| Acute gastrointestinal blood loss imaging (78278) |
$1,527 |
$1,527 |
4.2× |
| Angiography extremity bilateral rs&i (75716) |
$1,064 |
$1,064 |
0.4× |
| Angiography extremity unilateral rs&i (75710) |
$868 |
$868 |
0.3× |
| Ankle 2 views (73600) |
$533 |
$533 |
6.8× |
| Bone &/Joint Imaging Limited Area (78300) |
$1,527 |
$1,527 |
4.2× |
| Bone &/joint imaging whole body (78306) |
$1,527 |
$1,527 |
4.2× |
| Bone Imaging 3 Phase (78315) |
$1,527 |
$1,527 |
4.2× |
| Bone survey complete (77075) |
$1,650 |
$1,650 |
17.5× |
| Cervical spine 2 or 3 views (72040) |
$400 |
$400 |
5.1× |
| Chest 1 view (71045) |
$310 |
$310 |
3.9× |
| Clavicle complete (73000) |
$533 |
$533 |
6.8× |
| CT abdomen and pelvis without and with contrast (74178) |
$4,070 |
$4,070 |
12.9× |
| CT abdomen and pelvis without contrast (74176) |
$2,970 |
$2,970 |
13.8× |
| CT abdomen w contrast (74160) |
$2,200 |
$2,200 |
13.9× |
| CT abdomen w wo contrast (74170) |
$1,980 |
$1,980 |
12.5× |
| CT abdomen w/o contrast (74150) |
$1,650 |
$1,650 |
17.5× |
| CT angiography upper extremity lt (73206) |
$3,410 |
$3,410 |
21.5× |
| CT c-spine w/o contrast (72125) |
$1,430 |
$1,430 |
15.1× |
| CT cervical spine w&w/o contrast (72127) |
$1,760 |
$1,760 |
11.1× |
| CT cervical spine with contrast (72126) |
$1,650 |
$1,650 |
5.2× |
| CT chest w/wo contrast (71270) |
$2,090 |
$2,090 |
13.2× |
| CT chest with contrast (71260) |
$2,310 |
$2,310 |
14.6× |
| CT head/brain with contrast (70460) |
$1,650 |
$1,650 |
10.4× |
| CT head/brain without and with contrast (70470) |
$1,870 |
$1,870 |
11.8× |
| CT heart no contrast quant eval coronry calcium (75571) |
$99 |
$99 |
1.3× |
| CT iac w contrast (70481) |
$1,540 |
$1,540 |
9.7× |
| CT lower ext w/o (73700) |
$1,430 |
$1,430 |
15.1× |
| CT lower extremity w wo contrast (73702) |
$1,760 |
$1,760 |
11.1× |
| CT lower extremity with contrast (73701) |
$1,430 |
$1,430 |
9.0× |
| CT lumbar spine w & w/o contrast (72133) |
$1,870 |
$1,870 |
11.8× |
| CT lumbar spine w/o contrast (72131) |
$1,540 |
$1,540 |
16.3× |
| CT lumbar spine with contrast (72132) |
$1,650 |
$1,650 |
5.2× |
| CT maxillofacial w contrast (70487) |
$1,540 |
$1,540 |
9.7× |
| CT maxillofacial w/o contrast (70486) |
$1,430 |
$1,430 |
15.1× |
| CT maxillofacial w/wo contrast (70488) |
$1,760 |
$1,760 |
11.1× |
| CT neck soft tissue w contrast (70491) |
$1,650 |
$1,650 |
10.4× |
| CT orbit sella/post fossa/ear w/o & w/contr matr (70482) |
$1,760 |
$1,760 |
11.1× |
| CT orbits w/o contrast (70480) |
$1,430 |
$1,430 |
15.1× |
| CT pelvis w & w/o contrast (72194) |
$1,525 |
$1,525 |
9.6× |
| CT pelvis w/o contrast (72192) |
$1,980 |
$1,980 |
21.0× |
| CT soft tissue neck w/o & w/contrast material (70492) |
$1,760 |
$1,760 |
11.1× |
| CT soft tissue neck w/o contrast (70490) |
$1,430 |
$1,430 |
15.1× |
| CT thoracic spine w/contrast (72129) |
$1,650 |
$1,650 |
10.4× |
| CT thoracic spine w/o contrast (72128) |
$1,430 |
$1,430 |
15.1× |
| CT thoracic spine w/wo contrast (72130) |
$2,090 |
$2,090 |
13.2× |
| CT thorax w/o contrast (71250) |
$1,540 |
$1,540 |
16.3× |
| CT upper extremity w/o & w/contrast material (73202) |
$1,650 |
$1,650 |
10.4× |
| CT upper extremity w/o contrast rt (73200) |
$1,430 |
$1,430 |
15.1× |
| CT upper extremity with contrast (73201) |
$1,430 |
$1,430 |
4.5× |
| Cta Abdl Aorta&Bi Iliofem W/Contrast&Postp (75635) |
$7,040 |
$7,040 |
44.5× |
| Cta Abdomen (74175) |
$2,530 |
$2,530 |
16.0× |
| CTA abdomen pelvis (74174) |
$4,950 |
$4,950 |
15.7× |
| CTA chest (71275) |
$3,300 |
$3,300 |
20.8× |
| Cta Head (70496) |
$3,190 |
$3,190 |
20.1× |
| CTA lwr ext w&w/o contrast (73706) |
$1,435 |
$1,435 |
9.1× |
| Cta Neck (70498) |
$3,410 |
$3,410 |
21.5× |
| Doppler Echo Fetal Spectral Display Complete (76827) |
$550 |
$550 |
5.8× |
| Dxa bone density study 1/> sites axial skel (77080) |
$356 |
$356 |
3.8× |
| Dxa bone density study 1/>sites appendiclr skel (77081) |
$160 |
$160 |
2.0× |
| Esophagus (74220) |
$660 |
$660 |
4.2× |
| Fetal biophysical profile non-stress testing (76818) |
$735 |
$735 |
7.8× |
| Fluoroscopy up to 1 hr (76000) |
$331 |
$331 |
1.5× |
| Foot 2 views (73620) |
$506.50 |
$506.50 |
6.4× |
| Forearm 2 views (73090) |
$528 |
$528 |
6.7× |
| Gated Heart Planar Single (78472) |
$1,527 |
$1,527 |
4.2× |
| Hand 2 views (73120) |
$524.50 |
$524.50 |
5.6× |
| Hand 3 views (73130) |
$369 |
$369 |
4.7× |
| Hepatobil Syst Imag Inc Gb W/Pharma Intervenj (78227) |
$1,982 |
$1,982 |
4.0× |
| Hepatobiliary syst imaging including gallbladder (78226) |
$1,527 |
$1,527 |
4.2× |
| Ht muscle image spect sing (78451) |
$5,289 |
$5,289 |
4.5× |
| Humerus Min 2 Views Left (73060) |
$506.50 |
$506.50 |
6.4× |
| Kidney Img Morphology Vascular Flow 1 W/O Rx (78707) |
$1,982 |
$1,982 |
4.0× |
| Kidney img morphology vascular flow 1 w/rx (78708) |
$1,982 |
$1,982 |
4.0× |
| Knee 3 views (73562) |
$382 |
$382 |
4.9× |
| Liver & spleen imaging static only (78215) |
$1,527 |
$1,527 |
4.2× |
| Liver imaging static only (78201) |
$1,982 |
$1,982 |
4.0× |
| Lung perfusion differential (78597) |
$1,527 |
$1,527 |
4.2× |
| Lung Ventilation Imaging (78579) |
$1,527 |
$1,527 |
4.2× |
| Meckels Diverticulum (78290) |
$1,527 |
$1,527 |
4.2× |
| MRA head w & w/o contrast (70546) |
$3,740 |
$3,740 |
11.9× |
| MRA head w/o contrast (70544) |
$2,640 |
$2,640 |
12.3× |
| MRA head with contrast (70545) |
$2,970 |
$2,970 |
9.4× |
| MRA neck w contrast (70548) |
$2,860 |
$2,860 |
9.1× |
| Mra Neck W/O &W/Contrast Material (70549) |
$3,520 |
$3,520 |
11.2× |
| MRA neck w/o contrast (70547) |
$2,900 |
$2,900 |
13.5× |
| MRI abdomen w contrast (74182) |
$3,190 |
$3,190 |
10.1× |
| MRI abdomen w/o & w/contrast material (74183) |
$3,080 |
$3,080 |
9.8× |
| MRI abdomen w/o contrast (74181) |
$2,420 |
$2,420 |
11.2× |
| MRI any jnt lwr ext with con lt (73722) |
$2,970 |
$2,970 |
4.2× |
| MRI any jt upper extremity w/contrast matrl (73222) |
$3,080 |
$3,080 |
4.4× |
| MRI c-spine with contrast (72142) |
$2,750 |
$2,750 |
8.7× |
| MRI cervical spine w/o contrast (72141) |
$3,300 |
$3,300 |
15.3× |
| MRI chest w/o & w/contrast material (71552) |
$3,080 |
$3,080 |
9.8× |
| MRI chest w/o contrast (71550) |
$2,090 |
$2,090 |
9.7× |
| MRI chest with contrast (71551) |
$2,310 |
$2,310 |
3.3× |
| MRI lower extrem oth/thn jt w/contrast matrl (73719) |
$2,970 |
$2,970 |
9.4× |
| MRI lower extrem oth/thn jt w/o contr matrl (73718) |
$3,410 |
$3,410 |
15.8× |
| MRI orbit face &/neck w/o contrast (70540) |
$2,420 |
$2,420 |
11.2× |
| MRI orbit/face/neck w&w/o cont (70543) |
$3,080 |
$3,080 |
9.8× |
| MRI orbit/face/neck w/contrast (70542) |
$35 |
$35 |
0.1× |
| MRI pelvis w contrast (72196) |
$3,080 |
$3,080 |
9.8× |
| MRI pelvis w/o & w/contrast material (72197) |
$3,080 |
$3,080 |
9.8× |
| MRI pelvis w/o contrast (72195) |
$3,080 |
$3,080 |
14.3× |
| MRI scan of arm joint before and after contrast (73223) |
$3,080 |
$3,080 |
9.8× |
| MRI scan of leg joint before and after contrast (73723) |
$3,630 |
$3,630 |
11.5× |
| MRI spinal canal cervical w/o & w/contr matrl (72156) |
$4,950 |
$4,950 |
15.7× |
| MRI spinal canal lumbar w/contrast material (72149) |
$2,750 |
$2,750 |
8.7× |
| MRI spinal canal lumbar w/o & w/contr matrl (72158) |
$5,170 |
$5,170 |
16.4× |
| MRI spinal canal thoracic w/contrast matrl (72147) |
$2,750 |
$2,750 |
8.7× |
| MRI spinal canal thoracic w/o & w/contr matrl (72157) |
$4,950 |
$4,950 |
15.7× |
| MRI thoracic spine w/o contrast (72146) |
$3,520 |
$3,520 |
16.3× |
| MRI tmj (70336) |
$2,200 |
$2,200 |
10.2× |
| MRI upper ext joint w/o contrast (73221) |
$3,080 |
$3,080 |
14.3× |
| MRI upper extrem other than jt w/o & w/contras (73220) |
$3,080 |
$3,080 |
9.8× |
| MRI upper extremity oth than jt w/o contr matrl (73218) |
$2,530 |
$2,530 |
11.7× |
| Myocardial Spect Multiple Studies (78452) |
$5,289 |
$5,289 |
4.5× |
| Nm gastric emptying study (78264) |
$1,527 |
$1,527 |
4.2× |
| Osseous survey infant (77076) |
$550 |
$550 |
5.8× |
| Osseous survey limited (77074) |
$408 |
$408 |
4.3× |
| Parathyrd planar w/wo subtrj (78071) |
$1,765.20 |
$1,765.20 |
4.9× |
| Parathyroid imaging (78070) |
$1,527 |
$1,527 |
4.2× |
| Pelvis 1 or 2 views (72170) |
$343 |
$343 |
3.6× |
| PET whole body (78813) |
$5,887 |
$5,887 |
4.6× |
| Pr MRI, lower extr, w/o contrast f/u by contrast (73720) |
$3,080 |
$3,080 |
9.8× |
| Pulmonary Perfusion Imaging Particulate (78580) |
$1,527 |
$1,527 |
4.2× |
| Pulmonary Ventilation & Perfusion Imaging (78582) |
$1,982 |
$1,982 |
4.0× |
| Radex hips bilateral with pelvis 2 views (73521) |
$600 |
$600 |
6.4× |
| Radex X-Ray Exam Entire Spi 6/> Vw - Xr Entire Spine 6+ Vw (72084) |
$757 |
$757 |
8.0× |
| Radiolog exam mandible compl minimum 4 views (70110) |
$450 |
$450 |
4.8× |
| Radiologic Exam Abdomen 1 View - Xr Abdomen 1 View (74018) |
$300 |
$300 |
3.8× |
| Radiologic Exam Abdomen 3+ Views - Xr Abdomen 3+ Views (74021) |
$428 |
$428 |
4.5× |
| Radiologic Exam Chest 2 Views - Xr Chest 2 Views (71046) |
$383 |
$383 |
4.9× |
| Radiologic Examination Femur Minimum 2 Views - Xr Femur 2+ Vw Lt (73552) |
$415 |
$415 |
5.3× |
| Radiological examination surgical specimen (76098) |
$96 |
$96 |
0.2× |
| Ribs bilateral 3 views (71110) |
$455 |
$455 |
4.8× |
| Rp loclzj tum plnr 2+area 1+d img/1 area img>2+d (78801) |
$1,527 |
$1,527 |
4.2× |
| Rp loclzj tum plnr whole body single day imaging (78802) |
$5,289 |
$5,289 |
10.8× |
| Sacroiliac Joints < 3 Views (72200) |
$295 |
$295 |
3.1× |
| Scapula complete (73010) |
$513 |
$513 |
5.4× |
| Screening digital breast tomosynthesis (77063) |
$276 |
$276 |
11.8× |
| Spine thoracic 3 views (72072) |
$455 |
$455 |
4.8× |
| Thyroid Uptake W/Blood Flow Sngle/Mult Quan Meas (78014) |
$1,527 |
$1,527 |
4.2× |
| Ultrasound, abdomen limited (76705) |
$610 |
$610 |
6.5× |
| Upper Extremity Infant (73092) |
$155 |
$155 |
1.6× |
| Urography (pyelography), intravenous, with or without KUB, with or without tomography (74400) |
$1,025 |
$1,025 |
6.5× |
| Us abdl aorta screen aaa (76706) |
$355 |
$355 |
3.8× |
| Us breast unilateral complete (76641) |
$290 |
$290 |
3.1× |
| Us breast unilateral limited (76642) |
$220 |
$220 |
2.8× |
| Us chest (76604) |
$500 |
$500 |
5.3× |
| Us compl joint r-t w/image documentation (76881) |
$830 |
$830 |
8.8× |
| Us ob transvaginal (76817) |
$570 |
$570 |
6.0× |
| Us pelvic non ob complete (76856) |
$920 |
$920 |
9.7× |
| Us pelvic nonobstetric image dcmtn limited/f/u (76857) |
$469 |
$469 |
5.0× |
| Us pregnancy ltd (76815) |
$475 |
$475 |
5.0× |
| Us pregnant uterus 14 wk transabdl 1/1st gestat (76801) |
$645 |
$645 |
6.8× |
| Us retroperitoneal complete (76770) |
$675 |
$675 |
7.2× |
| Us retroperitoneal limited (76775) |
$1,125 |
$1,125 |
11.9× |
| Us scrotum and contents (76870) |
$385 |
$385 |
4.1× |
| Us soft tissue head/neck (76536) |
$715 |
$715 |
7.6× |
| Us xtr non-vasc lmtd (76882) |
$425 |
$425 |
4.5× |
| Wrist 2 views (73100) |
$343 |
$343 |
4.4× |
| X-Ray Abdomen,Comp Acute Series - Xr Abdomen 2 Vws With Chest 1 View (74022) |
$550 |
$550 |
5.8× |
| X-Ray Ac Jts - Xr Acromioclavicular Joints Bilateral (73050) |
$330 |
$330 |
4.2× |
| X-Ray Ankle 3+ Vw - Xr Ankle 3+ Views Right (73610) |
$385 |
$385 |
4.9× |
| X-Ray Elbow 2 Vw - Xr Elbow 1-2 Views Right (73070) |
$500 |
$500 |
6.4× |
| X-Ray Elbow 3+ Vw - Xr Elbow 3+ Views Right (73080) |
$495 |
$495 |
6.3× |
| X-ray exam entire spi 4/5 vw (72083) |
$647 |
$647 |
6.9× |
| X-ray exam hip uni 1 view (73501) |
$256 |
$256 |
3.3× |
| X-Ray Exam Hip Uni 2-3 Views (73502) |
$396 |
$396 |
5.0× |
| X-Ray Facial Bones 3+ Vw - Xr Facial Bones 3+ Views (70150) |
$472 |
$472 |
5.0× |
| X-Ray Facial Bones <3 Vw - Xr Facial Bones 1-2 Views (70140) |
$326 |
$326 |
4.1× |
| X-Ray Foot 3+ Vw - Xr Foot 3+ Views Right (73630) |
$358 |
$358 |
4.6× |
| X-Ray Heel - Xr Calcaneus 2 Views Right (73650) |
$288 |
$288 |
3.7× |
| X-Ray Knee 4+ View - Xr Knee 4+ Views Right (73564) |
$500 |
$500 |
5.3× |
| X-Ray Knee Bilat Standing - Xr Knees Anteroposterior Standing Bilat (73565) |
$347 |
$347 |
4.4× |
| X-Ray Leg, Infant - Xr Lower Extremity 2+ Views Infant Left (73592) |
$180 |
$180 |
2.3× |
| X-Ray Lumbar Spine 2/3 Vw - Xr Lumbar Spine 2-3 Views (72100) |
$425 |
$425 |
4.5× |
| X-Ray Lumbar Spine 6+ Vw - Xr Lumbar Spine 6+ Vws Including Bending (72114) |
$858 |
$858 |
9.1× |
| X-Ray Nasal Bones - Xr Nasal Bones (70160) |
$362 |
$362 |
4.6× |
| X-Ray Nose-Rectum Child F.B. - Xr Nose to Rectum Foreign Body Peds (76010) |
$211 |
$211 |
2.7× |
| X-Ray Orbits - Xr Orbits Complete 4+ Views (70200) |
$425 |
$425 |
4.5× |
| X-Ray Pelvis 3+ Vw - Xr Pelvis 3+ Views (72190) |
$565 |
$565 |
6.0× |
| X-Ray Ribs 2 Vw Unilat - Xr Ribs 2 Views Right (71100) |
$385 |
$385 |
4.9× |
| X-Ray Ribs, Chest 4+ Vw - Xr Ribs 3 Vws Bil W/ Chest Posteroanterior (71111) |
$690 |
$690 |
7.3× |
| X-Ray Sacroiliac Jts 3+ Vw - Xr Sacroiliac Joints 3+ Views (72202) |
$525 |
$525 |
5.6× |
| X-Ray Sacrum/Coccyx 2+ Vw - Xr Sacrum Coccyx 2+ Views (72220) |
$359 |
$359 |
4.6× |
| X-Ray Shoulder 2+ Vw - Xr Shoulder 2+ Views Right (73030) |
$408 |
$408 |
5.2× |
| X-Ray Sinuses 3+ Vw - Xr Paranasal Sinuses 3+ Views (70220) |
$435 |
$435 |
5.5× |
| X-Ray Sinuses <3 Vw - Xr Paranasal Sinuses 1-2 Views (70210) |
$275 |
$275 |
3.5× |
| X-Ray Skull 4+ Vw - Xr Skull Complete 4+ Views (70260) |
$524 |
$524 |
5.6× |
| X-Ray Skull <4 Vw - Xr Skull 1-3 Views (70250) |
$351 |
$351 |
3.7× |
| X-Ray Spine One View - Xr Spine (72020) |
$330 |
$330 |
4.2× |
| X-Ray Sterno-Clavicluar Jt - Xr Sternoclavicular Joints 3+ Views (71130) |
$315 |
$315 |
4.0× |
| X-Ray Sternum 2+ Vw - Xr Sternum 2+ Views (71120) |
$343 |
$343 |
4.4× |
| X-Ray Thoracic Spine 2 Vw - Xr Thoracic Spine 2 Views (72070) |
$300 |
$300 |
3.2× |
| X-Ray Thoracic Spine 4 Vw - Xr Thoracic Spine Complete 4+ Views (72074) |
$456 |
$456 |
4.8× |
| X-Ray Toe(S) - Xr Toes 2+ Views Right (73660) |
$310 |
$310 |
3.9× |
| X-Ray Wrist 3+ Vw - Xr Wrist 3+ Views Right (73110) |
$355 |
$355 |
4.5× |
| Xr c-spine 6 or more views (72052) |
$608 |
$608 |
6.4× |
| Xr finger(s) 2+ views (73140) |
$328 |
$328 |
4.2× |
| Xr shoulder 1 view (73020) |
$330 |
$330 |
4.2× |
| Xr spine cervical 4 or 5 views (72050) |
$595 |
$595 |
6.3× |
| Xr tibia/fibula 2 views (73590) |
$591.50 |
$591.50 |
7.5× |
| Xr tmj bilateral (70330) |
$384 |
$384 |
4.9× |
| Xray knee 1 or 2 views rt (73560) |
$520 |
$520 |
6.6× |