| Abdomen 1 View (74018) |
$111 |
$713.49 |
1.0× |
| Abdomen 2 views (74019) |
$133 |
$778.94 |
1.0× |
| Acute Gastrointestinal Blood Loss Imaging (78278) |
$511 |
$3,577.81 |
1.0× |
| Angio internal mammary (75756) |
$4,041 |
$5,508.30 |
1.0× |
| Angio pulmonary bilat (75743) |
$4,041 |
$17,368.60 |
1.0× |
| Angiography Adrenal Bilateral Slctv Rs&I (75733) |
$4,041 |
$7,478.22 |
1.0× |
| Angiography extremity bilateral rs&i (75716) |
$4,041 |
$14,100 |
1.0× |
Angiography extremity unilateral rs&i (75710)
range across 3 matching MRF lines |
$4,041 |
$7,049.99–$17,368.60 |
1.0× |
| Angiography pulmonary unilateral slctv rs&i (75741) |
$4,041 |
$17,368.60 |
1.0× |
| Angrph pulmonary nonslctv cath/ven njx rs&i (75746) |
$4,041 |
$17,368.60 |
1.0× |
| Ankle 2 views (73600) |
$111 |
$775 |
1.0× |
| Aortography thoracic serialography rs&i (75605) |
$7,121 |
$13,129.60 |
1.0× |
| Aortography thoracic w/o serialography rs&i (75600) |
$4,041 |
$6,690.70 |
1.0× |
| Artery X-Rays Abdomen (75726) |
$7,121 |
$37,458.60 |
1.0× |
| Artery X-Rays Adrenal Gland (75731) |
$4,041 |
$8,505.98 |
1.0× |
| Artery X-Rays Pelvis (75736) |
$7,121 |
$13,129.60 |
1.0× |
| Arthrogram ankle (73615) |
$446 |
$2,370.55 |
1.0× |
| Arthrogram hip (73525) |
$446 |
$1,454.95 |
1.0× |
| Arthrogram Wrist (73115) |
$446 |
$1,039.25 |
1.0× |
| Bone age studies (77072) |
$133 |
$623.15 |
1.0× |
| Bone Imaging 3 Phase (78315) |
$511 |
$3,825.78 |
1.0× |
| Bone Imaging Limited Area (78300) |
$511 |
$2,586.19 |
1.0× |
| Bone Imaging Multiple Areas (78305) |
$511 |
$2,326.17 |
1.0× |
| Bone Imaging Whole Body (78306) |
$511 |
$4,449.69 |
1.0× |
| Bone survey infant (77076) |
$133 |
$910.50 |
1.0× |
| Brain Flow Imaging Only (78610) |
$694 |
$1,195.48 |
1.0× |
| Brain Image W/Flow < 4 Views (78601) |
$511 |
$3,747 |
1.0× |
| Brain imaging < 4 static views (78600) |
$511 |
$1,239.42 |
1.0× |
| Brain Imaging Min 4 Static Views W Vascular Flow (78606) |
$694 |
$3,118.92 |
1.0× |
| Brain Imaging Minimum 4 Static Views (78605) |
$694 |
$2,154.11 |
1.0× |
| Card Bl Pool Gated Spect Rest Wal Motn Ejct Frct (78494) |
$511 |
$2,614.92 |
1.0× |
| Cardiac Shunt Detection (78428) |
$511 |
$2,614.92 |
1.0× |
| Cat Scan Follow-Up Study (76380) |
$111 |
$2,226.15 |
1.0× |
| Cerebrospinal Fluid Flow W/O Matl Shunt Evaltj (78645) |
$694 |
$3,900.75 |
1.0× |
| Cerebrospinal fluid flow, imaging (not including introduction of material); ventriculography Non-Facility (78635) |
$694 |
$3,900.75 |
1.0× |
| Cerebrospinal Fluid Scan (78630) |
$694 |
$2,941.44 |
1.0× |
Chest 1 view (71045)
range across 2 matching MRF lines |
$111 |
$344.52–$678.28 |
1.0× |
| Chest 2 views (71046) |
$111 |
$879.30 |
1.0× |
| Chest 3 views (71047) |
$111 |
$395.28 |
1.0× |
| Chest 4 or more views (71048) |
$133 |
$583 |
1.0× |
| Cholecystography Oral Contrast (74290) |
$224 |
$612.08 |
1.0× |
| Cineradiograpy/vidradiograpy xcpt where spec (76120) |
$133 |
$1,116.71 |
1.0× |
| Clavicle complete (73000) |
$111 |
$879.13 |
1.0× |
| Computed Tomography Thorax Lw Dose Lng Ca Scr C- (71271) |
$133 |
$404.50 |
1.0× |
| Contrast Exam Abdominl Aorta (75625) |
$4,041 |
$17,368.60 |
1.0× |
| Contrast X-Ray Bladder (74430) |
$446 |
$531.63 |
1.0× |
| Contrast X-Ray Of Elbow (73085) |
$446 |
$2,182.43 |
1.0× |
| Contrast X-Ray Of Knee Joint (73580) |
$446 |
$2,148.09 |
1.0× |
| Corpora cavernosography (74445) |
$133 |
$1,856.75 |
1.0× |
| CT abdomen and pelvis without and with contrast (74178) |
$446 |
$10,644.10 |
1.0× |
| CT abdomen and pelvis without contrast (74176) |
$305 |
$7,681.25 |
1.0× |
| CT abdomen w contrast (74160) |
$224 |
$4,676.52 |
1.0× |
| CT abdomen w wo contrast (74170) |
$224 |
$6,865.49 |
1.0× |
| CT abdomen w/o contrast (74150) |
$133 |
$4,484.59 |
1.0× |
| CT Angio Abdomen and Pelvis (74174) |
$446 |
$10,237.80 |
1.0× |
| CT Angio Chest (71275) |
$224 |
$5,864.76 |
1.0× |
| CT Angio Head (70496) |
$224 |
$5,619.94 |
1.0× |
| CT angio hrt w/3d image (75574) |
$446 |
$1,512.35 |
1.0× |
| Ct Angio Lwr Extr W/O&W/Dye (73706) |
$224 |
$4,087 |
1.0× |
| CT Angio Neck (70498) |
$224 |
$6,563.70 |
1.0× |
| Ct Angio Upr Extrm W/O&W/Dye (73206) |
$224 |
$4,037 |
1.0× |
| CT bone density (77078) |
$111 |
$505.82 |
1.0× |
| CT cervical spine w/ contrast (72126) |
$446 |
$4,515.60 |
1.0× |
| CT cervical spine w/o contrast (72125) |
$133 |
$5,497.09 |
1.0× |
| CT cervical spine w/wo cont (72127) |
$224 |
$2,248.50 |
1.0× |
| CT chest w contrast (71260) |
$224 |
$5,560.76 |
1.0× |
| CT chest w/wo contrast (71270) |
$224 |
$6,224.59 |
1.0× |
| CT colonography screening (74263) |
$305 |
$1,040.14 |
1.0× |
| CT colonogrphy dx image postprocess w/o contrast (74261) |
$133 |
$840.14 |
1.0× |
| CT head/brain with contrast (70460) |
$224 |
$4,043.42 |
1.0× |
| CT head/brain without and with contrast (70470) |
$224 |
$5,656.40 |
1.0× |
| CT iac w contrast (70481) |
$224 |
$4,715 |
1.0× |
| CT l-spine w&w/o contrast (72133) |
$224 |
$4,655.75 |
1.0× |
| CT lower ext w/o (73700) |
$133 |
$4,188.68 |
1.0× |
| CT lower extremity w/contrast material (73701) |
$224 |
$4,036.39 |
1.0× |
| CT lumbar spine w contrast (72132) |
$446 |
$5,934.03 |
1.0× |
| CT lumbar spine w/o contrast (72131) |
$133 |
$4,913.34 |
1.0× |
| CT maxillofacial w contrast (70487) |
$224 |
$5,690.25 |
1.0× |
| CT maxillofacial wo contrast (70486) |
$133 |
$4,810 |
1.0× |
| CT neck tissue combo (70492) |
$224 |
$4,489.28 |
1.0× |
| Ct Orbit/Ear/Fossa W/O&W/Dye (70482) |
$224 |
$2,945.16 |
1.0× |
| CT orbits w/o contrast (70480) |
$133 |
$4,077.50 |
1.0× |
| CT pelvis w&w/o contrast (72194) |
$224 |
$6,145 |
1.0× |
| CT pelvis w/o contrast (72192) |
$133 |
$5,110.51 |
1.0× |
| CT scan of leg combo (73702) |
$224 |
$3,983 |
1.0× |
| CT scans face/jaw combo (70488) |
$224 |
$2,479 |
1.0× |
| CT soft tissue neck w contrast (70491) |
$224 |
$4,923.45 |
1.0× |
| CT soft tissue neck w/o contrast (70490) |
$133 |
$4,923.45 |
1.0× |
| CT thoracic spine w contrast (72129) |
$224 |
$5,374.09 |
1.0× |
| CT thoracic spine w/o contrast (72128) |
$133 |
$4,923.45 |
1.0× |
| CT thoracic spine w/wo cont (72130) |
$224 |
$4,679.29 |
1.0× |
| CT thorax w/o contrast (71250) |
$133 |
$4,488.53 |
1.0× |
| CT upper ext wo (73200) |
$133 |
$5,487.91 |
1.0× |
| CT upper extremity w/o & w/contrast material (73202) |
$224 |
$4,093.04 |
1.0× |
| CT upper extremity with contrast (73201) |
$446 |
$4,867.01 |
1.0× |
| Cta Abdl Aorta&Bi Iliofem W/Contrast&Postp (75635) |
$224 |
$4,889.03 |
1.0× |
| Cta Abdomen (74175) |
$224 |
$4,787 |
1.0× |
| CTA pelvis (72191) |
$224 |
$4,515 |
1.0× |
| Dacryocystography, nasolacrimal duct, radiological supervision and interpretation Non-Facility (70170) |
$305 |
$438.48 |
1.0× |
| Dilation ureters/urethra rs&i (74485) |
$2,675 |
$5,087.44 |
1.0× |
| Diskography lumbar (72295) |
$2,499 |
$2,082.24 |
1.0× |
| Doppler Echo Fetal Puls Spectral F/U/Repeat (76828) |
$133 |
$641.83 |
1.0× |
| Doppler Echo Fetal Spectral Display Complete (76827) |
$133 |
$641.83 |
1.0× |
| Dxa Bone Density Axial (77080) |
$133 |
$549.64 |
1.0× |
| Dxa bone density study (77085) |
$133 |
$665.14 |
1.0× |
| Dxa bone density study 1/>sites appendiclr skel (77081) |
$111 |
$415.59 |
1.0× |
| Echo exam uterus (76831) |
$305 |
$1,064.07 |
1.0× |
| Echo Guide For Artery Repair (76936) |
$276 |
$1,197 |
1.0× |
| Echograp Trans R Pros Study (76873) |
$133 |
$1,327.34 |
1.0× |
| Esophageal Motility Study (78258) |
$511 |
$2,288.65 |
1.0× |
| Esophagram (74220) |
$224 |
$1,498.58 |
1.0× |
| Fetal Biophys Profile W/Nst (76818) |
$133 |
$1,070 |
1.0× |
| Fetal Biophysical Profile W/O Non-Stress Testing (76819) |
$133 |
$943.95 |
1.0× |
| Fluoroscopy up to 1 hr (76000) |
$305 |
$1,752.96 |
1.0× |
| Follow-Up Angiography (75898) |
$4,041 |
$17,368.60 |
1.0× |
| Foot 2 views (73620) |
$111 |
$772.50 |
1.0× |
| Forearm 2 views (73090) |
$111 |
$850 |
1.0× |
| Gastric emptying imaging study (78264) |
$511 |
$3,375 |
1.0× |
| Gastric Mucosa Imaging (78261) |
$511 |
$2,288.65 |
1.0× |
| Gastroesophageal Reflux Exam (78262) |
$511 |
$2,288.65 |
1.0× |
| Gastrointestinal Protein Loss (78282) |
$511 |
$2,288.65 |
1.0× |
| Gated Heart Planar Single (78472) |
$511 |
$1,751.19 |
1.0× |
| GI Endoscopic US S&I (76975) |
$305 |
$1,327.34 |
1.0× |
| Hand 2 views (73120) |
$133 |
$800 |
1.0× |
| Heart first pass single,planar (78481) |
$694 |
$1,751.19 |
1.0× |
| Hepatc Vngrph Wdg/Fr Hemodyn Eval Rs&I (75889) |
$4,041 |
$17,368.60 |
1.0× |
| Hepatc Vngrph Wdg/Fr W/O Hemodyn Eval Rs&I (75891) |
$4,041 |
$17,368.60 |
1.0× |
| Hepatobil Syst Image W/Drug (78227) |
$694 |
$3,552.96 |
1.0× |
| Hepatobiliary System Imaging (78226) |
$511 |
$4,211.25 |
1.0× |
| Ht Muscle Image Spect Sing (78451) |
$1,656 |
$4,710.96 |
1.0× |
| Hysterosalpingogram (74740) |
$305 |
$1,438.92 |
1.0× |
| Infant hip ultrasound with hip movement (dynamic) (76885) |
$111 |
$907.20 |
1.0× |
| Infant hip ultrasound, limited static exam (76886) |
$111 |
$472.60 |
1.0× |
| Joint Survey Single View (77077) |
$133 |
$665.14 |
1.0× |
| K Flow/Funct Image Multiple (78709) |
$694 |
$2,941.44 |
1.0× |
| K Flow/Funct Image W/Drug (78708) |
$694 |
$3,476.82 |
1.0× |
| K Flow/Funct Image W/O Drug (78707) |
$694 |
$1,522.92 |
1.0× |
| Kidney Funcj Study Non-Img Radioisotopic Study (78725) |
$511 |
$2,266.16 |
1.0× |
| Kidney Imaging Morphoogy W/Vascular Flow (78701) |
$511 |
$2,944.62 |
1.0× |
| Knee 3 Views (73562) |
$111 |
$1,022.85 |
1.0× |
| Liver & Spleen Imaging Static Only (78215) |
$511 |
$1,795.71 |
1.0× |
| Liver & Spleen Imaging W/Vascular Flow (78216) |
$511 |
$1,800.36 |
1.0× |
| Liver imaging static only (78201) |
$694 |
$2,611.35 |
1.0× |
| Liver imaging w/vascular flow (78202) |
$694 |
$2,611.35 |
1.0× |
| Lung Perf&Ventilat Diferentl (78598) |
$694 |
$3,082.38 |
1.0× |
| Lung perfusion differential (78597) |
$511 |
$1,710.43 |
1.0× |
| Lung Ventilat&Perfus Imaging (78582) |
$694 |
$3,899.54 |
1.0× |
| Lung Ventilation Imaging (78579) |
$511 |
$1,381.59 |
1.0× |
| Lymph System Imaging (78195) |
$694 |
$1,621.50 |
1.0× |
| Magnetic Image Jaw Joint (70336) |
$305 |
$3,851.28 |
1.0× |
| Mammary ductogram or galactogram multiple (77054) |
$305 |
$2,359.21 |
1.0× |
| Mammary ductogram or galactogram single (77053) |
$305 |
$707.28 |
1.0× |
| Meckels Divert Exam (78290) |
$511 |
$1,994.76 |
1.0× |
| Mra Head W/O & W/Contrast Material (70546) |
$446 |
$2,977.07 |
1.0× |
| MRA head w/o contrast (70544) |
$305 |
$5,625 |
1.0× |
| MRA head with contrast (70545) |
$446 |
$4,194.72 |
1.0× |
| MRA neck w contrast (70548) |
$446 |
$4,863 |
1.0× |
| Mra Neck W/O &W/Contrast Material (70549) |
$446 |
$6,190.87 |
1.0× |
| MRA neck w/o contrast (70547) |
$305 |
$5,625 |
1.0× |
| MRI abdomen w contrast (74182) |
$446 |
$5,968.46 |
1.0× |
| MRI abdomen w/o contrast (74181) |
$305 |
$6,293.45 |
1.0× |
| MRI any jt lower extrem w/contrast material (73722) |
$1,003 |
$6,297.19 |
1.0× |
| MRI any jt lower extrem w/o & w/contrast matrl (73723) |
$446 |
$6,867 |
1.0× |
| MRI any jt upper extremity w/contrast matrl (73222) |
$1,003 |
$2,597 |
1.0× |
| MRI bone marrow blood supply (77084) |
$305 |
$2,004.87 |
1.0× |
| MRI Breast W/O Contrast Bilateral (77047) |
$305 |
$2,721.10 |
1.0× |
| MRI Breast Without Contrast Material Unilateral (77046) |
$305 |
$2,721.10 |
1.0× |
| MRI cervical spine w contrast (72142) |
$446 |
$4,200.12 |
1.0× |
| MRI cervical spine w/o cont (72141) |
$305 |
$6,140.76 |
1.0× |
| MRI chest w/o contrast (71550) |
$305 |
$4,471.68 |
1.0× |
| MRI chest with contrast (71551) |
$1,003 |
$4,200.12 |
1.0× |
| MRI chest wo w contrast (71552) |
$446 |
$6,094 |
1.0× |
| MRI lower extrem oth/thn jt w/contrast matrl (73719) |
$446 |
$4,200.12 |
1.0× |
| MRI lower extrem oth/thn jt w/o & w/contr matr (73720) |
$446 |
$6,331 |
1.0× |
| MRI lower extrem oth/thn jt w/o contr matrl (73718) |
$305 |
$5,650 |
1.0× |
| MRI lumbar spine w contrast (72149) |
$446 |
$5,670.53 |
1.0× |
| Mri Neck Spine W/O & W/Dye (72156) |
$446 |
$7,070 |
1.0× |
| MRI orbit face &/neck w/o contrast (70540) |
$305 |
$4,764.47 |
1.0× |
| MRI orbit face neck w contrast (70542) |
$446 |
$4,200.12 |
1.0× |
| Mri Orbt/Fac/Nck W/O &W/Dye (70543) |
$446 |
$6,957.81 |
1.0× |
| MRI pelvis w contrast (72196) |
$446 |
$4,200.12 |
1.0× |
| MRI pelvis w/o & w contrast (72197) |
$446 |
$9,115 |
1.0× |
| MRI pelvis w/o contrast (72195) |
$305 |
$6,297.50 |
1.0× |
| MRI thoracic spine w/o contrast (72146) |
$305 |
$6,180.38 |
1.0× |
| MRI upper extremity oth than jt w/contr matrl (73219) |
$446 |
$4,200.12 |
1.0× |
| MRI upper extremity oth than jt w/o contr matrl (73218) |
$305 |
$4,736 |
1.0× |
| Mri Uppr Extremity W/O&W/Dye (73220) |
$446 |
$6,451 |
1.0× |
| MRI, abdomen, combo (74183) |
$446 |
$6,936 |
1.0× |
| MRI, dorsal spine combo (72157) |
$446 |
$8,670 |
1.0× |
| MRI, dorsal spine contrast (72147) |
$446 |
$4,200.12 |
1.0× |
| MRI, joint upper extrem (73221) |
$305 |
$5,785.73 |
1.0× |
| MRI, joint upper extrem combo (73223) |
$446 |
$7,171 |
1.0× |
| MRI, lumbar spine combo (72158) |
$446 |
$8,752.50 |
1.0× |
| Musculoskeletal Nuclear Exam (78399) |
$511 |
$2,326.17 |
1.0× |
| Myelogram cervical (72240) |
$1,003 |
$1,596.50 |
1.0× |
| Myelogram Lumbar (72265) |
$1,003 |
$4,318.87 |
1.0× |
| Myelography thoracic (72255) |
$1,003 |
$3,950.30 |
1.0× |
| Myelograpy 2/more regions rs&i (72270) |
$1,003 |
$2,210.50 |
1.0× |
| Myocardial Imaging Infarct Avid Planar Qual/Quan (78466) |
$511 |
$1,782 |
1.0× |
| Myocardial imaging, infarct avid, planar; with ejection fraction by first pass technique Non-Facility (78468) |
$694 |
$2,614.92 |
1.0× |
| Myocardial Spect Multiple Studies (78452) |
$1,656 |
$10,505 |
1.0× |
| Neck soft tissue (70360) |
$111 |
$637 |
1.0× |
| Nfs/Instlj Radioelmnt Sln 3 Mo Follow-Up Care (77750) |
$493 |
$1,352.68 |
1.0× |
| Njx Rp Loclzj Non-Img Probe Study Intravenous (78808) |
$511 |
$1,961.89 |
1.0× |
| Nm csf leak detection (78650) |
$1,656 |
$1,777 |
1.0× |
| Nm myocard infarct spect (78469) |
$694 |
$1,751.19 |
1.0× |
| Nm whole blood volume (78122) |
$694 |
$840.24 |
1.0× |
| Nuclear Rx Oral Admin (79005) |
$298 |
$1,614.55 |
1.0× |
| Ob us nuchal meas 1 gest (76813) |
$133 |
$710.50 |
1.0× |
| Oph bmtry us echograpy a-scan io lens pwr cal (76519) |
$133 |
$641.83 |
1.0× |
| Oph us dx ant sgm us immersion b-scan/hr biom (76513) |
$133 |
$943.95 |
1.0× |
| Ophthalmic Biometry US Echograpy a-Scan (76516) |
$133 |
$641.83 |
1.0× |
| Ophthalmic Ultrasonic Foreign Body Localization (76529) |
$111 |
$781 |
1.0× |
| Ophthalmic US Dx Corneal Pachymetry Uni/Bi (76514) |
$37 |
$204.68 |
1.0× |
| Optic foramina (70190) |
$111 |
$194.40 |
1.0× |
| Parathyroid imaging w/tomographic spect & CT (78072) |
$694 |
$1,886.65 |
1.0× |
| Parathyroid Planar Imaging (78070) |
$511 |
$2,738 |
1.0× |
| Parathyroid planar imaging w/wo subtraction (78071) |
$511 |
$1,886.65 |
1.0× |
| Pelvis 1 or 2 views (72170) |
$133 |
$920 |
1.0× |
| Peritoneogram Rs&I (74190) |
$699 |
$729.61 |
1.0× |
| Pet Image Skull-Thigh (78812) |
$1,830 |
$9,003.61 |
1.0× |
| Pet Image W/Ct Lmtd (78814) |
$1,830 |
$9,003.61 |
1.0× |
| PET image w/CT, full body (78816) |
$1,830 |
$9,003.61 |
1.0× |
| PET imaging CT attenuation skull base mid-thigh (78815) |
$1,830 |
$9,003.61 |
1.0× |
| Pet Imaging Limited Area Chest Head/Neck (78811) |
$1,656 |
$9,003.61 |
1.0× |
| PET whole body (78813) |
$1,830 |
$9,003.61 |
1.0× |
| Pulmonary Perfusion Imaging Particulate (78580) |
$511 |
$2,319.18 |
1.0× |
| Radex Abd Compl Aqt Abd W/S/E/D Views 1 View Ch (74022) |
$133 |
$1,473.75 |
1.0× |
| Radex abscess/fistula/sinus tract rs&i (76080) |
$699 |
$2,933.45 |
1.0× |
| Radex Ankle Complete Minimum 3 Views (73610) |
$111 |
$1,016.88 |
1.0× |
| Radex Calcaneus Minimum 2 Views (73650) |
$111 |
$731.88 |
1.0× |
| Radex elbow complete minimum 3 views (73080) |
$111 |
$1,041.59 |
1.0× |
| Radex Facial Bones Complete Minimum 3 Views (70150) |
$133 |
$900.44 |
1.0× |
| Radex fingr minimum 2 views (73140) |
$111 |
$759.63 |
1.0× |
| Radex foot complete minimum 3 views (73630) |
$111 |
$969.33 |
1.0× |
| Radex Hand Minimum 3 Views (73130) |
$111 |
$1,017.13 |
1.0× |
| Radex lower extremity infant minimum 2 views (73592) |
$111 |
$526.25 |
1.0× |
| Radex Mastoids Compl Minimum 3 Views PR Side (70130) |
$133 |
$664.20 |
1.0× |
| Radex Nasal Bones Complete Minimum 3 Views (70160) |
$111 |
$705 |
1.0× |
| Radex Ribs Unilateral 2 Views (71100) |
$111 |
$663 |
1.0× |
| Radex shoulder complete minimum 2 views (73030) |
$111 |
$1,051.89 |
1.0× |
| Radex Sinuses Paransl < 3 Views (70210) |
$111 |
$578.30 |
1.0× |
| Radex sm int w/mlt srl imges via enteroclss tube (74251) |
$224 |
$1,152.80 |
1.0× |
| Radex Spine 1 View Specify Level (72020) |
$111 |
$568 |
1.0× |
| Radex Sternum Minimum 2 Views (71120) |
$111 |
$651.29 |
1.0× |
| Radex Temporomandble Jt Opn & Clsd Mouth Bilat (70330) |
$111 |
$767 |
1.0× |
| Radex Toe Minimum 2 Views (73660) |
$111 |
$531 |
1.0× |
| Radex upper extremity infant minimum 2 views (73092) |
$133 |
$623.15 |
1.0× |
| Radex Wrist Complete Minimum 3 Views (73110) |
$111 |
$1,027.43 |
1.0× |
| Radex X-Ray Exam Entire Spi 6/> Vw - Xr Entire Spine 6+ Vw (72084) |
$133 |
$1,343.79 |
1.0× |
| Radiolog exam mandible compl minimum 4 views (70110) |
$133 |
$913.86 |
1.0× |
| Radiologic exam colon double contrast study (74280) |
$224 |
$970.92 |
1.0× |
Radiologic exam colon single contrast study (74270)
range across 2 matching MRF lines |
$224 |
$1,968.28–$2,014.65 |
1.0× |
| Radiologic exam knee complete 4/more views (73564) |
$133 |
$1,253.27 |
1.0× |
| Radiologic exam pelvis compl minimum 3 views (72190) |
$133 |
$178.20 |
1.0× |
| Radiologic Exam Small Int Single Contrast Study (74250) |
$224 |
$1,897.67 |
1.0× |
| Radiologic exam swallow function contrast study (74230) |
$224 |
$1,426.56 |
1.0× |
| Radiologic examination femur 1 view (73551) |
$111 |
$802 |
1.0× |
| Radiologic examination femur minimum 2 views (73552) |
$111 |
$1,032.58 |
1.0× |
| Radiologic examination knee 1/2 views (73560) |
$111 |
$863.81 |
1.0× |
| Radiologic Examination Osseous Survey Limited (77074) |
$133 |
$369.45 |
1.0× |
| Radiologic Examination Salivary Gland Calculus (70380) |
$111 |
$561.60 |
1.0× |
| Radiologic examination tibia & fibula 2 views (73590) |
$111 |
$972.96 |
1.0× |
| Radiologic examination, internal auditory meati, complete Non-Facility (70134) |
$699 |
$527.04 |
1.0× |
| Radiopharm Dacryocystography (78660) |
$511 |
$1,239.42 |
1.0× |
| Radiopharmaceutical therapy, by intracavitary administration Non-Facility (79200) |
$298 |
$1,938.51 |
1.0× |
| Renal Cyst Study (74470) |
$699 |
$707.28 |
1.0× |
| Ribs bilateral 3 views (71110) |
$133 |
$1,007 |
1.0× |
| Rp loclzj tum plnr 1 area single day imaging (78800) |
$511 |
$1,724.52 |
1.0× |
| Rp loclzj tum plnr 2+area 1+d img/1 area img>2+d (78801) |
$511 |
$3,511.82 |
1.0× |
| Rp Loclzj Tum Plnr Whole Body 2+ Days Imaging (78804) |
$694 |
$3,250 |
1.0× |
| Rp Loclzj Tum Plnr Whole Body Single Day Imaging (78802) |
$694 |
$9,673.15 |
1.0× |
| Rp Loclzj Tum Spect 1 Area Single Day Imaging (78803) |
$694 |
$7,738.52 |
1.0× |
| Rp Ther Radiolbld Monoclonal Antibody IV Infus (79403) |
$298 |
$1,938.51 |
1.0× |
| Rp Therapy Intravenous Administration (79101) |
$298 |
$1,614.55 |
1.0× |
| Rp Therapy Unlisted Procedure (79999) |
$298 |
$1,938.51 |
1.0× |
| Salivary Gland Function Study (78232) |
$511 |
$2,288.65 |
1.0× |
| Scapula (73010) |
$133 |
$713 |
1.0× |
| Screening Digital Breast Tomosynthesis Bi (77063) |
$27 |
$139.94 |
1.2× |
| Sella turcica (70240) |
$111 |
$303.94 |
1.0× |
| Shoulder 1 view (73020) |
$111 |
$753.60 |
1.0× |
| Shoulder Arthrography (73040) |
$446 |
$1,454.95 |
1.0× |
| Sialogram (70390) |
$305 |
$707.28 |
1.0× |
| Skull less than 4 views (70250) |
$133 |
$919.55 |
1.0× |
| Speech evaluation, complex (70371) |
$305 |
$966.32 |
1.0× |
| Spleen Imaging (78185) |
$511 |
$2,587.20 |
1.0× |
| Sternoclavicular joints (71130) |
$111 |
$697.91 |
1.0× |
| Superior sagittal sinus venogram (75870) |
$4,041 |
$2,628.78 |
1.0× |
| Testicular Imaging W/Flow (78761) |
$511 |
$1,257.12 |
1.0× |
| Ther rad simulaj-aided field setting simple (77280) |
$172 |
$567.60 |
1.0× |
| Therapeutic Enema Rdctj Intussusception/Obstrcj (74283) |
$224 |
$815.40 |
1.0× |
| Thoracic spine 2 views (72070) |
$133 |
$787.87 |
1.0× |
| Thoracic spine 3 views (72072) |
$133 |
$623.15 |
1.0× |
| Thoracolumbar 2 views (72080) |
$111 |
$736.76 |
1.0× |
| Thyroid carcinoma metastases imaging; with additional studies (eg, urinary recovery) Non-Facility (78016) |
$511 |
$2,641.31 |
1.0× |
| Thyroid Carcinoma Metastases Img Lmtd Area (78015) |
$511 |
$1,724.52 |
1.0× |
| Thyroid Imaging With Vascular Flow (78013) |
$511 |
$1,027.39 |
1.0× |
| Thyroid Met Imaging Body (78018) |
$694 |
$1,760 |
1.0× |
| Thyroid Uptake Measurement (78012) |
$511 |
$4,861.50 |
1.0× |
| Thyroid Uptake W/Blood Flow Sngle/Mult Quan Meas (78014) |
$511 |
$2,266.16 |
1.0× |
| Ultrasound Breast Limited (76642) |
$111 |
$1,355 |
1.0× |
| Ultrasound, abdomen limited (76705) |
$133 |
$1,918.21 |
1.0× |
| Unlisted Dx Radiographic Procedure (76499) |
$111 |
$554.50 |
1.0× |
| Unlisted magnetic resonance procedure (76498) |
$111 |
$2,004.87 |
1.0× |
| Unlisted Miscellaneous Px Dx Nuclear Medicine (78999) |
$511 |
$424.80 |
1.0× |
| Unlisted us procedure (76999) |
$111 |
$641.83 |
1.0× |
| Upper gi w/o kub (74240) |
$224 |
$1,098 |
1.0× |
| Urethrocystogram voiding (74455) |
$305 |
$1,064.70 |
1.0× |
| Urethrocystography retrograde (74450) |
$305 |
$1,064.70 |
1.0× |
| Us bone density measurement (76977) |
$133 |
$366.59 |
1.0× |
| Us breast unilateral complete (76641) |
$133 |
$962.75 |
1.0× |
| Us chest (76604) |
$133 |
$1,303.48 |
1.0× |
| Us complete joint (76881) |
$133 |
$1,456.82 |
1.0× |
| Us exam, pelvic, limited (76857) |
$133 |
$1,562.44 |
1.0× |
| Us head (76506) |
$133 |
$896.40 |
1.0× |
| Us kidney transplant (76776) |
$133 |
$735.70 |
1.0× |
| Us lmtd joint/oth nonvasc xtr strux r-t w/img (76882) |
$133 |
$1,171.99 |
1.0× |
| Us ob detailed single fetus (76811) |
$305 |
$1,700.01 |
1.0× |
| Us ob limited 1 or more fetuses (76815) |
$133 |
$984.50 |
1.0× |
| Us ob transvaginal (76817) |
$133 |
$1,319 |
1.0× |
| Us pelvic non ob complete (76856) |
$133 |
$2,116.25 |
1.0× |
| Us pg uter img f&mat 14 wk tabdl 1/1st gestation (76801) |
$133 |
$1,333.67 |
1.0× |
| Us preg uterus real time f/u trnsabdl per fetus (76816) |
$133 |
$953.25 |
1.0× |
| Us retroperitoneal complete (76770) |
$133 |
$2,062.90 |
1.0× |
| Us retroperitoneal limited (76775) |
$133 |
$827.05 |
1.0× |
| Us scrotum and contents (76870) |
$133 |
$1,609.31 |
1.0× |
| Us spinal canal and contents (76800) |
$133 |
$671.51 |
1.0× |
| Us thyroid (76536) |
$133 |
$1,706.96 |
1.0× |
| Us transrectal (76872) |
$133 |
$661.64 |
1.0× |
| Vascular Flow Imaging (78445) |
$511 |
$867.72 |
1.0× |
| Vasogram (74440) |
$305 |
$1,856.75 |
1.0× |
| Vein X-Ray Chest (75827) |
$2,014 |
$8,674.76 |
1.0× |
| Venogram Sinus/Jugular (75860) |
$4,041 |
$17,368.60 |
1.0× |
| Venography Adrenal Unilateral (75840) |
$4,041 |
$8,505.98 |
1.0× |
| Venography caval inferior serialography rs&i (75825) |
$4,041 |
$17,368.60 |
1.0× |
| Venography extremity bilateral rs&i (75822) |
$2,014 |
$8,674.76 |
1.0× |
| Venography extremity unilateral rs&i (75820) |
$2,014 |
$8,674.76 |
1.0× |
| Venography Renal Bilateral (75833) |
$4,041 |
$3,623.69 |
1.0× |
| Venography Renal Unilateral (75831) |
$4,041 |
$3,623.69 |
1.0× |
| Venous sampling by catheter (75893) |
$7,121 |
$12,794.90 |
1.0× |
| Venous Thrombosis Imaging Venogram Bilateral (78458) |
$511 |
$1,284.12 |
1.0× |
| Vertebral fracture assessment via dxa (77086) |
$111 |
$415.59 |
1.0× |
| Wrist 2 views (73100) |
$111 |
$803.95 |
1.0× |
| X-Ray Ac Jts - Xr Acromioclavicular Joints Bilateral (73050) |
$111 |
$614.21 |
1.0× |
| X-ray antegrade pyelogram tube (74425) |
$446 |
$1,064.70 |
1.0× |
| X-Ray Aorta Leg Arteries (75630) |
$4,041 |
$17,368.60 |
1.0× |
| X-Ray Bend Only L-S Spine (72120) |
$133 |
$681.50 |
1.0× |
| X-Ray Elbow 2 Vw - Xr Elbow 1-2 Views Right (73070) |
$111 |
$833.36 |
1.0× |
| X-Ray Exam Breast Specimen (76098) |
$699 |
$1,460.07 |
1.0× |
| X-Ray Exam Entire Spi 1 Vw (72081) |
$111 |
$425.60 |
1.0× |
| X-Ray Exam Entire Spi 2/3 Vw (72082) |
$133 |
$830.84 |
1.0× |
| X-Ray Exam Entire Spi 4/5 Vw (72083) |
$133 |
$1,343.79 |
1.0× |
| X-Ray Exam Hip Uni 1 View (73501) |
$111 |
$727.93 |
1.0× |
| X-Ray Exam Hip Uni 2-3 Views (73502) |
$111 |
$967.90 |
1.0× |
| X-Ray Exam Hip Uni 4/> Views (73503) |
$133 |
$704.83 |
1.0× |
| X-Ray Exam Hips Bi 2 Views (73521) |
$133 |
$1,158.48 |
1.0× |
| X-Ray Exam Hips Bi 3-4 Views (73522) |
$133 |
$1,187.65 |
1.0× |
| X-Ray Exam Hips Bi 5/> Views (73523) |
$133 |
$1,343.79 |
1.0× |
| X-Ray Exam L-S Spine Bending (72114) |
$133 |
$1,423.34 |
1.0× |
| X-Ray Exam Neck Spine 2-3 Vw (72040) |
$111 |
$1,040.31 |
1.0× |
| X-Ray Exam Neck Spine 6/>Vws (72052) |
$133 |
$1,354.75 |
1.0× |
| X-Ray Exam Unilat Ribs/Chest (71101) |
$133 |
$1,081.36 |
1.0× |
| X-ray eye for foreign body (70030) |
$111 |
$238.50 |
1.0× |
| X-ray head for orthodontia (70350) |
$111 |
$415.59 |
1.0× |
| X-ray humerus (73060) |
$111 |
$846.05 |
1.0× |
| X-ray IV pyelogram (ivp) (74400) |
$224 |
$1,039.50 |
1.0× |
| X-ray IV pyelogram+tomography (74415) |
$224 |
$1,385.64 |
1.0× |
| X-Ray Jaw <4 Vw - Xr Mandible < 4 Views (70100) |
$111 |
$562 |
1.0× |
| X-Ray Knee Bilat Standing - Xr Knees Anteroposterior Standing Bilat (73565) |
$111 |
$506.55 |
1.0× |
| X-Ray Lumbar Spine 2/3 Vw - Xr Lumbar Spine 2-3 Views (72100) |
$133 |
$1,091.25 |
1.0× |
| X-ray nose-rectum child f.b. (76010) |
$111 |
$401.97 |
1.0× |
| X-Ray Ribs, Chest 4+ Vw - Xr Ribs 3 Vws Bil W/ Chest Posteroanterior (71111) |
$133 |
$1,541.25 |
1.0× |
| X-Ray Sacroiliac Jts 3+ Vw - Xr Sacroiliac Joints 3+ Views (72202) |
$133 |
$719 |
1.0× |
| X-Ray Sacroiliac Jts <3 Vw - Xr Sacroiliac Joints 1-2 Views (72200) |
$133 |
$623.15 |
1.0× |
| X-Ray Sacrum/Coccyx 2+ Vw - Xr Sacrum Coccyx 2+ Views (72220) |
$111 |
$937.35 |
1.0× |
| X-Ray Sinuses 3+ Vw - Xr Paranasal Sinuses 3+ Views (70220) |
$111 |
$972 |
1.0× |
| X-Ray Skull 4+ Vw - Xr Skull Complete 4+ Views (70260) |
$133 |
$650.16 |
1.0× |
| X-Ray Stress View (77071) |
$111 |
$415.59 |
1.0× |
| X-ray thoracic spine 4 vw (72074) |
$133 |
$831.43 |
1.0× |
| X-Ray Tmj Unilat (70328) |
$111 |
$506.55 |
1.0× |
| X-Ray Urinary Tract Exam With Contrast Material (74420) |
$446 |
$2,148.09 |
1.0× |
| X-Rays Bone Length Studies (77073) |
$133 |
$697 |
1.0× |
| X-Rays Bone Survey Complete (77075) |
$133 |
$1,655.55 |
1.0× |
| Xr c-spine 4 or 5 views (72050) |
$133 |
$1,436.25 |
1.0× |
| Xr facial bones less than 3 views (70140) |
$111 |
$604.15 |
1.0× |
| XR Mastoids < 3 Views Bilateral (70120) |
$133 |
$415.59 |
1.0× |
| Xr orbits complete 4 views (70200) |
$133 |
$489.24 |
1.0× |
| Xr Tomogram Single Plane (76100) |
$133 |
$537.84 |
1.0× |