| Abdomen 1 View (74018) |
— |
$275.30 |
— |
| Abdomen 2 views (74019) |
— |
$526.30 |
— |
| Ankle 2 views (73600) |
— |
$371.81 |
— |
| Arthrogram ankle (73615) |
— |
$1,476.80 |
— |
| Arthrogram hip (73525) |
— |
$1,476.80 |
— |
| Arthrogram Wrist (73115) |
— |
$1,476.80 |
— |
| Bone age studies (77072) |
— |
$371.81 |
— |
| Bone survey infant (77076) |
— |
$485.73 |
— |
| Cat Scan Follow-Up Study (76380) |
— |
$1,015.48 |
— |
| Chest 1 view (71045) |
— |
$275.30 |
— |
| Chest 2 views (71046) |
— |
$275.30 |
— |
| Chest 3 views (71047) |
— |
$275.30 |
— |
| Chest 4 or more views (71048) |
— |
$526.30 |
— |
| Clavicle complete (73000) |
— |
$233.09 |
— |
| Computed Tomography Thorax Lw Dose Lng Ca Scr C- (71271) |
— |
$695.50 |
— |
| Contrast X-Ray Of Knee Joint (73580) |
— |
$1,476.80 |
— |
| CT abdomen and pelvis without and with contrast (74178) |
— |
$4,680.48 |
— |
| CT abdomen and pelvis without contrast (74176) |
— |
$3,514.08 |
— |
| CT abdomen w contrast (74160) |
— |
$2,104.28 |
— |
| CT abdomen w wo contrast (74170) |
— |
$2,624.27 |
— |
| CT abdomen w/o contrast (74150) |
— |
$1,687.04 |
— |
| CT Angio Abdomen and Pelvis (74174) |
— |
$3,427.42 |
— |
| CT Angio Chest (71275) |
— |
$3,689.50 |
— |
| CT Angio Head (70496) |
— |
$2,894.23 |
— |
| CT Angio Neck (70498) |
— |
$2,592.85 |
— |
| CT bone density (77078) |
— |
$264.15 |
— |
| CT cervical spine w/o contrast (72125) |
— |
$2,289.39 |
— |
| CT cervical spine w/wo cont (72127) |
— |
$2,294.52 |
— |
| CT chest w contrast (71260) |
— |
$2,613.39 |
— |
| CT chest w/wo contrast (71270) |
— |
$2,679.69 |
— |
| CT head/brain with contrast (70460) |
— |
$1,115.02 |
— |
| CT head/brain without and with contrast (70470) |
— |
$2,444.95 |
— |
| CT iac w contrast (70481) |
— |
$2,063.05 |
— |
| CT l-spine w&w/o contrast (72133) |
— |
$1,557.26 |
— |
| CT lower ext w/o (73700) |
— |
$1,682.15 |
— |
| CT lower extremity w/contrast material (73701) |
— |
$2,070.09 |
— |
| CT lumbar spine w contrast (72132) |
— |
$2,097.77 |
— |
| CT lumbar spine w/o contrast (72131) |
— |
$1,867.98 |
— |
| CT maxillofacial w contrast (70487) |
— |
$2,004.85 |
— |
| CT maxillofacial wo contrast (70486) |
— |
$2,322.50 |
— |
| CT neck tissue combo (70492) |
— |
$2,678.05 |
— |
| Ct Orbit/Ear/Fossa W/O&W/Dye (70482) |
— |
$2,376.53 |
— |
| CT orbits w/o contrast (70480) |
— |
$1,758.74 |
— |
| CT pelvis w&w/o contrast (72194) |
— |
$2,700.87 |
— |
| CT pelvis w/o contrast (72192) |
— |
$1,665.84 |
— |
| CT scan of leg combo (73702) |
— |
$1,735.93 |
— |
| CT scans face/jaw combo (70488) |
— |
$1,801.11 |
— |
| CT soft tissue neck w contrast (70491) |
— |
$1,975.53 |
— |
| CT soft tissue neck w/o contrast (70490) |
— |
$1,646.28 |
— |
| CT thoracic spine w/o contrast (72128) |
— |
$1,959.22 |
— |
| CT thorax w/o contrast (71250) |
— |
$2,582.65 |
— |
| CT upper ext wo (73200) |
— |
$1,625.10 |
— |
| CT upper extremity w/o & w/contrast material (73202) |
— |
$1,735.93 |
— |
| CT upper extremity with contrast (73201) |
— |
$2,063.53 |
— |
| Cta Abdl Aorta&Bi Iliofem W/Contrast&Postp (75635) |
— |
$3,379.22 |
— |
| Cta Abdomen (74175) |
— |
$2,697.60 |
— |
| CTA pelvis (72191) |
— |
$2,531.36 |
— |
| Doppler Fetal Mid Cerebral Artery (76821) |
— |
$430.58 |
— |
| Dxa Bone Density Axial (77080) |
— |
$563.29 |
— |
| Fetal Biophys Profile W/Nst (76818) |
— |
$430.58 |
— |
| Fetal Biophysical Profile W/O Non-Stress Testing (76819) |
— |
$430.58 |
— |
| Fluoroscopy up to 1 hr (76000) |
— |
$624.24 |
— |
| Foot 2 views (73620) |
— |
$232.32 |
— |
| Forearm 2 views (73090) |
— |
$232.32 |
— |
| Hand 2 views (73120) |
— |
$234.62 |
— |
| Infant hip ultrasound with hip movement (dynamic) (76885) |
— |
$238.42 |
— |
| Joint Survey Single View (77077) |
— |
$493.89 |
— |
| Knee 3 Views (73562) |
— |
$539.51 |
— |
| Magnetic Image Jaw Joint (70336) |
— |
$2,194.43 |
— |
| Mra Head W/O & W/Contrast Material (70546) |
— |
$3,476.28 |
— |
| MRA head w/o contrast (70544) |
— |
$3,088.82 |
— |
| MRA head with contrast (70545) |
— |
$2,781.38 |
— |
| MRA neck w contrast (70548) |
— |
$1,742.67 |
— |
| Mra Neck W/O &W/Contrast Material (70549) |
— |
$4,270.33 |
— |
| MRA neck w/o contrast (70547) |
— |
$2,545.73 |
— |
| MRI abdomen w/o contrast (74181) |
— |
$3,121.41 |
— |
| MRI any jt lower extrem w/contrast material (73722) |
— |
$2,647.33 |
— |
| MRI any jt lower extrem w/o & w/contrast matrl (73723) |
— |
$4,834.50 |
— |
| MRI any jt upper extremity w/contrast matrl (73222) |
— |
$3,029.11 |
— |
| MRI cervical spine w contrast (72142) |
— |
$1,854.84 |
— |
| MRI cervical spine w/o cont (72141) |
— |
$4,585.85 |
— |
| MRI chest w/o contrast (71550) |
— |
$2,260.24 |
— |
| MRI chest wo w contrast (71552) |
— |
$3,202.52 |
— |
| MRI lower extrem oth/thn jt w/contrast matrl (73719) |
— |
$2,222.73 |
— |
| MRI lower extrem oth/thn jt w/o & w/contr matr (73720) |
— |
$4,757.92 |
— |
| MRI lower extrem oth/thn jt w/o contr matrl (73718) |
— |
$3,129.58 |
— |
| MRI lumbar spine w contrast (72149) |
— |
$4,241.19 |
— |
| Mri Neck Spine W/O & W/Dye (72156) |
— |
$5,181.70 |
— |
| Mri Orbt/Fac/Nck W/O &W/Dye (70543) |
— |
$5,105.11 |
— |
| MRI pelvis w contrast (72196) |
— |
$1,708.51 |
— |
| MRI pelvis w/o & w contrast (72197) |
— |
$5,224.05 |
— |
| MRI pelvis w/o contrast (72195) |
— |
$3,096.95 |
— |
| MRI thoracic spine w/o contrast (72146) |
— |
$3,284.39 |
— |
| MRI upper extremity oth than jt w/o contr matrl (73218) |
— |
$3,436.01 |
— |
| Mri Uppr Extremity W/O&W/Dye (73220) |
— |
$4,832.87 |
— |
| MRI, abdomen, combo (74183) |
— |
$5,165.41 |
— |
| MRI, dorsal spine combo (72157) |
— |
$5,101.82 |
— |
| MRI, dorsal spine contrast (72147) |
— |
$4,241.19 |
— |
| MRI, joint upper extrem (73221) |
— |
$4,472.35 |
— |
| MRI, joint upper extrem combo (73223) |
— |
$4,076.66 |
— |
| MRI, lumbar spine combo (72158) |
— |
$7,279.67 |
— |
| Myelogram Lumbar (72265) |
— |
$2,647.33 |
— |
| Myelograpy 2/more regions rs&i (72270) |
— |
$2,647.33 |
— |
| Neck soft tissue (70360) |
— |
$234.74 |
— |
| Pelvis 1 or 2 views (72170) |
— |
$371.81 |
— |
| PET image w/CT, full body (78816) |
— |
$4,893.91 |
— |
| PET imaging CT attenuation skull base mid-thigh (78815) |
— |
$4,893.91 |
— |
| Radex Abd Compl Aqt Abd W/S/E/D Views 1 View Ch (74022) |
— |
$584.18 |
— |
| Radex Ankle Complete Minimum 3 Views (73610) |
— |
$539.51 |
— |
| Radex Calcaneus Minimum 2 Views (73650) |
— |
$232.32 |
— |
| Radex elbow complete minimum 3 views (73080) |
— |
$251 |
— |
| Radex Facial Bones Complete Minimum 3 Views (70150) |
— |
$399.37 |
— |
| Radex fingr minimum 2 views (73140) |
— |
$232.32 |
— |
| Radex foot complete minimum 3 views (73630) |
— |
$350.03 |
— |
| Radex Hand Minimum 3 Views (73130) |
— |
$337.11 |
— |
| Radex lower extremity infant minimum 2 views (73592) |
— |
$371.81 |
— |
| Radex Mastoids Compl Minimum 3 Views PR Side (70130) |
— |
$371.81 |
— |
| Radex Nasal Bones Complete Minimum 3 Views (70160) |
— |
$234.74 |
— |
| Radex Ribs Unilateral 2 Views (71100) |
— |
$251 |
— |
| Radex shoulder complete minimum 2 views (73030) |
— |
$539.51 |
— |
| Radex Sinuses Paransl < 3 Views (70210) |
— |
$244.87 |
— |
| Radex Spine 1 View Specify Level (72020) |
— |
$220 |
— |
| Radex Sternum Minimum 2 Views (71120) |
— |
$236.36 |
— |
| Radex Temporomandble Jt Opn & Clsd Mouth Bilat (70330) |
— |
$280.35 |
— |
| Radex Toe Minimum 2 Views (73660) |
— |
$232.32 |
— |
| Radex upper extremity infant minimum 2 views (73092) |
— |
$371.81 |
— |
| Radex Wrist Complete Minimum 3 Views (73110) |
— |
$286.34 |
— |
| Radex X-Ray Exam Entire Spi 6/> Vw - Xr Entire Spine 6+ Vw (72084) |
— |
$822.84 |
— |
| Radiolog exam mandible compl minimum 4 views (70110) |
— |
$360 |
— |
| Radiologic Exam Abdomen 3+ Views - Xr Abdomen 3+ Views (74021) |
— |
$526.30 |
— |
| Radiologic exam knee complete 4/more views (73564) |
— |
$452.83 |
— |
| Radiologic exam pelvis compl minimum 3 views (72190) |
— |
$371.81 |
— |
| Radiologic exam swallow function contrast study (74230) |
— |
$632.53 |
— |
| Radiologic examination femur 1 view (73551) |
— |
$241.23 |
— |
| Radiologic examination femur minimum 2 views (73552) |
— |
$391.82 |
— |
| Radiologic examination knee 1/2 views (73560) |
— |
$232.32 |
— |
| Radiologic Examination Osseous Survey Limited (77074) |
— |
$371.81 |
— |
| Radiologic examination tibia & fibula 2 views (73590) |
— |
$232.32 |
— |
| Ribs bilateral 3 views (71110) |
— |
$374.89 |
— |
| Scapula (73010) |
— |
$265.69 |
— |
Screening Digital Breast Tomosynthesis Bi (77063)
range across 2 matching MRF lines |
— |
$49.26–$56.98 |
— |
| Shoulder 1 view (73020) |
— |
$249.38 |
— |
| Shoulder Arthrography (73040) |
— |
$1,476.80 |
— |
| Skull less than 4 views (70250) |
— |
$371.81 |
— |
| Sternoclavicular joints (71130) |
— |
$232.32 |
— |
| Thoracic spine 2 views (72070) |
— |
$371.81 |
— |
| Thoracic spine 3 views (72072) |
— |
$371.81 |
— |
| Thoracolumbar 2 views (72080) |
— |
$227.07 |
— |
| Ultrasound Breast Limited (76642) |
— |
$415.71 |
— |
| Ultrasound Exam Aaa Screen (76706) |
— |
$440.87 |
— |
| Ultrasound, abdomen limited (76705) |
— |
$765.61 |
— |
| Umbilical-artery Doppler (OB) (76820) |
— |
$430.58 |
— |
| Unlisted us procedure (76999) |
— |
$358.77 |
— |
| Urethrocystography retrograde (74450) |
— |
$761.42 |
— |
| Us breast unilateral complete (76641) |
— |
$430.58 |
— |
| Us chest (76604) |
— |
$527.66 |
— |
| Us exam, pelvic, limited (76857) |
— |
$358.77 |
— |
| Us lmtd joint/oth nonvasc xtr strux r-t w/img (76882) |
— |
$491.38 |
— |
| Us ob detailed single fetus (76811) |
— |
$440.87 |
— |
| Us ob limited 1 or more fetuses (76815) |
— |
$527.66 |
— |
| Us ob transvaginal (76817) |
— |
$580.27 |
— |
| Us pelvic non ob complete (76856) |
— |
$653.64 |
— |
| Us pg uter img f&mat 14 wk tabdl 1/1st gestation (76801) |
— |
$580.27 |
— |
| Us preg uterus real time f/u trnsabdl per fetus (76816) |
— |
$363.53 |
— |
| Us retroperitoneal complete (76770) |
— |
$758.32 |
— |
| Us retroperitoneal limited (76775) |
— |
$549.32 |
— |
| Us scrotum and contents (76870) |
— |
$653.93 |
— |
| Us thyroid (76536) |
— |
$652.24 |
— |
| Us transrectal (76872) |
— |
$319.02 |
— |
| Wrist 2 views (73100) |
— |
$232.32 |
— |
| X-Ray Ac Jts - Xr Acromioclavicular Joints Bilateral (73050) |
— |
$252.46 |
— |
| X-Ray Bend Only L-S Spine (72120) |
— |
$444.44 |
— |
| X-Ray Elbow 2 Vw - Xr Elbow 1-2 Views Right (73070) |
— |
$232.32 |
— |
| X-Ray Exam Breast Specimen (76098) |
— |
$1,903.91 |
— |
| X-Ray Exam Entire Spi 1 Vw (72081) |
— |
$236.36 |
— |
| X-Ray Exam Entire Spi 2/3 Vw (72082) |
— |
$484.73 |
— |
| X-Ray Exam Entire Spi 4/5 Vw (72083) |
— |
$626.92 |
— |
| X-Ray Exam Hip Uni 1 View (73501) |
— |
$232.32 |
— |
| X-Ray Exam Hip Uni 2-3 Views (73502) |
— |
$313.47 |
— |
| X-Ray Exam Hip Uni 4/> Views (73503) |
— |
$405.54 |
— |
| X-Ray Exam Hips Bi 2 Views (73521) |
— |
$371.81 |
— |
| X-Ray Exam Hips Bi 3-4 Views (73522) |
— |
$509.38 |
— |
| X-Ray Exam Hips Bi 5/> Views (73523) |
— |
$773.20 |
— |
| X-Ray Exam L-S Spine Bending (72114) |
— |
$371.81 |
— |
| X-Ray Exam Neck Spine 2-3 Vw (72040) |
— |
$371.81 |
— |
| X-Ray Exam Neck Spine 6/>Vws (72052) |
— |
$542.79 |
— |
| X-Ray Exam Unilat Ribs/Chest (71101) |
— |
$371.81 |
— |
| X-ray eye for foreign body (70030) |
— |
$232.32 |
— |
| X-ray humerus (73060) |
— |
$232.32 |
— |
| X-Ray Jaw <4 Vw - Xr Mandible < 4 Views (70100) |
— |
$244.87 |
— |
| X-Ray Knee Bilat Standing - Xr Knees Anteroposterior Standing Bilat (73565) |
— |
$232.32 |
— |
| X-Ray Lumbar Spine 2/3 Vw - Xr Lumbar Spine 2-3 Views (72100) |
— |
$539.51 |
— |
| X-ray nose-rectum child f.b. (76010) |
— |
$232.32 |
— |
| X-Ray Ribs, Chest 4+ Vw - Xr Ribs 3 Vws Bil W/ Chest Posteroanterior (71111) |
— |
$374.89 |
— |
| X-Ray Sacroiliac Jts 3+ Vw - Xr Sacroiliac Joints 3+ Views (72202) |
— |
$371.81 |
— |
| X-Ray Sacrum/Coccyx 2+ Vw - Xr Sacrum Coccyx 2+ Views (72220) |
— |
$249.38 |
— |
| X-Ray Sinuses 3+ Vw - Xr Paranasal Sinuses 3+ Views (70220) |
— |
$371.81 |
— |
| X-Ray Skull 4+ Vw - Xr Skull Complete 4+ Views (70260) |
— |
$459.67 |
— |
| X-Rays Bone Survey Complete (77075) |
— |
$803.55 |
— |
| Xr c-spine 4 or 5 views (72050) |
— |
$371.81 |
— |
| Xr facial bones less than 3 views (70140) |
— |
$232.32 |
— |
| Xr orbits complete 4 views (70200) |
— |
$371.81 |
— |