| Abdomen 1 View (74018) |
— |
$225.15 |
— |
| Acute Gastrointestinal Blood Loss Imaging (78278) |
— |
$2,638.25 |
— |
| Angio internal mammary (75756) |
— |
$4,985.15 |
— |
| Angiography extremity bilateral rs&i (75716) |
— |
$3,019.30 |
— |
| Angiography extremity unilateral rs&i (75710) |
— |
$2,779.40 |
— |
| Ankle 2 views (73600) |
— |
$237.80 |
— |
| Bone age studies (77072) |
— |
$255.20 |
— |
| Bone Imaging 3 Phase (78315) |
— |
$2,668.60 |
— |
| Bone Imaging Whole Body (78306) |
— |
$2,000.35 |
— |
| Chest 1 view (71045) |
— |
$217.15 |
— |
| Chest 2 views (71046) |
— |
$305 |
— |
| Chest 3 views (71047) |
— |
$202.10 |
— |
Clavicle complete (73000)
range across 3 matching MRF lines |
— |
$279.05–$452.50 |
— |
| Computed Tomography Thorax Lw Dose Lng Ca Scr C- (71271) |
— |
$175 |
— |
| CT abdomen and pelvis without and with contrast (74178) |
— |
$5,537.60 |
— |
| CT abdomen and pelvis without contrast (74176) |
— |
$4,435.15 |
— |
| CT abdomen w contrast (74160) |
— |
$2,078.95 |
— |
| CT abdomen w wo contrast (74170) |
— |
$2,630.80 |
— |
| CT abdomen w/o contrast (74150) |
— |
$1,978.60 |
— |
| CT Angio Abdomen and Pelvis (74174) |
— |
$2,360.60 |
— |
| CT Angio Chest (71275) |
— |
$2,360.60 |
— |
| CT Angio Head (70496) |
— |
$2,173.30 |
— |
| Ct Angio Lwr Extr W/O&W/Dye (73706) |
— |
$2,837.75 |
— |
| CT Angio Neck (70498) |
— |
$2,360.60 |
— |
| Ct Angio Upr Extrm W/O&W/Dye (73206) |
— |
$2,360.60 |
— |
| CT cervical spine w/ contrast (72126) |
— |
$1,220 |
— |
| CT cervical spine w/o contrast (72125) |
— |
$2,130.50 |
— |
| CT cervical spine w/wo cont (72127) |
— |
$2,613.50 |
— |
| CT chest w contrast (71260) |
— |
$2,325.60 |
— |
| CT chest w/wo contrast (71270) |
— |
$2,570.65 |
— |
| CT head/brain with contrast (70460) |
— |
$2,200 |
— |
| CT head/brain without and with contrast (70470) |
— |
$2,526.25 |
— |
| CT heart no contrast quant eval coronry calcium (75571) |
— |
$75 |
— |
| CT iac w contrast (70481) |
— |
$1,825.80 |
— |
| CT l-spine w&w/o contrast (72133) |
— |
$3,229.65 |
— |
| CT lower ext w/o (73700) |
— |
$1,959.60 |
— |
| CT lower extremity w/contrast material (73701) |
— |
$1,553.35 |
— |
| CT lumbar spine w contrast (72132) |
— |
$3,088.65 |
— |
| CT lumbar spine w/o contrast (72131) |
— |
$2,309.80 |
— |
| CT maxillofacial w contrast (70487) |
— |
$2,150 |
— |
| CT maxillofacial wo contrast (70486) |
— |
$1,766.30 |
— |
| CT neck tissue combo (70492) |
— |
$2,286.80 |
— |
| Ct Orbit/Ear/Fossa W/O&W/Dye (70482) |
— |
$2,284.05 |
— |
| CT orbits w/o contrast (70480) |
— |
$1,717.70 |
— |
| CT pelvis w&w/o contrast (72194) |
— |
$2,777 |
— |
| CT pelvis w/o contrast (72192) |
— |
$2,037.30 |
— |
| CT scan of leg combo (73702) |
— |
$2,248.80 |
— |
| CT scans face/jaw combo (70488) |
— |
$2,281.80 |
— |
| CT soft tissue neck w contrast (70491) |
— |
$1,760.15 |
— |
| CT soft tissue neck w/o contrast (70490) |
— |
$1,667.80 |
— |
| CT thoracic spine w contrast (72129) |
— |
$2,574.65 |
— |
| CT thoracic spine w/o contrast (72128) |
— |
$2,103 |
— |
| CT thorax w/o contrast (71250) |
— |
$1,951.45 |
— |
| CT upper ext wo (73200) |
— |
$1,994.15 |
— |
| CT upper extremity with contrast (73201) |
— |
$2,342.20 |
— |
| Cta Abdl Aorta&Bi Iliofem W/Contrast&Postp (75635) |
— |
$2,383.05 |
— |
| Cta Abdomen (74175) |
— |
$2,295.45 |
— |
| Dxa Bone Density Axial (77080) |
— |
$433.45 |
— |
| Esophagram (74220) |
— |
$430.45 |
— |
| Fetal Biophys Profile W/Nst (76818) |
— |
$450.25 |
— |
| Fetal Biophysical Profile W/O Non-Stress Testing (76819) |
— |
$483.60 |
— |
| Fluoroscopy up to 1 hr (76000) |
— |
$477.85 |
— |
| Foot 2 views (73620) |
— |
$201.75 |
— |
| Forearm 2 views (73090) |
— |
$231.25 |
— |
| Gastric emptying imaging study (78264) |
— |
$1,227.30 |
— |
| Hand 2 views (73120) |
— |
$258.05 |
— |
| Hepatobil Syst Image W/Drug (78227) |
— |
$2,878.40 |
— |
| Hepatobiliary System Imaging (78226) |
— |
$2,878.40 |
— |
| Hysterosalpingogram (74740) |
— |
$705.25 |
— |
| Infant hip ultrasound with hip movement (dynamic) (76885) |
— |
$455.25 |
— |
| K Flow/Funct Image W/Drug (78708) |
— |
$1,814.70 |
— |
| Knee 3 Views (73562) |
— |
$251 |
— |
| Lung Ventilat&Perfus Imaging (78582) |
— |
$4,159.45 |
— |
| Lymph System Imaging (78195) |
— |
$1,575 |
— |
| Magnetic Image Jaw Joint (70336) |
— |
$2,047.30 |
— |
| MRA head w/o contrast (70544) |
— |
$1,750 |
— |
| Mra Neck W/O &W/Contrast Material (70549) |
— |
$2,642.85 |
— |
| MRA neck w/o contrast (70547) |
— |
$1,234 |
— |
| MRI abdomen w contrast (74182) |
— |
$1,964.05 |
— |
| MRI abdomen w/o contrast (74181) |
— |
$1,455.70 |
— |
| MRI any jt lower extrem w/o & w/contrast matrl (73723) |
— |
$2,735.80 |
— |
| MRI cervical spine w/o cont (72141) |
— |
$1,750 |
— |
| MRI lower extrem oth/thn jt w/o & w/contr matr (73720) |
— |
$3,654.40 |
— |
| MRI lower extrem oth/thn jt w/o contr matrl (73718) |
— |
$1,750 |
— |
| MRI lumbar spine w contrast (72149) |
— |
$2,472.40 |
— |
| Mri Neck Spine W/O & W/Dye (72156) |
— |
$4,408.20 |
— |
| MRI orbit face &/neck w/o contrast (70540) |
— |
$1,455.70 |
— |
| Mri Orbt/Fac/Nck W/O &W/Dye (70543) |
— |
$1,932.65 |
— |
MRI pelvis w/o & w contrast (72197)
range across 2 matching MRF lines |
— |
$1,037.58–$2,639.10 |
— |
| MRI pelvis w/o contrast (72195) |
— |
$1,750 |
— |
| MRI thoracic spine w/o contrast (72146) |
— |
$1,750 |
— |
| MRI upper extremity oth than jt w/o contr matrl (73218) |
— |
$1,750 |
— |
| Mri Uppr Extremity W/O&W/Dye (73220) |
— |
$3,611.10 |
— |
MRI, abdomen, combo (74183)
range across 2 matching MRF lines |
— |
$1,041.57–$2,669.85 |
— |
| MRI, dorsal spine combo (72157) |
— |
$4,408.20 |
— |
| MRI, dorsal spine contrast (72147) |
— |
$2,562.70 |
— |
| MRI, joint upper extrem (73221) |
— |
$1,455.70 |
— |
| MRI, joint upper extrem combo (73223) |
— |
$2,637.70 |
— |
| MRI, lumbar spine combo (72158) |
— |
$4,408.20 |
— |
| Myocardial Spect Multiple Studies (78452) |
— |
$5,188.05 |
— |
| Neck soft tissue (70360) |
— |
$257.25 |
— |
| Parathyroid Planar Imaging (78070) |
— |
$1,123.95 |
— |
| Pelvis 1 or 2 views (72170) |
— |
$242.20 |
— |
| Pulmonary Perfusion Imaging Particulate (78580) |
— |
$2,014.15 |
— |
| Radex Abd Compl Aqt Abd W/S/E/D Views 1 View Ch (74022) |
— |
$476.85 |
— |
| Radex Ankle Complete Minimum 3 Views (73610) |
— |
$246.20 |
— |
| Radex Calcaneus Minimum 2 Views (73650) |
— |
$227.20 |
— |
| Radex elbow complete minimum 3 views (73080) |
— |
$268.05 |
— |
| Radex Facial Bones Complete Minimum 3 Views (70150) |
— |
$329.40 |
— |
| Radex fingr minimum 2 views (73140) |
— |
$205.90 |
— |
| Radex foot complete minimum 3 views (73630) |
— |
$228.05 |
— |
| Radex Hand Minimum 3 Views (73130) |
— |
$223.50 |
— |
| Radex lower extremity infant minimum 2 views (73592) |
— |
$255.20 |
— |
| Radex Nasal Bones Complete Minimum 3 Views (70160) |
— |
$253.45 |
— |
| Radex Ribs Unilateral 2 Views (71100) |
— |
$355.25 |
— |
| Radex shoulder complete minimum 2 views (73030) |
— |
$257.20 |
— |
| Radex Sinuses Paransl < 3 Views (70210) |
— |
$272.50 |
— |
| Radex Sternum Minimum 2 Views (71120) |
— |
$284.45 |
— |
| Radex Temporomandble Jt Opn & Clsd Mouth Bilat (70330) |
— |
$294.15 |
— |
| Radex Toe Minimum 2 Views (73660) |
— |
$200.50 |
— |
| Radex upper extremity infant minimum 2 views (73092) |
— |
$164 |
— |
| Radex Wrist Complete Minimum 3 Views (73110) |
— |
$231.40 |
— |
| Radiolog exam mandible compl minimum 4 views (70110) |
— |
$306.85 |
— |
| Radiologic Exam Abdomen 3+ Views - Xr Abdomen 3+ Views (74021) |
— |
$281.85 |
— |
| Radiologic exam knee complete 4/more views (73564) |
— |
$322.55 |
— |
| Radiologic exam swallow function contrast study (74230) |
— |
$498.90 |
— |
| Radiologic exam teeth complete full mouth (70320) |
— |
$490.45 |
— |
| Radiologic examination femur minimum 2 views (73552) |
— |
$246.50 |
— |
| Radiologic examination knee 1/2 views (73560) |
— |
$233.05 |
— |
| Radiologic examination tibia & fibula 2 views (73590) |
— |
$254.55 |
— |
| Ribs bilateral 3 views (71110) |
— |
$358.65 |
— |
| Rp Loclzj Tum Spect 1 Area Single Day Imaging (78803) |
— |
$476.70 |
— |
| Scapula (73010) |
— |
$266.25 |
— |
| Screening Digital Breast Tomosynthesis Bi (77063) |
— |
$90.40 |
— |
| Skull less than 4 views (70250) |
— |
$283.20 |
— |
| Thoracic spine 2 views (72070) |
— |
$278.95 |
— |
| Thoracic spine 3 views (72072) |
— |
$334.90 |
— |
| Thyroid Uptake W/Blood Flow Sngle/Mult Quan Meas (78014) |
— |
$1,349.95 |
— |
| Ultrasound Breast Limited (76642) |
— |
$229.50 |
— |
| Ultrasound, abdomen limited (76705) |
— |
$553.30 |
— |
| Upper gi w/o kub (74240) |
— |
$487.40 |
— |
| Urethrocystogram voiding (74455) |
— |
$586 |
— |
| Urethrocystography retrograde (74450) |
— |
$574.15 |
— |
| Us chest (76604) |
— |
$640.20 |
— |
| Us complete joint (76881) |
— |
$515.75 |
— |
| Us exam, pelvic, limited (76857) |
— |
$569.75 |
— |
| Us head (76506) |
— |
$722.60 |
— |
| Us ob limited 1 or more fetuses (76815) |
— |
$207.70 |
— |
| Us pelvic non ob complete (76856) |
— |
$697.95 |
— |
| Us pg uter img f&mat 14 wk tabdl 1/1st gestation (76801) |
— |
$555.45 |
— |
| Us retroperitoneal complete (76770) |
— |
$629.20 |
— |
| Us scrotum and contents (76870) |
— |
$640.20 |
— |
| Us thyroid (76536) |
— |
$559.40 |
— |
| Us transrectal (76872) |
— |
$569.75 |
— |
| Wrist 2 views (73100) |
— |
$227.10 |
— |
| X-Ray Ac Jts - Xr Acromioclavicular Joints Bilateral (73050) |
— |
$373.85 |
— |
| X-Ray Aorta Leg Arteries (75630) |
— |
$2,982.40 |
— |
| X-Ray Elbow 2 Vw - Xr Elbow 1-2 Views Right (73070) |
— |
$214.40 |
— |
| X-Ray Exam Entire Spi 2/3 Vw (72082) |
— |
$325.85 |
— |
| X-Ray Exam Hip Uni 2-3 Views (73502) |
— |
$261.05 |
— |
| X-Ray Exam Hips Bi 2 Views (73521) |
— |
$482.80 |
— |
| X-Ray Exam L-S Spine Bending (72114) |
— |
$517.65 |
— |
| X-Ray Exam Neck Spine 2-3 Vw (72040) |
— |
$256.25 |
— |
| X-Ray Exam Neck Spine 6/>Vws (72052) |
— |
$485.20 |
— |
| X-ray humerus (73060) |
— |
$254.10 |
— |
| X-ray IV pyelogram (ivp) (74400) |
— |
$676.95 |
— |
| X-Ray Knee Bilat Standing - Xr Knees Anteroposterior Standing Bilat (73565) |
— |
$208.70 |
— |
| X-Ray Lumbar Spine 2/3 Vw - Xr Lumbar Spine 2-3 Views (72100) |
— |
$275.65 |
— |
| X-Ray Sacroiliac Jts 3+ Vw - Xr Sacroiliac Joints 3+ Views (72202) |
— |
$313.45 |
— |
| X-Ray Sacrum/Coccyx 2+ Vw - Xr Sacrum Coccyx 2+ Views (72220) |
— |
$257.20 |
— |
| X-Ray Sinuses 3+ Vw - Xr Paranasal Sinuses 3+ Views (70220) |
— |
$348.25 |
— |
| X-Ray Urinary Tract Exam With Contrast Material (74420) |
— |
$916.20 |
— |
| X-Rays Bone Survey Complete (77075) |
— |
$663.30 |
— |
| Xr c-spine 4 or 5 views (72050) |
— |
$425.10 |
— |
| Xr orbits complete 4 views (70200) |
— |
$332.70 |
— |