| Abdomen 1 View (74018) |
$185.65 |
$395 |
2.3× |
| Abdomen 2 views (74019) |
$198.81 |
$423 |
2.0× |
| Ankle 2 views (73600) |
$125.49 |
$267 |
1.5× |
| Bone age studies (77072) |
$181.89 |
$387 |
1.9× |
| Bone survey infant (77076) |
$565.88 |
$1,204 |
5.8× |
| Cat Scan Follow-Up Study (76380) |
$321.95 |
$685 |
3.9× |
| Chest 1 view (71045) |
$159.33 |
$339 |
2.0× |
| Chest 2 views (71046) |
$179.54 |
$382 |
2.2× |
| Chest 3 views (71047) |
$59.22 |
$126 |
0.7× |
| Chest 4 or more views (71048) |
$219.49 |
$467 |
2.2× |
| Clavicle complete (73000) |
$221.84 |
$472 |
2.7× |
| Computed Tomography Thorax Lw Dose Lng Ca Scr C- (71271) |
$1,275.58 |
$2,714 |
13.0× |
| Contrast X-Ray Bladder (74430) |
$219.49 |
$467 |
0.7× |
| CT abdomen and pelvis without and with contrast (74178) |
$2,639.99 |
$5,617 |
8.1× |
| CT abdomen and pelvis without contrast (74176) |
$2,130.04 |
$4,532 |
9.5× |
| CT abdomen w contrast (74160) |
$1,191.45 |
$2,535 |
7.2× |
| CT abdomen w wo contrast (74170) |
$1,378.51 |
$2,933 |
8.4× |
| CT abdomen w/o contrast (74150) |
$1,068.78 |
$2,274 |
10.9× |
| CT Angio Abdomen and Pelvis (74174) |
$2,397 |
$5,100 |
7.3× |
| CT Angio Chest (71275) |
$1,684.48 |
$3,584 |
10.2× |
| CT Angio Head (70496) |
$2,200.07 |
$4,681 |
13.4× |
| CT angio hrt w/3d image (75574) |
$1,700.93 |
$3,619 |
5.2× |
| Ct Angio Lwr Extr W/O&W/Dye (73706) |
$2,176.10 |
$4,630 |
13.2× |
| CT Angio Neck (70498) |
$1,050.92 |
$2,236 |
6.4× |
| Ct Angio Upr Extrm W/O&W/Dye (73206) |
$2,176.10 |
$4,630 |
13.2× |
| CT cervical spine w/ contrast (72126) |
$1,511.99 |
$3,217 |
4.6× |
| CT cervical spine w/o contrast (72125) |
$1,384.62 |
$2,946 |
14.1× |
| CT cervical spine w/wo cont (72127) |
$1,721.61 |
$3,663 |
10.5× |
| CT chest w contrast (71260) |
$1,150.56 |
$2,448 |
7.0× |
| CT chest w/wo contrast (71270) |
$1,378.51 |
$2,933 |
8.4× |
| CT head/brain with contrast (70460) |
$1,096.04 |
$2,332 |
6.7× |
| CT head/brain without and with contrast (70470) |
$1,255.84 |
$2,672 |
7.6× |
CT heart no contrast quant eval coronry calcium (75571)
range across 2 matching MRF lines |
$24.91–$87.89 |
$53–$187 |
varies |
| CT iac w contrast (70481) |
$1,009.09 |
$2,147 |
6.1× |
| CT l-spine w&w/o contrast (72133) |
$1,721.61 |
$3,663 |
10.5× |
| CT lower ext w/o (73700) |
$902.87 |
$1,921 |
9.2× |
| CT lower extremity w/contrast material (73701) |
$1,161.37 |
$2,471 |
7.1× |
| CT lumbar spine w contrast (72132) |
$1,511.99 |
$3,217 |
4.6× |
| CT lumbar spine w/o contrast (72131) |
$1,281.69 |
$2,727 |
13.1× |
| CT maxillofacial w contrast (70487) |
$1,099.80 |
$2,340 |
6.7× |
| CT maxillofacial wo contrast (70486) |
$988.41 |
$2,103 |
10.1× |
| CT neck tissue combo (70492) |
$1,263.83 |
$2,689 |
7.7× |
| Ct Orbit/Ear/Fossa W/O&W/Dye (70482) |
$1,211.66 |
$2,578 |
7.4× |
| CT orbits w/o contrast (70480) |
$947.05 |
$2,015 |
9.7× |
| CT pelvis w&w/o contrast (72194) |
$1,366.29 |
$2,907 |
8.3× |
| CT pelvis w/o contrast (72192) |
$874.67 |
$1,861 |
8.9× |
| CT scan of leg combo (73702) |
$1,349.37 |
$2,871 |
8.2× |
| CT scans face/jaw combo (70488) |
$1,211.66 |
$2,578 |
7.4× |
| CT soft tissue neck w contrast (70491) |
$1,053.74 |
$2,242 |
6.4× |
| CT soft tissue neck w/o contrast (70490) |
$988.41 |
$2,103 |
10.1× |
| CT thoracic spine w contrast (72129) |
$1,511.99 |
$3,217 |
9.2× |
| CT thoracic spine w/o contrast (72128) |
$1,384.62 |
$2,946 |
14.1× |
| CT thoracic spine w/wo cont (72130) |
$1,721.61 |
$3,663 |
10.5× |
| CT thorax w/o contrast (71250) |
$1,068.78 |
$2,274 |
10.9× |
| CT upper ext wo (73200) |
$1,096.04 |
$2,332 |
11.2× |
| CT upper extremity w/o & w/contrast material (73202) |
$1,430.21 |
$3,043 |
8.7× |
| CT upper extremity with contrast (73201) |
$1,109.20 |
$2,360 |
3.4× |
| Cta Abdl Aorta&Bi Iliofem W/Contrast&Postp (75635) |
$2,240.96 |
$4,768 |
13.6× |
| Cta Abdomen (74175) |
$2,176.10 |
$4,630 |
13.2× |
| CTA pelvis (72191) |
$2,176.10 |
$4,630 |
13.2× |
| Discography Cerv/Thor Spine (72285) |
$1,274.64 |
$2,712 |
0.7× |
| Diskography lumbar (72295) |
$1,274.64 |
$2,712 |
0.7× |
| Dxa Bone Density Axial (77080) |
$446.50 |
$950 |
4.6× |
| Dxa bone density study 1/>sites appendiclr skel (77081) |
$162.62 |
$346 |
2.0× |
| Echo Guide For Artery Repair (76936) |
$858.69 |
$1,827 |
4.2× |
| Esophagram (74220) |
$383.99 |
$817 |
2.3× |
| Fetal Biophys Profile W/Nst (76818) |
$450.73 |
$959 |
4.6× |
| Fetal Biophysical Profile W/O Non-Stress Testing (76819) |
$450.26 |
$958 |
4.6× |
| Fetal MRI w/placntl matrnl plvc img sing/1st ges (74712) |
$650.01 |
$1,383 |
2.9× |
| Fluoroscopy up to 1 hr (76000) |
$423 |
$900 |
1.9× |
| Foot 2 views (73620) |
$144.76 |
$308 |
1.8× |
| Forearm 2 views (73090) |
$223.25 |
$475 |
2.7× |
| Hand 2 views (73120) |
$148.05 |
$315 |
1.5× |
| Hysterosalpingogram (74740) |
$685.73 |
$1,459 |
3.1× |
| Infant hip ultrasound, limited static exam (76886) |
$238.76 |
$508 |
2.9× |
| Knee 3 Views (73562) |
$258.03 |
$549 |
3.2× |
| Magnetic Image Jaw Joint (70336) |
$1,444.78 |
$3,074 |
6.5× |
| Mr safety determination physician/other qhp (76016) |
$176.72 |
$376 |
2.2× |
| Mr safety implant&/fb assmt clin staf 1st 15 min (76014) |
$55.93 |
$119 |
2.1× |
| Mr safety implt electronics prepj supvj phys/qhp (76018) |
$184.24 |
$392 |
2.1× |
| Mr safety med physics xm customization plng&mntr (76017) |
$303.62 |
$646 |
1.4× |
| Mra Head W/O & W/Contrast Material (70546) |
$2,543.64 |
$5,412 |
7.8× |
| MRA head w/o contrast (70544) |
$1,594.24 |
$3,392 |
7.1× |
| MRA head with contrast (70545) |
$1,643.12 |
$3,496 |
5.0× |
| MRA neck w contrast (70548) |
$2,074.58 |
$4,414 |
6.3× |
| Mra Neck W/O &W/Contrast Material (70549) |
$3,006.59 |
$6,397 |
9.2× |
| MRA neck w/o contrast (70547) |
$1,961.31 |
$4,173 |
8.8× |
| MRI abdomen w contrast (74182) |
$1,812.79 |
$3,857 |
5.5× |
| MRI abdomen w/o contrast (74181) |
$1,521.39 |
$3,237 |
6.8× |
| MRI any jt lower extrem w/contrast material (73722) |
$1,756.39 |
$3,737 |
2.4× |
| MRI any jt lower extrem w/o & w/contrast matrl (73723) |
$2,128.63 |
$4,529 |
6.5× |
| MRI any jt upper extremity w/contrast matrl (73222) |
$1,739.94 |
$3,702 |
2.4× |
| MRI cervical spine w contrast (72142) |
$1,369.58 |
$2,914 |
4.2× |
| MRI cervical spine w/o cont (72141) |
$962.56 |
$2,048 |
4.3× |
| MRI chest w/o contrast (71550) |
$2,117.82 |
$4,506 |
9.5× |
| MRI chest with contrast (71551) |
$2,309.11 |
$4,913 |
3.1× |
| MRI chest wo w contrast (71552) |
$2,891.91 |
$6,153 |
8.8× |
| MRI lower extrem oth/thn jt w/contrast matrl (73719) |
$1,613.04 |
$3,432 |
4.9× |
| MRI lower extrem oth/thn jt w/o & w/contr matr (73720) |
$1,981.05 |
$4,215 |
6.1× |
| MRI lower extrem oth/thn jt w/o contr matrl (73718) |
$1,476.27 |
$3,141 |
6.6× |
| MRI lumbar spine w contrast (72149) |
$1,346.08 |
$2,864 |
4.1× |
| Mri Neck Spine W/O & W/Dye (72156) |
$1,550.06 |
$3,298 |
4.7× |
| MRI orbit face &/neck w/o contrast (70540) |
$1,707.51 |
$3,633 |
7.6× |
| MRI orbit face neck w contrast (70542) |
$765.16 |
$1,628 |
2.3× |
| Mri Orbt/Fac/Nck W/O &W/Dye (70543) |
$2,254.59 |
$4,797 |
6.9× |
| MRI pelvis w contrast (72196) |
$1,812.79 |
$3,857 |
5.5× |
| MRI pelvis w/o & w contrast (72197) |
$2,298.30 |
$4,890 |
7.0× |
| MRI pelvis w/o contrast (72195) |
$1,773.78 |
$3,774 |
7.9× |
| MRI spectroscopy (76390) |
$2,204.77 |
$4,691 |
27.0× |
| MRI thoracic spine w/o contrast (72146) |
$962.56 |
$2,048 |
4.3× |
| MRI upper extremity oth than jt w/contr matrl (73219) |
$1,812.79 |
$3,857 |
5.5× |
| MRI upper extremity oth than jt w/o contr matrl (73218) |
$1,739.94 |
$3,702 |
7.8× |
| Mri Uppr Extremity W/O&W/Dye (73220) |
$2,295.01 |
$4,883 |
7.0× |
| MRI, abdomen, combo (74183) |
$2,305.82 |
$4,906 |
7.0× |
| MRI, dorsal spine combo (72157) |
$1,551.47 |
$3,301 |
4.7× |
| MRI, dorsal spine contrast (72147) |
$1,356.42 |
$2,886 |
4.1× |
| MRI, joint upper extrem (73221) |
$959.27 |
$2,041 |
4.3× |
| MRI, joint upper extrem combo (73223) |
$2,115.94 |
$4,502 |
6.5× |
| MRI, lumbar spine combo (72158) |
$1,538.78 |
$3,274 |
4.7× |
| Myocardial Spect Multiple Studies (78452) |
$3,048.42 |
$6,486 |
2.5× |
| Neck soft tissue (70360) |
$204.92 |
$436 |
2.5× |
| Nonvascular Shunt X-Ray (75809) |
$210.56 |
$448 |
2.1× |
| Pelvis 1 or 2 views (72170) |
$201.16 |
$428 |
2.1× |
| Radex Abd Compl Aqt Abd W/S/E/D Views 1 View Ch (74022) |
$265.55 |
$565 |
2.7× |
| Radex abscess/fistula/sinus tract rs&i (76080) |
$61.57 |
$131 |
0.1× |
| Radex Ankle Complete Minimum 3 Views (73610) |
$228.42 |
$486 |
2.8× |
| Radex Calcaneus Minimum 2 Views (73650) |
$206.80 |
$440 |
2.5× |
| Radex elbow complete minimum 3 views (73080) |
$161.21 |
$343 |
2.0× |
| Radex Facial Bones Complete Minimum 3 Views (70150) |
$282.94 |
$602 |
2.9× |
| Radex fingr minimum 2 views (73140) |
$185.65 |
$395 |
2.3× |
| Radex foot complete minimum 3 views (73630) |
$230.30 |
$490 |
2.8× |
| Radex Hand Minimum 3 Views (73130) |
$239.23 |
$509 |
2.9× |
| Radex lower extremity infant minimum 2 views (73592) |
$121.73 |
$259 |
1.5× |
| Radex Mastoids Compl Minimum 3 Views PR Side (70130) |
$196.46 |
$418 |
2.0× |
| Radex Nasal Bones Complete Minimum 3 Views (70160) |
$169.67 |
$361 |
2.1× |
| Radex Pharynx/Larx W/Fluor&/Magnification Tq (70370) |
$255.68 |
$544 |
3.1× |
| Radex Ribs Unilateral 2 Views (71100) |
$240.64 |
$512 |
2.9× |
| Radex shoulder complete minimum 2 views (73030) |
$247.69 |
$527 |
3.0× |
| Radex Sinuses Paransl < 3 Views (70210) |
$96.35 |
$205 |
1.2× |
| Radex Spine 1 View Specify Level (72020) |
$129.72 |
$276 |
1.6× |
| Radex Sternum Minimum 2 Views (71120) |
$213.38 |
$454 |
2.6× |
| Radex Temporomandble Jt Opn & Clsd Mouth Bilat (70330) |
$196.46 |
$418 |
2.4× |
| Radex Toe Minimum 2 Views (73660) |
$188.47 |
$401 |
2.3× |
| Radex upper extremity infant minimum 2 views (73092) |
$103.87 |
$221 |
1.1× |
| Radex Wrist Complete Minimum 3 Views (73110) |
$239.23 |
$509 |
2.9× |
| Radiolog exam mandible compl minimum 4 views (70110) |
$267.90 |
$570 |
2.7× |
| Radiologic Exam Abdomen 3+ Views - Xr Abdomen 3+ Views (74021) |
$238.76 |
$508 |
2.4× |
| Radiologic exam colon double contrast study (74280) |
$455.43 |
$969 |
2.8× |
| Radiologic exam colon single contrast study (74270) |
$331.82 |
$706 |
2.0× |
| Radiologic exam knee complete 4/more views (73564) |
$211.97 |
$451 |
2.2× |
| Radiologic exam pelvis compl minimum 3 views (72190) |
$295.16 |
$628 |
3.0× |
| Radiologic Exam Small Int Single Contrast Study (74250) |
$240.17 |
$511 |
1.5× |
| Radiologic exam swallow function contrast study (74230) |
$352.50 |
$750 |
2.1× |
| Radiologic exam upr gi trc double contrast study (74246) |
$421.59 |
$897 |
2.6× |
| Radiologic examination femur 1 view (73551) |
$99.17 |
$211 |
1.2× |
| Radiologic examination femur minimum 2 views (73552) |
$198.34 |
$422 |
2.4× |
| Radiologic examination knee 1/2 views (73560) |
$234.06 |
$498 |
2.9× |
| Radiologic Examination Osseous Survey Limited (77074) |
$700.77 |
$1,491 |
7.1× |
| Radiologic Examination Salivary Gland Calculus (70380) |
$144.29 |
$307 |
1.8× |
| Radiologic examination tibia & fibula 2 views (73590) |
$217.61 |
$463 |
2.7× |
| Ribs bilateral 3 views (71110) |
$157.92 |
$336 |
1.6× |
| Rp Loclzj Tum Plnr Whole Body Single Day Imaging (78802) |
$2,514.97 |
$5,351 |
4.9× |
| Scapula (73010) |
$228.89 |
$487 |
2.3× |
| Screening Digital Breast Tomosynthesis Bi (77063) |
$29.61 |
$63 |
1.3× |
| Shoulder 1 view (73020) |
$120.32 |
$256 |
1.5× |
| Sialogram (70390) |
$236.88 |
$504 |
1.1× |
| Skull less than 4 views (70250) |
$225.60 |
$480 |
2.3× |
| Sternoclavicular joints (71130) |
$142.41 |
$303 |
1.7× |
| Therapeutic Enema Rdctj Intussusception/Obstrcj (74283) |
$479.87 |
$1,021 |
2.9× |
| Thoracic spine 2 views (72070) |
$140.53 |
$299 |
1.4× |
| Thoracic spine 3 views (72072) |
$305.50 |
$650 |
3.1× |
| Thoracolumbar 2 views (72080) |
$185.18 |
$394 |
2.3× |
Ultrasound Breast Limited (76642)
range across 2 matching MRF lines |
$295.63–$354.85 |
$629–$755 |
varies |
| Ultrasound Elastography Parenchyma (76981) |
$141 |
$300 |
1.4× |
| Ultrasound Exam Aaa Screen (76706) |
$240.17 |
$511 |
2.4× |
| Ultrasound, abdomen limited (76705) |
$541.91 |
$1,153 |
5.5× |
| Umbilical-artery Doppler (OB) (76820) |
$450.26 |
$958 |
4.6× |
| Urethrocystogram voiding (74455) |
$264.14 |
$562 |
1.2× |
| Urethrocystography retrograde (74450) |
$254.27 |
$541 |
1.1× |
Us breast unilateral complete (76641)
range across 2 matching MRF lines |
$213.85–$256.62 |
$455–$546 |
varies |
| Us chest (76604) |
$352.97 |
$751 |
3.6× |
| Us complete joint (76881) |
$350.15 |
$745 |
3.6× |
| Us exam, pelvic, limited (76857) |
$248.16 |
$528 |
2.5× |
| Us head (76506) |
$429.58 |
$914 |
4.4× |
| Us lmtd joint/oth nonvasc xtr strux r-t w/img (76882) |
$302.21 |
$643 |
3.1× |
| Us ob limited 1 or more fetuses (76815) |
$462.01 |
$983 |
4.7× |
| Us ob transvaginal (76817) |
$340.75 |
$725 |
3.5× |
| Us pelvic non ob complete (76856) |
$541.91 |
$1,153 |
5.5× |
| Us pg uter img f&mat 14 wk tabdl 1/1st gestation (76801) |
$423 |
$900 |
4.3× |
| Us preg uterus real time f/u trnsabdl per fetus (76816) |
$541.91 |
$1,153 |
5.5× |
| Us retroperitoneal complete (76770) |
$458.25 |
$975 |
4.7× |
| Us retroperitoneal limited (76775) |
$349.21 |
$743 |
3.6× |
| Us scrotum and contents (76870) |
$480.81 |
$1,023 |
4.9× |
| Us spinal canal and contents (76800) |
$321.48 |
$684 |
3.3× |
| Us thyroid (76536) |
$541.91 |
$1,153 |
5.5× |
| Us transrectal (76872) |
$334.17 |
$711 |
3.4× |
| Wrist 2 views (73100) |
$148.05 |
$315 |
1.8× |
| X-Ray Ac Jts - Xr Acromioclavicular Joints Bilateral (73050) |
$129.72 |
$276 |
1.6× |
| X-ray antegrade pyelogram tube (74425) |
$510.42 |
$1,086 |
1.6× |
| X-Ray Bend Only L-S Spine (72120) |
$236.41 |
$503 |
2.4× |
| X-Ray Elbow 2 Vw - Xr Elbow 1-2 Views Right (73070) |
$209.15 |
$445 |
2.6× |
| X-Ray Exam Breast Specimen (76098) |
$280.12 |
$596 |
0.5× |
| X-Ray Exam Entire Spi 1 Vw (72081) |
$198.81 |
$423 |
2.4× |
| X-Ray Exam Entire Spi 2/3 Vw (72082) |
$204.92 |
$436 |
2.1× |
| X-Ray Exam Hip Uni 1 View (73501) |
$112.80 |
$240 |
1.4× |
| X-Ray Exam Hip Uni 2-3 Views (73502) |
$195.99 |
$417 |
2.4× |
| X-Ray Exam Hip Uni 4/> Views (73503) |
$235 |
$500 |
2.4× |
| X-Ray Exam Hips Bi 2 Views (73521) |
$124.55 |
$265 |
1.3× |
| X-Ray Exam Hips Bi 3-4 Views (73522) |
$222.31 |
$473 |
2.3× |
| X-Ray Exam L-S Spine Bending (72114) |
$376 |
$800 |
3.8× |
| X-Ray Exam Neck Spine 2-3 Vw (72040) |
$277.77 |
$591 |
3.4× |
| X-Ray Exam Neck Spine 6/>Vws (72052) |
$294.69 |
$627 |
3.0× |
| X-Ray Exam Unilat Ribs/Chest (71101) |
$310.20 |
$660 |
3.2× |
| X-ray eye for foreign body (70030) |
$94 |
$200 |
1.2× |
| X-ray humerus (73060) |
$223.72 |
$476 |
2.7× |
| X-ray IV pyelogram (ivp) (74400) |
$476.58 |
$1,014 |
2.9× |
| X-Ray Jaw <4 Vw - Xr Mandible < 4 Views (70100) |
$110.45 |
$235 |
1.4× |
| X-Ray Knee Bilat Standing - Xr Knees Anteroposterior Standing Bilat (73565) |
$193.64 |
$412 |
2.4× |
| X-Ray Lumbar Spine 2/3 Vw - Xr Lumbar Spine 2-3 Views (72100) |
$258.03 |
$549 |
2.6× |
| X-ray nose-rectum child f.b. (76010) |
$145.23 |
$309 |
1.8× |
| X-Ray Ribs, Chest 4+ Vw - Xr Ribs 3 Vws Bil W/ Chest Posteroanterior (71111) |
$381.17 |
$811 |
3.9× |
| X-Ray Sacroiliac Jts 3+ Vw - Xr Sacroiliac Joints 3+ Views (72202) |
$235 |
$500 |
2.4× |
| X-Ray Sacroiliac Jts <3 Vw - Xr Sacroiliac Joints 1-2 Views (72200) |
$185.18 |
$394 |
1.9× |
| X-Ray Sacrum/Coccyx 2+ Vw - Xr Sacrum Coccyx 2+ Views (72220) |
$227.48 |
$484 |
2.8× |
| X-Ray Sinuses 3+ Vw - Xr Paranasal Sinuses 3+ Views (70220) |
$299.39 |
$637 |
3.7× |
| X-Ray Skull 4+ Vw - Xr Skull Complete 4+ Views (70260) |
$288.11 |
$613 |
2.9× |
| X-ray thoracic spine 4 vw (72074) |
$399.50 |
$850 |
4.1× |
| X-Ray Urinary Tract Exam With Contrast Material (74420) |
$215.73 |
$459 |
0.7× |
| X-Rays Bone Length Studies (77073) |
$384.46 |
$818 |
3.9× |
| X-Rays Bone Survey Complete (77075) |
$31.49 |
$67 |
0.3× |
| Xr c-spine 4 or 5 views (72050) |
$360.49 |
$767 |
3.7× |
| Xr facial bones less than 3 views (70140) |
$190.35 |
$405 |
2.3× |
| Xr orbits complete 4 views (70200) |
$202.10 |
$430 |
2.1× |