| Abdomen 1 View (74018) |
— |
$229 |
— |
| Abdomen 2 views (74019) |
— |
$387 |
— |
| Acute Gastrointestinal Blood Loss Imaging (78278) |
— |
$1,519 |
— |
| Adrenal Cortex & Medulla Img (78075) |
— |
$1,018 |
— |
| Ankle 2 views (73600) |
— |
$469 |
— |
Arthrogram hip (73525)
range across 4 matching MRF lines |
— |
$1,282–$2,563 |
— |
| Bone age studies (77072) |
— |
$246 |
— |
| Bone Imaging 3 Phase (78315) |
— |
$1,991 |
— |
| Bone Imaging Limited Area (78300) |
— |
$1,155 |
— |
| Bone Imaging Whole Body (78306) |
— |
$2,069 |
— |
| Bone marrow imaging; multiple areas (78103) |
— |
$889 |
— |
| Bone survey infant (77076) |
— |
$437 |
— |
| Cat Scan Follow-Up Study (76380) |
— |
$743 |
— |
| Chest 1 view (71045) |
— |
$236 |
— |
| Chest 2 views (71046) |
— |
$300 |
— |
| Chest 3 views (71047) |
— |
$334 |
— |
| Clavicle complete (73000) |
— |
$200 |
— |
| Computed Tomography Thorax Lw Dose Lng Ca Scr C- (71271) |
— |
$490 |
— |
| Contrast X-Ray Bladder (74430) |
— |
$582 |
— |
| Contrast X-Ray Of Knee Joint (73580) |
— |
$1,014 |
— |
| CT abdomen and pelvis without and with contrast (74178) |
— |
$5,530 |
— |
| CT abdomen and pelvis without contrast (74176) |
— |
$3,825 |
— |
| CT abdomen w contrast (74160) |
— |
$3,530 |
— |
| CT abdomen w wo contrast (74170) |
— |
$3,003 |
— |
| CT abdomen w/o contrast (74150) |
— |
$1,904 |
— |
| CT Angio Abdomen and Pelvis (74174) |
— |
$6,567 |
— |
| CT Angio Chest (71275) |
— |
$2,992 |
— |
| CT Angio Head (70496) |
— |
$3,074 |
— |
| CT angio hrt w/3d image (75574) |
— |
$1,964 |
— |
| Ct Angio Lwr Extr W/O&W/Dye (73706) |
— |
$2,790 |
— |
| CT Angio Neck (70498) |
— |
$3,103 |
— |
| Ct Angio Upr Extrm W/O&W/Dye (73206) |
— |
$2,709 |
— |
| CT bone density (77078) |
— |
$494 |
— |
| CT cervical spine w/ contrast (72126) |
— |
$1,900 |
— |
| CT cervical spine w/o contrast (72125) |
— |
$1,909 |
— |
| CT cervical spine w/wo cont (72127) |
— |
$2,323 |
— |
| CT chest w contrast (71260) |
— |
$2,372 |
— |
| CT chest w/wo contrast (71270) |
— |
$2,510 |
— |
| CT head/brain with contrast (70460) |
— |
$1,892 |
— |
| CT head/brain without and with contrast (70470) |
— |
$2,569 |
— |
| CT heart no contrast quant eval coronry calcium (75571) |
— |
$86 |
— |
| CT iac w contrast (70481) |
— |
$2,003 |
— |
| CT l-spine w&w/o contrast (72133) |
— |
$2,393 |
— |
| CT lower ext w/o (73700) |
— |
$1,859 |
— |
| CT lower extremity w/contrast material (73701) |
— |
$2,128 |
— |
| CT lumbar spine w contrast (72132) |
— |
$1,900 |
— |
| CT lumbar spine w/o contrast (72131) |
— |
$1,909 |
— |
| CT maxillofacial w contrast (70487) |
— |
$2,003 |
— |
| CT maxillofacial wo contrast (70486) |
— |
$1,902 |
— |
| CT neck tissue combo (70492) |
— |
$2,393 |
— |
| Ct Orbit/Ear/Fossa W/O&W/Dye (70482) |
— |
$2,393 |
— |
| CT orbits w/o contrast (70480) |
— |
$1,739 |
— |
| CT pelvis w&w/o contrast (72194) |
— |
$2,534 |
— |
| CT pelvis w/o contrast (72192) |
— |
$1,707 |
— |
| CT scan of leg combo (73702) |
— |
$2,323 |
— |
| CT scans face/jaw combo (70488) |
— |
$2,393 |
— |
| CT soft tissue neck w contrast (70491) |
— |
$2,411 |
— |
| CT soft tissue neck w/o contrast (70490) |
— |
$2,318 |
— |
| CT thoracic spine w contrast (72129) |
— |
$2,212 |
— |
| CT thoracic spine w/o contrast (72128) |
— |
$1,733 |
— |
| CT thoracic spine w/wo cont (72130) |
— |
$2,323 |
— |
| CT thorax w/o contrast (71250) |
— |
$1,801 |
— |
| CT upper ext wo (73200) |
— |
$1,486 |
— |
| CT upper extremity w/o & w/contrast material (73202) |
— |
$2,393 |
— |
| CT upper extremity with contrast (73201) |
— |
$1,900 |
— |
| Cta Abdl Aorta&Bi Iliofem W/Contrast&Postp (75635) |
— |
$4,007 |
— |
| Cta Abdomen (74175) |
— |
$3,455 |
— |
| CTA pelvis (72191) |
— |
$2,526 |
— |
| Doppler Fetal Mid Cerebral Artery (76821) |
— |
$340 |
— |
| Dxa Bone Density Axial (77080) |
— |
$588 |
— |
| Dxa bone density study (77085) |
— |
$255 |
— |
| Dxa bone density study 1/>sites appendiclr skel (77081) |
— |
$262 |
— |
| Echo exam of fetal heart (76825) |
— |
$909 |
— |
| Echo exam uterus (76831) |
— |
$975 |
— |
| Fetal Biophysical Profile W/O Non-Stress Testing (76819) |
— |
$416 |
— |
| Fluoroscopy up to 1 hr (76000) |
— |
$595 |
— |
| Foot 2 views (73620) |
— |
$207 |
— |
| Forearm 2 views (73090) |
— |
$398 |
— |
| Gastric emptying imaging study (78264) |
— |
$3,133 |
— |
| Gastric Mucosa Imaging (78261) |
— |
$1,717 |
— |
| Gated Heart Planar Single (78472) |
— |
$3,834 |
— |
| Gated Heart, Multiple (78473) |
— |
$1,979 |
— |
| Hand 2 views (73120) |
— |
$606 |
— |
| Hepatobil Syst Image W/Drug (78227) |
— |
$2,254 |
— |
| Hepatobiliary System Imaging (78226) |
— |
$1,340 |
— |
| Hysterosalpingogram (74740) |
— |
$928 |
— |
| Infant hip ultrasound with hip movement (dynamic) (76885) |
— |
$670 |
— |
| K Flow/Funct Image W/Drug (78708) |
— |
$2,840 |
— |
| K Flow/Funct Image W/O Drug (78707) |
— |
$1,802 |
— |
| Knee 3 Views (73562) |
— |
$290 |
— |
| Liver & Spleen Imaging Static Only (78215) |
— |
$919 |
— |
| Liver imaging static only (78201) |
— |
$1,282 |
— |
| Liver imaging w/vascular flow (78202) |
— |
$1,321 |
— |
| Lung perfusion differential (78597) |
— |
$1,093 |
— |
| Lung Ventilat&Perfus Imaging (78582) |
— |
$3,830 |
— |
| Lymph System Imaging (78195) |
— |
$1,458 |
— |
| Magnetic Image Jaw Joint (70336) |
— |
$2,965 |
— |
| Mra Head W/O & W/Contrast Material (70546) |
— |
$5,292 |
— |
| MRA head w/o contrast (70544) |
— |
$2,784 |
— |
| MRA head with contrast (70545) |
— |
$3,421 |
— |
| MRA neck w contrast (70548) |
— |
$2,815 |
— |
| Mra Neck W/O &W/Contrast Material (70549) |
— |
$4,500 |
— |
| MRA neck w/o contrast (70547) |
— |
$2,709 |
— |
| MRI abdomen w contrast (74182) |
— |
$3,422 |
— |
| MRI abdomen w/o contrast (74181) |
— |
$2,731 |
— |
| MRI any jt lower extrem w/contrast material (73722) |
— |
$2,986 |
— |
| MRI any jt lower extrem w/o & w/contrast matrl (73723) |
— |
$4,389 |
— |
| MRI any jt upper extremity w/contrast matrl (73222) |
— |
$3,091 |
— |
| MRI Breast W/O Contrast Bilateral (77047) |
— |
$2,448 |
— |
| MRI Breast Without Contrast Material Unilateral (77046) |
— |
$1,862 |
— |
| MRI cervical spine w contrast (72142) |
— |
$3,745 |
— |
| MRI cervical spine w/o cont (72141) |
— |
$3,679 |
— |
| MRI chest w/o contrast (71550) |
— |
$2,965 |
— |
| MRI chest with contrast (71551) |
— |
$3,422 |
— |
| MRI chest wo w contrast (71552) |
— |
$6,050 |
— |
| MRI lower extrem oth/thn jt w/o & w/contr matr (73720) |
— |
$7,391 |
— |
| MRI lower extrem oth/thn jt w/o contr matrl (73718) |
— |
$4,317 |
— |
| MRI lumbar spine w contrast (72149) |
— |
$3,834 |
— |
| Mri Neck Spine W/O & W/Dye (72156) |
— |
$8,342 |
— |
| MRI orbit face &/neck w/o contrast (70540) |
— |
$2,663 |
— |
| MRI orbit face neck w contrast (70542) |
— |
$3,019 |
— |
| Mri Orbt/Fac/Nck W/O &W/Dye (70543) |
— |
$6,275 |
— |
| MRI pelvis w contrast (72196) |
— |
$3,019 |
— |
| MRI pelvis w/o & w contrast (72197) |
— |
$4,534 |
— |
| MRI pelvis w/o contrast (72195) |
— |
$2,884 |
— |
| MRI thoracic spine w/o contrast (72146) |
— |
$3,167 |
— |
| MRI upper extremity oth than jt w/o contr matrl (73218) |
— |
$2,849 |
— |
| Mri Uppr Extremity W/O&W/Dye (73220) |
— |
$5,154 |
— |
| MRI, abdomen, combo (74183) |
— |
$4,194 |
— |
| MRI, dorsal spine combo (72157) |
— |
$4,739 |
— |
| MRI, dorsal spine contrast (72147) |
— |
$3,542 |
— |
| MRI, joint upper extrem (73221) |
— |
$2,863 |
— |
| MRI, joint upper extrem combo (73223) |
— |
$6,251 |
— |
| MRI, lumbar spine combo (72158) |
— |
$4,948 |
— |
Myocardial Spect Multiple Studies (78452)
range across 2 matching MRF lines |
— |
$3,789–$4,075 |
— |
| N-invas est c ffr sw aly CTA (75580) |
— |
$1,582 |
— |
| Neck soft tissue (70360) |
— |
$355 |
— |
| Ob us nuchal meas 1 gest (76813) |
— |
$392 |
— |
| Optic foramina (70190) |
— |
$226 |
— |
| Parathyroid Planar Imaging (78070) |
— |
$1,228 |
— |
| Pelvis 1 or 2 views (72170) |
— |
$241 |
— |
| PET image w/CT, full body (78816) |
— |
$5,711 |
— |
| PET imaging CT attenuation skull base mid-thigh (78815) |
— |
$5,711 |
— |
| Pulmonary Perfusion Imaging Particulate (78580) |
— |
$1,084 |
— |
| Radex abscess/fistula/sinus tract rs&i (76080) |
— |
$349 |
— |
| Radex Ankle Complete Minimum 3 Views (73610) |
— |
$283 |
— |
| Radex Calcaneus Minimum 2 Views (73650) |
— |
$209 |
— |
| Radex elbow complete minimum 3 views (73080) |
— |
$415 |
— |
| Radex Facial Bones Complete Minimum 3 Views (70150) |
— |
$977 |
— |
| Radex fingr minimum 2 views (73140) |
— |
$189 |
— |
| Radex foot complete minimum 3 views (73630) |
— |
$231 |
— |
| Radex Hand Minimum 3 Views (73130) |
— |
$255 |
— |
| Radex lower extremity infant minimum 2 views (73592) |
— |
$216 |
— |
| Radex Mastoids Compl Minimum 3 Views PR Side (70130) |
— |
$273 |
— |
| Radex Nasal Bones Complete Minimum 3 Views (70160) |
— |
$207 |
— |
| Radex Ribs Unilateral 2 Views (71100) |
— |
$314 |
— |
| Radex shoulder complete minimum 2 views (73030) |
— |
$297 |
— |
| Radex Sinuses Paransl < 3 Views (70210) |
— |
$223 |
— |
| Radex sm int w/mlt srl imges via enteroclss tube (74251) |
— |
$1,043 |
— |
| Radex Spine 1 View Specify Level (72020) |
— |
$283 |
— |
| Radex Sternum Minimum 2 Views (71120) |
— |
$219 |
— |
| Radex Temporomandble Jt Opn & Clsd Mouth Bilat (70330) |
— |
$223 |
— |
| Radex Toe Minimum 2 Views (73660) |
— |
$230 |
— |
| Radex upper extremity infant minimum 2 views (73092) |
— |
$208 |
— |
| Radex Wrist Complete Minimum 3 Views (73110) |
— |
$238 |
— |
| Radiolog exam mandible compl minimum 4 views (70110) |
— |
$293 |
— |
| Radiologic exam colon double contrast study (74280) |
— |
$1,366 |
— |
| Radiologic exam colon single contrast study (74270) |
— |
$629 |
— |
| Radiologic Exam Esophagus Double Contrast Study (74221) |
— |
$882 |
— |
| Radiologic exam knee complete 4/more views (73564) |
— |
$166 |
— |
| Radiologic exam pelvis compl minimum 3 views (72190) |
— |
$289 |
— |
| Radiologic Exam Small Int Single Contrast Study (74250) |
— |
$753 |
— |
| Radiologic exam swallow function contrast study (74230) |
— |
$808 |
— |
| Radiologic exam upr gi trc double contrast study (74246) |
— |
$659 |
— |
| Radiologic examination femur minimum 2 views (73552) |
— |
$202 |
— |
| Radiologic examination knee 1/2 views (73560) |
— |
$243 |
— |
| Radiologic Examination Osseous Survey Limited (77074) |
— |
$232 |
— |
| Radiologic examination tibia & fibula 2 views (73590) |
— |
$274 |
— |
| Ribs bilateral 3 views (71110) |
— |
$389 |
— |
| Rp loclzj tum plnr 2+area 1+d img/1 area img>2+d (78801) |
— |
$1,014 |
— |
| Rp Loclzj Tum Plnr Whole Body 2+ Days Imaging (78804) |
— |
$1,169 |
— |
Rp Loclzj Tum Spect 1 Area Single Day Imaging (78803)
range across 2 matching MRF lines |
— |
$1,260–$1,521 |
— |
| Scapula (73010) |
— |
$246 |
— |
| Screening Digital Breast Tomosynthesis Bi (77063) |
— |
$55 |
— |
| Sella turcica (70240) |
— |
$217 |
— |
| Shoulder 1 view (73020) |
— |
$174 |
— |
Shoulder Arthrography (73040)
range across 3 matching MRF lines |
— |
$1,741–$3,481 |
— |
| Sialogram (70390) |
— |
$507 |
— |
| Skull less than 4 views (70250) |
— |
$254 |
— |
| Sternoclavicular joints (71130) |
— |
$239 |
— |
| Therapeutic Enema Rdctj Intussusception/Obstrcj (74283) |
— |
$629 |
— |
| Thoracic spine 2 views (72070) |
— |
$346 |
— |
| Thoracic spine 3 views (72072) |
— |
$307 |
— |
| Thyroid Imaging With Vascular Flow (78013) |
— |
$653 |
— |
| Thyroid Uptake Measurement (78012) |
— |
$307 |
— |
| Thyroid Uptake W/Blood Flow Sngle/Mult Quan Meas (78014) |
— |
$1,170 |
— |
Ultrasound Breast Limited (76642)
range across 3 matching MRF lines |
— |
$574–$1,148 |
— |
| Ultrasound Exam Aaa Screen (76706) |
— |
$558 |
— |
| Ultrasound, abdomen limited (76705) |
— |
$774 |
— |
| Umbilical-artery Doppler (OB) (76820) |
— |
$350 |
— |
| Upper gi w/o kub (74240) |
— |
$530 |
— |
| Ureteral Reflux Study (78740) |
— |
$1,286 |
— |
| Urethrocystogram voiding (74455) |
— |
$654 |
— |
| Urethrocystography retrograde (74450) |
— |
$474 |
— |
Us breast unilateral complete (76641)
range across 3 matching MRF lines |
— |
$928–$1,856 |
— |
| Us chest (76604) |
— |
$670 |
— |
| Us complete joint (76881) |
— |
$565 |
— |
| Us exam, pelvic, limited (76857) |
— |
$464 |
— |
| Us head (76506) |
— |
$1,201 |
— |
| Us kidney transplant (76776) |
— |
$384 |
— |
| Us lmtd joint/oth nonvasc xtr strux r-t w/img (76882) |
— |
$496 |
— |
| Us ob detailed single fetus (76811) |
— |
$915 |
— |
| Us ob limited 1 or more fetuses (76815) |
— |
$615 |
— |
Us ob transvaginal (76817)
range across 4 matching MRF lines |
— |
$291–$676 |
— |
| Us pelvic non ob complete (76856) |
— |
$728 |
— |
| Us pg uter img f&mat 14 wk tabdl 1/1st gestation (76801) |
— |
$394 |
— |
| Us preg uterus real time f/u trnsabdl per fetus (76816) |
— |
$223 |
— |
| Us retroperitoneal complete (76770) |
— |
$811 |
— |
| Us retroperitoneal limited (76775) |
— |
$723 |
— |
| Us scrotum and contents (76870) |
— |
$654 |
— |
| Us spinal canal and contents (76800) |
— |
$670 |
— |
| Us thyroid (76536) |
— |
$661 |
— |
Us transrectal (76872)
range across 4 matching MRF lines |
— |
$25–$622 |
— |
| Venography extremity bilateral rs&i (75822) |
— |
$107 |
— |
| Venography extremity unilateral rs&i (75820) |
— |
$1,770 |
— |
| Vertebral fracture assessment via dxa (77086) |
— |
$313 |
— |
| Wrist 2 views (73100) |
— |
$111 |
— |
| X-Ray Ac Jts - Xr Acromioclavicular Joints Bilateral (73050) |
— |
$312 |
— |
| X-ray antegrade pyelogram tube (74425) |
— |
$772 |
— |
| X-Ray Bend Only L-S Spine (72120) |
— |
$394 |
— |
| X-Ray Elbow 2 Vw - Xr Elbow 1-2 Views Right (73070) |
— |
$571 |
— |
| X-Ray Exam Breast Specimen (76098) |
— |
$391 |
— |
| X-Ray Exam Entire Spi 1 Vw (72081) |
— |
$312 |
— |
| X-Ray Exam Entire Spi 2/3 Vw (72082) |
— |
$312 |
— |
| X-Ray Exam Hip Uni 1 View (73501) |
— |
$85 |
— |
| X-Ray Exam Hip Uni 2-3 Views (73502) |
— |
$224 |
— |
| X-Ray Exam Hips Bi 2 Views (73521) |
— |
$217 |
— |
| X-Ray Exam Hips Bi 5/> Views (73523) |
— |
$424 |
— |
| X-Ray Exam L-S Spine Bending (72114) |
— |
$658 |
— |
| X-Ray Exam Neck Spine 2-3 Vw (72040) |
— |
$361 |
— |
| X-Ray Exam Neck Spine 6/>Vws (72052) |
— |
$467 |
— |
| X-ray eye for foreign body (70030) |
— |
$414 |
— |
| X-ray humerus (73060) |
— |
$327 |
— |
| X-ray IV pyelogram (ivp) (74400) |
— |
$1,210 |
— |
| X-ray IV pyelogram+tomography (74415) |
— |
$785 |
— |
| X-Ray Knee Bilat Standing - Xr Knees Anteroposterior Standing Bilat (73565) |
— |
$299 |
— |
| X-Ray Lumbar Spine 2/3 Vw - Xr Lumbar Spine 2-3 Views (72100) |
— |
$344 |
— |
| X-ray nose-rectum child f.b. (76010) |
— |
$201 |
— |
| X-Ray Sacroiliac Jts 3+ Vw - Xr Sacroiliac Joints 3+ Views (72202) |
— |
$279 |
— |
| X-Ray Sacrum/Coccyx 2+ Vw - Xr Sacrum Coccyx 2+ Views (72220) |
— |
$384 |
— |
| X-Ray Sinuses 3+ Vw - Xr Paranasal Sinuses 3+ Views (70220) |
— |
$442 |
— |
| X-Ray Skull 4+ Vw - Xr Skull Complete 4+ Views (70260) |
— |
$389 |
— |
| X-Ray Stress View (77071) |
— |
$195 |
— |
| X-ray thoracic spine 4 vw (72074) |
— |
$294 |
— |
X-Ray Urinary Tract Exam With Contrast Material (74420)
range across 2 matching MRF lines |
— |
$97–$995 |
— |
| X-Rays Bone Length Studies (77073) |
— |
$239 |
— |
| X-Rays Bone Survey Complete (77075) |
— |
$769 |
— |
| Xr c-spine 4 or 5 views (72050) |
— |
$454 |
— |
| Xr orbits complete 4 views (70200) |
— |
$239 |
— |