| Acute gastrointestinal blood loss imaging (78278) |
$1,148 |
$1,275 |
2.8× |
| Acute venous thrombus image (78456) |
$1,800 |
$2,000 |
1.3× |
| Ankle 2 views (73600) |
$261 |
$290 |
2.9× |
| Bone &/Joint Imaging Limited Area (78300) |
$1,033.50 |
$1,148.50 |
2.5× |
| Bone &/Joint Imaging Multiple Areas (78305) |
$1,375.50 |
$1,528.50 |
3.3× |
| Bone &/joint imaging whole body (78306) |
$1,836.50 |
$2,040 |
4.4× |
| Bone age studies (77072) |
$252 |
$280 |
2.3× |
| Bone Imaging 3 Phase (78315) |
$2,170.50 |
$2,411.50 |
5.2× |
| Bone survey complete (77075) |
$990 |
$1,100 |
9.1× |
| Cervical spine 2 or 3 views (72040) |
$360 |
$400 |
4.0× |
| Chest 1 view (71045) |
$288 |
$320 |
3.2× |
| Clavicle complete (73000) |
$306 |
$340 |
3.4× |
| Computed Tomography Thorax Lw Dose Lng Ca Scr C- (71271) |
$1,810 |
$2,011 |
16.7× |
| CT abdomen and pelvis without and with contrast (74178) |
$5,535 |
$6,150 |
15.3× |
| CT abdomen and pelvis without contrast (74176) |
$4,163 |
$4,625 |
16.8× |
| CT abdomen w contrast (74160) |
$2,700 |
$3,000 |
14.8× |
| CT abdomen w wo contrast (74170) |
$3,060 |
$3,400 |
16.8× |
| CT abdomen w/o contrast (74150) |
$2,430 |
$2,700 |
22.4× |
| CT angiography upper extremity lt (73206) |
$2,970 |
$3,300 |
16.3× |
| CT c-spine w/o contrast (72125) |
$2,453 |
$2,725 |
22.6× |
| CT cervical spine w&w/o contrast (72127) |
$2,700 |
$3,000 |
14.8× |
| CT cervical spine with contrast (72126) |
$3,038 |
$3,375 |
8.4× |
| CT chest w/wo contrast (71270) |
$3,128 |
$3,475 |
17.2× |
| CT chest with contrast (71260) |
$2,565 |
$2,850 |
14.1× |
| CT head/brain with contrast (70460) |
$2,340 |
$2,600 |
12.8× |
| CT head/brain without and with contrast (70470) |
$3,150 |
$3,500 |
17.3× |
| CT heart no contrast quant eval coronry calcium (75571) |
$135 |
$150 |
1.5× |
| CT iac w contrast (70481) |
$2,430 |
$2,700 |
13.3× |
| CT limited/localized follow up study (76380) |
$1,611 |
$1,790 |
17.8× |
| CT lower ext w/o (73700) |
$2,295 |
$2,550 |
21.1× |
| CT lower extremity w wo contrast (73702) |
$3,150 |
$3,500 |
17.3× |
| CT lower extremity with contrast (73701) |
$2,520 |
$2,800 |
13.8× |
| CT lumbar spine w & w/o contrast (72133) |
$2,610 |
$2,900 |
14.3× |
| CT lumbar spine w/o contrast (72131) |
$2,430 |
$2,700 |
22.4× |
| CT lumbar spine with contrast (72132) |
$2,700 |
$3,000 |
7.5× |
| CT maxillofacial w contrast (70487) |
$2,340 |
$2,600 |
12.8× |
| CT maxillofacial w/o contrast (70486) |
$1,980 |
$2,200 |
18.2× |
| CT maxillofacial w/wo contrast (70488) |
$2,610 |
$2,900 |
14.3× |
| CT neck soft tissue w contrast (70491) |
$2,475 |
$2,750 |
13.6× |
| CT orbit sella/post fossa/ear w/o & w/contr matr (70482) |
$2,520 |
$2,800 |
13.8× |
| CT orbits w/o contrast (70480) |
$2,340 |
$2,600 |
21.6× |
| CT pelvis w & w/o contrast (72194) |
$2,970 |
$3,300 |
16.3× |
| CT pelvis w/o contrast (72192) |
$2,408 |
$2,675 |
22.2× |
| CT soft tissue neck w/o & w/contrast material (70492) |
$2,790 |
$3,100 |
15.3× |
| CT soft tissue neck w/o contrast (70490) |
$2,160 |
$2,400 |
19.9× |
| CT thoracic spine w/contrast (72129) |
$2,430 |
$2,700 |
13.3× |
| CT thoracic spine w/o contrast (72128) |
$2,453 |
$2,725 |
22.6× |
| CT thoracic spine w/wo contrast (72130) |
$2,673 |
$2,970 |
14.7× |
| CT thorax w/o contrast (71250) |
$2,385 |
$2,650 |
22.0× |
| CT unlisted procedure (76497) |
$5,850 |
$6,500 |
64.7× |
| CT upper extremity w/o & w/contrast material (73202) |
$2,700 |
$3,000 |
14.8× |
| CT upper extremity w/o contrast rt (73200) |
$2,160 |
$2,400 |
19.9× |
| Cta Abdl Aorta&Bi Iliofem W/Contrast&Postp (75635) |
$3,510 |
$3,900 |
19.3× |
| Cta Abdomen (74175) |
$3,353 |
$3,725 |
18.4× |
| CTA abdomen pelvis (74174) |
$5,760 |
$6,400 |
15.9× |
| CTA chest (71275) |
$3,330 |
$3,700 |
18.3× |
| Cta Head (70496) |
$3,150 |
$3,500 |
17.3× |
| CTA head&neck c+ w/noncontrast img&post-pxessing (70471) |
$6,255 |
$6,950 |
17.3× |
| CTA lwr ext w&w/o contrast (73706) |
$2,700 |
$3,000 |
14.8× |
| Cta Neck (70498) |
$3,105 |
$3,450 |
17.0× |
| Doppler Echo Fetal Puls Spectral F/U/Repeat (76828) |
$180 |
$200 |
1.7× |
| Doppler Echo Fetal Spectral Display Complete (76827) |
$185 |
$205 |
1.7× |
| Doppler Fetal Mid Cerebral Artery (76821) |
$224 |
$249 |
2.1× |
| Dxa bone density study 1/> sites axial skel (77080) |
$495 |
$550 |
4.6× |
| Dxa bone density study 1/>sites appendiclr skel (77081) |
$243 |
$270 |
2.7× |
| Echo exam of fetal heart (76825) |
$667 |
$741 |
1.2× |
| Echo fetal cardiovasc w/wo m-mode repeat std (76826) |
$371 |
$412 |
1.5× |
| Fetal biophysical profile non-stress testing (76818) |
$321 |
$357 |
3.0× |
| Fluoroscopy up to 1 hr (76000) |
$675 |
$750 |
2.7× |
| Foot 2 views (73620) |
$270 |
$300 |
3.0× |
| Forearm 2 views (73090) |
$293 |
$325 |
3.2× |
| Gated Heart Planar Single (78472) |
$1,625 |
$1,805 |
3.9× |
| Hand 2 views (73120) |
$270 |
$300 |
2.5× |
| Hand 3 views (73130) |
$374 |
$415 |
4.1× |
| Hepatobil Syst Imag Inc Gb W/Pharma Intervenj (78227) |
$1,868 |
$2,075 |
3.3× |
| Hepatobiliary syst imaging including gallbladder (78226) |
$1,515 |
$1,683.50 |
3.6× |
| Ht muscle image spect sing (78451) |
$2,183 |
$2,425 |
1.6× |
| Humerus Min 2 Views Left (73060) |
$324 |
$360 |
3.6× |
| Kidney Img Morphology Vascular Flow 1 W/O Rx (78707) |
$1,368 |
$1,520 |
2.4× |
| Kidney img morphology vascular flow 1 w/rx (78708) |
$1,350 |
$1,500 |
2.4× |
| Kidney Img Morphology Vascular Flow Multiple (78709) |
$1,418 |
$1,575 |
2.5× |
| Knee 3 views (73562) |
$383 |
$425 |
4.2× |
| Liver & spleen imaging static only (78215) |
$900 |
$1,000 |
2.2× |
| Liver & Spleen Imaging W/Vascular Flow (78216) |
$1,080 |
$1,200 |
2.6× |
| Liver imaging w/vascular flow (78202) |
$1,530 |
$1,700 |
2.7× |
| Lung perf&ventilat diferentl (78598) |
$1,980 |
$2,200 |
3.5× |
| Lung Ventilation Imaging (78579) |
$1,193 |
$1,325 |
2.9× |
| Meckels Diverticulum (78290) |
$1,215 |
$1,350 |
2.9× |
| MRA head w & w/o contrast (70546) |
$3,690 |
$4,100 |
10.2× |
| MRA head w/o contrast (70544) |
$3,966 |
$4,406.50 |
16.0× |
| MRA neck w contrast (70548) |
$3,374 |
$3,749 |
9.3× |
| Mra Neck W/O &W/Contrast Material (70549) |
$3,870 |
$4,300 |
10.7× |
| MRA neck w/o contrast (70547) |
$3,218 |
$3,575 |
13.0× |
| MRI abdomen w contrast (74182) |
$3,510 |
$3,900 |
9.7× |
| MRI abdomen w/o & w/contrast material (74183) |
$4,230 |
$4,700 |
11.7× |
| MRI abdomen w/o contrast (74181) |
$3,083 |
$3,425 |
12.4× |
| MRI any jnt lwr ext with con lt (73722) |
$3,375 |
$3,750 |
4.1× |
| MRI any jt upper extremity w/contrast matrl (73222) |
$3,420 |
$3,800 |
4.2× |
| MRI cervical spine w/o contrast (72141) |
$3,600 |
$4,000 |
14.5× |
| MRI chest w/o & w/contrast material (71552) |
$3,780 |
$4,200 |
10.4× |
| MRI chest w/o contrast (71550) |
$3,420 |
$3,800 |
13.8× |
| MRI lower extrem oth/thn jt w/o contr matrl (73718) |
$2,880 |
$3,200 |
11.6× |
| MRI orbit face &/neck w/o contrast (70540) |
$3,240 |
$3,600 |
13.1× |
| MRI orbit/face/neck w&w/o cont (70543) |
$3,870 |
$4,300 |
10.7× |
| MRI orbit/face/neck w/contrast (70542) |
$3,600 |
$4,000 |
9.9× |
| MRI pelvis w contrast (72196) |
$3,420 |
$3,800 |
9.4× |
| MRI pelvis w/o & w/contrast material (72197) |
$4,050 |
$4,500 |
11.2× |
| MRI pelvis w/o contrast (72195) |
$3,150 |
$3,500 |
12.7× |
| MRI scan of arm joint before and after contrast (73223) |
$3,690 |
$4,100 |
10.2× |
| MRI scan of leg joint before and after contrast (73723) |
$3,488 |
$3,875 |
9.6× |
| MRI spinal canal cervical w/o & w/contr matrl (72156) |
$4,963 |
$5,514 |
13.7× |
| MRI spinal canal lumbar w/contrast material (72149) |
$4,500 |
$5,000 |
12.4× |
| MRI spinal canal lumbar w/o & w/contr matrl (72158) |
$4,140 |
$4,600 |
11.4× |
| MRI spinal canal thoracic w/o & w/contr matrl (72157) |
$5,132 |
$5,702 |
14.2× |
| MRI thoracic spine w/o contrast (72146) |
$3,600 |
$4,000 |
14.5× |
| MRI upper ext joint w/o contrast (73221) |
$2,588 |
$2,875 |
10.4× |
| MRI upper extrem other than jt w/o & w/contras (73220) |
$3,510 |
$3,900 |
9.7× |
| MRI upper extremity oth than jt w/o contr matrl (73218) |
$2,700 |
$3,000 |
10.9× |
| Myocardial Spect Multiple Studies (78452) |
$4,005 |
$4,450 |
3.0× |
| Neck soft tissue (70360) |
$324 |
$360 |
3.6× |
| Nm gastric emptying study (78264) |
$1,620 |
$1,800 |
3.9× |
| Osseous survey infant (77076) |
$501 |
$557 |
4.6× |
| Osseous survey limited (77074) |
$720 |
$800 |
6.6× |
| Parathyroid imaging (78070) |
$1,215 |
$1,350 |
2.9× |
| Pelvis 1 or 2 views (72170) |
$347 |
$385 |
3.2× |
| Pulmonary Perfusion Imaging Particulate (78580) |
$990 |
$1,100 |
2.4× |
| Pulmonary Ventilation & Perfusion Imaging (78582) |
$1,890 |
$2,100 |
3.4× |
| Radex mastoids compl minimum 3 views pr side (70130) |
$311 |
$345 |
2.9× |
| Radiolog exam mandible compl minimum 4 views (70110) |
$450 |
$500 |
4.1× |
| Radiologic Exam Abdomen 1 View - Xr Abdomen 1 View (74018) |
$324 |
$360 |
3.6× |
| Radiologic Exam Abdomen 3+ Views - Xr Abdomen 3+ Views (74021) |
$495 |
$550 |
4.6× |
| Radiologic Exam Chest 2 Views - Xr Chest 2 Views (71046) |
$356 |
$395 |
3.9× |
| Radiologic Examination Femur Minimum 2 Views - Xr Femur 2+ Vw Lt (73552) |
$351 |
$390 |
3.9× |
| Ribs bilateral 3 views (71110) |
$477 |
$530 |
4.4× |
| Rp loclzj tum plnr 2+area 1+d img/1 area img>2+d (78801) |
$1,193 |
$1,325 |
2.9× |
| Scapula complete (73010) |
$320 |
$355 |
2.9× |
| Spine thoracic 3 views (72072) |
$513 |
$570 |
4.7× |
| Thoracolumbar 2 views (72080) |
$360 |
$400 |
4.0× |
| Tmj unilateral (70328) |
$185 |
$205 |
2.0× |
| Tumor Imaging, Limited Area - Nm Tumor Localization Limited (78800) |
$1,035 |
$1,150 |
2.5× |
| Ultrasound, abdomen limited (76705) |
$711 |
$790 |
6.5× |
| Umbilical-artery Doppler (OB) (76820) |
$180 |
$200 |
1.7× |
| Upper Extremity Infant (73092) |
$270 |
$300 |
2.5× |
| Us breast unilateral complete (76641) |
$585 |
$650 |
5.4× |
| Us breast unilateral limited (76642) |
$405 |
$450 |
4.5× |
| Us chest (76604) |
$585 |
$650 |
5.4× |
| Us compl joint r-t w/image documentation (76881) |
$675 |
$750 |
6.2× |
| Us fetal nuchal translucency 1st gestation (76813) |
$277 |
$308 |
2.6× |
| Us kidney transplant (76776) |
$765 |
$850 |
7.0× |
| Us ob detailed single fetus (76811) |
$540 |
$600 |
2.2× |
| Us pelvic non ob complete (76856) |
$788 |
$875 |
7.3× |
| Us retroperitoneal complete (76770) |
$810 |
$900 |
7.5× |
| Us retroperitoneal limited (76775) |
$603 |
$670 |
5.6× |
| Us scrotum and contents (76870) |
$698 |
$775 |
6.4× |
| Us soft tissue head/neck (76536) |
$912 |
$1,013 |
8.4× |
| Us transrectal (76872) |
$684 |
$760 |
6.3× |
| Us xtr non-vasc lmtd (76882) |
$563 |
$625 |
5.2× |
| Wrist 2 views (73100) |
$261 |
$290 |
2.9× |
| X-Ray Abdomen,Comp Acute Series - Xr Abdomen 2 Vws With Chest 1 View (74022) |
$545 |
$605 |
5.0× |
| X-Ray Ac Jts - Xr Acromioclavicular Joints Bilateral (73050) |
$287 |
$319 |
3.2× |
| X-Ray Ankle 3+ Vw - Xr Ankle 3+ Views Right (73610) |
$342 |
$380 |
3.8× |
| X-Ray Elbow 2 Vw - Xr Elbow 1-2 Views Right (73070) |
$284 |
$315 |
3.1× |
| X-Ray Elbow 3+ Vw - Xr Elbow 3+ Views Right (73080) |
$338 |
$375 |
3.7× |
| X-ray exam entire spi 4/5 vw (72083) |
$518 |
$575 |
4.8× |
| X-ray exam hip uni 1 view (73501) |
$279 |
$310 |
3.1× |
| X-Ray Exam Hip Uni 2-3 Views (73502) |
$360 |
$400 |
4.0× |
| X-ray eye for foreign body (70030) |
$279 |
$310 |
3.1× |
| X-Ray Facial Bones 3+ Vw - Xr Facial Bones 3+ Views (70150) |
$437 |
$485 |
4.0× |
| X-Ray Facial Bones <3 Vw - Xr Facial Bones 1-2 Views (70140) |
$297 |
$330 |
3.3× |
| X-Ray Foot 3+ Vw - Xr Foot 3+ Views Right (73630) |
$360 |
$400 |
4.0× |
| X-Ray Heel - Xr Calcaneus 2 Views Right (73650) |
$266 |
$295 |
2.9× |
| X-Ray Jaw <4 Vw - Xr Mandible < 4 Views (70100) |
$243 |
$270 |
2.7× |
| X-Ray Knee 4+ View - Xr Knee 4+ Views Right (73564) |
$405 |
$450 |
3.7× |
| X-Ray Knee Bilat Standing - Xr Knees Anteroposterior Standing Bilat (73565) |
$234 |
$260 |
2.6× |
| X-Ray Leg, Infant - Xr Lower Extremity 2+ Views Infant Left (73592) |
$248 |
$275 |
2.7× |
| X-Ray Lumbar Spine 2/3 Vw - Xr Lumbar Spine 2-3 Views (72100) |
$473 |
$525 |
4.4× |
| X-Ray Lumbar Spine 6+ Vw - Xr Lumbar Spine 6+ Vws Including Bending (72114) |
$630 |
$700 |
5.8× |
| X-Ray Nasal Bones - Xr Nasal Bones (70160) |
$338 |
$375 |
3.7× |
| X-Ray Orbits - Xr Orbits Complete 4+ Views (70200) |
$450 |
$500 |
4.1× |
| X-Ray Pelvis 3+ Vw - Xr Pelvis 3+ Views (72190) |
$405 |
$450 |
3.7× |
| X-Ray Ribs 2 Vw Unilat - Xr Ribs 2 Views Right (71100) |
$360 |
$400 |
4.0× |
| X-Ray Ribs, Chest 3+ Vw - Xr Ribs 2 Vws Lt W/ Chest Anteroposterior (71101) |
$432 |
$480 |
4.0× |
| X-Ray Ribs, Chest 4+ Vw - Xr Ribs 3 Vws Bil W/ Chest Posteroanterior (71111) |
$527 |
$585 |
4.9× |
| X-Ray Sacroiliac Jts 3+ Vw - Xr Sacroiliac Joints 3+ Views (72202) |
$374 |
$415 |
3.4× |
| X-Ray Sacrum/Coccyx 2+ Vw - Xr Sacrum Coccyx 2+ Views (72220) |
$338 |
$375 |
3.7× |
| X-Ray Shoulder 2+ Vw - Xr Shoulder 2+ Views Right (73030) |
$520 |
$578 |
5.8× |
| X-Ray Sinuses 3+ Vw - Xr Paranasal Sinuses 3+ Views (70220) |
$423 |
$470 |
4.7× |
| X-Ray Sinuses <3 Vw - Xr Paranasal Sinuses 1-2 Views (70210) |
$297 |
$330 |
3.3× |
| X-Ray Skull 4+ Vw - Xr Skull Complete 4+ Views (70260) |
$495 |
$550 |
4.6× |
| X-Ray Skull <4 Vw - Xr Skull 1-3 Views (70250) |
$333 |
$370 |
3.1× |
| X-Ray Spine One View - Xr Spine (72020) |
$338 |
$375 |
3.7× |
| X-Ray Sterno-Clavicluar Jt - Xr Sternoclavicular Joints 3+ Views (71130) |
$270 |
$300 |
3.0× |
| X-Ray Sternum 2+ Vw - Xr Sternum 2+ Views (71120) |
$338 |
$375 |
3.7× |
| X-Ray Thoracic Spine 2 Vw - Xr Thoracic Spine 2 Views (72070) |
$387 |
$430 |
3.6× |
| X-Ray Toe(S) - Xr Toes 2+ Views Right (73660) |
$248 |
$275 |
2.7× |
| X-Ray Wrist 3+ Vw - Xr Wrist 3+ Views Right (73110) |
$338 |
$375 |
3.7× |
| Xr finger(s) 2+ views (73140) |
$252 |
$280 |
2.8× |
| XR Mastoids < 3 Views Bilateral (70120) |
$270 |
$300 |
2.5× |
| Xr optic foramina (70190) |
$270 |
$300 |
3.0× |
| Xr shoulder 1 view (73020) |
$261 |
$290 |
2.9× |
| Xr spine cervical 4 or 5 views (72050) |
$518 |
$575 |
4.8× |
| Xr tibia/fibula 2 views (73590) |
$320 |
$355 |
3.5× |
| Xr tmj bilateral (70330) |
$253 |
$281 |
2.8× |
| Xray knee 1 or 2 views rt (73560) |
$333 |
$370 |
3.7× |