| Ankle 2 views (73600) |
— |
$102.50 |
— |
| Bone Imaging Whole Body (78306) |
— |
$773.50 |
— |
Chest 2 views (71046)
range across 2 matching MRF lines |
— |
$103.70–$141.50 |
— |
| Cholecystography Oral Contrast (74290) |
— |
$252.50 |
— |
| Clavicle complete (73000) |
— |
$125.70 |
— |
| CT abdomen w contrast (74160) |
— |
$1,209 |
— |
| CT abdomen w wo contrast (74170) |
— |
$1,283.40 |
— |
| CT abdomen w/o contrast (74150) |
— |
$905.20 |
— |
| CT cervical spine w/o contrast (72125) |
— |
$905.20 |
— |
| CT chest w contrast (71260) |
— |
$1,209 |
— |
| CT chest w/wo contrast (71270) |
— |
$1,283.40 |
— |
| CT head/brain with contrast (70460) |
— |
$1,209 |
— |
| CT head/brain without and with contrast (70470) |
— |
$1,283.40 |
— |
| CT iac w contrast (70481) |
— |
$1,209 |
— |
| CT l-spine w&w/o contrast (72133) |
— |
$1,283.40 |
— |
| CT lower ext w/o (73700) |
— |
$905.20 |
— |
| CT lower extremity w/contrast material (73701) |
— |
$1,209 |
— |
| CT lumbar spine w/o contrast (72131) |
— |
$905.20 |
— |
| CT neck tissue combo (70492) |
— |
$1,283.40 |
— |
| Ct Orbit/Ear/Fossa W/O&W/Dye (70482) |
— |
$1,283.40 |
— |
| CT orbits w/o contrast (70480) |
— |
$905.20 |
— |
| CT pelvis w&w/o contrast (72194) |
— |
$1,283.40 |
— |
| CT pelvis w/o contrast (72192) |
— |
$905.20 |
— |
| CT scan of leg combo (73702) |
— |
$1,283.40 |
— |
| CT soft tissue neck w contrast (70491) |
— |
$1,209 |
— |
| CT soft tissue neck w/o contrast (70490) |
— |
$905.20 |
— |
| CT thoracic spine w/o contrast (72128) |
— |
$905.20 |
— |
| CT thoracic spine w/wo cont (72130) |
— |
$1,283.40 |
— |
| CT thorax w/o contrast (71250) |
— |
$905.20 |
— |
| Dacryocystography, nasolacrimal duct, radiological supervision and interpretation Non-Facility (70170) |
— |
$1,045.50 |
— |
| Echo exam of fetal heart (76825) |
— |
$279.40 |
— |
| Esophagram (74220) |
— |
$203.70 |
— |
| Fluoroscopy up to 1 hr (76000) |
— |
$242.80 |
— |
| Foot 2 views (73620) |
— |
$102.50 |
— |
| Forearm 2 views (73090) |
— |
$113.50 |
— |
| Hand 2 views (73120) |
— |
$102.50 |
— |
| Knee 3 Views (73562) |
— |
$164.70 |
— |
| Liver & Spleen Imaging W/Vascular Flow (78216) |
— |
$552.70 |
— |
| Magnetic Image Jaw Joint (70336) |
— |
$1,548.20 |
— |
MRI abdomen w/o contrast (74181)
range across 7 matching MRF lines |
— |
$665–$1,548.20 |
— |
MRI cervical spine w/o cont (72141)
range across 2 matching MRF lines |
— |
$1,281–$1,548.20 |
— |
MRI chest w/o contrast (71550)
range across 3 matching MRF lines |
— |
$1,281–$1,548.20 |
— |
MRI lower extrem oth/thn jt w/o & w/contr matr (73720)
range across 11 matching MRF lines |
— |
$1,281–$1,548.20 |
— |
MRI orbit face &/neck w/o contrast (70540)
range across 2 matching MRF lines |
— |
$1,281–$1,548.20 |
— |
MRI pelvis w contrast (72196)
range across 2 matching MRF lines |
— |
$1,281–$1,548.20 |
— |
MRI thoracic spine w/o contrast (72146)
range across 2 matching MRF lines |
— |
$1,281–$1,548.20 |
— |
Mri Uppr Extremity W/O&W/Dye (73220)
range across 10 matching MRF lines |
— |
$1,281–$1,548.20 |
— |
| Neck soft tissue (70360) |
— |
$106.10 |
— |
| Pelvis 1 or 2 views (72170) |
— |
$106.10 |
— |
| Pulmonary Perfusion Imaging Particulate (78580) |
— |
$672.20 |
— |
Radex Abd Compl Aqt Abd W/S/E/D Views 1 View Ch (74022)
range across 2 matching MRF lines |
— |
$113.50–$213.50 |
— |
| Radex Ankle Complete Minimum 3 Views (73610) |
— |
$151.30 |
— |
Radex Calcaneus Minimum 2 Views (73650)
range across 2 matching MRF lines |
— |
$113.50–$151.30 |
— |
| Radex elbow complete minimum 3 views (73080) |
— |
$154.90 |
— |
| Radex Facial Bones Complete Minimum 3 Views (70150) |
— |
$207.40 |
— |
| Radex foot complete minimum 3 views (73630) |
— |
$135.40 |
— |
| Radex Hand Minimum 3 Views (73130) |
— |
$139.10 |
— |
| Radex Mastoids Compl Minimum 3 Views PR Side (70130) |
— |
$268.40 |
— |
| Radex Nasal Bones Complete Minimum 3 Views (70160) |
— |
$139.10 |
— |
| Radex shoulder complete minimum 2 views (73030) |
— |
$181.80 |
— |
Radex Spine 1 View Specify Level (72020)
range across 2 matching MRF lines |
— |
$90.30–$102.50 |
— |
| Radex Sternum Minimum 2 Views (71120) |
— |
$164.70 |
— |
| Radex Temporomandble Jt Opn & Clsd Mouth Bilat (70330) |
— |
$239.10 |
— |
| Radex Wrist Complete Minimum 3 Views (73110) |
— |
$154.90 |
— |
| Radiolog exam mandible compl minimum 4 views (70110) |
— |
$230.60 |
— |
| Radiologic exam colon double contrast study (74280) |
— |
$402.60 |
— |
| Radiologic exam colon single contrast study (74270) |
— |
$275.70 |
— |
| Radiologic exam pelvis compl minimum 3 views (72190) |
— |
$168.40 |
— |
| Radiologic Exam Small Int Single Contrast Study (74250) |
— |
$289.10 |
— |
| Radiologic exam upr gi trc double contrast study (74246) |
— |
$377 |
— |
| Radiologic examination knee 1/2 views (73560) |
— |
$113.50 |
— |
| Radiologic Examination Salivary Gland Calculus (70380) |
— |
$102.50 |
— |
| Radiologic examination tibia & fibula 2 views (73590) |
— |
$125.70 |
— |
| Radiologic examination, internal auditory meati, complete Non-Facility (70134) |
— |
$255 |
— |
Renal Cyst Study (74470)
range across 2 matching MRF lines |
— |
$518.50–$528.30 |
— |
| Ribs bilateral 3 views (71110) |
— |
$213.50 |
— |
| Scapula (73010) |
— |
$151.30 |
— |
| Sella turcica (70240) |
— |
$102.50 |
— |
| Shoulder 1 view (73020) |
— |
$148.80 |
— |
| Skull less than 4 views (70250) |
— |
$135.40 |
— |
| Sternoclavicular joints (71130) |
— |
$164.70 |
— |
| Thoracic spine 2 views (72070) |
— |
$125.70 |
— |
| Thoracic spine 3 views (72072) |
— |
$167.10 |
— |
Unlisted Dx Radiographic Procedure (76499)
range across 10 matching MRF lines |
— |
$35.40–$1,281 |
— |
| Unlisted us procedure (76999) |
— |
$305 |
— |
| Us pelvic non ob complete (76856) |
— |
$280.60 |
— |
| Us retroperitoneal complete (76770) |
— |
$280.60 |
— |
Us scrotum and contents (76870)
range across 2 matching MRF lines |
— |
$279.40–$280.60 |
— |
| Us thyroid (76536) |
— |
$280.60 |
— |
| Vasogram (74440) |
— |
$178.10 |
— |
X-Ray Ac Jts - Xr Acromioclavicular Joints Bilateral (73050)
range across 3 matching MRF lines |
— |
$102.50–$181.80 |
— |
| X-Ray Elbow 2 Vw - Xr Elbow 1-2 Views Right (73070) |
— |
$103.70 |
— |
| X-Ray Exam Breast Specimen (76098) |
— |
$135.40 |
— |
| X-Ray Exam Neck Spine 2-3 Vw (72040) |
— |
$151.30 |
— |
| X-Ray Exam Neck Spine 6/>Vws (72052) |
— |
$301.30 |
— |
| X-ray eye for foreign body (70030) |
— |
$197.60 |
— |
| X-ray humerus (73060) |
— |
$125.70 |
— |
| X-ray IV pyelogram (ivp) (74400) |
— |
$377 |
— |
| X-ray IV pyelogram+tomography (74415) |
— |
$447.70 |
— |
| X-Ray Jaw <4 Vw - Xr Mandible < 4 Views (70100) |
— |
$170.80 |
— |
| X-Ray Lumbar Spine 2/3 Vw - Xr Lumbar Spine 2-3 Views (72100) |
— |
$146.40 |
— |
| X-Ray Sacroiliac Jts 3+ Vw - Xr Sacroiliac Joints 3+ Views (72202) |
— |
$176.90 |
— |
| X-Ray Sacroiliac Jts <3 Vw - Xr Sacroiliac Joints 1-2 Views (72200) |
— |
$106.10 |
— |
X-Ray Sacrum/Coccyx 2+ Vw - Xr Sacrum Coccyx 2+ Views (72220)
range across 2 matching MRF lines |
— |
$146.40–$170.80 |
— |
| X-Ray Sinuses 3+ Vw - Xr Paranasal Sinuses 3+ Views (70220) |
— |
$226.90 |
— |
| X-Ray Skull 4+ Vw - Xr Skull Complete 4+ Views (70260) |
— |
$252.50 |
— |
| X-Ray Urinary Tract Exam With Contrast Material (74420) |
— |
$603.90 |
— |
| Xr c-spine 4 or 5 views (72050) |
— |
$252.50 |
— |
| Xr facial bones less than 3 views (70140) |
— |
$151.30 |
— |
| Xr orbits complete 4 views (70200) |
— |
$135.40 |
— |
| Xr Tomogram Single Plane (76100) |
— |
$353.80 |
— |