| Abdomen 2 views (74019) |
$223 |
$446 |
2.4× |
| Ankle 2 views (73600) |
$151 |
$302 |
1.9× |
| Arthrogram elbow (73085) |
$654 |
$1,308 |
2.1× |
| Arthrogram hip (73525) |
$510 |
$1,020 |
1.6× |
| Arthrogram shoulder (73040) |
$524 |
$1,048 |
1.7× |
| Bone &/Joint Imaging Limited Area (78300) |
$817 |
$1,634 |
2.3× |
| Bone &/joint imaging whole body (78306) |
$1,106.50 |
$2,213 |
3.1× |
| Bone age studies (77072) |
$129 |
$258 |
1.4× |
| Bone Imaging 3 Phase (78315) |
$1,245 |
$2,490 |
3.4× |
| Bone survey complete (77075) |
$441.50 |
$883 |
4.7× |
| Cervical spine 2 or 3 views (72040) |
$195 |
$390 |
2.5× |
| Chest 1 view (71045) |
$192 |
$384 |
2.4× |
| Chest 3 views (71047) |
$246 |
$492 |
3.1× |
| Cine/Vid X-Ray Throat/Esoph - Fl Esoph Barium Swlw W/ Video & Speech (74230) |
$382 |
$764 |
2.4× |
| Clavicle complete (73000) |
$161.50 |
$323 |
2.0× |
| Computed Tomography Thorax Lw Dose Lng Ca Scr C- (71271) |
$273 |
$546 |
2.9× |
| CT abdomen and pelvis without and with contrast (74178) |
$1,542 |
$3,084 |
4.9× |
| CT abdomen and pelvis without contrast (74176) |
$1,227.50 |
$2,455 |
5.7× |
| CT abdomen w contrast (74160) |
$1,488 |
$2,976 |
9.4× |
| CT abdomen w wo contrast (74170) |
$1,542 |
$3,084 |
9.7× |
| CT abdomen w/o contrast (74150) |
$1,227.50 |
$2,455 |
12.9× |
| CT angiography upper extremity lt (73206) |
$1,499 |
$2,998 |
9.4× |
| CT c-spine w/o contrast (72125) |
$1,232.50 |
$2,465 |
13.0× |
| CT cervical spine w&w/o contrast (72127) |
$1,378 |
$2,756 |
8.7× |
| CT cervical spine with contrast (72126) |
$1,301 |
$2,602 |
4.1× |
| CT chest w/wo contrast (71270) |
$1,544 |
$3,088 |
9.7× |
| CT chest with contrast (71260) |
$1,373 |
$2,746 |
8.6× |
| CT head/brain with contrast (70460) |
$1,042.50 |
$2,085 |
6.6× |
| CT head/brain without and with contrast (70470) |
$1,299 |
$2,598 |
8.2× |
| CT iac w contrast (70481) |
$1,159.50 |
$2,319 |
7.3× |
| CT limited/localized follow up study (76380) |
$437.50 |
$875 |
5.5× |
| CT lower ext w/o (73700) |
$1,227.50 |
$2,455 |
12.9× |
| CT lower extremity w wo contrast (73702) |
$1,706 |
$3,412 |
10.7× |
| CT lower extremity with contrast (73701) |
$1,551 |
$3,102 |
9.8× |
| CT lumbar spine w & w/o contrast (72133) |
$1,696.50 |
$3,393 |
10.7× |
| CT lumbar spine w/o contrast (72131) |
$1,495 |
$2,990 |
15.8× |
| CT lumbar spine with contrast (72132) |
$1,643 |
$3,286 |
5.2× |
| CT maxillofacial w contrast (70487) |
$1,165 |
$2,330 |
7.3× |
| CT maxillofacial w/o contrast (70486) |
$937 |
$1,874 |
9.9× |
| CT maxillofacial w/wo contrast (70488) |
$1,280.50 |
$2,561 |
8.1× |
| CT neck soft tissue w contrast (70491) |
$1,185.50 |
$2,371 |
7.5× |
| CT orbit sella/post fossa/ear w/o & w/contr matr (70482) |
$1,233.50 |
$2,467 |
7.8× |
| CT orbits w/o contrast (70480) |
$933.50 |
$1,867 |
9.8× |
| CT pelvis w & w/o contrast (72194) |
$1,602 |
$3,204 |
10.1× |
| CT pelvis w/o contrast (72192) |
$1,195.50 |
$2,391 |
12.6× |
| CT soft tissue neck w/o & w/contrast material (70492) |
$1,298 |
$2,596 |
8.2× |
| CT soft tissue neck w/o contrast (70490) |
$954 |
$1,908 |
10.1× |
| CT thoracic spine w/contrast (72129) |
$1,383 |
$2,766 |
8.7× |
| CT thoracic spine w/o contrast (72128) |
$1,313.50 |
$2,627 |
13.9× |
| CT thoracic spine w/wo contrast (72130) |
$1,454 |
$2,908 |
9.1× |
| CT thorax w/o contrast (71250) |
$1,284 |
$2,568 |
13.5× |
| CT upper extremity w/o & w/contrast material (73202) |
$1,699.50 |
$3,399 |
10.7× |
| CT upper extremity w/o contrast rt (73200) |
$1,136 |
$2,272 |
12.0× |
| CT upper extremity with contrast (73201) |
$1,362.50 |
$2,725 |
4.3× |
| Cta Abdl Aorta&Bi Iliofem W/Contrast&Postp (75635) |
$1,716 |
$3,432 |
10.8× |
| Cta Abdomen (74175) |
$1,590 |
$3,180 |
10.0× |
| CTA abdomen pelvis (74174) |
$1,848.50 |
$3,697 |
5.8× |
| CTA chest (71275) |
$1,610 |
$3,220 |
10.1× |
| Cta Head (70496) |
$1,532 |
$3,064 |
9.6× |
| CTA lwr ext w&w/o contrast (73706) |
$2,143.50 |
$4,287 |
13.5× |
| Cta Neck (70498) |
$1,425 |
$2,850 |
9.0× |
| Cta Pelvis (72191) |
$1,602 |
$3,204 |
10.1× |
| Cystography minimum 3 views rs&i (74430) |
$483 |
$966 |
1.5× |
| Doppler Fetal Mid Cerebral Artery (76821) |
$322.50 |
$645 |
3.4× |
| Dxa bone density study 1/> sites axial skel (77080) |
$250 |
$500 |
2.6× |
| Dxa bone density study axial skeleton (77085) |
$453 |
$906 |
4.8× |
| Esophagus (74220) |
$300.50 |
$601 |
1.9× |
| Fetal biophysical profile non-stress testing (76818) |
$265 |
$530 |
2.8× |
| Fetal Biophysical Profile W/O Non-Stress Testing (76819) |
$253.50 |
$507 |
2.7× |
| Fluoroscopy up to 1 hr (76000) |
$328 |
$656 |
1.5× |
| Foot 2 views (73620) |
$129.50 |
$259 |
1.6× |
| Forearm 2 views (73090) |
$154 |
$308 |
2.0× |
| Gated Heart Planar Single (78472) |
$1,040 |
$2,080 |
2.9× |
| Hand 2 views (73120) |
$129 |
$258 |
1.4× |
| Hand 3 views (73130) |
$159 |
$318 |
2.0× |
| Hepatobil Syst Imag Inc Gb W/Pharma Intervenj (78227) |
$623.50 |
$1,247 |
1.3× |
| Hepatobiliary syst imaging including gallbladder (78226) |
$570 |
$1,140 |
1.6× |
| Ht muscle image spect sing (78451) |
$1,655.50 |
$3,311 |
1.4× |
| Humerus Min 2 Views Left (73060) |
$159 |
$318 |
2.0× |
| Hysterosalpingogram (74740) |
$425 |
$850 |
2.0× |
| Kidney Img Morphology Vascular Flow 1 W/O Rx (78707) |
$1,249.50 |
$2,499 |
2.5× |
| Kidney img morphology vascular flow 1 w/rx (78708) |
$1,249.50 |
$2,499 |
2.5× |
| Knee 3 views (73562) |
$166 |
$332 |
2.1× |
| MRA head w/o contrast (70544) |
$1,558 |
$3,116 |
7.2× |
| MRA neck w/o contrast (70547) |
$1,798.50 |
$3,597 |
8.3× |
| MRI abdomen w/o & w/contrast material (74183) |
$1,969 |
$3,938 |
6.2× |
| MRI abdomen w/o contrast (74181) |
$1,500 |
$3,000 |
6.9× |
| MRI any jnt lwr ext with con lt (73722) |
$1,509.50 |
$3,019 |
2.1× |
| MRI any jt upper extremity w/contrast matrl (73222) |
$1,723 |
$3,446 |
2.4× |
| MRI cervical spine w/o contrast (72141) |
$1,740 |
$3,480 |
8.0× |
| MRI chest w/o & w/contrast material (71552) |
$1,973 |
$3,946 |
6.2× |
| MRI lower extrem oth/thn jt w/o contr matrl (73718) |
$1,546 |
$3,092 |
7.1× |
| MRI orbit face &/neck w/o contrast (70540) |
$1,011.50 |
$2,023 |
4.7× |
| MRI orbit/face/neck w&w/o cont (70543) |
$2,079 |
$4,158 |
6.6× |
| MRI orbit/face/neck w/contrast (70542) |
$1,699 |
$3,398 |
5.4× |
| MRI pelvis w/o & w/contrast material (72197) |
$1,943 |
$3,886 |
6.1× |
| MRI pelvis w/o contrast (72195) |
$1,388 |
$2,776 |
6.4× |
| MRI scan of arm joint before and after contrast (73223) |
$1,981 |
$3,962 |
6.3× |
| MRI scan of leg joint before and after contrast (73723) |
$1,857.50 |
$3,715 |
5.9× |
| MRI spinal canal cervical w/o & w/contr matrl (72156) |
$2,372 |
$4,744 |
7.5× |
| MRI spinal canal lumbar w/o & w/contr matrl (72158) |
$2,330.50 |
$4,661 |
7.4× |
| MRI spinal canal thoracic w/o & w/contr matrl (72157) |
$2,135 |
$4,270 |
6.7× |
| MRI thoracic spine w/o contrast (72146) |
$1,540 |
$3,080 |
7.1× |
| MRI tmj (70336) |
$557 |
$1,114 |
2.6× |
| MRI upper ext joint w/o contrast (73221) |
$1,485.50 |
$2,971 |
6.9× |
| MRI upper extrem other than jt w/o & w/contras (73220) |
$1,804 |
$3,608 |
5.7× |
| MRI upper extremity oth than jt w/o contr matrl (73218) |
$1,477 |
$2,954 |
6.8× |
| Myocardial Spect Multiple Studies (78452) |
$1,655.50 |
$3,311 |
1.4× |
| Neck soft tissue (70360) |
$167 |
$334 |
2.1× |
| Nm gastric emptying study (78264) |
$909 |
$1,818 |
2.5× |
| Nuclear Rx Oral Admin (79005) |
$654.50 |
$1,309 |
3.1× |
| Ob Us Follow-Up Per Fetus - Us Ob Follow Up Transabdominal Approach (76816) |
$165 |
$330 |
1.7× |
| Ophthalmic us dx quantitative a-scan only (76511) |
$165 |
$330 |
1.7× |
| Osseous survey infant (77076) |
$129 |
$258 |
1.4× |
| Osseous survey limited (77074) |
$367.50 |
$735 |
3.9× |
| Parathyroid imaging (78070) |
$786.50 |
$1,573 |
2.2× |
| Pelvis 1 or 2 views (72170) |
$149.50 |
$299 |
1.6× |
| Pr MRI, lower extr, w/o contrast f/u by contrast (73720) |
$1,882.50 |
$3,765 |
6.0× |
| Pulmonary Ventilation & Perfusion Imaging (78582) |
$623.50 |
$1,247 |
1.3× |
| Radex abscess/fistula/sinus tract rs&i (76080) |
$709 |
$1,418 |
1.4× |
| Radex Entir Thrc Lmbr Crv Sac Spi W/Skull 1 Vw - Xr Scoliosis 1 Vw (72081) |
$86 |
$172 |
1.1× |
| Radex entir thrc lmbr crv sac spi w/skull 2/3 vw (72082) |
$143 |
$286 |
1.5× |
| Radex hips bilateral with pelvis 2 views (73521) |
$143 |
$286 |
1.5× |
| Radiolog exam mandible compl minimum 4 views (70110) |
$219.50 |
$439 |
2.3× |
| Radiologic Exam Abdomen 1 View - Xr Abdomen 1 View (74018) |
$204.50 |
$409 |
2.6× |
| Radiologic Exam Abdomen 3+ Views - Xr Abdomen 3+ Views (74021) |
$314 |
$628 |
3.3× |
| Radiologic Exam Chest 2 Views - Xr Chest 2 Views (71046) |
$223.50 |
$447 |
2.8× |
| Radiologic exam colon single contrast study (74270) |
$494 |
$988 |
3.1× |
| Radiologic exam upr gi trc double contrast study (74246) |
$468 |
$936 |
2.9× |
| Radiologic exam upr gi trc single contrast study (74240) |
$468 |
$936 |
2.9× |
| Radiologic Examination Femur Minimum 2 Views - Xr Femur 2+ Vw Lt (73552) |
$86 |
$172 |
1.1× |
| Radiological examination surgical specimen (76098) |
$640 |
$1,280 |
1.3× |
| Ribs bilateral 3 views (71110) |
$215 |
$430 |
2.3× |
| Scanogram (77073) |
$137 |
$274 |
1.4× |
| Scapula complete (73010) |
$138.50 |
$277 |
1.5× |
| Screening digital breast tomosynthesis (77063) |
$31.50 |
$63 |
1.3× |
| Shuntogram indwelling nonvascular shunt rs&i (75809) |
$161 |
$322 |
1.7× |
| Small bowel series (74250) |
$390 |
$780 |
2.5× |
| Spine thoracic 3 views (72072) |
$207.50 |
$415 |
2.2× |
| Thoracolumbar 2 views (72080) |
$242.50 |
$485 |
3.1× |
| Thyroid Imaging With Vascular Flow (78013) |
$483.50 |
$967 |
1.3× |
| Thyroid uptake measurement (78012) |
$483.50 |
$967 |
1.3× |
| Thyroid Uptake W/Blood Flow Sngle/Mult Quan Meas (78014) |
$483.50 |
$967 |
1.3× |
| Tmj unilateral (70328) |
$72.50 |
$145 |
0.9× |
| Tumor Imaging, Limited Area - Nm Tumor Localization Limited (78800) |
$969 |
$1,938 |
2.7× |
| Ultrasound scan of cornea to determine thickness (76514) |
$62 |
$124 |
2.4× |
| Ultrasound scan to determine eye length and lens power (76519) |
$221.50 |
$443 |
2.3× |
| Ultrasound, abdomen limited (76705) |
$417.50 |
$835 |
4.4× |
| Umbilical-artery Doppler (OB) (76820) |
$165 |
$330 |
1.7× |
| Upper Extremity Infant (73092) |
$129 |
$258 |
1.4× |
| Urography (pyelography), intravenous, with or without KUB, with or without tomography (74400) |
$502.50 |
$1,005 |
3.2× |
| Us breast unilateral complete (76641) |
$173 |
$346 |
1.8× |
| Us breast unilateral limited (76642) |
$137 |
$274 |
1.7× |
| Us chest (76604) |
$437 |
$874 |
4.6× |
| Us compl joint r-t w/image documentation (76881) |
$225 |
$450 |
2.4× |
| Us elastography parenchyma (76981) |
$131.50 |
$263 |
1.4× |
| Us infant hips dynamic (76885) |
$127.50 |
$255 |
1.6× |
| Us ob detailed single fetus (76811) |
$509.50 |
$1,019 |
2.4× |
| Us ob transvaginal (76817) |
$293 |
$586 |
3.1× |
| Us pelvic non ob complete (76856) |
$488 |
$976 |
5.1× |
| Us pelvic nonobstetric image dcmtn limited/f/u (76857) |
$238.50 |
$477 |
2.5× |
| Us pregnancy ltd (76815) |
$190 |
$380 |
2.0× |
| Us pregnant uterus 14 wk transabdl 1/1st gestat (76801) |
$387 |
$774 |
4.1× |
| Us retroperitoneal complete (76770) |
$488 |
$976 |
5.1× |
| Us retroperitoneal limited (76775) |
$434 |
$868 |
4.6× |
| Us scrotum and contents (76870) |
$446 |
$892 |
4.7× |
| Us soft tissue head/neck (76536) |
$439.50 |
$879 |
4.6× |
| Us spinal canal and contents (76800) |
$201 |
$402 |
2.1× |
| Us transrectal prostate volume (76873) |
$164.50 |
$329 |
1.7× |
| Us xtr non-vasc lmtd (76882) |
$145 |
$290 |
1.5× |
| Us, eye b-scan (76512) |
$345 |
$690 |
3.6× |
| Wrist 2 views (73100) |
$146.50 |
$293 |
1.9× |
| X-Ray Abdomen,Comp Acute Series - Xr Abdomen 2 Vws With Chest 1 View (74022) |
$314 |
$628 |
3.3× |
| X-Ray Ac Jts - Xr Acromioclavicular Joints Bilateral (73050) |
$68.50 |
$137 |
0.9× |
| X-Ray Ankle 3+ Vw - Xr Ankle 3+ Views Right (73610) |
$164.50 |
$329 |
2.1× |
| X-Ray Colon Air Contrast - Fl Barium Enema Air Contrast (74280) |
$512 |
$1,024 |
3.2× |
| X-Ray Elbow 2 Vw - Xr Elbow 1-2 Views Right (73070) |
$161.50 |
$323 |
2.0× |
| X-Ray Elbow 3+ Vw - Xr Elbow 3+ Views Right (73080) |
$201.50 |
$403 |
2.6× |
| X-ray exam hip uni 1 view (73501) |
$86 |
$172 |
1.1× |
| X-Ray Exam Hip Uni 2-3 Views (73502) |
$86 |
$172 |
1.1× |
| X-Ray Exam Hips Bi 3-4 Views (73522) |
$243 |
$486 |
2.6× |
| X-ray exam of femur 1 (73551) |
$86 |
$172 |
1.1× |
| X-ray eye for foreign body (70030) |
$176.50 |
$353 |
2.2× |
| X-Ray Facial Bones 3+ Vw - Xr Facial Bones 3+ Views (70150) |
$209.50 |
$419 |
2.2× |
| X-Ray Facial Bones <3 Vw - Xr Facial Bones 1-2 Views (70140) |
$126 |
$252 |
1.6× |
| X-Ray Foot 3+ Vw - Xr Foot 3+ Views Right (73630) |
$155 |
$310 |
2.0× |
| X-Ray Heel - Xr Calcaneus 2 Views Right (73650) |
$137 |
$274 |
1.7× |
| X-Ray Jaw <4 Vw - Xr Mandible < 4 Views (70100) |
$143.50 |
$287 |
1.8× |
| X-Ray Knee 4+ View - Xr Knee 4+ Views Right (73564) |
$199.50 |
$399 |
2.1× |
| X-Ray Knee Bilat Standing - Xr Knees Anteroposterior Standing Bilat (73565) |
$90.50 |
$181 |
1.1× |
| X-Ray Leg, Infant - Xr Lower Extremity 2+ Views Infant Left (73592) |
$68.50 |
$137 |
0.9× |
| X-Ray Lumbar Spine 2/3 Vw - Xr Lumbar Spine 2-3 Views (72100) |
$129 |
$258 |
1.4× |
| X-Ray Lumbar Spine 6+ Vw - Xr Lumbar Spine 6+ Vws Including Bending (72114) |
$304 |
$608 |
3.2× |
| X-Ray Lumbar Spine Flex/Exten - Xr Lumbar Spine 4+ Views W/ Flex Ext (72120) |
$289.50 |
$579 |
3.1× |
| X-Ray Nasal Bones - Xr Nasal Bones (70160) |
$159 |
$318 |
2.0× |
| X-Ray Nose-Rectum Child F.B. - Xr Nose to Rectum Foreign Body Peds (76010) |
$87.50 |
$175 |
1.1× |
| X-Ray Orbits - Xr Orbits Complete 4+ Views (70200) |
$205.50 |
$411 |
2.2× |
| X-Ray Pelvis 3+ Vw - Xr Pelvis 3+ Views (72190) |
$191.50 |
$383 |
2.0× |
| X-Ray Ribs 2 Vw Unilat - Xr Ribs 2 Views Right (71100) |
$178 |
$356 |
2.3× |
| X-Ray Ribs, Chest 3+ Vw - Xr Ribs 2 Vws Lt W/ Chest Anteroposterior (71101) |
$183.50 |
$367 |
1.9× |
| X-Ray Ribs, Chest 4+ Vw - Xr Ribs 3 Vws Bil W/ Chest Posteroanterior (71111) |
$221.50 |
$443 |
2.3× |
| X-Ray Sacroiliac Jts 3+ Vw - Xr Sacroiliac Joints 3+ Views (72202) |
$195 |
$390 |
2.1× |
| X-Ray Sacrum/Coccyx 2+ Vw - Xr Sacrum Coccyx 2+ Views (72220) |
$159 |
$318 |
2.0× |
| X-Ray Shoulder 2+ Vw - Xr Shoulder 2+ Views Right (73030) |
$175 |
$350 |
2.2× |
| X-Ray Sinuses 3+ Vw - Xr Paranasal Sinuses 3+ Views (70220) |
$219.50 |
$439 |
2.8× |
| X-Ray Sinuses <3 Vw - Xr Paranasal Sinuses 1-2 Views (70210) |
$186.50 |
$373 |
2.4× |
| X-Ray Skull 4+ Vw - Xr Skull Complete 4+ Views (70260) |
$262.50 |
$525 |
2.8× |
| X-Ray Skull <4 Vw - Xr Skull 1-3 Views (70250) |
$159 |
$318 |
1.7× |
| X-Ray Spine One View - Xr Spine (72020) |
$143.50 |
$287 |
1.8× |
| X-Ray Sternum 2+ Vw - Xr Sternum 2+ Views (71120) |
$171.50 |
$343 |
2.2× |
| X-Ray Thoracic Spine 2 Vw - Xr Thoracic Spine 2 Views (72070) |
$191 |
$382 |
2.0× |
| X-Ray Thoracic Spine 4 Vw - Xr Thoracic Spine Complete 4+ Views (72074) |
$256 |
$512 |
2.7× |
| X-Ray Toe(S) - Xr Toes 2+ Views Right (73660) |
$137 |
$274 |
1.7× |
| X-Ray Wrist 3+ Vw - Xr Wrist 3+ Views Right (73110) |
$155 |
$310 |
2.0× |
| Xr c-spine 6 or more views (72052) |
$365 |
$730 |
3.9× |
| Xr chest 4+ views (71048) |
$255.50 |
$511 |
2.7× |
| Xr finger(s) 2+ views (73140) |
$130.50 |
$261 |
1.7× |
| Xr shoulder 1 view (73020) |
$151 |
$302 |
1.9× |
| Xr spine cervical 4 or 5 views (72050) |
$280 |
$560 |
3.0× |
| Xr tibia/fibula 2 views (73590) |
$159 |
$318 |
2.0× |
| Xr tmj bilateral (70330) |
$195 |
$390 |
2.5× |
| Xray knee 1 or 2 views rt (73560) |
$138.50 |
$277 |
1.8× |