| Abdomen 1 View (74018) |
— |
$222 |
— |
| Abdomen 2 views (74019) |
— |
$371 |
— |
| Acute Gastrointestinal Blood Loss Imaging (78278) |
— |
$721 |
— |
Ankle 2 views (73600)
range across 3 matching MRF lines |
— |
$231–$307 |
— |
| Arthrogram hip (73525) |
— |
$717 |
— |
| Bone age studies (77072) |
— |
$371 |
— |
| Bone Imaging 3 Phase (78315) |
— |
$1,634 |
— |
| Bone Imaging Whole Body (78306) |
— |
$1,682 |
— |
| Cat Scan Follow-Up Study (76380) |
— |
$721 |
— |
| Chest 1 view (71045) |
— |
$307 |
— |
| Chest 2 views (71046) |
— |
$319 |
— |
Chest 3 views (71047)
range across 3 matching MRF lines |
— |
$259–$380 |
— |
| Chest 4 or more views (71048) |
— |
$477 |
— |
| Cholecystography Oral Contrast (74290) |
— |
$231 |
— |
| Clavicle complete (73000) |
— |
$307 |
— |
| Computed Tomography Thorax Lw Dose Lng Ca Scr C- (71271) |
— |
$292 |
— |
| Contrast X-Ray Bladder (74430) |
— |
$537 |
— |
| Contrast X-Ray Of Knee Joint (73580) |
— |
$717 |
— |
| Contrast Xray Throat/Cerv Esopha (74210) |
— |
$621 |
— |
| CT abdomen and pelvis without and with contrast (74178) |
— |
$4,712 |
— |
CT abdomen and pelvis without contrast (74176)
range across 3 matching MRF lines |
— |
$2,558–$3,560 |
— |
| CT abdomen w contrast (74160) |
— |
$2,053 |
— |
| CT abdomen w wo contrast (74170) |
— |
$2,202 |
— |
| CT abdomen w/o contrast (74150) |
— |
$1,511 |
— |
| CT Angio Abdomen and Pelvis (74174) |
— |
$2,368 |
— |
| CT Angio Chest (71275) |
— |
$2,720 |
— |
| CT Angio Head (70496) |
— |
$2,475 |
— |
| CT angio hrt w/3d image (75574) |
— |
$3,355 |
— |
| Ct Angio Lwr Extr W/O&W/Dye (73706) |
— |
$2,300 |
— |
| CT Angio Neck (70498) |
— |
$2,680 |
— |
| Ct Angio Upr Extrm W/O&W/Dye (73206) |
— |
$914 |
— |
| CT cervical spine w/ contrast (72126) |
— |
$1,931 |
— |
| CT cervical spine w/o contrast (72125) |
— |
$1,802 |
— |
| CT cervical spine w/wo cont (72127) |
— |
$2,175 |
— |
| CT chest w contrast (71260) |
— |
$1,989 |
— |
| CT chest w/wo contrast (71270) |
— |
$2,180 |
— |
| CT head/brain with contrast (70460) |
— |
$2,053 |
— |
| CT head/brain without and with contrast (70470) |
— |
$2,360 |
— |
| CT heart contrast eval cardiac structure&morph (75572) |
— |
$2,669 |
— |
CT heart no contrast quant eval coronry calcium (75571)
range across 2 matching MRF lines |
— |
$152–$352 |
— |
| CT hrt w/3d image congen (75573) |
— |
$2,976 |
— |
| CT iac w contrast (70481) |
— |
$1,815 |
— |
| CT l-spine w&w/o contrast (72133) |
— |
$1,997 |
— |
| CT lower ext w/o (73700) |
— |
$1,520 |
— |
| CT lower extremity w/contrast material (73701) |
— |
$1,998 |
— |
| CT lumbar spine w contrast (72132) |
— |
$1,827 |
— |
| CT lumbar spine w/o contrast (72131) |
— |
$1,753 |
— |
| CT maxillofacial w contrast (70487) |
— |
$1,898 |
— |
CT maxillofacial wo contrast (70486)
range across 2 matching MRF lines |
— |
$1,585–$1,891 |
— |
| CT neck tissue combo (70492) |
— |
$2,280 |
— |
| Ct Orbit/Ear/Fossa W/O&W/Dye (70482) |
— |
$2,103 |
— |
| CT orbits w/o contrast (70480) |
— |
$1,676 |
— |
| CT pelvis w&w/o contrast (72194) |
— |
$2,152 |
— |
| CT pelvis w/o contrast (72192) |
— |
$1,448 |
— |
| CT scan of leg combo (73702) |
— |
$1,863 |
— |
| CT scans face/jaw combo (70488) |
— |
$2,205 |
— |
| CT soft tissue neck w contrast (70491) |
— |
$1,976 |
— |
| CT soft tissue neck w/o contrast (70490) |
— |
$1,528 |
— |
| CT thoracic spine w contrast (72129) |
— |
$1,931 |
— |
| CT thoracic spine w/o contrast (72128) |
— |
$1,796 |
— |
| CT thoracic spine w/wo cont (72130) |
— |
$2,175 |
— |
| CT thorax w/o contrast (71250) |
— |
$1,827 |
— |
| CT upper ext wo (73200) |
— |
$1,517 |
— |
| CT upper extremity w/o & w/contrast material (73202) |
— |
$1,910 |
— |
| CT upper extremity with contrast (73201) |
— |
$1,864 |
— |
| Cta Abdl Aorta&Bi Iliofem W/Contrast&Postp (75635) |
— |
$2,300 |
— |
Cta Abdomen (74175)
range across 2 matching MRF lines |
— |
$1,944–$2,368 |
— |
| CTA head&neck c+ w/noncontrast img&post-pxessing (70471) |
— |
$5,154 |
— |
| Dxa Bone Density Axial (77080) |
— |
$519 |
— |
| Dxa bone density study (77085) |
— |
$660 |
— |
| Echo exam uterus (76831) |
— |
$1,179 |
— |
| Esophagram (74220) |
— |
$175 |
— |
| Fluoroscopy up to 1 hr (76000) |
— |
$431 |
— |
Foot 2 views (73620)
range across 2 matching MRF lines |
— |
$200–$307 |
— |
| Forearm 2 views (73090) |
— |
$307 |
— |
| Gastric emptying imaging study (78264) |
— |
$1,473 |
— |
| Gated Heart Planar Single (78472) |
— |
$1,799 |
— |
| Hand 2 views (73120) |
— |
$371 |
— |
| Hepatobil Syst Image W/Drug (78227) |
— |
$2,366 |
— |
| Hepatobiliary System Imaging (78226) |
— |
$1,402 |
— |
| Ht Muscle Image Spect Sing (78451) |
— |
$1,426 |
— |
| Hysterosalpingogram (74740) |
— |
$802 |
— |
| Infusion Ivp (74410) |
— |
$895 |
— |
| K Flow/Funct Image Multiple (78709) |
— |
$920 |
— |
| K Flow/Funct Image W/Drug (78708) |
— |
$1,879 |
— |
| K Flow/Funct Image W/O Drug (78707) |
— |
$839 |
— |
| Knee 3 Views (73562) |
— |
$314 |
— |
| Liver & Spleen Imaging Static Only (78215) |
— |
$1,102 |
— |
| Liver imaging w/vascular flow (78202) |
— |
$1,042 |
— |
| Lung Ventilat&Perfus Imaging (78582) |
— |
$2,010 |
— |
| Lung Ventilation Imaging (78579) |
— |
$930 |
— |
| Magnetic Image Jaw Joint (70336) |
— |
$2,350 |
— |
| Meckels Divert Exam (78290) |
— |
$890 |
— |
| Mra Head W/O & W/Contrast Material (70546) |
— |
$2,350 |
— |
| MRA head w/o contrast (70544) |
— |
$2,002 |
— |
| MRA head with contrast (70545) |
— |
$2,164 |
— |
| MRA neck w/o contrast (70547) |
— |
$1,763 |
— |
| MRI abdomen w contrast (74182) |
— |
$2,464 |
— |
| MRI abdomen w/o contrast (74181) |
— |
$2,350 |
— |
| MRI any jt lower extrem w/contrast material (73722) |
— |
$2,464 |
— |
| MRI any jt lower extrem w/o & w/contrast matrl (73723) |
— |
$2,642 |
— |
| MRI any jt upper extremity w/contrast matrl (73222) |
— |
$2,464 |
— |
| MRI cervical spine w contrast (72142) |
— |
$2,692 |
— |
| MRI cervical spine w/o cont (72141) |
— |
$2,588 |
— |
| MRI chest w/o contrast (71550) |
— |
$2,368 |
— |
MRI chest with contrast (71551)
range across 2 matching MRF lines |
— |
$2,464–$2,751 |
— |
| MRI lower extrem oth/thn jt w/contrast matrl (73719) |
— |
$2,707 |
— |
| MRI lower extrem oth/thn jt w/o & w/contr matr (73720) |
— |
$3,543 |
— |
| MRI lower extrem oth/thn jt w/o contr matrl (73718) |
— |
$2,350 |
— |
| MRI lumbar spine w contrast (72149) |
— |
$3,353 |
— |
| Mri Neck Spine W/O & W/Dye (72156) |
— |
$3,681 |
— |
| MRI orbit face &/neck w/o contrast (70540) |
— |
$2,350 |
— |
| MRI orbit face neck w contrast (70542) |
— |
$2,464 |
— |
| Mri Orbt/Fac/Nck W/O &W/Dye (70543) |
— |
$3,582 |
— |
| MRI pelvis w contrast (72196) |
— |
$2,762 |
— |
| MRI pelvis w/o & w contrast (72197) |
— |
$3,668 |
— |
| MRI pelvis w/o contrast (72195) |
— |
$2,350 |
— |
| MRI thoracic spine w/o contrast (72146) |
— |
$2,350 |
— |
| MRI upper extremity oth than jt w/o contr matrl (73218) |
— |
$2,350 |
— |
| Mri Uppr Extremity W/O&W/Dye (73220) |
— |
$2,551 |
— |
| MRI, abdomen, combo (74183) |
— |
$3,547 |
— |
| MRI, dorsal spine combo (72157) |
— |
$3,719 |
— |
| MRI, dorsal spine contrast (72147) |
— |
$2,685 |
— |
MRI, joint upper extrem (73221)
range across 9 matching MRF lines |
— |
$2,350–$2,601 |
— |
MRI, joint upper extrem combo (73223)
range across 9 matching MRF lines |
— |
$2,601–$2,870 |
— |
| MRI, lumbar spine combo (72158) |
— |
$3,687 |
— |
| Myocardial Spect Multiple Studies (78452) |
— |
$5,773 |
— |
| Neck soft tissue (70360) |
— |
$307 |
— |
| Ob us nuchal meas 1 gest (76813) |
— |
$336 |
— |
| Parathyroid Planar Imaging (78070) |
— |
$1,402 |
— |
| Pelvis 1 or 2 views (72170) |
— |
$371 |
— |
| Pet Image W/Ct Lmtd (78814) |
— |
$6,118 |
— |
| PET image w/CT, full body (78816) |
— |
$6,415 |
— |
| PET imaging CT attenuation skull base mid-thigh (78815) |
— |
$6,919 |
— |
| Pulmonary Perfusion Imaging Particulate (78580) |
— |
$1,008 |
— |
| Radex Abd Compl Aqt Abd W/S/E/D Views 1 View Ch (74022) |
— |
$527 |
— |
| Radex abscess/fistula/sinus tract rs&i (76080) |
— |
$422 |
— |
| Radex Ankle Complete Minimum 3 Views (73610) |
— |
$355 |
— |
| Radex Calcaneus Minimum 2 Views (73650) |
— |
$307 |
— |
| Radex elbow complete minimum 3 views (73080) |
— |
$307 |
— |
| Radex Facial Bones Complete Minimum 3 Views (70150) |
— |
$490 |
— |
| Radex fingr minimum 2 views (73140) |
— |
$307 |
— |
| Radex foot complete minimum 3 views (73630) |
— |
$318 |
— |
| Radex Hand Minimum 3 Views (73130) |
— |
$307 |
— |
| Radex Mastoids Compl Minimum 3 Views PR Side (70130) |
— |
$271 |
— |
| Radex Nasal Bones Complete Minimum 3 Views (70160) |
— |
$307 |
— |
Radex Ribs Unilateral 2 Views (71100)
range across 3 matching MRF lines |
— |
$276–$307 |
— |
| Radex shoulder complete minimum 2 views (73030) |
— |
$307 |
— |
| Radex Sinuses Paransl < 3 Views (70210) |
— |
$214 |
— |
| Radex sm int w/mlt srl imges via enteroclss tube (74251) |
— |
$384 |
— |
| Radex Spine 1 View Specify Level (72020) |
— |
$220 |
— |
| Radex Sternum Minimum 2 Views (71120) |
— |
$307 |
— |
| Radex Temporomandble Jt Opn & Clsd Mouth Bilat (70330) |
— |
$314 |
— |
| Radex Toe Minimum 2 Views (73660) |
— |
$307 |
— |
| Radex Wrist Complete Minimum 3 Views (73110) |
— |
$324 |
— |
| Radiolog exam mandible compl minimum 4 views (70110) |
— |
$371 |
— |
| Radiologic exam colon double contrast study (74280) |
— |
$778 |
— |
| Radiologic exam colon single contrast study (74270) |
— |
$562 |
— |
| Radiologic Exam Esophagus Double Contrast Study (74221) |
— |
$196 |
— |
| Radiologic exam knee complete 4/more views (73564) |
— |
$430 |
— |
| Radiologic Exam Small Int Single Contrast Study (74250) |
— |
$570 |
— |
| Radiologic exam swallow function contrast study (74230) |
— |
$621 |
— |
| Radiologic exam upr gi trc double contrast study (74246) |
— |
$598 |
— |
| Radiologic examination femur minimum 2 views (73552) |
— |
$307 |
— |
| Radiologic examination knee 1/2 views (73560) |
— |
$307 |
— |
Radiologic examination tibia & fibula 2 views (73590)
range across 2 matching MRF lines |
— |
$244–$307 |
— |
| Ribs bilateral 3 views (71110) |
— |
$371 |
— |
| Scapula (73010) |
— |
$371 |
— |
| Screening Digital Breast Tomosynthesis Bi (77063) |
— |
$383 |
— |
| Sella turcica (70240) |
— |
$188 |
— |
| Sialogram (70390) |
— |
$412 |
— |
| Skull less than 4 views (70250) |
— |
$245 |
— |
| Sternoclavicular joints (71130) |
— |
$290 |
— |
| Thoracic spine 2 views (72070) |
— |
$274 |
— |
| Thoracic spine 3 views (72072) |
— |
$371 |
— |
| Thoracolumbar 2 views (72080) |
— |
$307 |
— |
| Thyroid Uptake Measurement (78012) |
— |
$949 |
— |
| Ultrasound Breast Limited (76642) |
— |
$605 |
— |
| Ultrasound Exam Aaa Screen (76706) |
— |
$371 |
— |
Ultrasound, abdomen limited (76705)
range across 5 matching MRF lines |
— |
$660–$878 |
— |
| Upper gi w/o kub (74240) |
— |
$514 |
— |
| Urethrocystogram voiding (74455) |
— |
$537 |
— |
| Us breast unilateral complete (76641) |
— |
$665 |
— |
| Us chest (76604) |
— |
$471 |
— |
| Us exam, pelvic, limited (76857) |
— |
$583 |
— |
| Us lmtd joint/oth nonvasc xtr strux r-t w/img (76882) |
— |
$537 |
— |
| Us ob detailed single fetus (76811) |
— |
$640 |
— |
| Us ob limited 1 or more fetuses (76815) |
— |
$623 |
— |
| Us ob transvaginal (76817) |
— |
$371 |
— |
Us pelvic non ob complete (76856)
range across 3 matching MRF lines |
— |
$599–$828 |
— |
| Us pg uter img f&mat 14 wk tabdl 1/1st gestation (76801) |
— |
$255 |
— |
| Us preg uterus real time f/u trnsabdl per fetus (76816) |
— |
$180 |
— |
| Us retroperitoneal complete (76770) |
— |
$642 |
— |
Us retroperitoneal limited (76775)
range across 3 matching MRF lines |
— |
$285–$642 |
— |
| Us scrotum and contents (76870) |
— |
$621 |
— |
| Us thyroid (76536) |
— |
$709 |
— |
| Venography extremity bilateral rs&i (75822) |
— |
$2,197 |
— |
| Venography extremity unilateral rs&i (75820) |
— |
$1,763 |
— |
| Wrist 2 views (73100) |
— |
$307 |
— |
| X-Ray Ac Jts - Xr Acromioclavicular Joints Bilateral (73050) |
— |
$198 |
— |
| X-ray antegrade pyelogram tube (74425) |
— |
$341 |
— |
| X-Ray Bend Only L-S Spine (72120) |
— |
$350 |
— |
| X-Ray Elbow 2 Vw - Xr Elbow 1-2 Views Right (73070) |
— |
$307 |
— |
| X-Ray Exam Breast Specimen (76098) |
— |
$608 |
— |
| X-Ray Exam Entire Spi 2/3 Vw (72082) |
— |
$375 |
— |
| X-Ray Exam Hip Uni 2-3 Views (73502) |
— |
$307 |
— |
| X-Ray Exam Hips Bi 3-4 Views (73522) |
— |
$347 |
— |
| X-Ray Exam L-S Spine Bending (72114) |
— |
$371 |
— |
| X-Ray Exam Neck Spine 2-3 Vw (72040) |
— |
$299 |
— |
| X-Ray Exam Neck Spine 6/>Vws (72052) |
— |
$474 |
— |
| X-Ray Exam Unilat Ribs/Chest (71101) |
— |
$371 |
— |
| X-ray humerus (73060) |
— |
$307 |
— |
| X-Ray Jaw <4 Vw - Xr Mandible < 4 Views (70100) |
— |
$258 |
— |
| X-Ray Knee Bilat Standing - Xr Knees Anteroposterior Standing Bilat (73565) |
— |
$200 |
— |
X-Ray Lumbar Spine 2/3 Vw - Xr Lumbar Spine 2-3 Views (72100)
range across 2 matching MRF lines |
— |
$236–$365 |
— |
| X-Ray Ribs, Chest 4+ Vw - Xr Ribs 3 Vws Bil W/ Chest Posteroanterior (71111) |
— |
$519 |
— |
| X-Ray Sacroiliac Jts 3+ Vw - Xr Sacroiliac Joints 3+ Views (72202) |
— |
$371 |
— |
| X-Ray Sacrum/Coccyx 2+ Vw - Xr Sacrum Coccyx 2+ Views (72220) |
— |
$307 |
— |
| X-Ray Sinuses 3+ Vw - Xr Paranasal Sinuses 3+ Views (70220) |
— |
$320 |
— |
| X-Ray Skull 4+ Vw - Xr Skull Complete 4+ Views (70260) |
— |
$383 |
— |
| X-Ray Urinary Tract Exam With Contrast Material (74420) |
— |
$1,246 |
— |
| X-Rays Bone Length Studies (77073) |
— |
$371 |
— |
X-Rays Bone Survey Complete (77075)
range across 2 matching MRF lines |
— |
$349–$556 |
— |
Xr c-spine 4 or 5 views (72050)
range across 2 matching MRF lines |
— |
$432–$490 |
— |
| Xr facial bones less than 3 views (70140) |
— |
$375 |
— |
| Xr orbits complete 4 views (70200) |
— |
$371 |
— |