| Abdomen 1 View (74018) |
$71 |
$142 |
0.9× |
| Abdomen 2 views (74019) |
$130 |
$260 |
1.4× |
| Acute Gastrointestinal Blood Loss Imaging (78278) |
$396.50 |
$793 |
1.1× |
| Ankle 2 views (73600) |
$71 |
$142 |
0.9× |
| Arthrogram hip (73525) |
$517.50 |
$1,035 |
1.7× |
| Arthrogram Wrist (73115) |
$517.50 |
$1,035 |
1.7× |
| Bone age studies (77072) |
$130 |
$260 |
1.4× |
| Bone Imaging 3 Phase (78315) |
$396.50 |
$793 |
1.1× |
| Bone Imaging Limited Area (78300) |
$396.50 |
$793 |
1.1× |
| Bone Imaging Whole Body (78306) |
$396.50 |
$793 |
1.1× |
| Bone survey infant (77076) |
$130 |
$260 |
1.4× |
| Brain Imaging Min 4 Static Views W Vascular Flow (78606) |
$514 |
$1,028 |
1.1× |
| Brain Imaging Pet Metabolic Evaluation (78608) |
$2,095.50 |
$4,191 |
1.7× |
| Cat Scan Follow-Up Study (76380) |
$135 |
$270 |
1.8× |
| Chest 1 view (71045) |
$71 |
$142 |
0.9× |
| Chest 2 views (71046) |
$71 |
$142 |
0.9× |
| Chest 3 views (71047) |
$71 |
$142 |
0.9× |
| Chest 4 or more views (71048) |
$130 |
$260 |
1.4× |
| Clavicle complete (73000) |
$71 |
$142 |
0.9× |
| Computed Tomography Thorax Lw Dose Lng Ca Scr C- (71271) |
$146.50 |
$293 |
1.6× |
| Contrast X-Ray Bladder (74430) |
$286.50 |
$573 |
0.9× |
| Contrast X-Ray Of Knee Joint (73580) |
$517.50 |
$1,035 |
1.7× |
| CT abdomen and pelvis without and with contrast (74178) |
$1,400.50 |
$2,801 |
4.6× |
| CT abdomen and pelvis without contrast (74176) |
$1,131.50 |
$2,263 |
5.4× |
| CT abdomen w contrast (74160) |
$970 |
$1,940 |
6.3× |
| CT abdomen w wo contrast (74170) |
$1,131.50 |
$2,263 |
7.4× |
| CT abdomen w/o contrast (74150) |
$862 |
$1,724 |
9.4× |
| CT Angio Abdomen and Pelvis (74174) |
$1,201.50 |
$2,403 |
3.9× |
| CT Angio Chest (71275) |
$970 |
$1,940 |
6.3× |
| CT Angio Head (70496) |
$1,102 |
$2,204 |
7.2× |
| CT angio hrt w/3d image (75574) |
$712.50 |
$1,425 |
2.3× |
| Ct Angio Lwr Extr W/O&W/Dye (73706) |
$1,120.50 |
$2,241 |
7.3× |
| CT Angio Neck (70498) |
$1,102 |
$2,204 |
7.2× |
| Ct Angio Upr Extrm W/O&W/Dye (73206) |
$1,223.50 |
$2,447 |
8.0× |
| CT cervical spine w/ contrast (72126) |
$970 |
$1,940 |
3.2× |
| CT cervical spine w/o contrast (72125) |
$862 |
$1,724 |
9.4× |
| CT cervical spine w/wo cont (72127) |
$1,131.50 |
$2,263 |
7.4× |
| CT chest w contrast (71260) |
$862 |
$1,724 |
5.6× |
| CT chest w/wo contrast (71270) |
$1,134 |
$2,268 |
7.4× |
| CT head/brain with contrast (70460) |
$929.50 |
$1,859 |
6.0× |
| CT head/brain without and with contrast (70470) |
$1,055.50 |
$2,111 |
6.9× |
| CT heart no contrast quant eval coronry calcium (75571) |
$80.50 |
$161 |
1.1× |
| CT iac w contrast (70481) |
$1,049 |
$2,098 |
6.8× |
| CT l-spine w&w/o contrast (72133) |
$1,239 |
$2,478 |
8.1× |
| CT lower ext w/o (73700) |
$710 |
$1,420 |
7.7× |
| CT lower extremity w/contrast material (73701) |
$970 |
$1,940 |
6.3× |
| CT lumbar spine w contrast (72132) |
$1,102 |
$2,204 |
3.6× |
| CT lumbar spine w/o contrast (72131) |
$970 |
$1,940 |
10.6× |
| CT maxillofacial w contrast (70487) |
$1,023.50 |
$2,047 |
6.7× |
| CT maxillofacial wo contrast (70486) |
$796.50 |
$1,593 |
8.7× |
| CT neck tissue combo (70492) |
$1,131.50 |
$2,263 |
7.4× |
| Ct Orbit/Ear/Fossa W/O&W/Dye (70482) |
$1,131.50 |
$2,263 |
7.4× |
| CT orbits w/o contrast (70480) |
$816.50 |
$1,633 |
8.9× |
| CT pelvis w&w/o contrast (72194) |
$1,110 |
$2,220 |
7.2× |
| CT pelvis w/o contrast (72192) |
$834.50 |
$1,669 |
9.1× |
| CT scan of leg combo (73702) |
$1,131.50 |
$2,263 |
7.4× |
| CT scans face/jaw combo (70488) |
$1,182 |
$2,364 |
7.7× |
| CT soft tissue neck w contrast (70491) |
$1,045.50 |
$2,091 |
6.8× |
| CT soft tissue neck w/o contrast (70490) |
$786.50 |
$1,573 |
8.6× |
| CT thoracic spine w contrast (72129) |
$970 |
$1,940 |
6.3× |
| CT thoracic spine w/o contrast (72128) |
$816.50 |
$1,633 |
8.9× |
| CT thoracic spine w/wo cont (72130) |
$1,062.50 |
$2,125 |
6.9× |
| CT thorax w/o contrast (71250) |
$795 |
$1,590 |
8.7× |
| CT upper ext wo (73200) |
$727.50 |
$1,455 |
7.9× |
| CT upper extremity w/o & w/contrast material (73202) |
$1,064 |
$2,128 |
6.9× |
| CT upper extremity with contrast (73201) |
$1,003 |
$2,006 |
3.3× |
| Cta Abdl Aorta&Bi Iliofem W/Contrast&Postp (75635) |
$1,131.50 |
$2,263 |
7.4× |
| Cta Abdomen (74175) |
$970 |
$1,940 |
6.3× |
| CTA pelvis (72191) |
$1,104 |
$2,208 |
7.2× |
| Dxa Bone Density Axial (77080) |
$130 |
$260 |
1.4× |
| Esophagram (74220) |
$286.50 |
$573 |
1.9× |
| Fetal Biophys Profile W/Nst (76818) |
$130 |
$260 |
1.4× |
| Fluoroscopy up to 1 hr (76000) |
$308.50 |
$617 |
1.5× |
| Foot 2 views (73620) |
$71 |
$142 |
0.9× |
| Forearm 2 views (73090) |
$71 |
$142 |
0.9× |
| Gastric emptying imaging study (78264) |
$396.50 |
$793 |
1.1× |
| Gated Heart Planar Single (78472) |
$817 |
$1,634 |
2.3× |
| Hand 2 views (73120) |
$130 |
$260 |
1.4× |
| Hepatobil Syst Image W/Drug (78227) |
$514 |
$1,028 |
1.1× |
| Hepatobiliary System Imaging (78226) |
$396.50 |
$793 |
1.1× |
| Ht Muscle Image Spect Sing (78451) |
$1,362.50 |
$2,725 |
1.2× |
| Hysterosalpingogram (74740) |
$263.50 |
$527 |
1.3× |
| Infusion Ivp (74410) |
$286.50 |
$573 |
1.9× |
| K Flow/Funct Image Multiple (78709) |
$514 |
$1,028 |
1.1× |
| K Flow/Funct Image W/Drug (78708) |
$514 |
$1,028 |
1.1× |
| Liver & Spleen Imaging Static Only (78215) |
$396.50 |
$793 |
1.1× |
| Lung Ventilat&Perfus Imaging (78582) |
$514 |
$1,028 |
1.1× |
| Lung Ventilation Imaging (78579) |
$396.50 |
$793 |
1.1× |
| Lymph System Imaging (78195) |
$514 |
$1,028 |
1.1× |
| Magnetic Image Jaw Joint (70336) |
$1,314 |
$2,628 |
6.3× |
| Meckels Divert Exam (78290) |
$396.50 |
$793 |
1.1× |
| Mra Head W/O & W/Contrast Material (70546) |
$1,898.50 |
$3,797 |
6.2× |
| MRA head w/o contrast (70544) |
$1,110 |
$2,220 |
5.3× |
| MRA head with contrast (70545) |
$1,350.50 |
$2,701 |
4.4× |
| MRA neck w contrast (70548) |
$1,350.50 |
$2,701 |
4.4× |
| Mra Neck W/O &W/Contrast Material (70549) |
$1,764 |
$3,528 |
5.8× |
| MRA neck w/o contrast (70547) |
$1,080 |
$2,160 |
5.2× |
| MRI abdomen w contrast (74182) |
$1,602 |
$3,204 |
5.2× |
| MRI abdomen w/o contrast (74181) |
$1,276.50 |
$2,553 |
6.1× |
| MRI any jt lower extrem w/contrast material (73722) |
$1,375.50 |
$2,751 |
2.0× |
| MRI any jt lower extrem w/o & w/contrast matrl (73723) |
$1,764 |
$3,528 |
5.8× |
| MRI any jt upper extremity w/contrast matrl (73222) |
$1,398.50 |
$2,797 |
2.0× |
| MRI Breast W/O Contrast Bilateral (77047) |
$1,276.50 |
$2,553 |
6.1× |
| MRI Breast Without Contrast Material Unilateral (77046) |
$1,129.50 |
$2,259 |
5.4× |
| MRI cervical spine w contrast (72142) |
$1,602 |
$3,204 |
5.2× |
| MRI cervical spine w/o cont (72141) |
$1,239 |
$2,478 |
5.9× |
| MRI lower extrem oth/thn jt w/contrast matrl (73719) |
$1,293 |
$2,586 |
4.2× |
| MRI lower extrem oth/thn jt w/o & w/contr matr (73720) |
$1,764 |
$3,528 |
5.8× |
| MRI lower extrem oth/thn jt w/o contr matrl (73718) |
$1,023.50 |
$2,047 |
4.9× |
| MRI lumbar spine w contrast (72149) |
$1,602 |
$3,204 |
5.2× |
| Mri Neck Spine W/O & W/Dye (72156) |
$1,764 |
$3,528 |
5.8× |
| MRI orbit face &/neck w/o contrast (70540) |
$1,219 |
$2,438 |
5.8× |
| MRI orbit face neck w contrast (70542) |
$1,350.50 |
$2,701 |
4.4× |
| Mri Orbt/Fac/Nck W/O &W/Dye (70543) |
$1,764 |
$3,528 |
5.8× |
| MRI pelvis w contrast (72196) |
$1,313.50 |
$2,627 |
4.3× |
| MRI pelvis w/o & w contrast (72197) |
$1,764 |
$3,528 |
5.8× |
| MRI pelvis w/o contrast (72195) |
$1,212 |
$2,424 |
5.8× |
| MRI thoracic spine w/o contrast (72146) |
$1,239 |
$2,478 |
5.9× |
| MRI upper extremity oth than jt w/contr matrl (73219) |
$1,350.50 |
$2,701 |
4.4× |
| MRI upper extremity oth than jt w/o contr matrl (73218) |
$1,201.50 |
$2,403 |
5.7× |
| Mri Uppr Extremity W/O&W/Dye (73220) |
$1,764 |
$3,528 |
5.8× |
| MRI, abdomen, combo (74183) |
$1,764 |
$3,528 |
5.8× |
| MRI, dorsal spine combo (72157) |
$1,764 |
$3,528 |
5.8× |
| MRI, dorsal spine contrast (72147) |
$1,602 |
$3,204 |
5.2× |
| MRI, joint upper extrem (73221) |
$1,112 |
$2,224 |
5.3× |
| MRI, joint upper extrem combo (73223) |
$1,764 |
$3,528 |
5.8× |
| MRI, lumbar spine combo (72158) |
$1,764 |
$3,528 |
5.8× |
| Myelogram Lumbar (72265) |
$772.50 |
$1,545 |
1.1× |
| Myocardial Imaging Infarct Avid Planar Qual/Quan (78466) |
$396.50 |
$793 |
1.1× |
| Myocardial Spect Multiple Studies (78452) |
$1,362.50 |
$2,725 |
1.2× |
| Neck soft tissue (70360) |
$71 |
$142 |
0.9× |
| Parathyroid planar imaging w/wo subtraction (78071) |
$396.50 |
$793 |
1.1× |
| Pelvis 1 or 2 views (72170) |
$130 |
$260 |
1.4× |
| Pet Image W/Ct Lmtd (78814) |
$2,095.50 |
$4,191 |
1.7× |
| PET image w/CT, full body (78816) |
$2,095.50 |
$4,191 |
1.7× |
| PET imaging CT attenuation skull base mid-thigh (78815) |
$2,095.50 |
$4,191 |
1.7× |
| Pulmonary Perfusion Imaging Particulate (78580) |
$396.50 |
$793 |
1.1× |
| Radex Abd Compl Aqt Abd W/S/E/D Views 1 View Ch (74022) |
$130 |
$260 |
1.4× |
| Radex abscess/fistula/sinus tract rs&i (76080) |
$263.50 |
$527 |
0.6× |
| Radex Ankle Complete Minimum 3 Views (73610) |
$71 |
$142 |
0.9× |
| Radex Calcaneus Minimum 2 Views (73650) |
$71 |
$142 |
0.9× |
| Radex elbow complete minimum 3 views (73080) |
$71 |
$142 |
0.9× |
| Radex Facial Bones Complete Minimum 3 Views (70150) |
$130 |
$260 |
1.4× |
| Radex fingr minimum 2 views (73140) |
$71 |
$142 |
0.9× |
| Radex foot complete minimum 3 views (73630) |
$71 |
$142 |
0.9× |
| Radex Hand Minimum 3 Views (73130) |
$71 |
$142 |
0.9× |
| Radex Mastoids Compl Minimum 3 Views PR Side (70130) |
$130 |
$260 |
1.4× |
| Radex Nasal Bones Complete Minimum 3 Views (70160) |
$71 |
$142 |
0.9× |
| Radex shoulder complete minimum 2 views (73030) |
$71 |
$142 |
0.9× |
| Radex Spine 1 View Specify Level (72020) |
$71 |
$142 |
0.9× |
| Radex Sternum Minimum 2 Views (71120) |
$71 |
$142 |
0.9× |
| Radex Temporomandble Jt Opn & Clsd Mouth Bilat (70330) |
$71 |
$142 |
0.9× |
| Radex Toe Minimum 2 Views (73660) |
$71 |
$142 |
0.9× |
| Radex Wrist Complete Minimum 3 Views (73110) |
$71 |
$142 |
0.9× |
| Radiolog exam mandible compl minimum 4 views (70110) |
$130 |
$260 |
1.4× |
| Radiologic exam colon double contrast study (74280) |
$286.50 |
$573 |
1.9× |
| Radiologic exam colon single contrast study (74270) |
$286.50 |
$573 |
1.9× |
| Radiologic exam knee complete 4/more views (73564) |
$130 |
$260 |
1.4× |
| Radiologic Exam Small Int Single Contrast Study (74250) |
$130 |
$260 |
0.8× |
| Radiologic exam upr gi trc double contrast study (74246) |
$286.50 |
$573 |
1.9× |
| Radiologic examination femur minimum 2 views (73552) |
$71 |
$142 |
0.9× |
| Radiologic examination knee 1/2 views (73560) |
$71 |
$142 |
0.9× |
| Radiologic Examination Osseous Survey Limited (77074) |
$130 |
$260 |
1.4× |
| Radiologic examination tibia & fibula 2 views (73590) |
$71 |
$142 |
0.9× |
| Radiologic examination, internal auditory meati, complete Non-Facility (70134) |
$263.50 |
$527 |
0.6× |
| Rp loclzj tum plnr 2+area 1+d img/1 area img>2+d (78801) |
$1,362.50 |
$2,725 |
3.9× |
| Rp Loclzj Tum Plnr Whole Body 2+ Days Imaging (78804) |
$1,362.50 |
$2,725 |
2.9× |
| Rp Loclzj Tum Spect 1 Area Single Day Imaging (78803) |
$1,362.50 |
$2,725 |
2.9× |
| Scapula (73010) |
$130 |
$260 |
1.4× |
| Screening Digital Breast Tomosynthesis Bi (77063) |
$74 |
$148 |
3.2× |
| Sella turcica (70240) |
$71 |
$142 |
0.9× |
| Shoulder Arthrography (73040) |
$517.50 |
$1,035 |
1.7× |
| Skull less than 4 views (70250) |
$130 |
$260 |
1.4× |
| Testicular Imaging W/Flow (78761) |
$396.50 |
$793 |
1.1× |
| Thoracic spine 3 views (72072) |
$130 |
$260 |
1.4× |
| Thyroid Imaging With Vascular Flow (78013) |
$396.50 |
$793 |
1.1× |
| Thyroid Met Imaging Body (78018) |
$514 |
$1,028 |
1.1× |
| Thyroid Uptake Measurement (78012) |
$396.50 |
$793 |
1.1× |
| Ultrasound Breast Limited (76642) |
$120 |
$240 |
1.6× |
| Ultrasound, abdomen limited (76705) |
$130 |
$260 |
1.4× |
| Umbilical-artery Doppler (OB) (76820) |
$130 |
$260 |
1.4× |
| Unlisted fluoroscopic procedure (76496) |
$71 |
$142 |
0.9× |
| Upper gi w/o kub (74240) |
$286.50 |
$573 |
1.9× |
| Ureteral Reflux Study (78740) |
$396.50 |
$793 |
1.1× |
| Urethrocystogram voiding (74455) |
$263.50 |
$527 |
1.3× |
| Urethrocystography retrograde (74450) |
$263.50 |
$527 |
1.3× |
| Us breast unilateral complete (76641) |
$120 |
$240 |
1.3× |
| Us chest (76604) |
$142 |
$284 |
1.5× |
| Us complete joint (76881) |
$130 |
$260 |
1.4× |
| Us head (76506) |
$130 |
$260 |
1.4× |
| Us lmtd joint/oth nonvasc xtr strux r-t w/img (76882) |
$130 |
$260 |
1.4× |
| Us ob limited 1 or more fetuses (76815) |
$130 |
$260 |
1.4× |
| Us pelvic non ob complete (76856) |
$130 |
$260 |
1.4× |
| Us retroperitoneal limited (76775) |
$130 |
$260 |
1.4× |
| Us scrotum and contents (76870) |
$130 |
$260 |
1.4× |
| Us thyroid (76536) |
$130 |
$260 |
1.4× |
| Venography extremity bilateral rs&i (75822) |
$1,114 |
$2,228 |
0.8× |
| Venography extremity unilateral rs&i (75820) |
$694 |
$1,388 |
0.5× |
| Wrist 2 views (73100) |
$71 |
$142 |
0.9× |
| X-Ray Ac Jts - Xr Acromioclavicular Joints Bilateral (73050) |
$71 |
$142 |
0.9× |
| X-ray antegrade pyelogram tube (74425) |
$286.50 |
$573 |
0.9× |
| X-Ray Elbow 2 Vw - Xr Elbow 1-2 Views Right (73070) |
$71 |
$142 |
0.9× |
| X-Ray Exam Breast Specimen (76098) |
$551.50 |
$1,103 |
1.2× |
| X-Ray Exam Entire Spi 4/5 Vw (72083) |
$130 |
$260 |
1.4× |
| X-Ray Exam Hip Uni 2-3 Views (73502) |
$71 |
$142 |
0.9× |
| X-Ray Exam Hips Bi 2 Views (73521) |
$130 |
$260 |
1.4× |
| X-Ray Exam L-S Spine Bending (72114) |
$130 |
$260 |
1.4× |
| X-Ray Exam Neck Spine 2-3 Vw (72040) |
$71 |
$142 |
0.9× |
| X-Ray Exam Neck Spine 6/>Vws (72052) |
$130 |
$260 |
1.4× |
| X-Ray Exam Unilat Ribs/Chest (71101) |
$130 |
$260 |
1.4× |
| X-ray humerus (73060) |
$71 |
$142 |
0.9× |
| X-ray IV pyelogram (ivp) (74400) |
$286.50 |
$573 |
1.9× |
| X-ray IV pyelogram+tomography (74415) |
$286.50 |
$573 |
1.9× |
| X-Ray Lumbar Spine 2/3 Vw - Xr Lumbar Spine 2-3 Views (72100) |
$130 |
$260 |
1.4× |
| X-Ray Ribs, Chest 4+ Vw - Xr Ribs 3 Vws Bil W/ Chest Posteroanterior (71111) |
$130 |
$260 |
1.4× |
| X-Ray Sacroiliac Jts <3 Vw - Xr Sacroiliac Joints 1-2 Views (72200) |
$130 |
$260 |
1.4× |
| X-Ray Sacrum/Coccyx 2+ Vw - Xr Sacrum Coccyx 2+ Views (72220) |
$71 |
$142 |
0.9× |
| X-Ray Sinuses 3+ Vw - Xr Paranasal Sinuses 3+ Views (70220) |
$71 |
$142 |
0.9× |
| X-Ray Skull 4+ Vw - Xr Skull Complete 4+ Views (70260) |
$130 |
$260 |
1.4× |
| X-Ray Urinary Tract Exam With Contrast Material (74420) |
$517.50 |
$1,035 |
1.7× |
| X-Rays Bone Length Studies (77073) |
$130 |
$260 |
1.4× |
| X-Rays Bone Survey Complete (77075) |
$130 |
$260 |
1.4× |
| Xr c-spine 4 or 5 views (72050) |
$130 |
$260 |
1.4× |
| Xr orbits complete 4 views (70200) |
$130 |
$260 |
1.4× |
| Xr Tomogram Single Plane (76100) |
$130 |
$260 |
1.4× |