Imaging prices at Mercy Hospital St. Louis
St. Louis, MO · every code in this section with a posted price and a Medicare benchmark.
460 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 |
$6,821.10–$97,268.76 | $10,494–$149,644.25 | varies |
| Abdomen 1 View (74018) | $228.80 | $352 | 2.6× |
| Abdomen 2 views (74019) | $302.25 | $465 | 2.9× |
| Acute Gastrointestinal Blood Loss Imaging (78278) | $734.50 | $1,130 | 1.8× |
| Angio internal mammary (75756) | $1,368.25 | $2,105 | 0.4× |
| Angio pulmonary bilat (75743) | $2,432.95 | $3,743 | 0.8× |
| Angiography Adrenal Bilateral Slctv Rs&I (75733) | $3,222.70 | $4,958 | 1.0× |
| Angiography extremity bilateral rs&i (75716) | $4,236.05 | $6,517 | 1.3× |
| Angiography extremity unilateral rs&i (75710) | $2,823.60 | $4,344 | 0.9× |
| Angiography pulmonary unilateral slctv rs&i (75741) | $1,621.75 | $2,495 | 0.5× |
| Angrph pulmonary nonslctv cath/ven njx rs&i (75746) | $1,436.50 | $2,210 | 0.5× |
| Ankle 2 views (73600) range across 6 matching MRF lines |
$217.75–$390 | $335–$600 | varies |
| Aortography thoracic serialography rs&i (75605) | $3,425.50 | $5,270 | 0.6× |
| Aortography thoracic w/o serialography rs&i (75600) | $2,570.10 | $3,954 | 0.8× |
| Artery X-Rays Abdomen (75726) | $3,829.15 | $5,891 | 0.7× |
| Artery X-Rays Adrenal Gland (75731) | $2,652.65 | $4,081 | 0.8× |
| Artery X-Rays Pelvis (75736) | $3,063.45 | $4,713 | 0.5× |
| Artery X-Rays Spine (75705) | $3,284.45 | $5,053 | 0.6× |
| Arthrogram ankle (73615) | $638.30 | $982 | 1.8× |
| Arthrogram hip (73525) range across 3 matching MRF lines |
$721.50–$1,082.25 | $1,110–$1,665 | varies |
| Arthrogram Wrist (73115) range across 3 matching MRF lines |
$551.85–$828.10 | $849–$1,274 | varies |
| Basic radiation dosimetry calculation (77300) range across 2 matching MRF lines |
$715–$59,719.40 | $1,100–$91,876 | varies |
| Bone age studies (77072) | $292.50 | $450 | 2.8× |
| Bone Imaging 3 Phase (78315) range across 2 matching MRF lines |
$1,261–$1,395.55 | $1,940–$2,147 | varies |
| Bone Imaging Limited Area (78300) range across 2 matching MRF lines |
$660.40–$794.95 | $1,016–$1,223 | varies |
| Bone Imaging Multiple Areas (78305) | $826.80 | $1,272 | 2.1× |
| Bone Imaging Whole Body (78306) range across 2 matching MRF lines |
$967.20–$1,108.90 | $1,488–$1,706 | varies |
| Bone marrow imaging limited area (78102) | $514.80 | $792 | 1.3× |
| Bone marrow imaging; multiple areas (78103) | $1,039.35 | $1,599 | 2.6× |
| Bone marrow imaging; whole body (78104) | $1,099.80 | $1,692 | 2.7× |
| Bone survey infant (77076) | $256.10 | $394 | 2.4× |
| Brachytx isodose complex (77318) | $2,015 | $3,100 | 5.4× |
| Brachytx isodose intermed (77317) range across 2 matching MRF lines |
$2,652–$39,809.36 | $4,080–$61,245.17 | varies |
| Brachytx Isodose Plan Simple (77316) range across 2 matching MRF lines |
$2,015–$43,876.95 | $3,100–$67,503 | varies |
| Brain Image W/Flow < 4 Views (78601) | $668.20 | $1,028 | 1.7× |
| Brain Imaging Min 4 Static Views W Vascular Flow (78606) | $1,011.40 | $1,556 | 1.9× |
| Brain Imaging Minimum 4 Static Views (78605) | $923.65 | $1,421 | 1.7× |
| Brain Imaging Pet Metabolic Evaluation (78608) range across 2 matching MRF lines |
$3,044.60–$4,039.10 | $4,684–$6,214 | varies |
| Card Bl Pool Gated Spect Rest Wal Motn Ejct Frct (78494) | $1,185.60 | $1,824 | 3.0× |
| Cardiac MRI w/w/o contrast & further seq (75561) | $2,234.70 | $3,438 | 6.4× |
| Cat Scan Follow-Up Study (76380) | $638.30 | $982 | 7.3× |
| Cerebrospinal Fluid Flow W/O Matl Shunt Evaltj (78645) | $750.75 | $1,155 | 1.4× |
| Cerebrospinal Fluid Scan (78630) | $828.10 | $1,274 | 1.5× |
| Chest 1 view (71045) | $240.50 | $370 | 2.8× |
| Chest 2 views (71046) | $301.60 | $464 | 3.5× |
| Chest 3 views (71047) | $305.50 | $470 | 3.5× |
| Chest 4 or more views (71048) | $327.60 | $504 | 3.1× |
| Chg us nrv&acc strux 1 xtr compre w/img pr extremity (76883) | $531.70 | $818 | 5.1× |
| Cineradiograpy/vidradiograpy xcpt where spec (76120) | $297.70 | $458 | 2.8× |
| Cisternography Positive Contrast Rs&I (70015) | $705.25 | $1,085 | 0.9× |
| Clavicle complete (73000) range across 3 matching MRF lines |
$265.20–$397.80 | $408–$612 | varies |
| Computed Tomography Thorax Lw Dose Lng Ca Scr C- (71271) | $607.10 | $934 | 5.8× |
| Continuing medical physics consltj pr wk (77336) range across 2 matching MRF lines |
$783.90–$56,700.80 | $1,206–$87,232 | varies |
| Contrast Exam Abdominl Aorta (75625) | $3,168.75 | $4,875 | 1.0× |
| Contrast X-Ray Bladder (74430) | $562.90 | $866 | 1.6× |
| Contrast X-Ray Of Elbow (73085) range across 3 matching MRF lines |
$515.45–$773.50 | $793–$1,190 | varies |
| Contrast X-Ray Of Knee Joint (73580) | $587.60 | $904 | 1.7× |
| Contrast Xray Throat/Cerv Esopha (74210) | $327.60 | $504 | 1.9× |
| Corpora cavernosography (74445) | $518.70 | $798 | 5.0× |
| CT abdomen and pelvis without and with contrast (74178) | $3,666.65 | $5,641 | 10.5× |
| CT abdomen and pelvis without contrast (74176) | $2,724.80 | $4,192 | 11.4× |
| CT abdomen w contrast (74160) | $1,671.15 | $2,571 | 9.5× |
| CT abdomen w wo contrast (74170) range across 2 matching MRF lines |
$1,821.30–$1,994.20 | $2,802–$3,068 | varies |
| CT abdomen w/o contrast (74150) | $1,333.15 | $2,051 | 12.7× |
| CT Angio Abdomen and Pelvis (74174) | $3,344.25 | $5,145 | 9.6× |
| CT Angio Chest (71275) | $1,838.85 | $2,829 | 10.5× |
| CT Angio Head (70496) | $2,134.60 | $3,284 | 12.2× |
| CT angio hrt w/3d image (75574) | $1,270.10 | $1,954 | 3.6× |
| Ct Angio Lwr Extr W/O&W/Dye (73706) range across 3 matching MRF lines |
$1,879.15–$2,819.05 | $2,891–$4,337 | varies |
| CT Angio Neck (70498) | $2,060.50 | $3,170 | 11.7× |
| Ct Angio Upr Extrm W/O&W/Dye (73206) range across 3 matching MRF lines |
$1,675.05–$2,512.25 | $2,577–$3,865 | varies |
| CT bone density (77078) | $369.20 | $568 | 4.2× |
| CT Cere Prfuj Alys C+ W/O CT/Cta Same Anatomy (70473) | $731.25 | $1,125 | 4.2× |
| CT cervical spine w/ contrast (72126) | $1,964.30 | $3,022 | 5.6× |
| CT cervical spine w/o contrast (72125) | $1,717.30 | $2,642 | 16.4× |
| CT cervical spine w/wo cont (72127) | $2,252.90 | $3,466 | 12.8× |
| CT chest w contrast (71260) | $1,705.60 | $2,624 | 9.7× |
| CT chest w/wo contrast (71270) | $1,851.20 | $2,848 | 10.5× |
| CT head/brain with contrast (70460) | $1,527.50 | $2,350 | 8.7× |
| CT head/brain without and with contrast (70470) | $1,927.25 | $2,965 | 11.0× |
| CT heart contrast eval cardiac structure&morph (75572) | $798.20 | $1,228 | 2.3× |
| CT heart no contrast quant eval coronry calcium (75571) | $84.50 | $130 | 1.0× |
| CT hrt w/3d image congen (75573) | $740.35 | $1,139 | 2.1× |
| CT iac w contrast (70481) | $1,634.75 | $2,515 | 9.3× |
| CT l-spine w&w/o contrast (72133) | $1,911.65 | $2,941 | 10.9× |
| CT lower ext w/o (73700) range across 3 matching MRF lines |
$1,321.45–$1,982.50 | $2,033–$3,050 | varies |
| CT lower extremity w/contrast material (73701) range across 3 matching MRF lines |
$1,467.05–$2,200.25 | $2,257–$3,385 | varies |
| CT lumbar spine w contrast (72132) | $1,621.75 | $2,495 | 4.6× |
| CT lumbar spine w/o contrast (72131) | $1,379.95 | $2,123 | 13.2× |
| CT maxillofacial w contrast (70487) | $1,656.20 | $2,548 | 9.4× |
| CT maxillofacial wo contrast (70486) range across 2 matching MRF lines |
$1,078.35–$1,517.10 | $1,659–$2,334 | varies |
| CT neck tissue combo (70492) | $1,719.90 | $2,646 | 9.8× |
| Ct Orbit/Ear/Fossa W/O&W/Dye (70482) | $1,881.75 | $2,895 | 10.7× |
| CT orbits w/o contrast (70480) | $1,288.30 | $1,982 | 12.3× |
| CT pelvis w&w/o contrast (72194) | $1,975.35 | $3,039 | 11.2× |
| CT pelvis w/o contrast (72192) | $1,473.55 | $2,267 | 14.1× |
| CT scan of leg combo (73702) | $1,691.30 | $2,602 | 9.6× |
| CT scans face/jaw combo (70488) | $1,989.65 | $3,061 | 11.3× |
| CT soft tissue neck w contrast (70491) | $1,424.80 | $2,192 | 8.1× |
| CT soft tissue neck w/o contrast (70490) | $1,173.25 | $1,805 | 11.2× |
| CT thoracic spine w contrast (72129) | $1,488.50 | $2,290 | 8.5× |
| CT thoracic spine w/o contrast (72128) | $1,328.60 | $2,044 | 12.7× |
| CT thoracic spine w/wo cont (72130) | $1,810.90 | $2,786 | 10.3× |
| CT thorax w/o contrast (71250) | $1,295.45 | $1,993 | 12.4× |
| CT unlisted procedure (76497) | $546 | $840 | 6.3× |
| CT upper ext wo (73200) range across 3 matching MRF lines |
$1,196–$1,794 | $1,840–$2,760 | varies |
| CT upper extremity w/o & w/contrast material (73202) range across 3 matching MRF lines |
$1,629.55–$2,470.65 | $2,507–$3,801 | varies |
| CT upper extremity with contrast (73201) range across 3 matching MRF lines |
$1,434.55–$2,137.85 | $2,207–$3,289 | varies |
| Cta Abdl Aorta&Bi Iliofem W/Contrast&Postp (75635) | $1,944.15 | $2,991 | 11.1× |
| Cta Abdomen (74175) | $1,665.30 | $2,562 | 9.5× |
| CTA head&neck c+ w/noncontrast img&post-pxessing (70471) | $2,134.60 | $3,284 | 6.1× |
| CTA pelvis (72191) | $2,007.85 | $3,089 | 11.4× |
| Dacryocystography, nasolacrimal duct, radiological supervision and interpretation Non-Facility (70170) | $425.75 | $655 | 1.8× |
| Dilation ureters/urethra rs&i (74485) range across 3 matching MRF lines |
$1,143.35–$1,715.35 | $1,759–$2,639 | varies |
| Doppler Echo Fetal Puls Spectral F/U/Repeat (76828) | $243.10 | $374 | 2.3× |
| Doppler Echo Fetal Spectral Display Complete (76827) | $351 | $540 | 3.4× |
| Doppler Fetal Mid Cerebral Artery (76821) | $230.10 | $354 | 2.2× |
| Dxa Bone Density Axial (77080) | $280.80 | $432 | 2.7× |
| Dxa bone density study (77085) | $295.75 | $455 | 2.8× |
| Dxa bone density study 1/>sites appendiclr skel (77081) | $152.75 | $235 | 1.8× |
| Echo exam of fetal heart (76825) | $735.15 | $1,131 | 1.3× |
| Echo exam uterus (76831) | $612.30 | $942 | 2.6× |
| Echo Guide For Artery Repair (76936) | $899.60 | $1,384 | 4.2× |
| Echocardiography, fetal, cardiovascular system, real time with image documentation (2D), with or without M-mode… (76826) | $448.50 | $690 | 1.9× |
| Echograp Trans R Pros Study (76873) | $577.20 | $888 | 5.5× |
| Esophagram (74220) | $402.35 | $619 | 2.3× |
| Fetal Biophys Profile W/Nst (76818) | $609.05 | $937 | 5.8× |
| Fetal Biophysical Profile W/O Non-Stress Testing (76819) | $492.05 | $757 | 4.7× |
| Fetal MRI w/placntl matrnl plvc img sing/1st ges (74712) | $508.95 | $783 | 2.1× |
| Fluoroscopy up to 1 hr (76000) | $630.50 | $970 | 2.6× |
| Follow-Up Angiography (75898) | $1,017.25 | $1,565 | 0.3× |
| Foot 2 views (73620) range across 6 matching MRF lines |
$196.95–$394.55 | $303–$607 | varies |
| Forearm 2 views (73090) range across 6 matching MRF lines |
$209.30–$431.60 | $322–$664 | varies |
| Gastric emptying imaging study (78264) range across 2 matching MRF lines |
$1,276.60–$1,589.25 | $1,964–$2,445 | varies |
| Gastric Emptyng Imag Std W/Sm Bwl Transit (78265) range across 2 matching MRF lines |
$917.80–$1,118.65 | $1,412–$1,721 | varies |
| Gastroesophageal Reflux Exam (78262) | $943.80 | $1,452 | 2.4× |
| Gated Heart Planar Single (78472) range across 2 matching MRF lines |
$890.50–$1,251.25 | $1,370–$1,925 | varies |
| Gated Heart, Multiple (78473) | $1,922.05 | $2,957 | 4.8× |
| Gstrc Emptng Imag Std W/Sm Bwl Col Trnst Mlt Day (78266) range across 2 matching MRF lines |
$1,490.45–$1,803.10 | $2,293–$2,774 | varies |
| Hand 2 views (73120) range across 6 matching MRF lines |
$185.90–$341.25 | $286–$525 | varies |
| Hdr Rdncl Ntrstl/Icav Brchtx (77772) | $5,729.75 | $8,815 | 8.2× |
| Hdr Rdncl Ntrstl/Icav Brchtx (77771) | $5,019.30 | $7,722 | 7.2× |
| Hdr Rdncl Ntrstl/Icav Brchtx 1 Channel (77770) | $4,662.45 | $7,173 | 6.7× |
| Heart Image (Pet) Multiple (78492) | $4,411.55 | $6,787 | 3.1× |
| Hepatc Vngrph Wdg/Fr Hemodyn Eval Rs&I (75889) | $2,531.75 | $3,895 | 0.8× |
| Hepatc Vngrph Wdg/Fr W/O Hemodyn Eval Rs&I (75891) | $2,461.55 | $3,787 | 0.8× |
| Hepatobil Syst Image W/Drug (78227) range across 2 matching MRF lines |
$1,234.35–$1,522.68 | $1,899–$2,342.59 | varies |
| Hepatobiliary System Imaging (78226) range across 2 matching MRF lines |
$1,190.80–$1,357.20 | $1,832–$2,088 | varies |
| Ht Musc Image Planar Mult (78454) range across 2 matching MRF lines |
$1,795.30–$20,763.39 | $2,762–$31,943.67 | varies |
| Ht Muscle Image Spect Sing (78451) | $1,597.05 | $2,457 | 1.2× |
| Hysterosalpingogram (74740) | $646.75 | $995 | 2.7× |
| Infant hip ultrasound with hip movement (dynamic) (76885) | $364.65 | $561 | 4.2× |
| Infant hip ultrasound, limited static exam (76886) | $250.25 | $385 | 2.9× |
| Interstitial radiation source applic complex (77778) | $3,160.30 | $4,862 | 4.5× |
| Intracavitary Radiation Source Applic Complex (77763) | $3,266.90 | $5,026 | 4.7× |
| Intracavitary Radiation Source Applic Intermed (77762) | $3,147.95 | $4,843 | 5.7× |
| Intracavitary radiation source applic simple (77761) | $2,947.10 | $4,534 | 5.3× |
| Joint Survey Single View (77077) | $296.40 | $456 | 2.8× |
| K Flow/Funct Image W/Drug (78708) range across 2 matching MRF lines |
$1,017.25–$1,674.40 | $1,565–$2,576 | varies |
| K Flow/Funct Image W/O Drug (78707) range across 2 matching MRF lines |
$1,502.80–$2,152.80 | $2,312–$3,312 | varies |
| Kidney Imaging Morphol (78700) | $803.40 | $1,236 | 2.0× |
| Kidney Imaging Morphoogy W/Vascular Flow (78701) | $1,085.50 | $1,670 | 2.7× |
| Knee 3 Views (73562) range across 3 matching MRF lines |
$258.70–$451.75 | $398–$695 | varies |
| Leveen/Shunt Patency Exam (78291) | $817.05 | $1,257 | 2.0× |
| Liver & Spleen Imaging Static Only (78215) | $1,010.75 | $1,555 | 2.5× |
| Liver & Spleen Imaging W/Vascular Flow (78216) | $1,808.30 | $2,782 | 4.5× |
| Liver imaging static only (78201) | $1,097.20 | $1,688 | 2.0× |
| Lung Perf&Ventilat Diferentl (78598) | $1,186.90 | $1,826 | 2.2× |
| Lung perfusion differential (78597) range across 2 matching MRF lines |
$960.70–$1,257.61 | $1,478–$1,934.78 | varies |
| Lung Ventilat&Perfus Imaging (78582) range across 2 matching MRF lines |
$1,294.80–$1,930.50 | $1,992–$2,970 | varies |
| Lung Ventilation Imaging (78579) | $601.25 | $925 | 1.5× |
| Lymph System Imaging (78195) range across 2 matching MRF lines |
$1,082.90–$15,929.05 | $1,666–$24,506.23 | varies |
| Lymphangiography Pelvic/Abdominal Bilateral Rs&I (75807) | $1,543.10 | $2,374 | 0.5× |
| Lymphangiography, pelvic/abdominal, unilateral (75805) | $1,090.70 | $1,678 | 0.3× |
| Magnetic Image Jaw Joint (70336) | $1,501.50 | $2,310 | 6.3× |
| Magnetic Resonance Elastography (76391) | $419.90 | $646 | 1.8× |
| Mammary ductogram or galactogram multiple (77054) range across 3 matching MRF lines |
$642.85–$936 | $989–$1,440 | varies |
| Mammary ductogram or galactogram single (77053) range across 3 matching MRF lines |
$560.95–$861.90 | $863–$1,326 | varies |
| Meckels Divert Exam (78290) | $799.50 | $1,230 | 2.0× |
| Medical physics dose eval radiation expos w/rprt (76145) | $279.50 | $430 | 0.7× |
| Mlc imrt design & construction per imrt plan (77338) range across 2 matching MRF lines |
$7,343.70–$59,356.05 | $11,298–$91,317 | varies |
| Mra Head W/O & W/Contrast Material (70546) | $2,717 | $4,180 | 7.8× |
| MRA head w/o contrast (70544) | $1,892.80 | $2,912 | 7.9× |
| MRA head with contrast (70545) | $2,120.30 | $3,262 | 6.1× |
| MRA neck w contrast (70548) | $1,741.35 | $2,679 | 5.0× |
| Mra Neck W/O &W/Contrast Material (70549) | $2,004.60 | $3,084 | 5.7× |
| MRA neck w/o contrast (70547) | $1,623.05 | $2,497 | 6.8× |
| MRI abdomen w contrast (74182) | $2,524.60 | $3,884 | 7.2× |
| MRI abdomen w/o contrast (74181) | $2,110.55 | $3,247 | 8.8× |
| MRI any jt lower extrem w/contrast material (73722) range across 3 matching MRF lines |
$1,950–$2,925 | $3,000–$4,500 | varies |
| MRI any jt lower extrem w/o & w/contrast matrl (73723) range across 3 matching MRF lines |
$2,120.30–$3,180.45 | $3,262–$4,893 | varies |
| MRI any jt upper extremity w/contrast matrl (73222) range across 3 matching MRF lines |
$2,066.35–$3,553.55 | $3,179–$5,467 | varies |
| MRI bone marrow blood supply (77084) | $1,248.65 | $1,921 | 5.2× |
| MRI brain functional w/o physician admnistration (70554) | $1,998.75 | $3,075 | 8.4× |
| MRI brain functional w/physician admnistration (70555) | $1,313 | $2,020 | 5.5× |
| MRI Breast W/O Contrast Bilateral (77047) | $3,062.15 | $4,711 | 12.8× |
| MRI Breast Without Contrast Material Unilateral (77046) | $2,041.65 | $3,141 | 8.5× |
| MRI cardiac w/o cont stress (75559) | $1,688.05 | $2,597 | 3.1× |
| MRI cardiac w/o contrast (75557) | $1,556.75 | $2,395 | 6.5× |
| MRI cervical spine w contrast (72142) | $2,546.70 | $3,918 | 7.3× |
| MRI cervical spine w/o cont (72141) | $1,970.15 | $3,031 | 8.2× |
| MRI chest w/o contrast (71550) | $1,830.40 | $2,816 | 7.7× |
| MRI chest with contrast (71551) | $1,885.65 | $2,901 | 2.4× |
| MRI chest wo w contrast (71552) | $3,108.30 | $4,782 | 8.9× |
| MRI lower extrem oth/thn jt w/contrast matrl (73719) range across 3 matching MRF lines |
$2,131.35–$3,196.70 | $3,279–$4,918 | varies |
| MRI lower extrem oth/thn jt w/o & w/contr matr (73720) range across 3 matching MRF lines |
$2,479.75–$3,961.10 | $3,815–$6,094 | varies |
| MRI lower extrem oth/thn jt w/o contr matrl (73718) range across 3 matching MRF lines |
$1,918.80–$2,858.05 | $2,952–$4,397 | varies |
| MRI lumbar spine w contrast (72149) | $2,496 | $3,840 | 7.1× |
| Mri Neck Spine W/O & W/Dye (72156) | $3,199.95 | $4,923 | 9.2× |
| MRI orbit face &/neck w/o contrast (70540) | $1,558.05 | $2,397 | 6.5× |
| MRI orbit face neck w contrast (70542) | $1,844.70 | $2,838 | 5.3× |
| Mri Orbt/Fac/Nck W/O &W/Dye (70543) | $2,273.70 | $3,498 | 6.5× |
| MRI pelvis w contrast (72196) | $2,465.45 | $3,793 | 7.1× |
| MRI pelvis w/o & w contrast (72197) | $2,881.45 | $4,433 | 8.2× |
| MRI pelvis w/o contrast (72195) | $1,916.85 | $2,949 | 8.0× |
| MRI spectroscopy (76390) | $1,431.30 | $2,202 | 16.4× |
| MRI thoracic spine w/o contrast (72146) | $1,985.75 | $3,055 | 8.3× |
| MRI upper extremity oth than jt w/o contr matrl (73218) range across 3 matching MRF lines |
$1,837.55–$3,062.15 | $2,827–$4,711 | varies |
| Mri Uppr Extremity W/O&W/Dye (73220) range across 3 matching MRF lines |
$2,449.20–$3,838.90 | $3,768–$5,906 | varies |
| MRI, abdomen, combo (74183) | $3,186.30 | $4,902 | 9.1× |
| MRI, dorsal spine combo (72157) | $3,067.35 | $4,719 | 8.8× |
| MRI, dorsal spine contrast (72147) | $2,587 | $3,980 | 7.4× |
| MRI, joint upper extrem (73221) range across 3 matching MRF lines |
$1,790.75–$3,288.35 | $2,755–$5,059 | varies |
| MRI, joint upper extrem combo (73223) range across 3 matching MRF lines |
$2,406.30–$4,076.80 | $3,702–$6,272 | varies |
| MRI, lumbar spine combo (72158) | $3,086.85 | $4,749 | 8.8× |
| Myelogram cervical (72240) | $1,007.50 | $1,550 | 1.3× |
| Myelogram Lumbar (72265) | $1,290.90 | $1,986 | 1.6× |
| Myelography thoracic (72255) | $1,133.60 | $1,744 | 1.4× |
| Myelograpy 2/more regions rs&i (72270) | $1,517.10 | $2,334 | 1.9× |
| Myocardial Imaging Infarct Avid Planar Qual/Quan (78466) | $1,063.40 | $1,636 | 2.7× |
| Myocardial Imaging Pet Metabolic Evaluation (78459) range across 2 matching MRF lines |
$2,971.15–$3,965.65 | $4,571–$6,101 | varies |
| Myocardial Perfusion Planar 1 Study Rest/Stress (78453) | $1,591.85 | $2,449 | 1.2× |
| Myocardial Spect Multiple Studies (78452) range across 2 matching MRF lines |
$2,931.50–$5,640.36 | $4,510–$8,677.48 | varies |
| Myocrd Img Pet Metab Eval Single Study Cncrnt CT (78429) | $3,482.70 | $5,358 | 2.4× |
| Myocrd img PET prfuj 1std rest/stress cncrnt CT (78430) | $3,803.80 | $5,852 | 2.7× |
| Myocrd Img Pet Prfuj Mlt Std Rst&Strs Cncrnt CT (78431) | $4,140.50 | $6,370 | 1.9× |
| Myocrd Img Pet Prfuj W/Metab 2rtracer Cncrnt CT (78433) | $4,915.30 | $7,562 | 2.2× |
| Myocrd Img Pet Prfuj W/Metab Dual Radiotracer (78432) | $6,634.55 | $10,207 | 4.4× |
| N-invas est c ffr sw aly CTA (75580) | $1,825.85 | $2,809 | 2.1× |
| Neck soft tissue (70360) | $253.50 | $390 | 2.9× |
| Nfs/Instlj Radioelmnt Sln 3 Mo Follow-Up Care (77750) | $858.65 | $1,321 | 2.2× |
| Nm csf leak detection (78650) range across 2 matching MRF lines |
$1,253.20–$10,879.05 | $1,928–$16,737 | varies |
| Nm myocard infarct spect (78469) range across 2 matching MRF lines |
$813.15–$937.95 | $1,251–$1,443 | varies |
| Nm whole blood volume (78122) | $1,392.95 | $2,143 | 2.6× |
| Nonvascular Shunt X-Ray (75809) | $339.30 | $522 | 3.2× |
| Ntsty modul radthx pln dose-vol histos (77301) range across 2 matching MRF lines |
$7,430.15–$59,358.34 | $11,431–$91,320.52 | varies |
| Nuclear Rx Intra-Arterial (79445) range across 2 matching MRF lines |
$680.55–$47,591.57 | $1,047–$73,217.80 | varies |
| Nuclear Rx Oral Admin (79005) range across 2 matching MRF lines |
$852.15–$8,680.75 | $1,311–$13,355 | varies |
| Ob us nuchal meas 1 gest (76813) | $380.90 | $586 | 3.6× |
| Ophthalmic ultrasound dx b-scan w/wo a-scan (76512) range across 2 matching MRF lines |
$227.50–$344.50 | $350–$530 | varies |
| Optic foramina (70190) | $163.80 | $252 | 1.9× |
| Panoramic X-ray of jaws (70355) | $258.70 | $398 | 3.0× |
| Parathyroid imaging w/tomographic spect & CT (78072) range across 2 matching MRF lines |
$1,193.40–$1,487.85 | $1,836–$2,289 | varies |
| Parathyroid Planar Imaging (78070) | $1,060.15 | $1,631 | 2.6× |
| Parathyroid planar imaging w/wo subtraction (78071) range across 2 matching MRF lines |
$966.55–$1,261 | $1,487–$1,940 | varies |
| Pelvis 1 or 2 views (72170) | $241.15 | $371 | 2.3× |
| Perineogram (74775) | $343.20 | $528 | 1.4× |
| Peritoneogram Rs&I (74190) | $612.95 | $943 | 1.1× |
| Pet Image Skull-Thigh (78812) | $4,108.65 | $6,321 | 2.9× |
| Pet Image W/Ct Lmtd (78814) range across 2 matching MRF lines |
$3,448.25–$7,790.25 | $5,305–$11,985 | varies |
| PET image w/CT, full body (78816) range across 2 matching MRF lines |
$4,371.25–$5,365.75 | $6,725–$8,255 | varies |
| PET imaging CT attenuation skull base mid-thigh (78815) range across 2 matching MRF lines |
$3,231.15–$4,225.65 | $4,971–$6,501 | varies |
| Pet Myocardial Sngl Study (78491) | $3,764.15 | $5,791 | 2.6× |
| PET whole body (78813) | $5,261.10 | $8,094 | 3.7× |
| Proton tx delivery complex (77525) | $4,992 | $7,680 | 4.0× |
| Proton tx delivery intermediate (77523) | $4,446 | $6,840 | 3.6× |
| Proton tx delivery simple w/o compensation (77520) | $2,964 | $4,560 | 5.4× |
| Prq Transhepatc Portograpy Hemodyn Eval Rs&I (75885) | $2,799.55 | $4,307 | 0.9× |
| Pulmonary Perfusion Imaging Particulate (78580) | $818.35 | $1,259 | 2.0× |
| Quan&Charac C Atherosclerotc Plaq Asses Sev C Ds (75577) | $1,950 | $3,000 | 2.1× |
| Radex Abd Compl Aqt Abd W/S/E/D Views 1 View Ch (74022) | $397.80 | $612 | 3.8× |
| Radex abscess/fistula/sinus tract rs&i (76080) | $547.30 | $842 | 1.0× |
| Radex Ankle Complete Minimum 3 Views (73610) range across 3 matching MRF lines |
$315.90–$473.85 | $486–$729 | varies |
| Radex Calcaneus Minimum 2 Views (73650) range across 3 matching MRF lines |
$200.20–$300.30 | $308–$462 | varies |
| Radex elbow complete minimum 3 views (73080) range across 3 matching MRF lines |
$313.95–$523.90 | $483–$806 | varies |
| Radex Facial Bones Complete Minimum 3 Views (70150) | $272.35 | $419 | 2.6× |
| Radex fingr minimum 2 views (73140) range across 3 matching MRF lines |
$211.90–$317.20 | $326–$488 | varies |
| Radex foot complete minimum 3 views (73630) range across 3 matching MRF lines |
$291.20–$436.80 | $448–$672 | varies |
| Radex Hand Minimum 3 Views (73130) range across 3 matching MRF lines |
$215.80–$373.10 | $332–$574 | varies |
| Radex lower extremity infant minimum 2 views (73592) range across 3 matching MRF lines |
$154.70–$232.70 | $238–$358 | varies |
| Radex Mastoids Compl Minimum 3 Views PR Side (70130) | $227.50 | $350 | 2.2× |
| Radex Nasal Bones Complete Minimum 3 Views (70160) | $248.30 | $382 | 2.8× |
| Radex Ribs Unilateral 2 Views (71100) | $222.95 | $343 | 2.6× |
| Radex shoulder complete minimum 2 views (73030) range across 3 matching MRF lines |
$291.20–$436.80 | $448–$672 | varies |
| Radex Sinuses Paransl < 3 Views (70210) | $152.75 | $235 | 1.8× |
| Radex Spine 1 View Specify Level (72020) | $231.40 | $356 | 2.7× |
| Radex Sternum Minimum 2 Views (71120) | $219.70 | $338 | 2.5× |
| Radex Temporomandble Jt Opn & Clsd Mouth Bilat (70330) | $256.75 | $395 | 2.9× |
| Radex Toe Minimum 2 Views (73660) range across 3 matching MRF lines |
$203.45–$305.50 | $313–$470 | varies |
| Radex upper extremity infant minimum 2 views (73092) range across 3 matching MRF lines |
$123.50–$185.90 | $190–$286 | varies |
| Radex Wrist Complete Minimum 3 Views (73110) range across 3 matching MRF lines |
$295.75–$483.60 | $455–$744 | varies |
| Radex X-Ray Exam Entire Spi 6/> Vw - Xr Entire Spine 6+ Vw (72084) | $675.35 | $1,039 | 6.4× |
| Radiation Delivery Stereotactic Cranial Linear (77372) range across 2 matching MRF lines |
$19,954.35–$51,883.65 | $30,699–$79,821 | varies |
| Radiation treatment delivery level 1 (77402) range across 2 matching MRF lines |
$560.30–$24,506.30 | $862–$37,702 | varies |
| Radiation treatment delivery level 2 (77407) range across 2 matching MRF lines |
$3,207.10–$52,306.80 | $4,934–$80,472 | varies |
| Radiation treatment delivery level 3 (77412) range across 2 matching MRF lines |
$4,119.70–$34,635.25 | $6,338–$53,285 | varies |
| Radiolog exam mandible compl minimum 4 views (70110) | $273 | $420 | 2.6× |
| Radiologic Exam Abdomen 3+ Views - Xr Abdomen 3+ Views (74021) | $353.60 | $544 | 3.4× |
| Radiologic exam colon double contrast study (74280) | $607.10 | $934 | 3.5× |
| Radiologic exam colon single contrast study (74270) | $543.40 | $836 | 3.1× |
| Radiologic Exam Esophagus Double Contrast Study (74221) | $646.10 | $994 | 3.7× |
| Radiologic exam knee complete 4/more views (73564) range across 3 matching MRF lines |
$305.50–$564.20 | $470–$868 | varies |
| Radiologic exam pelvis compl minimum 3 views (72190) | $328.25 | $505 | 3.1× |
| Radiologic Exam Small Int Single Contrast Study (74250) | $460.20 | $708 | 2.6× |
| Radiologic exam swallow function contrast study (74230) | $438.75 | $675 | 2.5× |
| Radiologic exam upr gi trc double contrast study (74246) | $435.50 | $670 | 2.5× |
| Radiologic examination femur 1 view (73551) range across 3 matching MRF lines |
$182.65–$266.50 | $281–$410 | varies |
| Radiologic examination femur minimum 2 views (73552) range across 3 matching MRF lines |
$212.55–$387.40 | $327–$596 | varies |
| Radiologic examination knee 1/2 views (73560) range across 3 matching MRF lines |
$228.15–$397.80 | $351–$612 | varies |
| Radiologic Examination Osseous Survey Limited (77074) | $286 | $440 | 2.7× |
| Radiologic examination tibia & fibula 2 views (73590) range across 6 matching MRF lines |
$232.05–$417.95 | $357–$643 | varies |
| Red Cell Volume Determination Spx 1 Sampling (78120) | $830.05 | $1,277 | 2.1× |
| Remote afterloading high dose rate radionuclide skin surface brachytherapy, includes basic dosimetry, when performed;… (77768) | $3,250 | $5,000 | 8.4× |
| Remote afterloading high dose rate radionuclide skin surface brachytherapy, includes basic dosimetry, when performed;… (77767) | $1,240.20 | $1,908 | 3.2× |
| Ribs bilateral 3 views (71110) | $271.70 | $418 | 2.6× |
| Rp loclzj tum plnr 1 area single day imaging (78800) range across 2 matching MRF lines |
$667.55–$4,479.15 | $1,027–$6,891 | varies |
| Rp loclzj tum plnr 2+area 1+d img/1 area img>2+d (78801) | $1,044.55 | $1,607 | 2.6× |
| Rp Loclzj Tum Plnr Whole Body 2+ Days Imaging (78804) range across 2 matching MRF lines |
$1,675.70–$15,045.87 | $2,578–$23,147.50 | varies |
| Rp Loclzj Tum Plnr Whole Body Single Day Imaging (78802) range across 2 matching MRF lines |
$1,409.85–$5,560.75 | $2,169–$8,555 | varies |
| Rp Loclzj Tum Spect 1 Area Single Day Imaging (78803) range across 2 matching MRF lines |
$1,285.05–$6,109.67 | $1,977–$9,399.50 | varies |
| Rp loclzj tum spect 2 area/sep acquisj img (78831) | $2,988.70 | $4,598 | 2.3× |
| Rp loclzj tum spect CT 2area 1d img/1 ar img>2+d (78832) range across 2 matching MRF lines |
$3,326.70–$4,529.20 | $5,118–$6,968 | varies |
| Rp loclzj tum spect w/CT 1 area/acquisj 1day img (78830) range across 2 matching MRF lines |
$3,513.90–$5,149.95 | $5,406–$7,923 | varies |
| Rp Ther Radiolbld Monoclonal Antibody IV Infus (79403) | $1,398.80 | $2,152 | 6.0× |
| Rp Therapy Intravenous Administration (79101) range across 2 matching MRF lines |
$651.95–$106,910.70 | $1,003–$164,478 | varies |
| Salivary Gland Imaging (78230) | $799.50 | $1,230 | 2.0× |
| Scapula (73010) range across 3 matching MRF lines |
$212.55–$318.50 | $327–$490 | varies |
| Screening Digital Breast Tomosynthesis Bi (77063) range across 3 matching MRF lines |
$70.85–$106.60 | $109–$164 | varies |
| Sella turcica (70240) | $131.30 | $202 | 1.5× |
| Shoulder 1 view (73020) range across 3 matching MRF lines |
$184.60–$277.55 | $284–$427 | varies |
| Shoulder Arthrography (73040) range across 3 matching MRF lines |
$678.60–$1,017.90 | $1,044–$1,566 | varies |
| Sialogram (70390) | $543.40 | $836 | 2.3× |
| Skull less than 4 views (70250) | $326.95 | $503 | 3.1× |
| Special dosimetry (77331) | $499.85 | $769 | 3.7× |
| Special Physics Consult (77370) range across 2 matching MRF lines |
$1,329.90–$119,392 | $2,046–$183,680 | varies |
| Special teletherapy port plan (77321) | $962 | $1,480 | 2.6× |
| Special treatment procedure (77470) range across 2 matching MRF lines |
$3,081–$96,602.35 | $4,740–$148,619 | varies |
| Speech evaluation, complex (70371) | $436.80 | $672 | 1.8× |
| Spleen Imaging (78185) range across 2 matching MRF lines |
$1,762.80–$2,123.55 | $2,712–$3,267 | varies |
| Stereotactic Body Radiation Delivery (77373) range across 2 matching MRF lines |
$19,110–$119,542.15 | $29,400–$183,911 | varies |
| Sternoclavicular joints (71130) | $209.30 | $322 | 2.4× |
| Superior sagittal sinus venogram (75870) | $1,506.70 | $2,318 | 0.5× |
| Surface Applic Low Dose Rate Radionuclide Source (77789) | $382.20 | $588 | 3.7× |
| Telethx isodose pln cplx w/basic dosimetry (77307) range across 2 matching MRF lines |
$2,718.30–$39,287.30 | $4,182–$60,442 | varies |
| Telethx isodose pln smpl w/dosimetry calculation (77306) | $1,450.80 | $2,232 | 3.9× |
| Temporomandble Jt Arthrography Rs&I (70332) range across 3 matching MRF lines |
$469.95–$704.60 | $723–$1,084 | varies |
| Testicular Imaging W/Flow (78761) | $738.40 | $1,136 | 1.8× |
| Ther Rad Simulaj-Aided Field Setting Complex (77290) range across 2 matching MRF lines |
$2,835.30–$59,832.50 | $4,362–$92,050 | varies |
| Ther Rad Simulaj-Aided Field Setting Intermed (77285) | $1,060.15 | $1,631 | 2.8× |
| Ther rad simulaj-aided field setting simple (77280) range across 2 matching MRF lines |
$1,063.40–$59,344.79 | $1,636–$91,299.68 | varies |
| Therapeutic Enema Rdctj Intussusception/Obstrcj (74283) | $663.65 | $1,021 | 3.8× |
| Thoracic spine 2 views (72070) | $234.65 | $361 | 2.2× |
| Thoracic spine 3 views (72072) | $284.70 | $438 | 2.7× |
| Thoracolumbar 2 views (72080) | $274.95 | $423 | 3.2× |
| Thyroid Imaging With Vascular Flow (78013) | $498.55 | $767 | 1.2× |
| Thyroid Met Imaging Body (78018) range across 2 matching MRF lines |
$1,202.50–$4,716.40 | $1,850–$7,256 | varies |
| Thyroid Uptake Measurement (78012) | $441.35 | $679 | 1.1× |
| Thyroid Uptake W/Blood Flow Sngle/Mult Quan Meas (78014) range across 2 matching MRF lines |
$713.05–$922.35 | $1,097–$1,419 | varies |
| Tx Devices Design & Construction Complex (77334) range across 2 matching MRF lines |
$1,691.30–$59,506.20 | $2,602–$91,548 | varies |
| Tx devices design & construction intermediate (77333) | $814.45 | $1,253 | 6.0× |
| Tx devices design & construction simple (77332) range across 2 matching MRF lines |
$594.10–$38,546.30 | $914–$59,302 | varies |
| Ultrasound Breast Limited (76642) range across 3 matching MRF lines |
$435.50–$653.25 | $670–$1,005 | varies |
| Ultrasound elastography first target lesion (76982) | $335.40 | $516 | 3.2× |
| Ultrasound Elastography Parenchyma (76981) | $287.95 | $443 | 2.7× |
| Ultrasound Exam Aaa Screen (76706) | $290.55 | $447 | 2.8× |
| Ultrasound, abdomen limited (76705) range across 2 matching MRF lines |
$162.50–$583.05 | $250–$897 | varies |
| Umbilical-artery Doppler (OB) (76820) | $338.65 | $521 | 3.2× |
| Unlisted Dx Radiographic Procedure (76499) | $222.95 | $343 | 2.6× |
| Unlisted fluoroscopic procedure (76496) | $254.80 | $392 | 2.9× |
| Unlisted magnetic resonance procedure (76498) range across 2 matching MRF lines |
$1,186.25–$1,949.35 | $1,825–$2,999 | varies |
| Unlisted Miscellaneous Px Dx Nuclear Medicine (78999) | $308.75 | $475 | 0.8× |
| Unlisted Procedure Clinical Brachytherapy (77799) | $2,799.55 | $4,307 | 27.4× |
| Unlisted respiratory px dx nuclear medicine (78599) range across 2 matching MRF lines |
$1,040–$1,651 | $1,600–$2,540 | varies |
| Unlisted us procedure (76999) | $274.30 | $422 | 3.1× |
| Upper gi w/o kub (74240) | $579.15 | $891 | 3.3× |
| Urea Breath Test C-14 Isotopic Acquisj Analysis (78267) | $331.50 | $510 | 30.0× |
| Urea breath test c-14 isotopic analysis (78268) | $350.35 | $539 | 3.7× |
| Ureteral Reflux Study (78740) | $837.85 | $1,289 | 2.1× |
| Urethrocystogram voiding (74455) | $765.05 | $1,177 | 3.2× |
| Urethrocystography retrograde (74450) | $469.30 | $722 | 2.0× |
| Us breast unilateral complete (76641) range across 3 matching MRF lines |
$314.60–$471.90 | $484–$726 | varies |
| Us chest (76604) range across 3 matching MRF lines |
$162.50–$453.05 | $250–$697 | varies |
| Us complete joint (76881) range across 3 matching MRF lines |
$393.25–$589.55 | $605–$907 | varies |
| Us exam, pelvic, limited (76857) | $445.90 | $686 | 4.3× |
| Us head (76506) | $386.10 | $594 | 3.7× |
| Us kidney transplant (76776) | $495.30 | $762 | 4.7× |
| Us lmtd joint/oth nonvasc xtr strux r-t w/img (76882) range across 3 matching MRF lines |
$306.15–$458.90 | $471–$706 | varies |
| Us ob detailed single fetus (76811) range across 2 matching MRF lines |
$683.80–$823.55 | $1,052–$1,267 | varies |
| Us ob limited 1 or more fetuses (76815) range across 2 matching MRF lines |
$136.50–$447.85 | $210–$689 | varies |
| Us ob transvaginal (76817) | $472.55 | $727 | 4.5× |
| Us pelvic non ob complete (76856) | $721.50 | $1,110 | 6.9× |
| Us pg uter img f&mat 14 wk tabdl 1/1st gestation (76801) | $537.55 | $827 | 5.1× |
| Us preg uterus real time f/u trnsabdl per fetus (76816) | $487.50 | $750 | 4.7× |
| Us retroperitoneal complete (76770) | $794.95 | $1,223 | 7.6× |
| Us retroperitoneal limited (76775) range across 2 matching MRF lines |
$108.55–$518.05 | $167–$797 | varies |
| Us scrotum and contents (76870) | $687.05 | $1,057 | 6.6× |
| Us spinal canal and contents (76800) | $422.50 | $650 | 4.0× |
| Us thyroid (76536) range across 2 matching MRF lines |
$82.55–$602.55 | $127–$927 | varies |
| Us transrectal (76872) | $477.10 | $734 | 4.6× |
| Vascular Flow Imaging (78445) | $586.30 | $902 | 1.5× |
| Vasogram (74440) | $195 | $300 | 0.8× |
| Vein X-Ray Chest (75827) | $2,045.55 | $3,147 | 1.3× |
| Vein X-Ray Liver W/O Hemodyn (75887) | $1,664 | $2,560 | 0.5× |
| Vein X-Ray Skull Epidural (75872) | $1,428.70 | $2,198 | 2.3× |
| Vein X-Ray Spleen/Liver (75810) | $2,250.95 | $3,463 | 0.7× |
| Venogram Sinus/Jugular (75860) | $1,722.50 | $2,650 | 0.5× |
| Venography Adrenal Unilateral (75840) | $1,742 | $2,680 | 0.6× |
| Venography caval inferior serialography rs&i (75825) | $2,017.60 | $3,104 | 0.6× |
| Venography extremity bilateral rs&i (75822) | $1,632.15 | $2,511 | 1.0× |
| Venography extremity unilateral rs&i (75820) | $1,088.10 | $1,674 | 0.7× |
| Venography Orbital Rs&I (75880) | $1,163.50 | $1,790 | 1.9× |
| Venography Renal Bilateral (75833) | $2,344.55 | $3,607 | 0.7× |
| Venography Renal Unilateral (75831) | $1,820.65 | $2,801 | 0.6× |
| Venous sampling by catheter (75893) unusually low: confirm this is the full procedure |
$2,279.55 | $3,507 | 0.4× |
| Vertebral fracture assessment via dxa (77086) | $131.30 | $202 | 1.5× |
| Wrist 2 views (73100) range across 5 matching MRF lines |
$203.45–$363.35 | $313–$559 | varies |
| X-Ray Ac Jts - Xr Acromioclavicular Joints Bilateral (73050) | $287.95 | $443 | 3.3× |
| X-ray antegrade pyelogram tube (74425) range across 4 matching MRF lines |
$406.90–$611 | $626–$940 | varies |
| X-Ray Aorta Leg Arteries (75630) | $2,728.70 | $4,198 | 0.9× |
| X-Ray Bend Only L-S Spine (72120) | $247.65 | $381 | 2.4× |
| X-Ray Elbow 2 Vw - Xr Elbow 1-2 Views Right (73070) range across 6 matching MRF lines |
$222.30–$380.90 | $342–$586 | varies |
| X-Ray Exam Breast Specimen (76098) range across 3 matching MRF lines |
$358.15–$537.55 | $551–$827 | varies |
| X-Ray Exam Entire Spi 1 Vw (72081) | $245.70 | $378 | 2.8× |
| X-Ray Exam Entire Spi 2/3 Vw (72082) | $284.70 | $438 | 2.7× |
| X-Ray Exam Entire Spi 4/5 Vw (72083) | $399.10 | $614 | 3.8× |
| X-Ray Exam Hip Uni 1 View (73501) | $211.90 | $326 | 2.4× |
| X-Ray Exam Hip Uni 2-3 Views (73502) | $272.35 | $419 | 3.1× |
| X-Ray Exam Hip Uni 4/> Views (73503) | $346.45 | $533 | 3.3× |
| X-Ray Exam Hips Bi 2 Views (73521) | $305.50 | $470 | 2.9× |
| X-Ray Exam Hips Bi 3-4 Views (73522) | $350.35 | $539 | 3.3× |
| X-Ray Exam Hips Bi 5/> Views (73523) | $435.50 | $670 | 4.2× |
| X-Ray Exam L-S Spine Bending (72114) | $532.35 | $819 | 5.1× |
| X-Ray Exam Neck Spine 2-3 Vw (72040) | $304.85 | $469 | 3.5× |
| X-Ray Exam Neck Spine 6/>Vws (72052) | $498.55 | $767 | 4.8× |
| X-Ray Exam Unilat Ribs/Chest (71101) | $260.65 | $401 | 2.5× |
| X-ray eye for foreign body (70030) range across 3 matching MRF lines |
$152.10–$228.15 | $234–$351 | varies |
| X-ray humerus (73060) range across 6 matching MRF lines |
$220.35–$371.80 | $339–$572 | varies |
| X-ray IV pyelogram (ivp) (74400) | $516.75 | $795 | 2.9× |
| X-ray IV pyelogram+tomography (74415) | $581.10 | $894 | 3.3× |
| X-Ray Jaw <4 Vw - Xr Mandible < 4 Views (70100) | $202.80 | $312 | 2.3× |
| X-Ray Knee Bilat Standing - Xr Knees Anteroposterior Standing Bilat (73565) | $204.10 | $314 | 2.3× |
| X-Ray Lumbar Spine 2/3 Vw - Xr Lumbar Spine 2-3 Views (72100) | $349.70 | $538 | 3.3× |
| X-ray nose-rectum child f.b. (76010) | $237.25 | $365 | 2.7× |
| X-Ray Ribs, Chest 4+ Vw - Xr Ribs 3 Vws Bil W/ Chest Posteroanterior (71111) | $365.30 | $562 | 3.5× |
| X-Ray Sacroiliac Jts 3+ Vw - Xr Sacroiliac Joints 3+ Views (72202) | $224.25 | $345 | 2.1× |
| X-Ray Sacroiliac Jts <3 Vw - Xr Sacroiliac Joints 1-2 Views (72200) | $182.65 | $281 | 1.7× |
| X-Ray Sacrum/Coccyx 2+ Vw - Xr Sacrum Coccyx 2+ Views (72220) | $233.35 | $359 | 2.7× |
| X-Ray Sinuses 3+ Vw - Xr Paranasal Sinuses 3+ Views (70220) | $245.70 | $378 | 2.8× |
| X-Ray Skull 4+ Vw - Xr Skull Complete 4+ Views (70260) | $404.30 | $622 | 3.9× |
| X-Ray Stress View (77071) | $284.05 | $437 | 3.3× |
| X-ray thoracic spine 4 vw (72074) | $350.35 | $539 | 3.3× |
| X-Ray Tmj Unilat (70328) | $170.95 | $263 | 2.0× |
| X-Ray Urinary Tract Exam With Contrast Material (74420) | $692.90 | $1,066 | 2.0× |
| X-Rays Bone Length Studies (77073) | $202.80 | $312 | 1.9× |
| X-Rays Bone Survey Complete (77075) | $493.35 | $759 | 4.7× |
| Xr c-spine 4 or 5 views (72050) | $423.15 | $651 | 4.0× |
| Xr facial bones less than 3 views (70140) | $187.20 | $288 | 2.1× |
| XR Mastoids < 3 Views Bilateral (70120) | $178.10 | $274 | 1.7× |
| Xr orbits complete 4 views (70200) | $351 | $540 | 3.4× |
| Xr Tomogram Single Plane (76100) | $771.55 | $1,187 | 7.4× |
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.