| Abdomen 1 View (74018) |
— |
$260 |
— |
| Abdomen 2 views (74019) |
— |
$315 |
— |
| Acute Gastrointestinal Blood Loss Imaging (78278) |
— |
$584 |
— |
| Ankle 2 views (73600) |
— |
$260 |
— |
| Bone age studies (77072) |
— |
$315 |
— |
| Bone Imaging 3 Phase (78315) |
— |
$578 |
— |
| Bone Imaging Limited Area (78300) |
— |
$315 |
— |
| Bone Imaging Multiple Areas (78305) |
— |
$450 |
— |
| Bone survey infant (77076) |
— |
$315 |
— |
| Brain Image W/Flow < 4 Views (78601) |
— |
$385 |
— |
| Brain Imaging Min 4 Static Views W Vascular Flow (78606) |
— |
$443 |
— |
| Cat Scan Follow-Up Study (76380) |
— |
$980 |
— |
| Chest 1 view (71045) |
— |
$260 |
— |
| Chest 2 views (71046) |
— |
$260 |
— |
| Chest 3 views (71047) |
— |
$260 |
— |
| Chest 4 or more views (71048) |
— |
$315 |
— |
| Clavicle complete (73000) |
— |
$260 |
— |
| Computed Tomography Thorax Lw Dose Lng Ca Scr C- (71271) |
— |
$1,096 |
— |
| Contrast Xray Throat/Cerv Esopha (74210) |
— |
$525 |
— |
| CT abdomen and pelvis without and with contrast (74178) |
— |
$3,297 |
— |
| CT abdomen and pelvis without contrast (74176) |
— |
$1,958 |
— |
| CT abdomen w contrast (74160) |
— |
$1,495 |
— |
| CT abdomen w wo contrast (74170) |
— |
$2,319 |
— |
| CT abdomen w/o contrast (74150) |
— |
$1,186 |
— |
| CT Angio Abdomen and Pelvis (74174) |
— |
$2,010 |
— |
CT Angio Chest (71275)
range across 4 matching MRF lines |
— |
$1,077–$2,010 |
— |
| CT Angio Head (70496) |
— |
$2,010 |
— |
| Ct Angio Lwr Extr W/O&W/Dye (73706) |
— |
$2,010 |
— |
| CT Angio Neck (70498) |
— |
$2,010 |
— |
| Ct Angio Upr Extrm W/O&W/Dye (73206) |
— |
$2,010 |
— |
| CT cervical spine w/ contrast (72126) |
— |
$1,495 |
— |
| CT cervical spine w/o contrast (72125) |
— |
$1,186 |
— |
| CT cervical spine w/wo cont (72127) |
— |
$1,850 |
— |
CT chest w contrast (71260)
range across 3 matching MRF lines |
— |
$1,129–$1,283 |
— |
CT chest w/wo contrast (71270)
range across 3 matching MRF lines |
— |
$1,283–$1,495 |
— |
| CT head/brain with contrast (70460) |
— |
$1,289 |
— |
| CT head/brain without and with contrast (70470) |
— |
$1,495 |
— |
| CT iac w contrast (70481) |
— |
$1,283 |
— |
| CT l-spine w&w/o contrast (72133) |
— |
$1,850 |
— |
| CT lower ext w/o (73700) |
— |
$1,026 |
— |
| CT lower extremity w/contrast material (73701) |
— |
$1,186 |
— |
| CT lumbar spine w contrast (72132) |
— |
$1,495 |
— |
| CT lumbar spine w/o contrast (72131) |
— |
$1,186 |
— |
| CT maxillofacial w contrast (70487) |
— |
$1,283 |
— |
| CT maxillofacial wo contrast (70486) |
— |
$1,129 |
— |
| CT neck tissue combo (70492) |
— |
$1,495 |
— |
| Ct Orbit/Ear/Fossa W/O&W/Dye (70482) |
— |
$1,495 |
— |
| CT orbits w/o contrast (70480) |
— |
$1,129 |
— |
CT pelvis w&w/o contrast (72194)
range across 2 matching MRF lines |
— |
$1,495–$2,319 |
— |
| CT pelvis w/o contrast (72192) |
— |
$1,186 |
— |
| CT scan of leg combo (73702) |
— |
$1,495 |
— |
| CT scans face/jaw combo (70488) |
— |
$1,495 |
— |
| CT soft tissue neck w contrast (70491) |
— |
$1,283 |
— |
| CT soft tissue neck w/o contrast (70490) |
— |
$1,129 |
— |
| CT thoracic spine w contrast (72129) |
— |
$1,495 |
— |
| CT thoracic spine w/o contrast (72128) |
— |
$1,186 |
— |
| CT thoracic spine w/wo cont (72130) |
— |
$1,850 |
— |
| CT thorax w/o contrast (71250) |
— |
$1,129 |
— |
| CT upper ext wo (73200) |
— |
$1,026 |
— |
| CT upper extremity w/o & w/contrast material (73202) |
— |
$1,495 |
— |
| CT upper extremity with contrast (73201) |
— |
$1,186 |
— |
| Cta Abdl Aorta&Bi Iliofem W/Contrast&Postp (75635) |
— |
$2,010 |
— |
| Cta Abdomen (74175) |
— |
$2,010 |
— |
| CTA pelvis (72191) |
— |
$2,010 |
— |
| Foot 2 views (73620) |
— |
$260 |
— |
| Forearm 2 views (73090) |
— |
$260 |
— |
| Hand 2 views (73120) |
— |
$315 |
— |
| Infusion Ivp (74410) |
— |
$525 |
— |
| K Flow/Funct Image W/O Drug (78707) |
— |
$467 |
— |
| Kidney Imaging Morphol (78700) |
— |
$347 |
— |
| Kidney Imaging Morphoogy W/Vascular Flow (78701) |
— |
$394 |
— |
| Knee 3 Views (73562) |
— |
$260 |
— |
| Liver & Spleen Imaging Static Only (78215) |
— |
$336 |
— |
| Liver & Spleen Imaging W/Vascular Flow (78216) |
— |
$372 |
— |
| Liver imaging static only (78201) |
— |
$278 |
— |
| Liver imaging w/vascular flow (78202) |
— |
$312 |
— |
| Magnetic Image Jaw Joint (70336) |
— |
$1,400 |
— |
| Meckels Divert Exam (78290) |
— |
$347 |
— |
| Mra Head W/O & W/Contrast Material (70546) |
— |
$2,198 |
— |
| MRA head w/o contrast (70544) |
— |
$1,400 |
— |
| MRA head with contrast (70545) |
— |
$2,198 |
— |
| MRA neck w contrast (70548) |
— |
$2,198 |
— |
| Mra Neck W/O &W/Contrast Material (70549) |
— |
$2,198 |
— |
| MRA neck w/o contrast (70547) |
— |
$1,400 |
— |
| MRI abdomen w contrast (74182) |
— |
$2,198 |
— |
| MRI abdomen w/o contrast (74181) |
— |
$1,400 |
— |
MRI any jt lower extrem w/contrast material (73722)
range across 3 matching MRF lines |
— |
$4,577–$6,866 |
— |
MRI any jt lower extrem w/o & w/contrast matrl (73723)
range across 3 matching MRF lines |
— |
$2,198–$3,298 |
— |
| MRI any jt upper extremity w/contrast matrl (73222) |
— |
$4,577 |
— |
| MRI cervical spine w contrast (72142) |
— |
$2,198 |
— |
| MRI cervical spine w/o cont (72141) |
— |
$1,400 |
— |
| MRI chest w/o contrast (71550) |
— |
$1,400 |
— |
| MRI chest with contrast (71551) |
— |
$4,577 |
— |
| MRI chest wo w contrast (71552) |
— |
$2,198 |
— |
| MRI lower extrem oth/thn jt w/contrast matrl (73719) |
— |
$2,198 |
— |
| MRI lower extrem oth/thn jt w/o & w/contr matr (73720) |
— |
$2,198 |
— |
| MRI lower extrem oth/thn jt w/o contr matrl (73718) |
— |
$1,400 |
— |
| MRI lumbar spine w contrast (72149) |
— |
$2,198 |
— |
| Mri Neck Spine W/O & W/Dye (72156) |
— |
$2,198 |
— |
| MRI orbit face &/neck w/o contrast (70540) |
— |
$1,400 |
— |
| MRI orbit face neck w contrast (70542) |
— |
$2,198 |
— |
| Mri Orbt/Fac/Nck W/O &W/Dye (70543) |
— |
$2,198 |
— |
| MRI pelvis w contrast (72196) |
— |
$2,198 |
— |
| MRI pelvis w/o & w contrast (72197) |
— |
$2,198 |
— |
| MRI pelvis w/o contrast (72195) |
— |
$1,400 |
— |
| MRI thoracic spine w/o contrast (72146) |
— |
$1,400 |
— |
| MRI upper extremity oth than jt w/contr matrl (73219) |
— |
$2,198 |
— |
| MRI upper extremity oth than jt w/o contr matrl (73218) |
— |
$1,400 |
— |
| Mri Uppr Extremity W/O&W/Dye (73220) |
— |
$2,198 |
— |
| MRI, abdomen, combo (74183) |
— |
$2,198 |
— |
| MRI, dorsal spine combo (72157) |
— |
$2,198 |
— |
| MRI, dorsal spine contrast (72147) |
— |
$2,198 |
— |
| MRI, joint upper extrem (73221) |
— |
$1,400 |
— |
| MRI, joint upper extrem combo (73223) |
— |
$2,198 |
— |
| MRI, lumbar spine combo (72158) |
— |
$2,198 |
— |
| Myelogram cervical (72240) |
— |
$2,289 |
— |
| Myelogram Lumbar (72265) |
— |
$2,289 |
— |
| Neck soft tissue (70360) |
— |
$260 |
— |
| Pelvis 1 or 2 views (72170) |
— |
$315 |
— |
| Pulmonary Perfusion Imaging Particulate (78580) |
— |
$417 |
— |
| Radex Abd Compl Aqt Abd W/S/E/D Views 1 View Ch (74022) |
— |
$315 |
— |
| Radex Ankle Complete Minimum 3 Views (73610) |
— |
$260 |
— |
| Radex Calcaneus Minimum 2 Views (73650) |
— |
$260 |
— |
| Radex elbow complete minimum 3 views (73080) |
— |
$260 |
— |
| Radex Facial Bones Complete Minimum 3 Views (70150) |
— |
$315 |
— |
| Radex fingr minimum 2 views (73140) |
— |
$260 |
— |
| Radex foot complete minimum 3 views (73630) |
— |
$260 |
— |
| Radex Hand Minimum 3 Views (73130) |
— |
$260 |
— |
| Radex lower extremity infant minimum 2 views (73592) |
— |
$260 |
— |
| Radex Mastoids Compl Minimum 3 Views PR Side (70130) |
— |
$315 |
— |
| Radex Nasal Bones Complete Minimum 3 Views (70160) |
— |
$260 |
— |
| Radex Ribs Unilateral 2 Views (71100) |
— |
$260 |
— |
| Radex shoulder complete minimum 2 views (73030) |
— |
$260 |
— |
| Radex Sinuses Paransl < 3 Views (70210) |
— |
$260 |
— |
| Radex Spine 1 View Specify Level (72020) |
— |
$260 |
— |
| Radex Sternum Minimum 2 Views (71120) |
— |
$260 |
— |
| Radex Temporomandble Jt Opn & Clsd Mouth Bilat (70330) |
— |
$260 |
— |
| Radex Toe Minimum 2 Views (73660) |
— |
$260 |
— |
| Radex upper extremity infant minimum 2 views (73092) |
— |
$315 |
— |
| Radex Wrist Complete Minimum 3 Views (73110) |
— |
$260 |
— |
| Radiolog exam mandible compl minimum 4 views (70110) |
— |
$315 |
— |
| Radiologic exam knee complete 4/more views (73564) |
— |
$315 |
— |
| Radiologic exam pelvis compl minimum 3 views (72190) |
— |
$315 |
— |
| Radiologic examination femur minimum 2 views (73552) |
— |
$260 |
— |
| Radiologic examination knee 1/2 views (73560) |
— |
$260 |
— |
| Radiologic Examination Osseous Survey Limited (77074) |
— |
$315 |
— |
| Radiologic examination tibia & fibula 2 views (73590) |
— |
$260 |
— |
| Ribs bilateral 3 views (71110) |
— |
$315 |
— |
| Scapula (73010) |
— |
$315 |
— |
| Sella turcica (70240) |
— |
$260 |
— |
| Shoulder 1 view (73020) |
— |
$260 |
— |
| Skull less than 4 views (70250) |
— |
$315 |
— |
| Spleen Imaging (78185) |
— |
$274 |
— |
| Sternoclavicular joints (71130) |
— |
$260 |
— |
| Testicular Imaging W/Flow (78761) |
— |
$392 |
— |
| Thoracic spine 2 views (72070) |
— |
$315 |
— |
| Thoracic spine 3 views (72072) |
— |
$315 |
— |
| Thoracolumbar 2 views (72080) |
— |
$260 |
— |
| Thyroid Carcinoma Metastases Img Lmtd Area (78015) |
— |
$330 |
— |
| Thyroid Met Imaging Body (78018) |
— |
$622 |
— |
| Ultrasound Breast Limited (76642) |
— |
$347 |
— |
| Ultrasound Exam Aaa Screen (76706) |
— |
$420 |
— |
| Ultrasound, abdomen limited (76705) |
— |
$420 |
— |
| Us breast unilateral complete (76641) |
— |
$420 |
— |
| Us chest (76604) |
— |
$420 |
— |
| Us exam, pelvic, limited (76857) |
— |
$420 |
— |
| Us lmtd joint/oth nonvasc xtr strux r-t w/img (76882) |
— |
$420 |
— |
| Us ob limited 1 or more fetuses (76815) |
— |
$420 |
— |
| Us ob transvaginal (76817) |
— |
$420 |
— |
| Us pelvic non ob complete (76856) |
— |
$420 |
— |
| Us pg uter img f&mat 14 wk tabdl 1/1st gestation (76801) |
— |
$420 |
— |
| Us preg uterus real time f/u trnsabdl per fetus (76816) |
— |
$420 |
— |
| Us retroperitoneal complete (76770) |
— |
$420 |
— |
| Us retroperitoneal limited (76775) |
— |
$420 |
— |
| Us scrotum and contents (76870) |
— |
$420 |
— |
Us thyroid (76536)
range across 3 matching MRF lines |
— |
$420–$423 |
— |
| Us transrectal (76872) |
— |
$420 |
— |
| Wrist 2 views (73100) |
— |
$260 |
— |
| X-Ray Ac Jts - Xr Acromioclavicular Joints Bilateral (73050) |
— |
$260 |
— |
| X-ray antegrade pyelogram tube (74425) |
— |
$1,100 |
— |
| X-Ray Bend Only L-S Spine (72120) |
— |
$315 |
— |
| X-Ray Elbow 2 Vw - Xr Elbow 1-2 Views Right (73070) |
— |
$260 |
— |
| X-Ray Exam Entire Spi 1 Vw (72081) |
— |
$260 |
— |
| X-Ray Exam Entire Spi 2/3 Vw (72082) |
— |
$315 |
— |
| X-Ray Exam Hip Uni 1 View (73501) |
— |
$260 |
— |
| X-Ray Exam Hip Uni 2-3 Views (73502) |
— |
$260 |
— |
| X-Ray Exam Hips Bi 2 Views (73521) |
— |
$315 |
— |
| X-Ray Exam L-S Spine Bending (72114) |
— |
$315 |
— |
| X-Ray Exam Neck Spine 2-3 Vw (72040) |
— |
$260 |
— |
| X-Ray Exam Neck Spine 6/>Vws (72052) |
— |
$315 |
— |
| X-Ray Exam Unilat Ribs/Chest (71101) |
— |
$315 |
— |
| X-ray humerus (73060) |
— |
$260 |
— |
| X-ray IV pyelogram+tomography (74415) |
— |
$525 |
— |
| X-Ray Jaw <4 Vw - Xr Mandible < 4 Views (70100) |
— |
$260 |
— |
| X-Ray Knee Bilat Standing - Xr Knees Anteroposterior Standing Bilat (73565) |
— |
$260 |
— |
| X-Ray Lumbar Spine 2/3 Vw - Xr Lumbar Spine 2-3 Views (72100) |
— |
$315 |
— |
| X-ray nose-rectum child f.b. (76010) |
— |
$260 |
— |
| X-Ray Ribs, Chest 4+ Vw - Xr Ribs 3 Vws Bil W/ Chest Posteroanterior (71111) |
— |
$315 |
— |
| X-Ray Sacroiliac Jts 3+ Vw - Xr Sacroiliac Joints 3+ Views (72202) |
— |
$315 |
— |
| X-Ray Sacroiliac Jts <3 Vw - Xr Sacroiliac Joints 1-2 Views (72200) |
— |
$315 |
— |
| X-Ray Sacrum/Coccyx 2+ Vw - Xr Sacrum Coccyx 2+ Views (72220) |
— |
$260 |
— |
| X-Ray Sinuses 3+ Vw - Xr Paranasal Sinuses 3+ Views (70220) |
— |
$260 |
— |
| X-Ray Skull 4+ Vw - Xr Skull Complete 4+ Views (70260) |
— |
$315 |
— |
| X-ray thoracic spine 4 vw (72074) |
— |
$315 |
— |
| X-Ray Tmj Unilat (70328) |
— |
$260 |
— |
| X-Ray Urinary Tract Exam With Contrast Material (74420) |
— |
$1,100 |
— |
| X-Rays Bone Length Studies (77073) |
— |
$315 |
— |
| X-Rays Bone Survey Complete (77075) |
— |
$315 |
— |
| Xr c-spine 4 or 5 views (72050) |
— |
$315 |
— |
| Xr facial bones less than 3 views (70140) |
— |
$260 |
— |
| XR Mastoids < 3 Views Bilateral (70120) |
— |
$315 |
— |
| Xr orbits complete 4 views (70200) |
— |
$315 |
— |