Abdomen 1 View (74018)
range across 2 matching MRF lines |
— |
$390–$540 |
— |
| Ankle 2 views (73600) |
— |
$305 |
— |
| Bone age studies (77072) |
— |
$390 |
— |
| Bone Imaging 3 Phase (78315) |
— |
$1,985 |
— |
| Bone Imaging Limited Area (78300) |
— |
$1,185 |
— |
| Bone Imaging Whole Body (78306) |
— |
$1,950 |
— |
| Cat Scan Follow-Up Study (76380) |
— |
$3,040 |
— |
| Chest 1 view (71045) |
— |
$380 |
— |
Chest 2 views (71046)
range across 3 matching MRF lines |
— |
$425–$680 |
— |
Chest 3 views (71047)
range across 3 matching MRF lines |
— |
$480–$585 |
— |
| Clavicle complete (73000) |
— |
$385 |
— |
| Contrast X-Ray Bladder (74430) |
— |
$585 |
— |
| CT abdomen and pelvis without and with contrast (74178) |
— |
$7,305 |
— |
| CT abdomen and pelvis without contrast (74176) |
— |
$6,640 |
— |
| CT abdomen w contrast (74160) |
— |
$3,350 |
— |
| CT abdomen w wo contrast (74170) |
— |
$3,655 |
— |
| CT abdomen w/o contrast (74150) |
— |
$3,345 |
— |
| CT Angio Abdomen and Pelvis (74174) |
— |
$4,930 |
— |
| CT Angio Chest (71275) |
— |
$4,080 |
— |
| CT Angio Head (70496) |
— |
$4,110 |
— |
| Ct Angio Lwr Extr W/O&W/Dye (73706) |
— |
$3,760 |
— |
| CT Angio Neck (70498) |
— |
$4,195 |
— |
| Ct Angio Upr Extrm W/O&W/Dye (73206) |
— |
$3,650 |
— |
| CT cervical spine w/ contrast (72126) |
— |
$3,350 |
— |
| CT cervical spine w/o contrast (72125) |
— |
$3,315 |
— |
| CT cervical spine w/wo cont (72127) |
— |
$3,655 |
— |
| CT chest w contrast (71260) |
— |
$3,350 |
— |
| CT chest w/wo contrast (71270) |
— |
$3,655 |
— |
| CT head/brain with contrast (70460) |
— |
$3,350 |
— |
| CT head/brain without and with contrast (70470) |
— |
$3,655 |
— |
| CT iac w contrast (70481) |
— |
$3,350 |
— |
| CT l-spine w&w/o contrast (72133) |
— |
$3,655 |
— |
| CT lower ext w/o (73700) |
— |
$3,315 |
— |
| CT lower extremity w/contrast material (73701) |
— |
$3,350 |
— |
| CT lumbar spine w contrast (72132) |
— |
$3,350 |
— |
| CT lumbar spine w/o contrast (72131) |
— |
$3,315 |
— |
| CT maxillofacial w contrast (70487) |
— |
$3,350 |
— |
| CT maxillofacial wo contrast (70486) |
— |
$3,315 |
— |
| CT neck tissue combo (70492) |
— |
$3,655 |
— |
| Ct Orbit/Ear/Fossa W/O&W/Dye (70482) |
— |
$3,655 |
— |
| CT orbits w/o contrast (70480) |
— |
$3,315 |
— |
| CT pelvis w&w/o contrast (72194) |
— |
$3,655 |
— |
| CT pelvis w/o contrast (72192) |
— |
$3,315 |
— |
| CT scan of leg combo (73702) |
— |
$3,655 |
— |
| CT scans face/jaw combo (70488) |
— |
$3,655 |
— |
| CT soft tissue neck w contrast (70491) |
— |
$3,350 |
— |
| CT soft tissue neck w/o contrast (70490) |
— |
$3,315 |
— |
| CT thoracic spine w contrast (72129) |
— |
$3,350 |
— |
| CT thoracic spine w/o contrast (72128) |
— |
$3,315 |
— |
| CT thoracic spine w/wo cont (72130) |
— |
$3,655 |
— |
| CT thorax w/o contrast (71250) |
— |
$3,315 |
— |
| CT unlisted procedure (76497) |
— |
$3,315 |
— |
| CT upper ext wo (73200) |
— |
$3,315 |
— |
| CT upper extremity w/o & w/contrast material (73202) |
— |
$3,655 |
— |
| CT upper extremity with contrast (73201) |
— |
$3,350 |
— |
| Cta Abdl Aorta&Bi Iliofem W/Contrast&Postp (75635) |
— |
$5,625 |
— |
| Cta Abdomen (74175) |
— |
$4,035 |
— |
| CTA pelvis (72191) |
— |
$3,965 |
— |
Dxa Bone Density Axial (77080)
range across 2 matching MRF lines |
— |
$155–$870 |
— |
| Echo Guide For Artery Repair (76936) |
— |
$2,810 |
— |
Esophagram (74220)
range across 2 matching MRF lines |
— |
$890–$1,675 |
— |
| Fetal Biophys Profile W/Nst (76818) |
— |
$760 |
— |
| Fetal Biophysical Profile W/O Non-Stress Testing (76819) |
— |
$760 |
— |
| Fluoroscopy up to 1 hr (76000) |
— |
$1,045 |
— |
| Forearm 2 views (73090) |
— |
$385 |
— |
| Gastric emptying imaging study (78264) |
— |
$1,925 |
— |
| Heart first pass single,planar (78481) |
— |
$1,510 |
— |
| Hepatobil Syst Image W/Drug (78227) |
— |
$1,135 |
— |
| Hepatobiliary System Imaging (78226) |
— |
$1,135 |
— |
| Ht Muscle Image Spect Sing (78451) |
— |
$3,120 |
— |
| Hysterosalpingogram (74740) |
— |
$735 |
— |
| Infusion Ivp (74410) |
— |
$970 |
— |
| K Flow/Funct Image Multiple (78709) |
— |
$1,970 |
— |
| K Flow/Funct Image W/O Drug (78707) |
— |
$1,755 |
— |
| Knee 3 Views (73562) |
— |
$530 |
— |
| Liver & Spleen Imaging Static Only (78215) |
— |
$1,000 |
— |
| Lung Ventilat&Perfus Imaging (78582) |
— |
$895 |
— |
| Lung Ventilation Imaging (78579) |
— |
$895 |
— |
| Magnetic Image Jaw Joint (70336) |
— |
$5,250 |
— |
| Mammary ductogram or galactogram single (77053) |
— |
$750 |
— |
| Meckels Divert Exam (78290) |
— |
$1,925 |
— |
| Mra Head W/O & W/Contrast Material (70546) |
— |
$5,875 |
— |
| MRA head w/o contrast (70544) |
— |
$5,250 |
— |
| Mra Neck W/O &W/Contrast Material (70549) |
— |
$5,875 |
— |
| MRA neck w/o contrast (70547) |
— |
$5,250 |
— |
| MRI abdomen w contrast (74182) |
— |
$5,250 |
— |
| MRI abdomen w/o contrast (74181) |
— |
$5,250 |
— |
| MRI any jt lower extrem w/contrast material (73722) |
— |
$5,250 |
— |
| MRI any jt lower extrem w/o & w/contrast matrl (73723) |
— |
$7,025 |
— |
| MRI any jt upper extremity w/contrast matrl (73222) |
— |
$5,250 |
— |
| MRI bone marrow blood supply (77084) |
— |
$5,250 |
— |
| MRI Breast W/O Contrast Bilateral (77047) |
— |
$3,500 |
— |
| MRI Breast Without Contrast Material Unilateral (77046) |
— |
$3,500 |
— |
| MRI cardiac w/o contrast (75557) |
— |
$5,250 |
— |
| MRI cervical spine w contrast (72142) |
— |
$5,250 |
— |
| MRI cervical spine w/o cont (72141) |
— |
$5,250 |
— |
| MRI chest w/o contrast (71550) |
— |
$5,250 |
— |
| MRI lower extrem oth/thn jt w/contrast matrl (73719) |
— |
$5,250 |
— |
| MRI lower extrem oth/thn jt w/o & w/contr matr (73720) |
— |
$5,250 |
— |
| MRI lower extrem oth/thn jt w/o contr matrl (73718) |
— |
$5,250 |
— |
| MRI lumbar spine w contrast (72149) |
— |
$5,250 |
— |
| Mri Neck Spine W/O & W/Dye (72156) |
— |
$6,145 |
— |
| MRI orbit face &/neck w/o contrast (70540) |
— |
$5,250 |
— |
| MRI orbit face neck w contrast (70542) |
— |
$5,690 |
— |
Mri Orbt/Fac/Nck W/O &W/Dye (70543)
range across 2 matching MRF lines |
— |
$6,145–$7,025 |
— |
| MRI pelvis w contrast (72196) |
— |
$5,250 |
— |
| MRI pelvis w/o & w contrast (72197) |
— |
$6,145 |
— |
| MRI pelvis w/o contrast (72195) |
— |
$5,250 |
— |
| MRI thoracic spine w/o contrast (72146) |
— |
$5,250 |
— |
| MRI upper extremity oth than jt w/contr matrl (73219) |
— |
$5,250 |
— |
| MRI upper extremity oth than jt w/o contr matrl (73218) |
— |
$5,250 |
— |
Mri Uppr Extremity W/O&W/Dye (73220)
range across 2 matching MRF lines |
— |
$5,250–$7,025 |
— |
| MRI, abdomen, combo (74183) |
— |
$6,145 |
— |
| MRI, dorsal spine combo (72157) |
— |
$5,250 |
— |
| MRI, joint upper extrem (73221) |
— |
$5,250 |
— |
| MRI, joint upper extrem combo (73223) |
— |
$7,025 |
— |
| MRI, lumbar spine combo (72158) |
— |
$6,145 |
— |
| Myelogram cervical (72240) |
— |
$1,665 |
— |
| Myelogram Lumbar (72265) |
— |
$1,665 |
— |
| Myelography thoracic (72255) |
— |
$1,665 |
— |
Myocardial Spect Multiple Studies (78452)
range across 3 matching MRF lines |
— |
$810–$4,870 |
— |
| Neck soft tissue (70360) |
— |
$335 |
— |
| Ob us nuchal meas 1 gest (76813) |
— |
$1,180 |
— |
| Parathyroid Planar Imaging (78070) |
— |
$840 |
— |
| Pelvis 1 or 2 views (72170) |
— |
$435 |
— |
| Pulmonary Perfusion Imaging Particulate (78580) |
— |
$1,145 |
— |
| Radex Abd Compl Aqt Abd W/S/E/D Views 1 View Ch (74022) |
— |
$640 |
— |
| Radex Ankle Complete Minimum 3 Views (73610) |
— |
$435 |
— |
| Radex Calcaneus Minimum 2 Views (73650) |
— |
$435 |
— |
| Radex elbow complete minimum 3 views (73080) |
— |
$455 |
— |
| Radex Facial Bones Complete Minimum 3 Views (70150) |
— |
$585 |
— |
| Radex fingr minimum 2 views (73140) |
— |
$310 |
— |
| Radex foot complete minimum 3 views (73630) |
— |
$435 |
— |
| Radex Hand Minimum 3 Views (73130) |
— |
$435 |
— |
| Radex lower extremity infant minimum 2 views (73592) |
— |
$435 |
— |
| Radex Nasal Bones Complete Minimum 3 Views (70160) |
— |
$450 |
— |
| Radex Pharynx/Larx W/Fluor&/Magnification Tq (70370) |
— |
$1,045 |
— |
| Radex Ribs Unilateral 2 Views (71100) |
— |
$410 |
— |
| Radex shoulder complete minimum 2 views (73030) |
— |
$435 |
— |
| Radex Spine 1 View Specify Level (72020) |
— |
$365 |
— |
| Radex Sternum Minimum 2 Views (71120) |
— |
$435 |
— |
| Radex Temporomandble Jt Opn & Clsd Mouth Bilat (70330) |
— |
$545 |
— |
| Radex Toe Minimum 2 Views (73660) |
— |
$310 |
— |
| Radex upper extremity infant minimum 2 views (73092) |
— |
$435 |
— |
| Radex Wrist Complete Minimum 3 Views (73110) |
— |
$435 |
— |
| Radiolog exam mandible compl minimum 4 views (70110) |
— |
$585 |
— |
| Radiologic exam colon double contrast study (74280) |
— |
$1,560 |
— |
| Radiologic exam colon single contrast study (74270) |
— |
$1,260 |
— |
| Radiologic exam knee complete 4/more views (73564) |
— |
$585 |
— |
| Radiologic exam pelvis compl minimum 3 views (72190) |
— |
$585 |
— |
| Radiologic Exam Small Int Single Contrast Study (74250) |
— |
$825 |
— |
| Radiologic exam swallow function contrast study (74230) |
— |
$915 |
— |
| Radiologic exam upr gi trc double contrast study (74246) |
— |
$1,160 |
— |
| Radiologic examination femur minimum 2 views (73552) |
— |
$450 |
— |
| Radiologic examination knee 1/2 views (73560) |
— |
$450 |
— |
| Radiologic examination tibia & fibula 2 views (73590) |
— |
$435 |
— |
| Ribs bilateral 3 views (71110) |
— |
$880 |
— |
| Scapula (73010) |
— |
$435 |
— |
| Screening Digital Breast Tomosynthesis Bi (77063) |
— |
$140 |
— |
| Shoulder Arthrography (73040) |
— |
$1,080 |
— |
| Sialogram (70390) |
— |
$480 |
— |
| Skull less than 4 views (70250) |
— |
$585 |
— |
| Sternoclavicular joints (71130) |
— |
$515 |
— |
| Testicular Imaging W/Flow (78761) |
— |
$1,020 |
— |
| Thoracic spine 2 views (72070) |
— |
$560 |
— |
| Thyroid Imaging With Vascular Flow (78013) |
— |
$1,200 |
— |
| Thyroid Uptake Measurement (78012) |
— |
$1,560 |
— |
| Thyroid Uptake W/Blood Flow Sngle/Mult Quan Meas (78014) |
— |
$1,625 |
— |
| Ultrasound Breast Limited (76642) |
— |
$655 |
— |
Ultrasound, abdomen limited (76705)
range across 4 matching MRF lines |
— |
$1,045–$1,080 |
— |
| Umbilical-artery Doppler (OB) (76820) |
— |
$760 |
— |
| Unlisted Dx Radiographic Procedure (76499) |
— |
$310 |
— |
| Upper gi w/o kub (74240) |
— |
$1,160 |
— |
| Urethrocystogram voiding (74455) |
— |
$735 |
— |
| Us head (76506) |
— |
$785 |
— |
| Us kidney transplant (76776) |
— |
$795 |
— |
| Us lmtd joint/oth nonvasc xtr strux r-t w/img (76882) |
— |
$775 |
— |
| Us ob detailed single fetus (76811) |
— |
$1,350 |
— |
| Us ob limited 1 or more fetuses (76815) |
— |
$870 |
— |
| Us ob transvaginal (76817) |
— |
$700 |
— |
| Us pelvic non ob complete (76856) |
— |
$1,080 |
— |
| Us pg uter img f&mat 14 wk tabdl 1/1st gestation (76801) |
— |
$1,020 |
— |
| Us preg uterus real time f/u trnsabdl per fetus (76816) |
— |
$1,350 |
— |
| Us retroperitoneal complete (76770) |
— |
$1,505 |
— |
| Us retroperitoneal limited (76775) |
— |
$1,005 |
— |
| Us scrotum and contents (76870) |
— |
$870 |
— |
Us thyroid (76536)
range across 3 matching MRF lines |
— |
$810–$930 |
— |
| Venography extremity unilateral rs&i (75820) |
— |
$2,180 |
— |
| X-Ray Ac Jts - Xr Acromioclavicular Joints Bilateral (73050) |
— |
$435 |
— |
| X-Ray Bend Only L-S Spine (72120) |
— |
$560 |
— |
| X-Ray Elbow 2 Vw - Xr Elbow 1-2 Views Right (73070) |
— |
$385 |
— |
| X-Ray Exam Breast Specimen (76098) |
— |
$200 |
— |
X-Ray Exam Entire Spi 2/3 Vw (72082)
range across 2 matching MRF lines |
— |
$460–$560 |
— |
| X-Ray Exam Hip Uni 2-3 Views (73502) |
— |
$450 |
— |
| X-Ray Exam Hips Bi 2 Views (73521) |
— |
$595 |
— |
| X-Ray Exam L-S Spine Bending (72114) |
— |
$685 |
— |
| X-Ray Exam Neck Spine 2-3 Vw (72040) |
— |
$435 |
— |
| X-Ray Exam Neck Spine 6/>Vws (72052) |
— |
$825 |
— |
| X-Ray Exam Unilat Ribs/Chest (71101) |
— |
$595 |
— |
| X-ray humerus (73060) |
— |
$450 |
— |
| X-Ray Jaw <4 Vw - Xr Mandible < 4 Views (70100) |
— |
$435 |
— |
| X-Ray Knee Bilat Standing - Xr Knees Anteroposterior Standing Bilat (73565) |
— |
$450 |
— |
| X-Ray Lumbar Spine 2/3 Vw - Xr Lumbar Spine 2-3 Views (72100) |
— |
$560 |
— |
| X-ray nose-rectum child f.b. (76010) |
— |
$385 |
— |
| X-Ray Ribs, Chest 4+ Vw - Xr Ribs 3 Vws Bil W/ Chest Posteroanterior (71111) |
— |
$1,080 |
— |
| X-Ray Sacroiliac Jts 3+ Vw - Xr Sacroiliac Joints 3+ Views (72202) |
— |
$425 |
— |
| X-Ray Sacrum/Coccyx 2+ Vw - Xr Sacrum Coccyx 2+ Views (72220) |
— |
$390 |
— |
| X-Ray Sinuses 3+ Vw - Xr Paranasal Sinuses 3+ Views (70220) |
— |
$585 |
— |
| X-Ray Skull 4+ Vw - Xr Skull Complete 4+ Views (70260) |
— |
$660 |
— |
| X-Ray Stress View (77071) |
— |
$455 |
— |
| X-ray thoracic spine 4 vw (72074) |
— |
$685 |
— |
| X-Ray Urinary Tract Exam With Contrast Material (74420) |
— |
$1,510 |
— |
| X-Rays Bone Survey Complete (77075) |
— |
$1,125 |
— |
| Xr c-spine 4 or 5 views (72050) |
— |
$685 |
— |
| Xr orbits complete 4 views (70200) |
— |
$585 |
— |