| Abdomen 1 View (74018) |
— |
$205 |
— |
| Abdomen 2 views (74019) |
— |
$194.26 |
— |
| Ankle 2 views (73600) |
— |
$164.81 |
— |
| Arthrogram ankle (73615) |
— |
$982.03 |
— |
| Arthrogram hip (73525) |
— |
$982.03 |
— |
| Arthrogram Wrist (73115) |
— |
$982.03 |
— |
| Chest 1 view (71045) |
— |
$156.80 |
— |
| Chest 2 views (71046) |
— |
$156.80 |
— |
| Chest 4 or more views (71048) |
— |
$194.26 |
— |
| Clavicle complete (73000) |
— |
$181.83 |
— |
| Contrast X-Ray Bladder (74430) |
— |
$656.24 |
— |
| Contrast X-Ray Of Elbow (73085) |
— |
$982.03 |
— |
| Contrast X-Ray Of Knee Joint (73580) |
— |
$982.03 |
— |
| CT abdomen and pelvis without and with contrast (74178) |
— |
$2,031.89 |
— |
| CT abdomen and pelvis without contrast (74176) |
— |
$1,418.10 |
— |
| CT abdomen w contrast (74160) |
— |
$1,051.72 |
— |
| CT abdomen w wo contrast (74170) |
— |
$1,169.32 |
— |
| CT abdomen w/o contrast (74150) |
— |
$671.62 |
— |
| CT Angio Abdomen and Pelvis (74174) |
— |
$2,031.89 |
— |
| CT Angio Chest (71275) |
— |
$1,184.65 |
— |
| Ct Angio Lwr Extr W/O&W/Dye (73706) |
— |
$1,184.65 |
— |
| CT Angio Neck (70498) |
— |
$1,184.65 |
— |
| Ct Angio Upr Extrm W/O&W/Dye (73206) |
— |
$1,184.65 |
— |
| CT cervical spine w/ contrast (72126) |
— |
$1,051.72 |
— |
| CT cervical spine w/o contrast (72125) |
— |
$671.62 |
— |
| CT cervical spine w/wo cont (72127) |
— |
$1,169.32 |
— |
| CT chest w contrast (71260) |
— |
$1,051.72 |
— |
| CT chest w/wo contrast (71270) |
— |
$1,169.32 |
— |
| CT head/brain with contrast (70460) |
— |
$1,051.72 |
— |
| CT head/brain without and with contrast (70470) |
— |
$1,169.32 |
— |
| CT iac w contrast (70481) |
— |
$1,051.72 |
— |
| CT l-spine w&w/o contrast (72133) |
— |
$1,169.32 |
— |
| CT lower ext w/o (73700) |
— |
$671.62 |
— |
| CT lower extremity w/contrast material (73701) |
— |
$1,051.72 |
— |
| CT lumbar spine w contrast (72132) |
— |
$1,051.72 |
— |
| CT lumbar spine w/o contrast (72131) |
— |
$671.62 |
— |
| CT maxillofacial w contrast (70487) |
— |
$1,051.72 |
— |
| CT maxillofacial wo contrast (70486) |
— |
$671.62 |
— |
| CT neck tissue combo (70492) |
— |
$1,169.32 |
— |
| Ct Orbit/Ear/Fossa W/O&W/Dye (70482) |
— |
$1,169.32 |
— |
| CT orbits w/o contrast (70480) |
— |
$671.62 |
— |
| CT pelvis w&w/o contrast (72194) |
— |
$1,169.32 |
— |
| CT pelvis w/o contrast (72192) |
— |
$671.62 |
— |
| CT scan of leg combo (73702) |
— |
$1,169.32 |
— |
| CT soft tissue neck w contrast (70491) |
— |
$1,051.72 |
— |
| CT soft tissue neck w/o contrast (70490) |
— |
$671.62 |
— |
| CT thoracic spine w contrast (72129) |
— |
$1,051.72 |
— |
| CT thoracic spine w/o contrast (72128) |
— |
$671.62 |
— |
| CT thoracic spine w/wo cont (72130) |
— |
$1,169.32 |
— |
| CT thorax w/o contrast (71250) |
— |
$671.62 |
— |
| CT upper ext wo (73200) |
— |
$671.62 |
— |
| CT upper extremity w/o & w/contrast material (73202) |
— |
$1,169.32 |
— |
| CT upper extremity with contrast (73201) |
— |
$1,051.72 |
— |
| Cta Abdl Aorta&Bi Iliofem W/Contrast&Postp (75635) |
— |
$3,306 |
— |
| Cta Abdomen (74175) |
— |
$1,184.65 |
— |
| CTA pelvis (72191) |
— |
$1,184.65 |
— |
| Esophagram (74220) |
— |
$363.60 |
— |
| Fetal Biophys Profile W/Nst (76818) |
— |
$337.09 |
— |
| Fluoroscopy up to 1 hr (76000) |
— |
$1,121.08 |
— |
| Foot 2 views (73620) |
— |
$176.31 |
— |
| Forearm 2 views (73090) |
— |
$217.39 |
— |
| Hand 2 views (73120) |
— |
$213 |
— |
| Infant hip ultrasound with hip movement (dynamic) (76885) |
— |
$220.22 |
— |
| Infant hip ultrasound, limited static exam (76886) |
— |
$220.22 |
— |
| Knee 3 Views (73562) |
— |
$273 |
— |
| Magnetic Image Jaw Joint (70336) |
— |
$1,184.44 |
— |
| Mra Head W/O & W/Contrast Material (70546) |
— |
$1,869.11 |
— |
| MRA head w/o contrast (70544) |
— |
$1,184.44 |
— |
| MRA neck w contrast (70548) |
— |
$1,525.44 |
— |
| Mra Neck W/O &W/Contrast Material (70549) |
— |
$1,869.11 |
— |
| MRA neck w/o contrast (70547) |
— |
$1,184.44 |
— |
| MRI abdomen w contrast (74182) |
— |
$1,525.44 |
— |
| MRI abdomen w/o contrast (74181) |
— |
$1,184.44 |
— |
| MRI any jt lower extrem w/contrast material (73722) |
— |
$1,525.44 |
— |
| MRI any jt lower extrem w/o & w/contrast matrl (73723) |
— |
$1,869.11 |
— |
| MRI any jt upper extremity w/contrast matrl (73222) |
— |
$1,525.44 |
— |
| MRI cervical spine w contrast (72142) |
— |
$1,525.44 |
— |
| MRI cervical spine w/o cont (72141) |
— |
$1,184.44 |
— |
| MRI chest wo w contrast (71552) |
— |
$1,869.11 |
— |
| MRI lower extrem oth/thn jt w/contrast matrl (73719) |
— |
$1,525.44 |
— |
| MRI lower extrem oth/thn jt w/o & w/contr matr (73720) |
— |
$1,869.11 |
— |
| MRI lower extrem oth/thn jt w/o contr matrl (73718) |
— |
$1,184.44 |
— |
| MRI lumbar spine w contrast (72149) |
— |
$1,525.44 |
— |
| Mri Neck Spine W/O & W/Dye (72156) |
— |
$1,869.11 |
— |
| MRI orbit face &/neck w/o contrast (70540) |
— |
$1,184.65 |
— |
| MRI orbit face neck w contrast (70542) |
— |
$1,525.44 |
— |
| Mri Orbt/Fac/Nck W/O &W/Dye (70543) |
— |
$1,869.11 |
— |
| MRI pelvis w contrast (72196) |
— |
$1,525.44 |
— |
| MRI pelvis w/o & w contrast (72197) |
— |
$1,869.11 |
— |
| MRI pelvis w/o contrast (72195) |
— |
$1,184.44 |
— |
| MRI thoracic spine w/o contrast (72146) |
— |
$1,184.44 |
— |
| MRI upper extremity oth than jt w/contr matrl (73219) |
— |
$1,525.44 |
— |
| MRI upper extremity oth than jt w/o contr matrl (73218) |
— |
$1,184.44 |
— |
| Mri Uppr Extremity W/O&W/Dye (73220) |
— |
$1,869.11 |
— |
| MRI, abdomen, combo (74183) |
— |
$1,869.11 |
— |
| MRI, dorsal spine combo (72157) |
— |
$1,869.11 |
— |
| MRI, dorsal spine contrast (72147) |
— |
$1,525.44 |
— |
| MRI, joint upper extrem (73221) |
— |
$1,184.44 |
— |
| MRI, joint upper extrem combo (73223) |
— |
$1,869.11 |
— |
| MRI, lumbar spine combo (72158) |
— |
$1,869.11 |
— |
| Myelogram Lumbar (72265) |
— |
$2,046.23 |
— |
| Myelography thoracic (72255) |
— |
$1,730.16 |
— |
| Neck soft tissue (70360) |
— |
$210.24 |
— |
| Pelvis 1 or 2 views (72170) |
— |
$195 |
— |
| Radex Abd Compl Aqt Abd W/S/E/D Views 1 View Ch (74022) |
— |
$414.09 |
— |
| Radex Ankle Complete Minimum 3 Views (73610) |
— |
$224.84 |
— |
| Radex Calcaneus Minimum 2 Views (73650) |
— |
$202.81 |
— |
| Radex elbow complete minimum 3 views (73080) |
— |
$225.37 |
— |
| Radex Facial Bones Complete Minimum 3 Views (70150) |
— |
$304.18 |
— |
| Radex fingr minimum 2 views (73140) |
— |
$174.72 |
— |
| Radex foot complete minimum 3 views (73630) |
— |
$227.28 |
— |
| Radex Hand Minimum 3 Views (73130) |
— |
$231.88 |
— |
| Radex Nasal Bones Complete Minimum 3 Views (70160) |
— |
$224.58 |
— |
| Radex Ribs Unilateral 2 Views (71100) |
— |
$231.72 |
— |
| Radex shoulder complete minimum 2 views (73030) |
— |
$234.97 |
— |
| Radex Spine 1 View Specify Level (72020) |
— |
$211.19 |
— |
| Radex Sternum Minimum 2 Views (71120) |
— |
$247.21 |
— |
| Radex Toe Minimum 2 Views (73660) |
— |
$174.22 |
— |
| Radex Wrist Complete Minimum 3 Views (73110) |
— |
$238.38 |
— |
| Radex X-Ray Exam Entire Spi 6/> Vw - Xr Entire Spine 6+ Vw (72084) |
— |
$194.26 |
— |
| Radiologic exam pelvis compl minimum 3 views (72190) |
— |
$294 |
— |
| Radiologic Exam Small Int Single Contrast Study (74250) |
— |
$422.02 |
— |
| Radiologic exam swallow function contrast study (74230) |
— |
$330.96 |
— |
| Radiologic exam upr gi trc double contrast study (74246) |
— |
$584.37 |
— |
| Radiologic examination femur 1 view (73551) |
— |
$156.80 |
— |
| Radiologic examination femur minimum 2 views (73552) |
— |
$156.80 |
— |
| Radiologic examination knee 1/2 views (73560) |
— |
$228.86 |
— |
| Radiologic examination tibia & fibula 2 views (73590) |
— |
$242.14 |
— |
| Ribs bilateral 3 views (71110) |
— |
$344.87 |
— |
| Scapula (73010) |
— |
$216.36 |
— |
| Shoulder 1 view (73020) |
— |
$190.74 |
— |
| Shoulder Arthrography (73040) |
— |
$982.03 |
— |
| Skull less than 4 views (70250) |
— |
$223.96 |
— |
| Thoracic spine 2 views (72070) |
— |
$198 |
— |
| Thoracolumbar 2 views (72080) |
— |
$192.75 |
— |
| Ultrasound Breast Limited (76642) |
— |
$220.22 |
— |
| Ultrasound Exam Aaa Screen (76706) |
— |
$498.50 |
— |
| Ultrasound, abdomen limited (76705) |
— |
$337.09 |
— |
| Urethrocystogram voiding (74455) |
— |
$410.24 |
— |
| Urethrocystography retrograde (74450) |
— |
$723.63 |
— |
| Us breast unilateral complete (76641) |
— |
$220.22 |
— |
| Us chest (76604) |
— |
$220.22 |
— |
| Us lmtd joint/oth nonvasc xtr strux r-t w/img (76882) |
— |
$220.22 |
— |
| Us pelvic non ob complete (76856) |
— |
$337.09 |
— |
| Us preg uterus real time f/u trnsabdl per fetus (76816) |
— |
$220.22 |
— |
| Us retroperitoneal complete (76770) |
— |
$337.09 |
— |
| Us retroperitoneal limited (76775) |
— |
$337.09 |
— |
| Us scrotum and contents (76870) |
— |
$337.09 |
— |
| Us thyroid (76536) |
— |
$337.09 |
— |
| Wrist 2 views (73100) |
— |
$172.31 |
— |
| X-Ray Ac Jts - Xr Acromioclavicular Joints Bilateral (73050) |
— |
$287.03 |
— |
| X-Ray Elbow 2 Vw - Xr Elbow 1-2 Views Right (73070) |
— |
$185.86 |
— |
| X-Ray Exam Entire Spi 1 Vw (72081) |
— |
$156.80 |
— |
| X-Ray Exam Entire Spi 2/3 Vw (72082) |
— |
$194.26 |
— |
| X-Ray Exam Entire Spi 4/5 Vw (72083) |
— |
$194.26 |
— |
| X-Ray Exam Hip Uni 1 View (73501) |
— |
$156.80 |
— |
| X-Ray Exam Hip Uni 2-3 Views (73502) |
— |
$156.80 |
— |
| X-Ray Exam Hip Uni 4/> Views (73503) |
— |
$194.26 |
— |
| X-Ray Exam Hips Bi 2 Views (73521) |
— |
$194.26 |
— |
| X-Ray Exam Hips Bi 3-4 Views (73522) |
— |
$194.26 |
— |
| X-Ray Exam Hips Bi 5/> Views (73523) |
— |
$194.26 |
— |
| X-Ray Exam Neck Spine 2-3 Vw (72040) |
— |
$257.64 |
— |
| X-Ray Exam Unilat Ribs/Chest (71101) |
— |
$316.90 |
— |
| X-ray humerus (73060) |
— |
$205.42 |
— |
| X-ray IV pyelogram (ivp) (74400) |
— |
$1,145 |
— |
| X-Ray Jaw <4 Vw - Xr Mandible < 4 Views (70100) |
— |
$213 |
— |
| X-Ray Knee Bilat Standing - Xr Knees Anteroposterior Standing Bilat (73565) |
— |
$254.80 |
— |
| X-Ray Lumbar Spine 2/3 Vw - Xr Lumbar Spine 2-3 Views (72100) |
— |
$247.36 |
— |
| X-Ray Ribs, Chest 4+ Vw - Xr Ribs 3 Vws Bil W/ Chest Posteroanterior (71111) |
— |
$433.72 |
— |
| X-Ray Sacroiliac Jts 3+ Vw - Xr Sacroiliac Joints 3+ Views (72202) |
— |
$259.71 |
— |
| X-Ray Sacrum/Coccyx 2+ Vw - Xr Sacrum Coccyx 2+ Views (72220) |
— |
$251.67 |
— |
| X-Ray Sinuses 3+ Vw - Xr Paranasal Sinuses 3+ Views (70220) |
— |
$270.39 |
— |
| X-Ray Skull 4+ Vw - Xr Skull Complete 4+ Views (70260) |
— |
$352.80 |
— |
| X-Ray Urinary Tract Exam With Contrast Material (74420) |
— |
$814.67 |
— |
| X-Rays Bone Survey Complete (77075) |
— |
$1,278 |
— |
| Xr c-spine 4 or 5 views (72050) |
— |
$392 |
— |
| Xr facial bones less than 3 views (70140) |
— |
$281 |
— |
| Xr orbits complete 4 views (70200) |
— |
$292.85 |
— |