| Abdomen 2 views (74019) |
— |
$499 |
— |
| Ankle 2 views (73600) |
— |
$329.50 |
— |
| Arthrogram hip (73525) |
— |
$888 |
— |
| Bone age studies (77072) |
— |
$345 |
— |
| Cervical spine 2 or 3 views (72040) |
— |
$381 |
— |
| Chest 1 view (71045) |
— |
$255 |
— |
| Chest 3 views (71047) |
— |
$244 |
— |
| Clavicle complete (73000) |
— |
$341 |
— |
| Computed Tomography Thorax Lw Dose Lng Ca Scr C- (71271) |
— |
$319 |
— |
| CT abdomen and pelvis without and with contrast (74178) |
— |
$1,452 |
— |
| CT abdomen and pelvis without contrast (74176) |
— |
$3,207 |
— |
| CT abdomen w contrast (74160) |
— |
$1,275 |
— |
| CT abdomen w wo contrast (74170) |
— |
$1,530 |
— |
| CT abdomen w/o contrast (74150) |
— |
$1,295 |
— |
| CT angiography upper extremity lt (73206) |
— |
$1,389 |
— |
| CT c-spine w/o contrast (72125) |
— |
$2,388 |
— |
| CT cervical spine w&w/o contrast (72127) |
— |
$2,696 |
— |
| CT cervical spine with contrast (72126) |
— |
$2,439 |
— |
| CT chest w/wo contrast (71270) |
— |
$3,163 |
— |
| CT chest with contrast (71260) |
— |
$1,812 |
— |
| CT head/brain with contrast (70460) |
— |
$1,530 |
— |
| CT head/brain without and with contrast (70470) |
— |
$1,553 |
— |
| CT iac w contrast (70481) |
— |
$2,513 |
— |
| CT limited/localized follow up study (76380) |
— |
$1,364 |
— |
| CT lower ext w/o (73700) |
— |
$2,057 |
— |
| CT lower extremity w wo contrast (73702) |
— |
$1,422 |
— |
| CT lower extremity with contrast (73701) |
— |
$2,569 |
— |
| CT lumbar spine w & w/o contrast (72133) |
— |
$1,361 |
— |
| CT lumbar spine w/o contrast (72131) |
— |
$2,341 |
— |
| CT lumbar spine with contrast (72132) |
— |
$1,553 |
— |
| CT maxillofacial w contrast (70487) |
— |
$2,118 |
— |
| CT maxillofacial w/o contrast (70486) |
— |
$1,797 |
— |
| CT maxillofacial w/wo contrast (70488) |
— |
$1,382 |
— |
| CT neck soft tissue w contrast (70491) |
— |
$2,689 |
— |
| CT orbit sella/post fossa/ear w/o & w/contr matr (70482) |
— |
$1,586.50 |
— |
| CT orbits w/o contrast (70480) |
— |
$2,362 |
— |
| CT pelvis w & w/o contrast (72194) |
— |
$1,530 |
— |
| CT pelvis w/o contrast (72192) |
— |
$1,771 |
— |
| CT soft tissue neck w/o & w/contrast material (70492) |
— |
$1,382 |
— |
| CT soft tissue neck w/o contrast (70490) |
— |
$2,124 |
— |
| CT thoracic spine w/contrast (72129) |
— |
$1,313 |
— |
| CT thoracic spine w/o contrast (72128) |
— |
$2,418 |
— |
| CT thoracic spine w/wo contrast (72130) |
— |
$1,531 |
— |
| CT thorax w/o contrast (71250) |
— |
$1,983 |
— |
| CT upper extremity w/o & w/contrast material (73202) |
— |
$783 |
— |
| CT upper extremity w/o contrast rt (73200) |
— |
$1,866 |
— |
| CT upper extremity with contrast (73201) |
— |
$1,363 |
— |
| Cta Abdl Aorta&Bi Iliofem W/Contrast&Postp (75635) |
— |
$1,553 |
— |
| Cta Abdomen (74175) |
— |
$1,530 |
— |
| CTA abdomen pelvis (74174) |
— |
$3,250 |
— |
| CTA chest (71275) |
— |
$3,153 |
— |
| Cta Head (70496) |
— |
$1,410 |
— |
| CTA lwr ext w&w/o contrast (73706) |
— |
$1,339.50 |
— |
| Cta Neck (70498) |
— |
$1,812 |
— |
| Cta Pelvis (72191) |
— |
$1,530 |
— |
| Dxa bone density study 1/> sites axial skel (77080) |
— |
$333 |
— |
| Foot 2 views (73620) |
— |
$320 |
— |
| Forearm 2 views (73090) |
— |
$401 |
— |
| Hand 2 views (73120) |
— |
$286.50 |
— |
| Hand 3 views (73130) |
— |
$412 |
— |
| Humerus Min 2 Views Left (73060) |
— |
$333.50 |
— |
| Joint Survey, Single View - Xr Joint Anteroposterior 2+ Joints (77077) |
— |
$206 |
— |
| Knee 3 views (73562) |
— |
$465 |
— |
| Manual appl stress pfrmd phys/qhp joint films (77071) |
— |
$135.50 |
— |
| MRA head w/o contrast (70544) |
— |
$3,341 |
— |
| MRA neck w contrast (70548) |
— |
$1,720 |
— |
| Mra Neck W/O &W/Contrast Material (70549) |
— |
$2,207 |
— |
| MRA neck w/o contrast (70547) |
— |
$1,232 |
— |
| MRI abdomen w contrast (74182) |
— |
$1,777 |
— |
| MRI abdomen w/o & w/contrast material (74183) |
— |
$4,507 |
— |
| MRI abdomen w/o contrast (74181) |
— |
$893 |
— |
| MRI any jnt lwr ext with con lt (73722) |
— |
$1,442 |
— |
| MRI c-spine with contrast (72142) |
— |
$1,604 |
— |
| MRI cervical spine w/o contrast (72141) |
— |
$3,167 |
— |
| MRI chest w/o & w/contrast material (71552) |
— |
$2,392 |
— |
| MRI chest w/o contrast (71550) |
— |
$2,534 |
— |
| MRI chest with contrast (71551) |
— |
$2,568 |
— |
| MRI Forearm w/ Contrast Bilateral 73219 (73219) |
— |
$1,591 |
— |
| MRI lower extrem oth/thn jt w/contrast matrl (73719) |
— |
$1,704 |
— |
| MRI lower extrem oth/thn jt w/o contr matrl (73718) |
— |
$2,752 |
— |
| MRI orbit face &/neck w/o contrast (70540) |
— |
$1,864 |
— |
| MRI orbit/face/neck w&w/o cont (70543) |
— |
$3,940 |
— |
| MRI orbit/face/neck w/contrast (70542) |
— |
$1,591 |
— |
| MRI pelvis w contrast (72196) |
— |
$1,530 |
— |
| MRI pelvis w/o & w/contrast material (72197) |
— |
$2,573 |
— |
| MRI pelvis w/o contrast (72195) |
— |
$3,491 |
— |
| MRI scan of arm joint before and after contrast (73223) |
— |
$2,295 |
— |
| MRI scan of leg joint before and after contrast (73723) |
— |
$2,238 |
— |
| MRI spinal canal cervical w/o & w/contr matrl (72156) |
— |
$4,553 |
— |
| MRI spinal canal lumbar w/contrast material (72149) |
— |
$1,549 |
— |
| MRI spinal canal lumbar w/o & w/contr matrl (72158) |
— |
$4,395 |
— |
| MRI spinal canal thoracic w/contrast matrl (72147) |
— |
$1,836 |
— |
| MRI spinal canal thoracic w/o & w/contr matrl (72157) |
— |
$2,506 |
— |
| MRI thoracic spine w/o contrast (72146) |
— |
$3,376 |
— |
| MRI tmj (70336) |
— |
$3,190 |
— |
| MRI upper ext joint w/o contrast (73221) |
— |
$2,534 |
— |
| MRI upper extrem other than jt w/o & w/contras (73220) |
— |
$2,015 |
— |
| MRI upper extremity oth than jt w/o contr matrl (73218) |
— |
$2,037 |
— |
| Neck soft tissue (70360) |
— |
$342 |
— |
| Ob Us Follow-Up Per Fetus - Us Ob Follow Up Transabdominal Approach (76816) |
— |
$294 |
— |
| Pelvis 1 or 2 views (72170) |
— |
$333.50 |
— |
| Pr MRI, lower extr, w/o contrast f/u by contrast (73720) |
— |
$2,295 |
— |
| Radex Entir Thrc Lmbr Crv Sac Spi W/Skull 1 Vw - Xr Scoliosis 1 Vw (72081) |
— |
$190 |
— |
| Radex entir thrc lmbr crv sac spi w/skull 2/3 vw (72082) |
— |
$356 |
— |
| Radex hips bilateral with pelvis 2 views (73521) |
— |
$527 |
— |
| Radex mastoids compl minimum 3 views pr side (70130) |
— |
$206 |
— |
| Radex X-Ray Exam Entire Spi 6/> Vw - Xr Entire Spine 6+ Vw (72084) |
— |
$209 |
— |
| Radiolog exam mandible compl minimum 4 views (70110) |
— |
$514 |
— |
| Radiologic Exam Abdomen 1 View - Xr Abdomen 1 View (74018) |
— |
$267 |
— |
| Radiologic Exam Abdomen 3+ Views - Xr Abdomen 3+ Views (74021) |
— |
$459 |
— |
| Radiologic Exam Chest 2 Views - Xr Chest 2 Views (71046) |
— |
$356 |
— |
| Radiologic Examination Femur Minimum 2 Views - Xr Femur 2+ Vw Lt (73552) |
— |
$305.50 |
— |
| Sacroiliac Joints < 3 Views (72200) |
— |
$278 |
— |
| Scanogram (77073) |
— |
$319 |
— |
| Scapula complete (73010) |
— |
$424.50 |
— |
| Sella turcica (70240) |
— |
$56 |
— |
| Spine thoracic 3 views (72072) |
— |
$523 |
— |
| Thoracolumbar 2 views (72080) |
— |
$84 |
— |
| Tmj unilateral (70328) |
— |
$62.50 |
— |
| Ultrasound, abdomen limited (76705) |
— |
$668 |
— |
| Upper Extremity Infant (73092) |
— |
$206 |
— |
| Us abdl aorta screen aaa (76706) |
— |
$397 |
— |
| Us chest (76604) |
— |
$508 |
— |
| Us compl joint r-t w/image documentation (76881) |
— |
$723 |
— |
| Us fetal nuchal translucency 1st gestation (76813) |
— |
$294 |
— |
| Us kidney transplant (76776) |
— |
$1,869 |
— |
| Us ob detailed single fetus (76811) |
— |
$655 |
— |
| Us ob transvaginal (76817) |
— |
$749 |
— |
| Us pelvic non ob complete (76856) |
— |
$909 |
— |
| Us pelvic nonobstetric image dcmtn limited/f/u (76857) |
— |
$311 |
— |
| Us pregnancy ltd (76815) |
— |
$414 |
— |
| Us pregnant uterus 14 wk transabdl 1/1st gestat (76801) |
— |
$798 |
— |
| Us retroperitoneal complete (76770) |
— |
$877 |
— |
| Us retroperitoneal limited (76775) |
— |
$790 |
— |
| Us scrotum and contents (76870) |
— |
$850 |
— |
| Us soft tissue head/neck (76536) |
— |
$415 |
— |
| Us spinal canal and contents (76800) |
— |
$244 |
— |
| Us xtr non-vasc lmtd (76882) |
— |
$723 |
— |
| Wrist 2 views (73100) |
— |
$320.50 |
— |
| X-Ray Abdomen,Comp Acute Series - Xr Abdomen 2 Vws With Chest 1 View (74022) |
— |
$484 |
— |
| X-Ray Ac Jts - Xr Acromioclavicular Joints Bilateral (73050) |
— |
$366 |
— |
| X-Ray Ankle 3+ Vw - Xr Ankle 3+ Views Right (73610) |
— |
$419 |
— |
| X-Ray Elbow 2 Vw - Xr Elbow 1-2 Views Right (73070) |
— |
$337 |
— |
| X-Ray Elbow 3+ Vw - Xr Elbow 3+ Views Right (73080) |
— |
$426 |
— |
| X-ray exam hip uni 1 view (73501) |
— |
$194 |
— |
| X-Ray Exam Hip Uni 2-3 Views (73502) |
— |
$274 |
— |
| X-ray exam hip uni 4/> views (73503) |
— |
$294 |
— |
| X-Ray Exam Hips Bi 3-4 Views (73522) |
— |
$455 |
— |
| X-Ray Exam Hips Bi 5/> Views (73523) |
— |
$588 |
— |
| X-ray exam of femur 1 (73551) |
— |
$79 |
— |
| X-ray eye for foreign body (70030) |
— |
$206 |
— |
| X-Ray Facial Bones 3+ Vw - Xr Facial Bones 3+ Views (70150) |
— |
$63 |
— |
| X-Ray Facial Bones <3 Vw - Xr Facial Bones 1-2 Views (70140) |
— |
$259 |
— |
| X-Ray Foot 3+ Vw - Xr Foot 3+ Views Right (73630) |
— |
$415 |
— |
| X-Ray Heel - Xr Calcaneus 2 Views Right (73650) |
— |
$258 |
— |
| X-Ray Jaw <4 Vw - Xr Mandible < 4 Views (70100) |
— |
$186 |
— |
| X-Ray Knee 4+ View - Xr Knee 4+ Views Right (73564) |
— |
$524 |
— |
| X-Ray Knee Bilat Standing - Xr Knees Anteroposterior Standing Bilat (73565) |
— |
$59 |
— |
| X-Ray Leg, Infant - Xr Lower Extremity 2+ Views Infant Left (73592) |
— |
$206 |
— |
| X-Ray Lumbar Spine 2/3 Vw - Xr Lumbar Spine 2-3 Views (72100) |
— |
$557 |
— |
| X-Ray Lumbar Spine 6+ Vw - Xr Lumbar Spine 6+ Vws Including Bending (72114) |
— |
$143 |
— |
| X-Ray Lumbar Spine Flex/Exten - Xr Lumbar Spine 4+ Views W/ Flex Ext (72120) |
— |
$277 |
— |
| X-Ray Nasal Bones - Xr Nasal Bones (70160) |
— |
$259 |
— |
| X-Ray Nose-Rectum Child F.B. - Xr Nose to Rectum Foreign Body Peds (76010) |
— |
$186 |
— |
| X-Ray Orbits - Xr Orbits Complete 4+ Views (70200) |
— |
$552.50 |
— |
| X-Ray Pelvis 3+ Vw - Xr Pelvis 3+ Views (72190) |
— |
$476 |
— |
| X-Ray Ribs 2 Vw Unilat - Xr Ribs 2 Views Right (71100) |
— |
$357 |
— |
| X-Ray Ribs, Chest 3+ Vw - Xr Ribs 2 Vws Lt W/ Chest Anteroposterior (71101) |
— |
$445 |
— |
| X-Ray Ribs, Chest 4+ Vw - Xr Ribs 3 Vws Bil W/ Chest Posteroanterior (71111) |
— |
$408 |
— |
| X-Ray Sacroiliac Jts 3+ Vw - Xr Sacroiliac Joints 3+ Views (72202) |
— |
$437 |
— |
| X-Ray Sacrum/Coccyx 2+ Vw - Xr Sacrum Coccyx 2+ Views (72220) |
— |
$349 |
— |
| X-Ray Shoulder 2+ Vw - Xr Shoulder 2+ Views Right (73030) |
— |
$373 |
— |
| X-Ray Sinuses 3+ Vw - Xr Paranasal Sinuses 3+ Views (70220) |
— |
$210 |
— |
| X-Ray Sinuses <3 Vw - Xr Paranasal Sinuses 1-2 Views (70210) |
— |
$208 |
— |
| X-Ray Skull 4+ Vw - Xr Skull Complete 4+ Views (70260) |
— |
$312 |
— |
| X-Ray Skull <4 Vw - Xr Skull 1-3 Views (70250) |
— |
$337 |
— |
| X-Ray Spine One View - Xr Spine (72020) |
— |
$156 |
— |
| X-Ray Sterno-Clavicluar Jt - Xr Sternoclavicular Joints 3+ Views (71130) |
— |
$86 |
— |
| X-Ray Sternum 2+ Vw - Xr Sternum 2+ Views (71120) |
— |
$208 |
— |
| X-Ray Thoracic Spine 2 Vw - Xr Thoracic Spine 2 Views (72070) |
— |
$397 |
— |
| X-Ray Toe(S) - Xr Toes 2+ Views Right (73660) |
— |
$284 |
— |
| X-Ray Wrist 3+ Vw - Xr Wrist 3+ Views Right (73110) |
— |
$425 |
— |
| Xr c-spine 6 or more views (72052) |
— |
$846.50 |
— |
| Xr chest 4+ views (71048) |
— |
$98 |
— |
| Xr finger(s) 2+ views (73140) |
— |
$296 |
— |
| XR Mastoids < 3 Views Bilateral (70120) |
— |
$206 |
— |
| Xr shoulder 1 view (73020) |
— |
$288.50 |
— |
| Xr spine cervical 4 or 5 views (72050) |
— |
$481 |
— |
| Xr tibia/fibula 2 views (73590) |
— |
$400 |
— |
| Xr tmj bilateral (70330) |
— |
$97 |
— |
| Xray knee 1 or 2 views rt (73560) |
— |
$453 |
— |