| 3-D radiotherapy plan dose-volume histograms (77295) |
$8,292.50 |
$16,585 |
6.0× |
| Abdomen 2 views (74019) |
$214 |
$428 |
2.0× |
| Ankle 2 views (73600) |
$130.50 |
$261 |
1.5× |
| Arthrogram hip (73525) |
$740.50 |
$1,481 |
2.1× |
| Basic radiation dosimetry calculation (77300) |
$628 |
$1,256 |
4.7× |
| Bone age studies (77072) |
$264 |
$528 |
2.5× |
| Bone survey complete (77075) |
$723.50 |
$1,447 |
6.9× |
| Brachytx isodose complex (77318) |
$1,236.50 |
$2,473 |
3.3× |
| Brachytx isodose pln smpl w/dosimetry cal (77316) |
$615 |
$1,230 |
1.6× |
| Cervical spine 2 or 3 views (72040) |
$123.50 |
$247 |
1.4× |
| Chest 1 view (71045) |
$120 |
$240 |
1.4× |
| Chest 3 views (71047) |
$267.50 |
$535 |
3.1× |
| Clavicle complete (73000) |
$132 |
$264 |
1.5× |
| CT abdomen and pelvis without and with contrast (74178) |
$6,271 |
$12,542 |
17.9× |
| CT abdomen and pelvis without contrast (74176) |
$2,795.50 |
$5,591 |
11.7× |
| CT abdomen w contrast (74160) |
$3,530.50 |
$7,061 |
20.0× |
| CT abdomen w wo contrast (74170) |
$4,060 |
$8,120 |
23.0× |
| CT abdomen w/o contrast (74150) |
$1,922.50 |
$3,845 |
18.3× |
| CT angiography upper extremity lt (73206) |
$1,454 |
$2,908 |
8.3× |
| CT c-spine w/o contrast (72125) |
$1,685.50 |
$3,371 |
16.0× |
| CT cervical spine w&w/o contrast (72127) |
$2,149.50 |
$4,299 |
12.2× |
| CT cervical spine with contrast (72126) |
$1,816.50 |
$3,633 |
5.2× |
| CT chest w/wo contrast (71270) |
$3,539.50 |
$7,079 |
20.1× |
| CT chest with contrast (71260) |
$3,078 |
$6,156 |
17.5× |
| CT head/brain with contrast (70460) |
$1,705 |
$3,410 |
9.7× |
| CT head/brain without and with contrast (70470) |
$1,447 |
$2,894 |
8.2× |
| CT iac w contrast (70481) |
$1,284.50 |
$2,569 |
7.3× |
| CT lower ext w/o (73700) |
$1,008 |
$2,016 |
9.6× |
| CT lower extremity w wo contrast (73702) |
$1,270 |
$2,540 |
7.2× |
| CT lower extremity with contrast (73701) |
$1,118.50 |
$2,237 |
6.3× |
| CT lumbar spine w & w/o contrast (72133) |
$2,789 |
$5,578 |
15.8× |
| CT lumbar spine w/o contrast (72131) |
$2,137 |
$4,274 |
20.3× |
| CT lumbar spine with contrast (72132) |
$2,471.50 |
$4,943 |
7.1× |
| CT maxillofacial w contrast (70487) |
$923.50 |
$1,847 |
5.2× |
| CT maxillofacial w/o contrast (70486) |
$844 |
$1,688 |
8.0× |
| CT maxillofacial w/wo contrast (70488) |
$1,073 |
$2,146 |
6.1× |
| CT neck soft tissue w contrast (70491) |
$934.50 |
$1,869 |
5.3× |
| CT orbit sella/post fossa/ear w/o & w/contr matr (70482) |
$1,447 |
$2,894 |
8.2× |
| CT orbits w/o contrast (70480) |
$1,138.50 |
$2,277 |
10.8× |
| CT pelvis w & w/o contrast (72194) |
$3,368 |
$6,736 |
19.1× |
| CT pelvis w/o contrast (72192) |
$1,153.50 |
$2,307 |
11.0× |
| CT soft tissue neck w/o & w/contrast material (70492) |
$1,028.50 |
$2,057 |
5.8× |
| CT soft tissue neck w/o contrast (70490) |
$844 |
$1,688 |
8.0× |
| CT thoracic spine w/contrast (72129) |
$2,236.50 |
$4,473 |
12.7× |
| CT thoracic spine w/o contrast (72128) |
$1,992.50 |
$3,985 |
19.0× |
| CT thoracic spine w/wo contrast (72130) |
$2,429.50 |
$4,859 |
13.8× |
| CT thorax w/o contrast (71250) |
$2,690.50 |
$5,381 |
25.6× |
| CT upper extremity w/o & w/contrast material (73202) |
$2,236.50 |
$4,473 |
12.7× |
| CT upper extremity w/o contrast rt (73200) |
$1,126.50 |
$2,253 |
10.7× |
| CT upper extremity with contrast (73201) |
$1,267.50 |
$2,535 |
3.6× |
| Cta Abdl Aorta&Bi Iliofem W/Contrast&Postp (75635) |
$5,150 |
$10,300 |
29.2× |
| Cta Abdomen (74175) |
$3,547 |
$7,094 |
20.1× |
| CTA abdomen pelvis (74174) |
$4,705 |
$9,410 |
13.4× |
| CTA chest (71275) |
$3,368 |
$6,736 |
19.1× |
| Cta Head (70496) |
$1,776.50 |
$3,553 |
10.1× |
| CTA head&neck c+ w/noncontrast img&post-pxessing (70471) |
$3,383 |
$6,766 |
9.7× |
| CTA lwr ext w&w/o contrast (73706) |
$1,203 |
$2,406 |
6.8× |
| Cta Neck (70498) |
$1,776.50 |
$3,553 |
10.1× |
| Cta Pelvis (72191) |
$1,159 |
$2,318 |
6.6× |
| Echoencephalography real time imaging (76506) |
$1,330.50 |
$2,661 |
12.7× |
| Fetal biophysical profile non-stress testing (76818) |
$186 |
$372 |
1.8× |
| Fetal Biophysical Profile W/O Non-Stress Testing (76819) |
$1,058 |
$2,116 |
10.1× |
| Fluoroscopy up to 1 hr (76000) |
$367.50 |
$735 |
1.5× |
| Foot 2 views (73620) |
$130.50 |
$261 |
1.5× |
| Forearm 2 views (73090) |
$136.50 |
$273 |
1.6× |
| Hand 2 views (73120) |
$130.50 |
$261 |
1.2× |
| Hand 3 views (73130) |
$170 |
$340 |
1.9× |
| Humerus Min 2 Views Left (73060) |
$145 |
$290 |
1.7× |
| Knee 3 views (73562) |
$699 |
$1,398 |
8.0× |
| Mr safety determination physician/other qhp (76016) |
$139.50 |
$279 |
1.6× |
| Mr safety implant pos&/immoblj supvj phys/qhp (76019) |
$94 |
$188 |
1.6× |
| Mr safety implant&/fb assmt clin staf 1st 15 min (76014) |
$39.50 |
$79 |
1.4× |
| Mr safety implt electronics prepj supvj phys/qhp (76018) |
$145 |
$290 |
1.5× |
| Mr safety med physics xm customization plng&mntr (76017) |
$381.50 |
$763 |
1.6× |
| MRA head w & w/o contrast (70546) |
$2,114.50 |
$4,229 |
6.0× |
| MRA head w/o contrast (70544) |
$1,676 |
$3,352 |
7.0× |
| MRA head with contrast (70545) |
$2,026 |
$4,052 |
5.8× |
| Mra Neck W/O &W/Contrast Material (70549) |
$2,114.50 |
$4,229 |
6.0× |
| MRA neck w/o contrast (70547) |
$1,676 |
$3,352 |
7.0× |
| MRI abdomen w contrast (74182) |
$2,810.50 |
$5,621 |
8.0× |
| MRI abdomen w/o & w/contrast material (74183) |
$3,773.50 |
$7,547 |
10.8× |
| MRI abdomen w/o contrast (74181) |
$1,675 |
$3,350 |
7.0× |
| MRI any jnt lwr ext with con lt (73722) |
$3,459 |
$6,918 |
4.4× |
| MRI any jt upper extremity w/contrast matrl (73222) |
$3,459 |
$6,918 |
4.4× |
| MRI c-spine with contrast (72142) |
$3,952.50 |
$7,905 |
11.3× |
| MRI cervical spine w/o contrast (72141) |
$3,436.50 |
$6,873 |
14.3× |
| MRI chest w/o & w/contrast material (71552) |
$4,665.50 |
$9,331 |
13.3× |
| MRI chest w/o contrast (71550) |
$3,479.50 |
$6,959 |
14.5× |
| MRI lower extrem oth/thn jt w/contrast matrl (73719) |
$3,332.50 |
$6,665 |
9.5× |
| MRI lower extrem oth/thn jt w/o contr matrl (73718) |
$2,897.50 |
$5,795 |
12.1× |
| MRI orbit face &/neck w/o contrast (70540) |
$1,946.50 |
$3,893 |
8.1× |
| MRI orbit/face/neck w&w/o cont (70543) |
$2,572.50 |
$5,145 |
7.3× |
| MRI pelvis w/o & w/contrast material (72197) |
$3,479.50 |
$6,959 |
9.9× |
| MRI pelvis w/o contrast (72195) |
$1,676 |
$3,352 |
7.0× |
| MRI scan of arm joint before and after contrast (73223) |
$3,977.50 |
$7,955 |
11.3× |
| MRI scan of leg joint before and after contrast (73723) |
$3,977.50 |
$7,955 |
11.3× |
| MRI spinal canal cervical w/o & w/contr matrl (72156) |
$4,007 |
$8,014 |
11.4× |
| MRI spinal canal lumbar w/contrast material (72149) |
$4,001.50 |
$8,003 |
11.4× |
| MRI spinal canal lumbar w/o & w/contr matrl (72158) |
$4,057.50 |
$8,115 |
11.6× |
| MRI spinal canal thoracic w/contrast matrl (72147) |
$4,001.50 |
$8,003 |
11.4× |
| MRI spinal canal thoracic w/o & w/contr matrl (72157) |
$4,057.50 |
$8,115 |
11.6× |
| MRI thoracic spine w/o contrast (72146) |
$3,479.50 |
$6,959 |
14.5× |
| MRI tmj (70336) |
$385.50 |
$771 |
1.6× |
| MRI upper ext joint w/o contrast (73221) |
$3,760 |
$7,520 |
15.7× |
| MRI upper extrem other than jt w/o & w/contras (73220) |
$3,977.50 |
$7,955 |
11.3× |
| MRI upper extremity oth than jt w/o contr matrl (73218) |
$3,008 |
$6,016 |
12.5× |
| Neck soft tissue (70360) |
$336 |
$672 |
3.8× |
| Ntsty modul radthx pln dose-vol histos (77301) |
$7,660.50 |
$15,321 |
5.5× |
| Ob Us Follow-Up Per Fetus - Us Ob Follow Up Transabdominal Approach (76816) |
$281 |
$562 |
2.7× |
| Osseous survey limited (77074) |
$310.50 |
$621 |
3.0× |
| Pelvis 1 or 2 views (72170) |
$83 |
$166 |
0.8× |
| Pr MRI, lower extr, w/o contrast f/u by contrast (73720) |
$3,832 |
$7,664 |
10.9× |
| Radex Entir Thrc Lmbr Crv Sac Spi W/Skull 1 Vw - Xr Scoliosis 1 Vw (72081) |
$369.50 |
$739 |
4.2× |
| Radex entir thrc lmbr crv sac spi w/skull 2/3 vw (72082) |
$150.50 |
$301 |
1.4× |
| Radex hips bilateral with pelvis 2 views (73521) |
$186.50 |
$373 |
1.8× |
| Radiolog exam mandible compl minimum 4 views (70110) |
$428 |
$856 |
4.1× |
| Radiologic Exam Abdomen 1 View - Xr Abdomen 1 View (74018) |
$244 |
$488 |
2.8× |
| Radiologic Exam Abdomen 3+ Views - Xr Abdomen 3+ Views (74021) |
$506 |
$1,012 |
4.8× |
| Radiologic Exam Chest 2 Views - Xr Chest 2 Views (71046) |
$225 |
$450 |
2.6× |
| Radiologic Examination Femur Minimum 2 Views - Xr Femur 2+ Vw Lt (73552) |
$330 |
$660 |
3.8× |
| Radiological examination surgical specimen (76098) |
$792 |
$1,584 |
1.4× |
| Ribs bilateral 3 views (71110) |
$419 |
$838 |
4.0× |
| Sacroiliac Joints < 3 Views (72200) |
$215 |
$430 |
2.0× |
| Scanogram (77073) |
$339.50 |
$679 |
3.2× |
| Scapula complete (73010) |
$97.50 |
$195 |
0.9× |
| Shuntogram indwelling nonvascular shunt rs&i (75809) |
$626 |
$1,252 |
6.0× |
| Spec telethx port pln parts hemibdy tot bdy (77321) |
$1,689.50 |
$3,379 |
4.5× |
| Spine thoracic 3 views (72072) |
$443.50 |
$887 |
4.2× |
| Telethx isodose pln cplx w/basic dosimetry (77307) |
$1,682 |
$3,364 |
4.5× |
| Telethx isodose pln smpl w/dosimetry calculation (77306) |
$674 |
$1,348 |
1.8× |
| Ther rad simulaj-aided field setting complex (77290) |
$2,939 |
$5,878 |
7.8× |
| Ther rad simulaj-aided field setting simple (77280) |
$1,515.50 |
$3,031 |
11.2× |
| Thoracolumbar 2 views (72080) |
$152.50 |
$305 |
1.7× |
| Tmj unilateral (70328) |
$317.50 |
$635 |
3.6× |
| Ultrasound, abdomen limited (76705) |
$1,025.50 |
$2,051 |
9.8× |
| Umbilical-artery Doppler (OB) (76820) |
$186 |
$372 |
1.8× |
| Us abdl aorta screen aaa (76706) |
$186 |
$372 |
1.8× |
| Us breast unilateral complete (76641) |
$591 |
$1,182 |
5.6× |
| Us breast unilateral limited (76642) |
$295.50 |
$591 |
3.4× |
| Us chest (76604) |
$1,025.50 |
$2,051 |
9.8× |
| Us compl joint r-t w/image documentation (76881) |
$1,152.50 |
$2,305 |
11.0× |
| Us fetal nuchal translucency 1st gestation (76813) |
$186 |
$372 |
1.8× |
| Us infant hips limited static (76886) |
$1,153 |
$2,306 |
13.2× |
| Us kidney transplant (76776) |
$787.50 |
$1,575 |
7.5× |
| Us ob detailed single fetus (76811) |
$392.50 |
$785 |
1.6× |
| Us ob transvaginal (76817) |
$281 |
$562 |
2.7× |
| Us pelvic non ob complete (76856) |
$1,249.50 |
$2,499 |
11.9× |
| Us pelvic nonobstetric image dcmtn limited/f/u (76857) |
$1,137 |
$2,274 |
10.8× |
| Us pregnancy ltd (76815) |
$498 |
$996 |
4.7× |
| Us pregnant uterus 14 wk transabdl 1/1st gestat (76801) |
$935.50 |
$1,871 |
8.9× |
| Us retroperitoneal complete (76770) |
$1,137 |
$2,274 |
10.8× |
| Us retroperitoneal limited (76775) |
$787.50 |
$1,575 |
7.5× |
| Us scrotum and contents (76870) |
$1,215 |
$2,430 |
11.6× |
| Us soft tissue head/neck (76536) |
$1,153 |
$2,306 |
11.0× |
| Us xtr non-vasc lmtd (76882) |
$1,049 |
$2,098 |
10.0× |
| Wrist 2 views (73100) |
$143.12 |
$286.25 |
1.6× |
| X-Ray Ac Jts - Xr Acromioclavicular Joints Bilateral (73050) |
$297.50 |
$595 |
3.4× |
| X-Ray Ankle 3+ Vw - Xr Ankle 3+ Views Right (73610) |
$138 |
$276 |
1.6× |
| X-Ray Elbow 2 Vw - Xr Elbow 1-2 Views Right (73070) |
$132 |
$264 |
1.5× |
| X-Ray Elbow 3+ Vw - Xr Elbow 3+ Views Right (73080) |
$139 |
$278 |
1.6× |
| X-ray exam hip uni 1 view (73501) |
$133.50 |
$267 |
1.5× |
| X-Ray Exam Hip Uni 2-3 Views (73502) |
$146.50 |
$293 |
1.7× |
| X-ray exam hip uni 4/> views (73503) |
$232.50 |
$465 |
2.2× |
| X-Ray Exam Hips Bi 3-4 Views (73522) |
$156 |
$312 |
1.5× |
| X-Ray Exam Hips Bi 5/> Views (73523) |
$606 |
$1,212 |
5.8× |
| X-ray exam of femur 1 (73551) |
$136.50 |
$273 |
1.6× |
| X-ray eye for foreign body (70030) |
$133.50 |
$267 |
1.5× |
| X-Ray Facial Bones 3+ Vw - Xr Facial Bones 3+ Views (70150) |
$405 |
$810 |
3.9× |
| X-Ray Facial Bones <3 Vw - Xr Facial Bones 1-2 Views (70140) |
$301 |
$602 |
3.4× |
| X-Ray Foot 3+ Vw - Xr Foot 3+ Views Right (73630) |
$200.62 |
$401.25 |
2.3× |
| X-Ray Heel - Xr Calcaneus 2 Views Right (73650) |
$102.50 |
$205 |
1.2× |
| X-Ray Jaw <4 Vw - Xr Mandible < 4 Views (70100) |
$404.50 |
$809 |
4.6× |
| X-Ray Knee 4+ View - Xr Knee 4+ Views Right (73564) |
$636.50 |
$1,273 |
6.1× |
| X-Ray Knee Bilat Standing - Xr Knees Anteroposterior Standing Bilat (73565) |
$83 |
$166 |
0.9× |
| X-Ray Leg, Infant - Xr Lower Extremity 2+ Views Infant Left (73592) |
$201 |
$402 |
2.3× |
| X-Ray Lumbar Spine 2/3 Vw - Xr Lumbar Spine 2-3 Views (72100) |
$196.50 |
$393 |
1.9× |
| X-Ray Lumbar Spine 6+ Vw - Xr Lumbar Spine 6+ Vws Including Bending (72114) |
$618.50 |
$1,237 |
5.9× |
| X-Ray Lumbar Spine Flex/Exten - Xr Lumbar Spine 4+ Views W/ Flex Ext (72120) |
$555 |
$1,110 |
5.3× |
| X-Ray Nasal Bones - Xr Nasal Bones (70160) |
$299.50 |
$599 |
3.4× |
| X-Ray Orbits - Xr Orbits Complete 4+ Views (70200) |
$443.50 |
$887 |
4.2× |
| X-Ray Pelvis 3+ Vw - Xr Pelvis 3+ Views (72190) |
$83 |
$166 |
0.8× |
| X-Ray Ribs 2 Vw Unilat - Xr Ribs 2 Views Right (71100) |
$405.50 |
$811 |
4.6× |
| X-Ray Ribs, Chest 3+ Vw - Xr Ribs 2 Vws Lt W/ Chest Anteroposterior (71101) |
$400.50 |
$801 |
3.8× |
| X-Ray Ribs, Chest 4+ Vw - Xr Ribs 3 Vws Bil W/ Chest Posteroanterior (71111) |
$680.50 |
$1,361 |
6.5× |
| X-Ray Sacroiliac Jts 3+ Vw - Xr Sacroiliac Joints 3+ Views (72202) |
$318.50 |
$637 |
3.0× |
| X-Ray Sacrum/Coccyx 2+ Vw - Xr Sacrum Coccyx 2+ Views (72220) |
$384 |
$768 |
4.4× |
| X-Ray Shoulder 2+ Vw - Xr Shoulder 2+ Views Right (73030) |
$202.50 |
$405 |
2.3× |
| X-Ray Sinuses 3+ Vw - Xr Paranasal Sinuses 3+ Views (70220) |
$436.50 |
$873 |
5.0× |
| X-Ray Sinuses <3 Vw - Xr Paranasal Sinuses 1-2 Views (70210) |
$264 |
$528 |
3.0× |
| X-Ray Skull 4+ Vw - Xr Skull Complete 4+ Views (70260) |
$489 |
$978 |
4.7× |
| X-Ray Skull <4 Vw - Xr Skull 1-3 Views (70250) |
$388.50 |
$777 |
3.7× |
| X-Ray Spine One View - Xr Spine (72020) |
$123.50 |
$247 |
1.4× |
| X-Ray Sterno-Clavicluar Jt - Xr Sternoclavicular Joints 3+ Views (71130) |
$311 |
$622 |
3.6× |
| X-Ray Sternum 2+ Vw - Xr Sternum 2+ Views (71120) |
$355 |
$710 |
4.1× |
| X-Ray Thoracic Spine 2 Vw - Xr Thoracic Spine 2 Views (72070) |
$152.50 |
$305 |
1.5× |
| X-Ray Thoracic Spine 4 Vw - Xr Thoracic Spine Complete 4+ Views (72074) |
$450.50 |
$901 |
4.3× |
| X-Ray Toe(S) - Xr Toes 2+ Views Right (73660) |
$97.50 |
$195 |
1.1× |
| X-Ray Wrist 3+ Vw - Xr Wrist 3+ Views Right (73110) |
$132 |
$264 |
1.5× |
| Xr c-spine 6 or more views (72052) |
$248.50 |
$497 |
2.4× |
| Xr chest 4+ views (71048) |
$243 |
$486 |
2.3× |
| Xr finger(s) 2+ views (73140) |
$136 |
$272 |
1.6× |
| Xr shoulder 1 view (73020) |
$97.50 |
$195 |
1.1× |
| Xr spine cervical 4 or 5 views (72050) |
$196.50 |
$393 |
1.9× |
| Xr tibia/fibula 2 views (73590) |
$136.50 |
$273 |
1.6× |
| Xr tmj bilateral (70330) |
$507.50 |
$1,015 |
5.8× |
| Xray knee 1 or 2 views rt (73560) |
$685 |
$1,370 |
7.8× |