Imaging prices at HCA Houston Healthcare Southeast
Pasadena, TX · every code in this section with a posted price and a Medicare benchmark.
402 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) | $28,575.92 | $28,575.92 | 20.6× |
| Abdomen 1 View (74018) | $2,178.18 | $2,178.18 | 24.9× |
| Abdomen 2 views (74019) | $2,709.88 | $2,709.88 | 25.8× |
| Acute Gastrointestinal Blood Loss Imaging (78278) | $8,670.03 | $8,670.03 | 21.6× |
| Angio pulmonary bilat (75743) | $19,132.28 | $19,132.28 | 6.0× |
| Angiography Adrenal Bilateral Slctv Rs&I (75733) | $19,132.28 | $19,132.28 | 6.0× |
| Angiography extremity bilateral rs&i (75716) range across 2 matching MRF lines |
$19,132.28–$22,314.95 | $19,132.28–$22,314.95 | varies |
| Angiography extremity unilateral rs&i (75710) range across 5 matching MRF lines |
$11,125–$20,467.58 | $11,125–$20,467.58 | varies |
| Angiography pulmonary unilateral slctv rs&i (75741) range across 4 matching MRF lines |
$12,608.33–$17,733.52 | $12,608.33–$17,733.52 | varies |
| Angrph pulmonary nonslctv cath/ven njx rs&i (75746) | $12,061.50 | $12,061.50 | 3.8× |
| Ankle 2 views (73600) range across 3 matching MRF lines |
$1,152.52–$2,576.94 | $1,152.52–$2,576.94 | varies |
| Aortography thoracic serialography rs&i (75605) range across 2 matching MRF lines |
$14,467.78–$19,132.28 | $14,467.78–$19,132.28 | varies |
| Aortography thoracic w/o serialography rs&i (75600) | $19,132.28 | $19,132.28 | 6.0× |
| Artery X-Rays Abdomen (75726) range across 2 matching MRF lines |
$19,215.34–$22,314.95 | $19,215.34–$22,314.95 | varies |
| Artery X-Rays Adrenal Gland (75731) range across 4 matching MRF lines |
$17,627.78–$17,911.77 | $17,627.78–$17,911.77 | varies |
| Artery X-Rays Pelvis (75736) range across 2 matching MRF lines |
$12,608.33–$22,314.95 | $12,608.33–$22,314.95 | varies |
| Artery X-Rays Spine (75705) | $19,132.28 | $19,132.28 | 3.4× |
| Arthrogram ankle (73615) range across 6 matching MRF lines |
$4,141.85–$10,602.36 | $4,141.85–$10,602.36 | varies |
| Arthrogram hip (73525) range across 3 matching MRF lines |
$5,300.41–$10,602.36 | $5,300.41–$10,602.36 | varies |
| Arthrogram Wrist (73115) range across 4 matching MRF lines |
$4,141.85–$9,434.72 | $4,141.85–$9,434.72 | varies |
| Basic radiation dosimetry calculation (77300) range across 2 matching MRF lines |
$2,744.45–$3,018.90 | $2,744.45–$3,018.90 | varies |
| Bone age studies (77072) | $1,040.75 | $1,040.75 | 9.9× |
| Bone Imaging 3 Phase (78315) range across 2 matching MRF lines |
$2,453.03–$6,172.27 | $2,453.03–$6,172.27 | varies |
| Bone Imaging Limited Area (78300) range across 2 matching MRF lines |
$2,453.03–$13,147.81 | $2,453.03–$13,147.81 | varies |
| Bone Imaging Multiple Areas (78305) | $2,453.03 | $2,453.03 | 6.1× |
| Bone Imaging Whole Body (78306) range across 2 matching MRF lines |
$2,453.03–$12,263.80 | $2,453.03–$12,263.80 | varies |
| Bone survey infant (77076) | $1,122.31 | $1,122.31 | 10.7× |
| Brachytx isodose complex (77318) | $6,537.53 | $6,537.53 | 17.4× |
| Brachytx isodose intermed (77317) | $5,771.47 | $5,771.47 | 15.3× |
| Brachytx Isodose Plan Simple (77316) | $5,771.47 | $5,771.47 | 15.3× |
| Brain Imaging Minimum 4 Static Views (78605) | $7,298.57 | $7,298.57 | 13.4× |
| Cardiac Shunt Detection (78428) | $7,111.11 | $7,111.11 | 17.7× |
| Cat Scan Follow-Up Study (76380) | $7,425.99 | $7,425.99 | 84.9× |
| Cerebrospinal Fluid Scan (78630) | $6,150.64 | $6,150.64 | 11.3× |
| Chest 1 view (71045) | $1,771.85 | $1,771.85 | 20.3× |
| Chest 2 views (71046) | $2,199.31 | $2,199.31 | 25.2× |
| Chest 3 views (71047) | $2,312.61 | $2,312.61 | 26.5× |
| Chest 4 or more views (71048) | $2,373.02 | $2,373.02 | 22.6× |
| Cisternography Positive Contrast Rs&I (70015) | $5,042.11 | $5,042.11 | 6.4× |
| Clavicle complete (73000) range across 3 matching MRF lines |
$1,619.29–$3,247.62 | $1,619.29–$3,247.62 | varies |
| Computed Tomography Thorax Lw Dose Lng Ca Scr C- (71271) | $1,040.28 | $1,040.28 | 9.9× |
| Continuing medical physics consltj pr wk (77336) | $2,896.73 | $2,896.73 | 21.5× |
| Contrast Exam Abdominl Aorta (75625) range across 2 matching MRF lines |
$19,132.28–$22,314.95 | $19,132.28–$22,314.95 | varies |
| Contrast X-Ray Bladder (74430) | $3,924.34 | $3,924.34 | 11.2× |
| Contrast X-Ray Of Elbow (73085) range across 3 matching MRF lines |
$4,141.85–$9,434.72 | $4,141.85–$9,434.72 | varies |
| Contrast X-Ray Of Knee Joint (73580) range across 3 matching MRF lines |
$5,300.41–$10,602.36 | $5,300.41–$10,602.36 | varies |
| CT abdomen and pelvis without and with contrast (74178) | $39,867.27 | $39,867.27 | 113.8× |
| CT abdomen and pelvis without contrast (74176) | $30,027.19 | $30,027.19 | 125.3× |
| CT abdomen w contrast (74160) | $18,228.49 | $18,228.49 | 103.5× |
| CT abdomen w wo contrast (74170) | $19,405.41 | $19,405.41 | 110.1× |
| CT abdomen w/o contrast (74150) | $17,173.50 | $17,173.50 | 163.5× |
| CT Angio Abdomen and Pelvis (74174) | $17,461.49 | $17,461.49 | 49.8× |
| CT Angio Chest (71275) | $7,173.25 | $7,173.25 | 40.7× |
| CT Angio Head (70496) | $18,509.13 | $18,509.13 | 105.0× |
| CT angio hrt w/3d image (75574) | $3,651.27 | $3,651.27 | 10.4× |
| Ct Angio Lwr Extr W/O&W/Dye (73706) range across 4 matching MRF lines |
$15,082.66–$30,156.49 | $15,082.66–$30,156.49 | varies |
| CT Angio Neck (70498) | $18,509.13 | $18,509.13 | 105.0× |
| Ct Angio Upr Extrm W/O&W/Dye (73206) | $14,624.22 | $14,624.22 | 83.0× |
| CT cervical spine w/ contrast (72126) | $19,903.50 | $19,903.50 | 56.8× |
| CT cervical spine w/o contrast (72125) | $19,136.53 | $19,136.53 | 182.2× |
| CT cervical spine w/wo cont (72127) | $21,812.18 | $21,812.18 | 123.8× |
| CT chest w contrast (71260) | $18,325.46 | $18,325.46 | 104.0× |
| CT chest w/wo contrast (71270) | $2,134.93 | $2,134.93 | 12.1× |
| CT head/brain with contrast (70460) | $14,461.14 | $14,461.14 | 82.1× |
| CT head/brain without and with contrast (70470) | $17,317.51 | $17,317.51 | 98.3× |
| CT heart contrast eval cardiac structure&morph (75572) | $3,651.27 | $3,651.27 | 10.4× |
| CT heart no contrast quant eval coronry calcium (75571) | $675.89 | $675.89 | 7.7× |
| CT hrt w/3d image congen (75573) | $3,651.27 | $3,651.27 | 10.4× |
| CT iac w contrast (70481) | $8,115.10 | $8,115.10 | 46.1× |
| CT l-spine w&w/o contrast (72133) | $18,266.68 | $18,266.68 | 103.7× |
| CT lower ext w/o (73700) range across 3 matching MRF lines |
$11,111.07–$22,216.25 | $11,111.07–$22,216.25 | varies |
| CT lower extremity w/contrast material (73701) range across 3 matching MRF lines |
$11,751.69–$23,507.78 | $11,751.69–$23,507.78 | varies |
| CT lumbar spine w contrast (72132) | $16,455 | $16,455 | 47.0× |
| CT lumbar spine w/o contrast (72131) | $16,205.23 | $16,205.23 | 154.3× |
| CT maxillofacial w contrast (70487) | $13,623.61 | $13,623.61 | 77.3× |
| CT maxillofacial wo contrast (70486) | $13,623.61 | $13,623.61 | 129.7× |
| CT neck tissue combo (70492) | $20,867.39 | $20,867.39 | 118.4× |
| CT orbits w/o contrast (70480) range across 2 matching MRF lines |
$8,649.94–$13,791.11 | $8,649.94–$13,791.11 | varies |
| CT pelvis w&w/o contrast (72194) | $14,461.14 | $14,461.14 | 82.1× |
| CT pelvis w/o contrast (72192) | $12,861.03 | $12,861.03 | 122.5× |
| CT scan of leg combo (73702) range across 3 matching MRF lines |
$12,700.88–$25,401.74 | $12,700.88–$25,401.74 | varies |
| CT scans face/jaw combo (70488) | $13,623.61 | $13,623.61 | 77.3× |
| CT soft tissue neck w contrast (70491) | $16,936.95 | $16,936.95 | 96.1× |
| CT soft tissue neck w/o contrast (70490) | $13,691.20 | $13,691.20 | 130.4× |
| CT thoracic spine w contrast (72129) | $21,400.77 | $21,400.77 | 121.5× |
| CT thoracic spine w/o contrast (72128) | $19,550.88 | $19,550.88 | 186.2× |
| CT thorax w/o contrast (71250) | $14,832.86 | $14,832.86 | 141.2× |
| CT unlisted procedure (76497) | $6,879.87 | $6,879.87 | 78.7× |
| CT upper ext wo (73200) range across 3 matching MRF lines |
$12,592.14–$25,194.56 | $12,592.14–$25,194.56 | varies |
| CT upper extremity w/o & w/contrast material (73202) range across 3 matching MRF lines |
$13,749.97–$27,489.66 | $13,749.97–$27,489.66 | varies |
| CT upper extremity with contrast (73201) range across 3 matching MRF lines |
$13,079.96–$26,149.63 | $13,079.96–$26,149.63 | varies |
| Cta Abdl Aorta&Bi Iliofem W/Contrast&Postp (75635) | $18,689.85 | $18,689.85 | 106.1× |
| Cta Abdomen (74175) | $15,814.38 | $15,814.38 | 89.8× |
| CTA pelvis (72191) | $15,463.21 | $15,463.21 | 87.8× |
| Dacryocystography, nasolacrimal duct, radiological supervision and interpretation Non-Facility (70170) | $5,070.83 | $5,070.83 | 21.2× |
| Dilation ureters/urethra rs&i (74485) range across 2 matching MRF lines |
$1,907.78–$5,829.09 | $1,907.78–$5,829.09 | varies |
| Discography Cerv/Thor Spine (72285) | $6,323.04 | $6,323.04 | 3.2× |
| Diskography lumbar (72295) range across 2 matching MRF lines |
$5,939.37–$6,474.09 | $5,939.37–$6,474.09 | varies |
| Dxa Bone Density Axial (77080) | $1,563.40 | $1,563.40 | 14.9× |
| Dxa bone density study 1/>sites appendiclr skel (77081) | $649.53 | $649.53 | 7.4× |
| Echo Guide For Artery Repair (76936) | $1,881.52 | $1,881.52 | 8.7× |
| Echograp Trans R Pros Study (76873) | $1,475.26 | $1,475.26 | 14.0× |
| Esophagram (74220) | $2,869.99 | $2,869.99 | 16.3× |
| Fetal Biophys Profile W/Nst (76818) | $1,776.24 | $1,776.24 | 16.9× |
| Fetal Biophysical Profile W/O Non-Stress Testing (76819) | $1,355.17 | $1,355.17 | 12.9× |
| Fetal MRI w/placntl matrnl plvc img sing/1st ges (74712) | $2,861.50 | $2,861.50 | 11.9× |
| Fluoroscopy up to 1 hr (76000) range across 4 matching MRF lines |
$2,223.49–$12,617.38 | $2,223.49–$12,617.38 | varies |
| Follow-Up Angiography (75898) range across 2 matching MRF lines |
$6,119.13–$12,002.60 | $6,119.13–$12,002.60 | varies |
| Foot 2 views (73620) range across 3 matching MRF lines |
$1,421.41–$2,845.82 | $1,421.41–$2,845.82 | varies |
| Forearm 2 views (73090) range across 3 matching MRF lines |
$1,614.75–$3,227.99 | $1,614.75–$3,227.99 | varies |
| Gastric emptying imaging study (78264) | $6,436.19 | $6,436.19 | 16.0× |
| Gastric Emptyng Imag Std W/Sm Bwl Transit (78265) | $3,321.20 | $3,321.20 | 8.3× |
| Gastroesophageal Reflux Exam (78262) | $5,700.71 | $5,700.71 | 14.2× |
| Gated Heart Planar Single (78472) | $7,915.81 | $7,915.81 | 19.7× |
| Gated Heart, Multiple (78473) | $12,219.09 | $12,219.09 | 30.4× |
| Gstrc Emptng Imag Std W/Sm Bwl Col Trnst Mlt Day (78266) | $4,410 | $4,410 | 8.1× |
| Hand 2 views (73120) range across 3 matching MRF lines |
$1,205.41–$2,401.74 | $1,205.41–$2,401.74 | varies |
| Hdr Rdncl Ntrstl/Icav Brchtx (77772) | $6,949.58 | $6,949.58 | 9.9× |
| Hdr Rdncl Ntrstl/Icav Brchtx (77771) | $6,949.58 | $6,949.58 | 9.9× |
| Hdr Rdncl Ntrstl/Icav Brchtx 1 Channel (77770) | $6,949.58 | $6,949.58 | 9.9× |
| Heart Image (Pet) Multiple (78492) | $24,385.61 | $24,385.61 | 17.0× |
| Hepatc Vngrph Wdg/Fr Hemodyn Eval Rs&I (75889) | $12,880.22 | $12,880.22 | 4.1× |
| Hepatc Vngrph Wdg/Fr W/O Hemodyn Eval Rs&I (75891) | $12,880.22 | $12,880.22 | 4.1× |
| Hepatobil Syst Image W/Drug (78227) | $4,407.12 | $4,407.12 | 8.1× |
| Hepatobiliary System Imaging (78226) | $4,407.12 | $4,407.12 | 11.0× |
| Ht Musc Image Planar Mult (78454) | $12,219.09 | $12,219.09 | 9.4× |
| Ht Muscle Image Spect Sing (78451) | $11,516.78 | $11,516.78 | 8.9× |
| Hysterosalpingogram (74740) | $4,243.05 | $4,243.05 | 17.7× |
| Image fusion (77399) | $1,466.20 | $1,466.20 | 10.9× |
| Infant hip ultrasound with hip movement (dynamic) (76885) | $1,018.60 | $1,018.60 | 11.7× |
| Infusion Ivp (74410) | $3,258.20 | $3,258.20 | 18.5× |
| Interstitial radiation source applic complex (77778) | $61,577.12 | $61,577.12 | 88.0× |
| Intracavitary Radiation Source Applic Complex (77763) | $61,577.12 | $61,577.12 | 88.0× |
| Intracavitary Radiation Source Applic Intermed (77762) | $61,577.12 | $61,577.12 | 110.9× |
| Intracavitary radiation source applic simple (77761) | $61,577.12 | $61,577.12 | 110.9× |
| Intraop radiaj tx deliver electrons sngl tx sess (77425) unusually low: confirm this is the full procedure |
$2,375.04 | $2,375.04 | 0.3× |
| Intraop radiaj tx deliver xray single tx session (77424) unusually low: confirm this is the full procedure |
$2,375.04 | $2,375.04 | 0.3× |
| K Flow/Funct Image Multiple (78709) | $9,179.10 | $9,179.10 | 16.8× |
| K Flow/Funct Image W/O Drug (78707) | $4,061.01 | $4,061.01 | 7.4× |
| Kidney Imaging Morphol (78700) | $2,900.10 | $2,900.10 | 7.2× |
| Kidney Imaging Morphoogy W/Vascular Flow (78701) | $8,107.61 | $8,107.61 | 20.2× |
| Knee 3 Views (73562) range across 3 matching MRF lines |
$1,265.80–$2,536.17 | $1,265.80–$2,536.17 | varies |
| Leveen/Shunt Patency Exam (78291) | $7,142.82 | $7,142.82 | 17.8× |
| Liver & Spleen Imaging Static Only (78215) | $7,875.42 | $7,875.42 | 19.6× |
| Liver imaging static only (78201) | $2,900.10 | $2,900.10 | 5.3× |
| Lung Perf&Ventilat Diferentl (78598) | $4,748.91 | $4,748.91 | 8.7× |
| Lung perfusion differential (78597) | $3,039.99 | $3,039.99 | 7.6× |
| Lung Ventilat&Perfus Imaging (78582) | $4,239.84 | $4,239.84 | 7.8× |
| Lung Ventilation Imaging (78579) | $3,039.99 | $3,039.99 | 7.6× |
| Lymph System Imaging (78195) | $9,965.05 | $9,965.05 | 18.3× |
| Lymphangiography Extremity Only Bilateral Rs&I (75803) | $8,294.28 | $8,294.28 | 5.2× |
| Lymphangiography extremity only unilateral rs&i (75801) | $5,380.48 | $5,380.48 | 8.5× |
| Lymphangiography Pelvic/Abdominal Bilateral Rs&I (75807) | $1,509.01 | $1,509.01 | 0.5× |
| Lymphangiography, pelvic/abdominal, unilateral (75805) | $1,120.80 | $1,120.80 | 0.4× |
| Magnetic Image Jaw Joint (70336) range across 2 matching MRF lines |
$17,098.88–$40,623.57 | $17,098.88–$40,623.57 | varies |
| Mammary ductogram or galactogram multiple (77054) | $2,161.56 | $2,161.56 | 9.0× |
| Mammary ductogram or galactogram single (77053) range across 2 matching MRF lines |
$2,954.57–$3,004.43 | $2,954.57–$3,004.43 | varies |
| Meckels Divert Exam (78290) | $7,581.22 | $7,581.22 | 18.9× |
| Mlc imrt design & construction per imrt plan (77338) | $2,966.73 | $2,966.73 | 7.9× |
| Mr safety determination physician/other qhp (76016) | $427.92 | $427.92 | 4.9× |
| Mr safety implant&/fb assmt clin staf 1st 15 min (76014) | $119.02 | $119.02 | 4.1× |
| Mr safety implt electronics prepj supvj phys/qhp (76018) | $446.09 | $446.09 | 4.7× |
| Mr safety implt pos&/immoblj (76019) | $267.30 | $267.30 | 4.5× |
| Mr safety med physics xm customization plng&mntr (76017) | $1,174.76 | $1,174.76 | 4.9× |
| Mra Head W/O & W/Contrast Material (70546) | $26,813.05 | $26,813.05 | 76.5× |
| MRA head w/o contrast (70544) | $16,499.75 | $16,499.75 | 68.8× |
| MRA head with contrast (70545) | $19,092.93 | $19,092.93 | 54.5× |
| MRA neck w contrast (70548) | $18,675.23 | $18,675.23 | 53.3× |
| Mra Neck W/O &W/Contrast Material (70549) | $25,538.55 | $25,538.55 | 72.9× |
| MRA neck w/o contrast (70547) | $23,715.24 | $23,715.24 | 98.9× |
| MRI abdomen w contrast (74182) | $22,125.19 | $22,125.19 | 63.1× |
| MRI abdomen w/o contrast (74181) | $14,363.92 | $14,363.92 | 59.9× |
| MRI any jt lower extrem w/contrast material (73722) range across 3 matching MRF lines |
$9,384.87–$18,751.46 | $9,384.87–$18,751.46 | varies |
| MRI any jt lower extrem w/o & w/contrast matrl (73723) range across 3 matching MRF lines |
$28,368.04–$56,740.66 | $28,368.04–$56,740.66 | varies |
| MRI any jt upper extremity w/contrast matrl (73222) range across 3 matching MRF lines |
$22,233.42–$46,672.82 | $22,233.42–$46,672.82 | varies |
| MRI bone marrow blood supply (77084) | $10,939.87 | $10,939.87 | 45.6× |
| MRI Breast W/O Contrast Bilateral (77047) | $16,670.49 | $16,670.49 | 69.6× |
| MRI cervical spine w contrast (72142) | $26,508.15 | $26,508.15 | 75.6× |
| MRI cervical spine w/o cont (72141) | $18,434.37 | $18,434.37 | 76.9× |
| MRI chest w/o contrast (71550) | $20,495.48 | $20,495.48 | 85.5× |
| MRI chest with contrast (71551) | $29,305.63 | $29,305.63 | 37.2× |
| MRI chest wo w contrast (71552) | $19,907.02 | $19,907.02 | 56.8× |
| MRI lower extrem oth/thn jt w/contrast matrl (73719) range across 3 matching MRF lines |
$20,946.73–$41,882.81 | $20,946.73–$41,882.81 | varies |
| MRI lower extrem oth/thn jt w/o & w/contr matr (73720) range across 3 matching MRF lines |
$29,782.78–$59,562.54 | $29,782.78–$59,562.54 | varies |
| MRI lower extrem oth/thn jt w/o contr matrl (73718) range across 3 matching MRF lines |
$19,721.03–$39,452.76 | $19,721.03–$39,452.76 | varies |
| MRI lumbar spine w contrast (72149) | $25,802.29 | $25,802.29 | 73.6× |
| Mri Neck Spine W/O & W/Dye (72156) | $29,979.46 | $29,979.46 | 85.5× |
| MRI orbit face &/neck w/o contrast (70540) | $12,705.26 | $12,705.26 | 53.0× |
| MRI orbit face neck w contrast (70542) | $18,419.11 | $18,419.11 | 52.6× |
| Mri Orbt/Fac/Nck W/O &W/Dye (70543) | $22,445.34 | $22,445.34 | 64.0× |
| MRI pelvis w contrast (72196) | $14,194.70 | $14,194.70 | 40.5× |
| MRI pelvis w/o & w contrast (72197) | $25,184.88 | $25,184.88 | 71.9× |
| MRI pelvis w/o contrast (72195) | $14,344.08 | $14,344.08 | 59.8× |
| MRI spectroscopy (76390) | $9,355.90 | $9,355.90 | 107.0× |
| MRI thoracic spine w/o contrast (72146) | $15,391.45 | $15,391.45 | 64.2× |
| MRI upper extremity oth than jt w/contr matrl (73219) range across 3 matching MRF lines |
$17,185.78–$34,366.99 | $17,185.78–$34,366.99 | varies |
| MRI upper extremity oth than jt w/o contr matrl (73218) range across 3 matching MRF lines |
$8,694.27–$17,383.96 | $8,694.27–$17,383.96 | varies |
| Mri Uppr Extremity W/O&W/Dye (73220) range across 3 matching MRF lines |
$23,335.65–$46,672.82 | $23,335.65–$46,672.82 | varies |
| MRI, abdomen, combo (74183) | $23,324.97 | $23,324.97 | 66.6× |
| MRI, dorsal spine combo (72157) | $28,834.54 | $28,834.54 | 82.3× |
| MRI, dorsal spine contrast (72147) | $13,034.55 | $13,034.55 | 37.2× |
| MRI, joint upper extrem (73221) range across 3 matching MRF lines |
$23,335.65–$46,672.82 | $23,335.65–$46,672.82 | varies |
| MRI, joint upper extrem combo (73223) range across 3 matching MRF lines |
$23,120.68–$46,247.48 | $23,120.68–$46,247.48 | varies |
| MRI, lumbar spine combo (72158) | $29,180.61 | $29,180.61 | 83.3× |
| Myelogram cervical (72240) | $9,561.61 | $9,561.61 | 12.1× |
| Myelogram Lumbar (72265) range across 2 matching MRF lines |
$7,634.17–$8,028.42 | $7,634.17–$8,028.42 | varies |
| Myelography thoracic (72255) | $8,028.42 | $8,028.42 | 10.2× |
| Myelograpy 2/more regions rs&i (72270) | $12,250.33 | $12,250.33 | 15.6× |
| Myocardial imaging, infarct avid, planar; with ejection fraction by first pass technique Non-Facility (78468) | $9,150.26 | $9,150.26 | 16.8× |
| Myocardial Perfusion Planar 1 Study Rest/Stress (78453) | $14,464.46 | $14,464.46 | 11.1× |
| Myocardial Spect Multiple Studies (78452) | $18,355.32 | $18,355.32 | 14.1× |
| Neck soft tissue (70360) | $1,288.47 | $1,288.47 | 14.7× |
| Nfs/Instlj Radioelmnt Sln 3 Mo Follow-Up Care (77750) | $11,622.05 | $11,622.05 | 30.0× |
| Nonvascular Shunt X-Ray (75809) range across 2 matching MRF lines |
$900.27–$5,894.06 | $900.27–$5,894.06 | varies |
| Ntsty modul radthx pln dose-vol histos (77301) | $21,056.82 | $21,056.82 | 15.1× |
| Nuclear Rx Intra-Arterial (79445) | $1,382.29 | $1,382.29 | 5.9× |
| Nuclear Rx Oral Admin (79005) | $8,139.34 | $8,139.34 | 34.7× |
| Optic foramina (70190) range across 3 matching MRF lines |
$684.26–$1,368.53 | $684.26–$1,368.53 | varies |
| Parathyroid imaging w/tomographic spect & CT (78072) | $4,395.60 | $4,395.60 | 8.1× |
| Parathyroid Planar Imaging (78070) | $3,401.97 | $3,401.97 | 8.5× |
| Parathyroid planar imaging w/wo subtraction (78071) | $4,395.60 | $4,395.60 | 10.9× |
| Pelvis 1 or 2 views (72170) | $1,643.45 | $1,643.45 | 15.6× |
| Peritoneogram Rs&I (74190) | $1,785.43 | $1,785.43 | 3.3× |
| Pet Image W/Ct Lmtd (78814) | $37,319.02 | $37,319.02 | 26.0× |
| PET image w/CT, full body (78816) | $37,319.02 | $37,319.02 | 26.0× |
| PET imaging CT attenuation skull base mid-thigh (78815) | $37,319.02 | $37,319.02 | 26.0× |
| Pet Myocardial Sngl Study (78491) | $24,385.61 | $24,385.61 | 17.0× |
| Prq Transhepatc Portograpy Hemodyn Eval Rs&I (75885) | $10,405.98 | $10,405.98 | 3.3× |
| Pulmonary Perfusion Imaging Particulate (78580) | $7,437.02 | $7,437.02 | 18.5× |
| Radex Abd Compl Aqt Abd W/S/E/D Views 1 View Ch (74022) | $2,093.58 | $2,093.58 | 19.9× |
| Radex abscess/fistula/sinus tract rs&i (76080) range across 2 matching MRF lines |
$2,034.68–$2,661.54 | $2,034.68–$2,661.54 | varies |
| Radex Ankle Complete Minimum 3 Views (73610) range across 3 matching MRF lines |
$2,176.66–$4,344.27 | $2,176.66–$4,344.27 | varies |
| Radex Calcaneus Minimum 2 Views (73650) range across 3 matching MRF lines |
$1,332.29–$2,672.11 | $1,332.29–$2,672.11 | varies |
| Radex elbow complete minimum 3 views (73080) range across 4 matching MRF lines |
$1,496.92–$3,718.90 | $1,496.92–$3,718.90 | varies |
| Radex Facial Bones Complete Minimum 3 Views (70150) | $2,572.42 | $2,572.42 | 24.5× |
| Radex fingr minimum 2 views (73140) | $1,374.57 | $1,374.57 | 15.7× |
| Radex foot complete minimum 3 views (73630) range across 3 matching MRF lines |
$2,155.51–$4,312.55 | $2,155.51–$4,312.55 | varies |
| Radex Hand Minimum 3 Views (73130) range across 4 matching MRF lines |
$1,496.92–$3,718.90 | $1,496.92–$3,718.90 | varies |
| Radex lower extremity infant minimum 2 views (73592) range across 3 matching MRF lines |
$1,291.51–$2,576.94 | $1,291.51–$2,576.94 | varies |
| Radex Mastoids Compl Minimum 3 Views PR Side (70130) range across 3 matching MRF lines |
$2,995.37–$5,990.74 | $2,995.37–$5,990.74 | varies |
| Radex Nasal Bones Complete Minimum 3 Views (70160) | $1,549.80 | $1,549.80 | 17.7× |
| Radex Ribs Unilateral 2 Views (71100) range across 3 matching MRF lines |
$637.44–$1,942.53 | $637.44–$1,942.53 | varies |
| Radex shoulder complete minimum 2 views (73030) range across 4 matching MRF lines |
$1,806.58–$4,492.29 | $1,806.58–$4,492.29 | varies |
| Radex Sinuses Paransl < 3 Views (70210) | $1,374.57 | $1,374.57 | 15.7× |
| Radex sm int w/mlt srl imges via enteroclss tube (74251) | $3,214.39 | $3,214.39 | 18.2× |
| Radex Spine 1 View Specify Level (72020) | $1,332.29 | $1,332.29 | 15.2× |
| Radex Sternum Minimum 2 Views (71120) | $1,741.63 | $1,741.63 | 19.9× |
| Radex Temporomandble Jt Opn & Clsd Mouth Bilat (70330) | $2,312.61 | $2,312.61 | 26.5× |
| Radex Toe Minimum 2 Views (73660) | $1,398.75 | $1,398.75 | 16.0× |
| Radex upper extremity infant minimum 2 views (73092) range across 3 matching MRF lines |
$1,217.47–$2,425.90 | $1,217.47–$2,425.90 | varies |
| Radex Wrist Complete Minimum 3 Views (73110) range across 3 matching MRF lines |
$1,907.78–$3,818.60 | $1,907.78–$3,818.60 | varies |
| Radex X-Ray Exam Entire Spi 6/> Vw - Xr Entire Spine 6+ Vw (72084) | $1,981.80 | $1,981.80 | 18.9× |
| Radiation Delivery Stereotactic Cranial Linear (77372) | $82,829.70 | $82,829.70 | 11.2× |
| Radiation treatment delivery level 1 (77402) | $1,044.74 | $1,044.74 | 10.2× |
| Radiation treatment delivery level 2 (77407) | $1,044.74 | $1,044.74 | 2.7× |
| Radiation treatment delivery level 3 (77412) | $2,018.09 | $2,018.09 | 3.6× |
| Radiolog exam mandible compl minimum 4 views (70110) | $2,377.56 | $2,377.56 | 22.6× |
| Radiologic Exam Abdomen 3+ Views - Xr Abdomen 3+ Views (74021) | $3,241.58 | $3,241.58 | 30.9× |
| Radiologic exam colon double contrast study (74280) | $6,055.68 | $6,055.68 | 34.4× |
| Radiologic exam colon single contrast study (74270) | $4,493.80 | $4,493.80 | 25.5× |
| Radiologic exam knee complete 4/more views (73564) range across 3 matching MRF lines |
$2,146.45–$4,292.89 | $2,146.45–$4,292.89 | varies |
| Radiologic exam pelvis compl minimum 3 views (72190) | $2,069.41 | $2,069.41 | 19.7× |
| Radiologic Exam Small Int Single Contrast Study (74250) | $3,924.34 | $3,924.34 | 22.3× |
| Radiologic exam swallow function contrast study (74230) | $3,490.82 | $3,490.82 | 19.8× |
| Radiologic exam upr gi trc double contrast study (74246) range across 2 matching MRF lines |
$1,465.20–$3,924.34 | $1,465.20–$3,924.34 | varies |
| Radiologic examination femur 1 view (73551) | $628.38 | $628.38 | 7.2× |
| Radiologic examination femur minimum 2 views (73552) | $628.38 | $628.38 | 7.2× |
| Radiologic examination knee 1/2 views (73560) range across 3 matching MRF lines |
$1,431.98–$2,862.43 | $1,431.98–$2,862.43 | varies |
| Radiologic Examination Osseous Survey Limited (77074) | $1,261.29 | $1,261.29 | 12.0× |
| Radiologic Examination Salivary Gland Calculus (70380) | $984.85 | $984.85 | 11.3× |
| Radiologic examination tibia & fibula 2 views (73590) range across 3 matching MRF lines |
$1,907.78–$3,818.60 | $1,907.78–$3,818.60 | varies |
| Radiologic examination, internal auditory meati, complete Non-Facility (70134) | $1,773.35 | $1,773.35 | 3.2× |
| Remote afterloading high dose rate radionuclide skin surface brachytherapy, includes basic dosimetry, when performed;… (77768) | $1,939.64 | $1,939.64 | 5.0× |
| Remote afterloading high dose rate radionuclide skin surface brachytherapy, includes basic dosimetry, when performed;… (77767) | $1,939.64 | $1,939.64 | 5.0× |
| Renal Cyst Study (74470) | $6,833.60 | $6,833.60 | 12.4× |
| Ribs bilateral 3 views (71110) | $2,154.01 | $2,154.01 | 20.5× |
| Rp loclzj tum plnr 1 area single day imaging (78800) range across 2 matching MRF lines |
$2,453.03–$7,563.92 | $2,453.03–$7,563.92 | varies |
| Rp loclzj tum plnr 2+area 1+d img/1 area img>2+d (78801) range across 2 matching MRF lines |
$2,453.03–$10,828.88 | $2,453.03–$10,828.88 | varies |
| Rp Loclzj Tum Plnr Whole Body Single Day Imaging (78802) range across 2 matching MRF lines |
$8,540.25–$19,485.93 | $8,540.25–$19,485.93 | varies |
| Rp Loclzj Tum Spect 1 Area Single Day Imaging (78803) range across 2 matching MRF lines |
$7,543.74–$7,561.04 | $7,543.74–$7,561.04 | varies |
| Rp loclzj tum spect 2 area/sep acquisj img (78831) | $3,164.01 | $3,164.01 | 2.4× |
| Rp loclzj tum spect CT 2area 1d img/1 ar img>2+d (78832) | $3,164.01 | $3,164.01 | 2.2× |
| Rp loclzj tum spect w/CT 1 area/acquisj 1day img (78830) | $3,164.01 | $3,164.01 | 2.4× |
| Rp Therapy Intravenous Administration (79101) | $5,276.71 | $5,276.71 | 22.5× |
| Salivary Gland Imaging Serial Images (78231) | $3,329.85 | $3,329.85 | 8.3× |
| Scapula (73010) range across 3 matching MRF lines |
$1,643.45–$3,282.38 | $1,643.45–$3,282.38 | varies |
| Screening Digital Breast Tomosynthesis Bi (77063) | $1,888.94 | $1,888.94 | 80.8× |
| Sella turcica (70240) | $756.78 | $756.78 | 8.7× |
| Shoulder 1 view (73020) range across 3 matching MRF lines |
$1,332.29–$2,672.11 | $1,332.29–$2,672.11 | varies |
| Shoulder Arthrography (73040) range across 6 matching MRF lines |
$4,141.85–$10,602.36 | $4,141.85–$10,602.36 | varies |
| Sialogram (70390) range across 2 matching MRF lines |
$4,007.42–$4,141.85 | $4,007.42–$4,141.85 | varies |
| Skull less than 4 views (70250) | $1,768.82 | $1,768.82 | 16.8× |
| Special dosimetry (77331) | $2,550.76 | $2,550.76 | 18.9× |
| Special Physics Consult (77370) range across 2 matching MRF lines |
$567.60–$6,916.43 | $567.60–$6,916.43 | varies |
| Special teletherapy port plan (77321) | $5,771.47 | $5,771.47 | 15.3× |
| Special treatment procedure (77470) range across 2 matching MRF lines |
$7,545.92–$13,606.34 | $7,545.92–$13,606.34 | varies |
| Speech evaluation, complex (70371) | $3,113.19 | $3,113.19 | 13.0× |
| Spleen Imaging (78185) | $1,507.01 | $1,507.01 | 3.8× |
| Stereotactic Body Radiation Delivery (77373) | $16,221.63 | $16,221.63 | 9.0× |
| Sternoclavicular joints (71130) | $406.34 | $406.34 | 4.6× |
| Superior sagittal sinus venogram (75870) | $10,405.98 | $10,405.98 | 3.3× |
| Telethx isodose pln cplx w/basic dosimetry (77307) | $5,010.92 | $5,010.92 | 13.3× |
| Telethx isodose pln smpl w/dosimetry calculation (77306) | $2,763.55 | $2,763.55 | 7.3× |
| Temporomandble Jt Arthrography Rs&I (70332) range across 3 matching MRF lines |
$5,120.67–$10,233.79 | $5,120.67–$10,233.79 | varies |
| Testicular Imaging W/Flow (78761) | $6,493.86 | $6,493.86 | 16.2× |
| Ther Rad Simulaj-Aided Field Setting Complex (77290) | $7,044.10 | $7,044.10 | 18.7× |
| Ther Rad Simulaj-Aided Field Setting Intermed (77285) | $5,771.47 | $5,771.47 | 15.3× |
| Ther rad simulaj-aided field setting simple (77280) | $3,498.03 | $3,498.03 | 25.9× |
| Thoracic spine 2 views (72070) | $2,312.61 | $2,312.61 | 22.0× |
| Thoracic spine 3 views (72072) | $2,373.02 | $2,373.02 | 22.6× |
| Thyroid carcinoma metastases imaging; with additional studies (eg, urinary recovery) Non-Facility (78016) | $3,615.39 | $3,615.39 | 9.0× |
| Thyroid Carcinoma Metastases Img Lmtd Area (78015) | $2,584.28 | $2,584.28 | 6.4× |
| Thyroid Imaging With Vascular Flow (78013) | $2,047.80 | $2,047.80 | 5.1× |
| Thyroid Met Imaging Body (78018) | $10,533.25 | $10,533.25 | 19.3× |
| Thyroid Uptake Measurement (78012) | $1,557.48 | $1,557.48 | 3.9× |
| Thyroid Uptake W/Blood Flow Sngle/Mult Quan Meas (78014) | $3,181.33 | $3,181.33 | 7.9× |
| Tx Devices Design & Construction Complex (77334) | $5,888.17 | $5,888.17 | 15.7× |
| Tx devices design & construction intermediate (77333) | $4,667.70 | $4,667.70 | 34.6× |
| Tx devices design & construction simple (77332) | $4,667.70 | $4,667.70 | 34.6× |
| Ultrasound Breast Limited (76642) | $944.47 | $944.47 | 10.8× |
| Ultrasound Exam Aaa Screen (76706) | $1,051.21 | $1,051.21 | 10.0× |
| Ultrasound, abdomen limited (76705) range across 2 matching MRF lines |
$3,318.71–$3,551.02 | $3,318.71–$3,551.02 | varies |
| Umbilical-artery Doppler (OB) (76820) | $1,063.09 | $1,063.09 | 10.1× |
| Unlisted magnetic resonance procedure (76498) | $13,174.80 | $13,174.80 | 150.7× |
| Unlisted Procedure Clinical Brachytherapy (77799) | $5,592.54 | $5,592.54 | 54.6× |
| Upper gi w/o kub (74240) range across 2 matching MRF lines |
$1,465.20–$3,773.29 | $1,465.20–$3,773.29 | varies |
| Urea Breath Test C-14 Isotopic Acquisj Analysis (78267) | $3,706.25 | $3,706.25 | 335.1× |
| Urea breath test c-14 isotopic analysis (78268) range across 2 matching MRF lines |
$2,191.98–$2,401.14 | $2,191.98–$2,401.14 | varies |
| Urethrocystogram voiding (74455) | $3,761.20 | $3,761.20 | 15.7× |
| Urethrocystography retrograde (74450) | $3,869.96 | $3,869.96 | 16.1× |
| Us breast unilateral complete (76641) range across 5 matching MRF lines |
$944.47–$3,063.21 | $944.47–$3,063.21 | varies |
| Us chest (76604) range across 2 matching MRF lines |
$2,344.57–$2,508.69 | $2,344.57–$2,508.69 | varies |
| Us complete joint (76881) | $3,921.68 | $3,921.68 | 37.3× |
| Us exam, pelvic, limited (76857) | $1,344.79 | $1,344.79 | 12.8× |
| Us head (76506) | $3,140.32 | $3,140.32 | 29.9× |
| Us lmtd joint/oth nonvasc xtr strux r-t w/img (76882) range across 2 matching MRF lines |
$916.29–$3,407.19 | $916.29–$3,407.19 | varies |
| Us ob detailed single fetus (76811) | $3,294.52 | $3,294.52 | 13.7× |
| Us ob limited 1 or more fetuses (76815) | $1,550.88 | $1,550.88 | 14.8× |
| Us ob transvaginal (76817) | $1,355.17 | $1,355.17 | 12.9× |
| Us pelvic non ob complete (76856) | $3,192.21 | $3,192.21 | 30.4× |
| Us pg uter img f&mat 14 wk tabdl 1/1st gestation (76801) | $1,435.23 | $1,435.23 | 13.7× |
| Us preg uterus real time f/u trnsabdl per fetus (76816) | $1,355.17 | $1,355.17 | 12.9× |
| Us retroperitoneal complete (76770) | $3,862.38 | $3,862.38 | 36.8× |
| Us retroperitoneal limited (76775) | $3,924.65 | $3,924.65 | 37.4× |
| Us scrotum and contents (76870) | $3,066.18 | $3,066.18 | 29.2× |
| Us spinal canal and contents (76800) | $1,493.07 | $1,493.07 | 14.2× |
| Us thyroid (76536) range across 2 matching MRF lines |
$2,914.08–$3,118.07 | $2,914.08–$3,118.07 | varies |
| Us transrectal (76872) range across 2 matching MRF lines |
$1,475.26–$3,899.43 | $1,475.26–$3,899.43 | varies |
| Vein X-Ray Chest (75827) range across 2 matching MRF lines |
$12,614.37–$12,936.11 | $12,614.37–$12,936.11 | varies |
| Vein X-Ray Liver W/O Hemodyn (75887) | $12,969.34 | $12,969.34 | 4.1× |
| Vein X-Ray Skull Epidural (75872) | $10,405.98 | $10,405.98 | 16.5× |
| Vein X-Ray Spleen/Liver (75810) | $5,894.06 | $5,894.06 | 1.9× |
| Venogram Sinus/Jugular (75860) | $11,312.29 | $11,312.29 | 3.6× |
| Venography Adrenal Unilateral (75840) range across 4 matching MRF lines |
$11,268.49–$11,866.66 | $11,268.49–$11,866.66 | varies |
| Venography caval inferior serialography rs&i (75825) range across 2 matching MRF lines |
$9,637.13–$12,937.61 | $9,637.13–$12,937.61 | varies |
| Venography extremity bilateral rs&i (75822) range across 2 matching MRF lines |
$6,536.03–$7,126.64 | $6,536.03–$7,126.64 | varies |
| Venography extremity unilateral rs&i (75820) range across 4 matching MRF lines |
$5,196.19–$5,658.41 | $5,196.19–$5,658.41 | varies |
| Venography Orbital Rs&I (75880) | $10,405.98 | $10,405.98 | 16.5× |
| Venography Renal Bilateral (75833) | $19,132.28 | $19,132.28 | 6.0× |
| Venography Renal Unilateral (75831) range across 4 matching MRF lines |
$11,866.66–$12,608.33 | $11,866.66–$12,608.33 | varies |
| Venous sampling by catheter (75893) | $12,880.22 | $12,880.22 | 2.3× |
| Venous Thrombosis Imaging Venogram Bilateral (78458) | $8,646.96 | $8,646.96 | 21.5× |
| Wrist 2 views (73100) range across 3 matching MRF lines |
$1,347.39–$2,696.28 | $1,347.39–$2,696.28 | varies |
| X-Ray Ac Jts - Xr Acromioclavicular Joints Bilateral (73050) | $1,758.24 | $1,758.24 | 20.1× |
| X-ray antegrade pyelogram tube (74425) | $5,338.18 | $5,338.18 | 15.2× |
| X-Ray Aorta Leg Arteries (75630) range across 2 matching MRF lines |
$15,526.65–$19,132.28 | $15,526.65–$19,132.28 | varies |
| X-Ray Bend Only L-S Spine (72120) | $1,499.96 | $1,499.96 | 14.3× |
| X-Ray Elbow 2 Vw - Xr Elbow 1-2 Views Right (73070) range across 3 matching MRF lines |
$1,421.41–$2,845.82 | $1,421.41–$2,845.82 | varies |
| X-Ray Exam Breast Specimen (76098) range across 2 matching MRF lines |
$1,152.52–$4,466.61 | $1,152.52–$4,466.61 | varies |
| X-Ray Exam Entire Spi 1 Vw (72081) | $628.38 | $628.38 | 7.2× |
| X-Ray Exam Entire Spi 2/3 Vw (72082) | $1,039.23 | $1,039.23 | 9.9× |
| X-Ray Exam Entire Spi 4/5 Vw (72083) | $1,981.80 | $1,981.80 | 18.9× |
| X-Ray Exam Hip Uni 1 View (73501) | $628.38 | $628.38 | 7.2× |
| X-Ray Exam Hip Uni 2-3 Views (73502) | $628.38 | $628.38 | 7.2× |
| X-Ray Exam Hip Uni 4/> Views (73503) | $1,039.23 | $1,039.23 | 9.9× |
| X-Ray Exam Hips Bi 2 Views (73521) | $1,039.23 | $1,039.23 | 9.9× |
| X-Ray Exam Hips Bi 3-4 Views (73522) | $1,039.23 | $1,039.23 | 9.9× |
| X-Ray Exam Hips Bi 5/> Views (73523) | $1,981.80 | $1,981.80 | 18.9× |
| X-Ray Exam L-S Spine Bending (72114) | $1,173.67 | $1,173.67 | 11.2× |
| X-Ray Exam Neck Spine 2-3 Vw (72040) | $1,802.06 | $1,802.06 | 20.6× |
| X-Ray Exam Neck Spine 6/>Vws (72052) | $3,880.54 | $3,880.54 | 37.0× |
| X-Ray Exam Unilat Ribs/Chest (71101) | $2,211.41 | $2,211.41 | 21.1× |
| X-ray eye for foreign body (70030) range across 3 matching MRF lines |
$684.26–$1,368.53 | $684.26–$1,368.53 | varies |
| X-ray humerus (73060) range across 4 matching MRF lines |
$1,222.01–$3,045.21 | $1,222.01–$3,045.21 | varies |
| X-ray IV pyelogram (ivp) (74400) | $4,821.58 | $4,821.58 | 27.4× |
| X-ray IV pyelogram+tomography (74415) | $5,001.34 | $5,001.34 | 28.4× |
| X-Ray Jaw <4 Vw - Xr Mandible < 4 Views (70100) | $1,718.97 | $1,718.97 | 19.7× |
| X-Ray Knee Bilat Standing - Xr Knees Anteroposterior Standing Bilat (73565) | $1,921.40 | $1,921.40 | 22.0× |
| X-Ray Lumbar Spine 2/3 Vw - Xr Lumbar Spine 2-3 Views (72100) | $1,885.13 | $1,885.13 | 18.0× |
| X-ray nose-rectum child f.b. (76010) | $1,802.06 | $1,802.06 | 20.6× |
| X-Ray Ribs, Chest 4+ Vw - Xr Ribs 3 Vws Bil W/ Chest Posteroanterior (71111) | $2,226.51 | $2,226.51 | 21.2× |
| X-Ray Sacroiliac Jts <3 Vw - Xr Sacroiliac Joints 1-2 Views (72200) | $1,987.86 | $1,987.86 | 18.9× |
| X-Ray Sacrum/Coccyx 2+ Vw - Xr Sacrum Coccyx 2+ Views (72220) | $1,919.87 | $1,919.87 | 22.0× |
| X-Ray Sinuses 3+ Vw - Xr Paranasal Sinuses 3+ Views (70220) | $2,566.38 | $2,566.38 | 29.4× |
| X-Ray Skull 4+ Vw - Xr Skull Complete 4+ Views (70260) | $2,802.02 | $2,802.02 | 26.7× |
| X-Ray Stress View (77071) range across 2 matching MRF lines |
$984.85–$1,969.73 | $984.85–$1,969.73 | varies |
| X-Ray Urinary Tract Exam With Contrast Material (74420) | $5,380.48 | $5,380.48 | 15.4× |
| X-Rays Bone Length Studies (77073) | $2,505.96 | $2,505.96 | 23.9× |
| X-Rays Bone Survey Complete (77075) | $1,299.06 | $1,299.06 | 12.4× |
| Xr c-spine 4 or 5 views (72050) | $2,572.42 | $2,572.42 | 24.5× |
| Xr orbits complete 4 views (70200) | $2,709.88 | $2,709.88 | 25.8× |
| Xr Tomogram Single Plane (76100) | $1,007.52 | $1,007.52 | 9.6× |
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.