Imaging prices at Bellin Memorial Hospital
Green Bay, WI · every code in this section with a posted price and a Medicare benchmark.
401 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 2 matching MRF lines |
$2,352.04–$2,652.99 | $5,080–$5,730 | varies |
| Abdomen 1 View (74018) range across 2 matching MRF lines |
$148.16–$174.55 | $320–$377 | varies |
| Abdomen 2 views (74019) range across 2 matching MRF lines |
$177.79–$210.67 | $384–$455 | varies |
| Acute Gastrointestinal Blood Loss Imaging (78278) range across 2 matching MRF lines |
$521.34–$727.84 | $1,126–$1,572 | varies |
| Angio internal mammary (75756) range across 2 matching MRF lines |
$961.65–$5,829.17 | $2,077–$12,590 | varies |
| Angio pulmonary bilat (75743) range across 2 matching MRF lines |
$731.54–$5,829.17 | $1,580–$12,590 | varies |
| Angiography extremity bilateral rs&i (75716) range across 2 matching MRF lines |
$2,425.19–$5,310.15 | $5,238–$11,469 | varies |
| Angiography extremity unilateral rs&i (75710) range across 2 matching MRF lines |
$2,086.74–$5,761.57 | $4,507–$12,444 | varies |
| Angiography pulmonary unilateral slctv rs&i (75741) | $723.67 | $1,563 | 0.2× |
| Angrph pulmonary nonslctv cath/ven njx rs&i (75746) | $574.12 | $1,240 | 0.2× |
| Ankle 2 views (73600) range across 2 matching MRF lines |
$135.66–$174.55 | $293–$377 | varies |
| Aortography thoracic serialography rs&i (75605) likely a partial charge, not the full procedure |
$684.31 | $1,478 | 0.1× |
| Artery X-Rays Abdomen (75726) range across 2 matching MRF lines |
$3,458.15–$8,578.93 | $7,469–$18,529 | varies |
| Artery X-Rays Adrenal Gland (75731) | $1,995.53 | $4,310 | 0.7× |
| Artery X-Rays Pelvis (75736) | $3,458.15 | $7,469 | 0.6× |
| Artery X-Rays Spine (75705) | $2,797.45 | $6,042 | 0.5× |
| Arthrogram ankle (73615) | $421.79 | $911 | 1.2× |
| Arthrogram hip (73525) range across 2 matching MRF lines |
$616.72–$657 | $1,332–$1,419 | varies |
| Arthrogram Wrist (73115) range across 2 matching MRF lines |
$652.37–$661.63 | $1,409–$1,429 | varies |
| Basic radiation dosimetry calculation (77300) range across 2 matching MRF lines |
$140.29–$260.67 | $303–$563 | varies |
| Bone age studies (77072) range across 2 matching MRF lines |
$110.66–$194 | $239–$419 | varies |
| Bone Imaging 3 Phase (78315) range across 2 matching MRF lines |
$527.82–$819.05 | $1,140–$1,769 | varies |
| Bone Imaging Limited Area (78300) range across 2 matching MRF lines |
$416.24–$764.41 | $899–$1,651 | varies |
| Bone Imaging Multiple Areas (78305) | $479.67 | $1,036 | 1.2× |
| Bone Imaging Whole Body (78306) range across 2 matching MRF lines |
$454.20–$789.88 | $981–$1,706 | varies |
| Bone marrow imaging limited area (78102) | $322.71 | $697 | 0.8× |
| Bone survey infant (77076) range across 2 matching MRF lines |
$194–$257.43 | $419–$556 | varies |
| Brachytx isodose complex (77318) range across 2 matching MRF lines |
$652.37–$1,241.30 | $1,409–$2,681 | varies |
| Brachytx isodose intermed (77317) range across 2 matching MRF lines |
$342.62–$652.37 | $740–$1,409 | varies |
| Brachytx Isodose Plan Simple (77316) range across 2 matching MRF lines |
$267.15–$712.56 | $577–$1,539 | varies |
| Brain Imaging Min 4 Static Views W Vascular Flow (78606) range across 2 matching MRF lines |
$604.68–$1,001.47 | $1,306–$2,163 | varies |
| Brain Imaging Pet Metabolic Evaluation (78608) range across 2 matching MRF lines |
$2,456.68–$2,898.84 | $5,306–$6,261 | varies |
| Cardiac MRI w/w/o contrast & further seq (75561) range across 2 matching MRF lines |
$756.54–$2,509.46 | $1,634–$5,420 | varies |
| Cardiac MRI w/w/o contrast w/stress (75563) | $2,886.81 | $6,235 | 3.8× |
| Cat Scan Follow-Up Study (76380) range across 2 matching MRF lines |
$160.66–$501.43 | $347–$1,083 | varies |
| Cerebrospinal Fluid Flow W/O Matl Shunt Evaltj (78645) | $650.52 | $1,405 | 1.2× |
| Cerebrospinal Fluid Scan (78630) | $643.57 | $1,390 | 1.2× |
| Chest 1 view (71045) range across 2 matching MRF lines |
$104.64–$150.01 | $226–$324 | varies |
| Chest 2 views (71046) range across 2 matching MRF lines |
$141.68–$157.42 | $306–$340 | varies |
| Chest 3 views (71047) range across 2 matching MRF lines |
$160.66–$204.65 | $347–$442 | varies |
| Chest 4 or more views (71048) | $193.53 | $418 | 1.9× |
| Chg us nrv&acc strux 1 xtr compre w/img pr extremity (76883) | $303.73 | $656 | 3.0× |
| Cineradiograpy/vidradiograpy xcpt where spec (76120) range across 2 matching MRF lines |
$158.81–$207.42 | $343–$448 | varies |
| Clavicle complete (73000) range across 2 matching MRF lines |
$135.66–$160.66 | $293–$347 | varies |
| Computed Tomography Thorax Lw Dose Lng Ca Scr C- (71271) range across 2 matching MRF lines |
$164.37–$314.84 | $355–$680 | varies |
| Continuing medical physics consltj pr wk (77336) range across 2 matching MRF lines |
$176.87–$260.67 | $382–$563 | varies |
| Contrast Exam Abdominl Aorta (75625) range across 2 matching MRF lines |
$2,086.74–$5,761.57 | $4,507–$12,444 | varies |
| Contrast X-Ray Bladder (74430) range across 2 matching MRF lines |
$300.49–$713.02 | $649–$1,540 | varies |
| Contrast X-Ray Of Elbow (73085) range across 2 matching MRF lines |
$371.33–$661.63 | $802–$1,429 | varies |
| Contrast X-Ray Of Knee Joint (73580) range across 2 matching MRF lines |
$363.92–$657 | $786–$1,419 | varies |
| Corpora cavernosography (74445) | $240.30 | $519 | 2.4× |
| CT abdomen and pelvis without and with contrast (74178) range across 2 matching MRF lines |
$751.91–$2,029.33 | $1,624–$4,383 | varies |
| CT abdomen and pelvis without contrast (74176) range across 2 matching MRF lines |
$469.48–$909.33 | $1,014–$1,964 | varies |
| CT abdomen w contrast (74160) range across 2 matching MRF lines |
$531.06–$1,342.24 | $1,147–$2,899 | varies |
| CT abdomen w wo contrast (74170) range across 2 matching MRF lines |
$614.40–$1,544.11 | $1,327–$3,335 | varies |
| CT abdomen w/o contrast (74150) range across 2 matching MRF lines |
$258.35–$720.43 | $558–$1,556 | varies |
| CT Angio Abdomen and Pelvis (74174) range across 2 matching MRF lines |
$891.74–$1,747.36 | $1,926–$3,774 | varies |
| CT Angio Chest (71275) range across 2 matching MRF lines |
$623.66–$1,676.06 | $1,347–$3,620 | varies |
| CT Angio Head (70496) range across 2 matching MRF lines |
$615.79–$1,644.11 | $1,330–$3,551 | varies |
| CT angio hrt w/3d image (75574) range across 2 matching MRF lines |
$831.55–$2,029.33 | $1,796–$4,383 | varies |
| Ct Angio Lwr Extr W/O&W/Dye (73706) range across 2 matching MRF lines |
$330.12–$1,901.54 | $713–$4,107 | varies |
| CT Angio Neck (70498) range across 2 matching MRF lines |
$615.79–$1,641.34 | $1,330–$3,545 | varies |
| Ct Angio Upr Extrm W/O&W/Dye (73206) range across 2 matching MRF lines |
$573.66–$1,875.61 | $1,239–$4,051 | varies |
| CT Cere Prfuj Alys C+ W/O CT/Cta Same Anatomy (70473) range across 2 matching MRF lines |
$352.81–$939.43 | $762–$2,029 | varies |
| CT cervical spine w/ contrast (72126) range across 2 matching MRF lines |
$678.76–$1,339.46 | $1,466–$2,893 | varies |
| CT cervical spine w/o contrast (72125) range across 2 matching MRF lines |
$326.42–$775.53 | $705–$1,675 | varies |
| CT cervical spine w/wo cont (72127) | $1,500.58 | $3,241 | 8.8× |
| CT chest w contrast (71260) range across 2 matching MRF lines |
$357.44–$1,076.48 | $772–$2,325 | varies |
| CT chest w/wo contrast (71270) range across 2 matching MRF lines |
$500.50–$1,332.98 | $1,081–$2,879 | varies |
| CT colonography screening (74263) | $1,812.18 | $3,914 | 7.8× |
| CT Colonogrphy Dx Image Postprocess W/Contrast (74262) | $1,911.26 | $4,128 | 11.2× |
| CT colonogrphy dx image postprocess w/o contrast (74261) | $1,105.18 | $2,387 | 10.9× |
| CT head/brain with contrast (70460) range across 2 matching MRF lines |
$362.99–$852.38 | $784–$1,841 | varies |
| CT head/brain without and with contrast (70470) range across 2 matching MRF lines |
$364.38–$1,026.01 | $787–$2,216 | varies |
| CT heart contrast eval cardiac structure&morph (75572) range across 2 matching MRF lines |
$661.63–$1,624.20 | $1,429–$3,508 | varies |
| CT heart no contrast quant eval coronry calcium (75571) | $34.73 | $75 | 0.4× |
| CT hrt w/3d image congen (75573) range across 2 matching MRF lines |
$341.23–$2,010.35 | $737–$4,342 | varies |
| CT iac w contrast (70481) range across 2 matching MRF lines |
$569.03–$1,487.62 | $1,229–$3,213 | varies |
| CT l-spine w&w/o contrast (72133) | $1,500.58 | $3,241 | 8.8× |
| CT lower ext w/o (73700) range across 2 matching MRF lines |
$239.83–$861.64 | $518–$1,861 | varies |
| CT lower extremity w/contrast material (73701) range across 2 matching MRF lines |
$456.52–$1,344.55 | $986–$2,904 | varies |
| CT lumbar spine w contrast (72132) range across 2 matching MRF lines |
$678.76–$1,339.46 | $1,466–$2,893 | varies |
| CT lumbar spine w/o contrast (72131) range across 2 matching MRF lines |
$295.86–$758.86 | $639–$1,639 | varies |
| CT maxillofacial w contrast (70487) range across 2 matching MRF lines |
$351.88–$891.28 | $760–$1,925 | varies |
| CT maxillofacial wo contrast (70486) range across 2 matching MRF lines |
$278.26–$771.82 | $601–$1,667 | varies |
| CT neck tissue combo (70492) range across 2 matching MRF lines |
$539.86–$1,313.99 | $1,166–$2,838 | varies |
| Ct Orbit/Ear/Fossa W/O&W/Dye (70482) range across 2 matching MRF lines |
$568.56–$1,784.40 | $1,228–$3,854 | varies |
| CT orbits w/o contrast (70480) range across 2 matching MRF lines |
$523.19–$935.26 | $1,130–$2,020 | varies |
| CT pelvis w&w/o contrast (72194) range across 2 matching MRF lines |
$531.99–$1,597.81 | $1,149–$3,451 | varies |
| CT pelvis w/o contrast (72192) range across 2 matching MRF lines |
$261.13–$733.39 | $564–$1,584 | varies |
| CT scan of leg combo (73702) | $1,507.99 | $3,257 | 8.9× |
| CT scans face/jaw combo (70488) | $1,128.33 | $2,437 | 6.6× |
| CT soft tissue neck w contrast (70491) range across 2 matching MRF lines |
$382.90–$1,074.16 | $827–$2,320 | varies |
| CT soft tissue neck w/o contrast (70490) range across 2 matching MRF lines |
$287.52–$824.14 | $621–$1,780 | varies |
| CT thoracic spine w contrast (72129) range across 2 matching MRF lines |
$324.10–$1,347.33 | $700–$2,910 | varies |
| CT thoracic spine w/o contrast (72128) range across 2 matching MRF lines |
$326.42–$758.86 | $705–$1,639 | varies |
| CT thoracic spine w/wo cont (72130) | $789.42 | $1,705 | 4.6× |
| CT thorax w/o contrast (71250) range across 2 matching MRF lines |
$261.13–$763.95 | $564–$1,650 | varies |
| CT unlisted procedure (76497) | $1,013.04 | $2,188 | 12.0× |
| CT upper ext wo (73200) range across 2 matching MRF lines |
$370.40–$861.64 | $800–$1,861 | varies |
| CT upper extremity w/o & w/contrast material (73202) | $1,507.99 | $3,257 | 8.9× |
| CT upper extremity with contrast (73201) range across 2 matching MRF lines |
$736.63–$1,319.55 | $1,591–$2,850 | varies |
| Cta Abdl Aorta&Bi Iliofem W/Contrast&Postp (75635) range across 2 matching MRF lines |
$819.51–$1,790.42 | $1,770–$3,867 | varies |
| Cta Abdomen (74175) range across 2 matching MRF lines |
$738.49–$1,657.54 | $1,595–$3,580 | varies |
| CTA head&neck c+ w/noncontrast img&post-pxessing (70471) range across 2 matching MRF lines |
$660.24–$2,027.01 | $1,426–$4,378 | varies |
| CTA pelvis (72191) range across 2 matching MRF lines |
$595.42–$1,623.28 | $1,286–$3,506 | varies |
| Dilation ureters/urethra rs&i (74485) | $2,785.87 | $6,017 | 1.4× |
| Diskography lumbar (72295) | $446.80 | $965 | 0.2× |
| Doppler Echo Fetal Puls Spectral F/U/Repeat (76828) | $209.74 | $453 | 2.1× |
| Doppler Echo Fetal Spectral Display Complete (76827) range across 2 matching MRF lines |
$203.72–$327.34 | $440–$707 | varies |
| Doppler Fetal Mid Cerebral Artery (76821) range across 2 matching MRF lines |
$194–$401.88 | $419–$868 | varies |
| Dxa Bone Density Axial (77080) range across 2 matching MRF lines |
$210.67–$215.30 | $455–$465 | varies |
| Dxa bone density study (77085) | $222.24 | $480 | 2.2× |
| Dxa bone density study 1/>sites appendiclr skel (77081) range across 2 matching MRF lines |
$122.70–$174.55 | $265–$377 | varies |
| Echo exam of fetal heart (76825) range across 2 matching MRF lines |
$1,022.77–$1,148.70 | $2,209–$2,481 | varies |
| Echo exam uterus (76831) | $694.50 | $1,500 | 3.0× |
| Echocardiography, fetal, cardiovascular system, real time with image documentation (2D), with or without M-mode… (76826) | $711.63 | $1,537 | 3.1× |
| Echograp Trans R Pros Study (76873) | $502.82 | $1,086 | 5.0× |
| Esophagram (74220) range across 2 matching MRF lines |
$269.47–$352.34 | $582–$761 | varies |
| Fetal Biophys Profile W/Nst (76818) range across 2 matching MRF lines |
$194–$438.92 | $419–$948 | varies |
| Fetal Biophysical Profile W/O Non-Stress Testing (76819) range across 2 matching MRF lines |
$194–$401.42 | $419–$867 | varies |
| Fetal MRI w/placntl matrnl plvc img sing/1st ges (74712) | $1,010.73 | $2,183 | 4.4× |
| Fluoroscopy up to 1 hr (76000) range across 4 matching MRF lines |
$325.03–$469.48 | $702–$1,014 | varies |
| Follow-Up Angiography (75898) | $1,577.90 | $3,408 | 0.5× |
| Foot 2 views (73620) range across 3 matching MRF lines |
$134.27–$174.55 | $290–$377 | varies |
| Forearm 2 views (73090) range across 2 matching MRF lines |
$135.66–$174.55 | $293–$377 | varies |
| Gastric emptying imaging study (78264) range across 2 matching MRF lines |
$517.63–$789.88 | $1,118–$1,706 | varies |
| Gastroesophageal Reflux Exam (78262) | $483.37 | $1,044 | 1.2× |
| Gated Heart Planar Single (78472) range across 2 matching MRF lines |
$503.28–$757.01 | $1,087–$1,635 | varies |
| Hand 2 views (73120) range across 3 matching MRF lines |
$162.98–$194 | $352–$419 | varies |
| Hdr Rdncl Ntrstl/Icav Brchtx (77772) range across 2 matching MRF lines |
$1,177.87–$1,265.38 | $2,544–$2,733 | varies |
| Hdr Rdncl Ntrstl/Icav Brchtx (77771) range across 2 matching MRF lines |
$743.12–$1,265.38 | $1,605–$2,733 | varies |
| Hdr Rdncl Ntrstl/Icav Brchtx 1 Channel (77770) range across 2 matching MRF lines |
$817.66–$1,349.65 | $1,766–$2,915 | varies |
| Hepatc Vngrph Wdg/Fr Hemodyn Eval Rs&I (75889) range across 2 matching MRF lines |
$3,944.76–$5,829.17 | $8,520–$12,590 | varies |
| Hepatc Vngrph Wdg/Fr W/O Hemodyn Eval Rs&I (75891) | $667.65 | $1,442 | 0.2× |
| Hepatobil Syst Image W/Drug (78227) range across 2 matching MRF lines |
$802.38–$1,035.27 | $1,733–$2,236 | varies |
| Hepatobiliary System Imaging (78226) range across 2 matching MRF lines |
$553.75–$727.84 | $1,196–$1,572 | varies |
| Ht Muscle Image Spect Sing (78451) range across 2 matching MRF lines |
$1,595.96–$2,505.76 | $3,447–$5,412 | varies |
| Hysterosalpingogram (74740) range across 2 matching MRF lines |
$432.91–$462.54 | $935–$999 | varies |
| Image fusion (77399) | $260.67 | $563 | 2.0× |
| Infant hip ultrasound with hip movement (dynamic) (76885) range across 2 matching MRF lines |
$247.71–$256.04 | $535–$553 | varies |
| Infant hip ultrasound, limited static exam (76886) | $160.66 | $347 | 1.9× |
| Interstitial radiation source applic complex (77778) | $1,570.96 | $3,393 | 2.3× |
| Intracavitary Radiation Source Applic Complex (77763) | $1,349.65 | $2,915 | 2.0× |
| Intracavitary Radiation Source Applic Intermed (77762) | $1,125.09 | $2,430 | 2.1× |
| Intracavitary radiation source applic simple (77761) | $1,125.09 | $2,430 | 2.1× |
| Joint Survey Single View (77077) | $99.55 | $215 | 1.0× |
| K Flow/Funct Image W/Drug (78708) range across 2 matching MRF lines |
$644.03–$1,035.27 | $1,391–$2,236 | varies |
| K Flow/Funct Image W/O Drug (78707) range across 2 matching MRF lines |
$544.03–$953.78 | $1,175–$2,060 | varies |
| Kidney Imaging Morphol (78700) | $351.42 | $759 | 0.9× |
| Knee 3 Views (73562) range across 2 matching MRF lines |
$137.51–$174.55 | $297–$377 | varies |
| Leveen/Shunt Patency Exam (78291) | $480.13 | $1,037 | 1.2× |
| Liver & Spleen Imaging Static Only (78215) range across 2 matching MRF lines |
$295.86–$764.41 | $639–$1,651 | varies |
| Liver & Spleen Imaging W/Vascular Flow (78216) | $478.28 | $1,033 | 1.2× |
| Lung Perf&Ventilat Diferentl (78598) | $723.21 | $1,562 | 1.4× |
| Lung perfusion differential (78597) | $723.21 | $1,562 | 1.9× |
| Lung Ventilat&Perfus Imaging (78582) range across 2 matching MRF lines |
$628.29–$1,035.27 | $1,357–$2,236 | varies |
| Lymph System Imaging (78195) range across 2 matching MRF lines |
$643.57–$1,073.23 | $1,390–$2,318 | varies |
| Lymphangiography extremity only unilateral rs&i (75801) | $639.40 | $1,381 | 1.0× |
| Lymphangiography Pelvic/Abdominal Bilateral Rs&I (75807) range across 2 matching MRF lines |
$1,621.43–$5,974.55 | $3,502–$12,904 | varies |
| Lymphangiography, pelvic/abdominal, unilateral (75805) | $1,621.43 | $3,502 | 0.5× |
| Magnetic Image Jaw Joint (70336) range across 2 matching MRF lines |
$405.59–$1,453.36 | $876–$3,139 | varies |
| Mammary ductogram or galactogram single (77053) | $330.12 | $713 | 1.4× |
| Meckels Divert Exam (78290) range across 2 matching MRF lines |
$518.10–$764.41 | $1,119–$1,651 | varies |
| Medical physics dose eval radiation expos w/rprt (76145) | $291.69 | $630 | 0.8× |
| Mlc imrt design & construction per imrt plan (77338) range across 2 matching MRF lines |
$707.93–$709.32 | $1,529–$1,532 | varies |
| Mra Head W/O & W/Contrast Material (70546) range across 2 matching MRF lines |
$865.81–$2,843.28 | $1,870–$6,141 | varies |
| MRA head w/o contrast (70544) range across 2 matching MRF lines |
$607.92–$1,574.20 | $1,313–$3,400 | varies |
| MRA head with contrast (70545) | $1,576.98 | $3,406 | 4.7× |
| MRA neck w contrast (70548) range across 2 matching MRF lines |
$736.63–$1,790.42 | $1,591–$3,867 | varies |
| Mra Neck W/O &W/Contrast Material (70549) range across 2 matching MRF lines |
$1,298.72–$2,843.28 | $2,805–$6,141 | varies |
| MRA neck w/o contrast (70547) range across 2 matching MRF lines |
$405.59–$1,574.20 | $876–$3,400 | varies |
| MRI abdomen w contrast (74182) range across 2 matching MRF lines |
$713.02–$2,381.67 | $1,540–$5,144 | varies |
| MRI abdomen w/o contrast (74181) range across 2 matching MRF lines |
$432.44–$1,643.19 | $934–$3,549 | varies |
| MRI any jt lower extrem w/contrast material (73722) | $2,415.01 | $5,216 | 3.2× |
| MRI any jt lower extrem w/o & w/contrast matrl (73723) range across 2 matching MRF lines |
$975.08–$2,819.21 | $2,106–$6,089 | varies |
| MRI any jt upper extremity w/contrast matrl (73222) range across 2 matching MRF lines |
$1,391.32–$2,396.03 | $3,005–$5,175 | varies |
| MRI bone marrow blood supply (77084) | $506.99 | $1,095 | 2.2× |
| MRI Breast W/O Contrast Bilateral (77047) | $367.16 | $793 | 1.6× |
| MRI cardiac w/o cont stress (75559) | $1,301.96 | $2,812 | 2.5× |
| MRI cardiac w/o contrast (75557) range across 2 matching MRF lines |
$569.49–$1,752.46 | $1,230–$3,785 | varies |
| MRI cervical spine w contrast (72142) range across 2 matching MRF lines |
$661.63–$1,903.86 | $1,429–$4,112 | varies |
| MRI cervical spine w/o cont (72141) range across 2 matching MRF lines |
$464.39–$1,207.97 | $1,003–$2,609 | varies |
| MRI chest w/o contrast (71550) range across 2 matching MRF lines |
$456.98–$1,643.19 | $987–$3,549 | varies |
| MRI chest with contrast (71551) | $1,140.37 | $2,463 | 1.5× |
| MRI chest wo w contrast (71552) range across 2 matching MRF lines |
$1,103.33–$2,969.68 | $2,383–$6,414 | varies |
| MRI lower extrem oth/thn jt w/contrast matrl (73719) | $1,645.50 | $3,554 | 4.9× |
| MRI lower extrem oth/thn jt w/o & w/contr matr (73720) range across 2 matching MRF lines |
$773.21–$2,558.08 | $1,670–$5,525 | varies |
| MRI lower extrem oth/thn jt w/o contr matrl (73718) range across 2 matching MRF lines |
$783.86–$1,615.41 | $1,693–$3,489 | varies |
| MRI lumbar spine w contrast (72149) range across 2 matching MRF lines |
$678.76–$1,869.13 | $1,466–$4,037 | varies |
| Mri Neck Spine W/O & W/Dye (72156) range across 2 matching MRF lines |
$736.63–$2,135.82 | $1,591–$4,613 | varies |
| MRI orbit face &/neck w/o contrast (70540) range across 2 matching MRF lines |
$560.23–$1,613.56 | $1,210–$3,485 | varies |
| MRI orbit face neck w contrast (70542) | $1,064.44 | $2,299 | 3.1× |
| Mri Orbt/Fac/Nck W/O &W/Dye (70543) range across 2 matching MRF lines |
$773.67–$2,386.77 | $1,671–$5,155 | varies |
| MRI pelvis w contrast (72196) | $1,070.92 | $2,313 | 3.2× |
| MRI pelvis w/o & w contrast (72197) range across 2 matching MRF lines |
$870.44–$2,541.41 | $1,880–$5,489 | varies |
| MRI pelvis w/o contrast (72195) range across 2 matching MRF lines |
$860.25–$1,645.04 | $1,858–$3,553 | varies |
| MRI spectroscopy (76390) | $718.11 | $1,551 | 8.5× |
| MRI thoracic spine w/o contrast (72146) range across 2 matching MRF lines |
$484.30–$1,210.75 | $1,046–$2,615 | varies |
| MRI upper extremity oth than jt w/contr matrl (73219) | $1,268.62 | $2,740 | 3.7× |
| MRI upper extremity oth than jt w/o contr matrl (73218) range across 2 matching MRF lines |
$789.42–$1,617.26 | $1,705–$3,493 | varies |
| Mri Uppr Extremity W/O&W/Dye (73220) range across 2 matching MRF lines |
$931.09–$2,940.05 | $2,011–$6,350 | varies |
| MRI, abdomen, combo (74183) range across 2 matching MRF lines |
$736.63–$2,550.67 | $1,591–$5,509 | varies |
| MRI, dorsal spine combo (72157) range across 2 matching MRF lines |
$736.63–$2,141.84 | $1,591–$4,626 | varies |
| MRI, dorsal spine contrast (72147) range across 2 matching MRF lines |
$762.10–$1,887.19 | $1,646–$4,076 | varies |
| MRI, joint upper extrem (73221) range across 2 matching MRF lines |
$472.72–$1,359.37 | $1,021–$2,936 | varies |
| MRI, joint upper extrem combo (73223) range across 2 matching MRF lines |
$863.96–$2,920.14 | $1,866–$6,307 | varies |
| MRI, lumbar spine combo (72158) range across 2 matching MRF lines |
$808.40–$2,127.95 | $1,746–$4,596 | varies |
| Myelogram cervical (72240) range across 2 matching MRF lines |
$935.26–$1,537.16 | $2,020–$3,320 | varies |
| Myelogram Lumbar (72265) range across 2 matching MRF lines |
$818.12–$1,537.16 | $1,767–$3,320 | varies |
| Myelography thoracic (72255) range across 2 matching MRF lines |
$838.03–$1,537.16 | $1,810–$3,320 | varies |
| Myocardial Spect Multiple Studies (78452) range across 2 matching MRF lines |
$1,609.85–$2,606.23 | $3,477–$5,629 | varies |
| Myocrd Img Pet Prfuj W/Metab 2rtracer Cncrnt CT (78433) | $2,628.45 | $5,677 | 1.2× |
| N-invas est c ffr sw aly CTA (75580) | $2,002.01 | $4,324 | 2.4× |
| Neck soft tissue (70360) range across 2 matching MRF lines |
$135.66–$160.66 | $293–$347 | varies |
| Nm csf leak detection (78650) | $907.94 | $1,961 | 0.7× |
| Nonvascular Shunt X-Ray (75809) | $237.98 | $514 | 2.3× |
| Ntsty modul radthx pln dose-vol histos (77301) range across 2 matching MRF lines |
$2,652.99–$6,016.69 | $5,730–$12,995 | varies |
| Nuclear Rx Intra-Arterial (79445) range across 2 matching MRF lines |
$386.61–$439.39 | $835–$949 | varies |
| Nuclear Rx Oral Admin (79005) range across 2 matching MRF lines |
$401.88–$439.39 | $868–$949 | varies |
| Ob us nuchal meas 1 gest (76813) range across 2 matching MRF lines |
$207.42–$457.44 | $448–$988 | varies |
| Oph bmtry us echograpy a-scan io lens pwr cal (76519) | $234.74 | $507 | 2.3× |
| Oph us dx ant sgm us immersion b-scan/hr biom (76513) | $250.02 | $540 | 2.5× |
| Oph US Dx B-Scan&Quan a-Scan Sm Pt Enctr (76510) | $323.17 | $698 | 2.5× |
| Ophthalmic Ultrasonic Foreign Body Localization (76529) | $135.20 | $292 | 1.6× |
| Ophthalmic ultrasound dx b-scan w/wo a-scan (76512) range across 2 matching MRF lines |
$197.24–$236.13 | $426–$510 | varies |
| Ophthalmic US Dx Corneal Pachymetry Uni/Bi (76514) | $44.45 | $96 | 1.6× |
| Parathyroid imaging w/tomographic spect & CT (78072) range across 2 matching MRF lines |
$756.08–$1,073.23 | $1,633–$2,318 | varies |
| Parathyroid Planar Imaging (78070) | $573.66 | $1,239 | 1.5× |
| Pelvis 1 or 2 views (72170) range across 2 matching MRF lines |
$189.83–$210.67 | $410–$455 | varies |
| Perineogram (74775) | $438.92 | $948 | 1.9× |
| Peritoneogram Rs&I (74190) range across 2 matching MRF lines |
$828.31–$942.21 | $1,789–$2,035 | varies |
| Pet Image W/Ct Lmtd (78814) range across 2 matching MRF lines |
$2,223.33–$2,836.80 | $4,802–$6,127 | varies |
| PET image w/CT, full body (78816) range across 2 matching MRF lines |
$2,243.24–$2,995.61 | $4,845–$6,470 | varies |
| PET imaging CT attenuation skull base mid-thigh (78815) range across 2 matching MRF lines |
$2,240.46–$2,995.61 | $4,839–$6,470 | varies |
| Prq Transhepatc Portograpy Hemodyn Eval Rs&I (75885) | $3,665.57 | $7,917 | 1.2× |
| Pulmonary Perfusion Imaging Particulate (78580) range across 2 matching MRF lines |
$430.13–$727.84 | $929–$1,572 | varies |
| Radex Abd Compl Aqt Abd W/S/E/D Views 1 View Ch (74022) range across 2 matching MRF lines |
$203.72–$225.48 | $440–$487 | varies |
| Radex abscess/fistula/sinus tract rs&i (76080) range across 2 matching MRF lines |
$274.10–$915.35 | $592–$1,977 | varies |
| Radex Ankle Complete Minimum 3 Views (73610) range across 2 matching MRF lines |
$136.12–$174.55 | $294–$377 | varies |
| Radex Calcaneus Minimum 2 Views (73650) range across 2 matching MRF lines |
$135.20–$160.66 | $292–$347 | varies |
| Radex elbow complete minimum 3 views (73080) range across 2 matching MRF lines |
$136.12–$163.44 | $294–$353 | varies |
| Radex Facial Bones Complete Minimum 3 Views (70150) range across 2 matching MRF lines |
$201.87–$221.31 | $436–$478 | varies |
| Radex fingr minimum 2 views (73140) range across 2 matching MRF lines |
$132.42–$174.55 | $286–$377 | varies |
| Radex foot complete minimum 3 views (73630) range across 2 matching MRF lines |
$135.66–$174.55 | $293–$377 | varies |
| Radex Hand Minimum 3 Views (73130) range across 2 matching MRF lines |
$136.12–$174.55 | $294–$377 | varies |
| Radex lower extremity infant minimum 2 views (73592) range across 2 matching MRF lines |
$135.20–$160.66 | $292–$347 | varies |
| Radex Nasal Bones Complete Minimum 3 Views (70160) range across 2 matching MRF lines |
$119.45–$160.66 | $258–$347 | varies |
| Radex Ribs Unilateral 2 Views (71100) range across 2 matching MRF lines |
$140.75–$160.66 | $304–$347 | varies |
| Radex shoulder complete minimum 2 views (73030) range across 2 matching MRF lines |
$137.51–$174.55 | $297–$377 | varies |
| Radex Sinuses Paransl < 3 Views (70210) range across 2 matching MRF lines |
$136.12–$160.66 | $294–$347 | varies |
| Radex Spine 1 View Specify Level (72020) range across 2 matching MRF lines |
$119.45–$174.55 | $258–$377 | varies |
| Radex Sternum Minimum 2 Views (71120) range across 2 matching MRF lines |
$138.44–$160.66 | $299–$347 | varies |
| Radex Temporomandble Jt Opn & Clsd Mouth Bilat (70330) range across 2 matching MRF lines |
$84.73–$160.66 | $183–$347 | varies |
| Radex Toe Minimum 2 Views (73660) range across 2 matching MRF lines |
$131.96–$174.55 | $285–$377 | varies |
| Radex upper extremity infant minimum 2 views (73092) range across 2 matching MRF lines |
$158.81–$194 | $343–$419 | varies |
| Radex Wrist Complete Minimum 3 Views (73110) range across 2 matching MRF lines |
$136.12–$174.55 | $294–$377 | varies |
| Radex X-Ray Exam Entire Spi 6/> Vw - Xr Entire Spine 6+ Vw (72084) | $431.98 | $933 | 4.3× |
| Radiation Delivery Stereotactic Cranial Linear (77372) range across 2 matching MRF lines |
$6,565.80–$13,741.38 | $14,181–$29,679 | varies |
| Radiation treatment delivery level 1 (77402) range across 2 matching MRF lines |
$1,157.50–$1,554.75 | $2,500–$3,358 | varies |
| Radiation treatment delivery level 2 (77407) range across 2 matching MRF lines |
$1,710.32–$1,805.24 | $3,694–$3,899 | varies |
| Radiation treatment delivery level 3 (77412) range across 2 matching MRF lines |
$2,005.72–$2,070.07 | $4,332–$4,471 | varies |
| Radiolog exam mandible compl minimum 4 views (70110) range across 2 matching MRF lines |
$201.87–$209.74 | $436–$453 | varies |
| Radiologic Exam Abdomen 3+ Views - Xr Abdomen 3+ Views (74021) | $192.61 | $416 | 1.9× |
| Radiologic exam colon double contrast study (74280) range across 2 matching MRF lines |
$296.32–$324.10 | $640–$700 | varies |
| Radiologic exam colon single contrast study (74270) range across 2 matching MRF lines |
$256.97–$352.34 | $555–$761 | varies |
| Radiologic Exam Esophagus Double Contrast Study (74221) | $263.45 | $569 | 1.5× |
| Radiologic exam knee complete 4/more views (73564) range across 2 matching MRF lines |
$210.67–$235.67 | $455–$509 | varies |
| Radiologic exam pelvis compl minimum 3 views (72190) range across 2 matching MRF lines |
$198.16–$223.17 | $428–$482 | varies |
| Radiologic Exam Small Int Single Contrast Study (74250) range across 2 matching MRF lines |
$237.98–$352.34 | $514–$761 | varies |
| Radiologic exam swallow function contrast study (74230) range across 2 matching MRF lines |
$242.61–$352.34 | $524–$761 | varies |
| Radiologic exam upr gi trc double contrast study (74246) range across 2 matching MRF lines |
$293.08–$352.34 | $633–$761 | varies |
| Radiologic examination femur 1 view (73551) range across 2 matching MRF lines |
$93.99–$171.77 | $203–$371 | varies |
| Radiologic examination femur minimum 2 views (73552) range across 2 matching MRF lines |
$120.84–$174.55 | $261–$377 | varies |
| Radiologic examination knee 1/2 views (73560) range across 2 matching MRF lines |
$135.66–$174.55 | $293–$377 | varies |
| Radiologic Examination Osseous Survey Limited (77074) | $160.20 | $346 | 1.6× |
| Radiologic examination tibia & fibula 2 views (73590) range across 2 matching MRF lines |
$135.66–$169 | $293–$365 | varies |
| Ribs bilateral 3 views (71110) range across 2 matching MRF lines |
$194–$209.74 | $419–$453 | varies |
| Rp loclzj tum plnr 1 area single day imaging (78800) | $502.82 | $1,086 | 1.3× |
| Rp loclzj tum plnr 2+area 1+d img/1 area img>2+d (78801) range across 2 matching MRF lines |
$497.73–$727.84 | $1,075–$1,572 | varies |
| Rp Loclzj Tum Plnr Whole Body 2+ Days Imaging (78804) range across 2 matching MRF lines |
$1,389–$2,505.76 | $3,000–$5,412 | varies |
| Rp Loclzj Tum Plnr Whole Body Single Day Imaging (78802) | $1,349.18 | $2,914 | 2.6× |
| Rp Loclzj Tum Spect 1 Area Single Day Imaging (78803) range across 2 matching MRF lines |
$722.74–$2,719.20 | $1,561–$5,873 | varies |
| Rp loclzj tum spect 2 area/sep acquisj img (78831) | $1,458.45 | $3,150 | 1.2× |
| Rp loclzj tum spect CT 2area 1d img/1 ar img>2+d (78832) | $1,654.30 | $3,573 | 1.2× |
| Rp loclzj tum spect w/CT 1 area/acquisj 1day img (78830) range across 2 matching MRF lines |
$1,487.16–$2,505.76 | $3,212–$5,412 | varies |
| Rp Ther Radiolbld Monoclonal Antibody IV Infus (79403) | $696.35 | $1,504 | 3.1× |
| Rp Therapy Intravenous Administration (79101) range across 2 matching MRF lines |
$406.05–$439.39 | $877–$949 | varies |
| Scapula (73010) range across 2 matching MRF lines |
$119.92–$194 | $259–$419 | varies |
| Screening Digital Breast Tomosynthesis Bi (77063) range across 2 matching MRF lines |
$47.69–$67.60 | $103–$146 | varies |
| Shoulder 1 view (73020) range across 2 matching MRF lines |
$121.77–$174.55 | $263–$377 | varies |
| Shoulder Arthrography (73040) range across 2 matching MRF lines |
$434.29–$713.02 | $938–$1,540 | varies |
| Sialogram (70390) | $189.37 | $409 | 0.8× |
| Skull less than 4 views (70250) range across 2 matching MRF lines |
$196.31–$210.67 | $424–$455 | varies |
| Special dosimetry (77331) range across 2 matching MRF lines |
$165.75–$258.82 | $358–$559 | varies |
| Special Physics Consult (77370) range across 2 matching MRF lines |
$239.83–$267.15 | $518–$577 | varies |
| Special teletherapy port plan (77321) range across 2 matching MRF lines |
$289.84–$652.37 | $626–$1,409 | varies |
| Special treatment procedure (77470) range across 2 matching MRF lines |
$319.47–$1,127.41 | $690–$2,435 | varies |
| Stereotactic Body Radiation Delivery (77373) range across 2 matching MRF lines |
$3,542.88–$3,749.37 | $7,652–$8,098 | varies |
| Sternoclavicular joints (71130) range across 2 matching MRF lines |
$140.75–$160.66 | $304–$347 | varies |
| Superior sagittal sinus venogram (75870) | $2,426.12 | $5,240 | 0.8× |
| Surface Applic Low Dose Rate Radionuclide Source (77789) | $212.98 | $460 | 2.1× |
| Telethx isodose pln cplx w/basic dosimetry (77307) | $707.93 | $1,529 | 1.9× |
| Telethx isodose pln smpl w/dosimetry calculation (77306) range across 2 matching MRF lines |
$671.81–$712.56 | $1,451–$1,539 | varies |
| Ther Rad Simulaj-Aided Field Setting Complex (77290) range across 2 matching MRF lines |
$707.93–$1,704.30 | $1,529–$3,681 | varies |
| Ther rad simulaj-aided field setting simple (77280) range across 2 matching MRF lines |
$260.67–$1,244.08 | $563–$2,687 | varies |
| Thoracic spine 2 views (72070) range across 2 matching MRF lines |
$187.52–$210.67 | $405–$455 | varies |
| Thoracic spine 3 views (72072) range across 2 matching MRF lines |
$194–$196.31 | $419–$424 | varies |
| Thoracolumbar 2 views (72080) range across 2 matching MRF lines |
$122.70–$171.77 | $265–$371 | varies |
| Thyroid Imaging With Vascular Flow (78013) range across 2 matching MRF lines |
$302.34–$727.84 | $653–$1,572 | varies |
| Thyroid Met Imaging Body (78018) range across 2 matching MRF lines |
$621.81–$1,035.27 | $1,343–$2,236 | varies |
| Thyroid Uptake Measurement (78012) | $389.85 | $842 | 1.0× |
| Thyroid Uptake W/Blood Flow Sngle/Mult Quan Meas (78014) range across 2 matching MRF lines |
$417.63–$789.88 | $902–$1,706 | varies |
| Tx Devices Design & Construction Complex (77334) range across 2 matching MRF lines |
$588.94–$707.93 | $1,272–$1,529 | varies |
| Tx devices design & construction intermediate (77333) range across 2 matching MRF lines |
$258.82–$262.06 | $559–$566 | varies |
| Tx devices design & construction simple (77332) range across 2 matching MRF lines |
$260.67–$267.15 | $563–$577 | varies |
| Ultrasound Breast Limited (76642) range across 2 matching MRF lines |
$174.55–$230.11 | $377–$497 | varies |
| Ultrasound elastography first target lesion (76982) | $110.66 | $239 | 1.1× |
| Ultrasound Elastography Parenchyma (76981) range across 2 matching MRF lines |
$129.18–$207.42 | $279–$448 | varies |
| Ultrasound Exam Aaa Screen (76706) range across 4 matching MRF lines |
$50.47–$209.28 | $109–$452 | varies |
| Ultrasound, abdomen limited (76705) range across 2 matching MRF lines |
$210.67–$375.03 | $455–$810 | varies |
| Umbilical-artery Doppler (OB) (76820) range across 2 matching MRF lines |
$187.52–$194 | $405–$419 | varies |
| Unlisted Dx Radiographic Procedure (76499) range across 2 matching MRF lines |
$49.08–$121.31 | $106–$262 | varies |
| Unlisted fluoroscopic procedure (76496) range across 3 matching MRF lines |
$164.37–$164.83 | $355–$356 | varies |
| Unlisted magnetic resonance procedure (76498) | $2,558.08 | $5,525 | 30.3× |
| Unlisted Miscellaneous Px Dx Nuclear Medicine (78999) | $508.84 | $1,099 | 1.3× |
| Upper gi w/o kub (74240) range across 2 matching MRF lines |
$293.08–$324.56 | $633–$701 | varies |
| Ureteral Reflux Study (78740) | $433.37 | $936 | 1.1× |
| Urethrocystogram voiding (74455) range across 2 matching MRF lines |
$419.48–$480.59 | $906–$1,038 | varies |
| Urethrocystography retrograde (74450) range across 2 matching MRF lines |
$419.48–$424.11 | $906–$916 | varies |
| Us breast unilateral complete (76641) range across 2 matching MRF lines |
$194–$387.07 | $419–$836 | varies |
| Us chest (76604) range across 2 matching MRF lines |
$210.67–$369.01 | $455–$797 | varies |
| Us complete joint (76881) range across 2 matching MRF lines |
$231.50–$380.12 | $500–$821 | varies |
| Us exam, pelvic, limited (76857) range across 4 matching MRF lines |
$50.93–$214.37 | $110–$463 | varies |
| Us head (76506) range across 2 matching MRF lines |
$194–$380.59 | $419–$822 | varies |
| Us kidney transplant (76776) range across 2 matching MRF lines |
$296.32–$397.72 | $640–$859 | varies |
| Us lmtd joint/oth nonvasc xtr strux r-t w/img (76882) range across 2 matching MRF lines |
$218.54–$223.17 | $472–$482 | varies |
| Us ob detailed single fetus (76811) range across 2 matching MRF lines |
$429.20–$432.44 | $927–$934 | varies |
| Us ob limited 1 or more fetuses (76815) range across 2 matching MRF lines |
$194–$384.75 | $419–$831 | varies |
| Us ob transvaginal (76817) range across 2 matching MRF lines |
$210.67–$297.71 | $455–$643 | varies |
| Us pelvic non ob complete (76856) range across 2 matching MRF lines |
$223.63–$343.08 | $483–$741 | varies |
| Us pg uter img f&mat 14 wk tabdl 1/1st gestation (76801) range across 2 matching MRF lines |
$210.67–$429.20 | $455–$927 | varies |
| Us preg uterus real time f/u trnsabdl per fetus (76816) range across 2 matching MRF lines |
$194–$362.07 | $419–$782 | varies |
| Us retroperitoneal complete (76770) range across 2 matching MRF lines |
$237.52–$349.10 | $513–$754 | varies |
| Us retroperitoneal limited (76775) range across 2 matching MRF lines |
$210.67–$243.08 | $455–$525 | varies |
| Us scrotum and contents (76870) range across 2 matching MRF lines |
$221.31–$300.02 | $478–$648 | varies |
| Us spinal canal and contents (76800) range across 2 matching MRF lines |
$228.26–$310.67 | $493–$671 | varies |
| Us thyroid (76536) range across 2 matching MRF lines |
$232.89–$371.33 | $503–$802 | varies |
| Us transrectal (76872) range across 2 matching MRF lines |
$210.67–$386.14 | $455–$834 | varies |
| Vein X-Ray Chest (75827) range across 2 matching MRF lines |
$810.25–$2,978.48 | $1,750–$6,433 | varies |
| Vein X-Ray Liver W/O Hemodyn (75887) | $1,977.94 | $4,272 | 0.6× |
| Venogram Sinus/Jugular (75860) range across 2 matching MRF lines |
$1,621.43–$5,829.17 | $3,502–$12,590 | varies |
| Venography Adrenal Unilateral (75840) | $757.93 | $1,637 | 0.2× |
| Venography caval inferior serialography rs&i (75825) range across 2 matching MRF lines |
$1,621.43–$5,829.17 | $3,502–$12,590 | varies |
| Venography extremity bilateral rs&i (75822) range across 2 matching MRF lines |
$810.25–$2,877.08 | $1,750–$6,214 | varies |
| Venography extremity unilateral rs&i (75820) range across 2 matching MRF lines |
$810.25–$2,652.06 | $1,750–$5,728 | varies |
| Venography Renal Bilateral (75833) | $549.12 | $1,186 | 0.2× |
| Venography Renal Unilateral (75831) range across 2 matching MRF lines |
$1,621.43–$5,310.15 | $3,502–$11,469 | varies |
| Venous sampling by catheter (75893) likely a partial charge, not the full procedure |
$777.38 | $1,679 | 0.1× |
| Vertebral fracture assessment via dxa (77086) | $136.12 | $294 | 1.6× |
| Wrist 2 views (73100) range across 2 matching MRF lines |
$135.66–$174.55 | $293–$377 | varies |
| X-Ray Ac Jts - Xr Acromioclavicular Joints Bilateral (73050) range across 2 matching MRF lines |
$139.36–$160.66 | $301–$347 | varies |
| X-ray antegrade pyelogram tube (74425) range across 2 matching MRF lines |
$670.42–$720.43 | $1,448–$1,556 | varies |
| X-Ray Aorta Leg Arteries (75630) range across 2 matching MRF lines |
$2,086.74–$5,829.17 | $4,507–$12,590 | varies |
| X-Ray Bend Only L-S Spine (72120) | $114.36 | $247 | 1.1× |
| X-Ray Elbow 2 Vw - Xr Elbow 1-2 Views Right (73070) range across 3 matching MRF lines |
$135.20–$174.55 | $292–$377 | varies |
| X-Ray Exam Breast Specimen (76098) range across 2 matching MRF lines |
$274.10–$973.69 | $592–$2,103 | varies |
| X-Ray Exam Entire Spi 1 Vw (72081) range across 2 matching MRF lines |
$144.92–$163.90 | $313–$354 | varies |
| X-Ray Exam Entire Spi 2/3 Vw (72082) range across 2 matching MRF lines |
$210.67–$255.58 | $455–$552 | varies |
| X-Ray Exam Hip Uni 1 View (73501) range across 2 matching MRF lines |
$120.84–$160.66 | $261–$347 | varies |
| X-Ray Exam Hip Uni 2-3 Views (73502) range across 2 matching MRF lines |
$123.16–$174.55 | $266–$377 | varies |
| X-Ray Exam Hip Uni 4/> Views (73503) range across 2 matching MRF lines |
$210.67–$251.87 | $455–$544 | varies |
| X-Ray Exam Hips Bi 2 Views (73521) range across 2 matching MRF lines |
$198.16–$217.61 | $428–$470 | varies |
| X-Ray Exam Hips Bi 3-4 Views (73522) range across 2 matching MRF lines |
$194–$223.63 | $419–$483 | varies |
| X-Ray Exam Hips Bi 5/> Views (73523) range across 2 matching MRF lines |
$210.67–$334.29 | $455–$722 | varies |
| X-Ray Exam L-S Spine Bending (72114) | $225.94 | $488 | 2.2× |
| X-Ray Exam Neck Spine 2-3 Vw (72040) range across 2 matching MRF lines |
$140.75–$174.55 | $304–$377 | varies |
| X-Ray Exam Neck Spine 6/>Vws (72052) range across 2 matching MRF lines |
$198.16–$258.82 | $428–$559 | varies |
| X-Ray Exam Unilat Ribs/Chest (71101) range across 2 matching MRF lines |
$201.87–$210.67 | $436–$455 | varies |
| X-ray eye for foreign body (70030) range across 2 matching MRF lines |
$135.66–$174.55 | $293–$377 | varies |
| X-ray humerus (73060) range across 2 matching MRF lines |
$135.66–$174.55 | $293–$377 | varies |
| X-ray IV pyelogram (ivp) (74400) | $437.07 | $944 | 2.6× |
| X-ray IV pyelogram+tomography (74415) | $497.26 | $1,074 | 2.9× |
| X-Ray Jaw <4 Vw - Xr Mandible < 4 Views (70100) | $119.92 | $259 | 1.4× |
| X-Ray Knee Bilat Standing - Xr Knees Anteroposterior Standing Bilat (73565) range across 2 matching MRF lines |
$136.12–$167.14 | $294–$361 | varies |
| X-Ray Lumbar Spine 2/3 Vw - Xr Lumbar Spine 2-3 Views (72100) range across 2 matching MRF lines |
$196.31–$210.67 | $424–$455 | varies |
| X-ray nose-rectum child f.b. (76010) | $137.05 | $296 | 1.6× |
| X-Ray Ribs, Chest 4+ Vw - Xr Ribs 3 Vws Bil W/ Chest Posteroanterior (71111) range across 2 matching MRF lines |
$194–$225.94 | $419–$488 | varies |
| X-Ray Sacroiliac Jts 3+ Vw - Xr Sacroiliac Joints 3+ Views (72202) range across 2 matching MRF lines |
$193.53–$210.67 | $418–$455 | varies |
| X-Ray Sacrum/Coccyx 2+ Vw - Xr Sacrum Coccyx 2+ Views (72220) range across 2 matching MRF lines |
$136.12–$160.66 | $294–$347 | varies |
| X-Ray Sinuses 3+ Vw - Xr Paranasal Sinuses 3+ Views (70220) range across 2 matching MRF lines |
$143.53–$160.20 | $310–$346 | varies |
| X-Ray Skull 4+ Vw - Xr Skull Complete 4+ Views (70260) | $223.17 | $482 | 2.2× |
| X-ray thoracic spine 4 vw (72074) range across 2 matching MRF lines |
$203.72–$212.52 | $440–$459 | varies |
| X-Ray Tmj Unilat (70328) | $81.49 | $176 | 1.0× |
| X-Ray Urinary Tract Exam With Contrast Material (74420) range across 2 matching MRF lines |
$634.31–$736.63 | $1,370–$1,591 | varies |
| X-Rays Bone Length Studies (77073) range across 2 matching MRF lines |
$146.31–$210.67 | $316–$455 | varies |
| X-Rays Bone Survey Complete (77075) range across 2 matching MRF lines |
$194–$243.08 | $419–$525 | varies |
| Xr c-spine 4 or 5 views (72050) range across 2 matching MRF lines |
$210.67–$224.56 | $455–$485 | varies |
| Xr facial bones less than 3 views (70140) | $138.90 | $300 | 1.6× |
| Xr orbits complete 4 views (70200) range across 2 matching MRF lines |
$99.08–$207.42 | $214–$448 | varies |
| Xr Tomogram Single Plane (76100) | $278.26 | $601 | 2.7× |
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.