| Abdomen 2 views (74019) |
— |
$658 |
— |
| Ankle 2 views (73600) |
— |
$567 |
— |
| Bone age studies (77072) |
— |
$440 |
— |
| Bone survey complete (77075) |
— |
$1,654 |
— |
| Bone survey infant (77076) |
— |
$742 |
— |
| Cervical spine 2 or 3 views (72040) |
— |
$628 |
— |
| Chest 1 view (71045) |
— |
$518 |
— |
| Clavicle complete (73000) |
— |
$519 |
— |
| Computed Tomography Thorax Lw Dose Lng Ca Scr C- (71271) |
— |
$3,220 |
— |
| CT abdomen and pelvis without and with contrast (74178) |
— |
$7,489 |
— |
| CT abdomen and pelvis without contrast (74176) |
— |
$4,255 |
— |
| CT abdomen w contrast (74160) |
— |
$4,896 |
— |
| CT abdomen w wo contrast (74170) |
— |
$5,568 |
— |
| CT abdomen w/o contrast (74150) |
— |
$2,354 |
— |
| CT angio lwr extr w/o&w/dye (73706) |
— |
$7,472 |
— |
| CT angiography upper extremity lt (73206) |
— |
$6,947 |
— |
| CT c-spine w/contrast (72126) |
— |
$4,265 |
— |
| CT c-spine w/o contrast (72125) |
— |
$3,918 |
— |
| CT chest w contrast (71260) |
— |
$4,865 |
— |
| CT chest w/wo contrast (71270) |
— |
$5,838 |
— |
| CT head/brain with contrast (70460) |
— |
$3,432 |
— |
| CT head/brain without and with contrast (70470) |
— |
$4,074 |
— |
| CT heart w/o contrast quant eval coronary calcium (75571) |
— |
$2,331 |
— |
| CT iac w contrast (70481) |
— |
$5,859 |
— |
| CT lower ext w/o (73700) |
— |
$3,802 |
— |
| CT lower extremity w/contrast material (73701) |
— |
$4,798 |
— |
| CT lumbar spine w/contrast (72132) |
— |
$4,851 |
— |
| CT lumbar spine w/o contrast (72131) |
— |
$3,809 |
— |
| CT maxillofacial w contrast (70487) |
— |
$3,577 |
— |
| CT maxillofacial wo contrast (70486) |
— |
$2,973 |
— |
| CT orbits w/o contrast (70480) |
— |
$4,956 |
— |
| CT pelvis w/o contrast (72192) |
— |
$3,101 |
— |
| CT soft tissue neck w contrast (70491) |
— |
$5,002 |
— |
| CT soft tissue neck w/o & w/contrast material (70492) |
— |
$3,327 |
— |
| CT soft tissue neck w/o contrast (70490) |
— |
$4,097 |
— |
| CT thoracic spine w/contrast (72129) |
— |
$3,306 |
— |
| CT thoracic spine w/o contrast (72128) |
— |
$3,825 |
— |
| CT thorax w/o contrast (71250) |
— |
$3,833 |
— |
| CT upper ext wo (73200) |
— |
$3,802 |
— |
| CT upper extremity with contrast (73201) |
— |
$4,730 |
— |
| Cta Aa&Bi Iliofem Lxtr Rs&I C-/C+ Post-Pxessing (75635) |
— |
$8,077 |
— |
| Cta Abdomen (74175) |
— |
$6,508 |
— |
| CTA abdomen pelvis (74174) |
— |
$8,242 |
— |
| CTA chest (71275) |
— |
$6,357 |
— |
| Cta Head (70496) |
— |
$6,244 |
— |
| Cta Neck (70498) |
— |
$6,222 |
— |
| Dxa bone density study 1/> sites axial skel (77080) |
— |
$782 |
— |
| Dxa bone density study 1/>sites appendiclr skel (77081) |
— |
$633 |
— |
| Facial bones min 3 views (70150) |
— |
$782 |
— |
| Fetal Biophysical Profile W/O Non-Stress Testing (76819) |
— |
$868 |
— |
| Foot 2 views (73620) |
— |
$492 |
— |
| Forearm 2 views (73090) |
— |
$487 |
— |
| Hand 2 views (73120) |
— |
$492 |
— |
| Joint Survey, Single View - Xr Joint Anteroposterior 2+ Joints (77077) |
— |
$947 |
— |
| Knee 3 views (73562) |
— |
$674 |
— |
| Magnetic resonance (eg, proton) imaging, upper extremity, other than joint; without contrast material(s), followed by… (73220) |
— |
$4,687 |
— |
| MRA head w & w/o contrast (70546) |
— |
$4,805 |
— |
| MRA head w/o contrast (70544) |
— |
$5,809 |
— |
| Mra Neck W/O &W/Contrast Material (70549) |
— |
$4,805 |
— |
| MRA neck w/o contrast (70547) |
— |
$3,605 |
— |
| MRI abdomen w/o & w/contrast material (74183) |
— |
$7,504 |
— |
| MRI abdomen w/o contrast (74181) |
— |
$4,940 |
— |
| MRI any jt lower extrem w/o & w/contrast matrl (73723) |
— |
$6,973 |
— |
| MRI cervical spine w/o contrast (72141) |
— |
$3,323 |
— |
| MRI chest w/o & w/contrast material (71552) |
— |
$8,590 |
— |
| MRI chest w/o contrast (71550) |
— |
$5,603 |
— |
| MRI lower extrem oth/thn jt w/o & w/contr matr (73720) |
— |
$7,447 |
— |
| MRI lower extrem oth/thn jt w/o contr matrl (73718) |
— |
$5,403 |
— |
| MRI orbit face &/neck w/o contrast (70540) |
— |
$5,323 |
— |
| MRI orbit/face/neck w&w/o cont (70543) |
— |
$4,564 |
— |
| MRI pelvis w/o & w/contrast material (72197) |
— |
$7,494 |
— |
| MRI pelvis w/o contrast (72195) |
— |
$5,555 |
— |
| MRI spinal canal cervical w/o & w/contr matrl (72156) |
— |
$5,045 |
— |
| MRI spinal canal lumbar w/o & w/contr matrl (72158) |
— |
$5,614 |
— |
| MRI spinal canal thoracic w/o & w/contr matrl (72157) |
— |
$4,564 |
— |
| MRI thoracic spine w/o contrast (72146) |
— |
$3,323 |
— |
| MRI up ext w/o contrast (73218) |
— |
$5,403 |
— |
| MRI upper ext joint w/o contrast (73221) |
— |
$3,500 |
— |
| MRI, joint upper extrem combo (73223) |
— |
$6,947 |
— |
| Neck soft tissue (70360) |
— |
$534 |
— |
| Nonvascular shunt X-ray (75809) |
— |
$1,879 |
— |
| Pelvis 1 or 2 views (72170) |
— |
$601 |
— |
| Radex Ankle Compl Minimum 3 Views (73610) |
— |
$587 |
— |
| Radex Calcaneus Minimum 2 Views (73650) |
— |
$513 |
— |
| Radex Elbw Compl Minimum 3 Views (73080) |
— |
$587 |
— |
| Radex entir thrc lmbr crv sac spi w/skull 2/3 vw (72082) |
— |
$734 |
— |
| Radex fingr minimum 2 views (73140) |
— |
$595 |
— |
| Radex Foot Compl Minimum 3 Views (73630) |
— |
$546 |
— |
| Radex Hand Minimum 3 Views (73130) |
— |
$579 |
— |
| Radex Hip Unilateral With Pelvis 1 View (73501) |
— |
$559 |
— |
| Radex Hips Bilateral With Pelvis 2 Views (73521) |
— |
$748 |
— |
| Radex Humerus Minimum 2 Views (73060) |
— |
$545 |
— |
| Radex Kne 1/2 Views (73560) |
— |
$587 |
— |
| Radex Kne Compl 4/More Views (73564) |
— |
$740 |
— |
| Radex Mndbl Compl Minimum 4 Views (70110) |
— |
$712 |
— |
| Radex Nasal Bones Complete Minimum 3 Views (70160) |
— |
$613 |
— |
| Radex Pelvis Compl Minimum 3 Views (72190) |
— |
$821 |
— |
| Radex Sho Compl Minimum 2 Views (73030) |
— |
$546 |
— |
| Radex Temporomandble Jt Opn & Clsd Mouth Bilat (70330) |
— |
$848 |
— |
| Radex Toe Minimum 2 Views (73660) |
— |
$534 |
— |
| Radex upper extremity infant minimum 2 views (73092) |
— |
$513 |
— |
| Radex Wrst Compl Minimum 3 Views (73110) |
— |
$667 |
— |
| Radiologic Exam Abdomen 1 View - Xr Abdomen 1 View (74018) |
— |
$538 |
— |
| Radiologic Exam Abdomen 3+ Views - Xr Abdomen 3+ Views (74021) |
— |
$868 |
— |
| Radiologic exam chest 2 views (71046) |
— |
$701 |
— |
| Radiologic examination tibia & fibula 2 views (73590) |
— |
$539 |
— |
| Ribs bilateral 3 views (71110) |
— |
$706 |
— |
| Sacroiliac Joints < 3 Views (72200) |
— |
$666 |
— |
| Scapula (73010) |
— |
$567 |
— |
| Screening Digital Breast Tomosynthesis Bi (77063) |
— |
$73 |
— |
| Shoulder 1 view (73020) |
— |
$432 |
— |
| Spine thoracic 3 views (72072) |
— |
$654 |
— |
| Thoracolumbar 2 views (72080) |
— |
$579 |
— |
| Ultrasound breast complete (76641) |
— |
$1,069 |
— |
| Ultrasound Exam Aaa Screen (76706) |
— |
$1,101 |
— |
| Ultrasound, abdomen limited (76705) |
— |
$891 |
— |
| Unlisted Diagnostic Radiographic Procedure (76499) |
— |
$52 |
— |
| Us breast unilateral limited (76642) |
— |
$861 |
— |
| Us chest (76604) |
— |
$856 |
— |
| Us compl joint r-t w/image documentation (76881) |
— |
$830 |
— |
| Us lmtd joint/oth nonvasc xtr strux r-t w/img (76882) |
— |
$354 |
— |
| Us ob detailed single fetus (76811) |
— |
$1,086 |
— |
| Us ob limited (76815) |
— |
$824 |
— |
| Us ob transvaginal (76817) |
— |
$948 |
— |
| Us pelvic non ob complete (76856) |
— |
$1,069 |
— |
| Us pelvic nonobstetric image dcmtn limited/f/u (76857) |
— |
$466 |
— |
| Us pg uter img f&mat 14 wk tabdl 1/1st gestation (76801) |
— |
$1,199 |
— |
| Us pg uter r-t img f-up tabdl appr pr fetus (76816) |
— |
$1,124 |
— |
| Us retroperitoneal complete (76770) |
— |
$1,104 |
— |
| Us retroperitoneal limited (76775) |
— |
$609 |
— |
| Us scrotum and contents (76870) |
— |
$658 |
— |
| Us soft tissue head/neck (76536) |
— |
$1,131 |
— |
| Wrist 2 views (73100) |
— |
$546 |
— |
| X-Ray Abdomen,Comp Acute Series - Xr Abdomen 2 Vws With Chest 1 View (74022) |
— |
$843 |
— |
| X-Ray Ac Jts - Xr Acromioclavicular Joints Bilateral (73050) |
— |
$667 |
— |
| X-Ray Elbow 2 Vw - Xr Elbow 1-2 Views Right (73070) |
— |
$513 |
— |
| X-Ray Exam Hip Uni 2-3 Views (73502) |
— |
$782 |
— |
| X-Ray Exam Hips Bi 3-4 Views (73522) |
— |
$922 |
— |
| X-ray exam of femur 2/> (73552) |
— |
$613 |
— |
| X-ray eye for foreign body (70030) |
— |
$526 |
— |
| X-Ray Facial Bones <3 Vw - Xr Facial Bones 1-2 Views (70140) |
— |
$559 |
— |
| X-Ray Jaw <4 Vw - Xr Mandible < 4 Views (70100) |
— |
$793 |
— |
| X-Ray Knee Bilat Standing - Xr Knees Anteroposterior Standing Bilat (73565) |
— |
$674 |
— |
| X-ray leg, infant (73592) |
— |
$526 |
— |
| X-Ray Lumbar Spine 2/3 Vw - Xr Lumbar Spine 2-3 Views (72100) |
— |
$660 |
— |
| X-Ray Lumbar Spine 6+ Vw - Xr Lumbar Spine 6+ Vws Including Bending (72114) |
— |
$1,177 |
— |
| X-ray nose-rectum child f.b. (76010) |
— |
$492 |
— |
| X-Ray Orbits - Xr Orbits Complete 4+ Views (70200) |
— |
$794 |
— |
| X-Ray Ribs 2 Vw Unilat - Xr Ribs 2 Views Right (71100) |
— |
$620 |
— |
| X-Ray Ribs, Chest 3+ Vw - Xr Ribs 2 Vws Lt W/ Chest Anteroposterior (71101) |
— |
$688 |
— |
| X-Ray Ribs, Chest 4+ Vw - Xr Ribs 3 Vws Bil W/ Chest Posteroanterior (71111) |
— |
$901 |
— |
| X-Ray Sacroiliac Jts 3+ Vw - Xr Sacroiliac Joints 3+ Views (72202) |
— |
$620 |
— |
| X-Ray Sacrum/Coccyx 2+ Vw - Xr Sacrum Coccyx 2+ Views (72220) |
— |
$534 |
— |
| X-Ray Sinuses 3+ Vw - Xr Paranasal Sinuses 3+ Views (70220) |
— |
$708 |
— |
| X-Ray Skull 4+ Vw - Xr Skull Complete 4+ Views (70260) |
— |
$892 |
— |
| X-Ray Skull <4 Vw - Xr Skull 1-3 Views (70250) |
— |
$680 |
— |
| X-Ray Spine One View - Xr Spine (72020) |
— |
$420 |
— |
| X-Ray Sterno-Clavicluar Jt - Xr Sternoclavicular Joints 3+ Views (71130) |
— |
$704 |
— |
| X-Ray Sternum 2+ Vw - Xr Sternum 2+ Views (71120) |
— |
$559 |
— |
| X-Ray Thoracic Spine 2 Vw - Xr Thoracic Spine 2 Views (72070) |
— |
$640 |
— |
| Xr c-spine 4 or 5 views (72050) |
— |
$849 |
— |
| Xr c-spine 6 or more views (72052) |
— |
$1,063 |
— |
| Xr chest 4+ views (71048) |
— |
$837 |
— |