| Abdomen 1 View (74018) |
— |
$501 |
— |
| Abdomen 2 views (74019) |
— |
$274 |
— |
| Acute Gastrointestinal Blood Loss Imaging (78278) |
— |
$1,242 |
— |
| Angio internal mammary (75756) |
— |
$4,659 |
— |
| Angiography extremity bilateral rs&i (75716) |
— |
$8,556 |
— |
| Angiography extremity unilateral rs&i (75710) |
— |
$7,624 |
— |
| Ankle 2 views (73600) |
— |
$431 |
— |
| Arthrogram hip (73525) |
— |
$1,314 |
— |
| Bone age studies (77072) |
— |
$347 |
— |
| Bone Imaging 3 Phase (78315) |
— |
$1,707 |
— |
| Bone Imaging Limited Area (78300) |
— |
$1,059 |
— |
| Bone Imaging Whole Body (78306) |
— |
$1,204 |
— |
| Cardiac MRI w/w/o contrast w/stress (75563) |
— |
$4,170 |
— |
| Cat Scan Follow-Up Study (76380) |
— |
$443 |
— |
| Cerebrospinal Fluid Flow W/O Matl Shunt Evaltj (78645) |
— |
$1,378 |
— |
| Chest 1 view (71045) |
— |
$546 |
— |
| Chest 2 views (71046) |
— |
$638 |
— |
| Chest 4 or more views (71048) |
— |
$347 |
— |
| Clavicle complete (73000) |
— |
$226 |
— |
| Computed Tomography Thorax Lw Dose Lng Ca Scr C- (71271) |
— |
$281 |
— |
| Contrast X-Ray Bladder (74430) |
— |
$1,013 |
— |
| CT abdomen and pelvis without and with contrast (74178) |
— |
$7,397 |
— |
| CT abdomen and pelvis without contrast (74176) |
— |
$7,635 |
— |
| CT abdomen w contrast (74160) |
— |
$4,026 |
— |
| CT abdomen w wo contrast (74170) |
— |
$4,403 |
— |
| CT abdomen w/o contrast (74150) |
— |
$3,907 |
— |
| CT Angio Abdomen and Pelvis (74174) |
— |
$6,175 |
— |
| CT Angio Chest (71275) |
— |
$4,347 |
— |
| CT Angio Head (70496) |
— |
$4,685 |
— |
| CT angio hrt w/3d image (75574) |
— |
$1,979 |
— |
| Ct Angio Lwr Extr W/O&W/Dye (73706) |
— |
$2,392 |
— |
| CT Angio Neck (70498) |
— |
$4,967 |
— |
| Ct Angio Upr Extrm W/O&W/Dye (73206) |
— |
$2,177 |
— |
| CT cervical spine w/ contrast (72126) |
— |
$2,177 |
— |
| CT cervical spine w/o contrast (72125) |
— |
$4,524 |
— |
| CT cervical spine w/wo cont (72127) |
— |
$4,377 |
— |
| CT chest w contrast (71260) |
— |
$4,110 |
— |
| CT chest w/wo contrast (71270) |
— |
$4,351 |
— |
| CT head/brain with contrast (70460) |
— |
$2,177 |
— |
| CT head/brain without and with contrast (70470) |
— |
$3,727 |
— |
| CT heart contrast eval cardiac structure&morph (75572) |
— |
$2,005 |
— |
| CT heart no contrast quant eval coronry calcium (75571) |
— |
$242 |
— |
| CT hrt w/3d image congen (75573) |
— |
$2,461 |
— |
| CT iac w contrast (70481) |
— |
$2,177 |
— |
| CT l-spine w&w/o contrast (72133) |
— |
$2,392 |
— |
| CT lower ext w/o (73700) |
— |
$2,943 |
— |
| CT lower extremity w/contrast material (73701) |
— |
$3,265 |
— |
| CT lumbar spine w contrast (72132) |
— |
$2,177 |
— |
| CT lumbar spine w/o contrast (72131) |
— |
$5,057 |
— |
| CT maxillofacial w contrast (70487) |
— |
$2,177 |
— |
| CT maxillofacial wo contrast (70486) |
— |
$3,175 |
— |
| CT neck tissue combo (70492) |
— |
$2,392 |
— |
| Ct Orbit/Ear/Fossa W/O&W/Dye (70482) |
— |
$2,392 |
— |
| CT orbits w/o contrast (70480) |
— |
$1,963 |
— |
| CT pelvis w&w/o contrast (72194) |
— |
$2,392 |
— |
| CT pelvis w/o contrast (72192) |
— |
$3,857 |
— |
| CT scan of leg combo (73702) |
— |
$2,392 |
— |
| CT scans face/jaw combo (70488) |
— |
$2,392 |
— |
| CT soft tissue neck w contrast (70491) |
— |
$3,693 |
— |
| CT soft tissue neck w/o contrast (70490) |
— |
$2,177 |
— |
| CT thoracic spine w contrast (72129) |
— |
$2,177 |
— |
| CT thoracic spine w/o contrast (72128) |
— |
$4,217 |
— |
| CT thoracic spine w/wo cont (72130) |
— |
$2,392 |
— |
| CT thorax w/o contrast (71250) |
— |
$3,232 |
— |
| CT upper ext wo (73200) |
— |
$1,963 |
— |
| CT upper extremity w/o & w/contrast material (73202) |
— |
$2,392 |
— |
| CT upper extremity with contrast (73201) |
— |
$2,177 |
— |
| Cta Abdl Aorta&Bi Iliofem W/Contrast&Postp (75635) |
— |
$3,826 |
— |
| Cta Abdomen (74175) |
— |
$2,392 |
— |
| CTA pelvis (72191) |
— |
$2,177 |
— |
| Dxa Bone Density Axial (77080) |
— |
$805 |
— |
| Echo Guide For Artery Repair (76936) |
— |
$1,252 |
— |
| Esophagram (74220) |
— |
$456 |
— |
| Fluoroscopy up to 1 hr (76000) |
— |
$829 |
— |
| Foot 2 views (73620) |
— |
$433 |
— |
| Forearm 2 views (73090) |
— |
$458 |
— |
| Gastric emptying imaging study (78264) |
— |
$1,532 |
— |
| Gated Heart Planar Single (78472) |
— |
$1,494 |
— |
| Gated Heart, Multiple (78473) |
— |
$2,664 |
— |
| Hand 2 views (73120) |
— |
$243 |
— |
| Hepatobil Syst Image W/Drug (78227) |
— |
$843 |
— |
| Hepatobiliary System Imaging (78226) |
— |
$843 |
— |
| Ht Muscle Image Spect Sing (78451) |
— |
$3,276 |
— |
| Hysterosalpingogram (74740) |
— |
$424 |
— |
| K Flow/Funct Image Multiple (78709) |
— |
$1,872 |
— |
| K Flow/Funct Image W/Drug (78708) |
— |
$1,840 |
— |
| Knee 3 Views (73562) |
— |
$704 |
— |
| Liver & Spleen Imaging W/Vascular Flow (78216) |
— |
$1,878 |
— |
| Lung perfusion differential (78597) |
— |
$945 |
— |
| Lung Ventilat&Perfus Imaging (78582) |
— |
$739 |
— |
| Lymph System Imaging (78195) |
— |
$1,181 |
— |
| Magnetic Image Jaw Joint (70336) |
— |
$3,066 |
— |
| Meckels Divert Exam (78290) |
— |
$1,242 |
— |
| Mra Head W/O & W/Contrast Material (70546) |
— |
$3,556 |
— |
| MRA head w/o contrast (70544) |
— |
$3,066 |
— |
| MRA head with contrast (70545) |
— |
$3,311 |
— |
| MRA neck w contrast (70548) |
— |
$3,311 |
— |
| Mra Neck W/O &W/Contrast Material (70549) |
— |
$3,556 |
— |
| MRA neck w/o contrast (70547) |
— |
$3,066 |
— |
| MRI abdomen w contrast (74182) |
— |
$3,311 |
— |
| MRI abdomen w/o contrast (74181) |
— |
$3,899 |
— |
| MRI any jt lower extrem w/contrast material (73722) |
— |
$4,965 |
— |
| MRI any jt lower extrem w/o & w/contrast matrl (73723) |
— |
$5,333 |
— |
| MRI any jt upper extremity w/contrast matrl (73222) |
— |
$3,311 |
— |
| MRI cervical spine w contrast (72142) |
— |
$3,311 |
— |
| MRI cervical spine w/o cont (72141) |
— |
$4,450 |
— |
| MRI chest w/o contrast (71550) |
— |
$3,066 |
— |
| MRI chest with contrast (71551) |
— |
$3,311 |
— |
| MRI chest wo w contrast (71552) |
— |
$3,556 |
— |
| MRI lower extrem oth/thn jt w/contrast matrl (73719) |
— |
$3,311 |
— |
| MRI lower extrem oth/thn jt w/o & w/contr matr (73720) |
— |
$5,333 |
— |
| MRI lower extrem oth/thn jt w/o contr matrl (73718) |
— |
$4,597 |
— |
| MRI lumbar spine w contrast (72149) |
— |
$3,311 |
— |
| Mri Neck Spine W/O & W/Dye (72156) |
— |
$5,601 |
— |
| MRI orbit face &/neck w/o contrast (70540) |
— |
$3,066 |
— |
| MRI orbit face neck w contrast (70542) |
— |
$3,311 |
— |
| Mri Orbt/Fac/Nck W/O &W/Dye (70543) |
— |
$3,556 |
— |
| MRI pelvis w contrast (72196) |
— |
$3,311 |
— |
| MRI pelvis w/o & w contrast (72197) |
— |
$4,922 |
— |
| MRI pelvis w/o contrast (72195) |
— |
$3,426 |
— |
| MRI thoracic spine w/o contrast (72146) |
— |
$4,234 |
— |
| MRI upper extremity oth than jt w/contr matrl (73219) |
— |
$4,965 |
— |
| MRI upper extremity oth than jt w/o contr matrl (73218) |
— |
$4,597 |
— |
| Mri Uppr Extremity W/O&W/Dye (73220) |
— |
$3,556 |
— |
| MRI, abdomen, combo (74183) |
— |
$5,080 |
— |
| MRI, dorsal spine combo (72157) |
— |
$3,556 |
— |
| MRI, dorsal spine contrast (72147) |
— |
$3,311 |
— |
| MRI, joint upper extrem (73221) |
— |
$4,597 |
— |
| MRI, joint upper extrem combo (73223) |
— |
$3,556 |
— |
| MRI, lumbar spine combo (72158) |
— |
$5,532 |
— |
| Myocardial Imaging Infarct Avid Planar Qual/Quan (78466) |
— |
$1,462 |
— |
| Myocardial Spect Multiple Studies (78452) |
— |
$8,065 |
— |
| Neck soft tissue (70360) |
— |
$264 |
— |
| Nonvascular Shunt X-Ray (75809) |
— |
$629 |
— |
| Optic foramina (70190) |
— |
$248 |
— |
| Parathyroid Planar Imaging (78070) |
— |
$1,297 |
— |
| Pelvis 1 or 2 views (72170) |
— |
$266 |
— |
| Pulmonary Perfusion Imaging Particulate (78580) |
— |
$1,070 |
— |
| Radex Abd Compl Aqt Abd W/S/E/D Views 1 View Ch (74022) |
— |
$329 |
— |
| Radex abscess/fistula/sinus tract rs&i (76080) |
— |
$976 |
— |
| Radex Ankle Complete Minimum 3 Views (73610) |
— |
$811 |
— |
| Radex Calcaneus Minimum 2 Views (73650) |
— |
$210 |
— |
| Radex elbow complete minimum 3 views (73080) |
— |
$509 |
— |
| Radex Facial Bones Complete Minimum 3 Views (70150) |
— |
$343 |
— |
| Radex fingr minimum 2 views (73140) |
— |
$373 |
— |
| Radex foot complete minimum 3 views (73630) |
— |
$740 |
— |
| Radex Hand Minimum 3 Views (73130) |
— |
$745 |
— |
| Radex lower extremity infant minimum 2 views (73592) |
— |
$217 |
— |
| Radex Mastoids Compl Minimum 3 Views PR Side (70130) |
— |
$347 |
— |
| Radex Nasal Bones Complete Minimum 3 Views (70160) |
— |
$226 |
— |
| Radex Ribs Unilateral 2 Views (71100) |
— |
$332 |
— |
| Radex shoulder complete minimum 2 views (73030) |
— |
$627 |
— |
| Radex Sinuses Paransl < 3 Views (70210) |
— |
$210 |
— |
| Radex Sternum Minimum 2 Views (71120) |
— |
$264 |
— |
| Radex Temporomandble Jt Opn & Clsd Mouth Bilat (70330) |
— |
$372 |
— |
| Radex Toe Minimum 2 Views (73660) |
— |
$188 |
— |
| Radex upper extremity infant minimum 2 views (73092) |
— |
$217 |
— |
| Radex Wrist Complete Minimum 3 Views (73110) |
— |
$451 |
— |
| Radiolog exam mandible compl minimum 4 views (70110) |
— |
$347 |
— |
| Radiologic exam colon double contrast study (74280) |
— |
$976 |
— |
| Radiologic exam colon single contrast study (74270) |
— |
$560 |
— |
| Radiologic exam knee complete 4/more views (73564) |
— |
$428 |
— |
| Radiologic exam pelvis compl minimum 3 views (72190) |
— |
$291 |
— |
| Radiologic Exam Small Int Single Contrast Study (74250) |
— |
$529 |
— |
| Radiologic exam swallow function contrast study (74230) |
— |
$433 |
— |
| Radiologic exam upr gi trc double contrast study (74246) |
— |
$1,112 |
— |
| Radiologic examination femur minimum 2 views (73552) |
— |
$455 |
— |
| Radiologic examination knee 1/2 views (73560) |
— |
$229 |
— |
| Radiologic examination tibia & fibula 2 views (73590) |
— |
$243 |
— |
| Ribs bilateral 3 views (71110) |
— |
$349 |
— |
| Rp loclzj tum plnr 2+area 1+d img/1 area img>2+d (78801) |
— |
$2,551 |
— |
| Rp Loclzj Tum Plnr Whole Body 2+ Days Imaging (78804) |
— |
$5,514 |
— |
| Scapula (73010) |
— |
$230 |
— |
| Screening Digital Breast Tomosynthesis Bi (77063) |
— |
$145 |
— |
| Shoulder 1 view (73020) |
— |
$165 |
— |
| Shoulder Arthrography (73040) |
— |
$1,445 |
— |
| Sialogram (70390) |
— |
$1,234 |
— |
| Skull less than 4 views (70250) |
— |
$274 |
— |
| Sternoclavicular joints (71130) |
— |
$312 |
— |
| Thoracic spine 3 views (72072) |
— |
$912 |
— |
| Thoracolumbar 2 views (72080) |
— |
$293 |
— |
| Thyroid Met Imaging Body (78018) |
— |
$1,779 |
— |
| Thyroid Uptake Measurement (78012) |
— |
$1,503 |
— |
| Thyroid Uptake W/Blood Flow Sngle/Mult Quan Meas (78014) |
— |
$909 |
— |
| Ultrasound Breast Limited (76642) |
— |
$471 |
— |
| Ultrasound Elastography Parenchyma (76981) |
— |
$621 |
— |
| Ultrasound, abdomen limited (76705) |
— |
$1,458 |
— |
| Upper gi w/o kub (74240) |
— |
$594 |
— |
| Urethrocystogram voiding (74455) |
— |
$1,013 |
— |
| Us breast unilateral complete (76641) |
— |
$1,064 |
— |
| Us chest (76604) |
— |
$572 |
— |
| Us complete joint (76881) |
— |
$627 |
— |
| Us exam, pelvic, limited (76857) |
— |
$1,289 |
— |
| Us kidney transplant (76776) |
— |
$925 |
— |
| Us lmtd joint/oth nonvasc xtr strux r-t w/img (76882) |
— |
$627 |
— |
| Us ob detailed single fetus (76811) |
— |
$1,789 |
— |
| Us ob transvaginal (76817) |
— |
$685 |
— |
| Us pelvic non ob complete (76856) |
— |
$1,542 |
— |
| Us pg uter img f&mat 14 wk tabdl 1/1st gestation (76801) |
— |
$685 |
— |
| Us retroperitoneal complete (76770) |
— |
$1,267 |
— |
| Us retroperitoneal limited (76775) |
— |
$596 |
— |
| Us scrotum and contents (76870) |
— |
$493 |
— |
| Us thyroid (76536) |
— |
$1,060 |
— |
| Venography extremity bilateral rs&i (75822) |
— |
$3,461 |
— |
| Venography extremity unilateral rs&i (75820) |
— |
$3,461 |
— |
| Wrist 2 views (73100) |
— |
$434 |
— |
| X-Ray Ac Jts - Xr Acromioclavicular Joints Bilateral (73050) |
— |
$391 |
— |
| X-Ray Aorta Leg Arteries (75630) |
— |
$5,907 |
— |
| X-Ray Bend Only L-S Spine (72120) |
— |
$292 |
— |
| X-Ray Elbow 2 Vw - Xr Elbow 1-2 Views Right (73070) |
— |
$251 |
— |
| X-Ray Exam Breast Specimen (76098) |
— |
$625 |
— |
| X-Ray Exam Entire Spi 1 Vw (72081) |
— |
$105 |
— |
| X-Ray Exam Entire Spi 2/3 Vw (72082) |
— |
$451 |
— |
| X-Ray Exam Hip Uni 1 View (73501) |
— |
$213 |
— |
| X-Ray Exam Hip Uni 2-3 Views (73502) |
— |
$309 |
— |
| X-Ray Exam Hips Bi 2 Views (73521) |
— |
$295 |
— |
| X-Ray Exam L-S Spine Bending (72114) |
— |
$488 |
— |
| X-Ray Exam Neck Spine 2-3 Vw (72040) |
— |
$818 |
— |
| X-Ray Exam Neck Spine 6/>Vws (72052) |
— |
$488 |
— |
| X-Ray Exam Unilat Ribs/Chest (71101) |
— |
$349 |
— |
| X-ray humerus (73060) |
— |
$264 |
— |
| X-ray IV pyelogram (ivp) (74400) |
— |
$947 |
— |
| X-Ray Jaw <4 Vw - Xr Mandible < 4 Views (70100) |
— |
$174 |
— |
| X-Ray Knee Bilat Standing - Xr Knees Anteroposterior Standing Bilat (73565) |
— |
$236 |
— |
| X-Ray Lumbar Spine 2/3 Vw - Xr Lumbar Spine 2-3 Views (72100) |
— |
$1,011 |
— |
| X-Ray Ribs, Chest 4+ Vw - Xr Ribs 3 Vws Bil W/ Chest Posteroanterior (71111) |
— |
$411 |
— |
| X-Ray Sacroiliac Jts 3+ Vw - Xr Sacroiliac Joints 3+ Views (72202) |
— |
$271 |
— |
| X-Ray Sacroiliac Jts <3 Vw - Xr Sacroiliac Joints 1-2 Views (72200) |
— |
$368 |
— |
| X-Ray Sacrum/Coccyx 2+ Vw - Xr Sacrum Coccyx 2+ Views (72220) |
— |
$261 |
— |
| X-Ray Sinuses 3+ Vw - Xr Paranasal Sinuses 3+ Views (70220) |
— |
$347 |
— |
| X-Ray Skull 4+ Vw - Xr Skull Complete 4+ Views (70260) |
— |
$297 |
— |
| X-Ray Urinary Tract Exam With Contrast Material (74420) |
— |
$1,170 |
— |
| X-Rays Bone Length Studies (77073) |
— |
$347 |
— |
| X-Rays Bone Survey Complete (77075) |
— |
$479 |
— |
| Xr c-spine 4 or 5 views (72050) |
— |
$988 |
— |
| Xr facial bones less than 3 views (70140) |
— |
$270 |
— |
| XR Mastoids < 3 Views Bilateral (70120) |
— |
$225 |
— |
| Xr orbits complete 4 views (70200) |
— |
$348 |
— |