| Acute gastrointestinal blood loss imaging (78278) |
$550.20 |
$786 |
1.4× |
| Bone &/Joint Imaging Limited Area (78300) |
$432.60 |
$618 |
1.1× |
| Bone &/joint imaging whole body (78306) |
$630 |
$900 |
1.6× |
| Bone Imaging 3 Phase (78315) |
$772.80 |
$1,104 |
1.9× |
| Bone survey complete (77075) |
$236.60 |
$338 |
2.3× |
| Cervical spine 2 or 3 views (72040) |
$130.90 |
$187 |
1.5× |
| Chest 1 view (71045) |
$105.70 |
$151 |
1.2× |
| Cine/Vid X-Ray Throat/Esoph - Fl Esoph Barium Swlw W/ Video & Speech (74230) |
$214.90 |
$307 |
1.2× |
| Clavicle complete (73000) |
$130.90 |
$187 |
1.5× |
| Computed Tomography Thorax Lw Dose Lng Ca Scr C- (71271) |
$121.39 |
$173.41 |
1.2× |
| CT abdomen and pelvis without and with contrast (74178) |
$425.95 |
$608.50 |
1.2× |
| CT abdomen and pelvis without contrast (74176) |
$1,455.30 |
$2,079 |
6.1× |
| CT abdomen w contrast (74160) |
$423.50 |
$605 |
2.4× |
| CT abdomen w/o contrast (74150) |
$508.55 |
$726.50 |
4.8× |
| CT angiography upper extremity lt (73206) |
$347.89 |
$496.98 |
2.0× |
| CT cervical spine with contrast (72126) |
$802.20 |
$1,146 |
2.3× |
| CT chest w/wo contrast (71270) |
$423.50 |
$605 |
2.4× |
| CT chest with contrast (71260) |
$423.50 |
$605 |
2.4× |
| CT head/brain with contrast (70460) |
$698.60 |
$998 |
4.0× |
| CT head/brain without and with contrast (70470) |
$423.50 |
$605 |
2.4× |
| CT heart no contrast quant eval coronry calcium (75571) |
$133 |
$190 |
1.5× |
| CT iac w contrast (70481) |
$410.36 |
$586.23 |
2.3× |
| CT lower ext w/o (73700) |
$280 |
$400 |
2.7× |
| CT lower extremity w wo contrast (73702) |
$382.90 |
$547 |
2.2× |
| CT lower extremity with contrast (73701) |
$423.50 |
$605 |
2.4× |
| CT lumbar spine w/o contrast (72131) |
$235.20 |
$336 |
2.2× |
| CT maxillofacial w contrast (70487) |
$423.50 |
$605 |
2.4× |
| CT maxillofacial w/o contrast (70486) |
$331.80 |
$474 |
3.2× |
| CT maxillofacial w/wo contrast (70488) |
$1,173.90 |
$1,677 |
6.7× |
| CT neck soft tissue w contrast (70491) |
$423.50 |
$605 |
2.4× |
| CT orbit sella/post fossa/ear w/o & w/contr matr (70482) |
$410.36 |
$586.23 |
2.3× |
| CT orbits w/o contrast (70480) |
$185.84 |
$265.49 |
1.8× |
| CT pelvis w & w/o contrast (72194) |
$382.90 |
$547 |
2.2× |
| CT pelvis w/o contrast (72192) |
$331.10 |
$473 |
3.2× |
| CT soft tissue neck w/o & w/contrast material (70492) |
$382.90 |
$547 |
2.2× |
| CT soft tissue neck w/o contrast (70490) |
$327.60 |
$468 |
3.1× |
| CT thoracic spine w/o contrast (72128) |
$284.90 |
$407 |
2.7× |
| CT thorax w/o contrast (71250) |
$319.90 |
$457 |
3.0× |
| CT upper extremity w/o & w/contrast material (73202) |
$1,066.80 |
$1,524 |
6.1× |
| CT upper extremity w/o contrast rt (73200) |
$285.60 |
$408 |
2.7× |
| CT upper extremity with contrast (73201) |
$806.40 |
$1,152 |
2.3× |
| Cta Abdl Aorta&Bi Iliofem W/Contrast&Postp (75635) |
$347.89 |
$496.98 |
2.0× |
| CTA abdomen pelvis (74174) |
$347.89 |
$496.98 |
1.0× |
| CTA chest (71275) |
$347.89 |
$496.98 |
2.0× |
| Cta Head (70496) |
$347.89 |
$496.98 |
2.0× |
| CTA lwr ext w&w/o contrast (73706) |
$347.89 |
$496.98 |
2.0× |
| Cta Neck (70498) |
$347.89 |
$496.98 |
2.0× |
| Cystography minimum 3 views rs&i (74430) |
$350.70 |
$501 |
1.0× |
| Dxa bone density study 1/> sites axial skel (77080) |
$249.90 |
$357 |
2.4× |
| Esophagus (74220) |
$186.40 |
$266.29 |
1.1× |
| Fetal biophysical profile non-stress testing (76818) |
$194.60 |
$278 |
1.9× |
| Fetal Biophysical Profile W/O Non-Stress Testing (76819) |
$212.10 |
$303 |
2.0× |
| Forearm 2 views (73090) |
$130.90 |
$187 |
1.5× |
| Hand 2 views (73120) |
$140.70 |
$201 |
1.3× |
| Hand 3 views (73130) |
$167.65 |
$239.50 |
1.9× |
| Hepatobil Syst Imag Inc Gb W/Pharma Intervenj (78227) |
$560 |
$800 |
1.0× |
| Hepatobiliary syst imaging including gallbladder (78226) |
$522.90 |
$747 |
1.3× |
| Ht muscle image spect sing (78451) |
$1,996.09 |
$2,851.55 |
1.5× |
| Humerus Min 2 Views Left (73060) |
$130.90 |
$187 |
1.5× |
| Knee 3 views (73562) |
$189.70 |
$271 |
2.2× |
| Lymphoscintigraphy (78195) |
$798 |
$1,140 |
1.5× |
| MRA head w & w/o contrast (70546) |
$2,031.40 |
$2,902 |
5.8× |
| MRA head w/o contrast (70544) |
$484.40 |
$692 |
2.0× |
| MRA neck w contrast (70548) |
$1,411.20 |
$2,016 |
4.0× |
| Mra Neck W/O &W/Contrast Material (70549) |
$2,031.40 |
$2,902 |
5.8× |
| MRA neck w/o contrast (70547) |
$489.30 |
$699 |
2.0× |
| MRI abdomen w/o & w/contrast material (74183) |
$810.60 |
$1,158 |
2.3× |
| MRI abdomen w/o contrast (74181) |
$484.40 |
$692 |
2.0× |
| MRI any jt upper extremity w/contrast matrl (73222) |
$1,494.50 |
$2,135 |
1.9× |
| MRI c-spine with contrast (72142) |
$1,411.20 |
$2,016 |
4.0× |
| MRI cervical spine w/o contrast (72141) |
$484.40 |
$692 |
2.0× |
| MRI chest w/o & w/contrast material (71552) |
$692.23 |
$988.90 |
2.0× |
| MRI chest with contrast (71551) |
$1,066.14 |
$1,523.05 |
1.4× |
| MRI lower extrem oth/thn jt w/contrast matrl (73719) |
$1,467.55 |
$2,096.50 |
4.2× |
| MRI lower extrem oth/thn jt w/o contr matrl (73718) |
$810.60 |
$1,158 |
3.4× |
| MRI orbit/face/neck w&w/o cont (70543) |
$810.60 |
$1,158 |
2.3× |
| MRI orbit/face/neck w/contrast (70542) |
$1,467.20 |
$2,096 |
4.2× |
| MRI pelvis w contrast (72196) |
$1,467.20 |
$2,096 |
4.2× |
| MRI pelvis w/o & w/contrast material (72197) |
$810.60 |
$1,158 |
2.3× |
| MRI pelvis w/o contrast (72195) |
$484.40 |
$692 |
2.0× |
| MRI scan of arm joint before and after contrast (73223) |
$802.20 |
$1,146 |
2.3× |
| MRI spinal canal cervical w/o & w/contr matrl (72156) |
$810.60 |
$1,158 |
2.3× |
| MRI spinal canal lumbar w/o & w/contr matrl (72158) |
$810.60 |
$1,158 |
2.3× |
| MRI spinal canal thoracic w/contrast matrl (72147) |
$1,353.80 |
$1,934 |
3.9× |
| MRI spinal canal thoracic w/o & w/contr matrl (72157) |
$802.20 |
$1,146 |
2.3× |
| MRI thoracic spine w/o contrast (72146) |
$484.40 |
$692 |
2.0× |
| MRI tmj (70336) |
$1,240.40 |
$1,772 |
5.2× |
| MRI upper extrem other than jt w/o & w/contras (73220) |
$802.20 |
$1,146 |
2.3× |
| MRI upper extremity oth than jt w/o contr matrl (73218) |
$1,111.60 |
$1,588 |
4.6× |
| Myocardial Spect Multiple Studies (78452) |
$2,082.50 |
$2,975 |
1.6× |
| Nm gastric emptying study (78264) |
$521.50 |
$745 |
1.3× |
| Ob Us Follow-Up Per Fetus - Us Ob Follow Up Transabdominal Approach (76816) |
$284.90 |
$407 |
2.7× |
| Parathyroid imaging (78070) |
$540.58 |
$772.25 |
1.3× |
| Pelvis 1 or 2 views (72170) |
$151.90 |
$217 |
1.4× |
| Pr MRI, lower extr, w/o contrast f/u by contrast (73720) |
$1,025.50 |
$1,465 |
2.9× |
| Pulmonary Perfusion Imaging Particulate (78580) |
$550.72 |
$786.74 |
1.4× |
| Pulmonary Ventilation & Perfusion Imaging (78582) |
$563.50 |
$805 |
1.0× |
| Radiolog exam mandible compl minimum 4 views (70110) |
$222.60 |
$318 |
2.1× |
| Radiologic exam colon single contrast study (74270) |
$186.40 |
$266.29 |
1.1× |
| Radiologic exam upr gi trc single contrast study (74240) |
$453.95 |
$648.50 |
2.6× |
| Ribs bilateral 3 views (71110) |
$214.20 |
$306 |
2.0× |
| Rp loclzj tum spect 1 area single day imaging (78803) |
$887.52 |
$1,267.89 |
1.6× |
| Scapula complete (73010) |
$98.98 |
$141.40 |
0.9× |
| Small bowel series (74250) |
$236.60 |
$338 |
1.3× |
| Thyroid uptake measurement (78012) |
$386.40 |
$552 |
1.0× |
| Thyroid Uptake W/Blood Flow Sngle/Mult Quan Meas (78014) |
$625.10 |
$893 |
1.6× |
| Ultrasound, abdomen limited (76705) |
$230.30 |
$329 |
2.2× |
| Umbilical-artery Doppler (OB) (76820) |
$212.10 |
$303 |
2.0× |
| Urography (pyelography), intravenous, with or without KUB, with or without tomography (74400) |
$477.40 |
$682 |
2.7× |
| Us abdl aorta screen aaa (76706) |
$212.10 |
$303 |
2.0× |
| Us breast unilateral complete (76641) |
$285.60 |
$408 |
2.7× |
| Us breast unilateral limited (76642) |
$158.90 |
$227 |
1.8× |
| Us chest (76604) |
$212.10 |
$303 |
2.0× |
| Us ob detailed single fetus (76811) |
$468.65 |
$669.50 |
2.0× |
| Us pelvic non ob complete (76856) |
$236.60 |
$338 |
2.3× |
| Us pelvic nonobstetric image dcmtn limited/f/u (76857) |
$212.10 |
$303 |
2.0× |
| Us pregnancy ltd (76815) |
$201.60 |
$288 |
1.9× |
| Us retroperitoneal complete (76770) |
$236.60 |
$338 |
2.3× |
| Us retroperitoneal limited (76775) |
$186.20 |
$266 |
1.8× |
| Us scrotum and contents (76870) |
$236.60 |
$338 |
2.3× |
| Us soft tissue head/neck (76536) |
$217.70 |
$311 |
2.1× |
| Us xtr non-vasc lmtd (76882) |
$212.10 |
$303 |
2.0× |
| Wrist 2 views (73100) |
$130.90 |
$187 |
1.5× |
| X-Ray Abdomen,Comp Acute Series - Xr Abdomen 2 Vws With Chest 1 View (74022) |
$181.30 |
$259 |
1.7× |
| X-Ray Ac Jts - Xr Acromioclavicular Joints Bilateral (73050) |
$95.90 |
$137 |
1.1× |
| X-Ray Ankle 3+ Vw - Xr Ankle 3+ Views Right (73610) |
$172.20 |
$246 |
2.0× |
| X-Ray Colon Air Contrast - Fl Barium Enema Air Contrast (74280) |
$382.90 |
$547 |
2.2× |
| X-Ray Elbow 2 Vw - Xr Elbow 1-2 Views Right (73070) |
$130.90 |
$187 |
1.5× |
| X-Ray Elbow 3+ Vw - Xr Elbow 3+ Views Right (73080) |
$145.60 |
$208 |
1.7× |
| X-Ray Exam Hip Uni 2-3 Views (73502) |
$130.90 |
$187 |
1.5× |
| X-Ray Facial Bones 3+ Vw - Xr Facial Bones 3+ Views (70150) |
$236.60 |
$338 |
2.3× |
| X-Ray Foot 3+ Vw - Xr Foot 3+ Views Right (73630) |
$179.90 |
$257 |
2.1× |
| X-Ray Heel - Xr Calcaneus 2 Views Right (73650) |
$130.90 |
$187 |
1.5× |
| X-Ray Knee 4+ View - Xr Knee 4+ Views Right (73564) |
$221.90 |
$317 |
2.1× |
| X-Ray Leg, Infant - Xr Lower Extremity 2+ Views Infant Left (73592) |
$167.30 |
$239 |
1.9× |
| X-Ray Lumbar Spine 2/3 Vw - Xr Lumbar Spine 2-3 Views (72100) |
$235.20 |
$336 |
2.2× |
| X-Ray Nasal Bones - Xr Nasal Bones (70160) |
$130.90 |
$187 |
1.5× |
| X-Ray Orbits - Xr Orbits Complete 4+ Views (70200) |
$192.50 |
$275 |
1.8× |
| X-Ray Pelvis 3+ Vw - Xr Pelvis 3+ Views (72190) |
$172.20 |
$246 |
1.6× |
| X-Ray Ribs 2 Vw Unilat - Xr Ribs 2 Views Right (71100) |
$65.10 |
$93 |
0.7× |
| X-Ray Ribs, Chest 4+ Vw - Xr Ribs 3 Vws Bil W/ Chest Posteroanterior (71111) |
$236.60 |
$338 |
2.3× |
| X-Ray Sacroiliac Jts 3+ Vw - Xr Sacroiliac Joints 3+ Views (72202) |
$136.50 |
$195 |
1.3× |
| X-Ray Sacrum/Coccyx 2+ Vw - Xr Sacrum Coccyx 2+ Views (72220) |
$144.90 |
$207 |
1.7× |
| X-Ray Shoulder 2+ Vw - Xr Shoulder 2+ Views Right (73030) |
$203.70 |
$291 |
2.3× |
| X-Ray Sinuses 3+ Vw - Xr Paranasal Sinuses 3+ Views (70220) |
$130.90 |
$187 |
1.5× |
| X-Ray Skull 4+ Vw - Xr Skull Complete 4+ Views (70260) |
$235.20 |
$336 |
2.2× |
| X-Ray Skull <4 Vw - Xr Skull 1-3 Views (70250) |
$186.40 |
$266.29 |
1.8× |
| X-Ray Spine One View - Xr Spine (72020) |
$217 |
$310 |
2.5× |
| X-Ray Sterno-Clavicluar Jt - Xr Sternoclavicular Joints 3+ Views (71130) |
$123.90 |
$177 |
1.4× |
| X-Ray Sternum 2+ Vw - Xr Sternum 2+ Views (71120) |
$130.90 |
$187 |
1.5× |
| X-Ray Thoracic Spine 2 Vw - Xr Thoracic Spine 2 Views (72070) |
$158.90 |
$227 |
1.5× |
| X-Ray Toe(S) - Xr Toes 2+ Views Right (73660) |
$131.60 |
$188 |
1.5× |
| Xr c-spine 6 or more views (72052) |
$292.60 |
$418 |
2.8× |
| Xr finger(s) 2+ views (73140) |
$130.90 |
$187 |
1.5× |
| Xr shoulder 1 view (73020) |
$155.40 |
$222 |
1.8× |
| Xr spine cervical 4 or 5 views (72050) |
$236.60 |
$338 |
2.3× |
| Xr tibia/fibula 2 views (73590) |
$193.90 |
$277 |
2.2× |
| Xr tmj bilateral (70330) |
$178.50 |
$255 |
2.0× |
| Xray knee 1 or 2 views rt (73560) |
$167.30 |
$239 |
1.9× |