| Abdomen 2 views (74019) |
— |
$244 |
— |
| Acute gastrointestinal blood loss imaging (78278) |
— |
$593 |
— |
| Antegrade urography radiological supvj & interpj (74425) |
— |
$1,379 |
— |
| Bone &/Joint Imaging Limited Area (78300) |
— |
$552 |
— |
| Bone &/Joint Imaging Multiple Areas (78305) |
— |
$557 |
— |
| Bone &/joint imaging whole body (78306) |
— |
$776 |
— |
| Bone age studies (77072) |
— |
$136 |
— |
| Bone Imaging 3 Phase (78315) |
— |
$766 |
— |
| Bone Marrow Imaging Limited Area (78102) |
— |
$658 |
— |
| Bone survey complete (77075) |
— |
$529 |
— |
| Cervical spine 2 or 3 views (72040) |
— |
$140 |
— |
| Chest 1 view (71045) |
— |
$171 |
— |
| Cine/Vid X-Ray Throat/Esoph - Fl Esoph Barium Swlw W/ Video & Speech (74230) |
— |
$425 |
— |
| Clavicle complete (73000) |
— |
$150 |
— |
| Computed Tomography Thorax Lw Dose Lng Ca Scr C- (71271) |
— |
$276 |
— |
| CT abdomen and pelvis without and with contrast (74178) |
— |
$2,439.14 |
— |
| CT abdomen and pelvis without contrast (74176) |
— |
$1,650 |
— |
| CT abdomen w contrast (74160) |
— |
$1,781 |
— |
| CT abdomen w wo contrast (74170) |
— |
$1,905 |
— |
| CT abdomen w/o contrast (74150) |
— |
$1,379 |
— |
| CT c-spine w/o contrast (72125) |
— |
$1,847 |
— |
| CT cervical spine with contrast (72126) |
— |
$1,966 |
— |
| CT chest w/wo contrast (71270) |
— |
$1,655 |
— |
| CT chest with contrast (71260) |
— |
$1,511 |
— |
| CT head/brain with contrast (70460) |
— |
$1,254 |
— |
| CT head/brain without and with contrast (70470) |
— |
$1,644 |
— |
| CT iac w contrast (70481) |
— |
$1,248 |
— |
| CT lumbar spine w & w/o contrast (72133) |
— |
$2,179 |
— |
| CT lumbar spine w/o contrast (72131) |
— |
$1,770 |
— |
| CT lumbar spine with contrast (72132) |
— |
$1,567 |
— |
| CT maxillofacial w contrast (70487) |
— |
$1,482 |
— |
| CT maxillofacial w/o contrast (70486) |
— |
$1,478 |
— |
| CT maxillofacial w/wo contrast (70488) |
— |
$1,353 |
— |
| CT neck soft tissue w contrast (70491) |
— |
$1,703 |
— |
| CT orbit sella/post fossa/ear w/o & w/contr matr (70482) |
— |
$2,494 |
— |
| CT orbits w/o contrast (70480) |
— |
$1,644 |
— |
| CT pelvis w & w/o contrast (72194) |
— |
$1,298 |
— |
| CT pelvis w/o contrast (72192) |
— |
$1,038 |
— |
| CT soft tissue neck w/o & w/contrast material (70492) |
— |
$1,353 |
— |
| CT soft tissue neck w/o contrast (70490) |
— |
$1,125 |
— |
| CT thoracic spine w/contrast (72129) |
— |
$1,567 |
— |
| CT thoracic spine w/o contrast (72128) |
— |
$1,423 |
— |
| CT thoracic spine w/wo contrast (72130) |
— |
$2,178 |
— |
| CT thorax w/o contrast (71250) |
— |
$1,111 |
— |
| Cta Abdl Aorta&Bi Iliofem W/Contrast&Postp (75635) |
— |
$1,893 |
— |
| Cta Abdomen (74175) |
— |
$2,071 |
— |
| CTA abdomen pelvis (74174) |
— |
$1,423 |
— |
| CTA chest (71275) |
— |
$1,892 |
— |
| Cta Head (70496) |
— |
$2,071 |
— |
| Cta Neck (70498) |
— |
$1,801 |
— |
| Cta Pelvis (72191) |
— |
$1,801 |
— |
| Esophagus (74220) |
— |
$504 |
— |
| Fetal biophysical profile non-stress testing (76818) |
— |
$510 |
— |
| Fetal Biophysical Profile W/O Non-Stress Testing (76819) |
— |
$510 |
— |
| Fluoroscopy up to 1 hr (76000) |
— |
$243 |
— |
| Forearm 2 views (73090) |
— |
$201 |
— |
| Gated Heart Planar Single (78472) |
— |
$956 |
— |
| Hand 3 views (73130) |
— |
$285 |
— |
| Hepatobil Syst Imag Inc Gb W/Pharma Intervenj (78227) |
— |
$1,360 |
— |
| Hepatobiliary syst imaging including gallbladder (78226) |
— |
$601 |
— |
| Ht muscle image spect sing (78451) |
— |
$2,342 |
— |
| Humerus Min 2 Views Left (73060) |
— |
$164.50 |
— |
| Hysterosalpingogram (74740) |
— |
$743 |
— |
| Kidney imaging morphology (78700) |
— |
$593 |
— |
| Kidney Img Morphology Vascular Flow 1 W/O Rx (78707) |
— |
$580 |
— |
| Kidney img morphology vascular flow 1 w/rx (78708) |
— |
$580 |
— |
| Kidney Img Morphology Vascular Flow Multiple (78709) |
— |
$997 |
— |
| Knee 3 views (73562) |
— |
$268 |
— |
| Liver & spleen imaging static only (78215) |
— |
$518 |
— |
| Lung Ventilation Imaging (78579) |
— |
$378 |
— |
| Lymphoscintigraphy (78195) |
— |
$1,042 |
— |
| Meckels Diverticulum (78290) |
— |
$419 |
— |
| Mr safety implant&/fb assmt clin staf 1st 15 min (76014) |
— |
$73.25 |
— |
| MRA head w & w/o contrast (70546) |
— |
$2,354 |
— |
| MRA head w/o contrast (70544) |
— |
$2,037 |
— |
| MRA head with contrast (70545) |
— |
$2,216 |
— |
| MRA neck w contrast (70548) |
— |
$2,325 |
— |
| Mra Neck W/O &W/Contrast Material (70549) |
— |
$2,472 |
— |
| MRA neck w/o contrast (70547) |
— |
$2,037 |
— |
| MRI abdomen w contrast (74182) |
— |
$2,216 |
— |
| MRI abdomen w/o & w/contrast material (74183) |
— |
$2,472 |
— |
| MRI abdomen w/o contrast (74181) |
— |
$2,255 |
— |
| MRI c-spine with contrast (72142) |
— |
$2,216 |
— |
| MRI cervical spine w/o contrast (72141) |
— |
$1,993 |
— |
| MRI chest w/o contrast (71550) |
— |
$1,940 |
— |
| MRI orbit face &/neck w/o contrast (70540) |
— |
$2,216 |
— |
| MRI orbit/face/neck w&w/o cont (70543) |
— |
$2,216 |
— |
| MRI orbit/face/neck w/contrast (70542) |
— |
$1,940 |
— |
| MRI pelvis w contrast (72196) |
— |
$2,216 |
— |
| MRI pelvis w/o & w/contrast material (72197) |
— |
$3,107 |
— |
| MRI pelvis w/o contrast (72195) |
— |
$2,037 |
— |
| MRI spinal canal cervical w/o & w/contr matrl (72156) |
— |
$2,472 |
— |
| MRI spinal canal lumbar w/contrast material (72149) |
— |
$2,216 |
— |
| MRI spinal canal lumbar w/o & w/contr matrl (72158) |
— |
$2,872 |
— |
| MRI spinal canal thoracic w/contrast matrl (72147) |
— |
$2,216 |
— |
| MRI spinal canal thoracic w/o & w/contr matrl (72157) |
— |
$2,472 |
— |
| MRI thoracic spine w/o contrast (72146) |
— |
$1,861 |
— |
| MRI tmj (70336) |
— |
$1,940 |
— |
| Myocardial Spect Multiple Studies (78452) |
— |
$3,189 |
— |
| Neck soft tissue (70360) |
— |
$121 |
— |
| Nm bone marrow multiple (78103) |
— |
$705 |
— |
| Nm bone marrow wb (78104) |
— |
$871 |
— |
| Nm gastric emptying study (78264) |
— |
$835 |
— |
| Nuclear medicine study to assess blood clot in vein of both sides (78458) |
— |
$413 |
— |
| Ob Us Follow-Up Per Fetus - Us Ob Follow Up Transabdominal Approach (76816) |
— |
$141 |
— |
| Osseous survey limited (77074) |
— |
$213 |
— |
| Parathyroid imaging (78070) |
— |
$671 |
— |
| Pelvis 1 or 2 views (72170) |
— |
$142 |
— |
| Pulmonary Perfusion Imaging Particulate (78580) |
— |
$390 |
— |
| Pulmonary Ventilation & Perfusion Imaging (78582) |
— |
$781 |
— |
| Radex abscess/fistula/sinus tract rs&i (76080) |
— |
$1,192 |
— |
| Radex Entir Thrc Lmbr Crv Sac Spi W/Skull 1 Vw - Xr Scoliosis 1 Vw (72081) |
— |
$343 |
— |
| Radex mastoids compl minimum 3 views pr side (70130) |
— |
$222 |
— |
| Radiolog exam mandible compl minimum 4 views (70110) |
— |
$165 |
— |
| Radiologic Exam Abdomen 1 View - Xr Abdomen 1 View (74018) |
— |
$217 |
— |
| Radiologic Exam Chest 2 Views - Xr Chest 2 Views (71046) |
— |
$207 |
— |
| Radiologic exam colon single contrast study (74270) |
— |
$303 |
— |
| Radiologic Exam Esophagus Double Contrast Study (74221) |
— |
$548 |
— |
| Radiologic exam upr gi trc double contrast study (74246) |
— |
$452 |
— |
| Radiologic exam upr gi trc single contrast study (74240) |
— |
$395 |
— |
| Radiologic Examination Femur Minimum 2 Views - Xr Femur 2+ Vw Lt (73552) |
— |
$171 |
— |
| Radiological examination surgical specimen (76098) |
— |
$2,149.88 |
— |
| Ribs bilateral 3 views (71110) |
— |
$237 |
— |
| Rp loclzj tum plnr whole body single day imaging (78802) |
— |
$1,567 |
— |
| Rp loclzj tum spect 1 area single day imaging (78803) |
— |
$1,700 |
— |
| Sacroiliac Joints < 3 Views (72200) |
— |
$159 |
— |
| Scanogram (77073) |
— |
$140 |
— |
| Scapula complete (73010) |
— |
$179 |
— |
| Small bowel series (74250) |
— |
$217 |
— |
| Spine thoracic 3 views (72072) |
— |
$91 |
— |
| Thoracolumbar 2 views (72080) |
— |
$180 |
— |
| Thyroid Imaging With Vascular Flow (78013) |
— |
$622 |
— |
| Tmj unilateral (70328) |
— |
$150 |
— |
| Tumor Imaging, Limited Area - Nm Tumor Localization Limited (78800) |
— |
$1,186 |
— |
| Ultrasound, abdomen limited (76705) |
— |
$413 |
— |
| Unlisted Ultrasound Procedure (76999) |
— |
$213 |
— |
| Ureteral Reflux Study Rp Voiding Cystogram (78740) |
— |
$563 |
— |
| Urethrocystography retrograde rs&i (74450) |
— |
$359 |
— |
| Urethrocystography voiding (74455) |
— |
$359 |
— |
| Urography (pyelography), intravenous, with or without KUB, with or without tomography (74400) |
— |
$717 |
— |
| Us abdl aorta screen aaa (76706) |
— |
$269 |
— |
| Us chest (76604) |
— |
$278 |
— |
| Us ob transvaginal (76817) |
— |
$332 |
— |
| Us pelvic non ob complete (76856) |
— |
$582 |
— |
| Us pelvic nonobstetric image dcmtn limited/f/u (76857) |
— |
$165 |
— |
| Us pregnancy ltd (76815) |
— |
$464 |
— |
| Us pregnant uterus 14 wk transabdl 1/1st gestat (76801) |
— |
$432 |
— |
| Us retroperitoneal complete (76770) |
— |
$543 |
— |
| Us retroperitoneal limited (76775) |
— |
$411 |
— |
| Us scrotum and contents (76870) |
— |
$343 |
— |
| Us soft tissue head/neck (76536) |
— |
$371 |
— |
| Us spinal canal and contents (76800) |
— |
$238 |
— |
| X-Ray Abdomen,Comp Acute Series - Xr Abdomen 2 Vws With Chest 1 View (74022) |
— |
$340 |
— |
| X-Ray Ac Jts - Xr Acromioclavicular Joints Bilateral (73050) |
— |
$108 |
— |
| X-Ray Ankle 3+ Vw - Xr Ankle 3+ Views Right (73610) |
— |
$192 |
— |
| X-Ray Colon Air Contrast - Fl Barium Enema Air Contrast (74280) |
— |
$498 |
— |
| X-Ray Elbow 3+ Vw - Xr Elbow 3+ Views Right (73080) |
— |
$205 |
— |
| X-ray exam hip uni 1 view (73501) |
— |
$130 |
— |
| X-Ray Exam Hip Uni 2-3 Views (73502) |
— |
$247 |
— |
| X-Ray Exam Hips Bi 3-4 Views (73522) |
— |
$172 |
— |
| X-ray eye for foreign body (70030) |
— |
$284 |
— |
| X-Ray Facial Bones 3+ Vw - Xr Facial Bones 3+ Views (70150) |
— |
$222 |
— |
| X-Ray Foot 3+ Vw - Xr Foot 3+ Views Right (73630) |
— |
$237 |
— |
| X-Ray Heel - Xr Calcaneus 2 Views Right (73650) |
— |
$205 |
— |
| X-Ray Jaw <4 Vw - Xr Mandible < 4 Views (70100) |
— |
$150 |
— |
| X-Ray Knee Bilat Standing - Xr Knees Anteroposterior Standing Bilat (73565) |
— |
$157 |
— |
| X-Ray Leg, Infant - Xr Lower Extremity 2+ Views Infant Left (73592) |
— |
$165 |
— |
| X-Ray Lumbar Spine 2/3 Vw - Xr Lumbar Spine 2-3 Views (72100) |
— |
$321 |
— |
| X-Ray Lumbar Spine 6+ Vw - Xr Lumbar Spine 6+ Vws Including Bending (72114) |
— |
$328 |
— |
| X-Ray Nasal Bones - Xr Nasal Bones (70160) |
— |
$174 |
— |
| X-Ray Nose-Rectum Child F.B. - Xr Nose to Rectum Foreign Body Peds (76010) |
— |
$157 |
— |
| X-Ray Orbits - Xr Orbits Complete 4+ Views (70200) |
— |
$142 |
— |
| X-Ray Retrograde Pyelogram - Fl Pyelogram Retrograde (74420) |
— |
$581 |
— |
| X-Ray Ribs 2 Vw Unilat - Xr Ribs 2 Views Right (71100) |
— |
$212 |
— |
| X-Ray Ribs, Chest 3+ Vw - Xr Ribs 2 Vws Lt W/ Chest Anteroposterior (71101) |
— |
$323 |
— |
| X-Ray Ribs, Chest 4+ Vw - Xr Ribs 3 Vws Bil W/ Chest Posteroanterior (71111) |
— |
$267 |
— |
| X-Ray Sacrum/Coccyx 2+ Vw - Xr Sacrum Coccyx 2+ Views (72220) |
— |
$155 |
— |
| X-Ray Shoulder 2+ Vw - Xr Shoulder 2+ Views Right (73030) |
— |
$162 |
— |
| X-Ray Sinuses 3+ Vw - Xr Paranasal Sinuses 3+ Views (70220) |
— |
$278 |
— |
| X-Ray Sinuses <3 Vw - Xr Paranasal Sinuses 1-2 Views (70210) |
— |
$195 |
— |
| X-Ray Skull 4+ Vw - Xr Skull Complete 4+ Views (70260) |
— |
$244 |
— |
| X-Ray Skull <4 Vw - Xr Skull 1-3 Views (70250) |
— |
$212 |
— |
| X-Ray Spine One View - Xr Spine (72020) |
— |
$141 |
— |
| X-Ray Sterno-Clavicluar Jt - Xr Sternoclavicular Joints 3+ Views (71130) |
— |
$108 |
— |
| X-Ray Sternum 2+ Vw - Xr Sternum 2+ Views (71120) |
— |
$243 |
— |
| X-Ray Thoracic Spine 2 Vw - Xr Thoracic Spine 2 Views (72070) |
— |
$228 |
— |
| X-Ray Toe(S) - Xr Toes 2+ Views Right (73660) |
— |
$239 |
— |
| X-Ray Wrist 3+ Vw - Xr Wrist 3+ Views Right (73110) |
— |
$229 |
— |
| Xr c-spine 6 or more views (72052) |
— |
$324 |
— |
| Xr finger(s) 2+ views (73140) |
— |
$171 |
— |
| Xr spine cervical 4 or 5 views (72050) |
— |
$266 |
— |
| Xr tibia/fibula 2 views (73590) |
— |
$193 |
— |
| Xr tmj bilateral (70330) |
— |
$157 |
— |