| Abdomen 1 View (74018) |
$83.98 |
$442 |
0.9× |
| Abdomen 2 views (74019) |
$102.41 |
$539 |
0.9× |
| Ankle 2 views (73600) |
$64.41 |
$339 |
0.7× |
| Arthrogram ankle (73615) |
$234.71 |
$1,101 |
0.6× |
| Arthrogram hip (73525) |
$264.34 |
$1,240 |
0.7× |
| Arthrogram Wrist (73115) |
$232.37 |
$1,090 |
0.6× |
| Bone age studies (77072) |
$63.27 |
$333 |
0.6× |
| Bone survey infant (77076) |
$200.07 |
$1,053 |
1.8× |
| Cat Scan Follow-Up Study (76380) |
$84.97 |
$586 |
0.9× |
| Chest 1 view (71045) |
$56.03 |
$272 |
0.6× |
| Chest 2 views (71046) |
$67.57 |
$328 |
0.7× |
| Chest 3 views (71047) |
$75.40 |
$366 |
0.8× |
| Chest 4 or more views (71048) |
$91.26 |
$443 |
0.8× |
| Cholecystography Oral Contrast (74290) |
$140.03 |
$737 |
0.7× |
| Cineradiograpy/vidradiograpy xcpt where spec (76120) |
$430.16 |
$2,264 |
3.9× |
| Clavicle complete (73000) |
$60.80 |
$320 |
0.7× |
| Computed Tomography Thorax Lw Dose Lng Ca Scr C- (71271) |
$82.66 |
$467 |
0.7× |
| Contrast X-Ray Bladder (74430) |
$193.42 |
$1,018 |
0.5× |
| Contrast X-Ray Of Elbow (73085) |
$234.71 |
$1,101 |
0.6× |
| Contrast X-Ray Of Knee Joint (73580) |
$234.71 |
$1,101 |
0.6× |
| Contrast Xray Throat/Cerv Esopha (74210) |
$97.47 |
$513 |
0.5× |
| CT abdomen and pelvis without and with contrast (74178) |
$672.60 |
$3,800 |
1.8× |
| CT abdomen and pelvis without contrast (74176) |
$448.34 |
$2,533 |
1.8× |
| CT abdomen w contrast (74160) |
$393.82 |
$2,225 |
2.1× |
| CT abdomen w wo contrast (74170) |
$472.59 |
$2,670 |
2.5× |
| CT abdomen w/o contrast (74150) |
$315.06 |
$1,780 |
2.8× |
| CT Angio Abdomen and Pelvis (74174) |
$706.23 |
$3,990 |
1.9× |
| CT Angio Chest (71275) |
$654.55 |
$3,698 |
3.5× |
| CT Angio Head (70496) |
$420 |
$2,561 |
2.2× |
| Ct Angio Lwr Extr W/O&W/Dye (73706) |
$455.07 |
$2,571 |
2.4× |
| CT Angio Neck (70498) |
$383.76 |
$2,340 |
2.1× |
| Ct Angio Upr Extrm W/O&W/Dye (73206) |
$480.20 |
$2,713 |
2.6× |
| CT bone density (77078) |
$63.54 |
$359 |
0.7× |
| CT cervical spine w/ contrast (72126) |
$584.63 |
$3,303 |
1.6× |
| CT cervical spine w/o contrast (72125) |
$467.63 |
$2,642 |
4.2× |
| CT cervical spine w/wo cont (72127) |
$701.45 |
$3,963 |
3.7× |
| CT chest w contrast (71260) |
$519.32 |
$2,934 |
2.8× |
| CT chest w/wo contrast (71270) |
$623.22 |
$3,521 |
3.3× |
| CT head/brain with contrast (70460) |
$333.41 |
$2,033 |
1.8× |
| CT head/brain without and with contrast (70470) |
$400 |
$2,439 |
2.1× |
| CT iac w contrast (70481) |
$390.65 |
$2,382 |
2.1× |
| CT l-spine w&w/o contrast (72133) |
$688.53 |
$3,890 |
3.7× |
| CT lower ext w/o (73700) |
$288.86 |
$1,632 |
2.6× |
| CT lower extremity w/contrast material (73701) |
$361.08 |
$2,040 |
1.9× |
| CT lumbar spine w contrast (72132) |
$573.83 |
$3,242 |
1.5× |
| CT lumbar spine w/o contrast (72131) |
$458.96 |
$2,593 |
4.1× |
| CT maxillofacial w contrast (70487) |
$312.26 |
$1,904 |
1.7× |
| CT maxillofacial wo contrast (70486) |
$249.77 |
$1,523 |
2.2× |
| CT neck tissue combo (70492) |
$365.39 |
$2,228 |
2.0× |
| Ct Orbit/Ear/Fossa W/O&W/Dye (70482) |
$468.71 |
$2,858 |
2.5× |
| CT orbits w/o contrast (70480) |
$312.42 |
$1,905 |
2.8× |
| CT pelvis w&w/o contrast (72194) |
$519.67 |
$2,936 |
2.8× |
| CT pelvis w/o contrast (72192) |
$346.39 |
$1,957 |
3.1× |
| CT scan of leg combo (73702) |
$433.30 |
$2,448 |
2.3× |
| CT scans face/jaw combo (70488) |
$374.74 |
$2,285 |
2.0× |
| CT soft tissue neck w contrast (70491) |
$304.55 |
$1,857 |
1.6× |
| CT soft tissue neck w/o contrast (70490) |
$243.54 |
$1,485 |
2.2× |
| CT thoracic spine w contrast (72129) |
$582.15 |
$3,289 |
3.1× |
| CT thoracic spine w/o contrast (72128) |
$465.69 |
$2,631 |
4.2× |
| CT thoracic spine w/wo cont (72130) |
$698.62 |
$3,947 |
3.7× |
| CT thorax w/o contrast (71250) |
$415.42 |
$2,347 |
3.7× |
| CT upper ext wo (73200) |
$304.79 |
$1,722 |
2.7× |
| CT upper extremity w/o & w/contrast material (73202) |
$457.19 |
$2,583 |
2.4× |
| CT upper extremity with contrast (73201) |
$381.08 |
$2,153 |
1.0× |
| Cta Abdl Aorta&Bi Iliofem W/Contrast&Postp (75635) |
$354.67 |
$2,446 |
1.9× |
| Cta Abdomen (74175) |
$496.31 |
$2,804 |
2.7× |
| CTA pelvis (72191) |
$545.69 |
$3,083 |
2.9× |
| Dacryocystography, nasolacrimal duct, radiological supervision and interpretation Non-Facility (70170) |
$123.31 |
$649 |
0.5× |
| Discography Cerv/Thor Spine (72285) |
$675.26 |
$3,554 |
0.3× |
| Diskography lumbar (72295) |
$682.48 |
$3,592 |
0.3× |
| Doppler Echo Fetal Puls Spectral F/U/Repeat (76828) |
$107.33 |
$603 |
1.0× |
| Doppler Echo Fetal Spectral Display Complete (76827) |
$136.70 |
$768 |
1.2× |
| Doppler Fetal Mid Cerebral Artery (76821) |
$71.02 |
$399 |
0.6× |
| Echo exam of fetal heart (76825) |
$257.21 |
$1,445 |
0.4× |
| Echo exam uterus (76831) |
$122.46 |
$688 |
0.5× |
| Echo Guide For Artery Repair (76936) |
$111.43 |
$626 |
0.5× |
| Echocardiography, fetal, cardiovascular system, real time with image documentation (2D), with or without M-mode… (76826) |
$122.46 |
$688 |
0.5× |
| Echograp Trans R Pros Study (76873) |
$93.98 |
$528 |
0.8× |
| Esophagram (74220) |
$101.46 |
$534 |
0.5× |
| Fetal Biophys Profile W/Nst (76818) |
$173.19 |
$973 |
1.6× |
| Fetal Biophysical Profile W/O Non-Stress Testing (76819) |
$113.21 |
$636 |
1.0× |
| Fluoroscopy up to 1 hr (76000) |
$130.72 |
$688 |
0.5× |
| Foot 2 views (73620) |
$59.28 |
$312 |
0.6× |
| Forearm 2 views (73090) |
$61.75 |
$325 |
0.7× |
| Hand 2 views (73120) |
$61.94 |
$326 |
0.6× |
| Hysterosalpingogram (74740) |
$130.72 |
$688 |
0.5× |
| Infant hip ultrasound with hip movement (dynamic) (76885) |
$100.04 |
$562 |
1.1× |
| Infant hip ultrasound, limited static exam (76886) |
$73.16 |
$411 |
0.8× |
| Infusion Ivp (74410) |
$444.41 |
$2,339 |
2.4× |
| Joint Survey Single View (77077) |
$67.83 |
$357 |
0.6× |
| Knee 3 Views (73562) |
$76 |
$400 |
0.8× |
| Mammary ductogram or galactogram single (77053) |
$151.81 |
$799 |
0.6× |
| Myelogram cervical (72240) |
$406.41 |
$2,139 |
0.5× |
| Myelogram Lumbar (72265) |
$406.41 |
$2,139 |
0.5× |
| Myelography thoracic (72255) |
$406.79 |
$2,141 |
0.5× |
| Myelograpy 2/more regions rs&i (72270) |
$513.57 |
$2,703 |
0.6× |
| Neck soft tissue (70360) |
$58.71 |
$309 |
0.6× |
| Nonvascular Shunt X-Ray (75809) |
$61.94 |
$326 |
0.6× |
| Ob us nuchal meas 1 gest (76813) |
$79.21 |
$445 |
0.7× |
| Ophthalmic ultrasound dx b-scan w/wo a-scan (76512) |
$65.86 |
$370 |
0.6× |
| Optic foramina (70190) |
$79.42 |
$418 |
0.9× |
| Panoramic X-ray of jaws (70355) |
$55.48 |
$292 |
0.6× |
| Pelvis 1 or 2 views (72170) |
$67.64 |
$356 |
0.6× |
| Perineogram (74775) |
$224.58 |
$1,182 |
0.9× |
| Peritoneogram Rs&I (74190) |
$157.13 |
$827 |
0.3× |
| Radex Abd Compl Aqt Abd W/S/E/D Views 1 View Ch (74022) |
$136.61 |
$719 |
1.2× |
| Radex abscess/fistula/sinus tract rs&i (76080) |
$201.78 |
$1,062 |
0.3× |
| Radex Ankle Complete Minimum 3 Views (73610) |
$70.87 |
$373 |
0.8× |
| Radex Calcaneus Minimum 2 Views (73650) |
$54.53 |
$287 |
0.6× |
| Radex elbow complete minimum 3 views (73080) |
$69.92 |
$368 |
0.8× |
| Radex Facial Bones Complete Minimum 3 Views (70150) |
$66.69 |
$351 |
0.6× |
| Radex fingr minimum 2 views (73140) |
$49.40 |
$260 |
0.5× |
| Radex foot complete minimum 3 views (73630) |
$69.92 |
$368 |
0.8× |
| Radex Hand Minimum 3 Views (73130) |
$68.40 |
$360 |
0.7× |
| Radex lower extremity infant minimum 2 views (73592) |
$89.49 |
$471 |
1.0× |
| Radex Mastoids Compl Minimum 3 Views PR Side (70130) |
$158.84 |
$836 |
1.4× |
| Radex Nasal Bones Complete Minimum 3 Views (70160) |
$57.19 |
$301 |
0.6× |
| Radex Pharynx/Larx W/Fluor&/Magnification Tq (70370) |
$100.32 |
$528 |
1.1× |
| Radex Ribs Unilateral 2 Views (71100) |
$54.91 |
$289 |
0.6× |
| Radex shoulder complete minimum 2 views (73030) |
$73.72 |
$388 |
0.8× |
| Radex Sinuses Paransl < 3 Views (70210) |
$54.15 |
$285 |
0.6× |
| Radex sm int w/mlt srl imges via enteroclss tube (74251) |
$375.44 |
$1,976 |
2.0× |
| Radex Spine 1 View Specify Level (72020) |
$46.17 |
$243 |
0.5× |
| Radex Sternum Minimum 2 Views (71120) |
$63.08 |
$332 |
0.7× |
| Radex Temporomandble Jt Opn & Clsd Mouth Bilat (70330) |
$74.67 |
$393 |
0.8× |
| Radex Toe Minimum 2 Views (73660) |
$47.69 |
$251 |
0.5× |
| Radex upper extremity infant minimum 2 views (73092) |
$99.37 |
$523 |
0.9× |
| Radex Wrist Complete Minimum 3 Views (73110) |
$67.26 |
$354 |
0.7× |
| Radiolog exam mandible compl minimum 4 views (70110) |
$73.91 |
$389 |
0.7× |
| Radiologic Exam Abdomen 3+ Views - Xr Abdomen 3+ Views (74021) |
$118.18 |
$622 |
1.1× |
| Radiologic exam colon double contrast study (74280) |
$198.36 |
$1,044 |
1.1× |
| Radiologic exam colon single contrast study (74270) |
$178.22 |
$938 |
1.0× |
| Radiologic exam knee complete 4/more views (73564) |
$85.12 |
$448 |
0.8× |
| Radiologic exam pelvis compl minimum 3 views (72190) |
$83.79 |
$441 |
0.8× |
| Radiologic Exam Small Int Single Contrast Study (74250) |
$104.31 |
$549 |
0.6× |
| Radiologic exam swallow function contrast study (74230) |
$117.61 |
$619 |
0.6× |
| Radiologic exam upr gi trc double contrast study (74246) |
$116.85 |
$615 |
0.6× |
| Radiologic examination femur 1 view (73551) |
$45.98 |
$242 |
0.5× |
| Radiologic examination femur minimum 2 views (73552) |
$70.30 |
$370 |
0.8× |
| Radiologic examination knee 1/2 views (73560) |
$64.60 |
$340 |
0.7× |
| Radiologic Examination Osseous Survey Limited (77074) |
$78.47 |
$413 |
0.7× |
| Radiologic Examination Salivary Gland Calculus (70380) |
$44.65 |
$235 |
0.5× |
| Radiologic examination tibia & fibula 2 views (73590) |
$60.04 |
$316 |
0.6× |
| Radiologic examination, internal auditory meati, complete Non-Facility (70134) |
$107.73 |
$567 |
0.2× |
| Ribs bilateral 3 views (71110) |
$64.41 |
$339 |
0.6× |
| Scapula (73010) |
$68.97 |
$363 |
0.6× |
| Sella turcica (70240) |
$64.98 |
$342 |
0.7× |
| Shoulder 1 view (73020) |
$53.01 |
$279 |
0.6× |
| Shoulder Arthrography (73040) |
$234.71 |
$1,101 |
0.6× |
| Sialogram (70390) |
$130.72 |
$688 |
0.5× |
| Skull less than 4 views (70250) |
$64.22 |
$338 |
0.6× |
| Speech evaluation, complex (70371) |
$141.93 |
$747 |
0.6× |
| Sternoclavicular joints (71130) |
$80.37 |
$423 |
0.9× |
| Temporomandble Jt Arthrography Rs&I (70332) |
$235.14 |
$1,103 |
0.9× |
| Therapeutic Enema Rdctj Intussusception/Obstrcj (74283) |
$254.98 |
$1,342 |
1.4× |
| Thoracic spine 2 views (72070) |
$61.94 |
$326 |
0.6× |
| Thoracic spine 3 views (72072) |
$71.44 |
$376 |
0.6× |
| Thoracolumbar 2 views (72080) |
$64.98 |
$342 |
0.7× |
Ultrasound Breast Limited (76642)
range across 3 matching MRF lines |
$57.49–$86.33 |
$323–$485 |
varies |
| Ultrasound Exam Aaa Screen (76706) |
$70.84 |
$398 |
0.6× |
| Ultrasound, abdomen limited (76705) |
$117.12 |
$658 |
1.0× |
| Umbilical-artery Doppler (OB) (76820) |
$69.42 |
$390 |
0.6× |
| Upper gi w/o kub (74240) |
$115.14 |
$606 |
0.6× |
| Urethrocystogram voiding (74455) |
$130.72 |
$688 |
0.5× |
| Urethrocystography retrograde (74450) |
$201.78 |
$1,062 |
0.8× |
Us breast unilateral complete (76641)
range across 3 matching MRF lines |
$74.76–$112.14 |
$420–$630 |
varies |
| Us chest (76604) |
$78.50 |
$441 |
0.7× |
| Us complete joint (76881) |
$83.30 |
$468 |
0.7× |
| Us exam, pelvic, limited (76857) |
$116.41 |
$654 |
1.0× |
| Us head (76506) |
$132.08 |
$742 |
1.2× |
| Us kidney transplant (76776) |
$99.32 |
$558 |
0.9× |
| Us lmtd joint/oth nonvasc xtr strux r-t w/img (76882) |
$59.99 |
$337 |
0.5× |
| Us ob detailed single fetus (76811) |
$155.39 |
$873 |
0.6× |
| Us ob limited 1 or more fetuses (76815) |
$89.89 |
$505 |
0.8× |
| Us ob transvaginal (76817) |
$102.17 |
$574 |
0.9× |
| Us pelvic non ob complete (76856) |
$137.77 |
$774 |
1.2× |
| Us pg uter img f&mat 14 wk tabdl 1/1st gestation (76801) |
$95.23 |
$535 |
0.9× |
| Us preg uterus real time f/u trnsabdl per fetus (76816) |
$90.42 |
$508 |
0.8× |
| Us retroperitoneal complete (76770) |
$120.86 |
$679 |
1.1× |
| Us retroperitoneal limited (76775) |
$77.96 |
$438 |
0.7× |
| Us scrotum and contents (76870) |
$127.09 |
$714 |
1.1× |
| Us spinal canal and contents (76800) |
$139.55 |
$784 |
1.3× |
| Us thyroid (76536) |
$105.20 |
$591 |
0.9× |
| Us transrectal (76872) |
$96.48 |
$542 |
0.9× |
| Vein X-Ray Chest (75827) |
$243.58 |
$1,282 |
0.1× |
| Venography extremity bilateral rs&i (75822) |
$433.58 |
$2,282 |
0.3× |
| Venography extremity unilateral rs&i (75820) |
$370.50 |
$1,950 |
0.2× |
| Vertebral fracture assessment via dxa (77086) |
$51.30 |
$270 |
0.6× |
| Wrist 2 views (73100) |
$56.43 |
$297 |
0.6× |
| X-Ray Ac Jts - Xr Acromioclavicular Joints Bilateral (73050) |
$57.19 |
$301 |
0.6× |
| X-ray antegrade pyelogram tube (74425) |
$257.07 |
$1,353 |
0.7× |
| X-Ray Bend Only L-S Spine (72120) |
$70.11 |
$369 |
0.6× |
| X-Ray Elbow 2 Vw - Xr Elbow 1-2 Views Right (73070) |
$64.41 |
$339 |
0.7× |
| X-Ray Exam Breast Specimen (76098) |
$97.66 |
$514 |
0.2× |
| X-Ray Exam Entire Spi 2/3 Vw (72082) |
$112.10 |
$590 |
1.0× |
| X-Ray Exam Hip Uni 1 View (73501) |
$49.59 |
$261 |
0.5× |
| X-Ray Exam Hip Uni 2-3 Views (73502) |
$60.23 |
$317 |
0.6× |
| X-Ray Exam Hip Uni 4/> Views (73503) |
$74.67 |
$393 |
0.7× |
| X-Ray Exam Hips Bi 2 Views (73521) |
$61.94 |
$326 |
0.6× |
| X-Ray Exam Hips Bi 3-4 Views (73522) |
$71.63 |
$377 |
0.6× |
| X-Ray Exam Hips Bi 5/> Views (73523) |
$84.36 |
$444 |
0.8× |
| X-Ray Exam L-S Spine Bending (72114) |
$113.24 |
$596 |
1.0× |
| X-Ray Exam Neck Spine 2-3 Vw (72040) |
$70.30 |
$370 |
0.8× |
| X-Ray Exam Neck Spine 6/>Vws (72052) |
$101.84 |
$536 |
0.9× |
| X-Ray Exam Unilat Ribs/Chest (71101) |
$62.89 |
$331 |
0.6× |
| X-ray eye for foreign body (70030) |
$45.98 |
$242 |
0.5× |
| X-ray humerus (73060) |
$66.88 |
$352 |
0.7× |
| X-ray IV pyelogram (ivp) (74400) |
$287.85 |
$1,515 |
1.5× |
| X-ray IV pyelogram+tomography (74415) |
$518.70 |
$2,730 |
2.8× |
| X-Ray Jaw <4 Vw - Xr Mandible < 4 Views (70100) |
$64.98 |
$342 |
0.7× |
| X-Ray Knee Bilat Standing - Xr Knees Anteroposterior Standing Bilat (73565) |
$75.24 |
$396 |
0.8× |
| X-Ray Lumbar Spine 2/3 Vw - Xr Lumbar Spine 2-3 Views (72100) |
$83.79 |
$441 |
0.8× |
| X-ray nose-rectum child f.b. (76010) |
$64.22 |
$338 |
0.7× |
| X-Ray Ribs, Chest 4+ Vw - Xr Ribs 3 Vws Bil W/ Chest Posteroanterior (71111) |
$87.78 |
$462 |
0.8× |
| X-Ray Sacroiliac Jts 3+ Vw - Xr Sacroiliac Joints 3+ Views (72202) |
$68.78 |
$362 |
0.6× |
| X-Ray Sacroiliac Jts <3 Vw - Xr Sacroiliac Joints 1-2 Views (72200) |
$61.94 |
$326 |
0.6× |
| X-Ray Sacrum/Coccyx 2+ Vw - Xr Sacrum Coccyx 2+ Views (72220) |
$68.97 |
$363 |
0.7× |
| X-Ray Sinuses 3+ Vw - Xr Paranasal Sinuses 3+ Views (70220) |
$64.41 |
$339 |
0.7× |
| X-Ray Skull 4+ Vw - Xr Skull Complete 4+ Views (70260) |
$81.70 |
$430 |
0.7× |
| X-Ray Stress View (77071) |
$59.85 |
$315 |
0.6× |
| X-ray thoracic spine 4 vw (72074) |
$76.57 |
$403 |
0.7× |
| X-Ray Tmj Unilat (70328) |
$60.80 |
$320 |
0.7× |
| X-Ray Urinary Tract Exam With Contrast Material (74420) |
$209.19 |
$1,101 |
0.6× |
| X-Rays Bone Length Studies (77073) |
$72.77 |
$383 |
0.7× |
| X-Rays Bone Survey Complete (77075) |
$104.31 |
$549 |
0.9× |
| Xr c-spine 4 or 5 views (72050) |
$76.38 |
$402 |
0.7× |
| Xr facial bones less than 3 views (70140) |
$60.42 |
$318 |
0.7× |
| XR Mastoids < 3 Views Bilateral (70120) |
$97.47 |
$513 |
0.9× |
| Xr orbits complete 4 views (70200) |
$82.27 |
$433 |
0.7× |
| Xr Tomogram Single Plane (76100) |
$152.57 |
$803 |
1.4× |