| Abdomen 2 views (74019) |
$173 |
$346 |
1.6× |
| Ankle 2 views (73600) |
$173 |
$346 |
1.9× |
| Bone &/joint imaging whole body (78306) |
$659.50 |
$1,319 |
1.6× |
| Bone age studies (77072) |
$299.50 |
$599 |
2.8× |
| Bone Imaging 3 Phase (78315) |
$659.50 |
$1,319 |
1.6× |
| Bone survey complete (77075) |
$344 |
$688 |
3.2× |
| Bone survey infant (77076) |
$282.50 |
$565 |
2.6× |
| Card Bpi Gtd =Brm Plnr 1 Std Rest/Strs (78472) |
$844 |
$1,688 |
2.0× |
| Cervical spine 2 or 3 views (72040) |
$185.50 |
$371 |
2.1× |
| Chest 1 view (71045) |
$174 |
$348 |
1.9× |
| Cine/Vid X-Ray Throat/Esoph - Fl Esoph Barium Swlw W/ Video & Speech (74230) |
$366 |
$732 |
2.0× |
| Clavicle complete (73000) |
$173 |
$346 |
1.9× |
| Computed Tomography Thorax Lw Dose Lng Ca Scr C- (71271) |
$120 |
$240 |
1.1× |
| CT abdomen and pelvis without and with contrast (74178) |
$2,012.50 |
$4,025 |
5.6× |
| CT abdomen and pelvis without contrast (74176) |
$1,500 |
$3,000 |
6.1× |
| CT abdomen w contrast (74160) |
$851.50 |
$1,703 |
4.7× |
| CT abdomen w wo contrast (74170) |
$1,021.50 |
$2,043 |
5.6× |
| CT abdomen w/o contrast (74150) |
$714.50 |
$1,429 |
6.6× |
| CT angio lwr extr w/o&w/dye (73706) |
$935 |
$1,870 |
5.2× |
| CT angiography upper extremity lt (73206) |
$991.50 |
$1,983 |
5.5× |
| CT c-spine w/contrast (72126) |
$919.50 |
$1,839 |
2.5× |
| CT c-spine w/o contrast (72125) |
$665 |
$1,330 |
6.1× |
| CT cere prfu aly c+wo CT/CTA (70473) |
$1,315 |
$2,630 |
7.2× |
| CT chest w contrast (71260) |
$855 |
$1,710 |
4.7× |
| CT chest w/wo contrast (71270) |
$991.50 |
$1,983 |
5.5× |
| CT head/brain with contrast (70460) |
$919.50 |
$1,839 |
5.1× |
| CT head/brain without and with contrast (70470) |
$1,071 |
$2,142 |
5.9× |
| CT iac w contrast (70481) |
$884.50 |
$1,769 |
4.9× |
| CT lower ext w/o (73700) |
$628 |
$1,256 |
5.8× |
| CT lower extremity w wo contrast (73702) |
$935 |
$1,870 |
5.2× |
| CT lower extremity w/contrast material (73701) |
$850.50 |
$1,701 |
4.7× |
| CT lumbar spine w & w/o contrast (72133) |
$935 |
$1,870 |
5.2× |
| CT lumbar spine w/contrast (72132) |
$850.50 |
$1,701 |
2.4× |
| CT lumbar spine w/o contrast (72131) |
$615.50 |
$1,231 |
5.7× |
| CT maxillofacial w contrast (70487) |
$919.50 |
$1,839 |
5.1× |
| CT maxillofacial w/wo contrast (70488) |
$1,071 |
$2,142 |
5.9× |
| CT maxillofacial wo contrast (70486) |
$665 |
$1,330 |
6.1× |
| CT orbit sella/post fossa/ear w/o & w/contr matr (70482) |
$1,051 |
$2,102 |
5.8× |
| CT orbits w/o contrast (70480) |
$693.50 |
$1,387 |
6.4× |
| CT pelvis w/o contrast (72192) |
$725.50 |
$1,451 |
6.7× |
| CT pelvis w/wo contrast (72194) |
$1,139 |
$2,278 |
6.3× |
| CT scan of arm combo (73202) |
$935 |
$1,870 |
5.2× |
| CT soft tissue neck w contrast (70491) |
$919.50 |
$1,839 |
5.1× |
| CT soft tissue neck w/o & w/contrast material (70492) |
$1,071 |
$2,142 |
5.9× |
| CT soft tissue neck w/o contrast (70490) |
$692 |
$1,384 |
6.4× |
| CT thoracic spine w/contrast (72129) |
$850.50 |
$1,701 |
4.7× |
| CT thoracic spine w/o contrast (72128) |
$758 |
$1,516 |
7.0× |
| CT thorax w/o contrast (71250) |
$734 |
$1,468 |
6.8× |
| CT upper ext wo (73200) |
$625 |
$1,250 |
5.8× |
| CT upper extremity with contrast (73201) |
$850.50 |
$1,701 |
2.4× |
| Cta Aa&Bi Iliofem Lxtr Rs&I C-/C+ Post-Pxessing (75635) |
$982 |
$1,964 |
5.4× |
| Cta Abdomen (74175) |
$991.50 |
$1,983 |
5.5× |
| CTA abdomen pelvis (74174) |
$1,949 |
$3,898 |
5.4× |
| CTA chest (71275) |
$1,250 |
$2,500 |
6.9× |
| Cta Head (70496) |
$1,071 |
$2,142 |
5.9× |
| CTA head&neck c+ w/noncontrast img&post-pxessing (70471) |
$1,315 |
$2,630 |
3.6× |
| Cta Neck (70498) |
$1,071 |
$2,142 |
5.9× |
| Diskography lumbar (72295) |
$1,870.50 |
$3,741 |
0.9× |
| Dxa bone density study 1/> sites axial skel (77080) |
$325.50 |
$651 |
3.0× |
| Echo exam of eye (76529) |
$87.50 |
$175 |
1.0× |
| Esophagus (74220) |
$366 |
$732 |
2.0× |
| Facial bones min 3 views (70150) |
$176.50 |
$353 |
1.6× |
| Fetal biophysical profile non-stress testing (76818) |
$193 |
$386 |
1.8× |
| Fetal Biophysical Profile W/O Non-Stress Testing (76819) |
$415.50 |
$831 |
3.8× |
| Fluoroscopy up to 1 hr (76000) |
$427.50 |
$855 |
1.7× |
| Foot 2 views (73620) |
$173 |
$346 |
1.9× |
| Forearm 2 views (73090) |
$173 |
$346 |
1.9× |
| Hand 2 views (73120) |
$173 |
$346 |
1.6× |
| Hepatobiliary syst imaging including gallbladder (78226) |
$851.50 |
$1,703 |
2.1× |
| Kidney img morphology vascular flow 1 w/rx (78708) |
$881.50 |
$1,763 |
1.6× |
| Knee 3 views (73562) |
$173 |
$346 |
1.9× |
| Magnetic resonance (eg, proton) imaging, any joint of upper extremity; with contrast material(s) Non-Facility (73222) |
$1,381.50 |
$2,763 |
1.7× |
| Magnetic resonance (eg, proton) imaging, upper extremity, other than joint; without contrast material(s), followed by… (73220) |
$1,854 |
$3,708 |
5.1× |
| MRA head w/o contrast (70544) |
$1,205.50 |
$2,411 |
4.9× |
| Mra Neck W/O &W/Contrast Material (70549) |
$1,854.50 |
$3,709 |
5.1× |
| MRI abdomen w/o & w/contrast material (74183) |
$1,854 |
$3,708 |
5.1× |
| MRI abdomen w/o contrast (74181) |
$1,205.50 |
$2,411 |
4.9× |
| MRI any jt lower extrem w/contrast material (73722) |
$1,381.50 |
$2,763 |
1.7× |
| MRI any jt lower extrem w/o & w/contrast matrl (73723) |
$1,854 |
$3,708 |
5.1× |
| MRI cervical spine w/o contrast (72141) |
$1,205.50 |
$2,411 |
4.9× |
| MRI chest w/o & w/contrast material (71552) |
$1,836.50 |
$3,673 |
5.1× |
| MRI lower extrem oth/thn jt w/o & w/contr matr (73720) |
$1,854 |
$3,708 |
5.1× |
| MRI lower extrem oth/thn jt w/o contr matrl (73718) |
$1,205.50 |
$2,411 |
4.9× |
| MRI orbit face &/neck w/o contrast (70540) |
$1,205.50 |
$2,411 |
4.9× |
| MRI orbit/face/neck w&w/o cont (70543) |
$1,854 |
$3,708 |
5.1× |
| MRI pelvis w/o & w/contrast material (72197) |
$1,854 |
$3,708 |
5.1× |
| MRI pelvis w/o contrast (72195) |
$1,166 |
$2,332 |
4.7× |
| MRI spinal canal cervical w/o & w/contr matrl (72156) |
$1,854.50 |
$3,709 |
5.1× |
| MRI spinal canal lumbar w/o & w/contr matrl (72158) |
$1,854.50 |
$3,709 |
5.1× |
| MRI spinal canal thoracic w/o & w/contr matrl (72157) |
$1,854.50 |
$3,709 |
5.1× |
| MRI thoracic spine w/o contrast (72146) |
$1,205.50 |
$2,411 |
4.9× |
| MRI up ext w/o contrast (73218) |
$1,205.50 |
$2,411 |
4.9× |
| MRI upper ext joint w/o contrast (73221) |
$1,205.50 |
$2,411 |
4.9× |
| MRI, joint upper extrem combo (73223) |
$1,854 |
$3,708 |
5.1× |
| Myocardial Spect Multiple Studies (78452) |
$2,988.50 |
$5,977 |
2.2× |
| Myocardial spect single study at rest or stress (78451) |
$2,056 |
$4,112 |
1.5× |
| Neck soft tissue (70360) |
$171.50 |
$343 |
1.9× |
| Nm gastric emptying study (78264) |
$786.50 |
$1,573 |
1.9× |
| Nonvascular shunt X-ray (75809) |
$99.50 |
$199 |
0.9× |
| Parathyrd planar w/spect&CT (78072) |
$784.50 |
$1,569 |
1.4× |
| Parathyroid Planar Imaging (78070) |
$594 |
$1,188 |
1.4× |
| Pelvis 1 or 2 views (72170) |
$173 |
$346 |
1.6× |
| PET image w/CT, skull-thigh (78815) |
$1,983 |
$3,966 |
1.3× |
| Pulmonary Ventilation & Perfusion Imaging (78582) |
$1,639 |
$3,278 |
2.9× |
| Quan&charac c atherosclerotc plaq asses sev c ds (75577) |
$891 |
$1,782 |
0.9× |
| Radex Ankle Compl Minimum 3 Views (73610) |
$173 |
$346 |
1.9× |
| Radex Calcaneus Minimum 2 Views (73650) |
$173 |
$346 |
1.9× |
| Radex Elbw Compl Minimum 3 Views (73080) |
$173 |
$346 |
1.9× |
| Radex Entir Thrc Lmbr Crv Sac Spi W/Skull 1 Vw - Xr Scoliosis 1 Vw (72081) |
$174.50 |
$349 |
1.9× |
| Radex entir thrc lmbr crv sac spi w/skull 2/3 vw (72082) |
$184 |
$368 |
1.7× |
| Radex fingr minimum 2 views (73140) |
$173 |
$346 |
1.9× |
| Radex Foot Compl Minimum 3 Views (73630) |
$173 |
$346 |
1.9× |
| Radex Hand Minimum 3 Views (73130) |
$173 |
$346 |
1.9× |
| Radex Hip Unilateral With Pelvis 1 View (73501) |
$172.50 |
$345 |
1.9× |
| Radex Hips Bilateral With Pelvis 2 Views (73521) |
$183 |
$366 |
1.7× |
| Radex Hips Bilateral With Pelvis Minimum 5 Views (73523) |
$190 |
$380 |
1.8× |
| Radex Humerus Minimum 2 Views (73060) |
$176.50 |
$353 |
2.0× |
| Radex Kne 1/2 Views (73560) |
$173 |
$346 |
1.9× |
| Radex Kne Compl 4/More Views (73564) |
$173 |
$346 |
1.6× |
| Radex Mndbl Compl Minimum 4 Views (70110) |
$173 |
$346 |
1.6× |
| Radex Nasal Bones Complete Minimum 3 Views (70160) |
$173 |
$346 |
1.9× |
| Radex Sho Compl Minimum 2 Views (73030) |
$178 |
$356 |
2.0× |
| Radex Sinuses Paransl < 3 Views (70210) |
$173 |
$346 |
1.9× |
| Radex Spine Lumbosacral Only Bending 2/3 Views (72120) |
$180.50 |
$361 |
1.7× |
| Radex Temporomandble Jt Opn & Clsd Mouth Bilat (70330) |
$171.50 |
$343 |
1.9× |
| Radex Toe Minimum 2 Views (73660) |
$173 |
$346 |
1.9× |
| Radex Wrst Compl Minimum 3 Views (73110) |
$173 |
$346 |
1.9× |
| Radex X-Ray Exam Entire Spi 6/> Vw - Xr Entire Spine 6+ Vw (72084) |
$200 |
$400 |
1.8× |
| Radiologic Exam Abdomen 1 View - Xr Abdomen 1 View (74018) |
$173 |
$346 |
1.9× |
| Radiologic exam chest 2 views (71046) |
$174 |
$348 |
1.9× |
| Radiologic exam colon single contrast study (74270) |
$411 |
$822 |
2.3× |
| Radiologic Exam Esophagus Double Contrast Study (74221) |
$349 |
$698 |
1.9× |
| Radiologic exam upr gi trc double contrast study (74246) |
$276 |
$552 |
1.5× |
| Radiologic exam upr gi trc single contrast study (74240) |
$366 |
$732 |
2.0× |
| Radiologic examination femur 1 view (73551) |
$176 |
$352 |
2.0× |
| Radiologic examination tibia & fibula 2 views (73590) |
$173 |
$346 |
1.9× |
| Radiological examination surgical specimen (76098) |
$414 |
$828 |
0.7× |
| Rp loclzj tum spect CT 2area 1d img/1 ar img>2+d (78832) |
$3,018 |
$6,036 |
2.0× |
| Rp loclzj tum spect w/CT 1 area 1 day imaging (78830) |
$2,661 |
$5,322 |
2.0× |
| Scapula (73010) |
$171.50 |
$343 |
1.6× |
| Screening Digital Breast Tomosynthesis Bi (77063) |
$82 |
$164 |
3.5× |
| Shoulder 1 view (73020) |
$173 |
$346 |
1.9× |
| Small bowel series (74250) |
$366 |
$732 |
2.0× |
| Spine thoracic 3 views (72072) |
$187 |
$374 |
1.7× |
| Thoracolumbar 2 views (72080) |
$187 |
$374 |
2.1× |
| Ultrasound breast complete (76641) |
$270 |
$540 |
2.5× |
| Ultrasound Exam Aaa Screen (76706) |
$420 |
$840 |
3.9× |
| Ultrasound, abdomen limited (76705) |
$440 |
$880 |
4.1× |
| Us breast unilateral limited (76642) |
$272.50 |
$545 |
3.0× |
| Us chest (76604) |
$436.50 |
$873 |
4.0× |
| Us lmtd joint/oth nonvasc xtr strux r-t w/img (76882) |
$325.50 |
$651 |
3.0× |
| Us ob detailed single fetus (76811) |
$493.50 |
$987 |
2.0× |
| Us ob limited (76815) |
$259 |
$518 |
2.4× |
| Us ob transvaginal (76817) |
$283 |
$566 |
2.6× |
| Us pelvic non ob complete (76856) |
$440.50 |
$881 |
4.1× |
| Us pelvic nonobstetric image dcmtn limited/f/u (76857) |
$273.50 |
$547 |
2.5× |
| Us pg uter img f&mat 14 wk tabdl 1/1st gestation (76801) |
$465.50 |
$931 |
4.3× |
| Us pg uter r-t img f-up tabdl appr pr fetus (76816) |
$276.50 |
$553 |
2.6× |
| Us retroperitoneal complete (76770) |
$440.50 |
$881 |
4.1× |
| Us retroperitoneal limited (76775) |
$436.50 |
$873 |
4.0× |
| Us scrotum and contents (76870) |
$440.50 |
$881 |
4.1× |
| Us soft tissue head/neck (76536) |
$440.50 |
$881 |
4.1× |
| Wrist 2 views (73100) |
$173 |
$346 |
1.9× |
| X-Ray Abdomen,Comp Acute Series - Xr Abdomen 2 Vws With Chest 1 View (74022) |
$299.50 |
$599 |
2.8× |
| X-Ray Ac Jts - Xr Acromioclavicular Joints Bilateral (73050) |
$163 |
$326 |
1.8× |
| X-Ray Colon Air Contrast - Fl Barium Enema Air Contrast (74280) |
$522 |
$1,044 |
2.9× |
| X-Ray Elbow 2 Vw - Xr Elbow 1-2 Views Right (73070) |
$173 |
$346 |
1.9× |
| X-Ray Exam Hip Uni 2-3 Views (73502) |
$175.50 |
$351 |
1.9× |
| X-Ray Exam Hips Bi 3-4 Views (73522) |
$186.50 |
$373 |
1.7× |
| X-ray exam of femur 2/> (73552) |
$180 |
$360 |
2.0× |
| X-ray eye for foreign body (70030) |
$179 |
$358 |
2.0× |
| X-Ray Facial Bones <3 Vw - Xr Facial Bones 1-2 Views (70140) |
$173 |
$346 |
1.9× |
| X-ray leg, infant (73592) |
$282.50 |
$565 |
3.1× |
| X-Ray Lumbar Spine 2/3 Vw - Xr Lumbar Spine 2-3 Views (72100) |
$222.50 |
$445 |
2.1× |
| X-ray nose-rectum child f.b. (76010) |
$173 |
$346 |
1.9× |
| X-Ray Orbits - Xr Orbits Complete 4+ Views (70200) |
$173 |
$346 |
1.6× |
| X-ray retrograde pyelogram (74420) |
$578.50 |
$1,157 |
1.6× |
| X-Ray Ribs 2 Vw Unilat - Xr Ribs 2 Views Right (71100) |
$171.50 |
$343 |
1.9× |
| X-Ray Ribs, Chest 3+ Vw - Xr Ribs 2 Vws Lt W/ Chest Anteroposterior (71101) |
$173 |
$346 |
1.6× |
| X-Ray Ribs, Chest 4+ Vw - Xr Ribs 3 Vws Bil W/ Chest Posteroanterior (71111) |
$299.50 |
$599 |
2.8× |
| X-Ray Sacroiliac Jts 3+ Vw - Xr Sacroiliac Joints 3+ Views (72202) |
$173 |
$346 |
1.6× |
| X-Ray Sacrum/Coccyx 2+ Vw - Xr Sacrum Coccyx 2+ Views (72220) |
$173 |
$346 |
1.9× |
| X-Ray Sinuses 3+ Vw - Xr Paranasal Sinuses 3+ Views (70220) |
$178.50 |
$357 |
2.0× |
| X-Ray Skull 4+ Vw - Xr Skull Complete 4+ Views (70260) |
$299.50 |
$599 |
2.8× |
| X-Ray Skull <4 Vw - Xr Skull 1-3 Views (70250) |
$183.50 |
$367 |
1.7× |
| X-Ray Spine One View - Xr Spine (72020) |
$173 |
$346 |
1.9× |
| X-Ray Sternum 2+ Vw - Xr Sternum 2+ Views (71120) |
$163 |
$326 |
1.8× |
| X-Ray Thoracic Spine 4 Vw - Xr Thoracic Spine Complete 4+ Views (72074) |
$173 |
$346 |
1.6× |
| Xr bone length studies (77073) |
$173 |
$346 |
1.6× |
| Xr c-spine 4 or 5 views (72050) |
$299.50 |
$599 |
2.8× |
| Xr c-spine 6 or more views (72052) |
$299.50 |
$599 |
2.8× |