| Abdomen 1 View (74018) |
$268.80 |
$336 |
2.9× |
| Abdomen 2 views (74019) |
$362.40 |
$453 |
3.2× |
| Acute Gastrointestinal Blood Loss Imaging (78278) |
$1,254.40 |
$1,568 |
2.9× |
| Ankle 2 views (73600) |
$251.20 |
$314 |
2.7× |
| Bone age studies (77072) |
$233.60 |
$292 |
2.1× |
| Bone Imaging 3 Phase (78315) |
$2,075.20 |
$2,594 |
4.8× |
| Bone Imaging Limited Area (78300) |
$678.40 |
$848 |
1.6× |
| Bone Imaging Multiple Areas (78305) |
$996.80 |
$1,246 |
2.3× |
| Bone Imaging Whole Body (78306) |
$1,994.40 |
$2,493 |
4.7× |
| Bone survey infant (77076) |
$303.20 |
$379 |
2.7× |
| Chest 1 view (71045) |
$189.60 |
$237 |
2.0× |
| Chest 2 views (71046) |
$294.40 |
$368 |
3.2× |
| Chest 4 or more views (71048) |
$233.60 |
$292 |
2.1× |
| Clavicle complete (73000) |
$242.40 |
$303 |
2.6× |
| Computed Tomography Thorax Lw Dose Lng Ca Scr C- (71271) |
$2,244.80 |
$2,806 |
20.0× |
| Contrast X-Ray Bladder (74430) |
$424 |
$530 |
1.1× |
| CT abdomen and pelvis without and with contrast (74178) |
$4,888.80 |
$6,111 |
13.1× |
| CT abdomen and pelvis without contrast (74176) |
$3,980 |
$4,975 |
15.6× |
| CT abdomen w contrast (74160) |
$2,302.40 |
$2,878 |
12.2× |
| CT abdomen w wo contrast (74170) |
$2,561.60 |
$3,202 |
13.6× |
| CT abdomen w/o contrast (74150) |
$2,016.80 |
$2,521 |
18.0× |
| CT Angio Abdomen and Pelvis (74174) |
$5,131.20 |
$6,414 |
13.7× |
| CT Angio Chest (71275) |
$3,028.80 |
$3,786 |
16.1× |
| CT Angio Head (70496) |
$2,354.40 |
$2,943 |
12.5× |
| Ct Angio Lwr Extr W/O&W/Dye (73706) |
$1,792 |
$2,240 |
9.5× |
| CT Angio Neck (70498) |
$3,417.60 |
$4,272 |
18.2× |
| Ct Angio Upr Extrm W/O&W/Dye (73206) |
$3,127.20 |
$3,909 |
16.6× |
| CT cervical spine w/ contrast (72126) |
$2,596 |
$3,245 |
6.9× |
| CT cervical spine w/o contrast (72125) |
$2,249.60 |
$2,812 |
20.1× |
| CT cervical spine w/wo cont (72127) |
$2,768.80 |
$3,461 |
14.7× |
| CT chest w contrast (71260) |
$2,596 |
$3,245 |
13.8× |
| CT chest w/wo contrast (71270) |
$2,768.80 |
$3,461 |
14.7× |
| CT head/brain with contrast (70460) |
$2,120 |
$2,650 |
11.3× |
| CT head/brain without and with contrast (70470) |
$2,120 |
$2,650 |
11.3× |
| CT iac w contrast (70481) |
$2,120 |
$2,650 |
11.3× |
| CT l-spine w&w/o contrast (72133) |
$2,596 |
$3,245 |
13.8× |
| CT lower ext w/o (73700) |
$1,816.80 |
$2,271 |
16.2× |
| CT lower extremity w/contrast material (73701) |
$1,990.40 |
$2,488 |
10.6× |
| CT lumbar spine w contrast (72132) |
$2,422.40 |
$3,028 |
6.5× |
| CT lumbar spine w/o contrast (72131) |
$2,249.60 |
$2,812 |
20.1× |
| CT maxillofacial w contrast (70487) |
$2,115.20 |
$2,644 |
11.3× |
| CT maxillofacial wo contrast (70486) |
$1,899.20 |
$2,374 |
17.0× |
| CT neck tissue combo (70492) |
$2,228 |
$2,785 |
11.9× |
| Ct Orbit/Ear/Fossa W/O&W/Dye (70482) |
$2,292.80 |
$2,866 |
12.2× |
| CT orbits w/o contrast (70480) |
$1,947.20 |
$2,434 |
17.4× |
| CT pelvis w&w/o contrast (72194) |
$2,280.80 |
$2,851 |
12.1× |
| CT pelvis w/o contrast (72192) |
$1,934.40 |
$2,418 |
17.3× |
| CT scan of leg combo (73702) |
$2,855.20 |
$3,569 |
15.2× |
| CT scans face/jaw combo (70488) |
$2,201.60 |
$2,752 |
11.7× |
| CT soft tissue neck w contrast (70491) |
$2,055.20 |
$2,569 |
10.9× |
| CT soft tissue neck w/o contrast (70490) |
$1,881.60 |
$2,352 |
16.8× |
| CT thoracic spine w contrast (72129) |
$2,508 |
$3,135 |
13.3× |
| CT thoracic spine w/o contrast (72128) |
$2,334.40 |
$2,918 |
20.8× |
| CT thoracic spine w/wo cont (72130) |
$2,680.80 |
$3,351 |
14.3× |
| CT thorax w/o contrast (71250) |
$2,163.20 |
$2,704 |
19.3× |
| CT upper ext wo (73200) |
$2,521.60 |
$3,152 |
22.5× |
| CT upper extremity w/o & w/contrast material (73202) |
$2,521.60 |
$3,152 |
13.4× |
| CT upper extremity with contrast (73201) |
$2,521.60 |
$3,152 |
6.7× |
| Cta Abdl Aorta&Bi Iliofem W/Contrast&Postp (75635) |
$3,115.20 |
$3,894 |
16.6× |
| Cta Abdomen (74175) |
$2,712 |
$3,390 |
14.4× |
| CTA pelvis (72191) |
$1,968.80 |
$2,461 |
10.5× |
| Dxa Bone Density Axial (77080) |
$424 |
$530 |
3.8× |
| Dxa bone density study (77085) |
$517.60 |
$647 |
4.6× |
| Dxa bone density study 1/>sites appendiclr skel (77081) |
$311.20 |
$389 |
3.3× |
| Fetal Biophys Profile W/Nst (76818) |
$331.20 |
$414 |
3.0× |
| Fetal Biophysical Profile W/O Non-Stress Testing (76819) |
$597.60 |
$747 |
5.3× |
| Foot 2 views (73620) |
$311.20 |
$389 |
3.3× |
| Forearm 2 views (73090) |
$294.40 |
$368 |
3.2× |
| Gastric emptying imaging study (78264) |
$1,582.40 |
$1,978 |
3.7× |
| Gastroesophageal Reflux Exam (78262) |
$932.80 |
$1,166 |
2.2× |
| Gated Heart Planar Single (78472) |
$886.40 |
$1,108 |
2.1× |
| Hand 2 views (73120) |
$285.60 |
$357 |
2.5× |
| Hepatobil Syst Image W/Drug (78227) |
$2,336 |
$2,920 |
4.0× |
| Hepatobiliary System Imaging (78226) |
$912.80 |
$1,141 |
2.1× |
| Ht Muscle Image Spect Sing (78451) |
$2,873.60 |
$3,592 |
2.1× |
| K Flow/Funct Image W/Drug (78708) |
$2,208.80 |
$2,761 |
3.8× |
| K Flow/Funct Image W/O Drug (78707) |
$1,084 |
$1,355 |
1.9× |
| Knee 3 Views (73562) |
$450.40 |
$563 |
4.8× |
| Liver & Spleen Imaging W/Vascular Flow (78216) |
$724 |
$905 |
1.7× |
| Lung Perf&Ventilat Diferentl (78598) |
$1,307.20 |
$1,634 |
2.2× |
| Lung Ventilat&Perfus Imaging (78582) |
$1,718.40 |
$2,148 |
3.0× |
| Lymph System Imaging (78195) |
$1,952.80 |
$2,441 |
3.4× |
| Magnetic Image Jaw Joint (70336) |
$2,205.60 |
$2,757 |
8.6× |
| Meckels Divert Exam (78290) |
$621.60 |
$777 |
1.5× |
| Mra Head W/O & W/Contrast Material (70546) |
$2,674.40 |
$3,343 |
7.2× |
| MRA head w/o contrast (70544) |
$2,500.80 |
$3,126 |
9.8× |
| Mra Neck W/O &W/Contrast Material (70549) |
$2,674.40 |
$3,343 |
7.2× |
| MRA neck w/o contrast (70547) |
$2,488 |
$3,110 |
9.7× |
| MRI abdomen w contrast (74182) |
$2,352.80 |
$2,941 |
6.3× |
| MRI abdomen w/o contrast (74181) |
$2,180 |
$2,725 |
8.5× |
| MRI any jt lower extrem w/o & w/contrast matrl (73723) |
$3,054.40 |
$3,818 |
8.2× |
| MRI any jt upper extremity w/contrast matrl (73222) |
$2,968 |
$3,710 |
3.5× |
| MRI cervical spine w contrast (72142) |
$2,847.20 |
$3,559 |
7.6× |
| MRI cervical spine w/o cont (72141) |
$2,941.60 |
$3,677 |
11.5× |
| MRI chest w/o contrast (71550) |
$2,682.40 |
$3,353 |
10.5× |
| MRI chest wo w contrast (71552) |
$4,110.40 |
$5,138 |
11.0× |
| MRI lower extrem oth/thn jt w/o & w/contr matr (73720) |
$2,300.80 |
$2,876 |
6.2× |
| MRI lower extrem oth/thn jt w/o contr matrl (73718) |
$2,127.20 |
$2,659 |
8.3× |
| MRI lumbar spine w contrast (72149) |
$2,812 |
$3,515 |
7.5× |
| Mri Neck Spine W/O & W/Dye (72156) |
$2,986.40 |
$3,733 |
8.0× |
| MRI orbit face &/neck w/o contrast (70540) |
$2,915.20 |
$3,644 |
11.4× |
| Mri Orbt/Fac/Nck W/O &W/Dye (70543) |
$3,261.60 |
$4,077 |
8.7× |
| MRI pelvis w contrast (72196) |
$2,466.40 |
$3,083 |
6.6× |
| MRI pelvis w/o & w contrast (72197) |
$2,972.80 |
$3,716 |
8.0× |
| MRI pelvis w/o contrast (72195) |
$2,292.80 |
$2,866 |
9.0× |
| MRI thoracic spine w/o contrast (72146) |
$2,640 |
$3,300 |
10.3× |
| MRI upper extremity oth than jt w/o contr matrl (73218) |
$2,328 |
$2,910 |
9.1× |
| Mri Uppr Extremity W/O&W/Dye (73220) |
$2,500.80 |
$3,126 |
6.7× |
| MRI, abdomen, combo (74183) |
$3,770.40 |
$4,713 |
10.1× |
| MRI, dorsal spine combo (72157) |
$2,986.40 |
$3,733 |
8.0× |
| MRI, dorsal spine contrast (72147) |
$2,812.80 |
$3,516 |
7.5× |
| MRI, joint upper extrem (73221) |
$3,028.80 |
$3,786 |
11.8× |
| MRI, joint upper extrem combo (73223) |
$3,140.80 |
$3,926 |
8.4× |
| MRI, lumbar spine combo (72158) |
$2,986.40 |
$3,733 |
8.0× |
| Myocardial Spect Multiple Studies (78452) |
$5,278.40 |
$6,598 |
3.8× |
| Neck soft tissue (70360) |
$233.60 |
$292 |
2.5× |
| Ob us nuchal meas 1 gest (76813) |
$368 |
$460 |
3.3× |
| Parathyroid imaging w/tomographic spect & CT (78072) |
$723.20 |
$904 |
1.2× |
| Parathyroid Planar Imaging (78070) |
$706.40 |
$883 |
1.6× |
| Pelvis 1 or 2 views (72170) |
$268 |
$335 |
2.4× |
| Pulmonary Perfusion Imaging Particulate (78580) |
$1,306.40 |
$1,633 |
3.0× |
| Radex Abd Compl Aqt Abd W/S/E/D Views 1 View Ch (74022) |
$605.60 |
$757 |
5.4× |
| Radex Ankle Complete Minimum 3 Views (73610) |
$303.20 |
$379 |
3.3× |
| Radex Calcaneus Minimum 2 Views (73650) |
$208 |
$260 |
2.2× |
| Radex elbow complete minimum 3 views (73080) |
$320 |
$400 |
3.4× |
| Radex Facial Bones Complete Minimum 3 Views (70150) |
$294.40 |
$368 |
2.6× |
| Radex fingr minimum 2 views (73140) |
$242.40 |
$303 |
2.6× |
| Radex foot complete minimum 3 views (73630) |
$337.60 |
$422 |
3.6× |
| Radex Hand Minimum 3 Views (73130) |
$298.40 |
$373 |
3.2× |
| Radex lower extremity infant minimum 2 views (73592) |
$311.20 |
$389 |
3.3× |
| Radex Nasal Bones Complete Minimum 3 Views (70160) |
$251.20 |
$314 |
2.7× |
| Radex Ribs Unilateral 2 Views (71100) |
$397.60 |
$497 |
4.3× |
| Radex shoulder complete minimum 2 views (73030) |
$368 |
$460 |
3.9× |
| Radex Spine 1 View Specify Level (72020) |
$242.40 |
$303 |
2.6× |
| Radex Sternum Minimum 2 Views (71120) |
$199.20 |
$249 |
2.1× |
| Radex Temporomandble Jt Opn & Clsd Mouth Bilat (70330) |
$268 |
$335 |
2.9× |
| Radex Toe Minimum 2 Views (73660) |
$190.40 |
$238 |
2.0× |
| Radex upper extremity infant minimum 2 views (73092) |
$276.80 |
$346 |
2.5× |
| Radex Wrist Complete Minimum 3 Views (73110) |
$285.60 |
$357 |
3.1× |
| Radiolog exam mandible compl minimum 4 views (70110) |
$424 |
$530 |
3.8× |
| Radiologic exam knee complete 4/more views (73564) |
$623.20 |
$779 |
5.6× |
| Radiologic examination femur minimum 2 views (73552) |
$360 |
$450 |
3.9× |
| Radiologic examination knee 1/2 views (73560) |
$294.40 |
$368 |
3.2× |
| Radiologic examination tibia & fibula 2 views (73590) |
$320 |
$400 |
3.4× |
| Ribs bilateral 3 views (71110) |
$428.80 |
$536 |
3.8× |
| Rp loclzj tum plnr 1 area single day imaging (78800) |
$1,378.40 |
$1,723 |
3.2× |
| Rp Loclzj Tum Spect 1 Area Single Day Imaging (78803) |
$1,228.80 |
$1,536 |
2.1× |
| Scapula (73010) |
$172.80 |
$216 |
1.5× |
| Screening Digital Breast Tomosynthesis Bi (77063) |
$55.20 |
$69 |
2.4× |
| Shoulder 1 view (73020) |
$199.20 |
$249 |
2.1× |
| Skull less than 4 views (70250) |
$268 |
$335 |
2.4× |
| Sternoclavicular joints (71130) |
$138.40 |
$173 |
1.5× |
| Testicular Imaging W/Flow (78761) |
$1,220.80 |
$1,526 |
2.8× |
| Thoracic spine 2 views (72070) |
$276.80 |
$346 |
2.5× |
| Thoracic spine 3 views (72072) |
$440.80 |
$551 |
3.9× |
| Thyroid Imaging With Vascular Flow (78013) |
$1,040.80 |
$1,301 |
2.4× |
| Thyroid Uptake W/Blood Flow Sngle/Mult Quan Meas (78014) |
$1,422.40 |
$1,778 |
3.3× |
| Ultrasound Breast Limited (76642) |
$554.40 |
$693 |
5.9× |
| Ultrasound Exam Aaa Screen (76706) |
$761.60 |
$952 |
6.8× |
| Ultrasound, abdomen limited (76705) |
$692 |
$865 |
6.2× |
| Urea Breath Test C-14 Isotopic Acquisj Analysis (78267) |
$408.80 |
$511 |
37.0× |
| Urea breath test c-14 isotopic analysis (78268) |
$217.60 |
$272 |
2.3× |
| Us breast unilateral complete (76641) |
$473.60 |
$592 |
4.2× |
| Us chest (76604) |
$456.80 |
$571 |
4.1× |
| Us complete joint (76881) |
$713.60 |
$892 |
6.4× |
| Us exam, pelvic, limited (76857) |
$278.40 |
$348 |
2.5× |
| Us lmtd joint/oth nonvasc xtr strux r-t w/img (76882) |
$411.20 |
$514 |
3.7× |
| Us ob limited 1 or more fetuses (76815) |
$523.20 |
$654 |
4.7× |
| Us ob transvaginal (76817) |
$374.40 |
$468 |
3.3× |
| Us pelvic non ob complete (76856) |
$787.20 |
$984 |
7.0× |
| Us pg uter img f&mat 14 wk tabdl 1/1st gestation (76801) |
$612 |
$765 |
5.5× |
| Us preg uterus real time f/u trnsabdl per fetus (76816) |
$433.60 |
$542 |
3.9× |
| Us retroperitoneal complete (76770) |
$822.40 |
$1,028 |
7.3× |
| Us retroperitoneal limited (76775) |
$326.40 |
$408 |
2.9× |
| Us scrotum and contents (76870) |
$830.40 |
$1,038 |
7.4× |
| Us thyroid (76536) |
$670.40 |
$838 |
6.0× |
| Wrist 2 views (73100) |
$259.20 |
$324 |
2.8× |
| X-Ray Ac Jts - Xr Acromioclavicular Joints Bilateral (73050) |
$303.20 |
$379 |
3.3× |
| X-Ray Elbow 2 Vw - Xr Elbow 1-2 Views Right (73070) |
$208 |
$260 |
2.2× |
| X-Ray Exam Entire Spi 1 Vw (72081) |
$308 |
$385 |
3.3× |
| X-Ray Exam Entire Spi 2/3 Vw (72082) |
$283.20 |
$354 |
2.5× |
| X-Ray Exam Hip Uni 1 View (73501) |
$368.80 |
$461 |
4.0× |
| X-Ray Exam Hip Uni 2-3 Views (73502) |
$404.80 |
$506 |
4.3× |
| X-Ray Exam Hips Bi 5/> Views (73523) |
$623.20 |
$779 |
5.6× |
| X-Ray Exam L-S Spine Bending (72114) |
$519.20 |
$649 |
4.6× |
| X-Ray Exam Neck Spine 2-3 Vw (72040) |
$363.20 |
$454 |
3.9× |
| X-Ray Exam Neck Spine 6/>Vws (72052) |
$458.40 |
$573 |
4.1× |
| X-Ray Exam Unilat Ribs/Chest (71101) |
$397.60 |
$497 |
3.5× |
| X-ray eye for foreign body (70030) |
$199.20 |
$249 |
2.1× |
| X-ray humerus (73060) |
$268 |
$335 |
2.9× |
| X-ray IV pyelogram (ivp) (74400) |
$848 |
$1,060 |
4.5× |
| X-Ray Lumbar Spine 2/3 Vw - Xr Lumbar Spine 2-3 Views (72100) |
$440.80 |
$551 |
3.9× |
| X-Ray Ribs, Chest 4+ Vw - Xr Ribs 3 Vws Bil W/ Chest Posteroanterior (71111) |
$428.80 |
$536 |
3.8× |
| X-Ray Sacroiliac Jts 3+ Vw - Xr Sacroiliac Joints 3+ Views (72202) |
$259.20 |
$324 |
2.3× |
| X-Ray Sacrum/Coccyx 2+ Vw - Xr Sacrum Coccyx 2+ Views (72220) |
$354.40 |
$443 |
3.8× |
| X-Ray Sinuses 3+ Vw - Xr Paranasal Sinuses 3+ Views (70220) |
$320 |
$400 |
3.4× |
| X-Ray Skull 4+ Vw - Xr Skull Complete 4+ Views (70260) |
$259.20 |
$324 |
2.3× |
| X-ray thoracic spine 4 vw (72074) |
$372 |
$465 |
3.3× |
| X-Ray Urinary Tract Exam With Contrast Material (74420) |
$450.40 |
$563 |
1.2× |
| X-Rays Bone Length Studies (77073) |
$190.40 |
$238 |
1.7× |
| X-Rays Bone Survey Complete (77075) |
$908.80 |
$1,136 |
8.1× |
| Xr c-spine 4 or 5 views (72050) |
$544.80 |
$681 |
4.9× |
| Xr orbits complete 4 views (70200) |
$285.60 |
$357 |
2.5× |