| 3-D radiotherapy plan dose-volume histograms (77295) |
$7,613 |
$7,613 |
4.6× |
| Abdomen 2 views (74019) |
$507 |
$507 |
4.0× |
| Ankle 2 views (73600) |
$425.57 |
$425.57 |
4.1× |
| Arthrogram elbow (73085) |
$2,160.17 |
$2,160.17 |
5.2× |
| Arthrogram hip (73525) |
$1,346.80 |
$1,346.80 |
3.2× |
| Arthrogram shoulder (73040) |
$2,072 |
$2,072 |
5.0× |
| Bone &/Joint Imaging Limited Area (78300) |
$1,264.08 |
$1,264.08 |
2.6× |
| Bone &/joint imaging whole body (78306) |
$1,646.40 |
$1,646.40 |
3.4× |
| Bone age studies (77072) |
$611 |
$611 |
4.9× |
| Bone Imaging 3 Phase (78315) |
$1,630.66 |
$1,630.66 |
3.4× |
| Cervical spine 2 or 3 views (72040) |
$640.99 |
$640.99 |
6.1× |
| Chest 1 view (71045) |
$267 |
$267 |
2.6× |
| Chest xray 3 views (71047) |
$343 |
$343 |
3.3× |
| Cine/Vid X-Ray Throat/Esoph - Fl Esoph Barium Swlw W/ Video & Speech (74230) |
$870.75 |
$870.75 |
4.1× |
| Clavicle complete (73000) |
$478.90 |
$478.90 |
4.6× |
| Computed Tomography Thorax Lw Dose Lng Ca Scr C- (71271) |
$1,163 |
$1,163 |
9.3× |
| CT abdomen and pelvis without and with contrast (74178) |
$3,509 |
$3,509 |
8.4× |
| CT abdomen and pelvis without contrast (74176) |
$2,083 |
$2,083 |
7.3× |
| CT abdomen w contrast (74160) |
$1,545 |
$1,545 |
7.3× |
| CT abdomen w wo contrast (74170) |
$1,838 |
$1,838 |
8.7× |
| CT abdomen w/o contrast (74150) |
$1,255 |
$1,255 |
10.0× |
| CT angio lwr extr w/o&w/dye (73706) |
$2,408 |
$2,408 |
11.5× |
| CT angiography upper extremity lt (73206) |
$1,996 |
$1,996 |
9.5× |
| CT c-spine w/contrast (72126) |
$1,843 |
$1,843 |
4.4× |
| CT c-spine w/o contrast (72125) |
$1,165 |
$1,165 |
9.3× |
| CT chest w contrast (71260) |
$1,475 |
$1,475 |
7.0× |
| CT chest w/wo contrast (71270) |
$2,205 |
$2,205 |
10.5× |
| CT head/brain with contrast (70460) |
$1,256 |
$1,256 |
6.0× |
| CT head/brain without and with contrast (70470) |
$1,382 |
$1,382 |
6.6× |
| CT iac w contrast (70481) |
$1,282 |
$1,282 |
6.1× |
| CT limited/localized follow up study (76380) |
$587 |
$587 |
5.6× |
| CT lower ext w/o (73700) |
$1,410.52 |
$1,410.52 |
11.3× |
| CT lower extremity w/contrast material (73701) |
$1,957.44 |
$1,957.44 |
9.3× |
| CT lumbar spine w & w/o contrast (72133) |
$3,417 |
$3,417 |
16.3× |
| CT lumbar spine w/contrast (72132) |
$2,150 |
$2,150 |
5.1× |
| CT lumbar spine w/o contrast (72131) |
$1,382 |
$1,382 |
11.0× |
| CT maxillofacial w contrast (70487) |
$1,256 |
$1,256 |
6.0× |
| CT maxillofacial wo contrast (70486) |
$1,014 |
$1,014 |
8.1× |
| CT orbit sella/post fossa/ear w/o & w/contr matr (70482) |
$1,316 |
$1,316 |
6.3× |
| CT orbits w/o contrast (70480) |
$1,014 |
$1,014 |
8.1× |
| CT pelvis w/o contrast (72192) |
$1,346 |
$1,346 |
10.7× |
| CT soft tissue neck w contrast (70491) |
$1,282 |
$1,282 |
6.1× |
| CT soft tissue neck w/o & w/contrast material (70492) |
$1,678 |
$1,678 |
8.0× |
| CT soft tissue neck w/o contrast (70490) |
$1,014 |
$1,014 |
8.1× |
| CT thoracic spine w/contrast (72129) |
$1,546 |
$1,546 |
7.4× |
| CT thoracic spine w/o contrast (72128) |
$1,407 |
$1,407 |
11.2× |
| CT thoracic spine w/wo contrast (72130) |
$2,665 |
$2,665 |
12.7× |
| CT thorax w/o contrast (71250) |
$1,163 |
$1,163 |
9.3× |
| CT upper ext wo (73200) |
$1,178 |
$1,178 |
9.4× |
| CT upper extremity with contrast (73201) |
$2,150 |
$2,150 |
5.1× |
| Cta Aa&Bi Iliofem Lxtr Rs&I C-/C+ Post-Pxessing (75635) |
$1,895 |
$1,895 |
9.0× |
| Cta Abdomen (74175) |
$1,701 |
$1,701 |
8.1× |
| CTA abdomen pelvis (74174) |
$3,646.61 |
$3,646.61 |
8.7× |
| CTA chest (71275) |
$1,752 |
$1,752 |
8.3× |
| Cta Head (70496) |
$1,508 |
$1,508 |
7.2× |
| Cta Neck (70498) |
$1,400 |
$1,400 |
6.7× |
| Cta Pelvis (72191) |
$2,254 |
$2,254 |
10.7× |
| Dxa bone density study 1/> sites axial skel (77080) |
$636 |
$636 |
5.1× |
| Dxa bone density study 1/>sites appendiclr skel (77081) |
$345 |
$345 |
3.3× |
| Dxa bone density study axial skeleton (77085) |
$560.41 |
$560.41 |
4.5× |
| Esophagus (74220) |
$808.22 |
$808.22 |
3.8× |
| Facial bones min 3 views (70150) |
$611 |
$611 |
4.9× |
| Fluoroscopy up to 1 hr (76000) |
$930 |
$930 |
3.3× |
| Foot 2 views (73620) |
$397.40 |
$397.40 |
3.8× |
| Forearm 2 views (73090) |
$462.90 |
$462.90 |
4.4× |
| Hand 2 views (73120) |
$641.55 |
$641.55 |
5.1× |
| Hepatobil Syst Imag Inc Gb W/Pharma Intervenj (78227) |
$1,981.18 |
$1,981.18 |
3.0× |
| Hepatobiliary syst imaging including gallbladder (78226) |
$1,486 |
$1,486 |
3.1× |
| Hysterosalpingogram (74740) |
$1,917.69 |
$1,917.69 |
6.7× |
| Kidney Img Morphology Vascular Flow 1 W/O Rx (78707) |
$1,821 |
$1,821 |
2.8× |
| Kidney img morphology vascular flow 1 w/rx (78708) |
$2,458.35 |
$2,458.35 |
3.8× |
| Knee 3 views (73562) |
$423.50 |
$423.50 |
4.1× |
| Lung perf&ventilat diferentl (78598) |
$1,821 |
$1,821 |
2.8× |
| Lung ventilation imaging (78579) |
$1,372 |
$1,372 |
2.9× |
| Magnetic resonance (eg, proton) imaging, upper extremity, other than joint; without contrast material(s), followed by… (73220) |
$3,231.31 |
$3,231.31 |
7.7× |
| Mammary ductogram or galactogram multiple (77054) |
$1,454.87 |
$1,454.87 |
5.1× |
| Mammary ductogram or galactogram single (77053) |
$1,383.66 |
$1,383.66 |
4.8× |
| MRA head w & w/o contrast (70546) |
$3,049 |
$3,049 |
7.3× |
| MRA head w/o contrast (70544) |
$1,995 |
$1,995 |
7.0× |
| Mra Neck W/O &W/Contrast Material (70549) |
$3,662 |
$3,662 |
8.8× |
| MRI abdomen w/o & w/contrast material (74183) |
$3,281 |
$3,281 |
7.8× |
| MRI abdomen w/o contrast (74181) |
$1,985 |
$1,985 |
6.9× |
| MRI any jt lower extrem w/o & w/contrast matrl (73723) |
$2,980 |
$2,980 |
7.1× |
| MRI c-spine with contrast (72142) |
$2,838 |
$2,838 |
6.8× |
| MRI cervical spine w/o contrast (72141) |
$1,961 |
$1,961 |
6.9× |
| MRI lower extrem oth/thn jt w/o & w/contr matr (73720) |
$4,255 |
$4,255 |
10.2× |
| MRI lower extrem oth/thn jt w/o contr matrl (73718) |
$1,851 |
$1,851 |
6.5× |
| MRI orbit/face/neck w&w/o cont (70543) |
$4,359 |
$4,359 |
10.4× |
| MRI pelvis w/o & w/contrast material (72197) |
$3,321.11 |
$3,321.11 |
7.9× |
| MRI pelvis w/o contrast (72195) |
$2,336.97 |
$2,336.97 |
8.2× |
| MRI spinal canal cervical w/o & w/contr matrl (72156) |
$3,325 |
$3,325 |
8.0× |
| MRI spinal canal lumbar w/contrast material (72149) |
$2,838 |
$2,838 |
6.8× |
| MRI spinal canal lumbar w/o & w/contr matrl (72158) |
$3,452 |
$3,452 |
8.3× |
| MRI spinal canal thoracic w/contrast matrl (72147) |
$2,838 |
$2,838 |
6.8× |
| MRI spinal canal thoracic w/o & w/contr matrl (72157) |
$3,325 |
$3,325 |
8.0× |
| MRI thoracic spine w/o contrast (72146) |
$1,961 |
$1,961 |
6.9× |
| MRI, joint upper extrem combo (73223) |
$2,931 |
$2,931 |
7.0× |
| Myocardial Spect Multiple Studies (78452) |
$5,050.53 |
$5,050.53 |
3.3× |
| Myocardial spect single study at rest or stress (78451) |
$4,570 |
$4,570 |
2.9× |
| Neck soft tissue (70360) |
$457.18 |
$457.18 |
4.4× |
| Nm cardiac blood pool multiple (78473) |
$1,372 |
$1,372 |
2.9× |
| Pelvis 1 or 2 views (72170) |
$611 |
$611 |
4.9× |
| Pulmonary Perfusion Imaging Particulate (78580) |
$1,372 |
$1,372 |
2.9× |
| Pulmonary Ventilation & Perfusion Imaging (78582) |
$1,821 |
$1,821 |
2.8× |
| Radex Ankle Compl Minimum 3 Views (73610) |
$515.62 |
$515.62 |
4.9× |
| Radex Calcaneus Minimum 2 Views (73650) |
$427.57 |
$427.57 |
4.1× |
| Radex Elbw Compl Minimum 3 Views (73080) |
$474.30 |
$474.30 |
4.5× |
| Radex Entir Thrc Lmbr Crv Sac Spi W/Skull 1 Vw - Xr Scoliosis 1 Vw (72081) |
$369 |
$369 |
3.5× |
| Radex entir thrc lmbr crv sac spi w/skull 2/3 vw (72082) |
$843.77 |
$843.77 |
6.7× |
| Radex fingr minimum 2 views (73140) |
$424.78 |
$424.78 |
4.1× |
| Radex Foot Compl Minimum 3 Views (73630) |
$493.45 |
$493.45 |
4.7× |
| Radex Hand Minimum 3 Views (73130) |
$702.65 |
$702.65 |
6.7× |
| Radex Hip Unilateral With Pelvis 1 View (73501) |
$369 |
$369 |
3.5× |
| Radex Hips Bilateral With Pelvis 2 Views (73521) |
$611 |
$611 |
4.9× |
| Radex Hips Bilateral With Pelvis Minimum 5 Views (73523) |
$756.60 |
$756.60 |
6.0× |
| Radex Humerus Minimum 2 Views (73060) |
$369 |
$369 |
3.5× |
| Radex Kne 1/2 Views (73560) |
$401 |
$401 |
3.8× |
| Radex Kne Compl 4/More Views (73564) |
$744 |
$744 |
5.9× |
| Radex Mndbl Compl Minimum 4 Views (70110) |
$611 |
$611 |
4.9× |
| Radex Nasal Bones Complete Minimum 3 Views (70160) |
$369 |
$369 |
3.5× |
| Radex Pelvis Compl Minimum 3 Views (72190) |
$642 |
$642 |
5.1× |
| Radex Sho Compl Minimum 2 Views (73030) |
$487.12 |
$487.12 |
4.7× |
| Radex Sinuses Paransl < 3 Views (70210) |
$369 |
$369 |
3.5× |
| Radex Spine Lumbosacral Only Bending 2/3 Views (72120) |
$642 |
$642 |
5.1× |
| Radex Toe Minimum 2 Views (73660) |
$369 |
$369 |
3.5× |
| Radex Wrst Compl Minimum 3 Views (73110) |
$502 |
$502 |
4.8× |
| Radiation treatment delivery level 2 (77407) |
$680.20 |
$680.20 |
1.5× |
| Radiologic Exam Abdomen 1 View - Xr Abdomen 1 View (74018) |
$265 |
$265 |
2.5× |
| Radiologic exam chest 2 views (71046) |
$339 |
$339 |
3.3× |
| Radiologic exam colon single contrast study (74270) |
$1,166.40 |
$1,166.40 |
5.5× |
| Radiologic Exam Esophagus Double Contrast Study (74221) |
$643 |
$643 |
3.1× |
| Radiologic exam upr gi trc double contrast study (74246) |
$677 |
$677 |
3.2× |
| Radiologic exam upr gi trc single contrast study (74240) |
$913.95 |
$913.95 |
4.3× |
| Radiologic examination tibia & fibula 2 views (73590) |
$427 |
$427 |
4.1× |
| Radiologic examination, teeth; single view Non-Facility (70300) |
$416 |
$416 |
4.0× |
| Radiologic examination; pharynx or larynx, including fluoroscopy and/or magnification technique Non-Facility (70370) |
$623.17 |
$623.17 |
6.0× |
| Radiological examination surgical specimen (76098) |
$2,196 |
$2,196 |
3.4× |
| Ribs bilateral 3 views (71110) |
$611 |
$611 |
4.9× |
| Rp loclzj tum spect 1 area single day imaging (78803) |
$4,570 |
$4,570 |
7.0× |
| Sacroiliac Joints < 3 Views (72200) |
$611 |
$611 |
4.9× |
| Scapula (73010) |
$506.58 |
$506.58 |
4.0× |
| Screening Digital Breast Tomosynthesis Bi (77063) |
$182.12 |
$182.12 |
7.8× |
| Shoulder 1 view (73020) |
$442 |
$442 |
4.2× |
| Small bowel series (74250) |
$623 |
$623 |
3.0× |
| Spine thoracic 3 views (72072) |
$673 |
$673 |
5.4× |
| Thoracolumbar 2 views (72080) |
$345 |
$345 |
3.3× |
| Treatment device complex (77334) |
$1,718 |
$1,718 |
3.8× |
| Ultrasound breast complete (76641) |
$1,162 |
$1,162 |
9.3× |
| Ultrasound Exam Aaa Screen (76706) |
$457 |
$457 |
3.6× |
| Ultrasound, abdomen limited (76705) |
$932 |
$932 |
7.4× |
| Unlisted Diagnostic Radiographic Procedure (76499) |
$120.28 |
$120.28 |
1.2× |
| Us breast unilateral limited (76642) |
$559 |
$559 |
5.4× |
| Us chest (76604) |
$752.39 |
$752.39 |
6.0× |
| Us lmtd joint/oth nonvasc xtr strux r-t w/img (76882) |
$559 |
$559 |
4.5× |
| Us ob limited (76815) |
$932 |
$932 |
7.4× |
| Us ob transvaginal (76817) |
$1,118.40 |
$1,118.40 |
8.9× |
| Us pelvic non ob complete (76856) |
$953.85 |
$953.85 |
7.6× |
| Us pelvic nonobstetric image dcmtn limited/f/u (76857) |
$590.69 |
$590.69 |
4.7× |
| Us pg uter img f&mat 14 wk tabdl 1/1st gestation (76801) |
$932 |
$932 |
7.4× |
| Us retroperitoneal complete (76770) |
$978 |
$978 |
7.8× |
| Us retroperitoneal limited (76775) |
$932 |
$932 |
7.4× |
| Us scrotum and contents (76870) |
$932 |
$932 |
7.4× |
| Us soft tissue head/neck (76536) |
$932 |
$932 |
7.4× |
| Us, eye b-scan (76512) |
$886.96 |
$886.96 |
7.1× |
| Vertebral fracture assessment via dxa (77086) |
$477.26 |
$477.26 |
4.6× |
| Wrist 2 views (73100) |
$448.34 |
$448.34 |
4.3× |
| X-Ray Abdomen,Comp Acute Series - Xr Abdomen 2 Vws With Chest 1 View (74022) |
$734.75 |
$734.75 |
5.9× |
| X-Ray Ac Jts - Xr Acromioclavicular Joints Bilateral (73050) |
$327.56 |
$327.56 |
3.1× |
| X-Ray Elbow 2 Vw - Xr Elbow 1-2 Views Right (73070) |
$442.80 |
$442.80 |
4.2× |
| X-Ray Exam Hip Uni 2-3 Views (73502) |
$434.57 |
$434.57 |
4.2× |
| X-Ray Exam Hips Bi 3-4 Views (73522) |
$642 |
$642 |
5.1× |
| X-ray exam of femur 2/> (73552) |
$426.50 |
$426.50 |
4.1× |
| X-ray eye for foreign body (70030) |
$424 |
$424 |
4.1× |
| X-Ray Facial Bones <3 Vw - Xr Facial Bones 1-2 Views (70140) |
$369 |
$369 |
3.5× |
| X-Ray Jaw <4 Vw - Xr Mandible < 4 Views (70100) |
$369 |
$369 |
3.5× |
| X-Ray Knee Bilat Standing - Xr Knees Anteroposterior Standing Bilat (73565) |
$369 |
$369 |
3.5× |
| X-ray leg, infant (73592) |
$437.81 |
$437.81 |
4.2× |
| X-Ray Lumbar Spine 2/3 Vw - Xr Lumbar Spine 2-3 Views (72100) |
$611 |
$611 |
4.9× |
| X-Ray Lumbar Spine 6+ Vw - Xr Lumbar Spine 6+ Vws Including Bending (72114) |
$673.65 |
$673.65 |
5.4× |
| X-ray nose-rectum child f.b. (76010) |
$1,186 |
$1,186 |
11.4× |
| X-Ray Orbits - Xr Orbits Complete 4+ Views (70200) |
$727.90 |
$727.90 |
5.8× |
| X-Ray Ribs 2 Vw Unilat - Xr Ribs 2 Views Right (71100) |
$478.77 |
$478.77 |
4.6× |
| X-Ray Ribs, Chest 3+ Vw - Xr Ribs 2 Vws Lt W/ Chest Anteroposterior (71101) |
$665.22 |
$665.22 |
5.3× |
| X-Ray Ribs, Chest 4+ Vw - Xr Ribs 3 Vws Bil W/ Chest Posteroanterior (71111) |
$841.05 |
$841.05 |
6.7× |
| X-Ray Sacroiliac Jts 3+ Vw - Xr Sacroiliac Joints 3+ Views (72202) |
$810.07 |
$810.07 |
6.5× |
| X-Ray Sacrum/Coccyx 2+ Vw - Xr Sacrum Coccyx 2+ Views (72220) |
$472.19 |
$472.19 |
4.5× |
| X-Ray Sinuses 3+ Vw - Xr Paranasal Sinuses 3+ Views (70220) |
$460.34 |
$460.34 |
4.4× |
| X-Ray Skull 4+ Vw - Xr Skull Complete 4+ Views (70260) |
$611 |
$611 |
4.9× |
| X-Ray Skull <4 Vw - Xr Skull 1-3 Views (70250) |
$549.90 |
$549.90 |
4.4× |
| X-Ray Spine One View - Xr Spine (72020) |
$369 |
$369 |
3.5× |
| X-Ray Sterno-Clavicluar Jt - Xr Sternoclavicular Joints 3+ Views (71130) |
$455.40 |
$455.40 |
4.4× |
| X-Ray Sternum 2+ Vw - Xr Sternum 2+ Views (71120) |
$414 |
$414 |
4.0× |
| X-Ray Thoracic Spine 2 Vw - Xr Thoracic Spine 2 Views (72070) |
$659 |
$659 |
5.3× |
| X-Ray Thoracic Spine 4 Vw - Xr Thoracic Spine Complete 4+ Views (72074) |
$685 |
$685 |
5.5× |
| Xr c-spine 4 or 5 views (72050) |
$643.10 |
$643.10 |
5.1× |
| Xr chest 4+ views (71048) |
$512 |
$512 |
4.1× |