| Acute gi blood loss imaging (78278) |
— |
$827 |
— |
| Ankle 2 views (73600) |
— |
$105 |
— |
| Barium enema (74270) |
— |
$233 |
— |
| Bone age studies (77072) |
— |
$105 |
— |
| Bone marrow imaging whole body (78104) |
— |
$803.50 |
— |
| Bowel imaging (78290) |
— |
$827 |
— |
| Brain image w/flow 4 + views (78606) |
— |
$721 |
— |
| Cardiac blood pool imaging (planar), first pass technique; single study, at rest or with stress (exercise and/or… (78481) |
— |
$650 |
— |
| Cardiac MRI w/wo contrast & further seq (75561) |
— |
$4,725 |
— |
| Cholecystography, oral contrast Other Diagnostic Radiology FS (74290) |
— |
$163 |
— |
| Cine/Vid X-Ray Throat/Esoph - Fl Esoph Barium Swlw W/ Video & Speech (74230) |
— |
$253 |
— |
| Clavicle complete (73000) |
— |
$112 |
— |
| Computed tomography, bone mineral density study, 1 or more sites, axial skeleton (eg, hips, pelvis, spine) Age Under 21 (77078) |
— |
$2,100 |
— |
| Computed tomography, orbit, sella, or posterior fossa or outer, middle, or inner ear; with contrast material(s) Age… (70481) |
— |
$929.50 |
— |
| Corpora cavernosography (74445) |
— |
$326 |
— |
| CT - st neck w&wo contr (70492) |
— |
$922.50 |
— |
| CT abdomen and pelvis without and with contrast (74178) |
— |
$2,205 |
— |
| CT abdomen and pelvis without contrast (74176) |
— |
$1,470 |
— |
| CT abdomen w wo contrast (74170) |
— |
$918 |
— |
| CT abdomen w/contrast (74160) |
— |
$849.50 |
— |
| CT abdomen w/o contrast (74150) |
— |
$883 |
— |
| CT angio abd&plvis cntrst mtrl w/wo cntrst imges (74174) |
— |
$1,622 |
— |
| CT angio abdom w/o & w/dye (74175) |
— |
$1,441 |
— |
| CT angio abdominal arteries (75635) |
— |
$1,554 |
— |
| CT angio hrt w/3d image (75574) |
— |
$1,155 |
— |
| CT cervical spine w/contrast (72126) |
— |
$1,108 |
— |
| CT cervical spine w/o contrast (72125) |
— |
$1,108 |
— |
| CT chest w/contrast (71260) |
— |
$978 |
— |
| CT extremity upper w & w/o contrast (73202) |
— |
$837 |
— |
| CT head/brain with contrast (70460) |
— |
$978 |
— |
| CT head/brain without and with contrast (70470) |
— |
$1,068 |
— |
| CT heart contrast eval cardiac structure&morph (75572) |
— |
$2,625 |
— |
| CT heart w/o contrast quant eval coronary calcium (75571) |
— |
$168 |
— |
| CT hrt w/3d image congen (75573) |
— |
$2,625 |
— |
| CT limited/localized follow up study (76380) |
— |
$883 |
— |
| CT lower ext w/wo contrast (73702) |
— |
$1,062 |
— |
| CT lower extremity w contrast (73701) |
— |
$928 |
— |
| CT lower extremity w/o contrast unilateral (73700) |
— |
$883 |
— |
| CT lumbar spine w/contrast (72132) |
— |
$1,108 |
— |
| CT lumbar spine w/o contrast (72131) |
— |
$860 |
— |
| CT lumbar spine w/o then w/ con (72133) |
— |
$1,103 |
— |
| CT maxillofacial area w/o contrast (70486) |
— |
$871.50 |
— |
| CT maxillofacial w/contrast (70487) |
— |
$909 |
— |
| CT maxillofacial w/o then w/ con (70488) |
— |
$906 |
— |
| CT orbit sella ear w/o con (70480) |
— |
$872 |
— |
| CT orbit/ear/fossa w/o then w/ con (70482) |
— |
$858 |
— |
| CT pelvis w & w/o contrast (72194) |
— |
$1,047 |
— |
| CT pelvis w/o contrast (72192) |
— |
$883 |
— |
| CT soft tissue neck w/contrast (70491) |
— |
$931 |
— |
| CT soft tissue neck w/o contrast (70490) |
— |
$673 |
— |
| CT spine cervical w/wo contrast (72127) |
— |
$1,077 |
— |
| CT thoracic spine w/contrast (72129) |
— |
$898 |
— |
| CT thoracic spine w/o contrast (72128) |
— |
$1,260 |
— |
| CT thoracic spine w/o then w/ con (72130) |
— |
$1,077 |
— |
| CT thorax lung cancer scr c- (71271) |
— |
$472.50 |
— |
| CT thorax w/o contrast (71250) |
— |
$883 |
— |
| CT thorax w/o then w/ contrast (71270) |
— |
$1,047 |
— |
| CT upper extremity w/dye (73201) |
— |
$900 |
— |
| CT upper extremity w/o contrast rt (73200) |
— |
$883 |
— |
| CTA chest w/wo contrast (71275) |
— |
$1,391 |
— |
| CTA head w contrast (70496) |
— |
$1,932 |
— |
| CTA head&neck c+ w/noncontrast img&post-pxessing (70471) |
— |
$1,068 |
— |
| CTA lower extremity w/wo contrast unilateral (73706) |
— |
$1,449 |
— |
| Cta Neck (70498) |
— |
$1,928 |
— |
| CTA upper extremity w/wo contrast unilateral (73206) |
— |
$1,449 |
— |
| Diskography lumbar (72295) |
— |
$2,100 |
— |
| Echo exam of eye (76516) |
— |
$413 |
— |
| Esophogram (74220) |
— |
$219 |
— |
| Fetal biophysical profile non-stress testing (76818) |
— |
$227 |
— |
| Fluoroscopy up to 1 hour physician/qhp time (76000) |
— |
$349 |
— |
| Gastric emptying study (78264) |
— |
$532 |
— |
| Gated heart planar single (78472) |
— |
$573 |
— |
| Heart infarct image (78466) |
— |
$768 |
— |
| Hepatobil syst image w/drug (78227) |
— |
$2,495 |
— |
| Hepatobiliary system imaging (78226) |
— |
$768 |
— |
| Humerus min 2 views (73060) |
— |
$116 |
— |
| Hysterosalpingography (74740) |
— |
$585 |
— |
| Ivp (74400) |
— |
$246 |
— |
| Ivp w tomography (74415) |
— |
$325 |
— |
| Kidney imaging morphology; with vascular flow and function, single study without pharmacological intervention Age Under… (78707) |
— |
$1,050 |
— |
| Liver imaging w/vascular flow (78202) |
— |
$354 |
— |
| Lung perf&ventilat diferentl (78598) |
— |
$1,365 |
— |
| Lung perfusion differential (78597) |
— |
$931.50 |
— |
| Lung ventilat&perfus imaging (78582) |
— |
$997.50 |
— |
| Lung ventilation imaging (78579) |
— |
$1,024 |
— |
| Magnetic resonance (eg, proton) imaging, any joint of lower extremity; without contrast material(s), followed by… (73723) |
— |
$3,150 |
— |
| Magnetic resonance (eg, proton) imaging, lower extremity other than joint; without contrast material(s), followed by… (73720) |
— |
$3,150 |
— |
| Mammary ductogram multiple ducts (77054) |
— |
$315 |
— |
| Mammary ductogram single (77053) |
— |
$263 |
— |
| MRA head w & w/o contrast (70546) |
— |
$3,150 |
— |
| MRA head w/contrast (70545) |
— |
$3,150 |
— |
| MRA head w/o contrast (70544) |
— |
$3,150 |
— |
| MRA neck w/contrast (70548) |
— |
$3,150 |
— |
| MRA neck w/o contrast (70547) |
— |
$3,150 |
— |
| MRA neck w/wo contrast (70549) |
— |
$3,150 |
— |
| MRI abdomen w/contrast (74182) |
— |
$3,150 |
— |
| MRI abdomen w/o & w/contrast material (74183) |
— |
$3,150 |
— |
| MRI abdomen w/o contrast (74181) |
— |
$3,150 |
— |
| MRI any jnt lwr ext with con lt (73722) |
— |
$3,150 |
— |
| MRI cardiac w/o contrast (75557) |
— |
$3,150 |
— |
| MRI cervical spine w/o contrast (72141) |
— |
$3,150 |
— |
| MRI cervical spine with contrast (72142) |
— |
$3,150 |
— |
| MRI chest w & w/o contrast (71552) |
— |
$3,150 |
— |
| MRI chest w/contrast (71551) |
— |
$3,150 |
— |
| MRI chest w/o contrast (71550) |
— |
$3,150 |
— |
| MRI joint upper ext w/contrast (73222) |
— |
$3,150 |
— |
| MRI joint upr extr w/o&w/dye (73223) |
— |
$3,150 |
— |
| MRI joint upr extrem w/o dye (73221) |
— |
$3,150 |
— |
| Mri Lower Extremity W/O Dye (73718) |
— |
$3,150 |
— |
| MRI lumbar spine with contrast (72149) |
— |
$3,150 |
— |
| MRI lumbar w/wo contrast (72158) |
— |
$3,150 |
— |
| MRI orbit/face/neck w/o & w/contrast (70543) |
— |
$3,150 |
— |
| MRI orbit/face/neck w/o contrast (70540) |
— |
$3,150 |
— |
| MRI pelvis w/ contrast (72196) |
— |
$3,150 |
— |
| MRI pelvis w/o contrast (72195) |
— |
$3,150 |
— |
| MRI pelvis w/wo contrast (72197) |
— |
$3,150 |
— |
| MRI spine cervical wo/w contrast (72156) |
— |
$3,150 |
— |
| MRI spine thoracic w/contrast (72147) |
— |
$3,150 |
— |
| MRI thoracic spine w wo contrast (72157) |
— |
$3,150 |
— |
| MRI thoracic spine w/o contrast (72146) |
— |
$3,150 |
— |
| MRI tmj (70336) |
— |
$3,150 |
— |
| MRI upper extremity oth than jt w/o contr matrl (73218) |
— |
$3,150 |
— |
| MRI upr ext w/o jnts w/o-w/con rt (73220) |
— |
$3,150 |
— |
| Myelography 2 or more regions (72270) |
— |
$182 |
— |
| Myocardial imaging, positron emission tomography (PET), perfusion study (including ventricular wall motionºs» and/or… (78492) |
— |
$2,100 |
— |
| Myocardial perfusion planar 1 study rest/stress (78453) |
— |
$768 |
— |
| Nm bone 3 phase (78315) |
— |
$975 |
— |
| Nm bone multi (78305) |
— |
$413 |
— |
| Nm heart perfusion spect stress rest (78452) |
— |
$1,536 |
— |
| Nm liver image static only (78201) |
— |
$450 |
— |
| Nm lymph system (78195) |
— |
$577 |
— |
| Nuclear medicine study of brain, less than 4 static views (78600) |
— |
$295 |
— |
| Oral radiopharm rx (79005) |
— |
$1,063 |
— |
| Parathyroid imaging (78070) |
— |
$525 |
— |
| Pulmonary perfusion imaging particulate (78580) |
— |
$1,024 |
— |
| Radex abscess/fistula/sinus tract rs&i (76080) |
— |
$312 |
— |
| Radex entir thrc lmbr crv sac spi w/skull 2/3 vw (72082) |
— |
$315 |
— |
| Radex hip unilateral with pelvis 1 view (73501) |
— |
$208 |
— |
| Radex hip unilateral with pelvis 2-3 views (73502) |
— |
$116 |
— |
| Radex hips bilateral with pelvis 2 views (73521) |
— |
$173.50 |
— |
| Radex spine cervical 2 or 3 views (72040) |
— |
$123 |
— |
| Radex spine cervical 4 or 5 views (72050) |
— |
$135 |
— |
| Radex spine cervical 6 or more views (72052) |
— |
$213 |
— |
| Radiologic Exam Chest 4+ Views - Xr Chest 4+ Views (71048) |
— |
$210 |
— |
| Radiologic exam upr gi trc double contrast study (74246) |
— |
$325 |
— |
| Radiologic Examination Femur Minimum 2 Views - Xr Femur 2+ Vw Lt (73552) |
— |
$111 |
— |
| Radiologic examination, complete acute abdomen series, including 2 or more views of the abdomen (eg, supine, erect,… (74022) |
— |
$176 |
— |
| Radiologic examination, mastoids; less than 3 views per side Other Diagnostic Radiology FS (70120) |
— |
$198 |
— |
| Red cell volume determination (separate procedure); single sampling Age Under 21 (78120) |
— |
$851 |
— |
| Rp loclzj tum plnr 1 area single day imaging (78800) |
— |
$1,260 |
— |
| Rp loclzj tum plnr 2+area 1+d img/1 area img>2+d (78801) |
— |
$2,100 |
— |
| Rp loclzj tum spect 1 area single day imaging (78803) |
— |
$541 |
— |
| Rp loclzj tum spect CT 2area/sep acquisj img (78832) |
— |
$2,212 |
— |
| Screening digital breast tomosynthesis; bilateral (77063) |
— |
$210 |
— |
| Small bowel series (74250) |
— |
$233 |
— |
| Spleen imaging only (78185) |
— |
$532 |
— |
| Testicular imaging w/flow (78761) |
— |
$1,181 |
— |
| Thyroid uptake single/multiple quant measurement (78012) |
— |
$551 |
— |
| Ultrasound breast limited (76642) |
— |
$210 |
— |
| Ultrasound, abdomen limited (76705) |
— |
$343 |
— |
| Unlisted endocrine procedure, diagnostic nuclear medicine UNSCHEDULED (78099) |
— |
$1,575 |
— |
| Unlisted genitourinary procedure, diagnostic nuclear medicine UNSCHEDULED (78799) |
— |
$827 |
— |
| Unlisted musculoskeletal procedure, diagnostic nuclear medicine UNSCHEDULED (78399) |
— |
$774.50 |
— |
| Urethrocystography retrograde rs&i (74450) |
— |
$325 |
— |
| Urethrocystography voiding (74455) |
— |
$325 |
— |
| Urography antegrade (74425) |
— |
$315 |
— |
| Urography retrograde w/wo kub (74420) |
— |
$233.50 |
— |
| Urography, infusion, drip technique and/or bolus technique; Other Diagnostic Radiology FS (74410) |
— |
$273 |
— |
| Us breast uni real time with image complete (76641) |
— |
$339 |
— |
| Us chest (76604) |
— |
$223.50 |
— |
| Us compl joint r-t w/image documentation (76881) |
— |
$282 |
— |
| Us lmtd jt/fcl eval nonvasc xtr strux r-t w/img (76882) |
— |
$241.50 |
— |
| Us ob limited 1 or more fetuses (76815) |
— |
$298 |
— |
| Us obstetric transvaginal (76817) |
— |
$525 |
— |
| Us pelvic limited or f/u non-ob (76857) |
— |
$272.50 |
— |
| Us pelvis complete (76856) |
— |
$525 |
— |
| Us retroperitoneal complete (76770) |
— |
$1,234 |
— |
| Us retroperitoneal limited (76775) |
— |
$273 |
— |
| Us scrotum (76870) |
— |
$272.50 |
— |
| Us soft tissue head/neck (76536) |
— |
$339 |
— |
| Us spinal canal (76800) |
— |
$256 |
— |
| Us transrectal (76872) |
— |
$385 |
— |
| Vascular flow imaging (78445) |
— |
$726.50 |
— |
| X-Ray Ac Jts - Xr Acromioclavicular Joints Bilateral (73050) |
— |
$128 |
— |
| X-Ray Ankle 3+ Vw - Xr Ankle 3+ Views Right (73610) |
— |
$116 |
— |
| X-ray aorta leg arteries (75630) |
— |
$2,100 |
— |
| X-Ray Colon Air Contrast - Fl Barium Enema Air Contrast (74280) |
— |
$325 |
— |
| X-Ray Elbow 3+ Vw - Xr Elbow 3+ Views Right (73080) |
— |
$116 |
— |
| X-ray exam of finger(s) (73140) |
— |
$105 |
— |
| X-Ray Foot 2 Vw - Xr Foot 1-2 Views Right (73620) |
— |
$105 |
— |
| X-Ray Foot 3+ Vw - Xr Foot 3+ Views Right (73630) |
— |
$116 |
— |
| X-Ray Hand 2 Vw - Xr Hand 1-2 Views Right (73120) |
— |
$105 |
— |
| X-Ray Hand 3+ Vw - Xr Hand 3+ Views Right (73130) |
— |
$116 |
— |
| X-Ray Knee 4+ View - Xr Knee 4+ Views Right (73564) |
— |
$127 |
— |
| X-Ray Lumbar Spine 2/3 Vw - Xr Lumbar Spine 2-3 Views (72100) |
— |
$116.50 |
— |
| X-Ray Mastoids 3+ Vw - Xr Mastoids 3+ Views (70130) |
— |
$216 |
— |
| X-Ray Ribs 2 Vw Unilat - Xr Ribs 2 Views Right (71100) |
— |
$111 |
— |
| X-Ray Sacroiliac Jts <3 Vw - Xr Sacroiliac Joints 1-2 Views (72200) |
— |
$149 |
— |
| X-Ray Sacrum/Coccyx 2+ Vw - Xr Sacrum Coccyx 2+ Views (72220) |
— |
$1,631 |
— |
| X-Ray Shoulder 2+ Vw - Xr Shoulder 2+ Views Right (73030) |
— |
$126 |
— |
| X-Ray Sinuses 3+ Vw - Xr Paranasal Sinuses 3+ Views (70220) |
— |
$176 |
— |
| X-Ray Skull 4+ Vw - Xr Skull Complete 4+ Views (70260) |
— |
$142 |
— |
| X-Ray Skull <4 Vw - Xr Skull 1-3 Views (70250) |
— |
$299 |
— |
| X-Ray Sterno-Clavicluar Jt - Xr Sternoclavicular Joints 3+ Views (71130) |
— |
$135 |
— |
| X-Ray Toe(S) - Xr Toes 2+ Views Right (73660) |
— |
$105 |
— |
| X-Ray Wrist 2 Vw - Xr Wrist 1-2 Views Right (73100) |
— |
$105 |
— |
| X-Ray Wrist 3+ Vw - Xr Wrist 3+ Views Right (73110) |
— |
$116 |
— |
| Xr abdomen 1 view (74018) |
— |
$171.50 |
— |
| Xr abdomen 2 views (74019) |
— |
$137 |
— |
| Xr bone density appendicular (77081) |
— |
$2,100 |
— |
| Xr bone density axial (77080) |
— |
$2,100 |
— |
| Xr bone survey infant (77076) |
— |
$144 |
— |
| Xr bone survey limited (77074) |
— |
$325 |
— |
| Xr chest 1 view (71045) |
— |
$113 |
— |
| Xr chest 2 views (71046) |
— |
$137 |
— |
| Xr chest 3 views (71047) |
— |
$184 |
— |
| Xr cystogram 3+ views (74430) |
— |
$541 |
— |
| Xr eye foreign body (70030) |
— |
$219 |
— |
| Xr facial bones 3 views (70150) |
— |
$176 |
— |
| Xr mandible 4 views (70110) |
— |
$176 |
— |
| Xr nasal bones (70160) |
— |
$112 |
— |
| Xr pelvis 3 views (72190) |
— |
$210 |
— |
| Xr sella turcica (70240) |
— |
$112 |
— |
| Xr spine 1 view (72020) |
— |
$109 |
— |
| Xr sternum 2 views (71120) |
— |
$112 |
— |
| Xr surgical specimen (76098) |
— |
$467 |
— |
| Xray elbow 2 views (73070) |
— |
$105 |
— |
| Xray forearm 2 views (73090) |
— |
$105 |
— |
| Xray internal auditory meati compl (70134) |
— |
$177 |
— |
| Xray knee 1 or 2 views rt (73560) |
— |
$118 |
— |
| Xray neck soft tissue (70360) |
— |
$92 |
— |
| Xray optic foramina (70190) |
— |
$112 |
— |
| Xray orbits complete min 4 views (70200) |
— |
$149 |
— |
| Xray pelvis 1 or 2 views (72170) |
— |
$124.50 |
— |
| Xray ribs bilateral 3 views (71110) |
— |
$219 |
— |
| Xray scapula complete (73010) |
— |
$111.50 |
— |
| Xray shoulder 1 view (73020) |
— |
$105 |
— |
| Xray spine thoracic 2 views (72070) |
— |
$110 |
— |
| Xray spine thoracic 3 views (72072) |
— |
$123 |
— |
| Xray tibia-fibula 2 views bil (73590) |
— |
$111 |
— |
| Xray tmj open - closed unilat (70328) |
— |
$83 |
— |
| Xray tmj's bilateral open-clsc (70330) |
— |
$673 |
— |