| Abdomen 1 View (74018) |
$280 |
$280 |
3.5× |
| Abdomen 2 views (74019) |
$360 |
$360 |
3.8× |
| Acute Gastrointestinal Blood Loss Imaging (78278) |
$974 |
$974 |
2.7× |
| Acute venous thrombosis imaging, peptide Non-Facility (78456) |
$3,336.55 |
$3,336.55 |
2.8× |
| Ankle 2 views (73600) |
$260 |
$260 |
3.3× |
| Bone age studies (77072) |
$282 |
$282 |
3.0× |
| Bone Imaging 3 Phase (78315) |
$974 |
$974 |
2.7× |
| Bone Imaging Limited Area (78300) |
$974 |
$974 |
2.7× |
| Bone Imaging Multiple Areas (78305) |
$974 |
$974 |
2.7× |
| Bone Imaging Whole Body (78306) |
$974 |
$974 |
2.7× |
| Bone survey infant (77076) |
$282 |
$282 |
3.0× |
| Brain Image W/Flow < 4 Views (78601) |
$974 |
$974 |
2.7× |
| Brain Imaging Min 4 Static Views W Vascular Flow (78606) |
$1,173 |
$1,173 |
2.4× |
| Brain Imaging Minimum 4 Static Views (78605) |
$1,173 |
$1,173 |
2.4× |
| Cat Scan Follow-Up Study (76380) |
$782 |
$782 |
9.9× |
| Cerebrospinal Fluid Flow W/O Matl Shunt Evaltj (78645) |
$1,173 |
$1,173 |
2.4× |
| Chest 1 view (71045) |
$230 |
$230 |
2.9× |
| Chest 2 views (71046) |
$279 |
$279 |
3.5× |
| Chest 3 views (71047) |
$206.53 |
$206.53 |
2.6× |
| Clavicle complete (73000) |
$312 |
$312 |
3.9× |
| Contrast X-Ray Bladder (74430) |
$940.23 |
$940.23 |
3.0× |
| CT abdomen and pelvis without and with contrast (74178) |
$2,207 |
$2,207 |
6.9× |
| CT abdomen and pelvis without contrast (74176) |
$3,500 |
$3,500 |
16.1× |
| CT abdomen w contrast (74160) |
$2,500 |
$2,500 |
15.7× |
| CT abdomen w wo contrast (74170) |
$3,200 |
$3,200 |
20.0× |
| CT abdomen w/o contrast (74150) |
$1,995 |
$1,995 |
21.0× |
| CT Angio Abdomen and Pelvis (74174) |
$2,005 |
$2,005 |
6.3× |
| CT Angio Chest (71275) |
$1,120 |
$1,120 |
7.0× |
CT Angio Head (70496) range across 2 matching MRF lines |
$1,100–$1,800 |
$1,100–$1,800 |
varies |
| Ct Angio Lwr Extr W/O&W/Dye (73706) |
$1,325 |
$1,325 |
8.3× |
| CT Angio Neck (70498) |
$1,325 |
$1,325 |
8.3× |
| Ct Angio Upr Extrm W/O&W/Dye (73206) |
$2,233 |
$2,233 |
14.0× |
| CT cervical spine w/ contrast (72126) |
$2,250 |
$2,250 |
7.1× |
| CT cervical spine w/o contrast (72125) |
$2,000 |
$2,000 |
21.0× |
| CT cervical spine w/wo cont (72127) |
$2,400 |
$2,400 |
15.0× |
| CT chest w contrast (71260) |
$2,250 |
$2,250 |
14.1× |
| CT chest w/wo contrast (71270) |
$3,000 |
$3,000 |
18.8× |
| CT head/brain with contrast (70460) |
$2,200 |
$2,200 |
13.8× |
| CT head/brain without and with contrast (70470) |
$2,500 |
$2,500 |
15.7× |
| CT heart no contrast quant eval coronry calcium (75571) |
$60 |
$60 |
0.8× |
| CT iac w contrast (70481) |
$2,250 |
$2,250 |
14.1× |
| CT l-spine w&w/o contrast (72133) |
$2,400 |
$2,400 |
15.0× |
| CT lower ext w/o (73700) |
$1,650 |
$1,650 |
17.3× |
| CT lower extremity w/contrast material (73701) |
$2,000 |
$2,000 |
12.5× |
| CT lumbar spine w contrast (72132) |
$2,250 |
$2,250 |
7.1× |
| CT lumbar spine w/o contrast (72131) |
$2,000 |
$2,000 |
21.0× |
| CT maxillofacial w contrast (70487) |
$1,800 |
$1,800 |
11.3× |
| CT maxillofacial wo contrast (70486) |
$1,600 |
$1,600 |
16.8× |
| CT neck tissue combo (70492) |
$2,400 |
$2,400 |
15.0× |
| Ct Orbit/Ear/Fossa W/O&W/Dye (70482) |
$2,400 |
$2,400 |
15.0× |
| CT orbits w/o contrast (70480) |
$2,000 |
$2,000 |
21.0× |
| CT pelvis w&w/o contrast (72194) |
$2,400 |
$2,400 |
15.0× |
| CT pelvis w/o contrast (72192) |
$2,000 |
$2,000 |
21.0× |
| CT scan of leg combo (73702) |
$2,200 |
$2,200 |
13.8× |
| CT scans face/jaw combo (70488) |
$2,250 |
$2,250 |
14.1× |
| CT soft tissue neck w contrast (70491) |
$2,250 |
$2,250 |
14.1× |
| CT soft tissue neck w/o contrast (70490) |
$2,000 |
$2,000 |
21.0× |
| CT thoracic spine w contrast (72129) |
$2,250 |
$2,250 |
14.1× |
| CT thoracic spine w/o contrast (72128) |
$2,000 |
$2,000 |
21.0× |
| CT thoracic spine w/wo cont (72130) |
$2,400 |
$2,400 |
15.0× |
| CT thorax w/o contrast (71250) |
$2,000 |
$2,000 |
21.0× |
| CT upper ext wo (73200) |
$1,550 |
$1,550 |
16.3× |
| CT upper extremity w/o & w/contrast material (73202) |
$1,900 |
$1,900 |
11.9× |
| CT upper extremity with contrast (73201) |
$1,750 |
$1,750 |
5.5× |
| Cta Abdl Aorta&Bi Iliofem W/Contrast&Postp (75635) |
$1,402 |
$1,402 |
8.8× |
| Cta Abdomen (74175) |
$1,481 |
$1,481 |
9.3× |
| CTA pelvis (72191) |
$456.08 |
$456.08 |
2.9× |
| Dxa Bone Density Axial (77080) |
$300 |
$300 |
3.2× |
| Esophagram (74220) |
$456.08 |
$456.08 |
2.9× |
| Fetal Biophysical Profile W/O Non-Stress Testing (76819) |
$277.98 |
$277.98 |
2.9× |
| Fluoroscopy up to 1 hr (76000) |
$587.50 |
$587.50 |
2.7× |
| Foot 2 views (73620) |
$289 |
$289 |
3.6× |
| Forearm 2 views (73090) |
$296 |
$296 |
3.7× |
| Gastric emptying imaging study (78264) |
$974 |
$974 |
2.7× |
| Gastric Emptyng Imag Std W/Sm Bwl Transit (78265) |
$974 |
$974 |
2.7× |
| Gated Heart Planar Single (78472) |
$974 |
$974 |
2.7× |
| Hand 2 views (73120) |
$282 |
$282 |
3.0× |
| Hepatobil Syst Image W/Drug (78227) |
$1,173 |
$1,173 |
2.4× |
| Hepatobiliary System Imaging (78226) |
$974 |
$974 |
2.7× |
| Ht Muscle Image Spect Sing (78451) |
$3,336.55 |
$3,336.55 |
2.8× |
| Hysterosalpingogram (74740) |
$587.50 |
$587.50 |
2.7× |
| Infant hip ultrasound with hip movement (dynamic) (76885) |
$206.53 |
$206.53 |
2.6× |
| K Flow/Funct Image W/Drug (78708) |
$1,173 |
$1,173 |
2.4× |
| K Flow/Funct Image W/O Drug (78707) |
$1,173 |
$1,173 |
2.4× |
| Knee 3 Views (73562) |
$350 |
$350 |
4.4× |
| Liver & Spleen Imaging Static Only (78215) |
$974 |
$974 |
2.7× |
| Liver & Spleen Imaging W/Vascular Flow (78216) |
$974 |
$974 |
2.7× |
| Lung Ventilat&Perfus Imaging (78582) |
$1,173 |
$1,173 |
2.4× |
| Lymph System Imaging (78195) |
$1,173 |
$1,173 |
2.4× |
| Meckels Divert Exam (78290) |
$974 |
$974 |
2.7× |
| MRI abdomen w contrast (74182) |
$2,880 |
$2,880 |
9.1× |
| MRI abdomen w/o contrast (74181) |
$2,800 |
$2,800 |
12.9× |
| MRI any jt lower extrem w/contrast material (73722) |
$2,419 |
$2,419 |
3.4× |
| MRI any jt lower extrem w/o & w/contrast matrl (73723) |
$2,791 |
$2,791 |
8.8× |
| MRI any jt upper extremity w/contrast matrl (73222) |
$2,419 |
$2,419 |
3.4× |
| MRI cervical spine w contrast (72142) |
$2,465 |
$2,465 |
7.8× |
| MRI cervical spine w/o cont (72141) |
$2,149 |
$2,149 |
9.9× |
| MRI chest w/o contrast (71550) |
$2,046 |
$2,046 |
9.4× |
| MRI chest with contrast (71551) |
$2,465 |
$2,465 |
3.5× |
| MRI chest wo w contrast (71552) |
$3,322 |
$3,322 |
10.5× |
| MRI lower extrem oth/thn jt w/o & w/contr matr (73720) |
$2,344 |
$2,344 |
7.4× |
| MRI lower extrem oth/thn jt w/o contr matrl (73718) |
$1,954 |
$1,954 |
9.0× |
| MRI lumbar spine w contrast (72149) |
$2,465 |
$2,465 |
7.8× |
| Mri Neck Spine W/O & W/Dye (72156) |
$3,487 |
$3,487 |
11.0× |
| MRI orbit face &/neck w/o contrast (70540) |
$2,149 |
$2,149 |
9.9× |
| MRI orbit face neck w contrast (70542) |
$2,465 |
$2,465 |
7.8× |
| Mri Orbt/Fac/Nck W/O &W/Dye (70543) |
$3,300 |
$3,300 |
10.4× |
| MRI pelvis w contrast (72196) |
$2,465 |
$2,465 |
7.8× |
| MRI pelvis w/o & w contrast (72197) |
$3,322 |
$3,322 |
10.5× |
| MRI pelvis w/o contrast (72195) |
$2,149 |
$2,149 |
9.9× |
| MRI thoracic spine w/o contrast (72146) |
$2,354 |
$2,354 |
10.8× |
| MRI upper extremity oth than jt w/contr matrl (73219) |
$2,233 |
$2,233 |
7.0× |
| MRI upper extremity oth than jt w/o contr matrl (73218) |
$1,954 |
$1,954 |
9.0× |
| Mri Uppr Extremity W/O&W/Dye (73220) |
$2,344 |
$2,344 |
7.4× |
| MRI, abdomen, combo (74183) |
$3,695 |
$3,695 |
11.6× |
| MRI, dorsal spine combo (72157) |
$3,487 |
$3,487 |
11.0× |
| MRI, dorsal spine contrast (72147) |
$2,465 |
$2,465 |
7.8× |
| MRI, joint upper extrem (73221) |
$2,149 |
$2,149 |
9.9× |
| MRI, joint upper extrem combo (73223) |
$3,209 |
$3,209 |
10.1× |
| MRI, lumbar spine combo (72158) |
$3,487 |
$3,487 |
11.0× |
| Myocardial Spect Multiple Studies (78452) |
$3,336.55 |
$3,336.55 |
2.8× |
| Neck soft tissue (70360) |
$299 |
$299 |
3.8× |
| Nm whole blood volume (78122) |
$1,249.45 |
$1,249.45 |
2.5× |
| Nonvascular Shunt X-Ray (75809) |
$282 |
$282 |
3.0× |
| Parathyroid Planar Imaging (78070) |
$974 |
$974 |
2.7× |
| Parathyroid planar imaging w/wo subtraction (78071) |
$974 |
$974 |
2.7× |
| Pelvis 1 or 2 views (72170) |
$282 |
$282 |
3.0× |
| Pulmonary Perfusion Imaging Particulate (78580) |
$974 |
$974 |
2.7× |
| Radex Abd Compl Aqt Abd W/S/E/D Views 1 View Ch (74022) |
$450 |
$450 |
4.7× |
| Radex abscess/fistula/sinus tract rs&i (76080) |
$1,233.70 |
$1,233.70 |
2.5× |
| Radex Ankle Complete Minimum 3 Views (73610) |
$379 |
$379 |
4.8× |
| Radex Calcaneus Minimum 2 Views (73650) |
$236 |
$236 |
3.0× |
| Radex elbow complete minimum 3 views (73080) |
$370 |
$370 |
4.7× |
| Radex Facial Bones Complete Minimum 3 Views (70150) |
$399 |
$399 |
4.2× |
| Radex fingr minimum 2 views (73140) |
$272 |
$272 |
3.4× |
Radex foot complete minimum 3 views (73630) range across 3 matching MRF lines |
$326–$349 |
$326–$349 |
varies |
| Radex Hand Minimum 3 Views (73130) |
$326 |
$326 |
4.1× |
| Radex lower extremity infant minimum 2 views (73592) |
$206.53 |
$206.53 |
2.6× |
| Radex Nasal Bones Complete Minimum 3 Views (70160) |
$339 |
$339 |
4.3× |
| Radex Ribs Unilateral 2 Views (71100) |
$300 |
$300 |
3.8× |
Radex shoulder complete minimum 2 views (73030) range across 7 matching MRF lines |
$206.53–$340 |
$206.53–$340 |
varies |
| Radex Sinuses Paransl < 3 Views (70210) |
$206.53 |
$206.53 |
2.6× |
| Radex Spine 1 View Specify Level (72020) |
$206.53 |
$206.53 |
2.6× |
| Radex Sternum Minimum 2 Views (71120) |
$350 |
$350 |
4.4× |
| Radex Temporomandble Jt Opn & Clsd Mouth Bilat (70330) |
$206.53 |
$206.53 |
2.6× |
| Radex Toe Minimum 2 Views (73660) |
$260 |
$260 |
3.3× |
| Radex upper extremity infant minimum 2 views (73092) |
$277.98 |
$277.98 |
2.9× |
| Radex Wrist Complete Minimum 3 Views (73110) |
$325 |
$325 |
4.1× |
| Radex X-Ray Exam Entire Spi 6/> Vw - Xr Entire Spine 6+ Vw (72084) |
$400 |
$400 |
4.2× |
| Radiolog exam mandible compl minimum 4 views (70110) |
$465 |
$465 |
4.9× |
| Radiologic Exam Abdomen 3+ Views - Xr Abdomen 3+ Views (74021) |
$282 |
$282 |
3.0× |
| Radiologic exam colon double contrast study (74280) |
$530 |
$530 |
3.3× |
| Radiologic exam colon single contrast study (74270) |
$456.08 |
$456.08 |
2.9× |
| Radiologic exam knee complete 4/more views (73564) |
$465 |
$465 |
4.9× |
| Radiologic exam pelvis compl minimum 3 views (72190) |
$415 |
$415 |
4.4× |
| Radiologic Exam Small Int Single Contrast Study (74250) |
$456.08 |
$456.08 |
2.9× |
| Radiologic exam swallow function contrast study (74230) |
$700 |
$700 |
4.4× |
| Radiologic exam upr gi trc double contrast study (74246) |
$456.08 |
$456.08 |
2.9× |
| Radiologic examination femur 1 view (73551) |
$286 |
$286 |
3.6× |
| Radiologic examination femur minimum 2 views (73552) |
$315 |
$315 |
4.0× |
| Radiologic examination knee 1/2 views (73560) |
$270 |
$270 |
3.4× |
| Radiologic examination tibia & fibula 2 views (73590) |
$300 |
$300 |
3.8× |
| Ribs bilateral 3 views (71110) |
$500 |
$500 |
5.3× |
| Rp Loclzj Tum Plnr Whole Body 2+ Days Imaging (78804) |
$3,336.55 |
$3,336.55 |
6.7× |
| Rp Loclzj Tum Plnr Whole Body Single Day Imaging (78802) |
$3,336.55 |
$3,336.55 |
6.7× |
| Scapula (73010) |
$335 |
$335 |
3.5× |
| Sella turcica (70240) |
$206.53 |
$206.53 |
2.6× |
| Shoulder 1 view (73020) |
$225 |
$225 |
2.8× |
Skull less than 4 views (70250) range across 2 matching MRF lines |
$300–$475 |
$300–$475 |
varies |
| Sternoclavicular joints (71130) |
$350 |
$350 |
4.4× |
| Testicular Imaging W/Flow (78761) |
$974 |
$974 |
2.7× |
| Therapeutic Enema Rdctj Intussusception/Obstrcj (74283) |
$456.08 |
$456.08 |
2.9× |
| Thoracic spine 2 views (72070) |
$430 |
$430 |
4.5× |
| Thoracic spine 3 views (72072) |
$277.98 |
$277.98 |
2.9× |
| Thoracolumbar 2 views (72080) |
$256 |
$256 |
3.2× |
| Thyroid Uptake Measurement (78012) |
$974 |
$974 |
2.7× |
| Thyroid Uptake W/Blood Flow Sngle/Mult Quan Meas (78014) |
$974 |
$974 |
2.7× |
| Ultrasound Breast Limited (76642) |
$206.53 |
$206.53 |
2.6× |
| Ultrasound Exam Aaa Screen (76706) |
$478 |
$478 |
5.0× |
Ultrasound, abdomen limited (76705) range across 5 matching MRF lines |
$277.98–$618 |
$277.98–$618 |
varies |
| Unlisted us procedure (76999) |
$462 |
$462 |
5.8× |
| Upper gi w/o kub (74240) |
$456.08 |
$456.08 |
2.9× |
| Ureteral Reflux Study (78740) |
$974 |
$974 |
2.7× |
| Urethrocystogram voiding (74455) |
$587.50 |
$587.50 |
2.7× |
| Us breast unilateral complete (76641) |
$277.98 |
$277.98 |
2.9× |
| Us chest (76604) |
$670 |
$670 |
7.0× |
| Us complete joint (76881) |
$462 |
$462 |
4.9× |
| Us exam, pelvic, limited (76857) |
$585 |
$585 |
6.1× |
| Us head (76506) |
$277.98 |
$277.98 |
2.9× |
Us lmtd joint/oth nonvasc xtr strux r-t w/img (76882) range across 7 matching MRF lines |
$452–$650 |
$452–$650 |
varies |
Us ob limited 1 or more fetuses (76815) range across 3 matching MRF lines |
$277.98–$600 |
$277.98–$600 |
varies |
| Us ob transvaginal (76817) |
$672 |
$672 |
7.1× |
| Us pelvic non ob complete (76856) |
$815 |
$815 |
8.6× |
| Us pg uter img f&mat 14 wk tabdl 1/1st gestation (76801) |
$800 |
$800 |
8.4× |
| Us retroperitoneal complete (76770) |
$1,100 |
$1,100 |
11.6× |
| Us retroperitoneal limited (76775) |
$750 |
$750 |
7.9× |
| Us scrotum and contents (76870) |
$750 |
$750 |
7.9× |
| Us spinal canal and contents (76800) |
$277.98 |
$277.98 |
2.9× |
| Us thyroid (76536) |
$718 |
$718 |
7.5× |
| Us transrectal (76872) |
$277.98 |
$277.98 |
2.9× |
| Vascular Flow Imaging (78445) |
$974 |
$974 |
2.7× |
| Venography extremity bilateral rs&i (75822) |
$3,590.40 |
$3,590.40 |
2.5× |
| Venography extremity unilateral rs&i (75820) |
$3,590.40 |
$3,590.40 |
2.5× |
| Venous thrombosis imaging (78457) |
$2,838 |
$2,838 |
5.7× |
| Venous Thrombosis Imaging Venogram Bilateral (78458) |
$974 |
$974 |
2.7× |
| Vertebral fracture assessment via dxa (77086) |
$284 |
$284 |
3.6× |
| Wrist 2 views (73100) |
$260 |
$260 |
3.3× |
| X-Ray Ac Jts - Xr Acromioclavicular Joints Bilateral (73050) |
$270 |
$270 |
3.4× |
| X-Ray Bend Only L-S Spine (72120) |
$277.98 |
$277.98 |
2.9× |
| X-Ray Elbow 2 Vw - Xr Elbow 1-2 Views Right (73070) |
$279 |
$279 |
3.5× |
| X-Ray Exam Entire Spi 2/3 Vw (72082) |
$282 |
$282 |
3.0× |
| X-Ray Exam Hip Uni 1 View (73501) |
$206.53 |
$206.53 |
2.6× |
| X-Ray Exam Hip Uni 2-3 Views (73502) |
$228 |
$228 |
2.9× |
| X-Ray Exam Hips Bi 3-4 Views (73522) |
$282 |
$282 |
3.0× |
| X-Ray Exam L-S Spine Bending (72114) |
$450 |
$450 |
4.7× |
| X-Ray Exam Neck Spine 2-3 Vw (72040) |
$400 |
$400 |
5.0× |
| X-Ray Exam Neck Spine 6/>Vws (72052) |
$530 |
$530 |
5.6× |
| X-Ray Exam Unilat Ribs/Chest (71101) |
$282 |
$282 |
3.0× |
| X-ray eye for foreign body (70030) |
$206.53 |
$206.53 |
2.6× |
| X-ray humerus (73060) |
$315 |
$315 |
4.0× |
| X-ray IV pyelogram (ivp) (74400) |
$565 |
$565 |
3.5× |
| X-Ray Knee Bilat Standing - Xr Knees Anteroposterior Standing Bilat (73565) |
$450 |
$450 |
5.7× |
| X-Ray Lumbar Spine 2/3 Vw - Xr Lumbar Spine 2-3 Views (72100) |
$430 |
$430 |
4.5× |
| X-ray nose-rectum child f.b. (76010) |
$206.53 |
$206.53 |
2.6× |
| X-Ray Sacroiliac Jts 3+ Vw - Xr Sacroiliac Joints 3+ Views (72202) |
$277.98 |
$277.98 |
2.9× |
| X-Ray Sacroiliac Jts <3 Vw - Xr Sacroiliac Joints 1-2 Views (72200) |
$330 |
$330 |
3.5× |
| X-Ray Sacrum/Coccyx 2+ Vw - Xr Sacrum Coccyx 2+ Views (72220) |
$345 |
$345 |
4.4× |
| X-Ray Skull 4+ Vw - Xr Skull Complete 4+ Views (70260) |
$282 |
$282 |
3.0× |
| X-Rays Bone Length Studies (77073) |
$277.98 |
$277.98 |
2.9× |
| X-Rays Bone Survey Complete (77075) |
$850 |
$850 |
8.9× |
| Xr c-spine 4 or 5 views (72050) |
$282 |
$282 |
3.0× |
| Xr orbits complete 4 views (70200) |
$282 |
$282 |
3.0× |