Imaging prices at Bellevue Medical Center
Bellevue, NE · every code in this section with a posted price and a Medicare benchmark.
544 codes. Prices are the hospital's own posted facility charges.
Compare against other hospitals interactively →
| Procedure | Posted cash | Posted gross | × Medicare |
|---|---|---|---|
| 3-D radiotherapy plan dose-volume histograms (77295) range across 4 matching MRF lines |
$950.04–$4,615 | $1,461.60–$7,100 | varies |
| Abdomen 1 View (74018) range across 3 matching MRF lines |
$39–$188.50 | $60–$290 | varies |
| Abdomen 2 views (74019) range across 2 matching MRF lines |
$54.80–$211.25 | $84.30–$325 | varies |
| Acute Gastrointestinal Blood Loss Imaging (78278) range across 2 matching MRF lines |
$741.20–$975 | $1,140.30–$1,500 | varies |
| Acute venous thrombosis imaging, peptide Non-Facility (78456) | $723.65 | $1,113.30 | 0.5× |
| Adrenal Cortex & Medulla Img (78075) | $858.33 | $1,320.50 | 0.6× |
| Angio internal mammary (75756) range across 2 matching MRF lines |
$874.97–$4,725.50 | $1,346.10–$7,270 | varies |
| Angio pulmonary bilat (75743) range across 3 matching MRF lines |
$916.63–$4,748.25 | $1,410.20–$7,305 | varies |
| Angiography Adrenal Bilateral Slctv Rs&I (75733) range across 2 matching MRF lines |
$887.25–$2,210 | $1,365–$3,400 | varies |
| Angiography extremity bilateral rs&i (75716) range across 3 matching MRF lines |
$844.29–$5,593.25 | $1,298.90–$8,605 | varies |
| Angiography extremity unilateral rs&i (75710) range across 2 matching MRF lines |
$831.29–$5,242.25 | $1,278.90–$8,065 | varies |
| Angiography pulmonary unilateral slctv rs&i (75741) range across 3 matching MRF lines |
$886.60–$4,748.25 | $1,364–$7,305 | varies |
| Angrph pulmonary nonslctv cath/ven njx rs&i (75746) range across 3 matching MRF lines |
$871.59–$4,748.25 | $1,340.90–$7,305 | varies |
| Ankle 2 views (73600) range across 2 matching MRF lines |
$68.25–$263.25 | $105–$405 | varies |
| Aortography thoracic serialography rs&i (75605) range across 2 matching MRF lines |
$831.29–$7,150 | $1,278.90–$11,000 | varies |
| Aortography thoracic w/o serialography rs&i (75600) range across 2 matching MRF lines |
$814.91–$1,950 | $1,253.70–$3,000 | varies |
| Artery X-Rays Abdomen (75726) range across 2 matching MRF lines |
$829.27–$7,585.50 | $1,275.80–$11,670 | varies |
| Artery X-Rays Adrenal Gland (75731) range across 2 matching MRF lines |
$871.59–$1,105 | $1,340.90–$1,700 | varies |
| Artery X-Rays Pelvis (75736) range across 2 matching MRF lines |
$829.92–$7,585.50 | $1,276.80–$11,670 | varies |
| Artery X-Rays Spine (75705) range across 2 matching MRF lines |
$919.36–$7,150 | $1,414.40–$11,000 | varies |
| Arthrogram ankle (73615) | $183.63 | $282.50 | 0.5× |
| Arthrogram hip (73525) range across 2 matching MRF lines |
$316.39–$1,243.13 | $486.75–$1,912.50 | varies |
| Arthrogram Wrist (73115) range across 2 matching MRF lines |
$347.20–$877.50 | $534.15–$1,350 | varies |
| Basic radiation dosimetry calculation (77300) range across 3 matching MRF lines |
$129.68–$422.50 | $199.50–$650 | varies |
| Bone age studies (77072) range across 2 matching MRF lines |
$45.31–$201.50 | $69.70–$310 | varies |
| Bone Imaging 3 Phase (78315) range across 2 matching MRF lines |
$711.75–$739.90 | $1,095–$1,138.30 | varies |
| Bone Imaging Limited Area (78300) range across 2 matching MRF lines |
$331.05–$975 | $509.30–$1,500 | varies |
| Bone Imaging Multiple Areas (78305) | $431.34 | $663.60 | 1.0× |
| Bone Imaging Whole Body (78306) range across 2 matching MRF lines |
$532.68–$711.75 | $819.50–$1,095 | varies |
| Bone marrow imaging limited area (78102) | $322.14 | $495.60 | 0.8× |
| Bone marrow imaging; multiple areas (78103) | $422.50 | $650 | 1.0× |
| Bone marrow imaging; whole body (78104) | $479.83 | $738.20 | 1.2× |
| Bone survey infant (77076) range across 2 matching MRF lines |
$216.91–$234 | $333.70–$360 | varies |
| Brachytx isodose complex (77318) range across 2 matching MRF lines |
$554.91–$910 | $853.70–$1,400 | varies |
| Brachytx isodose intermed (77317) range across 2 matching MRF lines |
$384.28–$910 | $591.20–$1,400 | varies |
| Brachytx Isodose Plan Simple (77316) range across 2 matching MRF lines |
$293.48–$910 | $451.50–$1,400 | varies |
| Brain Flow Imaging Only (78610) range across 2 matching MRF lines |
$357.05–$841.75 | $549.30–$1,295 | varies |
| Brain Image W/Flow < 4 Views (78601) range across 2 matching MRF lines |
$455.91–$975 | $701.40–$1,500 | varies |
| Brain imaging < 4 static views (78600) | $351.91 | $541.40 | 0.8× |
| Brain Imaging Min 4 Static Views W Vascular Flow (78606) | $665.60 | $1,024 | 1.2× |
| Brain Imaging Minimum 4 Static Views (78605) range across 2 matching MRF lines |
$378.37–$841.75 | $582.10–$1,295 | varies |
| Brain Imaging Pet Metabolic Evaluation (78608) range across 2 matching MRF lines |
$204.75–$4,225 | $315–$6,500 | varies |
| Card Bl Pool Gated Spect Rest Wal Motn Ejct Frct (78494) | $415.87 | $639.80 | 1.0× |
| Cardiac blood pool imaging, first pass technique; multiple studies, resting and with stress (exercise and/or… (78483) | $616.98 | $949.20 | 1.1× |
| Cardiac MRI w/w/o contrast & further seq (75561) range across 2 matching MRF lines |
$1,231.95–$1,365 | $1,895.30–$2,100 | varies |
| Cardiac MRI w/w/o contrast w/stress (75563) range across 2 matching MRF lines |
$1,430–$1,519.96 | $2,200–$2,338.40 | varies |
| Cardiac Shunt Detection (78428) | $411.58 | $633.20 | 1.0× |
| Cardiovasc nucl exam unlisted (78499) | $975 | $1,500 | 2.3× |
| Cat Scan Follow-Up Study (76380) range across 4 matching MRF lines |
$97.63–$780 | $150.20–$1,200 | varies |
| Cerebrospinal Fluid Flow W/O Matl Shunt Evaltj (78645) range across 2 matching MRF lines |
$647.99–$1,300 | $996.90–$2,000 | varies |
| Cerebrospinal fluid flow, imaging (not including introduction of material); ventriculography Non-Facility (78635) | $668.53 | $1,028.50 | 1.2× |
| Cerebrospinal Fluid Scan (78630) range across 2 matching MRF lines |
$735.93–$1,300 | $1,132.20–$2,000 | varies |
| Chest 1 view (71045) range across 3 matching MRF lines |
$45.50–$188.50 | $70–$290 | varies |
| Chest 2 views (71046) range across 2 matching MRF lines |
$50.05–$169 | $77–$260 | varies |
| Chest 3 views (71047) range across 2 matching MRF lines |
$64.35–$227.50 | $99–$350 | varies |
| Chest 4 or more views (71048) range across 3 matching MRF lines |
$68.90–$243.75 | $106–$375 | varies |
| Chg us nrv&acc strux 1 xtr compre w/img pr extremity (76883) range across 2 matching MRF lines |
$88.08–$260 | $135.50–$400 | varies |
| Cholecystography Oral Contrast (74290) | $130.39 | $200.60 | 0.7× |
| Cineradiograpy/vidradiograpy xcpt where spec (76120) | $127.34 | $195.90 | 1.2× |
| Cisternography Positive Contrast Rs&I (70015) | $273.72 | $421.10 | 0.3× |
| Clavicle complete (73000) range across 2 matching MRF lines |
$87.56–$219.38 | $134.70–$337.50 | varies |
| Computed Tomography Thorax Lw Dose Lng Ca Scr C- (71271) range across 4 matching MRF lines |
$70.85–$770.25 | $109–$1,185 | varies |
| Continuing medical physics consltj pr wk (77336) range across 2 matching MRF lines |
$116.95–$305.50 | $179.93–$470 | varies |
| Contrast Exam Abdominl Aorta (75625) range across 4 matching MRF lines |
$829.92–$3,568.50 | $1,276.80–$5,490 | varies |
| Contrast X-Ray Bladder (74430) range across 2 matching MRF lines |
$148.79–$464.75 | $228.90–$715 | varies |
| Contrast X-Ray Of Elbow (73085) range across 2 matching MRF lines |
$178.17–$588.25 | $274.10–$905 | varies |
| Contrast X-Ray Of Knee Joint (73580) range across 2 matching MRF lines |
$354.12–$1,287 | $544.80–$1,980 | varies |
| Contrast Xray Throat/Cerv Esopha (74210) range across 2 matching MRF lines |
$146.77–$237.25 | $225.80–$365 | varies |
| Corpora cavernosography (74445) range across 2 matching MRF lines |
$170.63–$325 | $262.50–$500 | varies |
| CT abdomen and pelvis without and with contrast (74178) range across 2 matching MRF lines |
$771.62–$1,160.25 | $1,187.10–$1,785 | varies |
| CT abdomen and pelvis without contrast (74176) range across 2 matching MRF lines |
$307.32–$819 | $472.80–$1,260 | varies |
| CT abdomen w contrast (74160) range across 2 matching MRF lines |
$690.69–$731.25 | $1,062.60–$1,125 | varies |
| CT abdomen w wo contrast (74170) range across 2 matching MRF lines |
$828.75–$925.47 | $1,275–$1,423.80 | varies |
| CT abdomen w/o contrast (74150) range across 2 matching MRF lines |
$500.96–$650 | $770.70–$1,000 | varies |
| CT Angio Abdomen and Pelvis (74174) range across 2 matching MRF lines |
$955.50–$984.69 | $1,470–$1,514.90 | varies |
| CT Angio Chest (71275) range across 3 matching MRF lines |
$682.50–$1,015.95 | $1,050–$1,563 | varies |
| CT Angio Head (70496) range across 2 matching MRF lines |
$682.50–$1,281.74 | $1,050–$1,971.90 | varies |
| CT angio hrt w/3d image (75574) range across 2 matching MRF lines |
$731.25–$944.78 | $1,125–$1,453.50 | varies |
| Ct Angio Lwr Extr W/O&W/Dye (73706) range across 2 matching MRF lines |
$1,023.75–$1,460.94 | $1,575–$2,247.60 | varies |
| CT Angio Neck (70498) range across 2 matching MRF lines |
$682.50–$1,291.29 | $1,050–$1,986.60 | varies |
| Ct Angio Upr Extrm W/O&W/Dye (73206) range across 2 matching MRF lines |
$999.38–$1,245.17 | $1,537.50–$1,915.65 | varies |
| CT bone density (77078) range across 2 matching MRF lines |
$296.34–$468.65 | $455.90–$721 | varies |
| CT Cere Prfuj Alys C+ W/O CT/Cta Same Anatomy (70473) range across 2 matching MRF lines |
$74.10–$292.50 | $114–$450 | varies |
| CT cervical spine w/ contrast (72126) range across 2 matching MRF lines |
$632.71–$845 | $973.40–$1,300 | varies |
| CT cervical spine w/o contrast (72125) range across 2 matching MRF lines |
$525.53–$650 | $808.50–$1,000 | varies |
| CT cervical spine w/wo cont (72127) range across 2 matching MRF lines |
$775.32–$780 | $1,192.80–$1,200 | varies |
| CT chest w contrast (71260) range across 3 matching MRF lines |
$634.08–$975 | $975.50–$1,500 | varies |
| CT chest w/wo contrast (71270) range across 2 matching MRF lines |
$782.15–$828.75 | $1,203.30–$1,275 | varies |
| CT colonography screening (74263) range across 2 matching MRF lines |
$1,300–$1,680.25 | $2,000–$2,585 | varies |
| CT Colonogrphy Dx Image Postprocess W/Contrast (74262) | $1,295 | $1,992.30 | 7.1× |
| CT colonogrphy dx image postprocess w/o contrast (74261) range across 2 matching MRF lines |
$1,098.44–$1,300 | $1,689.90–$2,000 | varies |
| CT head/brain with contrast (70460) range across 2 matching MRF lines |
$525.53–$731.25 | $808.50–$1,125 | varies |
| CT head/brain without and with contrast (70470) range across 2 matching MRF lines |
$632.71–$828.75 | $973.40–$1,275 | varies |
| CT heart contrast eval cardiac structure&morph (75572) range across 2 matching MRF lines |
$635.12–$731.25 | $977.10–$1,125 | varies |
| CT heart no contrast quant eval coronry calcium (75571) range across 2 matching MRF lines |
$146.25–$367.90 | $225–$566 | varies |
| CT hrt w/3d image congen (75573) range across 2 matching MRF lines |
$731.25–$867.69 | $1,125–$1,334.90 | varies |
| CT iac w contrast (70481) range across 2 matching MRF lines |
$731.25–$774.67 | $1,125–$1,191.80 | varies |
| CT l-spine w&w/o contrast (72133) range across 2 matching MRF lines |
$773.31–$861.25 | $1,189.70–$1,325 | varies |
| CT lower ext w/o (73700) range across 2 matching MRF lines |
$771.91–$975 | $1,187.55–$1,500 | varies |
| CT lower extremity w/contrast material (73701) range across 2 matching MRF lines |
$938.83–$1,096.88 | $1,444.35–$1,687.50 | varies |
| CT lumbar spine w contrast (72132) range across 2 matching MRF lines |
$631.35–$845 | $971.30–$1,300 | varies |
| CT lumbar spine w/o contrast (72131) range across 2 matching MRF lines |
$522.80–$650 | $804.30–$1,000 | varies |
| CT maxillofacial w contrast (70487) range across 2 matching MRF lines |
$660.66–$731.25 | $1,016.40–$1,125 | varies |
| CT maxillofacial wo contrast (70486) range across 8 matching MRF lines |
$65–$1,300 | $100–$2,000 | varies |
| CT neck tissue combo (70492) range across 2 matching MRF lines |
$785.59–$828.75 | $1,208.60–$1,275 | varies |
| Ct Orbit/Ear/Fossa W/O&W/Dye (70482) range across 2 matching MRF lines |
$828.75–$876.33 | $1,275–$1,348.20 | varies |
| CT orbits w/o contrast (70480) range across 2 matching MRF lines |
$650–$666.84 | $1,000–$1,025.90 | varies |
| CT pelvis w&w/o contrast (72194) range across 2 matching MRF lines |
$761.80–$775.32 | $1,172–$1,192.80 | varies |
| CT pelvis w/o contrast (72192) range across 2 matching MRF lines |
$491.40–$650 | $756–$1,000 | varies |
| CT scan of leg combo (73702) range across 2 matching MRF lines |
$1,170–$1,221.38 | $1,800–$1,879.05 | varies |
| CT scans face/jaw combo (70488) range across 2 matching MRF lines |
$763.75–$806.72 | $1,175–$1,241.10 | varies |
| CT soft tissue neck w contrast (70491) range across 3 matching MRF lines |
$442.98–$975 | $681.50–$1,500 | varies |
| CT soft tissue neck w/o contrast (70490) range across 2 matching MRF lines |
$534.43–$650 | $822.20–$1,000 | varies |
| CT thoracic spine w contrast (72129) range across 2 matching MRF lines |
$632.71–$731.25 | $973.40–$1,125 | varies |
| CT thoracic spine w/o contrast (72128) range across 2 matching MRF lines |
$524.88–$650 | $807.50–$1,000 | varies |
| CT thoracic spine w/wo cont (72130) range across 2 matching MRF lines |
$770.58–$780 | $1,185.50–$1,200 | varies |
| CT thorax w/o contrast (71250) range across 3 matching MRF lines |
$524.16–$770.25 | $806.40–$1,185 | varies |
| CT unlisted procedure (76497) | $1,218.75 | $1,875 | 13.5× |
| CT upper ext wo (73200) range across 2 matching MRF lines |
$770.93–$975 | $1,186.05–$1,500 | varies |
| CT upper extremity w/o & w/contrast material (73202) range across 2 matching MRF lines |
$1,170–$1,203.93 | $1,800–$1,852.20 | varies |
| CT upper extremity with contrast (73201) range across 2 matching MRF lines |
$931.61–$1,096.88 | $1,433.25–$1,687.50 | varies |
| Cta Abdl Aorta&Bi Iliofem W/Contrast&Postp (75635) range across 2 matching MRF lines |
$926.25–$1,116.57 | $1,425–$1,717.80 | varies |
| Cta Abdomen (74175) range across 2 matching MRF lines |
$682.50–$1,003.21 | $1,050–$1,543.40 | varies |
| CTA head&neck c+ w/noncontrast img&post-pxessing (70471) range across 2 matching MRF lines |
$184.60–$579.80 | $284–$892 | varies |
| CTA pelvis (72191) range across 2 matching MRF lines |
$666.25–$942.50 | $1,025–$1,450 | varies |
| Dacryocystography, nasolacrimal duct, radiological supervision and interpretation Non-Facility (70170) | $96.92 | $149.10 | 0.4× |
| Determination of central c-v hemodynamics (non-imaging) (eg, ejection fraction with probe technique) with or without… (78414) | $34.71 | $53.40 | 0.1× |
| Dilation ureters/urethra rs&i (74485) range across 2 matching MRF lines |
$240.24–$1,625 | $369.60–$2,500 | varies |
| Discography Cerv/Thor Spine (72285) range across 2 matching MRF lines |
$614.25–$1,020.50 | $945–$1,570 | varies |
| Diskography lumbar (72295) range across 2 matching MRF lines |
$554.19–$1,020.50 | $852.60–$1,570 | varies |
| Doppler Echo Fetal Puls Spectral F/U/Repeat (76828) range across 2 matching MRF lines |
$114.66–$173.55 | $176.40–$267 | varies |
| Doppler Echo Fetal Spectral Display Complete (76827) range across 2 matching MRF lines |
$151.52–$195 | $233.10–$300 | varies |
| Doppler Fetal Mid Cerebral Artery (76821) range across 3 matching MRF lines |
$68.97–$195 | $106.10–$300 | varies |
| Dxa Bone Density Axial (77080) range across 2 matching MRF lines |
$136.44–$211.25 | $209.90–$325 | varies |
| Dxa bone density study (77085) range across 3 matching MRF lines |
$88.73–$195 | $136.50–$300 | varies |
| Dxa bone density study 1/>sites appendiclr skel (77081) range across 2 matching MRF lines |
$55.90–$77.61 | $86–$119.40 | varies |
| Echo exam of fetal heart (76825) range across 2 matching MRF lines |
$419.77–$923 | $645.80–$1,420 | varies |
| Echo exam uterus (76831) range across 2 matching MRF lines |
$227.96–$365.30 | $350.70–$562 | varies |
| Echo Guide For Artery Repair (76936) range across 2 matching MRF lines |
$614.25–$1,170 | $945–$1,800 | varies |
| Echocardiography, fetal, cardiovascular system, real time with image documentation (2D), with or without M-mode… (76826) range across 2 matching MRF lines |
$247.78–$364 | $381.20–$560 | varies |
| Echograp Trans R Pros Study (76873) range across 2 matching MRF lines |
$216.26–$305.50 | $332.70–$470 | varies |
| Esophageal Motility Study (78258) | $431.99 | $664.60 | 1.0× |
| Esophagram (74220) range across 2 matching MRF lines |
$187.01–$453.70 | $287.70–$698 | varies |
| Fetal Biophys Profile W/Nst (76818) range across 3 matching MRF lines |
$103.74–$240.70 | $159.60–$370.30 | varies |
| Fetal Biophysical Profile W/O Non-Stress Testing (76819) range across 3 matching MRF lines |
$75.08–$195 | $115.50–$300 | varies |
| Fetal MRI w/placntl matrnl plvc img sing/1st ges (74712) range across 2 matching MRF lines |
$438.75–$725.40 | $675–$1,116 | varies |
| Fluoroscopy up to 1 hr (76000) range across 2 matching MRF lines |
$193.18–$425.75 | $297.20–$655 | varies |
| Follow-Up Angiography (75898) range across 2 matching MRF lines |
$201.37–$2,015 | $309.80–$3,100 | varies |
| Foot 2 views (73620) range across 2 matching MRF lines |
$58.50–$219.38 | $90–$337.50 | varies |
| Forearm 2 views (73090) range across 2 matching MRF lines |
$84.24–$263.25 | $129.60–$405 | varies |
| Gastric emptying imaging study (78264) range across 2 matching MRF lines |
$613.80–$711.75 | $944.30–$1,095 | varies |
| Gastric Emptyng Imag Std W/Sm Bwl Transit (78265) | $615.55 | $947 | 1.5× |
| Gastric Mucosa Imaging (78261) range across 2 matching MRF lines |
$534.69–$975 | $822.60–$1,500 | varies |
| Gastroesophageal Reflux Exam (78262) | $479.77 | $738.10 | 1.2× |
| Gastrointestinal Protein Loss (78282) | $45.76 | $70.40 | 0.1× |
| Gated Heart Planar Single (78472) range across 2 matching MRF lines |
$508.30–$975 | $782–$1,500 | varies |
| Gated Heart, Multiple (78473) range across 2 matching MRF lines |
$645.65–$975 | $993.30–$1,500 | varies |
| GI Endoscopic US S&I (76975) | $158.34 | $243.60 | 0.6× |
| Gstrc Emptng Imag Std W/Sm Bwl Col Trnst Mlt Day (78266) | $729.95 | $1,123 | 1.3× |
| Hand 2 views (73120) range across 4 matching MRF lines |
$84.24–$316.88 | $129.60–$487.50 | varies |
| Hdr Rdncl Ntrstl/Icav Brchtx (77772) range across 2 matching MRF lines |
$1,378–$1,430 | $2,120–$2,200 | varies |
| Hdr Rdncl Ntrstl/Icav Brchtx (77771) range across 2 matching MRF lines |
$904.80–$1,365 | $1,392–$2,100 | varies |
| Hdr Rdncl Ntrstl/Icav Brchtx 1 Channel (77770) range across 2 matching MRF lines |
$485.55–$1,300 | $747–$2,000 | varies |
| Heart first pass single,planar (78481) | $418.41 | $643.70 | 0.7× |
| Heart Image (Pet) Multiple (78492) range across 2 matching MRF lines |
$322.86–$2,600 | $496.70–$4,000 | varies |
| Hepatc Vngrph Wdg/Fr Hemodyn Eval Rs&I (75889) range across 2 matching MRF lines |
$829.27–$4,433 | $1,275.80–$6,820 | varies |
| Hepatc Vngrph Wdg/Fr W/O Hemodyn Eval Rs&I (75891) range across 2 matching MRF lines |
$829.27–$4,433 | $1,275.80–$6,820 | varies |
| Hepatobil Syst Image W/Drug (78227) range across 2 matching MRF lines |
$877.44–$949 | $1,349.90–$1,460 | varies |
| Hepatobiliary System Imaging (78226) range across 2 matching MRF lines |
$631.80–$975 | $972–$1,500 | varies |
| Ht Musc Image Planar Mult (78454) range across 2 matching MRF lines |
$820.89–$2,600 | $1,262.90–$4,000 | varies |
| Ht Muscle Image Spect Sing (78451) range across 2 matching MRF lines |
$744.71–$1,898 | $1,145.70–$2,920 | varies |
| Hyperthermia external generated superficial (77600) | $732.49 | $1,126.90 | 1.8× |
| Hyperthermia generated by interstitial probe(s); 5 or fewer interstitial applicators Non-Facility (77610) | $1,265.81 | $1,947.40 | 2.2× |
| Hyperthermia generated by interstitial probe(s); more than 5 interstitial applicators Non-Facility (77615) | $1,912.56 | $2,942.40 | 3.3× |
| Hyperthermia generated by intracavitary probe(s) Non-Facility (77620) | $1,140.36 | $1,754.40 | 2.0× |
| Hyperthermia, externally generated; deep (ie, heating to depths greater than 4 cm) Non-Facility (77605) | $1,279.79 | $1,968.90 | 1.8× |
| Hysterosalpingogram (74740) range across 2 matching MRF lines |
$164.58–$438.75 | $253.20–$675 | varies |
| Infant hip ultrasound with hip movement (dynamic) (76885) range across 2 matching MRF lines |
$306.74–$552.50 | $471.90–$850 | varies |
| Infant hip ultrasound, limited static exam (76886) | $165.56 | $254.70 | 1.8× |
| Infusion Ivp (74410) | $219.12 | $337.10 | 1.2× |
| Interstitial radiation source applic complex (77778) range across 3 matching MRF lines |
$1,618.89–$2,600 | $2,490.60–$4,000 | varies |
| Intracavitary Radiation Source Applic Complex (77763) range across 2 matching MRF lines |
$1,257.56–$2,141.75 | $1,934.70–$3,295 | varies |
| Intracavitary Radiation Source Applic Intermed (77762) range across 2 matching MRF lines |
$934.38–$1,513.20 | $1,437.50–$2,328 | varies |
| Intracavitary radiation source applic simple (77761) range across 2 matching MRF lines |
$385.26–$950.30 | $592.70–$1,462 | varies |
| Intraop radiaj tx deliver xray single tx session (77424) | $4,699.50 | $7,230 | 0.6× |
| Joint Survey Single View (77077) range across 2 matching MRF lines |
$79.69–$234 | $122.60–$360 | varies |
| K Flow/Funct Image Multiple (78709) | $702.98 | $1,081.50 | 1.2× |
| K Flow/Funct Image W/Drug (78708) range across 2 matching MRF lines |
$381.55–$975 | $587–$1,500 | varies |
| K Flow/Funct Image W/O Drug (78707) range across 2 matching MRF lines |
$492.05–$975 | $757–$1,500 | varies |
| Kidney Funcj Study Non-Img Radioisotopic Study (78725) range across 2 matching MRF lines |
$219.44–$975 | $337.60–$1,500 | varies |
| Kidney Imaging Morphol (78700) | $340.21 | $523.40 | 0.8× |
| Kidney Imaging Morphoogy W/Vascular Flow (78701) | $418.80 | $644.30 | 1.0× |
| Knee 3 Views (73562) range across 3 matching MRF lines |
$97.50–$341.25 | $150–$525 | varies |
| Labeled RBC Sequestration Differntl Organ/Tissue (78140) | $294.84 | $453.60 | 0.7× |
| Leveen/Shunt Patency Exam (78291) range across 2 matching MRF lines |
$465.79–$975 | $716.60–$1,500 | varies |
| Liver & Spleen Imaging Static Only (78215) range across 2 matching MRF lines |
$411.78–$975 | $633.50–$1,500 | varies |
| Liver & Spleen Imaging W/Vascular Flow (78216) | $263.45 | $405.30 | 0.6× |
| Liver imaging static only (78201) range across 2 matching MRF lines |
$393.84–$2,600 | $605.90–$4,000 | varies |
| Liver imaging w/vascular flow (78202) | $400.40 | $616 | 0.7× |
| Lung Perf&Ventilat Diferentl (78598) range across 2 matching MRF lines |
$566.48–$975 | $871.50–$1,500 | varies |
| Lung perfusion differential (78597) range across 2 matching MRF lines |
$349.44–$975 | $537.60–$1,500 | varies |
| Lung Ventilat&Perfus Imaging (78582) range across 2 matching MRF lines |
$584.81–$830.70 | $899.70–$1,278 | varies |
| Lung Ventilation Imaging (78579) range across 2 matching MRF lines |
$296.21–$975 | $455.70–$1,500 | varies |
| Lymph System Imaging (78195) range across 2 matching MRF lines |
$754.07–$812.50 | $1,160.10–$1,250 | varies |
| Lymphangiography Extremity Only Bilateral Rs&I (75803) range across 2 matching MRF lines |
$434.07–$910 | $667.80–$1,400 | varies |
| Lymphangiography extremity only unilateral rs&i (75801) range across 2 matching MRF lines |
$404.76–$949 | $622.70–$1,460 | varies |
| Lymphangiography Pelvic/Abdominal Bilateral Rs&I (75807) range across 2 matching MRF lines |
$476.39–$4,433 | $732.90–$6,820 | varies |
| Lymphangiography, pelvic/abdominal, unilateral (75805) range across 2 matching MRF lines |
$445.71–$1,170 | $685.70–$1,800 | varies |
| Magnetic Image Jaw Joint (70336) range across 2 matching MRF lines |
$935.03–$1,121.25 | $1,438.50–$1,725 | varies |
| Magnetic resonance (eg, proton) imaging, brain (including brain stem andskull base), during open intracranial procedure… (70558) | $269.30 | $414.30 | 1.5× |
| Magnetic resonance (eg, proton) imaging, brain (including brain stem andskull base), during open intracranial procedure… (70557) | $239.14 | $367.90 | 0.4× |
| Magnetic resonance (eg, proton) imaging, brain (including brain stem andskull base), during open intracranial procedure… (70559) | $254.15 | $391 | 1.4× |
| Magnetic Resonance Elastography (76391) range across 2 matching MRF lines |
$87.75–$272.68 | $135–$419.50 | varies |
| Mammary ductogram or galactogram multiple (77054) range across 2 matching MRF lines |
$139.10–$334.75 | $214–$515 | varies |
| Mammary ductogram or galactogram single (77053) | $100.17 | $154.10 | 0.4× |
| Meckels Divert Exam (78290) range across 2 matching MRF lines |
$568.75–$654.62 | $875–$1,007.10 | varies |
| Medical physics dose eval radiation expos w/rprt (76145) | $1,276.60 | $1,964 | 3.3× |
| Mlc imrt design & construction per imrt plan (77338) range across 2 matching MRF lines |
$913.25–$941.27 | $1,405–$1,448.10 | varies |
| Mr safety determination physician/other qhp (76016) | $136.50 | $210 | 1.5× |
| Mr safety implant&/fb assmt clin staf 1st 15 min (76014) | $39 | $60 | 1.3× |
| Mra Head W/O & W/Contrast Material (70546) range across 3 matching MRF lines |
$890.70–$1,745.19 | $1,370.30–$2,684.90 | varies |
| MRA head w/o contrast (70544) range across 3 matching MRF lines |
$579.48–$1,170 | $891.50–$1,800 | varies |
| MRA head with contrast (70545) range across 2 matching MRF lines |
$1,150.05–$1,774.50 | $1,769.30–$2,730 | varies |
| MRA neck w contrast (70548) range across 2 matching MRF lines |
$1,210.11–$1,774.50 | $1,861.70–$2,730 | varies |
| Mra Neck W/O &W/Contrast Material (70549) range across 3 matching MRF lines |
$193.31–$1,670.44 | $297.40–$2,569.90 | varies |
| MRA neck w/o contrast (70547) range across 3 matching MRF lines |
$129.22–$1,170 | $198.80–$1,800 | varies |
| MRI abdomen w contrast (74182) range across 2 matching MRF lines |
$1,301.56–$1,774.50 | $2,002.40–$2,730 | varies |
| MRI abdomen w/o contrast (74181) range across 2 matching MRF lines |
$948.03–$1,121.25 | $1,458.50–$1,725 | varies |
| MRI any jt lower extrem w/contrast material (73722) range across 2 matching MRF lines |
$1,644.14–$1,852.50 | $2,529.45–$2,850 | varies |
| MRI any jt lower extrem w/o & w/contrast matrl (73723) range across 2 matching MRF lines |
$2,291.25–$2,546.12 | $3,525–$3,917.10 | varies |
| MRI any jt upper extremity w/contrast matrl (73222) range across 2 matching MRF lines |
$1,625.72–$1,852.50 | $2,501.10–$2,850 | varies |
| MRI bone marrow blood supply (77084) | $1,017.84 | $1,565.90 | 4.1× |
| MRI brain functional w/o physician admnistration (70554) range across 2 matching MRF lines |
$944.97–$1,430 | $1,453.80–$2,200 | varies |
| MRI brain functional w/physician admnistration (70555) range across 2 matching MRF lines |
$252.53–$1,430 | $388.50–$2,200 | varies |
| MRI Breast W/O Contrast Bilateral (77047) range across 2 matching MRF lines |
$126.75–$1,072.50 | $195–$1,650 | varies |
| MRI Breast Without Contrast Material Unilateral (77046) range across 2 matching MRF lines |
$114.40–$497.25 | $176–$765 | varies |
| MRI cardiac w/o cont stress (75559) range across 2 matching MRF lines |
$1,333.61–$1,478.75 | $2,051.70–$2,275 | varies |
| MRI cardiac w/o contrast (75557) range across 2 matching MRF lines |
$911.82–$1,170 | $1,402.80–$1,800 | varies |
| MRI cervical spine w contrast (72142) range across 2 matching MRF lines |
$1,199.84–$1,235 | $1,845.90–$1,900 | varies |
| MRI cervical spine w/o cont (72141) range across 2 matching MRF lines |
$963.04–$1,121.25 | $1,481.60–$1,725 | varies |
| MRI chest w/o contrast (71550) range across 2 matching MRF lines |
$1,121.25–$1,208.74 | $1,725–$1,859.60 | varies |
| MRI chest with contrast (71551) range across 2 matching MRF lines |
$1,334.97–$1,950 | $2,053.80–$3,000 | varies |
| MRI chest wo w contrast (71552) range across 2 matching MRF lines |
$1,527.50–$1,722.63 | $2,350–$2,650.20 | varies |
| MRI lower extrem oth/thn jt w/contrast matrl (73719) range across 2 matching MRF lines |
$1,735.31–$2,925 | $2,669.70–$4,500 | varies |
| MRI lower extrem oth/thn jt w/o & w/contr matr (73720) range across 2 matching MRF lines |
$2,291.25–$2,544.07 | $3,525–$3,913.95 | varies |
| MRI lower extrem oth/thn jt w/o contr matrl (73718) range across 2 matching MRF lines |
$1,588.86–$1,681.88 | $2,444.40–$2,587.50 | varies |
| MRI lumbar spine w contrast (72149) range across 2 matching MRF lines |
$1,182.09–$1,774.50 | $1,818.60–$2,730 | varies |
| Mri Neck Spine W/O & W/Dye (72156) range across 2 matching MRF lines |
$1,527.50–$1,747.92 | $2,350–$2,689.10 | varies |
| MRI orbit face &/neck w/o contrast (70540) range across 2 matching MRF lines |
$1,052.42–$1,121.25 | $1,619.10–$1,725 | varies |
| MRI orbit face neck w contrast (70542) range across 2 matching MRF lines |
$1,149.33–$1,235 | $1,768.20–$1,900 | varies |
| Mri Orbt/Fac/Nck W/O &W/Dye (70543) range across 3 matching MRF lines |
$1,527.50–$2,275 | $2,350–$3,500 | varies |
| MRI pelvis w contrast (72196) range across 3 matching MRF lines |
$1,175.98–$1,774.50 | $1,809.20–$2,730 | varies |
| MRI pelvis w/o & w contrast (72197) range across 2 matching MRF lines |
$1,527.50–$1,708.33 | $2,350–$2,628.20 | varies |
| MRI pelvis w/o contrast (72195) range across 2 matching MRF lines |
$1,079.72–$1,121.25 | $1,661.10–$1,725 | varies |
| MRI spectroscopy (76390) range across 2 matching MRF lines |
$1,008.02–$1,430 | $1,550.80–$2,200 | varies |
| MRI thoracic spine w/o contrast (72146) range across 2 matching MRF lines |
$965.77–$1,121.25 | $1,485.80–$1,725 | varies |
| MRI upper extremity oth than jt w/contr matrl (73219) range across 2 matching MRF lines |
$1,462.50–$1,735.31 | $2,250–$2,669.70 | varies |
| MRI upper extremity oth than jt w/o contr matrl (73218) range across 2 matching MRF lines |
$1,625.72–$1,681.88 | $2,501.10–$2,587.50 | varies |
| Mri Uppr Extremity W/O&W/Dye (73220) range across 2 matching MRF lines |
$2,291.25–$2,546.12 | $3,525–$3,917.10 | varies |
| MRI, abdomen, combo (74183) range across 2 matching MRF lines |
$1,527.50–$1,708.33 | $2,350–$2,628.20 | varies |
| MRI, dorsal spine combo (72157) range across 2 matching MRF lines |
$1,527.50–$1,747.92 | $2,350–$2,689.10 | varies |
| MRI, dorsal spine contrast (72147) range across 2 matching MRF lines |
$1,064.70–$1,774.50 | $1,638–$2,730 | varies |
| MRI, joint upper extrem (73221) range across 2 matching MRF lines |
$1,517.20–$1,681.88 | $2,334.15–$2,587.50 | varies |
| MRI, joint upper extrem combo (73223) range across 2 matching MRF lines |
$2,291.25–$2,546.12 | $3,525–$3,917.10 | varies |
| MRI, lumbar spine combo (72158) range across 2 matching MRF lines |
$1,527.50–$1,729.46 | $2,350–$2,660.70 | varies |
| Musculoskeletal Nuclear Exam (78399) | $975 | $1,500 | 2.3× |
| Myelogram cervical (72240) range across 2 matching MRF lines |
$352.89–$585 | $542.90–$900 | varies |
| Myelogram Lumbar (72265) range across 2 matching MRF lines |
$321.49–$877.50 | $494.60–$1,350 | varies |
| Myelography thoracic (72255) range across 2 matching MRF lines |
$343.33–$650 | $528.20–$1,000 | varies |
| Myelograpy 2/more regions rs&i (72270) range across 2 matching MRF lines |
$490.04–$1,170 | $753.90–$1,800 | varies |
| Myocardial Imaging Infarct Avid Planar Qual/Quan (78466) | $359.71 | $553.40 | 0.9× |
| Myocardial Imaging Pet Metabolic Evaluation (78459) range across 2 matching MRF lines |
$204.75–$4,225 | $315–$6,500 | varies |
| Myocardial imaging, infarct avid, planar; with ejection fraction by first pass technique Non-Facility (78468) | $455.91 | $701.40 | 0.8× |
| Myocardial Perfusion Planar 1 Study Rest/Stress (78453) range across 2 matching MRF lines |
$567.19–$2,600 | $872.60–$4,000 | varies |
| Myocardial Spect Multiple Studies (78452) range across 2 matching MRF lines |
$1,046.63–$2,379 | $1,610.20–$3,660 | varies |
| Myocrd Img Pet Metab Eval Single Study Cncrnt CT (78429) range across 2 matching MRF lines |
$133.58–$1,878.50 | $205.50–$2,890 | varies |
| Myocrd img PET prfuj 1std rest/stress cncrnt CT (78430) range across 2 matching MRF lines |
$126.75–$1,878.50 | $195–$2,890 | varies |
| Myocrd Img Pet Prfuj Mlt Std Rst&Strs Cncrnt CT (78431) range across 2 matching MRF lines |
$146.90–$2,931.50 | $226–$4,510 | varies |
| Myocrd Img Pet Prfuj W/Metab 2rtracer Cncrnt CT (78433) range across 2 matching MRF lines |
$171.44–$3,581.50 | $263.75–$5,510 | varies |
| Myocrd Img Pet Prfuj W/Metab Dual Radiotracer (78432) range across 2 matching MRF lines |
$156.81–$3,581.50 | $241.25–$5,510 | varies |
| N-invas est c ffr sw aly CTA (75580) range across 2 matching MRF lines |
$58.50–$2,431 | $90–$3,740 | varies |
| Neck soft tissue (70360) range across 2 matching MRF lines |
$54.73–$146.25 | $84.20–$225 | varies |
| Nervous system nuclear exam (78699) range across 2 matching MRF lines |
$308.49–$975 | $474.60–$1,500 | varies |
| Nfs/Instlj Radioelmnt Sln 3 Mo Follow-Up Care (77750) | $670.93 | $1,032.20 | 1.7× |
| Njx Rp Loclzj Non-Img Probe Study Intravenous (78808) range across 2 matching MRF lines |
$67.81–$975 | $104.33–$1,500 | varies |
| Nm csf leak detection (78650) range across 2 matching MRF lines |
$667.10–$2,600 | $1,026.30–$4,000 | varies |
| Nm myocard infarct spect (78469) range across 2 matching MRF lines |
$505.77–$2,600 | $778.10–$4,000 | varies |
| Nm red cell survival study (78130) | $282.56 | $434.70 | 0.7× |
| Nm unlisted gi procedure (78299) | $1,625 | $2,500 | 3.9× |
| Nm whole blood volume (78122) range across 2 matching MRF lines |
$322.14–$1,170 | $495.60–$1,800 | varies |
| Nonvascular Shunt X-Ray (75809) range across 2 matching MRF lines |
$212.75–$292.50 | $327.30–$450 | varies |
| Ntsty modul radthx pln dose-vol histos (77301) range across 2 matching MRF lines |
$2,665–$4,051.13 | $4,100–$6,232.50 | varies |
| Nuclear medicine study of endocrine organs (78099) | $975 | $1,500 | 2.3× |
| Nuclear Rx Intra-Arterial (79445) range across 2 matching MRF lines |
$240.24–$650 | $369.60–$1,000 | varies |
| Nuclear Rx Oral Admin (79005) range across 2 matching MRF lines |
$251.88–$650 | $387.50–$1,000 | varies |
| Ob us nuchal meas 1 gest (76813) range across 3 matching MRF lines |
$115.38–$242.84 | $177.50–$373.60 | varies |
| Oph bmtry us echograpy a-scan io lens pwr cal (76519) range across 3 matching MRF lines |
$71.50–$289.90 | $110–$446 | varies |
| Oph us dx ant sgm us immersion b-scan/hr biom (76513) range across 2 matching MRF lines |
$146.25–$156.98 | $225–$241.50 | varies |
| Oph US Dx B-Scan&Quan a-Scan Sm Pt Enctr (76510) range across 2 matching MRF lines |
$195–$291.79 | $300–$448.90 | varies |
| Ophthalmic Biometry US Echograpy a-Scan (76516) | $144.04 | $221.60 | 1.3× |
| Ophthalmic Ultrasonic Foreign Body Localization (76529) | $126.95 | $195.30 | 1.4× |
| Ophthalmic ultrasound dx b-scan w/wo a-scan (76512) range across 2 matching MRF lines |
$286.65–$292.50 | $441–$450 | varies |
| Ophthalmic US Dx Corneal Pachymetry Uni/Bi (76514) range across 3 matching MRF lines |
$24.57–$289.90 | $37.80–$446 | varies |
| Ophthalmic us dx quantitative a-scan only (76511) | $201.37 | $309.80 | 1.9× |
| Optic foramina (70190) | $64.87 | $99.80 | 0.7× |
| Panoramic X-ray of jaws (70355) range across 4 matching MRF lines |
$34.13–$162.50 | $52.50–$250 | varies |
| Parathyroid imaging w/tomographic spect & CT (78072) range across 2 matching MRF lines |
$336.31–$1,300 | $517.40–$2,000 | varies |
| Parathyroid Planar Imaging (78070) range across 2 matching MRF lines |
$331.05–$975 | $509.30–$1,500 | varies |
| Parathyroid planar imaging w/wo subtraction (78071) range across 2 matching MRF lines |
$759.66–$975 | $1,168.70–$1,500 | varies |
| Pelvis 1 or 2 views (72170) range across 2 matching MRF lines |
$51.81–$227.50 | $79.70–$350 | varies |
| Perineogram (74775) | $144.69 | $222.60 | 0.6× |
| Peritoneogram Rs&I (74190) range across 2 matching MRF lines |
$122.85–$650 | $189–$1,000 | varies |
| Pet Image Skull-Thigh (78812) | $192.47 | $296.10 | 0.1× |
| Pet Image W/Ct Lmtd (78814) range across 2 matching MRF lines |
$217.04–$4,875 | $333.90–$7,500 | varies |
| PET image w/CT, full body (78816) range across 2 matching MRF lines |
$247.78–$4,225 | $381.20–$6,500 | varies |
| PET imaging CT attenuation skull base mid-thigh (78815) range across 2 matching MRF lines |
$242.32–$4,225 | $372.80–$6,500 | varies |
| Pet Imaging Limited Area Chest Head/Neck (78811) range across 2 matching MRF lines |
$154.25–$2,600 | $237.30–$4,000 | varies |
| Pet Myocardial Sngl Study (78491) range across 2 matching MRF lines |
$215.02–$2,600 | $330.80–$4,000 | varies |
| PET whole body (78813) | $198.64 | $305.60 | 0.1× |
| Plasma Vol Radiopharm Vol Dilute Spx Mult Smples (78111) | $178.17 | $274.10 | 0.1× |
| Plasma volume, radiopharmaceutical volume-dilution technique (separate procedure); single sampling Non-Facility (78110) | $164.58 | $253.20 | 0.1× |
| Platelet survival study Non-Facility (78191) | $502.32 | $772.80 | 1.2× |
| Proton trmt simple w/comp (77522) | $1,109.47 | $1,706.88 | 0.9× |
| Proton tx delivery complex (77525) | $1,402.10 | $2,157.08 | 1.1× |
| Proton tx delivery intermediate (77523) | $1,316.76 | $2,025.78 | 1.0× |
| Proton tx delivery simple w/o compensation (77520) | $1,080.32 | $1,662.03 | 1.9× |
| Prq Transhepatc Portograpy Hemodyn Eval Rs&I (75885) range across 2 matching MRF lines |
$313.30–$1,755 | $482–$2,700 | varies |
| Pulmonary Perfusion Imaging Particulate (78580) range across 2 matching MRF lines |
$466.64–$975 | $717.90–$1,500 | varies |
| Quan&Charac C Atherosclerotc Plaq Asses Sev C Ds (75577) range across 2 matching MRF lines |
$65–$1,545.05 | $100–$2,377 | varies |
| Radex Abd Compl Aqt Abd W/S/E/D Views 1 View Ch (74022) range across 2 matching MRF lines |
$97.37–$292.50 | $149.80–$450 | varies |
| Radex abscess/fistula/sinus tract rs&i (76080) range across 2 matching MRF lines |
$119.08–$412.75 | $183.20–$635 | varies |
| Radex Ankle Complete Minimum 3 Views (73610) range across 2 matching MRF lines |
$87.75–$341.25 | $135–$525 | varies |
| Radex Calcaneus Minimum 2 Views (73650) range across 2 matching MRF lines |
$78.88–$219.38 | $121.35–$337.50 | varies |
| Radex elbow complete minimum 3 views (73080) range across 2 matching MRF lines |
$104.13–$307.13 | $160.20–$472.50 | varies |
| Radex Facial Bones Complete Minimum 3 Views (70150) range across 2 matching MRF lines |
$86.78–$211.25 | $133.50–$325 | varies |
| Radex fingr minimum 2 views (73140) range across 2 matching MRF lines |
$101.69–$341.25 | $156.45–$525 | varies |
| Radex foot complete minimum 3 views (73630) range across 3 matching MRF lines |
$78–$312 | $120–$480 | varies |
| Radex Hand Minimum 3 Views (73130) range across 3 matching MRF lines |
$98.67–$370.50 | $151.80–$570 | varies |
| Radex lower extremity infant minimum 2 views (73592) range across 2 matching MRF lines |
$98.57–$263.25 | $151.65–$405 | varies |
| Radex Mastoids Compl Minimum 3 Views PR Side (70130) range across 2 matching MRF lines |
$115.90–$195 | $178.30–$300 | varies |
| Radex Nasal Bones Complete Minimum 3 Views (70160) range across 2 matching MRF lines |
$67.99–$219.70 | $104.60–$338 | varies |
| Radex Pharynx/Larx W/Fluor&/Magnification Tq (70370) range across 2 matching MRF lines |
$155.29–$162.50 | $238.90–$250 | varies |
| Radex Ribs Unilateral 2 Views (71100) range across 2 matching MRF lines |
$65.33–$175.50 | $100.50–$270 | varies |
| Radex shoulder complete minimum 2 views (73030) range across 2 matching MRF lines |
$91.07–$341.25 | $140.10–$525 | varies |
| Radex Sinuses Paransl < 3 Views (70210) range across 2 matching MRF lines |
$62.86–$175.50 | $96.70–$270 | varies |
| Radex sm int w/mlt srl imges via enteroclss tube (74251) range across 2 matching MRF lines |
$831.74–$1,187.55 | $1,279.60–$1,827 | varies |
| Radex Spine 1 View Specify Level (72020) range across 3 matching MRF lines |
$47.32–$195 | $72.80–$300 | varies |
| Radex Sternum Minimum 2 Views (71120) range across 2 matching MRF lines |
$63.70–$146.25 | $98–$225 | varies |
| Radex Temporomandble Jt Opn & Clsd Mouth Bilat (70330) range across 3 matching MRF lines |
$83.27–$195 | $128.10–$300 | varies |
| Radex Toe Minimum 2 Views (73660) range across 2 matching MRF lines |
$77.81–$263.25 | $119.70–$405 | varies |
| Radex upper extremity infant minimum 2 views (73092) range across 2 matching MRF lines |
$56.94–$175.50 | $87.60–$270 | varies |
| Radex Wrist Complete Minimum 3 Views (73110) range across 2 matching MRF lines |
$115.25–$341.25 | $177.30–$525 | varies |
| Radex X-Ray Exam Entire Spi 6/> Vw - Xr Entire Spine 6+ Vw (72084) range across 2 matching MRF lines |
$120.90–$227.50 | $186–$350 | varies |
| Radiation Delivery Stereotactic Cranial Linear (77372) range across 2 matching MRF lines |
$1,608.91–$13,455 | $2,475.25–$20,700 | varies |
| Radiation treatment delivery level 1 (77402) range across 2 matching MRF lines |
$364–$390 | $560–$600 | varies |
| Radiation treatment delivery level 2 (77407) range across 2 matching MRF lines |
$364–$585 | $560–$900 | varies |
| Radiation treatment delivery level 3 (77412) range across 2 matching MRF lines |
$650–$1,170 | $1,000–$1,800 | varies |
| Radiolog exam mandible compl minimum 4 views (70110) range across 2 matching MRF lines |
$80.15–$201.50 | $123.30–$310 | varies |
| Radiologic Exam Abdomen 3+ Views - Xr Abdomen 3+ Views (74021) range across 3 matching MRF lines |
$63.70–$260 | $98–$400 | varies |
| Radiologic exam colon double contrast study (74280) range across 2 matching MRF lines |
$449.80–$585 | $692–$900 | varies |
| Radiologic exam colon single contrast study (74270) range across 2 matching MRF lines |
$324.81–$585 | $499.70–$900 | varies |
| Radiologic Exam Esophagus Double Contrast Study (74221) range across 2 matching MRF lines |
$55.41–$237.25 | $85.25–$365 | varies |
| Radiologic exam knee complete 4/more views (73564) range across 2 matching MRF lines |
$110.57–$281.78 | $170.10–$433.50 | varies |
| Radiologic exam pelvis compl minimum 3 views (72190) range across 2 matching MRF lines |
$86.58–$211.25 | $133.20–$325 | varies |
| Radiologic Exam Small Int Single Contrast Study (74250) range across 2 matching MRF lines |
$225.29–$292.50 | $346.60–$450 | varies |
| Radiologic exam swallow function contrast study (74230) range across 2 matching MRF lines |
$188.11–$213.85 | $289.40–$329 | varies |
| Radiologic exam teeth complete full mouth (70320) range across 2 matching MRF lines |
$97.50–$104.98 | $150–$161.50 | varies |
| Radiologic Exam Teeth Prtl Exam < Full Mouth (70310) range across 2 matching MRF lines |
$65–$77.48 | $100–$119.20 | varies |
| Radiologic exam upr gi trc double contrast study (74246) range across 2 matching MRF lines |
$241.61–$453.70 | $371.70–$698 | varies |
| Radiologic examination femur 1 view (73551) range across 2 matching MRF lines |
$62.40–$263.25 | $96–$405 | varies |
| Radiologic examination femur minimum 2 views (73552) range across 2 matching MRF lines |
$73.13–$370.50 | $112.50–$570 | varies |
| Radiologic examination knee 1/2 views (73560) range across 3 matching MRF lines |
$78–$370.50 | $120–$570 | varies |
| Radiologic Examination Osseous Survey Limited (77074) range across 2 matching MRF lines |
$139.95–$585 | $215.30–$900 | varies |
| Radiologic Examination Salivary Gland Calculus (70380) | $68.97 | $106.10 | 0.8× |
| Radiologic examination tibia & fibula 2 views (73590) range across 2 matching MRF lines |
$78–$312 | $120–$480 | varies |
| Radiologic examination, internal auditory meati, complete Non-Facility (70134) | $88.73 | $136.50 | 0.2× |
| Radiologic examination, teeth; single view Non-Facility (70300) range across 2 matching MRF lines |
$27.24–$65 | $41.90–$100 | varies |
| Radiopharm Dacryocystography (78660) | $348.99 | $536.90 | 0.8× |
| Radiopharmaceutical therapy, by interstitial radioactive colloid administration Facility (79300) | $238.23 | $366.50 | 1.0× |
| Radiopharmaceutical therapy, by intra-articular administration Non-Facility (79440) | $340.60 | $524 | 1.4× |
| Radiopharmaceutical therapy, by intracavitary administration Non-Facility (79200) | $339.24 | $521.90 | 1.4× |
| Red Cell Volume Determination Spx 1 Sampling (78120) | $166.08 | $255.50 | 0.4× |
| Red Cell Volume Determination Spx Mult Samplings (78121) range across 2 matching MRF lines |
$206.83–$1,170 | $318.20–$1,800 | varies |
| Remote afterloading high dose rate radionuclide skin surface brachytherapy, includes basic dosimetry, when performed;… (77768) range across 2 matching MRF lines |
$466.05–$529.10 | $717–$814 | varies |
| Remote afterloading high dose rate radionuclide skin surface brachytherapy, includes basic dosimetry, when performed;… (77767) range across 2 matching MRF lines |
$338.65–$2,237.30 | $521–$3,442 | varies |
| Renal Cyst Study (74470) range across 2 matching MRF lines |
$124.93–$487.50 | $192.20–$750 | varies |
| Ribs bilateral 3 views (71110) range across 2 matching MRF lines |
$81.71–$204.75 | $125.70–$315 | varies |
| Rp loclzj tum plnr 1 area single day imaging (78800) range across 2 matching MRF lines |
$345.35–$975 | $531.30–$1,500 | varies |
| Rp loclzj tum plnr 2+area 1+d img/1 area img>2+d (78801) range across 2 matching MRF lines |
$468.20–$975 | $720.30–$1,500 | varies |
| Rp Loclzj Tum Plnr Whole Body 2+ Days Imaging (78804) range across 2 matching MRF lines |
$1,246.12–$2,600 | $1,917.10–$4,000 | varies |
| Rp Loclzj Tum Plnr Whole Body Single Day Imaging (78802) range across 2 matching MRF lines |
$691.08–$2,600 | $1,063.20–$4,000 | varies |
| Rp Loclzj Tum Spect 1 Area Single Day Imaging (78803) range across 2 matching MRF lines |
$737.30–$1,300 | $1,134.30–$2,000 | varies |
| Rp loclzj tum spect 2 area/sep acquisj img (78831) range across 2 matching MRF lines |
$139.59–$2,047.50 | $214.75–$3,150 | varies |
| Rp loclzj tum spect CT 2area 1d img/1 ar img>2+d (78832) range across 2 matching MRF lines |
$162.66–$2,047.50 | $250.25–$3,150 | varies |
| Rp loclzj tum spect w/CT 1 area/acquisj 1day img (78830) range across 2 matching MRF lines |
$114.56–$2,047.50 | $176.25–$3,150 | varies |
| Rp Ther Radiolbld Monoclonal Antibody IV Infus (79403) range across 2 matching MRF lines |
$359.06–$650 | $552.40–$1,000 | varies |
| Rp Therapy Intravenous Administration (79101) range across 2 matching MRF lines |
$273.33–$650 | $420.50–$1,000 | varies |
| Salivary Gland Function Study (78232) | $257.99 | $396.90 | 0.6× |
| Salivary Gland Imaging (78230) | $324.74 | $499.60 | 0.8× |
| Salivary Gland Imaging Serial Images (78231) | $240.96 | $370.70 | 0.6× |
| Scapula (73010) range across 2 matching MRF lines |
$93.21–$302.25 | $143.40–$465 | varies |
| Screening Digital Breast Tomosynthesis Bi (77063) range across 2 matching MRF lines |
$71.50–$162.50 | $110–$250 | varies |
| Sella turcica (70240) | $55.32 | $85.10 | 0.6× |
| Shoulder 1 view (73020) range across 3 matching MRF lines |
$72.05–$243.75 | $110.85–$375 | varies |
| Shoulder Arthrography (73040) range across 2 matching MRF lines |
$331.79–$1,027.84 | $510.45–$1,581.29 | varies |
| Sialogram (70390) range across 2 matching MRF lines |
$187.01–$195 | $287.70–$300 | varies |
| Skull less than 4 views (70250) range across 4 matching MRF lines |
$38.94–$211.25 | $59.90–$325 | varies |
| Special dosimetry (77331) range across 2 matching MRF lines |
$109.01–$490.75 | $167.70–$755 | varies |
| Special Physics Consult (77370) range across 2 matching MRF lines |
$179.43–$416 | $276.05–$640 | varies |
| Special teletherapy port plan (77321) range across 2 matching MRF lines |
$185.84–$1,250.60 | $285.90–$1,924 | varies |
| Special treatment procedure (77470) range across 3 matching MRF lines |
$316.55–$1,463.15 | $487–$2,251 | varies |
| Speech evaluation, complex (70371) range across 2 matching MRF lines |
$162.50–$204.10 | $250–$314 | varies |
| Spleen Imaging (78185) | $414.38 | $637.50 | 1.0× |
| Stereotactic Body Radiation Delivery (77373) range across 2 matching MRF lines |
$2,042.29–$2,990 | $3,141.98–$4,600 | varies |
| Sternoclavicular joints (71130) range across 2 matching MRF lines |
$75.60–$180.70 | $116.30–$278 | varies |
| Superior sagittal sinus venogram (75870) range across 2 matching MRF lines |
$872.24–$1,105 | $1,341.90–$1,700 | varies |
| Surface Applic Low Dose Rate Radionuclide Source (77789) range across 2 matching MRF lines |
$206.12–$334.75 | $317.10–$515 | varies |
| Tbs technical calculation only (77091) | $130 | $200 | 1.4× |
| Telethx isodose pln cplx w/basic dosimetry (77307) range across 2 matching MRF lines |
$450.45–$650 | $693–$1,000 | varies |
| Telethx isodose pln smpl w/dosimetry calculation (77306) range across 2 matching MRF lines |
$230.69–$1,112.15 | $354.90–$1,711 | varies |
| Temporomandble Jt Arthrography Rs&I (70332) | $178.82 | $275.10 | 0.7× |
| Testicular Imaging W/Flow (78761) | $394.49 | $606.90 | 1.0× |
| Ther Rad Simulaj-Aided Field Setting Complex (77290) range across 2 matching MRF lines |
$1,016.60–$1,113.84 | $1,564–$1,713.60 | varies |
| Ther Rad Simulaj-Aided Field Setting Intermed (77285) range across 2 matching MRF lines |
$602.68–$882.70 | $927.20–$1,358 | varies |
| Ther rad simulaj-aided field setting simple (77280) range across 3 matching MRF lines |
$385.13–$780 | $592.50–$1,200 | varies |
| Therapeutic Enema Rdctj Intussusception/Obstrcj (74283) | $389.03 | $598.50 | 2.1× |
| Thoracic spine 2 views (72070) range across 2 matching MRF lines |
$67.54–$204.75 | $103.90–$315 | varies |
| Thoracic spine 3 views (72072) range across 2 matching MRF lines |
$68.97–$234 | $106.10–$360 | varies |
| Thoracolumbar 2 views (72080) range across 2 matching MRF lines |
$72.67–$204.75 | $111.80–$315 | varies |
| Thyroid carcinoma metastases imaging; with additional studies (eg, urinary recovery) Non-Facility (78016) | $633.36 | $974.40 | 1.5× |
| Thyroid Carcinoma Metastases Img Lmtd Area (78015) | $408.85 | $629 | 1.0× |
| Thyroid Imaging With Vascular Flow (78013) range across 2 matching MRF lines |
$438.88–$975 | $675.20–$1,500 | varies |
| Thyroid Met Imaging Body (78018) range across 2 matching MRF lines |
$675.87–$975 | $1,039.80–$1,500 | varies |
| Thyroid Uptake Measurement (78012) range across 2 matching MRF lines |
$174.07–$975 | $267.80–$1,500 | varies |
| Thyroid Uptake W/Blood Flow Sngle/Mult Quan Meas (78014) range across 2 matching MRF lines |
$507.13–$711.75 | $780.20–$1,095 | varies |
| Tx Devices Design & Construction Complex (77334) range across 5 matching MRF lines |
$286.52–$698.75 | $440.80–$1,075 | varies |
| Tx devices design & construction intermediate (77333) range across 3 matching MRF lines |
$94.19–$490.75 | $144.90–$755 | varies |
| Tx devices design & construction simple (77332) range across 4 matching MRF lines |
$151.45–$520 | $233–$800 | varies |
| Ultrasound Breast Limited (76642) range across 2 matching MRF lines |
$210.89–$536.25 | $324.45–$825 | varies |
| Ultrasound elastography first target lesion (76982) range across 2 matching MRF lines |
$46.80–$146.25 | $72–$225 | varies |
| Ultrasound Elastography Parenchyma (76981) range across 2 matching MRF lines |
$46.80–$146.25 | $72–$225 | varies |
| Ultrasound Exam Aaa Screen (76706) range across 2 matching MRF lines |
$142.61–$325 | $219.40–$500 | varies |
| Ultrasound trgt dynamic microbubble 1st lesion (76978) range across 2 matching MRF lines |
$127.40–$247 | $196–$380 | varies |
| Ultrasound, abdomen limited (76705) range across 2 matching MRF lines |
$221.46–$332.15 | $340.70–$511 | varies |
| Umbilical-artery Doppler (OB) (76820) range across 3 matching MRF lines |
$49.14–$234 | $75.60–$360 | varies |
| Unlisted Dx Radiographic Procedure (76499) | $393.25 | $605 | 4.4× |
| Unlisted fluoroscopic procedure (76496) | $97.50 | $150 | 1.1× |
| Unlisted genitourinary px dx nuclear medicine (78799) | $975 | $1,500 | 2.3× |
| Unlisted hematopoietic, reticuloendothelial and lymphatic procedure, diagnostic nuclear medicine (78199) | $1,950 | $3,000 | 4.7× |
| Unlisted magnetic resonance procedure (76498) range across 2 matching MRF lines |
$767–$1,430 | $1,180–$2,200 | varies |
| Unlisted Miscellaneous Px Dx Nuclear Medicine (78999) range across 2 matching MRF lines |
$308.49–$975 | $474.60–$1,500 | varies |
| Unlisted Procedure Clinical Brachytherapy (77799) | $167.70 | $258 | 1.6× |
| Unlisted respiratory px dx nuclear medicine (78599) | $975 | $1,500 | 2.3× |
| Upper gi w/o kub (74240) range across 2 matching MRF lines |
$207.48–$429 | $319.20–$660 | varies |
| Urea Breath Test C-14 Isotopic Acquisj Analysis (78267) range across 2 matching MRF lines |
$14.66–$48.75 | $22.55–$75 | varies |
| Urea breath test c-14 isotopic analysis (78268) | $162.50 | $250 | 1.7× |
| Ureteral Reflux Study (78740) range across 2 matching MRF lines |
$444.47–$878.15 | $683.80–$1,351 | varies |
| Urethrocystogram voiding (74455) range across 2 matching MRF lines |
$185.58–$438.75 | $285.50–$675 | varies |
| Urethrocystography retrograde (74450) range across 2 matching MRF lines |
$119.47–$438.75 | $183.80–$675 | varies |
| Us bone density measurement (76977) | $52.59 | $80.90 | 0.5× |
| Us breast unilateral complete (76641) range across 2 matching MRF lines |
$255.94–$682.50 | $393.75–$1,050 | varies |
| Us chest (76604) range across 2 matching MRF lines |
$178.62–$390 | $274.80–$600 | varies |
| Us complete joint (76881) range across 2 matching MRF lines |
$200.07–$260 | $307.80–$400 | varies |
| Us exam, pelvic, limited (76857) range across 2 matching MRF lines |
$207.16–$289.25 | $318.70–$445 | varies |
| Us head (76506) range across 2 matching MRF lines |
$254.74–$471.25 | $391.90–$725 | varies |
| Us kidney transplant (76776) range across 2 matching MRF lines |
$317.14–$403.65 | $487.90–$621 | varies |
| Us lmtd joint/oth nonvasc xtr strux r-t w/img (76882) range across 2 matching MRF lines |
$48.75–$260 | $75–$400 | varies |
| Us ob detailed single fetus (76811) range across 3 matching MRF lines |
$187.01–$397.22 | $287.70–$611.10 | varies |
| Us ob limited 1 or more fetuses (76815) range across 4 matching MRF lines |
$65–$211.25 | $100–$325 | varies |
| Us ob transvaginal (76817) range across 3 matching MRF lines |
$73.06–$211.25 | $112.40–$325 | varies |
| Us pelvic non ob complete (76856) range across 3 matching MRF lines |
$257.27–$390 | $395.80–$600 | varies |
| Us pg uter img f&mat 14 wk tabdl 1/1st gestation (76801) range across 3 matching MRF lines |
$95.55–$257.34 | $147–$395.90 | varies |
| Us preg uterus real time f/u trnsabdl per fetus (76816) range across 4 matching MRF lines |
$83.27–$238.23 | $128.10–$366.50 | varies |
| Us retroperitoneal complete (76770) range across 2 matching MRF lines |
$273.65–$422.50 | $421–$650 | varies |
| Us retroperitoneal limited (76775) range across 2 matching MRF lines |
$149.50–$325 | $230–$500 | varies |
| Us scrotum and contents (76870) range across 3 matching MRF lines |
$256.23–$325 | $394.20–$500 | varies |
| Us spinal canal and contents (76800) range across 2 matching MRF lines |
$260.98–$325 | $401.50–$500 | varies |
| Us thyroid (76536) range across 2 matching MRF lines |
$250.71–$299.65 | $385.70–$461 | varies |
| Us transrectal (76872) range across 2 matching MRF lines |
$280.74–$325 | $431.90–$500 | varies |
| Vascular Flow Imaging (78445) | $337.87 | $519.80 | 0.8× |
| Vasogram (74440) | $163.15 | $251 | 0.7× |
| Vein X-Ray Chest (75827) range across 4 matching MRF lines |
$829.27–$2,613 | $1,275.80–$4,020 | varies |
| Vein X-Ray Liver W/O Hemodyn (75887) range across 2 matching MRF lines |
$896.81–$1,820 | $1,379.70–$2,800 | varies |
| Vein X-Ray Skull Epidural (75872) range across 2 matching MRF lines |
$368.55–$873.60 | $567–$1,344 | varies |
| Vein X-Ray Spleen/Liver (75810) range across 2 matching MRF lines |
$870.87–$1,170 | $1,339.80–$1,800 | varies |
| Venogram Sinus/Jugular (75860) range across 2 matching MRF lines |
$829.92–$4,433 | $1,276.80–$6,820 | varies |
| Venography Adrenal Unilateral (75840) range across 2 matching MRF lines |
$872.24–$1,755 | $1,341.90–$2,700 | varies |
| Venography caval inferior serialography rs&i (75825) range across 2 matching MRF lines |
$829.92–$4,433 | $1,276.80–$6,820 | varies |
| Venography extremity bilateral rs&i (75822) range across 2 matching MRF lines |
$312.78–$1,472.25 | $481.20–$2,265 | varies |
| Venography extremity unilateral rs&i (75820) range across 2 matching MRF lines |
$258.05–$1,123.20 | $397–$1,728 | varies |
| Venography Orbital Rs&I (75880) range across 2 matching MRF lines |
$268.26–$936 | $412.70–$1,440 | varies |
| Venography Renal Bilateral (75833) range across 2 matching MRF lines |
$313.95–$1,950 | $483–$3,000 | varies |
| Venography Renal Unilateral (75831) range across 2 matching MRF lines |
$871.59–$4,433 | $1,340.90–$6,820 | varies |
| Venous sampling by catheter (75893) range across 2 matching MRF lines |
$817.64–$7,800 | $1,257.90–$12,000 | varies |
| Venous thrombosis imaging (78457) | $371.28 | $571.20 | 0.7× |
| Venous Thrombosis Imaging Venogram Bilateral (78458) | $373.36 | $574.40 | 0.9× |
| Vertebral fracture assessment via dxa (77086) range across 3 matching MRF lines |
$55.97–$97.50 | $86.10–$150 | varies |
| Wrist 2 views (73100) range across 2 matching MRF lines |
$94.19–$263.25 | $144.90–$405 | varies |
| X-Ray Ac Jts - Xr Acromioclavicular Joints Bilateral (73050) range across 3 matching MRF lines |
$40.95–$234 | $63–$360 | varies |
| X-ray antegrade pyelogram tube (74425) range across 2 matching MRF lines |
$107.19–$438.75 | $164.90–$675 | varies |
| X-Ray Aorta Leg Arteries (75630) range across 3 matching MRF lines |
$918–$4,748.25 | $1,412.30–$7,305 | varies |
| X-Ray Bend Only L-S Spine (72120) range across 2 matching MRF lines |
$90.81–$234 | $139.70–$360 | varies |
| X-Ray Elbow 2 Vw - Xr Elbow 1-2 Views Right (73070) range across 2 matching MRF lines |
$86.39–$263.25 | $132.90–$405 | varies |
| X-Ray Exam Breast Specimen (76098) range across 2 matching MRF lines |
$39.59–$893.75 | $60.90–$1,375 | varies |
| X-Ray Exam Entire Spi 1 Vw (72081) range across 2 matching MRF lines |
$58.50–$102.70 | $90–$158 | varies |
| X-Ray Exam Entire Spi 2/3 Vw (72082) range across 2 matching MRF lines |
$93.60–$201.50 | $144–$310 | varies |
| X-Ray Exam Entire Spi 4/5 Vw (72083) range across 2 matching MRF lines |
$101.40–$214.50 | $156–$330 | varies |
| X-Ray Exam Hip Uni 1 View (73501) range across 3 matching MRF lines |
$44.85–$162.50 | $69–$250 | varies |
| X-Ray Exam Hip Uni 2-3 Views (73502) range across 3 matching MRF lines |
$62.40–$188.50 | $96–$290 | varies |
| X-Ray Exam Hip Uni 4/> Views (73503) range across 3 matching MRF lines |
$77.35–$260 | $119–$400 | varies |
| X-Ray Exam Hips Bi 2 Views (73521) range across 3 matching MRF lines |
$59.80–$227.50 | $92–$350 | varies |
| X-Ray Exam Hips Bi 3-4 Views (73522) range across 3 matching MRF lines |
$73.45–$260 | $113–$400 | varies |
| X-Ray Exam Hips Bi 5/> Views (73523) range across 2 matching MRF lines |
$85.15–$228.80 | $131–$352 | varies |
| X-Ray Exam L-S Spine Bending (72114) range across 2 matching MRF lines |
$135.79–$263.25 | $208.90–$405 | varies |
| X-Ray Exam Neck Spine 2-3 Vw (72040) range across 3 matching MRF lines |
$79.24–$175.50 | $121.90–$270 | varies |
| X-Ray Exam Neck Spine 6/>Vws (72052) range across 2 matching MRF lines |
$138.78–$292.50 | $213.50–$450 | varies |
| X-Ray Exam Unilat Ribs/Chest (71101) range across 2 matching MRF lines |
$79.50–$188.50 | $122.30–$290 | varies |
| X-ray eye for foreign body (70030) range across 2 matching MRF lines |
$53.95–$211.25 | $83–$325 | varies |
| X-ray head for orthodontia (70350) range across 2 matching MRF lines |
$40.95–$110.50 | $63–$170 | varies |
| X-ray humerus (73060) range across 2 matching MRF lines |
$88.73–$263.25 | $136.50–$405 | varies |
| X-ray IV pyelogram (ivp) (74400) range across 3 matching MRF lines |
$234.20–$487.50 | $360.30–$750 | varies |
| X-ray IV pyelogram+tomography (74415) | $257.34 | $395.90 | 1.4× |
| X-Ray Jaw <4 Vw - Xr Mandible < 4 Views (70100) range across 2 matching MRF lines |
$70.27–$146.25 | $108.10–$225 | varies |
| X-Ray Knee Bilat Standing - Xr Knees Anteroposterior Standing Bilat (73565) range across 2 matching MRF lines |
$70.20–$234 | $108–$360 | varies |
| X-Ray Lumbar Spine 2/3 Vw - Xr Lumbar Spine 2-3 Views (72100) range across 2 matching MRF lines |
$73.39–$211.25 | $112.90–$325 | varies |
| X-ray nose-rectum child f.b. (76010) range across 2 matching MRF lines |
$54.08–$109.20 | $83.20–$168 | varies |
| X-Ray Ribs, Chest 4+ Vw - Xr Ribs 3 Vws Bil W/ Chest Posteroanterior (71111) range across 2 matching MRF lines |
$107.71–$234 | $165.70–$360 | varies |
| X-Ray Sacroiliac Jts 3+ Vw - Xr Sacroiliac Joints 3+ Views (72202) range across 2 matching MRF lines |
$71.05–$201.50 | $109.30–$310 | varies |
| X-Ray Sacroiliac Jts <3 Vw - Xr Sacroiliac Joints 1-2 Views (72200) range across 3 matching MRF lines |
$51.87–$162.50 | $79.80–$250 | varies |
| X-Ray Sacrum/Coccyx 2+ Vw - Xr Sacrum Coccyx 2+ Views (72220) range across 2 matching MRF lines |
$51.87–$146.25 | $79.80–$225 | varies |
| X-Ray Sinuses 3+ Vw - Xr Paranasal Sinuses 3+ Views (70220) range across 3 matching MRF lines |
$79.43–$260 | $122.20–$400 | varies |
| X-Ray Skull 4+ Vw - Xr Skull Complete 4+ Views (70260) range across 2 matching MRF lines |
$94.58–$211.25 | $145.50–$325 | varies |
| X-Ray Stress View (77071) | $85.35 | $131.30 | 0.9× |
| X-ray thoracic spine 4 vw (72074) range across 2 matching MRF lines |
$74.49–$276.25 | $114.60–$425 | varies |
| X-Ray Tmj Unilat (70328) range across 2 matching MRF lines |
$62.92–$117 | $96.80–$180 | varies |
| X-Ray Urinary Tract Exam With Contrast Material (74420) range across 2 matching MRF lines |
$183.63–$903.50 | $282.50–$1,390 | varies |
| X-Rays Bone Length Studies (77073) range across 2 matching MRF lines |
$74.36–$195 | $114.40–$300 | varies |
| X-Rays Bone Survey Complete (77075) range across 2 matching MRF lines |
$213.14–$234 | $327.90–$360 | varies |
| Xr c-spine 4 or 5 views (72050) range across 2 matching MRF lines |
$107.64–$234 | $165.60–$360 | varies |
| Xr facial bones less than 3 views (70140) range across 3 matching MRF lines |
$60–$162.50 | $92.30–$250 | varies |
| XR Mastoids < 3 Views Bilateral (70120) | $63.51 | $97.70 | 0.6× |
| Xr myelogram posterior fossa (70010) | $370.63 | $570.20 | 1.0× |
| Xr orbits complete 4 views (70200) range across 2 matching MRF lines |
$88.40–$354.25 | $136–$545 | varies |
| Xr Tomogram Single Plane (76100) | $251.16 | $386.40 | 2.3× |
A range means this hospital published different amounts on matching machine-readable-file lines. We show the lowest–highest posted amount because we cannot tell from the published file which line would apply to a particular visit.