| Abdomen 1 View (74018) |
— |
$298 |
— |
| Abdomen 2 views (74019) |
— |
$356 |
— |
| Acute Gastrointestinal Blood Loss Imaging (78278) |
— |
$1,077 |
— |
| Angiography extremity unilateral rs&i (75710) |
— |
$881 |
— |
| Ankle 2 views (73600) |
— |
$265 |
— |
| Bone age studies (77072) |
— |
$317 |
— |
| Bone Imaging 3 Phase (78315) |
— |
$1,257 |
— |
| Bone Imaging Limited Area (78300) |
— |
$978 |
— |
| Bone Imaging Whole Body (78306) |
— |
$1,254 |
— |
| Bone survey infant (77076) |
— |
$193 |
— |
| Cat Scan Follow-Up Study (76380) |
— |
$1,288 |
— |
| Chest 1 view (71045) |
— |
$240 |
— |
| Chest 2 views (71046) |
— |
$280 |
— |
| Chest 3 views (71047) |
— |
$300 |
— |
Cholecystography Oral Contrast (74290)
range across 2 matching MRF lines |
— |
$246–$247 |
— |
| Clavicle complete (73000) |
— |
$213 |
— |
| Computed Tomography Thorax Lw Dose Lng Ca Scr C- (71271) |
— |
$1,019 |
— |
| CT abdomen and pelvis without and with contrast (74178) |
— |
$2,426 |
— |
| CT abdomen and pelvis without contrast (74176) |
— |
$2,576 |
— |
CT abdomen w contrast (74160)
range across 2 matching MRF lines |
— |
$1,835–$1,935 |
— |
| CT abdomen w wo contrast (74170) |
— |
$2,377 |
— |
| CT abdomen w/o contrast (74150) |
— |
$1,760 |
— |
| CT Angio Abdomen and Pelvis (74174) |
— |
$2,625 |
— |
CT Angio Chest (71275)
range across 2 matching MRF lines |
— |
$1,456–$2,363 |
— |
| CT Angio Head (70496) |
— |
$2,625 |
— |
| Ct Angio Lwr Extr W/O&W/Dye (73706) |
— |
$2,428 |
— |
| CT Angio Neck (70498) |
— |
$1,945 |
— |
| Ct Angio Upr Extrm W/O&W/Dye (73206) |
— |
$2,428 |
— |
| CT cervical spine w/ contrast (72126) |
— |
$1,545 |
— |
| CT cervical spine w/o contrast (72125) |
— |
$1,391 |
— |
| CT chest w contrast (71260) |
— |
$2,166 |
— |
| CT chest w/wo contrast (71270) |
— |
$2,122 |
— |
| CT head/brain with contrast (70460) |
— |
$1,865 |
— |
| CT head/brain without and with contrast (70470) |
— |
$2,013 |
— |
CT iac w contrast (70481)
range across 2 matching MRF lines |
— |
$1,484–$1,742 |
— |
CT lower ext w/o (73700)
range across 4 matching MRF lines |
— |
$1,140–$1,214 |
— |
| CT lower extremity w/contrast material (73701) |
— |
$1,553 |
— |
| CT lumbar spine w contrast (72132) |
— |
$1,762 |
— |
| CT lumbar spine w/o contrast (72131) |
— |
$1,607 |
— |
| CT maxillofacial w contrast (70487) |
— |
$1,483 |
— |
| CT maxillofacial wo contrast (70486) |
— |
$1,559 |
— |
| CT neck tissue combo (70492) |
— |
$1,415 |
— |
| Ct Orbit/Ear/Fossa W/O&W/Dye (70482) |
— |
$1,655 |
— |
CT orbits w/o contrast (70480)
range across 2 matching MRF lines |
— |
$1,274–$1,332 |
— |
| CT pelvis w&w/o contrast (72194) |
— |
$2,191 |
— |
| CT pelvis w/o contrast (72192) |
— |
$1,890 |
— |
| CT scans face/jaw combo (70488) |
— |
$1,689 |
— |
| CT soft tissue neck w contrast (70491) |
— |
$2,067 |
— |
| CT soft tissue neck w/o contrast (70490) |
— |
$1,343 |
— |
| CT thoracic spine w/o contrast (72128) |
— |
$1,445 |
— |
| CT thorax w/o contrast (71250) |
— |
$1,680 |
— |
| CT upper ext wo (73200) |
— |
$1,396 |
— |
| CT upper extremity w/o & w/contrast material (73202) |
— |
$1,607 |
— |
| CT upper extremity with contrast (73201) |
— |
$1,553 |
— |
| Cta Abdl Aorta&Bi Iliofem W/Contrast&Postp (75635) |
— |
$2,293 |
— |
| Cta Abdomen (74175) |
— |
$2,591 |
— |
| CTA pelvis (72191) |
— |
$2,605 |
— |
| Dxa Bone Density Axial (77080) |
— |
$459 |
— |
| Dxa bone density study 1/>sites appendiclr skel (77081) |
— |
$207 |
— |
| Echo exam of fetal heart (76825) |
— |
$711 |
— |
| Esophagram (74220) |
— |
$383 |
— |
| Fetal Biophysical Profile W/O Non-Stress Testing (76819) |
— |
$598 |
— |
| Fluoroscopy up to 1 hr (76000) |
— |
$576 |
— |
| Foot 2 views (73620) |
— |
$265 |
— |
| Forearm 2 views (73090) |
— |
$240 |
— |
| Gastric emptying imaging study (78264) |
— |
$1,259 |
— |
| Gated Heart Planar Single (78472) |
— |
$1,740 |
— |
| Hand 2 views (73120) |
— |
$267 |
— |
| Hepatobil Syst Image W/Drug (78227) |
— |
$1,504 |
— |
| Ht Muscle Image Spect Sing (78451) |
— |
$1,373 |
— |
| Hysterosalpingogram (74740) |
— |
$524 |
— |
| Joint Survey Single View (77077) |
— |
$300 |
— |
| K Flow/Funct Image W/O Drug (78707) |
— |
$1,282 |
— |
| Knee 3 Views (73562) |
— |
$389 |
— |
| Liver & Spleen Imaging W/Vascular Flow (78216) |
— |
$1,061 |
— |
| Magnetic Image Jaw Joint (70336) |
— |
$2,547 |
— |
| Mra Head W/O & W/Contrast Material (70546) |
— |
$3,131 |
— |
| MRA head w/o contrast (70544) |
— |
$2,812 |
— |
| MRA head with contrast (70545) |
— |
$3,131 |
— |
| MRA neck w contrast (70548) |
— |
$2,865 |
— |
| Mra Neck W/O &W/Contrast Material (70549) |
— |
$3,077 |
— |
| MRA neck w/o contrast (70547) |
— |
$2,653 |
— |
| MRI abdomen w contrast (74182) |
— |
$2,759 |
— |
| MRI abdomen w/o contrast (74181) |
— |
$2,547 |
— |
| MRI any jt lower extrem w/contrast material (73722) |
— |
$2,759 |
— |
| MRI any jt lower extrem w/o & w/contrast matrl (73723) |
— |
$2,971 |
— |
| MRI any jt upper extremity w/contrast matrl (73222) |
— |
$2,759 |
— |
| MRI bone marrow blood supply (77084) |
— |
$2,547 |
— |
| MRI cervical spine w contrast (72142) |
— |
$2,759 |
— |
| MRI cervical spine w/o cont (72141) |
— |
$2,759 |
— |
| MRI chest w/o contrast (71550) |
— |
$2,547 |
— |
| MRI chest with contrast (71551) |
— |
$2,878 |
— |
| MRI chest wo w contrast (71552) |
— |
$3,131 |
— |
| MRI lower extrem oth/thn jt w/contrast matrl (73719) |
— |
$2,759 |
— |
| MRI lower extrem oth/thn jt w/o & w/contr matr (73720) |
— |
$2,971 |
— |
| MRI lower extrem oth/thn jt w/o contr matrl (73718) |
— |
$2,547 |
— |
| MRI lumbar spine w contrast (72149) |
— |
$2,759 |
— |
| Mri Neck Spine W/O & W/Dye (72156) |
— |
$2,971 |
— |
| MRI orbit face &/neck w/o contrast (70540) |
— |
$2,547 |
— |
| MRI orbit face neck w contrast (70542) |
— |
$2,759 |
— |
| Mri Orbt/Fac/Nck W/O &W/Dye (70543) |
— |
$3,131 |
— |
| MRI pelvis w contrast (72196) |
— |
$2,759 |
— |
| MRI pelvis w/o & w contrast (72197) |
— |
$2,971 |
— |
| MRI pelvis w/o contrast (72195) |
— |
$2,547 |
— |
| MRI thoracic spine w/o contrast (72146) |
— |
$2,547 |
— |
MRI upper extremity oth than jt w/o contr matrl (73218)
range across 2 matching MRF lines |
— |
$2,547–$2,971 |
— |
| Mri Uppr Extremity W/O&W/Dye (73220) |
— |
$2,971 |
— |
| MRI, abdomen, combo (74183) |
— |
$2,971 |
— |
| MRI, dorsal spine combo (72157) |
— |
$2,971 |
— |
| MRI, dorsal spine contrast (72147) |
— |
$2,759 |
— |
| MRI, joint upper extrem (73221) |
— |
$2,547 |
— |
| MRI, joint upper extrem combo (73223) |
— |
$2,971 |
— |
| MRI, lumbar spine combo (72158) |
— |
$2,971 |
— |
| Myocardial Spect Multiple Studies (78452) |
— |
$1,913 |
— |
| Neck soft tissue (70360) |
— |
$295 |
— |
| Nuclear Rx Oral Admin (79005) |
— |
$572 |
— |
| Parathyroid Planar Imaging (78070) |
— |
$911 |
— |
| Pelvis 1 or 2 views (72170) |
— |
$255 |
— |
| Radex Abd Compl Aqt Abd W/S/E/D Views 1 View Ch (74022) |
— |
$502 |
— |
| Radex abscess/fistula/sinus tract rs&i (76080) |
— |
$542 |
— |
| Radex Ankle Complete Minimum 3 Views (73610) |
— |
$350 |
— |
| Radex Calcaneus Minimum 2 Views (73650) |
— |
$264 |
— |
| Radex elbow complete minimum 3 views (73080) |
— |
$343 |
— |
| Radex Facial Bones Complete Minimum 3 Views (70150) |
— |
$404 |
— |
| Radex fingr minimum 2 views (73140) |
— |
$232 |
— |
| Radex foot complete minimum 3 views (73630) |
— |
$343 |
— |
| Radex Hand Minimum 3 Views (73130) |
— |
$305 |
— |
| Radex Mastoids Compl Minimum 3 Views PR Side (70130) |
— |
$300 |
— |
| Radex Nasal Bones Complete Minimum 3 Views (70160) |
— |
$289 |
— |
| Radex Ribs Unilateral 2 Views (71100) |
— |
$253 |
— |
| Radex shoulder complete minimum 2 views (73030) |
— |
$350 |
— |
| Radex Spine 1 View Specify Level (72020) |
— |
$175 |
— |
| Radex Sternum Minimum 2 Views (71120) |
— |
$326 |
— |
| Radex Temporomandble Jt Opn & Clsd Mouth Bilat (70330) |
— |
$361 |
— |
| Radex Toe Minimum 2 Views (73660) |
— |
$220 |
— |
| Radex Wrist Complete Minimum 3 Views (73110) |
— |
$267 |
— |
| Radiolog exam mandible compl minimum 4 views (70110) |
— |
$380 |
— |
| Radiologic exam colon double contrast study (74280) |
— |
$1,463 |
— |
| Radiologic exam colon single contrast study (74270) |
— |
$1,463 |
— |
| Radiologic exam knee complete 4/more views (73564) |
— |
$382 |
— |
| Radiologic Exam Small Int Single Contrast Study (74250) |
— |
$542 |
— |
| Radiologic exam swallow function contrast study (74230) |
— |
$540 |
— |
| Radiologic examination femur 1 view (73551) |
— |
$250 |
— |
| Radiologic examination femur minimum 2 views (73552) |
— |
$281 |
— |
| Radiologic examination knee 1/2 views (73560) |
— |
$221 |
— |
| Radiologic Examination Osseous Survey Limited (77074) |
— |
$409 |
— |
| Radiologic Examination Salivary Gland Calculus (70380) |
— |
$248 |
— |
| Radiologic examination tibia & fibula 2 views (73590) |
— |
$346 |
— |
| Ribs bilateral 3 views (71110) |
— |
$404 |
— |
| Rp loclzj tum plnr 1 area single day imaging (78800) |
— |
$808 |
— |
| Rp Loclzj Tum Plnr Whole Body Single Day Imaging (78802) |
— |
$1,310 |
— |
| Scapula (73010) |
— |
$311 |
— |
| Screening Digital Breast Tomosynthesis Bi (77063) |
— |
$106 |
— |
| Sella turcica (70240) |
— |
$164 |
— |
| Shoulder Arthrography (73040) |
— |
$548 |
— |
| Sialogram (70390) |
— |
$393 |
— |
| Skull less than 4 views (70250) |
— |
$368 |
— |
| Speech evaluation, complex (70371) |
— |
$203 |
— |
| Sternoclavicular joints (71130) |
— |
$278 |
— |
| Thoracic spine 3 views (72072) |
— |
$452 |
— |
| Thyroid Uptake W/Blood Flow Sngle/Mult Quan Meas (78014) |
— |
$1,297 |
— |
| Ultrasound Breast Limited (76642) |
— |
$446 |
— |
| Ultrasound Exam Aaa Screen (76706) |
— |
$656 |
— |
| Ultrasound, abdomen limited (76705) |
— |
$655 |
— |
Unlisted Dx Radiographic Procedure (76499)
range across 2 matching MRF lines |
— |
$174–$212 |
— |
| Unlisted us procedure (76999) |
— |
$689 |
— |
| Upper gi w/o kub (74240) |
— |
$961 |
— |
| Urethrocystogram voiding (74455) |
— |
$615 |
— |
| Us breast unilateral complete (76641) |
— |
$446 |
— |
| Us chest (76604) |
— |
$338 |
— |
| Us complete joint (76881) |
— |
$521 |
— |
| Us exam, pelvic, limited (76857) |
— |
$642 |
— |
| Us lmtd joint/oth nonvasc xtr strux r-t w/img (76882) |
— |
$521 |
— |
| Us ob detailed single fetus (76811) |
— |
$695 |
— |
| Us ob limited 1 or more fetuses (76815) |
— |
$600 |
— |
| Us ob transvaginal (76817) |
— |
$545 |
— |
| Us pelvic non ob complete (76856) |
— |
$717 |
— |
| Us pg uter img f&mat 14 wk tabdl 1/1st gestation (76801) |
— |
$618 |
— |
| Us preg uterus real time f/u trnsabdl per fetus (76816) |
— |
$572 |
— |
| Us retroperitoneal complete (76770) |
— |
$750 |
— |
| Us retroperitoneal limited (76775) |
— |
$640 |
— |
| Us scrotum and contents (76870) |
— |
$532 |
— |
| Us thyroid (76536) |
— |
$739 |
— |
| Us transrectal (76872) |
— |
$424 |
— |
| Venography extremity bilateral rs&i (75822) |
— |
$1,207 |
— |
| Venography extremity unilateral rs&i (75820) |
— |
$689 |
— |
| Wrist 2 views (73100) |
— |
$242 |
— |
| X-Ray Ac Jts - Xr Acromioclavicular Joints Bilateral (73050) |
— |
$346 |
— |
| X-Ray Exam Breast Specimen (76098) |
— |
$314 |
— |
| X-Ray Exam Entire Spi 2/3 Vw (72082) |
— |
$309 |
— |
| X-Ray Exam Hip Uni 1 View (73501) |
— |
$273 |
— |
| X-Ray Exam Hip Uni 2-3 Views (73502) |
— |
$326 |
— |
| X-Ray Exam Hips Bi 2 Views (73521) |
— |
$368 |
— |
| X-Ray Exam L-S Spine Bending (72114) |
— |
$477 |
— |
| X-Ray Exam Neck Spine 2-3 Vw (72040) |
— |
$346 |
— |
| X-Ray Exam Neck Spine 6/>Vws (72052) |
— |
$514 |
— |
| X-Ray Exam Unilat Ribs/Chest (71101) |
— |
$360 |
— |
| X-ray eye for foreign body (70030) |
— |
$293 |
— |
| X-ray humerus (73060) |
— |
$281 |
— |
| X-ray IV pyelogram (ivp) (74400) |
— |
$858 |
— |
| X-Ray Lumbar Spine 2/3 Vw - Xr Lumbar Spine 2-3 Views (72100) |
— |
$393 |
— |
| X-Ray Sacroiliac Jts <3 Vw - Xr Sacroiliac Joints 1-2 Views (72200) |
— |
$302 |
— |
| X-Ray Sacrum/Coccyx 2+ Vw - Xr Sacrum Coccyx 2+ Views (72220) |
— |
$317 |
— |
| X-Ray Sinuses 3+ Vw - Xr Paranasal Sinuses 3+ Views (70220) |
— |
$361 |
— |
| X-Ray Skull 4+ Vw - Xr Skull Complete 4+ Views (70260) |
— |
$435 |
— |
| X-Ray Tmj Unilat (70328) |
— |
$315 |
— |
| X-Ray Urinary Tract Exam With Contrast Material (74420) |
— |
$689 |
— |
| X-Rays Bone Length Studies (77073) |
— |
$325 |
— |
| X-Rays Bone Survey Complete (77075) |
— |
$455 |
— |
| Xr c-spine 4 or 5 views (72050) |
— |
$520 |
— |
| Xr facial bones less than 3 views (70140) |
— |
$197 |
— |
| Xr orbits complete 4 views (70200) |
— |
$384 |
— |