| Abdomen 2 views (74019) |
— |
$130.50 |
— |
| Ankle 2 views (73600) |
— |
$131.50 |
— |
| Arthrogram shoulder (73040) |
— |
$97 |
— |
| Bone age studies (77072) |
— |
$65 |
— |
| Bone survey complete (77075) |
— |
$112.59 |
— |
| Cervical spine 2 or 3 views (72040) |
— |
$114.50 |
— |
| Chest 1 view (71045) |
— |
$100 |
— |
| Chest 3 views (71047) |
— |
$100 |
— |
| Cine/Vid X-Ray Throat/Esoph - Fl Esoph Barium Swlw W/ Video & Speech (74230) |
— |
$108.30 |
— |
| Clavicle complete (73000) |
— |
$129.50 |
— |
| Computed Tomography Thorax Lw Dose Lng Ca Scr C- (71271) |
— |
$270.52 |
— |
| CT abdomen and pelvis without and with contrast (74178) |
— |
$512.80 |
— |
| CT abdomen and pelvis without contrast (74176) |
— |
$326.81 |
— |
| CT abdomen w contrast (74160) |
— |
$789.50 |
— |
| CT abdomen w wo contrast (74170) |
— |
$888.50 |
— |
| CT abdomen w/o contrast (74150) |
— |
$714.50 |
— |
| CT angiography upper extremity lt (73206) |
— |
$627.32 |
— |
| CT c-spine w/o contrast (72125) |
— |
$782 |
— |
| CT cervical spine with contrast (72126) |
— |
$223.64 |
— |
| CT chest w/wo contrast (71270) |
— |
$869.50 |
— |
| CT chest with contrast (71260) |
— |
$786.50 |
— |
| CT head/brain with contrast (70460) |
— |
$708 |
— |
| CT head/brain without and with contrast (70470) |
— |
$807.50 |
— |
| CT iac w contrast (70481) |
— |
$653.50 |
— |
| CT lower ext w/o (73700) |
— |
$807.50 |
— |
| CT lower extremity w wo contrast (73702) |
— |
$1,055 |
— |
| CT lower extremity with contrast (73701) |
— |
$961 |
— |
| CT lumbar spine w & w/o contrast (72133) |
— |
$678.50 |
— |
| CT lumbar spine w/o contrast (72131) |
— |
$782 |
— |
| CT lumbar spine with contrast (72132) |
— |
$704.50 |
— |
| CT maxillofacial w contrast (70487) |
— |
$720 |
— |
| CT maxillofacial w/o contrast (70486) |
— |
$600 |
— |
| CT maxillofacial w/wo contrast (70488) |
— |
$818 |
— |
| CT neck soft tissue w contrast (70491) |
— |
$797.50 |
— |
| CT orbit sella/post fossa/ear w/o & w/contr matr (70482) |
— |
$763.50 |
— |
| CT orbits w/o contrast (70480) |
— |
$510.50 |
— |
| CT pelvis w & w/o contrast (72194) |
— |
$458.76 |
— |
| CT pelvis w/o contrast (72192) |
— |
$705 |
— |
| CT scan for measuring calcium and other minerals in bone (77078) |
— |
$137.50 |
— |
| CT soft tissue neck w/o & w/contrast material (70492) |
— |
$892 |
— |
| CT soft tissue neck w/o contrast (70490) |
— |
$718 |
— |
| CT thoracic spine w/o contrast (72128) |
— |
$782 |
— |
| CT thoracic spine w/wo contrast (72130) |
— |
$307.52 |
— |
| CT thorax w/o contrast (71250) |
— |
$710 |
— |
| CT upper extremity w/o & w/contrast material (73202) |
— |
$1,004 |
— |
| CT upper extremity w/o contrast rt (73200) |
— |
$779 |
— |
| CT upper extremity with contrast (73201) |
— |
$892 |
— |
| Cta Abdl Aorta&Bi Iliofem W/Contrast&Postp (75635) |
— |
$525.20 |
— |
| Cta Abdomen (74175) |
— |
$525.20 |
— |
| CTA abdomen pelvis (74174) |
— |
$429.14 |
— |
| CTA chest (71275) |
— |
$525.20 |
— |
| Cta Head (70496) |
— |
$846.18 |
— |
| CTA lwr ext w&w/o contrast (73706) |
— |
$627.32 |
— |
| Cta Neck (70498) |
— |
$525.20 |
— |
| Cta Pelvis (72191) |
— |
$525.20 |
— |
| Cystography minimum 3 views rs&i (74430) |
— |
$233 |
— |
| Esophagus (74220) |
— |
$143 |
— |
| Fluoroscopy up to 1 hr (76000) |
— |
$111 |
— |
| Foot 2 views (73620) |
— |
$127.50 |
— |
| Forearm 2 views (73090) |
— |
$136.50 |
— |
| Full Mouth X-Ray Of Teeth - Xr Teeth Full Mouth (70320) |
— |
$20 |
— |
| Hand 2 views (73120) |
— |
$126 |
— |
| Hand 3 views (73130) |
— |
$145.50 |
— |
| Humerus Min 2 Views Left (73060) |
— |
$137.50 |
— |
| Knee 3 views (73562) |
— |
$182 |
— |
| Myelogram Cervical (72240) |
— |
$507 |
— |
| Myelogram Lumbar (72265) |
— |
$503 |
— |
| Myelogram thoracic (72255) |
— |
$506.50 |
— |
| Neck soft tissue (70360) |
— |
$111.50 |
— |
| Osseous survey infant (77076) |
— |
$122.36 |
— |
| Pelvis 1 or 2 views (72170) |
— |
$99.50 |
— |
| Radex Entir Thrc Lmbr Crv Sac Spi W/Skull 1 Vw - Xr Scoliosis 1 Vw (72081) |
— |
$43.92 |
— |
| Radex entir thrc lmbr crv sac spi w/skull 2/3 vw (72082) |
— |
$90.50 |
— |
| Radex hips bilateral with pelvis 2 views (73521) |
— |
$183 |
— |
| Radex mastoids compl minimum 3 views pr side (70130) |
— |
$123 |
— |
| Radiolog exam mandible compl minimum 4 views (70110) |
— |
$117 |
— |
| Radiologic Exam Abdomen 1 View - Xr Abdomen 1 View (74018) |
— |
$112.50 |
— |
| Radiologic Exam Abdomen 3+ Views - Xr Abdomen 3+ Views (74021) |
— |
$166.50 |
— |
| Radiologic Exam Chest 2 Views - Xr Chest 2 Views (71046) |
— |
$123 |
— |
| Radiologic exam colon single contrast study (74270) |
— |
$200.50 |
— |
| Radiologic exam upr gi trc double contrast study (74246) |
— |
$218.50 |
— |
| Radiologic exam upr gi trc single contrast study (74240) |
— |
$319.50 |
— |
| Radiologic Examination Femur Minimum 2 Views - Xr Femur 2+ Vw Lt (73552) |
— |
$144 |
— |
| Ribs bilateral 3 views (71110) |
— |
$151 |
— |
| Scapula complete (73010) |
— |
$186.50 |
— |
| Screening digital breast tomosynthesis (77063) |
— |
$63.62 |
— |
| Shuntogram indwelling nonvascular shunt rs&i (75809) |
— |
$93.82 |
— |
| Small bowel series (74250) |
— |
$143 |
— |
| Spine thoracic 3 views (72072) |
— |
$114.50 |
— |
| Tmj unilateral (70328) |
— |
$85 |
— |
| Ultrasound, abdomen limited (76705) |
— |
$347.50 |
— |
| Upper Extremity Infant (73092) |
— |
$235.58 |
— |
| Urethrocystography retrograde rs&i (74450) |
— |
$224.50 |
— |
| Urethrocystography voiding (74455) |
— |
$134 |
— |
| Us abdl aorta screen aaa (76706) |
— |
$125.28 |
— |
| Us breast unilateral complete (76641) |
— |
$176 |
— |
| Us breast unilateral limited (76642) |
— |
$176 |
— |
| Us chest (76604) |
— |
$253.50 |
— |
| Us compl joint r-t w/image documentation (76881) |
— |
$306 |
— |
| Us pelvic non ob complete (76856) |
— |
$313 |
— |
| Us pelvic nonobstetric image dcmtn limited/f/u (76857) |
— |
$297 |
— |
| Us retroperitoneal complete (76770) |
— |
$313 |
— |
| Us scrotum and contents (76870) |
— |
$310.50 |
— |
| Us soft tissue head/neck (76536) |
— |
$304.50 |
— |
| Us spinal canal and contents (76800) |
— |
$189.42 |
— |
| Us xtr non-vasc lmtd (76882) |
— |
$54 |
— |
| Wrist 2 views (73100) |
— |
$125.50 |
— |
| X-Ray Abdomen,Comp Acute Series - Xr Abdomen 2 Vws With Chest 1 View (74022) |
— |
$123.50 |
— |
| X-Ray Ac Jts - Xr Acromioclavicular Joints Bilateral (73050) |
— |
$98 |
— |
| X-Ray Ankle 3+ Vw - Xr Ankle 3+ Views Right (73610) |
— |
$143 |
— |
| X-Ray Colon Air Contrast - Fl Barium Enema Air Contrast (74280) |
— |
$269 |
— |
| X-Ray Elbow 2 Vw - Xr Elbow 1-2 Views Right (73070) |
— |
$135.50 |
— |
| X-Ray Elbow 3+ Vw - Xr Elbow 3+ Views Right (73080) |
— |
$143 |
— |
| X-ray exam hip uni 1 view (73501) |
— |
$147 |
— |
| X-Ray Exam Hip Uni 2-3 Views (73502) |
— |
$132.50 |
— |
| X-ray exam of femur 1 (73551) |
— |
$40.92 |
— |
| X-ray eye for foreign body (70030) |
— |
$80.30 |
— |
| X-Ray Facial Bones 3+ Vw - Xr Facial Bones 3+ Views (70150) |
— |
$117.50 |
— |
| X-Ray Facial Bones <3 Vw - Xr Facial Bones 1-2 Views (70140) |
— |
$43.50 |
— |
| X-Ray Foot 3+ Vw - Xr Foot 3+ Views Right (73630) |
— |
$144.50 |
— |
| X-Ray Heel - Xr Calcaneus 2 Views Right (73650) |
— |
$122.50 |
— |
| X-Ray Jaw <4 Vw - Xr Mandible < 4 Views (70100) |
— |
$70 |
— |
| X-Ray Knee 4+ View - Xr Knee 4+ Views Right (73564) |
— |
$184.50 |
— |
| X-Ray Leg, Infant - Xr Lower Extremity 2+ Views Infant Left (73592) |
— |
$235.58 |
— |
| X-Ray Lumbar Spine 2/3 Vw - Xr Lumbar Spine 2-3 Views (72100) |
— |
$124 |
— |
| X-Ray Lumbar Spine 6+ Vw - Xr Lumbar Spine 6+ Vws Including Bending (72114) |
— |
$176.50 |
— |
| X-Ray Nasal Bones - Xr Nasal Bones (70160) |
— |
$99.50 |
— |
| X-Ray Nose-Rectum Child F.B. - Xr Nose to Rectum Foreign Body Peds (76010) |
— |
$34.25 |
— |
| X-Ray Orbits - Xr Orbits Complete 4+ Views (70200) |
— |
$118.50 |
— |
| X-Ray Ribs 2 Vw Unilat - Xr Ribs 2 Views Right (71100) |
— |
$88.50 |
— |
| X-Ray Ribs, Chest 3+ Vw - Xr Ribs 2 Vws Lt W/ Chest Anteroposterior (71101) |
— |
$148 |
— |
| X-Ray Ribs, Chest 4+ Vw - Xr Ribs 3 Vws Bil W/ Chest Posteroanterior (71111) |
— |
$133 |
— |
| X-Ray Sacroiliac Jts 3+ Vw - Xr Sacroiliac Joints 3+ Views (72202) |
— |
$100.50 |
— |
| X-Ray Sacrum/Coccyx 2+ Vw - Xr Sacrum Coccyx 2+ Views (72220) |
— |
$99.50 |
— |
| X-Ray Shoulder 2+ Vw - Xr Shoulder 2+ Views Right (73030) |
— |
$151.50 |
— |
| X-Ray Sinuses 3+ Vw - Xr Paranasal Sinuses 3+ Views (70220) |
— |
$117 |
— |
| X-Ray Sinuses <3 Vw - Xr Paranasal Sinuses 1-2 Views (70210) |
— |
$17 |
— |
| X-Ray Skull 4+ Vw - Xr Skull Complete 4+ Views (70260) |
— |
$123 |
— |
| X-Ray Skull <4 Vw - Xr Skull 1-3 Views (70250) |
— |
$73.50 |
— |
| X-Ray Spine One View - Xr Spine (72020) |
— |
$97.50 |
— |
| X-Ray Sterno-Clavicluar Jt - Xr Sternoclavicular Joints 3+ Views (71130) |
— |
$102.50 |
— |
| X-Ray Sternum 2+ Vw - Xr Sternum 2+ Views (71120) |
— |
$101.50 |
— |
| X-Ray Thoracic Spine 2 Vw - Xr Thoracic Spine 2 Views (72070) |
— |
$97.50 |
— |
| X-Ray Toe(S) - Xr Toes 2+ Views Right (73660) |
— |
$85.50 |
— |
| X-Ray Wrist 3+ Vw - Xr Wrist 3+ Views Right (73110) |
— |
$144.50 |
— |
| Xr c-spine 6 or more views (72052) |
— |
$137 |
— |
| Xr chest 4+ views (71048) |
— |
$156.50 |
— |
| Xr finger(s) 2+ views (73140) |
— |
$85.50 |
— |
| XR Mastoids < 3 Views Bilateral (70120) |
— |
$175 |
— |
| Xr optic foramina (70190) |
— |
$147 |
— |
| Xr shoulder 1 view (73020) |
— |
$114.50 |
— |
| Xr spine cervical 4 or 5 views (72050) |
— |
$133 |
— |
| Xr tibia/fibula 2 views (73590) |
— |
$142.50 |
— |
| Xr tmj bilateral (70330) |
— |
$104.50 |
— |
| Xray knee 1 or 2 views rt (73560) |
— |
$144.50 |
— |