| 3-D radiotherapy plan dose-volume histograms (77295) |
$3,048.75 |
$4,065 |
2.1× |
| Abdomen 2 views (74019) |
$150 |
$283 |
1.4× |
| Ankle 2 views (73600) |
$125 |
$283 |
1.4× |
| Arthrogram elbow (73085) |
$656.62 |
$875.50 |
1.8× |
| Arthrogram hip (73525) |
$125 |
$847.50 |
0.3× |
| Arthrogram shoulder (73040) |
$125 |
$585 |
0.3× |
| Arthrogram wrist (73115) |
$656.62 |
$875.50 |
1.8× |
| Arthrography knee lt (73580) |
$438.75 |
$585 |
1.2× |
| Bone survey complete (77075) |
$160 |
$454 |
1.5× |
| Cervical spine 2 or 3 views (72040) |
$125 |
$283 |
1.4× |
| Chest 1 view (71045) |
$313.12 |
$417.50 |
3.5× |
| Clavicle complete (73000) |
$125 |
$585 |
1.4× |
| CT abdomen and pelvis without and with contrast (74178) |
$550 |
$1,459 |
1.5× |
| CT abdomen and pelvis without contrast (74176) |
$500 |
$584.50 |
2.0× |
| CT abdomen w contrast (74160) |
$350 |
$1,272 |
1.9× |
| CT abdomen w wo contrast (74170) |
$350 |
$1,598 |
1.9× |
| CT abdomen w/o contrast (74150) |
$350 |
$1,053 |
3.2× |
| CT c-spine w/o contrast (72125) |
$350 |
$1,071.50 |
3.2× |
| CT cervical spine w&w/o contrast (72127) |
$350 |
$1,636 |
1.9× |
| CT cervical spine with contrast (72126) |
$550 |
$1,279.50 |
1.5× |
| CT chest w/wo contrast (71270) |
$350 |
$1,636 |
1.9× |
| CT chest with contrast (71260) |
$350 |
$1,555 |
1.9× |
| CT head/brain with contrast (70460) |
$350 |
$1,027.50 |
1.9× |
| CT head/brain without and with contrast (70470) |
$350 |
$1,279.50 |
1.9× |
| CT iac w contrast (70481) |
$350 |
$927 |
1.9× |
| CT limited/localized follow up study (76380) |
$125 |
$651 |
1.4× |
| CT lower ext w/o (73700) |
$350 |
$1,654 |
3.2× |
| CT lower extremity w wo contrast (73702) |
$500 |
$1,344 |
2.7× |
| CT lower extremity with contrast (73701) |
$350 |
$1,389 |
1.9× |
| CT lumbar spine w & w/o contrast (72133) |
$350 |
$1,636 |
1.9× |
| CT lumbar spine w/o contrast (72131) |
$350 |
$1,071.50 |
3.2× |
| CT lumbar spine with contrast (72132) |
$550 |
$1,311 |
1.5× |
| CT maxillofacial w contrast (70487) |
$350 |
$1,246.50 |
1.9× |
| CT maxillofacial w/o contrast (70486) |
$350 |
$857 |
3.2× |
| CT maxillofacial w/wo contrast (70488) |
$1,485 |
$1,980 |
8.2× |
| CT neck soft tissue w contrast (70491) |
$350 |
$1,027.50 |
1.9× |
| CT orbit sella/post fossa/ear w/o & w/contr matr (70482) |
$350 |
$1,428.50 |
1.9× |
| CT orbits w/o contrast (70480) |
$350 |
$917 |
3.2× |
| CT pelvis w & w/o contrast (72194) |
$350 |
$1,534.50 |
1.9× |
| CT pelvis w/o contrast (72192) |
$350 |
$1,071.50 |
3.2× |
| CT soft tissue neck w/o & w/contrast material (70492) |
$350 |
$1,311 |
1.9× |
| CT soft tissue neck w/o contrast (70490) |
$350 |
$872.50 |
3.2× |
| CT thoracic spine w/contrast (72129) |
$350 |
$1,311 |
1.9× |
| CT thoracic spine w/o contrast (72128) |
$350 |
$1,071.50 |
3.2× |
| CT thoracic spine w/wo contrast (72130) |
$350 |
$1,636 |
1.9× |
| CT thorax w/o contrast (71250) |
$350 |
$1,071.50 |
3.2× |
| CT upper extremity w/o & w/contrast material (73202) |
$350 |
$1,377 |
1.9× |
| CT upper extremity w/o contrast rt (73200) |
$350 |
$922 |
3.2× |
| CT upper extremity with contrast (73201) |
$1,032.75 |
$1,377 |
2.9× |
| CTA chest (71275) |
$400 |
$1,593 |
2.2× |
| Cta Head (70496) |
$350 |
$1,921 |
1.9× |
| CTA head&neck c+ w/noncontrast img&post-pxessing (70471) |
$1,476 |
$1,968 |
4.1× |
| Cta Neck (70498) |
$400 |
$1,921 |
2.2× |
| Diskography lumbar (72295) |
$1,282.50 |
$1,710 |
0.6× |
| Fluoroscopy up to 1 hr (76000) |
$500 |
$912 |
2.0× |
| Foot 2 views (73620) |
$125 |
$180.50 |
1.4× |
| Forearm 2 views (73090) |
$125 |
$185 |
1.4× |
| Hand 2 views (73120) |
$150 |
$290 |
1.4× |
| Hand 3 views (73130) |
$125 |
$185 |
1.4× |
| Humerus Min 2 Views Left (73060) |
$125 |
$185 |
1.4× |
| Knee 3 views (73562) |
$125 |
$283 |
1.4× |
| Mr safety implant&/fb assmt clin staf 1st 15 min (76014) |
$99 |
$132 |
3.3× |
| MRA head w & w/o contrast (70546) |
$600 |
$2,511.50 |
1.7× |
| MRA head w/o contrast (70544) |
$500 |
$1,932.50 |
2.0× |
| MRA neck w contrast (70548) |
$550 |
$1,980 |
1.5× |
| Mra Neck W/O &W/Contrast Material (70549) |
$600 |
$2,986 |
1.7× |
| MRA neck w/o contrast (70547) |
$500 |
$1,932.50 |
2.0× |
| MRI any jnt lwr ext with con lt (73722) |
$550 |
$2,012 |
0.7× |
| MRI any jt upper extremity w/contrast matrl (73222) |
$550 |
$2,559.50 |
0.7× |
| MRI c-spine with contrast (72142) |
$550 |
$2,511.50 |
1.5× |
| MRI cervical spine w/o contrast (72141) |
$500 |
$1,835 |
2.0× |
| MRI chest w/o & w/contrast material (71552) |
$600 |
$3,666.50 |
1.7× |
| MRI chest w/o contrast (71550) |
$500 |
$1,932.50 |
2.0× |
| MRI Forearm w/ Contrast Bilateral 73219 (73219) |
$550 |
$2,622 |
1.5× |
| MRI lower extrem oth/thn jt w/contrast matrl (73719) |
$1,485 |
$1,980 |
4.1× |
| MRI lower extrem oth/thn jt w/o contr matrl (73718) |
$550 |
$1,932.50 |
2.2× |
| MRI orbit face &/neck w/o contrast (70540) |
$500 |
$1,901.50 |
2.0× |
| MRI orbit/face/neck w&w/o cont (70543) |
$600 |
$3,756 |
1.7× |
| MRI orbit/face/neck w/contrast (70542) |
$550 |
$3,756 |
1.5× |
| MRI pelvis w contrast (72196) |
$550 |
$1,980 |
1.5× |
| MRI pelvis w/o & w/contrast material (72197) |
$600 |
$3,666.50 |
1.7× |
| MRI pelvis w/o contrast (72195) |
$500 |
$1,932.50 |
2.0× |
| MRI scan of arm joint before and after contrast (73223) |
$600 |
$2,340.50 |
1.7× |
| MRI scan of leg joint before and after contrast (73723) |
$600 |
$1,979 |
1.7× |
| MRI spectroscopy (76390) |
$500 |
$1,568 |
5.5× |
| MRI spinal canal cervical w/o & w/contr matrl (72156) |
$600 |
$3,666.50 |
1.7× |
| MRI spinal canal lumbar w/contrast material (72149) |
$550 |
$2,511.50 |
1.5× |
| MRI spinal canal lumbar w/o & w/contr matrl (72158) |
$600 |
$3,666.50 |
1.7× |
| MRI spinal canal thoracic w/contrast matrl (72147) |
$550 |
$2,573 |
1.5× |
| MRI spinal canal thoracic w/o & w/contr matrl (72157) |
$600 |
$3,666.50 |
1.7× |
| MRI thoracic spine w/o contrast (72146) |
$500 |
$2,125 |
2.0× |
| MRI upper ext joint w/o contrast (73221) |
$500 |
$1,932.50 |
2.0× |
| MRI upper extrem other than jt w/o & w/contras (73220) |
$600 |
$2,340.50 |
1.7× |
| MRI upper extremity oth than jt w/o contr matrl (73218) |
$500 |
$2,125 |
2.0× |
| Neck soft tissue (70360) |
$217.50 |
$290 |
2.4× |
| Pelvis 1 or 2 views (72170) |
$150 |
$428 |
1.4× |
| Pr MRI, lower extr, w/o contrast f/u by contrast (73720) |
$600 |
$3,666.50 |
1.7× |
| Radex hips bilateral with pelvis 2 views (73521) |
$150 |
$1,138 |
1.4× |
| Radex X-Ray Exam Entire Spi 6/> Vw - Xr Entire Spine 6+ Vw (72084) |
$217.50 |
$290 |
2.0× |
| Radiologic Exam Abdomen 1 View - Xr Abdomen 1 View (74018) |
$125 |
$218.50 |
1.4× |
| Radiologic Exam Abdomen 3+ Views - Xr Abdomen 3+ Views (74021) |
$217.50 |
$290 |
2.0× |
| Radiologic Exam Chest 2 Views - Xr Chest 2 Views (71046) |
$313.12 |
$417.50 |
3.5× |
| Radiologic Examination Femur Minimum 2 Views - Xr Femur 2+ Vw Lt (73552) |
$125 |
$428 |
1.4× |
| Sacroiliac Joints < 3 Views (72200) |
$150 |
$180.50 |
1.4× |
| Scanogram (77073) |
$691.50 |
$922 |
6.4× |
| Spine thoracic 3 views (72072) |
$217.50 |
$290 |
2.0× |
| Unlisted Diagnostic Radiographic Procedure (76499) |
$125 |
$185 |
1.4× |
| Unlisted magnetic resonance procedure (76498) |
$1,929.75 |
$2,573 |
21.4× |
| Wrist 2 views (73100) |
$125 |
$185 |
1.4× |
| X-Ray Abdomen,Comp Acute Series - Xr Abdomen 2 Vws With Chest 1 View (74022) |
$150 |
$218.50 |
1.4× |
| X-Ray Ac Jts - Xr Acromioclavicular Joints Bilateral (73050) |
$125 |
$290 |
1.4× |
| X-Ray Ankle 3+ Vw - Xr Ankle 3+ Views Right (73610) |
$125 |
$577 |
1.4× |
| X-Ray Elbow 2 Vw - Xr Elbow 1-2 Views Right (73070) |
$125 |
$180.50 |
1.4× |
| X-Ray Elbow 3+ Vw - Xr Elbow 3+ Views Right (73080) |
$125 |
$185 |
1.4× |
| X-ray exam entire spi 4/5 vw (72083) |
$217.50 |
$290 |
2.0× |
| X-ray exam hip uni 1 view (73501) |
$125 |
$571 |
1.4× |
| X-Ray Exam Hip Uni 2-3 Views (73502) |
$428.25 |
$571 |
4.7× |
| X-Ray Exam Hips Bi 3-4 Views (73522) |
$874.50 |
$1,166 |
8.1× |
| X-Ray Exam Hips Bi 5/> Views (73523) |
$757.50 |
$1,010 |
7.0× |
| X-ray eye for foreign body (70030) |
$125 |
$185 |
1.4× |
| X-Ray Foot 3+ Vw - Xr Foot 3+ Views Right (73630) |
$125 |
$209 |
1.4× |
| X-Ray Knee 4+ View - Xr Knee 4+ Views Right (73564) |
$138.75 |
$185 |
1.3× |
| X-Ray Knee Bilat Standing - Xr Knees Anteroposterior Standing Bilat (73565) |
$125 |
$185 |
1.4× |
| X-Ray Lumbar Spine 2/3 Vw - Xr Lumbar Spine 2-3 Views (72100) |
$150 |
$283 |
1.4× |
| X-Ray Lumbar Spine 6+ Vw - Xr Lumbar Spine 6+ Vws Including Bending (72114) |
$150 |
$343.50 |
1.4× |
| X-Ray Lumbar Spine Flex/Exten - Xr Lumbar Spine 4+ Views W/ Flex Ext (72120) |
$321 |
$428 |
3.0× |
| X-Ray Ribs 2 Vw Unilat - Xr Ribs 2 Views Right (71100) |
$125 |
$185 |
1.4× |
| X-Ray Sacroiliac Jts 3+ Vw - Xr Sacroiliac Joints 3+ Views (72202) |
$150 |
$283 |
1.4× |
| X-Ray Sacrum/Coccyx 2+ Vw - Xr Sacrum Coccyx 2+ Views (72220) |
$125 |
$180.50 |
1.4× |
| X-Ray Shoulder 2+ Vw - Xr Shoulder 2+ Views Right (73030) |
$125 |
$571 |
1.4× |
| X-Ray Sinuses 3+ Vw - Xr Paranasal Sinuses 3+ Views (70220) |
$125 |
$290 |
1.4× |
| X-Ray Sinuses <3 Vw - Xr Paranasal Sinuses 1-2 Views (70210) |
$125 |
$185 |
1.4× |
| X-Ray Skull 4+ Vw - Xr Skull Complete 4+ Views (70260) |
$150 |
$283 |
1.4× |
| X-Ray Skull <4 Vw - Xr Skull 1-3 Views (70250) |
$150 |
$283 |
1.4× |
| X-Ray Spine One View - Xr Spine (72020) |
$125 |
$252 |
1.4× |
| X-Ray Thoracic Spine 2 Vw - Xr Thoracic Spine 2 Views (72070) |
$150 |
$283 |
1.4× |
| X-Ray Thoracic Spine 4 Vw - Xr Thoracic Spine Complete 4+ Views (72074) |
$150 |
$283 |
1.4× |
| X-Ray Toe(S) - Xr Toes 2+ Views Right (73660) |
$125 |
$180.50 |
1.4× |
| X-Ray Wrist 3+ Vw - Xr Wrist 3+ Views Right (73110) |
$125 |
$185 |
1.4× |
| Xr arthrogram ankle (73615) |
$656.62 |
$875.50 |
1.8× |
| Xr c-spine 6 or more views (72052) |
$150 |
$290 |
1.4× |
| Xr finger(s) 2+ views (73140) |
$125 |
$185 |
1.4× |
| XR Mastoids < 3 Views Bilateral (70120) |
$150 |
$185 |
1.4× |
| Xr shoulder 1 view (73020) |
$428.25 |
$571 |
4.7× |
| Xr spine cervical 4 or 5 views (72050) |
$150 |
$283 |
1.4× |
| Xr tibia/fibula 2 views (73590) |
$125 |
$577 |
1.4× |
| Xr tmj bilateral (70330) |
$125 |
$185 |
1.4× |
| Xray knee 1 or 2 views rt (73560) |
$125 |
$569 |
1.4× |