Imaging prices at Montefiore Medical Center
Bronx, NY · every code in this section with a posted price and a Medicare benchmark.
524 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) | — | $15,509 | — |
| Abdomen 1 View (74018) | — | $451 | — |
| Abdomen 2 views (74019) | — | $496 | — |
| Acute Gastrointestinal Blood Loss Imaging (78278) | — | $1,495 | — |
| Acute venous thrombosis imaging, peptide Non-Facility (78456) range across 2 matching MRF lines |
$1,009.95 | $262.01–$1,544.26 | 0.6× |
| Adrenal Cortex & Medulla Img (78075) range across 2 matching MRF lines |
$1,111.47 | $131.39–$1,699.50 | 0.7× |
| Angio internal mammary (75756) range across 2 matching MRF lines |
$1,039.64 | $565–$1,589.67 | 0.3× |
| Angio pulmonary bilat (75743) | — | $9,588 | — |
| Angiography Adrenal Bilateral Slctv Rs&I (75733) range across 2 matching MRF lines |
$1,171.09 | $350.15–$1,790.66 | 0.3× |
| Angiography extremity bilateral rs&i (75716) | — | $10,796 | — |
| Angiography extremity unilateral rs&i (75710) | — | $8,434 | — |
| Angiography pulmonary unilateral slctv rs&i (75741) | — | $7,743 | — |
| Angrph pulmonary nonslctv cath/ven njx rs&i (75746) range across 2 matching MRF lines |
$979.59 | $189.53–$1,497.84 | 0.2× |
| Ankle 2 views (73600) | — | $858 | — |
| Aortography thoracic serialography rs&i (75605) range across 4 matching MRF lines |
$970.46–$4,090.37 | $1,483.88–$6,292.88 | varies |
| Aortography thoracic w/o serialography rs&i (75600) range across 2 matching MRF lines |
$1,151.93 | $95.94–$1,761.36 | 0.3× |
| Artery X-Rays Abdomen (75726) | — | $19,874 | — |
| Artery X-Rays Adrenal Gland (75731) range across 2 matching MRF lines |
$1,036.93 | $300.56–$1,585.52 | 0.3× |
| Artery X-Rays Pelvis (75736) | — | $13,509 | — |
| Artery X-Rays Spine (75705) | — | $13,509 | — |
| Arthrogram ankle (73615) range across 2 matching MRF lines |
$340.96 | $102.43–$521.34 | 0.8× |
| Arthrogram hip (73525) range across 2 matching MRF lines |
$331.83 | $101.35–$507.38 | 0.8× |
| Arthrogram Wrist (73115) range across 2 matching MRF lines |
$351.56 | $100.05–$537.56 | 0.8× |
| Basic radiation dosimetry calculation (77300) | — | $2,107 | — |
| Bone age studies (77072) | — | $577 | — |
| Bone Imaging 3 Phase (78315) | — | $6,511 | — |
| Bone Imaging Limited Area (78300) | — | $1,634 | — |
| Bone Imaging Multiple Areas (78305) range across 2 matching MRF lines |
$778.32 | $140.42–$1,190.09 | 1.6× |
| Bone Imaging Whole Body (78306) | — | $5,241 | — |
| Bone marrow imaging limited area (78102) | — | $1,482 | — |
| Bone marrow imaging; multiple areas (78103) | — | $1,586 | — |
| Bone marrow imaging; whole body (78104) range across 2 matching MRF lines |
$862.41 | $197.66–$1,318.67 | 1.7× |
| Bone survey infant (77076) range across 2 matching MRF lines |
$316.62 | $121.92–$484.13 | 2.4× |
| Brachytx isodose complex (77318) | — | $4,324 | — |
| Brachytx isodose intermed (77317) | — | $2,608 | — |
| Brachytx Isodose Plan Simple (77316) | — | $1,498 | — |
| Brain Flow Imaging Only (78610) range across 2 matching MRF lines |
$611.75 | $76.62–$935.39 | 0.9× |
| Brain Image W/Flow < 4 Views (78601) range across 2 matching MRF lines |
$719.67 | $86.51–$1,100.42 | 1.4× |
| Brain imaging < 4 static views (78600) range across 2 matching MRF lines |
$450.69 | $73.89–$689.13 | 0.9× |
| Brain Imaging Min 4 Static Views W Vascular Flow (78606) | — | $4,084 | — |
| Brain Imaging Minimum 4 Static Views (78605) range across 2 matching MRF lines |
$672.23 | $90.27–$1,027.88 | 1.0× |
| Brain Imaging Pet Metabolic Evaluation (78608) range across 2 matching MRF lines |
$7,435.98 | $255.72–$11,370 | 4.2× |
| Card Bl Pool Gated Spect Rest Wal Motn Ejct Frct (78494) range across 2 matching MRF lines |
$994.65 | $565–$1,520.87 | 2.0× |
| Cardiac blood pool imaging, first pass technique; multiple studies, resting and with stress (exercise and/or… (78483) range across 2 matching MRF lines |
$1,129.48 | $394.20–$1,727.03 | 1.7× |
| Cardiac MRI w/w/o contrast & further seq (75561) | — | $7,410 | — |
| Cardiac MRI w/w/o contrast w/stress (75563) range across 2 matching MRF lines |
$2,507.70 | $796.07–$3,834.40 | 2.6× |
| Cardiac Shunt Detection (78428) range across 2 matching MRF lines |
$564.05 | $200.39–$862.46 | 1.1× |
| Cat Scan Follow-Up Study (76380) range across 2 matching MRF lines |
$716.06 | $425–$1,094.90 | 6.6× |
| Cerebrospinal Fluid Flow W/O Matl Shunt Evaltj (78645) | — | $2,163 | — |
| Cerebrospinal fluid flow, imaging (not including introduction of material); ventriculography Non-Facility (78635) range across 2 matching MRF lines |
$837.47 | $107.91–$1,280.53 | 1.2× |
| Cerebrospinal Fluid Scan (78630) range across 2 matching MRF lines |
$834.12 | $117.07–$1,275.41 | 1.2× |
| Chest 1 view (71045) | — | $834 | — |
| Chest 2 views (71046) | — | $903 | — |
| Chest 3 views (71047) | — | $1,403 | — |
| Chest 4 or more views (71048) | — | $1,523 | — |
| Chg us nrv&acc strux 1 xtr compre w/img pr extremity (76883) | — | $1,179 | — |
| Cholecystography Oral Contrast (74290) range across 2 matching MRF lines |
$164.69 | $56.29–$251.82 | 0.8× |
| Cineradiograpy/vidradiograpy xcpt where spec (76120) range across 2 matching MRF lines |
$215.45 | $71.68–$329.44 | 1.7× |
| Cisternography Positive Contrast Rs&I (70015) range across 2 matching MRF lines |
$360.13 | $208.78–$550.65 | 0.4× |
| Clavicle complete (73000) | — | $636 | — |
| Computed Tomography Thorax Lw Dose Lng Ca Scr C- (71271) | — | $2,916 | — |
| Continuing medical physics consltj pr wk (77336) | — | $1,956 | — |
| Contrast Exam Abdominl Aorta (75625) | — | $8,800 | — |
| Contrast X-Ray Bladder (74430) | — | $1,167 | — |
| Contrast X-Ray Of Elbow (73085) range across 2 matching MRF lines |
$331.89 | $98.97–$507.47 | 0.8× |
| Contrast X-Ray Of Knee Joint (73580) range across 2 matching MRF lines |
$416.51 | $97.67–$636.86 | 1.0× |
| Contrast Xray Throat/Cerv Esopha (74210) range across 2 matching MRF lines |
$264.80 | $62.08–$404.90 | 1.2× |
| Corpora cavernosography (74445) range across 2 matching MRF lines |
$351.41 | $203.80–$537.32 | 2.7× |
| CT abdomen and pelvis without and with contrast (74178) | — | $5,427 | — |
| CT abdomen and pelvis without contrast (74176) | — | $4,698 | — |
| CT abdomen w contrast (74160) | — | $3,429 | — |
| CT abdomen w wo contrast (74170) | — | $3,780 | — |
| CT abdomen w/o contrast (74150) | — | $3,213 | — |
| CT Angio Abdomen and Pelvis (74174) | — | $5,940 | — |
| CT Angio Chest (71275) | — | $4,914 | — |
| CT Angio Head (70496) | — | $4,725 | — |
| CT angio hrt w/3d image (75574) | — | $3,150 | — |
| Ct Angio Lwr Extr W/O&W/Dye (73706) | — | $5,130 | — |
| CT Angio Neck (70498) | — | $4,725 | — |
| Ct Angio Upr Extrm W/O&W/Dye (73206) | — | $4,887 | — |
| CT bone density (77078) range across 2 matching MRF lines |
$507.25 | $42.15–$775.61 | 4.7× |
| CT cervical spine w/ contrast (72126) | — | $3,294 | — |
| CT cervical spine w/o contrast (72125) | — | $2,700 | — |
| CT cervical spine w/wo cont (72127) | — | $3,429 | — |
| CT chest w contrast (71260) | — | $3,132 | — |
| CT chest w/wo contrast (71270) | — | $3,375 | — |
| CT colonography screening (74263) | — | $6,156 | — |
| CT Colonogrphy Dx Image Postprocess W/Contrast (74262) | — | $6,750 | — |
| CT colonogrphy dx image postprocess w/o contrast (74261) | — | $6,480 | — |
| CT head/brain with contrast (70460) | — | $3,051 | — |
| CT head/brain without and with contrast (70470) | — | $3,429 | — |
| CT heart contrast eval cardiac structure&morph (75572) | — | $1,900 | — |
| CT heart no contrast quant eval coronry calcium (75571) | — | $1,725 | — |
| CT hrt w/3d image congen (75573) | — | $2,000 | — |
| CT iac w contrast (70481) | — | $3,051 | — |
| CT l-spine w&w/o contrast (72133) | — | $3,429 | — |
| CT lower ext w/o (73700) | — | $2,700 | — |
| CT lower extremity w/contrast material (73701) | — | $3,132 | — |
| CT lumbar spine w contrast (72132) | — | $3,294 | — |
| CT lumbar spine w/o contrast (72131) | — | $2,700 | — |
| CT maxillofacial w contrast (70487) | — | $3,051 | — |
| CT maxillofacial wo contrast (70486) | — | $2,295 | — |
| CT neck tissue combo (70492) | — | $4,374 | — |
| Ct Orbit/Ear/Fossa W/O&W/Dye (70482) | — | $3,429 | — |
| CT orbits w/o contrast (70480) | — | $3,456 | — |
| CT pelvis w&w/o contrast (72194) | — | $3,294 | — |
| CT pelvis w/o contrast (72192) | — | $2,943 | — |
| CT scan of leg combo (73702) | — | $3,294 | — |
| CT scans face/jaw combo (70488) | — | $3,429 | — |
| CT soft tissue neck w contrast (70491) | — | $3,726 | — |
| CT soft tissue neck w/o contrast (70490) | — | $3,456 | — |
| CT thoracic spine w contrast (72129) | — | $3,294 | — |
| CT thoracic spine w/o contrast (72128) | — | $2,700 | — |
| CT thoracic spine w/wo cont (72130) | — | $3,429 | — |
| CT thorax w/o contrast (71250) | — | $2,916 | — |
| CT unlisted procedure (76497) | — | $561 | — |
| CT upper ext wo (73200) | — | $2,700 | — |
| CT upper extremity w/o & w/contrast material (73202) | — | $3,294 | — |
| CT upper extremity with contrast (73201) | — | $3,132 | — |
| Cta Abdl Aorta&Bi Iliofem W/Contrast&Postp (75635) | — | $2,400 | — |
| Cta Abdomen (74175) | — | $4,914 | — |
| CTA pelvis (72191) | — | $4,887 | — |
| Dacryocystography, nasolacrimal duct, radiological supervision and interpretation Non-Facility (70170) range across 2 matching MRF lines |
$181.58 | $55.12–$277.64 | 0.6× |
| Determination of central c-v hemodynamics (non-imaging) (eg, ejection fraction with probe technique) with or without… (78414) | $51.32 | $78.47 | 0.1× |
| Dilation ureters/urethra rs&i (74485) range across 2 matching MRF lines |
$413.73 | $135.44–$632.61 | 0.2× |
| Discography Cerv/Thor Spine (72285) range across 4 matching MRF lines |
$513.57–$4,508.58 | $213.20–$6,936.28 | varies |
| Diskography lumbar (72295) range across 4 matching MRF lines |
$461.68–$4,457.01 | $325–$6,856.94 | varies |
| Doppler Echo Fetal Puls Spectral F/U/Repeat (76828) | — | $539 | — |
| Doppler Echo Fetal Spectral Display Complete (76827) | — | $1,105 | — |
| Doppler Fetal Mid Cerebral Artery (76821) | — | $633 | — |
| Dxa Bone Density Axial (77080) | — | $1,965 | — |
| Dxa bone density study (77085) | — | $1,313 | — |
| Dxa bone density study 1/>sites appendiclr skel (77081) | — | $889 | — |
| Echo exam of fetal heart (76825) | — | $2,483 | — |
| Echo exam uterus (76831) | — | $1,586 | — |
| Echo Guide For Artery Repair (76936) | — | $1,155 | — |
| Echocardiography, fetal, cardiovascular system, real time with image documentation (2D), with or without M-mode… (76826) | — | $1,462 | — |
| Echograp Trans R Pros Study (76873) | — | $1,251 | — |
| Esophageal Motility Study (78258) | — | $2,153 | — |
| Esophagram (74220) | — | $1,273 | — |
| Fetal Biophys Profile W/Nst (76818) | — | $1,279 | — |
| Fetal Biophysical Profile W/O Non-Stress Testing (76819) | — | $929 | — |
| Fetal MRI w/placntl matrnl plvc img sing/1st ges (74712) | $2,616 | $4,000 | 8.8× |
| Fluoroscopy up to 1 hr (76000) | — | $1,827 | — |
| Follow-Up Angiography (75898) | — | $7,743 | — |
| Foot 2 views (73620) | — | $749 | — |
| Forearm 2 views (73090) | — | $956 | — |
| Gastric emptying imaging study (78264) | — | $3,532 | — |
| Gastric Mucosa Imaging (78261) range across 2 matching MRF lines |
$619.57 | $120.80–$947.36 | 1.2× |
| Gastroesophageal Reflux Exam (78262) range across 2 matching MRF lines |
$830.08 | $111.02–$1,269.24 | 1.7× |
| Gastrointestinal Protein Loss (78282) | $44.48 | $68.01 | 0.1× |
| Gated Heart Planar Single (78472) | — | $4,345 | — |
| Gated Heart, Multiple (78473) range across 2 matching MRF lines |
$1,040.05 | $710–$1,590.29 | 2.1× |
| GI Endoscopic US S&I (76975) | $102.39 | $156.56 | 0.3× |
| Hand 2 views (73120) | — | $938 | — |
| Hdr Rdncl Ntrstl/Icav Brchtx (77772) | — | $12,110 | — |
| Hdr Rdncl Ntrstl/Icav Brchtx (77771) | — | $11,532 | — |
| Hdr Rdncl Ntrstl/Icav Brchtx 1 Channel (77770) | — | $7,669 | — |
| Heart first pass single,planar (78481) range across 2 matching MRF lines |
$800.36 | $258.84–$1,223.79 | 1.2× |
| Heart Image (Pet) Multiple (78492) range across 2 matching MRF lines |
$5,598.24 | $490.98–$8,560 | 3.1× |
| Hepatc Vngrph Wdg/Fr Hemodyn Eval Rs&I (75889) | — | $9,465 | — |
| Hepatc Vngrph Wdg/Fr W/O Hemodyn Eval Rs&I (75891) | — | $6,914 | — |
| Hepatobil Syst Image W/Drug (78227) | — | $3,022 | — |
| Hepatobiliary System Imaging (78226) | — | $2,813 | — |
| High energy neutron radj tx dlvr 1/> isocenter (77423) | $802.77 | $1,227.48 | 1.2× |
| Ht Musc Image Planar Mult (78454) range across 2 matching MRF lines |
$1,063.06 | $226.06–$1,625.47 | 0.7× |
| Ht Muscle Image Spect Sing (78451) | — | $4,433 | — |
| Hyperthermia external generated superficial (77600) range across 2 matching MRF lines |
$1,294.17 | $273.72–$1,978.85 | 2.7× |
| Hyperthermia generated by interstitial probe(s); 5 or fewer interstitial applicators Non-Facility (77610) range across 2 matching MRF lines |
$2,436.76 | $264.63–$3,725.93 | 3.5× |
| Hyperthermia generated by interstitial probe(s); more than 5 interstitial applicators Non-Facility (77615) range across 2 matching MRF lines |
$2,393.93 | $365.29–$3,660.45 | 3.5× |
| Hyperthermia generated by intracavitary probe(s) Non-Facility (77620) range across 2 matching MRF lines |
$1,114.23 | $525–$1,703.71 | 1.6× |
| Hyperthermia, externally generated; deep (ie, heating to depths greater than 4 cm) Non-Facility (77605) range across 2 matching MRF lines |
$1,800.12 | $362.69–$2,752.47 | 2.1× |
| Hysterosalpingogram (74740) | — | $1,459 | — |
| Infant hip ultrasound with hip movement (dynamic) (76885) range across 2 matching MRF lines |
$470.60 | $124.25–$719.57 | 4.3× |
| Infant hip ultrasound, limited static exam (76886) | — | $708 | — |
| Infusion Ivp (74410) range across 2 matching MRF lines |
$400.97 | $121.40–$613.10 | 1.8× |
| Interstitial radiation source applic complex (77778) range across 2 matching MRF lines |
$1,985.43 | $3,035.83–$5,485 | 2.3× |
| Intracavitary Radiation Source Applic Complex (77763) range across 2 matching MRF lines |
$1,673.22 | $1,519.73–$2,558.44 | 1.9× |
| Intracavitary Radiation Source Applic Intermed (77762) range across 2 matching MRF lines |
$1,325.78 | $1,210.26–$2,027.18 | 1.9× |
| Intracavitary radiation source applic simple (77761) range across 2 matching MRF lines |
$894.12 | $668.83–$1,367.15 | 1.3× |
| Intraop radiaj tx deliver xray single tx session (77424) | — | $22,794 | — |
| Joint Survey Single View (77077) range across 2 matching MRF lines |
$146.01 | $61.22–$223.26 | 1.1× |
| K Flow/Funct Image Multiple (78709) range across 2 matching MRF lines |
$1,216.63 | $645–$1,860.29 | 1.8× |
| K Flow/Funct Image W/Drug (78708) | — | $4,569 | — |
| K Flow/Funct Image W/O Drug (78707) | — | $3,260 | — |
| Kidney Funcj Study Non-Img Radioisotopic Study (78725) | — | $1,275 | — |
| Kidney Imaging Morphol (78700) | — | $2,088 | — |
| Kidney Imaging Morphoogy W/Vascular Flow (78701) range across 2 matching MRF lines |
$718.85 | $80.58–$1,099.16 | 1.4× |
| Knee 3 Views (73562) | — | $1,185 | — |
| Labeled RBC Sequestration Differntl Organ/Tissue (78140) range across 2 matching MRF lines |
$517.48 | $100.77–$791.25 | 1.0× |
| Leveen/Shunt Patency Exam (78291) range across 2 matching MRF lines |
$832.06 | $280–$1,272.27 | 1.7× |
| Liver & Spleen Imaging Static Only (78215) range across 2 matching MRF lines |
$475.42 | $81.88–$726.94 | 1.0× |
| Liver & Spleen Imaging W/Vascular Flow (78216) range across 2 matching MRF lines |
$483.44 | $95.85–$739.20 | 1.0× |
| Liver imaging static only (78201) range across 2 matching MRF lines |
$462.28 | $74.75–$706.85 | 0.7× |
| Liver imaging w/vascular flow (78202) range across 2 matching MRF lines |
$693.80 | $122.66–$1,060.86 | 1.0× |
| Lung Perf&Ventilat Diferentl (78598) range across 2 matching MRF lines |
$947.88 | $225–$1,449.36 | 1.4× |
| Lung perfusion differential (78597) | — | $3,074 | — |
| Lung Ventilat&Perfus Imaging (78582) | — | $4,163 | — |
| Lung Ventilation Imaging (78579) | — | $1,544 | — |
| Lymph System Imaging (78195) | — | $3,657 | — |
| Lymphangiography Extremity Only Bilateral Rs&I (75803) | $138.89 | $212.37 | 0.1× |
| Lymphangiography extremity only unilateral rs&i (75801) | $113.70 | $173.86 | 0.1× |
| Lymphangiography Pelvic/Abdominal Bilateral Rs&I (75807) | — | $7,779 | — |
| Lymphangiography, pelvic/abdominal, unilateral (75805) | $95.88 | $146.61 | 0.0× |
| Magnetic Image Jaw Joint (70336) | — | $4,218 | — |
| Magnetic resonance (eg, proton) imaging, brain (including brain stem andskull base), during open intracranial procedure… (70558) range across 2 matching MRF lines |
$5,236.79 | $586.69–$8,007.32 | 23.9× |
| Magnetic resonance (eg, proton) imaging, brain (including brain stem andskull base), during open intracranial procedure… (70557) range across 2 matching MRF lines |
$4,793.70 | $1,685–$7,329.81 | 7.0× |
| Magnetic resonance (eg, proton) imaging, brain (including brain stem andskull base), during open intracranial procedure… (70559) range across 2 matching MRF lines |
$5,331.74 | $592.75–$8,152.50 | 24.4× |
| Magnetic Resonance Elastography (76391) | — | $3,135 | — |
| Mammary ductogram or galactogram multiple (77054) range across 2 matching MRF lines |
$301.97 | $79.77–$461.73 | 1.0× |
| Mammary ductogram or galactogram single (77053) range across 2 matching MRF lines |
$223.57 | $62.08–$341.85 | 0.8× |
| Meckels Divert Exam (78290) | — | $2,498 | — |
| Medical physics dose eval radiation expos w/rprt (76145) range across 2 matching MRF lines |
$2,310.75–$2,324.97 | $3,555 | varies |
| Mlc imrt design & construction per imrt plan (77338) | — | $6,518 | — |
| Mr safety determination physician/other qhp (76016) range across 4 matching MRF lines |
$191.75–$192.93 | $110–$295 | varies |
| Mr safety implant&/fb assmt clin staf 1st 15 min (76014) | — | $259 | — |
| Mr safety implt electronics prepj supvj phys/qhp (76018) range across 4 matching MRF lines |
$302.25–$304.11 | $135–$465 | varies |
| Mr safety implt pos&/immoblj (76019) range across 4 matching MRF lines |
$396.50–$398.94 | $110–$610 | varies |
| Mr safety med physics xm customization plng&mntr (76017) range across 4 matching MRF lines |
$598–$601.68 | $140–$920 | varies |
| Mra Head W/O & W/Contrast Material (70546) | — | $4,218 | — |
| MRA head w/o contrast (70544) | — | $3,420 | — |
| MRA head with contrast (70545) | — | $3,420 | — |
| MRA neck w contrast (70548) range across 2 matching MRF lines |
$1,830.61 | $620–$2,799.10 | 4.2× |
| Mra Neck W/O &W/Contrast Material (70549) | — | $5,130 | — |
| MRA neck w/o contrast (70547) | — | $3,420 | — |
| MRI abdomen w contrast (74182) range across 2 matching MRF lines |
$2,001.67 | $865–$3,060.66 | 4.6× |
| MRI abdomen w/o contrast (74181) | — | $4,161 | — |
| MRI any jt lower extrem w/contrast material (73722) | — | $4,617 | — |
| MRI any jt lower extrem w/o & w/contrast matrl (73723) | — | $6,127.50 | — |
| MRI any jt upper extremity w/contrast matrl (73222) | — | $4,617 | — |
| MRI bone marrow blood supply (77084) range across 2 matching MRF lines |
$2,256.30 | $600–$3,450 | 7.6× |
| MRI brain functional w/o physician admnistration (70554) range across 2 matching MRF lines |
$1,819.77 | $375.31–$2,782.53 | 6.1× |
| MRI brain functional w/physician admnistration (70555) | — | $7,239 | — |
| MRI Breast W/O Contrast Bilateral (77047) | — | $3,821 | — |
| MRI Breast Without Contrast Material Unilateral (77046) range across 3 matching MRF lines |
$686.70–$1,599 | $295–$2,460 | varies |
| MRI cardiac w/o cont stress (75559) range across 2 matching MRF lines |
$2,628.88 | $768.08–$4,019.69 | 3.9× |
| MRI cardiac w/o contrast (75557) | — | $6,697.50 | — |
| MRI cervical spine w contrast (72142) | — | $5,073 | — |
| MRI cervical spine w/o cont (72141) | — | $4,218 | — |
| MRI chest w/o contrast (71550) | — | $4,161 | — |
| MRI chest with contrast (71551) range across 2 matching MRF lines |
$2,038.64 | $302.33–$3,117.18 | 2.1× |
| MRI chest wo w contrast (71552) | — | $6,441 | — |
| MRI lower extrem oth/thn jt w/contrast matrl (73719) range across 2 matching MRF lines |
$2,168.91 | $278.94–$3,316.37 | 5.0× |
| MRI lower extrem oth/thn jt w/o & w/contr matr (73720) | — | $6,127.50 | — |
| MRI lower extrem oth/thn jt w/o contr matrl (73718) | — | $3,847.50 | — |
| MRI lumbar spine w contrast (72149) | — | $5,073 | — |
| Mri Neck Spine W/O & W/Dye (72156) | — | $6,526.50 | — |
| MRI orbit face &/neck w/o contrast (70540) | — | $3,847.50 | — |
| MRI orbit face neck w contrast (70542) | — | $4,617 | — |
| Mri Orbt/Fac/Nck W/O &W/Dye (70543) | — | $6,127.50 | — |
| MRI pelvis w contrast (72196) | — | $4,930.50 | — |
| MRI pelvis w/o & w contrast (72197) | — | $6,270 | — |
| MRI pelvis w/o contrast (72195) | — | $4,161 | — |
| MRI spectroscopy (76390) | — | $2,025 | — |
| MRI thoracic spine w/o contrast (72146) | — | $4,218 | — |
| MRI upper extremity oth than jt w/contr matrl (73219) | — | $4,617 | — |
| MRI upper extremity oth than jt w/o contr matrl (73218) | — | $3,847.50 | — |
| Mri Uppr Extremity W/O&W/Dye (73220) | — | $6,127.50 | — |
| MRI, abdomen, combo (74183) | — | $6,270 | — |
| MRI, dorsal spine combo (72157) | — | $6,526.50 | — |
| MRI, dorsal spine contrast (72147) | — | $5,073 | — |
| MRI, joint upper extrem (73221) | — | $3,847.50 | — |
| MRI, joint upper extrem combo (73223) | — | $6,127.50 | — |
| MRI, lumbar spine combo (72158) | — | $6,526.50 | — |
| Myelogram cervical (72240) range across 2 matching MRF lines |
$457.59 | $160.66–$699.68 | 0.5× |
| Myelogram Lumbar (72265) range across 2 matching MRF lines |
$425.64 | $145.39–$650.83 | 0.4× |
| Myelography thoracic (72255) range across 2 matching MRF lines |
$416.42 | $161.96–$636.73 | 0.4× |
| Myelograpy 2/more regions rs&i (72270) range across 2 matching MRF lines |
$662.84 | $231–$1,013.51 | 0.7× |
| Myocardial Imaging Infarct Avid Planar Qual/Quan (78466) range across 2 matching MRF lines |
$474.83 | $330–$726.04 | 1.0× |
| Myocardial Imaging Pet Metabolic Evaluation (78459) range across 2 matching MRF lines |
$5,539.38 | $695–$8,470 | 3.4× |
| Myocardial imaging, infarct avid, planar; with ejection fraction by first pass technique Non-Facility (78468) range across 2 matching MRF lines |
$789.53 | $395–$1,207.23 | 1.2× |
| Myocardial Perfusion Planar 1 Study Rest/Stress (78453) range across 2 matching MRF lines |
$741.69 | $168.61–$1,134.09 | 0.5× |
| Myocardial Spect Multiple Studies (78452) | — | $7,150 | — |
| Myocrd Img Pet Metab Eval Single Study Cncrnt CT (78429) range across 4 matching MRF lines |
$418.56–$8,242 | $640–$12,680 | varies |
| Myocrd img PET prfuj 1std rest/stress cncrnt CT (78430) range across 4 matching MRF lines |
$395.67–$8,219.25 | $320–$12,645 | varies |
| Myocrd Img Pet Prfuj Mlt Std Rst&Strs Cncrnt CT (78431) range across 4 matching MRF lines |
$11,232.45–$12,662 | $375–$19,480 | varies |
| Myocrd Img Pet Prfuj W/Metab 2rtracer Cncrnt CT (78433) range across 4 matching MRF lines |
$7,929.75–$15,444 | $435–$23,760 | varies |
| Myocrd Img Pet Prfuj W/Metab Dual Radiotracer (78432) range across 4 matching MRF lines |
$7,903.59–$12,187.50 | $400–$18,750 | varies |
| N-invas est c ffr sw aly CTA (75580) range across 4 matching MRF lines |
$2,424.50–$2,439.42 | $135–$3,730 | varies |
| Neck soft tissue (70360) | — | $691 | — |
| Nfs/Instlj Radioelmnt Sln 3 Mo Follow-Up Care (77750) range across 2 matching MRF lines |
$843.78 | $877.44–$1,290.19 | 1.8× |
| Njx Rp Loclzj Non-Img Probe Study Intravenous (78808) | $155.88 | $238.35 | 0.3× |
| Nm csf leak detection (78650) range across 2 matching MRF lines |
$821.35 | $105.31–$1,255.89 | 0.5× |
| Nm myocard infarct spect (78469) | — | $5,080 | — |
| Nm red cell survival study (78130) range across 2 matching MRF lines |
$532.21 | $150.80–$813.77 | 1.1× |
| Nm whole blood volume (78122) range across 2 matching MRF lines |
$461.22 | $110.91–$705.23 | 0.7× |
| Nonvascular Shunt X-Ray (75809) range across 4 matching MRF lines |
$232.82–$363.35 | $220–$559 | varies |
| Ntsty modul radthx pln dose-vol histos (77301) | — | $18,957 | — |
| Nuclear medicine study of endocrine organs (78099) | $69.83 | $106.78 | 0.1× |
| Nuclear Rx Intra-Arterial (79445) | — | $1,972 | — |
| Nuclear Rx Oral Admin (79005) | — | $3,941 | — |
| Ob us nuchal meas 1 gest (76813) | — | $1,199 | — |
| Oph bmtry us echograpy a-scan io lens pwr cal (76519) range across 4 matching MRF lines |
$353.16–$451.75 | $255–$695 | varies |
| Oph us dx ant sgm us immersion b-scan/hr biom (76513) range across 4 matching MRF lines |
$224–$523.25 | $295–$805 | varies |
| Oph US Dx B-Scan&Quan a-Scan Sm Pt Enctr (76510) range across 4 matching MRF lines |
$390.78–$673.97 | $299.87–$1,036.88 | varies |
| Ophthalmic Biometry US Echograpy a-Scan (76516) range across 4 matching MRF lines |
$300.84–$419.25 | $250–$645 | varies |
| Ophthalmic Ultrasonic Foreign Body Localization (76529) range across 2 matching MRF lines |
$185.72 | $110.56–$283.98 | 1.7× |
| Ophthalmic ultrasound dx b-scan w/wo a-scan (76512) | — | $527 | — |
| Ophthalmic US Dx Corneal Pachymetry Uni/Bi (76514) | — | $152 | — |
| Ophthalmic us dx quantitative a-scan only (76511) range across 2 matching MRF lines |
$325.08 | $180.70–$497.06 | 2.5× |
| Optic foramina (70190) range across 2 matching MRF lines |
$121.19 | $38.96–$185.31 | 1.1× |
| Panoramic X-ray of jaws (70355) range across 2 matching MRF lines |
$77.09 | $40.21–$117.87 | 0.7× |
| Parathyroid imaging w/tomographic spect & CT (78072) | — | $4,189 | — |
| Parathyroid Planar Imaging (78070) | — | $2,881 | — |
| Parathyroid planar imaging w/wo subtraction (78071) range across 2 matching MRF lines |
$1,130.94 | $400–$1,729.26 | 2.3× |
| Pelvis 1 or 2 views (72170) | — | $590 | — |
| Perineogram (74775) range across 2 matching MRF lines |
$302.73 | $111.41–$462.89 | 1.0× |
| Peritoneogram Rs&I (74190) range across 2 matching MRF lines |
$265.77 | $84.22–$406.38 | 0.4× |
| Pet Image Skull-Thigh (78812) | $223.45 | $341.67 | 0.1× |
| Pet Image W/Ct Lmtd (78814) | $259 | $396.02 | 0.1× |
| PET image w/CT, full body (78816) | $745.56 | $1,140 | 0.4× |
| PET imaging CT attenuation skull base mid-thigh (78815) range across 2 matching MRF lines |
$12,259.23 | $1,120–$18,745 | 6.9× |
| Pet Imaging Limited Area Chest Head/Neck (78811) | $184.04 | $281.41 | 0.1× |
| Pet Myocardial Sngl Study (78491) range across 2 matching MRF lines |
$3,956.70 | $480–$6,050 | 2.2× |
| PET whole body (78813) | $233.55 | $357.11 | 0.1× |
| Plasma Vol Radiopharm Vol Dilute Spx Mult Smples (78111) range across 2 matching MRF lines |
$346.06 | $37.48–$529.14 | 0.2× |
| Plasma volume, radiopharmaceutical volume-dilution technique (separate procedure); single sampling Non-Facility (78110) range across 2 matching MRF lines |
$252.69 | $34.11–$386.37 | 0.2× |
| Platelet survival study Non-Facility (78191) range across 2 matching MRF lines |
$701.82 | $107.91–$1,073.12 | 1.4× |
| Prq Transhepatc Portograpy Hemodyn Eval Rs&I (75885) | — | $7,743 | — |
| Pulmonary Perfusion Imaging Particulate (78580) | — | $2,118 | — |
| Radex Abd Compl Aqt Abd W/S/E/D Views 1 View Ch (74022) range across 2 matching MRF lines |
$137.87 | $100–$210.81 | 1.1× |
| Radex abscess/fistula/sinus tract rs&i (76080) | — | $1,649 | — |
| Radex Ankle Complete Minimum 3 Views (73610) | — | $1,065 | — |
| Radex Calcaneus Minimum 2 Views (73650) | — | $593 | — |
| Radex elbow complete minimum 3 views (73080) | — | $1,084 | — |
| Radex Facial Bones Complete Minimum 3 Views (70150) | — | $752 | — |
| Radex fingr minimum 2 views (73140) | — | $991 | — |
| Radex foot complete minimum 3 views (73630) | — | $1,110 | — |
| Radex Hand Minimum 3 Views (73130) | — | $1,388 | — |
| Radex lower extremity infant minimum 2 views (73592) | — | $486 | — |
| Radex Mastoids Compl Minimum 3 Views PR Side (70130) | — | $480 | — |
| Radex Nasal Bones Complete Minimum 3 Views (70160) | — | $607 | — |
| Radex Pharynx/Larx W/Fluor&/Magnification Tq (70370) range across 2 matching MRF lines |
$190.84 | $57.37–$291.80 | 1.8× |
| Radex Ribs Unilateral 2 Views (71100) | — | $603 | — |
| Radex shoulder complete minimum 2 views (73030) | — | $976 | — |
| Radex Sinuses Paransl < 3 Views (70210) | — | $389 | — |
| Radex sm int w/mlt srl imges via enteroclss tube (74251) range across 2 matching MRF lines |
$990.48 | $120.80–$1,514.50 | 4.5× |
| Radex Spine 1 View Specify Level (72020) | — | $389 | — |
| Radex Sternum Minimum 2 Views (71120) | — | $388 | — |
| Radex Temporomandble Jt Opn & Clsd Mouth Bilat (70330) | — | $769 | — |
| Radex Toe Minimum 2 Views (73660) | — | $777 | — |
| Radex upper extremity infant minimum 2 views (73092) | — | $626 | — |
| Radex Wrist Complete Minimum 3 Views (73110) | — | $1,219 | — |
| Radex X-Ray Exam Entire Spi 6/> Vw - Xr Entire Spine 6+ Vw (72084) | — | $1,251 | — |
| Radiation Delivery Stereotactic Cranial Linear (77372) | — | $46,572 | — |
| Radiation treatment delivery level 3 (77412) | — | $3,073 | — |
| Radiolog exam mandible compl minimum 4 views (70110) | — | $529 | — |
| Radiologic Exam Abdomen 3+ Views - Xr Abdomen 3+ Views (74021) | — | $524 | — |
| Radiologic exam colon double contrast study (74280) range across 2 matching MRF lines |
$692.62 | $520–$1,059.05 | 3.2× |
| Radiologic exam colon single contrast study (74270) | — | $1,248 | — |
| Radiologic Exam Esophagus Double Contrast Study (74221) | — | $1,188 | — |
| Radiologic exam knee complete 4/more views (73564) | — | $1,267 | — |
| Radiologic exam pelvis compl minimum 3 views (72190) | — | $772 | — |
| Radiologic Exam Small Int Single Contrast Study (74250) | — | $1,159 | — |
| Radiologic exam swallow function contrast study (74230) | — | $999 | — |
| Radiologic exam teeth complete full mouth (70320) range across 2 matching MRF lines |
$127.52 | $46.14–$194.99 | 0.4× |
| Radiologic Exam Teeth Prtl Exam < Full Mouth (70310) range across 2 matching MRF lines |
$91.18 | $29.44–$139.42 | 0.3× |
| Radiologic exam upr gi trc double contrast study (74246) | — | $2,670 | — |
| Radiologic examination femur 1 view (73551) | — | $415 | — |
| Radiologic examination femur minimum 2 views (73552) | — | $519 | — |
| Radiologic examination knee 1/2 views (73560) | — | $892 | — |
| Radiologic Examination Osseous Survey Limited (77074) range across 2 matching MRF lines |
$197.12 | $210–$301.41 | 1.5× |
| Radiologic Examination Salivary Gland Calculus (70380) range across 2 matching MRF lines |
$127.37 | $34.24–$194.76 | 1.2× |
| Radiologic examination tibia & fibula 2 views (73590) | — | $1,236 | — |
| Radiologic examination, internal auditory meati, complete Non-Facility (70134) range across 2 matching MRF lines |
$119.66 | $60.05–$182.96 | 0.2× |
| Radiologic examination, teeth; single view Non-Facility (70300) range across 2 matching MRF lines |
$35.89 | $21.40–$54.88 | 0.3× |
| Radiopharm Dacryocystography (78660) range across 2 matching MRF lines |
$429.45 | $129.90–$656.65 | 0.9× |
| Radiopharmaceutical therapy, by interstitial radioactive colloid administration Facility (79300) range across 2 matching MRF lines |
$462.50 | $400.71–$707.18 | 1.6× |
| Radiopharmaceutical therapy, by intra-articular administration Non-Facility (79440) range across 2 matching MRF lines |
$536.53 | $488.48–$820.38 | 1.8× |
| Radiopharmaceutical therapy, by intracavitary administration Non-Facility (79200) range across 2 matching MRF lines |
$487.28 | $490.38–$745.08 | 1.7× |
| Red Cell Volume Determination Spx 1 Sampling (78120) range across 2 matching MRF lines |
$230.18 | $39.90–$351.95 | 0.5× |
| Red Cell Volume Determination Spx Mult Samplings (78121) range across 2 matching MRF lines |
$371.03 | $53.91–$567.33 | 0.5× |
| Remote afterloading high dose rate radionuclide skin surface brachytherapy, includes basic dosimetry, when performed;… (77768) range across 2 matching MRF lines |
$835.65 | $247.05–$1,277.75 | 1.7× |
| Remote afterloading high dose rate radionuclide skin surface brachytherapy, includes basic dosimetry, when performed;… (77767) range across 2 matching MRF lines |
$532.43 | $187.13–$814.12 | 1.1× |
| Renal Cyst Study (74470) | — | $1,986 | — |
| Ribs bilateral 3 views (71110) | — | $1,259 | — |
| Rp loclzj tum plnr 1 area single day imaging (78800) | — | $2,414 | — |
| Rp loclzj tum plnr 2+area 1+d img/1 area img>2+d (78801) range across 2 matching MRF lines |
$636.94 | $295–$973.92 | 1.3× |
| Rp Loclzj Tum Plnr Whole Body 2+ Days Imaging (78804) | — | $5,839 | — |
| Rp Loclzj Tum Plnr Whole Body Single Day Imaging (78802) | — | $5,396 | — |
| Rp Loclzj Tum Spect 1 Area Single Day Imaging (78803) | — | $6,891 | — |
| Rp loclzj tum spect 2 area/sep acquisj img (78831) | — | $8,625 | — |
| Rp loclzj tum spect CT 2area 1d img/1 ar img>2+d (78832) | — | $7,492 | — |
| Rp loclzj tum spect w/CT 1 area/acquisj 1day img (78830) | — | $7,840 | — |
| Rp Ther Radiolbld Monoclonal Antibody IV Infus (79403) range across 2 matching MRF lines |
$613.54 | $375.25–$938.13 | 2.1× |
| Rp Therapy Intravenous Administration (79101) | — | $2,370 | — |
| Salivary Gland Function Study (78232) range across 2 matching MRF lines |
$475.41 | $116.15–$726.93 | 1.0× |
| Salivary Gland Imaging (78230) range across 2 matching MRF lines |
$421.88 | $77.39–$645.08 | 0.8× |
| Salivary Gland Imaging Serial Images (78231) | — | $1,492 | — |
| Scapula (73010) | — | $603 | — |
| Screening Digital Breast Tomosynthesis Bi (77063) | — | $331 | — |
| Sella turcica (70240) range across 2 matching MRF lines |
$99.61 | $36.49–$152.31 | 0.9× |
| Shoulder 1 view (73020) | — | $869 | — |
| Shoulder Arthrography (73040) | — | $1,695 | — |
| Sialogram (70390) range across 2 matching MRF lines |
$288.52 | $65.63–$441.16 | 1.0× |
| Skull less than 4 views (70250) | — | $781 | — |
| Special dosimetry (77331) | — | $1,090 | — |
| Special Physics Consult (77370) | — | $2,286 | — |
| Special teletherapy port plan (77321) | — | $2,053 | — |
| Special treatment procedure (77470) | — | $6,729 | — |
| Speech evaluation, complex (70371) range across 2 matching MRF lines |
$274.80 | $144.36–$420.19 | 0.9× |
| Spleen Imaging (78185) range across 2 matching MRF lines |
$520.55 | $69.17–$795.95 | 1.0× |
| Stereotactic Body Radiation Delivery (77373) | — | $25,473 | — |
| Sternoclavicular joints (71130) | — | $620 | — |
| Superior sagittal sinus venogram (75870) | — | $7,743 | — |
| Surface Applic Low Dose Rate Radionuclide Source (77789) range across 2 matching MRF lines |
$279.28 | $203.75–$427.04 | 2.2× |
| Telethx isodose pln cplx w/basic dosimetry (77307) | — | $3,028 | — |
| Telethx isodose pln smpl w/dosimetry calculation (77306) range across 2 matching MRF lines |
$483.96 | $740–$840 | 1.0× |
| Temporomandble Jt Arthrography Rs&I (70332) range across 2 matching MRF lines |
$290.14 | $115.19–$443.64 | 1.0× |
| Testicular Imaging W/Flow (78761) range across 2 matching MRF lines |
$710.94 | $124.34–$1,087.07 | 1.4× |
| Ther Rad Simulaj-Aided Field Setting Complex (77290) | — | $6,079 | — |
| Ther Rad Simulaj-Aided Field Setting Intermed (77285) | — | $3,941 | — |
| Ther rad simulaj-aided field setting simple (77280) | — | $3,213 | — |
| Therapeutic Enema Rdctj Intussusception/Obstrcj (74283) | — | $1,585 | — |
| Thoracic spine 2 views (72070) | — | $745 | — |
| Thoracic spine 3 views (72072) | — | $695 | — |
| Thoracolumbar 2 views (72080) range across 2 matching MRF lines |
$160.23 | $90–$245 | 1.5× |
| Thyroid carcinoma metastases imaging; with additional studies (eg, urinary recovery) Non-Facility (78016) range across 2 matching MRF lines |
$1,082.59 | $200.91–$1,655.33 | 2.2× |
| Thyroid Carcinoma Metastases Img Lmtd Area (78015) range across 2 matching MRF lines |
$537.82 | $109.89–$822.35 | 1.1× |
| Thyroid Imaging With Vascular Flow (78013) range across 2 matching MRF lines |
$795.65 | $60.83–$1,216.59 | 1.6× |
| Thyroid Met Imaging Body (78018) | — | $3,773 | — |
| Thyroid Uptake Measurement (78012) range across 2 matching MRF lines |
$261.31 | $80–$399.56 | 0.5× |
| Thyroid Uptake W/Blood Flow Sngle/Mult Quan Meas (78014) | — | $3,504 | — |
| Tx Devices Design & Construction Complex (77334) | — | $3,519 | — |
| Tx devices design & construction intermediate (77333) | — | $2,500 | — |
| Tx devices design & construction simple (77332) | — | $2,034 | — |
| Ultrasound Breast Limited (76642) | — | $1,254 | — |
| Ultrasound elastography first target lesion (76982) range across 3 matching MRF lines |
$268.14–$711.75 | $125–$1,095 | varies |
| Ultrasound Elastography Parenchyma (76981) | — | $1,590 | — |
| Ultrasound Exam Aaa Screen (76706) | — | $774 | — |
| Ultrasound trgt dynamic microbubble 1st lesion (76978) | — | $1,074 | — |
| Ultrasound, abdomen limited (76705) | — | $1,327 | — |
| Umbilical-artery Doppler (OB) (76820) | — | $559 | — |
| Unlisted fluoroscopic procedure (76496) range across 3 matching MRF lines |
$73.25–$335.40 | $112–$516 | varies |
| Unlisted magnetic resonance procedure (76498) | — | $2,000 | — |
| Unlisted Procedure Clinical Brachytherapy (77799) range across 2 matching MRF lines |
$1,177.20 | $540–$1,800 | 9.2× |
| Unlisted us procedure (76999) | — | $315 | — |
| Upper gi w/o kub (74240) | — | $1,543 | — |
| Ureteral Reflux Study (78740) | — | $1,999 | — |
| Urethrocystogram voiding (74455) | — | $1,699 | — |
| Urethrocystography retrograde (74450) | — | $1,301 | — |
| Us bone density measurement (76977) range across 2 matching MRF lines |
$50.64 | $10.59–$77.43 | 0.4× |
| Us breast unilateral complete (76641) | — | $2,090 | — |
| Us chest (76604) | — | $1,559 | — |
| Us complete joint (76881) | — | $1,283 | — |
| Us exam, pelvic, limited (76857) | — | $1,505 | — |
| Us head (76506) | — | $1,224 | — |
| Us kidney transplant (76776) | — | $1,462 | — |
| Us lmtd joint/oth nonvasc xtr strux r-t w/img (76882) | — | $1,187 | — |
| Us ob detailed single fetus (76811) | — | $1,329 | — |
| Us ob limited 1 or more fetuses (76815) | — | $1,580 | — |
| Us ob transvaginal (76817) | — | $1,588 | — |
| Us pelvic non ob complete (76856) | — | $1,285 | — |
| Us pg uter img f&mat 14 wk tabdl 1/1st gestation (76801) | — | $974 | — |
| Us preg uterus real time f/u trnsabdl per fetus (76816) | — | $1,104 | — |
| Us retroperitoneal complete (76770) | — | $1,754 | — |
| Us retroperitoneal limited (76775) | — | $1,695 | — |
| Us scrotum and contents (76870) | — | $2,274 | — |
| Us spinal canal and contents (76800) | — | $879 | — |
| Us thyroid (76536) | — | $1,852 | — |
| Us transrectal (76872) | — | $964 | — |
| Vascular Flow Imaging (78445) range across 2 matching MRF lines |
$439.80 | $80.58–$672.47 | 0.9× |
| Vasogram (74440) range across 2 matching MRF lines |
$243.10 | $93.54–$371.71 | 0.8× |
| Vein X-Ray Chest (75827) | — | $3,901 | — |
| Vein X-Ray Liver W/O Hemodyn (75887) | — | $7,850 | — |
| Vein X-Ray Skull Epidural (75872) range across 2 matching MRF lines |
$1,033.88 | $301.89–$1,580.85 | 1.3× |
| Vein X-Ray Spleen/Liver (75810) | $135.84 | $207.70 | 0.0× |
| Venogram Sinus/Jugular (75860) | — | $7,743 | — |
| Venography Adrenal Unilateral (75840) range across 2 matching MRF lines |
$926.01 | $200.56–$1,415.91 | 0.2× |
| Venography caval inferior serialography rs&i (75825) | — | $10,826 | — |
| Venography extremity bilateral rs&i (75822) | — | $4,225 | — |
| Venography extremity unilateral rs&i (75820) | — | $3,901 | — |
| Venography Orbital Rs&I (75880) range across 2 matching MRF lines |
$341.85 | $122.35–$522.70 | 0.4× |
| Venography Renal Bilateral (75833) | — | $10,195 | — |
| Venography Renal Unilateral (75831) | — | $8,887 | — |
| Venous sampling by catheter (75893) | — | $13,509 | — |
| Venous thrombosis imaging (78457) range across 2 matching MRF lines |
$543.56 | $350–$831.13 | 0.8× |
| Venous Thrombosis Imaging Venogram Bilateral (78458) range across 2 matching MRF lines |
$720.44 | $365–$1,101.59 | 1.4× |
| Vertebral fracture assessment via dxa (77086) | — | $313 | — |
| Wrist 2 views (73100) | — | $756 | — |
| X-Ray Ac Jts - Xr Acromioclavicular Joints Bilateral (73050) | — | $974 | — |
| X-ray antegrade pyelogram tube (74425) | — | $1,498 | — |
| X-Ray Aorta Leg Arteries (75630) | — | $12,008 | — |
| X-Ray Bend Only L-S Spine (72120) | — | $449 | — |
| X-Ray Elbow 2 Vw - Xr Elbow 1-2 Views Right (73070) | — | $754 | — |
| X-Ray Exam Breast Specimen (76098) | — | $2,704 | — |
| X-Ray Exam Entire Spi 1 Vw (72081) | — | $752 | — |
| X-Ray Exam Entire Spi 2/3 Vw (72082) | — | $1,114 | — |
| X-Ray Exam Entire Spi 4/5 Vw (72083) | — | $1,172 | — |
| X-Ray Exam Hip Uni 1 View (73501) | — | $484 | — |
| X-Ray Exam Hip Uni 2-3 Views (73502) | — | $696 | — |
| X-Ray Exam Hips Bi 2 Views (73521) | — | $698 | — |
| X-Ray Exam Hips Bi 3-4 Views (73522) | — | $889 | — |
| X-Ray Exam L-S Spine Bending (72114) | — | $1,286 | — |
| X-Ray Exam Neck Spine 2-3 Vw (72040) | — | $1,212 | — |
| X-Ray Exam Neck Spine 6/>Vws (72052) | — | $1,999 | — |
| X-Ray Exam Unilat Ribs/Chest (71101) | — | $826 | — |
| X-ray eye for foreign body (70030) | — | $408 | — |
| X-ray head for orthodontia (70350) range across 2 matching MRF lines |
$68.79 | $36.84–$105.18 | 0.6× |
| X-ray humerus (73060) | — | $890 | — |
| X-ray IV pyelogram (ivp) (74400) range across 2 matching MRF lines |
$380.10 | $200–$581.19 | 1.7× |
| X-ray IV pyelogram+tomography (74415) range across 2 matching MRF lines |
$460.91 | $83.18–$704.76 | 2.1× |
| X-Ray Jaw <4 Vw - Xr Mandible < 4 Views (70100) | — | $288 | — |
| X-Ray Knee Bilat Standing - Xr Knees Anteroposterior Standing Bilat (73565) | — | $713 | — |
| X-Ray Lumbar Spine 2/3 Vw - Xr Lumbar Spine 2-3 Views (72100) | — | $622 | — |
| X-ray nose-rectum child f.b. (76010) | — | $276 | — |
| X-Ray Ribs, Chest 4+ Vw - Xr Ribs 3 Vws Bil W/ Chest Posteroanterior (71111) | — | $1,550 | — |
| X-Ray Sacroiliac Jts 3+ Vw - Xr Sacroiliac Joints 3+ Views (72202) | — | $758 | — |
| X-Ray Sacroiliac Jts <3 Vw - Xr Sacroiliac Joints 1-2 Views (72200) | — | $519 | — |
| X-Ray Sacrum/Coccyx 2+ Vw - Xr Sacrum Coccyx 2+ Views (72220) | — | $879 | — |
| X-Ray Sinuses 3+ Vw - Xr Paranasal Sinuses 3+ Views (70220) | — | $1,020 | — |
| X-Ray Skull 4+ Vw - Xr Skull Complete 4+ Views (70260) | — | $837 | — |
| X-Ray Stress View (77071) | — | $427 | — |
| X-ray thoracic spine 4 vw (72074) range across 2 matching MRF lines |
$186.39 | $100–$285 | 1.4× |
| X-Ray Tmj Unilat (70328) range across 2 matching MRF lines |
$101.15 | $32.99–$154.67 | 0.9× |
| X-Ray Urinary Tract Exam With Contrast Material (74420) | — | $1,503 | — |
| X-Rays Bone Length Studies (77073) | — | $1,147 | — |
| X-Rays Bone Survey Complete (77075) | — | $1,001 | — |
| Xr c-spine 4 or 5 views (72050) | — | $1,329 | — |
| Xr facial bones less than 3 views (70140) | — | $337 | — |
| XR Mastoids < 3 Views Bilateral (70120) range across 2 matching MRF lines |
$114.09 | $80–$174.45 | 0.9× |
| Xr myelogram posterior fossa (70010) | $490.11 | $749.40 | 1.1× |
| Xr orbits complete 4 views (70200) | — | $684 | — |
| Xr Tomogram Single Plane (76100) range across 2 matching MRF lines |
$388.99 | $113.41–$594.79 | 3.0× |
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.