| Abdomen 1 View (74018) |
$224 |
$448 |
2.8× |
| Abdomen 2 views (74019) |
$242.50 |
$485 |
2.5× |
| Acute Gastrointestinal Blood Loss Imaging (78278) |
$1,104 |
$2,208 |
3.0× |
| Ankle 2 views (73600) |
$240 |
$480 |
3.0× |
| Bone age studies (77072) |
$395.50 |
$791 |
4.1× |
| Bone Imaging 3 Phase (78315) |
$1,119 |
$2,238 |
3.0× |
| Bone Imaging Limited Area (78300) |
$780.50 |
$1,561 |
2.1× |
| Bone Imaging Whole Body (78306) |
$1,035 |
$2,070 |
2.8× |
| Brain Imaging Min 4 Static Views W Vascular Flow (78606) |
$435 |
$870 |
0.9× |
| Cat Scan Follow-Up Study (76380) |
$421.50 |
$843 |
5.2× |
| Chest 1 view (71045) |
$207 |
$414 |
2.6× |
| Chest 2 views (71046) |
$248 |
$496 |
3.1× |
| Chest 3 views (71047) |
$289.50 |
$579 |
3.6× |
| Chest 4 or more views (71048) |
$344.50 |
$689 |
3.5× |
| Clavicle complete (73000) |
$242.50 |
$485 |
3.0× |
| Computed Tomography Thorax Lw Dose Lng Ca Scr C- (71271) |
$59.50 |
$119 |
0.6× |
| Contrast X-Ray Bladder (74430) |
$375 |
$750 |
1.2× |
| CT abdomen and pelvis without and with contrast (74178) |
$4,641 |
$9,282 |
14.3× |
| CT abdomen and pelvis without contrast (74176) |
$3,720 |
$7,440 |
16.8× |
| CT abdomen w contrast (74160) |
$2,439.50 |
$4,879 |
15.0× |
| CT abdomen w wo contrast (74170) |
$2,439.50 |
$4,879 |
15.0× |
| CT abdomen w/o contrast (74150) |
$2,060.50 |
$4,121 |
21.2× |
| CT Angio Abdomen and Pelvis (74174) |
$4,909.50 |
$9,819 |
15.1× |
| CT Angio Chest (71275) |
$2,439.50 |
$4,879 |
15.0× |
| CT Angio Head (70496) |
$1,475.50 |
$2,951 |
9.0× |
| CT angio hrt w/3d image (75574) |
$1,466.50 |
$2,933 |
4.5× |
| Ct Angio Lwr Extr W/O&W/Dye (73706) |
$2,271.50 |
$4,543 |
13.9× |
| CT Angio Neck (70498) |
$1,462 |
$2,924 |
9.0× |
| Ct Angio Upr Extrm W/O&W/Dye (73206) |
$2,271.50 |
$4,543 |
13.9× |
| CT cervical spine w/ contrast (72126) |
$1,521.50 |
$3,043 |
4.7× |
| CT cervical spine w/o contrast (72125) |
$1,217 |
$2,434 |
12.5× |
| CT cervical spine w/wo cont (72127) |
$1,521.50 |
$3,043 |
9.3× |
| CT chest w contrast (71260) |
$1,870.50 |
$3,741 |
11.5× |
| CT chest w/wo contrast (71270) |
$2,004 |
$4,008 |
12.3× |
| CT head/brain with contrast (70460) |
$1,541.50 |
$3,083 |
9.4× |
| CT head/brain without and with contrast (70470) |
$1,541.50 |
$3,083 |
9.4× |
| CT heart no contrast quant eval coronry calcium (75571) |
$65 |
$130 |
0.8× |
| CT iac w contrast (70481) |
$1,245.50 |
$2,491 |
7.6× |
| CT l-spine w&w/o contrast (72133) |
$1,825 |
$3,650 |
11.2× |
| CT lower ext w/o (73700) |
$1,659.50 |
$3,319 |
17.1× |
| CT lower extremity w/contrast material (73701) |
$1,889.50 |
$3,779 |
11.6× |
| CT lumbar spine w contrast (72132) |
$2,293.50 |
$4,587 |
7.1× |
| CT lumbar spine w/o contrast (72131) |
$1,659.50 |
$3,319 |
17.1× |
| CT maxillofacial w contrast (70487) |
$1,135.50 |
$2,271 |
7.0× |
| CT maxillofacial wo contrast (70486) |
$1,100.50 |
$2,201 |
11.3× |
| CT neck tissue combo (70492) |
$1,319 |
$2,638 |
8.1× |
| Ct Orbit/Ear/Fossa W/O&W/Dye (70482) |
$1,245.50 |
$2,491 |
7.6× |
| CT orbits w/o contrast (70480) |
$1,100.50 |
$2,201 |
11.3× |
| CT pelvis w&w/o contrast (72194) |
$2,200.50 |
$4,401 |
13.5× |
| CT pelvis w/o contrast (72192) |
$1,659.50 |
$3,319 |
17.1× |
| CT scan of leg combo (73702) |
$1,889.50 |
$3,779 |
11.6× |
| CT scans face/jaw combo (70488) |
$1,568 |
$3,136 |
9.6× |
| CT soft tissue neck w contrast (70491) |
$1,241 |
$2,482 |
7.6× |
| CT soft tissue neck w/o contrast (70490) |
$1,100.50 |
$2,201 |
11.3× |
| CT thoracic spine w contrast (72129) |
$1,834.50 |
$3,669 |
11.2× |
| CT thoracic spine w/o contrast (72128) |
$1,659.50 |
$3,319 |
17.1× |
| CT thoracic spine w/wo cont (72130) |
$1,834.50 |
$3,669 |
11.2× |
| CT thorax w/o contrast (71250) |
$1,659.50 |
$3,319 |
17.1× |
| CT upper ext wo (73200) |
$1,659.50 |
$3,319 |
17.1× |
| CT upper extremity w/o & w/contrast material (73202) |
$1,825 |
$3,650 |
11.2× |
| CT upper extremity with contrast (73201) |
$1,979.50 |
$3,959 |
6.1× |
| Cta Abdl Aorta&Bi Iliofem W/Contrast&Postp (75635) |
$588.50 |
$1,177 |
3.6× |
| Cta Abdomen (74175) |
$2,439.50 |
$4,879 |
15.0× |
| CTA pelvis (72191) |
$861.50 |
$1,723 |
5.3× |
| Dxa Bone Density Axial (77080) |
$522 |
$1,044 |
5.4× |
| Dxa bone density study 1/>sites appendiclr skel (77081) |
$167 |
$334 |
2.1× |
| Esophagram (74220) |
$356.50 |
$713 |
2.2× |
| Fetal Biophys Profile W/Nst (76818) |
$698 |
$1,396 |
7.2× |
| Fetal Biophysical Profile W/O Non-Stress Testing (76819) |
$672.50 |
$1,345 |
6.9× |
| Fluoroscopy up to 1 hr (76000) |
$277.50 |
$555 |
1.3× |
| Foot 2 views (73620) |
$204 |
$408 |
2.5× |
| Forearm 2 views (73090) |
$243.50 |
$487 |
3.0× |
| Gastric emptying imaging study (78264) |
$943 |
$1,886 |
2.5× |
| Hand 2 views (73120) |
$215.50 |
$431 |
2.2× |
| Hepatobil Syst Image W/Drug (78227) |
$1,152 |
$2,304 |
2.3× |
| Hepatobiliary System Imaging (78226) |
$1,152 |
$2,304 |
3.1× |
| Ht Muscle Image Spect Sing (78451) |
$1,956 |
$3,912 |
1.6× |
| K Flow/Funct Image Multiple (78709) |
$1,445 |
$2,890 |
2.9× |
| K Flow/Funct Image W/Drug (78708) |
$1,378 |
$2,756 |
2.7× |
| Kidney Imaging Morphoogy W/Vascular Flow (78701) |
$451 |
$902 |
1.2× |
| Knee 3 Views (73562) |
$247 |
$494 |
3.1× |
| Liver & Spleen Imaging Static Only (78215) |
$909 |
$1,818 |
2.4× |
| Lung Perf&Ventilat Diferentl (78598) |
$1,075 |
$2,150 |
2.1× |
| Lung Ventilat&Perfus Imaging (78582) |
$1,075 |
$2,150 |
2.1× |
| Lymph System Imaging (78195) |
$1,783 |
$3,566 |
3.5× |
| Magnetic Image Jaw Joint (70336) |
$1,022 |
$2,044 |
4.6× |
| Mammary ductogram or galactogram multiple (77054) |
$289.50 |
$579 |
1.3× |
| Mammary ductogram or galactogram single (77053) |
$248 |
$496 |
1.1× |
| Mra Head W/O & W/Contrast Material (70546) |
$1,213 |
$2,426 |
3.7× |
| MRA head w/o contrast (70544) |
$2,027 |
$4,054 |
9.1× |
| Mra Neck W/O &W/Contrast Material (70549) |
$746.50 |
$1,493 |
2.3× |
| MRA neck w/o contrast (70547) |
$2,027 |
$4,054 |
9.1× |
| MRI abdomen w contrast (74182) |
$2,960 |
$5,920 |
9.1× |
| MRI abdomen w/o contrast (74181) |
$2,555 |
$5,110 |
11.5× |
| MRI any jt lower extrem w/contrast material (73722) |
$2,759.50 |
$5,519 |
3.8× |
| MRI any jt lower extrem w/o & w/contrast matrl (73723) |
$2,759.50 |
$5,519 |
8.5× |
| MRI any jt upper extremity w/contrast matrl (73222) |
$2,759.50 |
$5,519 |
3.8× |
| MRI cervical spine w contrast (72142) |
$2,459 |
$4,918 |
7.6× |
| MRI cervical spine w/o cont (72141) |
$2,293 |
$4,586 |
10.3× |
| MRI chest w/o contrast (71550) |
$2,555 |
$5,110 |
11.5× |
| MRI chest with contrast (71551) |
$2,960 |
$5,920 |
4.1× |
| MRI chest wo w contrast (71552) |
$3,766 |
$7,532 |
11.6× |
| MRI lower extrem oth/thn jt w/o & w/contr matr (73720) |
$2,759.50 |
$5,519 |
8.5× |
| MRI lower extrem oth/thn jt w/o contr matrl (73718) |
$2,379.50 |
$4,759 |
10.7× |
| MRI lumbar spine w contrast (72149) |
$2,960 |
$5,920 |
9.1× |
| Mri Neck Spine W/O & W/Dye (72156) |
$2,681.50 |
$5,363 |
8.3× |
| MRI orbit face &/neck w/o contrast (70540) |
$2,027 |
$4,054 |
9.1× |
| Mri Orbt/Fac/Nck W/O &W/Dye (70543) |
$3,130 |
$6,260 |
9.6× |
| MRI pelvis w contrast (72196) |
$2,960 |
$5,920 |
9.1× |
| MRI pelvis w/o & w contrast (72197) |
$3,227.50 |
$6,455 |
9.9× |
| MRI pelvis w/o contrast (72195) |
$2,689.50 |
$5,379 |
12.1× |
| MRI thoracic spine w/o contrast (72146) |
$2,960 |
$5,920 |
13.3× |
| MRI upper extremity oth than jt w/o contr matrl (73218) |
$2,318 |
$4,636 |
10.4× |
| Mri Uppr Extremity W/O&W/Dye (73220) |
$3,227.50 |
$6,455 |
9.9× |
| MRI, abdomen, combo (74183) |
$3,766 |
$7,532 |
11.6× |
| MRI, dorsal spine combo (72157) |
$3,766 |
$7,532 |
11.6× |
| MRI, dorsal spine contrast (72147) |
$3,362 |
$6,724 |
10.4× |
| MRI, joint upper extrem (73221) |
$2,689.50 |
$5,379 |
12.1× |
| MRI, joint upper extrem combo (73223) |
$2,759.50 |
$5,519 |
8.5× |
| MRI, lumbar spine combo (72158) |
$3,227.50 |
$6,455 |
9.9× |
| Myocardial Spect Multiple Studies (78452) |
$4,027.50 |
$8,055 |
3.3× |
| Neck soft tissue (70360) |
$224 |
$448 |
2.8× |
| Nonvascular Shunt X-Ray (75809) |
$654 |
$1,308 |
6.7× |
| Parathyroid Planar Imaging (78070) |
$753 |
$1,506 |
2.0× |
| Parathyroid planar imaging w/wo subtraction (78071) |
$744.50 |
$1,489 |
2.0× |
| Pelvis 1 or 2 views (72170) |
$242.50 |
$485 |
2.5× |
| PET image w/CT, full body (78816) |
$991.50 |
$1,983 |
0.7× |
| PET imaging CT attenuation skull base mid-thigh (78815) |
$1,277 |
$2,554 |
1.0× |
| Pulmonary Perfusion Imaging Particulate (78580) |
$785 |
$1,570 |
2.1× |
| Radex Abd Compl Aqt Abd W/S/E/D Views 1 View Ch (74022) |
$302 |
$604 |
3.1× |
| Radex abscess/fistula/sinus tract rs&i (76080) |
$358 |
$716 |
0.7× |
| Radex Ankle Complete Minimum 3 Views (73610) |
$267 |
$534 |
3.3× |
| Radex Calcaneus Minimum 2 Views (73650) |
$267 |
$534 |
3.3× |
| Radex elbow complete minimum 3 views (73080) |
$280 |
$560 |
3.5× |
| Radex Facial Bones Complete Minimum 3 Views (70150) |
$328 |
$656 |
3.4× |
| Radex fingr minimum 2 views (73140) |
$237 |
$474 |
2.9× |
| Radex foot complete minimum 3 views (73630) |
$237 |
$474 |
2.9× |
| Radex Hand Minimum 3 Views (73130) |
$237 |
$474 |
2.9× |
| Radex lower extremity infant minimum 2 views (73592) |
$368 |
$736 |
4.5× |
| Radex Mastoids Compl Minimum 3 Views PR Side (70130) |
$395 |
$790 |
4.1× |
| Radex Nasal Bones Complete Minimum 3 Views (70160) |
$325.50 |
$651 |
4.0× |
| Radex Ribs Unilateral 2 Views (71100) |
$267 |
$534 |
3.3× |
| Radex shoulder complete minimum 2 views (73030) |
$298.50 |
$597 |
3.7× |
| Radex Sinuses Paransl < 3 Views (70210) |
$210 |
$420 |
2.6× |
| Radex Spine 1 View Specify Level (72020) |
$178 |
$356 |
2.2× |
| Radex Sternum Minimum 2 Views (71120) |
$289 |
$578 |
3.6× |
| Radex Temporomandble Jt Opn & Clsd Mouth Bilat (70330) |
$369 |
$738 |
4.6× |
| Radex Toe Minimum 2 Views (73660) |
$222 |
$444 |
2.7× |
| Radex upper extremity infant minimum 2 views (73092) |
$122 |
$244 |
1.3× |
| Radex Wrist Complete Minimum 3 Views (73110) |
$243.50 |
$487 |
3.0× |
| Radex X-Ray Exam Entire Spi 6/> Vw - Xr Entire Spine 6+ Vw (72084) |
$349 |
$698 |
3.6× |
| Radiolog exam mandible compl minimum 4 views (70110) |
$344 |
$688 |
3.5× |
| Radiologic Exam Abdomen 3+ Views - Xr Abdomen 3+ Views (74021) |
$312.50 |
$625 |
3.2× |
| Radiologic exam colon double contrast study (74280) |
$969 |
$1,938 |
5.9× |
| Radiologic exam colon single contrast study (74270) |
$394 |
$788 |
2.4× |
| Radiologic Exam Esophagus Double Contrast Study (74221) |
$356.50 |
$713 |
2.2× |
| Radiologic exam knee complete 4/more views (73564) |
$309.50 |
$619 |
3.2× |
| Radiologic exam pelvis compl minimum 3 views (72190) |
$267 |
$534 |
2.7× |
| Radiologic Exam Small Int Single Contrast Study (74250) |
$473 |
$946 |
2.9× |
| Radiologic exam swallow function contrast study (74230) |
$454.50 |
$909 |
2.8× |
| Radiologic exam upr gi trc double contrast study (74246) |
$453 |
$906 |
2.8× |
| Radiologic examination femur 1 view (73551) |
$196 |
$392 |
2.4× |
| Radiologic examination femur minimum 2 views (73552) |
$298.50 |
$597 |
3.7× |
| Radiologic examination knee 1/2 views (73560) |
$247 |
$494 |
3.1× |
| Radiologic Examination Salivary Gland Calculus (70380) |
$87.50 |
$175 |
1.1× |
| Radiologic examination tibia & fibula 2 views (73590) |
$262.50 |
$525 |
3.2× |
| Ribs bilateral 3 views (71110) |
$341 |
$682 |
3.5× |
| Rp Loclzj Tum Plnr Whole Body Single Day Imaging (78802) |
$1,347 |
$2,694 |
2.7× |
| Rp loclzj tum spect 2 area/sep acquisj img (78831) |
$1,077 |
$2,154 |
0.9× |
| Rp loclzj tum spect CT 2area 1d img/1 ar img>2+d (78832) |
$1,221.50 |
$2,443 |
0.9× |
| Rp loclzj tum spect w/CT 1 area/acquisj 1day img (78830) |
$1,077 |
$2,154 |
0.9× |
| Salivary Gland Imaging Serial Images (78231) |
$337 |
$674 |
0.9× |
| Scapula (73010) |
$283 |
$566 |
2.9× |
| Screening Digital Breast Tomosynthesis Bi (77063) |
$358 |
$716 |
15.3× |
| Shoulder 1 view (73020) |
$271 |
$542 |
3.3× |
| Shoulder Arthrography (73040) |
$2,359.50 |
$4,719 |
7.3× |
| Skull less than 4 views (70250) |
$319.50 |
$639 |
3.3× |
| Sternoclavicular joints (71130) |
$262.50 |
$525 |
3.2× |
| Thoracic spine 2 views (72070) |
$289 |
$578 |
3.0× |
| Thoracic spine 3 views (72072) |
$302.50 |
$605 |
3.1× |
| Thoracolumbar 2 views (72080) |
$289 |
$578 |
3.6× |
| Thyroid Imaging With Vascular Flow (78013) |
$600.50 |
$1,201 |
1.6× |
| Ultrasound Breast Limited (76642) |
$449.50 |
$899 |
5.6× |
| Ultrasound Exam Aaa Screen (76706) |
$434.50 |
$869 |
4.5× |
| Ultrasound, abdomen limited (76705) |
$503 |
$1,006 |
5.2× |
| Umbilical-artery Doppler (OB) (76820) |
$337 |
$674 |
3.5× |
| Upper gi w/o kub (74240) |
$453 |
$906 |
2.8× |
| Urea breath test c-14 isotopic analysis (78268) |
$78.50 |
$157 |
0.8× |
| Urethrocystogram voiding (74455) |
$493 |
$986 |
2.2× |
| Us breast unilateral complete (76641) |
$449.50 |
$899 |
4.6× |
| Us chest (76604) |
$537 |
$1,074 |
5.5× |
| Us complete joint (76881) |
$446.50 |
$893 |
4.6× |
| Us exam, pelvic, limited (76857) |
$216.50 |
$433 |
2.2× |
| Us kidney transplant (76776) |
$431 |
$862 |
4.4× |
| Us lmtd joint/oth nonvasc xtr strux r-t w/img (76882) |
$223 |
$446 |
2.3× |
| Us ob limited 1 or more fetuses (76815) |
$446.50 |
$893 |
4.6× |
| Us ob transvaginal (76817) |
$577 |
$1,154 |
5.9× |
| Us pelvic non ob complete (76856) |
$559 |
$1,118 |
5.7× |
| Us pg uter img f&mat 14 wk tabdl 1/1st gestation (76801) |
$527.50 |
$1,055 |
5.4× |
| Us preg uterus real time f/u trnsabdl per fetus (76816) |
$424.50 |
$849 |
4.4× |
| Us retroperitoneal complete (76770) |
$537 |
$1,074 |
5.5× |
| Us retroperitoneal limited (76775) |
$434.50 |
$869 |
4.5× |
| Us scrotum and contents (76870) |
$559 |
$1,118 |
5.7× |
| Us spinal canal and contents (76800) |
$549 |
$1,098 |
5.6× |
| Us thyroid (76536) |
$503 |
$1,006 |
5.2× |
| Wrist 2 views (73100) |
$241 |
$482 |
3.0× |
| X-Ray Ac Jts - Xr Acromioclavicular Joints Bilateral (73050) |
$319.50 |
$639 |
3.9× |
| X-ray antegrade pyelogram tube (74425) |
$375 |
$750 |
1.2× |
| X-Ray Bend Only L-S Spine (72120) |
$407 |
$814 |
4.2× |
| X-Ray Elbow 2 Vw - Xr Elbow 1-2 Views Right (73070) |
$267 |
$534 |
3.3× |
| X-Ray Exam Breast Specimen (76098) |
$496 |
$992 |
1.0× |
| X-Ray Exam Entire Spi 1 Vw (72081) |
$175 |
$350 |
2.2× |
| X-Ray Exam Entire Spi 2/3 Vw (72082) |
$175 |
$350 |
1.8× |
| X-Ray Exam Entire Spi 4/5 Vw (72083) |
$349 |
$698 |
3.6× |
| X-Ray Exam Hip Uni 1 View (73501) |
$189 |
$378 |
2.3× |
| X-Ray Exam Hip Uni 2-3 Views (73502) |
$302.50 |
$605 |
3.7× |
| X-Ray Exam Hip Uni 4/> Views (73503) |
$454.50 |
$909 |
4.7× |
| X-Ray Exam Hips Bi 2 Views (73521) |
$325 |
$650 |
3.3× |
| X-Ray Exam Hips Bi 3-4 Views (73522) |
$325 |
$650 |
3.3× |
| X-Ray Exam Hips Bi 5/> Views (73523) |
$651 |
$1,302 |
6.7× |
| X-Ray Exam L-S Spine Bending (72114) |
$536 |
$1,072 |
5.5× |
| X-Ray Exam Neck Spine 2-3 Vw (72040) |
$267 |
$534 |
3.3× |
| X-Ray Exam Neck Spine 6/>Vws (72052) |
$473.50 |
$947 |
4.9× |
| X-Ray Exam Unilat Ribs/Chest (71101) |
$289 |
$578 |
3.0× |
| X-ray eye for foreign body (70030) |
$52 |
$104 |
0.6× |
| X-ray humerus (73060) |
$267 |
$534 |
3.3× |
| X-ray IV pyelogram (ivp) (74400) |
$496.50 |
$993 |
3.0× |
| X-ray IV pyelogram+tomography (74415) |
$582 |
$1,164 |
3.6× |
| X-Ray Jaw <4 Vw - Xr Mandible < 4 Views (70100) |
$123 |
$246 |
1.5× |
| X-Ray Knee Bilat Standing - Xr Knees Anteroposterior Standing Bilat (73565) |
$309.50 |
$619 |
3.8× |
| X-Ray Lumbar Spine 2/3 Vw - Xr Lumbar Spine 2-3 Views (72100) |
$302.50 |
$605 |
3.1× |
| X-Ray Ribs, Chest 4+ Vw - Xr Ribs 3 Vws Bil W/ Chest Posteroanterior (71111) |
$378.50 |
$757 |
3.9× |
| X-Ray Sacroiliac Jts 3+ Vw - Xr Sacroiliac Joints 3+ Views (72202) |
$270 |
$540 |
2.8× |
| X-Ray Sacroiliac Jts <3 Vw - Xr Sacroiliac Joints 1-2 Views (72200) |
$293.50 |
$587 |
3.0× |
| X-Ray Sacrum/Coccyx 2+ Vw - Xr Sacrum Coccyx 2+ Views (72220) |
$280.50 |
$561 |
3.5× |
| X-Ray Sinuses 3+ Vw - Xr Paranasal Sinuses 3+ Views (70220) |
$319.50 |
$639 |
3.9× |
| X-Ray Skull 4+ Vw - Xr Skull Complete 4+ Views (70260) |
$357.50 |
$715 |
3.7× |
| X-ray thoracic spine 4 vw (72074) |
$344 |
$688 |
3.5× |
| X-Ray Tmj Unilat (70328) |
$243.50 |
$487 |
3.0× |
| X-Ray Urinary Tract Exam With Contrast Material (74420) |
$473 |
$946 |
1.5× |
| X-Rays Bone Survey Complete (77075) |
$330.50 |
$661 |
3.4× |
| Xr c-spine 4 or 5 views (72050) |
$359.50 |
$719 |
3.7× |
| Xr facial bones less than 3 views (70140) |
$274 |
$548 |
3.4× |
| XR Mastoids < 3 Views Bilateral (70120) |
$344 |
$688 |
3.5× |
| Xr orbits complete 4 views (70200) |
$357.50 |
$715 |
3.7× |