| Ankle 2 views (73600) |
— |
$295 |
— |
| Computed tomographic angiography, abdomen and pelvis, with contrast material(s), including noncontrast images, if… (74174) |
— |
$3,600 |
— |
| Computed tomographic angiography, abdominal aorta and bilateral iliofemoral lower extremity runoff, with contrast… (75635) |
— |
$4,877 |
— |
| Computed tomographic angiography, chest (noncoronary), with contrast material(s), including noncontrast images, if… (71275) |
— |
$3,202 |
— |
| Computed tomographic angiography, neck, with contrast material(s), including noncontrast images, if performed, and… (70498) |
— |
$3,202 |
— |
| Computed tomographic angiography, upper extremity, with contrast material(s), including noncontrast images, if… (73206) |
— |
$2,110 |
— |
| Computed tomography, lower extremity; without contrast material Age Under 21 (73700) |
— |
$2,260.66 |
— |
| Computed tomography, maxillofacial area; with contrast material(s) Age Under 21 (70487) |
— |
$2,098.33 |
— |
| Computed tomography, maxillofacial area; without contrast material Age Under 21 (70486) |
— |
$2,068.53 |
— |
| Computed tomography, orbit, sella, or posterior fossa or outer, middle, or inner ear; with contrast material(s) Age… (70481) |
— |
$2,518 |
— |
| Computed tomography, orbit, sella, or posterior fossa or outer, middle, or inner ear; without contrast material Age… (70480) |
— |
$2,145 |
— |
| Computed tomography, soft tissue neck; without contrast material followed by contrast material(s) and further sections… (70492) |
— |
$2,946 |
— |
| Computed tomography, thorax, diagnostic; without contrast material, followed by contrast material(s) and further… (71270) |
— |
$2,945 |
— |
| CT abdomen and pelvis without and with contrast (74178) |
— |
$5,632 |
— |
| CT abdomen and pelvis without contrast (74176) |
— |
$4,605 |
— |
| CT abdomen w & w/o contrast (74170) |
— |
$2,946 |
— |
| CT abdomen w/contrast (74160) |
— |
$2,669 |
— |
| CT abdomen w/o contrast (74150) |
— |
$2,304 |
— |
| CT cervical spine w/o contrast (72125) |
— |
$2,336 |
— |
| CT chest w/contrast (71260) |
— |
$2,611.77 |
— |
| CT extremity upper w/o contrast (73200) |
— |
$2,182.82 |
— |
| CT head/brain with contrast (70460) |
— |
$2,288 |
— |
| CT head/brain without and with contrast (70470) |
— |
$2,946 |
— |
| CT lower extremity w/dye (73701) |
— |
$2,518 |
— |
| CT lumbar spine w/o contrast (72131) |
— |
$2,304 |
— |
| CT neck w/contrast (70491) |
— |
$2,431.88 |
— |
| CT neck w/o contrast (70490) |
— |
$2,145 |
— |
| CT pelvis w/o contrast (72192) |
— |
$2,304 |
— |
| CT thoracic spine w/o contrast (72128) |
— |
$2,304 |
— |
| CT thorax lung cancer scr c- (71271) |
— |
$416 |
— |
| CT thorax w/o contrast (71250) |
— |
$2,291.18 |
— |
| CTA head w contrast (70496) |
— |
$2,747.55 |
— |
| Dual-energy X-ray absorptiometry (DXA), bone density study, 1 or more sites; axial skeleton (eg, hips, pelvis, spine)… (77080) |
— |
$379.77 |
— |
| Fluoroscopy up to 1 hour physician/qhp time (76000) |
— |
$459 |
— |
| Magnetic resonance (eg, proton) imaging, lower extremity other than joint; without contrast material(s) Age Under 21 (73718) |
— |
$1,352 |
— |
| Magnetic resonance (eg, proton) imaging, lower extremity other than joint; without contrast material(s), followed by… (73720) |
— |
$1,664 |
— |
| Magnetic resonance (eg, proton) imaging, orbit, face, and/or neck; without contrast material(s) Age Under 21 (70540) |
— |
$1,352 |
— |
| Mandible min 4v (70110) |
— |
$444 |
— |
| MRA head w/o contrast (70544) |
— |
$1,352 |
— |
| MRA neck w/o contrast (70547) |
— |
$1,352 |
— |
| MRI abdomen w/o contrast (74181) |
— |
$1,352 |
— |
| MRI abdomen w/wo contrast (74183) |
— |
$1,664 |
— |
| MRI any jt lower extrem w/contrast material (73722) |
— |
$1,456 |
— |
| MRI c-spine w&w/o cont (72156) |
— |
$1,456 |
— |
| MRI cervical spine w/contrast (72142) |
— |
$1,456 |
— |
| MRI chest w/o contrast (71550) |
— |
$1,352 |
— |
| MRI joint upr extr w/o&w/dye (73223) |
— |
$1,664 |
— |
| MRI joint upr extrem w/dye (73222) |
— |
$1,456 |
— |
| MRI joint upr extrem w/o dye (73221) |
— |
$1,231.82 |
— |
| MRI lumbar spine w/contrast (72149) |
— |
$1,456 |
— |
| MRI lumbar spine w/wo contrast (72158) |
— |
$1,664 |
— |
| MRI orbit/face/neck w&w/o cont (70543) |
— |
$1,664 |
— |
| MRI pelvis w & w/o contrast (72197) |
— |
$1,664 |
— |
| MRI pelvis w/o contrast (72195) |
— |
$1,352 |
— |
| MRI spine cervical w/o contrast (72141) |
— |
$1,337.30 |
— |
| MRI t-spine w&w/o cont (72157) |
— |
$1,664 |
— |
| MRI thoracic spine w/o contrst (72146) |
— |
$1,352 |
— |
| MRI tmj (70336) |
— |
$1,352 |
— |
| MRI upper extremity oth than jt w/o contr matrl (73218) |
— |
$1,352 |
— |
| Myocardial spect multiple studies (78452) |
— |
$5,014 |
— |
| Pulmonary ventilation & perfusion imaging (78582) |
— |
$2,279 |
— |
| Radex entir thrc lmbr crv sac spi w/skull 1 vw (72081) |
— |
$345 |
— |
| Radex entir thrc lmbr crv sac spi w/skull 2/3 vw (72082) |
— |
$863 |
— |
| Radex hip unilateral with pelvis 1 view (73501) |
— |
$373 |
— |
| Radex hip unilateral with pelvis 2-3 views (73502) |
— |
$408.69 |
— |
| Radex hips bilateral with pelvis 2 views (73521) |
— |
$396.02 |
— |
| Radex spine cervical 2 or 3 views (72040) |
— |
$452 |
— |
| Radex spine cervical 4 or 5 views (72050) |
— |
$485 |
— |
| Radex spine thoracolumbar junction min 2 views (72080) |
— |
$414 |
— |
| Radiologic examination femur minimum 2 views (73552) |
— |
$432.82 |
— |
| Radiologic examination, ankle; complete, minimum of 3 views Age Under 21 (73610) |
— |
$342.20 |
— |
| Radiologic examination, complete acute abdomen series, including 2 or more views of the abdomen (eg, supine, erect,… (74022) |
— |
$574 |
— |
| Radiologic examination, elbow; 2 views Age Under 21 (73070) |
— |
$295 |
— |
| Radiologic examination, elbow; complete, minimum of 3 views Age Under 21 (73080) |
— |
$343.85 |
— |
| Radiologic examination, foot; complete, minimum of 3 views Age Under 21 (73630) |
— |
$336.57 |
— |
| Radiologic examination, hand; minimum of 3 views Age Under 21 (73130) |
— |
$332.22 |
— |
| Radiologic examination, knee; both knees, standing, anteroposterior Age Under 21 (73565) |
— |
$854.68 |
— |
| Radiologic examination, knee; complete, 4 or more views Age Under 21 (73564) |
— |
$430 |
— |
| Radiologic examination, mastoids; complete, minimum of 3 views per side Age Under 21 (70130) |
— |
$450 |
— |
| Radiologic examination, nasal bones, complete, minimum of 3 views Age Under 21 (70160) |
— |
$421 |
— |
| Radiologic examination, ribs, unilateral; including posteroanterior chest, minimum of 3 views Age Under 21 (71101) |
— |
$485 |
— |
| Radiologic examination, shoulder; complete, minimum of 2 views Age Under 21 (73030) |
— |
$379.03 |
— |
| Radiologic examination, sinuses, paranasal, less than 3 views Age Under 21 (70210) |
— |
$360 |
— |
| Radiologic examination, skull; less than 4 views Age Under 21 (70250) |
— |
$429 |
— |
| Radiologic examination, spine, lumbosacral; 2 or 3 views Age Under 21 (72100) |
— |
$529 |
— |
| Radiologic examination, spine; thoracic, minimum of 4 views Age Under 21 (72074) |
— |
$515 |
— |
| Radiologic examination, wrist; complete, minimum of 3 views Age Under 21 (73110) |
— |
$345.62 |
— |
| Radiologic examination; humerus, minimum of 2 views Age Under 21 (73060) |
— |
$381.18 |
— |
| Radiologic examination; toe(s), minimum of 2 views Age Under 21 (73660) |
— |
$154.50 |
— |
| Screening digital breast tomosynthesis bi (77063) |
— |
$90 |
— |
| Ultrasound breast limited (76642) |
— |
$857 |
— |
| Ultrasound, abdomen limited (76705) |
— |
$851 |
— |
| Ultrasound, pelvic (nonobstetric), real time with image documentation; complete Age Under 21 (76856) |
— |
$944 |
— |
| Ultrasound, pregnant uterus, real time with image documentation, fetal and maternal evaluation, first trimester (< 14… (76801) |
— |
$801 |
— |
| Us abdominal aorta real time screen study aaa (76706) |
— |
$827 |
— |
| Us breast uni real time with image complete (76641) |
— |
$1,143 |
— |
| Us chest (76604) |
— |
$968 |
— |
| Us compl joint r-t w/image documentation (76881) |
— |
$758 |
— |
| Us exam, pelvic, limited (76857) |
— |
$648 |
— |
| US OB Follow-Up/Repeat (76816) |
— |
$429 |
— |
| Us retroperitoneal complete (76770) |
— |
$968 |
— |
| Us soft tissue head/neck (76536) |
— |
$993 |
— |
| X-ray exam of finger(s) (73140) |
— |
$320.44 |
— |
| X-ray exam of knee 1 or 2 (73560) |
— |
$443.31 |
— |
| X-ray exam ribs uni 2 views (71100) |
— |
$459 |
— |
| Xr abdomen 1 view (74018) |
— |
$375 |
— |
| Xr abdomen 2 views (74019) |
— |
$489 |
— |
| Xr bone age studies (77072) |
— |
$282 |
— |
| Xr chest 1 view (71045) |
— |
$428.39 |
— |
| Xr chest 2 views (71046) |
— |
$458 |
— |
| Xr eye foreign body (70030) |
— |
$144 |
— |
| Xr facial bones 3+ views (70150) |
— |
$429 |
— |
| Xr foot arthritis pa only bilateral - report(ortho pro) (73620) |
— |
$272.88 |
— |
| Xr forearm 2 views (73090) |
— |
$349.93 |
— |
| Xr hand 2v (73120) |
— |
$295 |
— |
| Xr neck soft tissue (70360) |
— |
$430 |
— |
| Xr o knee w/ merchant view bilat - report(ortho pro) (73562) |
— |
$394.82 |
— |
| Xr pelvis 1-2 views (72170) |
— |
$375 |
— |
| Xr pelvis min 3 view (72190) |
— |
$459 |
— |
| Xr sinuses 3+ views (70220) |
— |
$444 |
— |
| Xr skull min 4 view (70260) |
— |
$459 |
— |
| Xr spine 1 view (72020) |
— |
$360 |
— |
| Xr spine thoracic 3v (72072) |
— |
$485 |
— |
| Xr t-spine 2 views (72070) |
— |
$413 |
— |
| Xr tibia/fibula 2 views (73590) |
— |
$412 |
— |
| Xr tmj bilateral (70330) |
— |
$459 |
— |
| Xr wrist 2 views (73100) |
— |
$324.50 |
— |