| Acute gastrointestinal blood loss imaging (78278) |
$1,179 |
$1,474 |
2.9× |
| Ankle 2 views (73600) |
$195 |
$244 |
2.2× |
| Arthrogram shoulder (73040) |
$648 |
$810 |
1.9× |
| Bone &/Joint Imaging Limited Area (78300) |
$1,153 |
$1,441 |
2.9× |
| Bone &/Joint Imaging Multiple Areas (78305) |
$980 |
$1,225 |
2.4× |
| Bone &/joint imaging whole body (78306) |
$980 |
$1,225 |
2.4× |
| Bone Imaging 3 Phase (78315) |
$1,347 |
$1,684 |
3.4× |
| Bone survey complete (77075) |
$377 |
$471 |
3.6× |
| Cervical spine 2 or 3 views (72040) |
$230 |
$287 |
2.6× |
| Chest 1 view (71045) |
$154 |
$192 |
1.8× |
| Chest 3 views (71047) |
$154 |
$192 |
1.8× |
| Cine/Vid X-Ray Throat/Esoph - Fl Esoph Barium Swlw W/ Video & Speech (74230) |
$362 |
$452 |
2.1× |
| Clavicle complete (73000) |
$234 |
$293 |
2.7× |
| Computed Tomography Thorax Lw Dose Lng Ca Scr C- (71271) |
$1,262 |
$1,578 |
12.1× |
| CT abdomen and pelvis without and with contrast (74178) |
$3,157 |
$3,946 |
9.0× |
| CT abdomen and pelvis without contrast (74176) |
$2,526 |
$3,157 |
10.6× |
| CT abdomen w contrast (74160) |
$1,421 |
$1,776 |
8.1× |
| CT abdomen w wo contrast (74170) |
$1,578 |
$1,973 |
9.0× |
| CT abdomen w/o contrast (74150) |
$1,262 |
$1,578 |
12.1× |
| CT c-spine w/o contrast (72125) |
$1,262 |
$1,578 |
12.1× |
| CT cervical spine w&w/o contrast (72127) |
$1,578 |
$1,973 |
9.0× |
| CT cervical spine with contrast (72126) |
$1,421 |
$1,776 |
4.1× |
| CT chest w/wo contrast (71270) |
$1,578 |
$1,973 |
9.0× |
| CT chest with contrast (71260) |
$1,421 |
$1,776 |
8.1× |
| CT head/brain with contrast (70460) |
$1,421 |
$1,776 |
8.1× |
| CT head/brain without and with contrast (70470) |
$1,578 |
$1,973 |
9.0× |
| CT iac w contrast (70481) |
$1,421 |
$1,776 |
8.1× |
| CT limited/localized follow up study (76380) |
$1,034 |
$1,293 |
11.9× |
| CT lower ext w/o (73700) |
$1,262 |
$1,578 |
12.1× |
| CT lower extremity w wo contrast (73702) |
$1,578 |
$1,973 |
9.0× |
| CT lower extremity with contrast (73701) |
$1,421 |
$1,776 |
8.1× |
| CT lumbar spine w & w/o contrast (72133) |
$1,578 |
$1,973 |
9.0× |
| CT lumbar spine w/o contrast (72131) |
$1,262 |
$1,578 |
12.1× |
| CT lumbar spine with contrast (72132) |
$1,421 |
$1,776 |
4.1× |
| CT maxillofacial w contrast (70487) |
$1,421 |
$1,776 |
8.1× |
| CT maxillofacial w/o contrast (70486) |
$1,262 |
$1,578 |
12.1× |
| CT maxillofacial w/wo contrast (70488) |
$1,578 |
$1,973 |
9.0× |
| CT neck soft tissue w contrast (70491) |
$1,421 |
$1,776 |
8.1× |
| CT orbit sella/post fossa/ear w/o & w/contr matr (70482) |
$1,578 |
$1,973 |
9.0× |
| CT orbits w/o contrast (70480) |
$1,262 |
$1,578 |
12.1× |
| CT pelvis w & w/o contrast (72194) |
$1,578 |
$1,973 |
9.0× |
| CT pelvis w/o contrast (72192) |
$1,262 |
$1,578 |
12.1× |
| CT soft tissue neck w/o & w/contrast material (70492) |
$1,578 |
$1,973 |
9.0× |
| CT soft tissue neck w/o contrast (70490) |
$1,262 |
$1,578 |
12.1× |
| CT thoracic spine w/contrast (72129) |
$1,421 |
$1,776 |
8.1× |
| CT thoracic spine w/o contrast (72128) |
$1,262 |
$1,578 |
12.1× |
| CT thoracic spine w/wo contrast (72130) |
$1,578 |
$1,973 |
9.0× |
| CT thorax w/o contrast (71250) |
$1,262 |
$1,578 |
12.1× |
| CT upper extremity w/o & w/contrast material (73202) |
$1,578 |
$1,973 |
9.0× |
| CT upper extremity w/o contrast rt (73200) |
$1,262 |
$1,578 |
12.1× |
| CT upper extremity with contrast (73201) |
$1,421 |
$1,776 |
4.1× |
| Cta Abdl Aorta&Bi Iliofem W/Contrast&Postp (75635) |
$1,698 |
$2,123 |
9.7× |
| Cta Abdomen (74175) |
$1,578 |
$1,973 |
9.0× |
| CTA abdomen pelvis (74174) |
$3,157 |
$3,946 |
9.0× |
| CTA chest (71275) |
$1,421 |
$1,776 |
8.1× |
| Cta Head (70496) |
$1,698 |
$2,123 |
9.7× |
| CTA head&neck c+ w/noncontrast img&post-pxessing (70471) |
$1,698 |
$2,123 |
4.9× |
| Cta Neck (70498) |
$1,698 |
$2,123 |
9.7× |
| Cta Pelvis (72191) |
$1,578 |
$1,973 |
9.0× |
| Cystography minimum 3 views rs&i (74430) |
$324 |
$405 |
0.9× |
| Dxa bone density study 1/> sites axial skel (77080) |
$300 |
$375 |
2.9× |
| Echoencephalography real time imaging (76506) |
$479 |
$599 |
4.6× |
| Esophagus (74220) |
$300 |
$375 |
1.7× |
| Fetal Biophysical Profile W/O Non-Stress Testing (76819) |
$451 |
$564 |
4.3× |
| Fluoroscopy up to 1 hr (76000) |
$438 |
$547 |
1.8× |
| Foot 2 views (73620) |
$174 |
$218 |
2.0× |
| Forearm 2 views (73090) |
$174 |
$218 |
2.0× |
| Full Mouth X-Ray Of Teeth - Xr Teeth Full Mouth (70320) |
$74 |
$93 |
0.3× |
| Gated Heart Planar Single (78472) |
$1,562 |
$1,952 |
3.9× |
| Hand 2 views (73120) |
$167 |
$209 |
1.6× |
| Hand 3 views (73130) |
$214 |
$268 |
2.5× |
| Hepatobiliary syst imaging including gallbladder (78226) |
$1,464 |
$1,830 |
3.7× |
| Humerus Min 2 Views Left (73060) |
$177 |
$221 |
2.0× |
| Hysterosalpingogram (74740) |
$351 |
$439 |
1.5× |
| Joint Survey, Single View - Xr Joint Anteroposterior 2+ Joints (77077) |
$89 |
$111 |
0.8× |
| Kidney Img Morphology Vascular Flow 1 W/O Rx (78707) |
$968 |
$1,210 |
1.8× |
| Kidney img morphology vascular flow 1 w/rx (78708) |
$968 |
$1,210 |
1.8× |
| Knee 3 views (73562) |
$178 |
$222 |
2.0× |
| Liver & spleen imaging static only (78215) |
$949 |
$1,186 |
2.4× |
| Liver & Spleen Imaging W/Vascular Flow (78216) |
$1,121 |
$1,401 |
2.8× |
| Liver imaging w/vascular flow (78202) |
$1,330 |
$1,663 |
2.4× |
| Lung perf&ventilat diferentl (78598) |
$963 |
$1,204 |
1.8× |
| Lung Ventilation Imaging (78579) |
$917 |
$1,146 |
2.3× |
| Meckels Diverticulum (78290) |
$1,077 |
$1,346 |
2.7× |
| MRA head w & w/o contrast (70546) |
$2,052 |
$2,565 |
5.9× |
| MRA head w/o contrast (70544) |
$1,578 |
$1,973 |
6.6× |
| MRA neck w contrast (70548) |
$1,815 |
$2,269 |
5.2× |
| Mra Neck W/O &W/Contrast Material (70549) |
$2,052 |
$2,565 |
5.9× |
| MRA neck w/o contrast (70547) |
$1,578 |
$1,973 |
6.6× |
| MRI abdomen w contrast (74182) |
$1,815 |
$2,269 |
5.2× |
| MRI abdomen w/o & w/contrast material (74183) |
$2,052 |
$2,565 |
5.9× |
| MRI abdomen w/o contrast (74181) |
$1,578 |
$1,973 |
6.6× |
| MRI any jnt lwr ext with con lt (73722) |
$1,815 |
$2,269 |
2.3× |
| MRI any jt upper extremity w/contrast matrl (73222) |
$1,815 |
$2,269 |
2.3× |
| MRI bone marrow blood supply (77084) |
$1,235 |
$1,544 |
5.2× |
| MRI c-spine with contrast (72142) |
$1,815 |
$2,269 |
5.2× |
| MRI cervical spine w/o contrast (72141) |
$1,578 |
$1,973 |
6.6× |
| MRI chest w/o & w/contrast material (71552) |
$2,314 |
$2,892 |
6.6× |
| MRI chest w/o contrast (71550) |
$1,578 |
$1,973 |
6.6× |
| MRI chest with contrast (71551) |
$1,815 |
$2,269 |
2.3× |
| MRI Forearm w/ Contrast Bilateral 73219 (73219) |
$1,815 |
$2,269 |
5.2× |
| MRI lower extrem oth/thn jt w/contrast matrl (73719) |
$1,815 |
$2,269 |
5.2× |
| MRI lower extrem oth/thn jt w/o contr matrl (73718) |
$1,578 |
$1,973 |
6.6× |
| MRI orbit face &/neck w/o contrast (70540) |
$1,578 |
$1,973 |
6.6× |
| MRI orbit/face/neck w&w/o cont (70543) |
$2,052 |
$2,565 |
5.9× |
| MRI orbit/face/neck w/contrast (70542) |
$1,815 |
$2,269 |
5.2× |
| MRI pelvis w contrast (72196) |
$1,815 |
$2,269 |
5.2× |
| MRI pelvis w/o & w/contrast material (72197) |
$2,052 |
$2,565 |
5.9× |
| MRI pelvis w/o contrast (72195) |
$1,578 |
$1,973 |
6.6× |
| MRI scan of arm joint before and after contrast (73223) |
$2,052 |
$2,565 |
5.9× |
| MRI scan of leg joint before and after contrast (73723) |
$2,052 |
$2,565 |
5.9× |
| MRI spinal canal cervical w/o & w/contr matrl (72156) |
$2,052 |
$2,565 |
5.9× |
| MRI spinal canal lumbar w/contrast material (72149) |
$1,815 |
$2,269 |
5.2× |
| MRI spinal canal lumbar w/o & w/contr matrl (72158) |
$2,052 |
$2,565 |
5.9× |
| MRI spinal canal thoracic w/contrast matrl (72147) |
$1,815 |
$2,269 |
5.2× |
| MRI spinal canal thoracic w/o & w/contr matrl (72157) |
$2,052 |
$2,565 |
5.9× |
| MRI thoracic spine w/o contrast (72146) |
$1,578 |
$1,973 |
6.6× |
| MRI tmj (70336) |
$1,578 |
$1,973 |
6.6× |
| MRI upper ext joint w/o contrast (73221) |
$1,578 |
$1,973 |
6.6× |
| MRI upper extrem other than jt w/o & w/contras (73220) |
$2,052 |
$2,565 |
5.9× |
| MRI upper extremity oth than jt w/o contr matrl (73218) |
$1,578 |
$1,973 |
6.6× |
| Nm gastric emptying study (78264) |
$1,179 |
$1,474 |
2.9× |
| Nuclear medicine study of kidney and blood flow (78701) |
$960 |
$1,200 |
2.4× |
| Ob Us Follow-Up Per Fetus - Us Ob Follow Up Transabdominal Approach (76816) |
$261 |
$326 |
2.5× |
| Osseous survey infant (77076) |
$398 |
$498 |
3.8× |
| Parathyroid imaging (78070) |
$1,055 |
$1,319 |
2.6× |
| Pelvis 1 or 2 views (72170) |
$184 |
$230 |
1.8× |
| Pr MRI, lower extr, w/o contrast f/u by contrast (73720) |
$2,052 |
$2,565 |
5.9× |
| Pulmonary Perfusion Imaging Particulate (78580) |
$1,135 |
$1,419 |
2.8× |
| Radex Entir Thrc Lmbr Crv Sac Spi W/Skull 1 Vw - Xr Scoliosis 1 Vw (72081) |
$190 |
$237 |
2.2× |
| Radex mastoids compl minimum 3 views pr side (70130) |
$190 |
$237 |
1.8× |
| Radiologic Exam Abdomen 1 View - Xr Abdomen 1 View (74018) |
$164 |
$205 |
1.9× |
| Radiologic Exam Abdomen 3+ Views - Xr Abdomen 3+ Views (74021) |
$331 |
$414 |
3.2× |
| Radiologic Exam Chest 2 Views - Xr Chest 2 Views (71046) |
$169.50 |
$212 |
1.9× |
| Radiologic exam colon single contrast study (74270) |
$480 |
$600 |
2.7× |
| Radiologic exam upr gi trc double contrast study (74246) |
$452 |
$565 |
2.6× |
| Radiologic Examination Femur Minimum 2 Views - Xr Femur 2+ Vw Lt (73552) |
$230 |
$287 |
2.6× |
| Rp loclzj tum spect 1 area single day imaging (78803) |
$1,255.50 |
$1,569.50 |
2.3× |
| Scanogram (77073) |
$246 |
$307 |
2.3× |
| Scapula complete (73010) |
$199 |
$249 |
1.9× |
| Shuntogram indwelling nonvascular shunt rs&i (75809) |
$407 |
$509 |
3.9× |
| Small bowel series (74250) |
$397 |
$496 |
2.3× |
| Spine thoracic 3 views (72072) |
$278 |
$348 |
2.7× |
| Ultrasound, abdomen limited (76705) |
$451 |
$564 |
4.3× |
| Urethrocystography voiding (74455) |
$13 |
$16 |
0.1× |
| Urography (pyelography), intravenous, with or without KUB, with or without tomography (74400) |
$469 |
$586 |
2.7× |
| Urograpy infusion drip &/bolus techq w/wo tomo (74415) |
$734 |
$918 |
4.2× |
| Us abdl aorta screen aaa (76706) |
$534 |
$667 |
5.1× |
| Us breast unilateral complete (76641) |
$369 |
$461 |
3.5× |
| Us breast unilateral limited (76642) |
$369 |
$461 |
4.2× |
| Us chest (76604) |
$479 |
$599 |
4.6× |
| Us compl joint r-t w/image documentation (76881) |
$429 |
$536 |
4.1× |
| Us elastography parenchyma (76981) |
$500 |
$625 |
4.8× |
| Us infant hips limited static (76886) |
$390 |
$487 |
4.5× |
| Us ob detailed single fetus (76811) |
$519 |
$649 |
2.2× |
| Us ob transvaginal (76817) |
$298 |
$373 |
2.8× |
| Us pelvic non ob complete (76856) |
$484 |
$605 |
4.6× |
| Us pelvic nonobstetric image dcmtn limited/f/u (76857) |
$92 |
$115 |
0.9× |
| Us pregnancy ltd (76815) |
$290 |
$362 |
2.8× |
| Us pregnant uterus 14 wk transabdl 1/1st gestat (76801) |
$452 |
$565 |
4.3× |
| Us retroperitoneal complete (76770) |
$565 |
$706 |
5.4× |
| Us retroperitoneal limited (76775) |
$534 |
$667 |
5.1× |
| Us scrotum and contents (76870) |
$590 |
$738 |
5.6× |
| Us soft tissue head/neck (76536) |
$489 |
$611 |
4.7× |
| Us xtr non-vasc lmtd (76882) |
$429 |
$536 |
4.1× |
| Wrist 2 views (73100) |
$176 |
$220 |
2.0× |
| X-Ray Abdomen,Comp Acute Series - Xr Abdomen 2 Vws With Chest 1 View (74022) |
$562 |
$703 |
5.4× |
| X-Ray Ac Jts - Xr Acromioclavicular Joints Bilateral (73050) |
$527 |
$659 |
6.0× |
| X-Ray Ankle 3+ Vw - Xr Ankle 3+ Views Right (73610) |
$214 |
$268 |
2.5× |
| X-Ray Colon Air Contrast - Fl Barium Enema Air Contrast (74280) |
$622 |
$777 |
3.5× |
| X-Ray Elbow 2 Vw - Xr Elbow 1-2 Views Right (73070) |
$214 |
$268 |
2.5× |
| X-Ray Elbow 3+ Vw - Xr Elbow 3+ Views Right (73080) |
$222 |
$278 |
2.5× |
| X-ray exam hip uni 1 view (73501) |
$161 |
$201 |
1.8× |
| X-Ray Exam Hip Uni 2-3 Views (73502) |
$178 |
$222 |
2.0× |
| X-Ray Exam Hips Bi 5/> Views (73523) |
$226 |
$282 |
2.2× |
| X-ray eye for foreign body (70030) |
$230 |
$287 |
2.6× |
| X-Ray Facial Bones 3+ Vw - Xr Facial Bones 3+ Views (70150) |
$291 |
$364 |
2.8× |
| X-Ray Foot 3+ Vw - Xr Foot 3+ Views Right (73630) |
$191 |
$239 |
2.2× |
| X-Ray Heel - Xr Calcaneus 2 Views Right (73650) |
$186 |
$232 |
2.1× |
| X-Ray Jaw <4 Vw - Xr Mandible < 4 Views (70100) |
$214 |
$268 |
2.5× |
| X-Ray Lumbar Spine 2/3 Vw - Xr Lumbar Spine 2-3 Views (72100) |
$258 |
$322 |
2.5× |
| X-Ray Nasal Bones - Xr Nasal Bones (70160) |
$214 |
$268 |
2.5× |
| X-Ray Retrograde Pyelogram - Fl Pyelogram Retrograde (74420) |
$458 |
$573 |
1.3× |
| X-Ray Ribs 2 Vw Unilat - Xr Ribs 2 Views Right (71100) |
$230 |
$287 |
2.6× |
| X-Ray Ribs, Chest 3+ Vw - Xr Ribs 2 Vws Lt W/ Chest Anteroposterior (71101) |
$16.50 |
$21 |
0.2× |
| X-Ray Sacroiliac Jts 3+ Vw - Xr Sacroiliac Joints 3+ Views (72202) |
$195 |
$244 |
1.9× |
| X-Ray Sacrum/Coccyx 2+ Vw - Xr Sacrum Coccyx 2+ Views (72220) |
$291 |
$364 |
3.3× |
| X-Ray Shoulder 2+ Vw - Xr Shoulder 2+ Views Right (73030) |
$195 |
$244 |
2.2× |
| X-Ray Sinuses 3+ Vw - Xr Paranasal Sinuses 3+ Views (70220) |
$233 |
$291 |
2.7× |
| X-Ray Skull 4+ Vw - Xr Skull Complete 4+ Views (70260) |
$245 |
$306 |
2.3× |
| X-Ray Skull <4 Vw - Xr Skull 1-3 Views (70250) |
$180 |
$225 |
1.7× |
| X-Ray Spine One View - Xr Spine (72020) |
$218 |
$272 |
2.5× |
| X-Ray Sternum 2+ Vw - Xr Sternum 2+ Views (71120) |
$186 |
$232 |
2.1× |
| X-Ray Toe(S) - Xr Toes 2+ Views Right (73660) |
$173 |
$216 |
2.0× |
| X-Ray Wrist 3+ Vw - Xr Wrist 3+ Views Right (73110) |
$214 |
$268 |
2.5× |
| Xr c-spine 6 or more views (72052) |
$342 |
$428 |
3.3× |
| Xr finger(s) 2+ views (73140) |
$170 |
$213 |
2.0× |
| Xr shoulder 1 view (73020) |
$154 |
$192 |
1.8× |
| Xr spine cervical 4 or 5 views (72050) |
$282 |
$352 |
2.7× |
| Xr tibia/fibula 2 views (73590) |
$169 |
$211 |
1.9× |
| Xray knee 1 or 2 views rt (73560) |
$154 |
$192 |
1.8× |