Imaging prices at AdventHealth Palm Coast
Palm Coast, FL · every code in this section with a posted price and a Medicare benchmark.
302 codes. Prices are the hospital's own posted facility charges.
Compare against other hospitals interactively →
| Procedure | Cash price | Gross charge | × Medicare |
|---|---|---|---|
| 3-D radiotherapy plan dose-volume histograms (77295) | $6,565.40 | $6,565.40 | 4.5× |
| Abdomen 2 views (74019) | $1,095.56 | $1,095.56 | 10.0× |
| Acute gi blood loss imaging (78278) | $2,545.74 | $2,545.74 | 6.1× |
| Angiography extremity bilateral rs&i (75716) | $9,926.25 | $9,926.25 | 3.0× |
| Angiography extremity unilateral rs&i (75710) | $9,926.25 | $9,926.25 | 3.0× |
| Angiography pelvic slctv/supraslctv rs&i (75736) | $9,926.25 | $9,926.25 | 1.7× |
| Angiography pulmonary bilateral slctv rs&i (75743) | $9,926.25 | $9,926.25 | 3.0× |
| Angiography pulmonary unilateral slctv rs&i (75741) | $9,926.25 | $9,926.25 | 3.0× |
| Angiography Spinal Selective Rs&I (75705) | $6,440.61 | $6,440.61 | 1.1× |
| Angiography visceral slctv/supraslctv rs&i (75726) | $20,642.46 | $20,642.46 | 3.6× |
| Angrph pulmonary nonslctv cath/ven njx rs&i (75746) | $3,208.13 | $3,208.13 | 1.0× |
| Ankle 2 views (73600) | $618.35 | $618.35 | 6.8× |
| Aortogram thoracic (75605) | $9,926.25 | $9,926.25 | 1.7× |
| Aortography abdl bi iliofem low extrem cath rs&i (75630) | $9,926.25 | $9,926.25 | 3.0× |
| Aortography abdominal serialography rs&i (75625) | $6,440.61 | $6,440.61 | 2.0× |
| Arthrogram ankle (73615) | $781.01 | $781.01 | 2.1× |
| Arthrogram elbow (73085) | $1,224.60 | $1,224.60 | 3.4× |
| Arthrogram hip (73525) | $1,222.46 | $1,222.46 | 3.4× |
| Arthrogram knee (73580) | $1,370.11 | $1,370.11 | 3.8× |
| Arthrogram shoulder (73040) | $1,187.22 | $1,187.22 | 3.3× |
| Arthrogram wrist (73115) | $818.76 | $818.76 | 2.2× |
| Basic dosimetry (77300) | $563.22 | $563.22 | 4.0× |
| Bone &/Joint Imaging Limited Area (78300) | $4,497.61 | $4,497.61 | 10.8× |
| Bone &/joint imaging whole body (78306) | $5,109.37 | $5,109.37 | 12.2× |
| Bone age studies (77072) | $569.31 | $569.31 | 5.2× |
| Bone Imaging 3 Phase (78315) | $2,310.64 | $2,310.64 | 5.5× |
| Bone Marrow Imaging Limited Area (78102) | $2,181.11 | $2,181.11 | 5.2× |
| Bone survey complete (77075) | $4,580.67 | $4,580.67 | 42.0× |
| Bone survey infant (77076) | $747.76 | $747.76 | 6.8× |
| Bowel imaging (78290) | $3,632.14 | $3,632.14 | 8.7× |
| Brachytx isodose complex (77318) | $1,341.43 | $1,341.43 | 3.4× |
| Brachytx isodose intermed (77317) | $1,341.43 | $1,341.43 | 3.4× |
| Brachytx isodose pln smpl w/dosimetry cal (77316) | $482.59 | $482.59 | 1.2× |
| Brain Imaging < 4 Static Views W Vascular Flow (78601) | $1,291.11 | $1,291.11 | 3.1× |
| Brain Imaging Pet Metabolic Evaluation (78608) | $6,891.35 | $6,891.35 | 4.6× |
| Card Bpi Gtd =Brm Plnr 1 Std Rest/Strs (78472) | $3,632.14 | $3,632.14 | 8.7× |
| Cervical spine 2 or 3 views (72040) | $827.94 | $827.94 | 9.1× |
| Chest 1 view (71045) | $674.53 | $674.53 | 7.4× |
| Chest xray 3 views (71047) | $2,557.73 | $2,557.73 | 28.1× |
| Cholecystography, oral contrast Non-Facility (74290) | $1,243.79 | $1,243.79 | 6.8× |
| Cine/Vid X-Ray Throat/Esoph - Fl Esoph Barium Swlw W/ Video & Speech (74230) | $1,182.30 | $1,182.30 | 6.5× |
| Clavicle complete (73000) | $827.94 | $827.94 | 9.1× |
| Computed Tomography Thorax Lw Dose Lng Ca Scr C- (71271) | $1,790.42 | $1,790.42 | 16.4× |
| Continuing medical physics consltj pr wk (77336) | $878.99 | $878.99 | 6.3× |
| CT abdomen and pelvis without and with contrast (74178) | $8,584.85 | $8,584.85 | 23.6× |
| CT abdomen and pelvis without contrast (74176) | $8,193.63 | $8,193.63 | 32.9× |
| CT abdomen w contrast (74160) | $5,723.42 | $5,723.42 | 31.2× |
| CT abdomen w wo contrast (74170) | $6,259.05 | $6,259.05 | 34.2× |
| CT abdomen w/o contrast (74150) | $5,462.61 | $5,462.61 | 50.0× |
| CT angio hrt w/3d image (75574) | $1,937.92 | $1,937.92 | 5.3× |
| CT angio lwr extr w/o&w/dye (73706) | $5,155.67 | $5,155.67 | 28.1× |
| CT angiography upper extremity lt (73206) | $5,155.67 | $5,155.67 | 28.1× |
| CT c-spine w/contrast (72126) | $5,765.54 | $5,765.54 | 15.8× |
| CT c-spine w/o contrast (72125) | $4,620.05 | $4,620.05 | 42.3× |
| CT cervical spine w&w/o contrast (72127) | $6,146.70 | $6,146.70 | 33.6× |
| CT chest w contrast (71260) | $4,583.87 | $4,583.87 | 25.0× |
| CT chest w/wo contrast (71270) | $5,267.33 | $5,267.33 | 28.8× |
| CT head/brain with contrast (70460) | $3,773.53 | $3,773.53 | 20.6× |
| CT head/brain without and with contrast (70470) | $3,918.52 | $3,918.52 | 21.4× |
| CT heart w/o contrast quant eval coronary calcium (75571) | $267.73 | $267.73 | 2.9× |
| CT iac w contrast (70481) | $3,674.90 | $3,674.90 | 20.1× |
| CT limited/localized follow up study (76380) | $509.54 | $509.54 | 5.6× |
| CT lower ext w/o (73700) | $2,226.78 | $2,226.78 | 20.4× |
| CT lower extremity w wo contrast (73702) | $3,518 | $3,518 | 19.2× |
| CT lower extremity w/contrast material (73701) | $2,969.05 | $2,969.05 | 16.2× |
| CT lumbar spine w & w/o contrast (72133) | $5,018.38 | $5,018.38 | 27.4× |
| CT lumbar spine w/contrast (72132) | $4,801.86 | $4,801.86 | 13.2× |
| CT lumbar spine w/o contrast (72131) | $4,241.10 | $4,241.10 | 38.8× |
| CT maxillofacial w contrast (70487) | $3,666.03 | $3,666.03 | 20.0× |
| CT maxillofacial w/wo contrast (70488) | $4,318.66 | $4,318.66 | 23.6× |
| CT maxillofacial wo contrast (70486) | $3,161.88 | $3,161.88 | 29.0× |
| CT orbit sella/post fossa/ear w/o & w/contr matr (70482) | $4,327.40 | $4,327.40 | 23.6× |
| CT orbits w/o contrast (70480) | $3,347.69 | $3,347.69 | 30.7× |
| CT pelvis w/o contrast (72192) | $3,810.37 | $3,810.37 | 34.9× |
| CT pelvis w/wo contrast (72194) | $5,196.71 | $5,196.71 | 28.4× |
| CT scan of arm combo (73202) | $4,379.51 | $4,379.51 | 23.9× |
| CT soft tissue neck w contrast (70491) | $2,648.47 | $2,648.47 | 14.5× |
| CT soft tissue neck w/o & w/contrast material (70492) | $2,720.03 | $2,720.03 | 14.8× |
| CT soft tissue neck w/o contrast (70490) | $2,039.09 | $2,039.09 | 18.7× |
| CT thoracic spine w/contrast (72129) | $4,947.05 | $4,947.05 | 27.0× |
| CT thoracic spine w/o contrast (72128) | $4,766.49 | $4,766.49 | 43.7× |
| CT thorax w/o contrast (71250) | $3,818.23 | $3,818.23 | 35.0× |
| CT upper ext wo (73200) | $3,471.65 | $3,471.65 | 31.8× |
| CT upper extremity with contrast (73201) | $3,961.81 | $3,961.81 | 10.9× |
| Cta Aa&Bi Iliofem Lxtr Rs&I C-/C+ Post-Pxessing (75635) | $8,513.90 | $8,513.90 | 46.5× |
| Cta Abdomen (74175) | $8,026.41 | $8,026.41 | 43.8× |
| CTA abdomen pelvis (74174) | $8,026.41 | $8,026.41 | 22.0× |
| CTA chest (71275) | $4,776.25 | $4,776.25 | 26.1× |
| Cta Head (70496) | $5,724.67 | $5,724.67 | 31.3× |
| Cta Neck (70498) | $4,999.60 | $4,999.60 | 27.3× |
| Cta Pelvis (72191) | $6,927.07 | $6,927.07 | 37.8× |
| Cystography minimum 3 views rs&i (74430) | $1,099.06 | $1,099.06 | 3.0× |
| Dxa bone density study 1/> sites axial skel (77080) | $473.09 | $473.09 | 4.3× |
| Dxa bone density study 1/>sites appendiclr skel (77081) | $473.09 | $473.09 | 5.2× |
| Dxa bone density study axial skeleton (77085) | $540 | $540 | 4.9× |
| Esophagus (74220) | $1,182.30 | $1,182.30 | 6.5× |
| Facial bones min 3 views (70150) | $1,311.05 | $1,311.05 | 12.0× |
| Fluoroscopy up to 1 hr (76000) | $740.86 | $740.86 | 3.0× |
| Foot 2 views (73620) | $827.94 | $827.94 | 9.1× |
| Forearm 2 views (73090) | $827.94 | $827.94 | 9.1× |
| Hand 2 views (73120) | $681.59 | $681.59 | 6.2× |
| Hepatobil Syst Imag Inc Gb W/Pharma Intervenj (78227) | $1,275.05 | $1,275.05 | 2.2× |
| Hepatobiliary syst imaging including gallbladder (78226) | $1,275.05 | $1,275.05 | 3.1× |
| Intracavitary Radiation Source Applic Complex (77763) | $2,096.75 | $2,096.75 | 2.9× |
| Intracavitary Radiation Source Applic Intermed (77762) | $1,603.67 | $1,603.67 | 2.8× |
| Intracavitary Radiation Source Applic Simple (77761) | $1,603.67 | $1,603.67 | 2.8× |
| Kidney img morphology vascular flow 1 w/rx (78708) | $2,118.08 | $2,118.08 | 3.7× |
| Knee 3 views (73562) | $801.47 | $801.47 | 8.8× |
| Lung perfusion differential (78597) | $879.80 | $879.80 | 2.1× |
| Lung ventilation imaging (78579) | $1,183.35 | $1,183.35 | 2.8× |
| Lymphangiography Pelvic/Abdominal Bilateral Rs&I (75807) | $12,609.73 | $12,609.73 | 3.8× |
| Lymphoscintigraphy (78195) | $2,596.41 | $2,596.41 | 4.6× |
| Magnetic resonance (eg, proton) imaging, any joint of upper extremity; with contrast material(s) Non-Facility (73222) | $5,472.88 | $5,472.88 | 6.7× |
| Magnetic resonance (eg, proton) imaging, upper extremity, other than joint; without contrast material(s), followed by… (73220) | $6,349.80 | $6,349.80 | 17.4× |
| Mlc imrt design & construction per imrt plan (77338) | $753.45 | $753.45 | 1.9× |
| Mr safety determination physician/other qhp (76016) | $210.74 | $210.74 | 2.3× |
| Mr safety implant&/fb assmt clin staf 1st 15 min (76014) | $58.85 | $58.85 | 1.9× |
| Mr safety implt electronics prepj supvj phys/qhp (76018) | $220.91 | $220.91 | 2.2× |
| Mr safety implt pos&/immoblj (76019) | $140.35 | $140.35 | 2.3× |
| Mr safety med physics xm customization plng&mntr (76017) | $580.70 | $580.70 | 2.3× |
| MRA head w & w/o contrast (70546) | $5,139.12 | $5,139.12 | 14.1× |
| MRA head w/o contrast (70544) | $4,206.89 | $4,206.89 | 16.9× |
| MRA neck w contrast (70548) | $4,211.69 | $4,211.69 | 11.6× |
| Mra Neck W/O &W/Contrast Material (70549) | $5,139.12 | $5,139.12 | 14.1× |
| MRA neck w/o contrast (70547) | $4,211.69 | $4,211.69 | 16.9× |
| MRI abdomen w contrast (74182) | $4,568.54 | $4,568.54 | 12.5× |
| MRI abdomen w/o & w/contrast material (74183) | $6,800.31 | $6,800.31 | 18.7× |
| MRI abdomen w/o contrast (74181) | $6,059.52 | $6,059.52 | 24.3× |
| MRI any jt lower extrem w/contrast material (73722) | $7,560.36 | $7,560.36 | 9.2× |
| MRI any jt lower extrem w/o & w/contrast matrl (73723) | $8,799.02 | $8,799.02 | 24.2× |
| MRI breast w/o contrast bilateral (77047) | $3,315.94 | $3,315.94 | 13.3× |
| MRI c-spine with contrast (72142) | $5,400.39 | $5,400.39 | 14.8× |
| MRI cervical spine w/o contrast (72141) | $5,666.42 | $5,666.42 | 22.7× |
| MRI chest w/o & w/contrast material (71552) | $5,702.71 | $5,702.71 | 15.7× |
| MRI chest w/o contrast (71550) | $4,819.78 | $4,819.78 | 19.3× |
| MRI chest with contrast (71551) | $2,114.61 | $2,114.61 | 2.6× |
| MRI lower extrem oth/thn jt w/o & w/contr matr (73720) | $8,799.02 | $8,799.02 | 24.2× |
| MRI lower extrem oth/thn jt w/o contr matrl (73718) | $6,514.68 | $6,514.68 | 26.1× |
| MRI orbit face &/neck w/o contrast (70540) | $5,528.39 | $5,528.39 | 22.2× |
| MRI orbit/face/neck w&w/o cont (70543) | $4,957.86 | $4,957.86 | 13.6× |
| MRI pelvis w/contrast (72196) | $5,515.28 | $5,515.28 | 15.1× |
| MRI pelvis w/o & w/contrast material (72197) | $6,500.13 | $6,500.13 | 17.8× |
| MRI pelvis w/o contrast (72195) | $5,468.13 | $5,468.13 | 21.9× |
| MRI spinal canal cervical w/o & w/contr matrl (72156) | $6,930.33 | $6,930.33 | 19.0× |
| MRI spinal canal lumbar w/contrast material (72149) | $5,713.77 | $5,713.77 | 15.7× |
| MRI spinal canal lumbar w/o & w/contr matrl (72158) | $7,520.61 | $7,520.61 | 20.6× |
| MRI spinal canal thoracic w/contrast matrl (72147) | $5,977.87 | $5,977.87 | 16.4× |
| MRI spinal canal thoracic w/o & w/contr matrl (72157) | $7,145.02 | $7,145.02 | 19.6× |
| MRI temporomandibular joint (70336) | $4,686.75 | $4,686.75 | 18.8× |
| MRI thoracic spine w/o contrast (72146) | $5,841.78 | $5,841.78 | 23.4× |
| MRI up ext w/o contrast (73218) | $5,472.88 | $5,472.88 | 22.0× |
| MRI upper ext joint w/o contrast (73221) | $5,140.32 | $5,140.32 | 20.6× |
| MRI, joint upper extrem combo (73223) | $6,349.80 | $6,349.80 | 17.4× |
| Myelogram Cervical (72240) | $3,012.09 | $3,012.09 | 3.7× |
| Myelogram Lumbar (72265) | $2,525.25 | $2,525.25 | 3.1× |
| Myelography 2 or more regions (72270) | $3,079.85 | $3,079.85 | 3.8× |
| Myocardial Imaging Pet Metabolic Evaluation (78459) | $5,946.91 | $5,946.91 | 4.4× |
| Myocardial Spect Multiple Studies (78452) | $9,151.31 | $9,151.31 | 6.8× |
| Myocardial spect single study at rest or stress (78451) | $3,034.22 | $3,034.22 | 2.2× |
| Neck soft tissue (70360) | $614.65 | $614.65 | 6.8× |
| Nm cardiac blood pool multiple (78473) | $4,716.55 | $4,716.55 | 11.3× |
| Nm gastric emptying study (78264) | $2,825.46 | $2,825.46 | 6.8× |
| Ntsty modul radthx pln dose-vol histos (77301) | $18,219.88 | $18,219.88 | 12.6× |
| Osseous survey limited (77074) | $1,214.83 | $1,214.83 | 11.1× |
| Parathyrd planar w/spect&CT (78072) | $2,546.90 | $2,546.90 | 4.5× |
| Pelvis 1 or 2 views (72170) | $809.90 | $809.90 | 7.4× |
| Peritoneogram after injection (74190) | $37,805.01 | $37,805.01 | 66.3× |
| PET image w/CT, skull-thigh (78815) | $11,184.15 | $11,184.15 | 7.5× |
| PET imaging for CT attenuation whole body (78816) | $11,187.77 | $11,187.77 | 7.5× |
| PET whole body (78813) | $10,531.58 | $10,531.58 | 7.1× |
| Pulmonary Perfusion Imaging Particulate (78580) | $4,394.27 | $4,394.27 | 10.5× |
| Pulmonary Ventilation & Perfusion Imaging (78582) | $1,373.45 | $1,373.45 | 2.4× |
| Radex abscess/fistula/sinus tract rs&i (76080) | $1,025.42 | $1,025.42 | 1.8× |
| Radex Ankle Compl Minimum 3 Views (73610) | $827.94 | $827.94 | 9.1× |
| Radex Calcaneus Minimum 2 Views (73650) | $725.69 | $725.69 | 8.0× |
| Radex Elbw Compl Minimum 3 Views (73080) | $934.16 | $934.16 | 10.3× |
| Radex Entir Thrc Lmbr Crv Sac Spi W/Skull 1 Vw - Xr Scoliosis 1 Vw (72081) | $2,376 | $2,376 | 26.1× |
| Radex Entir Thrc Lmbr Crv Sac Spi W/Skull 4/5 Vw (72083) | $613.43 | $613.43 | 5.6× |
| Radex fingr minimum 2 views (73140) | $645.48 | $645.48 | 7.1× |
| Radex Foot Compl Minimum 3 Views (73630) | $763.78 | $763.78 | 8.4× |
| Radex Hand Minimum 3 Views (73130) | $781.81 | $781.81 | 8.6× |
| Radex Hip Unilateral With Pelvis 1 View (73501) | $781.81 | $781.81 | 8.6× |
| Radex Hip Unilateral With Pelvis Minimum 4 Views (73503) | $2,254.19 | $2,254.19 | 20.6× |
| Radex Hips Bilateral With Pelvis 2 Views (73521) | $1,162.73 | $1,162.73 | 10.7× |
| Radex Hips Bilateral With Pelvis Minimum 5 Views (73523) | $1,179.85 | $1,179.85 | 10.8× |
| Radex Humerus Minimum 2 Views (73060) | $827.94 | $827.94 | 9.1× |
| Radex Kne 1/2 Views (73560) | $827.94 | $827.94 | 9.1× |
| Radex Kne Compl 4/More Views (73564) | $827.94 | $827.94 | 7.6× |
| Radex Mndbl Compl Minimum 4 Views (70110) | $1,355.14 | $1,355.14 | 12.4× |
| Radex Nasal Bones Complete Minimum 3 Views (70160) | $682.97 | $682.97 | 7.5× |
| Radex Pelvis Compl Minimum 3 Views (72190) | $1,012.35 | $1,012.35 | 9.3× |
| Radex Sho Compl Minimum 2 Views (73030) | $882.05 | $882.05 | 9.7× |
| Radex Sinuses Paransl < 3 Views (70210) | $681.59 | $681.59 | 7.5× |
| Radex Spine Lumbosacral Only Bending 2/3 Views (72120) | $922.17 | $922.17 | 8.4× |
| Radex Temporomandble Jt Opn & Clsd Mouth Bilat (70330) | $1,162.73 | $1,162.73 | 12.8× |
| Radex Toe Minimum 2 Views (73660) | $641.52 | $641.52 | 7.1× |
| Radex upper extremity infant minimum 2 views (73092) | $739.73 | $739.73 | 6.8× |
| Radex Wrst Compl Minimum 3 Views (73110) | $802.52 | $802.52 | 8.8× |
| Radex X-Ray Exam Entire Spi 6/> Vw - Xr Entire Spine 6+ Vw (72084) | $1,387.23 | $1,387.23 | 12.7× |
| Radiation Delivery Stereotactic Cranial Cobalt (77371) | $27,584.98 | $27,584.98 | 3.6× |
| Radiation Delivery Stereotactic Cranial Linear (77372) | $26,680.93 | $26,680.93 | 3.5× |
| Radiation treatment delivery level 1 (77402) | $847.72 | $847.72 | 8.0× |
| Radiation treatment delivery level 2 (77407) | $835.14 | $835.14 | 2.1× |
| Radiation treatment delivery level 3 (77412) | $1,169.12 | $1,169.12 | 2.0× |
| Radiologic Exam Abdomen 1 View - Xr Abdomen 1 View (74018) | $732.15 | $732.15 | 8.1× |
| Radiologic Exam Abdomen 3+ Views - Xr Abdomen 3+ Views (74021) | $959.96 | $959.96 | 8.8× |
| Radiologic exam chest 2 views (71046) | $1,274.94 | $1,274.94 | 14.0× |
| Radiologic exam colon single contrast study (74270) | $1,119.95 | $1,119.95 | 6.1× |
| Radiologic exam upr gi trc double contrast study (74246) | $1,625.22 | $1,625.22 | 8.9× |
| Radiologic exam upr gi trc single contrast study (74240) | $1,019.60 | $1,019.60 | 5.6× |
| Radiologic examination femur 1 view (73551) | $312.12 | $312.12 | 3.4× |
| Radiologic examination tibia & fibula 2 views (73590) | $629.46 | $629.46 | 6.9× |
| Radiological examination surgical specimen (76098) | $1,428.17 | $1,428.17 | 2.5× |
| Ribs bilateral 3 views (71110) | $1,214.83 | $1,214.83 | 11.1× |
| Rp Loclzj Tum Plnr 1 Area Single Day Imaging (78800) | $4,497.61 | $4,497.61 | 10.8× |
| Rp loclzj tum plnr whole body single day imaging (78802) | $3,508.95 | $3,508.95 | 6.2× |
| Rp loclzj tum spect 1 area single day imaging (78803) | $3,933.76 | $3,933.76 | 6.9× |
| Rp loclzj tum spect w/CT 1 area 1 day imaging (78830) | $3,862.48 | $3,862.48 | 2.9× |
| Sacroiliac Joints < 3 Views (72200) | $398.92 | $398.92 | 3.7× |
| Scapula (73010) | $934.16 | $934.16 | 8.6× |
| Screening Digital Breast Tomosynthesis Bi (77063) | $103.18 | $103.18 | 4.4× |
| Shoulder 1 view (73020) | $348.46 | $348.46 | 3.8× |
| Small bowel series (74250) | $1,028.12 | $1,028.12 | 5.6× |
| Spec telethx port pln parts hemibdy tot bdy (77321) | $1,635.64 | $1,635.64 | 4.2× |
| Special dosimetry (77331) | $759.48 | $759.48 | 5.4× |
| Special Physics Consult (77370) | $1,345.49 | $1,345.49 | 9.6× |
| Special treatment procedure (77470) | $2,713.76 | $2,713.76 | 4.7× |
| Spine thoracic 3 views (72072) | $1,054.43 | $1,054.43 | 9.7× |
| Splenoportograpy rs&i (75810) | $6,440.61 | $6,440.61 | 2.0× |
| Stereotactic Body Radiation Delivery (77373) | $6,110.77 | $6,110.77 | 3.3× |
| Tbs technical calculation only (77091) | $215.13 | $215.13 | 2.4× |
| Telethx isodose pln cplx w/basic dosimetry (77307) | $482.59 | $482.59 | 1.2× |
| Telethx isodose pln smpl w/dosimetry calculation (77306) | $482.59 | $482.59 | 1.2× |
| Ther rad simulaj-aided field setting complex (77290) | $3,279.84 | $3,279.84 | 8.4× |
| Ther rad simulaj-aided field setting simple (77280) | $1,945.76 | $1,945.76 | 13.9× |
| Thoracolumbar 2 views (72080) | $1,054.43 | $1,054.43 | 11.6× |
| Thyroid Uptake W/Blood Flow Sngle/Mult Quan Meas (78014) | $796.54 | $796.54 | 1.9× |
| Tmj unilateral (70328) | $112.27 | $112.27 | 1.2× |
| Treatment device complex (77334) | $1,379.62 | $1,379.62 | 3.5× |
| Treatment device intermediate (77333) | $802.19 | $802.19 | 5.7× |
| Treatment devices simple (77332) | $657.10 | $657.10 | 4.7× |
| Ultrasound breast complete (76641) | $470.88 | $470.88 | 4.3× |
| Ultrasound Exam Aaa Screen (76706) | $425.53 | $425.53 | 3.9× |
| Ultrasound, abdomen limited (76705) | $1,762.52 | $1,762.52 | 16.1× |
| Urethrocystogram voiding (74455) | $2,194.53 | $2,194.53 | 8.8× |
| Urethrocystography retrograde rs&i (74450) | $517.22 | $517.22 | 2.1× |
| Us breast unilateral limited (76642) | $355.48 | $355.48 | 3.9× |
| Us chest (76604) | $1,004.02 | $1,004.02 | 9.2× |
| Us compl joint r-t w/image documentation (76881) | $935.19 | $935.19 | 8.6× |
| Us encephalogram (76506) | $1,628.80 | $1,628.80 | 14.9× |
| Us lmtd joint/oth nonvasc xtr strux r-t w/img (76882) | $745.94 | $745.94 | 6.8× |
| Us ob limited (76815) | $1,762.52 | $1,762.52 | 16.1× |
| Us ob transvaginal (76817) | $911.63 | $911.63 | 8.4× |
| Us pelvic non ob complete (76856) | $1,543.56 | $1,543.56 | 14.1× |
| Us pelvic nonobstetric image dcmtn limited/f/u (76857) | $858.22 | $858.22 | 7.9× |
| Us pg uter img f&mat 14 wk tabdl 1/1st gestation (76801) | $1,070.03 | $1,070.03 | 9.8× |
| Us retroperitoneal complete (76770) | $1,159.63 | $1,159.63 | 10.6× |
| Us retroperitoneal limited (76775) | $1,762.52 | $1,762.52 | 16.1× |
| Us scrotum and contents (76870) | $962.70 | $962.70 | 8.8× |
| Us soft tissue head/neck (76536) | $1,493.28 | $1,493.28 | 13.7× |
| Us,transplanted kidney, real time/ doppler (76776) | $1,492.64 | $1,492.64 | 13.7× |
| Venogram extremity bilateral (75822) | $3,709 | $3,709 | 2.3× |
| Venogram Extremity Unilateral (75820) | $3,208.13 | $3,208.13 | 2.0× |
| Venography caval inferior serialography rs&i (75825) | $10,153.40 | $10,153.40 | 3.1× |
| Venography caval superior serialography rs&i (75827) | $4,222.55 | $4,222.55 | 2.6× |
| Venography renal unilateral selective rs&i (75831) | $6,343.48 | $6,343.48 | 1.9× |
| Wrist 2 views (73100) | $713.71 | $713.71 | 7.9× |
| X-Ray Abdomen,Comp Acute Series - Xr Abdomen 2 Vws With Chest 1 View (74022) | $1,368.51 | $1,368.51 | 12.5× |
| X-Ray Ac Jts - Xr Acromioclavicular Joints Bilateral (73050) | $908.10 | $908.10 | 10.0× |
| X-ray b.e. reductn intuss (74283) | $1,139.02 | $1,139.02 | 6.2× |
| X-Ray Colon Air Contrast - Fl Barium Enema Air Contrast (74280) | $1,829.51 | $1,829.51 | 10.0× |
| X-Ray Elbow 2 Vw - Xr Elbow 1-2 Views Right (73070) | $827.94 | $827.94 | 9.1× |
| X-Ray Exam Hip Uni 2-3 Views (73502) | $781.81 | $781.81 | 8.6× |
| X-Ray Exam Hips Bi 3-4 Views (73522) | $270 | $270 | 2.5× |
| X-ray exam of femur 2/> (73552) | $874.03 | $874.03 | 9.6× |
| X-ray eye for foreign body (70030) | $330.66 | $330.66 | 3.6× |
| X-Ray Facial Bones <3 Vw - Xr Facial Bones 1-2 Views (70140) | $1,012.35 | $1,012.35 | 11.1× |
| X-Ray Jaw <4 Vw - Xr Mandible < 4 Views (70100) | $827.94 | $827.94 | 9.1× |
| X-Ray Knee Bilat Standing - Xr Knees Anteroposterior Standing Bilat (73565) | $364.68 | $364.68 | 4.0× |
| X-ray leg, infant (73592) | $835.95 | $835.95 | 9.2× |
| X-Ray Lumbar Spine 2/3 Vw - Xr Lumbar Spine 2-3 Views (72100) | $1,311.05 | $1,311.05 | 12.0× |
| X-Ray Lumbar Spine 6+ Vw - Xr Lumbar Spine 6+ Vws Including Bending (72114) | $2,702.27 | $2,702.27 | 24.8× |
| X-ray nose-rectum child f.b. (76010) | $220 | $220 | 2.4× |
| X-Ray Orbits - Xr Orbits Complete 4+ Views (70200) | $1,295.84 | $1,295.84 | 11.9× |
| X-ray retrograde pyelogram (74420) | $1,214.36 | $1,214.36 | 3.3× |
| X-Ray Ribs 2 Vw Unilat - Xr Ribs 2 Views Right (71100) | $966.25 | $966.25 | 10.6× |
| X-Ray Ribs, Chest 3+ Vw - Xr Ribs 2 Vws Lt W/ Chest Anteroposterior (71101) | $1,196.79 | $1,196.79 | 11.0× |
| X-Ray Ribs, Chest 4+ Vw - Xr Ribs 3 Vws Bil W/ Chest Posteroanterior (71111) | $1,403.25 | $1,403.25 | 12.9× |
| X-Ray Sacroiliac Jts 3+ Vw - Xr Sacroiliac Joints 3+ Views (72202) | $934.16 | $934.16 | 8.6× |
| X-Ray Sacrum/Coccyx 2+ Vw - Xr Sacrum Coccyx 2+ Views (72220) | $934.16 | $934.16 | 10.3× |
| X-Ray Sinuses 3+ Vw - Xr Paranasal Sinuses 3+ Views (70220) | $1,064.48 | $1,064.48 | 11.7× |
| X-Ray Skull 4+ Vw - Xr Skull Complete 4+ Views (70260) | $1,134.64 | $1,134.64 | 10.4× |
| X-Ray Skull <4 Vw - Xr Skull 1-3 Views (70250) | $705.64 | $705.64 | 6.5× |
| X-Ray Spine One View - Xr Spine (72020) | $618.22 | $618.22 | 6.8× |
| X-Ray Sternum 2+ Vw - Xr Sternum 2+ Views (71120) | $934.16 | $934.16 | 10.3× |
| X-Ray Thoracic Spine 2 Vw - Xr Thoracic Spine 2 Views (72070) | $270 | $270 | 2.5× |
| X-Ray Thoracic Spine 4 Vw - Xr Thoracic Spine Complete 4+ Views (72074) | $1,016.37 | $1,016.37 | 9.3× |
| Xr bone length studies (77073) | $475.52 | $475.52 | 4.4× |
| Xr c-spine 4 or 5 views (72050) | $1,621.76 | $1,621.76 | 14.9× |
| Xr c-spine 6 or more views (72052) | $1,866.33 | $1,866.33 | 17.1× |
| Xr chest 4+ views (71048) | $1,506.71 | $1,506.71 | 13.8× |
| Xr urogram antegrade (74425) | $1,028.35 | $1,028.35 | 2.8× |