Imaging prices at HCA HealthOne Sky Ridge Medical Center
Lone Tree, CO · every code in this section with a posted price and a Medicare benchmark.
399 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) | $31,061.25 | $31,061.25 | 21.3× |
| Abdomen 1 View (74018) | $2,288 | $2,288 | 24.9× |
| Abdomen 2 views (74019) | $3,560.15 | $3,560.15 | 32.3× |
| Acute Gastrointestinal Blood Loss Imaging (78278) | $5,017.50 | $5,017.50 | 11.9× |
| Adrenal Cortex & Medulla Img (78075) | $14,603 | $14,603 | 10.7× |
| Angio internal mammary (75756) range across 2 matching MRF lines |
$13,716.45–$14,991.35 | $13,716.45–$14,991.35 | varies |
| Angio pulmonary bilat (75743) | $24,868.25 | $24,868.25 | 7.5× |
| Angiography extremity bilateral rs&i (75716) range across 2 matching MRF lines |
$36,977.60–$40,421.15 | $36,977.60–$40,421.15 | varies |
| Angiography extremity unilateral rs&i (75710) range across 6 matching MRF lines |
$19,133.40–$23,007.60 | $19,133.40–$23,007.60 | varies |
| Angiography pulmonary unilateral slctv rs&i (75741) | $17,284.85 | $17,284.85 | 5.2× |
| Angrph pulmonary nonslctv cath/ven njx rs&i (75746) | $24,197.25 | $24,197.25 | 7.3× |
| Ankle 2 views (73600) range across 2 matching MRF lines |
$1,492.15–$1,527.35 | $1,492.15–$1,527.35 | varies |
| Aortography thoracic serialography rs&i (75605) range across 2 matching MRF lines |
$17,415.20–$21,255.85 | $17,415.20–$21,255.85 | varies |
| Artery X-Rays Abdomen (75726) range across 2 matching MRF lines |
$25,983.65–$28,398.70 | $25,983.65–$28,398.70 | varies |
| Artery X-Rays Pelvis (75736) range across 2 matching MRF lines |
$20,754.25–$22,683.65 | $20,754.25–$22,683.65 | varies |
| Artery X-Rays Spine (75705) range across 2 matching MRF lines |
$18,260–$19,957.30 | $18,260–$19,957.30 | varies |
| Arthrogram ankle (73615) | $6,510.90 | $6,510.90 | 17.7× |
| Arthrogram hip (73525) range across 5 matching MRF lines |
$9,494.65–$9,961.60 | $9,494.65–$9,961.60 | varies |
| Arthrogram Wrist (73115) range across 5 matching MRF lines |
$9,186.10–$10,538 | $9,186.10–$10,538 | varies |
| Basic radiation dosimetry calculation (77300) | $4,162.40 | $4,162.40 | 29.4× |
| Bone age studies (77072) | $1,492.15 | $1,492.15 | 13.5× |
| Bone Imaging 3 Phase (78315) | $13,489.50 | $13,489.50 | 32.0× |
| Bone Imaging Limited Area (78300) | $11,150 | $11,150 | 26.4× |
| Bone Imaging Multiple Areas (78305) | $12,390.50 | $12,390.50 | 29.4× |
| Bone Imaging Whole Body (78306) | $14,767.50 | $14,767.50 | 35.0× |
| Bone marrow imaging limited area (78102) | $7,991.50 | $7,991.50 | 19.0× |
| Bone marrow imaging; whole body (78104) | $9,412 | $9,412 | 22.3× |
| Bone survey infant (77076) | $5,888.30 | $5,888.30 | 53.4× |
| Brachytx isodose complex (77318) | $25,481.50 | $25,481.50 | 64.5× |
| Brachytx isodose intermed (77317) | $25,481.50 | $25,481.50 | 64.5× |
| Brachytx Isodose Plan Simple (77316) | $25,481.50 | $25,481.50 | 64.5× |
| Brain Flow Imaging Only (78610) | $5,510 | $5,510 | 9.6× |
| Brain Imaging Min 4 Static Views W Vascular Flow (78606) | $10,412.50 | $10,412.50 | 18.2× |
| Brain Imaging Minimum 4 Static Views (78605) | $6,883.50 | $6,883.50 | 12.0× |
| Brain Imaging Pet Metabolic Evaluation (78608) | $35,879.80 | $35,879.80 | 23.8× |
| Cardiac MRI w/w/o contrast & further seq (75561) | $20,447.90 | $20,447.90 | 55.6× |
| Cardiac MRI w/w/o contrast w/stress (75563) | $28,740.80 | $28,740.80 | 34.8× |
| Cat Scan Follow-Up Study (76380) range across 3 matching MRF lines |
$7,043.85–$8,311.60 | $7,043.85–$8,311.60 | varies |
| Cerebrospinal Fluid Flow W/O Matl Shunt Evaltj (78645) | $6,442 | $6,442 | 11.2× |
| Cerebrospinal Fluid Scan (78630) | $13,412 | $13,412 | 23.4× |
| Chest 1 view (71045) | $1,689.05 | $1,689.05 | 18.4× |
| Chest 2 views (71046) | $2,561.35 | $2,561.35 | 27.9× |
| Chest 3 views (71047) | $3,432 | $3,432 | 37.4× |
| Chest 4 or more views (71048) | $3,843.95 | $3,843.95 | 34.9× |
| Cholecystography Oral Contrast (74290) | $4,130.50 | $4,130.50 | 22.3× |
| Clavicle complete (73000) range across 4 matching MRF lines |
$2,567.95–$5,135.35 | $2,567.95–$5,135.35 | varies |
| Continuing medical physics consltj pr wk (77336) | $5,445.55 | $5,445.55 | 38.4× |
| Contrast Exam Abdominl Aorta (75625) range across 2 matching MRF lines |
$29,769.30–$32,545.70 | $29,769.30–$32,545.70 | varies |
| Contrast X-Ray Bladder (74430) | $4,430.80 | $4,430.80 | 12.0× |
| Contrast X-Ray Of Elbow (73085) | $8,647.65 | $8,647.65 | 23.5× |
| Contrast X-Ray Of Knee Joint (73580) | $6,510.90 | $6,510.90 | 17.7× |
| Corpora cavernosography (74445) | $10,503.90 | $10,503.90 | 95.2× |
| CT abdomen and pelvis without and with contrast (74178) range across 2 matching MRF lines |
$24,140.60–$25,613.50 | $24,140.60–$25,613.50 | varies |
| CT abdomen and pelvis without contrast (74176) range across 2 matching MRF lines |
$17,640.70–$18,717.60 | $17,640.70–$18,717.60 | varies |
| CT abdomen w contrast (74160) range across 2 matching MRF lines |
$20,425.90–$21,672.20 | $20,425.90–$21,672.20 | varies |
| CT abdomen w wo contrast (74170) range across 3 matching MRF lines |
$24,140.60–$29,564.70 | $24,140.60–$29,564.70 | varies |
| CT abdomen w/o contrast (74150) range across 2 matching MRF lines |
$17,640.70–$18,717.60 | $17,640.70–$18,717.60 | varies |
| CT Angio Abdomen and Pelvis (74174) range across 2 matching MRF lines |
$20,931.35–$22,207.90 | $20,931.35–$22,207.90 | varies |
| CT Angio Chest (71275) range across 2 matching MRF lines |
$16,712.85–$17,732.55 | $16,712.85–$17,732.55 | varies |
| CT Angio Head (70496) range across 4 matching MRF lines |
$16,712.85–$17,732.55 | $16,712.85–$17,732.55 | varies |
| CT angio hrt w/3d image (75574) | $24,140.60 | $24,140.60 | 65.6× |
| Ct Angio Lwr Extr W/O&W/Dye (73706) range across 7 matching MRF lines |
$16,712.85–$17,732.55 | $16,712.85–$17,732.55 | varies |
| CT Angio Neck (70498) range across 4 matching MRF lines |
$16,712.85–$17,732.55 | $16,712.85–$17,732.55 | varies |
| Ct Angio Upr Extrm W/O&W/Dye (73206) range across 4 matching MRF lines |
$10,962.60–$11,631.40 | $10,962.60–$11,631.40 | varies |
| CT cervical spine w/ contrast (72126) range across 2 matching MRF lines |
$20,425.90–$21,672.20 | $20,425.90–$21,672.20 | varies |
| CT cervical spine w/o contrast (72125) range across 2 matching MRF lines |
$17,640.70–$18,717.60 | $17,640.70–$18,717.60 | varies |
| CT cervical spine w/wo cont (72127) range across 2 matching MRF lines |
$17,260.10–$18,313.35 | $17,260.10–$18,313.35 | varies |
| CT chest w contrast (71260) range across 2 matching MRF lines |
$20,425.90–$21,672.20 | $20,425.90–$21,672.20 | varies |
| CT chest w/wo contrast (71270) range across 2 matching MRF lines |
$24,140.60–$25,613.50 | $24,140.60–$25,613.50 | varies |
| CT head/brain with contrast (70460) range across 2 matching MRF lines |
$20,425.90–$21,672.20 | $20,425.90–$21,672.20 | varies |
| CT head/brain without and with contrast (70470) range across 2 matching MRF lines |
$24,140.60–$25,613.50 | $24,140.60–$25,613.50 | varies |
| CT heart no contrast quant eval coronry calcium (75571) | $3,716.90 | $3,716.90 | 40.5× |
| CT iac w contrast (70481) range across 2 matching MRF lines |
$20,425.90–$21,672.20 | $20,425.90–$21,672.20 | varies |
| CT l-spine w&w/o contrast (72133) range across 2 matching MRF lines |
$24,140.60–$25,613.50 | $24,140.60–$25,613.50 | varies |
| CT lower ext w/o (73700) range across 7 matching MRF lines |
$17,640.70–$18,717.60 | $17,640.70–$18,717.60 | varies |
| CT lower extremity w/contrast material (73701) range across 5 matching MRF lines |
$20,425.90–$21,672.20 | $20,425.90–$21,672.20 | varies |
| CT lumbar spine w contrast (72132) range across 2 matching MRF lines |
$20,425.90–$21,672.20 | $20,425.90–$21,672.20 | varies |
| CT lumbar spine w/o contrast (72131) range across 2 matching MRF lines |
$17,640.70–$18,717.60 | $17,640.70–$18,717.60 | varies |
| CT maxillofacial w contrast (70487) range across 2 matching MRF lines |
$20,425.90–$21,672.20 | $20,425.90–$21,672.20 | varies |
| CT maxillofacial wo contrast (70486) range across 2 matching MRF lines |
$17,640.70–$18,717.60 | $17,640.70–$18,717.60 | varies |
| CT neck tissue combo (70492) range across 2 matching MRF lines |
$24,140.60–$25,613.50 | $24,140.60–$25,613.50 | varies |
| Ct Orbit/Ear/Fossa W/O&W/Dye (70482) range across 2 matching MRF lines |
$24,140.60–$25,613.50 | $24,140.60–$25,613.50 | varies |
| CT orbits w/o contrast (70480) range across 2 matching MRF lines |
$17,640.70–$18,717.60 | $17,640.70–$18,717.60 | varies |
| CT pelvis w&w/o contrast (72194) range across 2 matching MRF lines |
$24,140.60–$25,613.50 | $24,140.60–$25,613.50 | varies |
| CT pelvis w/o contrast (72192) range across 2 matching MRF lines |
$17,640.70–$18,717.60 | $17,640.70–$18,717.60 | varies |
| CT scan of leg combo (73702) range across 6 matching MRF lines |
$15,969.25–$16,943.30 | $15,969.25–$16,943.30 | varies |
| CT scans face/jaw combo (70488) range across 2 matching MRF lines |
$22,497.75–$23,870.55 | $22,497.75–$23,870.55 | varies |
| CT soft tissue neck w contrast (70491) range across 2 matching MRF lines |
$20,425.90–$21,672.20 | $20,425.90–$21,672.20 | varies |
| CT soft tissue neck w/o contrast (70490) range across 2 matching MRF lines |
$17,640.70–$18,717.60 | $17,640.70–$18,717.60 | varies |
| CT thoracic spine w contrast (72129) range across 2 matching MRF lines |
$20,425.90–$21,672.20 | $20,425.90–$21,672.20 | varies |
| CT thoracic spine w/o contrast (72128) range across 2 matching MRF lines |
$17,640.70–$18,717.60 | $17,640.70–$18,717.60 | varies |
| CT thoracic spine w/wo cont (72130) range across 2 matching MRF lines |
$24,140.60–$25,613.50 | $24,140.60–$25,613.50 | varies |
| CT thorax w/o contrast (71250) range across 2 matching MRF lines |
$16,712.85–$17,732.55 | $16,712.85–$17,732.55 | varies |
| CT upper ext wo (73200) range across 5 matching MRF lines |
$12,244.65–$18,717.60 | $12,244.65–$18,717.60 | varies |
| CT upper extremity w/o & w/contrast material (73202) range across 6 matching MRF lines |
$15,436.85–$30,177.40 | $15,436.85–$30,177.40 | varies |
| CT upper extremity with contrast (73201) range across 5 matching MRF lines |
$20,425.90–$31,910.45 | $20,425.90–$31,910.45 | varies |
| Cta Abdl Aorta&Bi Iliofem W/Contrast&Postp (75635) range across 2 matching MRF lines |
$16,712.85–$17,732.55 | $16,712.85–$17,732.55 | varies |
| Cta Abdomen (74175) range across 2 matching MRF lines |
$16,712.85–$17,732.55 | $16,712.85–$17,732.55 | varies |
| CTA pelvis (72191) range across 2 matching MRF lines |
$16,712.85–$17,732.55 | $16,712.85–$17,732.55 | varies |
| Dilation ureters/urethra rs&i (74485) | $8,199.40 | $8,199.40 | 3.7× |
| Discography Cerv/Thor Spine (72285) range across 2 matching MRF lines |
$5,327.30–$9,186.10 | $5,327.30–$9,186.10 | varies |
| Diskography lumbar (72295) | $8,075.65 | $8,075.65 | 3.9× |
| Doppler Echo Fetal Puls Spectral F/U/Repeat (76828) | $1,114.85 | $1,114.85 | 10.1× |
| Doppler Echo Fetal Spectral Display Complete (76827) range across 3 matching MRF lines |
$1,066.45–$1,124.20 | $1,066.45–$1,124.20 | varies |
| Doppler Fetal Mid Cerebral Artery (76821) | $1,784.75 | $1,784.75 | 16.2× |
| Echo exam uterus (76831) | $5,474.70 | $5,474.70 | 21.8× |
| Echo Guide For Artery Repair (76936) | $4,791.05 | $4,791.05 | 21.0× |
| Esophageal Motility Study (78258) | $8,668 | $8,668 | 20.6× |
| Esophagram (74220) range across 2 matching MRF lines |
$4,430.80–$5,085.85 | $4,430.80–$5,085.85 | varies |
| Fetal Biophys Profile W/Nst (76818) range across 3 matching MRF lines |
$375.10–$1,540.55 | $375.10–$1,540.55 | varies |
| Fetal Biophysical Profile W/O Non-Stress Testing (76819) range across 3 matching MRF lines |
$2,413.40–$2,545.95 | $2,413.40–$2,545.95 | varies |
| Fetal MRI w/placntl matrnl plvc img sing/1st ges (74712) | $19,509.05 | $19,509.05 | 77.5× |
| Fluoroscopy up to 1 hr (76000) range across 3 matching MRF lines |
$3,699.30–$6,013.15 | $3,699.30–$6,013.15 | varies |
| Follow-Up Angiography (75898) | $10,391.70 | $10,391.70 | 3.1× |
| Foot 2 views (73620) range across 5 matching MRF lines |
$1,603.25–$2,353.45 | $1,603.25–$2,353.45 | varies |
| Forearm 2 views (73090) range across 4 matching MRF lines |
$1,603.25–$4,580.95 | $1,603.25–$4,580.95 | varies |
| Gastric emptying imaging study (78264) | $7,923 | $7,923 | 18.8× |
| Gastroesophageal Reflux Exam (78262) | $10,489 | $10,489 | 24.9× |
| Gated Heart Planar Single (78472) | $9,604.50 | $9,604.50 | 22.8× |
| Hand 2 views (73120) range across 6 matching MRF lines |
$897.05–$1,280.40 | $897.05–$1,280.40 | varies |
| Hdr Rdncl Ntrstl/Icav Brchtx (77771) | $43,842.70 | $43,842.70 | 59.7× |
| Hdr Rdncl Ntrstl/Icav Brchtx 1 Channel (77770) | $33,544.50 | $33,544.50 | 45.7× |
| Heart Image (Pet) Multiple (78492) | $26,552.90 | $26,552.90 | 17.6× |
| Hepatc Vngrph Wdg/Fr Hemodyn Eval Rs&I (75889) | $12,097.25 | $12,097.25 | 3.6× |
| Hepatc Vngrph Wdg/Fr W/O Hemodyn Eval Rs&I (75891) | $11,238.15 | $11,238.15 | 3.4× |
| Hepatobil Syst Image W/Drug (78227) | $11,363 | $11,363 | 19.8× |
| Hepatobiliary System Imaging (78226) | $9,032.50 | $9,032.50 | 21.4× |
| Ht Muscle Image Spect Sing (78451) | $17,253.50 | $17,253.50 | 12.6× |
| Hysterosalpingogram (74740) | $5,525.85 | $5,525.85 | 22.0× |
| Infant hip ultrasound with hip movement (dynamic) (76885) | $3,562.90 | $3,562.90 | 38.8× |
| Infant hip ultrasound, limited static exam (76886) range across 2 matching MRF lines |
$3,562.90–$3,596.45 | $3,562.90–$3,596.45 | varies |
| Interstitial radiation source applic complex (77778) | $34,814 | $34,814 | 47.4× |
| Joint Survey Single View (77077) | $2,173.05 | $2,173.05 | 19.7× |
| K Flow/Funct Image W/Drug (78708) | $20,270.50 | $20,270.50 | 35.4× |
| K Flow/Funct Image W/O Drug (78707) | $6,650.50 | $6,650.50 | 11.6× |
| Kidney Funcj Study Non-Img Radioisotopic Study (78725) | $8,502 | $8,502 | 20.2× |
| Kidney Imaging Morphol (78700) | $5,223.50 | $5,223.50 | 12.4× |
| Kidney Imaging Morphoogy W/Vascular Flow (78701) | $7,083.50 | $7,083.50 | 16.8× |
| Knee 3 Views (73562) | $2,595.45 | $2,595.45 | 28.3× |
| Leveen/Shunt Patency Exam (78291) | $3,735 | $3,735 | 8.9× |
| Liver & Spleen Imaging Static Only (78215) | $9,508 | $9,508 | 22.5× |
| Liver & Spleen Imaging W/Vascular Flow (78216) | $3,433.50 | $3,433.50 | 8.1× |
| Liver imaging static only (78201) | $5,585 | $5,585 | 9.8× |
| Liver imaging w/vascular flow (78202) | $11,410 | $11,410 | 19.9× |
| Lung Perf&Ventilat Diferentl (78598) | $15,303.50 | $15,303.50 | 26.7× |
| Lung perfusion differential (78597) | $8,802.50 | $8,802.50 | 20.9× |
| Lung Ventilat&Perfus Imaging (78582) | $14,415 | $14,415 | 25.2× |
| Lung Ventilation Imaging (78579) | $6,341.50 | $6,341.50 | 15.0× |
| Lymph System Imaging (78195) | $8,480.50 | $8,480.50 | 14.8× |
| Lymphangiography Pelvic/Abdominal Bilateral Rs&I (75807) | $8,605.30 | $8,605.30 | 2.6× |
| Lymphangiography, pelvic/abdominal, unilateral (75805) | $8,605.30 | $8,605.30 | 2.6× |
| Magnetic Image Jaw Joint (70336) | $21,188.20 | $21,188.20 | 84.2× |
| Magnetic Resonance Elastography (76391) | $19,509.05 | $19,509.05 | 77.5× |
| Meckels Divert Exam (78290) | $6,098 | $6,098 | 14.5× |
| Mlc imrt design & construction per imrt plan (77338) | $67,564.75 | $67,564.75 | 171.1× |
| Mr safety implant&/fb assmt clin staf 1st 15 min (76014) | $80.82 | $80.82 | 2.6× |
| Mra Head W/O & W/Contrast Material (70546) | $18,147.80 | $18,147.80 | 49.3× |
| MRA head w/o contrast (70544) | $13,065.80 | $13,065.80 | 51.9× |
| MRA head with contrast (70545) | $15,302.10 | $15,302.10 | 41.6× |
| MRA neck w contrast (70548) | $14,190 | $14,190 | 38.6× |
| Mra Neck W/O &W/Contrast Material (70549) | $20,097 | $20,097 | 54.6× |
| MRA neck w/o contrast (70547) | $11,788.15 | $11,788.15 | 46.8× |
| MRI abdomen w/o contrast (74181) | $19,509.05 | $19,509.05 | 77.5× |
| MRI any jt lower extrem w/contrast material (73722) | $22,559.35 | $22,559.35 | 27.3× |
| MRI any jt lower extrem w/o & w/contrast matrl (73723) | $24,954.60 | $24,954.60 | 67.8× |
| MRI any jt upper extremity w/contrast matrl (73222) | $22,037.40 | $22,037.40 | 26.6× |
| MRI Breast W/O Contrast Bilateral (77047) | $11,788.15 | $11,788.15 | 46.8× |
| MRI Breast Without Contrast Material Unilateral (77046) | $11,788.15 | $11,788.15 | 46.8× |
| MRI cardiac w/o cont stress (75559) | $27,669.40 | $27,669.40 | 48.0× |
| MRI cardiac w/o contrast (75557) | $19,272.55 | $19,272.55 | 76.6× |
| MRI cervical spine w contrast (72142) | $20,070.60 | $20,070.60 | 54.5× |
| MRI cervical spine w/o cont (72141) | $19,454.05 | $19,454.05 | 77.3× |
| MRI chest w/o contrast (71550) | $20,209.75 | $20,209.75 | 80.3× |
| MRI chest with contrast (71551) | $21,400.50 | $21,400.50 | 25.9× |
| MRI chest wo w contrast (71552) | $25,560.70 | $25,560.70 | 69.5× |
| MRI lower extrem oth/thn jt w/contrast matrl (73719) | $20,070.60 | $20,070.60 | 54.5× |
| MRI lower extrem oth/thn jt w/o & w/contr matr (73720) | $24,277.55 | $24,277.55 | 66.0× |
| MRI lower extrem oth/thn jt w/o contr matrl (73718) | $19,598.70 | $19,598.70 | 77.9× |
| MRI lumbar spine w contrast (72149) | $21,645.25 | $21,645.25 | 58.8× |
| Mri Neck Spine W/O & W/Dye (72156) | $24,408.45 | $24,408.45 | 66.3× |
| MRI orbit face &/neck w/o contrast (70540) | $20,658.55 | $20,658.55 | 82.1× |
| MRI orbit face neck w contrast (70542) | $20,070.60 | $20,070.60 | 54.5× |
| Mri Orbt/Fac/Nck W/O &W/Dye (70543) | $24,380.40 | $24,380.40 | 66.2× |
| MRI pelvis w contrast (72196) | $20,070.60 | $20,070.60 | 54.5× |
| MRI pelvis w/o & w contrast (72197) | $24,411.75 | $24,411.75 | 66.3× |
| MRI pelvis w/o contrast (72195) | $19,532.70 | $19,532.70 | 77.6× |
| MRI spectroscopy (76390) | $8,556.90 | $8,556.90 | 93.2× |
| MRI thoracic spine w/o contrast (72146) | $19,355.60 | $19,355.60 | 76.9× |
| MRI upper extremity oth than jt w/contr matrl (73219) | $22,260.70 | $22,260.70 | 60.5× |
| MRI upper extremity oth than jt w/o contr matrl (73218) | $19,363.30 | $19,363.30 | 76.9× |
| Mri Uppr Extremity W/O&W/Dye (73220) | $22,230.45 | $22,230.45 | 60.4× |
| MRI, abdomen, combo (74183) | $24,396.90 | $24,396.90 | 66.3× |
| MRI, dorsal spine combo (72157) | $24,552 | $24,552 | 66.7× |
| MRI, dorsal spine contrast (72147) | $23,489.95 | $23,489.95 | 63.8× |
| MRI, joint upper extrem (73221) range across 2 matching MRF lines |
$19,532.70–$19,598.70 | $19,532.70–$19,598.70 | varies |
| MRI, joint upper extrem combo (73223) | $24,277.55 | $24,277.55 | 66.0× |
| MRI, lumbar spine combo (72158) | $24,445.85 | $24,445.85 | 66.4× |
| Myelogram cervical (72240) range across 2 matching MRF lines |
$13,970.55–$14,773.55 | $13,970.55–$14,773.55 | varies |
| Myelogram Lumbar (72265) range across 2 matching MRF lines |
$12,498.20–$13,949.10 | $12,498.20–$13,949.10 | varies |
| Myelography thoracic (72255) range across 2 matching MRF lines |
$11,774.40–$13,137.30 | $11,774.40–$13,137.30 | varies |
| Myelograpy 2/more regions rs&i (72270) | $17,613.75 | $17,613.75 | 21.3× |
| Myocardial Imaging Infarct Avid Planar Qual/Quan (78466) | $9,722 | $9,722 | 23.1× |
| Myocardial Imaging Pet Metabolic Evaluation (78459) | $37,219.05 | $37,219.05 | 27.3× |
| Myocardial Perfusion Planar 1 Study Rest/Stress (78453) | $21,656.50 | $21,656.50 | 15.9× |
| Myocardial Spect Multiple Studies (78452) | $30,606.50 | $30,606.50 | 22.4× |
| N-invas est c ffr sw aly CTA (75580) | $24,070.20 | $24,070.20 | 26.6× |
| Neck soft tissue (70360) | $2,451.35 | $2,451.35 | 26.7× |
| Njx Rp Loclzj Non-Img Probe Study Intravenous (78808) | $5,809.50 | $5,809.50 | 13.8× |
| Nm csf leak detection (78650) | $6,805 | $6,805 | 5.0× |
| Nm myocard infarct spect (78469) | $7,210.50 | $7,210.50 | 12.6× |
| Nonvascular Shunt X-Ray (75809) range across 2 matching MRF lines |
$5,163.40–$5,641.35 | $5,163.40–$5,641.35 | varies |
| Ntsty modul radthx pln dose-vol histos (77301) | $48,282.30 | $48,282.30 | 33.1× |
| Nuclear Rx Intra-Arterial (79445) | $3,690 | $3,690 | 15.0× |
| Nuclear Rx Oral Admin (79005) range across 2 matching MRF lines |
$5,865–$7,181 | $5,865–$7,181 | varies |
| Ob us nuchal meas 1 gest (76813) | $1,784.75 | $1,784.75 | 16.2× |
| Panoramic X-ray of jaws (70355) | $3,579.95 | $3,579.95 | 39.0× |
| Parathyroid Planar Imaging (78070) | $11,212 | $11,212 | 26.6× |
| Parathyroid planar imaging w/wo subtraction (78071) | $13,319.50 | $13,319.50 | 31.6× |
| Pelvis 1 or 2 views (72170) | $2,223.10 | $2,223.10 | 20.2× |
| Peritoneogram Rs&I (74190) | $9,961.60 | $9,961.60 | 17.3× |
| Pet Image Skull-Thigh (78812) | $13,708.75 | $13,708.75 | 9.1× |
| Pet Image W/Ct Lmtd (78814) | $39,465.80 | $39,465.80 | 26.2× |
| PET image w/CT, full body (78816) | $39,465.80 | $39,465.80 | 26.2× |
| PET imaging CT attenuation skull base mid-thigh (78815) | $39,465.80 | $39,465.80 | 26.2× |
| Pet Imaging Limited Area Chest Head/Neck (78811) | $13,708.75 | $13,708.75 | 10.0× |
| Pet Myocardial Sngl Study (78491) | $16,605.60 | $16,605.60 | 11.0× |
| PET whole body (78813) | $13,708.75 | $13,708.75 | 9.1× |
| Platelet survival study Non-Facility (78191) | $7,126 | $7,126 | 16.9× |
| Prq Transhepatc Portograpy Hemodyn Eval Rs&I (75885) | $8,148.25 | $8,148.25 | 2.4× |
| Pulmonary Perfusion Imaging Particulate (78580) | $7,926 | $7,926 | 18.8× |
| Radex Abd Compl Aqt Abd W/S/E/D Views 1 View Ch (74022) | $3,699.30 | $3,699.30 | 33.5× |
| Radex abscess/fistula/sinus tract rs&i (76080) range across 2 matching MRF lines |
$5,860.80–$6,100.60 | $5,860.80–$6,100.60 | varies |
| Radex Ankle Complete Minimum 3 Views (73610) range across 3 matching MRF lines |
$3,075.05–$6,149.55 | $3,075.05–$6,149.55 | varies |
| Radex Calcaneus Minimum 2 Views (73650) range across 3 matching MRF lines |
$2,507.45–$2,514.05 | $2,507.45–$2,514.05 | varies |
| Radex elbow complete minimum 3 views (73080) | $2,490.95 | $2,490.95 | 27.1× |
| Radex Facial Bones Complete Minimum 3 Views (70150) | $3,699.30 | $3,699.30 | 33.5× |
| Radex fingr minimum 2 views (73140) | $2,310.55 | $2,310.55 | 25.2× |
| Radex foot complete minimum 3 views (73630) range across 3 matching MRF lines |
$2,385.35–$4,769.60 | $2,385.35–$4,769.60 | varies |
| Radex Hand Minimum 3 Views (73130) | $2,223.10 | $2,223.10 | 24.2× |
| Radex lower extremity infant minimum 2 views (73592) | $2,174.15 | $2,174.15 | 23.7× |
| Radex Mastoids Compl Minimum 3 Views PR Side (70130) | $5,157.90 | $5,157.90 | 46.8× |
| Radex Nasal Bones Complete Minimum 3 Views (70160) | $2,950.75 | $2,950.75 | 32.1× |
| Radex Ribs Unilateral 2 Views (71100) | $3,699.30 | $3,699.30 | 40.3× |
| Radex shoulder complete minimum 2 views (73030) range across 3 matching MRF lines |
$2,879.25–$5,758.50 | $2,879.25–$5,758.50 | varies |
| Radex Sinuses Paransl < 3 Views (70210) | $1,364 | $1,364 | 14.9× |
| Radex sm int w/mlt srl imges via enteroclss tube (74251) | $4,430.80 | $4,430.80 | 23.9× |
| Radex Spine 1 View Specify Level (72020) | $1,468.50 | $1,468.50 | 16.0× |
| Radex Sternum Minimum 2 Views (71120) | $3,008.50 | $3,008.50 | 32.8× |
| Radex Temporomandble Jt Opn & Clsd Mouth Bilat (70330) | $4,062.85 | $4,062.85 | 44.3× |
| Radex Toe Minimum 2 Views (73660) | $2,086.15 | $2,086.15 | 22.7× |
| Radex upper extremity infant minimum 2 views (73092) | $2,223.10 | $2,223.10 | 20.2× |
| Radex Wrist Complete Minimum 3 Views (73110) | $2,584.45 | $2,584.45 | 28.2× |
| Radex X-Ray Exam Entire Spi 6/> Vw - Xr Entire Spine 6+ Vw (72084) | $15,925.80 | $15,925.80 | 144.4× |
| Radiation Delivery Stereotactic Cranial Linear (77372) | $252,911.45 | $252,911.45 | 32.6× |
| Radiation treatment delivery level 1 (77402) | $5,001.15 | $5,001.15 | 46.5× |
| Radiation treatment delivery level 2 (77407) | $8,517.30 | $8,517.30 | 20.9× |
| Radiation treatment delivery level 3 (77412) | $8,680.10 | $8,680.10 | 14.9× |
| Radiolog exam mandible compl minimum 4 views (70110) | $4,062.85 | $4,062.85 | 36.8× |
| Radiologic Exam Abdomen 3+ Views - Xr Abdomen 3+ Views (74021) | $4,829.55 | $4,829.55 | 43.8× |
| Radiologic exam colon double contrast study (74280) | $6,981.15 | $6,981.15 | 37.7× |
| Radiologic exam colon single contrast study (74270) | $6,630.25 | $6,630.25 | 35.8× |
| Radiologic Exam Esophagus Double Contrast Study (74221) | $4,430.80 | $4,430.80 | 23.9× |
| Radiologic exam knee complete 4/more views (73564) | $3,880.25 | $3,880.25 | 35.2× |
| Radiologic exam pelvis compl minimum 3 views (72190) | $2,950.75 | $2,950.75 | 26.8× |
| Radiologic Exam Small Int Single Contrast Study (74250) | $4,062.85 | $4,062.85 | 22.0× |
| Radiologic exam swallow function contrast study (74230) | $5,525.85 | $5,525.85 | 29.9× |
| Radiologic exam upr gi trc double contrast study (74246) | $5,888.30 | $5,888.30 | 31.8× |
| Radiologic examination femur 1 view (73551) | $4,022.70 | $4,022.70 | 43.8× |
| Radiologic examination femur minimum 2 views (73552) | $6,034.05 | $6,034.05 | 65.7× |
| Radiologic examination knee 1/2 views (73560) range across 4 matching MRF lines |
$2,282.50–$4,585.90 | $2,282.50–$4,585.90 | varies |
| Radiologic Examination Osseous Survey Limited (77074) | $4,062.85 | $4,062.85 | 36.8× |
| Radiologic examination tibia & fibula 2 views (73590) range across 5 matching MRF lines |
$1,800.70–$2,571.25 | $1,800.70–$2,571.25 | varies |
| Radiopharm Dacryocystography (78660) | $6,098 | $6,098 | 14.5× |
| Radiopharmaceutical therapy, by intracavitary administration Non-Facility (79200) | $11,787 | $11,787 | 47.9× |
| Red Cell Volume Determination Spx 1 Sampling (78120) | $8,803.50 | $8,803.50 | 20.9× |
| Renal Cyst Study (74470) | $10,397.20 | $10,397.20 | 18.0× |
| Ribs bilateral 3 views (71110) | $4,430.80 | $4,430.80 | 40.2× |
| Rp loclzj tum plnr 1 area single day imaging (78800) | $5,424 | $5,424 | 12.9× |
| Rp loclzj tum plnr 2+area 1+d img/1 area img>2+d (78801) | $8,998.50 | $8,998.50 | 21.3× |
| Rp Loclzj Tum Plnr Whole Body 2+ Days Imaging (78804) | $10,516.50 | $10,516.50 | 18.4× |
| Rp Loclzj Tum Plnr Whole Body Single Day Imaging (78802) | $10,516.50 | $10,516.50 | 18.4× |
| Rp Loclzj Tum Spect 1 Area Single Day Imaging (78803) | $2,109.50 | $2,109.50 | 3.7× |
| Rp loclzj tum spect 2 area/sep acquisj img (78831) | $7,460.50 | $7,460.50 | 5.5× |
| Rp loclzj tum spect CT 2area 1d img/1 ar img>2+d (78832) | $7,460.50 | $7,460.50 | 4.9× |
| Rp loclzj tum spect w/CT 1 area/acquisj 1day img (78830) | $7,460.50 | $7,460.50 | 5.5× |
| Rp Therapy Intravenous Administration (79101) | $3,077 | $3,077 | 12.5× |
| Scapula (73010) | $2,746.70 | $2,746.70 | 24.9× |
| Shoulder 1 view (73020) | $2,173.05 | $2,173.05 | 23.7× |
| Shoulder Arthrography (73040) range across 4 matching MRF lines |
$5,694.70–$6,531.25 | $5,694.70–$6,531.25 | varies |
| Sialogram (70390) range across 2 matching MRF lines |
$5,786.55–$6,641.25 | $5,786.55–$6,641.25 | varies |
| Skull less than 4 views (70250) | $2,595.45 | $2,595.45 | 23.5× |
| Special dosimetry (77331) | $9,447.90 | $9,447.90 | 66.6× |
| Special Physics Consult (77370) range across 2 matching MRF lines |
$3,179–$10,742.05 | $3,179–$10,742.05 | varies |
| Special teletherapy port plan (77321) | $17,644 | $17,644 | 44.7× |
| Special treatment procedure (77470) | $83,727.05 | $83,727.05 | 143.6× |
| Speech evaluation, complex (70371) | $5,525.85 | $5,525.85 | 22.0× |
| Stereotactic Body Radiation Delivery (77373) | $56,069.20 | $56,069.20 | 29.7× |
| Sternoclavicular joints (71130) | $2,950.75 | $2,950.75 | 32.1× |
| Superior sagittal sinus venogram (75870) | $17,416.30 | $17,416.30 | 5.2× |
| Telethx isodose pln cplx w/basic dosimetry (77307) | $31,701.45 | $31,701.45 | 80.3× |
| Telethx isodose pln smpl w/dosimetry calculation (77306) | $22,454.30 | $22,454.30 | 56.8× |
| Testicular Imaging W/Flow (78761) | $10,547 | $10,547 | 25.0× |
| Ther Rad Simulaj-Aided Field Setting Complex (77290) range across 2 matching MRF lines |
$14,015.10–$14,652 | $14,015.10–$14,652 | varies |
| Ther Rad Simulaj-Aided Field Setting Intermed (77285) | $12,242.45 | $12,242.45 | 31.0× |
| Ther rad simulaj-aided field setting simple (77280) | $6,233.15 | $6,233.15 | 44.0× |
| Therapeutic Enema Rdctj Intussusception/Obstrcj (74283) | $4,430.80 | $4,430.80 | 23.9× |
| Thoracic spine 2 views (72070) | $3,694.90 | $3,694.90 | 33.5× |
| Thoracic spine 3 views (72072) | $3,765.30 | $3,765.30 | 34.1× |
| Thoracolumbar 2 views (72080) | $3,341.25 | $3,341.25 | 36.4× |
| Thyroid Imaging With Vascular Flow (78013) | $12,375.50 | $12,375.50 | 29.3× |
| Thyroid Met Imaging Body (78018) | $11,704.50 | $11,704.50 | 20.4× |
| Thyroid Uptake Measurement (78012) | $2,813.50 | $2,813.50 | 6.7× |
| Thyroid Uptake W/Blood Flow Sngle/Mult Quan Meas (78014) | $7,703.50 | $7,703.50 | 18.3× |
| Tx Devices Design & Construction Complex (77334) | $8,680.10 | $8,680.10 | 22.0× |
| Tx devices design & construction intermediate (77333) | $8,517.30 | $8,517.30 | 60.1× |
| Tx devices design & construction simple (77332) | $5,001.15 | $5,001.15 | 35.3× |
| Ultrasound Breast Limited (76642) range across 6 matching MRF lines |
$2,528.90–$2,552.55 | $2,528.90–$2,552.55 | varies |
| Ultrasound Elastography Parenchyma (76981) | $5,902.60 | $5,902.60 | 53.5× |
| Ultrasound, abdomen limited (76705) range across 4 matching MRF lines |
$4,387.35–$4,627.15 | $4,387.35–$4,627.15 | varies |
| Umbilical-artery Doppler (OB) (76820) | $1,784.75 | $1,784.75 | 16.2× |
| Unlisted magnetic resonance procedure (76498) | $8,556.90 | $8,556.90 | 93.2× |
| Upper gi w/o kub (74240) | $5,525.85 | $5,525.85 | 29.9× |
| Urethrocystogram voiding (74455) range across 2 matching MRF lines |
$3,596.45–$4,012.80 | $3,596.45–$4,012.80 | varies |
| Urethrocystography retrograde (74450) | $5,525.85 | $5,525.85 | 22.0× |
| Us breast unilateral complete (76641) range across 6 matching MRF lines |
$2,528.90–$2,552.55 | $2,528.90–$2,552.55 | varies |
| Us chest (76604) range across 3 matching MRF lines |
$2,398–$3,619.55 | $2,398–$3,619.55 | varies |
| Us complete joint (76881) range across 2 matching MRF lines |
$3,562.90–$3,596.45 | $3,562.90–$3,596.45 | varies |
| Us exam, pelvic, limited (76857) range across 3 matching MRF lines |
$1,770.45–$1,826 | $1,770.45–$1,826 | varies |
| Us head (76506) range across 2 matching MRF lines |
$2,552–$2,574.55 | $2,552–$2,574.55 | varies |
| Us kidney transplant (76776) range across 2 matching MRF lines |
$4,470.95–$4,512.20 | $4,470.95–$4,512.20 | varies |
| Us lmtd joint/oth nonvasc xtr strux r-t w/img (76882) range across 3 matching MRF lines |
$3,562.90–$3,724.60 | $3,562.90–$3,724.60 | varies |
| Us ob detailed single fetus (76811) range across 2 matching MRF lines |
$1,784.75–$4,503.95 | $1,784.75–$4,503.95 | varies |
| Us ob limited 1 or more fetuses (76815) range across 4 matching MRF lines |
$1,887.60–$2,289.10 | $1,887.60–$2,289.10 | varies |
| Us ob transvaginal (76817) range across 5 matching MRF lines |
$1,784.75–$6,078.05 | $1,784.75–$6,078.05 | varies |
| Us pelvic non ob complete (76856) range across 3 matching MRF lines |
$1,784.75–$5,948.25 | $1,784.75–$5,948.25 | varies |
| Us pg uter img f&mat 14 wk tabdl 1/1st gestation (76801) range across 3 matching MRF lines |
$1,784.75–$1,861.75 | $1,784.75–$1,861.75 | varies |
| Us preg uterus real time f/u trnsabdl per fetus (76816) range across 3 matching MRF lines |
$1,784.75–$3,174.05 | $1,784.75–$3,174.05 | varies |
| Us retroperitoneal complete (76770) range across 2 matching MRF lines |
$4,890.60–$4,935.70 | $4,890.60–$4,935.70 | varies |
| Us retroperitoneal limited (76775) range across 3 matching MRF lines |
$3,036.55–$3,130.60 | $3,036.55–$3,130.60 | varies |
| Us scrotum and contents (76870) range across 2 matching MRF lines |
$3,942.95–$3,978.70 | $3,942.95–$3,978.70 | varies |
| Us spinal canal and contents (76800) range across 2 matching MRF lines |
$2,247.85–$2,267.65 | $2,247.85–$2,267.65 | varies |
| Us thyroid (76536) range across 2 matching MRF lines |
$4,522.10–$4,563.35 | $4,522.10–$4,563.35 | varies |
| Us transrectal (76872) range across 2 matching MRF lines |
$4,484.15–$4,522.10 | $4,484.15–$4,522.10 | varies |
| Vascular Flow Imaging (78445) | $8,150.50 | $8,150.50 | 19.3× |
| Vein X-Ray Chest (75827) | $23,346.95 | $23,346.95 | 14.1× |
| Vein X-Ray Liver W/O Hemodyn (75887) | $6,432.80 | $6,432.80 | 1.9× |
| Vein X-Ray Spleen/Liver (75810) | $10,391.70 | $10,391.70 | 3.1× |
| Venogram Sinus/Jugular (75860) range across 2 matching MRF lines |
$3,257.10–$17,416.30 | $3,257.10–$17,416.30 | varies |
| Venography Adrenal Unilateral (75840) | $6,952.55 | $6,952.55 | 2.1× |
| Venography caval inferior serialography rs&i (75825) | $21,209.65 | $21,209.65 | 6.4× |
| Venography extremity bilateral rs&i (75822) range across 3 matching MRF lines |
$7,163.20–$11,824.45 | $7,163.20–$11,824.45 | varies |
| Venography extremity unilateral rs&i (75820) range across 6 matching MRF lines |
$11,261.80–$23,689.60 | $11,261.80–$23,689.60 | varies |
| Venography Renal Bilateral (75833) range across 2 matching MRF lines |
$30,815.40–$33,679.25 | $30,815.40–$33,679.25 | varies |
| Venography Renal Unilateral (75831) range across 4 matching MRF lines |
$7,518.50–$26,067.25 | $7,518.50–$26,067.25 | varies |
| Venous sampling by catheter (75893) | $24,026.20 | $24,026.20 | 4.1× |
| Venous thrombosis imaging (78457) | $5,573 | $5,573 | 9.7× |
| Venous Thrombosis Imaging Venogram Bilateral (78458) | $5,098 | $5,098 | 12.1× |
| Wrist 2 views (73100) range across 4 matching MRF lines |
$936.65–$1,911.25 | $936.65–$1,911.25 | varies |
| X-Ray Ac Jts - Xr Acromioclavicular Joints Bilateral (73050) | $2,950.75 | $2,950.75 | 32.1× |
| X-ray antegrade pyelogram tube (74425) range across 2 matching MRF lines |
$12,562.55–$13,133.45 | $12,562.55–$13,133.45 | varies |
| X-Ray Aorta Leg Arteries (75630) | $38,328.40 | $38,328.40 | 11.5× |
| X-Ray Bend Only L-S Spine (72120) | $5,142.50 | $5,142.50 | 46.6× |
| X-Ray Elbow 2 Vw - Xr Elbow 1-2 Views Right (73070) range across 3 matching MRF lines |
$2,272.60–$2,290.75 | $2,272.60–$2,290.75 | varies |
| X-Ray Exam Breast Specimen (76098) | $906.40 | $906.40 | 1.6× |
| X-Ray Exam Entire Spi 1 Vw (72081) | $1,492.15 | $1,492.15 | 16.3× |
| X-Ray Exam Entire Spi 2/3 Vw (72082) | $3,978.15 | $3,978.15 | 36.1× |
| X-Ray Exam Entire Spi 4/5 Vw (72083) | $11,924 | $11,924 | 108.1× |
| X-Ray Exam Hip Uni 1 View (73501) | $2,755.50 | $2,755.50 | 30.0× |
| X-Ray Exam Hip Uni 2-3 Views (73502) | $3,086.60 | $3,086.60 | 33.6× |
| X-Ray Exam Hip Uni 4/> Views (73503) | $3,416.60 | $3,416.60 | 31.0× |
| X-Ray Exam Hips Bi 2 Views (73521) | $4,610.10 | $4,610.10 | 41.8× |
| X-Ray Exam Hips Bi 3-4 Views (73522) | $9,219.10 | $9,219.10 | 83.6× |
| X-Ray Exam Hips Bi 5/> Views (73523) | $13,827 | $13,827 | 125.4× |
| X-Ray Exam L-S Spine Bending (72114) | $8,517.30 | $8,517.30 | 77.2× |
| X-Ray Exam Neck Spine 2-3 Vw (72040) | $3,022.80 | $3,022.80 | 32.9× |
| X-Ray Exam Neck Spine 6/>Vws (72052) | $5,729.35 | $5,729.35 | 52.0× |
| X-Ray Exam Unilat Ribs/Chest (71101) | $5,665.55 | $5,665.55 | 51.4× |
| X-ray eye for foreign body (70030) | $4,237.75 | $4,237.75 | 46.2× |
| X-ray humerus (73060) range across 4 matching MRF lines |
$1,910.15–$2,727.45 | $1,910.15–$2,727.45 | varies |
| X-ray IV pyelogram (ivp) (74400) | $10,443.40 | $10,443.40 | 56.4× |
| X-ray IV pyelogram+tomography (74415) | $10,511.60 | $10,511.60 | 56.8× |
| X-Ray Jaw <4 Vw - Xr Mandible < 4 Views (70100) | $2,837.45 | $2,837.45 | 30.9× |
| X-Ray Knee Bilat Standing - Xr Knees Anteroposterior Standing Bilat (73565) | $1,945.35 | $1,945.35 | 21.2× |
| X-Ray Lumbar Spine 2/3 Vw - Xr Lumbar Spine 2-3 Views (72100) | $4,536.40 | $4,536.40 | 41.1× |
| X-ray nose-rectum child f.b. (76010) | $2,413.40 | $2,413.40 | 26.3× |
| X-Ray Ribs, Chest 4+ Vw - Xr Ribs 3 Vws Bil W/ Chest Posteroanterior (71111) | $6,981.15 | $6,981.15 | 63.3× |
| X-Ray Sacroiliac Jts <3 Vw - Xr Sacroiliac Joints 1-2 Views (72200) | $2,950.75 | $2,950.75 | 26.8× |
| X-Ray Sacrum/Coccyx 2+ Vw - Xr Sacrum Coccyx 2+ Views (72220) | $2,490.95 | $2,490.95 | 27.1× |
| X-Ray Sinuses 3+ Vw - Xr Paranasal Sinuses 3+ Views (70220) | $3,699.30 | $3,699.30 | 40.3× |
| X-Ray Skull 4+ Vw - Xr Skull Complete 4+ Views (70260) | $4,430.80 | $4,430.80 | 40.2× |
| X-ray thoracic spine 4 vw (72074) | $4,312 | $4,312 | 39.1× |
| X-Ray Tmj Unilat (70328) | $3,326.95 | $3,326.95 | 36.2× |
| X-Ray Urinary Tract Exam With Contrast Material (74420) | $5,525.85 | $5,525.85 | 15.0× |
| X-Rays Bone Length Studies (77073) range across 2 matching MRF lines |
$2,950.75–$3,862.65 | $2,950.75–$3,862.65 | varies |
| X-Rays Bone Survey Complete (77075) | $13,181.30 | $13,181.30 | 119.5× |
| Xr c-spine 4 or 5 views (72050) | $4,702.50 | $4,702.50 | 42.6× |
| Xr facial bones less than 3 views (70140) | $2,595.45 | $2,595.45 | 28.3× |
| Xr orbits complete 4 views (70200) | $3,699.30 | $3,699.30 | 33.5× |
| Xr Tomogram Single Plane (76100) | $6,981.15 | $6,981.15 | 63.3× |
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.