| Abdomen 1 View (74018) |
— |
$411 |
— |
| Abdomen 2 views (74019) |
— |
$533 |
— |
Ankle 2 views (73600)
range across 5 matching MRF lines |
— |
$402–$580 |
— |
| Arthrogram hip (73525) |
— |
$1,189 |
— |
| Arthrogram Wrist (73115) |
— |
$607 |
— |
| Bone age studies (77072) |
— |
$330 |
— |
| Bone Imaging 3 Phase (78315) |
— |
$2,966 |
— |
| Bone Imaging Limited Area (78300) |
— |
$1,657 |
— |
| Bone Imaging Multiple Areas (78305) |
— |
$1,484 |
— |
| Bone Imaging Whole Body (78306) |
— |
$2,797 |
— |
| Bone survey infant (77076) |
— |
$875 |
— |
| Cat Scan Follow-Up Study (76380) |
— |
$2,191 |
— |
| Chest 1 view (71045) |
— |
$375 |
— |
| Chest 2 views (71046) |
— |
$466 |
— |
| Chest 3 views (71047) |
— |
$507 |
— |
| Chest 4 or more views (71048) |
— |
$555 |
— |
Clavicle complete (73000)
range across 5 matching MRF lines |
— |
$391–$624 |
— |
| Computed Tomography Thorax Lw Dose Lng Ca Scr C- (71271) |
— |
$2,636 |
— |
| Contrast X-Ray Bladder (74430) |
— |
$992 |
— |
| Contrast X-Ray Of Elbow (73085) |
— |
$597 |
— |
| CT abdomen and pelvis without and with contrast (74178) |
— |
$9,408 |
— |
| CT abdomen and pelvis without contrast (74176) |
— |
$5,849 |
— |
| CT abdomen w contrast (74160) |
— |
$3,545 |
— |
| CT abdomen w wo contrast (74170) |
— |
$5,157 |
— |
| CT abdomen w/o contrast (74150) |
— |
$3,279 |
— |
| CT Angio Abdomen and Pelvis (74174) |
— |
$7,579 |
— |
| CT Angio Chest (71275) |
— |
$4,414 |
— |
| CT Angio Head (70496) |
— |
$4,116 |
— |
| CT Angio Neck (70498) |
— |
$4,116 |
— |
| CT bone density (77078) |
— |
$24 |
— |
| CT cervical spine w/ contrast (72126) |
— |
$3,462 |
— |
| CT cervical spine w/o contrast (72125) |
— |
$3,544 |
— |
| CT cervical spine w/wo cont (72127) |
— |
$3,806 |
— |
| CT chest w contrast (71260) |
— |
$3,839 |
— |
| CT chest w/wo contrast (71270) |
— |
$4,236 |
— |
| CT head/brain with contrast (70460) |
— |
$2,472 |
— |
| CT head/brain without and with contrast (70470) |
— |
$3,283 |
— |
| CT iac w contrast (70481) |
— |
$4,358 |
— |
| CT l-spine w&w/o contrast (72133) |
— |
$3,225 |
— |
| CT lower ext w/o (73700) |
— |
$2,960 |
— |
| CT lower extremity w/contrast material (73701) |
— |
$2,915 |
— |
| CT lumbar spine w contrast (72132) |
— |
$3,554 |
— |
| CT lumbar spine w/o contrast (72131) |
— |
$3,247 |
— |
| CT maxillofacial w contrast (70487) |
— |
$2,851 |
— |
| CT maxillofacial wo contrast (70486) |
— |
$2,519 |
— |
| CT neck tissue combo (70492) |
— |
$3,806 |
— |
| Ct Orbit/Ear/Fossa W/O&W/Dye (70482) |
— |
$3,736 |
— |
| CT orbits w/o contrast (70480) |
— |
$3,757 |
— |
| CT pelvis w&w/o contrast (72194) |
— |
$3,485 |
— |
| CT pelvis w/o contrast (72192) |
— |
$3,883 |
— |
| CT scan of leg combo (73702) |
— |
$3,633 |
— |
| CT scans face/jaw combo (70488) |
— |
$3,385 |
— |
| CT soft tissue neck w contrast (70491) |
— |
$3,681 |
— |
| CT soft tissue neck w/o contrast (70490) |
— |
$3,653 |
— |
| CT thoracic spine w contrast (72129) |
— |
$3,856 |
— |
| CT thoracic spine w/o contrast (72128) |
— |
$3,425 |
— |
| CT thoracic spine w/wo cont (72130) |
— |
$3,889 |
— |
| CT thorax w/o contrast (71250) |
— |
$3,027 |
— |
| CT upper ext wo (73200) |
— |
$2,718 |
— |
| CT upper extremity w/o & w/contrast material (73202) |
— |
$3,633 |
— |
| CT upper extremity with contrast (73201) |
— |
$3,249 |
— |
| Cta Abdl Aorta&Bi Iliofem W/Contrast&Postp (75635) |
— |
$5,045 |
— |
| Cta Abdomen (74175) |
— |
$4,345 |
— |
Dxa Bone Density Axial (77080)
range across 4 matching MRF lines |
— |
$74–$795 |
— |
Dxa bone density study (77085)
range across 4 matching MRF lines |
— |
$29–$764 |
— |
Dxa bone density study 1/>sites appendiclr skel (77081)
range across 4 matching MRF lines |
— |
$19–$340 |
— |
| Fetal Biophys Profile W/Nst (76818) |
— |
$945 |
— |
| Fetal Biophysical Profile W/O Non-Stress Testing (76819) |
— |
$685 |
— |
Fluoroscopy up to 1 hr (76000)
range across 4 matching MRF lines |
— |
$34–$1,014 |
— |
Foot 2 views (73620)
range across 5 matching MRF lines |
— |
$350–$559 |
— |
Forearm 2 views (73090)
range across 5 matching MRF lines |
— |
$457–$730 |
— |
| Gastric emptying imaging study (78264) |
— |
$2,966 |
— |
| Gated Heart Planar Single (78472) |
— |
$2,497 |
— |
Hand 2 views (73120)
range across 5 matching MRF lines |
— |
$432–$624 |
— |
| Hepatobil Syst Image W/Drug (78227) |
— |
$4,893 |
— |
| Ht Muscle Image Spect Sing (78451) |
— |
$5,671 |
— |
| K Flow/Funct Image W/Drug (78708) |
— |
$2,356 |
— |
| K Flow/Funct Image W/O Drug (78707) |
— |
$2,018 |
— |
Knee 3 Views (73562)
range across 5 matching MRF lines |
— |
$553–$815 |
— |
| Liver & Spleen Imaging Static Only (78215) |
— |
$2,828 |
— |
| Liver & Spleen Imaging W/Vascular Flow (78216) |
— |
$2,828 |
— |
| Lung Ventilat&Perfus Imaging (78582) |
— |
$4,038 |
— |
| Magnetic Image Jaw Joint (70336) |
— |
$4,446 |
— |
| Meckels Divert Exam (78290) |
— |
$1,771 |
— |
| MRA head w/o contrast (70544) |
— |
$5,414 |
— |
| MRA neck w contrast (70548) |
— |
$4,228 |
— |
| Mra Neck W/O &W/Contrast Material (70549) |
— |
$8,356 |
— |
| MRA neck w/o contrast (70547) |
— |
$4,523 |
— |
| MRI abdomen w contrast (74182) |
— |
$5,656 |
— |
| MRI abdomen w/o contrast (74181) |
— |
$4,968 |
— |
| MRI any jt lower extrem w/contrast material (73722) |
— |
$2,936 |
— |
| MRI any jt lower extrem w/o & w/contrast matrl (73723) |
— |
$5,993 |
— |
| MRI any jt upper extremity w/contrast matrl (73222) |
— |
$4,269 |
— |
| MRI cervical spine w contrast (72142) |
— |
$5,656 |
— |
| MRI cervical spine w/o cont (72141) |
— |
$4,636 |
— |
| MRI chest w/o contrast (71550) |
— |
$5,354 |
— |
| MRI chest with contrast (71551) |
— |
$5,656 |
— |
| MRI chest wo w contrast (71552) |
— |
$5,958 |
— |
| MRI lower extrem oth/thn jt w/o & w/contr matr (73720) |
— |
$5,308 |
— |
| MRI lower extrem oth/thn jt w/o contr matrl (73718) |
— |
$3,964 |
— |
| MRI lumbar spine w contrast (72149) |
— |
$5,438 |
— |
| Mri Neck Spine W/O & W/Dye (72156) |
— |
$6,018 |
— |
| MRI orbit face &/neck w/o contrast (70540) |
— |
$4,853 |
— |
| MRI orbit face neck w contrast (70542) |
— |
$5,354 |
— |
| Mri Orbt/Fac/Nck W/O &W/Dye (70543) |
— |
$6,907 |
— |
| MRI pelvis w contrast (72196) |
— |
$5,047 |
— |
| MRI pelvis w/o & w contrast (72197) |
— |
$5,904 |
— |
| MRI pelvis w/o contrast (72195) |
— |
$5,516 |
— |
| MRI thoracic spine w/o contrast (72146) |
— |
$4,722 |
— |
| MRI upper extremity oth than jt w/o contr matrl (73218) |
— |
$3,690 |
— |
| Mri Uppr Extremity W/O&W/Dye (73220) |
— |
$5,907 |
— |
| MRI, abdomen, combo (74183) |
— |
$5,837 |
— |
| MRI, dorsal spine combo (72157) |
— |
$6,129 |
— |
| MRI, dorsal spine contrast (72147) |
— |
$5,656 |
— |
| MRI, joint upper extrem (73221) |
— |
$3,841 |
— |
| MRI, joint upper extrem combo (73223) |
— |
$4,794 |
— |
| MRI, lumbar spine combo (72158) |
— |
$5,878 |
— |
| Myelogram Lumbar (72265) |
— |
$1,644 |
— |
| Myocardial Perfusion Planar 1 Study Rest/Stress (78453) |
— |
$1,918 |
— |
| Myocardial Spect Multiple Studies (78452) |
— |
$7,524 |
— |
| Neck soft tissue (70360) |
— |
$500 |
— |
| Optic foramina (70190) |
— |
$405 |
— |
| Parathyroid Planar Imaging (78070) |
— |
$2,305 |
— |
| Pelvis 1 or 2 views (72170) |
— |
$435 |
— |
| Pet Image W/Ct Lmtd (78814) |
— |
$8,972 |
— |
| PET image w/CT, full body (78816) |
— |
$9,840 |
— |
| PET imaging CT attenuation skull base mid-thigh (78815) |
— |
$9,551 |
— |
| Pulmonary Perfusion Imaging Particulate (78580) |
— |
$1,766 |
— |
| Radex Abd Compl Aqt Abd W/S/E/D Views 1 View Ch (74022) |
— |
$720 |
— |
| Radex abscess/fistula/sinus tract rs&i (76080) |
— |
$1,398 |
— |
Radex Ankle Complete Minimum 3 Views (73610)
range across 5 matching MRF lines |
— |
$454–$722 |
— |
Radex Calcaneus Minimum 2 Views (73650)
range across 5 matching MRF lines |
— |
$354–$506 |
— |
Radex elbow complete minimum 3 views (73080)
range across 5 matching MRF lines |
— |
$501–$777 |
— |
| Radex Facial Bones Complete Minimum 3 Views (70150) |
— |
$648 |
— |
| Radex fingr minimum 2 views (73140) |
— |
$343 |
— |
Radex foot complete minimum 3 views (73630)
range across 5 matching MRF lines |
— |
$461–$726 |
— |
Radex Hand Minimum 3 Views (73130)
range across 5 matching MRF lines |
— |
$463–$726 |
— |
| Radex lower extremity infant minimum 2 views (73592) |
— |
$295 |
— |
| Radex Mastoids Compl Minimum 3 Views PR Side (70130) |
— |
$457 |
— |
| Radex Nasal Bones Complete Minimum 3 Views (70160) |
— |
$486 |
— |
| Radex Ribs Unilateral 2 Views (71100) |
— |
$453 |
— |
Radex shoulder complete minimum 2 views (73030)
range across 5 matching MRF lines |
— |
$505–$807 |
— |
| Radex Sinuses Paransl < 3 Views (70210) |
— |
$561 |
— |
| Radex Spine 1 View Specify Level (72020) |
— |
$478 |
— |
| Radex Sternum Minimum 2 Views (71120) |
— |
$484 |
— |
| Radex Temporomandble Jt Opn & Clsd Mouth Bilat (70330) |
— |
$585 |
— |
| Radex Toe Minimum 2 Views (73660) |
— |
$374 |
— |
| Radex upper extremity infant minimum 2 views (73092) |
— |
$379 |
— |
Radex Wrist Complete Minimum 3 Views (73110)
range across 5 matching MRF lines |
— |
$453–$720 |
— |
| Radex X-Ray Exam Entire Spi 6/> Vw - Xr Entire Spine 6+ Vw (72084) |
— |
$1,355 |
— |
| Radiolog exam mandible compl minimum 4 views (70110) |
— |
$707 |
— |
Radiologic exam knee complete 4/more views (73564)
range across 5 matching MRF lines |
— |
$516–$825 |
— |
| Radiologic exam pelvis compl minimum 3 views (72190) |
— |
$515 |
— |
Radiologic examination femur 1 view (73551)
range across 5 matching MRF lines |
— |
$392–$627 |
— |
Radiologic examination femur minimum 2 views (73552)
range across 5 matching MRF lines |
— |
$495–$762 |
— |
Radiologic examination knee 1/2 views (73560)
range across 5 matching MRF lines |
— |
$461–$736 |
— |
| Radiologic Examination Osseous Survey Limited (77074) |
— |
$1,382 |
— |
Radiologic examination tibia & fibula 2 views (73590)
range across 5 matching MRF lines |
— |
$464–$720 |
— |
| Ribs bilateral 3 views (71110) |
— |
$751 |
— |
Scapula (73010)
range across 5 matching MRF lines |
— |
$418–$669 |
— |
| Screening Digital Breast Tomosynthesis Bi (77063) |
— |
$128 |
— |
| Sella turcica (70240) |
— |
$457 |
— |
Shoulder 1 view (73020)
range across 5 matching MRF lines |
— |
$354–$565 |
— |
| Shoulder Arthrography (73040) |
— |
$1,147 |
— |
| Skull less than 4 views (70250) |
— |
$558 |
— |
| Sternoclavicular joints (71130) |
— |
$414 |
— |
| Thoracic spine 2 views (72070) |
— |
$547 |
— |
| Thoracic spine 3 views (72072) |
— |
$654 |
— |
| Thoracolumbar 2 views (72080) |
— |
$560 |
— |
| Thyroid Imaging With Vascular Flow (78013) |
— |
$1,313 |
— |
| Thyroid Uptake Measurement (78012) |
— |
$1,367 |
— |
| Ultrasound Breast Limited (76642) |
— |
$580 |
— |
| Ultrasound Exam Aaa Screen (76706) |
— |
$730 |
— |
| Ultrasound, abdomen limited (76705) |
— |
$990 |
— |
| Unlisted us procedure (76999) |
— |
$840 |
— |
| Urethrocystogram voiding (74455) |
— |
$1,435 |
— |
| Urethrocystography retrograde (74450) |
— |
$1,241 |
— |
| Us breast unilateral complete (76641) |
— |
$759 |
— |
| Us chest (76604) |
— |
$936 |
— |
| Us exam, pelvic, limited (76857) |
— |
$726 |
— |
| Us head (76506) |
— |
$751 |
— |
| Us kidney transplant (76776) |
— |
$1,050 |
— |
| Us lmtd joint/oth nonvasc xtr strux r-t w/img (76882) |
— |
$1,617 |
— |
| Us ob limited 1 or more fetuses (76815) |
— |
$653 |
— |
| Us ob transvaginal (76817) |
— |
$845 |
— |
| Us pelvic non ob complete (76856) |
— |
$1,258 |
— |
| Us pg uter img f&mat 14 wk tabdl 1/1st gestation (76801) |
— |
$1,021 |
— |
| Us preg uterus real time f/u trnsabdl per fetus (76816) |
— |
$992 |
— |
| Us retroperitoneal complete (76770) |
— |
$1,154 |
— |
| Us retroperitoneal limited (76775) |
— |
$872 |
— |
| Us scrotum and contents (76870) |
— |
$1,046 |
— |
| Us spinal canal and contents (76800) |
— |
$926 |
— |
| Us thyroid (76536) |
— |
$902 |
— |
Us transrectal (76872)
range across 4 matching MRF lines |
— |
$65–$1,100 |
— |
| Venography extremity unilateral rs&i (75820) |
— |
$7,311 |
— |
Wrist 2 views (73100)
range across 5 matching MRF lines |
— |
$355–$543 |
— |
| X-Ray Ac Jts - Xr Acromioclavicular Joints Bilateral (73050) |
— |
$422 |
— |
| X-Ray Bend Only L-S Spine (72120) |
— |
$754 |
— |
X-Ray Elbow 2 Vw - Xr Elbow 1-2 Views Right (73070)
range across 5 matching MRF lines |
— |
$463–$685 |
— |
| X-Ray Exam Entire Spi 1 Vw (72081) |
— |
$434 |
— |
| X-Ray Exam Entire Spi 2/3 Vw (72082) |
— |
$947 |
— |
| X-Ray Exam Entire Spi 4/5 Vw (72083) |
— |
$1,092 |
— |
| X-Ray Exam Hip Uni 1 View (73501) |
— |
$391 |
— |
| X-Ray Exam Hip Uni 2-3 Views (73502) |
— |
$506 |
— |
| X-Ray Exam Hips Bi 2 Views (73521) |
— |
$649 |
— |
| X-Ray Exam L-S Spine Bending (72114) |
— |
$1,100 |
— |
| X-Ray Exam Neck Spine 2-3 Vw (72040) |
— |
$497 |
— |
| X-Ray Exam Neck Spine 6/>Vws (72052) |
— |
$1,221 |
— |
| X-Ray Exam Unilat Ribs/Chest (71101) |
— |
$580 |
— |
| X-ray eye for foreign body (70030) |
— |
$327 |
— |
X-ray humerus (73060)
range across 5 matching MRF lines |
— |
$471–$730 |
— |
| X-ray IV pyelogram (ivp) (74400) |
— |
$1,409 |
— |
| X-Ray Knee Bilat Standing - Xr Knees Anteroposterior Standing Bilat (73565) |
— |
$332 |
— |
| X-Ray Lumbar Spine 2/3 Vw - Xr Lumbar Spine 2-3 Views (72100) |
— |
$673 |
— |
| X-ray nose-rectum child f.b. (76010) |
— |
$458 |
— |
| X-Ray Ribs, Chest 4+ Vw - Xr Ribs 3 Vws Bil W/ Chest Posteroanterior (71111) |
— |
$969 |
— |
| X-Ray Sacroiliac Jts <3 Vw - Xr Sacroiliac Joints 1-2 Views (72200) |
— |
$384 |
— |
| X-Ray Sacrum/Coccyx 2+ Vw - Xr Sacrum Coccyx 2+ Views (72220) |
— |
$515 |
— |
| X-Ray Sinuses 3+ Vw - Xr Paranasal Sinuses 3+ Views (70220) |
— |
$444 |
— |
| X-Ray Skull 4+ Vw - Xr Skull Complete 4+ Views (70260) |
— |
$599 |
— |
| X-Ray Urinary Tract Exam With Contrast Material (74420) |
— |
$2,094 |
— |
| X-Rays Bone Survey Complete (77075) |
— |
$1,369 |
— |
| Xr c-spine 4 or 5 views (72050) |
— |
$771 |
— |
| Xr orbits complete 4 views (70200) |
— |
$664 |
— |