| Abdomen 1 View (74018) |
$114.75 |
$225 |
1.3× |
| Abdomen 2 views (74019) |
$165.24 |
$324 |
1.5× |
| Acute Gastrointestinal Blood Loss Imaging (78278) |
$589.05 |
$1,155 |
1.4× |
| Angio internal mammary (75756) |
$2,324.58 |
$4,558 |
0.7× |
| Angio pulmonary bilat (75743) |
$2,367.42 |
$4,642 |
0.7× |
| Angiography extremity bilateral rs&i (75716) |
$1,967.07 |
$3,857 |
0.6× |
| Angiography extremity unilateral rs&i (75710) |
$2,893.23 |
$5,673 |
0.9× |
| Angiography pulmonary unilateral slctv rs&i (75741) |
$2,367.42 |
$4,642 |
0.7× |
| Angrph pulmonary nonslctv cath/ven njx rs&i (75746) |
$2,323.32 |
$4,555.52 |
0.7× |
| Ankle 2 views (73600) |
$93.33 |
$183 |
1.0× |
| Aortography thoracic serialography rs&i (75605) |
$3,977.49 |
$7,799 |
0.7× |
| Artery X-Rays Abdomen (75726) |
$4,861.83 |
$9,533 |
0.9× |
| Artery X-Rays Pelvis (75736) |
$4,419.66 |
$8,666 |
0.8× |
| Artery X-Rays Spine (75705) |
$3,481.77 |
$6,827 |
0.6× |
Arthrogram ankle (73615)
range across 2 matching MRF lines |
$481.95–$482.46 |
$945–$946 |
varies |
| Arthrogram hip (73525) |
$512.04 |
$1,004 |
1.4× |
| Arthrogram Wrist (73115) |
$512.04 |
$1,004 |
1.4× |
| Basic radiation dosimetry calculation (77300) |
$48.45 |
$95 |
0.4× |
| Bone age studies (77072) |
$107.10 |
$210 |
1.0× |
| Bone Imaging 3 Phase (78315) |
$775.20 |
$1,520 |
1.9× |
| Bone Imaging Limited Area (78300) |
$542.64 |
$1,064 |
1.3× |
| Bone Imaging Multiple Areas (78305) |
$387.60 |
$760 |
0.9× |
| Bone Imaging Whole Body (78306) |
$775.20 |
$1,520 |
1.9× |
| Bone survey infant (77076) |
$126.99 |
$249 |
1.2× |
| Brachytx isodose complex (77318) |
$275.91 |
$541 |
0.7× |
| Brain Flow Imaging Only (78610) |
$291.21 |
$571 |
0.5× |
| Brain Image W/Flow < 4 Views (78601) |
$344.76 |
$676 |
0.8× |
| Brain imaging < 4 static views (78600) |
$297.33 |
$583 |
0.7× |
| Brain Imaging Min 4 Static Views W Vascular Flow (78606) |
$550.80 |
$1,080 |
1.0× |
| Brain Imaging Minimum 4 Static Views (78605) |
$410.04 |
$804 |
0.7× |
| Brain Imaging Pet Metabolic Evaluation (78608) |
$2,104.77 |
$4,127 |
1.4× |
| Cardiac MRI w/w/o contrast & further seq (75561) |
$1,545.30 |
$3,030 |
4.3× |
| Cardiac Shunt Detection (78428) |
$260.61 |
$511 |
0.6× |
| Cat Scan Follow-Up Study (76380) |
$356.49 |
$699 |
4.0× |
| Cerebrospinal Fluid Flow W/O Matl Shunt Evaltj (78645) |
$537.54 |
$1,054 |
1.0× |
| Cerebrospinal Fluid Scan (78630) |
$718.08 |
$1,408 |
1.3× |
| Chest 1 view (71045) |
$105.57 |
$207 |
1.2× |
| Chest 2 views (71046) |
$138.21 |
$271 |
1.6× |
| Chest 3 views (71047) |
$145.35 |
$285 |
1.6× |
| Chest 4 or more views (71048) |
$161.16 |
$316 |
1.5× |
| Clavicle complete (73000) |
$143.82 |
$282 |
1.6× |
| Computed Tomography Thorax Lw Dose Lng Ca Scr C- (71271) |
$345.27 |
$677 |
3.2× |
| Contrast Exam Abdominl Aorta (75625) |
$2,939.13 |
$5,763 |
0.9× |
| Contrast X-Ray Bladder (74430) |
$380.46 |
$746 |
1.1× |
| Contrast X-Ray Of Elbow (73085) |
$578.34 |
$1,134 |
1.6× |
| Contrast X-Ray Of Knee Joint (73580) |
$748.68 |
$1,468 |
2.1× |
| CT abdomen and pelvis without and with contrast (74178) |
$2,444.94 |
$4,794 |
6.9× |
| CT abdomen and pelvis without contrast (74176) |
$1,956.36 |
$3,836 |
8.0× |
| CT abdomen w contrast (74160) |
$1,027.14 |
$2,014 |
5.7× |
| CT abdomen w wo contrast (74170) |
$1,388.22 |
$2,722 |
7.7× |
| CT abdomen w/o contrast (74150) |
$888.42 |
$1,742 |
8.3× |
| CT Angio Abdomen and Pelvis (74174) |
$2,129.25 |
$4,175 |
6.0× |
| CT Angio Chest (71275) |
$1,130.16 |
$2,216 |
6.3× |
| CT Angio Head (70496) |
$1,421.37 |
$2,787 |
7.9× |
| CT angio hrt w/3d image (75574) |
$1,221.45 |
$2,395 |
3.4× |
| Ct Angio Lwr Extr W/O&W/Dye (73706) |
$1,216.86 |
$2,386 |
6.8× |
| CT Angio Neck (70498) |
$1,401.48 |
$2,748 |
7.8× |
| Ct Angio Upr Extrm W/O&W/Dye (73206) |
$1,061.31 |
$2,081 |
5.9× |
| CT cervical spine w/ contrast (72126) |
$1,052.64 |
$2,064 |
3.0× |
| CT cervical spine w/o contrast (72125) |
$1,052.64 |
$2,064 |
9.9× |
| CT cervical spine w/wo cont (72127) |
$873.63 |
$1,713 |
4.9× |
| CT chest w contrast (71260) |
$953.70 |
$1,870 |
5.3× |
| CT chest w/wo contrast (71270) |
$1,126.59 |
$2,209 |
6.3× |
| CT head/brain with contrast (70460) |
$1,187.79 |
$2,329 |
6.6× |
| CT head/brain without and with contrast (70470) |
$1,522.35 |
$2,985 |
8.5× |
| CT heart contrast eval cardiac structure&morph (75572) |
$354.45 |
$695 |
1.0× |
| CT heart no contrast quant eval coronry calcium (75571) |
$48.96 |
$96 |
0.6× |
| CT hrt w/3d image congen (75573) |
$696.15 |
$1,365 |
2.0× |
| CT iac w contrast (70481) |
$1,009.80 |
$1,980 |
5.6× |
| CT l-spine w&w/o contrast (72133) |
$1,219.41 |
$2,391 |
6.8× |
| CT lower ext w/o (73700) |
$1,015.41 |
$1,991 |
9.5× |
| CT lower extremity w/contrast material (73701) |
$1,116.90 |
$2,190 |
6.2× |
| CT lumbar spine w contrast (72132) |
$1,048.05 |
$2,055 |
2.9× |
| CT lumbar spine w/o contrast (72131) |
$952.68 |
$1,868 |
8.9× |
| CT maxillofacial w contrast (70487) |
$981.24 |
$1,924 |
5.5× |
| CT maxillofacial wo contrast (70486) |
$908.31 |
$1,781 |
8.5× |
| CT neck tissue combo (70492) |
$1,378.02 |
$2,702 |
7.7× |
| Ct Orbit/Ear/Fossa W/O&W/Dye (70482) |
$1,074.06 |
$2,106 |
6.0× |
| CT orbits w/o contrast (70480) |
$918 |
$1,800 |
8.6× |
| CT pelvis w&w/o contrast (72194) |
$862.92 |
$1,692 |
4.8× |
| CT pelvis w/o contrast (72192) |
$908.31 |
$1,781 |
8.5× |
| CT scan of leg combo (73702) |
$1,167.39 |
$2,289 |
6.5× |
| CT scans face/jaw combo (70488) |
$1,035.81 |
$2,031 |
5.8× |
| CT soft tissue neck w contrast (70491) |
$1,138.83 |
$2,233 |
6.4× |
| CT soft tissue neck w/o contrast (70490) |
$910.86 |
$1,786 |
8.5× |
| CT thoracic spine w contrast (72129) |
$1,051.11 |
$2,061 |
5.9× |
| CT thoracic spine w/o contrast (72128) |
$955.74 |
$1,874 |
8.9× |
| CT thoracic spine w/wo cont (72130) |
$582.93 |
$1,143 |
3.3× |
| CT thorax w/o contrast (71250) |
$908.31 |
$1,781 |
8.5× |
| CT upper ext wo (73200) |
$908.31 |
$1,781 |
8.5× |
| CT upper extremity w/o & w/contrast material (73202) |
$862.92 |
$1,692 |
4.8× |
| CT upper extremity with contrast (73201) |
$772.14 |
$1,514 |
2.2× |
| Cta Abdl Aorta&Bi Iliofem W/Contrast&Postp (75635) |
$1,503.48 |
$2,948 |
8.4× |
| Cta Abdomen (74175) |
$1,277.55 |
$2,505 |
7.1× |
| CTA pelvis (72191) |
$1,157.70 |
$2,270 |
6.5× |
| Dilation ureters/urethra rs&i (74485) |
$1,310.70 |
$2,570 |
0.6× |
| Diskography lumbar (72295) |
$1,502.97 |
$2,947 |
0.8× |
| Doppler Echo Fetal Puls Spectral F/U/Repeat (76828) |
$60.92 |
$119.45 |
0.6× |
| Doppler Echo Fetal Spectral Display Complete (76827) |
$125.97 |
$247 |
1.2× |
| Doppler Fetal Mid Cerebral Artery (76821) |
$118.83 |
$233 |
1.1× |
| Dxa Bone Density Axial (77080) |
$146.88 |
$288 |
1.4× |
| Dxa bone density study (77085) |
$138.21 |
$271 |
1.3× |
| Dxa bone density study 1/>sites appendiclr skel (77081) |
$186.15 |
$365 |
2.1× |
| Echo exam of fetal heart (76825) |
$418.20 |
$820 |
0.7× |
| Echo Guide For Artery Repair (76936) |
$558.96 |
$1,096 |
2.5× |
| Echocardiography, fetal, cardiovascular system, real time with image documentation (2D), with or without M-mode… (76826) |
$122.08 |
$239.36 |
0.5× |
| Echograp Trans R Pros Study (76873) |
$71.91 |
$141 |
0.7× |
| Esophagram (74220) |
$333.03 |
$653 |
1.9× |
| Fetal Biophys Profile W/Nst (76818) |
$260.61 |
$511 |
2.4× |
| Fetal Biophysical Profile W/O Non-Stress Testing (76819) |
$140.76 |
$276 |
1.3× |
| Fetal MRI w/placntl matrnl plvc img sing/1st ges (74712) |
$205.53 |
$403 |
0.8× |
Fluoroscopy up to 1 hr (76000)
range across 3 matching MRF lines |
$178.61–$341.19 |
$350.21–$669 |
varies |
| Follow-Up Angiography (75898) |
$2,323.32 |
$4,555.52 |
0.7× |
| Foot 2 views (73620) |
$92.31 |
$181 |
1.0× |
| Forearm 2 views (73090) |
$158.61 |
$311 |
1.8× |
| Gastric emptying imaging study (78264) |
$574.26 |
$1,126 |
1.4× |
| Gastroesophageal Reflux Exam (78262) |
$385.56 |
$756 |
0.9× |
| Gated Heart Planar Single (78472) |
$703.80 |
$1,380 |
1.7× |
| Gated Heart, Multiple (78473) |
$478.89 |
$939 |
1.2× |
| Hand 2 views (73120) |
$134.64 |
$264 |
1.3× |
| Heart Image (Pet) Multiple (78492) |
$1,198.50 |
$2,350 |
0.8× |
| Hepatc Vngrph Wdg/Fr Hemodyn Eval Rs&I (75889) |
$2,324.58 |
$4,558 |
0.7× |
| Hepatc Vngrph Wdg/Fr W/O Hemodyn Eval Rs&I (75891) |
$1,652.40 |
$3,240 |
0.5× |
| Hepatobil Syst Image W/Drug (78227) |
$803.25 |
$1,575 |
1.4× |
| Hepatobiliary System Imaging (78226) |
$754.80 |
$1,480 |
1.8× |
| Ht Muscle Image Spect Sing (78451) |
$923.61 |
$1,811 |
0.7× |
| Infant hip ultrasound with hip movement (dynamic) (76885) |
$166.26 |
$326 |
1.9× |
| Infant hip ultrasound, limited static exam (76886) |
$161.16 |
$316 |
1.8× |
| Interstitial radiation source applic complex (77778) |
$1,101.60 |
$2,160 |
1.5× |
| Joint Survey Single View (77077) |
$107.10 |
$210 |
1.0× |
| K Flow/Funct Image Multiple (78709) |
$1,301.01 |
$2,551 |
2.3× |
| K Flow/Funct Image W/Drug (78708) |
$681.36 |
$1,336 |
1.2× |
| K Flow/Funct Image W/O Drug (78707) |
$681.36 |
$1,336 |
1.2× |
| Kidney Imaging Morphol (78700) |
$681.36 |
$1,336 |
1.7× |
| Kidney Imaging Morphoogy W/Vascular Flow (78701) |
$579.36 |
$1,136 |
1.4× |
Knee 3 Views (73562)
range across 2 matching MRF lines |
$249.90–$377.40 |
$490–$740 |
varies |
| Leveen/Shunt Patency Exam (78291) |
$308.55 |
$605 |
0.8× |
| Liver & Spleen Imaging Static Only (78215) |
$497.76 |
$976 |
1.2× |
| Liver & Spleen Imaging W/Vascular Flow (78216) |
$325.38 |
$638 |
0.8× |
| Liver imaging static only (78201) |
$1,120.98 |
$2,198 |
2.0× |
| Lung Perf&Ventilat Diferentl (78598) |
$466.65 |
$915 |
0.8× |
| Lung perfusion differential (78597) |
$271.32 |
$532 |
0.7× |
| Lung Ventilat&Perfus Imaging (78582) |
$420.75 |
$825 |
0.8× |
| Lung Ventilation Imaging (78579) |
$277.95 |
$545 |
0.7× |
| Lymph System Imaging (78195) |
$482.46 |
$946 |
0.9× |
| Lymphangiography extremity only unilateral rs&i (75801) |
$500.31 |
$981 |
0.8× |
| Lymphangiography Pelvic/Abdominal Bilateral Rs&I (75807) |
$2,324.58 |
$4,558 |
0.7× |
| Lymphangiography, pelvic/abdominal, unilateral (75805) |
$2,323.32 |
$4,555.52 |
0.7× |
| Magnetic Image Jaw Joint (70336) |
$1,343.85 |
$2,635 |
5.5× |
| Meckels Divert Exam (78290) |
$683.40 |
$1,340 |
1.7× |
| Mr safety determination physician/other qhp (76016) |
$137.70 |
$270 |
1.5× |
| Mr safety implant&/fb assmt clin staf 1st 15 min (76014) |
$137.70 |
$270 |
4.7× |
| Mr safety implt electronics prepj supvj phys/qhp (76018) |
$137.70 |
$270 |
1.4× |
| Mr safety implt pos&/immoblj (76019) |
$137.70 |
$270 |
2.3× |
| Mr safety med physics xm customization plng&mntr (76017) |
$137.70 |
$270 |
0.6× |
| Mra Head W/O & W/Contrast Material (70546) |
$1,870.68 |
$3,668 |
5.2× |
| MRA head w/o contrast (70544) |
$1,230.63 |
$2,413 |
5.0× |
| MRA head with contrast (70545) |
$1,157.19 |
$2,269 |
3.2× |
| MRA neck w contrast (70548) |
$1,492.77 |
$2,927 |
4.2× |
| Mra Neck W/O &W/Contrast Material (70549) |
$1,866.09 |
$3,659 |
5.2× |
| MRA neck w/o contrast (70547) |
$951.66 |
$1,866 |
3.9× |
| MRI abdomen w contrast (74182) |
$1,149.54 |
$2,254 |
3.2× |
| MRI abdomen w/o contrast (74181) |
$1,287.75 |
$2,525 |
5.3× |
| MRI any jt lower extrem w/contrast material (73722) |
$1,836.51 |
$3,601 |
2.3× |
| MRI any jt lower extrem w/o & w/contrast matrl (73723) |
$2,714.22 |
$5,322 |
7.6× |
| MRI any jt upper extremity w/contrast matrl (73222) |
$1,563.66 |
$3,066 |
2.0× |
| MRI Breast W/O Contrast Bilateral (77047) |
$2,291.43 |
$4,493 |
9.4× |
| MRI Breast Without Contrast Material Unilateral (77046) |
$1,735.02 |
$3,402 |
7.1× |
| MRI cardiac w/o contrast (75557) |
$1,252.05 |
$2,455 |
5.1× |
| MRI cervical spine w contrast (72142) |
$1,187.28 |
$2,328 |
3.3× |
| MRI cervical spine w/o cont (72141) |
$1,375.98 |
$2,698 |
5.6× |
| MRI chest w/o contrast (71550) |
$1,232.16 |
$2,416 |
5.1× |
| MRI chest with contrast (71551) |
$977.16 |
$1,916 |
1.2× |
| MRI chest wo w contrast (71552) |
$2,124.15 |
$4,165 |
6.0× |
| MRI lower extrem oth/thn jt w/contrast matrl (73719) |
$858.33 |
$1,683 |
2.4× |
| MRI lower extrem oth/thn jt w/o & w/contr matr (73720) |
$2,043.06 |
$4,006 |
5.7× |
| MRI lower extrem oth/thn jt w/o contr matrl (73718) |
$980.73 |
$1,923 |
4.0× |
| MRI lumbar spine w contrast (72149) |
$1,040.91 |
$2,041 |
2.9× |
| Mri Neck Spine W/O & W/Dye (72156) |
$2,698.41 |
$5,291 |
7.6× |
| MRI orbit face &/neck w/o contrast (70540) |
$777.75 |
$1,525 |
3.2× |
| MRI orbit face neck w contrast (70542) |
$842.52 |
$1,652 |
2.4× |
| Mri Orbt/Fac/Nck W/O &W/Dye (70543) |
$2,160.36 |
$4,236 |
6.1× |
| MRI pelvis w contrast (72196) |
$866.49 |
$1,699 |
2.4× |
| MRI pelvis w/o & w contrast (72197) |
$2,165.46 |
$4,246 |
6.1× |
| MRI pelvis w/o contrast (72195) |
$974.61 |
$1,911 |
4.0× |
| MRI thoracic spine w/o contrast (72146) |
$1,255.62 |
$2,462 |
5.2× |
| MRI upper extremity oth than jt w/contr matrl (73219) |
$1,074.57 |
$2,107 |
3.0× |
| MRI upper extremity oth than jt w/o contr matrl (73218) |
$1,432.59 |
$2,809 |
5.9× |
| Mri Uppr Extremity W/O&W/Dye (73220) |
$2,005.83 |
$3,933 |
5.6× |
| MRI, abdomen, combo (74183) |
$2,299.08 |
$4,508 |
6.5× |
| MRI, dorsal spine combo (72157) |
$2,368.95 |
$4,645 |
6.6× |
| MRI, dorsal spine contrast (72147) |
$1,042.44 |
$2,044 |
2.9× |
| MRI, joint upper extrem (73221) |
$1,384.14 |
$2,714 |
5.7× |
| MRI, joint upper extrem combo (73223) |
$2,366.40 |
$4,640 |
6.6× |
| MRI, lumbar spine combo (72158) |
$2,419.95 |
$4,745 |
6.8× |
| Myelogram cervical (72240) |
$515.10 |
$1,010 |
0.6× |
| Myelogram Lumbar (72265) |
$731.85 |
$1,435 |
0.9× |
| Myelography thoracic (72255) |
$503.37 |
$987 |
0.6× |
| Myelograpy 2/more regions rs&i (72270) |
$878.22 |
$1,722 |
1.1× |
| Myocardial Spect Multiple Studies (78452) |
$1,775.82 |
$3,482 |
1.3× |
| N-invas est c ffr sw aly CTA (75580) |
$1,063.35 |
$2,085 |
1.2× |
| Neck soft tissue (70360) |
$122.40 |
$240 |
1.4× |
| Njx Rp Loclzj Non-Img Probe Study Intravenous (78808) |
$302.94 |
$594 |
0.7× |
| Nm csf leak detection (78650) |
$1,035 |
$2,029.40 |
0.8× |
| Nonvascular Shunt X-Ray (75809) |
$261.12 |
$512 |
2.4× |
| Nuclear Rx Intra-Arterial (79445) |
$369.75 |
$725 |
1.6× |
| Nuclear Rx Oral Admin (79005) |
$376.38 |
$738 |
1.6× |
| Ophthalmic ultrasound dx b-scan w/wo a-scan (76512) |
$80.20 |
$157.25 |
0.8× |
| Parathyroid imaging w/tomographic spect & CT (78072) |
$683.91 |
$1,341 |
1.2× |
| Parathyroid Planar Imaging (78070) |
$479.91 |
$941 |
1.2× |
| Parathyroid planar imaging w/wo subtraction (78071) |
$522.40 |
$1,024.30 |
1.3× |
| Pelvis 1 or 2 views (72170) |
$131.07 |
$257 |
1.2× |
| Peritoneogram Rs&I (74190) |
$402.11 |
$788.45 |
0.7× |
| Pet Image W/Ct Lmtd (78814) |
$2,526.03 |
$4,953 |
1.7× |
| PET image w/CT, full body (78816) |
$2,526.03 |
$4,953 |
1.7× |
| PET imaging CT attenuation skull base mid-thigh (78815) |
$2,526.03 |
$4,953 |
1.7× |
| Pet Imaging Limited Area Chest Head/Neck (78811) |
$1,619.76 |
$3,176 |
1.2× |
| Prq Transhepatc Portograpy Hemodyn Eval Rs&I (75885) |
$1,587.63 |
$3,113 |
0.5× |
| Pulmonary Perfusion Imaging Particulate (78580) |
$533.97 |
$1,047 |
1.3× |
| Radex Abd Compl Aqt Abd W/S/E/D Views 1 View Ch (74022) |
$227.46 |
$446 |
2.1× |
| Radex abscess/fistula/sinus tract rs&i (76080) |
$323.85 |
$635 |
0.6× |
| Radex Ankle Complete Minimum 3 Views (73610) |
$115.26 |
$226 |
1.3× |
| Radex Calcaneus Minimum 2 Views (73650) |
$163.71 |
$321 |
1.8× |
| Radex elbow complete minimum 3 views (73080) |
$249.39 |
$489 |
2.8× |
| Radex Facial Bones Complete Minimum 3 Views (70150) |
$159.63 |
$313 |
1.5× |
Radex fingr minimum 2 views (73140)
range across 2 matching MRF lines |
$147.39–$158.61 |
$289–$311 |
varies |
| Radex foot complete minimum 3 views (73630) |
$116.79 |
$229 |
1.3× |
| Radex Hand Minimum 3 Views (73130) |
$249.39 |
$489 |
2.8× |
| Radex lower extremity infant minimum 2 views (73592) |
$73.95 |
$145 |
0.8× |
| Radex Mastoids Compl Minimum 3 Views PR Side (70130) |
$64.77 |
$127 |
0.6× |
| Radex Nasal Bones Complete Minimum 3 Views (70160) |
$120.87 |
$237 |
1.4× |
| Radex Ribs Unilateral 2 Views (71100) |
$119.34 |
$234 |
1.3× |
| Radex shoulder complete minimum 2 views (73030) |
$347.31 |
$681 |
3.9× |
| Radex Sinuses Paransl < 3 Views (70210) |
$71.40 |
$140 |
0.8× |
| Radex Spine 1 View Specify Level (72020) |
$92.31 |
$181 |
1.0× |
| Radex Sternum Minimum 2 Views (71120) |
$110.16 |
$216 |
1.2× |
| Radex Temporomandble Jt Opn & Clsd Mouth Bilat (70330) |
$110.67 |
$217 |
1.2× |
Radex Toe Minimum 2 Views (73660)
range across 2 matching MRF lines |
$94.86–$102 |
$186–$200 |
varies |
| Radex upper extremity infant minimum 2 views (73092) |
$72.93 |
$143 |
0.7× |
| Radex Wrist Complete Minimum 3 Views (73110) |
$249.39 |
$489 |
2.8× |
| Radiolog exam mandible compl minimum 4 views (70110) |
$192.78 |
$378 |
1.8× |
| Radiologic exam colon double contrast study (74280) |
$447.78 |
$878 |
2.5× |
| Radiologic exam colon single contrast study (74270) |
$282.03 |
$553 |
1.6× |
| Radiologic Exam Esophagus Double Contrast Study (74221) |
$164.94 |
$323.40 |
0.9× |
| Radiologic exam knee complete 4/more views (73564) |
$281.52 |
$552 |
2.6× |
| Radiologic exam pelvis compl minimum 3 views (72190) |
$191.25 |
$375 |
1.8× |
| Radiologic Exam Small Int Single Contrast Study (74250) |
$209.61 |
$411 |
1.2× |
| Radiologic exam swallow function contrast study (74230) |
$276.93 |
$543 |
1.5× |
Radiologic exam upr gi trc double contrast study (74246)
range across 2 matching MRF lines |
$379.95–$383.01 |
$745–$751 |
varies |
| Radiologic examination femur 1 view (73551) |
$110.67 |
$217 |
1.2× |
| Radiologic examination femur minimum 2 views (73552) |
$110.67 |
$217 |
1.2× |
| Radiologic examination knee 1/2 views (73560) |
$199.92 |
$392 |
2.2× |
| Radiologic Examination Osseous Survey Limited (77074) |
$101.49 |
$199 |
1.0× |
| Radiologic examination tibia & fibula 2 views (73590) |
$158.61 |
$311 |
1.8× |
| Renal Cyst Study (74470) |
$402.11 |
$788.45 |
0.7× |
| Ribs bilateral 3 views (71110) |
$142.29 |
$279 |
1.3× |
| Rp loclzj tum plnr 1 area single day imaging (78800) |
$445.23 |
$873 |
1.1× |
| Rp Loclzj Tum Plnr Whole Body 2+ Days Imaging (78804) |
$993.99 |
$1,949 |
1.8× |
| Rp Loclzj Tum Plnr Whole Body Single Day Imaging (78802) |
$1,035 |
$2,029.40 |
1.9× |
Rp Loclzj Tum Spect 1 Area Single Day Imaging (78803)
range across 3 matching MRF lines |
$724.71–$1,201.05 |
$1,421–$2,355 |
varies |
| Rp loclzj tum spect 2 area/sep acquisj img (78831) |
$867 |
$1,700 |
0.7× |
| Rp loclzj tum spect CT 2area 1d img/1 ar img>2+d (78832) |
$867 |
$1,700 |
0.6× |
| Rp loclzj tum spect w/CT 1 area/acquisj 1day img (78830) |
$765 |
$1,500 |
0.6× |
Rp Therapy Intravenous Administration (79101)
range across 2 matching MRF lines |
$173.40–$186.66 |
$340–$366 |
varies |
| Scapula (73010) |
$192.78 |
$378 |
1.8× |
| Screening Digital Breast Tomosynthesis Bi (77063) |
$46.41 |
$91 |
2.0× |
| Shoulder 1 view (73020) |
$139.23 |
$273 |
1.6× |
Shoulder Arthrography (73040)
range across 2 matching MRF lines |
$712.98–$713.49 |
$1,398–$1,399 |
varies |
| Sialogram (70390) |
$168.30 |
$330 |
0.7× |
| Skull less than 4 views (70250) |
$124.44 |
$244 |
1.2× |
| Special treatment procedure (77470) |
$408 |
$800 |
0.7× |
| Sternoclavicular joints (71130) |
$96.39 |
$189 |
1.1× |
| Ther Rad Simulaj-Aided Field Setting Complex (77290) |
$1,004.19 |
$1,969 |
2.6× |
| Thoracic spine 2 views (72070) |
$143.31 |
$281 |
1.3× |
| Thoracic spine 3 views (72072) |
$154.53 |
$303 |
1.4× |
| Thoracolumbar 2 views (72080) |
$107.10 |
$210 |
1.2× |
| Thyroid Imaging With Vascular Flow (78013) |
$355.98 |
$698 |
0.9× |
| Thyroid Met Imaging Body (78018) |
$718.08 |
$1,408 |
1.3× |
| Thyroid Uptake Measurement (78012) |
$325.38 |
$638 |
0.8× |
| Thyroid Uptake W/Blood Flow Sngle/Mult Quan Meas (78014) |
$635.46 |
$1,246 |
1.6× |
| Tx devices design & construction simple (77332) |
$205.53 |
$403 |
1.5× |
| Ultrasound Breast Limited (76642) |
$150.45 |
$295 |
1.7× |
| Ultrasound Exam Aaa Screen (76706) |
$157.59 |
$309 |
1.5× |
| Ultrasound, abdomen limited (76705) |
$232.05 |
$455 |
2.2× |
| Umbilical-artery Doppler (OB) (76820) |
$107.10 |
$210 |
1.0× |
| Unlisted Dx Radiographic Procedure (76499) |
$66.24 |
$129.87 |
0.7× |
| Unlisted fluoroscopic procedure (76496) |
$394.74 |
$774 |
4.4× |
| Unlisted us procedure (76999) |
$110.67 |
$217 |
1.2× |
Upper gi w/o kub (74240)
range across 2 matching MRF lines |
$231.03–$249.39 |
$453–$489 |
varies |
| Urethrocystogram voiding (74455) |
$240.72 |
$472 |
1.0× |
| Urethrocystography retrograde (74450) |
$289.17 |
$567 |
1.2× |
| Us breast unilateral complete (76641) |
$198.39 |
$389 |
1.9× |
| Us chest (76604) |
$60.92 |
$119.45 |
0.6× |
| Us complete joint (76881) |
$82.11 |
$161 |
0.8× |
| Us exam, pelvic, limited (76857) |
$151.98 |
$298 |
1.4× |
| Us head (76506) |
$177.48 |
$348 |
1.7× |
| Us kidney transplant (76776) |
$225.93 |
$443 |
2.1× |
| Us lmtd joint/oth nonvasc xtr strux r-t w/img (76882) |
$217.77 |
$427 |
2.0× |
| Us ob detailed single fetus (76811) |
$176.46 |
$346 |
0.7× |
| Us ob limited 1 or more fetuses (76815) |
$239.70 |
$470 |
2.2× |
| Us ob transvaginal (76817) |
$126.99 |
$249 |
1.2× |
| Us pelvic non ob complete (76856) |
$328.44 |
$644 |
3.1× |
| Us pg uter img f&mat 14 wk tabdl 1/1st gestation (76801) |
$251.94 |
$494 |
2.4× |
| Us preg uterus real time f/u trnsabdl per fetus (76816) |
$158.10 |
$310 |
1.5× |
| Us retroperitoneal complete (76770) |
$268.77 |
$527 |
2.5× |
| Us retroperitoneal limited (76775) |
$244.80 |
$480 |
2.3× |
| Us scrotum and contents (76870) |
$309.06 |
$606 |
2.9× |
| Us spinal canal and contents (76800) |
$188.70 |
$370 |
1.8× |
| Us thyroid (76536) |
$295.29 |
$579 |
2.8× |
| Us transrectal (76872) |
$71.91 |
$141 |
0.7× |
| Vein X-Ray Chest (75827) |
$1,187.79 |
$2,329 |
0.7× |
| Vein X-Ray Liver W/O Hemodyn (75887) |
$2,323.32 |
$4,555.52 |
0.7× |
| Venogram Sinus/Jugular (75860) |
$2,513.79 |
$4,929 |
0.8× |
| Venography Adrenal Unilateral (75840) |
$2,018.07 |
$3,957 |
0.6× |
| Venography caval inferior serialography rs&i (75825) |
$2,240.94 |
$4,394 |
0.7× |
| Venography extremity bilateral rs&i (75822) |
$1,027.65 |
$2,015 |
0.6× |
| Venography extremity unilateral rs&i (75820) |
$1,167.34 |
$2,288.90 |
0.7× |
| Venography Renal Bilateral (75833) |
$2,324.58 |
$4,558 |
0.7× |
| Venography Renal Unilateral (75831) |
$2,324.58 |
$4,558 |
0.7× |
| Venous Thrombosis Imaging Venogram Bilateral (78458) |
$236.13 |
$463 |
0.6× |
| Wrist 2 views (73100) |
$157.08 |
$308 |
1.8× |
| X-Ray Ac Jts - Xr Acromioclavicular Joints Bilateral (73050) |
$117.81 |
$231 |
1.3× |
| X-ray antegrade pyelogram tube (74425) |
$400.86 |
$786 |
1.1× |
| X-Ray Aorta Leg Arteries (75630) |
$1,763.58 |
$3,458 |
0.5× |
| X-Ray Bend Only L-S Spine (72120) |
$154.53 |
$303 |
1.4× |
| X-Ray Elbow 2 Vw - Xr Elbow 1-2 Views Right (73070) |
$144.84 |
$284 |
1.6× |
| X-Ray Exam Breast Specimen (76098) |
$431.46 |
$846 |
0.8× |
| X-Ray Exam Entire Spi 1 Vw (72081) |
$74.97 |
$147 |
0.8× |
| X-Ray Exam Entire Spi 2/3 Vw (72082) |
$126.99 |
$249 |
1.2× |
| X-Ray Exam Entire Spi 4/5 Vw (72083) |
$136.17 |
$267 |
1.3× |
| X-Ray Exam Hip Uni 1 View (73501) |
$102.51 |
$201 |
1.2× |
| X-Ray Exam Hip Uni 2-3 Views (73502) |
$93.84 |
$184 |
1.1× |
| X-Ray Exam Hip Uni 4/> Views (73503) |
$94.86 |
$186 |
0.9× |
| X-Ray Exam Hips Bi 2 Views (73521) |
$121.89 |
$239 |
1.1× |
| X-Ray Exam Hips Bi 3-4 Views (73522) |
$97.41 |
$191 |
0.9× |
| X-Ray Exam L-S Spine Bending (72114) |
$156.06 |
$306 |
1.5× |
| X-Ray Exam Neck Spine 2-3 Vw (72040) |
$112.20 |
$220 |
1.3× |
| X-Ray Exam Neck Spine 6/>Vws (72052) |
$224.40 |
$440 |
2.1× |
| X-Ray Exam Unilat Ribs/Chest (71101) |
$165.75 |
$325 |
1.6× |
| X-ray eye for foreign body (70030) |
$142.29 |
$279 |
1.6× |
| X-ray humerus (73060) |
$113.22 |
$222 |
1.3× |
| X-ray IV pyelogram (ivp) (74400) |
$376.89 |
$739 |
2.1× |
| X-Ray Jaw <4 Vw - Xr Mandible < 4 Views (70100) |
$96.39 |
$189 |
1.1× |
| X-Ray Knee Bilat Standing - Xr Knees Anteroposterior Standing Bilat (73565) |
$165.75 |
$325 |
1.9× |
| X-Ray Lumbar Spine 2/3 Vw - Xr Lumbar Spine 2-3 Views (72100) |
$149.94 |
$294 |
1.4× |
| X-ray nose-rectum child f.b. (76010) |
$90.78 |
$178 |
1.0× |
| X-Ray Ribs, Chest 4+ Vw - Xr Ribs 3 Vws Bil W/ Chest Posteroanterior (71111) |
$213.69 |
$419 |
2.0× |
| X-Ray Sacroiliac Jts 3+ Vw - Xr Sacroiliac Joints 3+ Views (72202) |
$100.47 |
$197 |
0.9× |
| X-Ray Sacroiliac Jts <3 Vw - Xr Sacroiliac Joints 1-2 Views (72200) |
$107.10 |
$210 |
1.0× |
X-Ray Sacrum/Coccyx 2+ Vw - Xr Sacrum Coccyx 2+ Views (72220)
range across 2 matching MRF lines |
$56.10–$111.69 |
$110–$219 |
varies |
| X-Ray Sinuses 3+ Vw - Xr Paranasal Sinuses 3+ Views (70220) |
$173.91 |
$341 |
2.0× |
| X-Ray Skull 4+ Vw - Xr Skull Complete 4+ Views (70260) |
$201.96 |
$396 |
1.9× |
| X-Ray Stress View (77071) |
$68.85 |
$135 |
0.8× |
| X-Ray Urinary Tract Exam With Contrast Material (74420) |
$464.10 |
$910 |
1.3× |
| X-Rays Bone Length Studies (77073) |
$116.79 |
$229 |
1.1× |
| X-Rays Bone Survey Complete (77075) |
$328.44 |
$644 |
3.1× |
| Xr c-spine 4 or 5 views (72050) |
$142.29 |
$279 |
1.3× |
| Xr facial bones less than 3 views (70140) |
$144.84 |
$284 |
1.6× |
| Xr orbits complete 4 views (70200) |
$149.43 |
$293 |
1.4× |