| Abdomen 1 View (74018) |
— |
$288.53 |
— |
| Abdomen 2 views (74019) |
— |
$520.68 |
— |
| Acute Gastrointestinal Blood Loss Imaging (78278) |
— |
$2,013.03 |
— |
| Angio pulmonary bilat (75743) |
— |
$12,235.77 |
— |
| Angiography extremity bilateral rs&i (75716) |
— |
$12,235.77 |
— |
| Angiography extremity unilateral rs&i (75710) |
— |
$12,235.77 |
— |
| Angiography pulmonary unilateral slctv rs&i (75741) |
— |
$11,690.24 |
— |
| Angrph pulmonary nonslctv cath/ven njx rs&i (75746) |
— |
$5,065.77 |
— |
| Ankle 2 views (73600) |
— |
$834.08 |
— |
| Aortography thoracic serialography rs&i (75605) |
— |
$20,273.02 |
— |
| Artery X-Rays Abdomen (75726) |
— |
$20,273.02 |
— |
| Artery X-Rays Pelvis (75736) |
— |
$20,273.02 |
— |
| Arthrogram ankle (73615) |
— |
$3,576.72 |
— |
| Arthrogram hip (73525) |
— |
$1,787.52 |
— |
| Arthrogram Wrist (73115) |
— |
$3,576.72 |
— |
| Bone age studies (77072) |
— |
$540.59 |
— |
| Bone Imaging 3 Phase (78315) |
— |
$2,439.20 |
— |
| Bone Imaging Limited Area (78300) |
— |
$1,636.64 |
— |
| Bone Imaging Whole Body (78306) |
— |
$2,271.71 |
— |
| Bone marrow imaging limited area (78102) |
— |
$1,636.64 |
— |
| Bone marrow imaging; multiple areas (78103) |
— |
$1,636.64 |
— |
| Bone survey infant (77076) |
— |
$520.68 |
— |
| Cat Scan Follow-Up Study (76380) |
— |
$1,523.87 |
— |
| Chest 1 view (71045) |
— |
$265.45 |
— |
| Chest 2 views (71046) |
— |
$288.53 |
— |
| Chest 3 views (71047) |
— |
$288.53 |
— |
| Chest 4 or more views (71048) |
— |
$520.68 |
— |
| Clavicle complete (73000) |
— |
$792.63 |
— |
| Computed Tomography Thorax Lw Dose Lng Ca Scr C- (71271) |
— |
$402.45 |
— |
| Contrast X-Ray Bladder (74430) |
— |
$1,787.52 |
— |
| Contrast X-Ray Of Elbow (73085) |
— |
$2,200.43 |
— |
| Contrast X-Ray Of Knee Joint (73580) |
— |
$3,576.72 |
— |
| CT abdomen and pelvis without and with contrast (74178) |
— |
$8,642.48 |
— |
| CT abdomen and pelvis without contrast (74176) |
— |
$5,667.36 |
— |
| CT abdomen w contrast (74160) |
— |
$3,911.68 |
— |
| CT abdomen w wo contrast (74170) |
— |
$4,830.31 |
— |
| CT abdomen w/o contrast (74150) |
— |
$3,399.31 |
— |
| CT Angio Abdomen and Pelvis (74174) |
— |
$2,318.17 |
— |
| CT Angio Chest (71275) |
— |
$3,464.49 |
— |
| CT Angio Head (70496) |
— |
$3,286.55 |
— |
| Ct Angio Lwr Extr W/O&W/Dye (73706) |
— |
$5,057.49 |
— |
| CT Angio Neck (70498) |
— |
$3,286.55 |
— |
| Ct Angio Upr Extrm W/O&W/Dye (73206) |
— |
$3,371.10 |
— |
| CT cervical spine w/ contrast (72126) |
— |
$2,692.91 |
— |
| CT cervical spine w/o contrast (72125) |
— |
$3,202.10 |
— |
| CT cervical spine w/wo cont (72127) |
— |
$3,641.38 |
— |
| CT chest w contrast (71260) |
— |
$2,765.79 |
— |
| CT chest w/wo contrast (71270) |
— |
$3,603.26 |
— |
| CT head/brain with contrast (70460) |
— |
$2,828.88 |
— |
| CT head/brain without and with contrast (70470) |
— |
$3,468.93 |
— |
| CT heart no contrast quant eval coronry calcium (75571) |
— |
$78.97 |
— |
| CT iac w contrast (70481) |
— |
$2,911.79 |
— |
| CT l-spine w&w/o contrast (72133) |
— |
$4,006.19 |
— |
| CT lower ext w/o (73700) |
— |
$3,619.84 |
— |
| CT lower extremity w/contrast material (73701) |
— |
$3,921.62 |
— |
| CT lumbar spine w contrast (72132) |
— |
$3,480.54 |
— |
| CT lumbar spine w/o contrast (72131) |
— |
$2,815.61 |
— |
| CT maxillofacial w contrast (70487) |
— |
$2,505.53 |
— |
| CT maxillofacial wo contrast (70486) |
— |
$2,885.25 |
— |
| CT neck tissue combo (70492) |
— |
$3,573.41 |
— |
| Ct Orbit/Ear/Fossa W/O&W/Dye (70482) |
— |
$3,400.95 |
— |
| CT orbits w/o contrast (70480) |
— |
$2,858.73 |
— |
| CT pelvis w&w/o contrast (72194) |
— |
$3,812.19 |
— |
| CT pelvis w/o contrast (72192) |
— |
$2,760.88 |
— |
| CT scan of leg combo (73702) |
— |
$4,759.02 |
— |
| CT scans face/jaw combo (70488) |
— |
$3,400.95 |
— |
| CT soft tissue neck w contrast (70491) |
— |
$2,840.49 |
— |
| CT soft tissue neck w/o contrast (70490) |
— |
$2,346.34 |
— |
| CT thoracic spine w contrast (72129) |
— |
$3,167.15 |
— |
| CT thoracic spine w/o contrast (72128) |
— |
$2,415.97 |
— |
| CT thoracic spine w/wo cont (72130) |
— |
$2,891.89 |
— |
| CT thorax w/o contrast (71250) |
— |
$2,623.25 |
— |
| CT unlisted procedure (76497) |
— |
$2,140.74 |
— |
| CT upper ext wo (73200) |
— |
$3,541.89 |
— |
| CT upper extremity w/o & w/contrast material (73202) |
— |
$4,679.41 |
— |
| CT upper extremity with contrast (73201) |
— |
$3,512.05 |
— |
| Cta Abdl Aorta&Bi Iliofem W/Contrast&Postp (75635) |
— |
$4,788.85 |
— |
| Cta Abdomen (74175) |
— |
$3,659.64 |
— |
| CTA pelvis (72191) |
— |
$3,636.40 |
— |
| Dilation ureters/urethra rs&i (74485) |
— |
$8,058.81 |
— |
| Dxa Bone Density Axial (77080) |
— |
$630.72 |
— |
| Dxa bone density study 1/>sites appendiclr skel (77081) |
— |
$316.88 |
— |
| Echo Guide For Artery Repair (76936) |
— |
$1,169.01 |
— |
| Esophagram (74220) |
— |
$935.22 |
— |
| Fetal Biophysical Profile W/O Non-Stress Testing (76819) |
— |
$1,087.78 |
— |
| Fluoroscopy up to 1 hr (76000) |
— |
$1,067.88 |
— |
| Foot 2 views (73620) |
— |
$578.70 |
— |
| Forearm 2 views (73090) |
— |
$744.52 |
— |
| Gastric emptying imaging study (78264) |
— |
$1,636.64 |
— |
| Gastroesophageal Reflux Exam (78262) |
— |
$1,636.64 |
— |
| Gated Heart Planar Single (78472) |
— |
$2,231.92 |
— |
| Hand 2 views (73120) |
— |
$722.96 |
— |
| Hepatobil Syst Image W/Drug (78227) |
— |
$2,110.88 |
— |
| Hepatobiliary System Imaging (78226) |
— |
$1,636.64 |
— |
| Ht Musc Image Planar Mult (78454) |
— |
$5,695.88 |
— |
| Ht Muscle Image Spect Sing (78451) |
— |
$5,695.88 |
— |
| Hysterosalpingogram (74740) |
— |
$1,213.79 |
— |
| Infant hip ultrasound, limited static exam (76886) |
— |
$548.87 |
— |
| K Flow/Funct Image Multiple (78709) |
— |
$2,110.88 |
— |
| K Flow/Funct Image W/Drug (78708) |
— |
$2,110.88 |
— |
| Knee 3 Views (73562) |
— |
$1,109.34 |
— |
| Liver & Spleen Imaging Static Only (78215) |
— |
$1,636.64 |
— |
| Liver & Spleen Imaging W/Vascular Flow (78216) |
— |
$1,636.64 |
— |
| Lung Ventilat&Perfus Imaging (78582) |
— |
$2,110.88 |
— |
| Lung Ventilation Imaging (78579) |
— |
$1,636.64 |
— |
| Lymph System Imaging (78195) |
— |
$2,110.88 |
— |
| Magnetic Image Jaw Joint (70336) |
— |
$3,662.93 |
— |
| Mammary ductogram or galactogram multiple (77054) |
— |
$1,067.28 |
— |
| Meckels Divert Exam (78290) |
— |
$1,636.64 |
— |
| MRA head w/o contrast (70544) |
— |
$5,140.40 |
— |
| MRA head with contrast (70545) |
— |
$5,231.60 |
— |
| MRA neck w contrast (70548) |
— |
$3,482.20 |
— |
| Mra Neck W/O &W/Contrast Material (70549) |
— |
$4,470.47 |
— |
| MRA neck w/o contrast (70547) |
— |
$2,755.92 |
— |
| MRI abdomen w contrast (74182) |
— |
$5,271.38 |
— |
| MRI abdomen w/o contrast (74181) |
— |
$6,113.76 |
— |
| MRI any jt lower extrem w/contrast material (73722) |
— |
$6,631.11 |
— |
| MRI any jt lower extrem w/o & w/contrast matrl (73723) |
— |
$7,513.26 |
— |
| MRI any jt upper extremity w/contrast matrl (73222) |
— |
$6,830.08 |
— |
| MRI cervical spine w contrast (72142) |
— |
$5,127.12 |
— |
| MRI cervical spine w/o cont (72141) |
— |
$5,105.56 |
— |
| MRI chest w/o contrast (71550) |
— |
$3,619.84 |
— |
| MRI chest with contrast (71551) |
— |
$3,203.63 |
— |
| MRI chest wo w contrast (71552) |
— |
$5,218.33 |
— |
| MRI lower extrem oth/thn jt w/contrast matrl (73719) |
— |
$6,306.10 |
— |
| MRI lower extrem oth/thn jt w/o & w/contr matr (73720) |
— |
$7,513.26 |
— |
| MRI lower extrem oth/thn jt w/o contr matrl (73718) |
— |
$6,045.77 |
— |
| MRI lumbar spine w contrast (72149) |
— |
$6,185.04 |
— |
| Mri Neck Spine W/O & W/Dye (72156) |
— |
$7,186.59 |
— |
| MRI orbit face &/neck w/o contrast (70540) |
— |
$3,662.93 |
— |
| MRI orbit face neck w contrast (70542) |
— |
$4,128.90 |
— |
| Mri Orbt/Fac/Nck W/O &W/Dye (70543) |
— |
$5,054.17 |
— |
| MRI pelvis w contrast (72196) |
— |
$4,880.05 |
— |
| MRI pelvis w/o & w contrast (72197) |
— |
$5,271.38 |
— |
| MRI pelvis w/o contrast (72195) |
— |
$4,619.73 |
— |
| MRI thoracic spine w/o contrast (72146) |
— |
$4,591.53 |
— |
| MRI upper extremity oth than jt w/contr matrl (73219) |
— |
$6,619.49 |
— |
| MRI upper extremity oth than jt w/o contr matrl (73218) |
— |
$6,228.16 |
— |
| Mri Uppr Extremity W/O&W/Dye (73220) |
— |
$7,513.26 |
— |
| MRI, abdomen, combo (74183) |
— |
$4,838.60 |
— |
| MRI, dorsal spine combo (72157) |
— |
$6,533.26 |
— |
| MRI, dorsal spine contrast (72147) |
— |
$5,593.07 |
— |
| MRI, joint upper extrem (73221) |
— |
$6,108.76 |
— |
| MRI, joint upper extrem combo (73223) |
— |
$9,595.93 |
— |
| MRI, lumbar spine combo (72158) |
— |
$7,334.16 |
— |
| Myocardial Imaging Infarct Avid Planar Qual/Quan (78466) |
— |
$1,636.64 |
— |
| Myocardial Perfusion Planar 1 Study Rest/Stress (78453) |
— |
$5,695.88 |
— |
| Myocardial Spect Multiple Studies (78452) |
— |
$5,695.88 |
— |
| Neck soft tissue (70360) |
— |
$371.44 |
— |
| Ophthalmic Ultrasonic Foreign Body Localization (76529) |
— |
$359.82 |
— |
| Ophthalmic ultrasound dx b-scan w/wo a-scan (76512) |
— |
$535.59 |
— |
| Parathyroid Planar Imaging (78070) |
— |
$1,636.64 |
— |
| Parathyroid planar imaging w/wo subtraction (78071) |
— |
$1,636.64 |
— |
| Pelvis 1 or 2 views (72170) |
— |
$520.68 |
— |
| Pulmonary Perfusion Imaging Particulate (78580) |
— |
$1,636.64 |
— |
| Radex Abd Compl Aqt Abd W/S/E/D Views 1 View Ch (74022) |
— |
$746.20 |
— |
| Radex abscess/fistula/sinus tract rs&i (76080) |
— |
$2,304.88 |
— |
| Radex Ankle Complete Minimum 3 Views (73610) |
— |
$1,018.13 |
— |
| Radex Calcaneus Minimum 2 Views (73650) |
— |
$613.55 |
— |
| Radex elbow complete minimum 3 views (73080) |
— |
$827.45 |
— |
| Radex Facial Bones Complete Minimum 3 Views (70150) |
— |
$520.68 |
— |
| Radex fingr minimum 2 views (73140) |
— |
$558.80 |
— |
| Radex foot complete minimum 3 views (73630) |
— |
$1,018.13 |
— |
| Radex Hand Minimum 3 Views (73130) |
— |
$749.52 |
— |
| Radex Mastoids Compl Minimum 3 Views PR Side (70130) |
— |
$548.87 |
— |
| Radex Nasal Bones Complete Minimum 3 Views (70160) |
— |
$467.61 |
— |
| Radex Ribs Unilateral 2 Views (71100) |
— |
$288.53 |
— |
| Radex shoulder complete minimum 2 views (73030) |
— |
$792.63 |
— |
| Radex Sinuses Paransl < 3 Views (70210) |
— |
$436.12 |
— |
| Radex sm int w/mlt srl imges via enteroclss tube (74251) |
— |
$844.02 |
— |
| Radex Spine 1 View Specify Level (72020) |
— |
$412.89 |
— |
| Radex Sternum Minimum 2 Views (71120) |
— |
$397.97 |
— |
| Radex Temporomandble Jt Opn & Clsd Mouth Bilat (70330) |
— |
$374.75 |
— |
| Radex Toe Minimum 2 Views (73660) |
— |
$744.52 |
— |
| Radex Wrist Complete Minimum 3 Views (73110) |
— |
$696.44 |
— |
| Radiolog exam mandible compl minimum 4 views (70110) |
— |
$552.18 |
— |
| Radiologic Exam Abdomen 3+ Views - Xr Abdomen 3+ Views (74021) |
— |
$520.68 |
— |
| Radiologic exam colon double contrast study (74280) |
— |
$1,328.21 |
— |
| Radiologic exam colon single contrast study (74270) |
— |
$1,190.59 |
— |
| Radiologic Exam Esophagus Double Contrast Study (74221) |
— |
$844.02 |
— |
| Radiologic exam knee complete 4/more views (73564) |
— |
$1,213.79 |
— |
| Radiologic exam pelvis compl minimum 3 views (72190) |
— |
$392.99 |
— |
| Radiologic Exam Small Int Single Contrast Study (74250) |
— |
$1,139.19 |
— |
| Radiologic exam swallow function contrast study (74230) |
— |
$527.31 |
— |
| Radiologic exam upr gi trc double contrast study (74246) |
— |
$844.02 |
— |
| Radiologic examination femur 1 view (73551) |
— |
$475.92 |
— |
| Radiologic examination femur minimum 2 views (73552) |
— |
$475.92 |
— |
| Radiologic examination knee 1/2 views (73560) |
— |
$870.55 |
— |
| Radiologic Examination Osseous Survey Limited (77074) |
— |
$1,175.66 |
— |
| Radiologic examination tibia & fibula 2 views (73590) |
— |
$994.92 |
— |
| Rp loclzj tum plnr 1 area single day imaging (78800) |
— |
$1,636.64 |
— |
| Rp Loclzj Tum Plnr Whole Body Single Day Imaging (78802) |
— |
$5,695.88 |
— |
| Rp Loclzj Tum Spect 1 Area Single Day Imaging (78803) |
— |
$2,379.50 |
— |
| Scapula (73010) |
— |
$850.65 |
— |
| Screening Digital Breast Tomosynthesis Bi (77063) |
— |
$112.77 |
— |
| Shoulder 1 view (73020) |
— |
$515.71 |
— |
| Shoulder Arthrography (73040) |
— |
$2,200.43 |
— |
| Sialogram (70390) |
— |
$1,067.88 |
— |
| Skull less than 4 views (70250) |
— |
$520.68 |
— |
| Thoracic spine 3 views (72072) |
— |
$520.68 |
— |
| Thoracolumbar 2 views (72080) |
— |
$452.69 |
— |
| Thyroid Imaging With Vascular Flow (78013) |
— |
$1,636.64 |
— |
| Thyroid Uptake W/Blood Flow Sngle/Mult Quan Meas (78014) |
— |
$1,636.64 |
— |
| Ultrasound Breast Limited (76642) |
— |
$359.82 |
— |
| Ultrasound Elastography Parenchyma (76981) |
— |
$520.68 |
— |
| Ultrasound Exam Aaa Screen (76706) |
— |
$520.68 |
— |
| Ultrasound, abdomen limited (76705) |
— |
$1,202.19 |
— |
| Umbilical-artery Doppler (OB) (76820) |
— |
$520.68 |
— |
| Unlisted us procedure (76999) |
— |
$527.31 |
— |
| Upper gi w/o kub (74240) |
— |
$844.02 |
— |
| Urethrocystogram voiding (74455) |
— |
$1,067.88 |
— |
| Urethrocystography retrograde (74450) |
— |
$1,067.88 |
— |
| Us breast unilateral complete (76641) |
— |
$410.08 |
— |
| Us chest (76604) |
— |
$800.91 |
— |
| Us complete joint (76881) |
— |
$714.68 |
— |
| Us exam, pelvic, limited (76857) |
— |
$739.58 |
— |
| Us head (76506) |
— |
$792.63 |
— |
| Us lmtd joint/oth nonvasc xtr strux r-t w/img (76882) |
— |
$520.68 |
— |
| Us ob detailed single fetus (76811) |
— |
$1,067.88 |
— |
| Us ob limited 1 or more fetuses (76815) |
— |
$784.33 |
— |
| Us ob transvaginal (76817) |
— |
$1,150.78 |
— |
| Us pelvic non ob complete (76856) |
— |
$1,021.46 |
— |
| Us pg uter img f&mat 14 wk tabdl 1/1st gestation (76801) |
— |
$567.12 |
— |
| Us preg uterus real time f/u trnsabdl per fetus (76816) |
— |
$535.59 |
— |
| Us retroperitoneal complete (76770) |
— |
$1,122.60 |
— |
| Us retroperitoneal limited (76775) |
— |
$870.55 |
— |
| Us scrotum and contents (76870) |
— |
$1,170.68 |
— |
| Us spinal canal and contents (76800) |
— |
$784.33 |
— |
| Us thyroid (76536) |
— |
$820.81 |
— |
| Us transrectal (76872) |
— |
$520.68 |
— |
| Vascular Flow Imaging (78445) |
— |
$1,636.64 |
— |
| Vein X-Ray Chest (75827) |
— |
$3,306.44 |
— |
| Venography caval inferior serialography rs&i (75825) |
— |
$12,235.77 |
— |
| Venography extremity bilateral rs&i (75822) |
— |
$5,065.77 |
— |
| Venography extremity unilateral rs&i (75820) |
— |
$2,871.99 |
— |
| Wrist 2 views (73100) |
— |
$535.59 |
— |
| X-Ray Ac Jts - Xr Acromioclavicular Joints Bilateral (73050) |
— |
$525.64 |
— |
| X-ray antegrade pyelogram tube (74425) |
— |
$1,787.52 |
— |
| X-Ray Elbow 2 Vw - Xr Elbow 1-2 Views Right (73070) |
— |
$819.15 |
— |
| X-Ray Exam Breast Specimen (76098) |
— |
$2,305.22 |
— |
| X-Ray Exam Entire Spi 2/3 Vw (72082) |
— |
$520.68 |
— |
| X-Ray Exam Entire Spi 4/5 Vw (72083) |
— |
$751.15 |
— |
| X-Ray Exam Hip Uni 1 View (73501) |
— |
$288.53 |
— |
| X-Ray Exam Hip Uni 2-3 Views (73502) |
— |
$288.53 |
— |
| X-Ray Exam Hips Bi 3-4 Views (73522) |
— |
$520.68 |
— |
| X-Ray Exam L-S Spine Bending (72114) |
— |
$1,175.66 |
— |
| X-Ray Exam Neck Spine 2-3 Vw (72040) |
— |
$522.34 |
— |
| X-Ray Exam Neck Spine 6/>Vws (72052) |
— |
$1,175.66 |
— |
| X-Ray Exam Unilat Ribs/Chest (71101) |
— |
$583.70 |
— |
| X-ray humerus (73060) |
— |
$467.61 |
— |
| X-ray IV pyelogram (ivp) (74400) |
— |
$1,346.46 |
— |
| X-Ray Lumbar Spine 2/3 Vw - Xr Lumbar Spine 2-3 Views (72100) |
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$527.31 |
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| X-ray nose-rectum child f.b. (76010) |
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$290.19 |
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| X-Ray Ribs, Chest 4+ Vw - Xr Ribs 3 Vws Bil W/ Chest Posteroanterior (71111) |
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$548.87 |
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| X-Ray Sacroiliac Jts 3+ Vw - Xr Sacroiliac Joints 3+ Views (72202) |
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$520.68 |
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| X-Ray Sacrum/Coccyx 2+ Vw - Xr Sacrum Coccyx 2+ Views (72220) |
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$409.58 |
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| X-Ray Sinuses 3+ Vw - Xr Paranasal Sinuses 3+ Views (70220) |
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$669.91 |
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| X-Ray Skull 4+ Vw - Xr Skull Complete 4+ Views (70260) |
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$520.68 |
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| X-Ray Urinary Tract Exam With Contrast Material (74420) |
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$1,787.52 |
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| X-Rays Bone Survey Complete (77075) |
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$1,175.66 |
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| Xr c-spine 4 or 5 views (72050) |
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$651.66 |
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| Xr facial bones less than 3 views (70140) |
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$288.53 |
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| Xr orbits complete 4 views (70200) |
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$520.68 |
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| Xr Tomogram Single Plane (76100) |
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$888.79 |
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