Imaging prices at Nacogdoches Memorial Hospital
Nacogdoches, TX · every code in this section with a posted price and a Medicare benchmark.
480 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) | $273 | $909 | 0.2× |
| Abdomen 1 View (74018) range across 3 matching MRF lines |
$17–$63 | $57–$210 | varies |
| Abdomen 2 views (74019) range across 2 matching MRF lines |
$21–$115 | $70–$382 | varies |
| Acute Gastrointestinal Blood Loss Imaging (78278) range across 2 matching MRF lines |
$200–$354 | $666–$1,181 | varies |
| Acute venous thrombosis imaging, peptide Non-Facility (78456) | $183 | $611 | 0.1× |
| Adrenal Cortex & Medulla Img (78075) | $257 | $858 | 0.2× |
| Angio internal mammary (75756) | $92 | $306 | 0.0× |
| Angio pulmonary bilat (75743) | $88 | $294 | 0.0× |
| Angiography Adrenal Bilateral Slctv Rs&I (75733) | $100 | $334 | 0.0× |
| Angiography extremity bilateral rs&i (75716) range across 3 matching MRF lines |
$3,073 | $322–$10,242 | 1.0× |
| Angiography extremity unilateral rs&i (75710) range across 7 matching MRF lines |
$2,751–$3,542 | $299–$11,807 | varies |
| Angiography pulmonary unilateral slctv rs&i (75741) | $78 | $260 | 0.0× |
| Angrph pulmonary nonslctv cath/ven njx rs&i (75746) | $80 | $267 | 0.0× |
| Ankle 2 views (73600) range across 4 matching MRF lines |
$18–$230 | $61–$768 | varies |
| Aortography thoracic serialography rs&i (75605) unusually low: confirm this is the full procedure |
$2,620 | $8,733 | 0.5× |
| Aortography thoracic w/o serialography rs&i (75600) | $117 | $389 | 0.0× |
| Artery X-Rays Abdomen (75726) range across 2 matching MRF lines |
$5,126 | $335–$17,086 | 0.9× |
| Artery X-Rays Adrenal Gland (75731) | $89 | $298 | 0.0× |
| Artery X-Rays Pelvis (75736) likely a partial charge, not the full procedure |
$83 | $276 | 0.0× |
| Artery X-Rays Spine (75705) likely a partial charge, not the full procedure |
$140 | $467 | 0.0× |
| Arthrogram ankle (73615) | $78 | $261 | 0.2× |
| Arthrogram hip (73525) range across 3 matching MRF lines |
$77–$353 | $256–$1,175 | varies |
| Arthrogram Wrist (73115) | $79 | $262 | 0.2× |
| Basic radiation dosimetry calculation (77300) | $38 | $125 | 0.3× |
| Bone age studies (77072) range across 2 matching MRF lines |
$15–$116 | $49–$386 | varies |
| Bone Imaging 3 Phase (78315) range across 2 matching MRF lines |
$199–$354 | $662–$1,181 | varies |
| Bone Imaging Limited Area (78300) range across 2 matching MRF lines |
$132–$258 | $439–$860 | varies |
| Bone Imaging Multiple Areas (78305) | $160 | $533 | 0.4× |
| Bone Imaging Whole Body (78306) range across 2 matching MRF lines |
$172–$354 | $573–$1,181 | varies |
| Bone marrow imaging limited area (78102) range across 2 matching MRF lines |
$99–$437 | $329–$1,456 | varies |
| Bone marrow imaging; multiple areas (78103) | $124 | $412 | 0.3× |
| Bone marrow imaging; whole body (78104) | $143 | $475 | 0.4× |
| Bone survey infant (77076) range across 2 matching MRF lines |
$61–$110 | $202–$367 | varies |
| Brachytx isodose complex (77318) | $246 | $821 | 0.7× |
| Brachytx isodose intermed (77317) | $173 | $577 | 0.5× |
| Brachytx Isodose Plan Simple (77316) | $131 | $438 | 0.3× |
| Brain Flow Imaging Only (78610) | $100 | $334 | 0.2× |
| Brain Image W/Flow < 4 Views (78601) | $124 | $413 | 0.3× |
| Brain imaging < 4 static views (78600) | $105 | $351 | 0.3× |
| Brain Imaging Min 4 Static Views W Vascular Flow (78606) range across 2 matching MRF lines |
$190–$841 | $634–$2,803 | varies |
| Brain Imaging Minimum 4 Static Views (78605) | $114 | $381 | 0.2× |
| Card Bl Pool Gated Spect Rest Wal Motn Ejct Frct (78494) | $133 | $442 | 0.3× |
| Cardiac blood pool imaging, first pass technique; multiple studies, resting and with stress (exercise and/or… (78483) | $141 | $470 | 0.3× |
| Cardiac MRI w/w/o contrast & further seq (75561) | $238 | $794 | 0.7× |
| Cardiac MRI w/w/o contrast w/stress (75563) | $282 | $940 | 0.4× |
| Cardiac Shunt Detection (78428) | $108 | $359 | 0.3× |
| Cat Scan Follow-Up Study (76380) range across 2 matching MRF lines |
$82–$141 | $272–$470 | varies |
| Cerebrospinal Fluid Flow W/O Matl Shunt Evaltj (78645) range across 2 matching MRF lines |
$186–$765 | $620–$2,549 | varies |
| Cerebrospinal fluid flow, imaging (not including introduction of material); ventriculography Non-Facility (78635) | $194 | $647 | 0.4× |
| Cerebrospinal Fluid Scan (78630) range across 2 matching MRF lines |
$194–$801 | $647–$2,669 | varies |
| Chest 1 view (71045) range across 5 matching MRF lines |
$14–$63 | $48–$210 | varies |
| Chest 2 views (71046) range across 4 matching MRF lines |
$19–$63 | $63–$210 | varies |
| Chest 3 views (71047) range across 3 matching MRF lines |
$24–$95 | $80–$315 | varies |
| Chest 4 or more views (71048) range across 3 matching MRF lines |
$26–$121 | $85–$402 | varies |
| Cholecystography Oral Contrast (74290) | $50 | $167 | 0.3× |
| Cineradiograpy/vidradiograpy xcpt where spec (76120) | $66 | $221 | 0.6× |
| Cisternography Positive Contrast Rs&I (70015) | $97 | $323 | 0.1× |
| Clavicle complete (73000) range across 4 matching MRF lines |
$18–$247 | $61–$822 | varies |
| Computed Tomography Thorax Lw Dose Lng Ca Scr C- (71271) range across 2 matching MRF lines |
$84–$85 | $280–$282 | varies |
| Continuing medical physics consltj pr wk (77336) | $46 | $153 | 0.3× |
| Contrast Exam Abdominl Aorta (75625) range across 2 matching MRF lines |
$3,073 | $254–$10,242 | 1.0× |
| Contrast X-Ray Bladder (74430) range across 2 matching MRF lines |
$23–$250 | $77–$832 | varies |
| Contrast X-Ray Of Elbow (73085) range across 3 matching MRF lines |
$68–$353 | $226–$1,175 | varies |
| Contrast X-Ray Of Knee Joint (73580) range across 3 matching MRF lines |
$85–$353 | $282–$1,175 | varies |
| Contrast Xray Throat/Cerv Esopha (74210) | $56 | $188 | 0.3× |
| CT abdomen and pelvis without and with contrast (74178) range across 2 matching MRF lines |
$213–$2,420 | $711–$8,066 | varies |
| CT abdomen and pelvis without contrast (74176) range across 2 matching MRF lines |
$112–$1,954 | $373–$6,513 | varies |
| CT abdomen w contrast (74160) range across 2 matching MRF lines |
$145–$1,285 | $484–$4,284 | varies |
| CT abdomen w wo contrast (74170) range across 2 matching MRF lines |
$163–$1,442 | $543–$4,807 | varies |
| CT abdomen w/o contrast (74150) range across 2 matching MRF lines |
$84–$877 | $279–$2,923 | varies |
| CT Angio Abdomen and Pelvis (74174) range across 2 matching MRF lines |
$234–$1,455 | $779–$4,851 | varies |
| CT Angio Chest (71275) range across 3 matching MRF lines |
$172–$1,452 | $574–$4,840 | varies |
| CT Angio Head (70496) range across 3 matching MRF lines |
$156–$1,627 | $521–$5,423 | varies |
| CT angio hrt w/3d image (75574) range across 2 matching MRF lines |
$228–$320 | $760–$1,066 | varies |
| Ct Angio Lwr Extr W/O&W/Dye (73706) range across 2 matching MRF lines |
$202–$663 | $672–$2,210 | varies |
| CT Angio Neck (70498) range across 2 matching MRF lines |
$168–$1,522 | $561–$5,072 | varies |
| Ct Angio Upr Extrm W/O&W/Dye (73206) range across 2 matching MRF lines |
$186–$522 | $619–$1,739 | varies |
| CT bone density (77078) | $65 | $217 | 0.7× |
| CT cervical spine w/ contrast (72126) range across 2 matching MRF lines |
$104–$1,187 | $347–$3,956 | varies |
| CT cervical spine w/o contrast (72125) range across 2 matching MRF lines |
$80–$989 | $266–$3,297 | varies |
| CT cervical spine w/wo cont (72127) range across 2 matching MRF lines |
$123–$1,356 | $409–$4,521 | varies |
| CT chest w contrast (71260) range across 5 matching MRF lines |
$103–$1,250 | $344–$4,167 | varies |
| CT chest w/wo contrast (71270) range across 3 matching MRF lines |
$123–$1,421 | $410–$4,737 | varies |
| CT Colonogrphy Dx Image Postprocess W/Contrast (74262) | $303 | $1,010 | 1.7× |
| CT colonogrphy dx image postprocess w/o contrast (74261) | $269 | $896 | 2.6× |
| CT head/brain with contrast (70460) range across 2 matching MRF lines |
$91–$1,240 | $304–$4,134 | varies |
| CT head/brain without and with contrast (70470) range across 2 matching MRF lines |
$107–$1,256 | $358–$4,185 | varies |
| CT heart contrast eval cardiac structure&morph (75572) range across 3 matching MRF lines |
$157–$305 | $522–$1,015 | varies |
| CT heart no contrast quant eval coronry calcium (75571) range across 2 matching MRF lines |
$60–$62 | $201–$205 | varies |
| CT hrt w/3d image congen (75573) range across 2 matching MRF lines |
$212–$305 | $706–$1,015 | varies |
| CT iac w contrast (70481) range across 4 matching MRF lines |
$112–$454 | $373–$1,514 | varies |
| CT l-spine w&w/o contrast (72133) range across 2 matching MRF lines |
$123–$1,424 | $409–$4,748 | varies |
| CT lower ext w/o (73700) range across 4 matching MRF lines |
$80–$408 | $265–$1,360 | varies |
| CT lower extremity w/contrast material (73701) range across 4 matching MRF lines |
$103–$705 | $343–$2,350 | varies |
| CT lumbar spine w contrast (72132) range across 2 matching MRF lines |
$104–$1,187 | $346–$3,956 | varies |
| CT lumbar spine w/o contrast (72131) range across 2 matching MRF lines |
$80–$989 | $265–$3,297 | varies |
| CT maxillofacial w contrast (70487) range across 3 matching MRF lines |
$94–$464 | $312–$1,546 | varies |
| CT maxillofacial wo contrast (70486) range across 3 matching MRF lines |
$79–$409 | $263–$1,363 | varies |
| CT neck tissue combo (70492) range across 2 matching MRF lines |
$138–$1,609 | $460–$5,363 | varies |
| Ct Orbit/Ear/Fossa W/O&W/Dye (70482) range across 4 matching MRF lines |
$132–$542 | $440–$1,808 | varies |
| CT orbits w/o contrast (70480) range across 4 matching MRF lines |
$98–$394 | $325–$1,314 | varies |
| CT pelvis w&w/o contrast (72194) range across 2 matching MRF lines |
$158–$1,559 | $528–$5,198 | varies |
| CT pelvis w/o contrast (72192) range across 2 matching MRF lines |
$82–$943 | $272–$3,142 | varies |
| CT scan of leg combo (73702) range across 4 matching MRF lines |
$121–$705 | $403–$2,350 | varies |
| CT scans face/jaw combo (70488) range across 3 matching MRF lines |
$115–$525 | $384–$1,749 | varies |
| CT soft tissue neck w contrast (70491) range across 2 matching MRF lines |
$114–$1,151 | $381–$3,836 | varies |
| CT soft tissue neck w/o contrast (70490) range across 2 matching MRF lines |
$92–$1,037 | $308–$3,458 | varies |
| CT thoracic spine w contrast (72129) range across 2 matching MRF lines |
$105–$1,130 | $350–$3,767 | varies |
| CT thoracic spine w/o contrast (72128) range across 2 matching MRF lines |
$80–$989 | $265–$3,297 | varies |
| CT thoracic spine w/wo cont (72130) range across 2 matching MRF lines |
$123–$1,356 | $411–$4,521 | varies |
| CT thorax w/o contrast (71250) range across 5 matching MRF lines |
$82–$1,011 | $272–$3,369 | varies |
| CT upper ext wo (73200) range across 4 matching MRF lines |
$101–$500 | $338–$1,667 | varies |
| CT upper extremity w/o & w/contrast material (73202) range across 4 matching MRF lines |
$158–$689 | $527–$2,295 | varies |
| CT upper extremity with contrast (73201) range across 4 matching MRF lines |
$126–$569 | $421–$1,897 | varies |
| Cta Abdl Aorta&Bi Iliofem W/Contrast&Postp (75635) range across 2 matching MRF lines |
$253–$1,572 | $844–$5,239 | varies |
| Cta Abdomen (74175) range across 2 matching MRF lines |
$187–$1,384 | $624–$4,612 | varies |
| CTA pelvis (72191) range across 2 matching MRF lines |
$187–$667 | $624–$2,223 | varies |
| Dilation ureters/urethra rs&i (74485) range across 2 matching MRF lines |
$1,536 | $234–$5,121 | 0.7× |
| Discography Cerv/Thor Spine (72285) range across 2 matching MRF lines |
$2,008 | $242–$6,692 | 1.0× |
| Diskography lumbar (72295) range across 2 matching MRF lines |
$2,008 | $216–$6,692 | 1.0× |
| Doppler Echo Fetal Puls Spectral F/U/Repeat (76828) | $30 | $100 | 0.3× |
| Doppler Echo Fetal Spectral Display Complete (76827) | $43 | $143 | 0.4× |
| Doppler Fetal Mid Cerebral Artery (76821) range across 2 matching MRF lines |
$53–$111 | $178–$370 | varies |
| Dxa Bone Density Axial (77080) range across 2 matching MRF lines |
$22–$112 | $73–$374 | varies |
| Dxa bone density study (77085) range across 2 matching MRF lines |
$30–$92 | $101–$308 | varies |
| Dxa bone density study 1/>sites appendiclr skel (77081) range across 2 matching MRF lines |
$18–$61 | $61–$203 | varies |
| Echo exam of fetal heart (76825) | $161 | $537 | 0.3× |
| Echo exam uterus (76831) | $71 | $236 | 0.3× |
| Echo Guide For Artery Repair (76936) range across 3 matching MRF lines |
$141–$154 | $470–$514 | varies |
| Echocardiography, fetal, cardiovascular system, real time with image documentation (2D), with or without M-mode… (76826) | $96 | $321 | 0.4× |
| Echograp Trans R Pros Study (76873) | $102 | $340 | 1.0× |
| Esophageal Motility Study (78258) | $123 | $409 | 0.3× |
| Esophagram (74220) range across 2 matching MRF lines |
$58–$190 | $192–$632 | varies |
| Fetal Biophys Profile W/Nst (76818) range across 2 matching MRF lines |
$68–$128 | $228–$425 | varies |
| Fetal Biophysical Profile W/O Non-Stress Testing (76819) range across 2 matching MRF lines |
$50–$128 | $167–$425 | varies |
| Fetal MRI w/placntl matrnl plvc img sing/1st ges (74712) | $262 | $874 | 1.1× |
| Fluoroscopy up to 1 hr (76000) range across 2 matching MRF lines |
$24–$220 | $80–$733 | varies |
| Follow-Up Angiography (75898) | $940 | $3,132 | 0.3× |
| Foot 2 views (73620) range across 5 matching MRF lines |
$16–$212 | $54–$708 | varies |
| Forearm 2 views (73090) range across 4 matching MRF lines |
$17–$262 | $56–$873 | varies |
| Gastric emptying imaging study (78264) range across 2 matching MRF lines |
$190–$354 | $634–$1,181 | varies |
| Gastric Emptyng Imag Std W/Sm Bwl Transit (78265) | $225 | $751 | 0.6× |
| Gastric Mucosa Imaging (78261) | $118 | $393 | 0.3× |
| Gastroesophageal Reflux Exam (78262) | $140 | $468 | 0.3× |
| Gated Heart Planar Single (78472) range across 2 matching MRF lines |
$132–$408 | $440–$1,360 | varies |
| Gated Heart, Multiple (78473) | $168 | $559 | 0.4× |
| Gstrc Emptng Imag Std W/Sm Bwl Col Trnst Mlt Day (78266) | $250 | $834 | 0.5× |
| Hand 2 views (73120) range across 5 matching MRF lines |
$18–$255 | $59–$850 | varies |
| Hdr Rdncl Ntrstl/Icav Brchtx (77772) | $513 | $1,709 | 0.7× |
| Hdr Rdncl Ntrstl/Icav Brchtx (77771) | $343 | $1,143 | 0.5× |
| Hdr Rdncl Ntrstl/Icav Brchtx 1 Channel (77770) | $197 | $656 | 0.3× |
| Heart first pass single,planar (78481) range across 3 matching MRF lines |
$103–$389 | $344–$1,295 | varies |
| Hepatc Vngrph Wdg/Fr Hemodyn Eval Rs&I (75889) | $74 | $246 | 0.0× |
| Hepatc Vngrph Wdg/Fr W/O Hemodyn Eval Rs&I (75891) | $74 | $248 | 0.0× |
| Hepatobil Syst Image W/Drug (78227) range across 2 matching MRF lines |
$254–$456 | $845–$1,520 | varies |
| Hepatobiliary System Imaging (78226) range across 2 matching MRF lines |
$188–$402 | $626–$1,341 | varies |
| High energy neutron radj tx dlvr 1/> isocenter (77423) | $75 | $249 | 0.1× |
| Ht Musc Image Planar Mult (78454) range across 2 matching MRF lines |
$249–$1,152 | $830–$3,839 | varies |
| Ht Muscle Image Spect Sing (78451) range across 2 matching MRF lines |
$198–$922 | $660–$3,072 | varies |
| Hyperthermia external generated superficial (77600) | $279 | $929 | 0.7× |
| Hyperthermia generated by interstitial probe(s); 5 or fewer interstitial applicators Non-Facility (77610) | $407 | $1,355 | 0.7× |
| Hyperthermia generated by interstitial probe(s); more than 5 interstitial applicators Non-Facility (77615) | $634 | $2,112 | 1.1× |
| Hyperthermia generated by intracavitary probe(s) Non-Facility (77620) | $371 | $1,236 | 0.7× |
| Hyperthermia, externally generated; deep (ie, heating to depths greater than 4 cm) Non-Facility (77605) | $589 | $1,962 | 0.8× |
| Hysterosalpingogram (74740) range across 2 matching MRF lines |
$56–$312 | $187–$1,040 | varies |
| Infant hip ultrasound with hip movement (dynamic) (76885) range across 2 matching MRF lines |
$82–$83 | $272–$278 | varies |
| Infant hip ultrasound, limited static exam (76886) | $60 | $199 | 0.7× |
| Infusion Ivp (74410) | $82 | $274 | 0.5× |
| Interstitial radiation source applic complex (77778) | $499 | $1,664 | 0.7× |
| Intracavitary Radiation Source Applic Complex (77763) | $426 | $1,421 | 0.6× |
| Intracavitary Radiation Source Applic Intermed (77762) | $303 | $1,010 | 0.5× |
| Intracavitary radiation source applic simple (77761) | $231 | $770 | 0.4× |
| Joint Survey Single View (77077) range across 3 matching MRF lines |
$26–$56 | $88–$188 | varies |
| K Flow/Funct Image Multiple (78709) | $212 | $705 | 0.4× |
| K Flow/Funct Image W/Drug (78708) range across 2 matching MRF lines |
$101–$529 | $336–$1,764 | varies |
| K Flow/Funct Image W/O Drug (78707) range across 2 matching MRF lines |
$133–$525 | $442–$1,749 | varies |
| Kidney Funcj Study Non-Img Radioisotopic Study (78725) | $65 | $216 | 0.2× |
| Kidney Imaging Morphol (78700) range across 2 matching MRF lines |
$99–$416 | $329–$1,386 | varies |
| Kidney Imaging Morphoogy W/Vascular Flow (78701) | $127 | $424 | 0.3× |
| Knee 3 Views (73562) range across 4 matching MRF lines |
$23–$305 | $76–$1,018 | varies |
| Labeled RBC Sequestration Differntl Organ/Tissue (78140) | $64 | $214 | 0.2× |
| Leveen/Shunt Patency Exam (78291) range across 2 matching MRF lines |
$144–$318 | $479–$1,060 | varies |
| Liver & Spleen Imaging Static Only (78215) | $112 | $374 | 0.3× |
| Liver & Spleen Imaging W/Vascular Flow (78216) range across 2 matching MRF lines |
$74–$402 | $246–$1,341 | varies |
| Liver imaging static only (78201) | $110 | $365 | 0.2× |
| Liver imaging w/vascular flow (78202) | $121 | $402 | 0.2× |
| Lung Perf&Ventilat Diferentl (78598) range across 2 matching MRF lines |
$175–$413 | $582–$1,377 | varies |
| Lung perfusion differential (78597) range across 2 matching MRF lines |
$116–$264 | $386–$881 | varies |
| Lung Ventilat&Perfus Imaging (78582) range across 2 matching MRF lines |
$191–$456 | $637–$1,520 | varies |
| Lung Ventilation Imaging (78579) range across 2 matching MRF lines |
$107–$337 | $357–$1,124 | varies |
| Lymph System Imaging (78195) range across 2 matching MRF lines |
$203–$334 | $678–$1,113 | varies |
| Magnetic Image Jaw Joint (70336) range across 2 matching MRF lines |
$172–$584 | $574–$1,948 | varies |
| Magnetic Resonance Elastography (76391) | $131 | $435 | 0.5× |
| Mammary ductogram or galactogram multiple (77054) range across 2 matching MRF lines |
$41–$262 | $136–$872 | varies |
| Mammary ductogram or galactogram single (77053) range across 2 matching MRF lines |
$32–$257 | $105–$856 | varies |
| Meckels Divert Exam (78290) range across 2 matching MRF lines |
$189–$354 | $631–$1,181 | varies |
| Medical physics dose eval radiation expos w/rprt (76145) | $471 | $1,571 | 1.3× |
| Mlc imrt design & construction per imrt plan (77338) | $267 | $890 | 0.7× |
| Mra Head W/O & W/Contrast Material (70546) range across 2 matching MRF lines |
$209–$1,127 | $695–$3,756 | varies |
| MRA head w/o contrast (70544) range across 2 matching MRF lines |
$137–$845 | $455–$2,817 | varies |
| MRA head with contrast (70545) range across 2 matching MRF lines |
$144–$966 | $479–$3,219 | varies |
| MRA neck w contrast (70548) range across 2 matching MRF lines |
$154–$1,014 | $514–$3,380 | varies |
| Mra Neck W/O &W/Contrast Material (70549) range across 2 matching MRF lines |
$218–$1,127 | $727–$3,756 | varies |
| MRA neck w/o contrast (70547) range across 2 matching MRF lines |
$137–$845 | $456–$2,817 | varies |
| MRI abdomen w contrast (74182) range across 2 matching MRF lines |
$195–$989 | $651–$3,297 | varies |
| MRI abdomen w/o contrast (74181) range across 2 matching MRF lines |
$125–$956 | $416–$3,187 | varies |
| MRI any jt lower extrem w/contrast material (73722) range across 4 matching MRF lines |
$205–$1,072 | $682–$3,573 | varies |
| MRI any jt lower extrem w/o & w/contrast matrl (73723) range across 4 matching MRF lines |
$252–$1,287 | $839–$4,290 | varies |
| MRI any jt upper extremity w/contrast matrl (73222) range across 4 matching MRF lines |
$204–$997 | $681–$3,323 | varies |
| MRI bone marrow blood supply (77084) | $207 | $689 | 0.9× |
| MRI brain functional w/o physician admnistration (70554) | $242 | $805 | 1.0× |
| MRI Breast W/O Contrast Bilateral (77047) | $140 | $466 | 0.6× |
| MRI Breast Without Contrast Material Unilateral (77046) | $136 | $453 | 0.6× |
| MRI cardiac w/o cont stress (75559) | $251 | $835 | 0.5× |
| MRI cardiac w/o contrast (75557) | $181 | $602 | 0.8× |
| MRI cervical spine w contrast (72142) range across 2 matching MRF lines |
$176–$771 | $586–$2,569 | varies |
| MRI cervical spine w/o cont (72141) range across 2 matching MRF lines |
$121–$647 | $403–$2,158 | varies |
| MRI chest w/o contrast (71550) range across 2 matching MRF lines |
$222–$686 | $740–$2,286 | varies |
| MRI chest with contrast (71551) range across 2 matching MRF lines |
$244–$822 | $814–$2,741 | varies |
| MRI chest wo w contrast (71552) range across 2 matching MRF lines |
$309–$960 | $1,031–$3,199 | varies |
| MRI lower extrem oth/thn jt w/contrast matrl (73719) range across 4 matching MRF lines |
$169–$1,503 | $562–$5,011 | varies |
| MRI lower extrem oth/thn jt w/o & w/contr matr (73720) range across 4 matching MRF lines |
$217–$1,670 | $724–$5,565 | varies |
| MRI lower extrem oth/thn jt w/o contr matrl (73718) range across 4 matching MRF lines |
$144–$1,003 | $479–$3,344 | varies |
| MRI lumbar spine w contrast (72149) range across 2 matching MRF lines |
$173–$838 | $576–$2,793 | varies |
| Mri Neck Spine W/O & W/Dye (72156) range across 3 matching MRF lines |
$204–$1,170 | $681–$3,901 | varies |
| MRI orbit face &/neck w/o contrast (70540) range across 2 matching MRF lines |
$146–$875 | $485–$2,915 | varies |
| MRI orbit face neck w contrast (70542) range across 2 matching MRF lines |
$173–$848 | $575–$2,825 | varies |
| Mri Orbt/Fac/Nck W/O &W/Dye (70543) range across 2 matching MRF lines |
$218–$1,157 | $725–$3,857 | varies |
| MRI pelvis w contrast (72196) range across 2 matching MRF lines |
$173–$1,011 | $576–$3,371 | varies |
| MRI pelvis w/o & w contrast (72197) range across 2 matching MRF lines |
$217–$1,197 | $724–$3,990 | varies |
| MRI pelvis w/o contrast (72195) range across 2 matching MRF lines |
$148–$885 | $493–$2,950 | varies |
| MRI thoracic spine w/o contrast (72146) range across 2 matching MRF lines |
$121–$602 | $402–$2,006 | varies |
| MRI upper extremity oth than jt w/contr matrl (73219) range across 4 matching MRF lines |
$216–$971 | $721–$3,238 | varies |
| MRI upper extremity oth than jt w/o contr matrl (73218) range across 4 matching MRF lines |
$199–$809 | $662–$2,697 | varies |
| Mri Uppr Extremity W/O&W/Dye (73220) range across 4 matching MRF lines |
$268–$1,131 | $892–$3,771 | varies |
| MRI, abdomen, combo (74183) range across 2 matching MRF lines |
$218–$1,320 | $726–$4,399 | varies |
| MRI, dorsal spine combo (72157) range across 3 matching MRF lines |
$205–$1,259 | $683–$4,195 | varies |
| MRI, dorsal spine contrast (72147) range across 2 matching MRF lines |
$174–$713 | $581–$2,378 | varies |
| MRI, joint upper extrem (73221) range across 4 matching MRF lines |
$128–$816 | $426–$2,720 | varies |
| MRI, joint upper extrem combo (73223) range across 4 matching MRF lines |
$253–$1,131 | $843–$3,771 | varies |
| MRI, lumbar spine combo (72158) range across 3 matching MRF lines |
$204–$920 | $680–$3,068 | varies |
| Myelogram cervical (72240) range across 2 matching MRF lines |
$66–$615 | $220–$2,049 | varies |
| Myelogram Lumbar (72265) range across 2 matching MRF lines |
$62–$615 | $207–$2,049 | varies |
| Myelography thoracic (72255) range across 2 matching MRF lines |
$68–$615 | $225–$2,049 | varies |
| Myelograpy 2/more regions rs&i (72270) range across 2 matching MRF lines |
$86–$621 | $285–$2,069 | varies |
| Myocardial Imaging Infarct Avid Planar Qual/Quan (78466) | $115 | $383 | 0.3× |
| Myocardial imaging, infarct avid, planar; with ejection fraction by first pass technique Non-Facility (78468) | $115 | $383 | 0.2× |
| Myocardial Perfusion Planar 1 Study Rest/Stress (78453) | $172 | $574 | 0.1× |
| Myocardial Spect Multiple Studies (78452) range across 2 matching MRF lines |
$277–$1,947 | $924–$6,489 | varies |
| Neck soft tissue (70360) range across 2 matching MRF lines |
$18–$148 | $60–$493 | varies |
| Nfs/Instlj Radioelmnt Sln 3 Mo Follow-Up Care (77750) | $217 | $723 | 0.6× |
| Njx Rp Loclzj Non-Img Probe Study Intravenous (78808) | $23 | $77 | 0.1× |
| Nm csf leak detection (78650) | $160 | $533 | 0.1× |
| Nm myocard infarct spect (78469) | $128 | $426 | 0.2× |
| Nm red cell survival study (78130) | $72 | $241 | 0.2× |
| Nm whole blood volume (78122) | $56 | $186 | 0.1× |
| Nonvascular Shunt X-Ray (75809) range across 2 matching MRF lines |
$51–$116 | $170–$386 | varies |
| Ntsty modul radthx pln dose-vol histos (77301) | $1,079 | $3,598 | 0.8× |
| Nuclear Rx Oral Admin (79005) range across 3 matching MRF lines |
$78–$316 | $259–$1,053 | varies |
| Ob us nuchal meas 1 gest (76813) | $71 | $238 | 0.7× |
| Oph bmtry us echograpy a-scan io lens pwr cal (76519) | $38 | $127 | 0.4× |
| Oph us dx ant sgm us immersion b-scan/hr biom (76513) | $44 | $147 | 0.4× |
| Oph US Dx B-Scan&Quan a-Scan Sm Pt Enctr (76510) | $41 | $136 | 0.3× |
| Ophthalmic Biometry US Echograpy a-Scan (76516) | $26 | $88 | 0.2× |
| Ophthalmic Ultrasonic Foreign Body Localization (76529) | $49 | $164 | 0.6× |
| Ophthalmic ultrasound dx b-scan w/wo a-scan (76512) | $28 | $92 | 0.3× |
| Ophthalmic US Dx Corneal Pachymetry Uni/Bi (76514) | $7 | $22 | 0.2× |
| Ophthalmic us dx quantitative a-scan only (76511) | $33 | $109 | 0.3× |
| Optic foramina (70190) range across 2 matching MRF lines |
$22–$56 | $73–$188 | varies |
| Panoramic X-ray of jaws (70355) range across 2 matching MRF lines |
$10–$59 | $34–$195 | varies |
| Parathyroid imaging w/tomographic spect & CT (78072) | $255 | $850 | 0.5× |
| Parathyroid Planar Imaging (78070) range across 2 matching MRF lines |
$169–$354 | $564–$1,181 | varies |
| Parathyroid planar imaging w/wo subtraction (78071) | $203 | $675 | 0.5× |
| Pelvis 1 or 2 views (72170) range across 2 matching MRF lines |
$16–$110 | $53–$367 | varies |
| Plasma Vol Radiopharm Vol Dilute Spx Mult Smples (78111) | $43 | $143 | 0.0× |
| Plasma volume, radiopharmaceutical volume-dilution technique (separate procedure); single sampling Non-Facility (78110) | $40 | $134 | 0.0× |
| Platelet survival study Non-Facility (78191) | $72 | $241 | 0.2× |
| Prq Transhepatc Portograpy Hemodyn Eval Rs&I (75885) | $81 | $269 | 0.0× |
| Pulmonary Perfusion Imaging Particulate (78580) range across 2 matching MRF lines |
$135–$354 | $451–$1,181 | varies |
| Radex Abd Compl Aqt Abd W/S/E/D Views 1 View Ch (74022) range across 2 matching MRF lines |
$28–$233 | $94–$777 | varies |
| Radex abscess/fistula/sinus tract rs&i (76080) range across 2 matching MRF lines |
$34–$438 | $113–$1,461 | varies |
| Radex Ankle Complete Minimum 3 Views (73610) range across 4 matching MRF lines |
$21–$297 | $69–$990 | varies |
| Radex Calcaneus Minimum 2 Views (73650) range across 4 matching MRF lines |
$17–$219 | $55–$730 | varies |
| Radex elbow complete minimum 3 views (73080) range across 4 matching MRF lines |
$18–$350 | $61–$1,168 | varies |
| Radex Facial Bones Complete Minimum 3 Views (70150) range across 2 matching MRF lines |
$27–$152 | $90–$508 | varies |
| Radex fingr minimum 2 views (73140) range across 3 matching MRF lines |
$21–$146 | $71–$488 | varies |
| Radex foot complete minimum 3 views (73630) range across 5 matching MRF lines |
$20–$278 | $65–$927 | varies |
| Radex Hand Minimum 3 Views (73130) range across 5 matching MRF lines |
$21–$274 | $69–$914 | varies |
| Radex lower extremity infant minimum 2 views (73592) range across 4 matching MRF lines |
$18–$85 | $60–$283 | varies |
| Radex Mastoids Compl Minimum 3 Views PR Side (70130) range across 2 matching MRF lines |
$35–$56 | $118–$188 | varies |
| Radex Nasal Bones Complete Minimum 3 Views (70160) range across 2 matching MRF lines |
$21–$162 | $71–$540 | varies |
| Radex Pharynx/Larx W/Fluor&/Magnification Tq (70370) | $55 | $184 | 0.6× |
| Radex Ribs Unilateral 2 Views (71100) range across 3 matching MRF lines |
$21–$201 | $69–$670 | varies |
| Radex shoulder complete minimum 2 views (73030) range across 4 matching MRF lines |
$19–$290 | $64–$966 | varies |
| Radex Sinuses Paransl < 3 Views (70210) range across 3 matching MRF lines |
$19–$135 | $62–$450 | varies |
| Radex sm int w/mlt srl imges via enteroclss tube (74251) | $233 | $778 | 1.3× |
| Radex Spine 1 View Specify Level (72020) range across 3 matching MRF lines |
$14–$59 | $46–$195 | varies |
| Radex Sternum Minimum 2 Views (71120) range across 2 matching MRF lines |
$19–$59 | $64–$195 | varies |
| Radex Temporomandble Jt Opn & Clsd Mouth Bilat (70330) range across 2 matching MRF lines |
$31–$59 | $102–$195 | varies |
| Radex Toe Minimum 2 Views (73660) range across 3 matching MRF lines |
$17–$168 | $56–$561 | varies |
| Radex upper extremity infant minimum 2 views (73092) range across 4 matching MRF lines |
$18–$85 | $60–$283 | varies |
| Radex Wrist Complete Minimum 3 Views (73110) range across 5 matching MRF lines |
$23–$272 | $76–$908 | varies |
| Radex X-Ray Exam Entire Spi 6/> Vw - Xr Entire Spine 6+ Vw (72084) range across 2 matching MRF lines |
$56–$197 | $185–$655 | varies |
| Radiation Delivery Stereotactic Cranial Linear (77372) likely a partial charge, not the full procedure |
$601 | $2,004 | 0.1× |
| Radiolog exam mandible compl minimum 4 views (70110) range across 2 matching MRF lines |
$25–$110 | $83–$367 | varies |
| Radiologic Exam Abdomen 3+ Views - Xr Abdomen 3+ Views (74021) range across 2 matching MRF lines |
$24–$172 | $81–$572 | varies |
| Radiologic exam colon double contrast study (74280) range across 2 matching MRF lines |
$132–$188 | $439–$627 | varies |
| Radiologic exam colon single contrast study (74270) range across 2 matching MRF lines |
$91–$116 | $303–$386 | varies |
| Radiologic Exam Esophagus Double Contrast Study (74221) | $65 | $215 | 0.4× |
| Radiologic exam knee complete 4/more views (73564) range across 4 matching MRF lines |
$26–$293 | $87–$978 | varies |
| Radiologic exam pelvis compl minimum 3 views (72190) range across 2 matching MRF lines |
$24–$200 | $79–$668 | varies |
| Radiologic Exam Small Int Single Contrast Study (74250) range across 2 matching MRF lines |
$72–$302 | $239–$1,005 | varies |
| Radiologic exam swallow function contrast study (74230) range across 2 matching MRF lines |
$76–$186 | $254–$621 | varies |
| Radiologic exam teeth complete full mouth (70320) | $32 | $106 | 0.1× |
| Radiologic Exam Teeth Prtl Exam < Full Mouth (70310) | $22 | $74 | 0.1× |
| Radiologic exam upr gi trc double contrast study (74246) range across 2 matching MRF lines |
$82–$512 | $273–$1,708 | varies |
| Radiologic examination femur 1 view (73551) range across 4 matching MRF lines |
$17–$104 | $56–$347 | varies |
| Radiologic examination femur minimum 2 views (73552) range across 4 matching MRF lines |
$20–$111 | $67–$371 | varies |
| Radiologic examination knee 1/2 views (73560) range across 4 matching MRF lines |
$20–$287 | $65–$957 | varies |
| Radiologic Examination Osseous Survey Limited (77074) range across 2 matching MRF lines |
$37–$100 | $124–$334 | varies |
| Radiologic Examination Salivary Gland Calculus (70380) | $21 | $71 | 0.2× |
| Radiologic examination tibia & fibula 2 views (73590) range across 4 matching MRF lines |
$18–$296 | $59–$986 | varies |
| Radiologic examination, internal auditory meati, complete Non-Facility (70134) range across 2 matching MRF lines |
$35–$95 | $117–$318 | varies |
| Radiologic examination, teeth; single view Non-Facility (70300) | $7 | $24 | 0.1× |
| Radiopharm Dacryocystography (78660) | $109 | $362 | 0.3× |
| Radiopharmaceutical therapy, by intra-articular administration Non-Facility (79440) | $70 | $232 | 0.3× |
| Radiopharmaceutical therapy, by intracavitary administration Non-Facility (79200) | $78 | $259 | 0.3× |
| Red Cell Volume Determination Spx 1 Sampling (78120) | $41 | $137 | 0.1× |
| Red Cell Volume Determination Spx Mult Samplings (78121) | $45 | $150 | 0.1× |
| Remote afterloading high dose rate radionuclide skin surface brachytherapy, includes basic dosimetry, when performed;… (77768) | $207 | $691 | 0.5× |
| Remote afterloading high dose rate radionuclide skin surface brachytherapy, includes basic dosimetry, when performed;… (77767) | $141 | $469 | 0.4× |
| Ribs bilateral 3 views (71110) range across 2 matching MRF lines |
$25–$296 | $83–$985 | varies |
| Rp loclzj tum plnr 1 area single day imaging (78800) range across 2 matching MRF lines |
$147–$366 | $489–$1,220 | varies |
| Rp loclzj tum plnr 2+area 1+d img/1 area img>2+d (78801) range across 2 matching MRF lines |
$162–$364 | $540–$1,213 | varies |
| Rp Loclzj Tum Plnr Whole Body 2+ Days Imaging (78804) range across 2 matching MRF lines |
$380–$1,348 | $1,265–$4,494 | varies |
| Rp Loclzj Tum Plnr Whole Body Single Day Imaging (78802) range across 2 matching MRF lines |
$179–$642 | $598–$2,141 | varies |
| Rp Loclzj Tum Spect 1 Area Single Day Imaging (78803) range across 2 matching MRF lines |
$223–$1,321 | $742–$4,402 | varies |
| Rp loclzj tum spect 2 area/sep acquisj img (78831) range across 2 matching MRF lines |
$409–$1,321 | $1,362–$4,402 | varies |
| Rp loclzj tum spect CT 2area 1d img/1 ar img>2+d (78832) | $532 | $1,773 | 0.4× |
| Rp loclzj tum spect w/CT 1 area/acquisj 1day img (78830) | $283 | $942 | 0.2× |
| Rp Ther Radiolbld Monoclonal Antibody IV Infus (79403) | $106 | $353 | 0.5× |
| Rp Therapy Intravenous Administration (79101) | $84 | $279 | 0.4× |
| Salivary Gland Function Study (78232) | $60 | $200 | 0.1× |
| Salivary Gland Imaging (78230) | $101 | $335 | 0.3× |
| Salivary Gland Imaging Serial Images (78231) | $61 | $203 | 0.2× |
| Scapula (73010) range across 5 matching MRF lines |
$13–$111 | $44–$370 | varies |
| Screening Digital Breast Tomosynthesis Bi (77063) range across 5 matching MRF lines |
$7–$30 | $24–$101 | varies |
| Sella turcica (70240) range across 2 matching MRF lines |
$19–$56 | $63–$188 | varies |
| Shoulder 1 view (73020) range across 4 matching MRF lines |
$12–$85 | $40–$283 | varies |
| Shoulder Arthrography (73040) range across 3 matching MRF lines |
$75–$353 | $249–$1,175 | varies |
| Sialogram (70390) range across 2 matching MRF lines |
$68–$297 | $228–$990 | varies |
| Skull less than 4 views (70250) range across 2 matching MRF lines |
$20–$110 | $67–$367 | varies |
| Special dosimetry (77331) | $36 | $121 | 0.3× |
| Special Physics Consult (77370) | $72 | $240 | 0.5× |
| Special teletherapy port plan (77321) | $53 | $177 | 0.1× |
| Special treatment procedure (77470) | $74 | $246 | 0.1× |
| Speech evaluation, complex (70371) | $63 | $210 | 0.3× |
| Spleen Imaging (78185) | $99 | $330 | 0.2× |
| Stereotactic Body Radiation Delivery (77373) | $656 | $2,187 | 0.4× |
| Sternoclavicular joints (71130) range across 2 matching MRF lines |
$23–$56 | $78–$188 | varies |
| Superior sagittal sinus venogram (75870) | $97 | $324 | 0.0× |
| Surface Applic Low Dose Rate Radionuclide Source (77789) | $74 | $246 | 0.7× |
| Telethx isodose pln cplx w/basic dosimetry (77307) | $162 | $540 | 0.4× |
| Telethx isodose pln smpl w/dosimetry calculation (77306) | $83 | $278 | 0.2× |
| Temporomandble Jt Arthrography Rs&I (70332) range across 2 matching MRF lines |
$49–$353 | $163–$1,175 | varies |
| Testicular Imaging W/Flow (78761) | $121 | $404 | 0.3× |
| Ther Rad Simulaj-Aided Field Setting Complex (77290) | $281 | $935 | 0.7× |
| Ther Rad Simulaj-Aided Field Setting Intermed (77285) | $268 | $892 | 0.7× |
| Ther rad simulaj-aided field setting simple (77280) | $162 | $539 | 1.2× |
| Therapeutic Enema Rdctj Intussusception/Obstrcj (74283) range across 2 matching MRF lines |
$114–$150 | $380–$501 | varies |
| Thoracic spine 2 views (72070) range across 2 matching MRF lines |
$19–$260 | $62–$868 | varies |
| Thoracic spine 3 views (72072) range across 2 matching MRF lines |
$22–$285 | $74–$950 | varies |
| Thoracolumbar 2 views (72080) range across 2 matching MRF lines |
$20–$59 | $66–$195 | varies |
| Thyroid carcinoma metastases imaging; with additional studies (eg, urinary recovery) Non-Facility (78016) | $163 | $544 | 0.4× |
| Thyroid Carcinoma Metastases Img Lmtd Area (78015) | $131 | $435 | 0.3× |
| Thyroid Imaging With Vascular Flow (78013) range across 2 matching MRF lines |
$113–$354 | $377–$1,181 | varies |
| Thyroid Met Imaging Body (78018) range across 2 matching MRF lines |
$180–$366 | $600–$1,220 | varies |
| Thyroid Uptake Measurement (78012) range across 2 matching MRF lines |
$47–$147 | $156–$491 | varies |
| Thyroid Uptake W/Blood Flow Sngle/Mult Quan Meas (78014) range across 2 matching MRF lines |
$137–$354 | $457–$1,181 | varies |
| Tx Devices Design & Construction Complex (77334) | $72 | $239 | 0.2× |
| Tx devices design & construction intermediate (77333) | $75 | $251 | 0.6× |
| Tx devices design & construction simple (77332) | $23 | $77 | 0.2× |
| Ultrasound Breast Limited (76642) range across 8 matching MRF lines |
$16–$145 | $53–$482 | varies |
| Ultrasound elastography first target lesion (76982) | $57 | $190 | 0.5× |
| Ultrasound Elastography Parenchyma (76981) | $61 | $204 | 0.6× |
| Ultrasound Exam Aaa Screen (76706) range across 2 matching MRF lines |
$62–$135 | $205–$451 | varies |
| Ultrasound trgt dynamic microbubble 1st lesion (76978) | $181 | $604 | 0.5× |
| Ultrasound, abdomen limited (76705) range across 2 matching MRF lines |
$52–$345 | $173–$1,151 | varies |
| Umbilical-artery Doppler (OB) (76820) range across 2 matching MRF lines |
$27–$111 | $91–$370 | varies |
| Unlisted us procedure (76999) | $79 | $264 | 0.9× |
| Upper gi w/o kub (74240) range across 2 matching MRF lines |
$72–$378 | $240–$1,259 | varies |
| Urea Breath Test C-14 Isotopic Acquisj Analysis (78267) | $7 | $23 | 0.6× |
| Urea breath test c-14 isotopic analysis (78268) | $59 | $195 | 0.6× |
| Ureteral Reflux Study (78740) range across 2 matching MRF lines |
$130–$416 | $432–$1,386 | varies |
| Urethrocystogram voiding (74455) range across 2 matching MRF lines |
$62–$243 | $206–$809 | varies |
| Urethrocystography retrograde (74450) | $231 | $770 | 1.0× |
| Us bone density measurement (76977) | $4 | $13 | 0.0× |
| Us breast unilateral complete (76641) range across 8 matching MRF lines |
$20–$174 | $68–$580 | varies |
| Us chest (76604) range across 3 matching MRF lines |
$38–$116 | $125–$386 | varies |
| Us complete joint (76881) range across 2 matching MRF lines |
$38–$121 | $125–$404 | varies |
| Us exam, pelvic, limited (76857) range across 3 matching MRF lines |
$28–$116 | $93–$386 | varies |
| Us head (76506) range across 2 matching MRF lines |
$67–$79 | $224–$264 | varies |
| Us kidney transplant (76776) range across 2 matching MRF lines |
$89–$121 | $296–$404 | varies |
| Us lmtd joint/oth nonvasc xtr strux r-t w/img (76882) range across 2 matching MRF lines |
$32–$83 | $107–$278 | varies |
| Us ob detailed single fetus (76811) range across 2 matching MRF lines |
$103–$191 | $342–$638 | varies |
| Us ob limited 1 or more fetuses (76815) range across 2 matching MRF lines |
$49–$116 | $162–$386 | varies |
| Us ob transvaginal (76817) range across 3 matching MRF lines |
$56–$116 | $185–$386 | varies |
| Us pelvic non ob complete (76856) range across 3 matching MRF lines |
$63–$128 | $210–$425 | varies |
| Us pg uter img f&mat 14 wk tabdl 1/1st gestation (76801) range across 3 matching MRF lines |
$70–$128 | $234–$425 | varies |
| Us preg uterus real time f/u trnsabdl per fetus (76816) range across 2 matching MRF lines |
$66–$79 | $220–$264 | varies |
| Us retroperitoneal complete (76770) range across 2 matching MRF lines |
$65–$153 | $215–$510 | varies |
| Us retroperitoneal limited (76775) range across 5 matching MRF lines |
$33–$128 | $110–$425 | varies |
| Us scrotum and contents (76870) range across 2 matching MRF lines |
$60–$128 | $200–$425 | varies |
| Us spinal canal and contents (76800) range across 2 matching MRF lines |
$82–$128 | $274–$425 | varies |
| Us thyroid (76536) range across 3 matching MRF lines |
$67–$128 | $222–$425 | varies |
| Us transrectal (76872) | $111 | $371 | 1.1× |
| Vascular Flow Imaging (78445) | $118 | $394 | 0.3× |
| Vasogram (74440) | $59 | $195 | 0.2× |
| Vein X-Ray Chest (75827) range across 2 matching MRF lines |
$72–$685 | $239–$2,283 | varies |
| Vein X-Ray Liver W/O Hemodyn (75887) | $82 | $273 | 0.0× |
| Vein X-Ray Skull Epidural (75872) | $77 | $256 | 0.1× |
| Venogram Sinus/Jugular (75860) range across 2 matching MRF lines |
$3,088 | $253–$10,292 | 1.0× |
| Venography Adrenal Unilateral (75840) | $77 | $256 | 0.0× |
| Venography caval inferior serialography rs&i (75825) range across 3 matching MRF lines |
$2,298–$2,926 | $229–$9,754 | varies |
| Venography extremity bilateral rs&i (75822) range across 2 matching MRF lines |
$80–$1,138 | $268–$3,793 | varies |
| Venography extremity unilateral rs&i (75820) range across 5 matching MRF lines |
$67–$1,084 | $222–$3,614 | varies |
| Venography Orbital Rs&I (75880) | $65 | $217 | 0.1× |
| Venography Renal Bilateral (75833) | $86 | $285 | 0.0× |
| Venography Renal Unilateral (75831) | $71 | $238 | 0.0× |
| Venous sampling by catheter (75893) likely a partial charge, not the full procedure |
$63 | $210 | 0.0× |
| Venous thrombosis imaging (78457) range across 3 matching MRF lines |
$104–$1,326 | $347–$4,421 | varies |
| Venous Thrombosis Imaging Venogram Bilateral (78458) range across 2 matching MRF lines |
$117–$1,989 | $391–$6,631 | varies |
| Vertebral fracture assessment via dxa (77086) range across 2 matching MRF lines |
$19–$58 | $64–$193 | varies |
| Wrist 2 views (73100) range across 4 matching MRF lines |
$19–$249 | $64–$829 | varies |
| X-Ray Ac Jts - Xr Acromioclavicular Joints Bilateral (73050) range across 2 matching MRF lines |
$16–$59 | $54–$195 | varies |
| X-ray antegrade pyelogram tube (74425) range across 2 matching MRF lines |
$80–$231 | $268–$770 | varies |
| X-Ray Aorta Leg Arteries (75630) range across 3 matching MRF lines |
$2,620–$3,073 | $313–$10,242 | varies |
| X-Ray Bend Only L-S Spine (72120) range across 2 matching MRF lines |
$23–$59 | $77–$195 | varies |
| X-Ray Elbow 2 Vw - Xr Elbow 1-2 Views Right (73070) range across 5 matching MRF lines |
$17–$249 | $55–$831 | varies |
| X-Ray Exam Breast Specimen (76098) range across 3 matching MRF lines |
$24–$425 | $79–$1,418 | varies |
| X-Ray Exam Entire Spi 1 Vw (72081) range across 2 matching MRF lines |
$24–$62 | $80–$206 | varies |
| X-Ray Exam Entire Spi 2/3 Vw (72082) range across 2 matching MRF lines |
$40–$110 | $133–$367 | varies |
| X-Ray Exam Entire Spi 4/5 Vw (72083) range across 2 matching MRF lines |
$45–$192 | $150–$639 | varies |
| X-Ray Exam Hip Uni 1 View (73501) range across 5 matching MRF lines |
$18–$74 | $61–$247 | varies |
| X-Ray Exam Hip Uni 2-3 Views (73502) range across 5 matching MRF lines |
$27–$80 | $89–$268 | varies |
| X-Ray Exam Hip Uni 4/> Views (73503) range across 5 matching MRF lines |
$33–$131 | $111–$436 | varies |
| X-Ray Exam Hips Bi 2 Views (73521) range across 3 matching MRF lines |
$23–$140 | $78–$468 | varies |
| X-Ray Exam Hips Bi 3-4 Views (73522) range across 3 matching MRF lines |
$31–$147 | $102–$489 | varies |
| X-Ray Exam Hips Bi 5/> Views (73523) range across 3 matching MRF lines |
$35–$220 | $116–$733 | varies |
| X-Ray Exam L-S Spine Bending (72114) range across 2 matching MRF lines |
$35–$336 | $118–$1,119 | varies |
| X-Ray Exam Neck Spine 2-3 Vw (72040) range across 2 matching MRF lines |
$22–$88 | $74–$292 | varies |
| X-Ray Exam Neck Spine 6/>Vws (72052) range across 2 matching MRF lines |
$35–$131 | $118–$436 | varies |
| X-Ray Exam Unilat Ribs/Chest (71101) range across 3 matching MRF lines |
$24–$263 | $80–$877 | varies |
| X-ray eye for foreign body (70030) | $18 | $61 | 0.2× |
| X-ray head for orthodontia (70350) range across 2 matching MRF lines |
$9–$56 | $31–$188 | varies |
| X-ray humerus (73060) range across 4 matching MRF lines |
$18–$281 | $60–$936 | varies |
| X-ray IV pyelogram (ivp) (74400) range across 2 matching MRF lines |
$78–$243 | $260–$809 | varies |
| X-ray IV pyelogram+tomography (74415) | $92 | $305 | 0.5× |
| X-Ray Jaw <4 Vw - Xr Mandible < 4 Views (70100) range across 2 matching MRF lines |
$22–$59 | $73–$195 | varies |
| X-Ray Knee Bilat Standing - Xr Knees Anteroposterior Standing Bilat (73565) range across 2 matching MRF lines |
$23–$59 | $76–$195 | varies |
| X-Ray Lumbar Spine 2/3 Vw - Xr Lumbar Spine 2-3 Views (72100) range across 2 matching MRF lines |
$23–$221 | $75–$735 | varies |
| X-ray nose-rectum child f.b. (76010) range across 2 matching MRF lines |
$17–$229 | $56–$764 | varies |
| X-Ray Ribs, Chest 4+ Vw - Xr Ribs 3 Vws Bil W/ Chest Posteroanterior (71111) range across 2 matching MRF lines |
$30–$289 | $99–$962 | varies |
| X-Ray Sacroiliac Jts 3+ Vw - Xr Sacroiliac Joints 3+ Views (72202) range across 2 matching MRF lines |
$22–$110 | $74–$367 | varies |
| X-Ray Sacroiliac Jts <3 Vw - Xr Sacroiliac Joints 1-2 Views (72200) range across 2 matching MRF lines |
$19–$111 | $63–$370 | varies |
| X-Ray Sacrum/Coccyx 2+ Vw - Xr Sacrum Coccyx 2+ Views (72220) range across 2 matching MRF lines |
$18–$59 | $61–$195 | varies |
| X-Ray Sinuses 3+ Vw - Xr Paranasal Sinuses 3+ Views (70220) range across 2 matching MRF lines |
$22–$215 | $72–$716 | varies |
| X-Ray Skull 4+ Vw - Xr Skull Complete 4+ Views (70260) range across 2 matching MRF lines |
$26–$165 | $85–$551 | varies |
| X-Ray Stress View (77071) range across 3 matching MRF lines |
$31–$56 | $103–$188 | varies |
| X-ray thoracic spine 4 vw (72074) range across 2 matching MRF lines |
$25–$111 | $84–$370 | varies |
| X-Ray Tmj Unilat (70328) | $20 | $66 | 0.2× |
| X-Ray Urinary Tract Exam With Contrast Material (74420) range across 2 matching MRF lines |
$44–$231 | $147–$770 | varies |
| X-Rays Bone Length Studies (77073) range across 2 matching MRF lines |
$26–$56 | $85–$188 | varies |
| X-Rays Bone Survey Complete (77075) range across 2 matching MRF lines |
$56–$121 | $187–$402 | varies |
| Xr c-spine 4 or 5 views (72050) range across 2 matching MRF lines |
$30–$126 | $100–$420 | varies |
| Xr facial bones less than 3 views (70140) range across 2 matching MRF lines |
$18–$59 | $61–$195 | varies |
| XR Mastoids < 3 Views Bilateral (70120) | $22 | $73 | 0.2× |
| Xr myelogram posterior fossa (70010) range across 2 matching MRF lines |
$33–$615 | $109–$2,049 | varies |
| Xr orbits complete 4 views (70200) range across 2 matching MRF lines |
$28–$110 | $92–$367 | varies |
| Xr Tomogram Single Plane (76100) | $54 | $179 | 0.5× |
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.