| Abdomen 1 View (74018) |
— |
$1,017 |
— |
| Abdomen 2 views (74019) |
— |
$781 |
— |
| Acute Gastrointestinal Blood Loss Imaging (78278) |
— |
$912 |
— |
| Angio pulmonary bilat (75743) |
— |
$17,599 |
— |
| Angiography Adrenal Bilateral Slctv Rs&I (75733) |
— |
$8,093 |
— |
| Angiography extremity bilateral rs&i (75716) |
— |
$14,526 |
— |
| Angiography extremity unilateral rs&i (75710) |
— |
$13,760 |
— |
| Angiography pulmonary unilateral slctv rs&i (75741) |
— |
$17,599 |
— |
Ankle 2 views (73600)
range across 3 matching MRF lines |
— |
$946–$1,890 |
— |
| Artery X-Rays Abdomen (75726) |
— |
$9,206 |
— |
| Artery X-Rays Pelvis (75736) |
— |
$12,275 |
— |
| Bone age studies (77072) |
— |
$1,016 |
— |
| Bone Imaging 3 Phase (78315) |
— |
$6,485 |
— |
| Bone Imaging Whole Body (78306) |
— |
$5,949 |
— |
| Bone marrow imaging; multiple areas (78103) |
— |
$2,525 |
— |
| Bone survey infant (77076) |
— |
$1,085 |
— |
| Brain Imaging Min 4 Static Views W Vascular Flow (78606) |
— |
$3,737 |
— |
| Cat Scan Follow-Up Study (76380) |
— |
$1,446 |
— |
| Chest 1 view (71045) |
— |
$912 |
— |
| Chest 2 views (71046) |
— |
$1,416 |
— |
| Chest 3 views (71047) |
— |
$1,524 |
— |
| Chest 4 or more views (71048) |
— |
$1,650 |
— |
| Clavicle complete (73000) |
— |
$657 |
— |
| Computed Tomography Thorax Lw Dose Lng Ca Scr C- (71271) |
— |
$1,060 |
— |
| Contrast Exam Abdominl Aorta (75625) |
— |
$9,206 |
— |
| Contrast X-Ray Bladder (74430) |
— |
$1,184 |
— |
| CT abdomen and pelvis without and with contrast (74178) |
— |
$4,582 |
— |
| CT abdomen and pelvis without contrast (74176) |
— |
$2,535 |
— |
| CT abdomen w contrast (74160) |
— |
$3,122 |
— |
| CT abdomen w wo contrast (74170) |
— |
$3,255 |
— |
| CT abdomen w/o contrast (74150) |
— |
$1,488 |
— |
| CT Angio Chest (71275) |
— |
$4,937 |
— |
| CT Angio Head (70496) |
— |
$4,041 |
— |
| Ct Angio Lwr Extr W/O&W/Dye (73706) |
— |
$2,669 |
— |
| CT Angio Neck (70498) |
— |
$4,047 |
— |
| Ct Angio Upr Extrm W/O&W/Dye (73206) |
— |
$2,299 |
— |
| CT cervical spine w/ contrast (72126) |
— |
$4,475 |
— |
| CT cervical spine w/o contrast (72125) |
— |
$3,913 |
— |
| CT chest w contrast (71260) |
— |
$3,102 |
— |
| CT chest w/wo contrast (71270) |
— |
$4,553 |
— |
| CT head/brain with contrast (70460) |
— |
$4,068 |
— |
| CT head/brain without and with contrast (70470) |
— |
$1,886 |
— |
| CT iac w contrast (70481) |
— |
$4,592 |
— |
| CT l-spine w&w/o contrast (72133) |
— |
$4,415 |
— |
CT lower ext w/o (73700)
range across 3 matching MRF lines |
— |
$3,001–$3,302 |
— |
CT lower extremity w/contrast material (73701)
range across 2 matching MRF lines |
— |
$3,188–$3,507 |
— |
| CT lumbar spine w contrast (72132) |
— |
$4,857 |
— |
| CT lumbar spine w/o contrast (72131) |
— |
$4,308 |
— |
| CT maxillofacial w contrast (70487) |
— |
$4,638 |
— |
| CT maxillofacial wo contrast (70486) |
— |
$4,020 |
— |
| CT neck tissue combo (70492) |
— |
$5,364 |
— |
| Ct Orbit/Ear/Fossa W/O&W/Dye (70482) |
— |
$5,527 |
— |
| CT orbits w/o contrast (70480) |
— |
$4,268 |
— |
| CT pelvis w&w/o contrast (72194) |
— |
$3,913 |
— |
| CT pelvis w/o contrast (72192) |
— |
$2,742 |
— |
| CT scan of leg combo (73702) |
— |
$4,090 |
— |
| CT scans face/jaw combo (70488) |
— |
$5,364 |
— |
| CT soft tissue neck w contrast (70491) |
— |
$5,715 |
— |
| CT soft tissue neck w/o contrast (70490) |
— |
$5,070 |
— |
| CT thoracic spine w contrast (72129) |
— |
$4,323 |
— |
| CT thoracic spine w/o contrast (72128) |
— |
$3,635 |
— |
| CT thoracic spine w/wo cont (72130) |
— |
$3,581 |
— |
| CT thorax w/o contrast (71250) |
— |
$1,477 |
— |
| CT upper ext wo (73200) |
— |
$2,898 |
— |
| CT upper extremity w/o & w/contrast material (73202) |
— |
$3,537 |
— |
| CT upper extremity with contrast (73201) |
— |
$3,177 |
— |
| Cta Abdl Aorta&Bi Iliofem W/Contrast&Postp (75635) |
— |
$5,070 |
— |
| Cta Abdomen (74175) |
— |
$5,185 |
— |
| CTA pelvis (72191) |
— |
$2,849 |
— |
| Doppler Echo Fetal Puls Spectral F/U/Repeat (76828) |
— |
$554 |
— |
| Doppler Echo Fetal Spectral Display Complete (76827) |
— |
$555 |
— |
| Doppler Fetal Mid Cerebral Artery (76821) |
— |
$555 |
— |
| Esophagram (74220) |
— |
$1,685 |
— |
| Fetal Biophys Profile W/Nst (76818) |
— |
$1,769 |
— |
Fetal Biophysical Profile W/O Non-Stress Testing (76819)
range across 2 matching MRF lines |
— |
$555–$1,568 |
— |
| Fluoroscopy up to 1 hr (76000) |
— |
$1,138 |
— |
| Follow-Up Angiography (75898) |
— |
$8,671 |
— |
Foot 2 views (73620)
range across 3 matching MRF lines |
— |
$888–$1,769 |
— |
Forearm 2 views (73090)
range across 3 matching MRF lines |
— |
$996–$1,989 |
— |
| Gastric emptying imaging study (78264) |
— |
$3,122 |
— |
| Gated Heart Planar Single (78472) |
— |
$3,413 |
— |
| Gated Heart, Multiple (78473) |
— |
$1,578 |
— |
Hand 2 views (73120)
range across 3 matching MRF lines |
— |
$844–$1,674 |
— |
| Hepatobiliary System Imaging (78226) |
— |
$3,248 |
— |
| Hysterosalpingogram (74740) |
— |
$1,411 |
— |
| Infant hip ultrasound, limited static exam (76886) |
— |
$334 |
— |
| K Flow/Funct Image Multiple (78709) |
— |
$1,645 |
— |
Knee 3 Views (73562)
range across 3 matching MRF lines |
— |
$1,073–$2,136 |
— |
| Lung Ventilat&Perfus Imaging (78582) |
— |
$5,954 |
— |
| Lymph System Imaging (78195) |
— |
$3,189 |
— |
| Meckels Divert Exam (78290) |
— |
$4,077 |
— |
| MRA head w/o contrast (70544) |
— |
$8,452 |
— |
| MRA head with contrast (70545) |
— |
$10,813 |
— |
| MRA neck w contrast (70548) |
— |
$9,203 |
— |
| Mra Neck W/O &W/Contrast Material (70549) |
— |
$10,196 |
— |
| MRA neck w/o contrast (70547) |
— |
$7,780 |
— |
| MRI abdomen w contrast (74182) |
— |
$6,202 |
— |
| MRI abdomen w/o contrast (74181) |
— |
$4,813 |
— |
| MRI any jt lower extrem w/contrast material (73722) |
— |
$6,184 |
— |
| MRI any jt lower extrem w/o & w/contrast matrl (73723) |
— |
$10,899 |
— |
| MRI any jt upper extremity w/contrast matrl (73222) |
— |
$5,216 |
— |
| MRI Breast Without Contrast Material Unilateral (77046) |
— |
$6,309 |
— |
| MRI cervical spine w contrast (72142) |
— |
$9,514 |
— |
| MRI cervical spine w/o cont (72141) |
— |
$8,819 |
— |
| MRI chest w/o contrast (71550) |
— |
$4,201 |
— |
| MRI chest wo w contrast (71552) |
— |
$6,222 |
— |
| MRI lower extrem oth/thn jt w/contrast matrl (73719) |
— |
$9,177 |
— |
| MRI lower extrem oth/thn jt w/o & w/contr matr (73720) |
— |
$10,361 |
— |
| MRI lower extrem oth/thn jt w/o contr matrl (73718) |
— |
$8,332 |
— |
| MRI lumbar spine w contrast (72149) |
— |
$10,351 |
— |
| Mri Neck Spine W/O & W/Dye (72156) |
— |
$13,568 |
— |
| MRI orbit face &/neck w/o contrast (70540) |
— |
$6,586 |
— |
| MRI orbit face neck w contrast (70542) |
— |
$8,301 |
— |
| Mri Orbt/Fac/Nck W/O &W/Dye (70543) |
— |
$9,002 |
— |
| MRI pelvis w contrast (72196) |
— |
$5,945 |
— |
| MRI pelvis w/o & w contrast (72197) |
— |
$6,927 |
— |
| MRI pelvis w/o contrast (72195) |
— |
$5,256 |
— |
| MRI thoracic spine w/o contrast (72146) |
— |
$8,824 |
— |
| MRI upper extremity oth than jt w/o contr matrl (73218) |
— |
$8,569 |
— |
| Mri Uppr Extremity W/O&W/Dye (73220) |
— |
$10,139 |
— |
| MRI, abdomen, combo (74183) |
— |
$7,137 |
— |
| MRI, dorsal spine combo (72157) |
— |
$11,471 |
— |
| MRI, dorsal spine contrast (72147) |
— |
$9,628 |
— |
| MRI, joint upper extrem (73221) |
— |
$8,531 |
— |
| MRI, joint upper extrem combo (73223) |
— |
$10,448 |
— |
| MRI, lumbar spine combo (72158) |
— |
$12,792 |
— |
| Myocardial Spect Multiple Studies (78452) |
— |
$9,749 |
— |
| Neck soft tissue (70360) |
— |
$656 |
— |
| Nuclear Rx Oral Admin (79005) |
— |
$733 |
— |
| Ob us nuchal meas 1 gest (76813) |
— |
$555 |
— |
| Oph us dx ant sgm us immersion b-scan/hr biom (76513) |
— |
$602 |
— |
| Ophthalmic ultrasound dx b-scan w/wo a-scan (76512) |
— |
$504 |
— |
| Ophthalmic US Dx Corneal Pachymetry Uni/Bi (76514) |
— |
$160 |
— |
| Ophthalmic us dx quantitative a-scan only (76511) |
— |
$732 |
— |
| Parathyroid Planar Imaging (78070) |
— |
$4,472 |
— |
| Pelvis 1 or 2 views (72170) |
— |
$1,049 |
— |
| Pulmonary Perfusion Imaging Particulate (78580) |
— |
$4,443 |
— |
| Radex Abd Compl Aqt Abd W/S/E/D Views 1 View Ch (74022) |
— |
$1,757 |
— |
| Radex abscess/fistula/sinus tract rs&i (76080) |
— |
$1,980 |
— |
Radex Ankle Complete Minimum 3 Views (73610)
range across 3 matching MRF lines |
— |
$1,135–$2,260 |
— |
Radex Calcaneus Minimum 2 Views (73650)
range across 3 matching MRF lines |
— |
$602–$1,202 |
— |
Radex elbow complete minimum 3 views (73080)
range across 3 matching MRF lines |
— |
$781–$1,556 |
— |
| Radex Facial Bones Complete Minimum 3 Views (70150) |
— |
$345 |
— |
| Radex fingr minimum 2 views (73140) |
— |
$935 |
— |
Radex foot complete minimum 3 views (73630)
range across 3 matching MRF lines |
— |
$1,062–$2,120 |
— |
Radex Hand Minimum 3 Views (73130)
range across 3 matching MRF lines |
— |
$1,055–$2,103 |
— |
Radex lower extremity infant minimum 2 views (73592)
range across 3 matching MRF lines |
— |
$427–$1,033 |
— |
| Radex Nasal Bones Complete Minimum 3 Views (70160) |
— |
$796 |
— |
| Radex Ribs Unilateral 2 Views (71100) |
— |
$1,149 |
— |
Radex shoulder complete minimum 2 views (73030)
range across 3 matching MRF lines |
— |
$1,252–$2,502 |
— |
| Radex Spine 1 View Specify Level (72020) |
— |
$877 |
— |
| Radex Sternum Minimum 2 Views (71120) |
— |
$783 |
— |
| Radex Temporomandble Jt Opn & Clsd Mouth Bilat (70330) |
— |
$995 |
— |
Radex Toe Minimum 2 Views (73660)
range across 10 matching MRF lines |
— |
$883–$912 |
— |
| Radex upper extremity infant minimum 2 views (73092) |
— |
$270 |
— |
Radex Wrist Complete Minimum 3 Views (73110)
range across 3 matching MRF lines |
— |
$1,119–$2,230 |
— |
| Radiolog exam mandible compl minimum 4 views (70110) |
— |
$900 |
— |
| Radiologic exam colon single contrast study (74270) |
— |
$1,274 |
— |
| Radiologic exam knee complete 4/more views (73564) |
— |
$1,209 |
— |
| Radiologic exam pelvis compl minimum 3 views (72190) |
— |
$1,448 |
— |
| Radiologic Exam Small Int Single Contrast Study (74250) |
— |
$1,128 |
— |
| Radiologic exam swallow function contrast study (74230) |
— |
$1,254 |
— |
| Radiologic exam upr gi trc double contrast study (74246) |
— |
$754 |
— |
Radiologic examination femur minimum 2 views (73552)
range across 3 matching MRF lines |
— |
$1,016–$2,028 |
— |
Radiologic examination knee 1/2 views (73560)
range across 3 matching MRF lines |
— |
$904–$1,800 |
— |
| Radiologic Examination Osseous Survey Limited (77074) |
— |
$1,366 |
— |
Radiologic examination tibia & fibula 2 views (73590)
range across 3 matching MRF lines |
— |
$1,001–$1,997 |
— |
| Ribs bilateral 3 views (71110) |
— |
$1,443 |
— |
| Rp Loclzj Tum Plnr Whole Body 2+ Days Imaging (78804) |
— |
$6,951 |
— |
| Rp Loclzj Tum Plnr Whole Body Single Day Imaging (78802) |
— |
$3,629 |
— |
| Rp Loclzj Tum Spect 1 Area Single Day Imaging (78803) |
— |
$2,771 |
— |
| Scapula (73010) |
— |
$1,119 |
— |
| Shoulder 1 view (73020) |
— |
$879 |
— |
| Skull less than 4 views (70250) |
— |
$685 |
— |
| Thoracic spine 2 views (72070) |
— |
$1,097 |
— |
| Thyroid Imaging With Vascular Flow (78013) |
— |
$2,335 |
— |
| Thyroid Met Imaging Body (78018) |
— |
$3,332 |
— |
| Thyroid Uptake W/Blood Flow Sngle/Mult Quan Meas (78014) |
— |
$3,518 |
— |
| Ultrasound Breast Limited (76642) |
— |
$1,302 |
— |
| Ultrasound, abdomen limited (76705) |
— |
$1,908 |
— |
| Umbilical-artery Doppler (OB) (76820) |
— |
$555 |
— |
| Upper gi w/o kub (74240) |
— |
$2,125 |
— |
| Urethrocystogram voiding (74455) |
— |
$1,961 |
— |
| Urethrocystography retrograde (74450) |
— |
$1,370 |
— |
| Us chest (76604) |
— |
$956 |
— |
| Us complete joint (76881) |
— |
$1,008 |
— |
| Us exam, pelvic, limited (76857) |
— |
$687 |
— |
| Us head (76506) |
— |
$1,010 |
— |
| Us lmtd joint/oth nonvasc xtr strux r-t w/img (76882) |
— |
$810 |
— |
Us ob detailed single fetus (76811)
range across 2 matching MRF lines |
— |
$1,051–$1,259 |
— |
Us ob limited 1 or more fetuses (76815)
range across 2 matching MRF lines |
— |
$555–$616 |
— |
Us ob transvaginal (76817)
range across 2 matching MRF lines |
— |
$555–$818 |
— |
Us pelvic non ob complete (76856)
range across 2 matching MRF lines |
— |
$555–$2,570 |
— |
Us pg uter img f&mat 14 wk tabdl 1/1st gestation (76801)
range across 2 matching MRF lines |
— |
$555–$1,105 |
— |
Us preg uterus real time f/u trnsabdl per fetus (76816)
range across 2 matching MRF lines |
— |
$555–$868 |
— |
| Us retroperitoneal complete (76770) |
— |
$1,918 |
— |
| Us retroperitoneal limited (76775) |
— |
$1,949 |
— |
| Us scrotum and contents (76870) |
— |
$1,716 |
— |
| Us thyroid (76536) |
— |
$2,093 |
— |
| Vein X-Ray Chest (75827) |
— |
$4,476 |
— |
| Venography caval inferior serialography rs&i (75825) |
— |
$9,206 |
— |
| Venography extremity bilateral rs&i (75822) |
— |
$12,317 |
— |
| Venography extremity unilateral rs&i (75820) |
— |
$2,943 |
— |
| Venous sampling by catheter (75893) |
— |
$10,229 |
— |
| X-Ray Ac Jts - Xr Acromioclavicular Joints Bilateral (73050) |
— |
$805 |
— |
| X-ray antegrade pyelogram tube (74425) |
— |
$2,140 |
— |
| X-Ray Aorta Leg Arteries (75630) |
— |
$11,720 |
— |
| X-Ray Elbow 2 Vw - Xr Elbow 1-2 Views Right (73070) |
— |
$611 |
— |
| X-Ray Exam Breast Specimen (76098) |
— |
$1,196 |
— |
| X-Ray Exam Entire Spi 2/3 Vw (72082) |
— |
$2,149 |
— |
| X-Ray Exam Hip Uni 1 View (73501) |
— |
$513 |
— |
X-Ray Exam Hip Uni 2-3 Views (73502)
range across 3 matching MRF lines |
— |
$924–$1,652 |
— |
| X-Ray Exam Hips Bi 2 Views (73521) |
— |
$1,362 |
— |
| X-Ray Exam Hips Bi 3-4 Views (73522) |
— |
$1,843 |
— |
| X-Ray Exam L-S Spine Bending (72114) |
— |
$1,873 |
— |
| X-Ray Exam Neck Spine 2-3 Vw (72040) |
— |
$1,202 |
— |
| X-Ray Exam Neck Spine 6/>Vws (72052) |
— |
$1,929 |
— |
| X-Ray Exam Unilat Ribs/Chest (71101) |
— |
$1,494 |
— |
X-ray humerus (73060)
range across 3 matching MRF lines |
— |
$1,105–$2,206 |
— |
| X-Ray Jaw <4 Vw - Xr Mandible < 4 Views (70100) |
— |
$678 |
— |
| X-Ray Knee Bilat Standing - Xr Knees Anteroposterior Standing Bilat (73565) |
— |
$927 |
— |
| X-Ray Lumbar Spine 2/3 Vw - Xr Lumbar Spine 2-3 Views (72100) |
— |
$1,209 |
— |
| X-Ray Ribs, Chest 4+ Vw - Xr Ribs 3 Vws Bil W/ Chest Posteroanterior (71111) |
— |
$1,875 |
— |
| X-Ray Sacroiliac Jts 3+ Vw - Xr Sacroiliac Joints 3+ Views (72202) |
— |
$799 |
— |
| X-Ray Sacrum/Coccyx 2+ Vw - Xr Sacrum Coccyx 2+ Views (72220) |
— |
$1,105 |
— |
| X-Ray Sinuses 3+ Vw - Xr Paranasal Sinuses 3+ Views (70220) |
— |
$1,518 |
— |
| X-Ray Skull 4+ Vw - Xr Skull Complete 4+ Views (70260) |
— |
$1,033 |
— |
| X-ray thoracic spine 4 vw (72074) |
— |
$1,220 |
— |
| X-Ray Urinary Tract Exam With Contrast Material (74420) |
— |
$1,665 |
— |
| X-Rays Bone Survey Complete (77075) |
— |
$541 |
— |
| Xr c-spine 4 or 5 views (72050) |
— |
$1,713 |
— |
Xr orbits complete 4 views (70200)
range across 3 matching MRF lines |
— |
$1,265–$1,337 |
— |