| Abdomen 2 views (74019) |
$159.50 |
$319 |
1.6× |
| Ankle 2 views (73600) |
$104 |
$208 |
1.2× |
| Bone &/joint imaging whole body (78306) |
$383 |
$766 |
1.0× |
| Bone age studies (77072) |
$183.50 |
$367 |
1.8× |
| Bone Imaging 3 Phase (78315) |
$383 |
$766 |
1.0× |
| Bone survey complete (77075) |
$342.50 |
$685 |
3.4× |
| Bone survey infant (77076) |
$185.50 |
$371 |
1.8× |
| Cervical spine 2 or 3 views (72040) |
$121 |
$242 |
1.4× |
| Chest 1 view (71045) |
$96 |
$192 |
1.1× |
| Clavicle complete (73000) |
$121 |
$242 |
1.4× |
| Computed Tomography Thorax Lw Dose Lng Ca Scr C- (71271) |
$120 |
$240 |
1.2× |
| CT abdomen and pelvis without and with contrast (74178) |
$1,583 |
$3,166 |
4.7× |
| CT abdomen and pelvis without contrast (74176) |
$1,166 |
$2,332 |
5.1× |
| CT abdomen w contrast (74160) |
$669 |
$1,338 |
4.0× |
| CT abdomen w wo contrast (74170) |
$820 |
$1,640 |
4.9× |
| CT abdomen w/o contrast (74150) |
$621 |
$1,242 |
6.2× |
| CT angio lwr extr w/o&w/dye (73706) |
$219 |
$438 |
1.3× |
| CT c-spine w/contrast (72126) |
$913 |
$1,826 |
2.7× |
| CT c-spine w/o contrast (72125) |
$730 |
$1,460 |
7.3× |
| CT cervical spine w&w/o contrast (72127) |
$1,255 |
$2,510 |
7.5× |
| CT chest w contrast (71260) |
$694 |
$1,388 |
4.1× |
| CT chest w/wo contrast (71270) |
$845.50 |
$1,691 |
5.0× |
| CT head/brain with contrast (70460) |
$657 |
$1,314 |
3.9× |
| CT head/brain without and with contrast (70470) |
$807 |
$1,614 |
4.8× |
| CT iac w contrast (70481) |
$340.50 |
$681 |
2.0× |
| CT lower ext w/o (73700) |
$287.50 |
$575 |
2.9× |
| CT lower extremity w wo contrast (73702) |
$400.50 |
$801 |
2.4× |
| CT lower extremity w/contrast material (73701) |
$422 |
$844 |
2.5× |
| CT lumbar spine w & w/o contrast (72133) |
$1,010 |
$2,020 |
6.0× |
| CT lumbar spine w/contrast (72132) |
$718.50 |
$1,437 |
2.1× |
| CT lumbar spine w/o contrast (72131) |
$1,132.50 |
$2,265 |
11.3× |
| CT maxillofacial w contrast (70487) |
$442.50 |
$885 |
2.6× |
| CT maxillofacial w/wo contrast (70488) |
$542.50 |
$1,085 |
3.2× |
| CT maxillofacial wo contrast (70486) |
$304 |
$608 |
3.0× |
| CT orbit sella/post fossa/ear w/o & w/contr matr (70482) |
$407 |
$814 |
2.4× |
| CT orbits w/o contrast (70480) |
$295 |
$590 |
2.9× |
| CT pelvis w/o contrast (72192) |
$546.50 |
$1,093 |
5.4× |
| CT pelvis w/wo contrast (72194) |
$764.50 |
$1,529 |
4.5× |
| CT scan of arm combo (73202) |
$533.50 |
$1,067 |
3.2× |
| CT soft tissue neck w contrast (70491) |
$442.50 |
$885 |
2.6× |
| CT soft tissue neck w/o & w/contrast material (70492) |
$542.50 |
$1,085 |
3.2× |
| CT soft tissue neck w/o contrast (70490) |
$304 |
$608 |
3.0× |
| CT thoracic spine w/o contrast (72128) |
$718.50 |
$1,437 |
7.2× |
| CT thorax w/o contrast (71250) |
$647 |
$1,294 |
6.5× |
| CT upper ext wo (73200) |
$299 |
$598 |
3.0× |
| CT upper extremity with contrast (73201) |
$422 |
$844 |
1.3× |
| Cta Aa&Bi Iliofem Lxtr Rs&I C-/C+ Post-Pxessing (75635) |
$777.75 |
$1,555.50 |
4.6× |
| Cta Abdomen (74175) |
$1,241.50 |
$2,483 |
7.4× |
| CTA abdomen pelvis (74174) |
$1,351.50 |
$2,703 |
4.0× |
| CTA chest (71275) |
$941.50 |
$1,883 |
5.6× |
| Cta Head (70496) |
$669 |
$1,338 |
4.0× |
| CTA head&neck c+ w/noncontrast img&post-pxessing (70471) |
$1,315 |
$2,630 |
3.9× |
| Cta Neck (70498) |
$669 |
$1,338 |
4.0× |
| Dxa bone density study 1/> sites axial skel (77080) |
$214.50 |
$429 |
2.1× |
| Echo exam of eye (76529) |
$87 |
$174 |
1.0× |
| Facial bones min 3 views (70150) |
$229 |
$458 |
2.3× |
| Foot 2 views (73620) |
$104 |
$208 |
1.2× |
| Forearm 2 views (73090) |
$121 |
$242 |
1.4× |
| Hand 2 views (73120) |
$104 |
$208 |
1.0× |
| Hepatobil Syst Imag Inc Gb W/Pharma Intervenj (78227) |
$520.50 |
$1,041 |
1.0× |
| Hepatobiliary syst imaging including gallbladder (78226) |
$383 |
$766 |
1.0× |
| Knee 3 views (73562) |
$164 |
$328 |
2.0× |
| Magnetic resonance (eg, proton) imaging, upper extremity, other than joint; without contrast material(s), followed by… (73220) |
$1,940 |
$3,880 |
5.8× |
| MRA head w & w/o contrast (70546) |
$1,585.50 |
$3,171 |
4.7× |
| MRA head w/o contrast (70544) |
$670.50 |
$1,341 |
2.9× |
| Mra Neck W/O &W/Contrast Material (70549) |
$1,438.50 |
$2,877 |
4.3× |
| MRI abdomen w contrast (74182) |
$637 |
$1,274 |
1.9× |
| MRI abdomen w/o & w/contrast material (74183) |
$1,445.50 |
$2,891 |
4.3× |
| MRI abdomen w/o contrast (74181) |
$1,184 |
$2,368 |
5.2× |
| MRI any jt lower extrem w/o & w/contrast matrl (73723) |
$1,191.50 |
$2,383 |
3.6× |
| MRI c-spine with contrast (72142) |
$1,156 |
$2,312 |
3.5× |
| MRI cervical spine w/o contrast (72141) |
$868.50 |
$1,737 |
3.8× |
| MRI chest w/o & w/contrast material (71552) |
$2,254 |
$4,508 |
6.7× |
| MRI lower extrem oth/thn jt w/o & w/contr matr (73720) |
$1,252.50 |
$2,505 |
3.7× |
| MRI lower extrem oth/thn jt w/o contr matrl (73718) |
$868.50 |
$1,737 |
3.8× |
| MRI orbit face &/neck w/o contrast (70540) |
$1,537.50 |
$3,075 |
6.7× |
| MRI orbit/face/neck w&w/o cont (70543) |
$1,247.50 |
$2,495 |
3.7× |
| MRI pelvis w/o & w/contrast material (72197) |
$1,808 |
$3,616 |
5.4× |
| MRI pelvis w/o contrast (72195) |
$868.50 |
$1,737 |
3.8× |
| MRI spinal canal cervical w/o & w/contr matrl (72156) |
$1,445.50 |
$2,891 |
4.3× |
| MRI spinal canal lumbar w/o & w/contr matrl (72158) |
$1,445.50 |
$2,891 |
4.3× |
| MRI spinal canal thoracic w/contrast matrl (72147) |
$1,092.50 |
$2,185 |
3.3× |
| MRI spinal canal thoracic w/o & w/contr matrl (72157) |
$1,928 |
$3,856 |
5.8× |
| MRI thoracic spine w/o contrast (72146) |
$868.50 |
$1,737 |
3.8× |
| MRI up ext w/o contrast (73218) |
$868.50 |
$1,737 |
3.8× |
| MRI upper ext joint w/o contrast (73221) |
$868.50 |
$1,737 |
3.8× |
| MRI, joint upper extrem combo (73223) |
$1,445.50 |
$2,891 |
4.3× |
| Myocardial Spect Multiple Studies (78452) |
$1,240 |
$2,480 |
1.0× |
| N-invas est c ffr sw aly CTA (75580) |
$822.50 |
$1,645 |
1.0× |
| Neck soft tissue (70360) |
$121 |
$242 |
1.4× |
| Nm gastric emptying study (78264) |
$383 |
$766 |
1.0× |
| Nonvascular shunt X-ray (75809) |
$104.50 |
$209 |
1.0× |
| Parathyrd planar w/spect&CT (78072) |
$520 |
$1,040 |
1.0× |
| Parathyroid Planar Imaging (78070) |
$383 |
$766 |
1.0× |
| Pelvis 1 or 2 views (72170) |
$100.50 |
$201 |
1.0× |
| PET image w/CT, skull-thigh (78815) |
$1,467.50 |
$2,935 |
1.1× |
| PET imaging for CT attenuation whole body (78816) |
$1,467.50 |
$2,935 |
1.1× |
| Pulmonary Ventilation & Perfusion Imaging (78582) |
$520 |
$1,040 |
1.0× |
| Quan&charac c atherosclerotc plaq asses sev c ds (75577) |
$891 |
$1,782 |
1.0× |
| Radex Ankle Compl Minimum 3 Views (73610) |
$121 |
$242 |
1.4× |
| Radex Calcaneus Minimum 2 Views (73650) |
$109.50 |
$219 |
1.3× |
| Radex Elbw Compl Minimum 3 Views (73080) |
$139 |
$278 |
1.7× |
| Radex Entir Thrc Lmbr Crv Sac Spi W/Skull 1 Vw - Xr Scoliosis 1 Vw (72081) |
$83.50 |
$167 |
1.0× |
| Radex entir thrc lmbr crv sac spi w/skull 2/3 vw (72082) |
$126 |
$252 |
1.3× |
| Radex fingr minimum 2 views (73140) |
$83.50 |
$167 |
1.0× |
| Radex Foot Compl Minimum 3 Views (73630) |
$121 |
$242 |
1.4× |
| Radex Hand Minimum 3 Views (73130) |
$121 |
$242 |
1.4× |
| Radex Hip Unilateral With Pelvis 1 View (73501) |
$120.50 |
$241 |
1.4× |
| Radex Hip Unilateral With Pelvis Minimum 4 Views (73503) |
$203.50 |
$407 |
2.0× |
| Radex Hips Bilateral With Pelvis 2 Views (73521) |
$203.50 |
$407 |
2.0× |
| Radex Hips Bilateral With Pelvis Minimum 5 Views (73523) |
$331 |
$662 |
3.3× |
| Radex Humerus Minimum 2 Views (73060) |
$156 |
$312 |
1.9× |
| Radex Kne 1/2 Views (73560) |
$120.50 |
$241 |
1.4× |
| Radex Kne Compl 4/More Views (73564) |
$220 |
$440 |
2.2× |
| Radex Mndbl Compl Minimum 4 Views (70110) |
$220 |
$440 |
2.2× |
| Radex Nasal Bones Complete Minimum 3 Views (70160) |
$121 |
$242 |
1.4× |
| Radex Pelvis Compl Minimum 3 Views (72190) |
$208.50 |
$417 |
2.1× |
| Radex Sho Compl Minimum 2 Views (73030) |
$166 |
$332 |
2.0× |
| Radex Sinuses Paransl < 3 Views (70210) |
$119 |
$238 |
1.4× |
| Radex Temporomandble Jt Opn & Clsd Mouth Bilat (70330) |
$156 |
$312 |
1.9× |
| Radex Toe Minimum 2 Views (73660) |
$233 |
$466 |
2.8× |
| Radex Wrst Compl Minimum 3 Views (73110) |
$139 |
$278 |
1.7× |
| Radex X-Ray Exam Entire Spi 6/> Vw - Xr Entire Spine 6+ Vw (72084) |
$354 |
$708 |
3.5× |
| Radiologic Exam Abdomen 1 View - Xr Abdomen 1 View (74018) |
$83.50 |
$167 |
1.0× |
| Radiologic Exam Abdomen 3+ Views - Xr Abdomen 3+ Views (74021) |
$176.50 |
$353 |
1.8× |
| Radiologic exam chest 2 views (71046) |
$141 |
$282 |
1.7× |
| Radiologic examination femur 1 view (73551) |
$205.50 |
$411 |
2.5× |
| Radiologic examination tibia & fibula 2 views (73590) |
$126 |
$252 |
1.5× |
| Radiologic examination, mastoids; complete, minimum of 3 views per side Non-Facility (70130) |
$209.50 |
$419 |
2.1× |
| Ribs bilateral 3 views (71110) |
$166.50 |
$333 |
1.7× |
| Scapula (73010) |
$166 |
$332 |
1.7× |
| Screening Digital Breast Tomosynthesis Bi (77063) |
$79 |
$158 |
3.4× |
| Shoulder 1 view (73020) |
$121 |
$242 |
1.4× |
| Spine thoracic 3 views (72072) |
$209.50 |
$419 |
2.1× |
| Thyroid Uptake W/Blood Flow Sngle/Mult Quan Meas (78014) |
$383 |
$766 |
1.0× |
| Ultrasound breast complete (76641) |
$300 |
$600 |
3.0× |
| Ultrasound Exam Aaa Screen (76706) |
$369 |
$738 |
3.7× |
| Ultrasound, abdomen limited (76705) |
$219.50 |
$439 |
2.2× |
| Us breast unilateral limited (76642) |
$254 |
$508 |
3.0× |
| Us chest (76604) |
$241 |
$482 |
2.4× |
| Us encephalogram (76506) |
$353 |
$706 |
3.5× |
| Us lmtd joint/oth nonvasc xtr strux r-t w/img (76882) |
$205 |
$410 |
2.0× |
| Us ob limited (76815) |
$368.50 |
$737 |
3.7× |
| Us ob transvaginal (76817) |
$232.50 |
$465 |
2.3× |
| Us pelvic non ob complete (76856) |
$108.50 |
$217 |
1.1× |
| Us pelvic nonobstetric image dcmtn limited/f/u (76857) |
$166 |
$332 |
1.7× |
| Us retroperitoneal complete (76770) |
$420 |
$840 |
4.2× |
| Us retroperitoneal limited (76775) |
$227.50 |
$455 |
2.3× |
| Us scrotum and contents (76870) |
$337.50 |
$675 |
3.4× |
| Us soft tissue head/neck (76536) |
$309.50 |
$619 |
3.1× |
| Us,transplanted kidney, real time/ doppler (76776) |
$372 |
$744 |
3.7× |
| Wrist 2 views (73100) |
$121 |
$242 |
1.4× |
| X-Ray Abdomen,Comp Acute Series - Xr Abdomen 2 Vws With Chest 1 View (74022) |
$247.50 |
$495 |
2.5× |
| X-Ray Ac Jts - Xr Acromioclavicular Joints Bilateral (73050) |
$126 |
$252 |
1.5× |
| X-Ray Elbow 2 Vw - Xr Elbow 1-2 Views Right (73070) |
$121 |
$242 |
1.4× |
| X-Ray Exam Hip Uni 2-3 Views (73502) |
$83.50 |
$167 |
1.0× |
| X-Ray Exam Hips Bi 3-4 Views (73522) |
$331 |
$662 |
3.3× |
| X-ray exam of femur 2/> (73552) |
$126 |
$252 |
1.5× |
| X-Ray Lumbar Spine 2/3 Vw - Xr Lumbar Spine 2-3 Views (72100) |
$141 |
$282 |
1.4× |
| X-ray nose-rectum child f.b. (76010) |
$116.50 |
$233 |
1.4× |
| X-Ray Orbits - Xr Orbits Complete 4+ Views (70200) |
$220 |
$440 |
2.2× |
| X-Ray Ribs 2 Vw Unilat - Xr Ribs 2 Views Right (71100) |
$129.50 |
$259 |
1.6× |
| X-Ray Ribs, Chest 3+ Vw - Xr Ribs 2 Vws Lt W/ Chest Anteroposterior (71101) |
$152.50 |
$305 |
1.5× |
| X-Ray Ribs, Chest 4+ Vw - Xr Ribs 3 Vws Bil W/ Chest Posteroanterior (71111) |
$184 |
$368 |
1.8× |
| X-Ray Sacroiliac Jts 3+ Vw - Xr Sacroiliac Joints 3+ Views (72202) |
$205.50 |
$411 |
2.0× |
| X-Ray Sacrum/Coccyx 2+ Vw - Xr Sacrum Coccyx 2+ Views (72220) |
$126 |
$252 |
1.5× |
| X-Ray Sinuses 3+ Vw - Xr Paranasal Sinuses 3+ Views (70220) |
$220 |
$440 |
2.6× |
| X-Ray Skull 4+ Vw - Xr Skull Complete 4+ Views (70260) |
$234.50 |
$469 |
2.3× |
| X-Ray Skull <4 Vw - Xr Skull 1-3 Views (70250) |
$208 |
$416 |
2.1× |
| X-Ray Sternum 2+ Vw - Xr Sternum 2+ Views (71120) |
$126 |
$252 |
1.5× |
| X-Ray Thoracic Spine 2 Vw - Xr Thoracic Spine 2 Views (72070) |
$126 |
$252 |
1.3× |
| X-Ray Thoracic Spine 4 Vw - Xr Thoracic Spine Complete 4+ Views (72074) |
$232.50 |
$465 |
2.3× |
| Xr c-spine 4 or 5 views (72050) |
$220.50 |
$441 |
2.2× |
| Xr c-spine 6 or more views (72052) |
$220.50 |
$441 |
2.2× |
| Xr chest 4+ views (71048) |
$163 |
$326 |
1.6× |