| Abdomen 1 View (74018) |
$205.20 |
$342 |
2.4× |
| Abdomen 2 views (74019) |
$252.60 |
$421 |
2.4× |
| Acute Gastrointestinal Blood Loss Imaging (78278) |
$1,273.20 |
$2,122 |
3.2× |
| Ankle 2 views (73600) |
$150 |
$250 |
1.7× |
| Bone age studies (77072) |
$199.20 |
$332 |
1.9× |
| Bone Imaging 3 Phase (78315) |
$1,492.80 |
$2,488 |
3.8× |
| Bone Imaging Limited Area (78300) |
$961.80 |
$1,603 |
2.4× |
| Bone Imaging Multiple Areas (78305) |
$1,191 |
$1,985 |
3.0× |
| Bone Imaging Whole Body (78306) |
$1,435.20 |
$2,392 |
3.6× |
| Bone survey infant (77076) |
$408.60 |
$681 |
3.9× |
| Brain Image W/Flow < 4 Views (78601) |
$1,384.80 |
$2,308 |
3.5× |
| Cat Scan Follow-Up Study (76380) |
$584.40 |
$974 |
6.7× |
| Chest 1 view (71045) |
$181.80 |
$303 |
2.1× |
| Chest 2 views (71046) |
$199.80 |
$333 |
2.3× |
| Chest 3 views (71047) |
$222 |
$370 |
2.6× |
| Chest 4 or more views (71048) |
$351.60 |
$586 |
3.4× |
| Clavicle complete (73000) |
$208.80 |
$348 |
2.4× |
| Computed Tomography Thorax Lw Dose Lng Ca Scr C- (71271) |
$2,171.40 |
$3,619 |
20.9× |
| Contrast X-Ray Bladder (74430) |
$319.20 |
$532 |
0.9× |
| CT abdomen and pelvis without and with contrast (74178) |
$4,984.20 |
$8,307 |
14.4× |
| CT abdomen and pelvis without contrast (74176) |
$4,109.40 |
$6,849 |
17.3× |
| CT abdomen w contrast (74160) |
$2,305.20 |
$3,842 |
13.2× |
| CT abdomen w wo contrast (74170) |
$2,533.20 |
$4,222 |
14.5× |
| CT abdomen w/o contrast (74150) |
$2,052 |
$3,420 |
19.7× |
| CT Angio Abdomen and Pelvis (74174) |
$4,331.40 |
$7,219 |
12.5× |
| CT Angio Chest (71275) |
$2,746.80 |
$4,578 |
15.7× |
| CT Angio Head (70496) |
$3,035.40 |
$5,059 |
17.4× |
| Ct Angio Lwr Extr W/O&W/Dye (73706) |
$1,366.20 |
$2,277 |
7.8× |
| CT Angio Neck (70498) |
$2,917.20 |
$4,862 |
16.7× |
| Ct Angio Upr Extrm W/O&W/Dye (73206) |
$1,807.80 |
$3,013 |
10.4× |
| CT cervical spine w/ contrast (72126) |
$1,893.60 |
$3,156 |
5.5× |
| CT cervical spine w/o contrast (72125) |
$1,675.80 |
$2,793 |
16.1× |
| CT cervical spine w/wo cont (72127) |
$2,346 |
$3,910 |
13.4× |
| CT chest w contrast (71260) |
$2,046.60 |
$3,411 |
11.7× |
| CT chest w/wo contrast (71270) |
$2,046.60 |
$3,411 |
11.7× |
| CT head/brain with contrast (70460) |
$1,597.80 |
$2,663 |
9.2× |
| CT head/brain without and with contrast (70470) |
$1,792.20 |
$2,987 |
10.3× |
| CT iac w contrast (70481) |
$1,854.60 |
$3,091 |
10.6× |
| CT l-spine w&w/o contrast (72133) |
$2,358 |
$3,930 |
13.5× |
| CT lower ext w/o (73700) |
$1,632.60 |
$2,721 |
15.7× |
| CT lower extremity w/contrast material (73701) |
$2,791.80 |
$4,653 |
16.0× |
| CT lumbar spine w contrast (72132) |
$1,794 |
$2,990 |
5.2× |
| CT lumbar spine w/o contrast (72131) |
$1,446.60 |
$2,411 |
13.9× |
| CT maxillofacial w contrast (70487) |
$2,042.40 |
$3,404 |
11.7× |
| CT maxillofacial wo contrast (70486) |
$1,761 |
$2,935 |
16.9× |
| CT neck tissue combo (70492) |
$2,726.40 |
$4,544 |
15.6× |
| Ct Orbit/Ear/Fossa W/O&W/Dye (70482) |
$2,112.60 |
$3,521 |
12.1× |
| CT orbits w/o contrast (70480) |
$1,717.20 |
$2,862 |
16.5× |
| CT pelvis w&w/o contrast (72194) |
$1,960.20 |
$3,267 |
11.2× |
| CT pelvis w/o contrast (72192) |
$1,647 |
$2,745 |
15.8× |
| CT scan of leg combo (73702) |
$1,828.80 |
$3,048 |
10.5× |
| CT scans face/jaw combo (70488) |
$2,341.80 |
$3,903 |
13.4× |
| CT soft tissue neck w contrast (70491) |
$2,330.40 |
$3,884 |
13.4× |
| CT soft tissue neck w/o contrast (70490) |
$2,074.20 |
$3,457 |
19.9× |
| CT thoracic spine w contrast (72129) |
$1,491.60 |
$2,486 |
8.5× |
| CT thoracic spine w/o contrast (72128) |
$1,393.80 |
$2,323 |
13.4× |
| CT thoracic spine w/wo cont (72130) |
$1,547.40 |
$2,579 |
8.9× |
| CT thorax w/o contrast (71250) |
$1,650.60 |
$2,751 |
15.9× |
| CT upper ext wo (73200) |
$1,443.60 |
$2,406 |
13.9× |
| CT upper extremity w/o & w/contrast material (73202) |
$2,136.60 |
$3,561 |
12.2× |
| CT upper extremity with contrast (73201) |
$1,833.60 |
$3,056 |
5.3× |
| Cta Abdl Aorta&Bi Iliofem W/Contrast&Postp (75635) |
$2,152.20 |
$3,587 |
12.3× |
| Cta Abdomen (74175) |
$2,382 |
$3,970 |
13.6× |
| Dxa Bone Density Axial (77080) |
$270.60 |
$451 |
2.6× |
| Dxa bone density study 1/>sites appendiclr skel (77081) |
$170.40 |
$284 |
2.0× |
| Esophagram (74220) |
$288 |
$480 |
1.7× |
| Fetal Biophys Profile W/Nst (76818) |
$485.40 |
$809 |
4.7× |
| Fetal Biophysical Profile W/O Non-Stress Testing (76819) |
$382.20 |
$637 |
3.7× |
| Fluoroscopy up to 1 hr (76000) |
$259.80 |
$433 |
1.1× |
| Foot 2 views (73620) |
$174 |
$290 |
2.0× |
| Forearm 2 views (73090) |
$227.40 |
$379 |
2.6× |
| Gastric emptying imaging study (78264) |
$1,221 |
$2,035 |
3.1× |
| Gastric Emptyng Imag Std W/Sm Bwl Transit (78265) |
$1,972.20 |
$3,287 |
5.0× |
| Gated Heart Planar Single (78472) |
$1,354.80 |
$2,258 |
3.4× |
| Gstrc Emptng Imag Std W/Sm Bwl Col Trnst Mlt Day (78266) |
$1,972.20 |
$3,287 |
3.7× |
| Hand 2 views (73120) |
$164.40 |
$274 |
1.6× |
| Hepatobil Syst Image W/Drug (78227) |
$1,563 |
$2,605 |
2.9× |
| Hepatobiliary System Imaging (78226) |
$1,356 |
$2,260 |
3.4× |
| Ht Musc Image Planar Mult (78454) |
$1,541.40 |
$2,569 |
1.2× |
| Ht Muscle Image Spect Sing (78451) |
$1,361.40 |
$2,269 |
1.1× |
| K Flow/Funct Image W/Drug (78708) |
$2,178.60 |
$3,631 |
4.0× |
| K Flow/Funct Image W/O Drug (78707) |
$1,356 |
$2,260 |
2.5× |
| Knee 3 Views (73562) |
$252.60 |
$421 |
2.9× |
| Leveen/Shunt Patency Exam (78291) |
$444 |
$740 |
1.1× |
| Liver & Spleen Imaging Static Only (78215) |
$865.20 |
$1,442 |
2.2× |
| Liver imaging static only (78201) |
$584.40 |
$974 |
1.1× |
| Liver imaging w/vascular flow (78202) |
$639.60 |
$1,066 |
1.2× |
| Lung Ventilat&Perfus Imaging (78582) |
$1,881.60 |
$3,136 |
3.5× |
| Magnetic Image Jaw Joint (70336) |
$1,813.20 |
$3,022 |
7.6× |
| Meckels Divert Exam (78290) |
$1,223.40 |
$2,039 |
3.1× |
| Mra Head W/O & W/Contrast Material (70546) |
$2,275.20 |
$3,792 |
6.6× |
| MRA head w/o contrast (70544) |
$2,166.60 |
$3,611 |
9.1× |
| MRA head with contrast (70545) |
$2,794.80 |
$4,658 |
8.1× |
| MRA neck w contrast (70548) |
$2,167.20 |
$3,612 |
6.2× |
| Mra Neck W/O &W/Contrast Material (70549) |
$3,009.60 |
$5,016 |
8.7× |
| MRA neck w/o contrast (70547) |
$1,866 |
$3,110 |
7.9× |
| MRI abdomen w contrast (74182) |
$3,081 |
$5,135 |
8.9× |
| MRI abdomen w/o contrast (74181) |
$2,152.80 |
$3,588 |
9.1× |
| MRI any jt lower extrem w/contrast material (73722) |
$2,476.20 |
$4,127 |
3.2× |
| MRI any jt lower extrem w/o & w/contrast matrl (73723) |
$3,078.60 |
$5,131 |
8.9× |
| MRI any jt upper extremity w/contrast matrl (73222) |
$2,275.20 |
$3,792 |
2.9× |
| MRI cervical spine w contrast (72142) |
$3,121.20 |
$5,202 |
9.0× |
| MRI cervical spine w/o cont (72141) |
$2,787 |
$4,645 |
11.7× |
| MRI chest wo w contrast (71552) |
$3,136.80 |
$5,228 |
9.0× |
| MRI lower extrem oth/thn jt w/contrast matrl (73719) |
$2,277 |
$3,795 |
6.6× |
| MRI lower extrem oth/thn jt w/o & w/contr matr (73720) |
$3,118.80 |
$5,198 |
9.0× |
| MRI lower extrem oth/thn jt w/o contr matrl (73718) |
$2,152.20 |
$3,587 |
9.1× |
| MRI lumbar spine w contrast (72149) |
$2,946.60 |
$4,911 |
8.5× |
| Mri Neck Spine W/O & W/Dye (72156) |
$3,846 |
$6,410 |
11.1× |
| MRI orbit face &/neck w/o contrast (70540) |
$1,800 |
$3,000 |
7.6× |
| MRI orbit face neck w contrast (70542) |
$1,942.80 |
$3,238 |
5.6× |
| Mri Orbt/Fac/Nck W/O &W/Dye (70543) |
$2,323.80 |
$3,873 |
6.7× |
| MRI pelvis w contrast (72196) |
$2,699.40 |
$4,499 |
7.8× |
| MRI pelvis w/o & w contrast (72197) |
$2,811.60 |
$4,686 |
8.1× |
| MRI pelvis w/o contrast (72195) |
$2,305.80 |
$3,843 |
9.7× |
| MRI thoracic spine w/o contrast (72146) |
$2,127 |
$3,545 |
9.0× |
| MRI upper extremity oth than jt w/contr matrl (73219) |
$1,797 |
$2,995 |
5.2× |
| MRI upper extremity oth than jt w/o contr matrl (73218) |
$1,704 |
$2,840 |
7.2× |
| Mri Uppr Extremity W/O&W/Dye (73220) |
$2,452.80 |
$4,088 |
7.1× |
| MRI, abdomen, combo (74183) |
$3,712.20 |
$6,187 |
10.7× |
| MRI, dorsal spine combo (72157) |
$3,731.40 |
$6,219 |
10.7× |
| MRI, dorsal spine contrast (72147) |
$3,246 |
$5,410 |
9.4× |
| MRI, joint upper extrem (73221) |
$2,230.80 |
$3,718 |
9.4× |
| MRI, joint upper extrem combo (73223) |
$3,078.60 |
$5,131 |
8.9× |
| MRI, lumbar spine combo (72158) |
$3,986.40 |
$6,644 |
11.5× |
| Myocardial Imaging Infarct Avid Planar Qual/Quan (78466) |
$568.20 |
$947 |
1.4× |
| Myocardial Spect Multiple Studies (78452) |
$2,568.60 |
$4,281 |
2.0× |
| Neck soft tissue (70360) |
$261 |
$435 |
3.0× |
| Parathyroid Planar Imaging (78070) |
$1,702.80 |
$2,838 |
4.3× |
| Pelvis 1 or 2 views (72170) |
$150.60 |
$251 |
1.4× |
| Pulmonary Perfusion Imaging Particulate (78580) |
$937.80 |
$1,563 |
2.4× |
| Radex Abd Compl Aqt Abd W/S/E/D Views 1 View Ch (74022) |
$359.40 |
$599 |
3.5× |
| Radex Ankle Complete Minimum 3 Views (73610) |
$220.20 |
$367 |
2.5× |
| Radex Calcaneus Minimum 2 Views (73650) |
$156.60 |
$261 |
1.8× |
| Radex elbow complete minimum 3 views (73080) |
$210 |
$350 |
2.4× |
| Radex Facial Bones Complete Minimum 3 Views (70150) |
$384.60 |
$641 |
3.7× |
| Radex fingr minimum 2 views (73140) |
$173.40 |
$289 |
2.0× |
| Radex foot complete minimum 3 views (73630) |
$241.80 |
$403 |
2.8× |
| Radex Hand Minimum 3 Views (73130) |
$234.60 |
$391 |
2.7× |
| Radex lower extremity infant minimum 2 views (73592) |
$154.80 |
$258 |
1.8× |
| Radex Mastoids Compl Minimum 3 Views PR Side (70130) |
$226.20 |
$377 |
2.2× |
| Radex Nasal Bones Complete Minimum 3 Views (70160) |
$189 |
$315 |
2.2× |
| Radex Ribs Unilateral 2 Views (71100) |
$190.80 |
$318 |
2.2× |
| Radex shoulder complete minimum 2 views (73030) |
$262.20 |
$437 |
3.0× |
| Radex Sinuses Paransl < 3 Views (70210) |
$131.40 |
$219 |
1.5× |
| Radex Spine 1 View Specify Level (72020) |
$150 |
$250 |
1.7× |
| Radex Sternum Minimum 2 Views (71120) |
$221.40 |
$369 |
2.6× |
| Radex Temporomandble Jt Opn & Clsd Mouth Bilat (70330) |
$298.20 |
$497 |
3.4× |
| Radex Toe Minimum 2 Views (73660) |
$173.40 |
$289 |
2.0× |
| Radex Wrist Complete Minimum 3 Views (73110) |
$253.20 |
$422 |
2.9× |
| Radiolog exam mandible compl minimum 4 views (70110) |
$234 |
$390 |
2.2× |
| Radiologic Exam Abdomen 3+ Views - Xr Abdomen 3+ Views (74021) |
$252.60 |
$421 |
2.4× |
| Radiologic exam colon double contrast study (74280) |
$712.80 |
$1,188 |
4.1× |
| Radiologic exam colon single contrast study (74270) |
$599.40 |
$999 |
3.4× |
| Radiologic exam knee complete 4/more views (73564) |
$365.40 |
$609 |
3.5× |
| Radiologic exam pelvis compl minimum 3 views (72190) |
$292.20 |
$487 |
2.8× |
| Radiologic Exam Small Int Single Contrast Study (74250) |
$380.40 |
$634 |
2.2× |
| Radiologic exam swallow function contrast study (74230) |
$366.60 |
$611 |
2.1× |
| Radiologic exam upr gi trc double contrast study (74246) |
$469.20 |
$782 |
2.7× |
| Radiologic examination femur 1 view (73551) |
$129.60 |
$216 |
1.5× |
| Radiologic examination femur minimum 2 views (73552) |
$393 |
$655 |
4.5× |
| Radiologic examination knee 1/2 views (73560) |
$173.40 |
$289 |
2.0× |
| Radiologic Examination Osseous Survey Limited (77074) |
$288 |
$480 |
2.8× |
| Radiologic examination tibia & fibula 2 views (73590) |
$253.20 |
$422 |
2.9× |
| Radiologic examination, internal auditory meati, complete Non-Facility (70134) |
$254.40 |
$424 |
0.5× |
| Ribs bilateral 3 views (71110) |
$838.20 |
$1,397 |
8.1× |
| Scapula (73010) |
$204.60 |
$341 |
2.0× |
| Screening Digital Breast Tomosynthesis Bi (77063) |
$173.40 |
$289 |
7.4× |
| Shoulder 1 view (73020) |
$172.80 |
$288 |
2.0× |
| Skull less than 4 views (70250) |
$242.40 |
$404 |
2.3× |
| Sternoclavicular joints (71130) |
$221.40 |
$369 |
2.6× |
| Thoracic spine 2 views (72070) |
$354 |
$590 |
3.4× |
| Thoracic spine 3 views (72072) |
$364.80 |
$608 |
3.5× |
| Thoracolumbar 2 views (72080) |
$352.80 |
$588 |
4.1× |
| Thyroid Imaging With Vascular Flow (78013) |
$990.60 |
$1,651 |
2.5× |
| Thyroid Uptake Measurement (78012) |
$823.20 |
$1,372 |
2.1× |
| Thyroid Uptake W/Blood Flow Sngle/Mult Quan Meas (78014) |
$1,233.60 |
$2,056 |
3.1× |
| Ultrasound Breast Limited (76642) |
$256.20 |
$427 |
3.0× |
| Ultrasound Exam Aaa Screen (76706) |
$392.40 |
$654 |
3.8× |
| Ultrasound, abdomen limited (76705) |
$369 |
$615 |
3.5× |
| Umbilical-artery Doppler (OB) (76820) |
$302.40 |
$504 |
2.9× |
| Upper gi w/o kub (74240) |
$666.60 |
$1,111 |
3.8× |
| Urethrocystogram voiding (74455) |
$417 |
$695 |
1.8× |
| Us breast unilateral complete (76641) |
$514.80 |
$858 |
4.9× |
| Us chest (76604) |
$432 |
$720 |
4.2× |
| Us complete joint (76881) |
$217.80 |
$363 |
2.1× |
| Us exam, pelvic, limited (76857) |
$390 |
$650 |
3.7× |
| Us kidney transplant (76776) |
$586.20 |
$977 |
5.6× |
| Us lmtd joint/oth nonvasc xtr strux r-t w/img (76882) |
$330 |
$550 |
3.2× |
| Us ob detailed single fetus (76811) |
$527.40 |
$879 |
2.2× |
| Us ob limited 1 or more fetuses (76815) |
$303.60 |
$506 |
2.9× |
| Us ob transvaginal (76817) |
$198 |
$330 |
1.9× |
| Us pelvic non ob complete (76856) |
$556.80 |
$928 |
5.4× |
| Us pg uter img f&mat 14 wk tabdl 1/1st gestation (76801) |
$411.60 |
$686 |
4.0× |
| Us preg uterus real time f/u trnsabdl per fetus (76816) |
$330 |
$550 |
3.2× |
| Us retroperitoneal complete (76770) |
$590.40 |
$984 |
5.7× |
| Us retroperitoneal limited (76775) |
$330.60 |
$551 |
3.2× |
| Us scrotum and contents (76870) |
$369 |
$615 |
3.5× |
| Us spinal canal and contents (76800) |
$229.80 |
$383 |
2.2× |
| Us thyroid (76536) |
$404.40 |
$674 |
3.9× |
| Wrist 2 views (73100) |
$172.20 |
$287 |
2.0× |
| X-Ray Ac Jts - Xr Acromioclavicular Joints Bilateral (73050) |
$206.40 |
$344 |
2.4× |
| X-Ray Bend Only L-S Spine (72120) |
$261 |
$435 |
2.5× |
| X-Ray Elbow 2 Vw - Xr Elbow 1-2 Views Right (73070) |
$151.20 |
$252 |
1.7× |
| X-Ray Exam Entire Spi 1 Vw (72081) |
$394.20 |
$657 |
4.6× |
| X-Ray Exam Entire Spi 2/3 Vw (72082) |
$519 |
$865 |
5.0× |
| X-Ray Exam Entire Spi 4/5 Vw (72083) |
$550.20 |
$917 |
5.3× |
| X-Ray Exam Hip Uni 1 View (73501) |
$151.20 |
$252 |
1.7× |
| X-Ray Exam Hip Uni 2-3 Views (73502) |
$232.80 |
$388 |
2.7× |
| X-Ray Exam Hip Uni 4/> Views (73503) |
$572.40 |
$954 |
5.5× |
| X-Ray Exam Hips Bi 2 Views (73521) |
$642.60 |
$1,071 |
6.2× |
| X-Ray Exam Hips Bi 3-4 Views (73522) |
$807.60 |
$1,346 |
7.8× |
| X-Ray Exam Hips Bi 5/> Views (73523) |
$854.40 |
$1,424 |
8.2× |
| X-Ray Exam L-S Spine Bending (72114) |
$563.40 |
$939 |
5.4× |
| X-Ray Exam Neck Spine 2-3 Vw (72040) |
$264 |
$440 |
3.0× |
| X-Ray Exam Neck Spine 6/>Vws (72052) |
$415.20 |
$692 |
4.0× |
| X-Ray Exam Unilat Ribs/Chest (71101) |
$323.40 |
$539 |
3.1× |
| X-ray eye for foreign body (70030) |
$189.60 |
$316 |
2.2× |
| X-ray humerus (73060) |
$220.20 |
$367 |
2.5× |
| X-Ray Jaw <4 Vw - Xr Mandible < 4 Views (70100) |
$262.80 |
$438 |
3.0× |
| X-Ray Knee Bilat Standing - Xr Knees Anteroposterior Standing Bilat (73565) |
$249.60 |
$416 |
2.9× |
| X-Ray Lumbar Spine 2/3 Vw - Xr Lumbar Spine 2-3 Views (72100) |
$261 |
$435 |
2.5× |
| X-ray nose-rectum child f.b. (76010) |
$163.20 |
$272 |
1.9× |
| X-Ray Ribs, Chest 4+ Vw - Xr Ribs 3 Vws Bil W/ Chest Posteroanterior (71111) |
$417.60 |
$696 |
4.0× |
| X-Ray Sacroiliac Jts 3+ Vw - Xr Sacroiliac Joints 3+ Views (72202) |
$273.60 |
$456 |
2.6× |
| X-Ray Sacrum/Coccyx 2+ Vw - Xr Sacrum Coccyx 2+ Views (72220) |
$258 |
$430 |
3.0× |
| X-Ray Sinuses 3+ Vw - Xr Paranasal Sinuses 3+ Views (70220) |
$262.20 |
$437 |
3.0× |
| X-Ray Skull 4+ Vw - Xr Skull Complete 4+ Views (70260) |
$343.80 |
$573 |
3.3× |
X-Ray Urinary Tract Exam With Contrast Material (74420) range across 2 matching MRF lines |
$291–$826.80 |
$485–$1,378 |
varies |
| X-Rays Bone Survey Complete (77075) |
$591 |
$985 |
5.7× |
| Xr c-spine 4 or 5 views (72050) |
$538.80 |
$898 |
5.2× |
| Xr facial bones less than 3 views (70140) |
$310.20 |
$517 |
3.6× |
| Xr orbits complete 4 views (70200) |
$331.80 |
$553 |
3.2× |