Imaging prices at Concord Hospital – Franklin
Franklin, NH · every code in this section with a posted price and a Medicare benchmark.
491 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) | $270.60 | $902 | 0.2× |
| Abdomen 1 View (74018) range across 4 matching MRF lines |
$11.40–$121.80 | $38–$406 | varies |
| Abdomen 2 views (74019) range across 2 matching MRF lines |
$13.80–$146.10 | $46–$487 | varies |
| Acute Gastrointestinal Blood Loss Imaging (78278) range across 2 matching MRF lines |
$62.40–$2,222.40 | $208–$7,408 | varies |
| Acute venous thrombosis imaging, peptide Non-Facility (78456) | $63 | $210 | 0.0× |
| Adrenal Cortex & Medulla Img (78075) | $46.80 | $156 | 0.0× |
| Angio internal mammary (75756) | $72.30 | $241 | 0.0× |
| Angio pulmonary bilat (75743) | $104.40 | $348 | 0.0× |
| Angiography Adrenal Bilateral Slctv Rs&I (75733) | $82.80 | $276 | 0.0× |
| Angiography extremity bilateral rs&i (75716) range across 3 matching MRF lines |
$2,562 | $369–$8,540 | 0.8× |
| Angiography extremity unilateral rs&i (75710) range across 4 matching MRF lines |
$2,619.90 | $247–$8,733 | 0.8× |
| Angiography pulmonary unilateral slctv rs&i (75741) | $82.80 | $276 | 0.0× |
| Angrph pulmonary nonslctv cath/ven njx rs&i (75746) | $72.30 | $241 | 0.0× |
| Ankle 2 views (73600) range across 5 matching MRF lines |
$10.50–$157.50 | $35–$525 | varies |
| Aortography thoracic serialography rs&i (75605) likely a partial charge, not the full procedure |
$74.10 | $247 | 0.0× |
| Aortography thoracic w/o serialography rs&i (75600) | $30.90 | $103 | 0.0× |
| Artery X-Rays Abdomen (75726) unusually low: confirm this is the full procedure |
$2,013 | $6,710 | 0.3× |
| Artery X-Rays Adrenal Gland (75731) | $72.30 | $241 | 0.0× |
| Artery X-Rays Pelvis (75736) unusually low: confirm this is the full procedure |
$2,013 | $6,710 | 0.3× |
| Artery X-Rays Spine (75705) likely a partial charge, not the full procedure |
$137.70 | $459 | 0.0× |
| Arthrogram ankle (73615) range across 3 matching MRF lines |
$34.20–$768.30 | $114–$2,561 | varies |
| Arthrogram hip (73525) range across 4 matching MRF lines |
$34.20–$1,097.70 | $114–$3,659 | varies |
| Arthrogram Wrist (73115) range across 3 matching MRF lines |
$34.20–$204 | $114–$680 | varies |
| Basic radiation dosimetry calculation (77300) | $39 | $130 | 0.3× |
| Bone age studies (77072) range across 2 matching MRF lines |
$12–$60.30 | $40–$201 | varies |
| Bone Imaging 3 Phase (78315) range across 2 matching MRF lines |
$64.20–$912 | $214–$3,040 | varies |
| Bone Imaging Limited Area (78300) range across 2 matching MRF lines |
$39–$912 | $130–$3,040 | varies |
| Bone Imaging Multiple Areas (78305) | $52.50 | $175 | 0.1× |
| Bone Imaging Whole Body (78306) range across 2 matching MRF lines |
$54–$912 | $180–$3,040 | varies |
| Bone marrow imaging limited area (78102) | $34.80 | $116 | 0.1× |
| Bone marrow imaging; multiple areas (78103) | $47.40 | $158 | 0.1× |
| Bone marrow imaging; whole body (78104) | $50.40 | $168 | 0.1× |
| Bone survey infant (77076) range across 2 matching MRF lines |
$44.10–$162.60 | $147–$542 | varies |
| Brachytx isodose complex (77318) range across 3 matching MRF lines |
$182.70–$1,020 | $609–$3,400 | varies |
| Brachytx isodose intermed (77317) | $115.50 | $385 | 0.3× |
| Brachytx Isodose Plan Simple (77316) | $88.20 | $294 | 0.2× |
| Brain Flow Imaging Only (78610) | $19.20 | $64 | 0.0× |
| Brain Image W/Flow < 4 Views (78601) | $32.40 | $108 | 0.1× |
| Brain imaging < 4 static views (78600) | $27.30 | $91 | 0.1× |
| Brain Imaging Min 4 Static Views W Vascular Flow (78606) range across 2 matching MRF lines |
$40.20–$2,222.40 | $134–$7,408 | varies |
| Brain Imaging Minimum 4 Static Views (78605) | $33.60 | $112 | 0.1× |
| Brain Imaging Pet Metabolic Evaluation (78608) range across 2 matching MRF lines |
$94.50–$6,370.50 | $315–$21,235 | varies |
| Card Bl Pool Gated Spect Rest Wal Motn Ejct Frct (78494) | $75 | $250 | 0.2× |
| Cardiac blood pool imaging, first pass technique; multiple studies, resting and with stress (exercise and/or… (78483) | $92.70 | $309 | 0.2× |
| Cardiac MRI w/w/o contrast & further seq (75561) | $164.10 | $547 | 0.4× |
| Cardiac MRI w/w/o contrast w/stress (75563) | $188.70 | $629 | 0.2× |
| Cardiac Shunt Detection (78428) | $49.50 | $165 | 0.1× |
| Cat Scan Follow-Up Study (76380) range across 2 matching MRF lines |
$61.80–$462 | $206–$1,540 | varies |
| Cerebrospinal Fluid Flow W/O Matl Shunt Evaltj (78645) range across 2 matching MRF lines |
$35.70–$1,781.70 | $119–$5,939 | varies |
| Cerebrospinal fluid flow, imaging (not including introduction of material); ventriculography Non-Facility (78635) | $38.10 | $127 | 0.1× |
| Cerebrospinal Fluid Scan (78630) range across 2 matching MRF lines |
$42.60–$1,197.60 | $142–$3,992 | varies |
| Chest 1 view (71045) range across 9 matching MRF lines |
$60.30–$106.50 | $201–$355 | varies |
| Chest 2 views (71046) range across 3 matching MRF lines |
$60.90–$106.50 | $203–$355 | varies |
| Chest 3 views (71047) | $71.40 | $238 | 0.8× |
| Chest 4 or more views (71048) | $76.20 | $254 | 0.7× |
| Cholecystography Oral Contrast (74290) | $21 | $70 | 0.1× |
| Cineradiograpy/vidradiograpy xcpt where spec (76120) | $23.70 | $79 | 0.2× |
| Clavicle complete (73000) range across 3 matching MRF lines |
$10.50–$120 | $35–$400 | varies |
| Computed Tomography Thorax Lw Dose Lng Ca Scr C- (71271) range across 3 matching MRF lines |
$64.20–$572.70 | $214–$1,909 | varies |
| Contrast Exam Abdominl Aorta (75625) | $72.30 | $241 | 0.0× |
| Contrast X-Ray Bladder (74430) range across 4 matching MRF lines |
$21–$414 | $70–$1,380 | varies |
| Contrast X-Ray Of Elbow (73085) range across 3 matching MRF lines |
$34.20–$204 | $114–$680 | varies |
| Contrast X-Ray Of Knee Joint (73580) range across 3 matching MRF lines |
$34.20–$570 | $114–$1,900 | varies |
| Contrast Xray Throat/Cerv Esopha (74210) | $22.80 | $76 | 0.1× |
| Corpora cavernosography (74445) | $72.30 | $241 | 0.6× |
| CT abdomen and pelvis without and with contrast (74178) range across 3 matching MRF lines |
$126.90–$806.70 | $423–$2,689 | varies |
| CT abdomen and pelvis without contrast (74176) range across 3 matching MRF lines |
$109.50–$462 | $365–$1,540 | varies |
| CT abdomen w contrast (74160) range across 2 matching MRF lines |
$79.80–$536.10 | $266–$1,787 | varies |
| CT abdomen w wo contrast (74170) range across 2 matching MRF lines |
$88.20–$951.30 | $294–$3,171 | varies |
| CT abdomen w/o contrast (74150) range across 2 matching MRF lines |
$75–$548.40 | $250–$1,828 | varies |
| CT Angio Abdomen and Pelvis (74174) range across 6 matching MRF lines |
$138.60–$738.60 | $462–$2,462 | varies |
| CT Angio Chest (71275) range across 4 matching MRF lines |
$114.90–$1,175.10 | $383–$3,917 | varies |
| CT Angio Head (70496) | $1,028.70 | $3,429 | 5.5× |
| CT angio hrt w/3d image (75574) | $151.20 | $504 | 0.4× |
| Ct Angio Lwr Extr W/O&W/Dye (73706) range across 4 matching MRF lines |
$119.70–$994.20 | $399–$3,314 | varies |
| CT Angio Neck (70498) range across 2 matching MRF lines |
$1,028.40–$1,028.70 | $3,428–$3,429 | varies |
| Ct Angio Upr Extrm W/O&W/Dye (73206) range across 4 matching MRF lines |
$114–$994.20 | $380–$3,314 | varies |
| CT bone density (77078) | $14.70 | $49 | 0.2× |
| CT cervical spine w/ contrast (72126) range across 2 matching MRF lines |
$76.50–$774.90 | $255–$2,583 | varies |
| CT cervical spine w/o contrast (72125) range across 3 matching MRF lines |
$67.20–$572.70 | $224–$1,909 | varies |
| CT cervical spine w/wo cont (72127) range across 2 matching MRF lines |
$79.80–$947.10 | $266–$3,157 | varies |
| CT chest w contrast (71260) range across 5 matching MRF lines |
$78.30–$774 | $261–$2,580 | varies |
| CT chest w/wo contrast (71270) range across 3 matching MRF lines |
$87–$947.40 | $290–$3,158 | varies |
| CT colonography screening (74263) | $143.70 | $479 | 0.6× |
| CT Colonogrphy Dx Image Postprocess W/Contrast (74262) | $157.50 | $525 | 0.8× |
| CT colonogrphy dx image postprocess w/o contrast (74261) | $151.20 | $504 | 1.4× |
| CT head/brain with contrast (70460) | $623.70 | $2,079 | 3.3× |
| CT head/brain without and with contrast (70470) | $768.60 | $2,562 | 4.1× |
| CT heart contrast eval cardiac structure&morph (75572) range across 2 matching MRF lines |
$110.40–$1,042.20 | $368–$3,474 | varies |
| CT heart no contrast quant eval coronry calcium (75571) range across 2 matching MRF lines |
$36.30–$164.40 | $121–$548 | varies |
| CT hrt w/3d image congen (75573) | $160.80 | $536 | 0.4× |
| CT iac w contrast (70481) | $860.70 | $2,869 | 4.6× |
| CT l-spine w&w/o contrast (72133) range across 2 matching MRF lines |
$79.80–$947.10 | $266–$3,157 | varies |
| CT lower ext w/o (73700) range across 4 matching MRF lines |
$63–$541.50 | $210–$1,805 | varies |
| CT lower extremity w/contrast material (73701) range across 4 matching MRF lines |
$73.50–$742.50 | $245–$2,475 | varies |
| CT lumbar spine w contrast (72132) range across 2 matching MRF lines |
$76.50–$774 | $255–$2,580 | varies |
| CT lumbar spine w/o contrast (72131) range across 2 matching MRF lines |
$63–$572.70 | $210–$1,909 | varies |
| CT maxillofacial w contrast (70487) | $760.20 | $2,534 | 4.1× |
| CT maxillofacial wo contrast (70486) | $541.80 | $1,806 | 4.9× |
| CT neck tissue combo (70492) | $924.60 | $3,082 | 4.9× |
| Ct Orbit/Ear/Fossa W/O&W/Dye (70482) | $952.50 | $3,175 | 5.1× |
| CT orbits w/o contrast (70480) | $543.90 | $1,813 | 4.9× |
| CT pelvis w&w/o contrast (72194) range across 2 matching MRF lines |
$76.50–$736.50 | $255–$2,455 | varies |
| CT pelvis w/o contrast (72192) range across 3 matching MRF lines |
$68.40–$572.70 | $228–$1,909 | varies |
| CT scan of leg combo (73702) range across 4 matching MRF lines |
$76.50–$951.30 | $255–$3,171 | varies |
| CT scans face/jaw combo (70488) | $951 | $3,170 | 5.1× |
| CT soft tissue neck w contrast (70491) | $734.10 | $2,447 | 3.9× |
| CT soft tissue neck w/o contrast (70490) | $541.50 | $1,805 | 4.9× |
| CT thoracic spine w contrast (72129) range across 2 matching MRF lines |
$76.50–$774.90 | $255–$2,583 | varies |
| CT thoracic spine w/o contrast (72128) range across 2 matching MRF lines |
$63–$572.70 | $210–$1,909 | varies |
| CT thoracic spine w/wo cont (72130) range across 2 matching MRF lines |
$79.80–$947.40 | $266–$3,158 | varies |
| CT thorax w/o contrast (71250) range across 6 matching MRF lines |
$64.20–$572.70 | $214–$1,909 | varies |
| CT unlisted procedure (76497) | $541.50 | $1,805 | 5.8× |
| CT upper ext wo (73200) range across 4 matching MRF lines |
$63–$541.50 | $210–$1,805 | varies |
| CT upper extremity w/o & w/contrast material (73202) range across 4 matching MRF lines |
$76.50–$737.10 | $255–$2,457 | varies |
| CT upper extremity with contrast (73201) range across 4 matching MRF lines |
$73.50–$737.10 | $245–$2,457 | varies |
| Cta Abdl Aorta&Bi Iliofem W/Contrast&Postp (75635) range across 2 matching MRF lines |
$151.20–$1,500 | $504–$5,000 | varies |
| Cta Abdomen (74175) range across 4 matching MRF lines |
$114.90–$1,142.70 | $383–$3,809 | varies |
| CTA head&neck c+ w/noncontrast img&post-pxessing (70471) | $2,057.40 | $6,858 | 5.5× |
| CTA pelvis (72191) range across 2 matching MRF lines |
$114–$1,142.70 | $380–$3,809 | varies |
| Determination of central c-v hemodynamics (non-imaging) (eg, ejection fraction with probe technique) with or without… (78414) | $27.90 | $93 | 0.0× |
| Dilation ureters/urethra rs&i (74485) | $34.20 | $114 | 0.0× |
| Discography Cerv/Thor Spine (72285) | $73.50 | $245 | 0.0× |
| Diskography lumbar (72295) | $52.50 | $175 | 0.0× |
| Doppler Echo Fetal Puls Spectral F/U/Repeat (76828) | $35.10 | $117 | 0.3× |
| Doppler Echo Fetal Spectral Display Complete (76827) | $36.30 | $121 | 0.3× |
| Doppler Fetal Mid Cerebral Artery (76821) | $44.10 | $147 | 0.4× |
| Dxa Bone Density Axial (77080) range across 2 matching MRF lines |
$12.30–$245.70 | $41–$819 | varies |
| Dxa bone density study (77085) | $19.20 | $64 | 0.2× |
| Dxa bone density study 1/>sites appendiclr skel (77081) range across 2 matching MRF lines |
$13.20–$59.10 | $44–$197 | varies |
| Echo exam of fetal heart (76825) | $105.30 | $351 | 0.2× |
| Echo exam uterus (76831) range across 3 matching MRF lines |
$45.30–$359.40 | $151–$1,198 | varies |
| Echo Guide For Artery Repair (76936) range across 2 matching MRF lines |
$125.40–$277.50 | $418–$925 | varies |
| Echocardiography, fetal, cardiovascular system, real time with image documentation (2D), with or without M-mode… (76826) | $52.50 | $175 | 0.2× |
| Echograp Trans R Pros Study (76873) | $98.10 | $327 | 0.9× |
| Esophageal Motility Study (78258) | $46.80 | $156 | 0.1× |
| Esophagram (74220) range across 4 matching MRF lines |
$28.80–$174.60 | $96–$582 | varies |
| Fetal Biophys Profile W/Nst (76818) range across 4 matching MRF lines |
$57.90–$289.50 | $193–$965 | varies |
| Fetal Biophysical Profile W/O Non-Stress Testing (76819) range across 9 matching MRF lines |
$43.50–$208.50 | $145–$695 | varies |
| Fetal MRI w/placntl matrnl plvc img sing/1st ges (74712) | $188.70 | $629 | 0.7× |
| Fluoroscopy up to 1 hr (76000) range across 8 matching MRF lines |
$43.50–$354.90 | $145–$1,183 | varies |
| Follow-Up Angiography (75898) range across 3 matching MRF lines |
$104.10–$709.20 | $347–$2,364 | varies |
| Foot 2 views (73620) range across 5 matching MRF lines |
$10.50–$150 | $35–$500 | varies |
| Forearm 2 views (73090) range across 5 matching MRF lines |
$10.50–$225 | $35–$750 | varies |
| Gastric emptying imaging study (78264) range across 2 matching MRF lines |
$49.80–$891.60 | $166–$2,972 | varies |
| Gastric Emptyng Imag Std W/Sm Bwl Transit (78265) | $61.80 | $206 | 0.1× |
| Gastric Mucosa Imaging (78261) | $43.50 | $145 | 0.1× |
| Gastroesophageal Reflux Exam (78262) range across 2 matching MRF lines |
$42.60–$858.90 | $142–$2,863 | varies |
| Gastrointestinal Protein Loss (78282) | $23.70 | $79 | 0.1× |
| Gated Heart Planar Single (78472) range across 2 matching MRF lines |
$61.80–$1,085.70 | $206–$3,619 | varies |
| Gated Heart, Multiple (78473) | $92.70 | $309 | 0.2× |
| GI Endoscopic US S&I (76975) | $51 | $170 | 0.2× |
| Gstrc Emptng Imag Std W/Sm Bwl Col Trnst Mlt Day (78266) | $68.10 | $227 | 0.1× |
| Hand 2 views (73120) range across 5 matching MRF lines |
$10.50–$225 | $35–$750 | varies |
| Hdr Rdncl Ntrstl/Icav Brchtx (77772) | $340.20 | $1,134 | 0.5× |
| Hdr Rdncl Ntrstl/Icav Brchtx (77771) | $239.40 | $798 | 0.3× |
| Hdr Rdncl Ntrstl/Icav Brchtx 1 Channel (77770) | $123 | $410 | 0.2× |
| Heart first pass single,planar (78481) | $61.80 | $206 | 0.1× |
| Heart Image (Pet) Multiple (78492) | $117.60 | $392 | 0.1× |
| Hepatc Vngrph Wdg/Fr Hemodyn Eval Rs&I (75889) | $72.30 | $241 | 0.0× |
| Hepatc Vngrph Wdg/Fr W/O Hemodyn Eval Rs&I (75891) range across 2 matching MRF lines |
$2,216.40 | $241–$7,388 | 0.7× |
| Hepatobil Syst Image W/Drug (78227) range across 2 matching MRF lines |
$56.40–$919.80 | $188–$3,066 | varies |
| Hepatobiliary System Imaging (78226) range across 2 matching MRF lines |
$46.80–$965.70 | $156–$3,219 | varies |
| Ht Musc Image Planar Mult (78454) | $84.60 | $282 | 0.1× |
| Ht Muscle Image Spect Sing (78451) range across 3 matching MRF lines |
$87–$2,832 | $290–$9,440 | varies |
| Hyperthermia external generated superficial (77600) | $82.80 | $276 | 0.2× |
| Hyperthermia generated by interstitial probe(s); 5 or fewer interstitial applicators Non-Facility (77610) | $82.80 | $276 | 0.1× |
| Hyperthermia generated by interstitial probe(s); more than 5 interstitial applicators Non-Facility (77615) | $115.80 | $386 | 0.2× |
| Hyperthermia generated by intracavitary probe(s) Non-Facility (77620) | $98.40 | $328 | 0.2× |
| Hyperthermia, externally generated; deep (ie, heating to depths greater than 4 cm) Non-Facility (77605) | $115.80 | $386 | 0.2× |
| Hysterosalpingogram (74740) range across 2 matching MRF lines |
$23.70–$280.80 | $79–$936 | varies |
| Infant hip ultrasound with hip movement (dynamic) (76885) range across 2 matching MRF lines |
$46.80–$185.40 | $156–$618 | varies |
| Infant hip ultrasound, limited static exam (76886) range across 2 matching MRF lines |
$39–$185.40 | $130–$618 | varies |
| Infusion Ivp (74410) | $30.90 | $103 | 0.2× |
| Interstitial radiation source applic complex (77778) | $553.50 | $1,845 | 0.7× |
| Intracavitary Radiation Source Applic Complex (77763) | $545.40 | $1,818 | 0.7× |
| Intracavitary Radiation Source Applic Intermed (77762) | $362.70 | $1,209 | 0.6× |
| Intracavitary radiation source applic simple (77761) | $243 | $810 | 0.4× |
| Joint Survey Single View (77077) | $20.40 | $68 | 0.2× |
| K Flow/Funct Image Multiple (78709) range across 2 matching MRF lines |
$88.80–$2,466.90 | $296–$8,223 | varies |
| K Flow/Funct Image W/Drug (78708) range across 2 matching MRF lines |
$76.20–$1,197.60 | $254–$3,992 | varies |
| K Flow/Funct Image W/O Drug (78707) range across 2 matching MRF lines |
$60.90–$1,197.60 | $203–$3,992 | varies |
| Kidney Funcj Study Non-Img Radioisotopic Study (78725) | $23.70 | $79 | 0.1× |
| Kidney Imaging Morphol (78700) | $27.90 | $93 | 0.1× |
| Kidney Imaging Morphoogy W/Vascular Flow (78701) | $30.90 | $103 | 0.1× |
| Knee 3 Views (73562) range across 3 matching MRF lines |
$11.40–$210 | $38–$700 | varies |
| Labeled RBC Sequestration Differntl Organ/Tissue (78140) | $38.10 | $127 | 0.1× |
| Leveen/Shunt Patency Exam (78291) | $55.50 | $185 | 0.1× |
| Liver & Spleen Imaging Static Only (78215) range across 2 matching MRF lines |
$30.90–$988.20 | $103–$3,294 | varies |
| Liver & Spleen Imaging W/Vascular Flow (78216) | $38.10 | $127 | 0.1× |
| Liver imaging static only (78201) | $27.30 | $91 | 0.0× |
| Liver imaging w/vascular flow (78202) | $32.40 | $108 | 0.1× |
| Lung Perf&Ventilat Diferentl (78598) range across 2 matching MRF lines |
$53.40–$1,869.60 | $178–$6,232 | varies |
| Lung perfusion differential (78597) range across 2 matching MRF lines |
$47.40–$666.90 | $158–$2,223 | varies |
| Lung Ventilat&Perfus Imaging (78582) range across 2 matching MRF lines |
$67.20–$1,041.30 | $224–$3,471 | varies |
| Lung Ventilation Imaging (78579) range across 2 matching MRF lines |
$30.90–$666.90 | $103–$2,223 | varies |
| Lymph System Imaging (78195) range across 4 matching MRF lines |
$75.60–$648.30 | $252–$2,161 | varies |
| Lymphangiography Extremity Only Bilateral Rs&I (75803) | $73.80 | $246 | 0.0× |
| Lymphangiography extremity only unilateral rs&i (75801) | $51 | $170 | 0.1× |
| Lymphangiography Pelvic/Abdominal Bilateral Rs&I (75807) | $73.80 | $246 | 0.0× |
| Lymphangiography, pelvic/abdominal, unilateral (75805) | $51 | $170 | 0.0× |
| Magnetic Image Jaw Joint (70336) | $921.60 | $3,072 | 3.6× |
| Magnetic resonance (eg, proton) imaging, brain (including brain stem andskull base), during open intracranial procedure… (70558) | $201.30 | $671 | 1.1× |
| Magnetic resonance (eg, proton) imaging, brain (including brain stem andskull base), during open intracranial procedure… (70557) | $182.70 | $609 | 0.3× |
| Magnetic resonance (eg, proton) imaging, brain (including brain stem andskull base), during open intracranial procedure… (70559) | $201.30 | $671 | 1.1× |
| Magnetic Resonance Elastography (76391) | $69.60 | $232 | 0.3× |
| Mammary ductogram or galactogram multiple (77054) | $27.90 | $93 | 0.1× |
| Mammary ductogram or galactogram single (77053) range across 2 matching MRF lines |
$22.80–$715.50 | $76–$2,385 | varies |
| Meckels Divert Exam (78290) range across 2 matching MRF lines |
$42.60–$891.60 | $142–$2,972 | varies |
| Mlc imrt design & construction per imrt plan (77338) | $270.60 | $902 | 0.7× |
| Mra Head W/O & W/Contrast Material (70546) | $1,446 | $4,820 | 3.9× |
| MRA head w/o contrast (70544) | $926.70 | $3,089 | 3.6× |
| MRA head with contrast (70545) | $1,138.50 | $3,795 | 3.1× |
| MRA neck w contrast (70548) | $1,139.10 | $3,797 | 3.1× |
| Mra Neck W/O &W/Contrast Material (70549) | $1,446 | $4,820 | 3.9× |
| MRA neck w/o contrast (70547) | $926.10 | $3,087 | 3.6× |
| MRI abdomen w contrast (74182) range across 3 matching MRF lines |
$109.20–$1,143 | $364–$3,810 | varies |
| MRI abdomen w/o contrast (74181) range across 3 matching MRF lines |
$91.80–$927.60 | $306–$3,092 | varies |
| MRI any jt lower extrem w/contrast material (73722) range across 10 matching MRF lines |
$102.30–$1,142.10 | $341–$3,807 | varies |
| MRI any jt lower extrem w/o & w/contrast matrl (73723) range across 10 matching MRF lines |
$135.30–$1,431 | $451–$4,770 | varies |
| MRI any jt upper extremity w/contrast matrl (73222) range across 7 matching MRF lines |
$102.30–$1,141.80 | $341–$3,806 | varies |
| MRI bone marrow blood supply (77084) | $101.10 | $337 | 0.4× |
| MRI brain functional w/o physician admnistration (70554) | $133.20 | $444 | 0.5× |
| MRI brain functional w/physician admnistration (70555) | $160.20 | $534 | 0.6× |
| MRI Breast W/O Contrast Bilateral (77047) | $101.10 | $337 | 0.4× |
| MRI Breast Without Contrast Material Unilateral (77046) | $91.50 | $305 | 0.4× |
| MRI cardiac w/o cont stress (75559) | $186.30 | $621 | 0.3× |
| MRI cardiac w/o contrast (75557) | $147.90 | $493 | 0.6× |
| MRI cervical spine w contrast (72142) range across 3 matching MRF lines |
$112.50–$1,133.40 | $375–$3,778 | varies |
| MRI cervical spine w/o cont (72141) range across 3 matching MRF lines |
$93.30–$921.60 | $311–$3,072 | varies |
| MRI chest w/o contrast (71550) range across 3 matching MRF lines |
$91.80–$1,876.80 | $306–$6,256 | varies |
| MRI chest with contrast (71551) range across 2 matching MRF lines |
$109.20–$1,143.60 | $364–$3,812 | varies |
| MRI chest wo w contrast (71552) range across 2 matching MRF lines |
$142.50–$1,442.10 | $475–$4,807 | varies |
| MRI lower extrem oth/thn jt w/contrast matrl (73719) range across 8 matching MRF lines |
$102.30–$1,143 | $341–$3,810 | varies |
| MRI lower extrem oth/thn jt w/o & w/contr matr (73720) range across 8 matching MRF lines |
$135.30–$1,433.70 | $451–$4,779 | varies |
| MRI lower extrem oth/thn jt w/o contr matrl (73718) range across 8 matching MRF lines |
$85.20–$932.40 | $284–$3,108 | varies |
| MRI lumbar spine w contrast (72149) range across 3 matching MRF lines |
$112.50–$1,133.40 | $375–$3,778 | varies |
| Mri Neck Spine W/O & W/Dye (72156) range across 3 matching MRF lines |
$144.30–$1,413.90 | $481–$4,713 | varies |
| MRI orbit face &/neck w/o contrast (70540) | $932.40 | $3,108 | 3.7× |
| MRI orbit face neck w contrast (70542) | $1,143 | $3,810 | 3.1× |
| Mri Orbt/Fac/Nck W/O &W/Dye (70543) | $1,433.40 | $4,778 | 3.8× |
| MRI pelvis w contrast (72196) range across 4 matching MRF lines |
$109.20–$1,141.50 | $364–$3,805 | varies |
| MRI pelvis w/o & w contrast (72197) range across 5 matching MRF lines |
$142.50–$1,430.40 | $475–$4,768 | varies |
| MRI pelvis w/o contrast (72195) range across 5 matching MRF lines |
$91.80–$930.30 | $306–$3,101 | varies |
| MRI spectroscopy (76390) | $88.20 | $294 | 0.9× |
| MRI thoracic spine w/o contrast (72146) range across 3 matching MRF lines |
$93.30–$920.70 | $311–$3,069 | varies |
| MRI upper extremity oth than jt w/contr matrl (73219) range across 7 matching MRF lines |
$102.30–$1,143.90 | $341–$3,813 | varies |
| MRI upper extremity oth than jt w/o contr matrl (73218) range across 7 matching MRF lines |
$85.20–$932.70 | $284–$3,109 | varies |
| Mri Uppr Extremity W/O&W/Dye (73220) range across 9 matching MRF lines |
$135.30–$1,433.70 | $451–$4,779 | varies |
| MRI, abdomen, combo (74183) range across 4 matching MRF lines |
$142.50–$1,430.40 | $475–$4,768 | varies |
| MRI, dorsal spine combo (72157) range across 3 matching MRF lines |
$144.30–$1,410 | $481–$4,700 | varies |
| MRI, dorsal spine contrast (72147) range across 3 matching MRF lines |
$112.50–$1,130.40 | $375–$3,768 | varies |
| MRI, joint upper extrem (73221) range across 7 matching MRF lines |
$85.20–$931.80 | $284–$3,106 | varies |
| MRI, joint upper extrem combo (73223) range across 7 matching MRF lines |
$135.30–$1,431.60 | $451–$4,772 | varies |
| MRI, lumbar spine combo (72158) range across 3 matching MRF lines |
$144.30–$1,413.90 | $481–$4,713 | varies |
| Myelogram cervical (72240) | $57.60 | $192 | 0.1× |
| Myelogram Lumbar (72265) | $52.50 | $175 | 0.1× |
| Myelography thoracic (72255) | $57.60 | $192 | 0.1× |
| Myelograpy 2/more regions rs&i (72270) | $83.70 | $279 | 0.1× |
| Myocardial Imaging Infarct Avid Planar Qual/Quan (78466) | $43.50 | $145 | 0.1× |
| Myocardial Imaging Pet Metabolic Evaluation (78459) | $94.50 | $315 | 0.1× |
| Myocardial imaging, infarct avid, planar; with ejection fraction by first pass technique Non-Facility (78468) | $50.40 | $168 | 0.1× |
| Myocardial Perfusion Planar 1 Study Rest/Stress (78453) | $63 | $210 | 0.0× |
| Myocardial Spect Multiple Studies (78452) range across 4 matching MRF lines |
$102.90–$2,832 | $343–$9,440 | varies |
| Myocrd Img Pet Prfuj Mlt Std Rst&Strs Cncrnt CT (78431) range across 2 matching MRF lines |
$162.60–$10,800 | $542–$36,000 | varies |
| Neck soft tissue (70360) range across 3 matching MRF lines |
$10.80–$60.30 | $36–$201 | varies |
| Nfs/Instlj Radioelmnt Sln 3 Mo Follow-Up Care (77750) | $315.30 | $1,051 | 0.8× |
| Njx Rp Loclzj Non-Img Probe Study Intravenous (78808) | $11.40 | $38 | 0.0× |
| Nm csf leak detection (78650) range across 2 matching MRF lines |
$1,464.90 | $127–$4,883 | 1.1× |
| Nm myocard infarct spect (78469) | $57.90 | $193 | 0.1× |
| Nm red cell survival study (78130) | $38.10 | $127 | 0.1× |
| Nm whole blood volume (78122) | $27.90 | $93 | 0.0× |
| Nonvascular Shunt X-Ray (75809) range across 2 matching MRF lines |
$29.70–$285.30 | $99–$951 | varies |
| Ntsty modul radthx pln dose-vol histos (77301) range across 2 matching MRF lines |
$503.40–$6,000 | $1,678–$20,000 | varies |
| Nuclear Rx Intra-Arterial (79445) | $151.20 | $504 | 0.6× |
| Nuclear Rx Oral Admin (79005) range across 2 matching MRF lines |
$113.70–$835.20 | $379–$2,784 | varies |
| Ob us nuchal meas 1 gest (76813) | $74.40 | $248 | 0.7× |
| Oph bmtry us echograpy a-scan io lens pwr cal (76519) | $34.20 | $114 | 0.3× |
| Oph us dx ant sgm us immersion b-scan/hr biom (76513) | $41.40 | $138 | 0.4× |
| Oph US Dx B-Scan&Quan a-Scan Sm Pt Enctr (76510) | $98.10 | $327 | 0.7× |
| Ophthalmic Biometry US Echograpy a-Scan (76516) | $34.20 | $114 | 0.3× |
| Ophthalmic Ultrasonic Foreign Body Localization (76529) | $35.70 | $119 | 0.4× |
| Ophthalmic ultrasound dx b-scan w/wo a-scan (76512) | $59.40 | $198 | 0.5× |
| Ophthalmic US Dx Corneal Pachymetry Uni/Bi (76514) | $10.80 | $36 | 0.3× |
| Ophthalmic us dx quantitative a-scan only (76511) | $59.40 | $198 | 0.5× |
| Parathyroid imaging w/tomographic spect & CT (78072) range across 2 matching MRF lines |
$101.10–$1,154.40 | $337–$3,848 | varies |
| Parathyroid Planar Imaging (78070) | $50.40 | $168 | 0.1× |
| Parathyroid planar imaging w/wo subtraction (78071) | $75.60 | $252 | 0.2× |
| Pelvis 1 or 2 views (72170) range across 3 matching MRF lines |
$10.80–$172.50 | $36–$575 | varies |
| Perineogram (74775) | $39 | $130 | 0.2× |
| Peritoneogram Rs&I (74190) | $30 | $100 | 0.1× |
| Pet Image Skull-Thigh (78812) | $121.80 | $406 | 0.1× |
| Pet Image W/Ct Lmtd (78814) | $138.60 | $462 | 0.1× |
| PET image w/CT, full body (78816) range across 3 matching MRF lines |
$157.50–$6,370.50 | $525–$21,235 | varies |
| PET imaging CT attenuation skull base mid-thigh (78815) range across 11 matching MRF lines |
$154.20–$6,370.50 | $514–$21,235 | varies |
| Pet Imaging Limited Area Chest Head/Neck (78811) | $96.90 | $323 | 0.1× |
| Pet Myocardial Sngl Study (78491) | $94.50 | $315 | 0.1× |
| PET whole body (78813) | $126.30 | $421 | 0.1× |
| Plasma Vol Radiopharm Vol Dilute Spx Mult Smples (78111) | $13.20 | $44 | 0.0× |
| Plasma volume, radiopharmaceutical volume-dilution technique (separate procedure); single sampling Non-Facility (78110) | $12 | $40 | 0.0× |
| Platelet survival study Non-Facility (78191) | $38.10 | $127 | 0.1× |
| Prq Transhepatc Portograpy Hemodyn Eval Rs&I (75885) | $90.90 | $303 | 0.0× |
| Pulmonary Perfusion Imaging Particulate (78580) range across 2 matching MRF lines |
$46.80–$734.10 | $156–$2,447 | varies |
| Radex Abd Compl Aqt Abd W/S/E/D Views 1 View Ch (74022) range across 2 matching MRF lines |
$21–$210 | $70–$700 | varies |
| Radex abscess/fistula/sinus tract rs&i (76080) range across 6 matching MRF lines |
$33.90–$280.80 | $113–$936 | varies |
| Radex Ankle Complete Minimum 3 Views (73610) range across 3 matching MRF lines |
$10.80–$150 | $36–$500 | varies |
| Radex Calcaneus Minimum 2 Views (73650) range across 3 matching MRF lines |
$10.50–$177.60 | $35–$592 | varies |
| Radex elbow complete minimum 3 views (73080) range across 3 matching MRF lines |
$10.80–$139.20 | $36–$464 | varies |
| Radex Facial Bones Complete Minimum 3 Views (70150) | $80.70 | $269 | 0.7× |
| Radex fingr minimum 2 views (73140) range across 3 matching MRF lines |
$9–$150 | $30–$500 | varies |
| Radex foot complete minimum 3 views (73630) range across 3 matching MRF lines |
$10.80–$195 | $36–$650 | varies |
| Radex Hand Minimum 3 Views (73130) range across 3 matching MRF lines |
$10.80–$225 | $36–$750 | varies |
| Radex lower extremity infant minimum 2 views (73592) range across 3 matching MRF lines |
$10.50–$192.30 | $35–$641 | varies |
| Radex Mastoids Compl Minimum 3 Views PR Side (70130) | $76.20 | $254 | 0.7× |
| Radex Nasal Bones Complete Minimum 3 Views (70160) range across 2 matching MRF lines |
$48–$63.60 | $160–$212 | varies |
| Radex shoulder complete minimum 2 views (73030) range across 3 matching MRF lines |
$11.40–$135 | $38–$450 | varies |
| Radex Sinuses Paransl < 3 Views (70210) | $60.90 | $203 | 0.7× |
| Radex sm int w/mlt srl imges via enteroclss tube (74251) | $43.50 | $145 | 0.2× |
| Radex Spine 1 View Specify Level (72020) range across 5 matching MRF lines |
$9.90–$60.30 | $33–$201 | varies |
| Radex Sternum Minimum 2 Views (71120) range across 2 matching MRF lines |
$12.30–$63.60 | $41–$212 | varies |
| Radex Temporomandble Jt Opn & Clsd Mouth Bilat (70330) | $189.90 | $633 | 2.0× |
| Radex Toe Minimum 2 Views (73660) range across 3 matching MRF lines |
$9–$120 | $30–$400 | varies |
| Radex upper extremity infant minimum 2 views (73092) range across 3 matching MRF lines |
$10.50–$120.30 | $35–$401 | varies |
| Radex Wrist Complete Minimum 3 Views (73110) range across 3 matching MRF lines |
$10.80–$138 | $36–$460 | varies |
| Radex X-Ray Exam Entire Spi 6/> Vw - Xr Entire Spine 6+ Vw (72084) range across 2 matching MRF lines |
$25.20–$146.40 | $84–$488 | varies |
| Radiation treatment delivery level 3 (77412) | $2,517.60 | $8,392 | 4.3× |
| Radiolog exam mandible compl minimum 4 views (70110) | $73.20 | $244 | 0.7× |
| Radiologic Exam Abdomen 3+ Views - Xr Abdomen 3+ Views (74021) range across 2 matching MRF lines |
$16.80–$171.90 | $56–$573 | varies |
| Radiologic exam colon double contrast study (74280) range across 2 matching MRF lines |
$62.40–$400.50 | $208–$1,335 | varies |
| Radiologic exam colon single contrast study (74270) range across 3 matching MRF lines |
$43.50–$245.70 | $145–$819 | varies |
| Radiologic Exam Esophagus Double Contrast Study (74221) | $390 | $1,300 | 2.1× |
| Radiologic exam knee complete 4/more views (73564) range across 3 matching MRF lines |
$13.20–$238.50 | $44–$795 | varies |
| Radiologic exam pelvis compl minimum 3 views (72190) range across 2 matching MRF lines |
$12.90–$78 | $43–$260 | varies |
| Radiologic Exam Small Int Single Contrast Study (74250) range across 2 matching MRF lines |
$29.70–$213 | $99–$710 | varies |
| Radiologic exam swallow function contrast study (74230) range across 2 matching MRF lines |
$33.60–$467.40 | $112–$1,558 | varies |
| Radiologic exam upr gi trc double contrast study (74246) range across 4 matching MRF lines |
$56.40–$241.50 | $188–$805 | varies |
| Radiologic examination femur 1 view (73551) range across 3 matching MRF lines |
$10.50–$150 | $35–$500 | varies |
| Radiologic examination femur minimum 2 views (73552) range across 3 matching MRF lines |
$11.40–$180 | $38–$600 | varies |
| Radiologic examination knee 1/2 views (73560) range across 5 matching MRF lines |
$10.50–$192.30 | $35–$641 | varies |
| Radiologic Examination Osseous Survey Limited (77074) | $27.90 | $93 | 0.2× |
| Radiologic examination tibia & fibula 2 views (73590) range across 5 matching MRF lines |
$10.50–$192.30 | $35–$641 | varies |
| Radiopharm Dacryocystography (78660) | $33.60 | $112 | 0.1× |
| Radiopharmaceutical therapy, by interstitial radioactive colloid administration Facility (79300) | $101.10 | $337 | 0.4× |
| Radiopharmaceutical therapy, by intra-articular administration Non-Facility (79440) | $125.40 | $418 | 0.5× |
| Radiopharmaceutical therapy, by intracavitary administration Non-Facility (79200) | $125.40 | $418 | 0.5× |
| Red Cell Volume Determination Spx 1 Sampling (78120) | $13.80 | $46 | 0.0× |
| Red Cell Volume Determination Spx Mult Samplings (78121) | $21 | $70 | 0.0× |
| Remote afterloading high dose rate radionuclide skin surface brachytherapy, includes basic dosimetry, when performed;… (77768) | $88.20 | $294 | 0.2× |
| Remote afterloading high dose rate radionuclide skin surface brachytherapy, includes basic dosimetry, when performed;… (77767) | $66 | $220 | 0.2× |
| Renal Cyst Study (74470) | $34.20 | $114 | 0.1× |
| Ribs bilateral 3 views (71110) | $200.70 | $669 | 1.8× |
| Rp loclzj tum plnr 1 area single day imaging (78800) | $41.40 | $138 | 0.1× |
| Rp loclzj tum plnr 2+area 1+d img/1 area img>2+d (78801) | $49.80 | $166 | 0.1× |
| Rp Loclzj Tum Plnr Whole Body 2+ Days Imaging (78804) range across 3 matching MRF lines |
$67.20–$1,770.30 | $224–$5,901 | varies |
| Rp Loclzj Tum Plnr Whole Body Single Day Imaging (78802) | $54 | $180 | 0.1× |
| Rp Loclzj Tum Spect 1 Area Single Day Imaging (78803) range across 7 matching MRF lines |
$68.40–$1,325.70 | $228–$4,419 | varies |
| Rp loclzj tum spect 2 area/sep acquisj img (78831) range across 3 matching MRF lines |
$1,650–$1,873.80 | $5,500–$6,246 | varies |
| Rp loclzj tum spect CT 2area 1d img/1 ar img>2+d (78832) | $1,770.30 | $5,901 | 1.2× |
| Rp loclzj tum spect w/CT 1 area/acquisj 1day img (78830) range across 3 matching MRF lines |
$912–$1,650 | $3,040–$5,500 | varies |
| Rp Ther Radiolbld Monoclonal Antibody IV Infus (79403) | $141.90 | $473 | 0.6× |
| Rp Therapy Intravenous Administration (79101) | $123.60 | $412 | 0.5× |
| Salivary Gland Function Study (78232) | $29.70 | $99 | 0.1× |
| Salivary Gland Imaging (78230) | $27.90 | $93 | 0.1× |
| Salivary Gland Imaging Serial Images (78231) | $33.30 | $111 | 0.1× |
| Scapula (73010) range across 3 matching MRF lines |
$10.80–$60.30 | $36–$201 | varies |
| Screening Digital Breast Tomosynthesis Bi (77063) range across 5 matching MRF lines |
$21–$37.80 | $70–$126 | varies |
| Shoulder 1 view (73020) range across 3 matching MRF lines |
$9.90–$60.30 | $33–$201 | varies |
| Shoulder Arthrography (73040) range across 3 matching MRF lines |
$34.20–$354.30 | $114–$1,181 | varies |
| Sialogram (70390) | $619.80 | $2,066 | 2.4× |
| Skull less than 4 views (70250) range across 3 matching MRF lines |
$14.40–$65.40 | $48–$218 | varies |
| Special dosimetry (77331) | $54.60 | $182 | 0.4× |
| Special teletherapy port plan (77321) | $60 | $200 | 0.2× |
| Special treatment procedure (77470) | $127.80 | $426 | 0.2× |
| Speech evaluation, complex (70371) | $52.80 | $176 | 0.2× |
| Spleen Imaging (78185) | $24.60 | $82 | 0.1× |
| Stereotactic Body Radiation Delivery (77373) | $5,670 | $18,900 | 3.0× |
| Sternoclavicular joints (71130) range across 2 matching MRF lines |
$13.20–$71.40 | $44–$238 | varies |
| Superior sagittal sinus venogram (75870) | $72.30 | $241 | 0.0× |
| Surface Applic Low Dose Rate Radionuclide Source (77789) | $72.30 | $241 | 0.7× |
| Telethx isodose pln cplx w/basic dosimetry (77307) | $182.70 | $609 | 0.5× |
| Telethx isodose pln smpl w/dosimetry calculation (77306) | $88.20 | $294 | 0.2× |
| Testicular Imaging W/Flow (78761) | $44.70 | $149 | 0.1× |
| Ther Rad Simulaj-Aided Field Setting Complex (77290) range across 4 matching MRF lines |
$98.40–$2,010 | $328–$6,700 | varies |
| Ther Rad Simulaj-Aided Field Setting Intermed (77285) range across 2 matching MRF lines |
$66–$1,740 | $220–$5,800 | varies |
| Ther rad simulaj-aided field setting simple (77280) range across 2 matching MRF lines |
$44.10–$1,050 | $147–$3,500 | varies |
| Therapeutic Enema Rdctj Intussusception/Obstrcj (74283) | $127.20 | $424 | 0.7× |
| Thoracic spine 2 views (72070) range across 2 matching MRF lines |
$13.20–$63.60 | $44–$212 | varies |
| Thoracic spine 3 views (72072) range across 2 matching MRF lines |
$14.10–$74.40 | $47–$248 | varies |
| Thoracolumbar 2 views (72080) range across 2 matching MRF lines |
$13.20–$139.20 | $44–$464 | varies |
| Thyroid carcinoma metastases imaging; with additional studies (eg, urinary recovery) Non-Facility (78016) | $51.60 | $172 | 0.1× |
| Thyroid Carcinoma Metastases Img Lmtd Area (78015) | $42.30 | $141 | 0.1× |
| Thyroid Imaging With Vascular Flow (78013) range across 2 matching MRF lines |
$23.40–$495 | $78–$1,650 | varies |
| Thyroid Met Imaging Body (78018) range across 3 matching MRF lines |
$54–$1,081.20 | $180–$3,604 | varies |
| Thyroid Uptake Measurement (78012) range across 2 matching MRF lines |
$375.90 | $40–$1,253 | 0.9× |
| Thyroid Uptake W/Blood Flow Sngle/Mult Quan Meas (78014) range across 2 matching MRF lines |
$31.80–$779.10 | $106–$2,597 | varies |
| Tx Devices Design & Construction Complex (77334) | $72.60 | $242 | 0.2× |
| Tx devices design & construction intermediate (77333) | $47.40 | $158 | 0.3× |
| Tx devices design & construction simple (77332) | $27.90 | $93 | 0.2× |
| Ultrasound Breast Limited (76642) range across 7 matching MRF lines |
$42.60–$230.40 | $142–$768 | varies |
| Ultrasound elastography first target lesion (76982) | $36.90 | $123 | 0.3× |
| Ultrasound Elastography Parenchyma (76981) | $36.90 | $123 | 0.3× |
| Ultrasound Exam Aaa Screen (76706) range across 2 matching MRF lines |
$34.80–$128.70 | $116–$429 | varies |
| Ultrasound trgt dynamic microbubble 1st lesion (76978) | $102.30 | $341 | 0.3× |
| Ultrasound, abdomen limited (76705) range across 8 matching MRF lines |
$36.90–$431.10 | $123–$1,437 | varies |
| Umbilical-artery Doppler (OB) (76820) range across 5 matching MRF lines |
$31.80–$128.70 | $106–$429 | varies |
| Unlisted Miscellaneous Px Dx Nuclear Medicine (78999) | $137.10 | $457 | 0.3× |
| Upper gi w/o kub (74240) range across 3 matching MRF lines |
$50.40–$198 | $168–$660 | varies |
| Urea breath test c-14 isotopic analysis (78268) | $185.40 | $618 | 2.0× |
| Ureteral Reflux Study (78740) range across 2 matching MRF lines |
$35.70–$1,197.60 | $119–$3,992 | varies |
| Urethrocystogram voiding (74455) range across 3 matching MRF lines |
$21.30–$449.70 | $71–$1,499 | varies |
| Urethrocystography retrograde (74450) range across 3 matching MRF lines |
$21.30–$141.30 | $71–$471 | varies |
| Us bone density measurement (76977) | $3 | $10 | 0.0× |
| Us breast unilateral complete (76641) | $46.50 | $155 | 0.4× |
| Us chest (76604) range across 6 matching MRF lines |
$34.80–$133.50 | $116–$445 | varies |
| Us complete joint (76881) range across 4 matching MRF lines |
$39.30–$526.20 | $131–$1,754 | varies |
| Us exam, pelvic, limited (76857) range across 8 matching MRF lines |
$31.80–$128.70 | $106–$429 | varies |
| Us head (76506) | $39.30 | $131 | 0.4× |
| Us kidney transplant (76776) range across 2 matching MRF lines |
$48–$625.20 | $160–$2,084 | varies |
| Us lmtd joint/oth nonvasc xtr strux r-t w/img (76882) range across 11 matching MRF lines |
$30.90–$338.10 | $103–$1,127 | varies |
| Us ob limited 1 or more fetuses (76815) range across 6 matching MRF lines |
$41.10–$220.20 | $137–$734 | varies |
| Us ob transvaginal (76817) range across 5 matching MRF lines |
$47.40–$249 | $158–$830 | varies |
| Us pelvic non ob complete (76856) range across 6 matching MRF lines |
$43.50–$159 | $145–$530 | varies |
| Us pg uter img f&mat 14 wk tabdl 1/1st gestation (76801) range across 6 matching MRF lines |
$61.50–$309.90 | $205–$1,033 | varies |
| Us preg uterus real time f/u trnsabdl per fetus (76816) range across 7 matching MRF lines |
$53.40–$302.70 | $178–$1,009 | varies |
| Us retroperitoneal complete (76770) range across 2 matching MRF lines |
$46.80–$217.50 | $156–$725 | varies |
| Us retroperitoneal limited (76775) range across 8 matching MRF lines |
$36.30–$430.20 | $121–$1,434 | varies |
| Us scrotum and contents (76870) range across 2 matching MRF lines |
$40.20–$382.50 | $134–$1,275 | varies |
| Us spinal canal and contents (76800) range across 2 matching MRF lines |
$71.40–$210.60 | $238–$702 | varies |
| Us thyroid (76536) range across 4 matching MRF lines |
$35.10–$217.50 | $117–$725 | varies |
| Us transrectal (76872) range across 3 matching MRF lines |
$43.50–$385.20 | $145–$1,284 | varies |
| Vascular Flow Imaging (78445) | $30.90 | $103 | 0.1× |
| Vasogram (74440) | $23.70 | $79 | 0.1× |
| Vein X-Ray Chest (75827) | $72.30 | $241 | 0.0× |
| Vein X-Ray Liver W/O Hemodyn (75887) | $90.90 | $303 | 0.0× |
| Vein X-Ray Skull Epidural (75872) | $72.30 | $241 | 0.1× |
| Vein X-Ray Spleen/Liver (75810) | $72.30 | $241 | 0.0× |
| Venogram Sinus/Jugular (75860) range across 2 matching MRF lines |
$1,835.10 | $241–$6,117 | 0.5× |
| Venography Adrenal Unilateral (75840) | $72.30 | $241 | 0.0× |
| Venography caval inferior serialography rs&i (75825) range across 2 matching MRF lines |
$70.20–$72.30 | $234–$241 | varies |
| Venography extremity bilateral rs&i (75822) range across 3 matching MRF lines |
$93.30–$784.50 | $311–$2,615 | varies |
| Venography extremity unilateral rs&i (75820) range across 4 matching MRF lines |
$66–$522.90 | $220–$1,743 | varies |
| Venography Orbital Rs&I (75880) | $44.10 | $147 | 0.1× |
| Venography Renal Bilateral (75833) | $93.90 | $313 | 0.0× |
| Venography Renal Unilateral (75831) | $72.30 | $241 | 0.0× |
| Venous sampling by catheter (75893) likely a partial charge, not the full procedure |
$34.20 | $114 | 0.0× |
| Venous thrombosis imaging (78457) | $48.60 | $162 | 0.1× |
| Venous Thrombosis Imaging Venogram Bilateral (78458) | $56.40 | $188 | 0.1× |
| Vertebral fracture assessment via dxa (77086) | $10.80 | $36 | 0.1× |
| Wrist 2 views (73100) range across 5 matching MRF lines |
$10.50–$225 | $35–$750 | varies |
| X-Ray Ac Jts - Xr Acromioclavicular Joints Bilateral (73050) range across 2 matching MRF lines |
$12.30–$68.40 | $41–$228 | varies |
| X-ray antegrade pyelogram tube (74425) range across 5 matching MRF lines |
$22.80–$126.90 | $76–$423 | varies |
| X-Ray Aorta Leg Arteries (75630) | $112.80 | $376 | 0.0× |
| X-Ray Bend Only L-S Spine (72120) | $13.20 | $44 | 0.1× |
| X-Ray Elbow 2 Vw - Xr Elbow 1-2 Views Right (73070) range across 5 matching MRF lines |
$9.90–$225 | $33–$750 | varies |
| X-Ray Exam Breast Specimen (76098) range across 4 matching MRF lines |
$530.10 | $35–$1,767 | 0.9× |
| X-Ray Exam Entire Spi 1 Vw (72081) range across 3 matching MRF lines |
$15.60–$46.20 | $52–$154 | varies |
| X-Ray Exam Entire Spi 2/3 Vw (72082) range across 3 matching MRF lines |
$20.40–$77.10 | $68–$257 | varies |
| X-Ray Exam Entire Spi 4/5 Vw (72083) range across 2 matching MRF lines |
$22.20–$146.40 | $74–$488 | varies |
| X-Ray Exam Hip Uni 1 View (73501) range across 5 matching MRF lines |
$11.40–$106.50 | $38–$355 | varies |
| X-Ray Exam Hip Uni 2-3 Views (73502) range across 5 matching MRF lines |
$13.20–$210 | $44–$700 | varies |
| X-Ray Exam Hip Uni 4/> Views (73503) | $16.20 | $54 | 0.1× |
| X-Ray Exam Hips Bi 2 Views (73521) range across 2 matching MRF lines |
$13.20–$210 | $44–$700 | varies |
| X-Ray Exam Hips Bi 3-4 Views (73522) range across 2 matching MRF lines |
$18.60–$304.80 | $62–$1,016 | varies |
| X-Ray Exam Hips Bi 5/> Views (73523) range across 2 matching MRF lines |
$20.40–$450 | $68–$1,500 | varies |
| X-Ray Exam L-S Spine Bending (72114) range across 2 matching MRF lines |
$21–$143.40 | $70–$478 | varies |
| X-Ray Exam Neck Spine 2-3 Vw (72040) range across 2 matching MRF lines |
$13.20–$180 | $44–$600 | varies |
| X-Ray Exam Neck Spine 6/>Vws (72052) range across 2 matching MRF lines |
$22.80–$128.40 | $76–$428 | varies |
| X-Ray Exam Unilat Ribs/Chest (71101) range across 4 matching MRF lines |
$70.80–$200.70 | $236–$669 | varies |
| X-ray eye for foreign body (70030) | $60.30 | $201 | 0.6× |
| X-ray humerus (73060) range across 5 matching MRF lines |
$10.50–$120 | $35–$400 | varies |
| X-ray IV pyelogram (ivp) (74400) range across 2 matching MRF lines |
$30.90–$232.20 | $103–$774 | varies |
| X-ray IV pyelogram+tomography (74415) | $30.90 | $103 | 0.2× |
| X-Ray Jaw <4 Vw - Xr Mandible < 4 Views (70100) | $66.30 | $221 | 0.7× |
| X-Ray Knee Bilat Standing - Xr Knees Anteroposterior Standing Bilat (73565) range across 2 matching MRF lines |
$10.50–$185.40 | $35–$618 | varies |
| X-Ray Lumbar Spine 2/3 Vw - Xr Lumbar Spine 2-3 Views (72100) range across 2 matching MRF lines |
$13.20–$210 | $44–$700 | varies |
| X-ray nose-rectum child f.b. (76010) | $11.40 | $38 | 0.1× |
| X-Ray Ribs, Chest 4+ Vw - Xr Ribs 3 Vws Bil W/ Chest Posteroanterior (71111) range across 2 matching MRF lines |
$21–$200.70 | $70–$669 | varies |
| X-Ray Sacroiliac Jts 3+ Vw - Xr Sacroiliac Joints 3+ Views (72202) range across 2 matching MRF lines |
$12–$172.50 | $40–$575 | varies |
| X-Ray Sacroiliac Jts <3 Vw - Xr Sacroiliac Joints 1-2 Views (72200) range across 2 matching MRF lines |
$10.80–$60.30 | $36–$201 | varies |
| X-Ray Sacrum/Coccyx 2+ Vw - Xr Sacrum Coccyx 2+ Views (72220) range across 2 matching MRF lines |
$10.80–$60.30 | $36–$201 | varies |
| X-Ray Sinuses 3+ Vw - Xr Paranasal Sinuses 3+ Views (70220) | $76.20 | $254 | 0.8× |
| X-Ray Skull 4+ Vw - Xr Skull Complete 4+ Views (70260) | $100.20 | $334 | 0.9× |
| X-Ray Stress View (77071) | $25.20 | $84 | 0.3× |
| X-ray thoracic spine 4 vw (72074) range across 2 matching MRF lines |
$15–$100.20 | $50–$334 | varies |
| X-Ray Urinary Tract Exam With Contrast Material (74420) range across 5 matching MRF lines |
$22.80–$780 | $76–$2,600 | varies |
| X-Rays Bone Length Studies (77073) range across 2 matching MRF lines |
$16.20–$70.80 | $54–$236 | varies |
| X-Rays Bone Survey Complete (77075) range across 2 matching MRF lines |
$34.20–$200.10 | $114–$667 | varies |
| Xr c-spine 4 or 5 views (72050) range across 2 matching MRF lines |
$20.40–$100.20 | $68–$334 | varies |
| Xr facial bones less than 3 views (70140) | $60.90 | $203 | 0.7× |
| Xr orbits complete 4 views (70200) range across 2 matching MRF lines |
$61.50–$81.60 | $205–$272 | varies |
| Xr Tomogram Single Plane (76100) | $36.30 | $121 | 0.3× |
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.