| Abdomen 2 views (74019) |
$143 |
$286 |
1.5× |
| Acute gastrointestinal blood loss imaging (78278) |
$401.50 |
$803 |
1.1× |
| Ankle 2 views (73600) |
$77.50 |
$155 |
1.0× |
| Bone &/Joint Imaging Limited Area (78300) |
$486 |
$972 |
1.3× |
| Bone &/joint imaging whole body (78306) |
$486 |
$972 |
1.3× |
| Bone age studies (77072) |
$91.50 |
$183 |
1.0× |
| Bone Imaging 3 Phase (78315) |
$417.50 |
$835 |
1.1× |
| Cervical spine 2 or 3 views (72040) |
$111.50 |
$223 |
1.4× |
| Chest 1 view (71045) |
$86 |
$172 |
1.1× |
| Cine/Vid X-Ray Throat/Esoph - Fl Esoph Barium Swlw W/ Video & Speech (74230) |
$143 |
$286 |
0.9× |
| Clavicle complete (73000) |
$95 |
$190 |
1.2× |
| Computed Tomography Thorax Lw Dose Lng Ca Scr C- (71271) |
$195 |
$390 |
2.0× |
| CT abdomen and pelvis without and with contrast (74178) |
$642.50 |
$1,285 |
2.0× |
| CT abdomen and pelvis without contrast (74176) |
$500 |
$1,000 |
2.3× |
| CT abdomen w contrast (74160) |
$316 |
$632 |
2.0× |
| CT abdomen w wo contrast (74170) |
$642.50 |
$1,285 |
4.0× |
| CT abdomen w/o contrast (74150) |
$203.50 |
$407 |
2.1× |
| CT angiography upper extremity lt (73206) |
$337.50 |
$675 |
2.1× |
| CT c-spine w/o contrast (72125) |
$275 |
$550 |
2.9× |
| CT cervical spine w&w/o contrast (72127) |
$124.50 |
$249 |
0.8× |
| CT cervical spine with contrast (72126) |
$570.50 |
$1,141 |
1.8× |
| CT chest w/wo contrast (71270) |
$384 |
$768 |
2.4× |
| CT chest with contrast (71260) |
$316 |
$632 |
2.0× |
| CT head/brain with contrast (70460) |
$217.74 |
$435.48 |
1.4× |
| CT head/brain without and with contrast (70470) |
$316 |
$632 |
2.0× |
| CT iac w contrast (70481) |
$282 |
$564 |
1.8× |
| CT lower ext w/o (73700) |
$202.50 |
$405 |
2.1× |
| CT lower extremity w wo contrast (73702) |
$299.50 |
$599 |
1.9× |
| CT lower extremity with contrast (73701) |
$412.50 |
$825 |
2.6× |
| CT lumbar spine w & w/o contrast (72133) |
$225.74 |
$451.48 |
1.4× |
| CT lumbar spine w/o contrast (72131) |
$215 |
$430 |
2.3× |
| CT lumbar spine with contrast (72132) |
$321.66 |
$643.32 |
1.0× |
| CT maxillofacial w contrast (70487) |
$316 |
$632 |
2.0× |
| CT maxillofacial w/o contrast (70486) |
$207.50 |
$415 |
2.2× |
| CT maxillofacial w/wo contrast (70488) |
$191.50 |
$383 |
1.2× |
| CT neck soft tissue w contrast (70491) |
$316 |
$632 |
2.0× |
| CT orbit sella/post fossa/ear w/o & w/contr matr (70482) |
$344 |
$688 |
2.2× |
| CT orbits w/o contrast (70480) |
$225 |
$450 |
2.4× |
| CT pelvis w & w/o contrast (72194) |
$500 |
$1,000 |
3.1× |
| CT pelvis w/o contrast (72192) |
$500 |
$1,000 |
5.3× |
| CT scan for measuring calcium and other minerals in bone (77078) |
$120 |
$240 |
1.5× |
| CT soft tissue neck w/o & w/contrast material (70492) |
$338 |
$676 |
2.1× |
| CT soft tissue neck w/o contrast (70490) |
$198 |
$396 |
2.1× |
| CT thoracic spine w/contrast (72129) |
$425 |
$850 |
2.7× |
| CT thoracic spine w/o contrast (72128) |
$244 |
$488 |
2.6× |
| CT thorax w/o contrast (71250) |
$136.50 |
$273 |
1.4× |
| CT upper extremity w/o & w/contrast material (73202) |
$296 |
$592 |
1.9× |
| CT upper extremity w/o contrast rt (73200) |
$176 |
$352 |
1.8× |
| CT upper extremity with contrast (73201) |
$309 |
$618 |
1.0× |
| Cta Abdl Aorta&Bi Iliofem W/Contrast&Postp (75635) |
$603.50 |
$1,207 |
3.8× |
| Cta Abdomen (74175) |
$306.50 |
$613 |
1.9× |
| CTA abdomen pelvis (74174) |
$512.50 |
$1,025 |
1.6× |
| CTA chest (71275) |
$407.50 |
$815 |
2.6× |
| Cta Head (70496) |
$495 |
$990 |
3.1× |
| CTA head&neck c+ w/noncontrast img&post-pxessing (70471) |
$719 |
$1,438 |
2.3× |
| CTA lwr ext w&w/o contrast (73706) |
$356.50 |
$713 |
2.2× |
| Cta Neck (70498) |
$495 |
$990 |
3.1× |
| Cta Pelvis (72191) |
$361.50 |
$723 |
2.3× |
| Fetal Biophysical Profile W/O Non-Stress Testing (76819) |
$225 |
$450 |
2.4× |
| Foot 2 views (73620) |
$65.50 |
$131 |
0.8× |
| Forearm 2 views (73090) |
$86 |
$172 |
1.1× |
| Gated Heart Planar Single (78472) |
$415 |
$830 |
1.1× |
| Hand 2 views (73120) |
$143 |
$286 |
1.5× |
| Hand 3 views (73130) |
$143 |
$286 |
1.8× |
| Hepatobil Syst Imag Inc Gb W/Pharma Intervenj (78227) |
$699 |
$1,398 |
1.4× |
| Hepatobiliary syst imaging including gallbladder (78226) |
$699 |
$1,398 |
1.9× |
| Humerus Min 2 Views Left (73060) |
$119 |
$238 |
1.5× |
| Kidney img morphology vascular flow 1 w/rx (78708) |
$688.50 |
$1,377 |
1.4× |
| Knee 3 views (73562) |
$105 |
$210 |
1.3× |
| MRA head w/o contrast (70544) |
$473 |
$946 |
2.2× |
| MRA neck w/o contrast (70547) |
$473 |
$946 |
2.2× |
| MRI abdomen w contrast (74182) |
$497.50 |
$995 |
1.6× |
| MRI abdomen w/o & w/contrast material (74183) |
$687.50 |
$1,375 |
2.2× |
| MRI abdomen w/o contrast (74181) |
$407.50 |
$815 |
1.9× |
| MRI any jt upper extremity w/contrast matrl (73222) |
$396.50 |
$793 |
0.6× |
| MRI c-spine with contrast (72142) |
$460.50 |
$921 |
1.4× |
| MRI cervical spine w/o contrast (72141) |
$375 |
$750 |
1.7× |
| MRI chest w/o & w/contrast material (71552) |
$732.50 |
$1,465 |
2.3× |
| MRI lower extrem oth/thn jt w/o contr matrl (73718) |
$266.50 |
$533 |
1.2× |
| MRI orbit face &/neck w/o contrast (70540) |
$447.50 |
$895 |
2.1× |
| MRI orbit/face/neck w&w/o cont (70543) |
$682.50 |
$1,365 |
2.1× |
| MRI pelvis w/o & w/contrast material (72197) |
$859.50 |
$1,719 |
2.7× |
| MRI pelvis w/o contrast (72195) |
$455 |
$910 |
2.1× |
| MRI scan of arm joint before and after contrast (73223) |
$483.50 |
$967 |
1.5× |
| MRI scan of leg joint before and after contrast (73723) |
$482.50 |
$965 |
1.5× |
| MRI spinal canal cervical w/o & w/contr matrl (72156) |
$687.50 |
$1,375 |
2.2× |
| MRI spinal canal lumbar w/contrast material (72149) |
$900 |
$1,800 |
2.8× |
| MRI spinal canal lumbar w/o & w/contr matrl (72158) |
$900 |
$1,800 |
2.8× |
| MRI spinal canal thoracic w/contrast matrl (72147) |
$252.50 |
$505 |
0.8× |
| MRI spinal canal thoracic w/o & w/contr matrl (72157) |
$662.50 |
$1,325 |
2.1× |
| MRI thoracic spine w/o contrast (72146) |
$600 |
$1,200 |
2.8× |
| MRI upper ext joint w/o contrast (73221) |
$225 |
$450 |
1.0× |
| MRI upper extrem other than jt w/o & w/contras (73220) |
$521 |
$1,042 |
1.6× |
| MRI upper extremity oth than jt w/o contr matrl (73218) |
$408.50 |
$817 |
1.9× |
| Myocardial Spect Multiple Studies (78452) |
$1,503.50 |
$3,007 |
1.3× |
| Neck soft tissue (70360) |
$77.50 |
$155 |
1.0× |
| Nm gastric emptying study (78264) |
$437 |
$874 |
1.2× |
| Parathyroid imaging (78070) |
$546.50 |
$1,093 |
1.5× |
| Pelvis 1 or 2 views (72170) |
$143 |
$286 |
1.5× |
| Pr MRI, lower extr, w/o contrast f/u by contrast (73720) |
$397 |
$794 |
1.2× |
| Pulmonary Perfusion Imaging Particulate (78580) |
$348.50 |
$697 |
1.0× |
| Pulmonary Ventilation & Perfusion Imaging (78582) |
$808.50 |
$1,617 |
1.6× |
| Radex Entir Thrc Lmbr Crv Sac Spi W/Skull 1 Vw - Xr Scoliosis 1 Vw (72081) |
$67.50 |
$135 |
0.9× |
| Radex entir thrc lmbr crv sac spi w/skull 2/3 vw (72082) |
$91.50 |
$183 |
1.0× |
| Radex hips bilateral with pelvis 2 views (73521) |
$143 |
$286 |
1.5× |
| Radiolog exam mandible compl minimum 4 views (70110) |
$143 |
$286 |
1.5× |
| Radiologic Exam Abdomen 1 View - Xr Abdomen 1 View (74018) |
$77.50 |
$155 |
1.0× |
| Radiologic Exam Chest 2 Views - Xr Chest 2 Views (71046) |
$77.50 |
$155 |
1.0× |
| Radiologic Examination Femur Minimum 2 Views - Xr Femur 2+ Vw Lt (73552) |
$77.50 |
$155 |
1.0× |
| Ribs bilateral 3 views (71110) |
$143 |
$286 |
1.5× |
| Scapula complete (73010) |
$38 |
$76 |
0.4× |
| Screening digital breast tomosynthesis (77063) |
$129 |
$258 |
5.5× |
| Thyroid Uptake W/Blood Flow Sngle/Mult Quan Meas (78014) |
$495 |
$990 |
1.4× |
| Ultrasound, abdomen limited (76705) |
$202 |
$404 |
2.1× |
| Upper Extremity Infant (73092) |
$114 |
$228 |
1.2× |
| Us abdl aorta screen aaa (76706) |
$143 |
$286 |
1.5× |
| Us breast unilateral complete (76641) |
$143 |
$286 |
1.5× |
| Us breast unilateral limited (76642) |
$102 |
$204 |
1.3× |
| Us chest (76604) |
$185.50 |
$371 |
1.9× |
| Us ob transvaginal (76817) |
$202 |
$404 |
2.1× |
| Us pelvic non ob complete (76856) |
$202 |
$404 |
2.1× |
| Us pelvic nonobstetric image dcmtn limited/f/u (76857) |
$149 |
$298 |
1.6× |
| Us pregnancy ltd (76815) |
$81 |
$162 |
0.9× |
| Us pregnant uterus 14 wk transabdl 1/1st gestat (76801) |
$202 |
$404 |
2.1× |
| Us retroperitoneal complete (76770) |
$103.50 |
$207 |
1.1× |
| Us scrotum and contents (76870) |
$202 |
$404 |
2.1× |
| Us soft tissue head/neck (76536) |
$202 |
$404 |
2.1× |
| Us xtr non-vasc lmtd (76882) |
$143 |
$286 |
1.5× |
| Wrist 2 views (73100) |
$39 |
$78 |
0.5× |
| X-Ray Abdomen,Comp Acute Series - Xr Abdomen 2 Vws With Chest 1 View (74022) |
$143 |
$286 |
1.5× |
| X-Ray Ac Jts - Xr Acromioclavicular Joints Bilateral (73050) |
$86 |
$172 |
1.1× |
| X-Ray Ankle 3+ Vw - Xr Ankle 3+ Views Right (73610) |
$105 |
$210 |
1.3× |
| X-Ray Elbow 2 Vw - Xr Elbow 1-2 Views Right (73070) |
$86 |
$172 |
1.1× |
| X-Ray Elbow 3+ Vw - Xr Elbow 3+ Views Right (73080) |
$110 |
$220 |
1.4× |
| X-ray exam hip uni 1 view (73501) |
$77.50 |
$155 |
1.0× |
| X-Ray Exam Hip Uni 2-3 Views (73502) |
$112.50 |
$225 |
1.4× |
| X-ray exam of femur 1 (73551) |
$51.50 |
$103 |
0.6× |
| X-Ray Facial Bones 3+ Vw - Xr Facial Bones 3+ Views (70150) |
$143 |
$286 |
1.5× |
| X-Ray Facial Bones <3 Vw - Xr Facial Bones 1-2 Views (70140) |
$67.50 |
$135 |
0.9× |
| X-Ray Foot 3+ Vw - Xr Foot 3+ Views Right (73630) |
$86 |
$172 |
1.1× |
| X-Ray Heel - Xr Calcaneus 2 Views Right (73650) |
$86 |
$172 |
1.1× |
| X-Ray Jaw <4 Vw - Xr Mandible < 4 Views (70100) |
$51.50 |
$103 |
0.6× |
| X-Ray Knee 4+ View - Xr Knee 4+ Views Right (73564) |
$143 |
$286 |
1.5× |
| X-Ray Knee Bilat Standing - Xr Knees Anteroposterior Standing Bilat (73565) |
$77.50 |
$155 |
1.0× |
| X-Ray Leg, Infant - Xr Lower Extremity 2+ Views Infant Left (73592) |
$105 |
$210 |
1.3× |
| X-Ray Lumbar Spine 2/3 Vw - Xr Lumbar Spine 2-3 Views (72100) |
$143 |
$286 |
1.5× |
| X-Ray Lumbar Spine 6+ Vw - Xr Lumbar Spine 6+ Vws Including Bending (72114) |
$179 |
$358 |
1.9× |
| X-Ray Lumbar Spine Flex/Exten - Xr Lumbar Spine 4+ Views W/ Flex Ext (72120) |
$92.50 |
$185 |
1.0× |
| X-Ray Nasal Bones - Xr Nasal Bones (70160) |
$86 |
$172 |
1.1× |
| X-Ray Nose-Rectum Child F.B. - Xr Nose to Rectum Foreign Body Peds (76010) |
$176.47 |
$352.93 |
2.2× |
| X-Ray Orbits - Xr Orbits Complete 4+ Views (70200) |
$114 |
$228 |
1.2× |
| X-Ray Ribs 2 Vw Unilat - Xr Ribs 2 Views Right (71100) |
$86 |
$172 |
1.1× |
| X-Ray Ribs, Chest 3+ Vw - Xr Ribs 2 Vws Lt W/ Chest Anteroposterior (71101) |
$143 |
$286 |
1.5× |
| X-Ray Ribs, Chest 4+ Vw - Xr Ribs 3 Vws Bil W/ Chest Posteroanterior (71111) |
$179 |
$358 |
1.9× |
| X-Ray Sacroiliac Jts 3+ Vw - Xr Sacroiliac Joints 3+ Views (72202) |
$111.50 |
$223 |
1.2× |
| X-Ray Sacrum/Coccyx 2+ Vw - Xr Sacrum Coccyx 2+ Views (72220) |
$86 |
$172 |
1.1× |
| X-Ray Shoulder 2+ Vw - Xr Shoulder 2+ Views Right (73030) |
$34.50 |
$69 |
0.4× |
| X-Ray Sinuses 3+ Vw - Xr Paranasal Sinuses 3+ Views (70220) |
$105 |
$210 |
1.3× |
| X-Ray Skull 4+ Vw - Xr Skull Complete 4+ Views (70260) |
$120 |
$240 |
1.3× |
| X-Ray Skull <4 Vw - Xr Skull 1-3 Views (70250) |
$179 |
$358 |
1.9× |
| X-Ray Sterno-Clavicluar Jt - Xr Sternoclavicular Joints 3+ Views (71130) |
$77.50 |
$155 |
1.0× |
| X-Ray Sternum 2+ Vw - Xr Sternum 2+ Views (71120) |
$86 |
$172 |
1.1× |
| X-Ray Thoracic Spine 2 Vw - Xr Thoracic Spine 2 Views (72070) |
$143 |
$286 |
1.5× |
| X-Ray Toe(S) - Xr Toes 2+ Views Right (73660) |
$86 |
$172 |
1.1× |
| X-Ray Wrist 3+ Vw - Xr Wrist 3+ Views Right (73110) |
$46.50 |
$93 |
0.6× |
| Xr finger(s) 2+ views (73140) |
$86 |
$172 |
1.1× |
| Xr shoulder 1 view (73020) |
$105 |
$210 |
1.3× |
| Xr spine cervical 4 or 5 views (72050) |
$143 |
$286 |
1.5× |
| Xr tibia/fibula 2 views (73590) |
$86 |
$172 |
1.1× |
| Xray knee 1 or 2 views rt (73560) |
$86 |
$172 |
1.1× |