| Abdomen 1 View (74018) |
— |
$570 |
— |
| Abdomen 2 views (74019) |
— |
$694 |
— |
| Acute Gastrointestinal Blood Loss Imaging (78278) |
— |
$5,670 |
— |
| Ankle 2 views (73600) |
— |
$579 |
— |
| Arthrogram ankle (73615) |
— |
$2,001 |
— |
| Arthrogram hip (73525) |
— |
$1,747 |
— |
| Arthrogram Wrist (73115) |
— |
$1,655 |
— |
| Bone age studies (77072) |
— |
$619 |
— |
| Bone Imaging 3 Phase (78315) |
— |
$5,635 |
— |
| Bone Imaging Limited Area (78300) |
— |
$2,925 |
— |
| Bone Imaging Multiple Areas (78305) |
— |
$3,325 |
— |
| Bone Imaging Whole Body (78306) |
— |
$4,088 |
— |
| Bone marrow imaging; whole body (78104) |
— |
$2,889 |
— |
| Brain Flow Imaging Only (78610) |
— |
$2,927 |
— |
| Brain imaging < 4 static views (78600) |
— |
$2,963 |
— |
| Cat Scan Follow-Up Study (76380) |
— |
$1,126 |
— |
| Cerebrospinal Fluid Scan (78630) |
— |
$5,716 |
— |
| Chest 1 view (71045) |
— |
$533 |
— |
| Chest 2 views (71046) |
— |
$654 |
— |
| Chest 3 views (71047) |
— |
$769 |
— |
| Chest 4 or more views (71048) |
— |
$959 |
— |
| Cholecystography Oral Contrast (74290) |
— |
$1,389 |
— |
| Cisternography Positive Contrast Rs&I (70015) |
— |
$3,723 |
— |
| Clavicle complete (73000) |
— |
$657 |
— |
| Computed Tomography Thorax Lw Dose Lng Ca Scr C- (71271) |
— |
$464 |
— |
| Contrast X-Ray Bladder (74430) |
— |
$1,353 |
— |
| Contrast X-Ray Of Elbow (73085) |
— |
$1,687 |
— |
| Contrast X-Ray Of Knee Joint (73580) |
— |
$1,769 |
— |
| CT abdomen and pelvis without and with contrast (74178) |
— |
$6,973 |
— |
| CT abdomen and pelvis without contrast (74176) |
— |
$4,166 |
— |
| CT abdomen w contrast (74160) |
— |
$3,645 |
— |
| CT abdomen w wo contrast (74170) |
— |
$3,645 |
— |
| CT abdomen w/o contrast (74150) |
— |
$2,033 |
— |
| CT Angio Abdomen and Pelvis (74174) |
— |
$6,973 |
— |
| CT Angio Chest (71275) |
— |
$936 |
— |
| CT Angio Head (70496) |
— |
$3,645 |
— |
| CT angio hrt w/3d image (75574) |
— |
$3,645 |
— |
| Ct Angio Lwr Extr W/O&W/Dye (73706) |
— |
$3,630 |
— |
| CT Angio Neck (70498) |
— |
$3,645 |
— |
| Ct Angio Upr Extrm W/O&W/Dye (73206) |
— |
$3,645 |
— |
| CT cervical spine w/ contrast (72126) |
— |
$4,804 |
— |
| CT cervical spine w/o contrast (72125) |
— |
$2,033 |
— |
| CT cervical spine w/wo cont (72127) |
— |
$3,645 |
— |
| CT chest w contrast (71260) |
— |
$3,645 |
— |
| CT chest w/wo contrast (71270) |
— |
$3,645 |
— |
| CT colonography screening (74263) |
— |
$1,213 |
— |
| CT head/brain with contrast (70460) |
— |
$3,645 |
— |
| CT head/brain without and with contrast (70470) |
— |
$3,645 |
— |
| CT heart no contrast quant eval coronry calcium (75571) |
— |
$850 |
— |
| CT hrt w/3d image congen (75573) |
— |
$1,047 |
— |
| CT iac w contrast (70481) |
— |
$3,645 |
— |
| CT l-spine w&w/o contrast (72133) |
— |
$3,645 |
— |
| CT lower ext w/o (73700) |
— |
$2,033 |
— |
| CT lower extremity w/contrast material (73701) |
— |
$3,645 |
— |
| CT lumbar spine w contrast (72132) |
— |
$4,500 |
— |
| CT lumbar spine w/o contrast (72131) |
— |
$2,033 |
— |
| CT maxillofacial w contrast (70487) |
— |
$3,645 |
— |
| CT maxillofacial wo contrast (70486) |
— |
$2,033 |
— |
| CT neck tissue combo (70492) |
— |
$3,645 |
— |
| Ct Orbit/Ear/Fossa W/O&W/Dye (70482) |
— |
$3,645 |
— |
| CT orbits w/o contrast (70480) |
— |
$2,033 |
— |
| CT pelvis w&w/o contrast (72194) |
— |
$3,645 |
— |
| CT pelvis w/o contrast (72192) |
— |
$2,033 |
— |
| CT scan of leg combo (73702) |
— |
$3,645 |
— |
| CT scans face/jaw combo (70488) |
— |
$3,645 |
— |
| CT soft tissue neck w contrast (70491) |
— |
$3,645 |
— |
| CT soft tissue neck w/o contrast (70490) |
— |
$2,033 |
— |
| CT thoracic spine w contrast (72129) |
— |
$3,645 |
— |
| CT thoracic spine w/o contrast (72128) |
— |
$2,033 |
— |
| CT thoracic spine w/wo cont (72130) |
— |
$3,645 |
— |
| CT thorax w/o contrast (71250) |
— |
$2,033 |
— |
| CT upper ext wo (73200) |
— |
$2,033 |
— |
| CT upper extremity w/o & w/contrast material (73202) |
— |
$3,645 |
— |
| CT upper extremity with contrast (73201) |
— |
$4,213 |
— |
| Cta Abdl Aorta&Bi Iliofem W/Contrast&Postp (75635) |
— |
$3,645 |
— |
| Cta Abdomen (74175) |
— |
$3,645 |
— |
| CTA pelvis (72191) |
— |
$3,645 |
— |
| Discography Cerv/Thor Spine (72285) |
— |
$7,862 |
— |
| Diskography lumbar (72295) |
— |
$5,565 |
— |
| Dxa Bone Density Axial (77080) |
— |
$949 |
— |
Echo Guide For Artery Repair (76936)
range across 2 matching MRF lines |
— |
$1,628–$1,846 |
— |
| Esophagram (74220) |
— |
$1,138 |
— |
| Fetal Biophys Profile W/Nst (76818) |
— |
$1,421 |
— |
| Fluoroscopy up to 1 hr (76000) |
— |
$1,202 |
— |
| Foot 2 views (73620) |
— |
$621 |
— |
| Forearm 2 views (73090) |
— |
$646 |
— |
| Gastric emptying imaging study (78264) |
— |
$4,698 |
— |
| Gastroesophageal Reflux Exam (78262) |
— |
$3,945 |
— |
| Gated Heart Planar Single (78472) |
— |
$3,316 |
— |
| Hand 2 views (73120) |
— |
$579 |
— |
| Heart first pass single,planar (78481) |
— |
$2,933 |
— |
| Hepatobil Syst Image W/Drug (78227) |
— |
$10,633 |
— |
| Hepatobiliary System Imaging (78226) |
— |
$7,845 |
— |
| Ht Muscle Image Spect Sing (78451) |
— |
$5,739 |
— |
| Hysterosalpingogram (74740) |
— |
$1,718 |
— |
| Infant hip ultrasound with hip movement (dynamic) (76885) |
— |
$919 |
— |
| Joint Survey Single View (77077) |
— |
$493 |
— |
| K Flow/Funct Image W/Drug (78708) |
— |
$2,916 |
— |
| K Flow/Funct Image W/O Drug (78707) |
— |
$3,346 |
— |
| Kidney Imaging Morphol (78700) |
— |
$2,816 |
— |
| Kidney Imaging Morphoogy W/Vascular Flow (78701) |
— |
$3,536 |
— |
| Knee 3 Views (73562) |
— |
$699 |
— |
| Leveen/Shunt Patency Exam (78291) |
— |
$4,063 |
— |
| Liver & Spleen Imaging Static Only (78215) |
— |
$3,263 |
— |
| Liver imaging static only (78201) |
— |
$3,025 |
— |
| Lung Perf&Ventilat Diferentl (78598) |
— |
$4,972 |
— |
| Lung Ventilat&Perfus Imaging (78582) |
— |
$7,926 |
— |
| Lung Ventilation Imaging (78579) |
— |
$4,522 |
— |
| Lymph System Imaging (78195) |
— |
$5,776 |
— |
| Meckels Divert Exam (78290) |
— |
$5,600 |
— |
| Mr safety determination physician/other qhp (76016) |
— |
$458 |
— |
| Mr safety implant&/fb assmt clin staf 1st 15 min (76014) |
— |
$128 |
— |
| Mr safety implt electronics prepj supvj phys/qhp (76018) |
— |
$477 |
— |
| Mr safety implt pos&/immoblj (76019) |
— |
$309 |
— |
| Mr safety med physics xm customization plng&mntr (76017) |
— |
$1,256 |
— |
| MRA head w/o contrast (70544) |
— |
$4,444 |
— |
| MRA head with contrast (70545) |
— |
$6,447 |
— |
| MRA neck w contrast (70548) |
— |
$5,922 |
— |
| Mra Neck W/O &W/Contrast Material (70549) |
— |
$7,084 |
— |
| MRA neck w/o contrast (70547) |
— |
$4,444 |
— |
| MRI abdomen w/o contrast (74181) |
— |
$4,444 |
— |
| MRI any jt lower extrem w/contrast material (73722) |
— |
$6,551 |
— |
| MRI any jt lower extrem w/o & w/contrast matrl (73723) |
— |
$7,438 |
— |
| MRI any jt upper extremity w/contrast matrl (73222) |
— |
$6,459 |
— |
| MRI cardiac w/o contrast (75557) |
— |
$4,444 |
— |
| MRI cervical spine w contrast (72142) |
— |
$7,171 |
— |
| MRI cervical spine w/o cont (72141) |
— |
$4,444 |
— |
| MRI chest w/o contrast (71550) |
— |
$4,444 |
— |
| MRI chest wo w contrast (71552) |
— |
$7,438 |
— |
| MRI lower extrem oth/thn jt w/contrast matrl (73719) |
— |
$6,161 |
— |
| MRI lower extrem oth/thn jt w/o & w/contr matr (73720) |
— |
$7,340 |
— |
| MRI lower extrem oth/thn jt w/o contr matrl (73718) |
— |
$4,444 |
— |
| MRI lumbar spine w contrast (72149) |
— |
$7,026 |
— |
| Mri Neck Spine W/O & W/Dye (72156) |
— |
$7,438 |
— |
| MRI orbit face &/neck w/o contrast (70540) |
— |
$4,444 |
— |
| MRI orbit face neck w contrast (70542) |
— |
$6,931 |
— |
| Mri Orbt/Fac/Nck W/O &W/Dye (70543) |
— |
$7,438 |
— |
| MRI pelvis w contrast (72196) |
— |
$6,938 |
— |
| MRI pelvis w/o & w contrast (72197) |
— |
$7,438 |
— |
| MRI pelvis w/o contrast (72195) |
— |
$4,444 |
— |
| MRI thoracic spine w/o contrast (72146) |
— |
$4,444 |
— |
| MRI upper extremity oth than jt w/contr matrl (73219) |
— |
$6,975 |
— |
| MRI upper extremity oth than jt w/o contr matrl (73218) |
— |
$4,444 |
— |
| Mri Uppr Extremity W/O&W/Dye (73220) |
— |
$7,434 |
— |
| MRI, abdomen, combo (74183) |
— |
$7,281 |
— |
| MRI, dorsal spine combo (72157) |
— |
$7,438 |
— |
| MRI, dorsal spine contrast (72147) |
— |
$7,121 |
— |
| MRI, joint upper extrem (73221) |
— |
$4,444 |
— |
| MRI, joint upper extrem combo (73223) |
— |
$7,438 |
— |
| MRI, lumbar spine combo (72158) |
— |
$7,438 |
— |
| Myelogram cervical (72240) |
— |
$3,450 |
— |
| Myelogram Lumbar (72265) |
— |
$3,572 |
— |
| Myelography thoracic (72255) |
— |
$2,414 |
— |
| Myelograpy 2/more regions rs&i (72270) |
— |
$3,849 |
— |
| Myocardial Spect Multiple Studies (78452) |
— |
$6,814 |
— |
| Neck soft tissue (70360) |
— |
$601 |
— |
| Nm csf leak detection (78650) |
— |
$5,623 |
— |
| Nonvascular Shunt X-Ray (75809) |
— |
$1,065 |
— |
| Nuclear Rx Intra-Arterial (79445) |
— |
$1,800 |
— |
| Optic foramina (70190) |
— |
$528 |
— |
| Parathyroid Planar Imaging (78070) |
— |
$4,876 |
— |
| Pelvis 1 or 2 views (72170) |
— |
$645 |
— |
| Pulmonary Perfusion Imaging Particulate (78580) |
— |
$3,440 |
— |
| Radex Abd Compl Aqt Abd W/S/E/D Views 1 View Ch (74022) |
— |
$995 |
— |
| Radex abscess/fistula/sinus tract rs&i (76080) |
— |
$1,545 |
— |
| Radex Ankle Complete Minimum 3 Views (73610) |
— |
$704 |
— |
| Radex Calcaneus Minimum 2 Views (73650) |
— |
$579 |
— |
| Radex elbow complete minimum 3 views (73080) |
— |
$719 |
— |
| Radex Facial Bones Complete Minimum 3 Views (70150) |
— |
$857 |
— |
| Radex fingr minimum 2 views (73140) |
— |
$509 |
— |
| Radex foot complete minimum 3 views (73630) |
— |
$704 |
— |
| Radex Hand Minimum 3 Views (73130) |
— |
$632 |
— |
| Radex lower extremity infant minimum 2 views (73592) |
— |
$522 |
— |
| Radex Mastoids Compl Minimum 3 Views PR Side (70130) |
— |
$770 |
— |
| Radex Nasal Bones Complete Minimum 3 Views (70160) |
— |
$647 |
— |
| Radex Pharynx/Larx W/Fluor&/Magnification Tq (70370) |
— |
$688 |
— |
| Radex Ribs Unilateral 2 Views (71100) |
— |
$715 |
— |
| Radex shoulder complete minimum 2 views (73030) |
— |
$723 |
— |
| Radex Sinuses Paransl < 3 Views (70210) |
— |
$598 |
— |
| Radex Spine 1 View Specify Level (72020) |
— |
$614 |
— |
| Radex Sternum Minimum 2 Views (71120) |
— |
$656 |
— |
| Radex Temporomandble Jt Opn & Clsd Mouth Bilat (70330) |
— |
$866 |
— |
| Radex Toe Minimum 2 Views (73660) |
— |
$510 |
— |
| Radex upper extremity infant minimum 2 views (73092) |
— |
$565 |
— |
| Radex Wrist Complete Minimum 3 Views (73110) |
— |
$709 |
— |
| Radiolog exam mandible compl minimum 4 views (70110) |
— |
$915 |
— |
| Radiologic Exam Abdomen 3+ Views - Xr Abdomen 3+ Views (74021) |
— |
$885 |
— |
| Radiologic exam colon double contrast study (74280) |
— |
$1,968 |
— |
| Radiologic exam colon single contrast study (74270) |
— |
$1,645 |
— |
| Radiologic exam knee complete 4/more views (73564) |
— |
$882 |
— |
| Radiologic Exam Small Int Single Contrast Study (74250) |
— |
$1,326 |
— |
| Radiologic exam swallow function contrast study (74230) |
— |
$1,163 |
— |
| Radiologic exam upr gi trc double contrast study (74246) |
— |
$1,543 |
— |
| Radiologic examination femur 1 view (73551) |
— |
$567 |
— |
| Radiologic examination femur minimum 2 views (73552) |
— |
$731 |
— |
Radiologic examination knee 1/2 views (73560)
range across 2 matching MRF lines |
— |
$618–$1,009 |
— |
| Radiologic Examination Osseous Survey Limited (77074) |
— |
$577 |
— |
Radiologic examination tibia & fibula 2 views (73590)
range across 2 matching MRF lines |
— |
$647–$1,009 |
— |
| Ribs bilateral 3 views (71110) |
— |
$906 |
— |
| Rp loclzj tum plnr 1 area single day imaging (78800) |
— |
$3,201 |
— |
| Rp loclzj tum plnr 2+area 1+d img/1 area img>2+d (78801) |
— |
$4,053 |
— |
| Rp Loclzj Tum Plnr Whole Body 2+ Days Imaging (78804) |
— |
$9,593 |
— |
| Rp Loclzj Tum Plnr Whole Body Single Day Imaging (78802) |
— |
$5,211 |
— |
| Rp Loclzj Tum Spect 1 Area Single Day Imaging (78803) |
— |
$5,732 |
— |
| Rp loclzj tum spect 2 area/sep acquisj img (78831) |
— |
$11,234 |
— |
| Rp Ther Radiolbld Monoclonal Antibody IV Infus (79403) |
— |
$3,099 |
— |
| Rp Therapy Intravenous Administration (79101) |
— |
$2,223 |
— |
| Salivary Gland Imaging (78230) |
— |
$2,904 |
— |
| Scapula (73010) |
— |
$644 |
— |
Screening Digital Breast Tomosynthesis Bi (77063)
range across 2 matching MRF lines |
— |
$104–$116 |
— |
| Shoulder 1 view (73020) |
— |
$596 |
— |
| Shoulder Arthrography (73040) |
— |
$1,735 |
— |
| Sialogram (70390) |
— |
$1,616 |
— |
| Skull less than 4 views (70250) |
— |
$693 |
— |
| Spleen Imaging (78185) |
— |
$3,406 |
— |
| Sternoclavicular joints (71130) |
— |
$654 |
— |
| Tbs techl prep&transmis data alys pfrmd elsewhr (77090) |
— |
$449 |
— |
| Tbs technical calculation only (77091) |
— |
$449 |
— |
| Temporomandble Jt Arthrography Rs&I (70332) |
— |
$2,825 |
— |
| Testicular Imaging W/Flow (78761) |
— |
$3,542 |
— |
| Thoracic spine 2 views (72070) |
— |
$808 |
— |
| Thoracic spine 3 views (72072) |
— |
$931 |
— |
| Thoracolumbar 2 views (72080) |
— |
$804 |
— |
| Thyroid Imaging With Vascular Flow (78013) |
— |
$2,739 |
— |
| Thyroid Met Imaging Body (78018) |
— |
$5,240 |
— |
| Thyroid Uptake W/Blood Flow Sngle/Mult Quan Meas (78014) |
— |
$3,908 |
— |
| Ultrasound Breast Limited (76642) |
— |
$795 |
— |
| Ultrasound Elastography Parenchyma (76981) |
— |
$364 |
— |
| Ultrasound Exam Aaa Screen (76706) |
— |
$560 |
— |
| Ultrasound, abdomen limited (76705) |
— |
$1,208 |
— |
| Unlisted us procedure (76999) |
— |
$919 |
— |
| Upper gi w/o kub (74240) |
— |
$1,319 |
— |
| Ureteral Reflux Study (78740) |
— |
$3,559 |
— |
| Urethrocystogram voiding (74455) |
— |
$1,616 |
— |
| Urethrocystography retrograde (74450) |
— |
$1,334 |
— |
| Us breast unilateral complete (76641) |
— |
$966 |
— |
Us chest (76604)
range across 2 matching MRF lines |
— |
$857–$973 |
— |
| Us complete joint (76881) |
— |
$1,310 |
— |
| Us exam, pelvic, limited (76857) |
— |
$1,067 |
— |
| Us lmtd joint/oth nonvasc xtr strux r-t w/img (76882) |
— |
$834 |
— |
| Us ob limited 1 or more fetuses (76815) |
— |
$867 |
— |
| Us ob transvaginal (76817) |
— |
$1,029 |
— |
| Us pelvic non ob complete (76856) |
— |
$1,452 |
— |
| Us pg uter img f&mat 14 wk tabdl 1/1st gestation (76801) |
— |
$1,148 |
— |
| Us retroperitoneal complete (76770) |
— |
$1,384 |
— |
| Us scrotum and contents (76870) |
— |
$1,067 |
— |
| Us spinal canal and contents (76800) |
— |
$1,059 |
— |
| Us thyroid (76536) |
— |
$1,151 |
— |
| Wrist 2 views (73100) |
— |
$590 |
— |
| X-Ray Ac Jts - Xr Acromioclavicular Joints Bilateral (73050) |
— |
$680 |
— |
| X-Ray Elbow 2 Vw - Xr Elbow 1-2 Views Right (73070) |
— |
$591 |
— |
| X-Ray Exam Breast Specimen (76098) |
— |
$1,175 |
— |
| X-Ray Exam Entire Spi 1 Vw (72081) |
— |
$723 |
— |
| X-Ray Exam Entire Spi 2/3 Vw (72082) |
— |
$989 |
— |
| X-Ray Exam Hip Uni 1 View (73501) |
— |
$564 |
— |
| X-Ray Exam Hip Uni 2-3 Views (73502) |
— |
$419 |
— |
| X-Ray Exam Hips Bi 2 Views (73521) |
— |
$837 |
— |
| X-Ray Exam Hips Bi 3-4 Views (73522) |
— |
$936 |
— |
| X-Ray Exam Hips Bi 5/> Views (73523) |
— |
$1,278 |
— |
| X-Ray Exam Neck Spine 2-3 Vw (72040) |
— |
$774 |
— |
| X-Ray Exam Neck Spine 6/>Vws (72052) |
— |
$1,278 |
— |
| X-Ray Exam Unilat Ribs/Chest (71101) |
— |
$875 |
— |
| X-ray eye for foreign body (70030) |
— |
$587 |
— |
| X-ray humerus (73060) |
— |
$591 |
— |
| X-ray IV pyelogram (ivp) (74400) |
— |
$1,870 |
— |
| X-Ray Jaw <4 Vw - Xr Mandible < 4 Views (70100) |
— |
$574 |
— |
| X-Ray Knee Bilat Standing - Xr Knees Anteroposterior Standing Bilat (73565) |
— |
$687 |
— |
| X-Ray Lumbar Spine 2/3 Vw - Xr Lumbar Spine 2-3 Views (72100) |
— |
$834 |
— |
| X-Ray Ribs, Chest 4+ Vw - Xr Ribs 3 Vws Bil W/ Chest Posteroanterior (71111) |
— |
$1,751 |
— |
| X-Ray Sacroiliac Jts 3+ Vw - Xr Sacroiliac Joints 3+ Views (72202) |
— |
$720 |
— |
| X-Ray Sacrum/Coccyx 2+ Vw - Xr Sacrum Coccyx 2+ Views (72220) |
— |
$738 |
— |
| X-Ray Sinuses 3+ Vw - Xr Paranasal Sinuses 3+ Views (70220) |
— |
$881 |
— |
| X-Ray Skull 4+ Vw - Xr Skull Complete 4+ Views (70260) |
— |
$1,130 |
— |
| X-Ray Tmj Unilat (70328) |
— |
$621 |
— |
| X-Ray Urinary Tract Exam With Contrast Material (74420) |
— |
$1,700 |
— |
| X-Rays Bone Length Studies (77073) |
— |
$720 |
— |
| X-Rays Bone Survey Complete (77075) |
— |
$1,609 |
— |
| Xr c-spine 4 or 5 views (72050) |
— |
$1,097 |
— |
| Xr facial bones less than 3 views (70140) |
— |
$656 |
— |
| Xr orbits complete 4 views (70200) |
— |
$887 |
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