| Abdomen 2 views (74019) |
$232.50 |
$465 |
2.3× |
| Ankle 2 views (73600) |
$150 |
$300 |
1.8× |
| Bone &/Joint Imaging Limited Area (78300) |
$417 |
$834 |
1.1× |
| Bone &/joint imaging whole body (78306) |
$771.50 |
$1,543 |
2.0× |
| Bone age studies (77072) |
$173.25 |
$346.50 |
1.7× |
| Bone Imaging 3 Phase (78315) |
$732 |
$1,464 |
1.9× |
| Bone survey complete (77075) |
$410.25 |
$820.50 |
4.1× |
| Bone survey infant (77076) |
$382.75 |
$765.50 |
3.8× |
| Card Bpi Gtd =Brm Plnr 1 Std Rest/Strs (78472) |
$775 |
$1,550 |
2.0× |
| Cervical spine 2 or 3 views (72040) |
$187.25 |
$374.50 |
2.2× |
| Chest 1 view (71045) |
$164.50 |
$329 |
2.0× |
| Cine/Vid X-Ray Throat/Esoph - Fl Esoph Barium Swlw W/ Video & Speech (74230) |
$384.50 |
$769 |
2.3× |
| Clavicle complete (73000) |
$219 |
$438 |
2.6× |
| CT abdomen and pelvis without and with contrast (74178) |
$1,690 |
$3,380 |
5.0× |
| CT abdomen and pelvis without contrast (74176) |
$1,334 |
$2,668 |
5.8× |
| CT abdomen w contrast (74160) |
$1,408.50 |
$2,817 |
8.4× |
| CT abdomen w wo contrast (74170) |
$1,681.50 |
$3,363 |
10.0× |
| CT abdomen w/o contrast (74150) |
$1,270 |
$2,540 |
12.7× |
| CT angio hrt w/3d image (75574) |
$1,036.75 |
$2,073.50 |
3.1× |
| CT angio lwr extr w/o&w/dye (73706) |
$228 |
$456 |
1.4× |
| CT angiography upper extremity lt (73206) |
$1,715.50 |
$3,431 |
10.2× |
| CT c-spine w/contrast (72126) |
$1,450 |
$2,900 |
4.3× |
| CT c-spine w/o contrast (72125) |
$1,325 |
$2,650 |
13.2× |
| CT cervical spine w&w/o contrast (72127) |
$1,694 |
$3,388 |
10.1× |
| CT chest w contrast (71260) |
$1,450 |
$2,900 |
8.6× |
| CT chest w/wo contrast (71270) |
$1,699.50 |
$3,399 |
10.1× |
| CT head/brain with contrast (70460) |
$1,442 |
$2,884 |
8.6× |
| CT head/brain without and with contrast (70470) |
$1,690 |
$3,380 |
10.0× |
| CT heart contrast eval cardiac structure&morph (75572) |
$868 |
$1,736 |
2.6× |
| CT heart w/o contrast quant eval coronary calcium (75571) |
$99 |
$198 |
1.2× |
| CT iac w contrast (70481) |
$1,325 |
$2,650 |
7.9× |
| CT lower ext w/o (73700) |
$628 |
$1,256 |
6.3× |
| CT lower extremity w wo contrast (73702) |
$1,121.50 |
$2,243 |
6.7× |
| CT lower extremity w/contrast material (73701) |
$885.50 |
$1,771 |
5.3× |
| CT lumbar spine w & w/o contrast (72133) |
$1,658.50 |
$3,317 |
9.9× |
| CT lumbar spine w/contrast (72132) |
$1,450 |
$2,900 |
4.3× |
| CT lumbar spine w/o contrast (72131) |
$1,325 |
$2,650 |
13.2× |
| CT maxillofacial w contrast (70487) |
$902 |
$1,804 |
5.4× |
| CT maxillofacial w/wo contrast (70488) |
$1,121.50 |
$2,243 |
6.7× |
| CT maxillofacial wo contrast (70486) |
$698.50 |
$1,397 |
7.0× |
| CT orbit sella/post fossa/ear w/o & w/contr matr (70482) |
$1,634 |
$3,268 |
9.7× |
| CT orbits w/o contrast (70480) |
$1,225.50 |
$2,451 |
12.2× |
| CT pelvis w/o contrast (72192) |
$1,121.50 |
$2,243 |
11.2× |
| CT pelvis w/wo contrast (72194) |
$1,577.50 |
$3,155 |
9.4× |
| CT scan of arm combo (73202) |
$1,694 |
$3,388 |
10.1× |
| CT soft tissue neck w contrast (70491) |
$902 |
$1,804 |
5.4× |
| CT soft tissue neck w/o & w/contrast material (70492) |
$1,121.50 |
$2,243 |
6.7× |
| CT soft tissue neck w/o contrast (70490) |
$698.50 |
$1,397 |
7.0× |
| CT thoracic spine w/contrast (72129) |
$1,576.50 |
$3,153 |
9.4× |
| CT thoracic spine w/o contrast (72128) |
$1,325 |
$2,650 |
13.2× |
| CT thoracic spine w/wo contrast (72130) |
$1,658.50 |
$3,317 |
9.9× |
| CT thorax w/o contrast (71250) |
$1,325 |
$2,650 |
13.2× |
| CT upper ext wo (73200) |
$733.50 |
$1,467 |
7.3× |
| CT upper extremity with contrast (73201) |
$885.50 |
$1,771 |
2.6× |
| Cta Aa&Bi Iliofem Lxtr Rs&I C-/C+ Post-Pxessing (75635) |
$1,037 |
$2,074 |
6.2× |
| Cta Abdomen (74175) |
$1,715.50 |
$3,431 |
10.2× |
| CTA abdomen pelvis (74174) |
$1,184 |
$2,368 |
3.5× |
| CTA chest (71275) |
$1,228.50 |
$2,457 |
7.3× |
| Cta Head (70496) |
$1,080 |
$2,160 |
6.4× |
| Cta Neck (70498) |
$1,080 |
$2,160 |
6.4× |
| Doppler Fetal Mid Cerebral Artery (76821) |
$222 |
$444 |
2.2× |
| Dxa bone density study 1/> sites axial skel (77080) |
$253.25 |
$506.50 |
2.5× |
| Dxa bone density study 1/>sites appendiclr skel (77081) |
$214.75 |
$429.50 |
2.6× |
| Echo exam of eye (76529) |
$88.50 |
$177 |
1.1× |
| Esophagus (74220) |
$284.25 |
$568.50 |
1.7× |
| Facial bones min 3 views (70150) |
$173.25 |
$346.50 |
1.7× |
| Fetal biophysical profile non-stress testing (76818) |
$187.25 |
$374.50 |
1.9× |
| Fetal Biophysical Profile W/O Non-Stress Testing (76819) |
$193 |
$386 |
1.9× |
| Fluoroscopy up to 1 hr (76000) |
$427 |
$854 |
1.9× |
| Foot 2 views (73620) |
$141 |
$282 |
1.7× |
| Forearm 2 views (73090) |
$211.25 |
$422.50 |
2.5× |
| Hand 2 views (73120) |
$130.50 |
$261 |
1.3× |
| Hepatobil Syst Imag Inc Gb W/Pharma Intervenj (78227) |
$645.50 |
$1,291 |
1.2× |
| Hepatobiliary syst imaging including gallbladder (78226) |
$603 |
$1,206 |
1.6× |
| Kidney img morphology vascular flow 1 w/rx (78708) |
$791 |
$1,582 |
1.5× |
| Knee 3 views (73562) |
$219 |
$438 |
2.6× |
| Liver & spleen imaging static only (78215) |
$508 |
$1,016 |
1.3× |
| Magnetic resonance (eg, proton) imaging, upper extremity, other than joint; without contrast material(s), followed by… (73220) |
$1,544.50 |
$3,089 |
4.6× |
| MRA head w & w/o contrast (70546) |
$2,273.50 |
$4,547 |
6.8× |
| MRA head w/o contrast (70544) |
$1,516 |
$3,032 |
6.6× |
| Mra Neck W/O &W/Contrast Material (70549) |
$2,273.50 |
$4,547 |
6.8× |
| MRA neck w/o contrast (70547) |
$1,516 |
$3,032 |
6.6× |
| MRI abdomen w/o & w/contrast material (74183) |
$2,415.50 |
$4,831 |
7.2× |
| MRI abdomen w/o contrast (74181) |
$1,544.50 |
$3,089 |
6.7× |
| MRI any jt lower extrem w/o & w/contrast matrl (73723) |
$1,544.50 |
$3,089 |
4.6× |
| MRI cervical spine w/o contrast (72141) |
$1,544.50 |
$3,089 |
6.7× |
| MRI chest w/o contrast (71550) |
$1,544.50 |
$3,089 |
6.7× |
| MRI lower extrem oth/thn jt w/o & w/contr matr (73720) |
$1,544.50 |
$3,089 |
4.6× |
| MRI lower extrem oth/thn jt w/o contr matrl (73718) |
$1,544.50 |
$3,089 |
6.7× |
| MRI orbit face &/neck w/o contrast (70540) |
$1,544.50 |
$3,089 |
6.7× |
| MRI orbit/face/neck w&w/o cont (70543) |
$1,544.50 |
$3,089 |
4.6× |
| MRI pelvis w/o & w/contrast material (72197) |
$1,917 |
$3,834 |
5.7× |
| MRI pelvis w/o contrast (72195) |
$1,544.50 |
$3,089 |
6.7× |
| MRI spinal canal cervical w/o & w/contr matrl (72156) |
$2,415.50 |
$4,831 |
7.2× |
| MRI spinal canal lumbar w/contrast material (72149) |
$1,800 |
$3,600 |
5.4× |
| MRI spinal canal lumbar w/o & w/contr matrl (72158) |
$1,971.50 |
$3,943 |
5.9× |
| MRI spinal canal thoracic w/o & w/contr matrl (72157) |
$2,415.50 |
$4,831 |
7.2× |
| MRI temporomandibular joint (70336) |
$945 |
$1,890 |
4.1× |
| MRI thoracic spine w/o contrast (72146) |
$1,544.50 |
$3,089 |
6.7× |
| MRI up ext w/o contrast (73218) |
$1,544.50 |
$3,089 |
6.7× |
| MRI upper ext joint w/o contrast (73221) |
$1,544.50 |
$3,089 |
6.7× |
| MRI, joint upper extrem combo (73223) |
$1,330 |
$2,660 |
4.0× |
| Myocardial Spect Multiple Studies (78452) |
$1,430.50 |
$2,861 |
1.2× |
| N-invas est c ffr sw aly CTA (75580) |
$1,736 |
$3,472 |
2.1× |
| Neck soft tissue (70360) |
$128.75 |
$257.50 |
1.5× |
| Nm gastric emptying study (78264) |
$732 |
$1,464 |
1.9× |
| Ob us nuchal meas 1 gest (76813) |
$131.75 |
$263.50 |
1.3× |
| Parathyroid Planar Imaging (78070) |
$401.50 |
$803 |
1.0× |
| Pelvis 1 or 2 views (72170) |
$189 |
$378 |
1.9× |
| PET image w/CT, skull-thigh (78815) |
$1,611.75 |
$3,223.50 |
1.2× |
| PET imaging for CT attenuation whole body (78816) |
$1,826 |
$3,652 |
1.3× |
| Pulmonary Ventilation & Perfusion Imaging (78582) |
$830 |
$1,660 |
1.6× |
| Quan&charac c atherosclerotc plaq asses sev c ds (75577) |
$891 |
$1,782 |
1.0× |
| Radex Ankle Compl Minimum 3 Views (73610) |
$188 |
$376 |
2.3× |
| Radex Calcaneus Minimum 2 Views (73650) |
$159.75 |
$319.50 |
1.9× |
| Radex Elbw Compl Minimum 3 Views (73080) |
$143.75 |
$287.50 |
1.7× |
| Radex Entir Thrc Lmbr Crv Sac Spi W/Skull 1 Vw - Xr Scoliosis 1 Vw (72081) |
$110 |
$220 |
1.3× |
| Radex entir thrc lmbr crv sac spi w/skull 2/3 vw (72082) |
$113 |
$226 |
1.1× |
| Radex fingr minimum 2 views (73140) |
$143.75 |
$287.50 |
1.7× |
| Radex Foot Compl Minimum 3 Views (73630) |
$191 |
$382 |
2.3× |
| Radex Hand Minimum 3 Views (73130) |
$236.75 |
$473.50 |
2.8× |
| Radex Hip Unilateral With Pelvis 1 View (73501) |
$193.50 |
$387 |
2.3× |
| Radex Hip Unilateral With Pelvis Minimum 4 Views (73503) |
$149.50 |
$299 |
1.5× |
| Radex Hips Bilateral With Pelvis 2 Views (73521) |
$149.50 |
$299 |
1.5× |
| Radex Hips Bilateral With Pelvis Minimum 5 Views (73523) |
$214.50 |
$429 |
2.1× |
| Radex Humerus Minimum 2 Views (73060) |
$184.25 |
$368.50 |
2.2× |
| Radex Kne 1/2 Views (73560) |
$171.50 |
$343 |
2.1× |
| Radex Kne Compl 4/More Views (73564) |
$188 |
$376 |
1.9× |
| Radex Mndbl Compl Minimum 4 Views (70110) |
$196 |
$392 |
2.0× |
| Radex Nasal Bones Complete Minimum 3 Views (70160) |
$143.25 |
$286.50 |
1.7× |
| Radex Pelvis Compl Minimum 3 Views (72190) |
$159.50 |
$319 |
1.6× |
| Radex Sho Compl Minimum 2 Views (73030) |
$189 |
$378 |
2.3× |
| Radex Sinuses Paransl < 3 Views (70210) |
$207.50 |
$415 |
2.5× |
| Radex Temporomandble Jt Opn & Clsd Mouth Bilat (70330) |
$196 |
$392 |
2.3× |
| Radex Toe Minimum 2 Views (73660) |
$116.25 |
$232.50 |
1.4× |
| Radex upper extremity infant minimum 2 views (73092) |
$158.75 |
$317.50 |
1.6× |
| Radex Wrst Compl Minimum 3 Views (73110) |
$164 |
$328 |
2.0× |
| Radex X-Ray Exam Entire Spi 6/> Vw - Xr Entire Spine 6+ Vw (72084) |
$179.50 |
$359 |
1.8× |
| Radiologic Exam Abdomen 1 View - Xr Abdomen 1 View (74018) |
$165 |
$330 |
2.0× |
| Radiologic Exam Abdomen 3+ Views - Xr Abdomen 3+ Views (74021) |
$260.50 |
$521 |
2.6× |
| Radiologic exam chest 2 views (71046) |
$211.25 |
$422.50 |
2.5× |
| Radiologic exam colon single contrast study (74270) |
$411.50 |
$823 |
2.4× |
| Radiologic Exam Esophagus Double Contrast Study (74221) |
$271.25 |
$542.50 |
1.6× |
| Radiologic exam upr gi trc double contrast study (74246) |
$282.75 |
$565.50 |
1.7× |
| Radiologic exam upr gi trc single contrast study (74240) |
$375 |
$750 |
2.2× |
| Radiologic examination femur 1 view (73551) |
$184.50 |
$369 |
2.2× |
| Radiologic examination tibia & fibula 2 views (73590) |
$191 |
$382 |
2.3× |
| Radiological examination surgical specimen (76098) |
$434.25 |
$868.50 |
0.8× |
| Ribs bilateral 3 views (71110) |
$214.50 |
$429 |
2.1× |
| Rp loclzj tum spect 1 area single day imaging (78803) |
$2,328.50 |
$4,657 |
4.5× |
| Saline Infus Sonohysterography W/Color Doppler (76831) |
$396.75 |
$793.50 |
1.7× |
| Scapula (73010) |
$193.50 |
$387 |
1.9× |
| Screening Digital Breast Tomosynthesis Bi (77063) |
$44.50 |
$89 |
1.9× |
| Shoulder 1 view (73020) |
$137 |
$274 |
1.6× |
| Small bowel series (74250) |
$302 |
$604 |
1.8× |
| Spine thoracic 3 views (72072) |
$251.50 |
$503 |
2.5× |
| Thoracolumbar 2 views (72080) |
$142.75 |
$285.50 |
1.7× |
| Thyroid Uptake W/Blood Flow Sngle/Mult Quan Meas (78014) |
$478 |
$956 |
1.2× |
| Ultrasound Exam Aaa Screen (76706) |
$339.25 |
$678.50 |
3.4× |
| Ultrasound, abdomen limited (76705) |
$326.75 |
$653.50 |
3.3× |
| Umbilical-artery Doppler (OB) (76820) |
$201.75 |
$403.50 |
2.0× |
| Urethrocystogram voiding (74455) |
$837 |
$1,674 |
3.7× |
| Us breast unilateral limited (76642) |
$230.50 |
$461 |
2.8× |
| Us chest (76604) |
$242.25 |
$484.50 |
2.4× |
| Us encephalogram (76506) |
$280 |
$560 |
2.8× |
| Us lmtd joint/oth nonvasc xtr strux r-t w/img (76882) |
$318 |
$636 |
3.2× |
| Us ob detailed single fetus (76811) |
$455.50 |
$911 |
2.0× |
| Us ob limited (76815) |
$235 |
$470 |
2.3× |
| Us ob transvaginal (76817) |
$230.75 |
$461.50 |
2.3× |
| Us pelvic non ob complete (76856) |
$475.50 |
$951 |
4.7× |
| Us pelvic nonobstetric image dcmtn limited/f/u (76857) |
$314.50 |
$629 |
3.1× |
| Us pg uter img f&mat 14 wk tabdl 1/1st gestation (76801) |
$151 |
$302 |
1.5× |
| Us pg uter r-t img f-up tabdl appr pr fetus (76816) |
$319 |
$638 |
3.2× |
| Us retroperitoneal complete (76770) |
$475.50 |
$951 |
4.7× |
| Us retroperitoneal limited (76775) |
$451 |
$902 |
4.5× |
| Us scrotum and contents (76870) |
$313.75 |
$627.50 |
3.1× |
| Us soft tissue head/neck (76536) |
$291 |
$582 |
2.9× |
| Us, eye b-scan (76512) |
$179 |
$358 |
1.8× |
| Us,transplanted kidney, real time/ doppler (76776) |
$511.50 |
$1,023 |
5.1× |
| Wrist 2 views (73100) |
$212.25 |
$424.50 |
2.5× |
| X-Ray Abdomen,Comp Acute Series - Xr Abdomen 2 Vws With Chest 1 View (74022) |
$232.50 |
$465 |
2.3× |
| X-Ray Ac Jts - Xr Acromioclavicular Joints Bilateral (73050) |
$219 |
$438 |
2.6× |
| X-Ray Colon Air Contrast - Fl Barium Enema Air Contrast (74280) |
$639 |
$1,278 |
3.8× |
| X-Ray Elbow 2 Vw - Xr Elbow 1-2 Views Right (73070) |
$131.25 |
$262.50 |
1.6× |
| X-Ray Exam Hip Uni 2-3 Views (73502) |
$115 |
$230 |
1.4× |
| X-Ray Exam Hips Bi 3-4 Views (73522) |
$283.25 |
$566.50 |
2.8× |
| X-ray exam of femur 2/> (73552) |
$195 |
$390 |
2.3× |
| X-ray eye for foreign body (70030) |
$180.50 |
$361 |
2.2× |
| X-Ray Facial Bones <3 Vw - Xr Facial Bones 1-2 Views (70140) |
$134 |
$268 |
1.6× |
| X-ray leg, infant (73592) |
$171.50 |
$343 |
2.1× |
| X-Ray Lumbar Spine 2/3 Vw - Xr Lumbar Spine 2-3 Views (72100) |
$251.50 |
$503 |
2.5× |
| X-Ray Lumbar Spine 6+ Vw - Xr Lumbar Spine 6+ Vws Including Bending (72114) |
$276.50 |
$553 |
2.8× |
| X-ray nose-rectum child f.b. (76010) |
$165 |
$330 |
2.0× |
| X-Ray Orbits - Xr Orbits Complete 4+ Views (70200) |
$215 |
$430 |
2.1× |
| X-Ray Ribs 2 Vw Unilat - Xr Ribs 2 Views Right (71100) |
$136 |
$272 |
1.6× |
| X-Ray Ribs, Chest 3+ Vw - Xr Ribs 2 Vws Lt W/ Chest Anteroposterior (71101) |
$207 |
$414 |
2.1× |
| X-Ray Ribs, Chest 4+ Vw - Xr Ribs 3 Vws Bil W/ Chest Posteroanterior (71111) |
$194.50 |
$389 |
1.9× |
| X-Ray Sacroiliac Jts 3+ Vw - Xr Sacroiliac Joints 3+ Views (72202) |
$133.25 |
$266.50 |
1.3× |
| X-Ray Sacrum/Coccyx 2+ Vw - Xr Sacrum Coccyx 2+ Views (72220) |
$168 |
$336 |
2.0× |
| X-Ray Sinuses 3+ Vw - Xr Paranasal Sinuses 3+ Views (70220) |
$227.25 |
$454.50 |
2.7× |
| X-Ray Skull 4+ Vw - Xr Skull Complete 4+ Views (70260) |
$239.75 |
$479.50 |
2.4× |
| X-Ray Skull <4 Vw - Xr Skull 1-3 Views (70250) |
$165.50 |
$331 |
1.7× |
| X-Ray Sterno-Clavicluar Jt - Xr Sternoclavicular Joints 3+ Views (71130) |
$251.50 |
$503 |
3.0× |
| X-Ray Sternum 2+ Vw - Xr Sternum 2+ Views (71120) |
$216.75 |
$433.50 |
2.6× |
| X-Ray Thoracic Spine 4 Vw - Xr Thoracic Spine Complete 4+ Views (72074) |
$161.75 |
$323.50 |
1.6× |
| Xr bone length studies (77073) |
$106.25 |
$212.50 |
1.1× |
| Xr c-spine 4 or 5 views (72050) |
$251.50 |
$503 |
2.5× |
| Xr c-spine 6 or more views (72052) |
$251.50 |
$503 |
2.5× |