Abdomen 1 View (74018)
range across 2 matching MRF lines |
— |
$171–$205 |
— |
| Abdomen 2 views (74019) |
— |
$176 |
— |
| Acute Gastrointestinal Blood Loss Imaging (78278) |
— |
$843 |
— |
| Adrenal Cortex & Medulla Img (78075) |
— |
$2,735 |
— |
Ankle 2 views (73600)
range across 3 matching MRF lines |
— |
$163–$245 |
— |
| Bone age studies (77072) |
— |
$305 |
— |
| Bone Imaging Whole Body (78306) |
— |
$843 |
— |
| Bone marrow imaging limited area (78102) |
— |
$843 |
— |
| Bone marrow imaging; multiple areas (78103) |
— |
$843 |
— |
| Bone survey infant (77076) |
— |
$401 |
— |
| Cardiac Shunt Detection (78428) |
— |
$843 |
— |
| Cat Scan Follow-Up Study (76380) |
— |
$876 |
— |
| Cerebrospinal Fluid Scan (78630) |
— |
$1,129 |
— |
Chest 1 view (71045)
range across 5 matching MRF lines |
— |
$55–$189 |
— |
Chest 2 views (71046)
range across 2 matching MRF lines |
— |
$192–$229 |
— |
| Chest 3 views (71047) |
— |
$245 |
— |
| Chest 4 or more views (71048) |
— |
$305 |
— |
Clavicle complete (73000)
range across 3 matching MRF lines |
— |
$171–$245 |
— |
| Computed Tomography Thorax Lw Dose Lng Ca Scr C- (71271) |
— |
$508 |
— |
| Contrast X-Ray Bladder (74430) |
— |
$913 |
— |
CT abdomen and pelvis without and with contrast (74178)
range across 4 matching MRF lines |
— |
$749–$1,777 |
— |
| CT abdomen and pelvis without contrast (74176) |
— |
$1,421 |
— |
| CT abdomen w contrast (74160) |
— |
$1,584 |
— |
| CT abdomen w wo contrast (74170) |
— |
$1,970 |
— |
| CT abdomen w/o contrast (74150) |
— |
$1,502 |
— |
| CT Angio Abdomen and Pelvis (74174) |
— |
$2,129 |
— |
| CT Angio Chest (71275) |
— |
$1,541 |
— |
| CT Angio Head (70496) |
— |
$1,777 |
— |
| CT angio hrt w/3d image (75574) |
— |
$749 |
— |
| Ct Angio Lwr Extr W/O&W/Dye (73706) |
— |
$1,760 |
— |
| CT Angio Neck (70498) |
— |
$1,541 |
— |
Ct Angio Upr Extrm W/O&W/Dye (73206)
range across 3 matching MRF lines |
— |
$373–$1,541 |
— |
| CT cervical spine w/ contrast (72126) |
— |
$1,704 |
— |
| CT cervical spine w/o contrast (72125) |
— |
$1,351 |
— |
| CT cervical spine w/wo cont (72127) |
— |
$2,277 |
— |
| CT chest w contrast (71260) |
— |
$1,727 |
— |
| CT chest w/wo contrast (71270) |
— |
$2,312 |
— |
| CT colonography screening (74263) |
— |
$507 |
— |
| CT head/brain with contrast (70460) |
— |
$1,824 |
— |
| CT head/brain without and with contrast (70470) |
— |
$1,903 |
— |
| CT heart no contrast quant eval coronry calcium (75571) |
— |
$235 |
— |
| CT iac w contrast (70481) |
— |
$1,285 |
— |
| CT l-spine w&w/o contrast (72133) |
— |
$2,310 |
— |
CT lower ext w/o (73700)
range across 15 matching MRF lines |
— |
$1,338–$1,581 |
— |
CT lower extremity w/contrast material (73701)
range across 15 matching MRF lines |
— |
$1,460–$1,704 |
— |
| CT lumbar spine w contrast (72132) |
— |
$2,044 |
— |
| CT lumbar spine w/o contrast (72131) |
— |
$1,478 |
— |
| CT maxillofacial w contrast (70487) |
— |
$1,927 |
— |
| CT maxillofacial wo contrast (70486) |
— |
$1,549 |
— |
| CT neck tissue combo (70492) |
— |
$2,432 |
— |
| Ct Orbit/Ear/Fossa W/O&W/Dye (70482) |
— |
$1,578 |
— |
| CT orbits w/o contrast (70480) |
— |
$1,231 |
— |
| CT pelvis w&w/o contrast (72194) |
— |
$1,547 |
— |
| CT pelvis w/o contrast (72192) |
— |
$1,329 |
— |
CT scan of leg combo (73702)
range across 14 matching MRF lines |
— |
$1,581–$1,824 |
— |
| CT scans face/jaw combo (70488) |
— |
$2,160 |
— |
| CT soft tissue neck w contrast (70491) |
— |
$1,929 |
— |
| CT soft tissue neck w/o contrast (70490) |
— |
$1,524 |
— |
| CT thoracic spine w contrast (72129) |
— |
$1,869 |
— |
| CT thoracic spine w/o contrast (72128) |
— |
$1,532 |
— |
| CT thoracic spine w/wo cont (72130) |
— |
$2,310 |
— |
CT thorax w/o contrast (71250)
range across 2 matching MRF lines |
— |
$1,311–$1,380 |
— |
CT upper ext wo (73200)
range across 18 matching MRF lines |
— |
$1,338–$1,581 |
— |
CT upper extremity w/o & w/contrast material (73202)
range across 18 matching MRF lines |
— |
$1,581–$1,824 |
— |
CT upper extremity with contrast (73201)
range across 18 matching MRF lines |
— |
$1,460–$1,704 |
— |
| Cta Abdl Aorta&Bi Iliofem W/Contrast&Postp (75635) |
— |
$1,885 |
— |
| Cta Abdomen (74175) |
— |
$1,541 |
— |
| CTA pelvis (72191) |
— |
$1,541 |
— |
| Dxa Bone Density Axial (77080) |
— |
$557 |
— |
Dxa bone density study 1/>sites appendiclr skel (77081)
range across 2 matching MRF lines |
— |
$93–$147 |
— |
| Esophagram (74220) |
— |
$508 |
— |
| Fetal Biophys Profile W/Nst (76818) |
— |
$460 |
— |
| Fluoroscopy up to 1 hr (76000) |
— |
$525 |
— |
Foot 2 views (73620)
range across 3 matching MRF lines |
— |
$163–$245 |
— |
Forearm 2 views (73090)
range across 3 matching MRF lines |
— |
$204–$366 |
— |
| Gastric emptying imaging study (78264) |
— |
$970 |
— |
| Gated Heart Planar Single (78472) |
— |
$843 |
— |
Hand 2 views (73120)
range across 3 matching MRF lines |
— |
$154–$245 |
— |
| Hepatobil Syst Image W/Drug (78227) |
— |
$1,129 |
— |
| K Flow/Funct Image Multiple (78709) |
— |
$1,129 |
— |
| K Flow/Funct Image W/Drug (78708) |
— |
$1,129 |
— |
| K Flow/Funct Image W/O Drug (78707) |
— |
$1,321 |
— |
| Kidney Funcj Study Non-Img Radioisotopic Study (78725) |
— |
$843 |
— |
Knee 3 Views (73562)
range across 5 matching MRF lines |
— |
$204–$457 |
— |
| Liver & Spleen Imaging Static Only (78215) |
— |
$843 |
— |
| Lung perfusion differential (78597) |
— |
$843 |
— |
| Lung Ventilat&Perfus Imaging (78582) |
— |
$1,321 |
— |
| Lung Ventilation Imaging (78579) |
— |
$1,019 |
— |
| Lymph System Imaging (78195) |
— |
$1,321 |
— |
| Mammary ductogram or galactogram multiple (77054) |
— |
$507 |
— |
| Mammary ductogram or galactogram single (77053) |
— |
$507 |
— |
| Meckels Divert Exam (78290) |
— |
$843 |
— |
| Mra Head W/O & W/Contrast Material (70546) |
— |
$1,551 |
— |
| MRA head w/o contrast (70544) |
— |
$1,157 |
— |
| MRA neck w contrast (70548) |
— |
$1,247 |
— |
| Mra Neck W/O &W/Contrast Material (70549) |
— |
$1,338 |
— |
| MRA neck w/o contrast (70547) |
— |
$1,157 |
— |
| MRI abdomen w contrast (74182) |
— |
$749 |
— |
| MRI abdomen w/o contrast (74181) |
— |
$1,157 |
— |
| MRI any jt lower extrem w/contrast material (73722) |
— |
$1,247 |
— |
MRI any jt lower extrem w/o & w/contrast matrl (73723)
range across 4 matching MRF lines |
— |
$1,338–$1,551 |
— |
MRI any jt upper extremity w/contrast matrl (73222)
range across 6 matching MRF lines |
— |
$1,247–$1,460 |
— |
| MRI cervical spine w contrast (72142) |
— |
$1,247 |
— |
| MRI cervical spine w/o cont (72141) |
— |
$1,157 |
— |
| MRI chest w/o contrast (71550) |
— |
$1,157 |
— |
| MRI chest with contrast (71551) |
— |
$1,656 |
— |
| MRI chest wo w contrast (71552) |
— |
$749 |
— |
MRI lower extrem oth/thn jt w/contrast matrl (73719)
range across 6 matching MRF lines |
— |
$1,247–$1,460 |
— |
MRI lower extrem oth/thn jt w/o & w/contr matr (73720)
range across 5 matching MRF lines |
— |
$1,338–$1,551 |
— |
MRI lower extrem oth/thn jt w/o contr matrl (73718)
range across 9 matching MRF lines |
— |
$1,157–$1,612 |
— |
| MRI lumbar spine w contrast (72149) |
— |
$1,247 |
— |
| Mri Neck Spine W/O & W/Dye (72156) |
— |
$1,338 |
— |
| MRI orbit face &/neck w/o contrast (70540) |
— |
$1,157 |
— |
| MRI orbit face neck w contrast (70542) |
— |
$1,247 |
— |
| Mri Orbt/Fac/Nck W/O &W/Dye (70543) |
— |
$1,338 |
— |
| MRI pelvis w contrast (72196) |
— |
$1,247 |
— |
| MRI pelvis w/o & w contrast (72197) |
— |
$1,338 |
— |
| MRI pelvis w/o contrast (72195) |
— |
$1,157 |
— |
| MRI thoracic spine w/o contrast (72146) |
— |
$1,157 |
— |
| MRI upper extremity oth than jt w/contr matrl (73219) |
— |
$1,247 |
— |
| MRI upper extremity oth than jt w/o contr matrl (73218) |
— |
$1,157 |
— |
| Mri Uppr Extremity W/O&W/Dye (73220) |
— |
$1,338 |
— |
| MRI, abdomen, combo (74183) |
— |
$1,338 |
— |
| MRI, dorsal spine combo (72157) |
— |
$1,338 |
— |
| MRI, dorsal spine contrast (72147) |
— |
$1,247 |
— |
MRI, joint upper extrem (73221)
range across 9 matching MRF lines |
— |
$1,157–$1,612 |
— |
| MRI, joint upper extrem combo (73223) |
— |
$1,337 |
— |
| MRI, lumbar spine combo (72158) |
— |
$1,338 |
— |
| Myocardial Spect Multiple Studies (78452) |
— |
$3,736 |
— |
| Neck soft tissue (70360) |
— |
$189 |
— |
| Nm whole blood volume (78122) |
— |
$1,129 |
— |
| Nonvascular Shunt X-Ray (75809) |
— |
$508 |
— |
| Nuclear Rx Oral Admin (79005) |
— |
$471 |
— |
| Parathyroid imaging w/tomographic spect & CT (78072) |
— |
$1,129 |
— |
| Parathyroid Planar Imaging (78070) |
— |
$1,029 |
— |
| Pelvis 1 or 2 views (72170) |
— |
$214 |
— |
| Pulmonary Perfusion Imaging Particulate (78580) |
— |
$1,019 |
— |
| Radex Abd Compl Aqt Abd W/S/E/D Views 1 View Ch (74022) |
— |
$330 |
— |
Radex Ankle Complete Minimum 3 Views (73610)
range across 3 matching MRF lines |
— |
$204–$245 |
— |
Radex Calcaneus Minimum 2 Views (73650)
range across 3 matching MRF lines |
— |
$171–$245 |
— |
Radex elbow complete minimum 3 views (73080)
range across 3 matching MRF lines |
— |
$204–$245 |
— |
Radex Facial Bones Complete Minimum 3 Views (70150)
range across 2 matching MRF lines |
— |
$302–$367 |
— |
| Radex fingr minimum 2 views (73140) |
— |
$204 |
— |
Radex foot complete minimum 3 views (73630)
range across 3 matching MRF lines |
— |
$245–$249 |
— |
Radex Hand Minimum 3 Views (73130)
range across 3 matching MRF lines |
— |
$204–$245 |
— |
Radex lower extremity infant minimum 2 views (73592)
range across 3 matching MRF lines |
— |
$245–$305 |
— |
| Radex Mastoids Compl Minimum 3 Views PR Side (70130) |
— |
$608 |
— |
| Radex Nasal Bones Complete Minimum 3 Views (70160) |
— |
$217 |
— |
| Radex Ribs Unilateral 2 Views (71100) |
— |
$204 |
— |
Radex shoulder complete minimum 2 views (73030)
range across 3 matching MRF lines |
— |
$249–$498 |
— |
| Radex Sinuses Paransl < 3 Views (70210) |
— |
$218 |
— |
| Radex Spine 1 View Specify Level (72020) |
— |
$271 |
— |
| Radex Sternum Minimum 2 Views (71120) |
— |
$238 |
— |
| Radex Temporomandble Jt Opn & Clsd Mouth Bilat (70330) |
— |
$293 |
— |
| Radex Toe Minimum 2 Views (73660) |
— |
$163 |
— |
Radex upper extremity infant minimum 2 views (73092)
range across 3 matching MRF lines |
— |
$195–$366 |
— |
Radex Wrist Complete Minimum 3 Views (73110)
range across 3 matching MRF lines |
— |
$184–$245 |
— |
| Radiolog exam mandible compl minimum 4 views (70110) |
— |
$255 |
— |
| Radiologic Exam Abdomen 3+ Views - Xr Abdomen 3+ Views (74021) |
— |
$282 |
— |
| Radiologic exam colon double contrast study (74280) |
— |
$608 |
— |
| Radiologic exam colon single contrast study (74270) |
— |
$549 |
— |
| Radiologic Exam Esophagus Double Contrast Study (74221) |
— |
$556 |
— |
Radiologic exam knee complete 4/more views (73564)
range across 3 matching MRF lines |
— |
$284–$366 |
— |
| Radiologic Exam Small Int Single Contrast Study (74250) |
— |
$305 |
— |
| Radiologic exam swallow function contrast study (74230) |
— |
$305 |
— |
Radiologic exam upr gi trc double contrast study (74246)
range across 2 matching MRF lines |
— |
$373–$508 |
— |
| Radiologic examination femur 1 view (73551) |
— |
$171 |
— |
Radiologic examination femur minimum 2 views (73552)
range across 3 matching MRF lines |
— |
$184–$245 |
— |
Radiologic examination knee 1/2 views (73560)
range across 3 matching MRF lines |
— |
$184–$245 |
— |
Radiologic examination tibia & fibula 2 views (73590)
range across 3 matching MRF lines |
— |
$163–$214 |
— |
| Ribs bilateral 3 views (71110) |
— |
$255 |
— |
| Rp loclzj tum plnr 2+area 1+d img/1 area img>2+d (78801) |
— |
$843 |
— |
| Rp Loclzj Tum Plnr Whole Body 2+ Days Imaging (78804) |
— |
$2,737 |
— |
| Rp Loclzj Tum Plnr Whole Body Single Day Imaging (78802) |
— |
$2,737 |
— |
| Rp Loclzj Tum Spect 1 Area Single Day Imaging (78803) |
— |
$2,737 |
— |
Rp loclzj tum spect w/CT 1 area/acquisj 1day img (78830)
range across 4 matching MRF lines |
— |
$2,735–$2,737 |
— |
Scapula (73010)
range across 3 matching MRF lines |
— |
$245–$366 |
— |
| Screening Digital Breast Tomosynthesis Bi (77063) |
— |
$91 |
— |
| Sella turcica (70240) |
— |
$130 |
— |
Shoulder 1 view (73020)
range across 3 matching MRF lines |
— |
$204–$245 |
— |
| Skull less than 4 views (70250) |
— |
$293 |
— |
| Sternoclavicular joints (71130) |
— |
$185 |
— |
| Testicular Imaging W/Flow (78761) |
— |
$843 |
— |
| Thoracic spine 2 views (72070) |
— |
$269 |
— |
| Thoracic spine 3 views (72072) |
— |
$305 |
— |
| Thoracolumbar 2 views (72080) |
— |
$385 |
— |
| Thyroid Carcinoma Metastases Img Lmtd Area (78015) |
— |
$843 |
— |
| Thyroid Uptake Measurement (78012) |
— |
$1,019 |
— |
Ultrasound Breast Limited (76642)
range across 7 matching MRF lines |
— |
$284–$567 |
— |
| Ultrasound Elastography Parenchyma (76981) |
— |
$305 |
— |
| Ultrasound Exam Aaa Screen (76706) |
— |
$390 |
— |
Ultrasound, abdomen limited (76705)
range across 5 matching MRF lines |
— |
$408–$427 |
— |
| Unlisted Dx Radiographic Procedure (76499) |
— |
$245 |
— |
| Unlisted us procedure (76999) |
— |
$294 |
— |
| Ureteral Reflux Study (78740) |
— |
$843 |
— |
| Us bone density measurement (76977) |
— |
$60 |
— |
Us breast unilateral complete (76641)
range across 6 matching MRF lines |
— |
$224–$389 |
— |
Us chest (76604)
range across 5 matching MRF lines |
— |
$427–$446 |
— |
| Us exam, pelvic, limited (76857) |
— |
$246 |
— |
| Us kidney transplant (76776) |
— |
$366 |
— |
Us lmtd joint/oth nonvasc xtr strux r-t w/img (76882)
range across 11 matching MRF lines |
— |
$366–$657 |
— |
| Us ob limited 1 or more fetuses (76815) |
— |
$460 |
— |
| Us ob transvaginal (76817) |
— |
$305 |
— |
| Us pelvic non ob complete (76856) |
— |
$609 |
— |
| Us pg uter img f&mat 14 wk tabdl 1/1st gestation (76801) |
— |
$441 |
— |
| Us retroperitoneal complete (76770) |
— |
$615 |
— |
| Us retroperitoneal limited (76775) |
— |
$372 |
— |
| Us scrotum and contents (76870) |
— |
$609 |
— |
| Us thyroid (76536) |
— |
$609 |
— |
| Vertebral fracture assessment via dxa (77086) |
— |
$154 |
— |
Wrist 2 views (73100)
range across 3 matching MRF lines |
— |
$163–$245 |
— |
| X-Ray Ac Jts - Xr Acromioclavicular Joints Bilateral (73050) |
— |
$168 |
— |
X-Ray Elbow 2 Vw - Xr Elbow 1-2 Views Right (73070)
range across 3 matching MRF lines |
— |
$146–$245 |
— |
| X-Ray Exam Breast Specimen (76098) |
— |
$136 |
— |
| X-Ray Exam Entire Spi 1 Vw (72081) |
— |
$193 |
— |
| X-Ray Exam Entire Spi 2/3 Vw (72082) |
— |
$305 |
— |
| X-Ray Exam Hip Uni 2-3 Views (73502) |
— |
$255 |
— |
| X-Ray Exam Hips Bi 2 Views (73521) |
— |
$305 |
— |
| X-Ray Exam Hips Bi 3-4 Views (73522) |
— |
$245 |
— |
| X-Ray Exam L-S Spine Bending (72114) |
— |
$508 |
— |
| X-Ray Exam Neck Spine 2-3 Vw (72040) |
— |
$305 |
— |
| X-Ray Exam Neck Spine 6/>Vws (72052) |
— |
$408 |
— |
| X-Ray Exam Unilat Ribs/Chest (71101) |
— |
$286 |
— |
| X-ray eye for foreign body (70030) |
— |
$206 |
— |
X-ray humerus (73060)
range across 3 matching MRF lines |
— |
$204–$366 |
— |
| X-ray IV pyelogram (ivp) (74400) |
— |
$488 |
— |
| X-Ray Knee Bilat Standing - Xr Knees Anteroposterior Standing Bilat (73565) |
— |
$225 |
— |
X-Ray Lumbar Spine 2/3 Vw - Xr Lumbar Spine 2-3 Views (72100)
range across 3 matching MRF lines |
— |
$305–$366 |
— |
| X-ray nose-rectum child f.b. (76010) |
— |
$146 |
— |
| X-Ray Ribs, Chest 4+ Vw - Xr Ribs 3 Vws Bil W/ Chest Posteroanterior (71111) |
— |
$224 |
— |
| X-Ray Sacroiliac Jts 3+ Vw - Xr Sacroiliac Joints 3+ Views (72202) |
— |
$224 |
— |
| X-Ray Sacrum/Coccyx 2+ Vw - Xr Sacrum Coccyx 2+ Views (72220) |
— |
$229 |
— |
| X-Ray Sinuses 3+ Vw - Xr Paranasal Sinuses 3+ Views (70220) |
— |
$296 |
— |
| X-Ray Skull 4+ Vw - Xr Skull Complete 4+ Views (70260) |
— |
$366 |
— |
| X-Rays Bone Length Studies (77073) |
— |
$343 |
— |
| X-Rays Bone Survey Complete (77075) |
— |
$877 |
— |
Xr c-spine 4 or 5 views (72050)
range across 2 matching MRF lines |
— |
$356–$427 |
— |
| Xr orbits complete 4 views (70200) |
— |
$275 |
— |