| Abdomen 1 View (74018) |
— |
$375 |
— |
| Abdomen 2 views (74019) |
— |
$489 |
— |
| Ankle 2 views (73600) |
— |
$295 |
— |
| Bone age studies (77072) |
— |
$282 |
— |
| Chest 1 view (71045) |
— |
$428.39 |
— |
| Chest 2 views (71046) |
— |
$458 |
— |
| Computed Tomography Thorax Lw Dose Lng Ca Scr C- (71271) |
— |
$416 |
— |
| CT abdomen and pelvis without and with contrast (74178) |
— |
$5,632 |
— |
| CT abdomen and pelvis without contrast (74176) |
— |
$4,605 |
— |
| CT abdomen w contrast (74160) |
— |
$2,669 |
— |
| CT abdomen w wo contrast (74170) |
— |
$2,946 |
— |
| CT abdomen w/o contrast (74150) |
— |
$2,304 |
— |
| CT Angio Abdomen and Pelvis (74174) |
— |
$3,600 |
— |
| CT Angio Chest (71275) |
— |
$3,202 |
— |
| CT Angio Head (70496) |
— |
$2,747.55 |
— |
| CT Angio Neck (70498) |
— |
$3,202 |
— |
| Ct Angio Upr Extrm W/O&W/Dye (73206) |
— |
$2,110 |
— |
| CT cervical spine w/o contrast (72125) |
— |
$2,336 |
— |
| CT chest w contrast (71260) |
— |
$2,611.77 |
— |
| CT chest w/wo contrast (71270) |
— |
$2,945 |
— |
| CT head/brain with contrast (70460) |
— |
$2,288 |
— |
| CT head/brain without and with contrast (70470) |
— |
$2,946 |
— |
| CT iac w contrast (70481) |
— |
$2,518 |
— |
| CT lower ext w/o (73700) |
— |
$2,260.66 |
— |
| CT lower extremity w/contrast material (73701) |
— |
$2,518 |
— |
| CT lumbar spine w/o contrast (72131) |
— |
$2,304 |
— |
| CT maxillofacial w contrast (70487) |
— |
$2,098.33 |
— |
| CT maxillofacial wo contrast (70486) |
— |
$2,068.53 |
— |
| CT neck tissue combo (70492) |
— |
$2,946 |
— |
| CT orbits w/o contrast (70480) |
— |
$2,145 |
— |
| CT pelvis w/o contrast (72192) |
— |
$2,304 |
— |
| CT soft tissue neck w contrast (70491) |
— |
$2,431.88 |
— |
| CT soft tissue neck w/o contrast (70490) |
— |
$2,145 |
— |
| CT thoracic spine w/o contrast (72128) |
— |
$2,304 |
— |
| CT thorax w/o contrast (71250) |
— |
$2,291.18 |
— |
| CT upper ext wo (73200) |
— |
$2,182.82 |
— |
| Cta Abdl Aorta&Bi Iliofem W/Contrast&Postp (75635) |
— |
$4,877 |
— |
| Dxa Bone Density Axial (77080) |
— |
$379.77 |
— |
| Fluoroscopy up to 1 hr (76000) |
— |
$459 |
— |
| Foot 2 views (73620) |
— |
$272.88 |
— |
| Forearm 2 views (73090) |
— |
$349.93 |
— |
| Hand 2 views (73120) |
— |
$295 |
— |
| Knee 3 Views (73562) |
— |
$394.82 |
— |
| Lung Ventilat&Perfus Imaging (78582) |
— |
$2,279 |
— |
| Magnetic Image Jaw Joint (70336) |
— |
$1,352 |
— |
| 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 any jt lower extrem w/contrast material (73722) |
— |
$1,456 |
— |
| MRI any jt upper extremity w/contrast matrl (73222) |
— |
$1,456 |
— |
| MRI cervical spine w contrast (72142) |
— |
$1,456 |
— |
| MRI cervical spine w/o cont (72141) |
— |
$1,337.30 |
— |
| MRI chest w/o contrast (71550) |
— |
$1,352 |
— |
| MRI lower extrem oth/thn jt w/o & w/contr matr (73720) |
— |
$1,664 |
— |
| MRI lower extrem oth/thn jt w/o contr matrl (73718) |
— |
$1,352 |
— |
| MRI lumbar spine w contrast (72149) |
— |
$1,456 |
— |
| Mri Neck Spine W/O & W/Dye (72156) |
— |
$1,456 |
— |
| MRI orbit face &/neck w/o contrast (70540) |
— |
$1,352 |
— |
| Mri Orbt/Fac/Nck W/O &W/Dye (70543) |
— |
$1,664 |
— |
| MRI pelvis w/o & w contrast (72197) |
— |
$1,664 |
— |
| MRI pelvis w/o contrast (72195) |
— |
$1,352 |
— |
| MRI thoracic spine w/o contrast (72146) |
— |
$1,352 |
— |
| MRI upper extremity oth than jt w/o contr matrl (73218) |
— |
$1,352 |
— |
| MRI, abdomen, combo (74183) |
— |
$1,664 |
— |
| MRI, dorsal spine combo (72157) |
— |
$1,664 |
— |
| MRI, joint upper extrem (73221) |
— |
$1,231.82 |
— |
| MRI, joint upper extrem combo (73223) |
— |
$1,664 |
— |
| MRI, lumbar spine combo (72158) |
— |
$1,664 |
— |
| Myocardial Spect Multiple Studies (78452) |
— |
$5,014 |
— |
| Neck soft tissue (70360) |
— |
$430 |
— |
| Pelvis 1 or 2 views (72170) |
— |
$375 |
— |
| Radex Abd Compl Aqt Abd W/S/E/D Views 1 View Ch (74022) |
— |
$574 |
— |
| Radex Ankle Complete Minimum 3 Views (73610) |
— |
$342.20 |
— |
| Radex elbow complete minimum 3 views (73080) |
— |
$343.85 |
— |
| Radex Facial Bones Complete Minimum 3 Views (70150) |
— |
$429 |
— |
| Radex fingr minimum 2 views (73140) |
— |
$320.44 |
— |
| Radex foot complete minimum 3 views (73630) |
— |
$336.57 |
— |
| Radex Hand Minimum 3 Views (73130) |
— |
$332.22 |
— |
| Radex Mastoids Compl Minimum 3 Views PR Side (70130) |
— |
$450 |
— |
| Radex Nasal Bones Complete Minimum 3 Views (70160) |
— |
$421 |
— |
| Radex Ribs Unilateral 2 Views (71100) |
— |
$459 |
— |
| Radex shoulder complete minimum 2 views (73030) |
— |
$379.03 |
— |
| Radex Sinuses Paransl < 3 Views (70210) |
— |
$360 |
— |
| Radex Spine 1 View Specify Level (72020) |
— |
$360 |
— |
| Radex Temporomandble Jt Opn & Clsd Mouth Bilat (70330) |
— |
$459 |
— |
| Radex Toe Minimum 2 Views (73660) |
— |
$154.50 |
— |
| Radex Wrist Complete Minimum 3 Views (73110) |
— |
$345.62 |
— |
| Radiolog exam mandible compl minimum 4 views (70110) |
— |
$444 |
— |
| Radiologic exam knee complete 4/more views (73564) |
— |
$430 |
— |
| Radiologic exam pelvis compl minimum 3 views (72190) |
— |
$459 |
— |
| Radiologic examination femur minimum 2 views (73552) |
— |
$432.82 |
— |
| Radiologic examination knee 1/2 views (73560) |
— |
$443.31 |
— |
| Radiologic examination tibia & fibula 2 views (73590) |
— |
$412 |
— |
| Screening Digital Breast Tomosynthesis Bi (77063) |
— |
$90 |
— |
| Skull less than 4 views (70250) |
— |
$429 |
— |
| Thoracic spine 2 views (72070) |
— |
$413 |
— |
| Thoracic spine 3 views (72072) |
— |
$485 |
— |
| Thoracolumbar 2 views (72080) |
— |
$414 |
— |
| Ultrasound Breast Limited (76642) |
— |
$857 |
— |
| Ultrasound Exam Aaa Screen (76706) |
— |
$827 |
— |
| Ultrasound, abdomen limited (76705) |
— |
$851 |
— |
| Us breast unilateral complete (76641) |
— |
$1,143 |
— |
| Us chest (76604) |
— |
$968 |
— |
| Us complete joint (76881) |
— |
$758 |
— |
| Us exam, pelvic, limited (76857) |
— |
$648 |
— |
| Us pelvic non ob complete (76856) |
— |
$944 |
— |
| Us pg uter img f&mat 14 wk tabdl 1/1st gestation (76801) |
— |
$801 |
— |
| Us preg uterus real time f/u trnsabdl per fetus (76816) |
— |
$429 |
— |
| Us retroperitoneal complete (76770) |
— |
$968 |
— |
| Us thyroid (76536) |
— |
$993 |
— |
| Wrist 2 views (73100) |
— |
$324.50 |
— |
| X-Ray Elbow 2 Vw - Xr Elbow 1-2 Views Right (73070) |
— |
$295 |
— |
| X-Ray Exam Entire Spi 1 Vw (72081) |
— |
$345 |
— |
| X-Ray Exam Entire Spi 2/3 Vw (72082) |
— |
$863 |
— |
| X-Ray Exam Hip Uni 1 View (73501) |
— |
$373 |
— |
| X-Ray Exam Hip Uni 2-3 Views (73502) |
— |
$408.69 |
— |
| X-Ray Exam Hips Bi 2 Views (73521) |
— |
$396.02 |
— |
| X-Ray Exam Neck Spine 2-3 Vw (72040) |
— |
$452 |
— |
| X-Ray Exam Unilat Ribs/Chest (71101) |
— |
$485 |
— |
| X-ray eye for foreign body (70030) |
— |
$144 |
— |
| X-ray humerus (73060) |
— |
$381.18 |
— |
| X-Ray Knee Bilat Standing - Xr Knees Anteroposterior Standing Bilat (73565) |
— |
$854.68 |
— |
| X-Ray Lumbar Spine 2/3 Vw - Xr Lumbar Spine 2-3 Views (72100) |
— |
$529 |
— |
| X-Ray Sinuses 3+ Vw - Xr Paranasal Sinuses 3+ Views (70220) |
— |
$444 |
— |
| X-Ray Skull 4+ Vw - Xr Skull Complete 4+ Views (70260) |
— |
$459 |
— |
| X-ray thoracic spine 4 vw (72074) |
— |
$515 |
— |
| Xr c-spine 4 or 5 views (72050) |
— |
$485 |
— |