| Abdomen 1 View (74018) |
— |
$366 |
— |
| Abdomen 2 views (74019) |
— |
$688 |
— |
| Acute Gastrointestinal Blood Loss Imaging (78278) |
— |
$1,204 |
— |
| Angiography extremity unilateral rs&i (75710) |
— |
$223 |
— |
Ankle 2 views (73600)
range across 3 matching MRF lines |
— |
$317–$353 |
— |
| Arthrogram hip (73525) |
— |
$1,277 |
— |
| Bone age studies (77072) |
— |
$380 |
— |
| Bone Imaging 3 Phase (78315) |
— |
$1,574 |
— |
| Bone Imaging Limited Area (78300) |
— |
$1,229 |
— |
| Bone Imaging Multiple Areas (78305) |
— |
$1,138 |
— |
| Bone Imaging Whole Body (78306) |
— |
$1,363 |
— |
| Bone marrow imaging limited area (78102) |
— |
$1,199 |
— |
| Bone survey infant (77076) |
— |
$809 |
— |
| Brain Image W/Flow < 4 Views (78601) |
— |
$1,960 |
— |
| Cat Scan Follow-Up Study (76380) |
— |
$1,158 |
— |
| Chest 1 view (71045) |
— |
$259 |
— |
| Chest 2 views (71046) |
— |
$359 |
— |
| Chest 3 views (71047) |
— |
$355 |
— |
| Chest 4 or more views (71048) |
— |
$324 |
— |
| Cholecystography Oral Contrast (74290) |
— |
$355 |
— |
| Clavicle complete (73000) |
— |
$406 |
— |
| Computed Tomography Thorax Lw Dose Lng Ca Scr C- (71271) |
— |
$586 |
— |
| Contrast X-Ray Bladder (74430) |
— |
$897 |
— |
| Contrast X-Ray Of Elbow (73085) |
— |
$1,277 |
— |
| Contrast X-Ray Of Knee Joint (73580) |
— |
$1,277 |
— |
| CT abdomen and pelvis without and with contrast (74178) |
— |
$7,282 |
— |
| CT abdomen and pelvis without contrast (74176) |
— |
$5,312 |
— |
| CT abdomen w contrast (74160) |
— |
$2,852 |
— |
| CT abdomen w wo contrast (74170) |
— |
$3,940 |
— |
| CT abdomen w/o contrast (74150) |
— |
$2,520 |
— |
| CT Angio Abdomen and Pelvis (74174) |
— |
$3,046 |
— |
| CT Angio Chest (71275) |
— |
$3,187 |
— |
| CT Angio Head (70496) |
— |
$2,912 |
— |
| Ct Angio Lwr Extr W/O&W/Dye (73706) |
— |
$2,906 |
— |
| CT Angio Neck (70498) |
— |
$2,777 |
— |
| Ct Angio Upr Extrm W/O&W/Dye (73206) |
— |
$3,088 |
— |
| CT cervical spine w/ contrast (72126) |
— |
$2,381 |
— |
| CT cervical spine w/o contrast (72125) |
— |
$2,460 |
— |
| CT cervical spine w/wo cont (72127) |
— |
$2,759 |
— |
| CT chest w contrast (71260) |
— |
$3,150 |
— |
| CT chest w/wo contrast (71270) |
— |
$3,445 |
— |
| CT head/brain with contrast (70460) |
— |
$2,133 |
— |
| CT head/brain without and with contrast (70470) |
— |
$3,141 |
— |
| CT iac w contrast (70481) |
— |
$2,249 |
— |
| CT l-spine w&w/o contrast (72133) |
— |
$2,906 |
— |
| CT lower ext w/o (73700) |
— |
$2,155 |
— |
CT lower extremity w/contrast material (73701)
range across 3 matching MRF lines |
— |
$2,381–$2,606 |
— |
| CT lumbar spine w contrast (72132) |
— |
$2,155 |
— |
| CT lumbar spine w/o contrast (72131) |
— |
$2,557 |
— |
CT maxillofacial w contrast (70487)
range across 3 matching MRF lines |
— |
$2,249–$2,333 |
— |
CT maxillofacial wo contrast (70486)
range across 3 matching MRF lines |
— |
$1,815–$2,209 |
— |
| CT neck tissue combo (70492) |
— |
$2,608 |
— |
| Ct Orbit/Ear/Fossa W/O&W/Dye (70482) |
— |
$2,906 |
— |
| CT orbits w/o contrast (70480) |
— |
$1,815 |
— |
| CT pelvis w&w/o contrast (72194) |
— |
$3,048 |
— |
| CT pelvis w/o contrast (72192) |
— |
$2,042 |
— |
| CT scan of leg combo (73702) |
— |
$2,901 |
— |
| CT scans face/jaw combo (70488) |
— |
$2,281 |
— |
| CT soft tissue neck w contrast (70491) |
— |
$2,606 |
— |
| CT soft tissue neck w/o contrast (70490) |
— |
$1,928 |
— |
| CT thoracic spine w contrast (72129) |
— |
$2,044 |
— |
| CT thoracic spine w/o contrast (72128) |
— |
$2,333 |
— |
| CT thoracic spine w/wo cont (72130) |
— |
$2,759 |
— |
| CT thorax w/o contrast (71250) |
— |
$2,245 |
— |
| CT upper ext wo (73200) |
— |
$2,841 |
— |
CT upper extremity w/o & w/contrast material (73202)
range across 3 matching MRF lines |
— |
$2,629–$2,906 |
— |
CT upper extremity with contrast (73201)
range across 3 matching MRF lines |
— |
$2,155–$2,381 |
— |
| Cta Abdl Aorta&Bi Iliofem W/Contrast&Postp (75635) |
— |
$3,502 |
— |
| Cta Abdomen (74175) |
— |
$2,793 |
— |
| CTA pelvis (72191) |
— |
$3,066 |
— |
| Discography Cerv/Thor Spine (72285) |
— |
$5,077 |
— |
| Diskography lumbar (72295) |
— |
$5,077 |
— |
| Dxa Bone Density Axial (77080) |
— |
$788 |
— |
| Esophagram (74220) |
— |
$776 |
— |
| Fetal Biophys Profile W/Nst (76818) |
— |
$755 |
— |
| Fetal Biophysical Profile W/O Non-Stress Testing (76819) |
— |
$755 |
— |
| Fluoroscopy up to 1 hr (76000) |
— |
$666 |
— |
| Foot 2 views (73620) |
— |
$406 |
— |
| Forearm 2 views (73090) |
— |
$491 |
— |
| Gastric emptying imaging study (78264) |
— |
$1,075 |
— |
| Gastroesophageal Reflux Exam (78262) |
— |
$1,098 |
— |
| Gated Heart Planar Single (78472) |
— |
$1,323 |
— |
| Gated Heart, Multiple (78473) |
— |
$1,323 |
— |
Hand 2 views (73120)
range across 3 matching MRF lines |
— |
$383–$406 |
— |
| Heart first pass single,planar (78481) |
— |
$1,323 |
— |
| Hepatobil Syst Image W/Drug (78227) |
— |
$1,474 |
— |
| Hepatobiliary System Imaging (78226) |
— |
$1,216 |
— |
| Ht Muscle Image Spect Sing (78451) |
— |
$3,805 |
— |
| Hysterosalpingogram (74740) |
— |
$1,199 |
— |
| Infusion Ivp (74410) |
— |
$897 |
— |
| K Flow/Funct Image Multiple (78709) |
— |
$1,631 |
— |
| K Flow/Funct Image W/Drug (78708) |
— |
$1,427 |
— |
| K Flow/Funct Image W/O Drug (78707) |
— |
$1,427 |
— |
| Kidney Funcj Study Non-Img Radioisotopic Study (78725) |
— |
$842 |
— |
| Kidney Imaging Morphol (78700) |
— |
$1,427 |
— |
| Knee 3 Views (73562) |
— |
$539 |
— |
| Liver & Spleen Imaging Static Only (78215) |
— |
$1,343 |
— |
| Liver & Spleen Imaging W/Vascular Flow (78216) |
— |
$1,343 |
— |
| Liver imaging w/vascular flow (78202) |
— |
$1,343 |
— |
| Lung Perf&Ventilat Diferentl (78598) |
— |
$1,437 |
— |
| Lung Ventilat&Perfus Imaging (78582) |
— |
$1,302 |
— |
| Lung Ventilation Imaging (78579) |
— |
$494 |
— |
| Lymph System Imaging (78195) |
— |
$1,874 |
— |
| Magnetic Image Jaw Joint (70336) |
— |
$4,537 |
— |
| Mammary ductogram or galactogram multiple (77054) |
— |
$1,094 |
— |
| Mammary ductogram or galactogram single (77053) |
— |
$1,094 |
— |
| Meckels Divert Exam (78290) |
— |
$1,098 |
— |
| Mra Head W/O & W/Contrast Material (70546) |
— |
$5,217 |
— |
| MRA head w/o contrast (70544) |
— |
$4,968 |
— |
| MRA head with contrast (70545) |
— |
$4,988 |
— |
| MRA neck w contrast (70548) |
— |
$4,988 |
— |
| Mra Neck W/O &W/Contrast Material (70549) |
— |
$6,021 |
— |
| MRA neck w/o contrast (70547) |
— |
$4,309 |
— |
| MRI abdomen w/o contrast (74181) |
— |
$4,710 |
— |
| MRI any jt lower extrem w/contrast material (73722) |
— |
$5,057 |
— |
| MRI any jt lower extrem w/o & w/contrast matrl (73723) |
— |
$5,375 |
— |
| MRI any jt upper extremity w/contrast matrl (73222) |
— |
$4,954 |
— |
| MRI bone marrow blood supply (77084) |
— |
$4,537 |
— |
| MRI cardiac w/o contrast (75557) |
— |
$5,065 |
— |
| MRI cervical spine w contrast (72142) |
— |
$4,988 |
— |
| MRI cervical spine w/o cont (72141) |
— |
$5,115 |
— |
| MRI chest w/o contrast (71550) |
— |
$4,537 |
— |
| MRI chest wo w contrast (71552) |
— |
$5,569 |
— |
MRI lower extrem oth/thn jt w/o & w/contr matr (73720)
range across 3 matching MRF lines |
— |
$6,021–$6,592 |
— |
MRI lower extrem oth/thn jt w/o contr matrl (73718)
range across 3 matching MRF lines |
— |
$4,303–$4,710 |
— |
| MRI lumbar spine w contrast (72149) |
— |
$5,464 |
— |
| Mri Neck Spine W/O & W/Dye (72156) |
— |
$6,592 |
— |
| MRI orbit face &/neck w/o contrast (70540) |
— |
$4,303 |
— |
| Mri Orbt/Fac/Nck W/O &W/Dye (70543) |
— |
$5,713 |
— |
| MRI pelvis w/o & w contrast (72197) |
— |
$4,948 |
— |
| MRI pelvis w/o contrast (72195) |
— |
$4,710 |
— |
| MRI thoracic spine w/o contrast (72146) |
— |
$5,115 |
— |
| MRI upper extremity oth than jt w/o contr matrl (73218) |
— |
$4,710 |
— |
| Mri Uppr Extremity W/O&W/Dye (73220) |
— |
$4,721 |
— |
| MRI, abdomen, combo (74183) |
— |
$4,473 |
— |
| MRI, dorsal spine combo (72157) |
— |
$6,592 |
— |
| MRI, dorsal spine contrast (72147) |
— |
$4,988 |
— |
MRI, joint upper extrem (73221)
range across 4 matching MRF lines |
— |
$5,115–$5,233 |
— |
MRI, joint upper extrem combo (73223)
range across 3 matching MRF lines |
— |
$5,445–$6,021 |
— |
| MRI, lumbar spine combo (72158) |
— |
$6,592 |
— |
| Myelogram cervical (72240) |
— |
$2,169 |
— |
| Myelogram Lumbar (72265) |
— |
$2,169 |
— |
| Myelography thoracic (72255) |
— |
$2,169 |
— |
| Myocardial Imaging Infarct Avid Planar Qual/Quan (78466) |
— |
$1,323 |
— |
| Myocardial Spect Multiple Studies (78452) |
— |
$4,991 |
— |
| Neck soft tissue (70360) |
— |
$410 |
— |
| Nm myocard infarct spect (78469) |
— |
$1,425 |
— |
| Parathyroid Planar Imaging (78070) |
— |
$996 |
— |
| Parathyroid planar imaging w/wo subtraction (78071) |
— |
$3,008 |
— |
| Pelvis 1 or 2 views (72170) |
— |
$442 |
— |
| Pulmonary Perfusion Imaging Particulate (78580) |
— |
$925 |
— |
| Radex Abd Compl Aqt Abd W/S/E/D Views 1 View Ch (74022) |
— |
$457 |
— |
| Radex abscess/fistula/sinus tract rs&i (76080) |
— |
$1,094 |
— |
| Radex Ankle Complete Minimum 3 Views (73610) |
— |
$491 |
— |
Radex Calcaneus Minimum 2 Views (73650)
range across 3 matching MRF lines |
— |
$406–$453 |
— |
| Radex elbow complete minimum 3 views (73080) |
— |
$491 |
— |
| Radex Facial Bones Complete Minimum 3 Views (70150) |
— |
$520 |
— |
Radex fingr minimum 2 views (73140)
range across 12 matching MRF lines |
— |
$390–$491 |
— |
| Radex foot complete minimum 3 views (73630) |
— |
$491 |
— |
| Radex Hand Minimum 3 Views (73130) |
— |
$491 |
— |
| Radex lower extremity infant minimum 2 views (73592) |
— |
$288 |
— |
| Radex Mastoids Compl Minimum 3 Views PR Side (70130) |
— |
$489 |
— |
| Radex Nasal Bones Complete Minimum 3 Views (70160) |
— |
$520 |
— |
| Radex Ribs Unilateral 2 Views (71100) |
— |
$533 |
— |
| Radex shoulder complete minimum 2 views (73030) |
— |
$491 |
— |
| Radex sm int w/mlt srl imges via enteroclss tube (74251) |
— |
$680 |
— |
| Radex Spine 1 View Specify Level (72020) |
— |
$345 |
— |
| Radex Sternum Minimum 2 Views (71120) |
— |
$419 |
— |
| Radex Temporomandble Jt Opn & Clsd Mouth Bilat (70330) |
— |
$476 |
— |
Radex Toe Minimum 2 Views (73660)
range across 12 matching MRF lines |
— |
$390–$453 |
— |
| Radex upper extremity infant minimum 2 views (73092) |
— |
$331 |
— |
| Radex Wrist Complete Minimum 3 Views (73110) |
— |
$526 |
— |
| Radiolog exam mandible compl minimum 4 views (70110) |
— |
$456 |
— |
| Radiologic Exam Abdomen 3+ Views - Xr Abdomen 3+ Views (74021) |
— |
$457 |
— |
| Radiologic exam colon double contrast study (74280) |
— |
$1,119 |
— |
| Radiologic exam colon single contrast study (74270) |
— |
$781 |
— |
| Radiologic Exam Esophagus Double Contrast Study (74221) |
— |
$781 |
— |
| Radiologic exam knee complete 4/more views (73564) |
— |
$491 |
— |
| Radiologic exam pelvis compl minimum 3 views (72190) |
— |
$491 |
— |
| Radiologic Exam Small Int Single Contrast Study (74250) |
— |
$680 |
— |
| Radiologic exam swallow function contrast study (74230) |
— |
$642 |
— |
| Radiologic exam upr gi trc double contrast study (74246) |
— |
$978 |
— |
| Radiologic examination femur 1 view (73551) |
— |
$264 |
— |
| Radiologic examination femur minimum 2 views (73552) |
— |
$406 |
— |
| Radiologic examination knee 1/2 views (73560) |
— |
$443 |
— |
| Radiologic Examination Salivary Gland Calculus (70380) |
— |
$456 |
— |
Radiologic examination tibia & fibula 2 views (73590)
range across 4 matching MRF lines |
— |
$390–$491 |
— |
| Ribs bilateral 3 views (71110) |
— |
$539 |
— |
| Rp loclzj tum plnr 1 area single day imaging (78800) |
— |
$1,286 |
— |
| Rp loclzj tum plnr 2+area 1+d img/1 area img>2+d (78801) |
— |
$2,148 |
— |
| Rp Loclzj Tum Plnr Whole Body Single Day Imaging (78802) |
— |
$2,148 |
— |
| Rp Loclzj Tum Spect 1 Area Single Day Imaging (78803) |
— |
$2,148 |
— |
| Salivary Gland Function Study (78232) |
— |
$1,098 |
— |
| Salivary Gland Imaging Serial Images (78231) |
— |
$1,098 |
— |
| Scapula (73010) |
— |
$383 |
— |
| Screening Digital Breast Tomosynthesis Bi (77063) |
— |
$117 |
— |
| Sella turcica (70240) |
— |
$387 |
— |
Shoulder 1 view (73020)
range across 3 matching MRF lines |
— |
$270–$284 |
— |
| Shoulder Arthrography (73040) |
— |
$1,277 |
— |
| Sialogram (70390) |
— |
$1,095 |
— |
| Skull less than 4 views (70250) |
— |
$495 |
— |
| Sternoclavicular joints (71130) |
— |
$456 |
— |
| Testicular Imaging W/Flow (78761) |
— |
$1,427 |
— |
| Thoracic spine 2 views (72070) |
— |
$505 |
— |
| Thoracic spine 3 views (72072) |
— |
$666 |
— |
| Thoracolumbar 2 views (72080) |
— |
$492 |
— |
| Thyroid Carcinoma Metastases Img Lmtd Area (78015) |
— |
$1,027 |
— |
| Thyroid Met Imaging Body (78018) |
— |
$1,436 |
— |
| Thyroid Uptake Measurement (78012) |
— |
$1,676 |
— |
| Thyroid Uptake W/Blood Flow Sngle/Mult Quan Meas (78014) |
— |
$1,676 |
— |
| Ultrasound Breast Limited (76642) |
— |
$1,370 |
— |
| Ultrasound Exam Aaa Screen (76706) |
— |
$529 |
— |
| Ultrasound, abdomen limited (76705) |
— |
$989 |
— |
| Unlisted Dx Radiographic Procedure (76499) |
— |
$657 |
— |
| Unlisted Miscellaneous Px Dx Nuclear Medicine (78999) |
— |
$1,231 |
— |
| Upper gi w/o kub (74240) |
— |
$781 |
— |
| Ureteral Reflux Study (78740) |
— |
$1,427 |
— |
| Urethrocystogram voiding (74455) |
— |
$811 |
— |
| Urethrocystography retrograde (74450) |
— |
$811 |
— |
Us breast unilateral complete (76641)
range across 3 matching MRF lines |
— |
$884–$1,370 |
— |
| Us chest (76604) |
— |
$715 |
— |
| Us complete joint (76881) |
— |
$884 |
— |
| Us exam, pelvic, limited (76857) |
— |
$350 |
— |
| Us head (76506) |
— |
$456 |
— |
| Us lmtd joint/oth nonvasc xtr strux r-t w/img (76882) |
— |
$968 |
— |
| Us ob limited 1 or more fetuses (76815) |
— |
$345 |
— |
| Us ob transvaginal (76817) |
— |
$715 |
— |
| Us pelvic non ob complete (76856) |
— |
$1,055 |
— |
| Us pg uter img f&mat 14 wk tabdl 1/1st gestation (76801) |
— |
$1,055 |
— |
| Us retroperitoneal complete (76770) |
— |
$854 |
— |
| Us retroperitoneal limited (76775) |
— |
$744 |
— |
| Us scrotum and contents (76870) |
— |
$800 |
— |
| Us thyroid (76536) |
— |
$968 |
— |
| Venography extremity bilateral rs&i (75822) |
— |
$3,064 |
— |
| Venography extremity unilateral rs&i (75820) |
— |
$3,064 |
— |
| Venous thrombosis imaging (78457) |
— |
$1,414 |
— |
| Venous Thrombosis Imaging Venogram Bilateral (78458) |
— |
$1,414 |
— |
| Wrist 2 views (73100) |
— |
$403 |
— |
| X-Ray Ac Jts - Xr Acromioclavicular Joints Bilateral (73050) |
— |
$439 |
— |
| X-Ray Bend Only L-S Spine (72120) |
— |
$758 |
— |
| X-Ray Elbow 2 Vw - Xr Elbow 1-2 Views Right (73070) |
— |
$353 |
— |
| X-Ray Exam Breast Specimen (76098) |
— |
$776 |
— |
| X-Ray Exam Entire Spi 1 Vw (72081) |
— |
$776 |
— |
| X-Ray Exam Entire Spi 2/3 Vw (72082) |
— |
$1,134 |
— |
| X-Ray Exam Hip Uni 2-3 Views (73502) |
— |
$699 |
— |
| X-Ray Exam Hips Bi 2 Views (73521) |
— |
$681 |
— |
| X-Ray Exam L-S Spine Bending (72114) |
— |
$624 |
— |
| X-Ray Exam Neck Spine 2-3 Vw (72040) |
— |
$391 |
— |
| X-Ray Exam Neck Spine 6/>Vws (72052) |
— |
$764 |
— |
| X-Ray Exam Unilat Ribs/Chest (71101) |
— |
$739 |
— |
X-ray humerus (73060)
range across 3 matching MRF lines |
— |
$468–$491 |
— |
| X-ray IV pyelogram (ivp) (74400) |
— |
$897 |
— |
| X-ray IV pyelogram+tomography (74415) |
— |
$897 |
— |
| X-Ray Jaw <4 Vw - Xr Mandible < 4 Views (70100) |
— |
$396 |
— |
| X-Ray Knee Bilat Standing - Xr Knees Anteroposterior Standing Bilat (73565) |
— |
$208 |
— |
| X-Ray Lumbar Spine 2/3 Vw - Xr Lumbar Spine 2-3 Views (72100) |
— |
$591 |
— |
| X-ray nose-rectum child f.b. (76010) |
— |
$298 |
— |
| X-Ray Ribs, Chest 4+ Vw - Xr Ribs 3 Vws Bil W/ Chest Posteroanterior (71111) |
— |
$795 |
— |
| X-Ray Sacroiliac Jts 3+ Vw - Xr Sacroiliac Joints 3+ Views (72202) |
— |
$460 |
— |
| X-Ray Sacrum/Coccyx 2+ Vw - Xr Sacrum Coccyx 2+ Views (72220) |
— |
$439 |
— |
| X-Ray Sinuses 3+ Vw - Xr Paranasal Sinuses 3+ Views (70220) |
— |
$503 |
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| X-Ray Skull 4+ Vw - Xr Skull Complete 4+ Views (70260) |
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$431 |
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| X-Ray Urinary Tract Exam With Contrast Material (74420) |
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$897 |
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| X-Rays Bone Length Studies (77073) |
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$256 |
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| X-Rays Bone Survey Complete (77075) |
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$824 |
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| Xr c-spine 4 or 5 views (72050) |
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$786 |
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| Xr facial bones less than 3 views (70140) |
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$403 |
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| XR Mastoids < 3 Views Bilateral (70120) |
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$362 |
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| Xr orbits complete 4 views (70200) |
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$503 |
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| Xr Tomogram Single Plane (76100) |
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$456 |
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