| Acute gastrointestinal blood loss imaging (78278) |
$250 |
$250 |
0.6× |
| Ankle 2 views (73600) |
$540 |
$540 |
6.0× |
| Bone &/Joint Imaging Limited Area (78300) |
$244 |
$244 |
0.6× |
| Bone &/Joint Imaging Multiple Areas (78305) |
$244 |
$244 |
0.6× |
| Bone &/joint imaging whole body (78306) |
$251 |
$251 |
0.6× |
| Bone age studies (77072) |
$126 |
$126 |
1.2× |
| Bone Imaging 3 Phase (78315) |
$253 |
$253 |
0.6× |
| Bone survey complete (77075) |
$214 |
$214 |
2.0× |
| Cervical spine 2 or 3 views (72040) |
$184 |
$184 |
2.0× |
| Chest 1 view (71045) |
$163 |
$163 |
1.8× |
| Clavicle complete (73000) |
$555 |
$555 |
6.1× |
| Computed Tomography Thorax Lw Dose Lng Ca Scr C- (71271) |
$252 |
$252 |
2.3× |
| CT abdomen and pelvis without and with contrast (74178) |
$360 |
$360 |
1.0× |
| CT abdomen and pelvis without contrast (74176) |
$345.50 |
$345.50 |
1.4× |
| CT abdomen w contrast (74160) |
$281 |
$281 |
1.5× |
| CT abdomen w wo contrast (74170) |
$295 |
$295 |
1.6× |
| CT abdomen w/o contrast (74150) |
$280.50 |
$280.50 |
2.6× |
| CT angio hrt w/3d image (75574) |
$261 |
$261 |
0.7× |
| CT angiography upper extremity lt (73206) |
$618 |
$618 |
3.4× |
| CT c-spine w/o contrast (72125) |
$265 |
$265 |
2.4× |
| CT cervical spine w&w/o contrast (72127) |
$285 |
$285 |
1.6× |
| CT cervical spine with contrast (72126) |
$285 |
$285 |
0.8× |
| CT chest w/wo contrast (71270) |
$308 |
$308 |
1.7× |
| CT chest with contrast (71260) |
$273.50 |
$273.50 |
1.5× |
| CT head/brain with contrast (70460) |
$266.50 |
$266.50 |
1.5× |
| CT head/brain without and with contrast (70470) |
$278 |
$278 |
1.5× |
| CT iac w contrast (70481) |
$273.50 |
$273.50 |
1.5× |
| CT lower ext w/o (73700) |
$605 |
$605 |
5.6× |
| CT lower extremity w wo contrast (73702) |
$613 |
$613 |
3.4× |
| CT lower extremity with contrast (73701) |
$550 |
$550 |
3.0× |
| CT lumbar spine w & w/o contrast (72133) |
$285 |
$285 |
1.6× |
| CT lumbar spine w/o contrast (72131) |
$265 |
$265 |
2.4× |
| CT lumbar spine with contrast (72132) |
$285 |
$285 |
0.8× |
| CT maxillofacial w contrast (70487) |
$264 |
$264 |
1.4× |
| CT maxillofacial w/o contrast (70486) |
$263 |
$263 |
2.4× |
| CT maxillofacial w/wo contrast (70488) |
$295 |
$295 |
1.6× |
| CT neck soft tissue w contrast (70491) |
$265 |
$265 |
1.5× |
| CT orbit sella/post fossa/ear w/o & w/contr matr (70482) |
$285 |
$285 |
1.6× |
| CT orbits w/o contrast (70480) |
$264 |
$264 |
2.4× |
| CT pelvis w & w/o contrast (72194) |
$310 |
$310 |
1.7× |
| CT pelvis w/o contrast (72192) |
$264 |
$264 |
2.4× |
| CT soft tissue neck w/o & w/contrast material (70492) |
$283 |
$283 |
1.6× |
| CT soft tissue neck w/o contrast (70490) |
$264 |
$264 |
2.4× |
| CT thoracic spine w/o contrast (72128) |
$265 |
$265 |
2.4× |
| CT thoracic spine w/wo contrast (72130) |
$285 |
$285 |
1.6× |
| CT thorax w/o contrast (71250) |
$264 |
$264 |
2.4× |
| CT upper extremity w/o & w/contrast material (73202) |
$618 |
$618 |
3.4× |
| CT upper extremity w/o contrast rt (73200) |
$601.50 |
$601.50 |
5.5× |
| CT upper extremity with contrast (73201) |
$611 |
$611 |
1.7× |
| Cta Abdl Aorta&Bi Iliofem W/Contrast&Postp (75635) |
$324 |
$324 |
1.8× |
| Cta Abdomen (74175) |
$335 |
$335 |
1.8× |
| CTA abdomen pelvis (74174) |
$360 |
$360 |
1.0× |
| CTA chest (71275) |
$324.50 |
$324.50 |
1.8× |
| Cta Head (70496) |
$310 |
$310 |
1.7× |
| Cta Neck (70498) |
$297 |
$297 |
1.6× |
| Cta Pelvis (72191) |
$274 |
$274 |
1.5× |
| Dxa bone density study 1/> sites axial skel (77080) |
$205 |
$205 |
1.9× |
| Fetal biophysical profile non-stress testing (76818) |
$210 |
$210 |
1.9× |
| Fluoroscopy up to 1 hr (76000) |
$214 |
$214 |
0.9× |
| Foot 2 views (73620) |
$540 |
$540 |
6.0× |
| Forearm 2 views (73090) |
$553.50 |
$553.50 |
6.1× |
| Gated Heart Planar Single (78472) |
$272 |
$272 |
0.7× |
| Hand 2 views (73120) |
$162 |
$162 |
1.5× |
| Hand 3 views (73130) |
$178.50 |
$178.50 |
2.0× |
| Hepatobil Syst Imag Inc Gb W/Pharma Intervenj (78227) |
$260 |
$260 |
0.5× |
| Hepatobiliary syst imaging including gallbladder (78226) |
$252 |
$252 |
0.6× |
| Ht muscle image spect sing (78451) |
$264 |
$264 |
0.2× |
| Humerus Min 2 Views Left (73060) |
$580 |
$580 |
6.4× |
| Knee 3 views (73562) |
$580 |
$580 |
6.4× |
| Lung perf&ventilat diferentl (78598) |
$311 |
$311 |
0.6× |
| Lung Ventilation Imaging (78579) |
$260 |
$260 |
0.6× |
| Lymphangio extrem unilat - ir lymphangiogram extremity (75801) |
$72 |
$72 |
0.1× |
| Mr safety implant&/fb assmt clin staf 1st 15 min (76014) |
$501 |
$501 |
16.7× |
| MRA head w & w/o contrast (70546) |
$345 |
$345 |
1.0× |
| MRA head w/o contrast (70544) |
$324 |
$324 |
1.3× |
| MRA neck w contrast (70548) |
$326 |
$326 |
0.9× |
| Mra Neck W/O &W/Contrast Material (70549) |
$333 |
$333 |
0.9× |
| MRA neck w/o contrast (70547) |
$313 |
$313 |
1.3× |
| MRI abdomen w contrast (74182) |
$320 |
$320 |
0.9× |
| MRI abdomen w/o & w/contrast material (74183) |
$358 |
$358 |
1.0× |
| MRI abdomen w/o contrast (74181) |
$311 |
$311 |
1.3× |
| MRI any jnt lwr ext with con lt (73722) |
$320 |
$320 |
0.4× |
| MRI any jt upper extremity w/contrast matrl (73222) |
$319.50 |
$319.50 |
0.4× |
| MRI c-spine with contrast (72142) |
$328 |
$328 |
0.9× |
| MRI cervical spine w/o contrast (72141) |
$320 |
$320 |
1.3× |
| MRI chest w/o & w/contrast material (71552) |
$345 |
$345 |
1.0× |
| MRI chest w/o contrast (71550) |
$325 |
$325 |
1.3× |
| MRI chest with contrast (71551) |
$333 |
$333 |
0.4× |
| MRI Forearm w/ Contrast Bilateral 73219 (73219) |
$301.50 |
$301.50 |
0.8× |
| MRI lower extrem oth/thn jt w/contrast matrl (73719) |
$291 |
$291 |
0.8× |
| MRI lower extrem oth/thn jt w/o contr matrl (73718) |
$278 |
$278 |
1.1× |
| MRI orbit face &/neck w/o contrast (70540) |
$313 |
$313 |
1.3× |
| MRI orbit/face/neck w&w/o cont (70543) |
$333 |
$333 |
0.9× |
| MRI orbit/face/neck w/contrast (70542) |
$326 |
$326 |
0.9× |
| MRI pelvis w contrast (72196) |
$320.50 |
$320.50 |
0.9× |
| MRI pelvis w/o & w/contrast material (72197) |
$341.50 |
$341.50 |
0.9× |
| MRI pelvis w/o contrast (72195) |
$303.50 |
$303.50 |
1.2× |
| MRI scan of arm joint before and after contrast (73223) |
$338 |
$338 |
0.9× |
| MRI scan of leg joint before and after contrast (73723) |
$326 |
$326 |
0.9× |
| MRI spinal canal cervical w/o & w/contr matrl (72156) |
$358 |
$358 |
1.0× |
| MRI spinal canal lumbar w/contrast material (72149) |
$326 |
$326 |
0.9× |
| MRI spinal canal lumbar w/o & w/contr matrl (72158) |
$348 |
$348 |
1.0× |
| MRI spinal canal thoracic w/contrast matrl (72147) |
$328 |
$328 |
0.9× |
| MRI spinal canal thoracic w/o & w/contr matrl (72157) |
$358 |
$358 |
1.0× |
| MRI thoracic spine w/o contrast (72146) |
$320 |
$320 |
1.3× |
| MRI tmj (70336) |
$155.50 |
$155.50 |
0.6× |
| MRI upper ext joint w/o contrast (73221) |
$278 |
$278 |
1.1× |
| MRI upper extrem other than jt w/o & w/contras (73220) |
$328 |
$328 |
0.9× |
| MRI upper extremity oth than jt w/o contr matrl (73218) |
$285 |
$285 |
1.2× |
| Myocardial Spect Multiple Studies (78452) |
$345 |
$345 |
0.3× |
| Neck soft tissue (70360) |
$163 |
$163 |
1.8× |
| Nm gastric emptying study (78264) |
$253 |
$253 |
0.6× |
| Nuclear medicine study to assess blood clot in vein of both sides (78458) |
$278 |
$278 |
0.7× |
| Nuclear medicine study to assess blood clot in vein of side (78457) |
$264 |
$264 |
0.5× |
| Osseous survey limited (77074) |
$215 |
$215 |
2.0× |
| Parathyrd planar w/wo subtrj (78071) |
$255 |
$255 |
0.6× |
| Parathyroid imaging (78070) |
$247 |
$247 |
0.6× |
| Pelvis 1 or 2 views (72170) |
$178 |
$178 |
1.6× |
| Pr MRI, lower extr, w/o contrast f/u by contrast (73720) |
$325 |
$325 |
0.9× |
| Pulmonary Perfusion Imaging Particulate (78580) |
$258 |
$258 |
0.6× |
| Pulmonary Ventilation & Perfusion Imaging (78582) |
$328 |
$328 |
0.6× |
| Radex hips bilateral with pelvis 2 views (73521) |
$202 |
$202 |
1.9× |
| Radex X-Ray Exam Entire Spi 6/> Vw - Xr Entire Spine 6+ Vw (72084) |
$400 |
$400 |
3.7× |
| Radiolog exam mandible compl minimum 4 views (70110) |
$191 |
$191 |
1.8× |
| Radiologic Exam Abdomen 1 View - Xr Abdomen 1 View (74018) |
$162 |
$162 |
1.8× |
| Radiologic Exam Abdomen 3+ Views - Xr Abdomen 3+ Views (74021) |
$203 |
$203 |
1.9× |
| Radiologic Exam Chest 2 Views - Xr Chest 2 Views (71046) |
$180 |
$180 |
2.0× |
| Radiologic Examination Femur Minimum 2 Views - Xr Femur 2+ Vw Lt (73552) |
$566.50 |
$566.50 |
6.3× |
| Red Cell Volume Determination Spx 1 Sampling (78120) |
$4 |
$4 |
0.0× |
| Ribs bilateral 3 views (71110) |
$194 |
$194 |
1.8× |
| Sacroiliac Joints < 3 Views (72200) |
$186 |
$186 |
1.7× |
| Scanogram (77073) |
$174 |
$174 |
1.6× |
| Scapula complete (73010) |
$190 |
$190 |
1.8× |
| Screening digital breast tomosynthesis (77063) |
$74 |
$74 |
3.2× |
| Spine thoracic 3 views (72072) |
$204 |
$204 |
1.9× |
| Thyroid Imaging With Vascular Flow (78013) |
$235 |
$235 |
0.6× |
| Thyroid Uptake W/Blood Flow Sngle/Mult Quan Meas (78014) |
$260 |
$260 |
0.6× |
| Ultrasound, abdomen limited (76705) |
$219 |
$219 |
2.0× |
| Unlisted Ultrasound Procedure (76999) |
$214 |
$214 |
2.4× |
| Upper Extremity Infant (73092) |
$163.50 |
$163.50 |
1.5× |
| Urography (pyelography), intravenous, with or without KUB, with or without tomography (74400) |
$233 |
$233 |
1.3× |
| Us abdl aorta screen aaa (76706) |
$214 |
$214 |
2.0× |
| Us breast unilateral complete (76641) |
$591 |
$591 |
5.4× |
| Us breast unilateral limited (76642) |
$587.50 |
$587.50 |
6.5× |
| Us chest (76604) |
$208 |
$208 |
1.9× |
| Us compl joint r-t w/image documentation (76881) |
$215 |
$215 |
2.0× |
| Us ob transvaginal (76817) |
$211 |
$211 |
1.9× |
| Us pelvic non ob complete (76856) |
$224 |
$224 |
2.1× |
| Us pelvic nonobstetric image dcmtn limited/f/u (76857) |
$210 |
$210 |
1.9× |
| Us pregnancy ltd (76815) |
$196 |
$196 |
1.8× |
| Us pregnant uterus 14 wk transabdl 1/1st gestat (76801) |
$214 |
$214 |
2.0× |
| Us retroperitoneal complete (76770) |
$221.50 |
$221.50 |
2.0× |
| Us retroperitoneal limited (76775) |
$213 |
$213 |
2.0× |
| Us scrotum and contents (76870) |
$222 |
$222 |
2.0× |
| Us soft tissue head/neck (76536) |
$214 |
$214 |
2.0× |
| Us xtr non-vasc lmtd (76882) |
$214 |
$214 |
2.0× |
| Us, eye b-scan (76512) |
$195 |
$195 |
1.8× |
| Wrist 2 views (73100) |
$148 |
$148 |
1.6× |
| X-Ray Abdomen,Comp Acute Series - Xr Abdomen 2 Vws With Chest 1 View (74022) |
$205 |
$205 |
1.9× |
| X-Ray Ac Jts - Xr Acromioclavicular Joints Bilateral (73050) |
$163 |
$163 |
1.8× |
| X-Ray Ankle 3+ Vw - Xr Ankle 3+ Views Right (73610) |
$184 |
$184 |
2.0× |
| X-Ray Elbow 2 Vw - Xr Elbow 1-2 Views Right (73070) |
$163 |
$163 |
1.8× |
| X-Ray Elbow 3+ Vw - Xr Elbow 3+ Views Right (73080) |
$190 |
$190 |
2.1× |
| X-ray exam entire spi 4/5 vw (72083) |
$400 |
$400 |
3.7× |
| X-ray exam hip uni 1 view (73501) |
$542 |
$542 |
6.0× |
| X-Ray Exam Hip Uni 2-3 Views (73502) |
$565.50 |
$565.50 |
6.3× |
| X-ray exam hip uni 4/> views (73503) |
$572 |
$572 |
5.3× |
| X-Ray Exam Hips Bi 3-4 Views (73522) |
$208 |
$208 |
1.9× |
| X-ray exam of femur 1 (73551) |
$551 |
$551 |
6.1× |
| X-ray eye for foreign body (70030) |
$142 |
$142 |
1.6× |
| X-Ray Facial Bones 3+ Vw - Xr Facial Bones 3+ Views (70150) |
$194 |
$194 |
1.8× |
| X-Ray Facial Bones <3 Vw - Xr Facial Bones 1-2 Views (70140) |
$93 |
$93 |
1.0× |
| X-Ray Foot 3+ Vw - Xr Foot 3+ Views Right (73630) |
$571.50 |
$571.50 |
6.3× |
| X-Ray Heel - Xr Calcaneus 2 Views Right (73650) |
$147 |
$147 |
1.6× |
| X-Ray Knee 4+ View - Xr Knee 4+ Views Right (73564) |
$587.50 |
$587.50 |
5.4× |
| X-Ray Knee Bilat Standing - Xr Knees Anteroposterior Standing Bilat (73565) |
$139 |
$139 |
1.5× |
| X-Ray Leg, Infant - Xr Lower Extremity 2+ Views Infant Left (73592) |
$162.50 |
$162.50 |
1.8× |
| X-Ray Lumbar Spine 2/3 Vw - Xr Lumbar Spine 2-3 Views (72100) |
$195 |
$195 |
1.8× |
| X-Ray Lumbar Spine 6+ Vw - Xr Lumbar Spine 6+ Vws Including Bending (72114) |
$214 |
$214 |
2.0× |
| X-Ray Lumbar Spine Flex/Exten - Xr Lumbar Spine 4+ Views W/ Flex Ext (72120) |
$200 |
$200 |
1.8× |
| X-Ray Nasal Bones - Xr Nasal Bones (70160) |
$174 |
$174 |
1.9× |
| X-Ray Nose-Rectum Child F.B. - Xr Nose to Rectum Foreign Body Peds (76010) |
$156 |
$156 |
1.7× |
| X-Ray Pelvis 3+ Vw - Xr Pelvis 3+ Views (72190) |
$194 |
$194 |
1.8× |
| X-Ray Ribs 2 Vw Unilat - Xr Ribs 2 Views Right (71100) |
$179 |
$179 |
2.0× |
| X-Ray Ribs, Chest 3+ Vw - Xr Ribs 2 Vws Lt W/ Chest Anteroposterior (71101) |
$31.50 |
$31.50 |
0.3× |
| X-Ray Ribs, Chest 4+ Vw - Xr Ribs 3 Vws Bil W/ Chest Posteroanterior (71111) |
$203 |
$203 |
1.9× |
| X-Ray Sacroiliac Jts 3+ Vw - Xr Sacroiliac Joints 3+ Views (72202) |
$192 |
$192 |
1.8× |
| X-Ray Sacrum/Coccyx 2+ Vw - Xr Sacrum Coccyx 2+ Views (72220) |
$174 |
$174 |
1.9× |
| X-Ray Shoulder 2+ Vw - Xr Shoulder 2+ Views Right (73030) |
$585 |
$585 |
6.5× |
| X-Ray Sinuses 3+ Vw - Xr Paranasal Sinuses 3+ Views (70220) |
$194 |
$194 |
2.1× |
| X-Ray Sinuses <3 Vw - Xr Paranasal Sinuses 1-2 Views (70210) |
$143 |
$143 |
1.6× |
| X-Ray Skull 4+ Vw - Xr Skull Complete 4+ Views (70260) |
$196 |
$196 |
1.8× |
| X-Ray Skull <4 Vw - Xr Skull 1-3 Views (70250) |
$163 |
$163 |
1.5× |
| X-Ray Spine One View - Xr Spine (72020) |
$179 |
$179 |
2.0× |
| X-Ray Sternum 2+ Vw - Xr Sternum 2+ Views (71120) |
$174 |
$174 |
1.9× |
| X-Ray Thoracic Spine 2 Vw - Xr Thoracic Spine 2 Views (72070) |
$181 |
$181 |
1.7× |
| X-Ray Toe(S) - Xr Toes 2+ Views Right (73660) |
$134 |
$134 |
1.5× |
| X-Ray Wrist 3+ Vw - Xr Wrist 3+ Views Right (73110) |
$189.50 |
$189.50 |
2.1× |
| Xr c-spine 6 or more views (72052) |
$212 |
$212 |
2.0× |
| Xr finger(s) 2+ views (73140) |
$137 |
$137 |
1.5× |
| Xr shoulder 1 view (73020) |
$549.50 |
$549.50 |
6.1× |
| Xr spine cervical 4 or 5 views (72050) |
$202.50 |
$202.50 |
1.9× |
| Xr tibia/fibula 2 views (73590) |
$402 |
$402 |
4.4× |
| Xr tmj bilateral (70330) |
$163 |
$163 |
1.8× |
| Xray knee 1 or 2 views rt (73560) |
$559.50 |
$559.50 |
6.2× |