| Abdomen 1 View (74018) |
— |
$2,142 |
— |
| Abdomen 2 views (74019) |
— |
$2,058 |
— |
| Acute Gastrointestinal Blood Loss Imaging (78278) |
— |
$3,802 |
— |
| Acute venous thrombosis imaging, peptide Non-Facility (78456) |
— |
$4,578 |
— |
| Angiography extremity unilateral rs&i (75710) |
— |
$2,286 |
— |
| Angiography pulmonary unilateral slctv rs&i (75741) |
— |
$2,063 |
— |
| Ankle 2 views (73600) |
— |
$3,024 |
— |
| Aortography thoracic serialography rs&i (75605) |
— |
$1,965 |
— |
| Artery X-Rays Abdomen (75726) |
— |
$2,293 |
— |
| Artery X-Rays Pelvis (75736) |
— |
$2,217 |
— |
| Arthrogram ankle (73615) |
— |
$1,364 |
— |
| Arthrogram hip (73525) |
— |
$1,364 |
— |
| Arthrogram Wrist (73115) |
— |
$1,440 |
— |
| Bone age studies (77072) |
— |
$298 |
— |
| Bone Imaging 3 Phase (78315) |
— |
$3,940 |
— |
| Bone Imaging Limited Area (78300) |
— |
$2,322 |
— |
| Bone Imaging Multiple Areas (78305) |
— |
$3,056 |
— |
| Bone Imaging Whole Body (78306) |
— |
$3,235 |
— |
| Bone survey infant (77076) |
— |
$2,019 |
— |
| Brain imaging < 4 static views (78600) |
— |
$2,365 |
— |
| Brain Imaging Min 4 Static Views W Vascular Flow (78606) |
— |
$4,292 |
— |
| Brain Imaging Minimum 4 Static Views (78605) |
— |
$2,548 |
— |
| Cat Scan Follow-Up Study (76380) |
— |
$6,804 |
— |
| Cerebrospinal Fluid Flow W/O Matl Shunt Evaltj (78645) |
— |
$3,643 |
— |
| Cerebrospinal Fluid Scan (78630) |
— |
$4,457 |
— |
| Chest 1 view (71045) |
— |
$2,370 |
— |
| Chest 2 views (71046) |
— |
$3,024 |
— |
| Chest 3 views (71047) |
— |
$3,024 |
— |
| Chest 4 or more views (71048) |
— |
$3,024 |
— |
| Cholecystography Oral Contrast (74290) |
— |
$899 |
— |
| Clavicle complete (73000) |
— |
$3,024 |
— |
| Contrast Exam Abdominl Aorta (75625) |
— |
$1,969 |
— |
| Contrast X-Ray Bladder (74430) |
— |
$520 |
— |
| Contrast X-Ray Of Elbow (73085) |
— |
$1,317 |
— |
| Contrast X-Ray Of Knee Joint (73580) |
— |
$1,691 |
— |
| Corpora cavernosography (74445) |
— |
$1,301 |
— |
| CT abdomen and pelvis without and with contrast (74178) |
— |
$12,555 |
— |
| CT abdomen and pelvis without contrast (74176) |
— |
$12,476 |
— |
| CT abdomen w contrast (74160) |
— |
$7,177 |
— |
| CT abdomen w wo contrast (74170) |
— |
$7,262 |
— |
| CT abdomen w/o contrast (74150) |
— |
$7,177 |
— |
| CT Angio Abdomen and Pelvis (74174) |
— |
$10,369 |
— |
| CT Angio Chest (71275) |
— |
$10,046 |
— |
| CT Angio Head (70496) |
— |
$7,000 |
— |
| Ct Angio Lwr Extr W/O&W/Dye (73706) |
— |
$5,992 |
— |
| CT Angio Neck (70498) |
— |
$7,010 |
— |
| Ct Angio Upr Extrm W/O&W/Dye (73206) |
— |
$7,115 |
— |
| CT cervical spine w/ contrast (72126) |
— |
$6,048 |
— |
| CT cervical spine w/o contrast (72125) |
— |
$8,000 |
— |
| CT cervical spine w/wo cont (72127) |
— |
$6,930 |
— |
| CT chest w contrast (71260) |
— |
$6,804 |
— |
| CT chest w/wo contrast (71270) |
— |
$6,804 |
— |
| CT head/brain with contrast (70460) |
— |
$6,804 |
— |
| CT head/brain without and with contrast (70470) |
— |
$7,507 |
— |
| CT iac w contrast (70481) |
— |
$6,804 |
— |
| CT l-spine w&w/o contrast (72133) |
— |
$7,366 |
— |
| CT lower ext w/o (73700) |
— |
$8,004 |
— |
| CT lower extremity w/contrast material (73701) |
— |
$7,770 |
— |
| CT lumbar spine w contrast (72132) |
— |
$6,804 |
— |
| CT lumbar spine w/o contrast (72131) |
— |
$6,804 |
— |
| CT maxillofacial w contrast (70487) |
— |
$6,804 |
— |
| CT maxillofacial wo contrast (70486) |
— |
$6,804 |
— |
| CT neck tissue combo (70492) |
— |
$6,650 |
— |
| Ct Orbit/Ear/Fossa W/O&W/Dye (70482) |
— |
$6,804 |
— |
| CT orbits w/o contrast (70480) |
— |
$6,804 |
— |
| CT pelvis w&w/o contrast (72194) |
— |
$7,507 |
— |
| CT pelvis w/o contrast (72192) |
— |
$6,804 |
— |
| CT scan of leg combo (73702) |
— |
$6,408 |
— |
| CT scans face/jaw combo (70488) |
— |
$6,250 |
— |
| CT soft tissue neck w contrast (70491) |
— |
$6,804 |
— |
| CT soft tissue neck w/o contrast (70490) |
— |
$6,048 |
— |
| CT thoracic spine w contrast (72129) |
— |
$6,048 |
— |
| CT thoracic spine w/o contrast (72128) |
— |
$6,804 |
— |
| CT thoracic spine w/wo cont (72130) |
— |
$6,804 |
— |
| CT thorax w/o contrast (71250) |
— |
$6,804 |
— |
| CT unlisted procedure (76497) |
— |
$1,236 |
— |
| CT upper ext wo (73200) |
— |
$6,804 |
— |
| CT upper extremity w/o & w/contrast material (73202) |
— |
$6,804 |
— |
| CT upper extremity with contrast (73201) |
— |
$6,804 |
— |
| Cta Abdl Aorta&Bi Iliofem W/Contrast&Postp (75635) |
— |
$7,069 |
— |
| Cta Abdomen (74175) |
— |
$7,170 |
— |
| CTA pelvis (72191) |
— |
$5,991 |
— |
| Dilation ureters/urethra rs&i (74485) |
— |
$1,249 |
— |
| Diskography lumbar (72295) |
— |
$1,309 |
— |
| Doppler Echo Fetal Spectral Display Complete (76827) |
— |
$1,948 |
— |
| Dxa Bone Density Axial (77080) |
— |
$631 |
— |
| Echo exam uterus (76831) |
— |
$1,616 |
— |
| Echo Guide For Artery Repair (76936) |
— |
$2,572 |
— |
| Echograp Trans R Pros Study (76873) |
— |
$2,171 |
— |
| Esophagram (74220) |
— |
$2,161 |
— |
| Fetal Biophys Profile W/Nst (76818) |
— |
$1,579 |
— |
| Fetal Biophysical Profile W/O Non-Stress Testing (76819) |
— |
$1,147 |
— |
| Fluoroscopy up to 1 hr (76000) |
— |
$665 |
— |
| Follow-Up Angiography (75898) |
— |
$1,600 |
— |
| Foot 2 views (73620) |
— |
$2,538 |
— |
| Forearm 2 views (73090) |
— |
$3,024 |
— |
| Gastric emptying imaging study (78264) |
— |
$3,690 |
— |
| Gated Heart Planar Single (78472) |
— |
$3,032 |
— |
| Hand 2 views (73120) |
— |
$2,584 |
— |
| Hysterosalpingogram (74740) |
— |
$993 |
— |
| Infusion Ivp (74410) |
— |
$1,436 |
— |
| K Flow/Funct Image W/Drug (78708) |
— |
$2,196 |
— |
| K Flow/Funct Image W/O Drug (78707) |
— |
$2,971 |
— |
| Knee 3 Views (73562) |
— |
$3,300 |
— |
| Leveen/Shunt Patency Exam (78291) |
— |
$3,298 |
— |
| Liver & Spleen Imaging Static Only (78215) |
— |
$2,518 |
— |
| Meckels Divert Exam (78290) |
— |
$3,618 |
— |
| Mra Head W/O & W/Contrast Material (70546) |
— |
$7,974 |
— |
| MRA head w/o contrast (70544) |
— |
$6,383 |
— |
| MRA head with contrast (70545) |
— |
$5,750 |
— |
| MRA neck w contrast (70548) |
— |
$6,188 |
— |
| Mra Neck W/O &W/Contrast Material (70549) |
— |
$7,971 |
— |
| MRA neck w/o contrast (70547) |
— |
$6,367 |
— |
| MRI abdomen w contrast (74182) |
— |
$6,615 |
— |
| MRI abdomen w/o contrast (74181) |
— |
$6,668 |
— |
| MRI any jt lower extrem w/contrast material (73722) |
— |
$9,075 |
— |
| MRI any jt lower extrem w/o & w/contrast matrl (73723) |
— |
$10,265 |
— |
| MRI any jt upper extremity w/contrast matrl (73222) |
— |
$5,545 |
— |
| MRI cervical spine w contrast (72142) |
— |
$6,240 |
— |
| MRI cervical spine w/o cont (72141) |
— |
$8,786 |
— |
| MRI chest w/o contrast (71550) |
— |
$6,086 |
— |
| MRI chest with contrast (71551) |
— |
$6,649 |
— |
| MRI chest wo w contrast (71552) |
— |
$8,244 |
— |
| MRI lower extrem oth/thn jt w/contrast matrl (73719) |
— |
$6,005 |
— |
| MRI lower extrem oth/thn jt w/o & w/contr matr (73720) |
— |
$10,265 |
— |
| MRI lower extrem oth/thn jt w/o contr matrl (73718) |
— |
$7,814 |
— |
| MRI lumbar spine w contrast (72149) |
— |
$6,031 |
— |
| Mri Neck Spine W/O & W/Dye (72156) |
— |
$10,265 |
— |
| MRI orbit face &/neck w/o contrast (70540) |
— |
$5,055 |
— |
| MRI orbit face neck w contrast (70542) |
— |
$5,844 |
— |
| Mri Orbt/Fac/Nck W/O &W/Dye (70543) |
— |
$7,174 |
— |
| MRI pelvis w contrast (72196) |
— |
$9,075 |
— |
| MRI pelvis w/o & w contrast (72197) |
— |
$7,341 |
— |
| MRI pelvis w/o contrast (72195) |
— |
$8,080 |
— |
| MRI thoracic spine w/o contrast (72146) |
— |
$4,859 |
— |
| MRI upper extremity oth than jt w/contr matrl (73219) |
— |
$5,907 |
— |
| MRI upper extremity oth than jt w/o contr matrl (73218) |
— |
$5,060 |
— |
| Mri Uppr Extremity W/O&W/Dye (73220) |
— |
$10,265 |
— |
| MRI, abdomen, combo (74183) |
— |
$10,265 |
— |
| MRI, dorsal spine combo (72157) |
— |
$10,265 |
— |
| MRI, dorsal spine contrast (72147) |
— |
$5,512 |
— |
| MRI, joint upper extrem (73221) |
— |
$6,086 |
— |
| MRI, joint upper extrem combo (73223) |
— |
$10,265 |
— |
| MRI, lumbar spine combo (72158) |
— |
$12,204 |
— |
| Myelogram cervical (72240) |
— |
$1,646 |
— |
| Myelogram Lumbar (72265) |
— |
$7,196 |
— |
| Myelography thoracic (72255) |
— |
$3,903 |
— |
| Myelograpy 2/more regions rs&i (72270) |
— |
$3,024 |
— |
| Neck soft tissue (70360) |
— |
$3,024 |
— |
| Nm csf leak detection (78650) |
— |
$4,308 |
— |
| Ophthalmic ultrasound dx b-scan w/wo a-scan (76512) |
— |
$3,141 |
— |
| Panoramic X-ray of jaws (70355) |
— |
$268 |
— |
| Parathyroid Planar Imaging (78070) |
— |
$3,388 |
— |
| Pelvis 1 or 2 views (72170) |
— |
$2,111 |
— |
| Perineogram (74775) |
— |
$1,163 |
— |
| Peritoneogram Rs&I (74190) |
— |
$3,024 |
— |
| Plasma volume, radiopharmaceutical volume-dilution technique (separate procedure); single sampling Non-Facility (78110) |
— |
$1,188 |
— |
| Pulmonary Perfusion Imaging Particulate (78580) |
— |
$3,064 |
— |
| Radex Abd Compl Aqt Abd W/S/E/D Views 1 View Ch (74022) |
— |
$2,275 |
— |
| Radex abscess/fistula/sinus tract rs&i (76080) |
— |
$772 |
— |
| Radex Ankle Complete Minimum 3 Views (73610) |
— |
$3,024 |
— |
| Radex Calcaneus Minimum 2 Views (73650) |
— |
$3,024 |
— |
| Radex elbow complete minimum 3 views (73080) |
— |
$3,024 |
— |
| Radex Facial Bones Complete Minimum 3 Views (70150) |
— |
$2,394 |
— |
| Radex fingr minimum 2 views (73140) |
— |
$2,274 |
— |
| Radex foot complete minimum 3 views (73630) |
— |
$2,700 |
— |
| Radex Hand Minimum 3 Views (73130) |
— |
$3,024 |
— |
| Radex lower extremity infant minimum 2 views (73592) |
— |
$3,024 |
— |
| Radex Mastoids Compl Minimum 3 Views PR Side (70130) |
— |
$1,824 |
— |
| Radex Nasal Bones Complete Minimum 3 Views (70160) |
— |
$3,024 |
— |
| Radex Ribs Unilateral 2 Views (71100) |
— |
$2,274 |
— |
| Radex shoulder complete minimum 2 views (73030) |
— |
$3,235 |
— |
| Radex Sinuses Paransl < 3 Views (70210) |
— |
$3,024 |
— |
| Radex sm int w/mlt srl imges via enteroclss tube (74251) |
— |
$3,024 |
— |
| Radex Spine 1 View Specify Level (72020) |
— |
$3,024 |
— |
| Radex Sternum Minimum 2 Views (71120) |
— |
$3,024 |
— |
| Radex Temporomandble Jt Opn & Clsd Mouth Bilat (70330) |
— |
$3,024 |
— |
| Radex Toe Minimum 2 Views (73660) |
— |
$1,760 |
— |
| Radex upper extremity infant minimum 2 views (73092) |
— |
$2,019 |
— |
| Radex Wrist Complete Minimum 3 Views (73110) |
— |
$3,164 |
— |
| Radiolog exam mandible compl minimum 4 views (70110) |
— |
$2,538 |
— |
| Radiologic Exam Abdomen 3+ Views - Xr Abdomen 3+ Views (74021) |
— |
$2,389 |
— |
| Radiologic exam colon double contrast study (74280) |
— |
$2,136 |
— |
| Radiologic exam colon single contrast study (74270) |
— |
$1,956 |
— |
| Radiologic exam knee complete 4/more views (73564) |
— |
$3,024 |
— |
| Radiologic exam pelvis compl minimum 3 views (72190) |
— |
$2,214 |
— |
| Radiologic Exam Small Int Single Contrast Study (74250) |
— |
$3,024 |
— |
| Radiologic exam swallow function contrast study (74230) |
— |
$1,168 |
— |
| Radiologic exam upr gi trc double contrast study (74246) |
— |
$1,654 |
— |
| Radiologic examination femur 1 view (73551) |
— |
$1,320 |
— |
| Radiologic examination femur minimum 2 views (73552) |
— |
$2,382 |
— |
| Radiologic examination knee 1/2 views (73560) |
— |
$2,019 |
— |
| Radiologic Examination Osseous Survey Limited (77074) |
— |
$895 |
— |
| Radiologic examination tibia & fibula 2 views (73590) |
— |
$3,024 |
— |
| Red Cell Volume Determination Spx 1 Sampling (78120) |
— |
$1,171 |
— |
| Renal Cyst Study (74470) |
— |
$997 |
— |
| Ribs bilateral 3 views (71110) |
— |
$3,024 |
— |
| Rp loclzj tum plnr 1 area single day imaging (78800) |
— |
$2,446 |
— |
| Rp loclzj tum plnr 2+area 1+d img/1 area img>2+d (78801) |
— |
$3,141 |
— |
| Rp Loclzj Tum Plnr Whole Body 2+ Days Imaging (78804) |
— |
$7,342 |
— |
| Rp Loclzj Tum Plnr Whole Body Single Day Imaging (78802) |
— |
$4,168 |
— |
| Rp Loclzj Tum Spect 1 Area Single Day Imaging (78803) |
— |
$4,390 |
— |
| Scapula (73010) |
— |
$3,024 |
— |
| Shoulder 1 view (73020) |
— |
$2,279 |
— |
| Shoulder Arthrography (73040) |
— |
$4,222 |
— |
| Skull less than 4 views (70250) |
— |
$2,724 |
— |
| Speech evaluation, complex (70371) |
— |
$1,173 |
— |
| Sternoclavicular joints (71130) |
— |
$2,270 |
— |
| Testicular Imaging W/Flow (78761) |
— |
$2,783 |
— |
| Thoracic spine 2 views (72070) |
— |
$3,024 |
— |
| Thoracic spine 3 views (72072) |
— |
$3,024 |
— |
| Thoracolumbar 2 views (72080) |
— |
$3,024 |
— |
| Thyroid Met Imaging Body (78018) |
— |
$4,036 |
— |
| Ultrasound Breast Limited (76642) |
— |
$1,941 |
— |
| Ultrasound Exam Aaa Screen (76706) |
— |
$414 |
— |
| Ultrasound, abdomen limited (76705) |
— |
$4,003 |
— |
| Unlisted fluoroscopic procedure (76496) |
— |
$1,428 |
— |
| Unlisted Miscellaneous Px Dx Nuclear Medicine (78999) |
— |
$1,425 |
— |
| Unlisted us procedure (76999) |
— |
$807 |
— |
| Upper gi w/o kub (74240) |
— |
$3,024 |
— |
| Urea Breath Test C-14 Isotopic Acquisj Analysis (78267) |
— |
$135 |
— |
| Urea breath test c-14 isotopic analysis (78268) |
— |
$1,157 |
— |
| Urethrocystogram voiding (74455) |
— |
$1,087 |
— |
| Urethrocystography retrograde (74450) |
— |
$5,637 |
— |
| Us breast unilateral complete (76641) |
— |
$2,866 |
— |
| Us chest (76604) |
— |
$2,866 |
— |
| Us complete joint (76881) |
— |
$3,024 |
— |
| Us exam, pelvic, limited (76857) |
— |
$2,724 |
— |
| Us lmtd joint/oth nonvasc xtr strux r-t w/img (76882) |
— |
$1,521 |
— |
| Us ob detailed single fetus (76811) |
— |
$2,377 |
— |
| Us ob limited 1 or more fetuses (76815) |
— |
$2,300 |
— |
| Us ob transvaginal (76817) |
— |
$3,024 |
— |
| Us pelvic non ob complete (76856) |
— |
$3,024 |
— |
| Us pg uter img f&mat 14 wk tabdl 1/1st gestation (76801) |
— |
$2,866 |
— |
| Us preg uterus real time f/u trnsabdl per fetus (76816) |
— |
$1,854 |
— |
| Us retroperitoneal complete (76770) |
— |
$2,866 |
— |
| Us retroperitoneal limited (76775) |
— |
$3,024 |
— |
| Us scrotum and contents (76870) |
— |
$3,654 |
— |
| Us thyroid (76536) |
— |
$3,024 |
— |
| Us transrectal (76872) |
— |
$921 |
— |
| Vasogram (74440) |
— |
$3,024 |
— |
| Venography caval inferior serialography rs&i (75825) |
— |
$1,897 |
— |
| Venography extremity bilateral rs&i (75822) |
— |
$2,003 |
— |
| Venography extremity unilateral rs&i (75820) |
— |
$1,611 |
— |
| Wrist 2 views (73100) |
— |
$3,024 |
— |
| X-Ray Ac Jts - Xr Acromioclavicular Joints Bilateral (73050) |
— |
$3,024 |
— |
| X-ray antegrade pyelogram tube (74425) |
— |
$915 |
— |
| X-Ray Aorta Leg Arteries (75630) |
— |
$2,337 |
— |
| X-Ray Bend Only L-S Spine (72120) |
— |
$13,053 |
— |
| X-Ray Elbow 2 Vw - Xr Elbow 1-2 Views Right (73070) |
— |
$3,024 |
— |
| X-Ray Exam Breast Specimen (76098) |
— |
$239 |
— |
| X-Ray Exam Entire Spi 2/3 Vw (72082) |
— |
$3,024 |
— |
| X-Ray Exam Hip Uni 1 View (73501) |
— |
$2,572 |
— |
| X-Ray Exam Hip Uni 2-3 Views (73502) |
— |
$3,024 |
— |
| X-Ray Exam Hip Uni 4/> Views (73503) |
— |
$3,024 |
— |
| X-Ray Exam Hips Bi 2 Views (73521) |
— |
$3,024 |
— |
| X-Ray Exam Hips Bi 3-4 Views (73522) |
— |
$3,024 |
— |
| X-Ray Exam Hips Bi 5/> Views (73523) |
— |
$582 |
— |
| X-Ray Exam L-S Spine Bending (72114) |
— |
$3,024 |
— |
| X-Ray Exam Neck Spine 2-3 Vw (72040) |
— |
$3,024 |
— |
| X-Ray Exam Neck Spine 6/>Vws (72052) |
— |
$3,025 |
— |
| X-Ray Exam Unilat Ribs/Chest (71101) |
— |
$2,634 |
— |
| X-ray eye for foreign body (70030) |
— |
$2,190 |
— |
| X-ray humerus (73060) |
— |
$3,024 |
— |
| X-ray IV pyelogram (ivp) (74400) |
— |
$7,069 |
— |
| X-ray IV pyelogram+tomography (74415) |
— |
$1,781 |
— |
| X-Ray Jaw <4 Vw - Xr Mandible < 4 Views (70100) |
— |
$154 |
— |
| X-Ray Knee Bilat Standing - Xr Knees Anteroposterior Standing Bilat (73565) |
— |
$7,196 |
— |
| X-Ray Lumbar Spine 2/3 Vw - Xr Lumbar Spine 2-3 Views (72100) |
— |
$3,258 |
— |
| X-ray nose-rectum child f.b. (76010) |
— |
$2,520 |
— |
| X-Ray Ribs, Chest 4+ Vw - Xr Ribs 3 Vws Bil W/ Chest Posteroanterior (71111) |
— |
$3,024 |
— |
| X-Ray Sacroiliac Jts 3+ Vw - Xr Sacroiliac Joints 3+ Views (72202) |
— |
$447 |
— |
| X-Ray Sacroiliac Jts <3 Vw - Xr Sacroiliac Joints 1-2 Views (72200) |
— |
$2,940 |
— |
| X-Ray Sacrum/Coccyx 2+ Vw - Xr Sacrum Coccyx 2+ Views (72220) |
— |
$3,024 |
— |
| X-Ray Sinuses 3+ Vw - Xr Paranasal Sinuses 3+ Views (70220) |
— |
$3,024 |
— |
| X-Ray Skull 4+ Vw - Xr Skull Complete 4+ Views (70260) |
— |
$2,724 |
— |
| X-ray thoracic spine 4 vw (72074) |
— |
$3,024 |
— |
| X-Ray Urinary Tract Exam With Contrast Material (74420) |
— |
$1,623 |
— |
| X-Rays Bone Survey Complete (77075) |
— |
$1,215 |
— |
| Xr c-spine 4 or 5 views (72050) |
— |
$3,025 |
— |
| Xr facial bones less than 3 views (70140) |
— |
$2,394 |
— |
| XR Mastoids < 3 Views Bilateral (70120) |
— |
$464 |
— |
| Xr orbits complete 4 views (70200) |
— |
$3,024 |
— |
| Xr Tomogram Single Plane (76100) |
— |
$1,274 |
— |