| Abdomen 2 views (74019) |
— |
$287.40 |
— |
| Angiography extremity bilateral rs&i (75716) |
— |
$3,986 |
— |
| Ankle 2 views (73600) |
— |
$360.10 |
— |
| Aortography abdl bi iliofem low extrem cath rs&i (75630) |
— |
$3,453.87 |
— |
| Bone &/joint imaging whole body (78306) |
— |
$1,577 |
— |
| Bone age studies (77072) |
— |
$321.45 |
— |
| Bone Imaging 3 Phase (78315) |
— |
$1,627 |
— |
| Bone survey complete (77075) |
— |
$1,038.70 |
— |
| Cervical spine 2 or 3 views (72040) |
— |
$659.10 |
— |
| Chest 1 view (71045) |
— |
$744.50 |
— |
| Cine/Vid X-Ray Throat/Esoph - Fl Esoph Barium Swlw W/ Video & Speech (74230) |
— |
$531.60 |
— |
| Clavicle complete (73000) |
— |
$315.10 |
— |
| Computed Tomography Thorax Lw Dose Lng Ca Scr C- (71271) |
— |
$2,125.50 |
— |
| CT abdomen and pelvis without and with contrast (74178) |
— |
$3,217 |
— |
| CT abdomen and pelvis without contrast (74176) |
— |
$2,535.50 |
— |
| CT abdomen w contrast (74160) |
— |
$1,856.50 |
— |
| CT abdomen w wo contrast (74170) |
— |
$2,093 |
— |
| CT abdomen w/o contrast (74150) |
— |
$1,581.50 |
— |
| CT angio hrt w/3d image (75574) |
— |
$1,704.50 |
— |
| CT angiography upper extremity lt (73206) |
— |
$2,007 |
— |
| CT c-spine w/o contrast (72125) |
— |
$2,469 |
— |
| CT cervical spine w&w/o contrast (72127) |
— |
$3,178 |
— |
| CT chest w/wo contrast (71270) |
— |
$2,121.50 |
— |
| CT chest with contrast (71260) |
— |
$2,604 |
— |
| CT head/brain with contrast (70460) |
— |
$1,656 |
— |
| CT head/brain without and with contrast (70470) |
— |
$1,940.50 |
— |
| CT heart no contrast quant eval coronry calcium (75571) |
— |
$66 |
— |
| CT iac w contrast (70481) |
— |
$1,755.50 |
— |
| CT lower ext w/o (73700) |
— |
$1,485.95 |
— |
| CT lower extremity w wo contrast (73702) |
— |
$1,958 |
— |
| CT lower extremity with contrast (73701) |
— |
$1,672.50 |
— |
| CT lumbar spine w/o contrast (72131) |
— |
$1,719 |
— |
| CT lumbar spine with contrast (72132) |
— |
$1,876.50 |
— |
| CT maxillofacial w contrast (70487) |
— |
$1,732.50 |
— |
| CT maxillofacial w/o contrast (70486) |
— |
$1,930.50 |
— |
| CT neck soft tissue w contrast (70491) |
— |
$1,734 |
— |
| CT orbit sella/post fossa/ear w/o & w/contr matr (70482) |
— |
$1,944.50 |
— |
| CT orbits w/o contrast (70480) |
— |
$1,543 |
— |
| CT pelvis w & w/o contrast (72194) |
— |
$2,786 |
— |
| CT pelvis w/o contrast (72192) |
— |
$1,603 |
— |
| CT soft tissue neck w/o & w/contrast material (70492) |
— |
$1,960 |
— |
| CT soft tissue neck w/o contrast (70490) |
— |
$1,622 |
— |
| CT thoracic spine w/contrast (72129) |
— |
$2,683 |
— |
| CT thoracic spine w/o contrast (72128) |
— |
$1,685 |
— |
| CT thorax w/o contrast (71250) |
— |
$1,774.70 |
— |
| CT upper extremity w/o & w/contrast material (73202) |
— |
$1,919.50 |
— |
| CT upper extremity w/o contrast rt (73200) |
— |
$1,461.40 |
— |
| CT upper extremity with contrast (73201) |
— |
$1,694 |
— |
| Cta Abdl Aorta&Bi Iliofem W/Contrast&Postp (75635) |
— |
$2,247 |
— |
| Cta Abdomen (74175) |
— |
$2,170 |
— |
| CTA abdomen pelvis (74174) |
— |
$2,880 |
— |
| CTA chest (71275) |
— |
$1,885.05 |
— |
| Cta Head (70496) |
— |
$2,289.50 |
— |
| CTA lwr ext w&w/o contrast (73706) |
— |
$2,055 |
— |
| Cta Neck (70498) |
— |
$2,073.50 |
— |
| Dxa bone density study 1/> sites axial skel (77080) |
— |
$537.82 |
— |
| Esophagus (74220) |
— |
$518.50 |
— |
| Fetal biophysical profile non-stress testing (76818) |
— |
$859.75 |
— |
| Fetal Biophysical Profile W/O Non-Stress Testing (76819) |
— |
$178 |
— |
| Fluoroscopy up to 1 hr (76000) |
— |
$1,000.55 |
— |
| Foot 2 views (73620) |
— |
$262.60 |
— |
| Forearm 2 views (73090) |
— |
$354.20 |
— |
| Gated Heart Planar Single (78472) |
— |
$1,568.50 |
— |
| Hand 2 views (73120) |
— |
$283.55 |
— |
| Hand 3 views (73130) |
— |
$423.80 |
— |
| Hepatobil Syst Imag Inc Gb W/Pharma Intervenj (78227) |
— |
$1,646.50 |
— |
| Hepatobiliary syst imaging including gallbladder (78226) |
— |
$1,528 |
— |
| Humerus Min 2 Views Left (73060) |
— |
$391.30 |
— |
| Hysterosalpingogram (74740) |
— |
$705.25 |
— |
| Kidney Img Morphology Vascular Flow 1 W/O Rx (78707) |
— |
$1,511.65 |
— |
| Knee 3 views (73562) |
— |
$374 |
— |
| Lymphoscintigraphy (78195) |
— |
$2,055.30 |
— |
| Meckels Diverticulum (78290) |
— |
$685 |
— |
| MRA head w/o contrast (70544) |
— |
$2,121.50 |
— |
| Mra Neck W/O &W/Contrast Material (70549) |
— |
$2,759.50 |
— |
| MRA neck w/o contrast (70547) |
— |
$3,180 |
— |
| MRI abdomen w/o & w/contrast material (74183) |
— |
$2,980.50 |
— |
| MRI abdomen w/o contrast (74181) |
— |
$2,203 |
— |
| MRI any jnt lwr ext with con lt (73722) |
— |
$2,096.50 |
— |
| MRI any jt upper extremity w/contrast matrl (73222) |
— |
$2,228 |
— |
| MRI cervical spine w/o contrast (72141) |
— |
$2,247.50 |
— |
| MRI chest w/o contrast (71550) |
— |
$2,783 |
— |
| MRI lower extrem oth/thn jt w/o contr matrl (73718) |
— |
$3,703 |
— |
| MRI orbit/face/neck w&w/o cont (70543) |
— |
$2,875.50 |
— |
| MRI pelvis w/o & w/contrast material (72197) |
— |
$2,923 |
— |
| MRI pelvis w/o contrast (72195) |
— |
$2,160 |
— |
| MRI scan of arm joint before and after contrast (73223) |
— |
$3,951 |
— |
| MRI scan of leg joint before and after contrast (73723) |
— |
$2,726 |
— |
| MRI spinal canal cervical w/o & w/contr matrl (72156) |
— |
$2,985.50 |
— |
| MRI spinal canal lumbar w/contrast material (72149) |
— |
$3,443 |
— |
| MRI spinal canal lumbar w/o & w/contr matrl (72158) |
— |
$2,992 |
— |
| MRI spinal canal thoracic w/contrast matrl (72147) |
— |
$3,039 |
— |
| MRI spinal canal thoracic w/o & w/contr matrl (72157) |
— |
$2,994.50 |
— |
| MRI thoracic spine w/o contrast (72146) |
— |
$2,236.50 |
— |
| MRI tmj (70336) |
— |
$2,110.50 |
— |
| MRI upper ext joint w/o contrast (73221) |
— |
$2,042.35 |
— |
| MRI upper extrem other than jt w/o & w/contras (73220) |
— |
$3,302.46 |
— |
| MRI upper extremity oth than jt w/o contr matrl (73218) |
— |
$2,424 |
— |
| Myocardial Spect Multiple Studies (78452) |
— |
$3,734 |
— |
| Neck soft tissue (70360) |
— |
$255 |
— |
| Nm gastric emptying study (78264) |
— |
$1,471.55 |
— |
| Ob Us Follow-Up Per Fetus - Us Ob Follow Up Transabdominal Approach (76816) |
— |
$224 |
— |
| Osseous survey infant (77076) |
— |
$786.50 |
— |
| Osseous survey limited (77074) |
— |
$716.30 |
— |
| Parathyrd planar w/spect&CT (78072) |
— |
$2,535 |
— |
| Pelvis 1 or 2 views (72170) |
— |
$262.85 |
— |
| PET image w/CT, skull-thigh (78815) |
— |
$4,025 |
— |
| PET imaging for CT attenuation whole body (78816) |
— |
$4,191.50 |
— |
| Pr MRI, lower extr, w/o contrast f/u by contrast (73720) |
— |
$2,682.50 |
— |
| Pulmonary Perfusion Imaging Particulate (78580) |
— |
$1,727.70 |
— |
| Radex Entir Thrc Lmbr Crv Sac Spi W/Skull 1 Vw - Xr Scoliosis 1 Vw (72081) |
— |
$256.80 |
— |
| Radex entir thrc lmbr crv sac spi w/skull 2/3 vw (72082) |
— |
$383.15 |
— |
| Radex hips bilateral with pelvis 2 views (73521) |
— |
$396.90 |
— |
| Radiolog exam mandible compl minimum 4 views (70110) |
— |
$509.60 |
— |
| Radiologic Exam Abdomen 1 View - Xr Abdomen 1 View (74018) |
— |
$513.60 |
— |
| Radiologic Exam Chest 2 Views - Xr Chest 2 Views (71046) |
— |
$550 |
— |
| Radiologic exam upr gi trc double contrast study (74246) |
— |
$698.70 |
— |
| Radiologic exam upr gi trc single contrast study (74240) |
— |
$383 |
— |
| Radiologic Examination Femur Minimum 2 Views - Xr Femur 2+ Vw Lt (73552) |
— |
$351.90 |
— |
| Radiological examination surgical specimen (76098) |
— |
$699.40 |
— |
| Ribs bilateral 3 views (71110) |
— |
$438.80 |
— |
| Sacroiliac Joints < 3 Views (72200) |
— |
$358.80 |
— |
| Scanogram (77073) |
— |
$290.35 |
— |
| Scapula complete (73010) |
— |
$278.40 |
— |
| Screening digital breast tomosynthesis (77063) |
— |
$193.05 |
— |
| Shuntogram indwelling nonvascular shunt rs&i (75809) |
— |
$486.75 |
— |
| Small bowel series (74250) |
— |
$614.25 |
— |
| Spine thoracic 3 views (72072) |
— |
$360.40 |
— |
| Tbs Technical Calculation Only (77091) |
— |
$300.13 |
— |
| Thoracolumbar 2 views (72080) |
— |
$279.55 |
— |
| Thyroid Uptake W/Blood Flow Sngle/Mult Quan Meas (78014) |
— |
$1,444.88 |
— |
| Tmj unilateral (70328) |
— |
$240.10 |
— |
| Ultrasound, abdomen limited (76705) |
— |
$881.40 |
— |
| Us abdl aorta screen aaa (76706) |
— |
$408.35 |
— |
| Us breast unilateral limited (76642) |
— |
$195 |
— |
| Us chest (76604) |
— |
$461.55 |
— |
| Us compl joint r-t w/image documentation (76881) |
— |
$541.25 |
— |
| Us elastography parenchyma (76981) |
— |
$310.28 |
— |
| Us infant hips dynamic (76885) |
— |
$416.05 |
— |
| Us ob detailed single fetus (76811) |
— |
$778.90 |
— |
| Us ob transvaginal (76817) |
— |
$523.25 |
— |
| Us pelvic non ob complete (76856) |
— |
$637 |
— |
| Us pelvic nonobstetric image dcmtn limited/f/u (76857) |
— |
$291.46 |
— |
| Us pregnancy ltd (76815) |
— |
$449.60 |
— |
| Us pregnant uterus 14 wk transabdl 1/1st gestat (76801) |
— |
$867.10 |
— |
| Us retroperitoneal limited (76775) |
— |
$873.60 |
— |
| Us scrotum and contents (76870) |
— |
$782.85 |
— |
| Us soft tissue head/neck (76536) |
— |
$569.90 |
— |
| Us spinal canal and contents (76800) |
— |
$291 |
— |
| Us xtr non-vasc lmtd (76882) |
— |
$551.20 |
— |
| Wrist 2 views (73100) |
— |
$283.65 |
— |
| X-Ray Abdomen,Comp Acute Series - Xr Abdomen 2 Vws With Chest 1 View (74022) |
— |
$441.25 |
— |
| X-Ray Ankle 3+ Vw - Xr Ankle 3+ Views Right (73610) |
— |
$326 |
— |
| X-Ray Elbow 2 Vw - Xr Elbow 1-2 Views Right (73070) |
— |
$312.80 |
— |
| X-Ray Elbow 3+ Vw - Xr Elbow 3+ Views Right (73080) |
— |
$366.60 |
— |
| X-ray exam hip uni 1 view (73501) |
— |
$232.90 |
— |
| X-Ray Exam Hip Uni 2-3 Views (73502) |
— |
$322 |
— |
| X-ray exam hip uni 4/> views (73503) |
— |
$308.35 |
— |
| X-Ray Exam Hips Bi 3-4 Views (73522) |
— |
$455 |
— |
| X-Ray Exam Hips Bi 5/> Views (73523) |
— |
$651.35 |
— |
| X-ray exam of femur 1 (73551) |
— |
$317.20 |
— |
| X-ray eye for foreign body (70030) |
— |
$211.30 |
— |
| X-Ray Facial Bones 3+ Vw - Xr Facial Bones 3+ Views (70150) |
— |
$357.45 |
— |
| X-Ray Foot 3+ Vw - Xr Foot 3+ Views Right (73630) |
— |
$377.65 |
— |
| X-Ray Heel - Xr Calcaneus 2 Views Right (73650) |
— |
$224.55 |
— |
| X-Ray Jaw <4 Vw - Xr Mandible < 4 Views (70100) |
— |
$249.10 |
— |
| X-Ray Knee 4+ View - Xr Knee 4+ Views Right (73564) |
— |
$325 |
— |
| X-Ray Knee Bilat Standing - Xr Knees Anteroposterior Standing Bilat (73565) |
— |
$240 |
— |
| X-Ray Leg, Infant - Xr Lower Extremity 2+ Views Infant Left (73592) |
— |
$220.95 |
— |
| X-Ray Lumbar Spine 2/3 Vw - Xr Lumbar Spine 2-3 Views (72100) |
— |
$344.85 |
— |
| X-Ray Lumbar Spine 6+ Vw - Xr Lumbar Spine 6+ Vws Including Bending (72114) |
— |
$564 |
— |
| X-Ray Lumbar Spine Flex/Exten - Xr Lumbar Spine 4+ Views W/ Flex Ext (72120) |
— |
$327.50 |
— |
| X-Ray Nasal Bones - Xr Nasal Bones (70160) |
— |
$270.05 |
— |
| X-Ray Nose-Rectum Child F.B. - Xr Nose to Rectum Foreign Body Peds (76010) |
— |
$287.40 |
— |
| X-Ray Orbits - Xr Orbits Complete 4+ Views (70200) |
— |
$481 |
— |
| X-Ray Pelvis 3+ Vw - Xr Pelvis 3+ Views (72190) |
— |
$305.90 |
— |
| X-Ray Ribs 2 Vw Unilat - Xr Ribs 2 Views Right (71100) |
— |
$280.20 |
— |
| X-Ray Ribs, Chest 3+ Vw - Xr Ribs 2 Vws Lt W/ Chest Anteroposterior (71101) |
— |
$358.60 |
— |
| X-Ray Ribs, Chest 4+ Vw - Xr Ribs 3 Vws Bil W/ Chest Posteroanterior (71111) |
— |
$465.15 |
— |
| X-Ray Sacroiliac Jts 3+ Vw - Xr Sacroiliac Joints 3+ Views (72202) |
— |
$313.10 |
— |
| X-Ray Sacrum/Coccyx 2+ Vw - Xr Sacrum Coccyx 2+ Views (72220) |
— |
$297.55 |
— |
| X-Ray Shoulder 2+ Vw - Xr Shoulder 2+ Views Right (73030) |
— |
$413.20 |
— |
| X-Ray Sinuses 3+ Vw - Xr Paranasal Sinuses 3+ Views (70220) |
— |
$505.70 |
— |
| X-Ray Spine One View - Xr Spine (72020) |
— |
$349.70 |
— |
| X-Ray Sternum 2+ Vw - Xr Sternum 2+ Views (71120) |
— |
$157 |
— |
| X-Ray Thoracic Spine 2 Vw - Xr Thoracic Spine 2 Views (72070) |
— |
$311.30 |
— |
| X-Ray Thoracic Spine 4 Vw - Xr Thoracic Spine Complete 4+ Views (72074) |
— |
$500.50 |
— |
| X-Ray Toe(S) - Xr Toes 2+ Views Right (73660) |
— |
$277.15 |
— |
| X-Ray Wrist 3+ Vw - Xr Wrist 3+ Views Right (73110) |
— |
$311.15 |
— |
| Xr c-spine 6 or more views (72052) |
— |
$492.15 |
— |
| Xr finger(s) 2+ views (73140) |
— |
$319.80 |
— |
| Xr shoulder 1 view (73020) |
— |
$301.30 |
— |
| Xr spine cervical 4 or 5 views (72050) |
— |
$441.25 |
— |
| Xr tibia/fibula 2 views (73590) |
— |
$310.70 |
— |
| Xr tmj bilateral (70330) |
— |
$504.40 |
— |
| Xray knee 1 or 2 views rt (73560) |
— |
$285 |
— |