| Abdomen 2 views (74019) |
$153.13 |
$306.25 |
1.7× |
| Acute gastrointestinal blood loss imaging (78278) |
$499.63 |
$999.25 |
1.4× |
| Ankle 2 views (73600) |
$87.38 |
$174.75 |
1.1× |
| Bone &/Joint Imaging Multiple Areas (78305) |
$775.50 |
$1,551 |
2.2× |
| Bone &/joint imaging whole body (78306) |
$812.88 |
$1,625.75 |
2.3× |
| Bone age studies (77072) |
$119.13 |
$238.25 |
1.3× |
| Bone Imaging 3 Phase (78315) |
$614.88 |
$1,229.75 |
1.8× |
| Bone survey complete (77075) |
$291.82 |
$583.62 |
3.2× |
| Cervical spine 2 or 3 views (72040) |
$166.06 |
$332.12 |
2.2× |
| Chest 1 view (71045) |
$136.88 |
$273.75 |
1.8× |
| Chest 3 views (71047) |
$167.88 |
$335.75 |
2.2× |
| Cine/Vid X-Ray Throat/Esoph - Fl Esoph Barium Swlw W/ Video & Speech (74230) |
$229.25 |
$458.50 |
1.5× |
| Clavicle complete (73000) |
$64.82 |
$129.62 |
0.8× |
| Computed Tomography Thorax Lw Dose Lng Ca Scr C- (71271) |
$111.50 |
$223 |
1.2× |
| CT abdomen and pelvis without and with contrast (74178) |
$1,585.49 |
$3,170.97 |
5.2× |
| CT abdomen and pelvis without contrast (74176) |
$832.45 |
$1,664.90 |
4.0× |
| CT abdomen w contrast (74160) |
$969.34 |
$1,938.68 |
6.3× |
| CT abdomen w wo contrast (74170) |
$994.84 |
$1,989.68 |
6.5× |
| CT abdomen w/o contrast (74150) |
$551.50 |
$1,103 |
6.0× |
| CT angiography upper extremity lt (73206) |
$845.25 |
$1,690.50 |
5.5× |
| CT c-spine w/o contrast (72125) |
$592.72 |
$1,185.44 |
6.5× |
| CT cervical spine w&w/o contrast (72127) |
$919.88 |
$1,839.75 |
6.0× |
| CT cervical spine with contrast (72126) |
$804.63 |
$1,609.25 |
2.6× |
| CT chest w/wo contrast (71270) |
$798 |
$1,596 |
5.2× |
| CT chest with contrast (71260) |
$760.39 |
$1,520.77 |
4.9× |
| CT head/brain with contrast (70460) |
$597 |
$1,194 |
3.9× |
| CT head/brain without and with contrast (70470) |
$795.69 |
$1,591.37 |
5.2× |
| CT iac w contrast (70481) |
$804.63 |
$1,609.25 |
5.2× |
| CT limited/localized follow up study (76380) |
$269.13 |
$538.25 |
3.5× |
| CT lower ext w/o (73700) |
$589.78 |
$1,179.55 |
6.4× |
| CT lower extremity w wo contrast (73702) |
$1,322.13 |
$2,644.25 |
8.6× |
| CT lower extremity with contrast (73701) |
$672 |
$1,344 |
4.4× |
| CT lumbar spine w & w/o contrast (72133) |
$2,125 |
$4,250 |
13.8× |
| CT lumbar spine w/o contrast (72131) |
$589.78 |
$1,179.55 |
6.4× |
| CT maxillofacial w contrast (70487) |
$612.50 |
$1,225 |
4.0× |
| CT maxillofacial w/o contrast (70486) |
$548.21 |
$1,096.42 |
6.0× |
| CT maxillofacial w/wo contrast (70488) |
$919.88 |
$1,839.75 |
6.0× |
| CT neck soft tissue w contrast (70491) |
$746 |
$1,492 |
4.9× |
| CT orbit sella/post fossa/ear w/o & w/contr matr (70482) |
$919.88 |
$1,839.75 |
6.0× |
| CT orbits w/o contrast (70480) |
$803.25 |
$1,606.50 |
8.8× |
| CT pelvis w & w/o contrast (72194) |
$1,322.13 |
$2,644.25 |
8.6× |
| CT pelvis w/o contrast (72192) |
$605.96 |
$1,211.91 |
6.6× |
| CT soft tissue neck w/o & w/contrast material (70492) |
$898 |
$1,796 |
5.8× |
| CT soft tissue neck w/o contrast (70490) |
$604.50 |
$1,209 |
6.6× |
| CT thoracic spine w/o contrast (72128) |
$591.25 |
$1,182.49 |
6.5× |
| CT thorax w/o contrast (71250) |
$604.49 |
$1,208.97 |
6.6× |
| CT upper extremity w/o & w/contrast material (73202) |
$1,322.13 |
$2,644.25 |
8.6× |
| CT upper extremity w/o contrast rt (73200) |
$560.50 |
$1,121 |
6.1× |
| CT upper extremity with contrast (73201) |
$816.50 |
$1,633 |
2.7× |
| Cta Abdl Aorta&Bi Iliofem W/Contrast&Postp (75635) |
$1,187.37 |
$2,374.73 |
7.7× |
| Cta Abdomen (74175) |
$1,076.74 |
$2,153.48 |
7.0× |
| CTA abdomen pelvis (74174) |
$2,480 |
$4,960 |
8.1× |
| CTA chest (71275) |
$1,077.89 |
$2,155.77 |
7.0× |
| Cta Head (70496) |
$938.50 |
$1,877 |
6.1× |
| CTA lwr ext w&w/o contrast (73706) |
$961.50 |
$1,923 |
6.3× |
| Cta Neck (70498) |
$938.50 |
$1,877 |
6.1× |
| Cystography minimum 3 views rs&i (74430) |
$268.13 |
$536.25 |
0.9× |
| Dxa bone density study 1/> sites axial skel (77080) |
$364.38 |
$728.75 |
4.0× |
| Dxa bone density study 1/>sites appendiclr skel (77081) |
$65.75 |
$131.50 |
0.9× |
| Esophagus (74220) |
$201.94 |
$403.88 |
1.3× |
| Fetal biophysical profile non-stress testing (76818) |
$457.50 |
$915 |
5.0× |
| Fluoroscopy up to 1 hr (76000) |
$384.76 |
$769.50 |
1.8× |
| Foot 2 views (73620) |
$90.94 |
$181.88 |
1.2× |
| Forearm 2 views (73090) |
$53.25 |
$106.50 |
0.7× |
| Gated Heart Planar Single (78472) |
$864.13 |
$1,728.25 |
2.5× |
| Hand 2 views (73120) |
$78.88 |
$157.75 |
0.9× |
| Hand 3 views (73130) |
$53.25 |
$106.50 |
0.7× |
| Hepatobil Syst Imag Inc Gb W/Pharma Intervenj (78227) |
$939 |
$1,878 |
2.0× |
| Hepatobiliary syst imaging including gallbladder (78226) |
$609.88 |
$1,219.75 |
1.7× |
| Ht muscle image spect sing (78451) |
$1,117.63 |
$2,235.25 |
1.0× |
| Humerus Min 2 Views Left (73060) |
$56.19 |
$112.38 |
0.7× |
| Kidney Img Morphology Vascular Flow 1 W/O Rx (78707) |
$576.38 |
$1,152.75 |
1.2× |
| Kidney img morphology vascular flow 1 w/rx (78708) |
$614.88 |
$1,229.75 |
1.3× |
| Knee 3 views (73562) |
$159.25 |
$318.50 |
2.1× |
| Liver & spleen imaging static only (78215) |
$422.75 |
$845.50 |
1.2× |
| Lymphoscintigraphy (78195) |
$499.63 |
$999.25 |
1.1× |
| Mammary ductogram or galactogram single (77053) |
$96.38 |
$192.75 |
0.5× |
| Meckels Diverticulum (78290) |
$384.25 |
$768.50 |
1.1× |
| MRA head w & w/o contrast (70546) |
$1,536.75 |
$3,073.50 |
5.0× |
| MRA head w/o contrast (70544) |
$934.38 |
$1,868.76 |
4.5× |
| MRA head with contrast (70545) |
$1,459.88 |
$2,919.75 |
4.8× |
| Mra Neck W/O &W/Contrast Material (70549) |
$1,536.75 |
$3,073.50 |
5.0× |
| MRA neck w/o contrast (70547) |
$878.50 |
$1,757 |
4.2× |
| MRI abdomen w/o & w/contrast material (74183) |
$1,573.72 |
$3,147.43 |
5.1× |
| MRI abdomen w/o contrast (74181) |
$904.52 |
$1,809.04 |
4.3× |
| MRI bone marrow blood supply (77084) |
$1,459.88 |
$2,919.75 |
7.0× |
| MRI c-spine with contrast (72142) |
$1,536.75 |
$3,073.50 |
5.0× |
| MRI cervical spine w/o contrast (72141) |
$880.99 |
$1,761.97 |
4.2× |
| MRI chest w/o & w/contrast material (71552) |
$1,536.75 |
$3,073.50 |
5.0× |
| MRI chest w/o contrast (71550) |
$1,459.88 |
$2,919.75 |
7.0× |
| MRI Forearm w/ Contrast Bilateral 73219 (73219) |
$1,459.88 |
$2,919.75 |
4.8× |
| MRI lower extrem oth/thn jt w/contrast matrl (73719) |
$1,459.88 |
$2,919.75 |
4.8× |
| MRI lower extrem oth/thn jt w/o contr matrl (73718) |
$1,036.89 |
$2,073.78 |
5.0× |
| MRI orbit face &/neck w/o contrast (70540) |
$926.50 |
$1,853 |
4.4× |
| MRI orbit/face/neck w&w/o cont (70543) |
$1,388.50 |
$2,777 |
4.5× |
| MRI pelvis w/o & w/contrast material (72197) |
$1,386 |
$2,772 |
4.5× |
| MRI pelvis w/o contrast (72195) |
$942 |
$1,884 |
4.5× |
| MRI scan of arm joint before and after contrast (73223) |
$1,601.50 |
$3,203 |
5.2× |
| MRI scan of leg joint before and after contrast (73723) |
$1,596 |
$3,192 |
5.2× |
| MRI spinal canal cervical w/o & w/contr matrl (72156) |
$1,307 |
$2,614 |
4.3× |
| MRI spinal canal lumbar w/o & w/contr matrl (72158) |
$1,303 |
$2,606 |
4.3× |
| MRI spinal canal thoracic w/o & w/contr matrl (72157) |
$1,308 |
$2,616 |
4.3× |
| MRI thoracic spine w/o contrast (72146) |
$776 |
$1,552 |
3.7× |
| MRI tmj (70336) |
$1,375.88 |
$2,751.75 |
6.6× |
| MRI upper ext joint w/o contrast (73221) |
$932.47 |
$1,864.93 |
4.5× |
| MRI upper extrem other than jt w/o & w/contras (73220) |
$1,536.75 |
$3,073.50 |
5.0× |
| MRI upper extremity oth than jt w/o contr matrl (73218) |
$1,051.50 |
$2,103 |
5.0× |
| Myelogram Cervical (72240) |
$691.75 |
$1,383.50 |
1.0× |
| Myelogram Lumbar (72265) |
$672.63 |
$1,345.25 |
1.0× |
| Myelogram thoracic (72255) |
$672.63 |
$1,345.25 |
1.0× |
| Myelography 2 or more regions (72270) |
$691.75 |
$1,383.50 |
1.0× |
| Myocardial Spect Multiple Studies (78452) |
$2,332.50 |
$4,665 |
2.1× |
| Neck soft tissue (70360) |
$93.25 |
$186.50 |
1.2× |
| Nm gastric emptying study (78264) |
$653.38 |
$1,306.75 |
1.9× |
| Nuclear medicine study of kidney and blood flow (78701) |
$346 |
$692 |
1.0× |
| Ob Us Follow-Up Per Fetus - Us Ob Follow Up Transabdominal Approach (76816) |
$153.88 |
$307.75 |
1.7× |
| Osseous survey limited (77074) |
$225.50 |
$451 |
2.5× |
| Parathyroid imaging (78070) |
$558.88 |
$1,117.75 |
1.6× |
| Pelvis 1 or 2 views (72170) |
$79.62 |
$159.25 |
0.9× |
| Pr MRI, lower extr, w/o contrast f/u by contrast (73720) |
$1,386 |
$2,772 |
4.5× |
| Pulmonary Perfusion Imaging Particulate (78580) |
$422.75 |
$845.50 |
1.2× |
| Pulmonary Ventilation & Perfusion Imaging (78582) |
$1,117.63 |
$2,235.25 |
2.3× |
| Radex abscess/fistula/sinus tract rs&i (76080) |
$115.63 |
$231.25 |
0.2× |
| Radex Entir Thrc Lmbr Crv Sac Spi W/Skull 1 Vw - Xr Scoliosis 1 Vw (72081) |
$90.13 |
$180.25 |
1.2× |
| Radex entir thrc lmbr crv sac spi w/skull 2/3 vw (72082) |
$183 |
$366 |
2.0× |
| Radex hips bilateral with pelvis 2 views (73521) |
$239.50 |
$479 |
2.6× |
| Radex mastoids compl minimum 3 views pr side (70130) |
$96.38 |
$192.75 |
1.1× |
| Radiolog exam mandible compl minimum 4 views (70110) |
$88.50 |
$177 |
1.0× |
| Radiologic Exam Abdomen 1 View - Xr Abdomen 1 View (74018) |
$160.50 |
$321 |
2.1× |
| Radiologic Exam Chest 2 Views - Xr Chest 2 Views (71046) |
$147.08 |
$294.15 |
1.9× |
| Radiologic exam colon single contrast study (74270) |
$345.44 |
$690.88 |
2.2× |
| Radiologic exam upr gi trc double contrast study (74246) |
$437.06 |
$874.12 |
2.8× |
| Radiologic exam upr gi trc single contrast study (74240) |
$300 |
$600 |
2.0× |
| Radiologic Examination Femur Minimum 2 Views - Xr Femur 2+ Vw Lt (73552) |
$119.06 |
$238.12 |
1.6× |
| Radiological examination surgical specimen (76098) |
$271.75 |
$543.50 |
0.6× |
| Ribs bilateral 3 views (71110) |
$289.75 |
$579.50 |
3.2× |
| Scanogram (77073) |
$88 |
$176 |
1.0× |
| Scapula complete (73010) |
$120.19 |
$240.38 |
1.3× |
| Screening digital breast tomosynthesis (77063) |
$75 |
$150 |
3.2× |
| Small bowel series (74250) |
$221 |
$442 |
1.4× |
| Spine thoracic 3 views (72072) |
$208.38 |
$416.75 |
2.3× |
| Therapeutic Enema (74283) |
$219.50 |
$439 |
1.4× |
| Thoracolumbar 2 views (72080) |
$82.88 |
$165.75 |
1.1× |
| Thyroid Uptake W/Blood Flow Sngle/Mult Quan Meas (78014) |
$689.50 |
$1,379 |
2.0× |
| Ultrasound, abdomen limited (76705) |
$344.88 |
$689.75 |
3.8× |
| Unlisted Diagnostic Radiographic Procedure (76499) |
$117.88 |
$235.75 |
1.5× |
| Urethrocystography retrograde rs&i (74450) |
$202.32 |
$404.62 |
1.0× |
| Urethrocystography voiding (74455) |
$334.25 |
$668.50 |
1.6× |
| Urography (pyelography), intravenous, with or without KUB, with or without tomography (74400) |
$434.63 |
$869.25 |
2.8× |
| Us abdl aorta screen aaa (76706) |
$330.50 |
$661 |
3.6× |
| Us breast unilateral complete (76641) |
$344.88 |
$689.75 |
3.8× |
| Us breast unilateral limited (76642) |
$172.50 |
$345 |
2.3× |
| Us chest (76604) |
$230.88 |
$461.75 |
2.5× |
| Us compl joint r-t w/image documentation (76881) |
$276.38 |
$552.75 |
3.0× |
| Us infant hips dynamic (76885) |
$192.25 |
$384.50 |
2.5× |
| Us ob transvaginal (76817) |
$330.50 |
$661 |
3.6× |
| Us pelvic non ob complete (76856) |
$371.75 |
$743.50 |
4.1× |
| Us pelvic nonobstetric image dcmtn limited/f/u (76857) |
$194.63 |
$389.25 |
2.1× |
| Us pregnancy ltd (76815) |
$243.13 |
$486.25 |
2.7× |
| Us pregnant uterus 14 wk transabdl 1/1st gestat (76801) |
$230.88 |
$461.75 |
2.5× |
| Us retroperitoneal complete (76770) |
$340.50 |
$681 |
3.7× |
| Us scrotum and contents (76870) |
$373.75 |
$747.50 |
4.1× |
| Us soft tissue head/neck (76536) |
$331.88 |
$663.75 |
3.6× |
| Us transrectal (76872) |
$250 |
$500 |
2.7× |
| Venogram extremity bilateral (75822) |
$365.25 |
$730.50 |
0.3× |
| Venography extremity unilateral rs&i (75820) |
$307.63 |
$615.25 |
0.2× |
| Vertebral fracture assessment via dxa (77086) |
$57.88 |
$115.75 |
0.8× |
| Wrist 2 views (73100) |
$98.94 |
$197.88 |
1.3× |
| X-Ray Abdomen,Comp Acute Series - Xr Abdomen 2 Vws With Chest 1 View (74022) |
$163.44 |
$326.88 |
1.8× |
| X-Ray Ac Jts - Xr Acromioclavicular Joints Bilateral (73050) |
$189.50 |
$379 |
2.5× |
| X-Ray Ankle 3+ Vw - Xr Ankle 3+ Views Right (73610) |
$66.88 |
$133.75 |
0.9× |
| X-Ray Colon Air Contrast - Fl Barium Enema Air Contrast (74280) |
$389 |
$778 |
2.5× |
| X-Ray Elbow 2 Vw - Xr Elbow 1-2 Views Right (73070) |
$79 |
$158 |
1.0× |
| X-Ray Elbow 3+ Vw - Xr Elbow 3+ Views Right (73080) |
$48.19 |
$96.38 |
0.6× |
| X-ray exam entire spi 4/5 vw (72083) |
$293.63 |
$587.25 |
3.2× |
| X-ray exam hip uni 1 view (73501) |
$117.13 |
$234.25 |
1.5× |
| X-Ray Exam Hip Uni 2-3 Views (73502) |
$127.25 |
$254.50 |
1.7× |
| X-ray exam hip uni 4/> views (73503) |
$133.88 |
$267.75 |
1.5× |
| X-ray exam of femur 1 (73551) |
$107.94 |
$215.88 |
1.4× |
| X-Ray Facial Bones 3+ Vw - Xr Facial Bones 3+ Views (70150) |
$229.25 |
$458.50 |
2.5× |
| X-Ray Facial Bones <3 Vw - Xr Facial Bones 1-2 Views (70140) |
$77.13 |
$154.25 |
1.0× |
| X-Ray Foot 3+ Vw - Xr Foot 3+ Views Right (73630) |
$71.38 |
$142.75 |
0.9× |
| X-Ray Heel - Xr Calcaneus 2 Views Right (73650) |
$144 |
$288 |
1.9× |
| X-ray IV pyelogram+drip infusn (74410) |
$230.88 |
$461.75 |
1.5× |
| X-Ray Knee 4+ View - Xr Knee 4+ Views Right (73564) |
$98 |
$196 |
1.1× |
| X-Ray Knee Bilat Standing - Xr Knees Anteroposterior Standing Bilat (73565) |
$79.50 |
$159 |
1.0× |
| X-Ray Lumbar Spine 2/3 Vw - Xr Lumbar Spine 2-3 Views (72100) |
$104.94 |
$209.88 |
1.1× |
| X-Ray Lumbar Spine 6+ Vw - Xr Lumbar Spine 6+ Vws Including Bending (72114) |
$265.25 |
$530.50 |
2.9× |
| X-Ray Nasal Bones - Xr Nasal Bones (70160) |
$103.88 |
$207.75 |
1.4× |
| X-Ray Orbits - Xr Orbits Complete 4+ Views (70200) |
$64.82 |
$129.62 |
0.7× |
| X-Ray Pelvis 3+ Vw - Xr Pelvis 3+ Views (72190) |
$115.63 |
$231.25 |
1.3× |
| X-Ray Retrograde Pyelogram - Fl Pyelogram Retrograde (74420) |
$230.88 |
$461.75 |
0.8× |
| X-Ray Ribs 2 Vw Unilat - Xr Ribs 2 Views Right (71100) |
$46.62 |
$93.25 |
0.6× |
| X-Ray Ribs, Chest 3+ Vw - Xr Ribs 2 Vws Lt W/ Chest Anteroposterior (71101) |
$102 |
$204 |
1.1× |
| X-Ray Ribs, Chest 4+ Vw - Xr Ribs 3 Vws Bil W/ Chest Posteroanterior (71111) |
$180.25 |
$360.50 |
2.0× |
| X-Ray Sacroiliac Jts 3+ Vw - Xr Sacroiliac Joints 3+ Views (72202) |
$216.63 |
$433.25 |
2.4× |
| X-Ray Sacrum/Coccyx 2+ Vw - Xr Sacrum Coccyx 2+ Views (72220) |
$102.88 |
$205.75 |
1.3× |
| X-Ray Shoulder 2+ Vw - Xr Shoulder 2+ Views Right (73030) |
$87.25 |
$174.50 |
1.1× |
| X-Ray Sinuses 3+ Vw - Xr Paranasal Sinuses 3+ Views (70220) |
$140.44 |
$280.88 |
1.8× |
| X-Ray Sinuses <3 Vw - Xr Paranasal Sinuses 1-2 Views (70210) |
$69.50 |
$139 |
0.9× |
| X-Ray Skull 4+ Vw - Xr Skull Complete 4+ Views (70260) |
$15.50 |
$31 |
0.2× |
| X-Ray Skull <4 Vw - Xr Skull 1-3 Views (70250) |
$107 |
$214 |
1.2× |
| X-Ray Spine One View - Xr Spine (72020) |
$96.38 |
$192.75 |
1.3× |
| X-Ray Sterno-Clavicluar Jt - Xr Sternoclavicular Joints 3+ Views (71130) |
$77.13 |
$154.25 |
1.0× |
| X-Ray Sternum 2+ Vw - Xr Sternum 2+ Views (71120) |
$144.88 |
$289.75 |
1.9× |
| X-Ray Thoracic Spine 2 Vw - Xr Thoracic Spine 2 Views (72070) |
$112.44 |
$224.88 |
1.2× |
| X-Ray Wrist 3+ Vw - Xr Wrist 3+ Views Right (73110) |
$52.50 |
$105 |
0.7× |
| Xr c-spine 6 or more views (72052) |
$287.75 |
$575.50 |
3.1× |
| Xr shoulder 1 view (73020) |
$115.25 |
$230.50 |
1.5× |
| Xr spine cervical 4 or 5 views (72050) |
$171.56 |
$343.12 |
1.9× |
| Xr tibia/fibula 2 views (73590) |
$65.82 |
$131.62 |
0.9× |
| Xr tmj bilateral (70330) |
$93.38 |
$186.75 |
1.2× |
| Xray knee 1 or 2 views rt (73560) |
$66.88 |
$133.75 |
0.9× |