| Abdomen 1 View (74018) |
$86 |
$415.35 |
1.0× |
| Abdomen 2 views (74019) |
$104 |
$765.29 |
1.0× |
| Acute Gastrointestinal Blood Loss Imaging (78278) |
$398 |
$2,069.62 |
1.0× |
| Angio pulmonary bilat (75743) |
$3,147 |
$9,639 |
1.0× |
| Angiography extremity bilateral rs&i (75716) |
$3,147 |
$9,095.15 |
1.0× |
Angiography extremity unilateral rs&i (75710)
range across 2 matching MRF lines |
$3,147 |
$9,095.15–$15,802 |
1.0× |
| Angiography pulmonary unilateral slctv rs&i (75741) |
$3,147 |
$9,639 |
1.0× |
| Angrph pulmonary nonslctv cath/ven njx rs&i (75746) |
$3,147 |
$15,802 |
1.0× |
| Ankle 2 views (73600) |
$86 |
$865.11 |
1.0× |
| Aortography thoracic serialography rs&i (75605) |
$5,546 |
$26,609.30 |
1.0× |
| Artery X-Rays Abdomen (75726) |
$5,546 |
$15,561.70 |
1.0× |
| Artery X-Rays Pelvis (75736) |
$5,546 |
$15,969 |
1.0× |
| Arthrogram hip (73525) |
$347 |
$1,365.37 |
1.0× |
| Arthrogram Wrist (73115) |
$347 |
$1,009.68 |
1.0× |
| Bone Imaging 3 Phase (78315) |
$398 |
$3,424.61 |
1.0× |
| Bone Imaging Whole Body (78306) |
$398 |
$3,325.17 |
1.0× |
| Brain Image W/Flow < 4 Views (78601) |
$398 |
$1,929.76 |
1.0× |
| Brain Imaging Min 4 Static Views W Vascular Flow (78606) |
$541 |
$2,676.13 |
1.0× |
| Brain Imaging Minimum 4 Static Views (78605) |
$541 |
$2,652.20 |
1.0× |
| Cat Scan Follow-Up Study (76380) |
$86 |
$451.35 |
1.0× |
| Chest 1 view (71045) |
$86 |
$416.49 |
1.0× |
| Chest 2 views (71046) |
$86 |
$533.53 |
1.0× |
| Chest 3 views (71047) |
$86 |
$654 |
1.0× |
| Chest 4 or more views (71048) |
$104 |
$766.43 |
1.0× |
| Clavicle complete (73000) |
$86 |
$1,065.90 |
1.0× |
| Computed Tomography Thorax Lw Dose Lng Ca Scr C- (71271) |
$104 |
$464.11 |
1.0× |
| Contrast Exam Abdominl Aorta (75625) |
$3,147 |
$9,095.15 |
1.0× |
| Contrast X-Ray Bladder (74430) |
$347 |
$1,813.98 |
1.0× |
| Contrast X-Ray Of Elbow (73085) |
$347 |
$1,887.06 |
1.0× |
| Contrast X-Ray Of Knee Joint (73580) |
$347 |
$2,054.82 |
1.0× |
| CT abdomen and pelvis without and with contrast (74178) |
$347 |
$9,899.45 |
1.0× |
| CT abdomen and pelvis without contrast (74176) |
$237 |
$7,974.73 |
1.0× |
| CT abdomen w contrast (74160) |
$174 |
$5,143.62 |
1.0× |
| CT abdomen w wo contrast (74170) |
$174 |
$5,840.09 |
1.0× |
| CT abdomen w/o contrast (74150) |
$104 |
$4,301.47 |
1.0× |
| CT Angio Abdomen and Pelvis (74174) |
$347 |
$9,457.71 |
1.0× |
| CT Angio Chest (71275) |
$174 |
$5,503.91 |
1.0× |
| CT Angio Head (70496) |
$174 |
$4,867.11 |
1.0× |
| CT angio hrt w/3d image (75574) |
$347 |
$3,476.52 |
1.0× |
| Ct Angio Lwr Extr W/O&W/Dye (73706) |
$174 |
$4,762.71 |
1.0× |
| CT Angio Neck (70498) |
$174 |
$5,631.26 |
1.0× |
| Ct Angio Upr Extrm W/O&W/Dye (73206) |
$174 |
$6,669.62 |
1.0× |
| CT cervical spine w/ contrast (72126) |
$347 |
$5,243.45 |
1.0× |
| CT cervical spine w/o contrast (72125) |
$104 |
$4,880.88 |
1.0× |
| CT chest w contrast (71260) |
$174 |
$4,560.77 |
1.0× |
| CT chest w/wo contrast (71270) |
$174 |
$5,480.96 |
1.0× |
| CT head/brain with contrast (70460) |
$174 |
$4,735.17 |
1.0× |
| CT head/brain without and with contrast (70470) |
$174 |
$5,015.13 |
1.0× |
| CT heart no contrast quant eval coronry calcium (75571) |
$86 |
$451.35 |
1.0× |
| CT iac w contrast (70481) |
$174 |
$3,517.82 |
1.0× |
| CT l-spine w&w/o contrast (72133) |
$174 |
$956.61 |
1.0× |
| CT lower ext w/o (73700) |
$104 |
$4,143.13 |
1.0× |
| CT lower extremity w/contrast material (73701) |
$174 |
$3,461.60 |
1.0× |
| CT lumbar spine w contrast (72132) |
$347 |
$5,532.58 |
1.0× |
| CT lumbar spine w/o contrast (72131) |
$104 |
$5,015.13 |
1.0× |
| CT maxillofacial w contrast (70487) |
$174 |
$4,575.68 |
1.0× |
| CT maxillofacial wo contrast (70486) |
$104 |
$4,512.58 |
1.0× |
| CT neck tissue combo (70492) |
$174 |
$3,253.91 |
1.0× |
| Ct Orbit/Ear/Fossa W/O&W/Dye (70482) |
$174 |
$3,193.10 |
1.0× |
| CT orbits w/o contrast (70480) |
$104 |
$4,412.76 |
1.0× |
| CT pelvis w&w/o contrast (72194) |
$174 |
$996.73 |
1.0× |
| CT pelvis w/o contrast (72192) |
$104 |
$3,781.71 |
1.0× |
| CT scan of leg combo (73702) |
$174 |
$2,428.90 |
1.0× |
| CT scans face/jaw combo (70488) |
$174 |
$996.73 |
1.0× |
| CT soft tissue neck w contrast (70491) |
$174 |
$5,025.45 |
1.0× |
| CT soft tissue neck w/o contrast (70490) |
$104 |
$3,672.71 |
1.0× |
| CT thoracic spine w contrast (72129) |
$174 |
$2,672.20 |
1.0× |
| CT thoracic spine w/o contrast (72128) |
$104 |
$4,894.65 |
1.0× |
| CT thorax w/o contrast (71250) |
$104 |
$4,067.41 |
1.0× |
| CT upper ext wo (73200) |
$104 |
$4,220 |
1.0× |
| CT upper extremity w/o & w/contrast material (73202) |
$174 |
$956.61 |
1.0× |
| CT upper extremity with contrast (73201) |
$347 |
$3,461.60 |
1.0× |
| Cta Abdl Aorta&Bi Iliofem W/Contrast&Postp (75635) |
$174 |
$5,385.73 |
1.0× |
| Cta Abdomen (74175) |
$174 |
$4,292.29 |
1.0× |
| CTA pelvis (72191) |
$174 |
$890.10 |
1.0× |
| Dxa Bone Density Axial (77080) |
$104 |
$977.55 |
1.0× |
| Dxa bone density study 1/>sites appendiclr skel (77081) |
$86 |
$391.25 |
1.0× |
| Echo Guide For Artery Repair (76936) |
$215 |
$1,520.26 |
1.0× |
| Esophagram (74220) |
$174 |
$984.44 |
1.0× |
| Fluoroscopy up to 1 hr (76000) |
$237 |
$1,122.12 |
1.0× |
| Follow-Up Angiography (75898) |
$3,147 |
$3,990.53 |
1.0× |
| Foot 2 views (73620) |
$86 |
$865.11 |
1.0× |
| Forearm 2 views (73090) |
$86 |
$920.18 |
1.0× |
| Gastric emptying imaging study (78264) |
$398 |
$3,050.89 |
1.0× |
| Gated Heart Planar Single (78472) |
$398 |
$2,103.45 |
1.0× |
| Hand 2 views (73120) |
$104 |
$814.64 |
1.0× |
| Hepatc Vngrph Wdg/Fr Hemodyn Eval Rs&I (75889) |
$3,147 |
$9,639 |
1.0× |
| Hepatobil Syst Image W/Drug (78227) |
$541 |
$2,730.62 |
1.0× |
| Hepatobiliary System Imaging (78226) |
$398 |
$3,091.33 |
1.0× |
| Ht Muscle Image Spect Sing (78451) |
$1,290 |
$6,596.79 |
1.0× |
| Hysterosalpingogram (74740) |
$237 |
$1,025.75 |
1.0× |
| K Flow/Funct Image W/Drug (78708) |
$541 |
$2,731.77 |
1.0× |
| Knee 3 Views (73562) |
$86 |
$1,041.80 |
1.0× |
| Liver imaging w/vascular flow (78202) |
$541 |
$1,240.24 |
1.0× |
| Lung Ventilat&Perfus Imaging (78582) |
$541 |
$3,742.59 |
1.0× |
| Lymph System Imaging (78195) |
$541 |
$2,485.96 |
1.0× |
| Magnetic Image Jaw Joint (70336) |
$237 |
$5,078.23 |
1.0× |
| MRA head w/o contrast (70544) |
$237 |
$4,810.89 |
1.0× |
| MRA head with contrast (70545) |
$347 |
$3,253.91 |
1.0× |
| MRA neck w contrast (70548) |
$347 |
$3,253.91 |
1.0× |
| Mra Neck W/O &W/Contrast Material (70549) |
$347 |
$1,954.33 |
1.0× |
| MRA neck w/o contrast (70547) |
$237 |
$4,541.27 |
1.0× |
| MRI abdomen w/o contrast (74181) |
$237 |
$5,320.33 |
1.0× |
| MRI any jt lower extrem w/contrast material (73722) |
$781 |
$8,061.38 |
1.0× |
| MRI any jt lower extrem w/o & w/contrast matrl (73723) |
$347 |
$8,866.82 |
1.0× |
| MRI any jt upper extremity w/contrast matrl (73222) |
$781 |
$8,639.65 |
1.0× |
| MRI Breast W/O Contrast Bilateral (77047) |
$237 |
$1,238.44 |
1.0× |
| MRI cervical spine w contrast (72142) |
$347 |
$5,267.55 |
1.0× |
| MRI cervical spine w/o cont (72141) |
$237 |
$5,479.81 |
1.0× |
| MRI lower extrem oth/thn jt w/contrast matrl (73719) |
$347 |
$5,262.96 |
1.0× |
| MRI lower extrem oth/thn jt w/o & w/contr matr (73720) |
$347 |
$9,445.10 |
1.0× |
| MRI lower extrem oth/thn jt w/o contr matrl (73718) |
$237 |
$6,806.16 |
1.0× |
| MRI lumbar spine w contrast (72149) |
$347 |
$3,644.03 |
1.0× |
| Mri Neck Spine W/O & W/Dye (72156) |
$347 |
$9,482.96 |
1.0× |
| MRI orbit face &/neck w/o contrast (70540) |
$237 |
$2,472.57 |
1.0× |
| Mri Orbt/Fac/Nck W/O &W/Dye (70543) |
$347 |
$5,765.51 |
1.0× |
| MRI pelvis w/o & w contrast (72197) |
$347 |
$6,849.77 |
1.0× |
| MRI pelvis w/o contrast (72195) |
$237 |
$5,241.16 |
1.0× |
| MRI thoracic spine w/o contrast (72146) |
$237 |
$5,388.01 |
1.0× |
| MRI upper extremity oth than jt w/o contr matrl (73218) |
$237 |
$6,302.47 |
1.0× |
| Mri Uppr Extremity W/O&W/Dye (73220) |
$347 |
$3,904.47 |
1.0× |
| MRI, abdomen, combo (74183) |
$347 |
$7,197.41 |
1.0× |
| MRI, dorsal spine combo (72157) |
$347 |
$7,792.90 |
1.0× |
| MRI, dorsal spine contrast (72147) |
$347 |
$3,644.03 |
1.0× |
| MRI, joint upper extrem (73221) |
$237 |
$7,132.01 |
1.0× |
| MRI, joint upper extrem combo (73223) |
$347 |
$8,705.05 |
1.0× |
| MRI, lumbar spine combo (72158) |
$347 |
$7,501.47 |
1.0× |
| Myocardial Imaging Infarct Avid Planar Qual/Quan (78466) |
$398 |
$1,929.76 |
1.0× |
| Myocardial Spect Multiple Studies (78452) |
$1,290 |
$7,670.95 |
1.0× |
| N-invas est c ffr sw aly CTA (75580) |
$855 |
$4,980.90 |
1.0× |
| Neck soft tissue (70360) |
$86 |
$713.66 |
1.0× |
| Parathyroid Planar Imaging (78070) |
$398 |
$2,447.71 |
1.0× |
| Pelvis 1 or 2 views (72170) |
$104 |
$735.46 |
1.0× |
| Prq Transhepatc Portograpy Hemodyn Eval Rs&I (75885) |
$3,147 |
$9,639 |
1.0× |
| Pulmonary Perfusion Imaging Particulate (78580) |
$398 |
$2,153.76 |
1.0× |
| Radex Abd Compl Aqt Abd W/S/E/D Views 1 View Ch (74022) |
$104 |
$962.64 |
1.0× |
| Radex abscess/fistula/sinus tract rs&i (76080) |
$544 |
$1,815.13 |
1.0× |
| Radex Ankle Complete Minimum 3 Views (73610) |
$86 |
$994.76 |
1.0× |
| Radex Calcaneus Minimum 2 Views (73650) |
$86 |
$865.11 |
1.0× |
| Radex elbow complete minimum 3 views (73080) |
$86 |
$1,092.29 |
1.0× |
| Radex Facial Bones Complete Minimum 3 Views (70150) |
$104 |
$980.99 |
1.0× |
| Radex fingr minimum 2 views (73140) |
$86 |
$761.85 |
1.0× |
| Radex foot complete minimum 3 views (73630) |
$86 |
$994.76 |
1.0× |
| Radex Hand Minimum 3 Views (73130) |
$86 |
$1,011.98 |
1.0× |
| Radex lower extremity infant minimum 2 views (73592) |
$86 |
$774.47 |
1.0× |
| Radex Nasal Bones Complete Minimum 3 Views (70160) |
$86 |
$721.69 |
1.0× |
| Radex Ribs Unilateral 2 Views (71100) |
$86 |
$485.33 |
1.0× |
| Radex shoulder complete minimum 2 views (73030) |
$86 |
$980.99 |
1.0× |
| Radex sm int w/mlt srl imges via enteroclss tube (74251) |
$174 |
$956.61 |
1.0× |
| Radex Spine 1 View Specify Level (72020) |
$86 |
$658.58 |
1.0× |
| Radex Sternum Minimum 2 Views (71120) |
$86 |
$658.58 |
1.0× |
| Radex Temporomandble Jt Opn & Clsd Mouth Bilat (70330) |
$86 |
$1,155.39 |
1.0× |
| Radex Toe Minimum 2 Views (73660) |
$86 |
$618.43 |
1.0× |
| Radex upper extremity infant minimum 2 views (73092) |
$104 |
$686.12 |
1.0× |
| Radex Wrist Complete Minimum 3 Views (73110) |
$86 |
$1,011.98 |
1.0× |
| Radiolog exam mandible compl minimum 4 views (70110) |
$104 |
$944.27 |
1.0× |
| Radiologic exam colon single contrast study (74270) |
$174 |
$996.73 |
1.0× |
| Radiologic Exam Esophagus Double Contrast Study (74221) |
$174 |
$901.56 |
1.0× |
| Radiologic exam knee complete 4/more views (73564) |
$104 |
$1,217.35 |
1.0× |
| Radiologic Exam Small Int Single Contrast Study (74250) |
$174 |
$1,400.93 |
1.0× |
| Radiologic exam swallow function contrast study (74230) |
$174 |
$1,172.60 |
1.0× |
| Radiologic exam upr gi trc double contrast study (74246) |
$174 |
$1,024.31 |
1.0× |
| Radiologic examination femur 1 view (73551) |
$86 |
$1,354.05 |
1.0× |
| Radiologic examination femur minimum 2 views (73552) |
$86 |
$741.20 |
1.0× |
| Radiologic examination knee 1/2 views (73560) |
$86 |
$815.78 |
1.0× |
| Radiologic examination tibia & fibula 2 views (73590) |
$86 |
$876.59 |
1.0× |
| Ribs bilateral 3 views (71110) |
$104 |
$682.67 |
1.0× |
| Rp loclzj tum plnr 2+area 1+d img/1 area img>2+d (78801) |
$398 |
$2,103.45 |
1.0× |
| Rp Loclzj Tum Spect 1 Area Single Day Imaging (78803) |
$541 |
$6,764.65 |
1.0× |
| Rp loclzj tum spect CT 2area 1d img/1 ar img>2+d (78832) |
$1,425 |
$8,258.61 |
1.0× |
| Scapula (73010) |
$104 |
$1,332.09 |
1.0× |
| Screening Digital Breast Tomosynthesis Bi (77063) |
$21 |
$91.79 |
0.9× |
| Shoulder 1 view (73020) |
$86 |
$993.62 |
1.0× |
| Shoulder Arthrography (73040) |
$347 |
$1,274.73 |
1.0× |
| Skull less than 4 views (70250) |
$104 |
$837.59 |
1.0× |
| Thoracic spine 2 views (72070) |
$104 |
$423.37 |
1.0× |
| Thoracic spine 3 views (72072) |
$104 |
$909.86 |
1.0× |
| Thyroid Uptake W/Blood Flow Sngle/Mult Quan Meas (78014) |
$398 |
$2,550.42 |
1.0× |
| Ultrasound Breast Limited (76642) |
$86 |
$464.11 |
1.0× |
| Ultrasound Exam Aaa Screen (76706) |
$104 |
$555.64 |
1.0× |
| Ultrasound, abdomen limited (76705) |
$104 |
$1,717.61 |
1.0× |
| Unlisted us procedure (76999) |
$86 |
$451.35 |
1.0× |
| Upper gi w/o kub (74240) |
$174 |
$1,682.03 |
1.0× |
| Us breast unilateral complete (76641) |
$104 |
$1,238.01 |
1.0× |
| Us chest (76604) |
$104 |
$874.28 |
1.0× |
| Us exam, pelvic, limited (76857) |
$104 |
$1,006.24 |
1.0× |
| Us kidney transplant (76776) |
$104 |
$1,155.39 |
1.0× |
| Us lmtd joint/oth nonvasc xtr strux r-t w/img (76882) |
$104 |
$1,014.27 |
1.0× |
| Us ob limited 1 or more fetuses (76815) |
$104 |
$1,137.04 |
1.0× |
| Us ob transvaginal (76817) |
$104 |
$1,112.95 |
1.0× |
| Us pelvic non ob complete (76856) |
$104 |
$1,559.27 |
1.0× |
| Us pg uter img f&mat 14 wk tabdl 1/1st gestation (76801) |
$104 |
$1,688.92 |
1.0× |
| Us preg uterus real time f/u trnsabdl per fetus (76816) |
$104 |
$1,023.45 |
1.0× |
| Us retroperitoneal complete (76770) |
$104 |
$1,680.89 |
1.0× |
| Us retroperitoneal limited (76775) |
$104 |
$1,251.78 |
1.0× |
| Us scrotum and contents (76870) |
$104 |
$1,481.25 |
1.0× |
| Us thyroid (76536) |
$104 |
$1,717.61 |
1.0× |
| Vein X-Ray Chest (75827) |
$1,568 |
$2,262.60 |
1.0× |
| Venography caval inferior serialography rs&i (75825) |
$3,147 |
$9,095.15 |
1.0× |
| Venography extremity bilateral rs&i (75822) |
$1,568 |
$3,990.53 |
1.0× |
| Venography extremity unilateral rs&i (75820) |
$1,568 |
$2,262.60 |
1.0× |
| Wrist 2 views (73100) |
$86 |
$865.11 |
1.0× |
| X-Ray Ac Jts - Xr Acromioclavicular Joints Bilateral (73050) |
$86 |
$712.51 |
1.0× |
| X-ray antegrade pyelogram tube (74425) |
$347 |
$1,954.33 |
1.0× |
| X-Ray Aorta Leg Arteries (75630) |
$3,147 |
$9,095.15 |
1.0× |
| X-Ray Bend Only L-S Spine (72120) |
$104 |
$753.83 |
1.0× |
| X-Ray Elbow 2 Vw - Xr Elbow 1-2 Views Right (73070) |
$86 |
$906.42 |
1.0× |
| X-Ray Exam Breast Specimen (76098) |
$544 |
$2,735.32 |
1.0× |
| X-Ray Exam Entire Spi 1 Vw (72081) |
$86 |
$460.85 |
1.0× |
| X-Ray Exam Entire Spi 2/3 Vw (72082) |
$104 |
$985.59 |
1.0× |
| X-Ray Exam Hip Uni 1 View (73501) |
$86 |
$1,194.41 |
1.0× |
| X-Ray Exam Hip Uni 2-3 Views (73502) |
$86 |
$699.90 |
1.0× |
| X-Ray Exam Hips Bi 2 Views (73521) |
$104 |
$607.50 |
1.0× |
| X-Ray Exam Hips Bi 3-4 Views (73522) |
$104 |
$607.50 |
1.0× |
| X-Ray Exam Hips Bi 5/> Views (73523) |
$104 |
$1,374.55 |
1.0× |
| X-Ray Exam L-S Spine Bending (72114) |
$104 |
$1,677.44 |
1.0× |
| X-Ray Exam Neck Spine 2-3 Vw (72040) |
$86 |
$984.44 |
1.0× |
| X-Ray Exam Neck Spine 6/>Vws (72052) |
$104 |
$1,295.37 |
1.0× |
| X-Ray Exam Unilat Ribs/Chest (71101) |
$104 |
$1,165.71 |
1.0× |
| X-ray eye for foreign body (70030) |
$86 |
$813.47 |
1.0× |
| X-ray humerus (73060) |
$86 |
$983.30 |
1.0× |
| X-ray IV pyelogram (ivp) (74400) |
$174 |
$1,171.46 |
1.0× |
| X-Ray Knee Bilat Standing - Xr Knees Anteroposterior Standing Bilat (73565) |
$86 |
$851.34 |
1.0× |
| X-Ray Lumbar Spine 2/3 Vw - Xr Lumbar Spine 2-3 Views (72100) |
$104 |
$1,225.38 |
1.0× |
| X-Ray Ribs, Chest 4+ Vw - Xr Ribs 3 Vws Bil W/ Chest Posteroanterior (71111) |
$104 |
$1,181.79 |
1.0× |
| X-Ray Sacroiliac Jts 3+ Vw - Xr Sacroiliac Joints 3+ Views (72202) |
$104 |
$686.12 |
1.0× |
| X-Ray Sacrum/Coccyx 2+ Vw - Xr Sacrum Coccyx 2+ Views (72220) |
$86 |
$1,001.64 |
1.0× |
| X-Ray Sinuses 3+ Vw - Xr Paranasal Sinuses 3+ Views (70220) |
$86 |
$1,202.43 |
1.0× |
| X-Ray Skull 4+ Vw - Xr Skull Complete 4+ Views (70260) |
$104 |
$894.95 |
1.0× |
| X-Ray Urinary Tract Exam With Contrast Material (74420) |
$347 |
$2,735.32 |
1.0× |
| X-Rays Bone Length Studies (77073) |
$104 |
$458.95 |
1.0× |
| X-Rays Bone Survey Complete (77075) |
$104 |
$1,387.16 |
1.0× |
| Xr c-spine 4 or 5 views (72050) |
$104 |
$1,348.15 |
1.0× |
| Xr facial bones less than 3 views (70140) |
$86 |
$451.35 |
1.0× |
| Xr orbits complete 4 views (70200) |
$104 |
$876.59 |
1.0× |