Imaging prices at Highland Hospital
Rochester, NY · 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) range across 3 matching MRF lines |
$1,642.94–$9,189.35 | — | varies |
| Abdomen 1 View (74018) range across 2 matching MRF lines |
$103.30–$371.45 | — | varies |
| Abdomen 2 views (74019) range across 2 matching MRF lines |
$124.09–$501.50 | — | varies |
| Acute Gastrointestinal Blood Loss Imaging (78278) range across 2 matching MRF lines |
$474.52–$1,734.85 | — | varies |
| Acute venous thrombosis imaging, peptide Non-Facility (78456) range across 2 matching MRF lines |
$1,536.73–$6,006.10 | — | varies |
| Adrenal Cortex & Medulla Img (78075) range across 2 matching MRF lines |
$1,536.73–$6,006.10 | — | varies |
| Angio internal mammary (75756) | $3,747.88 | — | 1.0× |
| Angio pulmonary bilat (75743) range across 2 matching MRF lines |
$3,747.88–$10,745.70 | — | varies |
| Angiography Adrenal Bilateral Slctv Rs&I (75733) | $3,747.88 | — | 1.0× |
| Angiography extremity bilateral rs&i (75716) | $3,747.88 | — | 1.0× |
| Angiography extremity unilateral rs&i (75710) range across 2 matching MRF lines |
$3,747.88–$10,745.70 | — | varies |
| Angiography pulmonary unilateral slctv rs&i (75741) | $3,747.88 | — | 1.0× |
| Angrph pulmonary nonslctv cath/ven njx rs&i (75746) | $3,747.88 | — | 1.0× |
| Ankle 2 views (73600) range across 2 matching MRF lines |
$103.30–$371.45 | — | varies |
| Aortography thoracic serialography rs&i (75605) range across 2 matching MRF lines |
$6,604.96–$18,496 | — | varies |
| Aortography thoracic w/o serialography rs&i (75600) | $3,747.88 | — | 1.0× |
| Artery X-Rays Abdomen (75726) range across 2 matching MRF lines |
$6,604.96–$18,496 | — | varies |
| Artery X-Rays Adrenal Gland (75731) | $3,747.88 | — | 1.0× |
| Artery X-Rays Pelvis (75736) range across 2 matching MRF lines |
$6,604.96–$18,496 | — | varies |
| Artery X-Rays Spine (75705) range across 2 matching MRF lines |
$6,604.96–$18,496 | — | varies |
| Arthrogram ankle (73615) range across 2 matching MRF lines |
$414.11–$1,770.55 | — | varies |
| Arthrogram hip (73525) range across 2 matching MRF lines |
$414.11–$1,692.35 | — | varies |
| Arthrogram Wrist (73115) range across 2 matching MRF lines |
$414.11–$1,692.35 | — | varies |
| Basic radiation dosimetry calculation (77300) range across 3 matching MRF lines |
$159.54–$1,207.85 | — | varies |
| Bone age studies (77072) range across 2 matching MRF lines |
$124.09–$501.50 | — | varies |
| Bone Imaging 3 Phase (78315) range across 2 matching MRF lines |
$474.52–$1,734.85 | — | varies |
| Bone Imaging Limited Area (78300) | $474.52 | — | 1.0× |
| Bone Imaging Multiple Areas (78305) | $474.52 | — | 1.0× |
| Bone Imaging Whole Body (78306) range across 2 matching MRF lines |
$474.52–$1,734.85 | — | varies |
| Bone marrow imaging limited area (78102) | $474.52 | — | 1.0× |
| Bone marrow imaging; multiple areas (78103) | $474.52 | — | 1.0× |
| Bone marrow imaging; whole body (78104) range across 2 matching MRF lines |
$474.52–$1,734.85 | — | varies |
| Bone survey infant (77076) range across 2 matching MRF lines |
$124.09–$501.50 | — | varies |
| Brachytx isodose complex (77318) range across 3 matching MRF lines |
$444.44–$2,752.30 | — | varies |
| Brachytx isodose intermed (77317) range across 3 matching MRF lines |
$444.44–$2,776.95 | — | varies |
| Brachytx Isodose Plan Simple (77316) range across 3 matching MRF lines |
$444.44–$3,464.60 | — | varies |
| Brain Flow Imaging Only (78610) | $644.50 | — | 1.0× |
| Brain Image W/Flow < 4 Views (78601) | $474.52 | — | 1.0× |
| Brain imaging < 4 static views (78600) | $474.52 | — | 1.0× |
| Brain Imaging Min 4 Static Views W Vascular Flow (78606) range across 2 matching MRF lines |
$644.50–$2,530.45 | — | varies |
| Brain Imaging Minimum 4 Static Views (78605) | $644.50 | — | 1.0× |
| Brain Imaging Pet Metabolic Evaluation (78608) | $1,697.33 | — | 1.0× |
| Card Bl Pool Gated Spect Rest Wal Motn Ejct Frct (78494) | $474.52 | — | 1.0× |
| Cardiac blood pool imaging, first pass technique; multiple studies, resting and with stress (exercise and/or… (78483) | $644.50 | — | 1.0× |
| Cardiac MRI w/w/o contrast & further seq (75561) range across 2 matching MRF lines |
$414.11–$2,680.05 | — | varies |
| Cardiac MRI w/w/o contrast w/stress (75563) range across 2 matching MRF lines |
$930.50–$4,581.50 | — | varies |
| Cardiac Shunt Detection (78428) | $474.52 | — | 1.0× |
| Cardiovasc nucl exam unlisted (78499) | $474.52 | — | 1.0× |
| Cat Scan Follow-Up Study (76380) | $103.30 | — | 1.0× |
| Cerebrospinal Fluid Flow W/O Matl Shunt Evaltj (78645) range across 2 matching MRF lines |
$644.50–$2,174.30 | — | varies |
| Cerebrospinal fluid flow, imaging (not including introduction of material); ventriculography Non-Facility (78635) | $644.50 | — | 1.0× |
| Cerebrospinal Fluid Scan (78630) range across 2 matching MRF lines |
$644.50–$2,530.45 | — | varies |
| Chest 1 view (71045) range across 2 matching MRF lines |
$103.30–$371.45 | — | varies |
| Chest 2 views (71046) range across 2 matching MRF lines |
$103.30–$371.45 | — | varies |
| Chest 3 views (71047) range across 2 matching MRF lines |
$103.30–$371.45 | — | varies |
| Chest 4 or more views (71048) range across 2 matching MRF lines |
$124.09–$501.50 | — | varies |
| Chg us nrv&acc strux 1 xtr compre w/img pr extremity (76883) | $124.09 | — | 1.0× |
| Cholecystography Oral Contrast (74290) range across 2 matching MRF lines |
$208.20–$821.10 | — | varies |
| Cineradiograpy/vidradiograpy xcpt where spec (76120) | $124.09 | — | 1.0× |
| Cisternography Positive Contrast Rs&I (70015) range across 3 matching MRF lines |
$930.50–$3,289.50 | — | varies |
| Clavicle complete (73000) range across 2 matching MRF lines |
$103.30–$371.45 | — | varies |
| Computed Tomography Thorax Lw Dose Lng Ca Scr C- (71271) range across 2 matching MRF lines |
$124.09–$335.75 | — | varies |
| Continuing medical physics consltj pr wk (77336) range across 2 matching MRF lines |
$159.54–$905.25 | — | varies |
| Contrast Exam Abdominl Aorta (75625) range across 2 matching MRF lines |
$3,747.88–$10,745.70 | — | varies |
| Contrast X-Ray Bladder (74430) range across 2 matching MRF lines |
$414.11–$1,692.35 | — | varies |
| Contrast X-Ray Of Elbow (73085) range across 2 matching MRF lines |
$414.11–$1,692.35 | — | varies |
| Contrast X-Ray Of Knee Joint (73580) range across 2 matching MRF lines |
$414.11–$1,692.35 | — | varies |
| Contrast Xray Throat/Cerv Esopha (74210) | $208.20 | — | 1.0× |
| Corpora cavernosography (74445) range across 2 matching MRF lines |
$124.09–$684.25 | — | varies |
| CT abdomen and pelvis without and with contrast (74178) range across 2 matching MRF lines |
$414.11–$2,680.05 | — | varies |
| CT abdomen and pelvis without contrast (74176) range across 2 matching MRF lines |
$283.22–$1,675.35 | — | varies |
| CT abdomen w contrast (74160) range across 2 matching MRF lines |
$208.20–$1,301.35 | — | varies |
| CT abdomen w wo contrast (74170) range across 2 matching MRF lines |
$208.20–$1,301.35 | — | varies |
| CT abdomen w/o contrast (74150) range across 2 matching MRF lines |
$124.09–$793.90 | — | varies |
| CT Angio Abdomen and Pelvis (74174) range across 2 matching MRF lines |
$414.11–$2,680.05 | — | varies |
| CT Angio Chest (71275) range across 2 matching MRF lines |
$208.20–$1,301.35 | — | varies |
| CT Angio Head (70496) range across 2 matching MRF lines |
$208.20–$1,301.35 | — | varies |
| CT angio hrt w/3d image (75574) | $414.11 | — | 1.0× |
| Ct Angio Lwr Extr W/O&W/Dye (73706) range across 2 matching MRF lines |
$208.20–$1,301.35 | — | varies |
| CT Angio Neck (70498) range across 2 matching MRF lines |
$208.20–$1,301.35 | — | varies |
| Ct Angio Upr Extrm W/O&W/Dye (73206) range across 2 matching MRF lines |
$208.20–$1,301.35 | — | varies |
| CT bone density (77078) | $103.30 | — | 1.0× |
| CT Cere Prfuj Alys C+ W/O CT/Cta Same Anatomy (70473) | $208.20 | — | 1.0× |
| CT cervical spine w/ contrast (72126) range across 2 matching MRF lines |
$414.11–$1,870 | — | varies |
| CT cervical spine w/o contrast (72125) range across 2 matching MRF lines |
$124.09–$793.90 | — | varies |
| CT cervical spine w/wo cont (72127) range across 2 matching MRF lines |
$208.20–$1,301.35 | — | varies |
| CT chest w contrast (71260) range across 2 matching MRF lines |
$208.20–$1,301.35 | — | varies |
| CT chest w/wo contrast (71270) range across 2 matching MRF lines |
$208.20–$1,301.35 | — | varies |
| CT colonography screening (74263) range across 2 matching MRF lines |
$283.22–$1,206.15 | — | varies |
| CT Colonogrphy Dx Image Postprocess W/Contrast (74262) range across 2 matching MRF lines |
$208.20–$1,301.35 | — | varies |
| CT colonogrphy dx image postprocess w/o contrast (74261) range across 2 matching MRF lines |
$124.09–$793.90 | — | varies |
| CT head/brain with contrast (70460) range across 2 matching MRF lines |
$208.20–$1,301.35 | — | varies |
| CT head/brain without and with contrast (70470) range across 2 matching MRF lines |
$208.20–$1,301.35 | — | varies |
| CT heart contrast eval cardiac structure&morph (75572) | $414.11 | — | 1.0× |
| CT heart no contrast quant eval coronry calcium (75571) | $103.30 | — | 1.0× |
| CT hrt w/3d image congen (75573) | $414.11 | — | 1.0× |
| CT iac w contrast (70481) range across 2 matching MRF lines |
$208.20–$1,301.35 | — | varies |
| CT l-spine w&w/o contrast (72133) range across 2 matching MRF lines |
$208.20–$1,301.35 | — | varies |
| CT lower ext w/o (73700) range across 2 matching MRF lines |
$124.09–$793.90 | — | varies |
| CT lower extremity w/contrast material (73701) range across 2 matching MRF lines |
$208.20–$1,301.35 | — | varies |
| CT lumbar spine w contrast (72132) range across 2 matching MRF lines |
$414.11–$1,870 | — | varies |
| CT lumbar spine w/o contrast (72131) range across 2 matching MRF lines |
$124.09–$793.90 | — | varies |
| CT maxillofacial w contrast (70487) range across 2 matching MRF lines |
$208.20–$1,301.35 | — | varies |
| CT maxillofacial wo contrast (70486) range across 2 matching MRF lines |
$124.09–$793.90 | — | varies |
| CT neck tissue combo (70492) range across 2 matching MRF lines |
$208.20–$1,301.35 | — | varies |
| Ct Orbit/Ear/Fossa W/O&W/Dye (70482) range across 2 matching MRF lines |
$208.20–$1,301.35 | — | varies |
| CT orbits w/o contrast (70480) range across 2 matching MRF lines |
$124.09–$793.90 | — | varies |
| CT pelvis w&w/o contrast (72194) range across 2 matching MRF lines |
$208.20–$1,301.35 | — | varies |
| CT pelvis w/o contrast (72192) range across 2 matching MRF lines |
$124.09–$793.90 | — | varies |
| CT scan of leg combo (73702) range across 2 matching MRF lines |
$208.20–$1,301.35 | — | varies |
| CT scans face/jaw combo (70488) range across 2 matching MRF lines |
$208.20–$1,301.35 | — | varies |
| CT soft tissue neck w contrast (70491) range across 2 matching MRF lines |
$208.20–$1,301.35 | — | varies |
| CT soft tissue neck w/o contrast (70490) range across 2 matching MRF lines |
$124.09–$793.90 | — | varies |
| CT thoracic spine w contrast (72129) range across 2 matching MRF lines |
$208.20–$1,301.35 | — | varies |
| CT thoracic spine w/o contrast (72128) range across 2 matching MRF lines |
$124.09–$793.90 | — | varies |
| CT thoracic spine w/wo cont (72130) range across 2 matching MRF lines |
$208.20–$1,301.35 | — | varies |
| CT thorax w/o contrast (71250) range across 2 matching MRF lines |
$124.09–$793.90 | — | varies |
| CT unlisted procedure (76497) | $103.30 | — | 1.0× |
| CT upper ext wo (73200) range across 2 matching MRF lines |
$124.09–$793.90 | — | varies |
| CT upper extremity w/o & w/contrast material (73202) range across 2 matching MRF lines |
$208.20–$1,301.35 | — | varies |
| CT upper extremity with contrast (73201) range across 2 matching MRF lines |
$414.11–$1,870 | — | varies |
| Cta Abdl Aorta&Bi Iliofem W/Contrast&Postp (75635) range across 2 matching MRF lines |
$208.20–$1,301.35 | — | varies |
| Cta Abdomen (74175) range across 2 matching MRF lines |
$208.20–$1,301.35 | — | varies |
| CTA head&neck c+ w/noncontrast img&post-pxessing (70471) | $414.11 | — | 1.0× |
| CTA pelvis (72191) range across 2 matching MRF lines |
$208.20–$1,301.35 | — | varies |
| Dacryocystography, nasolacrimal duct, radiological supervision and interpretation Non-Facility (70170) | $283.22 | — | 1.0× |
| Determination of central c-v hemodynamics (non-imaging) (eg, ejection fraction with probe technique) with or without… (78414) | $644.50 | — | 1.0× |
| Dilation ureters/urethra rs&i (74485) range across 2 matching MRF lines |
$2,481.25–$7,741.80 | — | varies |
| Discography Cerv/Thor Spine (72285) | $2,317.85 | — | 1.0× |
| Diskography lumbar (72295) | $2,317.85 | — | 1.0× |
| Doppler Echo Fetal Puls Spectral F/U/Repeat (76828) range across 2 matching MRF lines |
$124.09–$501.50 | — | varies |
| Doppler Echo Fetal Spectral Display Complete (76827) range across 2 matching MRF lines |
$124.09–$501.50 | — | varies |
| Doppler Fetal Mid Cerebral Artery (76821) range across 2 matching MRF lines |
$124.09–$501.50 | — | varies |
| Dxa Bone Density Axial (77080) | $124.09 | — | 1.0× |
| Dxa bone density study (77085) | $124.09 | — | 1.0× |
| Dxa bone density study 1/>sites appendiclr skel (77081) | $103.30 | — | 1.0× |
| Echo exam of fetal heart (76825) range across 2 matching MRF lines |
$648.59–$2,221.90 | — | varies |
| Echo exam uterus (76831) range across 2 matching MRF lines |
$283.22–$1,058.25 | — | varies |
| Echo Guide For Artery Repair (76936) | $256.30 | — | 1.0× |
| Echocardiography, fetal, cardiovascular system, real time with image documentation (2D), with or without M-mode… (76826) range across 2 matching MRF lines |
$283.22–$1,058.25 | — | varies |
| Echograp Trans R Pros Study (76873) range across 2 matching MRF lines |
$124.09–$530.40 | — | varies |
| Esophageal Motility Study (78258) range across 2 matching MRF lines |
$474.52–$1,734.85 | — | varies |
| Esophagram (74220) range across 2 matching MRF lines |
$208.20–$821.10 | — | varies |
| Fetal Biophys Profile W/Nst (76818) range across 2 matching MRF lines |
$124.09–$501.50 | — | varies |
| Fetal Biophysical Profile W/O Non-Stress Testing (76819) range across 2 matching MRF lines |
$124.09–$501.50 | — | varies |
| Fetal MRI w/placntl matrnl plvc img sing/1st ges (74712) range across 2 matching MRF lines |
$283.22–$1,675.35 | — | varies |
| Fluoroscopy up to 1 hr (76000) range across 2 matching MRF lines |
$283.22–$1,058.25 | — | varies |
| Follow-Up Angiography (75898) range across 2 matching MRF lines |
$3,747.88–$10,745.70 | — | varies |
| Foot 2 views (73620) range across 2 matching MRF lines |
$103.30–$371.45 | — | varies |
| Forearm 2 views (73090) range across 2 matching MRF lines |
$103.30–$371.45 | — | varies |
| Gastric emptying imaging study (78264) range across 2 matching MRF lines |
$474.52–$1,734.85 | — | varies |
| Gastric Emptyng Imag Std W/Sm Bwl Transit (78265) | $474.52 | — | 1.0× |
| Gastric Mucosa Imaging (78261) | $474.52 | — | 1.0× |
| Gastroesophageal Reflux Exam (78262) range across 2 matching MRF lines |
$474.52–$1,734.85 | — | varies |
| Gastrointestinal Protein Loss (78282) range across 2 matching MRF lines |
$474.52–$1,734.85 | — | varies |
| Gated Heart Planar Single (78472) range across 2 matching MRF lines |
$474.52–$1,734.85 | — | varies |
| Gated Heart, Multiple (78473) range across 2 matching MRF lines |
$474.52–$1,734.85 | — | varies |
| GI Endoscopic US S&I (76975) | $283.22 | — | 1.0× |
| Gstrc Emptng Imag Std W/Sm Bwl Col Trnst Mlt Day (78266) | $644.50 | — | 1.0× |
| Hand 2 views (73120) range across 2 matching MRF lines |
$124.09–$501.50 | — | varies |
| Hdr Rdncl Ntrstl/Icav Brchtx (77772) range across 3 matching MRF lines |
$826.70–$6,207.55 | — | varies |
| Hdr Rdncl Ntrstl/Icav Brchtx (77771) range across 3 matching MRF lines |
$826.70–$5,827.60 | — | varies |
| Hdr Rdncl Ntrstl/Icav Brchtx 1 Channel (77770) range across 3 matching MRF lines |
$826.70–$5,385.60 | — | varies |
| Heart first pass single,planar (78481) range across 2 matching MRF lines |
$644.50–$2,250.80 | — | varies |
| Heart Image (Pet) Multiple (78492) | $1,697.33 | — | 1.0× |
| Hepatc Vngrph Wdg/Fr Hemodyn Eval Rs&I (75889) range across 2 matching MRF lines |
$3,747.88–$10,745.70 | — | varies |
| Hepatc Vngrph Wdg/Fr W/O Hemodyn Eval Rs&I (75891) | $3,747.88 | — | 1.0× |
| Hepatobil Syst Image W/Drug (78227) range across 2 matching MRF lines |
$644.50–$2,250.80 | — | varies |
| Hepatobiliary System Imaging (78226) range across 2 matching MRF lines |
$474.52–$1,734.85 | — | varies |
| High energy neutron radj tx dlvr 1/> isocenter (77423) | $655.86 | — | 1.0× |
| Ht Musc Image Planar Mult (78454) | $1,536.73 | — | 1.0× |
| Ht Muscle Image Spect Sing (78451) range across 2 matching MRF lines |
$1,536.73–$6,006.10 | — | varies |
| Hyperthermia external generated superficial (77600) | $457.82 | — | 1.0× |
| Hyperthermia generated by interstitial probe(s); 5 or fewer interstitial applicators Non-Facility (77610) | $655.86 | — | 1.0× |
| Hyperthermia generated by interstitial probe(s); more than 5 interstitial applicators Non-Facility (77615) | $655.86 | — | 1.0× |
| Hyperthermia generated by intracavitary probe(s) Non-Facility (77620) | $655.86 | — | 1.0× |
| Hyperthermia, externally generated; deep (ie, heating to depths greater than 4 cm) Non-Facility (77605) | $826.70 | — | 1.0× |
| Hysterosalpingogram (74740) range across 2 matching MRF lines |
$283.22–$1,172.15 | — | varies |
| Image fusion (77399) | $159.54 | — | 1.0× |
| Infant hip ultrasound with hip movement (dynamic) (76885) range across 2 matching MRF lines |
$103.30–$428.40 | — | varies |
| Infant hip ultrasound, limited static exam (76886) range across 2 matching MRF lines |
$103.30–$371.45 | — | varies |
| Infusion Ivp (74410) range across 2 matching MRF lines |
$208.20–$821.10 | — | varies |
| Interstitial radiation source applic complex (77778) range across 2 matching MRF lines |
$826.70–$5,967.85 | — | varies |
| Intracavitary Radiation Source Applic Complex (77763) | $826.70 | — | 1.0× |
| Intracavitary Radiation Source Applic Intermed (77762) | $655.86 | — | 1.0× |
| Intracavitary radiation source applic simple (77761) | $655.86 | — | 1.0× |
| Intraop radiaj tx deliver electrons sngl tx sess (77425) | $8,742.49 | — | 1.0× |
| Intraop radiaj tx deliver xray single tx session (77424) | $8,742.49 | — | 1.0× |
| Joint Survey Single View (77077) range across 2 matching MRF lines |
$124.09–$501.50 | — | varies |
| K Flow/Funct Image Multiple (78709) range across 2 matching MRF lines |
$644.50–$2,250.80 | — | varies |
| K Flow/Funct Image W/Drug (78708) range across 2 matching MRF lines |
$644.50–$2,250.80 | — | varies |
| K Flow/Funct Image W/O Drug (78707) range across 2 matching MRF lines |
$644.50–$2,250.80 | — | varies |
| Kidney Funcj Study Non-Img Radioisotopic Study (78725) range across 2 matching MRF lines |
$474.52–$1,734.85 | — | varies |
| Kidney Imaging Morphol (78700) range across 2 matching MRF lines |
$474.52–$1,734.85 | — | varies |
| Kidney Imaging Morphoogy W/Vascular Flow (78701) range across 2 matching MRF lines |
$474.52–$1,734.85 | — | varies |
| Knee 3 Views (73562) range across 2 matching MRF lines |
$103.30–$371.45 | — | varies |
| Labeled RBC Sequestration Differntl Organ/Tissue (78140) | $474.52 | — | 1.0× |
| Leveen/Shunt Patency Exam (78291) range across 2 matching MRF lines |
$474.52–$1,734.85 | — | varies |
| Liver & Spleen Imaging Static Only (78215) range across 2 matching MRF lines |
$474.52–$1,734.85 | — | varies |
| Liver & Spleen Imaging W/Vascular Flow (78216) range across 2 matching MRF lines |
$474.52–$1,734.85 | — | varies |
| Liver imaging static only (78201) | $644.50 | — | 1.0× |
| Liver imaging w/vascular flow (78202) | $644.50 | — | 1.0× |
| Lung Perf&Ventilat Diferentl (78598) range across 2 matching MRF lines |
$644.50–$2,250.80 | — | varies |
| Lung perfusion differential (78597) range across 2 matching MRF lines |
$474.52–$1,734.85 | — | varies |
| Lung Ventilat&Perfus Imaging (78582) range across 2 matching MRF lines |
$644.50–$2,250.80 | — | varies |
| Lung Ventilation Imaging (78579) range across 2 matching MRF lines |
$474.52–$1,734.85 | — | varies |
| Lymph System Imaging (78195) range across 2 matching MRF lines |
$644.50–$2,250.80 | — | varies |
| Lymphangiography Extremity Only Bilateral Rs&I (75803) | $1,868.50 | — | 1.0× |
| Lymphangiography extremity only unilateral rs&i (75801) | $744.60 | — | 1.0× |
| Lymphangiography Pelvic/Abdominal Bilateral Rs&I (75807) | $3,747.88 | — | 1.0× |
| Lymphangiography, pelvic/abdominal, unilateral (75805) | $3,747.88 | — | 1.0× |
| Magnetic Image Jaw Joint (70336) range across 2 matching MRF lines |
$283.22–$1,675.35 | — | varies |
| Magnetic resonance (eg, proton) imaging, brain (including brain stem andskull base), during open intracranial procedure… (70558) | $208.20 | — | 1.0× |
| Magnetic resonance (eg, proton) imaging, brain (including brain stem andskull base), during open intracranial procedure… (70557) | $648.59 | — | 1.0× |
| Magnetic resonance (eg, proton) imaging, brain (including brain stem andskull base), during open intracranial procedure… (70559) | $208.20 | — | 1.0× |
| Magnetic Resonance Elastography (76391) range across 2 matching MRF lines |
$283.22–$957.10 | — | varies |
| Mammary ductogram or galactogram multiple (77054) range across 2 matching MRF lines |
$283.22–$1,058.25 | — | varies |
| Mammary ductogram or galactogram single (77053) range across 2 matching MRF lines |
$283.22–$1,058.25 | — | varies |
| Meckels Divert Exam (78290) range across 2 matching MRF lines |
$474.52–$1,734.85 | — | varies |
| Medical physics dose eval radiation expos w/rprt (76145) | $442.93 | — | 1.0× |
| Mlc imrt design & construction per imrt plan (77338) range across 3 matching MRF lines |
$444.44–$3,477.35 | — | varies |
| Mr safety determination physician/other qhp (76016) | $103.30 | — | 1.0× |
| Mr safety implant&/fb assmt clin staf 1st 15 min (76014) | $34.33 | — | 1.0× |
| Mr safety implt electronics prepj supvj phys/qhp (76018) | $112.85 | — | 1.0× |
| Mr safety implt pos&/immoblj (76019) | $70.02 | — | 1.0× |
| Mr safety med physics xm customization plng&mntr (76017) | $283.22 | — | 1.0× |
| Mra Head W/O & W/Contrast Material (70546) range across 2 matching MRF lines |
$414.11–$2,680.05 | — | varies |
| MRA head w/o contrast (70544) range across 2 matching MRF lines |
$283.22–$1,675.35 | — | varies |
| MRA head with contrast (70545) range across 2 matching MRF lines |
$414.11–$2,680.05 | — | varies |
| MRA neck w contrast (70548) range across 2 matching MRF lines |
$414.11–$2,680.05 | — | varies |
| Mra Neck W/O &W/Contrast Material (70549) range across 2 matching MRF lines |
$414.11–$2,680.05 | — | varies |
| MRA neck w/o contrast (70547) range across 2 matching MRF lines |
$283.22–$1,675.35 | — | varies |
| MRI abdomen w contrast (74182) range across 2 matching MRF lines |
$414.11–$2,680.05 | — | varies |
| MRI abdomen w/o contrast (74181) range across 2 matching MRF lines |
$283.22–$1,675.35 | — | varies |
| MRI any jt lower extrem w/contrast material (73722) range across 2 matching MRF lines |
$930.50–$3,751.90 | — | varies |
| MRI any jt lower extrem w/o & w/contrast matrl (73723) range across 2 matching MRF lines |
$414.11–$2,680.05 | — | varies |
| MRI any jt upper extremity w/contrast matrl (73222) range across 2 matching MRF lines |
$930.50–$3,751.90 | — | varies |
| MRI bone marrow blood supply (77084) | $283.22 | — | 1.0× |
| MRI brain functional w/o physician admnistration (70554) | $283.22 | — | 1.0× |
| MRI brain functional w/physician admnistration (70555) | $283.22 | — | 1.0× |
| MRI Breast W/O Contrast Bilateral (77047) range across 2 matching MRF lines |
$283.22–$1,675.35 | — | varies |
| MRI Breast Without Contrast Material Unilateral (77046) range across 2 matching MRF lines |
$283.22–$957.10 | — | varies |
| MRI cardiac w/o cont stress (75559) range across 2 matching MRF lines |
$648.59–$2,946.10 | — | varies |
| MRI cardiac w/o contrast (75557) range across 2 matching MRF lines |
$283.22–$1,675.35 | — | varies |
| MRI cervical spine w contrast (72142) range across 2 matching MRF lines |
$414.11–$2,680.05 | — | varies |
| MRI cervical spine w/o cont (72141) range across 2 matching MRF lines |
$283.22–$1,675.35 | — | varies |
| MRI chest w/o contrast (71550) range across 2 matching MRF lines |
$283.22–$1,675.35 | — | varies |
| MRI chest with contrast (71551) range across 2 matching MRF lines |
$930.50–$3,751.90 | — | varies |
| MRI chest wo w contrast (71552) range across 2 matching MRF lines |
$414.11–$2,680.05 | — | varies |
| MRI lower extrem oth/thn jt w/contrast matrl (73719) range across 2 matching MRF lines |
$414.11–$2,680.05 | — | varies |
| MRI lower extrem oth/thn jt w/o & w/contr matr (73720) range across 2 matching MRF lines |
$414.11–$2,680.05 | — | varies |
| MRI lower extrem oth/thn jt w/o contr matrl (73718) range across 2 matching MRF lines |
$283.22–$1,675.35 | — | varies |
| MRI lumbar spine w contrast (72149) range across 2 matching MRF lines |
$414.11–$2,680.05 | — | varies |
| Mri Neck Spine W/O & W/Dye (72156) range across 2 matching MRF lines |
$414.11–$2,680.05 | — | varies |
| MRI orbit face &/neck w/o contrast (70540) range across 2 matching MRF lines |
$283.22–$1,675.35 | — | varies |
| MRI orbit face neck w contrast (70542) range across 2 matching MRF lines |
$414.11–$2,680.05 | — | varies |
| Mri Orbt/Fac/Nck W/O &W/Dye (70543) range across 2 matching MRF lines |
$414.11–$2,680.05 | — | varies |
| MRI pelvis w contrast (72196) range across 2 matching MRF lines |
$414.11–$2,680.05 | — | varies |
| MRI pelvis w/o & w contrast (72197) range across 2 matching MRF lines |
$414.11–$2,680.05 | — | varies |
| MRI pelvis w/o contrast (72195) range across 2 matching MRF lines |
$283.22–$1,675.35 | — | varies |
| MRI spectroscopy (76390) range across 2 matching MRF lines |
$103.30–$589.05 | — | varies |
| MRI thoracic spine w/o contrast (72146) range across 2 matching MRF lines |
$283.22–$1,675.35 | — | varies |
| MRI upper extremity oth than jt w/contr matrl (73219) range across 2 matching MRF lines |
$414.11–$2,680.05 | — | varies |
| MRI upper extremity oth than jt w/o contr matrl (73218) range across 2 matching MRF lines |
$283.22–$1,675.35 | — | varies |
| Mri Uppr Extremity W/O&W/Dye (73220) range across 2 matching MRF lines |
$414.11–$2,680.05 | — | varies |
| MRI, abdomen, combo (74183) range across 2 matching MRF lines |
$414.11–$2,680.05 | — | varies |
| MRI, dorsal spine combo (72157) range across 2 matching MRF lines |
$414.11–$2,680.05 | — | varies |
| MRI, dorsal spine contrast (72147) range across 2 matching MRF lines |
$414.11–$2,680.05 | — | varies |
| MRI, joint upper extrem (73221) range across 2 matching MRF lines |
$283.22–$1,675.35 | — | varies |
| MRI, joint upper extrem combo (73223) range across 2 matching MRF lines |
$414.11–$2,680.05 | — | varies |
| MRI, lumbar spine combo (72158) range across 2 matching MRF lines |
$414.11–$2,680.05 | — | varies |
| Musculoskeletal Nuclear Exam (78399) | $474.52 | — | 1.0× |
| Myelogram cervical (72240) | $930.50 | — | 1.0× |
| Myelogram Lumbar (72265) range across 2 matching MRF lines |
$930.50–$3,289.50 | — | varies |
| Myelography thoracic (72255) | $930.50 | — | 1.0× |
| Myelograpy 2/more regions rs&i (72270) | $930.50 | — | 1.0× |
| Myocardial Imaging Infarct Avid Planar Qual/Quan (78466) range across 2 matching MRF lines |
$474.52–$1,734.85 | — | varies |
| Myocardial Imaging Pet Metabolic Evaluation (78459) | $1,536.73 | — | 1.0× |
| Myocardial imaging, infarct avid, planar; with ejection fraction by first pass technique Non-Facility (78468) | $644.50 | — | 1.0× |
| Myocardial Perfusion Planar 1 Study Rest/Stress (78453) | $1,536.73 | — | 1.0× |
| Myocardial Spect Multiple Studies (78452) range across 2 matching MRF lines |
$1,536.73–$6,006.10 | — | varies |
| Myocrd Img Pet Metab Eval Single Study Cncrnt CT (78429) | $1,697.33 | — | 1.0× |
| Myocrd img PET prfuj 1std rest/stress cncrnt CT (78430) | $1,697.33 | — | 1.0× |
| Myocrd Img Pet Prfuj Mlt Std Rst&Strs Cncrnt CT (78431) | $2,614.68 | — | 1.0× |
| Myocrd Img Pet Prfuj W/Metab 2rtracer Cncrnt CT (78433) | $2,614.68 | — | 1.0× |
| Myocrd Img Pet Prfuj W/Metab Dual Radiotracer (78432) | $1,801.40 | — | 1.0× |
| N-invas est c ffr sw aly CTA (75580) | $1,019.31 | — | 1.0× |
| Neck soft tissue (70360) range across 2 matching MRF lines |
$103.30–$371.45 | — | varies |
| Nervous system nuclear exam (78699) | $474.52 | — | 1.0× |
| Nfs/Instlj Radioelmnt Sln 3 Mo Follow-Up Care (77750) range across 2 matching MRF lines |
$457.82–$1,264.80 | — | varies |
| Njx Rp Loclzj Non-Img Probe Study Intravenous (78808) | $474.52 | — | 1.0× |
| Nm csf leak detection (78650) | $1,536.73 | — | 1.0× |
| Nm myocard infarct spect (78469) | $644.50 | — | 1.0× |
| Nm red cell survival study (78130) | $474.52 | — | 1.0× |
| Nm unlisted gi procedure (78299) | $474.52 | — | 1.0× |
| Nm whole blood volume (78122) | $644.50 | — | 1.0× |
| Nonvascular Shunt X-Ray (75809) | $124.09 | — | 1.0× |
| Ntsty modul radthx pln dose-vol histos (77301) range across 3 matching MRF lines |
$1,642.94–$10,075.05 | — | varies |
| Nuclear medicine study of endocrine organs (78099) | $474.52 | — | 1.0× |
| Nuclear Rx Intra-Arterial (79445) | $276.97 | — | 1.0× |
| Nuclear Rx Oral Admin (79005) range across 2 matching MRF lines |
$276.97–$1,242.70 | — | varies |
| Ob us nuchal meas 1 gest (76813) range across 2 matching MRF lines |
$124.09–$505.75 | — | varies |
| Oph bmtry us echograpy a-scan io lens pwr cal (76519) | $124.09 | — | 1.0× |
| Oph us dx ant sgm us immersion b-scan/hr biom (76513) | $124.09 | — | 1.0× |
| Oph US Dx B-Scan&Quan a-Scan Sm Pt Enctr (76510) | $157.93 | — | 1.0× |
| Ophthalmic Biometry US Echograpy a-Scan (76516) | $124.09 | — | 1.0× |
| Ophthalmic Ultrasonic Foreign Body Localization (76529) | $103.30 | — | 1.0× |
| Ophthalmic ultrasound dx b-scan w/wo a-scan (76512) range across 3 matching MRF lines |
$124.09–$653.65 | — | varies |
| Ophthalmic US Dx Corneal Pachymetry Uni/Bi (76514) | $34.33 | — | 1.0× |
| Ophthalmic us dx quantitative a-scan only (76511) | $124.09 | — | 1.0× |
| Optic foramina (70190) range across 2 matching MRF lines |
$103.30–$371.45 | — | varies |
| Panoramic X-ray of jaws (70355) range across 2 matching MRF lines |
$103.30–$371.45 | — | varies |
| Parathyroid imaging w/tomographic spect & CT (78072) | $644.50 | — | 1.0× |
| Parathyroid Planar Imaging (78070) range across 2 matching MRF lines |
$474.52–$1,734.85 | — | varies |
| Parathyroid planar imaging w/wo subtraction (78071) | $474.52 | — | 1.0× |
| Pelvis 1 or 2 views (72170) range across 2 matching MRF lines |
$124.09–$501.50 | — | varies |
| Perineogram (74775) range across 2 matching MRF lines |
$283.22–$1,058.25 | — | varies |
| Peritoneogram Rs&I (74190) | $648.59 | — | 1.0× |
| Pet Image Skull-Thigh (78812) | $1,697.33 | — | 1.0× |
| Pet Image W/Ct Lmtd (78814) | $1,697.33 | — | 1.0× |
| PET image w/CT, full body (78816) | $1,697.33 | — | 1.0× |
| PET imaging CT attenuation skull base mid-thigh (78815) | $1,697.33 | — | 1.0× |
| Pet Imaging Limited Area Chest Head/Neck (78811) | $1,536.73 | — | 1.0× |
| Pet Myocardial Sngl Study (78491) | $1,697.33 | — | 1.0× |
| PET whole body (78813) | $1,697.33 | — | 1.0× |
| Plasma Vol Radiopharm Vol Dilute Spx Mult Smples (78111) | $1,536.73 | — | 1.0× |
| Plasma volume, radiopharmaceutical volume-dilution technique (separate procedure); single sampling Non-Facility (78110) range across 2 matching MRF lines |
$1,536.73–$6,006.10 | — | varies |
| Platelet survival study Non-Facility (78191) | $474.52 | — | 1.0× |
| Proton trmt simple w/comp (77522) | $1,483.42 | — | 1.0× |
| Proton tx delivery complex (77525) | $1,483.42 | — | 1.0× |
| Proton tx delivery intermediate (77523) | $1,483.42 | — | 1.0× |
| Proton tx delivery simple w/o compensation (77520) | $655.86 | — | 1.0× |
| Prq Transhepatc Portograpy Hemodyn Eval Rs&I (75885) range across 2 matching MRF lines |
$3,747.88–$10,745.70 | — | varies |
| Pulmonary Perfusion Imaging Particulate (78580) range across 2 matching MRF lines |
$474.52–$1,734.85 | — | varies |
| Quan&Charac C Atherosclerotc Plaq Asses Sev C Ds (75577) | $1,104.31 | — | 1.0× |
| Radex Abd Compl Aqt Abd W/S/E/D Views 1 View Ch (74022) range across 2 matching MRF lines |
$124.09–$501.50 | — | varies |
| Radex abscess/fistula/sinus tract rs&i (76080) range across 2 matching MRF lines |
$648.59–$2,221.90 | — | varies |
| Radex Ankle Complete Minimum 3 Views (73610) range across 2 matching MRF lines |
$103.30–$371.45 | — | varies |
| Radex Calcaneus Minimum 2 Views (73650) range across 2 matching MRF lines |
$103.30–$371.45 | — | varies |
| Radex elbow complete minimum 3 views (73080) range across 2 matching MRF lines |
$103.30–$371.45 | — | varies |
| Radex Facial Bones Complete Minimum 3 Views (70150) range across 2 matching MRF lines |
$124.09–$501.50 | — | varies |
| Radex fingr minimum 2 views (73140) range across 2 matching MRF lines |
$103.30–$371.45 | — | varies |
| Radex foot complete minimum 3 views (73630) range across 2 matching MRF lines |
$103.30–$371.45 | — | varies |
| Radex Hand Minimum 3 Views (73130) range across 2 matching MRF lines |
$103.30–$371.45 | — | varies |
| Radex lower extremity infant minimum 2 views (73592) | $103.30 | — | 1.0× |
| Radex Mastoids Compl Minimum 3 Views PR Side (70130) range across 2 matching MRF lines |
$124.09–$501.50 | — | varies |
| Radex Nasal Bones Complete Minimum 3 Views (70160) range across 2 matching MRF lines |
$103.30–$371.45 | — | varies |
| Radex Pharynx/Larx W/Fluor&/Magnification Tq (70370) | $103.30 | — | 1.0× |
| Radex Ribs Unilateral 2 Views (71100) range across 2 matching MRF lines |
$103.30–$371.45 | — | varies |
| Radex shoulder complete minimum 2 views (73030) range across 2 matching MRF lines |
$103.30–$371.45 | — | varies |
| Radex Sinuses Paransl < 3 Views (70210) range across 2 matching MRF lines |
$103.30–$371.45 | — | varies |
| Radex sm int w/mlt srl imges via enteroclss tube (74251) range across 2 matching MRF lines |
$208.20–$821.10 | — | varies |
| Radex Spine 1 View Specify Level (72020) range across 2 matching MRF lines |
$103.30–$371.45 | — | varies |
| Radex Sternum Minimum 2 Views (71120) range across 2 matching MRF lines |
$103.30–$371.45 | — | varies |
| Radex Temporomandble Jt Opn & Clsd Mouth Bilat (70330) range across 2 matching MRF lines |
$103.30–$371.45 | — | varies |
| Radex Toe Minimum 2 Views (73660) range across 2 matching MRF lines |
$103.30–$371.45 | — | varies |
| Radex upper extremity infant minimum 2 views (73092) | $124.09 | — | 1.0× |
| Radex Wrist Complete Minimum 3 Views (73110) range across 2 matching MRF lines |
$103.30–$371.45 | — | varies |
| Radex X-Ray Exam Entire Spi 6/> Vw - Xr Entire Spine 6+ Vw (72084) range across 2 matching MRF lines |
$124.09–$603.50 | — | varies |
| Radiation Delivery Stereotactic Cranial Linear (77372) | $8,742.49 | — | 1.0× |
| Radiation treatment delivery level 1 (77402) range across 2 matching MRF lines |
$121.11–$865.30 | — | varies |
| Radiation treatment delivery level 2 (77407) | $457.82 | — | 1.0× |
| Radiation treatment delivery level 3 (77412) range across 2 matching MRF lines |
$655.86–$2,037.45 | — | varies |
| Radiolog exam mandible compl minimum 4 views (70110) range across 2 matching MRF lines |
$124.09–$501.50 | — | varies |
| Radiologic Exam Abdomen 3+ Views - Xr Abdomen 3+ Views (74021) range across 2 matching MRF lines |
$124.09–$501.50 | — | varies |
| Radiologic exam colon double contrast study (74280) range across 2 matching MRF lines |
$208.20–$821.10 | — | varies |
| Radiologic exam colon single contrast study (74270) range across 2 matching MRF lines |
$208.20–$821.10 | — | varies |
| Radiologic Exam Esophagus Double Contrast Study (74221) | $208.20 | — | 1.0× |
| Radiologic exam knee complete 4/more views (73564) range across 2 matching MRF lines |
$124.09–$501.50 | — | varies |
| Radiologic exam pelvis compl minimum 3 views (72190) range across 2 matching MRF lines |
$124.09–$501.50 | — | varies |
| Radiologic Exam Small Int Single Contrast Study (74250) range across 2 matching MRF lines |
$208.20–$821.10 | — | varies |
| Radiologic exam swallow function contrast study (74230) range across 2 matching MRF lines |
$208.20–$821.10 | — | varies |
| Radiologic exam teeth complete full mouth (70320) | $283.22 | — | 1.0× |
| Radiologic Exam Teeth Prtl Exam < Full Mouth (70310) | $283.22 | — | 1.0× |
| Radiologic exam upr gi trc double contrast study (74246) range across 2 matching MRF lines |
$208.20–$821.10 | — | varies |
| Radiologic examination femur 1 view (73551) range across 2 matching MRF lines |
$103.30–$371.45 | — | varies |
| Radiologic examination femur minimum 2 views (73552) range across 2 matching MRF lines |
$103.30–$371.45 | — | varies |
| Radiologic examination knee 1/2 views (73560) range across 2 matching MRF lines |
$103.30–$371.45 | — | varies |
| Radiologic Examination Osseous Survey Limited (77074) range across 2 matching MRF lines |
$124.09–$501.50 | — | varies |
| Radiologic Examination Salivary Gland Calculus (70380) range across 2 matching MRF lines |
$103.30–$371.45 | — | varies |
| Radiologic examination tibia & fibula 2 views (73590) range across 2 matching MRF lines |
$103.30–$371.45 | — | varies |
| Radiologic examination, internal auditory meati, complete Non-Facility (70134) | $648.59 | — | 1.0× |
| Radiologic examination, teeth; single view Non-Facility (70300) | $103.30 | — | 1.0× |
| Radiopharm Dacryocystography (78660) | $474.52 | — | 1.0× |
| Radiopharmaceutical therapy, by interstitial radioactive colloid administration Facility (79300) | $276.97 | — | 1.0× |
| Radiopharmaceutical therapy, by intra-articular administration Non-Facility (79440) | $276.97 | — | 1.0× |
| Radiopharmaceutical therapy, by intracavitary administration Non-Facility (79200) | $276.97 | — | 1.0× |
| Red Cell Volume Determination Spx 1 Sampling (78120) | $474.52 | — | 1.0× |
| Red Cell Volume Determination Spx Mult Samplings (78121) | $644.50 | — | 1.0× |
| Remote afterloading high dose rate radionuclide skin surface brachytherapy, includes basic dosimetry, when performed;… (77768) | $457.82 | — | 1.0× |
| Remote afterloading high dose rate radionuclide skin surface brachytherapy, includes basic dosimetry, when performed;… (77767) | $457.82 | — | 1.0× |
| Renal Cyst Study (74470) | $648.59 | — | 1.0× |
| Ribs bilateral 3 views (71110) range across 2 matching MRF lines |
$124.09–$501.50 | — | varies |
| Rp loclzj tum plnr 1 area single day imaging (78800) range across 2 matching MRF lines |
$474.52–$1,734.85 | — | varies |
| Rp loclzj tum plnr 2+area 1+d img/1 area img>2+d (78801) | $474.52 | — | 1.0× |
| Rp Loclzj Tum Plnr Whole Body 2+ Days Imaging (78804) range across 2 matching MRF lines |
$644.50–$6,006.10 | — | varies |
| Rp Loclzj Tum Plnr Whole Body Single Day Imaging (78802) | $644.50 | — | 1.0× |
| Rp Loclzj Tum Spect 1 Area Single Day Imaging (78803) range across 2 matching MRF lines |
$644.50–$6,006.10 | — | varies |
| Rp loclzj tum spect 2 area/sep acquisj img (78831) | $1,536.73 | — | 1.0× |
| Rp loclzj tum spect CT 2area 1d img/1 ar img>2+d (78832) | $1,697.33 | — | 1.0× |
| Rp loclzj tum spect w/CT 1 area/acquisj 1day img (78830) | $1,536.73 | — | 1.0× |
| Rp Ther Radiolbld Monoclonal Antibody IV Infus (79403) | $276.97 | — | 1.0× |
| Rp Therapy Intravenous Administration (79101) | $276.97 | — | 1.0× |
| Rp Therapy Unlisted Procedure (79999) | $276.97 | — | 1.0× |
| Salivary Gland Function Study (78232) | $474.52 | — | 1.0× |
| Salivary Gland Imaging (78230) | $474.52 | — | 1.0× |
| Salivary Gland Imaging Serial Images (78231) range across 2 matching MRF lines |
$474.52–$1,734.85 | — | varies |
| Scapula (73010) range across 2 matching MRF lines |
$124.09–$501.50 | — | varies |
| Screening Digital Breast Tomosynthesis Bi (77063) | $85 | — | 3.6× |
| Sella turcica (70240) range across 2 matching MRF lines |
$103.30–$371.45 | — | varies |
| Shoulder 1 view (73020) range across 2 matching MRF lines |
$103.30–$371.45 | — | varies |
| Shoulder Arthrography (73040) range across 2 matching MRF lines |
$414.11–$1,692.35 | — | varies |
| Sialogram (70390) range across 2 matching MRF lines |
$283.22–$1,058.25 | — | varies |
| Skull less than 4 views (70250) range across 2 matching MRF lines |
$124.09–$501.50 | — | varies |
| Special dosimetry (77331) range across 3 matching MRF lines |
$159.54–$1,118.60 | — | varies |
| Special Physics Consult (77370) range across 3 matching MRF lines |
$159.54–$1,535.95 | — | varies |
| Special teletherapy port plan (77321) range across 2 matching MRF lines |
$444.44–$2,452.25 | — | varies |
| Special treatment procedure (77470) range across 3 matching MRF lines |
$655.86–$3,984.80 | — | varies |
| Speech evaluation, complex (70371) | $283.22 | — | 1.0× |
| Spleen Imaging (78185) range across 2 matching MRF lines |
$474.52–$1,734.85 | — | varies |
| Srs Multisource (77371) | $8,742.49 | — | 1.0× |
| Stereotactic Body Radiation Delivery (77373) range across 2 matching MRF lines |
$2,122.39–$8,348.70 | — | varies |
| Sternoclavicular joints (71130) range across 2 matching MRF lines |
$103.30–$371.45 | — | varies |
| Superior sagittal sinus venogram (75870) | $3,747.88 | — | 1.0× |
| Surf radj ther orthvlt dlvr>150-500 kv per fxj (77438) | $121.11 | — | 1.0× |
| Surf radj ther supfc dlvr<=150 kv per fraction (77437) | $121.11 | — | 1.0× |
| Surf radj ther supfc/orthvlt treatment planning (77436) | $44.34 | — | 1.0× |
| Surface Applic Low Dose Rate Radionuclide Source (77789) | $121.11 | — | 1.0× |
| Tbs techl prep&transmis data alys pfrmd elsewhr (77090) | $103.30 | — | 1.0× |
| Tbs technical calculation only (77091) | $103.30 | — | 1.0× |
| Telethx isodose pln cplx w/basic dosimetry (77307) range across 3 matching MRF lines |
$444.44–$3,144.15 | — | varies |
| Telethx isodose pln smpl w/dosimetry calculation (77306) range across 3 matching MRF lines |
$444.44–$1,972 | — | varies |
| Temporomandble Jt Arthrography Rs&I (70332) range across 2 matching MRF lines |
$283.22–$1,218.90 | — | varies |
| Testicular Imaging W/Flow (78761) range across 2 matching MRF lines |
$474.52–$1,734.85 | — | varies |
| Ther Rad Simulaj-Aided Field Setting Complex (77290) range across 3 matching MRF lines |
$444.44–$2,829.65 | — | varies |
| Ther Rad Simulaj-Aided Field Setting Intermed (77285) range across 2 matching MRF lines |
$444.44–$1,637.95 | — | varies |
| Ther rad simulaj-aided field setting simple (77280) range across 3 matching MRF lines |
$159.54–$1,078.65 | — | varies |
| Therapeutic Enema Rdctj Intussusception/Obstrcj (74283) range across 2 matching MRF lines |
$208.20–$821.10 | — | varies |
| Thoracic spine 2 views (72070) range across 2 matching MRF lines |
$124.09–$501.50 | — | varies |
| Thoracic spine 3 views (72072) range across 2 matching MRF lines |
$124.09–$501.50 | — | varies |
| Thoracolumbar 2 views (72080) range across 2 matching MRF lines |
$103.30–$371.45 | — | varies |
| Thyroid carcinoma metastases imaging; with additional studies (eg, urinary recovery) Non-Facility (78016) | $474.52 | — | 1.0× |
| Thyroid Carcinoma Metastases Img Lmtd Area (78015) range across 2 matching MRF lines |
$474.52–$1,734.85 | — | varies |
| Thyroid Imaging With Vascular Flow (78013) range across 2 matching MRF lines |
$474.52–$1,734.85 | — | varies |
| Thyroid Met Imaging Body (78018) range across 2 matching MRF lines |
$644.50–$2,250.80 | — | varies |
| Thyroid Uptake Measurement (78012) range across 2 matching MRF lines |
$474.52–$1,734.85 | — | varies |
| Thyroid Uptake W/Blood Flow Sngle/Mult Quan Meas (78014) range across 2 matching MRF lines |
$474.52–$1,734.85 | — | varies |
| Tx Devices Design & Construction Complex (77334) range across 3 matching MRF lines |
$444.44–$1,956.70 | — | varies |
| Tx devices design & construction intermediate (77333) | $159.54 | — | 1.0× |
| Tx devices design & construction simple (77332) range across 3 matching MRF lines |
$159.54–$1,178.95 | — | varies |
| Ultrasound Breast Limited (76642) range across 2 matching MRF lines |
$103.30–$372.30 | — | varies |
| Ultrasound elastography first target lesion (76982) | $124.09 | — | 1.0× |
| Ultrasound Elastography Parenchyma (76981) | $124.09 | — | 1.0× |
| Ultrasound Exam Aaa Screen (76706) range across 3 matching MRF lines |
$124.09–$756.50 | — | varies |
| Ultrasound trgt dynamic microbubble 1st lesion (76978) | $414.11 | — | 1.0× |
| Ultrasound, abdomen limited (76705) range across 3 matching MRF lines |
$124.09–$760.75 | — | varies |
| Umbilical-artery Doppler (OB) (76820) range across 2 matching MRF lines |
$124.09–$501.50 | — | varies |
| Unlis px ther radiol clinical tx planning (77299) | $159.54 | — | 1.0× |
| Unlisted Dx Radiographic Procedure (76499) | $103.30 | — | 1.0× |
| Unlisted fluoroscopic procedure (76496) | $103.30 | — | 1.0× |
| Unlisted genitourinary px dx nuclear medicine (78799) | $474.52 | — | 1.0× |
| Unlisted hematopoietic, reticuloendothelial and lymphatic procedure, diagnostic nuclear medicine (78199) | $474.52 | — | 1.0× |
| Unlisted magnetic resonance procedure (76498) range across 2 matching MRF lines |
$103.30–$589.05 | — | varies |
| Unlisted Miscellaneous Px Dx Nuclear Medicine (78999) | $474.52 | — | 1.0× |
| Unlisted Procedure Clinical Brachytherapy (77799) | $121.11 | — | 1.0× |
| Unlisted respiratory px dx nuclear medicine (78599) | $474.52 | — | 1.0× |
| Unlisted us procedure (76999) range across 2 matching MRF lines |
$103.30–$371.45 | — | varies |
| Upper gi w/o kub (74240) range across 2 matching MRF lines |
$208.20–$821.10 | — | varies |
| Urea Breath Test C-14 Isotopic Acquisj Analysis (78267) | $40.80 | — | 3.7× |
| Urea breath test c-14 isotopic analysis (78268) | $430.95 | — | 4.6× |
| Ureteral Reflux Study (78740) | $474.52 | — | 1.0× |
| Urethrocystogram voiding (74455) range across 2 matching MRF lines |
$283.22–$1,058.25 | — | varies |
| Urethrocystography retrograde (74450) | $283.22 | — | 1.0× |
| Us bone density measurement (76977) | $124.09 | — | 1.0× |
| Us breast unilateral complete (76641) range across 2 matching MRF lines |
$124.09–$501.50 | — | varies |
| Us chest (76604) range across 3 matching MRF lines |
$124.09–$760.75 | — | varies |
| Us complete joint (76881) range across 3 matching MRF lines |
$124.09–$772.65 | — | varies |
| Us exam, pelvic, limited (76857) range across 3 matching MRF lines |
$124.09–$614.55 | — | varies |
| Us head (76506) range across 2 matching MRF lines |
$124.09–$631.55 | — | varies |
| Us kidney transplant (76776) range across 2 matching MRF lines |
$124.09–$631.55 | — | varies |
| Us lmtd joint/oth nonvasc xtr strux r-t w/img (76882) range across 3 matching MRF lines |
$124.09–$624.75 | — | varies |
| Us ob detailed single fetus (76811) range across 2 matching MRF lines |
$283.22–$1,058.25 | — | varies |
| Us ob limited 1 or more fetuses (76815) range across 3 matching MRF lines |
$124.09–$646.85 | — | varies |
| Us ob transvaginal (76817) range across 3 matching MRF lines |
$124.09–$660.45 | — | varies |
| Us pelvic non ob complete (76856) range across 2 matching MRF lines |
$124.09–$505.75 | — | varies |
| Us pg uter img f&mat 14 wk tabdl 1/1st gestation (76801) range across 2 matching MRF lines |
$124.09–$501.50 | — | varies |
| Us preg uterus real time f/u trnsabdl per fetus (76816) range across 2 matching MRF lines |
$124.09–$501.50 | — | varies |
| Us retroperitoneal complete (76770) range across 2 matching MRF lines |
$124.09–$631.55 | — | varies |
| Us retroperitoneal limited (76775) range across 3 matching MRF lines |
$124.09–$760.75 | — | varies |
| Us scrotum and contents (76870) range across 2 matching MRF lines |
$124.09–$631.55 | — | varies |
| Us spinal canal and contents (76800) range across 2 matching MRF lines |
$124.09–$501.50 | — | varies |
| Us thyroid (76536) range across 3 matching MRF lines |
$124.09–$850.85 | — | varies |
| Us transrectal (76872) range across 2 matching MRF lines |
$124.09–$505.75 | — | varies |
| Vascular Flow Imaging (78445) range across 2 matching MRF lines |
$474.52–$1,734.85 | — | varies |
| Vasogram (74440) range across 2 matching MRF lines |
$283.22–$1,058.25 | — | varies |
| Vein X-Ray Chest (75827) range across 2 matching MRF lines |
$1,868.50–$5,292.10 | — | varies |
| Vein X-Ray Liver W/O Hemodyn (75887) range across 2 matching MRF lines |
$3,747.88–$10,745.70 | — | varies |
| Vein X-Ray Skull Epidural (75872) | $744.60 | — | 1.0× |
| Vein X-Ray Spleen/Liver (75810) range across 2 matching MRF lines |
$3,747.88–$10,745.70 | — | varies |
| Venogram Sinus/Jugular (75860) | $3,747.88 | — | 1.0× |
| Venography Adrenal Unilateral (75840) | $3,747.88 | — | 1.0× |
| Venography caval inferior serialography rs&i (75825) range across 2 matching MRF lines |
$3,747.88–$10,745.70 | — | varies |
| Venography extremity bilateral rs&i (75822) range across 2 matching MRF lines |
$1,868.50–$5,292.10 | — | varies |
| Venography extremity unilateral rs&i (75820) range across 2 matching MRF lines |
$1,868.50–$5,292.10 | — | varies |
| Venography Orbital Rs&I (75880) | $744.60 | — | 1.0× |
| Venography Renal Bilateral (75833) range across 2 matching MRF lines |
$3,747.88–$10,745.70 | — | varies |
| Venography Renal Unilateral (75831) range across 2 matching MRF lines |
$3,747.88–$10,745.70 | — | varies |
| Venous sampling by catheter (75893) | $6,604.96 | — | 1.0× |
| Venous thrombosis imaging (78457) | $644.50 | — | 1.0× |
| Venous Thrombosis Imaging Venogram Bilateral (78458) range across 2 matching MRF lines |
$474.52–$1,734.85 | — | varies |
| Vertebral fracture assessment via dxa (77086) | $103.30 | — | 1.0× |
| Wrist 2 views (73100) range across 2 matching MRF lines |
$103.30–$371.45 | — | varies |
| X-Ray Ac Jts - Xr Acromioclavicular Joints Bilateral (73050) range across 2 matching MRF lines |
$103.30–$371.45 | — | varies |
| X-ray antegrade pyelogram tube (74425) range across 2 matching MRF lines |
$414.11–$1,692.35 | — | varies |
| X-Ray Aorta Leg Arteries (75630) range across 2 matching MRF lines |
$3,747.88–$10,745.70 | — | varies |
| X-Ray Bend Only L-S Spine (72120) range across 2 matching MRF lines |
$124.09–$501.50 | — | varies |
| X-Ray Elbow 2 Vw - Xr Elbow 1-2 Views Right (73070) range across 2 matching MRF lines |
$103.30–$371.45 | — | varies |
| X-Ray Exam Breast Specimen (76098) range across 2 matching MRF lines |
$648.59–$2,221.90 | — | varies |
| X-Ray Exam Entire Spi 1 Vw (72081) range across 2 matching MRF lines |
$103.30–$371.45 | — | varies |
| X-Ray Exam Entire Spi 2/3 Vw (72082) range across 2 matching MRF lines |
$124.09–$501.50 | — | varies |
| X-Ray Exam Entire Spi 4/5 Vw (72083) range across 2 matching MRF lines |
$124.09–$640.90 | — | varies |
| X-Ray Exam Hip Uni 1 View (73501) range across 2 matching MRF lines |
$103.30–$371.45 | — | varies |
| X-Ray Exam Hip Uni 2-3 Views (73502) range across 2 matching MRF lines |
$103.30–$371.45 | — | varies |
| X-Ray Exam Hip Uni 4/> Views (73503) range across 2 matching MRF lines |
$124.09–$501.50 | — | varies |
| X-Ray Exam Hips Bi 2 Views (73521) range across 2 matching MRF lines |
$124.09–$501.50 | — | varies |
| X-Ray Exam Hips Bi 3-4 Views (73522) range across 2 matching MRF lines |
$124.09–$501.50 | — | varies |
| X-Ray Exam Hips Bi 5/> Views (73523) range across 2 matching MRF lines |
$124.09–$603.50 | — | varies |
| X-Ray Exam L-S Spine Bending (72114) range across 2 matching MRF lines |
$124.09–$501.50 | — | varies |
| X-Ray Exam Neck Spine 2-3 Vw (72040) range across 2 matching MRF lines |
$103.30–$371.45 | — | varies |
| X-Ray Exam Neck Spine 6/>Vws (72052) range across 2 matching MRF lines |
$124.09–$501.50 | — | varies |
| X-Ray Exam Unilat Ribs/Chest (71101) range across 2 matching MRF lines |
$124.09–$501.50 | — | varies |
| X-ray eye for foreign body (70030) range across 2 matching MRF lines |
$103.30–$371.45 | — | varies |
| X-ray head for orthodontia (70350) | $103.30 | — | 1.0× |
| X-ray humerus (73060) range across 2 matching MRF lines |
$103.30–$371.45 | — | varies |
| X-ray IV pyelogram (ivp) (74400) | $208.20 | — | 1.0× |
| X-ray IV pyelogram+tomography (74415) | $208.20 | — | 1.0× |
| X-Ray Jaw <4 Vw - Xr Mandible < 4 Views (70100) | $103.30 | — | 1.0× |
| X-Ray Knee Bilat Standing - Xr Knees Anteroposterior Standing Bilat (73565) range across 2 matching MRF lines |
$103.30–$371.45 | — | varies |
| X-Ray Lumbar Spine 2/3 Vw - Xr Lumbar Spine 2-3 Views (72100) range across 2 matching MRF lines |
$124.09–$501.50 | — | varies |
| X-ray nose-rectum child f.b. (76010) range across 3 matching MRF lines |
$103.30–$408 | — | varies |
| X-Ray Ribs, Chest 4+ Vw - Xr Ribs 3 Vws Bil W/ Chest Posteroanterior (71111) range across 2 matching MRF lines |
$124.09–$501.50 | — | varies |
| X-Ray Sacroiliac Jts 3+ Vw - Xr Sacroiliac Joints 3+ Views (72202) range across 2 matching MRF lines |
$124.09–$501.50 | — | varies |
| X-Ray Sacroiliac Jts <3 Vw - Xr Sacroiliac Joints 1-2 Views (72200) range across 2 matching MRF lines |
$124.09–$501.50 | — | varies |
| X-Ray Sacrum/Coccyx 2+ Vw - Xr Sacrum Coccyx 2+ Views (72220) range across 2 matching MRF lines |
$103.30–$371.45 | — | varies |
| X-Ray Sinuses 3+ Vw - Xr Paranasal Sinuses 3+ Views (70220) range across 2 matching MRF lines |
$103.30–$371.45 | — | varies |
| X-Ray Skull 4+ Vw - Xr Skull Complete 4+ Views (70260) range across 2 matching MRF lines |
$124.09–$501.50 | — | varies |
| X-Ray Stress View (77071) | $103.30 | — | 1.0× |
| X-ray thoracic spine 4 vw (72074) range across 2 matching MRF lines |
$124.09–$501.50 | — | varies |
| X-Ray Tmj Unilat (70328) range across 2 matching MRF lines |
$103.30–$371.45 | — | varies |
| X-Ray Urinary Tract Exam With Contrast Material (74420) range across 2 matching MRF lines |
$414.11–$1,692.35 | — | varies |
| X-Rays Bone Length Studies (77073) range across 2 matching MRF lines |
$124.09–$501.50 | — | varies |
| X-Rays Bone Survey Complete (77075) range across 2 matching MRF lines |
$124.09–$623.90 | — | varies |
| Xr c-spine 4 or 5 views (72050) range across 2 matching MRF lines |
$124.09–$501.50 | — | varies |
| Xr facial bones less than 3 views (70140) range across 2 matching MRF lines |
$103.30–$371.45 | — | varies |
| XR Mastoids < 3 Views Bilateral (70120) range across 2 matching MRF lines |
$124.09–$501.50 | — | varies |
| Xr myelogram posterior fossa (70010) | $414.11 | — | 1.0× |
| Xr orbits complete 4 views (70200) range across 2 matching MRF lines |
$124.09–$501.50 | — | varies |
| Xr Tomogram Single Plane (76100) | $124.09 | — | 1.0× |
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.