Imaging prices at Loyola University Medical Center
Maywood, IL · every code in this section with a posted price and a Medicare benchmark.
466 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) | $2,183.39 | $9,493 | 1.5× |
| Abdomen 1 View (74018) | $129.49 | $563 | 1.4× |
| Abdomen 2 views (74019) | $154.79 | $673 | 1.4× |
| Acute Gastrointestinal Blood Loss Imaging (78278) | $510.37 | $2,219 | 1.2× |
| Acute venous thrombosis imaging, peptide Non-Facility (78456) | $377.20 | $1,640 | 0.3× |
| Adrenal Cortex & Medulla Img (78075) | $603.06 | $2,622 | 0.4× |
| Angio internal mammary (75756) | $1,473.38 | $6,406 | 0.4× |
| Angio pulmonary bilat (75743) | $1,532.72 | $6,664 | 0.5× |
| Angiography Adrenal Bilateral Slctv Rs&I (75733) | $1,612.99 | $7,013 | 0.5× |
| Angiography extremity bilateral rs&i (75716) | $1,560.55 | $6,785 | 0.5× |
| Angiography extremity unilateral rs&i (75710) | $1,213.02 | $5,274 | 0.4× |
| Angiography pulmonary unilateral slctv rs&i (75741) | $1,021.89 | $4,443 | 0.3× |
| Angrph pulmonary nonslctv cath/ven njx rs&i (75746) | $802.70 | $3,490 | 0.2× |
| Ankle 2 views (73600) range across 7 matching MRF lines |
$119.60–$179.40 | $520–$780 | varies |
| Aortography thoracic serialography rs&i (75605) unusually low: confirm this is the full procedure |
$2,542.19 | $11,053 | 0.4× |
| Aortography thoracic w/o serialography rs&i (75600) | $1,425.31 | $6,197 | 0.4× |
| Artery X-Rays Abdomen (75726) likely a partial charge, not the full procedure |
$1,388.28 | $6,036 | 0.2× |
| Artery X-Rays Adrenal Gland (75731) | $1,075.25 | $4,675 | 0.3× |
| Artery X-Rays Pelvis (75736) unusually low: confirm this is the full procedure |
$2,542.19 | $11,053 | 0.4× |
| Artery X-Rays Spine (75705) unusually low: confirm this is the full procedure |
$2,542.19 | $11,053 | 0.4× |
| Arthrogram ankle (73615) range across 3 matching MRF lines |
$149.50–$224.25 | $650–$975 | varies |
| Arthrogram hip (73525) range across 3 matching MRF lines |
$179.17–$268.64 | $779–$1,168 | varies |
| Arthrogram Wrist (73115) range across 3 matching MRF lines |
$226.32–$339.71 | $984–$1,477 | varies |
| Basic radiation dosimetry calculation (77300) | $213.90 | $930 | 1.5× |
| Bone age studies (77072) | $92.92 | $404 | 0.8× |
| Bone Imaging 3 Phase (78315) | $692.53 | $3,011 | 1.6× |
| Bone Imaging Limited Area (78300) | $363.86 | $1,582 | 0.8× |
| Bone Imaging Multiple Areas (78305) | $418.37 | $1,819 | 1.0× |
| Bone Imaging Whole Body (78306) | $631.12 | $2,744 | 1.5× |
| Bone marrow imaging limited area (78102) | $236.67 | $1,029 | 0.6× |
| Bone marrow imaging; whole body (78104) | $295.78 | $1,286 | 0.7× |
| Bone survey infant (77076) | $83.26 | $362 | 0.7× |
| Brachytx isodose complex (77318) | $543.03 | $2,361 | 1.4× |
| Brachytx isodose intermed (77317) | $481.62 | $2,094 | 1.2× |
| Brachytx Isodose Plan Simple (77316) | $308.89 | $1,343 | 0.8× |
| Brain Flow Imaging Only (78610) | $419.29 | $1,823 | 0.7× |
| Brain Imaging Min 4 Static Views W Vascular Flow (78606) | $672.52 | $2,924 | 1.2× |
| Brain Imaging Minimum 4 Static Views (78605) | $377.20 | $1,640 | 0.6× |
| Brain Imaging Pet Metabolic Evaluation (78608) | $2,033.43 | $8,841 | 1.3× |
| Cardiac MRI w/w/o contrast & further seq (75561) | $1,105.84 | $4,808 | 3.0× |
| Cardiac MRI w/w/o contrast w/stress (75563) | $1,163.34 | $5,058 | 1.4× |
| Cardiac Shunt Detection (78428) | $186.76 | $812 | 0.4× |
| Cat Scan Follow-Up Study (76380) | $358.11 | $1,557 | 3.8× |
| Cerebrospinal Fluid Flow W/O Matl Shunt Evaltj (78645) | $394.22 | $1,714 | 0.7× |
| Cerebrospinal Fluid Scan (78630) | $582.36 | $2,532 | 1.0× |
| Chest 1 view (71045) | $117.53 | $511 | 1.3× |
| Chest 2 views (71046) | $129.49 | $563 | 1.4× |
| Chest 3 views (71047) | $135.24 | $588 | 1.5× |
| Chest 4 or more views (71048) | $156.63 | $681 | 1.4× |
| Cineradiograpy/vidradiograpy xcpt where spec (76120) | $97.06 | $422 | 0.9× |
| Cisternography Positive Contrast Rs&I (70015) | $329.13 | $1,431 | 0.4× |
| Clavicle complete (73000) range across 3 matching MRF lines |
$136.16–$204.24 | $592–$888 | varies |
| Computed Tomography Thorax Lw Dose Lng Ca Scr C- (71271) | $88.78 | $386 | 0.8× |
| Continuing medical physics consltj pr wk (77336) | $229.54 | $998 | 1.6× |
| Contrast Exam Abdominl Aorta (75625) | $1,014.30 | $4,410 | 0.3× |
| Contrast X-Ray Bladder (74430) | $249.09 | $1,083 | 0.7× |
| Contrast X-Ray Of Elbow (73085) range across 3 matching MRF lines |
$149.50–$224.25 | $650–$975 | varies |
| Contrast X-Ray Of Knee Joint (73580) range across 3 matching MRF lines |
$175.49–$263.12 | $763–$1,144 | varies |
| Corpora cavernosography (74445) | $118.22 | $514 | 1.1× |
| CT abdomen and pelvis without and with contrast (74178) | $1,542.61 | $6,707 | 4.1× |
| CT abdomen and pelvis without contrast (74176) | $1,064.67 | $4,629 | 4.2× |
| CT abdomen w contrast (74160) | $718.06 | $3,122 | 3.8× |
| CT abdomen w wo contrast (74170) | $846.40 | $3,680 | 4.5× |
| CT abdomen w/o contrast (74150) | $584.89 | $2,543 | 5.2× |
| CT Angio Abdomen and Pelvis (74174) | $931.27 | $4,049 | 2.5× |
| CT Angio Chest (71275) | $739.45 | $3,215 | 3.9× |
| CT Angio Head (70496) | $701.96 | $3,052 | 3.7× |
| CT angio hrt w/3d image (75574) | $1,167.25 | $5,075 | 3.1× |
| Ct Angio Lwr Extr W/O&W/Dye (73706) range across 2 matching MRF lines |
$450.80–$676.20 | $1,960–$2,940 | varies |
| CT Angio Neck (70498) | $696.44 | $3,028 | 3.7× |
| Ct Angio Upr Extrm W/O&W/Dye (73206) | $707.25 | $3,075 | 3.8× |
| CT cervical spine w/ contrast (72126) | $694.14 | $3,018 | 1.9× |
| CT cervical spine w/o contrast (72125) | $614.33 | $2,671 | 5.5× |
| CT cervical spine w/wo cont (72127) | $763.60 | $3,320 | 4.1× |
| CT chest w contrast (71260) | $705.64 | $3,068 | 3.8× |
| CT chest w/wo contrast (71270) | $778.78 | $3,386 | 4.1× |
| CT colonography screening (74263) | $462.99 | $2,013 | 1.8× |
| CT Colonogrphy Dx Image Postprocess W/Contrast (74262) | $442.75 | $1,925 | 2.4× |
| CT colonogrphy dx image postprocess w/o contrast (74261) | $484.38 | $2,106 | 4.3× |
| CT head/brain with contrast (70460) | $617.09 | $2,683 | 3.3× |
| CT head/brain without and with contrast (70470) | $812.36 | $3,532 | 4.3× |
| CT heart contrast eval cardiac structure&morph (75572) | $872.16 | $3,792 | 2.3× |
| CT heart no contrast quant eval coronry calcium (75571) range across 2 matching MRF lines |
$59.24–$120.06 | $257.58–$522 | varies |
| CT hrt w/3d image congen (75573) | $872.16 | $3,792 | 2.3× |
| CT iac w contrast (70481) | $664.93 | $2,891 | 3.5× |
| CT l-spine w&w/o contrast (72133) | $760.61 | $3,307 | 4.0× |
| CT lower ext w/o (73700) range across 4 matching MRF lines |
$508.07–$762.22 | $2,209–$3,314 | varies |
| CT lower extremity w/contrast material (73701) range across 3 matching MRF lines |
$568.10–$852.15 | $2,470–$3,705 | varies |
| CT lumbar spine w contrast (72132) | $743.82 | $3,234 | 2.0× |
| CT lumbar spine w/o contrast (72131) | $640.55 | $2,785 | 5.7× |
| CT maxillofacial w contrast (70487) | $635.49 | $2,763 | 3.4× |
| CT maxillofacial wo contrast (70486) range across 7 matching MRF lines |
$505.08–$531.76 | $2,196–$2,312 | varies |
| CT neck tissue combo (70492) | $717.60 | $3,120 | 3.8× |
| Ct Orbit/Ear/Fossa W/O&W/Dye (70482) | $719.67 | $3,129 | 3.8× |
| CT orbits w/o contrast (70480) | $495.65 | $2,155 | 4.4× |
| CT pelvis w&w/o contrast (72194) | $853.30 | $3,710 | 4.5× |
| CT pelvis w/o contrast (72192) | $550.85 | $2,395 | 4.9× |
| CT scan of leg combo (73702) range across 3 matching MRF lines |
$634.11–$951.28 | $2,757–$4,136 | varies |
| CT scans face/jaw combo (70488) | $807.30 | $3,510 | 4.3× |
| CT soft tissue neck w contrast (70491) | $692.53 | $3,011 | 3.7× |
| CT soft tissue neck w/o contrast (70490) | $587.88 | $2,556 | 5.2× |
| CT thoracic spine w contrast (72129) | $656.19 | $2,853 | 3.5× |
| CT thoracic spine w/o contrast (72128) | $597.77 | $2,599 | 5.3× |
| CT thoracic spine w/wo cont (72130) | $763.37 | $3,319 | 4.1× |
| CT thorax w/o contrast (71250) | $560.05 | $2,435 | 5.0× |
| CT upper ext wo (73200) range across 3 matching MRF lines |
$564.65–$847.09 | $2,455–$3,683 | varies |
| CT upper extremity w/o & w/contrast material (73202) range across 3 matching MRF lines |
$646.99–$970.37 | $2,813–$4,219 | varies |
| CT upper extremity with contrast (73201) range across 3 matching MRF lines |
$613.87–$920.92 | $2,669–$4,004 | varies |
| Cta Abdl Aorta&Bi Iliofem W/Contrast&Postp (75635) | $687.70 | $2,990 | 3.7× |
| Cta Abdomen (74175) | $562.12 | $2,444 | 3.0× |
| CTA pelvis (72191) | $598.23 | $2,601 | 3.2× |
| Dacryocystography, nasolacrimal duct, radiological supervision and interpretation Non-Facility (70170) | $139.15 | $605 | 0.5× |
| Determination of central c-v hemodynamics (non-imaging) (eg, ejection fraction with probe technique) with or without… (78414) | $377.20 | $1,640 | 0.6× |
| Dilation ureters/urethra rs&i (74485) | $917.47 | $3,989 | 0.4× |
| Discography Cerv/Thor Spine (72285) | $597.77 | $2,599 | 0.3× |
| Diskography lumbar (72295) | $491.51 | $2,137 | 0.2× |
| Doppler Echo Fetal Puls Spectral F/U/Repeat (76828) | $166.75 | $725 | 1.5× |
| Doppler Echo Fetal Spectral Display Complete (76827) | $231.15 | $1,005 | 2.1× |
| Doppler Fetal Mid Cerebral Artery (76821) | $114.08 | $496 | 1.0× |
| Dxa Bone Density Axial (77080) | $182.62 | $794 | 1.6× |
| Dxa bone density study (77085) | $79.81 | $347 | 0.7× |
| Dxa bone density study 1/>sites appendiclr skel (77081) | $83.95 | $365 | 0.9× |
| Echo exam of fetal heart (76825) | $324.07 | $1,409 | 0.6× |
| Echo exam uterus (76831) | $305.67 | $1,329 | 1.2× |
| Echo Guide For Artery Repair (76936) | $423.89 | $1,843 | 1.8× |
| Echocardiography, fetal, cardiovascular system, real time with image documentation (2D), with or without M-mode… (76826) | $231.15 | $1,005 | 0.9× |
| Echograp Trans R Pros Study (76873) | $234.37 | $1,019 | 2.1× |
| Esophagram (74220) | $191.82 | $834 | 1.0× |
| Fetal Biophys Profile W/Nst (76818) | $234.60 | $1,020 | 2.1× |
| Fetal Biophysical Profile W/O Non-Stress Testing (76819) | $183.77 | $799 | 1.6× |
| Fetal MRI w/placntl matrnl plvc img sing/1st ges (74712) | $144.21 | $627 | 0.6× |
| Fluoroscopy up to 1 hr (76000) | $241.04 | $1,048 | 0.9× |
| Follow-Up Angiography (75898) | $1,473.38 | $6,406 | 0.4× |
| Foot 2 views (73620) range across 13 matching MRF lines |
$100.74–$151.11 | $438–$657 | varies |
| Forearm 2 views (73090) range across 3 matching MRF lines |
$143.06–$214.59 | $622–$933 | varies |
| Gastric emptying imaging study (78264) | $705.41 | $3,067 | 1.6× |
| Gastric Emptyng Imag Std W/Sm Bwl Transit (78265) | $240.81 | $1,047 | 0.6× |
| Gastroesophageal Reflux Exam (78262) | $377.20 | $1,640 | 0.9× |
| Gated Heart Planar Single (78472) | $666.54 | $2,898 | 1.6× |
| Gated Heart, Multiple (78473) | $724.04 | $3,148 | 1.7× |
| GI Endoscopic US S&I (76975) | $324.53 | $1,411 | 1.3× |
| Gstrc Emptng Imag Std W/Sm Bwl Col Trnst Mlt Day (78266) | $319.47 | $1,389 | 0.5× |
| Hand 2 views (73120) range across 3 matching MRF lines |
$113.39–$170.20 | $493–$740 | varies |
| Hdr Rdncl Ntrstl/Icav Brchtx (77772) | $1,344.81 | $5,847 | 1.8× |
| Hdr Rdncl Ntrstl/Icav Brchtx (77771) | $1,198.07 | $5,209 | 1.6× |
| Hdr Rdncl Ntrstl/Icav Brchtx 1 Channel (77770) | $1,198.07 | $5,209 | 1.6× |
| Heart Image (Pet) Multiple (78492) | $1,064.90 | $4,630 | 0.7× |
| Hepatc Vngrph Wdg/Fr Hemodyn Eval Rs&I (75889) | $932.88 | $4,056 | 0.3× |
| Hepatc Vngrph Wdg/Fr W/O Hemodyn Eval Rs&I (75891) | $915.17 | $3,979 | 0.3× |
| Hepatobil Syst Image W/Drug (78227) | $538.66 | $2,342 | 0.9× |
| Hepatobiliary System Imaging (78226) | $487.83 | $2,121 | 1.1× |
| Ht Musc Image Planar Mult (78454) | $1,125.16 | $4,892 | 0.8× |
| Ht Muscle Image Spect Sing (78451) | $917.47 | $3,989 | 0.7× |
| Hyperthermia external generated superficial (77600) | $345 | $1,500 | 0.8× |
| Hysterosalpingogram (74740) | $296.93 | $1,291 | 1.2× |
| Infant hip ultrasound with hip movement (dynamic) (76885) | $150.19 | $653 | 1.6× |
| Infant hip ultrasound, limited static exam (76886) | $139.15 | $605 | 1.5× |
| Interstitial radiation source applic complex (77778) | $1,365.97 | $5,939 | 1.8× |
| Intracavitary Radiation Source Applic Complex (77763) | $1,267.53 | $5,511 | 1.7× |
| Intracavitary Radiation Source Applic Intermed (77762) | $488.29 | $2,123 | 0.8× |
| Intracavitary radiation source applic simple (77761) | $304.98 | $1,326 | 0.5× |
| Intraop radiaj tx deliver electrons sngl tx sess (77425) unusually low: confirm this is the full procedure |
$2,599 | $11,300 | 0.3× |
| Intraop radiaj tx deliver xray single tx session (77424) unusually low: confirm this is the full procedure |
$2,599 | $11,300 | 0.3× |
| Joint Survey Single View (77077) | $75.90 | $330 | 0.7× |
| K Flow/Funct Image Multiple (78709) | $819.26 | $3,562 | 1.4× |
| K Flow/Funct Image W/Drug (78708) | $546.25 | $2,375 | 0.9× |
| K Flow/Funct Image W/O Drug (78707) | $522.10 | $2,270 | 0.9× |
| Kidney Funcj Study Non-Img Radioisotopic Study (78725) | $320.39 | $1,393 | 0.7× |
| Kidney Imaging Morphoogy W/Vascular Flow (78701) | $373.98 | $1,626 | 0.9× |
| Knee 3 Views (73562) range across 10 matching MRF lines |
$124.66–$186.99 | $542–$813 | varies |
| Leveen/Shunt Patency Exam (78291) | $433.55 | $1,885 | 1.0× |
| Liver & Spleen Imaging Static Only (78215) | $186.76 | $812 | 0.4× |
| Liver imaging w/vascular flow (78202) | $377.20 | $1,640 | 0.6× |
| Lung Perf&Ventilat Diferentl (78598) | $501.63 | $2,181 | 0.9× |
| Lung perfusion differential (78597) | $362.94 | $1,578 | 0.8× |
| Lung Ventilat&Perfus Imaging (78582) | $526.01 | $2,287 | 0.9× |
| Lung Ventilation Imaging (78579) | $320.39 | $1,393 | 0.7× |
| Lymph System Imaging (78195) | $598.23 | $2,601 | 1.0× |
| Lymphangiography Extremity Only Bilateral Rs&I (75803) | $430.33 | $1,871 | 0.3× |
| Lymphangiography extremity only unilateral rs&i (75801) | $286.81 | $1,247 | 0.4× |
| Lymphangiography Pelvic/Abdominal Bilateral Rs&I (75807) | $1,473.38 | $6,406 | 0.4× |
| Lymphangiography, pelvic/abdominal, unilateral (75805) | $1,473.38 | $6,406 | 0.4× |
| Magnetic Image Jaw Joint (70336) | $867.10 | $3,770 | 3.4× |
| Magnetic Resonance Elastography (76391) | $91.31 | $397 | 0.4× |
| Mammary ductogram or galactogram multiple (77054) | $221.49 | $963 | 0.9× |
| Mammary ductogram or galactogram single (77053) | $135.01 | $587 | 0.5× |
| Meckels Divert Exam (78290) | $436.54 | $1,898 | 1.0× |
| Mlc imrt design & construction per imrt plan (77338) | $385.71 | $1,677 | 1.0× |
| Mr safety determination physician/other qhp (76016) | $40.71 | $177 | 0.4× |
| Mr safety implant&/fb assmt clin staf 1st 15 min (76014) | $17.02 | $74 | 0.5× |
| Mr safety implt pos&/immoblj (76019) | $27.37 | $119 | 0.4× |
| Mr safety med physics xm customization plng&mntr (76017) | $111.32 | $484 | 0.4× |
| Mra Head W/O & W/Contrast Material (70546) | $1,035.46 | $4,502 | 2.8× |
| MRA head w/o contrast (70544) | $793.50 | $3,450 | 3.1× |
| MRA head with contrast (70545) | $859.51 | $3,737 | 2.3× |
| MRA neck w contrast (70548) | $752.56 | $3,272 | 2.0× |
| Mra Neck W/O &W/Contrast Material (70549) | $1,002.34 | $4,358 | 2.7× |
| MRA neck w/o contrast (70547) | $699.89 | $3,043 | 2.7× |
| MRI abdomen w contrast (74182) | $971.06 | $4,222 | 2.6× |
| MRI abdomen w/o contrast (74181) | $895.39 | $3,893 | 3.5× |
| MRI any jt lower extrem w/contrast material (73722) range across 3 matching MRF lines |
$1,050.18–$1,575.27 | $4,566–$6,849 | varies |
| MRI any jt lower extrem w/o & w/contrast matrl (73723) range across 3 matching MRF lines |
$1,157.13–$1,735.81 | $5,031–$7,547 | varies |
| MRI any jt upper extremity w/contrast matrl (73222) range across 3 matching MRF lines |
$1,257.87–$1,886.92 | $5,469–$8,204 | varies |
| MRI bone marrow blood supply (77084) | $598.46 | $2,602 | 2.3× |
| MRI brain functional w/o physician admnistration (70554) | $797.18 | $3,466 | 3.1× |
| MRI brain functional w/physician admnistration (70555) | $876.76 | $3,812 | 3.4× |
| MRI Breast W/O Contrast Bilateral (77047) | $1,006.02 | $4,374 | 3.9× |
| MRI Breast Without Contrast Material Unilateral (77046) | $677.35 | $2,945 | 2.6× |
| MRI cardiac w/o cont stress (75559) | $1,080.08 | $4,696 | 1.8× |
| MRI cardiac w/o contrast (75557) | $1,075.02 | $4,674 | 4.2× |
| MRI cervical spine w contrast (72142) | $1,087.67 | $4,729 | 2.9× |
| MRI cervical spine w/o cont (72141) | $913.33 | $3,971 | 3.6× |
| MRI chest w/o contrast (71550) | $717.37 | $3,119 | 2.8× |
| MRI chest with contrast (71551) | $854.45 | $3,715 | 1.0× |
| MRI chest wo w contrast (71552) | $999.35 | $4,345 | 2.7× |
| MRI lower extrem oth/thn jt w/contrast matrl (73719) range across 4 matching MRF lines |
$927.59–$1,391.50 | $4,033–$6,050 | varies |
| MRI lower extrem oth/thn jt w/o & w/contr matr (73720) range across 3 matching MRF lines |
$1,019.36–$1,529.04 | $4,432–$6,648 | varies |
| MRI lower extrem oth/thn jt w/o contr matrl (73718) range across 3 matching MRF lines |
$866.41–$1,299.73 | $3,767–$5,651 | varies |
| MRI lumbar spine w contrast (72149) | $1,127.69 | $4,903 | 3.0× |
| Mri Neck Spine W/O & W/Dye (72156) | $1,203.13 | $5,231 | 3.2× |
| MRI orbit face &/neck w/o contrast (70540) | $745.43 | $3,241 | 2.9× |
| MRI orbit face neck w contrast (70542) | $822.94 | $3,578 | 2.2× |
| Mri Orbt/Fac/Nck W/O &W/Dye (70543) | $1,128.61 | $4,907 | 3.0× |
| MRI pelvis w contrast (72196) | $949.67 | $4,129 | 2.5× |
| MRI pelvis w/o & w contrast (72197) | $1,249.82 | $5,434 | 3.3× |
| MRI pelvis w/o contrast (72195) | $856.06 | $3,722 | 3.3× |
| MRI spectroscopy (76390) | $478.86 | $2,082 | 5.1× |
| MRI thoracic spine w/o contrast (72146) | $900.68 | $3,916 | 3.5× |
| MRI upper extremity oth than jt w/contr matrl (73219) range across 3 matching MRF lines |
$938.40–$1,407.83 | $4,080–$6,121 | varies |
| MRI upper extremity oth than jt w/o contr matrl (73218) range across 4 matching MRF lines |
$840.42–$1,260.63 | $3,654–$5,481 | varies |
| Mri Uppr Extremity W/O&W/Dye (73220) range across 3 matching MRF lines |
$1,027.87–$1,541.92 | $4,469–$6,704 | varies |
| MRI, abdomen, combo (74183) | $1,268.91 | $5,517 | 3.4× |
| MRI, dorsal spine combo (72157) | $1,224.52 | $5,324 | 3.3× |
| MRI, dorsal spine contrast (72147) | $1,092.04 | $4,748 | 2.9× |
| MRI, joint upper extrem (73221) range across 3 matching MRF lines |
$945.99–$1,419.10 | $4,113–$6,170 | varies |
| MRI, joint upper extrem combo (73223) range across 3 matching MRF lines |
$1,293.06–$1,939.59 | $5,622–$8,433 | varies |
| MRI, lumbar spine combo (72158) | $1,213.02 | $5,274 | 3.2× |
| Myelogram cervical (72240) | $472.19 | $2,053 | 0.6× |
| Myelogram Lumbar (72265) | $415.84 | $1,808 | 0.5× |
| Myelography thoracic (72255) | $435.39 | $1,893 | 0.5× |
| Myelograpy 2/more regions rs&i (72270) | $552.46 | $2,402 | 0.7× |
| Myocardial Imaging Infarct Avid Planar Qual/Quan (78466) | $377.20 | $1,640 | 0.9× |
| Myocardial Imaging Pet Metabolic Evaluation (78459) | $1,200.60 | $5,220 | 0.9× |
| Myocardial Perfusion Planar 1 Study Rest/Stress (78453) | $774.18 | $3,366 | 0.6× |
| Myocardial Spect Multiple Studies (78452) | $1,529.27 | $6,649 | 1.1× |
| Myocrd Img Pet Metab Eval Single Study Cncrnt CT (78429) | $742.44 | $3,228 | 0.5× |
| Myocrd Img Pet Prfuj W/Metab Dual Radiotracer (78432) | $4,191.75 | $18,225 | 2.6× |
| N-invas est c ffr sw aly CTA (75580) | $633.19 | $2,753 | 0.7× |
| Neck soft tissue (70360) | $135.47 | $589 | 1.5× |
| Nfs/Instlj Radioelmnt Sln 3 Mo Follow-Up Care (77750) | $351.44 | $1,528 | 0.9× |
| Njx Rp Loclzj Non-Img Probe Study Intravenous (78808) | $138.69 | $603 | 0.3× |
| Nm csf leak detection (78650) | $377.20 | $1,640 | 0.3× |
| Nm myocard infarct spect (78469) | $596.85 | $2,595 | 1.0× |
| Nm red cell survival study (78130) | $377.20 | $1,640 | 0.9× |
| Nm whole blood volume (78122) | $377.20 | $1,640 | 0.6× |
| Ntsty modul radthx pln dose-vol histos (77301) | $2,087.94 | $9,078 | 1.4× |
| Nuclear Rx Intra-Arterial (79445) | $380.65 | $1,655 | 1.5× |
| Nuclear Rx Oral Admin (79005) | $380.65 | $1,655 | 1.5× |
| Ob us nuchal meas 1 gest (76813) | $139.15 | $605 | 1.2× |
| Oph bmtry us echograpy a-scan io lens pwr cal (76519) | $171.81 | $747 | 1.5× |
| Oph US Dx B-Scan&Quan a-Scan Sm Pt Enctr (76510) | $186.76 | $812 | 1.3× |
| Ophthalmic Biometry US Echograpy a-Scan (76516) | $159.85 | $695 | 1.4× |
| Ophthalmic ultrasound dx b-scan w/wo a-scan (76512) range across 3 matching MRF lines |
$141.22–$211.83 | $614–$921 | varies |
| Ophthalmic US Dx Corneal Pachymetry Uni/Bi (76514) | $14.95 | $65 | 0.5× |
| Ophthalmic us dx quantitative a-scan only (76511) | $137.08 | $596 | 1.2× |
| Panoramic X-ray of jaws (70355) | $126.27 | $549 | 1.4× |
| Parathyroid imaging w/tomographic spect & CT (78072) | $977.73 | $4,251 | 1.7× |
| Parathyroid Planar Imaging (78070) | $506.92 | $2,204 | 1.2× |
| Parathyroid planar imaging w/wo subtraction (78071) | $564.42 | $2,454 | 1.3× |
| Pelvis 1 or 2 views (72170) | $138.69 | $603 | 1.2× |
| Perineogram (74775) | $190.44 | $828 | 0.7× |
| Peritoneogram Rs&I (74190) | $366.16 | $1,592 | 0.6× |
| Pet Image W/Ct Lmtd (78814) | $1,792.39 | $7,793 | 1.2× |
| PET image w/CT, full body (78816) | $2,541.04 | $11,048 | 1.7× |
| PET imaging CT attenuation skull base mid-thigh (78815) | $2,670.30 | $11,610 | 1.7× |
| Pet Imaging Limited Area Chest Head/Neck (78811) range across 2 matching MRF lines |
$1,885.54–$2,074.60 | $8,198–$9,020 | varies |
| Pet Myocardial Sngl Study (78491) | $820.64 | $3,568 | 0.5× |
| Plasma volume, radiopharmaceutical volume-dilution technique (separate procedure); single sampling Non-Facility (78110) | $377.20 | $1,640 | 0.3× |
| Prq Transhepatc Portograpy Hemodyn Eval Rs&I (75885) | $1,105.84 | $4,808 | 0.3× |
| Pulmonary Perfusion Imaging Particulate (78580) | $331.89 | $1,443 | 0.8× |
| Radex Abd Compl Aqt Abd W/S/E/D Views 1 View Ch (74022) | $208.15 | $905 | 1.9× |
| Radex abscess/fistula/sinus tract rs&i (76080) | $296.70 | $1,290 | 0.5× |
| Radex Ankle Complete Minimum 3 Views (73610) range across 16 matching MRF lines |
$133.86–$200.79 | $582–$873 | varies |
| Radex Calcaneus Minimum 2 Views (73650) range across 7 matching MRF lines |
$132.02–$198.26 | $574–$862 | varies |
| Radex elbow complete minimum 3 views (73080) range across 10 matching MRF lines |
$143.06–$214.59 | $622–$933 | varies |
| Radex Facial Bones Complete Minimum 3 Views (70150) | $154.33 | $671 | 1.4× |
| Radex fingr minimum 2 views (73140) range across 19 matching MRF lines |
$82.34–$123.51 | $358–$537 | varies |
| Radex foot complete minimum 3 views (73630) range across 13 matching MRF lines |
$148.81–$223.33 | $647–$971 | varies |
| Radex Hand Minimum 3 Views (73130) range across 3 matching MRF lines |
$132.02–$198.03 | $574–$861 | varies |
| Radex lower extremity infant minimum 2 views (73592) range across 3 matching MRF lines |
$141.68–$212.75 | $616–$925 | varies |
| Radex Mastoids Compl Minimum 3 Views PR Side (70130) | $137.77 | $599 | 1.2× |
| Radex Nasal Bones Complete Minimum 3 Views (70160) | $147.20 | $640 | 1.6× |
| Radex Ribs Unilateral 2 Views (71100) | $140.76 | $612 | 1.5× |
| Radex shoulder complete minimum 2 views (73030) range across 13 matching MRF lines |
$168.59–$253.23 | $733–$1,101 | varies |
| Radex Sinuses Paransl < 3 Views (70210) | $104.65 | $455 | 1.1× |
| Radex sm int w/mlt srl imges via enteroclss tube (74251) | $140.07 | $609 | 0.7× |
| Radex Spine 1 View Specify Level (72020) | $124.66 | $542 | 1.3× |
| Radex Sternum Minimum 2 Views (71120) | $112.93 | $491 | 1.2× |
| Radex Temporomandble Jt Opn & Clsd Mouth Bilat (70330) | $174.34 | $758 | 1.9× |
| Radex Toe Minimum 2 Views (73660) range across 14 matching MRF lines |
$85.79–$128.80 | $373–$560 | varies |
| Radex upper extremity infant minimum 2 views (73092) range across 3 matching MRF lines |
$71.30–$107.18 | $310–$466 | varies |
| Radex Wrist Complete Minimum 3 Views (73110) range across 13 matching MRF lines |
$146.05–$219.19 | $635–$953 | varies |
| Radex X-Ray Exam Entire Spi 6/> Vw - Xr Entire Spine 6+ Vw (72084) | $221.49 | $963 | 2.0× |
| Radiation Delivery Stereotactic Cranial Linear (77372) | $5,445.94 | $23,678 | 0.7× |
| Radiation treatment delivery level 1 (77402) | $215.74 | $938 | 2.0× |
| Radiation treatment delivery level 2 (77407) | $234.14 | $1,018 | 0.6× |
| Radiation treatment delivery level 3 (77412) | $307.28 | $1,336 | 0.5× |
| Radiolog exam mandible compl minimum 4 views (70110) | $150.42 | $654 | 1.3× |
| Radiologic Exam Abdomen 3+ Views - Xr Abdomen 3+ Views (74021) | $164.22 | $714 | 1.5× |
| Radiologic exam colon double contrast study (74280) | $362.02 | $1,574 | 1.9× |
| Radiologic exam colon single contrast study (74270) | $307.28 | $1,336 | 1.6× |
| Radiologic Exam Esophagus Double Contrast Study (74221) | $97.06 | $422 | 0.5× |
| Radiologic exam knee complete 4/more views (73564) range across 10 matching MRF lines |
$183.77–$275.77 | $799–$1,199 | varies |
| Radiologic exam pelvis compl minimum 3 views (72190) | $194.12 | $844 | 1.7× |
| Radiologic Exam Small Int Single Contrast Study (74250) | $235.06 | $1,022 | 1.3× |
| Radiologic exam swallow function contrast study (74230) | $200.56 | $872 | 1.1× |
| Radiologic exam upr gi trc double contrast study (74246) | $280.83 | $1,221 | 1.5× |
| Radiologic examination femur 1 view (73551) range across 9 matching MRF lines |
$73.14–$110.17 | $318–$479 | varies |
| Radiologic examination femur minimum 2 views (73552) range across 10 matching MRF lines |
$88.32–$132.48 | $384–$576 | varies |
| Radiologic examination knee 1/2 views (73560) range across 13 matching MRF lines |
$101.66–$152.49 | $442–$663 | varies |
| Radiologic Examination Osseous Survey Limited (77074) | $163.53 | $711 | 1.5× |
| Radiologic Examination Salivary Gland Calculus (70380) | $33.12 | $144 | 0.4× |
| Radiologic examination tibia & fibula 2 views (73590) range across 3 matching MRF lines |
$148.35–$222.64 | $645–$968 | varies |
| Radiopharm Dacryocystography (78660) | $377.20 | $1,640 | 0.9× |
| Radiopharmaceutical therapy, by interstitial radioactive colloid administration Facility (79300) | $380.65 | $1,655 | 1.5× |
| Radiopharmaceutical therapy, by intracavitary administration Non-Facility (79200) | $418.83 | $1,821 | 1.7× |
| Red Cell Volume Determination Spx 1 Sampling (78120) | $377.20 | $1,640 | 0.9× |
| Remote afterloading high dose rate radionuclide skin surface brachytherapy, includes basic dosimetry, when performed;… (77768) | $134.55 | $585 | 0.3× |
| Remote afterloading high dose rate radionuclide skin surface brachytherapy, includes basic dosimetry, when performed;… (77767) | $117.07 | $509 | 0.3× |
| Renal Cyst Study (74470) | $281.75 | $1,225 | 0.5× |
| Ribs bilateral 3 views (71110) | $184 | $800 | 1.6× |
| Rp loclzj tum plnr 1 area single day imaging (78800) | $329.13 | $1,431 | 0.8× |
| Rp loclzj tum plnr 2+area 1+d img/1 area img>2+d (78801) | $446.66 | $1,942 | 1.0× |
| Rp Loclzj Tum Plnr Whole Body 2+ Days Imaging (78804) | $837.20 | $3,640 | 1.4× |
| Rp Loclzj Tum Plnr Whole Body Single Day Imaging (78802) | $822.94 | $3,578 | 1.4× |
| Rp Loclzj Tum Spect 1 Area Single Day Imaging (78803) | $801.09 | $3,483 | 1.4× |
| Rp loclzj tum spect 2 area/sep acquisj img (78831) | $818.11 | $3,557 | 0.6× |
| Rp loclzj tum spect CT 2area 1d img/1 ar img>2+d (78832) | $927.82 | $4,034 | 0.6× |
| Rp loclzj tum spect w/CT 1 area/acquisj 1day img (78830) | $818.11 | $3,557 | 0.6× |
| Rp Ther Radiolbld Monoclonal Antibody IV Infus (79403) | $462.99 | $2,013 | 1.9× |
| Rp Therapy Intravenous Administration (79101) | $380.65 | $1,655 | 1.5× |
| Salivary Gland Imaging Serial Images (78231) | $377.20 | $1,640 | 0.9× |
| Scapula (73010) range across 3 matching MRF lines |
$152.49–$228.85 | $663–$995 | varies |
| Screening Digital Breast Tomosynthesis Bi (77063) range across 2 matching MRF lines |
$45.31–$68.08 | $197–$296 | varies |
| Sella turcica (70240) | $33.12 | $144 | 0.4× |
| Shoulder 1 view (73020) range across 3 matching MRF lines |
$78.89–$118.45 | $343–$515 | varies |
| Shoulder Arthrography (73040) range across 3 matching MRF lines |
$290.26–$435.39 | $1,262–$1,893 | varies |
| Sialogram (70390) | $281.29 | $1,223 | 1.1× |
| Skull less than 4 views (70250) | $126.04 | $548 | 1.1× |
| Special dosimetry (77331) | $284.28 | $1,236 | 2.0× |
| Special Physics Consult (77370) | $274.16 | $1,192 | 1.9× |
| Special teletherapy port plan (77321) | $350.29 | $1,523 | 0.9× |
| Special treatment procedure (77470) | $663.78 | $2,886 | 1.1× |
| Spleen Imaging (78185) | $377.20 | $1,640 | 0.9× |
| Stereotactic Body Radiation Delivery (77373) | $2,147.51 | $9,337 | 1.1× |
| Sternoclavicular joints (71130) | $113.39 | $493 | 1.2× |
| Superior sagittal sinus venogram (75870) | $1,473.38 | $6,406 | 0.4× |
| Surface Applic Low Dose Rate Radionuclide Source (77789) | $139.84 | $608 | 1.3× |
| Tbs techl prep&transmis data alys pfrmd elsewhr (77090) | $43.01 | $187 | 0.5× |
| Tbs technical calculation only (77091) | $43.01 | $187 | 0.5× |
| Telethx isodose pln cplx w/basic dosimetry (77307) | $535.21 | $2,327 | 1.3× |
| Telethx isodose pln smpl w/dosimetry calculation (77306) | $304.98 | $1,326 | 0.8× |
| Testicular Imaging W/Flow (78761) | $320.39 | $1,393 | 0.7× |
| Ther Rad Simulaj-Aided Field Setting Complex (77290) | $694.83 | $3,021 | 1.7× |
| Ther Rad Simulaj-Aided Field Setting Intermed (77285) | $495.88 | $2,156 | 1.2× |
| Ther rad simulaj-aided field setting simple (77280) | $357.42 | $1,554 | 2.5× |
| Therapeutic Enema Rdctj Intussusception/Obstrcj (74283) | $207.92 | $904 | 1.1× |
| Thoracic spine 2 views (72070) | $150.65 | $655 | 1.3× |
| Thoracic spine 3 views (72072) | $199.64 | $868 | 1.8× |
| Thoracolumbar 2 views (72080) | $120.75 | $525 | 1.3× |
| Thyroid Imaging With Vascular Flow (78013) | $377.20 | $1,640 | 0.9× |
| Thyroid Met Imaging Body (78018) | $663.55 | $2,885 | 1.1× |
| Thyroid Uptake Measurement (78012) | $185.15 | $805 | 0.4× |
| Thyroid Uptake W/Blood Flow Sngle/Mult Quan Meas (78014) | $482.77 | $2,099 | 1.1× |
| Tx Devices Design & Construction Complex (77334) | $399.74 | $1,738 | 1.0× |
| Tx devices design & construction intermediate (77333) | $267.95 | $1,165 | 1.9× |
| Tx devices design & construction simple (77332) | $246.79 | $1,073 | 1.7× |
| Ultrasound Breast Limited (76642) range across 8 matching MRF lines |
$146.97–$220.57 | $639–$959 | varies |
| Ultrasound elastography first target lesion (76982) | $111.09 | $483 | 1.0× |
| Ultrasound Elastography Parenchyma (76981) | $111.09 | $483 | 1.0× |
| Ultrasound Exam Aaa Screen (76706) | $161.69 | $703 | 1.4× |
| Ultrasound trgt dynamic microbubble 1st lesion (76978) | $152.26 | $662 | 0.4× |
| Ultrasound, abdomen limited (76705) | $289.57 | $1,259 | 2.6× |
| Umbilical-artery Doppler (OB) (76820) | $166.75 | $725 | 1.5× |
| Unlisted fluoroscopic procedure (76496) | $33.12 | $144 | 0.4× |
| Unlisted magnetic resonance procedure (76498) range across 3 matching MRF lines |
$559.36–$951.97 | $2,432–$4,139 | varies |
| Upper gi w/o kub (74240) | $268.64 | $1,168 | 1.4× |
| Ureteral Reflux Study (78740) | $320.39 | $1,393 | 0.7× |
| Urethrocystogram voiding (74455) | $235.06 | $1,022 | 0.9× |
| Urethrocystography retrograde (74450) | $234.60 | $1,020 | 0.9× |
| Us breast unilateral complete (76641) range across 5 matching MRF lines |
$156.86–$235.29 | $682–$1,023 | varies |
| Us chest (76604) | $152.26 | $662 | 1.4× |
| Us complete joint (76881) range across 6 matching MRF lines |
$291.87–$437.92 | $1,269–$1,904 | varies |
| Us exam, pelvic, limited (76857) | $189.29 | $823 | 1.7× |
| Us head (76506) | $159.85 | $695 | 1.4× |
| Us kidney transplant (76776) | $308.89 | $1,343 | 2.8× |
| Us lmtd joint/oth nonvasc xtr strux r-t w/img (76882) range across 9 matching MRF lines |
$160.08–$239.89 | $696–$1,043 | varies |
| Us ob detailed single fetus (76811) | $290.03 | $1,261 | 1.1× |
| Us ob limited 1 or more fetuses (76815) | $142.37 | $619 | 1.3× |
| Us ob transvaginal (76817) | $147.89 | $643 | 1.3× |
| Us pelvic non ob complete (76856) | $380.65 | $1,655 | 3.4× |
| Us pg uter img f&mat 14 wk tabdl 1/1st gestation (76801) | $154.10 | $670 | 1.4× |
| Us preg uterus real time f/u trnsabdl per fetus (76816) | $160.31 | $697 | 1.4× |
| Us retroperitoneal complete (76770) | $287.96 | $1,252 | 2.6× |
| Us retroperitoneal limited (76775) | $266.34 | $1,158 | 2.4× |
| Us scrotum and contents (76870) | $282.44 | $1,228 | 2.5× |
| Us spinal canal and contents (76800) | $127.88 | $556 | 1.1× |
| Us thyroid (76536) | $338.33 | $1,471 | 3.0× |
| Us transrectal (76872) | $315.56 | $1,372 | 2.8× |
| Vascular Flow Imaging (78445) | $377.20 | $1,640 | 0.9× |
| Vein X-Ray Chest (75827) | $722.43 | $3,141 | 0.4× |
| Vein X-Ray Liver W/O Hemodyn (75887) | $1,086.52 | $4,724 | 0.3× |
| Vein X-Ray Skull Epidural (75872) | $678.73 | $2,951 | 1.0× |
| Vein X-Ray Spleen/Liver (75810) | $1,276.04 | $5,548 | 0.4× |
| Venogram Sinus/Jugular (75860) | $780.39 | $3,393 | 0.2× |
| Venography Adrenal Unilateral (75840) | $1,106.30 | $4,810 | 0.3× |
| Venography caval inferior serialography rs&i (75825) | $997.97 | $4,339 | 0.3× |
| Venography extremity bilateral rs&i (75822) | $577.30 | $2,510 | 0.3× |
| Venography extremity unilateral rs&i (75820) | $477.25 | $2,075 | 0.3× |
| Venography Orbital Rs&I (75880) | $328.90 | $1,430 | 0.5× |
| Venography Renal Bilateral (75833) | $1,239.70 | $5,390 | 0.4× |
| Venography Renal Unilateral (75831) | $1,473.38 | $6,406 | 0.4× |
| Venous sampling by catheter (75893) unusually low: confirm this is the full procedure |
$2,542.19 | $11,053 | 0.4× |
| Venous Thrombosis Imaging Venogram Bilateral (78458) | $377.20 | $1,640 | 0.9× |
| Wrist 2 views (73100) range across 7 matching MRF lines |
$110.17–$165.37 | $479–$719 | varies |
| X-Ray Ac Jts - Xr Acromioclavicular Joints Bilateral (73050) | $141.45 | $615 | 1.5× |
| X-ray antegrade pyelogram tube (74425) | $304.52 | $1,324 | 0.8× |
| X-Ray Aorta Leg Arteries (75630) | $1,177.37 | $5,119 | 0.3× |
| X-Ray Bend Only L-S Spine (72120) | $156.86 | $682 | 1.4× |
| X-Ray Elbow 2 Vw - Xr Elbow 1-2 Views Right (73070) range across 3 matching MRF lines |
$94.76–$142.14 | $412–$618 | varies |
| X-Ray Exam Breast Specimen (76098) | $167.90 | $730 | 0.3× |
| X-Ray Exam Entire Spi 1 Vw (72081) | $80.96 | $352 | 0.9× |
| X-Ray Exam Entire Spi 2/3 Vw (72082) | $139.84 | $608 | 1.2× |
| X-Ray Exam Entire Spi 4/5 Vw (72083) | $201.25 | $875 | 1.8× |
| X-Ray Exam Hip Uni 1 View (73501) | $82.80 | $360 | 0.9× |
| X-Ray Exam Hip Uni 2-3 Views (73502) | $88.55 | $385 | 0.9× |
| X-Ray Exam Hip Uni 4/> Views (73503) | $105.57 | $459 | 0.9× |
| X-Ray Exam Hips Bi 2 Views (73521) | $115 | $500 | 1.0× |
| X-Ray Exam Hips Bi 3-4 Views (73522) | $137.08 | $596 | 1.2× |
| X-Ray Exam Hips Bi 5/> Views (73523) | $201.25 | $875 | 1.8× |
| X-Ray Exam L-S Spine Bending (72114) | $240.12 | $1,044 | 2.1× |
| X-Ray Exam Neck Spine 2-3 Vw (72040) | $142.83 | $621 | 1.5× |
| X-Ray Exam Neck Spine 6/>Vws (72052) | $265.65 | $1,155 | 2.4× |
| X-Ray Exam Unilat Ribs/Chest (71101) | $180.09 | $783 | 1.6× |
| X-ray eye for foreign body (70030) | $43.93 | $191 | 0.5× |
| X-ray humerus (73060) range across 7 matching MRF lines |
$142.83–$214.13 | $621–$931 | varies |
| X-ray IV pyelogram (ivp) (74400) | $254.84 | $1,108 | 1.4× |
| X-ray IV pyelogram+tomography (74415) | $393.30 | $1,710 | 2.1× |
| X-Ray Jaw <4 Vw - Xr Mandible < 4 Views (70100) | $54.28 | $236 | 0.6× |
| X-Ray Knee Bilat Standing - Xr Knees Anteroposterior Standing Bilat (73565) | $113.85 | $495 | 1.2× |
| X-Ray Lumbar Spine 2/3 Vw - Xr Lumbar Spine 2-3 Views (72100) | $161 | $700 | 1.4× |
| X-ray nose-rectum child f.b. (76010) | $37.95 | $165 | 0.4× |
| X-Ray Ribs, Chest 4+ Vw - Xr Ribs 3 Vws Bil W/ Chest Posteroanterior (71111) | $288.88 | $1,256 | 2.6× |
| X-Ray Sacroiliac Jts 3+ Vw - Xr Sacroiliac Joints 3+ Views (72202) | $181.24 | $788 | 1.6× |
| X-Ray Sacrum/Coccyx 2+ Vw - Xr Sacrum Coccyx 2+ Views (72220) | $159.85 | $695 | 1.7× |
| X-Ray Sinuses 3+ Vw - Xr Paranasal Sinuses 3+ Views (70220) | $172.27 | $749 | 1.8× |
| X-Ray Skull 4+ Vw - Xr Skull Complete 4+ Views (70260) | $235.98 | $1,026 | 2.1× |
| X-Ray Stress View (77071) | $70.38 | $306 | 0.8× |
| X-ray thoracic spine 4 vw (72074) | $209.76 | $912 | 1.9× |
| X-Ray Urinary Tract Exam With Contrast Material (74420) | $261.28 | $1,136 | 0.7× |
| X-Rays Bone Length Studies (77073) | $146.97 | $639 | 1.3× |
| X-Rays Bone Survey Complete (77075) | $335.80 | $1,460 | 3.0× |
| Xr c-spine 4 or 5 views (72050) | $225.17 | $979 | 2.0× |
| Xr facial bones less than 3 views (70140) | $102.81 | $447 | 1.1× |
| Xr orbits complete 4 views (70200) | $164.68 | $716 | 1.5× |
| Xr Tomogram Single Plane (76100) | $251.62 | $1,094 | 2.2× |
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.