| Abdomen 1 View (74018) |
— |
$213 |
— |
Abdomen 2 views (74019)
range across 2 matching MRF lines |
— |
$162–$251 |
— |
| Acute Gastrointestinal Blood Loss Imaging (78278) |
— |
$2,587 |
— |
Ankle 2 views (73600)
range across 2 matching MRF lines |
— |
$136–$166 |
— |
| Arthrogram hip (73525) |
— |
$469 |
— |
| Arthrogram Wrist (73115) |
— |
$421 |
— |
| Bone age studies (77072) |
— |
$179 |
— |
| Bone Imaging 3 Phase (78315) |
— |
$1,990 |
— |
| Bone Imaging Limited Area (78300) |
— |
$1,179 |
— |
| Bone Imaging Multiple Areas (78305) |
— |
$1,179 |
— |
| Bone Imaging Whole Body (78306) |
— |
$1,689 |
— |
| Bone survey infant (77076) |
— |
$518 |
— |
| Chest 1 view (71045) |
— |
$250 |
— |
Chest 2 views (71046)
range across 2 matching MRF lines |
— |
$255–$277 |
— |
| Chest 3 views (71047) |
— |
$307 |
— |
| Chest 4 or more views (71048) |
— |
$317 |
— |
| Clavicle complete (73000) |
— |
$195 |
— |
| Computed Tomography Thorax Lw Dose Lng Ca Scr C- (71271) |
— |
$289 |
— |
| Contrast X-Ray Bladder (74430) |
— |
$502 |
— |
| Contrast X-Ray Of Knee Joint (73580) |
— |
$456 |
— |
| Contrast Xray Throat/Cerv Esopha (74210) |
— |
$279 |
— |
| CT abdomen and pelvis without and with contrast (74178) |
— |
$4,218 |
— |
| CT abdomen and pelvis without contrast (74176) |
— |
$2,922 |
— |
| CT abdomen w contrast (74160) |
— |
$1,676 |
— |
| CT abdomen w wo contrast (74170) |
— |
$3,319 |
— |
| CT abdomen w/o contrast (74150) |
— |
$1,327 |
— |
| CT Angio Abdomen and Pelvis (74174) |
— |
$3,730 |
— |
| CT Angio Chest (71275) |
— |
$3,398 |
— |
| CT Angio Head (70496) |
— |
$3,370 |
— |
| CT angio hrt w/3d image (75574) |
— |
$2,726 |
— |
| Ct Angio Lwr Extr W/O&W/Dye (73706) |
— |
$1,675 |
— |
| CT Angio Neck (70498) |
— |
$3,398 |
— |
| Ct Angio Upr Extrm W/O&W/Dye (73206) |
— |
$2,950 |
— |
| CT cervical spine w/ contrast (72126) |
— |
$1,950 |
— |
| CT cervical spine w/o contrast (72125) |
— |
$1,868 |
— |
| CT chest w contrast (71260) |
— |
$2,361 |
— |
CT chest w/wo contrast (71270)
range across 2 matching MRF lines |
— |
$2,005–$2,875 |
— |
| CT colonography screening (74263) |
— |
$4,458 |
— |
| CT Colonogrphy Dx Image Postprocess W/Contrast (74262) |
— |
$2,715 |
— |
| CT colonogrphy dx image postprocess w/o contrast (74261) |
— |
$1,981 |
— |
| CT head/brain with contrast (70460) |
— |
$1,292 |
— |
| CT head/brain without and with contrast (70470) |
— |
$1,676 |
— |
| CT heart no contrast quant eval coronry calcium (75571) |
— |
$288 |
— |
| CT iac w contrast (70481) |
— |
$1,676 |
— |
| CT l-spine w&w/o contrast (72133) |
— |
$1,518 |
— |
| CT lower ext w/o (73700) |
— |
$1,980 |
— |
| CT lower extremity w/contrast material (73701) |
— |
$1,935 |
— |
| CT lumbar spine w contrast (72132) |
— |
$2,314 |
— |
| CT lumbar spine w/o contrast (72131) |
— |
$1,975 |
— |
| CT maxillofacial w contrast (70487) |
— |
$1,676 |
— |
| CT maxillofacial wo contrast (70486) |
— |
$1,169 |
— |
| CT neck tissue combo (70492) |
— |
$1,496 |
— |
| Ct Orbit/Ear/Fossa W/O&W/Dye (70482) |
— |
$1,534 |
— |
| CT orbits w/o contrast (70480) |
— |
$1,424 |
— |
| CT pelvis w&w/o contrast (72194) |
— |
$2,849 |
— |
| CT pelvis w/o contrast (72192) |
— |
$1,602 |
— |
| CT scan of leg combo (73702) |
— |
$2,950 |
— |
| CT scans face/jaw combo (70488) |
— |
$1,412 |
— |
| CT soft tissue neck w contrast (70491) |
— |
$2,222 |
— |
| CT soft tissue neck w/o contrast (70490) |
— |
$1,824 |
— |
| CT thoracic spine w contrast (72129) |
— |
$2,194 |
— |
| CT thoracic spine w/o contrast (72128) |
— |
$1,927 |
— |
| CT thorax w/o contrast (71250) |
— |
$2,262 |
— |
| CT upper ext wo (73200) |
— |
$1,626 |
— |
| CT upper extremity w/o & w/contrast material (73202) |
— |
$1,405 |
— |
| CT upper extremity with contrast (73201) |
— |
$2,201 |
— |
| Cta Abdl Aorta&Bi Iliofem W/Contrast&Postp (75635) |
— |
$4,423 |
— |
| Cta Abdomen (74175) |
— |
$3,311 |
— |
| CTA head&neck c+ w/noncontrast img&post-pxessing (70471) |
— |
$4,854 |
— |
| Dxa Bone Density Axial (77080) |
— |
$387 |
— |
| Dxa bone density study 1/>sites appendiclr skel (77081) |
— |
$195 |
— |
| Echo exam uterus (76831) |
— |
$792 |
— |
| Echograp Trans R Pros Study (76873) |
— |
$691 |
— |
| Esophagram (74220) |
— |
$579 |
— |
| Fetal Biophys Profile W/Nst (76818) |
— |
$838 |
— |
| Fetal Biophysical Profile W/O Non-Stress Testing (76819) |
— |
$850 |
— |
| Fluoroscopy up to 1 hr (76000) |
— |
$700 |
— |
Foot 2 views (73620)
range across 4 matching MRF lines |
— |
$125–$159 |
— |
Forearm 2 views (73090)
range across 3 matching MRF lines |
— |
$164–$240 |
— |
| Gastric emptying imaging study (78264) |
— |
$1,702 |
— |
| Gastric Emptyng Imag Std W/Sm Bwl Transit (78265) |
— |
$2,760 |
— |
| Gastric Mucosa Imaging (78261) |
— |
$1,179 |
— |
| Gated Heart Planar Single (78472) |
— |
$1,179 |
— |
Hand 2 views (73120)
range across 3 matching MRF lines |
— |
$170–$215 |
— |
| Hepatobil Syst Image W/Drug (78227) |
— |
$1,915 |
— |
| Hepatobiliary System Imaging (78226) |
— |
$2,048 |
— |
| Ht Muscle Image Spect Sing (78451) |
— |
$2,856 |
— |
| Hysterosalpingogram (74740) |
— |
$613 |
— |
| Infusion Ivp (74410) |
— |
$430 |
— |
| K Flow/Funct Image W/Drug (78708) |
— |
$1,749 |
— |
| K Flow/Funct Image W/O Drug (78707) |
— |
$1,030 |
— |
| Knee 3 Views (73562) |
— |
$266 |
— |
| Liver & Spleen Imaging Static Only (78215) |
— |
$804 |
— |
| Liver & Spleen Imaging W/Vascular Flow (78216) |
— |
$711 |
— |
| Lung Ventilat&Perfus Imaging (78582) |
— |
$2,787 |
— |
| Lung Ventilation Imaging (78579) |
— |
$1,049 |
— |
| Lymph System Imaging (78195) |
— |
$3,604 |
— |
| Magnetic Image Jaw Joint (70336) |
— |
$3,345 |
— |
| Meckels Divert Exam (78290) |
— |
$1,756 |
— |
| Mra Head W/O & W/Contrast Material (70546) |
— |
$6,160 |
— |
| MRA head w/o contrast (70544) |
— |
$3,552 |
— |
| MRA head with contrast (70545) |
— |
$2,188 |
— |
| MRA neck w contrast (70548) |
— |
$2,061 |
— |
| Mra Neck W/O &W/Contrast Material (70549) |
— |
$4,727 |
— |
| MRA neck w/o contrast (70547) |
— |
$3,309 |
— |
| MRI abdomen w contrast (74182) |
— |
$2,250 |
— |
| MRI abdomen w/o contrast (74181) |
— |
$3,652 |
— |
| MRI any jt lower extrem w/contrast material (73722) |
— |
$3,879 |
— |
| MRI any jt lower extrem w/o & w/contrast matrl (73723) |
— |
$4,814 |
— |
| MRI any jt upper extremity w/contrast matrl (73222) |
— |
$3,840 |
— |
| MRI Breast W/O Contrast Bilateral (77047) |
— |
$3,217 |
— |
MRI cervical spine w contrast (72142)
range across 2 matching MRF lines |
— |
$3,021–$4,277 |
— |
MRI cervical spine w/o cont (72141)
range across 2 matching MRF lines |
— |
$2,231–$3,071 |
— |
| MRI chest w/o contrast (71550) |
— |
$2,048 |
— |
| MRI chest with contrast (71551) |
— |
$2,289 |
— |
| MRI chest wo w contrast (71552) |
— |
$5,954 |
— |
| MRI lower extrem oth/thn jt w/contrast matrl (73719) |
— |
$4,046 |
— |
| MRI lower extrem oth/thn jt w/o & w/contr matr (73720) |
— |
$4,036 |
— |
| MRI lower extrem oth/thn jt w/o contr matrl (73718) |
— |
$4,023 |
— |
| MRI lumbar spine w contrast (72149) |
— |
$4,223 |
— |
Mri Neck Spine W/O & W/Dye (72156)
range across 2 matching MRF lines |
— |
$4,209–$5,079 |
— |
| MRI orbit face &/neck w/o contrast (70540) |
— |
$2,759 |
— |
| MRI orbit face neck w contrast (70542) |
— |
$4,043 |
— |
| Mri Orbt/Fac/Nck W/O &W/Dye (70543) |
— |
$5,088 |
— |
| MRI pelvis w contrast (72196) |
— |
$4,141 |
— |
| MRI pelvis w/o & w contrast (72197) |
— |
$4,328 |
— |
| MRI pelvis w/o contrast (72195) |
— |
$3,200 |
— |
MRI thoracic spine w/o contrast (72146)
range across 2 matching MRF lines |
— |
$3,356–$3,615 |
— |
| MRI upper extremity oth than jt w/o contr matrl (73218) |
— |
$2,478 |
— |
| Mri Uppr Extremity W/O&W/Dye (73220) |
— |
$5,152 |
— |
| MRI, abdomen, combo (74183) |
— |
$5,066 |
— |
MRI, dorsal spine combo (72157)
range across 2 matching MRF lines |
— |
$4,209–$4,714 |
— |
| MRI, dorsal spine contrast (72147) |
— |
$3,799 |
— |
| MRI, joint upper extrem (73221) |
— |
$3,183 |
— |
| MRI, joint upper extrem combo (73223) |
— |
$4,831 |
— |
MRI, lumbar spine combo (72158)
range across 2 matching MRF lines |
— |
$4,507–$4,883 |
— |
| Myocardial Spect Multiple Studies (78452) |
— |
$4,059 |
— |
Neck soft tissue (70360)
range across 2 matching MRF lines |
— |
$169–$187 |
— |
| Ob us nuchal meas 1 gest (76813) |
— |
$626 |
— |
| Parathyroid Planar Imaging (78070) |
— |
$828 |
— |
| Parathyroid planar imaging w/wo subtraction (78071) |
— |
$1,465 |
— |
| Pelvis 1 or 2 views (72170) |
— |
$181 |
— |
| Pet Image W/Ct Lmtd (78814) |
— |
$6,568 |
— |
| PET image w/CT, full body (78816) |
— |
$6,592 |
— |
| PET imaging CT attenuation skull base mid-thigh (78815) |
— |
$6,156 |
— |
| Pulmonary Perfusion Imaging Particulate (78580) |
— |
$2,147 |
— |
| Radex abscess/fistula/sinus tract rs&i (76080) |
— |
$288 |
— |
Radex Ankle Complete Minimum 3 Views (73610)
range across 2 matching MRF lines |
— |
$246–$266 |
— |
Radex Calcaneus Minimum 2 Views (73650)
range across 2 matching MRF lines |
— |
$123–$147 |
— |
| Radex elbow complete minimum 3 views (73080) |
— |
$251 |
— |
| Radex Facial Bones Complete Minimum 3 Views (70150) |
— |
$317 |
— |
Radex fingr minimum 2 views (73140)
range across 2 matching MRF lines |
— |
$204–$208 |
— |
Radex foot complete minimum 3 views (73630)
range across 2 matching MRF lines |
— |
$161–$242 |
— |
| Radex Hand Minimum 3 Views (73130) |
— |
$257 |
— |
| Radex lower extremity infant minimum 2 views (73592) |
— |
$156 |
— |
| Radex Mastoids Compl Minimum 3 Views PR Side (70130) |
— |
$163 |
— |
| Radex Nasal Bones Complete Minimum 3 Views (70160) |
— |
$179 |
— |
| Radex Ribs Unilateral 2 Views (71100) |
— |
$341 |
— |
Radex shoulder complete minimum 2 views (73030)
range across 2 matching MRF lines |
— |
$280–$290 |
— |
| Radex Sinuses Paransl < 3 Views (70210) |
— |
$129 |
— |
Radex Spine 1 View Specify Level (72020)
range across 2 matching MRF lines |
— |
$63–$85 |
— |
| Radex Sternum Minimum 2 Views (71120) |
— |
$179 |
— |
| Radex Temporomandble Jt Opn & Clsd Mouth Bilat (70330) |
— |
$226 |
— |
Radex Toe Minimum 2 Views (73660)
range across 2 matching MRF lines |
— |
$135–$181 |
— |
| Radex upper extremity infant minimum 2 views (73092) |
— |
$156 |
— |
| Radex Wrist Complete Minimum 3 Views (73110) |
— |
$258 |
— |
| Radex X-Ray Exam Entire Spi 6/> Vw - Xr Entire Spine 6+ Vw (72084) |
— |
$314 |
— |
| Radiolog exam mandible compl minimum 4 views (70110) |
— |
$207 |
— |
| Radiologic exam colon double contrast study (74280) |
— |
$785 |
— |
| Radiologic exam colon single contrast study (74270) |
— |
$651 |
— |
| Radiologic exam knee complete 4/more views (73564) |
— |
$253 |
— |
| Radiologic exam pelvis compl minimum 3 views (72190) |
— |
$317 |
— |
| Radiologic Exam Small Int Single Contrast Study (74250) |
— |
$631 |
— |
| Radiologic exam swallow function contrast study (74230) |
— |
$533 |
— |
| Radiologic exam upr gi trc double contrast study (74246) |
— |
$955 |
— |
Radiologic examination femur 1 view (73551)
range across 2 matching MRF lines |
— |
$186–$215 |
— |
Radiologic examination femur minimum 2 views (73552)
range across 3 matching MRF lines |
— |
$179–$247 |
— |
Radiologic examination knee 1/2 views (73560)
range across 2 matching MRF lines |
— |
$149–$176 |
— |
| Radiologic Examination Osseous Survey Limited (77074) |
— |
$375 |
— |
Radiologic examination tibia & fibula 2 views (73590)
range across 3 matching MRF lines |
— |
$165–$234 |
— |
| Ribs bilateral 3 views (71110) |
— |
$186 |
— |
| Scapula (73010) |
— |
$181 |
— |
Screening Digital Breast Tomosynthesis Bi (77063)
range across 2 matching MRF lines |
— |
$93–$199 |
— |
Shoulder 1 view (73020)
range across 2 matching MRF lines |
— |
$116–$145 |
— |
| Shoulder Arthrography (73040) |
— |
$482 |
— |
| Sialogram (70390) |
— |
$482 |
— |
Skull less than 4 views (70250)
range across 2 matching MRF lines |
— |
$157–$284 |
— |
| Sternoclavicular joints (71130) |
— |
$231 |
— |
Thoracic spine 2 views (72070)
range across 2 matching MRF lines |
— |
$173–$176 |
— |
| Thoracic spine 3 views (72072) |
— |
$303 |
— |
Thoracolumbar 2 views (72080)
range across 2 matching MRF lines |
— |
$215–$317 |
— |
| Thyroid Imaging With Vascular Flow (78013) |
— |
$1,103 |
— |
| Thyroid Uptake W/Blood Flow Sngle/Mult Quan Meas (78014) |
— |
$1,179 |
— |
| Ultrasound Breast Limited (76642) |
— |
$574 |
— |
| Ultrasound Elastography Parenchyma (76981) |
— |
$316 |
— |
| Ultrasound Exam Aaa Screen (76706) |
— |
$530 |
— |
| Ultrasound, abdomen limited (76705) |
— |
$586 |
— |
| Umbilical-artery Doppler (OB) (76820) |
— |
$340 |
— |
| Upper gi w/o kub (74240) |
— |
$730 |
— |
| Ureteral Reflux Study (78740) |
— |
$1,179 |
— |
| Urethrocystogram voiding (74455) |
— |
$436 |
— |
| Urethrocystography retrograde (74450) |
— |
$502 |
— |
| Us breast unilateral complete (76641) |
— |
$492 |
— |
| Us chest (76604) |
— |
$479 |
— |
| Us exam, pelvic, limited (76857) |
— |
$313 |
— |
| Us kidney transplant (76776) |
— |
$602 |
— |
| Us lmtd joint/oth nonvasc xtr strux r-t w/img (76882) |
— |
$338 |
— |
| Us ob detailed single fetus (76811) |
— |
$1,068 |
— |
Us ob limited 1 or more fetuses (76815)
range across 3 matching MRF lines |
— |
$619–$647 |
— |
| Us ob transvaginal (76817) |
— |
$859 |
— |
| Us pelvic non ob complete (76856) |
— |
$857 |
— |
| Us pg uter img f&mat 14 wk tabdl 1/1st gestation (76801) |
— |
$873 |
— |
| Us preg uterus real time f/u trnsabdl per fetus (76816) |
— |
$575 |
— |
| Us retroperitoneal complete (76770) |
— |
$864 |
— |
Us retroperitoneal limited (76775)
range across 3 matching MRF lines |
— |
$489–$779 |
— |
| Us scrotum and contents (76870) |
— |
$770 |
— |
| Us spinal canal and contents (76800) |
— |
$645 |
— |
| Us thyroid (76536) |
— |
$782 |
— |
| Us transrectal (76872) |
— |
$711 |
— |
| Venography extremity unilateral rs&i (75820) |
— |
$501 |
— |
| Wrist 2 views (73100) |
— |
$202 |
— |
| X-Ray Ac Jts - Xr Acromioclavicular Joints Bilateral (73050) |
— |
$202 |
— |
| X-ray antegrade pyelogram tube (74425) |
— |
$218 |
— |
| X-Ray Bend Only L-S Spine (72120) |
— |
$255 |
— |
X-Ray Elbow 2 Vw - Xr Elbow 1-2 Views Right (73070)
range across 3 matching MRF lines |
— |
$140–$166 |
— |
| X-Ray Exam Breast Specimen (76098) |
— |
$316 |
— |
| X-Ray Exam Entire Spi 1 Vw (72081) |
— |
$217 |
— |
X-Ray Exam Entire Spi 2/3 Vw (72082)
range across 3 matching MRF lines |
— |
$170–$244 |
— |
| X-Ray Exam Entire Spi 4/5 Vw (72083) |
— |
$314 |
— |
X-Ray Exam Hip Uni 1 View (73501)
range across 2 matching MRF lines |
— |
$199–$215 |
— |
X-Ray Exam Hip Uni 2-3 Views (73502)
range across 3 matching MRF lines |
— |
$204–$275 |
— |
| X-Ray Exam Hip Uni 4/> Views (73503) |
— |
$192 |
— |
X-Ray Exam Hips Bi 2 Views (73521)
range across 3 matching MRF lines |
— |
$276–$474 |
— |
| X-Ray Exam Hips Bi 3-4 Views (73522) |
— |
$233 |
— |
| X-Ray Exam L-S Spine Bending (72114) |
— |
$391 |
— |
X-Ray Exam Neck Spine 2-3 Vw (72040)
range across 2 matching MRF lines |
— |
$173–$230 |
— |
| X-Ray Exam Neck Spine 6/>Vws (72052) |
— |
$279 |
— |
| X-Ray Exam Unilat Ribs/Chest (71101) |
— |
$329 |
— |
| X-ray eye for foreign body (70030) |
— |
$293 |
— |
X-ray humerus (73060)
range across 3 matching MRF lines |
— |
$232–$264 |
— |
| X-Ray Jaw <4 Vw - Xr Mandible < 4 Views (70100) |
— |
$125 |
— |
X-Ray Lumbar Spine 2/3 Vw - Xr Lumbar Spine 2-3 Views (72100)
range across 2 matching MRF lines |
— |
$191–$193 |
— |
| X-ray nose-rectum child f.b. (76010) |
— |
$222 |
— |
| X-Ray Ribs, Chest 4+ Vw - Xr Ribs 3 Vws Bil W/ Chest Posteroanterior (71111) |
— |
$398 |
— |
| X-Ray Sacroiliac Jts 3+ Vw - Xr Sacroiliac Joints 3+ Views (72202) |
— |
$216 |
— |
| X-Ray Sacroiliac Jts <3 Vw - Xr Sacroiliac Joints 1-2 Views (72200) |
— |
$175 |
— |
| X-Ray Sacrum/Coccyx 2+ Vw - Xr Sacrum Coccyx 2+ Views (72220) |
— |
$262 |
— |
| X-Ray Sinuses 3+ Vw - Xr Paranasal Sinuses 3+ Views (70220) |
— |
$217 |
— |
| X-Ray Skull 4+ Vw - Xr Skull Complete 4+ Views (70260) |
— |
$393 |
— |
| X-ray thoracic spine 4 vw (72074) |
— |
$203 |
— |
| X-Ray Tmj Unilat (70328) |
— |
$108 |
— |
| X-Ray Urinary Tract Exam With Contrast Material (74420) |
— |
$563 |
— |
| X-Rays Bone Length Studies (77073) |
— |
$80 |
— |
| X-Rays Bone Survey Complete (77075) |
— |
$506 |
— |
| Xr c-spine 4 or 5 views (72050) |
— |
$326 |
— |
| Xr facial bones less than 3 views (70140) |
— |
$212 |
— |
Xr orbits complete 4 views (70200)
range across 2 matching MRF lines |
— |
$192–$350 |
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