| Abdomen 2 views (74019) |
$190 |
$380 |
1.9× |
| Ankle 2 views (73600) |
$108 |
$216 |
1.3× |
| Bone &/Joint Imaging Limited Area (78300) |
$313 |
$626 |
0.8× |
| Bone &/Joint Imaging Multiple Areas (78305) |
$561 |
$1,122 |
1.5× |
| Bone &/joint imaging whole body (78306) |
$842 |
$1,684 |
2.2× |
| Bone age studies (77072) |
$91.50 |
$183 |
0.9× |
| Bone Imaging 3 Phase (78315) |
$713.50 |
$1,427 |
1.9× |
| Bone survey complete (77075) |
$215.50 |
$431 |
2.2× |
| Cervical spine 2 or 3 views (72040) |
$164 |
$328 |
2.0× |
| Chest 1 view (71045) |
$222.50 |
$445 |
2.7× |
| Cine/Vid X-Ray Throat/Esoph - Fl Esoph Barium Swlw W/ Video & Speech (74230) |
$318 |
$636 |
1.9× |
| Clavicle complete (73000) |
$120 |
$240 |
1.4× |
| Contrast Xray Throat/Cerv Esopha - Fl Esophagus Pharynx (74210) |
$142.50 |
$285 |
0.8× |
| CT abdomen and pelvis without and with contrast (74178) |
$2,808 |
$5,616 |
8.4× |
| CT abdomen and pelvis without contrast (74176) |
$2,340 |
$4,680 |
10.3× |
| CT abdomen w contrast (74160) |
$1,263.50 |
$2,527 |
7.5× |
| CT abdomen w wo contrast (74170) |
$1,405.50 |
$2,811 |
8.4× |
| CT abdomen w/o contrast (74150) |
$1,146.50 |
$2,293 |
11.5× |
| CT angiography upper extremity lt (73206) |
$1,245.50 |
$2,491 |
7.4× |
| CT c-spine w/o contrast (72125) |
$1,231 |
$2,462 |
12.3× |
| CT chest w/wo contrast (71270) |
$1,351.50 |
$2,703 |
8.1× |
| CT chest with contrast (71260) |
$1,293 |
$2,586 |
7.7× |
| CT head/brain with contrast (70460) |
$1,082.50 |
$2,165 |
6.5× |
| CT head/brain without and with contrast (70470) |
$1,097 |
$2,194 |
6.5× |
| CT heart no contrast quant eval coronry calcium (75571) |
$149.50 |
$299 |
1.8× |
| CT limited/localized follow up study (76380) |
$335.50 |
$671 |
4.0× |
| CT lower ext w/o (73700) |
$766.50 |
$1,533 |
7.7× |
| CT lower extremity w wo contrast (73702) |
$1,767 |
$3,534 |
10.5× |
| CT lower extremity with contrast (73701) |
$883.50 |
$1,767 |
5.3× |
| CT lumbar spine w & w/o contrast (72133) |
$1,009 |
$2,018 |
6.0× |
| CT lumbar spine w/o contrast (72131) |
$994.50 |
$1,989 |
10.0× |
| CT lumbar spine with contrast (72132) |
$994.50 |
$1,989 |
3.0× |
| CT maxillofacial w contrast (70487) |
$825 |
$1,650 |
4.9× |
| CT maxillofacial w/o contrast (70486) |
$777.50 |
$1,555 |
7.8× |
| CT maxillofacial w/wo contrast (70488) |
$868.50 |
$1,737 |
5.2× |
| CT neck soft tissue w contrast (70491) |
$1,170 |
$2,340 |
7.0× |
| CT orbits w/o contrast (70480) |
$708.50 |
$1,417 |
7.1× |
| CT pelvis w & w/o contrast (72194) |
$1,415.50 |
$2,831 |
8.4× |
| CT pelvis w/o contrast (72192) |
$1,146.50 |
$2,293 |
11.5× |
| CT soft tissue neck w/o & w/contrast material (70492) |
$1,199.50 |
$2,399 |
7.2× |
| CT soft tissue neck w/o contrast (70490) |
$877.50 |
$1,755 |
8.8× |
| CT thoracic spine w/o contrast (72128) |
$763 |
$1,526 |
7.6× |
| CT thorax w/o contrast (71250) |
$1,117.50 |
$2,235 |
11.2× |
| CT upper extremity w/o & w/contrast material (73202) |
$839 |
$1,678 |
5.0× |
| CT upper extremity w/o contrast rt (73200) |
$564.14 |
$1,128.27 |
5.6× |
| CT upper extremity with contrast (73201) |
$220.22 |
$440.43 |
0.7× |
| Cta Abdl Aorta&Bi Iliofem W/Contrast&Postp (75635) |
$1,123 |
$2,246 |
6.7× |
| Cta Abdomen (74175) |
$1,459.50 |
$2,919 |
8.7× |
| CTA abdomen pelvis (74174) |
$2,793.50 |
$5,587 |
8.4× |
| CTA chest (71275) |
$1,459.50 |
$2,919 |
8.7× |
| Cta Head (70496) |
$1,459.50 |
$2,919 |
8.7× |
| Cta Neck (70498) |
$1,251.50 |
$2,503 |
7.5× |
| Cta Pelvis (72191) |
$1,459.50 |
$2,919 |
8.7× |
| Cystography minimum 3 views rs&i (74430) |
$170 |
$340 |
0.5× |
| Dxa bone density study 1/> sites axial skel (77080) |
$137.50 |
$275 |
1.4× |
| Dxa bone density study 1/>sites appendiclr skel (77081) |
$113 |
$226 |
1.4× |
| Echo exam of fetal heart (76825) |
$900 |
$1,800 |
1.7× |
| Esophagus (74220) |
$310 |
$620 |
1.8× |
| Fetal biophysical profile non-stress testing (76818) |
$278 |
$556 |
2.8× |
| Fetal Biophysical Profile W/O Non-Stress Testing (76819) |
$112.50 |
$225 |
1.1× |
| Foot 2 views (73620) |
$108 |
$216 |
1.3× |
| Forearm 2 views (73090) |
$142.50 |
$285 |
1.7× |
| Hand 2 views (73120) |
$121.50 |
$243 |
1.2× |
| Hand 3 views (73130) |
$121.50 |
$243 |
1.5× |
| Humerus Min 2 Views Left (73060) |
$124.75 |
$249.50 |
1.5× |
| Knee 3 views (73562) |
$159 |
$318 |
1.9× |
| MRI abdomen w contrast (74182) |
$1,183 |
$2,366 |
3.5× |
| MRI abdomen w/o & w/contrast material (74183) |
$1,515.50 |
$3,031 |
4.5× |
| MRI abdomen w/o contrast (74181) |
$109.50 |
$219 |
0.5× |
| MRI bone marrow blood supply (77084) |
$1,067 |
$2,134 |
4.7× |
| MRI breast w/o contrast unilat (77046) |
$799.50 |
$1,599 |
3.5× |
| MRI cervical spine w/o contrast (72141) |
$140.50 |
$281 |
0.6× |
| MRI chest w/o & w/contrast material (71552) |
$109.50 |
$219 |
0.3× |
| MRI chest w/o contrast (71550) |
$109.50 |
$219 |
0.5× |
| MRI orbit face &/neck w/o contrast (70540) |
$222.50 |
$445 |
1.0× |
| MRI orbit/face/neck w/contrast (70542) |
$254.50 |
$509 |
0.8× |
| MRI pelvis w contrast (72196) |
$140.50 |
$281 |
0.4× |
| MRI pelvis w/o contrast (72195) |
$114.50 |
$229 |
0.5× |
| MRI spinal canal thoracic w/contrast matrl (72147) |
$1,459.50 |
$2,919 |
4.4× |
| MRI thoracic spine w/o contrast (72146) |
$146.50 |
$293 |
0.6× |
| Neck soft tissue (70360) |
$113.50 |
$227 |
1.4× |
| Ob Us Follow-Up Per Fetus - Us Ob Follow Up Transabdominal Approach (76816) |
$277.50 |
$555 |
2.8× |
| Ophthalmic biometry us echograpy a-scan (76516) |
$127.50 |
$255 |
1.3× |
| Osseous survey infant (77076) |
$259 |
$518 |
2.6× |
| Osseous survey limited (77074) |
$137 |
$274 |
1.4× |
| Pelvis 1 or 2 views (72170) |
$140.50 |
$281 |
1.4× |
| Radex abscess/fistula/sinus tract rs&i (76080) |
$147.50 |
$295 |
0.3× |
| Radex Entir Thrc Lmbr Crv Sac Spi W/Skull 1 Vw - Xr Scoliosis 1 Vw (72081) |
$123.92 |
$247.83 |
1.5× |
| Radex hips bilateral with pelvis 2 views (73521) |
$339.50 |
$679 |
3.4× |
| Radiolog exam mandible compl minimum 4 views (70110) |
$149 |
$298 |
1.5× |
| Radiologic Exam Abdomen 1 View - Xr Abdomen 1 View (74018) |
$178.50 |
$357 |
2.1× |
| Radiologic Exam Chest 2 Views - Xr Chest 2 Views (71046) |
$254.50 |
$509 |
3.1× |
| Radiologic exam upr gi trc double contrast study (74246) |
$245.50 |
$491 |
1.5× |
| Radiologic Examination Femur Minimum 2 Views - Xr Femur 2+ Vw Lt (73552) |
$121 |
$242 |
1.5× |
| Ribs bilateral 3 views (71110) |
$364 |
$728 |
3.6× |
| Rp loclzj tum plnr 2+area 1+d img/1 area img>2+d (78801) |
$1,041.50 |
$2,083 |
2.7× |
| Rp loclzj tum plnr whole body single day imaging (78802) |
$762 |
$1,524 |
1.5× |
| Rp loclzj tum spect 1 area single day imaging (78803) |
$1,492.50 |
$2,985 |
2.9× |
| Rp loclzj tum spect 2 area/sep acquisj img (78831) |
$1,922.50 |
$3,845 |
1.6× |
| Rp loclzj tum spect CT 2area 1d img/1 ar img>2+d (78832) |
$2,848 |
$5,696 |
2.1× |
| Rp loclzj tum spect w/CT 1 area 1 day imaging (78830) |
$1,507 |
$3,014 |
1.2× |
| Scapula complete (73010) |
$134.50 |
$269 |
1.3× |
| Screening digital breast tomosynthesis (77063) |
$247 |
$494 |
10.6× |
| Sella turcica (70240) |
$66 |
$132 |
0.8× |
| Spine thoracic 3 views (72072) |
$175.50 |
$351 |
1.8× |
| Tomogram (76100) |
$127 |
$254 |
1.3× |
| Tumor Imaging, Limited Area - Nm Tumor Localization Limited (78800) |
$1,041.50 |
$2,083 |
2.7× |
| Ultrasound, abdomen limited (76705) |
$143.50 |
$287 |
1.4× |
| Upper Extremity Infant (73092) |
$87 |
$174 |
0.9× |
| Urethrocystography voiding (74455) |
$259 |
$518 |
1.1× |
| Urography (pyelography), intravenous, with or without KUB, with or without tomography (74400) |
$305 |
$610 |
1.8× |
| Urograpy infusion drip &/bolus techq w/wo tomo (74415) |
$292.50 |
$585 |
1.7× |
| Us abdl aorta screen aaa (76706) |
$461.50 |
$923 |
4.6× |
| Us breast unilateral complete (76641) |
$300 |
$600 |
3.0× |
| Us breast unilateral limited (76642) |
$261 |
$522 |
3.1× |
| Us chest (76604) |
$127.50 |
$255 |
1.3× |
| Us compl joint r-t w/image documentation (76881) |
$217.50 |
$435 |
2.2× |
| Us kidney transplant (76776) |
$305 |
$610 |
3.1× |
| Us ob detailed single fetus (76811) |
$343.50 |
$687 |
1.5× |
| Us ob transvaginal (76817) |
$189.50 |
$379 |
1.9× |
| Us pelvic non ob complete (76856) |
$512 |
$1,024 |
5.1× |
| Us pelvic nonobstetric image dcmtn limited/f/u (76857) |
$220.25 |
$440.50 |
2.2× |
| Us pregnancy ltd (76815) |
$424 |
$848 |
4.2× |
| Us pregnant uterus 14 wk transabdl 1/1st gestat (76801) |
$365.25 |
$730.50 |
3.7× |
| Us retroperitoneal complete (76770) |
$185.50 |
$371 |
1.9× |
| Us retroperitoneal limited (76775) |
$229.50 |
$459 |
2.3× |
| Us scrotum and contents (76870) |
$281 |
$562 |
2.8× |
| Us soft tissue head/neck (76536) |
$225 |
$450 |
2.3× |
| Us transrectal (76872) |
$217.50 |
$435 |
2.2× |
| Us xtr non-vasc lmtd (76882) |
$125 |
$250 |
1.3× |
| Us, eye b-scan (76512) |
$150 |
$300 |
1.5× |
| Venography extremity unilateral rs&i (75820) |
$329.50 |
$659 |
0.2× |
| Wrist 2 views (73100) |
$133.50 |
$267 |
1.6× |
| X-Ray Abdomen,Comp Acute Series - Xr Abdomen 2 Vws With Chest 1 View (74022) |
$357 |
$714 |
3.6× |
| X-Ray Ac Jts - Xr Acromioclavicular Joints Bilateral (73050) |
$107.50 |
$215 |
1.3× |
| X-Ray Ankle 3+ Vw - Xr Ankle 3+ Views Right (73610) |
$135 |
$270 |
1.6× |
| X-Ray Colon Air Contrast - Fl Barium Enema Air Contrast (74280) |
$500 |
$1,000 |
3.0× |
| X-Ray Elbow 2 Vw - Xr Elbow 1-2 Views Right (73070) |
$120 |
$240 |
1.4× |
| X-Ray Elbow 3+ Vw - Xr Elbow 3+ Views Right (73080) |
$150.50 |
$301 |
1.8× |
| X-ray exam hip uni 1 view (73501) |
$293 |
$586 |
3.5× |
| X-ray exam of femur 1 (73551) |
$108 |
$216 |
1.3× |
| X-ray eye for foreign body (70030) |
$150 |
$300 |
1.8× |
| X-Ray Facial Bones 3+ Vw - Xr Facial Bones 3+ Views (70150) |
$154 |
$308 |
1.5× |
| X-Ray Foot 3+ Vw - Xr Foot 3+ Views Right (73630) |
$183.50 |
$367 |
2.2× |
| X-Ray Heel - Xr Calcaneus 2 Views Right (73650) |
$114.50 |
$229 |
1.4× |
| X-Ray Knee 4+ View - Xr Knee 4+ Views Right (73564) |
$147.50 |
$295 |
1.5× |
| X-Ray Leg, Infant - Xr Lower Extremity 2+ Views Infant Left (73592) |
$99.50 |
$199 |
1.2× |
| X-Ray Lumbar Spine 2/3 Vw - Xr Lumbar Spine 2-3 Views (72100) |
$199 |
$398 |
2.0× |
| X-Ray Lumbar Spine Flex/Exten - Xr Lumbar Spine 4+ Views W/ Flex Ext (72120) |
$304 |
$608 |
3.0× |
| X-Ray Nasal Bones - Xr Nasal Bones (70160) |
$128 |
$256 |
1.5× |
| X-Ray Nose-Rectum Child F.B. - Xr Nose to Rectum Foreign Body Peds (76010) |
$67 |
$134 |
0.8× |
| X-Ray Orbits - Xr Orbits Complete 4+ Views (70200) |
$192.50 |
$385 |
1.9× |
| X-Ray Pelvis 3+ Vw - Xr Pelvis 3+ Views (72190) |
$146.50 |
$293 |
1.5× |
| X-Ray Ribs 2 Vw Unilat - Xr Ribs 2 Views Right (71100) |
$137.50 |
$275 |
1.7× |
| X-Ray Ribs, Chest 3+ Vw - Xr Ribs 2 Vws Lt W/ Chest Anteroposterior (71101) |
$182 |
$364 |
1.8× |
| X-Ray Ribs, Chest 4+ Vw - Xr Ribs 3 Vws Bil W/ Chest Posteroanterior (71111) |
$374.50 |
$749 |
3.7× |
| X-Ray Sacroiliac Jts 3+ Vw - Xr Sacroiliac Joints 3+ Views (72202) |
$114.50 |
$229 |
1.1× |
| X-Ray Sacrum/Coccyx 2+ Vw - Xr Sacrum Coccyx 2+ Views (72220) |
$105.50 |
$211 |
1.3× |
| X-Ray Shoulder 2+ Vw - Xr Shoulder 2+ Views Right (73030) |
$155 |
$310 |
1.9× |
| X-Ray Sinuses 3+ Vw - Xr Paranasal Sinuses 3+ Views (70220) |
$94.50 |
$189 |
1.1× |
| X-Ray Sinuses <3 Vw - Xr Paranasal Sinuses 1-2 Views (70210) |
$92.50 |
$185 |
1.1× |
| X-Ray Skull 4+ Vw - Xr Skull Complete 4+ Views (70260) |
$131.50 |
$263 |
1.3× |
| X-Ray Skull <4 Vw - Xr Skull 1-3 Views (70250) |
$128 |
$256 |
1.3× |
| X-Ray Spine One View - Xr Spine (72020) |
$109.50 |
$219 |
1.3× |
| X-Ray Sterno-Clavicluar Jt - Xr Sternoclavicular Joints 3+ Views (71130) |
$131.50 |
$263 |
1.6× |
| X-Ray Sternum 2+ Vw - Xr Sternum 2+ Views (71120) |
$140.50 |
$281 |
1.7× |
| X-Ray Thoracic Spine 2 Vw - Xr Thoracic Spine 2 Views (72070) |
$166.78 |
$333.57 |
1.7× |
| X-Ray Thoracic Spine 4 Vw - Xr Thoracic Spine Complete 4+ Views (72074) |
$16.78 |
$33.57 |
0.2× |
| X-Ray Toe(S) - Xr Toes 2+ Views Right (73660) |
$114.50 |
$229 |
1.4× |
| X-Ray Wrist 3+ Vw - Xr Wrist 3+ Views Right (73110) |
$137.50 |
$275 |
1.7× |
| Xr c-spine 6 or more views (72052) |
$251 |
$502 |
2.5× |
| Xr Cholecystography Oral Contrast (74290) |
$131.50 |
$263 |
0.8× |
| Xr finger(s) 2+ views (73140) |
$121 |
$242 |
1.5× |
| XR Mastoids < 3 Views Bilateral (70120) |
$149 |
$298 |
1.5× |
| Xr shoulder 1 view (73020) |
$137.50 |
$275 |
1.7× |
| Xr spine cervical 4 or 5 views (72050) |
$245.50 |
$491 |
2.5× |
| Xr tibia/fibula 2 views (73590) |
$140.50 |
$281 |
1.7× |
| Xr tmj bilateral (70330) |
$121.50 |
$243 |
1.5× |
| Xray knee 1 or 2 views rt (73560) |
$114.50 |
$229 |
1.4× |