| Abdomen 1 View (74018) |
— |
$322.06 |
— |
| Abdomen 2 views (74019) |
— |
$715.07 |
— |
| Acute Gastrointestinal Blood Loss Imaging (78278) |
— |
$3,022.39 |
— |
| Angio internal mammary (75756) |
— |
$5,065.03 |
— |
| Angiography extremity bilateral rs&i (75716) |
— |
$8,832.38 |
— |
| Angiography extremity unilateral rs&i (75710) |
— |
$16,146.97 |
— |
| Ankle 2 views (73600) |
— |
$607.05 |
— |
| Aortography thoracic serialography rs&i (75605) |
— |
$8,614.78 |
— |
| Artery X-Rays Abdomen (75726) |
— |
$28,287.55 |
— |
| Artery X-Rays Pelvis (75736) |
— |
$22,370.79 |
— |
| Arthrogram hip (73525) |
— |
$3,174.52 |
— |
| Arthrogram Wrist (73115) |
— |
$2,107.44 |
— |
| Bone age studies (77072) |
— |
$717.93 |
— |
| Bone Imaging 3 Phase (78315) |
— |
$4,266.66 |
— |
| Bone Imaging Limited Area (78300) |
— |
$2,316.42 |
— |
| Bone Imaging Multiple Areas (78305) |
— |
$3,118.53 |
— |
| Bone Imaging Whole Body (78306) |
— |
$6,566.57 |
— |
| Bone survey infant (77076) |
— |
$1,280.65 |
— |
| Cat Scan Follow-Up Study (76380) |
— |
$1,912.17 |
— |
| Chest 1 view (71045) |
— |
$514.24 |
— |
| Chest 2 views (71046) |
— |
$1,222.38 |
— |
| Chest 3 views (71047) |
— |
$695.72 |
— |
| Chest 4 or more views (71048) |
— |
$1,536.83 |
— |
| Clavicle complete (73000) |
— |
$1,252.90 |
— |
| Contrast Exam Abdominl Aorta (75625) |
— |
$9,274.01 |
— |
| Contrast X-Ray Bladder (74430) |
— |
$523.04 |
— |
| Contrast X-Ray Of Knee Joint (73580) |
— |
$1,273.42 |
— |
| CT abdomen and pelvis without and with contrast (74178) |
— |
$10,058.53 |
— |
| CT abdomen and pelvis without contrast (74176) |
— |
$8,215.50 |
— |
| CT abdomen w contrast (74160) |
— |
$4,164.26 |
— |
| CT abdomen w wo contrast (74170) |
— |
$2,849.98 |
— |
| CT abdomen w/o contrast (74150) |
— |
$2,042.21 |
— |
| CT Angio Abdomen and Pelvis (74174) |
— |
$5,922.54 |
— |
| CT Angio Chest (71275) |
— |
$6,387.65 |
— |
| CT Angio Head (70496) |
— |
$2,874.84 |
— |
| CT angio hrt w/3d image (75574) |
— |
$2,916.46 |
— |
| Ct Angio Lwr Extr W/O&W/Dye (73706) |
— |
$5,674.78 |
— |
| CT Angio Neck (70498) |
— |
$5,005.37 |
— |
| Ct Angio Upr Extrm W/O&W/Dye (73206) |
— |
$7,026.65 |
— |
| CT cervical spine w/ contrast (72126) |
— |
$7,724.29 |
— |
| CT cervical spine w/o contrast (72125) |
— |
$4,423.97 |
— |
| CT cervical spine w/wo cont (72127) |
— |
$5,915.70 |
— |
| CT chest w contrast (71260) |
— |
$4,246.85 |
— |
| CT chest w/wo contrast (71270) |
— |
$4,156.83 |
— |
| CT head/brain with contrast (70460) |
— |
$3,397.07 |
— |
| CT head/brain without and with contrast (70470) |
— |
$2,411.70 |
— |
| CT heart no contrast quant eval coronry calcium (75571) |
— |
$307.09 |
— |
| CT iac w contrast (70481) |
— |
$2,878.68 |
— |
| CT l-spine w&w/o contrast (72133) |
— |
$4,546.30 |
— |
| CT lower ext w/o (73700) |
— |
$5,594.37 |
— |
| CT lower extremity w/contrast material (73701) |
— |
$5,931.25 |
— |
| CT lumbar spine w contrast (72132) |
— |
$7,435.23 |
— |
| CT lumbar spine w/o contrast (72131) |
— |
$3,994.56 |
— |
| CT maxillofacial w contrast (70487) |
— |
$6,026.86 |
— |
| CT maxillofacial wo contrast (70486) |
— |
$3,037.11 |
— |
| CT neck tissue combo (70492) |
— |
$7,676.49 |
— |
| Ct Orbit/Ear/Fossa W/O&W/Dye (70482) |
— |
$5,146.91 |
— |
| CT orbits w/o contrast (70480) |
— |
$4,567.58 |
— |
| CT pelvis w&w/o contrast (72194) |
— |
$2,486.61 |
— |
| CT pelvis w/o contrast (72192) |
— |
$2,354.30 |
— |
| CT scan of leg combo (73702) |
— |
$6,809.31 |
— |
| CT scans face/jaw combo (70488) |
— |
$3,641.30 |
— |
| CT soft tissue neck w contrast (70491) |
— |
$3,784.85 |
— |
| CT soft tissue neck w/o contrast (70490) |
— |
$6,000.78 |
— |
| CT thoracic spine w contrast (72129) |
— |
$2,490.56 |
— |
| CT thoracic spine w/o contrast (72128) |
— |
$3,675.25 |
— |
| CT thoracic spine w/wo cont (72130) |
— |
$4,683.68 |
— |
| CT thorax w/o contrast (71250) |
— |
$1,772.59 |
— |
| CT upper ext wo (73200) |
— |
$5,666.13 |
— |
| CT upper extremity w/o & w/contrast material (73202) |
— |
$7,674.33 |
— |
| CT upper extremity with contrast (73201) |
— |
$14,574.87 |
— |
| Cta Abdl Aorta&Bi Iliofem W/Contrast&Postp (75635) |
— |
$5,422.61 |
— |
| Cta Abdomen (74175) |
— |
$5,759.51 |
— |
| CTA pelvis (72191) |
— |
$6,060.49 |
— |
| Dxa Bone Density Axial (77080) |
— |
$1,327.74 |
— |
| Dxa bone density study 1/>sites appendiclr skel (77081) |
— |
$375.32 |
— |
| Echo exam uterus (76831) |
— |
$2,168.26 |
— |
| Esophagram (74220) |
— |
$901.26 |
— |
| Fetal Biophysical Profile W/O Non-Stress Testing (76819) |
— |
$816.47 |
— |
| Fluoroscopy up to 1 hr (76000) |
— |
$1,944.32 |
— |
| Foot 2 views (73620) |
— |
$418.54 |
— |
| Forearm 2 views (73090) |
— |
$1,155.87 |
— |
| Gastric emptying imaging study (78264) |
— |
$3,101.08 |
— |
| Gated Heart Planar Single (78472) |
— |
$3,327.54 |
— |
| Hand 2 views (73120) |
— |
$984.02 |
— |
| Hepatobil Syst Image W/Drug (78227) |
— |
$5,001.99 |
— |
| Hepatobiliary System Imaging (78226) |
— |
$2,459.70 |
— |
| Ht Musc Image Planar Mult (78454) |
— |
$4,017.15 |
— |
| Ht Muscle Image Spect Sing (78451) |
— |
$6,304.60 |
— |
| Hysterosalpingogram (74740) |
— |
$777.68 |
— |
| Infant hip ultrasound with hip movement (dynamic) (76885) |
— |
$628.13 |
— |
| K Flow/Funct Image Multiple (78709) |
— |
$3,161.77 |
— |
| K Flow/Funct Image W/Drug (78708) |
— |
$5,324.80 |
— |
| K Flow/Funct Image W/O Drug (78707) |
— |
$2,922.98 |
— |
| Knee 3 Views (73562) |
— |
$1,543.35 |
— |
| Lung Ventilat&Perfus Imaging (78582) |
— |
$1,491.71 |
— |
| Magnetic Image Jaw Joint (70336) |
— |
$2,439.91 |
— |
| Mammary ductogram or galactogram multiple (77054) |
— |
$1,384.36 |
— |
| Mammary ductogram or galactogram single (77053) |
— |
$2,094.70 |
— |
| Meckels Divert Exam (78290) |
— |
$4,177.27 |
— |
| Mra Head W/O & W/Contrast Material (70546) |
— |
$4,170.56 |
— |
| MRA head w/o contrast (70544) |
— |
$2,667.61 |
— |
| MRA head with contrast (70545) |
— |
$5,626.30 |
— |
| MRA neck w contrast (70548) |
— |
$6,513.16 |
— |
| Mra Neck W/O &W/Contrast Material (70549) |
— |
$4,366.04 |
— |
| MRA neck w/o contrast (70547) |
— |
$2,667.61 |
— |
| MRI abdomen w contrast (74182) |
— |
$3,148.20 |
— |
| MRI abdomen w/o contrast (74181) |
— |
$3,314.46 |
— |
| MRI any jt lower extrem w/contrast material (73722) |
— |
$8,267.66 |
— |
| MRI any jt lower extrem w/o & w/contrast matrl (73723) |
— |
$9,457.60 |
— |
| MRI any jt upper extremity w/contrast matrl (73222) |
— |
$7,878.63 |
— |
| MRI Breast W/O Contrast Bilateral (77047) |
— |
$4,362.81 |
— |
| MRI Breast Without Contrast Material Unilateral (77046) |
— |
$5,164.23 |
— |
| MRI cervical spine w contrast (72142) |
— |
$9,333.95 |
— |
| MRI cervical spine w/o cont (72141) |
— |
$4,327.85 |
— |
| MRI chest w/o contrast (71550) |
— |
$1,896.74 |
— |
| MRI chest wo w contrast (71552) |
— |
$3,684.29 |
— |
| MRI lower extrem oth/thn jt w/contrast matrl (73719) |
— |
$9,047.89 |
— |
| MRI lower extrem oth/thn jt w/o & w/contr matr (73720) |
— |
$10,627.97 |
— |
| MRI lower extrem oth/thn jt w/o contr matrl (73718) |
— |
$8,267.66 |
— |
| MRI lumbar spine w contrast (72149) |
— |
$5,566.99 |
— |
| Mri Neck Spine W/O & W/Dye (72156) |
— |
$5,809.58 |
— |
| MRI orbit face &/neck w/o contrast (70540) |
— |
$5,805.24 |
— |
| MRI orbit face neck w contrast (70542) |
— |
$3,696.21 |
— |
| Mri Orbt/Fac/Nck W/O &W/Dye (70543) |
— |
$6,947.74 |
— |
| MRI pelvis w contrast (72196) |
— |
$5,376.42 |
— |
| MRI pelvis w/o & w contrast (72197) |
— |
$7,069.13 |
— |
| MRI pelvis w/o contrast (72195) |
— |
$8,172 |
— |
| MRI thoracic spine w/o contrast (72146) |
— |
$4,179.32 |
— |
| MRI upper extremity oth than jt w/contr matrl (73219) |
— |
$11,021.39 |
— |
| MRI upper extremity oth than jt w/o contr matrl (73218) |
— |
$11,030.06 |
— |
| Mri Uppr Extremity W/O&W/Dye (73220) |
— |
$13,218.71 |
— |
| MRI, abdomen, combo (74183) |
— |
$10,158.52 |
— |
| MRI, dorsal spine combo (72157) |
— |
$8,790.58 |
— |
| MRI, dorsal spine contrast (72147) |
— |
$7,429.28 |
— |
| MRI, joint upper extrem (73221) |
— |
$7,878.63 |
— |
| MRI, joint upper extrem combo (73223) |
— |
$8,678.44 |
— |
| MRI, lumbar spine combo (72158) |
— |
$4,027.01 |
— |
| Myelogram cervical (72240) |
— |
$2,117.12 |
— |
| Myelogram Lumbar (72265) |
— |
$2,114.62 |
— |
| Myelography thoracic (72255) |
— |
$2,195.75 |
— |
| Myelograpy 2/more regions rs&i (72270) |
— |
$3,612.59 |
— |
| Myocardial Perfusion Planar 1 Study Rest/Stress (78453) |
— |
$2,752.37 |
— |
| Myocardial Spect Multiple Studies (78452) |
— |
$5,826.86 |
— |
| Neck soft tissue (70360) |
— |
$1,031.89 |
— |
| Ophthalmic us dx quantitative a-scan only (76511) |
— |
$631.64 |
— |
| Parathyroid Planar Imaging (78070) |
— |
$1,225.85 |
— |
| Pelvis 1 or 2 views (72170) |
— |
$694.13 |
— |
| Pulmonary Perfusion Imaging Particulate (78580) |
— |
$1,993.01 |
— |
| Radex Abd Compl Aqt Abd W/S/E/D Views 1 View Ch (74022) |
— |
$1,123.65 |
— |
| Radex abscess/fistula/sinus tract rs&i (76080) |
— |
$280.85 |
— |
| Radex Ankle Complete Minimum 3 Views (73610) |
— |
$1,513.44 |
— |
| Radex Calcaneus Minimum 2 Views (73650) |
— |
$745.64 |
— |
| Radex elbow complete minimum 3 views (73080) |
— |
$733.86 |
— |
| Radex Facial Bones Complete Minimum 3 Views (70150) |
— |
$644.77 |
— |
| Radex fingr minimum 2 views (73140) |
— |
$978.48 |
— |
| Radex foot complete minimum 3 views (73630) |
— |
$1,300.02 |
— |
| Radex Hand Minimum 3 Views (73130) |
— |
$1,205.81 |
— |
| Radex lower extremity infant minimum 2 views (73592) |
— |
$665.24 |
— |
| Radex Mastoids Compl Minimum 3 Views PR Side (70130) |
— |
$1,565.61 |
— |
| Radex Nasal Bones Complete Minimum 3 Views (70160) |
— |
$1,402.55 |
— |
| Radex Ribs Unilateral 2 Views (71100) |
— |
$1,402.55 |
— |
| Radex shoulder complete minimum 2 views (73030) |
— |
$1,446.92 |
— |
| Radex Spine 1 View Specify Level (72020) |
— |
$834.35 |
— |
| Radex Sternum Minimum 2 Views (71120) |
— |
$554.02 |
— |
| Radex Temporomandble Jt Opn & Clsd Mouth Bilat (70330) |
— |
$415.71 |
— |
| Radex Toe Minimum 2 Views (73660) |
— |
$916.49 |
— |
| Radex upper extremity infant minimum 2 views (73092) |
— |
$692.95 |
— |
| Radex Wrist Complete Minimum 3 Views (73110) |
— |
$1,313.89 |
— |
| Radiolog exam mandible compl minimum 4 views (70110) |
— |
$477.61 |
— |
| Radiologic Exam Abdomen 3+ Views - Xr Abdomen 3+ Views (74021) |
— |
$368.26 |
— |
| Radiologic exam colon double contrast study (74280) |
— |
$2,395.11 |
— |
| Radiologic exam colon single contrast study (74270) |
— |
$946.21 |
— |
| Radiologic exam knee complete 4/more views (73564) |
— |
$1,005.44 |
— |
| Radiologic Exam Small Int Single Contrast Study (74250) |
— |
$772.70 |
— |
| Radiologic exam swallow function contrast study (74230) |
— |
$843.30 |
— |
| Radiologic exam upr gi trc double contrast study (74246) |
— |
$1,844.06 |
— |
| Radiologic examination femur 1 view (73551) |
— |
$750.43 |
— |
| Radiologic examination femur minimum 2 views (73552) |
— |
$1,014.51 |
— |
| Radiologic examination knee 1/2 views (73560) |
— |
$1,128.17 |
— |
| Radiologic examination tibia & fibula 2 views (73590) |
— |
$705.45 |
— |
| Ribs bilateral 3 views (71110) |
— |
$1,141.48 |
— |
| Rp Loclzj Tum Spect 1 Area Single Day Imaging (78803) |
— |
$2,511.05 |
— |
| Scapula (73010) |
— |
$1,438.64 |
— |
| Screening Digital Breast Tomosynthesis Bi (77063) |
— |
$124.95 |
— |
| Shoulder 1 view (73020) |
— |
$1,111.52 |
— |
| Shoulder Arthrography (73040) |
— |
$1,986.33 |
— |
| Skull less than 4 views (70250) |
— |
$253.14 |
— |
| Sternoclavicular joints (71130) |
— |
$1,510.63 |
— |
| Thoracic spine 2 views (72070) |
— |
$923.38 |
— |
| Thoracic spine 3 views (72072) |
— |
$1,052.73 |
— |
| Thyroid Imaging With Vascular Flow (78013) |
— |
$1,225.85 |
— |
| Ultrasound Breast Limited (76642) |
— |
$975.69 |
— |
| Ultrasound Exam Aaa Screen (76706) |
— |
$1,197.46 |
— |
| Ultrasound, abdomen limited (76705) |
— |
$973.69 |
— |
| Upper gi w/o kub (74240) |
— |
$851.34 |
— |
| Urethrocystogram voiding (74455) |
— |
$999.79 |
— |
| Urethrocystography retrograde (74450) |
— |
$949.75 |
— |
| Us breast unilateral complete (76641) |
— |
$748.40 |
— |
| Us chest (76604) |
— |
$352.03 |
— |
| Us complete joint (76881) |
— |
$1,051.92 |
— |
| Us exam, pelvic, limited (76857) |
— |
$686.79 |
— |
| Us head (76506) |
— |
$788.93 |
— |
| Us lmtd joint/oth nonvasc xtr strux r-t w/img (76882) |
— |
$1,051.92 |
— |
| Us ob limited 1 or more fetuses (76815) |
— |
$688.98 |
— |
| Us ob transvaginal (76817) |
— |
$493.37 |
— |
| Us pelvic non ob complete (76856) |
— |
$787.67 |
— |
| Us pg uter img f&mat 14 wk tabdl 1/1st gestation (76801) |
— |
$868.39 |
— |
| Us preg uterus real time f/u trnsabdl per fetus (76816) |
— |
$484.66 |
— |
| Us retroperitoneal complete (76770) |
— |
$1,640.92 |
— |
| Us retroperitoneal limited (76775) |
— |
$624.15 |
— |
| Us scrotum and contents (76870) |
— |
$1,014.88 |
— |
| Us spinal canal and contents (76800) |
— |
$793.92 |
— |
| Us thyroid (76536) |
— |
$1,208.79 |
— |
| Vein X-Ray Chest (75827) |
— |
$5,822.57 |
— |
| Venography caval inferior serialography rs&i (75825) |
— |
$7,958.20 |
— |
| Venography extremity bilateral rs&i (75822) |
— |
$2,187.01 |
— |
| Venography extremity unilateral rs&i (75820) |
— |
$2,590.70 |
— |
| Wrist 2 views (73100) |
— |
$693.34 |
— |
| X-Ray Ac Jts - Xr Acromioclavicular Joints Bilateral (73050) |
— |
$512.64 |
— |
| X-Ray Aorta Leg Arteries (75630) |
— |
$16,146.97 |
— |
| X-Ray Bend Only L-S Spine (72120) |
— |
$995.15 |
— |
| X-Ray Elbow 2 Vw - Xr Elbow 1-2 Views Right (73070) |
— |
$1,031.14 |
— |
| X-Ray Exam Breast Specimen (76098) |
— |
$630.44 |
— |
| X-Ray Exam Entire Spi 2/3 Vw (72082) |
— |
$713.77 |
— |
| X-Ray Exam Entire Spi 4/5 Vw (72083) |
— |
$1,360.82 |
— |
| X-Ray Exam Hip Uni 1 View (73501) |
— |
$750.43 |
— |
| X-Ray Exam Hip Uni 2-3 Views (73502) |
— |
$750.43 |
— |
| X-Ray Exam Hips Bi 2 Views (73521) |
— |
$684.02 |
— |
| X-Ray Exam Hips Bi 3-4 Views (73522) |
— |
$713.77 |
— |
| X-Ray Exam L-S Spine Bending (72114) |
— |
$576.80 |
— |
| X-Ray Exam Neck Spine 2-3 Vw (72040) |
— |
$729.15 |
— |
| X-Ray Exam Neck Spine 6/>Vws (72052) |
— |
$2,763.56 |
— |
| X-Ray Exam Unilat Ribs/Chest (71101) |
— |
$1,602.17 |
— |
| X-ray humerus (73060) |
— |
$1,189.16 |
— |
| X-ray IV pyelogram (ivp) (74400) |
— |
$1,258.29 |
— |
| X-Ray Knee Bilat Standing - Xr Knees Anteroposterior Standing Bilat (73565) |
— |
$440.77 |
— |
| X-Ray Lumbar Spine 2/3 Vw - Xr Lumbar Spine 2-3 Views (72100) |
— |
$896.32 |
— |
| X-ray nose-rectum child f.b. (76010) |
— |
$262.14 |
— |
| X-Ray Ribs, Chest 4+ Vw - Xr Ribs 3 Vws Bil W/ Chest Posteroanterior (71111) |
— |
$2,206.40 |
— |
| X-Ray Sacroiliac Jts 3+ Vw - Xr Sacroiliac Joints 3+ Views (72202) |
— |
$749.12 |
— |
| X-Ray Sacrum/Coccyx 2+ Vw - Xr Sacrum Coccyx 2+ Views (72220) |
— |
$796.92 |
— |
| X-Ray Sinuses 3+ Vw - Xr Paranasal Sinuses 3+ Views (70220) |
— |
$652.73 |
— |
| X-Ray Skull 4+ Vw - Xr Skull Complete 4+ Views (70260) |
— |
$901.70 |
— |
| X-Ray Tmj Unilat (70328) |
— |
$189.19 |
— |
| X-Ray Urinary Tract Exam With Contrast Material (74420) |
— |
$1,614.86 |
— |
| X-Rays Bone Survey Complete (77075) |
— |
$1,159.55 |
— |
| Xr c-spine 4 or 5 views (72050) |
— |
$2,245.23 |
— |
| Xr orbits complete 4 views (70200) |
— |
$814.95 |
— |