| Abdomen 2 views (74019) |
$45.60 |
$91.20 |
0.5× |
| Angrph Cath F-Up Std Tcat Other Than Thrombylsis (75898) |
$299.75 |
$599.50 |
0.1× |
| Ankle 2 views (73600) |
$142.75 |
$285.50 |
1.9× |
| Antegrade urography radiological supvj & interpj (74425) |
$98.75 |
$197.50 |
0.3× |
| Arthrogram elbow (73085) |
$192.12 |
$384.25 |
0.6× |
| Arthrogram hip (73525) |
$211 |
$422 |
0.7× |
| Arthrogram wrist (73115) |
$365.38 |
$730.75 |
1.2× |
| Arthrography knee lt (73580) |
$170.62 |
$341.25 |
0.6× |
| Bone age studies (77072) |
$169.19 |
$338.38 |
1.8× |
| Bone Imaging 3 Phase (78315) |
$1,195.50 |
$2,391 |
3.4× |
| Cerebrospinal Fluid Flow W/O Matl Shunt Evaltj (78645) |
$450.50 |
$901 |
0.9× |
| Cervical spine 2 or 3 views (72040) |
$104.31 |
$208.62 |
1.4× |
| Chest 1 view (71045) |
$76 |
$152 |
1.0× |
| Chest 3 views (71047) |
$159.75 |
$319.50 |
2.1× |
| Clavicle complete (73000) |
$148 |
$296 |
1.9× |
| Computed Tomography Thorax Lw Dose Lng Ca Scr C- (71271) |
$81 |
$162 |
0.9× |
| CT angiography upper extremity lt (73206) |
$365.38 |
$730.75 |
2.4× |
| CT chest w/wo contrast (71270) |
$803.75 |
$1,607.50 |
5.2× |
| CT heart no contrast quant eval coronry calcium (75571) |
$50 |
$100 |
0.7× |
| CT iac w contrast (70481) |
$988 |
$1,976 |
6.4× |
| CT limited/localized follow up study (76380) |
$91.38 |
$182.75 |
1.2× |
| CT maxillofacial w/wo contrast (70488) |
$326 |
$652 |
2.1× |
| CT neck soft tissue w contrast (70491) |
$988 |
$1,976 |
6.4× |
| CTA lwr ext w&w/o contrast (73706) |
$365.38 |
$730.75 |
2.4× |
| Cta Pelvis (72191) |
$359.62 |
$719.25 |
2.3× |
| Cystography minimum 3 views rs&i (74430) |
$488 |
$976 |
1.6× |
| Diskography lumbar (72295) |
$207.88 |
$415.75 |
0.1× |
| Doppler Fetal Mid Cerebral Artery (76821) |
$211.94 |
$423.88 |
2.3× |
| Dxa bone density study 1/> sites axial skel (77080) |
$209.19 |
$418.38 |
2.3× |
| Dxa bone density study 1/>sites appendiclr skel (77081) |
$118.50 |
$237 |
1.6× |
| Dxa bone density study axial skeleton (77085) |
$156.06 |
$312.12 |
1.7× |
| Esophagus (74220) |
$224.75 |
$449.50 |
1.5× |
| Fetal biophysical profile non-stress testing (76818) |
$137.50 |
$275 |
1.5× |
| Fetal Biophysical Profile W/O Non-Stress Testing (76819) |
$137.50 |
$275 |
1.5× |
| Fluoroscopy up to 1 hr (76000) |
$99.25 |
$198.50 |
0.5× |
| Foot 2 views (73620) |
$108.62 |
$217.25 |
1.4× |
| Forearm 2 views (73090) |
$167.50 |
$335 |
2.2× |
| Hand 2 views (73120) |
$146 |
$292 |
1.6× |
| Hand 3 views (73130) |
$201 |
$402 |
2.6× |
| Humerus Min 2 Views Left (73060) |
$197 |
$394 |
2.6× |
| Hysterosalpingogram (74740) |
$246.25 |
$492.50 |
1.2× |
| Joint Survey, Single View - Xr Joint Anteroposterior 2+ Joints (77077) |
$163.38 |
$326.75 |
1.8× |
| Knee 3 views (73562) |
$201 |
$402 |
2.6× |
| Liver imaging w/vascular flow (78202) |
$536.50 |
$1,073 |
1.1× |
| Lymphoscintigraphy (78195) |
$675 |
$1,350 |
1.4× |
| Mammary ductogram or galactogram multiple (77054) |
$306.50 |
$613 |
1.5× |
| Mammary ductogram or galactogram single (77053) |
$255.25 |
$510.50 |
1.2× |
| Manual appl stress pfrmd phys/qhp joint films (77071) |
$73.05 |
$146.10 |
1.0× |
| Meckels Diverticulum (78290) |
$370.62 |
$741.25 |
1.1× |
| Neck soft tissue (70360) |
$151.50 |
$303 |
2.0× |
| Nm adrenal scan (78075) |
$330.75 |
$661.50 |
0.3× |
| Nuclear Rx Oral Admin (79005) |
$479.50 |
$959 |
2.3× |
| Ob Us Follow-Up Per Fetus - Us Ob Follow Up Transabdominal Approach (76816) |
$88 |
$176 |
1.0× |
| Osseous survey infant (77076) |
$139.94 |
$279.88 |
1.5× |
| Osseous survey limited (77074) |
$194 |
$388 |
2.1× |
| Pelvis 1 or 2 views (72170) |
$97.62 |
$195.25 |
1.1× |
| PET image w/CT, skull-thigh (78815) |
$1,652.75 |
$3,305.50 |
1.3× |
| PET imaging for CT attenuation whole body (78816) |
$1,652.75 |
$3,305.50 |
1.3× |
| Radex Entir Thrc Lmbr Crv Sac Spi W/Skull 1 Vw - Xr Scoliosis 1 Vw (72081) |
$117.50 |
$235 |
1.5× |
| Radex entir thrc lmbr crv sac spi w/skull 2/3 vw (72082) |
$194 |
$388 |
2.1× |
| Radex hips bilateral with pelvis 2 views (73521) |
$123.88 |
$247.77 |
1.4× |
| Radex mastoids compl minimum 3 views pr side (70130) |
$257.25 |
$514.50 |
2.8× |
| Radiolog exam mandible compl minimum 4 views (70110) |
$425.25 |
$850.50 |
4.6× |
| Radiologic Exam Abdomen 1 View - Xr Abdomen 1 View (74018) |
$86.69 |
$173.38 |
1.1× |
| Radiologic Exam Abdomen 3+ Views - Xr Abdomen 3+ Views (74021) |
$148.50 |
$297 |
1.6× |
| Radiologic Exam Chest 2 Views - Xr Chest 2 Views (71046) |
$88 |
$176 |
1.2× |
| Radiologic exam colon single contrast study (74270) |
$837 |
$1,674 |
5.4× |
| Radiologic exam upr gi trc single contrast study (74240) |
$168 |
$336 |
1.1× |
| Radiologic Examination Femur Minimum 2 Views - Xr Femur 2+ Vw Lt (73552) |
$99.75 |
$199.50 |
1.3× |
| Radiological examination surgical specimen (76098) |
$48.25 |
$96.50 |
0.1× |
| Ribs bilateral 3 views (71110) |
$283.50 |
$567 |
3.1× |
| Rp Therapy Intravenous Administration (79101) |
$479.50 |
$959 |
2.3× |
| Sacroiliac Joints < 3 Views (72200) |
$169 |
$338 |
1.8× |
| Scapula complete (73010) |
$188.50 |
$377 |
2.1× |
| Screening digital breast tomosynthesis (77063) |
$32.50 |
$65 |
1.4× |
| Sella turcica (70240) |
$101.88 |
$203.75 |
1.3× |
| Shuntogram indwelling nonvascular shunt rs&i (75809) |
$120.25 |
$240.50 |
1.3× |
| Small bowel series (74250) |
$167 |
$334 |
1.1× |
| Spine thoracic 3 views (72072) |
$261.50 |
$523 |
2.9× |
| Thoracolumbar 2 views (72080) |
$108.30 |
$216.60 |
1.4× |
| Thyroid carcinoma metastases img whole body (78018) |
$503.50 |
$1,007 |
1.1× |
| Tmj unilateral (70328) |
$212.62 |
$425.25 |
2.8× |
| Tumor Imaging, Limited Area - Nm Tumor Localization Limited (78800) |
$375 |
$750 |
1.1× |
| Ultrasound, abdomen limited (76705) |
$171 |
$342 |
1.9× |
| Umbilical-artery Doppler (OB) (76820) |
$96 |
$192 |
1.0× |
| Unlisted Diagnostic Radiographic Procedure (76499) |
$188 |
$376 |
2.5× |
| Unlisted fluoroscopic procedure (76496) |
$277.06 |
$554.12 |
3.6× |
| Unlisted Ultrasound Procedure (76999) |
$144.88 |
$289.75 |
1.9× |
| Upper Extremity Infant (73092) |
$131.75 |
$263.50 |
1.4× |
| Us abdl aorta screen aaa (76706) |
$135.61 |
$271.22 |
1.5× |
| Us breast unilateral complete (76641) |
$284 |
$568 |
3.1× |
| Us breast unilateral limited (76642) |
$284 |
$568 |
3.7× |
| Us chest (76604) |
$212.12 |
$424.25 |
2.3× |
| Us compl joint r-t w/image documentation (76881) |
$509.25 |
$1,018.50 |
5.6× |
| Us fetal nuchal translucency 1st gestation (76813) |
$88 |
$176 |
1.0× |
| Us guided compression repair (76936) |
$756.94 |
$1,513.88 |
4.0× |
| Us ob transvaginal (76817) |
$96 |
$192 |
1.0× |
| Us pelvic non ob complete (76856) |
$242 |
$484 |
2.6× |
| Us pelvic nonobstetric image dcmtn limited/f/u (76857) |
$144.88 |
$289.75 |
1.6× |
| Us pregnancy ltd (76815) |
$129.50 |
$259 |
1.4× |
| Us pregnant uterus 14 wk transabdl 1/1st gestat (76801) |
$96 |
$192 |
1.0× |
| Us retroperitoneal complete (76770) |
$211.87 |
$423.75 |
2.3× |
| Us retroperitoneal limited (76775) |
$115.06 |
$230.12 |
1.3× |
| Us scrotum and contents (76870) |
$317.12 |
$634.25 |
3.5× |
| Us soft tissue head/neck (76536) |
$127.12 |
$254.25 |
1.4× |
| Us transrectal (76872) |
$120 |
$240 |
1.3× |
| Us transrectal prostate volume (76873) |
$537.81 |
$1,075.62 |
5.9× |
| Venography extremity unilateral rs&i (75820) |
$546 |
$1,092 |
0.4× |
| Vertebral fracture assessment via dxa (77086) |
$157 |
$314 |
2.1× |
| Wrist 2 views (73100) |
$132.88 |
$265.75 |
1.7× |
| X-Ray Abdomen,Comp Acute Series - Xr Abdomen 2 Vws With Chest 1 View (74022) |
$167 |
$334 |
1.8× |
| X-Ray Ac Jts - Xr Acromioclavicular Joints Bilateral (73050) |
$136.05 |
$272.10 |
1.8× |
| X-Ray Ankle 3+ Vw - Xr Ankle 3+ Views Right (73610) |
$189 |
$378 |
2.5× |
| X-Ray Elbow 2 Vw - Xr Elbow 1-2 Views Right (73070) |
$140.75 |
$281.50 |
1.8× |
| X-Ray Elbow 3+ Vw - Xr Elbow 3+ Views Right (73080) |
$180.69 |
$361.38 |
2.4× |
| X-ray exam hip uni 1 view (73501) |
$90.25 |
$180.50 |
1.2× |
| X-Ray Exam Hip Uni 2-3 Views (73502) |
$117.50 |
$235 |
1.5× |
| X-ray exam hip uni 4/> views (73503) |
$183.12 |
$366.25 |
2.0× |
| X-Ray Exam Hips Bi 3-4 Views (73522) |
$110.25 |
$220.50 |
1.2× |
| X-ray exam of femur 1 (73551) |
$104 |
$208 |
1.4× |
| X-ray exam of small bowel - fl small bowel series enteroclysis tube (74251) |
$246.25 |
$492.50 |
1.6× |
| X-Ray Facial Bones 3+ Vw - Xr Facial Bones 3+ Views (70150) |
$277.50 |
$555 |
3.0× |
| X-Ray Facial Bones <3 Vw - Xr Facial Bones 1-2 Views (70140) |
$196.44 |
$392.88 |
2.6× |
| X-Ray Foot 3+ Vw - Xr Foot 3+ Views Right (73630) |
$189 |
$378 |
2.5× |
| X-Ray Heel - Xr Calcaneus 2 Views Right (73650) |
$142.75 |
$285.50 |
1.9× |
| X-Ray Knee 4+ View - Xr Knee 4+ Views Right (73564) |
$226 |
$452 |
2.5× |
| X-Ray Knee Bilat Standing - Xr Knees Anteroposterior Standing Bilat (73565) |
$117.50 |
$235 |
1.5× |
| X-Ray Leg, Infant - Xr Lower Extremity 2+ Views Infant Left (73592) |
$117.50 |
$235 |
1.5× |
| X-Ray Lumbar Spine 2/3 Vw - Xr Lumbar Spine 2-3 Views (72100) |
$213.12 |
$426.25 |
2.3× |
| X-Ray Nasal Bones - Xr Nasal Bones (70160) |
$188.50 |
$377 |
2.5× |
| X-Ray Nose-Rectum Child F.B. - Xr Nose to Rectum Foreign Body Peds (76010) |
$293.38 |
$586.75 |
3.8× |
| X-Ray Pelvis 3+ Vw - Xr Pelvis 3+ Views (72190) |
$170.12 |
$340.25 |
1.9× |
| X-Ray Renal Cyst Xlumbar+Contrst - Xr Renal Cyst Lumbar W Contrast (74470) |
$888.25 |
$1,776.50 |
1.9× |
| X-Ray Retrograde Pyelogram - Fl Pyelogram Retrograde (74420) |
$203.12 |
$406.25 |
0.7× |
| X-Ray Ribs 2 Vw Unilat - Xr Ribs 2 Views Right (71100) |
$217 |
$434 |
2.8× |
| X-Ray Ribs, Chest 3+ Vw - Xr Ribs 2 Vws Lt W/ Chest Anteroposterior (71101) |
$280.81 |
$561.62 |
3.1× |
| X-Ray Ribs, Chest 4+ Vw - Xr Ribs 3 Vws Bil W/ Chest Posteroanterior (71111) |
$361.25 |
$722.50 |
3.9× |
| X-Ray Sacroiliac Jts 3+ Vw - Xr Sacroiliac Joints 3+ Views (72202) |
$146.26 |
$292.52 |
1.6× |
| X-Ray Sacrum/Coccyx 2+ Vw - Xr Sacrum Coccyx 2+ Views (72220) |
$121.30 |
$242.60 |
1.6× |
| X-Ray Shoulder 2+ Vw - Xr Shoulder 2+ Views Right (73030) |
$198.50 |
$397 |
2.6× |
| X-Ray Sinuses 3+ Vw - Xr Paranasal Sinuses 3+ Views (70220) |
$160.80 |
$321.60 |
2.1× |
| X-Ray Sinuses <3 Vw - Xr Paranasal Sinuses 1-2 Views (70210) |
$140.75 |
$281.50 |
1.8× |
| X-Ray Skull 4+ Vw - Xr Skull Complete 4+ Views (70260) |
$174.76 |
$349.52 |
1.9× |
| X-Ray Skull <4 Vw - Xr Skull 1-3 Views (70250) |
$142.56 |
$285.12 |
1.6× |
| X-Ray Spine One View - Xr Spine (72020) |
$146 |
$292 |
1.9× |
| X-Ray Sterno-Clavicluar Jt - Xr Sternoclavicular Joints 3+ Views (71130) |
$45.60 |
$91.20 |
0.6× |
| X-Ray Sternum 2+ Vw - Xr Sternum 2+ Views (71120) |
$196.38 |
$392.75 |
2.6× |
| X-Ray Thoracic Spine 2 Vw - Xr Thoracic Spine 2 Views (72070) |
$213.12 |
$426.25 |
2.3× |
| X-Ray Toe(S) - Xr Toes 2+ Views Right (73660) |
$128.62 |
$257.25 |
1.7× |
| X-Ray Wrist 3+ Vw - Xr Wrist 3+ Views Right (73110) |
$178.25 |
$356.50 |
2.3× |
| Xr arthrogram ankle (73615) |
$168 |
$336 |
0.5× |
| Xr c-spine 6 or more views (72052) |
$232.51 |
$465.02 |
2.5× |
| Xr chest 4+ views (71048) |
$183.75 |
$367.50 |
2.0× |
| Xr finger(s) 2+ views (73140) |
$128.62 |
$257.25 |
1.7× |
| XR Mastoids < 3 Views Bilateral (70120) |
$188 |
$376 |
2.1× |
| Xr optic foramina (70190) |
$83.50 |
$167 |
1.1× |
| Xr shoulder 1 view (73020) |
$132.88 |
$265.75 |
1.7× |
| Xr spine cervical 4 or 5 views (72050) |
$75.52 |
$151.04 |
0.8× |
| Xr tibia/fibula 2 views (73590) |
$167.50 |
$335 |
2.2× |
| Xray knee 1 or 2 views rt (73560) |
$89.75 |
$179.50 |
1.2× |