cont (72141) |
$1,585.60 |
$1,982 |
6.3× |
| MRI chest w/o contrast (71550) |
$1,390.40 |
$1,738 |
5.5× |
| MRI chest wo w contrast (71552) |
$2,503.20 |
$3,129 |
6.8× |
| MRI lower extrem oth/thn jt w/o & w/contr matr (73720) |
$2,432 |
$3,040 |
6.6× |
| MRI lower extrem oth/thn jt w/o contr matrl (73718) |
$1,552.80 |
$1,941 |
6.2× |
| MRI lumbar spine w contrast (72149) |
$2,240.80 |
$2,801 |
6.1× |
| Mri Neck Spine W/O & W/Dye (72156) |
$2,432 |
$3,040 |
6.6× |
| MRI orbit face &/neck w/o contrast (70540) |
$1,281.60 |
$1,602 |
5.1× |
| Mri Orbt/Fac/Nck W/O &W/Dye (70543) |
$2,432 |
$3,040 |
6.6× |
| MRI pelvis w/o & w contrast (72197) |
$2,432 |
$3,040 |
6.6× |
| MRI pelvis w/o contrast (72195) |
$1,597.60 |
$1,997 |
6.3× |
| MRI thoracic spine w/o contrast (72146) |
$1,552.80 |
$1,941 |
6.2× |
| MRI upper extremity oth than jt w/contr matrl (73219) |
$1,708 |
$2,135 |
4.6× |
| MRI upper extremity oth than jt w/o contr matrl (73218) |
$1,597.60 |
$1,997 |
6.3× |
| Mri Uppr Extremity W/O&W/Dye (73220) |
$2,432 |
$3,040 |
6.6× |
| MRI, abdomen, combo (74183) |
$2,503.20 |
$3,129 |
6.8× |
| MRI, dorsal spine combo (72157) |
$2,432 |
$3,040 |
6.6× |
| MRI, dorsal spine contrast (72147) |
$1,908 |
$2,385 |
5.2× |
| MRI, joint upper extrem (73221) |
$1,552.80 |
$1,941 |
6.2× |
| MRI, joint upper extrem combo (73223) |
$2,432 |
$3,040 |
6.6× |
| MRI, lumbar spine combo (72158) |
$3,498.40 |
$4,373 |
9.5× |
| Myelogram Lumbar (72265) |
$1,320.80 |
$1,651 |
1.6× |
| Myocardial Spect Multiple Studies (78452) |
$2,176.80 |
$2,721 |
1.6× |
| Neck soft tissue (70360) |
$270.40 |
$338 |
2.9× |
| Ob us nuchal meas 1 gest (76813) |
$211.20 |
$264 |
1.9× |
| Ophthalmic ultrasound dx b-scan w/wo a-scan (76512) |
$292 |
$365 |
2.6× |
| Pelvis 1 or 2 views (72170) |
$310.40 |
$388 |
2.8× |
| Pet Myocardial Sngl Study (78491) |
$3,949.60 |
$4,937 |
2.6× |
| Radex Abd Compl Aqt Abd W/S/E/D Views 1 View Ch (74022) |
$382.40 |
$478 |
3.5× |
| Radex abscess/fistula/sinus tract rs&i (76080) |
$655.20 |
$819 |
1.1× |
| Radex Ankle Complete Minimum 3 Views (73610) |
$343.20 |
$429 |
3.7× |
| Radex Calcaneus Minimum 2 Views (73650) |
$184.80 |
$231 |
2.0× |
| Radex elbow complete minimum 3 views (73080) |
$310.40 |
$388 |
3.4× |
| Radex Facial Bones Complete Minimum 3 Views (70150) |
$289.60 |
$362 |
2.6× |
| Radex fingr minimum 2 views (73140) |
$280 |
$350 |
3.1× |
| Radex foot complete minimum 3 views (73630) |
$360 |
$450 |
3.9× |
| Radex Hand Minimum 3 Views (73130) |
$360 |
$450 |
3.9× |
| Radex lower extremity infant minimum 2 views (73592) |
$270.40 |
$338 |
2.9× |
| Radex Mastoids Compl Minimum 3 Views PR Side (70130) |
$317.60 |
$397 |
2.9× |
| Radex Nasal Bones Complete Minimum 3 Views (70160) |
$243.20 |
$304 |
2.6× |
| Radex Ribs Unilateral 2 Views (71100) |
$310.40 |
$388 |
3.4× |
| Radex shoulder complete minimum 2 views (73030) |
$344 |
$430 |
3.7× |
| Radex Sinuses Paransl < 3 Views (70210) |
$200 |
$250 |
2.2× |
| Radex Spine 1 View Specify Level (72020) |
$248 |
$310 |
2.7× |
| Radex Sternum Minimum 2 Views (71120) |
$175.20 |
$219 |
1.9× |
| Radex Temporomandble Jt Opn & Clsd Mouth Bilat (70330) |
$426.40 |
$533 |
4.6× |
| Radex Toe Minimum 2 Views (73660) |
$256 |
$320 |
2.8× |
| Radex upper extremity infant minimum 2 views (73092) |
$270.40 |
$338 |
2.5× |
| Radex Wrist Complete Minimum 3 Views (73110) |
$360 |
$450 |
3.9× |
| Radex X-Ray Exam Entire Spi 6/> Vw - Xr Entire Spine 6+ Vw (72084) |
$731.20 |
$914 |
6.6× |
| Radiolog exam mandible compl minimum 4 views (70110) |
$310.40 |
$388 |
2.8× |
| Radiologic Exam Abdomen 3+ Views - Xr Abdomen 3+ Views (74021) |
$331.20 |
$414 |
3.0× |
| Radiologic exam colon double contrast study (74280) |
$669.60 |
$837 |
3.6× |
| Radiologic exam colon single contrast study (74270) |
$603.20 |
$754 |
3.3× |
| Radiologic Exam Esophagus Double Contrast Study (74221) |
$582.40 |
$728 |
3.1× |
| Radiologic exam knee complete 4/more views (73564) |
$403.20 |
$504 |
3.7× |
| Radiologic exam pelvis compl minimum 3 views (72190) |
$399.20 |
$499 |
3.6× |
| Radiologic Exam Small Int Single Contrast Study (74250) |
$411.20 |
$514 |
2.2× |
| Radiologic exam upr gi trc double contrast study (74246) |
$621.60 |
$777 |
3.4× |
| Radiologic examination femur 1 view (73551) |
$188 |
$235 |
2.0× |
| Radiologic examination femur minimum 2 views (73552) |
$230.40 |
$288 |
2.5× |
| Radiologic examination knee 1/2 views (73560) |
$310.40 |
$388 |
3.4× |
| Radiologic examination tibia & fibula 2 views (73590) |
$310.40 |
$388 |
3.4× |
| Ribs bilateral 3 views (71110) |
$406.40 |
$508 |
3.7× |
| Scapula (73010) |
$246.40 |
$308 |
2.2× |
| Screening Digital Breast Tomosynthesis Bi (77063) |
$52 |
$65 |
2.2× |
| Shoulder 1 view (73020) |
$240 |
$300 |
2.6× |
| Shoulder Arthrography (73040) |
$464.80 |
$581 |
1.3× |
| Skull less than 4 views (70250) |
$293.60 |
$367 |
2.7× |
| Sternoclavicular joints (71130) |
$270.40 |
$338 |
2.9× |
| Thoracic spine 2 views (72070) |
$310.40 |
$388 |
2.8× |
| Thoracic spine 3 views (72072) |
$339.20 |
$424 |
3.1× |
| Thoracolumbar 2 views (72080) |
$310.40 |
$388 |
3.4× |
| Ultrasound Breast Limited (76642) |
$262.40 |
$328 |
2.9× |
| Ultrasound Exam Aaa Screen (76706) |
$366.40 |
$458 |
3.3× |
| Ultrasound, abdomen limited (76705) |
$632 |
$790 |
5.7× |
| Unlisted us procedure (76999) |
$361.40 |
$451.75 |
3.9× |
| Upper gi w/o kub (74240) |
$415.20 |
$519 |
2.2× |
| Us breast unilateral complete (76641) |
$425.60 |
$532 |
3.9× |
| Us chest (76604) |
$440.80 |
$551 |
4.0× |
| Us complete joint (76881) |
$563.20 |
$704 |
5.1× |
| Us exam, pelvic, limited (76857) |
$480.80 |
$601 |
4.4× |
| Us kidney transplant (76776) |
$824 |
$1,030 |
7.5× |
| Us lmtd joint/oth nonvasc xtr strux r-t w/img (76882) |
$486.40 |
$608 |
4.4× |
| Us ob limited 1 or more fetuses (76815) |
$350.40 |
$438 |
3.2× |
| Us ob transvaginal (76817) |
$304 |
$380 |
2.8× |
| Us pelvic non ob complete (76856) |
$789.60 |
$987 |
7.2× |
| Us pg uter img f&mat 14 wk tabdl 1/1st gestation (76801) |
$476.80 |
$596 |
4.3× |
| Us preg uterus real time f/u trnsabdl per fetus (76816) |
$349.60 |
$437 |
3.2× |
| Us retroperitoneal complete (76770) |
$906.40 |
$1,133 |
8.2× |
| Us retroperitoneal limited (76775) |
$482.40 |
$603 |
4.4× |
| Us scrotum and contents (76870) |
$628 |
$785 |
5.7× |
| Us thyroid (76536) |
$628 |
$785 |
5.7× |
| Wrist 2 views (73100) |
$310.40 |
$388 |
3.4× |
| X-Ray Ac Jts - Xr Acromioclavicular Joints Bilateral (73050) |
$270.40 |
$338 |
2.9× |
| X-Ray Bend Only L-S Spine (72120) |
$259.20 |
$324 |
2.4× |
| X-Ray Elbow 2 Vw - Xr Elbow 1-2 Views Right (73070) |
$272 |
$340 |
3.0× |
| X-Ray Exam Entire Spi 1 Vw (72081) |
$270.40 |
$338 |
2.9× |
| X-Ray Exam Entire Spi 2/3 Vw (72082) |
$587.20 |
$734 |
5.3× |
| X-Ray Exam Entire Spi 4/5 Vw (72083) |
$668.80 |
$836 |
6.1× |
| X-Ray Exam Hip Uni 1 View (73501) |
$216 |
$270 |
2.4× |
| X-Ray Exam Hip Uni 2-3 Views (73502) |
$356.80 |
$446 |
3.9× |
| X-Ray Exam Hip Uni 4/> Views (73503) |
$400.80 |
$501 |
3.6× |
| X-Ray Exam Hips Bi 2 Views (73521) |
$397.60 |
$497 |
3.6× |
| X-Ray Exam Hips Bi 3-4 Views (73522) |
$522.40 |
$653 |
4.7× |
| X-Ray Exam Hips Bi 5/> Views (73523) |
$548.80 |
$686 |
5.0× |
| X-Ray Exam L-S Spine Bending (72114) |
$310.40 |
$388 |
2.8× |
| X-Ray Exam Neck Spine 2-3 Vw (72040) |
$310.40 |
$388 |
3.4× |
| X-Ray Exam Neck Spine 6/>Vws (72052) |
$364.80 |
$456 |
3.3× |
| X-Ray Exam Unilat Ribs/Chest (71101) |
$350.40 |
$438 |
3.2× |
| X-ray eye for foreign body (70030) |
$240 |
$300 |
2.6× |
| X-ray humerus (73060) |
$310.40 |
$388 |
3.4× |
| X-Ray Jaw <4 Vw - Xr Mandible < 4 Views (70100) |
$270.40 |
$338 |
2.9× |
| X-Ray Knee Bilat Standing - Xr Knees Anteroposterior Standing Bilat (73565) |
$292.80 |
$366 |
3.2× |
| X-Ray Lumbar Spine 2/3 Vw - Xr Lumbar Spine 2-3 Views (72100) |
$310.40 |
$388 |
2.8× |
| X-ray nose-rectum child f.b. (76010) |
$288 |
$360 |
3.1× |
| X-Ray Ribs, Chest 4+ Vw - Xr Ribs 3 Vws Bil W/ Chest Posteroanterior (71111) |
$413.60 |
$517 |
3.8× |
| X-Ray Sacroiliac Jts 3+ Vw - Xr Sacroiliac Joints 3+ Views (72202) |
$310.40 |
$388 |
2.8× |
| X-Ray Sacroiliac Jts <3 Vw - Xr Sacroiliac Joints 1-2 Views (72200) |
$274.40 |
$343 |
2.5× |
| X-Ray Sacrum/Coccyx 2+ Vw - Xr Sacrum Coccyx 2+ Views (72220) |
$310.40 |
$388 |
3.4× |
| X-Ray Sinuses 3+ Vw - Xr Paranasal Sinuses 3+ Views (70220) |
$310.40 |
$388 |
3.4× |
| X-Ray Skull 4+ Vw - Xr Skull Complete 4+ Views (70260) |
$310.40 |
$388 |
2.8× |
| X-Ray Tmj Unilat (70328) |
$340 |
$425 |
3.7× |
| X-Rays Bone Length Studies (77073) |
$398.40 |
$498 |
3.6× |
| X-Rays Bone Survey Complete (77075) |
$500 |
$625 |
4.5× |
| Xr c-spine 4 or 5 views (72050) |
$324 |
$405 |
2.9× |
| Xr facial bones less than 3 views (70140) |
$270.40 |
$338 |
2.9× |
| Xr orbits complete 4 views (70200) |
$310.40 |
$388 |
2.8× |