| Acute gi blood loss imaging (78278) |
— |
$5,230.80 |
— |
| Angio extremity unilateral (75710) |
— |
$6,519.75 |
— |
| Angio pulmonary unilateral (75741) |
— |
$6,519.75 |
— |
| Angiogram extremity bilateral (75716) |
— |
$6,519.75 |
— |
| Angiogram pelvic (75736) |
— |
$6,519.75 |
— |
| Angiography pulmonary bilateral slctv rs&i (75743) |
— |
$6,519.75 |
— |
| Angiography visceral slctv/supraslctv rs&i (75726) |
— |
$12,116.97 |
— |
| Angrph cath f-up std tcat other than thrombylsis (75898) |
— |
$3,508.87 |
— |
| Ankle 2 views (73600) |
— |
$1,606.80 |
— |
| Arthrography knee lt (73580) |
— |
$5,389.15 |
— |
| Arthrography wrist lt (73115) |
— |
$4,821.54 |
— |
| Barium enema (74270) |
— |
$3,391.84 |
— |
| Bone age studies (77072) |
— |
$787.91 |
— |
| Bone imaging limited area (78300) |
— |
$3,367.36 |
— |
| Bone survey complete (77075) |
— |
$3,554.77 |
— |
| Cine/Vid X-Ray Throat/Esoph - Fl Esoph Barium Swlw W/ Video & Speech (74230) |
— |
$2,426.45 |
— |
| Clavicle complete (73000) |
— |
$1,789.63 |
— |
| Computed tomography, orbit, sella, or posterior fossa or outer, middle, or inner ear; with contrast material(s) Age… (70481) |
— |
$7,443.06 |
— |
| Contrast exam abdominl aorta (75625) |
— |
$6,519.75 |
— |
| Contrast exam thoracic aorta (75605) |
— |
$6,519.75 |
— |
| CT - st neck w&wo contr (70492) |
— |
$8,246.27 |
— |
| CT abdomen and pelvis without and with contrast (74178) |
— |
$16,496.36 |
— |
| CT abdomen and pelvis without contrast (74176) |
— |
$9,402.89 |
— |
| CT abdomen w wo contrast (74170) |
— |
$8,246.27 |
— |
| CT abdomen w/contrast (74160) |
— |
$7,443.06 |
— |
| CT abdomen w/o contrast (74150) |
— |
$4,700.68 |
— |
| CT angio abd&plvis cntrst mtrl w/wo cntrst imges (74174) |
— |
$17,016.54 |
— |
| CT angio abdom w/o & w/dye (74175) |
— |
$8,510.18 |
— |
| CT angio abdominal arteries (75635) |
— |
$8,510.18 |
— |
| CT angiograph pelv w/o&w/dye (72191) |
— |
$8,510.18 |
— |
| CT cervical spine w/contrast (72126) |
— |
$7,443.06 |
— |
| CT cervical spine w/o contrast (72125) |
— |
$4,700.68 |
— |
| CT chest w/contrast (71260) |
— |
$7,443.06 |
— |
| CT extremity upper w & w/o contrast (73202) |
— |
$8,246.27 |
— |
| CT head/brain with contrast (70460) |
— |
$7,443.06 |
— |
| CT head/brain without and with contrast (70470) |
— |
$8,246.27 |
— |
| CT heart w/o contrast quant eval coronary calcium (75571) |
— |
$76.50 |
— |
| CT limited/localized follow up study (76380) |
— |
$2,540.43 |
— |
| CT lower ext w/wo contrast (73702) |
— |
$8,246.27 |
— |
| CT lower extremity w contrast (73701) |
— |
$7,443.06 |
— |
| CT lower extremity w/o contrast unilateral (73700) |
— |
$4,700.68 |
— |
| CT lumbar spine w/contrast (72132) |
— |
$7,443.06 |
— |
| CT lumbar spine w/o contrast (72131) |
— |
$4,700.68 |
— |
| CT lumbar spine w/o then w/ con (72133) |
— |
$8,246.27 |
— |
| CT maxillofacial area w/o contrast (70486) |
— |
$4,700.68 |
— |
| CT maxillofacial w/contrast (70487) |
— |
$7,443.06 |
— |
| CT maxillofacial w/o then w/ con (70488) |
— |
$8,246.27 |
— |
| CT orbit sella ear w/o con (70480) |
— |
$4,700.68 |
— |
| CT orbit/ear/fossa w/o then w/ con (70482) |
— |
$8,246.27 |
— |
| CT pelvis w & w/o contrast (72194) |
— |
$8,246.27 |
— |
| CT pelvis w/o contrast (72192) |
— |
$4,700.68 |
— |
| CT soft tissue neck w/contrast (70491) |
— |
$7,443.06 |
— |
| CT soft tissue neck w/o contrast (70490) |
— |
$4,700.68 |
— |
| CT spine cervical w/wo contrast (72127) |
— |
$8,246.27 |
— |
| CT thoracic spine w/contrast (72129) |
— |
$7,443.06 |
— |
| CT thoracic spine w/o contrast (72128) |
— |
$4,700.68 |
— |
| CT thoracic spine w/o then w/ con (72130) |
— |
$8,246.27 |
— |
| CT thorax w/o contrast (71250) |
— |
$4,700.68 |
— |
| CT thorax w/o then w/ contrast (71270) |
— |
$8,246.27 |
— |
| CT upper extremity w/dye (73201) |
— |
$7,443.06 |
— |
| CT upper extremity w/o contrast rt (73200) |
— |
$4,700.68 |
— |
| CTA chest w/wo contrast (71275) |
— |
$8,510.18 |
— |
| CTA head w contrast (70496) |
— |
$8,510.18 |
— |
| CTA lower extremity w/wo contrast unilateral (73706) |
— |
$8,510.18 |
— |
| Cta Neck (70498) |
— |
$8,510.18 |
— |
| CTA upper extremity w/wo contrast unilateral (73206) |
— |
$8,510.18 |
— |
| Esophogram (74220) |
— |
$2,009.55 |
— |
| Fetal biophysical profile non-stress testing (76818) |
— |
$1,976.66 |
— |
| Fetal biophysical profile w/o nst (76819) |
— |
$1,976.66 |
— |
| Fluoroscopy up to 1 hour physician/qhp time (76000) |
— |
$2,721.48 |
— |
| Gastric emptying study (78264) |
— |
$3,052.95 |
— |
| Hepatc vngrph wdg/fr w/o hemodyn eval rs&i (75891) |
— |
$6,389.71 |
— |
| Hepatic venography, wedged or free, with hemodynamic evaluation, radiological supervision and interpretation Other… (75889) |
— |
$605.67 |
— |
| Hepatobil syst image w/drug (78227) |
— |
$4,670.85 |
— |
| Hepatobiliary system imaging (78226) |
— |
$4,670.85 |
— |
| Humerus min 2 views (73060) |
— |
$2,130.80 |
— |
| Hysterosalpingography (74740) |
— |
$4,377.86 |
— |
| Ivp (74400) |
— |
$5,716.54 |
— |
| Ivp w tomography (74415) |
— |
$7,290.07 |
— |
| Kidney imaging morphology; with vascular flow and function, single study without pharmacological intervention Age Under… (78707) |
— |
$4,485.73 |
— |
| Kidney imaging morphology; with vascular flow and function, single study, with pharmacological intervention (eg,… (78708) |
— |
$6,560.30 |
— |
| Lung perfusion differential (78597) |
— |
$3,115.68 |
— |
| Lung ventilat&perfus imaging (78582) |
— |
$6,081.43 |
— |
| Magnetic resonance (eg, proton) imaging, any joint of lower extremity; without contrast material(s), followed by… (73723) |
— |
$8,377.85 |
— |
| Magnetic resonance (eg, proton) imaging, lower extremity other than joint; without contrast material(s), followed by… (73720) |
— |
$7,948.70 |
— |
| MRA head w & w/o contrast (70546) |
— |
$8,377.85 |
— |
| MRA head w/contrast (70545) |
— |
$6,647.50 |
— |
| MRA head w/o contrast (70544) |
— |
$5,415.15 |
— |
| MRA neck w/contrast (70548) |
— |
$6,647.50 |
— |
| MRA neck w/o contrast (70547) |
— |
$5,415.15 |
— |
| MRA neck w/wo contrast (70549) |
— |
$8,377.85 |
— |
| MRI abdomen w/contrast (74182) |
— |
$6,647.50 |
— |
| MRI abdomen w/o & w/contrast material (74183) |
— |
$8,377.85 |
— |
| MRI abdomen w/o contrast (74181) |
— |
$5,415.15 |
— |
| MRI any jnt lwr ext with con lt (73722) |
— |
$6,647.50 |
— |
| MRI breast without contrast bilateral (77047) |
— |
$5,415.15 |
— |
| MRI breast without contrast material unilateral (77046) |
— |
$5,415.15 |
— |
| MRI cervical spine w/o contrast (72141) |
— |
$5,415.15 |
— |
| MRI cervical spine with contrast (72142) |
— |
$6,647.50 |
— |
| MRI chest w & w/o contrast (71552) |
— |
$8,377.85 |
— |
| MRI chest w/contrast (71551) |
— |
$6,647.50 |
— |
| MRI chest w/o contrast (71550) |
— |
$5,415.15 |
— |
| MRI joint upper ext w/contrast (73222) |
— |
$6,647.50 |
— |
| MRI joint upr extr w/o&w/dye (73223) |
— |
$8,377.85 |
— |
| MRI joint upr extrem w/o dye (73221) |
— |
$5,415.15 |
— |
| Mri Lower Extremity W/O Dye (73718) |
— |
$7,290.84 |
— |
| MRI lumbar spine with contrast (72149) |
— |
$6,647.50 |
— |
| MRI lumbar w/wo contrast (72158) |
— |
$8,377.85 |
— |
| MRI lwr ext w/o jnts with con rt (73719) |
— |
$6,647.50 |
— |
| MRI orbit/face/neck w/contrast (70542) |
— |
$6,647.50 |
— |
| MRI orbit/face/neck w/o & w/contrast (70543) |
— |
$8,377.85 |
— |
| MRI orbit/face/neck w/o contrast (70540) |
— |
$5,415.15 |
— |
| MRI pelvis w/ contrast (72196) |
— |
$6,647.50 |
— |
| MRI pelvis w/o contrast (72195) |
— |
$5,415.15 |
— |
| MRI pelvis w/wo contrast (72197) |
— |
$8,377.85 |
— |
| MRI spine cervical wo/w contrast (72156) |
— |
$8,377.85 |
— |
| MRI spine thoracic w/contrast (72147) |
— |
$6,647.50 |
— |
| MRI thoracic spine w wo contrast (72157) |
— |
$8,377.85 |
— |
| MRI thoracic spine w/o contrast (72146) |
— |
$5,415.15 |
— |
| MRI tmj (70336) |
— |
$5,415.15 |
— |
| MRI upper extremity oth than jt w/o contr matrl (73218) |
— |
$5,415.15 |
— |
| Mri Upper Extremity W/Dye (73219) |
— |
$6,647.50 |
— |
| MRI upr ext w/o jnts w/o-w/con rt (73220) |
— |
$8,377.85 |
— |
| Myocardial perfusion planar multiple studies (78454) |
— |
$8,413.03 |
— |
| Myocardial spect single study at rest or stress (78451) |
— |
$8,243.21 |
— |
| Nm bone 3 phase (78315) |
— |
$7,436.94 |
— |
| Nm bone imaging whole body (78306) |
— |
$6,560.30 |
— |
| Nm heart perfusion spect stress rest (78452) |
— |
$13,797.58 |
— |
| Nm lymph system (78195) |
— |
$6,541.94 |
— |
| Nose to rectum for fb child (76010) |
— |
$1,080.12 |
— |
| Ob us < 14 wks single fetus (76801) |
— |
$1,562.05 |
— |
| Parathyroid imaging (78070) |
— |
$2,662.83 |
— |
| PET imaging CT attenuation skull base mid-thigh (78815) |
— |
$8,892.66 |
— |
| PET imaging for CT attenuation whole body (78816) |
— |
$8,892.66 |
— |
| Radex abscess/fistula/sinus tract rs&i (76080) |
— |
$4,041.28 |
— |
| Radex Entir Thrc Lmbr Crv Sac Spi W/Skull 1 Vw - Xr Scoliosis 1 Vw (72081) |
— |
$995.98 |
— |
| Radex entir thrc lmbr crv sac spi w/skull 2/3 vw (72082) |
— |
$1,991.96 |
— |
| Radex entir thrc lmbr crv sac spi w/skull 4/5 vw (72083) |
— |
$1,991.96 |
— |
| Radex entir thrc lmbr crv sac spi w/skull 6/> vw (72084) |
— |
$1,991.96 |
— |
| Radex hip unilateral with pelvis 1 view (73501) |
— |
$530.12 |
— |
| Radex hip unilateral with pelvis 2-3 views (73502) |
— |
$1,062.53 |
— |
| Radex hip unilateral with pelvis minimum 4 views (73503) |
— |
$1,594.18 |
— |
| Radex hips bilateral with pelvis 2 views (73521) |
— |
$1,152.80 |
— |
| Radex hips bilateral with pelvis minimum 5 views (73523) |
— |
$2,305.59 |
— |
| Radex spine cervical 2 or 3 views (72040) |
— |
$1,158.15 |
— |
| Radex spine cervical 4 or 5 views (72050) |
— |
$2,364.49 |
— |
| Radex spine cervical 6 or more views (72052) |
— |
$2,280.35 |
— |
| Radiologic Exam Chest 4+ Views - Xr Chest 4+ Views (71048) |
— |
$1,299.67 |
— |
| Radiologic exam upr gi trc double contrast study (74246) |
— |
$3,455.15 |
— |
| Radiologic exam upr gi trc single contrast study (74240) |
— |
$3,344.76 |
— |
| Radiologic Examination Femur 1 View - Xr Femur 1 Vw Right (73551) |
— |
$686.93 |
— |
| Radiologic Examination Femur Minimum 2 Views - Xr Femur 2+ Vw Lt (73552) |
— |
$2,058.89 |
— |
| Radiologic examination, complete acute abdomen series, including 2 or more views of the abdomen (eg, supine, erect,… (74022) |
— |
$2,244.72 |
— |
| Radiologic examination, spine; thoracic, minimum of 4 views Other Diagnostic Radiology FS (72074) |
— |
$2,278.82 |
— |
| Rp loclzj tum plnr 1 area single day imaging (78800) |
— |
$3,130.22 |
— |
| Rp loclzj tum plnr whole body single day imaging (78802) |
— |
$5,435.81 |
— |
| Rp loclzj tum spect 1 area single day imaging (78803) |
— |
$9,193.29 |
— |
| Saline infused sonohysterogram (76831) |
— |
$2,792.10 |
— |
| Screening digital breast tomosynthesis; bilateral (77063) |
— |
$1,014.34 |
— |
| Shoulder arthrogram (73040) |
— |
$5,109.93 |
— |
| Small bowel series (74250) |
— |
$2,354.55 |
— |
| Thyroid uptake w/blood flow sngle/mult quan meas (78014) |
— |
$3,362.77 |
— |
| Ultrasound breast limited (76642) |
— |
$2,082.60 |
— |
| Ultrasound, abdomen limited (76705) |
— |
$2,426.45 |
— |
| Urethrocystography retrograde rs&i (74450) |
— |
$7,290.07 |
— |
| Urethrocystography voiding (74455) |
— |
$7,290.07 |
— |
| Urography antegrade (74425) |
— |
$6,776.78 |
— |
| Us abdominal aorta real time screen study aaa (76706) |
— |
$3,139.40 |
— |
| Us breast uni real time with image complete (76641) |
— |
$5,553.61 |
— |
| Us chest (76604) |
— |
$1,562.05 |
— |
| Us compl joint r-t w/image documentation (76881) |
— |
$2,327.01 |
— |
| Us encephalogram (76506) |
— |
$1,617.89 |
— |
| Us guided compression repair (76936) |
— |
$1,302.73 |
— |
| Us inft hips r-t img dynamic req phys/qhp manj (76885) |
— |
$1,966.71 |
— |
| Us lmtd jt/fcl eval nonvasc xtr strux r-t w/img (76882) |
— |
$1,161.97 |
— |
| Us ob detailed single fetus (76811) |
— |
$3,003.23 |
— |
| Us ob limited 1 or more fetuses (76815) |
— |
$1,382.28 |
— |
| Us obstetric transvaginal (76817) |
— |
$1,562.05 |
— |
| Us pelvic limited or f/u non-ob (76857) |
— |
$1,321.09 |
— |
| Us pelvis complete (76856) |
— |
$2,768.39 |
— |
| Us retroperitoneal complete (76770) |
— |
$3,139.40 |
— |
| Us retroperitoneal limited (76775) |
— |
$3,078.20 |
— |
| Us scrotum (76870) |
— |
$1,785.42 |
— |
| Us soft tissue head/neck (76536) |
— |
$3,003.23 |
— |
| Us spinal canal (76800) |
— |
$1,382.28 |
— |
| Us transrectal (76872) |
— |
$1,382.28 |
— |
| Us unlstd proc (76999) |
— |
$952.38 |
— |
| Vein X-ray liver w/hemodynam (75885) |
— |
$3,061.80 |
— |
| Venogram extremity bilateral (75822) |
— |
$1,869.56 |
— |
| Venogram ivc w serialography (75825) |
— |
$6,917.53 |
— |
| Venogram svc w serialography (75827) |
— |
$2,219.92 |
— |
| Venography ext unilateral (75820) |
— |
$2,092.17 |
— |
| Venography renal unilateral selective rs&i (75831) |
— |
$2,785.22 |
— |
| Venography venous sinus/jugular cath rs&i (75860) |
— |
$4,431.70 |
— |
| Venous sampling by catheter (75893) |
— |
$4,492.61 |
— |
| X-Ray Ac Jts - Xr Acromioclavicular Joints Bilateral (73050) |
— |
$958.50 |
— |
| X-Ray Ankle 3+ Vw - Xr Ankle 3+ Views Right (73610) |
— |
$1,934.58 |
— |
| X-ray aorta leg arteries (75630) |
— |
$6,519.75 |
— |
| X-Ray Colon Air Contrast - Fl Barium Enema Air Contrast (74280) |
— |
$4,592.06 |
— |
| X-Ray Elbow 3+ Vw - Xr Elbow 3+ Views Right (73080) |
— |
$2,043.98 |
— |
| X-ray exam hips bi 3-4 views (73522) |
— |
$1,152.80 |
— |
| X-ray exam of finger(s) (73140) |
— |
$1,106.90 |
— |
| X-Ray Facial Bones <3 Vw - Xr Facial Bones 1-2 Views (70140) |
— |
$635.68 |
— |
| X-Ray Foot 2 Vw - Xr Foot 1-2 Views Right (73620) |
— |
$904.18 |
— |
| X-Ray Foot 3+ Vw - Xr Foot 3+ Views Right (73630) |
— |
$1,279.78 |
— |
| X-Ray Hand 2 Vw - Xr Hand 1-2 Views Right (73120) |
— |
$995.98 |
— |
| X-Ray Hand 3+ Vw - Xr Hand 3+ Views Right (73130) |
— |
$1,312.67 |
— |
| X-Ray Heel - Xr Calcaneus 2 Views Right (73650) |
— |
$917.95 |
— |
| X-Ray Knee 3 View - Xr Knee 3 Views Right (73562) |
— |
$1,344.80 |
— |
| X-Ray Knee 4+ View - Xr Knee 4+ Views Right (73564) |
— |
$1,458.02 |
— |
| X-Ray Knee Bilat Standing - Xr Knees Anteroposterior Standing Bilat (73565) |
— |
$975.32 |
— |
| X-Ray Lumbar Spine 2/3 Vw - Xr Lumbar Spine 2-3 Views (72100) |
— |
$1,468.73 |
— |
| X-Ray Lumbar Spine 6+ Vw - Xr Lumbar Spine 6+ Vws Including Bending (72114) |
— |
$2,131.94 |
— |
| X-Ray Mastoids 3+ Vw - Xr Mastoids 3+ Views (70130) |
— |
$1,395.29 |
— |
| X-Ray Ribs, Chest 4+ Vw - Xr Ribs 3 Vws Bil W/ Chest Posteroanterior (71111) |
— |
$1,822.90 |
— |
| X-Ray Sacroiliac Jts 3+ Vw - Xr Sacroiliac Joints 3+ Views (72202) |
— |
$1,315.73 |
— |
| X-Ray Sacroiliac Jts <3 Vw - Xr Sacroiliac Joints 1-2 Views (72200) |
— |
$1,152.80 |
— |
| X-Ray Sacrum/Coccyx 2+ Vw - Xr Sacrum Coccyx 2+ Views (72220) |
— |
$1,152.80 |
— |
| X-Ray Shoulder 2+ Vw - Xr Shoulder 2+ Views Right (73030) |
— |
$1,288.96 |
— |
| X-Ray Sinuses 3+ Vw - Xr Paranasal Sinuses 3+ Views (70220) |
— |
$1,695.92 |
— |
| X-Ray Skull 4+ Vw - Xr Skull Complete 4+ Views (70260) |
— |
$1,695.92 |
— |
| X-Ray Skull <4 Vw - Xr Skull 1-3 Views (70250) |
— |
$1,146.68 |
— |
| X-Ray Toe(S) - Xr Toes 2+ Views Right (73660) |
— |
$1,106.90 |
— |
| X-Ray Wrist 2 Vw - Xr Wrist 1-2 Views Right (73100) |
— |
$1,036.52 |
— |
| X-Ray Wrist 3+ Vw - Xr Wrist 3+ Views Right (73110) |
— |
$1,295.84 |
— |
| Xr abdomen 1 view (74018) |
— |
$1,468.73 |
— |
| Xr abdomen 2 views (74019) |
— |
$1,505 |
— |
| Xr abdomen 3 views (74021) |
— |
$1,577.35 |
— |
| Xr arthrogram ankle (73615) |
— |
$5,389.15 |
— |
| Xr arthrogram elbow (73085) |
— |
$4,821.54 |
— |
| Xr arthrogram hip (73525) |
— |
$5,731.08 |
— |
| Xr bone density axial (77080) |
— |
$857.52 |
— |
| Xr bone length study (77073) |
— |
$1,324.91 |
— |
| Xr bone survey infant (77076) |
— |
$1,587.29 |
— |
| Xr chest 1 view (71045) |
— |
$739.72 |
— |
| Xr chest 2 views (71046) |
— |
$940.14 |
— |
| Xr chest 3 views (71047) |
— |
$1,299.67 |
— |
| Xr cystogram 3+ views (74430) |
— |
$4,380.93 |
— |
| Xr eye foreign body (70030) |
— |
$934.02 |
— |
| Xr facial bones 3 views (70150) |
— |
$1,822.90 |
— |
| Xr lower extremity 2 views infant (73592) |
— |
$1,788.48 |
— |
| Xr lumbar spine 4 views w/ flex ext (72120) |
— |
$1,468.73 |
— |
| Xr mandible 4 views (70110) |
— |
$2,134.24 |
— |
| Xr nasal bones (70160) |
— |
$1,146.68 |
— |
| Xr pelvis 3 views (72190) |
— |
$1,471.79 |
— |
| Xr sialogram (70390) |
— |
$3,934.19 |
— |
| Xr spine 1 view (72020) |
— |
$339.64 |
— |
| Xr sternum 2 views (71120) |
— |
$820.04 |
— |
| Xr surgical specimen (76098) |
— |
$940.14 |
— |
| Xr upper extremity 2 views infant (73092) |
— |
$1,788.48 |
— |
| Xray elbow 2 views (73070) |
— |
$1,539.48 |
— |
| Xray forearm 2 views (73090) |
— |
$1,361.63 |
— |
| Xray knee 1 or 2 views rt (73560) |
— |
$975.32 |
— |
| Xray neck soft tissue (70360) |
— |
$1,361.63 |
— |
| Xray orbits complete min 4 views (70200) |
— |
$1,353.98 |
— |
| Xray pelvis 1 or 2 views (72170) |
— |
$989.09 |
— |
| Xray ribs unilat w/ pa chest 3v rt (71101) |
— |
$1,360.10 |
— |
| Xray scapula complete (73010) |
— |
$1,120.67 |
— |
| Xray shoulder 1 view (73020) |
— |
$649.45 |
— |
| Xray sinuses paranasal <3 views (70210) |
— |
$1,080.12 |
— |
| Xray spine thoracic 2 views (72070) |
— |
$1,240 |
— |
| Xray spine thoracic 3 views (72072) |
— |
$1,861.15 |
— |
| Xray tibia-fibula 2 views bil (73590) |
— |
$1,240 |
— |
| Xray tmj's bilateral open-clsc (70330) |
— |
$1,382.28 |
— |