Imaging prices at Mercy Hospital Springfield
Springfield, MO · every code in this section with a posted price and a Medicare benchmark.
444 codes. Prices are the hospital's own posted facility charges.
Compare against other hospitals interactively →
| Procedure | Posted cash | Posted gross | × Medicare |
|---|---|---|---|
| 3-D radiotherapy plan dose-volume histograms (77295) range across 2 matching MRF lines |
$5,493.15–$35,483.71 | $8,451–$54,590.33 | varies |
| Abdomen 1 View (74018) | $347.10 | $534 | 4.0× |
| Abdomen 2 views (74019) | $326.95 | $503 | 3.1× |
| Acute Gastrointestinal Blood Loss Imaging (78278) range across 2 matching MRF lines |
$643.50–$1,050.40 | $990–$1,616 | varies |
| Adrenal Cortex & Medulla Img (78075) | $2,867.15 | $4,411 | 2.2× |
| Angio internal mammary (75756) | $2,068.95 | $3,183 | 0.7× |
| Angio pulmonary bilat (75743) | $3,399.50 | $5,230 | 1.1× |
| Angiography Adrenal Bilateral Slctv Rs&I (75733) | $7,221.50 | $11,110 | 2.3× |
| Angiography extremity bilateral rs&i (75716) | $3,863.60 | $5,944 | 1.2× |
| Angiography extremity unilateral rs&i (75710) | $2,265.90 | $3,486 | 0.7× |
| Angiography pulmonary unilateral slctv rs&i (75741) | $2,232.75 | $3,435 | 0.7× |
| Angrph pulmonary nonslctv cath/ven njx rs&i (75746) | $6,602.70 | $10,158 | 2.1× |
| Ankle 2 views (73600) range across 6 matching MRF lines |
$211.90–$423.15 | $326–$651 | varies |
| Aortography thoracic serialography rs&i (75605) unusually low: confirm this is the full procedure |
$2,624.05 | $4,037 | 0.5× |
| Aortography thoracic w/o serialography rs&i (75600) | $3,093.35 | $4,759 | 1.0× |
| Artery X-Rays Abdomen (75726) | $3,515.20 | $5,408 | 0.6× |
| Artery X-Rays Adrenal Gland (75731) | $6,072.95 | $9,343 | 1.9× |
| Artery X-Rays Pelvis (75736) | $3,808.35 | $5,859 | 0.7× |
| Artery X-Rays Spine (75705) | $2,843.75 | $4,375 | 0.5× |
| Arthrogram ankle (73615) range across 3 matching MRF lines |
$844.35–$1,266.85 | $1,299–$1,949 | varies |
| Arthrogram hip (73525) range across 3 matching MRF lines |
$805.35–$1,235 | $1,239–$1,900 | varies |
| Arthrogram Wrist (73115) range across 3 matching MRF lines |
$988.65–$1,483.30 | $1,521–$2,282 | varies |
| Basic radiation dosimetry calculation (77300) range across 2 matching MRF lines |
$577.20–$46,314.58 | $888–$71,253.20 | varies |
| Bone age studies (77072) | $194.35 | $299 | 1.9× |
| Bone Imaging 3 Phase (78315) range across 2 matching MRF lines |
$1,842.75–$2,057.90 | $2,835–$3,166 | varies |
| Bone Imaging Limited Area (78300) range across 2 matching MRF lines |
$1,147.90–$1,381.25 | $1,766–$2,125 | varies |
| Bone Imaging Multiple Areas (78305) | $1,329.25 | $2,045 | 3.3× |
| Bone Imaging Whole Body (78306) range across 2 matching MRF lines |
$1,784.25–$2,017.60 | $2,745–$3,104 | varies |
| Bone marrow imaging limited area (78102) range across 2 matching MRF lines |
$699.40–$949 | $1,076–$1,460 | varies |
| Bone marrow imaging; multiple areas (78103) | $1,424.15 | $2,191 | 3.6× |
| Bone marrow imaging; whole body (78104) | $1,318.20 | $2,028 | 3.3× |
| Bone survey infant (77076) | $399.75 | $615 | 3.8× |
| Brachytx isodose complex (77318) | $3,342.30 | $5,142 | 8.9× |
| Brachytx isodose intermed (77317) range across 2 matching MRF lines |
$2,196.35–$25,431.17 | $3,379–$39,124.88 | varies |
| Brachytx Isodose Plan Simple (77316) range across 2 matching MRF lines |
$1,300–$29,050.45 | $2,000–$44,693 | varies |
| Brain Flow Imaging Only (78610) | $1,636.05 | $2,517 | 3.0× |
| Brain Image W/Flow < 4 Views (78601) | $663 | $1,020 | 1.7× |
| Brain imaging < 4 static views (78600) | $1,530.10 | $2,354 | 3.8× |
| Brain Imaging Min 4 Static Views W Vascular Flow (78606) | $2,260.05 | $3,477 | 4.2× |
| Brain Imaging Minimum 4 Static Views (78605) | $3,463.85 | $5,329 | 6.4× |
| Brain Imaging Pet Metabolic Evaluation (78608) range across 2 matching MRF lines |
$4,382.30–$5,746 | $6,742–$8,840 | varies |
| Card Bl Pool Gated Spect Rest Wal Motn Ejct Frct (78494) | $1,155.70 | $1,778 | 2.9× |
| Cardiac MRI w/w/o contrast & further seq (75561) | $2,048.80 | $3,152 | 5.9× |
| Cardiac MRI w/w/o contrast w/stress (75563) | $2,620.80 | $4,032 | 3.3× |
| Cardiac Shunt Detection (78428) | $1,448.85 | $2,229 | 3.6× |
| Cat Scan Follow-Up Study (76380) range across 2 matching MRF lines |
$583.05–$732.55 | $897–$1,127 | varies |
| Cerebrospinal Fluid Flow W/O Matl Shunt Evaltj (78645) range across 2 matching MRF lines |
$940.55–$2,132.65 | $1,447–$3,281 | varies |
| Cerebrospinal fluid flow, imaging (not including introduction of material); ventriculography Non-Facility (78635) | $1,585.35 | $2,439 | 2.9× |
| Cerebrospinal Fluid Scan (78630) | $1,588.60 | $2,444 | 2.9× |
| Chest 1 view (71045) | $286 | $440 | 3.3× |
| Chest 2 views (71046) | $361.40 | $556 | 4.1× |
| Chest 3 views (71047) | $412.75 | $635 | 4.7× |
| Chest 4 or more views (71048) | $438.75 | $675 | 4.2× |
| Clavicle complete (73000) range across 3 matching MRF lines |
$401.05–$601.90 | $617–$926 | varies |
| Computed Tomography Thorax Lw Dose Lng Ca Scr C- (71271) | $1,129.70 | $1,738 | 10.8× |
| Continuing medical physics consltj pr wk (77336) range across 2 matching MRF lines |
$676–$44,606.25 | $1,040–$68,625 | varies |
| Contrast Exam Abdominl Aorta (75625) | $2,146.95 | $3,303 | 0.7× |
| Contrast X-Ray Bladder (74430) | $793.65 | $1,221 | 2.3× |
| Contrast X-Ray Of Elbow (73085) range across 3 matching MRF lines |
$817.05–$1,225.25 | $1,257–$1,885 | varies |
| Contrast X-Ray Of Knee Joint (73580) range across 3 matching MRF lines |
$962–$1,443 | $1,480–$2,220 | varies |
| CT abdomen and pelvis without and with contrast (74178) | $4,526.60 | $6,964 | 13.0× |
| CT abdomen and pelvis without contrast (74176) | $3,736.20 | $5,748 | 15.6× |
| CT abdomen w contrast (74160) | $1,325.35 | $2,039 | 7.5× |
| CT abdomen w wo contrast (74170) range across 2 matching MRF lines |
$1,454.05–$2,304.25 | $2,237–$3,545 | varies |
| CT abdomen w/o contrast (74150) | $1,070.55 | $1,647 | 10.2× |
| CT Angio Abdomen and Pelvis (74174) | $3,564.60 | $5,484 | 10.2× |
| CT Angio Chest (71275) | $1,774.50 | $2,730 | 10.1× |
| CT Angio Head (70496) | $2,841.15 | $4,371 | 16.2× |
| CT angio hrt w/3d image (75574) | $1,907.75 | $2,935 | 5.5× |
| Ct Angio Lwr Extr W/O&W/Dye (73706) range across 3 matching MRF lines |
$2,156.70–$3,595.80 | $3,318–$5,532 | varies |
| CT Angio Neck (70498) | $2,967.90 | $4,566 | 16.9× |
| Ct Angio Upr Extrm W/O&W/Dye (73206) range across 3 matching MRF lines |
$2,349.10–$3,523 | $3,614–$5,420 | varies |
| CT Cere Prfuj Alys C+ W/O CT/Cta Same Anatomy (70473) | $706.55 | $1,087 | 4.0× |
| CT cervical spine w/ contrast (72126) | $2,450.50 | $3,770 | 7.0× |
| CT cervical spine w/o contrast (72125) | $2,314 | $3,560 | 22.1× |
| CT cervical spine w/wo cont (72127) | $2,722.20 | $4,188 | 15.5× |
| CT chest w contrast (71260) | $1,643.20 | $2,528 | 9.4× |
| CT chest w/wo contrast (71270) | $1,858.35 | $2,859 | 10.6× |
| CT Colonogrphy Dx Image Postprocess W/Contrast (74262) | $772.20 | $1,188 | 4.4× |
| CT colonogrphy dx image postprocess w/o contrast (74261) | $639.60 | $984 | 6.1× |
| CT head/brain with contrast (70460) | $2,139.15 | $3,291 | 12.2× |
| CT head/brain without and with contrast (70470) | $2,357.55 | $3,627 | 13.4× |
| CT heart contrast eval cardiac structure&morph (75572) | $770.90 | $1,186 | 2.2× |
| CT heart no contrast quant eval coronry calcium (75571) | $35.75 | $55 | 0.4× |
| CT hrt w/3d image congen (75573) | $2,403.05 | $3,697 | 6.9× |
| CT iac w contrast (70481) | $1,605.50 | $2,470 | 9.1× |
| CT l-spine w&w/o contrast (72133) | $2,045.55 | $3,147 | 11.6× |
| CT lower ext w/o (73700) range across 3 matching MRF lines |
$1,947.40–$2,629.25 | $2,996–$4,045 | varies |
| CT lower extremity w/contrast material (73701) range across 3 matching MRF lines |
$2,146.30–$2,951.65 | $3,302–$4,541 | varies |
| CT lumbar spine w contrast (72132) | $1,979.25 | $3,045 | 5.7× |
| CT lumbar spine w/o contrast (72131) | $1,670.50 | $2,570 | 16.0× |
| CT maxillofacial w contrast (70487) | $1,863.55 | $2,867 | 10.6× |
| CT maxillofacial wo contrast (70486) range across 2 matching MRF lines |
$1,405.30–$1,717.95 | $2,162–$2,643 | varies |
| CT neck tissue combo (70492) | $1,418.95 | $2,183 | 8.1× |
| Ct Orbit/Ear/Fossa W/O&W/Dye (70482) | $1,990.30 | $3,062 | 11.3× |
| CT orbits w/o contrast (70480) | $926.25 | $1,425 | 8.8× |
| CT pelvis w&w/o contrast (72194) | $2,460.25 | $3,785 | 14.0× |
| CT pelvis w/o contrast (72192) | $1,551.55 | $2,387 | 14.8× |
| CT scan of leg combo (73702) range across 3 matching MRF lines |
$2,299.05–$3,358.55 | $3,537–$5,167 | varies |
| CT scans face/jaw combo (70488) | $2,018.90 | $3,106 | 11.5× |
| CT soft tissue neck w contrast (70491) | $1,192.75 | $1,835 | 6.8× |
| CT soft tissue neck w/o contrast (70490) | $1,012.05 | $1,557 | 9.7× |
| CT thoracic spine w contrast (72129) | $1,937 | $2,980 | 11.0× |
| CT thoracic spine w/o contrast (72128) | $1,700.40 | $2,616 | 16.2× |
| CT thoracic spine w/wo cont (72130) | $2,994.55 | $4,607 | 17.0× |
| CT thorax w/o contrast (71250) | $1,448.20 | $2,228 | 13.8× |
| CT upper ext wo (73200) range across 3 matching MRF lines |
$1,964.30–$2,946.45 | $3,022–$4,533 | varies |
| CT upper extremity w/o & w/contrast material (73202) range across 2 matching MRF lines |
$2,526.55–$2,583.75 | $3,887–$3,975 | varies |
| CT upper extremity with contrast (73201) | $2,148.25 | $3,305 | 6.1× |
| Cta Abdl Aorta&Bi Iliofem W/Contrast&Postp (75635) | $2,695.55 | $4,147 | 15.3× |
| Cta Abdomen (74175) | $2,162.55 | $3,327 | 12.3× |
| CTA head&neck c+ w/noncontrast img&post-pxessing (70471) | $2,967.90 | $4,566 | 8.5× |
| CTA pelvis (72191) | $1,419.60 | $2,184 | 8.1× |
| Dilation ureters/urethra rs&i (74485) | $16,588.65 | $25,521 | 7.9× |
| Discography Cerv/Thor Spine (72285) | $4,724.20 | $7,268 | 2.4× |
| Diskography lumbar (72295) | $7,066.80 | $10,872 | 3.6× |
| Doppler Echo Fetal Puls Spectral F/U/Repeat (76828) | $465.40 | $716 | 4.4× |
| Doppler Echo Fetal Spectral Display Complete (76827) | $498.55 | $767 | 4.8× |
| Doppler Fetal Mid Cerebral Artery (76821) | $260.65 | $401 | 2.5× |
| Dxa Bone Density Axial (77080) | $384.15 | $591 | 3.7× |
| Dxa bone density study (77085) | $778.70 | $1,198 | 7.4× |
| Dxa bone density study 1/>sites appendiclr skel (77081) | $183.30 | $282 | 2.1× |
| Echo exam of fetal heart (76825) | $1,136.20 | $1,748 | 2.1× |
| Echo Guide For Artery Repair (76936) | $926.25 | $1,425 | 4.3× |
| Echocardiography, fetal, cardiovascular system, real time with image documentation (2D), with or without M-mode… (76826) | $1,184.30 | $1,822 | 5.0× |
| Echograp Trans R Pros Study (76873) | $910.65 | $1,401 | 8.7× |
| Esophageal Motility Study (78258) | $1,542.45 | $2,373 | 3.9× |
| Esophagram (74220) | $469.95 | $723 | 2.7× |
| Fetal Biophys Profile W/Nst (76818) | $845.65 | $1,301 | 8.1× |
| Fetal Biophysical Profile W/O Non-Stress Testing (76819) | $584.35 | $899 | 5.6× |
| Fetal MRI w/placntl matrnl plvc img sing/1st ges (74712) | $3,548.35 | $5,459 | 14.8× |
| Fluoroscopy up to 1 hr (76000) | $655.85 | $1,009 | 2.7× |
| Follow-Up Angiography (75898) | $887.25 | $1,365 | 0.3× |
| Foot 2 views (73620) range across 6 matching MRF lines |
$221.65–$369.85 | $341–$569 | varies |
| Forearm 2 views (73090) range across 5 matching MRF lines |
$312–$515.45 | $480–$793 | varies |
| Gastric emptying imaging study (78264) range across 2 matching MRF lines |
$1,517.10–$1,766.70 | $2,334–$2,718 | varies |
| Gastroesophageal Reflux Exam (78262) | $1,602.25 | $2,465 | 4.0× |
| Gated Heart Planar Single (78472) range across 2 matching MRF lines |
$1,099.15–$1,499.55 | $1,691–$2,307 | varies |
| Gated Heart, Multiple (78473) | $2,522.65 | $3,881 | 6.3× |
| Hand 2 views (73120) range across 6 matching MRF lines |
$189.80–$355.55 | $292–$547 | varies |
| Hdr Rdncl Ntrstl/Icav Brchtx (77772) | $5,963.10 | $9,174 | 8.5× |
| Hdr Rdncl Ntrstl/Icav Brchtx (77771) | $4,031.95 | $6,203 | 5.8× |
| Hdr Rdncl Ntrstl/Icav Brchtx 1 Channel (77770) | $3,461.90 | $5,326 | 5.0× |
| Heart first pass single,planar (78481) | $1,780.35 | $2,739 | 3.3× |
| Hepatc Vngrph Wdg/Fr Hemodyn Eval Rs&I (75889) | $2,210.65 | $3,401 | 0.7× |
| Hepatc Vngrph Wdg/Fr W/O Hemodyn Eval Rs&I (75891) | $3,409.25 | $5,245 | 1.1× |
| Hepatobil Syst Image W/Drug (78227) | $1,812.20 | $2,788 | 3.3× |
| Hepatobiliary System Imaging (78226) range across 2 matching MRF lines |
$1,860.95–$2,117.05 | $2,863–$3,257 | varies |
| Ht Musc Image Planar Mult (78454) | $5,094.05 | $7,837 | 3.9× |
| Ht Muscle Image Spect Sing (78451) | $1,287.65 | $1,981 | 1.0× |
| Hysterosalpingogram (74740) | $786.50 | $1,210 | 3.3× |
| Infant hip ultrasound with hip movement (dynamic) (76885) | $538.20 | $828 | 6.2× |
| Infant hip ultrasound, limited static exam (76886) | $258.70 | $398 | 3.0× |
| Infusion Ivp (74410) | $692.25 | $1,065 | 3.9× |
| Interstitial radiation source applic complex (77778) | $5,378.75 | $8,275 | 7.7× |
| Intracavitary Radiation Source Applic Complex (77763) | $6,435 | $9,900 | 9.2× |
| Intracavitary Radiation Source Applic Intermed (77762) | $5,141.50 | $7,910 | 9.3× |
| Intracavitary radiation source applic simple (77761) | $4,383.60 | $6,744 | 7.9× |
| Joint Survey Single View (77077) | $193.70 | $298 | 1.8× |
| K Flow/Funct Image W/Drug (78708) range across 2 matching MRF lines |
$1,430–$2,388.10 | $2,200–$3,674 | varies |
| K Flow/Funct Image W/O Drug (78707) range across 2 matching MRF lines |
$911.95–$1,869.40 | $1,403–$2,876 | varies |
| Kidney Imaging Morphol (78700) | $1,392.95 | $2,143 | 3.5× |
| Knee 3 Views (73562) range across 3 matching MRF lines |
$294.45–$442 | $453–$680 | varies |
| Leveen/Shunt Patency Exam (78291) | $809.25 | $1,245 | 2.0× |
| Liver & Spleen Imaging Static Only (78215) | $1,244.10 | $1,914 | 3.1× |
| Liver & Spleen Imaging W/Vascular Flow (78216) | $1,865.50 | $2,870 | 4.7× |
| Liver imaging static only (78201) range across 2 matching MRF lines |
$609.05–$47,298.41 | $937–$72,766.78 | varies |
| Liver imaging w/vascular flow (78202) | $2,147.60 | $3,304 | 3.9× |
| Lung Perf&Ventilat Diferentl (78598) | $1,845.35 | $2,839 | 3.4× |
| Lung perfusion differential (78597) | $834.60 | $1,284 | 2.1× |
| Lung Ventilat&Perfus Imaging (78582) | $1,539.85 | $2,369 | 2.8× |
| Lung Ventilation Imaging (78579) | $1,206.40 | $1,856 | 3.0× |
| Lymph System Imaging (78195) range across 2 matching MRF lines |
$921.05–$17,136.37 | $1,417–$26,363.64 | varies |
| Magnetic Image Jaw Joint (70336) | $1,631.50 | $2,510 | 6.8× |
| Magnetic Resonance Elastography (76391) | $1,420.25 | $2,185 | 5.9× |
| Mammary ductogram or galactogram multiple (77054) range across 3 matching MRF lines |
$969.15–$1,066.65 | $1,491–$1,641 | varies |
| Mammary ductogram or galactogram single (77053) range across 3 matching MRF lines |
$1,088.75–$1,113.45 | $1,675–$1,713 | varies |
| Meckels Divert Exam (78290) range across 2 matching MRF lines |
$925.60–$1,218.10 | $1,424–$1,874 | varies |
| Mlc imrt design & construction per imrt plan (77338) range across 2 matching MRF lines |
$4,273.75–$48,914.45 | $6,575–$75,253 | varies |
| Mra Head W/O & W/Contrast Material (70546) | $3,139.50 | $4,830 | 9.0× |
| MRA head w/o contrast (70544) | $1,875.25 | $2,885 | 7.8× |
| MRA neck w contrast (70548) | $2,301 | $3,540 | 6.6× |
| Mra Neck W/O &W/Contrast Material (70549) | $3,274.70 | $5,038 | 9.4× |
| MRA neck w/o contrast (70547) | $1,777.10 | $2,734 | 7.4× |
| MRI abdomen w contrast (74182) | $1,666.60 | $2,564 | 4.8× |
| MRI abdomen w/o contrast (74181) | $1,381.90 | $2,126 | 5.8× |
| MRI any jt lower extrem w/contrast material (73722) range across 3 matching MRF lines |
$2,783.30–$4,174.95 | $4,282–$6,423 | varies |
| MRI any jt lower extrem w/o & w/contrast matrl (73723) range across 3 matching MRF lines |
$3,025.10–$4,537.65 | $4,654–$6,981 | varies |
| MRI any jt upper extremity w/contrast matrl (73222) range across 3 matching MRF lines |
$3,147.30–$5,245.50 | $4,842–$8,070 | varies |
| MRI Breast W/O Contrast Bilateral (77047) | $2,661.10 | $4,094 | 11.1× |
| MRI Breast Without Contrast Material Unilateral (77046) | $2,152.80 | $3,312 | 9.0× |
| MRI cardiac w/o cont stress (75559) | $2,286.05 | $3,517 | 4.2× |
| MRI cardiac w/o contrast (75557) | $1,197.30 | $1,842 | 5.0× |
| MRI cervical spine w contrast (72142) | $2,916.55 | $4,487 | 8.3× |
| MRI cervical spine w/o cont (72141) | $2,731.30 | $4,202 | 11.4× |
| MRI chest w/o contrast (71550) | $1,520.35 | $2,339 | 6.4× |
| MRI chest wo w contrast (71552) | $2,991.30 | $4,602 | 8.6× |
| MRI lower extrem oth/thn jt w/contrast matrl (73719) | $1,732.90 | $2,666 | 5.0× |
| MRI lower extrem oth/thn jt w/o & w/contr matr (73720) range across 3 matching MRF lines |
$1,860.30–$2,790.45 | $2,862–$4,293 | varies |
| MRI lower extrem oth/thn jt w/o contr matrl (73718) range across 3 matching MRF lines |
$1,470.95–$2,206.75 | $2,263–$3,395 | varies |
| MRI lumbar spine w contrast (72149) | $1,893.45 | $2,913 | 5.4× |
| Mri Neck Spine W/O & W/Dye (72156) | $2,999.10 | $4,614 | 8.6× |
| MRI orbit face &/neck w/o contrast (70540) | $1,342.25 | $2,065 | 5.6× |
| MRI orbit face neck w contrast (70542) | $2,668.90 | $4,106 | 7.6× |
| Mri Orbt/Fac/Nck W/O &W/Dye (70543) range across 2 matching MRF lines |
$2,978.95–$3,045.90 | $4,583–$4,686 | varies |
| MRI pelvis w contrast (72196) | $2,414.10 | $3,714 | 6.9× |
| MRI pelvis w/o & w contrast (72197) | $2,056.60 | $3,164 | 5.9× |
| MRI pelvis w/o contrast (72195) | $2,912 | $4,480 | 12.2× |
| MRI spectroscopy (76390) | $3,474.90 | $5,346 | 39.9× |
| MRI thoracic spine w/o contrast (72146) | $1,665.95 | $2,563 | 7.0× |
| MRI upper extremity oth than jt w/contr matrl (73219) | $2,349.10 | $3,614 | 6.7× |
| MRI upper extremity oth than jt w/o contr matrl (73218) range across 3 matching MRF lines |
$2,211.30–$3,317.60 | $3,402–$5,104 | varies |
| Mri Uppr Extremity W/O&W/Dye (73220) range across 3 matching MRF lines |
$2,502.50–$3,754.40 | $3,850–$5,776 | varies |
| MRI, abdomen, combo (74183) | $2,087.80 | $3,212 | 6.0× |
| MRI, dorsal spine combo (72157) | $3,141.45 | $4,833 | 9.0× |
| MRI, dorsal spine contrast (72147) | $1,948.70 | $2,998 | 5.6× |
| MRI, joint upper extrem (73221) range across 3 matching MRF lines |
$2,925–$4,387.50 | $4,500–$6,750 | varies |
| MRI, joint upper extrem combo (73223) range across 3 matching MRF lines |
$3,339.70–$5,010.20 | $5,138–$7,708 | varies |
| MRI, lumbar spine combo (72158) | $2,998.45 | $4,613 | 8.6× |
| Myelogram cervical (72240) | $2,481.70 | $3,818 | 3.2× |
| Myelogram Lumbar (72265) | $1,315.60 | $2,024 | 1.7× |
| Myelography thoracic (72255) | $2,150.85 | $3,309 | 2.7× |
| Myelograpy 2/more regions rs&i (72270) | $2,256.15 | $3,471 | 2.9× |
| Myocardial Imaging Infarct Avid Planar Qual/Quan (78466) | $1,770.60 | $2,724 | 4.4× |
| Myocardial Imaging Pet Metabolic Evaluation (78459) | $4,478.50 | $6,890 | 3.5× |
| Myocardial Perfusion Planar 1 Study Rest/Stress (78453) | $3,873.35 | $5,959 | 3.0× |
| Myocardial Spect Multiple Studies (78452) range across 2 matching MRF lines |
$3,091.40–$4,978.67 | $4,756–$7,659.50 | varies |
| Myocrd Img Pet Metab Eval Single Study Cncrnt CT (78429) | $5,225.35 | $8,039 | 3.6× |
| Myocrd img PET prfuj 1std rest/stress cncrnt CT (78430) | $5,651.75 | $8,695 | 3.9× |
| Myocrd Img Pet Prfuj Mlt Std Rst&Strs Cncrnt CT (78431) range across 2 matching MRF lines |
$7,402.20–$10,256.02 | $11,388–$15,778.50 | varies |
| Myocrd Img Pet Prfuj W/Metab 2rtracer Cncrnt CT (78433) | $7,919.60 | $12,184 | 3.6× |
| Myocrd Img Pet Prfuj W/Metab Dual Radiotracer (78432) | $8,972.60 | $13,804 | 5.9× |
| N-invas est c ffr sw aly CTA (75580) | $3,226.60 | $4,964 | 3.8× |
| Neck soft tissue (70360) | $234.65 | $361 | 2.7× |
| Njx Rp Loclzj Non-Img Probe Study Intravenous (78808) | $733.20 | $1,128 | 1.8× |
| Nm csf leak detection (78650) | $1,271.40 | $1,956 | 1.0× |
| Nm myocard infarct spect (78469) range across 2 matching MRF lines |
$857.35–$1,084.20 | $1,319–$1,668 | varies |
| Nm whole blood volume (78122) | $1,988.35 | $3,059 | 3.7× |
| Ntsty modul radthx pln dose-vol histos (77301) range across 2 matching MRF lines |
$7,382.05–$48,826.70 | $11,357–$75,118 | varies |
| Nuclear Rx Intra-Arterial (79445) range across 2 matching MRF lines |
$560.30–$49,612.48 | $862–$76,326.90 | varies |
| Nuclear Rx Oral Admin (79005) range across 2 matching MRF lines |
$1,460.55–$18,830.50 | $2,247–$28,970 | varies |
| Oph bmtry us echograpy a-scan io lens pwr cal (76519) range across 2 matching MRF lines |
$52–$107.90 | $80–$166 | varies |
| Oph us dx ant sgm us immersion b-scan/hr biom (76513) range across 2 matching MRF lines |
$62.40–$107.90 | $96–$166 | varies |
| Oph US Dx B-Scan&Quan a-Scan Sm Pt Enctr (76510) range across 2 matching MRF lines |
$92.95–$181.35 | $143–$279 | varies |
| Ophthalmic ultrasound dx b-scan w/wo a-scan (76512) range across 2 matching MRF lines |
$37.05–$395.85 | $57–$609 | varies |
| Ophthalmic US Dx Corneal Pachymetry Uni/Bi (76514) range across 2 matching MRF lines |
$11.05–$29.25 | $17–$45 | varies |
| Optic foramina (70190) | $397.80 | $612 | 4.6× |
| Panoramic X-ray of jaws (70355) | $183.95 | $283 | 2.1× |
| Parathyroid Planar Imaging (78070) | $934.05 | $1,437 | 2.3× |
| Parathyroid planar imaging w/wo subtraction (78071) range across 2 matching MRF lines |
$950.30–$1,446.25 | $1,462–$2,225 | varies |
| Pelvis 1 or 2 views (72170) | $348.40 | $536 | 3.3× |
| Perineogram (74775) | $496.60 | $764 | 2.1× |
| Peritoneogram Rs&I (74190) | $871 | $1,340 | 1.6× |
| Pet Image Skull-Thigh (78812) | $4,589 | $7,060 | 3.2× |
| Pet Image W/Ct Lmtd (78814) range across 2 matching MRF lines |
$3,396.90–$7,386.60 | $5,226–$11,364 | varies |
| PET image w/CT, full body (78816) range across 2 matching MRF lines |
$6,296.55–$7,660.25 | $9,687–$11,785 | varies |
| PET imaging CT attenuation skull base mid-thigh (78815) range across 2 matching MRF lines |
$5,941.65–$7,312.50 | $9,141–$11,250 | varies |
| Pet Imaging Limited Area Chest Head/Neck (78811) | $6,535.75 | $10,055 | 5.0× |
| PET whole body (78813) | $4,824.30 | $7,422 | 3.4× |
| Pulmonary Perfusion Imaging Particulate (78580) range across 2 matching MRF lines |
$478.40–$775.45 | $736–$1,193 | varies |
| Radex Abd Compl Aqt Abd W/S/E/D Views 1 View Ch (74022) | $532.35 | $819 | 5.1× |
| Radex abscess/fistula/sinus tract rs&i (76080) | $529.10 | $814 | 1.0× |
| Radex Ankle Complete Minimum 3 Views (73610) range across 3 matching MRF lines |
$407.55–$611 | $627–$940 | varies |
| Radex Calcaneus Minimum 2 Views (73650) range across 3 matching MRF lines |
$288.60–$432.90 | $444–$666 | varies |
| Radex elbow complete minimum 3 views (73080) range across 3 matching MRF lines |
$319.15–$478.40 | $491–$736 | varies |
| Radex Facial Bones Complete Minimum 3 Views (70150) | $256.10 | $394 | 2.4× |
| Radex fingr minimum 2 views (73140) range across 3 matching MRF lines |
$312–$466.70 | $480–$718 | varies |
| Radex foot complete minimum 3 views (73630) range across 3 matching MRF lines |
$395.20–$593.45 | $608–$913 | varies |
| Radex Hand Minimum 3 Views (73130) range across 3 matching MRF lines |
$405.60–$609.05 | $624–$937 | varies |
| Radex lower extremity infant minimum 2 views (73592) range across 3 matching MRF lines |
$178.10–$267.15 | $274–$411 | varies |
| Radex Mastoids Compl Minimum 3 Views PR Side (70130) | $278.85 | $429 | 2.7× |
| Radex Nasal Bones Complete Minimum 3 Views (70160) | $193.70 | $298 | 2.2× |
| Radex Ribs Unilateral 2 Views (71100) | $281.45 | $433 | 3.2× |
| Radex shoulder complete minimum 2 views (73030) range across 3 matching MRF lines |
$409.50–$614.25 | $630–$945 | varies |
| Radex Sinuses Paransl < 3 Views (70210) | $185.25 | $285 | 2.1× |
| Radex sm int w/mlt srl imges via enteroclss tube (74251) | $1,157.65 | $1,781 | 6.6× |
| Radex Spine 1 View Specify Level (72020) | $308.75 | $475 | 3.5× |
| Radex Sternum Minimum 2 Views (71120) | $196.30 | $302 | 2.3× |
| Radex Temporomandble Jt Opn & Clsd Mouth Bilat (70330) | $319.80 | $492 | 3.7× |
| Radex Toe Minimum 2 Views (73660) range across 3 matching MRF lines |
$315.25–$472.55 | $485–$727 | varies |
| Radex upper extremity infant minimum 2 views (73092) range across 3 matching MRF lines |
$377–$564.20 | $580–$868 | varies |
| Radex Wrist Complete Minimum 3 Views (73110) range across 3 matching MRF lines |
$403–$605.15 | $620–$931 | varies |
| Radex X-Ray Exam Entire Spi 6/> Vw - Xr Entire Spine 6+ Vw (72084) | $731.90 | $1,126 | 7.0× |
| Radiation Delivery Stereotactic Cranial Linear (77372) range across 2 matching MRF lines |
$19,317.35–$36,708.10 | $29,719–$56,474 | varies |
| Radiation treatment delivery level 1 (77402) range across 2 matching MRF lines |
$522.60–$10,626.85 | $804–$16,349 | varies |
| Radiation treatment delivery level 2 (77407) range across 2 matching MRF lines |
$2,849.60–$36,752.30 | $4,384–$56,542 | varies |
| Radiation treatment delivery level 3 (77412) range across 2 matching MRF lines |
$3,816.15–$23,122.45 | $5,871–$35,573 | varies |
| Radiolog exam mandible compl minimum 4 views (70110) | $270.40 | $416 | 2.6× |
| Radiologic Exam Abdomen 3+ Views - Xr Abdomen 3+ Views (74021) | $352.95 | $543 | 3.4× |
| Radiologic exam colon double contrast study (74280) | $633.75 | $975 | 3.6× |
| Radiologic exam colon single contrast study (74270) | $755.30 | $1,162 | 4.3× |
| Radiologic Exam Esophagus Double Contrast Study (74221) | $687.05 | $1,057 | 3.9× |
| Radiologic exam knee complete 4/more views (73564) range across 3 matching MRF lines |
$398.45–$596.70 | $613–$918 | varies |
| Radiologic exam pelvis compl minimum 3 views (72190) | $342.55 | $527 | 3.3× |
| Radiologic Exam Small Int Single Contrast Study (74250) | $426.40 | $656 | 2.4× |
| Radiologic exam swallow function contrast study (74230) | $482.30 | $742 | 2.7× |
| Radiologic exam upr gi trc double contrast study (74246) | $458.90 | $706 | 2.6× |
| Radiologic examination femur 1 view (73551) | $266.50 | $410 | 3.1× |
| Radiologic examination femur minimum 2 views (73552) range across 3 matching MRF lines |
$345.15–$517.40 | $531–$796 | varies |
| Radiologic examination knee 1/2 views (73560) range across 3 matching MRF lines |
$291.20–$435.50 | $448–$670 | varies |
| Radiologic examination tibia & fibula 2 views (73590) range across 5 matching MRF lines |
$323.05–$516.10 | $497–$794 | varies |
| Radiopharm Dacryocystography (78660) | $869.05 | $1,337 | 2.2× |
| Radiopharmaceutical therapy, by intracavitary administration Non-Facility (79200) | $2,573.35 | $3,959 | 11.0× |
| Red Cell Volume Determination Spx 1 Sampling (78120) | $1,216.15 | $1,871 | 3.0× |
| Ribs bilateral 3 views (71110) | $292.50 | $450 | 2.8× |
| Rp loclzj tum plnr 1 area single day imaging (78800) range across 2 matching MRF lines |
$951.60–$3,680.95 | $1,464–$5,663 | varies |
| Rp loclzj tum plnr 2+area 1+d img/1 area img>2+d (78801) | $2,189.85 | $3,369 | 5.5× |
| Rp Loclzj Tum Plnr Whole Body 2+ Days Imaging (78804) | $1,866.15 | $2,871 | 3.4× |
| Rp Loclzj Tum Plnr Whole Body Single Day Imaging (78802) range across 2 matching MRF lines |
$1,235.65–$3,965 | $1,901–$6,100 | varies |
| Rp Loclzj Tum Spect 1 Area Single Day Imaging (78803) range across 2 matching MRF lines |
$2,294.50–$8,957 | $3,530–$13,780 | varies |
| Rp loclzj tum spect 2 area/sep acquisj img (78831) | $3,162.90 | $4,866 | 2.4× |
| Rp loclzj tum spect CT 2area 1d img/1 ar img>2+d (78832) | $4,284.80 | $6,592 | 3.0× |
| Rp loclzj tum spect w/CT 1 area/acquisj 1day img (78830) | $3,747.25 | $5,765 | 2.9× |
| Rp Ther Radiolbld Monoclonal Antibody IV Infus (79403) | $1,131 | $1,740 | 4.8× |
| Rp Therapy Intravenous Administration (79101) range across 2 matching MRF lines |
$863.20–$87,648.60 | $1,328–$134,844 | varies |
| Salivary Gland Imaging Serial Images (78231) | $878.80 | $1,352 | 2.2× |
| Scapula (73010) range across 3 matching MRF lines |
$305.50–$458.25 | $470–$705 | varies |
| Screening Digital Breast Tomosynthesis Bi (77063) range across 6 matching MRF lines |
$63.05–$114.40 | $97–$176 | varies |
| Sella turcica (70240) | $224.25 | $345 | 2.6× |
| Shoulder 1 view (73020) range across 3 matching MRF lines |
$222.95–$334.10 | $343–$514 | varies |
| Shoulder Arthrography (73040) range across 3 matching MRF lines |
$1,017.25–$1,525.55 | $1,565–$2,347 | varies |
| Sialogram (70390) | $789.75 | $1,215 | 3.3× |
| Skull less than 4 views (70250) | $322.40 | $496 | 3.1× |
| Special dosimetry (77331) | $419.90 | $646 | 3.1× |
| Special Physics Consult (77370) range across 2 matching MRF lines |
$741–$73,102.90 | $1,140–$112,466 | varies |
| Special teletherapy port plan (77321) range across 2 matching MRF lines |
$817.70–$9,573.85 | $1,258–$14,729 | varies |
| Special treatment procedure (77470) range across 2 matching MRF lines |
$2,355.60–$50,831.28 | $3,624–$78,201.97 | varies |
| Spleen Imaging (78185) | $1,515.15 | $2,331 | 3.8× |
| Stereotactic Body Radiation Delivery (77373) range across 2 matching MRF lines |
$14,177.80–$71,565 | $21,812–$110,100 | varies |
| Sternoclavicular joints (71130) | $338.65 | $521 | 3.9× |
| Superior sagittal sinus venogram (75870) | $2,284.75 | $3,515 | 0.7× |
| Surface Applic Low Dose Rate Radionuclide Source (77789) | $828.10 | $1,274 | 8.1× |
| Telethx isodose pln cplx w/basic dosimetry (77307) range across 2 matching MRF lines |
$2,632.50–$22,783.80 | $4,050–$35,052 | varies |
| Telethx isodose pln smpl w/dosimetry calculation (77306) | $1,450.80 | $2,232 | 3.9× |
| Temporomandble Jt Arthrography Rs&I (70332) | $2,522.65 | $3,881 | 10.6× |
| Testicular Imaging W/Flow (78761) | $1,015.95 | $1,563 | 2.5× |
| Ther Rad Simulaj-Aided Field Setting Complex (77290) range across 2 matching MRF lines |
$2,416.05–$34,732.10 | $3,717–$53,434 | varies |
| Ther Rad Simulaj-Aided Field Setting Intermed (77285) | $1,458.60 | $2,244 | 3.9× |
| Ther rad simulaj-aided field setting simple (77280) range across 2 matching MRF lines |
$884.65–$29,050.45 | $1,361–$44,693 | varies |
| Therapeutic Enema Rdctj Intussusception/Obstrcj (74283) | $897.65 | $1,381 | 5.1× |
| Thoracic spine 2 views (72070) | $377 | $580 | 3.6× |
| Thoracic spine 3 views (72072) | $469.30 | $722 | 4.5× |
| Thoracolumbar 2 views (72080) | $302.90 | $466 | 3.5× |
| Thyroid Carcinoma Metastases Img Lmtd Area (78015) | $1,279.85 | $1,969 | 3.2× |
| Thyroid Imaging With Vascular Flow (78013) | $577.20 | $888 | 1.4× |
| Thyroid Met Imaging Body (78018) | $1,735.50 | $2,670 | 3.2× |
| Thyroid Uptake Measurement (78012) | $420.55 | $647 | 1.1× |
| Thyroid Uptake W/Blood Flow Sngle/Mult Quan Meas (78014) range across 2 matching MRF lines |
$1,294.80–$2,747.55 | $1,992–$4,227 | varies |
| Tx Devices Design & Construction Complex (77334) range across 2 matching MRF lines |
$1,370.85–$43,001.40 | $2,109–$66,156 | varies |
| Tx devices design & construction intermediate (77333) range across 2 matching MRF lines |
$1,115.40–$30,334.85 | $1,716–$46,669 | varies |
| Tx devices design & construction simple (77332) range across 2 matching MRF lines |
$884.65–$61,327.50 | $1,361–$94,350 | varies |
| Ultrasound Breast Limited (76642) range across 3 matching MRF lines |
$485.55–$809.25 | $747–$1,245 | varies |
| Ultrasound elastography first target lesion (76982) | $748.80 | $1,152 | 7.2× |
| Ultrasound Elastography Parenchyma (76981) | $377 | $580 | 3.6× |
| Ultrasound Exam Aaa Screen (76706) | $274.30 | $422 | 2.6× |
| Ultrasound, abdomen limited (76705) | $720.85 | $1,109 | 6.9× |
| Umbilical-artery Doppler (OB) (76820) | $241.80 | $372 | 2.3× |
| Unlisted fluoroscopic procedure (76496) | $672.10 | $1,034 | 7.7× |
| Unlisted magnetic resonance procedure (76498) | $1,298.70 | $1,998 | 14.9× |
| Unlisted Procedure Clinical Brachytherapy (77799) | $3,841.50 | $5,910 | 37.6× |
| Unlisted us procedure (76999) | $212.55 | $327 | 2.4× |
| Upper gi w/o kub (74240) | $635.05 | $977 | 3.6× |
| Urea Breath Test C-14 Isotopic Acquisj Analysis (78267) | $412.75 | $635 | 37.3× |
| Urea breath test c-14 isotopic analysis (78268) | $550.55 | $847 | 5.8× |
| Ureteral Reflux Study (78740) | $832.65 | $1,281 | 2.1× |
| Urethrocystogram voiding (74455) | $949.65 | $1,461 | 4.0× |
| Urethrocystography retrograde (74450) | $663 | $1,020 | 2.8× |
| Us breast unilateral complete (76641) range across 3 matching MRF lines |
$672.10–$1,007.50 | $1,034–$1,550 | varies |
| Us chest (76604) range across 2 matching MRF lines |
$462.15–$529.75 | $711–$815 | varies |
| Us complete joint (76881) range across 3 matching MRF lines |
$580.45–$776.75 | $893–$1,195 | varies |
| Us exam, pelvic, limited (76857) | $573.95 | $883 | 5.5× |
| Us head (76506) | $571.35 | $879 | 5.5× |
| Us kidney transplant (76776) | $475.80 | $732 | 4.5× |
| Us lmtd joint/oth nonvasc xtr strux r-t w/img (76882) range across 3 matching MRF lines |
$637.65–$955.50 | $981–$1,470 | varies |
| Us ob detailed single fetus (76811) | $552.50 | $850 | 2.3× |
| Us ob limited 1 or more fetuses (76815) | $433.55 | $667 | 4.1× |
| Us ob transvaginal (76817) | $590.85 | $909 | 5.6× |
| Us pelvic non ob complete (76856) | $902.20 | $1,388 | 8.6× |
| Us pg uter img f&mat 14 wk tabdl 1/1st gestation (76801) | $830.05 | $1,277 | 7.9× |
| Us preg uterus real time f/u trnsabdl per fetus (76816) | $347.10 | $534 | 3.3× |
| Us retroperitoneal complete (76770) | $769.60 | $1,184 | 7.3× |
| Us retroperitoneal limited (76775) | $365.30 | $562 | 3.5× |
| Us scrotum and contents (76870) | $867.75 | $1,335 | 8.3× |
| Us spinal canal and contents (76800) | $412.10 | $634 | 3.9× |
| Us thyroid (76536) range across 2 matching MRF lines |
$42.90–$823.55 | $66–$1,267 | varies |
| Us transrectal (76872) | $395.20 | $608 | 3.8× |
| Vascular Flow Imaging (78445) | $1,866.80 | $2,872 | 4.7× |
| Vein X-Ray Chest (75827) | $1,866.15 | $2,871 | 1.2× |
| Vein X-Ray Skull Epidural (75872) | $1,465.75 | $2,255 | 2.3× |
| Venogram Sinus/Jugular (75860) | $2,601.30 | $4,002 | 0.8× |
| Venography caval inferior serialography rs&i (75825) | $2,178.80 | $3,352 | 0.7× |
| Venography extremity bilateral rs&i (75822) | $1,502.80 | $2,312 | 1.0× |
| Venography extremity unilateral rs&i (75820) | $1,275.30 | $1,962 | 0.8× |
| Venography Orbital Rs&I (75880) | $1,580.80 | $2,432 | 2.5× |
| Venography Renal Bilateral (75833) | $3,121.30 | $4,802 | 1.0× |
| Venography Renal Unilateral (75831) | $2,106 | $3,240 | 0.7× |
| Venous sampling by catheter (75893) | $3,000.40 | $4,616 | 0.5× |
| Venous thrombosis imaging (78457) | $1,143.35 | $1,759 | 2.1× |
| Venous Thrombosis Imaging Venogram Bilateral (78458) | $1,441.05 | $2,217 | 3.6× |
| Vertebral fracture assessment via dxa (77086) | $298.35 | $459 | 3.4× |
| Wrist 2 views (73100) range across 5 matching MRF lines |
$180.70–$471.90 | $278–$726 | varies |
| X-Ray Ac Jts - Xr Acromioclavicular Joints Bilateral (73050) | $293.80 | $452 | 3.4× |
| X-ray antegrade pyelogram tube (74425) | $392.60 | $604 | 1.1× |
| X-Ray Aorta Leg Arteries (75630) | $3,450.20 | $5,308 | 1.1× |
| X-Ray Bend Only L-S Spine (72120) | $405.60 | $624 | 3.9× |
| X-Ray Elbow 2 Vw - Xr Elbow 1-2 Views Right (73070) range across 6 matching MRF lines |
$299.65–$419.90 | $461–$646 | varies |
| X-Ray Exam Breast Specimen (76098) range across 3 matching MRF lines |
$344.50–$516.10 | $530–$794 | varies |
| X-Ray Exam Entire Spi 1 Vw (72081) | $229.45 | $353 | 2.6× |
| X-Ray Exam Entire Spi 2/3 Vw (72082) | $333.45 | $513 | 3.2× |
| X-Ray Exam Entire Spi 4/5 Vw (72083) | $648.05 | $997 | 6.2× |
| X-Ray Exam Hip Uni 1 View (73501) | $262.60 | $404 | 3.0× |
| X-Ray Exam Hip Uni 2-3 Views (73502) | $310.70 | $478 | 3.6× |
| X-Ray Exam Hip Uni 4/> Views (73503) | $365.95 | $563 | 3.5× |
| X-Ray Exam Hips Bi 2 Views (73521) | $514.15 | $791 | 4.9× |
| X-Ray Exam Hips Bi 3-4 Views (73522) | $681.85 | $1,049 | 6.5× |
| X-Ray Exam Hips Bi 5/> Views (73523) | $871.65 | $1,341 | 8.3× |
| X-Ray Exam L-S Spine Bending (72114) | $384.80 | $592 | 3.7× |
| X-Ray Exam Neck Spine 2-3 Vw (72040) | $447.20 | $688 | 5.1× |
| X-Ray Exam Neck Spine 6/>Vws (72052) | $491.40 | $756 | 4.7× |
| X-Ray Exam Unilat Ribs/Chest (71101) range across 2 matching MRF lines |
$388.70–$583.70 | $598–$898 | varies |
| X-ray eye for foreign body (70030) | $339.95 | $523 | 3.9× |
| X-ray humerus (73060) range across 5 matching MRF lines |
$300.30–$540.80 | $462–$832 | varies |
| X-ray IV pyelogram (ivp) (74400) | $1,099.15 | $1,691 | 6.3× |
| X-ray IV pyelogram+tomography (74415) | $989.95 | $1,523 | 5.6× |
| X-Ray Jaw <4 Vw - Xr Mandible < 4 Views (70100) | $212.55 | $327 | 2.4× |
| X-Ray Knee Bilat Standing - Xr Knees Anteroposterior Standing Bilat (73565) | $202.15 | $311 | 2.3× |
| X-Ray Lumbar Spine 2/3 Vw - Xr Lumbar Spine 2-3 Views (72100) | $439.40 | $676 | 4.2× |
| X-ray nose-rectum child f.b. (76010) | $287.95 | $443 | 3.3× |
| X-Ray Ribs, Chest 4+ Vw - Xr Ribs 3 Vws Bil W/ Chest Posteroanterior (71111) | $463.45 | $713 | 4.4× |
| X-Ray Sacroiliac Jts 3+ Vw - Xr Sacroiliac Joints 3+ Views (72202) | $227.50 | $350 | 2.2× |
| X-Ray Sacroiliac Jts <3 Vw - Xr Sacroiliac Joints 1-2 Views (72200) | $291.20 | $448 | 2.8× |
| X-Ray Sacrum/Coccyx 2+ Vw - Xr Sacrum Coccyx 2+ Views (72220) | $289.90 | $446 | 3.3× |
| X-Ray Sinuses 3+ Vw - Xr Paranasal Sinuses 3+ Views (70220) | $237.25 | $365 | 2.7× |
| X-Ray Skull 4+ Vw - Xr Skull Complete 4+ Views (70260) | $319.80 | $492 | 3.1× |
| X-ray thoracic spine 4 vw (72074) | $378.95 | $583 | 3.6× |
| X-Ray Tmj Unilat (70328) | $175.50 | $270 | 2.0× |
| X-Ray Urinary Tract Exam With Contrast Material (74420) | $793.65 | $1,221 | 2.3× |
| X-Rays Bone Length Studies (77073) | $212.55 | $327 | 2.0× |
| X-Rays Bone Survey Complete (77075) | $559.65 | $861 | 5.3× |
| Xr c-spine 4 or 5 views (72050) | $592.15 | $911 | 5.7× |
| Xr facial bones less than 3 views (70140) | $214.50 | $330 | 2.5× |
| XR Mastoids < 3 Views Bilateral (70120) | $350.35 | $539 | 3.3× |
| Xr orbits complete 4 views (70200) | $288.60 | $444 | 2.8× |
| Xr Tomogram Single Plane (76100) | $702.65 | $1,081 | 6.7× |
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.