| Abdomen 1 View (74018) |
— |
$264.15 |
— |
| Abdomen 2 views (74019) |
— |
$319.02 |
— |
Ankle 2 views (73600)
range across 2 matching MRF lines |
— |
$264–$264.15 |
— |
| Chest 1 view (71045) |
— |
$264.15 |
— |
| Chest 2 views (71046) |
— |
$264.15 |
— |
Cholecystography Oral Contrast (74290)
range across 2 matching MRF lines |
— |
$37–$534 |
— |
Clavicle complete (73000)
range across 3 matching MRF lines |
— |
$27–$264.15 |
— |
| Computed Tomography Thorax Lw Dose Lng Ca Scr C- (71271) |
— |
$273 |
— |
| Contrast X-Ray Bladder (74430) |
— |
$1,071 |
— |
| Contrast Xray Throat/Cerv Esopha (74210) |
— |
$534 |
— |
| CT abdomen and pelvis without and with contrast (74178) |
— |
$2,286 |
— |
| CT abdomen and pelvis without contrast (74176) |
— |
$1,497 |
— |
CT abdomen w contrast (74160)
range across 3 matching MRF lines |
— |
$204–$1,497 |
— |
CT abdomen w wo contrast (74170)
range across 2 matching MRF lines |
— |
$204–$2,286 |
— |
| CT abdomen w/o contrast (74150) |
— |
$1,497 |
— |
| CT Angio Chest (71275) |
— |
$2,286 |
— |
| CT bone density (77078) |
— |
$259 |
— |
| CT cervical spine w/o contrast (72125) |
— |
$1,497 |
— |
| CT cervical spine w/wo cont (72127) |
— |
$2,197 |
— |
| CT chest w contrast (71260) |
— |
$2,286 |
— |
| CT chest w/wo contrast (71270) |
— |
$2,286 |
— |
| CT head/brain with contrast (70460) |
— |
$2,286 |
— |
| CT head/brain without and with contrast (70470) |
— |
$3,286 |
— |
| CT iac w contrast (70481) |
— |
$2,197 |
— |
CT lower ext w/o (73700)
range across 3 matching MRF lines |
— |
$1,497–$2,286 |
— |
| CT lower extremity w/contrast material (73701) |
— |
$2,286 |
— |
CT lumbar spine w/o contrast (72131)
range across 2 matching MRF lines |
— |
$1,497–$2,197 |
— |
| CT maxillofacial w contrast (70487) |
— |
$2,197 |
— |
| CT maxillofacial wo contrast (70486) |
— |
$2,197 |
— |
| CT neck tissue combo (70492) |
— |
$2,286 |
— |
| Ct Orbit/Ear/Fossa W/O&W/Dye (70482) |
— |
$2,597 |
— |
| CT orbits w/o contrast (70480) |
— |
$2,197 |
— |
| CT pelvis w&w/o contrast (72194) |
— |
$2,286 |
— |
| CT pelvis w/o contrast (72192) |
— |
$1,497 |
— |
| CT scan of leg combo (73702) |
— |
$2,286 |
— |
| CT scans face/jaw combo (70488) |
— |
$2,560 |
— |
| CT soft tissue neck w contrast (70491) |
— |
$2,286 |
— |
| CT soft tissue neck w/o contrast (70490) |
— |
$1,497 |
— |
| CT thoracic spine w/o contrast (72128) |
— |
$1,497 |
— |
| CT thorax w/o contrast (71250) |
— |
$1,497 |
— |
| CT upper ext wo (73200) |
— |
$1,497 |
— |
| CT upper extremity w/o & w/contrast material (73202) |
— |
$2,286 |
— |
CT upper extremity with contrast (73201)
range across 2 matching MRF lines |
— |
$1,071.39–$1,072 |
— |
| Esophagram (74220) |
— |
$534 |
— |
| Fetal Biophys Profile W/Nst (76818) |
— |
$352 |
— |
| Fluoroscopy up to 1 hr (76000) |
— |
$725 |
— |
Foot 2 views (73620)
range across 2 matching MRF lines |
— |
$264–$264.15 |
— |
Forearm 2 views (73090)
range across 3 matching MRF lines |
— |
$27–$264.15 |
— |
| Hand 2 views (73120) |
— |
$319 |
— |
| Ht Muscle Image Spect Sing (78451) |
— |
$1,936 |
— |
| Hysterosalpingogram (74740) |
— |
$725 |
— |
Knee 3 Views (73562)
range across 4 matching MRF lines |
— |
$27–$264.15 |
— |
| Mra Head W/O & W/Contrast Material (70546) |
— |
$3,565 |
— |
| MRA head w/o contrast (70544) |
— |
$2,560 |
— |
| MRA head with contrast (70545) |
— |
$3,565 |
— |
| MRA neck w/o contrast (70547) |
— |
$2,560 |
— |
| MRI abdomen w/o contrast (74181) |
— |
$2,560 |
— |
| MRI any jt lower extrem w/o & w/contrast matrl (73723) |
— |
$3,565 |
— |
| MRI any jt upper extremity w/contrast matrl (73222) |
— |
$2,370.18 |
— |
| MRI cervical spine w contrast (72142) |
— |
$3,565 |
— |
| MRI cervical spine w/o cont (72141) |
— |
$2,560 |
— |
| MRI chest w/o contrast (71550) |
— |
$2,560 |
— |
| MRI lower extrem oth/thn jt w/contrast matrl (73719) |
— |
$3,565 |
— |
| MRI lower extrem oth/thn jt w/o & w/contr matr (73720) |
— |
$3,565 |
— |
| MRI lower extrem oth/thn jt w/o contr matrl (73718) |
— |
$2,560 |
— |
| MRI lumbar spine w contrast (72149) |
— |
$3,565 |
— |
| Mri Neck Spine W/O & W/Dye (72156) |
— |
$3,565 |
— |
| MRI orbit face &/neck w/o contrast (70540) |
— |
$2,560 |
— |
| MRI orbit face neck w contrast (70542) |
— |
$3,565 |
— |
| Mri Orbt/Fac/Nck W/O &W/Dye (70543) |
— |
$3,565 |
— |
| MRI pelvis w/o & w contrast (72197) |
— |
$2,560 |
— |
| MRI pelvis w/o contrast (72195) |
— |
$2,560 |
— |
| MRI thoracic spine w/o contrast (72146) |
— |
$2,560 |
— |
MRI upper extremity oth than jt w/o contr matrl (73218)
range across 2 matching MRF lines |
— |
$2,560–$2,727 |
— |
Mri Uppr Extremity W/O&W/Dye (73220)
range across 2 matching MRF lines |
— |
$2,560–$3,565 |
— |
| MRI, abdomen, combo (74183) |
— |
$3,565 |
— |
| MRI, dorsal spine combo (72157) |
— |
$3,565 |
— |
| MRI, dorsal spine contrast (72147) |
— |
$3,565 |
— |
| MRI, joint upper extrem (73221) |
— |
$2,560 |
— |
| MRI, joint upper extrem combo (73223) |
— |
$3,565 |
— |
| MRI, lumbar spine combo (72158) |
— |
$3,565 |
— |
| Myocardial Spect Multiple Studies (78452) |
— |
$3,916.44 |
— |
| Neck soft tissue (70360) |
— |
$264.15 |
— |
| Pelvis 1 or 2 views (72170) |
— |
$319.02 |
— |
| Radex Abd Compl Aqt Abd W/S/E/D Views 1 View Ch (74022) |
— |
$319.02 |
— |
| Radex abscess/fistula/sinus tract rs&i (76080) |
— |
$269 |
— |
Radex Ankle Complete Minimum 3 Views (73610)
range across 3 matching MRF lines |
— |
$27–$264.15 |
— |
Radex Calcaneus Minimum 2 Views (73650)
range across 3 matching MRF lines |
— |
$20–$264 |
— |
Radex elbow complete minimum 3 views (73080)
range across 3 matching MRF lines |
— |
$27–$264.15 |
— |
| Radex Facial Bones Complete Minimum 3 Views (70150) |
— |
$319.02 |
— |
Radex fingr minimum 2 views (73140)
range across 3 matching MRF lines |
— |
$20–$264.15 |
— |
Radex foot complete minimum 3 views (73630)
range across 3 matching MRF lines |
— |
$27–$264.15 |
— |
Radex Hand Minimum 3 Views (73130)
range across 3 matching MRF lines |
— |
$27–$264.15 |
— |
Radex lower extremity infant minimum 2 views (73592)
range across 3 matching MRF lines |
— |
$264–$322 |
— |
| Radex Mastoids Compl Minimum 3 Views PR Side (70130) |
— |
$319 |
— |
| Radex Nasal Bones Complete Minimum 3 Views (70160) |
— |
$264.15 |
— |
| Radex Ribs Unilateral 2 Views (71100) |
— |
$264.15 |
— |
| Radex shoulder complete minimum 2 views (73030) |
— |
$264.15 |
— |
| Radex Sinuses Paransl < 3 Views (70210) |
— |
$264 |
— |
| Radex Spine 1 View Specify Level (72020) |
— |
$264 |
— |
Radex Sternum Minimum 2 Views (71120)
range across 2 matching MRF lines |
— |
$27–$264 |
— |
Radex Toe Minimum 2 Views (73660)
range across 3 matching MRF lines |
— |
$20–$264.15 |
— |
| Radex upper extremity infant minimum 2 views (73092) |
— |
$319 |
— |
Radex Wrist Complete Minimum 3 Views (73110)
range across 3 matching MRF lines |
— |
$27–$264.15 |
— |
Radiolog exam mandible compl minimum 4 views (70110)
range across 2 matching MRF lines |
— |
$35–$319.02 |
— |
Radiologic exam colon double contrast study (74280)
range across 2 matching MRF lines |
— |
$69–$534 |
— |
Radiologic exam colon single contrast study (74270)
range across 2 matching MRF lines |
— |
$65–$534 |
— |
| Radiologic exam knee complete 4/more views (73564) |
— |
$319 |
— |
| Radiologic exam pelvis compl minimum 3 views (72190) |
— |
$319 |
— |
| Radiologic Exam Small Int Single Contrast Study (74250) |
— |
$534 |
— |
| Radiologic exam upr gi trc double contrast study (74246) |
— |
$534 |
— |
| Radiologic examination femur 1 view (73551) |
— |
$264 |
— |
| Radiologic examination femur minimum 2 views (73552) |
— |
$264.15 |
— |
| Radiologic examination knee 1/2 views (73560) |
— |
$264.15 |
— |
| Radiologic Examination Osseous Survey Limited (77074) |
— |
$268 |
— |
Radiologic examination tibia & fibula 2 views (73590)
range across 3 matching MRF lines |
— |
$27–$264.15 |
— |
| Radiologic examination, internal auditory meati, complete Non-Facility (70134) |
— |
$35 |
— |
| Ribs bilateral 3 views (71110) |
— |
$319 |
— |
Scapula (73010)
range across 3 matching MRF lines |
— |
$25–$319 |
— |
| Shoulder 1 view (73020) |
— |
$264 |
— |
| Skull less than 4 views (70250) |
— |
$319.02 |
— |
| Thoracic spine 2 views (72070) |
— |
$319 |
— |
| Thoracic spine 3 views (72072) |
— |
$319.02 |
— |
Ultrasound Breast Limited (76642)
range across 3 matching MRF lines |
— |
$234–$264.15 |
— |
| Ultrasound Exam Aaa Screen (76706) |
— |
$694 |
— |
| Ultrasound, abdomen limited (76705) |
— |
$694 |
— |
| Unlisted us procedure (76999) |
— |
$250 |
— |
| Upper gi w/o kub (74240) |
— |
$534 |
— |
| Urethrocystogram voiding (74455) |
— |
$725 |
— |
Us breast unilateral complete (76641)
range across 5 matching MRF lines |
— |
$319–$338 |
— |
| Us chest (76604) |
— |
$319 |
— |
| Us complete joint (76881) |
— |
$352 |
— |
| Us exam, pelvic, limited (76857) |
— |
$576 |
— |
| Us head (76506) |
— |
$319 |
— |
Us lmtd joint/oth nonvasc xtr strux r-t w/img (76882)
range across 4 matching MRF lines |
— |
$224–$319.02 |
— |
| Us ob limited 1 or more fetuses (76815) |
— |
$319.02 |
— |
| Us ob transvaginal (76817) |
— |
$352 |
— |
| Us pelvic non ob complete (76856) |
— |
$694 |
— |
| Us retroperitoneal complete (76770) |
— |
$694 |
— |
| Us retroperitoneal limited (76775) |
— |
$694 |
— |
| Us scrotum and contents (76870) |
— |
$694 |
— |
| Us thyroid (76536) |
— |
$352 |
— |
| Venography extremity bilateral rs&i (75822) |
— |
$4,660 |
— |
| Venography extremity unilateral rs&i (75820) |
— |
$4,660 |
— |
Wrist 2 views (73100)
range across 2 matching MRF lines |
— |
$264–$264.15 |
— |
X-Ray Ac Jts - Xr Acromioclavicular Joints Bilateral (73050)
range across 4 matching MRF lines |
— |
$25–$264 |
— |
X-Ray Elbow 2 Vw - Xr Elbow 1-2 Views Right (73070)
range across 2 matching MRF lines |
— |
$264–$264.15 |
— |
| X-Ray Exam Breast Specimen (76098) |
— |
$1,645 |
— |
| X-Ray Exam Entire Spi 4/5 Vw (72083) |
— |
$319.02 |
— |
| X-Ray Exam Hip Uni 2-3 Views (73502) |
— |
$264.15 |
— |
| X-Ray Exam Hip Uni 4/> Views (73503) |
— |
$319.02 |
— |
| X-Ray Exam Hips Bi 2 Views (73521) |
— |
$319 |
— |
| X-Ray Exam Hips Bi 3-4 Views (73522) |
— |
$319.02 |
— |
| X-Ray Exam Hips Bi 5/> Views (73523) |
— |
$319 |
— |
| X-Ray Exam L-S Spine Bending (72114) |
— |
$268 |
— |
| X-Ray Exam Neck Spine 2-3 Vw (72040) |
— |
$264.15 |
— |
| X-Ray Exam Neck Spine 6/>Vws (72052) |
— |
$319 |
— |
X-Ray Exam Unilat Ribs/Chest (71101)
range across 3 matching MRF lines |
— |
$319–$319.02 |
— |
X-ray humerus (73060)
range across 3 matching MRF lines |
— |
$27–$264.15 |
— |
| X-ray IV pyelogram (ivp) (74400) |
— |
$534 |
— |
| X-Ray Jaw <4 Vw - Xr Mandible < 4 Views (70100) |
— |
$264.15 |
— |
| X-Ray Lumbar Spine 2/3 Vw - Xr Lumbar Spine 2-3 Views (72100) |
— |
$319.02 |
— |
| X-ray nose-rectum child f.b. (76010) |
— |
$264.15 |
— |
| X-Ray Ribs, Chest 4+ Vw - Xr Ribs 3 Vws Bil W/ Chest Posteroanterior (71111) |
— |
$319.02 |
— |
| X-Ray Sacroiliac Jts 3+ Vw - Xr Sacroiliac Joints 3+ Views (72202) |
— |
$319 |
— |
| X-Ray Sacroiliac Jts <3 Vw - Xr Sacroiliac Joints 1-2 Views (72200) |
— |
$27 |
— |
| X-Ray Sacrum/Coccyx 2+ Vw - Xr Sacrum Coccyx 2+ Views (72220) |
— |
$264.15 |
— |
| X-Ray Sinuses 3+ Vw - Xr Paranasal Sinuses 3+ Views (70220) |
— |
$264.15 |
— |
| X-Ray Skull 4+ Vw - Xr Skull Complete 4+ Views (70260) |
— |
$319.02 |
— |
| X-ray thoracic spine 4 vw (72074) |
— |
$319 |
— |
X-Ray Urinary Tract Exam With Contrast Material (74420)
range across 2 matching MRF lines |
— |
$47–$1,071 |
— |
| X-Rays Bone Length Studies (77073) |
— |
$300 |
— |
| X-Rays Bone Survey Complete (77075) |
— |
$398 |
— |
| Xr c-spine 4 or 5 views (72050) |
— |
$319.02 |
— |
| Xr facial bones less than 3 views (70140) |
— |
$264 |
— |
| Xr orbits complete 4 views (70200) |
— |
$319 |
— |