| Abdomen 1 View (74018) |
— |
$175 |
— |
| Abdomen 2 views (74019) |
— |
$218 |
— |
| Bone age studies (77072) |
— |
$150 |
— |
| Chest 1 view (71045) |
— |
$100 |
— |
| Chest 2 views (71046) |
— |
$150 |
— |
| Chest 3 views (71047) |
— |
$162.75 |
— |
| Chest 4 or more views (71048) |
— |
$174.50 |
— |
Clavicle complete (73000)
range across 3 matching MRF lines |
— |
$163.33–$653.32 |
— |
| CT abdomen and pelvis without and with contrast (74178) |
— |
$2,400.50 |
— |
| CT abdomen and pelvis without contrast (74176) |
— |
$2,072.50 |
— |
| CT abdomen w contrast (74160) |
— |
$1,450 |
— |
| CT abdomen w wo contrast (74170) |
— |
$1,550 |
— |
| CT abdomen w/o contrast (74150) |
— |
$1,100 |
— |
| CT Angio Abdomen and Pelvis (74174) |
— |
$1,878 |
— |
| CT Angio Chest (71275) |
— |
$1,450 |
— |
| CT Angio Head (70496) |
— |
$1,746 |
— |
Ct Angio Lwr Extr W/O&W/Dye (73706)
range across 3 matching MRF lines |
— |
$1,400–$5,600 |
— |
| CT Angio Neck (70498) |
— |
$1,863.50 |
— |
| Ct Angio Upr Extrm W/O&W/Dye (73206) |
— |
$1,668.50 |
— |
| CT cervical spine w/ contrast (72126) |
— |
$1,350 |
— |
| CT cervical spine w/o contrast (72125) |
— |
$1,250 |
— |
| CT cervical spine w/wo cont (72127) |
— |
$1,322 |
— |
| CT chest w contrast (71260) |
— |
$1,450 |
— |
| CT head/brain with contrast (70460) |
— |
$1,279.43 |
— |
| CT head/brain without and with contrast (70470) |
— |
$1,400 |
— |
| CT heart no contrast quant eval coronry calcium (75571) |
— |
$99 |
— |
| CT iac w contrast (70481) |
— |
$1,142 |
— |
| CT lower ext w/o (73700) |
— |
$589 |
— |
| CT lower extremity w/contrast material (73701) |
— |
$1,200 |
— |
| CT lumbar spine w/o contrast (72131) |
— |
$991.50 |
— |
| CT maxillofacial w contrast (70487) |
— |
$1,150 |
— |
| CT maxillofacial wo contrast (70486) |
— |
$875 |
— |
| CT orbits w/o contrast (70480) |
— |
$1,142 |
— |
| CT pelvis w&w/o contrast (72194) |
— |
$1,500 |
— |
| CT pelvis w/o contrast (72192) |
— |
$1,000.39 |
— |
| CT soft tissue neck w contrast (70491) |
— |
$1,252.39 |
— |
| CT soft tissue neck w/o contrast (70490) |
— |
$859.79 |
— |
| CT thoracic spine w/o contrast (72128) |
— |
$991.50 |
— |
| CT thorax w/o contrast (71250) |
— |
$1,021.50 |
— |
CT upper ext wo (73200)
range across 3 matching MRF lines |
— |
$513.71–$2,054.84 |
— |
| CT upper extremity with contrast (73201) |
— |
$784 |
— |
| Cta Abdl Aorta&Bi Iliofem W/Contrast&Postp (75635) |
— |
$1,750 |
— |
| Cta Abdomen (74175) |
— |
$1,650 |
— |
Forearm 2 views (73090)
range across 3 matching MRF lines |
— |
$150–$600 |
— |
Knee 3 Views (73562)
range across 3 matching MRF lines |
— |
$200–$800 |
— |
| Neck soft tissue (70360) |
— |
$150 |
— |
Pelvis 1 or 2 views (72170)
range across 3 matching MRF lines |
— |
$150–$600 |
— |
Radex Ankle Complete Minimum 3 Views (73610)
range across 3 matching MRF lines |
— |
$200–$800 |
— |
| Radex Calcaneus Minimum 2 Views (73650) |
— |
$200 |
— |
| Radex Facial Bones Complete Minimum 3 Views (70150) |
— |
$239.35 |
— |
Radex fingr minimum 2 views (73140)
range across 3 matching MRF lines |
— |
$150–$600 |
— |
Radex foot complete minimum 3 views (73630)
range across 3 matching MRF lines |
— |
$200–$800 |
— |
Radex Hand Minimum 3 Views (73130)
range across 3 matching MRF lines |
— |
$150–$600 |
— |
| Radex Nasal Bones Complete Minimum 3 Views (70160) |
— |
$174.20 |
— |
| Radex Ribs Unilateral 2 Views (71100) |
— |
$175 |
— |
Radex shoulder complete minimum 2 views (73030)
range across 3 matching MRF lines |
— |
$175–$700 |
— |
| Radex Spine 1 View Specify Level (72020) |
— |
$185 |
— |
| Radex Toe Minimum 2 Views (73660) |
— |
$200 |
— |
Radex Wrist Complete Minimum 3 Views (73110)
range across 3 matching MRF lines |
— |
$150–$600 |
— |
| Radiolog exam mandible compl minimum 4 views (70110) |
— |
$208.64 |
— |
| Radiologic exam knee complete 4/more views (73564) |
— |
$250 |
— |
Radiologic examination femur minimum 2 views (73552)
range across 3 matching MRF lines |
— |
$200–$800 |
— |
Radiologic examination knee 1/2 views (73560)
range across 3 matching MRF lines |
— |
$200–$800 |
— |
| Radiologic Examination Osseous Survey Limited (77074) |
— |
$386 |
— |
Radiologic examination tibia & fibula 2 views (73590)
range across 3 matching MRF lines |
— |
$200–$800 |
— |
| Ribs bilateral 3 views (71110) |
— |
$275 |
— |
| Scapula (73010) |
— |
$175 |
— |
| Shoulder 1 view (73020) |
— |
$91.93 |
— |
| Thoracic spine 2 views (72070) |
— |
$230 |
— |
| Thoracic spine 3 views (72072) |
— |
$230 |
— |
| Ultrasound Elastography Parenchyma (76981) |
— |
$178 |
— |
| Ultrasound, abdomen limited (76705) |
— |
$375 |
— |
| Us chest (76604) |
— |
$223 |
— |
| Us complete joint (76881) |
— |
$279.47 |
— |
| Us exam, pelvic, limited (76857) |
— |
$245 |
— |
| Us lmtd joint/oth nonvasc xtr strux r-t w/img (76882) |
— |
$250 |
— |
| Us ob transvaginal (76817) |
— |
$350 |
— |
| Us pelvic non ob complete (76856) |
— |
$372.50 |
— |
| Us pg uter img f&mat 14 wk tabdl 1/1st gestation (76801) |
— |
$350 |
— |
| Us preg uterus real time f/u trnsabdl per fetus (76816) |
— |
$236.72 |
— |
| Us retroperitoneal complete (76770) |
— |
$550 |
— |
| Us retroperitoneal limited (76775) |
— |
$450 |
— |
| Us scrotum and contents (76870) |
— |
$255 |
— |
| Us thyroid (76536) |
— |
$350 |
— |
X-Ray Elbow 2 Vw - Xr Elbow 1-2 Views Right (73070)
range across 3 matching MRF lines |
— |
$150–$600 |
— |
| X-Ray Exam Entire Spi 2/3 Vw (72082) |
— |
$275 |
— |
| X-Ray Exam Hip Uni 2-3 Views (73502) |
— |
$200 |
— |
| X-Ray Exam Hips Bi 2 Views (73521) |
— |
$250 |
— |
| X-Ray Exam L-S Spine Bending (72114) |
— |
$223 |
— |
| X-Ray Exam Neck Spine 2-3 Vw (72040) |
— |
$275 |
— |
| X-Ray Exam Neck Spine 6/>Vws (72052) |
— |
$297.41 |
— |
X-ray humerus (73060)
range across 3 matching MRF lines |
— |
$150–$600 |
— |
| X-ray IV pyelogram (ivp) (74400) |
— |
$450 |
— |
| X-Ray Knee Bilat Standing - Xr Knees Anteroposterior Standing Bilat (73565) |
— |
$185 |
— |
| X-Ray Lumbar Spine 2/3 Vw - Xr Lumbar Spine 2-3 Views (72100) |
— |
$223 |
— |
| X-ray nose-rectum child f.b. (76010) |
— |
$118.91 |
— |
| X-Ray Sacroiliac Jts 3+ Vw - Xr Sacroiliac Joints 3+ Views (72202) |
— |
$228 |
— |
| X-Ray Sacroiliac Jts <3 Vw - Xr Sacroiliac Joints 1-2 Views (72200) |
— |
$191 |
— |
| X-Ray Sacrum/Coccyx 2+ Vw - Xr Sacrum Coccyx 2+ Views (72220) |
— |
$168.84 |
— |
| X-Ray Sinuses 3+ Vw - Xr Paranasal Sinuses 3+ Views (70220) |
— |
$250 |
— |
| X-Ray Skull 4+ Vw - Xr Skull Complete 4+ Views (70260) |
— |
$266 |
— |
| X-Rays Bone Length Studies (77073) |
— |
$332.50 |
— |
| X-Rays Bone Survey Complete (77075) |
— |
$288.75 |
— |
| Xr c-spine 4 or 5 views (72050) |
— |
$275 |
— |