| Abdomen 2 views (74019) |
$175 |
$350 |
1.7× |
| Ankle 2 views (73600) |
$144 |
$288 |
1.7× |
| Bone &/joint imaging whole body (78306) |
$659 |
$1,318 |
1.7× |
| Bone age studies (77072) |
$111.60 |
$205 |
1.1× |
| Bone Imaging 3 Phase (78315) |
$736 |
$1,472 |
1.9× |
| Bone survey complete (77075) |
$198 |
$396 |
2.0× |
| Brain Imaging Vascular Flow Only (78610) |
$827 |
$1,654 |
1.6× |
| Cervical spine 2 or 3 views (72040) |
$147 |
$294 |
1.8× |
| Chest 1 view (71045) |
$144 |
$249 |
1.7× |
| Chest xray 3 views (71047) |
$152 |
$300 |
1.8× |
| Cholecystography, oral contrast Non-Facility (74290) |
$130.20 |
$186 |
0.8× |
| Clavicle complete (73000) |
$157.75 |
$315.50 |
1.9× |
| Computed Tomography Thorax Lw Dose Lng Ca Scr C- (71271) |
$797 |
$1,594 |
7.9× |
| Contrast Xray Throat/Cerv Esopha (74210) |
$93.10 |
$133 |
0.6× |
| CT abdomen and pelvis without and with contrast (74178) |
$686.50 |
$1,373 |
2.1× |
| CT abdomen and pelvis without contrast (74176) |
$1,222 |
$2,444 |
5.3× |
| CT abdomen w contrast (74160) |
$941.50 |
$1,883 |
5.6× |
| CT abdomen w wo contrast (74170) |
$1,181.50 |
$2,363 |
7.0× |
| CT abdomen w/o contrast (74150) |
$718.30 |
$1,254 |
7.2× |
| CT angio hrt w/3d image (75574) |
$1,261 |
$2,522 |
3.8× |
| CT angio lwr extr w/o&w/dye (73706) |
$1,068 |
$2,136 |
6.3× |
| CT angiography upper extremity lt (73206) |
$1,020 |
$2,040 |
6.1× |
| CT c-spine w/contrast (72126) |
$981 |
$1,962 |
2.9× |
| CT c-spine w/o contrast (72125) |
$810.75 |
$1,621.50 |
8.1× |
| CT cervical spine w&w/o contrast (72127) |
$1,086 |
$2,172 |
6.5× |
| CT chest w contrast (71260) |
$903 |
$1,806 |
5.4× |
| CT chest w/wo contrast (71270) |
$1,069 |
$2,138 |
6.4× |
| CT head/brain with contrast (70460) |
$895 |
$1,790 |
5.3× |
| CT head/brain without and with contrast (70470) |
$1,042 |
$2,084 |
6.2× |
| CT heart w/o contrast quant eval coronary calcium (75571) |
$193.75 |
$387.50 |
2.3× |
| CT iac w contrast (70481) |
$842.50 |
$1,685 |
5.0× |
| CT lower ext w/o (73700) |
$669.50 |
$1,339 |
6.7× |
| CT lower extremity w wo contrast (73702) |
$889 |
$1,778 |
5.3× |
| CT lower extremity w/contrast material (73701) |
$725 |
$1,450 |
4.3× |
| CT lumbar spine w & w/o contrast (72133) |
$1,094.50 |
$2,189 |
6.5× |
| CT lumbar spine w/contrast (72132) |
$956 |
$1,912 |
2.9× |
| CT lumbar spine w/o contrast (72131) |
$807.25 |
$1,614.50 |
8.0× |
| CT maxillofacial w contrast (70487) |
$843 |
$1,686 |
5.0× |
| CT maxillofacial w/wo contrast (70488) |
$977.50 |
$1,955 |
5.8× |
| CT maxillofacial wo contrast (70486) |
$709.50 |
$1,419 |
7.1× |
| CT orbit sella/post fossa/ear w/o & w/contr matr (70482) |
$983.50 |
$1,967 |
5.8× |
| CT orbits w/o contrast (70480) |
$764 |
$1,528 |
7.6× |
| CT pelvis w/o contrast (72192) |
$809.50 |
$1,619 |
8.1× |
| CT pelvis w/wo contrast (72194) |
$1,056 |
$2,112 |
6.3× |
| CT scan of arm combo (73202) |
$964.75 |
$1,929.50 |
5.7× |
| CT soft tissue neck w contrast (70491) |
$821 |
$1,642 |
4.9× |
| CT soft tissue neck w/o & w/contrast material (70492) |
$1,003.50 |
$2,007 |
6.0× |
| CT soft tissue neck w/o contrast (70490) |
$726 |
$1,452 |
7.2× |
| CT thoracic spine w/contrast (72129) |
$983 |
$1,966 |
5.8× |
| CT thoracic spine w/o contrast (72128) |
$808.50 |
$1,617 |
8.1× |
| CT thorax w/o contrast (71250) |
$772 |
$1,544 |
7.7× |
| CT upper ext wo (73200) |
$700 |
$1,400 |
7.0× |
| CT upper extremity with contrast (73201) |
$915.50 |
$1,831 |
2.7× |
| Cta Aa&Bi Iliofem Lxtr Rs&I C-/C+ Post-Pxessing (75635) |
$1,074 |
$2,148 |
6.4× |
| Cta Abdomen (74175) |
$1,098 |
$2,196 |
6.5× |
| CTA abdomen pelvis (74174) |
$1,269.75 |
$2,539.50 |
3.8× |
| CTA chest (71275) |
$1,065.50 |
$2,131 |
6.3× |
| Cta Head (70496) |
$1,080.25 |
$2,160.50 |
6.4× |
| Cta Neck (70498) |
$1,096 |
$2,192 |
6.5× |
| Cta Pelvis (72191) |
$1,042.50 |
$2,085 |
6.2× |
| Cystography minimum 3 views rs&i (74430) |
$558 |
$1,116 |
1.7× |
| Dilation of ureter(s) or urethra, radiological supervision and interpretation Non-Facility (74485) |
$151.50 |
$303 |
0.1× |
| Dxa bone density study 1/> sites axial skel (77080) |
$214 |
$428 |
2.1× |
| Esophagus (74220) |
$246 |
$492 |
1.5× |
| Facial bones min 3 views (70150) |
$177.50 |
$355 |
1.8× |
| Fluoroscopy up to 1 hr (76000) |
$388.50 |
$777 |
1.7× |
| Foot 2 views (73620) |
$144.50 |
$289 |
1.7× |
| Forearm 2 views (73090) |
$157.25 |
$314.50 |
1.9× |
| Hand 2 views (73120) |
$172 |
$344 |
1.7× |
| Hepatobil Syst Imag Inc Gb W/Pharma Intervenj (78227) |
$866.50 |
$1,733 |
1.7× |
| Hepatobiliary syst imaging including gallbladder (78226) |
$651.50 |
$1,303 |
1.7× |
| Kidney Img Morphology Vascular Flow 1 W/O Rx (78707) |
$849 |
$1,698 |
1.6× |
| Kidney img morphology vascular flow 1 w/rx (78708) |
$859.50 |
$1,719 |
1.7× |
| Knee 3 views (73562) |
$147 |
$294 |
1.8× |
| Liver & spleen imaging static only (78215) |
$634.50 |
$1,269 |
1.7× |
| Lung ventilation imaging (78579) |
$634.50 |
$1,269 |
1.7× |
| Magnetic resonance (eg, proton) imaging, upper extremity, other than joint; without contrast material(s), followed by… (73220) |
$1,767 |
$3,534 |
5.3× |
| Mr safety implant&/fb assmt clin staf 1st 15 min (76014) |
$36.50 |
$73 |
1.3× |
| MRA head w & w/o contrast (70546) |
$1,750.25 |
$2,933.50 |
5.2× |
| MRA head w/o contrast (70544) |
$1,150 |
$2,300 |
5.0× |
| MRA head with contrast (70545) |
$1,276.95 |
$2,141.50 |
3.8× |
| MRA neck w contrast (70548) |
$1,540 |
$2,200 |
4.6× |
| Mra Neck W/O &W/Contrast Material (70549) |
$1,937.60 |
$2,768 |
5.8× |
| MRA neck w/o contrast (70547) |
$1,135 |
$2,270 |
5.0× |
| MRI abdomen w contrast (74182) |
$650.50 |
$1,301 |
1.9× |
| MRI abdomen w/o & w/contrast material (74183) |
$1,657.75 |
$3,315.50 |
5.0× |
| MRI abdomen w/o contrast (74181) |
$833.50 |
$1,667 |
3.6× |
| MRI any jt lower extrem w/contrast material (73722) |
$1,383.50 |
$2,767 |
1.8× |
| MRI any jt lower extrem w/o & w/contrast matrl (73723) |
$697 |
$1,394 |
2.1× |
| MRI c-spine with contrast (72142) |
$1,431 |
$2,862 |
4.3× |
| MRI cervical spine w/o contrast (72141) |
$1,107.60 |
$1,928 |
4.8× |
| MRI chest w/o & w/contrast material (71552) |
$1,699.50 |
$3,399 |
5.1× |
| MRI chest w/o contrast (71550) |
$1,463 |
$2,090 |
6.4× |
| MRI chest with contrast (71551) |
$1,682.10 |
$2,403 |
2.2× |
| MRI lower extrem oth/thn jt w/o & w/contr matr (73720) |
$1,729 |
$3,458 |
5.2× |
| MRI lower extrem oth/thn jt w/o contr matrl (73718) |
$1,195.50 |
$2,391 |
5.2× |
| MRI orbit face &/neck w/o contrast (70540) |
$1,182.35 |
$1,985.50 |
5.2× |
| MRI orbit/face/neck w&w/o cont (70543) |
$1,654 |
$3,308 |
4.9× |
| MRI pelvis w/contrast (72196) |
$1,338.50 |
$2,677 |
4.0× |
| MRI pelvis w/o & w/contrast material (72197) |
$1,670 |
$3,340 |
5.0× |
| MRI pelvis w/o contrast (72195) |
$1,171.50 |
$2,343 |
5.1× |
| MRI spinal canal cervical w/o & w/contr matrl (72156) |
$1,812.50 |
$3,625 |
5.4× |
| MRI spinal canal lumbar w/contrast material (72149) |
$1,429.50 |
$2,859 |
4.3× |
| MRI spinal canal lumbar w/o & w/contr matrl (72158) |
$1,825.50 |
$3,651 |
5.5× |
| MRI spinal canal thoracic w/contrast matrl (72147) |
$1,428 |
$2,856 |
4.3× |
| MRI spinal canal thoracic w/o & w/contr matrl (72157) |
$1,813.50 |
$3,627 |
5.4× |
| MRI temporomandibular joint (70336) |
$1,129.50 |
$2,259 |
4.9× |
| MRI thoracic spine w/o contrast (72146) |
$1,226 |
$2,452 |
5.4× |
| MRI up ext w/o contrast (73218) |
$1,196 |
$2,392 |
5.2× |
| MRI upper ext joint w/o contrast (73221) |
$1,278 |
$2,556 |
5.6× |
| MRI, joint upper extrem combo (73223) |
$1,748 |
$3,496 |
5.2× |
| Myocardial Spect Multiple Studies (78452) |
$1,127.75 |
$2,255.50 |
0.9× |
| Myocardial spect single study at rest or stress (78451) |
$2,047 |
$4,094 |
1.6× |
| N-invas est c ffr sw aly CTA (75580) |
$1,575 |
$3,150 |
1.9× |
| Neck soft tissue (70360) |
$146 |
$292 |
1.7× |
| Nm cardiac blood pool multiple (78473) |
$797.50 |
$1,595 |
2.1× |
| Nm gastric emptying study (78264) |
$654.50 |
$1,309 |
1.7× |
| Osseous survey limited (77074) |
$191 |
$382 |
1.9× |
| Parathyroid Planar Imaging (78070) |
$655.50 |
$1,311 |
1.7× |
| Pelvis 1 or 2 views (72170) |
$180.50 |
$361 |
1.8× |
| Pulmonary Perfusion Imaging Particulate (78580) |
$856.50 |
$1,713 |
2.2× |
| Pulmonary Ventilation & Perfusion Imaging (78582) |
$877 |
$1,754 |
1.7× |
| Quan&charac c atherosclerotc plaq asses sev c ds (75577) |
$1,326 |
$2,652 |
1.5× |
| Radex Ankle Compl Minimum 3 Views (73610) |
$158.75 |
$317.50 |
1.9× |
| Radex Calcaneus Minimum 2 Views (73650) |
$143.50 |
$287 |
1.7× |
| Radex Elbw Compl Minimum 3 Views (73080) |
$183.90 |
$304 |
2.2× |
| Radex Entir Thrc Lmbr Crv Sac Spi W/Skull 1 Vw - Xr Scoliosis 1 Vw (72081) |
$151 |
$302 |
1.8× |
| Radex entir thrc lmbr crv sac spi w/skull 2/3 vw (72082) |
$77.70 |
$111 |
0.8× |
| Radex Entir Thrc Lmbr Crv Sac Spi W/Skull 4/5 Vw (72083) |
$67.50 |
$135 |
0.7× |
| Radex fingr minimum 2 views (73140) |
$156.25 |
$302.50 |
1.9× |
| Radex Foot Compl Minimum 3 Views (73630) |
$171.50 |
$343 |
2.1× |
| Radex Hand Minimum 3 Views (73130) |
$158.50 |
$317 |
1.9× |
| Radex Hip Unilateral With Pelvis 1 View (73501) |
$146.50 |
$293 |
1.8× |
| Radex Hip Unilateral With Pelvis Minimum 4 Views (73503) |
$313.60 |
$448 |
3.1× |
| Radex Humerus Minimum 2 Views (73060) |
$145 |
$290 |
1.7× |
| Radex Kne 1/2 Views (73560) |
$145 |
$290 |
1.7× |
| Radex Kne Compl 4/More Views (73564) |
$248.80 |
$408 |
2.5× |
| Radex Mndbl Compl Minimum 4 Views (70110) |
$176.50 |
$353 |
1.8× |
| Radex Nasal Bones Complete Minimum 3 Views (70160) |
$144.50 |
$289 |
1.7× |
| Radex Pelvis Compl Minimum 3 Views (72190) |
$242 |
$484 |
2.4× |
| Radex Sho Compl Minimum 2 Views (73030) |
$159 |
$318 |
1.9× |
| Radex Sinuses Paransl < 3 Views (70210) |
$144.50 |
$289 |
1.7× |
| Radex Temporomandble Jt Opn & Clsd Mouth Bilat (70330) |
$148.50 |
$297 |
1.8× |
| Radex Toe Minimum 2 Views (73660) |
$155.25 |
$310.50 |
1.9× |
| Radex upper extremity infant minimum 2 views (73092) |
$171.50 |
$343 |
1.7× |
| Radex Wrst Compl Minimum 3 Views (73110) |
$159 |
$318 |
1.9× |
| Radiologic Exam Abdomen 1 View - Xr Abdomen 1 View (74018) |
$145 |
$290 |
1.7× |
| Radiologic Exam Abdomen 3+ Views - Xr Abdomen 3+ Views (74021) |
$178.50 |
$357 |
1.8× |
| Radiologic exam chest 2 views (71046) |
$135.75 |
$271.50 |
1.6× |
| Radiologic exam colon single contrast study (74270) |
$163.10 |
$233 |
1.0× |
| Radiologic exam upr gi trc double contrast study (74246) |
$194.60 |
$278 |
1.2× |
| Radiologic exam upr gi trc single contrast study (74240) |
$170.10 |
$243 |
1.0× |
| Radiologic examination tibia & fibula 2 views (73590) |
$144.50 |
$289 |
1.7× |
| Radiologic examination, mastoids; complete, minimum of 3 views per side Non-Facility (70130) |
$183 |
$366 |
1.8× |
| Radiologic examination, mastoids; less than 3 views per side Non-Facility (70120) |
$172.50 |
$345 |
1.7× |
| Radiologic examination, teeth; single view Non-Facility (70300) |
$40 |
$80 |
0.5× |
| Ribs bilateral 3 views (71110) |
$134.75 |
$269.50 |
1.3× |
| Rp Loclzj Tum Plnr 1 Area Single Day Imaging (78800) |
$646 |
$1,292 |
1.7× |
| Rp loclzj tum plnr whole body single day imaging (78802) |
$2,010.50 |
$4,021 |
3.9× |
| Sacroiliac Joints < 3 Views (72200) |
$172.50 |
$345 |
1.7× |
| Scapula (73010) |
$172.50 |
$345 |
1.7× |
| Screening Digital Breast Tomosynthesis Bi (77063) |
$83.50 |
$167 |
3.6× |
| Sella turcica (70240) |
$77.70 |
$111 |
0.9× |
| Shoulder 1 view (73020) |
$144 |
$288 |
1.7× |
| Small bowel series (74250) |
$120.40 |
$172 |
0.7× |
| Spine thoracic 3 views (72072) |
$119.10 |
$220 |
1.2× |
| Thoracolumbar 2 views (72080) |
$146.50 |
$293 |
1.8× |
| Thyroid imaging w/blood flow (78013) |
$627 |
$1,254 |
1.6× |
| Tmj unilateral (70328) |
$145 |
$290 |
1.7× |
| Ultrasound breast complete (76641) |
$234 |
$468 |
2.3× |
| Ultrasound Exam Aaa Screen (76706) |
$260.50 |
$521 |
2.6× |
| Ultrasound, abdomen limited (76705) |
$292.50 |
$585 |
2.9× |
| Unlisted Diagnostic Radiographic Procedure (76499) |
$308 |
$440 |
3.7× |
| Urethrocystography retrograde rs&i (74450) |
$189 |
$270 |
0.8× |
| Us breast unilateral limited (76642) |
$217 |
$434 |
2.6× |
| Us chest (76604) |
$232.05 |
$331.50 |
2.3× |
| Us compl joint r-t w/image documentation (76881) |
$282 |
$564 |
2.8× |
| Us elastography parenchyma (76981) |
$200.50 |
$401 |
2.0× |
| Us lmtd joint/oth nonvasc xtr strux r-t w/img (76882) |
$235 |
$470 |
2.3× |
| Us ob limited (76815) |
$431.20 |
$616 |
4.3× |
| Us pelvic non ob complete (76856) |
$324.50 |
$649 |
3.2× |
| Us pelvic nonobstetric image dcmtn limited/f/u (76857) |
$218 |
$436 |
2.2× |
| Us pg uter r-t img f-up tabdl appr pr fetus (76816) |
$388.50 |
$555 |
3.9× |
| Us retroperitoneal complete (76770) |
$320.50 |
$641 |
3.2× |
| Us retroperitoneal limited (76775) |
$301 |
$602 |
3.0× |
| Us scrotum and contents (76870) |
$306 |
$612 |
3.1× |
| Us soft tissue head/neck (76536) |
$291 |
$582 |
2.9× |
| Us transrectal (76872) |
$213.50 |
$427 |
2.1× |
| Us transrectal prostate volume (76873) |
$266 |
$532 |
2.7× |
| Us,transplanted kidney, real time/ doppler (76776) |
$210.50 |
$421 |
2.1× |
| Venogram Extremity Unilateral (75820) |
$175 |
$350 |
0.1× |
| Vertebral fracture assessment via dxa (77086) |
$105 |
$210 |
1.3× |
| Wrist 2 views (73100) |
$145.50 |
$291 |
1.7× |
| X-Ray Abdomen,Comp Acute Series - Xr Abdomen 2 Vws With Chest 1 View (74022) |
$129.60 |
$237 |
1.3× |
| X-Ray Ac Jts - Xr Acromioclavicular Joints Bilateral (73050) |
$147 |
$294 |
1.8× |
| X-Ray Colon Air Contrast - Fl Barium Enema Air Contrast (74280) |
$200.90 |
$287 |
1.2× |
| X-Ray Elbow 2 Vw - Xr Elbow 1-2 Views Right (73070) |
$157.75 |
$315.50 |
1.9× |
| X-Ray Exam Hip Uni 2-3 Views (73502) |
$149 |
$298 |
1.8× |
| X-Ray Exam Hips Bi 3-4 Views (73522) |
$181 |
$362 |
1.8× |
| X-ray exam of femur 2/> (73552) |
$159.25 |
$318.50 |
1.9× |
| X-ray eye for foreign body (70030) |
$145 |
$290 |
1.7× |
| X-Ray Facial Bones <3 Vw - Xr Facial Bones 1-2 Views (70140) |
$146 |
$292 |
1.7× |
| X-ray IV pyelogram (ivp) (74400) |
$214.90 |
$307 |
1.3× |
| X-Ray Jaw <4 Vw - Xr Mandible < 4 Views (70100) |
$145.50 |
$291 |
1.7× |
| X-Ray Knee Bilat Standing - Xr Knees Anteroposterior Standing Bilat (73565) |
$145.50 |
$291 |
1.7× |
| X-ray leg, infant (73592) |
$144.50 |
$289 |
1.7× |
| X-Ray Lumbar Spine 2/3 Vw - Xr Lumbar Spine 2-3 Views (72100) |
$175 |
$350 |
1.7× |
| X-Ray Lumbar Spine 6+ Vw - Xr Lumbar Spine 6+ Vws Including Bending (72114) |
$192.75 |
$385.50 |
1.9× |
| X-ray nose-rectum child f.b. (76010) |
$144.50 |
$289 |
1.7× |
| X-ray optic foramen (70190) |
$51 |
$102 |
0.6× |
| X-Ray Orbits - Xr Orbits Complete 4+ Views (70200) |
$178.50 |
$357 |
1.8× |
| X-ray retrograde pyelogram (74420) |
$570 |
$1,140 |
1.7× |
| X-Ray Ribs 2 Vw Unilat - Xr Ribs 2 Views Right (71100) |
$55.50 |
$111 |
0.7× |
| X-Ray Ribs, Chest 3+ Vw - Xr Ribs 2 Vws Lt W/ Chest Anteroposterior (71101) |
$186 |
$372 |
1.9× |
| X-Ray Ribs, Chest 4+ Vw - Xr Ribs 3 Vws Bil W/ Chest Posteroanterior (71111) |
$182.25 |
$312.50 |
1.8× |
| X-Ray Sacroiliac Jts 3+ Vw - Xr Sacroiliac Joints 3+ Views (72202) |
$174.50 |
$349 |
1.7× |
| X-Ray Sacrum/Coccyx 2+ Vw - Xr Sacrum Coccyx 2+ Views (72220) |
$144.50 |
$289 |
1.7× |
| X-Ray Sinuses 3+ Vw - Xr Paranasal Sinuses 3+ Views (70220) |
$122.85 |
$217.50 |
1.5× |
| X-Ray Skull 4+ Vw - Xr Skull Complete 4+ Views (70260) |
$178.50 |
$357 |
1.8× |
| X-Ray Skull <4 Vw - Xr Skull 1-3 Views (70250) |
$172.50 |
$345 |
1.7× |
| X-Ray Spine One View - Xr Spine (72020) |
$143.50 |
$287 |
1.7× |
| X-Ray Sterno-Clavicluar Jt - Xr Sternoclavicular Joints 3+ Views (71130) |
$147 |
$294 |
1.8× |
| X-Ray Sternum 2+ Vw - Xr Sternum 2+ Views (71120) |
$146 |
$292 |
1.7× |
| X-Ray Thoracic Spine 2 Vw - Xr Thoracic Spine 2 Views (72070) |
$173.50 |
$347 |
1.7× |
| X-Ray Thoracic Spine 4 Vw - Xr Thoracic Spine Complete 4+ Views (72074) |
$176 |
$352 |
1.8× |
| Xr c-spine 4 or 5 views (72050) |
$179 |
$358 |
1.8× |
| Xr c-spine 6 or more views (72052) |
$123.75 |
$247.50 |
1.2× |
| Xr chest 4+ views (71048) |
$166 |
$332 |
1.7× |