| Abdomen 2 views (74019) |
$214 |
$252 |
2.2× |
| Acute gastrointestinal blood loss imaging (78278) |
$1,185 |
$1,394 |
3.2× |
| Ankle 2 views (73600) |
$150 |
$177 |
1.9× |
| Arthrogram hip (73525) |
$178 |
$209 |
0.6× |
| Bone &/Joint Imaging Limited Area (78300) |
$814 |
$958 |
2.2× |
| Bone &/Joint Imaging Multiple Areas (78305) |
$848 |
$998 |
2.3× |
| Bone &/joint imaging whole body (78306) |
$848 |
$998 |
2.3× |
| Bone Imaging 3 Phase (78315) |
$804 |
$946 |
2.2× |
| Bone survey complete (77075) |
$1,138 |
$1,339 |
11.8× |
| Brain Imaging Vascular Flow Only (78610) |
$807 |
$949 |
1.6× |
| Cardiac MRI w/w/o contrast & further seq (75561) |
$1,176 |
$1,384 |
3.7× |
| Cervical spine 2 or 3 views (72040) |
$201 |
$237 |
2.5× |
| Chest 1 view (71045) |
$145 |
$170 |
1.8× |
| Chest 3 views (71047) |
$265 |
$312 |
3.3× |
| Clavicle complete (73000) |
$174.50 |
$205 |
2.2× |
| Computed Tomography Thorax Lw Dose Lng Ca Scr C- (71271) |
$746 |
$878 |
7.8× |
| CT abdomen and pelvis without and with contrast (74178) |
$1,194 |
$1,405 |
3.7× |
| CT abdomen and pelvis without contrast (74176) |
$1,159 |
$1,364 |
5.3× |
| CT abdomen w contrast (74160) |
$926 |
$1,089 |
5.7× |
| CT abdomen w wo contrast (74170) |
$921 |
$1,083 |
5.7× |
| CT abdomen w/o contrast (74150) |
$891 |
$1,048 |
9.3× |
| CT c-spine w/o contrast (72125) |
$876 |
$1,031 |
9.1× |
| CT cervical spine w&w/o contrast (72127) |
$921 |
$1,083 |
5.7× |
| CT cervical spine with contrast (72126) |
$894 |
$1,052 |
2.8× |
| CT chest w/wo contrast (71270) |
$921 |
$1,083 |
5.7× |
| CT chest with contrast (71260) |
$894 |
$1,052 |
5.5× |
| CT head/brain with contrast (70460) |
$894 |
$1,052 |
5.5× |
| CT head/brain without and with contrast (70470) |
$921 |
$1,083 |
5.7× |
| CT heart no contrast quant eval coronry calcium (75571) |
$213 |
$250 |
2.7× |
| CT iac w contrast (70481) |
$894 |
$1,052 |
5.5× |
| CT limited/localized follow up study (76380) |
$666 |
$783 |
8.3× |
| CT lower ext w/o (73700) |
$885 |
$1,041.50 |
9.2× |
| CT lower extremity w wo contrast (73702) |
$929.50 |
$1,093 |
5.8× |
| CT lower extremity with contrast (73701) |
$907.50 |
$1,067.50 |
5.6× |
| CT lumbar spine w & w/o contrast (72133) |
$921 |
$1,083 |
5.7× |
| CT lumbar spine w/o contrast (72131) |
$876 |
$1,031 |
9.1× |
| CT lumbar spine with contrast (72132) |
$894 |
$1,052 |
2.8× |
| CT maxillofacial w contrast (70487) |
$894 |
$1,052 |
5.5× |
| CT maxillofacial w/o contrast (70486) |
$876 |
$1,031 |
9.1× |
| CT maxillofacial w/wo contrast (70488) |
$921 |
$1,083 |
5.7× |
| CT neck soft tissue w contrast (70491) |
$894 |
$1,052 |
5.5× |
| CT orbit sella/post fossa/ear w/o & w/contr matr (70482) |
$921 |
$1,083 |
5.7× |
| CT orbits w/o contrast (70480) |
$876 |
$1,031 |
9.1× |
| CT pelvis w & w/o contrast (72194) |
$921 |
$1,083 |
5.7× |
| CT pelvis w/o contrast (72192) |
$876 |
$1,031 |
9.1× |
| CT soft tissue neck w/o & w/contrast material (70492) |
$921 |
$1,083 |
5.7× |
| CT soft tissue neck w/o contrast (70490) |
$876 |
$1,031 |
9.1× |
| CT thoracic spine w/contrast (72129) |
$894 |
$1,052 |
5.5× |
| CT thoracic spine w/o contrast (72128) |
$876 |
$1,031 |
9.1× |
| CT thoracic spine w/wo contrast (72130) |
$921 |
$1,083 |
5.7× |
| CT thorax w/o contrast (71250) |
$1,077 |
$1,267.50 |
11.2× |
| CT upper extremity w/o & w/contrast material (73202) |
$929.50 |
$1,093 |
5.8× |
| CT upper extremity w/o contrast rt (73200) |
$885 |
$1,041.50 |
9.2× |
| CT upper extremity with contrast (73201) |
$907.50 |
$1,067.50 |
2.8× |
| Cta Abdl Aorta&Bi Iliofem W/Contrast&Postp (75635) |
$1,560 |
$1,835 |
9.7× |
| Cta Abdomen (74175) |
$1,482 |
$1,743 |
9.2× |
| CTA abdomen pelvis (74174) |
$2,128 |
$2,503 |
6.6× |
| CTA chest (71275) |
$1,428 |
$1,680 |
8.9× |
| Cta Head (70496) |
$1,447 |
$1,702 |
9.0× |
| CTA head&neck c+ w/noncontrast img&post-pxessing (70471) |
$2,601 |
$3,060 |
8.1× |
| Cta Neck (70498) |
$1,448 |
$1,703 |
9.0× |
| Cystography minimum 3 views rs&i (74430) |
$435 |
$512 |
1.4× |
| Dxa bone density study 1/> sites axial skel (77080) |
$342 |
$402 |
3.6× |
| Dxa bone density study 1/>sites appendiclr skel (77081) |
$119 |
$140 |
1.5× |
| Esophagus (74220) |
$337 |
$397 |
2.1× |
| Fetal Biophysical Profile W/O Non-Stress Testing (76819) |
$289 |
$340 |
3.0× |
| Fluoroscopy up to 1 hr (76000) |
$292 |
$344 |
1.3× |
| Foot 2 views (73620) |
$173.50 |
$204 |
2.2× |
| Forearm 2 views (73090) |
$173.50 |
$204 |
2.2× |
| Hand 2 views (73120) |
$168.50 |
$198.50 |
1.8× |
| Hand 3 views (73130) |
$208.50 |
$245 |
2.6× |
| Hepatobil Syst Imag Inc Gb W/Pharma Intervenj (78227) |
$1,145 |
$1,347 |
2.3× |
| Humerus Min 2 Views Left (73060) |
$208.50 |
$245 |
2.6× |
| Joint Survey, Single View - Xr Joint Anteroposterior 2+ Joints (77077) |
$178 |
$209 |
1.9× |
| Kidney Img Morphology Vascular Flow 1 W/O Rx (78707) |
$807 |
$949 |
1.6× |
| Kidney img morphology vascular flow 1 w/rx (78708) |
$1,049 |
$1,234 |
2.1× |
| Knee 3 views (73562) |
$205.50 |
$242 |
2.6× |
| Liver & spleen imaging static only (78215) |
$757 |
$890 |
2.1× |
| Lung perf&ventilat diferentl (78598) |
$1,624 |
$1,910 |
3.3× |
| MRA head w & w/o contrast (70546) |
$1,194 |
$1,405 |
3.7× |
| MRA head w/o contrast (70544) |
$1,159 |
$1,364 |
5.3× |
| MRA head with contrast (70545) |
$1,176 |
$1,384 |
3.7× |
| MRA neck w contrast (70548) |
$1,176 |
$1,384 |
3.7× |
| Mra Neck W/O &W/Contrast Material (70549) |
$1,194 |
$1,405 |
3.7× |
| MRA neck w/o contrast (70547) |
$1,159 |
$1,364 |
5.3× |
| MRI abdomen w contrast (74182) |
$1,128 |
$1,327 |
3.5× |
| MRI abdomen w/o & w/contrast material (74183) |
$1,194 |
$1,405 |
3.7× |
| MRI abdomen w/o contrast (74181) |
$1,071 |
$1,260 |
4.9× |
| MRI any jnt lwr ext with con lt (73722) |
$1,220.50 |
$1,436 |
1.7× |
| MRI any jt upper extremity w/contrast matrl (73222) |
$1,176 |
$1,384 |
1.6× |
| MRI bone marrow blood supply (77084) |
$1,194 |
$1,405 |
5.4× |
| MRI c-spine with contrast (72142) |
$1,176 |
$1,384 |
3.7× |
| MRI cardiac w/o contrast (75557) |
$1,159 |
$1,364 |
5.3× |
| MRI cervical spine w/o contrast (72141) |
$1,159 |
$1,364 |
5.3× |
| MRI chest w/o & w/contrast material (71552) |
$1,194 |
$1,405 |
3.7× |
| MRI chest w/o contrast (71550) |
$1,159 |
$1,364 |
5.3× |
| MRI chest with contrast (71551) |
$1,176 |
$1,384 |
1.6× |
| MRI Forearm w/ Contrast Bilateral 73219 (73219) |
$1,176 |
$1,384 |
3.7× |
| MRI lower extrem oth/thn jt w/o contr matrl (73718) |
$1,211.50 |
$1,425.50 |
5.5× |
| MRI orbit face &/neck w/o contrast (70540) |
$1,159 |
$1,364 |
5.3× |
| MRI orbit/face/neck w&w/o cont (70543) |
$1,194 |
$1,405 |
3.7× |
| MRI orbit/face/neck w/contrast (70542) |
$1,176 |
$1,384 |
3.7× |
| MRI pelvis w contrast (72196) |
$1,176 |
$1,384 |
3.7× |
| MRI pelvis w/o & w/contrast material (72197) |
$1,194 |
$1,405 |
3.7× |
| MRI pelvis w/o contrast (72195) |
$1,159 |
$1,364 |
5.3× |
| MRI scan of arm joint before and after contrast (73223) |
$1,194 |
$1,405 |
3.7× |
| MRI scan of leg joint before and after contrast (73723) |
$1,220.50 |
$1,436 |
3.8× |
| MRI spinal canal cervical w/o & w/contr matrl (72156) |
$1,194 |
$1,405 |
3.7× |
| MRI spinal canal lumbar w/contrast material (72149) |
$1,176 |
$1,384 |
3.7× |
| MRI spinal canal lumbar w/o & w/contr matrl (72158) |
$1,194 |
$1,405 |
3.7× |
| MRI spinal canal thoracic w/contrast matrl (72147) |
$1,176 |
$1,384 |
3.7× |
| MRI spinal canal thoracic w/o & w/contr matrl (72157) |
$1,194 |
$1,405 |
3.7× |
| MRI thoracic spine w/o contrast (72146) |
$1,159 |
$1,364 |
5.3× |
| MRI tmj (70336) |
$1,159 |
$1,364 |
5.3× |
| MRI upper ext joint w/o contrast (73221) |
$1,159 |
$1,364 |
5.3× |
| MRI upper extrem other than jt w/o & w/contras (73220) |
$1,194 |
$1,405 |
3.7× |
| MRI upper extremity oth than jt w/o contr matrl (73218) |
$1,211.50 |
$1,425.50 |
5.5× |
| Myocardial Spect Multiple Studies (78452) |
$2,790 |
$3,282 |
2.3× |
| Neck soft tissue (70360) |
$162 |
$190 |
2.0× |
| Nm gastric emptying study (78264) |
$805 |
$947 |
2.2× |
| Parathyroid imaging (78070) |
$300 |
$353 |
0.8× |
| Pelvis 1 or 2 views (72170) |
$157 |
$185 |
1.6× |
| Pr MRI, lower extr, w/o contrast f/u by contrast (73720) |
$1,220.50 |
$1,436 |
3.8× |
| Pulmonary Perfusion Imaging Particulate (78580) |
$753 |
$886 |
2.0× |
| Radex abscess/fistula/sinus tract rs&i (76080) |
$265 |
$312 |
0.5× |
| Radex Entir Thrc Lmbr Crv Sac Spi W/Skull 1 Vw - Xr Scoliosis 1 Vw (72081) |
$224 |
$264 |
2.8× |
| Radex entir thrc lmbr crv sac spi w/skull 2/3 vw (72082) |
$219 |
$258 |
2.3× |
| Radex hips bilateral with pelvis 2 views (73521) |
$307 |
$361 |
3.2× |
| Radiolog exam mandible compl minimum 4 views (70110) |
$264 |
$310 |
2.7× |
| Radiologic Exam Abdomen 1 View - Xr Abdomen 1 View (74018) |
$168 |
$198 |
2.1× |
| Radiologic Exam Abdomen 3+ Views - Xr Abdomen 3+ Views (74021) |
$224 |
$263 |
2.3× |
| Radiologic Exam Chest 2 Views - Xr Chest 2 Views (71046) |
$184 |
$216 |
2.3× |
| Radiologic exam upr gi trc double contrast study (74246) |
$445 |
$523 |
2.8× |
| Radiologic exam upr gi trc single contrast study (74240) |
$532 |
$626 |
3.3× |
| Radiologic Examination Femur Minimum 2 Views - Xr Femur 2+ Vw Lt (73552) |
$202 |
$238 |
2.5× |
| Ribs bilateral 3 views (71110) |
$228 |
$268 |
2.4× |
| Scapula complete (73010) |
$145 |
$170 |
1.5× |
| Screening digital breast tomosynthesis (77063) |
$106 |
$125 |
4.5× |
| Small bowel series (74250) |
$388 |
$457 |
2.4× |
| Spine thoracic 3 views (72072) |
$224 |
$263 |
2.3× |
| Thoracolumbar 2 views (72080) |
$224 |
$263 |
2.8× |
| Thyroid Imaging With Vascular Flow (78013) |
$688 |
$809 |
1.9× |
| Thyroid Uptake W/Blood Flow Sngle/Mult Quan Meas (78014) |
$568 |
$668 |
1.5× |
| Ultrasound, abdomen limited (76705) |
$300 |
$353 |
3.1× |
| Upper Extremity Infant (73092) |
$211 |
$248 |
2.2× |
| Urography (pyelography), intravenous, with or without KUB, with or without tomography (74400) |
$601 |
$707 |
3.7× |
| Us abdl aorta screen aaa (76706) |
$288 |
$339 |
3.0× |
| Us breast unilateral complete (76641) |
$196 |
$231 |
2.0× |
| Us breast unilateral limited (76642) |
$163 |
$192 |
2.0× |
| Us chest (76604) |
$172 |
$202 |
1.8× |
| Us compl joint r-t w/image documentation (76881) |
$227 |
$267 |
2.4× |
| Us infant hips limited static (76886) |
$181 |
$213 |
2.3× |
| Us ob transvaginal (76817) |
$426 |
$501 |
4.4× |
| Us pelvic non ob complete (76856) |
$496 |
$584 |
5.2× |
| Us pelvic nonobstetric image dcmtn limited/f/u (76857) |
$475 |
$559 |
4.9× |
| Us pregnancy ltd (76815) |
$338 |
$398 |
3.5× |
| Us pregnant uterus 14 wk transabdl 1/1st gestat (76801) |
$290 |
$341 |
3.0× |
| Us retroperitoneal complete (76770) |
$400 |
$470 |
4.2× |
| Us retroperitoneal limited (76775) |
$355 |
$418 |
3.7× |
| Us scrotum and contents (76870) |
$300 |
$353 |
3.1× |
| Us soft tissue head/neck (76536) |
$700 |
$824 |
7.3× |
| Us xtr non-vasc lmtd (76882) |
$179 |
$210 |
1.9× |
| Wrist 2 views (73100) |
$175.50 |
$206 |
2.2× |
| X-Ray Ac Jts - Xr Acromioclavicular Joints Bilateral (73050) |
$184 |
$216 |
2.3× |
| X-Ray Ankle 3+ Vw - Xr Ankle 3+ Views Right (73610) |
$172.50 |
$203 |
2.2× |
| X-Ray Colon Air Contrast - Fl Barium Enema Air Contrast (74280) |
$1,465 |
$1,723 |
9.1× |
| X-Ray Elbow 2 Vw - Xr Elbow 1-2 Views Right (73070) |
$173.50 |
$204 |
2.2× |
| X-Ray Elbow 3+ Vw - Xr Elbow 3+ Views Right (73080) |
$214 |
$251.50 |
2.7× |
| X-ray exam hip uni 1 view (73501) |
$202 |
$238 |
2.5× |
| X-Ray Exam Hip Uni 2-3 Views (73502) |
$213 |
$250 |
2.7× |
| X-ray exam of femur 1 (73551) |
$150 |
$176 |
1.9× |
| X-Ray Facial Bones 3+ Vw - Xr Facial Bones 3+ Views (70150) |
$394 |
$464 |
4.1× |
| X-Ray Facial Bones <3 Vw - Xr Facial Bones 1-2 Views (70140) |
$230 |
$271 |
2.9× |
| X-Ray Foot 3+ Vw - Xr Foot 3+ Views Right (73630) |
$214 |
$251.50 |
2.7× |
| X-Ray Heel - Xr Calcaneus 2 Views Right (73650) |
$164.50 |
$193.50 |
2.1× |
| X-Ray Knee 4+ View - Xr Knee 4+ Views Right (73564) |
$264.50 |
$311 |
2.8× |
| X-Ray Knee Bilat Standing - Xr Knees Anteroposterior Standing Bilat (73565) |
$251 |
$295 |
3.1× |
| X-Ray Lumbar Spine 2/3 Vw - Xr Lumbar Spine 2-3 Views (72100) |
$201 |
$237 |
2.1× |
| X-Ray Lumbar Spine 6+ Vw - Xr Lumbar Spine 6+ Vws Including Bending (72114) |
$373 |
$439 |
3.9× |
| X-Ray Nasal Bones - Xr Nasal Bones (70160) |
$201 |
$237 |
2.5× |
| X-Ray Nose-Rectum Child F.B. - Xr Nose to Rectum Foreign Body Peds (76010) |
$207 |
$244 |
2.6× |
| X-Ray Orbits - Xr Orbits Complete 4+ Views (70200) |
$213 |
$250 |
2.2× |
| X-Ray Pelvis 3+ Vw - Xr Pelvis 3+ Views (72190) |
$188 |
$221 |
2.0× |
| X-Ray Ribs 2 Vw Unilat - Xr Ribs 2 Views Right (71100) |
$203 |
$239 |
2.5× |
| X-Ray Ribs, Chest 3+ Vw - Xr Ribs 2 Vws Lt W/ Chest Anteroposterior (71101) |
$249 |
$293 |
2.6× |
| X-Ray Ribs, Chest 4+ Vw - Xr Ribs 3 Vws Bil W/ Chest Posteroanterior (71111) |
$283 |
$333 |
2.9× |
| X-Ray Sacroiliac Jts 3+ Vw - Xr Sacroiliac Joints 3+ Views (72202) |
$213 |
$250 |
2.2× |
| X-Ray Sacrum/Coccyx 2+ Vw - Xr Sacrum Coccyx 2+ Views (72220) |
$201 |
$237 |
2.5× |
| X-Ray Shoulder 2+ Vw - Xr Shoulder 2+ Views Right (73030) |
$175.50 |
$206 |
2.2× |
| X-Ray Sinuses 3+ Vw - Xr Paranasal Sinuses 3+ Views (70220) |
$241 |
$283 |
3.0× |
| X-Ray Sinuses <3 Vw - Xr Paranasal Sinuses 1-2 Views (70210) |
$230 |
$271 |
2.9× |
| X-Ray Skull 4+ Vw - Xr Skull Complete 4+ Views (70260) |
$264 |
$310 |
2.7× |
| X-Ray Skull <4 Vw - Xr Skull 1-3 Views (70250) |
$204 |
$240 |
2.1× |
| X-Ray Spine One View - Xr Spine (72020) |
$204 |
$240 |
2.5× |
| X-Ray Sternum 2+ Vw - Xr Sternum 2+ Views (71120) |
$181 |
$213 |
2.3× |
| X-Ray Thoracic Spine 2 Vw - Xr Thoracic Spine 2 Views (72070) |
$156 |
$183 |
1.6× |
| X-Ray Thoracic Spine 4 Vw - Xr Thoracic Spine Complete 4+ Views (72074) |
$282 |
$332 |
2.9× |
| X-Ray Toe(S) - Xr Toes 2+ Views Right (73660) |
$134 |
$158 |
1.7× |
| X-Ray Wrist 3+ Vw - Xr Wrist 3+ Views Right (73110) |
$219 |
$257.50 |
2.7× |
| Xr c-spine 6 or more views (72052) |
$338 |
$398 |
3.5× |
| Xr chest 4+ views (71048) |
$230 |
$271 |
2.4× |
| Xr finger(s) 2+ views (73140) |
$133 |
$156 |
1.7× |
| XR Mastoids < 3 Views Bilateral (70120) |
$157 |
$185 |
1.6× |
| Xr shoulder 1 view (73020) |
$149 |
$175 |
1.9× |
| Xr spine cervical 4 or 5 views (72050) |
$287 |
$338 |
3.0× |
| Xr tibia/fibula 2 views (73590) |
$182 |
$214.50 |
2.3× |
| Xr tmj bilateral (70330) |
$286 |
$336 |
3.6× |
| Xray knee 1 or 2 views rt (73560) |
$177.50 |
$209 |
2.2× |