| Abdomen 2 views (74019) |
$132.12 |
$264.25 |
1.3× |
| Acute gi blood loss imaging (78278) |
$1,012.62 |
$2,025.25 |
2.6× |
| Ankle 2 views (73600) |
$91.25 |
$182.50 |
1.1× |
| Arthrogram shoulder (73040) |
$180.62 |
$361.25 |
0.5× |
| Bone &/Joint Imaging Limited Area (78300) |
$525 |
$1,050 |
1.4× |
| Bone &/joint imaging whole body (78306) |
$795.75 |
$1,591.50 |
2.1× |
| Bone age studies (77072) |
$78.62 |
$157.25 |
0.8× |
| Bone Imaging 3 Phase (78315) |
$1,010.50 |
$2,021 |
2.6× |
| Bone survey complete (77075) |
$224.25 |
$448.50 |
2.2× |
| Bone survey infant (77076) |
$283.38 |
$566.75 |
2.8× |
| Card Bpi Gtd =Brm Plnr 1 Std Rest/Strs (78472) |
$895.62 |
$1,791.25 |
2.3× |
| Cervical spine 2 or 3 views (72040) |
$121.50 |
$243 |
1.5× |
| Chest 1 view (71045) |
$84.88 |
$169.75 |
1.0× |
| Chest xray 3 views (71047) |
$110.12 |
$220.25 |
1.3× |
| Cine/Vid X-Ray Throat/Esoph - Fl Esoph Barium Swlw W/ Video & Speech (74230) |
$286.88 |
$573.75 |
1.7× |
| Clavicle complete (73000) |
$92.25 |
$184.50 |
1.1× |
| Computed Tomography Thorax Lw Dose Lng Ca Scr C- (71271) |
$99 |
$198 |
1.0× |
| CT abdomen and pelvis without and with contrast (74178) |
$2,929.12 |
$5,858.25 |
8.8× |
| CT abdomen and pelvis without contrast (74176) |
$1,874.62 |
$3,749.25 |
8.2× |
| CT abdomen w contrast (74160) |
$1,204 |
$2,408 |
7.2× |
| CT abdomen w wo contrast (74170) |
$1,373 |
$2,746 |
8.2× |
| CT abdomen w/o contrast (74150) |
$937.75 |
$1,875.50 |
9.4× |
| CT angio lwr extr w/o&w/dye (73706) |
$1,771.38 |
$3,542.75 |
10.5× |
| CT c-spine w/o contrast (72125) |
$973.88 |
$1,947.75 |
9.7× |
| CT chest w contrast (71260) |
$1,160.88 |
$2,321.75 |
6.9× |
| CT chest w/wo contrast (71270) |
$1,433 |
$2,866 |
8.5× |
| CT head/brain with contrast (70460) |
$957.62 |
$1,915.25 |
5.7× |
| CT head/brain without and with contrast (70470) |
$1,162.25 |
$2,324.50 |
6.9× |
| CT iac w contrast (70481) |
$1,208.12 |
$2,416.25 |
7.2× |
| CT lower ext w/o (73700) |
$894 |
$1,788 |
8.9× |
| CT lower extremity w wo contrast (73702) |
$1,354.38 |
$2,708.75 |
8.0× |
| CT lower extremity w/contrast material (73701) |
$1,069.62 |
$2,139.25 |
6.4× |
| CT lumbar spine w/o contrast (72131) |
$971.75 |
$1,943.50 |
9.7× |
| CT maxillofacial w contrast (70487) |
$1,095.25 |
$2,190.50 |
6.5× |
| CT maxillofacial w/wo contrast (70488) |
$1,336.25 |
$2,672.50 |
7.9× |
| CT maxillofacial wo contrast (70486) |
$909.12 |
$1,818.25 |
9.1× |
| CT orbit sella/post fossa/ear w/o & w/contr matr (70482) |
$1,403.88 |
$2,807.75 |
8.3× |
| CT orbits w/o contrast (70480) |
$1,035.50 |
$2,071 |
10.3× |
| CT pelvis w/o contrast (72192) |
$937.75 |
$1,875.50 |
9.4× |
| CT pelvis w/wo contrast (72194) |
$1,107.12 |
$2,214.25 |
6.6× |
| CT scan of arm combo (73202) |
$1,342.62 |
$2,685.25 |
8.0× |
| CT soft tissue neck w contrast (70491) |
$1,087.12 |
$2,174.25 |
6.5× |
| CT soft tissue neck w/o & w/contrast material (70492) |
$1,317.75 |
$2,635.50 |
7.8× |
| CT soft tissue neck w/o contrast (70490) |
$911.50 |
$1,823 |
9.1× |
| CT thoracic spine w/o contrast (72128) |
$972.88 |
$1,945.75 |
9.7× |
| CT thorax w/o contrast (71250) |
$972.88 |
$1,945.75 |
9.7× |
| CT upper ext wo (73200) |
$894 |
$1,788 |
8.9× |
| CT upper extremity with contrast (73201) |
$1,064.50 |
$2,129 |
3.2× |
| Cta Aa&Bi Iliofem Lxtr Rs&I C-/C+ Post-Pxessing (75635) |
$1,763 |
$3,526 |
10.5× |
| Cta Abdomen (74175) |
$1,831.62 |
$3,663.25 |
10.9× |
| CTA abdomen pelvis (74174) |
$2,779.62 |
$5,559.25 |
8.3× |
| CTA chest (71275) |
$1,991.62 |
$3,983.25 |
11.8× |
| Cta Head (70496) |
$2,779.62 |
$5,559.25 |
16.5× |
| Cta Neck (70498) |
$1,730.62 |
$3,461.25 |
10.3× |
| Cystography minimum 3 views rs&i (74430) |
$241.88 |
$483.75 |
0.7× |
| Dxa bone density study 1/> sites axial skel (77080) |
$316 |
$632 |
3.2× |
| Esophagus (74220) |
$273.25 |
$546.50 |
1.6× |
| Facial bones min 3 views (70150) |
$143.62 |
$287.25 |
1.4× |
| Fluoroscopy up to 1 hr (76000) |
$302.31 |
$604.62 |
1.3× |
| Foot 2 views (73620) |
$90.25 |
$180.50 |
1.1× |
| Forearm 2 views (73090) |
$92.25 |
$184.50 |
1.1× |
| Hand 2 views (73120) |
$91.25 |
$182.50 |
0.9× |
| Heart first pass single,planar (78481) |
$815.88 |
$1,631.75 |
1.6× |
| Hepatobil Syst Imag Inc Gb W/Pharma Intervenj (78227) |
$905.88 |
$1,811.75 |
1.7× |
| Hepatobiliary syst imaging including gallbladder (78226) |
$861 |
$1,722 |
2.2× |
| Hysterosalpingogram (74740) |
$317.88 |
$635.75 |
1.4× |
| Joint Survey, Single View - Xr Joint Anteroposterior 2+ Joints (77077) |
$73.88 |
$147.75 |
0.7× |
| Kidney Img Morphology Vascular Flow 1 W/O Rx (78707) |
$785.75 |
$1,571.50 |
1.5× |
| Kidney img morphology vascular flow 1 w/rx (78708) |
$694.25 |
$1,388.50 |
1.3× |
| Kidney Img Morphology Vascular Flow Multiple (78709) |
$1,164.50 |
$2,329 |
2.2× |
| Knee 3 views (73562) |
$112.38 |
$224.75 |
1.3× |
| Liver & spleen imaging static only (78215) |
$572.62 |
$1,145.25 |
1.5× |
| Lung ventilation imaging (78579) |
$95.62 |
$191.25 |
0.2× |
| Magnetic resonance (eg, proton) imaging, any joint of upper extremity; with contrast material(s) Non-Facility (73222) |
$2,022.25 |
$4,044.50 |
2.7× |
| Magnetic resonance (eg, proton) imaging, upper extremity, other than joint; with contrast material(s) Non-Facility (73219) |
$2,091.12 |
$4,182.25 |
6.2× |
| Magnetic resonance (eg, proton) imaging, upper extremity, other than joint; without contrast material(s), followed by… (73220) |
$2,091.12 |
$4,182.25 |
6.2× |
| MRA head w & w/o contrast (70546) |
$2,630.38 |
$5,260.75 |
7.9× |
| MRA head w/o contrast (70544) |
$1,763.12 |
$3,526.25 |
7.7× |
| Mra Neck W/O &W/Contrast Material (70549) |
$2,768.62 |
$5,537.25 |
8.3× |
| MRA neck w/o contrast (70547) |
$1,931 |
$3,862 |
8.4× |
| MRI abdomen w/o & w/contrast material (74183) |
$2,826.50 |
$5,653 |
8.4× |
| MRI abdomen w/o contrast (74181) |
$1,740.50 |
$3,481 |
7.6× |
| MRI any jt lower extrem w/contrast material (73722) |
$2,033.75 |
$4,067.50 |
2.7× |
| MRI any jt lower extrem w/o & w/contrast matrl (73723) |
$3,063.12 |
$6,126.25 |
9.2× |
| MRI c-spine with contrast (72142) |
$2,174.38 |
$4,348.75 |
6.5× |
| MRI cervical spine w/o contrast (72141) |
$1,777.75 |
$3,555.50 |
7.8× |
| MRI chest w/o & w/contrast material (71552) |
$3,370.75 |
$6,741.50 |
10.1× |
| MRI chest w/o contrast (71550) |
$1,985.88 |
$3,971.75 |
8.7× |
| MRI lower extrem oth/thn jt w/contrast matrl (73719) |
$2,091.12 |
$4,182.25 |
6.2× |
| MRI lower extrem oth/thn jt w/o & w/contr matr (73720) |
$3,151 |
$6,302 |
9.4× |
| MRI lower extrem oth/thn jt w/o contr matrl (73718) |
$1,831.62 |
$3,663.25 |
8.0× |
| MRI orbit face &/neck w/o contrast (70540) |
$1,825.25 |
$3,650.50 |
8.0× |
| MRI orbit face neck w contrast (70542) |
$2,084 |
$4,168 |
6.2× |
| MRI orbit/face/neck w&w/o cont (70543) |
$3,137.38 |
$6,274.75 |
9.4× |
| MRI pelvis w/o & w/contrast material (72197) |
$3,175 |
$6,350 |
9.5× |
| MRI pelvis w/o contrast (72195) |
$1,864.62 |
$3,729.25 |
8.1× |
| MRI spinal canal cervical w/o & w/contr matrl (72156) |
$3,192.50 |
$6,385 |
9.5× |
| MRI spinal canal lumbar w/contrast material (72149) |
$1,975.50 |
$3,951 |
5.9× |
| MRI spinal canal lumbar w/o & w/contr matrl (72158) |
$3,158.50 |
$6,317 |
9.4× |
| MRI spinal canal thoracic w/contrast matrl (72147) |
$2,046 |
$4,092 |
6.1× |
| MRI spinal canal thoracic w/o & w/contr matrl (72157) |
$3,093.50 |
$6,187 |
9.2× |
| MRI temporomandibular joint (70336) |
$1,744 |
$3,488 |
7.6× |
| MRI thoracic spine w/o contrast (72146) |
$1,862.75 |
$3,725.50 |
8.1× |
| MRI up ext w/o contrast (73218) |
$1,855.62 |
$3,711.25 |
8.1× |
| MRI upper ext joint w/o contrast (73221) |
$1,787.12 |
$3,574.25 |
7.8× |
| MRI, joint upper extrem combo (73223) |
$3,063.12 |
$6,126.25 |
9.2× |
| Myocardial Spect Multiple Studies (78452) |
$1,736.62 |
$3,473.25 |
1.4× |
| Myocardial spect single study at rest or stress (78451) |
$1,008 |
$2,016 |
0.8× |
| Neck soft tissue (70360) |
$88.88 |
$177.75 |
1.1× |
| Nm gastric emptying study (78264) |
$493.62 |
$987.25 |
1.3× |
| Parathyroid Planar Imaging (78070) |
$519.12 |
$1,038.25 |
1.4× |
| Parathyroid planar imaging w/wo subtraction (78071) |
$847.88 |
$1,695.75 |
2.2× |
| Pelvis 1 or 2 views (72170) |
$91.25 |
$182.50 |
0.9× |
| Pulmonary Perfusion Imaging Particulate (78580) |
$661.38 |
$1,322.75 |
1.7× |
| Pulmonary Ventilation & Perfusion Imaging (78582) |
$167.50 |
$335 |
0.3× |
| Radex abscess/fistula/sinus tract rs&i (76080) |
$72.38 |
$144.75 |
0.1× |
| Radex Ankle Compl Minimum 3 Views (73610) |
$102.88 |
$205.75 |
1.2× |
| Radex Calcaneus Minimum 2 Views (73650) |
$88.88 |
$177.75 |
1.1× |
| Radex Elbw Compl Minimum 3 Views (73080) |
$112.38 |
$224.75 |
1.3× |
| Radex Entir Thrc Lmbr Crv Sac Spi W/Skull 1 Vw - Xr Scoliosis 1 Vw (72081) |
$150.62 |
$301.25 |
1.8× |
| Radex entir thrc lmbr crv sac spi w/skull 2/3 vw (72082) |
$191.44 |
$382.88 |
1.9× |
| Radex Entir Thrc Lmbr Crv Sac Spi W/Skull 4/5 Vw (72083) |
$166.50 |
$333 |
1.7× |
| Radex fingr minimum 2 views (73140) |
$90.25 |
$180.50 |
1.1× |
| Radex Foot Compl Minimum 3 Views (73630) |
$102.88 |
$205.75 |
1.2× |
| Radex Hand Minimum 3 Views (73130) |
$102.88 |
$205.75 |
1.2× |
| Radex Hip Unilateral With Pelvis 1 View (73501) |
$202 |
$404 |
2.4× |
| Radex Hips Bilateral With Pelvis 2 Views (73521) |
$132.12 |
$264.25 |
1.3× |
| Radex Humerus Minimum 2 Views (73060) |
$100.62 |
$201.25 |
1.2× |
| Radex Kne 1/2 Views (73560) |
$96.62 |
$193.25 |
1.2× |
| Radex Kne Compl 4/More Views (73564) |
$127.88 |
$255.75 |
1.3× |
| Radex Mndbl Compl Minimum 4 Views (70110) |
$129.12 |
$258.25 |
1.3× |
| Radex Nasal Bones Complete Minimum 3 Views (70160) |
$103.75 |
$207.50 |
1.2× |
| Radex Sho Compl Minimum 2 Views (73030) |
$102.88 |
$205.75 |
1.2× |
| Radex Sinuses Paransl < 3 Views (70210) |
$103.75 |
$207.50 |
1.2× |
| Radex Spine Lumbosacral Only Bending 2/3 Views (72120) |
$159.88 |
$319.75 |
1.6× |
| Radex Temporomandble Jt Opn & Clsd Mouth Bilat (70330) |
$197.12 |
$394.25 |
2.4× |
| Radex Toe Minimum 2 Views (73660) |
$87.25 |
$174.50 |
1.0× |
| Radex upper extremity infant minimum 2 views (73092) |
$92.25 |
$184.50 |
0.9× |
| Radex Wrst Compl Minimum 3 Views (73110) |
$108.62 |
$217.25 |
1.3× |
| Radiologic Exam Abdomen 1 View - Xr Abdomen 1 View (74018) |
$90.25 |
$180.50 |
1.1× |
| Radiologic Exam Abdomen 3+ Views - Xr Abdomen 3+ Views (74021) |
$132.12 |
$264.25 |
1.3× |
| Radiologic exam chest 2 views (71046) |
$142.38 |
$284.75 |
1.7× |
| Radiologic exam colon single contrast study (74270) |
$441 |
$882 |
2.6× |
| Radiologic exam upr gi trc double contrast study (74246) |
$402.12 |
$804.25 |
2.4× |
| Radiologic exam upr gi trc single contrast study (74240) |
$351.44 |
$702.88 |
2.1× |
| Radiologic examination femur 1 view (73551) |
$91.75 |
$183.50 |
1.1× |
| Radiologic examination tibia & fibula 2 views (73590) |
$93.38 |
$186.75 |
1.1× |
| Radiologic examination, internal auditory meati, complete Non-Facility (70134) |
$156.38 |
$312.75 |
0.3× |
| Radiologic examination, mastoids; complete, minimum of 3 views per side Non-Facility (70130) |
$349.38 |
$698.75 |
3.5× |
| Radiological examination surgical specimen (76098) |
$59 |
$118 |
0.1× |
| Ribs bilateral 3 views (71110) |
$141.75 |
$283.50 |
1.4× |
| Sacroiliac Joints < 3 Views (72200) |
$97.38 |
$194.75 |
1.0× |
| Scapula (73010) |
$96.62 |
$193.25 |
1.0× |
| Screening Digital Breast Tomosynthesis Bi (77063) |
$101.12 |
$202.25 |
4.3× |
| Sella turcica (70240) |
$93.38 |
$186.75 |
1.1× |
| Shoulder 1 view (73020) |
$81.50 |
$163 |
1.0× |
| Small bowel series (74250) |
$310.50 |
$621 |
1.8× |
| Spine thoracic 3 views (72072) |
$130 |
$260 |
1.3× |
| Thoracolumbar 2 views (72080) |
$141.38 |
$282.75 |
1.7× |
| Thyroid Uptake W/Blood Flow Sngle/Mult Quan Meas (78014) |
$695.38 |
$1,390.75 |
1.8× |
| Ultrasound breast complete (76641) |
$465.12 |
$930.25 |
4.6× |
| Ultrasound Exam Aaa Screen (76706) |
$438.62 |
$877.25 |
4.4× |
| Ultrasound, abdomen limited (76705) |
$275.56 |
$551.12 |
2.7× |
| Unlisted ultrasound procedure (76999) |
$185.88 |
$371.75 |
2.2× |
| Urethrocystogram voiding (74455) |
$295.75 |
$591.50 |
1.3× |
| Us breast unilateral limited (76642) |
$224 |
$448 |
2.7× |
| Us chest (76604) |
$280.75 |
$561.50 |
2.8× |
| Us lmtd joint/oth nonvasc xtr strux r-t w/img (76882) |
$381.12 |
$762.25 |
3.8× |
| Us ob detailed single fetus (76811) |
$732.38 |
$1,464.75 |
3.2× |
| Us ob limited (76815) |
$301.75 |
$603.50 |
3.0× |
| Us ob transvaginal (76817) |
$332 |
$664 |
3.3× |
| Us pelvic non ob complete (76856) |
$378.38 |
$756.75 |
3.8× |
| Us pelvic nonobstetric image dcmtn limited/f/u (76857) |
$323.38 |
$646.75 |
3.2× |
| Us pg uter img f&mat 14 wk tabdl 1/1st gestation (76801) |
$406.50 |
$813 |
4.1× |
| Us retroperitoneal complete (76770) |
$422.38 |
$844.75 |
4.2× |
| Us retroperitoneal limited (76775) |
$331 |
$662 |
3.3× |
| Us scrotum and contents (76870) |
$373.50 |
$747 |
3.7× |
| Us soft tissue head/neck (76536) |
$343.50 |
$687 |
3.4× |
| Us transrectal (76872) |
$372.50 |
$745 |
3.7× |
| Wrist 2 views (73100) |
$93.38 |
$186.75 |
1.1× |
| X-Ray Abdomen,Comp Acute Series - Xr Abdomen 2 Vws With Chest 1 View (74022) |
$158 |
$316 |
1.6× |
| X-Ray Ac Jts - Xr Acromioclavicular Joints Bilateral (73050) |
$121.50 |
$243 |
1.5× |
| X-Ray Colon Air Contrast - Fl Barium Enema Air Contrast (74280) |
$601.75 |
$1,203.50 |
3.6× |
| X-Ray Elbow 2 Vw - Xr Elbow 1-2 Views Right (73070) |
$91.25 |
$182.50 |
1.1× |
| X-Ray Exam Hip Uni 2-3 Views (73502) |
$209.88 |
$419.75 |
2.5× |
| X-Ray Exam Hips Bi 3-4 Views (73522) |
$164.25 |
$328.50 |
1.6× |
| X-ray exam of femur 2/> (73552) |
$99.88 |
$199.75 |
1.2× |
| X-ray eye for foreign body (70030) |
$181 |
$362 |
2.2× |
| X-Ray Facial Bones <3 Vw - Xr Facial Bones 1-2 Views (70140) |
$106 |
$212 |
1.3× |
| X-Ray Jaw <4 Vw - Xr Mandible < 4 Views (70100) |
$100.62 |
$201.25 |
1.2× |
| X-Ray Knee Bilat Standing - Xr Knees Anteroposterior Standing Bilat (73565) |
$98.50 |
$197 |
1.2× |
| X-ray leg, infant (73592) |
$92.25 |
$184.50 |
1.1× |
| X-Ray Lumbar Spine 2/3 Vw - Xr Lumbar Spine 2-3 Views (72100) |
$127.88 |
$255.75 |
1.3× |
| X-Ray Lumbar Spine 6+ Vw - Xr Lumbar Spine 6+ Vws Including Bending (72114) |
$230.62 |
$461.25 |
2.3× |
| X-ray nose-rectum child f.b. (76010) |
$95.38 |
$190.75 |
1.1× |
| X-Ray Orbits - Xr Orbits Complete 4+ Views (70200) |
$53.62 |
$107.25 |
0.5× |
| X-Ray Ribs 2 Vw Unilat - Xr Ribs 2 Views Right (71100) |
$110.12 |
$220.25 |
1.3× |
| X-Ray Ribs, Chest 3+ Vw - Xr Ribs 2 Vws Lt W/ Chest Anteroposterior (71101) |
$132.12 |
$264.25 |
1.3× |
| X-Ray Ribs, Chest 4+ Vw - Xr Ribs 3 Vws Bil W/ Chest Posteroanterior (71111) |
$173.75 |
$347.50 |
1.7× |
| X-Ray Sacroiliac Jts 3+ Vw - Xr Sacroiliac Joints 3+ Views (72202) |
$118 |
$236 |
1.2× |
| X-Ray Sacrum/Coccyx 2+ Vw - Xr Sacrum Coccyx 2+ Views (72220) |
$102.88 |
$205.75 |
1.2× |
| X-Ray Sinuses 3+ Vw - Xr Paranasal Sinuses 3+ Views (70220) |
$136.25 |
$272.50 |
1.6× |
| X-Ray Skull 4+ Vw - Xr Skull Complete 4+ Views (70260) |
$166.50 |
$333 |
1.7× |
| X-Ray Skull <4 Vw - Xr Skull 1-3 Views (70250) |
$120.12 |
$240.25 |
1.2× |
| X-Ray Spine One View - Xr Spine (72020) |
$80.12 |
$160.25 |
1.0× |
| X-Ray Sterno-Clavicluar Jt - Xr Sternoclavicular Joints 3+ Views (71130) |
$126.38 |
$252.75 |
1.5× |
| X-Ray Sternum 2+ Vw - Xr Sternum 2+ Views (71120) |
$115.12 |
$230.25 |
1.4× |
| X-Ray Thoracic Spine 2 Vw - Xr Thoracic Spine 2 Views (72070) |
$116 |
$232 |
1.2× |
| Xr bone length studies (77073) |
$136.25 |
$272.50 |
1.4× |
| Xr c-spine 4 or 5 views (72050) |
$172.62 |
$345.25 |
1.7× |
| Xr c-spine 6 or more views (72052) |
$216.50 |
$433 |
2.2× |
| Xr chest 4+ views (71048) |
$173.75 |
$347.50 |
1.7× |