Abdomen 1 View (74018)
range across 4 matching MRF lines |
— |
$113–$230 |
— |
| Abdomen 2 views (74019) |
— |
$137 |
— |
| Acute Gastrointestinal Blood Loss Imaging (78278) |
— |
$827 |
— |
| Ankle 2 views (73600) |
— |
$105 |
— |
| Bone age studies (77072) |
— |
$105 |
— |
| Bone Imaging 3 Phase (78315) |
— |
$975 |
— |
| Bone Imaging Multiple Areas (78305) |
— |
$413 |
— |
Bone marrow imaging; whole body (78104)
range across 4 matching MRF lines |
— |
$756–$851 |
— |
| Bone survey infant (77076) |
— |
$144 |
— |
| Brain imaging < 4 static views (78600) |
— |
$295 |
— |
| Brain Imaging Min 4 Static Views W Vascular Flow (78606) |
— |
$721 |
— |
| Cardiac MRI w/w/o contrast & further seq (75561) |
— |
$4,725 |
— |
Cat Scan Follow-Up Study (76380)
range across 10 matching MRF lines |
— |
$434–$978 |
— |
Chest 1 view (71045)
range across 7 matching MRF lines |
— |
$64–$117 |
— |
| Chest 2 views (71046) |
— |
$137 |
— |
| Chest 3 views (71047) |
— |
$184 |
— |
| Chest 4 or more views (71048) |
— |
$210 |
— |
| Cholecystography Oral Contrast (74290) |
— |
$163 |
— |
| Clavicle complete (73000) |
— |
$112 |
— |
Computed Tomography Thorax Lw Dose Lng Ca Scr C- (71271)
range across 4 matching MRF lines |
— |
$315–$630 |
— |
| Contrast X-Ray Bladder (74430) |
— |
$541 |
— |
| Corpora cavernosography (74445) |
— |
$326 |
— |
CT abdomen and pelvis without and with contrast (74178)
range across 4 matching MRF lines |
— |
$2,100–$2,310 |
— |
| CT abdomen and pelvis without contrast (74176) |
— |
$1,470 |
— |
CT abdomen w contrast (74160)
range across 4 matching MRF lines |
— |
$721–$978 |
— |
CT abdomen w wo contrast (74170)
range across 8 matching MRF lines |
— |
$275.19–$1,470 |
— |
CT abdomen w/o contrast (74150)
range across 5 matching MRF lines |
— |
$673–$883 |
— |
| CT Angio Abdomen and Pelvis (74174) |
— |
$1,622 |
— |
| CT Angio Chest (71275) |
— |
$1,391 |
— |
| CT Angio Head (70496) |
— |
$1,932 |
— |
| CT angio hrt w/3d image (75574) |
— |
$1,155 |
— |
| Ct Angio Lwr Extr W/O&W/Dye (73706) |
— |
$1,449 |
— |
| CT Angio Neck (70498) |
— |
$1,928 |
— |
| Ct Angio Upr Extrm W/O&W/Dye (73206) |
— |
$1,449 |
— |
| CT bone density (77078) |
— |
$2,100 |
— |
| CT cervical spine w/ contrast (72126) |
— |
$1,108 |
— |
| CT cervical spine w/o contrast (72125) |
— |
$1,108 |
— |
| CT cervical spine w/wo cont (72127) |
— |
$1,077 |
— |
| CT chest w contrast (71260) |
— |
$978 |
— |
| CT chest w/wo contrast (71270) |
— |
$1,047 |
— |
| CT head/brain with contrast (70460) |
— |
$978 |
— |
| CT head/brain without and with contrast (70470) |
— |
$1,068 |
— |
| CT heart contrast eval cardiac structure&morph (75572) |
— |
$2,625 |
— |
| CT heart no contrast quant eval coronry calcium (75571) |
— |
$168 |
— |
| CT hrt w/3d image congen (75573) |
— |
$2,625 |
— |
CT iac w contrast (70481)
range across 8 matching MRF lines |
— |
$718–$1,062 |
— |
| CT l-spine w&w/o contrast (72133) |
— |
$1,103 |
— |
| CT lower ext w/o (73700) |
— |
$883 |
— |
| CT lower extremity w/contrast material (73701) |
— |
$928 |
— |
| CT lumbar spine w contrast (72132) |
— |
$1,108 |
— |
| CT lumbar spine w/o contrast (72131) |
— |
$860 |
— |
CT maxillofacial w contrast (70487)
range across 4 matching MRF lines |
— |
$840–$978 |
— |
CT maxillofacial wo contrast (70486)
range across 4 matching MRF lines |
— |
$860–$883 |
— |
CT neck tissue combo (70492)
range across 4 matching MRF lines |
— |
$768–$1,077 |
— |
Ct Orbit/Ear/Fossa W/O&W/Dye (70482)
range across 7 matching MRF lines |
— |
$852–$978 |
— |
CT orbits w/o contrast (70480)
range across 9 matching MRF lines |
— |
$837–$2,625 |
— |
| CT pelvis w&w/o contrast (72194) |
— |
$1,047 |
— |
| CT pelvis w/o contrast (72192) |
— |
$883 |
— |
| CT scan of leg combo (73702) |
— |
$1,062 |
— |
CT scans face/jaw combo (70488)
range across 4 matching MRF lines |
— |
$867–$945 |
— |
| CT soft tissue neck w contrast (70491) |
— |
$931 |
— |
CT soft tissue neck w/o contrast (70490)
range across 6 matching MRF lines |
— |
$650–$883 |
— |
| CT thoracic spine w contrast (72129) |
— |
$898 |
— |
| CT thoracic spine w/o contrast (72128) |
— |
$1,260 |
— |
| CT thoracic spine w/wo cont (72130) |
— |
$1,077 |
— |
| CT thorax w/o contrast (71250) |
— |
$883 |
— |
| CT upper ext wo (73200) |
— |
$883 |
— |
| CT upper extremity w/o & w/contrast material (73202) |
— |
$837 |
— |
| CT upper extremity with contrast (73201) |
— |
$900 |
— |
| Cta Abdl Aorta&Bi Iliofem W/Contrast&Postp (75635) |
— |
$1,554 |
— |
| Cta Abdomen (74175) |
— |
$1,441 |
— |
| CTA head&neck c+ w/noncontrast img&post-pxessing (70471) |
— |
$1,068 |
— |
| Diskography lumbar (72295) |
— |
$2,100 |
— |
| Dxa Bone Density Axial (77080) |
— |
$2,100 |
— |
| Dxa bone density study 1/>sites appendiclr skel (77081) |
— |
$2,100 |
— |
| Esophagram (74220) |
— |
$219 |
— |
| Fetal Biophys Profile W/Nst (76818) |
— |
$227 |
— |
Fluoroscopy up to 1 hr (76000)
range across 4 matching MRF lines |
— |
$194–$504 |
— |
| Foot 2 views (73620) |
— |
$105 |
— |
| Forearm 2 views (73090) |
— |
$105 |
— |
| Gastric emptying imaging study (78264) |
— |
$532 |
— |
Gated Heart Planar Single (78472)
range across 4 matching MRF lines |
— |
$319–$827 |
— |
| Hand 2 views (73120) |
— |
$105 |
— |
| Heart first pass single,planar (78481) |
— |
$650 |
— |
| Heart Image (Pet) Multiple (78492) |
— |
$2,100 |
— |
| Hepatobil Syst Image W/Drug (78227) |
— |
$2,495 |
— |
Hepatobiliary System Imaging (78226)
range across 7 matching MRF lines |
— |
$650–$992 |
— |
| Hysterosalpingogram (74740) |
— |
$585 |
— |
| Infusion Ivp (74410) |
— |
$273 |
— |
| K Flow/Funct Image W/O Drug (78707) |
— |
$1,050 |
— |
Liver imaging static only (78201)
range across 4 matching MRF lines |
— |
$368–$532 |
— |
| Liver imaging w/vascular flow (78202) |
— |
$354 |
— |
| Lung Perf&Ventilat Diferentl (78598) |
— |
$1,365 |
— |
Lung perfusion differential (78597)
range across 4 matching MRF lines |
— |
$839–$1,024 |
— |
Lung Ventilat&Perfus Imaging (78582)
range across 4 matching MRF lines |
— |
$630–$1,365 |
— |
| Lung Ventilation Imaging (78579) |
— |
$1,024 |
— |
| Lymph System Imaging (78195) |
— |
$577 |
— |
| Magnetic Image Jaw Joint (70336) |
— |
$3,150 |
— |
| Mammary ductogram or galactogram multiple (77054) |
— |
$315 |
— |
| Mammary ductogram or galactogram single (77053) |
— |
$263 |
— |
| Meckels Divert Exam (78290) |
— |
$827 |
— |
| Mra Head W/O & W/Contrast Material (70546) |
— |
$3,150 |
— |
| MRA head w/o contrast (70544) |
— |
$3,150 |
— |
| MRA head with contrast (70545) |
— |
$3,150 |
— |
| MRA neck w contrast (70548) |
— |
$3,150 |
— |
| Mra Neck W/O &W/Contrast Material (70549) |
— |
$3,150 |
— |
| MRA neck w/o contrast (70547) |
— |
$3,150 |
— |
| MRI abdomen w contrast (74182) |
— |
$3,150 |
— |
| MRI abdomen w/o contrast (74181) |
— |
$3,150 |
— |
| MRI any jt lower extrem w/contrast material (73722) |
— |
$3,150 |
— |
| MRI any jt lower extrem w/o & w/contrast matrl (73723) |
— |
$3,150 |
— |
| MRI any jt upper extremity w/contrast matrl (73222) |
— |
$3,150 |
— |
| MRI cardiac w/o contrast (75557) |
— |
$3,150 |
— |
| MRI cervical spine w contrast (72142) |
— |
$3,150 |
— |
| MRI cervical spine w/o cont (72141) |
— |
$3,150 |
— |
| MRI chest w/o contrast (71550) |
— |
$3,150 |
— |
| MRI chest with contrast (71551) |
— |
$3,150 |
— |
| MRI chest wo w contrast (71552) |
— |
$3,150 |
— |
| MRI lower extrem oth/thn jt w/o & w/contr matr (73720) |
— |
$3,150 |
— |
| MRI lower extrem oth/thn jt w/o contr matrl (73718) |
— |
$3,150 |
— |
| MRI lumbar spine w contrast (72149) |
— |
$3,150 |
— |
| Mri Neck Spine W/O & W/Dye (72156) |
— |
$3,150 |
— |
| MRI orbit face &/neck w/o contrast (70540) |
— |
$3,150 |
— |
| Mri Orbt/Fac/Nck W/O &W/Dye (70543) |
— |
$3,150 |
— |
| MRI pelvis w contrast (72196) |
— |
$3,150 |
— |
| MRI pelvis w/o & w contrast (72197) |
— |
$3,150 |
— |
| MRI pelvis w/o contrast (72195) |
— |
$3,150 |
— |
| MRI thoracic spine w/o contrast (72146) |
— |
$3,150 |
— |
| MRI upper extremity oth than jt w/o contr matrl (73218) |
— |
$3,150 |
— |
| Mri Uppr Extremity W/O&W/Dye (73220) |
— |
$3,150 |
— |
| MRI, abdomen, combo (74183) |
— |
$3,150 |
— |
| MRI, dorsal spine combo (72157) |
— |
$3,150 |
— |
| MRI, dorsal spine contrast (72147) |
— |
$3,150 |
— |
| MRI, joint upper extrem (73221) |
— |
$3,150 |
— |
| MRI, joint upper extrem combo (73223) |
— |
$3,150 |
— |
| MRI, lumbar spine combo (72158) |
— |
$3,150 |
— |
Musculoskeletal Nuclear Exam (78399)
range across 4 matching MRF lines |
— |
$368–$1,181 |
— |
| Myelograpy 2/more regions rs&i (72270) |
— |
$182 |
— |
| Myocardial Imaging Infarct Avid Planar Qual/Quan (78466) |
— |
$768 |
— |
| Myocardial Perfusion Planar 1 Study Rest/Stress (78453) |
— |
$768 |
— |
| Myocardial Spect Multiple Studies (78452) |
— |
$1,536 |
— |
| Neck soft tissue (70360) |
— |
$92 |
— |
| Nuclear medicine study of endocrine organs (78099) |
— |
$1,575 |
— |
| Nuclear Rx Oral Admin (79005) |
— |
$1,063 |
— |
| Ophthalmic Biometry US Echograpy a-Scan (76516) |
— |
$413 |
— |
| Optic foramina (70190) |
— |
$112 |
— |
| Parathyroid Planar Imaging (78070) |
— |
$525 |
— |
Pelvis 1 or 2 views (72170)
range across 4 matching MRF lines |
— |
$111–$138 |
— |
| Pulmonary Perfusion Imaging Particulate (78580) |
— |
$1,024 |
— |
| Radex Abd Compl Aqt Abd W/S/E/D Views 1 View Ch (74022) |
— |
$176 |
— |
| Radex abscess/fistula/sinus tract rs&i (76080) |
— |
$312 |
— |
| Radex Ankle Complete Minimum 3 Views (73610) |
— |
$116 |
— |
| Radex elbow complete minimum 3 views (73080) |
— |
$116 |
— |
| Radex Facial Bones Complete Minimum 3 Views (70150) |
— |
$176 |
— |
| Radex fingr minimum 2 views (73140) |
— |
$105 |
— |
| Radex foot complete minimum 3 views (73630) |
— |
$116 |
— |
| Radex Hand Minimum 3 Views (73130) |
— |
$116 |
— |
| Radex Mastoids Compl Minimum 3 Views PR Side (70130) |
— |
$216 |
— |
| Radex Nasal Bones Complete Minimum 3 Views (70160) |
— |
$112 |
— |
| Radex Ribs Unilateral 2 Views (71100) |
— |
$111 |
— |
| Radex shoulder complete minimum 2 views (73030) |
— |
$126 |
— |
| Radex Spine 1 View Specify Level (72020) |
— |
$109 |
— |
| Radex Sternum Minimum 2 Views (71120) |
— |
$112 |
— |
Radex Temporomandble Jt Opn & Clsd Mouth Bilat (70330)
range across 6 matching MRF lines |
— |
$115–$721 |
— |
| Radex Toe Minimum 2 Views (73660) |
— |
$105 |
— |
| Radex Wrist Complete Minimum 3 Views (73110) |
— |
$116 |
— |
| Radiolog exam mandible compl minimum 4 views (70110) |
— |
$176 |
— |
| Radiologic exam colon double contrast study (74280) |
— |
$325 |
— |
| Radiologic exam colon single contrast study (74270) |
— |
$233 |
— |
| Radiologic exam knee complete 4/more views (73564) |
— |
$127 |
— |
| Radiologic exam pelvis compl minimum 3 views (72190) |
— |
$210 |
— |
| Radiologic Exam Small Int Single Contrast Study (74250) |
— |
$233 |
— |
| Radiologic exam swallow function contrast study (74230) |
— |
$253 |
— |
| Radiologic exam upr gi trc double contrast study (74246) |
— |
$325 |
— |
| Radiologic examination femur minimum 2 views (73552) |
— |
$111 |
— |
Radiologic examination knee 1/2 views (73560)
range across 6 matching MRF lines |
— |
$116–$120 |
— |
| Radiologic Examination Osseous Survey Limited (77074) |
— |
$325 |
— |
| Radiologic examination tibia & fibula 2 views (73590) |
— |
$111 |
— |
| Radiologic examination, internal auditory meati, complete Non-Facility (70134) |
— |
$177 |
— |
| Red Cell Volume Determination Spx 1 Sampling (78120) |
— |
$851 |
— |
| Ribs bilateral 3 views (71110) |
— |
$219 |
— |
| Rp loclzj tum plnr 1 area single day imaging (78800) |
— |
$1,260 |
— |
| Rp loclzj tum plnr 2+area 1+d img/1 area img>2+d (78801) |
— |
$2,100 |
— |
| Rp Loclzj Tum Spect 1 Area Single Day Imaging (78803) |
— |
$541 |
— |
| Rp loclzj tum spect CT 2area 1d img/1 ar img>2+d (78832) |
— |
$2,212 |
— |
Scapula (73010)
range across 4 matching MRF lines |
— |
$111–$112 |
— |
Screening Digital Breast Tomosynthesis Bi (77063)
range across 4 matching MRF lines |
— |
$105–$315 |
— |
| Sella turcica (70240) |
— |
$112 |
— |
| Shoulder 1 view (73020) |
— |
$105 |
— |
| Skull less than 4 views (70250) |
— |
$299 |
— |
| Spleen Imaging (78185) |
— |
$532 |
— |
| Sternoclavicular joints (71130) |
— |
$135 |
— |
| Testicular Imaging W/Flow (78761) |
— |
$1,181 |
— |
| Thoracic spine 2 views (72070) |
— |
$110 |
— |
| Thoracic spine 3 views (72072) |
— |
$123 |
— |
| Thyroid Uptake Measurement (78012) |
— |
$551 |
— |
Ultrasound Breast Limited (76642)
range across 5 matching MRF lines |
— |
$150–$210 |
— |
Ultrasound, abdomen limited (76705)
range across 11 matching MRF lines |
— |
$230–$525 |
— |
| Unlisted genitourinary px dx nuclear medicine (78799) |
— |
$827 |
— |
| Urethrocystogram voiding (74455) |
— |
$325 |
— |
| Urethrocystography retrograde (74450) |
— |
$325 |
— |
Us breast unilateral complete (76641)
range across 6 matching MRF lines |
— |
$230–$507 |
— |
Us chest (76604)
range across 6 matching MRF lines |
— |
$127–$320 |
— |
| Us complete joint (76881) |
— |
$282 |
— |
Us exam, pelvic, limited (76857)
range across 4 matching MRF lines |
— |
$272–$273 |
— |
Us lmtd joint/oth nonvasc xtr strux r-t w/img (76882)
range across 4 matching MRF lines |
— |
$210–$273 |
— |
| Us ob limited 1 or more fetuses (76815) |
— |
$298 |
— |
| Us ob transvaginal (76817) |
— |
$525 |
— |
| Us pelvic non ob complete (76856) |
— |
$525 |
— |
| Us retroperitoneal complete (76770) |
— |
$1,234 |
— |
Us retroperitoneal limited (76775)
range across 7 matching MRF lines |
— |
$202–$343 |
— |
Us scrotum and contents (76870)
range across 4 matching MRF lines |
— |
$176–$369 |
— |
| Us spinal canal and contents (76800) |
— |
$256 |
— |
Us thyroid (76536)
range across 6 matching MRF lines |
— |
$177–$520 |
— |
Us transrectal (76872)
range across 4 matching MRF lines |
— |
$274–$496 |
— |
Vascular Flow Imaging (78445)
range across 4 matching MRF lines |
— |
$721–$732 |
— |
| Wrist 2 views (73100) |
— |
$105 |
— |
| X-Ray Ac Jts - Xr Acromioclavicular Joints Bilateral (73050) |
— |
$128 |
— |
| X-ray antegrade pyelogram tube (74425) |
— |
$315 |
— |
| X-Ray Aorta Leg Arteries (75630) |
— |
$2,100 |
— |
| X-Ray Elbow 2 Vw - Xr Elbow 1-2 Views Right (73070) |
— |
$105 |
— |
X-Ray Exam Breast Specimen (76098)
range across 4 matching MRF lines |
— |
$446–$488 |
— |
| X-Ray Exam Entire Spi 2/3 Vw (72082) |
— |
$315 |
— |
X-Ray Exam Hip Uni 1 View (73501)
range across 10 matching MRF lines |
— |
$105–$945 |
— |
| X-Ray Exam Hip Uni 2-3 Views (73502) |
— |
$116 |
— |
X-Ray Exam Hips Bi 2 Views (73521)
range across 4 matching MRF lines |
— |
$116–$231 |
— |
| X-Ray Exam Neck Spine 2-3 Vw (72040) |
— |
$123 |
— |
| X-Ray Exam Neck Spine 6/>Vws (72052) |
— |
$213 |
— |
| X-ray eye for foreign body (70030) |
— |
$219 |
— |
| X-ray humerus (73060) |
— |
$116 |
— |
| X-ray IV pyelogram (ivp) (74400) |
— |
$246 |
— |
| X-ray IV pyelogram+tomography (74415) |
— |
$325 |
— |
X-Ray Lumbar Spine 2/3 Vw - Xr Lumbar Spine 2-3 Views (72100)
range across 4 matching MRF lines |
— |
$110–$123 |
— |
| X-Ray Sacroiliac Jts <3 Vw - Xr Sacroiliac Joints 1-2 Views (72200) |
— |
$149 |
— |
X-Ray Sacrum/Coccyx 2+ Vw - Xr Sacrum Coccyx 2+ Views (72220)
range across 4 matching MRF lines |
— |
$112–$3,150 |
— |
| X-Ray Sinuses 3+ Vw - Xr Paranasal Sinuses 3+ Views (70220) |
— |
$176 |
— |
| X-Ray Skull 4+ Vw - Xr Skull Complete 4+ Views (70260) |
— |
$142 |
— |
X-Ray Tmj Unilat (70328)
range across 5 matching MRF lines |
— |
$83–$673 |
— |
X-Ray Urinary Tract Exam With Contrast Material (74420)
range across 4 matching MRF lines |
— |
$210–$257 |
— |
| Xr c-spine 4 or 5 views (72050) |
— |
$135 |
— |
| XR Mastoids < 3 Views Bilateral (70120) |
— |
$198 |
— |
| Xr orbits complete 4 views (70200) |
— |
$149 |
— |