| Abdomen 2 views (74019) |
— |
$762 |
— |
| Acute gastrointestinal blood loss imaging (78278) |
— |
$1,995 |
— |
| Angiography Adrenal Bilateral Slctv Rs&I (75733) |
— |
$6,677 |
— |
| Angiography extremity bilateral rs&i (75716) |
— |
$9,750 |
— |
| Angiography extremity unilateral rs&i (75710) |
— |
$6,500 |
— |
| Angiography internal mammary rs&i (75756) |
— |
$5,578 |
— |
| Angiography pelvic slctv/supraslctv rs&i (75736) |
— |
$9,650 |
— |
| Angiography pulmonary bilateral slctv rs&i (75743) |
— |
$6,435 |
— |
| Angiography pulmonary unilateral slctv rs&i (75741) |
— |
$5,578 |
— |
| Angiography Spinal Selective Rs&I (75705) |
— |
$9,650 |
— |
| Angiography visceral slctv/supraslctv rs&i (75726) |
— |
$9,650 |
— |
| Angrph Cath F-Up Std Tcat Other Than Thrombylsis (75898) |
— |
$8,500 |
— |
| Angrph pulmonary nonslctv cath/ven njx rs&i (75746) |
— |
$2,844 |
— |
| Ankle 2 views (73600) |
— |
$522 |
— |
| Antegrade urography radiological supvj & interpj (74425) |
— |
$1,228 |
— |
| Aortogram thoracic (75605) |
— |
$9,650 |
— |
| Aortography abdl bi iliofem low extrem cath rs&i (75630) |
— |
$7,336 |
— |
| Aortography abdominal serialography rs&i (75625) |
— |
$6,760 |
— |
| Aortography thoracic w/o serialography rs&i (75600) |
— |
$6,435 |
— |
| Artery X-Rays Adrenal Gland (75731) |
— |
$5,578 |
— |
| Arthrogram elbow (73085) |
— |
$1,170 |
— |
| Arthrogram hip (73525) |
— |
$1,228 |
— |
| Arthrogram shoulder (73040) |
— |
$1,841.50 |
— |
| Arthrogram wrist (73115) |
— |
$1,462.50 |
— |
| Arthrography knee lt (73580) |
— |
$1,625 |
— |
| Bone &/Joint Imaging Limited Area (78300) |
— |
$2,639 |
— |
| Bone &/joint imaging whole body (78306) |
— |
$3,217 |
— |
| Bone age studies (77072) |
— |
$484 |
— |
| Bone Imaging 3 Phase (78315) |
— |
$6,205 |
— |
| Bone Marrow Imaging Limited Area (78102) |
— |
$1,762 |
— |
| Bone survey complete (77075) |
— |
$1,585 |
— |
| Brain image w/flow 4 + views (78606) |
— |
$2,850 |
— |
| Brain Imaging Pet Metabolic Evaluation (78608) |
— |
$11,553 |
— |
| Brain Imaging Vascular Flow Only (78610) |
— |
$1,725 |
— |
| Card Bl Pool Gated Spect Rest Wal Motn Ejct Frct (78494) |
— |
$2,036 |
— |
| Cardiac MRI w/w/o contrast & further seq (75561) |
— |
$5,058 |
— |
| Cerebrospinal Fluid Flow W/O Matl Shunt Evaltj (78645) |
— |
$1,772 |
— |
| Cervical spine 2 or 3 views (72040) |
— |
$400 |
— |
| Chest 1 view (71045) |
— |
$561 |
— |
| Chest 3 views (71047) |
— |
$859 |
— |
| Cine/Vid X-Ray Throat/Esoph - Fl Esoph Barium Swlw W/ Video & Speech (74230) |
— |
$1,044 |
— |
| Clavicle complete (73000) |
— |
$400 |
— |
| Corpora cavernosography (74445) |
— |
$1,400 |
— |
| CT abdomen and pelvis without and with contrast (74178) |
— |
$6,017 |
— |
| CT abdomen and pelvis without contrast (74176) |
— |
$4,301 |
— |
| CT abdomen w contrast (74160) |
— |
$3,377 |
— |
| CT abdomen w wo contrast (74170) |
— |
$4,375 |
— |
| CT abdomen w/o contrast (74150) |
— |
$2,402 |
— |
| CT angio hrt w/3d image (75574) |
— |
$4,590 |
— |
| CT angiography upper extremity lt (73206) |
— |
$4,843 |
— |
| CT c-spine w/o contrast (72125) |
— |
$2,500 |
— |
| CT cervical spine with contrast (72126) |
— |
$4,875 |
— |
| CT chest w/wo contrast (71270) |
— |
$4,080 |
— |
| CT chest with contrast (71260) |
— |
$3,450 |
— |
| CT head/brain with contrast (70460) |
— |
$3,000 |
— |
| CT head/brain without and with contrast (70470) |
— |
$3,681 |
— |
| CT heart contrast eval cardiac structure&morph (75572) |
— |
$2,889 |
— |
| CT heart no contrast quant eval coronry calcium (75571) |
— |
$1,575 |
— |
| CT hrt w/3d image congen (75573) |
— |
$3,231 |
— |
| CT iac w contrast (70481) |
— |
$3,013 |
— |
| CT limited/localized follow up study (76380) |
— |
$1,313 |
— |
| CT lower ext w/o (73700) |
— |
$2,640 |
— |
| CT lower extremity w wo contrast (73702) |
— |
$3,920 |
— |
| CT lower extremity with contrast (73701) |
— |
$3,388 |
— |
| CT lumbar spine w & w/o contrast (72133) |
— |
$6,855 |
— |
| CT lumbar spine w/o contrast (72131) |
— |
$2,500 |
— |
| CT lumbar spine with contrast (72132) |
— |
$5,601 |
— |
| CT maxillofacial w contrast (70487) |
— |
$2,985 |
— |
| CT maxillofacial w/o contrast (70486) |
— |
$2,102 |
— |
| CT maxillofacial w/wo contrast (70488) |
— |
$3,938 |
— |
| CT neck soft tissue w contrast (70491) |
— |
$3,000 |
— |
| CT orbit sella/post fossa/ear w/o & w/contr matr (70482) |
— |
$4,040 |
— |
| CT orbits w/o contrast (70480) |
— |
$2,500 |
— |
| CT pelvis w & w/o contrast (72194) |
— |
$4,375 |
— |
| CT pelvis w/o contrast (72192) |
— |
$2,584 |
— |
| CT soft tissue neck w/o & w/contrast material (70492) |
— |
$3,987 |
— |
| CT soft tissue neck w/o contrast (70490) |
— |
$2,500 |
— |
| CT thoracic spine w/contrast (72129) |
— |
$4,230 |
— |
| CT thoracic spine w/o contrast (72128) |
— |
$2,500 |
— |
| CT thoracic spine w/wo contrast (72130) |
— |
$4,493 |
— |
| CT thorax w/o contrast (71250) |
— |
$2,630 |
— |
| CT unlisted procedure (76497) |
— |
$2,500 |
— |
| CT upper extremity w/o & w/contrast material (73202) |
— |
$4,301 |
— |
| CT upper extremity w/o contrast rt (73200) |
— |
$2,789 |
— |
| CT upper extremity with contrast (73201) |
— |
$3,076 |
— |
| Cta Abdl Aorta&Bi Iliofem W/Contrast&Postp (75635) |
— |
$3,125 |
— |
| Cta Abdomen (74175) |
— |
$7,465 |
— |
| CTA abdomen pelvis (74174) |
— |
$9,308 |
— |
| CTA chest (71275) |
— |
$4,284 |
— |
| Cta Head (70496) |
— |
$3,865 |
— |
| CTA lwr ext w&w/o contrast (73706) |
— |
$4,479 |
— |
| Cta Neck (70498) |
— |
$4,186 |
— |
| Cta Pelvis (72191) |
— |
$4,594 |
— |
| Cystography minimum 3 views rs&i (74430) |
— |
$1,453 |
— |
| Doppler Echo Fetal Puls Spectral F/U/Repeat (76828) |
— |
$850 |
— |
| Doppler Echo Fetal Spectral Display Complete (76827) |
— |
$1,051 |
— |
| Doppler Fetal Mid Cerebral Artery (76821) |
— |
$641 |
— |
| Dxa bone density study 1/> sites axial skel (77080) |
— |
$1,193 |
— |
| Dxa bone density study 1/>sites appendiclr skel (77081) |
— |
$493 |
— |
| Echo exam of fetal heart (76825) |
— |
$2,001 |
— |
| Echo fetal cardiovasc w/wo m-mode repeat std (76826) |
— |
$1,364 |
— |
| Echoencephalography real time imaging (76506) |
— |
$1,250 |
— |
| Esophageal motility (78258) |
— |
$2,175 |
— |
| Esophagus (74220) |
— |
$750 |
— |
| Fetal biophysical profile non-stress testing (76818) |
— |
$963 |
— |
| Fluoroscopy up to 1 hr (76000) |
— |
$750 |
— |
| Foot 2 views (73620) |
— |
$491 |
— |
| Forearm 2 views (73090) |
— |
$442 |
— |
| Functional MRI brain by phys/psych (70555) |
— |
$6,051 |
— |
| Functional MRI brain by tech (70554) |
— |
$3,500 |
— |
| Gated Heart Planar Single (78472) |
— |
$2,378 |
— |
| Hand 2 views (73120) |
— |
$400 |
— |
| Hand 3 views (73130) |
— |
$507 |
— |
| Hepatc vngrph wdg/fr w/o hemodyn eval rs&i (75891) |
— |
$6,098 |
— |
| Hepatobil Syst Imag Inc Gb W/Pharma Intervenj (78227) |
— |
$4,900 |
— |
| Hepatobiliary syst imaging including gallbladder (78226) |
— |
$3,893 |
— |
| Ht muscle image spect sing (78451) |
— |
$3,088 |
— |
| Humerus Min 2 Views Left (73060) |
— |
$461 |
— |
| Hysterosalpingogram (74740) |
— |
$750 |
— |
| Joint Survey, Single View - Xr Joint Anteroposterior 2+ Joints (77077) |
— |
$400 |
— |
| Kidney funcj study non-img radioisotopic study (78725) |
— |
$1,534 |
— |
| Kidney imaging morphology (78700) |
— |
$3,422 |
— |
| Kidney Img Morphology Vascular Flow 1 W/O Rx (78707) |
— |
$3,451 |
— |
| Kidney img morphology vascular flow 1 w/rx (78708) |
— |
$2,625 |
— |
| Kidney Img Morphology Vascular Flow Multiple (78709) |
— |
$3,821 |
— |
| Knee 3 views (73562) |
— |
$747 |
— |
| Liver & spleen imaging static only (78215) |
— |
$3,505 |
— |
| Liver imaging static only (78201) |
— |
$2,148 |
— |
| Lung perf&ventilat diferentl (78598) |
— |
$3,829 |
— |
| Lung perfusion differential (78597) |
— |
$1,971 |
— |
| Lung Ventilation Imaging (78579) |
— |
$1,725 |
— |
| Lymphangio Abd/Pelv Bilat - Ir Lymphangiogram Abdomen Pelvis Bilat (75807) |
— |
$8,775 |
— |
| Lymphangio extrem unilat - ir lymphangiogram extremity (75801) |
— |
$2,875 |
— |
| Lymphangiography extremity only bilateral rs&i (75803) |
— |
$5,210 |
— |
| Lymphangiography Pelvic/Abdominal Unilat Rs&I (75805) |
— |
$7,118 |
— |
| Lymphoscintigraphy (78195) |
— |
$3,493 |
— |
| Manual appl stress pfrmd phys/qhp joint films (77071) |
— |
$443 |
— |
| Meckels Diverticulum (78290) |
— |
$3,411 |
— |
| Mr elastography (76391) |
— |
$2,026 |
— |
| Mr safety determination physician/other qhp (76016) |
— |
$189 |
— |
| Mr safety implant pos&/immoblj supvj phys/qhp (76019) |
— |
$290 |
— |
| Mr safety implant&/fb assmt clin staf 1st 15 min (76014) |
— |
$53 |
— |
| Mr safety implt electronics prepj supvj phys/qhp (76018) |
— |
$196 |
— |
| Mr safety med physics xm customization plng&mntr (76017) |
— |
$516 |
— |
| MRA head w & w/o contrast (70546) |
— |
$4,000 |
— |
| MRA head w/o contrast (70544) |
— |
$2,800 |
— |
| MRA head with contrast (70545) |
— |
$3,400 |
— |
| MRA neck w contrast (70548) |
— |
$4,420 |
— |
| Mra Neck W/O &W/Contrast Material (70549) |
— |
$5,021 |
— |
| MRA neck w/o contrast (70547) |
— |
$2,800 |
— |
| MRI abdomen w contrast (74182) |
— |
$5,418 |
— |
| MRI abdomen w/o & w/contrast material (74183) |
— |
$5,763 |
— |
| MRI abdomen w/o contrast (74181) |
— |
$3,500 |
— |
| MRI any jnt lwr ext with con lt (73722) |
— |
$6,680 |
— |
| MRI any jt upper extremity w/contrast matrl (73222) |
— |
$4,457 |
— |
| MRI c-spine with contrast (72142) |
— |
$3,740 |
— |
| MRI cardiac w/o contrast (75557) |
— |
$4,158 |
— |
| MRI cervical spine w/o contrast (72141) |
— |
$3,080 |
— |
| MRI chest w/o & w/contrast material (71552) |
— |
$6,218 |
— |
| MRI chest w/o contrast (71550) |
— |
$3,321 |
— |
| MRI chest with contrast (71551) |
— |
$4,861 |
— |
| MRI fetal sngl/1st gestation (74712) |
— |
$3,320 |
— |
| MRI Forearm w/ Contrast Bilateral 73219 (73219) |
— |
$4,854 |
— |
| MRI lower extrem oth/thn jt w/contrast matrl (73719) |
— |
$4,930 |
— |
| MRI lower extrem oth/thn jt w/o contr matrl (73718) |
— |
$3,255 |
— |
| MRI orbit face &/neck w/o contrast (70540) |
— |
$3,169 |
— |
| MRI orbit/face/neck w&w/o cont (70543) |
— |
$5,000 |
— |
| MRI orbit/face/neck w/contrast (70542) |
— |
$4,337 |
— |
| MRI pelvis w contrast (72196) |
— |
$5,160 |
— |
| MRI pelvis w/o & w/contrast material (72197) |
— |
$6,237 |
— |
| MRI pelvis w/o contrast (72195) |
— |
$4,400 |
— |
| MRI scan of arm joint before and after contrast (73223) |
— |
$5,312 |
— |
| MRI scan of heart before and after contrast with stress imaging (75563) |
— |
$5,755 |
— |
| MRI scan of leg joint before and after contrast (73723) |
— |
$6,827 |
— |
| MRI spectroscopy (76390) |
— |
$2,682 |
— |
| MRI spinal canal cervical w/o & w/contr matrl (72156) |
— |
$5,362 |
— |
| MRI spinal canal lumbar w/contrast material (72149) |
— |
$3,740 |
— |
| MRI spinal canal lumbar w/o & w/contr matrl (72158) |
— |
$4,708 |
— |
| MRI spinal canal thoracic w/contrast matrl (72147) |
— |
$3,740 |
— |
| MRI spinal canal thoracic w/o & w/contr matrl (72157) |
— |
$5,256 |
— |
| MRI thoracic spine w/o contrast (72146) |
— |
$3,080 |
— |
| MRI tmj (70336) |
— |
$4,550 |
— |
| MRI upper ext joint w/o contrast (73221) |
— |
$3,500 |
— |
| MRI upper extrem other than jt w/o & w/contras (73220) |
— |
$5,484 |
— |
| MRI upper extremity oth than jt w/o contr matrl (73218) |
— |
$4,550 |
— |
| Myelogram Cervical (72240) |
— |
$2,025 |
— |
| Myelogram Lumbar (72265) |
— |
$2,188 |
— |
| Myelogram thoracic (72255) |
— |
$2,188 |
— |
| Myelography 2 or more regions (72270) |
— |
$2,428 |
— |
| Myocardial Spect Multiple Studies (78452) |
— |
$4,440 |
— |
| Neck soft tissue (70360) |
— |
$425 |
— |
| Nm bone marrow multiple (78103) |
— |
$1,828 |
— |
| Nm bone marrow wb (78104) |
— |
$1,950 |
— |
| Nm cisternogram (78630) |
— |
$2,184 |
— |
| Nm csf leak detection (78650) |
— |
$2,784 |
— |
| Nm gastric emptying study (78264) |
— |
$5,698 |
— |
| Nm gastroesophageal reflux study (78262) |
— |
$2,355 |
— |
| Nm peritoneal-venous shunt patency (78291) |
— |
$2,025 |
— |
| Nuclear medicine of heart pumping function (78473) |
— |
$3,500 |
— |
| Nuclear medicine study of endocrine organs (78099) |
— |
$1,800 |
— |
| Nuclear medicine study of limited area for thyroid cancer (78015) |
— |
$2,400 |
— |
| Nuclear medicine study to assess blood clot in vein of both sides (78458) |
— |
$2,250 |
— |
| Nuclear Rx Oral Admin (79005) |
— |
$3,737 |
— |
| Ob Us Follow-Up Per Fetus - Us Ob Follow Up Transabdominal Approach (76816) |
— |
$1,336 |
— |
| Orthopantogram (70355) |
— |
$382 |
— |
| Osseous survey infant (77076) |
— |
$789 |
— |
| Osseous survey limited (77074) |
— |
$677 |
— |
| Parathyrd planar w/wo subtrj (78071) |
— |
$1,974 |
— |
| Parathyroid imaging (78070) |
— |
$1,733 |
— |
| Pelvis 1 or 2 views (72170) |
— |
$500 |
— |
| Perineogram (74775) |
— |
$1,725 |
— |
| Peritoneogram rs&i (74190) |
— |
$3,045 |
— |
| PET image w/CT, skull-thigh (78815) |
— |
$9,868 |
— |
| PET imaging CT for attenuation limited area (78814) |
— |
$7,517 |
— |
| PET imaging for CT attenuation whole body (78816) |
— |
$12,951 |
— |
| Pr MRI, lower extr, w/o contrast f/u by contrast (73720) |
— |
$5,316 |
— |
| Prq Transhepatc Portograpy Hemodyn Eval Rs&I (75885) |
— |
$6,435 |
— |
| Prq transhepatc portograpy w/o hemodyn evl intrp (75887) |
— |
$4,084 |
— |
| Pulmonary Perfusion Imaging Particulate (78580) |
— |
$2,988 |
— |
| Pulmonary Ventilation & Perfusion Imaging (78582) |
— |
$3,748 |
— |
| Radex abscess/fistula/sinus tract rs&i (76080) |
— |
$1,138 |
— |
| Radex Entir Thrc Lmbr Crv Sac Spi W/Skull 1 Vw - Xr Scoliosis 1 Vw (72081) |
— |
$488 |
— |
| Radex entir thrc lmbr crv sac spi w/skull 2/3 vw (72082) |
— |
$736 |
— |
| Radex hips bilateral with pelvis 2 views (73521) |
— |
$556 |
— |
| Radex X-Ray Exam Entire Spi 6/> Vw - Xr Entire Spine 6+ Vw (72084) |
— |
$1,310 |
— |
| Radiolog exam mandible compl minimum 4 views (70110) |
— |
$663 |
— |
| Radiologic Exam Abdomen 1 View - Xr Abdomen 1 View (74018) |
— |
$650 |
— |
| Radiologic Exam Abdomen 3+ Views - Xr Abdomen 3+ Views (74021) |
— |
$889 |
— |
| Radiologic Exam Chest 2 Views - Xr Chest 2 Views (71046) |
— |
$694 |
— |
| Radiologic exam colon single contrast study (74270) |
— |
$1,719 |
— |
| Radiologic exam upr gi trc double contrast study (74246) |
— |
$1,157 |
— |
| Radiologic exam upr gi trc single contrast study (74240) |
— |
$1,014 |
— |
| Radiologic Examination Femur Minimum 2 Views - Xr Femur 2+ Vw Lt (73552) |
— |
$500 |
— |
| Radiological examination surgical specimen (76098) |
— |
$1,169 |
— |
| Radiopharmaceutical therapy, unlisted procedure UNSCHEDULED (79999) |
— |
$2,300 |
— |
| Review by radiologist of adrenal gland vein image (75840) |
— |
$6,435 |
— |
| Review by radiologist of liver vein image with assessment of blood flow (75889) |
— |
$6,070 |
— |
| Ribs bilateral 3 views (71110) |
— |
$725 |
— |
| Rp loclzj tum plnr whole body single day imaging (78802) |
— |
$2,815 |
— |
| Rp loclzj tum spect 1 area single day imaging (78803) |
— |
$5,117 |
— |
| Rp loclzj tum spect CT 2area 1d img/1 ar img>2+d (78832) |
— |
$6,638 |
— |
| Sacroiliac Joints < 3 Views (72200) |
— |
$335 |
— |
| Salivary gland function study (78232) |
— |
$2,175 |
— |
| Scanogram (77073) |
— |
$423 |
— |
| Scapula complete (73010) |
— |
$520 |
— |
| Shuntogram indwelling nonvascular shunt rs&i (75809) |
— |
$639 |
— |
| Sialogram (70390) |
— |
$910 |
— |
| Small bowel series (74250) |
— |
$956 |
— |
| Speech evaluation complex (70371) |
— |
$750 |
— |
| Spine thoracic 3 views (72072) |
— |
$920 |
— |
| Splenoportograpy rs&i (75810) |
— |
$9,458 |
— |
| Superior sagittal sinus venogram (75870) |
— |
$4,084 |
— |
| Temporomandble Jt Arthrography Rs&I (70332) |
— |
$1,000 |
— |
| Therapeutic Enema (74283) |
— |
$1,625 |
— |
| Thoracolumbar 2 views (72080) |
— |
$613 |
— |
| Thyroid carcinoma metastases img whole body (78018) |
— |
$5,693 |
— |
| Thyroid Imaging With Vascular Flow (78013) |
— |
$1,650 |
— |
| Thyroid uptake measurement (78012) |
— |
$1,350 |
— |
| Thyroid Uptake W/Blood Flow Sngle/Mult Quan Meas (78014) |
— |
$3,835 |
— |
| Tmj unilateral (70328) |
— |
$625 |
— |
| Tumor Imaging Whole Body - Nm Tumor Local Whole Body Mult Days (78804) |
— |
$5,950 |
— |
| Tumor Imaging, Limited Area - Nm Tumor Localization Limited (78800) |
— |
$1,111 |
— |
| Ultrasound elastography first target lesion (76982) |
— |
$945 |
— |
| Ultrasound trgt dynamic microbubble 1st lesion (76978) |
— |
$1,001 |
— |
| Ultrasound, abdomen limited (76705) |
— |
$866 |
— |
| Umbilical-artery Doppler (OB) (76820) |
— |
$540 |
— |
| Unlisted Diagnostic Radiographic Procedure (76499) |
— |
$269 |
— |
| Unlisted fluoroscopic procedure (76496) |
— |
$750 |
— |
| Unlisted magnetic resonance procedure (76498) |
— |
$2,303 |
— |
| Unlisted miscellaneous px dx nuclear medicine (78999) |
— |
$2,300 |
— |
| Unlisted Ultrasound Procedure (76999) |
— |
$790 |
— |
| Upper Extremity Infant (73092) |
— |
$613 |
— |
| Ureteral Reflux Study Rp Voiding Cystogram (78740) |
— |
$1,675 |
— |
| Urethrocystography retrograde rs&i (74450) |
— |
$1,104 |
— |
| Urethrocystography voiding (74455) |
— |
$1,081 |
— |
| Urography (pyelography), intravenous, with or without KUB, with or without tomography (74400) |
— |
$1,500 |
— |
| Us breast unilateral complete (76641) |
— |
$1,375 |
— |
| Us breast unilateral limited (76642) |
— |
$600 |
— |
| Us chest (76604) |
— |
$899 |
— |
| Us compl joint r-t w/image documentation (76881) |
— |
$704 |
— |
| Us elastography parenchyma (76981) |
— |
$921 |
— |
| Us guided compression repair (76936) |
— |
$1,103 |
— |
| Us infant hips dynamic (76885) |
— |
$1,659 |
— |
| Us infant hips limited static (76886) |
— |
$546 |
— |
| Us kidney transplant (76776) |
— |
$920 |
— |
| Us ob detailed single fetus (76811) |
— |
$1,329 |
— |
| Us ob transvaginal (76817) |
— |
$1,196 |
— |
| Us pelvic non ob complete (76856) |
— |
$850 |
— |
| Us pelvic nonobstetric image dcmtn limited/f/u (76857) |
— |
$542 |
— |
| Us pregnancy ltd (76815) |
— |
$878 |
— |
| Us pregnant uterus 14 wk transabdl 1/1st gestat (76801) |
— |
$821 |
— |
| Us retroperitoneal complete (76770) |
— |
$979 |
— |
| Us retroperitoneal limited (76775) |
— |
$748 |
— |
| Us scrotum and contents (76870) |
— |
$948 |
— |
| Us soft tissue head/neck (76536) |
— |
$1,013 |
— |
| Us spinal canal and contents (76800) |
— |
$1,235 |
— |
| Us transrectal (76872) |
— |
$903 |
— |
| Us xtr non-vasc lmtd (76882) |
— |
$525 |
— |
| Us, eye b-scan (76512) |
— |
$692 |
— |
| Vasogram (74440) |
— |
$850 |
— |
| Venogram extremity bilateral (75822) |
— |
$3,145 |
— |
| Venogram orbital (75880) |
— |
$2,850 |
— |
| Venography caval inferior serialography rs&i (75825) |
— |
$5,578 |
— |
| Venography caval superior serialography rs&i (75827) |
— |
$5,913 |
— |
| Venography epidural rs&i (75872) |
— |
$3,800 |
— |
| Venography extremity unilateral rs&i (75820) |
— |
$2,731 |
— |
| Venography Renal Bilateral (75833) |
— |
$6,677 |
— |
| Venography renal unilateral selective rs&i (75831) |
— |
$5,578 |
— |
| Venography venous sinus/jugular cath rs&i (75860) |
— |
$5,578 |
— |
| Venous sampling thru cath w/wo angiography rs& (75893) |
— |
$9,650 |
— |
| Vertebral fracture assessment via dxa (77086) |
— |
$465 |
— |
| Wrist 2 views (73100) |
— |
$415 |
— |
| X-Ray Abdomen,Comp Acute Series - Xr Abdomen 2 Vws With Chest 1 View (74022) |
— |
$1,016 |
— |
| X-Ray Ac Jts - Xr Acromioclavicular Joints Bilateral (73050) |
— |
$590 |
— |
| X-Ray Ankle 3+ Vw - Xr Ankle 3+ Views Right (73610) |
— |
$578 |
— |
| X-Ray Elbow 2 Vw - Xr Elbow 1-2 Views Right (73070) |
— |
$448 |
— |
| X-Ray Elbow 3+ Vw - Xr Elbow 3+ Views Right (73080) |
— |
$564 |
— |
| X-ray exam entire spi 4/5 vw (72083) |
— |
$1,187 |
— |
| X-ray exam hip uni 1 view (73501) |
— |
$300 |
— |
| X-Ray Exam Hip Uni 2-3 Views (73502) |
— |
$476 |
— |
| X-ray exam hip uni 4/> views (73503) |
— |
$715 |
— |
| X-Ray Exam Hips Bi 3-4 Views (73522) |
— |
$834 |
— |
| X-Ray Exam Hips Bi 5/> Views (73523) |
— |
$1,161 |
— |
| X-ray exam of femur 1 (73551) |
— |
$425 |
— |
| X-Ray Facial Bones 3+ Vw - Xr Facial Bones 3+ Views (70150) |
— |
$578 |
— |
| X-Ray Facial Bones <3 Vw - Xr Facial Bones 1-2 Views (70140) |
— |
$490 |
— |
| X-Ray Foot 3+ Vw - Xr Foot 3+ Views Right (73630) |
— |
$515 |
— |
| X-ray guide gu dilation - ir nephrostomy dilation (74485) |
— |
$4,082 |
— |
| X-ray head for orthodontia (70350) |
— |
$509 |
— |
| X-Ray Heel - Xr Calcaneus 2 Views Right (73650) |
— |
$703 |
— |
| X-Ray Jaw <4 Vw - Xr Mandible < 4 Views (70100) |
— |
$466 |
— |
| X-Ray Knee 4+ View - Xr Knee 4+ Views Right (73564) |
— |
$854 |
— |
| X-Ray Knee Bilat Standing - Xr Knees Anteroposterior Standing Bilat (73565) |
— |
$752 |
— |
| X-Ray Leg, Infant - Xr Lower Extremity 2+ Views Infant Left (73592) |
— |
$348 |
— |
| X-Ray Lumbar Spine 2/3 Vw - Xr Lumbar Spine 2-3 Views (72100) |
— |
$400 |
— |
| X-Ray Lumbar Spine 6+ Vw - Xr Lumbar Spine 6+ Vws Including Bending (72114) |
— |
$1,507 |
— |
| X-Ray Lumbar Spine Flex/Exten - Xr Lumbar Spine 4+ Views W/ Flex Ext (72120) |
— |
$727 |
— |
| X-Ray Nasal Bones - Xr Nasal Bones (70160) |
— |
$644 |
— |
| X-Ray Nose-Rectum Child F.B. - Xr Nose to Rectum Foreign Body Peds (76010) |
— |
$334 |
— |
| X-ray of voice box or throat (70370) |
— |
$620 |
— |
| X-Ray Orbits - Xr Orbits Complete 4+ Views (70200) |
— |
$700 |
— |
| X-Ray Pelvis 3+ Vw - Xr Pelvis 3+ Views (72190) |
— |
$682 |
— |
| X-Ray Renal Cyst Xlumbar+Contrst - Xr Renal Cyst Lumbar W Contrast (74470) |
— |
$2,550 |
— |
| X-Ray Retrograde Pyelogram - Fl Pyelogram Retrograde (74420) |
— |
$1,093 |
— |
| X-Ray Ribs 2 Vw Unilat - Xr Ribs 2 Views Right (71100) |
— |
$327 |
— |
| X-Ray Ribs, Chest 3+ Vw - Xr Ribs 2 Vws Lt W/ Chest Anteroposterior (71101) |
— |
$700 |
— |
| X-Ray Ribs, Chest 4+ Vw - Xr Ribs 3 Vws Bil W/ Chest Posteroanterior (71111) |
— |
$913 |
— |
| X-Ray Sacroiliac Jts 3+ Vw - Xr Sacroiliac Joints 3+ Views (72202) |
— |
$670 |
— |
| X-Ray Sacrum/Coccyx 2+ Vw - Xr Sacrum Coccyx 2+ Views (72220) |
— |
$520 |
— |
| X-Ray Shoulder 2+ Vw - Xr Shoulder 2+ Views Right (73030) |
— |
$563 |
— |
| X-Ray Sinuses 3+ Vw - Xr Paranasal Sinuses 3+ Views (70220) |
— |
$813 |
— |
| X-Ray Sinuses <3 Vw - Xr Paranasal Sinuses 1-2 Views (70210) |
— |
$350 |
— |
| X-Ray Skull 4+ Vw - Xr Skull Complete 4+ Views (70260) |
— |
$917 |
— |
| X-Ray Skull <4 Vw - Xr Skull 1-3 Views (70250) |
— |
$400 |
— |
| X-Ray Spine One View - Xr Spine (72020) |
— |
$373 |
— |
| X-Ray Sterno-Clavicluar Jt - Xr Sternoclavicular Joints 3+ Views (71130) |
— |
$1,110 |
— |
| X-Ray Sternum 2+ Vw - Xr Sternum 2+ Views (71120) |
— |
$600 |
— |
| X-Ray Thoracic Spine 2 Vw - Xr Thoracic Spine 2 Views (72070) |
— |
$375 |
— |
| X-Ray Thoracic Spine 4 Vw - Xr Thoracic Spine Complete 4+ Views (72074) |
— |
$1,048 |
— |
| X-Ray Toe(S) - Xr Toes 2+ Views Right (73660) |
— |
$369 |
— |
| X-Ray Wrist 3+ Vw - Xr Wrist 3+ Views Right (73110) |
— |
$498 |
— |
| Xr arthrogram ankle (73615) |
— |
$1,228 |
— |
| Xr c-spine 6 or more views (72052) |
— |
$949 |
— |
| Xr chest 4+ views (71048) |
— |
$918 |
— |
| Xr finger(s) 2+ views (73140) |
— |
$516 |
— |
| Xr shoulder 1 view (73020) |
— |
$400 |
— |
| Xr spine cervical 4 or 5 views (72050) |
— |
$500 |
— |
| Xr tibia/fibula 2 views (73590) |
— |
$473 |
— |
| Xr tmj bilateral (70330) |
— |
$750 |
— |
| Xray knee 1 or 2 views rt (73560) |
— |
$570 |
— |