| Abdomen 1 View (74018) |
$174 |
$174 |
2.0× |
| Abdomen 2 views (74019) |
$342 |
$342 |
3.2× |
| Acute Gastrointestinal Blood Loss Imaging (78278) |
$1,860 |
$1,860 |
4.6× |
| Ankle 2 views (73600) |
$246 |
$246 |
2.8× |
| Bone Imaging 3 Phase (78315) |
$1,836 |
$1,836 |
4.5× |
| Bone Imaging Limited Area (78300) |
$930 |
$930 |
2.3× |
| Bone Imaging Multiple Areas (78305) |
$1,176 |
$1,176 |
2.9× |
| Bone Imaging Whole Body (78306) |
$1,302 |
$1,302 |
3.2× |
| Brain Flow Imaging Only (78610) |
$990 |
$990 |
1.8× |
| Brain Imaging Min 4 Static Views W Vascular Flow (78606) |
$1,854 |
$1,854 |
3.3× |
| Brain Imaging Minimum 4 Static Views (78605) |
$1,068 |
$1,068 |
1.9× |
| Cat Scan Follow-Up Study (76380) |
$996 |
$996 |
11.2× |
| Chest 1 view (71045) |
$150 |
$150 |
1.7× |
| Chest 2 views (71046) |
$186 |
$186 |
2.1× |
| Chest 3 views (71047) |
$210 |
$210 |
2.4× |
| Chest 4 or more views (71048) |
$246 |
$246 |
2.3× |
| Clavicle complete (73000) |
$264 |
$264 |
3.0× |
| Contrast X-Ray Bladder (74430) |
$282 |
$282 |
0.8× |
| CT abdomen and pelvis without and with contrast (74178) |
$3,480 |
$3,480 |
9.8× |
| CT abdomen and pelvis without contrast (74176) |
$3,066 |
$3,066 |
12.6× |
| CT abdomen w contrast (74160) |
$1,668 |
$1,668 |
9.3× |
| CT abdomen w wo contrast (74170) |
$2,508 |
$2,508 |
14.0× |
| CT abdomen w/o contrast (74150) |
$1,254 |
$1,254 |
11.7× |
| CT Angio Abdomen and Pelvis (74174) |
$2,784 |
$2,784 |
7.8× |
| CT Angio Chest (71275) |
$2,124 |
$2,124 |
11.9× |
CT Angio Head (70496) range across 2 matching MRF lines |
$246–$2,010 |
$246–$2,010 |
varies |
| CT cervical spine w/ contrast (72126) |
$1,536 |
$1,536 |
4.3× |
| CT cervical spine w/o contrast (72125) |
$1,392 |
$1,392 |
13.0× |
| CT cervical spine w/wo cont (72127) |
$1,896 |
$1,896 |
10.6× |
| CT chest w contrast (71260) |
$1,668 |
$1,668 |
9.3× |
| CT chest w/wo contrast (71270) |
$2,088 |
$2,088 |
11.7× |
| CT head/brain with contrast (70460) |
$1,284 |
$1,284 |
7.2× |
| CT head/brain without and with contrast (70470) |
$1,668 |
$1,668 |
9.3× |
| CT iac w contrast (70481) |
$1,488 |
$1,488 |
8.3× |
| CT lower ext w/o (73700) |
$1,212 |
$1,212 |
11.3× |
| CT lower extremity w/contrast material (73701) |
$1,536 |
$1,536 |
8.6× |
| CT lumbar spine w contrast (72132) |
$1,530 |
$1,530 |
4.3× |
| CT lumbar spine w/o contrast (72131) |
$1,362 |
$1,362 |
12.8× |
| CT maxillofacial w contrast (70487) |
$1,284 |
$1,284 |
7.2× |
| CT maxillofacial wo contrast (70486) |
$1,056 |
$1,056 |
9.9× |
| CT neck tissue combo (70492) |
$2,352 |
$2,352 |
13.1× |
| Ct Orbit/Ear/Fossa W/O&W/Dye (70482) |
$2,094 |
$2,094 |
11.7× |
| CT orbits w/o contrast (70480) |
$1,254 |
$1,254 |
11.7× |
| CT pelvis w&w/o contrast (72194) |
$2,316 |
$2,316 |
12.9× |
| CT pelvis w/o contrast (72192) |
$1,296 |
$1,296 |
12.1× |
| CT scan of leg combo (73702) |
$1,950 |
$1,950 |
10.9× |
| CT scans face/jaw combo (70488) |
$1,602 |
$1,602 |
8.9× |
| CT soft tissue neck w contrast (70491) |
$1,518 |
$1,518 |
8.5× |
| CT soft tissue neck w/o contrast (70490) |
$1,380 |
$1,380 |
12.9× |
| CT thoracic spine w contrast (72129) |
$1,536 |
$1,536 |
8.6× |
| CT thoracic spine w/o contrast (72128) |
$1,992 |
$1,992 |
18.6× |
| CT thoracic spine w/wo cont (72130) |
$1,908 |
$1,908 |
10.6× |
| CT thorax w/o contrast (71250) |
$1,242 |
$1,242 |
11.6× |
| CT upper ext wo (73200) |
$1,176 |
$1,176 |
11.0× |
| CT upper extremity w/o & w/contrast material (73202) |
$1,980 |
$1,980 |
11.0× |
| CT upper extremity with contrast (73201) |
$1,506 |
$1,506 |
4.2× |
Cta Abdomen (74175) range across 2 matching MRF lines |
$252–$2,172 |
$252–$2,172 |
varies |
| Dxa Bone Density Axial (77080) |
$648 |
$648 |
6.1× |
| Dxa bone density study (77085) |
$192 |
$192 |
1.8× |
| Dxa bone density study 1/>sites appendiclr skel (77081) |
$258 |
$258 |
2.9× |
| Fetal Biophys Profile W/Nst (76818) |
$714 |
$714 |
6.7× |
| Foot 2 views (73620) |
$234 |
$234 |
2.6× |
| Forearm 2 views (73090) |
$150 |
$150 |
1.7× |
| Gated Heart Planar Single (78472) |
$1,128 |
$1,128 |
2.8× |
| Hand 2 views (73120) |
$156 |
$156 |
1.5× |
| Hepatobil Syst Image W/Drug (78227) |
$2,508 |
$2,508 |
4.5× |
| Hepatobiliary System Imaging (78226) |
$1,830 |
$1,830 |
4.5× |
| Joint Survey Single View (77077) |
$114 |
$114 |
1.1× |
| K Flow/Funct Image W/O Drug (78707) |
$1,356 |
$1,356 |
2.4× |
| Kidney Imaging Morphol (78700) |
$930 |
$930 |
2.3× |
| Kidney Imaging Morphoogy W/Vascular Flow (78701) |
$1,158 |
$1,158 |
2.8× |
| Knee 3 Views (73562) |
$210 |
$210 |
2.4× |
| Liver & Spleen Imaging Static Only (78215) |
$1,056 |
$1,056 |
2.6× |
| Magnetic Image Jaw Joint (70336) |
$2,256 |
$2,256 |
9.3× |
| Meckels Divert Exam (78290) |
$1,860 |
$1,860 |
4.6× |
Mra Head W/O & W/Contrast Material (70546) range across 2 matching MRF lines |
$192–$2,838 |
$192–$2,838 |
varies |
| MRA head w/o contrast (70544) |
$1,746 |
$1,746 |
7.2× |
| Mra Neck W/O &W/Contrast Material (70549) |
$4,680 |
$4,680 |
13.1× |
| MRA neck w/o contrast (70547) |
$3,042 |
$3,042 |
12.5× |
| MRI abdomen w contrast (74182) |
$3,354 |
$3,354 |
9.4× |
| MRI abdomen w/o contrast (74181) |
$2,910 |
$2,910 |
11.9× |
| MRI cervical spine w contrast (72142) |
$2,508 |
$2,508 |
7.0× |
| MRI cervical spine w/o cont (72141) |
$2,088 |
$2,088 |
8.6× |
| MRI chest w/o contrast (71550) |
$3,114 |
$3,114 |
12.8× |
| MRI lower extrem oth/thn jt w/o & w/contr matr (73720) |
$3,648 |
$3,648 |
10.2× |
| MRI lower extrem oth/thn jt w/o contr matrl (73718) |
$2,712 |
$2,712 |
11.1× |
| MRI lumbar spine w contrast (72149) |
$2,490 |
$2,490 |
7.0× |
| Mri Neck Spine W/O & W/Dye (72156) |
$4,164 |
$4,164 |
11.7× |
| MRI orbit face &/neck w/o contrast (70540) |
$2,670 |
$2,670 |
11.0× |
| Mri Orbt/Fac/Nck W/O &W/Dye (70543) |
$3,618 |
$3,618 |
10.2× |
| MRI pelvis w contrast (72196) |
$2,964 |
$2,964 |
8.3× |
| MRI pelvis w/o & w contrast (72197) |
$3,660 |
$3,660 |
10.3× |
| MRI pelvis w/o contrast (72195) |
$2,754 |
$2,754 |
11.3× |
| MRI thoracic spine w/o contrast (72146) |
$2,892 |
$2,892 |
11.9× |
| MRI upper extremity oth than jt w/o contr matrl (73218) |
$2,976 |
$2,976 |
12.2× |
| Mri Uppr Extremity W/O&W/Dye (73220) |
$3,690 |
$3,690 |
10.4× |
| MRI, abdomen, combo (74183) |
$3,660 |
$3,660 |
10.3× |
| MRI, dorsal spine combo (72157) |
$3,366 |
$3,366 |
9.4× |
| MRI, dorsal spine contrast (72147) |
$2,196 |
$2,196 |
6.2× |
| MRI, joint upper extrem (73221) |
$2,370 |
$2,370 |
9.7× |
| MRI, joint upper extrem combo (73223) |
$3,618 |
$3,618 |
10.2× |
| MRI, lumbar spine combo (72158) |
$4,176 |
$4,176 |
11.7× |
| Myocardial Spect Multiple Studies (78452) |
$2,508 |
$2,508 |
1.9× |
| Neck soft tissue (70360) |
$120 |
$120 |
1.3× |
| Pelvis 1 or 2 views (72170) |
$168 |
$168 |
1.6× |
| Pulmonary Perfusion Imaging Particulate (78580) |
$1,260 |
$1,260 |
3.1× |
| Radex Abd Compl Aqt Abd W/S/E/D Views 1 View Ch (74022) |
$300 |
$300 |
2.8× |
| Radex Ankle Complete Minimum 3 Views (73610) |
$192 |
$192 |
2.2× |
| Radex Calcaneus Minimum 2 Views (73650) |
$192 |
$192 |
2.2× |
| Radex elbow complete minimum 3 views (73080) |
$174 |
$174 |
2.0× |
| Radex Facial Bones Complete Minimum 3 Views (70150) |
$168 |
$168 |
1.6× |
| Radex fingr minimum 2 views (73140) |
$144 |
$144 |
1.6× |
| Radex foot complete minimum 3 views (73630) |
$174 |
$174 |
2.0× |
| Radex Hand Minimum 3 Views (73130) |
$174 |
$174 |
2.0× |
| Radex Mastoids Compl Minimum 3 Views PR Side (70130) |
$222 |
$222 |
2.1× |
| Radex Nasal Bones Complete Minimum 3 Views (70160) |
$144 |
$144 |
1.6× |
| Radex Ribs Unilateral 2 Views (71100) |
$180 |
$180 |
2.0× |
| Radex shoulder complete minimum 2 views (73030) |
$198 |
$198 |
2.2× |
| Radex Sinuses Paransl < 3 Views (70210) |
$180 |
$180 |
2.0× |
| Radex Spine 1 View Specify Level (72020) |
$150 |
$150 |
1.7× |
| Radex Sternum Minimum 2 Views (71120) |
$114 |
$114 |
1.3× |
| Radex Temporomandble Jt Opn & Clsd Mouth Bilat (70330) |
$204 |
$204 |
2.3× |
| Radex Toe Minimum 2 Views (73660) |
$174 |
$174 |
2.0× |
| Radex Wrist Complete Minimum 3 Views (73110) |
$162 |
$162 |
1.8× |
| Radiolog exam mandible compl minimum 4 views (70110) |
$150 |
$150 |
1.4× |
| Radiologic Exam Abdomen 3+ Views - Xr Abdomen 3+ Views (74021) |
$360 |
$360 |
3.4× |
| Radiologic exam knee complete 4/more views (73564) |
$210 |
$210 |
2.0× |
| Radiologic examination femur 1 view (73551) |
$114 |
$114 |
1.3× |
| Radiologic examination femur minimum 2 views (73552) |
$168 |
$168 |
1.9× |
| Radiologic examination knee 1/2 views (73560) |
$174 |
$174 |
2.0× |
| Radiologic examination tibia & fibula 2 views (73590) |
$210 |
$210 |
2.4× |
| Ribs bilateral 3 views (71110) |
$258 |
$258 |
2.4× |
| Scapula (73010) |
$126 |
$126 |
1.2× |
| Screening Digital Breast Tomosynthesis Bi (77063) |
$138 |
$138 |
5.9× |
| Shoulder 1 view (73020) |
$216 |
$216 |
2.4× |
| Skull less than 4 views (70250) |
$210 |
$210 |
2.0× |
| Testicular Imaging W/Flow (78761) |
$1,074 |
$1,074 |
2.6× |
| Thoracic spine 2 views (72070) |
$168 |
$168 |
1.6× |
| Thoracic spine 3 views (72072) |
$222 |
$222 |
2.1× |
| Thoracolumbar 2 views (72080) |
$288 |
$288 |
3.2× |
| Ultrasound Breast Limited (76642) |
$414 |
$414 |
4.7× |
| Ultrasound, abdomen limited (76705) |
$414 |
$414 |
3.9× |
| Unlisted us procedure (76999) |
$186 |
$186 |
2.1× |
| Us breast unilateral complete (76641) |
$570 |
$570 |
5.3× |
| Us exam, pelvic, limited (76857) |
$510 |
$510 |
4.8× |
| Us lmtd joint/oth nonvasc xtr strux r-t w/img (76882) |
$432 |
$432 |
4.0× |
| Us ob limited 1 or more fetuses (76815) |
$348 |
$348 |
3.3× |
| Us ob transvaginal (76817) |
$354 |
$354 |
3.3× |
| Us pelvic non ob complete (76856) |
$594 |
$594 |
5.6× |
| Us pg uter img f&mat 14 wk tabdl 1/1st gestation (76801) |
$438 |
$438 |
4.1× |
| Us retroperitoneal complete (76770) |
$612 |
$612 |
5.7× |
| Us retroperitoneal limited (76775) |
$528 |
$528 |
4.9× |
| Us scrotum and contents (76870) |
$438 |
$438 |
4.1× |
| Us thyroid (76536) |
$528 |
$528 |
4.9× |
| Venography extremity bilateral rs&i (75822) |
$510 |
$510 |
0.3× |
| Venography extremity unilateral rs&i (75820) |
$486 |
$486 |
0.3× |
| Venous Thrombosis Imaging Venogram Bilateral (78458) |
$834 |
$834 |
2.0× |
| Vertebral fracture assessment via dxa (77086) |
$132 |
$132 |
1.5× |
| Wrist 2 views (73100) |
$168 |
$168 |
1.9× |
| X-Ray Ac Jts - Xr Acromioclavicular Joints Bilateral (73050) |
$144 |
$144 |
1.6× |
| X-Ray Elbow 2 Vw - Xr Elbow 1-2 Views Right (73070) |
$168 |
$168 |
1.9× |
| X-Ray Exam Entire Spi 1 Vw (72081) |
$168 |
$168 |
1.9× |
| X-Ray Exam Hip Uni 1 View (73501) |
$168 |
$168 |
1.9× |
| X-Ray Exam Hip Uni 2-3 Views (73502) |
$168 |
$168 |
1.9× |
| X-Ray Exam Hips Bi 2 Views (73521) |
$282 |
$282 |
2.6× |
| X-Ray Exam L-S Spine Bending (72114) |
$270 |
$270 |
2.5× |
| X-Ray Exam Neck Spine 2-3 Vw (72040) |
$192 |
$192 |
2.2× |
| X-Ray Exam Neck Spine 6/>Vws (72052) |
$432 |
$432 |
4.0× |
| X-Ray Exam Unilat Ribs/Chest (71101) |
$180 |
$180 |
1.7× |
| X-ray eye for foreign body (70030) |
$162 |
$162 |
1.8× |
| X-ray humerus (73060) |
$210 |
$210 |
2.4× |
| X-ray IV pyelogram (ivp) (74400) |
$510 |
$510 |
2.8× |
| X-Ray Jaw <4 Vw - Xr Mandible < 4 Views (70100) |
$144 |
$144 |
1.6× |
| X-Ray Knee Bilat Standing - Xr Knees Anteroposterior Standing Bilat (73565) |
$210 |
$210 |
2.4× |
| X-Ray Lumbar Spine 2/3 Vw - Xr Lumbar Spine 2-3 Views (72100) |
$216 |
$216 |
2.0× |
| X-ray nose-rectum child f.b. (76010) |
$102 |
$102 |
1.1× |
| X-Ray Ribs, Chest 4+ Vw - Xr Ribs 3 Vws Bil W/ Chest Posteroanterior (71111) |
$186 |
$186 |
1.7× |
| X-Ray Sacroiliac Jts <3 Vw - Xr Sacroiliac Joints 1-2 Views (72200) |
$108 |
$108 |
1.0× |
| X-Ray Sacrum/Coccyx 2+ Vw - Xr Sacrum Coccyx 2+ Views (72220) |
$222 |
$222 |
2.5× |
| X-Ray Sinuses 3+ Vw - Xr Paranasal Sinuses 3+ Views (70220) |
$288 |
$288 |
3.2× |
| X-Ray Skull 4+ Vw - Xr Skull Complete 4+ Views (70260) |
$168 |
$168 |
1.6× |
| X-Ray Tmj Unilat (70328) |
$126 |
$126 |
1.4× |
| Xr c-spine 4 or 5 views (72050) |
$270 |
$270 |
2.5× |
| Xr facial bones less than 3 views (70140) |
$114 |
$114 |
1.3× |
| XR Mastoids < 3 Views Bilateral (70120) |
$150 |
$150 |
1.4× |