| Acute gastrointestinal blood loss imaging (78278) |
$846.50 |
$1,693 |
2.1× |
| Ankle 2 views (73600) |
$187 |
$374 |
2.1× |
| Bone &/Joint Imaging Limited Area (78300) |
$628 |
$1,256 |
1.6× |
| Bone &/joint imaging whole body (78306) |
$871.50 |
$1,743 |
2.2× |
| Bone age studies (77072) |
$117.50 |
$235 |
1.1× |
| Bone Imaging 3 Phase (78315) |
$1,163 |
$2,326 |
2.9× |
| Bone survey complete (77075) |
$321.50 |
$643 |
3.1× |
| Cervical spine 2 or 3 views (72040) |
$201 |
$402 |
2.3× |
| Chest 1 view (71045) |
$188.50 |
$377 |
2.2× |
| Cine/Vid X-Ray Throat/Esoph - Fl Esoph Barium Swlw W/ Video & Speech (74230) |
$225.75 |
$451.50 |
1.3× |
| Clavicle complete (73000) |
$187 |
$374 |
2.1× |
| Computed Tomography Thorax Lw Dose Lng Ca Scr C- (71271) |
$299 |
$598 |
2.8× |
| CT abdomen and pelvis without and with contrast (74178) |
$2,465 |
$4,930 |
7.0× |
| CT abdomen and pelvis without contrast (74176) |
$1,761.50 |
$3,523 |
7.3× |
| CT abdomen w contrast (74160) |
$1,619.50 |
$3,239 |
9.2× |
| CT abdomen w wo contrast (74170) |
$1,726.50 |
$3,453 |
9.8× |
| CT abdomen w/o contrast (74150) |
$1,446 |
$2,892 |
13.8× |
| CT angio hrt w/3d image (75574) |
$1,568.50 |
$3,137 |
4.5× |
| CT angiography upper extremity lt (73206) |
$1,586.50 |
$3,173 |
9.0× |
| CT c-spine w/o contrast (72125) |
$1,446 |
$2,892 |
13.8× |
| CT cervical spine w&w/o contrast (72127) |
$1,656.50 |
$3,313 |
9.4× |
| CT cervical spine with contrast (72126) |
$1,550.50 |
$3,101 |
4.4× |
| CT chest w/wo contrast (71270) |
$1,656.50 |
$3,313 |
9.4× |
| CT chest with contrast (71260) |
$1,550.50 |
$3,101 |
8.8× |
| CT colonography screening (74263) |
$968 |
$1,936 |
4.0× |
| CT colonography w/o cntrst (74261) |
$968 |
$1,936 |
9.2× |
| CT head/brain with contrast (70460) |
$1,374.50 |
$2,749 |
7.8× |
| CT head/brain without and with contrast (70470) |
$1,656.50 |
$3,313 |
9.4× |
| CT heart no contrast quant eval coronry calcium (75571) |
$194 |
$388 |
2.2× |
| CT hrt w/3d image congen (75573) |
$1,590.50 |
$3,181 |
4.5× |
| CT iac w contrast (70481) |
$1,374.50 |
$2,749 |
7.8× |
| CT limited/localized follow up study (76380) |
$366 |
$732 |
4.2× |
| CT lower ext w/o (73700) |
$1,058 |
$2,116 |
10.1× |
| CT lower extremity w wo contrast (73702) |
$1,563.25 |
$3,126.50 |
8.9× |
| CT lower extremity with contrast (73701) |
$1,233.50 |
$2,467 |
7.0× |
| CT lumbar spine w & w/o contrast (72133) |
$1,656.50 |
$3,313 |
9.4× |
| CT lumbar spine w/o contrast (72131) |
$1,446 |
$2,892 |
13.8× |
| CT lumbar spine with contrast (72132) |
$1,550.50 |
$3,101 |
4.4× |
| CT maxillofacial w contrast (70487) |
$1,374.50 |
$2,749 |
7.8× |
| CT maxillofacial w/o contrast (70486) |
$1,198.50 |
$2,397 |
11.4× |
| CT maxillofacial w/wo contrast (70488) |
$1,632.25 |
$3,264.50 |
9.3× |
| CT neck soft tissue w contrast (70491) |
$1,374.50 |
$2,749 |
7.8× |
| CT orbit sella/post fossa/ear w/o & w/contr matr (70482) |
$1,656.50 |
$3,313 |
9.4× |
| CT orbits w/o contrast (70480) |
$1,198.50 |
$2,397 |
11.4× |
| CT pelvis w & w/o contrast (72194) |
$1,656.50 |
$3,313 |
9.4× |
| CT pelvis w/o contrast (72192) |
$1,446 |
$2,892 |
13.8× |
| CT soft tissue neck w/o & w/contrast material (70492) |
$1,656.50 |
$3,313 |
9.4× |
| CT soft tissue neck w/o contrast (70490) |
$1,198.50 |
$2,397 |
11.4× |
| CT thoracic spine w/contrast (72129) |
$1,550.50 |
$3,101 |
8.8× |
| CT thoracic spine w/o contrast (72128) |
$1,446 |
$2,892 |
13.8× |
| CT thoracic spine w/wo contrast (72130) |
$1,656.50 |
$3,313 |
9.4× |
| CT thorax w/o contrast (71250) |
$1,446 |
$2,892 |
13.8× |
| CT upper extremity w/o & w/contrast material (73202) |
$1,586.50 |
$3,173 |
9.0× |
| CT upper extremity w/o contrast rt (73200) |
$1,058 |
$2,116 |
10.1× |
| CT upper extremity with contrast (73201) |
$1,233.50 |
$2,467 |
3.5× |
| Cta Abdl Aorta&Bi Iliofem W/Contrast&Postp (75635) |
$1,110.64 |
$2,221.27 |
6.3× |
| Cta Abdomen (74175) |
$1,726.50 |
$3,453 |
9.8× |
| CTA chest (71275) |
$1,656.50 |
$3,313 |
9.4× |
| Cta Head (70496) |
$1,656.50 |
$3,313 |
9.4× |
| CTA lwr ext w&w/o contrast (73706) |
$1,982.75 |
$3,965.50 |
11.3× |
| Cta Neck (70498) |
$1,656.50 |
$3,313 |
9.4× |
| Cta Pelvis (72191) |
$1,656.50 |
$3,313 |
9.4× |
| Dxa bone density study 1/> sites axial skel (77080) |
$194 |
$388 |
1.8× |
| Esophagus (74220) |
$367 |
$734 |
2.1× |
| Fetal biophysical profile non-stress testing (76818) |
$314 |
$628 |
3.0× |
| Fetal Biophysical Profile W/O Non-Stress Testing (76819) |
$314 |
$628 |
3.0× |
| Fluoroscopy up to 1 hr (76000) |
$270 |
$540 |
1.1× |
| Foot 2 views (73620) |
$187 |
$374 |
2.1× |
| Forearm 2 views (73090) |
$187 |
$374 |
2.1× |
| Gated Heart Planar Single (78472) |
$724 |
$1,448 |
1.8× |
| Hand 2 views (73120) |
$187 |
$374 |
1.8× |
| Hand 3 views (73130) |
$187 |
$374 |
2.1× |
| Hepatobiliary syst imaging including gallbladder (78226) |
$793.50 |
$1,587 |
2.0× |
| Humerus Min 2 Views Left (73060) |
$187 |
$374 |
2.1× |
| Kidney funcj study non-img radioisotopic study (78725) |
$628 |
$1,256 |
1.6× |
| Kidney Img Morphology Vascular Flow 1 W/O Rx (78707) |
$881.50 |
$1,763 |
1.6× |
| Kidney img morphology vascular flow 1 w/rx (78708) |
$969.50 |
$1,939 |
1.8× |
| Knee 3 views (73562) |
$187 |
$374 |
2.1× |
| Liver & Spleen Imaging W/Vascular Flow (78216) |
$688 |
$1,376 |
1.7× |
| Liver imaging static only (78201) |
$757.50 |
$1,515 |
1.4× |
| Lymphoscintigraphy (78195) |
$524.50 |
$1,049 |
1.0× |
| Meckels Diverticulum (78290) |
$653.50 |
$1,307 |
1.6× |
| MRA head w & w/o contrast (70546) |
$1,931 |
$3,862 |
5.5× |
| MRA head w/o contrast (70544) |
$1,340 |
$2,680 |
5.6× |
| MRA head with contrast (70545) |
$1,558 |
$3,116 |
4.4× |
| MRA neck w contrast (70548) |
$1,622 |
$3,244 |
4.6× |
| Mra Neck W/O &W/Contrast Material (70549) |
$1,787 |
$3,574 |
5.1× |
| MRA neck w/o contrast (70547) |
$1,749.25 |
$3,498.50 |
7.3× |
| MRI abdomen w contrast (74182) |
$1,551 |
$3,102 |
4.4× |
| MRI abdomen w/o & w/contrast material (74183) |
$1,884.50 |
$3,769 |
5.4× |
| MRI abdomen w/o contrast (74181) |
$1,339 |
$2,678 |
5.6× |
| MRI breast w/o contrast unilat (77046) |
$1,796.50 |
$3,593 |
7.5× |
| MRI c-spine with contrast (72142) |
$1,796.50 |
$3,593 |
5.1× |
| MRI cervical spine w/o contrast (72141) |
$1,619.50 |
$3,239 |
6.8× |
| MRI chest w/o & w/contrast material (71552) |
$1,884.50 |
$3,769 |
5.4× |
| MRI chest w/o contrast (71550) |
$1,339 |
$2,678 |
5.6× |
| MRI chest with contrast (71551) |
$1,515.50 |
$3,031 |
1.9× |
| MRI Forearm w/ Contrast Bilateral 73219 (73219) |
$1,586.50 |
$3,173 |
4.5× |
| MRI lower extrem oth/thn jt w/contrast matrl (73719) |
$1,409 |
$2,818 |
4.0× |
| MRI lower extrem oth/thn jt w/o contr matrl (73718) |
$1,409 |
$2,818 |
5.9× |
| MRI orbit face &/neck w/o contrast (70540) |
$1,420.50 |
$2,841 |
5.9× |
| MRI orbit/face/neck w&w/o cont (70543) |
$1,850 |
$3,700 |
5.3× |
| MRI orbit/face/neck w/contrast (70542) |
$1,596 |
$3,192 |
4.6× |
| MRI pelvis w contrast (72196) |
$1,515.50 |
$3,031 |
4.3× |
| MRI pelvis w/o & w/contrast material (72197) |
$1,884.50 |
$3,769 |
5.4× |
| MRI pelvis w/o contrast (72195) |
$1,339 |
$2,678 |
5.6× |
| MRI scan of leg joint before and after contrast (73723) |
$1,831.50 |
$3,663 |
5.2× |
| MRI spinal canal cervical w/o & w/contr matrl (72156) |
$2,096.50 |
$4,193 |
6.0× |
| MRI spinal canal lumbar w/contrast material (72149) |
$1,796.50 |
$3,593 |
5.1× |
| MRI spinal canal lumbar w/o & w/contr matrl (72158) |
$2,096.50 |
$4,193 |
6.0× |
| MRI spinal canal thoracic w/contrast matrl (72147) |
$1,796.50 |
$3,593 |
5.1× |
| MRI spinal canal thoracic w/o & w/contr matrl (72157) |
$2,096.50 |
$4,193 |
6.0× |
| MRI thoracic spine w/o contrast (72146) |
$1,619.50 |
$3,239 |
6.8× |
| MRI tmj (70336) |
$1,420.50 |
$2,841 |
5.9× |
| MRI upper ext joint w/o contrast (73221) |
$1,409 |
$2,818 |
5.9× |
| MRI upper extrem other than jt w/o & w/contras (73220) |
$1,831.50 |
$3,663 |
5.2× |
| MRI upper extremity oth than jt w/o contr matrl (73218) |
$1,409 |
$2,818 |
5.9× |
| Myocardial Spect Multiple Studies (78452) |
$1,656 |
$3,312 |
1.3× |
| Neck soft tissue (70360) |
$135.50 |
$271 |
1.5× |
| Nm gastric emptying study (78264) |
$935.50 |
$1,871 |
2.3× |
| Nuclear medicine study of digestive tracts (78299) |
$769.50 |
$1,539 |
1.9× |
| Nuclear medicine study of heart muscle at rest with stress (78453) |
$1,011.50 |
$2,023 |
0.8× |
| Ob Us Follow-Up Per Fetus - Us Ob Follow Up Transabdominal Approach (76816) |
$260.50 |
$521 |
2.5× |
| Osseous survey infant (77076) |
$196.50 |
$393 |
1.9× |
| Parathyroid imaging (78070) |
$688 |
$1,376 |
1.7× |
| Pelvis 1 or 2 views (72170) |
$117.50 |
$235 |
1.1× |
| Pr MRI, lower extr, w/o contrast f/u by contrast (73720) |
$1,831.50 |
$3,663 |
5.2× |
| Pulmonary Perfusion Imaging Particulate (78580) |
$899 |
$1,798 |
2.2× |
| Pulmonary Ventilation & Perfusion Imaging (78582) |
$628 |
$1,256 |
1.2× |
| Radex Entir Thrc Lmbr Crv Sac Spi W/Skull 1 Vw - Xr Scoliosis 1 Vw (72081) |
$225 |
$450 |
2.6× |
| Radex entir thrc lmbr crv sac spi w/skull 2/3 vw (72082) |
$376 |
$752 |
3.6× |
| Radex hips bilateral with pelvis 2 views (73521) |
$278.50 |
$557 |
2.7× |
| Radex mastoids compl minimum 3 views pr side (70130) |
$135.50 |
$271 |
1.3× |
| Radiolog exam mandible compl minimum 4 views (70110) |
$135.50 |
$271 |
1.3× |
| Radiologic Exam Abdomen 1 View - Xr Abdomen 1 View (74018) |
$187 |
$374 |
2.1× |
| Radiologic Exam Abdomen 3+ Views - Xr Abdomen 3+ Views (74021) |
$187 |
$374 |
1.8× |
| Radiologic Exam Chest 2 Views - Xr Chest 2 Views (71046) |
$203 |
$406 |
2.3× |
| Radiologic Examination Femur Minimum 2 Views - Xr Femur 2+ Vw Lt (73552) |
$187 |
$374 |
2.1× |
| Radiological examination surgical specimen (76098) |
$976 |
$1,952 |
1.8× |
| Ribs bilateral 3 views (71110) |
$283.50 |
$567 |
2.7× |
| Saline Infus Sonohysterography W/Color Doppler (76831) |
$480 |
$960 |
2.0× |
| Scanogram (77073) |
$144 |
$288 |
1.4× |
| Scapula complete (73010) |
$187 |
$374 |
1.8× |
| Small bowel series (74250) |
$367 |
$734 |
2.1× |
| Spine thoracic 3 views (72072) |
$201 |
$402 |
1.9× |
| Thyroid Imaging With Vascular Flow (78013) |
$600.50 |
$1,201 |
1.5× |
| Thyroid uptake measurement (78012) |
$448.50 |
$897 |
1.1× |
| Thyroid Uptake W/Blood Flow Sngle/Mult Quan Meas (78014) |
$653.50 |
$1,307 |
1.6× |
| Tmj unilateral (70328) |
$135.50 |
$271 |
1.5× |
| Ultrasound, abdomen limited (76705) |
$382 |
$764 |
3.6× |
| Unlisted magnetic resonance procedure (76498) |
$1,420.50 |
$2,841 |
16.2× |
| Unlisted Ultrasound Procedure (76999) |
$291 |
$582 |
3.3× |
| Urography (pyelography), intravenous, with or without KUB, with or without tomography (74400) |
$451 |
$902 |
2.6× |
| Us breast unilateral complete (76641) |
$210.80 |
$421.60 |
2.0× |
| Us breast unilateral limited (76642) |
$195 |
$390 |
2.2× |
| Us chest (76604) |
$267 |
$534 |
2.5× |
| Us compl joint r-t w/image documentation (76881) |
$286.50 |
$573 |
2.7× |
| Us ob transvaginal (76817) |
$216 |
$432 |
2.1× |
| Us pelvic non ob complete (76856) |
$408 |
$816 |
3.9× |
| Us pregnancy ltd (76815) |
$260.50 |
$521 |
2.5× |
| Us pregnant uterus 14 wk transabdl 1/1st gestat (76801) |
$407 |
$814 |
3.9× |
| Us retroperitoneal complete (76770) |
$382 |
$764 |
3.6× |
| Us scrotum and contents (76870) |
$408 |
$816 |
3.9× |
| Us soft tissue head/neck (76536) |
$380.50 |
$761 |
3.6× |
| Wrist 2 views (73100) |
$187 |
$374 |
2.1× |
| X-Ray Abdomen,Comp Acute Series - Xr Abdomen 2 Vws With Chest 1 View (74022) |
$306.50 |
$613 |
2.9× |
| X-Ray Ac Jts - Xr Acromioclavicular Joints Bilateral (73050) |
$130.50 |
$261 |
1.5× |
| X-Ray Ankle 3+ Vw - Xr Ankle 3+ Views Right (73610) |
$187 |
$374 |
2.1× |
| X-Ray Elbow 2 Vw - Xr Elbow 1-2 Views Right (73070) |
$187 |
$374 |
2.1× |
| X-Ray Elbow 3+ Vw - Xr Elbow 3+ Views Right (73080) |
$187 |
$374 |
2.1× |
| X-ray exam hip uni 1 view (73501) |
$187 |
$374 |
2.1× |
| X-Ray Exam Hip Uni 2-3 Views (73502) |
$187 |
$374 |
2.1× |
| X-Ray Exam Hips Bi 3-4 Views (73522) |
$278.50 |
$557 |
2.7× |
| X-ray eye for foreign body (70030) |
$135.50 |
$271 |
1.5× |
| X-Ray Facial Bones 3+ Vw - Xr Facial Bones 3+ Views (70150) |
$135.50 |
$271 |
1.3× |
| X-Ray Facial Bones <3 Vw - Xr Facial Bones 1-2 Views (70140) |
$135.50 |
$271 |
1.5× |
| X-Ray Foot 3+ Vw - Xr Foot 3+ Views Right (73630) |
$187 |
$374 |
2.1× |
| X-Ray Heel - Xr Calcaneus 2 Views Right (73650) |
$187 |
$374 |
2.1× |
| X-ray IV pyelogram+drip infusn (74410) |
$590 |
$1,180 |
3.3× |
| X-Ray Jaw <4 Vw - Xr Mandible < 4 Views (70100) |
$135.50 |
$271 |
1.5× |
| X-Ray Knee 4+ View - Xr Knee 4+ Views Right (73564) |
$187 |
$374 |
1.8× |
| X-Ray Leg, Infant - Xr Lower Extremity 2+ Views Infant Left (73592) |
$187 |
$374 |
2.1× |
| X-Ray Lumbar Spine 2/3 Vw - Xr Lumbar Spine 2-3 Views (72100) |
$201 |
$402 |
1.9× |
| X-Ray Lumbar Spine 6+ Vw - Xr Lumbar Spine 6+ Vws Including Bending (72114) |
$408.50 |
$817 |
3.9× |
| X-Ray Lumbar Spine Flex/Exten - Xr Lumbar Spine 4+ Views W/ Flex Ext (72120) |
$196.50 |
$393 |
1.9× |
| X-Ray Nasal Bones - Xr Nasal Bones (70160) |
$135.50 |
$271 |
1.5× |
| X-Ray Nose-Rectum Child F.B. - Xr Nose to Rectum Foreign Body Peds (76010) |
$44.50 |
$89 |
0.5× |
| X-Ray Orbits - Xr Orbits Complete 4+ Views (70200) |
$135.50 |
$271 |
1.3× |
| X-Ray Pelvis 3+ Vw - Xr Pelvis 3+ Views (72190) |
$187 |
$374 |
1.8× |
| X-Ray Ribs 2 Vw Unilat - Xr Ribs 2 Views Right (71100) |
$188.50 |
$377 |
2.2× |
| X-Ray Sacroiliac Jts 3+ Vw - Xr Sacroiliac Joints 3+ Views (72202) |
$201 |
$402 |
1.9× |
| X-Ray Sacrum/Coccyx 2+ Vw - Xr Sacrum Coccyx 2+ Views (72220) |
$213 |
$426 |
2.4× |
| X-Ray Shoulder 2+ Vw - Xr Shoulder 2+ Views Right (73030) |
$187 |
$374 |
2.1× |
| X-Ray Sinuses 3+ Vw - Xr Paranasal Sinuses 3+ Views (70220) |
$135.50 |
$271 |
1.5× |
| X-Ray Sinuses <3 Vw - Xr Paranasal Sinuses 1-2 Views (70210) |
$135.50 |
$271 |
1.5× |
| X-Ray Skull 4+ Vw - Xr Skull Complete 4+ Views (70260) |
$225 |
$450 |
2.1× |
| X-Ray Skull <4 Vw - Xr Skull 1-3 Views (70250) |
$117.50 |
$235 |
1.1× |
| X-Ray Spine One View - Xr Spine (72020) |
$201 |
$402 |
2.3× |
| X-Ray Sterno-Clavicluar Jt - Xr Sternoclavicular Joints 3+ Views (71130) |
$189 |
$378 |
2.2× |
| X-Ray Sternum 2+ Vw - Xr Sternum 2+ Views (71120) |
$189 |
$378 |
2.2× |
| X-Ray Thoracic Spine 4 Vw - Xr Thoracic Spine Complete 4+ Views (72074) |
$306 |
$612 |
2.9× |
| X-Ray Toe(S) - Xr Toes 2+ Views Right (73660) |
$187 |
$374 |
2.1× |
| X-Ray Wrist 3+ Vw - Xr Wrist 3+ Views Right (73110) |
$187 |
$374 |
2.1× |
| Xr finger(s) 2+ views (73140) |
$187 |
$374 |
2.1× |
| Xr spine cervical 4 or 5 views (72050) |
$311 |
$622 |
3.0× |
| Xr tibia/fibula 2 views (73590) |
$187 |
$374 |
2.1× |
| Xr tmj bilateral (70330) |
$157 |
$314 |
1.8× |
| Xray knee 1 or 2 views rt (73560) |
$187 |
$374 |
2.1× |