| Abdomen 2 views (74019) |
— |
$520.68 |
— |
| Acute gastrointestinal blood loss imaging (78278) |
— |
$2,013.03 |
— |
| Angiography extremity bilateral rs&i (75716) |
— |
$12,235.77 |
— |
| Angiography extremity unilateral rs&i (75710) |
— |
$12,235.77 |
— |
| Angiography pelvic slctv/supraslctv rs&i (75736) |
— |
$20,273.02 |
— |
| Angiography pulmonary bilateral slctv rs&i (75743) |
— |
$12,235.77 |
— |
| Angiography pulmonary unilateral slctv rs&i (75741) |
— |
$11,690.24 |
— |
| Angiography visceral slctv/supraslctv rs&i (75726) |
— |
$20,273.02 |
— |
| Angrph pulmonary nonslctv cath/ven njx rs&i (75746) |
— |
$5,065.77 |
— |
| Ankle 2 views (73600) |
— |
$834.08 |
— |
| Antegrade urography radiological supvj & interpj (74425) |
— |
$1,787.52 |
— |
| Aortogram thoracic (75605) |
— |
$20,273.02 |
— |
| Arthrogram elbow (73085) |
— |
$2,200.43 |
— |
| Arthrogram hip (73525) |
— |
$1,787.52 |
— |
| Arthrogram shoulder (73040) |
— |
$2,200.43 |
— |
| Arthrogram wrist (73115) |
— |
$3,576.72 |
— |
| Arthrography knee lt (73580) |
— |
$3,576.72 |
— |
| Bone &/Joint Imaging Limited Area (78300) |
— |
$1,636.64 |
— |
| Bone &/joint imaging whole body (78306) |
— |
$2,271.71 |
— |
| Bone age studies (77072) |
— |
$540.59 |
— |
| Bone Imaging 3 Phase (78315) |
— |
$2,439.20 |
— |
| Bone Marrow Imaging Limited Area (78102) |
— |
$1,636.64 |
— |
| Bone survey complete (77075) |
— |
$1,175.66 |
— |
| Cervical spine 2 or 3 views (72040) |
— |
$522.34 |
— |
| Chest 1 view (71045) |
— |
$265.45 |
— |
| Chest 3 views (71047) |
— |
$288.53 |
— |
| Cine/Vid X-Ray Throat/Esoph - Fl Esoph Barium Swlw W/ Video & Speech (74230) |
— |
$527.31 |
— |
| Clavicle complete (73000) |
— |
$792.63 |
— |
| Computed Tomography Thorax Lw Dose Lng Ca Scr C- (71271) |
— |
$402.45 |
— |
| 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 angiography upper extremity lt (73206) |
— |
$3,371.10 |
— |
| CT c-spine w/o contrast (72125) |
— |
$3,202.10 |
— |
| CT cervical spine w&w/o contrast (72127) |
— |
$3,641.38 |
— |
| CT cervical spine with contrast (72126) |
— |
$2,692.91 |
— |
| CT chest w/wo contrast (71270) |
— |
$3,603.26 |
— |
| CT chest with contrast (71260) |
— |
$2,765.79 |
— |
| 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 limited/localized follow up study (76380) |
— |
$1,523.87 |
— |
| CT lower ext w/o (73700) |
— |
$3,619.84 |
— |
| CT lower extremity w wo contrast (73702) |
— |
$4,759.02 |
— |
| CT lower extremity with contrast (73701) |
— |
$3,921.62 |
— |
| CT lumbar spine w & w/o contrast (72133) |
— |
$4,006.19 |
— |
| CT lumbar spine w/o contrast (72131) |
— |
$2,815.61 |
— |
| CT lumbar spine with contrast (72132) |
— |
$3,480.54 |
— |
| CT maxillofacial w contrast (70487) |
— |
$2,505.53 |
— |
| CT maxillofacial w/o contrast (70486) |
— |
$2,885.25 |
— |
| CT maxillofacial w/wo contrast (70488) |
— |
$3,400.95 |
— |
| CT neck soft tissue w contrast (70491) |
— |
$2,840.49 |
— |
| CT orbit sella/post fossa/ear w/o & w/contr matr (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 soft tissue neck w/o & w/contrast material (70492) |
— |
$3,573.41 |
— |
| 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 contrast (72130) |
— |
$2,891.89 |
— |
| CT thorax w/o contrast (71250) |
— |
$2,623.25 |
— |
| CT unlisted procedure (76497) |
— |
$2,140.74 |
— |
| CT upper extremity w/o & w/contrast material (73202) |
— |
$4,679.41 |
— |
| CT upper extremity w/o contrast rt (73200) |
— |
$3,541.89 |
— |
| 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 abdomen pelvis (74174) |
— |
$2,318.17 |
— |
| CTA chest (71275) |
— |
$3,464.49 |
— |
| Cta Head (70496) |
— |
$3,286.55 |
— |
| CTA lwr ext w&w/o contrast (73706) |
— |
$5,057.49 |
— |
| Cta Neck (70498) |
— |
$3,286.55 |
— |
| Cta Pelvis (72191) |
— |
$3,636.40 |
— |
| Cystography minimum 3 views rs&i (74430) |
— |
$1,787.52 |
— |
| Dxa bone density study 1/> sites axial skel (77080) |
— |
$630.72 |
— |
| Dxa bone density study 1/>sites appendiclr skel (77081) |
— |
$316.88 |
— |
| Echo exam of eye (76529) |
— |
$359.82 |
— |
| Echoencephalography real time imaging (76506) |
— |
$792.63 |
— |
| Esophagus (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 |
— |
| Gated Heart Planar Single (78472) |
— |
$2,231.92 |
— |
| Hand 2 views (73120) |
— |
$722.96 |
— |
| Hand 3 views (73130) |
— |
$749.52 |
— |
| Heart Infarct Image (78466) |
— |
$1,636.64 |
— |
| Hepatobil Syst Imag Inc Gb W/Pharma Intervenj (78227) |
— |
$2,110.88 |
— |
| Hepatobiliary syst imaging including gallbladder (78226) |
— |
$1,636.64 |
— |
| Ht muscle image spect sing (78451) |
— |
$5,695.88 |
— |
| Humerus Min 2 Views Left (73060) |
— |
$467.61 |
— |
| Hysterosalpingogram (74740) |
— |
$1,213.79 |
— |
| Kidney img morphology vascular flow 1 w/rx (78708) |
— |
$2,110.88 |
— |
| Kidney Img Morphology Vascular Flow Multiple (78709) |
— |
$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 Ventilation Imaging (78579) |
— |
$1,636.64 |
— |
| Lymphoscintigraphy (78195) |
— |
$2,110.88 |
— |
| Mammary ductogram or galactogram multiple (77054) |
— |
$1,067.28 |
— |
| Meckels Diverticulum (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 & w/contrast material (74183) |
— |
$4,838.60 |
— |
| MRI abdomen w/o contrast (74181) |
— |
$6,113.76 |
— |
| MRI any jnt lwr ext with con lt (73722) |
— |
$6,631.11 |
— |
| MRI any jt upper extremity w/contrast matrl (73222) |
— |
$6,830.08 |
— |
| MRI c-spine with contrast (72142) |
— |
$5,127.12 |
— |
| MRI cervical spine w/o contrast (72141) |
— |
$5,105.56 |
— |
| MRI chest w/o & w/contrast material (71552) |
— |
$5,218.33 |
— |
| MRI chest w/o contrast (71550) |
— |
$3,619.84 |
— |
| MRI chest with contrast (71551) |
— |
$3,203.63 |
— |
| MRI Forearm w/ Contrast Bilateral 73219 (73219) |
— |
$6,619.49 |
— |
| MRI lower extrem oth/thn jt w/contrast matrl (73719) |
— |
$6,306.10 |
— |
| MRI lower extrem oth/thn jt w/o contr matrl (73718) |
— |
$6,045.77 |
— |
| MRI orbit face &/neck w/o contrast (70540) |
— |
$3,662.93 |
— |
| MRI orbit/face/neck w&w/o cont (70543) |
— |
$5,054.17 |
— |
| MRI orbit/face/neck w/contrast (70542) |
— |
$4,128.90 |
— |
| MRI pelvis w contrast (72196) |
— |
$4,880.05 |
— |
| MRI pelvis w/o & w/contrast material (72197) |
— |
$5,271.38 |
— |
| MRI pelvis w/o contrast (72195) |
— |
$4,619.73 |
— |
| MRI scan of arm joint before and after contrast (73223) |
— |
$9,595.93 |
— |
| MRI scan of leg joint before and after contrast (73723) |
— |
$7,513.26 |
— |
| MRI spinal canal cervical w/o & w/contr matrl (72156) |
— |
$7,186.59 |
— |
| MRI spinal canal lumbar w/contrast material (72149) |
— |
$6,185.04 |
— |
| MRI spinal canal lumbar w/o & w/contr matrl (72158) |
— |
$7,334.16 |
— |
| MRI spinal canal thoracic w/contrast matrl (72147) |
— |
$5,593.07 |
— |
| MRI spinal canal thoracic w/o & w/contr matrl (72157) |
— |
$6,533.26 |
— |
| MRI thoracic spine w/o contrast (72146) |
— |
$4,591.53 |
— |
| MRI tmj (70336) |
— |
$3,662.93 |
— |
| MRI upper ext joint w/o contrast (73221) |
— |
$6,108.76 |
— |
| MRI upper extrem other than jt w/o & w/contras (73220) |
— |
$7,513.26 |
— |
| MRI upper extremity oth than jt w/o contr matrl (73218) |
— |
$6,228.16 |
— |
| Myocardial Spect Multiple Studies (78452) |
— |
$5,695.88 |
— |
| Neck soft tissue (70360) |
— |
$371.44 |
— |
| Nm bone marrow multiple (78103) |
— |
$1,636.64 |
— |
| Nm gastric emptying study (78264) |
— |
$1,636.64 |
— |
| Nm gastroesophageal reflux study (78262) |
— |
$1,636.64 |
— |
| Nuclear medicine of heart muscle at rest with stress (78454) |
— |
$5,695.88 |
— |
| Nuclear medicine study of heart muscle at rest with stress (78453) |
— |
$5,695.88 |
— |
| Ob Us Follow-Up Per Fetus - Us Ob Follow Up Transabdominal Approach (76816) |
— |
$535.59 |
— |
| Osseous survey infant (77076) |
— |
$520.68 |
— |
| Osseous survey limited (77074) |
— |
$1,175.66 |
— |
| Parathyrd planar w/wo subtrj (78071) |
— |
$1,636.64 |
— |
| Parathyroid imaging (78070) |
— |
$1,636.64 |
— |
| Pelvis 1 or 2 views (72170) |
— |
$520.68 |
— |
| Pr MRI, lower extr, w/o contrast f/u by contrast (73720) |
— |
$7,513.26 |
— |
| Pulmonary Perfusion Imaging Particulate (78580) |
— |
$1,636.64 |
— |
| Pulmonary Ventilation & Perfusion Imaging (78582) |
— |
$2,110.88 |
— |
| Radex abscess/fistula/sinus tract rs&i (76080) |
— |
$2,304.88 |
— |
| Radex entir thrc lmbr crv sac spi w/skull 2/3 vw (72082) |
— |
$520.68 |
— |
| Radex mastoids compl minimum 3 views pr side (70130) |
— |
$548.87 |
— |
| Radiolog exam mandible compl minimum 4 views (70110) |
— |
$552.18 |
— |
| Radiologic Exam Abdomen 1 View - Xr Abdomen 1 View (74018) |
— |
$288.53 |
— |
| Radiologic Exam Abdomen 3+ Views - Xr Abdomen 3+ Views (74021) |
— |
$520.68 |
— |
| Radiologic Exam Chest 2 Views - Xr Chest 2 Views (71046) |
— |
$288.53 |
— |
| Radiologic exam colon single contrast study (74270) |
— |
$1,190.59 |
— |
| Radiologic Exam Esophagus Double Contrast Study (74221) |
— |
$844.02 |
— |
| Radiologic exam upr gi trc double contrast study (74246) |
— |
$844.02 |
— |
| Radiologic exam upr gi trc single contrast study (74240) |
— |
$844.02 |
— |
| Radiologic Examination Femur Minimum 2 Views - Xr Femur 2+ Vw Lt (73552) |
— |
$475.92 |
— |
| Radiological examination surgical specimen (76098) |
— |
$2,305.22 |
— |
| 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 complete (73010) |
— |
$850.65 |
— |
| Screening digital breast tomosynthesis (77063) |
— |
$112.77 |
— |
| Sialogram (70390) |
— |
$1,067.88 |
— |
| Small bowel series (74250) |
— |
$1,139.19 |
— |
| Spine thoracic 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 |
— |
| Tomogram (76100) |
— |
$888.79 |
— |
| Tumor Imaging, Limited Area - Nm Tumor Localization Limited (78800) |
— |
$1,636.64 |
— |
| Ultrasound, abdomen limited (76705) |
— |
$1,202.19 |
— |
| Umbilical-artery Doppler (OB) (76820) |
— |
$520.68 |
— |
| Unlisted Ultrasound Procedure (76999) |
— |
$527.31 |
— |
| Urethrocystography retrograde rs&i (74450) |
— |
$1,067.88 |
— |
| Urethrocystography voiding (74455) |
— |
$1,067.88 |
— |
| Urography (pyelography), intravenous, with or without KUB, with or without tomography (74400) |
— |
$1,346.46 |
— |
| Us abdl aorta screen aaa (76706) |
— |
$520.68 |
— |
| Us breast unilateral complete (76641) |
— |
$410.08 |
— |
| Us breast unilateral limited (76642) |
— |
$359.82 |
— |
| Us chest (76604) |
— |
$800.91 |
— |
| Us compl joint r-t w/image documentation (76881) |
— |
$714.68 |
— |
| Us elastography parenchyma (76981) |
— |
$520.68 |
— |
| Us guided compression repair (76936) |
— |
$1,169.01 |
— |
| Us infant hips limited static (76886) |
— |
$548.87 |
— |
| Us ob detailed single fetus (76811) |
— |
$1,067.88 |
— |
| Us ob transvaginal (76817) |
— |
$1,150.78 |
— |
| Us pelvic non ob complete (76856) |
— |
$1,021.46 |
— |
| Us pelvic nonobstetric image dcmtn limited/f/u (76857) |
— |
$739.58 |
— |
| Us pregnancy ltd (76815) |
— |
$784.33 |
— |
| Us pregnant uterus 14 wk transabdl 1/1st gestat (76801) |
— |
$567.12 |
— |
| Us retroperitoneal complete (76770) |
— |
$1,122.60 |
— |
| Us retroperitoneal limited (76775) |
— |
$870.55 |
— |
| Us scrotum and contents (76870) |
— |
$1,170.68 |
— |
| Us soft tissue head/neck (76536) |
— |
$820.81 |
— |
| Us spinal canal and contents (76800) |
— |
$784.33 |
— |
| Us transrectal (76872) |
— |
$520.68 |
— |
| Us xtr non-vasc lmtd (76882) |
— |
$520.68 |
— |
| Us, eye b-scan (76512) |
— |
$535.59 |
— |
| Vascular flow imaging (78445) |
— |
$1,636.64 |
— |
| Venogram extremity bilateral (75822) |
— |
$5,065.77 |
— |
| Venography caval inferior serialography rs&i (75825) |
— |
$12,235.77 |
— |
| Venography caval superior serialography rs&i (75827) |
— |
$3,306.44 |
— |
| Venography extremity unilateral rs&i (75820) |
— |
$2,871.99 |
— |
| Wrist 2 views (73100) |
— |
$535.59 |
— |
| X-Ray Abdomen,Comp Acute Series - Xr Abdomen 2 Vws With Chest 1 View (74022) |
— |
$746.20 |
— |
| X-Ray Ac Jts - Xr Acromioclavicular Joints Bilateral (73050) |
— |
$525.64 |
— |
| X-Ray Ankle 3+ Vw - Xr Ankle 3+ Views Right (73610) |
— |
$1,018.13 |
— |
| X-Ray Colon Air Contrast - Fl Barium Enema Air Contrast (74280) |
— |
$1,328.21 |
— |
| X-Ray Elbow 2 Vw - Xr Elbow 1-2 Views Right (73070) |
— |
$819.15 |
— |
| X-Ray Elbow 3+ Vw - Xr Elbow 3+ Views Right (73080) |
— |
$827.45 |
— |
| 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 of femur 1 (73551) |
— |
$475.92 |
— |
| X-ray exam of small bowel - fl small bowel series enteroclysis tube (74251) |
— |
$844.02 |
— |
| X-Ray Facial Bones 3+ Vw - Xr Facial Bones 3+ Views (70150) |
— |
$520.68 |
— |
| X-Ray Facial Bones <3 Vw - Xr Facial Bones 1-2 Views (70140) |
— |
$288.53 |
— |
| X-Ray Foot 3+ Vw - Xr Foot 3+ Views Right (73630) |
— |
$1,018.13 |
— |
| X-ray guide gu dilation - ir nephrostomy dilation (74485) |
— |
$8,058.81 |
— |
| X-Ray Heel - Xr Calcaneus 2 Views Right (73650) |
— |
$613.55 |
— |
| X-Ray Knee 4+ View - Xr Knee 4+ Views Right (73564) |
— |
$1,213.79 |
— |
| X-Ray Lumbar Spine 2/3 Vw - Xr Lumbar Spine 2-3 Views (72100) |
— |
$527.31 |
— |
| X-Ray Lumbar Spine 6+ Vw - Xr Lumbar Spine 6+ Vws Including Bending (72114) |
— |
$1,175.66 |
— |
| X-Ray Nasal Bones - Xr Nasal Bones (70160) |
— |
$467.61 |
— |
| X-Ray Nose-Rectum Child F.B. - Xr Nose to Rectum Foreign Body Peds (76010) |
— |
$290.19 |
— |
| X-Ray Orbits - Xr Orbits Complete 4+ Views (70200) |
— |
$520.68 |
— |
| X-Ray Pelvis 3+ Vw - Xr Pelvis 3+ Views (72190) |
— |
$392.99 |
— |
| X-Ray Retrograde Pyelogram - Fl Pyelogram Retrograde (74420) |
— |
$1,787.52 |
— |
| X-Ray Ribs 2 Vw Unilat - Xr Ribs 2 Views Right (71100) |
— |
$288.53 |
— |
| X-Ray Ribs, Chest 3+ Vw - Xr Ribs 2 Vws Lt W/ Chest Anteroposterior (71101) |
— |
$583.70 |
— |
| 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) |
— |
$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 Shoulder 2+ Vw - Xr Shoulder 2+ Views Right (73030) |
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$792.63 |
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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 Sinuses <3 Vw - Xr Paranasal Sinuses 1-2 Views (70210) |
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$436.12 |
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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 Skull <4 Vw - Xr Skull 1-3 Views (70250) |
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$520.68 |
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| X-Ray Spine One View - Xr Spine (72020) |
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$412.89 |
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| X-Ray Sternum 2+ Vw - Xr Sternum 2+ Views (71120) |
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$397.97 |
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| X-Ray Toe(S) - Xr Toes 2+ Views Right (73660) |
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$744.52 |
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| X-Ray Wrist 3+ Vw - Xr Wrist 3+ Views Right (73110) |
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$696.44 |
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| Xr arthrogram ankle (73615) |
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$3,576.72 |
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| Xr c-spine 6 or more views (72052) |
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$1,175.66 |
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| Xr chest 4+ views (71048) |
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$520.68 |
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| Xr finger(s) 2+ views (73140) |
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$558.80 |
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| Xr shoulder 1 view (73020) |
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$515.71 |
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| Xr spine cervical 4 or 5 views (72050) |
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$651.66 |
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| Xr tibia/fibula 2 views (73590) |
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$994.92 |
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| Xr tmj bilateral (70330) |
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$374.75 |
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| Xray knee 1 or 2 views rt (73560) |
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$870.55 |
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