| Abdomen 2 views (74019) |
$193.50 |
$387 |
2.0× |
| Acute gastrointestinal blood loss imaging (78278) |
$969 |
$1,938 |
2.6× |
| Ankle 2 views (73600) |
$79.50 |
$159 |
1.0× |
| Bone &/Joint Imaging Limited Area (78300) |
$709.50 |
$1,419 |
1.9× |
| Bone &/joint imaging whole body (78306) |
$848.50 |
$1,697 |
2.3× |
| Bone age studies (77072) |
$67.50 |
$135 |
0.7× |
| Bone Imaging 3 Phase (78315) |
$990.50 |
$1,981 |
2.6× |
| Bone survey complete (77075) |
$132.50 |
$265 |
1.4× |
| Cervical spine 2 or 3 views (72040) |
$174 |
$348 |
2.1× |
| Chest 1 view (71045) |
$122 |
$244 |
1.5× |
| Chest 3 views (71047) |
$187 |
$374 |
2.3× |
| Cine/Vid X-Ray Throat/Esoph - Fl Esoph Barium Swlw W/ Video & Speech (74230) |
$286.50 |
$573 |
1.7× |
| Clavicle complete (73000) |
$140 |
$280 |
1.7× |
| Computed Tomography Thorax Lw Dose Lng Ca Scr C- (71271) |
$398 |
$796 |
4.1× |
| CT abdomen and pelvis without and with contrast (74178) |
$1,768.50 |
$3,537 |
5.4× |
| CT abdomen and pelvis without contrast (74176) |
$1,568 |
$3,136 |
7.0× |
| CT abdomen w contrast (74160) |
$1,232.50 |
$2,465 |
7.5× |
| CT abdomen w wo contrast (74170) |
$1,272.50 |
$2,545 |
7.7× |
| CT abdomen w/o contrast (74150) |
$1,053.50 |
$2,107 |
10.7× |
| CT angiography upper extremity lt (73206) |
$1,406 |
$2,812 |
8.5× |
| CT c-spine w/o contrast (72125) |
$1,176 |
$2,352 |
12.0× |
| CT cervical spine w&w/o contrast (72127) |
$1,786 |
$3,572 |
10.9× |
| CT cervical spine with contrast (72126) |
$1,388 |
$2,776 |
4.2× |
| CT chest w/wo contrast (71270) |
$1,371 |
$2,742 |
8.3× |
| CT chest with contrast (71260) |
$1,253 |
$2,506 |
7.6× |
| CT head/brain with contrast (70460) |
$781.50 |
$1,563 |
4.7× |
| CT head/brain without and with contrast (70470) |
$1,184.50 |
$2,369 |
7.2× |
| CT heart no contrast quant eval coronry calcium (75571) |
$50 |
$100 |
0.6× |
| CT iac w contrast (70481) |
$840.50 |
$1,681 |
5.1× |
| CT lower ext w/o (73700) |
$1,218.50 |
$2,437 |
12.4× |
| CT lower extremity w wo contrast (73702) |
$1,371 |
$2,742 |
8.3× |
| CT lower extremity with contrast (73701) |
$1,218.50 |
$2,437 |
7.4× |
| CT lumbar spine w & w/o contrast (72133) |
$2,002 |
$4,004 |
12.2× |
| CT lumbar spine w/o contrast (72131) |
$1,376 |
$2,752 |
14.0× |
| CT lumbar spine with contrast (72132) |
$1,641 |
$3,282 |
5.0× |
| CT maxillofacial w contrast (70487) |
$940.25 |
$1,880.50 |
5.7× |
| CT maxillofacial w/o contrast (70486) |
$781.50 |
$1,563 |
8.0× |
| CT maxillofacial w/wo contrast (70488) |
$1,348 |
$2,696 |
8.2× |
| CT neck soft tissue w contrast (70491) |
$1,092 |
$2,184 |
6.6× |
| CT orbit sella/post fossa/ear w/o & w/contr matr (70482) |
$1,325 |
$2,650 |
8.1× |
| CT orbits w/o contrast (70480) |
$781.50 |
$1,563 |
8.0× |
| CT pelvis w & w/o contrast (72194) |
$1,371 |
$2,742 |
8.3× |
| CT pelvis w/o contrast (72192) |
$1,052.50 |
$2,105 |
10.7× |
| CT scan for measuring calcium and other minerals in bone (77078) |
$178 |
$356 |
2.2× |
| CT soft tissue neck w/o & w/contrast material (70492) |
$1,290 |
$2,580 |
7.8× |
| CT soft tissue neck w/o contrast (70490) |
$1,025 |
$2,050 |
10.4× |
| CT thoracic spine w/contrast (72129) |
$1,641 |
$3,282 |
10.0× |
| CT thoracic spine w/o contrast (72128) |
$1,387.50 |
$2,775 |
14.1× |
| CT thoracic spine w/wo contrast (72130) |
$2,002 |
$4,004 |
12.2× |
| CT thorax w/o contrast (71250) |
$1,048.50 |
$2,097 |
10.7× |
| CT upper extremity w/o & w/contrast material (73202) |
$1,371 |
$2,742 |
8.3× |
| CT upper extremity w/o contrast rt (73200) |
$1,046 |
$2,092 |
10.7× |
| CT upper extremity with contrast (73201) |
$1,218.50 |
$2,437 |
3.7× |
| Cta Abdl Aorta&Bi Iliofem W/Contrast&Postp (75635) |
$1,281.50 |
$2,563 |
7.8× |
| Cta Abdomen (74175) |
$1,281.50 |
$2,563 |
7.8× |
| CTA abdomen pelvis (74174) |
$1,281.50 |
$2,563 |
3.9× |
| CTA chest (71275) |
$1,262 |
$2,524 |
7.7× |
| Cta Head (70496) |
$1,281.50 |
$2,563 |
7.8× |
| CTA lwr ext w&w/o contrast (73706) |
$1,406 |
$2,812 |
8.5× |
| Cta Neck (70498) |
$1,281.50 |
$2,563 |
7.8× |
| Cta Pelvis (72191) |
$1,406 |
$2,812 |
8.5× |
| Diskogram cervical (72285) |
$2,573.71 |
$5,147.41 |
1.4× |
| Diskography lumbar (72295) |
$2,573.71 |
$5,147.41 |
1.4× |
| Esophagus (74220) |
$312 |
$624 |
1.9× |
| Fluoroscopy up to 1 hr (76000) |
$220.49 |
$440.98 |
1.0× |
| Foot 2 views (73620) |
$110.50 |
$221 |
1.4× |
| Forearm 2 views (73090) |
$183.50 |
$367 |
2.2× |
| Gated Heart Planar Single (78472) |
$768 |
$1,536 |
2.0× |
| Hand 2 views (73120) |
$78.50 |
$157 |
0.8× |
| Hand 3 views (73130) |
$188.50 |
$377 |
2.3× |
| Hepatobil Syst Imag Inc Gb W/Pharma Intervenj (78227) |
$1,107.50 |
$2,215 |
2.2× |
| Hepatobiliary syst imaging including gallbladder (78226) |
$1,060.50 |
$2,121 |
2.8× |
| Ht muscle image spect sing (78451) |
$1,277 |
$2,554 |
1.1× |
| Humerus Min 2 Views Left (73060) |
$183.50 |
$367 |
2.2× |
| Kidney Img Morphology Vascular Flow 1 W/O Rx (78707) |
$795.50 |
$1,591 |
1.6× |
| Kidney img morphology vascular flow 1 w/rx (78708) |
$620 |
$1,240 |
1.2× |
| Kidney Img Morphology Vascular Flow Multiple (78709) |
$1,476.50 |
$2,953 |
2.9× |
| Knee 3 views (73562) |
$205.75 |
$411.50 |
2.5× |
| Liver & spleen imaging static only (78215) |
$693 |
$1,386 |
1.8× |
| MRA head w & w/o contrast (70546) |
$2,080 |
$4,160 |
6.4× |
| MRA head w/o contrast (70544) |
$1,105.50 |
$2,211 |
4.9× |
| MRA head with contrast (70545) |
$1,664 |
$3,328 |
5.1× |
| Mra Neck W/O &W/Contrast Material (70549) |
$1,588 |
$3,176 |
4.9× |
| MRA neck w/o contrast (70547) |
$1,105.50 |
$2,211 |
4.9× |
| MRI abdomen w contrast (74182) |
$1,716 |
$3,432 |
5.2× |
| MRI abdomen w/o & w/contrast material (74183) |
$1,835.50 |
$3,671 |
5.6× |
| MRI abdomen w/o contrast (74181) |
$1,615 |
$3,230 |
7.2× |
| MRI any jnt lwr ext with con lt (73722) |
$1,664 |
$3,328 |
2.3× |
| MRI any jt upper extremity w/contrast matrl (73222) |
$1,664 |
$3,328 |
2.3× |
| MRI c-spine with contrast (72142) |
$1,976 |
$3,952 |
6.0× |
| MRI cervical spine w/o contrast (72141) |
$1,559.50 |
$3,119 |
7.0× |
| MRI chest w/o & w/contrast material (71552) |
$1,985.50 |
$3,971 |
6.1× |
| MRI chest w/o contrast (71550) |
$1,615 |
$3,230 |
7.2× |
| MRI chest with contrast (71551) |
$1,615 |
$3,230 |
2.2× |
| MRI Forearm w/ Contrast Bilateral 73219 (73219) |
$1,664 |
$3,328 |
5.1× |
| MRI lower extrem oth/thn jt w/contrast matrl (73719) |
$1,456 |
$2,912 |
4.4× |
| MRI lower extrem oth/thn jt w/o contr matrl (73718) |
$1,237.50 |
$2,475 |
5.5× |
| MRI orbit face &/neck w/o contrast (70540) |
$1,371 |
$2,742 |
6.1× |
| MRI orbit/face/neck w&w/o cont (70543) |
$2,184 |
$4,368 |
6.7× |
| MRI orbit/face/neck w/contrast (70542) |
$1,871.50 |
$3,743 |
5.7× |
| MRI pelvis w contrast (72196) |
$1,976 |
$3,952 |
6.0× |
| MRI pelvis w/o & w/contrast material (72197) |
$2,184 |
$4,368 |
6.7× |
| MRI pelvis w/o contrast (72195) |
$1,713.50 |
$3,427 |
7.7× |
| MRI scan of arm joint before and after contrast (73223) |
$1,985.50 |
$3,971 |
6.1× |
| MRI scan of leg joint before and after contrast (73723) |
$1,890.50 |
$3,781 |
5.8× |
| MRI spinal canal cervical w/o & w/contr matrl (72156) |
$2,184 |
$4,368 |
6.7× |
| MRI spinal canal lumbar w/contrast material (72149) |
$1,976 |
$3,952 |
6.0× |
| MRI spinal canal lumbar w/o & w/contr matrl (72158) |
$2,184 |
$4,368 |
6.7× |
| MRI spinal canal thoracic w/contrast matrl (72147) |
$2,110 |
$4,220 |
6.4× |
| MRI spinal canal thoracic w/o & w/contr matrl (72157) |
$2,258.50 |
$4,517 |
6.9× |
| MRI thoracic spine w/o contrast (72146) |
$1,581 |
$3,162 |
7.1× |
| MRI upper ext joint w/o contrast (73221) |
$1,512.50 |
$3,025 |
6.8× |
| MRI upper extrem other than jt w/o & w/contras (73220) |
$1,687.50 |
$3,375 |
5.2× |
| MRI upper extremity oth than jt w/o contr matrl (73218) |
$1,616.50 |
$3,233 |
7.2× |
| Myocardial Spect Multiple Studies (78452) |
$1,759 |
$3,518 |
1.4× |
| Neck soft tissue (70360) |
$117.50 |
$235 |
1.4× |
| Nm gastric emptying study (78264) |
$939.50 |
$1,879 |
2.5× |
| Osseous survey infant (77076) |
$732.50 |
$1,465 |
7.5× |
| Parathyrd planar w/wo subtrj (78071) |
$340.50 |
$681 |
0.9× |
| Parathyroid imaging (78070) |
$387.50 |
$775 |
1.0× |
| Pelvis 1 or 2 views (72170) |
$128.50 |
$257 |
1.3× |
| Pr MRI, lower extr, w/o contrast f/u by contrast (73720) |
$1,687.50 |
$3,375 |
5.2× |
| Pulmonary Ventilation & Perfusion Imaging (78582) |
$1,421.50 |
$2,843 |
2.8× |
| Radex Entir Thrc Lmbr Crv Sac Spi W/Skull 1 Vw - Xr Scoliosis 1 Vw (72081) |
$179 |
$358 |
2.2× |
| Radex hips bilateral with pelvis 2 views (73521) |
$206.50 |
$413 |
2.1× |
| Radiolog exam mandible compl minimum 4 views (70110) |
$283 |
$566 |
2.9× |
| Radiologic Exam Abdomen 1 View - Xr Abdomen 1 View (74018) |
$142 |
$284 |
1.7× |
| Radiologic Exam Chest 2 Views - Xr Chest 2 Views (71046) |
$155 |
$310 |
1.9× |
| Radiologic exam colon single contrast study (74270) |
$481 |
$962 |
2.9× |
| Radiologic exam upr gi trc double contrast study (74246) |
$407.50 |
$815 |
2.5× |
| Radiologic Examination Femur Minimum 2 Views - Xr Femur 2+ Vw Lt (73552) |
$170.75 |
$341.50 |
2.1× |
| Rp loclzj tum spect 1 area single day imaging (78803) |
$748.50 |
$1,497 |
1.5× |
| Scanogram (77073) |
$68.50 |
$137 |
0.7× |
| Scapula complete (73010) |
$179.25 |
$358.50 |
1.8× |
| Screening digital breast tomosynthesis (77063) |
$139 |
$278 |
5.9× |
| Spine thoracic 3 views (72072) |
$182 |
$364 |
1.9× |
| Thyroid Uptake W/Blood Flow Sngle/Mult Quan Meas (78014) |
$769.50 |
$1,539 |
2.1× |
| Tmj unilateral (70328) |
$100.50 |
$201 |
1.2× |
| Ultrasound, abdomen limited (76705) |
$356 |
$712 |
3.6× |
| Upper Extremity Infant (73092) |
$190 |
$380 |
1.9× |
| Urethrocystography voiding (74455) |
$308 |
$616 |
1.4× |
| Urography (pyelography), intravenous, with or without KUB, with or without tomography (74400) |
$443 |
$886 |
2.7× |
| Us abdl aorta screen aaa (76706) |
$89 |
$178 |
0.9× |
| Us breast unilateral complete (76641) |
$288.75 |
$577.50 |
2.9× |
| Us breast unilateral limited (76642) |
$128.50 |
$257 |
1.6× |
| Us ob transvaginal (76817) |
$224.50 |
$449 |
2.3× |
| Us pelvic non ob complete (76856) |
$275 |
$550 |
2.8× |
| Us pelvic nonobstetric image dcmtn limited/f/u (76857) |
$164 |
$328 |
1.7× |
| Us pregnancy ltd (76815) |
$245.50 |
$491 |
2.5× |
| Us pregnant uterus 14 wk transabdl 1/1st gestat (76801) |
$224.50 |
$449 |
2.3× |
| Us retroperitoneal complete (76770) |
$341 |
$682 |
3.5× |
| Us scrotum and contents (76870) |
$375 |
$750 |
3.8× |
| Us soft tissue head/neck (76536) |
$341 |
$682 |
3.5× |
| Us xtr non-vasc lmtd (76882) |
$217 |
$434 |
2.2× |
| Wrist 2 views (73100) |
$90.75 |
$181.50 |
1.1× |
| X-Ray Abdomen,Comp Acute Series - Xr Abdomen 2 Vws With Chest 1 View (74022) |
$301 |
$602 |
3.1× |
| X-Ray Ac Jts - Xr Acromioclavicular Joints Bilateral (73050) |
$232 |
$464 |
2.8× |
| X-Ray Ankle 3+ Vw - Xr Ankle 3+ Views Right (73610) |
$199 |
$398 |
2.4× |
| X-Ray Colon Air Contrast - Fl Barium Enema Air Contrast (74280) |
$481 |
$962 |
2.9× |
| X-Ray Elbow 2 Vw - Xr Elbow 1-2 Views Right (73070) |
$38.50 |
$77 |
0.5× |
| X-Ray Elbow 3+ Vw - Xr Elbow 3+ Views Right (73080) |
$177 |
$354 |
2.2× |
| X-ray exam hip uni 1 view (73501) |
$180 |
$360 |
2.2× |
| X-Ray Exam Hip Uni 2-3 Views (73502) |
$147.50 |
$295 |
1.8× |
| X-ray eye for foreign body (70030) |
$279.50 |
$559 |
3.4× |
| X-Ray Facial Bones 3+ Vw - Xr Facial Bones 3+ Views (70150) |
$283 |
$566 |
2.9× |
| X-Ray Foot 3+ Vw - Xr Foot 3+ Views Right (73630) |
$199 |
$398 |
2.4× |
| X-Ray Heel - Xr Calcaneus 2 Views Right (73650) |
$176 |
$352 |
2.2× |
| X-Ray Knee 4+ View - Xr Knee 4+ Views Right (73564) |
$315 |
$630 |
3.2× |
| X-Ray Knee Bilat Standing - Xr Knees Anteroposterior Standing Bilat (73565) |
$222 |
$444 |
2.7× |
| X-Ray Leg, Infant - Xr Lower Extremity 2+ Views Infant Left (73592) |
$190 |
$380 |
2.3× |
| X-Ray Lumbar Spine 2/3 Vw - Xr Lumbar Spine 2-3 Views (72100) |
$224.50 |
$449 |
2.3× |
| X-Ray Lumbar Spine 6+ Vw - Xr Lumbar Spine 6+ Vws Including Bending (72114) |
$354.50 |
$709 |
3.6× |
| X-Ray Nasal Bones - Xr Nasal Bones (70160) |
$142 |
$284 |
1.7× |
| X-Ray Nose-Rectum Child F.B. - Xr Nose to Rectum Foreign Body Peds (76010) |
$165.50 |
$331 |
2.0× |
| X-Ray Orbits - Xr Orbits Complete 4+ Views (70200) |
$283 |
$566 |
2.9× |
| X-Ray Pelvis 3+ Vw - Xr Pelvis 3+ Views (72190) |
$176.50 |
$353 |
1.8× |
| X-Ray Ribs, Chest 3+ Vw - Xr Ribs 2 Vws Lt W/ Chest Anteroposterior (71101) |
$183.50 |
$367 |
1.9× |
| X-Ray Ribs, Chest 4+ Vw - Xr Ribs 3 Vws Bil W/ Chest Posteroanterior (71111) |
$220 |
$440 |
2.2× |
| X-Ray Sacroiliac Jts 3+ Vw - Xr Sacroiliac Joints 3+ Views (72202) |
$196 |
$392 |
2.0× |
| X-Ray Sacrum/Coccyx 2+ Vw - Xr Sacrum Coccyx 2+ Views (72220) |
$158 |
$316 |
1.9× |
| X-Ray Shoulder 2+ Vw - Xr Shoulder 2+ Views Right (73030) |
$182.25 |
$364.50 |
2.2× |
| X-Ray Sinuses 3+ Vw - Xr Paranasal Sinuses 3+ Views (70220) |
$211 |
$422 |
2.6× |
| X-Ray Skull 4+ Vw - Xr Skull Complete 4+ Views (70260) |
$324.50 |
$649 |
3.3× |
| X-Ray Sternum 2+ Vw - Xr Sternum 2+ Views (71120) |
$160.50 |
$321 |
2.0× |
| X-Ray Thoracic Spine 2 Vw - Xr Thoracic Spine 2 Views (72070) |
$146.50 |
$293 |
1.5× |
| X-Ray Toe(S) - Xr Toes 2+ Views Right (73660) |
$176 |
$352 |
2.2× |
| X-Ray Wrist 3+ Vw - Xr Wrist 3+ Views Right (73110) |
$193.75 |
$387.50 |
2.4× |
| Xr c-spine 6 or more views (72052) |
$252 |
$504 |
2.6× |
| Xr chest 4+ views (71048) |
$187 |
$374 |
1.9× |
| Xr finger(s) 2+ views (73140) |
$141.25 |
$282.50 |
1.7× |
| Xr spine cervical 4 or 5 views (72050) |
$228.50 |
$457 |
2.3× |
| Xr tibia/fibula 2 views (73590) |
$176 |
$352 |
2.2× |
| Xr tmj bilateral (70330) |
$184 |
$368 |
2.3× |
| Xray knee 1 or 2 views rt (73560) |
$128.25 |
$256.50 |
1.6× |