| Abdomen 2 views (74019) |
$360 |
$360 |
3.8× |
| Acute gastrointestinal blood loss imaging (78278) |
$974 |
$974 |
2.7× |
| Acute venous thrombus image (78456) |
$3,336.55 |
$3,336.55 |
2.8× |
| Ankle 2 views (73600) |
$260 |
$260 |
3.3× |
| Bone &/Joint Imaging Limited Area (78300) |
$974 |
$974 |
2.7× |
| Bone &/Joint Imaging Multiple Areas (78305) |
$974 |
$974 |
2.7× |
| Bone &/joint imaging whole body (78306) |
$974 |
$974 |
2.7× |
| Bone age studies (77072) |
$282 |
$282 |
3.0× |
| Bone Imaging 3 Phase (78315) |
$974 |
$974 |
2.7× |
| Bone survey complete (77075) |
$850 |
$850 |
8.9× |
| Brain image w/flow 4 + views (78606) |
$1,173 |
$1,173 |
2.4× |
| Brain imaging < 4 static views w vascular flow (78601) |
$974 |
$974 |
2.7× |
| Brain Imaging Minimum 4 Static Views (78605) |
$1,173 |
$1,173 |
2.4× |
| Cerebrospinal Fluid Flow W/O Matl Shunt Evaltj (78645) |
$1,173 |
$1,173 |
2.4× |
| Cervical spine 2 or 3 views (72040) |
$400 |
$400 |
5.0× |
| Chest 1 view (71045) |
$230 |
$230 |
2.9× |
| Chest 3 views (71047) |
$206.53 |
$206.53 |
2.6× |
| Cine/Vid X-Ray Throat/Esoph - Fl Esoph Barium Swlw W/ Video & Speech (74230) |
$700 |
$700 |
4.4× |
| Clavicle complete (73000) |
$312 |
$312 |
3.9× |
| CT abdomen and pelvis without and with contrast (74178) |
$2,207 |
$2,207 |
6.9× |
| CT abdomen and pelvis without contrast (74176) |
$3,500 |
$3,500 |
16.1× |
| CT abdomen w contrast (74160) |
$2,500 |
$2,500 |
15.7× |
| CT abdomen w wo contrast (74170) |
$3,200 |
$3,200 |
20.0× |
| CT abdomen w/o contrast (74150) |
$1,995 |
$1,995 |
21.0× |
| CT angiography upper extremity lt (73206) |
$2,233 |
$2,233 |
14.0× |
| CT c-spine w/o contrast (72125) |
$2,000 |
$2,000 |
21.0× |
| CT cervical spine w&w/o contrast (72127) |
$2,400 |
$2,400 |
15.0× |
| CT cervical spine with contrast (72126) |
$2,250 |
$2,250 |
7.1× |
| CT chest w/wo contrast (71270) |
$3,000 |
$3,000 |
18.8× |
| CT chest with contrast (71260) |
$2,250 |
$2,250 |
14.1× |
| CT head/brain with contrast (70460) |
$2,200 |
$2,200 |
13.8× |
| CT head/brain without and with contrast (70470) |
$2,500 |
$2,500 |
15.7× |
| CT heart no contrast quant eval coronry calcium (75571) |
$60 |
$60 |
0.8× |
| CT iac w contrast (70481) |
$2,250 |
$2,250 |
14.1× |
| CT limited/localized follow up study (76380) |
$782 |
$782 |
9.9× |
| CT lower ext w/o (73700) |
$1,650 |
$1,650 |
17.3× |
| CT lower extremity w wo contrast (73702) |
$2,200 |
$2,200 |
13.8× |
| CT lower extremity with contrast (73701) |
$2,000 |
$2,000 |
12.5× |
| CT lumbar spine w & w/o contrast (72133) |
$2,400 |
$2,400 |
15.0× |
| CT lumbar spine w/o contrast (72131) |
$2,000 |
$2,000 |
21.0× |
| CT lumbar spine with contrast (72132) |
$2,250 |
$2,250 |
7.1× |
| CT maxillofacial w contrast (70487) |
$1,800 |
$1,800 |
11.3× |
| CT maxillofacial w/o contrast (70486) |
$1,600 |
$1,600 |
16.8× |
| CT maxillofacial w/wo contrast (70488) |
$2,250 |
$2,250 |
14.1× |
| CT neck soft tissue w contrast (70491) |
$2,250 |
$2,250 |
14.1× |
| CT orbit sella/post fossa/ear w/o & w/contr matr (70482) |
$2,400 |
$2,400 |
15.0× |
| CT orbits w/o contrast (70480) |
$2,000 |
$2,000 |
21.0× |
| CT pelvis w & w/o contrast (72194) |
$2,400 |
$2,400 |
15.0× |
| CT pelvis w/o contrast (72192) |
$2,000 |
$2,000 |
21.0× |
| CT soft tissue neck w/o & w/contrast material (70492) |
$2,400 |
$2,400 |
15.0× |
| CT soft tissue neck w/o contrast (70490) |
$2,000 |
$2,000 |
21.0× |
| CT thoracic spine w/contrast (72129) |
$2,250 |
$2,250 |
14.1× |
| CT thoracic spine w/o contrast (72128) |
$2,000 |
$2,000 |
21.0× |
| CT thoracic spine w/wo contrast (72130) |
$2,400 |
$2,400 |
15.0× |
| CT thorax w/o contrast (71250) |
$2,000 |
$2,000 |
21.0× |
| CT upper extremity w/o & w/contrast material (73202) |
$1,900 |
$1,900 |
11.9× |
| CT upper extremity w/o contrast rt (73200) |
$1,550 |
$1,550 |
16.3× |
| CT upper extremity with contrast (73201) |
$1,750 |
$1,750 |
5.5× |
| Cta Abdl Aorta&Bi Iliofem W/Contrast&Postp (75635) |
$1,402 |
$1,402 |
8.8× |
| Cta Abdomen (74175) |
$1,481 |
$1,481 |
9.3× |
| CTA abdomen pelvis (74174) |
$2,005 |
$2,005 |
6.3× |
| CTA chest (71275) |
$1,120 |
$1,120 |
7.0× |
| Cta Head (70496) |
$1,450 |
$1,450 |
9.1× |
| CTA lwr ext w&w/o contrast (73706) |
$1,325 |
$1,325 |
8.3× |
| Cta Neck (70498) |
$1,325 |
$1,325 |
8.3× |
| Cta Pelvis (72191) |
$456.08 |
$456.08 |
2.9× |
| Cystography minimum 3 views rs&i (74430) |
$940.23 |
$940.23 |
3.0× |
| Dxa bone density study 1/> sites axial skel (77080) |
$300 |
$300 |
3.2× |
| Echoencephalography real time imaging (76506) |
$277.98 |
$277.98 |
2.9× |
| Esophagus (74220) |
$456.08 |
$456.08 |
2.9× |
| Fetal Biophysical Profile W/O Non-Stress Testing (76819) |
$277.98 |
$277.98 |
2.9× |
| Fluoroscopy up to 1 hr (76000) |
$587.50 |
$587.50 |
2.7× |
| Foot 2 views (73620) |
$289 |
$289 |
3.6× |
| Forearm 2 views (73090) |
$296 |
$296 |
3.7× |
| Gated Heart Planar Single (78472) |
$974 |
$974 |
2.7× |
| Hand 2 views (73120) |
$282 |
$282 |
3.0× |
| Hand 3 views (73130) |
$326 |
$326 |
4.1× |
| Hepatobil Syst Imag Inc Gb W/Pharma Intervenj (78227) |
$1,173 |
$1,173 |
2.4× |
| Hepatobiliary syst imaging including gallbladder (78226) |
$974 |
$974 |
2.7× |
| Ht muscle image spect sing (78451) |
$3,336.55 |
$3,336.55 |
2.8× |
| Humerus Min 2 Views Left (73060) |
$315 |
$315 |
4.0× |
| Hysterosalpingogram (74740) |
$587.50 |
$587.50 |
2.7× |
| Kidney Img Morphology Vascular Flow 1 W/O Rx (78707) |
$1,173 |
$1,173 |
2.4× |
| Kidney img morphology vascular flow 1 w/rx (78708) |
$1,173 |
$1,173 |
2.4× |
| Knee 3 views (73562) |
$350 |
$350 |
4.4× |
| Liver & spleen imaging static only (78215) |
$974 |
$974 |
2.7× |
| Liver & Spleen Imaging W/Vascular Flow (78216) |
$974 |
$974 |
2.7× |
| Lymphoscintigraphy (78195) |
$1,173 |
$1,173 |
2.4× |
| Meckels Diverticulum (78290) |
$974 |
$974 |
2.7× |
| MRI abdomen w contrast (74182) |
$2,880 |
$2,880 |
9.1× |
| MRI abdomen w/o & w/contrast material (74183) |
$3,695 |
$3,695 |
11.6× |
| MRI abdomen w/o contrast (74181) |
$2,800 |
$2,800 |
12.9× |
| MRI any jnt lwr ext with con lt (73722) |
$2,419 |
$2,419 |
3.4× |
| MRI any jt upper extremity w/contrast matrl (73222) |
$2,419 |
$2,419 |
3.4× |
| MRI c-spine with contrast (72142) |
$2,465 |
$2,465 |
7.8× |
| MRI cervical spine w/o contrast (72141) |
$2,149 |
$2,149 |
9.9× |
| MRI chest w/o & w/contrast material (71552) |
$3,322 |
$3,322 |
10.5× |
| MRI chest w/o contrast (71550) |
$2,046 |
$2,046 |
9.4× |
| MRI chest with contrast (71551) |
$2,465 |
$2,465 |
3.5× |
| MRI Forearm w/ Contrast Bilateral 73219 (73219) |
$2,233 |
$2,233 |
7.0× |
| MRI lower extrem oth/thn jt w/o contr matrl (73718) |
$1,954 |
$1,954 |
9.0× |
| MRI orbit face &/neck w/o contrast (70540) |
$2,149 |
$2,149 |
9.9× |
| MRI orbit/face/neck w&w/o cont (70543) |
$3,300 |
$3,300 |
10.4× |
| MRI orbit/face/neck w/contrast (70542) |
$2,465 |
$2,465 |
7.8× |
| MRI pelvis w contrast (72196) |
$2,465 |
$2,465 |
7.8× |
| MRI pelvis w/o & w/contrast material (72197) |
$3,322 |
$3,322 |
10.5× |
| MRI pelvis w/o contrast (72195) |
$2,149 |
$2,149 |
9.9× |
| MRI scan of arm joint before and after contrast (73223) |
$3,209 |
$3,209 |
10.1× |
| MRI scan of leg joint before and after contrast (73723) |
$2,791 |
$2,791 |
8.8× |
| MRI spinal canal cervical w/o & w/contr matrl (72156) |
$3,487 |
$3,487 |
11.0× |
| MRI spinal canal lumbar w/contrast material (72149) |
$2,465 |
$2,465 |
7.8× |
| MRI spinal canal lumbar w/o & w/contr matrl (72158) |
$3,487 |
$3,487 |
11.0× |
| MRI spinal canal thoracic w/contrast matrl (72147) |
$2,465 |
$2,465 |
7.8× |
| MRI spinal canal thoracic w/o & w/contr matrl (72157) |
$3,487 |
$3,487 |
11.0× |
| MRI thoracic spine w/o contrast (72146) |
$2,354 |
$2,354 |
10.8× |
| MRI upper ext joint w/o contrast (73221) |
$2,149 |
$2,149 |
9.9× |
| MRI upper extrem other than jt w/o & w/contras (73220) |
$2,344 |
$2,344 |
7.4× |
| MRI upper extremity oth than jt w/o contr matrl (73218) |
$1,954 |
$1,954 |
9.0× |
| Myocardial Spect Multiple Studies (78452) |
$3,336.55 |
$3,336.55 |
2.8× |
| Neck soft tissue (70360) |
$299 |
$299 |
3.8× |
| Nm gastric emptying study (78264) |
$974 |
$974 |
2.7× |
| Nm whole blood volume (78122) |
$1,249.45 |
$1,249.45 |
2.5× |
| Nuclear medicine study of stomach to assess emptying small bowel movement (78265) |
$974 |
$974 |
2.7× |
| Nuclear medicine study to assess blood clot in vein of both sides (78458) |
$974 |
$974 |
2.7× |
| Nuclear medicine study to assess blood clot in vein of side (78457) |
$2,838 |
$2,838 |
5.7× |
| Osseous survey infant (77076) |
$282 |
$282 |
3.0× |
| Parathyrd planar w/wo subtrj (78071) |
$974 |
$974 |
2.7× |
| Parathyroid imaging (78070) |
$974 |
$974 |
2.7× |
| Pelvis 1 or 2 views (72170) |
$282 |
$282 |
3.0× |
| Pr MRI, lower extr, w/o contrast f/u by contrast (73720) |
$2,344 |
$2,344 |
7.4× |
| Pulmonary Perfusion Imaging Particulate (78580) |
$974 |
$974 |
2.7× |
| Pulmonary Ventilation & Perfusion Imaging (78582) |
$1,173 |
$1,173 |
2.4× |
| Radex abscess/fistula/sinus tract rs&i (76080) |
$1,233.70 |
$1,233.70 |
2.5× |
| Radex entir thrc lmbr crv sac spi w/skull 2/3 vw (72082) |
$282 |
$282 |
3.0× |
| Radex X-Ray Exam Entire Spi 6/> Vw - Xr Entire Spine 6+ Vw (72084) |
$400 |
$400 |
4.2× |
| Radiolog exam mandible compl minimum 4 views (70110) |
$465 |
$465 |
4.9× |
| Radiologic Exam Abdomen 1 View - Xr Abdomen 1 View (74018) |
$280 |
$280 |
3.5× |
| Radiologic Exam Abdomen 3+ Views - Xr Abdomen 3+ Views (74021) |
$282 |
$282 |
3.0× |
| Radiologic Exam Chest 2 Views - Xr Chest 2 Views (71046) |
$279 |
$279 |
3.5× |
| Radiologic exam colon single contrast study (74270) |
$456.08 |
$456.08 |
2.9× |
| Radiologic exam upr gi trc double contrast study (74246) |
$456.08 |
$456.08 |
2.9× |
| Radiologic exam upr gi trc single contrast study (74240) |
$456.08 |
$456.08 |
2.9× |
| Radiologic Examination Femur Minimum 2 Views - Xr Femur 2+ Vw Lt (73552) |
$315 |
$315 |
4.0× |
| Ribs bilateral 3 views (71110) |
$500 |
$500 |
5.3× |
| Rp loclzj tum plnr whole body single day imaging (78802) |
$3,336.55 |
$3,336.55 |
6.7× |
| Sacroiliac Joints < 3 Views (72200) |
$330 |
$330 |
3.5× |
| Scanogram (77073) |
$277.98 |
$277.98 |
2.9× |
| Scapula complete (73010) |
$335 |
$335 |
3.5× |
| Sella turcica (70240) |
$206.53 |
$206.53 |
2.6× |
| Shuntogram indwelling nonvascular shunt rs&i (75809) |
$282 |
$282 |
3.0× |
| Small bowel series (74250) |
$456.08 |
$456.08 |
2.9× |
| Spine thoracic 3 views (72072) |
$277.98 |
$277.98 |
2.9× |
| Testicular Imaging With Vascular Flow (78761) |
$974 |
$974 |
2.7× |
| Therapeutic Enema (74283) |
$456.08 |
$456.08 |
2.9× |
| Thoracolumbar 2 views (72080) |
$256 |
$256 |
3.2× |
| Thyroid uptake measurement (78012) |
$974 |
$974 |
2.7× |
| Thyroid Uptake W/Blood Flow Sngle/Mult Quan Meas (78014) |
$974 |
$974 |
2.7× |
| Tumor Imaging Whole Body - Nm Tumor Local Whole Body Mult Days (78804) |
$3,336.55 |
$3,336.55 |
6.7× |
| Ultrasound, abdomen limited (76705) |
$618 |
$618 |
6.5× |
| Unlisted Ultrasound Procedure (76999) |
$462 |
$462 |
5.8× |
| Upper Extremity Infant (73092) |
$277.98 |
$277.98 |
2.9× |
| Ureteral Reflux Study Rp Voiding Cystogram (78740) |
$974 |
$974 |
2.7× |
| Urethrocystography voiding (74455) |
$587.50 |
$587.50 |
2.7× |
| Urography (pyelography), intravenous, with or without KUB, with or without tomography (74400) |
$565 |
$565 |
3.5× |
| Us abdl aorta screen aaa (76706) |
$478 |
$478 |
5.0× |
| Us breast unilateral complete (76641) |
$277.98 |
$277.98 |
2.9× |
| Us breast unilateral limited (76642) |
$206.53 |
$206.53 |
2.6× |
| Us chest (76604) |
$670 |
$670 |
7.0× |
| Us compl joint r-t w/image documentation (76881) |
$462 |
$462 |
4.9× |
| Us infant hips dynamic (76885) |
$206.53 |
$206.53 |
2.6× |
| Us ob transvaginal (76817) |
$672 |
$672 |
7.1× |
| Us pelvic non ob complete (76856) |
$815 |
$815 |
8.6× |
| Us pelvic nonobstetric image dcmtn limited/f/u (76857) |
$585 |
$585 |
6.1× |
| Us pregnancy ltd (76815) |
$277.98 |
$277.98 |
2.9× |
| Us pregnant uterus 14 wk transabdl 1/1st gestat (76801) |
$800 |
$800 |
8.4× |
| Us retroperitoneal complete (76770) |
$1,100 |
$1,100 |
11.6× |
| Us retroperitoneal limited (76775) |
$750 |
$750 |
7.9× |
| Us scrotum and contents (76870) |
$750 |
$750 |
7.9× |
| Us soft tissue head/neck (76536) |
$718 |
$718 |
7.5× |
| Us spinal canal and contents (76800) |
$277.98 |
$277.98 |
2.9× |
| Us transrectal (76872) |
$277.98 |
$277.98 |
2.9× |
| Us xtr non-vasc lmtd (76882) |
$452 |
$452 |
4.7× |
| Vascular flow imaging (78445) |
$974 |
$974 |
2.7× |
| Venogram extremity bilateral (75822) |
$3,590.40 |
$3,590.40 |
2.5× |
| Venography extremity unilateral rs&i (75820) |
$3,590.40 |
$3,590.40 |
2.5× |
| Vertebral fracture assessment via dxa (77086) |
$284 |
$284 |
3.6× |
| Wrist 2 views (73100) |
$260 |
$260 |
3.3× |
| X-Ray Abdomen,Comp Acute Series - Xr Abdomen 2 Vws With Chest 1 View (74022) |
$450 |
$450 |
4.7× |
| X-Ray Ac Jts - Xr Acromioclavicular Joints Bilateral (73050) |
$270 |
$270 |
3.4× |
| X-Ray Ankle 3+ Vw - Xr Ankle 3+ Views Right (73610) |
$379 |
$379 |
4.8× |
| X-Ray Colon Air Contrast - Fl Barium Enema Air Contrast (74280) |
$530 |
$530 |
3.3× |
| X-Ray Elbow 2 Vw - Xr Elbow 1-2 Views Right (73070) |
$279 |
$279 |
3.5× |
| X-Ray Elbow 3+ Vw - Xr Elbow 3+ Views Right (73080) |
$370 |
$370 |
4.7× |
| X-ray exam hip uni 1 view (73501) |
$206.53 |
$206.53 |
2.6× |
| X-Ray Exam Hip Uni 2-3 Views (73502) |
$228 |
$228 |
2.9× |
| X-Ray Exam Hips Bi 3-4 Views (73522) |
$282 |
$282 |
3.0× |
| X-ray exam of femur 1 (73551) |
$286 |
$286 |
3.6× |
| X-ray eye for foreign body (70030) |
$206.53 |
$206.53 |
2.6× |
| X-Ray Facial Bones 3+ Vw - Xr Facial Bones 3+ Views (70150) |
$399 |
$399 |
4.2× |
| X-Ray Foot 3+ Vw - Xr Foot 3+ Views Right (73630) |
$349 |
$349 |
4.4× |
| X-Ray Heel - Xr Calcaneus 2 Views Right (73650) |
$236 |
$236 |
3.0× |
| X-Ray Knee 4+ View - Xr Knee 4+ Views Right (73564) |
$465 |
$465 |
4.9× |
| X-Ray Knee Bilat Standing - Xr Knees Anteroposterior Standing Bilat (73565) |
$450 |
$450 |
5.7× |
| X-Ray Leg, Infant - Xr Lower Extremity 2+ Views Infant Left (73592) |
$206.53 |
$206.53 |
2.6× |
| X-Ray Lumbar Spine 2/3 Vw - Xr Lumbar Spine 2-3 Views (72100) |
$430 |
$430 |
4.5× |
| X-Ray Lumbar Spine 6+ Vw - Xr Lumbar Spine 6+ Vws Including Bending (72114) |
$450 |
$450 |
4.7× |
| X-Ray Lumbar Spine Flex/Exten - Xr Lumbar Spine 4+ Views W/ Flex Ext (72120) |
$277.98 |
$277.98 |
2.9× |
| X-Ray Nasal Bones - Xr Nasal Bones (70160) |
$339 |
$339 |
4.3× |
| X-Ray Nose-Rectum Child F.B. - Xr Nose to Rectum Foreign Body Peds (76010) |
$206.53 |
$206.53 |
2.6× |
| X-Ray Orbits - Xr Orbits Complete 4+ Views (70200) |
$282 |
$282 |
3.0× |
| X-Ray Pelvis 3+ Vw - Xr Pelvis 3+ Views (72190) |
$415 |
$415 |
4.4× |
| X-Ray Ribs 2 Vw Unilat - Xr Ribs 2 Views Right (71100) |
$300 |
$300 |
3.8× |
| X-Ray Ribs, Chest 3+ Vw - Xr Ribs 2 Vws Lt W/ Chest Anteroposterior (71101) |
$282 |
$282 |
3.0× |
| X-Ray Sacroiliac Jts 3+ Vw - Xr Sacroiliac Joints 3+ Views (72202) |
$277.98 |
$277.98 |
2.9× |
| X-Ray Sacrum/Coccyx 2+ Vw - Xr Sacrum Coccyx 2+ Views (72220) |
$345 |
$345 |
4.4× |
| X-Ray Shoulder 2+ Vw - Xr Shoulder 2+ Views Right (73030) |
$340 |
$340 |
4.3× |
| X-Ray Sinuses <3 Vw - Xr Paranasal Sinuses 1-2 Views (70210) |
$206.53 |
$206.53 |
2.6× |
| X-Ray Skull 4+ Vw - Xr Skull Complete 4+ Views (70260) |
$282 |
$282 |
3.0× |
| X-Ray Skull <4 Vw - Xr Skull 1-3 Views (70250) |
$387.50 |
$387.50 |
4.1× |
| X-Ray Spine One View - Xr Spine (72020) |
$206.53 |
$206.53 |
2.6× |
| X-Ray Sterno-Clavicluar Jt - Xr Sternoclavicular Joints 3+ Views (71130) |
$350 |
$350 |
4.4× |
| X-Ray Sternum 2+ Vw - Xr Sternum 2+ Views (71120) |
$350 |
$350 |
4.4× |
| X-Ray Thoracic Spine 2 Vw - Xr Thoracic Spine 2 Views (72070) |
$430 |
$430 |
4.5× |
| X-Ray Toe(S) - Xr Toes 2+ Views Right (73660) |
$260 |
$260 |
3.3× |
| X-Ray Wrist 3+ Vw - Xr Wrist 3+ Views Right (73110) |
$325 |
$325 |
4.1× |
| Xr c-spine 6 or more views (72052) |
$530 |
$530 |
5.6× |
| Xr finger(s) 2+ views (73140) |
$272 |
$272 |
3.4× |
| Xr shoulder 1 view (73020) |
$225 |
$225 |
2.8× |
| Xr spine cervical 4 or 5 views (72050) |
$282 |
$282 |
3.0× |
| Xr tibia/fibula 2 views (73590) |
$300 |
$300 |
3.8× |
| Xr tmj bilateral (70330) |
$206.53 |
$206.53 |
2.6× |
| Xray knee 1 or 2 views rt (73560) |
$270 |
$270 |
3.4× |