| Abdomen 2 views (74019) |
— |
$52 |
— |
| Angiography extremity unilateral rs&i (75710) |
— |
$220 |
— |
| Angiography visceral slctv/supraslctv rs&i (75726) |
— |
$247 |
— |
| Ankle 2 views (73600) |
— |
$45 |
— |
| Aortography abdl bi iliofem low extrem cath rs&i (75630) |
— |
$229 |
— |
| Arthrogram hip (73525) |
— |
$187 |
— |
| Arthrogram shoulder (73040) |
— |
$182 |
— |
| Basic dosimetry (77300) |
— |
$92 |
— |
| Bone &/Joint Imaging Limited Area (78300) |
— |
$321 |
— |
| Bone &/Joint Imaging Multiple Areas (78305) |
— |
$388 |
— |
| Bone &/joint imaging whole body (78306) |
— |
$418 |
— |
| Bone Imaging 3 Phase (78315) |
— |
$483 |
— |
| Bone survey complete (77075) |
— |
$137 |
— |
| 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 |
— |
| Cervical spine 2 or 3 views (72040) |
— |
$55 |
— |
| Chest 1 view (71045) |
— |
$36 |
— |
| Chest xray 3 views (71047) |
— |
$59 |
— |
| Cholecystography, oral contrast Non-Facility (74290) |
— |
$122 |
— |
| Cine/Vid X-Ray Throat/Esoph - Fl Esoph Barium Swlw W/ Video & Speech (74230) |
— |
$186 |
— |
| Clavicle complete (73000) |
— |
$45 |
— |
| Computed Tomography Thorax Lw Dose Lng Ca Scr C- (71271) |
— |
$205 |
— |
| Continuing medical physics consltj pr wk (77336) |
— |
$113 |
— |
| 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 lwr extr w/o&w/dye (73706) |
— |
$368 |
— |
| CT c-spine w/contrast (72126) |
— |
$254 |
— |
| CT c-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 limited/localized follow up study (76380) |
— |
$174 |
— |
| CT lower ext w/o (73700) |
— |
$194 |
— |
| CT lower extremity w wo contrast (73702) |
— |
$293 |
— |
| 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 w/wo contrast (70488) |
— |
$280 |
— |
| CT maxillofacial wo contrast (70486) |
— |
$192 |
— |
| CT orbit sella/post fossa/ear w/o & w/contr matr (70482) |
— |
$321 |
— |
| CT orbits w/o contrast (70480) |
— |
$233 |
— |
| CT pelvis w/o contrast (72192) |
— |
$199 |
— |
| CT pelvis w/wo contrast (72194) |
— |
$324 |
— |
| CT scan of arm combo (73202) |
— |
$324 |
— |
| CT soft tissue neck w contrast (70491) |
— |
$278 |
— |
| CT soft tissue neck w/o & w/contrast material (70492) |
— |
$337 |
— |
| 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 with contrast (73201) |
— |
$307 |
— |
| Cta Aa&Bi Iliofem Lxtr Rs&I C-/C+ Post-Pxessing (75635) |
— |
$402 |
— |
| Cta Abdomen (74175) |
— |
$364 |
— |
| CTA chest (71275) |
— |
$365 |
— |
| Cta Neck (70498) |
— |
$360 |
— |
| Cystography minimum 3 views rs&i (74430) |
— |
$57 |
— |
| Doppler Echo Fetal Puls Spectral F/U/Repeat (76828) |
— |
$72 |
— |
| Dxa bone density study 1/> sites axial skel (77080) |
— |
$53 |
— |
| Dxa bone density study 1/>sites appendiclr skel (77081) |
— |
$44 |
— |
| Esophagus (74220) |
— |
$141 |
— |
| Facial bones min 3 views (70150) |
— |
$66 |
— |
| Fetal Biophysical Profile W/O Non-Stress Testing (76819) |
— |
$120 |
— |
| Fetal Echo (76825) |
— |
$383 |
— |
| Fluoroscopy up to 1 hr (76000) |
— |
$60 |
— |
| Foot 2 views (73620) |
— |
$40 |
— |
| Forearm 2 views (73090) |
— |
$41 |
— |
| Hand 2 views (73120) |
— |
$44 |
— |
| Heart first pass single,planar (78481) |
— |
$247 |
— |
| Hepatc Vngrph Wdg/Fr Hemodyn Eval Rs&I (75889) |
— |
$180 |
— |
| Hepatobil Syst Imag Inc Gb W/Pharma Intervenj (78227) |
— |
$615 |
— |
| Knee 3 views (73562) |
— |
$56 |
— |
| Liver & spleen imaging static only (78215) |
— |
$273 |
— |
| Magnetic resonance (eg, proton) imaging, upper extremity, other than joint; with contrast material(s) Non-Facility (73219) |
— |
$526 |
— |
| Magnetic resonance (eg, proton) imaging, upper extremity, other than joint; without contrast material(s), followed by… (73220) |
— |
$644 |
— |
| Mlc imrt design & construction per imrt plan (77338) |
— |
$653 |
— |
| MRA head w & w/o contrast (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 & w/contrast material (74183) |
— |
$530 |
— |
| MRI abdomen w/o contrast (74181) |
— |
$303 |
— |
| MRI any jt lower extrem w/o & w/contrast matrl (73723) |
— |
$612 |
— |
| MRI c-spine with contrast (72142) |
— |
$428 |
— |
| MRI cervical spine w/o contrast (72141) |
— |
$294 |
— |
| MRI chest w/o & w/contrast material (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 orbit face &/neck w/o contrast (70540) |
— |
$353 |
— |
| MRI pelvis w/o & w/contrast material (72197) |
— |
$529 |
— |
| MRI pelvis w/o contrast (72195) |
— |
$359 |
— |
| MRI spinal canal cervical w/o & w/contr matrl (72156) |
— |
$498 |
— |
| MRI spinal canal lumbar w/contrast material (72149) |
— |
$421 |
— |
| MRI spinal canal thoracic w/contrast matrl (72147) |
— |
$425 |
— |
| MRI spinal canal thoracic w/o & w/contr matrl (72157) |
— |
$499 |
— |
| MRI thoracic spine w/o contrast (72146) |
— |
$294 |
— |
| MRI upper ext joint w/o contrast (73221) |
— |
$311 |
— |
| Myocardial Spect Multiple Studies (78452) |
— |
$661 |
— |
| Neck soft tissue (70360) |
— |
$44 |
— |
| Nm cardiac blood pool multiple (78473) |
— |
$403 |
— |
| Nm cisternogram (78630) |
— |
$471 |
— |
| Nm gastric emptying study (78264) |
— |
$463 |
— |
| Nonvascular shunt X-ray (75809) |
— |
$124 |
— |
| Ntsty modul radthx pln dose-vol histos (77301) |
— |
$2,629 |
— |
| Nuclear Rx Oral Admin (79005) |
— |
$189 |
— |
| Ophthalmic biometry by ultrasound echography, A-scan; with intraocular lens power calculation Non-Facility (76519) |
— |
$93 |
— |
| Orthopantogram (70355) |
— |
$26 |
— |
| Parathyrd planar w/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 after injection (74190) |
— |
$113 |
— |
| PET image w/CT, skull-thigh (78815) |
— |
$2,171 |
— |
| PET imaging for CT attenuation whole body (78816) |
— |
$2,213 |
— |
| Pulmonary Perfusion Imaging Particulate (78580) |
— |
$330 |
— |
| Pulmonary Ventilation & Perfusion Imaging (78582) |
— |
$464 |
— |
| Radex abscess/fistula/sinus tract rs&i (76080) |
— |
$84 |
— |
| Radex Ankle Compl Minimum 3 Views (73610) |
— |
$51 |
— |
| Radex Calcaneus Minimum 2 Views (73650) |
— |
$40 |
— |
| Radex Elbw Compl Minimum 3 Views (73080) |
— |
$45 |
— |
| Radex Entir Thrc Lmbr Crv Sac Spi W/Skull 1 Vw - Xr Scoliosis 1 Vw (72081) |
— |
$59 |
— |
| Radex entir thrc lmbr crv sac spi w/skull 2/3 vw (72082) |
— |
$97 |
— |
| Radex fingr minimum 2 views (73140) |
— |
$52 |
— |
| Radex Foot Compl Minimum 3 Views (73630) |
— |
$48 |
— |
| Radex Hand Minimum 3 Views (73130) |
— |
$51 |
— |
| Radex Hip Unilateral With Pelvis 1 View (73501) |
— |
$45 |
— |
| Radex Hips Bilateral With Pelvis 2 Views (73521) |
— |
$57 |
— |
| Radex Hips Bilateral With Pelvis Minimum 5 Views (73523) |
— |
$85 |
— |
| Radex Humerus Minimum 2 Views (73060) |
— |
$45 |
— |
| Radex Kne 1/2 Views (73560) |
— |
$48 |
— |
| Radex Kne Compl 4/More Views (73564) |
— |
$64 |
— |
| Radex Mndbl Compl Minimum 4 Views (70110) |
— |
$61 |
— |
| Radex Nasal Bones Complete Minimum 3 Views (70160) |
— |
$53 |
— |
| Radex Pelvis Compl Minimum 3 Views (72190) |
— |
$58 |
— |
| Radex Sho Compl Minimum 2 Views (73030) |
— |
$48 |
— |
| Radex Sinuses Paransl < 3 Views (70210) |
— |
$45 |
— |
| Radex Spine Lumbosacral Only Bending 2/3 Views (72120) |
— |
$57 |
— |
| Radex Temporomandble Jt Opn & Clsd Mouth Bilat (70330) |
— |
$74 |
— |
| Radex Toe Minimum 2 Views (73660) |
— |
$41 |
— |
| Radex Wrst Compl Minimum 3 Views (73110) |
— |
$56 |
— |
| Radiologic Exam Abdomen 1 View - Xr Abdomen 1 View (74018) |
— |
$42 |
— |
| Radiologic Exam Abdomen 3+ Views - Xr Abdomen 3+ Views (74021) |
— |
$60 |
— |
| Radiologic exam chest 2 views (71046) |
— |
$47 |
— |
| Radiologic exam colon single contrast study (74270) |
— |
$221 |
— |
| Radiologic exam upr gi trc double contrast study (74246) |
— |
$200 |
— |
| Radiologic exam upr gi trc single contrast study (74240) |
— |
$174 |
— |
| Radiologic examination femur 1 view (73551) |
— |
$41 |
— |
| Radiologic examination tibia & fibula 2 views (73590) |
— |
$44 |
— |
| Radiologic examination, mastoids; complete, minimum of 3 views per side Non-Facility (70130) |
— |
$87 |
— |
| Radiologic examination, mastoids; less than 3 views per side Non-Facility (70120) |
— |
$53 |
— |
| Radiological examination surgical specimen (76098) |
— |
$59 |
— |
| Ribs bilateral 3 views (71110) |
— |
$61 |
— |
| Rp loclzj tum plnr whole body single day imaging (78802) |
— |
$437 |
— |
| Sacroiliac Joints < 3 Views (72200) |
— |
$46 |
— |
| Scapula (73010) |
— |
$33 |
— |
| Screening Digital Breast Tomosynthesis Bi (77063) |
— |
$76 |
— |
| Sella turcica (70240) |
— |
$46 |
— |
| Shoulder 1 view (73020) |
— |
$30 |
— |
| Small bowel series (74250) |
— |
$175 |
— |
| Spec telethx port pln parts hemibdy tot bdy (77321) |
— |
$131 |
— |
| Special dosimetry (77331) |
— |
$90 |
— |
| Speech evaluation complex (70371) |
— |
$153 |
— |
| Spine thoracic 3 views (72072) |
— |
$55 |
— |
| Stereotactic Body Radiation Delivery (77373) |
— |
$1,592 |
— |
| Telethx isodose pln cplx w/basic dosimetry (77307) |
— |
$398 |
— |
| Testicular Imaging With Vascular Flow (78761) |
— |
$296 |
— |
| Ther rad simulaj-aided field setting complex (77290) |
— |
$682 |
— |
| Ther rad simulaj-aided field setting simple (77280) |
— |
$394 |
— |
| Thoracolumbar 2 views (72080) |
— |
$48 |
— |
| Thyroid carcinoma metastases img whole body (78018) |
— |
$438 |
— |
| Thyroid Uptake W/Blood Flow Sngle/Mult Quan Meas (78014) |
— |
$334 |
— |
| Tmj unilateral (70328) |
— |
$48 |
— |
| Tomogram (76100) |
— |
$131 |
— |
| Treatment device complex (77334) |
— |
$175 |
— |
| Ultrasound bone density measurement and interpretation, peripheral site(s), any method Non-Facility (76977) |
— |
$10 |
— |
| Ultrasound breast complete (76641) |
— |
$148 |
— |
| Ultrasound Exam Aaa Screen (76706) |
— |
$153 |
— |
| Ultrasound, abdomen limited (76705) |
— |
$127 |
— |
| Urethrocystogram voiding (74455) |
— |
$147 |
— |
| Urethrocystography retrograde rs&i (74450) |
— |
$113 |
— |
| Urography, infusion, drip technique and/or bolus technique; Non-Facility (74410) |
— |
$195 |
— |
| Urography, infusion, drip technique and/or bolus technique; with nephrotomography Non-Facility (74415) |
— |
$222 |
— |
| Us breast unilateral limited (76642) |
— |
$122 |
— |
| Us chest (76604) |
— |
$93 |
— |
| Us compl joint r-t w/image documentation (76881) |
— |
$92 |
— |
| Us lmtd joint/oth nonvasc xtr strux r-t w/img (76882) |
— |
$79 |
— |
| Us ob detailed single fetus (76811) |
— |
$245 |
— |
| Us ob limited (76815) |
— |
$118 |
— |
| Us ob transvaginal (76817) |
— |
$134 |
— |
| Us pelvic non ob complete (76856) |
— |
$153 |
— |
| Us pelvic nonobstetric image dcmtn limited/f/u (76857) |
— |
$67 |
— |
| 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 soft tissue head/neck (76536) |
— |
$163 |
— |
| Us transrectal (76872) |
— |
$194 |
— |
| Us, eye b-scan (76512) |
— |
$68 |
— |
| Venogram extremity bilateral (75822) |
— |
$196 |
— |
| Venogram Extremity Unilateral (75820) |
— |
$164 |
— |
| Venography caval superior serialography rs&i (75827) |
— |
$176 |
— |
| Wrist 2 views (73100) |
— |
$47 |
— |
| X-Ray Abdomen,Comp Acute Series - Xr Abdomen 2 Vws With Chest 1 View (74022) |
— |
$69 |
— |
| X-Ray Ac Jts - Xr Acromioclavicular Joints Bilateral (73050) |
— |
$40 |
— |
| X-Ray Colon Air Contrast - Fl Barium Enema Air Contrast (74280) |
— |
$320 |
— |
| X-Ray Elbow 2 Vw - Xr Elbow 1-2 Views Right (73070) |
— |
$41 |
— |
| X-Ray Exam Hip Uni 2-3 Views (73502) |
— |
$65 |
— |
| X-Ray Exam Hips Bi 3-4 Views (73522) |
— |
$74 |
— |
| X-ray exam of femur 2/> (73552) |
— |
$49 |
— |
| X-ray eye for foreign body (70030) |
— |
$45 |
— |
| X-Ray Facial Bones <3 Vw - Xr Facial Bones 1-2 Views (70140) |
— |
$45 |
— |
| X-ray IV pyelogram (ivp) (74400) |
— |
$189 |
— |
| 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 Lumbar Spine 6+ Vw - Xr Lumbar Spine 6+ Vws Including Bending (72114) |
— |
$86 |
— |
| X-ray optic foramen (70190) |
— |
$54 |
— |
| X-Ray Orbits - Xr Orbits Complete 4+ Views (70200) |
— |
$67 |
— |
| X-ray retrograde pyelogram (74420) |
— |
$107 |
— |
| X-Ray Ribs 2 Vw Unilat - Xr Ribs 2 Views Right (71100) |
— |
$51 |
— |
| X-Ray Ribs, Chest 3+ Vw - Xr Ribs 2 Vws Lt W/ Chest Anteroposterior (71101) |
— |
$59 |
— |
| 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 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 Skull <4 Vw - Xr Skull 1-3 Views (70250) |
— |
$50 |
— |
| X-Ray Small Bowel Enteroclysis (74251) |
— |
$321 |
— |
| X-Ray Spine One View - Xr Spine (72020) |
— |
$35 |
— |
| X-Ray Sterno-Clavicluar Jt - Xr Sternoclavicular Joints 3+ Views (71130) |
— |
$58 |
— |
| X-Ray Sternum 2+ Vw - Xr Sternum 2+ Views (71120) |
— |
$47 |
— |
| X-Ray Thoracic Spine 2 Vw - Xr Thoracic Spine 2 Views (72070) |
— |
$45 |
— |
| Xr c-spine 4 or 5 views (72050) |
— |
$73 |
— |
| Xr c-spine 6 or more views (72052) |
— |
$86 |
— |
| Xr chest 4+ views (71048) |
— |
$64 |
— |