Imaging prices at Loma Linda University Children's Hospital
Loma Linda, CA · every code in this section with a posted price and a Medicare benchmark.
449 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) | $6,460.65 | $14,357 | 3.6× |
| Abdomen 1 View (74018) | $266.40 | $592 | 2.4× |
| Abdomen 2 views (74019) | $333.45 | $741 | 2.5× |
| Acute Gastrointestinal Blood Loss Imaging (78278) | $1,780.65 | $3,957 | 3.5× |
| Adrenal Cortex & Medulla Img (78075) | $2,582.55 | $5,739 | 1.6× |
| Angio internal mammary (75756) | $4,570.20 | $10,156 | 1.1× |
| Angio pulmonary bilat (75743) | $4,435.65 | $9,857 | 1.1× |
| Angiography Adrenal Bilateral Slctv Rs&I (75733) | $4,750.20 | $10,556 | 1.2× |
| Angiography extremity bilateral rs&i (75716) | $5,024.70 | $11,166 | 1.2× |
| Angiography extremity unilateral rs&i (75710) | $4,315.50 | $9,590 | 1.1× |
| Angiography pulmonary unilateral slctv rs&i (75741) | $2,956.95 | $6,571 | 0.7× |
| Angrph pulmonary nonslctv cath/ven njx rs&i (75746) | $4,570.20 | $10,156 | 1.1× |
| Ankle 2 views (73600) | $303.75 | $675 | 2.7× |
| Aortography thoracic serialography rs&i (75605) | $4,480.20 | $9,956 | 0.6× |
| Aortography thoracic w/o serialography rs&i (75600) | $3,520.35 | $7,823 | 0.9× |
| Artery X-Rays Abdomen (75726) | $5,394.15 | $11,987 | 0.8× |
| Artery X-Rays Adrenal Gland (75731) | $3,111.75 | $6,915 | 0.8× |
| Artery X-Rays Pelvis (75736) | $4,530.60 | $10,068 | 0.6× |
| Artery X-Rays Spine (75705) | $6,204.15 | $13,787 | 0.9× |
| Arthrogram ankle (73615) | $544.50 | $1,210 | 1.2× |
| Arthrogram hip (73525) | $899.55 | $1,999 | 2.0× |
| Arthrogram Wrist (73115) | $753.75 | $1,675 | 1.7× |
| Basic radiation dosimetry calculation (77300) | $543.15 | $1,207 | 3.1× |
| Bone age studies (77072) | $263.25 | $585 | 2.0× |
| Bone Imaging 3 Phase (78315) | $1,419.30 | $3,154 | 2.8× |
| Bone Imaging Limited Area (78300) | $821.25 | $1,825 | 1.6× |
| Bone Imaging Whole Body (78306) | $1,448.10 | $3,218 | 2.8× |
| Bone marrow imaging limited area (78102) | $646.65 | $1,437 | 1.3× |
| Bone survey infant (77076) | $143.10 | $318 | 1.1× |
| Brachytx isodose complex (77318) | $1,559.25 | $3,465 | 3.2× |
| Brachytx isodose intermed (77317) | $1,425.60 | $3,168 | 3.0× |
| Brachytx Isodose Plan Simple (77316) | $1,248.75 | $2,775 | 2.6× |
| Brain Flow Imaging Only (78610) | $1,411.20 | $3,136 | 2.0× |
| Brain Imaging Min 4 Static Views W Vascular Flow (78606) | $940.95 | $2,091 | 1.3× |
| Brain Imaging Minimum 4 Static Views (78605) | $752.40 | $1,672 | 1.1× |
| Brain Imaging Pet Metabolic Evaluation (78608) | $3,517.20 | $7,816 | 1.9× |
| Cardiac MRI w/w/o contrast & further seq (75561) range across 2 matching MRF lines |
$2,555.55–$3,398.40 | $5,679–$7,552 | varies |
| Cardiac MRI w/w/o contrast w/stress (75563) range across 2 matching MRF lines |
$2,770.65–$4,160.25 | $6,157–$9,245 | varies |
| Cat Scan Follow-Up Study (76380) range across 2 matching MRF lines |
$399.60–$596.25 | $888–$1,325 | varies |
| Cerebrospinal Fluid Flow W/O Matl Shunt Evaltj (78645) | $1,084.95 | $2,411 | 1.6× |
| Cerebrospinal Fluid Scan (78630) | $1,296.90 | $2,882 | 1.9× |
| Chest 1 view (71045) | $317.70 | $706 | 2.8× |
| Chest 2 views (71046) | $318.60 | $708 | 2.8× |
| Chest 3 views (71047) | $352.80 | $784 | 3.2× |
| Chest 4 or more views (71048) | $383.40 | $852 | 2.9× |
| Cholecystography Oral Contrast (74290) | $233.10 | $518 | 1.0× |
| Cineradiograpy/vidradiograpy xcpt where spec (76120) | $153 | $340 | 1.1× |
| Clavicle complete (73000) | $297 | $660 | 2.7× |
| Continuing medical physics consltj pr wk (77336) | $576 | $1,280 | 3.3× |
| Contrast Exam Abdominl Aorta (75625) | $4,968 | $11,040 | 1.2× |
| Contrast X-Ray Bladder (74430) | $624.60 | $1,388 | 1.4× |
| Contrast X-Ray Of Elbow (73085) | $615.60 | $1,368 | 1.4× |
| Contrast X-Ray Of Knee Joint (73580) | $693 | $1,540 | 1.5× |
| Corpora cavernosography (74445) | $341.55 | $759 | 2.5× |
| CT abdomen and pelvis without and with contrast (74178) range across 2 matching MRF lines |
$1,937.70–$3,614.85 | $4,306–$8,033 | varies |
| CT abdomen and pelvis without contrast (74176) range across 2 matching MRF lines |
$1,611.45–$3,007.80 | $3,581–$6,684 | varies |
| CT abdomen w contrast (74160) range across 2 matching MRF lines |
$1,348.20–$2,724.75 | $2,996–$6,055 | varies |
| CT abdomen w wo contrast (74170) range across 2 matching MRF lines |
$1,577.25–$2,942.55 | $3,505–$6,539 | varies |
| CT abdomen w/o contrast (74150) range across 2 matching MRF lines |
$1,199.25–$2,258.10 | $2,665–$5,018 | varies |
| CT Angio Abdomen and Pelvis (74174) range across 2 matching MRF lines |
$1,710.90–$3,193.20 | $3,802–$7,096 | varies |
| CT Angio Chest (71275) range across 2 matching MRF lines |
$1,646.10–$2,681.10 | $3,658–$5,958 | varies |
| CT Angio Head (70496) range across 2 matching MRF lines |
$1,928.25–$3,474.90 | $4,285–$7,722 | varies |
| CT angio hrt w/3d image (75574) range across 2 matching MRF lines |
$1,448.10–$2,161.80 | $3,218–$4,804 | varies |
| Ct Angio Lwr Extr W/O&W/Dye (73706) range across 2 matching MRF lines |
$1,231.20–$2,192.85 | $2,736–$4,873 | varies |
| CT Angio Neck (70498) range across 2 matching MRF lines |
$1,928.25–$3,474.90 | $4,285–$7,722 | varies |
| Ct Angio Upr Extrm W/O&W/Dye (73206) range across 2 matching MRF lines |
$1,351.80–$2,407.50 | $3,004–$5,350 | varies |
| CT Cere Prfuj Alys C+ W/O CT/Cta Same Anatomy (70473) | $247.50 | $550 | 1.1× |
| CT cervical spine w/ contrast (72126) range across 2 matching MRF lines |
$1,300.05–$2,929.05 | $2,889–$6,509 | varies |
| CT cervical spine w/o contrast (72125) range across 2 matching MRF lines |
$1,207.80–$2,720.70 | $2,684–$6,046 | varies |
| CT cervical spine w/wo cont (72127) range across 2 matching MRF lines |
$1,358.10–$3,075.30 | $3,018–$6,834 | varies |
| CT chest w contrast (71260) range across 2 matching MRF lines |
$1,242.45–$2,213.10 | $2,761–$4,918 | varies |
| CT chest w/wo contrast (71270) range across 2 matching MRF lines |
$1,473.30–$2,749.05 | $3,274–$6,109 | varies |
| CT colonography screening (74263) range across 4 matching MRF lines |
$527.40–$984.15 | $1,172–$2,187 | varies |
| CT Colonogrphy Dx Image Postprocess W/Contrast (74262) range across 2 matching MRF lines |
$1,567.80–$2,645.55 | $3,484–$5,879 | varies |
| CT colonogrphy dx image postprocess w/o contrast (74261) range across 2 matching MRF lines |
$1,417.95–$2,340.45 | $3,151–$5,201 | varies |
| CT head/brain with contrast (70460) range across 2 matching MRF lines |
$1,333.80–$3,003.30 | $2,964–$6,674 | varies |
| CT head/brain without and with contrast (70470) range across 2 matching MRF lines |
$1,493.55–$3,120.30 | $3,319–$6,934 | varies |
| CT heart contrast eval cardiac structure&morph (75572) range across 2 matching MRF lines |
$1,062–$1,584.90 | $2,360–$3,522 | varies |
| CT heart no contrast quant eval coronry calcium (75571) range across 2 matching MRF lines |
$243–$452.70 | $540–$1,006 | varies |
| CT hrt w/3d image congen (75573) range across 2 matching MRF lines |
$1,062–$1,927.80 | $2,360–$4,284 | varies |
| CT iac w contrast (70481) range across 2 matching MRF lines |
$1,333.80–$3,003.30 | $2,964–$6,674 | varies |
| CT l-spine w&w/o contrast (72133) range across 2 matching MRF lines |
$1,351.80–$2,411.10 | $3,004–$5,358 | varies |
| CT lower ext w/o (73700) range across 2 matching MRF lines |
$1,143.45–$2,036.25 | $2,541–$4,525 | varies |
| CT lower extremity w/contrast material (73701) range across 2 matching MRF lines |
$1,283.85–$2,286.45 | $2,853–$5,081 | varies |
| CT lumbar spine w contrast (72132) range across 2 matching MRF lines |
$1,231.20–$2,296.80 | $2,736–$5,104 | varies |
| CT lumbar spine w/o contrast (72131) range across 2 matching MRF lines |
$1,147.50–$2,141.10 | $2,550–$4,758 | varies |
| CT maxillofacial w contrast (70487) range across 2 matching MRF lines |
$1,094.85–$2,466 | $2,433–$5,480 | varies |
| CT maxillofacial wo contrast (70486) range across 2 matching MRF lines |
$955.80–$2,153.25 | $2,124–$4,785 | varies |
| CT neck tissue combo (70492) range across 2 matching MRF lines |
$1,469.70–$2,822.40 | $3,266–$6,272 | varies |
| Ct Orbit/Ear/Fossa W/O&W/Dye (70482) range across 2 matching MRF lines |
$1,469.70–$3,152.70 | $3,266–$7,006 | varies |
| CT orbits w/o contrast (70480) range across 2 matching MRF lines |
$1,195.20–$2,691.90 | $2,656–$5,982 | varies |
| CT pelvis w&w/o contrast (72194) range across 2 matching MRF lines |
$1,358.10–$2,533.50 | $3,018–$5,630 | varies |
| CT pelvis w/o contrast (72192) range across 2 matching MRF lines |
$1,143.45–$2,133 | $2,541–$4,740 | varies |
| CT scan of leg combo (73702) range across 2 matching MRF lines |
$1,435.95–$2,401.20 | $3,191–$5,336 | varies |
| CT scans face/jaw combo (70488) range across 2 matching MRF lines |
$1,513.35–$2,845.35 | $3,363–$6,323 | varies |
| CT soft tissue neck w contrast (70491) range across 2 matching MRF lines |
$1,233–$2,778.75 | $2,740–$6,175 | varies |
| CT soft tissue neck w/o contrast (70490) range across 2 matching MRF lines |
$1,094.85–$2,466 | $2,433–$5,480 | varies |
| CT thoracic spine w contrast (72129) range across 2 matching MRF lines |
$1,135.35–$2,296.80 | $2,523–$5,104 | varies |
| CT thoracic spine w/o contrast (72128) range across 2 matching MRF lines |
$1,147.50–$2,141.10 | $2,550–$4,758 | varies |
| CT thoracic spine w/wo cont (72130) range across 2 matching MRF lines |
$1,351.80–$2,411.10 | $3,004–$5,358 | varies |
| CT thorax w/o contrast (71250) range across 2 matching MRF lines |
$1,011.60–$1,887.75 | $2,248–$4,195 | varies |
| CT upper ext wo (73200) range across 2 matching MRF lines |
$1,062–$1,892.25 | $2,360–$4,205 | varies |
| CT upper extremity w/o & w/contrast material (73202) range across 2 matching MRF lines |
$1,237.95–$2,205 | $2,751–$4,900 | varies |
| CT upper extremity with contrast (73201) range across 2 matching MRF lines |
$1,059.75–$2,048.85 | $2,355–$4,553 | varies |
| Cta Abdl Aorta&Bi Iliofem W/Contrast&Postp (75635) range across 2 matching MRF lines |
$1,939.50–$3,047.40 | $4,310–$6,772 | varies |
| Cta Abdomen (74175) range across 2 matching MRF lines |
$1,750.50–$2,612.70 | $3,890–$5,806 | varies |
| CTA head&neck c+ w/noncontrast img&post-pxessing (70471) | $491.85 | $1,093 | 1.1× |
| CTA pelvis (72191) range across 2 matching MRF lines |
$1,393.65–$2,600.10 | $3,097–$5,778 | varies |
| Dacryocystography, nasolacrimal duct, radiological supervision and interpretation Non-Facility (70170) | $413.55 | $919 | 1.3× |
| Dilation ureters/urethra rs&i (74485) | $2,223.45 | $4,941 | 0.8× |
| Discography Cerv/Thor Spine (72285) | $2,115.45 | $4,701 | 0.8× |
| Diskography lumbar (72295) | $3,080.70 | $6,846 | 1.2× |
| Doppler Echo Fetal Puls Spectral F/U/Repeat (76828) | $775.35 | $1,723 | 5.8× |
| Doppler Echo Fetal Spectral Display Complete (76827) | $986.85 | $2,193 | 7.3× |
| Doppler Fetal Mid Cerebral Artery (76821) | $638.10 | $1,418 | 4.7× |
| Echo Guide For Artery Repair (76936) | $669.60 | $1,488 | 2.4× |
| Echocardiography, fetal, cardiovascular system, real time with image documentation (2D), with or without M-mode… (76826) | $857.25 | $1,905 | 2.8× |
| Esophagram (74220) | $593.55 | $1,319 | 2.6× |
| Fetal Biophys Profile W/Nst (76818) | $692.10 | $1,538 | 5.1× |
| Fetal Biophysical Profile W/O Non-Stress Testing (76819) | $986.85 | $2,193 | 7.3× |
| Fetal MRI w/placntl matrnl plvc img sing/1st ges (74712) | $387.45 | $861 | 1.3× |
| Fluoroscopy up to 1 hr (76000) | $607.05 | $1,349 | 2.0× |
| Follow-Up Angiography (75898) | $1,023.75 | $2,275 | 0.3× |
| Foot 2 views (73620) | $270 | $600 | 2.4× |
| Forearm 2 views (73090) | $277.65 | $617 | 2.5× |
| Gastric emptying imaging study (78264) | $1,297.80 | $2,884 | 2.5× |
| Gastroesophageal Reflux Exam (78262) | $774 | $1,720 | 1.5× |
| Gastrointestinal Protein Loss (78282) | $614.70 | $1,366 | 1.2× |
| Gated Heart Planar Single (78472) | $1,647.45 | $3,661 | 3.2× |
| GI Endoscopic US S&I (76975) | $592.20 | $1,316 | 1.9× |
| Hand 2 views (73120) range across 2 matching MRF lines |
$340.20–$492.75 | $756–$1,095 | varies |
| Hdr Rdncl Ntrstl/Icav Brchtx (77772) | $856.80 | $1,904 | 1.0× |
| Hdr Rdncl Ntrstl/Icav Brchtx (77771) | $856.80 | $1,904 | 1.0× |
| Hdr Rdncl Ntrstl/Icav Brchtx 1 Channel (77770) | $856.80 | $1,904 | 1.0× |
| Heart first pass single,planar (78481) | $646.65 | $1,437 | 0.9× |
| Heart Image (Pet) Multiple (78492) | $6,086.70 | $13,526 | 3.3× |
| Hepatc Vngrph Wdg/Fr Hemodyn Eval Rs&I (75889) | $5,124.60 | $11,388 | 1.3× |
| Hepatc Vngrph Wdg/Fr W/O Hemodyn Eval Rs&I (75891) | $2,409.30 | $5,354 | 0.6× |
| Hepatobil Syst Image W/Drug (78227) | $475.65 | $1,057 | 0.7× |
| Hepatobiliary System Imaging (78226) | $1,184.40 | $2,632 | 2.3× |
| Ht Musc Image Planar Mult (78454) | $1,126.80 | $2,504 | 0.7× |
| Ht Muscle Image Spect Sing (78451) | $1,366.20 | $3,036 | 0.8× |
| Hysterosalpingogram (74740) | $553.95 | $1,231 | 1.8× |
| Infant hip ultrasound with hip movement (dynamic) (76885) | $1,220.40 | $2,712 | 10.9× |
| Infant hip ultrasound, limited static exam (76886) | $986.85 | $2,193 | 8.8× |
| Intracavitary Radiation Source Applic Complex (77763) | $13,421.25 | $29,825 | 15.0× |
| Intracavitary Radiation Source Applic Intermed (77762) | $16,287.75 | $36,195 | 22.9× |
| Intracavitary radiation source applic simple (77761) | $15,512.40 | $34,472 | 21.8× |
| K Flow/Funct Image Multiple (78709) | $1,736.10 | $3,858 | 2.5× |
| K Flow/Funct Image W/Drug (78708) | $1,588.95 | $3,531 | 2.3× |
| K Flow/Funct Image W/O Drug (78707) | $1,566.45 | $3,481 | 2.2× |
| Kidney Funcj Study Non-Img Radioisotopic Study (78725) | $698.85 | $1,553 | 1.4× |
| Kidney Imaging Morphoogy W/Vascular Flow (78701) | $1,091.70 | $2,426 | 2.1× |
| Knee 3 Views (73562) | $320.85 | $713 | 2.9× |
| Labeled RBC Sequestration Differntl Organ/Tissue (78140) | $741.60 | $1,648 | 1.4× |
| Leveen/Shunt Patency Exam (78291) | $554.85 | $1,233 | 1.1× |
| Liver & Spleen Imaging Static Only (78215) | $811.35 | $1,803 | 1.6× |
| Liver & Spleen Imaging W/Vascular Flow (78216) | $1,072.35 | $2,383 | 2.1× |
| Lung Perf&Ventilat Diferentl (78598) | $2,024.10 | $4,498 | 2.9× |
| Lung perfusion differential (78597) | $1,444.05 | $3,209 | 2.8× |
| Lung Ventilat&Perfus Imaging (78582) | $1,980.90 | $4,402 | 2.8× |
| Lung Ventilation Imaging (78579) | $728.55 | $1,619 | 1.4× |
| Lymph System Imaging (78195) | $1,347.75 | $2,995 | 1.9× |
| Lymphangiography Extremity Only Bilateral Rs&I (75803) | $1,008.90 | $2,242 | 0.5× |
| Lymphangiography extremity only unilateral rs&i (75801) | $672.30 | $1,494 | 0.8× |
| Lymphangiography Pelvic/Abdominal Bilateral Rs&I (75807) | $1,011.15 | $2,247 | 0.2× |
| Lymphangiography, pelvic/abdominal, unilateral (75805) | $674.10 | $1,498 | 0.2× |
| Magnetic Image Jaw Joint (70336) range across 2 matching MRF lines |
$2,543.85–$3,055.95 | $5,653–$6,791 | varies |
| Magnetic resonance (eg, proton) imaging, brain (including brain stem andskull base), during open intracranial procedure… (70558) | $480.15 | $1,067 | 2.1× |
| Magnetic resonance (eg, proton) imaging, brain (including brain stem andskull base), during open intracranial procedure… (70557) | $254.25 | $565 | 0.4× |
| Magnetic resonance (eg, proton) imaging, brain (including brain stem andskull base), during open intracranial procedure… (70559) | $504.45 | $1,121 | 2.2× |
| Mammary ductogram or galactogram multiple (77054) | $433.80 | $964 | 1.4× |
| Mammary ductogram or galactogram single (77053) | $395.55 | $879 | 1.3× |
| Meckels Divert Exam (78290) | $1,535.85 | $3,413 | 3.0× |
| Mlc imrt design & construction per imrt plan (77338) | $603 | $1,340 | 1.3× |
| Mr safety determination physician/other qhp (76016) | $107.10 | $238 | 1.0× |
| Mr safety implant&/fb assmt clin staf 1st 15 min (76014) | $29.70 | $66 | 0.8× |
| Mr safety implt electronics prepj supvj phys/qhp (76018) | $111.60 | $248 | 0.9× |
| Mr safety implt pos&/immoblj (76019) | $72.45 | $161 | 1.0× |
| Mr safety med physics xm customization plng&mntr (76017) | $293.85 | $653 | 1.0× |
| Mra Head W/O & W/Contrast Material (70546) range across 2 matching MRF lines |
$2,821.50–$3,321.45 | $6,270–$7,381 | varies |
| MRA head w/o contrast (70544) range across 2 matching MRF lines |
$2,351.70–$2,534.40 | $5,226–$5,632 | varies |
| MRA head with contrast (70545) range across 2 matching MRF lines |
$2,633.85–$2,660.85 | $5,853–$5,913 | varies |
| MRA neck w contrast (70548) range across 2 matching MRF lines |
$2,503.80–$2,633.85 | $5,564–$5,853 | varies |
| Mra Neck W/O &W/Contrast Material (70549) range across 2 matching MRF lines |
$2,912.40–$2,970.45 | $6,472–$6,601 | varies |
| MRA neck w/o contrast (70547) range across 2 matching MRF lines |
$2,418.75–$2,542.95 | $5,375–$5,651 | varies |
| MRI abdomen w contrast (74182) range across 2 matching MRF lines |
$2,418.75–$3,160.80 | $5,375–$7,024 | varies |
| MRI abdomen w/o contrast (74181) range across 2 matching MRF lines |
$2,109.15–$2,873.25 | $4,687–$6,385 | varies |
| MRI any jt lower extrem w/contrast material (73722) range across 2 matching MRF lines |
$1,903.95–$2,286.45 | $4,231–$5,081 | varies |
| MRI any jt lower extrem w/o & w/contrast matrl (73723) range across 2 matching MRF lines |
$3,048.30–$3,502.80 | $6,774–$7,784 | varies |
| MRI any jt upper extremity w/contrast matrl (73222) range across 2 matching MRF lines |
$1,730.70–$2,286.45 | $3,846–$5,081 | varies |
| MRI bone marrow blood supply (77084) range across 2 matching MRF lines |
$1,667.70–$2,003.40 | $3,706–$4,452 | varies |
| MRI brain functional w/o physician admnistration (70554) range across 2 matching MRF lines |
$700.20–$769.50 | $1,556–$1,710 | varies |
| MRI brain functional w/physician admnistration (70555) range across 2 matching MRF lines |
$736.20–$875.25 | $1,636–$1,945 | varies |
| MRI Breast W/O Contrast Bilateral (77047) range across 2 matching MRF lines |
$2,183.85–$2,622.60 | $4,853–$5,828 | varies |
| MRI Breast Without Contrast Material Unilateral (77046) range across 2 matching MRF lines |
$1,939.50–$2,329.20 | $4,310–$5,176 | varies |
| MRI cardiac w/o cont stress (75559) range across 2 matching MRF lines |
$2,358.90–$2,834.10 | $5,242–$6,298 | varies |
| MRI cardiac w/o contrast (75557) range across 2 matching MRF lines |
$2,154.15–$3,187.80 | $4,787–$7,084 | varies |
| MRI cervical spine w contrast (72142) range across 2 matching MRF lines |
$2,317.50–$2,673.90 | $5,150–$5,942 | varies |
| MRI cervical spine w/o cont (72141) range across 2 matching MRF lines |
$2,234.25–$2,549.25 | $4,965–$5,665 | varies |
| MRI chest w/o contrast (71550) range across 2 matching MRF lines |
$1,998.90–$2,401.20 | $4,442–$5,336 | varies |
| MRI chest with contrast (71551) range across 2 matching MRF lines |
$2,234.25–$2,683.80 | $4,965–$5,964 | varies |
| MRI chest wo w contrast (71552) range across 2 matching MRF lines |
$2,766.15–$3,971.70 | $6,147–$8,826 | varies |
| MRI lower extrem oth/thn jt w/contrast matrl (73719) range across 2 matching MRF lines |
$2,007.90–$2,411.10 | $4,462–$5,358 | varies |
| MRI lower extrem oth/thn jt w/o & w/contr matr (73720) range across 2 matching MRF lines |
$2,255.40–$3,385.80 | $5,012–$7,524 | varies |
| MRI lower extrem oth/thn jt w/o contr matrl (73718) range across 2 matching MRF lines |
$1,802.25–$2,208.60 | $4,005–$4,908 | varies |
| MRI lumbar spine w contrast (72149) range across 2 matching MRF lines |
$2,317.50–$3,088.80 | $5,150–$6,864 | varies |
| Mri Neck Spine W/O & W/Dye (72156) range across 2 matching MRF lines |
$2,550.15–$3,062.70 | $5,667–$6,806 | varies |
| MRI orbit face &/neck w/o contrast (70540) range across 2 matching MRF lines |
$1,978.65–$2,138.85 | $4,397–$4,753 | varies |
| MRI orbit face neck w contrast (70542) range across 2 matching MRF lines |
$2,257.65–$2,352.60 | $5,017–$5,228 | varies |
| Mri Orbt/Fac/Nck W/O &W/Dye (70543) range across 2 matching MRF lines |
$3,021.30–$3,434.40 | $6,714–$7,632 | varies |
| MRI pelvis w contrast (72196) range across 2 matching MRF lines |
$2,317.50–$3,166.65 | $5,150–$7,037 | varies |
| MRI pelvis w/o & w contrast (72197) range across 2 matching MRF lines |
$2,781–$3,514.95 | $6,180–$7,811 | varies |
| MRI pelvis w/o contrast (72195) range across 2 matching MRF lines |
$2,109.15–$2,783.25 | $4,687–$6,185 | varies |
| MRI spectroscopy (76390) range across 2 matching MRF lines |
$1,879.65–$2,257.65 | $4,177–$5,017 | varies |
| MRI thoracic spine w/o contrast (72146) range across 2 matching MRF lines |
$2,234.25–$2,683.80 | $4,965–$5,964 | varies |
| MRI upper extremity oth than jt w/contr matrl (73219) range across 2 matching MRF lines |
$1,939.50–$2,329.20 | $4,310–$5,176 | varies |
| MRI upper extremity oth than jt w/o contr matrl (73218) range across 2 matching MRF lines |
$1,733.40–$2,229.30 | $3,852–$4,954 | varies |
| Mri Uppr Extremity W/O&W/Dye (73220) range across 2 matching MRF lines |
$2,039.85–$2,982.15 | $4,533–$6,627 | varies |
| MRI, abdomen, combo (74183) range across 2 matching MRF lines |
$2,781–$3,855.60 | $6,180–$8,568 | varies |
| MRI, dorsal spine combo (72157) range across 2 matching MRF lines |
$2,550.15–$3,224.25 | $5,667–$7,165 | varies |
| MRI, dorsal spine contrast (72147) range across 2 matching MRF lines |
$2,317.50–$2,951.55 | $5,150–$6,559 | varies |
| MRI, joint upper extrem (73221) range across 2 matching MRF lines |
$1,543.95–$2,199.60 | $3,431–$4,888 | varies |
| MRI, joint upper extrem combo (73223) range across 2 matching MRF lines |
$2,525.40–$3,384.90 | $5,612–$7,522 | varies |
| MRI, lumbar spine combo (72158) range across 2 matching MRF lines |
$2,550.15–$3,224.25 | $5,667–$7,165 | varies |
| Myelogram cervical (72240) | $1,123.65 | $2,497 | 1.1× |
| Myelogram Lumbar (72265) | $1,123.65 | $2,497 | 1.1× |
| Myelography thoracic (72255) | $1,124.10 | $2,498 | 1.1× |
| Myelograpy 2/more regions rs&i (72270) | $1,237.50 | $2,750 | 1.2× |
| Myocardial Imaging Infarct Avid Planar Qual/Quan (78466) | $646.65 | $1,437 | 1.3× |
| Myocardial Perfusion Planar 1 Study Rest/Stress (78453) | $1,422.45 | $3,161 | 0.9× |
| Myocardial Spect Multiple Studies (78452) | $2,684.70 | $5,966 | 1.6× |
| Myocrd Img Pet Metab Eval Single Study Cncrnt CT (78429) | $1,518.75 | $3,375 | 0.8× |
| Myocrd img PET prfuj 1std rest/stress cncrnt CT (78430) | $1,518.75 | $3,375 | 0.8× |
| Myocrd Img Pet Prfuj Mlt Std Rst&Strs Cncrnt CT (78431) | $2,368.80 | $5,264 | 0.8× |
| Myocrd Img Pet Prfuj W/Metab 2rtracer Cncrnt CT (78433) | $2,895.30 | $6,434 | 1.0× |
| Neck soft tissue (70360) | $325.35 | $723 | 2.9× |
| Nm csf leak detection (78650) | $792.45 | $1,761 | 0.5× |
| Nm red cell survival study (78130) | $677.25 | $1,505 | 1.3× |
| Nm whole blood volume (78122) | $1,222.65 | $2,717 | 1.8× |
| Nonvascular Shunt X-Ray (75809) | $409.95 | $911 | 3.0× |
| Ntsty modul radthx pln dose-vol histos (77301) | $2,821.50 | $6,270 | 1.6× |
| Nuclear Rx Intra-Arterial (79445) | $2,258.10 | $5,018 | 7.5× |
| Nuclear Rx Oral Admin (79005) | $1,089.90 | $2,422 | 3.6× |
| Ob us nuchal meas 1 gest (76813) | $381.15 | $847 | 2.8× |
| Ophthalmic ultrasound dx b-scan w/wo a-scan (76512) | $205.20 | $456 | 1.5× |
| Optic foramina (70190) | $217.80 | $484 | 1.9× |
| Panoramic X-ray of jaws (70355) | $336.60 | $748 | 3.0× |
| Parathyroid planar imaging w/wo subtraction (78071) | $600.30 | $1,334 | 1.2× |
| Pelvis 1 or 2 views (72170) | $290.70 | $646 | 2.2× |
| Peritoneogram Rs&I (74190) | $583.20 | $1,296 | 0.8× |
| Pet Image Skull-Thigh (78812) | $3,808.35 | $8,463 | 2.1× |
| Pet Image W/Ct Lmtd (78814) | $4,967.55 | $11,039 | 2.7× |
| PET image w/CT, full body (78816) | $5,254.20 | $11,676 | 2.9× |
| PET imaging CT attenuation skull base mid-thigh (78815) | $5,345.10 | $11,878 | 2.9× |
| Pet Imaging Limited Area Chest Head/Neck (78811) | $3,808.35 | $8,463 | 2.3× |
| Pet Myocardial Sngl Study (78491) | $2,499.30 | $5,554 | 1.4× |
| PET whole body (78813) | $5,038.65 | $11,197 | 2.7× |
| Plasma Vol Radiopharm Vol Dilute Spx Mult Smples (78111) | $653.40 | $1,452 | 0.4× |
| Platelet survival study Non-Facility (78191) | $381.60 | $848 | 0.7× |
| Proton trmt simple w/comp (77522) | $3,758.40 | $8,352 | 2.3× |
| Proton tx delivery complex (77525) | $5,221.80 | $11,604 | 3.2× |
| Proton tx delivery intermediate (77523) | $4,917.60 | $10,928 | 3.1× |
| Proton tx delivery simple w/o compensation (77520) | $2,589.30 | $5,754 | 3.6× |
| Prq Transhepatc Portograpy Hemodyn Eval Rs&I (75885) | $2,956.50 | $6,570 | 0.7× |
| Pulmonary Perfusion Imaging Particulate (78580) | $1,003.50 | $2,230 | 2.0× |
| Radex Abd Compl Aqt Abd W/S/E/D Views 1 View Ch (74022) | $277.20 | $616 | 2.1× |
| Radex abscess/fistula/sinus tract rs&i (76080) | $652.95 | $1,451 | 0.9× |
| Radex Ankle Complete Minimum 3 Views (73610) | $355.50 | $790 | 3.2× |
| Radex Calcaneus Minimum 2 Views (73650) | $270 | $600 | 2.4× |
| Radex elbow complete minimum 3 views (73080) | $391.50 | $870 | 3.5× |
| Radex Facial Bones Complete Minimum 3 Views (70150) | $536.85 | $1,193 | 4.0× |
| Radex fingr minimum 2 views (73140) | $233.10 | $518 | 2.1× |
| Radex foot complete minimum 3 views (73630) | $347.85 | $773 | 3.1× |
| Radex Hand Minimum 3 Views (73130) | $341.55 | $759 | 3.1× |
| Radex lower extremity infant minimum 2 views (73592) | $207.90 | $462 | 1.9× |
| Radex Mastoids Compl Minimum 3 Views PR Side (70130) | $364.05 | $809 | 2.7× |
| Radex Nasal Bones Complete Minimum 3 Views (70160) | $371.25 | $825 | 3.3× |
| Radex Pharynx/Larx W/Fluor&/Magnification Tq (70370) | $395.10 | $878 | 3.5× |
| Radex Ribs Unilateral 2 Views (71100) | $392.40 | $872 | 3.5× |
| Radex shoulder complete minimum 2 views (73030) | $365.40 | $812 | 3.3× |
| Radex Sinuses Paransl < 3 Views (70210) | $307.80 | $684 | 2.7× |
| Radex sm int w/mlt srl imges via enteroclss tube (74251) | $694.80 | $1,544 | 3.1× |
| Radex Spine 1 View Specify Level (72020) | $315 | $700 | 2.8× |
| Radex Sternum Minimum 2 Views (71120) | $366.30 | $814 | 3.3× |
| Radex Temporomandble Jt Opn & Clsd Mouth Bilat (70330) | $360 | $800 | 3.2× |
| Radex Toe Minimum 2 Views (73660) | $234 | $520 | 2.1× |
| Radex upper extremity infant minimum 2 views (73092) | $211.50 | $470 | 1.6× |
| Radex Wrist Complete Minimum 3 Views (73110) | $350.10 | $778 | 3.1× |
| Radex X-Ray Exam Entire Spi 6/> Vw - Xr Entire Spine 6+ Vw (72084) | $577.80 | $1,284 | 4.3× |
| Radiation treatment delivery level 1 (77402) | $300.15 | $667 | 2.3× |
| Radiation treatment delivery level 2 (77407) | $357.30 | $794 | 0.7× |
| Radiation treatment delivery level 3 (77412) | $732.60 | $1,628 | 1.0× |
| Radiolog exam mandible compl minimum 4 views (70110) | $567 | $1,260 | 4.2× |
| Radiologic Exam Abdomen 3+ Views - Xr Abdomen 3+ Views (74021) | $416.70 | $926 | 3.1× |
| Radiologic exam colon double contrast study (74280) | $981 | $2,180 | 4.3× |
| Radiologic exam colon single contrast study (74270) | $711.90 | $1,582 | 3.2× |
| Radiologic Exam Esophagus Double Contrast Study (74221) | $593.55 | $1,319 | 2.6× |
| Radiologic exam knee complete 4/more views (73564) | $393.75 | $875 | 2.9× |
| Radiologic exam pelvis compl minimum 3 views (72190) | $465.30 | $1,034 | 3.5× |
| Radiologic Exam Small Int Single Contrast Study (74250) | $785.25 | $1,745 | 3.5× |
| Radiologic exam swallow function contrast study (74230) | $517.05 | $1,149 | 2.3× |
| Radiologic exam upr gi trc double contrast study (74246) | $493.20 | $1,096 | 2.2× |
| Radiologic examination femur 1 view (73551) | $165.60 | $368 | 1.5× |
| Radiologic examination femur minimum 2 views (73552) | $207.45 | $461 | 1.9× |
| Radiologic examination knee 1/2 views (73560) | $279 | $620 | 2.5× |
| Radiologic Examination Salivary Gland Calculus (70380) | $154.80 | $344 | 1.4× |
| Radiologic examination tibia & fibula 2 views (73590) | $320.85 | $713 | 2.9× |
| Radiologic examination, internal auditory meati, complete Non-Facility (70134) | $302.85 | $673 | 0.4× |
| Radiopharm Dacryocystography (78660) | $531 | $1,180 | 1.0× |
| Radiopharmaceutical therapy, by intracavitary administration Non-Facility (79200) | $526.95 | $1,171 | 1.8× |
| Renal Cyst Study (74470) | $635.85 | $1,413 | 0.9× |
| Ribs bilateral 3 views (71110) | $499.50 | $1,110 | 3.7× |
| Rp loclzj tum plnr 1 area single day imaging (78800) | $704.70 | $1,566 | 1.4× |
| Rp loclzj tum plnr 2+area 1+d img/1 area img>2+d (78801) | $450.45 | $1,001 | 0.9× |
| Rp Loclzj Tum Plnr Whole Body 2+ Days Imaging (78804) | $1,594.80 | $3,544 | 2.3× |
| Rp Loclzj Tum Plnr Whole Body Single Day Imaging (78802) | $2,010.60 | $4,468 | 2.9× |
| Rp Loclzj Tum Spect 1 Area Single Day Imaging (78803) | $1,961.55 | $4,359 | 2.8× |
| Rp loclzj tum spect CT 2area 1d img/1 ar img>2+d (78832) | $1,518.75 | $3,375 | 0.8× |
| Rp loclzj tum spect w/CT 1 area/acquisj 1day img (78830) | $1,339.20 | $2,976 | 0.8× |
| Rp Ther Radiolbld Monoclonal Antibody IV Infus (79403) | $1,962 | $4,360 | 6.5× |
| Rp Therapy Intravenous Administration (79101) | $1,246.05 | $2,769 | 4.2× |
| Salivary Gland Imaging (78230) | $554.85 | $1,233 | 1.1× |
| Scapula (73010) | $380.70 | $846 | 2.8× |
| Sella turcica (70240) | $233.10 | $518 | 2.1× |
| Shoulder 1 view (73020) | $307.80 | $684 | 2.7× |
| Shoulder Arthrography (73040) | $1,110.60 | $2,468 | 2.5× |
| Sialogram (70390) | $220.95 | $491 | 0.7× |
| Skull less than 4 views (70250) | $371.25 | $825 | 2.8× |
| Special dosimetry (77331) | $398.70 | $886 | 2.3× |
| Special Physics Consult (77370) | $622.80 | $1,384 | 3.6× |
| Special teletherapy port plan (77321) | $1,415.25 | $3,145 | 2.9× |
| Special treatment procedure (77470) | $1,611.45 | $3,581 | 2.3× |
| Speech evaluation, complex (70371) | $395.10 | $878 | 1.3× |
| Stereotactic Body Radiation Delivery (77373) | $3,477.60 | $7,728 | 1.5× |
| Sternoclavicular joints (71130) | $314.55 | $699 | 2.8× |
| Superior sagittal sinus venogram (75870) | $1,624.95 | $3,611 | 0.4× |
| Surface Applic Low Dose Rate Radionuclide Source (77789) | $240.30 | $534 | 1.8× |
| Telethx isodose pln cplx w/basic dosimetry (77307) | $866.70 | $1,926 | 1.8× |
| Telethx isodose pln smpl w/dosimetry calculation (77306) | $472.95 | $1,051 | 1.0× |
| Temporomandble Jt Arthrography Rs&I (70332) | $587.70 | $1,306 | 1.9× |
| Testicular Imaging W/Flow (78761) | $526.95 | $1,171 | 1.0× |
| Ther Rad Simulaj-Aided Field Setting Complex (77290) | $1,600.20 | $3,556 | 3.3× |
| Ther Rad Simulaj-Aided Field Setting Intermed (77285) | $564.30 | $1,254 | 1.2× |
| Ther rad simulaj-aided field setting simple (77280) | $765.90 | $1,702 | 4.4× |
| Therapeutic Enema Rdctj Intussusception/Obstrcj (74283) | $706.05 | $1,569 | 3.1× |
| Thoracic spine 2 views (72070) | $358.20 | $796 | 2.7× |
| Thoracic spine 3 views (72072) | $392.85 | $873 | 2.9× |
| Thoracolumbar 2 views (72080) | $366.30 | $814 | 3.3× |
| Thyroid Imaging With Vascular Flow (78013) | $573.75 | $1,275 | 1.1× |
| Thyroid Met Imaging Body (78018) | $1,883.70 | $4,186 | 2.7× |
| Thyroid Uptake Measurement (78012) | $383.85 | $853 | 0.7× |
| Thyroid Uptake W/Blood Flow Sngle/Mult Quan Meas (78014) | $1,086.30 | $2,414 | 2.1× |
| Tx Devices Design & Construction Complex (77334) | $1,546.65 | $3,437 | 3.2× |
| Tx devices design & construction intermediate (77333) | $471.60 | $1,048 | 2.7× |
| Tx devices design & construction simple (77332) | $442.80 | $984 | 2.6× |
| Ultrasound Breast Limited (76642) | $83.70 | $186 | 0.7× |
| Ultrasound elastography first target lesion (76982) | $423 | $940 | 3.1× |
| Ultrasound Elastography Parenchyma (76981) | $423 | $940 | 3.1× |
| Ultrasound Exam Aaa Screen (76706) | $202.05 | $449 | 1.5× |
| Ultrasound trgt dynamic microbubble 1st lesion (76978) | $284.85 | $633 | 0.6× |
| Ultrasound, abdomen limited (76705) | $960.30 | $2,134 | 7.1× |
| Umbilical-artery Doppler (OB) (76820) | $671.85 | $1,493 | 5.0× |
| Unlisted Dx Radiographic Procedure (76499) | $534.15 | $1,187 | 4.8× |
| Unlisted magnetic resonance procedure (76498) range across 2 matching MRF lines |
$1,423.80–$1,710.45 | $3,164–$3,801 | varies |
| Unlisted Procedure Clinical Brachytherapy (77799) range across 2 matching MRF lines |
$13,606.65–$14,287.50 | $30,237–$31,750 | varies |
| Unlisted us procedure (76999) | $877.50 | $1,950 | 7.8× |
| Upper gi w/o kub (74240) | $552.60 | $1,228 | 2.4× |
| Urea Breath Test C-14 Isotopic Acquisj Analysis (78267) | $233.10 | $518 | 21.1× |
| Urea breath test c-14 isotopic analysis (78268) | $226.35 | $503 | 2.4× |
| Ureteral Reflux Study (78740) | $804.60 | $1,788 | 1.6× |
| Urethrocystogram voiding (74455) | $572.40 | $1,272 | 1.9× |
| Urethrocystography retrograde (74450) | $541.80 | $1,204 | 1.8× |
| Us breast unilateral complete (76641) | $166.95 | $371 | 1.2× |
| Us chest (76604) | $781.20 | $1,736 | 5.8× |
| Us complete joint (76881) | $982.35 | $2,183 | 7.3× |
| Us exam, pelvic, limited (76857) | $511.65 | $1,137 | 3.8× |
| Us head (76506) | $836.55 | $1,859 | 6.2× |
| Us kidney transplant (76776) | $1,207.80 | $2,684 | 9.0× |
| Us lmtd joint/oth nonvasc xtr strux r-t w/img (76882) | $877.50 | $1,950 | 6.5× |
| Us ob detailed single fetus (76811) | $969.30 | $2,154 | 3.2× |
| Us ob limited 1 or more fetuses (76815) | $738 | $1,640 | 5.5× |
| Us ob transvaginal (76817) | $706.05 | $1,569 | 5.3× |
| Us pelvic non ob complete (76856) | $1,146.60 | $2,548 | 8.5× |
| Us pg uter img f&mat 14 wk tabdl 1/1st gestation (76801) | $823.50 | $1,830 | 6.1× |
| Us preg uterus real time f/u trnsabdl per fetus (76816) | $704.25 | $1,565 | 5.2× |
| Us retroperitoneal complete (76770) | $1,062 | $2,360 | 7.9× |
| Us retroperitoneal limited (76775) | $914.85 | $2,033 | 6.8× |
| Us scrotum and contents (76870) | $1,015.20 | $2,256 | 7.6× |
| Us spinal canal and contents (76800) | $1,062 | $2,360 | 7.9× |
| Us thyroid (76536) | $800.55 | $1,779 | 6.0× |
| Us transrectal (76872) | $1,012.95 | $2,251 | 7.5× |
| Vascular Flow Imaging (78445) | $775.80 | $1,724 | 1.5× |
| Vein X-Ray Chest (75827) | $2,483.55 | $5,519 | 1.2× |
| Vein X-Ray Liver W/O Hemodyn (75887) | $1,359.45 | $3,021 | 0.3× |
| Vein X-Ray Skull Epidural (75872) | $4,570.20 | $10,156 | 5.7× |
| Venogram Sinus/Jugular (75860) | $4,570.20 | $10,156 | 1.1× |
| Venography Adrenal Unilateral (75840) | $2,956.95 | $6,571 | 0.7× |
| Venography caval inferior serialography rs&i (75825) | $5,004.90 | $11,122 | 1.2× |
| Venography extremity bilateral rs&i (75822) | $2,284.65 | $5,077 | 1.1× |
| Venography extremity unilateral rs&i (75820) | $1,523.25 | $3,385 | 0.8× |
| Venography Orbital Rs&I (75880) | $4,570.20 | $10,156 | 5.7× |
| Venography Renal Bilateral (75833) | $4,435.65 | $9,857 | 1.1× |
| Venography Renal Unilateral (75831) | $2,956.95 | $6,571 | 0.7× |
| Venous sampling by catheter (75893) | $4,512.60 | $10,028 | 0.6× |
| Venous Thrombosis Imaging Venogram Bilateral (78458) | $578.70 | $1,286 | 1.1× |
| Wrist 2 views (73100) | $290.70 | $646 | 2.6× |
| X-Ray Ac Jts - Xr Acromioclavicular Joints Bilateral (73050) | $400.05 | $889 | 3.6× |
| X-ray antegrade pyelogram tube (74425) | $491.85 | $1,093 | 1.1× |
| X-Ray Aorta Leg Arteries (75630) | $5,483.70 | $12,186 | 1.4× |
| X-Ray Bend Only L-S Spine (72120) | $455.40 | $1,012 | 3.4× |
| X-Ray Elbow 2 Vw - Xr Elbow 1-2 Views Right (73070) | $276.75 | $615 | 2.5× |
| X-Ray Exam Breast Specimen (76098) | $629.55 | $1,399 | 0.9× |
| X-Ray Exam Entire Spi 1 Vw (72081) | $337.95 | $751 | 3.0× |
| X-Ray Exam Entire Spi 2/3 Vw (72082) | $500.40 | $1,112 | 3.7× |
| X-Ray Exam Entire Spi 4/5 Vw (72083) | $549.90 | $1,222 | 4.1× |
| X-Ray Exam Hip Uni 1 View (73501) | $252 | $560 | 2.3× |
| X-Ray Exam Hip Uni 2-3 Views (73502) | $350.10 | $778 | 3.1× |
| X-Ray Exam Hip Uni 4/> Views (73503) | $345.60 | $768 | 2.6× |
| X-Ray Exam Hips Bi 2 Views (73521) | $409.95 | $911 | 3.0× |
| X-Ray Exam Hips Bi 3-4 Views (73522) | $457.65 | $1,017 | 3.4× |
| X-Ray Exam Hips Bi 5/> Views (73523) | $480.60 | $1,068 | 3.6× |
| X-Ray Exam L-S Spine Bending (72114) | $703.80 | $1,564 | 5.2× |
| X-Ray Exam Neck Spine 2-3 Vw (72040) | $358.20 | $796 | 3.2× |
| X-Ray Exam Neck Spine 6/>Vws (72052) | $585.45 | $1,301 | 4.4× |
| X-Ray Exam Unilat Ribs/Chest (71101) | $392.40 | $872 | 2.9× |
| X-ray eye for foreign body (70030) | $216.45 | $481 | 1.9× |
| X-ray humerus (73060) | $331.20 | $736 | 3.0× |
| X-ray IV pyelogram (ivp) (74400) | $618.75 | $1,375 | 2.7× |
| X-ray IV pyelogram+tomography (74415) | $395.10 | $878 | 1.8× |
| X-Ray Jaw <4 Vw - Xr Mandible < 4 Views (70100) | $364.05 | $809 | 3.3× |
| X-Ray Knee Bilat Standing - Xr Knees Anteroposterior Standing Bilat (73565) | $314.10 | $698 | 2.8× |
| X-Ray Lumbar Spine 2/3 Vw - Xr Lumbar Spine 2-3 Views (72100) range across 2 matching MRF lines |
$76.05–$383.85 | $169–$853 | varies |
| X-ray nose-rectum child f.b. (76010) | $121.50 | $270 | 1.1× |
| X-Ray Ribs, Chest 4+ Vw - Xr Ribs 3 Vws Bil W/ Chest Posteroanterior (71111) | $499.50 | $1,110 | 3.7× |
| X-Ray Sacroiliac Jts 3+ Vw - Xr Sacroiliac Joints 3+ Views (72202) | $394.65 | $877 | 2.9× |
| X-Ray Sacrum/Coccyx 2+ Vw - Xr Sacrum Coccyx 2+ Views (72220) | $364.50 | $810 | 3.3× |
| X-Ray Sinuses 3+ Vw - Xr Paranasal Sinuses 3+ Views (70220) | $544.95 | $1,211 | 4.9× |
| X-Ray Skull 4+ Vw - Xr Skull Complete 4+ Views (70260) | $495.90 | $1,102 | 3.7× |
| X-ray thoracic spine 4 vw (72074) | $529.20 | $1,176 | 3.9× |
| X-Ray Tmj Unilat (70328) | $303.75 | $675 | 2.7× |
| X-Ray Urinary Tract Exam With Contrast Material (74420) | $457.65 | $1,017 | 1.0× |
| X-Rays Bone Length Studies (77073) | $436.05 | $969 | 3.2× |
| X-Rays Bone Survey Complete (77075) | $957.15 | $2,127 | 7.1× |
| Xr c-spine 4 or 5 views (72050) | $556.65 | $1,237 | 4.1× |
| Xr facial bones less than 3 views (70140) | $358.20 | $796 | 3.2× |
| XR Mastoids < 3 Views Bilateral (70120) | $364.05 | $809 | 2.7× |
| Xr orbits complete 4 views (70200) | $507.60 | $1,128 | 3.8× |
| Xr Tomogram Single Plane (76100) | $337.95 | $751 | 2.5× |
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.