| Abdomen 1 View (74018) |
$160.30 |
$229 |
1.9× |
| Abdomen 2 views (74019) |
$186.20 |
$266 |
1.8× |
| Ankle 2 views (73600) |
$189 |
$270 |
2.2× |
| Bone age studies (77072) |
$191.10 |
$273 |
1.8× |
| Cat Scan Follow-Up Study (76380) |
$342.30 |
$489 |
4.0× |
| Chest 1 view (71045) |
$189.70 |
$271 |
2.2× |
| Chest 2 views (71046) |
$226.10 |
$323 |
2.6× |
| Chest 3 views (71047) |
$375.20 |
$536 |
4.4× |
| Chest 4 or more views (71048) |
$535.50 |
$765 |
5.2× |
| Clavicle complete (73000) |
$200.20 |
$286 |
2.3× |
| CT abdomen and pelvis without and with contrast (74178) |
$5,690.30 |
$8,129 |
16.5× |
| CT abdomen and pelvis without contrast (74176) |
$2,929.50 |
$4,185 |
12.4× |
| CT abdomen w contrast (74160) |
$2,275.70 |
$3,251 |
13.1× |
| CT abdomen w wo contrast (74170) |
$2,773.40 |
$3,962 |
16.0× |
| CT abdomen w/o contrast (74150) |
$1,702.40 |
$2,432 |
16.4× |
| CT Angio Abdomen and Pelvis (74174) |
$5,940.20 |
$8,486 |
17.2× |
| CT Angio Chest (71275) |
$2,969.40 |
$4,242 |
17.1× |
| CT Angio Head (70496) |
$2,940 |
$4,200 |
16.9× |
| CT angio hrt w/3d image (75574) |
$1,558.20 |
$2,226 |
4.5× |
| Ct Angio Lwr Extr W/O&W/Dye (73706) |
$1,837.50 |
$2,625 |
10.6× |
| CT Angio Neck (70498) |
$2,541 |
$3,630 |
14.6× |
| Ct Angio Upr Extrm W/O&W/Dye (73206) |
$2,114.70 |
$3,021 |
12.2× |
| CT cervical spine w/ contrast (72126) |
$2,104.20 |
$3,006 |
6.1× |
| CT cervical spine w/o contrast (72125) |
$1,600.20 |
$2,286 |
15.5× |
| CT chest w contrast (71260) |
$1,821.40 |
$2,602 |
10.5× |
| CT chest w/wo contrast (71270) |
$2,601.20 |
$3,716 |
15.0× |
| CT head/brain with contrast (70460) |
$1,815.80 |
$2,594 |
10.5× |
| CT head/brain without and with contrast (70470) |
$2,125.90 |
$3,037 |
12.2× |
| CT iac w contrast (70481) |
$1,334.90 |
$1,907 |
7.7× |
| CT l-spine w&w/o contrast (72133) |
$3,285.80 |
$4,694 |
18.9× |
| CT lower ext w/o (73700) |
$1,109.50 |
$1,585 |
10.7× |
| CT lower extremity w/contrast material (73701) |
$1,810.20 |
$2,586 |
10.4× |
| CT lumbar spine w contrast (72132) |
$2,986.20 |
$4,266 |
8.6× |
| CT lumbar spine w/o contrast (72131) |
$1,707.30 |
$2,439 |
16.5× |
| CT maxillofacial w contrast (70487) |
$1,234.10 |
$1,763 |
7.1× |
| CT maxillofacial wo contrast (70486) |
$802.20 |
$1,146 |
7.8× |
| CT neck tissue combo (70492) |
$2,871.40 |
$4,102 |
16.5× |
| Ct Orbit/Ear/Fossa W/O&W/Dye (70482) |
$2,130.80 |
$3,044 |
12.3× |
| CT orbits w/o contrast (70480) |
$1,249.50 |
$1,785 |
12.1× |
| CT pelvis w&w/o contrast (72194) |
$2,547.30 |
$3,639 |
14.7× |
| CT pelvis w/o contrast (72192) |
$1,747.20 |
$2,496 |
16.9× |
| CT scan of leg combo (73702) |
$2,032.80 |
$2,904 |
11.7× |
| CT scans face/jaw combo (70488) |
$2,564.10 |
$3,663 |
14.8× |
| CT soft tissue neck w contrast (70491) |
$1,384.60 |
$1,978 |
8.0× |
| CT soft tissue neck w/o contrast (70490) |
$891.80 |
$1,274 |
8.6× |
| CT thoracic spine w contrast (72129) |
$1,703.10 |
$2,433 |
9.8× |
| CT thoracic spine w/o contrast (72128) |
$1,120 |
$1,600 |
10.8× |
| CT thorax w/o contrast (71250) |
$1,086.40 |
$1,552 |
10.5× |
| CT upper ext wo (73200) |
$1,710.80 |
$2,444 |
16.5× |
| CT upper extremity w/o & w/contrast material (73202) |
$2,878.40 |
$4,112 |
16.6× |
| CT upper extremity with contrast (73201) |
$2,472.40 |
$3,532 |
7.2× |
| Cta Abdl Aorta&Bi Iliofem W/Contrast&Postp (75635) |
$3,145.10 |
$4,493 |
18.1× |
| Cta Abdomen (74175) |
$4,232.20 |
$6,046 |
24.4× |
| Dxa Bone Density Axial (77080) |
$386.40 |
$552 |
3.7× |
| Dxa bone density study 1/>sites appendiclr skel (77081) |
$54.60 |
$78 |
0.6× |
| Esophagram (74220) |
$387.80 |
$554 |
2.2× |
| Fetal Biophys Profile W/Nst (76818) |
$676.20 |
$966 |
6.5× |
| Fetal Biophysical Profile W/O Non-Stress Testing (76819) |
$97.30 |
$139 |
0.9× |
| Foot 2 views (73620) |
$190.40 |
$272 |
2.2× |
| Forearm 2 views (73090) |
$234.50 |
$335 |
2.7× |
| Hand 2 views (73120) |
$221.20 |
$316 |
2.1× |
| Knee 3 Views (73562) |
$293.30 |
$419 |
3.4× |
| Mr safety determination physician/other qhp (76016) |
$45.50 |
$65 |
0.5× |
| Mr safety implant&/fb assmt clin staf 1st 15 min (76014) |
$12.60 |
$18 |
0.4× |
| Mr safety implt electronics prepj supvj phys/qhp (76018) |
$46.90 |
$67 |
0.5× |
| Mr safety implt pos&/immoblj (76019) |
$30.80 |
$44 |
0.5× |
| Mr safety med physics xm customization plng&mntr (76017) |
$123.90 |
$177 |
0.5× |
| Mra Head W/O & W/Contrast Material (70546) |
$2,986.20 |
$4,266 |
8.6× |
| MRA head w/o contrast (70544) |
$1,949.50 |
$2,785 |
8.3× |
| Mra Neck W/O &W/Contrast Material (70549) |
$2,837.10 |
$4,053 |
8.2× |
| MRA neck w/o contrast (70547) |
$1,852.20 |
$2,646 |
7.8× |
| MRI abdomen w/o contrast (74181) |
$2,449.30 |
$3,499 |
10.4× |
| MRI any jt lower extrem w/contrast material (73722) |
$2,864.40 |
$4,092 |
3.7× |
| MRI any jt lower extrem w/o & w/contrast matrl (73723) |
$3,412.50 |
$4,875 |
9.9× |
| MRI cervical spine w contrast (72142) |
$2,454.90 |
$3,507 |
7.1× |
| MRI cervical spine w/o cont (72141) |
$1,286.60 |
$1,838 |
5.4× |
| MRI chest w/o contrast (71550) |
$2,259.60 |
$3,228 |
9.6× |
| MRI lower extrem oth/thn jt w/o & w/contr matr (73720) |
$3,509.80 |
$5,014 |
10.2× |
| MRI lower extrem oth/thn jt w/o contr matrl (73718) |
$2,129.40 |
$3,042 |
9.0× |
| Mri Neck Spine W/O & W/Dye (72156) |
$1,774.50 |
$2,535 |
5.1× |
| MRI orbit face &/neck w/o contrast (70540) |
$1,964.90 |
$2,807 |
8.3× |
| Mri Orbt/Fac/Nck W/O &W/Dye (70543) |
$2,200.10 |
$3,143 |
6.4× |
| MRI pelvis w/o & w contrast (72197) |
$3,752 |
$5,360 |
10.9× |
| MRI pelvis w/o contrast (72195) |
$2,730.70 |
$3,901 |
11.6× |
| MRI thoracic spine w/o contrast (72146) |
$1,611.40 |
$2,302 |
6.8× |
| MRI upper extremity oth than jt w/o contr matrl (73218) |
$1,986.60 |
$2,838 |
8.4× |
| Mri Uppr Extremity W/O&W/Dye (73220) |
$2,721.60 |
$3,888 |
7.9× |
| MRI, abdomen, combo (74183) |
$3,752 |
$5,360 |
10.9× |
| MRI, dorsal spine combo (72157) |
$4,305.70 |
$6,151 |
12.5× |
| MRI, joint upper extrem (73221) |
$1,488.20 |
$2,126 |
6.3× |
| MRI, joint upper extrem combo (73223) |
$2,316.30 |
$3,309 |
6.7× |
| MRI, lumbar spine combo (72158) |
$2,113.30 |
$3,019 |
6.1× |
| Neck soft tissue (70360) |
$334.60 |
$478 |
3.9× |
| Pelvis 1 or 2 views (72170) |
$193.20 |
$276 |
1.9× |
| Radex Abd Compl Aqt Abd W/S/E/D Views 1 View Ch (74022) |
$336 |
$480 |
3.2× |
| Radex Ankle Complete Minimum 3 Views (73610) |
$252.70 |
$361 |
2.9× |
| Radex Calcaneus Minimum 2 Views (73650) |
$291.90 |
$417 |
3.4× |
| Radex elbow complete minimum 3 views (73080) |
$272.30 |
$389 |
3.2× |
| Radex Facial Bones Complete Minimum 3 Views (70150) |
$596.40 |
$852 |
5.8× |
| Radex fingr minimum 2 views (73140) |
$171.50 |
$245 |
2.0× |
| Radex foot complete minimum 3 views (73630) |
$249.20 |
$356 |
2.9× |
| Radex Hand Minimum 3 Views (73130) |
$252.70 |
$361 |
2.9× |
| Radex lower extremity infant minimum 2 views (73592) |
$565.60 |
$808 |
6.6× |
| Radex Nasal Bones Complete Minimum 3 Views (70160) |
$391.30 |
$559 |
4.5× |
| Radex Ribs Unilateral 2 Views (71100) |
$266 |
$380 |
3.1× |
| Radex shoulder complete minimum 2 views (73030) |
$650.30 |
$929 |
7.5× |
| Radex Sinuses Paransl < 3 Views (70210) |
$237.30 |
$339 |
2.8× |
| Radex Spine 1 View Specify Level (72020) |
$203 |
$290 |
2.4× |
| Radex Sternum Minimum 2 Views (71120) |
$445.20 |
$636 |
5.2× |
| Radex Temporomandble Jt Opn & Clsd Mouth Bilat (70330) |
$530.60 |
$758 |
6.2× |
| Radex Toe Minimum 2 Views (73660) |
$171.50 |
$245 |
2.0× |
| Radex upper extremity infant minimum 2 views (73092) |
$228.90 |
$327 |
2.2× |
| Radex Wrist Complete Minimum 3 Views (73110) |
$250.60 |
$358 |
2.9× |
| Radiolog exam mandible compl minimum 4 views (70110) |
$619.50 |
$885 |
6.0× |
| Radiologic exam colon double contrast study (74280) |
$1,139.60 |
$1,628 |
6.6× |
| Radiologic exam colon single contrast study (74270) |
$1,121.40 |
$1,602 |
6.5× |
| Radiologic exam knee complete 4/more views (73564) |
$403.20 |
$576 |
3.9× |
| Radiologic exam pelvis compl minimum 3 views (72190) |
$572.60 |
$818 |
5.5× |
| Radiologic Exam Small Int Single Contrast Study (74250) |
$533.40 |
$762 |
3.1× |
| Radiologic exam upr gi trc double contrast study (74246) |
$632.10 |
$903 |
3.6× |
| Radiologic examination femur minimum 2 views (73552) |
$184.80 |
$264 |
2.1× |
| Radiologic examination knee 1/2 views (73560) |
$161.70 |
$231 |
1.9× |
| Radiologic examination tibia & fibula 2 views (73590) |
$235.90 |
$337 |
2.7× |
| Ribs bilateral 3 views (71110) |
$366.80 |
$524 |
3.5× |
| Scapula (73010) |
$357.70 |
$511 |
3.5× |
| Screening Digital Breast Tomosynthesis Bi (77063) |
$198.10 |
$283 |
8.5× |
| Shoulder 1 view (73020) |
$407.40 |
$582 |
4.7× |
| Skull less than 4 views (70250) |
$415.80 |
$594 |
4.0× |
| Sternoclavicular joints (71130) |
$511 |
$730 |
5.9× |
| Thoracic spine 2 views (72070) |
$290.50 |
$415 |
2.8× |
| Thoracic spine 3 views (72072) |
$477.40 |
$682 |
4.6× |
| Thoracolumbar 2 views (72080) |
$436.80 |
$624 |
5.1× |
| Ultrasound Breast Limited (76642) |
$485.80 |
$694 |
5.6× |
| Ultrasound Exam Aaa Screen (76706) |
$107.80 |
$154 |
1.0× |
| Ultrasound, abdomen limited (76705) |
$466.90 |
$667 |
4.5× |
| Umbilical-artery Doppler (OB) (76820) |
$242.90 |
$347 |
2.3× |
| Upper gi w/o kub (74240) |
$548.80 |
$784 |
3.2× |
| Us chest (76604) |
$369.60 |
$528 |
3.6× |
| Us complete joint (76881) |
$93.10 |
$133 |
0.9× |
| Us exam, pelvic, limited (76857) |
$219.80 |
$314 |
2.1× |
| Us head (76506) |
$333.20 |
$476 |
3.2× |
| Us kidney transplant (76776) |
$560 |
$800 |
5.4× |
| Us lmtd joint/oth nonvasc xtr strux r-t w/img (76882) |
$63.70 |
$91 |
0.6× |
| Us ob limited 1 or more fetuses (76815) |
$189 |
$270 |
1.8× |
| Us ob transvaginal (76817) |
$228.90 |
$327 |
2.2× |
| Us pelvic non ob complete (76856) |
$419.30 |
$599 |
4.1× |
| Us pg uter img f&mat 14 wk tabdl 1/1st gestation (76801) |
$359.10 |
$513 |
3.5× |
| Us retroperitoneal complete (76770) |
$682.50 |
$975 |
6.6× |
| Us retroperitoneal limited (76775) |
$593.60 |
$848 |
5.7× |
| Us scrotum and contents (76870) |
$269.50 |
$385 |
2.6× |
| Us thyroid (76536) |
$312.20 |
$446 |
3.0× |
| Wrist 2 views (73100) |
$188.30 |
$269 |
2.2× |
| X-Ray Ac Jts - Xr Acromioclavicular Joints Bilateral (73050) |
$112.70 |
$161 |
1.3× |
| X-Ray Bend Only L-S Spine (72120) |
$176.40 |
$252 |
1.7× |
| X-Ray Elbow 2 Vw - Xr Elbow 1-2 Views Right (73070) |
$198.80 |
$284 |
2.3× |
X-Ray Exam Breast Specimen (76098) range across 2 matching MRF lines |
$65.10–$2,440.90 |
$93–$3,487 |
varies |
| X-Ray Exam Entire Spi 1 Vw (72081) |
$305.20 |
$436 |
3.5× |
| X-Ray Exam Entire Spi 2/3 Vw (72082) |
$351.40 |
$502 |
3.4× |
| X-Ray Exam Hip Uni 1 View (73501) |
$126 |
$180 |
1.5× |
| X-Ray Exam Hip Uni 2-3 Views (73502) |
$252 |
$360 |
2.9× |
| X-Ray Exam Hips Bi 3-4 Views (73522) |
$389.90 |
$557 |
3.8× |
| X-Ray Exam L-S Spine Bending (72114) |
$549.50 |
$785 |
5.3× |
| X-Ray Exam Neck Spine 2-3 Vw (72040) |
$221.20 |
$316 |
2.6× |
| X-Ray Exam Neck Spine 6/>Vws (72052) |
$406 |
$580 |
3.9× |
| X-Ray Exam Unilat Ribs/Chest (71101) |
$316.40 |
$452 |
3.1× |
| X-ray humerus (73060) |
$265.30 |
$379 |
3.1× |
| X-Ray Jaw <4 Vw - Xr Mandible < 4 Views (70100) |
$428.40 |
$612 |
5.0× |
| X-Ray Knee Bilat Standing - Xr Knees Anteroposterior Standing Bilat (73565) |
$226.80 |
$324 |
2.6× |
| X-Ray Lumbar Spine 2/3 Vw - Xr Lumbar Spine 2-3 Views (72100) |
$310.10 |
$443 |
3.0× |
| X-ray nose-rectum child f.b. (76010) |
$189.70 |
$271 |
2.2× |
| X-Ray Ribs, Chest 4+ Vw - Xr Ribs 3 Vws Bil W/ Chest Posteroanterior (71111) |
$420.70 |
$601 |
4.1× |
| X-Ray Sacroiliac Jts 3+ Vw - Xr Sacroiliac Joints 3+ Views (72202) |
$515.90 |
$737 |
5.0× |
| X-Ray Sacroiliac Jts <3 Vw - Xr Sacroiliac Joints 1-2 Views (72200) |
$239.40 |
$342 |
2.3× |
| X-Ray Sacrum/Coccyx 2+ Vw - Xr Sacrum Coccyx 2+ Views (72220) |
$481.60 |
$688 |
5.6× |
| X-Ray Sinuses 3+ Vw - Xr Paranasal Sinuses 3+ Views (70220) |
$352.10 |
$503 |
4.1× |
| X-Ray Skull 4+ Vw - Xr Skull Complete 4+ Views (70260) |
$613.90 |
$877 |
5.9× |
| X-ray thoracic spine 4 vw (72074) |
$613.90 |
$877 |
5.9× |
| X-Ray Tmj Unilat (70328) |
$354.20 |
$506 |
4.1× |
| X-Ray Urinary Tract Exam With Contrast Material (74420) |
$994 |
$1,420 |
2.9× |
| X-Rays Bone Length Studies (77073) |
$599.90 |
$857 |
5.8× |
| X-Rays Bone Survey Complete (77075) |
$860.30 |
$1,229 |
8.3× |
| Xr c-spine 4 or 5 views (72050) |
$320.60 |
$458 |
3.1× |
| Xr facial bones less than 3 views (70140) |
$70 |
$100 |
0.8× |
| Xr orbits complete 4 views (70200) |
$553.70 |
$791 |
5.3× |