| Abdomen 2 views (74019) |
$111.50 |
$223 |
1.1× |
| Acute gi blood loss imaging (78278) |
$865 |
$1,730 |
2.3× |
| Ankle 2 views (73600) |
$116.50 |
$233 |
1.4× |
| Bone &/Joint Imaging Limited Area (78300) |
$383.50 |
$767 |
1.0× |
| Bone &/joint imaging whole body (78306) |
$771 |
$1,542 |
2.0× |
| Bone age studies (77072) |
$116.50 |
$233 |
1.2× |
| Bone Imaging 3 Phase (78315) |
$858 |
$1,716 |
2.2× |
| Bone survey complete (77075) |
$275.50 |
$551 |
2.7× |
| Bone survey infant (77076) |
$341 |
$682 |
3.4× |
| Bowel imaging (78290) |
$552 |
$1,104 |
1.4× |
| Card Bpi Gtd =Brm Plnr 1 Std Rest/Strs (78472) |
$738 |
$1,476 |
1.9× |
| Cervical spine 2 or 3 views (72040) |
$149.50 |
$299 |
1.8× |
| Chest 1 view (71045) |
$123.50 |
$247 |
1.5× |
| Chest xray 3 views (71047) |
$207.50 |
$415 |
2.5× |
| Clavicle complete (73000) |
$123.50 |
$247 |
1.5× |
| Computed Tomography Thorax Lw Dose Lng Ca Scr C- (71271) |
$120 |
$240 |
1.2× |
| CT abdomen and pelvis without and with contrast (74178) |
$1,706.50 |
$3,413 |
5.1× |
| CT abdomen and pelvis without contrast (74176) |
$1,232.50 |
$2,465 |
5.4× |
| CT abdomen w contrast (74160) |
$720 |
$1,440 |
4.3× |
| CT abdomen w wo contrast (74170) |
$868 |
$1,736 |
5.2× |
| CT abdomen w/o contrast (74150) |
$615 |
$1,230 |
6.1× |
| CT angio hrt w/3d image (75574) |
$334.50 |
$669 |
1.0× |
| CT angio lwr extr w/o&w/dye (73706) |
$879 |
$1,758 |
5.2× |
| CT angiography upper extremity lt (73206) |
$891.50 |
$1,783 |
5.3× |
| CT c-spine w/contrast (72126) |
$702 |
$1,404 |
2.1× |
| CT c-spine w/o contrast (72125) |
$619.50 |
$1,239 |
6.2× |
| CT chest w contrast (71260) |
$728.50 |
$1,457 |
4.3× |
| CT chest w/wo contrast (71270) |
$891 |
$1,782 |
5.3× |
| CT head/brain with contrast (70460) |
$596 |
$1,192 |
3.5× |
| CT head/brain without and with contrast (70470) |
$725 |
$1,450 |
4.3× |
| CT heart contrast eval cardiac structure&morph (75572) |
$495.50 |
$991 |
1.5× |
| CT heart w/o contrast quant eval coronary calcium (75571) |
$99 |
$198 |
1.2× |
| CT iac w contrast (70481) |
$609.50 |
$1,219 |
3.6× |
| CT lower ext w/o (73700) |
$544.50 |
$1,089 |
5.4× |
| CT lower extremity w wo contrast (73702) |
$800 |
$1,600 |
4.8× |
| CT lower extremity w/contrast material (73701) |
$630 |
$1,260 |
3.7× |
| CT lumbar spine w & w/o contrast (72133) |
$860.50 |
$1,721 |
5.1× |
| CT lumbar spine w/contrast (72132) |
$771.50 |
$1,543 |
2.3× |
| CT lumbar spine w/o contrast (72131) |
$630 |
$1,260 |
6.3× |
| CT maxillofacial w contrast (70487) |
$559.50 |
$1,119 |
3.3× |
| CT maxillofacial w/wo contrast (70488) |
$786.50 |
$1,573 |
4.7× |
| CT maxillofacial wo contrast (70486) |
$526.50 |
$1,053 |
5.2× |
| CT orbit sella/post fossa/ear w/o & w/contr matr (70482) |
$630.50 |
$1,261 |
3.7× |
| CT orbits w/o contrast (70480) |
$546 |
$1,092 |
5.4× |
| CT pelvis w/o contrast (72192) |
$616.50 |
$1,233 |
6.1× |
| CT pelvis w/wo contrast (72194) |
$901 |
$1,802 |
5.4× |
| CT scan of arm combo (73202) |
$700 |
$1,400 |
4.2× |
| CT soft tissue neck w contrast (70491) |
$569 |
$1,138 |
3.4× |
| CT soft tissue neck w/o & w/contrast material (70492) |
$681 |
$1,362 |
4.0× |
| CT soft tissue neck w/o contrast (70490) |
$546 |
$1,092 |
5.4× |
| CT thoracic spine w/contrast (72129) |
$843 |
$1,686 |
5.0× |
| CT thoracic spine w/o contrast (72128) |
$630 |
$1,260 |
6.3× |
| CT thorax w/o contrast (71250) |
$590.50 |
$1,181 |
5.9× |
| CT upper ext wo (73200) |
$492.50 |
$985 |
4.9× |
| CT upper extremity with contrast (73201) |
$571.50 |
$1,143 |
1.7× |
| Cta Aa&Bi Iliofem Lxtr Rs&I C-/C+ Post-Pxessing (75635) |
$1,444 |
$2,888 |
8.6× |
| Cta Abdomen (74175) |
$954 |
$1,908 |
5.7× |
| CTA abdomen pelvis (74174) |
$1,104 |
$2,208 |
3.3× |
| CTA chest (71275) |
$982 |
$1,964 |
5.8× |
| Cta Head (70496) |
$750 |
$1,500 |
4.5× |
| CTA head&neck c+ w/noncontrast img&post-pxessing (70471) |
$1,315 |
$2,630 |
3.9× |
| Cta Neck (70498) |
$750 |
$1,500 |
4.5× |
| Cta Pelvis (72191) |
$992.50 |
$1,985 |
5.9× |
| Cystography minimum 3 views rs&i (74430) |
$389.50 |
$779 |
1.2× |
| Dxa bone density study 1/> sites axial skel (77080) |
$352.50 |
$705 |
3.5× |
| Echo exam of eye (76529) |
$91 |
$182 |
1.1× |
| Esophagus (74220) |
$305.50 |
$611 |
1.8× |
| Facial bones min 3 views (70150) |
$187 |
$374 |
1.9× |
| Fluoroscopy up to 1 hr (76000) |
$513 |
$1,026 |
2.2× |
| Foot 2 views (73620) |
$116.50 |
$233 |
1.4× |
| Forearm 2 views (73090) |
$123.50 |
$247 |
1.5× |
| Hand 2 views (73120) |
$111.50 |
$223 |
1.1× |
| Hepatobil Syst Imag Inc Gb W/Pharma Intervenj (78227) |
$828.50 |
$1,657 |
1.6× |
| Hepatobiliary syst imaging including gallbladder (78226) |
$602 |
$1,204 |
1.6× |
| Knee 3 views (73562) |
$139.50 |
$279 |
1.7× |
| Magnetic resonance (eg, proton) imaging, any joint of upper extremity; with contrast material(s) Non-Facility (73222) |
$1,313 |
$2,626 |
1.7× |
| Magnetic resonance (eg, proton) imaging, upper extremity, other than joint; with contrast material(s) Non-Facility (73219) |
$1,404 |
$2,808 |
4.2× |
| Magnetic resonance (eg, proton) imaging, upper extremity, other than joint; without contrast material(s), followed by… (73220) |
$1,780.50 |
$3,561 |
5.3× |
| MRA head w & w/o contrast (70546) |
$1,595.50 |
$3,191 |
4.8× |
| MRA head w/o contrast (70544) |
$1,137.50 |
$2,275 |
5.0× |
| MRA neck w contrast (70548) |
$1,221.50 |
$2,443 |
3.6× |
| Mra Neck W/O &W/Contrast Material (70549) |
$1,595.50 |
$3,191 |
4.8× |
| MRA neck w/o contrast (70547) |
$1,137.50 |
$2,275 |
5.0× |
| MRI abdomen w contrast (74182) |
$1,313 |
$2,626 |
3.9× |
| MRI abdomen w/o & w/contrast material (74183) |
$1,740.50 |
$3,481 |
5.2× |
| MRI abdomen w/o contrast (74181) |
$1,132 |
$2,264 |
4.9× |
| MRI any jt lower extrem w/contrast material (73722) |
$1,313 |
$2,626 |
1.7× |
| MRI any jt lower extrem w/o & w/contrast matrl (73723) |
$1,727.50 |
$3,455 |
5.2× |
| MRI cervical spine w/o contrast (72141) |
$993.50 |
$1,987 |
4.3× |
| MRI chest w/o & w/contrast material (71552) |
$2,655.50 |
$5,311 |
7.9× |
| MRI chest w/o contrast (71550) |
$1,636.50 |
$3,273 |
7.2× |
| MRI lower extrem oth/thn jt w/o & w/contr matr (73720) |
$1,780.50 |
$3,561 |
5.3× |
| MRI lower extrem oth/thn jt w/o contr matrl (73718) |
$1,143.50 |
$2,287 |
5.0× |
| MRI orbit face &/neck w/o contrast (70540) |
$993.50 |
$1,987 |
4.3× |
| MRI orbit/face/neck w&w/o cont (70543) |
$1,545.50 |
$3,091 |
4.6× |
| MRI pelvis w/o & w/contrast material (72197) |
$1,780.50 |
$3,561 |
5.3× |
| MRI pelvis w/o contrast (72195) |
$1,058.50 |
$2,117 |
4.6× |
| MRI spinal canal cervical w/o & w/contr matrl (72156) |
$1,524 |
$3,048 |
4.6× |
| MRI spinal canal lumbar w/contrast material (72149) |
$1,228 |
$2,456 |
3.7× |
| MRI spinal canal lumbar w/o & w/contr matrl (72158) |
$1,755 |
$3,510 |
5.2× |
| MRI spinal canal thoracic w/o & w/contr matrl (72157) |
$1,767 |
$3,534 |
5.3× |
| MRI thoracic spine w/o contrast (72146) |
$1,143.50 |
$2,287 |
5.0× |
| MRI up ext w/o contrast (73218) |
$1,143.50 |
$2,287 |
5.0× |
| MRI upper ext joint w/o contrast (73221) |
$1,132 |
$2,264 |
4.9× |
| MRI, joint upper extrem combo (73223) |
$1,727.50 |
$3,455 |
5.2× |
| Myocardial Spect Multiple Studies (78452) |
$2,033 |
$4,066 |
1.6× |
| Myocardial spect single study at rest or stress (78451) |
$2,033 |
$4,066 |
1.6× |
| N-invas est c ffr sw aly CTA (75580) |
$2,073 |
$4,146 |
2.5× |
| Neck soft tissue (70360) |
$107.50 |
$215 |
1.3× |
| Nm gastric emptying study (78264) |
$602 |
$1,204 |
1.6× |
| Parathyroid Planar Imaging (78070) |
$383.50 |
$767 |
1.0× |
| Pelvis 1 or 2 views (72170) |
$111 |
$222 |
1.1× |
| PET image w/CT, skull-thigh (78815) |
$2,623.50 |
$5,247 |
1.9× |
| PET imaging for CT attenuation whole body (78816) |
$2,623.50 |
$5,247 |
1.9× |
| Pulmonary Perfusion Imaging Particulate (78580) |
$609.50 |
$1,219 |
1.6× |
| Pulmonary Ventilation & Perfusion Imaging (78582) |
$524 |
$1,048 |
1.0× |
| Quan&charac c atherosclerotc plaq asses sev c ds (75577) |
$891 |
$1,782 |
1.0× |
| Radex Ankle Compl Minimum 3 Views (73610) |
$127 |
$254 |
1.5× |
| Radex Calcaneus Minimum 2 Views (73650) |
$113 |
$226 |
1.4× |
| Radex Elbw Compl Minimum 3 Views (73080) |
$133 |
$266 |
1.6× |
| Radex Entir Thrc Lmbr Crv Sac Spi W/Skull 1 Vw - Xr Scoliosis 1 Vw (72081) |
$103.50 |
$207 |
1.2× |
| Radex entir thrc lmbr crv sac spi w/skull 2/3 vw (72082) |
$172 |
$344 |
1.7× |
| Radex fingr minimum 2 views (73140) |
$99.50 |
$199 |
1.2× |
| Radex Foot Compl Minimum 3 Views (73630) |
$127 |
$254 |
1.5× |
| Radex Hand Minimum 3 Views (73130) |
$127 |
$254 |
1.5× |
| Radex Hip Unilateral With Pelvis 1 View (73501) |
$88 |
$176 |
1.1× |
| Radex Hip Unilateral With Pelvis Minimum 4 Views (73503) |
$154 |
$308 |
1.5× |
| Radex Hips Bilateral With Pelvis 2 Views (73521) |
$151 |
$302 |
1.5× |
| Radex Hips Bilateral With Pelvis Minimum 5 Views (73523) |
$165 |
$330 |
1.6× |
| Radex Humerus Minimum 2 Views (73060) |
$131 |
$262 |
1.6× |
| Radex Kne 1/2 Views (73560) |
$123.50 |
$247 |
1.5× |
| Radex Kne Compl 4/More Views (73564) |
$156.50 |
$313 |
1.6× |
| Radex Mndbl Compl Minimum 4 Views (70110) |
$159 |
$318 |
1.6× |
| Radex Nasal Bones Complete Minimum 3 Views (70160) |
$107.50 |
$215 |
1.3× |
| Radex Pelvis Compl Minimum 3 Views (72190) |
$137 |
$274 |
1.4× |
| Radex Sho Compl Minimum 2 Views (73030) |
$133 |
$266 |
1.6× |
| Radex Sinuses Paransl < 3 Views (70210) |
$92.50 |
$185 |
1.1× |
| Radex Temporomandble Jt Opn & Clsd Mouth Bilat (70330) |
$187 |
$374 |
2.2× |
| Radex Toe Minimum 2 Views (73660) |
$92 |
$184 |
1.1× |
| Radex Wrst Compl Minimum 3 Views (73110) |
$127 |
$254 |
1.5× |
| Radiologic Exam Abdomen 1 View - Xr Abdomen 1 View (74018) |
$127 |
$254 |
1.5× |
| Radiologic Exam Abdomen 3+ Views - Xr Abdomen 3+ Views (74021) |
$111.50 |
$223 |
1.1× |
| Radiologic exam chest 2 views (71046) |
$166 |
$332 |
2.0× |
| Radiologic exam colon single contrast study (74270) |
$439.50 |
$879 |
2.6× |
| Radiologic Exam Esophagus Double Contrast Study (74221) |
$289 |
$578 |
1.7× |
| Radiologic exam upr gi trc double contrast study (74246) |
$463.50 |
$927 |
2.8× |
| Radiologic exam upr gi trc single contrast study (74240) |
$409 |
$818 |
2.4× |
| Radiologic examination femur 1 view (73551) |
$84 |
$168 |
1.0× |
| Radiologic examination tibia & fibula 2 views (73590) |
$123.50 |
$247 |
1.5× |
| Radiologic examination, mastoids; complete, minimum of 3 views per side Non-Facility (70130) |
$210 |
$420 |
2.1× |
| Ribs bilateral 3 views (71110) |
$104 |
$208 |
1.0× |
| Scapula (73010) |
$111.50 |
$223 |
1.1× |
| Screening Digital Breast Tomosynthesis Bi (77063) |
$98 |
$196 |
4.2× |
| Shoulder 1 view (73020) |
$123.50 |
$247 |
1.5× |
| Small bowel series (74250) |
$330.50 |
$661 |
2.0× |
| Spine thoracic 3 views (72072) |
$166 |
$332 |
1.7× |
| Thoracolumbar 2 views (72080) |
$119.50 |
$239 |
1.4× |
| Thyroid Uptake W/Blood Flow Sngle/Mult Quan Meas (78014) |
$383.50 |
$767 |
1.0× |
| Ultrasound breast complete (76641) |
$393.50 |
$787 |
3.9× |
| Ultrasound Exam Aaa Screen (76706) |
$308 |
$616 |
3.1× |
| Ultrasound, abdomen limited (76705) |
$442 |
$884 |
4.4× |
| Us breast unilateral limited (76642) |
$113 |
$226 |
1.4× |
| Us chest (76604) |
$222 |
$444 |
2.2× |
| Us compl joint r-t w/image documentation (76881) |
$100.50 |
$201 |
1.0× |
| Us infant hips w manipulation (76885) |
$401 |
$802 |
4.8× |
| Us lmtd joint/oth nonvasc xtr strux r-t w/img (76882) |
$299.75 |
$599.50 |
3.0× |
| Us ob limited (76815) |
$333.50 |
$667 |
3.3× |
| Us ob transvaginal (76817) |
$208.50 |
$417 |
2.1× |
| Us pelvic non ob complete (76856) |
$413 |
$826 |
4.1× |
| Us pelvic nonobstetric image dcmtn limited/f/u (76857) |
$210.50 |
$421 |
2.1× |
| Us retroperitoneal complete (76770) |
$490.50 |
$981 |
4.9× |
| Us retroperitoneal limited (76775) |
$289.50 |
$579 |
2.9× |
| Us scrotum and contents (76870) |
$394 |
$788 |
3.9× |
| Us soft tissue head/neck (76536) |
$371 |
$742 |
3.7× |
| Us transrectal (76872) |
$446.50 |
$893 |
4.5× |
| Us, eye b-scan (76512) |
$208.50 |
$417 |
2.1× |
| Wrist 2 views (73100) |
$116.50 |
$233 |
1.4× |
| X-Ray Abdomen,Comp Acute Series - Xr Abdomen 2 Vws With Chest 1 View (74022) |
$120.50 |
$241 |
1.2× |
| X-Ray Ac Jts - Xr Acromioclavicular Joints Bilateral (73050) |
$156.50 |
$313 |
1.9× |
| X-Ray Colon Air Contrast - Fl Barium Enema Air Contrast (74280) |
$604.50 |
$1,209 |
3.6× |
| X-Ray Elbow 2 Vw - Xr Elbow 1-2 Views Right (73070) |
$120 |
$240 |
1.4× |
| X-Ray Exam Hip Uni 2-3 Views (73502) |
$154 |
$308 |
1.8× |
| X-Ray Exam Hips Bi 3-4 Views (73522) |
$133 |
$266 |
1.3× |
| X-ray exam of femur 2/> (73552) |
$139.50 |
$279 |
1.7× |
| X-ray eye for foreign body (70030) |
$112.50 |
$225 |
1.3× |
| X-Ray Knee Bilat Standing - Xr Knees Anteroposterior Standing Bilat (73565) |
$120 |
$240 |
1.4× |
| X-Ray Lumbar Spine 2/3 Vw - Xr Lumbar Spine 2-3 Views (72100) |
$159 |
$318 |
1.6× |
| X-Ray Orbits - Xr Orbits Complete 4+ Views (70200) |
$139 |
$278 |
1.4× |
| X-ray retrograde pyelogram (74420) |
$485.50 |
$971 |
1.5× |
| X-Ray Ribs 2 Vw Unilat - Xr Ribs 2 Views Right (71100) |
$146.50 |
$293 |
1.8× |
| X-Ray Ribs, Chest 3+ Vw - Xr Ribs 2 Vws Lt W/ Chest Anteroposterior (71101) |
$111.50 |
$223 |
1.1× |
| X-Ray Ribs, Chest 4+ Vw - Xr Ribs 3 Vws Bil W/ Chest Posteroanterior (71111) |
$144 |
$288 |
1.4× |
| X-Ray Sacroiliac Jts 3+ Vw - Xr Sacroiliac Joints 3+ Views (72202) |
$146.50 |
$293 |
1.5× |
| X-Ray Sacrum/Coccyx 2+ Vw - Xr Sacrum Coccyx 2+ Views (72220) |
$133 |
$266 |
1.6× |
| X-Ray Sinuses 3+ Vw - Xr Paranasal Sinuses 3+ Views (70220) |
$184 |
$368 |
2.2× |
| X-Ray Skull 4+ Vw - Xr Skull Complete 4+ Views (70260) |
$115.50 |
$231 |
1.2× |
| X-Ray Skull <4 Vw - Xr Skull 1-3 Views (70250) |
$104 |
$208 |
1.0× |
| X-Ray Spine One View - Xr Spine (72020) |
$84 |
$168 |
1.0× |
| X-Ray Sterno-Clavicluar Jt - Xr Sternoclavicular Joints 3+ Views (71130) |
$163.50 |
$327 |
2.0× |
| X-Ray Sternum 2+ Vw - Xr Sternum 2+ Views (71120) |
$113.50 |
$227 |
1.4× |
| X-Ray Thoracic Spine 4 Vw - Xr Thoracic Spine Complete 4+ Views (72074) |
$160 |
$320 |
1.6× |
| Xr bone length studies (77073) |
$190.50 |
$381 |
1.9× |
| Xr c-spine 4 or 5 views (72050) |
$259.50 |
$519 |
2.6× |
| Xr c-spine 6 or more views (72052) |
$259.50 |
$519 |
2.6× |
| Xr chest 4+ views (71048) |
$199 |
$398 |
2.0× |