Imaging prices at Indiana University Health White Memorial Hospital
Monticello, IN · every code in this section with a posted price and a Medicare benchmark.
479 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 |
$5,435.61–$11,073.27 | $17,433–$35,514 | varies |
| Abdomen 1 View (74018) | $129.40 | $415 | 1.4× |
| Abdomen 2 views (74019) | $232.29 | $745 | 2.1× |
| Acute Gastrointestinal Blood Loss Imaging (78278) | $670.37 | $2,150 | 1.6× |
| Angio internal mammary (75756) | $5,438.42 | $17,442 | 1.6× |
| Angio pulmonary bilat (75743) | $5,438.42 | $17,442 | 1.6× |
| Angiography Adrenal Bilateral Slctv Rs&I (75733) | $5,438.42 | $17,442 | 1.6× |
| Angiography extremity bilateral rs&i (75716) | $5,438.42 | $17,442 | 1.6× |
| Angiography extremity unilateral rs&i (75710) | $5,438.42 | $17,442 | 1.6× |
| Angiography pulmonary unilateral slctv rs&i (75741) | $5,438.42 | $17,442 | 1.6× |
| Angrph pulmonary nonslctv cath/ven njx rs&i (75746) | $2,252.13 | $7,223 | 0.7× |
| Ankle 2 views (73600) range across 3 matching MRF lines |
$129.40–$193.94 | $415–$622 | varies |
| Aortography thoracic serialography rs&i (75605) | $9,009.46 | $28,895 | 1.5× |
| Aortography thoracic w/o serialography rs&i (75600) | $5,438.42 | $17,442 | 1.6× |
| Artery X-Rays Abdomen (75726) | $9,009.46 | $28,895 | 1.5× |
| Artery X-Rays Adrenal Gland (75731) | $2,252.13 | $7,223 | 0.7× |
| Artery X-Rays Pelvis (75736) | $9,009.46 | $28,895 | 1.5× |
| Artery X-Rays Spine (75705) | $9,009.46 | $28,895 | 1.5× |
| Arthrogram ankle (73615) range across 3 matching MRF lines |
$795.09–$1,192.95 | $2,550–$3,826 | varies |
| Arthrogram hip (73525) range across 3 matching MRF lines |
$795.09–$1,192.95 | $2,550–$3,826 | varies |
| Arthrogram Wrist (73115) range across 3 matching MRF lines |
$795.09–$1,192.95 | $2,550–$3,826 | varies |
| Basic radiation dosimetry calculation (77300) | $543.47 | $1,743 | 3.8× |
| Bone age studies (77072) | $232.29 | $745 | 2.1× |
| Bone Imaging 3 Phase (78315) | $2,017.03 | $6,469 | 4.8× |
| Bone Imaging Limited Area (78300) | $956.29 | $3,067 | 2.3× |
| Bone Imaging Multiple Areas (78305) | $550.95 | $1,767 | 1.3× |
| Bone Imaging Whole Body (78306) | $1,545.59 | $4,957 | 3.7× |
| Bone marrow imaging limited area (78102) | $389.13 | $1,248 | 0.9× |
| Bone marrow imaging; whole body (78104) | $673.80 | $2,161 | 1.6× |
| Bone survey infant (77076) | $232.29 | $745 | 2.1× |
| Brachytx isodose complex (77318) | $2,862.64 | $9,181 | 7.2× |
| Brachytx isodose intermed (77317) | $2,481.62 | $7,959 | 6.3× |
| Brachytx Isodose Plan Simple (77316) | $2,036.37 | $6,531 | 5.1× |
| Brain Image W/Flow < 4 Views (78601) | $888.01 | $2,848 | 2.1× |
| Brain imaging < 4 static views (78600) | $888.01 | $2,848 | 2.1× |
| Brain Imaging Min 4 Static Views W Vascular Flow (78606) | $1,242.52 | $3,985 | 2.2× |
| Brain Imaging Pet Metabolic Evaluation (78608) | $2,832.08 | $9,083 | 1.9× |
| Cardiac blood pool imaging, first pass technique; multiple studies, resting and with stress (exercise and/or… (78483) | $1,099.41 | $3,526 | 1.9× |
| Cardiac MRI w/w/o contrast & further seq (75561) | $675.98 | $2,168 | 1.8× |
| Cardiac MRI w/w/o contrast w/stress (75563) | $1,211.03 | $3,884 | 1.5× |
| Cardiac Shunt Detection (78428) | $587.12 | $1,883 | 1.4× |
| Cat Scan Follow-Up Study (76380) | $110.07 | $353 | 1.2× |
| Cerebrospinal Fluid Flow W/O Matl Shunt Evaltj (78645) | $1,227.56 | $3,937 | 2.1× |
| Cerebrospinal Fluid Scan (78630) | $1,941.58 | $6,227 | 3.4× |
| Chest 1 view (71045) | $100.09 | $321 | 1.1× |
| Chest 2 views (71046) | $100.09 | $321 | 1.1× |
| Chest 3 views (71047) | $100.09 | $321 | 1.1× |
| Chest 4 or more views (71048) | $232.29 | $745 | 2.1× |
| Chg us nrv&acc strux 1 xtr compre w/img pr extremity (76883) range across 4 matching MRF lines |
$117.86–$201.11 | $378–$645 | varies |
| Cisternography Positive Contrast Rs&I (70015) | $1,424.30 | $4,568 | 1.7× |
| Clavicle complete (73000) range across 3 matching MRF lines |
$129.40–$193.94 | $415–$622 | varies |
| Computed Tomography Thorax Lw Dose Lng Ca Scr C- (71271) range across 2 matching MRF lines |
$15.28–$277.19 | $49–$889 | varies |
| Continuing medical physics consltj pr wk (77336) | $955.04 | $3,063 | 6.7× |
| Contrast Exam Abdominl Aorta (75625) | $5,438.42 | $17,442 | 1.6× |
| Contrast X-Ray Bladder (74430) | $795.09 | $2,550 | 2.2× |
| Contrast X-Ray Of Elbow (73085) range across 3 matching MRF lines |
$795.09–$1,192.95 | $2,550–$3,826 | varies |
| Contrast X-Ray Of Knee Joint (73580) range across 3 matching MRF lines |
$795.09–$1,192.95 | $2,550–$3,826 | varies |
| Contrast Xray Throat/Cerv Esopha (74210) | $415.63 | $1,333 | 2.2× |
| CT abdomen and pelvis without and with contrast (74178) | $675.98 | $2,168 | 1.8× |
| CT abdomen and pelvis without contrast (74176) | $404.09 | $1,296 | 1.6× |
| CT abdomen w contrast (74160) | $353.89 | $1,135 | 1.9× |
| CT abdomen w wo contrast (74170) | $353.89 | $1,135 | 1.9× |
| CT abdomen w/o contrast (74150) | $277.19 | $889 | 2.5× |
| CT Angio Abdomen and Pelvis (74174) | $675.98 | $2,168 | 1.8× |
| CT Angio Chest (71275) | $353.89 | $1,135 | 1.9× |
| CT Angio Head (70496) | $353.89 | $1,135 | 1.9× |
| CT angio hrt w/3d image (75574) range across 3 matching MRF lines |
$353.89–$545.65 | $1,135–$1,750 | varies |
| Ct Angio Lwr Extr W/O&W/Dye (73706) range across 3 matching MRF lines |
$353.89–$530.68 | $1,135–$1,702 | varies |
| CT Angio Neck (70498) | $353.89 | $1,135 | 1.9× |
| Ct Angio Upr Extrm W/O&W/Dye (73206) range across 2 matching MRF lines |
$353.89–$530.06 | $1,135–$1,700 | varies |
| CT bone density (77078) | $110.07 | $353 | 1.2× |
| CT Cere Prfuj Alys C+ W/O CT/Cta Same Anatomy (70473) | $1,057.31 | $3,391 | 5.7× |
| CT cervical spine w/ contrast (72126) | $675.98 | $2,168 | 1.8× |
| CT cervical spine w/o contrast (72125) | $277.19 | $889 | 2.5× |
| CT cervical spine w/wo cont (72127) | $353.89 | $1,135 | 1.9× |
| CT chest w contrast (71260) | $353.89 | $1,135 | 1.9× |
| CT chest w/wo contrast (71270) | $353.89 | $1,135 | 1.9× |
| CT colonography screening (74263) | $1,224.44 | $3,927 | 4.9× |
| CT Colonogrphy Dx Image Postprocess W/Contrast (74262) | $353.89 | $1,135 | 1.9× |
| CT colonogrphy dx image postprocess w/o contrast (74261) | $277.19 | $889 | 2.5× |
| CT head/brain with contrast (70460) | $353.89 | $1,135 | 1.9× |
| CT head/brain without and with contrast (70470) | $353.89 | $1,135 | 1.9× |
| CT heart contrast eval cardiac structure&morph (75572) | $353.89 | $1,135 | 1.0× |
| CT heart no contrast quant eval coronry calcium (75571) | $15.28 | $49 | 0.2× |
| CT hrt w/3d image congen (75573) | $353.89 | $1,135 | 1.0× |
| CT iac w contrast (70481) | $353.89 | $1,135 | 1.9× |
| CT l-spine w&w/o contrast (72133) | $353.89 | $1,135 | 1.9× |
| CT lower ext w/o (73700) range across 4 matching MRF lines |
$277.19–$295.90 | $889–$949 | varies |
| CT lower extremity w/contrast material (73701) range across 4 matching MRF lines |
$353.89–$530.68 | $1,135–$1,702 | varies |
| CT lumbar spine w contrast (72132) | $675.98 | $2,168 | 1.8× |
| CT lumbar spine w/o contrast (72131) | $277.19 | $889 | 2.5× |
| CT maxillofacial w contrast (70487) | $353.89 | $1,135 | 1.9× |
| CT maxillofacial wo contrast (70486) | $277.19 | $889 | 2.5× |
| CT neck tissue combo (70492) | $353.89 | $1,135 | 1.9× |
| Ct Orbit/Ear/Fossa W/O&W/Dye (70482) | $353.89 | $1,135 | 1.9× |
| CT orbits w/o contrast (70480) | $277.19 | $889 | 2.5× |
| CT pelvis w&w/o contrast (72194) | $353.89 | $1,135 | 1.9× |
| CT pelvis w/o contrast (72192) | $277.19 | $889 | 2.5× |
| CT scan of leg combo (73702) range across 4 matching MRF lines |
$353.89–$530.68 | $1,135–$1,702 | varies |
| CT scans face/jaw combo (70488) | $353.89 | $1,135 | 1.9× |
| CT soft tissue neck w contrast (70491) | $353.89 | $1,135 | 1.9× |
| CT soft tissue neck w/o contrast (70490) | $277.19 | $889 | 2.5× |
| CT thoracic spine w contrast (72129) | $353.89 | $1,135 | 1.9× |
| CT thoracic spine w/o contrast (72128) | $277.19 | $889 | 2.5× |
| CT thoracic spine w/wo cont (72130) | $353.89 | $1,135 | 1.9× |
| CT thorax w/o contrast (71250) | $277.19 | $889 | 2.5× |
| CT unlisted procedure (76497) | $110.07 | $353 | 1.2× |
| CT upper ext wo (73200) range across 3 matching MRF lines |
$277.19–$295.90 | $889–$949 | varies |
| CT upper extremity w/o & w/contrast material (73202) range across 3 matching MRF lines |
$353.89–$530.68 | $1,135–$1,702 | varies |
| CT upper extremity with contrast (73201) range across 3 matching MRF lines |
$675.98–$1,014.29 | $2,168–$3,253 | varies |
| Cta Abdl Aorta&Bi Iliofem W/Contrast&Postp (75635) | $353.89 | $1,135 | 1.9× |
| Cta Abdomen (74175) | $353.89 | $1,135 | 1.9× |
| CTA head&neck c+ w/noncontrast img&post-pxessing (70471) range across 2 matching MRF lines |
$707.79–$894.24 | $2,270–$2,868 | varies |
| CTA pelvis (72191) | $353.89 | $1,135 | 1.9× |
| Dilation ureters/urethra rs&i (74485) | $3,582.27 | $11,489 | 1.6× |
| Discography Cerv/Thor Spine (72285) | $3,359.02 | $10,773 | 1.6× |
| Diskography lumbar (72295) | $3,359.02 | $10,773 | 1.6× |
| Doppler Echo Fetal Puls Spectral F/U/Repeat (76828) | $133.76 | $429 | 1.2× |
| Doppler Echo Fetal Spectral Display Complete (76827) | $133.76 | $429 | 1.2× |
| Doppler Fetal Mid Cerebral Artery (76821) | $133.76 | $429 | 1.2× |
| Dxa Bone Density Axial (77080) | $232.29 | $745 | 2.1× |
| Dxa bone density study (77085) | $232.29 | $745 | 2.1× |
| Dxa bone density study 1/>sites appendiclr skel (77081) | $129.40 | $415 | 1.4× |
| Echo exam of fetal heart (76825) | $564.05 | $1,809 | 1.0× |
| Echo exam uterus (76831) | $261.91 | $840 | 1.0× |
| Echo Guide For Artery Repair (76936) | $286.23 | $918 | 1.3× |
| Echocardiography, fetal, cardiovascular system, real time with image documentation (2D), with or without M-mode… (76826) | $261.91 | $840 | 1.0× |
| Echograp Trans R Pros Study (76873) | $133.76 | $429 | 1.2× |
| Esophageal Motility Study (78258) | $209.53 | $672 | 0.5× |
| Esophagram (74220) | $415.63 | $1,333 | 2.2× |
| Fetal Biophys Profile W/Nst (76818) | $133.76 | $429 | 1.2× |
| Fetal Biophysical Profile W/O Non-Stress Testing (76819) | $133.76 | $429 | 1.2× |
| Fetal MRI w/placntl matrnl plvc img sing/1st ges (74712) | $404.09 | $1,296 | 1.6× |
| Fluoroscopy up to 1 hr (76000) | $475.50 | $1,525 | 1.9× |
| Follow-Up Angiography (75898) | $2,252.13 | $7,223 | 0.7× |
| Foot 2 views (73620) range across 3 matching MRF lines |
$129.40–$193.94 | $415–$622 | varies |
| Forearm 2 views (73090) range across 3 matching MRF lines |
$129.40–$193.94 | $415–$622 | varies |
| Gastric emptying imaging study (78264) | $1,353.21 | $4,340 | 3.2× |
| Gastric Emptyng Imag Std W/Sm Bwl Transit (78265) | $1,072.59 | $3,440 | 2.5× |
| Gastroesophageal Reflux Exam (78262) | $608.63 | $1,952 | 1.4× |
| Gated Heart Planar Single (78472) | $2,235.61 | $7,170 | 5.3× |
| Gated Heart, Multiple (78473) | $1,368.49 | $4,389 | 3.2× |
| Gstrc Emptng Imag Std W/Sm Bwl Col Trnst Mlt Day (78266) | $1,422.12 | $4,561 | 2.5× |
| Hand 2 views (73120) range across 3 matching MRF lines |
$232.29–$348.28 | $745–$1,117 | varies |
| Hdr Rdncl Ntrstl/Icav Brchtx (77772) | $6,179.56 | $19,819 | 8.4× |
| Hdr Rdncl Ntrstl/Icav Brchtx (77771) | $4,050.59 | $12,991 | 5.5× |
| Hdr Rdncl Ntrstl/Icav Brchtx 1 Channel (77770) | $2,179.17 | $6,989 | 3.0× |
| Heart first pass single,planar (78481) | $1,094.42 | $3,510 | 1.9× |
| Heart Image (Pet) Multiple (78492) | $2,832.08 | $9,083 | 1.9× |
| Hepatc Vngrph Wdg/Fr Hemodyn Eval Rs&I (75889) | $5,438.42 | $17,442 | 1.6× |
| Hepatc Vngrph Wdg/Fr W/O Hemodyn Eval Rs&I (75891) | $5,438.42 | $17,442 | 1.6× |
| Hepatobil Syst Image W/Drug (78227) | $362 | $1,161 | 0.6× |
| Hepatobiliary System Imaging (78226) | $289.66 | $929 | 0.7× |
| Ht Musc Image Planar Mult (78454) range across 2 matching MRF lines |
$897.98–$1,679.35 | $2,880–$5,386 | varies |
| Ht Muscle Image Spect Sing (78451) | $2,366.87 | $7,591 | 1.7× |
| Hysterosalpingogram (74740) | $475.50 | $1,525 | 1.9× |
| Infant hip ultrasound with hip movement (dynamic) (76885) | $167.44 | $537 | 1.8× |
| Infant hip ultrasound, limited static exam (76886) | $167.44 | $537 | 1.8× |
| Interstitial radiation source applic complex (77778) | $3,796.79 | $12,177 | 5.2× |
| Intracavitary Radiation Source Applic Complex (77763) | $1,442.70 | $4,627 | 2.0× |
| Intracavitary Radiation Source Applic Intermed (77762) | $1,008.67 | $3,235 | 1.7× |
| Intracavitary radiation source applic simple (77761) | $761.42 | $2,442 | 1.3× |
| Intraop radiaj tx deliver electrons sngl tx sess (77425) | $32,154.38 | $103,125 | 4.1× |
| Joint Survey Single View (77077) | $232.29 | $745 | 2.1× |
| K Flow/Funct Image Multiple (78709) | $2,206.61 | $7,077 | 3.8× |
| K Flow/Funct Image W/Drug (78708) | $1,187.96 | $3,810 | 2.1× |
| K Flow/Funct Image W/O Drug (78707) | $1,725.50 | $5,534 | 3.0× |
| Kidney Funcj Study Non-Img Radioisotopic Study (78725) | $806 | $2,585 | 1.9× |
| Kidney Imaging Morphol (78700) | $1,190.76 | $3,819 | 2.8× |
| Knee 3 Views (73562) range across 3 matching MRF lines |
$129.40–$193.94 | $415–$622 | varies |
| Leveen/Shunt Patency Exam (78291) | $868.99 | $2,787 | 2.1× |
| Liver & Spleen Imaging Static Only (78215) | $824.71 | $2,645 | 1.9× |
| Liver & Spleen Imaging W/Vascular Flow (78216) | $584 | $1,873 | 1.4× |
| Liver imaging static only (78201) | $337.06 | $1,081 | 0.6× |
| Liver imaging w/vascular flow (78202) | $371.04 | $1,190 | 0.6× |
| Lung Perf&Ventilat Diferentl (78598) | $1,896.68 | $6,083 | 3.3× |
| Lung perfusion differential (78597) | $990.28 | $3,176 | 2.3× |
| Lung Ventilat&Perfus Imaging (78582) | $1,616.37 | $5,184 | 2.8× |
| Lung Ventilation Imaging (78579) | $609.88 | $1,956 | 1.4× |
| Lymph System Imaging (78195) | $1,654.10 | $5,305 | 2.9× |
| Lymphangiography Extremity Only Bilateral Rs&I (75803) | $2,252.13 | $7,223 | 1.4× |
| Lymphangiography extremity only unilateral rs&i (75801) | $1,276.51 | $4,094 | 1.9× |
| Lymphangiography Pelvic/Abdominal Bilateral Rs&I (75807) | $5,438.42 | $17,442 | 1.6× |
| Lymphangiography, pelvic/abdominal, unilateral (75805) | $2,252.13 | $7,223 | 0.7× |
| Magnetic Image Jaw Joint (70336) | $404.09 | $1,296 | 1.6× |
| Magnetic resonance (eg, proton) imaging, brain (including brain stem andskull base), during open intracranial procedure… (70558) | $353.89 | $1,135 | 1.9× |
| Magnetic resonance (eg, proton) imaging, brain (including brain stem andskull base), during open intracranial procedure… (70557) | $870.86 | $2,793 | 1.5× |
| Magnetic resonance (eg, proton) imaging, brain (including brain stem andskull base), during open intracranial procedure… (70559) | $353.89 | $1,135 | 1.9× |
| Magnetic Resonance Elastography (76391) | $1,433.66 | $4,598 | 5.7× |
| Mammary ductogram or galactogram multiple (77054) | $475.50 | $1,525 | 1.9× |
| Mammary ductogram or galactogram single (77053) range across 2 matching MRF lines |
$333–$499.19 | $1,068–$1,601 | varies |
| Meckels Divert Exam (78290) | $1,133.39 | $3,635 | 2.7× |
| Mlc imrt design & construction per imrt plan (77338) | $3,422.01 | $10,975 | 8.6× |
| Mr safety determination physician/other qhp (76016) | $353.89 | $1,135 | 3.8× |
| Mr safety implant&/fb assmt clin staf 1st 15 min (76014) | $353.89 | $1,135 | 11.6× |
| Mr safety implt electronics prepj supvj phys/qhp (76018) | $353.89 | $1,135 | 3.5× |
| Mr safety implt pos&/immoblj (76019) | $353.89 | $1,135 | 5.7× |
| Mr safety med physics xm customization plng&mntr (76017) | $353.89 | $1,135 | 1.4× |
| Mra Head W/O & W/Contrast Material (70546) | $675.98 | $2,168 | 1.8× |
| MRA head w/o contrast (70544) | $404.09 | $1,296 | 1.6× |
| MRA head with contrast (70545) | $675.98 | $2,168 | 1.8× |
| MRA neck w contrast (70548) | $675.98 | $2,168 | 1.8× |
| Mra Neck W/O &W/Contrast Material (70549) | $675.98 | $2,168 | 1.8× |
| MRA neck w/o contrast (70547) | $404.09 | $1,296 | 1.6× |
| MRI abdomen w contrast (74182) | $675.98 | $2,168 | 1.8× |
| MRI abdomen w/o contrast (74181) | $404.09 | $1,296 | 1.6× |
| MRI any jt lower extrem w/contrast material (73722) range across 3 matching MRF lines |
$1,211.03–$1,816.55 | $3,884–$5,826 | varies |
| MRI any jt lower extrem w/o & w/contrast matrl (73723) range across 3 matching MRF lines |
$675.98–$1,014.29 | $2,168–$3,253 | varies |
| MRI any jt upper extremity w/contrast matrl (73222) range across 3 matching MRF lines |
$1,211.03–$1,816.55 | $3,884–$5,826 | varies |
| MRI bone marrow blood supply (77084) | $404.09 | $1,296 | 1.6× |
| MRI brain functional w/o physician admnistration (70554) | $404.09 | $1,296 | 1.6× |
| MRI brain functional w/physician admnistration (70555) range across 3 matching MRF lines |
$404.09–$605.83 | $1,296–$1,943 | varies |
| MRI Breast W/O Contrast Bilateral (77047) | $612.69 | $1,965 | 2.4× |
| MRI Breast Without Contrast Material Unilateral (77046) | $612.69 | $1,965 | 2.4× |
| MRI cardiac w/o cont stress (75559) | $870.86 | $2,793 | 1.5× |
| MRI cardiac w/o contrast (75557) | $404.09 | $1,296 | 1.6× |
| MRI cervical spine w contrast (72142) | $675.98 | $2,168 | 1.8× |
| MRI cervical spine w/o cont (72141) | $404.09 | $1,296 | 1.6× |
| MRI chest w/o contrast (71550) | $404.09 | $1,296 | 1.6× |
| MRI chest with contrast (71551) | $1,211.03 | $3,884 | 1.5× |
| MRI chest wo w contrast (71552) | $675.98 | $2,168 | 1.8× |
| MRI lower extrem oth/thn jt w/contrast matrl (73719) range across 3 matching MRF lines |
$675.98–$1,014.29 | $2,168–$3,253 | varies |
| MRI lower extrem oth/thn jt w/o & w/contr matr (73720) range across 3 matching MRF lines |
$675.98–$1,014.29 | $2,168–$3,253 | varies |
| MRI lower extrem oth/thn jt w/o contr matrl (73718) range across 3 matching MRF lines |
$404.09–$605.83 | $1,296–$1,943 | varies |
| MRI lumbar spine w contrast (72149) | $675.98 | $2,168 | 1.8× |
| Mri Neck Spine W/O & W/Dye (72156) | $675.98 | $2,168 | 1.8× |
| MRI orbit face &/neck w/o contrast (70540) | $404.09 | $1,296 | 1.6× |
| MRI orbit face neck w contrast (70542) | $675.98 | $2,168 | 1.8× |
| Mri Orbt/Fac/Nck W/O &W/Dye (70543) | $675.98 | $2,168 | 1.8× |
| MRI pelvis w contrast (72196) | $675.98 | $2,168 | 1.8× |
| MRI pelvis w/o & w contrast (72197) | $675.98 | $2,168 | 1.8× |
| MRI pelvis w/o contrast (72195) | $404.09 | $1,296 | 1.6× |
| MRI spectroscopy (76390) | $708.10 | $2,271 | 7.7× |
| MRI thoracic spine w/o contrast (72146) | $404.09 | $1,296 | 1.6× |
| MRI upper extremity oth than jt w/contr matrl (73219) range across 3 matching MRF lines |
$675.98–$1,014.29 | $2,168–$3,253 | varies |
| MRI upper extremity oth than jt w/o contr matrl (73218) range across 3 matching MRF lines |
$404.09–$605.83 | $1,296–$1,943 | varies |
| Mri Uppr Extremity W/O&W/Dye (73220) range across 3 matching MRF lines |
$675.98–$1,014.29 | $2,168–$3,253 | varies |
| MRI, abdomen, combo (74183) | $675.98 | $2,168 | 1.8× |
| MRI, dorsal spine combo (72157) | $675.98 | $2,168 | 1.8× |
| MRI, dorsal spine contrast (72147) | $675.98 | $2,168 | 1.8× |
| MRI, joint upper extrem (73221) range across 3 matching MRF lines |
$404.09–$605.83 | $1,296–$1,943 | varies |
| MRI, joint upper extrem combo (73223) range across 3 matching MRF lines |
$675.98–$1,013.04 | $2,168–$3,249 | varies |
| MRI, lumbar spine combo (72158) | $675.98 | $2,168 | 1.8× |
| Myelogram cervical (72240) | $1,424.30 | $4,568 | 1.7× |
| Myelogram Lumbar (72265) | $1,424.30 | $4,568 | 1.7× |
| Myelography thoracic (72255) | $1,424.30 | $4,568 | 1.7× |
| Myelograpy 2/more regions rs&i (72270) | $1,424.30 | $4,568 | 1.7× |
| Myocardial Imaging Infarct Avid Planar Qual/Quan (78466) | $540.35 | $1,733 | 1.3× |
| Myocardial Imaging Pet Metabolic Evaluation (78459) | $2,531.82 | $8,120 | 1.8× |
| Myocardial Perfusion Planar 1 Study Rest/Stress (78453) range across 2 matching MRF lines |
$571.84–$989.03 | $1,834–$3,172 | varies |
| Myocardial Spect Multiple Studies (78452) | $2,366.87 | $7,591 | 1.7× |
| Myocrd Img Pet Metab Eval Single Study Cncrnt CT (78429) | $2,923.75 | $9,377 | 1.9× |
| Myocrd img PET prfuj 1std rest/stress cncrnt CT (78430) | $2,923.75 | $9,377 | 1.9× |
| Myocrd Img Pet Prfuj Mlt Std Rst&Strs Cncrnt CT (78431) | $4,560.70 | $14,627 | 2.0× |
| Myocrd Img Pet Prfuj W/Metab 2rtracer Cncrnt CT (78433) | $5,574.05 | $17,877 | 2.4× |
| Myocrd Img Pet Prfuj W/Metab Dual Radiotracer (78432) | $5,574.05 | $17,877 | 3.5× |
| N-invas est c ffr sw aly CTA (75580) | $2,445.76 | $7,844 | 2.7× |
| Neck soft tissue (70360) | $129.40 | $415 | 1.4× |
| Nfs/Instlj Radioelmnt Sln 3 Mo Follow-Up Care (77750) | $940.70 | $3,017 | 2.3× |
| Njx Rp Loclzj Non-Img Probe Study Intravenous (78808) | $194.88 | $625 | 0.5× |
| Nm csf leak detection (78650) | $610.19 | $1,957 | 0.4× |
| Nonvascular Shunt X-Ray (75809) | $232.29 | $745 | 2.1× |
| Ntsty modul radthx pln dose-vol histos (77301) | $9,221.80 | $29,576 | 6.3× |
| Nuclear medicine study of endocrine organs (78099) range across 2 matching MRF lines |
$371.35–$725.87 | $1,191–$2,328 | varies |
| Nuclear Rx Intra-Arterial (79445) | $1,233.79 | $3,957 | 5.0× |
| Nuclear Rx Oral Admin (79005) | $1,773.52 | $5,688 | 7.2× |
| Ob us nuchal meas 1 gest (76813) | $133.76 | $429 | 1.2× |
| Oph bmtry us echograpy a-scan io lens pwr cal (76519) | $192.07 | $616 | 1.7× |
| Oph us dx ant sgm us immersion b-scan/hr biom (76513) | $192.07 | $616 | 1.7× |
| Oph US Dx B-Scan&Quan a-Scan Sm Pt Enctr (76510) range across 3 matching MRF lines |
$120.98–$181.16 | $388–$581 | varies |
| Ophthalmic Biometry US Echograpy a-Scan (76516) | $192.07 | $616 | 1.7× |
| Ophthalmic Ultrasonic Foreign Body Localization (76529) range across 3 matching MRF lines |
$129.40–$193.94 | $415–$622 | varies |
| Ophthalmic ultrasound dx b-scan w/wo a-scan (76512) range across 4 matching MRF lines |
$133.76–$192.07 | $429–$616 | varies |
| Ophthalmic US Dx Corneal Pachymetry Uni/Bi (76514) | $133.76 | $429 | 4.4× |
| Ophthalmic us dx quantitative a-scan only (76511) range across 3 matching MRF lines |
$128.15–$192.07 | $411–$616 | varies |
| Panoramic X-ray of jaws (70355) | $129.40 | $415 | 1.4× |
| Parathyroid imaging w/tomographic spect & CT (78072) | $1,291.79 | $4,143 | 2.2× |
| Parathyroid Planar Imaging (78070) | $928.54 | $2,978 | 2.2× |
| Parathyroid planar imaging w/wo subtraction (78071) | $1,113.75 | $3,572 | 2.6× |
| Pelvis 1 or 2 views (72170) | $232.29 | $745 | 2.1× |
| Peritoneogram Rs&I (74190) | $1,024.89 | $3,287 | 1.8× |
| Pet Image Skull-Thigh (78812) | $2,832.08 | $9,083 | 1.9× |
| Pet Image W/Ct Lmtd (78814) | $2,832.08 | $9,083 | 1.9× |
| PET image w/CT, full body (78816) | $2,832.08 | $9,083 | 1.9× |
| PET imaging CT attenuation skull base mid-thigh (78815) | $2,832.08 | $9,083 | 1.9× |
| Pet Imaging Limited Area Chest Head/Neck (78811) | $2,531.82 | $8,120 | 1.8× |
| Pet Myocardial Sngl Study (78491) | $2,832.08 | $9,083 | 1.9× |
| PET whole body (78813) | $2,832.08 | $9,083 | 1.9× |
| Prq Transhepatc Portograpy Hemodyn Eval Rs&I (75885) | $5,438.42 | $17,442 | 1.6× |
| Pulmonary Perfusion Imaging Particulate (78580) | $661.33 | $2,121 | 1.6× |
| Quan&Charac C Atherosclerotc Plaq Asses Sev C Ds (75577) | $727.43 | $2,333 | 0.7× |
| Radex Abd Compl Aqt Abd W/S/E/D Views 1 View Ch (74022) | $232.29 | $745 | 2.1× |
| Radex abscess/fistula/sinus tract rs&i (76080) | $1,024.89 | $3,287 | 1.8× |
| Radex Ankle Complete Minimum 3 Views (73610) range across 3 matching MRF lines |
$129.40–$193.94 | $415–$622 | varies |
| Radex Calcaneus Minimum 2 Views (73650) range across 3 matching MRF lines |
$129.40–$193.94 | $415–$622 | varies |
| Radex elbow complete minimum 3 views (73080) range across 3 matching MRF lines |
$129.40–$193.94 | $415–$622 | varies |
| Radex Facial Bones Complete Minimum 3 Views (70150) | $232.29 | $745 | 2.1× |
| Radex fingr minimum 2 views (73140) range across 3 matching MRF lines |
$129.40–$193.94 | $415–$622 | varies |
| Radex foot complete minimum 3 views (73630) range across 3 matching MRF lines |
$129.40–$193.94 | $415–$622 | varies |
| Radex Hand Minimum 3 Views (73130) range across 3 matching MRF lines |
$129.40–$193.94 | $415–$622 | varies |
| Radex lower extremity infant minimum 2 views (73592) range across 3 matching MRF lines |
$129.40–$193.94 | $415–$622 | varies |
| Radex Mastoids Compl Minimum 3 Views PR Side (70130) range across 3 matching MRF lines |
$232.29–$348.28 | $745–$1,117 | varies |
| Radex Nasal Bones Complete Minimum 3 Views (70160) | $129.40 | $415 | 1.4× |
| Radex Ribs Unilateral 2 Views (71100) | $129.40 | $415 | 1.4× |
| Radex shoulder complete minimum 2 views (73030) range across 3 matching MRF lines |
$129.40–$193.94 | $415–$622 | varies |
| Radex Sinuses Paransl < 3 Views (70210) | $129.40 | $415 | 1.4× |
| Radex sm int w/mlt srl imges via enteroclss tube (74251) | $475.50 | $1,525 | 2.6× |
| Radex Spine 1 View Specify Level (72020) | $129.40 | $415 | 1.4× |
| Radex Sternum Minimum 2 Views (71120) | $129.40 | $415 | 1.4× |
| Radex Temporomandble Jt Opn & Clsd Mouth Bilat (70330) | $129.40 | $415 | 1.4× |
| Radex Toe Minimum 2 Views (73660) range across 3 matching MRF lines |
$129.40–$193.94 | $415–$622 | varies |
| Radex upper extremity infant minimum 2 views (73092) range across 3 matching MRF lines |
$232.29–$348.28 | $745–$1,117 | varies |
| Radex Wrist Complete Minimum 3 Views (73110) range across 3 matching MRF lines |
$129.40–$193.94 | $415–$622 | varies |
| Radex X-Ray Exam Entire Spi 6/> Vw - Xr Entire Spine 6+ Vw (72084) | $232.29 | $745 | 2.1× |
| Radiation Delivery Stereotactic Cranial Linear (77372) | $15,331.52 | $49,171 | 2.0× |
| Radiation treatment delivery level 1 (77402) | $1,332.01 | $4,272 | 12.3× |
| Radiation treatment delivery level 2 (77407) | $2,935.29 | $9,414 | 7.2× |
| Radiation treatment delivery level 3 (77412) | $3,326.91 | $10,670 | 5.7× |
| Radiolog exam mandible compl minimum 4 views (70110) | $232.29 | $745 | 2.1× |
| Radiologic Exam Abdomen 3+ Views - Xr Abdomen 3+ Views (74021) | $232.29 | $745 | 2.1× |
| Radiologic exam colon double contrast study (74280) | $415.63 | $1,333 | 2.2× |
| Radiologic exam colon single contrast study (74270) | $415.63 | $1,333 | 2.2× |
| Radiologic Exam Esophagus Double Contrast Study (74221) | $369.48 | $1,185 | 2.0× |
| Radiologic exam knee complete 4/more views (73564) range across 3 matching MRF lines |
$232.29–$348.28 | $745–$1,117 | varies |
| Radiologic exam pelvis compl minimum 3 views (72190) | $232.29 | $745 | 2.1× |
| Radiologic Exam Small Int Single Contrast Study (74250) | $232.29 | $745 | 1.3× |
| Radiologic exam swallow function contrast study (74230) | $232.29 | $745 | 1.3× |
| Radiologic exam upr gi trc double contrast study (74246) | $415.63 | $1,333 | 2.2× |
| Radiologic examination femur 1 view (73551) range across 3 matching MRF lines |
$129.40–$193.94 | $415–$622 | varies |
| Radiologic examination femur minimum 2 views (73552) range across 3 matching MRF lines |
$129.40–$193.94 | $415–$622 | varies |
| Radiologic examination knee 1/2 views (73560) range across 3 matching MRF lines |
$129.40–$193.94 | $415–$622 | varies |
| Radiologic Examination Osseous Survey Limited (77074) | $232.29 | $745 | 2.1× |
| Radiologic examination tibia & fibula 2 views (73590) range across 3 matching MRF lines |
$129.40–$193.94 | $415–$622 | varies |
| Radiopharm Dacryocystography (78660) | $908.90 | $2,915 | 2.1× |
| Radiopharmaceutical therapy, by intracavitary administration Non-Facility (79200) | $459.59 | $1,474 | 1.9× |
| Renal Cyst Study (74470) | $1,024.89 | $3,287 | 1.8× |
| Ribs bilateral 3 views (71110) | $232.29 | $745 | 2.1× |
| Rp loclzj tum plnr 1 area single day imaging (78800) range across 2 matching MRF lines |
$589.93–$1,251.88 | $1,892–$4,015 | varies |
| Rp Loclzj Tum Plnr Whole Body 2+ Days Imaging (78804) | $2,534 | $8,127 | 4.4× |
| Rp Loclzj Tum Plnr Whole Body Single Day Imaging (78802) range across 2 matching MRF lines |
$1,696.50–$1,807.82 | $5,441–$5,798 | varies |
| Rp Loclzj Tum Spect 1 Area Single Day Imaging (78803) range across 8 matching MRF lines |
$315.85–$2,680.86 | $1,013–$8,598 | varies |
| Rp loclzj tum spect 2 area/sep acquisj img (78831) | $3,599.42 | $11,544 | 2.6× |
| Rp loclzj tum spect CT 2area 1d img/1 ar img>2+d (78832) | $3,883.47 | $12,455 | 2.6× |
| Rp loclzj tum spect w/CT 1 area/acquisj 1day img (78830) | $3,323.48 | $10,659 | 2.4× |
| Rp Ther Radiolbld Monoclonal Antibody IV Infus (79403) | $1,626.97 | $5,218 | 6.6× |
| Rp Therapy Intravenous Administration (79101) | $1,329.20 | $4,263 | 5.4× |
| Salivary Gland Imaging Serial Images (78231) | $581.82 | $1,866 | 1.4× |
| Scapula (73010) range across 3 matching MRF lines |
$232.29–$348.28 | $745–$1,117 | varies |
| Screening Digital Breast Tomosynthesis Bi (77063) | $67.04 | $215 | 2.9× |
| Shoulder 1 view (73020) range across 3 matching MRF lines |
$129.40–$193.94 | $415–$622 | varies |
| Shoulder Arthrography (73040) range across 3 matching MRF lines |
$795.09–$1,192.95 | $2,550–$3,826 | varies |
| Sialogram (70390) | $475.50 | $1,525 | 1.9× |
| Skull less than 4 views (70250) | $232.29 | $745 | 2.1× |
| Special dosimetry (77331) range across 2 matching MRF lines |
$299.33–$370.73 | $960–$1,189 | varies |
| Special Physics Consult (77370) | $816.60 | $2,619 | 5.7× |
| Special teletherapy port plan (77321) | $975 | $3,127 | 2.5× |
| Special treatment procedure (77470) range across 3 matching MRF lines |
$3,390.51–$7,158.30 | $10,874–$22,958 | varies |
| Speech evaluation, complex (70371) | $475.50 | $1,525 | 1.9× |
| Spleen Imaging (78185) | $379.15 | $1,216 | 0.9× |
| Srs Multisource (77371) | $48,976.61 | $157,077 | 6.3× |
| Stereotactic Body Radiation Delivery (77373) | $3,254.88 | $10,439 | 1.7× |
| Sternoclavicular joints (71130) | $129.40 | $415 | 1.4× |
| Superior sagittal sinus venogram (75870) | $2,252.13 | $7,223 | 0.7× |
| Tbs techl prep&transmis data alys pfrmd elsewhr (77090) | $159.02 | $510 | 1.7× |
| Tbs technical calculation only (77091) | $159.02 | $510 | 1.7× |
| Telethx isodose pln cplx w/basic dosimetry (77307) | $2,734.49 | $8,770 | 6.9× |
| Telethx isodose pln smpl w/dosimetry calculation (77306) | $2,150.80 | $6,898 | 5.4× |
| Temporomandble Jt Arthrography Rs&I (70332) range across 3 matching MRF lines |
$475.50–$712.15 | $1,525–$2,284 | varies |
| Testicular Imaging W/Flow (78761) | $410.95 | $1,318 | 1.0× |
| Ther Rad Simulaj-Aided Field Setting Complex (77290) | $1,935.34 | $6,207 | 4.9× |
| Ther Rad Simulaj-Aided Field Setting Intermed (77285) | $1,023.64 | $3,283 | 2.6× |
| Ther rad simulaj-aided field setting simple (77280) range across 3 matching MRF lines |
$885.20–$991.84 | $2,839–$3,181 | varies |
| Therapeutic Enema Rdctj Intussusception/Obstrcj (74283) | $415.63 | $1,333 | 2.2× |
| Thoracic spine 2 views (72070) | $232.29 | $745 | 2.1× |
| Thoracic spine 3 views (72072) | $232.29 | $745 | 2.1× |
| Thoracolumbar 2 views (72080) | $129.40 | $415 | 1.4× |
| Thyroid Carcinoma Metastases Img Lmtd Area (78015) | $481.73 | $1,545 | 1.1× |
| Thyroid Imaging With Vascular Flow (78013) | $581.82 | $1,866 | 1.4× |
| Thyroid Met Imaging Body (78018) | $2,010.80 | $6,449 | 3.5× |
| Thyroid Uptake Measurement (78012) | $406.28 | $1,303 | 1.0× |
| Thyroid Uptake W/Blood Flow Sngle/Mult Quan Meas (78014) | $1,067.29 | $3,423 | 2.5× |
| Tx Devices Design & Construction Complex (77334) range across 6 matching MRF lines |
$1,029.25–$1,118.43 | $3,301–$3,587 | varies |
| Tx devices design & construction intermediate (77333) | $657.27 | $2,108 | 4.6× |
| Tx devices design & construction simple (77332) | $395.99 | $1,270 | 2.8× |
| Ultrasound Breast Limited (76642) range across 3 matching MRF lines |
$133.76–$201.11 | $429–$645 | varies |
| Ultrasound elastography first target lesion (76982) | $789.17 | $2,531 | 7.1× |
| Ultrasound Elastography Parenchyma (76981) | $217.95 | $699 | 2.0× |
| Ultrasound Exam Aaa Screen (76706) | $301.82 | $968 | 2.7× |
| Ultrasound trgt dynamic microbubble 1st lesion (76978) range across 4 matching MRF lines |
$282.18–$666 | $905–$2,136 | varies |
| Ultrasound, abdomen limited (76705) | $133.76 | $429 | 1.2× |
| Umbilical-artery Doppler (OB) (76820) | $133.76 | $429 | 1.2× |
| Unlisted Dx Radiographic Procedure (76499) | $129.40 | $415 | 1.4× |
| Unlisted magnetic resonance procedure (76498) | $353.89 | $1,135 | 3.8× |
| Unlisted Procedure Clinical Brachytherapy (77799) range across 3 matching MRF lines |
$275.01–$1,166.13 | $882–$3,740 | varies |
| Unlisted us procedure (76999) | $71.40 | $229 | 0.8× |
| Upper gi w/o kub (74240) range across 3 matching MRF lines |
$415.63–$475.50 | $1,333–$1,525 | varies |
| Urea Breath Test C-14 Isotopic Acquisj Analysis (78267) | $23.70 | $76 | 2.1× |
| Urea breath test c-14 isotopic analysis (78268) | $166.81 | $535 | 1.8× |
| Ureteral Reflux Study (78740) | $852.77 | $2,735 | 2.0× |
| Urethrocystogram voiding (74455) | $475.50 | $1,525 | 1.9× |
| Urethrocystography retrograde (74450) | $475.50 | $1,525 | 1.9× |
| Us breast unilateral complete (76641) range across 3 matching MRF lines |
$133.76–$192.07 | $429–$616 | varies |
| Us chest (76604) | $133.76 | $429 | 1.2× |
| Us complete joint (76881) range across 2 matching MRF lines |
$133.76–$192.07 | $429–$616 | varies |
| Us exam, pelvic, limited (76857) | $133.76 | $429 | 1.2× |
| Us head (76506) | $133.76 | $429 | 1.2× |
| Us kidney transplant (76776) | $133.76 | $429 | 1.2× |
| Us lmtd joint/oth nonvasc xtr strux r-t w/img (76882) range across 2 matching MRF lines |
$133.76–$192.07 | $429–$616 | varies |
| Us ob detailed single fetus (76811) | $261.91 | $840 | 1.0× |
| Us ob limited 1 or more fetuses (76815) | $133.76 | $429 | 1.2× |
| Us ob transvaginal (76817) | $133.76 | $429 | 1.2× |
| Us pelvic non ob complete (76856) | $133.76 | $429 | 1.2× |
| Us pg uter img f&mat 14 wk tabdl 1/1st gestation (76801) | $133.76 | $429 | 1.2× |
| Us preg uterus real time f/u trnsabdl per fetus (76816) | $133.76 | $429 | 1.2× |
| Us retroperitoneal complete (76770) | $133.76 | $429 | 1.2× |
| Us retroperitoneal limited (76775) | $133.76 | $429 | 1.2× |
| Us scrotum and contents (76870) | $133.76 | $429 | 1.2× |
| Us spinal canal and contents (76800) | $133.76 | $429 | 1.2× |
| Us thyroid (76536) | $133.76 | $429 | 1.2× |
| Us transrectal (76872) | $133.76 | $429 | 1.2× |
| Vascular Flow Imaging (78445) | $349.22 | $1,120 | 0.8× |
| Vein X-Ray Chest (75827) | $1,276.51 | $4,094 | 0.8× |
| Vein X-Ray Liver W/O Hemodyn (75887) | $2,252.13 | $7,223 | 0.7× |
| Vein X-Ray Skull Epidural (75872) | $1,276.51 | $4,094 | 1.9× |
| Vein X-Ray Spleen/Liver (75810) | $2,252.13 | $7,223 | 0.7× |
| Venogram Sinus/Jugular (75860) | $5,438.42 | $17,442 | 1.6× |
| Venography Adrenal Unilateral (75840) | $5,438.42 | $17,442 | 1.6× |
| Venography caval inferior serialography rs&i (75825) | $5,438.42 | $17,442 | 1.6× |
| Venography extremity bilateral rs&i (75822) | $2,252.13 | $7,223 | 1.4× |
| Venography extremity unilateral rs&i (75820) | $1,276.51 | $4,094 | 0.8× |
| Venography Orbital Rs&I (75880) | $1,276.51 | $4,094 | 1.9× |
| Venography Renal Bilateral (75833) | $5,438.42 | $17,442 | 1.6× |
| Venography Renal Unilateral (75831) | $5,438.42 | $17,442 | 1.6× |
| Venous sampling by catheter (75893) | $9,009.46 | $28,895 | 1.5× |
| Vertebral fracture assessment via dxa (77086) | $129.40 | $415 | 1.4× |
| Wrist 2 views (73100) range across 3 matching MRF lines |
$129.40–$193.94 | $415–$622 | varies |
| X-Ray Ac Jts - Xr Acromioclavicular Joints Bilateral (73050) | $129.40 | $415 | 1.4× |
| X-ray antegrade pyelogram tube (74425) | $795.09 | $2,550 | 2.2× |
| X-Ray Aorta Leg Arteries (75630) | $5,438.42 | $17,442 | 1.6× |
| X-Ray Bend Only L-S Spine (72120) | $232.29 | $745 | 2.1× |
| X-Ray Elbow 2 Vw - Xr Elbow 1-2 Views Right (73070) range across 3 matching MRF lines |
$129.40–$193.94 | $415–$622 | varies |
| X-Ray Exam Breast Specimen (76098) | $1,024.89 | $3,287 | 1.8× |
| X-Ray Exam Entire Spi 1 Vw (72081) | $129.40 | $415 | 1.4× |
| X-Ray Exam Entire Spi 2/3 Vw (72082) | $232.29 | $745 | 2.1× |
| X-Ray Exam Entire Spi 4/5 Vw (72083) | $232.29 | $745 | 2.1× |
| X-Ray Exam Hip Uni 1 View (73501) | $129.40 | $415 | 1.4× |
| X-Ray Exam Hip Uni 2-3 Views (73502) | $129.40 | $415 | 1.4× |
| X-Ray Exam Hip Uni 4/> Views (73503) | $232.29 | $745 | 2.1× |
| X-Ray Exam Hips Bi 2 Views (73521) | $232.29 | $745 | 2.1× |
| X-Ray Exam Hips Bi 3-4 Views (73522) | $232.29 | $745 | 2.1× |
| X-Ray Exam Hips Bi 5/> Views (73523) | $232.29 | $745 | 2.1× |
| X-Ray Exam L-S Spine Bending (72114) | $232.29 | $745 | 2.1× |
| X-Ray Exam Neck Spine 2-3 Vw (72040) | $129.40 | $415 | 1.4× |
| X-Ray Exam Neck Spine 6/>Vws (72052) | $232.29 | $745 | 2.1× |
| X-Ray Exam Unilat Ribs/Chest (71101) | $232.29 | $745 | 2.1× |
| X-ray eye for foreign body (70030) range across 3 matching MRF lines |
$129.40–$193.94 | $415–$622 | varies |
| X-ray humerus (73060) range across 3 matching MRF lines |
$129.40–$193.94 | $415–$622 | varies |
| X-ray IV pyelogram (ivp) (74400) | $415.63 | $1,333 | 2.2× |
| X-ray IV pyelogram+tomography (74415) | $415.63 | $1,333 | 2.2× |
| X-Ray Jaw <4 Vw - Xr Mandible < 4 Views (70100) | $129.40 | $415 | 1.4× |
| X-Ray Knee Bilat Standing - Xr Knees Anteroposterior Standing Bilat (73565) | $129.40 | $415 | 1.4× |
| X-Ray Lumbar Spine 2/3 Vw - Xr Lumbar Spine 2-3 Views (72100) | $232.29 | $745 | 2.1× |
| X-ray nose-rectum child f.b. (76010) | $129.40 | $415 | 1.4× |
| X-Ray Ribs, Chest 4+ Vw - Xr Ribs 3 Vws Bil W/ Chest Posteroanterior (71111) | $232.29 | $745 | 2.1× |
| X-Ray Sacroiliac Jts 3+ Vw - Xr Sacroiliac Joints 3+ Views (72202) | $232.29 | $745 | 2.1× |
| X-Ray Sacroiliac Jts <3 Vw - Xr Sacroiliac Joints 1-2 Views (72200) | $232.29 | $745 | 2.1× |
| X-Ray Sacrum/Coccyx 2+ Vw - Xr Sacrum Coccyx 2+ Views (72220) | $129.40 | $415 | 1.4× |
| X-Ray Sinuses 3+ Vw - Xr Paranasal Sinuses 3+ Views (70220) | $129.40 | $415 | 1.4× |
| X-Ray Skull 4+ Vw - Xr Skull Complete 4+ Views (70260) | $232.29 | $745 | 2.1× |
| X-Ray Stress View (77071) range across 2 matching MRF lines |
$129.40–$193.32 | $415–$620 | varies |
| X-ray thoracic spine 4 vw (72074) | $232.29 | $745 | 2.1× |
| X-Ray Tmj Unilat (70328) | $129.40 | $415 | 1.4× |
| X-Ray Urinary Tract Exam With Contrast Material (74420) | $795.09 | $2,550 | 2.2× |
| X-Rays Bone Length Studies (77073) | $232.29 | $745 | 2.1× |
| X-Rays Bone Survey Complete (77075) | $232.29 | $745 | 2.1× |
| Xr c-spine 4 or 5 views (72050) | $232.29 | $745 | 2.1× |
| Xr facial bones less than 3 views (70140) | $129.40 | $415 | 1.4× |
| Xr orbits complete 4 views (70200) | $232.29 | $745 | 2.1× |
| Xr Tomogram Single Plane (76100) | $232.29 | $745 | 2.1× |
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.