| Abdomen 1 View (74018) |
$77.50 |
$155 |
1.0× |
| Abdomen 2 views (74019) |
$143 |
$286 |
1.5× |
| Acute Gastrointestinal Blood Loss Imaging (78278) |
$401.50 |
$803 |
1.1× |
| Ankle 2 views (73600) |
$77.50 |
$155 |
1.0× |
| Bone age studies (77072) |
$91.50 |
$183 |
1.0× |
| Bone Imaging 3 Phase (78315) |
$417.50 |
$835 |
1.1× |
| Bone Imaging Limited Area (78300) |
$486 |
$972 |
1.3× |
| Bone Imaging Whole Body (78306) |
$486 |
$972 |
1.3× |
| Chest 1 view (71045) |
$86 |
$172 |
1.1× |
| Chest 2 views (71046) |
$77.50 |
$155 |
1.0× |
| Clavicle complete (73000) |
$95 |
$190 |
1.2× |
| Computed Tomography Thorax Lw Dose Lng Ca Scr C- (71271) |
$195 |
$390 |
2.0× |
| CT abdomen and pelvis without and with contrast (74178) |
$642.50 |
$1,285 |
2.0× |
| CT abdomen and pelvis without contrast (74176) |
$500 |
$1,000 |
2.3× |
| CT abdomen w contrast (74160) |
$316 |
$632 |
2.0× |
| CT abdomen w wo contrast (74170) |
$642.50 |
$1,285 |
4.0× |
| CT abdomen w/o contrast (74150) |
$203.50 |
$407 |
2.1× |
| CT Angio Abdomen and Pelvis (74174) |
$512.50 |
$1,025 |
1.6× |
| CT Angio Chest (71275) |
$407.50 |
$815 |
2.6× |
| CT Angio Head (70496) |
$495 |
$990 |
3.1× |
| Ct Angio Lwr Extr W/O&W/Dye (73706) |
$356.50 |
$713 |
2.2× |
| CT Angio Neck (70498) |
$495 |
$990 |
3.1× |
| Ct Angio Upr Extrm W/O&W/Dye (73206) |
$337.50 |
$675 |
2.1× |
| CT bone density (77078) |
$120 |
$240 |
1.5× |
| CT cervical spine w/ contrast (72126) |
$570.50 |
$1,141 |
1.8× |
| CT cervical spine w/o contrast (72125) |
$275 |
$550 |
2.9× |
| CT cervical spine w/wo cont (72127) |
$124.50 |
$249 |
0.8× |
| CT chest w contrast (71260) |
$316 |
$632 |
2.0× |
| CT chest w/wo contrast (71270) |
$384 |
$768 |
2.4× |
| CT head/brain with contrast (70460) |
$217.74 |
$435.48 |
1.4× |
| CT head/brain without and with contrast (70470) |
$316 |
$632 |
2.0× |
| CT iac w contrast (70481) |
$282 |
$564 |
1.8× |
| CT l-spine w&w/o contrast (72133) |
$225.74 |
$451.48 |
1.4× |
| CT lower ext w/o (73700) |
$202.50 |
$405 |
2.1× |
| CT lower extremity w/contrast material (73701) |
$412.50 |
$825 |
2.6× |
| CT lumbar spine w contrast (72132) |
$321.66 |
$643.32 |
1.0× |
| CT lumbar spine w/o contrast (72131) |
$215 |
$430 |
2.3× |
| CT maxillofacial w contrast (70487) |
$316 |
$632 |
2.0× |
| CT maxillofacial wo contrast (70486) |
$207.50 |
$415 |
2.2× |
| CT neck tissue combo (70492) |
$338 |
$676 |
2.1× |
| Ct Orbit/Ear/Fossa W/O&W/Dye (70482) |
$344 |
$688 |
2.2× |
| CT orbits w/o contrast (70480) |
$225 |
$450 |
2.4× |
| CT pelvis w&w/o contrast (72194) |
$500 |
$1,000 |
3.1× |
| CT pelvis w/o contrast (72192) |
$500 |
$1,000 |
5.3× |
| CT scan of leg combo (73702) |
$299.50 |
$599 |
1.9× |
| CT scans face/jaw combo (70488) |
$191.50 |
$383 |
1.2× |
| CT soft tissue neck w contrast (70491) |
$316 |
$632 |
2.0× |
| CT soft tissue neck w/o contrast (70490) |
$198 |
$396 |
2.1× |
| CT thoracic spine w contrast (72129) |
$425 |
$850 |
2.7× |
| CT thoracic spine w/o contrast (72128) |
$244 |
$488 |
2.6× |
| CT thorax w/o contrast (71250) |
$136.50 |
$273 |
1.4× |
| CT upper ext wo (73200) |
$176 |
$352 |
1.8× |
| CT upper extremity w/o & w/contrast material (73202) |
$296 |
$592 |
1.9× |
| CT upper extremity with contrast (73201) |
$309 |
$618 |
1.0× |
| Cta Abdl Aorta&Bi Iliofem W/Contrast&Postp (75635) |
$603.50 |
$1,207 |
3.8× |
| Cta Abdomen (74175) |
$306.50 |
$613 |
1.9× |
| CTA head&neck c+ w/noncontrast img&post-pxessing (70471) |
$719 |
$1,438 |
2.3× |
| CTA pelvis (72191) |
$361.50 |
$723 |
2.3× |
| Fetal Biophysical Profile W/O Non-Stress Testing (76819) |
$225 |
$450 |
2.4× |
| Foot 2 views (73620) |
$65.50 |
$131 |
0.8× |
| Forearm 2 views (73090) |
$86 |
$172 |
1.1× |
| Gastric emptying imaging study (78264) |
$437 |
$874 |
1.2× |
| Gated Heart Planar Single (78472) |
$415 |
$830 |
1.1× |
| Hand 2 views (73120) |
$143 |
$286 |
1.5× |
| Hepatobil Syst Image W/Drug (78227) |
$699 |
$1,398 |
1.4× |
| Hepatobiliary System Imaging (78226) |
$699 |
$1,398 |
1.9× |
| K Flow/Funct Image W/Drug (78708) |
$688.50 |
$1,377 |
1.4× |
| Knee 3 Views (73562) |
$105 |
$210 |
1.3× |
| Lung Ventilat&Perfus Imaging (78582) |
$808.50 |
$1,617 |
1.6× |
| MRA head w/o contrast (70544) |
$473 |
$946 |
2.2× |
| MRA neck w/o contrast (70547) |
$473 |
$946 |
2.2× |
| MRI abdomen w contrast (74182) |
$497.50 |
$995 |
1.6× |
| MRI abdomen w/o contrast (74181) |
$407.50 |
$815 |
1.9× |
| MRI any jt lower extrem w/o & w/contrast matrl (73723) |
$482.50 |
$965 |
1.5× |
| MRI any jt upper extremity w/contrast matrl (73222) |
$396.50 |
$793 |
0.6× |
| MRI cervical spine w contrast (72142) |
$460.50 |
$921 |
1.4× |
| MRI cervical spine w/o cont (72141) |
$375 |
$750 |
1.7× |
| MRI chest wo w contrast (71552) |
$732.50 |
$1,465 |
2.3× |
| MRI lower extrem oth/thn jt w/o & w/contr matr (73720) |
$397 |
$794 |
1.2× |
| MRI lower extrem oth/thn jt w/o contr matrl (73718) |
$266.50 |
$533 |
1.2× |
| MRI lumbar spine w contrast (72149) |
$900 |
$1,800 |
2.8× |
| Mri Neck Spine W/O & W/Dye (72156) |
$687.50 |
$1,375 |
2.2× |
| MRI orbit face &/neck w/o contrast (70540) |
$447.50 |
$895 |
2.1× |
| Mri Orbt/Fac/Nck W/O &W/Dye (70543) |
$682.50 |
$1,365 |
2.1× |
| MRI pelvis w/o & w contrast (72197) |
$859.50 |
$1,719 |
2.7× |
| MRI pelvis w/o contrast (72195) |
$455 |
$910 |
2.1× |
| MRI thoracic spine w/o contrast (72146) |
$600 |
$1,200 |
2.8× |
| MRI upper extremity oth than jt w/o contr matrl (73218) |
$408.50 |
$817 |
1.9× |
Mri Uppr Extremity W/O&W/Dye (73220) range across 6 matching MRF lines |
$521–$651 |
$1,042–$1,302 |
varies |
| MRI, abdomen, combo (74183) |
$687.50 |
$1,375 |
2.2× |
| MRI, dorsal spine combo (72157) |
$662.50 |
$1,325 |
2.1× |
| MRI, dorsal spine contrast (72147) |
$252.50 |
$505 |
0.8× |
| MRI, joint upper extrem (73221) |
$225 |
$450 |
1.0× |
| MRI, joint upper extrem combo (73223) |
$483.50 |
$967 |
1.5× |
| MRI, lumbar spine combo (72158) |
$900 |
$1,800 |
2.8× |
| Myocardial Spect Multiple Studies (78452) |
$1,503.50 |
$3,007 |
1.3× |
| Neck soft tissue (70360) |
$77.50 |
$155 |
1.0× |
| Parathyroid Planar Imaging (78070) |
$546.50 |
$1,093 |
1.5× |
| Pelvis 1 or 2 views (72170) |
$143 |
$286 |
1.5× |
| Pulmonary Perfusion Imaging Particulate (78580) |
$348.50 |
$697 |
1.0× |
| Radex Abd Compl Aqt Abd W/S/E/D Views 1 View Ch (74022) |
$143 |
$286 |
1.5× |
| Radex Ankle Complete Minimum 3 Views (73610) |
$105 |
$210 |
1.3× |
| Radex Calcaneus Minimum 2 Views (73650) |
$86 |
$172 |
1.1× |
| Radex elbow complete minimum 3 views (73080) |
$110 |
$220 |
1.4× |
| Radex Facial Bones Complete Minimum 3 Views (70150) |
$143 |
$286 |
1.5× |
| Radex fingr minimum 2 views (73140) |
$86 |
$172 |
1.1× |
| Radex foot complete minimum 3 views (73630) |
$86 |
$172 |
1.1× |
| Radex Hand Minimum 3 Views (73130) |
$143 |
$286 |
1.8× |
| Radex lower extremity infant minimum 2 views (73592) |
$105 |
$210 |
1.3× |
| Radex Nasal Bones Complete Minimum 3 Views (70160) |
$86 |
$172 |
1.1× |
| Radex Ribs Unilateral 2 Views (71100) |
$86 |
$172 |
1.1× |
| Radex shoulder complete minimum 2 views (73030) |
$34.50 |
$69 |
0.4× |
| Radex Sternum Minimum 2 Views (71120) |
$86 |
$172 |
1.1× |
| Radex Toe Minimum 2 Views (73660) |
$86 |
$172 |
1.1× |
| Radex upper extremity infant minimum 2 views (73092) |
$114 |
$228 |
1.2× |
| Radex Wrist Complete Minimum 3 Views (73110) |
$46.50 |
$93 |
0.6× |
| Radiolog exam mandible compl minimum 4 views (70110) |
$143 |
$286 |
1.5× |
| Radiologic exam knee complete 4/more views (73564) |
$143 |
$286 |
1.5× |
| Radiologic exam swallow function contrast study (74230) |
$143 |
$286 |
0.9× |
| Radiologic examination femur 1 view (73551) |
$51.50 |
$103 |
0.6× |
| Radiologic examination femur minimum 2 views (73552) |
$77.50 |
$155 |
1.0× |
| Radiologic examination knee 1/2 views (73560) |
$86 |
$172 |
1.1× |
| Radiologic examination tibia & fibula 2 views (73590) |
$86 |
$172 |
1.1× |
| Ribs bilateral 3 views (71110) |
$143 |
$286 |
1.5× |
| Scapula (73010) |
$38 |
$76 |
0.4× |
| Screening Digital Breast Tomosynthesis Bi (77063) |
$129 |
$258 |
5.5× |
| Shoulder 1 view (73020) |
$105 |
$210 |
1.3× |
| Skull less than 4 views (70250) |
$179 |
$358 |
1.9× |
| Sternoclavicular joints (71130) |
$77.50 |
$155 |
1.0× |
| Thoracic spine 2 views (72070) |
$143 |
$286 |
1.5× |
| Thyroid Uptake W/Blood Flow Sngle/Mult Quan Meas (78014) |
$495 |
$990 |
1.4× |
| Ultrasound Breast Limited (76642) |
$102 |
$204 |
1.3× |
| Ultrasound Exam Aaa Screen (76706) |
$143 |
$286 |
1.5× |
| Ultrasound, abdomen limited (76705) |
$202 |
$404 |
2.1× |
| Us breast unilateral complete (76641) |
$143 |
$286 |
1.5× |
| Us chest (76604) |
$185.50 |
$371 |
1.9× |
| Us exam, pelvic, limited (76857) |
$149 |
$298 |
1.6× |
| Us lmtd joint/oth nonvasc xtr strux r-t w/img (76882) |
$143 |
$286 |
1.5× |
| Us ob limited 1 or more fetuses (76815) |
$81 |
$162 |
0.9× |
| Us ob transvaginal (76817) |
$202 |
$404 |
2.1× |
| Us pelvic non ob complete (76856) |
$202 |
$404 |
2.1× |
| Us pg uter img f&mat 14 wk tabdl 1/1st gestation (76801) |
$202 |
$404 |
2.1× |
| Us retroperitoneal complete (76770) |
$103.50 |
$207 |
1.1× |
| Us scrotum and contents (76870) |
$202 |
$404 |
2.1× |
| Us thyroid (76536) |
$202 |
$404 |
2.1× |
| Wrist 2 views (73100) |
$39 |
$78 |
0.5× |
| X-Ray Ac Jts - Xr Acromioclavicular Joints Bilateral (73050) |
$86 |
$172 |
1.1× |
| X-Ray Bend Only L-S Spine (72120) |
$92.50 |
$185 |
1.0× |
| X-Ray Elbow 2 Vw - Xr Elbow 1-2 Views Right (73070) |
$86 |
$172 |
1.1× |
| X-Ray Exam Entire Spi 1 Vw (72081) |
$67.50 |
$135 |
0.9× |
| X-Ray Exam Entire Spi 2/3 Vw (72082) |
$91.50 |
$183 |
1.0× |
| X-Ray Exam Hip Uni 1 View (73501) |
$77.50 |
$155 |
1.0× |
| X-Ray Exam Hip Uni 2-3 Views (73502) |
$112.50 |
$225 |
1.4× |
| X-Ray Exam Hips Bi 2 Views (73521) |
$143 |
$286 |
1.5× |
| X-Ray Exam L-S Spine Bending (72114) |
$179 |
$358 |
1.9× |
| X-Ray Exam Neck Spine 2-3 Vw (72040) |
$111.50 |
$223 |
1.4× |
| X-Ray Exam Unilat Ribs/Chest (71101) |
$143 |
$286 |
1.5× |
| X-ray humerus (73060) |
$119 |
$238 |
1.5× |
| X-Ray Jaw <4 Vw - Xr Mandible < 4 Views (70100) |
$51.50 |
$103 |
0.6× |
| X-Ray Knee Bilat Standing - Xr Knees Anteroposterior Standing Bilat (73565) |
$77.50 |
$155 |
1.0× |
| X-Ray Lumbar Spine 2/3 Vw - Xr Lumbar Spine 2-3 Views (72100) |
$143 |
$286 |
1.5× |
| X-ray nose-rectum child f.b. (76010) |
$176.47 |
$352.93 |
2.2× |
| X-Ray Ribs, Chest 4+ Vw - Xr Ribs 3 Vws Bil W/ Chest Posteroanterior (71111) |
$179 |
$358 |
1.9× |
| X-Ray Sacroiliac Jts 3+ Vw - Xr Sacroiliac Joints 3+ Views (72202) |
$111.50 |
$223 |
1.2× |
| X-Ray Sacrum/Coccyx 2+ Vw - Xr Sacrum Coccyx 2+ Views (72220) |
$86 |
$172 |
1.1× |
| X-Ray Sinuses 3+ Vw - Xr Paranasal Sinuses 3+ Views (70220) |
$105 |
$210 |
1.3× |
| X-Ray Skull 4+ Vw - Xr Skull Complete 4+ Views (70260) |
$120 |
$240 |
1.3× |
| Xr c-spine 4 or 5 views (72050) |
$143 |
$286 |
1.5× |
| Xr facial bones less than 3 views (70140) |
$67.50 |
$135 |
0.9× |
| Xr orbits complete 4 views (70200) |
$114 |
$228 |
1.2× |