| Abdomen 1 View (74018) |
$124 |
$248 |
1.5× |
| Abdomen 2 views (74019) |
$166.88 |
$333.75 |
1.7× |
| Angiography extremity bilateral rs&i (75716) |
$4,385.50 |
$8,771 |
1.5× |
| Ankle 2 views (73600) |
$124 |
$248 |
1.5× |
| Bone Imaging 3 Phase (78315) |
$577.50 |
$1,155 |
1.5× |
| Bone Imaging Whole Body (78306) |
$577.50 |
$1,155 |
1.5× |
| Chest 1 view (71045) |
$124 |
$248 |
1.5× |
| Chest 2 views (71046) |
$124 |
$248 |
1.5× |
| Clavicle complete (73000) |
$124 |
$248 |
1.5× |
| Computed Tomography Thorax Lw Dose Lng Ca Scr C- (71271) |
$166.88 |
$333.75 |
1.7× |
| Contrast Exam Abdominl Aorta (75625) |
$4,385.50 |
$8,771 |
1.5× |
| Contrast X-Ray Bladder (74430) |
$564.25 |
$1,128.50 |
1.7× |
| CT abdomen and pelvis without and with contrast (74178) |
$1,333 |
$2,666 |
4.1× |
| CT abdomen and pelvis without contrast (74176) |
$319 |
$638 |
1.4× |
| CT abdomen w contrast (74160) |
$651.25 |
$1,302.50 |
4.0× |
| CT abdomen w wo contrast (74170) |
$755 |
$1,510 |
4.6× |
| CT abdomen w/o contrast (74150) |
$341.50 |
$683 |
3.5× |
| CT Angio Abdomen and Pelvis (74174) |
$564.25 |
$1,128.50 |
1.7× |
| CT Angio Chest (71275) |
$702.25 |
$1,404.50 |
4.3× |
| CT Angio Head (70496) |
$702.25 |
$1,404.50 |
4.3× |
| Ct Angio Lwr Extr W/O&W/Dye (73706) |
$275.75 |
$551.50 |
1.7× |
| CT Angio Neck (70498) |
$702.25 |
$1,404.50 |
4.3× |
| Ct Angio Upr Extrm W/O&W/Dye (73206) |
$672 |
$1,344 |
4.1× |
| CT cervical spine w/ contrast (72126) |
$702.25 |
$1,404.50 |
2.1× |
| CT cervical spine w/o contrast (72125) |
$421.25 |
$842.50 |
4.3× |
| CT cervical spine w/wo cont (72127) |
$755 |
$1,510 |
4.6× |
| CT chest w contrast (71260) |
$702.25 |
$1,404.50 |
4.3× |
| CT chest w/wo contrast (71270) |
$702.25 |
$1,404.50 |
4.3× |
| CT head/brain without and with contrast (70470) |
$702.25 |
$1,404.50 |
4.3× |
| CT iac w contrast (70481) |
$702.25 |
$1,404.50 |
4.3× |
| CT l-spine w&w/o contrast (72133) |
$702.25 |
$1,404.50 |
4.3× |
| CT lower ext w/o (73700) |
$356.75 |
$713.50 |
3.6× |
| CT lower extremity w/contrast material (73701) |
$651.25 |
$1,302.50 |
4.0× |
| CT lumbar spine w contrast (72132) |
$702.25 |
$1,404.50 |
2.1× |
| CT lumbar spine w/o contrast (72131) |
$421.25 |
$842.50 |
4.3× |
| CT maxillofacial w contrast (70487) |
$702.25 |
$1,404.50 |
4.3× |
| CT maxillofacial wo contrast (70486) |
$420.25 |
$840.50 |
4.3× |
| CT neck tissue combo (70492) |
$702.25 |
$1,404.50 |
4.3× |
| Ct Orbit/Ear/Fossa W/O&W/Dye (70482) |
$702.25 |
$1,404.50 |
4.3× |
| CT orbits w/o contrast (70480) |
$420.25 |
$840.50 |
4.3× |
| CT pelvis w&w/o contrast (72194) |
$702.25 |
$1,404.50 |
4.3× |
| CT pelvis w/o contrast (72192) |
$421.25 |
$842.50 |
4.3× |
| CT scan of leg combo (73702) |
$412.25 |
$824.50 |
2.5× |
| CT scans face/jaw combo (70488) |
$702.25 |
$1,404.50 |
4.3× |
| CT soft tissue neck w contrast (70491) |
$702.25 |
$1,404.50 |
4.3× |
| CT soft tissue neck w/o contrast (70490) |
$500.25 |
$1,000.50 |
5.1× |
| CT thoracic spine w contrast (72129) |
$702.25 |
$1,404.50 |
4.3× |
| CT thoracic spine w/o contrast (72128) |
$421.25 |
$842.50 |
4.3× |
| CT thorax w/o contrast (71250) |
$420.25 |
$840.50 |
4.3× |
| CT upper ext wo (73200) |
$420.25 |
$840.50 |
4.3× |
| CT upper extremity w/o & w/contrast material (73202) |
$564.25 |
$1,128.50 |
3.4× |
| CT upper extremity with contrast (73201) |
$564.25 |
$1,128.50 |
1.7× |
| Cta Abdl Aorta&Bi Iliofem W/Contrast&Postp (75635) |
$900 |
$1,800 |
5.5× |
| Cta Abdomen (74175) |
$464.25 |
$928.50 |
2.8× |
| Dxa Bone Density Axial (77080) |
$166.88 |
$333.75 |
1.7× |
| Dxa bone density study (77085) |
$166.88 |
$333.75 |
1.7× |
| Dxa bone density study 1/>sites appendiclr skel (77081) |
$124 |
$248 |
1.5× |
| Esophagram (74220) |
$273.75 |
$547.50 |
1.7× |
| Fetal Biophysical Profile W/O Non-Stress Testing (76819) |
$166.88 |
$333.75 |
1.7× |
| Fluoroscopy up to 1 hr (76000) |
$352.50 |
$705 |
1.6× |
| Foot 2 views (73620) |
$124 |
$248 |
1.5× |
| Forearm 2 views (73090) |
$124 |
$248 |
1.5× |
| Gastric emptying imaging study (78264) |
$577.50 |
$1,155 |
1.5× |
| Hand 2 views (73120) |
$166.88 |
$333.75 |
1.7× |
| Hepatobil Syst Image W/Drug (78227) |
$749.75 |
$1,499.50 |
1.5× |
| Hepatobiliary System Imaging (78226) |
$577.50 |
$1,155 |
1.5× |
| Hysterosalpingogram (74740) |
$352.50 |
$705 |
1.6× |
| Joint Survey Single View (77077) |
$166.88 |
$333.75 |
1.7× |
| K Flow/Funct Image W/Drug (78708) |
$749.75 |
$1,499.50 |
1.5× |
| Knee 3 Views (73562) |
$124 |
$248 |
1.5× |
| Lung Ventilat&Perfus Imaging (78582) |
$749.75 |
$1,499.50 |
1.5× |
| Lymph System Imaging (78195) |
$749.75 |
$1,499.50 |
1.5× |
| MRA head w/o contrast (70544) |
$800.88 |
$1,601.75 |
3.6× |
| MRA neck w/o contrast (70547) |
$800.88 |
$1,601.75 |
3.6× |
| MRI abdomen w contrast (74182) |
$1,291.75 |
$2,583.50 |
3.9× |
| MRI abdomen w/o contrast (74181) |
$800.88 |
$1,601.75 |
3.6× |
| MRI any jt lower extrem w/o & w/contrast matrl (73723) |
$1,291.75 |
$2,583.50 |
3.9× |
| MRI any jt upper extremity w/contrast matrl (73222) |
$1,291.75 |
$2,583.50 |
1.8× |
| MRI cervical spine w contrast (72142) |
$1,291.75 |
$2,583.50 |
3.9× |
| MRI cervical spine w/o cont (72141) |
$800.88 |
$1,601.75 |
3.6× |
| MRI lower extrem oth/thn jt w/contrast matrl (73719) |
$1,291.75 |
$2,583.50 |
3.9× |
| MRI lower extrem oth/thn jt w/o & w/contr matr (73720) |
$1,291.75 |
$2,583.50 |
3.9× |
| MRI lower extrem oth/thn jt w/o contr matrl (73718) |
$800.88 |
$1,601.75 |
3.6× |
| MRI lumbar spine w contrast (72149) |
$1,291.75 |
$2,583.50 |
3.9× |
| Mri Neck Spine W/O & W/Dye (72156) |
$1,291.75 |
$2,583.50 |
3.9× |
| MRI orbit face &/neck w/o contrast (70540) |
$800.88 |
$1,601.75 |
3.6× |
| MRI pelvis w/o & w contrast (72197) |
$1,291.75 |
$2,583.50 |
3.9× |
| MRI pelvis w/o contrast (72195) |
$800.88 |
$1,601.75 |
3.6× |
| MRI thoracic spine w/o contrast (72146) |
$800.88 |
$1,601.75 |
3.6× |
| MRI upper extremity oth than jt w/o contr matrl (73218) |
$800.88 |
$1,601.75 |
3.6× |
| Mri Uppr Extremity W/O&W/Dye (73220) |
$1,291.75 |
$2,583.50 |
3.9× |
| MRI, abdomen, combo (74183) |
$1,291.75 |
$2,583.50 |
3.9× |
| MRI, dorsal spine combo (72157) |
$1,291.75 |
$2,583.50 |
3.9× |
| MRI, joint upper extrem (73221) |
$800.88 |
$1,601.75 |
3.6× |
| MRI, joint upper extrem combo (73223) |
$1,291.75 |
$2,583.50 |
3.9× |
| MRI, lumbar spine combo (72158) |
$1,291.75 |
$2,583.50 |
3.9× |
| Myocardial Spect Multiple Studies (78452) |
$2,002 |
$4,004 |
1.6× |
| Neck soft tissue (70360) |
$124 |
$248 |
1.5× |
| Optic foramina (70190) |
$124 |
$248 |
1.5× |
| Parathyroid planar imaging w/wo subtraction (78071) |
$577.50 |
$1,155 |
1.5× |
| Pelvis 1 or 2 views (72170) |
$166.88 |
$333.75 |
1.7× |
| Pulmonary Perfusion Imaging Particulate (78580) |
$577.50 |
$1,155 |
1.5× |
| Radex Abd Compl Aqt Abd W/S/E/D Views 1 View Ch (74022) |
$166.88 |
$333.75 |
1.7× |
| Radex Ankle Complete Minimum 3 Views (73610) |
$124 |
$248 |
1.5× |
| Radex Calcaneus Minimum 2 Views (73650) |
$124 |
$248 |
1.5× |
| Radex elbow complete minimum 3 views (73080) |
$124 |
$248 |
1.5× |
| Radex Facial Bones Complete Minimum 3 Views (70150) |
$166.88 |
$333.75 |
1.7× |
| Radex fingr minimum 2 views (73140) |
$124 |
$248 |
1.5× |
| Radex foot complete minimum 3 views (73630) |
$124 |
$248 |
1.5× |
| Radex Hand Minimum 3 Views (73130) |
$124 |
$248 |
1.5× |
| Radex lower extremity infant minimum 2 views (73592) |
$124 |
$248 |
1.5× |
| Radex Nasal Bones Complete Minimum 3 Views (70160) |
$124 |
$248 |
1.5× |
| Radex Ribs Unilateral 2 Views (71100) |
$124 |
$248 |
1.5× |
| Radex shoulder complete minimum 2 views (73030) |
$124 |
$248 |
1.5× |
| Radex Sinuses Paransl < 3 Views (70210) |
$124 |
$248 |
1.5× |
| Radex Spine 1 View Specify Level (72020) |
$124 |
$248 |
1.5× |
| Radex Sternum Minimum 2 Views (71120) |
$124 |
$248 |
1.5× |
| Radex Toe Minimum 2 Views (73660) |
$124 |
$248 |
1.5× |
| Radex upper extremity infant minimum 2 views (73092) |
$166.88 |
$333.75 |
1.7× |
| Radex Wrist Complete Minimum 3 Views (73110) |
$124 |
$248 |
1.5× |
| Radiolog exam mandible compl minimum 4 views (70110) |
$166.88 |
$333.75 |
1.7× |
| Radiologic exam colon double contrast study (74280) |
$273.75 |
$547.50 |
1.7× |
| Radiologic exam colon single contrast study (74270) |
$273.75 |
$547.50 |
1.7× |
| Radiologic Exam Esophagus Double Contrast Study (74221) |
$273.75 |
$547.50 |
1.7× |
| Radiologic exam knee complete 4/more views (73564) |
$166.88 |
$333.75 |
1.7× |
| Radiologic exam pelvis compl minimum 3 views (72190) |
$166.88 |
$333.75 |
1.7× |
| Radiologic Exam Small Int Single Contrast Study (74250) |
$273.75 |
$547.50 |
1.7× |
| Radiologic exam swallow function contrast study (74230) |
$273.75 |
$547.50 |
1.7× |
| Radiologic exam upr gi trc double contrast study (74246) |
$665.07 |
$1,330.14 |
4.0× |
| Radiologic examination femur 1 view (73551) |
$124 |
$248 |
1.5× |
| Radiologic examination femur minimum 2 views (73552) |
$124 |
$248 |
1.5× |
| Radiologic examination knee 1/2 views (73560) |
$124 |
$248 |
1.5× |
| Radiologic Examination Osseous Survey Limited (77074) |
$166.88 |
$333.75 |
1.7× |
| Radiologic examination tibia & fibula 2 views (73590) |
$124 |
$248 |
1.5× |
| Ribs bilateral 3 views (71110) |
$166.88 |
$333.75 |
1.7× |
| Rp Loclzj Tum Spect 1 Area Single Day Imaging (78803) |
$608.62 |
$1,217.25 |
1.2× |
| Scapula (73010) |
$166.88 |
$333.75 |
1.7× |
| Screening Digital Breast Tomosynthesis Bi (77063) |
$70.56 |
$141.12 |
3.0× |
| Shoulder 1 view (73020) |
$124 |
$248 |
1.5× |
| Skull less than 4 views (70250) |
$166.88 |
$333.75 |
1.7× |
| Thoracic spine 2 views (72070) |
$166.88 |
$333.75 |
1.7× |
| Thoracic spine 3 views (72072) |
$166.88 |
$333.75 |
1.7× |
| Thoracolumbar 2 views (72080) |
$124 |
$248 |
1.5× |
| Thyroid Uptake W/Blood Flow Sngle/Mult Quan Meas (78014) |
$826.96 |
$1,653.91 |
2.2× |
| Ultrasound Breast Limited (76642) |
$124 |
$248 |
1.5× |
| Ultrasound Exam Aaa Screen (76706) |
$166.88 |
$333.75 |
1.7× |
| Ultrasound, abdomen limited (76705) |
$166.88 |
$333.75 |
1.7× |
| Umbilical-artery Doppler (OB) (76820) |
$166.88 |
$333.75 |
1.7× |
| Urethrocystogram voiding (74455) |
$352.50 |
$705 |
1.6× |
| Us breast unilateral complete (76641) |
$166.88 |
$333.75 |
1.7× |
| Us chest (76604) |
$205.50 |
$411 |
2.1× |
| Us exam, pelvic, limited (76857) |
$166.88 |
$333.75 |
1.7× |
| Us lmtd joint/oth nonvasc xtr strux r-t w/img (76882) |
$166.88 |
$333.75 |
1.7× |
| Us ob detailed single fetus (76811) |
$352.50 |
$705 |
1.6× |
| Us ob limited 1 or more fetuses (76815) |
$166.88 |
$333.75 |
1.7× |
| Us ob transvaginal (76817) |
$166.88 |
$333.75 |
1.7× |
| Us pelvic non ob complete (76856) |
$166.88 |
$333.75 |
1.7× |
| Us pg uter img f&mat 14 wk tabdl 1/1st gestation (76801) |
$166.88 |
$333.75 |
1.7× |
| Us retroperitoneal complete (76770) |
$166.88 |
$333.75 |
1.7× |
| Us retroperitoneal limited (76775) |
$166.88 |
$333.75 |
1.7× |
| Us scrotum and contents (76870) |
$200 |
$400 |
2.0× |
| Us thyroid (76536) |
$166.88 |
$333.75 |
1.7× |
| Venography caval inferior serialography rs&i (75825) |
$4,385.50 |
$8,771 |
1.5× |
| Wrist 2 views (73100) |
$124 |
$248 |
1.5× |
| X-Ray Aorta Leg Arteries (75630) |
$4,385.50 |
$8,771 |
1.5× |
| X-Ray Elbow 2 Vw - Xr Elbow 1-2 Views Right (73070) |
$124 |
$248 |
1.5× |
| X-Ray Exam Breast Specimen (76098) |
$740.25 |
$1,480.50 |
1.4× |
| X-Ray Exam Entire Spi 1 Vw (72081) |
$124 |
$248 |
1.5× |
| X-Ray Exam Entire Spi 2/3 Vw (72082) |
$166.88 |
$333.75 |
1.7× |
| X-Ray Exam Hip Uni 1 View (73501) |
$124 |
$248 |
1.5× |
| X-Ray Exam Hip Uni 2-3 Views (73502) |
$124 |
$248 |
1.5× |
| X-Ray Exam Hip Uni 4/> Views (73503) |
$166.88 |
$333.75 |
1.7× |
| X-Ray Exam Hips Bi 2 Views (73521) |
$166.88 |
$333.75 |
1.7× |
| X-Ray Exam Hips Bi 3-4 Views (73522) |
$166.88 |
$333.75 |
1.7× |
| X-Ray Exam Hips Bi 5/> Views (73523) |
$166.88 |
$333.75 |
1.7× |
| X-Ray Exam L-S Spine Bending (72114) |
$166.88 |
$333.75 |
1.7× |
| X-Ray Exam Neck Spine 2-3 Vw (72040) |
$124 |
$248 |
1.5× |
| X-Ray Exam Neck Spine 6/>Vws (72052) |
$166.88 |
$333.75 |
1.7× |
| X-Ray Exam Unilat Ribs/Chest (71101) |
$166.88 |
$333.75 |
1.7× |
| X-ray humerus (73060) |
$124 |
$248 |
1.5× |
| X-ray IV pyelogram (ivp) (74400) |
$273.75 |
$547.50 |
1.7× |
| X-Ray Jaw <4 Vw - Xr Mandible < 4 Views (70100) |
$124 |
$248 |
1.5× |
| X-Ray Knee Bilat Standing - Xr Knees Anteroposterior Standing Bilat (73565) |
$124 |
$248 |
1.5× |
| X-Ray Lumbar Spine 2/3 Vw - Xr Lumbar Spine 2-3 Views (72100) |
$166.88 |
$333.75 |
1.7× |
| X-ray nose-rectum child f.b. (76010) |
$124 |
$248 |
1.5× |
| X-Ray Ribs, Chest 4+ Vw - Xr Ribs 3 Vws Bil W/ Chest Posteroanterior (71111) |
$166.88 |
$333.75 |
1.7× |
| X-Ray Sacroiliac Jts 3+ Vw - Xr Sacroiliac Joints 3+ Views (72202) |
$166.88 |
$333.75 |
1.7× |
| X-Ray Sacroiliac Jts <3 Vw - Xr Sacroiliac Joints 1-2 Views (72200) |
$166.88 |
$333.75 |
1.7× |
| X-Ray Sacrum/Coccyx 2+ Vw - Xr Sacrum Coccyx 2+ Views (72220) |
$124 |
$248 |
1.5× |
| X-Ray Sinuses 3+ Vw - Xr Paranasal Sinuses 3+ Views (70220) |
$124 |
$248 |
1.5× |
| X-Ray Skull 4+ Vw - Xr Skull Complete 4+ Views (70260) |
$166.88 |
$333.75 |
1.7× |
| X-ray thoracic spine 4 vw (72074) |
$166.88 |
$333.75 |
1.7× |
| X-Ray Tmj Unilat (70328) |
$124 |
$248 |
1.5× |
| X-Rays Bone Length Studies (77073) |
$166.88 |
$333.75 |
1.7× |
| Xr c-spine 4 or 5 views (72050) |
$166.88 |
$333.75 |
1.7× |
| Xr facial bones less than 3 views (70140) |
$124 |
$248 |
1.5× |
| Xr orbits complete 4 views (70200) |
$166.88 |
$333.75 |
1.7× |