| Abdomen 2 views (74019) |
$210.25 |
$420.50 |
2.1× |
| Acute gi blood loss imaging (78278) |
$681.50 |
$1,363 |
1.8× |
| Ankle 2 views (73600) |
$130.25 |
$260.50 |
1.6× |
| Bone &/Joint Imaging Limited Area (78300) |
$430.50 |
$861 |
1.1× |
| Bone &/joint imaging whole body (78306) |
$714.50 |
$1,429 |
1.9× |
| Bone age studies (77072) |
$141.50 |
$283 |
1.4× |
| Bone Imaging 3 Phase (78315) |
$732.50 |
$1,465 |
1.9× |
| Bone survey complete (77075) |
$207 |
$414 |
2.1× |
| Bone survey infant (77076) |
$117 |
$234 |
1.2× |
| Bowel imaging (78290) |
$526 |
$1,052 |
1.4× |
| Card Bpi Gtd =Brm Plnr 1 Std Rest/Strs (78472) |
$738.50 |
$1,477 |
1.9× |
| Cervical spine 2 or 3 views (72040) |
$142 |
$284 |
1.7× |
| Chest 1 view (71045) |
$138 |
$276 |
1.7× |
| Chest xray 3 views (71047) |
$112 |
$224 |
1.3× |
| Cine/Vid X-Ray Throat/Esoph - Fl Esoph Barium Swlw W/ Video & Speech (74230) |
$320 |
$640 |
1.9× |
| Clavicle complete (73000) |
$155.50 |
$311 |
1.9× |
| Computed Tomography Thorax Lw Dose Lng Ca Scr C- (71271) |
$120 |
$240 |
1.2× |
| CT abdomen and pelvis without and with contrast (74178) |
$2,348 |
$4,696 |
7.0× |
| CT abdomen and pelvis without contrast (74176) |
$1,806.25 |
$3,612.50 |
7.9× |
| CT abdomen w contrast (74160) |
$964.75 |
$1,929.50 |
5.7× |
| CT abdomen w wo contrast (74170) |
$1,102.50 |
$2,205 |
6.6× |
| CT abdomen w/o contrast (74150) |
$919.50 |
$1,839 |
9.2× |
| CT angio lwr extr w/o&w/dye (73706) |
$1,027.50 |
$2,055 |
6.1× |
| CT angiography upper extremity lt (73206) |
$917.50 |
$1,835 |
5.5× |
| CT c-spine w/contrast (72126) |
$862.50 |
$1,725 |
2.6× |
| CT c-spine w/o contrast (72125) |
$889.25 |
$1,778.50 |
8.9× |
| CT cere prfu aly c+wo CT/CTA (70473) |
$1,753.50 |
$3,507 |
10.4× |
| CT chest w contrast (71260) |
$993.25 |
$1,986.50 |
5.9× |
| CT chest w/wo contrast (71270) |
$1,148.75 |
$2,297.50 |
6.8× |
| CT head/brain with contrast (70460) |
$784.50 |
$1,569 |
4.7× |
| CT head/brain without and with contrast (70470) |
$964.75 |
$1,929.50 |
5.7× |
| CT heart contrast eval cardiac structure&morph (75572) |
$251.50 |
$503 |
0.8× |
| CT heart w/o contrast quant eval coronary calcium (75571) |
$99 |
$198 |
1.2× |
| CT iac w contrast (70481) |
$763.25 |
$1,526.50 |
4.5× |
| CT lower ext w/o (73700) |
$837.50 |
$1,675 |
8.4× |
| CT lower extremity w wo contrast (73702) |
$835.50 |
$1,671 |
5.0× |
| CT lower extremity w/contrast material (73701) |
$1,115 |
$2,230 |
6.6× |
| CT lumbar spine w & w/o contrast (72133) |
$1,027.50 |
$2,055 |
6.1× |
| CT lumbar spine w/contrast (72132) |
$884.25 |
$1,768.50 |
2.6× |
| CT lumbar spine w/o contrast (72131) |
$889.25 |
$1,778.50 |
8.9× |
| CT maxillofacial w contrast (70487) |
$719.25 |
$1,438.50 |
4.3× |
| CT maxillofacial w/wo contrast (70488) |
$805.25 |
$1,610.50 |
4.8× |
| CT maxillofacial wo contrast (70486) |
$674.50 |
$1,349 |
6.7× |
| CT orbit sella/post fossa/ear w/o & w/contr matr (70482) |
$862.50 |
$1,725 |
5.1× |
| CT orbits w/o contrast (70480) |
$656 |
$1,312 |
6.5× |
| CT pelvis w/o contrast (72192) |
$815.50 |
$1,631 |
8.1× |
| CT pelvis w/wo contrast (72194) |
$1,027.50 |
$2,055 |
6.1× |
| CT scan of arm combo (73202) |
$725.50 |
$1,451 |
4.3× |
| CT soft tissue neck w contrast (70491) |
$919.50 |
$1,839 |
5.5× |
| CT soft tissue neck w/o & w/contrast material (70492) |
$940.50 |
$1,881 |
5.6× |
| CT soft tissue neck w/o contrast (70490) |
$671 |
$1,342 |
6.7× |
| CT thoracic spine w/contrast (72129) |
$862.50 |
$1,725 |
5.1× |
| CT thoracic spine w/o contrast (72128) |
$889.25 |
$1,778.50 |
8.9× |
| CT thoracic spine w/wo contrast (72130) |
$1,367.25 |
$2,734.50 |
8.1× |
| CT thorax w/o contrast (71250) |
$810.50 |
$1,621 |
8.1× |
| CT upper ext wo (73200) |
$719.25 |
$1,438.50 |
7.2× |
| CT upper extremity with contrast (73201) |
$815.50 |
$1,631 |
2.4× |
| Cta Aa&Bi Iliofem Lxtr Rs&I C-/C+ Post-Pxessing (75635) |
$1,262.25 |
$2,524.50 |
7.5× |
| Cta Abdomen (74175) |
$1,345 |
$2,690 |
8.0× |
| CTA abdomen pelvis (74174) |
$1,481.75 |
$2,963.50 |
4.4× |
| CTA chest (71275) |
$998 |
$1,996 |
5.9× |
| Cta Head (70496) |
$1,053.25 |
$2,106.50 |
6.3× |
| Cta Neck (70498) |
$1,053.25 |
$2,106.50 |
6.3× |
| Cta Pelvis (72191) |
$1,270 |
$2,540 |
7.5× |
| Cystography minimum 3 views rs&i (74430) |
$278.50 |
$557 |
0.8× |
| Dxa bone density study 1/> sites axial skel (77080) |
$310.75 |
$621.50 |
3.1× |
| Dxa bone density study 1/>sites appendiclr skel (77081) |
$117.50 |
$235 |
1.4× |
| Echo exam of eye (76529) |
$82.50 |
$165 |
1.0× |
| Esophagus (74220) |
$221 |
$442 |
1.3× |
| Facial bones min 3 views (70150) |
$203.50 |
$407 |
2.0× |
| Fluoroscopy up to 1 hr (76000) |
$279.50 |
$559 |
1.2× |
| Foot 2 views (73620) |
$130.25 |
$260.50 |
1.6× |
| Forearm 2 views (73090) |
$130.75 |
$261.50 |
1.6× |
| Hand 2 views (73120) |
$123 |
$246 |
1.2× |
| Hepatobil Syst Imag Inc Gb W/Pharma Intervenj (78227) |
$895.50 |
$1,791 |
1.7× |
| Hepatobiliary syst imaging including gallbladder (78226) |
$671.50 |
$1,343 |
1.8× |
| Hysterosalpingogram (74740) |
$273 |
$546 |
1.2× |
| Kidney img morphology vascular flow 1 w/rx (78708) |
$663.25 |
$1,326.50 |
1.3× |
| Knee 3 views (73562) |
$176.50 |
$353 |
2.1× |
| Magnetic resonance (eg, proton) imaging, any joint of upper extremity; with contrast material(s) Non-Facility (73222) |
$1,168 |
$2,336 |
1.6× |
| Magnetic resonance (eg, proton) imaging, upper extremity, other than joint; with contrast material(s) Non-Facility (73219) |
$1,376 |
$2,752 |
4.1× |
| Magnetic resonance (eg, proton) imaging, upper extremity, other than joint; without contrast material(s), followed by… (73220) |
$1,575.75 |
$3,151.50 |
4.7× |
| MRA head w & w/o contrast (70546) |
$1,122 |
$2,244 |
3.4× |
| MRA head w/o contrast (70544) |
$795 |
$1,590 |
3.5× |
| MRA neck w contrast (70548) |
$889.50 |
$1,779 |
2.7× |
| Mra Neck W/O &W/Contrast Material (70549) |
$1,467.50 |
$2,935 |
4.4× |
| MRA neck w/o contrast (70547) |
$815.50 |
$1,631 |
3.6× |
| MRI abdomen w contrast (74182) |
$526.50 |
$1,053 |
1.6× |
| MRI abdomen w/o & w/contrast material (74183) |
$1,733.75 |
$3,467.50 |
5.2× |
| MRI abdomen w/o contrast (74181) |
$1,285.25 |
$2,570.50 |
5.6× |
| MRI any jt lower extrem w/contrast material (73722) |
$1,168 |
$2,336 |
1.6× |
| MRI any jt lower extrem w/o & w/contrast matrl (73723) |
$1,575.75 |
$3,151.50 |
4.7× |
| MRI c-spine with contrast (72142) |
$1,480.50 |
$2,961 |
4.4× |
| MRI cervical spine w/o contrast (72141) |
$1,378.25 |
$2,756.50 |
6.0× |
| MRI chest w/o & w/contrast material (71552) |
$2,161 |
$4,322 |
6.5× |
| MRI chest w/o contrast (71550) |
$1,533.50 |
$3,067 |
6.7× |
| MRI lower extrem oth/thn jt w/o & w/contr matr (73720) |
$1,575.75 |
$3,151.50 |
4.7× |
| MRI lower extrem oth/thn jt w/o contr matrl (73718) |
$1,246 |
$2,492 |
5.4× |
| MRI orbit face &/neck w/o contrast (70540) |
$1,248 |
$2,496 |
5.5× |
| MRI orbit/face/neck w&w/o cont (70543) |
$2,136.75 |
$4,273.50 |
6.4× |
| MRI pelvis w/o & w/contrast material (72197) |
$1,663.75 |
$3,327.50 |
5.0× |
| MRI pelvis w/o contrast (72195) |
$1,195.50 |
$2,391 |
5.2× |
| MRI spinal canal cervical w/o & w/contr matrl (72156) |
$1,786.25 |
$3,572.50 |
5.3× |
| MRI spinal canal lumbar w/contrast material (72149) |
$1,376 |
$2,752 |
4.1× |
| MRI spinal canal lumbar w/o & w/contr matrl (72158) |
$1,981 |
$3,962 |
5.9× |
| MRI spinal canal thoracic w/o & w/contr matrl (72157) |
$1,830 |
$3,660 |
5.5× |
| MRI thoracic spine w/o contrast (72146) |
$1,253.25 |
$2,506.50 |
5.5× |
| MRI up ext w/o contrast (73218) |
$1,265 |
$2,530 |
5.5× |
| MRI upper ext joint w/o contrast (73221) |
$1,313.25 |
$2,626.50 |
5.7× |
| MRI, joint upper extrem combo (73223) |
$1,176.50 |
$2,353 |
3.5× |
| Myocardial Spect Multiple Studies (78452) |
$2,023 |
$4,046 |
1.6× |
| Myocardial spect single study at rest or stress (78451) |
$910 |
$1,820 |
0.7× |
| Neck soft tissue (70360) |
$144.75 |
$289.50 |
1.7× |
| Nm gastric emptying study (78264) |
$732.50 |
$1,465 |
1.9× |
| Nonvascular shunt X-ray (75809) |
$99.50 |
$199 |
1.0× |
| Parathyrd planar w/spect&CT (78072) |
$816 |
$1,632 |
1.6× |
| Parathyroid Planar Imaging (78070) |
$547 |
$1,094 |
1.4× |
| Parathyroid planar imaging w/wo subtraction (78071) |
$636 |
$1,272 |
1.7× |
| Pelvis 1 or 2 views (72170) |
$115.50 |
$231 |
1.2× |
| PET image w/CT, skull-thigh (78815) |
$2,494 |
$4,988 |
1.8× |
| PET imaging for CT attenuation whole body (78816) |
$2,494 |
$4,988 |
1.8× |
| Pulmonary Perfusion Imaging Particulate (78580) |
$413.50 |
$827 |
1.1× |
| Pulmonary Ventilation & Perfusion Imaging (78582) |
$938.50 |
$1,877 |
1.8× |
| Quan&charac c atherosclerotc plaq asses sev c ds (75577) |
$891 |
$1,782 |
1.0× |
| Radex Ankle Compl Minimum 3 Views (73610) |
$176 |
$352 |
2.1× |
| Radex Calcaneus Minimum 2 Views (73650) |
$158.50 |
$317 |
1.9× |
| Radex Elbw Compl Minimum 3 Views (73080) |
$142 |
$284 |
1.7× |
| Radex Entir Thrc Lmbr Crv Sac Spi W/Skull 1 Vw - Xr Scoliosis 1 Vw (72081) |
$229.75 |
$459.50 |
2.8× |
| Radex entir thrc lmbr crv sac spi w/skull 2/3 vw (72082) |
$164.50 |
$329 |
1.6× |
| Radex Entir Thrc Lmbr Crv Sac Spi W/Skull 4/5 Vw (72083) |
$204.50 |
$409 |
2.0× |
| Radex fingr minimum 2 views (73140) |
$106 |
$212 |
1.3× |
| Radex Foot Compl Minimum 3 Views (73630) |
$180.50 |
$361 |
2.2× |
| Radex Hand Minimum 3 Views (73130) |
$157.50 |
$315 |
1.9× |
| Radex Hip Unilateral With Pelvis 1 View (73501) |
$91.50 |
$183 |
1.1× |
| Radex Hip Unilateral With Pelvis Minimum 4 Views (73503) |
$164.50 |
$329 |
1.6× |
| Radex Hips Bilateral With Pelvis 2 Views (73521) |
$190.25 |
$380.50 |
1.9× |
| Radex Hips Bilateral With Pelvis Minimum 5 Views (73523) |
$164.50 |
$329 |
1.6× |
| Radex Humerus Minimum 2 Views (73060) |
$142 |
$284 |
1.7× |
| Radex Kne 1/2 Views (73560) |
$111.50 |
$223 |
1.3× |
| Radex Kne Compl 4/More Views (73564) |
$270.25 |
$540.50 |
2.7× |
| Radex Mndbl Compl Minimum 4 Views (70110) |
$148.75 |
$297.50 |
1.5× |
| Radex Nasal Bones Complete Minimum 3 Views (70160) |
$126.75 |
$253.50 |
1.5× |
| Radex Pelvis Compl Minimum 3 Views (72190) |
$161 |
$322 |
1.6× |
| Radex Sho Compl Minimum 2 Views (73030) |
$180 |
$360 |
2.2× |
| Radex Sinuses Paransl < 3 Views (70210) |
$58 |
$116 |
0.7× |
| Radex Temporomandble Jt Opn & Clsd Mouth Bilat (70330) |
$203.50 |
$407 |
2.4× |
| Radex Toe Minimum 2 Views (73660) |
$91.75 |
$183.50 |
1.1× |
| Radex Wrst Compl Minimum 3 Views (73110) |
$159 |
$318 |
1.9× |
| Radex X-Ray Exam Entire Spi 6/> Vw - Xr Entire Spine 6+ Vw (72084) |
$242.50 |
$485 |
2.4× |
| Radiologic Exam Abdomen 1 View - Xr Abdomen 1 View (74018) |
$130.75 |
$261.50 |
1.6× |
| Radiologic Exam Abdomen 3+ Views - Xr Abdomen 3+ Views (74021) |
$218.50 |
$437 |
2.2× |
| Radiologic exam chest 2 views (71046) |
$162.50 |
$325 |
1.9× |
| Radiologic exam colon single contrast study (74270) |
$416 |
$832 |
2.5× |
| Radiologic Exam Esophagus Double Contrast Study (74221) |
$320 |
$640 |
1.9× |
| Radiologic exam upr gi trc double contrast study (74246) |
$416 |
$832 |
2.5× |
| Radiologic exam upr gi trc single contrast study (74240) |
$308.50 |
$617 |
1.8× |
| Radiologic examination femur 1 view (73551) |
$117.50 |
$235 |
1.4× |
| Radiologic examination tibia & fibula 2 views (73590) |
$153.50 |
$307 |
1.8× |
| Radiologic examination, mastoids; complete, minimum of 3 views per side Non-Facility (70130) |
$171 |
$342 |
1.7× |
| Ribs bilateral 3 views (71110) |
$152.75 |
$305.50 |
1.5× |
| Rp loclzj tum spect w/CT 1 area 1 day imaging (78830) |
$2,199 |
$4,398 |
1.8× |
| Scapula (73010) |
$87.75 |
$175.50 |
0.9× |
| Screening Digital Breast Tomosynthesis Bi (77063) |
$53.50 |
$107 |
2.3× |
| Shoulder 1 view (73020) |
$120 |
$240 |
1.4× |
| Small bowel series (74250) |
$237 |
$474 |
1.4× |
| Spine thoracic 3 views (72072) |
$185.75 |
$371.50 |
1.9× |
| Thoracolumbar 2 views (72080) |
$220.50 |
$441 |
2.6× |
| Thyroid Uptake W/Blood Flow Sngle/Mult Quan Meas (78014) |
$607.50 |
$1,215 |
1.6× |
| Ultrasound breast complete (76641) |
$262 |
$524 |
2.6× |
| Ultrasound Exam Aaa Screen (76706) |
$298.75 |
$597.50 |
3.0× |
| Ultrasound, abdomen limited (76705) |
$364 |
$728 |
3.6× |
| Urethrocystography retrograde rs&i (74450) |
$837 |
$1,674 |
3.7× |
| Us breast unilateral limited (76642) |
$285 |
$570 |
3.4× |
| Us chest (76604) |
$205 |
$410 |
2.0× |
| Us compl joint r-t w/image documentation (76881) |
$198 |
$396 |
2.0× |
| Us infant hips w manipulation (76885) |
$141.50 |
$283 |
1.7× |
| Us lmtd joint/oth nonvasc xtr strux r-t w/img (76882) |
$340 |
$680 |
3.4× |
| Us ob limited (76815) |
$218.50 |
$437 |
2.2× |
| Us ob transvaginal (76817) |
$280 |
$560 |
2.8× |
| Us pelvic non ob complete (76856) |
$364.50 |
$729 |
3.6× |
| Us pelvic nonobstetric image dcmtn limited/f/u (76857) |
$334.50 |
$669 |
3.3× |
| Us pg uter img f&mat 14 wk tabdl 1/1st gestation (76801) |
$437.50 |
$875 |
4.4× |
| Us retroperitoneal complete (76770) |
$245.50 |
$491 |
2.4× |
| Us retroperitoneal limited (76775) |
$267.50 |
$535 |
2.7× |
| Us scrotum and contents (76870) |
$281.75 |
$563.50 |
2.8× |
| Us soft tissue head/neck (76536) |
$378.50 |
$757 |
3.8× |
| Us transrectal (76872) |
$189.50 |
$379 |
1.9× |
| Us,transplanted kidney, real time/ doppler (76776) |
$437.50 |
$875 |
4.4× |
| Wrist 2 views (73100) |
$123 |
$246 |
1.5× |
| X-Ray Abdomen,Comp Acute Series - Xr Abdomen 2 Vws With Chest 1 View (74022) |
$224 |
$448 |
2.2× |
| X-Ray Ac Jts - Xr Acromioclavicular Joints Bilateral (73050) |
$171 |
$342 |
2.0× |
| X-Ray Colon Air Contrast - Fl Barium Enema Air Contrast (74280) |
$533 |
$1,066 |
3.2× |
| X-Ray Elbow 2 Vw - Xr Elbow 1-2 Views Right (73070) |
$117 |
$234 |
1.4× |
| X-Ray Exam Hip Uni 2-3 Views (73502) |
$161 |
$322 |
1.9× |
| X-Ray Exam Hips Bi 3-4 Views (73522) |
$168.75 |
$337.50 |
1.7× |
| X-ray exam of femur 2/> (73552) |
$150.75 |
$301.50 |
1.8× |
| X-ray eye for foreign body (70030) |
$84.75 |
$169.50 |
1.0× |
| X-Ray Facial Bones <3 Vw - Xr Facial Bones 1-2 Views (70140) |
$157 |
$314 |
1.9× |
| X-Ray Knee Bilat Standing - Xr Knees Anteroposterior Standing Bilat (73565) |
$208.50 |
$417 |
2.5× |
| X-Ray Lumbar Spine 2/3 Vw - Xr Lumbar Spine 2-3 Views (72100) |
$144.25 |
$288.50 |
1.4× |
| X-Ray Lumbar Spine 6+ Vw - Xr Lumbar Spine 6+ Vws Including Bending (72114) |
$351 |
$702 |
3.5× |
| X-ray nose-rectum child f.b. (76010) |
$198 |
$396 |
2.4× |
| X-Ray Orbits - Xr Orbits Complete 4+ Views (70200) |
$133 |
$266 |
1.3× |
| X-ray retrograde pyelogram (74420) |
$435.25 |
$870.50 |
1.3× |
| X-Ray Ribs 2 Vw Unilat - Xr Ribs 2 Views Right (71100) |
$158 |
$316 |
1.9× |
| X-Ray Ribs, Chest 3+ Vw - Xr Ribs 2 Vws Lt W/ Chest Anteroposterior (71101) |
$212.75 |
$425.50 |
2.1× |
| X-Ray Ribs, Chest 4+ Vw - Xr Ribs 3 Vws Bil W/ Chest Posteroanterior (71111) |
$226.25 |
$452.50 |
2.3× |
| X-Ray Sacroiliac Jts 3+ Vw - Xr Sacroiliac Joints 3+ Views (72202) |
$161 |
$322 |
1.6× |
| X-Ray Sacrum/Coccyx 2+ Vw - Xr Sacrum Coccyx 2+ Views (72220) |
$144.25 |
$288.50 |
1.7× |
| X-Ray Sinuses 3+ Vw - Xr Paranasal Sinuses 3+ Views (70220) |
$211.25 |
$422.50 |
2.5× |
| X-Ray Skull 4+ Vw - Xr Skull Complete 4+ Views (70260) |
$150.75 |
$301.50 |
1.5× |
| X-Ray Skull <4 Vw - Xr Skull 1-3 Views (70250) |
$91.50 |
$183 |
0.9× |
| X-Ray Spine One View - Xr Spine (72020) |
$78 |
$156 |
0.9× |
| X-Ray Sterno-Clavicluar Jt - Xr Sternoclavicular Joints 3+ Views (71130) |
$132.50 |
$265 |
1.6× |
| X-Ray Sternum 2+ Vw - Xr Sternum 2+ Views (71120) |
$161 |
$322 |
1.9× |
| X-Ray Thoracic Spine 2 Vw - Xr Thoracic Spine 2 Views (72070) |
$150.75 |
$301.50 |
1.5× |
| X-Ray Thoracic Spine 4 Vw - Xr Thoracic Spine Complete 4+ Views (72074) |
$284.50 |
$569 |
2.8× |
| Xr bone length studies (77073) |
$174.50 |
$349 |
1.7× |
| Xr c-spine 4 or 5 views (72050) |
$258 |
$516 |
2.6× |
| Xr c-spine 6 or more views (72052) |
$166.25 |
$332.50 |
1.7× |
| Xr chest 4+ views (71048) |
$156.50 |
$313 |
1.6× |