Imaging prices at Saint Anthony Medical Center
Rockford, IL · every code in this section with a posted price and a Medicare benchmark.
443 codes. Prices are the hospital's own posted facility charges.
Compare against other hospitals interactively →
| Procedure | Posted cash | Posted gross | × Medicare |
|---|---|---|---|
| 3-D radiotherapy plan dose-volume histograms (77295) range across 2 matching MRF lines |
$2,485.80–$6,105.60 | $4,143–$10,176 | varies |
| Abdomen 1 View (74018) | $326.40 | $544 | 3.5× |
| Abdomen 2 views (74019) | $397.80 | $663 | 3.6× |
| Acute Gastrointestinal Blood Loss Imaging (78278) | $1,786.20 | $2,977 | 4.2× |
| Acute venous thrombosis imaging, peptide Non-Facility (78456) | $1,721.40 | $2,869 | 1.2× |
| Angio pulmonary bilat (75743) | $3,614.40 | $6,024 | 1.1× |
| Angiography Adrenal Bilateral Slctv Rs&I (75733) | $3,235.80 | $5,393 | 1.0× |
| Angiography extremity bilateral rs&i (75716) | $4,345.80 | $7,243 | 1.3× |
| Angiography extremity unilateral rs&i (75710) | $4,020.60 | $6,701 | 1.2× |
| Angiography pulmonary unilateral slctv rs&i (75741) | $3,678.60 | $6,131 | 1.1× |
| Angrph pulmonary nonslctv cath/ven njx rs&i (75746) | $2,013 | $3,355 | 0.6× |
| Ankle 2 views (73600) range across 3 matching MRF lines |
$347.40–$519.60 | $579–$866 | varies |
| Aortography thoracic serialography rs&i (75605) | $3,653.40 | $6,089 | 0.6× |
| Artery X-Rays Abdomen (75726) | $4,519.80 | $7,533 | 0.8× |
| Artery X-Rays Adrenal Gland (75731) | $4,008.60 | $6,681 | 1.2× |
| Artery X-Rays Pelvis (75736) | $4,020.60 | $6,701 | 0.7× |
| Artery X-Rays Spine (75705) | $4,519.80 | $7,533 | 0.8× |
| Arthrogram ankle (73615) | $921.60 | $1,536 | 2.5× |
| Arthrogram hip (73525) | $1,019.40 | $1,699 | 2.7× |
| Arthrogram Wrist (73115) | $887.40 | $1,479 | 2.4× |
| Basic radiation dosimetry calculation (77300) range across 4 matching MRF lines |
$301.80–$604.80 | $503–$1,008 | varies |
| Bone age studies (77072) | $353.40 | $589 | 3.2× |
| Bone Imaging 3 Phase (78315) | $2,274 | $3,790 | 5.3× |
| Bone Imaging Limited Area (78300) | $1,391.40 | $2,319 | 3.2× |
| Bone Imaging Multiple Areas (78305) | $1,543.80 | $2,573 | 3.6× |
| Bone Imaging Whole Body (78306) | $2,020.80 | $3,368 | 4.7× |
| Bone marrow imaging; whole body (78104) | $1,591.80 | $2,653 | 3.7× |
| Bone survey infant (77076) | $341.40 | $569 | 3.0× |
| Brachytx isodose complex (77318) range across 2 matching MRF lines |
$1,655.40–$3,855.60 | $2,759–$6,426 | varies |
| Brachytx isodose intermed (77317) range across 2 matching MRF lines |
$1,655.40–$3,606.60 | $2,759–$6,011 | varies |
| Brachytx Isodose Plan Simple (77316) range across 2 matching MRF lines |
$1,655.40–$3,606.60 | $2,759–$6,011 | varies |
| Brain Flow Imaging Only (78610) | $1,215 | $2,025 | 2.1× |
| Brain Imaging Min 4 Static Views W Vascular Flow (78606) | $1,969.20 | $3,282 | 3.4× |
| Brain Imaging Pet Metabolic Evaluation (78608) | $5,974.80 | $9,958 | 3.9× |
| Cardiac blood pool imaging, first pass technique; multiple studies, resting and with stress (exercise and/or… (78483) | $2,163 | $3,605 | 3.7× |
| Cardiac MRI w/w/o contrast & further seq (75561) | $3,091.80 | $5,153 | 8.3× |
| Cardiac MRI w/w/o contrast w/stress (75563) | $3,068.40 | $5,114 | 3.7× |
| Cardiac Shunt Detection (78428) | $1,421.40 | $2,369 | 3.3× |
| Cat Scan Follow-Up Study (76380) | $1,881 | $3,135 | 20.2× |
| Cerebrospinal Fluid Flow W/O Matl Shunt Evaltj (78645) | $1,510.80 | $2,518 | 2.6× |
| Cerebrospinal Fluid Scan (78630) | $2,156.40 | $3,594 | 3.7× |
| Chest 1 view (71045) range across 3 matching MRF lines |
$203.40–$279 | $339–$465 | varies |
| Chest 2 views (71046) range across 2 matching MRF lines |
$328.80–$334.80 | $548–$558 | varies |
| Chest 3 views (71047) | $391.20 | $652 | 4.2× |
| Chest 4 or more views (71048) range across 3 matching MRF lines |
$441.60–$538.80 | $736–$898 | varies |
| Cholecystography Oral Contrast (74290) | $414.60 | $691 | 2.2× |
| Cisternography Positive Contrast Rs&I (70015) | $1,423.20 | $2,372 | 1.7× |
| Clavicle complete (73000) range across 3 matching MRF lines |
$370.20–$553.20 | $617–$922 | varies |
| Computed Tomography Thorax Lw Dose Lng Ca Scr C- (71271) | $176.40 | $294 | 1.6× |
| Continuing medical physics consltj pr wk (77336) | $995.40 | $1,659 | 6.9× |
| Contrast Exam Abdominl Aorta (75625) | $4,020.60 | $6,701 | 1.2× |
| Contrast X-Ray Bladder (74430) | $786.60 | $1,311 | 2.1× |
| Contrast X-Ray Of Elbow (73085) | $815.40 | $1,359 | 2.2× |
| Contrast X-Ray Of Knee Joint (73580) | $1,006.80 | $1,678 | 2.7× |
| Contrast Xray Throat/Cerv Esopha (74210) | $590.40 | $984 | 3.1× |
| Corpora cavernosography (74445) | $557.40 | $929 | 5.0× |
| CT abdomen and pelvis without and with contrast (74178) | $3,355.80 | $5,593 | 9.0× |
| CT abdomen and pelvis without contrast (74176) | $2,695.20 | $4,492 | 10.5× |
| CT abdomen w contrast (74160) | $2,099.40 | $3,499 | 11.2× |
| CT abdomen w wo contrast (74170) | $2,215.20 | $3,692 | 11.8× |
| CT abdomen w/o contrast (74150) | $1,939.20 | $3,232 | 17.3× |
| CT Angio Abdomen and Pelvis (74174) | $3,521.40 | $5,869 | 9.4× |
| CT Angio Chest (71275) | $2,762.40 | $4,604 | 14.7× |
| CT Angio Head (70496) | $2,910 | $4,850 | 15.5× |
| CT angio hrt w/3d image (75574) | $2,074.80 | $3,458 | 5.5× |
| Ct Angio Lwr Extr W/O&W/Dye (73706) range across 3 matching MRF lines |
$2,768.40–$4,152 | $4,614–$6,920 | varies |
| CT Angio Neck (70498) | $2,892 | $4,820 | 15.4× |
| Ct Angio Upr Extrm W/O&W/Dye (73206) range across 3 matching MRF lines |
$2,493.60–$3,740.40 | $4,156–$6,234 | varies |
| CT bone density (77078) | $1,881 | $3,135 | 20.2× |
| CT Cere Prfuj Alys C+ W/O CT/Cta Same Anatomy (70473) | $1,713 | $2,855 | 9.1× |
| CT cervical spine w/ contrast (72126) | $2,443.20 | $4,072 | 6.5× |
| CT cervical spine w/o contrast (72125) | $2,403.60 | $4,006 | 21.5× |
| CT cervical spine w/wo cont (72127) | $2,825.40 | $4,709 | 15.0× |
| CT chest w contrast (71260) | $2,330.40 | $3,884 | 12.4× |
| CT chest w/wo contrast (71270) | $2,757.60 | $4,596 | 14.7× |
| CT colonography screening (74263) | $1,881 | $3,135 | 7.4× |
| CT Colonogrphy Dx Image Postprocess W/Contrast (74262) | $1,881 | $3,135 | 10.0× |
| CT colonogrphy dx image postprocess w/o contrast (74261) | $1,881 | $3,135 | 16.8× |
| CT head/brain with contrast (70460) | $2,160.60 | $3,601 | 11.5× |
| CT head/brain without and with contrast (70470) | $2,469 | $4,115 | 13.1× |
| CT heart contrast eval cardiac structure&morph (75572) | $1,881 | $3,135 | 5.0× |
| CT heart no contrast quant eval coronry calcium (75571) | $117 | $195 | 1.3× |
| CT hrt w/3d image congen (75573) | $1,881 | $3,135 | 5.0× |
| CT iac w contrast (70481) | $2,218.20 | $3,697 | 11.8× |
| CT l-spine w&w/o contrast (72133) | $2,964 | $4,940 | 15.8× |
| CT lower ext w/o (73700) range across 3 matching MRF lines |
$1,881–$2,822.40 | $3,135–$4,704 | varies |
| CT lower extremity w/contrast material (73701) range across 3 matching MRF lines |
$2,099.40–$3,148.20 | $3,499–$5,247 | varies |
| CT lumbar spine w contrast (72132) | $2,376 | $3,960 | 6.4× |
| CT lumbar spine w/o contrast (72131) | $2,022 | $3,370 | 18.0× |
| CT maxillofacial w contrast (70487) | $2,257.20 | $3,762 | 12.0× |
| CT maxillofacial wo contrast (70486) | $1,915.80 | $3,193 | 17.1× |
| CT neck tissue combo (70492) | $2,752.80 | $4,588 | 14.6× |
| Ct Orbit/Ear/Fossa W/O&W/Dye (70482) | $2,298 | $3,830 | 12.2× |
| CT orbits w/o contrast (70480) | $2,187.60 | $3,646 | 19.5× |
| CT pelvis w&w/o contrast (72194) | $2,456.40 | $4,094 | 13.1× |
| CT pelvis w/o contrast (72192) | $1,881 | $3,135 | 16.8× |
| CT scan of leg combo (73702) range across 3 matching MRF lines |
$2,671.80–$4,007.40 | $4,453–$6,679 | varies |
| CT scans face/jaw combo (70488) | $2,298 | $3,830 | 12.2× |
| CT soft tissue neck w contrast (70491) | $2,248.80 | $3,748 | 12.0× |
| CT soft tissue neck w/o contrast (70490) | $1,956.60 | $3,261 | 17.5× |
| CT thoracic spine w contrast (72129) | $2,297.40 | $3,829 | 12.2× |
| CT thoracic spine w/o contrast (72128) | $2,023.80 | $3,373 | 18.1× |
| CT thoracic spine w/wo cont (72130) | $2,644.20 | $4,407 | 14.1× |
| CT thorax w/o contrast (71250) | $1,978.20 | $3,297 | 17.7× |
| CT unlisted procedure (76497) | $1,881 | $3,135 | 20.2× |
| CT upper ext wo (73200) range across 3 matching MRF lines |
$2,255.40–$3,383.40 | $3,759–$5,639 | varies |
| CT upper extremity w/o & w/contrast material (73202) range across 3 matching MRF lines |
$2,350.80–$3,526.20 | $3,918–$5,877 | varies |
| CT upper extremity with contrast (73201) range across 3 matching MRF lines |
$2,483.40–$3,725.40 | $4,139–$6,209 | varies |
| Cta Abdl Aorta&Bi Iliofem W/Contrast&Postp (75635) | $2,478.60 | $4,131 | 13.2× |
| Cta Abdomen (74175) | $2,336.40 | $3,894 | 12.4× |
| CTA head&neck c+ w/noncontrast img&post-pxessing (70471) | $1,939.80 | $3,233 | 5.2× |
| CTA pelvis (72191) | $2,437.20 | $4,062 | 13.0× |
| Dilation ureters/urethra rs&i (74485) | $4,393.80 | $7,323 | 2.0× |
| Discography Cerv/Thor Spine (72285) | $4,150.20 | $6,917 | 2.0× |
| Diskography lumbar (72295) | $3,572.40 | $5,954 | 1.7× |
| Doppler Echo Fetal Puls Spectral F/U/Repeat (76828) | $630 | $1,050 | 5.6× |
| Doppler Echo Fetal Spectral Display Complete (76827) | $873.60 | $1,456 | 7.8× |
| Doppler Fetal Mid Cerebral Artery (76821) | $715.20 | $1,192 | 6.4× |
| Dxa Bone Density Axial (77080) | $576 | $960 | 5.1× |
| Dxa bone density study 1/>sites appendiclr skel (77081) | $484.20 | $807 | 5.2× |
| Echo exam of fetal heart (76825) | $1,336.80 | $2,228 | 2.3× |
| Echo exam uterus (76831) | $1,107 | $1,845 | 4.3× |
| Echo Guide For Artery Repair (76936) | $952.80 | $1,588 | 4.1× |
| Echocardiography, fetal, cardiovascular system, real time with image documentation (2D), with or without M-mode… (76826) | $589.20 | $982 | 2.3× |
| Echograp Trans R Pros Study (76873) range across 2 matching MRF lines |
$492.60–$1,068.60 | $821–$1,781 | varies |
| Esophageal Motility Study (78258) | $778.80 | $1,298 | 1.8× |
| Esophagram (74220) | $645.60 | $1,076 | 3.4× |
| Fetal Biophys Profile W/Nst (76818) range across 2 matching MRF lines |
$461.40–$919.20 | $769–$1,532 | varies |
| Fetal Biophysical Profile W/O Non-Stress Testing (76819) range across 2 matching MRF lines |
$366.60–$727.20 | $611–$1,212 | varies |
| Fetal MRI w/placntl matrnl plvc img sing/1st ges (74712) | $3,091.80 | $5,153 | 12.1× |
| Fluoroscopy up to 1 hr (76000) range across 2 matching MRF lines |
$188.40–$648 | $314–$1,080 | varies |
| Follow-Up Angiography (75898) | $1,983 | $3,305 | 0.6× |
| Foot 2 views (73620) range across 3 matching MRF lines |
$352.80–$525 | $588–$875 | varies |
| Forearm 2 views (73090) range across 3 matching MRF lines |
$369.60–$551.40 | $616–$919 | varies |
| Gastric emptying imaging study (78264) | $1,719 | $2,865 | 4.0× |
| Gastric Emptyng Imag Std W/Sm Bwl Transit (78265) | $591 | $985 | 1.4× |
| Gastroesophageal Reflux Exam (78262) | $1,549.80 | $2,583 | 3.6× |
| Gated Heart Planar Single (78472) | $2,107.20 | $3,512 | 4.9× |
| Gated Heart, Multiple (78473) | $2,671.20 | $4,452 | 6.2× |
| GI Endoscopic US S&I (76975) range across 2 matching MRF lines |
$980.40–$1,366.80 | $1,634–$2,278 | varies |
| Hand 2 views (73120) range across 3 matching MRF lines |
$354.60–$529.80 | $591–$883 | varies |
| Hdr Rdncl Ntrstl/Icav Brchtx (77771) range across 2 matching MRF lines |
$3,588–$5,179.80 | $5,980–$8,633 | varies |
| Hdr Rdncl Ntrstl/Icav Brchtx 1 Channel (77770) range across 2 matching MRF lines |
$2,188.20–$3,197.40 | $3,647–$5,329 | varies |
| Heart first pass single,planar (78481) | $917.40 | $1,529 | 1.6× |
| Hepatc Vngrph Wdg/Fr Hemodyn Eval Rs&I (75889) | $3,643.20 | $6,072 | 1.1× |
| Hepatc Vngrph Wdg/Fr W/O Hemodyn Eval Rs&I (75891) | $3,523.80 | $5,873 | 1.0× |
| Hepatobil Syst Image W/Drug (78227) | $2,218.20 | $3,697 | 3.8× |
| Hepatobiliary System Imaging (78226) | $2,015.40 | $3,359 | 4.7× |
| Ht Musc Image Planar Mult (78454) | $3,356.40 | $5,594 | 2.4× |
| Ht Muscle Image Spect Sing (78451) | $2,864.40 | $4,774 | 2.1× |
| Hysterosalpingogram (74740) | $967.80 | $1,613 | 3.8× |
| Infant hip ultrasound with hip movement (dynamic) (76885) | $264 | $440 | 2.8× |
| Infant hip ultrasound, limited static exam (76886) | $319.80 | $533 | 3.4× |
| Intracavitary Radiation Source Applic Complex (77763) range across 2 matching MRF lines |
$2,339.40–$3,555.60 | $3,899–$5,926 | varies |
| Intracavitary Radiation Source Applic Intermed (77762) range across 2 matching MRF lines |
$1,584–$2,471.40 | $2,640–$4,119 | varies |
| Intracavitary radiation source applic simple (77761) range across 2 matching MRF lines |
$1,060.80–$1,653.60 | $1,768–$2,756 | varies |
| Joint Survey Single View (77077) | $354 | $590 | 3.2× |
| K Flow/Funct Image Multiple (78709) | $1,797.60 | $2,996 | 3.1× |
| K Flow/Funct Image W/Drug (78708) | $1,995 | $3,325 | 3.4× |
| K Flow/Funct Image W/O Drug (78707) | $1,949.40 | $3,249 | 3.4× |
| Kidney Imaging Morphol (78700) | $1,440.60 | $2,401 | 3.4× |
| Kidney Imaging Morphoogy W/Vascular Flow (78701) | $1,665 | $2,775 | 3.9× |
| Knee 3 Views (73562) range across 3 matching MRF lines |
$466.80–$700.20 | $778–$1,167 | varies |
| Leveen/Shunt Patency Exam (78291) | $1,623.60 | $2,706 | 3.8× |
| Liver & Spleen Imaging Static Only (78215) | $1,749 | $2,915 | 4.1× |
| Lung Perf&Ventilat Diferentl (78598) | $2,386.20 | $3,977 | 4.1× |
| Lung perfusion differential (78597) | $2,305.20 | $3,842 | 5.4× |
| Lung Ventilat&Perfus Imaging (78582) | $2,333.40 | $3,889 | 4.0× |
| Lung Ventilation Imaging (78579) | $1,776 | $2,960 | 4.1× |
| Lymph System Imaging (78195) | $1,726.20 | $2,877 | 3.0× |
| Magnetic Image Jaw Joint (70336) | $3,091.80 | $5,153 | 12.1× |
| Magnetic resonance (eg, proton) imaging, brain (including brain stem andskull base), during open intracranial procedure… (70558) | $3,091.80 | $5,153 | 16.4× |
| Magnetic resonance (eg, proton) imaging, brain (including brain stem andskull base), during open intracranial procedure… (70557) | $3,091.80 | $5,153 | 5.3× |
| Magnetic resonance (eg, proton) imaging, brain (including brain stem andskull base), during open intracranial procedure… (70559) | $3,091.80 | $5,153 | 16.4× |
| Magnetic Resonance Elastography (76391) | $3,091.80 | $5,153 | 12.1× |
| Mammary ductogram or galactogram multiple (77054) | $1,114.20 | $1,857 | 4.4× |
| Mammary ductogram or galactogram single (77053) | $744 | $1,240 | 2.9× |
| Meckels Divert Exam (78290) | $2,678.40 | $4,464 | 6.3× |
| Mlc imrt design & construction per imrt plan (77338) range across 2 matching MRF lines |
$637.80–$1,811.40 | $1,063–$3,019 | varies |
| Mr safety determination physician/other qhp (76016) | $166.20 | $277 | 1.8× |
| Mr safety implant&/fb assmt clin staf 1st 15 min (76014) | $46.80 | $78 | 1.5× |
| Mr safety implt electronics prepj supvj phys/qhp (76018) | $173.40 | $289 | 1.7× |
| Mr safety implt pos&/immoblj (76019) | $112.20 | $187 | 1.8× |
| Mr safety med physics xm customization plng&mntr (76017) | $456.60 | $761 | 1.8× |
| Mra Head W/O & W/Contrast Material (70546) | $3,264.60 | $5,441 | 8.7× |
| MRA head w/o contrast (70544) | $3,091.80 | $5,153 | 12.1× |
| MRA head with contrast (70545) | $3,107.40 | $5,179 | 8.3× |
| MRA neck w contrast (70548) | $3,107.40 | $5,179 | 8.3× |
| Mra Neck W/O &W/Contrast Material (70549) | $3,264.60 | $5,441 | 8.7× |
| MRA neck w/o contrast (70547) | $3,091.80 | $5,153 | 12.1× |
| MRI abdomen w contrast (74182) | $3,303 | $5,505 | 8.8× |
| MRI abdomen w/o contrast (74181) | $3,091.80 | $5,153 | 12.1× |
| MRI any jt lower extrem w/contrast material (73722) range across 3 matching MRF lines |
$3,484.80–$5,227.20 | $5,808–$8,712 | varies |
| MRI any jt lower extrem w/o & w/contrast matrl (73723) range across 3 matching MRF lines |
$3,860.40–$5,790.60 | $6,434–$9,651 | varies |
| MRI any jt upper extremity w/contrast matrl (73222) range across 3 matching MRF lines |
$3,484.80–$5,227.20 | $5,808–$8,712 | varies |
| MRI bone marrow blood supply (77084) | $3,091.80 | $5,153 | 12.1× |
| MRI brain functional w/o physician admnistration (70554) | $3,091.80 | $5,153 | 12.1× |
| MRI brain functional w/physician admnistration (70555) | $3,120.60 | $5,201 | 12.2× |
| MRI Breast W/O Contrast Bilateral (77047) | $4,637.40 | $7,729 | 18.1× |
| MRI Breast Without Contrast Material Unilateral (77046) | $3,091.80 | $5,153 | 12.1× |
| MRI cardiac w/o cont stress (75559) | $3,091.80 | $5,153 | 5.3× |
| MRI cardiac w/o contrast (75557) | $3,091.80 | $5,153 | 12.1× |
| MRI cervical spine w contrast (72142) | $3,343.80 | $5,573 | 8.9× |
| MRI cervical spine w/o cont (72141) | $3,189 | $5,315 | 12.5× |
| MRI chest w/o contrast (71550) | $3,091.80 | $5,153 | 12.1× |
| MRI chest with contrast (71551) | $3,681.60 | $6,136 | 4.4× |
| MRI chest wo w contrast (71552) | $3,889.20 | $6,482 | 10.4× |
| MRI lower extrem oth/thn jt w/contrast matrl (73719) range across 3 matching MRF lines |
$3,484.80–$5,227.20 | $5,808–$8,712 | varies |
| MRI lower extrem oth/thn jt w/o & w/contr matr (73720) range across 3 matching MRF lines |
$3,679.80–$5,520 | $6,133–$9,200 | varies |
| MRI lower extrem oth/thn jt w/o contr matrl (73718) range across 3 matching MRF lines |
$3,094.20–$4,642.20 | $5,157–$7,737 | varies |
| MRI lumbar spine w contrast (72149) | $3,343.80 | $5,573 | 8.9× |
| Mri Neck Spine W/O & W/Dye (72156) | $3,525 | $5,875 | 9.4× |
| MRI orbit face &/neck w/o contrast (70540) | $3,255 | $5,425 | 12.7× |
| MRI orbit face neck w contrast (70542) | $3,239.40 | $5,399 | 8.7× |
| Mri Orbt/Fac/Nck W/O &W/Dye (70543) range across 2 matching MRF lines |
$3,091.80–$3,410.40 | $5,153–$5,684 | varies |
| MRI pelvis w contrast (72196) | $3,217.20 | $5,362 | 8.6× |
| MRI pelvis w/o & w contrast (72197) | $3,927 | $6,545 | 10.5× |
| MRI pelvis w/o contrast (72195) | $3,091.80 | $5,153 | 12.1× |
| MRI spectroscopy (76390) | $3,091.80 | $5,153 | 33.2× |
| MRI thoracic spine w/o contrast (72146) | $3,091.80 | $5,153 | 12.1× |
| MRI upper extremity oth than jt w/contr matrl (73219) range across 3 matching MRF lines |
$3,484.80–$5,227.20 | $5,808–$8,712 | varies |
| MRI upper extremity oth than jt w/o contr matrl (73218) range across 3 matching MRF lines |
$3,094.20–$4,642.20 | $5,157–$7,737 | varies |
| Mri Uppr Extremity W/O&W/Dye (73220) range across 3 matching MRF lines |
$3,679.80–$5,520 | $6,133–$9,200 | varies |
| MRI, abdomen, combo (74183) | $3,480.60 | $5,801 | 9.3× |
| MRI, dorsal spine combo (72157) | $3,525 | $5,875 | 9.4× |
| MRI, dorsal spine contrast (72147) | $3,343.80 | $5,573 | 8.9× |
| MRI, joint upper extrem (73221) range across 3 matching MRF lines |
$3,094.20–$4,642.20 | $5,157–$7,737 | varies |
| MRI, joint upper extrem combo (73223) range across 3 matching MRF lines |
$3,679.80–$5,520 | $6,133–$9,200 | varies |
| MRI, lumbar spine combo (72158) | $3,525 | $5,875 | 9.4× |
| Myelogram cervical (72240) | $1,677 | $2,795 | 2.0× |
| Myelogram Lumbar (72265) | $1,677 | $2,795 | 2.0× |
| Myelography thoracic (72255) | $1,677 | $2,795 | 2.0× |
| Myelograpy 2/more regions rs&i (72270) | $2,155.80 | $3,593 | 2.6× |
| Myocardial Imaging Infarct Avid Planar Qual/Quan (78466) | $828 | $1,380 | 1.9× |
| Myocardial Imaging Pet Metabolic Evaluation (78459) | $5,148.60 | $8,581 | 3.7× |
| Myocardial Perfusion Planar 1 Study Rest/Stress (78453) | $2,864.40 | $4,774 | 2.1× |
| Myocardial Spect Multiple Studies (78452) | $4,667.40 | $7,779 | 3.4× |
| Myocrd Img Pet Metab Eval Single Study Cncrnt CT (78429) | $4,042.80 | $6,738 | 2.6× |
| Myocrd img PET prfuj 1std rest/stress cncrnt CT (78430) | $4,042.80 | $6,738 | 2.6× |
| Myocrd Img Pet Prfuj Mlt Std Rst&Strs Cncrnt CT (78431) | $6,304.20 | $10,507 | 2.7× |
| Myocrd Img Pet Prfuj W/Metab 2rtracer Cncrnt CT (78433) | $7,705.20 | $12,842 | 3.3× |
| Myocrd Img Pet Prfuj W/Metab Dual Radiotracer (78432) | $7,705.20 | $12,842 | 4.7× |
| N-invas est c ffr sw aly CTA (75580) | $1,925.40 | $3,209 | 2.1× |
| Neck soft tissue (70360) | $356.40 | $594 | 3.8× |
| Nfs/Instlj Radioelmnt Sln 3 Mo Follow-Up Care (77750) range across 2 matching MRF lines |
$1,465.80–$2,622 | $2,443–$4,370 | varies |
| Nm csf leak detection (78650) | $1,885.80 | $3,143 | 1.4× |
| Nm unlisted gi procedure (78299) | $868.20 | $1,447 | 2.0× |
| Nm whole blood volume (78122) | $1,820.40 | $3,034 | 3.1× |
| Nonvascular Shunt X-Ray (75809) range across 2 matching MRF lines |
$726.60–$771 | $1,211–$1,285 | varies |
| Ntsty modul radthx pln dose-vol histos (77301) range across 2 matching MRF lines |
$4,465.20–$6,471 | $7,442–$10,785 | varies |
| Nuclear Rx Oral Admin (79005) range across 2 matching MRF lines |
$321–$1,738.80 | $535–$2,898 | varies |
| Ob us nuchal meas 1 gest (76813) | $604.20 | $1,007 | 5.4× |
| Panoramic X-ray of jaws (70355) | $1,518.60 | $2,531 | 16.3× |
| Parathyroid imaging w/tomographic spect & CT (78072) | $2,417.40 | $4,029 | 4.2× |
| Parathyroid Planar Imaging (78070) | $1,581.60 | $2,636 | 3.7× |
| Parathyroid planar imaging w/wo subtraction (78071) | $1,962 | $3,270 | 4.6× |
| Pelvis 1 or 2 views (72170) range across 2 matching MRF lines |
$360–$453 | $600–$755 | varies |
| Peritoneogram Rs&I (74190) | $1,157.40 | $1,929 | 2.0× |
| Pet Image W/Ct Lmtd (78814) | $4,821 | $8,035 | 3.1× |
| PET image w/CT, full body (78816) | $6,149.40 | $10,249 | 4.0× |
| PET imaging CT attenuation skull base mid-thigh (78815) | $5,626.20 | $9,377 | 3.7× |
| Prq Transhepatc Portograpy Hemodyn Eval Rs&I (75885) | $1,983 | $3,305 | 0.6× |
| Pulmonary Perfusion Imaging Particulate (78580) | $1,646.40 | $2,744 | 3.8× |
| Radex Abd Compl Aqt Abd W/S/E/D Views 1 View Ch (74022) | $625.80 | $1,043 | 5.6× |
| Radex abscess/fistula/sinus tract rs&i (76080) | $579.60 | $966 | 1.0× |
| Radex Ankle Complete Minimum 3 Views (73610) range across 3 matching MRF lines |
$434.40–$649.80 | $724–$1,083 | varies |
| Radex Calcaneus Minimum 2 Views (73650) range across 3 matching MRF lines |
$339.60–$510.60 | $566–$851 | varies |
| Radex elbow complete minimum 3 views (73080) range across 3 matching MRF lines |
$423–$634.80 | $705–$1,058 | varies |
| Radex Facial Bones Complete Minimum 3 Views (70150) | $601.20 | $1,002 | 5.4× |
| Radex fingr minimum 2 views (73140) range across 4 matching MRF lines |
$274.80–$460.20 | $458–$767 | varies |
| Radex foot complete minimum 3 views (73630) range across 3 matching MRF lines |
$439.20–$654.60 | $732–$1,091 | varies |
| Radex Hand Minimum 3 Views (73130) range across 3 matching MRF lines |
$441.60–$663 | $736–$1,105 | varies |
| Radex lower extremity infant minimum 2 views (73592) range across 3 matching MRF lines |
$257.40–$386.40 | $429–$644 | varies |
| Radex Mastoids Compl Minimum 3 Views PR Side (70130) range across 3 matching MRF lines |
$557.40–$834 | $929–$1,390 | varies |
| Radex Nasal Bones Complete Minimum 3 Views (70160) | $411 | $685 | 4.4× |
| Radex Ribs Unilateral 2 Views (71100) | $432.60 | $721 | 4.6× |
| Radex shoulder complete minimum 2 views (73030) range across 3 matching MRF lines |
$411–$613.20 | $685–$1,022 | varies |
| Radex Sinuses Paransl < 3 Views (70210) | $278.40 | $464 | 3.0× |
| Radex sm int w/mlt srl imges via enteroclss tube (74251) | $1,111.20 | $1,852 | 5.9× |
| Radex Spine 1 View Specify Level (72020) range across 6 matching MRF lines |
$354.60–$381.60 | $591–$636 | varies |
| Radex Sternum Minimum 2 Views (71120) | $460.20 | $767 | 4.9× |
| Radex Temporomandble Jt Opn & Clsd Mouth Bilat (70330) | $616.80 | $1,028 | 6.6× |
| Radex Toe Minimum 2 Views (73660) range across 4 matching MRF lines |
$268.80–$452.40 | $448–$754 | varies |
| Radex upper extremity infant minimum 2 views (73092) range across 3 matching MRF lines |
$248.40–$370.20 | $414–$617 | varies |
| Radex Wrist Complete Minimum 3 Views (73110) range across 3 matching MRF lines |
$415.80–$621 | $693–$1,035 | varies |
| Radex X-Ray Exam Entire Spi 6/> Vw - Xr Entire Spine 6+ Vw (72084) | $453 | $755 | 4.0× |
| Radiation Delivery Stereotactic Cranial Linear (77372) | $19,326 | $32,210 | 2.4× |
| Radiation treatment delivery level 1 (77402) | $1,254.60 | $2,091 | 11.5× |
| Radiation treatment delivery level 2 (77407) | $4,742.40 | $7,904 | 11.5× |
| Radiation treatment delivery level 3 (77412) | $5,082.60 | $8,471 | 8.6× |
| Radiolog exam mandible compl minimum 4 views (70110) | $592.80 | $988 | 5.3× |
| Radiologic Exam Abdomen 3+ Views - Xr Abdomen 3+ Views (74021) | $457.80 | $763 | 4.1× |
| Radiologic exam colon double contrast study (74280) | $1,212.60 | $2,021 | 6.5× |
| Radiologic exam colon single contrast study (74270) | $915 | $1,525 | 4.9× |
| Radiologic Exam Esophagus Double Contrast Study (74221) | $917.40 | $1,529 | 4.9× |
| Radiologic exam knee complete 4/more views (73564) range across 3 matching MRF lines |
$586.20–$877.20 | $977–$1,462 | varies |
| Radiologic exam pelvis compl minimum 3 views (72190) | $505.20 | $842 | 4.5× |
| Radiologic Exam Small Int Single Contrast Study (74250) | $787.80 | $1,313 | 4.2× |
| Radiologic exam swallow function contrast study (74230) | $715.80 | $1,193 | 3.8× |
| Radiologic exam upr gi trc double contrast study (74246) | $1,098.60 | $1,831 | 5.8× |
| Radiologic examination femur 1 view (73551) range across 3 matching MRF lines |
$698.40–$1,043.40 | $1,164–$1,739 | varies |
| Radiologic examination femur minimum 2 views (73552) range across 3 matching MRF lines |
$658.80–$985.80 | $1,098–$1,643 | varies |
| Radiologic examination knee 1/2 views (73560) range across 3 matching MRF lines |
$375.60–$562.80 | $626–$938 | varies |
| Radiologic Examination Osseous Survey Limited (77074) | $673.80 | $1,123 | 6.0× |
| Radiologic Examination Salivary Gland Calculus (70380) | $280.80 | $468 | 3.0× |
| Radiologic examination tibia & fibula 2 views (73590) range across 3 matching MRF lines |
$392.40–$586.80 | $654–$978 | varies |
| Radiopharm Dacryocystography (78660) | $906.60 | $1,511 | 2.1× |
| Radiopharmaceutical therapy, by intracavitary administration Non-Facility (79200) | $820.20 | $1,367 | 3.3× |
| Remote afterloading high dose rate radionuclide skin surface brachytherapy, includes basic dosimetry, when performed;… (77768) range across 2 matching MRF lines |
$2,946–$5,056.80 | $4,910–$8,428 | varies |
| Remote afterloading high dose rate radionuclide skin surface brachytherapy, includes basic dosimetry, when performed;… (77767) range across 2 matching MRF lines |
$2,216.40–$3,802.20 | $3,694–$6,337 | varies |
| Renal Cyst Study (74470) | $1,331.40 | $2,219 | 2.3× |
| Ribs bilateral 3 views (71110) | $719.40 | $1,199 | 6.4× |
| Rp loclzj tum plnr 1 area single day imaging (78800) | $1,444.80 | $2,408 | 3.4× |
| Rp loclzj tum plnr 2+area 1+d img/1 area img>2+d (78801) | $1,942.20 | $3,237 | 4.5× |
| Rp Loclzj Tum Plnr Whole Body 2+ Days Imaging (78804) | $2,914.20 | $4,857 | 5.0× |
| Rp Loclzj Tum Plnr Whole Body Single Day Imaging (78802) | $2,415 | $4,025 | 4.2× |
| Rp Loclzj Tum Spect 1 Area Single Day Imaging (78803) | $2,410.80 | $4,018 | 4.1× |
| Rp loclzj tum spect 2 area/sep acquisj img (78831) | $3,617.40 | $6,029 | 2.6× |
| Rp loclzj tum spect CT 2area 1d img/1 ar img>2+d (78832) | $4,821.60 | $8,036 | 3.1× |
| Rp loclzj tum spect w/CT 1 area/acquisj 1day img (78830) | $3,214.80 | $5,358 | 2.3× |
| Rp Ther Radiolbld Monoclonal Antibody IV Infus (79403) range across 2 matching MRF lines |
$788.40–$2,341.80 | $1,314–$3,903 | varies |
| Rp Therapy Intravenous Administration (79101) range across 3 matching MRF lines |
$163.20–$790.80 | $272–$1,318 | varies |
| Salivary Gland Function Study (78232) | $1,170.60 | $1,951 | 2.7× |
| Salivary Gland Imaging Serial Images (78231) | $1,248.60 | $2,081 | 2.9× |
| Scapula (73010) range across 3 matching MRF lines |
$436.20–$651.60 | $727–$1,086 | varies |
| Screening Digital Breast Tomosynthesis Bi (77063) | $47.40 | $79 | 2.0× |
| Shoulder 1 view (73020) range across 3 matching MRF lines |
$329.40–$490.20 | $549–$817 | varies |
| Shoulder Arthrography (73040) | $976.20 | $1,627 | 2.6× |
| Sialogram (70390) | $782.40 | $1,304 | 3.1× |
| Skull less than 4 views (70250) | $415.80 | $693 | 3.7× |
| Special dosimetry (77331) range across 2 matching MRF lines |
$227.40–$473.40 | $379–$789 | varies |
| Special Physics Consult (77370) | $1,071.60 | $1,786 | 7.4× |
| Special teletherapy port plan (77321) range across 2 matching MRF lines |
$1,655.40–$3,606.60 | $2,759–$6,011 | varies |
| Special treatment procedure (77470) range across 2 matching MRF lines |
$1,465.80–$2,753.40 | $2,443–$4,589 | varies |
| Speech evaluation, complex (70371) | $898.20 | $1,497 | 3.5× |
| Srs Multisource (77371) | $40,143.60 | $66,906 | 5.1× |
| Stereotactic Body Radiation Delivery (77373) range across 2 matching MRF lines |
$6,442.20–$11,086.80 | $10,737–$18,478 | varies |
| Sternoclavicular joints (71130) | $432.60 | $721 | 4.6× |
| Superior sagittal sinus venogram (75870) | $4,620 | $7,700 | 1.4× |
| Telethx isodose pln cplx w/basic dosimetry (77307) range across 2 matching MRF lines |
$1,655.40–$3,606.60 | $2,759–$6,011 | varies |
| Telethx isodose pln smpl w/dosimetry calculation (77306) range across 2 matching MRF lines |
$1,655.40–$3,606.60 | $2,759–$6,011 | varies |
| Testicular Imaging W/Flow (78761) | $908.40 | $1,514 | 2.1× |
| Ther Rad Simulaj-Aided Field Setting Complex (77290) range across 2 matching MRF lines |
$1,016.40–$1,607.40 | $1,694–$2,679 | varies |
| Ther Rad Simulaj-Aided Field Setting Intermed (77285) range across 2 matching MRF lines |
$522–$1,219.20 | $870–$2,032 | varies |
| Ther rad simulaj-aided field setting simple (77280) range across 4 matching MRF lines |
$418.20–$1,062.60 | $697–$1,771 | varies |
| Therapeutic Enema Rdctj Intussusception/Obstrcj (74283) | $891 | $1,485 | 4.7× |
| Thoracic spine 2 views (72070) | $476.40 | $794 | 4.3× |
| Thoracic spine 3 views (72072) | $547.80 | $913 | 4.9× |
| Thoracolumbar 2 views (72080) | $232.20 | $387 | 2.5× |
| Thyroid Carcinoma Metastases Img Lmtd Area (78015) | $1,224 | $2,040 | 2.9× |
| Thyroid Imaging With Vascular Flow (78013) | $1,054.80 | $1,758 | 2.5× |
| Thyroid Met Imaging Body (78018) | $2,263.20 | $3,772 | 3.9× |
| Thyroid Uptake Measurement (78012) | $774.60 | $1,291 | 1.8× |
| Thyroid Uptake W/Blood Flow Sngle/Mult Quan Meas (78014) | $1,483.80 | $2,473 | 3.5× |
| Tx Devices Design & Construction Complex (77334) range across 4 matching MRF lines |
$534–$1,070.40 | $890–$1,784 | varies |
| Tx devices design & construction intermediate (77333) range across 4 matching MRF lines |
$372.60–$704.40 | $621–$1,174 | varies |
| Tx devices design & construction simple (77332) range across 4 matching MRF lines |
$271.80–$563.40 | $453–$939 | varies |
| Ultrasound Breast Limited (76642) range across 3 matching MRF lines |
$252–$376.20 | $420–$627 | varies |
| Ultrasound Exam Aaa Screen (76706) | $608.40 | $1,014 | 5.4× |
| Ultrasound, abdomen limited (76705) range across 3 matching MRF lines |
$918.60–$1,434 | $1,531–$2,390 | varies |
| Umbilical-artery Doppler (OB) (76820) | $687 | $1,145 | 6.1× |
| Unlisted fluoroscopic procedure (76496) | $224.40 | $374 | 2.4× |
| Unlisted magnetic resonance procedure (76498) | $3,091.80 | $5,153 | 33.2× |
| Unlisted Procedure Clinical Brachytherapy (77799) range across 4 matching MRF lines |
$1,249.80–$3,086.40 | $2,083–$5,144 | varies |
| Unlisted respiratory px dx nuclear medicine (78599) | $897 | $1,495 | 2.1× |
| Unlisted us procedure (76999) | $556.20 | $927 | 6.0× |
| Upper gi w/o kub (74240) | $883.80 | $1,473 | 4.7× |
| Ureteral Reflux Study (78740) | $1,470.60 | $2,451 | 3.4× |
| Urethrocystogram voiding (74455) | $887.40 | $1,479 | 3.5× |
| Urethrocystography retrograde (74450) | $898.20 | $1,497 | 3.5× |
| Us breast unilateral complete (76641) range across 3 matching MRF lines |
$252–$376.20 | $420–$627 | varies |
| Us chest (76604) | $836.40 | $1,394 | 7.5× |
| Us complete joint (76881) range across 3 matching MRF lines |
$944.40–$1,414.80 | $1,574–$2,358 | varies |
| Us exam, pelvic, limited (76857) | $715.80 | $1,193 | 6.4× |
| Us head (76506) | $737.40 | $1,229 | 6.6× |
| Us kidney transplant (76776) | $1,205.40 | $2,009 | 10.8× |
| Us lmtd joint/oth nonvasc xtr strux r-t w/img (76882) range across 3 matching MRF lines |
$577.20–$865.20 | $962–$1,442 | varies |
| Us ob detailed single fetus (76811) | $1,011.60 | $1,686 | 4.0× |
| Us ob limited 1 or more fetuses (76815) | $347.40 | $579 | 3.1× |
| Us ob transvaginal (76817) | $650.40 | $1,084 | 5.8× |
| Us pelvic non ob complete (76856) | $1,021.80 | $1,703 | 9.1× |
| Us pg uter img f&mat 14 wk tabdl 1/1st gestation (76801) | $721.20 | $1,202 | 6.4× |
| Us preg uterus real time f/u trnsabdl per fetus (76816) range across 2 matching MRF lines |
$396–$786.60 | $660–$1,311 | varies |
| Us retroperitoneal complete (76770) range across 2 matching MRF lines |
$984–$3,540.60 | $1,640–$5,901 | varies |
| Us retroperitoneal limited (76775) | $841.20 | $1,402 | 7.5× |
| Us scrotum and contents (76870) | $955.80 | $1,593 | 8.5× |
| Us spinal canal and contents (76800) | $963.60 | $1,606 | 8.6× |
| Us thyroid (76536) | $920.40 | $1,534 | 8.2× |
| Us transrectal (76872) | $1,205.40 | $2,009 | 10.8× |
| Vascular Flow Imaging (78445) | $868.20 | $1,447 | 2.0× |
| Vein X-Ray Chest (75827) | $2,676.60 | $4,461 | 1.6× |
| Vein X-Ray Liver W/O Hemodyn (75887) | $1,983 | $3,305 | 0.6× |
| Venogram Sinus/Jugular (75860) | $1,983 | $3,305 | 0.6× |
| Venography caval inferior serialography rs&i (75825) | $2,933.40 | $4,889 | 0.9× |
| Venography extremity bilateral rs&i (75822) range across 3 matching MRF lines |
$1,726.80–$1,774.80 | $2,878–$2,958 | varies |
| Venography extremity unilateral rs&i (75820) | $1,209.60 | $2,016 | 0.7× |
| Venography Renal Bilateral (75833) | $3,847.20 | $6,412 | 1.1× |
| Venography Renal Unilateral (75831) | $2,788.80 | $4,648 | 0.8× |
| Venous sampling by catheter (75893) | $3,405.60 | $5,676 | 0.6× |
| Wrist 2 views (73100) range across 3 matching MRF lines |
$333.60–$499.20 | $556–$832 | varies |
| X-Ray Ac Jts - Xr Acromioclavicular Joints Bilateral (73050) | $456 | $760 | 4.9× |
| X-ray antegrade pyelogram tube (74425) | $886.80 | $1,478 | 2.4× |
| X-Ray Aorta Leg Arteries (75630) | $4,020.60 | $6,701 | 1.2× |
| X-Ray Bend Only L-S Spine (72120) | $489.60 | $816 | 4.4× |
| X-Ray Elbow 2 Vw - Xr Elbow 1-2 Views Right (73070) range across 3 matching MRF lines |
$337.80–$507 | $563–$845 | varies |
| X-Ray Exam Breast Specimen (76098) | $690 | $1,150 | 1.2× |
| X-Ray Exam Entire Spi 1 Vw (72081) | $306 | $510 | 3.3× |
| X-Ray Exam Entire Spi 2/3 Vw (72082) | $354.60 | $591 | 3.2× |
| X-Ray Exam Entire Spi 4/5 Vw (72083) | $393.60 | $656 | 3.5× |
| X-Ray Exam Hip Uni 1 View (73501) | $333 | $555 | 3.6× |
| X-Ray Exam Hip Uni 2-3 Views (73502) | $424.20 | $707 | 4.5× |
| X-Ray Exam Hip Uni 4/> Views (73503) | $563.40 | $939 | 5.0× |
| X-Ray Exam Hips Bi 2 Views (73521) | $474.60 | $791 | 4.2× |
| X-Ray Exam Hips Bi 3-4 Views (73522) | $556.80 | $928 | 5.0× |
| X-Ray Exam Hips Bi 5/> Views (73523) | $710.40 | $1,184 | 6.3× |
| X-Ray Exam L-S Spine Bending (72114) | $636 | $1,060 | 5.7× |
| X-Ray Exam Neck Spine 2-3 Vw (72040) | $486 | $810 | 5.2× |
| X-Ray Exam Neck Spine 6/>Vws (72052) | $659.40 | $1,099 | 5.9× |
| X-Ray Exam Unilat Ribs/Chest (71101) | $529.80 | $883 | 4.7× |
| X-ray eye for foreign body (70030) | $376.20 | $627 | 4.0× |
| X-ray humerus (73060) range across 3 matching MRF lines |
$382.20–$571.80 | $637–$953 | varies |
| X-ray IV pyelogram (ivp) (74400) range across 4 matching MRF lines |
$828–$1,143 | $1,380–$1,905 | varies |
| X-Ray Jaw <4 Vw - Xr Mandible < 4 Views (70100) | $429 | $715 | 4.6× |
| X-Ray Knee Bilat Standing - Xr Knees Anteroposterior Standing Bilat (73565) | $520.80 | $868 | 5.6× |
| X-Ray Lumbar Spine 2/3 Vw - Xr Lumbar Spine 2-3 Views (72100) | $489.60 | $816 | 4.4× |
| X-ray nose-rectum child f.b. (76010) | $329.40 | $549 | 3.5× |
| X-Ray Ribs, Chest 4+ Vw - Xr Ribs 3 Vws Bil W/ Chest Posteroanterior (71111) | $885.60 | $1,476 | 7.9× |
| X-Ray Sacroiliac Jts 3+ Vw - Xr Sacroiliac Joints 3+ Views (72202) | $455.40 | $759 | 4.1× |
| X-Ray Sacroiliac Jts <3 Vw - Xr Sacroiliac Joints 1-2 Views (72200) | $403.20 | $672 | 3.6× |
| X-Ray Sacrum/Coccyx 2+ Vw - Xr Sacrum Coccyx 2+ Views (72220) | $416.40 | $694 | 4.5× |
| X-Ray Sinuses 3+ Vw - Xr Paranasal Sinuses 3+ Views (70220) | $459.60 | $766 | 4.9× |
| X-Ray Skull 4+ Vw - Xr Skull Complete 4+ Views (70260) | $579.60 | $966 | 5.2× |
| X-Ray Stress View (77071) range across 2 matching MRF lines |
$99–$495 | $165–$825 | varies |
| X-ray thoracic spine 4 vw (72074) | $591.60 | $986 | 5.3× |
| X-Ray Tmj Unilat (70328) | $413.40 | $689 | 4.4× |
| X-Ray Urinary Tract Exam With Contrast Material (74420) | $976.20 | $1,627 | 2.6× |
| X-Rays Bone Length Studies (77073) | $497.40 | $829 | 4.4× |
| X-Rays Bone Survey Complete (77075) | $1,108.20 | $1,847 | 9.9× |
| Xr c-spine 4 or 5 views (72050) | $599.40 | $999 | 5.4× |
| Xr facial bones less than 3 views (70140) | $399 | $665 | 4.3× |
| XR Mastoids < 3 Views Bilateral (70120) range across 3 matching MRF lines |
$395.40–$592.80 | $659–$988 | varies |
| Xr orbits complete 4 views (70200) | $573 | $955 | 5.1× |
| Xr Tomogram Single Plane (76100) range across 4 matching MRF lines |
$681–$1,292.40 | $1,135–$2,154 | varies |
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.