| Abdomen 1 View (74018) |
— |
$832.22 |
— |
| Abdomen 2 views (74019) |
— |
$1,502.95 |
— |
| Angiography extremity bilateral rs&i (75716) |
— |
$35,286.28 |
— |
| Angiography extremity unilateral rs&i (75710) |
— |
$30,160.62 |
— |
| Ankle 2 views (73600) |
— |
$832.22 |
— |
| Aortography thoracic serialography rs&i (75605) |
— |
$52,476.40 |
— |
| Artery X-Rays Abdomen (75726) |
— |
$49,970.68 |
— |
| Artery X-Rays Pelvis (75736) |
— |
$52,473.04 |
— |
| Arthrogram hip (73525) |
— |
$3,726.34 |
— |
| Arthrogram Wrist (73115) |
— |
$5,154.71 |
— |
| Bone age studies (77072) |
— |
$1,502.95 |
— |
| Chest 1 view (71045) |
— |
$832.22 |
— |
| Chest 2 views (71046) |
— |
$832.22 |
— |
| Clavicle complete (73000) |
— |
$832.22 |
— |
| Computed Tomography Thorax Lw Dose Lng Ca Scr C- (71271) |
— |
$832.22 |
— |
| Contrast Exam Abdominl Aorta (75625) |
— |
$35,286.28 |
— |
| Contrast X-Ray Of Elbow (73085) |
— |
$5,154.71 |
— |
| Contrast X-Ray Of Knee Joint (73580) |
— |
$5,154.71 |
— |
CT abdomen and pelvis without and with contrast (74178)
range across 2 matching MRF lines |
— |
$6,851.22–$7,435.99 |
— |
| CT abdomen and pelvis without contrast (74176) |
— |
$5,144.58 |
— |
| CT abdomen w contrast (74160) |
— |
$3,544.07 |
— |
| CT abdomen w wo contrast (74170) |
— |
$3,789.58 |
— |
| CT abdomen w/o contrast (74150) |
— |
$2,588.85 |
— |
| CT Angio Abdomen and Pelvis (74174) |
— |
$5,154.71 |
— |
CT Angio Chest (71275)
range across 3 matching MRF lines |
— |
$4,610.34–$13,886.02 |
— |
| CT Angio Head (70496) |
— |
$4,847.14 |
— |
| Ct Angio Lwr Extr W/O&W/Dye (73706) |
— |
$3,877.74 |
— |
| CT Angio Neck (70498) |
— |
$4,838.88 |
— |
| CT cervical spine w/ contrast (72126) |
— |
$5,154.71 |
— |
| CT cervical spine w/o contrast (72125) |
— |
$3,328.71 |
— |
| CT cervical spine w/wo cont (72127) |
— |
$4,310.08 |
— |
CT chest w contrast (71260)
range across 3 matching MRF lines |
— |
$3,522.30–$9,665.73 |
— |
CT chest w/wo contrast (71270)
range across 3 matching MRF lines |
— |
$4,307.37–$11,158.58 |
— |
| CT head/brain with contrast (70460) |
— |
$3,059.20 |
— |
| CT head/brain without and with contrast (70470) |
— |
$3,662.92 |
— |
| CT heart contrast eval cardiac structure&morph (75572) |
— |
$7,711.39 |
— |
| CT heart no contrast quant eval coronry calcium (75571) |
— |
$832.22 |
— |
| CT l-spine w&w/o contrast (72133) |
— |
$4,725.43 |
— |
| CT lower ext w/o (73700) |
— |
$2,112.39 |
— |
| CT lower extremity w/contrast material (73701) |
— |
$3,065.56 |
— |
| CT lumbar spine w contrast (72132) |
— |
$5,154.71 |
— |
| CT lumbar spine w/o contrast (72131) |
— |
$2,872.52 |
— |
| CT maxillofacial w contrast (70487) |
— |
$3,071.81 |
— |
| CT maxillofacial wo contrast (70486) |
— |
$2,517.22 |
— |
| CT neck tissue combo (70492) |
— |
$4,164.82 |
— |
| CT orbits w/o contrast (70480) |
— |
$1,502.95 |
— |
| CT pelvis w&w/o contrast (72194) |
— |
$3,646.43 |
— |
| CT pelvis w/o contrast (72192) |
— |
$2,555.77 |
— |
| CT scan of leg combo (73702) |
— |
$3,157.85 |
— |
| CT scans face/jaw combo (70488) |
— |
$3,588.56 |
— |
| CT soft tissue neck w contrast (70491) |
— |
$3,066.82 |
— |
| CT soft tissue neck w/o contrast (70490) |
— |
$2,550.29 |
— |
| CT thoracic spine w contrast (72129) |
— |
$3,461.84 |
— |
| CT thoracic spine w/o contrast (72128) |
— |
$2,886.28 |
— |
CT thorax w/o contrast (71250)
range across 2 matching MRF lines |
— |
$2,638.38–$7,783 |
— |
CT upper ext wo (73200)
range across 10 matching MRF lines |
— |
$2,087.84–$2,192.24 |
— |
| CT upper extremity w/o & w/contrast material (73202) |
— |
$1,225.42 |
— |
| CT upper extremity with contrast (73201) |
— |
$5,154.71 |
— |
| Cta Abdl Aorta&Bi Iliofem W/Contrast&Postp (75635) |
— |
$6,474.82 |
— |
| Cta Abdomen (74175) |
— |
$4,637.85 |
— |
| Diskography lumbar (72295) |
— |
$21,793.85 |
— |
| Dxa Bone Density Axial (77080) |
— |
$1,502.95 |
— |
| Dxa bone density study 1/>sites appendiclr skel (77081) |
— |
$832.22 |
— |
| Echograp Trans R Pros Study (76873) |
— |
$1,502.95 |
— |
| Esophagram (74220) |
— |
$2,694.91 |
— |
| Fluoroscopy up to 1 hr (76000) |
— |
$3,079.88 |
— |
| Foot 2 views (73620) |
— |
$832.22 |
— |
| Forearm 2 views (73090) |
— |
$832.22 |
— |
| Hand 2 views (73120) |
— |
$1,502.95 |
— |
| Knee 3 Views (73562) |
— |
$832.22 |
— |
| Magnetic Image Jaw Joint (70336) |
— |
$4,983.55 |
— |
| Mammary ductogram or galactogram single (77053) |
— |
$3,079.88 |
— |
| MRA head w/o contrast (70544) |
— |
$6,155.32 |
— |
| MRA neck w contrast (70548) |
— |
$9,215.11 |
— |
| Mra Neck W/O &W/Contrast Material (70549) |
— |
$11,817.73 |
— |
| MRA neck w/o contrast (70547) |
— |
$8,063.92 |
— |
| MRI abdomen w/o contrast (74181) |
— |
$7,218.41 |
— |
| MRI any jt lower extrem w/contrast material (73722) |
— |
$9,240.63 |
— |
| MRI any jt lower extrem w/o & w/contrast matrl (73723) |
— |
$7,480.06 |
— |
| MRI any jt upper extremity w/contrast matrl (73222) |
— |
$9,240.63 |
— |
| MRI Breast W/O Contrast Bilateral (77047) |
— |
$3,288.20 |
— |
| MRI cervical spine w/o cont (72141) |
— |
$5,987.34 |
— |
| MRI chest w/o contrast (71550) |
— |
$6,830.09 |
— |
| MRI lower extrem oth/thn jt w/contrast matrl (73719) |
— |
$6,009.38 |
— |
| MRI lower extrem oth/thn jt w/o & w/contr matr (73720) |
— |
$7,614.99 |
— |
| MRI lower extrem oth/thn jt w/o contr matrl (73718) |
— |
$5,282.34 |
— |
| MRI lumbar spine w contrast (72149) |
— |
$6,923.72 |
— |
| Mri Neck Spine W/O & W/Dye (72156) |
— |
$8,460.50 |
— |
| MRI orbit face &/neck w/o contrast (70540) |
— |
$7,339.57 |
— |
| MRI orbit face neck w contrast (70542) |
— |
$7,791.25 |
— |
| Mri Orbt/Fac/Nck W/O &W/Dye (70543) |
— |
$11,062.96 |
— |
| MRI pelvis w/o & w contrast (72197) |
— |
$8,631.25 |
— |
| MRI pelvis w/o contrast (72195) |
— |
$6,830.09 |
— |
| MRI thoracic spine w/o contrast (72146) |
— |
$3,079.88 |
— |
| MRI upper extremity oth than jt w/contr matrl (73219) |
— |
$5,621.05 |
— |
| MRI upper extremity oth than jt w/o contr matrl (73218) |
— |
$4,717.70 |
— |
| Mri Uppr Extremity W/O&W/Dye (73220) |
— |
$6,962.28 |
— |
| MRI, abdomen, combo (74183) |
— |
$9,739.06 |
— |
| MRI, dorsal spine combo (72157) |
— |
$8,884.63 |
— |
| MRI, dorsal spine contrast (72147) |
— |
$7,011.86 |
— |
| MRI, joint upper extrem (73221) |
— |
$5,353.89 |
— |
| MRI, joint upper extrem combo (73223) |
— |
$7,747.19 |
— |
| MRI, lumbar spine combo (72158) |
— |
$8,840.56 |
— |
| Myelogram cervical (72240) |
— |
$9,240.63 |
— |
| Myelogram Lumbar (72265) |
— |
$9,240.63 |
— |
| Myelography thoracic (72255) |
— |
$9,240.63 |
— |
| Myelograpy 2/more regions rs&i (72270) |
— |
$9,240.63 |
— |
| Neck soft tissue (70360) |
— |
$832.22 |
— |
| Pelvis 1 or 2 views (72170) |
— |
$1,502.95 |
— |
| Radex Abd Compl Aqt Abd W/S/E/D Views 1 View Ch (74022) |
— |
$1,502.95 |
— |
| Radex Ankle Complete Minimum 3 Views (73610) |
— |
$832.22 |
— |
| Radex Calcaneus Minimum 2 Views (73650) |
— |
$832.22 |
— |
| Radex elbow complete minimum 3 views (73080) |
— |
$832.22 |
— |
| Radex Facial Bones Complete Minimum 3 Views (70150) |
— |
$1,502.95 |
— |
| Radex fingr minimum 2 views (73140) |
— |
$832.22 |
— |
| Radex foot complete minimum 3 views (73630) |
— |
$832.22 |
— |
| Radex Hand Minimum 3 Views (73130) |
— |
$832.22 |
— |
| Radex lower extremity infant minimum 2 views (73592) |
— |
$832.22 |
— |
| Radex Nasal Bones Complete Minimum 3 Views (70160) |
— |
$832.22 |
— |
| Radex Ribs Unilateral 2 Views (71100) |
— |
$832.22 |
— |
| Radex shoulder complete minimum 2 views (73030) |
— |
$832.22 |
— |
| Radex Spine 1 View Specify Level (72020) |
— |
$832.22 |
— |
| Radex Sternum Minimum 2 Views (71120) |
— |
$832.22 |
— |
| Radex Temporomandble Jt Opn & Clsd Mouth Bilat (70330) |
— |
$832.22 |
— |
| Radex Toe Minimum 2 Views (73660) |
— |
$832.22 |
— |
| Radex Wrist Complete Minimum 3 Views (73110) |
— |
$832.22 |
— |
| Radiolog exam mandible compl minimum 4 views (70110) |
— |
$1,502.95 |
— |
| Radiologic Exam Abdomen 3+ Views - Xr Abdomen 3+ Views (74021) |
— |
$1,502.95 |
— |
| Radiologic exam colon double contrast study (74280) |
— |
$2,694.91 |
— |
| Radiologic exam colon single contrast study (74270) |
— |
$2,694.91 |
— |
| Radiologic exam knee complete 4/more views (73564) |
— |
$1,502.95 |
— |
| Radiologic exam pelvis compl minimum 3 views (72190) |
— |
$1,502.95 |
— |
| Radiologic exam upr gi trc double contrast study (74246) |
— |
$2,694.91 |
— |
| Radiologic examination femur minimum 2 views (73552) |
— |
$832.22 |
— |
| Radiologic examination knee 1/2 views (73560) |
— |
$832.22 |
— |
| Radiologic examination tibia & fibula 2 views (73590) |
— |
$832.22 |
— |
| Ribs bilateral 3 views (71110) |
— |
$1,502.95 |
— |
| Scapula (73010) |
— |
$1,502.95 |
— |
| Screening Digital Breast Tomosynthesis Bi (77063) |
— |
$206.82 |
— |
| Shoulder 1 view (73020) |
— |
$832.22 |
— |
| Shoulder Arthrography (73040) |
— |
$5,154.71 |
— |
| Skull less than 4 views (70250) |
— |
$1,502.95 |
— |
| Thoracic spine 2 views (72070) |
— |
$1,502.95 |
— |
| Thoracic spine 3 views (72072) |
— |
$1,502.95 |
— |
| Ultrasound Breast Limited (76642) |
— |
$616.35 |
— |
| Ultrasound Elastography Parenchyma (76981) |
— |
$1,502.95 |
— |
| Ultrasound Exam Aaa Screen (76706) |
— |
$1,502.95 |
— |
| Ultrasound, abdomen limited (76705) |
— |
$1,502.95 |
— |
Upper gi w/o kub (74240)
range across 3 matching MRF lines |
— |
$2,200–$3,079.88 |
— |
| Us breast unilateral complete (76641) |
— |
$616.35 |
— |
| Us chest (76604) |
— |
$1,502.95 |
— |
| Us complete joint (76881) |
— |
$1,502.95 |
— |
| Us exam, pelvic, limited (76857) |
— |
$1,502.95 |
— |
| Us lmtd joint/oth nonvasc xtr strux r-t w/img (76882) |
— |
$1,502.95 |
— |
| Us pelvic non ob complete (76856) |
— |
$1,502.95 |
— |
| Us retroperitoneal complete (76770) |
— |
$1,502.95 |
— |
| Us retroperitoneal limited (76775) |
— |
$1,502.95 |
— |
| Us scrotum and contents (76870) |
— |
$1,502.95 |
— |
| Us thyroid (76536) |
— |
$1,502.95 |
— |
| Us transrectal (76872) |
— |
$1,502.95 |
— |
| Venography caval inferior serialography rs&i (75825) |
— |
$35,279.34 |
— |
| Venography extremity bilateral rs&i (75822) |
— |
$14,609.08 |
— |
| Venography extremity unilateral rs&i (75820) |
— |
$8,282.29 |
— |
| Wrist 2 views (73100) |
— |
$832.22 |
— |
| X-Ray Ac Jts - Xr Acromioclavicular Joints Bilateral (73050) |
— |
$484.28 |
— |
| X-Ray Aorta Leg Arteries (75630) |
— |
$30,160.62 |
— |
| X-Ray Elbow 2 Vw - Xr Elbow 1-2 Views Right (73070) |
— |
$832.22 |
— |
| X-Ray Exam Breast Specimen (76098) |
— |
$6,645.63 |
— |
| X-Ray Exam Hip Uni 1 View (73501) |
— |
$832.22 |
— |
| X-Ray Exam Hip Uni 2-3 Views (73502) |
— |
$832.22 |
— |
| X-Ray Exam Hips Bi 2 Views (73521) |
— |
$1,502.95 |
— |
| X-Ray Exam L-S Spine Bending (72114) |
— |
$1,502.95 |
— |
| X-Ray Exam Neck Spine 2-3 Vw (72040) |
— |
$832.22 |
— |
| X-Ray Exam Neck Spine 6/>Vws (72052) |
— |
$1,502.95 |
— |
| X-Ray Exam Unilat Ribs/Chest (71101) |
— |
$1,502.95 |
— |
| X-ray eye for foreign body (70030) |
— |
$832.22 |
— |
| X-ray humerus (73060) |
— |
$832.22 |
— |
| X-Ray Jaw <4 Vw - Xr Mandible < 4 Views (70100) |
— |
$832.22 |
— |
| X-Ray Knee Bilat Standing - Xr Knees Anteroposterior Standing Bilat (73565) |
— |
$832.22 |
— |
| X-Ray Lumbar Spine 2/3 Vw - Xr Lumbar Spine 2-3 Views (72100) |
— |
$1,502.95 |
— |
| X-Ray Ribs, Chest 4+ Vw - Xr Ribs 3 Vws Bil W/ Chest Posteroanterior (71111) |
— |
$1,502.95 |
— |
| X-Ray Sacroiliac Jts 3+ Vw - Xr Sacroiliac Joints 3+ Views (72202) |
— |
$1,502.95 |
— |
| X-Ray Sacroiliac Jts <3 Vw - Xr Sacroiliac Joints 1-2 Views (72200) |
— |
$1,502.95 |
— |
| X-Ray Sacrum/Coccyx 2+ Vw - Xr Sacrum Coccyx 2+ Views (72220) |
— |
$832.22 |
— |
| X-Ray Sinuses 3+ Vw - Xr Paranasal Sinuses 3+ Views (70220) |
— |
$832.22 |
— |
| X-Ray Skull 4+ Vw - Xr Skull Complete 4+ Views (70260) |
— |
$1,502.95 |
— |
| X-Ray Stress View (77071) |
— |
$937.93 |
— |
| X-ray thoracic spine 4 vw (72074) |
— |
$1,502.95 |
— |
| X-Ray Tmj Unilat (70328) |
— |
$832.22 |
— |
| X-Ray Urinary Tract Exam With Contrast Material (74420) |
— |
$5,154.71 |
— |
| Xr c-spine 4 or 5 views (72050) |
— |
$1,502.95 |
— |
| Xr facial bones less than 3 views (70140) |
— |
$832.22 |
— |
| Xr orbits complete 4 views (70200) |
— |
$1,502.95 |
— |