Penrad Price Quote Grid Updated 4/1/15
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- George Bruce Chambers
- 7 years ago
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1 77073 CT Bone length studies(orthotoentgenogram, scanogram) $75.00 $75.00 $ CT CT Abdomen w Contrast $ Q9967 $50.00 $ $ CT CT Abdomen w, w/o Contrast $ Q9967 $50.00 $ $ CT CT Abdomen w/o Contrast $ $ $ CT CT Abdomen, Pelvis w and w/o Contrast $ Q9967 $50.00 $ $ CT CT Abdomen, Pelvis w Contrast $ Q9967 $50.00 $ $ CT CT Abdomen, Pelvis w/o Contrast $ $ $ CT CT Chest w Contrast $ Q9967 $50.00 $ $ CT CT Chest w, w/o Contrast $ Q9967 $50.00 $ $ CT CT Chest w/o Contrast $ $ $ CT CT Guided Needle Placement $ $ $ CT CT Head/ Brain w Contrast $ Q9967 $50.00 $ $ CT CT Head/ Brain w, w/o Contrast $ Q9967 $50.00 $ $ CT CT Head/ Brain w/o Contrast $ $ $ CT CT Heart Screen Calcium Scoring $ $ $ CT CT Lower Extremity w Contrast $ Q9967 $50.00 $ $ CT CT Lower Extremity w, w/o Contrast $ Q9967 $50.00 $ $ CT CT Lower Extremity w/o Contrast $ $ $ CT CT Maxillofacial Complete $ $ $ CT CT Maxillofacial w Contrast $ Q9967 $50.00 $ $ CT CT Maxillofacial w, w/o Contrast $ Q9967 $50.00 $ $ CT CT Neck Soft Tissue w Contrast $ Q9967 $50.00 $ $ CT CT Neck Soft Tissue w, w/o Contrast $ Q9967 $50.00 $ $ CT CT Neck Soft Tissue w/o Contrast $ $ $ CT CT Orbit, Pituitary or IACs w Contrast $ Q9967 $50.00 $ $ CT CT Orbit, Pituitary or IACs w, w/o Contrast $ Q9967 $50.00 $ $ CT CT Orbit, Pituitary or IACs w/o Contrast $ $ $ CT CT Pelvis w Contrast $ Q9967 $50.00 $ $ CT CT Pelvis w, w/o Contrast $ Q9967 $50.00 $ $ CT CT Pelvis w/o Contrast $ $ $ CT CT Spine Cervical w Contrast $ Q9967 $50.00 $ $ CT CT Spine Cervical w, w/o Contrast $ Q9967 $50.00 $ $ CT CT Spine Cervical w/o Contrast $ $ $ CT CT Spine Lumbar w Contrast $ Q9967 $50.00 $ $ CT CT Spine Lumbar w, w/o Contrast $ Q9967 $50.00 $ $ CT CT Spine Lumbar w/o Contrast $ $ $425.00
2 72129 CT CT Spine Thoracic w Contrast $ Q9967 $50.00 $ $ CT CT Spine Thoracic w, w/o Contrast $ Q9967 $50.00 $ $ CT CT Spine Thoracic w/o Contrast $ $ $ CT CT Tomography Limited or Follow Up $ $ $ CT CT Upper Extremity w Contrast $ Q9967 $50.00 $ $ CT CT Upper Extremity w, w/o Contrast $ Q9967 $50.00 $ $ CT CT Upper Extremity w/o Contrast $ $ $ CT CTA Abdomen w and or w/o Contrast $1, Q9967 $50.00 $1, $ CT CTA Abdomen w Bilateral Runoff w, w/o Contrast $1, Q9967 $50.00 $1, $ CT CTA Abdomen, Pelvis w and or w/o Contrast $1, Q9967 $50.00 $1, $ CT CTA Brain w, w/o Contrast $1, Q9967 $50.00 $1, $ CT CTA Carotid (Neck) w, w/o Contrast $1, Q9967 $50.00 $1, $ CT CTA Coronary Arteries w Calcium Scoring, CT Heart, Funct Eval $1, Q9967 $50.00 $1, $ CT CTA Coronary Arteries w Function Evaluation w Contrast $1, Q9967 $50.00 $1, $ CT CTA Lower Extremity $1, Q9967 $50.00 $1, $ CT CTA Pelvis w and or w/o Contrast $1, Q9967 $50.00 $1, $ CT CTA Thorax (non coronary) w, w/o Contrast $1, Q9967 $50.00 $1, $ CT CTA Upper Extremity $1, Q9967 $50.00 $1, $ LB Lab Analysis - Urea Nitrogen; Quantitative $9.72 $9.72 $ LB SP Lab Analysis $3.08 $3.08 $ LB SP Urine Analysis $10.00 $10.00 $ MA MG Digital breast tomosynthesis, bilateral $ $ $ MA MG Digital breast tomosynthesis, unilateral $ $ $ MA MG Screening digital breast tomosynthesis, bilateral $ $ $ MG Biopsy, breast, percutaneous; each additional lesion, including stereotactic guidance $1, $1, $ MG Biopsy, breast, percutaneous; first lesion, including stereotactic guidance $1, $1, $1, G0204 MG Diagnostic Mammography, Digital Image, Bilateral $ $22.00 $ $ G0206 MG Diagnostic Mammography, Digital Image, Unilateral $ $22.00 $ $ MG MA Surgical Specimen Breast $52.80 $52.80 $ MG Mammographic Breast Ductogram Injection $ $ $ MG Mammographic Galactogram Multiple Ducts $ $ $ MG Mammographic Galactogram Single Duct $ $ $ MG Mammography Computer Aided Detection Diagnostic $22.00 $22.00 $ MG Mammography Computer Aided Detection Screening $22.00 $22.00 $17.60
3 Plcmnt of breast localization device; each additional lesion, including mammo MG guidance $ $ $ MG Plcmnt of breast localization device; each addtl lesion, including stereotactic guidance $ $ $ MG Plcmnt of breast localization device; first lesion, including mammo guidance $ $ $ Plcmnt of breast localization device; first lesion, including stereotactic MG guidance $ $ $ G0202 MG Screening Mammography, Digital Image, Bilateral $ $22.00 $ $ MR Biopsy, breast, Each additional lesion, including MR guidance $1, $1, $1, MR Biopsy, breast, First lesion, including MR guidance $2, $2, $1, MR MR Cardiac for Morphology, Function w/o Contrast $1, $1, $ MR MR Cardiac for Morphology, Function w, w/o $1, A9577 $50.00 $1, $ MR MR Cardiac for Velocity Flow Mapping $ $ $ T MR MR Computer Aided Detection MRI Breast $35.00 $35.00 $ MR MR Guidance for Needle Placement $1, $1, $ MR MRA Abdomen w or w/o Contrast $1, A9577 $50.00 $1, $ MR MRA Chest w or w/o Contrast $1, A9577 $50.00 $1, $ MR MRA Head w Contrast $1, A9577 $50.00 $1, $ MR MRA Head w, w/o Contrast $1, A9577 $50.00 $1, $ MR MRA Head w/o Contrast $1, $1, $ MR MRA Lower Extremity w or w/o Contrast $1, A9577 $50.00 $1, $ MR MRA Neck w, w/o Contrast $1, A9577 $50.00 $1, $ MR MRA Neck w/ Contrast $1, A9577 $50.00 $1, $ MR MRA Neck w/o Contrast $1, $1, $ MR MRA Pelvis w or w/o Contrast $1, A9577 $50.00 $1, $ MR MRA Upper Extremity w or w/o Contrast $1, A9577 $50.00 $1, $ MR MRI Abdomen w Contrast $1, A9577 $50.00 $1, $ MR MRI Abdomen w, w/o Contrast $1, A9577 $50.00 $1, $ MR MRI Abdomen w/o Contrast $1, $1, $ , 27648, MR MRI Arthrography-Ankle $1, A9577 $ $1, $1, MR MRI Arthrography-Elbow $1, , 24220, A9577 $ $1, $1, MR MRI Arthrography-Hip $1, , 27093, A9577 $ $1, $1,316.40
4 73580, 27370, MR MRI Arthrography-Knee $1, A9577 $ $1, $1, MR MRI Arthrography-Shoulder $1, , 23350, A9577 $ $1, $1, MR MRI Arthrography-Wrist $1, , 25246, A9577 $ $1, $1, MR MRI Brain w Contrast $1, A9577 $50.00 $1, $ MR MRI Brain w, w/o Contrast $1, A9577 $50.00 $1, $ MR MRI Brain w/o Contrast $1, $1, $ MR MRI Breast Bilateral w/o and/or w contrast $1, T, A9577 $85.00 $1, $ MR MRI Breast Unilateral w/o and/or w contrast $1, T, A9577 $85.00 $1, $ MR MRI Chest w, w/o Contrast $1, A9577 $50.00 $1, $ MR MRI Chest w/contrast $1, A9577 $50.00 $1, $ MR MRI Chest w/o Contrast $1, $1, $ MR MRI Low Extremity Any Joint w, w/o Contrast $1, A9577 $50.00 $1, $ MR MRI Lower Extremity Any Joint w Contrast $1, A9577 $50.00 $1, $ MR MRI Lower Extremity Any Joint w/o Contrast $1, $1, $ MR MRI Lower Extremity Not Joint w and w/o Contrast $1, A9577 $50.00 $1, $ MR MRI Lower Extremity Not Joint w Contrast $1, A9577 $50.00 $1, $ MR MRI Lower Extremity Not Joint w/o Contrast $1, $1, $ MR MRI Orbit, Face And/Or Neck; w/o Contrast $1, $1, $ MR MRI Orbit, Face, Neck w Contrast $1, A9577 $50.00 $1, $ MR MRI Orbit, Face, Neck w, w/o Contrast $1, A9577 $50.00 $1, $ MR MRI Pelvis w Contrast $1, A9577 $50.00 $1, $ MR MRI Pelvis w, w/o Contrast $1, A9577 $50.00 $1, $ MR MRI Pelvis w/o Contrast $1, $1, $ MR MRI Spectroscopy $1, $1, $ MR MRI Spine Cervical w Contrast $1, A9577 $50.00 $1, $ MR MRI Spine Cervical w, w/o Contrast $1, A9577 $50.00 $1, $ MR MRI Spine Cervical w/o Contrast $1, $1, $ MR MRI Spine Lumbar w Contrast $1, A9577 $50.00 $1, $ MR MRI Spine Lumbar w, w/o Contrast $1, A9577 $50.00 $1, $ MR MRI Spine Lumbar w/o Contrast $1, $1, $ MR MRI Spine Thoracic w Contrast $1, A9577 $50.00 $1, $ MR MRI Spine Thoracic w, w/o Contrast $1, A9577 $50.00 $1, $ MR MRI Spine Thoracic w/o Contrast $1, $1, $650.00
5 70336 MR MRI Temporomandibular Joints $1, $1, $ MR MRI Upper Extremity Any Joint w, w/o Contrast $1, A9577 $50.00 $1, $ MR MRI Upper Extremity Any Joint w Contrast $1, A9577 $50.00 $1, $ MR MRI Upper Extremity Any Joint w/o Contrast $1, $1, $ MR MRI Upper Extremity Not Joint w Contrast $1, A9577 $50.00 $1, $ MR MRI Upper Extremity Not Joint w, w/o Contrast $1, A9577 $50.00 $1, $ MR MRI Upper Extremity Not Joint w/o Contrast $1, $1, $ MR Plcmnt of breast localization device; each additional lesion, including MR guidance $1, $1, $1, MR Plcmnt of breast localization device; First lesion, including MR guidance $1, $1, $1, NM NM Abscess Localization SPECT $ A9556 $39.00 $ $ NM NM Acute GI Blood Loss $ A9512, A9560 $ $ $ NM NM Bone 3 Phase $ A9561 $60.00 $ $ NM NM Bone Limited Area $ A9561 $60.00 $ $ NM NM Bone Marrow Limited $ A9541 $60.00 $ $ NM NM Bone Marrow MuLtiple Areas $ A9541 $60.00 $ $ NM NM Bone Marrow Whole Body $ A9541 $60.00 $ $ NM NM Bone Multiple Areas $ A9561 $60.00 $ $ NM NM Bone Scan SPECT $ A9561 $60.00 $ $ NM NM Bone Whole Body $ A9561 $60.00 $ $ NM NM Cardiac BloodPool w Ejection Fraction $ A9560 $ $ $ NM NM Gallium Limited Area $ A9556 $39.00 $ $ NM NM Gastric Emptying Study $ A9541 $60.00 $ $ NM NM Hepatobiliary System (HIDA Scan) $1, A9537 $ $1, $ NM NM Hepatobiliary System (HIDA Scan) w/o CCK $ A9537 $ $ $ NM NM Kidney Scan w/vascular Flow, Drug Intervention $ A9562 $ $ $ NM NM Liver (Spect) $ A9541 $60.00 $ $ NM NM Liver and Spleen Static $ A9541 $60.00 $ $ NM NM Liver and Spleen w Flow $ A9541 $60.00 $ $ NM NM Liver Static Only $ A9541 $60.00 $ $ NM NM Liver w Vascular Flow $ A9541 $60.00 $ $ NM NM Lymphoscintigraphy $ A9541 $60.00 $ $ NM NM Meckels Localization $ A9512 $50.00 $ $ NM NM Non-Cardiac Vascular Flow $ $ $ NM NM Parathyroid Scan $ A9512, A9500 $ $ $ NM NM Pulmonary Perfusion $ A9540 $21.00 $ $313.12
6 78582 NM NM Pulmonary Perfusion with Ventilation $ A9540, A9567 $68.72 $ $ NM NM Renal w Flow and Function $ A9562 $ $ $ NM NM Testicular w Flow $ A9512 $50.00 $ $ NM NM Thyroid Uptake and Scan $ A9516 $35.92 $ $ NM NM Tumor Localization SPECT $ A9556 $39.00 $ $ NM NM Tumor Localization Whole Body $ A9556 $39.00 $ $ OT DEXA Body Fat Composition $ $ $ OT DEXA Bone Densitometry $ $ $ OT DEXA Bone Densitometry Forearm $88.80 $88.80 $71.04 OT dual-energy absorptiometry (DXA); axial skeleton (eg. Hips, pelvis, spine) OT incl. VFA $ $ $ OT OT VFA via dual-energy xray absorptiometry $80.00 $80.00 $ PT PET Brain Metabolic $2, A9552 $ $3, $2, PT PET Conversion $2, A9552 $ $3, $2, PT PET Limited Area $2, A9552 $ $3, $2, PT PET Myocardial Metabolic $2, A9552 $ $3, $2, PT PET Myocardial Perfusion $2, A9552 $ $3, $2, PT PT PET Scan w CT Chest Head/Neck $2, A9552 $ $3, $2, PT PT PET w CT Skull Base to Mid Thigh $2, A9552 $ $3, $2, PT PT PET w CT Whole Body $2, A9552 $ $3, $2, PT PT PET Whole Body Bone Scan $2, A9580 $ $2, $1, RF RF Barium Enema $ $ $ RF RF Barium Enema w Air Contrast $ $ $ RF RF Barium Swallow (Pharynx-Esophagus) $ $ $ RF RF Chest w PA and Lateral CXR $75.00 $75.00 $ RF RF Cystogram $ , A4352 $ $ $ RF RF Cystourethrogram Voiding (VCUG) $ , A4352 $ $ $ RF RF Esophagram $ $ $ RF RF FL Flouroscopy <1Hr $ $ $ RF RF Flouroscopy >1Hr $ $ $ RF RF Fluoro Guidance for Needle Placement $ $ $ $ , A4550, RF RF Hysterosalpingography $ A4352 $ $ $ RF RF Retrograde Urethrogram $ $ $ RF RF Small Bowel Follow Through $ $ $ RF RF Speech Pathologist $ $ $224.80
7 74249 RF RF Upper GI Air Contrast w Small Bowel $ $ $ RF RF Upper GI Tract $ $ $ RF RF Upper GI w Air Contrast $ $ $ RF RF Upper GI w Small Bowel Follow Through $ $ $ RF RF Video Swallow $ $ $ $ RF RF Arthrography Ankle $ $ $ $ RF RF Arthrography Elbow $ $ $ $ RF RF Arthrography Hip $ $ $ $ RF RF Arthrography Knee $ $ $ $ RF RF Arthrography Shoulder $ $ $ $ RF RF Arthrography Wrist $ $ $ $ RF RF Urography Antegrade Study $ $ $ $ RF RF Urography Excretory Study $ Q9967 $50.00 $ $ SP CT 3-DIMENSIONAL RECONSTRUCTION C-T MR $ $ $ SP Myelography via lumbar injection, incl RS&I; 2 or more regions $ $ $ SP Myelography via lumbar injection, incl RS&I; cervical $ $ $ SP RF Injection for Cystography/Voiding Urethrocystography $ $ $ SP SP Hydration $ $ $ SP SP Hydration Additional 3 Hours $ $ $88.32 SP ablation therapy 1 or more bone tumor(s)percuataneous incl. imaging SP guidance; radiofrequency $8, $6, SP SP Arthrocentesis Intermediate Joint or Bursa $ $ $ SP SP Arthrocentesis Major Joint or Bursa $ $ $ SP SP Arthrocentesis, aspir.&/or injection major joint or bursa w/us guidance $ $ $ SP SP Arthrocentesis, aspiration &/or injection intermed.joint or bursa w/us guidance $ $ $ SP SP Arthrocentesis, aspiration &/or injection small joint or bursa w/us guidance $ $ $ SP SP Arthrography Elbow $ $ $ $ SP SP Arthrography Hip $ $ $ $ SP SP Arthrography Knee $ $ $ $ SP SP Arthrography Shoulder CT/ MR $ $ $ $ SP SP Arthrography Wrist $ $ $ $ SP SP Central Venous Access Device Eval (CVA) $ $ $ SP SP Fine Needle Aspiration w Guidance $ $ $249.60
8 58340 SP SP Hysterosalpingography-Catheterization and Saline/Contrast Intro $ $ $ SP SP Incision and Drainage of epididymis, testis $ $ $ SP SP Injection for Pyelography $ $ $ SP SP Injection for Ureteropyelography $ $ $ SP SP Injection of Contrast $80.80 $80.80 $ SP SP Injection Procedure for Ankle Arthrography $ $ $ $ SP SP Injection Si Joint $ $ $ SP SP Myelography via lumbar injection, incl RS&I; lumbosacral $ $ $ SP SP Myelography via lumbar injection, incl RS&I; thoracic $ $ $ SP SP Percutaneous vertebroplasty 1 vertebral body, uni or bilateral injection, cervicothoracic $3, $3, $3, SP SP Percutaneous vertebroplasty 1 vertebral body, uni or bilateral injection, each addtl vert body $2, $2, $1, SP SP Percutaneous vertebroplasty 1 vertebral body, uni or bilateral injection, lumbosacral $3, $3, $3, SP SP Percutaneuos Needle Biopsy of Muscle $ $ $ SP SP transcath.plcmt intravascular stent intrathoracic common carotid artery or innominate,incl. angio $1, $1, $1, A9586 SU Florbetapir F18 up to 10 Millicures $2, $2, $0.00 A9556 SU SU 67 GALLIUM (5-10 UNITS) $39.00 $39.00 $ SU SU Conscious Sedation, 5 yrs and older $ $ $ A9580 SU SU F-18 NAF Administration $ $ $ A9552 SU SU Fluorodeoxyglucose-FDG administration $ $ $ A9579 SU SU Injection gadolinium based (price per unit) $4.00 $4.00 $3.20 A9577 SU SU Injection, Gadobenate Dimeglumine (Multihance)(price per unit) $4.00 $4.00 $3.20 A9516 SU SU IU123 Sodium Iodide-Capsure-per 100 Microcuries (price per unit) $35.92 $35.92 $28.74 Q9967 SU SU Low Osmolar Contrast Material mg/ml (price per unit) $0.50 $ SU SU Moderate Sedation; Each Addtional 15 minutes $49.60 $49.60 $39.68 A4550 SU SU Surgical Tray $ $ $91.60 A9562 SU SU TC 99 M MERTIATIDE (MAG3) $ $ $ A9537 SU SU TC 99M MEBROFENIN $ $ $80.00 A9503 SU SU TC-99 Medronate MDP $25.50 $25.50 $20.40 A9561 SU SU TC-99 OXIDRONATE (HDP) $60.00 $60.00 $48.00 A9560 SU SU TC-99 RBCS $ $ $ A9500 SU SU TC-99 Sestabimi $64.27 $64.27 $51.42 A9565 SU SU TC-99M DTPA AEROSOL/INJECTION $21.00 $21.00 $16.80
9 A9567 SU SU TC-99M DTPA AEROSOL/INJECTION $47.72 $47.72 $38.18 A9540 SU SU TC-99M MAA $21.00 $21.00 $16.80 A9512 SU SU TC-99M Pertec $50.00 $50.00 $40.00 A9541 SU SU TC-99M SULP COLLOID $60.00 $60.00 $48.00 A4352 SU SU Urological Catheter $43.00 $43.00 $ US Ablation crysurgical, fibroadenoma, w/us guidance $3, $3, $2, US Biopsy, breast, Each additional lesion, including ultrasound guidance $1, $1, $ US Biopsy, breast, First lesion, including ultrasound guidance $1, $1, $1, US Plcmnt of breast localization device; Each additional lesion, including US guidance $ $ $ US Plcmnt of breast localization device; First lesion, including US guidance $1, $1, $ G0389 US Ultrasound exam AAA screen $ $ $ US US Abdomen Complete $ $ $ $ US US Abdomen Limited $ $ $ US US Abdominal Doppler Complete $ $ $ US US Abdominal Doppler Limited $ $ $ US US ABI $ $ $ US US Additional Cyst Puncture, Aspiration $56.80 $56.80 $ US US Arterial Bilat w Graft $ $ $ US US Arterial Lower Extremities $ $ $ US US Arterial Lower Extremity Unilateral or Limited $ $ $ US US Arterial Upper Extremities $ $ $ US US Arterial Upper Extremity Unilateral or Limited $ $ $ An additional will be US US breast complete, unilateral w/image documentation, incl. axilla when performe $ billed if exam is Bilateral $ $ US US Breast Cyst Puncture/ Aspiration $ $ $ US US breast limited, unilateral w/image documentation, incl. axilla when performe $ An additional will be billed if exam is Bilateral $ $ US US Carotid Arteries $ $ $ US US Chest, Mediastinum $ $ $ US US Guidance Needle Placement $ $ $ US US Guidance Vascular Access $72.80 $72.80 $58.24
10 93990 US US Hemodialysis Graft $ $ $ US US Hysterosonography w, Pelvic Transvaginal $ $ $ US US Infant Hips Pediatric $ $ $ US US Obstetric Additional Gestation 2nd Trimester $ $ $ US US Obstetric First Trimester Transabdominal $ $ $ $ US US Obstetric First Trimester Transvaginal $ $ $ $ US US Obstetric Follow Up $ $ $ US US Pelvic Limited $ $ $ US US Pelvic Transabdominal $ $ $ $ US US Renal Transplant $ $ $ $ US US Retroperitoneal Limited $ $ $ US US Retroperitoneal (Renal, Aorta, Nodes) Complete $ $ $ $ US US Segmental Pressure Upper or Lower Extremity $ $ $ US US Soft Tissue Head and Neck $ $ $ US US Soft Tissue Musculoskeletal Complete $ $ $ US US Spinal Canal Pediatric $ $ $ US US Testicular $ $ $ $ US US Transvaginal $ $ $ $ US US Ultrasound Extremity Nonvascular, Limited $55.00 $55.00 $ US US Vascular Aorta/ IVC/ Iliac Limited $ $ $ US US Venous Extremity Bilateral $ $ $ US US Venous Extremity Unilateral or Limited $ $ $ XR Ankle 2 Views $75.00 $75.00 $ XR Ankle 3+ Views $75.00 $75.00 $ XR Chest Single View Frontal $75.00 $75.00 $ XR Clavicle Complete $75.00 $75.00 $ XR Elbow 2 Views $75.00 $75.00 $ XR Elbow 3+ Views $75.00 $75.00 $ XR Femur 2 Views $75.00 $75.00 $ XR Finger/ Thumb 2+ Views $75.00 $75.00 $ XR Foot 2 Views $75.00 $75.00 $ XR Foot 3+ Views $75.00 $75.00 $ XR Forearm 2 Views $75.00 $75.00 $ XR Hand 2 Views $75.00 $75.00 $ XR Hand 3+ Views $75.00 $75.00 $ XR Hip 2+ Views $75.00 $75.00 $60.00
11 73500 XR Hip Unilateral 1View $75.00 $75.00 $ XR Humerus 2+ Views $75.00 $75.00 $ XR Knee 1-2 Views $75.00 $75.00 $ XR Knee 3 Views $75.00 $75.00 $ XR Knee Complete 4+ Views $75.00 $75.00 $ XR Lower Extremity Infant 2+ Views $75.00 $75.00 $ XR Os Calcis 2+ Views $75.00 $75.00 $ XR Osseous Survey Complete, Metastatic $ $ $ XR Radiologic examination, chest, complete, minimum of 4 views; with fluoroscopy $ $ $ XR Ribs Unilateraleral 2 Views $75.00 $75.00 $ XR Ribs Unilateraleral 3 + Views w PA Chest $75.00 $75.00 $ XR Scapula Complete $75.00 $75.00 $ XR Shoulder 1 View $75.00 $75.00 $ XR Shoulder 2+ Views $75.00 $75.00 $ XR Tibia, Fibula 2 Views $75.00 $75.00 $ XR Toe 2+ Views $75.00 $75.00 $ XR Upper Extremity Infant 2+ Views $75.00 $75.00 $ XR Wrist 2 View $75.00 $75.00 $ XR Wrist 3+ Views $75.00 $75.00 $ XR XR Abdomen 2 View $75.00 $75.00 $ XR XR Abdomen 3 View $75.00 $75.00 $ XR XR Abdomen 3 View Includes PA Chest $75.00 $75.00 $ XR XR Abdomen KUB 1 View (AP) $75.00 $75.00 $ XR XR AC Joints Bilat $75.00 $75.00 $ XR Bone length studies(orthotoentgenogram, scanogram) $75.00 $75.00 $ XR XR Bone Age Study $75.00 $75.00 $ XR XR Chest 2 View w Apical-Lordotic View $75.00 $75.00 $ XR XR Chest 2 View w Oblique Views $75.00 $75.00 $ XR XR Chest 4+ View $75.00 $75.00 $ XR XR Chest PA and Lateral $75.00 $75.00 $ XR XR Chest Special View $75.00 $75.00 $ XR XR Facial Bones 1-2 View $75.00 $75.00 $ XR XR Facial Bones 3+ View Complete $75.00 $75.00 $ XR XR Foreign Body Nose To Rectum 1 View Child $75.00 $75.00 $ XR XR Hip Bilat & AP Pelvis $75.00 $75.00 $60.00
12 77076 XR XR Infant Bone Survey $ $ $ XR XR Mandible 1-3 View $75.00 $75.00 $ XR XR Mandible 4+ View $75.00 $75.00 $ XR XR Mastoids 1-2 View $75.00 $75.00 $ XR XR Mastoids 3+ View Complete $75.00 $75.00 $ XR XR Metabolic Bone Survey $ $ $ XR XR Nasal Bones $75.00 $75.00 $ XR XR Neck Soft Tissue $75.00 $75.00 $ XR XR Orbits 4+ View $75.00 $75.00 $ XR XR Orbits for Foreign Body $75.00 $75.00 $ XR XR Pelvis 1 View (AP) $75.00 $75.00 $ XR XR Pelvis 3+ View $75.00 $75.00 $ XR XR Ribs Bilat 3 View $75.00 $75.00 $ XR XR Ribs Bilat 4+ View w PA CXR $75.00 $75.00 $ XR XR Sacroiliac Joints 3+ View $75.00 $75.00 $ XR XR Sacrum, Coccyx 2 View $75.00 $75.00 $ XR XR Salivary Gland w Calculus $75.00 $75.00 $ XR XR Sella Turcica $75.00 $75.00 $ XR XR Sinuses 1-2 View $75.00 $75.00 $ XR XR Sinuses 3+ View $75.00 $75.00 $ XR XR Skull 1-3 Views $75.00 $75.00 $ XR XR Skull 4+ View $75.00 $75.00 $ XR XR Spine 1 View $75.00 $75.00 $ XR XR Spine C, T, L (AP and Lateral) $75.00 $75.00 $ XR XR Spine Cervical 2-3 Views or Less $75.00 $75.00 $ XR XR Spine Cervical 4+ Views $80.00 $80.00 $ XR XR Spine Cervical w Obl, Flex, Ext 7 View $ $ $ XR XR Spine Lumbar w Flex and Ext 7 View $ $ $ XR XR Spine Lumbar Bending 4+ View $75.00 $75.00 $ XR XR Spine Lumbosacral 2-3 View $75.00 $75.00 $ XR XR Spine Lumbosacral 4+ View $85.00 $85.00 $ XR XR Spine Scoliosis Study Supine and Erect $75.00 $75.00 $ XR XR Spine Thoracic 2 View $75.00 $75.00 $ XR XR Spine Thoracic 3 View $75.00 $75.00 $ XR XR Spine Thoracic 4+ View $75.00 $75.00 $ XR XR Spine Thoracolumbar 2 View $75.00 $75.00 $60.00
13 72069 XR XR Spine Thoracolumbar AP $75.00 $75.00 $ XR XR Sternoclavicular Joints 3+ View $75.00 $75.00 $ XR XR Sternum 2+ View $75.00 $75.00 $ XR XR Temporomandibular Joints $75.00 $75.00 $ XR XR Tomogram $ $ $60.00
Department of Radiology DX PROCEDURES
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