| Abdomen 2 views (74019) |
$121 |
$121 |
1.3× |
| Acute gastrointestinal blood loss imaging (78278) |
$651 |
$651 |
1.9× |
| Ankle 2 views (73600) |
$121 |
$121 |
1.6× |
| Bone &/joint imaging whole body (78306) |
$664 |
$664 |
1.9× |
| Bone age studies (77072) |
$119 |
$119 |
1.3× |
| Bone Imaging 3 Phase (78315) |
$747 |
$747 |
2.2× |
| Bone survey complete (77075) |
$196 |
$196 |
2.2× |
| Cervical spine 2 or 3 views (72040) |
$121 |
$121 |
1.6× |
| Chest 1 view (71045) |
$139 |
$139 |
1.9× |
| Clavicle complete (73000) |
$121 |
$121 |
1.6× |
| CT abdomen and pelvis without and with contrast (74178) |
$2,246 |
$2,246 |
7.5× |
| CT abdomen and pelvis without contrast (74176) |
$1,180 |
$1,180 |
5.7× |
| CT abdomen w contrast (74160) |
$912 |
$912 |
6.0× |
| CT abdomen w wo contrast (74170) |
$1,128 |
$1,128 |
7.5× |
| CT abdomen w/o contrast (74150) |
$757 |
$757 |
8.4× |
| CT angiography upper extremity lt (73206) |
$824 |
$824 |
5.4× |
| CT c-spine w/o contrast (72125) |
$787 |
$787 |
8.7× |
| CT chest w/wo contrast (71270) |
$1,177 |
$1,177 |
7.8× |
| CT chest with contrast (71260) |
$944 |
$944 |
6.2× |
| CT head/brain with contrast (70460) |
$754 |
$754 |
5.0× |
| CT head/brain without and with contrast (70470) |
$828 |
$828 |
5.5× |
| CT iac w contrast (70481) |
$632 |
$632 |
4.2× |
| CT limited/localized follow up study (76380) |
$467 |
$467 |
6.2× |
| CT lower ext w/o (73700) |
$661 |
$661 |
7.3× |
| CT lower extremity with contrast (73701) |
$888.50 |
$888.50 |
5.9× |
| CT lumbar spine w/o contrast (72131) |
$787 |
$787 |
8.7× |
| CT maxillofacial w contrast (70487) |
$990 |
$990 |
6.5× |
| CT maxillofacial w/o contrast (70486) |
$629 |
$629 |
7.0× |
| CT maxillofacial w/wo contrast (70488) |
$1,200 |
$1,200 |
7.9× |
| CT neck soft tissue w contrast (70491) |
$757 |
$757 |
5.0× |
| CT orbit sella/post fossa/ear w/o & w/contr matr (70482) |
$916 |
$916 |
6.1× |
| CT orbits w/o contrast (70480) |
$632 |
$632 |
7.0× |
| CT pelvis w & w/o contrast (72194) |
$1,128 |
$1,128 |
7.5× |
| CT pelvis w/o contrast (72192) |
$787 |
$787 |
8.7× |
| CT scan for measuring calcium and other minerals in bone (77078) |
$401 |
$401 |
5.3× |
| CT soft tissue neck w/o & w/contrast material (70492) |
$1,208 |
$1,208 |
8.0× |
| CT soft tissue neck w/o contrast (70490) |
$632 |
$632 |
7.0× |
| CT thoracic spine w/o contrast (72128) |
$787 |
$787 |
8.7× |
| CT thorax w/o contrast (71250) |
$787 |
$787 |
8.7× |
| CT upper extremity w/o contrast rt (73200) |
$661 |
$661 |
7.3× |
| CT upper extremity with contrast (73201) |
$787 |
$787 |
2.6× |
| Cta Abdl Aorta&Bi Iliofem W/Contrast&Postp (75635) |
$2,067 |
$2,067 |
13.7× |
| Cta Abdomen (74175) |
$1,999 |
$1,999 |
13.2× |
| CTA abdomen pelvis (74174) |
$1,703 |
$1,703 |
5.7× |
| CTA chest (71275) |
$2,067 |
$2,067 |
13.7× |
| Cta Head (70496) |
$1,753 |
$1,753 |
11.6× |
| CTA lwr ext w&w/o contrast (73706) |
$824 |
$824 |
5.4× |
| Cta Neck (70498) |
$2,067 |
$2,067 |
13.7× |
| Cta Pelvis (72191) |
$1,999 |
$1,999 |
13.2× |
| Cystography minimum 3 views rs&i (74430) |
$422 |
$422 |
1.4× |
| Esophagus (74220) |
$217 |
$217 |
1.4× |
| Fetal biophysical profile non-stress testing (76818) |
$248.50 |
$248.50 |
2.8× |
| Fetal Biophysical Profile W/O Non-Stress Testing (76819) |
$220 |
$220 |
2.4× |
| Fluoroscopy up to 1 hr (76000) |
$183 |
$183 |
0.9× |
| Foot 2 views (73620) |
$121 |
$121 |
1.6× |
| Forearm 2 views (73090) |
$121 |
$121 |
1.6× |
| Hand 2 views (73120) |
$121 |
$121 |
1.3× |
| Hand 3 views (73130) |
$135 |
$135 |
1.8× |
| Hepatobil Syst Imag Inc Gb W/Pharma Intervenj (78227) |
$863 |
$863 |
1.8× |
| Hepatobiliary syst imaging including gallbladder (78226) |
$633 |
$633 |
1.8× |
| Ht muscle image spect sing (78451) |
$1,299.93 |
$1,299.93 |
1.2× |
| Humerus Min 2 Views Left (73060) |
$121 |
$121 |
1.6× |
| Kidney Img Morphology Vascular Flow 1 W/O Rx (78707) |
$1,322 |
$1,322 |
2.8× |
| Knee 3 views (73562) |
$121 |
$121 |
1.6× |
| Lung perf&ventilat diferentl (78598) |
$1,139 |
$1,139 |
2.4× |
| MRA head w & w/o contrast (70546) |
$2,411 |
$2,411 |
8.0× |
| MRA head w/o contrast (70544) |
$1,516 |
$1,516 |
7.4× |
| Mra Neck W/O &W/Contrast Material (70549) |
$2,411 |
$2,411 |
8.0× |
| MRA neck w/o contrast (70547) |
$1,722 |
$1,722 |
8.4× |
| MRI abdomen w/o & w/contrast material (74183) |
$3,030 |
$3,030 |
10.1× |
| MRI abdomen w/o contrast (74181) |
$1,414.50 |
$1,414.50 |
6.9× |
| MRI cervical spine w/o contrast (72141) |
$1,378 |
$1,378 |
6.7× |
| MRI chest w/o contrast (71550) |
$1,211 |
$1,211 |
5.9× |
| MRI lower extrem oth/thn jt w/o contr matrl (73718) |
$1,378 |
$1,378 |
6.7× |
| MRI orbit face &/neck w/o contrast (70540) |
$1,378 |
$1,378 |
6.7× |
| MRI orbit/face/neck w&w/o cont (70543) |
$3,030 |
$3,030 |
10.1× |
| MRI pelvis w/o & w/contrast material (72197) |
$3,030 |
$3,030 |
10.1× |
| MRI pelvis w/o contrast (72195) |
$1,516 |
$1,516 |
7.4× |
| MRI scan of arm joint before and after contrast (73223) |
$2,755 |
$2,755 |
9.2× |
| MRI scan of leg joint before and after contrast (73723) |
$3,030 |
$3,030 |
10.1× |
| MRI spinal canal cervical w/o & w/contr matrl (72156) |
$2,755 |
$2,755 |
9.2× |
| MRI spinal canal lumbar w/o & w/contr matrl (72158) |
$2,755 |
$2,755 |
9.2× |
| MRI spinal canal thoracic w/o & w/contr matrl (72157) |
$3,168 |
$3,168 |
10.5× |
| MRI thoracic spine w/o contrast (72146) |
$1,516 |
$1,516 |
7.4× |
| MRI upper ext joint w/o contrast (73221) |
$1,378 |
$1,378 |
6.7× |
| MRI upper extrem other than jt w/o & w/contras (73220) |
$2,224.50 |
$2,224.50 |
7.4× |
| MRI upper extremity oth than jt w/o contr matrl (73218) |
$1,398.50 |
$1,398.50 |
6.8× |
| Myocardial Spect Multiple Studies (78452) |
$2,126 |
$2,126 |
1.9× |
| Neck soft tissue (70360) |
$121 |
$121 |
1.6× |
| Nm gastric emptying study (78264) |
$592 |
$592 |
1.7× |
| Ob Us Follow-Up Per Fetus - Us Ob Follow Up Transabdominal Approach (76816) |
$190 |
$190 |
2.1× |
| Parathyroid imaging (78070) |
$518 |
$518 |
1.5× |
| Pelvis 1 or 2 views (72170) |
$121 |
$121 |
1.3× |
| Pr MRI, lower extr, w/o contrast f/u by contrast (73720) |
$3,030 |
$3,030 |
10.1× |
| Pulmonary Perfusion Imaging Particulate (78580) |
$657 |
$657 |
1.9× |
| Radex hips bilateral with pelvis 2 views (73521) |
$121 |
$121 |
1.3× |
| Radiolog exam mandible compl minimum 4 views (70110) |
$116 |
$116 |
1.3× |
| Radiologic Exam Abdomen 1 View - Xr Abdomen 1 View (74018) |
$121 |
$121 |
1.6× |
| Radiologic Exam Chest 2 Views - Xr Chest 2 Views (71046) |
$139 |
$139 |
1.9× |
| Radiologic exam colon single contrast study (74270) |
$217 |
$217 |
1.4× |
| Radiologic exam upr gi trc single contrast study (74240) |
$217 |
$217 |
1.4× |
| Radiologic Examination Femur Minimum 2 Views - Xr Femur 2+ Vw Lt (73552) |
$121 |
$121 |
1.6× |
| Radiological examination surgical specimen (76098) |
$953 |
$953 |
2.0× |
| Scapula complete (73010) |
$121 |
$121 |
1.3× |
| Screening digital breast tomosynthesis (77063) |
$54 |
$54 |
2.3× |
| Small bowel series (74250) |
$217 |
$217 |
1.4× |
| Spine thoracic 3 views (72072) |
$121 |
$121 |
1.3× |
| Thyroid uptake measurement (78012) |
$518 |
$518 |
1.5× |
| Ultrasound, abdomen limited (76705) |
$237.50 |
$237.50 |
2.6× |
| Umbilical-artery Doppler (OB) (76820) |
$186 |
$186 |
2.1× |
| Unlisted Ultrasound Procedure (76999) |
$300 |
$300 |
4.0× |
| Upper Extremity Infant (73092) |
$121 |
$121 |
1.3× |
| Urethrocystography voiding (74455) |
$422 |
$422 |
2.1× |
| Us breast unilateral complete (76641) |
$416 |
$416 |
4.6× |
| Us breast unilateral limited (76642) |
$352 |
$352 |
4.7× |
| Us chest (76604) |
$161 |
$161 |
1.8× |
| Us ob detailed single fetus (76811) |
$480.50 |
$480.50 |
2.3× |
| Us ob transvaginal (76817) |
$207 |
$207 |
2.3× |
| Us pelvic non ob complete (76856) |
$222.50 |
$222.50 |
2.5× |
| Us pelvic nonobstetric image dcmtn limited/f/u (76857) |
$210 |
$210 |
2.3× |
| Us pregnancy ltd (76815) |
$208 |
$208 |
2.3× |
| Us pregnant uterus 14 wk transabdl 1/1st gestat (76801) |
$222.50 |
$222.50 |
2.5× |
| Us retroperitoneal complete (76770) |
$239 |
$239 |
2.7× |
| Us retroperitoneal limited (76775) |
$239 |
$239 |
2.7× |
| Us scrotum and contents (76870) |
$239 |
$239 |
2.7× |
| Us soft tissue head/neck (76536) |
$185 |
$185 |
2.1× |
| Us xtr non-vasc lmtd (76882) |
$305 |
$305 |
3.4× |
| Wrist 2 views (73100) |
$121 |
$121 |
1.6× |
| X-Ray Abdomen,Comp Acute Series - Xr Abdomen 2 Vws With Chest 1 View (74022) |
$192 |
$192 |
2.1× |
| X-Ray Ac Jts - Xr Acromioclavicular Joints Bilateral (73050) |
$121 |
$121 |
1.6× |
| X-Ray Ankle 3+ Vw - Xr Ankle 3+ Views Right (73610) |
$121 |
$121 |
1.6× |
| X-Ray Elbow 2 Vw - Xr Elbow 1-2 Views Right (73070) |
$121 |
$121 |
1.6× |
| X-Ray Elbow 3+ Vw - Xr Elbow 3+ Views Right (73080) |
$121 |
$121 |
1.6× |
| X-ray exam hip uni 1 view (73501) |
$121 |
$121 |
1.6× |
| X-Ray Exam Hip Uni 2-3 Views (73502) |
$121 |
$121 |
1.6× |
| X-Ray Facial Bones 3+ Vw - Xr Facial Bones 3+ Views (70150) |
$116 |
$116 |
1.3× |
| X-Ray Facial Bones <3 Vw - Xr Facial Bones 1-2 Views (70140) |
$192 |
$192 |
2.6× |
| X-Ray Foot 3+ Vw - Xr Foot 3+ Views Right (73630) |
$121 |
$121 |
1.6× |
| X-Ray Heel - Xr Calcaneus 2 Views Right (73650) |
$121 |
$121 |
1.6× |
| X-ray IV pyelogram+drip infusn (74410) |
$422 |
$422 |
2.8× |
| X-Ray Knee 4+ View - Xr Knee 4+ Views Right (73564) |
$121 |
$121 |
1.3× |
| X-Ray Knee Bilat Standing - Xr Knees Anteroposterior Standing Bilat (73565) |
$121 |
$121 |
1.6× |
| X-Ray Leg, Infant - Xr Lower Extremity 2+ Views Infant Left (73592) |
$121 |
$121 |
1.6× |
| X-Ray Lumbar Spine 2/3 Vw - Xr Lumbar Spine 2-3 Views (72100) |
$121 |
$121 |
1.3× |
| X-Ray Lumbar Spine 6+ Vw - Xr Lumbar Spine 6+ Vws Including Bending (72114) |
$203 |
$203 |
2.3× |
| X-Ray Nasal Bones - Xr Nasal Bones (70160) |
$121 |
$121 |
1.6× |
| X-Ray Nose-Rectum Child F.B. - Xr Nose to Rectum Foreign Body Peds (76010) |
$215.50 |
$215.50 |
2.9× |
| X-Ray Orbits - Xr Orbits Complete 4+ Views (70200) |
$116 |
$116 |
1.3× |
| X-Ray Ribs 2 Vw Unilat - Xr Ribs 2 Views Right (71100) |
$121 |
$121 |
1.6× |
| X-Ray Ribs, Chest 3+ Vw - Xr Ribs 2 Vws Lt W/ Chest Anteroposterior (71101) |
$128 |
$128 |
1.4× |
| X-Ray Ribs, Chest 4+ Vw - Xr Ribs 3 Vws Bil W/ Chest Posteroanterior (71111) |
$190 |
$190 |
2.1× |
| X-Ray Sacroiliac Jts 3+ Vw - Xr Sacroiliac Joints 3+ Views (72202) |
$121 |
$121 |
1.3× |
| X-Ray Sacrum/Coccyx 2+ Vw - Xr Sacrum Coccyx 2+ Views (72220) |
$121 |
$121 |
1.6× |
| X-Ray Shoulder 2+ Vw - Xr Shoulder 2+ Views Right (73030) |
$121 |
$121 |
1.6× |
| X-Ray Sinuses 3+ Vw - Xr Paranasal Sinuses 3+ Views (70220) |
$116 |
$116 |
1.5× |
| X-Ray Skull 4+ Vw - Xr Skull Complete 4+ Views (70260) |
$196 |
$196 |
2.2× |
| X-Ray Skull <4 Vw - Xr Skull 1-3 Views (70250) |
$124 |
$124 |
1.4× |
| X-Ray Spine One View - Xr Spine (72020) |
$121 |
$121 |
1.6× |
| X-Ray Sternum 2+ Vw - Xr Sternum 2+ Views (71120) |
$121 |
$121 |
1.6× |
| X-Ray Thoracic Spine 2 Vw - Xr Thoracic Spine 2 Views (72070) |
$121 |
$121 |
1.3× |
| X-Ray Thoracic Spine 4 Vw - Xr Thoracic Spine Complete 4+ Views (72074) |
$121 |
$121 |
1.3× |
| X-Ray Toe(S) - Xr Toes 2+ Views Right (73660) |
$121 |
$121 |
1.6× |
| X-Ray Wrist 3+ Vw - Xr Wrist 3+ Views Right (73110) |
$121 |
$121 |
1.6× |
| Xr c-spine 6 or more views (72052) |
$134 |
$134 |
1.5× |
| Xr chest 4+ views (71048) |
$220 |
$220 |
2.4× |
| Xr finger(s) 2+ views (73140) |
$121 |
$121 |
1.6× |
| Xr shoulder 1 view (73020) |
$121 |
$121 |
1.6× |
| Xr spine cervical 4 or 5 views (72050) |
$107 |
$107 |
1.2× |
| Xr tibia/fibula 2 views (73590) |
$121 |
$121 |
1.6× |
| Xr tmj bilateral (70330) |
$124 |
$124 |
1.7× |
| Xray knee 1 or 2 views rt (73560) |
$121 |
$121 |
1.6× |