| Abdomen 2 views (74019) |
$192.50 |
$385 |
2.1× |
| Acute gastrointestinal blood loss imaging (78278) |
$1,084.15 |
$2,168.30 |
3.1× |
| Ankle 2 views (73600) |
$129 |
$258 |
1.7× |
| Bone &/Joint Imaging Limited Area (78300) |
$347 |
$694 |
1.0× |
| Bone &/joint imaging whole body (78306) |
$750 |
$1,500 |
2.2× |
| Bone age studies (77072) |
$148.50 |
$297 |
1.6× |
| Bone Imaging 3 Phase (78315) |
$355 |
$710 |
1.0× |
| Bone survey complete (77075) |
$387.50 |
$775 |
4.3× |
| Cervical spine 2 or 3 views (72040) |
$147.50 |
$295 |
2.0× |
| Chest 1 view (71045) |
$126 |
$252 |
1.7× |
| Chest 3 views (71047) |
$133.50 |
$267 |
1.8× |
| Clavicle complete (73000) |
$143 |
$286 |
1.9× |
| Computed Tomography Thorax Lw Dose Lng Ca Scr C- (71271) |
$95 |
$189.99 |
1.1× |
| CT abdomen and pelvis without and with contrast (74178) |
$987.50 |
$1,975 |
3.3× |
| CT abdomen and pelvis without contrast (74176) |
$600 |
$1,200 |
2.9× |
| CT abdomen w contrast (74160) |
$1,209.50 |
$2,419 |
8.0× |
| CT abdomen w wo contrast (74170) |
$1,373.50 |
$2,747 |
9.1× |
| CT abdomen w/o contrast (74150) |
$1,000 |
$2,000 |
11.1× |
| CT c-spine w/o contrast (72125) |
$1,275 |
$2,550 |
14.2× |
| CT cervical spine w&w/o contrast (72127) |
$1,477.70 |
$2,955.40 |
9.8× |
| CT cervical spine with contrast (72126) |
$1,266.05 |
$2,532.10 |
4.2× |
| CT chest w/wo contrast (71270) |
$1,225 |
$2,450 |
8.1× |
| CT chest with contrast (71260) |
$1,100 |
$2,200 |
7.3× |
| CT head/brain with contrast (70460) |
$1,100 |
$2,200 |
7.3× |
| CT head/brain without and with contrast (70470) |
$1,200 |
$2,400 |
7.9× |
| CT heart no contrast quant eval coronry calcium (75571) |
$100 |
$200 |
1.3× |
| CT iac w contrast (70481) |
$1,125.50 |
$2,251 |
7.4× |
| CT lower ext w/o (73700) |
$1,150 |
$2,300 |
12.8× |
| CT lower extremity w wo contrast (73702) |
$1,225 |
$2,450 |
8.1× |
| CT lower extremity with contrast (73701) |
$1,255 |
$2,510 |
8.3× |
| CT lumbar spine w/o contrast (72131) |
$1,275 |
$2,550 |
14.2× |
| CT lumbar spine with contrast (72132) |
$371.44 |
$742.88 |
1.2× |
| CT maxillofacial w contrast (70487) |
$1,050 |
$2,100 |
6.9× |
| CT maxillofacial w/o contrast (70486) |
$548.50 |
$1,097 |
6.1× |
| CT maxillofacial w/wo contrast (70488) |
$1,000 |
$2,000 |
6.6× |
| CT neck soft tissue w contrast (70491) |
$1,150 |
$2,300 |
7.6× |
| CT orbit sella/post fossa/ear w/o & w/contr matr (70482) |
$1,382.10 |
$2,764.20 |
9.1× |
| CT orbits w/o contrast (70480) |
$750 |
$1,500 |
8.3× |
| CT pelvis w & w/o contrast (72194) |
$1,298.50 |
$2,597 |
8.6× |
| CT pelvis w/o contrast (72192) |
$1,050 |
$2,100 |
11.7× |
| CT soft tissue neck w/o & w/contrast material (70492) |
$1,325 |
$2,650 |
8.8× |
| CT soft tissue neck w/o contrast (70490) |
$1,050 |
$2,100 |
11.7× |
| CT thoracic spine w/contrast (72129) |
$1,275 |
$2,550 |
8.4× |
| CT thoracic spine w/o contrast (72128) |
$1,025 |
$2,050 |
11.4× |
| CT thorax w/o contrast (71250) |
$1,025 |
$2,050 |
11.4× |
| CT upper extremity w/o & w/contrast material (73202) |
$1,382.10 |
$2,764.20 |
9.1× |
| CT upper extremity w/o contrast rt (73200) |
$950 |
$1,900 |
10.5× |
| CT upper extremity with contrast (73201) |
$1,169.05 |
$2,338.10 |
3.9× |
| Cta Abdomen (74175) |
$400 |
$800 |
2.6× |
| CTA abdomen pelvis (74174) |
$400 |
$800 |
1.3× |
| CTA chest (71275) |
$400 |
$800 |
2.6× |
| Cta Head (70496) |
$560.42 |
$1,120.83 |
3.7× |
| CTA lwr ext w&w/o contrast (73706) |
$577.78 |
$1,155.55 |
3.8× |
| Cta Neck (70498) |
$423 |
$846 |
2.8× |
| Cta Pelvis (72191) |
$400 |
$800 |
2.6× |
| Cystography minimum 3 views rs&i (74430) |
$160.50 |
$321 |
0.5× |
| Dxa bone density study 1/> sites axial skel (77080) |
$205 |
$410 |
2.3× |
| Esophagus (74220) |
$150.50 |
$301 |
1.0× |
| Fluoroscopy up to 1 hr (76000) |
$205.50 |
$411 |
1.0× |
| Foot 2 views (73620) |
$126 |
$252 |
1.7× |
| Forearm 2 views (73090) |
$122.50 |
$245 |
1.6× |
| Hand 2 views (73120) |
$144 |
$288 |
1.6× |
| Hand 3 views (73130) |
$160.50 |
$321 |
2.1× |
| Heart Infarct Image (78466) |
$1,155.70 |
$2,311.40 |
3.4× |
| Hepatobil Syst Imag Inc Gb W/Pharma Intervenj (78227) |
$625 |
$1,250 |
1.3× |
| Hepatobiliary syst imaging including gallbladder (78226) |
$500 |
$1,000 |
1.5× |
| Ht muscle image spect sing (78451) |
$575 |
$1,150 |
0.5× |
| Humerus Min 2 Views Left (73060) |
$108.50 |
$217 |
1.4× |
| Hysterosalpingogram (74740) |
$205 |
$410 |
1.0× |
| Kidney Img Morphology Vascular Flow 1 W/O Rx (78707) |
$438.50 |
$877 |
0.9× |
| Kidney img morphology vascular flow 1 w/rx (78708) |
$1,121.30 |
$2,242.60 |
2.4× |
| Kidney Img Morphology Vascular Flow Multiple (78709) |
$1,002.85 |
$2,005.70 |
2.1× |
| Knee 3 views (73562) |
$154.50 |
$309 |
2.1× |
| Liver & spleen imaging static only (78215) |
$955.85 |
$1,911.70 |
2.8× |
| Meckels Diverticulum (78290) |
$875.60 |
$1,751.20 |
2.5× |
| MRA head w & w/o contrast (70546) |
$443.23 |
$886.46 |
1.5× |
| MRA head w/o contrast (70544) |
$388 |
$776 |
1.9× |
| MRA head with contrast (70545) |
$283.17 |
$566.34 |
0.9× |
| MRA neck w contrast (70548) |
$496.41 |
$992.82 |
1.7× |
| Mra Neck W/O &W/Contrast Material (70549) |
$461.51 |
$923.02 |
1.5× |
| MRA neck w/o contrast (70547) |
$388 |
$776 |
1.9× |
| MRI abdomen w contrast (74182) |
$352.74 |
$705.48 |
1.2× |
| MRI abdomen w/o & w/contrast material (74183) |
$577.14 |
$1,154.27 |
1.9× |
| MRI abdomen w/o contrast (74181) |
$388 |
$776 |
1.9× |
| MRI any jnt lwr ext with con lt (73722) |
$351.51 |
$703.02 |
0.5× |
| MRI any jt upper extremity w/contrast matrl (73222) |
$1,021.36 |
$2,042.73 |
1.5× |
| MRI c-spine with contrast (72142) |
$301.20 |
$602.40 |
1.0× |
| MRI cervical spine w/o contrast (72141) |
$388 |
$776 |
1.9× |
| MRI Forearm w/ Contrast Bilateral 73219 (73219) |
$303.27 |
$606.54 |
1.0× |
| MRI lower extrem oth/thn jt w/contrast matrl (73719) |
$303.77 |
$607.54 |
1.0× |
| MRI lower extrem oth/thn jt w/o contr matrl (73718) |
$272.35 |
$544.70 |
1.3× |
| MRI orbit face &/neck w/o contrast (70540) |
$388 |
$776 |
1.9× |
| MRI orbit/face/neck w&w/o cont (70543) |
$373.04 |
$746.08 |
1.2× |
| MRI orbit/face/neck w/contrast (70542) |
$296.72 |
$593.44 |
1.0× |
| MRI pelvis w contrast (72196) |
$320.72 |
$641.44 |
1.1× |
| MRI pelvis w/o & w/contrast material (72197) |
$393.28 |
$786.56 |
1.3× |
| MRI pelvis w/o contrast (72195) |
$388 |
$776 |
1.9× |
| MRI scan of arm joint before and after contrast (73223) |
$572.78 |
$1,145.55 |
1.9× |
| MRI scan of leg joint before and after contrast (73723) |
$572.78 |
$1,145.55 |
1.9× |
| MRI spinal canal cervical w/o & w/contr matrl (72156) |
$577.14 |
$1,154.27 |
1.9× |
| MRI spinal canal lumbar w/contrast material (72149) |
$457.90 |
$915.80 |
1.5× |
| MRI spinal canal lumbar w/o & w/contr matrl (72158) |
$577.14 |
$1,154.27 |
1.9× |
| MRI spinal canal thoracic w/contrast matrl (72147) |
$299.45 |
$598.90 |
1.0× |
| MRI spinal canal thoracic w/o & w/contr matrl (72157) |
$577.14 |
$1,154.27 |
1.9× |
| MRI thoracic spine w/o contrast (72146) |
$388 |
$776 |
1.9× |
| MRI upper ext joint w/o contrast (73221) |
$349.56 |
$699.12 |
1.7× |
| MRI upper extrem other than jt w/o & w/contras (73220) |
$577.14 |
$1,154.27 |
1.9× |
| MRI upper extremity oth than jt w/o contr matrl (73218) |
$272.73 |
$545.46 |
1.3× |
| Myocardial infarct spect (78469) |
$1,303.85 |
$2,607.70 |
2.8× |
| Myocardial Spect Multiple Studies (78452) |
$1,761 |
$3,522 |
1.6× |
| Neck soft tissue (70360) |
$104 |
$208 |
1.4× |
| Nm gastric emptying study (78264) |
$388.50 |
$777 |
1.1× |
| Nm red cell sequestration (78140) |
$362 |
$724 |
1.1× |
| Nuclear medicine of heart pumping function (78473) |
$934.50 |
$1,869 |
2.7× |
| Nuclear medicine study of kidney and blood flow (78701) |
$1,058.93 |
$2,117.85 |
3.1× |
| Osseous survey infant (77076) |
$150 |
$300 |
1.7× |
| Osseous survey limited (77074) |
$349.25 |
$698.50 |
3.9× |
| Pelvis 1 or 2 views (72170) |
$147.50 |
$295 |
1.6× |
| Pr MRI, lower extr, w/o contrast f/u by contrast (73720) |
$577.14 |
$1,154.27 |
1.9× |
| Pulmonary Perfusion Imaging Particulate (78580) |
$438.50 |
$877 |
1.3× |
| Pulmonary Ventilation & Perfusion Imaging (78582) |
$458 |
$916 |
1.0× |
| Radex entir thrc lmbr crv sac spi w/skull 2/3 vw (72082) |
$112.50 |
$225 |
1.2× |
| Radex hips bilateral with pelvis 2 views (73521) |
$202.52 |
$405.04 |
2.2× |
| Radiolog exam mandible compl minimum 4 views (70110) |
$157.50 |
$315 |
1.7× |
| Radiologic Exam Abdomen 1 View - Xr Abdomen 1 View (74018) |
$134 |
$268 |
1.8× |
| Radiologic Exam Chest 2 Views - Xr Chest 2 Views (71046) |
$153.50 |
$307 |
2.0× |
| Radiologic exam colon single contrast study (74270) |
$287.50 |
$575 |
1.9× |
| Radiologic exam upr gi trc double contrast study (74246) |
$440 |
$880 |
2.9× |
| Radiologic exam upr gi trc single contrast study (74240) |
$64.50 |
$129 |
0.4× |
| Radiologic Examination Femur Minimum 2 Views - Xr Femur 2+ Vw Lt (73552) |
$150 |
$300 |
2.0× |
| Radiological examination surgical specimen (76098) |
$402.55 |
$805.10 |
0.9× |
| Ribs bilateral 3 views (71110) |
$282.50 |
$565 |
3.1× |
| Rp loclzj tum spect 1 area single day imaging (78803) |
$558.50 |
$1,117 |
1.2× |
| Scanogram (77073) |
$243.65 |
$487.30 |
2.7× |
| Scapula complete (73010) |
$125 |
$250 |
1.4× |
| Screening digital breast tomosynthesis (77063) |
$77.91 |
$155.82 |
3.3× |
| Small bowel series (74250) |
$162.50 |
$325 |
1.1× |
| Spine thoracic 3 views (72072) |
$197.50 |
$395 |
2.2× |
| Tbs Technical Calculation Only (77091) |
$225 |
$450 |
3.0× |
| Thoracolumbar 2 views (72080) |
$189.70 |
$379.40 |
2.5× |
| Thyroid Uptake W/Blood Flow Sngle/Mult Quan Meas (78014) |
$679.85 |
$1,359.70 |
2.0× |
| Tmj unilateral (70328) |
$148.50 |
$297 |
2.0× |
| Ultrasound, abdomen limited (76705) |
$282.50 |
$565 |
3.1× |
| Urethrocystography voiding (74455) |
$297.25 |
$594.50 |
1.4× |
| Us abdl aorta screen aaa (76706) |
$120.18 |
$240.35 |
1.3× |
| Us breast unilateral complete (76641) |
$222.50 |
$445 |
2.5× |
| Us chest (76604) |
$176.10 |
$352.20 |
2.0× |
| Us compl joint r-t w/image documentation (76881) |
$275 |
$550 |
3.1× |
| Us pelvic non ob complete (76856) |
$292.50 |
$585 |
3.2× |
| Us pregnancy ltd (76815) |
$140.58 |
$281.15 |
1.6× |
| Us pregnant uterus 14 wk transabdl 1/1st gestat (76801) |
$120.18 |
$240.35 |
1.3× |
| Us retroperitoneal complete (76770) |
$427.50 |
$855 |
4.7× |
| Us retroperitoneal limited (76775) |
$259 |
$518 |
2.9× |
| Us scrotum and contents (76870) |
$191.50 |
$383 |
2.1× |
| Us soft tissue head/neck (76536) |
$237.75 |
$475.50 |
2.6× |
| Us xtr non-vasc lmtd (76882) |
$185 |
$370 |
2.1× |
| Wrist 2 views (73100) |
$99 |
$198 |
1.3× |
| X-Ray Abdomen,Comp Acute Series - Xr Abdomen 2 Vws With Chest 1 View (74022) |
$282.50 |
$565 |
3.1× |
| X-Ray Ac Jts - Xr Acromioclavicular Joints Bilateral (73050) |
$116 |
$232 |
1.5× |
| X-Ray Ankle 3+ Vw - Xr Ankle 3+ Views Right (73610) |
$172.50 |
$345 |
2.3× |
| X-Ray Colon Air Contrast - Fl Barium Enema Air Contrast (74280) |
$308.50 |
$617 |
2.0× |
| X-Ray Elbow 2 Vw - Xr Elbow 1-2 Views Right (73070) |
$127.50 |
$255 |
1.7× |
| X-Ray Elbow 3+ Vw - Xr Elbow 3+ Views Right (73080) |
$175 |
$350 |
2.3× |
| X-ray exam hip uni 1 view (73501) |
$67 |
$134 |
0.9× |
| X-Ray Exam Hip Uni 2-3 Views (73502) |
$142 |
$284 |
1.9× |
| X-Ray Facial Bones 3+ Vw - Xr Facial Bones 3+ Views (70150) |
$214.90 |
$429.80 |
2.4× |
| X-Ray Facial Bones <3 Vw - Xr Facial Bones 1-2 Views (70140) |
$192.50 |
$385 |
2.6× |
| X-Ray Foot 3+ Vw - Xr Foot 3+ Views Right (73630) |
$179.50 |
$359 |
2.4× |
| X-Ray Heel - Xr Calcaneus 2 Views Right (73650) |
$121 |
$242 |
1.6× |
| X-ray IV pyelogram+drip infusn (74410) |
$309 |
$618 |
2.0× |
| X-Ray Jaw <4 Vw - Xr Mandible < 4 Views (70100) |
$87.50 |
$175 |
1.2× |
| X-Ray Knee 4+ View - Xr Knee 4+ Views Right (73564) |
$233.50 |
$467 |
2.6× |
| X-Ray Knee Bilat Standing - Xr Knees Anteroposterior Standing Bilat (73565) |
$102.50 |
$205 |
1.4× |
| X-Ray Lumbar Spine 2/3 Vw - Xr Lumbar Spine 2-3 Views (72100) |
$142.50 |
$285 |
1.6× |
| X-Ray Lumbar Spine 6+ Vw - Xr Lumbar Spine 6+ Vws Including Bending (72114) |
$337.50 |
$675 |
3.7× |
| X-Ray Nasal Bones - Xr Nasal Bones (70160) |
$138.50 |
$277 |
1.8× |
| X-Ray Orbits - Xr Orbits Complete 4+ Views (70200) |
$162.50 |
$325 |
1.8× |
| X-Ray Pelvis 3+ Vw - Xr Pelvis 3+ Views (72190) |
$194.55 |
$389.10 |
2.2× |
| X-Ray Ribs, Chest 3+ Vw - Xr Ribs 2 Vws Lt W/ Chest Anteroposterior (71101) |
$197.50 |
$395 |
2.2× |
| X-Ray Ribs, Chest 4+ Vw - Xr Ribs 3 Vws Bil W/ Chest Posteroanterior (71111) |
$159 |
$318 |
1.8× |
| X-Ray Sacroiliac Jts 3+ Vw - Xr Sacroiliac Joints 3+ Views (72202) |
$161 |
$322 |
1.8× |
| X-Ray Sacrum/Coccyx 2+ Vw - Xr Sacrum Coccyx 2+ Views (72220) |
$151 |
$302 |
2.0× |
| X-Ray Shoulder 2+ Vw - Xr Shoulder 2+ Views Right (73030) |
$146 |
$292 |
1.9× |
| X-Ray Sinuses 3+ Vw - Xr Paranasal Sinuses 3+ Views (70220) |
$170 |
$340 |
2.3× |
| X-Ray Sinuses <3 Vw - Xr Paranasal Sinuses 1-2 Views (70210) |
$137.50 |
$275 |
1.8× |
| X-Ray Skull 4+ Vw - Xr Skull Complete 4+ Views (70260) |
$246 |
$492 |
2.7× |
| X-Ray Skull <4 Vw - Xr Skull 1-3 Views (70250) |
$137.50 |
$275 |
1.5× |
| X-Ray Spine One View - Xr Spine (72020) |
$97.50 |
$195 |
1.3× |
| X-Ray Sternum 2+ Vw - Xr Sternum 2+ Views (71120) |
$137.50 |
$275 |
1.8× |
| X-Ray Thoracic Spine 2 Vw - Xr Thoracic Spine 2 Views (72070) |
$178 |
$356 |
2.0× |
| X-Ray Thoracic Spine 4 Vw - Xr Thoracic Spine Complete 4+ Views (72074) |
$212.50 |
$425 |
2.4× |
| X-Ray Toe(S) - Xr Toes 2+ Views Right (73660) |
$114.50 |
$229 |
1.5× |
| X-Ray Wrist 3+ Vw - Xr Wrist 3+ Views Right (73110) |
$137.50 |
$275 |
1.8× |
| Xr c-spine 6 or more views (72052) |
$207.50 |
$415 |
2.3× |
| Xr chest 4+ views (71048) |
$222.90 |
$445.80 |
2.5× |
| Xr finger(s) 2+ views (73140) |
$91 |
$182 |
1.2× |
| XR Mastoids < 3 Views Bilateral (70120) |
$120.10 |
$240.20 |
1.3× |
| Xr shoulder 1 view (73020) |
$92.50 |
$185 |
1.2× |
| Xr spine cervical 4 or 5 views (72050) |
$265 |
$530 |
2.9× |
| Xr tibia/fibula 2 views (73590) |
$136.50 |
$273 |
1.8× |
| Xr tmj bilateral (70330) |
$243.65 |
$487.30 |
3.2× |
| Xray knee 1 or 2 views rt (73560) |
$101 |
$202 |
1.3× |