Imaging prices at St. Luke's Jerome Medical Center

Jerome, ID · every code in this section with a posted price and a Medicare benchmark.

417 codes. Prices are the hospital's own posted facility charges.

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ProcedureCash priceGross charge× Medicare
3-D radiotherapy plan dose-volume histograms (77295) $9,659 $9,659 7.0×
Abdomen 2 views (74019) $441 $441 4.3×
Acute gi blood loss imaging (78278) $1,425 $1,425 3.6×
Angiography extremity bilateral rs&i (75716) $10,789 $10,789 3.4×
Angiography extremity unilateral rs&i (75710) $10,789 $10,789 3.4×
Angiography internal mammary rs&i (75756) $10,789 $10,789 3.4×
Angiography pelvic slctv/supraslctv rs&i (75736) $18,620 $18,620 3.4×
Angiography pulmonary bilateral slctv rs&i (75743) $10,789 $10,789 3.4×
Angiography pulmonary unilateral slctv rs&i (75741) $10,789 $10,789 3.4×
Angiography Spinal Selective Rs&I (75705) $18,620 $18,620 3.4×
Angiography visceral slctv/supraslctv rs&i (75726) $18,620 $18,620 3.4×
Angrph Cath F-Up Std Tcat Other Than Thrombylsis (75898) $10,789 $10,789 3.4×
Angrph pulmonary nonslctv cath/ven njx rs&i (75746) $10,789 $10,789 3.4×
Ankle 2 views (73600) $365 $365 4.2×
Aortogram thoracic (75605) $18,620 $18,620 3.4×
Aortography abdl bi iliofem low extrem cath rs&i (75630) $10,789 $10,789 3.4×
Aortography abdominal serialography rs&i (75625) $10,789 $10,789 3.4×
Aortography Thoracic W/O Serialography Rs&I (75600) $10,789 $10,789 3.4×
Artery X-Rays Adrenal Gland (75731) $10,789 $10,789 3.4×
Arthrogram ankle (73615) $1,220 $1,220 3.5×
Arthrogram elbow (73085) $1,220 $1,220 3.5×
Arthrogram hip (73525) $1,220 $1,220 3.5×
Arthrogram knee (73580) $1,220 $1,220 3.5×
Arthrogram shoulder (73040) $1,220 $1,220 3.5×
Arthrogram wrist (73115) $1,220 $1,220 3.5×
Basic dosimetry (77300) $943 $943 7.1×
Bone &/Joint Imaging Limited Area (78300) $1,425 $1,425 3.6×
Bone &/Joint Imaging Multiple Areas (78305) $1,425 $1,425 3.6×
Bone &/joint imaging whole body (78306) $1,425 $1,425 3.6×
Bone age studies (77072) $441 $441 4.3×
Bone Imaging 3 Phase (78315) $1,425 $1,425 3.6×
Bone survey complete (77075) $441 $441 4.3×
Bone survey infant (77076) $441 $441 4.3×
Bowel imaging (78290) $1,425 $1,425 3.6×
Brachytx isodose complex (77318) $2,592 $2,592 7.0×
Brachytx isodose intermed (77317) $2,592 $2,592 7.0×
Brachytx isodose pln smpl w/dosimetry cal (77316) $2,592 $2,592 7.0×
Brain Imaging Min 4 Static Views W Vascular Flow (78606) $1,761 $1,761 3.3×
Brain Imaging Pet Metabolic Evaluation (78608) $16,439 $16,439 11.6×
Card Bpi Gtd =Brm Plnr 1 Std Rest/Strs (78472) $1,425 $1,425 3.6×
Cardiac MRI w/w/o contrast & further seq (75561) $3,763 $3,763 10.9×
Cardiac shunt detection (78428) $1,425 $1,425 3.6×
Cerebrospinal Fluid Flow W/O Matl Shunt Evaltj (78645) $1,761 $1,761 3.3×
Cervical spine 2 or 3 views (72040) $365 $365 4.2×
Chest 1 view (71045) $365 $365 4.2×
Chest xray 3 views (71047) $365 $365 4.2×
Cine/Vid X-Ray Throat/Esoph - Fl Esoph Barium Swlw W/ Video & Speech (74230) $589 $589 3.4×
Cineradiography/videoradiography (76120) $441 $441 4.3×
Clavicle complete (73000) $365 $365 4.2×
Computed Tomography Thorax Lw Dose Lng Ca Scr C- (71271) $819 $819 7.9×
Continuing medical physics consltj pr wk (77336) $943 $943 7.1×
CT abdomen and pelvis without and with contrast (74178) $2,263 $2,263 6.5×
CT abdomen and pelvis without contrast (74176) $1,857 $1,857 7.8×
CT abdomen w contrast (74160) $1,093 $1,093 6.3×
CT abdomen w wo contrast (74170) $1,093 $1,093 6.3×
CT abdomen w/o contrast (74150) $819 $819 7.9×
CT angio hrt w/3d image (75574) $2,263 $2,263 6.5×
CT angio lwr extr w/o&w/dye (73706) $1,093 $1,093 6.3×
CT angiography upper extremity lt (73206) $1,093 $1,093 6.3×
CT c-spine w/contrast (72126) $2,263 $2,263 6.5×
CT c-spine w/o contrast (72125) $819 $819 7.9×
CT cere prfu aly c+wo CT/CTA (70473) $1,816 $1,816 10.4×
CT cervical spine w&w/o contrast (72127) $1,093 $1,093 6.3×
CT chest w contrast (71260) $1,093 $1,093 6.3×
CT chest w/wo contrast (71270) $1,093 $1,093 6.3×
CT colonography screening (74263) $3,087 $3,087 13.0×
CT colonography w/dye (74262) $1,816 $1,816 10.4×
CT head/brain with contrast (70460) $1,093 $1,093 6.3×
CT head/brain without and with contrast (70470) $1,093 $1,093 6.3×
CT heart contrast eval cardiac structure&morph (75572) $2,263 $2,263 6.5×
CT heart w/o contrast quant eval coronary calcium (75571) $677 $677 7.8×
CT iac w contrast (70481) $1,093 $1,093 6.3×
CT limited/localized follow up study (76380) $1,126 $1,126 13.0×
CT lower ext w/o (73700) $819 $819 7.9×
CT lower extremity w wo contrast (73702) $1,093 $1,093 6.3×
CT lower extremity w/contrast material (73701) $1,093 $1,093 6.3×
CT lumbar spine w & w/o contrast (72133) $1,093 $1,093 6.3×
CT lumbar spine w/contrast (72132) $2,263 $2,263 6.5×
CT lumbar spine w/o contrast (72131) $819 $819 7.9×
CT maxillofacial w contrast (70487) $1,093 $1,093 6.3×
CT maxillofacial w/wo contrast (70488) $1,093 $1,093 6.3×
CT maxillofacial wo contrast (70486) $819 $819 7.9×
CT orbit sella/post fossa/ear w/o & w/contr matr (70482) $1,093 $1,093 6.3×
CT orbits w/o contrast (70480) $819 $819 7.9×
CT pelvis w/o contrast (72192) $819 $819 7.9×
CT pelvis w/wo contrast (72194) $1,093 $1,093 6.3×
CT scan of arm combo (73202) $1,093 $1,093 6.3×
CT soft tissue neck w contrast (70491) $1,093 $1,093 6.3×
CT soft tissue neck w/o & w/contrast material (70492) $1,093 $1,093 6.3×
CT soft tissue neck w/o contrast (70490) $819 $819 7.9×
CT thoracic spine w/contrast (72129) $1,093 $1,093 6.3×
CT thoracic spine w/o contrast (72128) $819 $819 7.9×
CT thoracic spine w/wo contrast (72130) $1,093 $1,093 6.3×
CT thorax w/o contrast (71250) $819 $819 7.9×
CT upper ext wo (73200) $819 $819 7.9×
CT upper extremity with contrast (73201) $2,263 $2,263 6.5×
Cta Aa&Bi Iliofem Lxtr Rs&I C-/C+ Post-Pxessing (75635) $1,093 $1,093 6.3×
Cta Abdomen (74175) $1,093 $1,093 6.3×
CTA abdomen pelvis (74174) $2,263 $2,263 6.5×
CTA chest (71275) $1,093 $1,093 6.3×
Cta Head (70496) $1,093 $1,093 6.3×
CTA head&neck c+ w/noncontrast img&post-pxessing (70471) $2,263 $2,263 6.5×
Cta Neck (70498) $1,093 $1,093 6.3×
Cta Pelvis (72191) $1,093 $1,093 6.3×
Cystography minimum 3 views rs&i (74430) $1,220 $1,220 3.5×
Dilation of ureter(s) or urethra, radiological supervision and interpretation Non-Facility (74485) $7,861 $7,861 3.8×
Diskogram cervical (72285) $7,978 $7,978 4.1×
Diskography lumbar (72295) $7,978 $7,978 4.1×
Doppler Echo Fetal Puls Spectral F/U/Repeat (76828) $532 $532 5.1×
Doppler Echo Fetal Spectral Display Complete (76827) $532 $532 5.1×
Doppler Fetal Mid Cerebral Artery (76821) $441 $441 4.3×
Dxa bone density study 1/> sites axial skel (77080) $441 $441 4.3×
Dxa bone density study 1/>sites appendiclr skel (77081) $365 $365 4.2×
Dxa bone density study axial skeleton (77085) $441 $441 4.3×
Echocardiography, fetal, cardiovascular system, real time with image documentation (2D), with or without M-mode… (76826) $1,206 $1,206 5.1×
Esophagus (74220) $589 $589 3.4×
Facial bones min 3 views (70150) $441 $441 4.3×
Fetal biophysical profile non-stress testing (76818) $441 $441 4.3×
Fetal Biophysical Profile W/O Non-Stress Testing (76819) $441 $441 4.3×
Fetal Echo (76825) $2,729 $2,729 5.0×
Fluoroscopy up to 1 hr (76000) $1,001 $1,001 4.2×
Foot 2 views (73620) $365 $365 4.2×
Forearm 2 views (73090) $365 $365 4.2×
Functional MRI brain by phys/psych (70555) $3,087 $3,087 13.0×
Functional MRI brain by tech (70554) $3,087 $3,087 13.0×
Hand 2 views (73120) $441 $441 4.3×
Hdr rdncl ntrstl/intrcav brachytx 1 channel (77770) $4,924 $4,924 7.1×
Hdr rdncl ntrstl/intrcav brachytx 2-12 channel (77771) $4,924 $4,924 7.1×
Hdr rdncl ntrstl/intrcav brachytx >12 channels (77772) $4,924 $4,924 7.1×
Hepatc Vngrph Wdg/Fr Hemodyn Eval Rs&I (75889) $10,789 $10,789 3.4×
Hepatc vngrph wdg/fr w/o hemodyn eval rs&i (75891) $10,789 $10,789 3.4×
Hepatobil Syst Imag Inc Gb W/Pharma Intervenj (78227) $1,761 $1,761 3.3×
Hepatobiliary syst imaging including gallbladder (78226) $1,425 $1,425 3.6×
Hyperthermia, externally generated; deep (ie, heating to depths greater than 4 cm) Non-Facility (77605) $4,924 $4,924 7.1×
Hysterosalpingogram (74740) $1,001 $1,001 4.2×
Image fusion (77399) $296 $296 2.2×
Interstitial radiation source applic complex (77778) $4,924 $4,924 7.1×
Joint Survey, Single View - Xr Joint Anteroposterior 2+ Joints (77077) $441 $441 4.3×
Kidney imaging morphology (78700) $1,425 $1,425 3.6×
Kidney Img Morphology Vascular Flow 1 W/O Rx (78707) $1,761 $1,761 3.3×
Kidney img morphology vascular flow 1 w/rx (78708) $1,761 $1,761 3.3×
Kidney Img Morphology Vascular Flow Multiple (78709) $1,761 $1,761 3.3×
Knee 3 views (73562) $365 $365 4.2×
Liver & spleen imaging static only (78215) $1,425 $1,425 3.6×
Liver & Spleen Imaging W/Vascular Flow (78216) $1,425 $1,425 3.6×
Lung perf&ventilat diferentl (78598) $1,761 $1,761 3.3×
Lung perfusion differential (78597) $1,425 $1,425 3.6×
Lymphangiography Pelvic/Abdominal Bilateral Rs&I (75807) $10,789 $10,789 3.4×
Lymphangiography Pelvic/Abdominal Unilat Rs&I (75805) $10,789 $10,789 3.4×
Lymphangiography, extremity only, bilateral, radiological supervision and interpretation Facility (75803) $5,250 $5,250 3.4×
Lymphangiography, extremity only, unilateral, radiological supervision and interpretation Facility (75801) $2,478 $2,478 4.0×
Lymphoscintigraphy (78195) $1,761 $1,761 3.3×
Magnetic resonance (eg, proton) imaging, any joint of upper extremity; with contrast material(s) Non-Facility (73222) $5,145 $5,145 6.6×
Magnetic resonance (eg, proton) imaging, upper extremity, other than joint; without contrast material(s), followed by… (73220) $2,263 $2,263 6.5×
Magnetic Resonance Elastography (76391) $3,087 $3,087 13.0×
Mammary ductogram or galactogram multiple (77054) $1,001 $1,001 4.2×
Mammary ductogram or galactogram single (77053) $1,001 $1,001 4.2×
Manual Appl Stress Pfrmd Phys/Qhp Joint Films (77071) $365 $365 4.2×
Mlc imrt design & construction per imrt plan (77338) $2,592 $2,592 7.0×
Mr safety determination physician/other qhp (76016) $365 $365 4.2×
Mr safety implant&/fb assmt clin staf 1st 15 min (76014) $102 $102 3.6×
MRA head w & w/o contrast (70546) $2,263 $2,263 6.5×
MRA head w/o contrast (70544) $1,857 $1,857 7.8×
MRA head with contrast (70545) $3,763 $3,763 10.9×
MRA neck w contrast (70548) $2,263 $2,263 6.5×
Mra Neck W/O &W/Contrast Material (70549) $2,263 $2,263 6.5×
MRA neck w/o contrast (70547) $1,857 $1,857 7.8×
MRI abdomen w/o & w/contrast material (74183) $2,263 $2,263 6.5×
MRI abdomen w/o contrast (74181) $1,857 $1,857 7.8×
MRI any jt lower extrem w/contrast material (73722) $5,145 $5,145 6.6×
MRI any jt lower extrem w/o & w/contrast matrl (73723) $2,263 $2,263 6.5×
MRI bone marrow blood supply (77084) $3,087 $3,087 13.0×
MRI breast w/o contrast bilateral (77047) $1,857 $1,857 7.8×
MRI breast wo contrast unilateral (77046) $3,087 $3,087 13.0×
MRI c-spine with contrast (72142) $2,263 $2,263 6.5×
MRI cardiac w/o contrast (75557) $3,087 $3,087 13.0×
MRI cervical spine w/o contrast (72141) $1,857 $1,857 7.8×
MRI chest w/o & w/contrast material (71552) $2,263 $2,263 6.5×
MRI chest w/o contrast (71550) $1,857 $1,857 7.8×
MRI fetal sngl/1st gestation (74712) $3,087 $3,087 13.0×
MRI lower extrem oth/thn jt w/o & w/contr matr (73720) $2,263 $2,263 6.5×
MRI lower extrem oth/thn jt w/o contr matrl (73718) $1,857 $1,857 7.8×
MRI orbit face &/neck w/o contrast (70540) $1,857 $1,857 7.8×
MRI orbit/face/neck w&w/o cont (70543) $2,263 $2,263 6.5×
MRI pelvis w/contrast (72196) $3,763 $3,763 10.9×
MRI pelvis w/o & w/contrast material (72197) $2,263 $2,263 6.5×
MRI pelvis w/o contrast (72195) $1,857 $1,857 7.8×
MRI spectroscopy (76390) $1,126 $1,126 13.0×
MRI spinal canal cervical w/o & w/contr matrl (72156) $2,263 $2,263 6.5×
MRI spinal canal lumbar w/contrast material (72149) $2,263 $2,263 6.5×
MRI spinal canal lumbar w/o & w/contr matrl (72158) $2,263 $2,263 6.5×
MRI spinal canal thoracic w/contrast matrl (72147) $2,263 $2,263 6.5×
MRI spinal canal thoracic w/o & w/contr matrl (72157) $2,263 $2,263 6.5×
MRI temporomandibular joint (70336) $1,857 $1,857 7.8×
MRI thoracic spine w/o contrast (72146) $1,857 $1,857 7.8×
MRI up ext w/o contrast (73218) $1,857 $1,857 7.8×
MRI upper ext joint w/o contrast (73221) $1,857 $1,857 7.8×
MRI, joint upper extrem combo (73223) $2,263 $2,263 6.5×
Myelogram Lumbar (72265) $2,773 $2,773 3.6×
Myocardial Imaging Pet Metabolic Evaluation (78459) $13,173 $13,173 10.3×
Myocardial imaging, positron emission tomography (PET), combined perfusion with metabolic evaluation study (including… (78433) $24,966 $24,966 11.4×
Myocardial imaging, positron emission tomography (PET), metabolic evaluation study (including ventricular wall… (78429) $16,439 $16,439 11.6×
Myocardial imaging, positron emission tomography (PET), perfusion study (including ventricular wall motionºs» and/or… (78431) $28,806 $28,806 13.2×
Myocardial Spect Multiple Studies (78452) $4,271 $4,271 3.3×
Myocardial spect single study at rest or stress (78451) $4,271 $4,271 3.3×
Myocrd img PET prfuj 1std rest/stress cncrnt CT (78430) $16,439 $16,439 11.6×
Myocrd Img Pet Prfuj W/Metab Dual Radiotracer (78432) $23,686 $23,686 15.7×
N-invas est c ffr sw aly CTA (75580) $7,834 $7,834 9.2×
Neck soft tissue (70360) $365 $365 4.2×
Nm cisternogram (78630) $1,761 $1,761 3.3×
Nm csf leak detection (78650) $4,271 $4,271 3.3×
Nm gastric emptying study (78264) $1,425 $1,425 3.6×
Nm gastroesophageal reflux study (78262) $1,425 $1,425 3.6×
Nm kidney scan w/flow (78701) $1,425 $1,425 3.6×
Nm peritoneal-venous shunt patency (78291) $1,425 $1,425 3.6×
Nonvascular shunt X-ray (75809) $441 $441 4.3×
Ntsty modul radthx pln dose-vol histos (77301) $9,659 $9,659 7.0×
Nuclear Rx Oral Admin (79005) $918 $918 4.0×
Ob us nuchal meas 1 gest (76813) $441 $441 4.3×
Ophthalmic ultrasound, diagnostic; corneal pachymetry, unilateral or bilateral (determination of corneal thickness)… (76514) $9 $9 0.3×
Osseous survey limited (77074) $441 $441 4.3×
Parathyrd planar w/spect&CT (78072) $1,761 $1,761 3.3×
Parathyroid Planar Imaging (78070) $1,425 $1,425 3.6×
Pelvis 1 or 2 views (72170) $441 $441 4.3×
Perineogram (74775) $1,001 $1,001 4.2×
Peritoneogram after injection (74190) $2,265 $2,265 4.2×
PET image w/CT, skull-thigh (78815) $9,889 $9,889 7.0×
PET imaging CT for attenuation limited area (78814) $16,439 $16,439 11.6×
PET imaging for CT attenuation whole body (78816) $9,889 $9,889 7.0×
Prq Transhepatc Portograpy Hemodyn Eval Rs&I (75885) $10,789 $10,789 3.4×
Prq transhepatc portograpy w/o hemodyn evl intrp (75887) $10,789 $10,789 3.4×
Pulmonary Perfusion Imaging Particulate (78580) $1,425 $1,425 3.6×
Pulmonary Ventilation & Perfusion Imaging (78582) $1,761 $1,761 3.3×
Radex abscess/fistula/sinus tract rs&i (76080) $2,265 $2,265 4.2×
Radex Ankle Compl Minimum 3 Views (73610) $365 $365 4.2×
Radex Calcaneus Minimum 2 Views (73650) $365 $365 4.2×
Radex Elbw Compl Minimum 3 Views (73080) $365 $365 4.2×
Radex Entir Thrc Lmbr Crv Sac Spi W/Skull 1 Vw - Xr Scoliosis 1 Vw (72081) $365 $365 4.2×
Radex entir thrc lmbr crv sac spi w/skull 2/3 vw (72082) $441 $441 4.3×
Radex Entir Thrc Lmbr Crv Sac Spi W/Skull 4/5 Vw (72083) $441 $441 4.3×
Radex fingr minimum 2 views (73140) $365 $365 4.2×
Radex Foot Compl Minimum 3 Views (73630) $365 $365 4.2×
Radex Hand Minimum 3 Views (73130) $365 $365 4.2×
Radex Hip Unilateral With Pelvis 1 View (73501) $365 $365 4.2×
Radex Hip Unilateral With Pelvis Minimum 4 Views (73503) $441 $441 4.3×
Radex Hips Bilateral With Pelvis 2 Views (73521) $441 $441 4.3×
Radex Humerus Minimum 2 Views (73060) $365 $365 4.2×
Radex Kne 1/2 Views (73560) $365 $365 4.2×
Radex Kne Compl 4/More Views (73564) $441 $441 4.3×
Radex Mndbl Compl Minimum 4 Views (70110) $441 $441 4.3×
Radex Nasal Bones Complete Minimum 3 Views (70160) $365 $365 4.2×
Radex Pelvis Compl Minimum 3 Views (72190) $441 $441 4.3×
Radex Sho Compl Minimum 2 Views (73030) $365 $365 4.2×
Radex Sinuses Paransl < 3 Views (70210) $365 $365 4.2×
Radex Spine Lumbosacral Only Bending 2/3 Views (72120) $441 $441 4.3×
Radex Temporomandble Jt Opn & Clsd Mouth Bilat (70330) $365 $365 4.2×
Radex Toe Minimum 2 Views (73660) $365 $365 4.2×
Radex upper extremity infant minimum 2 views (73092) $441 $441 4.3×
Radex Wrst Compl Minimum 3 Views (73110) $365 $365 4.2×
Radex X-Ray Exam Entire Spi 6/> Vw - Xr Entire Spine 6+ Vw (72084) $441 $441 4.3×
Radiation Delivery Stereotactic Cranial Linear (77372) $53,956 $53,956 7.4×
Radiation treatment delivery level 1 (77402) $777 $777 7.7×
Radiation treatment delivery level 2 (77407) $1,867 $1,867 4.9×
Radiation treatment delivery level 3 (77412) $4,107 $4,107 7.5×
Radiologic Exam Abdomen 1 View - Xr Abdomen 1 View (74018) $365 $365 4.2×
Radiologic Exam Abdomen 3+ Views - Xr Abdomen 3+ Views (74021) $441 $441 4.3×
Radiologic exam chest 2 views (71046) $365 $365 4.2×
Radiologic exam colon single contrast study (74270) $589 $589 3.4×
Radiologic Exam Esophagus Double Contrast Study (74221) $589 $589 3.4×
Radiologic exam upr gi trc double contrast study (74246) $589 $589 3.4×
Radiologic exam upr gi trc single contrast study (74240) $589 $589 3.4×
Radiologic examination femur 1 view (73551) $365 $365 4.2×
Radiologic Examination Salivary Gland Calculus (70380) $365 $365 4.2×
Radiologic examination tibia & fibula 2 views (73590) $365 $365 4.2×
Radiologic examination, internal auditory meati, complete Non-Facility (70134) $2,265 $2,265 4.2×
Radiologic examination, mastoids; complete, minimum of 3 views per side Non-Facility (70130) $441 $441 4.3×
Radiologic examination, teeth; single view Non-Facility (70300) $365 $365 4.2×
Radiologic examination; pharynx or larynx, including fluoroscopy and/or magnification technique Non-Facility (70370) $365 $365 4.2×
Radiological examination surgical specimen (76098) $2,265 $2,265 4.2×
Renal Cyst Study (74470) $2,265 $2,265 4.2×
Ribs bilateral 3 views (71110) $441 $441 4.3×
Rp Loclzj Tum Plnr 1 Area Single Day Imaging (78800) $1,425 $1,425 3.6×
Rp loclzj tum plnr 2+area 1+d img/1 area img>2+d (78801) $1,425 $1,425 3.6×
Rp Loclzj Tum Plnr Whole Body 2+ Days Imaging (78804) $4,271 $4,271 7.9×
Rp loclzj tum plnr whole body single day imaging (78802) $4,271 $4,271 7.9×
Rp loclzj tum spect 1 area single day imaging (78803) $4,271 $4,271 7.9×
Rp loclzj tum spect 2 area/sep acquisj img (78831) $4,271 $4,271 3.3×
Rp loclzj tum spect CT 2area 1d img/1 ar img>2+d (78832) $5,330 $5,330 3.8×
Rp loclzj tum spect w/CT 1 area 1 day imaging (78830) $4,271 $4,271 3.3×
Rp therapy intra-arterial particulate admn (79445) $918 $918 4.0×
Rp Therapy Intravenous Administration (79101) $918 $918 4.0×
Saline Infus Sonohysterography W/Color Doppler (76831) $1,001 $1,001 4.2×
Scapula (73010) $441 $441 4.3×
Screening Digital Breast Tomosynthesis Bi (77063) $88 $88 3.8×
Shoulder 1 view (73020) $365 $365 4.2×
Sialogram (70390) $1,001 $1,001 4.2×
Simulation intermediate (77285) $2,592 $2,592 7.0×
Small bowel series (74250) $589 $589 3.4×
Spec telethx port pln parts hemibdy tot bdy (77321) $2,592 $2,592 7.0×
Special dosimetry (77331) $943 $943 7.1×
Special Physics Consult (77370) $943 $943 7.1×
Special treatment procedure (77470) $4,107 $4,107 7.5×
Speech evaluation complex (70371) $1,001 $1,001 4.2×
Spine thoracic 3 views (72072) $441 $441 4.3×
Spleen imaging only (78185) $1,425 $1,425 3.6×
Splenoportograpy rs&i (75810) $10,789 $10,789 3.4×
Stereotactic Body Radiation Delivery (77373) $12,467 $12,467 7.0×
Superior sagittal sinus venogram (75870) $10,789 $10,789 3.4×
Surface Applic Low Dose Rate Radionuclide Source (77789) $777 $777 7.7×
Tbs techl prep&transmis data alys pfrmd elsewhr (77090) $365 $365 4.2×
Tbs technical calculation only (77091) $365 $365 4.2×
Telethx isodose pln cplx w/basic dosimetry (77307) $2,592 $2,592 7.0×
Telethx isodose pln smpl w/dosimetry calculation (77306) $2,592 $2,592 7.0×
Temporomandibular joint arthrography, radiological supervision and interpretation Non-Facility (70332) $1,001 $1,001 4.2×
Testicular Imaging With Vascular Flow (78761) $1,425 $1,425 3.6×
Ther rad simulaj-aided field setting complex (77290) $2,592 $2,592 7.0×
Ther rad simulaj-aided field setting simple (77280) $943 $943 7.1×
Thoracolumbar 2 views (72080) $365 $365 4.2×
Thyroid carcinoma metastases imaging; limited area (eg, neck and chest only) Non-Facility (78015) $1,425 $1,425 3.6×
Thyroid carcinoma metastases img whole body (78018) $1,761 $1,761 3.3×
Thyroid imaging w/blood flow (78013) $1,425 $1,425 3.6×
Thyroid uptake measurement (78012) $1,425 $1,425 3.6×
Thyroid Uptake W/Blood Flow Sngle/Mult Quan Meas (78014) $1,425 $1,425 3.6×
Tmj unilateral (70328) $365 $365 4.2×
Tomogram (76100) $441 $441 4.3×
Treatment device complex (77334) $2,592 $2,592 7.0×
Treatment device intermediate (77333) $943 $943 7.1×
Treatment devices simple (77332) $943 $943 7.1×
Ultrasound breast complete (76641) $441 $441 4.3×
Ultrasound Exam Aaa Screen (76706) $441 $441 4.3×
Ultrasound trgt dynamic microbubble 1st lesion (76978) $589 $589 1.7×
Ultrasound, abdomen limited (76705) $441 $441 4.3×
Umbilical-artery Doppler (OB) (76820) $441 $441 4.3×
Unlisted Diagnostic Radiographic Procedure (76499) $806 $806 9.3×
Unlisted magnetic resonance procedure (76498) $3,087 $3,087 35.7×
Urea Breath Test C-14 Isotopic Acquisj Analysis (78267) $46 $46 4.2×
Ureteral reflux study (78740) $1,425 $1,425 3.6×
Urethrocystogram voiding (74455) $1,001 $1,001 4.2×
Urethrocystography retrograde rs&i (74450) $1,001 $1,001 4.2×
Urography, infusion, drip technique and/or bolus technique; with nephrotomography Non-Facility (74415) $589 $589 3.4×
Us breast unilateral limited (76642) $365 $365 4.2×
Us chest (76604) $441 $441 4.3×
Us Cmprn Rpr Artl Pseudoarysm/Arven Fstl (76936) $1,279 $1,279 6.0×
Us compl joint r-t w/image documentation (76881) $441 $441 4.3×
Us elastography parenchyma (76981) $441 $441 4.3×
Us encephalogram (76506) $441 $441 4.3×
Us hips infant static (76886) $365 $365 4.2×
Us infant hips w manipulation (76885) $365 $365 4.2×
Us lmtd joint/oth nonvasc xtr strux r-t w/img (76882) $441 $441 4.3×
Us nrv&acc strux 1 xtr compre w/img pr extremity (76883) $441 $441 4.3×
Us ob detailed single fetus (76811) $1,001 $1,001 4.2×
Us ob limited (76815) $441 $441 4.3×
Us ob transvaginal (76817) $441 $441 4.3×
Us pelvic non ob complete (76856) $441 $441 4.3×
Us pelvic nonobstetric image dcmtn limited/f/u (76857) $441 $441 4.3×
Us pg uter img f&mat 14 wk tabdl 1/1st gestation (76801) $441 $441 4.3×
Us pg uter r-t img f-up tabdl appr pr fetus (76816) $441 $441 4.3×
Us retroperitoneal complete (76770) $441 $441 4.3×
Us retroperitoneal limited (76775) $441 $441 4.3×
Us scrotum and contents (76870) $441 $441 4.3×
Us soft tissue head/neck (76536) $441 $441 4.3×
Us spinal canal and contents (76800) $441 $441 4.3×
Us transrectal (76872) $441 $441 4.3×
Us transrectal prostate volume (76873) $441 $441 4.3×
Us, eye b-scan (76512) $441 $441 4.3×
Us,transplanted kidney, real time/ doppler (76776) $441 $441 4.3×
Venogram adrenal unilat (75840) $10,789 $10,789 3.4×
Venogram extremity bilateral (75822) $5,250 $5,250 3.4×
Venogram Extremity Unilateral (75820) $5,250 $5,250 3.4×
Venography caval inferior serialography rs&i (75825) $10,789 $10,789 3.4×
Venography caval superior serialography rs&i (75827) $5,250 $5,250 3.4×
Venography Orbital Rs&I (75880) $2,478 $2,478 4.0×
Venography Renal Bilateral (75833) $10,789 $10,789 3.4×
Venography renal unilateral selective rs&i (75831) $10,789 $10,789 3.4×
Venography venous sinus/jugular cath rs&i (75860) $10,789 $10,789 3.4×
Venous sampling by catheter (75893) $18,620 $18,620 3.4×
Vertebral fracture assessment via dxa (77086) $365 $365 4.2×
Wrist 2 views (73100) $365 $365 4.2×
X-Ray Abdomen,Comp Acute Series - Xr Abdomen 2 Vws With Chest 1 View (74022) $441 $441 4.3×
X-Ray Ac Jts - Xr Acromioclavicular Joints Bilateral (73050) $365 $365 4.2×
X-ray b.e. reductn intuss (74283) $589 $589 3.4×
X-Ray Colon Air Contrast - Fl Barium Enema Air Contrast (74280) $589 $589 3.4×
X-Ray Elbow 2 Vw - Xr Elbow 1-2 Views Right (73070) $365 $365 4.2×
X-Ray Exam Hip Uni 2-3 Views (73502) $365 $365 4.2×
X-Ray Exam Hips Bi 3-4 Views (73522) $441 $441 4.3×
X-ray exam of femur 2/> (73552) $365 $365 4.2×
X-ray eye for foreign body (70030) $365 $365 4.2×
X-Ray Facial Bones <3 Vw - Xr Facial Bones 1-2 Views (70140) $365 $365 4.2×
X-ray IV pyelogram (ivp) (74400) $589 $589 3.4×
X-Ray Jaw <4 Vw - Xr Mandible < 4 Views (70100) $365 $365 4.2×
X-Ray Knee Bilat Standing - Xr Knees Anteroposterior Standing Bilat (73565) $365 $365 4.2×
X-ray leg, infant (73592) $365 $365 4.2×
X-Ray Lumbar Spine 2/3 Vw - Xr Lumbar Spine 2-3 Views (72100) $441 $441 4.3×
X-Ray Lumbar Spine 6+ Vw - Xr Lumbar Spine 6+ Vws Including Bending (72114) $441 $441 4.3×
X-ray nose-rectum child f.b. (76010) $365 $365 4.2×
X-ray optic foramen (70190) $365 $365 4.2×
X-Ray Orbits - Xr Orbits Complete 4+ Views (70200) $441 $441 4.3×
X-ray retrograde pyelogram (74420) $1,220 $1,220 3.5×
X-Ray Ribs 2 Vw Unilat - Xr Ribs 2 Views Right (71100) $365 $365 4.2×
X-Ray Ribs, Chest 3+ Vw - Xr Ribs 2 Vws Lt W/ Chest Anteroposterior (71101) $441 $441 4.3×
X-Ray Ribs, Chest 4+ Vw - Xr Ribs 3 Vws Bil W/ Chest Posteroanterior (71111) $441 $441 4.3×
X-Ray Sacroiliac Jts 3+ Vw - Xr Sacroiliac Joints 3+ Views (72202) $441 $441 4.3×
X-Ray Sacrum/Coccyx 2+ Vw - Xr Sacrum Coccyx 2+ Views (72220) $365 $365 4.2×
X-Ray Sinuses 3+ Vw - Xr Paranasal Sinuses 3+ Views (70220) $365 $365 4.2×
X-Ray Skull 4+ Vw - Xr Skull Complete 4+ Views (70260) $441 $441 4.3×
X-Ray Skull <4 Vw - Xr Skull 1-3 Views (70250) $441 $441 4.3×
X-Ray Small Bowel Enteroclysis (74251) $589 $589 3.4×
X-Ray Spine One View - Xr Spine (72020) $365 $365 4.2×
X-Ray Sterno-Clavicluar Jt - Xr Sternoclavicular Joints 3+ Views (71130) $365 $365 4.2×
X-Ray Sternum 2+ Vw - Xr Sternum 2+ Views (71120) $365 $365 4.2×
X-Ray Thoracic Spine 2 Vw - Xr Thoracic Spine 2 Views (72070) $441 $441 4.3×
X-Ray Thoracic Spine 4 Vw - Xr Thoracic Spine Complete 4+ Views (72074) $441 $441 4.3×
Xr bone length studies (77073) $441 $441 4.3×
Xr c-spine 4 or 5 views (72050) $441 $441 4.3×
Xr c-spine 6 or more views (72052) $441 $441 4.3×
Xr chest 4+ views (71048) $441 $441 4.3×
Xr urogram antegrade (74425) $1,220 $1,220 3.5×