| Abdomen 1 View (74018) |
— |
$422 |
— |
Abdomen 2 views (74019)
range across 2 matching MRF lines |
— |
$447–$561 |
— |
Acute Gastrointestinal Blood Loss Imaging (78278)
range across 2 matching MRF lines |
— |
$1,648–$2,149 |
— |
| Ankle 2 views (73600) |
— |
$223 |
— |
| Arthrogram ankle (73615) |
— |
$409 |
— |
| Arthrogram hip (73525) |
— |
$633 |
— |
| Arthrogram Wrist (73115) |
— |
$562 |
— |
| Bone age studies (77072) |
— |
$244 |
— |
| Bone Imaging 3 Phase (78315) |
— |
$1,644 |
— |
| Bone Imaging Limited Area (78300) |
— |
$1,644 |
— |
| Bone Imaging Multiple Areas (78305) |
— |
$1,644 |
— |
| Bone Imaging Whole Body (78306) |
— |
$1,644 |
— |
| Chest 1 view (71045) |
— |
$280 |
— |
| Chest 2 views (71046) |
— |
$422 |
— |
| Chest 3 views (71047) |
— |
$422 |
— |
Chest 4 or more views (71048)
range across 2 matching MRF lines |
— |
$336–$422 |
— |
Clavicle complete (73000)
range across 3 matching MRF lines |
— |
$223–$244 |
— |
| Computed Tomography Thorax Lw Dose Lng Ca Scr C- (71271) |
— |
$2,638 |
— |
| Contrast X-Ray Of Elbow (73085) |
— |
$404 |
— |
| Contrast X-Ray Of Knee Joint (73580) |
— |
$380 |
— |
| Contrast Xray Throat/Cerv Esopha (74210) |
— |
$732 |
— |
CT abdomen and pelvis without and with contrast (74178)
range across 3 matching MRF lines |
— |
$5,128–$5,538 |
— |
| CT abdomen and pelvis without contrast (74176) |
— |
$3,956 |
— |
| CT abdomen w contrast (74160) |
— |
$3,166 |
— |
| CT abdomen w wo contrast (74170) |
— |
$3,419 |
— |
| CT abdomen w/o contrast (74150) |
— |
$2,638 |
— |
CT Angio Abdomen and Pelvis (74174)
range across 2 matching MRF lines |
— |
$4,371–$4,397 |
— |
| CT Angio Chest (71275) |
— |
$4,748 |
— |
| CT Angio Head (70496) |
— |
$4,748 |
— |
| Ct Angio Lwr Extr W/O&W/Dye (73706) |
— |
$2,929 |
— |
| CT Angio Neck (70498) |
— |
$4,748 |
— |
| Ct Angio Upr Extrm W/O&W/Dye (73206) |
— |
$2,442 |
— |
| CT cervical spine w/ contrast (72126) |
— |
$2,513 |
— |
| CT cervical spine w/o contrast (72125) |
— |
$2,638 |
— |
| CT cervical spine w/wo cont (72127) |
— |
$3,419 |
— |
| CT chest w contrast (71260) |
— |
$3,166 |
— |
| CT chest w/wo contrast (71270) |
— |
$3,419 |
— |
| CT head/brain with contrast (70460) |
— |
$2,930 |
— |
| CT head/brain without and with contrast (70470) |
— |
$3,692 |
— |
| CT heart no contrast quant eval coronry calcium (75571) |
— |
$150 |
— |
| CT iac w contrast (70481) |
— |
$2,929 |
— |
| CT l-spine w&w/o contrast (72133) |
— |
$3,419 |
— |
| CT lower ext w/o (73700) |
— |
$2,638 |
— |
| CT lower extremity w/contrast material (73701) |
— |
$3,166 |
— |
| CT lumbar spine w contrast (72132) |
— |
$2,930 |
— |
| CT lumbar spine w/o contrast (72131) |
— |
$2,638 |
— |
| CT maxillofacial w contrast (70487) |
— |
$2,930 |
— |
| CT maxillofacial wo contrast (70486) |
— |
$2,638 |
— |
| CT neck tissue combo (70492) |
— |
$3,692 |
— |
| Ct Orbit/Ear/Fossa W/O&W/Dye (70482) |
— |
$3,419 |
— |
CT orbits w/o contrast (70480)
range across 2 matching MRF lines |
— |
$2,443–$2,930 |
— |
| CT pelvis w&w/o contrast (72194) |
— |
$3,419 |
— |
| CT pelvis w/o contrast (72192) |
— |
$2,443 |
— |
| CT scan of leg combo (73702) |
— |
$3,419 |
— |
| CT scans face/jaw combo (70488) |
— |
$3,419 |
— |
| CT soft tissue neck w contrast (70491) |
— |
$2,930 |
— |
| CT soft tissue neck w/o contrast (70490) |
— |
$2,638 |
— |
| CT thoracic spine w contrast (72129) |
— |
$2,930 |
— |
| CT thoracic spine w/o contrast (72128) |
— |
$2,638 |
— |
| CT thoracic spine w/wo cont (72130) |
— |
$3,419 |
— |
| CT thorax w/o contrast (71250) |
— |
$2,638 |
— |
| CT upper ext wo (73200) |
— |
$2,443 |
— |
| CT upper extremity w/o & w/contrast material (73202) |
— |
$2,930 |
— |
CT upper extremity with contrast (73201)
range across 3 matching MRF lines |
— |
$2,443–$2,638 |
— |
| Cta Abdl Aorta&Bi Iliofem W/Contrast&Postp (75635) |
— |
$6,106 |
— |
| Cta Abdomen (74175) |
— |
$4,397 |
— |
| CTA pelvis (72191) |
— |
$4,397 |
— |
| Dxa Bone Density Axial (77080) |
— |
$723 |
— |
Fluoroscopy up to 1 hr (76000)
range across 4 matching MRF lines |
— |
$191–$336 |
— |
| Foot 2 views (73620) |
— |
$223 |
— |
Forearm 2 views (73090)
range across 3 matching MRF lines |
— |
$223–$280 |
— |
| Gastric emptying imaging study (78264) |
— |
$1,644 |
— |
| Gated Heart Planar Single (78472) |
— |
$1,644 |
— |
| Hand 2 views (73120) |
— |
$223 |
— |
| Hepatobil Syst Image W/Drug (78227) |
— |
$2,149 |
— |
| Hepatobiliary System Imaging (78226) |
— |
$1,644 |
— |
K Flow/Funct Image W/Drug (78708)
range across 3 matching MRF lines |
— |
$437–$2,149 |
— |
| K Flow/Funct Image W/O Drug (78707) |
— |
$2,149 |
— |
Knee 3 Views (73562)
range across 3 matching MRF lines |
— |
$223–$280 |
— |
| Liver & Spleen Imaging Static Only (78215) |
— |
$1,644 |
— |
| Liver imaging static only (78201) |
— |
$2,149 |
— |
| Lung perfusion differential (78597) |
— |
$1,644 |
— |
| Lung Ventilat&Perfus Imaging (78582) |
— |
$2,149 |
— |
| Lung Ventilation Imaging (78579) |
— |
$1,644 |
— |
| Magnetic Image Jaw Joint (70336) |
— |
$3,663 |
— |
| Mra Head W/O & W/Contrast Material (70546) |
— |
$4,397 |
— |
MRA head w/o contrast (70544)
range across 2 matching MRF lines |
— |
$3,908–$4,029 |
— |
| MRA head with contrast (70545) |
— |
$3,908 |
— |
| MRA neck w contrast (70548) |
— |
$3,908 |
— |
| Mra Neck W/O &W/Contrast Material (70549) |
— |
$4,397 |
— |
| MRA neck w/o contrast (70547) |
— |
$4,029 |
— |
| MRI abdomen w contrast (74182) |
— |
$3,908 |
— |
MRI abdomen w/o contrast (74181)
range across 2 matching MRF lines |
— |
$2,404–$3,663 |
— |
| MRI any jt lower extrem w/contrast material (73722) |
— |
$3,908 |
— |
| MRI any jt lower extrem w/o & w/contrast matrl (73723) |
— |
$4,397 |
— |
| MRI any jt upper extremity w/contrast matrl (73222) |
— |
$3,908 |
— |
| MRI bone marrow blood supply (77084) |
— |
$820 |
— |
| MRI Breast W/O Contrast Bilateral (77047) |
— |
$3,663 |
— |
| MRI Breast Without Contrast Material Unilateral (77046) |
— |
$3,663 |
— |
| MRI cervical spine w contrast (72142) |
— |
$3,908 |
— |
| MRI cervical spine w/o cont (72141) |
— |
$4,029 |
— |
| MRI chest w/o contrast (71550) |
— |
$3,663 |
— |
| MRI chest with contrast (71551) |
— |
$3,908 |
— |
| MRI chest wo w contrast (71552) |
— |
$4,397 |
— |
| MRI lower extrem oth/thn jt w/contrast matrl (73719) |
— |
$3,908 |
— |
| MRI lower extrem oth/thn jt w/o & w/contr matr (73720) |
— |
$4,396 |
— |
| MRI lower extrem oth/thn jt w/o contr matrl (73718) |
— |
$3,663 |
— |
| MRI lumbar spine w contrast (72149) |
— |
$4,300 |
— |
| Mri Neck Spine W/O & W/Dye (72156) |
— |
$4,397 |
— |
| MRI orbit face &/neck w/o contrast (70540) |
— |
$3,663 |
— |
| MRI orbit face neck w contrast (70542) |
— |
$3,908 |
— |
| Mri Orbt/Fac/Nck W/O &W/Dye (70543) |
— |
$4,835 |
— |
| MRI pelvis w contrast (72196) |
— |
$3,908 |
— |
| MRI pelvis w/o & w contrast (72197) |
— |
$4,397 |
— |
| MRI pelvis w/o contrast (72195) |
— |
$4,029 |
— |
| MRI thoracic spine w/o contrast (72146) |
— |
$4,029 |
— |
| MRI upper extremity oth than jt w/contr matrl (73219) |
— |
$3,908 |
— |
| MRI upper extremity oth than jt w/o contr matrl (73218) |
— |
$3,663 |
— |
| Mri Uppr Extremity W/O&W/Dye (73220) |
— |
$4,397 |
— |
MRI, abdomen, combo (74183)
range across 2 matching MRF lines |
— |
$3,060–$4,397 |
— |
| MRI, dorsal spine combo (72157) |
— |
$4,397 |
— |
| MRI, dorsal spine contrast (72147) |
— |
$3,908 |
— |
MRI, joint upper extrem (73221)
range across 4 matching MRF lines |
— |
$3,663–$4,029 |
— |
| MRI, joint upper extrem combo (73223) |
— |
$4,152 |
— |
| MRI, lumbar spine combo (72158) |
— |
$4,397 |
— |
| Myelogram cervical (72240) |
— |
$251 |
— |
| Myelogram Lumbar (72265) |
— |
$459 |
— |
| Myelography thoracic (72255) |
— |
$426 |
— |
| Myocardial Spect Multiple Studies (78452) |
— |
$5,623 |
— |
| Neck soft tissue (70360) |
— |
$280 |
— |
| Parathyroid Planar Imaging (78070) |
— |
$1,644 |
— |
| Parathyroid planar imaging w/wo subtraction (78071) |
— |
$1,644 |
— |
| Pelvis 1 or 2 views (72170) |
— |
$226 |
— |
| Pulmonary Perfusion Imaging Particulate (78580) |
— |
$1,644 |
— |
| Radex Abd Compl Aqt Abd W/S/E/D Views 1 View Ch (74022) |
— |
$561 |
— |
Radex Ankle Complete Minimum 3 Views (73610)
range across 3 matching MRF lines |
— |
$336–$422 |
— |
Radex Calcaneus Minimum 2 Views (73650)
range across 3 matching MRF lines |
— |
$223–$244 |
— |
| Radex elbow complete minimum 3 views (73080) |
— |
$336 |
— |
| Radex Facial Bones Complete Minimum 3 Views (70150) |
— |
$422 |
— |
Radex fingr minimum 2 views (73140)
range across 3 matching MRF lines |
— |
$223–$280 |
— |
Radex foot complete minimum 3 views (73630)
range across 5 matching MRF lines |
— |
$336–$422 |
— |
Radex Hand Minimum 3 Views (73130)
range across 3 matching MRF lines |
— |
$336–$422 |
— |
Radex lower extremity infant minimum 2 views (73592)
range across 3 matching MRF lines |
— |
$140–$153 |
— |
| Radex Mastoids Compl Minimum 3 Views PR Side (70130) |
— |
$367 |
— |
| Radex Nasal Bones Complete Minimum 3 Views (70160) |
— |
$422 |
— |
| Radex Ribs Unilateral 2 Views (71100) |
— |
$336 |
— |
| Radex shoulder complete minimum 2 views (73030) |
— |
$280 |
— |
| Radex Sinuses Paransl < 3 Views (70210) |
— |
$196 |
— |
| Radex Sternum Minimum 2 Views (71120) |
— |
$367 |
— |
Radex Toe Minimum 2 Views (73660)
range across 3 matching MRF lines |
— |
$223–$244 |
— |
Radex upper extremity infant minimum 2 views (73092)
range across 3 matching MRF lines |
— |
$125–$137 |
— |
Radex Wrist Complete Minimum 3 Views (73110)
range across 3 matching MRF lines |
— |
$336–$422 |
— |
| Radiolog exam mandible compl minimum 4 views (70110) |
— |
$422 |
— |
Radiologic Exam Abdomen 3+ Views - Xr Abdomen 3+ Views (74021)
range across 2 matching MRF lines |
— |
$336–$561 |
— |
| Radiologic exam colon double contrast study (74280) |
— |
$894 |
— |
| Radiologic exam colon single contrast study (74270) |
— |
$732 |
— |
| Radiologic exam pelvis compl minimum 3 views (72190) |
— |
$336 |
— |
| Radiologic Exam Small Int Single Contrast Study (74250) |
— |
$843 |
— |
Radiologic exam swallow function contrast study (74230)
range across 2 matching MRF lines |
— |
$670–$732 |
— |
Radiologic exam upr gi trc double contrast study (74246)
range across 2 matching MRF lines |
— |
$732–$746 |
— |
Radiologic examination femur minimum 2 views (73552)
range across 3 matching MRF lines |
— |
$223–$280 |
— |
| Radiologic examination knee 1/2 views (73560) |
— |
$336 |
— |
Radiologic examination tibia & fibula 2 views (73590)
range across 3 matching MRF lines |
— |
$223–$244 |
— |
| Ribs bilateral 3 views (71110) |
— |
$447 |
— |
| Rp loclzj tum plnr 1 area single day imaging (78800) |
— |
$1,148 |
— |
Rp Loclzj Tum Spect 1 Area Single Day Imaging (78803)
range across 3 matching MRF lines |
— |
$1,159–$5,623 |
— |
Scapula (73010)
range across 3 matching MRF lines |
— |
$223–$244 |
— |
| Screening Digital Breast Tomosynthesis Bi (77063) |
— |
$116 |
— |
| Shoulder Arthrography (73040) |
— |
$371 |
— |
| Skull less than 4 views (70250) |
— |
$226 |
— |
Sternoclavicular joints (71130)
range across 3 matching MRF lines |
— |
$223–$244 |
— |
| Thoracic spine 2 views (72070) |
— |
$561 |
— |
| Thyroid Uptake Measurement (78012) |
— |
$1,644 |
— |
Ultrasound Breast Limited (76642)
range across 3 matching MRF lines |
— |
$273–$315 |
— |
| Ultrasound Exam Aaa Screen (76706) |
— |
$702 |
— |
Ultrasound, abdomen limited (76705)
range across 5 matching MRF lines |
— |
$611–$2,732 |
— |
| Unlisted Dx Radiographic Procedure (76499) |
— |
$125 |
— |
| Us breast unilateral complete (76641) |
— |
$702 |
— |
| Us chest (76604) |
— |
$152 |
— |
Us lmtd joint/oth nonvasc xtr strux r-t w/img (76882)
range across 2 matching MRF lines |
— |
$470–$541 |
— |
| Us ob limited 1 or more fetuses (76815) |
— |
$447 |
— |
| Us ob transvaginal (76817) |
— |
$577 |
— |
Us pelvic non ob complete (76856)
range across 2 matching MRF lines |
— |
$611–$702 |
— |
| Us pg uter img f&mat 14 wk tabdl 1/1st gestation (76801) |
— |
$458 |
— |
Us retroperitoneal complete (76770)
range across 2 matching MRF lines |
— |
$611–$702 |
— |
| Us retroperitoneal limited (76775) |
— |
$765 |
— |
| Us scrotum and contents (76870) |
— |
$702 |
— |
Us thyroid (76536)
range across 2 matching MRF lines |
— |
$447–$702 |
— |
| Vein X-Ray Chest (75827) |
— |
$3,737 |
— |
| Venography caval inferior serialography rs&i (75825) |
— |
$781 |
— |
| Wrist 2 views (73100) |
— |
$223 |
— |
| X-Ray Ac Jts - Xr Acromioclavicular Joints Bilateral (73050) |
— |
$244 |
— |
X-Ray Elbow 2 Vw - Xr Elbow 1-2 Views Right (73070)
range across 3 matching MRF lines |
— |
$223–$280 |
— |
| X-Ray Exam Breast Specimen (76098) |
— |
$196 |
— |
| X-Ray Exam Entire Spi 1 Vw (72081) |
— |
$262 |
— |
| X-Ray Exam Hip Uni 1 View (73501) |
— |
$251 |
— |
X-Ray Exam Hip Uni 2-3 Views (73502)
range across 3 matching MRF lines |
— |
$223–$280 |
— |
| X-Ray Exam Hips Bi 2 Views (73521) |
— |
$481 |
— |
| X-Ray Exam L-S Spine Bending (72114) |
— |
$604 |
— |
| X-Ray Exam Neck Spine 2-3 Vw (72040) |
— |
$422 |
— |
| X-Ray Exam Neck Spine 6/>Vws (72052) |
— |
$470 |
— |
| X-Ray Exam Unilat Ribs/Chest (71101) |
— |
$333 |
— |
| X-ray eye for foreign body (70030) |
— |
$367 |
— |
X-ray humerus (73060)
range across 2 matching MRF lines |
— |
$244–$280 |
— |
| X-ray IV pyelogram (ivp) (74400) |
— |
$488 |
— |
| X-Ray Jaw <4 Vw - Xr Mandible < 4 Views (70100) |
— |
$153 |
— |
| X-Ray Knee Bilat Standing - Xr Knees Anteroposterior Standing Bilat (73565) |
— |
$422 |
— |
| X-Ray Lumbar Spine 2/3 Vw - Xr Lumbar Spine 2-3 Views (72100) |
— |
$333 |
— |
| X-ray nose-rectum child f.b. (76010) |
— |
$196 |
— |
| X-Ray Ribs, Chest 4+ Vw - Xr Ribs 3 Vws Bil W/ Chest Posteroanterior (71111) |
— |
$355 |
— |
X-Ray Sacroiliac Jts 3+ Vw - Xr Sacroiliac Joints 3+ Views (72202)
range across 3 matching MRF lines |
— |
$292–$319 |
— |
X-Ray Sacrum/Coccyx 2+ Vw - Xr Sacrum Coccyx 2+ Views (72220)
range across 2 matching MRF lines |
— |
$223–$280 |
— |
| X-Ray Sinuses 3+ Vw - Xr Paranasal Sinuses 3+ Views (70220) |
— |
$422 |
— |
| X-Ray Skull 4+ Vw - Xr Skull Complete 4+ Views (70260) |
— |
$367 |
— |
X-Ray Tmj Unilat (70328)
range across 3 matching MRF lines |
— |
$208–$367 |
— |
| X-Rays Bone Length Studies (77073) |
— |
$383 |
— |
| X-Rays Bone Survey Complete (77075) |
— |
$843 |
— |
| Xr c-spine 4 or 5 views (72050) |
— |
$702 |
— |
| Xr facial bones less than 3 views (70140) |
— |
$196 |
— |
| XR Mastoids < 3 Views Bilateral (70120) |
— |
$153 |
— |
Xr orbits complete 4 views (70200)
range across 3 matching MRF lines |
— |
$336–$367 |
— |