| Acute gastrointestinal blood loss imaging (78278) |
— |
$2,638.25 |
— |
| Angiography extremity bilateral rs&i (75716) |
— |
$3,019.30 |
— |
| Angiography extremity unilateral rs&i (75710) |
— |
$2,779.40 |
— |
| Angiography internal mammary rs&i (75756) |
— |
$4,985.15 |
— |
| Ankle 2 views (73600) |
— |
$237.80 |
— |
| Aortography abdl bi iliofem low extrem cath rs&i (75630) |
— |
$2,982.40 |
— |
| Bone &/joint imaging whole body (78306) |
— |
$2,000.35 |
— |
| Bone age studies (77072) |
— |
$255.20 |
— |
| Bone Imaging 3 Phase (78315) |
— |
$2,668.60 |
— |
| Bone survey complete (77075) |
— |
$663.30 |
— |
| Cervical spine 2 or 3 views (72040) |
— |
$256.25 |
— |
| Chest 1 view (71045) |
— |
$217.15 |
— |
| Chest 3 views (71047) |
— |
$202.10 |
— |
| Cine/Vid X-Ray Throat/Esoph - Fl Esoph Barium Swlw W/ Video & Speech (74230) |
— |
$498.90 |
— |
| Clavicle complete (73000) |
— |
$279.50 |
— |
| Computed Tomography Thorax Lw Dose Lng Ca Scr C- (71271) |
— |
$175 |
— |
| CT abdomen and pelvis without and with contrast (74178) |
— |
$5,537.60 |
— |
| CT abdomen and pelvis without contrast (74176) |
— |
$4,435.15 |
— |
| CT abdomen w contrast (74160) |
— |
$2,078.95 |
— |
| CT abdomen w wo contrast (74170) |
— |
$2,630.80 |
— |
| CT abdomen w/o contrast (74150) |
— |
$1,978.60 |
— |
| CT angiography upper extremity lt (73206) |
— |
$2,360.60 |
— |
| CT c-spine w/o contrast (72125) |
— |
$2,130.50 |
— |
| CT cervical spine w&w/o contrast (72127) |
— |
$2,613.50 |
— |
| CT cervical spine with contrast (72126) |
— |
$1,220 |
— |
| CT chest w/wo contrast (71270) |
— |
$2,570.65 |
— |
| CT chest with contrast (71260) |
— |
$2,325.60 |
— |
| CT head/brain with contrast (70460) |
— |
$2,200 |
— |
| CT head/brain without and with contrast (70470) |
— |
$2,526.25 |
— |
| CT heart no contrast quant eval coronry calcium (75571) |
— |
$75 |
— |
| CT iac w contrast (70481) |
— |
$1,825.80 |
— |
| CT lower ext w/o (73700) |
— |
$1,959.60 |
— |
| CT lower extremity w wo contrast (73702) |
— |
$2,248.80 |
— |
| CT lower extremity with contrast (73701) |
— |
$1,553.35 |
— |
| CT lumbar spine w & w/o contrast (72133) |
— |
$3,229.65 |
— |
| CT lumbar spine w/o contrast (72131) |
— |
$2,309.80 |
— |
| CT lumbar spine with contrast (72132) |
— |
$3,088.65 |
— |
| CT maxillofacial w contrast (70487) |
— |
$2,150 |
— |
| CT maxillofacial w/o contrast (70486) |
— |
$1,766.30 |
— |
| CT maxillofacial w/wo contrast (70488) |
— |
$2,281.80 |
— |
| CT neck soft tissue w contrast (70491) |
— |
$1,760.15 |
— |
| CT orbit sella/post fossa/ear w/o & w/contr matr (70482) |
— |
$2,284.05 |
— |
| CT orbits w/o contrast (70480) |
— |
$1,717.70 |
— |
| CT pelvis w & w/o contrast (72194) |
— |
$2,777 |
— |
| CT pelvis w/o contrast (72192) |
— |
$2,037.30 |
— |
| CT soft tissue neck w/o & w/contrast material (70492) |
— |
$2,286.80 |
— |
| CT soft tissue neck w/o contrast (70490) |
— |
$1,667.80 |
— |
| CT thoracic spine w/contrast (72129) |
— |
$2,574.65 |
— |
| CT thoracic spine w/o contrast (72128) |
— |
$2,103 |
— |
| CT thorax w/o contrast (71250) |
— |
$1,951.45 |
— |
| CT upper extremity w/o contrast rt (73200) |
— |
$1,994.15 |
— |
| CT upper extremity with contrast (73201) |
— |
$2,342.20 |
— |
| Cta Abdl Aorta&Bi Iliofem W/Contrast&Postp (75635) |
— |
$2,383.05 |
— |
| Cta Abdomen (74175) |
— |
$2,295.45 |
— |
| CTA abdomen pelvis (74174) |
— |
$2,360.60 |
— |
| CTA chest (71275) |
— |
$2,360.60 |
— |
| Cta Head (70496) |
— |
$2,173.30 |
— |
| CTA lwr ext w&w/o contrast (73706) |
— |
$2,837.75 |
— |
| Cta Neck (70498) |
— |
$2,360.60 |
— |
| Dxa bone density study 1/> sites axial skel (77080) |
— |
$433.45 |
— |
| Echoencephalography real time imaging (76506) |
— |
$722.60 |
— |
| Esophagus (74220) |
— |
$430.45 |
— |
| Fetal biophysical profile non-stress testing (76818) |
— |
$450.25 |
— |
| Fetal Biophysical Profile W/O Non-Stress Testing (76819) |
— |
$483.60 |
— |
| Fluoroscopy up to 1 hr (76000) |
— |
$477.85 |
— |
| Foot 2 views (73620) |
— |
$201.75 |
— |
| Forearm 2 views (73090) |
— |
$231.25 |
— |
| Full Mouth X-Ray Of Teeth - Xr Teeth Full Mouth (70320) |
— |
$490.45 |
— |
| Hand 2 views (73120) |
— |
$258.05 |
— |
| Hand 3 views (73130) |
— |
$223.50 |
— |
| Hepatobil Syst Imag Inc Gb W/Pharma Intervenj (78227) |
— |
$2,878.40 |
— |
| Hepatobiliary syst imaging including gallbladder (78226) |
— |
$2,878.40 |
— |
| Humerus Min 2 Views Left (73060) |
— |
$254.10 |
— |
| Hysterosalpingogram (74740) |
— |
$705.25 |
— |
| Kidney img morphology vascular flow 1 w/rx (78708) |
— |
$1,814.70 |
— |
| Knee 3 views (73562) |
— |
$251 |
— |
| Lymphoscintigraphy (78195) |
— |
$1,575 |
— |
| MRA head w/o contrast (70544) |
— |
$1,750 |
— |
| Mra Neck W/O &W/Contrast Material (70549) |
— |
$2,642.85 |
— |
| MRA neck w/o contrast (70547) |
— |
$1,234 |
— |
| MRI abdomen w contrast (74182) |
— |
$1,964.05 |
— |
| MRI abdomen w/o & w/contrast material (74183) |
— |
$1,855.71 |
— |
| MRI abdomen w/o contrast (74181) |
— |
$1,455.70 |
— |
| MRI cervical spine w/o contrast (72141) |
— |
$1,750 |
— |
| MRI lower extrem oth/thn jt w/o contr matrl (73718) |
— |
$1,750 |
— |
| MRI orbit face &/neck w/o contrast (70540) |
— |
$1,455.70 |
— |
| MRI orbit/face/neck w&w/o cont (70543) |
— |
$1,932.65 |
— |
| MRI pelvis w/o & w/contrast material (72197) |
— |
$1,838.34 |
— |
| MRI pelvis w/o contrast (72195) |
— |
$1,750 |
— |
| MRI scan of arm joint before and after contrast (73223) |
— |
$2,637.70 |
— |
| MRI scan of leg joint before and after contrast (73723) |
— |
$2,735.80 |
— |
| MRI spinal canal cervical w/o & w/contr matrl (72156) |
— |
$4,408.20 |
— |
| MRI spinal canal lumbar w/contrast material (72149) |
— |
$2,472.40 |
— |
| MRI spinal canal lumbar w/o & w/contr matrl (72158) |
— |
$4,408.20 |
— |
| MRI spinal canal thoracic w/contrast matrl (72147) |
— |
$2,562.70 |
— |
| MRI spinal canal thoracic w/o & w/contr matrl (72157) |
— |
$4,408.20 |
— |
| MRI thoracic spine w/o contrast (72146) |
— |
$1,750 |
— |
| MRI tmj (70336) |
— |
$2,047.30 |
— |
| MRI upper ext joint w/o contrast (73221) |
— |
$1,455.70 |
— |
| MRI upper extrem other than jt w/o & w/contras (73220) |
— |
$3,611.10 |
— |
| MRI upper extremity oth than jt w/o contr matrl (73218) |
— |
$1,750 |
— |
| Myocardial Spect Multiple Studies (78452) |
— |
$5,188.05 |
— |
| Neck soft tissue (70360) |
— |
$257.25 |
— |
| Nm gastric emptying study (78264) |
— |
$1,227.30 |
— |
| Parathyroid imaging (78070) |
— |
$1,123.95 |
— |
| Pelvis 1 or 2 views (72170) |
— |
$242.20 |
— |
| Pr MRI, lower extr, w/o contrast f/u by contrast (73720) |
— |
$3,654.40 |
— |
| Pulmonary Perfusion Imaging Particulate (78580) |
— |
$2,014.15 |
— |
| Pulmonary Ventilation & Perfusion Imaging (78582) |
— |
$4,159.45 |
— |
| Radex entir thrc lmbr crv sac spi w/skull 2/3 vw (72082) |
— |
$325.85 |
— |
| Radex hips bilateral with pelvis 2 views (73521) |
— |
$482.80 |
— |
| Radiolog exam mandible compl minimum 4 views (70110) |
— |
$306.85 |
— |
| Radiologic Exam Abdomen 1 View - Xr Abdomen 1 View (74018) |
— |
$225.15 |
— |
| Radiologic Exam Abdomen 3+ Views - Xr Abdomen 3+ Views (74021) |
— |
$281.85 |
— |
| Radiologic Exam Chest 2 Views - Xr Chest 2 Views (71046) |
— |
$305 |
— |
| Radiologic exam upr gi trc single contrast study (74240) |
— |
$487.40 |
— |
| Radiologic Examination Femur Minimum 2 Views - Xr Femur 2+ Vw Lt (73552) |
— |
$246.50 |
— |
| Ribs bilateral 3 views (71110) |
— |
$358.65 |
— |
| Rp loclzj tum spect 1 area single day imaging (78803) |
— |
$476.70 |
— |
| Scapula complete (73010) |
— |
$266.25 |
— |
| Screening digital breast tomosynthesis (77063) |
— |
$90.40 |
— |
| Spine thoracic 3 views (72072) |
— |
$334.90 |
— |
| Thyroid Uptake W/Blood Flow Sngle/Mult Quan Meas (78014) |
— |
$1,349.95 |
— |
| Ultrasound, abdomen limited (76705) |
— |
$553.30 |
— |
| Upper Extremity Infant (73092) |
— |
$164 |
— |
| Urethrocystography retrograde rs&i (74450) |
— |
$574.15 |
— |
| Urethrocystography voiding (74455) |
— |
$586 |
— |
| Urography (pyelography), intravenous, with or without KUB, with or without tomography (74400) |
— |
$676.95 |
— |
| Us breast unilateral limited (76642) |
— |
$229.50 |
— |
| Us chest (76604) |
— |
$640.20 |
— |
| Us compl joint r-t w/image documentation (76881) |
— |
$515.75 |
— |
| Us infant hips dynamic (76885) |
— |
$455.25 |
— |
| Us pelvic non ob complete (76856) |
— |
$697.95 |
— |
| Us pelvic nonobstetric image dcmtn limited/f/u (76857) |
— |
$569.75 |
— |
| Us pregnancy ltd (76815) |
— |
$207.70 |
— |
| Us pregnant uterus 14 wk transabdl 1/1st gestat (76801) |
— |
$555.45 |
— |
| Us retroperitoneal complete (76770) |
— |
$629.20 |
— |
| Us scrotum and contents (76870) |
— |
$640.20 |
— |
| Us soft tissue head/neck (76536) |
— |
$559.40 |
— |
| Us transrectal (76872) |
— |
$569.75 |
— |
| Wrist 2 views (73100) |
— |
$227.10 |
— |
| X-Ray Abdomen,Comp Acute Series - Xr Abdomen 2 Vws With Chest 1 View (74022) |
— |
$476.85 |
— |
| X-Ray Ac Jts - Xr Acromioclavicular Joints Bilateral (73050) |
— |
$373.85 |
— |
| X-Ray Ankle 3+ Vw - Xr Ankle 3+ Views Right (73610) |
— |
$246.20 |
— |
| X-Ray Elbow 2 Vw - Xr Elbow 1-2 Views Right (73070) |
— |
$214.40 |
— |
| X-Ray Elbow 3+ Vw - Xr Elbow 3+ Views Right (73080) |
— |
$268.05 |
— |
| X-Ray Exam Hip Uni 2-3 Views (73502) |
— |
$261.05 |
— |
| X-Ray Facial Bones 3+ Vw - Xr Facial Bones 3+ Views (70150) |
— |
$329.40 |
— |
| X-Ray Foot 3+ Vw - Xr Foot 3+ Views Right (73630) |
— |
$228.05 |
— |
| X-Ray Heel - Xr Calcaneus 2 Views Right (73650) |
— |
$227.20 |
— |
| X-Ray Knee 4+ View - Xr Knee 4+ Views Right (73564) |
— |
$322.55 |
— |
| X-Ray Knee Bilat Standing - Xr Knees Anteroposterior Standing Bilat (73565) |
— |
$208.70 |
— |
| X-Ray Leg, Infant - Xr Lower Extremity 2+ Views Infant Left (73592) |
— |
$255.20 |
— |
| X-Ray Lumbar Spine 2/3 Vw - Xr Lumbar Spine 2-3 Views (72100) |
— |
$275.65 |
— |
| X-Ray Lumbar Spine 6+ Vw - Xr Lumbar Spine 6+ Vws Including Bending (72114) |
— |
$517.65 |
— |
| X-Ray Nasal Bones - Xr Nasal Bones (70160) |
— |
$253.45 |
— |
| X-Ray Orbits - Xr Orbits Complete 4+ Views (70200) |
— |
$332.70 |
— |
| X-Ray Retrograde Pyelogram - Fl Pyelogram Retrograde (74420) |
— |
$916.20 |
— |
| X-Ray Ribs 2 Vw Unilat - Xr Ribs 2 Views Right (71100) |
— |
$355.25 |
— |
| X-Ray Sacroiliac Jts 3+ Vw - Xr Sacroiliac Joints 3+ Views (72202) |
— |
$313.45 |
— |
| X-Ray Sacrum/Coccyx 2+ Vw - Xr Sacrum Coccyx 2+ Views (72220) |
— |
$257.20 |
— |
| X-Ray Shoulder 2+ Vw - Xr Shoulder 2+ Views Right (73030) |
— |
$257.20 |
— |
| X-Ray Sinuses 3+ Vw - Xr Paranasal Sinuses 3+ Views (70220) |
— |
$348.25 |
— |
| X-Ray Sinuses <3 Vw - Xr Paranasal Sinuses 1-2 Views (70210) |
— |
$272.50 |
— |
| X-Ray Skull <4 Vw - Xr Skull 1-3 Views (70250) |
— |
$283.20 |
— |
| X-Ray Sternum 2+ Vw - Xr Sternum 2+ Views (71120) |
— |
$284.45 |
— |
| X-Ray Thoracic Spine 2 Vw - Xr Thoracic Spine 2 Views (72070) |
— |
$278.95 |
— |
| X-Ray Toe(S) - Xr Toes 2+ Views Right (73660) |
— |
$200.50 |
— |
| X-Ray Wrist 3+ Vw - Xr Wrist 3+ Views Right (73110) |
— |
$231.40 |
— |
| Xr c-spine 6 or more views (72052) |
— |
$485.20 |
— |
| Xr finger(s) 2+ views (73140) |
— |
$205.90 |
— |
| Xr spine cervical 4 or 5 views (72050) |
— |
$425.10 |
— |
| Xr tibia/fibula 2 views (73590) |
— |
$254.55 |
— |
| Xr tmj bilateral (70330) |
— |
$294.15 |
— |
| Xray knee 1 or 2 views rt (73560) |
— |
$233.05 |
— |