Imaging prices at Lima Memorial Health System
Lima, OH · every code in this section with a posted price and a Medicare benchmark.
543 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 2 matching MRF lines |
$1,584.90–$12,183.30 | $1,761–$13,537 | varies |
| Abdomen 1 View (74018) range across 4 matching MRF lines |
$101.70–$485.10 | $113–$539 | varies |
| Abdomen 2 views (74019) range across 3 matching MRF lines |
$137.70–$679.50 | $153–$755 | varies |
| Acute Gastrointestinal Blood Loss Imaging (78278) range across 2 matching MRF lines |
$472.50–$2,932.20 | $525–$3,258 | varies |
| Acute venous thrombosis imaging, peptide Non-Facility (78456) | $1,638.90 | $1,821 | 1.3× |
| Adrenal Cortex & Medulla Img (78075) | $1,638.90 | $1,821 | 1.3× |
| Angio internal mammary (75756) range across 2 matching MRF lines |
$2,245.50–$3,592.80 | $2,495–$3,992 | varies |
| Angio pulmonary bilat (75743) range across 2 matching MRF lines |
$3,442.50–$3,592.80 | $3,825–$3,992 | varies |
| Angiography Adrenal Bilateral Slctv Rs&I (75733) | $3,592.80 | $3,992 | 1.2× |
| Angiography extremity bilateral rs&i (75716) range across 2 matching MRF lines |
$3,592.80–$3,606.30 | $3,992–$4,007 | varies |
| Angiography extremity unilateral rs&i (75710) range across 3 matching MRF lines |
$3,135.60–$3,592.80 | $3,484–$3,992 | varies |
| Angiography pulmonary unilateral slctv rs&i (75741) range across 2 matching MRF lines |
$2,827.80–$3,592.80 | $3,142–$3,992 | varies |
| Angrph pulmonary nonslctv cath/ven njx rs&i (75746) range across 2 matching MRF lines |
$2,213.10–$3,592.80 | $2,459–$3,992 | varies |
| Ankle 2 views (73600) range across 2 matching MRF lines |
$101.70–$684.90 | $113–$761 | varies |
| Aortography thoracic serialography rs&i (75605) range across 3 matching MRF lines |
$4,474.80–$5,983.20 | $4,972–$6,648 | varies |
| Aortography thoracic w/o serialography rs&i (75600) range across 2 matching MRF lines |
$3,592.80–$3,891.60 | $3,992–$4,324 | varies |
| Artery X-Rays Abdomen (75726) range across 2 matching MRF lines |
$3,722.40–$5,983.20 | $4,136–$6,648 | varies |
| Artery X-Rays Adrenal Gland (75731) | $3,592.80 | $3,992 | 1.2× |
| Artery X-Rays Pelvis (75736) range across 2 matching MRF lines |
$3,722.40–$5,983.20 | $4,136–$6,648 | varies |
| Artery X-Rays Spine (75705) range across 2 matching MRF lines |
$5,983.20–$10,436.40 | $6,648–$11,596 | varies |
| Arthrogram ankle (73615) range across 2 matching MRF lines |
$462.60–$1,800.90 | $514–$2,001 | varies |
| Arthrogram hip (73525) range across 2 matching MRF lines |
$462.60–$1,598.40 | $514–$1,776 | varies |
| Arthrogram Wrist (73115) range across 2 matching MRF lines |
$462.60–$1,664.10 | $514–$1,849 | varies |
| Basic radiation dosimetry calculation (77300) range across 2 matching MRF lines |
$158.40–$1,240.20 | $176–$1,378 | varies |
| Bone age studies (77072) range across 2 matching MRF lines |
$137.70–$731.70 | $153–$813 | varies |
| Bone Imaging 3 Phase (78315) range across 2 matching MRF lines |
$472.50–$3,961.80 | $525–$4,402 | varies |
| Bone Imaging Limited Area (78300) range across 2 matching MRF lines |
$472.50–$2,291.40 | $525–$2,546 | varies |
| Bone Imaging Multiple Areas (78305) range across 2 matching MRF lines |
$472.50–$2,559.60 | $525–$2,844 | varies |
| Bone Imaging Whole Body (78306) range across 2 matching MRF lines |
$472.50–$3,961.80 | $525–$4,402 | varies |
| Bone marrow imaging limited area (78102) range across 2 matching MRF lines |
$472.50–$1,443.60 | $525–$1,604 | varies |
| Bone marrow imaging; multiple areas (78103) | $472.50 | $525 | 1.2× |
| Bone marrow imaging; whole body (78104) | $472.50 | $525 | 1.2× |
| Bone survey infant (77076) range across 2 matching MRF lines |
$137.70–$1,366.20 | $153–$1,518 | varies |
| Brachytx isodose complex (77318) range across 2 matching MRF lines |
$425.70–$4,184.10 | $473–$4,649 | varies |
| Brachytx isodose intermed (77317) range across 2 matching MRF lines |
$425.70–$4,184.10 | $473–$4,649 | varies |
| Brachytx Isodose Plan Simple (77316) range across 2 matching MRF lines |
$425.70–$2,057.40 | $473–$2,286 | varies |
| Brain Flow Imaging Only (78610) | $614.70 | $683 | 1.2× |
| Brain Image W/Flow < 4 Views (78601) | $472.50 | $525 | 1.2× |
| Brain imaging < 4 static views (78600) | $472.50 | $525 | 1.2× |
| Brain Imaging Min 4 Static Views W Vascular Flow (78606) range across 2 matching MRF lines |
$614.70–$2,088 | $683–$2,320 | varies |
| Brain Imaging Minimum 4 Static Views (78605) | $614.70 | $683 | 1.2× |
| Brain Imaging Pet Metabolic Evaluation (78608) range across 2 matching MRF lines |
$1,856.70–$8,644.50 | $2,063–$9,605 | varies |
| Card Bl Pool Gated Spect Rest Wal Motn Ejct Frct (78494) | $472.50 | $525 | 1.2× |
| Cardiac blood pool imaging, first pass technique; multiple studies, resting and with stress (exercise and/or… (78483) range across 2 matching MRF lines |
$614.70–$4,539.60 | $683–$5,044 | varies |
| Cardiac MRI w/w/o contrast & further seq (75561) range across 3 matching MRF lines |
$462.60–$4,932.90 | $514–$5,481 | varies |
| Cardiac MRI w/w/o contrast w/stress (75563) range across 3 matching MRF lines |
$898.20–$4,932.90 | $998–$5,481 | varies |
| Cardiac Shunt Detection (78428) | $472.50 | $525 | 1.2× |
| Cardiovasc nucl exam unlisted (78499) | $472.50 | $525 | 1.2× |
| Cat Scan Follow-Up Study (76380) | $101.70 | $113 | 1.2× |
| Cerebrospinal Fluid Flow W/O Matl Shunt Evaltj (78645) | $614.70 | $683 | 1.2× |
| Cerebrospinal fluid flow, imaging (not including introduction of material); ventriculography Non-Facility (78635) | $614.70 | $683 | 1.2× |
| Cerebrospinal Fluid Scan (78630) range across 2 matching MRF lines |
$614.70–$4,095 | $683–$4,550 | varies |
| Chest 1 view (71045) range across 2 matching MRF lines |
$101.70–$451.80 | $113–$502 | varies |
| Chest 2 views (71046) range across 3 matching MRF lines |
$101.70–$894.60 | $113–$994 | varies |
| Chest 3 views (71047) range across 2 matching MRF lines |
$101.70–$1,010.70 | $113–$1,123 | varies |
| Chest 4 or more views (71048) range across 2 matching MRF lines |
$137.70–$1,166.40 | $153–$1,296 | varies |
| Cholecystography Oral Contrast (74290) | $224.10 | $249 | 1.3× |
| Cineradiograpy/vidradiograpy xcpt where spec (76120) | $137.70 | $153 | 1.4× |
| Cisternography Positive Contrast Rs&I (70015) | $898.20 | $998 | 1.2× |
| Clavicle complete (73000) range across 3 matching MRF lines |
$101.70–$1,049.40 | $113–$1,166 | varies |
| Computed Tomography Thorax Lw Dose Lng Ca Scr C- (71271) range across 5 matching MRF lines |
$137.70–$230.40 | $153–$256 | varies |
| Continuing medical physics consltj pr wk (77336) range across 2 matching MRF lines |
$158.40–$2,169.90 | $176–$2,411 | varies |
| Contrast Exam Abdominl Aorta (75625) range across 3 matching MRF lines |
$3,135.60–$3,592.80 | $3,484–$3,992 | varies |
| Contrast X-Ray Bladder (74430) range across 2 matching MRF lines |
$462.60–$1,199.70 | $514–$1,333 | varies |
| Contrast X-Ray Of Elbow (73085) range across 2 matching MRF lines |
$462.60–$861.30 | $514–$957 | varies |
| Contrast X-Ray Of Knee Joint (73580) range across 3 matching MRF lines |
$462.60–$3,878.10 | $514–$4,309 | varies |
| Contrast Xray Throat/Cerv Esopha (74210) range across 2 matching MRF lines |
$224.10–$761.40 | $249–$846 | varies |
| Corpora cavernosography (74445) | $137.70 | $153 | 1.4× |
| CT abdomen and pelvis without and with contrast (74178) range across 5 matching MRF lines |
$462.60–$6,323.40 | $514–$7,026 | varies |
| CT abdomen and pelvis without contrast (74176) range across 5 matching MRF lines |
$289.80–$4,216.50 | $322–$4,685 | varies |
| CT abdomen w contrast (74160) range across 5 matching MRF lines |
$224.10–$2,520 | $249–$2,800 | varies |
| CT abdomen w wo contrast (74170) range across 5 matching MRF lines |
$224.10–$2,669.40 | $249–$2,966 | varies |
| CT abdomen w/o contrast (74150) range across 3 matching MRF lines |
$137.70–$2,388.60 | $153–$2,654 | varies |
| CT Angio Abdomen and Pelvis (74174) range across 3 matching MRF lines |
$462.60–$3,873.60 | $514–$4,304 | varies |
| CT Angio Chest (71275) range across 3 matching MRF lines |
$224.10–$3,466.80 | $249–$3,852 | varies |
| CT Angio Head (70496) range across 3 matching MRF lines |
$224.10–$2,146.50 | $249–$2,385 | varies |
| CT angio hrt w/3d image (75574) range across 3 matching MRF lines |
$224.10–$568.80 | $249–$632 | varies |
| Ct Angio Lwr Extr W/O&W/Dye (73706) range across 3 matching MRF lines |
$224.10–$3,727.80 | $249–$4,142 | varies |
| CT Angio Neck (70498) range across 3 matching MRF lines |
$224.10–$2,146.50 | $249–$2,385 | varies |
| Ct Angio Upr Extrm W/O&W/Dye (73206) range across 3 matching MRF lines |
$224.10–$2,669.40 | $249–$2,966 | varies |
| CT bone density (77078) | $101.70 | $113 | 1.2× |
| CT cervical spine w/ contrast (72126) range across 5 matching MRF lines |
$462.60–$1,919.70 | $514–$2,133 | varies |
| CT cervical spine w/o contrast (72125) range across 2 matching MRF lines |
$137.70–$1,863 | $153–$2,070 | varies |
| CT cervical spine w/wo cont (72127) | $224.10 | $249 | 1.3× |
| CT chest w contrast (71260) range across 3 matching MRF lines |
$224.10–$2,868.30 | $249–$3,187 | varies |
| CT chest w/wo contrast (71270) range across 5 matching MRF lines |
$224.10–$3,347.10 | $249–$3,719 | varies |
| CT colonography screening (74263) | $446.40 | $496 | 2.0× |
| CT Colonogrphy Dx Image Postprocess W/Contrast (74262) | $224.10 | $249 | 1.3× |
| CT colonogrphy dx image postprocess w/o contrast (74261) | $137.70 | $153 | 1.4× |
| CT head/brain with contrast (70460) range across 3 matching MRF lines |
$224.10–$1,620 | $249–$1,800 | varies |
| CT head/brain without and with contrast (70470) range across 3 matching MRF lines |
$224.10–$1,701 | $249–$1,890 | varies |
| CT heart contrast eval cardiac structure&morph (75572) range across 2 matching MRF lines |
$224.10–$385.20 | $249–$428 | varies |
| CT heart no contrast quant eval coronry calcium (75571) range across 3 matching MRF lines |
$84.60–$114.30 | $94–$127 | varies |
| CT hrt w/3d image congen (75573) range across 3 matching MRF lines |
$224.10–$568.80 | $249–$632 | varies |
| CT iac w contrast (70481) range across 3 matching MRF lines |
$224.10–$1,946.70 | $249–$2,163 | varies |
| CT l-spine w&w/o contrast (72133) range across 2 matching MRF lines |
$224.10–$3,633.30 | $249–$4,037 | varies |
| CT lower ext w/o (73700) range across 7 matching MRF lines |
$137.70–$2,106.90 | $153–$2,341 | varies |
| CT lower extremity w/contrast material (73701) range across 9 matching MRF lines |
$224.10–$3,060.90 | $249–$3,401 | varies |
| CT lumbar spine w contrast (72132) range across 5 matching MRF lines |
$462.60–$3,098.70 | $514–$3,443 | varies |
| CT lumbar spine w/o contrast (72131) range across 3 matching MRF lines |
$137.70–$2,630.70 | $153–$2,923 | varies |
| CT maxillofacial w contrast (70487) range across 3 matching MRF lines |
$224.10–$1,782.90 | $249–$1,981 | varies |
| CT maxillofacial wo contrast (70486) range across 2 matching MRF lines |
$137.70–$1,458 | $153–$1,620 | varies |
| CT neck tissue combo (70492) range across 5 matching MRF lines |
$224.10–$2,079 | $249–$2,310 | varies |
| Ct Orbit/Ear/Fossa W/O&W/Dye (70482) range across 5 matching MRF lines |
$224.10–$2,205.90 | $249–$2,451 | varies |
| CT orbits w/o contrast (70480) range across 3 matching MRF lines |
$137.70–$1,620 | $153–$1,800 | varies |
| CT pelvis w&w/o contrast (72194) range across 5 matching MRF lines |
$224.10–$2,518.20 | $249–$2,798 | varies |
| CT pelvis w/o contrast (72192) range across 3 matching MRF lines |
$137.70–$2,080.80 | $153–$2,312 | varies |
| CT scan of leg combo (73702) range across 9 matching MRF lines |
$224.10–$5,157.90 | $249–$5,731 | varies |
| CT scans face/jaw combo (70488) range across 5 matching MRF lines |
$224.10–$2,178 | $249–$2,420 | varies |
| CT soft tissue neck w contrast (70491) range across 3 matching MRF lines |
$224.10–$1,782.90 | $249–$1,981 | varies |
| CT soft tissue neck w/o contrast (70490) range across 2 matching MRF lines |
$137.70–$1,539 | $153–$1,710 | varies |
| CT thoracic spine w contrast (72129) range across 5 matching MRF lines |
$224.10–$2,669.40 | $249–$2,966 | varies |
| CT thoracic spine w/o contrast (72128) range across 3 matching MRF lines |
$137.70–$2,570.40 | $153–$2,856 | varies |
| CT thoracic spine w/wo cont (72130) | $224.10 | $249 | 1.3× |
| CT thorax w/o contrast (71250) range across 5 matching MRF lines |
$137.70–$2,269.80 | $153–$2,522 | varies |
| CT unlisted procedure (76497) range across 2 matching MRF lines |
$101.70–$329.40 | $113–$366 | varies |
| CT upper ext wo (73200) range across 7 matching MRF lines |
$137.70–$2,086.20 | $153–$2,318 | varies |
| CT upper extremity w/o & w/contrast material (73202) range across 9 matching MRF lines |
$224.10–$2,524.50 | $249–$2,805 | varies |
| CT upper extremity with contrast (73201) range across 9 matching MRF lines |
$462.60–$2,295 | $514–$2,550 | varies |
| Cta Abdl Aorta&Bi Iliofem W/Contrast&Postp (75635) range across 3 matching MRF lines |
$224.10–$4,779 | $249–$5,310 | varies |
| Cta Abdomen (74175) range across 3 matching MRF lines |
$224.10–$2,952 | $249–$3,280 | varies |
| CTA pelvis (72191) range across 5 matching MRF lines |
$224.10–$3,232.80 | $249–$3,592 | varies |
| Dacryocystography, nasolacrimal duct, radiological supervision and interpretation Non-Facility (70170) | $289.80 | $322 | 1.3× |
| Determination of central c-v hemodynamics (non-imaging) (eg, ejection fraction with probe technique) with or without… (78414) | $614.70 | $683 | 1.2× |
| Dilation ureters/urethra rs&i (74485) | $2,246.40 | $2,496 | 1.1× |
| Discography Cerv/Thor Spine (72285) | $2,203.20 | $2,448 | 1.2× |
| Diskography lumbar (72295) range across 2 matching MRF lines |
$2,203.20–$6,390 | $2,448–$7,100 | varies |
| Doppler Echo Fetal Puls Spectral F/U/Repeat (76828) | $137.70 | $153 | 1.4× |
| Doppler Echo Fetal Spectral Display Complete (76827) | $137.70 | $153 | 1.4× |
| Doppler Fetal Mid Cerebral Artery (76821) | $137.70 | $153 | 1.4× |
| Dxa Bone Density Axial (77080) range across 2 matching MRF lines |
$137.70–$839.70 | $153–$933 | varies |
| Dxa bone density study (77085) | $137.70 | $153 | 1.4× |
| Dxa bone density study 1/>sites appendiclr skel (77081) range across 2 matching MRF lines |
$101.70–$546.30 | $113–$607 | varies |
| Echo exam of fetal heart (76825) | $606.60 | $674 | 1.2× |
| Echo exam uterus (76831) range across 2 matching MRF lines |
$289.80–$1,782 | $322–$1,980 | varies |
| Echo Guide For Artery Repair (76936) range across 2 matching MRF lines |
$332.10–$1,952.10 | $369–$2,169 | varies |
| Echocardiography, fetal, cardiovascular system, real time with image documentation (2D), with or without M-mode… (76826) | $289.80 | $322 | 1.3× |
| Echograp Trans R Pros Study (76873) range across 2 matching MRF lines |
$137.70–$1,308.60 | $153–$1,454 | varies |
| Esophageal Motility Study (78258) | $472.50 | $525 | 1.2× |
| Esophagram (74220) range across 2 matching MRF lines |
$224.10–$793.80 | $249–$882 | varies |
| Fetal Biophys Profile W/Nst (76818) | $137.70 | $153 | 1.4× |
| Fetal Biophysical Profile W/O Non-Stress Testing (76819) range across 2 matching MRF lines |
$137.70–$1,081.80 | $153–$1,202 | varies |
| Fetal MRI w/placntl matrnl plvc img sing/1st ges (74712) | $289.80 | $322 | 1.3× |
| Fluoroscopy up to 1 hr (76000) range across 2 matching MRF lines |
$289.80–$542.70 | $322–$603 | varies |
| Follow-Up Angiography (75898) range across 2 matching MRF lines |
$1,468.80–$3,592.80 | $1,632–$3,992 | varies |
| Foot 2 views (73620) range across 2 matching MRF lines |
$101.70–$684.90 | $113–$761 | varies |
| Forearm 2 views (73090) range across 3 matching MRF lines |
$101.70–$785.70 | $113–$873 | varies |
| Gastric emptying imaging study (78264) range across 2 matching MRF lines |
$472.50–$2,764.80 | $525–$3,072 | varies |
| Gastric Emptyng Imag Std W/Sm Bwl Transit (78265) | $472.50 | $525 | 1.2× |
| Gastric Mucosa Imaging (78261) | $472.50 | $525 | 1.2× |
| Gastroesophageal Reflux Exam (78262) | $472.50 | $525 | 1.2× |
| Gastrointestinal Protein Loss (78282) | $472.50 | $525 | 1.2× |
| Gated Heart Planar Single (78472) range across 2 matching MRF lines |
$472.50–$3,576.60 | $525–$3,974 | varies |
| Gated Heart, Multiple (78473) range across 2 matching MRF lines |
$472.50–$4,189.50 | $525–$4,655 | varies |
| GI Endoscopic US S&I (76975) | $289.80 | $322 | 1.3× |
| Gstrc Emptng Imag Std W/Sm Bwl Col Trnst Mlt Day (78266) range across 2 matching MRF lines |
$614.70–$2,887.20 | $683–$3,208 | varies |
| Hand 2 views (73120) range across 2 matching MRF lines |
$137.70–$731.70 | $153–$813 | varies |
| Hdr Rdncl Ntrstl/Icav Brchtx (77772) | $891 | $990 | 1.3× |
| Hdr Rdncl Ntrstl/Icav Brchtx (77771) range across 2 matching MRF lines |
$891–$6,462.90 | $990–$7,181 | varies |
| Hdr Rdncl Ntrstl/Icav Brchtx 1 Channel (77770) range across 2 matching MRF lines |
$891–$6,462.90 | $990–$7,181 | varies |
| Heart first pass single,planar (78481) range across 2 matching MRF lines |
$614.70–$3,948.30 | $683–$4,387 | varies |
| Heart Image (Pet) Multiple (78492) | $1,856.70 | $2,063 | 1.4× |
| Hepatc Vngrph Wdg/Fr Hemodyn Eval Rs&I (75889) range across 2 matching MRF lines |
$3,592.80–$10,724.40 | $3,992–$11,916 | varies |
| Hepatc Vngrph Wdg/Fr W/O Hemodyn Eval Rs&I (75891) | $3,592.80 | $3,992 | 1.2× |
| Hepatobil Syst Image W/Drug (78227) range across 2 matching MRF lines |
$614.70–$4,067.10 | $683–$4,519 | varies |
| Hepatobiliary System Imaging (78226) range across 2 matching MRF lines |
$472.50–$3,536.10 | $525–$3,929 | varies |
| High energy neutron radj tx dlvr 1/> isocenter (77423) | $680.40 | $756 | 1.3× |
| Ht Musc Image Planar Mult (78454) range across 2 matching MRF lines |
$1,638.90–$4,326.30 | $1,821–$4,807 | varies |
| Ht Muscle Image Spect Sing (78451) range across 2 matching MRF lines |
$1,638.90–$2,885.40 | $1,821–$3,206 | varies |
| Hyperthermia external generated superficial (77600) | $303.30 | $337 | 0.8× |
| Hyperthermia generated by interstitial probe(s); 5 or fewer interstitial applicators Non-Facility (77610) | $680.40 | $756 | 1.3× |
| Hyperthermia generated by interstitial probe(s); more than 5 interstitial applicators Non-Facility (77615) | $680.40 | $756 | 1.3× |
| Hyperthermia generated by intracavitary probe(s) Non-Facility (77620) | $680.40 | $756 | 1.3× |
| Hyperthermia, externally generated; deep (ie, heating to depths greater than 4 cm) Non-Facility (77605) | $891 | $990 | 1.3× |
| Hysterosalpingogram (74740) range across 2 matching MRF lines |
$289.80–$1,205.10 | $322–$1,339 | varies |
| Image fusion (77399) | $158.40 | $176 | 1.2× |
| Infant hip ultrasound with hip movement (dynamic) (76885) range across 2 matching MRF lines |
$101.70–$1,823.40 | $113–$2,026 | varies |
| Infant hip ultrasound, limited static exam (76886) range across 3 matching MRF lines |
$101.70–$711 | $113–$790 | varies |
| Infusion Ivp (74410) | $224.10 | $249 | 1.3× |
| Interstitial radiation source applic complex (77778) range across 2 matching MRF lines |
$891–$16,257.60 | $990–$18,064 | varies |
| Intracavitary Radiation Source Applic Complex (77763) | $891 | $990 | 1.3× |
| Intracavitary Radiation Source Applic Intermed (77762) | $680.40 | $756 | 1.3× |
| Intracavitary radiation source applic simple (77761) | $680.40 | $756 | 1.3× |
| Intraop radiaj tx deliver electrons sngl tx sess (77425) | $9,759.60 | $10,844 | 1.4× |
| Intraop radiaj tx deliver xray single tx session (77424) | $9,759.60 | $10,844 | 1.4× |
| Joint Survey Single View (77077) range across 2 matching MRF lines |
$137.70–$1,679.40 | $153–$1,866 | varies |
| K Flow/Funct Image Multiple (78709) range across 2 matching MRF lines |
$614.70–$3,835.80 | $683–$4,262 | varies |
| K Flow/Funct Image W/Drug (78708) range across 3 matching MRF lines |
$614.70–$3,684.60 | $683–$4,094 | varies |
| K Flow/Funct Image W/O Drug (78707) range across 2 matching MRF lines |
$614.70–$3,072.60 | $683–$3,414 | varies |
| Kidney Funcj Study Non-Img Radioisotopic Study (78725) | $472.50 | $525 | 1.2× |
| Kidney Imaging Morphol (78700) range across 2 matching MRF lines |
$472.50–$2,249.10 | $525–$2,499 | varies |
| Kidney Imaging Morphoogy W/Vascular Flow (78701) | $472.50 | $525 | 1.2× |
| Knee 3 Views (73562) range across 3 matching MRF lines |
$101.70–$957.60 | $113–$1,064 | varies |
| Labeled RBC Sequestration Differntl Organ/Tissue (78140) | $472.50 | $525 | 1.2× |
| Leveen/Shunt Patency Exam (78291) range across 2 matching MRF lines |
$472.50–$2,091.60 | $525–$2,324 | varies |
| Liver & Spleen Imaging Static Only (78215) range across 2 matching MRF lines |
$472.50–$2,358.90 | $525–$2,621 | varies |
| Liver & Spleen Imaging W/Vascular Flow (78216) | $472.50 | $525 | 1.2× |
| Liver imaging static only (78201) | $614.70 | $683 | 1.2× |
| Liver imaging w/vascular flow (78202) range across 2 matching MRF lines |
$614.70–$2,162.70 | $683–$2,403 | varies |
| Lung Perf&Ventilat Diferentl (78598) | $614.70 | $683 | 1.2× |
| Lung perfusion differential (78597) range across 2 matching MRF lines |
$472.50–$2,790.90 | $525–$3,101 | varies |
| Lung Ventilat&Perfus Imaging (78582) range across 3 matching MRF lines |
$614.70–$3,933 | $683–$4,370 | varies |
| Lung Ventilation Imaging (78579) range across 2 matching MRF lines |
$472.50–$2,266.20 | $525–$2,518 | varies |
| Lymph System Imaging (78195) range across 2 matching MRF lines |
$614.70–$4,020.30 | $683–$4,467 | varies |
| Lymphangiography Extremity Only Bilateral Rs&I (75803) | $1,764.90 | $1,961 | 1.2× |
| Lymphangiography extremity only unilateral rs&i (75801) | $678.60 | $754 | 1.1× |
| Lymphangiography Pelvic/Abdominal Bilateral Rs&I (75807) | $3,592.80 | $3,992 | 1.2× |
| Lymphangiography, pelvic/abdominal, unilateral (75805) | $3,592.80 | $3,992 | 1.2× |
| Magnetic Image Jaw Joint (70336) range across 3 matching MRF lines |
$289.80–$2,115 | $322–$2,350 | varies |
| Magnetic resonance (eg, proton) imaging, brain (including brain stem andskull base), during open intracranial procedure… (70558) | $224.10 | $249 | 1.3× |
| Magnetic resonance (eg, proton) imaging, brain (including brain stem andskull base), during open intracranial procedure… (70557) | $606.60 | $674 | 1.2× |
| Magnetic resonance (eg, proton) imaging, brain (including brain stem andskull base), during open intracranial procedure… (70559) | $224.10 | $249 | 1.3× |
| Magnetic Resonance Elastography (76391) | $289.80 | $322 | 1.3× |
| Mammary ductogram or galactogram multiple (77054) range across 2 matching MRF lines |
$289.80–$2,882.70 | $322–$3,203 | varies |
| Mammary ductogram or galactogram single (77053) range across 2 matching MRF lines |
$289.80–$2,269.80 | $322–$2,522 | varies |
| Meckels Divert Exam (78290) range across 2 matching MRF lines |
$472.50–$2,298.60 | $525–$2,554 | varies |
| Medical physics dose eval radiation expos w/rprt (76145) | $425.70 | $473 | 1.2× |
| Mlc imrt design & construction per imrt plan (77338) range across 2 matching MRF lines |
$425.70–$3,212.10 | $473–$3,569 | varies |
| Mra Head W/O & W/Contrast Material (70546) range across 3 matching MRF lines |
$462.60–$3,311.10 | $514–$3,679 | varies |
| MRA head w/o contrast (70544) range across 3 matching MRF lines |
$289.80–$1,765.80 | $322–$1,962 | varies |
| MRA head with contrast (70545) range across 3 matching MRF lines |
$462.60–$2,676.60 | $514–$2,974 | varies |
| MRA neck w contrast (70548) range across 3 matching MRF lines |
$462.60–$1,742.40 | $514–$1,936 | varies |
| Mra Neck W/O &W/Contrast Material (70549) range across 3 matching MRF lines |
$462.60–$2,916 | $514–$3,240 | varies |
| MRA neck w/o contrast (70547) range across 3 matching MRF lines |
$289.80–$1,513.80 | $322–$1,682 | varies |
| MRI abdomen w contrast (74182) | $462.60 | $514 | 1.4× |
| MRI abdomen w/o contrast (74181) range across 5 matching MRF lines |
$289.80–$4,553.10 | $322–$5,059 | varies |
| MRI any jt lower extrem w/contrast material (73722) range across 3 matching MRF lines |
$898.20–$5,365.80 | $998–$5,962 | varies |
| MRI any jt lower extrem w/o & w/contrast matrl (73723) range across 3 matching MRF lines |
$462.60–$6,669 | $514–$7,410 | varies |
| MRI any jt upper extremity w/contrast matrl (73222) range across 3 matching MRF lines |
$898.20–$6,381.90 | $998–$7,091 | varies |
| MRI bone marrow blood supply (77084) | $289.80 | $322 | 1.3× |
| MRI brain functional w/o physician admnistration (70554) | $289.80 | $322 | 1.3× |
| MRI brain functional w/physician admnistration (70555) | $289.80 | $322 | 1.3× |
| MRI Breast W/O Contrast Bilateral (77047) range across 4 matching MRF lines |
$289.80–$6,075.90 | $322–$6,751 | varies |
| MRI cardiac w/o cont stress (75559) range across 2 matching MRF lines |
$606.60–$4,479.30 | $674–$4,977 | varies |
| MRI cardiac w/o contrast (75557) range across 3 matching MRF lines |
$289.80–$4,563 | $322–$5,070 | varies |
| MRI cervical spine w contrast (72142) range across 3 matching MRF lines |
$462.60–$4,707.90 | $514–$5,231 | varies |
| MRI cervical spine w/o cont (72141) range across 3 matching MRF lines |
$289.80–$4,181.40 | $322–$4,646 | varies |
| MRI chest w/o contrast (71550) range across 3 matching MRF lines |
$289.80–$3,135.60 | $322–$3,484 | varies |
| MRI chest with contrast (71551) | $898.20 | $998 | 1.2× |
| MRI chest wo w contrast (71552) range across 3 matching MRF lines |
$462.60–$3,919.50 | $514–$4,355 | varies |
| MRI lower extrem oth/thn jt w/contrast matrl (73719) range across 3 matching MRF lines |
$462.60–$4,988.70 | $514–$5,543 | varies |
| MRI lower extrem oth/thn jt w/o & w/contr matr (73720) range across 3 matching MRF lines |
$462.60–$5,530.50 | $514–$6,145 | varies |
| MRI lower extrem oth/thn jt w/o contr matrl (73718) range across 5 matching MRF lines |
$289.80–$4,772.70 | $322–$5,303 | varies |
| MRI lumbar spine w contrast (72149) range across 3 matching MRF lines |
$462.60–$5,543.10 | $514–$6,159 | varies |
| Mri Neck Spine W/O & W/Dye (72156) range across 3 matching MRF lines |
$462.60–$5,973.30 | $514–$6,637 | varies |
| MRI orbit face &/neck w/o contrast (70540) range across 3 matching MRF lines |
$289.80–$2,619.90 | $322–$2,911 | varies |
| MRI orbit face neck w contrast (70542) | $462.60 | $514 | 1.4× |
| Mri Orbt/Fac/Nck W/O &W/Dye (70543) range across 3 matching MRF lines |
$462.60–$3,255.30 | $514–$3,617 | varies |
| MRI pelvis w contrast (72196) range across 3 matching MRF lines |
$462.60–$4,391.10 | $514–$4,879 | varies |
| MRI pelvis w/o & w contrast (72197) range across 3 matching MRF lines |
$462.60–$4,542.30 | $514–$5,047 | varies |
| MRI pelvis w/o contrast (72195) range across 3 matching MRF lines |
$289.80–$4,311.90 | $322–$4,791 | varies |
| MRI spectroscopy (76390) | $101.70 | $113 | 1.2× |
| MRI thoracic spine w/o contrast (72146) range across 3 matching MRF lines |
$289.80–$3,925.80 | $322–$4,362 | varies |
| MRI upper extremity oth than jt w/contr matrl (73219) range across 3 matching MRF lines |
$462.60–$4,962.60 | $514–$5,514 | varies |
| MRI upper extremity oth than jt w/o contr matrl (73218) range across 3 matching MRF lines |
$289.80–$4,553.10 | $322–$5,059 | varies |
| Mri Uppr Extremity W/O&W/Dye (73220) range across 3 matching MRF lines |
$462.60–$5,408.10 | $514–$6,009 | varies |
| MRI, abdomen, combo (74183) range across 3 matching MRF lines |
$462.60–$4,715.10 | $514–$5,239 | varies |
| MRI, dorsal spine combo (72157) range across 3 matching MRF lines |
$462.60–$4,927.50 | $514–$5,475 | varies |
| MRI, dorsal spine contrast (72147) range across 3 matching MRF lines |
$462.60–$4,391.10 | $514–$4,879 | varies |
| MRI, joint upper extrem (73221) range across 3 matching MRF lines |
$289.80–$5,543.10 | $322–$6,159 | varies |
| MRI, joint upper extrem combo (73223) range across 3 matching MRF lines |
$462.60–$7,364.70 | $514–$8,183 | varies |
| MRI, lumbar spine combo (72158) range across 5 matching MRF lines |
$462.60–$7,236 | $514–$8,040 | varies |
| Musculoskeletal Nuclear Exam (78399) | $472.50 | $525 | 1.2× |
| Myelogram cervical (72240) range across 2 matching MRF lines |
$898.20–$1,782.90 | $998–$1,981 | varies |
| Myelogram Lumbar (72265) range across 2 matching MRF lines |
$898.20–$1,598.40 | $998–$1,776 | varies |
| Myelography thoracic (72255) range across 2 matching MRF lines |
$898.20–$1,476 | $998–$1,640 | varies |
| Myelograpy 2/more regions rs&i (72270) range across 2 matching MRF lines |
$898.20–$1,967.40 | $998–$2,186 | varies |
| Myocardial Imaging Infarct Avid Planar Qual/Quan (78466) | $472.50 | $525 | 1.2× |
| Myocardial Imaging Pet Metabolic Evaluation (78459) range across 2 matching MRF lines |
$1,638.90–$5,006.70 | $1,821–$5,563 | varies |
| Myocardial imaging, infarct avid, planar; with ejection fraction by first pass technique Non-Facility (78468) | $614.70 | $683 | 1.2× |
| Myocardial Perfusion Planar 1 Study Rest/Stress (78453) range across 2 matching MRF lines |
$1,638.90–$3,607.20 | $1,821–$4,008 | varies |
| Myocardial Spect Multiple Studies (78452) range across 2 matching MRF lines |
$1,638.90–$8,221.50 | $1,821–$9,135 | varies |
| Myocrd Img Pet Metab Eval Single Study Cncrnt CT (78429) | $1,856.70 | $2,063 | 1.4× |
| Myocrd img PET prfuj 1std rest/stress cncrnt CT (78430) | $1,856.70 | $2,063 | 1.4× |
| Myocrd Img Pet Prfuj Mlt Std Rst&Strs Cncrnt CT (78431) | $2,764.80 | $3,072 | 1.3× |
| Myocrd Img Pet Prfuj W/Metab 2rtracer Cncrnt CT (78433) | $3,379.50 | $3,755 | 1.6× |
| Myocrd Img Pet Prfuj W/Metab Dual Radiotracer (78432) | $3,379.50 | $3,755 | 2.3× |
| N-invas est c ffr sw aly CTA (75580) | $3,661.20 | $4,068 | 4.5× |
| Neck soft tissue (70360) range across 3 matching MRF lines |
$101.70–$485.10 | $113–$539 | varies |
| Nervous system nuclear exam (78699) | $472.50 | $525 | 1.2× |
| Nfs/Instlj Radioelmnt Sln 3 Mo Follow-Up Care (77750) | $303.30 | $337 | 0.8× |
| Njx Rp Loclzj Non-Img Probe Study Intravenous (78808) range across 2 matching MRF lines |
$472.50–$1,090.80 | $525–$1,212 | varies |
| Nm csf leak detection (78650) range across 2 matching MRF lines |
$1,638.90–$2,452.50 | $1,821–$2,725 | varies |
| Nm myocard infarct spect (78469) range across 2 matching MRF lines |
$614.70–$3,040.20 | $683–$3,378 | varies |
| Nm red cell survival study (78130) | $472.50 | $525 | 1.2× |
| Nm unlisted gi procedure (78299) | $472.50 | $525 | 1.2× |
| Nm whole blood volume (78122) | $614.70 | $683 | 1.2× |
| Nonvascular Shunt X-Ray (75809) range across 2 matching MRF lines |
$137.70–$337.50 | $153–$375 | varies |
| Ntsty modul radthx pln dose-vol histos (77301) range across 2 matching MRF lines |
$1,584.90–$9,633.60 | $1,761–$10,704 | varies |
| Nuclear medicine study of endocrine organs (78099) | $472.50 | $525 | 1.2× |
| Nuclear Rx Intra-Arterial (79445) | $317.70 | $353 | 1.4× |
| Nuclear Rx Oral Admin (79005) | $317.70 | $353 | 1.4× |
| Ob us nuchal meas 1 gest (76813) | $137.70 | $153 | 1.4× |
| Oph bmtry us echograpy a-scan io lens pwr cal (76519) | $137.70 | $153 | 1.4× |
| Oph us dx ant sgm us immersion b-scan/hr biom (76513) | $137.70 | $153 | 1.4× |
| Oph US Dx B-Scan&Quan a-Scan Sm Pt Enctr (76510) | $142.20 | $158 | 1.1× |
| Ophthalmic Biometry US Echograpy a-Scan (76516) | $137.70 | $153 | 1.4× |
| Ophthalmic Ultrasonic Foreign Body Localization (76529) | $101.70 | $113 | 1.2× |
| Ophthalmic ultrasound dx b-scan w/wo a-scan (76512) | $137.70 | $153 | 1.4× |
| Ophthalmic US Dx Corneal Pachymetry Uni/Bi (76514) | $31.50 | $35 | 1.1× |
| Ophthalmic us dx quantitative a-scan only (76511) | $137.70 | $153 | 1.4× |
| Optic foramina (70190) range across 2 matching MRF lines |
$101.70–$576.90 | $113–$641 | varies |
| Panoramic X-ray of jaws (70355) range across 2 matching MRF lines |
$101.70–$1,049.40 | $113–$1,166 | varies |
| Parathyroid imaging w/tomographic spect & CT (78072) range across 2 matching MRF lines |
$614.70–$1,934.10 | $683–$2,149 | varies |
| Parathyroid Planar Imaging (78070) | $472.50 | $525 | 1.2× |
| Parathyroid planar imaging w/wo subtraction (78071) range across 2 matching MRF lines |
$472.50–$1,682.10 | $525–$1,869 | varies |
| Pelvis 1 or 2 views (72170) range across 3 matching MRF lines |
$137.70–$729.90 | $153–$811 | varies |
| Perineogram (74775) | $289.80 | $322 | 1.3× |
| Peritoneogram Rs&I (74190) range across 2 matching MRF lines |
$606.60–$940.50 | $674–$1,045 | varies |
| Pet Image Skull-Thigh (78812) | $1,856.70 | $2,063 | 1.4× |
| Pet Image W/Ct Lmtd (78814) | $1,856.70 | $2,063 | 1.4× |
| PET image w/CT, full body (78816) range across 2 matching MRF lines |
$1,856.70–$9,280.80 | $2,063–$10,312 | varies |
| PET imaging CT attenuation skull base mid-thigh (78815) range across 3 matching MRF lines |
$1,856.70–$9,058.50 | $2,063–$10,065 | varies |
| Pet Imaging Limited Area Chest Head/Neck (78811) | $1,638.90 | $1,821 | 1.3× |
| Pet Myocardial Sngl Study (78491) | $1,856.70 | $2,063 | 1.4× |
| PET whole body (78813) | $1,856.70 | $2,063 | 1.4× |
| Plasma Vol Radiopharm Vol Dilute Spx Mult Smples (78111) | $1,638.90 | $1,821 | 1.3× |
| Plasma volume, radiopharmaceutical volume-dilution technique (separate procedure); single sampling Non-Facility (78110) | $1,638.90 | $1,821 | 1.3× |
| Platelet survival study Non-Facility (78191) | $472.50 | $525 | 1.2× |
| Proton trmt simple w/comp (77522) | $1,623.60 | $1,804 | 1.4× |
| Proton tx delivery complex (77525) | $1,623.60 | $1,804 | 1.4× |
| Proton tx delivery intermediate (77523) | $1,623.60 | $1,804 | 1.4× |
| Proton tx delivery simple w/o compensation (77520) | $680.40 | $756 | 1.3× |
| Prq Transhepatc Portograpy Hemodyn Eval Rs&I (75885) range across 2 matching MRF lines |
$3,592.80–$5,842.80 | $3,992–$6,492 | varies |
| Pulmonary Perfusion Imaging Particulate (78580) range across 2 matching MRF lines |
$472.50–$2,201.40 | $525–$2,446 | varies |
| Radex Abd Compl Aqt Abd W/S/E/D Views 1 View Ch (74022) range across 3 matching MRF lines |
$137.70–$855 | $153–$950 | varies |
| Radex abscess/fistula/sinus tract rs&i (76080) range across 2 matching MRF lines |
$606.60–$1,141.20 | $674–$1,268 | varies |
| Radex Ankle Complete Minimum 3 Views (73610) range across 3 matching MRF lines |
$101.70–$957.60 | $113–$1,064 | varies |
| Radex Calcaneus Minimum 2 Views (73650) range across 3 matching MRF lines |
$101.70–$672.30 | $113–$747 | varies |
| Radex elbow complete minimum 3 views (73080) range across 3 matching MRF lines |
$101.70–$957.60 | $113–$1,064 | varies |
| Radex Facial Bones Complete Minimum 3 Views (70150) range across 2 matching MRF lines |
$137.70–$1,094.40 | $153–$1,216 | varies |
| Radex fingr minimum 2 views (73140) range across 3 matching MRF lines |
$101.70–$775.80 | $113–$862 | varies |
| Radex foot complete minimum 3 views (73630) range across 3 matching MRF lines |
$101.70–$775.80 | $113–$862 | varies |
| Radex Hand Minimum 3 Views (73130) range across 4 matching MRF lines |
$101.70–$775.80 | $113–$862 | varies |
| Radex lower extremity infant minimum 2 views (73592) range across 2 matching MRF lines |
$101.70–$526.50 | $113–$585 | varies |
| Radex Mastoids Compl Minimum 3 Views PR Side (70130) range across 2 matching MRF lines |
$137.70–$839.70 | $153–$933 | varies |
| Radex Nasal Bones Complete Minimum 3 Views (70160) range across 2 matching MRF lines |
$101.70–$912.60 | $113–$1,014 | varies |
| Radex Pharynx/Larx W/Fluor&/Magnification Tq (70370) | $101.70 | $113 | 1.2× |
| Radex Ribs Unilateral 2 Views (71100) range across 3 matching MRF lines |
$101.70–$957.60 | $113–$1,064 | varies |
| Radex shoulder complete minimum 2 views (73030) range across 4 matching MRF lines |
$101.70–$957.60 | $113–$1,064 | varies |
| Radex Sinuses Paransl < 3 Views (70210) range across 2 matching MRF lines |
$101.70–$630 | $113–$700 | varies |
| Radex sm int w/mlt srl imges via enteroclss tube (74251) | $224.10 | $249 | 1.3× |
| Radex Spine 1 View Specify Level (72020) range across 2 matching MRF lines |
$101.70–$729.90 | $113–$811 | varies |
| Radex Sternum Minimum 2 Views (71120) range across 2 matching MRF lines |
$101.70–$940.50 | $113–$1,045 | varies |
| Radex Temporomandble Jt Opn & Clsd Mouth Bilat (70330) range across 2 matching MRF lines |
$101.70–$1,260 | $113–$1,400 | varies |
| Radex Toe Minimum 2 Views (73660) range across 3 matching MRF lines |
$101.70–$684.90 | $113–$761 | varies |
| Radex upper extremity infant minimum 2 views (73092) range across 2 matching MRF lines |
$137.70–$526.50 | $153–$585 | varies |
| Radex Wrist Complete Minimum 3 Views (73110) range across 3 matching MRF lines |
$198.90–$775.80 | $221–$862 | varies |
| Radex X-Ray Exam Entire Spi 6/> Vw - Xr Entire Spine 6+ Vw (72084) range across 2 matching MRF lines |
$137.70–$453.60 | $153–$504 | varies |
| Radiation Delivery Stereotactic Cranial Linear (77372) range across 2 matching MRF lines |
$9,759.60–$43,253.10 | $10,844–$48,059 | varies |
| Radiation treatment delivery level 1 (77402) range across 2 matching MRF lines |
$150.30–$1,211.40 | $167–$1,346 | varies |
| Radiation treatment delivery level 2 (77407) range across 2 matching MRF lines |
$303.30–$1,394.10 | $337–$1,549 | varies |
| Radiation treatment delivery level 3 (77412) range across 2 matching MRF lines |
$303.30–$1,602.90 | $337–$1,781 | varies |
| Radiolog exam mandible compl minimum 4 views (70110) range across 2 matching MRF lines |
$137.70–$1,094.40 | $153–$1,216 | varies |
| Radiologic Exam Abdomen 3+ Views - Xr Abdomen 3+ Views (74021) range across 2 matching MRF lines |
$137.70–$701.10 | $153–$779 | varies |
| Radiologic exam colon double contrast study (74280) range across 2 matching MRF lines |
$224.10–$1,591.20 | $249–$1,768 | varies |
| Radiologic exam colon single contrast study (74270) range across 2 matching MRF lines |
$224.10–$1,292.40 | $249–$1,436 | varies |
| Radiologic Exam Esophagus Double Contrast Study (74221) range across 2 matching MRF lines |
$224.10–$912.60 | $249–$1,014 | varies |
| Radiologic exam knee complete 4/more views (73564) range across 3 matching MRF lines |
$137.70–$1,049.40 | $153–$1,166 | varies |
| Radiologic exam pelvis compl minimum 3 views (72190) range across 2 matching MRF lines |
$137.70–$821.70 | $153–$913 | varies |
| Radiologic Exam Small Int Single Contrast Study (74250) range across 2 matching MRF lines |
$224.10–$879.30 | $249–$977 | varies |
| Radiologic exam swallow function contrast study (74230) | $224.10 | $249 | 1.3× |
| Radiologic exam teeth complete full mouth (70320) | $289.80 | $322 | 1.3× |
| Radiologic Exam Teeth Prtl Exam < Full Mouth (70310) | $289.80 | $322 | 1.3× |
| Radiologic exam upr gi trc double contrast study (74246) range across 2 matching MRF lines |
$224.10–$1,173.60 | $249–$1,304 | varies |
| Radiologic examination femur 1 view (73551) range across 2 matching MRF lines |
$101.70–$576.90 | $113–$641 | varies |
| Radiologic examination femur minimum 2 views (73552) range across 4 matching MRF lines |
$101.70–$775.80 | $113–$862 | varies |
| Radiologic examination knee 1/2 views (73560) range across 3 matching MRF lines |
$101.70–$821.70 | $113–$913 | varies |
| Radiologic Examination Osseous Survey Limited (77074) range across 2 matching MRF lines |
$137.70–$1,153.80 | $153–$1,282 | varies |
| Radiologic Examination Salivary Gland Calculus (70380) range across 2 matching MRF lines |
$101.70–$379.80 | $113–$422 | varies |
| Radiologic examination tibia & fibula 2 views (73590) range across 3 matching MRF lines |
$101.70–$785.70 | $113–$873 | varies |
| Radiologic examination, internal auditory meati, complete Non-Facility (70134) | $606.60 | $674 | 1.2× |
| Radiologic examination, teeth; single view Non-Facility (70300) | $101.70 | $113 | 1.2× |
| Radiopharm Dacryocystography (78660) | $472.50 | $525 | 1.2× |
| Radiopharmaceutical therapy, by interstitial radioactive colloid administration Facility (79300) | $317.70 | $353 | 1.4× |
| Radiopharmaceutical therapy, by intra-articular administration Non-Facility (79440) | $317.70 | $353 | 1.4× |
| Radiopharmaceutical therapy, by intracavitary administration Non-Facility (79200) | $317.70 | $353 | 1.4× |
| Red Cell Volume Determination Spx 1 Sampling (78120) | $472.50 | $525 | 1.2× |
| Red Cell Volume Determination Spx Mult Samplings (78121) | $614.70 | $683 | 1.2× |
| Remote afterloading high dose rate radionuclide skin surface brachytherapy, includes basic dosimetry, when performed;… (77768) | $303.30 | $337 | 0.8× |
| Remote afterloading high dose rate radionuclide skin surface brachytherapy, includes basic dosimetry, when performed;… (77767) | $303.30 | $337 | 0.8× |
| Renal Cyst Study (74470) | $606.60 | $674 | 1.2× |
| Ribs bilateral 3 views (71110) range across 2 matching MRF lines |
$137.70–$1,004.40 | $153–$1,116 | varies |
| Rp loclzj tum plnr 1 area single day imaging (78800) range across 2 matching MRF lines |
$472.50–$2,369.70 | $525–$2,633 | varies |
| Rp loclzj tum plnr 2+area 1+d img/1 area img>2+d (78801) range across 2 matching MRF lines |
$472.50–$2,725.20 | $525–$3,028 | varies |
| Rp Loclzj Tum Plnr Whole Body 2+ Days Imaging (78804) | $1,638.90 | $1,821 | 3.2× |
| Rp Loclzj Tum Plnr Whole Body Single Day Imaging (78802) range across 3 matching MRF lines |
$1,638.90–$3,132.90 | $1,821–$3,481 | varies |
| Rp Loclzj Tum Spect 1 Area Single Day Imaging (78803) range across 3 matching MRF lines |
$1,638.90–$4,144.50 | $1,821–$4,605 | varies |
| Rp loclzj tum spect 2 area/sep acquisj img (78831) | $1,638.90 | $1,821 | 1.3× |
| Rp loclzj tum spect CT 2area 1d img/1 ar img>2+d (78832) | $1,856.70 | $2,063 | 1.4× |
| Rp loclzj tum spect w/CT 1 area/acquisj 1day img (78830) range across 2 matching MRF lines |
$1,638.90–$4,765.50 | $1,821–$5,295 | varies |
| Rp Ther Radiolbld Monoclonal Antibody IV Infus (79403) | $317.70 | $353 | 1.4× |
| Rp Therapy Intravenous Administration (79101) | $317.70 | $353 | 1.4× |
| Rp Therapy Unlisted Procedure (79999) | $317.70 | $353 | 1.4× |
| Salivary Gland Function Study (78232) | $472.50 | $525 | 1.2× |
| Salivary Gland Imaging (78230) | $472.50 | $525 | 1.2× |
| Salivary Gland Imaging Serial Images (78231) | $472.50 | $525 | 1.2× |
| Scapula (73010) range across 2 matching MRF lines |
$137.70–$821.70 | $153–$913 | varies |
| Screening Digital Breast Tomosynthesis Bi (77063) range across 2 matching MRF lines |
$34.20–$59.40 | $38–$66 | varies |
| Sella turcica (70240) range across 2 matching MRF lines |
$101.70–$418.50 | $113–$465 | varies |
| Shoulder 1 view (73020) range across 2 matching MRF lines |
$101.70–$684.90 | $113–$761 | varies |
| Shoulder Arthrography (73040) range across 2 matching MRF lines |
$462.60–$918 | $514–$1,020 | varies |
| Sialogram (70390) range across 2 matching MRF lines |
$289.80–$999 | $322–$1,110 | varies |
| Skull less than 4 views (70250) range across 2 matching MRF lines |
$137.70–$957.60 | $153–$1,064 | varies |
| Special dosimetry (77331) range across 2 matching MRF lines |
$158.40–$1,398.60 | $176–$1,554 | varies |
| Special Physics Consult (77370) range across 2 matching MRF lines |
$158.40–$1,831.50 | $176–$2,035 | varies |
| Special teletherapy port plan (77321) range across 2 matching MRF lines |
$425.70–$2,255.40 | $473–$2,506 | varies |
| Special treatment procedure (77470) range across 2 matching MRF lines |
$680.40–$4,655.70 | $756–$5,173 | varies |
| Speech evaluation, complex (70371) | $289.80 | $322 | 1.3× |
| Spleen Imaging (78185) | $472.50 | $525 | 1.2× |
| Srs Multisource (77371) | $9,759.60 | $10,844 | 1.4× |
| Stereotactic Body Radiation Delivery (77373) range across 2 matching MRF lines |
$2,177.10–$4,772.70 | $2,419–$5,303 | varies |
| Sternoclavicular joints (71130) range across 2 matching MRF lines |
$101.70–$630 | $113–$700 | varies |
| Superior sagittal sinus venogram (75870) | $3,592.80 | $3,992 | 1.2× |
| Surface Applic Low Dose Rate Radionuclide Source (77789) | $150.30 | $167 | 1.5× |
| Telethx isodose pln cplx w/basic dosimetry (77307) range across 2 matching MRF lines |
$425.70–$3,673.80 | $473–$4,082 | varies |
| Telethx isodose pln smpl w/dosimetry calculation (77306) range across 2 matching MRF lines |
$425.70–$2,434.50 | $473–$2,705 | varies |
| Temporomandble Jt Arthrography Rs&I (70332) | $289.80 | $322 | 1.3× |
| Testicular Imaging W/Flow (78761) range across 2 matching MRF lines |
$472.50–$2,088.90 | $525–$2,321 | varies |
| Ther Rad Simulaj-Aided Field Setting Complex (77290) range across 2 matching MRF lines |
$425.70–$5,995.80 | $473–$6,662 | varies |
| Ther Rad Simulaj-Aided Field Setting Intermed (77285) range across 2 matching MRF lines |
$425.70–$2,793.60 | $473–$3,104 | varies |
| Ther rad simulaj-aided field setting simple (77280) range across 2 matching MRF lines |
$158.40–$2,150.10 | $176–$2,389 | varies |
| Therapeutic Enema Rdctj Intussusception/Obstrcj (74283) range across 2 matching MRF lines |
$224.10–$862.20 | $249–$958 | varies |
| Thoracic spine 2 views (72070) range across 2 matching MRF lines |
$137.70–$548.10 | $153–$609 | varies |
| Thoracic spine 3 views (72072) range across 3 matching MRF lines |
$137.70–$1,004.40 | $153–$1,116 | varies |
| Thoracolumbar 2 views (72080) range across 2 matching MRF lines |
$101.70–$957.60 | $113–$1,064 | varies |
| Thyroid carcinoma metastases imaging; with additional studies (eg, urinary recovery) Non-Facility (78016) | $472.50 | $525 | 1.2× |
| Thyroid Carcinoma Metastases Img Lmtd Area (78015) | $472.50 | $525 | 1.2× |
| Thyroid Imaging With Vascular Flow (78013) range across 2 matching MRF lines |
$472.50–$1,067.40 | $525–$1,186 | varies |
| Thyroid Met Imaging Body (78018) range across 2 matching MRF lines |
$614.70–$3,240 | $683–$3,600 | varies |
| Thyroid Uptake Measurement (78012) range across 2 matching MRF lines |
$472.50–$1,329.30 | $525–$1,477 | varies |
| Thyroid Uptake W/Blood Flow Sngle/Mult Quan Meas (78014) range across 2 matching MRF lines |
$472.50–$2,839.50 | $525–$3,155 | varies |
| Tx Devices Design & Construction Complex (77334) range across 2 matching MRF lines |
$425.70–$3,085.20 | $473–$3,428 | varies |
| Tx devices design & construction intermediate (77333) range across 2 matching MRF lines |
$158.40–$1,691.10 | $176–$1,879 | varies |
| Tx devices design & construction simple (77332) range across 2 matching MRF lines |
$158.40–$1,240.20 | $176–$1,378 | varies |
| Ultrasound Breast Limited (76642) range across 2 matching MRF lines |
$101.70–$1,220.40 | $113–$1,356 | varies |
| Ultrasound elastography first target lesion (76982) range across 2 matching MRF lines |
$137.70–$960.30 | $153–$1,067 | varies |
| Ultrasound Elastography Parenchyma (76981) range across 2 matching MRF lines |
$137.70–$960.30 | $153–$1,067 | varies |
| Ultrasound Exam Aaa Screen (76706) range across 2 matching MRF lines |
$137.70–$1,213.20 | $153–$1,348 | varies |
| Ultrasound trgt dynamic microbubble 1st lesion (76978) | $224.10 | $249 | 0.7× |
| Ultrasound, abdomen limited (76705) range across 5 matching MRF lines |
$137.70–$2,223.90 | $153–$2,471 | varies |
| Umbilical-artery Doppler (OB) (76820) range across 2 matching MRF lines |
$137.70–$396 | $153–$440 | varies |
| Unlis px ther radiol clinical tx planning (77299) | $158.40 | $176 | 1.2× |
| Unlisted Dx Radiographic Procedure (76499) | $101.70 | $113 | 1.2× |
| Unlisted fluoroscopic procedure (76496) | $101.70 | $113 | 1.2× |
| Unlisted genitourinary px dx nuclear medicine (78799) | $472.50 | $525 | 1.2× |
| Unlisted hematopoietic, reticuloendothelial and lymphatic procedure, diagnostic nuclear medicine (78199) | $472.50 | $525 | 1.2× |
| Unlisted magnetic resonance procedure (76498) | $101.70 | $113 | 1.2× |
| Unlisted Miscellaneous Px Dx Nuclear Medicine (78999) | $472.50 | $525 | 1.2× |
| Unlisted Procedure Clinical Brachytherapy (77799) range across 2 matching MRF lines |
$150.30–$2,150.10 | $167–$2,389 | varies |
| Unlisted respiratory px dx nuclear medicine (78599) | $472.50 | $525 | 1.2× |
| Unlisted us procedure (76999) range across 2 matching MRF lines |
$101.70–$1,080.90 | $113–$1,201 | varies |
| Upper gi w/o kub (74240) range across 2 matching MRF lines |
$224.10–$1,125 | $249–$1,250 | varies |
| Urea Breath Test C-14 Isotopic Acquisj Analysis (78267) | $12.60 | $14 | 1.1× |
| Urea breath test c-14 isotopic analysis (78268) | $116.10 | $129 | 1.2× |
| Ureteral Reflux Study (78740) | $472.50 | $525 | 1.2× |
| Urethrocystogram voiding (74455) range across 2 matching MRF lines |
$289.80–$1,052.10 | $322–$1,169 | varies |
| Urethrocystography retrograde (74450) range across 2 matching MRF lines |
$289.80–$1,141.20 | $322–$1,268 | varies |
| Us bone density measurement (76977) | $137.70 | $153 | 1.4× |
| Us breast unilateral complete (76641) range across 4 matching MRF lines |
$137.70–$1,404 | $153–$1,560 | varies |
| Us chest (76604) range across 2 matching MRF lines |
$137.70–$960.30 | $153–$1,067 | varies |
| Us complete joint (76881) | $137.70 | $153 | 1.4× |
| Us exam, pelvic, limited (76857) range across 2 matching MRF lines |
$137.70–$1,134 | $153–$1,260 | varies |
| Us head (76506) range across 2 matching MRF lines |
$137.70–$1,763.10 | $153–$1,959 | varies |
| Us kidney transplant (76776) range across 2 matching MRF lines |
$137.70–$1,483.20 | $153–$1,648 | varies |
| Us lmtd joint/oth nonvasc xtr strux r-t w/img (76882) range across 3 matching MRF lines |
$137.70–$872.10 | $153–$969 | varies |
| Us ob detailed single fetus (76811) | $289.80 | $322 | 1.3× |
| Us ob limited 1 or more fetuses (76815) range across 3 matching MRF lines |
$137.70–$1,467.90 | $153–$1,631 | varies |
| Us ob transvaginal (76817) range across 2 matching MRF lines |
$137.70–$1,134 | $153–$1,260 | varies |
| Us pelvic non ob complete (76856) range across 2 matching MRF lines |
$137.70–$1,570.50 | $153–$1,745 | varies |
| Us pg uter img f&mat 14 wk tabdl 1/1st gestation (76801) range across 2 matching MRF lines |
$137.70–$1,178.10 | $153–$1,309 | varies |
| Us preg uterus real time f/u trnsabdl per fetus (76816) range across 2 matching MRF lines |
$137.70–$872.10 | $153–$969 | varies |
| Us retroperitoneal complete (76770) range across 2 matching MRF lines |
$137.70–$1,440 | $153–$1,600 | varies |
| Us retroperitoneal limited (76775) range across 2 matching MRF lines |
$137.70–$1,351.80 | $153–$1,502 | varies |
| Us scrotum and contents (76870) range across 2 matching MRF lines |
$137.70–$1,395.90 | $153–$1,551 | varies |
| Us spinal canal and contents (76800) range across 2 matching MRF lines |
$137.70–$960.30 | $153–$1,067 | varies |
| Us thyroid (76536) range across 2 matching MRF lines |
$137.70–$1,483.20 | $153–$1,648 | varies |
| Us transrectal (76872) | $156.60 | $174 | 1.6× |
| Vascular Flow Imaging (78445) | $472.50 | $525 | 1.2× |
| Vasogram (74440) | $289.80 | $322 | 1.3× |
| Vein X-Ray Chest (75827) range across 2 matching MRF lines |
$1,764.90–$2,458.80 | $1,961–$2,732 | varies |
| Vein X-Ray Liver W/O Hemodyn (75887) | $3,592.80 | $3,992 | 1.2× |
| Vein X-Ray Skull Epidural (75872) | $678.60 | $754 | 1.1× |
| Vein X-Ray Spleen/Liver (75810) | $3,592.80 | $3,992 | 1.2× |
| Venogram Sinus/Jugular (75860) range across 2 matching MRF lines |
$2,245.50–$3,592.80 | $2,495–$3,992 | varies |
| Venography Adrenal Unilateral (75840) range across 2 matching MRF lines |
$2,458.80–$3,592.80 | $2,732–$3,992 | varies |
| Venography caval inferior serialography rs&i (75825) range across 2 matching MRF lines |
$2,245.50–$3,592.80 | $2,495–$3,992 | varies |
| Venography extremity bilateral rs&i (75822) range across 3 matching MRF lines |
$1,321.20–$1,764.90 | $1,468–$1,961 | varies |
| Venography extremity unilateral rs&i (75820) range across 2 matching MRF lines |
$961.20–$1,764.90 | $1,068–$1,961 | varies |
| Venography Orbital Rs&I (75880) | $678.60 | $754 | 1.1× |
| Venography Renal Bilateral (75833) range across 2 matching MRF lines |
$2,245.50–$3,592.80 | $2,495–$3,992 | varies |
| Venography Renal Unilateral (75831) range across 2 matching MRF lines |
$2,245.50–$3,592.80 | $2,495–$3,992 | varies |
| Venous sampling by catheter (75893) range across 2 matching MRF lines |
$3,722.40–$5,983.20 | $4,136–$6,648 | varies |
| Venous thrombosis imaging (78457) | $614.70 | $683 | 1.2× |
| Venous Thrombosis Imaging Venogram Bilateral (78458) | $472.50 | $525 | 1.2× |
| Vertebral fracture assessment via dxa (77086) range across 2 matching MRF lines |
$101.70–$150.30 | $113–$167 | varies |
| Wrist 2 views (73100) range across 2 matching MRF lines |
$101.70–$775.80 | $113–$862 | varies |
| X-Ray Ac Jts - Xr Acromioclavicular Joints Bilateral (73050) range across 2 matching MRF lines |
$101.70–$821.70 | $113–$913 | varies |
| X-ray antegrade pyelogram tube (74425) range across 3 matching MRF lines |
$462.60–$1,326.60 | $514–$1,474 | varies |
| X-Ray Aorta Leg Arteries (75630) range across 3 matching MRF lines |
$3,592.80–$3,762 | $3,992–$4,180 | varies |
| X-Ray Bend Only L-S Spine (72120) range across 2 matching MRF lines |
$137.70–$1,049.40 | $153–$1,166 | varies |
| X-Ray Elbow 2 Vw - Xr Elbow 1-2 Views Right (73070) range across 2 matching MRF lines |
$101.70–$639 | $113–$710 | varies |
| X-Ray Exam Breast Specimen (76098) range across 3 matching MRF lines |
$606.60–$1,361.70 | $674–$1,513 | varies |
| X-Ray Exam Entire Spi 1 Vw (72081) range across 2 matching MRF lines |
$101.70–$267.30 | $113–$297 | varies |
| X-Ray Exam Entire Spi 2/3 Vw (72082) range across 2 matching MRF lines |
$137.70–$375.30 | $153–$417 | varies |
| X-Ray Exam Entire Spi 4/5 Vw (72083) range across 2 matching MRF lines |
$137.70–$453.60 | $153–$504 | varies |
| X-Ray Exam Hip Uni 1 View (73501) range across 2 matching MRF lines |
$101.70–$684.90 | $113–$761 | varies |
| X-Ray Exam Hip Uni 2-3 Views (73502) range across 3 matching MRF lines |
$101.70–$775.80 | $113–$862 | varies |
| X-Ray Exam Hip Uni 4/> Views (73503) range across 2 matching MRF lines |
$137.70–$945 | $153–$1,050 | varies |
| X-Ray Exam Hips Bi 2 Views (73521) range across 2 matching MRF lines |
$137.70–$1,049.40 | $153–$1,166 | varies |
| X-Ray Exam Hips Bi 3-4 Views (73522) range across 3 matching MRF lines |
$137.70–$1,049.40 | $153–$1,166 | varies |
| X-Ray Exam Hips Bi 5/> Views (73523) range across 2 matching MRF lines |
$137.70–$1,460.70 | $153–$1,623 | varies |
| X-Ray Exam L-S Spine Bending (72114) range across 2 matching MRF lines |
$137.70–$1,415.70 | $153–$1,573 | varies |
| X-Ray Exam Neck Spine 2-3 Vw (72040) range across 4 matching MRF lines |
$101.70–$731.70 | $113–$813 | varies |
| X-Ray Exam Neck Spine 6/>Vws (72052) range across 2 matching MRF lines |
$137.70–$1,460.70 | $153–$1,623 | varies |
| X-Ray Exam Unilat Ribs/Chest (71101) range across 3 matching MRF lines |
$137.70–$1,004.40 | $153–$1,116 | varies |
| X-ray eye for foreign body (70030) range across 3 matching MRF lines |
$101.70–$856.80 | $113–$952 | varies |
| X-ray head for orthodontia (70350) | $101.70 | $113 | 1.2× |
| X-ray humerus (73060) range across 2 matching MRF lines |
$159.30–$684.90 | $177–$761 | varies |
| X-ray IV pyelogram (ivp) (74400) range across 2 matching MRF lines |
$224.10–$1,674.90 | $249–$1,861 | varies |
| X-ray IV pyelogram+tomography (74415) | $224.10 | $249 | 1.3× |
| X-Ray Jaw <4 Vw - Xr Mandible < 4 Views (70100) range across 3 matching MRF lines |
$101.70–$630 | $113–$700 | varies |
| X-Ray Knee Bilat Standing - Xr Knees Anteroposterior Standing Bilat (73565) range across 2 matching MRF lines |
$101.70–$821.70 | $113–$913 | varies |
| X-Ray Lumbar Spine 2/3 Vw - Xr Lumbar Spine 2-3 Views (72100) range across 3 matching MRF lines |
$137.70–$1,049.40 | $153–$1,166 | varies |
| X-ray nose-rectum child f.b. (76010) range across 2 matching MRF lines |
$101.70–$501.30 | $113–$557 | varies |
| X-Ray Ribs, Chest 4+ Vw - Xr Ribs 3 Vws Bil W/ Chest Posteroanterior (71111) range across 2 matching MRF lines |
$137.70–$1,323.90 | $153–$1,471 | varies |
| X-Ray Sacroiliac Jts 3+ Vw - Xr Sacroiliac Joints 3+ Views (72202) range across 3 matching MRF lines |
$137.70–$1,049.40 | $153–$1,166 | varies |
| X-Ray Sacroiliac Jts <3 Vw - Xr Sacroiliac Joints 1-2 Views (72200) | $137.70 | $153 | 1.4× |
| X-Ray Sacrum/Coccyx 2+ Vw - Xr Sacrum Coccyx 2+ Views (72220) range across 3 matching MRF lines |
$101.70–$1,049.40 | $113–$1,166 | varies |
| X-Ray Sinuses 3+ Vw - Xr Paranasal Sinuses 3+ Views (70220) range across 2 matching MRF lines |
$101.70–$957.60 | $113–$1,064 | varies |
| X-Ray Skull 4+ Vw - Xr Skull Complete 4+ Views (70260) range across 2 matching MRF lines |
$137.70–$1,102.50 | $153–$1,225 | varies |
| X-Ray Stress View (77071) range across 2 matching MRF lines |
$31.50–$526.50 | $35–$585 | varies |
| X-ray thoracic spine 4 vw (72074) range across 2 matching MRF lines |
$137.70–$1,094.40 | $153–$1,216 | varies |
| X-Ray Tmj Unilat (70328) | $101.70 | $113 | 1.2× |
| X-Ray Urinary Tract Exam With Contrast Material (74420) range across 3 matching MRF lines |
$462.60–$1,453.50 | $514–$1,615 | varies |
| X-Rays Bone Length Studies (77073) range across 3 matching MRF lines |
$137.70–$839.70 | $153–$933 | varies |
| X-Rays Bone Survey Complete (77075) range across 2 matching MRF lines |
$137.70–$1,733.40 | $153–$1,926 | varies |
| Xr c-spine 4 or 5 views (72050) range across 3 matching MRF lines |
$137.70–$1,206.90 | $153–$1,341 | varies |
| Xr facial bones less than 3 views (70140) range across 2 matching MRF lines |
$101.70–$684.90 | $113–$761 | varies |
| XR Mastoids < 3 Views Bilateral (70120) range across 2 matching MRF lines |
$137.70–$526.50 | $153–$585 | varies |
| Xr myelogram posterior fossa (70010) | $462.60 | $514 | 1.4× |
| Xr orbits complete 4 views (70200) range across 2 matching MRF lines |
$137.70–$1,049.40 | $153–$1,166 | varies |
| Xr Tomogram Single Plane (76100) range across 2 matching MRF lines |
$137.70–$936 | $153–$1,040 | varies |
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.