| Abdomen 1 View (74018) |
— |
$538 |
— |
| Abdomen 2 views (74019) |
— |
$658 |
— |
| Ankle 2 views (73600) |
— |
$567 |
— |
| Bone age studies (77072) |
— |
$440 |
— |
| Bone survey infant (77076) |
— |
$742 |
— |
| Chest 1 view (71045) |
— |
$518 |
— |
| Chest 2 views (71046) |
— |
$701 |
— |
| Chest 4 or more views (71048) |
— |
$837 |
— |
| 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 Abdomen and Pelvis (74174) |
— |
$8,242 |
— |
| CT Angio Chest (71275) |
— |
$6,357 |
— |
| CT Angio Head (70496) |
— |
$6,244 |
— |
| Ct Angio Lwr Extr W/O&W/Dye (73706) |
— |
$7,472 |
— |
| CT Angio Neck (70498) |
— |
$6,222 |
— |
| Ct Angio Upr Extrm W/O&W/Dye (73206) |
— |
$6,947 |
— |
| CT cervical spine w/ contrast (72126) |
— |
$4,265 |
— |
| CT cervical 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 no contrast quant eval coronry 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 neck tissue combo (70492) |
— |
$3,327 |
— |
| 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 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 Abdl Aorta&Bi Iliofem W/Contrast&Postp (75635) |
— |
$8,077 |
— |
| Cta Abdomen (74175) |
— |
$6,508 |
— |
| Dxa Bone Density Axial (77080) |
— |
$782 |
— |
| Dxa bone density study 1/>sites appendiclr skel (77081) |
— |
$633 |
— |
| 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 (77077) |
— |
$947 |
— |
| Knee 3 Views (73562) |
— |
$674 |
— |
| Mra Head W/O & W/Contrast Material (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 contrast (74181) |
— |
$4,940 |
— |
| MRI any jt lower extrem w/o & w/contrast matrl (73723) |
— |
$6,973 |
— |
| MRI cervical spine w/o cont (72141) |
— |
$3,323 |
— |
| MRI chest w/o contrast (71550) |
— |
$5,603 |
— |
| MRI chest wo w contrast (71552) |
— |
$8,590 |
— |
| 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 Neck Spine W/O & W/Dye (72156) |
— |
$5,045 |
— |
| MRI orbit face &/neck w/o contrast (70540) |
— |
$5,323 |
— |
| Mri Orbt/Fac/Nck W/O &W/Dye (70543) |
— |
$4,564 |
— |
| MRI pelvis w/o & w contrast (72197) |
— |
$7,494 |
— |
| MRI pelvis w/o contrast (72195) |
— |
$5,555 |
— |
| MRI thoracic spine w/o contrast (72146) |
— |
$3,323 |
— |
| MRI upper extremity oth than jt w/o contr matrl (73218) |
— |
$5,403 |
— |
| Mri Uppr Extremity W/O&W/Dye (73220) |
— |
$4,687 |
— |
| MRI, abdomen, combo (74183) |
— |
$7,504 |
— |
| MRI, dorsal spine combo (72157) |
— |
$4,564 |
— |
| MRI, joint upper extrem (73221) |
— |
$3,500 |
— |
| MRI, joint upper extrem combo (73223) |
— |
$6,947 |
— |
| MRI, lumbar spine combo (72158) |
— |
$5,614 |
— |
| Neck soft tissue (70360) |
— |
$534 |
— |
| Nonvascular Shunt X-Ray (75809) |
— |
$1,879 |
— |
| Pelvis 1 or 2 views (72170) |
— |
$601 |
— |
| Radex Abd Compl Aqt Abd W/S/E/D Views 1 View Ch (74022) |
— |
$843 |
— |
| Radex Ankle Complete Minimum 3 Views (73610) |
— |
$587 |
— |
| Radex Calcaneus Minimum 2 Views (73650) |
— |
$513 |
— |
| Radex elbow complete minimum 3 views (73080) |
— |
$587 |
— |
| Radex Facial Bones Complete Minimum 3 Views (70150) |
— |
$782 |
— |
| Radex fingr minimum 2 views (73140) |
— |
$595 |
— |
| Radex foot complete minimum 3 views (73630) |
— |
$546 |
— |
| Radex Hand Minimum 3 Views (73130) |
— |
$579 |
— |
| Radex lower extremity infant minimum 2 views (73592) |
— |
$526 |
— |
| Radex Nasal Bones Complete Minimum 3 Views (70160) |
— |
$613 |
— |
| Radex Ribs Unilateral 2 Views (71100) |
— |
$620 |
— |
| Radex shoulder complete minimum 2 views (73030) |
— |
$546 |
— |
| Radex Spine 1 View Specify Level (72020) |
— |
$420 |
— |
| Radex Sternum Minimum 2 Views (71120) |
— |
$559 |
— |
| 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 Wrist Complete Minimum 3 Views (73110) |
— |
$667 |
— |
| Radiolog exam mandible compl minimum 4 views (70110) |
— |
$712 |
— |
| Radiologic Exam Abdomen 3+ Views - Xr Abdomen 3+ Views (74021) |
— |
$868 |
— |
| Radiologic exam knee complete 4/more views (73564) |
— |
$740 |
— |
| Radiologic exam pelvis compl minimum 3 views (72190) |
— |
$821 |
— |
| Radiologic examination femur minimum 2 views (73552) |
— |
$613 |
— |
| Radiologic examination knee 1/2 views (73560) |
— |
$587 |
— |
| Radiologic examination tibia & fibula 2 views (73590) |
— |
$539 |
— |
| Ribs bilateral 3 views (71110) |
— |
$706 |
— |
| Scapula (73010) |
— |
$567 |
— |
| Screening Digital Breast Tomosynthesis Bi (77063) |
— |
$73 |
— |
| Shoulder 1 view (73020) |
— |
$432 |
— |
| Skull less than 4 views (70250) |
— |
$680 |
— |
| Sternoclavicular joints (71130) |
— |
$704 |
— |
| Thoracic spine 2 views (72070) |
— |
$640 |
— |
| Thoracic spine 3 views (72072) |
— |
$654 |
— |
| Thoracolumbar 2 views (72080) |
— |
$579 |
— |
| Ultrasound Breast Limited (76642) |
— |
$861 |
— |
| Ultrasound Exam Aaa Screen (76706) |
— |
$1,101 |
— |
| Ultrasound, abdomen limited (76705) |
— |
$891 |
— |
| Unlisted Dx Radiographic Procedure (76499) |
— |
$52 |
— |
| Us breast unilateral complete (76641) |
— |
$1,069 |
— |
| Us chest (76604) |
— |
$856 |
— |
| Us complete joint (76881) |
— |
$830 |
— |
| Us exam, pelvic, limited (76857) |
— |
$466 |
— |
| Us lmtd joint/oth nonvasc xtr strux r-t w/img (76882) |
— |
$354 |
— |
| Us ob detailed single fetus (76811) |
— |
$1,086 |
— |
| Us ob limited 1 or more fetuses (76815) |
— |
$824 |
— |
| Us ob transvaginal (76817) |
— |
$948 |
— |
| Us pelvic non ob complete (76856) |
— |
$1,069 |
— |
| Us pg uter img f&mat 14 wk tabdl 1/1st gestation (76801) |
— |
$1,199 |
— |
| Us preg uterus real time f/u trnsabdl per fetus (76816) |
— |
$1,124 |
— |
| Us retroperitoneal complete (76770) |
— |
$1,104 |
— |
| Us retroperitoneal limited (76775) |
— |
$609 |
— |
| Us scrotum and contents (76870) |
— |
$658 |
— |
| Us thyroid (76536) |
— |
$1,131 |
— |
| Wrist 2 views (73100) |
— |
$546 |
— |
| 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 Entire Spi 2/3 Vw (72082) |
— |
$734 |
— |
| X-Ray Exam Hip Uni 1 View (73501) |
— |
$559 |
— |
| X-Ray Exam Hip Uni 2-3 Views (73502) |
— |
$782 |
— |
| X-Ray Exam Hips Bi 2 Views (73521) |
— |
$748 |
— |
| X-Ray Exam Hips Bi 3-4 Views (73522) |
— |
$922 |
— |
| X-Ray Exam L-S Spine Bending (72114) |
— |
$1,177 |
— |
| X-Ray Exam Neck Spine 2-3 Vw (72040) |
— |
$628 |
— |
| X-Ray Exam Neck Spine 6/>Vws (72052) |
— |
$1,063 |
— |
| X-Ray Exam Unilat Ribs/Chest (71101) |
— |
$688 |
— |
| X-ray eye for foreign body (70030) |
— |
$526 |
— |
X-ray humerus (73060)
range across 2 matching MRF lines |
— |
$544–$546 |
— |
| 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 Lumbar Spine 2/3 Vw - Xr Lumbar Spine 2-3 Views (72100) |
— |
$660 |
— |
| X-ray nose-rectum child f.b. (76010) |
— |
$492 |
— |
| 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 Sacroiliac Jts <3 Vw - Xr Sacroiliac Joints 1-2 Views (72200) |
— |
$666 |
— |
| 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-Rays Bone Survey Complete (77075) |
— |
$1,654 |
— |
| Xr c-spine 4 or 5 views (72050) |
— |
$849 |
— |
| Xr facial bones less than 3 views (70140) |
— |
$559 |
— |
| Xr orbits complete 4 views (70200) |
— |
$794 |
— |