| Arthrogram elbow (73085) |
$433 |
$1,061.28 |
1.4× |
| Arthrogram hip (73525) |
$433 |
$1,061.28 |
1.4× |
| Arthrogram shoulder (73040) |
$433 |
$1,061.28 |
1.4× |
| Arthrogram wrist (73115) |
$433 |
$1,061.28 |
1.4× |
| Arthrography knee lt (73580) |
$433 |
$1,061.28 |
1.4× |
| Bone survey complete (77075) |
$128 |
$321 |
1.4× |
| Brain image w/flow 4 + views (78606) |
$575 |
$800 |
1.2× |
| Breath Test,Acquire/Analyze - Nm Breath Test Acquire Analyze (78267) |
— |
$150 |
— |
| CT angiography upper extremity lt (73206) |
$210 |
$960.81 |
1.4× |
| CT cervical spine w&w/o contrast (72127) |
$210 |
$3,450 |
1.4× |
| CT cervical spine with contrast (72126) |
$433 |
$3,714.50 |
1.4× |
| CT chest w/wo contrast (71270) |
$210 |
$2,850 |
1.4× |
| CT heart no contrast quant eval coronry calcium (75571) |
— |
$125 |
— |
| CT iac w contrast (70481) |
$276 |
$1,250 |
1.8× |
| CT lumbar spine w & w/o contrast (72133) |
$210 |
$2,178 |
1.4× |
| CT lumbar spine with contrast (72132) |
$433 |
$2,992 |
1.4× |
| CT maxillofacial w/wo contrast (70488) |
$276 |
$2,035.12 |
1.8× |
| CT orbit sella/post fossa/ear w/o & w/contr matr (70482) |
$276 |
$1,800 |
1.8× |
| CT soft tissue neck w/o & w/contrast material (70492) |
$276 |
$2,678 |
1.8× |
| CT thoracic spine w/contrast (72129) |
$210 |
$2,599 |
1.4× |
| CT thoracic spine w/wo contrast (72130) |
$210 |
$4,145 |
1.4× |
| CT upper extremity w/o & w/contrast material (73202) |
$210 |
$3,072 |
1.4× |
| CT upper extremity with contrast (73201) |
$433 |
$1,000 |
1.4× |
| Cta Pelvis (72191) |
$210 |
$960.81 |
1.4× |
| Cystography minimum 3 views rs&i (74430) |
— |
$413.50 |
— |
| Doppler Echo Fetal Spectral Display Complete (76827) |
$271 |
$765 |
2.9× |
| Echoencephalography real time imaging (76506) |
$128 |
$560 |
1.4× |
| Fetal biophysical profile non-stress testing (76818) |
$128 |
$718 |
1.4× |
| Foot 2 views (73620) |
$95 |
$178 |
1.2× |
| Hepatobiliary syst imaging including gallbladder (78226) |
$370 |
$2,100 |
1.1× |
| Ht muscle image spect sing (78451) |
$1,535 |
$6,500 |
1.3× |
| Hysterosalpingogram (74740) |
$270 |
$800 |
1.3× |
| Kidney funcj study non-img radioisotopic study (78725) |
$443 |
$752 |
1.3× |
| Kidney imaging morphology (78700) |
$443 |
$2,897 |
1.3× |
| Kidney img morphology vascular flow 1 w/rx (78708) |
$443 |
$775 |
0.9× |
| Lymphoscintigraphy (78195) |
— |
$1,223 |
— |
| Mammary ductogram or galactogram multiple (77054) |
$231.90 |
$237.75 |
1.1× |
| Mammary ductogram or galactogram single (77053) |
$231.90 |
$356.62 |
1.1× |
| Manual appl stress pfrmd phys/qhp joint films (77071) |
$82.45 |
$180 |
1.1× |
| MRA neck w contrast (70548) |
$307.67 |
$1,700 |
1.0× |
| Mra Neck W/O &W/Contrast Material (70549) |
$449.11 |
$2,140 |
1.5× |
| MRI abdomen w contrast (74182) |
$400 |
$1,700 |
1.3× |
| MRI any jnt lwr ext with con lt (73722) |
$840 |
$1,700 |
1.2× |
| MRI c-spine with contrast (72142) |
$433 |
$1,700 |
1.4× |
| MRI chest w/o & w/contrast material (71552) |
$433 |
$2,140 |
1.4× |
| MRI chest w/o contrast (71550) |
$270 |
$1,400 |
1.3× |
| MRI chest with contrast (71551) |
$840 |
$1,700 |
1.2× |
| MRI Forearm w/ Contrast Bilateral 73219 (73219) |
$433 |
$1,700 |
1.4× |
| MRI lower extrem oth/thn jt w/contrast matrl (73719) |
$500 |
$1,700 |
1.6× |
| MRI scan of leg joint before and after contrast (73723) |
$550 |
$2,140 |
1.8× |
| MRI spinal canal thoracic w/contrast matrl (72147) |
$433 |
$1,700 |
1.4× |
| MRI upper extremity oth than jt w/o contr matrl (73218) |
$270 |
$1,400 |
1.3× |
| Nm peritoneal-venous shunt patency (78291) |
$443 |
$810 |
1.3× |
| Nuclear medicine of heart muscle at rest with stress (78454) |
$800 |
$834.75 |
0.7× |
| Nuclear medicine study of kidney and blood flow (78701) |
$443 |
$775 |
1.3× |
| Osseous survey infant (77076) |
$128 |
$273 |
1.4× |
| Pulmonary Ventilation & Perfusion Imaging (78582) |
$575 |
$2,500 |
1.2× |
| Radex abscess/fistula/sinus tract rs&i (76080) |
$472.27 |
$583.50 |
1.0× |
| Radiolog exam mandible compl minimum 4 views (70110) |
$128 |
$290 |
1.4× |
| Radiological examination surgical specimen (76098) |
$536.84 |
$631 |
1.1× |
| Rp loclzj tum plnr whole body single day imaging (78802) |
$1,150 |
$2,268.50 |
2.4× |
| Scapula complete (73010) |
$128 |
$220 |
1.4× |
| Spleen imaging only (78185) |
$443 |
$808.50 |
1.3× |
| Testicular Imaging With Vascular Flow (78761) |
$366.39 |
$1,334.50 |
1.0× |
| Thoracolumbar 2 views (72080) |
$128 |
$388 |
1.7× |
| Tumor Imaging, Limited Area - Nm Tumor Localization Limited (78800) |
$443 |
$2,325 |
1.3× |
| Upper Extremity Infant (73092) |
— |
$108 |
— |
| Urethrocystography voiding (74455) |
$237.18 |
$600 |
1.1× |
| Us breast unilateral complete (76641) |
$128 |
$300 |
1.4× |
| Us ob transvaginal (76817) |
$128 |
$636 |
1.4× |
| Us spinal canal and contents (76800) |
$128 |
$654 |
1.4× |
| Vascular flow imaging (78445) |
— |
$395 |
— |
| Venogram extremity bilateral (75822) |
$1,650 |
$1,900 |
1.2× |
| Venography extremity unilateral rs&i (75820) |
$695.40 |
$450 |
0.5× |
| X-Ray Colon Air Contrast - Fl Barium Enema Air Contrast (74280) |
$210 |
$595.50 |
1.4× |
| X-Ray Elbow 2 Vw - Xr Elbow 1-2 Views Right (73070) |
$95 |
$315 |
1.2× |
| X-ray eye for foreign body (70030) |
$104.83 |
$130.30 |
1.4× |
| X-Ray Facial Bones <3 Vw - Xr Facial Bones 1-2 Views (70140) |
$95 |
$229.50 |
1.2× |
| X-ray IV pyelogram+drip infusn (74410) |
$237 |
$704 |
1.5× |
| X-Ray Jaw <4 Vw - Xr Mandible < 4 Views (70100) |
$105 |
$180 |
1.4× |
| X-Ray Lumbar Spine 6+ Vw - Xr Lumbar Spine 6+ Vws Including Bending (72114) |
$128 |
$301 |
1.4× |
| X-Ray Nose-Rectum Child F.B. - Xr Nose to Rectum Foreign Body Peds (76010) |
$128.27 |
$173 |
1.7× |
| X-Ray Orbits - Xr Orbits Complete 4+ Views (70200) |
$135.32 |
$682 |
1.5× |
| X-Ray Pelvis 3+ Vw - Xr Pelvis 3+ Views (72190) |
$128 |
$446 |
1.4× |
| X-Ray Sacroiliac Jts 3+ Vw - Xr Sacroiliac Joints 3+ Views (72202) |
$128 |
$272 |
1.4× |
| X-Ray Sacrum/Coccyx 2+ Vw - Xr Sacrum Coccyx 2+ Views (72220) |
$71.13 |
$200 |
0.9× |
| X-Ray Sinuses 3+ Vw - Xr Paranasal Sinuses 3+ Views (70220) |
$95 |
$401 |
1.2× |
| X-Ray Sinuses <3 Vw - Xr Paranasal Sinuses 1-2 Views (70210) |
$95 |
$197 |
1.2× |
| X-Ray Spine One View - Xr Spine (72020) |
$125.55 |
$194 |
1.6× |
| X-Ray Sterno-Clavicluar Jt - Xr Sternoclavicular Joints 3+ Views (71130) |
$95 |
$378 |
1.2× |
| X-Ray Sternum 2+ Vw - Xr Sternum 2+ Views (71120) |
$95 |
$604 |
1.2× |
| X-Ray Thoracic Spine 2 Vw - Xr Thoracic Spine 2 Views (72070) |
$128 |
$388 |
1.4× |
| Xr arthrogram ankle (73615) |
$433 |
$1,061.28 |
1.4× |
| Xr chest 4+ views (71048) |
— |
$522.50 |
— |
| Xr spine cervical 4 or 5 views (72050) |
$128 |
$388 |
1.4× |