| Abdomen 1 View (74018) |
— |
$1,468.73 |
— |
| Abdomen 2 views (74019) |
— |
$1,505 |
— |
| Acute Gastrointestinal Blood Loss Imaging (78278) |
— |
$5,230.80 |
— |
| Angio pulmonary bilat (75743) |
— |
$6,519.75 |
— |
| Angiography extremity bilateral rs&i (75716) |
— |
$6,519.75 |
— |
| Angiography extremity unilateral rs&i (75710) |
— |
$6,519.75 |
— |
| Angiography pulmonary unilateral slctv rs&i (75741) |
— |
$6,519.75 |
— |
Ankle 2 views (73600)
range across 2 matching MRF lines |
— |
$1,072.48–$2,141.13 |
— |
| Aortography thoracic serialography rs&i (75605) |
— |
$6,519.75 |
— |
| Artery X-Rays Abdomen (75726) |
— |
$12,116.97 |
— |
| Artery X-Rays Pelvis (75736) |
— |
$6,519.75 |
— |
| Arthrogram ankle (73615) |
— |
$5,389.15 |
— |
| Arthrogram hip (73525) |
— |
$5,731.08 |
— |
| Arthrogram Wrist (73115) |
— |
$4,821.54 |
— |
| Bone age studies (77072) |
— |
$787.91 |
— |
| Bone Imaging 3 Phase (78315) |
— |
$7,436.94 |
— |
| Bone Imaging Limited Area (78300) |
— |
$3,367.36 |
— |
| Bone Imaging Whole Body (78306) |
— |
$6,560.30 |
— |
| Bone survey infant (77076) |
— |
$1,587.29 |
— |
| Cat Scan Follow-Up Study (76380) |
— |
$2,540.43 |
— |
| Chest 1 view (71045) |
— |
$739.72 |
— |
| Chest 2 views (71046) |
— |
$940.14 |
— |
| Chest 3 views (71047) |
— |
$1,299.67 |
— |
| Chest 4 or more views (71048) |
— |
$1,299.67 |
— |
Clavicle complete (73000)
range across 2 matching MRF lines |
— |
$1,192.58–$2,386.68 |
— |
| Contrast Exam Abdominl Aorta (75625) |
— |
$6,519.75 |
— |
| Contrast X-Ray Bladder (74430) |
— |
$4,380.93 |
— |
| Contrast X-Ray Of Elbow (73085) |
— |
$4,821.54 |
— |
| Contrast X-Ray Of Knee Joint (73580) |
— |
$5,389.15 |
— |
| CT abdomen and pelvis without and with contrast (74178) |
— |
$16,496.36 |
— |
| CT abdomen and pelvis without contrast (74176) |
— |
$9,402.89 |
— |
| CT abdomen w contrast (74160) |
— |
$7,443.06 |
— |
| CT abdomen w wo contrast (74170) |
— |
$8,246.27 |
— |
| CT abdomen w/o contrast (74150) |
— |
$4,700.68 |
— |
| CT Angio Abdomen and Pelvis (74174) |
— |
$17,016.54 |
— |
| CT Angio Chest (71275) |
— |
$8,510.18 |
— |
| CT Angio Head (70496) |
— |
$8,510.18 |
— |
Ct Angio Lwr Extr W/O&W/Dye (73706)
range across 3 matching MRF lines |
— |
$8,510.18–$12,765.27 |
— |
| CT Angio Neck (70498) |
— |
$8,510.18 |
— |
Ct Angio Upr Extrm W/O&W/Dye (73206)
range across 3 matching MRF lines |
— |
$8,510.18–$12,765.27 |
— |
| CT cervical spine w/ contrast (72126) |
— |
$7,443.06 |
— |
| CT cervical spine w/o contrast (72125) |
— |
$4,700.68 |
— |
| CT cervical spine w/wo cont (72127) |
— |
$8,246.27 |
— |
| CT chest w contrast (71260) |
— |
$7,443.06 |
— |
| CT chest w/wo contrast (71270) |
— |
$8,246.27 |
— |
| CT head/brain with contrast (70460) |
— |
$7,443.06 |
— |
| CT head/brain without and with contrast (70470) |
— |
$8,246.27 |
— |
| CT heart no contrast quant eval coronry calcium (75571) |
— |
$76.50 |
— |
| CT iac w contrast (70481) |
— |
$7,443.06 |
— |
| CT l-spine w&w/o contrast (72133) |
— |
$8,246.27 |
— |
| CT lower ext w/o (73700) |
— |
$4,700.68 |
— |
| CT lower extremity w/contrast material (73701) |
— |
$7,443.06 |
— |
| CT lumbar spine w contrast (72132) |
— |
$7,443.06 |
— |
| CT lumbar spine w/o contrast (72131) |
— |
$4,700.68 |
— |
| CT maxillofacial w contrast (70487) |
— |
$7,443.06 |
— |
| CT maxillofacial wo contrast (70486) |
— |
$4,700.68 |
— |
| CT neck tissue combo (70492) |
— |
$8,246.27 |
— |
| Ct Orbit/Ear/Fossa W/O&W/Dye (70482) |
— |
$8,246.27 |
— |
| CT orbits w/o contrast (70480) |
— |
$4,700.68 |
— |
| CT pelvis w&w/o contrast (72194) |
— |
$8,246.27 |
— |
| CT pelvis w/o contrast (72192) |
— |
$4,700.68 |
— |
| CT scan of leg combo (73702) |
— |
$8,246.27 |
— |
| CT scans face/jaw combo (70488) |
— |
$8,246.27 |
— |
| CT soft tissue neck w contrast (70491) |
— |
$7,443.06 |
— |
| CT soft tissue neck w/o contrast (70490) |
— |
$4,700.68 |
— |
| CT thoracic spine w contrast (72129) |
— |
$7,443.06 |
— |
| CT thoracic spine w/o contrast (72128) |
— |
$4,700.68 |
— |
| CT thoracic spine w/wo cont (72130) |
— |
$8,246.27 |
— |
| CT thorax w/o contrast (71250) |
— |
$4,700.68 |
— |
| CT upper ext wo (73200) |
— |
$4,700.68 |
— |
| CT upper extremity w/o & w/contrast material (73202) |
— |
$8,246.27 |
— |
| CT upper extremity with contrast (73201) |
— |
$7,443.06 |
— |
| Cta Abdl Aorta&Bi Iliofem W/Contrast&Postp (75635) |
— |
$8,510.18 |
— |
| Cta Abdomen (74175) |
— |
$8,510.18 |
— |
| CTA pelvis (72191) |
— |
$8,510.18 |
— |
| Dxa Bone Density Axial (77080) |
— |
$857.52 |
— |
| Echo exam uterus (76831) |
— |
$2,792.10 |
— |
| Echo Guide For Artery Repair (76936) |
— |
$1,302.73 |
— |
| Esophagram (74220) |
— |
$2,009.55 |
— |
| Fetal Biophys Profile W/Nst (76818) |
— |
$1,976.66 |
— |
| Fetal Biophysical Profile W/O Non-Stress Testing (76819) |
— |
$1,976.66 |
— |
Fluoroscopy up to 1 hr (76000)
range across 2 matching MRF lines |
— |
$805–$4,637.96 |
— |
| Follow-Up Angiography (75898) |
— |
$3,508.87 |
— |
| Foot 2 views (73620) |
— |
$904.18 |
— |
| Forearm 2 views (73090) |
— |
$1,361.63 |
— |
| Gastric emptying imaging study (78264) |
— |
$3,052.95 |
— |
| Hand 2 views (73120) |
— |
$995.98 |
— |
Hepatc Vngrph Wdg/Fr Hemodyn Eval Rs&I (75889)
range across 2 matching MRF lines |
— |
$602–$609.34 |
— |
| Hepatc Vngrph Wdg/Fr W/O Hemodyn Eval Rs&I (75891) |
— |
$6,389.71 |
— |
| Hepatobil Syst Image W/Drug (78227) |
— |
$4,670.85 |
— |
| Hepatobiliary System Imaging (78226) |
— |
$4,670.85 |
— |
| Ht Musc Image Planar Mult (78454) |
— |
$8,413.03 |
— |
| Ht Muscle Image Spect Sing (78451) |
— |
$8,243.21 |
— |
| Hysterosalpingogram (74740) |
— |
$4,377.86 |
— |
| Infant hip ultrasound with hip movement (dynamic) (76885) |
— |
$1,966.71 |
— |
| K Flow/Funct Image W/Drug (78708) |
— |
$6,560.30 |
— |
| K Flow/Funct Image W/O Drug (78707) |
— |
$4,485.73 |
— |
| Knee 3 Views (73562) |
— |
$1,344.80 |
— |
| Lung perfusion differential (78597) |
— |
$3,115.68 |
— |
| Lung Ventilat&Perfus Imaging (78582) |
— |
$6,081.43 |
— |
| Lymph System Imaging (78195) |
— |
$6,541.94 |
— |
| Magnetic Image Jaw Joint (70336) |
— |
$5,415.15 |
— |
| Mra Head W/O & W/Contrast Material (70546) |
— |
$8,377.85 |
— |
| MRA head w/o contrast (70544) |
— |
$5,415.15 |
— |
| MRA head with contrast (70545) |
— |
$6,647.50 |
— |
| MRA neck w contrast (70548) |
— |
$6,647.50 |
— |
| Mra Neck W/O &W/Contrast Material (70549) |
— |
$8,377.85 |
— |
| MRA neck w/o contrast (70547) |
— |
$5,415.15 |
— |
| MRI abdomen w contrast (74182) |
— |
$6,647.50 |
— |
| MRI abdomen w/o contrast (74181) |
— |
$5,415.15 |
— |
| MRI any jt lower extrem w/contrast material (73722) |
— |
$6,647.50 |
— |
| MRI any jt lower extrem w/o & w/contrast matrl (73723) |
— |
$8,377.85 |
— |
| MRI any jt upper extremity w/contrast matrl (73222) |
— |
$6,647.50 |
— |
| MRI Breast W/O Contrast Bilateral (77047) |
— |
$5,415.15 |
— |
| MRI Breast Without Contrast Material Unilateral (77046) |
— |
$5,415.15 |
— |
| MRI cervical spine w contrast (72142) |
— |
$6,647.50 |
— |
| MRI cervical spine w/o cont (72141) |
— |
$5,415.15 |
— |
| MRI chest w/o contrast (71550) |
— |
$5,415.15 |
— |
| MRI chest with contrast (71551) |
— |
$6,647.50 |
— |
| MRI chest wo w contrast (71552) |
— |
$8,377.85 |
— |
| MRI lower extrem oth/thn jt w/contrast matrl (73719) |
— |
$6,647.50 |
— |
MRI lower extrem oth/thn jt w/o & w/contr matr (73720)
range across 2 matching MRF lines |
— |
$7,519.55–$8,377.85 |
— |
MRI lower extrem oth/thn jt w/o contr matrl (73718)
range across 3 matching MRF lines |
— |
$5,415.15–$7,290.84 |
— |
| MRI lumbar spine w contrast (72149) |
— |
$6,647.50 |
— |
| Mri Neck Spine W/O & W/Dye (72156) |
— |
$8,377.85 |
— |
| MRI orbit face &/neck w/o contrast (70540) |
— |
$5,415.15 |
— |
| MRI orbit face neck w contrast (70542) |
— |
$6,647.50 |
— |
| Mri Orbt/Fac/Nck W/O &W/Dye (70543) |
— |
$8,377.85 |
— |
| MRI pelvis w contrast (72196) |
— |
$6,647.50 |
— |
| MRI pelvis w/o & w contrast (72197) |
— |
$8,377.85 |
— |
| MRI pelvis w/o contrast (72195) |
— |
$5,415.15 |
— |
| MRI thoracic spine w/o contrast (72146) |
— |
$5,415.15 |
— |
| MRI upper extremity oth than jt w/contr matrl (73219) |
— |
$6,647.50 |
— |
| MRI upper extremity oth than jt w/o contr matrl (73218) |
— |
$5,415.15 |
— |
Mri Uppr Extremity W/O&W/Dye (73220)
range across 3 matching MRF lines |
— |
$7,519.55–$8,377.85 |
— |
| MRI, abdomen, combo (74183) |
— |
$8,377.85 |
— |
| MRI, dorsal spine combo (72157) |
— |
$8,377.85 |
— |
| MRI, dorsal spine contrast (72147) |
— |
$6,647.50 |
— |
| MRI, joint upper extrem (73221) |
— |
$5,415.15 |
— |
| MRI, joint upper extrem combo (73223) |
— |
$8,377.85 |
— |
| MRI, lumbar spine combo (72158) |
— |
$8,377.85 |
— |
| Myocardial Spect Multiple Studies (78452) |
— |
$13,797.58 |
— |
| Neck soft tissue (70360) |
— |
$1,361.63 |
— |
| Parathyroid Planar Imaging (78070) |
— |
$2,662.83 |
— |
| Pelvis 1 or 2 views (72170) |
— |
$989.09 |
— |
| PET image w/CT, full body (78816) |
— |
$8,892.66 |
— |
| PET imaging CT attenuation skull base mid-thigh (78815) |
— |
$8,892.66 |
— |
| Prq Transhepatc Portograpy Hemodyn Eval Rs&I (75885) |
— |
$3,061.80 |
— |
| Radex Abd Compl Aqt Abd W/S/E/D Views 1 View Ch (74022) |
— |
$2,244.72 |
— |
| Radex abscess/fistula/sinus tract rs&i (76080) |
— |
$4,041.28 |
— |
Radex Ankle Complete Minimum 3 Views (73610)
range across 2 matching MRF lines |
— |
$1,288.96–$2,580.21 |
— |
| Radex Calcaneus Minimum 2 Views (73650) |
— |
$917.95 |
— |
Radex elbow complete minimum 3 views (73080)
range across 2 matching MRF lines |
— |
$1,361.63–$2,726.32 |
— |
| Radex Facial Bones Complete Minimum 3 Views (70150) |
— |
$1,822.90 |
— |
| Radex fingr minimum 2 views (73140) |
— |
$1,106.90 |
— |
| Radex foot complete minimum 3 views (73630) |
— |
$1,279.78 |
— |
| Radex Hand Minimum 3 Views (73130) |
— |
$1,312.67 |
— |
| Radex lower extremity infant minimum 2 views (73592) |
— |
$1,788.48 |
— |
| Radex Mastoids Compl Minimum 3 Views PR Side (70130) |
— |
$1,395.29 |
— |
| Radex Nasal Bones Complete Minimum 3 Views (70160) |
— |
$1,146.68 |
— |
| Radex shoulder complete minimum 2 views (73030) |
— |
$1,288.96 |
— |
| Radex Sinuses Paransl < 3 Views (70210) |
— |
$1,080.12 |
— |
| Radex Spine 1 View Specify Level (72020) |
— |
$339.64 |
— |
| Radex Sternum Minimum 2 Views (71120) |
— |
$820.04 |
— |
| Radex Temporomandble Jt Opn & Clsd Mouth Bilat (70330) |
— |
$1,382.28 |
— |
| Radex Toe Minimum 2 Views (73660) |
— |
$1,106.90 |
— |
| Radex upper extremity infant minimum 2 views (73092) |
— |
$1,788.48 |
— |
| Radex Wrist Complete Minimum 3 Views (73110) |
— |
$1,295.84 |
— |
| Radex X-Ray Exam Entire Spi 6/> Vw - Xr Entire Spine 6+ Vw (72084) |
— |
$1,991.96 |
— |
| Radiolog exam mandible compl minimum 4 views (70110) |
— |
$2,134.24 |
— |
| Radiologic Exam Abdomen 3+ Views - Xr Abdomen 3+ Views (74021) |
— |
$1,577.35 |
— |
| Radiologic exam colon double contrast study (74280) |
— |
$4,592.06 |
— |
| Radiologic exam colon single contrast study (74270) |
— |
$3,391.84 |
— |
| Radiologic exam knee complete 4/more views (73564) |
— |
$1,458.02 |
— |
| Radiologic exam pelvis compl minimum 3 views (72190) |
— |
$1,471.79 |
— |
| Radiologic Exam Small Int Single Contrast Study (74250) |
— |
$2,354.55 |
— |
| Radiologic exam swallow function contrast study (74230) |
— |
$2,426.45 |
— |
| Radiologic exam upr gi trc double contrast study (74246) |
— |
$3,455.15 |
— |
| Radiologic examination femur 1 view (73551) |
— |
$686.93 |
— |
Radiologic examination femur minimum 2 views (73552)
range across 2 matching MRF lines |
— |
$1,373.87–$2,743.91 |
— |
| Radiologic examination knee 1/2 views (73560) |
— |
$975.32 |
— |
| Radiologic examination tibia & fibula 2 views (73590) |
— |
$1,240 |
— |
| Rp loclzj tum plnr 1 area single day imaging (78800) |
— |
$3,130.22 |
— |
| Rp Loclzj Tum Plnr Whole Body Single Day Imaging (78802) |
— |
$5,435.81 |
— |
| Rp Loclzj Tum Spect 1 Area Single Day Imaging (78803) |
— |
$9,193.29 |
— |
| Scapula (73010) |
— |
$1,120.67 |
— |
| Screening Digital Breast Tomosynthesis Bi (77063) |
— |
$1,014.34 |
— |
| Shoulder 1 view (73020) |
— |
$649.45 |
— |
| Shoulder Arthrography (73040) |
— |
$5,109.93 |
— |
| Sialogram (70390) |
— |
$3,934.19 |
— |
| Skull less than 4 views (70250) |
— |
$1,146.68 |
— |
| Thoracic spine 2 views (72070) |
— |
$1,240 |
— |
| Thoracic spine 3 views (72072) |
— |
$1,861.15 |
— |
| Thyroid Uptake W/Blood Flow Sngle/Mult Quan Meas (78014) |
— |
$3,362.77 |
— |
Ultrasound Breast Limited (76642)
range across 2 matching MRF lines |
— |
$1,388.40–$2,776.80 |
— |
| Ultrasound Exam Aaa Screen (76706) |
— |
$3,139.40 |
— |
| Ultrasound, abdomen limited (76705) |
— |
$2,426.45 |
— |
| Unlisted us procedure (76999) |
— |
$952.38 |
— |
| Upper gi w/o kub (74240) |
— |
$3,344.76 |
— |
| Urethrocystogram voiding (74455) |
— |
$7,290.07 |
— |
| Urethrocystography retrograde (74450) |
— |
$7,290.07 |
— |
Us breast unilateral complete (76641)
range across 3 matching MRF lines |
— |
$2,776.80–$5,553.61 |
— |
| Us chest (76604) |
— |
$1,562.05 |
— |
| Us complete joint (76881) |
— |
$2,327.01 |
— |
| Us exam, pelvic, limited (76857) |
— |
$1,321.09 |
— |
| Us head (76506) |
— |
$1,617.89 |
— |
| Us lmtd joint/oth nonvasc xtr strux r-t w/img (76882) |
— |
$1,161.97 |
— |
| Us ob detailed single fetus (76811) |
— |
$3,003.23 |
— |
| Us ob limited 1 or more fetuses (76815) |
— |
$1,382.28 |
— |
| Us ob transvaginal (76817) |
— |
$1,562.05 |
— |
| Us pelvic non ob complete (76856) |
— |
$2,768.39 |
— |
| Us pg uter img f&mat 14 wk tabdl 1/1st gestation (76801) |
— |
$1,562.05 |
— |
| Us retroperitoneal complete (76770) |
— |
$3,139.40 |
— |
| Us retroperitoneal limited (76775) |
— |
$3,078.20 |
— |
| Us scrotum and contents (76870) |
— |
$1,785.42 |
— |
| Us spinal canal and contents (76800) |
— |
$1,382.28 |
— |
| Us thyroid (76536) |
— |
$3,003.23 |
— |
| Us transrectal (76872) |
— |
$1,382.28 |
— |
| Vein X-Ray Chest (75827) |
— |
$2,219.92 |
— |
| Venogram Sinus/Jugular (75860) |
— |
$4,431.70 |
— |
| Venography caval inferior serialography rs&i (75825) |
— |
$6,917.53 |
— |
| Venography extremity bilateral rs&i (75822) |
— |
$1,869.56 |
— |
| Venography extremity unilateral rs&i (75820) |
— |
$2,092.17 |
— |
| Venography Renal Unilateral (75831) |
— |
$2,785.22 |
— |
| Venous sampling by catheter (75893) |
— |
$4,492.61 |
— |
| Wrist 2 views (73100) |
— |
$1,036.52 |
— |
| X-Ray Ac Jts - Xr Acromioclavicular Joints Bilateral (73050) |
— |
$958.50 |
— |
| X-ray antegrade pyelogram tube (74425) |
— |
$6,776.78 |
— |
| X-Ray Aorta Leg Arteries (75630) |
— |
$6,519.75 |
— |
| X-Ray Bend Only L-S Spine (72120) |
— |
$1,468.73 |
— |
X-Ray Elbow 2 Vw - Xr Elbow 1-2 Views Right (73070)
range across 2 matching MRF lines |
— |
$1,026.58–$2,052.39 |
— |
| X-Ray Exam Breast Specimen (76098) |
— |
$940.14 |
— |
| X-Ray Exam Entire Spi 1 Vw (72081) |
— |
$995.98 |
— |
| X-Ray Exam Entire Spi 2/3 Vw (72082) |
— |
$1,991.96 |
— |
| X-Ray Exam Entire Spi 4/5 Vw (72083) |
— |
$1,991.96 |
— |
| X-Ray Exam Hip Uni 1 View (73501) |
— |
$530.12 |
— |
| X-Ray Exam Hip Uni 2-3 Views (73502) |
— |
$1,062.53 |
— |
| X-Ray Exam Hip Uni 4/> Views (73503) |
— |
$1,594.18 |
— |
| X-Ray Exam Hips Bi 2 Views (73521) |
— |
$1,152.80 |
— |
| X-Ray Exam Hips Bi 3-4 Views (73522) |
— |
$1,152.80 |
— |
| X-Ray Exam Hips Bi 5/> Views (73523) |
— |
$2,305.59 |
— |
| X-Ray Exam L-S Spine Bending (72114) |
— |
$2,131.94 |
— |
| X-Ray Exam Neck Spine 2-3 Vw (72040) |
— |
$1,158.15 |
— |
| X-Ray Exam Neck Spine 6/>Vws (72052) |
— |
$2,280.35 |
— |
| X-Ray Exam Unilat Ribs/Chest (71101) |
— |
$1,360.10 |
— |
| X-ray eye for foreign body (70030) |
— |
$934.02 |
— |
X-ray humerus (73060)
range across 2 matching MRF lines |
— |
$1,420.53–$2,841.06 |
— |
| X-ray IV pyelogram (ivp) (74400) |
— |
$5,716.54 |
— |
| X-ray IV pyelogram+tomography (74415) |
— |
$7,290.07 |
— |
| X-Ray Knee Bilat Standing - Xr Knees Anteroposterior Standing Bilat (73565) |
— |
$975.32 |
— |
| X-Ray Lumbar Spine 2/3 Vw - Xr Lumbar Spine 2-3 Views (72100) |
— |
$1,468.73 |
— |
| X-ray nose-rectum child f.b. (76010) |
— |
$1,080.12 |
— |
| X-Ray Ribs, Chest 4+ Vw - Xr Ribs 3 Vws Bil W/ Chest Posteroanterior (71111) |
— |
$1,822.90 |
— |
| X-Ray Sacroiliac Jts 3+ Vw - Xr Sacroiliac Joints 3+ Views (72202) |
— |
$1,315.73 |
— |
| X-Ray Sacroiliac Jts <3 Vw - Xr Sacroiliac Joints 1-2 Views (72200) |
— |
$1,152.80 |
— |
| X-Ray Sacrum/Coccyx 2+ Vw - Xr Sacrum Coccyx 2+ Views (72220) |
— |
$1,152.80 |
— |
| X-Ray Sinuses 3+ Vw - Xr Paranasal Sinuses 3+ Views (70220) |
— |
$1,695.92 |
— |
| X-Ray Skull 4+ Vw - Xr Skull Complete 4+ Views (70260) |
— |
$1,695.92 |
— |
| X-ray thoracic spine 4 vw (72074) |
— |
$2,278.82 |
— |
| X-Rays Bone Length Studies (77073) |
— |
$1,324.91 |
— |
| X-Rays Bone Survey Complete (77075) |
— |
$3,554.77 |
— |
| Xr c-spine 4 or 5 views (72050) |
— |
$2,364.49 |
— |
| Xr facial bones less than 3 views (70140) |
— |
$635.68 |
— |
| Xr orbits complete 4 views (70200) |
— |
$1,353.98 |
— |