| Ankle 2 views (73600) |
— |
$163.90 |
— |
| Bone &/Joint Imaging Multiple Areas (78305) |
— |
$670.80 |
— |
| Bone &/joint imaging whole body (78306) |
— |
$1,894.10 |
— |
| Cervical spine 2 or 3 views (72040) |
— |
$98 |
— |
| Chest 1 view (71045) |
— |
$180 |
— |
| Clavicle complete (73000) |
— |
$164.50 |
— |
| CT abdomen and pelvis without contrast (74176) |
— |
$620.50 |
— |
| CT abdomen w contrast (74160) |
— |
$344.50 |
— |
| CT abdomen w wo contrast (74170) |
— |
$464.40 |
— |
| CT abdomen w/o contrast (74150) |
— |
$344.50 |
— |
| CT c-spine w/o contrast (72125) |
— |
$344.50 |
— |
| CT cervical spine w&w/o contrast (72127) |
— |
$673.50 |
— |
| CT cervical spine with contrast (72126) |
— |
$531.50 |
— |
| CT chest w/wo contrast (71270) |
— |
$451.75 |
— |
| CT chest with contrast (71260) |
— |
$344.50 |
— |
| CT head/brain with contrast (70460) |
— |
$668 |
— |
| CT head/brain without and with contrast (70470) |
— |
$442 |
— |
| CT iac w contrast (70481) |
— |
$531.70 |
— |
| CT lower ext w/o (73700) |
— |
$344.50 |
— |
| CT lower extremity w wo contrast (73702) |
— |
$673.40 |
— |
| CT lower extremity with contrast (73701) |
— |
$531.70 |
— |
| CT lumbar spine w & w/o contrast (72133) |
— |
$673.40 |
— |
| CT lumbar spine w/o contrast (72131) |
— |
$344.50 |
— |
| CT lumbar spine with contrast (72132) |
— |
$531.70 |
— |
| CT maxillofacial w contrast (70487) |
— |
$530.40 |
— |
| CT maxillofacial w/o contrast (70486) |
— |
$533 |
— |
| CT maxillofacial w/wo contrast (70488) |
— |
$904.15 |
— |
| CT neck soft tissue w contrast (70491) |
— |
$344.50 |
— |
| CT orbit sella/post fossa/ear w/o & w/contr matr (70482) |
— |
$679.90 |
— |
| CT orbits w/o contrast (70480) |
— |
$530 |
— |
| CT pelvis w & w/o contrast (72194) |
— |
$451.75 |
— |
| CT pelvis w/o contrast (72192) |
— |
$344.50 |
— |
| CT soft tissue neck w/o & w/contrast material (70492) |
— |
$673.40 |
— |
| CT soft tissue neck w/o contrast (70490) |
— |
$344.50 |
— |
| CT thoracic spine w/contrast (72129) |
— |
$531.70 |
— |
| CT thoracic spine w/o contrast (72128) |
— |
$344.50 |
— |
| CT thoracic spine w/wo contrast (72130) |
— |
$673.40 |
— |
| CT thorax w/o contrast (71250) |
— |
$344.50 |
— |
| CT upper extremity w/o & w/contrast material (73202) |
— |
$673.40 |
— |
| CT upper extremity w/o contrast rt (73200) |
— |
$344.50 |
— |
| CT upper extremity with contrast (73201) |
— |
$531.70 |
— |
| Cta Abdomen (74175) |
— |
$650 |
— |
| Doppler Echo Fetal Spectral Display Complete (76827) |
— |
$269.75 |
— |
| Echo exam of fetal heart (76825) |
— |
$422.50 |
— |
| Echo fetal cardiovasc w/wo m-mode repeat std (76826) |
— |
$125 |
— |
| Esophagus (74220) |
— |
$239.75 |
— |
| Fluoroscopy up to 1 hr (76000) |
— |
$256.10 |
— |
| Foot 2 views (73620) |
— |
$164 |
— |
| Forearm 2 views (73090) |
— |
$163.90 |
— |
| Hand 2 views (73120) |
— |
$163.80 |
— |
| Hand 3 views (73130) |
— |
$163.50 |
— |
| Humerus Min 2 Views Left (73060) |
— |
$164 |
— |
| Knee 3 views (73562) |
— |
$164 |
— |
| Neck soft tissue (70360) |
— |
$40 |
— |
| Ob Us Follow-Up Per Fetus - Us Ob Follow Up Transabdominal Approach (76816) |
— |
$263.25 |
— |
| Pelvis 1 or 2 views (72170) |
— |
$117 |
— |
| Radex hips bilateral with pelvis 2 views (73521) |
— |
$372 |
— |
| Radex mastoids compl minimum 3 views pr side (70130) |
— |
$79 |
— |
| Radiolog exam mandible compl minimum 4 views (70110) |
— |
$186 |
— |
| Radiologic Exam Abdomen 1 View - Xr Abdomen 1 View (74018) |
— |
$164 |
— |
| Radiologic Exam Abdomen 3+ Views - Xr Abdomen 3+ Views (74021) |
— |
$218 |
— |
| Radiologic Exam Chest 2 Views - Xr Chest 2 Views (71046) |
— |
$196 |
— |
| Radiologic exam colon single contrast study (74270) |
— |
$261 |
— |
| Radiologic exam upr gi trc single contrast study (74240) |
— |
$100 |
— |
| Radiologic Examination Femur Minimum 2 Views - Xr Femur 2+ Vw Lt (73552) |
— |
$163.90 |
— |
| Scapula complete (73010) |
— |
$164 |
— |
| Sella turcica (70240) |
— |
$163.80 |
— |
| Small bowel series (74250) |
— |
$178.50 |
— |
| Thoracolumbar 2 views (72080) |
— |
$40 |
— |
| Ultrasound, abdomen limited (76705) |
— |
$292.50 |
— |
| Urography (pyelography), intravenous, with or without KUB, with or without tomography (74400) |
— |
$502 |
— |
| Us compl joint r-t w/image documentation (76881) |
— |
$193.50 |
— |
| Us pelvic non ob complete (76856) |
— |
$299 |
— |
| Us pregnancy ltd (76815) |
— |
$212 |
— |
| Us retroperitoneal complete (76770) |
— |
$345 |
— |
| Us retroperitoneal limited (76775) |
— |
$125 |
— |
| Us scrotum and contents (76870) |
— |
$176.50 |
— |
| Us soft tissue head/neck (76536) |
— |
$197.50 |
— |
| Vascular flow imaging (78445) |
— |
$329.40 |
— |
| Wrist 2 views (73100) |
— |
$163.80 |
— |
| X-Ray Ankle 3+ Vw - Xr Ankle 3+ Views Right (73610) |
— |
$164 |
— |
| X-Ray Colon Air Contrast - Fl Barium Enema Air Contrast (74280) |
— |
$290.55 |
— |
| X-Ray Elbow 2 Vw - Xr Elbow 1-2 Views Right (73070) |
— |
$26 |
— |
| X-Ray Elbow 3+ Vw - Xr Elbow 3+ Views Right (73080) |
— |
$164 |
— |
| X-ray exam hip uni 1 view (73501) |
— |
$186 |
— |
| X-Ray Exam Hip Uni 2-3 Views (73502) |
— |
$186 |
— |
| X-Ray Facial Bones 3+ Vw - Xr Facial Bones 3+ Views (70150) |
— |
$153.50 |
— |
| X-Ray Facial Bones <3 Vw - Xr Facial Bones 1-2 Views (70140) |
— |
$499.30 |
— |
| X-Ray Foot 3+ Vw - Xr Foot 3+ Views Right (73630) |
— |
$164 |
— |
| X-Ray Heel - Xr Calcaneus 2 Views Right (73650) |
— |
$164 |
— |
| X-ray IV pyelogram+drip infusn (74410) |
— |
$127 |
— |
| X-Ray Lumbar Spine 2/3 Vw - Xr Lumbar Spine 2-3 Views (72100) |
— |
$129 |
— |
| X-Ray Nasal Bones - Xr Nasal Bones (70160) |
— |
$113 |
— |
| X-Ray Orbits - Xr Orbits Complete 4+ Views (70200) |
— |
$142 |
— |
| X-Ray Renal Cyst Xlumbar+Contrst - Xr Renal Cyst Lumbar W Contrast (74470) |
— |
$469.15 |
— |
| X-Ray Ribs 2 Vw Unilat - Xr Ribs 2 Views Right (71100) |
— |
$186 |
— |
| X-Ray Ribs, Chest 4+ Vw - Xr Ribs 3 Vws Bil W/ Chest Posteroanterior (71111) |
— |
$66 |
— |
| X-Ray Sacrum/Coccyx 2+ Vw - Xr Sacrum Coccyx 2+ Views (72220) |
— |
$102 |
— |
| X-Ray Shoulder 2+ Vw - Xr Shoulder 2+ Views Right (73030) |
— |
$186 |
— |
| X-Ray Sinuses 3+ Vw - Xr Paranasal Sinuses 3+ Views (70220) |
— |
$153.50 |
— |
| X-Ray Skull 4+ Vw - Xr Skull Complete 4+ Views (70260) |
— |
$66 |
— |
| X-Ray Skull <4 Vw - Xr Skull 1-3 Views (70250) |
— |
$186 |
— |
| X-Ray Sternum 2+ Vw - Xr Sternum 2+ Views (71120) |
— |
$102 |
— |
| X-Ray Thoracic Spine 2 Vw - Xr Thoracic Spine 2 Views (72070) |
— |
$153.50 |
— |
| X-Ray Wrist 3+ Vw - Xr Wrist 3+ Views Right (73110) |
— |
$164 |
— |
| Xr chest 4+ views (71048) |
— |
$164 |
— |
| Xr Cholecystography Oral Contrast (74290) |
— |
$59 |
— |
| Xr finger(s) 2+ views (73140) |
— |
$164 |
— |
| Xr internal auditory meati complete (70134) |
— |
$191.95 |
— |
| Xr spine cervical 4 or 5 views (72050) |
— |
$202.50 |
— |
| Xr tibia/fibula 2 views (73590) |
— |
$164 |
— |
| Xr tmj bilateral (70330) |
— |
$66 |
— |
| Xray knee 1 or 2 views rt (73560) |
— |
$138 |
— |