| Abdomen 1 View (74018) |
— |
$298 |
— |
| Abdomen 2 views (74019) |
— |
$336 |
— |
| Acute Gastrointestinal Blood Loss Imaging (78278) |
— |
$1,043 |
— |
| Ankle 2 views (73600) |
— |
$229 |
— |
| Bone age studies (77072) |
— |
$308 |
— |
| Bone Imaging 3 Phase (78315) |
— |
$1,182 |
— |
| Bone Imaging Limited Area (78300) |
— |
$1,182 |
— |
| Bone Imaging Multiple Areas (78305) |
— |
$1,182 |
— |
| Bone Imaging Whole Body (78306) |
— |
$1,182 |
— |
| Bone survey infant (77076) |
— |
$229 |
— |
Chest 1 view (71045)
range across 3 matching MRF lines |
— |
$237–$317 |
— |
| Chest 2 views (71046) |
— |
$321 |
— |
| Clavicle complete (73000) |
— |
$252 |
— |
| Computed Tomography Thorax Lw Dose Lng Ca Scr C- (71271) |
— |
$810 |
— |
| CT abdomen and pelvis without and with contrast (74178) |
— |
$1,607 |
— |
| CT abdomen and pelvis without contrast (74176) |
— |
$1,453 |
— |
| CT abdomen w contrast (74160) |
— |
$1,496 |
— |
| CT abdomen w wo contrast (74170) |
— |
$1,607 |
— |
| CT abdomen w/o contrast (74150) |
— |
$1,453 |
— |
| CT Angio Abdomen and Pelvis (74174) |
— |
$3,015 |
— |
| CT Angio Chest (71275) |
— |
$2,528 |
— |
| CT Angio Head (70496) |
— |
$2,560 |
— |
| Ct Angio Lwr Extr W/O&W/Dye (73706) |
— |
$2,528 |
— |
| CT Angio Neck (70498) |
— |
$2,564 |
— |
| Ct Angio Upr Extrm W/O&W/Dye (73206) |
— |
$2,528 |
— |
| CT cervical spine w/ contrast (72126) |
— |
$1,496 |
— |
| CT cervical spine w/o contrast (72125) |
— |
$1,453 |
— |
| CT cervical spine w/wo cont (72127) |
— |
$1,607 |
— |
| CT chest w contrast (71260) |
— |
$1,496 |
— |
| CT chest w/wo contrast (71270) |
— |
$1,607 |
— |
| CT head/brain with contrast (70460) |
— |
$1,496 |
— |
| CT head/brain without and with contrast (70470) |
— |
$1,607 |
— |
CT iac w contrast (70481)
range across 3 matching MRF lines |
— |
$1,453–$1,496 |
— |
| CT l-spine w&w/o contrast (72133) |
— |
$1,607 |
— |
| CT lower ext w/o (73700) |
— |
$1,453 |
— |
| CT lower extremity w/contrast material (73701) |
— |
$1,496 |
— |
| CT lumbar spine w contrast (72132) |
— |
$1,496 |
— |
| CT lumbar spine w/o contrast (72131) |
— |
$1,453 |
— |
CT maxillofacial w contrast (70487)
range across 2 matching MRF lines |
— |
$1,425–$1,496 |
— |
| CT maxillofacial wo contrast (70486) |
— |
$1,453 |
— |
| CT neck tissue combo (70492) |
— |
$1,607 |
— |
Ct Orbit/Ear/Fossa W/O&W/Dye (70482)
range across 2 matching MRF lines |
— |
$1,530–$1,607 |
— |
CT orbits w/o contrast (70480)
range across 3 matching MRF lines |
— |
$1,384–$1,453 |
— |
| CT pelvis w&w/o contrast (72194) |
— |
$1,607 |
— |
| CT pelvis w/o contrast (72192) |
— |
$1,453 |
— |
| CT scan of leg combo (73702) |
— |
$1,607 |
— |
| CT scans face/jaw combo (70488) |
— |
$1,530 |
— |
| CT soft tissue neck w contrast (70491) |
— |
$1,496 |
— |
| CT soft tissue neck w/o contrast (70490) |
— |
$1,453 |
— |
| CT thoracic spine w contrast (72129) |
— |
$771 |
— |
| CT thoracic spine w/o contrast (72128) |
— |
$1,453 |
— |
| CT thoracic spine w/wo cont (72130) |
— |
$1,607 |
— |
| CT thorax w/o contrast (71250) |
— |
$1,453 |
— |
| CT upper ext wo (73200) |
— |
$1,453 |
— |
| CT upper extremity w/o & w/contrast material (73202) |
— |
$1,607 |
— |
| CT upper extremity with contrast (73201) |
— |
$1,496 |
— |
| Cta Abdl Aorta&Bi Iliofem W/Contrast&Postp (75635) |
— |
$2,528 |
— |
| Cta Abdomen (74175) |
— |
$2,528 |
— |
| Doppler Echo Fetal Puls Spectral F/U/Repeat (76828) |
— |
$213 |
— |
| Doppler Echo Fetal Spectral Display Complete (76827) |
— |
$279 |
— |
| Doppler Fetal Mid Cerebral Artery (76821) |
— |
$298 |
— |
| Dxa Bone Density Axial (77080) |
— |
$438 |
— |
| Dxa bone density study 1/>sites appendiclr skel (77081) |
— |
$149 |
— |
| Echo exam of fetal heart (76825) |
— |
$613 |
— |
| Fetal Biophys Profile W/Nst (76818) |
— |
$812 |
— |
| Fetal Biophysical Profile W/O Non-Stress Testing (76819) |
— |
$229 |
— |
| Fluoroscopy up to 1 hr (76000) |
— |
$534 |
— |
| Foot 2 views (73620) |
— |
$229 |
— |
| Forearm 2 views (73090) |
— |
$274 |
— |
| Gastric emptying imaging study (78264) |
— |
$595 |
— |
| Gated Heart Planar Single (78472) |
— |
$950 |
— |
Hand 2 views (73120)
range across 4 matching MRF lines |
— |
$218–$229 |
— |
| Hepatobil Syst Image W/Drug (78227) |
— |
$1,322 |
— |
| Joint Survey Single View (77077) |
— |
$229 |
— |
| K Flow/Funct Image W/Drug (78708) |
— |
$1,166 |
— |
| K Flow/Funct Image W/O Drug (78707) |
— |
$1,586 |
— |
| Knee 3 Views (73562) |
— |
$291 |
— |
| Lymph System Imaging (78195) |
— |
$502 |
— |
| Meckels Divert Exam (78290) |
— |
$526 |
— |
| Mra Head W/O & W/Contrast Material (70546) |
— |
$2,403 |
— |
| MRA head w/o contrast (70544) |
— |
$2,185 |
— |
| MRA head with contrast (70545) |
— |
$2,294 |
— |
| MRA neck w contrast (70548) |
— |
$2,294 |
— |
| Mra Neck W/O &W/Contrast Material (70549) |
— |
$2,403 |
— |
| MRA neck w/o contrast (70547) |
— |
$2,185 |
— |
MRI abdomen w contrast (74182)
range across 2 matching MRF lines |
— |
$1,861–$1,954 |
— |
| MRI abdomen w/o contrast (74181) |
— |
$1,844 |
— |
| MRI any jt lower extrem w/contrast material (73722) |
— |
$1,954 |
— |
| MRI any jt lower extrem w/o & w/contrast matrl (73723) |
— |
$2,062 |
— |
| MRI any jt upper extremity w/contrast matrl (73222) |
— |
$1,954 |
— |
| MRI cervical spine w contrast (72142) |
— |
$1,954 |
— |
| MRI cervical spine w/o cont (72141) |
— |
$1,844 |
— |
| MRI chest w/o contrast (71550) |
— |
$1,844 |
— |
| MRI chest with contrast (71551) |
— |
$1,954 |
— |
| MRI chest wo w contrast (71552) |
— |
$2,062 |
— |
| MRI lower extrem oth/thn jt w/contrast matrl (73719) |
— |
$1,954 |
— |
| MRI lower extrem oth/thn jt w/o & w/contr matr (73720) |
— |
$2,062 |
— |
| MRI lower extrem oth/thn jt w/o contr matrl (73718) |
— |
$1,844 |
— |
| MRI lumbar spine w contrast (72149) |
— |
$1,954 |
— |
| Mri Neck Spine W/O & W/Dye (72156) |
— |
$2,062 |
— |
| MRI orbit face &/neck w/o contrast (70540) |
— |
$1,844 |
— |
| MRI orbit face neck w contrast (70542) |
— |
$1,954 |
— |
| Mri Orbt/Fac/Nck W/O &W/Dye (70543) |
— |
$2,062 |
— |
| MRI pelvis w contrast (72196) |
— |
$1,954 |
— |
| MRI pelvis w/o & w contrast (72197) |
— |
$2,062 |
— |
| MRI pelvis w/o contrast (72195) |
— |
$1,844 |
— |
| MRI thoracic spine w/o contrast (72146) |
— |
$1,844 |
— |
| MRI upper extremity oth than jt w/contr matrl (73219) |
— |
$1,954 |
— |
| MRI upper extremity oth than jt w/o contr matrl (73218) |
— |
$1,844 |
— |
| Mri Uppr Extremity W/O&W/Dye (73220) |
— |
$2,062 |
— |
MRI, abdomen, combo (74183)
range across 2 matching MRF lines |
— |
$1,964–$2,062 |
— |
| MRI, dorsal spine combo (72157) |
— |
$2,062 |
— |
| MRI, dorsal spine contrast (72147) |
— |
$1,954 |
— |
| MRI, joint upper extrem (73221) |
— |
$1,844 |
— |
| MRI, joint upper extrem combo (73223) |
— |
$2,062 |
— |
| MRI, lumbar spine combo (72158) |
— |
$2,062 |
— |
| Myocardial Spect Multiple Studies (78452) |
— |
$1,865 |
— |
| Neck soft tissue (70360) |
— |
$229 |
— |
| Njx Rp Loclzj Non-Img Probe Study Intravenous (78808) |
— |
$1,005 |
— |
| Ntsty modul radthx pln dose-vol histos (77301) |
— |
$2,498 |
— |
| Parathyroid Planar Imaging (78070) |
— |
$1,070 |
— |
| Parathyroid planar imaging w/wo subtraction (78071) |
— |
$1,070 |
— |
| Pelvis 1 or 2 views (72170) |
— |
$280 |
— |
| Radex Abd Compl Aqt Abd W/S/E/D Views 1 View Ch (74022) |
— |
$585 |
— |
| Radex Ankle Complete Minimum 3 Views (73610) |
— |
$308 |
— |
| Radex Calcaneus Minimum 2 Views (73650) |
— |
$252 |
— |
| Radex elbow complete minimum 3 views (73080) |
— |
$336 |
— |
| Radex Facial Bones Complete Minimum 3 Views (70150) |
— |
$328 |
— |
| Radex fingr minimum 2 views (73140) |
— |
$234 |
— |
| Radex foot complete minimum 3 views (73630) |
— |
$298 |
— |
| Radex Hand Minimum 3 Views (73130) |
— |
$302 |
— |
| Radex lower extremity infant minimum 2 views (73592) |
— |
$305 |
— |
| Radex Nasal Bones Complete Minimum 3 Views (70160) |
— |
$326 |
— |
| Radex Ribs Unilateral 2 Views (71100) |
— |
$237 |
— |
| Radex shoulder complete minimum 2 views (73030) |
— |
$310 |
— |
| Radex Sinuses Paransl < 3 Views (70210) |
— |
$196 |
— |
| Radex Spine 1 View Specify Level (72020) |
— |
$252 |
— |
| Radex Sternum Minimum 2 Views (71120) |
— |
$321 |
— |
| Radex Temporomandble Jt Opn & Clsd Mouth Bilat (70330) |
— |
$381 |
— |
| Radex Toe Minimum 2 Views (73660) |
— |
$237 |
— |
| Radex upper extremity infant minimum 2 views (73092) |
— |
$229 |
— |
| Radex Wrist Complete Minimum 3 Views (73110) |
— |
$316 |
— |
| Radiolog exam mandible compl minimum 4 views (70110) |
— |
$373 |
— |
| Radiologic exam knee complete 4/more views (73564) |
— |
$478 |
— |
| Radiologic exam pelvis compl minimum 3 views (72190) |
— |
$301 |
— |
| Radiologic Exam Small Int Single Contrast Study (74250) |
— |
$432 |
— |
| Radiologic examination femur minimum 2 views (73552) |
— |
$229 |
— |
| Radiologic examination knee 1/2 views (73560) |
— |
$229 |
— |
| Radiologic Examination Osseous Survey Limited (77074) |
— |
$229 |
— |
| Radiologic examination tibia & fibula 2 views (73590) |
— |
$315 |
— |
| Ribs bilateral 3 views (71110) |
— |
$298 |
— |
| Scapula (73010) |
— |
$252 |
— |
| Screening Digital Breast Tomosynthesis Bi (77063) |
— |
$102 |
— |
| Shoulder 1 view (73020) |
— |
$234 |
— |
| Skull less than 4 views (70250) |
— |
$317 |
— |
| Sternoclavicular joints (71130) |
— |
$378 |
— |
| Ther Rad Simulaj-Aided Field Setting Complex (77290) |
— |
$2,042 |
— |
| Thoracic spine 2 views (72070) |
— |
$296 |
— |
| Thoracic spine 3 views (72072) |
— |
$444 |
— |
| Thoracolumbar 2 views (72080) |
— |
$252 |
— |
| Thyroid Imaging With Vascular Flow (78013) |
— |
$739 |
— |
| Thyroid Uptake W/Blood Flow Sngle/Mult Quan Meas (78014) |
— |
$1,070 |
— |
| Tx Devices Design & Construction Complex (77334) |
— |
$615 |
— |
| Ultrasound Breast Limited (76642) |
— |
$764 |
— |
| Ultrasound elastography first target lesion (76982) |
— |
$764 |
— |
| Ultrasound Elastography Parenchyma (76981) |
— |
$764 |
— |
| Ultrasound Exam Aaa Screen (76706) |
— |
$337 |
— |
| Ultrasound, abdomen limited (76705) |
— |
$764 |
— |
| Umbilical-artery Doppler (OB) (76820) |
— |
$268 |
— |
| Us breast unilateral complete (76641) |
— |
$764 |
— |
| Us chest (76604) |
— |
$764 |
— |
| Us exam, pelvic, limited (76857) |
— |
$206 |
— |
| Us head (76506) |
— |
$1,063 |
— |
| Us lmtd joint/oth nonvasc xtr strux r-t w/img (76882) |
— |
$764 |
— |
| Us ob detailed single fetus (76811) |
— |
$856 |
— |
| Us ob limited 1 or more fetuses (76815) |
— |
$742 |
— |
| Us ob transvaginal (76817) |
— |
$764 |
— |
| Us pelvic non ob complete (76856) |
— |
$764 |
— |
| Us pg uter img f&mat 14 wk tabdl 1/1st gestation (76801) |
— |
$764 |
— |
| Us preg uterus real time f/u trnsabdl per fetus (76816) |
— |
$764 |
— |
| Us retroperitoneal complete (76770) |
— |
$764 |
— |
| Us retroperitoneal limited (76775) |
— |
$764 |
— |
| Us scrotum and contents (76870) |
— |
$764 |
— |
| Us thyroid (76536) |
— |
$1,063 |
— |
| Wrist 2 views (73100) |
— |
$229 |
— |
| X-Ray Ac Jts - Xr Acromioclavicular Joints Bilateral (73050) |
— |
$322 |
— |
| X-Ray Bend Only L-S Spine (72120) |
— |
$516 |
— |
| X-Ray Elbow 2 Vw - Xr Elbow 1-2 Views Right (73070) |
— |
$250 |
— |
| X-Ray Exam Breast Specimen (76098) |
— |
$310 |
— |
| X-Ray Exam Entire Spi 2/3 Vw (72082) |
— |
$461 |
— |
| X-Ray Exam Hip Uni 1 View (73501) |
— |
$229 |
— |
| X-Ray Exam Hip Uni 2-3 Views (73502) |
— |
$229 |
— |
| X-Ray Exam Hip Uni 4/> Views (73503) |
— |
$492 |
— |
| X-Ray Exam Hips Bi 2 Views (73521) |
— |
$229 |
— |
| X-Ray Exam Hips Bi 5/> Views (73523) |
— |
$617 |
— |
| X-Ray Exam L-S Spine Bending (72114) |
— |
$528 |
— |
| X-Ray Exam Neck Spine 2-3 Vw (72040) |
— |
$373 |
— |
| X-Ray Exam Neck Spine 6/>Vws (72052) |
— |
$600 |
— |
| X-Ray Exam Unilat Ribs/Chest (71101) |
— |
$441 |
— |
| X-ray eye for foreign body (70030) |
— |
$229 |
— |
| X-ray humerus (73060) |
— |
$305 |
— |
| X-ray IV pyelogram (ivp) (74400) |
— |
$881 |
— |
| X-Ray Jaw <4 Vw - Xr Mandible < 4 Views (70100) |
— |
$306 |
— |
| X-Ray Knee Bilat Standing - Xr Knees Anteroposterior Standing Bilat (73565) |
— |
$322 |
— |
| X-Ray Lumbar Spine 2/3 Vw - Xr Lumbar Spine 2-3 Views (72100) |
— |
$387 |
— |
| X-ray nose-rectum child f.b. (76010) |
— |
$229 |
— |
| X-Ray Ribs, Chest 4+ Vw - Xr Ribs 3 Vws Bil W/ Chest Posteroanterior (71111) |
— |
$543 |
— |
| X-Ray Sacroiliac Jts 3+ Vw - Xr Sacroiliac Joints 3+ Views (72202) |
— |
$321 |
— |
| X-Ray Sacrum/Coccyx 2+ Vw - Xr Sacrum Coccyx 2+ Views (72220) |
— |
$249 |
— |
| X-Ray Sinuses 3+ Vw - Xr Paranasal Sinuses 3+ Views (70220) |
— |
$432 |
— |
| X-Ray Skull 4+ Vw - Xr Skull Complete 4+ Views (70260) |
— |
$380 |
— |
| X-Ray Tmj Unilat (70328) |
— |
$229 |
— |
| X-Rays Bone Length Studies (77073) |
— |
$528 |
— |
| X-Rays Bone Survey Complete (77075) |
— |
$1,119 |
— |
| Xr c-spine 4 or 5 views (72050) |
— |
$397 |
— |
| Xr facial bones less than 3 views (70140) |
— |
$397 |
— |
| XR Mastoids < 3 Views Bilateral (70120) |
— |
$229 |
— |
| Xr orbits complete 4 views (70200) |
— |
$403 |
— |