| Abdomen 1 View (74018) |
— |
$1,599 |
— |
| Abdomen 2 views (74019) |
— |
$323 |
— |
| Acute Gastrointestinal Blood Loss Imaging (78278) |
— |
$1,427 |
— |
| Angio internal mammary (75756) |
— |
$124 |
— |
| Angio pulmonary bilat (75743) |
— |
$119 |
— |
| Angiography extremity bilateral rs&i (75716) |
— |
$11,440 |
— |
Angiography extremity unilateral rs&i (75710)
range across 4 matching MRF lines |
— |
$665–$11,440 |
— |
| Angiography pulmonary unilateral slctv rs&i (75741) |
— |
$19,739 |
— |
| Angrph pulmonary nonslctv cath/ven njx rs&i (75746) |
— |
$178 |
— |
| Ankle 2 views (73600) |
— |
$323 |
— |
| Artery X-Rays Abdomen (75726) |
— |
$11,440 |
— |
Arthrogram ankle (73615)
range across 3 matching MRF lines |
— |
$323–$1,353 |
— |
Arthrogram hip (73525)
range across 3 matching MRF lines |
— |
$396–$1,353 |
— |
Arthrogram Wrist (73115)
range across 3 matching MRF lines |
— |
$323–$1,353 |
— |
| Bone age studies (77072) |
— |
$92 |
— |
| Bone Imaging 3 Phase (78315) |
— |
$1,427 |
— |
| Bone Imaging Limited Area (78300) |
— |
$987 |
— |
| Bone Imaging Whole Body (78306) |
— |
$1,427 |
— |
| Bone survey infant (77076) |
— |
$396 |
— |
| Brain Imaging Min 4 Static Views W Vascular Flow (78606) |
— |
$1,850 |
— |
| Cerebrospinal Fluid Scan (78630) |
— |
$1,850 |
— |
| Chest 1 view (71045) |
— |
$1,354 |
— |
| Chest 2 views (71046) |
— |
$323 |
— |
| Chest 3 views (71047) |
— |
$323 |
— |
| Chest 4 or more views (71048) |
— |
$323 |
— |
Clavicle complete (73000)
range across 3 matching MRF lines |
— |
$323–$2,714 |
— |
| Computed Tomography Thorax Lw Dose Lng Ca Scr C- (71271) |
— |
$665 |
— |
| Contrast Exam Abdominl Aorta (75625) |
— |
$665 |
— |
| Contrast X-Ray Bladder (74430) |
— |
$1,353 |
— |
Contrast X-Ray Of Elbow (73085)
range across 3 matching MRF lines |
— |
$323–$1,353 |
— |
Contrast X-Ray Of Knee Joint (73580)
range across 3 matching MRF lines |
— |
$323–$1,353 |
— |
| CT abdomen and pelvis without and with contrast (74178) |
— |
$1,353 |
— |
| CT abdomen and pelvis without contrast (74176) |
— |
$859 |
— |
| CT abdomen w contrast (74160) |
— |
$396 |
— |
| CT abdomen w wo contrast (74170) |
— |
$665 |
— |
| CT abdomen w/o contrast (74150) |
— |
$396 |
— |
| CT Angio Abdomen and Pelvis (74174) |
— |
$1,353 |
— |
| CT Angio Chest (71275) |
— |
$665 |
— |
| CT Angio Head (70496) |
— |
$665 |
— |
| CT angio hrt w/3d image (75574) |
— |
$665 |
— |
| Ct Angio Lwr Extr W/O&W/Dye (73706) |
— |
$665 |
— |
| CT Angio Neck (70498) |
— |
$665 |
— |
| Ct Angio Upr Extrm W/O&W/Dye (73206) |
— |
$665 |
— |
| CT cervical spine w/ contrast (72126) |
— |
$396 |
— |
| CT cervical spine w/o contrast (72125) |
— |
$396 |
— |
| CT cervical spine w/wo cont (72127) |
— |
$1,353 |
— |
| CT chest w contrast (71260) |
— |
$396 |
— |
| CT chest w/wo contrast (71270) |
— |
$665 |
— |
| CT head/brain with contrast (70460) |
— |
$396 |
— |
| CT head/brain without and with contrast (70470) |
— |
$665 |
— |
| CT heart no contrast quant eval coronry calcium (75571) |
— |
$859 |
— |
| CT iac w contrast (70481) |
— |
$665 |
— |
| CT l-spine w&w/o contrast (72133) |
— |
$1,353 |
— |
| CT lower ext w/o (73700) |
— |
$396 |
— |
| CT lower extremity w/contrast material (73701) |
— |
$665 |
— |
| CT lumbar spine w contrast (72132) |
— |
$396 |
— |
| CT lumbar spine w/o contrast (72131) |
— |
$665 |
— |
| CT maxillofacial w contrast (70487) |
— |
$665 |
— |
| CT maxillofacial wo contrast (70486) |
— |
$665 |
— |
| CT neck tissue combo (70492) |
— |
$665 |
— |
| Ct Orbit/Ear/Fossa W/O&W/Dye (70482) |
— |
$665 |
— |
| CT orbits w/o contrast (70480) |
— |
$665 |
— |
| CT pelvis w&w/o contrast (72194) |
— |
$665 |
— |
| CT pelvis w/o contrast (72192) |
— |
$665 |
— |
| CT scan of leg combo (73702) |
— |
$665 |
— |
| CT scans face/jaw combo (70488) |
— |
$665 |
— |
| CT soft tissue neck w contrast (70491) |
— |
$396 |
— |
| CT soft tissue neck w/o contrast (70490) |
— |
$665 |
— |
| CT thoracic spine w contrast (72129) |
— |
$396 |
— |
| CT thoracic spine w/o contrast (72128) |
— |
$665 |
— |
| CT thoracic spine w/wo cont (72130) |
— |
$665 |
— |
| CT thorax w/o contrast (71250) |
— |
$396 |
— |
| CT unlisted procedure (76497) |
— |
$740 |
— |
| CT upper ext wo (73200) |
— |
$396 |
— |
CT upper extremity w/o & w/contrast material (73202)
range across 3 matching MRF lines |
— |
$665–$1,353 |
— |
| CT upper extremity with contrast (73201) |
— |
$1,353 |
— |
| Cta Abdl Aorta&Bi Iliofem W/Contrast&Postp (75635) |
— |
$11,440 |
— |
| Cta Abdomen (74175) |
— |
$1,353 |
— |
| CTA pelvis (72191) |
— |
$396 |
— |
| Dxa Bone Density Axial (77080) |
— |
$396 |
— |
| Dxa bone density study (77085) |
— |
$323 |
— |
| Dxa bone density study 1/>sites appendiclr skel (77081) |
— |
$396 |
— |
| Esophagram (74220) |
— |
$1,850 |
— |
| Fetal Biophys Profile W/Nst (76818) |
— |
$396 |
— |
| Fetal Biophysical Profile W/O Non-Stress Testing (76819) |
— |
$396 |
— |
| Fluoroscopy up to 1 hr (76000) |
— |
$972 |
— |
Foot 2 views (73620)
range across 3 matching MRF lines |
— |
$323–$1,353 |
— |
Forearm 2 views (73090)
range across 4 matching MRF lines |
— |
$323–$1,353 |
— |
| Gastric emptying imaging study (78264) |
— |
$1,850 |
— |
| Gated Heart Planar Single (78472) |
— |
$4,859 |
— |
Hand 2 views (73120)
range across 3 matching MRF lines |
— |
$396–$1,353 |
— |
| Hepatobil Syst Image W/Drug (78227) |
— |
$1,850 |
— |
| Hepatobiliary System Imaging (78226) |
— |
$1,427 |
— |
| Ht Muscle Image Spect Sing (78451) |
— |
$1,427 |
— |
| Hysterosalpingogram (74740) |
— |
$859 |
— |
| Infant hip ultrasound with hip movement (dynamic) (76885) |
— |
$267 |
— |
| Joint Survey Single View (77077) |
— |
$396 |
— |
| K Flow/Funct Image Multiple (78709) |
— |
$1,850 |
— |
| K Flow/Funct Image W/Drug (78708) |
— |
$1,850 |
— |
| K Flow/Funct Image W/O Drug (78707) |
— |
$4,859 |
— |
| Knee 3 Views (73562) |
— |
$323 |
— |
| Leveen/Shunt Patency Exam (78291) |
— |
$1,427 |
— |
| Liver & Spleen Imaging Static Only (78215) |
— |
$1,850 |
— |
| Liver & Spleen Imaging W/Vascular Flow (78216) |
— |
$1,427 |
— |
| Lung Perf&Ventilat Diferentl (78598) |
— |
$1,850 |
— |
| Lung Ventilat&Perfus Imaging (78582) |
— |
$1,427 |
— |
| Lymph System Imaging (78195) |
— |
$1,427 |
— |
| Magnetic Image Jaw Joint (70336) |
— |
$323 |
— |
| Mammary ductogram or galactogram multiple (77054) |
— |
$859 |
— |
| Mammary ductogram or galactogram single (77053) |
— |
$1,958 |
— |
| Meckels Divert Exam (78290) |
— |
$1,427 |
— |
| MRA head w/o contrast (70544) |
— |
$1,354 |
— |
| MRA head with contrast (70545) |
— |
$860 |
— |
| MRA neck w contrast (70548) |
— |
$860 |
— |
| MRA neck w/o contrast (70547) |
— |
$1,354 |
— |
| MRI abdomen w/o contrast (74181) |
— |
$1,353 |
— |
| MRI any jt lower extrem w/contrast material (73722) |
— |
$2,715 |
— |
MRI any jt lower extrem w/o & w/contrast matrl (73723)
range across 3 matching MRF lines |
— |
$1,354–$2,715 |
— |
| MRI any jt upper extremity w/contrast matrl (73222) |
— |
$2,715 |
— |
| MRI Breast W/O Contrast Bilateral (77047) |
— |
$593 |
— |
| MRI cervical spine w contrast (72142) |
— |
$860 |
— |
| MRI cervical spine w/o cont (72141) |
— |
$665 |
— |
| MRI chest w/o contrast (71550) |
— |
$665 |
— |
| MRI chest with contrast (71551) |
— |
$860 |
— |
| MRI lower extrem oth/thn jt w/contrast matrl (73719) |
— |
$1,354 |
— |
| MRI lower extrem oth/thn jt w/o & w/contr matr (73720) |
— |
$1,354 |
— |
| MRI lower extrem oth/thn jt w/o contr matrl (73718) |
— |
$860 |
— |
| MRI lumbar spine w contrast (72149) |
— |
$860 |
— |
| Mri Neck Spine W/O & W/Dye (72156) |
— |
$1,354 |
— |
| MRI orbit face &/neck w/o contrast (70540) |
— |
$860 |
— |
| MRI orbit face neck w contrast (70542) |
— |
$1,354 |
— |
| Mri Orbt/Fac/Nck W/O &W/Dye (70543) |
— |
$1,354 |
— |
| MRI pelvis w contrast (72196) |
— |
$1,354 |
— |
| MRI pelvis w/o & w contrast (72197) |
— |
$1,354 |
— |
| MRI pelvis w/o contrast (72195) |
— |
$860 |
— |
| MRI thoracic spine w/o contrast (72146) |
— |
$1,354 |
— |
| MRI upper extremity oth than jt w/contr matrl (73219) |
— |
$1,354 |
— |
| MRI upper extremity oth than jt w/o contr matrl (73218) |
— |
$860 |
— |
| Mri Uppr Extremity W/O&W/Dye (73220) |
— |
$1,354 |
— |
| MRI, abdomen, combo (74183) |
— |
$1,354 |
— |
| MRI, dorsal spine combo (72157) |
— |
$1,354 |
— |
| MRI, dorsal spine contrast (72147) |
— |
$860 |
— |
MRI, joint upper extrem (73221)
range across 3 matching MRF lines |
— |
$860–$1,354 |
— |
MRI, joint upper extrem combo (73223)
range across 3 matching MRF lines |
— |
$1,354–$2,715 |
— |
| MRI, lumbar spine combo (72158) |
— |
$1,354 |
— |
| Myelogram cervical (72240) |
— |
$323 |
— |
| Myelogram Lumbar (72265) |
— |
$2,714 |
— |
| Myelography thoracic (72255) |
— |
$2,714 |
— |
| Myelograpy 2/more regions rs&i (72270) |
— |
$2,714 |
— |
| Myocardial Spect Multiple Studies (78452) |
— |
$4,859 |
— |
| Neck soft tissue (70360) |
— |
$860 |
— |
| Nm csf leak detection (78650) |
— |
$1,850 |
— |
| Nuclear Rx Oral Admin (79005) |
— |
$5,452 |
— |
| Ob us nuchal meas 1 gest (76813) |
— |
$252 |
— |
| Parathyroid Planar Imaging (78070) |
— |
$1,427 |
— |
| Pelvis 1 or 2 views (72170) |
— |
$1,354 |
— |
| Peritoneogram Rs&I (74190) |
— |
$1,419 |
— |
Pet Image W/Ct Lmtd (78814)
range across 3 matching MRF lines |
— |
$2,855–$5,665 |
— |
| PET image w/CT, full body (78816) |
— |
$5,665 |
— |
| PET imaging CT attenuation skull base mid-thigh (78815) |
— |
$5,665 |
— |
| Pulmonary Perfusion Imaging Particulate (78580) |
— |
$1,427 |
— |
| Radex Abd Compl Aqt Abd W/S/E/D Views 1 View Ch (74022) |
— |
$396 |
— |
| Radex abscess/fistula/sinus tract rs&i (76080) |
— |
$859 |
— |
| Radex Ankle Complete Minimum 3 Views (73610) |
— |
$323 |
— |
| Radex Calcaneus Minimum 2 Views (73650) |
— |
$323 |
— |
| Radex elbow complete minimum 3 views (73080) |
— |
$323 |
— |
| Radex Facial Bones Complete Minimum 3 Views (70150) |
— |
$396 |
— |
| Radex fingr minimum 2 views (73140) |
— |
$323 |
— |
| Radex foot complete minimum 3 views (73630) |
— |
$323 |
— |
Radex Hand Minimum 3 Views (73130)
range across 4 matching MRF lines |
— |
$323–$396 |
— |
| Radex lower extremity infant minimum 2 views (73592) |
— |
$323 |
— |
| Radex Mastoids Compl Minimum 3 Views PR Side (70130) |
— |
$396 |
— |
| Radex Nasal Bones Complete Minimum 3 Views (70160) |
— |
$396 |
— |
Radex Ribs Unilateral 2 Views (71100)
range across 3 matching MRF lines |
— |
$323–$396 |
— |
| Radex shoulder complete minimum 2 views (73030) |
— |
$323 |
— |
| Radex Spine 1 View Specify Level (72020) |
— |
$1,419 |
— |
| Radex Sternum Minimum 2 Views (71120) |
— |
$396 |
— |
| Radex Temporomandble Jt Opn & Clsd Mouth Bilat (70330) |
— |
$396 |
— |
| Radex Toe Minimum 2 Views (73660) |
— |
$323 |
— |
Radex upper extremity infant minimum 2 views (73092)
range across 3 matching MRF lines |
— |
$323–$396 |
— |
| Radex Wrist Complete Minimum 3 Views (73110) |
— |
$323 |
— |
| Radiolog exam mandible compl minimum 4 views (70110) |
— |
$221 |
— |
| Radiologic Exam Abdomen 3+ Views - Xr Abdomen 3+ Views (74021) |
— |
$396 |
— |
| Radiologic exam colon double contrast study (74280) |
— |
$665 |
— |
| Radiologic exam colon single contrast study (74270) |
— |
$665 |
— |
| Radiologic Exam Small Int Single Contrast Study (74250) |
— |
$665 |
— |
| Radiologic exam swallow function contrast study (74230) |
— |
$665 |
— |
| Radiologic exam upr gi trc double contrast study (74246) |
— |
$665 |
— |
Radiologic examination femur minimum 2 views (73552)
range across 4 matching MRF lines |
— |
$323–$1,353 |
— |
| Radiologic examination knee 1/2 views (73560) |
— |
$323 |
— |
Radiologic examination tibia & fibula 2 views (73590)
range across 4 matching MRF lines |
— |
$323–$1,353 |
— |
| Ribs bilateral 3 views (71110) |
— |
$396 |
— |
| Rp loclzj tum plnr 2+area 1+d img/1 area img>2+d (78801) |
— |
$1,427 |
— |
| Rp Loclzj Tum Plnr Whole Body 2+ Days Imaging (78804) |
— |
$4,859 |
— |
| Rp Loclzj Tum Plnr Whole Body Single Day Imaging (78802) |
— |
$4,859 |
— |
| Rp Loclzj Tum Spect 1 Area Single Day Imaging (78803) |
— |
$4,859 |
— |
| Rp loclzj tum spect 2 area/sep acquisj img (78831) |
— |
$5,665 |
— |
| Rp loclzj tum spect CT 2area 1d img/1 ar img>2+d (78832) |
— |
$4,859 |
— |
Scapula (73010)
range across 3 matching MRF lines |
— |
$323–$396 |
— |
| Screening Digital Breast Tomosynthesis Bi (77063) |
— |
$859 |
— |
Shoulder 1 view (73020)
range across 3 matching MRF lines |
— |
$323–$396 |
— |
Shoulder Arthrography (73040)
range across 3 matching MRF lines |
— |
$323–$1,353 |
— |
| Skull less than 4 views (70250) |
— |
$323 |
— |
| Sternoclavicular joints (71130) |
— |
$323 |
— |
| Testicular Imaging W/Flow (78761) |
— |
$1,850 |
— |
| Therapeutic Enema Rdctj Intussusception/Obstrcj (74283) |
— |
$679 |
— |
| Thoracic spine 2 views (72070) |
— |
$396 |
— |
| Thyroid Imaging With Vascular Flow (78013) |
— |
$323 |
— |
| Thyroid Uptake W/Blood Flow Sngle/Mult Quan Meas (78014) |
— |
$1,427 |
— |
Ultrasound Breast Limited (76642)
range across 4 matching MRF lines |
— |
$267–$1,080 |
— |
| Ultrasound Elastography Parenchyma (76981) |
— |
$30 |
— |
| Ultrasound Exam Aaa Screen (76706) |
— |
$396 |
— |
| Ultrasound, abdomen limited (76705) |
— |
$396 |
— |
| Unlisted Dx Radiographic Procedure (76499) |
— |
$323 |
— |
| Upper gi w/o kub (74240) |
— |
$665 |
— |
| Urethrocystogram voiding (74455) |
— |
$859 |
— |
| Urethrocystography retrograde (74450) |
— |
$1,353 |
— |
| Us breast unilateral complete (76641) |
— |
$396 |
— |
| Us chest (76604) |
— |
$396 |
— |
| Us complete joint (76881) |
— |
$396 |
— |
| Us exam, pelvic, limited (76857) |
— |
$396 |
— |
| Us head (76506) |
— |
$35 |
— |
| Us lmtd joint/oth nonvasc xtr strux r-t w/img (76882) |
— |
$396 |
— |
| Us ob detailed single fetus (76811) |
— |
$409 |
— |
| Us ob limited 1 or more fetuses (76815) |
— |
$396 |
— |
| Us ob transvaginal (76817) |
— |
$396 |
— |
| Us pelvic non ob complete (76856) |
— |
$396 |
— |
| Us pg uter img f&mat 14 wk tabdl 1/1st gestation (76801) |
— |
$396 |
— |
| Us preg uterus real time f/u trnsabdl per fetus (76816) |
— |
$396 |
— |
| Us retroperitoneal complete (76770) |
— |
$396 |
— |
| Us retroperitoneal limited (76775) |
— |
$396 |
— |
| Us scrotum and contents (76870) |
— |
$396 |
— |
| Us spinal canal and contents (76800) |
— |
$396 |
— |
| Us thyroid (76536) |
— |
$396 |
— |
| Vein X-Ray Chest (75827) |
— |
$3,279 |
— |
| Venogram Sinus/Jugular (75860) |
— |
$5,714 |
— |
| Venography caval inferior serialography rs&i (75825) |
— |
$11,440 |
— |
| Venography extremity bilateral rs&i (75822) |
— |
$5,714 |
— |
Venography extremity unilateral rs&i (75820)
range across 4 matching MRF lines |
— |
$5,447–$5,714 |
— |
| Vertebral fracture assessment via dxa (77086) |
— |
$396 |
— |
Wrist 2 views (73100)
range across 3 matching MRF lines |
— |
$323–$396 |
— |
| X-Ray Ac Jts - Xr Acromioclavicular Joints Bilateral (73050) |
— |
$1,353 |
— |
| X-Ray Aorta Leg Arteries (75630) |
— |
$11,440 |
— |
| X-Ray Bend Only L-S Spine (72120) |
— |
$396 |
— |
| X-Ray Elbow 2 Vw - Xr Elbow 1-2 Views Right (73070) |
— |
$323 |
— |
| X-Ray Exam Entire Spi 2/3 Vw (72082) |
— |
$396 |
— |
X-Ray Exam Hip Uni 1 View (73501)
range across 3 matching MRF lines |
— |
$323–$1,354 |
— |
| X-Ray Exam Hip Uni 2-3 Views (73502) |
— |
$323 |
— |
| X-Ray Exam Hips Bi 2 Views (73521) |
— |
$323 |
— |
| X-Ray Exam L-S Spine Bending (72114) |
— |
$396 |
— |
| X-Ray Exam Neck Spine 2-3 Vw (72040) |
— |
$323 |
— |
| X-Ray Exam Neck Spine 6/>Vws (72052) |
— |
$396 |
— |
X-Ray Exam Unilat Ribs/Chest (71101)
range across 3 matching MRF lines |
— |
$323–$396 |
— |
| X-ray humerus (73060) |
— |
$323 |
— |
| X-ray IV pyelogram (ivp) (74400) |
— |
$320 |
— |
| X-Ray Knee Bilat Standing - Xr Knees Anteroposterior Standing Bilat (73565) |
— |
$323 |
— |
| X-Ray Lumbar Spine 2/3 Vw - Xr Lumbar Spine 2-3 Views (72100) |
— |
$396 |
— |
| X-Ray Sacroiliac Jts 3+ Vw - Xr Sacroiliac Joints 3+ Views (72202) |
— |
$1,354 |
— |
| X-Ray Sacrum/Coccyx 2+ Vw - Xr Sacrum Coccyx 2+ Views (72220) |
— |
$396 |
— |
| X-Ray Sinuses 3+ Vw - Xr Paranasal Sinuses 3+ Views (70220) |
— |
$396 |
— |
| X-Ray Stress View (77071) |
— |
$255 |
— |
| X-Ray Urinary Tract Exam With Contrast Material (74420) |
— |
$665 |
— |
| X-Rays Bone Length Studies (77073) |
— |
$396 |
— |
| X-Rays Bone Survey Complete (77075) |
— |
$396 |
— |
| Xr c-spine 4 or 5 views (72050) |
— |
$323 |
— |
| Xr orbits complete 4 views (70200) |
— |
$323 |
— |