| 3-D radiotherapy plan dose-volume histograms (77295) |
$3,516 |
$4,395 |
2.3× |
| Abdomen 2 views (74019) |
$145.60 |
$182 |
1.2× |
| Ankle 2 views (73600) |
$220 |
$275 |
2.3× |
| Bone &/Joint Imaging Multiple Areas (78305) |
$1,184.80 |
$1,481 |
2.7× |
| Bone age studies (77072) |
$165.60 |
$207 |
1.4× |
| Bone survey complete (77075) |
$447.20 |
$559 |
3.8× |
| Cervical spine 2 or 3 views (72040) |
$237.60 |
$297 |
2.4× |
| Chest 1 view (71045) |
$151.20 |
$189 |
1.6× |
| Chest xray 3 views (71047) |
$213.60 |
$267 |
2.2× |
| Cholecystography, oral contrast Non-Facility (74290) |
$336.80 |
$421 |
1.7× |
| Clavicle complete (73000) |
$202.40 |
$253 |
2.1× |
| Computed Tomography Thorax Lw Dose Lng Ca Scr C- (71271) |
$2,097.60 |
$2,622 |
18.0× |
| CT abdomen and pelvis without and with contrast (74178) |
$2,002.80 |
$2,503.50 |
5.2× |
| CT abdomen and pelvis without contrast (74176) |
$1,566 |
$1,957.50 |
5.9× |
| CT abdomen w contrast (74160) |
$1,509.20 |
$1,886.50 |
7.7× |
| CT abdomen w wo contrast (74170) |
$1,917.60 |
$2,397 |
9.8× |
| CT abdomen w/o contrast (74150) |
$1,284.80 |
$1,606 |
11.0× |
| CT angio lwr extr w/o&w/dye (73706) |
$2,928.80 |
$3,661 |
15.0× |
| CT angiography upper extremity lt (73206) |
$2,809.60 |
$3,512 |
14.4× |
| CT c-spine w/contrast (72126) |
$927.20 |
$1,159 |
2.4× |
| CT c-spine w/o contrast (72125) |
$1,242.40 |
$1,553 |
10.7× |
| CT cervical spine w&w/o contrast (72127) |
$1,304.80 |
$1,631 |
6.7× |
| CT chest w contrast (71260) |
$1,408.80 |
$1,761 |
7.2× |
| CT chest w/wo contrast (71270) |
$1,712 |
$2,140 |
8.8× |
| CT head/brain with contrast (70460) |
$1,183.60 |
$1,479.50 |
6.1× |
| CT head/brain without and with contrast (70470) |
$1,707.20 |
$2,134 |
8.7× |
| CT iac w contrast (70481) |
$1,090.80 |
$1,363.50 |
5.6× |
| CT lower ext w/o (73700) |
$1,564 |
$1,955 |
13.4× |
| CT lower extremity w wo contrast (73702) |
$1,862.80 |
$2,328.50 |
9.5× |
| CT lower extremity w/contrast material (73701) |
$1,827.20 |
$2,284 |
9.3× |
| CT lumbar spine w & w/o contrast (72133) |
$1,187.60 |
$1,484.50 |
6.1× |
| CT lumbar spine w/contrast (72132) |
$865.20 |
$1,081.50 |
2.2× |
| CT lumbar spine w/o contrast (72131) |
$744.40 |
$930.50 |
6.4× |
| CT maxillofacial w contrast (70487) |
$1,090.80 |
$1,363.50 |
5.6× |
| CT maxillofacial w/wo contrast (70488) |
$1,163.60 |
$1,454.50 |
6.0× |
| CT maxillofacial wo contrast (70486) |
$925.60 |
$1,157 |
7.9× |
| CT orbit sella/post fossa/ear w/o & w/contr matr (70482) |
$1,183.20 |
$1,479 |
6.1× |
| CT orbits w/o contrast (70480) |
$954.80 |
$1,193.50 |
8.2× |
| CT pelvis w/o contrast (72192) |
$1,154 |
$1,442.50 |
9.9× |
| CT pelvis w/wo contrast (72194) |
$1,643.60 |
$2,054.50 |
8.4× |
| CT scan of arm combo (73202) |
$1,827.20 |
$2,284 |
9.3× |
| CT soft tissue neck w contrast (70491) |
$1,242.80 |
$1,553.50 |
6.4× |
| CT soft tissue neck w/o & w/contrast material (70492) |
$1,503.60 |
$1,879.50 |
7.7× |
| CT soft tissue neck w/o contrast (70490) |
$961.60 |
$1,202 |
8.3× |
| CT thoracic spine w/contrast (72129) |
$900.80 |
$1,126 |
4.6× |
| CT thoracic spine w/o contrast (72128) |
$781.60 |
$977 |
6.7× |
| CT thoracic spine w/wo contrast (72130) |
$1,284.40 |
$1,605.50 |
6.6× |
| CT thorax w/o contrast (71250) |
$1,228.80 |
$1,536 |
10.5× |
| CT upper ext wo (73200) |
$878.40 |
$1,098 |
7.5× |
| CT upper extremity with contrast (73201) |
$848.40 |
$1,060.50 |
2.2× |
| Cta Aa&Bi Iliofem Lxtr Rs&I C-/C+ Post-Pxessing (75635) |
$1,485.20 |
$1,856.50 |
7.6× |
| Cta Abdomen (74175) |
$1,793.60 |
$2,242 |
9.2× |
| CTA abdomen pelvis (74174) |
$2,644.40 |
$3,305.50 |
6.8× |
| CTA chest (71275) |
$1,998.80 |
$2,498.50 |
10.2× |
| Cta Head (70496) |
$1,806.40 |
$2,258 |
9.2× |
| CTA head&neck c+ w/noncontrast img&post-pxessing (70471) |
$1,830 |
$2,287.50 |
4.7× |
| Cta Neck (70498) |
$1,806 |
$2,257.50 |
9.2× |
| Cta Pelvis (72191) |
$1,722 |
$2,152.50 |
8.8× |
| Dxa bone density study 1/> sites axial skel (77080) |
$318.40 |
$398 |
2.7× |
| Esophagus (74220) |
$702.40 |
$878 |
3.6× |
| Facial bones min 3 views (70150) |
$370.80 |
$463.50 |
3.2× |
| Fetal Biophysical Profile W/O Non-Stress Testing (76819) |
$254 |
$317.50 |
2.2× |
| Fluoroscopy up to 1 hr (76000) |
$713.60 |
$892 |
2.7× |
| Foot 2 views (73620) |
$184.80 |
$231 |
1.9× |
| Forearm 2 views (73090) |
$210.40 |
$263 |
2.2× |
| Functional MRI brain by phys/psych (70555) |
$862.80 |
$1,078.50 |
3.2× |
| Functional MRI brain by tech (70554) |
$862.40 |
$1,078 |
3.2× |
| Hand 2 views (73120) |
$212.80 |
$266 |
1.8× |
| Knee 3 views (73562) |
$56.80 |
$71 |
0.6× |
| Magnetic resonance (eg, proton) imaging, any joint of upper extremity; with contrast material(s) Non-Facility (73222) |
$1,416.80 |
$1,771 |
1.6× |
| Magnetic resonance (eg, proton) imaging, upper extremity, other than joint; with contrast material(s) Non-Facility (73219) |
$1,050 |
$1,312.50 |
2.7× |
| Magnetic resonance (eg, proton) imaging, upper extremity, other than joint; without contrast material(s), followed by… (73220) |
$1,442.40 |
$1,803 |
3.7× |
| MRA head w & w/o contrast (70546) |
$1,534 |
$1,917.50 |
3.9× |
| MRA head w/o contrast (70544) |
$1,092.40 |
$1,365.50 |
4.1× |
| MRA head with contrast (70545) |
$1,416 |
$1,770 |
3.6× |
| MRA neck w contrast (70548) |
$1,200.40 |
$1,500.50 |
3.1× |
| Mra Neck W/O &W/Contrast Material (70549) |
$1,366.40 |
$1,708 |
3.5× |
| MRA neck w/o contrast (70547) |
$1,005.60 |
$1,257 |
3.8× |
| MRI abdomen w contrast (74182) |
$1,728.40 |
$2,160.50 |
4.4× |
| MRI abdomen w/o & w/contrast material (74183) |
$1,980.40 |
$2,475.50 |
5.1× |
| MRI abdomen w/o contrast (74181) |
$1,560.40 |
$1,950.50 |
5.9× |
| MRI any jt lower extrem w/contrast material (73722) |
$1,216.80 |
$1,521 |
1.4× |
| MRI any jt lower extrem w/o & w/contrast matrl (73723) |
$1,764 |
$2,205 |
4.5× |
| MRI breast w/o contrast bilateral (77047) |
$988.40 |
$1,235.50 |
3.7× |
| MRI breast wo contrast unilateral (77046) |
$862.40 |
$1,078 |
3.2× |
| MRI c-spine with contrast (72142) |
$1,369.20 |
$1,711.50 |
3.5× |
| MRI cervical spine w/o contrast (72141) |
$1,201.20 |
$1,501.50 |
4.5× |
| MRI chest w/o & w/contrast material (71552) |
$1,260.40 |
$1,575.50 |
3.2× |
| MRI chest w/o contrast (71550) |
$863.20 |
$1,079 |
3.2× |
| MRI chest with contrast (71551) |
$1,061.60 |
$1,327 |
1.2× |
| MRI fetal sngl/1st gestation (74712) |
$862.40 |
$1,078 |
3.2× |
| MRI lower extrem oth/thn jt w/contrast matrl (73719) |
$1,226 |
$1,532.50 |
3.2× |
| MRI lower extrem oth/thn jt w/o & w/contr matr (73720) |
$1,521.20 |
$1,901.50 |
3.9× |
| MRI lower extrem oth/thn jt w/o contr matrl (73718) |
$1,106.80 |
$1,383.50 |
4.2× |
| MRI orbit face &/neck w/o contrast (70540) |
$1,092 |
$1,365 |
4.1× |
| MRI orbit face neck w contrast (70542) |
$1,510 |
$1,887.50 |
3.9× |
| MRI orbit/face/neck w&w/o cont (70543) |
$1,617.60 |
$2,022 |
4.2× |
| MRI pelvis w/contrast (72196) |
$1,437.20 |
$1,796.50 |
3.7× |
| MRI pelvis w/o & w/contrast material (72197) |
$1,594.40 |
$1,993 |
4.1× |
| MRI pelvis w/o contrast (72195) |
$1,120.40 |
$1,400.50 |
4.2× |
| MRI spinal canal cervical w/o & w/contr matrl (72156) |
$1,754 |
$2,192.50 |
4.5× |
| MRI spinal canal lumbar w/contrast material (72149) |
$1,445.20 |
$1,806.50 |
3.7× |
| MRI spinal canal lumbar w/o & w/contr matrl (72158) |
$1,641.60 |
$2,052 |
4.2× |
| MRI spinal canal thoracic w/contrast matrl (72147) |
$1,376 |
$1,720 |
3.5× |
| MRI spinal canal thoracic w/o & w/contr matrl (72157) |
$1,507.60 |
$1,884.50 |
3.9× |
| MRI temporomandibular joint (70336) |
$1,036.80 |
$1,296 |
3.9× |
| MRI thoracic spine w/o contrast (72146) |
$1,166 |
$1,457.50 |
4.4× |
| MRI up ext w/o contrast (73218) |
$924 |
$1,155 |
3.5× |
| MRI upper ext joint w/o contrast (73221) |
$1,149.20 |
$1,436.50 |
4.3× |
| MRI, joint upper extrem combo (73223) |
$1,526.80 |
$1,908.50 |
3.9× |
| Neck soft tissue (70360) |
$146.40 |
$183 |
1.5× |
| Nm gastric emptying study (78264) |
$2,299.20 |
$2,874 |
5.2× |
| Pelvis 1 or 2 views (72170) |
$224 |
$280 |
1.9× |
| Radex Ankle Compl Minimum 3 Views (73610) |
$53.60 |
$67 |
0.6× |
| Radex Calcaneus Minimum 2 Views (73650) |
$187.60 |
$234.50 |
1.9× |
| Radex Elbw Compl Minimum 3 Views (73080) |
$230 |
$287.50 |
2.4× |
| Radex Entir Thrc Lmbr Crv Sac Spi W/Skull 1 Vw - Xr Scoliosis 1 Vw (72081) |
$100.80 |
$126 |
1.0× |
| Radex fingr minimum 2 views (73140) |
$164 |
$205 |
1.7× |
| Radex Foot Compl Minimum 3 Views (73630) |
$52.80 |
$66 |
0.5× |
| Radex Hand Minimum 3 Views (73130) |
$210.40 |
$263 |
2.2× |
| Radex Hip Unilateral With Pelvis 1 View (73501) |
$53.60 |
$67 |
0.6× |
| Radex Hip Unilateral With Pelvis Minimum 4 Views (73503) |
$64.80 |
$81 |
0.6× |
| Radex Hips Bilateral With Pelvis 2 Views (73521) |
$276.40 |
$345.50 |
2.4× |
| Radex Hips Bilateral With Pelvis Minimum 5 Views (73523) |
$300.80 |
$376 |
2.6× |
| Radex Humerus Minimum 2 Views (73060) |
$222 |
$277.50 |
2.3× |
| Radex Kne 1/2 Views (73560) |
$53.60 |
$67 |
0.6× |
| Radex Kne Compl 4/More Views (73564) |
$71.20 |
$89 |
0.6× |
| Radex Mndbl Compl Minimum 4 Views (70110) |
$193.20 |
$241.50 |
1.7× |
| Radex Nasal Bones Complete Minimum 3 Views (70160) |
$276.80 |
$346 |
2.9× |
| Radex Pelvis Compl Minimum 3 Views (72190) |
$192 |
$240 |
1.6× |
| Radex Sho Compl Minimum 2 Views (73030) |
$254 |
$317.50 |
2.6× |
| Radex Sinuses Paransl < 3 Views (70210) |
$254.80 |
$318.50 |
2.6× |
| Radex Spine Lumbosacral Only Bending 2/3 Views (72120) |
$280 |
$350 |
2.4× |
| Radex Temporomandble Jt Opn & Clsd Mouth Bilat (70330) |
$194.40 |
$243 |
2.0× |
| Radex Toe Minimum 2 Views (73660) |
$178.40 |
$223 |
1.8× |
| Radex upper extremity infant minimum 2 views (73092) |
$101.60 |
$127 |
0.9× |
| Radex Wrst Compl Minimum 3 Views (73110) |
$213.60 |
$267 |
2.2× |
| Radiologic Exam Abdomen 1 View - Xr Abdomen 1 View (74018) |
$106.40 |
$133 |
1.1× |
| Radiologic Exam Abdomen 3+ Views - Xr Abdomen 3+ Views (74021) |
$159.60 |
$199.50 |
1.4× |
| Radiologic exam chest 2 views (71046) |
$164.80 |
$206 |
1.7× |
| Radiologic exam colon single contrast study (74270) |
$1,138.40 |
$1,423 |
5.8× |
| Radiologic exam upr gi trc double contrast study (74246) |
$1,192.80 |
$1,491 |
6.1× |
| Radiologic exam upr gi trc single contrast study (74240) |
$673.60 |
$842 |
3.4× |
| Radiologic examination femur 1 view (73551) |
$228.40 |
$285.50 |
2.4× |
| Radiologic examination tibia & fibula 2 views (73590) |
$50.40 |
$63 |
0.5× |
| Radiologic examination, mastoids; complete, minimum of 3 views per side Non-Facility (70130) |
$18.40 |
$23 |
0.2× |
| Radiologic examination, mastoids; less than 3 views per side Non-Facility (70120) |
$25.60 |
$32 |
0.2× |
| Radiologic examination, teeth; partial examination, less than full mouth Non-Facility (70310) |
$73.60 |
$92 |
0.3× |
| Ribs bilateral 3 views (71110) |
$373.60 |
$467 |
3.2× |
| Sacroiliac Joints < 3 Views (72200) |
$148.40 |
$185.50 |
1.3× |
| Scapula (73010) |
$230 |
$287.50 |
2.0× |
| Screening Digital Breast Tomosynthesis Bi (77063) |
$62.80 |
$78.50 |
2.7× |
| Sella turcica (70240) |
$96.40 |
$120.50 |
1.0× |
| Shoulder 1 view (73020) |
$156.40 |
$195.50 |
1.6× |
| Small bowel series (74250) |
$575.20 |
$719 |
2.9× |
| Spine thoracic 3 views (72072) |
$312.40 |
$390.50 |
2.7× |
| Ther rad simulaj-aided field setting simple (77280) |
$1,232 |
$1,540 |
8.2× |
| Thoracolumbar 2 views (72080) |
$327.60 |
$409.50 |
3.4× |
| Tmj unilateral (70328) |
$138 |
$172.50 |
1.4× |
| Tomogram (76100) |
$283.20 |
$354 |
2.4× |
| Ultrasound Exam Aaa Screen (76706) |
$304 |
$380 |
2.6× |
| Ultrasound, abdomen limited (76705) |
$303.20 |
$379 |
2.6× |
| Urography, infusion, drip technique and/or bolus technique; with nephrotomography Non-Facility (74415) |
$918.40 |
$1,148 |
4.7× |
| Us chest (76604) |
$304 |
$380 |
2.6× |
| Us compl joint r-t w/image documentation (76881) |
$268.40 |
$335.50 |
2.3× |
| Us lmtd joint/oth nonvasc xtr strux r-t w/img (76882) |
$422 |
$527.50 |
3.6× |
| Us ob detailed single fetus (76811) |
$584 |
$730 |
2.2× |
| Us ob limited (76815) |
$240 |
$300 |
2.1× |
| Us ob transvaginal (76817) |
$252.80 |
$316 |
2.2× |
| Us pelvic non ob complete (76856) |
$303.20 |
$379 |
2.6× |
| Us pelvic nonobstetric image dcmtn limited/f/u (76857) |
$218 |
$272.50 |
1.9× |
| Us pg uter img f&mat 14 wk tabdl 1/1st gestation (76801) |
$284 |
$355 |
2.4× |
| Us pg uter r-t img f-up tabdl appr pr fetus (76816) |
$265.20 |
$331.50 |
2.3× |
| Us retroperitoneal complete (76770) |
$250.40 |
$313 |
2.1× |
| Us retroperitoneal limited (76775) |
$229.20 |
$286.50 |
2.0× |
| Us scrotum and contents (76870) |
$456.80 |
$571 |
3.9× |
| Us soft tissue head/neck (76536) |
$228.80 |
$286 |
2.0× |
| Us, eye b-scan (76512) |
$237.20 |
$296.50 |
2.0× |
| Wrist 2 views (73100) |
$201.20 |
$251.50 |
2.1× |
| X-Ray Abdomen,Comp Acute Series - Xr Abdomen 2 Vws With Chest 1 View (74022) |
$362.80 |
$453.50 |
3.1× |
| X-Ray Ac Jts - Xr Acromioclavicular Joints Bilateral (73050) |
$155.60 |
$194.50 |
1.6× |
| X-Ray Colon Air Contrast - Fl Barium Enema Air Contrast (74280) |
$1,550.40 |
$1,938 |
7.9× |
| X-Ray Elbow 2 Vw - Xr Elbow 1-2 Views Right (73070) |
$233.20 |
$291.50 |
2.4× |
| X-Ray Exam Hip Uni 2-3 Views (73502) |
$64.80 |
$81 |
0.7× |
| X-Ray Exam Hips Bi 3-4 Views (73522) |
$300.80 |
$376 |
2.6× |
| X-ray exam of femur 2/> (73552) |
$244.80 |
$306 |
2.5× |
| X-ray eye for foreign body (70030) |
$184 |
$230 |
1.9× |
| X-Ray Facial Bones <3 Vw - Xr Facial Bones 1-2 Views (70140) |
$140.40 |
$175.50 |
1.4× |
| X-ray IV pyelogram (ivp) (74400) |
$761.60 |
$952 |
3.9× |
| X-Ray Jaw <4 Vw - Xr Mandible < 4 Views (70100) |
$115.20 |
$144 |
1.2× |
| X-ray leg, infant (73592) |
$105.60 |
$132 |
1.1× |
| X-Ray Lumbar Spine 2/3 Vw - Xr Lumbar Spine 2-3 Views (72100) |
$284.40 |
$355.50 |
2.4× |
| X-Ray Lumbar Spine 6+ Vw - Xr Lumbar Spine 6+ Vws Including Bending (72114) |
$105.60 |
$132 |
0.9× |
| X-Ray Orbits - Xr Orbits Complete 4+ Views (70200) |
$76.40 |
$95.50 |
0.7× |
| X-Ray Ribs 2 Vw Unilat - Xr Ribs 2 Views Right (71100) |
$70.40 |
$88 |
0.7× |
| X-Ray Ribs, Chest 3+ Vw - Xr Ribs 2 Vws Lt W/ Chest Anteroposterior (71101) |
$85.60 |
$107 |
0.7× |
| X-Ray Ribs, Chest 4+ Vw - Xr Ribs 3 Vws Bil W/ Chest Posteroanterior (71111) |
$520.40 |
$650.50 |
4.5× |
| X-Ray Sacroiliac Jts 3+ Vw - Xr Sacroiliac Joints 3+ Views (72202) |
$272 |
$340 |
2.3× |
| X-Ray Sacrum/Coccyx 2+ Vw - Xr Sacrum Coccyx 2+ Views (72220) |
$277.60 |
$347 |
2.9× |
| X-Ray Sinuses 3+ Vw - Xr Paranasal Sinuses 3+ Views (70220) |
$246 |
$307.50 |
2.5× |
| X-Ray Skull 4+ Vw - Xr Skull Complete 4+ Views (70260) |
$205.20 |
$256.50 |
1.8× |
| X-Ray Skull <4 Vw - Xr Skull 1-3 Views (70250) |
$140.40 |
$175.50 |
1.2× |
| X-Ray Spine One View - Xr Spine (72020) |
$258.40 |
$323 |
2.7× |
| X-Ray Sterno-Clavicluar Jt - Xr Sternoclavicular Joints 3+ Views (71130) |
$160 |
$200 |
1.6× |
| X-Ray Sternum 2+ Vw - Xr Sternum 2+ Views (71120) |
$167.60 |
$209.50 |
1.7× |
| X-Ray Thoracic Spine 2 Vw - Xr Thoracic Spine 2 Views (72070) |
$310.80 |
$388.50 |
2.7× |
| Xr c-spine 4 or 5 views (72050) |
$430.40 |
$538 |
3.7× |
| Xr c-spine 6 or more views (72052) |
$464 |
$580 |
4.0× |
| Xr chest 4+ views (71048) |
$243.20 |
$304 |
2.1× |