Imaging prices at Froedtert Memorial Lutheran Hospital
Milwaukee, WI · every code in this section with a posted price and a Medicare benchmark.
413 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 3 matching MRF lines |
$4,125–$5,249.75 | $7,500–$9,545 | varies |
| Abdomen 1 View (74018) range across 2 matching MRF lines |
$255.75–$267.30 | $465–$486 | varies |
| Abdomen 2 views (74019) range across 2 matching MRF lines |
$310.75–$340.45 | $565–$619 | varies |
| Acute Gastrointestinal Blood Loss Imaging (78278) | $1,487.20 | $2,704 | 3.7× |
| Adrenal Cortex & Medulla Img (78075) | $3,056.35 | $5,557 | 2.3× |
| Angio internal mammary (75756) | $2,849.55 | $5,181 | 0.9× |
| Angio pulmonary bilat (75743) | $3,953.40 | $7,188 | 1.2× |
| Angiography extremity bilateral rs&i (75716) | $4,725.60 | $8,592 | 1.5× |
| Angiography extremity unilateral rs&i (75710) | $3,258.75 | $5,925 | 1.0× |
| Angiography pulmonary unilateral slctv rs&i (75741) | $4,380.20 | $7,964 | 1.4× |
| Angrph pulmonary nonslctv cath/ven njx rs&i (75746) | $3,078.90 | $5,598 | 1.0× |
| Ankle 2 views (73600) range across 2 matching MRF lines |
$244.20–$268.95 | $444–$489 | varies |
| Aortography thoracic serialography rs&i (75605) | $5,082 | $9,240 | 0.9× |
| Artery X-Rays Abdomen (75726) | $3,946.80 | $7,176 | 0.7× |
| Artery X-Rays Adrenal Gland (75731) | $5,712.30 | $10,386 | 1.8× |
| Artery X-Rays Pelvis (75736) | $4,386.25 | $7,975 | 0.8× |
| Artery X-Rays Spine (75705) range across 2 matching MRF lines |
$4,743.75–$4,785 | $8,625–$8,700 | varies |
| Arthrogram ankle (73615) | $692.45 | $1,259 | 2.0× |
| Arthrogram hip (73525) | $784.85 | $1,427 | 2.2× |
| Basic radiation dosimetry calculation (77300) range across 3 matching MRF lines |
$405.35–$553.30 | $737–$1,006 | varies |
| Bone age studies (77072) | $380.60 | $692 | 3.6× |
| Bone Imaging 3 Phase (78315) | $1,185.25 | $2,155 | 2.9× |
| Bone Imaging Limited Area (78300) | $762.85 | $1,387 | 1.9× |
| Bone Imaging Multiple Areas (78305) | $808.50 | $1,470 | 2.0× |
| Bone Imaging Whole Body (78306) | $1,381.60 | $2,512 | 3.4× |
| Bone marrow imaging; multiple areas (78103) | $569.25 | $1,035 | 1.4× |
| Bone marrow imaging; whole body (78104) | $686.40 | $1,248 | 1.7× |
| Brachytx isodose complex (77318) | $2,602.60 | $4,732 | 6.9× |
| Brachytx isodose intermed (77317) | $2,341.35 | $4,257 | 6.2× |
| Brachytx Isodose Plan Simple (77316) | $2,030.60 | $3,692 | 5.4× |
| Brain Image W/Flow < 4 Views (78601) | $1,229.25 | $2,235 | 3.0× |
| Brain Imaging Pet Metabolic Evaluation (78608) | $2,553.65 | $4,643 | 1.8× |
| Cardiac MRI w/w/o contrast & further seq (75561) range across 2 matching MRF lines |
$2,724.70–$3,347.30 | $4,954–$6,086 | varies |
| Cardiac MRI w/w/o contrast w/stress (75563) | $3,853.85 | $7,007 | 4.9× |
| Cardiac Shunt Detection (78428) | $3,512.30 | $6,386 | 8.7× |
| Cat Scan Follow-Up Study (76380) range across 3 matching MRF lines |
$58.85–$806.30 | $107–$1,466 | varies |
| Cerebrospinal Fluid Flow W/O Matl Shunt Evaltj (78645) | $1,416.80 | $2,576 | 2.6× |
| Cerebrospinal Fluid Scan (78630) | $1,072.50 | $1,950 | 2.0× |
| Chest 1 view (71045) range across 2 matching MRF lines |
$169.40–$184.25 | $308–$335 | varies |
| Chest 2 views (71046) range across 2 matching MRF lines |
$189.20–$202.95 | $344–$369 | varies |
| Chest 3 views (71047) | $333.30 | $606 | 3.8× |
| Chest 4 or more views (71048) | $383.35 | $697 | 3.6× |
| Clavicle complete (73000) range across 2 matching MRF lines |
$227.70–$249.15 | $414–$453 | varies |
| Computed Tomography Thorax Lw Dose Lng Ca Scr C- (71271) range across 2 matching MRF lines |
$437.25–$625.35 | $795–$1,137 | varies |
| Continuing medical physics consltj pr wk (77336) range across 3 matching MRF lines |
$1,518–$1,769.90 | $2,760–$3,218 | varies |
| Contrast Exam Abdominl Aorta (75625) | $6,096.20 | $11,084 | 1.9× |
| Contrast X-Ray Bladder (74430) | $707.85 | $1,287 | 2.0× |
| Contrast Xray Throat/Cerv Esopha (74210) | $330.55 | $601 | 1.9× |
| CT abdomen and pelvis without and with contrast (74178) range across 2 matching MRF lines |
$4,688.75–$5,146.35 | $8,525–$9,357 | varies |
| CT abdomen and pelvis without contrast (74176) range across 2 matching MRF lines |
$2,427.15–$2,961.20 | $4,413–$5,384 | varies |
| CT abdomen w contrast (74160) range across 2 matching MRF lines |
$1,937.10–$2,130.70 | $3,522–$3,874 | varies |
| CT abdomen w wo contrast (74170) range across 2 matching MRF lines |
$2,303.40–$2,532.75 | $4,188–$4,605 | varies |
| CT abdomen w/o contrast (74150) range across 2 matching MRF lines |
$1,581.25–$1,739.10 | $2,875–$3,162 | varies |
| CT Angio Abdomen and Pelvis (74174) range across 2 matching MRF lines |
$3,208.70–$3,646.50 | $5,834–$6,630 | varies |
| CT Angio Chest (71275) range across 2 matching MRF lines |
$2,176.90–$2,291.85 | $3,958–$4,167 | varies |
| CT Angio Head (70496) range across 2 matching MRF lines |
$2,214.30–$2,447.50 | $4,026–$4,450 | varies |
| CT angio hrt w/3d image (75574) | $2,439.80 | $4,436 | 6.9× |
| Ct Angio Lwr Extr W/O&W/Dye (73706) range across 2 matching MRF lines |
$1,412.40–$1,647.80 | $2,568–$2,996 | varies |
| CT Angio Neck (70498) range across 2 matching MRF lines |
$2,043.25–$2,247.85 | $3,715–$4,087 | varies |
| Ct Angio Upr Extrm W/O&W/Dye (73206) range across 2 matching MRF lines |
$1,942.05–$2,412.85 | $3,531–$4,387 | varies |
| CT cervical spine w/ contrast (72126) | $1,725.35 | $3,137 | 4.9× |
| CT cervical spine w/o contrast (72125) range across 2 matching MRF lines |
$1,464.10–$1,650 | $2,662–$3,000 | varies |
| CT cervical spine w/wo cont (72127) | $2,985.95 | $5,429 | 16.8× |
| CT chest w contrast (71260) range across 2 matching MRF lines |
$1,987.70–$2,106.50 | $3,614–$3,830 | varies |
| CT chest w/wo contrast (71270) | $2,151.05 | $3,911 | 12.1× |
| CT colonography screening (74263) | $1,316.15 | $2,393 | 5.5× |
| CT Colonogrphy Dx Image Postprocess W/Contrast (74262) | $1,928.30 | $3,506 | 10.9× |
| CT colonogrphy dx image postprocess w/o contrast (74261) | $1,306.80 | $2,376 | 12.4× |
| CT head/brain with contrast (70460) range across 2 matching MRF lines |
$1,437.70–$2,053.70 | $2,614–$3,734 | varies |
| CT head/brain without and with contrast (70470) range across 2 matching MRF lines |
$1,855.70–$2,416.15 | $3,374–$4,393 | varies |
| CT heart contrast eval cardiac structure&morph (75572) | $1,461.90 | $2,658 | 4.1× |
| CT heart no contrast quant eval coronry calcium (75571) range across 4 matching MRF lines |
$27.50–$154.55 | $50–$281 | varies |
| CT hrt w/3d image congen (75573) | $2,075.15 | $3,773 | 5.9× |
| CT iac w contrast (70481) range across 2 matching MRF lines |
$1,883.20–$2,000.90 | $3,424–$3,638 | varies |
| CT l-spine w&w/o contrast (72133) | $3,009.60 | $5,472 | 17.0× |
| CT lower ext w/o (73700) range across 2 matching MRF lines |
$1,427.80–$1,610.40 | $2,596–$2,928 | varies |
| CT lower extremity w/contrast material (73701) range across 2 matching MRF lines |
$1,661.55–$1,826.55 | $3,021–$3,321 | varies |
| CT lumbar spine w contrast (72132) | $1,824.35 | $3,317 | 5.2× |
| CT lumbar spine w/o contrast (72131) range across 2 matching MRF lines |
$1,543.30–$1,695.10 | $2,806–$3,082 | varies |
| CT maxillofacial w contrast (70487) range across 2 matching MRF lines |
$1,649.45–$1,815 | $2,999–$3,300 | varies |
| CT maxillofacial wo contrast (70486) range across 4 matching MRF lines |
$111.10–$1,549.90 | $202–$2,818 | varies |
| CT neck tissue combo (70492) range across 2 matching MRF lines |
$2,221.45–$2,445.30 | $4,039–$4,446 | varies |
| Ct Orbit/Ear/Fossa W/O&W/Dye (70482) range across 2 matching MRF lines |
$2,000.90–$2,118.60 | $3,638–$3,852 | varies |
| CT orbits w/o contrast (70480) range across 2 matching MRF lines |
$1,765.50–$1,883.20 | $3,210–$3,424 | varies |
| CT pelvis w&w/o contrast (72194) | $2,122.45 | $3,859 | 12.0× |
| CT pelvis w/o contrast (72192) range across 2 matching MRF lines |
$1,211.65–$1,333.20 | $2,203–$2,424 | varies |
| CT scan of leg combo (73702) | $2,000.90 | $3,638 | 11.3× |
| CT scans face/jaw combo (70488) | $2,280.30 | $4,146 | 12.8× |
| CT soft tissue neck w contrast (70491) range across 2 matching MRF lines |
$1,849.10–$2,075.70 | $3,362–$3,774 | varies |
| CT soft tissue neck w/o contrast (70490) range across 2 matching MRF lines |
$1,639–$1,840.85 | $2,980–$3,347 | varies |
| CT thoracic spine w contrast (72129) | $1,728.65 | $3,143 | 9.7× |
| CT thoracic spine w/o contrast (72128) range across 2 matching MRF lines |
$1,047.75–$1,583.45 | $1,905–$2,879 | varies |
| CT thoracic spine w/wo cont (72130) | $2,339.15 | $4,253 | 13.2× |
| CT thorax w/o contrast (71250) range across 2 matching MRF lines |
$1,562–$1,784.20 | $2,840–$3,244 | varies |
| CT unlisted procedure (76497) | $524.15 | $953 | 6.0× |
| CT upper ext wo (73200) range across 2 matching MRF lines |
$1,335.40–$1,530.65 | $2,428–$2,783 | varies |
| CT upper extremity w/o & w/contrast material (73202) | $2,039.40 | $3,708 | 11.5× |
| CT upper extremity with contrast (73201) range across 2 matching MRF lines |
$1,829.85–$1,995.95 | $3,327–$3,629 | varies |
| Cta Abdl Aorta&Bi Iliofem W/Contrast&Postp (75635) range across 2 matching MRF lines |
$2,355.65–$2,486 | $4,283–$4,520 | varies |
| Cta Abdomen (74175) range across 2 matching MRF lines |
$2,279.75–$2,656.50 | $4,145–$4,830 | varies |
| CTA pelvis (72191) range across 2 matching MRF lines |
$2,355.65–$2,591.05 | $4,283–$4,711 | varies |
| Dacryocystography, nasolacrimal duct, radiological supervision and interpretation Non-Facility (70170) | $370.70 | $674 | 1.5× |
| Doppler Echo Fetal Puls Spectral F/U/Repeat (76828) | $299.75 | $545 | 2.8× |
| Doppler Echo Fetal Spectral Display Complete (76827) | $380.60 | $692 | 3.6× |
| Doppler Fetal Mid Cerebral Artery (76821) | $290.40 | $528 | 2.7× |
| Dxa Bone Density Axial (77080) range across 2 matching MRF lines |
$404.80–$425.70 | $736–$774 | varies |
| Dxa bone density study (77085) | $472.45 | $859 | 4.5× |
| Dxa bone density study 1/>sites appendiclr skel (77081) range across 2 matching MRF lines |
$194.15–$233.20 | $353–$424 | varies |
| Echo exam of fetal heart (76825) | $957.55 | $1,741 | 1.7× |
| Echo exam uterus (76831) | $545.60 | $992 | 2.3× |
| Echo Guide For Artery Repair (76936) | $933.35 | $1,697 | 4.3× |
| Echocardiography, fetal, cardiovascular system, real time with image documentation (2D), with or without M-mode… (76826) | $876.70 | $1,594 | 3.6× |
| Echograp Trans R Pros Study (76873) | $391.05 | $711 | 3.7× |
| Esophagram (74220) | $503.25 | $915 | 2.8× |
| Fetal Biophys Profile W/Nst (76818) | $832.15 | $1,513 | 7.9× |
| Fetal Biophysical Profile W/O Non-Stress Testing (76819) | $629.75 | $1,145 | 6.0× |
| Fetal MRI w/placntl matrnl plvc img sing/1st ges (74712) | $499.95 | $909 | 2.1× |
| Fluoroscopy up to 1 hr (76000) range across 3 matching MRF lines |
$55–$558.25 | $100–$1,015 | varies |
| Follow-Up Angiography (75898) | $2,221.45 | $4,039 | 0.7× |
| Foot 2 views (73620) range across 2 matching MRF lines |
$327.80–$354.75 | $596–$645 | varies |
| Forearm 2 views (73090) range across 2 matching MRF lines |
$254.10–$277.75 | $462–$505 | varies |
| Gastric emptying imaging study (78264) | $1,258.95 | $2,289 | 3.1× |
| Gastric Emptyng Imag Std W/Sm Bwl Transit (78265) | $860.20 | $1,564 | 2.1× |
| Gated Heart Planar Single (78472) | $983.40 | $1,788 | 2.4× |
| Hand 2 views (73120) range across 2 matching MRF lines |
$371.25–$402.05 | $675–$731 | varies |
| Hdr Rdncl Ntrstl/Icav Brchtx (77772) | $5,109.50 | $9,290 | 7.2× |
| Hdr Rdncl Ntrstl/Icav Brchtx (77771) | $4,059 | $7,380 | 5.8× |
| Hdr Rdncl Ntrstl/Icav Brchtx 1 Channel (77770) | $3,436.40 | $6,248 | 4.9× |
| Hepatc Vngrph Wdg/Fr Hemodyn Eval Rs&I (75889) | $3,641.55 | $6,621 | 1.1× |
| Hepatc Vngrph Wdg/Fr W/O Hemodyn Eval Rs&I (75891) | $3,936.90 | $7,158 | 1.2× |
| Hepatobil Syst Image W/Drug (78227) | $1,562 | $2,840 | 2.8× |
| Hepatobiliary System Imaging (78226) | $1,273.80 | $2,316 | 3.1× |
| Ht Musc Image Planar Mult (78454) | $2,037.20 | $3,704 | 1.6× |
| Ht Muscle Image Spect Sing (78451) | $2,413.95 | $4,389 | 1.8× |
| Hysterosalpingogram (74740) range across 2 matching MRF lines |
$762.30–$871.20 | $1,386–$1,584 | varies |
| Interstitial radiation source applic complex (77778) | $5,079.25 | $9,235 | 7.2× |
| K Flow/Funct Image W/Drug (78708) | $1,473.45 | $2,679 | 2.7× |
| K Flow/Funct Image W/O Drug (78707) | $1,355.20 | $2,464 | 2.5× |
| Kidney Funcj Study Non-Img Radioisotopic Study (78725) | $1,487.20 | $2,704 | 3.7× |
| Kidney Imaging Morphoogy W/Vascular Flow (78701) | $1,115.95 | $2,029 | 2.8× |
| Knee 3 Views (73562) range across 2 matching MRF lines |
$426.25–$459.25 | $775–$835 | varies |
| Leveen/Shunt Patency Exam (78291) | $721.05 | $1,311 | 1.8× |
| Liver & Spleen Imaging Static Only (78215) | $793.10 | $1,442 | 2.0× |
| Liver imaging static only (78201) | $1,199.55 | $2,181 | 2.2× |
| Liver imaging w/vascular flow (78202) | $1,566.95 | $2,849 | 2.9× |
| Lung Perf&Ventilat Diferentl (78598) | $1,303.50 | $2,370 | 2.4× |
| Lung perfusion differential (78597) | $1,051.60 | $1,912 | 2.6× |
| Lung Ventilat&Perfus Imaging (78582) | $1,402.50 | $2,550 | 2.6× |
| Lung Ventilation Imaging (78579) | $580.80 | $1,056 | 1.4× |
| Lymph System Imaging (78195) | $1,502.60 | $2,732 | 2.7× |
| Lymphangiography extremity only unilateral rs&i (75801) | $1,166.55 | $2,121 | 1.8× |
| Lymphangiography Pelvic/Abdominal Bilateral Rs&I (75807) | $2,406.25 | $4,375 | 0.8× |
| Lymphangiography, pelvic/abdominal, unilateral (75805) | $2,120.80 | $3,856 | 0.7× |
| Magnetic Image Jaw Joint (70336) range across 2 matching MRF lines |
$2,756.60–$2,928.75 | $5,012–$5,325 | varies |
| Magnetic resonance (eg, proton) imaging, brain (including brain stem andskull base), during open intracranial procedure… (70558) | $3,018.95 | $5,489 | 17.0× |
| Magnetic resonance (eg, proton) imaging, brain (including brain stem andskull base), during open intracranial procedure… (70557) | $2,851.75 | $5,185 | 5.2× |
| Magnetic resonance (eg, proton) imaging, brain (including brain stem andskull base), during open intracranial procedure… (70559) | $3,811.50 | $6,930 | 21.5× |
| Magnetic Resonance Elastography (76391) | $441.10 | $802 | 1.8× |
| Mammary ductogram or galactogram multiple (77054) | $973.50 | $1,770 | 4.0× |
| Mammary ductogram or galactogram single (77053) | $614.35 | $1,117 | 2.5× |
| Meckels Divert Exam (78290) | $768.90 | $1,398 | 1.9× |
| Mlc imrt design & construction per imrt plan (77338) range across 2 matching MRF lines |
$1,307.63–$1,503.70 | $2,377.50–$2,734 | varies |
| Mr safety determination physician/other qhp (76016) | $134.75 | $245 | 1.5× |
| Mr safety implant&/fb assmt clin staf 1st 15 min (76014) | $37.40 | $68 | 1.3× |
| Mr safety implt electronics prepj supvj phys/qhp (76018) | $140.25 | $255 | 1.5× |
| Mr safety implt pos&/immoblj (76019) | $90.75 | $165 | 1.5× |
| Mr safety med physics xm customization plng&mntr (76017) | $369.60 | $672 | 1.5× |
| Mra Head W/O & W/Contrast Material (70546) range across 2 matching MRF lines |
$3,046.45–$4,211.35 | $5,539–$7,657 | varies |
| MRA head w/o contrast (70544) range across 2 matching MRF lines |
$2,255–$2,797.30 | $4,100–$5,086 | varies |
| MRA head with contrast (70545) range across 2 matching MRF lines |
$2,400.75–$3,131.70 | $4,365–$5,694 | varies |
| MRA neck w contrast (70548) | $3,114.10 | $5,662 | 8.8× |
| Mra Neck W/O &W/Contrast Material (70549) | $3,268.65 | $5,943 | 9.3× |
| MRA neck w/o contrast (70547) | $2,834.15 | $5,153 | 11.7× |
| MRI abdomen w contrast (74182) | $3,230.70 | $5,874 | 9.2× |
| MRI abdomen w/o contrast (74181) range across 2 matching MRF lines |
$1,700.05–$2,586.10 | $3,091–$4,702 | varies |
| MRI any jt lower extrem w/contrast material (73722) range across 2 matching MRF lines |
$2,923.25–$3,155.35 | $5,315–$5,737 | varies |
| MRI any jt lower extrem w/o & w/contrast matrl (73723) range across 2 matching MRF lines |
$3,083.30–$3,803.80 | $5,606–$6,916 | varies |
| MRI any jt upper extremity w/contrast matrl (73222) range across 2 matching MRF lines |
$2,671.35–$2,974.40 | $4,857–$5,408 | varies |
| MRI brain functional w/o physician admnistration (70554) | $3,663 | $6,660 | 15.2× |
| MRI brain functional w/physician admnistration (70555) | $5,353.15 | $9,733 | 22.2× |
| MRI Breast W/O Contrast Bilateral (77047) range across 2 matching MRF lines |
$2,030.05–$3,877.50 | $3,691–$7,050 | varies |
| MRI Breast Without Contrast Material Unilateral (77046) | $2,806.65 | $5,103 | 11.6× |
| MRI cardiac w/o contrast (75557) | $2,519.55 | $4,581 | 10.4× |
| MRI cervical spine w contrast (72142) | $3,138.85 | $5,707 | 8.9× |
| MRI cervical spine w/o cont (72141) range across 2 matching MRF lines |
$2,752.75–$3,000.80 | $5,005–$5,456 | varies |
| MRI chest w/o contrast (71550) range across 2 matching MRF lines |
$2,273.70–$2,546.50 | $4,134–$4,630 | varies |
| MRI chest with contrast (71551) | $3,023.35 | $5,497 | 3.8× |
| MRI chest wo w contrast (71552) range across 2 matching MRF lines |
$3,265.90–$3,342.35 | $5,938–$6,077 | varies |
| MRI lower extrem oth/thn jt w/contrast matrl (73719) | $3,210.35 | $5,837 | 9.1× |
| MRI lower extrem oth/thn jt w/o & w/contr matr (73720) range across 2 matching MRF lines |
$3,048.65–$3,322.55 | $5,543–$6,041 | varies |
| MRI lower extrem oth/thn jt w/o contr matrl (73718) range across 2 matching MRF lines |
$2,620.20–$2,670.25 | $4,764–$4,855 | varies |
| MRI lumbar spine w contrast (72149) range across 2 matching MRF lines |
$2,872.10–$2,930.95 | $5,222–$5,329 | varies |
| Mri Neck Spine W/O & W/Dye (72156) | $3,779.05 | $6,871 | 10.7× |
| MRI orbit face &/neck w/o contrast (70540) range across 2 matching MRF lines |
$2,882–$2,947.45 | $5,240–$5,359 | varies |
| MRI orbit face neck w contrast (70542) | $3,241.15 | $5,893 | 9.2× |
| Mri Orbt/Fac/Nck W/O &W/Dye (70543) range across 2 matching MRF lines |
$3,443–$3,854.95 | $6,260–$7,009 | varies |
| MRI pelvis w contrast (72196) | $3,011.80 | $5,476 | 8.5× |
| MRI pelvis w/o & w contrast (72197) range across 2 matching MRF lines |
$2,999.70–$3,876.95 | $5,454–$7,049 | varies |
| MRI pelvis w/o contrast (72195) range across 3 matching MRF lines |
$313.50–$2,682.35 | $570–$4,877 | varies |
| MRI spectroscopy (76390) | $1,727 | $3,140 | 19.6× |
| MRI thoracic spine w/o contrast (72146) | $2,668.05 | $4,851 | 11.0× |
| MRI upper extremity oth than jt w/contr matrl (73219) | $3,030.50 | $5,510 | 8.6× |
| MRI upper extremity oth than jt w/o contr matrl (73218) | $2,592.70 | $4,714 | 10.7× |
| Mri Uppr Extremity W/O&W/Dye (73220) range across 2 matching MRF lines |
$2,922.15–$3,545.85 | $5,313–$6,447 | varies |
| MRI, abdomen, combo (74183) | $3,314.30 | $6,026 | 9.4× |
| MRI, dorsal spine combo (72157) range across 2 matching MRF lines |
$3,278.55–$3,733.95 | $5,961–$6,789 | varies |
| MRI, dorsal spine contrast (72147) | $3,599.75 | $6,545 | 10.2× |
| MRI, joint upper extrem (73221) | $2,593.25 | $4,715 | 10.7× |
| MRI, joint upper extrem combo (73223) range across 2 matching MRF lines |
$2,919.95–$3,639.35 | $5,309–$6,617 | varies |
| MRI, lumbar spine combo (72158) | $3,562.35 | $6,477 | 10.1× |
| Myocardial Imaging Pet Metabolic Evaluation (78459) | $6,168.25 | $11,215 | 4.7× |
| Myocardial Perfusion Planar 1 Study Rest/Stress (78453) | $2,213.75 | $4,025 | 1.7× |
| Myocardial Spect Multiple Studies (78452) | $3,131.15 | $5,693 | 2.4× |
| Myocrd img PET prfuj 1std rest/stress cncrnt CT (78430) | $2,797.85 | $5,087 | 1.9× |
| Myocrd Img Pet Prfuj Mlt Std Rst&Strs Cncrnt CT (78431) | $3,272.50 | $5,950 | 1.5× |
| Myocrd Img Pet Prfuj W/Metab 2rtracer Cncrnt CT (78433) | $3,424.85 | $6,227 | 1.5× |
| N-invas est c ffr sw aly CTA (75580) | $1,667.05 | $3,031 | 1.9× |
| Neck soft tissue (70360) range across 2 matching MRF lines |
$268.95–$292.60 | $489–$532 | varies |
| Njx Rp Loclzj Non-Img Probe Study Intravenous (78808) | $361.35 | $657 | 0.9× |
| Nm csf leak detection (78650) | $2,508.55 | $4,561 | 1.9× |
| Nm myocard infarct spect (78469) | $1,740.75 | $3,165 | 3.2× |
| Nm whole blood volume (78122) | $979.55 | $1,781 | 1.8× |
| Ntsty modul radthx pln dose-vol histos (77301) range across 2 matching MRF lines |
$7,150–$8,222.50 | $13,000–$14,950 | varies |
| Nuclear Rx Intra-Arterial (79445) | $1,231.45 | $2,239 | 5.2× |
| Nuclear Rx Oral Admin (79005) | $657.25 | $1,195 | 2.8× |
| Ob us nuchal meas 1 gest (76813) | $538.45 | $979 | 5.1× |
| Oph bmtry us echograpy a-scan io lens pwr cal (76519) | $248.60 | $452 | 2.3× |
| Oph us dx ant sgm us immersion b-scan/hr biom (76513) | $328.35 | $597 | 3.1× |
| Ophthalmic Biometry US Echograpy a-Scan (76516) | $232.65 | $423 | 2.2× |
| Ophthalmic ultrasound dx b-scan w/wo a-scan (76512) | $550.55 | $1,001 | 5.2× |
| Ophthalmic US Dx Corneal Pachymetry Uni/Bi (76514) | $114.95 | $209 | 3.9× |
| Panoramic X-ray of jaws (70355) | $252.45 | $459 | 2.9× |
| Parathyroid imaging w/tomographic spect & CT (78072) | $1,577.95 | $2,869 | 2.9× |
| Parathyroid Planar Imaging (78070) | $1,035.10 | $1,882 | 2.6× |
| Parathyroid planar imaging w/wo subtraction (78071) | $1,447.60 | $2,632 | 3.6× |
| Pelvis 1 or 2 views (72170) range across 2 matching MRF lines |
$300.30–$326.15 | $546–$593 | varies |
| Peritoneogram Rs&I (74190) | $704 | $1,280 | 1.3× |
| Pet Image W/Ct Lmtd (78814) | $3,819.75 | $6,945 | 2.6× |
| PET image w/CT, full body (78816) | $5,948.25 | $10,815 | 4.1× |
| PET imaging CT attenuation skull base mid-thigh (78815) | $5,381.75 | $9,785 | 3.7× |
| Pet Myocardial Sngl Study (78491) | $4,604.05 | $8,371 | 3.2× |
| Plasma Vol Radiopharm Vol Dilute Spx Mult Smples (78111) | $1,922.80 | $3,496 | 1.5× |
| Proton tx delivery complex (77525) | $1,782.28 | $3,240.50 | 1.4× |
| Proton tx delivery intermediate (77523) | $1,782.28 | $3,240.50 | 1.4× |
| Prq Transhepatc Portograpy Hemodyn Eval Rs&I (75885) | $3,914.35 | $7,117 | 1.2× |
| Pulmonary Perfusion Imaging Particulate (78580) | $1,372.25 | $2,495 | 3.4× |
| Radex Abd Compl Aqt Abd W/S/E/D Views 1 View Ch (74022) range across 2 matching MRF lines |
$553.85–$700.15 | $1,007–$1,273 | varies |
| Radex abscess/fistula/sinus tract rs&i (76080) | $631.95 | $1,149 | 1.1× |
| Radex Ankle Complete Minimum 3 Views (73610) range across 2 matching MRF lines |
$292.60–$316.80 | $532–$576 | varies |
| Radex Calcaneus Minimum 2 Views (73650) range across 2 matching MRF lines |
$256.30–$275 | $466–$500 | varies |
| Radex elbow complete minimum 3 views (73080) range across 2 matching MRF lines |
$306.35–$332.75 | $557–$605 | varies |
| Radex Facial Bones Complete Minimum 3 Views (70150) range across 2 matching MRF lines |
$492.80–$531.85 | $896–$967 | varies |
| Radex fingr minimum 2 views (73140) range across 2 matching MRF lines |
$229.35–$259.60 | $417–$472 | varies |
| Radex foot complete minimum 3 views (73630) range across 2 matching MRF lines |
$386.10–$416.90 | $702–$758 | varies |
| Radex Hand Minimum 3 Views (73130) range across 2 matching MRF lines |
$415.80–$447.15 | $756–$813 | varies |
| Radex lower extremity infant minimum 2 views (73592) | $295.35 | $537 | 3.4× |
| Radex Mastoids Compl Minimum 3 Views PR Side (70130) | $114.40 | $208 | 1.1× |
| Radex Nasal Bones Complete Minimum 3 Views (70160) range across 2 matching MRF lines |
$351.45–$367.40 | $639–$668 | varies |
| Radex Ribs Unilateral 2 Views (71100) range across 2 matching MRF lines |
$327.25–$350.35 | $595–$637 | varies |
| Radex shoulder complete minimum 2 views (73030) range across 2 matching MRF lines |
$342.65–$370.70 | $623–$674 | varies |
| Radex Sinuses Paransl < 3 Views (70210) | $249.70 | $454 | 2.8× |
| Radex Spine 1 View Specify Level (72020) range across 2 matching MRF lines |
$146.85–$161.70 | $267–$294 | varies |
| Radex Sternum Minimum 2 Views (71120) range across 2 matching MRF lines |
$365.20–$379.50 | $664–$690 | varies |
| Radex Temporomandble Jt Opn & Clsd Mouth Bilat (70330) | $399.85 | $727 | 4.5× |
| Radex Toe Minimum 2 Views (73660) range across 2 matching MRF lines |
$268.95–$281.05 | $489–$511 | varies |
| Radex upper extremity infant minimum 2 views (73092) | $287.65 | $523 | 2.7× |
| Radex Wrist Complete Minimum 3 Views (73110) range across 2 matching MRF lines |
$279.95–$305.25 | $509–$555 | varies |
| Radex X-Ray Exam Entire Spi 6/> Vw - Xr Entire Spine 6+ Vw (72084) range across 2 matching MRF lines |
$384.45–$422.40 | $699–$768 | varies |
| Radiation treatment delivery level 1 (77402) | $717.75 | $1,305 | 7.0× |
| Radiation treatment delivery level 2 (77407) | $923.45 | $1,679 | 2.4× |
| Radiation treatment delivery level 3 (77412) | $1,706.10 | $3,102 | 3.1× |
| Radiolog exam mandible compl minimum 4 views (70110) range across 2 matching MRF lines |
$315.15–$506 | $573–$920 | varies |
| Radiologic Exam Abdomen 3+ Views - Xr Abdomen 3+ Views (74021) | $504.90 | $918 | 4.8× |
| Radiologic exam colon double contrast study (74280) | $989.45 | $1,799 | 5.6× |
| Radiologic exam colon single contrast study (74270) | $612.70 | $1,114 | 3.5× |
| Radiologic Exam Esophagus Double Contrast Study (74221) | $628.10 | $1,142 | 3.5× |
| Radiologic exam knee complete 4/more views (73564) range across 2 matching MRF lines |
$397.10–$488.40 | $722–$888 | varies |
| Radiologic exam pelvis compl minimum 3 views (72190) range across 2 matching MRF lines |
$295.35–$324.50 | $537–$590 | varies |
| Radiologic Exam Small Int Single Contrast Study (74250) | $473 | $860 | 2.7× |
| Radiologic exam swallow function contrast study (74230) | $501.05 | $911 | 2.8× |
| Radiologic exam upr gi trc double contrast study (74246) | $634.15 | $1,153 | 3.6× |
| Radiologic examination femur 1 view (73551) | $256.30 | $466 | 2.9× |
| Radiologic examination femur minimum 2 views (73552) range across 2 matching MRF lines |
$287.10–$315.70 | $522–$574 | varies |
| Radiologic examination knee 1/2 views (73560) range across 2 matching MRF lines |
$244.75–$262.90 | $445–$478 | varies |
| Radiologic Examination Osseous Survey Limited (77074) | $550.55 | $1,001 | 5.2× |
| Radiologic examination tibia & fibula 2 views (73590) range across 2 matching MRF lines |
$276.65–$302.50 | $503–$550 | varies |
| Radiopharm Dacryocystography (78660) | $558.80 | $1,016 | 1.4× |
| Red Cell Volume Determination Spx Mult Samplings (78121) | $729.30 | $1,326 | 1.3× |
| Renal Cyst Study (74470) | $854.15 | $1,553 | 1.5× |
| Ribs bilateral 3 views (71110) | $561 | $1,020 | 5.3× |
| Rp loclzj tum plnr 1 area single day imaging (78800) | $922.35 | $1,677 | 2.3× |
| Rp loclzj tum plnr 2+area 1+d img/1 area img>2+d (78801) | $1,266.65 | $2,303 | 3.1× |
| Rp Loclzj Tum Plnr Whole Body 2+ Days Imaging (78804) | $3,157.55 | $5,741 | 5.7× |
| Rp Loclzj Tum Plnr Whole Body Single Day Imaging (78802) | $1,923.35 | $3,497 | 3.5× |
| Rp Loclzj Tum Spect 1 Area Single Day Imaging (78803) | $1,923.35 | $3,497 | 3.5× |
| Rp loclzj tum spect 2 area/sep acquisj img (78831) | $2,617.45 | $4,759 | 2.0× |
| Rp loclzj tum spect CT 2area 1d img/1 ar img>2+d (78832) | $2,869.90 | $5,218 | 2.0× |
| Rp loclzj tum spect w/CT 1 area/acquisj 1day img (78830) | $2,189.55 | $3,981 | 1.7× |
| Rp Ther Radiolbld Monoclonal Antibody IV Infus (79403) | $3,552.45 | $6,459 | 15.0× |
| Rp Therapy Intravenous Administration (79101) range across 2 matching MRF lines |
$592.35–$760.65 | $1,077–$1,383 | varies |
| Salivary Gland Function Study (78232) | $558.80 | $1,016 | 1.4× |
| Scapula (73010) range across 2 matching MRF lines |
$282.70–$310.20 | $514–$564 | varies |
| Screening Digital Breast Tomosynthesis Bi (77063) | $104.50 | $190 | 4.5× |
| Shoulder 1 view (73020) range across 2 matching MRF lines |
$124.85–$134.75 | $227–$245 | varies |
| Shoulder Arthrography (73040) | $856.35 | $1,557 | 2.4× |
| Skull less than 4 views (70250) range across 2 matching MRF lines |
$220–$239.80 | $400–$436 | varies |
| Special dosimetry (77331) range across 2 matching MRF lines |
$434.50–$499.95 | $790–$909 | varies |
| Special Physics Consult (77370) range across 2 matching MRF lines |
$707.85–$814 | $1,287–$1,480 | varies |
| Special teletherapy port plan (77321) | $1,359.05 | $2,471 | 3.6× |
| Special treatment procedure (77470) range across 3 matching MRF lines |
$1,741.30–$2,334.75 | $3,166–$4,245 | varies |
| Srs Multisource (77371) | $53,762.50 | $97,750 | 7.2× |
| Stereotactic Body Radiation Delivery (77373) range across 3 matching MRF lines |
$5,653.45–$14,335.20 | $10,279–$26,064 | varies |
| Sternoclavicular joints (71130) range across 2 matching MRF lines |
$386.65–$417.45 | $703–$759 | varies |
| Superior sagittal sinus venogram (75870) | $2,120.80 | $3,856 | 0.7× |
| Tbs technical calculation only (77091) range across 2 matching MRF lines |
$119.63–$137.50 | $217.50–$250 | varies |
| Telethx isodose pln cplx w/basic dosimetry (77307) | $2,630.10 | $4,782 | 6.9× |
| Telethx isodose pln smpl w/dosimetry calculation (77306) | $2,264.90 | $4,118 | 6.0× |
| Ther Rad Simulaj-Aided Field Setting Complex (77290) range across 4 matching MRF lines |
$2,475.55–$2,846.80 | $4,501–$5,176 | varies |
| Ther Rad Simulaj-Aided Field Setting Intermed (77285) | $2,719.75 | $4,945 | 7.2× |
| Ther rad simulaj-aided field setting simple (77280) range across 2 matching MRF lines |
$1,099.45–$1,264.45 | $1,999–$2,299 | varies |
| Therapeutic Enema Rdctj Intussusception/Obstrcj (74283) | $525.80 | $956 | 3.0× |
| Thoracic spine 2 views (72070) range across 2 matching MRF lines |
$425.70–$449.35 | $774–$817 | varies |
| Thoracic spine 3 views (72072) range across 2 matching MRF lines |
$523.05–$559.90 | $951–$1,018 | varies |
| Thoracolumbar 2 views (72080) range across 2 matching MRF lines |
$292.60–$312.40 | $532–$568 | varies |
| Thyroid Imaging With Vascular Flow (78013) | $558.80 | $1,016 | 1.4× |
| Thyroid Met Imaging Body (78018) | $1,558.15 | $2,833 | 2.8× |
| Thyroid Uptake Measurement (78012) | $721.05 | $1,311 | 1.8× |
| Thyroid Uptake W/Blood Flow Sngle/Mult Quan Meas (78014) | $1,247.95 | $2,269 | 3.1× |
| Tx Devices Design & Construction Complex (77334) range across 4 matching MRF lines |
$1,140.15–$1,311.20 | $2,073–$2,384 | varies |
| Tx devices design & construction intermediate (77333) range across 2 matching MRF lines |
$364.65–$419.10 | $663–$762 | varies |
| Tx devices design & construction simple (77332) range across 2 matching MRF lines |
$324.50–$373.45 | $590–$679 | varies |
| Ultrasound Breast Limited (76642) range across 4 matching MRF lines |
$414.15–$502.15 | $753–$913 | varies |
| Ultrasound elastography first target lesion (76982) | $255.75 | $465 | 2.4× |
| Ultrasound Elastography Parenchyma (76981) | $316.80 | $576 | 3.0× |
| Ultrasound Exam Aaa Screen (76706) range across 2 matching MRF lines |
$301.95–$641.85 | $549–$1,167 | varies |
| Ultrasound trgt dynamic microbubble 1st lesion (76978) | $287.65 | $523 | 0.8× |
| Ultrasound, abdomen limited (76705) range across 3 matching MRF lines |
$725.45–$748 | $1,319–$1,360 | varies |
| Umbilical-artery Doppler (OB) (76820) | $298.10 | $542 | 2.8× |
| Unlisted Dx Radiographic Procedure (76499) range across 2 matching MRF lines |
$485.10–$2,060.30 | $882–$3,746 | varies |
| Unlisted magnetic resonance procedure (76498) range across 5 matching MRF lines |
$485.65–$3,307.15 | $883–$6,013 | varies |
| Unlisted us procedure (76999) range across 2 matching MRF lines |
$368.50–$598.40 | $670–$1,088 | varies |
| Upper gi w/o kub (74240) | $574.75 | $1,045 | 3.2× |
| Urethrocystogram voiding (74455) | $526.35 | $957 | 2.2× |
| Urethrocystography retrograde (74450) | $604.45 | $1,099 | 2.5× |
| Us breast unilateral complete (76641) range across 2 matching MRF lines |
$599.50–$761.75 | $1,090–$1,385 | varies |
| Us chest (76604) | $636.90 | $1,158 | 6.0× |
| Us complete joint (76881) | $805.75 | $1,465 | 7.6× |
| Us exam, pelvic, limited (76857) range across 3 matching MRF lines |
$366.30–$531.85 | $666–$967 | varies |
| Us kidney transplant (76776) | $859.65 | $1,563 | 8.1× |
| Us lmtd joint/oth nonvasc xtr strux r-t w/img (76882) range across 2 matching MRF lines |
$473–$529.65 | $860–$963 | varies |
| Us ob detailed single fetus (76811) | $666.05 | $1,211 | 2.8× |
| Us ob limited 1 or more fetuses (76815) | $337.70 | $614 | 3.2× |
| Us ob transvaginal (76817) range across 2 matching MRF lines |
$462–$507.65 | $840–$923 | varies |
| Us pelvic non ob complete (76856) range across 2 matching MRF lines |
$864.05–$1,031.25 | $1,571–$1,875 | varies |
| Us pg uter img f&mat 14 wk tabdl 1/1st gestation (76801) range across 3 matching MRF lines |
$411.95–$539 | $749–$980 | varies |
| Us preg uterus real time f/u trnsabdl per fetus (76816) range across 2 matching MRF lines |
$633.60–$667.15 | $1,152–$1,213 | varies |
| Us retroperitoneal complete (76770) range across 2 matching MRF lines |
$775.50–$794.20 | $1,410–$1,444 | varies |
| Us retroperitoneal limited (76775) range across 3 matching MRF lines |
$809.60–$844.80 | $1,472–$1,536 | varies |
| Us scrotum and contents (76870) range across 2 matching MRF lines |
$682–$876.70 | $1,240–$1,594 | varies |
| Us thyroid (76536) range across 2 matching MRF lines |
$805.75–$894.30 | $1,465–$1,626 | varies |
| Us transrectal (76872) range across 2 matching MRF lines |
$724.35–$725.45 | $1,317–$1,319 | varies |
| Vein X-Ray Chest (75827) | $2,626.80 | $4,776 | 1.6× |
| Vein X-Ray Liver W/O Hemodyn (75887) | $2,473.90 | $4,498 | 0.8× |
| Vein X-Ray Skull Epidural (75872) | $2,440.35 | $4,437 | 3.8× |
| Vein X-Ray Spleen/Liver (75810) | $2,390.85 | $4,347 | 0.7× |
| Venogram Sinus/Jugular (75860) | $3,322.55 | $6,041 | 1.0× |
| Venography Adrenal Unilateral (75840) | $4,934.60 | $8,972 | 1.5× |
| Venography caval inferior serialography rs&i (75825) | $3,238.40 | $5,888 | 1.0× |
| Venography extremity bilateral rs&i (75822) | $1,576.85 | $2,867 | 1.0× |
| Venography extremity unilateral rs&i (75820) | $1,588.40 | $2,888 | 1.0× |
| Venography Renal Bilateral (75833) | $3,689.95 | $6,709 | 1.2× |
| Venography Renal Unilateral (75831) | $3,689.95 | $6,709 | 1.2× |
| Venous sampling by catheter (75893) | $5,436.20 | $9,884 | 1.0× |
| Vertebral fracture assessment via dxa (77086) | $220 | $400 | 2.5× |
| Wrist 2 views (73100) range across 2 matching MRF lines |
$265.10–$277.20 | $482–$504 | varies |
| X-Ray Ac Jts - Xr Acromioclavicular Joints Bilateral (73050) range across 2 matching MRF lines |
$262.90–$275.55 | $478–$501 | varies |
| X-ray antegrade pyelogram tube (74425) | $621.50 | $1,130 | 1.8× |
| X-Ray Aorta Leg Arteries (75630) | $3,545.30 | $6,446 | 1.1× |
| X-Ray Bend Only L-S Spine (72120) | $446.05 | $811 | 4.2× |
| X-Ray Elbow 2 Vw - Xr Elbow 1-2 Views Right (73070) range across 2 matching MRF lines |
$179.85–$196.35 | $327–$357 | varies |
| X-Ray Exam Breast Specimen (76098) | $601.15 | $1,093 | 1.1× |
| X-Ray Exam Entire Spi 1 Vw (72081) | $428.45 | $779 | 4.9× |
| X-Ray Exam Entire Spi 2/3 Vw (72082) range across 2 matching MRF lines |
$441.10–$468.60 | $802–$852 | varies |
| X-Ray Exam Entire Spi 4/5 Vw (72083) range across 2 matching MRF lines |
$455.95–$493.90 | $829–$898 | varies |
| X-Ray Exam Hip Uni 1 View (73501) range across 2 matching MRF lines |
$193.05–$202.95 | $351–$369 | varies |
| X-Ray Exam Hip Uni 2-3 Views (73502) range across 2 matching MRF lines |
$298.10–$316.80 | $542–$576 | varies |
| X-Ray Exam Hip Uni 4/> Views (73503) | $342.65 | $623 | 3.2× |
| X-Ray Exam Hips Bi 2 Views (73521) range across 2 matching MRF lines |
$623.70–$630.85 | $1,134–$1,147 | varies |
| X-Ray Exam Hips Bi 3-4 Views (73522) range across 2 matching MRF lines |
$479.60–$725.45 | $872–$1,319 | varies |
| X-Ray Exam Hips Bi 5/> Views (73523) | $274.45 | $499 | 2.6× |
| X-Ray Exam L-S Spine Bending (72114) range across 2 matching MRF lines |
$337.70–$564.30 | $614–$1,026 | varies |
| X-Ray Exam Neck Spine 2-3 Vw (72040) range across 2 matching MRF lines |
$382.80–$400.40 | $696–$728 | varies |
| X-Ray Exam Neck Spine 6/>Vws (72052) range across 2 matching MRF lines |
$551.10–$649 | $1,002–$1,180 | varies |
| X-Ray Exam Unilat Ribs/Chest (71101) range across 2 matching MRF lines |
$633.05–$639.65 | $1,151–$1,163 | varies |
| X-ray eye for foreign body (70030) range across 2 matching MRF lines |
$228.80–$448.25 | $416–$815 | varies |
| X-ray humerus (73060) range across 2 matching MRF lines |
$277.75–$303.60 | $505–$552 | varies |
| X-Ray Jaw <4 Vw - Xr Mandible < 4 Views (70100) | $393.80 | $716 | 4.5× |
| X-Ray Knee Bilat Standing - Xr Knees Anteroposterior Standing Bilat (73565) range across 2 matching MRF lines |
$345.40–$365.20 | $628–$664 | varies |
| X-Ray Lumbar Spine 2/3 Vw - Xr Lumbar Spine 2-3 Views (72100) range across 2 matching MRF lines |
$426.80–$447.15 | $776–$813 | varies |
| X-ray nose-rectum child f.b. (76010) | $177.65 | $323 | 2.0× |
| X-Ray Ribs, Chest 4+ Vw - Xr Ribs 3 Vws Bil W/ Chest Posteroanterior (71111) range across 2 matching MRF lines |
$605.55–$660.55 | $1,101–$1,201 | varies |
| X-Ray Sacroiliac Jts 3+ Vw - Xr Sacroiliac Joints 3+ Views (72202) range across 2 matching MRF lines |
$398.75–$437.80 | $725–$796 | varies |
| X-Ray Sacrum/Coccyx 2+ Vw - Xr Sacrum Coccyx 2+ Views (72220) range across 2 matching MRF lines |
$476.30–$508.75 | $866–$925 | varies |
| X-Ray Sinuses 3+ Vw - Xr Paranasal Sinuses 3+ Views (70220) range across 2 matching MRF lines |
$306.90–$387.20 | $558–$704 | varies |
| X-Ray Skull 4+ Vw - Xr Skull Complete 4+ Views (70260) range across 2 matching MRF lines |
$704–$720.50 | $1,280–$1,310 | varies |
| X-Ray Stress View (77071) | $156.20 | $284 | 1.8× |
| X-ray thoracic spine 4 vw (72074) range across 2 matching MRF lines |
$482.35–$610.50 | $877–$1,110 | varies |
| X-Ray Urinary Tract Exam With Contrast Material (74420) | $1,257.30 | $2,286 | 3.6× |
| X-Rays Bone Length Studies (77073) range across 2 matching MRF lines |
$277.20–$304.70 | $504–$554 | varies |
| X-Rays Bone Survey Complete (77075) | $1,071.95 | $1,949 | 10.1× |
| Xr c-spine 4 or 5 views (72050) range across 2 matching MRF lines |
$611.60–$634.15 | $1,112–$1,153 | varies |
| Xr facial bones less than 3 views (70140) | $382.80 | $696 | 4.3× |
| Xr orbits complete 4 views (70200) | $295.35 | $537 | 2.8× |
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.