| Abdomen 2 views (74019) |
$169 |
$338 |
1.6× |
| Acute gastrointestinal blood loss imaging (78278) |
$506 |
$1,012 |
1.3× |
| Ankle 2 views (73600) |
$94 |
$187 |
1.1× |
| Bone &/joint imaging whole body (78306) |
$530 |
$1,060 |
1.3× |
| Bone age studies (77072) |
$140 |
$280 |
1.3× |
| Bone Imaging 3 Phase (78315) |
$530 |
$1,060 |
1.3× |
| Bone survey complete (77075) |
$188 |
$376 |
1.8× |
| Cervical spine 2 or 3 views (72040) |
$117 |
$234 |
1.3× |
| Chest 1 view (71045) |
$108 |
$215 |
1.2× |
| Chest 3 views (71047) |
$94 |
$187 |
1.1× |
| Clavicle complete (73000) |
$94 |
$187 |
1.1× |
| CT abdomen and pelvis without and with contrast (74178) |
$782 |
$1,563 |
2.2× |
| CT abdomen and pelvis without contrast (74176) |
$799 |
$1,597 |
3.3× |
| CT abdomen w contrast (74160) |
$686 |
$1,371 |
3.9× |
| CT abdomen w wo contrast (74170) |
$774 |
$1,547 |
4.4× |
| CT abdomen w/o contrast (74150) |
$513 |
$1,025 |
4.9× |
| CT angiography upper extremity lt (73206) |
$597 |
$1,193 |
3.4× |
| CT c-spine w/o contrast (72125) |
$579 |
$1,158 |
5.5× |
| CT cervical spine w&w/o contrast (72127) |
$722 |
$1,444 |
4.1× |
| CT cervical spine with contrast (72126) |
$669 |
$1,337 |
1.9× |
| CT chest w/wo contrast (71270) |
$744 |
$1,488 |
4.2× |
| CT chest with contrast (71260) |
$669 |
$1,337 |
3.8× |
| CT head/brain with contrast (70460) |
$624 |
$1,247 |
3.5× |
| CT head/brain without and with contrast (70470) |
$702 |
$1,403 |
4.0× |
| CT heart no contrast quant eval coronry calcium (75571) |
$95 |
$189 |
1.1× |
| CT iac w contrast (70481) |
$624 |
$1,247 |
3.5× |
| CT lower ext w/o (73700) |
$409 |
$818 |
3.9× |
| CT lower extremity w wo contrast (73702) |
$642 |
$1,283 |
3.6× |
| CT lower extremity with contrast (73701) |
$589 |
$1,177 |
3.3× |
| CT lumbar spine w & w/o contrast (72133) |
$691 |
$1,382 |
3.9× |
| CT lumbar spine w/o contrast (72131) |
$504 |
$1,007 |
4.8× |
| CT lumbar spine with contrast (72132) |
$633 |
$1,266 |
1.8× |
| CT maxillofacial w contrast (70487) |
$624 |
$1,247 |
3.5× |
| CT maxillofacial w/o contrast (70486) |
$427 |
$853 |
4.1× |
| CT maxillofacial w/wo contrast (70488) |
$702 |
$1,403 |
4.0× |
| CT neck soft tissue w contrast (70491) |
$639 |
$1,277 |
3.6× |
| CT orbit sella/post fossa/ear w/o & w/contr matr (70482) |
$702 |
$1,403 |
4.0× |
| CT orbits w/o contrast (70480) |
$427 |
$853 |
4.1× |
| CT pelvis w & w/o contrast (72194) |
$691 |
$1,382 |
3.9× |
| CT pelvis w/o contrast (72192) |
$447 |
$894 |
4.3× |
| CT soft tissue neck w/o & w/contrast material (70492) |
$696 |
$1,391 |
4.0× |
| CT soft tissue neck w/o contrast (70490) |
$486 |
$971 |
4.6× |
| CT thoracic spine w/contrast (72129) |
$669 |
$1,337 |
3.8× |
| CT thoracic spine w/o contrast (72128) |
$504 |
$1,007 |
4.8× |
| CT thoracic spine w/wo contrast (72130) |
$722 |
$1,444 |
4.1× |
| CT thorax w/o contrast (71250) |
$577 |
$1,153 |
5.5× |
| CT upper extremity w/o & w/contrast material (73202) |
$642 |
$1,283 |
3.6× |
| CT upper extremity w/o contrast rt (73200) |
$409 |
$818 |
3.9× |
| CT upper extremity with contrast (73201) |
$589 |
$1,177 |
1.7× |
| Cta Abdl Aorta&Bi Iliofem W/Contrast&Postp (75635) |
$1,026 |
$2,052 |
5.8× |
| Cta Abdomen (74175) |
$744 |
$1,488 |
4.2× |
| CTA abdomen pelvis (74174) |
$808 |
$1,616 |
2.3× |
| CTA chest (71275) |
$856 |
$1,712 |
4.9× |
| Cta Head (70496) |
$649 |
$1,297 |
3.7× |
| CTA lwr ext w&w/o contrast (73706) |
$669 |
$1,337 |
3.8× |
| Cta Neck (70498) |
$696 |
$1,391 |
4.0× |
| Dxa bone density study 1/> sites axial skel (77080) |
$194 |
$388 |
1.8× |
| Esophagus (74220) |
$299 |
$597 |
1.7× |
| Fetal Biophysical Profile W/O Non-Stress Testing (76819) |
$66 |
$132 |
0.6× |
| Fluoroscopy up to 1 hr (76000) |
$346 |
$692 |
1.4× |
| Foot 2 views (73620) |
$94 |
$187 |
1.1× |
| Forearm 2 views (73090) |
$94 |
$187 |
1.1× |
| Gated Heart Planar Single (78472) |
$413 |
$825 |
1.0× |
| Hand 2 views (73120) |
$169 |
$338 |
1.6× |
| Hand 3 views (73130) |
$194 |
$388 |
2.2× |
| Hepatobil Syst Imag Inc Gb W/Pharma Intervenj (78227) |
$684 |
$1,367 |
1.3× |
| Hepatobiliary syst imaging including gallbladder (78226) |
$530 |
$1,060 |
1.3× |
| Humerus Min 2 Views Left (73060) |
$94 |
$187 |
1.1× |
| Kidney Img Morphology Vascular Flow 1 W/O Rx (78707) |
$535 |
$1,070 |
1.0× |
| Kidney img morphology vascular flow 1 w/rx (78708) |
$538 |
$1,075 |
1.0× |
| Kidney Img Morphology Vascular Flow Multiple (78709) |
$535 |
$1,070 |
1.0× |
| Knee 3 views (73562) |
$94 |
$187 |
1.1× |
| Liver & spleen imaging static only (78215) |
$413 |
$825 |
1.0× |
| Lymphoscintigraphy (78195) |
$535 |
$1,070 |
1.0× |
| MRA head w/o contrast (70544) |
$888 |
$1,775 |
3.7× |
| MRA head with contrast (70545) |
$888 |
$1,775 |
2.5× |
| Mra Neck W/O &W/Contrast Material (70549) |
$933 |
$1,866 |
2.7× |
| MRA neck w/o contrast (70547) |
$897 |
$1,794 |
3.7× |
| MRI abdomen w contrast (74182) |
$915 |
$1,829 |
2.6× |
| MRI abdomen w/o & w/contrast material (74183) |
$1,040 |
$2,079 |
3.0× |
| MRI abdomen w/o contrast (74181) |
$897 |
$1,794 |
3.7× |
| MRI any jnt lwr ext with con lt (73722) |
$897 |
$1,794 |
1.1× |
| MRI any jt upper extremity w/contrast matrl (73222) |
$1,038 |
$2,075 |
1.3× |
| MRI c-spine with contrast (72142) |
$915 |
$1,830 |
2.6× |
| MRI cervical spine w/o contrast (72141) |
$897 |
$1,794 |
3.7× |
| MRI Forearm w/ Contrast Bilateral 73219 (73219) |
$915 |
$1,829 |
2.6× |
| MRI lower extrem oth/thn jt w/contrast matrl (73719) |
$915 |
$1,829 |
2.6× |
| MRI lower extrem oth/thn jt w/o contr matrl (73718) |
$897 |
$1,794 |
3.7× |
| MRI orbit face &/neck w/o contrast (70540) |
$897 |
$1,794 |
3.7× |
| MRI orbit/face/neck w&w/o cont (70543) |
$1,040 |
$2,079 |
3.0× |
| MRI pelvis w contrast (72196) |
$897 |
$1,794 |
2.6× |
| MRI pelvis w/o & w/contrast material (72197) |
$1,040 |
$2,079 |
3.0× |
| MRI pelvis w/o contrast (72195) |
$897 |
$1,794 |
3.7× |
| MRI scan of arm joint before and after contrast (73223) |
$932 |
$1,863 |
2.7× |
| MRI scan of leg joint before and after contrast (73723) |
$1,040 |
$2,079 |
3.0× |
| MRI spinal canal cervical w/o & w/contr matrl (72156) |
$1,559 |
$3,118 |
4.4× |
| MRI spinal canal lumbar w/contrast material (72149) |
$928 |
$1,855 |
2.6× |
| MRI spinal canal lumbar w/o & w/contr matrl (72158) |
$1,561 |
$3,122 |
4.5× |
| MRI spinal canal thoracic w/contrast matrl (72147) |
$915 |
$1,830 |
2.6× |
| MRI spinal canal thoracic w/o & w/contr matrl (72157) |
$1,559 |
$3,118 |
4.4× |
| MRI thoracic spine w/o contrast (72146) |
$883 |
$1,766 |
3.7× |
| MRI upper ext joint w/o contrast (73221) |
$897 |
$1,794 |
3.7× |
| MRI upper extrem other than jt w/o & w/contras (73220) |
$1,040 |
$2,079 |
3.0× |
| MRI upper extremity oth than jt w/o contr matrl (73218) |
$897 |
$1,794 |
3.7× |
| Myocardial Spect Multiple Studies (78452) |
$1,844 |
$3,688 |
1.4× |
| Neck soft tissue (70360) |
$94 |
$187 |
1.1× |
| Nm gastric emptying study (78264) |
$530 |
$1,060 |
1.3× |
| Ob Us Follow-Up Per Fetus - Us Ob Follow Up Transabdominal Approach (76816) |
$86 |
$171 |
0.8× |
| Parathyrd planar w/wo subtrj (78071) |
$505 |
$1,009 |
1.3× |
| Parathyroid imaging (78070) |
$439 |
$878 |
1.1× |
| Pelvis 1 or 2 views (72170) |
$169 |
$338 |
1.6× |
| Pr MRI, lower extr, w/o contrast f/u by contrast (73720) |
$1,040 |
$2,079 |
3.0× |
| Pulmonary Ventilation & Perfusion Imaging (78582) |
$684 |
$1,367 |
1.3× |
| Radex Entir Thrc Lmbr Crv Sac Spi W/Skull 1 Vw - Xr Scoliosis 1 Vw (72081) |
$94 |
$187 |
1.1× |
| Radex hips bilateral with pelvis 2 views (73521) |
$169 |
$338 |
1.6× |
| Radex mastoids compl minimum 3 views pr side (70130) |
$169 |
$338 |
1.6× |
| Radiolog exam mandible compl minimum 4 views (70110) |
$169 |
$338 |
1.6× |
| Radiologic Exam Abdomen 1 View - Xr Abdomen 1 View (74018) |
$94 |
$187 |
1.1× |
| Radiologic Exam Chest 2 Views - Xr Chest 2 Views (71046) |
$122 |
$244 |
1.4× |
| Radiologic Examination Femur Minimum 2 Views - Xr Femur 2+ Vw Lt (73552) |
$94 |
$187 |
1.1× |
| Radiological examination surgical specimen (76098) |
$746 |
$1,492 |
1.4× |
| Ribs bilateral 3 views (71110) |
$169 |
$338 |
1.6× |
| Rp loclzj tum plnr 2+area 1+d img/1 area img>2+d (78801) |
$413 |
$825 |
1.0× |
| Rp loclzj tum plnr whole body single day imaging (78802) |
$1,420 |
$2,839 |
2.6× |
| Rp loclzj tum spect 1 area single day imaging (78803) |
$979 |
$1,957 |
1.8× |
| Scanogram (77073) |
$140 |
$280 |
1.3× |
| Scapula complete (73010) |
$169 |
$338 |
1.6× |
| Screening digital breast tomosynthesis (77063) |
$92 |
$183 |
3.9× |
| Small bowel series (74250) |
$170 |
$340 |
1.0× |
| Thyroid Imaging With Vascular Flow (78013) |
$417 |
$834 |
1.0× |
| Thyroid Uptake W/Blood Flow Sngle/Mult Quan Meas (78014) |
$530 |
$1,060 |
1.3× |
| Ultrasound, abdomen limited (76705) |
$194 |
$388 |
1.8× |
| Urethrocystography retrograde rs&i (74450) |
$290 |
$579 |
1.2× |
| Urography (pyelography), intravenous, with or without KUB, with or without tomography (74400) |
$299 |
$597 |
1.7× |
| Us abdl aorta screen aaa (76706) |
$142 |
$283 |
1.4× |
| Us breast unilateral complete (76641) |
$169 |
$338 |
1.6× |
| Us breast unilateral limited (76642) |
$169 |
$338 |
1.9× |
| Us chest (76604) |
$169 |
$338 |
1.6× |
| Us ob transvaginal (76817) |
$119.50 |
$238.50 |
1.1× |
| Us pelvic non ob complete (76856) |
$126 |
$252 |
1.2× |
| Us pelvic nonobstetric image dcmtn limited/f/u (76857) |
$61 |
$121 |
0.6× |
| Us pregnancy ltd (76815) |
$102 |
$203.50 |
1.0× |
| Us pregnant uterus 14 wk transabdl 1/1st gestat (76801) |
$93 |
$185 |
0.9× |
| Us retroperitoneal complete (76770) |
$169 |
$338 |
1.6× |
| Us scrotum and contents (76870) |
$169 |
$338 |
1.6× |
| Us soft tissue head/neck (76536) |
$169 |
$338 |
1.6× |
| Us transrectal (76872) |
$140 |
$280 |
1.3× |
| Us transrectal prostate volume (76873) |
$154 |
$308 |
1.5× |
| Us xtr non-vasc lmtd (76882) |
$169 |
$338 |
1.6× |
| Wrist 2 views (73100) |
$94 |
$187 |
1.1× |
| X-Ray Abdomen,Comp Acute Series - Xr Abdomen 2 Vws With Chest 1 View (74022) |
$169 |
$338 |
1.6× |
| X-Ray Ac Jts - Xr Acromioclavicular Joints Bilateral (73050) |
$94 |
$187 |
1.1× |
| X-Ray Ankle 3+ Vw - Xr Ankle 3+ Views Right (73610) |
$94 |
$187 |
1.1× |
| X-Ray Elbow 2 Vw - Xr Elbow 1-2 Views Right (73070) |
$94 |
$187 |
1.1× |
| X-ray exam hip uni 1 view (73501) |
$108 |
$215 |
1.2× |
| X-Ray Exam Hip Uni 2-3 Views (73502) |
$108 |
$215 |
1.2× |
| X-Ray Facial Bones 3+ Vw - Xr Facial Bones 3+ Views (70150) |
$169 |
$338 |
1.6× |
| X-Ray Foot 3+ Vw - Xr Foot 3+ Views Right (73630) |
$94 |
$187 |
1.1× |
| X-Ray Heel - Xr Calcaneus 2 Views Right (73650) |
$94 |
$187 |
1.1× |
| X-Ray Knee 4+ View - Xr Knee 4+ Views Right (73564) |
$169 |
$338 |
1.6× |
| X-Ray Lumbar Spine 2/3 Vw - Xr Lumbar Spine 2-3 Views (72100) |
$194 |
$388 |
1.8× |
| X-Ray Lumbar Spine 6+ Vw - Xr Lumbar Spine 6+ Vws Including Bending (72114) |
$219 |
$438 |
2.1× |
| X-Ray Nasal Bones - Xr Nasal Bones (70160) |
$94 |
$187 |
1.1× |
| X-Ray Pelvis 3+ Vw - Xr Pelvis 3+ Views (72190) |
$219 |
$438 |
2.1× |
| X-Ray Retrograde Pyelogram - Fl Pyelogram Retrograde (74420) |
$539 |
$1,077 |
1.5× |
| X-Ray Ribs 2 Vw Unilat - Xr Ribs 2 Views Right (71100) |
$94 |
$187 |
1.1× |
| X-Ray Sacroiliac Jts 3+ Vw - Xr Sacroiliac Joints 3+ Views (72202) |
$169 |
$338 |
1.6× |
| X-Ray Sacrum/Coccyx 2+ Vw - Xr Sacrum Coccyx 2+ Views (72220) |
$94 |
$187 |
1.1× |
| X-Ray Shoulder 2+ Vw - Xr Shoulder 2+ Views Right (73030) |
$108 |
$215 |
1.2× |
| X-Ray Sinuses 3+ Vw - Xr Paranasal Sinuses 3+ Views (70220) |
$106 |
$212 |
1.2× |
| X-Ray Sinuses <3 Vw - Xr Paranasal Sinuses 1-2 Views (70210) |
$94 |
$187 |
1.1× |
| X-Ray Skull 4+ Vw - Xr Skull Complete 4+ Views (70260) |
$169 |
$338 |
1.6× |
| X-Ray Skull <4 Vw - Xr Skull 1-3 Views (70250) |
$169 |
$338 |
1.6× |
| X-Ray Sternum 2+ Vw - Xr Sternum 2+ Views (71120) |
$94 |
$187 |
1.1× |
| X-Ray Thoracic Spine 2 Vw - Xr Thoracic Spine 2 Views (72070) |
$169 |
$338 |
1.6× |
| X-Ray Toe(S) - Xr Toes 2+ Views Right (73660) |
$94 |
$187 |
1.1× |
| X-Ray Wrist 3+ Vw - Xr Wrist 3+ Views Right (73110) |
$126 |
$251 |
1.4× |
| Xr c-spine 6 or more views (72052) |
$169 |
$338 |
1.6× |
| Xr chest 4+ views (71048) |
$169 |
$338 |
1.6× |
| Xr finger(s) 2+ views (73140) |
$94 |
$187 |
1.1× |
| Xr shoulder 1 view (73020) |
$94 |
$187 |
1.1× |
| Xr spine cervical 4 or 5 views (72050) |
$169 |
$338 |
1.6× |
| Xr tibia/fibula 2 views (73590) |
$94 |
$187 |
1.1× |
| Xr tmj bilateral (70330) |
$93 |
$185 |
1.1× |
| Xray knee 1 or 2 views rt (73560) |
$94 |
$187 |
1.1× |