| Abdomen 1 View (74018) |
$152 |
$190 |
1.9× |
| Acute Gastrointestinal Blood Loss Imaging (78278) |
$588.93 |
$736.16 |
1.6× |
| Ankle 2 views (73600) |
$120 |
$150 |
1.5× |
| Bone age studies (77072) |
$144 |
$180 |
1.5× |
| Bone Imaging 3 Phase (78315) |
$674.40 |
$843 |
1.8× |
| Bone Imaging Limited Area (78300) |
$612.72 |
$765.90 |
1.7× |
| Bone Imaging Multiple Areas (78305) |
$721.44 |
$901.80 |
2.0× |
| Bone Imaging Whole Body (78306) |
$808.90 |
$1,011.13 |
2.2× |
| Bone survey infant (77076) |
$160 |
$200 |
1.7× |
| Chest 1 view (71045) |
$128 |
$160 |
1.6× |
| Chest 2 views (71046) |
$152 |
$190 |
1.9× |
| Chest 3 views (71047) |
$152 |
$190 |
1.9× |
| Clavicle complete (73000) |
$124 |
$155 |
1.5× |
| Computed Tomography Thorax Lw Dose Lng Ca Scr C- (71271) |
$240 |
$300 |
2.5× |
| CT abdomen and pelvis without and with contrast (74178) |
$760 |
$950 |
2.4× |
| CT abdomen and pelvis without contrast (74176) |
$760 |
$950 |
3.5× |
| CT abdomen w contrast (74160) |
$760 |
$950 |
4.7× |
| CT abdomen w wo contrast (74170) |
$760 |
$950 |
4.7× |
| CT abdomen w/o contrast (74150) |
$760 |
$950 |
7.9× |
| CT Angio Abdomen and Pelvis (74174) |
$2,000 |
$2,500 |
6.2× |
| CT Angio Chest (71275) |
$1,200 |
$1,500 |
7.4× |
| CT Angio Head (70496) |
$1,200 |
$1,500 |
7.4× |
| CT Angio Neck (70498) |
$1,200 |
$1,500 |
7.4× |
| CT cervical spine w/ contrast (72126) |
$760 |
$950 |
2.4× |
| CT cervical spine w/o contrast (72125) |
$760 |
$950 |
7.9× |
| CT cervical spine w/wo cont (72127) |
$760 |
$950 |
4.7× |
| CT chest w contrast (71260) |
$760 |
$950 |
4.7× |
| CT chest w/wo contrast (71270) |
$760 |
$950 |
4.7× |
| CT head/brain with contrast (70460) |
$760 |
$950 |
4.7× |
| CT head/brain without and with contrast (70470) |
$760 |
$950 |
4.7× |
| CT iac w contrast (70481) |
$760 |
$950 |
4.7× |
| CT l-spine w&w/o contrast (72133) |
$760 |
$950 |
4.7× |
| CT lower ext w/o (73700) |
$760 |
$950 |
7.9× |
| CT lower extremity w/contrast material (73701) |
$760 |
$950 |
4.7× |
| CT lumbar spine w contrast (72132) |
$760 |
$950 |
2.4× |
| CT lumbar spine w/o contrast (72131) |
$760 |
$950 |
7.9× |
| CT maxillofacial w contrast (70487) |
$760 |
$950 |
4.7× |
| CT maxillofacial wo contrast (70486) |
$760 |
$950 |
7.9× |
| CT neck tissue combo (70492) |
$760 |
$950 |
4.7× |
| Ct Orbit/Ear/Fossa W/O&W/Dye (70482) |
$760 |
$950 |
4.7× |
| CT orbits w/o contrast (70480) |
$760 |
$950 |
7.9× |
| CT pelvis w&w/o contrast (72194) |
$760 |
$950 |
4.7× |
| CT pelvis w/o contrast (72192) |
$760 |
$950 |
7.9× |
| CT scan of leg combo (73702) |
$760 |
$950 |
4.7× |
| CT scans face/jaw combo (70488) |
$760 |
$950 |
4.7× |
| CT soft tissue neck w contrast (70491) |
$760 |
$950 |
4.7× |
| CT soft tissue neck w/o contrast (70490) |
$760 |
$950 |
7.9× |
| CT thoracic spine w contrast (72129) |
$760 |
$950 |
4.7× |
| CT thoracic spine w/o contrast (72128) |
$760 |
$950 |
7.9× |
| CT thoracic spine w/wo cont (72130) |
$760 |
$950 |
4.7× |
| CT thorax w/o contrast (71250) |
$760 |
$950 |
7.9× |
| CT upper ext wo (73200) |
$760 |
$950 |
7.9× |
| CT upper extremity w/o & w/contrast material (73202) |
$760 |
$950 |
4.7× |
| CT upper extremity with contrast (73201) |
$760 |
$950 |
2.4× |
| Cta Abdl Aorta&Bi Iliofem W/Contrast&Postp (75635) |
$1,280 |
$1,600 |
7.9× |
| Cta Abdomen (74175) |
$1,280 |
$1,600 |
7.9× |
| Dxa Bone Density Axial (77080) |
$208 |
$260 |
2.2× |
| Dxa bone density study 1/>sites appendiclr skel (77081) |
$60 |
$75 |
0.7× |
| Esophagram (74220) |
$288 |
$360 |
1.8× |
| Fetal Biophysical Profile W/O Non-Stress Testing (76819) |
$200 |
$250 |
2.1× |
| Fluoroscopy up to 1 hr (76000) |
$280 |
$350 |
1.3× |
| Foot 2 views (73620) |
$112 |
$140 |
1.4× |
| Forearm 2 views (73090) |
$136 |
$170 |
1.7× |
| Gastric emptying imaging study (78264) |
$839.22 |
$1,049.03 |
2.3× |
| Gated Heart Planar Single (78472) |
$912.22 |
$1,140.27 |
2.5× |
| Hand 2 views (73120) |
$112 |
$140 |
1.2× |
| Hepatobil Syst Image W/Drug (78227) |
$776.11 |
$970.14 |
1.6× |
| Hepatobiliary System Imaging (78226) |
$839.04 |
$1,048.80 |
2.3× |
| Ht Muscle Image Spect Sing (78451) |
$1,160 |
$1,450 |
1.0× |
| K Flow/Funct Image Multiple (78709) |
$962.74 |
$1,203.42 |
1.9× |
| K Flow/Funct Image W/Drug (78708) |
$1,164.35 |
$1,455.44 |
2.3× |
| K Flow/Funct Image W/O Drug (78707) |
$641.82 |
$802.28 |
1.3× |
| Knee 3 Views (73562) |
$180 |
$225 |
2.2× |
| Lung Ventilat&Perfus Imaging (78582) |
$960.85 |
$1,201.06 |
1.9× |
| Magnetic Image Jaw Joint (70336) |
$720 |
$900 |
3.3× |
| Meckels Divert Exam (78290) |
$633.10 |
$791.37 |
1.7× |
| MRA head w/o contrast (70544) |
$1,200 |
$1,500 |
5.5× |
| MRA head with contrast (70545) |
$1,200 |
$1,500 |
3.7× |
| Mra Neck W/O &W/Contrast Material (70549) |
$1,200 |
$1,500 |
3.7× |
| MRA neck w/o contrast (70547) |
$1,200 |
$1,500 |
5.5× |
| MRI abdomen w contrast (74182) |
$720 |
$900 |
2.2× |
| MRI abdomen w/o contrast (74181) |
$720 |
$900 |
3.3× |
| MRI any jt lower extrem w/contrast material (73722) |
$720 |
$900 |
1.0× |
MRI any jt lower extrem w/o & w/contrast matrl (73723) range across 2 matching MRF lines |
$720–$1,200 |
$900–$1,500 |
varies |
| MRI any jt upper extremity w/contrast matrl (73222) |
$720 |
$900 |
1.0× |
| MRI cervical spine w contrast (72142) |
$720 |
$900 |
2.2× |
| MRI cervical spine w/o cont (72141) |
$720 |
$900 |
3.3× |
| MRI chest w/o contrast (71550) |
$720 |
$900 |
3.3× |
| MRI lower extrem oth/thn jt w/contrast matrl (73719) |
$720 |
$900 |
2.2× |
| MRI lower extrem oth/thn jt w/o & w/contr matr (73720) |
$720 |
$900 |
2.2× |
| MRI lower extrem oth/thn jt w/o contr matrl (73718) |
$720 |
$900 |
3.3× |
| MRI lumbar spine w contrast (72149) |
$720 |
$900 |
2.2× |
| Mri Neck Spine W/O & W/Dye (72156) |
$720 |
$900 |
2.2× |
| MRI orbit face &/neck w/o contrast (70540) |
$720 |
$900 |
3.3× |
| Mri Orbt/Fac/Nck W/O &W/Dye (70543) |
$720 |
$900 |
2.2× |
| MRI pelvis w contrast (72196) |
$720 |
$900 |
2.2× |
| MRI pelvis w/o & w contrast (72197) |
$720 |
$900 |
2.2× |
| MRI pelvis w/o contrast (72195) |
$720 |
$900 |
3.3× |
| MRI thoracic spine w/o contrast (72146) |
$720 |
$900 |
3.3× |
| MRI upper extremity oth than jt w/o contr matrl (73218) |
$720 |
$900 |
3.3× |
| Mri Uppr Extremity W/O&W/Dye (73220) |
$720 |
$900 |
2.2× |
| MRI, abdomen, combo (74183) |
$720 |
$900 |
2.2× |
| MRI, dorsal spine combo (72157) |
$720 |
$900 |
2.2× |
| MRI, dorsal spine contrast (72147) |
$720 |
$900 |
2.2× |
| MRI, joint upper extrem (73221) |
$720 |
$900 |
3.3× |
| MRI, joint upper extrem combo (73223) |
$720 |
$900 |
2.2× |
| MRI, lumbar spine combo (72158) |
$720 |
$900 |
2.2× |
| Myocardial Spect Multiple Studies (78452) |
$1,480 |
$1,850 |
1.2× |
| Neck soft tissue (70360) |
$132 |
$165 |
1.6× |
| Parathyroid Planar Imaging (78070) |
$574.21 |
$717.76 |
1.6× |
| Pelvis 1 or 2 views (72170) |
$140 |
$175 |
1.5× |
| Pulmonary Perfusion Imaging Particulate (78580) |
$544.76 |
$680.95 |
1.5× |
| Radex Abd Compl Aqt Abd W/S/E/D Views 1 View Ch (74022) |
$300 |
$375 |
3.1× |
| Radex Ankle Complete Minimum 3 Views (73610) |
$152 |
$190 |
1.9× |
| Radex Calcaneus Minimum 2 Views (73650) |
$120 |
$150 |
1.5× |
| Radex elbow complete minimum 3 views (73080) |
$160 |
$200 |
2.0× |
| Radex Facial Bones Complete Minimum 3 Views (70150) |
$188 |
$235 |
2.0× |
| Radex fingr minimum 2 views (73140) |
$112 |
$140 |
1.4× |
| Radex foot complete minimum 3 views (73630) |
$140 |
$175 |
1.7× |
| Radex Hand Minimum 3 Views (73130) |
$152 |
$190 |
1.9× |
| Radex lower extremity infant minimum 2 views (73592) |
$148 |
$185 |
1.8× |
| Radex Nasal Bones Complete Minimum 3 Views (70160) |
$160 |
$200 |
2.0× |
| Radex Ribs Unilateral 2 Views (71100) |
$152 |
$190 |
1.9× |
| Radex shoulder complete minimum 2 views (73030) |
$152 |
$190 |
1.9× |
| Radex Sinuses Paransl < 3 Views (70210) |
$144 |
$180 |
1.8× |
| Radex Spine 1 View Specify Level (72020) |
$208 |
$260 |
2.6× |
| Radex Sternum Minimum 2 Views (71120) |
$184 |
$230 |
2.3× |
| Radex Temporomandble Jt Opn & Clsd Mouth Bilat (70330) |
$120 |
$150 |
1.5× |
| Radex Toe Minimum 2 Views (73660) |
$120 |
$150 |
1.5× |
| Radex Wrist Complete Minimum 3 Views (73110) |
$152 |
$190 |
1.9× |
| Radiolog exam mandible compl minimum 4 views (70110) |
$216 |
$270 |
2.2× |
| Radiologic Exam Abdomen 3+ Views - Xr Abdomen 3+ Views (74021) |
$180 |
$225 |
1.9× |
Radiologic exam knee complete 4/more views (73564) range across 2 matching MRF lines |
$240–$480 |
$300–$600 |
varies |
| Radiologic exam pelvis compl minimum 3 views (72190) |
$160 |
$200 |
1.7× |
| Radiologic Exam Small Int Single Contrast Study (74250) |
$320 |
$400 |
2.0× |
| Radiologic examination femur 1 view (73551) |
$152 |
$190 |
1.9× |
| Radiologic examination femur minimum 2 views (73552) |
$103.73 |
$129.66 |
1.3× |
| Radiologic examination knee 1/2 views (73560) |
$160 |
$200 |
2.0× |
| Radiologic Examination Osseous Survey Limited (77074) |
$320 |
$400 |
3.3× |
| Radiologic examination tibia & fibula 2 views (73590) |
$160 |
$200 |
2.0× |
| Ribs bilateral 3 views (71110) |
$180 |
$225 |
1.9× |
| Rp Loclzj Tum Spect 1 Area Single Day Imaging (78803) |
$674.40 |
$843 |
1.4× |
| Scapula (73010) |
$128 |
$160 |
1.3× |
| Screening Digital Breast Tomosynthesis Bi (77063) |
$88 |
$110 |
3.8× |
| Shoulder 1 view (73020) |
$120 |
$150 |
1.5× |
| Skull less than 4 views (70250) |
$144 |
$180 |
1.5× |
| Sternoclavicular joints (71130) |
$160 |
$200 |
2.0× |
| Thoracic spine 2 views (72070) |
$152 |
$190 |
1.6× |
| Thoracic spine 3 views (72072) |
$240 |
$300 |
2.5× |
| Thoracolumbar 2 views (72080) |
$216 |
$270 |
2.7× |
| Thyroid Imaging With Vascular Flow (78013) |
$529.92 |
$662.40 |
1.4× |
| Thyroid Uptake W/Blood Flow Sngle/Mult Quan Meas (78014) |
$454.07 |
$567.59 |
1.2× |
| Ultrasound Breast Limited (76642) |
$160 |
$200 |
2.0× |
| Ultrasound Exam Aaa Screen (76706) |
$176 |
$220 |
1.8× |
Ultrasound, abdomen limited (76705) range across 2 matching MRF lines |
$28–$280 |
$35–$350 |
varies |
| Unlisted Dx Radiographic Procedure (76499) |
$76 |
$95 |
0.9× |
| Unlisted us procedure (76999) |
$100 |
$125 |
1.2× |
| Us breast unilateral complete (76641) |
$160 |
$200 |
1.7× |
Us chest (76604) range across 2 matching MRF lines |
$28–$140 |
$35–$175 |
varies |
| Us complete joint (76881) |
$120 |
$150 |
1.2× |
Us exam, pelvic, limited (76857) range across 2 matching MRF lines |
$24.80–$144 |
$31–$180 |
varies |
Us lmtd joint/oth nonvasc xtr strux r-t w/img (76882) range across 2 matching MRF lines |
$160–$240 |
$200–$300 |
varies |
| Us ob detailed single fetus (76811) |
$240 |
$300 |
1.1× |
Us ob limited 1 or more fetuses (76815) range across 2 matching MRF lines |
$31.20–$104 |
$39–$130 |
varies |
Us ob transvaginal (76817) range across 2 matching MRF lines |
$35.20–$112 |
$44–$140 |
varies |
| Us pelvic non ob complete (76856) |
$240 |
$300 |
2.5× |
| Us pg uter img f&mat 14 wk tabdl 1/1st gestation (76801) |
$160 |
$200 |
1.7× |
| Us preg uterus real time f/u trnsabdl per fetus (76816) |
$80 |
$100 |
0.8× |
| Us retroperitoneal complete (76770) |
$280 |
$350 |
2.9× |
Us retroperitoneal limited (76775) range across 2 matching MRF lines |
$28–$220 |
$35–$275 |
varies |
| Us scrotum and contents (76870) |
$280 |
$350 |
2.9× |
| Us thyroid (76536) |
$480 |
$600 |
5.0× |
| Us transrectal (76872) |
$140 |
$175 |
1.5× |
| Wrist 2 views (73100) |
$112 |
$140 |
1.4× |
| X-Ray Ac Jts - Xr Acromioclavicular Joints Bilateral (73050) |
$156 |
$195 |
1.9× |
| X-Ray Bend Only L-S Spine (72120) |
$248 |
$310 |
2.6× |
| X-Ray Elbow 2 Vw - Xr Elbow 1-2 Views Right (73070) |
$124 |
$155 |
1.5× |
X-Ray Exam Hip Uni 1 View (73501) range across 2 matching MRF lines |
$148–$152 |
$185–$190 |
varies |
X-Ray Exam Hip Uni 2-3 Views (73502) range across 2 matching MRF lines |
$160–$180 |
$200–$225 |
varies |
| X-Ray Exam Hips Bi 2 Views (73521) |
$220 |
$275 |
2.3× |
| X-Ray Exam Hips Bi 5/> Views (73523) |
$240 |
$300 |
2.5× |
| X-Ray Exam L-S Spine Bending (72114) |
$304 |
$380 |
3.2× |
| X-Ray Exam Neck Spine 2-3 Vw (72040) |
$200 |
$250 |
2.5× |
| X-Ray Exam Neck Spine 6/>Vws (72052) |
$296 |
$370 |
3.1× |
| X-Ray Exam Unilat Ribs/Chest (71101) |
$208 |
$260 |
2.2× |
| X-ray eye for foreign body (70030) |
$96 |
$120 |
1.2× |
| X-ray humerus (73060) |
$152 |
$190 |
1.9× |
| X-ray IV pyelogram (ivp) (74400) |
$480 |
$600 |
3.0× |
| X-Ray Jaw <4 Vw - Xr Mandible < 4 Views (70100) |
$96 |
$120 |
1.2× |
| X-Ray Knee Bilat Standing - Xr Knees Anteroposterior Standing Bilat (73565) |
$120 |
$150 |
1.5× |
| X-Ray Lumbar Spine 2/3 Vw - Xr Lumbar Spine 2-3 Views (72100) |
$212 |
$265 |
2.2× |
| X-ray nose-rectum child f.b. (76010) |
$120 |
$150 |
1.5× |
| X-Ray Ribs, Chest 4+ Vw - Xr Ribs 3 Vws Bil W/ Chest Posteroanterior (71111) |
$260 |
$325 |
2.7× |
| X-Ray Sacroiliac Jts 3+ Vw - Xr Sacroiliac Joints 3+ Views (72202) |
$180 |
$225 |
1.9× |
| X-Ray Sacrum/Coccyx 2+ Vw - Xr Sacrum Coccyx 2+ Views (72220) |
$180 |
$225 |
2.2× |
| X-Ray Sinuses 3+ Vw - Xr Paranasal Sinuses 3+ Views (70220) |
$200 |
$250 |
2.5× |
| X-Ray Skull 4+ Vw - Xr Skull Complete 4+ Views (70260) |
$216 |
$270 |
2.2× |
| X-Ray Stress View (77071) |
$100 |
$125 |
1.2× |
| X-ray thoracic spine 4 vw (72074) |
$256 |
$320 |
2.7× |
| X-Ray Urinary Tract Exam With Contrast Material (74420) |
$240 |
$300 |
0.7× |
| X-Rays Bone Length Studies (77073) |
$240 |
$300 |
2.5× |
| X-Rays Bone Survey Complete (77075) |
$504 |
$630 |
5.2× |
| Xr c-spine 4 or 5 views (72050) |
$260 |
$325 |
2.7× |
| Xr facial bones less than 3 views (70140) |
$180 |
$225 |
2.2× |