| Abdomen 1 View (74018) |
— |
$416 |
— |
| Abdomen 2 views (74019) |
— |
$407 |
— |
| Acute Gastrointestinal Blood Loss Imaging (78278) |
— |
$451.25 |
— |
Angiography extremity bilateral rs&i (75716)
range across 2 matching MRF lines |
— |
$58–$136 |
— |
Angiography extremity unilateral rs&i (75710)
range across 2 matching MRF lines |
— |
$58–$86 |
— |
| Ankle 2 views (73600) |
— |
$375 |
— |
| Arthrogram hip (73525) |
— |
$2,915 |
— |
| Arthrogram Wrist (73115) |
— |
$458 |
— |
| Bone age studies (77072) |
— |
$248 |
— |
| Bone Imaging 3 Phase (78315) |
— |
$2,226 |
— |
| Bone Imaging Limited Area (78300) |
— |
$1,460 |
— |
| Bone Imaging Whole Body (78306) |
— |
$2,067 |
— |
| Bone marrow imaging; whole body (78104) |
— |
$552.75 |
— |
| Bone survey infant (77076) |
— |
$288 |
— |
| Brain Flow Imaging Only (78610) |
— |
$556 |
— |
| Brain Imaging Min 4 Static Views W Vascular Flow (78606) |
— |
$506.25 |
— |
| Brain Imaging Pet Metabolic Evaluation (78608) |
— |
$3,000 |
— |
| Cat Scan Follow-Up Study (76380) |
— |
$918 |
— |
| Chest 1 view (71045) |
— |
$281 |
— |
| Chest 2 views (71046) |
— |
$477 |
— |
| Chest 3 views (71047) |
— |
$471 |
— |
| Chg us nrv&acc strux 1 xtr compre w/img pr extremity (76883) |
— |
$538 |
— |
| Cholecystography Oral Contrast (74290) |
— |
$201 |
— |
| Clavicle complete (73000) |
— |
$378 |
— |
| Computed Tomography Thorax Lw Dose Lng Ca Scr C- (71271) |
— |
$85 |
— |
Contrast X-Ray Bladder (74430)
range across 3 matching MRF lines |
— |
$100–$1,028 |
— |
| Contrast X-Ray Of Elbow (73085) |
— |
$550 |
— |
Contrast X-Ray Of Knee Joint (73580)
range across 3 matching MRF lines |
— |
$458–$542 |
— |
| CT abdomen and pelvis without and with contrast (74178) |
— |
$7,973 |
— |
| CT abdomen and pelvis without contrast (74176) |
— |
$6,027 |
— |
| CT abdomen w contrast (74160) |
— |
$2,880 |
— |
| CT abdomen w wo contrast (74170) |
— |
$4,800 |
— |
| CT abdomen w/o contrast (74150) |
— |
$2,183 |
— |
| CT Angio Abdomen and Pelvis (74174) |
— |
$3,840 |
— |
| CT Angio Chest (71275) |
— |
$2,500 |
— |
| CT Angio Head (70496) |
— |
$2,500 |
— |
CT angio hrt w/3d image (75574)
range across 3 matching MRF lines |
— |
$180–$1,118 |
— |
| Ct Angio Lwr Extr W/O&W/Dye (73706) |
— |
$1,547 |
— |
| CT Angio Neck (70498) |
— |
$2,500 |
— |
Ct Angio Upr Extrm W/O&W/Dye (73206)
range across 2 matching MRF lines |
— |
$1,500–$1,800 |
— |
| CT cervical spine w/ contrast (72126) |
— |
$1,845 |
— |
| CT cervical spine w/o contrast (72125) |
— |
$5,952 |
— |
| CT cervical spine w/wo cont (72127) |
— |
$5,518 |
— |
| CT chest w contrast (71260) |
— |
$2,272 |
— |
| CT chest w/wo contrast (71270) |
— |
$2,152 |
— |
| CT head/brain with contrast (70460) |
— |
$2,228 |
— |
| CT head/brain without and with contrast (70470) |
— |
$2,500 |
— |
CT heart contrast eval cardiac structure&morph (75572)
range across 2 matching MRF lines |
— |
$75–$240 |
— |
CT heart no contrast quant eval coronry calcium (75571)
range across 2 matching MRF lines |
— |
$75–$85 |
— |
| CT iac w contrast (70481) |
— |
$1,638 |
— |
| CT l-spine w&w/o contrast (72133) |
— |
$3,900 |
— |
CT lower ext w/o (73700)
range across 9 matching MRF lines |
— |
$1,934–$2,327 |
— |
| CT lower extremity w/contrast material (73701) |
— |
$1,934 |
— |
| CT lumbar spine w contrast (72132) |
— |
$2,500 |
— |
| CT lumbar spine w/o contrast (72131) |
— |
$4,344 |
— |
| CT maxillofacial w contrast (70487) |
— |
$2,200 |
— |
| CT maxillofacial wo contrast (70486) |
— |
$4,608 |
— |
| CT neck tissue combo (70492) |
— |
$2,600 |
— |
| Ct Orbit/Ear/Fossa W/O&W/Dye (70482) |
— |
$1,750 |
— |
| CT orbits w/o contrast (70480) |
— |
$1,800 |
— |
| CT pelvis w&w/o contrast (72194) |
— |
$2,800 |
— |
| CT pelvis w/o contrast (72192) |
— |
$2,200 |
— |
| CT scan of leg combo (73702) |
— |
$2,327 |
— |
| CT scans face/jaw combo (70488) |
— |
$2,931 |
— |
| CT soft tissue neck w contrast (70491) |
— |
$3,544 |
— |
| CT soft tissue neck w/o contrast (70490) |
— |
$1,667 |
— |
| CT thoracic spine w contrast (72129) |
— |
$1,750 |
— |
| CT thoracic spine w/o contrast (72128) |
— |
$3,900 |
— |
| CT thoracic spine w/wo cont (72130) |
— |
$3,683 |
— |
| CT thorax w/o contrast (71250) |
— |
$950 |
— |
CT upper ext wo (73200)
range across 9 matching MRF lines |
— |
$1,950–$2,437 |
— |
| CT upper extremity w/o & w/contrast material (73202) |
— |
$2,437 |
— |
| CT upper extremity with contrast (73201) |
— |
$1,950 |
— |
| Cta Abdl Aorta&Bi Iliofem W/Contrast&Postp (75635) |
— |
$2,080 |
— |
| Cta Abdomen (74175) |
— |
$3,072 |
— |
| CTA pelvis (72191) |
— |
$2,233 |
— |
| Dxa Bone Density Axial (77080) |
— |
$487 |
— |
| Echo Guide For Artery Repair (76936) |
— |
$338.25 |
— |
| Echocardiography, fetal, cardiovascular system, real time with image documentation (2D), with or without M-mode… (76826) |
— |
$525 |
— |
| Echograp Trans R Pros Study (76873) |
— |
$110 |
— |
| Esophagram (74220) |
— |
$564 |
— |
Fetal Biophys Profile W/Nst (76818)
range across 3 matching MRF lines |
— |
$83–$489 |
— |
Fetal Biophysical Profile W/O Non-Stress Testing (76819)
range across 2 matching MRF lines |
— |
$320–$509 |
— |
| Fetal MRI w/placntl matrnl plvc img sing/1st ges (74712) |
— |
$177.75 |
— |
Fluoroscopy up to 1 hr (76000)
range across 4 matching MRF lines |
— |
$39.59–$864 |
— |
| Foot 2 views (73620) |
— |
$376 |
— |
| Forearm 2 views (73090) |
— |
$367 |
— |
| Gastric emptying imaging study (78264) |
— |
$1,812 |
— |
| Gastroesophageal Reflux Exam (78262) |
— |
$538.75 |
— |
| Gated Heart Planar Single (78472) |
— |
$592.25 |
— |
| Gated Heart, Multiple (78473) |
— |
$539.75 |
— |
| Hand 2 views (73120) |
— |
$599 |
— |
| Hepatobil Syst Image W/Drug (78227) |
— |
$2,173 |
— |
| Hepatobiliary System Imaging (78226) |
— |
$2,173 |
— |
Ht Musc Image Planar Mult (78454)
range across 2 matching MRF lines |
— |
$150–$1,666 |
— |
Ht Muscle Image Spect Sing (78451)
range across 3 matching MRF lines |
— |
$156–$1,752 |
— |
| Hysterosalpingogram (74740) |
— |
$700 |
— |
| K Flow/Funct Image W/Drug (78708) |
— |
$1,948 |
— |
| K Flow/Funct Image W/O Drug (78707) |
— |
$576 |
— |
| Kidney Imaging Morphoogy W/Vascular Flow (78701) |
— |
$404.75 |
— |
| Knee 3 Views (73562) |
— |
$444 |
— |
| Liver & Spleen Imaging Static Only (78215) |
— |
$449 |
— |
| Liver & Spleen Imaging W/Vascular Flow (78216) |
— |
$458.25 |
— |
Lung perfusion differential (78597)
range across 2 matching MRF lines |
— |
$424.50–$538.75 |
— |
| Lung Ventilation Imaging (78579) |
— |
$390.50 |
— |
| Lymph System Imaging (78195) |
— |
$90 |
— |
| Magnetic Image Jaw Joint (70336) |
— |
$930 |
— |
| Mammary ductogram or galactogram single (77053) |
— |
$247 |
— |
| Meckels Divert Exam (78290) |
— |
$420 |
— |
| MRA head w/o contrast (70544) |
— |
$2,800 |
— |
| MRA neck w contrast (70548) |
— |
$1,469 |
— |
| Mra Neck W/O &W/Contrast Material (70549) |
— |
$2,416 |
— |
| MRA neck w/o contrast (70547) |
— |
$2,709 |
— |
| MRI abdomen w/o contrast (74181) |
— |
$2,950 |
— |
| MRI any jt lower extrem w/contrast material (73722) |
— |
$3,214 |
— |
| MRI any jt lower extrem w/o & w/contrast matrl (73723) |
— |
$3,250 |
— |
| MRI any jt upper extremity w/contrast matrl (73222) |
— |
$4,000 |
— |
| MRI cervical spine w contrast (72142) |
— |
$2,791 |
— |
| MRI cervical spine w/o cont (72141) |
— |
$5,000 |
— |
| MRI chest w/o contrast (71550) |
— |
$2,249 |
— |
| MRI chest with contrast (71551) |
— |
$1,396 |
— |
| MRI chest wo w contrast (71552) |
— |
$4,049 |
— |
| MRI lower extrem oth/thn jt w/contrast matrl (73719) |
— |
$2,756 |
— |
| MRI lower extrem oth/thn jt w/o & w/contr matr (73720) |
— |
$4,628 |
— |
| MRI lower extrem oth/thn jt w/o contr matrl (73718) |
— |
$4,450 |
— |
| MRI lumbar spine w contrast (72149) |
— |
$1,486 |
— |
| Mri Neck Spine W/O & W/Dye (72156) |
— |
$5,900 |
— |
| MRI orbit face &/neck w/o contrast (70540) |
— |
$2,713 |
— |
| MRI orbit face neck w contrast (70542) |
— |
$3,030 |
— |
| Mri Orbt/Fac/Nck W/O &W/Dye (70543) |
— |
$3,036 |
— |
| MRI pelvis w contrast (72196) |
— |
$4,557 |
— |
| MRI pelvis w/o & w contrast (72197) |
— |
$4,500 |
— |
| MRI pelvis w/o contrast (72195) |
— |
$3,947 |
— |
| MRI thoracic spine w/o contrast (72146) |
— |
$4,900 |
— |
| MRI upper extremity oth than jt w/contr matrl (73219) |
— |
$2,448 |
— |
| MRI upper extremity oth than jt w/o contr matrl (73218) |
— |
$2,007 |
— |
| Mri Uppr Extremity W/O&W/Dye (73220) |
— |
$3,500 |
— |
| MRI, abdomen, combo (74183) |
— |
$4,400 |
— |
| MRI, dorsal spine combo (72157) |
— |
$3,500 |
— |
| MRI, dorsal spine contrast (72147) |
— |
$2,400 |
— |
| MRI, joint upper extrem (73221) |
— |
$4,450 |
— |
| MRI, joint upper extrem combo (73223) |
— |
$4,000 |
— |
| MRI, lumbar spine combo (72158) |
— |
$6,120 |
— |
| Myelogram cervical (72240) |
— |
$698.75 |
— |
| Myelogram Lumbar (72265) |
— |
$698.75 |
— |
| Myelography thoracic (72255) |
— |
$698.75 |
— |
| Myelograpy 2/more regions rs&i (72270) |
— |
$859.50 |
— |
| Myocardial Imaging Infarct Avid Planar Qual/Quan (78466) |
— |
$506.25 |
— |
| Myocardial Imaging Pet Metabolic Evaluation (78459) |
— |
$3,000 |
— |
Myocardial Spect Multiple Studies (78452)
range across 4 matching MRF lines |
— |
$184–$4,682 |
— |
| Neck soft tissue (70360) |
— |
$382 |
— |
| Ob us nuchal meas 1 gest (76813) |
— |
$379 |
— |
| Panoramic X-ray of jaws (70355) |
— |
$295 |
— |
| Parathyroid Planar Imaging (78070) |
— |
$759 |
— |
| Pelvis 1 or 2 views (72170) |
— |
$330 |
— |
| Pet Image W/Ct Lmtd (78814) |
— |
$3,105 |
— |
| PET image w/CT, full body (78816) |
— |
$5,783 |
— |
| PET imaging CT attenuation skull base mid-thigh (78815) |
— |
$6,709 |
— |
| Pulmonary Perfusion Imaging Particulate (78580) |
— |
$1,384 |
— |
| Radex abscess/fistula/sinus tract rs&i (76080) |
— |
$1,075 |
— |
| Radex Ankle Complete Minimum 3 Views (73610) |
— |
$605 |
— |
| Radex Calcaneus Minimum 2 Views (73650) |
— |
$352 |
— |
| Radex elbow complete minimum 3 views (73080) |
— |
$412 |
— |
| Radex Facial Bones Complete Minimum 3 Views (70150) |
— |
$459 |
— |
Radex fingr minimum 2 views (73140)
range across 12 matching MRF lines |
— |
$15–$319 |
— |
| Radex foot complete minimum 3 views (73630) |
— |
$582 |
— |
| Radex Hand Minimum 3 Views (73130) |
— |
$640 |
— |
| Radex lower extremity infant minimum 2 views (73592) |
— |
$303 |
— |
| Radex Mastoids Compl Minimum 3 Views PR Side (70130) |
— |
$183 |
— |
| Radex Nasal Bones Complete Minimum 3 Views (70160) |
— |
$389 |
— |
| Radex Ribs Unilateral 2 Views (71100) |
— |
$366 |
— |
| Radex shoulder complete minimum 2 views (73030) |
— |
$632 |
— |
Radex Spine 1 View Specify Level (72020)
range across 3 matching MRF lines |
— |
$275–$323 |
— |
| Radex Sternum Minimum 2 Views (71120) |
— |
$196 |
— |
| Radex Temporomandble Jt Opn & Clsd Mouth Bilat (70330) |
— |
$194 |
— |
| Radex Toe Minimum 2 Views (73660) |
— |
$321 |
— |
Radex upper extremity infant minimum 2 views (73092)
range across 3 matching MRF lines |
— |
$172–$194 |
— |
| Radex Wrist Complete Minimum 3 Views (73110) |
— |
$566 |
— |
| Radiolog exam mandible compl minimum 4 views (70110) |
— |
$469 |
— |
| Radiologic Exam Abdomen 3+ Views - Xr Abdomen 3+ Views (74021) |
— |
$614 |
— |
| Radiologic exam colon double contrast study (74280) |
— |
$1,112 |
— |
| Radiologic exam colon single contrast study (74270) |
— |
$580 |
— |
| Radiologic exam knee complete 4/more views (73564) |
— |
$393 |
— |
| Radiologic exam pelvis compl minimum 3 views (72190) |
— |
$308 |
— |
| Radiologic Exam Small Int Single Contrast Study (74250) |
— |
$908 |
— |
| Radiologic exam swallow function contrast study (74230) |
— |
$651 |
— |
| Radiologic exam upr gi trc double contrast study (74246) |
— |
$1,185 |
— |
| Radiologic examination femur minimum 2 views (73552) |
— |
$410 |
— |
| Radiologic examination knee 1/2 views (73560) |
— |
$588 |
— |
| Radiologic Examination Osseous Survey Limited (77074) |
— |
$822 |
— |
| Radiologic examination tibia & fibula 2 views (73590) |
— |
$416 |
— |
| Ribs bilateral 3 views (71110) |
— |
$498 |
— |
| Rp loclzj tum plnr 1 area single day imaging (78800) |
— |
$477 |
— |
| Rp loclzj tum plnr 2+area 1+d img/1 area img>2+d (78801) |
— |
$592.25 |
— |
| Rp Loclzj Tum Plnr Whole Body Single Day Imaging (78802) |
— |
$1,460 |
— |
Rp Loclzj Tum Spect 1 Area Single Day Imaging (78803)
range across 4 matching MRF lines |
— |
$541–$1,460 |
— |
| Scapula (73010) |
— |
$401 |
— |
| Screening Digital Breast Tomosynthesis Bi (77063) |
— |
$85 |
— |
| Sella turcica (70240) |
— |
$114.50 |
— |
| Shoulder 1 view (73020) |
— |
$354 |
— |
Shoulder Arthrography (73040)
range across 3 matching MRF lines |
— |
$573–$836 |
— |
| Sialogram (70390) |
— |
$379.50 |
— |
| Skull less than 4 views (70250) |
— |
$451 |
— |
| Speech evaluation, complex (70371) |
— |
$813 |
— |
| Sternoclavicular joints (71130) |
— |
$144 |
— |
| Testicular Imaging W/Flow (78761) |
— |
$432.50 |
— |
| Thoracic spine 2 views (72070) |
— |
$493 |
— |
| Thoracic spine 3 views (72072) |
— |
$491 |
— |
| Thyroid Carcinoma Metastases Img Lmtd Area (78015) |
— |
$363.75 |
— |
| Thyroid Uptake Measurement (78012) |
— |
$732 |
— |
| Thyroid Uptake W/Blood Flow Sngle/Mult Quan Meas (78014) |
— |
$1,331 |
— |
| Ultrasound Breast Limited (76642) |
— |
$784 |
— |
| Ultrasound Elastography Parenchyma (76981) |
— |
$424 |
— |
| Ultrasound Exam Aaa Screen (76706) |
— |
$482 |
— |
| Ultrasound, abdomen limited (76705) |
— |
$1,749 |
— |
Umbilical-artery Doppler (OB) (76820)
range across 2 matching MRF lines |
— |
$40–$134 |
— |
| Upper gi w/o kub (74240) |
— |
$952 |
— |
| Ureteral Reflux Study (78740) |
— |
$363.75 |
— |
| Urethrocystogram voiding (74455) |
— |
$495 |
— |
| Urethrocystography retrograde (74450) |
— |
$495 |
— |
| Us breast unilateral complete (76641) |
— |
$710 |
— |
| Us chest (76604) |
— |
$578 |
— |
| Us complete joint (76881) |
— |
$683 |
— |
| Us exam, pelvic, limited (76857) |
— |
$346 |
— |
| Us kidney transplant (76776) |
— |
$582 |
— |
| Us lmtd joint/oth nonvasc xtr strux r-t w/img (76882) |
— |
$570 |
— |
Us ob detailed single fetus (76811)
range across 2 matching MRF lines |
— |
$349–$474 |
— |
| Us ob limited 1 or more fetuses (76815) |
— |
$244 |
— |
| Us ob transvaginal (76817) |
— |
$876 |
— |
| Us pelvic non ob complete (76856) |
— |
$848 |
— |
Us pg uter img f&mat 14 wk tabdl 1/1st gestation (76801)
range across 3 matching MRF lines |
— |
$74–$664 |
— |
| Us preg uterus real time f/u trnsabdl per fetus (76816) |
— |
$244 |
— |
| Us retroperitoneal complete (76770) |
— |
$1,166 |
— |
| Us retroperitoneal limited (76775) |
— |
$511 |
— |
| Us scrotum and contents (76870) |
— |
$848 |
— |
| Us thyroid (76536) |
— |
$800 |
— |
| Us transrectal (76872) |
— |
$778 |
— |
| Vascular Flow Imaging (78445) |
— |
$420 |
— |
| Venography caval inferior serialography rs&i (75825) |
— |
$86 |
— |
| Venography extremity bilateral rs&i (75822) |
— |
$1,299 |
— |
Venography extremity unilateral rs&i (75820)
range across 2 matching MRF lines |
— |
$53–$736 |
— |
| Venous thrombosis imaging (78457) |
— |
$1,460 |
— |
| Venous Thrombosis Imaging Venogram Bilateral (78458) |
— |
$361.50 |
— |
| Vertebral fracture assessment via dxa (77086) |
— |
$204 |
— |
| Wrist 2 views (73100) |
— |
$365 |
— |
| X-Ray Ac Jts - Xr Acromioclavicular Joints Bilateral (73050) |
— |
$407 |
— |
| X-ray antegrade pyelogram tube (74425) |
— |
$873 |
— |
| X-Ray Aorta Leg Arteries (75630) |
— |
$138 |
— |
| X-Ray Elbow 2 Vw - Xr Elbow 1-2 Views Right (73070) |
— |
$371 |
— |
| X-Ray Exam Entire Spi 1 Vw (72081) |
— |
$414 |
— |
| X-Ray Exam Hip Uni 1 View (73501) |
— |
$644 |
— |
| X-Ray Exam Hip Uni 2-3 Views (73502) |
— |
$530 |
— |
| X-Ray Exam Hips Bi 2 Views (73521) |
— |
$745 |
— |
| X-Ray Exam L-S Spine Bending (72114) |
— |
$581 |
— |
| X-Ray Exam Neck Spine 2-3 Vw (72040) |
— |
$795 |
— |
| X-Ray Exam Neck Spine 6/>Vws (72052) |
— |
$636 |
— |
| X-Ray Exam Unilat Ribs/Chest (71101) |
— |
$474 |
— |
| X-ray humerus (73060) |
— |
$377 |
— |
| X-ray IV pyelogram (ivp) (74400) |
— |
$851 |
— |
| X-Ray Lumbar Spine 2/3 Vw - Xr Lumbar Spine 2-3 Views (72100) |
— |
$461 |
— |
| X-ray nose-rectum child f.b. (76010) |
— |
$93 |
— |
| X-Ray Ribs, Chest 4+ Vw - Xr Ribs 3 Vws Bil W/ Chest Posteroanterior (71111) |
— |
$656 |
— |
| X-Ray Sacroiliac Jts 3+ Vw - Xr Sacroiliac Joints 3+ Views (72202) |
— |
$303 |
— |
| X-Ray Sacrum/Coccyx 2+ Vw - Xr Sacrum Coccyx 2+ Views (72220) |
— |
$404 |
— |
| X-Ray Sinuses 3+ Vw - Xr Paranasal Sinuses 3+ Views (70220) |
— |
$534 |
— |
| X-Ray Skull 4+ Vw - Xr Skull Complete 4+ Views (70260) |
— |
$547 |
— |
X-Ray Urinary Tract Exam With Contrast Material (74420)
range across 2 matching MRF lines |
— |
$37–$633 |
— |
| X-Rays Bone Length Studies (77073) |
— |
$134 |
— |
| X-Rays Bone Survey Complete (77075) |
— |
$360 |
— |
| Xr facial bones less than 3 views (70140) |
— |
$122 |
— |
| Xr orbits complete 4 views (70200) |
— |
$436 |
— |
| Xr Tomogram Single Plane (76100) |
— |
$203 |
— |