| Abdomen 1 View (74018) |
— |
$155 |
— |
| Abdomen 2 views (74019) |
— |
$216 |
— |
| Ankle 2 views (73600) |
— |
$124 |
— |
| Bone age studies (77072) |
— |
$118 |
— |
| Chest 1 view (71045) |
— |
$145 |
— |
| Chest 2 views (71046) |
— |
$167 |
— |
| Clavicle complete (73000) |
— |
$95 |
— |
| CT abdomen and pelvis without and with contrast (74178) |
— |
$3,985 |
— |
| CT abdomen and pelvis without contrast (74176) |
— |
$2,586 |
— |
| CT abdomen w contrast (74160) |
— |
$2,097 |
— |
| CT abdomen w wo contrast (74170) |
— |
$2,661 |
— |
| CT abdomen w/o contrast (74150) |
— |
$1,650 |
— |
| CT Angio Abdomen and Pelvis (74174) |
— |
$3,548 |
— |
| CT Angio Chest (71275) |
— |
$2,818 |
— |
| CT Angio Head (70496) |
— |
$1,542 |
— |
| CT Angio Neck (70498) |
— |
$1,600 |
— |
| CT cervical spine w/o contrast (72125) |
— |
$1,698 |
— |
| CT chest w contrast (71260) |
— |
$2,262 |
— |
| CT chest w/wo contrast (71270) |
— |
$2,777 |
— |
| CT head/brain without and with contrast (70470) |
— |
$2,355 |
— |
| CT lower ext w/o (73700) |
— |
$1,617 |
— |
| CT lower extremity w/contrast material (73701) |
— |
$2,112 |
— |
| CT lumbar spine w/o contrast (72131) |
— |
$1,412 |
— |
| CT maxillofacial w contrast (70487) |
— |
$2,353 |
— |
| CT maxillofacial wo contrast (70486) |
— |
$1,651 |
— |
| CT neck tissue combo (70492) |
— |
$2,152 |
— |
| CT orbits w/o contrast (70480) |
— |
$1,153 |
— |
| CT pelvis w/o contrast (72192) |
— |
$1,470 |
— |
| CT scans face/jaw combo (70488) |
— |
$2,379 |
— |
| CT soft tissue neck w contrast (70491) |
— |
$2,036 |
— |
| CT thoracic spine w/o contrast (72128) |
— |
$1,318 |
— |
| CT thorax w/o contrast (71250) |
— |
$1,627 |
— |
| CT upper ext wo (73200) |
— |
$1,541 |
— |
| CT upper extremity with contrast (73201) |
— |
$1,979 |
— |
| Cta Abdomen (74175) |
— |
$1,236 |
— |
| Dxa Bone Density Axial (77080) |
— |
$492 |
— |
| Echograp Trans R Pros Study (76873) |
— |
$398 |
— |
| Fetal Biophysical Profile W/O Non-Stress Testing (76819) |
— |
$393 |
— |
| Foot 2 views (73620) |
— |
$248 |
— |
| Forearm 2 views (73090) |
— |
$184 |
— |
| Hand 2 views (73120) |
— |
$134 |
— |
| Knee 3 Views (73562) |
— |
$324 |
— |
| Mra Head W/O & W/Contrast Material (70546) |
— |
$3,193 |
— |
| MRA head w/o contrast (70544) |
— |
$2,156 |
— |
| Mra Neck W/O &W/Contrast Material (70549) |
— |
$2,786 |
— |
| MRI abdomen w/o contrast (74181) |
— |
$1,444 |
— |
| MRI any jt lower extrem w/o & w/contrast matrl (73723) |
— |
$3,552 |
— |
| MRI cervical spine w/o cont (72141) |
— |
$2,293 |
— |
| MRI lower extrem oth/thn jt w/o & w/contr matr (73720) |
— |
$2,974 |
— |
| MRI lower extrem oth/thn jt w/o contr matrl (73718) |
— |
$2,033 |
— |
| Mri Neck Spine W/O & W/Dye (72156) |
— |
$3,148 |
— |
| Mri Orbt/Fac/Nck W/O &W/Dye (70543) |
— |
$2,419 |
— |
| MRI pelvis w/o contrast (72195) |
— |
$1,791 |
— |
| MRI thoracic spine w/o contrast (72146) |
— |
$2,147 |
— |
| MRI upper extremity oth than jt w/o contr matrl (73218) |
— |
$1,557 |
— |
| MRI, abdomen, combo (74183) |
— |
$3,629 |
— |
| MRI, dorsal spine combo (72157) |
— |
$3,380 |
— |
| MRI, joint upper extrem (73221) |
— |
$2,378 |
— |
| MRI, joint upper extrem combo (73223) |
— |
$3,241 |
— |
| MRI, lumbar spine combo (72158) |
— |
$3,501 |
— |
| Neck soft tissue (70360) |
— |
$119 |
— |
| Pelvis 1 or 2 views (72170) |
— |
$253 |
— |
| Radex Ankle Complete Minimum 3 Views (73610) |
— |
$203 |
— |
| Radex Calcaneus Minimum 2 Views (73650) |
— |
$136 |
— |
| Radex elbow complete minimum 3 views (73080) |
— |
$238 |
— |
| Radex Facial Bones Complete Minimum 3 Views (70150) |
— |
$205 |
— |
| Radex fingr minimum 2 views (73140) |
— |
$171 |
— |
| Radex foot complete minimum 3 views (73630) |
— |
$215 |
— |
| Radex Hand Minimum 3 Views (73130) |
— |
$189 |
— |
| Radex Nasal Bones Complete Minimum 3 Views (70160) |
— |
$179 |
— |
| Radex Ribs Unilateral 2 Views (71100) |
— |
$247 |
— |
| Radex shoulder complete minimum 2 views (73030) |
— |
$256 |
— |
| Radex Sternum Minimum 2 Views (71120) |
— |
$152 |
— |
| Radex Toe Minimum 2 Views (73660) |
— |
$199 |
— |
| Radex Wrist Complete Minimum 3 Views (73110) |
— |
$203 |
— |
| Radiologic exam knee complete 4/more views (73564) |
— |
$324 |
— |
| Radiologic exam pelvis compl minimum 3 views (72190) |
— |
$201 |
— |
| Radiologic examination femur 1 view (73551) |
— |
$119 |
— |
| Radiologic examination femur minimum 2 views (73552) |
— |
$233 |
— |
| Radiologic examination knee 1/2 views (73560) |
— |
$314 |
— |
| Radiologic examination tibia & fibula 2 views (73590) |
— |
$232 |
— |
| Ribs bilateral 3 views (71110) |
— |
$159 |
— |
| Scapula (73010) |
— |
$127 |
— |
| Screening Digital Breast Tomosynthesis Bi (77063) |
— |
$28 |
— |
| Skull less than 4 views (70250) |
— |
$163 |
— |
| Thoracic spine 2 views (72070) |
— |
$158 |
— |
| Thoracic spine 3 views (72072) |
— |
$247 |
— |
Ultrasound Breast Limited (76642)
range across 2 matching MRF lines |
— |
$430–$753 |
— |
| Ultrasound, abdomen limited (76705) |
— |
$551 |
— |
| Us complete joint (76881) |
— |
$416 |
— |
| Us lmtd joint/oth nonvasc xtr strux r-t w/img (76882) |
— |
$359 |
— |
| Us ob transvaginal (76817) |
— |
$374 |
— |
| Us pelvic non ob complete (76856) |
— |
$661 |
— |
| Us pg uter img f&mat 14 wk tabdl 1/1st gestation (76801) |
— |
$449 |
— |
| Us preg uterus real time f/u trnsabdl per fetus (76816) |
— |
$362 |
— |
| Us retroperitoneal complete (76770) |
— |
$519 |
— |
| Us retroperitoneal limited (76775) |
— |
$598 |
— |
| Us scrotum and contents (76870) |
— |
$431 |
— |
| Us thyroid (76536) |
— |
$451 |
— |
| Wrist 2 views (73100) |
— |
$101 |
— |
| X-Ray Ac Jts - Xr Acromioclavicular Joints Bilateral (73050) |
— |
$158 |
— |
| X-Ray Elbow 2 Vw - Xr Elbow 1-2 Views Right (73070) |
— |
$231 |
— |
| X-Ray Exam Entire Spi 2/3 Vw (72082) |
— |
$163 |
— |
| X-Ray Exam Hip Uni 1 View (73501) |
— |
$111 |
— |
| X-Ray Exam Hip Uni 2-3 Views (73502) |
— |
$246 |
— |
| X-Ray Exam Hips Bi 3-4 Views (73522) |
— |
$217 |
— |
| X-Ray Exam Hips Bi 5/> Views (73523) |
— |
$255 |
— |
| X-Ray Exam Neck Spine 2-3 Vw (72040) |
— |
$255 |
— |
| X-Ray Exam Unilat Ribs/Chest (71101) |
— |
$247 |
— |
| X-ray eye for foreign body (70030) |
— |
$140 |
— |
| X-ray humerus (73060) |
— |
$206 |
— |
| X-Ray Lumbar Spine 2/3 Vw - Xr Lumbar Spine 2-3 Views (72100) |
— |
$349 |
— |
| X-Ray Ribs, Chest 4+ Vw - Xr Ribs 3 Vws Bil W/ Chest Posteroanterior (71111) |
— |
$187 |
— |
| X-Ray Sacrum/Coccyx 2+ Vw - Xr Sacrum Coccyx 2+ Views (72220) |
— |
$273 |
— |
| X-Ray Sinuses 3+ Vw - Xr Paranasal Sinuses 3+ Views (70220) |
— |
$311 |
— |
| X-Rays Bone Survey Complete (77075) |
— |
$509 |
— |
| Xr c-spine 4 or 5 views (72050) |
— |
$260 |
— |
| Xr facial bones less than 3 views (70140) |
— |
$203 |
— |
| Xr orbits complete 4 views (70200) |
— |
$132 |
— |