| Abdomen 2 views (74019) |
$254.25 |
$508.50 |
2.5× |
| Acute gi blood loss imaging (78278) |
$882 |
$1,764 |
2.3× |
| Ankle 2 views (73600) |
$114.75 |
$229.50 |
1.4× |
| Bone &/Joint Imaging Limited Area (78300) |
$611 |
$1,222 |
1.6× |
| Bone &/joint imaging whole body (78306) |
$772 |
$1,544 |
2.0× |
| Bone age studies (77072) |
$124.50 |
$249 |
1.2× |
| Bone Imaging 3 Phase (78315) |
$874.50 |
$1,749 |
2.3× |
| Bone survey complete (77075) |
$363.50 |
$727 |
3.6× |
| Bone survey infant (77076) |
$361.50 |
$723 |
3.6× |
| Bowel imaging (78290) |
$510 |
$1,020 |
1.3× |
| Card Bpi Gtd =Brm Plnr 1 Std Rest/Strs (78472) |
$695 |
$1,390 |
1.8× |
| Cervical spine 2 or 3 views (72040) |
$146 |
$292 |
1.7× |
| Chest 1 view (71045) |
$115.50 |
$231 |
1.4× |
| Chest xray 3 views (71047) |
$192 |
$384 |
2.3× |
| Cine/Vid X-Ray Throat/Esoph - Fl Esoph Barium Swlw W/ Video & Speech (74230) |
$246.50 |
$493 |
1.5× |
| Clavicle complete (73000) |
$124.50 |
$249 |
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) |
$1,458 |
$2,916 |
4.4× |
| CT abdomen and pelvis without contrast (74176) |
$1,020 |
$2,040 |
4.5× |
| CT abdomen w contrast (74160) |
$1,204 |
$2,408 |
7.2× |
| CT abdomen w wo contrast (74170) |
$1,458 |
$2,916 |
8.7× |
| CT abdomen w/o contrast (74150) |
$1,020 |
$2,040 |
10.2× |
| CT angio lwr extr w/o&w/dye (73706) |
$1,400.50 |
$2,801 |
8.3× |
| CT angiography upper extremity lt (73206) |
$1,400.50 |
$2,801 |
8.3× |
| CT c-spine w/contrast (72126) |
$896 |
$1,792 |
2.7× |
| CT c-spine w/o contrast (72125) |
$737 |
$1,474 |
7.3× |
| CT cervical spine w&w/o contrast (72127) |
$933 |
$1,866 |
5.5× |
| CT chest w contrast (71260) |
$1,229 |
$2,458 |
7.3× |
| CT chest w/wo contrast (71270) |
$1,507 |
$3,014 |
9.0× |
| CT head/brain with contrast (70460) |
$709.50 |
$1,419 |
4.2× |
| CT head/brain without and with contrast (70470) |
$867 |
$1,734 |
5.2× |
| CT heart contrast eval cardiac structure&morph (75572) |
$1,595.50 |
$3,191 |
4.8× |
| CT heart w/o contrast quant eval coronary calcium (75571) |
$99 |
$198 |
1.2× |
| CT iac w contrast (70481) |
$896 |
$1,792 |
5.3× |
| CT lower ext w/o (73700) |
$903.50 |
$1,807 |
9.0× |
| CT lower extremity w wo contrast (73702) |
$1,329.50 |
$2,659 |
7.9× |
| CT lower extremity w/contrast material (73701) |
$1,912.50 |
$3,825 |
11.4× |
| CT lumbar spine w & w/o contrast (72133) |
$1,329.50 |
$2,659 |
7.9× |
| CT lumbar spine w/contrast (72132) |
$1,227 |
$2,454 |
3.7× |
| CT lumbar spine w/o contrast (72131) |
$1,051 |
$2,102 |
10.5× |
| CT maxillofacial w contrast (70487) |
$896 |
$1,792 |
5.3× |
| CT maxillofacial w/wo contrast (70488) |
$886 |
$1,772 |
5.3× |
| CT maxillofacial wo contrast (70486) |
$617.50 |
$1,235 |
6.2× |
| CT orbit sella/post fossa/ear w/o & w/contr matr (70482) |
$933 |
$1,866 |
5.5× |
| CT orbits w/o contrast (70480) |
$637 |
$1,274 |
6.4× |
| CT pelvis w/o contrast (72192) |
$1,037 |
$2,074 |
10.3× |
| CT pelvis w/wo contrast (72194) |
$1,423.50 |
$2,847 |
8.5× |
| CT scan of arm combo (73202) |
$1,329.50 |
$2,659 |
7.9× |
| CT soft tissue neck w contrast (70491) |
$741 |
$1,482 |
4.4× |
| CT soft tissue neck w/o & w/contrast material (70492) |
$890 |
$1,780 |
5.3× |
| CT soft tissue neck w/o contrast (70490) |
$635.50 |
$1,271 |
6.3× |
| CT thoracic spine w/contrast (72129) |
$1,224.50 |
$2,449 |
7.3× |
| CT thoracic spine w/o contrast (72128) |
$1,050.50 |
$2,101 |
10.5× |
| CT thorax w/o contrast (71250) |
$1,050.50 |
$2,101 |
10.5× |
| CT upper ext wo (73200) |
$903.50 |
$1,807 |
9.0× |
| CT upper extremity with contrast (73201) |
$1,277 |
$2,554 |
3.8× |
| Cta Aa&Bi Iliofem Lxtr Rs&I C-/C+ Post-Pxessing (75635) |
$2,192 |
$4,384 |
13.0× |
| Cta Abdomen (74175) |
$1,543 |
$3,086 |
9.2× |
| CTA abdomen pelvis (74174) |
$1,157 |
$2,314 |
3.5× |
| CTA chest (71275) |
$1,595.50 |
$3,191 |
9.5× |
| Cta Head (70496) |
$1,095 |
$2,190 |
6.5× |
| Cta Neck (70498) |
$1,282 |
$2,564 |
7.6× |
| Cta Pelvis (72191) |
$1,527 |
$3,054 |
9.1× |
| Dxa bone density study 1/> sites axial skel (77080) |
$293.75 |
$587.50 |
2.9× |
| Echo exam of eye (76529) |
$85.75 |
$171.50 |
1.0× |
| Esophagus (74220) |
$233 |
$466 |
1.4× |
| Facial bones min 3 views (70150) |
$184.25 |
$368.50 |
1.8× |
| Fluoroscopy up to 1 hr (76000) |
$421.50 |
$843 |
1.8× |
| Foot 2 views (73620) |
$136 |
$272 |
1.6× |
| Forearm 2 views (73090) |
$122.50 |
$245 |
1.5× |
| Hand 2 views (73120) |
$119 |
$238 |
1.2× |
| Hepatobil Syst Imag Inc Gb W/Pharma Intervenj (78227) |
$1,068 |
$2,136 |
2.1× |
| Hepatobiliary syst imaging including gallbladder (78226) |
$681 |
$1,362 |
1.8× |
| Kidney Img Morphology Vascular Flow 1 W/O Rx (78707) |
$819.50 |
$1,639 |
1.6× |
| Kidney img morphology vascular flow 1 w/rx (78708) |
$819.50 |
$1,639 |
1.6× |
| Knee 3 views (73562) |
$161 |
$322 |
1.9× |
| Magnetic resonance (eg, proton) imaging, any joint of upper extremity; with contrast material(s) Non-Facility (73222) |
$1,398 |
$2,796 |
1.9× |
| Magnetic resonance (eg, proton) imaging, upper extremity, other than joint; with contrast material(s) Non-Facility (73219) |
$1,398 |
$2,796 |
4.2× |
| Magnetic resonance (eg, proton) imaging, upper extremity, other than joint; without contrast material(s), followed by… (73220) |
$1,690.50 |
$3,381 |
5.1× |
| MRA head w & w/o contrast (70546) |
$1,690.50 |
$3,381 |
5.1× |
| MRA head w/o contrast (70544) |
$1,040.50 |
$2,081 |
4.5× |
| MRA neck w contrast (70548) |
$1,398 |
$2,796 |
4.2× |
| Mra Neck W/O &W/Contrast Material (70549) |
$1,690.50 |
$3,381 |
5.1× |
| MRA neck w/o contrast (70547) |
$1,040.50 |
$2,081 |
4.5× |
| MRI abdomen w contrast (74182) |
$1,398 |
$2,796 |
4.2× |
| MRI abdomen w/o & w/contrast material (74183) |
$1,690.50 |
$3,381 |
5.1× |
| MRI abdomen w/o contrast (74181) |
$1,040.50 |
$2,081 |
4.5× |
| MRI any jt lower extrem w/contrast material (73722) |
$1,398 |
$2,796 |
1.9× |
| MRI any jt lower extrem w/o & w/contrast matrl (73723) |
$1,690.50 |
$3,381 |
5.1× |
| MRI c-spine with contrast (72142) |
$1,398 |
$2,796 |
4.2× |
| MRI cervical spine w/o contrast (72141) |
$1,040.50 |
$2,081 |
4.5× |
| MRI chest w/o & w/contrast material (71552) |
$1,690.50 |
$3,381 |
5.1× |
| MRI chest w/o contrast (71550) |
$1,040.50 |
$2,081 |
4.5× |
| MRI lower extrem oth/thn jt w/o & w/contr matr (73720) |
$1,690.50 |
$3,381 |
5.1× |
| MRI lower extrem oth/thn jt w/o contr matrl (73718) |
$1,040.50 |
$2,081 |
4.5× |
| MRI orbit face &/neck w/o contrast (70540) |
$1,040.50 |
$2,081 |
4.5× |
| MRI orbit/face/neck w&w/o cont (70543) |
$1,690.50 |
$3,381 |
5.1× |
| MRI pelvis w/o & w/contrast material (72197) |
$1,690.50 |
$3,381 |
5.1× |
| MRI pelvis w/o contrast (72195) |
$1,040.50 |
$2,081 |
4.5× |
| MRI spinal canal cervical w/o & w/contr matrl (72156) |
$1,690.50 |
$3,381 |
5.1× |
| MRI spinal canal lumbar w/contrast material (72149) |
$1,398 |
$2,796 |
4.2× |
| MRI spinal canal lumbar w/o & w/contr matrl (72158) |
$1,690.50 |
$3,381 |
5.1× |
| MRI spinal canal thoracic w/o & w/contr matrl (72157) |
$1,690.50 |
$3,381 |
5.1× |
| MRI thoracic spine w/o contrast (72146) |
$1,040.50 |
$2,081 |
4.5× |
| MRI up ext w/o contrast (73218) |
$1,560.75 |
$3,121.50 |
6.8× |
| MRI upper ext joint w/o contrast (73221) |
$1,040.50 |
$2,081 |
4.5× |
| MRI, joint upper extrem combo (73223) |
$1,690.50 |
$3,381 |
5.1× |
| Myocardial Spect Multiple Studies (78452) |
$1,751.50 |
$3,503 |
1.4× |
| Myocardial spect single study at rest or stress (78451) |
$1,426.50 |
$2,853 |
1.1× |
| N-invas est c ffr sw aly CTA (75580) |
$1,054.50 |
$2,109 |
1.3× |
| Neck soft tissue (70360) |
$84.75 |
$169.50 |
1.0× |
| Nm gastric emptying study (78264) |
$498 |
$996 |
1.3× |
| Nonvascular shunt X-ray (75809) |
$107 |
$214 |
1.1× |
| Ophthalmic ultrasound, diagnostic; anterior segment ultrasound, immersion (water bath) B-scan or high resolution… (76513) |
$118.50 |
$237 |
1.2× |
| Parathyrd planar w/spect&CT (78072) |
$755 |
$1,510 |
1.4× |
| Parathyroid Planar Imaging (78070) |
$416.50 |
$833 |
1.1× |
| Pelvis 1 or 2 views (72170) |
$121 |
$242 |
1.2× |
| PET image w/CT, skull-thigh (78815) |
$1,450 |
$2,900 |
1.1× |
| PET imaging for CT attenuation whole body (78816) |
$1,502.50 |
$3,005 |
1.1× |
| Pulmonary Perfusion Imaging Particulate (78580) |
$629 |
$1,258 |
1.6× |
| Pulmonary Ventilation & Perfusion Imaging (78582) |
$507 |
$1,014 |
1.0× |
| Quan&charac c atherosclerotc plaq asses sev c ds (75577) |
$891 |
$1,782 |
1.0× |
| Radex Ankle Compl Minimum 3 Views (73610) |
$131 |
$262 |
1.6× |
| Radex Calcaneus Minimum 2 Views (73650) |
$129.75 |
$259.50 |
1.6× |
| Radex Elbw Compl Minimum 3 Views (73080) |
$141.50 |
$283 |
1.7× |
| Radex Entir Thrc Lmbr Crv Sac Spi W/Skull 1 Vw - Xr Scoliosis 1 Vw (72081) |
$129.75 |
$259.50 |
1.6× |
| Radex entir thrc lmbr crv sac spi w/skull 2/3 vw (72082) |
$172.75 |
$345.50 |
1.7× |
| Radex Entir Thrc Lmbr Crv Sac Spi W/Skull 4/5 Vw (72083) |
$282.25 |
$564.50 |
2.8× |
| Radex fingr minimum 2 views (73140) |
$97.25 |
$194.50 |
1.2× |
| Radex Foot Compl Minimum 3 Views (73630) |
$135.50 |
$271 |
1.6× |
| Radex Hand Minimum 3 Views (73130) |
$140.50 |
$281 |
1.7× |
| Radex Hip Unilateral With Pelvis 1 View (73501) |
$114.25 |
$228.50 |
1.4× |
| Radex Hip Unilateral With Pelvis Minimum 4 Views (73503) |
$289.50 |
$579 |
2.9× |
| Radex Hips Bilateral With Pelvis 2 Views (73521) |
$280.75 |
$561.50 |
2.8× |
| Radex Hips Bilateral With Pelvis Minimum 5 Views (73523) |
$279.25 |
$558.50 |
2.8× |
| Radex Humerus Minimum 2 Views (73060) |
$132.50 |
$265 |
1.6× |
| Radex Kne 1/2 Views (73560) |
$139.50 |
$279 |
1.7× |
| Radex Kne Compl 4/More Views (73564) |
$174.50 |
$349 |
1.7× |
| Radex Mndbl Compl Minimum 4 Views (70110) |
$155.25 |
$310.50 |
1.5× |
| Radex Nasal Bones Complete Minimum 3 Views (70160) |
$121 |
$242 |
1.4× |
| Radex Pelvis Compl Minimum 3 Views (72190) |
$155.25 |
$310.50 |
1.5× |
| Radex Sho Compl Minimum 2 Views (73030) |
$146 |
$292 |
1.7× |
| Radex Sinuses Paransl < 3 Views (70210) |
$139.25 |
$278.50 |
1.7× |
| Radex Temporomandble Jt Opn & Clsd Mouth Bilat (70330) |
$189 |
$378 |
2.3× |
| Radex Toe Minimum 2 Views (73660) |
$101 |
$202 |
1.2× |
| Radex Wrst Compl Minimum 3 Views (73110) |
$134 |
$268 |
1.6× |
| Radex X-Ray Exam Entire Spi 6/> Vw - Xr Entire Spine 6+ Vw (72084) |
$293.75 |
$587.50 |
2.9× |
| Radiologic Exam Abdomen 1 View - Xr Abdomen 1 View (74018) |
$101.50 |
$203 |
1.2× |
| Radiologic Exam Abdomen 3+ Views - Xr Abdomen 3+ Views (74021) |
$203 |
$406 |
2.0× |
| Radiologic exam chest 2 views (71046) |
$144.25 |
$288.50 |
1.7× |
| Radiologic exam colon single contrast study (74270) |
$339.50 |
$679 |
2.0× |
| Radiologic Exam Esophagus Double Contrast Study (74221) |
$221 |
$442 |
1.3× |
| Radiologic exam upr gi trc double contrast study (74246) |
$340.50 |
$681 |
2.0× |
| Radiologic exam upr gi trc single contrast study (74240) |
$307.75 |
$615.50 |
1.8× |
| Radiologic examination femur 1 view (73551) |
$98.25 |
$196.50 |
1.2× |
| Radiologic examination tibia & fibula 2 views (73590) |
$134 |
$268 |
1.6× |
| Radiologic examination, internal auditory meati, complete Non-Facility (70134) |
$556.50 |
$1,113 |
1.1× |
| Radiologic examination, mastoids; complete, minimum of 3 views per side Non-Facility (70130) |
$209.50 |
$419 |
2.1× |
| Radiological examination surgical specimen (76098) |
$579 |
$1,158 |
1.1× |
| Ribs bilateral 3 views (71110) |
$185.25 |
$370.50 |
1.8× |
| Scapula (73010) |
$121 |
$242 |
1.2× |
| Screening Digital Breast Tomosynthesis Bi (77063) |
$97.25 |
$194.50 |
4.2× |
| Shoulder 1 view (73020) |
$109.50 |
$219 |
1.3× |
| Small bowel series (74250) |
$249.75 |
$499.50 |
1.5× |
| Spine thoracic 3 views (72072) |
$168.75 |
$337.50 |
1.7× |
| Thoracolumbar 2 views (72080) |
$158.75 |
$317.50 |
1.9× |
| Thyroid Uptake W/Blood Flow Sngle/Mult Quan Meas (78014) |
$461 |
$922 |
1.2× |
| Ultrasound breast complete (76641) |
$274.50 |
$549 |
2.7× |
| Ultrasound Exam Aaa Screen (76706) |
$152 |
$304 |
1.5× |
| Ultrasound, abdomen limited (76705) |
$367 |
$734 |
3.7× |
| Us breast unilateral limited (76642) |
$284.50 |
$569 |
3.4× |
| Us chest (76604) |
$316 |
$632 |
3.2× |
| Us compl joint r-t w/image documentation (76881) |
$279 |
$558 |
2.8× |
| Us elastography parenchyma (76981) |
$62 |
$124 |
0.6× |
| Us encephalogram (76506) |
$280 |
$560 |
2.8× |
| Us infant hips w manipulation (76885) |
$116 |
$232 |
1.4× |
| Us lmtd joint/oth nonvasc xtr strux r-t w/img (76882) |
$262.50 |
$525 |
2.6× |
| Us ob limited (76815) |
$357 |
$714 |
3.6× |
| Us ob transvaginal (76817) |
$156.75 |
$313.50 |
1.6× |
| Us pelvic non ob complete (76856) |
$379.25 |
$758.50 |
3.8× |
| Us pelvic nonobstetric image dcmtn limited/f/u (76857) |
$376.75 |
$753.50 |
3.8× |
| Us pg uter img f&mat 14 wk tabdl 1/1st gestation (76801) |
$156.75 |
$313.50 |
1.6× |
| Us pg uter r-t img f-up tabdl appr pr fetus (76816) |
$348.75 |
$697.50 |
3.5× |
| Us retroperitoneal complete (76770) |
$456 |
$912 |
4.5× |
| Us retroperitoneal limited (76775) |
$342 |
$684 |
3.4× |
| Us scrotum and contents (76870) |
$368.50 |
$737 |
3.7× |
| Us soft tissue head/neck (76536) |
$334.75 |
$669.50 |
3.3× |
| Us, eye b-scan (76512) |
$111 |
$222 |
1.1× |
| Us,transplanted kidney, real time/ doppler (76776) |
$375 |
$750 |
3.7× |
| Wrist 2 views (73100) |
$122.50 |
$245 |
1.5× |
| X-Ray Abdomen,Comp Acute Series - Xr Abdomen 2 Vws With Chest 1 View (74022) |
$152.75 |
$305.50 |
1.5× |
| X-Ray Ac Jts - Xr Acromioclavicular Joints Bilateral (73050) |
$155.25 |
$310.50 |
1.9× |
| X-Ray Colon Air Contrast - Fl Barium Enema Air Contrast (74280) |
$460.75 |
$921.50 |
2.7× |
| X-Ray Elbow 2 Vw - Xr Elbow 1-2 Views Right (73070) |
$118 |
$236 |
1.4× |
| X-Ray Exam Hip Uni 2-3 Views (73502) |
$140.75 |
$281.50 |
1.7× |
| X-Ray Exam Hips Bi 3-4 Views (73522) |
$273 |
$546 |
2.7× |
| X-ray exam of femur 2/> (73552) |
$144.50 |
$289 |
1.7× |
| X-ray eye for foreign body (70030) |
$84.75 |
$169.50 |
1.0× |
| X-Ray Facial Bones <3 Vw - Xr Facial Bones 1-2 Views (70140) |
$141.75 |
$283.50 |
1.7× |
| X-Ray Knee Bilat Standing - Xr Knees Anteroposterior Standing Bilat (73565) |
$191 |
$382 |
2.3× |
| X-Ray Lumbar Spine 2/3 Vw - Xr Lumbar Spine 2-3 Views (72100) |
$158.75 |
$317.50 |
1.6× |
| X-Ray Lumbar Spine 6+ Vw - Xr Lumbar Spine 6+ Vws Including Bending (72114) |
$351 |
$702 |
3.5× |
| X-Ray Orbits - Xr Orbits Complete 4+ Views (70200) |
$189 |
$378 |
1.9× |
| X-ray retrograde pyelogram (74420) |
$755.50 |
$1,511 |
2.3× |
| X-Ray Ribs 2 Vw Unilat - Xr Ribs 2 Views Right (71100) |
$140.75 |
$281.50 |
1.7× |
| X-Ray Ribs, Chest 3+ Vw - Xr Ribs 2 Vws Lt W/ Chest Anteroposterior (71101) |
$168.25 |
$336.50 |
1.7× |
| X-Ray Ribs, Chest 4+ Vw - Xr Ribs 3 Vws Bil W/ Chest Posteroanterior (71111) |
$440 |
$880 |
4.4× |
| X-Ray Sacroiliac Jts 3+ Vw - Xr Sacroiliac Joints 3+ Views (72202) |
$141.75 |
$283.50 |
1.4× |
| X-Ray Sacrum/Coccyx 2+ Vw - Xr Sacrum Coccyx 2+ Views (72220) |
$130.75 |
$261.50 |
1.6× |
| X-Ray Sinuses 3+ Vw - Xr Paranasal Sinuses 3+ Views (70220) |
$183.25 |
$366.50 |
2.2× |
| X-Ray Skull 4+ Vw - Xr Skull Complete 4+ Views (70260) |
$221.75 |
$443.50 |
2.2× |
| X-Ray Skull <4 Vw - Xr Skull 1-3 Views (70250) |
$153.25 |
$306.50 |
1.5× |
| X-Ray Spine One View - Xr Spine (72020) |
$105.50 |
$211 |
1.3× |
| X-Ray Sterno-Clavicluar Jt - Xr Sternoclavicular Joints 3+ Views (71130) |
$161.50 |
$323 |
1.9× |
| X-Ray Sternum 2+ Vw - Xr Sternum 2+ Views (71120) |
$151.50 |
$303 |
1.8× |
| X-Ray Thoracic Spine 2 Vw - Xr Thoracic Spine 2 Views (72070) |
$153.25 |
$306.50 |
1.5× |
| X-Ray Thoracic Spine 4 Vw - Xr Thoracic Spine Complete 4+ Views (72074) |
$197.75 |
$395.50 |
2.0× |
| Xr bone length studies (77073) |
$189 |
$378 |
1.9× |
| Xr c-spine 4 or 5 views (72050) |
$260.50 |
$521 |
2.6× |
| Xr c-spine 6 or more views (72052) |
$260.50 |
$521 |
2.6× |
| Xr chest 4+ views (71048) |
$358.50 |
$717 |
3.6× |