Imaging prices at Henry Ford West Bloomfield Hospital
West Bloomfield, MI · every code in this section with a posted price and a Medicare benchmark.
558 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) | $1,903.23 | $3,252 | 1.4× |
| Abdomen 1 View (74018) range across 2 matching MRF lines |
$119.66 | $211–$261 | 1.4× |
| Abdomen 2 views (74019) range across 2 matching MRF lines |
$143.75 | $251–$301 | 1.4× |
| Acute Gastrointestinal Blood Loss Imaging (78278) | $549.70 | $2,159 | 1.4× |
| Acute venous thrombosis imaging, peptide Non-Facility (78456) | $1,780.19 | $2,391 | 1.4× |
| Adrenal Cortex & Medulla Img (78075) | $1,780.19 | $2,979 | 1.4× |
| Angio internal mammary (75756) | $4,341.66 | $1,748 | 1.4× |
| Angio pulmonary bilat (75743) | $4,341.66 | $2,198 | 1.4× |
| Angiography Adrenal Bilateral Slctv Rs&I (75733) | $4,341.66 | — | 1.4× |
| Angiography extremity bilateral rs&i (75716) | $4,341.66 | $2,198 | 1.4× |
| Angiography extremity unilateral rs&i (75710) range across 2 matching MRF lines |
$4,341.66 | $1,479–$1,515 | 1.4× |
| Angiography pulmonary unilateral slctv rs&i (75741) | $4,341.66 | $1,366 | 1.4× |
| Angrph pulmonary nonslctv cath/ven njx rs&i (75746) | $4,341.66 | $1,509 | 1.4× |
| Ankle 2 views (73600) range across 3 matching MRF lines |
$119.66 | $226–$276 | 1.4× |
| Aortography thoracic serialography rs&i (75605) | $7,651.38 | $2,794 | 1.4× |
| Aortography thoracic w/o serialography rs&i (75600) | $4,341.66 | $4,162 | 1.4× |
| Artery X-Rays Abdomen (75726) | $7,651.38 | $1,675 | 1.4× |
| Artery X-Rays Adrenal Gland (75731) | $4,341.66 | $1,809 | 1.4× |
| Artery X-Rays Pelvis (75736) | $7,651.38 | $1,431 | 1.4× |
| Artery X-Rays Spine (75705) | $7,651.38 | $1,931 | 1.4× |
| Arthrogram ankle (73615) | $479.72 | $1,222 | 1.4× |
| Arthrogram hip (73525) | $479.72 | $1,171 | 1.4× |
| Arthrogram Wrist (73115) | $479.72 | $1,236 | 1.4× |
| Basic radiation dosimetry calculation (77300) | $184.82 | $379 | 1.4× |
| Bone age studies (77072) range across 2 matching MRF lines |
$143.75 | $214–$252 | 1.4× |
| Bone Imaging 3 Phase (78315) | $549.70 | $2,133 | 1.4× |
| Bone Imaging Limited Area (78300) | $549.70 | $1,431 | 1.4× |
| Bone Imaging Multiple Areas (78305) | $549.70 | $1,730 | 1.4× |
| Bone Imaging Whole Body (78306) | $549.70 | $1,873 | 1.4× |
| Bone marrow imaging limited area (78102) | $549.70 | $1,029 | 1.4× |
| Bone marrow imaging; multiple areas (78103) | $549.70 | $2,689 | 1.4× |
| Bone marrow imaging; whole body (78104) | $549.70 | — | 1.4× |
| Bone survey infant (77076) range across 2 matching MRF lines |
$143.75 | $636–$650 | 1.4× |
| Brachytx isodose complex (77318) | $514.85 | $1,469 | 1.4× |
| Brachytx isodose intermed (77317) | $514.85 | $1,255 | 1.4× |
| Brachytx Isodose Plan Simple (77316) | $514.85 | $807 | 1.4× |
| Brain Flow Imaging Only (78610) | $746.61 | $1,164 | 1.4× |
| Brain Image W/Flow < 4 Views (78601) | $549.70 | — | 1.4× |
| Brain imaging < 4 static views (78600) | $549.70 | $1,660 | 1.4× |
| Brain Imaging Min 4 Static Views W Vascular Flow (78606) | $746.61 | $2,278 | 1.4× |
| Brain Imaging Minimum 4 Static Views (78605) | $746.61 | $1,412 | 1.4× |
| Brain Imaging Pet Metabolic Evaluation (78608) | $1,966.24 | $6,440 | 1.4× |
| Card Bl Pool Gated Spect Rest Wal Motn Ejct Frct (78494) | $549.70 | $1,536 | 1.4× |
| Cardiac blood pool imaging, first pass technique; multiple studies, resting and with stress (exercise and/or… (78483) | $746.61 | — | 1.4× |
| Cardiac MRI w/w/o contrast & further seq (75561) | $479.72 | $4,827 | 1.4× |
| Cardiac MRI w/w/o contrast w/stress (75563) | $1,077.92 | $5,815 | 1.4× |
| Cardiac Shunt Detection (78428) | $549.70 | $1,392 | 1.4× |
| Cardiovasc nucl exam unlisted (78499) | $549.70 | — | 1.4× |
| Cat Scan Follow-Up Study (76380) | $119.66 | $1,458 | 1.4× |
| Cerebrospinal Fluid Flow W/O Matl Shunt Evaltj (78645) | $746.61 | $2,278 | 1.4× |
| Cerebrospinal fluid flow, imaging (not including introduction of material); ventriculography Non-Facility (78635) | $746.61 | — | 1.4× |
| Cerebrospinal Fluid Scan (78630) | $746.61 | $2,329 | 1.4× |
| Chest 1 view (71045) range across 3 matching MRF lines |
$119.66 | $179–$229 | 1.4× |
| Chest 2 views (71046) range across 2 matching MRF lines |
$119.66 | $258–$308 | 1.4× |
| Chest 3 views (71047) range across 2 matching MRF lines |
$119.66 | $296–$346 | 1.4× |
| Chest 4 or more views (71048) range across 2 matching MRF lines |
$143.75 | $337–$387 | 1.4× |
| Chg us nrv&acc strux 1 xtr compre w/img pr extremity (76883) | $143.75 | $924 | 1.4× |
| Cholecystography Oral Contrast (74290) | $241.18 | $563 | 1.4× |
| Cineradiograpy/vidradiograpy xcpt where spec (76120) | $143.75 | — | 1.4× |
| Cisternography Positive Contrast Rs&I (70015) | $1,077.92 | $888 | 1.4× |
| Clavicle complete (73000) range across 3 matching MRF lines |
$119.66 | $207–$257 | 1.4× |
| Computed Tomography Thorax Lw Dose Lng Ca Scr C- (71271) | $143.75 | $1,668 | 1.4× |
| Continuing medical physics consltj pr wk (77336) | $184.82 | $526 | 1.4× |
| Contrast Exam Abdominl Aorta (75625) | $4,341.66 | $2,794 | 1.4× |
| Contrast X-Ray Bladder (74430) | $479.72 | $349 | 1.4× |
| Contrast X-Ray Of Elbow (73085) | $479.72 | $1,055 | 1.4× |
| Contrast X-Ray Of Knee Joint (73580) | $479.72 | $1,392 | 1.4× |
| Contrast Xray Throat/Cerv Esopha (74210) | $241.18 | $441 | 1.4× |
| Corpora cavernosography (74445) | $143.75 | $417 | 1.4× |
| CT abdomen and pelvis without and with contrast (74178) | $479.72 | $4,501 | 1.4× |
| CT abdomen and pelvis without contrast (74176) | $328.08 | $2,732 | 1.4× |
| CT abdomen w contrast (74160) | $241.18 | $2,524 | 1.4× |
| CT abdomen w wo contrast (74170) | $241.18 | $2,901 | 1.4× |
| CT abdomen w/o contrast (74150) | $143.75 | $1,353 | 1.4× |
| CT Angio Abdomen and Pelvis (74174) | $479.72 | $3,981 | 1.4× |
| CT Angio Chest (71275) | $241.18 | $3,147 | 1.4× |
| CT Angio Head (70496) | $241.18 | $3,095 | 1.4× |
| CT angio hrt w/3d image (75574) | $479.72 | $3,036 | 1.4× |
| Ct Angio Lwr Extr W/O&W/Dye (73706) | $241.18 | $3,147 | 1.4× |
| CT Angio Neck (70498) | $241.18 | $3,084 | 1.4× |
| Ct Angio Upr Extrm W/O&W/Dye (73206) | $241.18 | $3,239 | 1.4× |
| CT bone density (77078) | $119.66 | — | 1.4× |
| CT Cere Prfuj Alys C+ W/O CT/Cta Same Anatomy (70473) | $241.18 | $1,638 | 1.4× |
| CT cervical spine w/ contrast (72126) | $479.72 | $2,263 | 1.4× |
| CT cervical spine w/o contrast (72125) | $143.75 | $1,575 | 1.4× |
| CT cervical spine w/wo cont (72127) | $241.18 | $3,110 | 1.4× |
| CT chest w contrast (71260) | $241.18 | $2,016 | 1.4× |
| CT chest w/wo contrast (71270) | $241.18 | $2,497 | 1.4× |
| CT colonography screening (74263) | $328.08 | $2,096 | 1.4× |
| CT Colonogrphy Dx Image Postprocess W/Contrast (74262) | $241.18 | $4,422 | 1.4× |
| CT colonogrphy dx image postprocess w/o contrast (74261) | $143.75 | $4,411 | 1.4× |
| CT head/brain with contrast (70460) | $241.18 | $1,602 | 1.4× |
| CT head/brain without and with contrast (70470) | $241.18 | $1,926 | 1.4× |
| CT heart contrast eval cardiac structure&morph (75572) | $479.72 | $2,230 | 1.4× |
| CT heart no contrast quant eval coronry calcium (75571) | $119.66 | $364 | 1.4× |
| CT hrt w/3d image congen (75573) | $479.72 | $2,726 | 1.4× |
| CT iac w contrast (70481) | $241.18 | $3,110 | 1.4× |
| CT l-spine w&w/o contrast (72133) | $241.18 | $3,095 | 1.4× |
| CT lower ext w/o (73700) | $143.75 | $1,560 | 1.4× |
| CT lower extremity w/contrast material (73701) | $241.18 | $2,278 | 1.4× |
| CT lumbar spine w contrast (72132) | $479.72 | $2,263 | 1.4× |
| CT lumbar spine w/o contrast (72131) | $143.75 | $1,560 | 1.4× |
| CT maxillofacial w contrast (70487) | $241.18 | $1,679 | 1.4× |
| CT maxillofacial wo contrast (70486) | $143.75 | $1,458 | 1.4× |
| CT neck tissue combo (70492) | $241.18 | $2,458 | 1.4× |
| Ct Orbit/Ear/Fossa W/O&W/Dye (70482) | $241.18 | $3,434 | 1.4× |
| CT orbits w/o contrast (70480) | $143.75 | $2,029 | 1.4× |
| CT pelvis w&w/o contrast (72194) | $241.18 | $2,693 | 1.4× |
| CT pelvis w/o contrast (72192) | $143.75 | $1,379 | 1.4× |
| CT scan of leg combo (73702) | $241.18 | $2,576 | 1.4× |
| CT scans face/jaw combo (70488) | $241.18 | $2,121 | 1.4× |
| CT soft tissue neck w contrast (70491) | $241.18 | $2,016 | 1.4× |
| CT soft tissue neck w/o contrast (70490) | $143.75 | $1,560 | 1.4× |
| CT thoracic spine w contrast (72129) | $241.18 | $2,278 | 1.4× |
| CT thoracic spine w/o contrast (72128) | $143.75 | $1,575 | 1.4× |
| CT thoracic spine w/wo cont (72130) | $241.18 | $3,135 | 1.4× |
| CT thorax w/o contrast (71250) | $143.75 | $1,418 | 1.4× |
| CT unlisted procedure (76497) range across 2 matching MRF lines |
$119.66 | $1,653–$1,908 | 1.4× |
| CT upper ext wo (73200) | $143.75 | $1,560 | 1.4× |
| CT upper extremity w/o & w/contrast material (73202) | $241.18 | $3,265 | 1.4× |
| CT upper extremity with contrast (73201) | $479.72 | $2,225 | 1.4× |
| Cta Abdl Aorta&Bi Iliofem W/Contrast&Postp (75635) | $241.18 | $4,864 | 1.4× |
| Cta Abdomen (74175) | $241.18 | $2,940 | 1.4× |
| CTA head&neck c+ w/noncontrast img&post-pxessing (70471) | $479.72 | $4,380 | 1.4× |
| CTA pelvis (72191) | $241.18 | $3,252 | 1.4× |
| Dacryocystography, nasolacrimal duct, radiological supervision and interpretation Non-Facility (70170) | $328.08 | — | 1.4× |
| Determination of central c-v hemodynamics (non-imaging) (eg, ejection fraction with probe technique) with or without… (78414) | $746.61 | — | 1.4× |
| Dilation ureters/urethra rs&i (74485) | $2,874.36 | $596 | 1.4× |
| Discography Cerv/Thor Spine (72285) | $2,685.07 | $547 | 1.4× |
| Diskography lumbar (72295) | $2,685.07 | $566 | 1.4× |
| Doppler Echo Fetal Puls Spectral F/U/Repeat (76828) | $143.75 | $293 | 1.4× |
| Doppler Echo Fetal Spectral Display Complete (76827) | $143.75 | $495 | 1.4× |
| Doppler Fetal Mid Cerebral Artery (76821) | $143.75 | $605 | 1.4× |
| Dxa Bone Density Axial (77080) range across 2 matching MRF lines |
$143.75 | $338–$369 | 1.4× |
| Dxa bone density study (77085) | $143.75 | — | 1.4× |
| Dxa bone density study 1/>sites appendiclr skel (77081) range across 2 matching MRF lines |
$119.66 | $193–$232 | 1.4× |
| Echo exam of fetal heart (76825) range across 2 matching MRF lines |
$751.34 | $1,444–$1,494 | 1.4× |
| Echo exam uterus (76831) | $328.08 | $615 | 1.4× |
| Echo Guide For Artery Repair (76936) | $296.91 | $1,665 | 1.4× |
| Echocardiography, fetal, cardiovascular system, real time with image documentation (2D), with or without M-mode… (76826) | $328.08 | $911 | 1.4× |
| Echograp Trans R Pros Study (76873) | $143.75 | $806 | 1.4× |
| Esophageal Motility Study (78258) | $549.70 | $1,444 | 1.4× |
| Esophagram (74220) | $241.18 | $478 | 1.4× |
| Fetal Biophys Profile W/Nst (76818) | $143.75 | $588 | 1.4× |
| Fetal Biophysical Profile W/O Non-Stress Testing (76819) | $143.75 | $429 | 1.4× |
| Fetal MRI w/placntl matrnl plvc img sing/1st ges (74712) | $328.08 | $3,771 | 1.4× |
| Fluoroscopy up to 1 hr (76000) | $328.08 | $616 | 1.4× |
| Follow-Up Angiography (75898) | $4,341.66 | $1,560 | 1.4× |
| Foot 2 views (73620) range across 3 matching MRF lines |
$119.66 | $244–$294 | 1.4× |
| Forearm 2 views (73090) range across 3 matching MRF lines |
$119.66 | $184–$234 | 1.4× |
| Gastric emptying imaging study (78264) | $549.70 | $1,990 | 1.4× |
| Gastric Emptyng Imag Std W/Sm Bwl Transit (78265) | $549.70 | — | 1.4× |
| Gastric Mucosa Imaging (78261) | $549.70 | — | 1.4× |
| Gastroesophageal Reflux Exam (78262) | $549.70 | $1,392 | 1.4× |
| Gastrointestinal Protein Loss (78282) | $549.70 | — | 1.4× |
| Gated Heart Planar Single (78472) | $549.70 | $1,392 | 1.4× |
| Gated Heart, Multiple (78473) | $549.70 | $1,887 | 1.4× |
| GI Endoscopic US S&I (76975) | $328.08 | — | 1.4× |
| Gstrc Emptng Imag Std W/Sm Bwl Col Trnst Mlt Day (78266) | $746.61 | — | 1.4× |
| Hand 2 views (73120) range across 3 matching MRF lines |
$143.75 | $211–$261 | 1.4× |
| Hdr Rdncl Ntrstl/Icav Brchtx (77772) | $957.68 | $2,732 | 1.4× |
| Hdr Rdncl Ntrstl/Icav Brchtx (77771) | $957.68 | $2,075 | 1.4× |
| Hdr Rdncl Ntrstl/Icav Brchtx 1 Channel (77770) | $957.68 | $1,431 | 1.4× |
| Heart first pass single,planar (78481) | $746.61 | $1,164 | 1.4× |
| Heart Image (Pet) Multiple (78492) | $1,966.24 | $6,132 | 1.4× |
| Hepatc Vngrph Wdg/Fr Hemodyn Eval Rs&I (75889) | $4,341.66 | $1,406 | 1.4× |
| Hepatc Vngrph Wdg/Fr W/O Hemodyn Eval Rs&I (75891) | $4,341.66 | $1,406 | 1.4× |
| Hepatobil Syst Image W/Drug (78227) | $746.61 | $2,705 | 1.4× |
| Hepatobiliary System Imaging (78226) | $549.70 | $1,978 | 1.4× |
| High energy neutron radj tx dlvr 1/> isocenter (77423) | $759.77 | — | 1.4× |
| Ht Musc Image Planar Mult (78454) | $1,780.19 | $3,382 | 1.4× |
| Ht Muscle Image Spect Sing (78451) | $1,780.19 | $3,147 | 1.4× |
| Hyperthermia external generated superficial (77600) | $530.35 | $1,452 | 1.4× |
| Hyperthermia generated by interstitial probe(s); 5 or fewer interstitial applicators Non-Facility (77610) | $759.77 | $2,459 | 1.4× |
| Hyperthermia generated by interstitial probe(s); more than 5 interstitial applicators Non-Facility (77615) | $759.77 | $3,748 | 1.4× |
| Hyperthermia generated by intracavitary probe(s) Non-Facility (77620) | $759.77 | — | 1.4× |
| Hyperthermia, externally generated; deep (ie, heating to depths greater than 4 cm) Non-Facility (77605) | $957.68 | $2,592 | 1.4× |
| Hysterosalpingogram (74740) | $328.08 | $584 | 1.4× |
| Image fusion (77399) | $184.82 | — | 1.4× |
| Infant hip ultrasound with hip movement (dynamic) (76885) | $119.66 | $682 | 1.4× |
| Infant hip ultrasound, limited static exam (76886) | $119.66 | $473 | 1.4× |
| Infusion Ivp (74410) | $241.18 | $906 | 1.4× |
| Interstitial radiation source applic complex (77778) | $957.68 | $1,854 | 1.4× |
| Intracavitary Radiation Source Applic Complex (77763) | $957.68 | $2,099 | 1.4× |
| Intracavitary Radiation Source Applic Intermed (77762) | $759.77 | $1,406 | 1.4× |
| Intracavitary radiation source applic simple (77761) | $759.77 | $1,550 | 1.4× |
| Intraop radiaj tx deliver electrons sngl tx sess (77425) | $10,127.56 | $19,511 | 1.4× |
| Intraop radiaj tx deliver xray single tx session (77424) | $10,127.56 | $19,511 | 1.4× |
| Joint Survey Single View (77077) | $143.75 | $275 | 1.4× |
| K Flow/Funct Image Multiple (78709) | $746.61 | $2,179 | 1.4× |
| K Flow/Funct Image W/Drug (78708) | $746.61 | $1,353 | 1.4× |
| K Flow/Funct Image W/O Drug (78707) | $746.61 | $1,783 | 1.4× |
| Kidney Funcj Study Non-Img Radioisotopic Study (78725) | $549.70 | $683 | 1.4× |
| Kidney Imaging Morphol (78700) | $549.70 | $1,103 | 1.4× |
| Kidney Imaging Morphoogy W/Vascular Flow (78701) | $549.70 | $1,735 | 1.4× |
| Knee 3 Views (73562) range across 3 matching MRF lines |
$119.66 | $278–$328 | 1.4× |
| Labeled RBC Sequestration Differntl Organ/Tissue (78140) | $549.70 | — | 1.4× |
| Leveen/Shunt Patency Exam (78291) | $549.70 | $1,848 | 1.4× |
| Liver & Spleen Imaging Static Only (78215) | $549.70 | $1,627 | 1.4× |
| Liver & Spleen Imaging W/Vascular Flow (78216) | $549.70 | — | 1.4× |
| Liver imaging static only (78201) | $746.61 | $1,612 | 1.4× |
| Liver imaging w/vascular flow (78202) | $746.61 | $1,691 | 1.4× |
| Lung Perf&Ventilat Diferentl (78598) | $746.61 | $1,900 | 1.4× |
| Lung perfusion differential (78597) | $549.70 | $1,153 | 1.4× |
| Lung Ventilat&Perfus Imaging (78582) | $746.61 | $2,433 | 1.4× |
| Lung Ventilation Imaging (78579) | $549.70 | $1,406 | 1.4× |
| Lymph System Imaging (78195) | $746.61 | $2,849 | 1.4× |
| Lymphangiography Extremity Only Bilateral Rs&I (75803) | $2,164.52 | $1,118 | 1.4× |
| Lymphangiography extremity only unilateral rs&i (75801) | $862.57 | $875 | 1.4× |
| Lymphangiography Pelvic/Abdominal Bilateral Rs&I (75807) | $4,341.66 | $1,431 | 1.4× |
| Lymphangiography, pelvic/abdominal, unilateral (75805) | $4,341.66 | $1,001 | 1.4× |
| Magnetic Image Jaw Joint (70336) | $328.08 | $3,135 | 1.4× |
| Magnetic resonance (eg, proton) imaging, brain (including brain stem andskull base), during open intracranial procedure… (70558) | $241.18 | $6,270 | 1.4× |
| Magnetic resonance (eg, proton) imaging, brain (including brain stem andskull base), during open intracranial procedure… (70557) | $751.34 | $5,696 | 1.4× |
| Magnetic resonance (eg, proton) imaging, brain (including brain stem andskull base), during open intracranial procedure… (70559) | $241.18 | $7,492 | 1.4× |
| Magnetic Resonance Elastography (76391) | $328.08 | $2,834 | 1.4× |
| Mammary ductogram or galactogram multiple (77054) | $328.08 | — | 1.4× |
| Mammary ductogram or galactogram single (77053) | $328.08 | $425 | 1.4× |
| Meckels Divert Exam (78290) | $549.70 | $2,133 | 1.4× |
| Medical physics dose eval radiation expos w/rprt (76145) | $513.11 | $607 | 1.4× |
| Mlc imrt design & construction per imrt plan (77338) | $514.85 | $2,590 | 1.4× |
| Mr safety determination physician/other qhp (76016) | $119.66 | $95 | 1.4× |
| Mr safety implant&/fb assmt clin staf 1st 15 min (76014) | $39.77 | $95 | 1.4× |
| Mr safety implt electronics prepj supvj phys/qhp (76018) | $130.73 | $225 | 1.4× |
| Mr safety implt pos&/immoblj (76019) | $81.12 | $345 | 1.4× |
| Mr safety med physics xm customization plng&mntr (76017) | $328.08 | $585 | 1.4× |
| Mra Head W/O & W/Contrast Material (70546) | $479.72 | $6,465 | 1.4× |
| MRA head w/o contrast (70544) | $328.08 | $3,370 | 1.4× |
| MRA head with contrast (70545) | $479.72 | $3,760 | 1.4× |
| MRA neck w contrast (70548) | $479.72 | $3,590 | 1.4× |
| Mra Neck W/O &W/Contrast Material (70549) | $479.72 | $4,553 | 1.4× |
| MRA neck w/o contrast (70547) | $328.08 | $3,395 | 1.4× |
| MRI abdomen w contrast (74182) | $479.72 | $4,670 | 1.4× |
| MRI abdomen w/o contrast (74181) | $328.08 | $3,292 | 1.4× |
| MRI any jt lower extrem w/contrast material (73722) | $1,077.92 | $3,785 | 1.4× |
| MRI any jt lower extrem w/o & w/contrast matrl (73723) | $479.72 | $4,566 | 1.4× |
| MRI any jt upper extremity w/contrast matrl (73222) | $1,077.92 | $3,760 | 1.4× |
| MRI bone marrow blood supply (77084) | $328.08 | $3,890 | 1.4× |
| MRI brain functional w/o physician admnistration (70554) | $328.08 | $4,059 | 1.4× |
| MRI brain functional w/physician admnistration (70555) | $328.08 | $4,059 | 1.4× |
| MRI Breast W/O Contrast Bilateral (77047) | $328.08 | $4,136 | 1.4× |
| MRI Breast Without Contrast Material Unilateral (77046) | $328.08 | $2,757 | 1.4× |
| MRI cardiac w/o cont stress (75559) | $751.34 | $4,749 | 1.4× |
| MRI cardiac w/o contrast (75557) | $328.08 | $3,355 | 1.4× |
| MRI cervical spine w contrast (72142) | $479.72 | $3,733 | 1.4× |
| MRI cervical spine w/o cont (72141) | $328.08 | $2,719 | 1.4× |
| MRI chest w/o contrast (71550) | $328.08 | $4,310 | 1.4× |
| MRI chest with contrast (71551) | $1,077.92 | $4,670 | 1.4× |
| MRI chest wo w contrast (71552) | $479.72 | $5,878 | 1.4× |
| MRI lower extrem oth/thn jt w/contrast matrl (73719) | $479.72 | $3,292 | 1.4× |
| MRI lower extrem oth/thn jt w/o & w/contr matr (73720) | $479.72 | $4,007 | 1.4× |
| MRI lower extrem oth/thn jt w/o contr matrl (73718) | $328.08 | $3,018 | 1.4× |
| MRI lumbar spine w contrast (72149) | $479.72 | $3,668 | 1.4× |
| Mri Neck Spine W/O & W/Dye (72156) | $479.72 | $4,189 | 1.4× |
| MRI orbit face &/neck w/o contrast (70540) | $328.08 | $3,200 | 1.4× |
| MRI orbit face neck w contrast (70542) | $479.72 | $3,785 | 1.4× |
| Mri Orbt/Fac/Nck W/O &W/Dye (70543) | $479.72 | $4,670 | 1.4× |
| MRI pelvis w contrast (72196) | $479.72 | $3,694 | 1.4× |
| MRI pelvis w/o & w contrast (72197) | $479.72 | $4,475 | 1.4× |
| MRI pelvis w/o contrast (72195) | $328.08 | $3,447 | 1.4× |
| MRI spectroscopy (76390) | $119.66 | $2,289 | 1.4× |
| MRI thoracic spine w/o contrast (72146) | $328.08 | $2,849 | 1.4× |
| MRI upper extremity oth than jt w/contr matrl (73219) | $479.72 | $4,059 | 1.4× |
| MRI upper extremity oth than jt w/o contr matrl (73218) | $328.08 | $3,771 | 1.4× |
| Mri Uppr Extremity W/O&W/Dye (73220) | $479.72 | $4,944 | 1.4× |
| MRI, abdomen, combo (74183) | $479.72 | $4,996 | 1.4× |
| MRI, dorsal spine combo (72157) | $479.72 | $4,202 | 1.4× |
| MRI, dorsal spine contrast (72147) | $479.72 | $4,436 | 1.4× |
| MRI, joint upper extrem (73221) | $328.08 | $2,940 | 1.4× |
| MRI, joint upper extrem combo (73223) | $479.72 | $4,579 | 1.4× |
| MRI, lumbar spine combo (72158) | $479.72 | $4,176 | 1.4× |
| Musculoskeletal Nuclear Exam (78399) | $549.70 | — | 1.4× |
| Myelogram cervical (72240) | $1,077.92 | $550 | 1.4× |
| Myelogram Lumbar (72265) | $1,077.92 | $531 | 1.4× |
| Myelography thoracic (72255) | $1,077.92 | — | 1.4× |
| Myelograpy 2/more regions rs&i (72270) | $1,077.92 | $633 | 1.4× |
| Myocardial Imaging Infarct Avid Planar Qual/Quan (78466) | $549.70 | $1,188 | 1.4× |
| Myocardial Imaging Pet Metabolic Evaluation (78459) | $1,780.19 | $5,352 | 1.4× |
| Myocardial imaging, infarct avid, planar; with ejection fraction by first pass technique Non-Facility (78468) | $746.61 | — | 1.4× |
| Myocardial Perfusion Planar 1 Study Rest/Stress (78453) | $1,780.19 | $2,329 | 1.4× |
| Myocardial Spect Multiple Studies (78452) | $1,780.19 | $4,032 | 1.4× |
| Myocrd Img Pet Metab Eval Single Study Cncrnt CT (78429) | $1,966.24 | $5,333 | 1.4× |
| Myocrd img PET prfuj 1std rest/stress cncrnt CT (78430) | $1,966.24 | $6,270 | 1.4× |
| Myocrd Img Pet Prfuj Mlt Std Rst&Strs Cncrnt CT (78431) | $3,028.92 | $6,830 | 1.4× |
| Myocrd Img Pet Prfuj W/Metab 2rtracer Cncrnt CT (78433) | $3,028.92 | $7,154 | 1.4× |
| Myocrd Img Pet Prfuj W/Metab Dual Radiotracer (78432) | $2,086.79 | $6,504 | 1.4× |
| N-invas est c ffr sw aly CTA (75580) | $1,180.80 | $13,078 | 1.4× |
| Neck soft tissue (70360) range across 2 matching MRF lines |
$119.66 | $211–$261 | 1.4× |
| Nervous system nuclear exam (78699) | $549.70 | — | 1.4× |
| Nfs/Instlj Radioelmnt Sln 3 Mo Follow-Up Care (77750) | $530.35 | — | 1.4× |
| Njx Rp Loclzj Non-Img Probe Study Intravenous (78808) | $549.70 | $676 | 1.4× |
| Nm csf leak detection (78650) | $1,780.19 | $2,255 | 1.4× |
| Nm myocard infarct spect (78469) | $746.61 | $1,350 | 1.4× |
| Nm red cell survival study (78130) | $549.70 | $800 | 1.4× |
| Nm unlisted gi procedure (78299) | $549.70 | — | 1.4× |
| Nm whole blood volume (78122) | $746.61 | — | 1.4× |
| Nonvascular Shunt X-Ray (75809) | $143.75 | $550 | 1.4× |
| Ntsty modul radthx pln dose-vol histos (77301) | $1,903.23 | $6,531 | 1.4× |
| Nuclear medicine study of endocrine organs (78099) | $549.70 | — | 1.4× |
| Nuclear Rx Intra-Arterial (79445) range across 2 matching MRF lines |
$320.85 | $1,110–$1,124 | 1.4× |
| Nuclear Rx Oral Admin (79005) | $320.85 | $878 | 1.4× |
| Ob us nuchal meas 1 gest (76813) | $143.75 | $586 | 1.4× |
| Oph bmtry us echograpy a-scan io lens pwr cal (76519) | $143.75 | $545 | 1.4× |
| Oph us dx ant sgm us immersion b-scan/hr biom (76513) | $143.75 | $633 | 1.4× |
| Oph US Dx B-Scan&Quan a-Scan Sm Pt Enctr (76510) | $182.95 | $911 | 1.4× |
| Ophthalmic Biometry US Echograpy a-Scan (76516) | $143.75 | $489 | 1.4× |
| Ophthalmic Ultrasonic Foreign Body Localization (76529) | $119.66 | $275 | 1.4× |
| Ophthalmic ultrasound dx b-scan w/wo a-scan (76512) | $143.75 | $511 | 1.4× |
| Ophthalmic US Dx Corneal Pachymetry Uni/Bi (76514) | $39.77 | $93 | 1.4× |
| Ophthalmic us dx quantitative a-scan only (76511) | $143.75 | — | 1.4× |
| Optic foramina (70190) | $119.66 | — | 1.4× |
| Panoramic X-ray of jaws (70355) | $119.66 | $102 | 1.4× |
| Parathyroid imaging w/tomographic spect & CT (78072) | $746.61 | $2,433 | 1.4× |
| Parathyroid Planar Imaging (78070) | $549.70 | $1,496 | 1.4× |
| Parathyroid planar imaging w/wo subtraction (78071) | $549.70 | $2,003 | 1.4× |
| Pelvis 1 or 2 views (72170) range across 2 matching MRF lines |
$143.75 | $243–$293 | 1.4× |
| Perineogram (74775) | $328.08 | — | 1.4× |
| Peritoneogram Rs&I (74190) | $751.34 | $703 | 1.4× |
| Pet Image Skull-Thigh (78812) | $1,966.24 | $5,228 | 1.4× |
| Pet Image W/Ct Lmtd (78814) | $1,966.24 | $6,790 | 1.4× |
| PET image w/CT, full body (78816) | $1,966.24 | $6,790 | 1.4× |
| PET imaging CT attenuation skull base mid-thigh (78815) | $1,966.24 | $6,790 | 1.4× |
| Pet Imaging Limited Area Chest Head/Neck (78811) | $1,780.19 | $5,490 | 1.4× |
| Pet Myocardial Sngl Study (78491) | $1,966.24 | $6,132 | 1.4× |
| PET whole body (78813) | $1,966.24 | $5,228 | 1.4× |
| Plasma Vol Radiopharm Vol Dilute Spx Mult Smples (78111) | $1,780.19 | $590 | 1.4× |
| Plasma volume, radiopharmaceutical volume-dilution technique (separate procedure); single sampling Non-Facility (78110) | $1,780.19 | — | 1.4× |
| Platelet survival study Non-Facility (78191) | $549.70 | — | 1.4× |
| Proton trmt simple w/comp (77522) | $1,718.45 | — | 1.4× |
| Proton tx delivery complex (77525) | $1,718.45 | — | 1.4× |
| Proton tx delivery intermediate (77523) | $1,718.45 | — | 1.4× |
| Proton tx delivery simple w/o compensation (77520) | $759.77 | — | 1.4× |
| Prq Transhepatc Portograpy Hemodyn Eval Rs&I (75885) | $4,341.66 | $1,392 | 1.4× |
| Pulmonary Perfusion Imaging Particulate (78580) | $549.70 | $1,743 | 1.4× |
| Quan&Charac C Atherosclerotc Plaq Asses Sev C Ds (75577) | $1,279.26 | — | 1.4× |
| Radex Abd Compl Aqt Abd W/S/E/D Views 1 View Ch (74022) range across 2 matching MRF lines |
$143.75 | $330–$380 | 1.4× |
| Radex abscess/fistula/sinus tract rs&i (76080) range across 2 matching MRF lines |
$751.34 | $367–$396 | 1.4× |
| Radex Ankle Complete Minimum 3 Views (73610) range across 3 matching MRF lines |
$119.66 | $240–$290 | 1.4× |
| Radex Calcaneus Minimum 2 Views (73650) range across 3 matching MRF lines |
$119.66 | $222–$272 | 1.4× |
| Radex elbow complete minimum 3 views (73080) range across 3 matching MRF lines |
$119.66 | $240–$290 | 1.4× |
| Radex Facial Bones Complete Minimum 3 Views (70150) range across 3 matching MRF lines |
$143.75 | $296–$346 | 1.4× |
| Radex fingr minimum 2 views (73140) range across 3 matching MRF lines |
$119.66 | $265–$315 | 1.4× |
| Radex foot complete minimum 3 views (73630) range across 3 matching MRF lines |
$119.66 | $222–$272 | 1.4× |
| Radex Hand Minimum 3 Views (73130) range across 3 matching MRF lines |
$119.66 | $243–$293 | 1.4× |
| Radex lower extremity infant minimum 2 views (73592) range across 2 matching MRF lines |
$119.66 | $195–$234 | 1.4× |
| Radex Mastoids Compl Minimum 3 Views PR Side (70130) range across 2 matching MRF lines |
$143.75 | $388–$416 | 1.4× |
| Radex Nasal Bones Complete Minimum 3 Views (70160) range across 3 matching MRF lines |
$119.66 | $255–$305 | 1.4× |
| Radex Pharynx/Larx W/Fluor&/Magnification Tq (70370) | $119.66 | $588 | 1.4× |
| Radex Ribs Unilateral 2 Views (71100) range across 2 matching MRF lines |
$119.66 | $232–$282 | 1.4× |
| Radex shoulder complete minimum 2 views (73030) range across 3 matching MRF lines |
$119.66 | $211–$261 | 1.4× |
| Radex Sinuses Paransl < 3 Views (70210) range across 3 matching MRF lines |
$119.66 | $222–$272 | 1.4× |
| Radex sm int w/mlt srl imges via enteroclss tube (74251) | $241.18 | $4,020 | 1.4× |
| Radex Spine 1 View Specify Level (72020) | $119.66 | $155 | 1.4× |
| Radex Sternum Minimum 2 Views (71120) range across 2 matching MRF lines |
$119.66 | $207–$257 | 1.4× |
| Radex Temporomandble Jt Opn & Clsd Mouth Bilat (70330) | $119.66 | $367 | 1.4× |
| Radex Toe Minimum 2 Views (73660) range across 3 matching MRF lines |
$119.66 | $229–$279 | 1.4× |
| Radex upper extremity infant minimum 2 views (73092) range across 2 matching MRF lines |
$143.75 | $204–$242 | 1.4× |
| Radex Wrist Complete Minimum 3 Views (73110) range across 3 matching MRF lines |
$119.66 | $278–$328 | 1.4× |
| Radex X-Ray Exam Entire Spi 6/> Vw - Xr Entire Spine 6+ Vw (72084) | $143.75 | $520 | 1.4× |
| Radiation Delivery Stereotactic Cranial Linear (77372) | $10,127.56 | $10,529 | 1.4× |
| Radiation treatment delivery level 1 (77402) range across 3 matching MRF lines |
$140.29 | $851–$1,439 | 1.4× |
| Radiation treatment delivery level 2 (77407) range across 4 matching MRF lines |
$530.35 | $846–$3,790 | 1.4× |
| Radiation treatment delivery level 3 (77412) range across 6 matching MRF lines |
$759.77 | $2,216–$3,790 | 1.4× |
| Radiolog exam mandible compl minimum 4 views (70110) range across 2 matching MRF lines |
$143.75 | $313–$363 | 1.4× |
| Radiologic Exam Abdomen 3+ Views - Xr Abdomen 3+ Views (74021) range across 2 matching MRF lines |
$143.75 | $293–$343 | 1.4× |
| Radiologic exam colon double contrast study (74280) | $241.18 | $1,029 | 1.4× |
| Radiologic exam colon single contrast study (74270) | $241.18 | $726 | 1.4× |
| Radiologic Exam Esophagus Double Contrast Study (74221) | $241.18 | $774 | 1.4× |
| Radiologic exam knee complete 4/more views (73564) range across 2 matching MRF lines |
$143.75 | $300–$350 | 1.4× |
| Radiologic exam pelvis compl minimum 3 views (72190) range across 2 matching MRF lines |
$143.75 | $283–$333 | 1.4× |
| Radiologic Exam Small Int Single Contrast Study (74250) | $241.18 | $669 | 1.4× |
| Radiologic exam swallow function contrast study (74230) | $241.18 | $752 | 1.4× |
| Radiologic exam teeth complete full mouth (70320) | $328.08 | $342 | 1.4× |
| Radiologic Exam Teeth Prtl Exam < Full Mouth (70310) | $328.08 | — | 1.4× |
| Radiologic exam upr gi trc double contrast study (74246) | $241.18 | $674 | 1.4× |
| Radiologic examination femur 1 view (73551) range across 2 matching MRF lines |
$119.66 | $207–$257 | 1.4× |
| Radiologic examination femur minimum 2 views (73552) range across 2 matching MRF lines |
$119.66 | $248–$298 | 1.4× |
| Radiologic examination knee 1/2 views (73560) range across 3 matching MRF lines |
$119.66 | $240–$290 | 1.4× |
| Radiologic Examination Osseous Survey Limited (77074) | $143.75 | $523 | 1.4× |
| Radiologic Examination Salivary Gland Calculus (70380) | $119.66 | — | 1.4× |
| Radiologic examination tibia & fibula 2 views (73590) range across 3 matching MRF lines |
$119.66 | $213–$263 | 1.4× |
| Radiologic examination, internal auditory meati, complete Non-Facility (70134) | $751.34 | — | 1.4× |
| Radiologic examination, teeth; single view Non-Facility (70300) | $119.66 | $197 | 1.4× |
| Radiopharm Dacryocystography (78660) | $549.70 | — | 1.4× |
| Radiopharmaceutical therapy, by interstitial radioactive colloid administration Facility (79300) | $320.85 | $1,239 | 1.4× |
| Radiopharmaceutical therapy, by intra-articular administration Non-Facility (79440) | $320.85 | $1,065 | 1.4× |
| Radiopharmaceutical therapy, by intracavitary administration Non-Facility (79200) | $320.85 | $808 | 1.4× |
| Red Cell Volume Determination Spx 1 Sampling (78120) | $549.70 | — | 1.4× |
| Red Cell Volume Determination Spx Mult Samplings (78121) | $746.61 | $619 | 1.4× |
| Remote afterloading high dose rate radionuclide skin surface brachytherapy, includes basic dosimetry, when performed;… (77768) | $530.35 | $391 | 1.4× |
| Remote afterloading high dose rate radionuclide skin surface brachytherapy, includes basic dosimetry, when performed;… (77767) | $530.35 | $391 | 1.4× |
| Renal Cyst Study (74470) | $751.34 | $618 | 1.4× |
| Ribs bilateral 3 views (71110) range across 2 matching MRF lines |
$143.75 | $313–$363 | 1.4× |
| Rp loclzj tum plnr 1 area single day imaging (78800) | $549.70 | $1,522 | 1.4× |
| Rp loclzj tum plnr 2+area 1+d img/1 area img>2+d (78801) | $549.70 | $2,007 | 1.4× |
| Rp Loclzj Tum Plnr Whole Body 2+ Days Imaging (78804) | $746.61 | $3,461 | 1.4× |
| Rp Loclzj Tum Plnr Whole Body Single Day Imaging (78802) | $746.61 | $2,433 | 1.4× |
| Rp Loclzj Tum Spect 1 Area Single Day Imaging (78803) | $746.61 | $2,510 | 1.4× |
| Rp loclzj tum spect 2 area/sep acquisj img (78831) | $1,780.19 | $9,188 | 1.4× |
| Rp loclzj tum spect CT 2area 1d img/1 ar img>2+d (78832) | $1,966.24 | $3,306 | 1.4× |
| Rp loclzj tum spect w/CT 1 area/acquisj 1day img (78830) | $1,780.19 | $6,186 | 1.4× |
| Rp Ther Radiolbld Monoclonal Antibody IV Infus (79403) | $320.85 | $1,449 | 1.4× |
| Rp Therapy Intravenous Administration (79101) range across 2 matching MRF lines |
$320.85 | $1,070–$1,081 | 1.4× |
| Rp Therapy Unlisted Procedure (79999) | $320.85 | — | 1.4× |
| Salivary Gland Function Study (78232) | $549.70 | — | 1.4× |
| Salivary Gland Imaging (78230) | $549.70 | — | 1.4× |
| Salivary Gland Imaging Serial Images (78231) | $549.70 | — | 1.4× |
| Scapula (73010) range across 3 matching MRF lines |
$143.75 | $275–$325 | 1.4× |
| Screening Digital Breast Tomosynthesis Bi (77063) | $31.13 | $133 | 1.3× |
| Sella turcica (70240) | $119.66 | — | 1.4× |
| Shoulder 1 view (73020) range across 3 matching MRF lines |
$119.66 | $158–$208 | 1.4× |
| Shoulder Arthrography (73040) | $479.72 | $1,159 | 1.4× |
| Sialogram (70390) | $328.08 | $788 | 1.4× |
| Skull less than 4 views (70250) range across 3 matching MRF lines |
$143.75 | $251–$301 | 1.4× |
| Special dosimetry (77331) | $184.82 | $195 | 1.4× |
| Special Physics Consult (77370) | $184.82 | $638 | 1.4× |
| Special teletherapy port plan (77321) | $514.85 | $683 | 1.4× |
| Special treatment procedure (77470) | $759.77 | $2,081 | 1.4× |
| Speech evaluation, complex (70371) | $328.08 | — | 1.4× |
| Spleen Imaging (78185) | $549.70 | $1,483 | 1.4× |
| Srs Multisource (77371) | $10,127.56 | $17,962 | 1.4× |
| Stereotactic Body Radiation Delivery (77373) range across 3 matching MRF lines |
$2,458.64 | $4,553–$5,352 | 1.4× |
| Sternoclavicular joints (71130) range across 2 matching MRF lines |
$119.66 | $262–$312 | 1.4× |
| Superior sagittal sinus venogram (75870) | $4,341.66 | $1,431 | 1.4× |
| Surf radj ther orthvlt dlvr>150-500 kv per fxj (77438) | $140.29 | — | 1.4× |
| Surf radj ther supfc dlvr<=150 kv per fraction (77437) | $140.29 | — | 1.4× |
| Surf radj ther supfc/orthvlt treatment planning (77436) | $51.36 | — | 1.4× |
| Surface Applic Low Dose Rate Radionuclide Source (77789) | $140.29 | — | 1.4× |
| Tbs techl prep&transmis data alys pfrmd elsewhr (77090) | $119.66 | — | 1.4× |
| Tbs technical calculation only (77091) | $119.66 | — | 1.4× |
| Telethx isodose pln cplx w/basic dosimetry (77307) | $514.85 | $1,176 | 1.4× |
| Telethx isodose pln smpl w/dosimetry calculation (77306) | $514.85 | $815 | 1.4× |
| Temporomandble Jt Arthrography Rs&I (70332) | $328.08 | — | 1.4× |
| Testicular Imaging W/Flow (78761) | $549.70 | $1,598 | 1.4× |
| Ther Rad Simulaj-Aided Field Setting Complex (77290) | $514.85 | $1,756 | 1.4× |
| Ther Rad Simulaj-Aided Field Setting Intermed (77285) | $514.85 | $1,274 | 1.4× |
| Ther rad simulaj-aided field setting simple (77280) | $184.82 | $748 | 1.4× |
| Therapeutic Enema Rdctj Intussusception/Obstrcj (74283) | $241.18 | $1,118 | 1.4× |
| Thoracic spine 2 views (72070) range across 2 matching MRF lines |
$143.75 | $240–$290 | 1.4× |
| Thoracic spine 3 views (72072) range across 2 matching MRF lines |
$143.75 | $251–$301 | 1.4× |
| Thoracolumbar 2 views (72080) | $119.66 | $236 | 1.4× |
| Thyroid carcinoma metastases imaging; with additional studies (eg, urinary recovery) Non-Facility (78016) | $549.70 | $1,665 | 1.4× |
| Thyroid Carcinoma Metastases Img Lmtd Area (78015) | $549.70 | — | 1.4× |
| Thyroid Imaging With Vascular Flow (78013) | $549.70 | $1,171 | 1.4× |
| Thyroid Met Imaging Body (78018) | $746.61 | $1,821 | 1.4× |
| Thyroid Uptake Measurement (78012) | $549.70 | $772 | 1.4× |
| Thyroid Uptake W/Blood Flow Sngle/Mult Quan Meas (78014) | $549.70 | $1,458 | 1.4× |
| Tx Devices Design & Construction Complex (77334) | $514.85 | $918 | 1.4× |
| Tx devices design & construction intermediate (77333) | $184.82 | $538 | 1.4× |
| Tx devices design & construction simple (77332) range across 2 matching MRF lines |
$184.82 | $404–$2,962 | 1.4× |
| Ultrasound Breast Limited (76642) range across 2 matching MRF lines |
$119.66 | $573–$623 | 1.4× |
| Ultrasound elastography first target lesion (76982) | $143.75 | $703 | 1.4× |
| Ultrasound Elastography Parenchyma (76981) | $143.75 | $820 | 1.4× |
| Ultrasound Exam Aaa Screen (76706) | $143.75 | $566 | 1.4× |
| Ultrasound trgt dynamic microbubble 1st lesion (76978) | $479.72 | $2,549 | 1.4× |
| Ultrasound, abdomen limited (76705) range across 2 matching MRF lines |
$143.75 | $658–$708 | 1.4× |
| Umbilical-artery Doppler (OB) (76820) | $143.75 | $479 | 1.4× |
| Unlis px ther radiol clinical tx planning (77299) | $184.82 | — | 1.4× |
| Unlisted Dx Radiographic Procedure (76499) range across 3 matching MRF lines |
$119.66 | $162–$1,717 | 1.4× |
| Unlisted fluoroscopic procedure (76496) | $119.66 | $1,171 | 1.4× |
| Unlisted genitourinary px dx nuclear medicine (78799) | $549.70 | — | 1.4× |
| Unlisted hematopoietic, reticuloendothelial and lymphatic procedure, diagnostic nuclear medicine (78199) | $549.70 | — | 1.4× |
| Unlisted magnetic resonance procedure (76498) | $119.66 | $8,226 | 1.4× |
| Unlisted Miscellaneous Px Dx Nuclear Medicine (78999) | $549.70 | — | 1.4× |
| Unlisted Procedure Clinical Brachytherapy (77799) | $140.29 | — | 1.4× |
| Unlisted respiratory px dx nuclear medicine (78599) | $549.70 | $2,278 | 1.4× |
| Unlisted us procedure (76999) range across 3 matching MRF lines |
$119.66 | $411–$1,301 | 1.4× |
| Upper gi w/o kub (74240) | $241.18 | $572 | 1.4× |
| Urea Breath Test C-14 Isotopic Acquisj Analysis (78267) | $15.26 | — | 1.4× |
| Urea breath test c-14 isotopic analysis (78268) | $130.29 | $500 | 1.4× |
| Ureteral Reflux Study (78740) | $549.70 | $1,301 | 1.4× |
| Urethrocystogram voiding (74455) | $328.08 | $551 | 1.4× |
| Urethrocystography retrograde (74450) | $328.08 | $499 | 1.4× |
| Us bone density measurement (76977) | $143.75 | $127 | 1.4× |
| Us breast unilateral complete (76641) range across 2 matching MRF lines |
$143.75 | $1,502–$1,552 | 1.4× |
| Us chest (76604) range across 2 matching MRF lines |
$143.75 | $561–$611 | 1.4× |
| Us complete joint (76881) | $143.75 | $776 | 1.4× |
| Us exam, pelvic, limited (76857) range across 2 matching MRF lines |
$143.75 | $501–$551 | 1.4× |
| Us head (76506) | $143.75 | $812 | 1.4× |
| Us kidney transplant (76776) | $143.75 | $1,132 | 1.4× |
| Us lmtd joint/oth nonvasc xtr strux r-t w/img (76882) range across 2 matching MRF lines |
$143.75 | $526–$576 | 1.4× |
| Us ob detailed single fetus (76811) | $328.08 | $905 | 1.4× |
| Us ob limited 1 or more fetuses (76815) range across 2 matching MRF lines |
$143.75 | $495–$545 | 1.4× |
| Us ob transvaginal (76817) | $143.75 | $536 | 1.4× |
| Us pelvic non ob complete (76856) range across 2 matching MRF lines |
$143.75 | $802–$852 | 1.4× |
| Us pg uter img f&mat 14 wk tabdl 1/1st gestation (76801) range across 2 matching MRF lines |
$143.75 | $623–$673 | 1.4× |
| Us preg uterus real time f/u trnsabdl per fetus (76816) range across 2 matching MRF lines |
$143.75 | $611–$661 | 1.4× |
| Us retroperitoneal complete (76770) range across 2 matching MRF lines |
$143.75 | $810–$860 | 1.4× |
| Us retroperitoneal limited (76775) range across 2 matching MRF lines |
$143.75 | $481–$531 | 1.4× |
| Us scrotum and contents (76870) range across 2 matching MRF lines |
$143.75 | $667–$717 | 1.4× |
| Us spinal canal and contents (76800) | $143.75 | $728 | 1.4× |
| Us thyroid (76536) range across 2 matching MRF lines |
$143.75 | $797–$847 | 1.4× |
| Us transrectal (76872) | $143.75 | $846 | 1.4× |
| Vascular Flow Imaging (78445) | $549.70 | $1,476 | 1.4× |
| Vasogram (74440) | $328.08 | $455 | 1.4× |
| Vein X-Ray Chest (75827) | $2,164.52 | $1,301 | 1.4× |
| Vein X-Ray Liver W/O Hemodyn (75887) | $4,341.66 | $1,392 | 1.4× |
| Vein X-Ray Skull Epidural (75872) | $862.57 | $1,431 | 1.4× |
| Vein X-Ray Spleen/Liver (75810) | $4,341.66 | $1,496 | 1.4× |
| Venogram Sinus/Jugular (75860) | $4,341.66 | $1,392 | 1.4× |
| Venography Adrenal Unilateral (75840) | $4,341.66 | $1,431 | 1.4× |
| Venography caval inferior serialography rs&i (75825) | $4,341.66 | $1,236 | 1.4× |
| Venography extremity bilateral rs&i (75822) | $2,164.52 | $877 | 1.4× |
| Venography extremity unilateral rs&i (75820) | $2,164.52 | $847 | 1.4× |
| Venography Orbital Rs&I (75880) | $862.57 | $1,431 | 1.4× |
| Venography Renal Bilateral (75833) | $4,341.66 | $1,469 | 1.4× |
| Venography Renal Unilateral (75831) | $4,341.66 | $1,341 | 1.4× |
| Venous sampling by catheter (75893) | $7,651.38 | $1,182 | 1.4× |
| Venous thrombosis imaging (78457) | $746.61 | $1,412 | 1.4× |
| Venous Thrombosis Imaging Venogram Bilateral (78458) | $549.70 | $1,462 | 1.4× |
| Vertebral fracture assessment via dxa (77086) | $119.66 | — | 1.4× |
| Wrist 2 views (73100) range across 3 matching MRF lines |
$119.66 | $240–$290 | 1.4× |
| X-Ray Ac Jts - Xr Acromioclavicular Joints Bilateral (73050) range across 3 matching MRF lines |
$119.66 | $265–$315 | 1.4× |
| X-ray antegrade pyelogram tube (74425) | $479.72 | $417 | 1.4× |
| X-Ray Aorta Leg Arteries (75630) | $4,341.66 | $2,794 | 1.4× |
| X-Ray Bend Only L-S Spine (72120) range across 2 matching MRF lines |
$143.75 | $311–$361 | 1.4× |
| X-Ray Elbow 2 Vw - Xr Elbow 1-2 Views Right (73070) range across 3 matching MRF lines |
$119.66 | $204–$254 | 1.4× |
| X-Ray Exam Breast Specimen (76098) range across 2 matching MRF lines |
$751.34 | $293–$326 | 1.4× |
| X-Ray Exam Entire Spi 1 Vw (72081) | $119.66 | $265 | 1.4× |
| X-Ray Exam Entire Spi 2/3 Vw (72082) | $143.75 | $313 | 1.4× |
| X-Ray Exam Entire Spi 4/5 Vw (72083) | $143.75 | $417 | 1.4× |
| X-Ray Exam Hip Uni 1 View (73501) range across 2 matching MRF lines |
$119.66 | $217–$267 | 1.4× |
| X-Ray Exam Hip Uni 2-3 Views (73502) range across 2 matching MRF lines |
$119.66 | $317–$367 | 1.4× |
| X-Ray Exam Hip Uni 4/> Views (73503) range across 2 matching MRF lines |
$143.75 | $392–$442 | 1.4× |
| X-Ray Exam Hips Bi 2 Views (73521) range across 2 matching MRF lines |
$143.75 | $278–$328 | 1.4× |
| X-Ray Exam Hips Bi 3-4 Views (73522) range across 2 matching MRF lines |
$143.75 | $355–$405 | 1.4× |
| X-Ray Exam Hips Bi 5/> Views (73523) range across 2 matching MRF lines |
$143.75 | $425–$475 | 1.4× |
| X-Ray Exam L-S Spine Bending (72114) range across 2 matching MRF lines |
$143.75 | $473–$523 | 1.4× |
| X-Ray Exam Neck Spine 2-3 Vw (72040) range across 2 matching MRF lines |
$119.66 | $232–$282 | 1.4× |
| X-Ray Exam Neck Spine 6/>Vws (72052) range across 2 matching MRF lines |
$143.75 | $395–$445 | 1.4× |
| X-Ray Exam Unilat Ribs/Chest (71101) range across 2 matching MRF lines |
$143.75 | $259–$309 | 1.4× |
| X-ray eye for foreign body (70030) | $119.66 | $207 | 1.4× |
| X-ray head for orthodontia (70350) | $119.66 | $102 | 1.4× |
| X-ray humerus (73060) range across 3 matching MRF lines |
$119.66 | $217–$267 | 1.4× |
| X-ray IV pyelogram (ivp) (74400) | $241.18 | $893 | 1.4× |
| X-ray IV pyelogram+tomography (74415) | $241.18 | $1,171 | 1.4× |
| X-Ray Jaw <4 Vw - Xr Mandible < 4 Views (70100) range across 2 matching MRF lines |
$119.66 | $251–$301 | 1.4× |
| X-Ray Knee Bilat Standing - Xr Knees Anteroposterior Standing Bilat (73565) range across 2 matching MRF lines |
$119.66 | $283–$333 | 1.4× |
| X-Ray Lumbar Spine 2/3 Vw - Xr Lumbar Spine 2-3 Views (72100) range across 2 matching MRF lines |
$143.75 | $251–$301 | 1.4× |
| X-ray nose-rectum child f.b. (76010) | $119.66 | $181 | 1.4× |
| X-Ray Ribs, Chest 4+ Vw - Xr Ribs 3 Vws Bil W/ Chest Posteroanterior (71111) range across 2 matching MRF lines |
$143.75 | $364–$414 | 1.4× |
| X-Ray Sacroiliac Jts 3+ Vw - Xr Sacroiliac Joints 3+ Views (72202) range across 2 matching MRF lines |
$143.75 | $248–$298 | 1.4× |
| X-Ray Sacroiliac Jts <3 Vw - Xr Sacroiliac Joints 1-2 Views (72200) range across 2 matching MRF lines |
$143.75 | $207–$257 | 1.4× |
| X-Ray Sacrum/Coccyx 2+ Vw - Xr Sacrum Coccyx 2+ Views (72220) range across 2 matching MRF lines |
$119.66 | $207–$257 | 1.4× |
| X-Ray Sinuses 3+ Vw - Xr Paranasal Sinuses 3+ Views (70220) range across 3 matching MRF lines |
$119.66 | $262–$312 | 1.4× |
| X-Ray Skull 4+ Vw - Xr Skull Complete 4+ Views (70260) range across 3 matching MRF lines |
$143.75 | $364–$414 | 1.4× |
| X-Ray Stress View (77071) | $119.66 | $198 | 1.4× |
| X-ray thoracic spine 4 vw (72074) range across 2 matching MRF lines |
$143.75 | $296–$346 | 1.4× |
| X-Ray Tmj Unilat (70328) | $119.66 | $226 | 1.4× |
| X-Ray Urinary Tract Exam With Contrast Material (74420) | $479.72 | $1,181 | 1.4× |
| X-Rays Bone Length Studies (77073) range across 2 matching MRF lines |
$143.75 | $343–$374 | 1.4× |
| X-Rays Bone Survey Complete (77075) range across 2 matching MRF lines |
$143.75 | $696–$707 | 1.4× |
| Xr c-spine 4 or 5 views (72050) range across 2 matching MRF lines |
$143.75 | $311–$361 | 1.4× |
| Xr facial bones less than 3 views (70140) range across 3 matching MRF lines |
$119.66 | $204–$254 | 1.4× |
| XR Mastoids < 3 Views Bilateral (70120) | $143.75 | — | 1.4× |
| Xr myelogram posterior fossa (70010) | $479.72 | $785 | 1.4× |
| Xr orbits complete 4 views (70200) range across 3 matching MRF lines |
$143.75 | $296–$346 | 1.4× |
| Xr Tomogram Single Plane (76100) | $143.75 | — | 1.4× |
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.