Imaging prices at Lutheran Hospital of Indiana
Fort Wayne, IN · every code in this section with a posted price and a Medicare benchmark.
401 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) | $1,955.40 | $6,518 | 1.3× |
| Abdomen 1 View (74018) range across 6 matching MRF lines |
$12.46–$271.80 | $41.52–$906 | varies |
| Abdomen 2 views (74019) range across 5 matching MRF lines |
$15.34–$263.70 | $51.12–$879 | varies |
| Acute Gastrointestinal Blood Loss Imaging (78278) | $564 | $1,880 | 1.3× |
| Acute venous thrombosis imaging, peptide Non-Facility (78456) | $510 | $1,700 | 0.4× |
| Adrenal Cortex & Medulla Img (78075) | $932.70 | $3,109 | 0.7× |
| Angio internal mammary (75756) range across 5 matching MRF lines |
$3,121.80–$3,309 | $10,406–$11,030 | varies |
| Angio pulmonary bilat (75743) range across 7 matching MRF lines |
$4,135.50–$4,383.60 | $13,785–$14,612 | varies |
| Angiography Adrenal Bilateral Slctv Rs&I (75733) range across 3 matching MRF lines |
$2,375.40–$2,517.90 | $7,918–$8,393 | varies |
| Angiography extremity bilateral rs&i (75716) range across 10 matching MRF lines |
$204.60–$4,382.10 | $167–$14,607 | varies |
| Angiography extremity unilateral rs&i (75710) range across 12 matching MRF lines |
$1,859.70–$4,383.60 | $533–$14,612 | varies |
| Angiography pulmonary unilateral slctv rs&i (75741) range across 9 matching MRF lines |
$3,745.50–$4,135.50 | $12,485–$13,785 | varies |
| Angrph pulmonary nonslctv cath/ven njx rs&i (75746) range across 7 matching MRF lines |
$2,216.40–$2,936.40 | $7,388–$9,788 | varies |
| Ankle 2 views (73600) range across 5 matching MRF lines |
$6.60–$199.20 | $22–$664 | varies |
| Aortography thoracic serialography rs&i (75605) range across 7 matching MRF lines |
$5,482.50–$7,263.30 | $544–$24,211 | varies |
| Artery X-Rays Abdomen (75726) range across 5 matching MRF lines |
$6,646.20–$8,361.90 | $22,154–$27,873 | varies |
| Artery X-Rays Adrenal Gland (75731) range across 6 matching MRF lines |
$2,726.40–$2,889.90 | $9,088–$9,633 | varies |
| Artery X-Rays Pelvis (75736) range across 6 matching MRF lines |
$5,482.50–$7,263.30 | $18,275–$24,211 | varies |
| Artery X-Rays Spine (75705) range across 3 matching MRF lines |
$6,852.30–$7,263.30 | $22,841–$24,211 | varies |
| Arthrogram hip (73525) | $772.20 | $2,574 | 2.1× |
| Arthrogram Wrist (73115) | $263.70 | $879 | 0.7× |
| Basic radiation dosimetry calculation (77300) | $235.50 | $785 | 1.7× |
| Bone age studies (77072) range across 2 matching MRF lines |
$141.30–$156 | $471–$520 | varies |
| Bone Imaging 3 Phase (78315) | $1,474.80 | $4,916 | 3.5× |
| Bone Imaging Limited Area (78300) | $1,449 | $4,830 | 3.4× |
| Bone Imaging Multiple Areas (78305) | $731.40 | $2,438 | 1.7× |
| Bone Imaging Whole Body (78306) range across 2 matching MRF lines |
$70.11–$1,344.30 | $233.71–$4,481 | varies |
| Bone marrow imaging limited area (78102) | $990 | $3,300 | 2.3× |
| Bone marrow imaging; multiple areas (78103) | $237 | $790 | 0.6× |
| Bone marrow imaging; whole body (78104) | $1,395 | $4,650 | 3.3× |
| Bone survey infant (77076) | $355.80 | $1,186 | 3.2× |
| Brachytx isodose complex (77318) | $1,074.60 | $3,582 | 2.7× |
| Brachytx isodose intermed (77317) | $891.60 | $2,972 | 2.3× |
| Brachytx Isodose Plan Simple (77316) | $707.70 | $2,359 | 1.8× |
| Brain Image W/Flow < 4 Views (78601) | $1,015.80 | $3,386 | 2.4× |
| Brain Imaging Min 4 Static Views W Vascular Flow (78606) | $867.30 | $2,891 | 1.5× |
| Brain Imaging Pet Metabolic Evaluation (78608) | $4,967.10 | $16,557 | 3.3× |
| Card Bl Pool Gated Spect Rest Wal Motn Ejct Frct (78494) | $1,084.80 | $3,616 | 2.6× |
| Cardiac MRI w/w/o contrast & further seq (75561) range across 3 matching MRF lines |
$100.50–$1,245.30 | $335–$4,151 | varies |
| Cardiac MRI w/w/o contrast w/stress (75563) range across 3 matching MRF lines |
$115.50–$521.70 | $385–$1,739 | varies |
| Cardiac Shunt Detection (78428) | $471.30 | $1,571 | 1.1× |
| Cat Scan Follow-Up Study (76380) | $356.10 | $1,187 | 3.9× |
| Cerebrospinal Fluid Flow W/O Matl Shunt Evaltj (78645) | $700.80 | $2,336 | 1.2× |
| Cerebrospinal Fluid Scan (78630) | $2,000.10 | $6,667 | 3.5× |
| Chest 1 view (71045) range across 13 matching MRF lines |
$6.60–$173.40 | $22–$578 | varies |
| Chest 2 views (71046) range across 12 matching MRF lines |
$12–$269.40 | $40–$898 | varies |
| Chest 3 views (71047) | $327.90 | $1,093 | 3.6× |
| Chest 4 or more views (71048) | $379.50 | $1,265 | 3.4× |
| Cineradiograpy/vidradiograpy xcpt where spec (76120) | $15.60 | $52 | 0.1× |
| Clavicle complete (73000) range across 7 matching MRF lines |
$6.90–$246.60 | $23–$822 | varies |
| Computed Tomography Thorax Lw Dose Lng Ca Scr C- (71271) | $194.70 | $649 | 1.8× |
| Continuing medical physics consltj pr wk (77336) | $280.20 | $934 | 2.0× |
| Contrast Exam Abdominl Aorta (75625) range across 6 matching MRF lines |
$163.20–$4,382.10 | $544–$14,607 | varies |
| Contrast X-Ray Bladder (74430) range across 7 matching MRF lines |
$42–$483.30 | $140–$1,611 | varies |
| Contrast X-Ray Of Elbow (73085) | $213 | $710 | 0.6× |
| CT abdomen and pelvis without and with contrast (74178) range across 8 matching MRF lines |
$1,296–$3,113.10 | $4,320–$10,377 | varies |
| CT abdomen and pelvis without contrast (74176) range across 7 matching MRF lines |
$636.90–$2,285.70 | $2,123–$7,619 | varies |
| CT abdomen w contrast (74160) range across 6 matching MRF lines |
$492.60–$1,454.10 | $1,642–$4,847 | varies |
| CT abdomen w wo contrast (74170) range across 4 matching MRF lines |
$647.70–$1,662.30 | $2,159–$5,541 | varies |
| CT abdomen w/o contrast (74150) range across 2 matching MRF lines |
$362.70–$1,246.80 | $1,209–$4,156 | varies |
| CT Angio Abdomen and Pelvis (74174) range across 4 matching MRF lines |
$699.60–$2,513.40 | $2,332–$8,378 | varies |
| CT Angio Chest (71275) range across 5 matching MRF lines |
$700.80–$1,201.50 | $2,336–$4,005 | varies |
| CT Angio Head (70496) range across 3 matching MRF lines |
$700.80–$1,158.60 | $2,336–$3,862 | varies |
| CT angio hrt w/3d image (75574) range across 5 matching MRF lines |
$87–$742.50 | $290–$2,475 | varies |
| Ct Angio Lwr Extr W/O&W/Dye (73706) | $1,156.50 | $3,855 | 6.2× |
| CT Angio Neck (70498) range across 4 matching MRF lines |
$588.30–$1,158.60 | $1,961–$3,862 | varies |
| Ct Angio Upr Extrm W/O&W/Dye (73206) | $1,114.20 | $3,714 | 6.0× |
| CT cervical spine w/ contrast (72126) | $1,352.70 | $4,509 | 3.7× |
| CT cervical spine w/o contrast (72125) range across 3 matching MRF lines |
$362.70–$1,352.70 | $1,209–$4,509 | varies |
| CT cervical spine w/wo cont (72127) | $1,610.40 | $5,368 | 8.7× |
| CT chest w contrast (71260) range across 6 matching MRF lines |
$52.34–$987.60 | $174.48–$3,292 | varies |
| CT chest w/wo contrast (71270) range across 2 matching MRF lines |
$621.60–$1,403.40 | $2,072–$4,678 | varies |
| CT colonography screening (74263) | $541.50 | $1,805 | 2.1× |
| CT Colonogrphy Dx Image Postprocess W/Contrast (74262) | $685.50 | $2,285 | 3.7× |
| CT colonogrphy dx image postprocess w/o contrast (74261) | $639 | $2,130 | 5.8× |
| CT head/brain with contrast (70460) range across 3 matching MRF lines |
$52.34–$1,038.60 | $174.48–$3,462 | varies |
| CT head/brain without and with contrast (70470) range across 3 matching MRF lines |
$52.34–$1,246.80 | $174.48–$4,156 | varies |
| CT heart contrast eval cardiac structure&morph (75572) range across 3 matching MRF lines |
$68.10–$742.50 | $227–$2,475 | varies |
| CT heart no contrast quant eval coronry calcium (75571) range across 6 matching MRF lines |
$16.80–$186.90 | $56–$623 | varies |
| CT hrt w/3d image congen (75573) range across 3 matching MRF lines |
$98.10–$742.50 | $327–$2,475 | varies |
| CT iac w contrast (70481) range across 8 matching MRF lines |
$492.60–$1,316.10 | $1,642–$4,387 | varies |
| CT l-spine w&w/o contrast (72133) | $1,610.40 | $5,368 | 8.7× |
| CT lower ext w/o (73700) range across 24 matching MRF lines |
$362.70–$846.90 | $1,209–$2,823 | varies |
| CT lower extremity w/contrast material (73701) range across 24 matching MRF lines |
$492.60–$862.20 | $1,642–$2,874 | varies |
| CT lumbar spine w contrast (72132) range across 2 matching MRF lines |
$483.30–$962.70 | $1,611–$3,209 | varies |
| CT lumbar spine w/o contrast (72131) range across 2 matching MRF lines |
$362.70–$1,418.40 | $1,209–$4,728 | varies |
| CT maxillofacial w contrast (70487) range across 4 matching MRF lines |
$492.60–$1,141.80 | $1,642–$3,806 | varies |
| CT maxillofacial wo contrast (70486) range across 4 matching MRF lines |
$492.60–$817.50 | $1,642–$2,725 | varies |
| CT neck tissue combo (70492) range across 2 matching MRF lines |
$621.60–$1,172.10 | $2,072–$3,907 | varies |
| Ct Orbit/Ear/Fossa W/O&W/Dye (70482) range across 8 matching MRF lines |
$621.60–$1,359 | $2,072–$4,530 | varies |
| CT orbits w/o contrast (70480) range across 8 matching MRF lines |
$362.70–$1,049.10 | $1,209–$3,497 | varies |
| CT pelvis w&w/o contrast (72194) range across 4 matching MRF lines |
$621.60–$1,552.20 | $2,072–$5,174 | varies |
| CT pelvis w/o contrast (72192) range across 4 matching MRF lines |
$362.70–$1,035.30 | $1,209–$3,451 | varies |
| CT scan of leg combo (73702) | $621.60 | $2,072 | 3.3× |
| CT scans face/jaw combo (70488) range across 4 matching MRF lines |
$621.60–$1,251 | $2,072–$4,170 | varies |
| CT soft tissue neck w contrast (70491) range across 3 matching MRF lines |
$52.34–$1,218.60 | $174.48–$4,062 | varies |
| CT soft tissue neck w/o contrast (70490) range across 2 matching MRF lines |
$362.70–$1,218.60 | $1,209–$4,062 | varies |
| CT thoracic spine w contrast (72129) range across 2 matching MRF lines |
$492.60–$1,091.10 | $1,642–$3,637 | varies |
| CT thoracic spine w/o contrast (72128) range across 2 matching MRF lines |
$362.70–$1,179.60 | $1,209–$3,932 | varies |
| CT thoracic spine w/wo cont (72130) | $1,400.10 | $4,667 | 7.5× |
| CT thorax w/o contrast (71250) range across 5 matching MRF lines |
$335.70–$1,349.40 | $1,119–$4,498 | varies |
| CT upper ext wo (73200) range across 24 matching MRF lines |
$362.70–$934.80 | $1,209–$3,116 | varies |
| CT upper extremity w/o & w/contrast material (73202) | $621.60 | $2,072 | 3.3× |
| CT upper extremity with contrast (73201) range across 24 matching MRF lines |
$492.60–$679.20 | $1,642–$2,264 | varies |
| Cta Abdl Aorta&Bi Iliofem W/Contrast&Postp (75635) range across 2 matching MRF lines |
$700.80–$2,638.20 | $2,336–$8,794 | varies |
| Cta Abdomen (74175) range across 2 matching MRF lines |
$699.60–$1,388.40 | $2,332–$4,628 | varies |
| CTA pelvis (72191) | $1,124.70 | $3,749 | 6.1× |
| Dilation ureters/urethra rs&i (74485) range across 6 matching MRF lines |
$2,723.70–$2,887.20 | $9,079–$9,624 | varies |
| Diskography lumbar (72295) range across 4 matching MRF lines |
$2,979.30–$3,158.10 | $9,931–$10,527 | varies |
| Doppler Echo Fetal Puls Spectral F/U/Repeat (76828) | $342.30 | $1,141 | 3.1× |
| Dxa Bone Density Axial (77080) range across 3 matching MRF lines |
$11.10–$141.30 | $37–$471 | varies |
| Dxa bone density study (77085) | $189.30 | $631 | 1.7× |
| Dxa bone density study 1/>sites appendiclr skel (77081) range across 3 matching MRF lines |
$11.10–$78.30 | $37–$261 | varies |
| Echo exam of fetal heart (76825) | $1,148.10 | $3,827 | 2.0× |
| Echo exam uterus (76831) range across 4 matching MRF lines |
$63.30–$289.20 | $211–$964 | varies |
| Esophageal Motility Study (78258) | $847.50 | $2,825 | 2.0× |
| Esophagram (74220) range across 4 matching MRF lines |
$259.50–$519 | $865–$1,730 | varies |
| Fetal Biophys Profile W/Nst (76818) range across 6 matching MRF lines |
$42.60–$584.40 | $142–$1,948 | varies |
| Fetal Biophysical Profile W/O Non-Stress Testing (76819) range across 4 matching MRF lines |
$36.90–$129.30 | $123–$431 | varies |
| Fluoroscopy up to 1 hr (76000) range across 14 matching MRF lines |
$59.10–$736.80 | $20–$2,456 | varies |
| Follow-Up Angiography (75898) range across 8 matching MRF lines |
$1,071.30–$1,814.10 | $219–$6,047 | varies |
| Foot 2 views (73620) range across 6 matching MRF lines |
$19.50–$255 | $65–$850 | varies |
| Forearm 2 views (73090) range across 7 matching MRF lines |
$6.60–$198.30 | $22–$661 | varies |
| Gastric emptying imaging study (78264) | $1,040.70 | $3,469 | 2.5× |
| Gastroesophageal Reflux Exam (78262) | $899.10 | $2,997 | 2.1× |
| Gated Heart Planar Single (78472) range across 4 matching MRF lines |
$33–$1,214.10 | $110–$4,047 | varies |
| Gated Heart, Multiple (78473) | $2,512.20 | $8,374 | 5.9× |
| Hand 2 views (73120) range across 6 matching MRF lines |
$13.70–$199.20 | $45.66–$664 | varies |
| Hdr Rdncl Ntrstl/Icav Brchtx (77772) | $3,556.20 | $11,854 | 4.8× |
| Hdr Rdncl Ntrstl/Icav Brchtx (77771) | $2,194.20 | $7,314 | 3.0× |
| Hdr Rdncl Ntrstl/Icav Brchtx 1 Channel (77770) | $1,013.40 | $3,378 | 1.4× |
| Heart first pass single,planar (78481) | $1,971.90 | $6,573 | 3.4× |
| Heart Image (Pet) Multiple (78492) | $3,451.20 | $11,504 | 2.3× |
| Hepatc Vngrph Wdg/Fr Hemodyn Eval Rs&I (75889) range across 3 matching MRF lines |
$3,121.80–$3,309 | $10,406–$11,030 | varies |
| Hepatc Vngrph Wdg/Fr W/O Hemodyn Eval Rs&I (75891) range across 3 matching MRF lines |
$2,305.20–$2,443.50 | $7,684–$8,145 | varies |
| Hepatobil Syst Image W/Drug (78227) | $1,283.40 | $4,278 | 2.2× |
| Hepatobiliary System Imaging (78226) | $1,123.80 | $3,746 | 2.7× |
| Ht Musc Image Planar Mult (78454) | $51.90 | $173 | 0.0× |
| Ht Muscle Image Spect Sing (78451) range across 7 matching MRF lines |
$261.60–$2,329.50 | $164–$7,765 | varies |
| Hysterosalpingogram (74740) | $289.20 | $964 | 1.1× |
| Infant hip ultrasound with hip movement (dynamic) (76885) range across 3 matching MRF lines |
$100.20–$203.10 | $334–$677 | varies |
| Infant hip ultrasound, limited static exam (76886) | $73.50 | $245 | 0.8× |
| Interstitial radiation source applic complex (77778) | $3,604.80 | $12,016 | 4.9× |
| Intracavitary Radiation Source Applic Complex (77763) | $745.80 | $2,486 | 1.0× |
| Intracavitary Radiation Source Applic Intermed (77762) | $751.80 | $2,506 | 1.3× |
| Intracavitary radiation source applic simple (77761) | $751.80 | $2,506 | 1.3× |
| Intraop radiaj tx deliver xray single tx session (77424) | $4,504.80 | $15,016 | 0.6× |
| Joint Survey Single View (77077) range across 5 matching MRF lines |
$29.10–$195.90 | $97–$653 | varies |
| K Flow/Funct Image Multiple (78709) | $1,805.40 | $6,018 | 3.1× |
| K Flow/Funct Image W/Drug (78708) | $1,043.10 | $3,477 | 1.8× |
| K Flow/Funct Image W/O Drug (78707) | $1,000.80 | $3,336 | 1.7× |
| Kidney Imaging Morphol (78700) | $495 | $1,650 | 1.2× |
| Knee 3 Views (73562) range across 9 matching MRF lines |
$7.80–$260.40 | $26–$868 | varies |
| Leveen/Shunt Patency Exam (78291) | $501 | $1,670 | 1.2× |
| Liver & Spleen Imaging Static Only (78215) | $1,032 | $3,440 | 2.4× |
| Liver & Spleen Imaging W/Vascular Flow (78216) | $700.80 | $2,336 | 1.7× |
| Liver imaging static only (78201) | $1,540.20 | $5,134 | 2.7× |
| Lung Perf&Ventilat Diferentl (78598) | $2,328.90 | $7,763 | 4.1× |
| Lung Ventilat&Perfus Imaging (78582) | $1,603.80 | $5,346 | 2.8× |
| Lung Ventilation Imaging (78579) | $1,319.70 | $4,399 | 3.1× |
| Lymph System Imaging (78195) range across 2 matching MRF lines |
$45.90–$954 | $153–$3,180 | varies |
| Lymphangiography Extremity Only Bilateral Rs&I (75803) range across 4 matching MRF lines |
$2,237.70–$2,372.10 | $7,459–$7,907 | varies |
| Lymphangiography extremity only unilateral rs&i (75801) range across 4 matching MRF lines |
$862.20–$913.80 | $2,874–$3,046 | varies |
| Lymphangiography Pelvic/Abdominal Bilateral Rs&I (75807) range across 3 matching MRF lines |
$4,554–$4,827.30 | $15,180–$16,091 | varies |
| Lymphangiography, pelvic/abdominal, unilateral (75805) range across 4 matching MRF lines |
$4,554–$4,827.30 | $15,180–$16,091 | varies |
| Magnetic Image Jaw Joint (70336) | $569.40 | $1,898 | 2.3× |
| Mammary ductogram or galactogram multiple (77054) | $278.70 | $929 | 1.1× |
| Mammary ductogram or galactogram single (77053) | $289.20 | $964 | 1.1× |
| Meckels Divert Exam (78290) | $831.60 | $2,772 | 2.0× |
| Mlc imrt design & construction per imrt plan (77338) | $1,462.50 | $4,875 | 3.7× |
| Mra Head W/O & W/Contrast Material (70546) | $1,309.80 | $4,366 | 3.5× |
| MRA head w/o contrast (70544) range across 4 matching MRF lines |
$569.40–$842.10 | $1,898–$2,807 | varies |
| MRA head with contrast (70545) | $742.80 | $2,476 | 2.0× |
| MRA neck w contrast (70548) | $1,122.90 | $3,743 | 3.0× |
| Mra Neck W/O &W/Contrast Material (70549) range across 2 matching MRF lines |
$960.60–$1,309.80 | $3,202–$4,366 | varies |
| MRA neck w/o contrast (70547) range across 2 matching MRF lines |
$569.40–$842.10 | $1,898–$2,807 | varies |
| MRI abdomen w contrast (74182) | $842.10 | $2,807 | 2.3× |
| MRI abdomen w/o contrast (74181) range across 4 matching MRF lines |
$569.40–$894.90 | $1,898–$2,983 | varies |
| MRI any jt lower extrem w/contrast material (73722) range across 10 matching MRF lines |
$866.70–$1,195.50 | $2,889–$3,985 | varies |
| MRI any jt lower extrem w/o & w/contrast matrl (73723) range across 12 matching MRF lines |
$960.60–$1,791.90 | $3,202–$5,973 | varies |
| MRI any jt upper extremity w/contrast matrl (73222) range across 12 matching MRF lines |
$866.70–$1,268.10 | $2,889–$4,227 | varies |
| MRI Breast W/O Contrast Bilateral (77047) | $664.20 | $2,214 | 2.6× |
| MRI Breast Without Contrast Material Unilateral (77046) | $777.60 | $2,592 | 3.1× |
| MRI cardiac w/o cont stress (75559) range across 2 matching MRF lines |
$112.20–$1,122.90 | $374–$3,743 | varies |
| MRI cardiac w/o contrast (75557) range across 3 matching MRF lines |
$85.20–$1,124.40 | $284–$3,748 | varies |
| MRI cervical spine w contrast (72142) | $842.10 | $2,807 | 2.3× |
| MRI cervical spine w/o cont (72141) range across 5 matching MRF lines |
$324.90–$1,309.80 | $1,083–$4,366 | varies |
| MRI chest w/o contrast (71550) range across 4 matching MRF lines |
$569.40–$842.10 | $1,898–$2,807 | varies |
| MRI chest with contrast (71551) | $842.10 | $2,807 | 1.0× |
| MRI chest wo w contrast (71552) range across 4 matching MRF lines |
$960.60–$1,309.80 | $3,202–$4,366 | varies |
| MRI lower extrem oth/thn jt w/contrast matrl (73719) | $1,195.50 | $3,985 | 3.2× |
| MRI lower extrem oth/thn jt w/o & w/contr matr (73720) range across 12 matching MRF lines |
$960.60–$1,791.90 | $3,202–$5,973 | varies |
| MRI lower extrem oth/thn jt w/o contr matrl (73718) range across 12 matching MRF lines |
$569.40–$1,129.50 | $1,898–$3,765 | varies |
| MRI lumbar spine w contrast (72149) range across 2 matching MRF lines |
$742.80–$842.10 | $2,476–$2,807 | varies |
| Mri Neck Spine W/O & W/Dye (72156) range across 3 matching MRF lines |
$960.60–$1,247.70 | $3,202–$4,159 | varies |
| MRI orbit face &/neck w/o contrast (70540) | $842.10 | $2,807 | 3.3× |
| MRI orbit face neck w contrast (70542) | $842.10 | $2,807 | 2.3× |
| Mri Orbt/Fac/Nck W/O &W/Dye (70543) range across 14 matching MRF lines |
$842.10–$960.30 | $2,807–$3,201 | varies |
| MRI pelvis w contrast (72196) | $680.40 | $2,268 | 1.8× |
| MRI pelvis w/o & w contrast (72197) range across 6 matching MRF lines |
$106.94–$1,415.10 | $356.45–$4,717 | varies |
| MRI pelvis w/o contrast (72195) range across 2 matching MRF lines |
$569.40–$842.10 | $1,898–$2,807 | varies |
| MRI spectroscopy (76390) | $414.30 | $1,381 | 4.5× |
| MRI thoracic spine w/o contrast (72146) range across 6 matching MRF lines |
$192.90–$904.50 | $643–$3,015 | varies |
| MRI upper extremity oth than jt w/contr matrl (73219) | $1,335.90 | $4,453 | 3.6× |
| MRI upper extremity oth than jt w/o contr matrl (73218) range across 14 matching MRF lines |
$569.40–$1,336.20 | $1,898–$4,454 | varies |
| Mri Uppr Extremity W/O&W/Dye (73220) range across 13 matching MRF lines |
$960.60–$1,358.70 | $3,202–$4,529 | varies |
| MRI, abdomen, combo (74183) range across 5 matching MRF lines |
$960.60–$1,244.70 | $3,202–$4,149 | varies |
| MRI, dorsal spine combo (72157) range across 3 matching MRF lines |
$960.60–$1,247.70 | $3,202–$4,159 | varies |
| MRI, dorsal spine contrast (72147) range across 2 matching MRF lines |
$742.80–$922.50 | $2,476–$3,075 | varies |
| MRI, joint upper extrem (73221) range across 12 matching MRF lines |
$569.40–$1,361.70 | $1,898–$4,539 | varies |
| MRI, joint upper extrem combo (73223) range across 10 matching MRF lines |
$960.60–$1,361.70 | $3,202–$4,539 | varies |
| MRI, lumbar spine combo (72158) range across 3 matching MRF lines |
$960.60–$1,758.30 | $3,202–$5,861 | varies |
| Myocardial Imaging Infarct Avid Planar Qual/Quan (78466) range across 3 matching MRF lines |
$27.30–$865.20 | $91–$2,884 | varies |
| Myocardial Imaging Pet Metabolic Evaluation (78459) | $4,713 | $15,710 | 3.4× |
| Myocardial Perfusion Planar 1 Study Rest/Stress (78453) | $38.40 | $128 | 0.0× |
| Myocardial Spect Multiple Studies (78452) range across 9 matching MRF lines |
$361.80–$3,582.90 | $180–$11,943 | varies |
| N-invas est c ffr sw aly CTA (75580) range across 2 matching MRF lines |
$1,713.60–$1,816.50 | $5,712–$6,055 | varies |
| Neck soft tissue (70360) range across 7 matching MRF lines |
$6.60–$236.40 | $22–$788 | varies |
| Nfs/Instlj Radioelmnt Sln 3 Mo Follow-Up Care (77750) | $377.40 | $1,258 | 0.9× |
| Njx Rp Loclzj Non-Img Probe Study Intravenous (78808) | $442.80 | $1,476 | 1.0× |
| Nm csf leak detection (78650) | $907.50 | $3,025 | 0.7× |
| Nonvascular Shunt X-Ray (75809) | $217.80 | $726 | 2.0× |
| Ntsty modul radthx pln dose-vol histos (77301) | $9,039.30 | $30,131 | 6.2× |
| Nuclear Rx Intra-Arterial (79445) range across 6 matching MRF lines |
$337.50–$357.90 | $1,125–$1,193 | varies |
| Nuclear Rx Oral Admin (79005) range across 2 matching MRF lines |
$68.40–$1,291.80 | $228–$4,306 | varies |
| Ob us nuchal meas 1 gest (76813) range across 2 matching MRF lines |
$92.10–$129.90 | $307–$433 | varies |
| Oph bmtry us echograpy a-scan io lens pwr cal (76519) | $24.30 | $81 | 0.2× |
| Ophthalmic ultrasound dx b-scan w/wo a-scan (76512) | $70.80 | $236 | 0.6× |
| Ophthalmic US Dx Corneal Pachymetry Uni/Bi (76514) | $11.70 | $39 | 0.4× |
| Panoramic X-ray of jaws (70355) range across 2 matching MRF lines |
$216.90–$302.10 | $723–$1,007 | varies |
| Parathyroid Planar Imaging (78070) | $729.30 | $2,431 | 1.7× |
| Pelvis 1 or 2 views (72170) range across 6 matching MRF lines |
$7.20–$242.70 | $24–$809 | varies |
| PET image w/CT, full body (78816) | $4,835.10 | $16,117 | 3.2× |
| PET imaging CT attenuation skull base mid-thigh (78815) range across 11 matching MRF lines |
$4,556.40–$4,829.70 | $15,188–$16,099 | varies |
| Pet Myocardial Sngl Study (78491) | $2,690.10 | $8,967 | 1.8× |
| Prq Transhepatc Portograpy Hemodyn Eval Rs&I (75885) range across 3 matching MRF lines |
$2,165.40–$2,295.30 | $7,218–$7,651 | varies |
| Pulmonary Perfusion Imaging Particulate (78580) | $564 | $1,880 | 1.3× |
| Radex Abd Compl Aqt Abd W/S/E/D Views 1 View Ch (74022) range across 4 matching MRF lines |
$12.60–$570 | $42–$1,900 | varies |
| Radex abscess/fistula/sinus tract rs&i (76080) range across 9 matching MRF lines |
$417.90–$623.40 | $1,393–$2,078 | varies |
| Radex Ankle Complete Minimum 3 Views (73610) range across 7 matching MRF lines |
$7.20–$207.90 | $24–$693 | varies |
| Radex Calcaneus Minimum 2 Views (73650) range across 5 matching MRF lines |
$6.30–$234 | $21–$780 | varies |
| Radex elbow complete minimum 3 views (73080) range across 7 matching MRF lines |
$7.20–$207.90 | $24–$693 | varies |
| Radex Facial Bones Complete Minimum 3 Views (70150) range across 9 matching MRF lines |
$10.50–$332.40 | $35–$1,108 | varies |
| Radex fingr minimum 2 views (73140) range across 29 matching MRF lines |
$5.70–$173.70 | $19–$579 | varies |
| Radex foot complete minimum 3 views (73630) range across 7 matching MRF lines |
$6.60–$240.60 | $22–$802 | varies |
| Radex Hand Minimum 3 Views (73130) range across 7 matching MRF lines |
$6.90–$216.90 | $23–$723 | varies |
| Radex lower extremity infant minimum 2 views (73592) range across 4 matching MRF lines |
$21.60–$223.80 | $72–$746 | varies |
| Radex Nasal Bones Complete Minimum 3 Views (70160) range across 6 matching MRF lines |
$6.90–$237.60 | $23–$792 | varies |
| Radex Pharynx/Larx W/Fluor&/Magnification Tq (70370) | $547.20 | $1,824 | 5.9× |
| Radex Ribs Unilateral 2 Views (71100) range across 9 matching MRF lines |
$9–$336.90 | $30–$1,123 | varies |
| Radex shoulder complete minimum 2 views (73030) range across 8 matching MRF lines |
$7.80–$302.40 | $26–$1,008 | varies |
| Radex Sinuses Paransl < 3 Views (70210) range across 8 matching MRF lines |
$6.90–$215.10 | $23–$717 | varies |
| Radex sm int w/mlt srl imges via enteroclss tube (74251) range across 2 matching MRF lines |
$287.10–$304.20 | $957–$1,014 | varies |
| Radex Spine 1 View Specify Level (72020) range across 15 matching MRF lines |
$6.30–$208.50 | $21–$695 | varies |
| Radex Sternum Minimum 2 Views (71120) range across 4 matching MRF lines |
$8.10–$260.40 | $27–$868 | varies |
| Radex Temporomandble Jt Opn & Clsd Mouth Bilat (70330) range across 2 matching MRF lines |
$25.01–$308.70 | $83.38–$1,029 | varies |
| Radex Toe Minimum 2 Views (73660) range across 22 matching MRF lines |
$5.40–$173.70 | $18–$579 | varies |
| Radex upper extremity infant minimum 2 views (73092) | $152.70 | $509 | 1.4× |
| Radex Wrist Complete Minimum 3 Views (73110) range across 13 matching MRF lines |
$7.20–$216.90 | $24–$723 | varies |
| Radex X-Ray Exam Entire Spi 6/> Vw - Xr Entire Spine 6+ Vw (72084) range across 2 matching MRF lines |
$46.42–$456 | $154.74–$1,520 | varies |
| Radiation Delivery Stereotactic Cranial Linear (77372) likely a partial charge, not the full procedure |
$1,085.40 | $3,618 | 0.1× |
| Radiation treatment delivery level 1 (77402) | $875.70 | $2,919 | 8.1× |
| Radiation treatment delivery level 2 (77407) | $40.20 | $134 | 0.1× |
| Radiation treatment delivery level 3 (77412) | $1,309.80 | $4,366 | 2.2× |
| Radiolog exam mandible compl minimum 4 views (70110) range across 4 matching MRF lines |
$9.90–$158.10 | $33–$527 | varies |
| Radiologic Exam Abdomen 3+ Views - Xr Abdomen 3+ Views (74021) range across 6 matching MRF lines |
$96.90–$523.20 | $323–$1,744 | varies |
| Radiologic exam colon single contrast study (74270) | $581.10 | $1,937 | 3.1× |
| Radiologic Exam Esophagus Double Contrast Study (74221) | $519 | $1,730 | 2.8× |
| Radiologic exam knee complete 4/more views (73564) range across 16 matching MRF lines |
$9.30–$156 | $31–$520 | varies |
| Radiologic exam pelvis compl minimum 3 views (72190) range across 6 matching MRF lines |
$8.70–$329.10 | $29–$1,097 | varies |
| Radiologic Exam Small Int Single Contrast Study (74250) range across 5 matching MRF lines |
$77.40–$646.80 | $258–$2,156 | varies |
| Radiologic exam swallow function contrast study (74230) | $297 | $990 | 1.6× |
| Radiologic exam upr gi trc double contrast study (74246) range across 4 matching MRF lines |
$804.90–$853.20 | $2,683–$2,844 | varies |
| Radiologic examination femur 1 view (73551) | $128.40 | $428 | 1.4× |
| Radiologic examination femur minimum 2 views (73552) range across 4 matching MRF lines |
$96.90–$120 | $323–$400 | varies |
| Radiologic examination knee 1/2 views (73560) range across 8 matching MRF lines |
$7.50–$216.90 | $25–$723 | varies |
| Radiologic Examination Osseous Survey Limited (77074) | $137.40 | $458 | 1.2× |
| Radiologic examination tibia & fibula 2 views (73590) range across 6 matching MRF lines |
$6.90–$260.40 | $23–$868 | varies |
| Radiopharmaceutical therapy, by intracavitary administration Non-Facility (79200) | $1,239.90 | $4,133 | 5.0× |
| Remote afterloading high dose rate radionuclide skin surface brachytherapy, includes basic dosimetry, when performed;… (77768) | $377.40 | $1,258 | 0.9× |
| Remote afterloading high dose rate radionuclide skin surface brachytherapy, includes basic dosimetry, when performed;… (77767) | $377.40 | $1,258 | 0.9× |
| Ribs bilateral 3 views (71110) range across 6 matching MRF lines |
$10.80–$346.80 | $36–$1,156 | varies |
| Rp loclzj tum plnr 1 area single day imaging (78800) range across 7 matching MRF lines |
$25.80–$1,337.40 | $86–$4,458 | varies |
| Rp loclzj tum plnr 2+area 1+d img/1 area img>2+d (78801) range across 2 matching MRF lines |
$509.40–$540 | $1,698–$1,800 | varies |
| Rp Loclzj Tum Plnr Whole Body 2+ Days Imaging (78804) range across 3 matching MRF lines |
$2,994.60–$3,174.30 | $9,982–$10,581 | varies |
| Rp Loclzj Tum Plnr Whole Body Single Day Imaging (78802) range across 6 matching MRF lines |
$1,484.40–$1,573.50 | $4,948–$5,245 | varies |
| Rp Loclzj Tum Spect 1 Area Single Day Imaging (78803) range across 20 matching MRF lines |
$38.70–$1,517.40 | $129–$5,058 | varies |
| Rp loclzj tum spect 2 area/sep acquisj img (78831) range across 2 matching MRF lines |
$1,760.10–$1,865.70 | $5,867–$6,219 | varies |
| Rp Ther Radiolbld Monoclonal Antibody IV Infus (79403) | $7,943.10 | $26,477 | 32.2× |
| Rp Therapy Intravenous Administration (79101) | $331.80 | $1,106 | 1.3× |
| Salivary Gland Function Study (78232) | $100.20 | $334 | 0.2× |
| Scapula (73010) range across 10 matching MRF lines |
$8.75–$316.50 | $29.16–$1,055 | varies |
| Screening Digital Breast Tomosynthesis Bi (77063) range across 12 matching MRF lines |
$20.10–$162 | $67–$540 | varies |
| Shoulder 1 view (73020) range across 4 matching MRF lines |
$8.33–$279.30 | $27.78–$931 | varies |
| Shoulder Arthrography (73040) range across 4 matching MRF lines |
$555.30–$675.30 | $1,851–$2,251 | varies |
| Skull less than 4 views (70250) range across 6 matching MRF lines |
$9.90–$153.60 | $33–$512 | varies |
| Special dosimetry (77331) | $235.50 | $785 | 1.7× |
| Special Physics Consult (77370) | $623.70 | $2,079 | 4.4× |
| Special teletherapy port plan (77321) | $594.90 | $1,983 | 1.5× |
| Special treatment procedure (77470) | $707.70 | $2,359 | 1.2× |
| Stereotactic Body Radiation Delivery (77373) | $2,118.30 | $7,061 | 1.1× |
| Sternoclavicular joints (71130) range across 5 matching MRF lines |
$9–$225 | $30–$750 | varies |
| Superior sagittal sinus venogram (75870) range across 3 matching MRF lines |
$2,018.40–$2,139.60 | $6,728–$7,132 | varies |
| Telethx isodose pln cplx w/basic dosimetry (77307) | $1,203.60 | $4,012 | 3.0× |
| Telethx isodose pln smpl w/dosimetry calculation (77306) | $870.90 | $2,903 | 2.2× |
| Testicular Imaging W/Flow (78761) | $1,071.90 | $3,573 | 2.5× |
| Ther Rad Simulaj-Aided Field Setting Complex (77290) | $2,424.30 | $8,081 | 6.1× |
| Ther Rad Simulaj-Aided Field Setting Intermed (77285) | $1,369.50 | $4,565 | 3.5× |
| Ther rad simulaj-aided field setting simple (77280) | $825.90 | $2,753 | 5.8× |
| Therapeutic Enema Rdctj Intussusception/Obstrcj (74283) | $599.40 | $1,998 | 3.2× |
| Thoracic spine 2 views (72070) range across 6 matching MRF lines |
$9–$270.30 | $30–$901 | varies |
| Thoracic spine 3 views (72072) range across 6 matching MRF lines |
$8.70–$355.80 | $29–$1,186 | varies |
| Thoracolumbar 2 views (72080) range across 7 matching MRF lines |
$9.30–$261.60 | $31–$872 | varies |
| Thyroid Imaging With Vascular Flow (78013) | $474.60 | $1,582 | 1.1× |
| Thyroid Met Imaging Body (78018) | $954 | $3,180 | 1.7× |
| Thyroid Uptake Measurement (78012) | $286.20 | $954 | 0.7× |
| Thyroid Uptake W/Blood Flow Sngle/Mult Quan Meas (78014) | $899.10 | $2,997 | 2.1× |
| Tx Devices Design & Construction Complex (77334) | $492.90 | $1,643 | 1.2× |
| Tx devices design & construction intermediate (77333) | $440.70 | $1,469 | 3.1× |
| Tx devices design & construction simple (77332) | $440.40 | $1,468 | 3.1× |
| Ultrasound Breast Limited (76642) range across 8 matching MRF lines |
$24.90–$270.60 | $83–$902 | varies |
| Ultrasound Elastography Parenchyma (76981) range across 2 matching MRF lines |
$638.40–$676.80 | $2,128–$2,256 | varies |
| Ultrasound Exam Aaa Screen (76706) range across 2 matching MRF lines |
$130.50–$154.20 | $435–$514 | varies |
| Ultrasound, abdomen limited (76705) range across 23 matching MRF lines |
$23.10–$668.40 | $77–$2,228 | varies |
| Umbilical-artery Doppler (OB) (76820) | $90.90 | $303 | 0.8× |
| Unlisted us procedure (76999) | $246.60 | $822 | 2.7× |
| Upper gi w/o kub (74240) range across 11 matching MRF lines |
$605.40–$680.10 | $2,018–$2,267 | varies |
| Ureteral Reflux Study (78740) | $782.40 | $2,608 | 1.8× |
| Urethrocystogram voiding (74455) | $573.90 | $1,913 | 2.3× |
| Urethrocystography retrograde (74450) | $656.70 | $2,189 | 2.6× |
| Us breast unilateral complete (76641) range across 7 matching MRF lines |
$31.02–$405.90 | $103.40–$1,353 | varies |
| Us chest (76604) range across 3 matching MRF lines |
$21.60–$335.10 | $72–$1,117 | varies |
| Us complete joint (76881) range across 10 matching MRF lines |
$24.90–$335.10 | $83–$1,117 | varies |
| Us exam, pelvic, limited (76857) range across 8 matching MRF lines |
$66.30–$540.30 | $221–$1,801 | varies |
| Us head (76506) | $569.10 | $1,897 | 5.1× |
| Us kidney transplant (76776) range across 9 matching MRF lines |
$29.70–$1,049.70 | $99–$3,499 | varies |
| Us lmtd joint/oth nonvasc xtr strux r-t w/img (76882) range across 15 matching MRF lines |
$19.20–$391.50 | $64–$1,305 | varies |
| Us ob detailed single fetus (76811) range across 3 matching MRF lines |
$138–$654.90 | $460–$2,183 | varies |
| Us ob limited 1 or more fetuses (76815) range across 15 matching MRF lines |
$63.90–$445.80 | $213–$1,486 | varies |
| Us ob transvaginal (76817) range across 6 matching MRF lines |
$73.50–$405 | $245–$1,350 | varies |
| Us pelvic non ob complete (76856) range across 5 matching MRF lines |
$77.40–$570.90 | $258–$1,903 | varies |
| Us pg uter img f&mat 14 wk tabdl 1/1st gestation (76801) range across 9 matching MRF lines |
$93.60–$642.60 | $312–$2,142 | varies |
| Us preg uterus real time f/u trnsabdl per fetus (76816) range across 4 matching MRF lines |
$86.70–$99.30 | $289–$331 | varies |
| Us retroperitoneal complete (76770) range across 2 matching MRF lines |
$321–$482.40 | $1,070–$1,608 | varies |
| Us retroperitoneal limited (76775) range across 14 matching MRF lines |
$20.40–$282.90 | $68–$943 | varies |
| Us scrotum and contents (76870) range across 2 matching MRF lines |
$259.50–$564 | $865–$1,880 | varies |
| Us spinal canal and contents (76800) range across 2 matching MRF lines |
$248.70–$263.70 | $829–$879 | varies |
| Us thyroid (76536) range across 11 matching MRF lines |
$21.90–$532.80 | $73–$1,776 | varies |
| Us transrectal (76872) range across 4 matching MRF lines |
$26.40–$531.60 | $88–$1,772 | varies |
| Vein X-Ray Chest (75827) range across 10 matching MRF lines |
$158.70–$2,147.40 | $144–$7,158 | varies |
| Vein X-Ray Liver W/O Hemodyn (75887) range across 3 matching MRF lines |
$1,458.30–$1,545.90 | $4,861–$5,153 | varies |
| Venogram Sinus/Jugular (75860) range across 5 matching MRF lines |
$2,011.50–$4,383.60 | $6,705–$14,612 | varies |
| Venography Adrenal Unilateral (75840) range across 6 matching MRF lines |
$1,806–$1,914.30 | $6,020–$6,381 | varies |
| Venography caval inferior serialography rs&i (75825) range across 5 matching MRF lines |
$2,933.70–$4,383.60 | $9,779–$14,612 | varies |
| Venography extremity bilateral rs&i (75822) range across 10 matching MRF lines |
$1,369.80–$1,815 | $136–$6,050 | varies |
| Venography extremity unilateral rs&i (75820) range across 19 matching MRF lines |
$95.70–$1,029 | $91–$3,430 | varies |
| Venography Renal Bilateral (75833) range across 4 matching MRF lines |
$2,134.50–$2,262.60 | $194–$7,542 | varies |
| Venography Renal Unilateral (75831) range across 6 matching MRF lines |
$4,135.50–$4,383.60 | $13,785–$14,612 | varies |
| Venous sampling by catheter (75893) range across 5 matching MRF lines |
$5,482.50–$7,263.30 | $18,275–$24,211 | varies |
| Venous thrombosis imaging (78457) | $585.90 | $1,953 | 1.0× |
| Venous Thrombosis Imaging Venogram Bilateral (78458) | $1,719.30 | $5,731 | 4.1× |
| Vertebral fracture assessment via dxa (77086) | $87.60 | $292 | 1.0× |
| Wrist 2 views (73100) range across 8 matching MRF lines |
$15.34–$191.10 | $51.12–$637 | varies |
| X-Ray Ac Jts - Xr Acromioclavicular Joints Bilateral (73050) range across 6 matching MRF lines |
$8.40–$375 | $28–$1,250 | varies |
| X-ray antegrade pyelogram tube (74425) | $713.10 | $2,377 | 1.9× |
| X-Ray Aorta Leg Arteries (75630) range across 10 matching MRF lines |
$191.10–$4,393.50 | $230–$14,645 | varies |
| X-Ray Bend Only L-S Spine (72120) range across 4 matching MRF lines |
$9.30–$349.80 | $31–$1,166 | varies |
| X-Ray Elbow 2 Vw - Xr Elbow 1-2 Views Right (73070) range across 8 matching MRF lines |
$6.60–$199.20 | $22–$664 | varies |
| X-Ray Exam Breast Specimen (76098) | $669.30 | $2,231 | 1.2× |
| X-Ray Exam Entire Spi 1 Vw (72081) range across 6 matching MRF lines |
$11.70–$395.40 | $39–$1,318 | varies |
| X-Ray Exam Entire Spi 2/3 Vw (72082) range across 4 matching MRF lines |
$32.84–$403.50 | $109.46–$1,345 | varies |
| X-Ray Exam Entire Spi 4/5 Vw (72083) range across 3 matching MRF lines |
$36.90–$433.50 | $123–$1,445 | varies |
| X-Ray Exam Hip Uni 1 View (73501) range across 9 matching MRF lines |
$7.80–$123.30 | $26–$411 | varies |
| X-Ray Exam Hip Uni 2-3 Views (73502) range across 12 matching MRF lines |
$9–$194.70 | $30–$649 | varies |
| X-Ray Exam Hips Bi 2 Views (73521) range across 9 matching MRF lines |
$9.30–$291.90 | $31–$973 | varies |
| X-Ray Exam Hips Bi 3-4 Views (73522) range across 6 matching MRF lines |
$12.30–$562.20 | $41–$1,874 | varies |
| X-Ray Exam L-S Spine Bending (72114) range across 5 matching MRF lines |
$13.50–$687.30 | $45–$2,291 | varies |
| X-Ray Exam Neck Spine 2-3 Vw (72040) range across 6 matching MRF lines |
$9–$338.70 | $30–$1,129 | varies |
| X-Ray Exam Neck Spine 6/>Vws (72052) range across 6 matching MRF lines |
$14.70–$492.60 | $49–$1,642 | varies |
| X-Ray Exam Unilat Ribs/Chest (71101) range across 7 matching MRF lines |
$10.50–$370.80 | $35–$1,236 | varies |
| X-ray eye for foreign body (70030) range across 11 matching MRF lines |
$13.90–$220.50 | $46.32–$735 | varies |
| X-ray humerus (73060) range across 8 matching MRF lines |
$14.31–$207.90 | $47.70–$693 | varies |
| X-ray IV pyelogram (ivp) (74400) range across 2 matching MRF lines |
$395.70–$781.20 | $1,319–$2,604 | varies |
| X-ray IV pyelogram+tomography (74415) | $569.40 | $1,898 | 3.1× |
| X-Ray Jaw <4 Vw - Xr Mandible < 4 Views (70100) range across 4 matching MRF lines |
$7.20–$96 | $24–$320 | varies |
| X-Ray Knee Bilat Standing - Xr Knees Anteroposterior Standing Bilat (73565) range across 6 matching MRF lines |
$7.50–$176.10 | $25–$587 | varies |
| X-Ray Lumbar Spine 2/3 Vw - Xr Lumbar Spine 2-3 Views (72100) range across 6 matching MRF lines |
$9–$402.90 | $30–$1,343 | varies |
| X-ray nose-rectum child f.b. (76010) range across 3 matching MRF lines |
$7.20–$248.70 | $24–$829 | varies |
| X-Ray Ribs, Chest 4+ Vw - Xr Ribs 3 Vws Bil W/ Chest Posteroanterior (71111) range across 6 matching MRF lines |
$12.90–$433.80 | $43–$1,446 | varies |
| X-Ray Sacroiliac Jts 3+ Vw - Xr Sacroiliac Joints 3+ Views (72202) range across 6 matching MRF lines |
$7.50–$320.10 | $25–$1,067 | varies |
| X-Ray Sacrum/Coccyx 2+ Vw - Xr Sacrum Coccyx 2+ Views (72220) range across 6 matching MRF lines |
$6.90–$314.40 | $23–$1,048 | varies |
| X-Ray Sinuses 3+ Vw - Xr Paranasal Sinuses 3+ Views (70220) range across 7 matching MRF lines |
$9.90–$338.70 | $33–$1,129 | varies |
| X-Ray Skull 4+ Vw - Xr Skull Complete 4+ Views (70260) range across 8 matching MRF lines |
$13.80–$392.40 | $46–$1,308 | varies |
| X-ray thoracic spine 4 vw (72074) range across 3 matching MRF lines |
$19.46–$380.70 | $64.86–$1,269 | varies |
| X-Ray Tmj Unilat (70328) | $185.40 | $618 | 2.0× |
| X-Ray Urinary Tract Exam With Contrast Material (74420) range across 4 matching MRF lines |
$90.60–$657.60 | $47–$2,192 | varies |
| X-Rays Bone Length Studies (77073) range across 5 matching MRF lines |
$27–$351.30 | $90–$1,171 | varies |
| X-Rays Bone Survey Complete (77075) range across 3 matching MRF lines |
$45.90–$416.70 | $153–$1,389 | varies |
| Xr c-spine 4 or 5 views (72050) range across 6 matching MRF lines |
$12.60–$450.60 | $42–$1,502 | varies |
| Xr facial bones less than 3 views (70140) range across 4 matching MRF lines |
$8.40–$300.30 | $28–$1,001 | varies |
| Xr orbits complete 4 views (70200) range across 4 matching MRF lines |
$20.69–$338.10 | $68.98–$1,127 | 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.