| Abdomen 2 views (74019) |
— |
$715.07 |
— |
| Acute gastrointestinal blood loss imaging (78278) |
— |
$3,022.39 |
— |
| Angiography extremity bilateral rs&i (75716) |
— |
$8,832.38 |
— |
| Angiography extremity unilateral rs&i (75710) |
— |
$16,146.97 |
— |
| Angiography internal mammary rs&i (75756) |
— |
$5,065.03 |
— |
| Angiography pelvic slctv/supraslctv rs&i (75736) |
— |
$22,370.79 |
— |
| Angiography visceral slctv/supraslctv rs&i (75726) |
— |
$28,287.55 |
— |
| Ankle 2 views (73600) |
— |
$607.05 |
— |
| Aortogram thoracic (75605) |
— |
$8,614.78 |
— |
| Aortography abdl bi iliofem low extrem cath rs&i (75630) |
— |
$16,146.97 |
— |
| Aortography abdominal serialography rs&i (75625) |
— |
$9,274.01 |
— |
| Arthrogram hip (73525) |
— |
$3,174.52 |
— |
| Arthrogram shoulder (73040) |
— |
$1,986.33 |
— |
| Arthrogram wrist (73115) |
— |
$2,107.44 |
— |
| Arthrography knee lt (73580) |
— |
$1,273.42 |
— |
| Bone &/Joint Imaging Limited Area (78300) |
— |
$2,316.42 |
— |
| Bone &/Joint Imaging Multiple Areas (78305) |
— |
$3,118.53 |
— |
| Bone &/joint imaging whole body (78306) |
— |
$6,566.57 |
— |
| Bone age studies (77072) |
— |
$717.93 |
— |
| Bone Imaging 3 Phase (78315) |
— |
$4,266.66 |
— |
| Bone survey complete (77075) |
— |
$1,159.55 |
— |
| Cervical spine 2 or 3 views (72040) |
— |
$729.15 |
— |
| Chest 1 view (71045) |
— |
$514.24 |
— |
| Chest 3 views (71047) |
— |
$695.72 |
— |
| Cine/Vid X-Ray Throat/Esoph - Fl Esoph Barium Swlw W/ Video & Speech (74230) |
— |
$843.30 |
— |
| Clavicle complete (73000) |
— |
$1,252.90 |
— |
| 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 hrt w/3d image (75574) |
— |
$2,916.46 |
— |
| CT angiography upper extremity lt (73206) |
— |
$7,026.65 |
— |
| CT c-spine w/o contrast (72125) |
— |
$4,423.97 |
— |
| CT cervical spine w&w/o contrast (72127) |
— |
$5,915.70 |
— |
| CT cervical spine with contrast (72126) |
— |
$7,724.29 |
— |
| CT chest w/wo contrast (71270) |
— |
$4,156.83 |
— |
| CT chest with contrast (71260) |
— |
$4,246.85 |
— |
| 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 limited/localized follow up study (76380) |
— |
$1,912.17 |
— |
| CT lower ext w/o (73700) |
— |
$5,594.37 |
— |
| CT lower extremity w wo contrast (73702) |
— |
$6,809.31 |
— |
| CT lower extremity with contrast (73701) |
— |
$5,931.25 |
— |
| CT lumbar spine w & w/o contrast (72133) |
— |
$4,546.30 |
— |
| CT lumbar spine w/o contrast (72131) |
— |
$3,994.56 |
— |
| CT lumbar spine with contrast (72132) |
— |
$7,435.23 |
— |
| CT maxillofacial w contrast (70487) |
— |
$6,026.86 |
— |
| CT maxillofacial w/o contrast (70486) |
— |
$3,037.11 |
— |
| CT maxillofacial w/wo contrast (70488) |
— |
$3,641.30 |
— |
| CT neck soft tissue w contrast (70491) |
— |
$3,784.85 |
— |
| CT orbit sella/post fossa/ear w/o & w/contr matr (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 soft tissue neck w/o & w/contrast material (70492) |
— |
$7,676.49 |
— |
| 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 contrast (72130) |
— |
$4,683.68 |
— |
| CT thorax w/o contrast (71250) |
— |
$1,772.59 |
— |
| CT upper extremity w/o & w/contrast material (73202) |
— |
$7,674.33 |
— |
| CT upper extremity w/o contrast rt (73200) |
— |
$5,666.13 |
— |
| 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 abdomen pelvis (74174) |
— |
$5,922.54 |
— |
| CTA chest (71275) |
— |
$6,387.65 |
— |
| Cta Head (70496) |
— |
$2,874.84 |
— |
| CTA lwr ext w&w/o contrast (73706) |
— |
$5,674.78 |
— |
| Cta Neck (70498) |
— |
$5,005.37 |
— |
| Cta Pelvis (72191) |
— |
$6,060.49 |
— |
| Cystography minimum 3 views rs&i (74430) |
— |
$523.04 |
— |
| Dxa bone density study 1/> sites axial skel (77080) |
— |
$1,327.74 |
— |
| Dxa bone density study 1/>sites appendiclr skel (77081) |
— |
$375.32 |
— |
| Echoencephalography real time imaging (76506) |
— |
$788.93 |
— |
| Esophagus (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 |
— |
| Gated Heart Planar Single (78472) |
— |
$3,327.54 |
— |
| Hand 2 views (73120) |
— |
$984.02 |
— |
| Hand 3 views (73130) |
— |
$1,205.81 |
— |
| Hepatobil Syst Imag Inc Gb W/Pharma Intervenj (78227) |
— |
$5,001.99 |
— |
| Hepatobiliary syst imaging including gallbladder (78226) |
— |
$2,459.70 |
— |
| Ht muscle image spect sing (78451) |
— |
$6,304.60 |
— |
| Humerus Min 2 Views Left (73060) |
— |
$1,189.16 |
— |
| Hysterosalpingogram (74740) |
— |
$777.68 |
— |
| Kidney Img Morphology Vascular Flow 1 W/O Rx (78707) |
— |
$2,922.98 |
— |
| Kidney img morphology vascular flow 1 w/rx (78708) |
— |
$5,324.80 |
— |
| Kidney Img Morphology Vascular Flow Multiple (78709) |
— |
$3,161.77 |
— |
| Knee 3 views (73562) |
— |
$1,543.35 |
— |
| Mammary ductogram or galactogram multiple (77054) |
— |
$1,384.36 |
— |
| Mammary ductogram or galactogram single (77053) |
— |
$2,094.70 |
— |
| Meckels Diverticulum (78290) |
— |
$4,177.27 |
— |
| MRA head w & w/o contrast (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 & w/contrast material (74183) |
— |
$10,158.52 |
— |
| MRI abdomen w/o contrast (74181) |
— |
$3,314.46 |
— |
| MRI any jnt lwr ext with con lt (73722) |
— |
$8,267.66 |
— |
| MRI any jt upper extremity w/contrast matrl (73222) |
— |
$7,878.63 |
— |
| MRI breast w/o contrast bilateral (77047) |
— |
$4,362.81 |
— |
| MRI breast w/o contrast unilat (77046) |
— |
$5,164.23 |
— |
| MRI c-spine with contrast (72142) |
— |
$9,333.95 |
— |
| MRI cervical spine w/o contrast (72141) |
— |
$4,327.85 |
— |
| MRI chest w/o & w/contrast material (71552) |
— |
$3,684.29 |
— |
| MRI chest w/o contrast (71550) |
— |
$1,896.74 |
— |
| MRI Forearm w/ Contrast Bilateral 73219 (73219) |
— |
$11,021.39 |
— |
| MRI lower extrem oth/thn jt w/contrast matrl (73719) |
— |
$9,047.89 |
— |
| MRI lower extrem oth/thn jt w/o contr matrl (73718) |
— |
$8,267.66 |
— |
| MRI orbit face &/neck w/o contrast (70540) |
— |
$5,805.24 |
— |
| MRI orbit/face/neck w&w/o cont (70543) |
— |
$6,947.74 |
— |
| MRI orbit/face/neck w/contrast (70542) |
— |
$3,696.21 |
— |
| MRI pelvis w contrast (72196) |
— |
$5,376.42 |
— |
| MRI pelvis w/o & w/contrast material (72197) |
— |
$7,069.13 |
— |
| MRI pelvis w/o contrast (72195) |
— |
$8,172 |
— |
| MRI scan of arm joint before and after contrast (73223) |
— |
$8,678.44 |
— |
| MRI scan of leg joint before and after contrast (73723) |
— |
$9,457.60 |
— |
| MRI spinal canal cervical w/o & w/contr matrl (72156) |
— |
$5,809.58 |
— |
| MRI spinal canal lumbar w/contrast material (72149) |
— |
$5,566.99 |
— |
| MRI spinal canal lumbar w/o & w/contr matrl (72158) |
— |
$4,027.01 |
— |
| MRI spinal canal thoracic w/contrast matrl (72147) |
— |
$7,429.28 |
— |
| MRI spinal canal thoracic w/o & w/contr matrl (72157) |
— |
$8,790.58 |
— |
| MRI thoracic spine w/o contrast (72146) |
— |
$4,179.32 |
— |
| MRI tmj (70336) |
— |
$2,439.91 |
— |
| MRI upper ext joint w/o contrast (73221) |
— |
$7,878.63 |
— |
| MRI upper extrem other than jt w/o & w/contras (73220) |
— |
$13,218.71 |
— |
| MRI upper extremity oth than jt w/o contr matrl (73218) |
— |
$11,030.06 |
— |
| Myelogram Cervical (72240) |
— |
$2,117.12 |
— |
| Myelogram Lumbar (72265) |
— |
$2,114.62 |
— |
| Myelogram thoracic (72255) |
— |
$2,195.75 |
— |
| Myelography 2 or more regions (72270) |
— |
$3,612.59 |
— |
| Myocardial Spect Multiple Studies (78452) |
— |
$5,826.86 |
— |
| Neck soft tissue (70360) |
— |
$1,031.89 |
— |
| Nm gastric emptying study (78264) |
— |
$3,101.08 |
— |
| Nuclear medicine of heart muscle at rest with stress (78454) |
— |
$4,017.15 |
— |
| Nuclear medicine study of heart muscle at rest with stress (78453) |
— |
$2,752.37 |
— |
| Ob Us Follow-Up Per Fetus - Us Ob Follow Up Transabdominal Approach (76816) |
— |
$484.66 |
— |
| Ophthalmic us dx quantitative a-scan only (76511) |
— |
$631.64 |
— |
| Osseous survey infant (77076) |
— |
$1,280.65 |
— |
| Parathyroid imaging (78070) |
— |
$1,225.85 |
— |
| Pelvis 1 or 2 views (72170) |
— |
$694.13 |
— |
| Pr MRI, lower extr, w/o contrast f/u by contrast (73720) |
— |
$10,627.97 |
— |
| Pulmonary Perfusion Imaging Particulate (78580) |
— |
$1,993.01 |
— |
| Pulmonary Ventilation & Perfusion Imaging (78582) |
— |
$1,491.71 |
— |
| Radex abscess/fistula/sinus tract rs&i (76080) |
— |
$280.85 |
— |
| Radex entir thrc lmbr crv sac spi w/skull 2/3 vw (72082) |
— |
$713.77 |
— |
| Radex hips bilateral with pelvis 2 views (73521) |
— |
$684.02 |
— |
| Radex mastoids compl minimum 3 views pr side (70130) |
— |
$1,565.61 |
— |
| Radiolog exam mandible compl minimum 4 views (70110) |
— |
$477.61 |
— |
| Radiologic Exam Abdomen 1 View - Xr Abdomen 1 View (74018) |
— |
$322.06 |
— |
| Radiologic Exam Abdomen 3+ Views - Xr Abdomen 3+ Views (74021) |
— |
$368.26 |
— |
| Radiologic Exam Chest 2 Views - Xr Chest 2 Views (71046) |
— |
$1,222.38 |
— |
| Radiologic exam colon single contrast study (74270) |
— |
$946.21 |
— |
| Radiologic exam upr gi trc double contrast study (74246) |
— |
$1,844.06 |
— |
| Radiologic exam upr gi trc single contrast study (74240) |
— |
$851.34 |
— |
| Radiologic Examination Femur Minimum 2 Views - Xr Femur 2+ Vw Lt (73552) |
— |
$1,014.51 |
— |
| Radiological examination surgical specimen (76098) |
— |
$630.44 |
— |
| Ribs bilateral 3 views (71110) |
— |
$1,141.48 |
— |
| Rp loclzj tum spect 1 area single day imaging (78803) |
— |
$2,511.05 |
— |
| Saline Infus Sonohysterography W/Color Doppler (76831) |
— |
$2,168.26 |
— |
| Scapula complete (73010) |
— |
$1,438.64 |
— |
| Screening digital breast tomosynthesis (77063) |
— |
$124.95 |
— |
| Small bowel series (74250) |
— |
$772.70 |
— |
| Spine thoracic 3 views (72072) |
— |
$1,052.73 |
— |
| Thyroid Imaging With Vascular Flow (78013) |
— |
$1,225.85 |
— |
| Tmj unilateral (70328) |
— |
$189.19 |
— |
| Ultrasound, abdomen limited (76705) |
— |
$973.69 |
— |
| Upper Extremity Infant (73092) |
— |
$692.95 |
— |
| Urethrocystography retrograde rs&i (74450) |
— |
$949.75 |
— |
| Urethrocystography voiding (74455) |
— |
$999.79 |
— |
| Urography (pyelography), intravenous, with or without KUB, with or without tomography (74400) |
— |
$1,258.29 |
— |
| Us abdl aorta screen aaa (76706) |
— |
$1,197.46 |
— |
| Us breast unilateral complete (76641) |
— |
$748.40 |
— |
| Us breast unilateral limited (76642) |
— |
$975.69 |
— |
| Us chest (76604) |
— |
$352.03 |
— |
| Us compl joint r-t w/image documentation (76881) |
— |
$1,051.92 |
— |
| Us infant hips dynamic (76885) |
— |
$628.13 |
— |
| Us ob transvaginal (76817) |
— |
$493.37 |
— |
| Us pelvic non ob complete (76856) |
— |
$787.67 |
— |
| Us pelvic nonobstetric image dcmtn limited/f/u (76857) |
— |
$686.79 |
— |
| Us pregnancy ltd (76815) |
— |
$688.98 |
— |
| Us pregnant uterus 14 wk transabdl 1/1st gestat (76801) |
— |
$868.39 |
— |
| Us retroperitoneal complete (76770) |
— |
$1,640.92 |
— |
| Us retroperitoneal limited (76775) |
— |
$624.15 |
— |
| Us scrotum and contents (76870) |
— |
$1,014.88 |
— |
| Us soft tissue head/neck (76536) |
— |
$1,208.79 |
— |
| Us spinal canal and contents (76800) |
— |
$793.92 |
— |
| Us xtr non-vasc lmtd (76882) |
— |
$1,051.92 |
— |
| Venogram extremity bilateral (75822) |
— |
$2,187.01 |
— |
| Venography caval inferior serialography rs&i (75825) |
— |
$7,958.20 |
— |
| Venography caval superior serialography rs&i (75827) |
— |
$5,822.57 |
— |
| Venography extremity unilateral rs&i (75820) |
— |
$2,590.70 |
— |
| Wrist 2 views (73100) |
— |
$693.34 |
— |
| X-Ray Abdomen,Comp Acute Series - Xr Abdomen 2 Vws With Chest 1 View (74022) |
— |
$1,123.65 |
— |
| X-Ray Ac Jts - Xr Acromioclavicular Joints Bilateral (73050) |
— |
$512.64 |
— |
| X-Ray Ankle 3+ Vw - Xr Ankle 3+ Views Right (73610) |
— |
$1,513.44 |
— |
| X-Ray Colon Air Contrast - Fl Barium Enema Air Contrast (74280) |
— |
$2,395.11 |
— |
| X-Ray Elbow 2 Vw - Xr Elbow 1-2 Views Right (73070) |
— |
$1,031.14 |
— |
| X-Ray Elbow 3+ Vw - Xr Elbow 3+ Views Right (73080) |
— |
$733.86 |
— |
| 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 3-4 Views (73522) |
— |
$713.77 |
— |
| X-ray exam of femur 1 (73551) |
— |
$750.43 |
— |
| X-Ray Facial Bones 3+ Vw - Xr Facial Bones 3+ Views (70150) |
— |
$644.77 |
— |
| X-Ray Foot 3+ Vw - Xr Foot 3+ Views Right (73630) |
— |
$1,300.02 |
— |
| X-Ray Heel - Xr Calcaneus 2 Views Right (73650) |
— |
$745.64 |
— |
| X-Ray Knee 4+ View - Xr Knee 4+ Views Right (73564) |
— |
$1,005.44 |
— |
| X-Ray Knee Bilat Standing - Xr Knees Anteroposterior Standing Bilat (73565) |
— |
$440.77 |
— |
| X-Ray Leg, Infant - Xr Lower Extremity 2+ Views Infant Left (73592) |
— |
$665.24 |
— |
| X-Ray Lumbar Spine 2/3 Vw - Xr Lumbar Spine 2-3 Views (72100) |
— |
$896.32 |
— |
| X-Ray Lumbar Spine 6+ Vw - Xr Lumbar Spine 6+ Vws Including Bending (72114) |
— |
$576.80 |
— |
| X-Ray Lumbar Spine Flex/Exten - Xr Lumbar Spine 4+ Views W/ Flex Ext (72120) |
— |
$995.15 |
— |
| X-Ray Nasal Bones - Xr Nasal Bones (70160) |
— |
$1,402.55 |
— |
| X-Ray Nose-Rectum Child F.B. - Xr Nose to Rectum Foreign Body Peds (76010) |
— |
$262.14 |
— |
| X-Ray Orbits - Xr Orbits Complete 4+ Views (70200) |
— |
$814.95 |
— |
| X-Ray Retrograde Pyelogram - Fl Pyelogram Retrograde (74420) |
— |
$1,614.86 |
— |
| X-Ray Ribs 2 Vw Unilat - Xr Ribs 2 Views Right (71100) |
— |
$1,402.55 |
— |
| X-Ray Ribs, Chest 3+ Vw - Xr Ribs 2 Vws Lt W/ Chest Anteroposterior (71101) |
— |
$1,602.17 |
— |
| 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 Shoulder 2+ Vw - Xr Shoulder 2+ Views Right (73030) |
— |
$1,446.92 |
— |
| 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 Skull <4 Vw - Xr Skull 1-3 Views (70250) |
— |
$253.14 |
— |
| X-Ray Spine One View - Xr Spine (72020) |
— |
$834.35 |
— |
| X-Ray Sterno-Clavicluar Jt - Xr Sternoclavicular Joints 3+ Views (71130) |
— |
$1,510.63 |
— |
| X-Ray Sternum 2+ Vw - Xr Sternum 2+ Views (71120) |
— |
$554.02 |
— |
| X-Ray Thoracic Spine 2 Vw - Xr Thoracic Spine 2 Views (72070) |
— |
$923.38 |
— |
| X-Ray Toe(S) - Xr Toes 2+ Views Right (73660) |
— |
$916.49 |
— |
| X-Ray Wrist 3+ Vw - Xr Wrist 3+ Views Right (73110) |
— |
$1,313.89 |
— |
| Xr c-spine 6 or more views (72052) |
— |
$2,763.56 |
— |
| Xr chest 4+ views (71048) |
— |
$1,536.83 |
— |
| Xr finger(s) 2+ views (73140) |
— |
$978.48 |
— |
| Xr shoulder 1 view (73020) |
— |
$1,111.52 |
— |
| Xr spine cervical 4 or 5 views (72050) |
— |
$2,245.23 |
— |
| Xr tibia/fibula 2 views (73590) |
— |
$705.45 |
— |
| Xr tmj bilateral (70330) |
— |
$415.71 |
— |
| Xray knee 1 or 2 views rt (73560) |
— |
$1,128.17 |
— |