| Abdomen 2 views (74019) |
— |
$218 |
— |
| Bone age studies (77072) |
— |
$150 |
— |
| Bone survey complete (77075) |
— |
$288.75 |
— |
| Cervical spine 2 or 3 views (72040) |
— |
$275 |
— |
| Chest 1 view (71045) |
— |
$100 |
— |
| Chest 3 views (71047) |
— |
$162.75 |
— |
| Clavicle complete (73000) |
— |
$163.33 |
— |
| CT abdomen and pelvis without and with contrast (74178) |
— |
$2,400.50 |
— |
| CT abdomen and pelvis without contrast (74176) |
— |
$2,072.50 |
— |
| CT abdomen w contrast (74160) |
— |
$1,450 |
— |
| CT abdomen w wo contrast (74170) |
— |
$1,550 |
— |
| CT abdomen w/o contrast (74150) |
— |
$1,100 |
— |
| CT angiography upper extremity lt (73206) |
— |
$1,668.50 |
— |
| CT c-spine w/o contrast (72125) |
— |
$1,250 |
— |
| CT cervical spine w&w/o contrast (72127) |
— |
$1,322 |
— |
| CT cervical spine with contrast (72126) |
— |
$1,350 |
— |
| CT chest with contrast (71260) |
— |
$1,450 |
— |
| CT head/brain with contrast (70460) |
— |
$1,279.43 |
— |
| CT head/brain without and with contrast (70470) |
— |
$1,400 |
— |
| CT heart no contrast quant eval coronry calcium (75571) |
— |
$99 |
— |
| CT iac w contrast (70481) |
— |
$1,142 |
— |
| CT lower ext w/o (73700) |
— |
$589 |
— |
| CT lower extremity with contrast (73701) |
— |
$1,200 |
— |
| CT lumbar spine w/o contrast (72131) |
— |
$991.50 |
— |
| CT maxillofacial w contrast (70487) |
— |
$1,150 |
— |
| CT maxillofacial w/o contrast (70486) |
— |
$875 |
— |
| CT neck soft tissue w contrast (70491) |
— |
$1,252.39 |
— |
| CT orbits w/o contrast (70480) |
— |
$1,142 |
— |
| CT pelvis w & w/o contrast (72194) |
— |
$1,500 |
— |
| CT pelvis w/o contrast (72192) |
— |
$1,000.39 |
— |
| CT soft tissue neck w/o contrast (70490) |
— |
$859.79 |
— |
| CT thoracic spine w/o contrast (72128) |
— |
$991.50 |
— |
| CT thorax w/o contrast (71250) |
— |
$1,021.50 |
— |
| CT upper extremity w/o contrast rt (73200) |
— |
$513.71 |
— |
| CT upper extremity with contrast (73201) |
— |
$784 |
— |
| Cta Abdl Aorta&Bi Iliofem W/Contrast&Postp (75635) |
— |
$1,750 |
— |
| Cta Abdomen (74175) |
— |
$1,650 |
— |
| CTA abdomen pelvis (74174) |
— |
$1,878 |
— |
| CTA chest (71275) |
— |
$1,450 |
— |
| Cta Head (70496) |
— |
$1,746 |
— |
| CTA lwr ext w&w/o contrast (73706) |
— |
$1,400 |
— |
| Cta Neck (70498) |
— |
$1,863.50 |
— |
| Forearm 2 views (73090) |
— |
$150 |
— |
| Hand 3 views (73130) |
— |
$150 |
— |
| Humerus Min 2 Views Left (73060) |
— |
$150 |
— |
| Knee 3 views (73562) |
— |
$200 |
— |
| Neck soft tissue (70360) |
— |
$150 |
— |
| Ob Us Follow-Up Per Fetus - Us Ob Follow Up Transabdominal Approach (76816) |
— |
$236.72 |
— |
| Osseous survey limited (77074) |
— |
$386 |
— |
| Pelvis 1 or 2 views (72170) |
— |
$150 |
— |
| Radex entir thrc lmbr crv sac spi w/skull 2/3 vw (72082) |
— |
$275 |
— |
| Radex hips bilateral with pelvis 2 views (73521) |
— |
$250 |
— |
| Radiolog exam mandible compl minimum 4 views (70110) |
— |
$208.64 |
— |
| Radiologic Exam Abdomen 1 View - Xr Abdomen 1 View (74018) |
— |
$175 |
— |
| Radiologic Exam Chest 2 Views - Xr Chest 2 Views (71046) |
— |
$150 |
— |
| Radiologic Examination Femur Minimum 2 Views - Xr Femur 2+ Vw Lt (73552) |
— |
$200 |
— |
| Ribs bilateral 3 views (71110) |
— |
$275 |
— |
| Sacroiliac Joints < 3 Views (72200) |
— |
$191 |
— |
| Scanogram (77073) |
— |
$332.50 |
— |
| Scapula complete (73010) |
— |
$175 |
— |
| Spine thoracic 3 views (72072) |
— |
$230 |
— |
| Ultrasound, abdomen limited (76705) |
— |
$375 |
— |
| Urography (pyelography), intravenous, with or without KUB, with or without tomography (74400) |
— |
$450 |
— |
| Us chest (76604) |
— |
$223 |
— |
| Us compl joint r-t w/image documentation (76881) |
— |
$279.47 |
— |
| Us elastography parenchyma (76981) |
— |
$178 |
— |
| Us ob transvaginal (76817) |
— |
$350 |
— |
| Us pelvic non ob complete (76856) |
— |
$372.50 |
— |
| Us pelvic nonobstetric image dcmtn limited/f/u (76857) |
— |
$245 |
— |
| Us pregnant uterus 14 wk transabdl 1/1st gestat (76801) |
— |
$350 |
— |
| Us retroperitoneal complete (76770) |
— |
$550 |
— |
| Us retroperitoneal limited (76775) |
— |
$450 |
— |
| Us scrotum and contents (76870) |
— |
$255 |
— |
| Us soft tissue head/neck (76536) |
— |
$350 |
— |
| Us xtr non-vasc lmtd (76882) |
— |
$250 |
— |
| X-Ray Ankle 3+ Vw - Xr Ankle 3+ Views Right (73610) |
— |
$200 |
— |
| X-Ray Elbow 2 Vw - Xr Elbow 1-2 Views Right (73070) |
— |
$150 |
— |
| X-Ray Exam Hip Uni 2-3 Views (73502) |
— |
$200 |
— |
| X-Ray Facial Bones 3+ Vw - Xr Facial Bones 3+ Views (70150) |
— |
$239.35 |
— |
| X-Ray Foot 3+ Vw - Xr Foot 3+ Views Right (73630) |
— |
$200 |
— |
| X-Ray Heel - Xr Calcaneus 2 Views Right (73650) |
— |
$200 |
— |
| X-Ray Knee 4+ View - Xr Knee 4+ Views Right (73564) |
— |
$250 |
— |
| X-Ray Knee Bilat Standing - Xr Knees Anteroposterior Standing Bilat (73565) |
— |
$185 |
— |
| X-Ray Lumbar Spine 2/3 Vw - Xr Lumbar Spine 2-3 Views (72100) |
— |
$223 |
— |
| X-Ray Lumbar Spine 6+ Vw - Xr Lumbar Spine 6+ Vws Including Bending (72114) |
— |
$223 |
— |
| X-Ray Nasal Bones - Xr Nasal Bones (70160) |
— |
$174.20 |
— |
| X-Ray Nose-Rectum Child F.B. - Xr Nose to Rectum Foreign Body Peds (76010) |
— |
$118.91 |
— |
| X-Ray Ribs 2 Vw Unilat - Xr Ribs 2 Views Right (71100) |
— |
$175 |
— |
| X-Ray Sacroiliac Jts 3+ Vw - Xr Sacroiliac Joints 3+ Views (72202) |
— |
$228 |
— |
| X-Ray Sacrum/Coccyx 2+ Vw - Xr Sacrum Coccyx 2+ Views (72220) |
— |
$168.84 |
— |
| X-Ray Shoulder 2+ Vw - Xr Shoulder 2+ Views Right (73030) |
— |
$175 |
— |
| X-Ray Sinuses 3+ Vw - Xr Paranasal Sinuses 3+ Views (70220) |
— |
$250 |
— |
| X-Ray Skull 4+ Vw - Xr Skull Complete 4+ Views (70260) |
— |
$266 |
— |
| X-Ray Spine One View - Xr Spine (72020) |
— |
$185 |
— |
| X-Ray Thoracic Spine 2 Vw - Xr Thoracic Spine 2 Views (72070) |
— |
$230 |
— |
| X-Ray Toe(S) - Xr Toes 2+ Views Right (73660) |
— |
$200 |
— |
| X-Ray Wrist 3+ Vw - Xr Wrist 3+ Views Right (73110) |
— |
$150 |
— |
| Xr c-spine 6 or more views (72052) |
— |
$297.41 |
— |
| Xr chest 4+ views (71048) |
— |
$174.50 |
— |
| Xr finger(s) 2+ views (73140) |
— |
$150 |
— |
| Xr shoulder 1 view (73020) |
— |
$91.93 |
— |
| Xr spine cervical 4 or 5 views (72050) |
— |
$275 |
— |
| Xr tibia/fibula 2 views (73590) |
— |
$200 |
— |
| Xray knee 1 or 2 views rt (73560) |
— |
$200 |
— |