| Abdomen 1 View (74018) |
$183 |
$244 |
2.2× |
| Abdomen 2 views (74019) |
$277.50 |
$370 |
2.7× |
| Acute Gastrointestinal Blood Loss Imaging (78278) |
$873 |
$1,164 |
2.3× |
| Acute venous thrombosis imaging, peptide Non-Facility (78456) |
$308.25 |
$411 |
0.2× |
| Angio internal mammary (75756) |
$7,113 |
$9,484 |
2.3× |
| Angio pulmonary bilat (75743) |
$2,846.25 |
$3,795 |
0.9× |
| Angiography Adrenal Bilateral Slctv Rs&I (75733) |
$2,965.50 |
$3,954 |
1.0× |
| Angiography extremity bilateral rs&i (75716) |
$3,619.50 |
$4,826 |
1.2× |
| Angiography extremity unilateral rs&i (75710) |
$3,217.50 |
$4,290 |
1.1× |
| Angiography pulmonary unilateral slctv rs&i (75741) |
$2,046.75 |
$2,729 |
0.7× |
| Ankle 2 views (73600) |
$213.75 |
$285 |
2.5× |
| Aortography thoracic serialography rs&i (75605) |
$8,066.25 |
$10,755 |
1.5× |
| Artery X-Rays Abdomen (75726) |
$3,710.25 |
$4,947 |
0.7× |
| Artery X-Rays Adrenal Gland (75731) |
$2,823.75 |
$3,765 |
0.9× |
| Artery X-Rays Pelvis (75736) |
$3,333 |
$4,444 |
0.6× |
| Artery X-Rays Spine (75705) |
$10,069.50 |
$13,426 |
1.9× |
| Arthrogram ankle (73615) |
$1,136.25 |
$1,515 |
3.4× |
| Arthrogram hip (73525) |
$506.25 |
$675 |
1.5× |
| Arthrogram Wrist (73115) |
$417.75 |
$557 |
1.2× |
| Basic radiation dosimetry calculation (77300) |
$340.50 |
$454 |
2.6× |
| Bone age studies (77072) |
$196.50 |
$262 |
1.9× |
| Bone Imaging 3 Phase (78315) |
$1,161 |
$1,548 |
3.0× |
| Bone Imaging Whole Body (78306) |
$773.25 |
$1,031 |
2.0× |
| Bone survey infant (77076) |
$240.75 |
$321 |
2.4× |
| Brain Flow Imaging Only (78610) |
$627 |
$836 |
1.2× |
| Brain Imaging Pet Metabolic Evaluation (78608) |
$3,126.75 |
$4,169 |
2.3× |
| Cardiac MRI w/w/o contrast & further seq (75561) |
$3,611.25 |
$4,815 |
10.7× |
| Cardiac MRI w/w/o contrast w/stress (75563) |
$4,758.75 |
$6,345 |
6.3× |
| Cat Scan Follow-Up Study (76380) |
$787.50 |
$1,050 |
9.3× |
| Cerebrospinal Fluid Flow W/O Matl Shunt Evaltj (78645) |
$612 |
$816 |
1.2× |
| Cerebrospinal Fluid Scan (78630) |
$904.50 |
$1,206 |
1.7× |
| Chest 1 view (71045) |
$246 |
$328 |
2.9× |
| Chest 2 views (71046) |
$309 |
$412 |
3.7× |
| Chest 3 views (71047) |
$347.25 |
$463 |
4.1× |
| Chest 4 or more views (71048) |
$357 |
$476 |
3.5× |
| Clavicle complete (73000) |
$267.75 |
$357 |
3.2× |
| Computed Tomography Thorax Lw Dose Lng Ca Scr C- (71271) |
$101.25 |
$135 |
1.0× |
| Contrast Exam Abdominl Aorta (75625) |
$3,006.75 |
$4,009 |
1.0× |
| Contrast X-Ray Bladder (74430) |
$633 |
$844 |
1.9× |
| Contrast X-Ray Of Elbow (73085) |
$1,155 |
$1,540 |
3.4× |
| Contrast X-Ray Of Knee Joint (73580) |
$686.25 |
$915 |
2.0× |
| CT abdomen and pelvis without and with contrast (74178) |
$3,610.50 |
$4,814 |
10.7× |
| CT abdomen and pelvis without contrast (74176) |
$2,865.75 |
$3,821 |
12.4× |
| CT abdomen w contrast (74160) |
$1,704.75 |
$2,273 |
10.0× |
| CT abdomen w wo contrast (74170) |
$2,047.50 |
$2,730 |
12.0× |
| CT abdomen w/o contrast (74150) |
$1,475.25 |
$1,967 |
14.6× |
| CT Angio Abdomen and Pelvis (74174) |
$3,652.50 |
$4,870 |
10.8× |
| CT Angio Chest (71275) |
$1,899.75 |
$2,533 |
11.2× |
| CT Angio Head (70496) |
$1,899.75 |
$2,533 |
11.2× |
| CT angio hrt w/3d image (75574) |
$2,749.50 |
$3,666 |
8.1× |
| Ct Angio Lwr Extr W/O&W/Dye (73706) |
$1,899.75 |
$2,533 |
11.2× |
| CT Angio Neck (70498) |
$1,899.75 |
$2,533 |
11.2× |
| Ct Angio Upr Extrm W/O&W/Dye (73206) |
$2,025.75 |
$2,701 |
11.9× |
| CT Cere Prfuj Alys C+ W/O CT/Cta Same Anatomy (70473) |
$775.50 |
$1,034 |
4.6× |
| CT cervical spine w/ contrast (72126) |
$2,125.50 |
$2,834 |
6.3× |
| CT cervical spine w/o contrast (72125) |
$1,345.50 |
$1,794 |
13.3× |
| CT chest w contrast (71260) |
$1,730.25 |
$2,307 |
10.2× |
| CT chest w/wo contrast (71270) |
$2,241.75 |
$2,989 |
13.2× |
| CT colonogrphy dx image postprocess w/o contrast (74261) |
$2,616 |
$3,488 |
25.8× |
| CT head/brain with contrast (70460) |
$1,833.75 |
$2,445 |
10.8× |
| CT head/brain without and with contrast (70470) |
$1,720.50 |
$2,294 |
10.1× |
| CT heart contrast eval cardiac structure&morph (75572) |
$3,534 |
$4,712 |
10.4× |
CT heart no contrast quant eval coronry calcium (75571)
range across 2 matching MRF lines |
$81–$2,514.75 |
$108–$3,353 |
varies |
| CT hrt w/3d image congen (75573) |
$2,965.50 |
$3,954 |
8.8× |
| CT iac w contrast (70481) |
$1,834.50 |
$2,446 |
10.8× |
| CT l-spine w&w/o contrast (72133) |
$2,228.25 |
$2,971 |
13.1× |
| CT lower ext w/o (73700) |
$1,169.25 |
$1,559 |
11.5× |
| CT lower extremity w/contrast material (73701) |
$1,555.50 |
$2,074 |
9.1× |
| CT lumbar spine w contrast (72132) |
$2,241.75 |
$2,989 |
6.6× |
| CT lumbar spine w/o contrast (72131) |
$1,797 |
$2,396 |
17.7× |
| CT maxillofacial w contrast (70487) |
$1,689.75 |
$2,253 |
9.9× |
| CT maxillofacial wo contrast (70486) |
$1,650 |
$2,200 |
16.3× |
| CT neck tissue combo (70492) |
$2,149.50 |
$2,866 |
12.6× |
| Ct Orbit/Ear/Fossa W/O&W/Dye (70482) |
$1,923 |
$2,564 |
11.3× |
| CT orbits w/o contrast (70480) |
$1,651.50 |
$2,202 |
16.3× |
| CT pelvis w&w/o contrast (72194) |
$2,305.50 |
$3,074 |
13.6× |
| CT pelvis w/o contrast (72192) |
$1,505.25 |
$2,007 |
14.8× |
| CT scan of leg combo (73702) |
$1,983.75 |
$2,645 |
11.7× |
| CT scans face/jaw combo (70488) |
$1,931.25 |
$2,575 |
11.4× |
| CT soft tissue neck w contrast (70491) |
$1,953 |
$2,604 |
11.5× |
| CT soft tissue neck w/o contrast (70490) |
$1,689.75 |
$2,253 |
16.7× |
| CT thoracic spine w contrast (72129) |
$1,293 |
$1,724 |
7.6× |
| CT thoracic spine w/o contrast (72128) |
$944.25 |
$1,259 |
9.3× |
| CT thoracic spine w/wo cont (72130) |
$2,228.25 |
$2,971 |
13.1× |
| CT thorax w/o contrast (71250) |
$1,557 |
$2,076 |
15.4× |
| CT unlisted procedure (76497) |
$1,578.75 |
$2,105 |
18.7× |
| CT upper ext wo (73200) |
$1,476 |
$1,968 |
14.6× |
| CT upper extremity w/o & w/contrast material (73202) |
$2,726.25 |
$3,635 |
16.0× |
| CT upper extremity with contrast (73201) |
$1,536.75 |
$2,049 |
4.5× |
| Cta Abdl Aorta&Bi Iliofem W/Contrast&Postp (75635) |
$1,899.75 |
$2,533 |
11.2× |
| Cta Abdomen (74175) |
$1,899.75 |
$2,533 |
11.2× |
| CTA head&neck c+ w/noncontrast img&post-pxessing (70471) |
$1,899.75 |
$2,533 |
5.6× |
| CTA pelvis (72191) |
$2,965.50 |
$3,954 |
17.4× |
| Dilation ureters/urethra rs&i (74485) |
$1,476.75 |
$1,969 |
0.7× |
| Discography Cerv/Thor Spine (72285) |
$2,062.50 |
$2,750 |
1.1× |
| Diskography lumbar (72295) |
$2,409.75 |
$3,213 |
1.3× |
| Doppler Echo Fetal Puls Spectral F/U/Repeat (76828) |
$250.50 |
$334 |
2.5× |
| Doppler Echo Fetal Spectral Display Complete (76827) |
$479.25 |
$639 |
4.7× |
| Doppler Fetal Mid Cerebral Artery (76821) |
$645.75 |
$861 |
6.4× |
| Dxa Bone Density Axial (77080) |
$277.50 |
$370 |
2.7× |
| Dxa bone density study (77085) |
$510 |
$680 |
5.0× |
| Dxa bone density study 1/>sites appendiclr skel (77081) |
$412.50 |
$550 |
4.9× |
| Echo exam of fetal heart (76825) |
$532.50 |
$710 |
1.0× |
| Echo exam uterus (76831) |
$595.50 |
$794 |
2.6× |
| Echo Guide For Artery Repair (76936) |
$1,208.25 |
$1,611 |
5.8× |
| Echocardiography, fetal, cardiovascular system, real time with image documentation (2D), with or without M-mode… (76826) |
$398.25 |
$531 |
1.7× |
| Esophagram (74220) |
$561 |
$748 |
3.3× |
| Fetal Biophys Profile W/Nst (76818) |
$656.25 |
$875 |
6.5× |
| Fetal Biophysical Profile W/O Non-Stress Testing (76819) |
$728.25 |
$971 |
7.2× |
| Fluoroscopy up to 1 hr (76000) |
$492.75 |
$657 |
2.1× |
| Follow-Up Angiography (75898) |
$4,329 |
$5,772 |
1.4× |
| Foot 2 views (73620) |
$222.75 |
$297 |
2.6× |
| Forearm 2 views (73090) |
$259.50 |
$346 |
3.1× |
| Gastric emptying imaging study (78264) |
$616.50 |
$822 |
1.6× |
| Gastroesophageal Reflux Exam (78262) |
$553.50 |
$738 |
1.4× |
| Gated Heart Planar Single (78472) |
$1,031.25 |
$1,375 |
2.7× |
| Hand 2 views (73120) |
$213.75 |
$285 |
2.1× |
| Hepatc Vngrph Wdg/Fr Hemodyn Eval Rs&I (75889) |
$3,125.25 |
$4,167 |
1.0× |
| Hepatc Vngrph Wdg/Fr W/O Hemodyn Eval Rs&I (75891) |
$2,163.75 |
$2,885 |
0.7× |
| Hepatobil Syst Image W/Drug (78227) |
$1,245.75 |
$1,661 |
2.4× |
| Hepatobiliary System Imaging (78226) |
$716.25 |
$955 |
1.8× |
| Ht Musc Image Planar Mult (78454) |
$2,607.75 |
$3,477 |
2.1× |
| Ht Muscle Image Spect Sing (78451) |
$2,148.75 |
$2,865 |
1.7× |
| Hysterosalpingogram (74740) |
$682.50 |
$910 |
2.9× |
| Infant hip ultrasound with hip movement (dynamic) (76885) |
$317.25 |
$423 |
3.8× |
| Infant hip ultrasound, limited static exam (76886) |
$258 |
$344 |
3.1× |
| Joint Survey Single View (77077) |
$256.50 |
$342 |
2.5× |
| K Flow/Funct Image W/Drug (78708) |
$722.25 |
$963 |
1.4× |
| K Flow/Funct Image W/O Drug (78707) |
$704.25 |
$939 |
1.3× |
| Kidney Funcj Study Non-Img Radioisotopic Study (78725) |
$549.75 |
$733 |
1.4× |
| Kidney Imaging Morphol (78700) |
$627 |
$836 |
1.6× |
| Kidney Imaging Morphoogy W/Vascular Flow (78701) |
$638.25 |
$851 |
1.6× |
| Knee 3 Views (73562) |
$210.75 |
$281 |
2.5× |
| Liver & Spleen Imaging Static Only (78215) |
$726 |
$968 |
1.9× |
| Liver imaging static only (78201) |
$558.75 |
$745 |
1.1× |
| Lung Perf&Ventilat Diferentl (78598) |
$1,161.75 |
$1,549 |
2.2× |
| Lung perfusion differential (78597) |
$805.50 |
$1,074 |
2.1× |
| Lung Ventilat&Perfus Imaging (78582) |
$1,221 |
$1,628 |
2.3× |
| Lung Ventilation Imaging (78579) |
$398.25 |
$531 |
1.0× |
| Lymph System Imaging (78195) |
$730.50 |
$974 |
1.4× |
| Lymphangiography Extremity Only Bilateral Rs&I (75803) |
$1,302 |
$1,736 |
0.9× |
| Lymphangiography extremity only unilateral rs&i (75801) |
$2,379 |
$3,172 |
3.9× |
| Lymphangiography Pelvic/Abdominal Bilateral Rs&I (75807) |
$2,179.50 |
$2,906 |
0.7× |
| Lymphangiography, pelvic/abdominal, unilateral (75805) |
$3,555.75 |
$4,741 |
1.2× |
| Magnetic Image Jaw Joint (70336) |
$2,280.75 |
$3,041 |
9.9× |
| Magnetic resonance (eg, proton) imaging, brain (including brain stem andskull base), during open intracranial procedure… (70557) |
$1,714.50 |
$2,286 |
3.2× |
| Magnetic resonance (eg, proton) imaging, brain (including brain stem andskull base), during open intracranial procedure… (70559) |
$3,198 |
$4,264 |
18.8× |
| Mammary ductogram or galactogram multiple (77054) |
$438 |
$584 |
1.9× |
| Mammary ductogram or galactogram single (77053) |
$691.50 |
$922 |
3.0× |
| Meckels Divert Exam (78290) |
$610.50 |
$814 |
1.6× |
| Medical physics dose eval radiation expos w/rprt (76145) |
$621 |
$828 |
1.7× |
| Mr safety determination physician/other qhp (76016) |
$85.50 |
$114 |
1.0× |
| Mr safety implant&/fb assmt clin staf 1st 15 min (76014) |
$24 |
$32 |
0.9× |
| Mr safety implt electronics prepj supvj phys/qhp (76018) |
$90 |
$120 |
1.0× |
| Mr safety implt pos&/immoblj (76019) |
$58.50 |
$78 |
1.0× |
| Mr safety med physics xm customization plng&mntr (76017) |
$235.50 |
$314 |
1.0× |
| Mra Head W/O & W/Contrast Material (70546) |
$2,919.75 |
$3,893 |
8.6× |
| MRA head w/o contrast (70544) |
$2,682.75 |
$3,577 |
11.6× |
| MRA head with contrast (70545) |
$2,449.50 |
$3,266 |
7.2× |
| MRA neck w contrast (70548) |
$2,449.50 |
$3,266 |
7.2× |
| Mra Neck W/O &W/Contrast Material (70549) |
$2,733 |
$3,644 |
8.1× |
| MRA neck w/o contrast (70547) |
$2,451 |
$3,268 |
10.6× |
| MRI abdomen w contrast (74182) |
$3,013.50 |
$4,018 |
8.9× |
| MRI abdomen w/o contrast (74181) |
$2,439.75 |
$3,253 |
10.5× |
| MRI any jt lower extrem w/contrast material (73722) |
$2,682.75 |
$3,577 |
3.5× |
| MRI any jt lower extrem w/o & w/contrast matrl (73723) |
$2,854.50 |
$3,806 |
8.4× |
| MRI any jt upper extremity w/contrast matrl (73222) |
$2,769.75 |
$3,693 |
3.6× |
| MRI brain functional w/o physician admnistration (70554) |
$1,337.25 |
$1,783 |
5.8× |
| MRI Breast W/O Contrast Bilateral (77047) |
$262.50 |
$350 |
1.1× |
| MRI cardiac w/o cont stress (75559) |
$5,208 |
$6,944 |
9.8× |
| MRI cardiac w/o contrast (75557) |
$2,917.50 |
$3,890 |
12.6× |
| MRI cervical spine w contrast (72142) |
$2,439.75 |
$3,253 |
7.2× |
| MRI cervical spine w/o cont (72141) |
$2,854.50 |
$3,806 |
12.3× |
| MRI chest w/o contrast (71550) |
$2,439.75 |
$3,253 |
10.5× |
| MRI chest with contrast (71551) |
$2,580 |
$3,440 |
3.4× |
| MRI chest wo w contrast (71552) |
$2,919.75 |
$3,893 |
8.6× |
| MRI lower extrem oth/thn jt w/contrast matrl (73719) |
$2,769.75 |
$3,693 |
8.2× |
| MRI lower extrem oth/thn jt w/o & w/contr matr (73720) |
$2,854.50 |
$3,806 |
8.4× |
| MRI lower extrem oth/thn jt w/o contr matrl (73718) |
$2,439.75 |
$3,253 |
10.5× |
| MRI lumbar spine w contrast (72149) |
$2,994 |
$3,992 |
8.8× |
| Mri Neck Spine W/O & W/Dye (72156) |
$2,919.75 |
$3,893 |
8.6× |
| MRI orbit face &/neck w/o contrast (70540) |
$2,307.75 |
$3,077 |
10.0× |
| MRI orbit face neck w contrast (70542) |
$3,403.50 |
$4,538 |
10.1× |
| Mri Orbt/Fac/Nck W/O &W/Dye (70543) |
$2,919.75 |
$3,893 |
8.6× |
| MRI pelvis w contrast (72196) |
$2,909.25 |
$3,879 |
8.6× |
| MRI pelvis w/o & w contrast (72197) |
$2,919.75 |
$3,893 |
8.6× |
| MRI pelvis w/o contrast (72195) |
$2,682.75 |
$3,577 |
11.6× |
| MRI spectroscopy (76390) |
$1,974 |
$2,632 |
23.4× |
| MRI thoracic spine w/o contrast (72146) |
$2,847.75 |
$3,797 |
12.3× |
| MRI upper extremity oth than jt w/contr matrl (73219) |
$3,126.75 |
$4,169 |
9.2× |
| MRI upper extremity oth than jt w/o contr matrl (73218) |
$2,682.75 |
$3,577 |
11.6× |
| Mri Uppr Extremity W/O&W/Dye (73220) |
$2,854.50 |
$3,806 |
8.4× |
| MRI, abdomen, combo (74183) |
$2,854.50 |
$3,806 |
8.4× |
| MRI, dorsal spine combo (72157) |
$2,919.75 |
$3,893 |
8.6× |
| MRI, dorsal spine contrast (72147) |
$2,994 |
$3,992 |
8.8× |
| MRI, joint upper extrem (73221) |
$2,854.50 |
$3,806 |
12.3× |
| MRI, joint upper extrem combo (73223) |
$2,854.50 |
$3,806 |
8.4× |
| MRI, lumbar spine combo (72158) |
$2,919.75 |
$3,893 |
8.6× |
| Myocardial Imaging Pet Metabolic Evaluation (78459) |
$2,528.25 |
$3,371 |
2.0× |
| Myocardial Perfusion Planar 1 Study Rest/Stress (78453) |
$1,778.25 |
$2,371 |
1.4× |
| Myocardial Spect Multiple Studies (78452) |
$2,765.25 |
$3,687 |
2.2× |
| Myocrd Img Pet Prfuj W/Metab Dual Radiotracer (78432) |
$1,876.50 |
$2,502 |
1.3× |
| N-invas est c ffr sw aly CTA (75580) |
$1,010.25 |
$1,347 |
1.2× |
| Neck soft tissue (70360) |
$228 |
$304 |
2.7× |
| Nm csf leak detection (78650) |
$1,371.75 |
$1,829 |
1.1× |
| Nm myocard infarct spect (78469) |
$471.75 |
$629 |
0.9× |
| Nuclear Rx Intra-Arterial (79445) |
$487.50 |
$650 |
2.2× |
Nuclear Rx Oral Admin (79005)
range across 2 matching MRF lines |
$240–$546 |
$320–$728 |
varies |
| Ophthalmic ultrasound dx b-scan w/wo a-scan (76512) |
$336 |
$448 |
3.3× |
| Ophthalmic us dx quantitative a-scan only (76511) |
$105.75 |
$141 |
1.0× |
| Optic foramina (70190) |
$338.25 |
$451 |
4.0× |
| Panoramic X-ray of jaws (70355) |
$163.50 |
$218 |
1.9× |
| Parathyroid imaging w/tomographic spect & CT (78072) |
$1,072.50 |
$1,430 |
2.0× |
| Parathyroid Planar Imaging (78070) |
$641.25 |
$855 |
1.7× |
| Parathyroid planar imaging w/wo subtraction (78071) |
$948.75 |
$1,265 |
2.4× |
| Pelvis 1 or 2 views (72170) |
$184.50 |
$246 |
1.8× |
| Pet Image W/Ct Lmtd (78814) |
$2,528.25 |
$3,371 |
1.8× |
| PET image w/CT, full body (78816) |
$2,999.25 |
$3,999 |
2.2× |
| PET imaging CT attenuation skull base mid-thigh (78815) |
$2,581.50 |
$3,442 |
1.9× |
| Pet Imaging Limited Area Chest Head/Neck (78811) |
$2,478.75 |
$3,305 |
2.0× |
| Pet Myocardial Sngl Study (78491) |
$2,425.50 |
$3,234 |
1.7× |
| Prq Transhepatc Portograpy Hemodyn Eval Rs&I (75885) |
$2,943.75 |
$3,925 |
1.0× |
| Pulmonary Perfusion Imaging Particulate (78580) |
$700.50 |
$934 |
1.8× |
| Quan&Charac C Atherosclerotc Plaq Asses Sev C Ds (75577) |
$1,009.50 |
$1,346 |
1.1× |
| Radex Abd Compl Aqt Abd W/S/E/D Views 1 View Ch (74022) |
$440.25 |
$587 |
4.3× |
| Radex abscess/fistula/sinus tract rs&i (76080) |
$779.25 |
$1,039 |
1.5× |
| Radex Ankle Complete Minimum 3 Views (73610) |
$236.25 |
$315 |
2.8× |
| Radex Calcaneus Minimum 2 Views (73650) |
$216 |
$288 |
2.6× |
| Radex elbow complete minimum 3 views (73080) |
$283.50 |
$378 |
3.4× |
| Radex Facial Bones Complete Minimum 3 Views (70150) |
$457.50 |
$610 |
4.5× |
| Radex fingr minimum 2 views (73140) |
$216.75 |
$289 |
2.6× |
| Radex foot complete minimum 3 views (73630) |
$236.25 |
$315 |
2.8× |
| Radex Hand Minimum 3 Views (73130) |
$236.25 |
$315 |
2.8× |
| Radex lower extremity infant minimum 2 views (73592) |
$183.75 |
$245 |
2.2× |
| Radex Mastoids Compl Minimum 3 Views PR Side (70130) |
$361.50 |
$482 |
3.6× |
| Radex Nasal Bones Complete Minimum 3 Views (70160) |
$283.50 |
$378 |
3.4× |
| Radex Ribs Unilateral 2 Views (71100) |
$287.25 |
$383 |
3.4× |
| Radex shoulder complete minimum 2 views (73030) |
$276 |
$368 |
3.3× |
| Radex Sinuses Paransl < 3 Views (70210) |
$267 |
$356 |
3.2× |
| Radex Spine 1 View Specify Level (72020) |
$254.25 |
$339 |
3.0× |
| Radex Sternum Minimum 2 Views (71120) |
$283.50 |
$378 |
3.4× |
| Radex Temporomandble Jt Opn & Clsd Mouth Bilat (70330) |
$349.50 |
$466 |
4.1× |
| Radex Toe Minimum 2 Views (73660) |
$186.75 |
$249 |
2.2× |
| Radex upper extremity infant minimum 2 views (73092) |
$237.75 |
$317 |
2.3× |
| Radex Wrist Complete Minimum 3 Views (73110) |
$236.25 |
$315 |
2.8× |
| Radex X-Ray Exam Entire Spi 6/> Vw - Xr Entire Spine 6+ Vw (72084) |
$333.75 |
$445 |
3.3× |
| Radiolog exam mandible compl minimum 4 views (70110) |
$288.75 |
$385 |
2.8× |
| Radiologic Exam Abdomen 3+ Views - Xr Abdomen 3+ Views (74021) |
$305.25 |
$407 |
3.0× |
| Radiologic exam colon double contrast study (74280) |
$1,115.25 |
$1,487 |
6.6× |
| Radiologic exam colon single contrast study (74270) |
$690.75 |
$921 |
4.1× |
| Radiologic Exam Esophagus Double Contrast Study (74221) |
$759 |
$1,012 |
4.5× |
| Radiologic exam knee complete 4/more views (73564) |
$267.75 |
$357 |
2.6× |
| Radiologic exam pelvis compl minimum 3 views (72190) |
$351.75 |
$469 |
3.5× |
| Radiologic Exam Small Int Single Contrast Study (74250) |
$551.25 |
$735 |
3.2× |
| Radiologic exam swallow function contrast study (74230) |
$241.50 |
$322 |
1.4× |
| Radiologic exam upr gi trc double contrast study (74246) |
$589.50 |
$786 |
3.5× |
| Radiologic examination femur 1 view (73551) |
$176.25 |
$235 |
2.1× |
| Radiologic examination femur minimum 2 views (73552) |
$244.50 |
$326 |
2.9× |
| Radiologic examination knee 1/2 views (73560) |
$184.50 |
$246 |
2.2× |
| Radiologic Examination Osseous Survey Limited (77074) |
$259.50 |
$346 |
2.6× |
| Radiologic examination tibia & fibula 2 views (73590) |
$228 |
$304 |
2.7× |
| Radiopharm Dacryocystography (78660) |
$428.25 |
$571 |
1.1× |
| Radiopharmaceutical therapy, by intra-articular administration Non-Facility (79440) |
$240 |
$320 |
1.1× |
| Radiopharmaceutical therapy, by intracavitary administration Non-Facility (79200) |
$789 |
$1,052 |
3.5× |
| Ribs bilateral 3 views (71110) |
$295.50 |
$394 |
2.9× |
| Rp Loclzj Tum Plnr Whole Body 2+ Days Imaging (78804) |
$1,455 |
$1,940 |
2.8× |
| Rp Loclzj Tum Plnr Whole Body Single Day Imaging (78802) |
$1,333.50 |
$1,778 |
2.5× |
| Rp Loclzj Tum Spect 1 Area Single Day Imaging (78803) |
$1,187.25 |
$1,583 |
2.3× |
| Rp loclzj tum spect w/CT 1 area/acquisj 1day img (78830) |
$2,531.25 |
$3,375 |
2.0× |
| Rp Therapy Intravenous Administration (79101) |
$504 |
$672 |
2.2× |
| Salivary Gland Imaging (78230) |
$262.50 |
$350 |
0.7× |
| Scapula (73010) |
$236.25 |
$315 |
2.3× |
| Screening Digital Breast Tomosynthesis Bi (77063) |
$84.75 |
$113 |
3.6× |
| Shoulder 1 view (73020) |
$216.75 |
$289 |
2.6× |
| Shoulder Arthrography (73040) |
$576.75 |
$769 |
1.7× |
| Skull less than 4 views (70250) |
$262.50 |
$350 |
2.6× |
| Speech evaluation, complex (70371) |
$691.50 |
$922 |
3.0× |
| Spleen Imaging (78185) |
$390.75 |
$521 |
1.0× |
| Sternoclavicular joints (71130) |
$288.75 |
$385 |
3.4× |
| Superior sagittal sinus venogram (75870) |
$3,549 |
$4,732 |
1.2× |
| Testicular Imaging W/Flow (78761) |
$544.50 |
$726 |
1.4× |
| Therapeutic Enema Rdctj Intussusception/Obstrcj (74283) |
$208.50 |
$278 |
1.2× |
| Thoracic spine 2 views (72070) |
$306.75 |
$409 |
3.0× |
| Thoracic spine 3 views (72072) |
$307.50 |
$410 |
3.0× |
| Thoracolumbar 2 views (72080) |
$298.50 |
$398 |
3.5× |
| Thyroid Met Imaging Body (78018) |
$1,128 |
$1,504 |
2.1× |
| Thyroid Uptake Measurement (78012) |
$396 |
$528 |
1.0× |
| Thyroid Uptake W/Blood Flow Sngle/Mult Quan Meas (78014) |
$675 |
$900 |
1.7× |
| Ultrasound Breast Limited (76642) |
$216.75 |
$289 |
2.6× |
| Ultrasound elastography first target lesion (76982) |
$151.50 |
$202 |
1.5× |
| Ultrasound Exam Aaa Screen (76706) |
$548.25 |
$731 |
5.4× |
| Ultrasound, abdomen limited (76705) |
$735.75 |
$981 |
7.3× |
| Unlisted magnetic resonance procedure (76498) |
$1,596.75 |
$2,129 |
18.9× |
| Unlisted Miscellaneous Px Dx Nuclear Medicine (78999) |
$680.25 |
$907 |
1.8× |
Unlisted us procedure (76999)
range across 2 matching MRF lines |
$414.75–$460.50 |
$553–$614 |
varies |
| Upper gi w/o kub (74240) |
$488.25 |
$651 |
2.9× |
| Ureteral Reflux Study (78740) |
$609 |
$812 |
1.6× |
| Urethrocystogram voiding (74455) |
$634.50 |
$846 |
2.7× |
| Urethrocystography retrograde (74450) |
$613.50 |
$818 |
2.7× |
| Us breast unilateral complete (76641) |
$439.50 |
$586 |
4.3× |
| Us chest (76604) |
$362.25 |
$483 |
3.6× |
| Us complete joint (76881) |
$763.50 |
$1,018 |
7.5× |
| Us exam, pelvic, limited (76857) |
$590.25 |
$787 |
5.8× |
| Us head (76506) |
$397.50 |
$530 |
3.9× |
| Us kidney transplant (76776) |
$885.75 |
$1,181 |
8.7× |
| Us lmtd joint/oth nonvasc xtr strux r-t w/img (76882) |
$752.25 |
$1,003 |
7.4× |
| Us ob detailed single fetus (76811) |
$970.50 |
$1,294 |
4.2× |
| Us ob limited 1 or more fetuses (76815) |
$527.25 |
$703 |
5.2× |
| Us ob transvaginal (76817) |
$703.50 |
$938 |
6.9× |
| Us pelvic non ob complete (76856) |
$736.50 |
$982 |
7.3× |
| Us pg uter img f&mat 14 wk tabdl 1/1st gestation (76801) |
$610.50 |
$814 |
6.0× |
| Us preg uterus real time f/u trnsabdl per fetus (76816) |
$597.75 |
$797 |
5.9× |
| Us retroperitoneal complete (76770) |
$806.25 |
$1,075 |
8.0× |
| Us retroperitoneal limited (76775) |
$674.25 |
$899 |
6.7× |
| Us scrotum and contents (76870) |
$736.50 |
$982 |
7.3× |
| Us spinal canal and contents (76800) |
$292.50 |
$390 |
2.9× |
| Us thyroid (76536) |
$736.50 |
$982 |
7.3× |
| Us transrectal (76872) |
$745.50 |
$994 |
7.4× |
| Vascular Flow Imaging (78445) |
$411.75 |
$549 |
1.1× |
| Vein X-Ray Chest (75827) |
$2,241.75 |
$2,989 |
1.5× |
| Vein X-Ray Liver W/O Hemodyn (75887) |
$3,975 |
$5,300 |
1.3× |
| Vein X-Ray Skull Epidural (75872) |
$797.25 |
$1,063 |
1.3× |
| Venogram Sinus/Jugular (75860) |
$1,914.75 |
$2,553 |
0.6× |
| Venography Adrenal Unilateral (75840) |
$3,696 |
$4,928 |
1.2× |
| Venography caval inferior serialography rs&i (75825) |
$3,076.50 |
$4,102 |
1.0× |
| Venography extremity bilateral rs&i (75822) |
$1,189.50 |
$1,586 |
0.8× |
| Venography extremity unilateral rs&i (75820) |
$1,140 |
$1,520 |
0.7× |
| Venography Orbital Rs&I (75880) |
$1,141.50 |
$1,522 |
1.9× |
| Venography Renal Bilateral (75833) |
$2,628.75 |
$3,505 |
0.9× |
| Venography Renal Unilateral (75831) |
$1,925.25 |
$2,567 |
0.6× |
| Venous sampling by catheter (75893) |
$8,633.25 |
$11,511 |
1.6× |
| Venous Thrombosis Imaging Venogram Bilateral (78458) |
$498 |
$664 |
1.3× |
| Vertebral fracture assessment via dxa (77086) |
$530.25 |
$707 |
6.3× |
| Wrist 2 views (73100) |
$213.75 |
$285 |
2.5× |
| X-Ray Ac Jts - Xr Acromioclavicular Joints Bilateral (73050) |
$283.50 |
$378 |
3.4× |
| X-ray antegrade pyelogram tube (74425) |
$780 |
$1,040 |
2.3× |
| X-Ray Aorta Leg Arteries (75630) |
$3,160.50 |
$4,214 |
1.0× |
| X-Ray Bend Only L-S Spine (72120) |
$385.50 |
$514 |
3.8× |
| X-Ray Elbow 2 Vw - Xr Elbow 1-2 Views Right (73070) |
$259.50 |
$346 |
3.1× |
| X-Ray Exam Breast Specimen (76098) |
$195 |
$260 |
0.4× |
| X-Ray Exam Entire Spi 1 Vw (72081) |
$291 |
$388 |
3.4× |
| X-Ray Exam Entire Spi 2/3 Vw (72082) |
$326.25 |
$435 |
3.2× |
| X-Ray Exam Entire Spi 4/5 Vw (72083) |
$330 |
$440 |
3.3× |
| X-Ray Exam Hip Uni 1 View (73501) |
$270.75 |
$361 |
3.2× |
| X-Ray Exam Hip Uni 2-3 Views (73502) |
$319.50 |
$426 |
3.8× |
| X-Ray Exam Hip Uni 4/> Views (73503) |
$374.25 |
$499 |
3.7× |
| X-Ray Exam Hips Bi 2 Views (73521) |
$445.50 |
$594 |
4.4× |
| X-Ray Exam Hips Bi 3-4 Views (73522) |
$493.50 |
$658 |
4.9× |
| X-Ray Exam Hips Bi 5/> Views (73523) |
$507.75 |
$677 |
5.0× |
| X-Ray Exam L-S Spine Bending (72114) |
$420.75 |
$561 |
4.1× |
| X-Ray Exam Neck Spine 2-3 Vw (72040) |
$332.25 |
$443 |
3.9× |
| X-Ray Exam Neck Spine 6/>Vws (72052) |
$488.25 |
$651 |
4.8× |
| X-Ray Exam Unilat Ribs/Chest (71101) |
$291 |
$388 |
2.9× |
| X-ray humerus (73060) |
$236.25 |
$315 |
2.8× |
| X-Ray Jaw <4 Vw - Xr Mandible < 4 Views (70100) |
$191.25 |
$255 |
2.3× |
| X-Ray Knee Bilat Standing - Xr Knees Anteroposterior Standing Bilat (73565) |
$192 |
$256 |
2.3× |
| X-Ray Lumbar Spine 2/3 Vw - Xr Lumbar Spine 2-3 Views (72100) |
$293.25 |
$391 |
2.9× |
| X-ray nose-rectum child f.b. (76010) |
$246 |
$328 |
2.9× |
| X-Ray Ribs, Chest 4+ Vw - Xr Ribs 3 Vws Bil W/ Chest Posteroanterior (71111) |
$307.50 |
$410 |
3.0× |
| X-Ray Sacroiliac Jts 3+ Vw - Xr Sacroiliac Joints 3+ Views (72202) |
$269.25 |
$359 |
2.7× |
| X-Ray Sacrum/Coccyx 2+ Vw - Xr Sacrum Coccyx 2+ Views (72220) |
$262.50 |
$350 |
3.1× |
| X-Ray Sinuses 3+ Vw - Xr Paranasal Sinuses 3+ Views (70220) |
$377.25 |
$503 |
4.5× |
| X-Ray Skull 4+ Vw - Xr Skull Complete 4+ Views (70260) |
$410.25 |
$547 |
4.0× |
| X-ray thoracic spine 4 vw (72074) |
$309 |
$412 |
3.0× |
| X-Ray Tmj Unilat (70328) |
$257.25 |
$343 |
3.0× |
| X-Ray Urinary Tract Exam With Contrast Material (74420) |
$774.75 |
$1,033 |
2.3× |
| X-Rays Bone Length Studies (77073) |
$283.50 |
$378 |
2.8× |
| X-Rays Bone Survey Complete (77075) |
$267.75 |
$357 |
2.6× |
| Xr c-spine 4 or 5 views (72050) |
$468 |
$624 |
4.6× |
| Xr facial bones less than 3 views (70140) |
$256.50 |
$342 |
3.0× |
| XR Mastoids < 3 Views Bilateral (70120) |
$258 |
$344 |
2.5× |
| Xr orbits complete 4 views (70200) |
$387.75 |
$517 |
3.8× |
| Xr Tomogram Single Plane (76100) |
$711 |
$948 |
7.0× |