| Abdomen 1 View (74018) |
$86 |
$734 |
1.0× |
| Abdomen 2 views (74019) |
$104 |
$1,335.04 |
1.0× |
| Acute Gastrointestinal Blood Loss Imaging (78278) |
$399 |
$2,215 |
1.0× |
| Angio internal mammary (75756) |
$3,156 |
$2,849.22 |
1.0× |
| Angio pulmonary bilat (75743) |
$3,156 |
$8,083 |
1.0× |
| Angiography Adrenal Bilateral Slctv Rs&I (75733) |
$3,156 |
$5,857.94 |
1.0× |
| Angiography extremity bilateral rs&i (75716) |
$3,156 |
$12,389.20 |
1.0× |
Angiography extremity unilateral rs&i (75710)
range across 3 matching MRF lines |
$3,156 |
$8,083–$12,389.20 |
1.0× |
| Angiography pulmonary unilateral slctv rs&i (75741) |
$3,156 |
$8,083 |
1.0× |
| Angrph pulmonary nonslctv cath/ven njx rs&i (75746) |
$3,156 |
$2,624.89 |
1.0× |
| Ankle 2 views (73600) |
$86 |
$1,583 |
1.0× |
| Aortography thoracic serialography rs&i (75605) |
$5,562 |
$8,083 |
1.0× |
| Aortography thoracic w/o serialography rs&i (75600) |
$3,156 |
$10,965 |
1.0× |
| Artery X-Rays Abdomen (75726) |
$5,562 |
$14,160 |
1.0× |
| Artery X-Rays Adrenal Gland (75731) |
$3,156 |
$4,234.33 |
1.0× |
| Artery X-Rays Pelvis (75736) |
$5,562 |
$10,965 |
1.0× |
| Arthrogram ankle (73615) |
$348 |
$2,370.55 |
1.0× |
| Arthrogram hip (73525) |
$348 |
$1,857.89 |
1.0× |
| Arthrogram Wrist (73115) |
$348 |
$2,944.78 |
1.0× |
| Basic radiation dosimetry calculation (77300) |
$134 |
$1,571.99 |
1.0× |
| Bone age studies (77072) |
$104 |
$1,064 |
1.0× |
| Bone Imaging 3 Phase (78315) |
$399 |
$4,863.27 |
1.0× |
| Bone Imaging Limited Area (78300) |
$399 |
$2,687 |
1.0× |
| Bone Imaging Multiple Areas (78305) |
$399 |
$1,641.85 |
1.0× |
| Bone Imaging Whole Body (78306) |
$399 |
$3,993.68 |
1.0× |
| Bone marrow imaging limited area (78102) |
$399 |
$1,436 |
1.0× |
| Bone marrow imaging; multiple areas (78103) |
$399 |
$1,288.63 |
1.0× |
| Bone marrow imaging; whole body (78104) |
$399 |
$1,866.58 |
1.0× |
| Bone survey infant (77076) |
$104 |
$713.46 |
1.0× |
| Brain Flow Imaging Only (78610) |
$542 |
$1,825 |
1.0× |
| Brain Image W/Flow < 4 Views (78601) |
$399 |
$1,485.15 |
1.0× |
| Brain imaging < 4 static views (78600) |
$399 |
$1,107.94 |
1.0× |
| Brain Imaging Min 4 Static Views W Vascular Flow (78606) |
$542 |
$2,786.25 |
1.0× |
| Brain Imaging Minimum 4 Static Views (78605) |
$542 |
$1,879.57 |
1.0× |
| Card Bl Pool Gated Spect Rest Wal Motn Ejct Frct (78494) |
$399 |
$2,628 |
1.0× |
| Cardiac Shunt Detection (78428) |
$399 |
$1,467.44 |
1.0× |
| Cat Scan Follow-Up Study (76380) |
$86 |
$1,174.16 |
1.0× |
| Cerebrospinal Fluid Flow W/O Matl Shunt Evaltj (78645) |
$542 |
$1,657.12 |
1.0× |
| Cerebrospinal fluid flow, imaging (not including introduction of material); ventriculography Non-Facility (78635) |
$542 |
$3,900.75 |
1.0× |
| Cerebrospinal Fluid Scan (78630) |
$542 |
$1,934.29 |
1.0× |
Chest 1 view (71045)
range across 3 matching MRF lines |
$86 |
$635–$4,715.17 |
1.0× |
| Chest 2 views (71046) |
$86 |
$997.58 |
1.0× |
| Chest 3 views (71047) |
$86 |
$625.20 |
1.0× |
| Chest 4 or more views (71048) |
$104 |
$648.04 |
1.0× |
| Cholecystography Oral Contrast (74290) |
$175 |
$386.17 |
1.0× |
| Cineradiograpy/vidradiograpy xcpt where spec (76120) |
$104 |
$590.11 |
1.0× |
| Clavicle complete (73000) |
$86 |
$2,149.83 |
1.0× |
| Computed Tomography Thorax Lw Dose Lng Ca Scr C- (71271) |
$104 |
$427.30 |
1.0× |
| Contrast Exam Abdominl Aorta (75625) |
$3,156 |
$12,389.20 |
1.0× |
| Contrast X-Ray Bladder (74430) |
$348 |
$2,058 |
1.0× |
| Contrast X-Ray Of Elbow (73085) |
$348 |
$916.93 |
1.0× |
| Contrast X-Ray Of Knee Joint (73580) |
$348 |
$2,453 |
1.0× |
| Contrast Xray Throat/Cerv Esopha (74210) |
$175 |
$580 |
1.0× |
| Corpora cavernosography (74445) |
$104 |
$1,278.29 |
1.0× |
| CT abdomen and pelvis without and with contrast (74178) |
$348 |
$15,515.40 |
1.0× |
| CT abdomen and pelvis without contrast (74176) |
$238 |
$1,167.60 |
1.0× |
| CT abdomen w contrast (74160) |
$175 |
$4,489 |
1.0× |
| CT abdomen w wo contrast (74170) |
$175 |
$5,776.20 |
1.0× |
| CT abdomen w/o contrast (74150) |
$104 |
$2,985 |
1.0× |
| CT Angio Abdomen and Pelvis (74174) |
$348 |
$5,447 |
1.0× |
| CT Angio Chest (71275) |
$175 |
$11,591.60 |
1.0× |
| CT Angio Head (70496) |
$175 |
$6,895.99 |
1.0× |
| CT angio hrt w/3d image (75574) |
$348 |
$3,398.19 |
1.0× |
| Ct Angio Lwr Extr W/O&W/Dye (73706) |
$175 |
$4,205 |
1.0× |
| CT Angio Neck (70498) |
$175 |
$7,439.25 |
1.0× |
| Ct Angio Upr Extrm W/O&W/Dye (73206) |
$175 |
$4,996.90 |
1.0× |
| CT bone density (77078) |
$86 |
$581.02 |
1.0× |
| CT cervical spine w/ contrast (72126) |
$348 |
$8,941 |
1.0× |
| CT cervical spine w/o contrast (72125) |
$104 |
$6,959.97 |
1.0× |
| CT cervical spine w/wo cont (72127) |
$175 |
$9,314.24 |
1.0× |
| CT chest w contrast (71260) |
$175 |
$6,276.47 |
1.0× |
| CT chest w/wo contrast (71270) |
$175 |
$6,109.32 |
1.0× |
| CT colonography screening (74263) |
$238 |
$2,043 |
1.0× |
| CT colonogrphy dx image postprocess w/o contrast (74261) |
$104 |
$1,972 |
1.0× |
| CT head/brain with contrast (70460) |
$175 |
$4,442.95 |
1.0× |
| CT head/brain without and with contrast (70470) |
$175 |
$6,313.56 |
1.0× |
| CT heart contrast eval cardiac structure&morph (75572) |
$348 |
$2,490.95 |
1.0× |
| CT heart no contrast quant eval coronry calcium (75571) |
$86 |
$672.54 |
1.0× |
| CT hrt w/3d image congen (75573) |
$348 |
$2,670.25 |
1.0× |
| CT iac w contrast (70481) |
$175 |
$3,746 |
1.0× |
| CT l-spine w&w/o contrast (72133) |
$175 |
$4,466.77 |
1.0× |
| CT lower ext w/o (73700) |
$104 |
$6,650.86 |
1.0× |
| CT lower extremity w/contrast material (73701) |
$175 |
$3,316 |
1.0× |
| CT lumbar spine w contrast (72132) |
$348 |
$7,728.30 |
1.0× |
| CT lumbar spine w/o contrast (72131) |
$104 |
$3,140 |
1.0× |
| CT maxillofacial w contrast (70487) |
$175 |
$6,208.39 |
1.0× |
| CT maxillofacial wo contrast (70486) |
$104 |
$6,382.49 |
1.0× |
| CT neck tissue combo (70492) |
$175 |
$7,273.66 |
1.0× |
| Ct Orbit/Ear/Fossa W/O&W/Dye (70482) |
$175 |
$10,198.40 |
1.0× |
| CT orbits w/o contrast (70480) |
$104 |
$4,059 |
1.0× |
| CT pelvis w&w/o contrast (72194) |
$175 |
$5,486 |
1.0× |
| CT pelvis w/o contrast (72192) |
$104 |
$3,080 |
1.0× |
| CT scan of leg combo (73702) |
$175 |
$4,975 |
1.0× |
| CT scans face/jaw combo (70488) |
$175 |
$7,318.01 |
1.0× |
| CT soft tissue neck w contrast (70491) |
$175 |
$7,019.29 |
1.0× |
| CT soft tissue neck w/o contrast (70490) |
$104 |
$5,910.30 |
1.0× |
| CT thoracic spine w contrast (72129) |
$175 |
$7,025.73 |
1.0× |
| CT thoracic spine w/o contrast (72128) |
$104 |
$5,511.20 |
1.0× |
| CT thoracic spine w/wo cont (72130) |
$175 |
$4,466.77 |
1.0× |
| CT thorax w/o contrast (71250) |
$104 |
$2,765 |
1.0× |
| CT unlisted procedure (76497) |
$86 |
$6,249.55 |
1.0× |
| CT upper ext wo (73200) |
$104 |
$2,557 |
1.0× |
| CT upper extremity w/o & w/contrast material (73202) |
$175 |
$4,263 |
1.0× |
| CT upper extremity with contrast (73201) |
$348 |
$4,419 |
1.0× |
| Cta Abdl Aorta&Bi Iliofem W/Contrast&Postp (75635) |
$175 |
$4,299 |
1.0× |
| Cta Abdomen (74175) |
$175 |
$4,580 |
1.0× |
| CTA pelvis (72191) |
$175 |
$4,415 |
1.0× |
| Dilation ureters/urethra rs&i (74485) |
$2,089 |
$1,691.49 |
1.0× |
| Discography Cerv/Thor Spine (72285) |
$1,952 |
$2,799.16 |
1.0× |
| Diskography lumbar (72295) |
$1,952 |
$8,662 |
1.0× |
| Doppler Echo Fetal Puls Spectral F/U/Repeat (76828) |
$104 |
$572.17 |
1.0× |
| Doppler Echo Fetal Spectral Display Complete (76827) |
$104 |
$759.71 |
1.0× |
| Dxa Bone Density Axial (77080) |
$104 |
$1,439.73 |
1.0× |
| Dxa bone density study (77085) |
$104 |
$665.14 |
1.0× |
| Dxa bone density study 1/>sites appendiclr skel (77081) |
$86 |
$760 |
1.0× |
| Echo exam uterus (76831) |
$238 |
$1,064.07 |
1.0× |
| Echo Guide For Artery Repair (76936) |
$215 |
$1,950 |
1.0× |
| Echograp Trans R Pros Study (76873) |
$104 |
$965 |
1.0× |
| Esophageal Motility Study (78258) |
$399 |
$1,235 |
1.0× |
| Esophagram (74220) |
$175 |
$1,603 |
1.0× |
| Fetal Biophys Profile W/Nst (76818) |
$104 |
$2,135 |
1.0× |
| Fetal Biophysical Profile W/O Non-Stress Testing (76819) |
$104 |
$1,352 |
1.0× |
| Fluoroscopy up to 1 hr (76000) |
$238 |
$1,848 |
1.0× |
| Follow-Up Angiography (75898) |
$3,156 |
$4,712.18 |
1.0× |
| Foot 2 views (73620) |
$86 |
$1,775.40 |
1.0× |
| Forearm 2 views (73090) |
$86 |
$2,602.68 |
1.0× |
| Gastric emptying imaging study (78264) |
$399 |
$3,374.97 |
1.0× |
| Gastric Mucosa Imaging (78261) |
$399 |
$1,618.37 |
1.0× |
| Gastroesophageal Reflux Exam (78262) |
$399 |
$1,709.73 |
1.0× |
| Gastrointestinal Protein Loss (78282) |
$399 |
$6,267.75 |
1.0× |
| Gated Heart Planar Single (78472) |
$399 |
$2,747.80 |
1.0× |
| Gated Heart, Multiple (78473) |
$399 |
$2,494.92 |
1.0× |
| GI Endoscopic US S&I (76975) |
$238 |
$888.09 |
1.0× |
| Hand 2 views (73120) |
$104 |
$1,775.40 |
1.0× |
| Heart first pass single,planar (78481) |
$542 |
$2,114.58 |
1.0× |
| Hepatc Vngrph Wdg/Fr Hemodyn Eval Rs&I (75889) |
$3,156 |
$8,083 |
1.0× |
| Hepatc Vngrph Wdg/Fr W/O Hemodyn Eval Rs&I (75891) |
$3,156 |
$8,083 |
1.0× |
| Hepatobil Syst Image W/Drug (78227) |
$542 |
$5,948.98 |
1.0× |
| Hepatobiliary System Imaging (78226) |
$399 |
$4,685.83 |
1.0× |
| Ht Muscle Image Spect Sing (78451) |
$1,294 |
$5,923.68 |
1.0× |
| Hysterosalpingogram (74740) |
$238 |
$3,870 |
1.0× |
| Infant hip ultrasound with hip movement (dynamic) (76885) |
$86 |
$861.75 |
1.0× |
| Infant hip ultrasound, limited static exam (76886) |
$86 |
$695.13 |
1.0× |
| Infusion Ivp (74410) |
$175 |
$1,957 |
1.0× |
| Joint Survey Single View (77077) |
$104 |
$665.14 |
1.0× |
| K Flow/Funct Image Multiple (78709) |
$542 |
$2,443 |
1.0× |
| K Flow/Funct Image W/Drug (78708) |
$542 |
$3,149 |
1.0× |
| K Flow/Funct Image W/O Drug (78707) |
$542 |
$2,788 |
1.0× |
| Kidney Funcj Study Non-Img Radioisotopic Study (78725) |
$399 |
$1,252 |
1.0× |
| Kidney Imaging Morphoogy W/Vascular Flow (78701) |
$399 |
$1,667.30 |
1.0× |
| Knee 3 Views (73562) |
$86 |
$1,024 |
1.0× |
| Leveen/Shunt Patency Exam (78291) |
$399 |
$1,285.72 |
1.0× |
| Liver & Spleen Imaging Static Only (78215) |
$399 |
$3,025 |
1.0× |
| Liver & Spleen Imaging W/Vascular Flow (78216) |
$399 |
$2,326 |
1.0× |
| Liver imaging static only (78201) |
$542 |
$1,502.31 |
1.0× |
| Liver imaging w/vascular flow (78202) |
$542 |
$2,326 |
1.0× |
| Lung Perf&Ventilat Diferentl (78598) |
$542 |
$1,173.58 |
1.0× |
| Lung perfusion differential (78597) |
$399 |
$1,825 |
1.0× |
| Lung Ventilat&Perfus Imaging (78582) |
$542 |
$2,100.82 |
1.0× |
| Lung Ventilation Imaging (78579) |
$399 |
$2,180.01 |
1.0× |
| Lymph System Imaging (78195) |
$542 |
$2,119.58 |
1.0× |
| Magnetic Image Jaw Joint (70336) |
$238 |
$8,762 |
1.0× |
| Mammary ductogram or galactogram multiple (77054) |
$238 |
$998 |
1.0× |
| Mammary ductogram or galactogram single (77053) |
$238 |
$1,685.15 |
1.0× |
| Meckels Divert Exam (78290) |
$399 |
$2,326 |
1.0× |
| Mra Head W/O & W/Contrast Material (70546) |
$348 |
$10,901.40 |
1.0× |
| MRA head w/o contrast (70544) |
$238 |
$7,818 |
1.0× |
| MRA head with contrast (70545) |
$348 |
$8,675.23 |
1.0× |
| MRA neck w contrast (70548) |
$348 |
$3,304.50 |
1.0× |
| Mra Neck W/O &W/Contrast Material (70549) |
$348 |
$10,824.30 |
1.0× |
| MRA neck w/o contrast (70547) |
$238 |
$7,446 |
1.0× |
| MRI abdomen w contrast (74182) |
$348 |
$8,675.23 |
1.0× |
| MRI abdomen w/o contrast (74181) |
$238 |
$8,829.95 |
1.0× |
| MRI any jt lower extrem w/contrast material (73722) |
$783 |
$19,092 |
1.0× |
| MRI any jt lower extrem w/o & w/contrast matrl (73723) |
$348 |
$8,687 |
1.0× |
| MRI any jt upper extremity w/contrast matrl (73222) |
$783 |
$20,515 |
1.0× |
| MRI bone marrow blood supply (77084) |
$238 |
$3,230.91 |
1.0× |
| MRI Breast W/O Contrast Bilateral (77047) |
$238 |
$2,721.10 |
1.0× |
| MRI Breast Without Contrast Material Unilateral (77046) |
$238 |
$2,721.10 |
1.0× |
| MRI cardiac w/o contrast (75557) |
$238 |
$3,217.75 |
1.0× |
| MRI cervical spine w contrast (72142) |
$348 |
$10,333.60 |
1.0× |
| MRI cervical spine w/o cont (72141) |
$238 |
$12,112 |
1.0× |
| MRI chest w/o contrast (71550) |
$238 |
$6,746.86 |
1.0× |
| MRI chest with contrast (71551) |
$783 |
$4,042 |
1.0× |
| MRI chest wo w contrast (71552) |
$348 |
$9,342.54 |
1.0× |
| MRI lower extrem oth/thn jt w/contrast matrl (73719) |
$348 |
$5,383 |
1.0× |
| MRI lower extrem oth/thn jt w/o & w/contr matr (73720) |
$348 |
$9,777.58 |
1.0× |
| MRI lower extrem oth/thn jt w/o contr matrl (73718) |
$238 |
$7,867 |
1.0× |
| MRI lumbar spine w contrast (72149) |
$348 |
$4,278 |
1.0× |
| Mri Neck Spine W/O & W/Dye (72156) |
$348 |
$13,476.40 |
1.0× |
| MRI orbit face &/neck w/o contrast (70540) |
$238 |
$4,075 |
1.0× |
| MRI orbit face neck w contrast (70542) |
$348 |
$5,739.02 |
1.0× |
| Mri Orbt/Fac/Nck W/O &W/Dye (70543) |
$348 |
$9,577 |
1.0× |
| MRI pelvis w contrast (72196) |
$348 |
$5,739.02 |
1.0× |
| MRI pelvis w/o & w contrast (72197) |
$348 |
$9,121 |
1.0× |
| MRI pelvis w/o contrast (72195) |
$238 |
$4,040 |
1.0× |
| MRI thoracic spine w/o contrast (72146) |
$238 |
$10,470.10 |
1.0× |
| MRI upper extremity oth than jt w/contr matrl (73219) |
$348 |
$3,826 |
1.0× |
| MRI upper extremity oth than jt w/o contr matrl (73218) |
$238 |
$4,040 |
1.0× |
| Mri Uppr Extremity W/O&W/Dye (73220) |
$348 |
$9,342.54 |
1.0× |
| MRI, abdomen, combo (74183) |
$348 |
$10,690.90 |
1.0× |
| MRI, dorsal spine combo (72157) |
$348 |
$12,779.50 |
1.0× |
| MRI, dorsal spine contrast (72147) |
$348 |
$4,919.16 |
1.0× |
| MRI, joint upper extrem (73221) |
$238 |
$10,861 |
1.0× |
| MRI, joint upper extrem combo (73223) |
$348 |
$22,313 |
1.0× |
| MRI, lumbar spine combo (72158) |
$348 |
$14,836.30 |
1.0× |
| Musculoskeletal Nuclear Exam (78399) |
$399 |
$2,326.17 |
1.0× |
| Myelogram cervical (72240) |
$783 |
$2,098 |
1.0× |
| Myelogram Lumbar (72265) |
$783 |
$4,675.51 |
1.0× |
| Myelography thoracic (72255) |
$783 |
$1,964 |
1.0× |
| Myelograpy 2/more regions rs&i (72270) |
$783 |
$2,602.70 |
1.0× |
| Myocardial Imaging Infarct Avid Planar Qual/Quan (78466) |
$399 |
$1,598.91 |
1.0× |
| Myocardial imaging, infarct avid, planar; with ejection fraction by first pass technique Non-Facility (78468) |
$542 |
$2,614.92 |
1.0× |
| Myocardial Spect Multiple Studies (78452) |
$1,294 |
$6,355.93 |
1.0× |
| Neck soft tissue (70360) |
$86 |
$743 |
1.0× |
| Nfs/Instlj Radioelmnt Sln 3 Mo Follow-Up Care (77750) |
$385 |
$1,111.39 |
1.0× |
| Njx Rp Loclzj Non-Img Probe Study Intravenous (78808) |
$399 |
$2,866.39 |
1.0× |
| Nm csf leak detection (78650) |
$1,294 |
$1,971 |
1.0× |
| Nm myocard infarct spect (78469) |
$542 |
$1,521.18 |
1.0× |
| Nuclear Rx Intra-Arterial (79445) |
$233 |
$2,499.80 |
1.0× |
| Nuclear Rx Oral Admin (79005) |
$233 |
$2,390 |
1.0× |
| Ob us nuchal meas 1 gest (76813) |
$104 |
$710.50 |
1.0× |
| Oph bmtry us echograpy a-scan io lens pwr cal (76519) |
$104 |
$563.34 |
1.0× |
| Oph us dx ant sgm us immersion b-scan/hr biom (76513) |
$104 |
$539 |
1.0× |
| Ophthalmic Biometry US Echograpy a-Scan (76516) |
$104 |
$366.78 |
1.0× |
| Ophthalmic Ultrasonic Foreign Body Localization (76529) |
$86 |
$443 |
1.0× |
| Ophthalmic ultrasound dx b-scan w/wo a-scan (76512) |
$104 |
$538 |
1.0× |
| Ophthalmic US Dx Corneal Pachymetry Uni/Bi (76514) |
$28 |
$204.68 |
1.0× |
| Parathyroid imaging w/tomographic spect & CT (78072) |
$542 |
$2,746.67 |
1.0× |
| Parathyroid Planar Imaging (78070) |
$399 |
$6,348.56 |
1.0× |
| Parathyroid planar imaging w/wo subtraction (78071) |
$399 |
$2,077.87 |
1.0× |
| Pelvis 1 or 2 views (72170) |
$104 |
$755 |
1.0× |
| Peritoneogram Rs&I (74190) |
$546 |
$1,522 |
1.0× |
| Pet Image Skull-Thigh (78812) |
$1,429 |
$6,660.27 |
1.0× |
| Pet Image W/Ct Lmtd (78814) |
$1,429 |
$6,558.11 |
1.0× |
| PET image w/CT, full body (78816) |
$1,429 |
$21,270 |
1.0× |
| PET imaging CT attenuation skull base mid-thigh (78815) |
$1,429 |
$21,270 |
1.0× |
| Pet Imaging Limited Area Chest Head/Neck (78811) |
$1,294 |
$5,714.24 |
1.0× |
| PET whole body (78813) |
$1,429 |
$3,855.51 |
1.0× |
| Pulmonary Perfusion Imaging Particulate (78580) |
$399 |
$2,215 |
1.0× |
| Radex Abd Compl Aqt Abd W/S/E/D Views 1 View Ch (74022) |
$104 |
$1,422.35 |
1.0× |
| Radex abscess/fistula/sinus tract rs&i (76080) |
$546 |
$2,144.25 |
1.0× |
| Radex Ankle Complete Minimum 3 Views (73610) |
$86 |
$1,831.98 |
1.0× |
| Radex Calcaneus Minimum 2 Views (73650) |
$86 |
$1,588.58 |
1.0× |
| Radex elbow complete minimum 3 views (73080) |
$86 |
$2,249.78 |
1.0× |
| Radex Facial Bones Complete Minimum 3 Views (70150) |
$104 |
$1,777.30 |
1.0× |
| Radex fingr minimum 2 views (73140) |
$86 |
$2,494.10 |
1.0× |
| Radex foot complete minimum 3 views (73630) |
$86 |
$1,959.54 |
1.0× |
| Radex Hand Minimum 3 Views (73130) |
$86 |
$2,466.86 |
1.0× |
| Radex lower extremity infant minimum 2 views (73592) |
$86 |
$2,236 |
1.0× |
| Radex Mastoids Compl Minimum 3 Views PR Side (70130) |
$104 |
$658 |
1.0× |
| Radex Nasal Bones Complete Minimum 3 Views (70160) |
$86 |
$1,403.09 |
1.0× |
| Radex Pharynx/Larx W/Fluor&/Magnification Tq (70370) |
$86 |
$536.51 |
1.0× |
| Radex Ribs Unilateral 2 Views (71100) |
$86 |
$745 |
1.0× |
| Radex shoulder complete minimum 2 views (73030) |
$86 |
$2,666.40 |
1.0× |
| Radex Sinuses Paransl < 3 Views (70210) |
$86 |
$900.89 |
1.0× |
| Radex sm int w/mlt srl imges via enteroclss tube (74251) |
$175 |
$1,059.05 |
1.0× |
| Radex Spine 1 View Specify Level (72020) |
$86 |
$654.25 |
1.0× |
| Radex Sternum Minimum 2 Views (71120) |
$86 |
$1,522.19 |
1.0× |
| Radex Temporomandble Jt Opn & Clsd Mouth Bilat (70330) |
$86 |
$682 |
1.0× |
| Radex Toe Minimum 2 Views (73660) |
$86 |
$1,914.73 |
1.0× |
| Radex upper extremity infant minimum 2 views (73092) |
$104 |
$1,549.84 |
1.0× |
| Radex Wrist Complete Minimum 3 Views (73110) |
$86 |
$3,072.72 |
1.0× |
| Radex X-Ray Exam Entire Spi 6/> Vw - Xr Entire Spine 6+ Vw (72084) |
$104 |
$1,343.79 |
1.0× |
| Radiolog exam mandible compl minimum 4 views (70110) |
$104 |
$993 |
1.0× |
| Radiologic Exam Abdomen 3+ Views - Xr Abdomen 3+ Views (74021) |
$104 |
$544.85 |
1.0× |
| Radiologic exam colon double contrast study (74280) |
$175 |
$3,462.64 |
1.0× |
Radiologic exam colon single contrast study (74270)
range across 2 matching MRF lines |
$175 |
$1,706.38–$2,148.12 |
1.0× |
| Radiologic exam knee complete 4/more views (73564) |
$104 |
$3,945.22 |
1.0× |
| Radiologic exam pelvis compl minimum 3 views (72190) |
$104 |
$904.78 |
1.0× |
| Radiologic Exam Small Int Single Contrast Study (74250) |
$175 |
$1,971.54 |
1.0× |
| Radiologic exam swallow function contrast study (74230) |
$175 |
$1,300 |
1.0× |
| Radiologic exam upr gi trc double contrast study (74246) |
$175 |
$974 |
1.0× |
| Radiologic examination femur 1 view (73551) |
$86 |
$760 |
1.0× |
| Radiologic examination femur minimum 2 views (73552) |
$86 |
$1,280 |
1.0× |
| Radiologic examination knee 1/2 views (73560) |
$86 |
$1,545.76 |
1.0× |
| Radiologic Examination Osseous Survey Limited (77074) |
$104 |
$1,919.51 |
1.0× |
| Radiologic Examination Salivary Gland Calculus (70380) |
$86 |
$266.10 |
1.0× |
| Radiologic examination tibia & fibula 2 views (73590) |
$86 |
$2,077.76 |
1.0× |
| Radiopharm Dacryocystography (78660) |
$399 |
$997.95 |
1.0× |
| Radiopharmaceutical therapy, by intracavitary administration Non-Facility (79200) |
$233 |
$1,873.67 |
1.0× |
| Renal Cyst Study (74470) |
$546 |
$1,097 |
1.0× |
| Ribs bilateral 3 views (71110) |
$104 |
$1,185 |
1.0× |
| Rp loclzj tum plnr 1 area single day imaging (78800) |
$399 |
$1,796.08 |
1.0× |
| Rp loclzj tum plnr 2+area 1+d img/1 area img>2+d (78801) |
$399 |
$2,736 |
1.0× |
| Rp Loclzj Tum Plnr Whole Body 2+ Days Imaging (78804) |
$542 |
$5,943.70 |
1.0× |
| Rp Loclzj Tum Plnr Whole Body Single Day Imaging (78802) |
$542 |
$5,519.14 |
1.0× |
| Rp Loclzj Tum Spect 1 Area Single Day Imaging (78803) |
$542 |
$5,237.29 |
1.0× |
| Rp Ther Radiolbld Monoclonal Antibody IV Infus (79403) |
$233 |
$5,185.74 |
1.0× |
| Rp Therapy Intravenous Administration (79101) |
$233 |
$1,455.50 |
1.0× |
| Rp Therapy Unlisted Procedure (79999) |
$233 |
$749.94 |
1.0× |
| Salivary Gland Function Study (78232) |
$399 |
$1,618.37 |
1.0× |
| Scapula (73010) |
$104 |
$1,433.17 |
1.0× |
| Screening Digital Breast Tomosynthesis Bi (77063) |
$23 |
$139.94 |
1.0× |
| Sella turcica (70240) |
$86 |
$658 |
1.0× |
| Shoulder 1 view (73020) |
$86 |
$1,303.88 |
1.0× |
| Shoulder Arthrography (73040) |
$348 |
$4,444.64 |
1.0× |
| Sialogram (70390) |
$238 |
$789.86 |
1.0× |
| Skull less than 4 views (70250) |
$104 |
$1,333.45 |
1.0× |
| Special Physics Consult (77370) |
$134 |
$1,666.50 |
1.0× |
| Special treatment procedure (77470) |
$552 |
$4,549.59 |
1.0× |
| Speech evaluation, complex (70371) |
$238 |
$807.99 |
1.0× |
| Spleen Imaging (78185) |
$399 |
$1,122.99 |
1.0× |
| Sternoclavicular joints (71130) |
$86 |
$658 |
1.0× |
| Superior sagittal sinus venogram (75870) |
$3,156 |
$2,683.25 |
1.0× |
| Testicular Imaging W/Flow (78761) |
$399 |
$1,299.13 |
1.0× |
| Ther rad simulaj-aided field setting simple (77280) |
$134 |
$1,218 |
1.0× |
| Therapeutic Enema Rdctj Intussusception/Obstrcj (74283) |
$175 |
$1,381.42 |
1.0× |
| Thoracic spine 2 views (72070) |
$104 |
$1,360.92 |
1.0× |
| Thoracic spine 3 views (72072) |
$104 |
$1,883.72 |
1.0× |
| Thoracolumbar 2 views (72080) |
$86 |
$710 |
1.0× |
| Thyroid carcinoma metastases imaging; with additional studies (eg, urinary recovery) Non-Facility (78016) |
$399 |
$1,233.73 |
1.0× |
| Thyroid Carcinoma Metastases Img Lmtd Area (78015) |
$399 |
$1,226 |
1.0× |
| Thyroid Imaging With Vascular Flow (78013) |
$399 |
$1,908.50 |
1.0× |
| Thyroid Met Imaging Body (78018) |
$542 |
$3,821.11 |
1.0× |
| Thyroid Uptake Measurement (78012) |
$399 |
$1,173 |
1.0× |
| Thyroid Uptake W/Blood Flow Sngle/Mult Quan Meas (78014) |
$399 |
$2,755 |
1.0× |
| Ultrasound Breast Limited (76642) |
$86 |
$962.75 |
1.0× |
| Ultrasound, abdomen limited (76705) |
$104 |
$1,406.55 |
1.0× |
| Unlisted Dx Radiographic Procedure (76499) |
$86 |
$12.75 |
1.0× |
| Unlisted fluoroscopic procedure (76496) |
$86 |
$942.69 |
1.0× |
| Unlisted magnetic resonance procedure (76498) |
$86 |
$3,978 |
1.0× |
| Unlisted Miscellaneous Px Dx Nuclear Medicine (78999) |
$399 |
$997.95 |
1.0× |
| Unlisted us procedure (76999) |
$86 |
$2,630.38 |
1.0× |
| Upper gi w/o kub (74240) |
$175 |
$880 |
1.0× |
| Urethrocystogram voiding (74455) |
$238 |
$3,135.27 |
1.0× |
| Urethrocystography retrograde (74450) |
$238 |
$2,218 |
1.0× |
| Us bone density measurement (76977) |
$104 |
$366.59 |
1.0× |
| Us breast unilateral complete (76641) |
$104 |
$976.80 |
1.0× |
| Us chest (76604) |
$104 |
$692 |
1.0× |
| Us complete joint (76881) |
$104 |
$1,605 |
1.0× |
| Us exam, pelvic, limited (76857) |
$104 |
$1,376.27 |
1.0× |
| Us head (76506) |
$104 |
$1,424 |
1.0× |
| Us kidney transplant (76776) |
$104 |
$1,104 |
1.0× |
| Us lmtd joint/oth nonvasc xtr strux r-t w/img (76882) |
$104 |
$875.02 |
1.0× |
| Us ob detailed single fetus (76811) |
$238 |
$1,138.35 |
1.0× |
| Us ob limited 1 or more fetuses (76815) |
$104 |
$2,175.14 |
1.0× |
| Us ob transvaginal (76817) |
$104 |
$2,267.34 |
1.0× |
| Us pelvic non ob complete (76856) |
$104 |
$3,633.53 |
1.0× |
| Us pg uter img f&mat 14 wk tabdl 1/1st gestation (76801) |
$104 |
$1,612 |
1.0× |
| Us preg uterus real time f/u trnsabdl per fetus (76816) |
$104 |
$806 |
1.0× |
| Us retroperitoneal complete (76770) |
$104 |
$1,495 |
1.0× |
| Us retroperitoneal limited (76775) |
$104 |
$1,376.01 |
1.0× |
| Us scrotum and contents (76870) |
$104 |
$2,070.61 |
1.0× |
| Us spinal canal and contents (76800) |
$104 |
$792.73 |
1.0× |
| Us thyroid (76536) |
$104 |
$3,196.57 |
1.0× |
| Us transrectal (76872) |
$104 |
$1,495 |
1.0× |
| Vascular Flow Imaging (78445) |
$399 |
$1,079.09 |
1.0× |
| Vasogram (74440) |
$238 |
$3,528 |
1.0× |
| Vein X-Ray Chest (75827) |
$1,573 |
$6,224.85 |
1.0× |
| Venogram Sinus/Jugular (75860) |
$3,156 |
$2,429.82 |
1.0× |
| Venography Adrenal Unilateral (75840) |
$3,156 |
$5,203.27 |
1.0× |
| Venography caval inferior serialography rs&i (75825) |
$3,156 |
$8,083 |
1.0× |
| Venography extremity bilateral rs&i (75822) |
$1,573 |
$6,224.85 |
1.0× |
| Venography extremity unilateral rs&i (75820) |
$1,573 |
$6,224.85 |
1.0× |
| Venography Renal Bilateral (75833) |
$3,156 |
$8,083 |
1.0× |
| Venography Renal Unilateral (75831) |
$3,156 |
$8,083 |
1.0× |
| Venous sampling by catheter (75893) |
$5,562 |
$8,083 |
1.0× |
| Venous thrombosis imaging (78457) |
$542 |
$785.63 |
1.0× |
| Venous Thrombosis Imaging Venogram Bilateral (78458) |
$399 |
$1,756.56 |
1.0× |
| Vertebral fracture assessment via dxa (77086) |
$86 |
$306.50 |
1.0× |
| Wrist 2 views (73100) |
$86 |
$1,543.86 |
1.0× |
| X-Ray Ac Jts - Xr Acromioclavicular Joints Bilateral (73050) |
$86 |
$1,042.86 |
1.0× |
| X-ray antegrade pyelogram tube (74425) |
$348 |
$1,960 |
1.0× |
| X-Ray Aorta Leg Arteries (75630) |
$3,156 |
$12,389.20 |
1.0× |
| X-Ray Bend Only L-S Spine (72120) |
$104 |
$822 |
1.0× |
| X-Ray Elbow 2 Vw - Xr Elbow 1-2 Views Right (73070) |
$86 |
$795 |
1.0× |
| X-Ray Exam Breast Specimen (76098) |
$546 |
$3,780.18 |
1.0× |
| X-Ray Exam Entire Spi 1 Vw (72081) |
$86 |
$760 |
1.0× |
| X-Ray Exam Entire Spi 2/3 Vw (72082) |
$104 |
$1,064 |
1.0× |
| X-Ray Exam Entire Spi 4/5 Vw (72083) |
$104 |
$1,343.79 |
1.0× |
| X-Ray Exam Hip Uni 1 View (73501) |
$86 |
$581 |
1.0× |
| X-Ray Exam Hip Uni 2-3 Views (73502) |
$86 |
$751 |
1.0× |
| X-Ray Exam Hip Uni 4/> Views (73503) |
$104 |
$704.83 |
1.0× |
| X-Ray Exam Hips Bi 2 Views (73521) |
$104 |
$3,533.90 |
1.0× |
| X-Ray Exam Hips Bi 3-4 Views (73522) |
$104 |
$1,259 |
1.0× |
| X-Ray Exam Hips Bi 5/> Views (73523) |
$104 |
$1,343.79 |
1.0× |
| X-Ray Exam L-S Spine Bending (72114) |
$104 |
$1,813.90 |
1.0× |
| X-Ray Exam Neck Spine 2-3 Vw (72040) |
$86 |
$1,152.33 |
1.0× |
| X-Ray Exam Neck Spine 6/>Vws (72052) |
$104 |
$1,587.96 |
1.0× |
| X-Ray Exam Unilat Ribs/Chest (71101) |
$104 |
$1,633.28 |
1.0× |
| X-ray eye for foreign body (70030) |
$86 |
$260.10 |
1.0× |
| X-ray head for orthodontia (70350) |
$86 |
$415.59 |
1.0× |
| X-ray humerus (73060) |
$86 |
$1,543.86 |
1.0× |
| X-ray IV pyelogram (ivp) (74400) |
$175 |
$2,424 |
1.0× |
| X-ray IV pyelogram+tomography (74415) |
$175 |
$4,215.59 |
1.0× |
| X-Ray Jaw <4 Vw - Xr Mandible < 4 Views (70100) |
$86 |
$1,405.74 |
1.0× |
| X-Ray Knee Bilat Standing - Xr Knees Anteroposterior Standing Bilat (73565) |
$86 |
$678.17 |
1.0× |
| X-Ray Lumbar Spine 2/3 Vw - Xr Lumbar Spine 2-3 Views (72100) |
$104 |
$1,138.42 |
1.0× |
| X-ray nose-rectum child f.b. (76010) |
$86 |
$959.85 |
1.0× |
| X-Ray Ribs, Chest 4+ Vw - Xr Ribs 3 Vws Bil W/ Chest Posteroanterior (71111) |
$104 |
$2,104.07 |
1.0× |
| X-Ray Sacroiliac Jts 3+ Vw - Xr Sacroiliac Joints 3+ Views (72202) |
$104 |
$997.66 |
1.0× |
| X-Ray Sacroiliac Jts <3 Vw - Xr Sacroiliac Joints 1-2 Views (72200) |
$104 |
$691 |
1.0× |
| X-Ray Sacrum/Coccyx 2+ Vw - Xr Sacrum Coccyx 2+ Views (72220) |
$86 |
$842.91 |
1.0× |
| X-Ray Sinuses 3+ Vw - Xr Paranasal Sinuses 3+ Views (70220) |
$86 |
$1,410.78 |
1.0× |
| X-Ray Skull 4+ Vw - Xr Skull Complete 4+ Views (70260) |
$104 |
$2,097.01 |
1.0× |
| X-Ray Stress View (77071) |
$86 |
$411.75 |
1.0× |
| X-ray thoracic spine 4 vw (72074) |
$104 |
$1,204 |
1.0× |
| X-Ray Tmj Unilat (70328) |
$86 |
$374.24 |
1.0× |
| X-Ray Urinary Tract Exam With Contrast Material (74420) |
$348 |
$2,162 |
1.0× |
| X-Rays Bone Length Studies (77073) |
$104 |
$1,104.33 |
1.0× |
| X-Rays Bone Survey Complete (77075) |
$104 |
$1,259 |
1.0× |
| Xr c-spine 4 or 5 views (72050) |
$104 |
$1,843.59 |
1.0× |
| Xr facial bones less than 3 views (70140) |
$86 |
$847.71 |
1.0× |
| XR Mastoids < 3 Views Bilateral (70120) |
$104 |
$295.96 |
1.0× |
| Xr myelogram posterior fossa (70010) |
$348 |
$1,455 |
1.0× |
| Xr orbits complete 4 views (70200) |
$104 |
$1,780.27 |
1.0× |
| Xr Tomogram Single Plane (76100) |
$104 |
$1,013 |
1.0× |