| Abdomen 2 views (74019) |
$267 |
$534 |
2.4× |
| Acute gastrointestinal blood loss imaging (78278) |
$1,157.50 |
$2,315 |
2.7× |
| Ankle 2 views (73600) |
$177.75 |
$355.50 |
1.9× |
| Arthrogram shoulder (73040) |
$972.50 |
$1,945 |
2.6× |
| Arthrogram wrist (73115) |
$972.50 |
$1,945 |
2.6× |
| Bone &/joint imaging whole body (78306) |
$1,305.25 |
$2,610.50 |
3.1× |
| Bone age studies (77072) |
$148 |
$296 |
1.3× |
| Bone Imaging 3 Phase (78315) |
$1,453.50 |
$2,907 |
3.4× |
| Bone survey complete (77075) |
$949.25 |
$1,898.50 |
8.6× |
| Cervical spine 2 or 3 views (72040) |
$237.25 |
$474.50 |
2.6× |
| Chest 1 view (71045) |
$148 |
$296 |
1.6× |
| Cine/Vid X-Ray Throat/Esoph - Fl Esoph Barium Swlw W/ Video & Speech (74230) |
$608 |
$1,216 |
3.3× |
| Clavicle complete (73000) |
$177.75 |
$355.50 |
1.9× |
| Computed Tomography Thorax Lw Dose Lng Ca Scr C- (71271) |
$148 |
$296 |
1.3× |
| CT abdomen and pelvis without and with contrast (74178) |
$2,514.25 |
$5,028.50 |
6.8× |
| CT abdomen and pelvis without contrast (74176) |
$1,661 |
$3,322 |
6.6× |
| CT abdomen w contrast (74160) |
$1,476 |
$2,952 |
8.0× |
| CT abdomen w wo contrast (74170) |
$1,683.50 |
$3,367 |
9.1× |
| CT abdomen w/o contrast (74150) |
$1,097.75 |
$2,195.50 |
10.0× |
| CT angiography upper extremity lt (73206) |
$1,664.50 |
$3,329 |
9.0× |
| CT c-spine w/o contrast (72125) |
$1,127 |
$2,254 |
10.2× |
| CT cervical spine with contrast (72126) |
$1,481.50 |
$2,963 |
4.0× |
| CT chest w/wo contrast (71270) |
$1,664.50 |
$3,329 |
9.0× |
| CT chest with contrast (71260) |
$1,446.25 |
$2,892.50 |
7.8× |
| CT head/brain with contrast (70460) |
$1,387.25 |
$2,774.50 |
7.5× |
| CT head/brain without and with contrast (70470) |
$1,603.50 |
$3,207 |
8.7× |
| CT heart no contrast quant eval coronry calcium (75571) |
$119 |
$238 |
1.3× |
| CT lower ext w/o (73700) |
$1,068 |
$2,136 |
9.7× |
| CT lower extremity w wo contrast (73702) |
$1,512 |
$3,024 |
8.2× |
| CT lower extremity with contrast (73701) |
$1,357.50 |
$2,715 |
7.3× |
| CT lumbar spine w & w/o contrast (72133) |
$1,585 |
$3,170 |
8.6× |
| CT lumbar spine w/o contrast (72131) |
$1,127 |
$2,254 |
10.2× |
| CT lumbar spine with contrast (72132) |
$1,446.25 |
$2,892.50 |
3.9× |
| CT maxillofacial w contrast (70487) |
$1,209 |
$2,418 |
6.5× |
| CT maxillofacial w/o contrast (70486) |
$949.25 |
$1,898.50 |
8.6× |
| CT maxillofacial w/wo contrast (70488) |
$1,360.50 |
$2,721 |
7.4× |
| CT neck soft tissue w contrast (70491) |
$1,446.25 |
$2,892.50 |
7.8× |
| CT orbit sella/post fossa/ear w/o & w/contr matr (70482) |
$1,473.50 |
$2,947 |
8.0× |
| CT orbits w/o contrast (70480) |
$1,127 |
$2,254 |
10.2× |
| CT pelvis w & w/o contrast (72194) |
$1,566 |
$3,132 |
8.5× |
| CT pelvis w/o contrast (72192) |
$1,127 |
$2,254 |
10.2× |
| CT soft tissue neck w/o & w/contrast material (70492) |
$1,624.75 |
$3,249.50 |
8.8× |
| CT soft tissue neck w/o contrast (70490) |
$1,154.50 |
$2,309 |
10.5× |
| CT thoracic spine w/contrast (72129) |
$1,481.50 |
$2,963 |
8.0× |
| CT thoracic spine w/o contrast (72128) |
$1,127 |
$2,254 |
10.2× |
| CT thorax w/o contrast (71250) |
$1,127 |
$2,254 |
10.2× |
| CT upper extremity w/o & w/contrast material (73202) |
$1,512 |
$3,024 |
8.2× |
| CT upper extremity w/o contrast rt (73200) |
$1,068 |
$2,136 |
9.7× |
| CT upper extremity with contrast (73201) |
$1,299.75 |
$2,599.50 |
3.5× |
| Cta Abdl Aorta&Bi Iliofem W/Contrast&Postp (75635) |
$1,921.25 |
$3,842.50 |
10.4× |
| Cta Abdomen (74175) |
$1,505.75 |
$3,011.50 |
8.1× |
| CTA abdomen pelvis (74174) |
$2,811 |
$5,622 |
7.6× |
| CTA chest (71275) |
$1,713.25 |
$3,426.50 |
9.3× |
| Cta Head (70496) |
$1,565.25 |
$3,130.50 |
8.5× |
| CTA lwr ext w&w/o contrast (73706) |
$1,743 |
$3,486 |
9.4× |
| Cta Neck (70498) |
$1,565.25 |
$3,130.50 |
8.5× |
| Cystography minimum 3 views rs&i (74430) |
$486 |
$972 |
1.3× |
| Dxa bone density study 1/> sites axial skel (77080) |
$237.25 |
$474.50 |
2.2× |
| Echoencephalography real time imaging (76506) |
$415.25 |
$830.50 |
3.8× |
| Esophagus (74220) |
$534 |
$1,068 |
2.9× |
| Fetal biophysical profile non-stress testing (76818) |
$486 |
$972 |
4.4× |
| Fluoroscopy up to 1 hr (76000) |
$334.50 |
$669 |
1.3× |
| Foot 2 views (73620) |
$177.75 |
$355.50 |
1.9× |
| Forearm 2 views (73090) |
$177.75 |
$355.50 |
1.9× |
| Hand 2 views (73120) |
$206.75 |
$413.50 |
1.9× |
| Hand 3 views (73130) |
$251.75 |
$503.50 |
2.7× |
| Hepatobil Syst Imag Inc Gb W/Pharma Intervenj (78227) |
$1,423.75 |
$2,847.50 |
2.5× |
| Hepatobiliary syst imaging including gallbladder (78226) |
$1,299.75 |
$2,599.50 |
3.1× |
| Ht muscle image spect sing (78451) |
$1,582 |
$3,164 |
1.2× |
| Humerus Min 2 Views Left (73060) |
$177.75 |
$355.50 |
1.9× |
| Hysterosalpingogram (74740) |
$711.75 |
$1,423.50 |
2.8× |
| Kidney Img Morphology Vascular Flow Multiple (78709) |
$1,350 |
$2,700 |
2.4× |
| Knee 3 views (73562) |
$266.25 |
$532.50 |
2.9× |
| Lung perf&ventilat diferentl (78598) |
$2,218.50 |
$4,437 |
3.9× |
| Lung Ventilation Imaging (78579) |
$810.50 |
$1,621 |
1.9× |
| Meckels Diverticulum (78290) |
$881.50 |
$1,763 |
2.1× |
| Mr safety implant&/fb assmt clin staf 1st 15 min (76014) |
$38.50 |
$77 |
1.3× |
| MRA head w/o contrast (70544) |
$1,645.25 |
$3,290.50 |
6.5× |
| MRA neck w contrast (70548) |
$1,551 |
$3,102 |
4.2× |
| Mra Neck W/O &W/Contrast Material (70549) |
$2,089.50 |
$4,179 |
5.7× |
| MRA neck w/o contrast (70547) |
$1,641 |
$3,282 |
6.5× |
| MRI abdomen w contrast (74182) |
$2,332.50 |
$4,665 |
6.3× |
| MRI abdomen w/o & w/contrast material (74183) |
$2,396 |
$4,792 |
6.5× |
| MRI abdomen w/o contrast (74181) |
$1,957.75 |
$3,915.50 |
7.8× |
| MRI any jnt lwr ext with con lt (73722) |
$2,217.50 |
$4,435 |
2.7× |
| MRI any jt upper extremity w/contrast matrl (73222) |
$2,039.75 |
$4,079.50 |
2.5× |
| MRI breast w/o contrast bilateral (77047) |
$1,884 |
$3,768 |
7.5× |
| MRI c-spine with contrast (72142) |
$1,943 |
$3,886 |
5.3× |
| MRI cervical spine w/o contrast (72141) |
$1,602 |
$3,204 |
6.4× |
| MRI chest w/o & w/contrast material (71552) |
$2,393.50 |
$4,787 |
6.5× |
| MRI chest w/o contrast (71550) |
$1,641 |
$3,282 |
6.5× |
| MRI lower extrem oth/thn jt w/o contr matrl (73718) |
$1,602 |
$3,204 |
6.4× |
| MRI orbit face &/neck w/o contrast (70540) |
$1,641 |
$3,282 |
6.5× |
| MRI orbit/face/neck w&w/o cont (70543) |
$2,336.50 |
$4,673 |
6.3× |
| MRI orbit/face/neck w/contrast (70542) |
$1,500.50 |
$3,001 |
4.1× |
| MRI pelvis w/o & w/contrast material (72197) |
$2,336.50 |
$4,673 |
6.3× |
| MRI pelvis w/o contrast (72195) |
$1,602 |
$3,204 |
6.4× |
| MRI scan of arm joint before and after contrast (73223) |
$2,336.50 |
$4,673 |
6.3× |
| MRI scan of leg joint before and after contrast (73723) |
$2,336.50 |
$4,673 |
6.3× |
| MRI spinal canal cervical w/o & w/contr matrl (72156) |
$2,336.50 |
$4,673 |
6.3× |
| MRI spinal canal lumbar w/contrast material (72149) |
$2,089.50 |
$4,179 |
5.7× |
| MRI spinal canal lumbar w/o & w/contr matrl (72158) |
$2,336.50 |
$4,673 |
6.3× |
| MRI spinal canal thoracic w/o & w/contr matrl (72157) |
$2,336.50 |
$4,673 |
6.3× |
| MRI thoracic spine w/o contrast (72146) |
$1,602 |
$3,204 |
6.4× |
| MRI tmj (70336) |
$1,641 |
$3,282 |
6.5× |
| MRI upper ext joint w/o contrast (73221) |
$1,602 |
$3,204 |
6.4× |
| MRI upper extrem other than jt w/o & w/contras (73220) |
$2,336.50 |
$4,673 |
6.3× |
| MRI upper extremity oth than jt w/o contr matrl (73218) |
$1,602 |
$3,204 |
6.4× |
| Myelogram Cervical (72240) |
$972.50 |
$1,945 |
1.2× |
| Myelogram Lumbar (72265) |
$949.25 |
$1,898.50 |
1.1× |
| Myocardial Spect Multiple Studies (78452) |
$2,818.25 |
$5,636.50 |
2.1× |
| Neck soft tissue (70360) |
$237.25 |
$474.50 |
2.6× |
| Nm gastric emptying study (78264) |
$1,290.50 |
$2,581 |
3.1× |
| Nuclear medicine study of kidney and blood flow (78701) |
$723.50 |
$1,447 |
1.7× |
| Ob Us Follow-Up Per Fetus - Us Ob Follow Up Transabdominal Approach (76816) |
$167 |
$334 |
1.5× |
| Osseous survey infant (77076) |
$661.50 |
$1,323 |
6.0× |
| Parathyroid imaging (78070) |
$1,186.50 |
$2,373 |
2.8× |
| Pelvis 1 or 2 views (72170) |
$237.25 |
$474.50 |
2.2× |
| Pr MRI, lower extr, w/o contrast f/u by contrast (73720) |
$2,336.50 |
$4,673 |
6.3× |
| Pulmonary Ventilation & Perfusion Imaging (78582) |
$2,165.25 |
$4,330.50 |
3.8× |
| Radex Entir Thrc Lmbr Crv Sac Spi W/Skull 1 Vw - Xr Scoliosis 1 Vw (72081) |
$356.25 |
$712.50 |
3.9× |
| Radiolog exam mandible compl minimum 4 views (70110) |
$356.25 |
$712.50 |
3.2× |
| Radiologic Exam Abdomen 1 View - Xr Abdomen 1 View (74018) |
$237.25 |
$474.50 |
2.6× |
| Radiologic Exam Chest 2 Views - Xr Chest 2 Views (71046) |
$173.50 |
$347 |
1.9× |
| Radiologic exam colon single contrast study (74270) |
$652.50 |
$1,305 |
3.5× |
| Radiologic exam upr gi trc double contrast study (74246) |
$593.50 |
$1,187 |
3.2× |
| Radiologic Examination Femur Minimum 2 Views - Xr Femur 2+ Vw Lt (73552) |
$182 |
$364 |
2.0× |
| Radiological examination surgical specimen (76098) |
$212.50 |
$425 |
0.4× |
| Ribs bilateral 3 views (71110) |
$296.75 |
$593.50 |
2.7× |
| Sacroiliac Joints < 3 Views (72200) |
$237.25 |
$474.50 |
2.2× |
| Saline Infus Sonohysterography W/Color Doppler (76831) |
$334.50 |
$669 |
1.3× |
| Scanogram (77073) |
$267 |
$534 |
2.4× |
| Scapula complete (73010) |
$177.75 |
$355.50 |
1.6× |
| Screening digital breast tomosynthesis (77063) |
$38.50 |
$77 |
1.6× |
| Small bowel series (74250) |
$504.25 |
$1,008.50 |
2.7× |
| Spine thoracic 3 views (72072) |
$296.75 |
$593.50 |
2.7× |
| Thoracolumbar 2 views (72080) |
$237.25 |
$474.50 |
2.6× |
| Thyroid Uptake W/Blood Flow Sngle/Mult Quan Meas (78014) |
$2,165.25 |
$4,330.50 |
5.1× |
| Ultrasound, abdomen limited (76705) |
$415.25 |
$830.50 |
3.8× |
| Unlisted Diagnostic Radiographic Procedure (76499) |
$66.50 |
$133 |
0.7× |
| Upper Extremity Infant (73092) |
$182 |
$364 |
1.7× |
| Urethrocystography voiding (74455) |
$547 |
$1,094 |
2.2× |
| Urography (pyelography), intravenous, with or without KUB, with or without tomography (74400) |
$665.50 |
$1,331 |
3.6× |
| Us abdl aorta screen aaa (76706) |
$192.75 |
$385.50 |
1.7× |
| Us breast unilateral complete (76641) |
$608 |
$1,216 |
5.5× |
| Us breast unilateral limited (76642) |
$198.50 |
$397 |
2.2× |
| Us chest (76604) |
$504.25 |
$1,008.50 |
4.6× |
| Us compl joint r-t w/image documentation (76881) |
$296.75 |
$593.50 |
2.7× |
| Us elastography parenchyma (76981) |
$282 |
$564 |
2.6× |
| Us infant hips dynamic (76885) |
$296.75 |
$593.50 |
3.2× |
| Us ob transvaginal (76817) |
$173.50 |
$347 |
1.6× |
| Us pelvic non ob complete (76856) |
$356.25 |
$712.50 |
3.2× |
| Us pelvic nonobstetric image dcmtn limited/f/u (76857) |
$296.75 |
$593.50 |
2.7× |
| Us pregnancy ltd (76815) |
$296.75 |
$593.50 |
2.7× |
| Us pregnant uterus 14 wk transabdl 1/1st gestat (76801) |
$385.50 |
$771 |
3.5× |
| Us retroperitoneal complete (76770) |
$415.25 |
$830.50 |
3.8× |
| Us retroperitoneal limited (76775) |
$415.25 |
$830.50 |
3.8× |
| Us scrotum and contents (76870) |
$415.25 |
$830.50 |
3.8× |
| Us soft tissue head/neck (76536) |
$492 |
$984 |
4.5× |
| Us spinal canal and contents (76800) |
$356.25 |
$712.50 |
3.2× |
| Wrist 2 views (73100) |
$206.75 |
$413.50 |
2.3× |
| X-Ray Abdomen,Comp Acute Series - Xr Abdomen 2 Vws With Chest 1 View (74022) |
$326.50 |
$653 |
3.0× |
| X-Ray Ac Jts - Xr Acromioclavicular Joints Bilateral (73050) |
$237.25 |
$474.50 |
2.6× |
| X-Ray Ankle 3+ Vw - Xr Ankle 3+ Views Right (73610) |
$237.25 |
$474.50 |
2.6× |
| X-Ray Colon Air Contrast - Fl Barium Enema Air Contrast (74280) |
$790 |
$1,580 |
4.3× |
| X-Ray Elbow 2 Vw - Xr Elbow 1-2 Views Right (73070) |
$177.75 |
$355.50 |
1.9× |
| X-Ray Elbow 3+ Vw - Xr Elbow 3+ Views Right (73080) |
$237.25 |
$474.50 |
2.6× |
| X-ray exam hip uni 1 view (73501) |
$148 |
$296 |
1.6× |
| X-Ray Exam Hip Uni 2-3 Views (73502) |
$237.25 |
$474.50 |
2.6× |
| X-ray eye for foreign body (70030) |
$135.25 |
$270.50 |
1.5× |
| X-Ray Facial Bones 3+ Vw - Xr Facial Bones 3+ Views (70150) |
$326.50 |
$653 |
3.0× |
| X-Ray Facial Bones <3 Vw - Xr Facial Bones 1-2 Views (70140) |
$237.25 |
$474.50 |
2.6× |
| X-Ray Foot 3+ Vw - Xr Foot 3+ Views Right (73630) |
$237.25 |
$474.50 |
2.6× |
| X-Ray Heel - Xr Calcaneus 2 Views Right (73650) |
$177.75 |
$355.50 |
1.9× |
| X-Ray Jaw <4 Vw - Xr Mandible < 4 Views (70100) |
$318 |
$636 |
3.5× |
| X-Ray Knee 4+ View - Xr Knee 4+ Views Right (73564) |
$267 |
$534 |
2.4× |
| X-Ray Knee Bilat Standing - Xr Knees Anteroposterior Standing Bilat (73565) |
$148 |
$296 |
1.6× |
| X-Ray Leg, Infant - Xr Lower Extremity 2+ Views Infant Left (73592) |
$177.75 |
$355.50 |
1.9× |
| X-Ray Lumbar Spine 2/3 Vw - Xr Lumbar Spine 2-3 Views (72100) |
$243 |
$486 |
2.2× |
| X-Ray Lumbar Spine 6+ Vw - Xr Lumbar Spine 6+ Vws Including Bending (72114) |
$296.75 |
$593.50 |
2.7× |
| X-Ray Nasal Bones - Xr Nasal Bones (70160) |
$326.50 |
$653 |
3.6× |
| X-Ray Nose-Rectum Child F.B. - Xr Nose to Rectum Foreign Body Peds (76010) |
$148 |
$296 |
1.6× |
| X-Ray Orbits - Xr Orbits Complete 4+ Views (70200) |
$243 |
$486 |
2.2× |
| X-Ray Ribs 2 Vw Unilat - Xr Ribs 2 Views Right (71100) |
$273.50 |
$547 |
3.0× |
| X-Ray Ribs, Chest 3+ Vw - Xr Ribs 2 Vws Lt W/ Chest Anteroposterior (71101) |
$326.50 |
$653 |
3.0× |
| X-Ray Ribs, Chest 4+ Vw - Xr Ribs 3 Vws Bil W/ Chest Posteroanterior (71111) |
$356.25 |
$712.50 |
3.2× |
| X-Ray Sacrum/Coccyx 2+ Vw - Xr Sacrum Coccyx 2+ Views (72220) |
$237.25 |
$474.50 |
2.6× |
| X-Ray Shoulder 2+ Vw - Xr Shoulder 2+ Views Right (73030) |
$237.25 |
$474.50 |
2.6× |
| X-Ray Sinuses 3+ Vw - Xr Paranasal Sinuses 3+ Views (70220) |
$243 |
$486 |
2.6× |
| X-Ray Skull 4+ Vw - Xr Skull Complete 4+ Views (70260) |
$385.50 |
$771 |
3.5× |
| X-Ray Skull <4 Vw - Xr Skull 1-3 Views (70250) |
$237.25 |
$474.50 |
2.2× |
| X-Ray Spine One View - Xr Spine (72020) |
$207.50 |
$415 |
2.3× |
| X-Ray Sternum 2+ Vw - Xr Sternum 2+ Views (71120) |
$237.25 |
$474.50 |
2.6× |
| X-Ray Thoracic Spine 2 Vw - Xr Thoracic Spine 2 Views (72070) |
$237.25 |
$474.50 |
2.2× |
| X-Ray Toe(S) - Xr Toes 2+ Views Right (73660) |
$177.75 |
$355.50 |
1.9× |
| X-Ray Wrist 3+ Vw - Xr Wrist 3+ Views Right (73110) |
$251.75 |
$503.50 |
2.7× |
| Xr c-spine 6 or more views (72052) |
$296.75 |
$593.50 |
2.7× |
| Xr chest 4+ views (71048) |
$243 |
$486 |
2.2× |
| Xr finger(s) 2+ views (73140) |
$177.75 |
$355.50 |
1.9× |
| Xr shoulder 1 view (73020) |
$148 |
$296 |
1.6× |
| Xr spine cervical 4 or 5 views (72050) |
$296.75 |
$593.50 |
2.7× |
| Xr tibia/fibula 2 views (73590) |
$177.75 |
$355.50 |
1.9× |
| Xr tmj bilateral (70330) |
$356.25 |
$712.50 |
3.9× |
| Xray knee 1 or 2 views rt (73560) |
$177.75 |
$355.50 |
1.9× |