| Abdomen 1 View (74018) |
— |
$730.99 |
— |
| Abdomen 2 views (74019) |
— |
$774.59 |
— |
| Angiography extremity bilateral rs&i (75716) |
— |
$7,851.82 |
— |
| Angiography extremity unilateral rs&i (75710) |
— |
$6,870.34 |
— |
| Ankle 2 views (73600) |
— |
$567.75 |
— |
| Bone age studies (77072) |
— |
$615.07 |
— |
| Chest 1 view (71045) |
— |
$612.12 |
— |
| Chest 2 views (71046) |
— |
$754.04 |
— |
| Clavicle complete (73000) |
— |
$599.91 |
— |
| Computed Tomography Thorax Lw Dose Lng Ca Scr C- (71271) |
— |
$3,907.22 |
— |
| Contrast Exam Abdominl Aorta (75625) |
— |
$6,870.34 |
— |
| CT abdomen and pelvis without and with contrast (74178) |
— |
$9,496.13 |
— |
| CT abdomen and pelvis without contrast (74176) |
— |
$8,035.17 |
— |
| CT abdomen w contrast (74160) |
— |
$4,967.21 |
— |
| CT Angio Abdomen and Pelvis (74174) |
— |
$9,934.42 |
— |
| CT Angio Chest (71275) |
— |
$7,665.07 |
— |
| CT Angio Head (70496) |
— |
$6,047.70 |
— |
| Ct Angio Lwr Extr W/O&W/Dye (73706) |
— |
$5,824.30 |
— |
| CT Angio Neck (70498) |
— |
$7,429.18 |
— |
| CT cervical spine w/o contrast (72125) |
— |
$4,591.41 |
— |
| CT chest w contrast (71260) |
— |
$5,162 |
— |
| CT head/brain without and with contrast (70470) |
— |
$5,208.31 |
— |
| CT lower ext w/o (73700) |
— |
$3,856.88 |
— |
| CT lumbar spine w/o contrast (72131) |
— |
$4,577.62 |
— |
| CT maxillofacial w contrast (70487) |
— |
$4,409.38 |
— |
| CT maxillofacial wo contrast (70486) |
— |
$3,903.68 |
— |
| CT pelvis w/o contrast (72192) |
— |
$3,954.29 |
— |
| CT soft tissue neck w contrast (70491) |
— |
$4,854.36 |
— |
| CT soft tissue neck w/o contrast (70490) |
— |
$4,186.88 |
— |
| CT thoracic spine w/o contrast (72128) |
— |
$3,798.45 |
— |
| CT thorax w/o contrast (71250) |
— |
$4,480.23 |
— |
| CT upper ext wo (73200) |
— |
$3,798.45 |
— |
| CT upper extremity with contrast (73201) |
— |
$4,285.44 |
— |
| Dxa Bone Density Axial (77080) |
— |
$949.22 |
— |
| Fetal Biophysical Profile W/O Non-Stress Testing (76819) |
— |
$1,069.75 |
— |
| Fluoroscopy up to 1 hr (76000) |
— |
$1,399.59 |
— |
| Foot 2 views (73620) |
— |
$567.75 |
— |
| Forearm 2 views (73090) |
— |
$605.61 |
— |
| Gastric emptying imaging study (78264) |
— |
$3,398.03 |
— |
| Hand 2 views (73120) |
— |
$603.25 |
— |
| Hepatobil Syst Image W/Drug (78227) |
— |
$4,546.90 |
— |
| Hepatobiliary System Imaging (78226) |
— |
$2,560.66 |
— |
| Infant hip ultrasound, limited static exam (76886) |
— |
$1,069.75 |
— |
| K Flow/Funct Image W/Drug (78708) |
— |
$3,033.95 |
— |
| Knee 3 Views (73562) |
— |
$709.68 |
— |
| Lung Perf&Ventilat Diferentl (78598) |
— |
$4,387.11 |
— |
| Lung Ventilat&Perfus Imaging (78582) |
— |
$3,869.33 |
— |
| Mra Head W/O & W/Contrast Material (70546) |
— |
$7,220.85 |
— |
| MRA head w/o contrast (70544) |
— |
$5,703.86 |
— |
| Mra Neck W/O &W/Contrast Material (70549) |
— |
$9,506.45 |
— |
| MRI abdomen w/o contrast (74181) |
— |
$5,855.03 |
— |
| MRI any jt lower extrem w/o & w/contrast matrl (73723) |
— |
$6,511.49 |
— |
| MRI any jt upper extremity w/contrast matrl (73222) |
— |
$5,624.39 |
— |
| MRI cervical spine w/o cont (72141) |
— |
$6,108.38 |
— |
| MRI lower extrem oth/thn jt w/o & w/contr matr (73720) |
— |
$6,777.63 |
— |
| MRI lower extrem oth/thn jt w/o contr matrl (73718) |
— |
$5,446.96 |
— |
| Mri Neck Spine W/O & W/Dye (72156) |
— |
$7,625.39 |
— |
| MRI pelvis w/o & w contrast (72197) |
— |
$7,008.27 |
— |
| MRI pelvis w/o contrast (72195) |
— |
$5,145.32 |
— |
| MRI thoracic spine w/o contrast (72146) |
— |
$5,358.23 |
— |
| MRI, abdomen, combo (74183) |
— |
$7,185.72 |
— |
| MRI, dorsal spine combo (72157) |
— |
$6,688.92 |
— |
| MRI, joint upper extrem (73221) |
— |
$5,180.80 |
— |
| MRI, joint upper extrem combo (73223) |
— |
$6,511.49 |
— |
| MRI, lumbar spine combo (72158) |
— |
$6,866.36 |
— |
| Myocardial Spect Multiple Studies (78452) |
— |
$7,346.24 |
— |
| Neck soft tissue (70360) |
— |
$705.57 |
— |
| Pelvis 1 or 2 views (72170) |
— |
$771.80 |
— |
| Radex Abd Compl Aqt Abd W/S/E/D Views 1 View Ch (74022) |
— |
$1,654.69 |
— |
| Radex Ankle Complete Minimum 3 Views (73610) |
— |
$665.37 |
— |
| Radex Calcaneus Minimum 2 Views (73650) |
— |
$537.27 |
— |
| Radex elbow complete minimum 3 views (73080) |
— |
$754.04 |
— |
| Radex fingr minimum 2 views (73140) |
— |
$546.74 |
— |
| Radex foot complete minimum 3 views (73630) |
— |
$674.22 |
— |
| Radex Hand Minimum 3 Views (73130) |
— |
$674.22 |
— |
| Radex Nasal Bones Complete Minimum 3 Views (70160) |
— |
$681.53 |
— |
| Radex Ribs Unilateral 2 Views (71100) |
— |
$780.67 |
— |
| Radex shoulder complete minimum 2 views (73030) |
— |
$665.37 |
— |
| Radex Spine 1 View Specify Level (72020) |
— |
$560.03 |
— |
| Radex Toe Minimum 2 Views (73660) |
— |
$546.74 |
— |
| Radex upper extremity infant minimum 2 views (73092) |
— |
$510.68 |
— |
| Radex Wrist Complete Minimum 3 Views (73110) |
— |
$709.68 |
— |
| Radiologic Exam Small Int Single Contrast Study (74250) |
— |
$1,284.55 |
— |
| Radiologic exam swallow function contrast study (74230) |
— |
$1,770.72 |
— |
| Radiologic exam upr gi trc double contrast study (74246) |
— |
$1,486.81 |
— |
| Radiologic examination femur minimum 2 views (73552) |
— |
$704.31 |
— |
| Radiologic examination knee 1/2 views (73560) |
— |
$603.25 |
— |
| Radiologic examination tibia & fibula 2 views (73590) |
— |
$641.67 |
— |
| Screening Digital Breast Tomosynthesis Bi (77063) |
— |
$174.67 |
— |
| Shoulder Arthrography (73040) |
— |
$1,868.72 |
— |
| Skull less than 4 views (70250) |
— |
$878.99 |
— |
| Thoracic spine 2 views (72070) |
— |
$1,064.54 |
— |
| Thoracic spine 3 views (72072) |
— |
$1,108.90 |
— |
| Thoracolumbar 2 views (72080) |
— |
$819.47 |
— |
| Ultrasound Breast Limited (76642) |
— |
$892.82 |
— |
| Ultrasound Elastography Parenchyma (76981) |
— |
$813.74 |
— |
| Ultrasound Exam Aaa Screen (76706) |
— |
$1,100.75 |
— |
| Ultrasound, abdomen limited (76705) |
— |
$1,337.19 |
— |
| Umbilical-artery Doppler (OB) (76820) |
— |
$875.48 |
— |
| Us complete joint (76881) |
— |
$980.61 |
— |
| Us exam, pelvic, limited (76857) |
— |
$962.78 |
— |
| Us head (76506) |
— |
$1,230.17 |
— |
| Us kidney transplant (76776) |
— |
$1,425.07 |
— |
| Us lmtd joint/oth nonvasc xtr strux r-t w/img (76882) |
— |
$891.48 |
— |
| Us ob limited 1 or more fetuses (76815) |
— |
$944.30 |
— |
| Us ob transvaginal (76817) |
— |
$1,117.95 |
— |
| Us pelvic non ob complete (76856) |
— |
$1,515.48 |
— |
| Us pg uter img f&mat 14 wk tabdl 1/1st gestation (76801) |
— |
$1,280.09 |
— |
| Us preg uterus real time f/u trnsabdl per fetus (76816) |
— |
$927.14 |
— |
| Us retroperitoneal complete (76770) |
— |
$1,515.48 |
— |
| Us retroperitoneal limited (76775) |
— |
$1,248.07 |
— |
| Us scrotum and contents (76870) |
— |
$1,365.93 |
— |
| Us spinal canal and contents (76800) |
— |
$999.66 |
— |
| Us thyroid (76536) |
— |
$1,278.18 |
— |
| Venography caval inferior serialography rs&i (75825) |
— |
$6,761.07 |
— |
| Wrist 2 views (73100) |
— |
$487.93 |
— |
| X-Ray Bend Only L-S Spine (72120) |
— |
$1,475.09 |
— |
| X-Ray Elbow 2 Vw - Xr Elbow 1-2 Views Right (73070) |
— |
$674.22 |
— |
| X-Ray Exam Entire Spi 1 Vw (72081) |
— |
$653.05 |
— |
| X-Ray Exam Hip Uni 1 View (73501) |
— |
$766.98 |
— |
| X-Ray Exam Hip Uni 2-3 Views (73502) |
— |
$766.98 |
— |
| X-Ray Exam Hips Bi 2 Views (73521) |
— |
$1,058.20 |
— |
| X-Ray Exam L-S Spine Bending (72114) |
— |
$2,129.10 |
— |
| X-Ray Exam Neck Spine 2-3 Vw (72040) |
— |
$745.17 |
— |
| X-Ray Exam Neck Spine 6/>Vws (72052) |
— |
$1,685.53 |
— |
| X-Ray Exam Unilat Ribs/Chest (71101) |
— |
$931.48 |
— |
| X-ray humerus (73060) |
— |
$624.58 |
— |
| X-Ray Knee Bilat Standing - Xr Knees Anteroposterior Standing Bilat (73565) |
— |
$1,015.37 |
— |
| X-Ray Lumbar Spine 2/3 Vw - Xr Lumbar Spine 2-3 Views (72100) |
— |
$1,330.69 |
— |
| X-Ray Ribs, Chest 4+ Vw - Xr Ribs 3 Vws Bil W/ Chest Posteroanterior (71111) |
— |
$1,286.34 |
— |
| X-Ray Sacroiliac Jts 3+ Vw - Xr Sacroiliac Joints 3+ Views (72202) |
— |
$689.13 |
— |
| X-Ray Sacrum/Coccyx 2+ Vw - Xr Sacrum Coccyx 2+ Views (72220) |
— |
$801.15 |
— |
| X-Ray Sinuses 3+ Vw - Xr Paranasal Sinuses 3+ Views (70220) |
— |
$896.56 |
— |
| X-Ray Urinary Tract Exam With Contrast Material (74420) |
— |
$1,630.52 |
— |
| Xr c-spine 4 or 5 views (72050) |
— |
$1,348.42 |
— |