Imaging prices at Maimonides Medical Center

Brooklyn, NY · every code in this section with a posted price and a Medicare benchmark.

482 codes. Prices are the hospital's own posted facility charges.

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ProcedurePosted cashPosted gross× Medicare
3-D radiotherapy plan dose-volume histograms (77295)
range across 2 matching MRF lines		 $6,600–$7,700 $6,600–$7,700 varies
Abdomen 1 View (74018) $335 $335 3.1×
Abdomen 2 views (74019) $440 $440 3.4×
Acute Gastrointestinal Blood Loss Imaging (78278) $1,712 $1,712 3.4×
Acute venous thrombosis imaging, peptide Non-Facility (78456) $6,144 $6,144 3.8×
Adrenal Cortex & Medulla Img (78075) $5,851 $5,851 3.6×
Angio internal mammary (75756) $12,128 $12,128 3.1×
Angio pulmonary bilat (75743)
range across 2 matching MRF lines		 $11,000–$12,474 $11,000–$12,474 varies
Angiography Adrenal Bilateral Slctv Rs&I (75733) $12,128 $12,128 3.1×
Angiography extremity bilateral rs&i (75716)
range across 4 matching MRF lines		 $11,550–$12,474 $11,550–$12,474 varies
Angiography extremity unilateral rs&i (75710)
range across 5 matching MRF lines		 $11,000–$12,474 $11,000–$12,474 varies
Angiography pulmonary unilateral slctv rs&i (75741)
range across 2 matching MRF lines		 $11,000–$12,474 $11,000–$12,474 varies
Angrph pulmonary nonslctv cath/ven njx rs&i (75746) $4,400 $4,400 1.1×
Ankle 2 views (73600) $374 $374 3.4×
Aortography thoracic serialography rs&i (75605) $20,161 $20,161 2.9×
Aortography thoracic w/o serialography rs&i (75600) $12,128 $12,128 3.1×
Artery X-Rays Abdomen (75726) $20,161 $20,161 2.9×
Artery X-Rays Adrenal Gland (75731) $3,692 $3,692 0.9×
Artery X-Rays Pelvis (75736) $20,161 $20,161 2.9×
Artery X-Rays Spine (75705) $20,161 $20,161 2.9×
Arthrogram ankle (73615) $2,426 $2,426 5.6×
Arthrogram hip (73525) $2,310 $2,310 5.3×
Arthrogram Wrist (73115) $2,420 $2,420 5.6×
Basic radiation dosimetry calculation (77300) $770 $770 4.6×
Bone age studies (77072) $660 $660 5.1×
Bone Imaging 3 Phase (78315) $1,760 $1,760 3.5×
Bone Imaging Limited Area (78300)
range across 2 matching MRF lines		 $1,630–$1,712 $1,630–$1,712 varies
Bone Imaging Multiple Areas (78305) $1,760 $1,760 3.5×
Bone Imaging Whole Body (78306) $1,760 $1,760 3.5×
Bone marrow imaging limited area (78102) $1,797 $1,797 3.6×
Bone marrow imaging; multiple areas (78103) $1,797 $1,797 3.6×
Bone marrow imaging; whole body (78104) $1,797 $1,797 3.6×
Bone survey infant (77076) $620 $620 4.8×
Brachytx isodose complex (77318) $1,760 $1,760 3.8×
Brachytx isodose intermed (77317) $1,870 $1,870 4.0×
Brachytx Isodose Plan Simple (77316) $1,101 $1,101 2.4×
Brain Flow Imaging Only (78610) $2,316 $2,316 3.4×
Brain Image W/Flow < 4 Views (78601) $1,797 $1,797 3.6×
Brain imaging < 4 static views (78600) $1,797 $1,797 3.6×
Brain Imaging Min 4 Static Views W Vascular Flow (78606) $2,400 $2,400 3.5×
Brain Imaging Minimum 4 Static Views (78605) $2,314 $2,314 3.4×
Brain Imaging Pet Metabolic Evaluation (78608) $6,050 $6,050 3.4×
Cardiac blood pool imaging, first pass technique; multiple studies, resting and with stress (exercise and/or… (78483)
range across 2 matching MRF lines		 $2,100–$2,267 $2,100–$2,267 varies
Cardiac MRI w/w/o contrast & further seq (75561) $2,530 $2,530 5.8×
Cardiac MRI w/w/o contrast w/stress (75563) $3,630 $3,630 3.7×
Cardiac Shunt Detection (78428) $1,797 $1,797 3.6×
Cat Scan Follow-Up Study (76380) $415 $415 3.8×
Cerebrospinal Fluid Flow W/O Matl Shunt Evaltj (78645) $2,316 $2,316 3.4×
Cerebrospinal fluid flow, imaging (not including introduction of material); ventriculography Non-Facility (78635) $2,316 $2,316 3.4×
Cerebrospinal Fluid Scan (78630) $2,316 $2,316 3.4×
Chest 1 view (71045) $320 $320 2.9×
Chest 2 views (71046) $355 $355 3.3×
Chest 3 views (71047) $476 $476 4.4×
Chest 4 or more views (71048) $507 $507 3.9×
Cholecystography Oral Contrast (74290) $661 $661 3.0×
Cisternography Positive Contrast Rs&I (70015) $2,310 $2,310 2.4×
Clavicle complete (73000) $440 $440 4.1×
Computed Tomography Thorax Lw Dose Lng Ca Scr C- (71271) $1,320 $1,320 10.1×
Continuing medical physics consltj pr wk (77336) $611 $611 3.6×
Contrast Exam Abdominl Aorta (75625)
range across 2 matching MRF lines		 $11,550–$12,474 $11,550–$12,474 varies
Contrast X-Ray Bladder (74430) $1,276 $1,276 2.9×
Contrast X-Ray Of Elbow (73085) $2,420 $2,420 5.6×
Contrast X-Ray Of Knee Joint (73580) $2,310 $2,310 5.3×
Contrast Xray Throat/Cerv Esopha (74210) $580 $580 2.6×
Corpora cavernosography (74445) $580 $580 4.4×
CT abdomen and pelvis without and with contrast (74178) $3,100 $3,100 7.1×
CT abdomen and pelvis without contrast (74176) $2,800 $2,800 9.4×
CT abdomen w contrast (74160) $2,170 $2,170 9.9×
CT abdomen w wo contrast (74170) $3,805 $3,805 17.4×
CT abdomen w/o contrast (74150) $1,100 $1,100 8.4×
CT Angio Abdomen and Pelvis (74174) $3,400 $3,400 7.8×
CT Angio Chest (71275) $3,300 $3,300 15.1×
CT Angio Head (70496) $3,600 $3,600 16.4×
CT angio hrt w/3d image (75574) $1,485 $1,485 3.4×
Ct Angio Lwr Extr W/O&W/Dye (73706) $1,980 $1,980 9.0×
CT Angio Neck (70498) $3,800 $3,800 17.4×
Ct Angio Upr Extrm W/O&W/Dye (73206) $2,750 $2,750 12.6×
CT Cere Prfuj Alys C+ W/O CT/Cta Same Anatomy (70473) $975 $975 4.5×
CT cervical spine w/ contrast (72126) $3,214 $3,214 7.4×
CT cervical spine w/o contrast (72125) $1,575 $1,575 12.1×
CT cervical spine w/wo cont (72127) $3,214 $3,214 14.7×
CT chest w contrast (71260) $2,150 $2,150 9.8×
CT chest w/wo contrast (71270) $963 $963 4.4×
CT colonography screening (74263) $1,485 $1,485 5.0×
CT Colonogrphy Dx Image Postprocess W/Contrast (74262) $1,650 $1,650 7.5×
CT colonogrphy dx image postprocess w/o contrast (74261) $1,430 $1,430 11.0×
CT head/brain with contrast (70460) $2,500 $2,500 11.4×
CT head/brain without and with contrast (70470)
range across 2 matching MRF lines		 $2,420–$3,214 $2,420–$3,214 varies
CT heart contrast eval cardiac structure&morph (75572) $1,428 $1,428 3.3×
CT heart no contrast quant eval coronry calcium (75571) $287 $287 2.6×
CT hrt w/3d image congen (75573) $1,540 $1,540 3.5×
CT iac w contrast (70481) $2,413 $2,413 11.0×
CT l-spine w&w/o contrast (72133) $3,299 $3,299 15.1×
CT lower ext w/o (73700) $1,430 $1,430 11.0×
CT lower extremity w/contrast material (73701) $1,800 $1,800 8.2×
CT lumbar spine w contrast (72132) $3,214 $3,214 7.4×
CT lumbar spine w/o contrast (72131) $1,599 $1,599 12.3×
CT maxillofacial w contrast (70487) $2,500 $2,500 11.4×
CT maxillofacial wo contrast (70486) $1,800 $1,800 13.8×
CT neck tissue combo (70492) $3,520 $3,520 16.1×
Ct Orbit/Ear/Fossa W/O&W/Dye (70482) $2,681 $2,681 12.2×
CT orbits w/o contrast (70480) $580 $580 4.4×
CT pelvis w&w/o contrast (72194) $2,530 $2,530 11.6×
CT pelvis w/o contrast (72192) $2,090 $2,090 16.0×
CT scan of leg combo (73702) $3,300 $3,300 15.1×
CT scans face/jaw combo (70488) $3,214 $3,214 14.7×
CT soft tissue neck w contrast (70491) $2,800 $2,800 12.8×
CT soft tissue neck w/o contrast (70490) $2,000 $2,000 15.3×
CT thoracic spine w contrast (72129) $1,980 $1,980 9.0×
CT thoracic spine w/o contrast (72128) $1,650 $1,650 12.6×
CT thoracic spine w/wo cont (72130) $2,310 $2,310 10.6×
CT thorax w/o contrast (71250) $1,925 $1,925 14.8×
CT unlisted procedure (76497)
range across 3 matching MRF lines		 $303–$2,000 $303–$2,000 varies
CT upper ext wo (73200) $1,485 $1,485 11.4×
CT upper extremity w/o & w/contrast material (73202)
range across 2 matching MRF lines		 $2,200–$2,449 $2,200–$2,449 varies
CT upper extremity with contrast (73201) $1,700 $1,700 3.9×
Cta Abdl Aorta&Bi Iliofem W/Contrast&Postp (75635) $1,362 $1,362 6.2×
Cta Abdomen (74175) $2,530 $2,530 11.6×
CTA head&neck c+ w/noncontrast img&post-pxessing (70471) $935 $935 2.1×
CTA pelvis (72191) $1,650 $1,650 7.5×
Dacryocystography, nasolacrimal duct, radiological supervision and interpretation Non-Facility (70170) $1,161 $1,161 3.9×
Dilation ureters/urethra rs&i (74485) $8,449 $8,449 3.2×
Discography Cerv/Thor Spine (72285) $8,032 $8,032 3.3×
Diskography lumbar (72295) $7,285 $7,285 3.0×
Doppler Echo Fetal Puls Spectral F/U/Repeat (76828)
range across 3 matching MRF lines		 $526–$539 $526–$539 varies
Doppler Echo Fetal Spectral Display Complete (76827)
range across 2 matching MRF lines		 $1,053–$1,195 $1,053–$1,195 varies
Doppler Fetal Mid Cerebral Artery (76821) $550 $550 4.2×
Dxa Bone Density Axial (77080)
range across 2 matching MRF lines		 $115–$581 $115–$581 varies
Dxa bone density study 1/>sites appendiclr skel (77081)
range across 4 matching MRF lines		 $95–$330 $95–$330 varies
Echo exam of fetal heart (76825) $2,495 $2,495 3.7×
Echo exam uterus (76831) $1,053 $1,053 3.5×
Echo Guide For Artery Repair (76936) $1,195 $1,195 4.4×
Echocardiography, fetal, cardiovascular system, real time with image documentation (2D), with or without M-mode… (76826) $1,232 $1,232 4.1×
Echograp Trans R Pros Study (76873) $550 $550 4.2×
Esophageal Motility Study (78258) $1,797 $1,797 3.6×
Esophagram (74220) $580 $580 2.6×
Fetal Biophys Profile W/Nst (76818) $549 $549 4.2×
Fetal Biophysical Profile W/O Non-Stress Testing (76819) $567 $567 4.3×
Fetal MRI w/placntl matrnl plvc img sing/1st ges (74712) $985 $985 3.3×
Fluoroscopy up to 1 hr (76000) $1,053 $1,053 3.5×
Follow-Up Angiography (75898)
range across 3 matching MRF lines		 $3,464–$3,617 $3,464–$3,617 varies
Foot 2 views (73620) $400 $400 3.7×
Forearm 2 views (73090) $375 $375 3.5×
Gastric emptying imaging study (78264) $2,054 $2,054 4.1×
Gastric Emptyng Imag Std W/Sm Bwl Transit (78265) $1,630 $1,630 3.3×
Gastric Mucosa Imaging (78261) $1,797 $1,797 3.6×
Gastroesophageal Reflux Exam (78262) $1,983 $1,983 4.0×
Gated Heart Planar Single (78472) $1,931 $1,931 3.9×
Gated Heart, Multiple (78473) $1,760 $1,760 3.5×
Gstrc Emptng Imag Std W/Sm Bwl Col Trnst Mlt Day (78266) $2,500 $2,500 3.7×
Hand 2 views (73120) $600 $600 4.6×
Hdr Rdncl Ntrstl/Icav Brchtx (77772) $3,794 $3,794 4.4×
Hdr Rdncl Ntrstl/Icav Brchtx (77771) $3,794 $3,794 4.4×
Hdr Rdncl Ntrstl/Icav Brchtx 1 Channel (77770) $3,794 $3,794 4.4×
Heart first pass single,planar (78481)
range across 2 matching MRF lines		 $2,000–$2,267 $2,000–$2,267 varies
Hepatc Vngrph Wdg/Fr Hemodyn Eval Rs&I (75889) $12,128 $12,128 3.1×
Hepatc Vngrph Wdg/Fr W/O Hemodyn Eval Rs&I (75891) $12,128 $12,128 3.1×
Hepatobil Syst Image W/Drug (78227) $2,640 $2,640 3.9×
Hepatobiliary System Imaging (78226) $1,800 $1,800 3.6×
High energy neutron radj tx dlvr 1/> isocenter (77423) $2,670 $2,670 3.9×
Ht Musc Image Planar Mult (78454) $6,144 $6,144 3.8×
Ht Muscle Image Spect Sing (78451) $5,851 $5,851 3.6×
Hysterosalpingogram (74740) $1,161 $1,161 3.9×
Image fusion (77399) $114 $114 0.7×
Infant hip ultrasound with hip movement (dynamic) (76885) $347 $347 3.2×
Infant hip ultrasound, limited static exam (76886) $347 $347 3.2×
Infusion Ivp (74410) $1,161 $1,161 5.3×
Interstitial radiation source applic complex (77778) $3,794 $3,794 4.4×
Intracavitary Radiation Source Applic Complex (77763) $3,983 $3,983 4.6×
Intracavitary Radiation Source Applic Intermed (77762) $2,670 $2,670 3.9×
Intracavitary radiation source applic simple (77761) $2,670 $2,670 3.9×
Joint Survey Single View (77077) $608 $608 4.7×
K Flow/Funct Image Multiple (78709) $2,395 $2,395 3.5×
K Flow/Funct Image W/Drug (78708) $2,395 $2,395 3.5×
K Flow/Funct Image W/O Drug (78707) $2,395 $2,395 3.5×
Kidney Funcj Study Non-Img Radioisotopic Study (78725) $1,797 $1,797 3.6×
Kidney Imaging Morphol (78700) $1,797 $1,797 3.6×
Kidney Imaging Morphoogy W/Vascular Flow (78701) $1,797 $1,797 3.6×
Knee 3 Views (73562) $455 $455 4.2×
Labeled RBC Sequestration Differntl Organ/Tissue (78140) $1,797 $1,797 3.6×
Leveen/Shunt Patency Exam (78291) $1,712 $1,712 3.4×
Liver & Spleen Imaging Static Only (78215) $1,797 $1,797 3.6×
Liver & Spleen Imaging W/Vascular Flow (78216) $1,797 $1,797 3.6×
Liver imaging static only (78201) $5,851 $5,851 8.6×
Liver imaging w/vascular flow (78202) $5,851 $5,851 8.6×
Lung Perf&Ventilat Diferentl (78598) $2,314 $2,314 3.4×
Lung perfusion differential (78597) $1,821 $1,821 3.6×
Lung Ventilat&Perfus Imaging (78582) $2,316 $2,316 3.4×
Lung Ventilation Imaging (78579) $2,316 $2,316 4.6×
Lymph System Imaging (78195) $2,332 $2,332 3.4×
Lymphangiography Extremity Only Bilateral Rs&I (75803) $3,516 $3,516 1.8×
Lymphangiography extremity only unilateral rs&i (75801) $3,516 $3,516 4.5×
Lymphangiography Pelvic/Abdominal Bilateral Rs&I (75807) $12,128 $12,128 3.1×
Lymphangiography, pelvic/abdominal, unilateral (75805) $3,516 $3,516 0.9×
Magnetic Image Jaw Joint (70336) $2,602 $2,602 8.7×
Meckels Divert Exam (78290) $1,712 $1,712 3.4×
Medical physics dose eval radiation expos w/rprt (76145) $677 $677 1.5×
Mlc imrt design & construction per imrt plan (77338) $1,705 $1,705 3.6×
Mra Head W/O & W/Contrast Material (70546) $4,730 $4,730 10.9×
MRA head w/o contrast (70544) $3,080 $3,080 10.3×
MRA head with contrast (70545) $2,860 $2,860 6.6×
MRA neck w contrast (70548) $2,202 $2,202 5.1×
Mra Neck W/O &W/Contrast Material (70549) $4,540 $4,540 10.4×
MRA neck w/o contrast (70547) $2,640 $2,640 8.9×
MRI abdomen w contrast (74182) $2,530 $2,530 5.8×
MRI abdomen w/o contrast (74181) $2,310 $2,310 7.8×
MRI any jt lower extrem w/contrast material (73722) $3,465 $3,465 3.5×
MRI any jt lower extrem w/o & w/contrast matrl (73723) $3,740 $3,740 8.6×
MRI any jt upper extremity w/contrast matrl (73222) $3,375 $3,375 3.4×
MRI bone marrow blood supply (77084) $2,426 $2,426 8.1×
MRI brain functional w/o physician admnistration (70554) $4,400 $4,400 14.8×
MRI brain functional w/physician admnistration (70555) $4,400 $4,400 14.8×
MRI Breast W/O Contrast Bilateral (77047) $1,485 $1,485 5.0×
MRI Breast Without Contrast Material Unilateral (77046) $1,403 $1,403 4.7×
MRI cardiac w/o cont stress (75559) $2,090 $2,090 3.1×
MRI cardiac w/o contrast (75557) $1,650 $1,650 5.5×
MRI cervical spine w contrast (72142) $3,603 $3,603 8.3×
MRI cervical spine w/o cont (72141) $3,400 $3,400 11.4×
MRI chest w/o contrast (71550) $3,080 $3,080 10.3×
MRI chest with contrast (71551) $3,630 $3,630 3.7×
MRI chest wo w contrast (71552) $3,520 $3,520 8.1×
MRI lower extrem oth/thn jt w/contrast matrl (73719) $2,310 $2,310 5.3×
MRI lower extrem oth/thn jt w/o & w/contr matr (73720) $3,960 $3,960 9.1×
MRI lower extrem oth/thn jt w/o contr matrl (73718) $2,145 $2,145 7.2×
MRI lumbar spine w contrast (72149) $3,300 $3,300 7.6×
Mri Neck Spine W/O & W/Dye (72156) $3,740 $3,740 8.6×
MRI orbit face &/neck w/o contrast (70540) $2,439 $2,439 8.2×
MRI orbit face neck w contrast (70542) $2,860 $2,860 6.6×
Mri Orbt/Fac/Nck W/O &W/Dye (70543) $4,510 $4,510 10.4×
MRI pelvis w contrast (72196) $3,080 $3,080 7.1×
MRI pelvis w/o & w contrast (72197) $3,685 $3,685 8.5×
MRI pelvis w/o contrast (72195) $2,750 $2,750 9.2×
MRI spectroscopy (76390) $2,917 $2,917 26.9×
MRI thoracic spine w/o contrast (72146) $3,410 $3,410 11.4×
MRI upper extremity oth than jt w/contr matrl (73219) $2,530 $2,530 5.8×
MRI upper extremity oth than jt w/o contr matrl (73218) $2,200 $2,200 7.4×
Mri Uppr Extremity W/O&W/Dye (73220) $3,685 $3,685 8.5×
MRI, abdomen, combo (74183) $3,300 $3,300 7.6×
MRI, dorsal spine combo (72157) $3,740 $3,740 8.6×
MRI, dorsal spine contrast (72147) $3,630 $3,630 8.3×
MRI, joint upper extrem (73221) $2,035 $2,035 6.8×
MRI, joint upper extrem combo (73223) $3,630 $3,630 8.3×
MRI, lumbar spine combo (72158) $3,850 $3,850 8.8×
Myelogram cervical (72240) $2,310 $2,310 2.4×
Myelogram Lumbar (72265) $2,310 $2,310 2.4×
Myelography thoracic (72255) $2,310 $2,310 2.4×
Myelograpy 2/more regions rs&i (72270) $2,475 $2,475 2.5×
Myocardial Imaging Infarct Avid Planar Qual/Quan (78466) $1,870 $1,870 3.7×
Myocardial imaging, infarct avid, planar; with ejection fraction by first pass technique Non-Facility (78468) $2,204 $2,204 3.3×
Myocardial Perfusion Planar 1 Study Rest/Stress (78453) $5,851 $5,851 3.6×
Myocardial Spect Multiple Studies (78452)
range across 3 matching MRF lines		 $5,995–$6,215 $5,995–$6,215 varies
N-invas est c ffr sw aly CTA (75580) $2,850 $2,850 2.7×
Neck soft tissue (70360) $345 $345 3.2×
Nfs/Instlj Radioelmnt Sln 3 Mo Follow-Up Care (77750) $1,104 $1,104 2.3×
Njx Rp Loclzj Non-Img Probe Study Intravenous (78808) $1,797 $1,797 3.6×
Nm csf leak detection (78650) $6,144 $6,144 3.8×
Nm myocard infarct spect (78469) $5,851 $5,851 8.6×
Nonvascular Shunt X-Ray (75809) $767 $767 5.9×
Ntsty modul radthx pln dose-vol histos (77301) $8,800 $8,800 5.1×
Nuclear medicine study of endocrine organs (78099) $1,797 $1,797 3.6×
Nuclear Rx Intra-Arterial (79445) $1,276 $1,276 4.4×
Nuclear Rx Oral Admin (79005) $1,210 $1,210 4.2×
Ob us nuchal meas 1 gest (76813) $551 $551 4.2×
Oph bmtry us echograpy a-scan io lens pwr cal (76519) $400 $400 3.1×
Oph us dx ant sgm us immersion b-scan/hr biom (76513) $500 $500 3.8×
Ophthalmic Ultrasonic Foreign Body Localization (76529) $330 $330 3.0×
Ophthalmic ultrasound dx b-scan w/wo a-scan (76512)
range across 3 matching MRF lines		 $526–$538 $526–$538 varies
Ophthalmic US Dx Corneal Pachymetry Uni/Bi (76514) $115 $115 3.2×
Optic foramina (70190) $323 $323 3.0×
Panoramic X-ray of jaws (70355) $605 $605 5.6×
Parathyroid imaging w/tomographic spect & CT (78072) $2,204 $2,204 3.3×
Parathyroid Planar Imaging (78070) $1,797 $1,797 3.6×
Parathyroid planar imaging w/wo subtraction (78071) $1,797 $1,797 3.6×
Pelvis 1 or 2 views (72170) $600 $600 4.6×
Perineogram (74775) $1,161 $1,161 3.9×
Pet Image Skull-Thigh (78812) $7,150 $7,150 4.0×
Pet Image W/Ct Lmtd (78814) $7,150 $7,150 4.0×
PET image w/CT, full body (78816) $7,150 $7,150 4.0×
PET imaging CT attenuation skull base mid-thigh (78815) $7,150 $7,150 4.0×
Plasma Vol Radiopharm Vol Dilute Spx Mult Smples (78111) $5,000 $5,000 3.1×
Prq Transhepatc Portograpy Hemodyn Eval Rs&I (75885)
range across 2 matching MRF lines		 $12,128–$14,850 $12,128–$14,850 varies
Pulmonary Perfusion Imaging Particulate (78580) $1,712 $1,712 3.4×
Radex Abd Compl Aqt Abd W/S/E/D Views 1 View Ch (74022) $580 $580 4.4×
Radex abscess/fistula/sinus tract rs&i (76080) $2,585 $2,585 3.8×
Radex Ankle Complete Minimum 3 Views (73610) $550 $550 5.1×
Radex Calcaneus Minimum 2 Views (73650) $396 $396 3.6×
Radex elbow complete minimum 3 views (73080) $440 $440 4.1×
Radex Facial Bones Complete Minimum 3 Views (70150) $580 $580 4.4×
Radex fingr minimum 2 views (73140) $388 $388 3.6×
Radex foot complete minimum 3 views (73630) $590 $590 5.4×
Radex Hand Minimum 3 Views (73130) $625 $625 5.8×
Radex lower extremity infant minimum 2 views (73592) $374 $374 3.4×
Radex Mastoids Compl Minimum 3 Views PR Side (70130) $580 $580 4.4×
Radex Nasal Bones Complete Minimum 3 Views (70160) $359 $359 3.3×
Radex Pharynx/Larx W/Fluor&/Magnification Tq (70370) $608 $608 5.6×
Radex Ribs Unilateral 2 Views (71100) $377 $377 3.5×
Radex shoulder complete minimum 2 views (73030) $525 $525 4.8×
Radex Sinuses Paransl < 3 Views (70210) $308 $308 2.8×
Radex sm int w/mlt srl imges via enteroclss tube (74251) $616 $616 2.8×
Radex Spine 1 View Specify Level (72020) $308 $308 2.8×
Radex Sternum Minimum 2 Views (71120) $353 $353 3.2×
Radex Temporomandble Jt Opn & Clsd Mouth Bilat (70330) $392 $392 3.6×
Radex Toe Minimum 2 Views (73660) $435 $435 4.0×
Radex upper extremity infant minimum 2 views (73092) $608 $608 4.7×
Radex Wrist Complete Minimum 3 Views (73110) $593 $593 5.5×
Radex X-Ray Exam Entire Spi 6/> Vw - Xr Entire Spine 6+ Vw (72084) $1,320 $1,320 10.1×
Radiation Delivery Stereotactic Cranial Linear (77372) $40,218 $40,218 4.4×
Radiation treatment delivery level 1 (77402) $611 $611 4.8×
Radiation treatment delivery level 2 (77407) $836 $836 1.7×
Radiation treatment delivery level 3 (77412) $1,101 $1,101 1.6×
Radiolog exam mandible compl minimum 4 views (70110) $580 $580 4.4×
Radiologic Exam Abdomen 3+ Views - Xr Abdomen 3+ Views (74021) $354 $354 2.7×
Radiologic exam colon double contrast study (74280) $770 $770 3.5×
Radiologic exam colon single contrast study (74270) $715 $715 3.3×
Radiologic Exam Esophagus Double Contrast Study (74221) $800 $800 3.7×
Radiologic exam knee complete 4/more views (73564) $605 $605 4.6×
Radiologic exam pelvis compl minimum 3 views (72190) $608 $608 4.7×
Radiologic Exam Small Int Single Contrast Study (74250) $580 $580 2.6×
Radiologic exam swallow function contrast study (74230) $660 $660 3.0×
Radiologic exam teeth complete full mouth (70320) $1,161 $1,161 3.9×
Radiologic exam upr gi trc double contrast study (74246) $770 $770 3.5×
Radiologic examination femur 1 view (73551) $325 $325 3.0×
Radiologic examination femur minimum 2 views (73552) $352 $352 3.2×
Radiologic examination knee 1/2 views (73560) $391 $391 3.6×
Radiologic Examination Osseous Survey Limited (77074) $660 $660 5.1×
Radiologic Examination Salivary Gland Calculus (70380) $608 $608 5.6×
Radiologic examination tibia & fibula 2 views (73590) $575 $575 5.3×
Radiologic examination, internal auditory meati, complete Non-Facility (70134) $1,546 $1,546 2.3×
Radiopharm Dacryocystography (78660) $1,797 $1,797 3.6×
Red Cell Volume Determination Spx Mult Samplings (78121) $2,500 $2,500 3.7×
Remote afterloading high dose rate radionuclide skin surface brachytherapy, includes basic dosimetry, when performed;… (77768) $1,099 $1,099 2.3×
Remote afterloading high dose rate radionuclide skin surface brachytherapy, includes basic dosimetry, when performed;… (77767) $1,018 $1,018 2.1×
Renal Cyst Study (74470) $1,623 $1,623 2.4×
Ribs bilateral 3 views (71110) $580 $580 4.4×
Rp loclzj tum plnr 1 area single day imaging (78800) $1,712 $1,712 3.4×
Rp loclzj tum plnr 2+area 1+d img/1 area img>2+d (78801)
range across 4 matching MRF lines		 $1,712–$1,797 $1,712–$1,797 varies
Rp Loclzj Tum Plnr Whole Body 2+ Days Imaging (78804) $6,463 $6,463 9.5×
Rp Loclzj Tum Plnr Whole Body Single Day Imaging (78802)
range across 2 matching MRF lines		 $5,573–$5,851 $5,573–$5,851 varies
Rp Loclzj Tum Spect 1 Area Single Day Imaging (78803) $3,300 $3,300 4.9×
Rp loclzj tum spect 2 area/sep acquisj img (78831) $6,764 $6,764 4.2×
Rp loclzj tum spect w/CT 1 area/acquisj 1day img (78830) $5,573 $5,573 3.4×
Rp Ther Radiolbld Monoclonal Antibody IV Infus (79403) $1,210 $1,210 4.2×
Rp Therapy Intravenous Administration (79101) $1,210 $1,210 4.2×
Salivary Gland Function Study (78232) $1,797 $1,797 3.6×
Salivary Gland Imaging (78230) $1,797 $1,797 3.6×
Salivary Gland Imaging Serial Images (78231) $1,797 $1,797 3.6×
Scapula (73010) $440 $440 3.4×
Screening Digital Breast Tomosynthesis Bi (77063) $226 $226 9.7×
Sella turcica (70240) $308 $308 2.8×
Shoulder 1 view (73020) $337 $337 3.1×
Shoulder Arthrography (73040) $1,320 $1,320 3.0×
Sialogram (70390) $1,320 $1,320 4.4×
Skull less than 4 views (70250) $580 $580 4.4×
Special dosimetry (77331) $633 $633 3.8×
Special Physics Consult (77370) $633 $633 3.8×
Special teletherapy port plan (77321) $1,931 $1,931 4.1×
Special treatment procedure (77470) $3,080 $3,080 4.5×
Speech evaluation, complex (70371) $1,271 $1,271 4.3×
Spleen Imaging (78185) $1,797 $1,797 3.6×
Srs Multisource (77371) $40,218 $40,218 4.4×
Stereotactic Body Radiation Delivery (77373) $9,331 $9,331 4.2×
Sternoclavicular joints (71130) $323 $323 3.0×
Superior sagittal sinus venogram (75870) $3,516 $3,516 0.9×
Surf radj ther orthvlt dlvr>150-500 kv per fxj (77438) $1,300 $1,300 10.2×
Surf radj ther supfc dlvr<=150 kv per fraction (77437) $1,200 $1,200 9.4×
Surf radj ther supfc/orthvlt treatment planning (77436) $1,350 $1,350 29.0×
Surface Applic Low Dose Rate Radionuclide Source (77789) $556 $556 4.4×
Telethx isodose pln cplx w/basic dosimetry (77307) $1,650 $1,650 3.5×
Telethx isodose pln smpl w/dosimetry calculation (77306) $1,525 $1,525 3.3×
Temporomandble Jt Arthrography Rs&I (70332) $1,161 $1,161 3.9×
Testicular Imaging W/Flow (78761) $1,797 $1,797 3.6×
Ther Rad Simulaj-Aided Field Setting Complex (77290) $1,672 $1,672 3.6×
Ther Rad Simulaj-Aided Field Setting Intermed (77285) $1,672 $1,672 3.6×
Ther rad simulaj-aided field setting simple (77280) $666 $666 4.0×
Therapeutic Enema Rdctj Intussusception/Obstrcj (74283) $661 $661 3.0×
Thoracic spine 2 views (72070) $580 $580 4.4×
Thoracic spine 3 views (72072) $580 $580 4.4×
Thoracolumbar 2 views (72080) $308 $308 2.8×
Thyroid carcinoma metastases imaging; with additional studies (eg, urinary recovery) Non-Facility (78016) $1,797 $1,797 3.6×
Thyroid Carcinoma Metastases Img Lmtd Area (78015) $1,712 $1,712 3.4×
Thyroid Imaging With Vascular Flow (78013) $1,797 $1,797 3.6×
Thyroid Met Imaging Body (78018) $2,321 $2,321 3.4×
Thyroid Uptake Measurement (78012) $1,712 $1,712 3.4×
Thyroid Uptake W/Blood Flow Sngle/Mult Quan Meas (78014) $1,797 $1,797 3.6×
Tx Devices Design & Construction Complex (77334) $1,711 $1,711 3.7×
Tx devices design & construction intermediate (77333) $644 $644 3.8×
Tx devices design & construction simple (77332) $633 $633 3.8×
Ultrasound Breast Limited (76642) $391 $391 3.6×
Ultrasound elastography first target lesion (76982) $576 $576 4.4×
Ultrasound Elastography Parenchyma (76981)
range across 2 matching MRF lines		 $440–$607 $440–$607 varies
Ultrasound Exam Aaa Screen (76706) $528 $528 4.0×
Ultrasound, abdomen limited (76705) $570 $570 4.4×
Umbilical-artery Doppler (OB) (76820)
range across 4 matching MRF lines		 $526–$596 $526–$596 varies
Unlisted Dx Radiographic Procedure (76499) $385 $385 3.5×
Unlisted fluoroscopic procedure (76496) $440 $440 4.1×
Unlisted genitourinary px dx nuclear medicine (78799) $1,797 $1,797 3.6×
Unlisted magnetic resonance procedure (76498) $1,650 $1,650 15.2×
Unlisted Procedure Clinical Brachytherapy (77799) $605 $605 4.8×
Unlisted us procedure (76999) $328 $328 3.0×
Upper gi w/o kub (74240) $655 $655 3.0×
Ureteral Reflux Study (78740) $1,797 $1,797 3.6×
Urethrocystogram voiding (74455) $1,099 $1,099 3.7×
Urethrocystography retrograde (74450) $1,161 $1,161 3.9×
Us breast unilateral complete (76641) $193 $193 1.5×
Us chest (76604) $560 $560 4.3×
Us complete joint (76881) $578 $578 4.4×
Us exam, pelvic, limited (76857) $578 $578 4.4×
Us head (76506) $605 $605 4.6×
Us kidney transplant (76776) $580 $580 4.4×
Us lmtd joint/oth nonvasc xtr strux r-t w/img (76882) $575 $575 4.4×
Us ob detailed single fetus (76811) $880 $880 3.0×
Us ob limited 1 or more fetuses (76815) $528 $528 4.0×
Us ob transvaginal (76817) $534 $534 4.1×
Us pelvic non ob complete (76856) $680 $680 5.2×
Us pg uter img f&mat 14 wk tabdl 1/1st gestation (76801) $556 $556 4.3×
Us preg uterus real time f/u trnsabdl per fetus (76816) $539 $539 4.1×
Us retroperitoneal complete (76770) $600 $600 4.6×
Us retroperitoneal limited (76775) $545 $545 4.2×
Us scrotum and contents (76870) $633 $633 4.9×
Us spinal canal and contents (76800) $440 $440 3.4×
Us thyroid (76536)
range across 3 matching MRF lines		 $320–$570 $320–$570 varies
Us transrectal (76872) $526 $526 4.0×
Vascular Flow Imaging (78445) $1,797 $1,797 3.6×
Vein X-Ray Chest (75827)
range across 3 matching MRF lines		 $3,348–$3,617 $3,348–$3,617 varies
Vein X-Ray Liver W/O Hemodyn (75887) $3,692 $3,692 0.9×
Vein X-Ray Skull Epidural (75872) $3,516 $3,516 4.5×
Vein X-Ray Spleen/Liver (75810) $3,516 $3,516 0.9×
Venogram Sinus/Jugular (75860) $12,128 $12,128 3.1×
Venography Adrenal Unilateral (75840) $12,128 $12,128 3.1×
Venography caval inferior serialography rs&i (75825)
range across 2 matching MRF lines		 $11,550–$12,474 $11,550–$12,474 varies
Venography extremity bilateral rs&i (75822)
range across 2 matching MRF lines		 $3,464–$3,617 $3,464–$3,617 varies
Venography extremity unilateral rs&i (75820)
range across 2 matching MRF lines		 $3,189–$3,617 $3,189–$3,617 varies
Venography Orbital Rs&I (75880) $3,516 $3,516 4.5×
Venography Renal Bilateral (75833) $12,128 $12,128 3.1×
Venography Renal Unilateral (75831) $12,128 $12,128 3.1×
Venous sampling by catheter (75893) $20,161 $20,161 2.9×
Venous thrombosis imaging (78457) $5,851 $5,851 8.6×
Venous Thrombosis Imaging Venogram Bilateral (78458) $1,797 $1,797 3.6×
Wrist 2 views (73100) $400 $400 3.7×
X-Ray Ac Jts - Xr Acromioclavicular Joints Bilateral (73050) $391 $391 3.6×
X-ray antegrade pyelogram tube (74425) $2,310 $2,310 5.3×
X-Ray Aorta Leg Arteries (75630)
range across 2 matching MRF lines		 $11,550–$12,474 $11,550–$12,474 varies
X-Ray Bend Only L-S Spine (72120) $660 $660 5.1×
X-Ray Elbow 2 Vw - Xr Elbow 1-2 Views Right (73070) $415 $415 3.8×
X-Ray Exam Breast Specimen (76098)
range across 3 matching MRF lines		 $45–$2,371 $45–$2,371 varies
X-Ray Exam Entire Spi 1 Vw (72081) $330 $330 3.0×
X-Ray Exam Entire Spi 2/3 Vw (72082) $580 $580 4.4×
X-Ray Exam Entire Spi 4/5 Vw (72083) $1,161 $1,161 8.9×
X-Ray Exam Hip Uni 1 View (73501) $308 $308 2.8×
X-Ray Exam Hip Uni 2-3 Views (73502) $330 $330 3.0×
X-Ray Exam Hip Uni 4/> Views (73503) $605 $605 4.6×
X-Ray Exam Hips Bi 2 Views (73521) $580 $580 4.4×
X-Ray Exam Hips Bi 3-4 Views (73522) $580 $580 4.4×
X-Ray Exam Hips Bi 5/> Views (73523) $1,161 $1,161 8.9×
X-Ray Exam L-S Spine Bending (72114) $908 $908 7.0×
X-Ray Exam Neck Spine 2-3 Vw (72040) $470 $470 4.3×
X-Ray Exam Neck Spine 6/>Vws (72052) $880 $880 6.7×
X-Ray Exam Unilat Ribs/Chest (71101) $651 $651 5.0×
X-ray humerus (73060) $425 $425 3.9×
X-ray IV pyelogram (ivp) (74400) $1,161 $1,161 5.3×
X-ray IV pyelogram+tomography (74415) $1,161 $1,161 5.3×
X-Ray Jaw <4 Vw - Xr Mandible < 4 Views (70100) $308 $308 2.8×
X-Ray Knee Bilat Standing - Xr Knees Anteroposterior Standing Bilat (73565) $374 $374 3.4×
X-Ray Lumbar Spine 2/3 Vw - Xr Lumbar Spine 2-3 Views (72100) $580 $580 4.4×
X-ray nose-rectum child f.b. (76010) $325 $325 3.0×
X-Ray Ribs, Chest 4+ Vw - Xr Ribs 3 Vws Bil W/ Chest Posteroanterior (71111) $605 $605 4.6×
X-Ray Sacroiliac Jts 3+ Vw - Xr Sacroiliac Joints 3+ Views (72202) $580 $580 4.4×
X-Ray Sacroiliac Jts <3 Vw - Xr Sacroiliac Joints 1-2 Views (72200) $580 $580 4.4×
X-Ray Sacrum/Coccyx 2+ Vw - Xr Sacrum Coccyx 2+ Views (72220) $385 $385 3.5×
X-Ray Sinuses 3+ Vw - Xr Paranasal Sinuses 3+ Views (70220) $380 $380 3.5×
X-Ray Skull 4+ Vw - Xr Skull Complete 4+ Views (70260) $583 $583 4.5×
X-Ray Stress View (77071) $330 $330 3.0×
X-ray thoracic spine 4 vw (72074) $608 $608 4.7×
X-Ray Tmj Unilat (70328) $323 $323 3.0×
X-Ray Urinary Tract Exam With Contrast Material (74420) $2,310 $2,310 5.3×
X-Rays Bone Length Studies (77073) $385 $385 3.0×
X-Rays Bone Survey Complete (77075) $660 $660 5.1×
Xr c-spine 4 or 5 views (72050) $825 $825 6.3×
Xr facial bones less than 3 views (70140) $329 $329 3.0×
XR Mastoids < 3 Views Bilateral (70120) $580 $580 4.4×
Xr myelogram posterior fossa (70010) $2,310 $2,310 5.3×
Xr orbits complete 4 views (70200) $580 $580 4.4×

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.