| Abdomen 1 View (74018) |
— |
$42 |
— |
| Abdomen 2 views (74019) |
— |
$52 |
— |
| Angiography extremity unilateral rs&i (75710) |
— |
$220 |
— |
| Ankle 2 views (73600) |
— |
$45 |
— |
| Artery X-Rays Abdomen (75726) |
— |
$247 |
— |
| Arthrogram hip (73525) |
— |
$187 |
— |
| Basic radiation dosimetry calculation (77300) |
— |
$92 |
— |
| Bone Imaging 3 Phase (78315) |
— |
$483 |
— |
| Bone Imaging Limited Area (78300) |
— |
$321 |
— |
| Bone Imaging Multiple Areas (78305) |
— |
$388 |
— |
| Bone Imaging Whole Body (78306) |
— |
$418 |
— |
| Brain imaging < 4 static views (78600) |
— |
$256 |
— |
| Brain Imaging Min 4 Static Views W Vascular Flow (78606) |
— |
$463 |
— |
| Brain Imaging Pet Metabolic Evaluation (78608) |
— |
$2,032 |
— |
| Cat Scan Follow-Up Study (76380) |
— |
$174 |
— |
| Cerebrospinal Fluid Scan (78630) |
— |
$471 |
— |
| Chest 1 view (71045) |
— |
$36 |
— |
| Chest 2 views (71046) |
— |
$47 |
— |
| Chest 3 views (71047) |
— |
$59 |
— |
| Chest 4 or more views (71048) |
— |
$64 |
— |
| Cholecystography Oral Contrast (74290) |
— |
$122 |
— |
| Clavicle complete (73000) |
— |
$45 |
— |
| Computed Tomography Thorax Lw Dose Lng Ca Scr C- (71271) |
— |
$205 |
— |
| Continuing medical physics consltj pr wk (77336) |
— |
$113 |
— |
| Contrast X-Ray Bladder (74430) |
— |
$57 |
— |
| Contrast Xray Throat/Cerv Esopha (74210) |
— |
$138 |
— |
| CT abdomen and pelvis without and with contrast (74178) |
— |
$517 |
— |
| CT abdomen and pelvis without contrast (74176) |
— |
$273 |
— |
| CT abdomen w contrast (74160) |
— |
$328 |
— |
| CT abdomen w wo contrast (74170) |
— |
$336 |
— |
| CT abdomen w/o contrast (74150) |
— |
$204 |
— |
| CT Angio Chest (71275) |
— |
$365 |
— |
| Ct Angio Lwr Extr W/O&W/Dye (73706) |
— |
$368 |
— |
| CT Angio Neck (70498) |
— |
$360 |
— |
| CT cervical spine w/ contrast (72126) |
— |
$254 |
— |
| CT cervical spine w/o contrast (72125) |
— |
$195 |
— |
| CT chest w contrast (71260) |
— |
$251 |
— |
| CT chest w/wo contrast (71270) |
— |
$298 |
— |
| CT head/brain without and with contrast (70470) |
— |
$261 |
— |
| CT iac w contrast (70481) |
— |
$273 |
— |
| CT lower ext w/o (73700) |
— |
$194 |
— |
| CT lower extremity w/contrast material (73701) |
— |
$251 |
— |
| CT lumbar spine w contrast (72132) |
— |
$254 |
— |
| CT lumbar spine w/o contrast (72131) |
— |
$194 |
— |
| CT maxillofacial w contrast (70487) |
— |
$229 |
— |
| CT maxillofacial wo contrast (70486) |
— |
$192 |
— |
| CT neck tissue combo (70492) |
— |
$337 |
— |
| Ct Orbit/Ear/Fossa W/O&W/Dye (70482) |
— |
$321 |
— |
| CT orbits w/o contrast (70480) |
— |
$233 |
— |
| CT pelvis w&w/o contrast (72194) |
— |
$324 |
— |
| CT pelvis w/o contrast (72192) |
— |
$199 |
— |
| CT scan of leg combo (73702) |
— |
$293 |
— |
| CT scans face/jaw combo (70488) |
— |
$280 |
— |
| CT soft tissue neck w contrast (70491) |
— |
$278 |
— |
| CT soft tissue neck w/o contrast (70490) |
— |
$224 |
— |
| CT thoracic spine w contrast (72129) |
— |
$255 |
— |
| CT thoracic spine w/o contrast (72128) |
— |
$194 |
— |
| CT thorax w/o contrast (71250) |
— |
$199 |
— |
| CT upper ext wo (73200) |
— |
$215 |
— |
| CT upper extremity w/o & w/contrast material (73202) |
— |
$324 |
— |
| CT upper extremity with contrast (73201) |
— |
$307 |
— |
| Cta Abdl Aorta&Bi Iliofem W/Contrast&Postp (75635) |
— |
$402 |
— |
| Cta Abdomen (74175) |
— |
$364 |
— |
| Doppler Echo Fetal Puls Spectral F/U/Repeat (76828) |
— |
$72 |
— |
| Dxa Bone Density Axial (77080) |
— |
$53 |
— |
| Dxa bone density study 1/>sites appendiclr skel (77081) |
— |
$44 |
— |
| Echo exam of fetal heart (76825) |
— |
$383 |
— |
| Esophagram (74220) |
— |
$141 |
— |
| Fetal Biophysical Profile W/O Non-Stress Testing (76819) |
— |
$120 |
— |
| Fluoroscopy up to 1 hr (76000) |
— |
$60 |
— |
| Foot 2 views (73620) |
— |
$40 |
— |
| Forearm 2 views (73090) |
— |
$41 |
— |
| Gastric emptying imaging study (78264) |
— |
$463 |
— |
| Gated Heart, Multiple (78473) |
— |
$403 |
— |
| Hand 2 views (73120) |
— |
$44 |
— |
| Heart first pass single,planar (78481) |
— |
$247 |
— |
| Hepatc Vngrph Wdg/Fr Hemodyn Eval Rs&I (75889) |
— |
$180 |
— |
| Hepatobil Syst Image W/Drug (78227) |
— |
$615 |
— |
| Infusion Ivp (74410) |
— |
$195 |
— |
| Knee 3 Views (73562) |
— |
$56 |
— |
| Liver & Spleen Imaging Static Only (78215) |
— |
$273 |
— |
| Lung Ventilat&Perfus Imaging (78582) |
— |
$464 |
— |
| Mlc imrt design & construction per imrt plan (77338) |
— |
$653 |
— |
| Mra Head W/O & W/Contrast Material (70546) |
— |
$506 |
— |
| MRA head w/o contrast (70544) |
— |
$331 |
— |
| MRA neck w contrast (70548) |
— |
$375 |
— |
| MRA neck w/o contrast (70547) |
— |
$333 |
— |
| MRI abdomen w/o contrast (74181) |
— |
$303 |
— |
| MRI any jt lower extrem w/o & w/contrast matrl (73723) |
— |
$612 |
— |
| MRI cervical spine w contrast (72142) |
— |
$428 |
— |
| MRI cervical spine w/o cont (72141) |
— |
$294 |
— |
| MRI chest wo w contrast (71552) |
— |
$651 |
— |
| MRI lower extrem oth/thn jt w/o & w/contr matr (73720) |
— |
$529 |
— |
| MRI lower extrem oth/thn jt w/o contr matrl (73718) |
— |
$349 |
— |
| MRI lumbar spine w contrast (72149) |
— |
$421 |
— |
| Mri Neck Spine W/O & W/Dye (72156) |
— |
$498 |
— |
| MRI orbit face &/neck w/o contrast (70540) |
— |
$353 |
— |
| MRI pelvis w/o & w contrast (72197) |
— |
$529 |
— |
| MRI pelvis w/o contrast (72195) |
— |
$359 |
— |
| MRI thoracic spine w/o contrast (72146) |
— |
$294 |
— |
| MRI upper extremity oth than jt w/contr matrl (73219) |
— |
$526 |
— |
| Mri Uppr Extremity W/O&W/Dye (73220) |
— |
$644 |
— |
| MRI, abdomen, combo (74183) |
— |
$530 |
— |
| MRI, dorsal spine combo (72157) |
— |
$499 |
— |
| MRI, dorsal spine contrast (72147) |
— |
$425 |
— |
| MRI, joint upper extrem (73221) |
— |
$311 |
— |
| Myocardial Spect Multiple Studies (78452) |
— |
$661 |
— |
| Neck soft tissue (70360) |
— |
$44 |
— |
| Nonvascular Shunt X-Ray (75809) |
— |
$124 |
— |
| Ntsty modul radthx pln dose-vol histos (77301) |
— |
$2,629 |
— |
| Nuclear Rx Oral Admin (79005) |
— |
$189 |
— |
| Oph bmtry us echograpy a-scan io lens pwr cal (76519) |
— |
$93 |
— |
| Ophthalmic ultrasound dx b-scan w/wo a-scan (76512) |
— |
$68 |
— |
| Optic foramina (70190) |
— |
$54 |
— |
| Panoramic X-ray of jaws (70355) |
— |
$26 |
— |
| Parathyroid imaging w/tomographic spect & CT (78072) |
— |
$619 |
— |
| Parathyroid Planar Imaging (78070) |
— |
$412 |
— |
| Parathyroid planar imaging w/wo subtraction (78071) |
— |
$492 |
— |
| Pelvis 1 or 2 views (72170) |
— |
$39 |
— |
| Peritoneogram Rs&I (74190) |
— |
$113 |
— |
| PET image w/CT, full body (78816) |
— |
$2,213 |
— |
| PET imaging CT attenuation skull base mid-thigh (78815) |
— |
$2,171 |
— |
| Pulmonary Perfusion Imaging Particulate (78580) |
— |
$330 |
— |
| Radex Abd Compl Aqt Abd W/S/E/D Views 1 View Ch (74022) |
— |
$69 |
— |
| Radex abscess/fistula/sinus tract rs&i (76080) |
— |
$84 |
— |
| Radex Ankle Complete Minimum 3 Views (73610) |
— |
$51 |
— |
| Radex Calcaneus Minimum 2 Views (73650) |
— |
$40 |
— |
| Radex elbow complete minimum 3 views (73080) |
— |
$45 |
— |
| Radex Facial Bones Complete Minimum 3 Views (70150) |
— |
$66 |
— |
| Radex fingr minimum 2 views (73140) |
— |
$52 |
— |
| Radex foot complete minimum 3 views (73630) |
— |
$48 |
— |
| Radex Hand Minimum 3 Views (73130) |
— |
$51 |
— |
| Radex Mastoids Compl Minimum 3 Views PR Side (70130) |
— |
$87 |
— |
| Radex Nasal Bones Complete Minimum 3 Views (70160) |
— |
$53 |
— |
| Radex Ribs Unilateral 2 Views (71100) |
— |
$51 |
— |
| Radex shoulder complete minimum 2 views (73030) |
— |
$48 |
— |
| Radex Sinuses Paransl < 3 Views (70210) |
— |
$45 |
— |
| Radex sm int w/mlt srl imges via enteroclss tube (74251) |
— |
$321 |
— |
| Radex Spine 1 View Specify Level (72020) |
— |
$35 |
— |
| Radex Sternum Minimum 2 Views (71120) |
— |
$47 |
— |
| Radex Temporomandble Jt Opn & Clsd Mouth Bilat (70330) |
— |
$74 |
— |
| Radex Toe Minimum 2 Views (73660) |
— |
$41 |
— |
| Radex Wrist Complete Minimum 3 Views (73110) |
— |
$56 |
— |
| Radiolog exam mandible compl minimum 4 views (70110) |
— |
$61 |
— |
| Radiologic Exam Abdomen 3+ Views - Xr Abdomen 3+ Views (74021) |
— |
$60 |
— |
| Radiologic exam colon double contrast study (74280) |
— |
$320 |
— |
| Radiologic exam colon single contrast study (74270) |
— |
$221 |
— |
| Radiologic exam knee complete 4/more views (73564) |
— |
$64 |
— |
| Radiologic exam pelvis compl minimum 3 views (72190) |
— |
$58 |
— |
| Radiologic Exam Small Int Single Contrast Study (74250) |
— |
$175 |
— |
| Radiologic exam swallow function contrast study (74230) |
— |
$186 |
— |
| Radiologic exam upr gi trc double contrast study (74246) |
— |
$200 |
— |
| Radiologic examination femur 1 view (73551) |
— |
$41 |
— |
| Radiologic examination femur minimum 2 views (73552) |
— |
$49 |
— |
| Radiologic examination knee 1/2 views (73560) |
— |
$48 |
— |
| Radiologic examination tibia & fibula 2 views (73590) |
— |
$44 |
— |
| Ribs bilateral 3 views (71110) |
— |
$61 |
— |
| Rp Loclzj Tum Plnr Whole Body Single Day Imaging (78802) |
— |
$437 |
— |
| Scapula (73010) |
— |
$33 |
— |
| Screening Digital Breast Tomosynthesis Bi (77063) |
— |
$76 |
— |
| Sella turcica (70240) |
— |
$46 |
— |
| Shoulder 1 view (73020) |
— |
$30 |
— |
| Shoulder Arthrography (73040) |
— |
$182 |
— |
| Skull less than 4 views (70250) |
— |
$50 |
— |
| Special dosimetry (77331) |
— |
$90 |
— |
| Special teletherapy port plan (77321) |
— |
$131 |
— |
| Speech evaluation, complex (70371) |
— |
$153 |
— |
| Stereotactic Body Radiation Delivery (77373) |
— |
$1,592 |
— |
| Sternoclavicular joints (71130) |
— |
$58 |
— |
| Telethx isodose pln cplx w/basic dosimetry (77307) |
— |
$398 |
— |
| Testicular Imaging W/Flow (78761) |
— |
$296 |
— |
| Ther Rad Simulaj-Aided Field Setting Complex (77290) |
— |
$682 |
— |
| Ther rad simulaj-aided field setting simple (77280) |
— |
$394 |
— |
| Thoracic spine 2 views (72070) |
— |
$45 |
— |
| Thoracic spine 3 views (72072) |
— |
$55 |
— |
| Thoracolumbar 2 views (72080) |
— |
$48 |
— |
| Thyroid Met Imaging Body (78018) |
— |
$438 |
— |
| Thyroid Uptake W/Blood Flow Sngle/Mult Quan Meas (78014) |
— |
$334 |
— |
| Tx Devices Design & Construction Complex (77334) |
— |
$175 |
— |
| Ultrasound Breast Limited (76642) |
— |
$122 |
— |
| Ultrasound Exam Aaa Screen (76706) |
— |
$153 |
— |
| Ultrasound, abdomen limited (76705) |
— |
$127 |
— |
| Upper gi w/o kub (74240) |
— |
$174 |
— |
| Urethrocystogram voiding (74455) |
— |
$147 |
— |
| Urethrocystography retrograde (74450) |
— |
$113 |
— |
| Us bone density measurement (76977) |
— |
$10 |
— |
| Us breast unilateral complete (76641) |
— |
$148 |
— |
| Us chest (76604) |
— |
$93 |
— |
| Us complete joint (76881) |
— |
$92 |
— |
| Us exam, pelvic, limited (76857) |
— |
$67 |
— |
| Us lmtd joint/oth nonvasc xtr strux r-t w/img (76882) |
— |
$79 |
— |
| Us ob detailed single fetus (76811) |
— |
$245 |
— |
| Us ob limited 1 or more fetuses (76815) |
— |
$118 |
— |
| Us ob transvaginal (76817) |
— |
$134 |
— |
| Us pelvic non ob complete (76856) |
— |
$153 |
— |
| Us pg uter img f&mat 14 wk tabdl 1/1st gestation (76801) |
— |
$169 |
— |
| Us retroperitoneal complete (76770) |
— |
$157 |
— |
| Us retroperitoneal limited (76775) |
— |
$82 |
— |
| Us scrotum and contents (76870) |
— |
$146 |
— |
| Us thyroid (76536) |
— |
$163 |
— |
| Us transrectal (76872) |
— |
$194 |
— |
| Vein X-Ray Chest (75827) |
— |
$176 |
— |
| Venography extremity bilateral rs&i (75822) |
— |
$196 |
— |
| Venography extremity unilateral rs&i (75820) |
— |
$164 |
— |
| Wrist 2 views (73100) |
— |
$47 |
— |
| X-Ray Ac Jts - Xr Acromioclavicular Joints Bilateral (73050) |
— |
$40 |
— |
| X-Ray Aorta Leg Arteries (75630) |
— |
$229 |
— |
| X-Ray Bend Only L-S Spine (72120) |
— |
$57 |
— |
| X-Ray Elbow 2 Vw - Xr Elbow 1-2 Views Right (73070) |
— |
$41 |
— |
| X-Ray Exam Breast Specimen (76098) |
— |
$59 |
— |
| X-Ray Exam Entire Spi 1 Vw (72081) |
— |
$59 |
— |
| X-Ray Exam Entire Spi 2/3 Vw (72082) |
— |
$97 |
— |
| X-Ray Exam Hip Uni 1 View (73501) |
— |
$45 |
— |
| X-Ray Exam Hip Uni 2-3 Views (73502) |
— |
$65 |
— |
| X-Ray Exam Hips Bi 2 Views (73521) |
— |
$57 |
— |
| X-Ray Exam Hips Bi 3-4 Views (73522) |
— |
$74 |
— |
| X-Ray Exam Hips Bi 5/> Views (73523) |
— |
$85 |
— |
| X-Ray Exam L-S Spine Bending (72114) |
— |
$86 |
— |
| X-Ray Exam Neck Spine 2-3 Vw (72040) |
— |
$55 |
— |
| X-Ray Exam Neck Spine 6/>Vws (72052) |
— |
$86 |
— |
| X-Ray Exam Unilat Ribs/Chest (71101) |
— |
$59 |
— |
| X-ray eye for foreign body (70030) |
— |
$45 |
— |
| X-ray humerus (73060) |
— |
$45 |
— |
| X-ray IV pyelogram (ivp) (74400) |
— |
$189 |
— |
| X-ray IV pyelogram+tomography (74415) |
— |
$222 |
— |
| X-Ray Jaw <4 Vw - Xr Mandible < 4 Views (70100) |
— |
$54 |
— |
| X-Ray Knee Bilat Standing - Xr Knees Anteroposterior Standing Bilat (73565) |
— |
$57 |
— |
| X-Ray Lumbar Spine 2/3 Vw - Xr Lumbar Spine 2-3 Views (72100) |
— |
$55 |
— |
| X-Ray Ribs, Chest 4+ Vw - Xr Ribs 3 Vws Bil W/ Chest Posteroanterior (71111) |
— |
$73 |
— |
| X-Ray Sacroiliac Jts 3+ Vw - Xr Sacroiliac Joints 3+ Views (72202) |
— |
$55 |
— |
| X-Ray Sacroiliac Jts <3 Vw - Xr Sacroiliac Joints 1-2 Views (72200) |
— |
$46 |
— |
| X-Ray Sacrum/Coccyx 2+ Vw - Xr Sacrum Coccyx 2+ Views (72220) |
— |
$45 |
— |
| X-Ray Sinuses 3+ Vw - Xr Paranasal Sinuses 3+ Views (70220) |
— |
$53 |
— |
| X-Ray Skull 4+ Vw - Xr Skull Complete 4+ Views (70260) |
— |
$63 |
— |
| X-Ray Tmj Unilat (70328) |
— |
$48 |
— |
| X-Ray Urinary Tract Exam With Contrast Material (74420) |
— |
$107 |
— |
| X-Rays Bone Survey Complete (77075) |
— |
$137 |
— |
| Xr c-spine 4 or 5 views (72050) |
— |
$73 |
— |
| Xr facial bones less than 3 views (70140) |
— |
$45 |
— |
| XR Mastoids < 3 Views Bilateral (70120) |
— |
$53 |
— |
| Xr orbits complete 4 views (70200) |
— |
$67 |
— |
| Xr Tomogram Single Plane (76100) |
— |
$131 |
— |