| Abdomen 2 views (74019) |
— |
$508 |
— |
| Ankle 2 views (73600) |
— |
$383 |
— |
| Arthrogram elbow (73085) |
— |
$569 |
— |
| Arthrogram hip (73525) |
— |
$1,132 |
— |
| Arthrogram shoulder (73040) |
— |
$1,092 |
— |
| Arthrogram wrist (73115) |
— |
$578 |
— |
| Bone &/Joint Imaging Limited Area (78300) |
— |
$1,578 |
— |
| Bone &/Joint Imaging Multiple Areas (78305) |
— |
$1,413 |
— |
| Bone &/joint imaging whole body (78306) |
— |
$2,664 |
— |
| Bone age studies (77072) |
— |
$314 |
— |
| Bone Imaging 3 Phase (78315) |
— |
$2,825 |
— |
| Bone survey complete (77075) |
— |
$1,304 |
— |
| Cervical spine 2 or 3 views (72040) |
— |
$473 |
— |
| Chest 1 view (71045) |
— |
$357 |
— |
| Chest 3 views (71047) |
— |
$483 |
— |
| Clavicle complete (73000) |
— |
$372 |
— |
| Computed Tomography Thorax Lw Dose Lng Ca Scr C- (71271) |
— |
$2,510 |
— |
| CT abdomen and pelvis without and with contrast (74178) |
— |
$8,960 |
— |
| CT abdomen and pelvis without contrast (74176) |
— |
$5,570 |
— |
| CT abdomen w contrast (74160) |
— |
$3,376 |
— |
| CT abdomen w wo contrast (74170) |
— |
$4,911 |
— |
| CT abdomen w/o contrast (74150) |
— |
$3,123 |
— |
| CT c-spine w/o contrast (72125) |
— |
$3,375 |
— |
| CT cervical spine w&w/o contrast (72127) |
— |
$3,625 |
— |
| CT cervical spine with contrast (72126) |
— |
$3,297 |
— |
| CT chest w/wo contrast (71270) |
— |
$4,034 |
— |
| CT chest with contrast (71260) |
— |
$3,656 |
— |
| CT head/brain with contrast (70460) |
— |
$2,354 |
— |
| CT head/brain without and with contrast (70470) |
— |
$3,127 |
— |
| CT iac w contrast (70481) |
— |
$4,150 |
— |
| CT limited/localized follow up study (76380) |
— |
$2,087 |
— |
| CT lower ext w/o (73700) |
— |
$2,819 |
— |
| CT lower extremity w wo contrast (73702) |
— |
$3,460 |
— |
| CT lower extremity with contrast (73701) |
— |
$2,776 |
— |
| CT lumbar spine w & w/o contrast (72133) |
— |
$3,071 |
— |
| CT lumbar spine w/o contrast (72131) |
— |
$3,092 |
— |
| CT lumbar spine with contrast (72132) |
— |
$3,385 |
— |
| CT maxillofacial w contrast (70487) |
— |
$2,715 |
— |
| CT maxillofacial w/o contrast (70486) |
— |
$2,399 |
— |
| CT maxillofacial w/wo contrast (70488) |
— |
$3,224 |
— |
| CT neck soft tissue w contrast (70491) |
— |
$3,506 |
— |
| CT orbit sella/post fossa/ear w/o & w/contr matr (70482) |
— |
$3,558 |
— |
| CT orbits w/o contrast (70480) |
— |
$3,578 |
— |
| CT pelvis w & w/o contrast (72194) |
— |
$3,319 |
— |
| CT pelvis w/o contrast (72192) |
— |
$3,698 |
— |
| CT scan for measuring calcium and other minerals in bone (77078) |
— |
$24 |
— |
| CT soft tissue neck w/o & w/contrast material (70492) |
— |
$3,625 |
— |
| CT soft tissue neck w/o contrast (70490) |
— |
$3,479 |
— |
| CT thoracic spine w/contrast (72129) |
— |
$3,672 |
— |
| CT thoracic spine w/o contrast (72128) |
— |
$3,262 |
— |
| CT thoracic spine w/wo contrast (72130) |
— |
$3,704 |
— |
| CT thorax w/o contrast (71250) |
— |
$2,883 |
— |
| CT upper extremity w/o & w/contrast material (73202) |
— |
$3,460 |
— |
| CT upper extremity w/o contrast rt (73200) |
— |
$2,589 |
— |
| CT upper extremity with contrast (73201) |
— |
$3,094 |
— |
| Cta Abdl Aorta&Bi Iliofem W/Contrast&Postp (75635) |
— |
$4,805 |
— |
| Cta Abdomen (74175) |
— |
$4,138 |
— |
| CTA abdomen pelvis (74174) |
— |
$7,218 |
— |
| CTA chest (71275) |
— |
$4,204 |
— |
| Cta Head (70496) |
— |
$3,920 |
— |
| Cta Neck (70498) |
— |
$3,920 |
— |
| Cystography minimum 3 views rs&i (74430) |
— |
$945 |
— |
| Dxa bone density study 1/> sites axial skel (77080) |
— |
$415.50 |
— |
| Dxa bone density study 1/>sites appendiclr skel (77081) |
— |
$171.50 |
— |
| Dxa bone density study axial skeleton (77085) |
— |
$378.50 |
— |
| Echoencephalography real time imaging (76506) |
— |
$715 |
— |
| Fetal biophysical profile non-stress testing (76818) |
— |
$900 |
— |
| Fetal Biophysical Profile W/O Non-Stress Testing (76819) |
— |
$652 |
— |
| Fluoroscopy up to 1 hr (76000) |
— |
$499 |
— |
| Foot 2 views (73620) |
— |
$333 |
— |
| Forearm 2 views (73090) |
— |
$435 |
— |
| Gated Heart Planar Single (78472) |
— |
$2,378 |
— |
| Hand 2 views (73120) |
— |
$411 |
— |
| Hand 3 views (73130) |
— |
$441 |
— |
| Hepatobil Syst Imag Inc Gb W/Pharma Intervenj (78227) |
— |
$4,660 |
— |
| Ht muscle image spect sing (78451) |
— |
$5,401 |
— |
| Humerus Min 2 Views Left (73060) |
— |
$449 |
— |
| Kidney Img Morphology Vascular Flow 1 W/O Rx (78707) |
— |
$1,922 |
— |
| Kidney img morphology vascular flow 1 w/rx (78708) |
— |
$2,244 |
— |
| Knee 3 views (73562) |
— |
$527 |
— |
| Liver & spleen imaging static only (78215) |
— |
$2,693 |
— |
| Liver & Spleen Imaging W/Vascular Flow (78216) |
— |
$2,693 |
— |
| Meckels Diverticulum (78290) |
— |
$1,687 |
— |
| MRA head w/o contrast (70544) |
— |
$5,156 |
— |
| MRA neck w contrast (70548) |
— |
$4,027 |
— |
| Mra Neck W/O &W/Contrast Material (70549) |
— |
$7,958 |
— |
| MRA neck w/o contrast (70547) |
— |
$4,308 |
— |
| MRI abdomen w contrast (74182) |
— |
$5,387 |
— |
| MRI abdomen w/o & w/contrast material (74183) |
— |
$5,559 |
— |
| MRI abdomen w/o contrast (74181) |
— |
$4,731 |
— |
| MRI any jnt lwr ext with con lt (73722) |
— |
$2,796 |
— |
| MRI any jt upper extremity w/contrast matrl (73222) |
— |
$4,066 |
— |
| MRI c-spine with contrast (72142) |
— |
$5,387 |
— |
| MRI cervical spine w/o contrast (72141) |
— |
$4,415 |
— |
| MRI chest w/o & w/contrast material (71552) |
— |
$5,674 |
— |
| MRI chest w/o contrast (71550) |
— |
$5,099 |
— |
| MRI chest with contrast (71551) |
— |
$5,387 |
— |
| MRI lower extrem oth/thn jt w/o contr matrl (73718) |
— |
$3,775 |
— |
| MRI orbit face &/neck w/o contrast (70540) |
— |
$4,622 |
— |
| MRI orbit/face/neck w&w/o cont (70543) |
— |
$6,578 |
— |
| MRI orbit/face/neck w/contrast (70542) |
— |
$5,099 |
— |
| MRI pelvis w contrast (72196) |
— |
$4,807 |
— |
| MRI pelvis w/o & w/contrast material (72197) |
— |
$5,623 |
— |
| MRI pelvis w/o contrast (72195) |
— |
$5,253 |
— |
| MRI scan of arm joint before and after contrast (73223) |
— |
$4,566 |
— |
| MRI scan of leg joint before and after contrast (73723) |
— |
$5,708 |
— |
| MRI spinal canal cervical w/o & w/contr matrl (72156) |
— |
$5,731 |
— |
| MRI spinal canal lumbar w/contrast material (72149) |
— |
$5,179 |
— |
| MRI spinal canal lumbar w/o & w/contr matrl (72158) |
— |
$5,598 |
— |
| MRI spinal canal thoracic w/contrast matrl (72147) |
— |
$5,387 |
— |
| MRI spinal canal thoracic w/o & w/contr matrl (72157) |
— |
$5,837 |
— |
| MRI thoracic spine w/o contrast (72146) |
— |
$4,497 |
— |
| MRI tmj (70336) |
— |
$4,234 |
— |
| MRI upper ext joint w/o contrast (73221) |
— |
$3,658 |
— |
| MRI upper extrem other than jt w/o & w/contras (73220) |
— |
$5,626 |
— |
| MRI upper extremity oth than jt w/o contr matrl (73218) |
— |
$3,514 |
— |
| Myelogram Lumbar (72265) |
— |
$1,566 |
— |
| Myocardial Spect Multiple Studies (78452) |
— |
$7,166 |
— |
| Neck soft tissue (70360) |
— |
$476 |
— |
| Nm gastric emptying study (78264) |
— |
$2,825 |
— |
| Nuclear medicine study of heart muscle at rest with stress (78453) |
— |
$1,827 |
— |
| Ob Us Follow-Up Per Fetus - Us Ob Follow Up Transabdominal Approach (76816) |
— |
$945 |
— |
| Osseous survey infant (77076) |
— |
$833 |
— |
| Osseous survey limited (77074) |
— |
$1,316 |
— |
| Parathyroid imaging (78070) |
— |
$2,195 |
— |
| Pelvis 1 or 2 views (72170) |
— |
$414 |
— |
| PET image w/CT, skull-thigh (78815) |
— |
$9,096 |
— |
| PET imaging CT for attenuation limited area (78814) |
— |
$8,545 |
— |
| PET imaging for CT attenuation whole body (78816) |
— |
$9,371 |
— |
| Pr MRI, lower extr, w/o contrast f/u by contrast (73720) |
— |
$5,055 |
— |
| Pulmonary Perfusion Imaging Particulate (78580) |
— |
$1,682 |
— |
| Pulmonary Ventilation & Perfusion Imaging (78582) |
— |
$3,846 |
— |
| Radex abscess/fistula/sinus tract rs&i (76080) |
— |
$1,331 |
— |
| Radex Entir Thrc Lmbr Crv Sac Spi W/Skull 1 Vw - Xr Scoliosis 1 Vw (72081) |
— |
$413 |
— |
| Radex entir thrc lmbr crv sac spi w/skull 2/3 vw (72082) |
— |
$902 |
— |
| Radex hips bilateral with pelvis 2 views (73521) |
— |
$618 |
— |
| Radex mastoids compl minimum 3 views pr side (70130) |
— |
$435 |
— |
| Radex X-Ray Exam Entire Spi 6/> Vw - Xr Entire Spine 6+ Vw (72084) |
— |
$1,290 |
— |
| Radiolog exam mandible compl minimum 4 views (70110) |
— |
$673 |
— |
| Radiologic Exam Abdomen 1 View - Xr Abdomen 1 View (74018) |
— |
$391 |
— |
| Radiologic Exam Chest 2 Views - Xr Chest 2 Views (71046) |
— |
$444 |
— |
| Radiologic Examination Femur Minimum 2 Views - Xr Femur 2+ Vw Lt (73552) |
— |
$471 |
— |
| Ribs bilateral 3 views (71110) |
— |
$715 |
— |
| Sacroiliac Joints < 3 Views (72200) |
— |
$366 |
— |
| Scapula complete (73010) |
— |
$398 |
— |
| Screening digital breast tomosynthesis (77063) |
— |
$122 |
— |
| Sella turcica (70240) |
— |
$435 |
— |
| Spine thoracic 3 views (72072) |
— |
$623 |
— |
| Thoracolumbar 2 views (72080) |
— |
$533 |
— |
| Thyroid Imaging With Vascular Flow (78013) |
— |
$1,250 |
— |
| Thyroid uptake measurement (78012) |
— |
$1,302 |
— |
| Ultrasound, abdomen limited (76705) |
— |
$943 |
— |
| Unlisted Ultrasound Procedure (76999) |
— |
$800 |
— |
| Upper Extremity Infant (73092) |
— |
$361 |
— |
| Urethrocystography retrograde rs&i (74450) |
— |
$1,182 |
— |
| Urethrocystography voiding (74455) |
— |
$1,367 |
— |
| Urography (pyelography), intravenous, with or without KUB, with or without tomography (74400) |
— |
$1,342 |
— |
| Us abdl aorta screen aaa (76706) |
— |
$695 |
— |
| Us breast unilateral complete (76641) |
— |
$723 |
— |
| Us breast unilateral limited (76642) |
— |
$552 |
— |
| Us chest (76604) |
— |
$891 |
— |
| Us kidney transplant (76776) |
— |
$1,000 |
— |
| Us ob transvaginal (76817) |
— |
$805 |
— |
| Us pelvic non ob complete (76856) |
— |
$1,198 |
— |
| Us pelvic nonobstetric image dcmtn limited/f/u (76857) |
— |
$691 |
— |
| Us pregnancy ltd (76815) |
— |
$622 |
— |
| Us pregnant uterus 14 wk transabdl 1/1st gestat (76801) |
— |
$972 |
— |
| Us retroperitoneal complete (76770) |
— |
$1,099 |
— |
| Us retroperitoneal limited (76775) |
— |
$830 |
— |
| Us scrotum and contents (76870) |
— |
$996 |
— |
| Us soft tissue head/neck (76536) |
— |
$859 |
— |
| Us spinal canal and contents (76800) |
— |
$882 |
— |
| Us transrectal (76872) |
— |
$556.50 |
— |
| Us xtr non-vasc lmtd (76882) |
— |
$1,540 |
— |
| Venography extremity unilateral rs&i (75820) |
— |
$6,963 |
— |
| Wrist 2 views (73100) |
— |
$338 |
— |
| X-Ray Abdomen,Comp Acute Series - Xr Abdomen 2 Vws With Chest 1 View (74022) |
— |
$686 |
— |
| X-Ray Ac Jts - Xr Acromioclavicular Joints Bilateral (73050) |
— |
$402 |
— |
| X-Ray Ankle 3+ Vw - Xr Ankle 3+ Views Right (73610) |
— |
$432 |
— |
| X-Ray Elbow 2 Vw - Xr Elbow 1-2 Views Right (73070) |
— |
$441 |
— |
| X-Ray Elbow 3+ Vw - Xr Elbow 3+ Views Right (73080) |
— |
$477 |
— |
| X-ray exam entire spi 4/5 vw (72083) |
— |
$1,040 |
— |
| X-ray exam hip uni 1 view (73501) |
— |
$372 |
— |
| X-Ray Exam Hip Uni 2-3 Views (73502) |
— |
$482 |
— |
| X-ray exam of femur 1 (73551) |
— |
$373 |
— |
| X-ray eye for foreign body (70030) |
— |
$311 |
— |
| X-Ray Facial Bones 3+ Vw - Xr Facial Bones 3+ Views (70150) |
— |
$617 |
— |
| X-Ray Foot 3+ Vw - Xr Foot 3+ Views Right (73630) |
— |
$439 |
— |
| X-Ray Heel - Xr Calcaneus 2 Views Right (73650) |
— |
$337 |
— |
| X-Ray Knee 4+ View - Xr Knee 4+ Views Right (73564) |
— |
$491 |
— |
| X-Ray Knee Bilat Standing - Xr Knees Anteroposterior Standing Bilat (73565) |
— |
$316 |
— |
| X-Ray Leg, Infant - Xr Lower Extremity 2+ Views Infant Left (73592) |
— |
$281 |
— |
| X-Ray Lumbar Spine 2/3 Vw - Xr Lumbar Spine 2-3 Views (72100) |
— |
$641 |
— |
| X-Ray Lumbar Spine 6+ Vw - Xr Lumbar Spine 6+ Vws Including Bending (72114) |
— |
$1,048 |
— |
| X-Ray Lumbar Spine Flex/Exten - Xr Lumbar Spine 4+ Views W/ Flex Ext (72120) |
— |
$718 |
— |
| X-Ray Nasal Bones - Xr Nasal Bones (70160) |
— |
$463 |
— |
| X-Ray Nose-Rectum Child F.B. - Xr Nose to Rectum Foreign Body Peds (76010) |
— |
$436 |
— |
| X-Ray Orbits - Xr Orbits Complete 4+ Views (70200) |
— |
$632 |
— |
| X-Ray Pelvis 3+ Vw - Xr Pelvis 3+ Views (72190) |
— |
$490 |
— |
| X-Ray Retrograde Pyelogram - Fl Pyelogram Retrograde (74420) |
— |
$1,994 |
— |
| X-Ray Ribs 2 Vw Unilat - Xr Ribs 2 Views Right (71100) |
— |
$431 |
— |
| X-Ray Ribs, Chest 3+ Vw - Xr Ribs 2 Vws Lt W/ Chest Anteroposterior (71101) |
— |
$552 |
— |
| X-Ray Ribs, Chest 4+ Vw - Xr Ribs 3 Vws Bil W/ Chest Posteroanterior (71111) |
— |
$923 |
— |
| X-Ray Sacrum/Coccyx 2+ Vw - Xr Sacrum Coccyx 2+ Views (72220) |
— |
$490 |
— |
| X-Ray Shoulder 2+ Vw - Xr Shoulder 2+ Views Right (73030) |
— |
$481 |
— |
| X-Ray Sinuses 3+ Vw - Xr Paranasal Sinuses 3+ Views (70220) |
— |
$423 |
— |
| X-Ray Sinuses <3 Vw - Xr Paranasal Sinuses 1-2 Views (70210) |
— |
$534 |
— |
| X-Ray Skull 4+ Vw - Xr Skull Complete 4+ Views (70260) |
— |
$570 |
— |
| X-Ray Skull <4 Vw - Xr Skull 1-3 Views (70250) |
— |
$531 |
— |
| X-Ray Spine One View - Xr Spine (72020) |
— |
$455 |
— |
| X-Ray Sterno-Clavicluar Jt - Xr Sternoclavicular Joints 3+ Views (71130) |
— |
$394 |
— |
| X-Ray Sternum 2+ Vw - Xr Sternum 2+ Views (71120) |
— |
$461 |
— |
| X-Ray Thoracic Spine 2 Vw - Xr Thoracic Spine 2 Views (72070) |
— |
$521 |
— |
| X-Ray Toe(S) - Xr Toes 2+ Views Right (73660) |
— |
$356 |
— |
| X-Ray Wrist 3+ Vw - Xr Wrist 3+ Views Right (73110) |
— |
$431 |
— |
| Xr c-spine 6 or more views (72052) |
— |
$1,163 |
— |
| Xr chest 4+ views (71048) |
— |
$529 |
— |
| Xr finger(s) 2+ views (73140) |
— |
$327 |
— |
| Xr optic foramina (70190) |
— |
$386 |
— |
| Xr shoulder 1 view (73020) |
— |
$337 |
— |
| Xr spine cervical 4 or 5 views (72050) |
— |
$734 |
— |
| Xr tibia/fibula 2 views (73590) |
— |
$442 |
— |
| Xr tmj bilateral (70330) |
— |
$557 |
— |
| Xray knee 1 or 2 views rt (73560) |
— |
$439 |
— |