| Abdomen 2 views (74019) |
— |
$356 |
— |
| Acute gastrointestinal blood loss imaging (78278) |
— |
$1,077 |
— |
| Angiography extremity unilateral rs&i (75710) |
— |
$881 |
— |
| Ankle 2 views (73600) |
— |
$265 |
— |
| Arthrogram shoulder (73040) |
— |
$548 |
— |
| Bone &/Joint Imaging Limited Area (78300) |
— |
$978 |
— |
| Bone &/joint imaging whole body (78306) |
— |
$1,254 |
— |
| Bone age studies (77072) |
— |
$317 |
— |
| Bone Imaging 3 Phase (78315) |
— |
$1,257 |
— |
| Bone survey complete (77075) |
— |
$455 |
— |
| Cervical spine 2 or 3 views (72040) |
— |
$346 |
— |
| Chest 1 view (71045) |
— |
$240 |
— |
| Chest 3 views (71047) |
— |
$300 |
— |
| Cine/Vid X-Ray Throat/Esoph - Fl Esoph Barium Swlw W/ Video & Speech (74230) |
— |
$540 |
— |
| Clavicle complete (73000) |
— |
$213 |
— |
| Computed Tomography Thorax Lw Dose Lng Ca Scr C- (71271) |
— |
$1,019 |
— |
| CT abdomen and pelvis without and with contrast (74178) |
— |
$2,426 |
— |
| CT abdomen and pelvis without contrast (74176) |
— |
$2,576 |
— |
| CT abdomen w contrast (74160) |
— |
$1,885 |
— |
| CT abdomen w wo contrast (74170) |
— |
$2,377 |
— |
| CT abdomen w/o contrast (74150) |
— |
$1,760 |
— |
| CT angiography upper extremity lt (73206) |
— |
$2,428 |
— |
| CT c-spine w/o contrast (72125) |
— |
$1,391 |
— |
| CT cervical spine with contrast (72126) |
— |
$1,545 |
— |
| CT chest w/wo contrast (71270) |
— |
$2,122 |
— |
| CT chest with contrast (71260) |
— |
$2,166 |
— |
| CT head/brain with contrast (70460) |
— |
$1,865 |
— |
| CT head/brain without and with contrast (70470) |
— |
$2,013 |
— |
| CT iac w contrast (70481) |
— |
$1,613 |
— |
| CT limited/localized follow up study (76380) |
— |
$1,288 |
— |
| CT lower ext w/o (73700) |
— |
$1,177 |
— |
| CT lower extremity with contrast (73701) |
— |
$1,553 |
— |
| CT lumbar spine w/o contrast (72131) |
— |
$1,607 |
— |
| CT lumbar spine with contrast (72132) |
— |
$1,762 |
— |
| CT maxillofacial w contrast (70487) |
— |
$1,483 |
— |
| CT maxillofacial w/o contrast (70486) |
— |
$1,559 |
— |
| CT maxillofacial w/wo contrast (70488) |
— |
$1,689 |
— |
| CT neck soft tissue w contrast (70491) |
— |
$2,067 |
— |
| CT orbit sella/post fossa/ear w/o & w/contr matr (70482) |
— |
$1,655 |
— |
| CT orbits w/o contrast (70480) |
— |
$1,303 |
— |
| CT pelvis w & w/o contrast (72194) |
— |
$2,191 |
— |
| CT pelvis w/o contrast (72192) |
— |
$1,890 |
— |
| CT soft tissue neck w/o & w/contrast material (70492) |
— |
$1,415 |
— |
| CT soft tissue neck w/o contrast (70490) |
— |
$1,343 |
— |
| CT thoracic spine w/o contrast (72128) |
— |
$1,445 |
— |
| CT thorax w/o contrast (71250) |
— |
$1,680 |
— |
| CT upper extremity w/o & w/contrast material (73202) |
— |
$1,607 |
— |
| CT upper extremity w/o contrast rt (73200) |
— |
$1,396 |
— |
| CT upper extremity with contrast (73201) |
— |
$1,553 |
— |
| Cta Abdl Aorta&Bi Iliofem W/Contrast&Postp (75635) |
— |
$2,293 |
— |
| Cta Abdomen (74175) |
— |
$2,591 |
— |
| CTA abdomen pelvis (74174) |
— |
$2,625 |
— |
| CTA chest (71275) |
— |
$1,909.50 |
— |
| Cta Head (70496) |
— |
$2,625 |
— |
| CTA lwr ext w&w/o contrast (73706) |
— |
$2,428 |
— |
| Cta Neck (70498) |
— |
$1,945 |
— |
| Cta Pelvis (72191) |
— |
$2,605 |
— |
| Dxa bone density study 1/> sites axial skel (77080) |
— |
$459 |
— |
| Dxa bone density study 1/>sites appendiclr skel (77081) |
— |
$207 |
— |
| Echo exam of fetal heart (76825) |
— |
$711 |
— |
| Esophagus (74220) |
— |
$383 |
— |
| Fetal Biophysical Profile W/O Non-Stress Testing (76819) |
— |
$598 |
— |
| Fluoroscopy up to 1 hr (76000) |
— |
$576 |
— |
| Foot 2 views (73620) |
— |
$265 |
— |
| Forearm 2 views (73090) |
— |
$240 |
— |
| Gated Heart Planar Single (78472) |
— |
$1,740 |
— |
| Hand 2 views (73120) |
— |
$267 |
— |
| Hand 3 views (73130) |
— |
$305 |
— |
| Hepatobil Syst Imag Inc Gb W/Pharma Intervenj (78227) |
— |
$1,504 |
— |
| Ht muscle image spect sing (78451) |
— |
$1,373 |
— |
| Humerus Min 2 Views Left (73060) |
— |
$281 |
— |
| Hysterosalpingogram (74740) |
— |
$524 |
— |
| Joint Survey, Single View - Xr Joint Anteroposterior 2+ Joints (77077) |
— |
$300 |
— |
| Kidney Img Morphology Vascular Flow 1 W/O Rx (78707) |
— |
$1,282 |
— |
| Knee 3 views (73562) |
— |
$389 |
— |
| Liver & Spleen Imaging W/Vascular Flow (78216) |
— |
$1,061 |
— |
| MRA head w & w/o contrast (70546) |
— |
$3,131 |
— |
| MRA head w/o contrast (70544) |
— |
$2,812 |
— |
| MRA head with contrast (70545) |
— |
$3,131 |
— |
| MRA neck w contrast (70548) |
— |
$2,865 |
— |
| Mra Neck W/O &W/Contrast Material (70549) |
— |
$3,077 |
— |
| MRA neck w/o contrast (70547) |
— |
$2,653 |
— |
| MRI abdomen w contrast (74182) |
— |
$2,759 |
— |
| MRI abdomen w/o & w/contrast material (74183) |
— |
$2,971 |
— |
| MRI abdomen w/o contrast (74181) |
— |
$2,547 |
— |
| MRI any jnt lwr ext with con lt (73722) |
— |
$2,759 |
— |
| MRI any jt upper extremity w/contrast matrl (73222) |
— |
$2,759 |
— |
| MRI bone marrow blood supply (77084) |
— |
$2,547 |
— |
| MRI c-spine with contrast (72142) |
— |
$2,759 |
— |
| MRI cervical spine w/o contrast (72141) |
— |
$2,759 |
— |
| MRI chest w/o & w/contrast material (71552) |
— |
$3,131 |
— |
| MRI chest w/o contrast (71550) |
— |
$2,547 |
— |
| MRI chest with contrast (71551) |
— |
$2,878 |
— |
| MRI lower extrem oth/thn jt w/contrast matrl (73719) |
— |
$2,759 |
— |
| MRI lower extrem oth/thn jt w/o contr matrl (73718) |
— |
$2,547 |
— |
| MRI orbit face &/neck w/o contrast (70540) |
— |
$2,547 |
— |
| MRI orbit/face/neck w&w/o cont (70543) |
— |
$3,131 |
— |
| MRI orbit/face/neck w/contrast (70542) |
— |
$2,759 |
— |
| MRI pelvis w contrast (72196) |
— |
$2,759 |
— |
| MRI pelvis w/o & w/contrast material (72197) |
— |
$2,971 |
— |
| MRI pelvis w/o contrast (72195) |
— |
$2,547 |
— |
| MRI scan of arm joint before and after contrast (73223) |
— |
$2,971 |
— |
| MRI scan of leg joint before and after contrast (73723) |
— |
$2,971 |
— |
| MRI spinal canal cervical w/o & w/contr matrl (72156) |
— |
$2,971 |
— |
| MRI spinal canal lumbar w/contrast material (72149) |
— |
$2,759 |
— |
| MRI spinal canal lumbar w/o & w/contr matrl (72158) |
— |
$2,971 |
— |
| MRI spinal canal thoracic w/contrast matrl (72147) |
— |
$2,759 |
— |
| MRI spinal canal thoracic w/o & w/contr matrl (72157) |
— |
$2,971 |
— |
| MRI thoracic spine w/o contrast (72146) |
— |
$2,547 |
— |
| MRI tmj (70336) |
— |
$2,547 |
— |
| MRI upper ext joint w/o contrast (73221) |
— |
$2,547 |
— |
| MRI upper extrem other than jt w/o & w/contras (73220) |
— |
$2,971 |
— |
| MRI upper extremity oth than jt w/o contr matrl (73218) |
— |
$2,759 |
— |
| Myocardial Spect Multiple Studies (78452) |
— |
$1,913 |
— |
| Neck soft tissue (70360) |
— |
$295 |
— |
| Nm gastric emptying study (78264) |
— |
$1,259 |
— |
| Nuclear Rx Oral Admin (79005) |
— |
$572 |
— |
| Ob Us Follow-Up Per Fetus - Us Ob Follow Up Transabdominal Approach (76816) |
— |
$572 |
— |
| Osseous survey infant (77076) |
— |
$193 |
— |
| Osseous survey limited (77074) |
— |
$409 |
— |
| Parathyroid imaging (78070) |
— |
$911 |
— |
| Pelvis 1 or 2 views (72170) |
— |
$255 |
— |
| Pr MRI, lower extr, w/o contrast f/u by contrast (73720) |
— |
$2,971 |
— |
| Radex abscess/fistula/sinus tract rs&i (76080) |
— |
$542 |
— |
| Radex entir thrc lmbr crv sac spi w/skull 2/3 vw (72082) |
— |
$309 |
— |
| Radex hips bilateral with pelvis 2 views (73521) |
— |
$368 |
— |
| Radex mastoids compl minimum 3 views pr side (70130) |
— |
$300 |
— |
| Radiolog exam mandible compl minimum 4 views (70110) |
— |
$380 |
— |
| Radiologic Exam Abdomen 1 View - Xr Abdomen 1 View (74018) |
— |
$298 |
— |
| Radiologic Exam Chest 2 Views - Xr Chest 2 Views (71046) |
— |
$280 |
— |
| Radiologic exam colon single contrast study (74270) |
— |
$1,463 |
— |
| Radiologic exam upr gi trc single contrast study (74240) |
— |
$961 |
— |
| Radiologic Examination Femur Minimum 2 Views - Xr Femur 2+ Vw Lt (73552) |
— |
$281 |
— |
| Radiologic Examination Salivary Gland Calculus (70380) |
— |
$248 |
— |
| Radiological examination surgical specimen (76098) |
— |
$314 |
— |
| Ribs bilateral 3 views (71110) |
— |
$404 |
— |
| Rp loclzj tum plnr whole body single day imaging (78802) |
— |
$1,310 |
— |
| Sacroiliac Joints < 3 Views (72200) |
— |
$302 |
— |
| Scanogram (77073) |
— |
$325 |
— |
| Scapula complete (73010) |
— |
$311 |
— |
| Screening digital breast tomosynthesis (77063) |
— |
$106 |
— |
| Sella turcica (70240) |
— |
$164 |
— |
| Sialogram (70390) |
— |
$393 |
— |
| Small bowel series (74250) |
— |
$542 |
— |
| Speech evaluation complex (70371) |
— |
$203 |
— |
| Spine thoracic 3 views (72072) |
— |
$452 |
— |
| Thyroid Uptake W/Blood Flow Sngle/Mult Quan Meas (78014) |
— |
$1,297 |
— |
| Tmj unilateral (70328) |
— |
$315 |
— |
| Tumor Imaging, Limited Area - Nm Tumor Localization Limited (78800) |
— |
$808 |
— |
| Ultrasound, abdomen limited (76705) |
— |
$655 |
— |
| Unlisted Diagnostic Radiographic Procedure (76499) |
— |
$193 |
— |
| Unlisted Ultrasound Procedure (76999) |
— |
$689 |
— |
| Urethrocystography voiding (74455) |
— |
$615 |
— |
| Urography (pyelography), intravenous, with or without KUB, with or without tomography (74400) |
— |
$858 |
— |
| Us abdl aorta screen aaa (76706) |
— |
$656 |
— |
| Us breast unilateral complete (76641) |
— |
$446 |
— |
| Us breast unilateral limited (76642) |
— |
$446 |
— |
| Us chest (76604) |
— |
$338 |
— |
| Us compl joint r-t w/image documentation (76881) |
— |
$521 |
— |
| Us ob detailed single fetus (76811) |
— |
$695 |
— |
| Us ob transvaginal (76817) |
— |
$545 |
— |
| Us pelvic non ob complete (76856) |
— |
$717 |
— |
| Us pelvic nonobstetric image dcmtn limited/f/u (76857) |
— |
$642 |
— |
| Us pregnancy ltd (76815) |
— |
$600 |
— |
| Us pregnant uterus 14 wk transabdl 1/1st gestat (76801) |
— |
$618 |
— |
| Us retroperitoneal complete (76770) |
— |
$750 |
— |
| Us retroperitoneal limited (76775) |
— |
$640 |
— |
| Us scrotum and contents (76870) |
— |
$532 |
— |
| Us soft tissue head/neck (76536) |
— |
$739 |
— |
| Us transrectal (76872) |
— |
$424 |
— |
| Us xtr non-vasc lmtd (76882) |
— |
$521 |
— |
| Venogram extremity bilateral (75822) |
— |
$1,207 |
— |
| Venography extremity unilateral rs&i (75820) |
— |
$689 |
— |
| Wrist 2 views (73100) |
— |
$242 |
— |
| X-Ray Abdomen,Comp Acute Series - Xr Abdomen 2 Vws With Chest 1 View (74022) |
— |
$502 |
— |
| X-Ray Ac Jts - Xr Acromioclavicular Joints Bilateral (73050) |
— |
$346 |
— |
| X-Ray Ankle 3+ Vw - Xr Ankle 3+ Views Right (73610) |
— |
$350 |
— |
| X-Ray Colon Air Contrast - Fl Barium Enema Air Contrast (74280) |
— |
$1,463 |
— |
| X-Ray Elbow 3+ Vw - Xr Elbow 3+ Views Right (73080) |
— |
$343 |
— |
| X-ray exam hip uni 1 view (73501) |
— |
$273 |
— |
| X-Ray Exam Hip Uni 2-3 Views (73502) |
— |
$326 |
— |
| X-ray exam of femur 1 (73551) |
— |
$250 |
— |
| X-ray eye for foreign body (70030) |
— |
$293 |
— |
| X-Ray Facial Bones 3+ Vw - Xr Facial Bones 3+ Views (70150) |
— |
$404 |
— |
| X-Ray Facial Bones <3 Vw - Xr Facial Bones 1-2 Views (70140) |
— |
$197 |
— |
| X-Ray Foot 3+ Vw - Xr Foot 3+ Views Right (73630) |
— |
$343 |
— |
| X-Ray Heel - Xr Calcaneus 2 Views Right (73650) |
— |
$264 |
— |
| X-Ray Knee 4+ View - Xr Knee 4+ Views Right (73564) |
— |
$382 |
— |
| X-Ray Lumbar Spine 2/3 Vw - Xr Lumbar Spine 2-3 Views (72100) |
— |
$393 |
— |
| X-Ray Lumbar Spine 6+ Vw - Xr Lumbar Spine 6+ Vws Including Bending (72114) |
— |
$477 |
— |
| X-Ray Nasal Bones - Xr Nasal Bones (70160) |
— |
$289 |
— |
| X-Ray Orbits - Xr Orbits Complete 4+ Views (70200) |
— |
$384 |
— |
| X-Ray Retrograde Pyelogram - Fl Pyelogram Retrograde (74420) |
— |
$689 |
— |
| X-Ray Ribs 2 Vw Unilat - Xr Ribs 2 Views Right (71100) |
— |
$253 |
— |
| X-Ray Ribs, Chest 3+ Vw - Xr Ribs 2 Vws Lt W/ Chest Anteroposterior (71101) |
— |
$360 |
— |
| X-Ray Sacrum/Coccyx 2+ Vw - Xr Sacrum Coccyx 2+ Views (72220) |
— |
$317 |
— |
| X-Ray Shoulder 2+ Vw - Xr Shoulder 2+ Views Right (73030) |
— |
$350 |
— |
| X-Ray Sinuses 3+ Vw - Xr Paranasal Sinuses 3+ Views (70220) |
— |
$361 |
— |
| X-Ray Skull 4+ Vw - Xr Skull Complete 4+ Views (70260) |
— |
$435 |
— |
| X-Ray Skull <4 Vw - Xr Skull 1-3 Views (70250) |
— |
$368 |
— |
| X-Ray Spine One View - Xr Spine (72020) |
— |
$175 |
— |
| X-Ray Sterno-Clavicluar Jt - Xr Sternoclavicular Joints 3+ Views (71130) |
— |
$278 |
— |
| X-Ray Sternum 2+ Vw - Xr Sternum 2+ Views (71120) |
— |
$326 |
— |
| X-Ray Toe(S) - Xr Toes 2+ Views Right (73660) |
— |
$220 |
— |
| X-Ray Wrist 3+ Vw - Xr Wrist 3+ Views Right (73110) |
— |
$267 |
— |
| Xr c-spine 6 or more views (72052) |
— |
$514 |
— |
| Xr Cholecystography Oral Contrast (74290) |
— |
$246.50 |
— |
| Xr finger(s) 2+ views (73140) |
— |
$232 |
— |
| Xr spine cervical 4 or 5 views (72050) |
— |
$520 |
— |
| Xr tibia/fibula 2 views (73590) |
— |
$346 |
— |
| Xr tmj bilateral (70330) |
— |
$361 |
— |
| Xray knee 1 or 2 views rt (73560) |
— |
$221 |
— |