Imaging prices at Morton Plant Hospital
Clearwater, FL · every code in this section with a posted price and a Medicare benchmark.
468 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) | $4,078.80 | $6,798 | 2.8× |
| Abdomen 1 View (74018) | $351 | $585 | 3.9× |
| Abdomen 2 views (74019) | $638.40 | $1,064 | 5.8× |
| Acute Gastrointestinal Blood Loss Imaging (78278) | $1,690.80 | $2,818 | 4.1× |
| Acute venous thrombosis imaging, peptide Non-Facility (78456) | $425.40 | $709 | 0.3× |
| Angio internal mammary (75756) | $665.40 | $1,109 | 0.2× |
| Angio pulmonary bilat (75743) | $3,088.80 | $5,148 | 0.9× |
| Angiography Adrenal Bilateral Slctv Rs&I (75733) | $5,027.40 | $8,379 | 1.5× |
| Angiography extremity bilateral rs&i (75716) | $5,244.60 | $8,741 | 1.6× |
| Angiography extremity unilateral rs&i (75710) | $4,930.20 | $8,217 | 1.5× |
| Angiography pulmonary unilateral slctv rs&i (75741) | $2,749.20 | $4,582 | 0.8× |
| Angrph pulmonary nonslctv cath/ven njx rs&i (75746) | $2,779.80 | $4,633 | 0.8× |
| Ankle 2 views (73600) range across 2 matching MRF lines |
$434.40–$668.40 | $724–$1,114 | varies |
| Aortography thoracic serialography rs&i (75605) | $4,642.80 | $7,738 | 0.8× |
| Aortography thoracic w/o serialography rs&i (75600) | $4,656 | $7,760 | 1.4× |
| Artery X-Rays Abdomen (75726) | $3,771 | $6,285 | 0.6× |
| Artery X-Rays Adrenal Gland (75731) | $2,059.20 | $3,432 | 0.6× |
| Artery X-Rays Pelvis (75736) unusually low: confirm this is the full procedure |
$2,698.20 | $4,497 | 0.5× |
| Artery X-Rays Spine (75705) range across 2 matching MRF lines |
$2,582.40–$10,995.60 | $4,304–$18,326 | varies |
| Arthrogram ankle (73615) | $886.80 | $1,478 | 2.4× |
| Arthrogram hip (73525) range across 3 matching MRF lines |
$886.80–$1,330.20 | $1,478–$2,217 | varies |
| Arthrogram Wrist (73115) range across 3 matching MRF lines |
$886.80–$1,330.20 | $1,478–$2,217 | varies |
| Basic radiation dosimetry calculation (77300) | $424.20 | $707 | 3.0× |
| Bone age studies (77072) | $282.60 | $471 | 2.6× |
| Bone Imaging 3 Phase (78315) | $2,508 | $4,180 | 6.0× |
| Bone Imaging Limited Area (78300) | $1,657.80 | $2,763 | 4.0× |
| Bone Imaging Multiple Areas (78305) | $2,028.60 | $3,381 | 4.9× |
| Bone Imaging Whole Body (78306) | $2,181 | $3,635 | 5.2× |
| Bone marrow imaging limited area (78102) | $1,106.40 | $1,844 | 2.7× |
| Bone marrow imaging; multiple areas (78103) | $1,418.40 | $2,364 | 3.4× |
| Bone marrow imaging; whole body (78104) | $1,617 | $2,695 | 3.9× |
| Bone survey infant (77076) | $944.40 | $1,574 | 8.7× |
| Brachytx isodose complex (77318) | $436.80 | $728 | 1.1× |
| Brachytx isodose intermed (77317) | $304.20 | $507 | 0.8× |
| Brachytx Isodose Plan Simple (77316) | $232.20 | $387 | 0.6× |
| Brain Image W/Flow < 4 Views (78601) | $1,184.40 | $1,974 | 2.8× |
| Brain Imaging Min 4 Static Views W Vascular Flow (78606) | $1,800 | $3,000 | 3.2× |
| Brain Imaging Pet Metabolic Evaluation (78608) | $4,019.40 | $6,699 | 2.7× |
| Cardiac MRI w/w/o contrast & further seq (75561) | $1,709.40 | $2,849 | 4.7× |
| Cardiac MRI w/w/o contrast w/stress (75563) | $1,709.40 | $2,849 | 2.1× |
| Cat Scan Follow-Up Study (76380) | $1,108.20 | $1,847 | 12.2× |
| Cerebrospinal Fluid Flow W/O Matl Shunt Evaltj (78645) | $1,532.40 | $2,554 | 2.7× |
| Cerebrospinal Fluid Scan (78630) | $1,263.60 | $2,106 | 2.2× |
| Chest 1 view (71045) | $358.80 | $598 | 3.9× |
| Chest 2 views (71046) | $455.40 | $759 | 5.0× |
| Chest 3 views (71047) | $574.20 | $957 | 6.3× |
| Chest 4 or more views (71048) | $621 | $1,035 | 5.7× |
| Chg us nrv&acc strux 1 xtr compre w/img pr extremity (76883) | $225 | $375 | 2.1× |
| Cholecystography Oral Contrast (74290) | $199.80 | $333 | 1.1× |
| Cineradiograpy/vidradiograpy xcpt where spec (76120) | $201.60 | $336 | 1.8× |
| Clavicle complete (73000) range across 2 matching MRF lines |
$382.20–$573.60 | $637–$956 | varies |
| Computed Tomography Thorax Lw Dose Lng Ca Scr C- (71271) | $158.40 | $264 | 1.5× |
| Continuing medical physics consltj pr wk (77336) | $448.80 | $748 | 3.2× |
| Contrast Exam Abdominl Aorta (75625) | $5,027.40 | $8,379 | 1.5× |
| Contrast X-Ray Bladder (74430) | $601.20 | $1,002 | 1.7× |
| Contrast X-Ray Of Elbow (73085) range across 3 matching MRF lines |
$432.60–$649.20 | $721–$1,082 | varies |
| Contrast X-Ray Of Knee Joint (73580) range across 3 matching MRF lines |
$886.80–$1,330.20 | $1,478–$2,217 | varies |
| Contrast Xray Throat/Cerv Esopha (74210) | $693.60 | $1,156 | 3.8× |
| Corpora cavernosography (74445) | $177.60 | $296 | 1.6× |
| CT abdomen and pelvis without and with contrast (74178) | $5,664.75 | $9,441.25 | 15.5× |
| CT abdomen and pelvis without contrast (74176) | $3,398.85 | $5,664.75 | 13.6× |
| CT abdomen w contrast (74160) | $3,172.20 | $5,287 | 17.3× |
| CT abdomen w wo contrast (74170) | $3,852 | $6,420 | 21.0× |
| CT abdomen w/o contrast (74150) | $2,266.20 | $3,777 | 20.8× |
| CT Angio Abdomen and Pelvis (74174) | $4,906.80 | $8,178 | 13.5× |
| CT Angio Chest (71275) | $3,283.80 | $5,473 | 17.9× |
| CT Angio Head (70496) | $3,536.40 | $5,894 | 19.3× |
| CT angio hrt w/3d image (75574) | $1,641.60 | $2,736 | 4.5× |
| Ct Angio Lwr Extr W/O&W/Dye (73706) range across 2 matching MRF lines |
$2,266.80–$3,400.20 | $3,778–$5,667 | varies |
| CT Angio Neck (70498) | $3,579 | $5,965 | 19.5× |
| Ct Angio Upr Extrm W/O&W/Dye (73206) | $2,756.40 | $4,594 | 15.0× |
| CT cervical spine w/ contrast (72126) | $3,725.40 | $6,209 | 10.2× |
| CT cervical spine w/o contrast (72125) | $3,004.20 | $5,007 | 27.5× |
| CT cervical spine w/wo cont (72127) | $4,416 | $7,360 | 24.1× |
| CT chest w contrast (71260) | $3,348.60 | $5,581 | 18.3× |
| CT chest w/wo contrast (71270) | $3,984.60 | $6,641 | 21.8× |
| CT colonography screening (74263) | $391.20 | $652 | 1.6× |
| CT Colonogrphy Dx Image Postprocess W/Contrast (74262) | $1,621.80 | $2,703 | 8.9× |
| CT colonogrphy dx image postprocess w/o contrast (74261) | $1,787.40 | $2,979 | 16.4× |
| CT head/brain with contrast (70460) | $3,743.40 | $6,239 | 20.4× |
| CT head/brain without and with contrast (70470) | $4,407.60 | $7,346 | 24.1× |
| CT heart contrast eval cardiac structure&morph (75572) | $1,641.60 | $2,736 | 4.5× |
| CT heart no contrast quant eval coronry calcium (75571) | $1,395.60 | $2,326 | 15.4× |
| CT hrt w/3d image congen (75573) | $1,641.60 | $2,736 | 4.5× |
| CT iac w contrast (70481) | $3,060 | $5,100 | 16.7× |
| CT l-spine w&w/o contrast (72133) | $4,861.80 | $8,103 | 26.5× |
| CT lower ext w/o (73700) range across 2 matching MRF lines |
$2,932.80–$4,399.20 | $4,888–$7,332 | varies |
| CT lower extremity w/contrast material (73701) range across 2 matching MRF lines |
$3,695.40–$5,161.80 | $6,159–$8,603 | varies |
| CT lumbar spine w contrast (72132) | $4,116.60 | $6,861 | 11.3× |
| CT lumbar spine w/o contrast (72131) | $3,241.20 | $5,402 | 29.7× |
| CT maxillofacial w contrast (70487) | $3,157.80 | $5,263 | 17.2× |
| CT maxillofacial wo contrast (70486) | $2,631.60 | $4,386 | 24.1× |
| CT neck tissue combo (70492) | $3,616.20 | $6,027 | 19.7× |
| Ct Orbit/Ear/Fossa W/O&W/Dye (70482) | $3,317.40 | $5,529 | 18.1× |
| CT orbits w/o contrast (70480) | $2,571.60 | $4,286 | 23.6× |
| CT pelvis w&w/o contrast (72194) | $5,367 | $8,945 | 29.3× |
| CT pelvis w/o contrast (72192) | $2,932.80 | $4,888 | 26.9× |
| CT scan of leg combo (73702) range across 2 matching MRF lines |
$4,458–$5,924.40 | $7,430–$9,874 | varies |
| CT scans face/jaw combo (70488) | $3,842.40 | $6,404 | 21.0× |
| CT soft tissue neck w contrast (70491) | $2,988.60 | $4,981 | 16.3× |
| CT soft tissue neck w/o contrast (70490) | $2,421 | $4,035 | 22.2× |
| CT thoracic spine w contrast (72129) | $4,288.20 | $7,147 | 23.4× |
| CT thoracic spine w/o contrast (72128) | $2,395.80 | $3,993 | 21.9× |
| CT thoracic spine w/wo cont (72130) | $4,288.20 | $7,147 | 23.4× |
| CT thorax w/o contrast (71250) | $2,712.60 | $4,521 | 24.8× |
| CT upper ext wo (73200) range across 2 matching MRF lines |
$1,783.20–$2,674.80 | $2,972–$4,458 | varies |
| CT upper extremity w/o & w/contrast material (73202) range across 2 matching MRF lines |
$2,764.20–$3,655.80 | $4,607–$6,093 | varies |
| CT upper extremity with contrast (73201) range across 2 matching MRF lines |
$2,211–$3,102.60 | $3,685–$5,171 | varies |
| Cta Abdl Aorta&Bi Iliofem W/Contrast&Postp (75635) | $3,345 | $5,575 | 18.3× |
| Cta Abdomen (74175) | $3,876.60 | $6,461 | 21.2× |
| CTA pelvis (72191) | $3,151.20 | $5,252 | 17.2× |
| Dacryocystography, nasolacrimal duct, radiological supervision and interpretation Non-Facility (70170) | $454.20 | $757 | 1.8× |
| Dilation ureters/urethra rs&i (74485) | $3,244.20 | $5,407 | 1.5× |
| Discography Cerv/Thor Spine (72285) | $3,084 | $5,140 | 1.5× |
| Diskography lumbar (72295) | $1,659.60 | $2,766 | 0.8× |
| Doppler Echo Fetal Puls Spectral F/U/Repeat (76828) | $502.20 | $837 | 4.6× |
| Doppler Echo Fetal Spectral Display Complete (76827) | $707.40 | $1,179 | 6.5× |
| Doppler Fetal Mid Cerebral Artery (76821) | $130.20 | $217 | 1.2× |
| Dxa Bone Density Axial (77080) | $175.20 | $292 | 1.6× |
| Dxa bone density study (77085) | $175.20 | $292 | 1.6× |
| Dxa bone density study 1/>sites appendiclr skel (77081) | $96.60 | $161 | 1.1× |
| Echo exam of fetal heart (76825) | $919.80 | $1,533 | 1.6× |
| Echo exam uterus (76831) | $611.40 | $1,019 | 2.5× |
| Echo Guide For Artery Repair (76936) | $1,027.20 | $1,712 | 4.6× |
| Echocardiography, fetal, cardiovascular system, real time with image documentation (2D), with or without M-mode… (76826) | $423 | $705 | 1.7× |
| Echograp Trans R Pros Study (76873) | $1,576.20 | $2,627 | 14.4× |
| Esophageal Motility Study (78258) | $930 | $1,550 | 2.2× |
| Esophagram (74220) | $628.80 | $1,048 | 3.4× |
| Fetal Biophys Profile W/Nst (76818) | $702.60 | $1,171 | 6.4× |
| Fetal Biophysical Profile W/O Non-Stress Testing (76819) | $516.60 | $861 | 4.7× |
| Fetal MRI w/placntl matrnl plvc img sing/1st ges (74712) | $537 | $895 | 2.2× |
| Fluoroscopy up to 1 hr (76000) | $672 | $1,120 | 2.7× |
| Follow-Up Angiography (75898) | $924.60 | $1,541 | 0.3× |
| Foot 2 views (73620) range across 2 matching MRF lines |
$457.20–$723 | $762–$1,205 | varies |
| Forearm 2 views (73090) range across 2 matching MRF lines |
$570–$855 | $950–$1,425 | varies |
| Gastric emptying imaging study (78264) | $2,036.40 | $3,394 | 4.9× |
| Gastric Emptyng Imag Std W/Sm Bwl Transit (78265) | $653.40 | $1,089 | 1.6× |
| Gastroesophageal Reflux Exam (78262) | $1,126.80 | $1,878 | 2.7× |
| Gated Heart Planar Single (78472) | $2,818.80 | $4,698 | 6.8× |
| Gated Heart, Multiple (78473) | $3,551.40 | $5,919 | 8.5× |
| Gstrc Emptng Imag Std W/Sm Bwl Col Trnst Mlt Day (78266) | $866.40 | $1,444 | 1.5× |
| Hand 2 views (73120) range across 2 matching MRF lines |
$475.80–$749.40 | $793–$1,249 | varies |
| Hdr Rdncl Ntrstl/Icav Brchtx (77772) | $5,042.40 | $8,404 | 6.9× |
| Hdr Rdncl Ntrstl/Icav Brchtx (77771) | $3,325.20 | $5,542 | 4.6× |
| Hdr Rdncl Ntrstl/Icav Brchtx 1 Channel (77770) | $1,827 | $3,045 | 2.5× |
| Heart first pass single,planar (78481) | $430.80 | $718 | 0.8× |
| Hepatc Vngrph Wdg/Fr Hemodyn Eval Rs&I (75889) | $4,918.20 | $8,197 | 1.5× |
| Hepatc Vngrph Wdg/Fr W/O Hemodyn Eval Rs&I (75891) | $1,483.80 | $2,473 | 0.5× |
| Hepatobil Syst Image W/Drug (78227) | $2,709.60 | $4,516 | 4.8× |
| Hepatobiliary System Imaging (78226) | $1,977.60 | $3,296 | 4.7× |
| Ht Musc Image Planar Mult (78454) | $5,370 | $8,950 | 4.0× |
| Ht Muscle Image Spect Sing (78451) | $4,457.40 | $7,429 | 3.3× |
| Hysterosalpingogram (74740) | $865.80 | $1,443 | 3.5× |
| Infant hip ultrasound with hip movement (dynamic) (76885) | $569.40 | $949 | 6.3× |
| Infant hip ultrasound, limited static exam (76886) | $415.80 | $693 | 4.6× |
| Interstitial radiation source applic complex (77778) | $3,618 | $6,030 | 5.0× |
| Intracavitary Radiation Source Applic Complex (77763) | $2,329.20 | $3,882 | 3.2× |
| Intracavitary Radiation Source Applic Intermed (77762) | $1,207.20 | $2,012 | 2.1× |
| Intracavitary radiation source applic simple (77761) | $1,207.20 | $2,012 | 2.1× |
| K Flow/Funct Image Multiple (78709) | $1,525.80 | $2,543 | 2.7× |
| K Flow/Funct Image W/Drug (78708) | $732.60 | $1,221 | 1.3× |
| K Flow/Funct Image W/O Drug (78707) | $961.20 | $1,602 | 1.7× |
| Kidney Imaging Morphol (78700) | $702 | $1,170 | 1.7× |
| Kidney Imaging Morphoogy W/Vascular Flow (78701) | $900 | $1,500 | 2.2× |
| Knee 3 Views (73562) range across 2 matching MRF lines |
$695.40–$1,081.80 | $1,159–$1,803 | varies |
| Leveen/Shunt Patency Exam (78291) | $1,017.60 | $1,696 | 2.4× |
| Liver & Spleen Imaging Static Only (78215) | $1,472.40 | $2,454 | 3.5× |
| Liver & Spleen Imaging W/Vascular Flow (78216) | $957 | $1,595 | 2.3× |
| Liver imaging static only (78201) | $1,200.60 | $2,001 | 2.1× |
| Liver imaging w/vascular flow (78202) | $1,280.40 | $2,134 | 2.3× |
| Lung Perf&Ventilat Diferentl (78598) | $1,812 | $3,020 | 3.2× |
| Lung perfusion differential (78597) | $1,177.80 | $1,963 | 2.8× |
| Lung Ventilat&Perfus Imaging (78582) | $1,477.20 | $2,462 | 2.6× |
| Lung Ventilation Imaging (78579) | $827.40 | $1,379 | 2.0× |
| Lymph System Imaging (78195) | $2,008.80 | $3,348 | 3.5× |
| Lymphangiography Extremity Only Bilateral Rs&I (75803) | $768 | $1,280 | 0.5× |
| Lymphangiography extremity only unilateral rs&i (75801) | $768 | $1,280 | 1.2× |
| Lymphangiography Pelvic/Abdominal Bilateral Rs&I (75807) | $768 | $1,280 | 0.2× |
| Lymphangiography, pelvic/abdominal, unilateral (75805) | $1,349.40 | $2,249 | 0.4× |
| Magnetic Image Jaw Joint (70336) | $1,858.80 | $3,098 | 7.5× |
| Magnetic resonance (eg, proton) imaging, brain (including brain stem andskull base), during open intracranial procedure… (70558) | $375 | $625 | 2.0× |
| Magnetic resonance (eg, proton) imaging, brain (including brain stem andskull base), during open intracranial procedure… (70557) | $1,155.60 | $1,926 | 2.0× |
| Magnetic resonance (eg, proton) imaging, brain (including brain stem andskull base), during open intracranial procedure… (70559) | $375 | $625 | 2.0× |
| Magnetic Resonance Elastography (76391) | $452.40 | $754 | 1.8× |
| Mammary ductogram or galactogram multiple (77054) | $70.20 | $117 | 0.3× |
| Mammary ductogram or galactogram single (77053) | $53.40 | $89 | 0.2× |
| Meckels Divert Exam (78290) | $1,486.20 | $2,477 | 3.6× |
| Mlc imrt design & construction per imrt plan (77338) | $622.20 | $1,037 | 1.6× |
| Mr safety determination physician/other qhp (76016) | $185.40 | $309 | 2.0× |
| Mr safety implant&/fb assmt clin staf 1st 15 min (76014) | $51.60 | $86 | 1.7× |
| Mr safety implt electronics prepj supvj phys/qhp (76018) | $193.20 | $322 | 1.9× |
| Mr safety implt pos&/immoblj (76019) | $125.40 | $209 | 2.0× |
| Mr safety med physics xm customization plng&mntr (76017) | $509.40 | $849 | 2.0× |
| Mra Head W/O & W/Contrast Material (70546) | $4,425 | $7,375 | 12.1× |
| MRA head w/o contrast (70544) | $2,649.60 | $4,416 | 10.6× |
| MRA head with contrast (70545) | $4,425 | $7,375 | 12.1× |
| MRA neck w contrast (70548) | $3,028.80 | $5,048 | 8.3× |
| Mra Neck W/O &W/Contrast Material (70549) | $3,028.80 | $5,048 | 8.3× |
| MRA neck w/o contrast (70547) | $1,817.40 | $3,029 | 7.3× |
| MRI abdomen w contrast (74182) | $3,396.60 | $5,661 | 9.3× |
| MRI abdomen w/o contrast (74181) | $2,038.20 | $3,397 | 8.2× |
| MRI any jt lower extrem w/contrast material (73722) range across 2 matching MRF lines |
$8,767.80–$10,229.40 | $14,613–$17,049 | varies |
| MRI any jt lower extrem w/o & w/contrast matrl (73723) range across 2 matching MRF lines |
$4,881–$6,342 | $8,135–$10,570 | varies |
| MRI any jt upper extremity w/contrast matrl (73222) range across 2 matching MRF lines |
$7,374.60–$8,604 | $12,291–$14,340 | varies |
| MRI bone marrow blood supply (77084) | $419.40 | $699 | 1.7× |
| MRI brain functional w/o physician admnistration (70554) | $1,908 | $3,180 | 7.7× |
| MRI brain functional w/physician admnistration (70555) | $793.20 | $1,322 | 3.2× |
| MRI Breast W/O Contrast Bilateral (77047) | $1,543.20 | $2,572 | 6.2× |
| MRI Breast Without Contrast Material Unilateral (77046) | $1,543.20 | $2,572 | 6.2× |
| MRI cardiac w/o cont stress (75559) | $1,487.40 | $2,479 | 2.6× |
| MRI cardiac w/o contrast (75557) | $1,487.40 | $2,479 | 6.0× |
| MRI cervical spine w contrast (72142) | $3,064.80 | $5,108 | 8.4× |
| MRI cervical spine w/o cont (72141) | $1,839 | $3,065 | 7.4× |
| MRI chest w/o contrast (71550) | $1,586.40 | $2,644 | 6.4× |
| MRI chest with contrast (71551) | $4,732.20 | $7,887 | 5.8× |
| MRI chest wo w contrast (71552) | $2,643.60 | $4,406 | 7.3× |
| MRI lower extrem oth/thn jt w/contrast matrl (73719) range across 2 matching MRF lines |
$3,313.20–$4,970.40 | $5,522–$8,284 | varies |
| MRI lower extrem oth/thn jt w/o & w/contr matr (73720) range across 2 matching MRF lines |
$4,390.20–$6,599.40 | $7,317–$10,999 | varies |
| MRI lower extrem oth/thn jt w/o contr matrl (73718) range across 2 matching MRF lines |
$2,761.20–$4,141.80 | $4,602–$6,903 | varies |
| MRI lumbar spine w contrast (72149) | $4,185 | $6,975 | 11.5× |
| Mri Neck Spine W/O & W/Dye (72156) | $3,064.80 | $5,108 | 8.4× |
| MRI orbit face &/neck w/o contrast (70540) | $1,736.40 | $2,894 | 7.0× |
| MRI orbit face neck w contrast (70542) | $2,894.40 | $4,824 | 7.9× |
| Mri Orbt/Fac/Nck W/O &W/Dye (70543) | $2,894.40 | $4,824 | 7.9× |
| MRI pelvis w contrast (72196) | $3,090.60 | $5,151 | 8.5× |
| MRI pelvis w/o & w contrast (72197) | $3,090.60 | $5,151 | 8.5× |
| MRI pelvis w/o contrast (72195) | $1,854.60 | $3,091 | 7.4× |
| MRI spectroscopy (76390) | $1,859.40 | $3,099 | 20.5× |
| MRI thoracic spine w/o contrast (72146) | $2,199 | $3,665 | 8.8× |
| MRI upper extremity oth than jt w/contr matrl (73219) range across 2 matching MRF lines |
$2,994.60–$4,492.20 | $4,991–$7,487 | varies |
| MRI upper extremity oth than jt w/o contr matrl (73218) range across 2 matching MRF lines |
$1,797–$3,294 | $2,995–$5,490 | varies |
| Mri Uppr Extremity W/O&W/Dye (73220) range across 2 matching MRF lines |
$2,994.60–$4,492.20 | $4,991–$7,487 | varies |
| MRI, abdomen, combo (74183) | $3,396.60 | $5,661 | 9.3× |
| MRI, dorsal spine combo (72157) | $3,665.40 | $6,109 | 10.1× |
| MRI, dorsal spine contrast (72147) | $3,665.40 | $6,109 | 10.1× |
| MRI, joint upper extrem (73221) range across 2 matching MRF lines |
$2,458.20–$3,687.60 | $4,097–$6,146 | varies |
| MRI, joint upper extrem combo (73223) range across 2 matching MRF lines |
$4,105.20–$5,334 | $6,842–$8,890 | varies |
| MRI, lumbar spine combo (72158) | $4,185 | $6,975 | 11.5× |
| Myelogram cervical (72240) | $1,875.60 | $3,126 | 2.3× |
| Myelogram Lumbar (72265) | $1,845 | $3,075 | 2.3× |
| Myelography thoracic (72255) | $1,299 | $2,165 | 1.6× |
| Myelograpy 2/more regions rs&i (72270) | $1,946.40 | $3,244 | 2.4× |
| Myocardial Imaging Infarct Avid Planar Qual/Quan (78466) | $685.80 | $1,143 | 1.6× |
| Myocardial Perfusion Planar 1 Study Rest/Stress (78453) | $4,457.40 | $7,429 | 3.3× |
| Myocardial Spect Multiple Studies (78452) | $5,370 | $8,950 | 4.0× |
| Myocrd Img Pet Metab Eval Single Study Cncrnt CT (78429) | $2,814.60 | $4,691 | 1.9× |
| Myocrd img PET prfuj 1std rest/stress cncrnt CT (78430) | $2,814.60 | $4,691 | 1.9× |
| Myocrd Img Pet Prfuj Mlt Std Rst&Strs Cncrnt CT (78431) | $4,389.60 | $7,316 | 1.9× |
| Myocrd Img Pet Prfuj W/Metab 2rtracer Cncrnt CT (78433) | $5,365.20 | $8,942 | 2.3× |
| Myocrd Img Pet Prfuj W/Metab Dual Radiotracer (78432) | $5,365.20 | $8,942 | 3.4× |
| Neck soft tissue (70360) | $382.80 | $638 | 4.2× |
| Nfs/Instlj Radioelmnt Sln 3 Mo Follow-Up Care (77750) | $556.80 | $928 | 1.4× |
| Njx Rp Loclzj Non-Img Probe Study Intravenous (78808) | $657 | $1,095 | 1.6× |
| Nm csf leak detection (78650) | $1,249.80 | $2,083 | 0.9× |
| Nm myocard infarct spect (78469) | $2,481.60 | $4,136 | 4.4× |
| Nm unlisted gi procedure (78299) | $493.80 | $823 | 1.2× |
| Nonvascular Shunt X-Ray (75809) | $454.20 | $757 | 4.2× |
| Ntsty modul radthx pln dose-vol histos (77301) | $5,076 | $8,460 | 3.5× |
| Nuclear Rx Intra-Arterial (79445) | $1,197 | $1,995 | 4.9× |
| Nuclear Rx Oral Admin (79005) | $1,457.40 | $2,429 | 6.0× |
| Ob us nuchal meas 1 gest (76813) | $279 | $465 | 2.6× |
| Ophthalmic ultrasound dx b-scan w/wo a-scan (76512) range across 2 matching MRF lines |
$758.40–$1,137 | $1,264–$1,895 | varies |
| Panoramic X-ray of jaws (70355) | $324 | $540 | 3.6× |
| Parathyroid imaging w/tomographic spect & CT (78072) | $807.60 | $1,346 | 1.4× |
| Parathyroid Planar Imaging (78070) | $1,292.40 | $2,154 | 3.1× |
| Parathyroid planar imaging w/wo subtraction (78071) | $741 | $1,235 | 1.8× |
| Pelvis 1 or 2 views (72170) | $472.80 | $788 | 4.3× |
| Perineogram (74775) | $520.80 | $868 | 2.1× |
| Peritoneogram Rs&I (74190) | $661.80 | $1,103 | 1.2× |
| Pet Image W/Ct Lmtd (78814) | $4,634.40 | $7,724 | 3.1× |
| PET image w/CT, full body (78816) | $5,252.40 | $8,754 | 3.5× |
| PET imaging CT attenuation skull base mid-thigh (78815) | $5,149.20 | $8,582 | 3.4× |
| Plasma Vol Radiopharm Vol Dilute Spx Mult Smples (78111) | $2,841 | $4,735 | 2.1× |
| Prq Transhepatc Portograpy Hemodyn Eval Rs&I (75885) | $3,379.80 | $5,633 | 1.0× |
| Pulmonary Perfusion Imaging Particulate (78580) | $1,048.80 | $1,748 | 2.5× |
| Radex Abd Compl Aqt Abd W/S/E/D Views 1 View Ch (74022) | $638.40 | $1,064 | 5.8× |
| Radex abscess/fistula/sinus tract rs&i (76080) | $477.60 | $796 | 0.8× |
| Radex Ankle Complete Minimum 3 Views (73610) range across 2 matching MRF lines |
$467.40–$701.40 | $779–$1,169 | varies |
| Radex Calcaneus Minimum 2 Views (73650) range across 2 matching MRF lines |
$330–$495 | $550–$825 | varies |
| Radex elbow complete minimum 3 views (73080) range across 2 matching MRF lines |
$559.20–$838.80 | $932–$1,398 | varies |
| Radex Facial Bones Complete Minimum 3 Views (70150) | $736.20 | $1,227 | 6.7× |
| Radex fingr minimum 2 views (73140) range across 2 matching MRF lines |
$424.20–$636.60 | $707–$1,061 | varies |
| Radex foot complete minimum 3 views (73630) range across 2 matching MRF lines |
$531.60–$797.40 | $886–$1,329 | varies |
| Radex Hand Minimum 3 Views (73130) range across 2 matching MRF lines |
$547.20–$820.80 | $912–$1,368 | varies |
| Radex lower extremity infant minimum 2 views (73592) | $285.60 | $476 | 3.1× |
| Radex Mastoids Compl Minimum 3 Views PR Side (70130) | $595.80 | $993 | 5.5× |
| Radex Nasal Bones Complete Minimum 3 Views (70160) | $477 | $795 | 5.2× |
| Radex Pharynx/Larx W/Fluor&/Magnification Tq (70370) | $189.60 | $316 | 2.1× |
| Radex Ribs Unilateral 2 Views (71100) | $583.20 | $972 | 6.4× |
| Radex shoulder complete minimum 2 views (73030) range across 2 matching MRF lines |
$524.40–$786.60 | $874–$1,311 | varies |
| Radex Sinuses Paransl < 3 Views (70210) | $492 | $820 | 5.4× |
| Radex sm int w/mlt srl imges via enteroclss tube (74251) | $3,483.60 | $5,806 | 19.0× |
| Radex Spine 1 View Specify Level (72020) | $366.60 | $611 | 4.0× |
| Radex Sternum Minimum 2 Views (71120) | $602.40 | $1,004 | 6.6× |
| Radex Temporomandble Jt Opn & Clsd Mouth Bilat (70330) | $449.40 | $749 | 4.9× |
| Radex Toe Minimum 2 Views (73660) range across 2 matching MRF lines |
$388.20–$582.60 | $647–$971 | varies |
| Radex upper extremity infant minimum 2 views (73092) | $285 | $475 | 2.6× |
| Radex Wrist Complete Minimum 3 Views (73110) range across 2 matching MRF lines |
$709.20–$1,063.80 | $1,182–$1,773 | varies |
| Radex X-Ray Exam Entire Spi 6/> Vw - Xr Entire Spine 6+ Vw (72084) | $265.20 | $442 | 2.4× |
| Radiation Delivery Stereotactic Cranial Linear (77372) | $19,180.80 | $31,968 | 2.5× |
| Radiation treatment delivery level 1 (77402) | $225.60 | $376 | 2.1× |
| Radiation treatment delivery level 2 (77407) | $225.60 | $376 | 0.6× |
| Radiation treatment delivery level 3 (77412) | $668.40 | $1,114 | 1.2× |
| Radiolog exam mandible compl minimum 4 views (70110) | $762.60 | $1,271 | 7.0× |
| Radiologic Exam Abdomen 3+ Views - Xr Abdomen 3+ Views (74021) | $638.40 | $1,064 | 5.8× |
| Radiologic exam colon double contrast study (74280) | $1,194.60 | $1,991 | 6.5× |
| Radiologic exam colon single contrast study (74270) | $853.20 | $1,422 | 4.7× |
| Radiologic Exam Esophagus Double Contrast Study (74221) | $355.20 | $592 | 1.9× |
| Radiologic exam knee complete 4/more views (73564) range across 2 matching MRF lines |
$772.80–$1,159.20 | $1,288–$1,932 | varies |
| Radiologic exam pelvis compl minimum 3 views (72190) | $567.60 | $946 | 5.2× |
| Radiologic Exam Small Int Single Contrast Study (74250) | $907.20 | $1,512 | 5.0× |
| Radiologic exam swallow function contrast study (74230) | $786 | $1,310 | 4.3× |
| Radiologic exam upr gi trc double contrast study (74246) | $796.20 | $1,327 | 4.3× |
| Radiologic examination femur 1 view (73551) | $445.80 | $743 | 4.9× |
| Radiologic examination femur minimum 2 views (73552) range across 6 matching MRF lines |
$524.40–$786.60 | $874–$1,311 | varies |
| Radiologic examination knee 1/2 views (73560) range across 2 matching MRF lines |
$603–$989.40 | $1,005–$1,649 | varies |
| Radiologic Examination Osseous Survey Limited (77074) | $632.40 | $1,054 | 5.8× |
| Radiologic examination tibia & fibula 2 views (73590) range across 2 matching MRF lines |
$630–$945 | $1,050–$1,575 | varies |
| Radiopharm Dacryocystography (78660) | $645 | $1,075 | 1.5× |
| Radiopharmaceutical therapy, by intra-articular administration Non-Facility (79440) | $824.40 | $1,374 | 3.4× |
| Radiopharmaceutical therapy, by intracavitary administration Non-Facility (79200) | $824.40 | $1,374 | 3.4× |
| Red Cell Volume Determination Spx Mult Samplings (78121) | $1,081.20 | $1,802 | 1.9× |
| Remote afterloading high dose rate radionuclide skin surface brachytherapy, includes basic dosimetry, when performed;… (77768) | $1,827 | $3,045 | 4.5× |
| Remote afterloading high dose rate radionuclide skin surface brachytherapy, includes basic dosimetry, when performed;… (77767) | $1,827 | $3,045 | 4.5× |
| Renal Cyst Study (74470) | $1,645.20 | $2,742 | 2.9× |
| Ribs bilateral 3 views (71110) | $695.40 | $1,159 | 6.4× |
| Rp loclzj tum plnr 1 area single day imaging (78800) | $763.80 | $1,273 | 1.8× |
| Rp loclzj tum plnr 2+area 1+d img/1 area img>2+d (78801) | $1,011 | $1,685 | 2.4× |
| Rp Loclzj Tum Plnr Whole Body 2+ Days Imaging (78804) | $2,246.40 | $3,744 | 4.0× |
| Rp Loclzj Tum Plnr Whole Body Single Day Imaging (78802) | $1,280.40 | $2,134 | 2.3× |
| Rp Loclzj Tum Spect 1 Area Single Day Imaging (78803) | $1,347.60 | $2,246 | 2.4× |
| Rp loclzj tum spect 2 area/sep acquisj img (78831) | $2,481 | $4,135 | 1.8× |
| Rp loclzj tum spect CT 2area 1d img/1 ar img>2+d (78832) | $2,814.60 | $4,691 | 1.9× |
| Rp loclzj tum spect w/CT 1 area/acquisj 1day img (78830) | $2,481 | $4,135 | 1.8× |
| Rp Ther Radiolbld Monoclonal Antibody IV Infus (79403) | $1,486.80 | $2,478 | 6.1× |
| Rp Therapy Intravenous Administration (79101) | $2,480.40 | $4,134 | 10.2× |
| Salivary Gland Imaging Serial Images (78231) | $553.80 | $923 | 1.3× |
| Scapula (73010) range across 2 matching MRF lines |
$453–$679.80 | $755–$1,133 | varies |
| Screening Digital Breast Tomosynthesis Bi (77063) | $66 | $110 | 2.8× |
| Sella turcica (70240) | $96.60 | $161 | 1.1× |
| Shoulder 1 view (73020) range across 2 matching MRF lines |
$414–$676.20 | $690–$1,127 | varies |
| Shoulder Arthrography (73040) range across 4 matching MRF lines |
$993–$1,489.80 | $1,655–$2,483 | varies |
| Sialogram (70390) | $921.60 | $1,536 | 3.7× |
| Skull less than 4 views (70250) | $536.40 | $894 | 4.9× |
| Special dosimetry (77331) | $240 | $400 | 1.7× |
| Special Physics Consult (77370) | $700.20 | $1,167 | 5.0× |
| Special teletherapy port plan (77321) | $617.40 | $1,029 | 1.6× |
| Special treatment procedure (77470) | $1,491.60 | $2,486 | 2.6× |
| Speech evaluation, complex (70371) | $727.80 | $1,213 | 2.9× |
| Spleen Imaging (78185) | $634.20 | $1,057 | 1.5× |
| Srs Multisource (77371) | $31,627.20 | $52,712 | 4.1× |
| Stereotactic Body Radiation Delivery (77373) | $3,366 | $5,610 | 1.8× |
| Sternoclavicular joints (71130) | $717 | $1,195 | 7.9× |
| Superior sagittal sinus venogram (75870) | $1,573.80 | $2,623 | 0.5× |
| Surface Applic Low Dose Rate Radionuclide Source (77789) | $129 | $215 | 1.2× |
| Telethx isodose pln cplx w/basic dosimetry (77307) | $614.40 | $1,024 | 1.6× |
| Telethx isodose pln smpl w/dosimetry calculation (77306) | $319.20 | $532 | 0.8× |
| Temporomandble Jt Arthrography Rs&I (70332) | $691.80 | $1,153 | 2.8× |
| Testicular Imaging W/Flow (78761) | $987 | $1,645 | 2.4× |
| Ther Rad Simulaj-Aided Field Setting Complex (77290) | $4,242 | $7,070 | 10.8× |
| Ther Rad Simulaj-Aided Field Setting Intermed (77285) | $3,834 | $6,390 | 9.8× |
| Ther rad simulaj-aided field setting simple (77280) | $2,325 | $3,875 | 16.6× |
| Therapeutic Enema Rdctj Intussusception/Obstrcj (74283) | $1,098.60 | $1,831 | 6.0× |
| Thoracic spine 2 views (72070) | $618.60 | $1,031 | 5.7× |
| Thoracic spine 3 views (72072) | $658.20 | $1,097 | 6.0× |
| Thoracolumbar 2 views (72080) | $521.40 | $869 | 5.7× |
| Thyroid Carcinoma Metastases Img Lmtd Area (78015) | $1,207.20 | $2,012 | 2.9× |
| Thyroid Imaging With Vascular Flow (78013) | $525.60 | $876 | 1.3× |
| Thyroid Met Imaging Body (78018) | $1,677 | $2,795 | 3.0× |
| Thyroid Uptake Measurement (78012) | $1,288.20 | $2,147 | 3.1× |
| Thyroid Uptake W/Blood Flow Sngle/Mult Quan Meas (78014) | $657 | $1,095 | 1.6× |
| Tx Devices Design & Construction Complex (77334) | $820.80 | $1,368 | 2.1× |
| Tx devices design & construction intermediate (77333) | $697.80 | $1,163 | 5.0× |
| Tx devices design & construction simple (77332) | $336.60 | $561 | 2.4× |
| Ultrasound Breast Limited (76642) | $155.40 | $259 | 1.7× |
| Ultrasound elastography first target lesion (76982) | $220.80 | $368 | 2.0× |
| Ultrasound Elastography Parenchyma (76981) | $220.80 | $368 | 2.0× |
| Ultrasound Exam Aaa Screen (76706) | $222.60 | $371 | 2.0× |
| Ultrasound trgt dynamic microbubble 1st lesion (76978) | $354 | $590 | 1.0× |
| Ultrasound, abdomen limited (76705) range across 2 matching MRF lines |
$455.40–$909 | $759–$1,515 | varies |
| Umbilical-artery Doppler (OB) (76820) | $297 | $495 | 2.7× |
| Unlisted Dx Radiographic Procedure (76499) | $276.60 | $461 | 3.0× |
| Unlisted fluoroscopic procedure (76496) | $158.40 | $264 | 1.7× |
| Unlisted magnetic resonance procedure (76498) | $1,634.40 | $2,724 | 18.0× |
| Unlisted Procedure Clinical Brachytherapy (77799) | $222 | $370 | 2.1× |
| Upper gi w/o kub (74240) | $706.80 | $1,178 | 3.9× |
| Urea Breath Test C-14 Isotopic Acquisj Analysis (78267) | $591 | $985 | 53.4× |
| Ureteral Reflux Study (78740) | $900.60 | $1,501 | 2.2× |
| Urethrocystogram voiding (74455) | $805.20 | $1,342 | 3.2× |
| Urethrocystography retrograde (74450) | $805.20 | $1,342 | 3.2× |
| Us breast unilateral complete (76641) | $204.60 | $341 | 1.9× |
| Us chest (76604) | $585.60 | $976 | 5.4× |
| Us complete joint (76881) | $987.60 | $1,646 | 9.0× |
| Us exam, pelvic, limited (76857) | $882 | $1,470 | 8.1× |
| Us head (76506) | $469.80 | $783 | 4.3× |
| Us kidney transplant (76776) | $666 | $1,110 | 6.1× |
| Us lmtd joint/oth nonvasc xtr strux r-t w/img (76882) | $637.20 | $1,062 | 5.8× |
| Us ob detailed single fetus (76811) | $687 | $1,145 | 2.8× |
| Us ob limited 1 or more fetuses (76815) | $501.60 | $836 | 4.6× |
| Us ob transvaginal (76817) | $576.60 | $961 | 5.3× |
| Us pelvic non ob complete (76856) | $882 | $1,470 | 8.1× |
| Us pg uter img f&mat 14 wk tabdl 1/1st gestation (76801) | $559.80 | $933 | 5.1× |
| Us preg uterus real time f/u trnsabdl per fetus (76816) | $680.40 | $1,134 | 6.2× |
| Us retroperitoneal complete (76770) | $898.20 | $1,497 | 8.2× |
| Us retroperitoneal limited (76775) | $466.80 | $778 | 4.3× |
| Us scrotum and contents (76870) | $921.60 | $1,536 | 8.4× |
| Us spinal canal and contents (76800) | $549 | $915 | 5.0× |
| Us thyroid (76536) | $1,206 | $2,010 | 11.0× |
| Us transrectal (76872) | $1,167.60 | $1,946 | 10.7× |
| Vascular Flow Imaging (78445) | $425.40 | $709 | 1.0× |
| Vein X-Ray Chest (75827) | $3,096 | $5,160 | 1.9× |
| Vein X-Ray Liver W/O Hemodyn (75887) | $1,386 | $2,310 | 0.4× |
| Vein X-Ray Skull Epidural (75872) | $1,554.60 | $2,591 | 2.4× |
| Vein X-Ray Spleen/Liver (75810) | $1,698.60 | $2,831 | 0.5× |
| Venogram Sinus/Jugular (75860) | $1,101.60 | $1,836 | 0.3× |
| Venography Adrenal Unilateral (75840) | $4,028.40 | $6,714 | 1.2× |
| Venography caval inferior serialography rs&i (75825) | $6,162 | $10,270 | 1.9× |
| Venography extremity bilateral rs&i (75822) | $1,906.20 | $3,177 | 1.2× |
| Venography extremity unilateral rs&i (75820) | $1,629 | $2,715 | 1.0× |
| Venography Orbital Rs&I (75880) | $918 | $1,530 | 1.4× |
| Venography Renal Bilateral (75833) | $5,494.20 | $9,157 | 1.7× |
| Venography Renal Unilateral (75831) | $4,656 | $7,760 | 1.4× |
| Venous sampling by catheter (75893) | $7,740 | $12,900 | 1.3× |
| Vertebral fracture assessment via dxa (77086) | $52.20 | $87 | 0.6× |
| Wrist 2 views (73100) range across 2 matching MRF lines |
$616.80–$971.40 | $1,028–$1,619 | varies |
| X-Ray Ac Jts - Xr Acromioclavicular Joints Bilateral (73050) | $349.20 | $582 | 3.8× |
| X-ray antegrade pyelogram tube (74425) | $1,101.60 | $1,836 | 3.0× |
| X-Ray Aorta Leg Arteries (75630) | $6,284.40 | $10,474 | 1.9× |
| X-Ray Bend Only L-S Spine (72120) | $744 | $1,240 | 6.8× |
| X-Ray Elbow 2 Vw - Xr Elbow 1-2 Views Right (73070) range across 2 matching MRF lines |
$503.40–$783 | $839–$1,305 | varies |
| X-Ray Exam Breast Specimen (76098) | $77.40 | $129 | 0.1× |
| X-Ray Exam Entire Spi 1 Vw (72081) | $119.40 | $199 | 1.3× |
| X-Ray Exam Entire Spi 2/3 Vw (72082) | $192 | $320 | 1.8× |
| X-Ray Exam Entire Spi 4/5 Vw (72083) | $226.80 | $378 | 2.1× |
| X-Ray Exam Hip Uni 1 View (73501) | $419.40 | $699 | 4.6× |
| X-Ray Exam Hip Uni 2-3 Views (73502) | $582.60 | $971 | 6.4× |
| X-Ray Exam Hip Uni 4/> Views (73503) | $728.40 | $1,214 | 6.7× |
| X-Ray Exam Hips Bi 2 Views (73521) | $518.40 | $864 | 4.7× |
| X-Ray Exam Hips Bi 3-4 Views (73522) | $675.60 | $1,126 | 6.2× |
| X-Ray Exam Hips Bi 5/> Views (73523) | $792.60 | $1,321 | 7.3× |
| X-Ray Exam L-S Spine Bending (72114) | $1,002.60 | $1,671 | 9.2× |
| X-Ray Exam Neck Spine 2-3 Vw (72040) | $594.60 | $991 | 6.5× |
| X-Ray Exam Neck Spine 6/>Vws (72052) | $975 | $1,625 | 8.9× |
| X-Ray Exam Unilat Ribs/Chest (71101) | $662.40 | $1,104 | 6.1× |
| X-ray eye for foreign body (70030) | $193.20 | $322 | 2.1× |
| X-ray humerus (73060) | $500.40 | $834 | 5.5× |
| X-ray IV pyelogram (ivp) (74400) | $2,203.20 | $3,672 | 12.0× |
| X-ray IV pyelogram+tomography (74415) | $2,688 | $4,480 | 14.7× |
| X-Ray Jaw <4 Vw - Xr Mandible < 4 Views (70100) | $655.80 | $1,093 | 7.2× |
| X-Ray Knee Bilat Standing - Xr Knees Anteroposterior Standing Bilat (73565) | $695.40 | $1,159 | 7.7× |
| X-Ray Lumbar Spine 2/3 Vw - Xr Lumbar Spine 2-3 Views (72100) | $630.60 | $1,051 | 5.8× |
| X-ray nose-rectum child f.b. (76010) | $211.80 | $353 | 2.3× |
| X-Ray Ribs, Chest 4+ Vw - Xr Ribs 3 Vws Bil W/ Chest Posteroanterior (71111) | $821.40 | $1,369 | 7.5× |
| X-Ray Sacroiliac Jts 3+ Vw - Xr Sacroiliac Joints 3+ Views (72202) | $610.80 | $1,018 | 5.6× |
| X-Ray Sacroiliac Jts <3 Vw - Xr Sacroiliac Joints 1-2 Views (72200) | $541.20 | $902 | 5.0× |
| X-Ray Sacrum/Coccyx 2+ Vw - Xr Sacrum Coccyx 2+ Views (72220) | $535.80 | $893 | 5.9× |
| X-Ray Sinuses 3+ Vw - Xr Paranasal Sinuses 3+ Views (70220) | $610.20 | $1,017 | 6.7× |
| X-Ray Skull 4+ Vw - Xr Skull Complete 4+ Views (70260) | $670.80 | $1,118 | 6.1× |
| X-Ray Stress View (77071) | $102 | $170 | 1.1× |
| X-ray thoracic spine 4 vw (72074) | $724.20 | $1,207 | 6.6× |
| X-Ray Tmj Unilat (70328) | $287.40 | $479 | 3.2× |
| X-Ray Urinary Tract Exam With Contrast Material (74420) | $1,101.60 | $1,836 | 3.0× |
| X-Rays Bone Length Studies (77073) | $215.40 | $359 | 2.0× |
| X-Rays Bone Survey Complete (77075) | $866.40 | $1,444 | 7.9× |
| Xr c-spine 4 or 5 views (72050) | $820.80 | $1,368 | 7.5× |
| Xr facial bones less than 3 views (70140) | $515.40 | $859 | 5.7× |
| Xr orbits complete 4 views (70200) | $630.60 | $1,051 | 5.8× |
| Xr Tomogram Single Plane (76100) | $780.60 | $1,301 | 7.2× |
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.