| Abdomen 1 View (74018) |
$140.25 |
$187 |
1.7× |
| Abdomen 2 views (74019) |
$216 |
$288 |
2.1× |
| Ankle 2 views (73600) |
$135 |
$180 |
1.6× |
| Arthrogram hip (73525) |
$614.25 |
$819 |
1.8× |
| Bone age studies (77072) |
$147 |
$196 |
1.5× |
| Bone Imaging 3 Phase (78315) |
$1,436.25 |
$1,915 |
3.7× |
| Bone Imaging Limited Area (78300) |
$847.50 |
$1,130 |
2.2× |
| Bone Imaging Whole Body (78306) |
$922.50 |
$1,230 |
2.4× |
| Cat Scan Follow-Up Study (76380) |
$626.25 |
$835 |
7.5× |
| Chest 1 view (71045) |
$140.25 |
$187 |
1.7× |
| Chest 2 views (71046) |
$171.75 |
$229 |
2.1× |
| Clavicle complete (73000) |
$127.50 |
$170 |
1.5× |
| Computed Tomography Thorax Lw Dose Lng Ca Scr C- (71271) |
$1,192.50 |
$1,590 |
11.9× |
| CT abdomen and pelvis without and with contrast (74178) |
$2,983.50 |
$3,978 |
8.9× |
| CT abdomen and pelvis without contrast (74176) |
$2,301 |
$3,068 |
10.0× |
| CT abdomen w contrast (74160) |
$1,256.25 |
$1,675 |
7.5× |
| CT abdomen w wo contrast (74170) |
$1,492.50 |
$1,990 |
8.9× |
| CT abdomen w/o contrast (74150) |
$1,150.50 |
$1,534 |
11.4× |
| CT Angio Abdomen and Pelvis (74174) |
$1,548 |
$2,064 |
4.6× |
| CT Angio Chest (71275) |
$1,554.75 |
$2,073 |
9.2× |
| CT Angio Head (70496) |
$2,212.50 |
$2,950 |
13.1× |
| Ct Angio Lwr Extr W/O&W/Dye (73706) |
$1,932 |
$2,576 |
11.5× |
| CT Angio Neck (70498) |
$2,184 |
$2,912 |
13.0× |
| Ct Angio Upr Extrm W/O&W/Dye (73206) |
$1,780.50 |
$2,374 |
10.6× |
| CT Cere Prfuj Alys C+ W/O CT/Cta Same Anatomy (70473) |
$1,950 |
$2,600 |
11.6× |
| CT cervical spine w/o contrast (72125) |
$1,150.50 |
$1,534 |
11.4× |
| CT chest w contrast (71260) |
$1,256.25 |
$1,675 |
7.5× |
| CT chest w/wo contrast (71270) |
$1,554.75 |
$2,073 |
9.2× |
| CT head/brain with contrast (70460) |
$1,197.75 |
$1,597 |
7.1× |
| CT head/brain without and with contrast (70470) |
$1,302.75 |
$1,737 |
7.7× |
| CT iac w contrast (70481) |
$1,197.75 |
$1,597 |
7.1× |
| CT l-spine w&w/o contrast (72133) |
$2,013.75 |
$2,685 |
11.9× |
| CT lower ext w/o (73700) |
$1,150.50 |
$1,534 |
11.4× |
| CT lower extremity w/contrast material (73701) |
$1,177.50 |
$1,570 |
7.0× |
| CT lumbar spine w contrast (72132) |
$1,587 |
$2,116 |
4.7× |
| CT lumbar spine w/o contrast (72131) |
$1,587 |
$2,116 |
15.8× |
| CT maxillofacial w contrast (70487) |
$1,197.75 |
$1,597 |
7.1× |
| CT maxillofacial wo contrast (70486) |
$1,150.50 |
$1,534 |
11.4× |
| CT neck tissue combo (70492) |
$1,302.75 |
$1,737 |
7.7× |
| CT orbits w/o contrast (70480) |
$1,150.50 |
$1,534 |
11.4× |
| CT pelvis w/o contrast (72192) |
$1,150.50 |
$1,534 |
11.4× |
| CT scans face/jaw combo (70488) |
$1,736.25 |
$2,315 |
10.3× |
| CT soft tissue neck w contrast (70491) |
$1,197.75 |
$1,597 |
7.1× |
| CT soft tissue neck w/o contrast (70490) |
$1,150.50 |
$1,534 |
11.4× |
| CT thoracic spine w contrast (72129) |
$1,302.75 |
$1,737 |
7.7× |
| CT thoracic spine w/o contrast (72128) |
$1,150.50 |
$1,534 |
11.4× |
| CT thorax w/o contrast (71250) |
$1,150.50 |
$1,534 |
11.4× |
| CT upper ext wo (73200) |
$1,150.50 |
$1,534 |
11.4× |
| CT upper extremity with contrast (73201) |
$1,250.25 |
$1,667 |
3.7× |
| Cta Abdl Aorta&Bi Iliofem W/Contrast&Postp (75635) |
$1,554.75 |
$2,073 |
9.2× |
| Cta Abdomen (74175) |
$1,434 |
$1,912 |
8.5× |
| CTA head&neck c+ w/noncontrast img&post-pxessing (70471) |
$2,625 |
$3,500 |
7.8× |
| Dxa Bone Density Axial (77080) |
$327.75 |
$437 |
3.3× |
| Dxa bone density study 1/>sites appendiclr skel (77081) |
$327.75 |
$437 |
3.9× |
| Esophagram (74220) |
$228 |
$304 |
1.4× |
| Fetal Biophysical Profile W/O Non-Stress Testing (76819) |
$413.25 |
$551 |
4.1× |
| Fluoroscopy up to 1 hr (76000) |
$273.75 |
$365 |
1.2× |
| Foot 2 views (73620) |
$135 |
$180 |
1.6× |
| Forearm 2 views (73090) |
$147 |
$196 |
1.8× |
| Gastric emptying imaging study (78264) |
$1,117.50 |
$1,490 |
2.9× |
| Hand 2 views (73120) |
$135 |
$180 |
1.3× |
| Hepatobil Syst Image W/Drug (78227) |
$1,140.75 |
$1,521 |
2.2× |
| Hepatobiliary System Imaging (78226) |
$1,140.75 |
$1,521 |
3.0× |
| Infant hip ultrasound, limited static exam (76886) |
$146.25 |
$195 |
1.7× |
| K Flow/Funct Image W/Drug (78708) |
$1,190.25 |
$1,587 |
2.3× |
| Kidney Imaging Morphoogy W/Vascular Flow (78701) |
$700.50 |
$934 |
1.8× |
| Knee 3 Views (73562) |
$156.75 |
$209 |
1.9× |
| Lung Ventilat&Perfus Imaging (78582) |
$1,308 |
$1,744 |
2.5× |
| Mra Head W/O & W/Contrast Material (70546) |
$2,942.25 |
$3,923 |
8.8× |
| MRA head w/o contrast (70544) |
$1,902 |
$2,536 |
8.3× |
| Mra Neck W/O &W/Contrast Material (70549) |
$2,942.25 |
$3,923 |
8.8× |
| MRA neck w/o contrast (70547) |
$1,902 |
$2,536 |
8.3× |
| MRI abdomen w/o contrast (74181) |
$1,902 |
$2,536 |
8.3× |
| MRI any jt lower extrem w/contrast material (73722) |
$1,977 |
$2,636 |
2.6× |
| MRI any jt lower extrem w/o & w/contrast matrl (73723) |
$2,942.25 |
$3,923 |
8.8× |
| MRI any jt upper extremity w/contrast matrl (73222) |
$1,977 |
$2,636 |
2.6× |
| MRI cervical spine w/o cont (72141) |
$1,902 |
$2,536 |
8.3× |
| MRI chest wo w contrast (71552) |
$2,941.50 |
$3,922 |
8.8× |
| MRI lower extrem oth/thn jt w/o & w/contr matr (73720) |
$2,942.25 |
$3,923 |
8.8× |
| MRI lower extrem oth/thn jt w/o contr matrl (73718) |
$1,902 |
$2,536 |
8.3× |
| MRI lumbar spine w contrast (72149) |
$1,977 |
$2,636 |
5.9× |
| Mri Neck Spine W/O & W/Dye (72156) |
$2,942.25 |
$3,923 |
8.8× |
| MRI orbit face neck w contrast (70542) |
$1,977 |
$2,636 |
5.9× |
| Mri Orbt/Fac/Nck W/O &W/Dye (70543) |
$2,942.25 |
$3,923 |
8.8× |
| MRI pelvis w/o & w contrast (72197) |
$2,942.25 |
$3,923 |
8.8× |
| MRI pelvis w/o contrast (72195) |
$1,902 |
$2,536 |
8.3× |
| MRI thoracic spine w/o contrast (72146) |
$1,902 |
$2,536 |
8.3× |
| MRI upper extremity oth than jt w/o contr matrl (73218) |
$1,902 |
$2,536 |
8.3× |
| Mri Uppr Extremity W/O&W/Dye (73220) |
$2,942.25 |
$3,923 |
8.8× |
| MRI, abdomen, combo (74183) |
$2,942.25 |
$3,923 |
8.8× |
| MRI, dorsal spine combo (72157) |
$2,942.25 |
$3,923 |
8.8× |
| MRI, joint upper extrem (73221) |
$1,902 |
$2,536 |
8.3× |
| MRI, joint upper extrem combo (73223) |
$2,942.25 |
$3,923 |
8.8× |
| MRI, lumbar spine combo (72158) |
$2,942.25 |
$3,923 |
8.8× |
| Myocardial Spect Multiple Studies (78452) |
$2,167.50 |
$2,890 |
1.7× |
| Neck soft tissue (70360) |
$148.50 |
$198 |
1.8× |
| Parathyroid planar imaging w/wo subtraction (78071) |
$1,270.50 |
$1,694 |
3.3× |
| Pelvis 1 or 2 views (72170) |
$135 |
$180 |
1.3× |
| PET image w/CT, full body (78816) |
$5,020.50 |
$6,694 |
3.7× |
| PET imaging CT attenuation skull base mid-thigh (78815) |
$4,944.75 |
$6,593 |
3.6× |
| Pulmonary Perfusion Imaging Particulate (78580) |
$1,184.25 |
$1,579 |
3.1× |
| Radex Abd Compl Aqt Abd W/S/E/D Views 1 View Ch (74022) |
$228 |
$304 |
2.3× |
| Radex Ankle Complete Minimum 3 Views (73610) |
$147 |
$196 |
1.8× |
| Radex Calcaneus Minimum 2 Views (73650) |
$135 |
$180 |
1.6× |
| Radex elbow complete minimum 3 views (73080) |
$147 |
$196 |
1.8× |
| Radex Facial Bones Complete Minimum 3 Views (70150) |
$267.75 |
$357 |
2.7× |
| Radex fingr minimum 2 views (73140) |
$113.25 |
$151 |
1.4× |
| Radex foot complete minimum 3 views (73630) |
$147 |
$196 |
1.8× |
| Radex Hand Minimum 3 Views (73130) |
$147 |
$196 |
1.8× |
| Radex lower extremity infant minimum 2 views (73592) |
$238.50 |
$318 |
2.9× |
| Radex Nasal Bones Complete Minimum 3 Views (70160) |
$144.75 |
$193 |
1.7× |
| Radex Ribs Unilateral 2 Views (71100) |
$153 |
$204 |
1.8× |
| Radex shoulder complete minimum 2 views (73030) |
$155.25 |
$207 |
1.9× |
| Radex Spine 1 View Specify Level (72020) |
$126.75 |
$169 |
1.5× |
| Radex Sternum Minimum 2 Views (71120) |
$135 |
$180 |
1.6× |
| Radex Temporomandble Jt Opn & Clsd Mouth Bilat (70330) |
$292.50 |
$390 |
3.5× |
| Radex Toe Minimum 2 Views (73660) |
$113.25 |
$151 |
1.4× |
| Radex upper extremity infant minimum 2 views (73092) |
$143.25 |
$191 |
1.4× |
| Radex Wrist Complete Minimum 3 Views (73110) |
$147 |
$196 |
1.8× |
| Radiolog exam mandible compl minimum 4 views (70110) |
$216 |
$288 |
2.1× |
| Radiologic exam colon double contrast study (74280) |
$448.50 |
$598 |
2.7× |
| Radiologic Exam Esophagus Double Contrast Study (74221) |
$269.25 |
$359 |
1.6× |
| Radiologic exam knee complete 4/more views (73564) |
$183 |
$244 |
1.8× |
| Radiologic exam pelvis compl minimum 3 views (72190) |
$182.25 |
$243 |
1.8× |
| Radiologic exam swallow function contrast study (74230) |
$415.50 |
$554 |
2.5× |
| Radiologic exam upr gi trc double contrast study (74246) |
$357.75 |
$477 |
2.1× |
| Radiologic examination femur minimum 2 views (73552) |
$155.25 |
$207 |
1.9× |
| Radiologic examination knee 1/2 views (73560) |
$135 |
$180 |
1.6× |
| Radiologic Examination Osseous Survey Limited (77074) |
$417.75 |
$557 |
4.2× |
| Radiologic examination tibia & fibula 2 views (73590) |
$156.75 |
$209 |
1.9× |
| Ribs bilateral 3 views (71110) |
$216 |
$288 |
2.1× |
| Scapula (73010) |
$155.25 |
$207 |
1.5× |
| Screening Digital Breast Tomosynthesis Bi (77063) |
$72.75 |
$97 |
3.1× |
| Shoulder 1 view (73020) |
$126.75 |
$169 |
1.5× |
| Shoulder Arthrography (73040) |
$614.25 |
$819 |
1.8× |
| Skull less than 4 views (70250) |
$168 |
$224 |
1.7× |
| Sternoclavicular joints (71130) |
$156.75 |
$209 |
1.9× |
| Thoracic spine 2 views (72070) |
$194.25 |
$259 |
1.9× |
| Thoracic spine 3 views (72072) |
$194.25 |
$259 |
1.9× |
| Thoracolumbar 2 views (72080) |
$174 |
$232 |
2.1× |
| Thyroid Uptake W/Blood Flow Sngle/Mult Quan Meas (78014) |
$1,024.50 |
$1,366 |
2.7× |
| Ultrasound Breast Limited (76642) |
$234.75 |
$313 |
2.8× |
| Ultrasound Exam Aaa Screen (76706) |
$330.75 |
$441 |
3.3× |
| Ultrasound, abdomen limited (76705) |
$330.75 |
$441 |
3.3× |
| Unlisted Dx Radiographic Procedure (76499) |
$111 |
$148 |
1.3× |
| Upper gi w/o kub (74240) |
$302.25 |
$403 |
1.8× |
| Us breast unilateral complete (76641) |
$365.25 |
$487 |
3.6× |
| Us chest (76604) |
$244.50 |
$326 |
2.4× |
| Us lmtd joint/oth nonvasc xtr strux r-t w/img (76882) |
$255 |
$340 |
2.5× |
| Us ob detailed single fetus (76811) |
$339 |
$452 |
1.5× |
| Us ob limited 1 or more fetuses (76815) |
$276.75 |
$369 |
2.8× |
| Us ob transvaginal (76817) |
$315 |
$420 |
3.1× |
| Us pelvic non ob complete (76856) |
$471.75 |
$629 |
4.7× |
| Us pg uter img f&mat 14 wk tabdl 1/1st gestation (76801) |
$276.75 |
$369 |
2.8× |
| Us preg uterus real time f/u trnsabdl per fetus (76816) |
$198 |
$264 |
2.0× |
| Us retroperitoneal complete (76770) |
$435.75 |
$581 |
4.3× |
| Us retroperitoneal limited (76775) |
$330.75 |
$441 |
3.3× |
| Us scrotum and contents (76870) |
$353.25 |
$471 |
3.5× |
| Us thyroid (76536) |
$353.25 |
$471 |
3.5× |
| Wrist 2 views (73100) |
$135 |
$180 |
1.6× |
| X-Ray Ac Jts - Xr Acromioclavicular Joints Bilateral (73050) |
$182.25 |
$243 |
2.2× |
| X-Ray Bend Only L-S Spine (72120) |
$215.25 |
$287 |
2.1× |
| X-Ray Elbow 2 Vw - Xr Elbow 1-2 Views Right (73070) |
$135 |
$180 |
1.6× |
| X-Ray Exam Breast Specimen (76098) |
$386.25 |
$515 |
0.7× |
| X-Ray Exam Entire Spi 1 Vw (72081) |
$198.75 |
$265 |
2.4× |
| X-Ray Exam Entire Spi 2/3 Vw (72082) |
$219 |
$292 |
2.2× |
| X-Ray Exam Hip Uni 1 View (73501) |
$111.75 |
$149 |
1.3× |
| X-Ray Exam Hip Uni 2-3 Views (73502) |
$155.25 |
$207 |
1.9× |
| X-Ray Exam Hips Bi 5/> Views (73523) |
$261.75 |
$349 |
2.6× |
| X-Ray Exam L-S Spine Bending (72114) |
$304.50 |
$406 |
3.0× |
| X-Ray Exam Neck Spine 2-3 Vw (72040) |
$148.50 |
$198 |
1.8× |
| X-Ray Exam Neck Spine 6/>Vws (72052) |
$302.25 |
$403 |
3.0× |
| X-Ray Exam Unilat Ribs/Chest (71101) |
$188.25 |
$251 |
1.9× |
| X-ray eye for foreign body (70030) |
$210.75 |
$281 |
2.5× |
| X-ray humerus (73060) |
$147 |
$196 |
1.8× |
| X-Ray Jaw <4 Vw - Xr Mandible < 4 Views (70100) |
$144.75 |
$193 |
1.7× |
| X-Ray Knee Bilat Standing - Xr Knees Anteroposterior Standing Bilat (73565) |
$135 |
$180 |
1.6× |
| X-Ray Lumbar Spine 2/3 Vw - Xr Lumbar Spine 2-3 Views (72100) |
$194.25 |
$259 |
1.9× |
| X-ray nose-rectum child f.b. (76010) |
$106.50 |
$142 |
1.3× |
| X-Ray Ribs, Chest 4+ Vw - Xr Ribs 3 Vws Bil W/ Chest Posteroanterior (71111) |
$259.50 |
$346 |
2.6× |
| X-Ray Sacroiliac Jts 3+ Vw - Xr Sacroiliac Joints 3+ Views (72202) |
$182.25 |
$243 |
1.8× |
| X-Ray Sacrum/Coccyx 2+ Vw - Xr Sacrum Coccyx 2+ Views (72220) |
$147 |
$196 |
1.8× |
| X-Ray Skull 4+ Vw - Xr Skull Complete 4+ Views (70260) |
$267.75 |
$357 |
2.7× |
| X-Rays Bone Length Studies (77073) |
$294 |
$392 |
2.9× |
| X-Rays Bone Survey Complete (77075) |
$1,006.50 |
$1,342 |
10.0× |
| Xr c-spine 4 or 5 views (72050) |
$234.75 |
$313 |
2.3× |
| Xr facial bones less than 3 views (70140) |
$228.75 |
$305 |
2.7× |
| Xr orbits complete 4 views (70200) |
$302.25 |
$403 |
3.0× |