| Abdomen 1 View (74018) |
— |
$650 |
— |
| Abdomen 2 views (74019) |
— |
$762 |
— |
| Acute Gastrointestinal Blood Loss Imaging (78278) |
— |
$1,995 |
— |
| Angio internal mammary (75756) |
— |
$5,578 |
— |
| Angio pulmonary bilat (75743) |
— |
$6,435 |
— |
| Angiography Adrenal Bilateral Slctv Rs&I (75733) |
— |
$6,677 |
— |
| Angiography extremity bilateral rs&i (75716) |
— |
$9,750 |
— |
| Angiography extremity unilateral rs&i (75710) |
— |
$6,500 |
— |
| Angiography pulmonary unilateral slctv rs&i (75741) |
— |
$5,578 |
— |
| Angrph pulmonary nonslctv cath/ven njx rs&i (75746) |
— |
$2,844 |
— |
Ankle 2 views (73600)
range across 6 matching MRF lines |
— |
$522–$783 |
— |
| Aortography thoracic serialography rs&i (75605) |
— |
$9,650 |
— |
| Aortography thoracic w/o serialography rs&i (75600) |
— |
$6,435 |
— |
| Artery X-Rays Abdomen (75726) |
— |
$9,650 |
— |
| Artery X-Rays Adrenal Gland (75731) |
— |
$5,578 |
— |
| Artery X-Rays Pelvis (75736) |
— |
$9,650 |
— |
| Artery X-Rays Spine (75705) |
— |
$9,650 |
— |
| Arthrogram ankle (73615) |
— |
$1,228 |
— |
Arthrogram hip (73525)
range across 4 matching MRF lines |
— |
$1,228–$1,842 |
— |
Arthrogram Wrist (73115)
range across 2 matching MRF lines |
— |
$1,170–$1,755 |
— |
| Bone age studies (77072) |
— |
$484 |
— |
| Bone Imaging 3 Phase (78315) |
— |
$6,205 |
— |
| Bone Imaging Limited Area (78300) |
— |
$2,639 |
— |
| Bone Imaging Whole Body (78306) |
— |
$3,217 |
— |
| Bone marrow imaging limited area (78102) |
— |
$1,762 |
— |
| Bone marrow imaging; multiple areas (78103) |
— |
$1,828 |
— |
| Bone marrow imaging; whole body (78104) |
— |
$1,950 |
— |
| Bone survey infant (77076) |
— |
$789 |
— |
| Brain Flow Imaging Only (78610) |
— |
$1,725 |
— |
| Brain Imaging Min 4 Static Views W Vascular Flow (78606) |
— |
$2,850 |
— |
| Brain Imaging Pet Metabolic Evaluation (78608) |
— |
$11,553 |
— |
| Card Bl Pool Gated Spect Rest Wal Motn Ejct Frct (78494) |
— |
$2,036 |
— |
| Cardiac MRI w/w/o contrast & further seq (75561) |
— |
$5,058 |
— |
| Cardiac MRI w/w/o contrast w/stress (75563) |
— |
$5,755 |
— |
| Cat Scan Follow-Up Study (76380) |
— |
$1,313 |
— |
| Cerebrospinal Fluid Flow W/O Matl Shunt Evaltj (78645) |
— |
$1,772 |
— |
| Cerebrospinal Fluid Scan (78630) |
— |
$2,184 |
— |
| Chest 1 view (71045) |
— |
$561 |
— |
| Chest 2 views (71046) |
— |
$694 |
— |
| Chest 3 views (71047) |
— |
$859 |
— |
| Chest 4 or more views (71048) |
— |
$918 |
— |
Clavicle complete (73000)
range across 3 matching MRF lines |
— |
$400–$600 |
— |
| Contrast Exam Abdominl Aorta (75625) |
— |
$6,760 |
— |
| Contrast X-Ray Bladder (74430) |
— |
$1,453 |
— |
| Contrast X-Ray Of Elbow (73085) |
— |
$1,170 |
— |
Contrast X-Ray Of Knee Joint (73580)
range across 2 matching MRF lines |
— |
$1,300–$1,950 |
— |
| Corpora cavernosography (74445) |
— |
$1,400 |
— |
| CT abdomen and pelvis without and with contrast (74178) |
— |
$6,017 |
— |
| CT abdomen and pelvis without contrast (74176) |
— |
$4,301 |
— |
| CT abdomen w contrast (74160) |
— |
$3,377 |
— |
| CT abdomen w wo contrast (74170) |
— |
$4,375 |
— |
| CT abdomen w/o contrast (74150) |
— |
$2,402 |
— |
| CT Angio Abdomen and Pelvis (74174) |
— |
$9,308 |
— |
| CT Angio Chest (71275) |
— |
$4,284 |
— |
| CT Angio Head (70496) |
— |
$3,865 |
— |
| CT angio hrt w/3d image (75574) |
— |
$4,590 |
— |
Ct Angio Lwr Extr W/O&W/Dye (73706)
range across 3 matching MRF lines |
— |
$4,479–$6,719 |
— |
| CT Angio Neck (70498) |
— |
$4,186 |
— |
Ct Angio Upr Extrm W/O&W/Dye (73206)
range across 3 matching MRF lines |
— |
$4,843–$7,265 |
— |
| CT cervical spine w/ contrast (72126) |
— |
$4,875 |
— |
| CT cervical spine w/o contrast (72125) |
— |
$2,500 |
— |
| CT chest w contrast (71260) |
— |
$3,450 |
— |
| CT chest w/wo contrast (71270) |
— |
$4,080 |
— |
| CT head/brain with contrast (70460) |
— |
$3,000 |
— |
| CT head/brain without and with contrast (70470) |
— |
$3,681 |
— |
| CT heart contrast eval cardiac structure&morph (75572) |
— |
$2,889 |
— |
| CT heart no contrast quant eval coronry calcium (75571) |
— |
$1,575 |
— |
| CT hrt w/3d image congen (75573) |
— |
$3,231 |
— |
| CT iac w contrast (70481) |
— |
$3,013 |
— |
| CT l-spine w&w/o contrast (72133) |
— |
$6,855 |
— |
CT lower ext w/o (73700)
range across 3 matching MRF lines |
— |
$2,640–$3,960 |
— |
CT lower extremity w/contrast material (73701)
range across 3 matching MRF lines |
— |
$3,388–$5,082 |
— |
| CT lumbar spine w contrast (72132) |
— |
$5,601 |
— |
| CT lumbar spine w/o contrast (72131) |
— |
$2,500 |
— |
| CT maxillofacial w contrast (70487) |
— |
$2,985 |
— |
| CT maxillofacial wo contrast (70486) |
— |
$2,102 |
— |
| CT neck tissue combo (70492) |
— |
$3,987 |
— |
| Ct Orbit/Ear/Fossa W/O&W/Dye (70482) |
— |
$4,040 |
— |
| CT orbits w/o contrast (70480) |
— |
$2,500 |
— |
| CT pelvis w&w/o contrast (72194) |
— |
$4,375 |
— |
| CT pelvis w/o contrast (72192) |
— |
$2,584 |
— |
CT scan of leg combo (73702)
range across 3 matching MRF lines |
— |
$3,920–$5,880 |
— |
| CT scans face/jaw combo (70488) |
— |
$3,938 |
— |
| CT soft tissue neck w contrast (70491) |
— |
$3,000 |
— |
| CT soft tissue neck w/o contrast (70490) |
— |
$2,500 |
— |
| CT thoracic spine w contrast (72129) |
— |
$4,230 |
— |
| CT thoracic spine w/o contrast (72128) |
— |
$2,500 |
— |
| CT thoracic spine w/wo cont (72130) |
— |
$4,493 |
— |
| CT thorax w/o contrast (71250) |
— |
$2,630 |
— |
| CT unlisted procedure (76497) |
— |
$2,500 |
— |
CT upper ext wo (73200)
range across 3 matching MRF lines |
— |
$2,789–$4,184 |
— |
CT upper extremity w/o & w/contrast material (73202)
range across 3 matching MRF lines |
— |
$4,301–$6,452 |
— |
CT upper extremity with contrast (73201)
range across 3 matching MRF lines |
— |
$3,076–$4,614 |
— |
| Cta Abdl Aorta&Bi Iliofem W/Contrast&Postp (75635) |
— |
$3,125 |
— |
| Cta Abdomen (74175) |
— |
$7,465 |
— |
| CTA pelvis (72191) |
— |
$4,594 |
— |
| Dilation ureters/urethra rs&i (74485) |
— |
$4,082 |
— |
| Doppler Echo Fetal Puls Spectral F/U/Repeat (76828) |
— |
$850 |
— |
| Doppler Echo Fetal Spectral Display Complete (76827) |
— |
$1,051 |
— |
| Doppler Fetal Mid Cerebral Artery (76821) |
— |
$641 |
— |
| Dxa Bone Density Axial (77080) |
— |
$1,193 |
— |
| Dxa bone density study 1/>sites appendiclr skel (77081) |
— |
$493 |
— |
| Echo exam of fetal heart (76825) |
— |
$2,001 |
— |
| Echo Guide For Artery Repair (76936) |
— |
$1,103 |
— |
| Echocardiography, fetal, cardiovascular system, real time with image documentation (2D), with or without M-mode… (76826) |
— |
$1,364 |
— |
| Esophageal Motility Study (78258) |
— |
$2,175 |
— |
| Esophagram (74220) |
— |
$750 |
— |
| Fetal Biophys Profile W/Nst (76818) |
— |
$963 |
— |
| Fetal MRI w/placntl matrnl plvc img sing/1st ges (74712) |
— |
$3,320 |
— |
| Fluoroscopy up to 1 hr (76000) |
— |
$750 |
— |
| Follow-Up Angiography (75898) |
— |
$8,500 |
— |
Foot 2 views (73620)
range across 6 matching MRF lines |
— |
$491–$737 |
— |
Forearm 2 views (73090)
range across 3 matching MRF lines |
— |
$442–$663 |
— |
| Gastric emptying imaging study (78264) |
— |
$5,698 |
— |
| Gastroesophageal Reflux Exam (78262) |
— |
$2,355 |
— |
| Gated Heart Planar Single (78472) |
— |
$2,378 |
— |
| Gated Heart, Multiple (78473) |
— |
$3,500 |
— |
Hand 2 views (73120)
range across 6 matching MRF lines |
— |
$400–$600 |
— |
| Hepatc Vngrph Wdg/Fr Hemodyn Eval Rs&I (75889) |
— |
$6,070 |
— |
| Hepatc Vngrph Wdg/Fr W/O Hemodyn Eval Rs&I (75891) |
— |
$6,098 |
— |
| Hepatobil Syst Image W/Drug (78227) |
— |
$4,900 |
— |
| Hepatobiliary System Imaging (78226) |
— |
$3,893 |
— |
| Ht Muscle Image Spect Sing (78451) |
— |
$3,088 |
— |
| Hysterosalpingogram (74740) |
— |
$750 |
— |
| Infant hip ultrasound with hip movement (dynamic) (76885) |
— |
$1,659 |
— |
| Infant hip ultrasound, limited static exam (76886) |
— |
$546 |
— |
| Joint Survey Single View (77077) |
— |
$400 |
— |
| K Flow/Funct Image Multiple (78709) |
— |
$3,821 |
— |
| K Flow/Funct Image W/Drug (78708) |
— |
$2,625 |
— |
| K Flow/Funct Image W/O Drug (78707) |
— |
$3,451 |
— |
| Kidney Funcj Study Non-Img Radioisotopic Study (78725) |
— |
$1,534 |
— |
| Kidney Imaging Morphol (78700) |
— |
$3,422 |
— |
Knee 3 Views (73562)
range across 3 matching MRF lines |
— |
$747–$1,121 |
— |
| Leveen/Shunt Patency Exam (78291) |
— |
$2,025 |
— |
| Liver & Spleen Imaging Static Only (78215) |
— |
$3,505 |
— |
| Liver imaging static only (78201) |
— |
$2,148 |
— |
| Lung Perf&Ventilat Diferentl (78598) |
— |
$3,829 |
— |
| Lung perfusion differential (78597) |
— |
$1,971 |
— |
| Lung Ventilat&Perfus Imaging (78582) |
— |
$3,748 |
— |
| Lung Ventilation Imaging (78579) |
— |
$1,725 |
— |
| Lymph System Imaging (78195) |
— |
$3,493 |
— |
| Lymphangiography Extremity Only Bilateral Rs&I (75803) |
— |
$5,210 |
— |
| Lymphangiography extremity only unilateral rs&i (75801) |
— |
$2,875 |
— |
| Lymphangiography Pelvic/Abdominal Bilateral Rs&I (75807) |
— |
$8,775 |
— |
| Lymphangiography, pelvic/abdominal, unilateral (75805) |
— |
$7,118 |
— |
| Magnetic Image Jaw Joint (70336) |
— |
$4,550 |
— |
| Magnetic Resonance Elastography (76391) |
— |
$2,026 |
— |
| Meckels Divert Exam (78290) |
— |
$3,411 |
— |
| Mr safety determination physician/other qhp (76016) |
— |
$189 |
— |
| Mr safety implant&/fb assmt clin staf 1st 15 min (76014) |
— |
$53 |
— |
| Mr safety implt electronics prepj supvj phys/qhp (76018) |
— |
$196 |
— |
| Mr safety implt pos&/immoblj (76019) |
— |
$290 |
— |
| Mr safety med physics xm customization plng&mntr (76017) |
— |
$516 |
— |
| Mra Head W/O & W/Contrast Material (70546) |
— |
$4,000 |
— |
| MRA head w/o contrast (70544) |
— |
$2,800 |
— |
| MRA head with contrast (70545) |
— |
$3,400 |
— |
| MRA neck w contrast (70548) |
— |
$4,420 |
— |
| Mra Neck W/O &W/Contrast Material (70549) |
— |
$5,021 |
— |
| MRA neck w/o contrast (70547) |
— |
$2,800 |
— |
| MRI abdomen w contrast (74182) |
— |
$5,418 |
— |
| MRI abdomen w/o contrast (74181) |
— |
$3,500 |
— |
MRI any jt lower extrem w/contrast material (73722)
range across 3 matching MRF lines |
— |
$6,680–$10,020 |
— |
MRI any jt lower extrem w/o & w/contrast matrl (73723)
range across 3 matching MRF lines |
— |
$6,827–$10,241 |
— |
MRI any jt upper extremity w/contrast matrl (73222)
range across 3 matching MRF lines |
— |
$4,457–$6,686 |
— |
| MRI brain functional w/o physician admnistration (70554) |
— |
$3,500 |
— |
| MRI brain functional w/physician admnistration (70555) |
— |
$6,051 |
— |
| MRI cardiac w/o contrast (75557) |
— |
$4,158 |
— |
| MRI cervical spine w contrast (72142) |
— |
$3,740 |
— |
| MRI cervical spine w/o cont (72141) |
— |
$3,080 |
— |
| MRI chest w/o contrast (71550) |
— |
$3,321 |
— |
| MRI chest with contrast (71551) |
— |
$4,861 |
— |
| MRI chest wo w contrast (71552) |
— |
$6,218 |
— |
MRI lower extrem oth/thn jt w/contrast matrl (73719)
range across 3 matching MRF lines |
— |
$4,930–$7,395 |
— |
MRI lower extrem oth/thn jt w/o & w/contr matr (73720)
range across 3 matching MRF lines |
— |
$5,316–$7,974 |
— |
MRI lower extrem oth/thn jt w/o contr matrl (73718)
range across 3 matching MRF lines |
— |
$3,255–$4,883 |
— |
| MRI lumbar spine w contrast (72149) |
— |
$3,740 |
— |
| Mri Neck Spine W/O & W/Dye (72156) |
— |
$5,362 |
— |
| MRI orbit face &/neck w/o contrast (70540) |
— |
$3,169 |
— |
| MRI orbit face neck w contrast (70542) |
— |
$4,337 |
— |
| Mri Orbt/Fac/Nck W/O &W/Dye (70543) |
— |
$5,000 |
— |
| MRI pelvis w contrast (72196) |
— |
$5,160 |
— |
| MRI pelvis w/o & w contrast (72197) |
— |
$6,237 |
— |
| MRI pelvis w/o contrast (72195) |
— |
$4,400 |
— |
| MRI spectroscopy (76390) |
— |
$2,682 |
— |
| MRI thoracic spine w/o contrast (72146) |
— |
$3,080 |
— |
MRI upper extremity oth than jt w/contr matrl (73219)
range across 3 matching MRF lines |
— |
$4,854–$7,281 |
— |
MRI upper extremity oth than jt w/o contr matrl (73218)
range across 3 matching MRF lines |
— |
$4,550–$6,825 |
— |
Mri Uppr Extremity W/O&W/Dye (73220)
range across 3 matching MRF lines |
— |
$5,484–$8,226 |
— |
| MRI, abdomen, combo (74183) |
— |
$5,763 |
— |
| MRI, dorsal spine combo (72157) |
— |
$5,256 |
— |
| MRI, dorsal spine contrast (72147) |
— |
$3,740 |
— |
MRI, joint upper extrem (73221)
range across 3 matching MRF lines |
— |
$3,500–$5,250 |
— |
MRI, joint upper extrem combo (73223)
range across 3 matching MRF lines |
— |
$5,312–$7,968 |
— |
| MRI, lumbar spine combo (72158) |
— |
$4,708 |
— |
| Myelogram cervical (72240) |
— |
$2,025 |
— |
| Myelogram Lumbar (72265) |
— |
$2,188 |
— |
| Myelography thoracic (72255) |
— |
$2,188 |
— |
| Myelograpy 2/more regions rs&i (72270) |
— |
$2,428 |
— |
| Myocardial Spect Multiple Studies (78452) |
— |
$4,440 |
— |
| Neck soft tissue (70360) |
— |
$425 |
— |
| Nm csf leak detection (78650) |
— |
$2,784 |
— |
| Nonvascular Shunt X-Ray (75809) |
— |
$639 |
— |
| Nuclear medicine study of endocrine organs (78099) |
— |
$1,800 |
— |
| Nuclear Rx Oral Admin (79005) |
— |
$3,737 |
— |
| Ophthalmic ultrasound dx b-scan w/wo a-scan (76512) |
— |
$692 |
— |
| Panoramic X-ray of jaws (70355) |
— |
$382 |
— |
| Parathyroid Planar Imaging (78070) |
— |
$1,733 |
— |
| Parathyroid planar imaging w/wo subtraction (78071) |
— |
$1,974 |
— |
| Pelvis 1 or 2 views (72170) |
— |
$500 |
— |
| Perineogram (74775) |
— |
$1,725 |
— |
| Peritoneogram Rs&I (74190) |
— |
$3,045 |
— |
| Pet Image W/Ct Lmtd (78814) |
— |
$7,517 |
— |
| PET image w/CT, full body (78816) |
— |
$12,951 |
— |
| PET imaging CT attenuation skull base mid-thigh (78815) |
— |
$9,868 |
— |
| Prq Transhepatc Portograpy Hemodyn Eval Rs&I (75885) |
— |
$6,435 |
— |
| Pulmonary Perfusion Imaging Particulate (78580) |
— |
$2,988 |
— |
| Radex Abd Compl Aqt Abd W/S/E/D Views 1 View Ch (74022) |
— |
$1,016 |
— |
| Radex abscess/fistula/sinus tract rs&i (76080) |
— |
$1,138 |
— |
Radex Ankle Complete Minimum 3 Views (73610)
range across 3 matching MRF lines |
— |
$578–$867 |
— |
Radex Calcaneus Minimum 2 Views (73650)
range across 3 matching MRF lines |
— |
$703–$1,055 |
— |
Radex elbow complete minimum 3 views (73080)
range across 3 matching MRF lines |
— |
$564–$846 |
— |
| Radex Facial Bones Complete Minimum 3 Views (70150) |
— |
$578 |
— |
Radex fingr minimum 2 views (73140)
range across 6 matching MRF lines |
— |
$516–$774 |
— |
Radex foot complete minimum 3 views (73630)
range across 3 matching MRF lines |
— |
$515–$773 |
— |
Radex Hand Minimum 3 Views (73130)
range across 3 matching MRF lines |
— |
$507–$761 |
— |
Radex lower extremity infant minimum 2 views (73592)
range across 3 matching MRF lines |
— |
$348–$522 |
— |
| Radex Nasal Bones Complete Minimum 3 Views (70160) |
— |
$644 |
— |
| Radex Pharynx/Larx W/Fluor&/Magnification Tq (70370) |
— |
$620 |
— |
| Radex Ribs Unilateral 2 Views (71100) |
— |
$327 |
— |
Radex shoulder complete minimum 2 views (73030)
range across 3 matching MRF lines |
— |
$563–$845 |
— |
| Radex Sinuses Paransl < 3 Views (70210) |
— |
$350 |
— |
| Radex Spine 1 View Specify Level (72020) |
— |
$373 |
— |
| Radex Sternum Minimum 2 Views (71120) |
— |
$600 |
— |
| Radex Temporomandble Jt Opn & Clsd Mouth Bilat (70330) |
— |
$750 |
— |
Radex Toe Minimum 2 Views (73660)
range across 3 matching MRF lines |
— |
$369–$554 |
— |
Radex upper extremity infant minimum 2 views (73092)
range across 3 matching MRF lines |
— |
$613–$920 |
— |
Radex Wrist Complete Minimum 3 Views (73110)
range across 3 matching MRF lines |
— |
$498–$747 |
— |
| Radex X-Ray Exam Entire Spi 6/> Vw - Xr Entire Spine 6+ Vw (72084) |
— |
$1,310 |
— |
| Radiolog exam mandible compl minimum 4 views (70110) |
— |
$663 |
— |
| Radiologic Exam Abdomen 3+ Views - Xr Abdomen 3+ Views (74021) |
— |
$889 |
— |
| Radiologic exam colon single contrast study (74270) |
— |
$1,719 |
— |
Radiologic exam knee complete 4/more views (73564)
range across 3 matching MRF lines |
— |
$854–$1,281 |
— |
| Radiologic exam pelvis compl minimum 3 views (72190) |
— |
$682 |
— |
| Radiologic Exam Small Int Single Contrast Study (74250) |
— |
$956 |
— |
| Radiologic exam swallow function contrast study (74230) |
— |
$1,044 |
— |
| Radiologic exam upr gi trc double contrast study (74246) |
— |
$1,157 |
— |
Radiologic examination femur 1 view (73551)
range across 3 matching MRF lines |
— |
$425–$638 |
— |
Radiologic examination femur minimum 2 views (73552)
range across 3 matching MRF lines |
— |
$500–$750 |
— |
Radiologic examination knee 1/2 views (73560)
range across 9 matching MRF lines |
— |
$570–$855 |
— |
| Radiologic Examination Osseous Survey Limited (77074) |
— |
$677 |
— |
Radiologic examination tibia & fibula 2 views (73590)
range across 7 matching MRF lines |
— |
$473–$1,065 |
— |
| Renal Cyst Study (74470) |
— |
$2,550 |
— |
| Ribs bilateral 3 views (71110) |
— |
$725 |
— |
| Rp loclzj tum plnr 1 area single day imaging (78800) |
— |
$1,111 |
— |
| Rp Loclzj Tum Plnr Whole Body 2+ Days Imaging (78804) |
— |
$5,950 |
— |
| Rp Loclzj Tum Plnr Whole Body Single Day Imaging (78802) |
— |
$2,815 |
— |
| Rp Loclzj Tum Spect 1 Area Single Day Imaging (78803) |
— |
$5,117 |
— |
| Rp loclzj tum spect CT 2area 1d img/1 ar img>2+d (78832) |
— |
$6,638 |
— |
| Rp Therapy Unlisted Procedure (79999) |
— |
$2,300 |
— |
| Salivary Gland Function Study (78232) |
— |
$2,175 |
— |
Scapula (73010)
range across 3 matching MRF lines |
— |
$520–$780 |
— |
Shoulder 1 view (73020)
range across 3 matching MRF lines |
— |
$400–$600 |
— |
Shoulder Arthrography (73040)
range across 2 matching MRF lines |
— |
$1,473–$2,210 |
— |
| Sialogram (70390) |
— |
$910 |
— |
| Skull less than 4 views (70250) |
— |
$400 |
— |
| Speech evaluation, complex (70371) |
— |
$750 |
— |
| Sternoclavicular joints (71130) |
— |
$1,110 |
— |
| Superior sagittal sinus venogram (75870) |
— |
$4,084 |
— |
| Temporomandble Jt Arthrography Rs&I (70332) |
— |
$1,000 |
— |
| Therapeutic Enema Rdctj Intussusception/Obstrcj (74283) |
— |
$1,625 |
— |
| Thoracic spine 2 views (72070) |
— |
$375 |
— |
| Thoracic spine 3 views (72072) |
— |
$920 |
— |
| Thoracolumbar 2 views (72080) |
— |
$613 |
— |
| Thyroid Carcinoma Metastases Img Lmtd Area (78015) |
— |
$2,400 |
— |
| Thyroid Imaging With Vascular Flow (78013) |
— |
$1,650 |
— |
| Thyroid Met Imaging Body (78018) |
— |
$5,693 |
— |
| Thyroid Uptake Measurement (78012) |
— |
$1,350 |
— |
| Thyroid Uptake W/Blood Flow Sngle/Mult Quan Meas (78014) |
— |
$3,835 |
— |
Ultrasound Breast Limited (76642)
range across 4 matching MRF lines |
— |
$600–$900 |
— |
| Ultrasound elastography first target lesion (76982) |
— |
$945 |
— |
| Ultrasound Elastography Parenchyma (76981) |
— |
$921 |
— |
| Ultrasound trgt dynamic microbubble 1st lesion (76978) |
— |
$1,001 |
— |
| Ultrasound, abdomen limited (76705) |
— |
$866 |
— |
| Umbilical-artery Doppler (OB) (76820) |
— |
$540 |
— |
| Unlisted Dx Radiographic Procedure (76499) |
— |
$269 |
— |
| Unlisted fluoroscopic procedure (76496) |
— |
$750 |
— |
Unlisted magnetic resonance procedure (76498)
range across 2 matching MRF lines |
— |
$606–$4,000 |
— |
| Unlisted Miscellaneous Px Dx Nuclear Medicine (78999) |
— |
$2,300 |
— |
| Unlisted us procedure (76999) |
— |
$790 |
— |
| Upper gi w/o kub (74240) |
— |
$1,014 |
— |
| Ureteral Reflux Study (78740) |
— |
$1,675 |
— |
| Urethrocystogram voiding (74455) |
— |
$1,081 |
— |
| Urethrocystography retrograde (74450) |
— |
$1,104 |
— |
Us breast unilateral complete (76641)
range across 4 matching MRF lines |
— |
$1,375–$2,063 |
— |
| Us chest (76604) |
— |
$899 |
— |
| Us complete joint (76881) |
— |
$704 |
— |
| Us exam, pelvic, limited (76857) |
— |
$542 |
— |
| Us head (76506) |
— |
$1,250 |
— |
| Us kidney transplant (76776) |
— |
$920 |
— |
| Us lmtd joint/oth nonvasc xtr strux r-t w/img (76882) |
— |
$525 |
— |
| Us ob detailed single fetus (76811) |
— |
$1,329 |
— |
| Us ob limited 1 or more fetuses (76815) |
— |
$878 |
— |
| Us ob transvaginal (76817) |
— |
$1,196 |
— |
| Us pelvic non ob complete (76856) |
— |
$850 |
— |
| Us pg uter img f&mat 14 wk tabdl 1/1st gestation (76801) |
— |
$821 |
— |
| Us preg uterus real time f/u trnsabdl per fetus (76816) |
— |
$1,336 |
— |
| Us retroperitoneal complete (76770) |
— |
$979 |
— |
| Us retroperitoneal limited (76775) |
— |
$748 |
— |
| Us scrotum and contents (76870) |
— |
$948 |
— |
| Us spinal canal and contents (76800) |
— |
$1,235 |
— |
| Us thyroid (76536) |
— |
$1,013 |
— |
| Us transrectal (76872) |
— |
$903 |
— |
| Vasogram (74440) |
— |
$850 |
— |
| Vein X-Ray Chest (75827) |
— |
$5,913 |
— |
| Vein X-Ray Liver W/O Hemodyn (75887) |
— |
$4,084 |
— |
| Vein X-Ray Skull Epidural (75872) |
— |
$3,800 |
— |
| Vein X-Ray Spleen/Liver (75810) |
— |
$9,458 |
— |
| Venogram Sinus/Jugular (75860) |
— |
$5,578 |
— |
| Venography Adrenal Unilateral (75840) |
— |
$6,435 |
— |
| Venography caval inferior serialography rs&i (75825) |
— |
$5,578 |
— |
| Venography extremity bilateral rs&i (75822) |
— |
$3,145 |
— |
| Venography extremity unilateral rs&i (75820) |
— |
$2,731 |
— |
| Venography Orbital Rs&I (75880) |
— |
$2,850 |
— |
| Venography Renal Bilateral (75833) |
— |
$6,677 |
— |
| Venography Renal Unilateral (75831) |
— |
$5,578 |
— |
| Venous sampling by catheter (75893) |
— |
$9,650 |
— |
| Venous Thrombosis Imaging Venogram Bilateral (78458) |
— |
$2,250 |
— |
| Vertebral fracture assessment via dxa (77086) |
— |
$465 |
— |
Wrist 2 views (73100)
range across 6 matching MRF lines |
— |
$415–$623 |
— |
| X-Ray Ac Jts - Xr Acromioclavicular Joints Bilateral (73050) |
— |
$590 |
— |
| X-ray antegrade pyelogram tube (74425) |
— |
$1,228 |
— |
| X-Ray Aorta Leg Arteries (75630) |
— |
$7,336 |
— |
| X-Ray Bend Only L-S Spine (72120) |
— |
$727 |
— |
X-Ray Elbow 2 Vw - Xr Elbow 1-2 Views Right (73070)
range across 6 matching MRF lines |
— |
$448–$672 |
— |
| X-Ray Exam Breast Specimen (76098) |
— |
$1,169 |
— |
| X-Ray Exam Entire Spi 1 Vw (72081) |
— |
$488 |
— |
| X-Ray Exam Entire Spi 2/3 Vw (72082) |
— |
$736 |
— |
| X-Ray Exam Entire Spi 4/5 Vw (72083) |
— |
$1,187 |
— |
| X-Ray Exam Hip Uni 1 View (73501) |
— |
$300 |
— |
| X-Ray Exam Hip Uni 2-3 Views (73502) |
— |
$476 |
— |
| X-Ray Exam Hip Uni 4/> Views (73503) |
— |
$715 |
— |
| X-Ray Exam Hips Bi 2 Views (73521) |
— |
$556 |
— |
| X-Ray Exam Hips Bi 3-4 Views (73522) |
— |
$834 |
— |
| X-Ray Exam Hips Bi 5/> Views (73523) |
— |
$1,161 |
— |
| X-Ray Exam L-S Spine Bending (72114) |
— |
$1,507 |
— |
| X-Ray Exam Neck Spine 2-3 Vw (72040) |
— |
$400 |
— |
| X-Ray Exam Neck Spine 6/>Vws (72052) |
— |
$949 |
— |
| X-Ray Exam Unilat Ribs/Chest (71101) |
— |
$700 |
— |
| X-ray head for orthodontia (70350) |
— |
$509 |
— |
X-ray humerus (73060)
range across 3 matching MRF lines |
— |
$461–$692 |
— |
| X-ray IV pyelogram (ivp) (74400) |
— |
$1,500 |
— |
| X-Ray Jaw <4 Vw - Xr Mandible < 4 Views (70100) |
— |
$466 |
— |
| X-Ray Knee Bilat Standing - Xr Knees Anteroposterior Standing Bilat (73565) |
— |
$752 |
— |
| X-Ray Lumbar Spine 2/3 Vw - Xr Lumbar Spine 2-3 Views (72100) |
— |
$400 |
— |
| X-ray nose-rectum child f.b. (76010) |
— |
$334 |
— |
| X-Ray Ribs, Chest 4+ Vw - Xr Ribs 3 Vws Bil W/ Chest Posteroanterior (71111) |
— |
$913 |
— |
| X-Ray Sacroiliac Jts 3+ Vw - Xr Sacroiliac Joints 3+ Views (72202) |
— |
$670 |
— |
| X-Ray Sacroiliac Jts <3 Vw - Xr Sacroiliac Joints 1-2 Views (72200) |
— |
$335 |
— |
| X-Ray Sacrum/Coccyx 2+ Vw - Xr Sacrum Coccyx 2+ Views (72220) |
— |
$520 |
— |
| X-Ray Sinuses 3+ Vw - Xr Paranasal Sinuses 3+ Views (70220) |
— |
$813 |
— |
| X-Ray Skull 4+ Vw - Xr Skull Complete 4+ Views (70260) |
— |
$917 |
— |
| X-Ray Stress View (77071) |
— |
$443 |
— |
| X-ray thoracic spine 4 vw (72074) |
— |
$1,048 |
— |
| X-Ray Tmj Unilat (70328) |
— |
$625 |
— |
| X-Ray Urinary Tract Exam With Contrast Material (74420) |
— |
$1,093 |
— |
| X-Rays Bone Length Studies (77073) |
— |
$423 |
— |
| X-Rays Bone Survey Complete (77075) |
— |
$1,585 |
— |
| Xr c-spine 4 or 5 views (72050) |
— |
$500 |
— |
| Xr facial bones less than 3 views (70140) |
— |
$490 |
— |
| Xr orbits complete 4 views (70200) |
— |
$700 |
— |