| Abdomen 1 View (74018) |
— |
$163 |
— |
| Abdomen 2 views (74019) |
— |
$215 |
— |
| Acute Gastrointestinal Blood Loss Imaging (78278) |
— |
$2,011 |
— |
| Ankle 2 views (73600) |
— |
$164 |
— |
| Arthrogram ankle (73615) |
— |
$605 |
— |
| Arthrogram hip (73525) |
— |
$605 |
— |
| Arthrogram Wrist (73115) |
— |
$605 |
— |
| Bone age studies (77072) |
— |
$134 |
— |
| Bone Imaging 3 Phase (78315) |
— |
$1,340 |
— |
| Bone Imaging Limited Area (78300) |
— |
$1,295 |
— |
| Bone Imaging Multiple Areas (78305) |
— |
$1,304 |
— |
| Bone Imaging Whole Body (78306) |
— |
$1,309 |
— |
| Chest 1 view (71045) |
— |
$224 |
— |
| Chest 2 views (71046) |
— |
$288 |
— |
| Chest 3 views (71047) |
— |
$222 |
— |
| Chest 4 or more views (71048) |
— |
$222 |
— |
| Clavicle complete (73000) |
— |
$169 |
— |
| Computed Tomography Thorax Lw Dose Lng Ca Scr C- (71271) |
— |
$430 |
— |
| Contrast X-Ray Bladder (74430) |
— |
$330 |
— |
| Contrast X-Ray Of Knee Joint (73580) |
— |
$426 |
— |
| CT abdomen and pelvis without and with contrast (74178) |
— |
$2,924 |
— |
| CT abdomen and pelvis without contrast (74176) |
— |
$2,050 |
— |
| CT abdomen w contrast (74160) |
— |
$1,502 |
— |
CT abdomen w wo contrast (74170)
range across 5 matching MRF lines |
— |
$1,502–$2,278 |
— |
| CT abdomen w/o contrast (74150) |
— |
$1,502 |
— |
| CT Angio Abdomen and Pelvis (74174) |
— |
$2,278 |
— |
CT Angio Chest (71275)
range across 3 matching MRF lines |
— |
$2,576–$2,633 |
— |
| CT Angio Head (70496) |
— |
$2,223 |
— |
| Ct Angio Lwr Extr W/O&W/Dye (73706) |
— |
$2,310 |
— |
| CT Angio Neck (70498) |
— |
$1,939 |
— |
| Ct Angio Upr Extrm W/O&W/Dye (73206) |
— |
$2,849 |
— |
| CT cervical spine w/ contrast (72126) |
— |
$1,809 |
— |
| CT cervical spine w/o contrast (72125) |
— |
$1,794 |
— |
| CT cervical spine w/wo cont (72127) |
— |
$1,908 |
— |
| CT chest w contrast (71260) |
— |
$2,161 |
— |
| CT chest w/wo contrast (71270) |
— |
$2,278 |
— |
| CT colonogrphy dx image postprocess w/o contrast (74261) |
— |
$1,912 |
— |
| CT head/brain with contrast (70460) |
— |
$1,514 |
— |
| CT head/brain without and with contrast (70470) |
— |
$1,908 |
— |
| CT iac w contrast (70481) |
— |
$1,212 |
— |
| CT l-spine w&w/o contrast (72133) |
— |
$1,706 |
— |
| CT lower ext w/o (73700) |
— |
$1,484 |
— |
| CT lower extremity w/contrast material (73701) |
— |
$1,484 |
— |
| CT lumbar spine w contrast (72132) |
— |
$1,312 |
— |
| CT lumbar spine w/o contrast (72131) |
— |
$1,317 |
— |
| CT maxillofacial w contrast (70487) |
— |
$1,069 |
— |
| CT maxillofacial wo contrast (70486) |
— |
$1,212 |
— |
| CT neck tissue combo (70492) |
— |
$1,642 |
— |
| Ct Orbit/Ear/Fossa W/O&W/Dye (70482) |
— |
$2,099 |
— |
| CT orbits w/o contrast (70480) |
— |
$1,212 |
— |
| CT pelvis w&w/o contrast (72194) |
— |
$2,165 |
— |
| CT pelvis w/o contrast (72192) |
— |
$1,427 |
— |
CT scan of leg combo (73702)
range across 2 matching MRF lines |
— |
$1,708–$1,939 |
— |
| CT scans face/jaw combo (70488) |
— |
$1,607 |
— |
| CT soft tissue neck w contrast (70491) |
— |
$1,212 |
— |
| CT soft tissue neck w/o contrast (70490) |
— |
$1,212 |
— |
| CT thoracic spine w contrast (72129) |
— |
$1,312 |
— |
| CT thoracic spine w/o contrast (72128) |
— |
$1,312 |
— |
| CT thoracic spine w/wo cont (72130) |
— |
$1,708 |
— |
CT thorax w/o contrast (71250)
range across 4 matching MRF lines |
— |
$751–$1,675 |
— |
| CT unlisted procedure (76497) |
— |
$309 |
— |
| CT upper ext wo (73200) |
— |
$1,484 |
— |
CT upper extremity w/o & w/contrast material (73202)
range across 2 matching MRF lines |
— |
$1,708–$1,939 |
— |
| CT upper extremity with contrast (73201) |
— |
$1,514 |
— |
| Cta Abdl Aorta&Bi Iliofem W/Contrast&Postp (75635) |
— |
$2,749 |
— |
| Cta Abdomen (74175) |
— |
$2,278 |
— |
| CTA pelvis (72191) |
— |
$2,110 |
— |
| Dilation ureters/urethra rs&i (74485) |
— |
$1,942 |
— |
| Dxa Bone Density Axial (77080) |
— |
$648 |
— |
| Echo Guide For Artery Repair (76936) |
— |
$1,607 |
— |
| Esophagram (74220) |
— |
$333 |
— |
| Fetal Biophysical Profile W/O Non-Stress Testing (76819) |
— |
$592 |
— |
Fluoroscopy up to 1 hr (76000)
range across 2 matching MRF lines |
— |
$332–$383 |
— |
| Foot 2 views (73620) |
— |
$164 |
— |
| Forearm 2 views (73090) |
— |
$164 |
— |
| Gastric emptying imaging study (78264) |
— |
$2,011 |
— |
| Gated Heart Planar Single (78472) |
— |
$1,438 |
— |
| Hand 2 views (73120) |
— |
$164 |
— |
| Hepatc Vngrph Wdg/Fr Hemodyn Eval Rs&I (75889) |
— |
$1,137 |
— |
| Hepatobil Syst Image W/Drug (78227) |
— |
$1,404 |
— |
| Hepatobiliary System Imaging (78226) |
— |
$1,404 |
— |
| Ht Muscle Image Spect Sing (78451) |
— |
$1,805 |
— |
| Hysterosalpingogram (74740) |
— |
$325 |
— |
| K Flow/Funct Image Multiple (78709) |
— |
$2,744 |
— |
| K Flow/Funct Image W/O Drug (78707) |
— |
$2,744 |
— |
| Knee 3 Views (73562) |
— |
$212 |
— |
| Liver & Spleen Imaging Static Only (78215) |
— |
$2,011 |
— |
| Liver & Spleen Imaging W/Vascular Flow (78216) |
— |
$1,470 |
— |
| Lung Ventilat&Perfus Imaging (78582) |
— |
$3,574 |
— |
| Lymph System Imaging (78195) |
— |
$2,011 |
— |
| Magnetic Image Jaw Joint (70336) |
— |
$3,143 |
— |
Mammary ductogram or galactogram single (77053)
range across 6 matching MRF lines |
— |
$510–$526 |
— |
| Meckels Divert Exam (78290) |
— |
$1,499 |
— |
| Mra Head W/O & W/Contrast Material (70546) |
— |
$4,241 |
— |
| MRA head w/o contrast (70544) |
— |
$2,841 |
— |
| MRA head with contrast (70545) |
— |
$3,177 |
— |
| MRA neck w contrast (70548) |
— |
$2,702 |
— |
| Mra Neck W/O &W/Contrast Material (70549) |
— |
$3,614 |
— |
| MRA neck w/o contrast (70547) |
— |
$2,702 |
— |
| MRI abdomen w contrast (74182) |
— |
$3,143 |
— |
| MRI abdomen w/o contrast (74181) |
— |
$3,299 |
— |
MRI any jt upper extremity w/contrast matrl (73222)
range across 8 matching MRF lines |
— |
$2,574–$2,702 |
— |
| MRI cervical spine w contrast (72142) |
— |
$3,055 |
— |
| MRI cervical spine w/o cont (72141) |
— |
$3,208 |
— |
MRI chest w/o contrast (71550)
range across 3 matching MRF lines |
— |
$2,574–$2,727 |
— |
MRI chest with contrast (71551)
range across 3 matching MRF lines |
— |
$2,702–$3,288 |
— |
MRI chest wo w contrast (71552)
range across 3 matching MRF lines |
— |
$3,823–$4,076 |
— |
| MRI lower extrem oth/thn jt w/contrast matrl (73719) |
— |
$2,702 |
— |
MRI lower extrem oth/thn jt w/o & w/contr matr (73720)
range across 14 matching MRF lines |
— |
$3,414–$3,584 |
— |
MRI lower extrem oth/thn jt w/o contr matrl (73718)
range across 8 matching MRF lines |
— |
$2,574–$2,702 |
— |
| MRI lumbar spine w contrast (72149) |
— |
$3,392 |
— |
| Mri Neck Spine W/O & W/Dye (72156) |
— |
$4,418 |
— |
| MRI orbit face &/neck w/o contrast (70540) |
— |
$3,055 |
— |
MRI orbit face neck w contrast (70542)
range across 3 matching MRF lines |
— |
$2,910–$3,055 |
— |
| Mri Orbt/Fac/Nck W/O &W/Dye (70543) |
— |
$4,637 |
— |
| MRI pelvis w contrast (72196) |
— |
$3,143 |
— |
| MRI pelvis w/o & w contrast (72197) |
— |
$4,637 |
— |
| MRI pelvis w/o contrast (72195) |
— |
$3,143 |
— |
| MRI thoracic spine w/o contrast (72146) |
— |
$3,562 |
— |
| MRI upper extremity oth than jt w/contr matrl (73219) |
— |
$2,702 |
— |
| MRI upper extremity oth than jt w/o contr matrl (73218) |
— |
$2,837 |
— |
| Mri Uppr Extremity W/O&W/Dye (73220) |
— |
$4,015 |
— |
| MRI, abdomen, combo (74183) |
— |
$4,847 |
— |
| MRI, dorsal spine combo (72157) |
— |
$5,058 |
— |
| MRI, dorsal spine contrast (72147) |
— |
$3,392 |
— |
MRI, joint upper extrem (73221)
range across 8 matching MRF lines |
— |
$2,702–$2,837 |
— |
MRI, joint upper extrem combo (73223)
range across 8 matching MRF lines |
— |
$3,823–$4,015 |
— |
| MRI, lumbar spine combo (72158) |
— |
$5,058 |
— |
| Myelogram Lumbar (72265) |
— |
$885 |
— |
| Myocardial Spect Multiple Studies (78452) |
— |
$3,490 |
— |
| Neck soft tissue (70360) |
— |
$169 |
— |
| Parathyroid imaging w/tomographic spect & CT (78072) |
— |
$2,630 |
— |
| Parathyroid Planar Imaging (78070) |
— |
$1,404 |
— |
| Pelvis 1 or 2 views (72170) |
— |
$194 |
— |
| Radex Abd Compl Aqt Abd W/S/E/D Views 1 View Ch (74022) |
— |
$273 |
— |
| Radex Ankle Complete Minimum 3 Views (73610) |
— |
$202 |
— |
| Radex Calcaneus Minimum 2 Views (73650) |
— |
$164 |
— |
| Radex elbow complete minimum 3 views (73080) |
— |
$194 |
— |
| Radex Facial Bones Complete Minimum 3 Views (70150) |
— |
$231 |
— |
| Radex fingr minimum 2 views (73140) |
— |
$151 |
— |
| Radex foot complete minimum 3 views (73630) |
— |
$225 |
— |
| Radex Hand Minimum 3 Views (73130) |
— |
$202 |
— |
| Radex lower extremity infant minimum 2 views (73592) |
— |
$169 |
— |
| Radex Mastoids Compl Minimum 3 Views PR Side (70130) |
— |
$231 |
— |
| Radex Nasal Bones Complete Minimum 3 Views (70160) |
— |
$160 |
— |
| Radex Ribs Unilateral 2 Views (71100) |
— |
$183 |
— |
| Radex shoulder complete minimum 2 views (73030) |
— |
$185 |
— |
| Radex Sinuses Paransl < 3 Views (70210) |
— |
$177 |
— |
| Radex Spine 1 View Specify Level (72020) |
— |
$134 |
— |
| Radex Sternum Minimum 2 Views (71120) |
— |
$182 |
— |
| Radex Temporomandble Jt Opn & Clsd Mouth Bilat (70330) |
— |
$242 |
— |
| Radex Toe Minimum 2 Views (73660) |
— |
$133 |
— |
| Radex upper extremity infant minimum 2 views (73092) |
— |
$169 |
— |
| Radex Wrist Complete Minimum 3 Views (73110) |
— |
$202 |
— |
| Radiolog exam mandible compl minimum 4 views (70110) |
— |
$231 |
— |
| Radiologic Exam Abdomen 3+ Views - Xr Abdomen 3+ Views (74021) |
— |
$202 |
— |
| Radiologic exam colon double contrast study (74280) |
— |
$652 |
— |
| Radiologic exam colon single contrast study (74270) |
— |
$484 |
— |
| Radiologic exam knee complete 4/more views (73564) |
— |
$243 |
— |
| Radiologic exam pelvis compl minimum 3 views (72190) |
— |
$222 |
— |
| Radiologic Exam Small Int Single Contrast Study (74250) |
— |
$382 |
— |
| Radiologic exam swallow function contrast study (74230) |
— |
$422 |
— |
Radiologic exam upr gi trc double contrast study (74246)
range across 3 matching MRF lines |
— |
$493–$706 |
— |
| Radiologic examination femur minimum 2 views (73552) |
— |
$171 |
— |
| Radiologic examination knee 1/2 views (73560) |
— |
$171 |
— |
| Radiologic Examination Osseous Survey Limited (77074) |
— |
$474 |
— |
| Radiologic examination tibia & fibula 2 views (73590) |
— |
$164 |
— |
| Ribs bilateral 3 views (71110) |
— |
$242 |
— |
| Rp Loclzj Tum Spect 1 Area Single Day Imaging (78803) |
— |
$1,354 |
— |
| Rp loclzj tum spect w/CT 1 area/acquisj 1day img (78830) |
— |
$3,814 |
— |
| Rp Therapy Intravenous Administration (79101) |
— |
$623 |
— |
| Scapula (73010) |
— |
$169 |
— |
| Shoulder 1 view (73020) |
— |
$148 |
— |
| Shoulder Arthrography (73040) |
— |
$605 |
— |
| Skull less than 4 views (70250) |
— |
$200 |
— |
| Sternoclavicular joints (71130) |
— |
$202 |
— |
| Thoracic spine 2 views (72070) |
— |
$202 |
— |
| Thoracic spine 3 views (72072) |
— |
$222 |
— |
| Thoracolumbar 2 views (72080) |
— |
$207 |
— |
| Thyroid Imaging With Vascular Flow (78013) |
— |
$1,470 |
— |
| Thyroid Uptake W/Blood Flow Sngle/Mult Quan Meas (78014) |
— |
$1,939 |
— |
| Ultrasound Breast Limited (76642) |
— |
$592 |
— |
| Ultrasound Exam Aaa Screen (76706) |
— |
$570 |
— |
Ultrasound, abdomen limited (76705)
range across 3 matching MRF lines |
— |
$592–$780 |
— |
| Umbilical-artery Doppler (OB) (76820) |
— |
$357 |
— |
| Unlisted us procedure (76999) |
— |
$379 |
— |
Upper gi w/o kub (74240)
range across 3 matching MRF lines |
— |
$373–$441 |
— |
| Urethrocystogram voiding (74455) |
— |
$425 |
— |
| Us breast unilateral complete (76641) |
— |
$461 |
— |
| Us chest (76604) |
— |
$546 |
— |
| Us complete joint (76881) |
— |
$914 |
— |
Us exam, pelvic, limited (76857)
range across 2 matching MRF lines |
— |
$303–$544 |
— |
| Us lmtd joint/oth nonvasc xtr strux r-t w/img (76882) |
— |
$210 |
— |
| Us ob limited 1 or more fetuses (76815) |
— |
$416 |
— |
| Us ob transvaginal (76817) |
— |
$665 |
— |
| Us pelvic non ob complete (76856) |
— |
$705 |
— |
| Us pg uter img f&mat 14 wk tabdl 1/1st gestation (76801) |
— |
$859 |
— |
| Us preg uterus real time f/u trnsabdl per fetus (76816) |
— |
$554 |
— |
| Us retroperitoneal complete (76770) |
— |
$605 |
— |
Us retroperitoneal limited (76775)
range across 3 matching MRF lines |
— |
$597–$626 |
— |
| Us scrotum and contents (76870) |
— |
$747 |
— |
Us thyroid (76536)
range across 5 matching MRF lines |
— |
$327–$651 |
— |
| Us transrectal (76872) |
— |
$503 |
— |
| Venography extremity unilateral rs&i (75820) |
— |
$749 |
— |
| Wrist 2 views (73100) |
— |
$164 |
— |
| X-Ray Ac Jts - Xr Acromioclavicular Joints Bilateral (73050) |
— |
$202 |
— |
| X-ray antegrade pyelogram tube (74425) |
— |
$329 |
— |
| X-Ray Bend Only L-S Spine (72120) |
— |
$287 |
— |
| X-Ray Elbow 2 Vw - Xr Elbow 1-2 Views Right (73070) |
— |
$164 |
— |
X-Ray Exam Breast Specimen (76098)
range across 3 matching MRF lines |
— |
$153–$530 |
— |
X-Ray Exam Entire Spi 1 Vw (72081)
range across 2 matching MRF lines |
— |
$284–$291 |
— |
| X-Ray Exam Hip Uni 1 View (73501) |
— |
$164 |
— |
| X-Ray Exam Hip Uni 2-3 Views (73502) |
— |
$208 |
— |
| X-Ray Exam Hips Bi 2 Views (73521) |
— |
$182 |
— |
| X-Ray Exam Hips Bi 3-4 Views (73522) |
— |
$220 |
— |
| X-Ray Exam Hips Bi 5/> Views (73523) |
— |
$267 |
— |
| X-Ray Exam L-S Spine Bending (72114) |
— |
$358 |
— |
| X-Ray Exam Neck Spine 2-3 Vw (72040) |
— |
$182 |
— |
| X-Ray Exam Unilat Ribs/Chest (71101) |
— |
$212 |
— |
| X-ray eye for foreign body (70030) |
— |
$169 |
— |
| X-ray humerus (73060) |
— |
$171 |
— |
| X-Ray Jaw <4 Vw - Xr Mandible < 4 Views (70100) |
— |
$169 |
— |
| X-Ray Knee Bilat Standing - Xr Knees Anteroposterior Standing Bilat (73565) |
— |
$423 |
— |
| X-Ray Lumbar Spine 2/3 Vw - Xr Lumbar Spine 2-3 Views (72100) |
— |
$212 |
— |
| X-ray nose-rectum child f.b. (76010) |
— |
$169 |
— |
| X-Ray Ribs, Chest 4+ Vw - Xr Ribs 3 Vws Bil W/ Chest Posteroanterior (71111) |
— |
$271 |
— |
| X-Ray Sacroiliac Jts 3+ Vw - Xr Sacroiliac Joints 3+ Views (72202) |
— |
$169 |
— |
| X-Ray Sacrum/Coccyx 2+ Vw - Xr Sacrum Coccyx 2+ Views (72220) |
— |
$153 |
— |
| X-Ray Sinuses 3+ Vw - Xr Paranasal Sinuses 3+ Views (70220) |
— |
$238 |
— |
| X-Ray Skull 4+ Vw - Xr Skull Complete 4+ Views (70260) |
— |
$271 |
— |
| X-Ray Stress View (77071) |
— |
$141 |
— |
| X-ray thoracic spine 4 vw (72074) |
— |
$260 |
— |
| X-Ray Tmj Unilat (70328) |
— |
$153 |
— |
| X-Ray Urinary Tract Exam With Contrast Material (74420) |
— |
$530 |
— |
| X-Rays Bone Survey Complete (77075) |
— |
$638 |
— |
| Xr c-spine 4 or 5 views (72050) |
— |
$296 |
— |
| Xr facial bones less than 3 views (70140) |
— |
$171 |
— |
| XR Mastoids < 3 Views Bilateral (70120) |
— |
$179 |
— |
| Xr orbits complete 4 views (70200) |
— |
$242 |
— |