Abdomen 1 View (74018)
range across 2 matching MRF lines |
— |
$218.56–$304.50 |
— |
| Abdomen 2 views (74019) |
— |
$269.81 |
— |
| Acute Gastrointestinal Blood Loss Imaging (78278) |
— |
$962.48 |
— |
| Ankle 2 views (73600) |
— |
$239.25 |
— |
| Arthrogram ankle (73615) |
— |
$940.23 |
— |
| Arthrogram hip (73525) |
— |
$940.23 |
— |
| Arthrogram Wrist (73115) |
— |
$940.23 |
— |
| Bone age studies (77072) |
— |
$188.50 |
— |
| Bone Imaging 3 Phase (78315) |
— |
$962.48 |
— |
| Bone Imaging Limited Area (78300) |
— |
$962.48 |
— |
| Bone Imaging Whole Body (78306) |
— |
$962.48 |
— |
| Bone survey infant (77076) |
— |
$313.63 |
— |
| Chest 1 view (71045) |
— |
$188.50 |
— |
| Chest 2 views (71046) |
— |
$245 |
— |
| Chest 3 views (71047) |
— |
$206.53 |
— |
| Chest 4 or more views (71048) |
— |
$277.98 |
— |
| Cholecystography Oral Contrast (74290) |
— |
$456.08 |
— |
Clavicle complete (73000)
range across 3 matching MRF lines |
— |
$206.53–$286 |
— |
| Computed Tomography Thorax Lw Dose Lng Ca Scr C- (71271) |
— |
$1,032.81 |
— |
| Contrast X-Ray Bladder (74430) |
— |
$940.23 |
— |
| Contrast X-Ray Of Elbow (73085) |
— |
$940.23 |
— |
| Contrast X-Ray Of Knee Joint (73580) |
— |
$940.23 |
— |
| CT abdomen and pelvis without and with contrast (74178) |
— |
$2,604.09 |
— |
| CT abdomen and pelvis without contrast (74176) |
— |
$1,362.25 |
— |
| CT abdomen w contrast (74160) |
— |
$1,790.69 |
— |
| CT abdomen w wo contrast (74170) |
— |
$2,010.22 |
— |
| CT abdomen w/o contrast (74150) |
— |
$1,022 |
— |
| CT Angio Chest (71275) |
— |
$2,128.43 |
— |
| CT Angio Head (70496) |
— |
$2,090.32 |
— |
| Ct Angio Lwr Extr W/O&W/Dye (73706) |
— |
$2,459.84 |
— |
| CT Angio Neck (70498) |
— |
$2,087.82 |
— |
| Ct Angio Upr Extrm W/O&W/Dye (73206) |
— |
$2,259.25 |
— |
| CT cervical spine w/ contrast (72126) |
— |
$1,271.13 |
— |
| CT cervical spine w/o contrast (72125) |
— |
$974.37 |
— |
| CT cervical spine w/wo cont (72127) |
— |
$1,494.56 |
— |
| CT chest w contrast (71260) |
— |
$1,257.87 |
— |
| CT chest w/wo contrast (71270) |
— |
$1,486.65 |
— |
| CT head/brain with contrast (70460) |
— |
$1,111.63 |
— |
| CT head/brain without and with contrast (70470) |
— |
$1,308.66 |
— |
| CT iac w contrast (70481) |
— |
$1,369.86 |
— |
| CT l-spine w&w/o contrast (72133) |
— |
$1,499.56 |
— |
| CT lower ext w/o (73700) |
— |
$971.88 |
— |
| CT lower extremity w/contrast material (73701) |
— |
$1,257.88 |
— |
| CT lumbar spine w contrast (72132) |
— |
$1,273.62 |
— |
| CT lumbar spine w/o contrast (72131) |
— |
$969.37 |
— |
CT maxillofacial w contrast (70487)
range across 2 matching MRF lines |
— |
$1,144.65–$1,396.81 |
— |
| CT maxillofacial wo contrast (70486) |
— |
$968.81 |
— |
| CT neck tissue combo (70492) |
— |
$1,673.93 |
— |
| Ct Orbit/Ear/Fossa W/O&W/Dye (70482) |
— |
$1,599.93 |
— |
| CT orbits w/o contrast (70480) |
— |
$1,189 |
— |
| CT pelvis w&w/o contrast (72194) |
— |
$1,946.25 |
— |
| CT pelvis w/o contrast (72192) |
— |
$997.37 |
— |
| CT scan of leg combo (73702) |
— |
$1,479.44 |
— |
| CT scans face/jaw combo (70488) |
— |
$1,117.35 |
— |
| CT soft tissue neck w contrast (70491) |
— |
$1,390.90 |
— |
| CT soft tissue neck w/o contrast (70490) |
— |
$1,123.81 |
— |
| CT thoracic spine w contrast (72129) |
— |
$1,280.19 |
— |
| CT thoracic spine w/o contrast (72128) |
— |
$974.37 |
— |
| CT thoracic spine w/wo cont (72130) |
— |
$1,509.63 |
— |
| CT thorax w/o contrast (71250) |
— |
$997.37 |
— |
| CT upper ext wo (73200) |
— |
$1,227.87 |
— |
| CT upper extremity w/o & w/contrast material (73202) |
— |
$1,911.13 |
— |
| CT upper extremity with contrast (73201) |
— |
$1,533.93 |
— |
| Cta Abdl Aorta&Bi Iliofem W/Contrast&Postp (75635) |
— |
$3,108.16 |
— |
| Cta Abdomen (74175) |
— |
$2,331.69 |
— |
| Doppler Echo Fetal Spectral Display Complete (76827) |
— |
$277.98 |
— |
| Doppler Fetal Mid Cerebral Artery (76821) |
— |
$277.98 |
— |
| Dxa Bone Density Axial (77080) |
— |
$277.98 |
— |
| Dxa bone density study (77085) |
— |
$277.98 |
— |
| Dxa bone density study 1/>sites appendiclr skel (77081) |
— |
$206.53 |
— |
| Echo exam of fetal heart (76825) |
— |
$1,233.70 |
— |
| Echo exam uterus (76831) |
— |
$587.50 |
— |
| Fetal MRI w/placntl matrnl plvc img sing/1st ges (74712) |
— |
$3,108.06 |
— |
| Fluoroscopy up to 1 hr (76000) |
— |
$587.50 |
— |
Foot 2 views (73620)
range across 3 matching MRF lines |
— |
$206.53–$206.63 |
— |
| Forearm 2 views (73090) |
— |
$214.18 |
— |
| Gastric emptying imaging study (78264) |
— |
$962.48 |
— |
| Gastric Emptyng Imag Std W/Sm Bwl Transit (78265) |
— |
$962.48 |
— |
| Gated Heart, Multiple (78473) |
— |
$962.48 |
— |
| Hand 2 views (73120) |
— |
$229.25 |
— |
| Heart first pass single,planar (78481) |
— |
$1,249.45 |
— |
| Hepatobil Syst Image W/Drug (78227) |
— |
$1,249.45 |
— |
| Ht Muscle Image Spect Sing (78451) |
— |
$3,336.55 |
— |
| Hysterosalpingogram (74740) |
— |
$587.50 |
— |
| Infant hip ultrasound with hip movement (dynamic) (76885) |
— |
$1,006.25 |
— |
| K Flow/Funct Image W/Drug (78708) |
— |
$1,249.45 |
— |
| Kidney Imaging Morphoogy W/Vascular Flow (78701) |
— |
$962.48 |
— |
Knee 3 Views (73562)
range across 4 matching MRF lines |
— |
$206.53–$300 |
— |
| Liver & Spleen Imaging Static Only (78215) |
— |
$962.48 |
— |
| Lung Ventilat&Perfus Imaging (78582) |
— |
$1,249.45 |
— |
| Lymph System Imaging (78195) |
— |
$1,249.45 |
— |
| Magnetic Image Jaw Joint (70336) |
— |
$2,031.96 |
— |
| Mammary ductogram or galactogram multiple (77054) |
— |
$587.50 |
— |
| Mammary ductogram or galactogram single (77053) |
— |
$587.50 |
— |
| Meckels Divert Exam (78290) |
— |
$962.48 |
— |
| Mra Head W/O & W/Contrast Material (70546) |
— |
$2,526.96 |
— |
MRA head w/o contrast (70544)
range across 2 matching MRF lines |
— |
$1,643.18–$1,645.19 |
— |
| MRA head with contrast (70545) |
— |
$1,736.59 |
— |
| MRA neck w contrast (70548) |
— |
$1,871.32 |
— |
| Mra Neck W/O &W/Contrast Material (70549) |
— |
$2,641 |
— |
| MRA neck w/o contrast (70547) |
— |
$1,645.68 |
— |
| MRI abdomen w contrast (74182) |
— |
$2,319.32 |
— |
| MRI abdomen w/o contrast (74181) |
— |
$1,485.43 |
— |
| MRI any jt lower extrem w/contrast material (73722) |
— |
$2,411.85 |
— |
| MRI any jt lower extrem w/o & w/contrast matrl (73723) |
— |
$2,969.09 |
— |
| MRI any jt upper extremity w/contrast matrl (73222) |
— |
$2,409.32 |
— |
| MRI bone marrow blood supply (77084) |
— |
$587.50 |
— |
| MRI Breast W/O Contrast Bilateral (77047) |
— |
$587.50 |
— |
| MRI Breast Without Contrast Material Unilateral (77046) |
— |
$587.50 |
— |
| MRI cervical spine w contrast (72142) |
— |
$2,096.44 |
— |
MRI cervical spine w/o cont (72141)
range across 2 matching MRF lines |
— |
$876.57–$1,437.19 |
— |
| MRI chest w/o contrast (71550) |
— |
$2,612.88 |
— |
| MRI chest with contrast (71551) |
— |
$2,884 |
— |
| MRI chest wo w contrast (71552) |
— |
$3,641.88 |
— |
| MRI lower extrem oth/thn jt w/contrast matrl (73719) |
— |
$2,005.25 |
— |
| MRI lower extrem oth/thn jt w/o & w/contr matr (73720) |
— |
$2,576.94 |
— |
| MRI lower extrem oth/thn jt w/o contr matrl (73718) |
— |
$1,708 |
— |
| MRI lumbar spine w contrast (72149) |
— |
$2,059.90 |
— |
| Mri Neck Spine W/O & W/Dye (72156) |
— |
$2,428.75 |
— |
MRI orbit face &/neck w/o contrast (70540)
range across 3 matching MRF lines |
— |
$587.50–$1,728.13 |
— |
| MRI orbit face neck w contrast (70542) |
— |
$2,052.91 |
— |
Mri Orbt/Fac/Nck W/O &W/Dye (70543)
range across 2 matching MRF lines |
— |
$940.23–$2,587 |
— |
| MRI pelvis w contrast (72196) |
— |
$2,050.22 |
— |
| MRI pelvis w/o & w contrast (72197) |
— |
$2,572.96 |
— |
| MRI pelvis w/o contrast (72195) |
— |
$1,746.46 |
— |
MRI thoracic spine w/o contrast (72146)
range across 2 matching MRF lines |
— |
$876.57–$1,437.19 |
— |
| MRI upper extremity oth than jt w/contr matrl (73219) |
— |
$2,557.94 |
— |
| MRI upper extremity oth than jt w/o contr matrl (73218) |
— |
$2,346.06 |
— |
| Mri Uppr Extremity W/O&W/Dye (73220) |
— |
$3,156.72 |
— |
| MRI, abdomen, combo (74183) |
— |
$2,583 |
— |
| MRI, dorsal spine combo (72157) |
— |
$2,433.78 |
— |
| MRI, dorsal spine contrast (72147) |
— |
$2,078.88 |
— |
| MRI, joint upper extrem (73221) |
— |
$1,537 |
— |
| MRI, joint upper extrem combo (73223) |
— |
$2,976 |
— |
| MRI, lumbar spine combo (72158) |
— |
$2,423.75 |
— |
| Myocardial Imaging Infarct Avid Planar Qual/Quan (78466) |
— |
$962.48 |
— |
| Myocardial Spect Multiple Studies (78452) |
— |
$3,336.55 |
— |
| Neck soft tissue (70360) |
— |
$231.13 |
— |
| Nm unlisted gi procedure (78299) |
— |
$962.48 |
— |
| Pelvis 1 or 2 views (72170) |
— |
$203.88 |
— |
| Pulmonary Perfusion Imaging Particulate (78580) |
— |
$962.48 |
— |
| Radex Abd Compl Aqt Abd W/S/E/D Views 1 View Ch (74022) |
— |
$364.06 |
— |
| Radex abscess/fistula/sinus tract rs&i (76080) |
— |
$1,233.70 |
— |
Radex Ankle Complete Minimum 3 Views (73610)
range across 3 matching MRF lines |
— |
$206.53–$271.63 |
— |
| Radex Calcaneus Minimum 2 Views (73650) |
— |
$209.13 |
— |
Radex elbow complete minimum 3 views (73080)
range across 3 matching MRF lines |
— |
$206.53–$238.96 |
— |
| Radex Facial Bones Complete Minimum 3 Views (70150) |
— |
$345.75 |
— |
| Radex fingr minimum 2 views (73140) |
— |
$224.25 |
— |
Radex foot complete minimum 3 views (73630)
range across 3 matching MRF lines |
— |
$206.53–$251.54 |
— |
Radex Hand Minimum 3 Views (73130)
range across 3 matching MRF lines |
— |
$206.53–$284.23 |
— |
| Radex lower extremity infant minimum 2 views (73592) |
— |
$231.75 |
— |
| Radex Mastoids Compl Minimum 3 Views PR Side (70130) |
— |
$458.75 |
— |
| Radex Nasal Bones Complete Minimum 3 Views (70160) |
— |
$281.63 |
— |
| Radex Ribs Unilateral 2 Views (71100) |
— |
$263.75 |
— |
Radex shoulder complete minimum 2 views (73030)
range across 3 matching MRF lines |
— |
$206.53–$253.73 |
— |
Radex Sinuses Paransl < 3 Views (70210)
range across 2 matching MRF lines |
— |
$206.53–$236.48 |
— |
| Radex Spine 1 View Specify Level (72020) |
— |
$206.53 |
— |
| Radex Sternum Minimum 2 Views (71120) |
— |
$245.63 |
— |
| Radex Temporomandble Jt Opn & Clsd Mouth Bilat (70330) |
— |
$387.75 |
— |
| Radex Toe Minimum 2 Views (73660) |
— |
$215.06 |
— |
| Radex upper extremity infant minimum 2 views (73092) |
— |
$231.75 |
— |
Radex Wrist Complete Minimum 3 Views (73110)
range across 5 matching MRF lines |
— |
$206.53–$301.72 |
— |
| Radex X-Ray Exam Entire Spi 6/> Vw - Xr Entire Spine 6+ Vw (72084) |
— |
$277.98 |
— |
| Radiolog exam mandible compl minimum 4 views (70110) |
— |
$316.88 |
— |
| Radiologic Exam Abdomen 3+ Views - Xr Abdomen 3+ Views (74021) |
— |
$313.81 |
— |
| Radiologic exam colon double contrast study (74280) |
— |
$456.08 |
— |
| Radiologic exam colon single contrast study (74270) |
— |
$456.08 |
— |
| Radiologic Exam Esophagus Double Contrast Study (74221) |
— |
$456.08 |
— |
Radiologic exam knee complete 4/more views (73564)
range across 3 matching MRF lines |
— |
$277.98–$342.88 |
— |
| Radiologic exam pelvis compl minimum 3 views (72190) |
— |
$309.38 |
— |
| Radiologic Exam Small Int Single Contrast Study (74250) |
— |
$456.08 |
— |
| Radiologic exam swallow function contrast study (74230) |
— |
$456.08 |
— |
| Radiologic exam upr gi trc double contrast study (74246) |
— |
$456.08 |
— |
| Radiologic examination femur 1 view (73551) |
— |
$216.25 |
— |
| Radiologic examination femur minimum 2 views (73552) |
— |
$261.25 |
— |
| Radiologic examination knee 1/2 views (73560) |
— |
$251.81 |
— |
Radiologic examination tibia & fibula 2 views (73590)
range across 3 matching MRF lines |
— |
$206.53–$231.75 |
— |
| Ribs bilateral 3 views (71110) |
— |
$320.75 |
— |
| Rp loclzj tum spect 2 area/sep acquisj img (78831) |
— |
$3,336.55 |
— |
| Scapula (73010) |
— |
$171.19 |
— |
| Screening Digital Breast Tomosynthesis Bi (77063) |
— |
$122.05 |
— |
| Shoulder 1 view (73020) |
— |
$156.75 |
— |
| Shoulder Arthrography (73040) |
— |
$940.23 |
— |
| Skull less than 4 views (70250) |
— |
$263.75 |
— |
| Speech evaluation, complex (70371) |
— |
$587.50 |
— |
| Sternoclavicular joints (71130) |
— |
$302.75 |
— |
| Therapeutic Enema Rdctj Intussusception/Obstrcj (74283) |
— |
$456.08 |
— |
| Thoracic spine 3 views (72072) |
— |
$287.38 |
— |
| Thoracolumbar 2 views (72080) |
— |
$206.53 |
— |
| Thyroid Imaging With Vascular Flow (78013) |
— |
$962.48 |
— |
| Thyroid Met Imaging Body (78018) |
— |
$568 |
— |
| Thyroid Uptake Measurement (78012) |
— |
$962.48 |
— |
| Thyroid Uptake W/Blood Flow Sngle/Mult Quan Meas (78014) |
— |
$568 |
— |
| Ultrasound elastography first target lesion (76982) |
— |
$277.98 |
— |
| Ultrasound Elastography Parenchyma (76981) |
— |
$277.98 |
— |
| Umbilical-artery Doppler (OB) (76820) |
— |
$277.98 |
— |
| Upper gi w/o kub (74240) |
— |
$456.08 |
— |
| Ureteral Reflux Study (78740) |
— |
$962.48 |
— |
Urethrocystogram voiding (74455)
range across 2 matching MRF lines |
— |
$587.50–$778.81 |
— |
| Urethrocystography retrograde (74450) |
— |
$587.50 |
— |
| Us breast unilateral complete (76641) |
— |
$277.98 |
— |
| Us chest (76604) |
— |
$277.98 |
— |
| Us complete joint (76881) |
— |
$372.50 |
— |
| Us exam, pelvic, limited (76857) |
— |
$277.98 |
— |
| Us lmtd joint/oth nonvasc xtr strux r-t w/img (76882) |
— |
$290.91 |
— |
| Us pelvic non ob complete (76856) |
— |
$772.78 |
— |
| Us retroperitoneal complete (76770) |
— |
$635.10 |
— |
| Us scrotum and contents (76870) |
— |
$739.13 |
— |
| Us transrectal (76872) |
— |
$1,489 |
— |
| Vascular Flow Imaging (78445) |
— |
$962.48 |
— |
| Venography extremity unilateral rs&i (75820) |
— |
$3,590.40 |
— |
| Vertebral fracture assessment via dxa (77086) |
— |
$206.53 |
— |
| Wrist 2 views (73100) |
— |
$249.31 |
— |
| X-Ray Ac Jts - Xr Acromioclavicular Joints Bilateral (73050) |
— |
$208.56 |
— |
| X-ray antegrade pyelogram tube (74425) |
— |
$940.23 |
— |
| X-Ray Bend Only L-S Spine (72120) |
— |
$277.98 |
— |
| X-Ray Elbow 2 Vw - Xr Elbow 1-2 Views Right (73070) |
— |
$224.06 |
— |
| X-Ray Exam Breast Specimen (76098) |
— |
$1,233.70 |
— |
| X-Ray Exam Entire Spi 1 Vw (72081) |
— |
$206.53 |
— |
| X-Ray Exam Entire Spi 2/3 Vw (72082) |
— |
$517.20 |
— |
| X-Ray Exam Entire Spi 4/5 Vw (72083) |
— |
$277.98 |
— |
| X-Ray Exam Hip Uni 1 View (73501) |
— |
$192.95 |
— |
| X-Ray Exam Hip Uni 2-3 Views (73502) |
— |
$276.30 |
— |
| X-Ray Exam Hip Uni 4/> Views (73503) |
— |
$277.98 |
— |
| X-Ray Exam Hips Bi 2 Views (73521) |
— |
$302.75 |
— |
| X-Ray Exam Hips Bi 3-4 Views (73522) |
— |
$277.98 |
— |
| X-Ray Exam Hips Bi 5/> Views (73523) |
— |
$277.98 |
— |
| X-Ray Exam L-S Spine Bending (72114) |
— |
$455 |
— |
X-Ray Exam Neck Spine 2-3 Vw (72040)
range across 2 matching MRF lines |
— |
$290.02–$293.94 |
— |
| X-Ray Exam Neck Spine 6/>Vws (72052) |
— |
$457.50 |
— |
| X-Ray Exam Unilat Ribs/Chest (71101) |
— |
$308.78 |
— |
| X-ray eye for foreign body (70030) |
— |
$238.69 |
— |
| X-ray humerus (73060) |
— |
$236.75 |
— |
X-ray IV pyelogram (ivp) (74400)
range across 2 matching MRF lines |
— |
$456.08–$1,008.62 |
— |
| X-Ray Jaw <4 Vw - Xr Mandible < 4 Views (70100) |
— |
$283.75 |
— |
| X-Ray Knee Bilat Standing - Xr Knees Anteroposterior Standing Bilat (73565) |
— |
$294.50 |
— |
| X-Ray Lumbar Spine 2/3 Vw - Xr Lumbar Spine 2-3 Views (72100) |
— |
$292.69 |
— |
| X-ray nose-rectum child f.b. (76010) |
— |
$218.56 |
— |
| X-Ray Sacroiliac Jts 3+ Vw - Xr Sacroiliac Joints 3+ Views (72202) |
— |
$287.38 |
— |
| X-Ray Sacrum/Coccyx 2+ Vw - Xr Sacrum Coccyx 2+ Views (72220) |
— |
$239 |
— |
| X-Ray Sinuses 3+ Vw - Xr Paranasal Sinuses 3+ Views (70220) |
— |
$275.13 |
— |
| X-Ray Skull 4+ Vw - Xr Skull Complete 4+ Views (70260) |
— |
$326.06 |
— |
| X-ray thoracic spine 4 vw (72074) |
— |
$277.98 |
— |
| X-Ray Urinary Tract Exam With Contrast Material (74420) |
— |
$940.23 |
— |
| X-Rays Bone Length Studies (77073) |
— |
$568 |
— |
| X-Rays Bone Survey Complete (77075) |
— |
$730.75 |
— |
| Xr c-spine 4 or 5 views (72050) |
— |
$391.60 |
— |
| Xr facial bones less than 3 views (70140) |
— |
$235.88 |
— |
| XR Mastoids < 3 Views Bilateral (70120) |
— |
$283.84 |
— |
| Xr orbits complete 4 views (70200) |
— |
$351.15 |
— |