Imaging prices at Saint Francis Medical Center
Peoria, IL · every code in this section with a posted price and a Medicare benchmark.
473 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 |
$1,887–$8,967.60 | $3,145–$14,946 | 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) | $1,038.60 | $1,731 | 2.4× |
| Acute venous thrombosis imaging, peptide Non-Facility (78456) | $1,508.40 | $2,514 | 1.1× |
| Angio internal mammary (75756) | $2,911.80 | $4,853 | 0.9× |
| Angio pulmonary bilat (75743) | $4,656 | $7,760 | 1.4× |
| Angiography Adrenal Bilateral Slctv Rs&I (75733) | $4,047 | $6,745 | 1.2× |
| Angiography extremity bilateral rs&i (75716) | $7,126.20 | $11,877 | 2.1× |
| Angiography extremity unilateral rs&i (75710) | $7,126.20 | $11,877 | 2.1× |
| Angiography pulmonary unilateral slctv rs&i (75741) | $4,487.40 | $7,479 | 1.3× |
| Angrph pulmonary nonslctv cath/ven njx rs&i (75746) | $3,233.40 | $5,389 | 1.0× |
| Ankle 2 views (73600) range across 3 matching MRF lines |
$520.80–$781.80 | $868–$1,303 | varies |
| Aortography thoracic serialography rs&i (75605) | $6,642 | $11,070 | 1.1× |
| Artery X-Rays Abdomen (75726) | $7,126.20 | $11,877 | 1.2× |
| Artery X-Rays Adrenal Gland (75731) | $2,969.40 | $4,949 | 0.9× |
| Artery X-Rays Pelvis (75736) | $7,126.20 | $11,877 | 1.2× |
| Artery X-Rays Spine (75705) | $5,314.80 | $8,858 | 0.9× |
| Arthrogram ankle (73615) | $888 | $1,480 | 2.4× |
| Arthrogram hip (73525) | $1,021.20 | $1,702 | 2.7× |
| Arthrogram Wrist (73115) | $1,021.20 | $1,702 | 2.7× |
| Basic radiation dosimetry calculation (77300) range across 2 matching MRF lines |
$270–$762.60 | $450–$1,271 | varies |
| Bone age studies (77072) | $520.80 | $868 | 4.6× |
| Bone Imaging 3 Phase (78315) | $1,603.20 | $2,672 | 3.7× |
| Bone Imaging Limited Area (78300) | $1,377.60 | $2,296 | 3.2× |
| Bone Imaging Multiple Areas (78305) | $1,461 | $2,435 | 3.4× |
| Bone Imaging Whole Body (78306) | $2,019.60 | $3,366 | 4.7× |
| Bone marrow imaging; whole body (78104) | $1,640.40 | $2,734 | 3.8× |
| Bone survey infant (77076) | $659.40 | $1,099 | 5.9× |
| Brachytx isodose complex (77318) range across 2 matching MRF lines |
$592.20–$1,480.20 | $987–$2,467 | varies |
| Brachytx isodose intermed (77317) range across 2 matching MRF lines |
$592.20–$998.40 | $987–$1,664 | varies |
| Brachytx Isodose Plan Simple (77316) range across 2 matching MRF lines |
$664.80–$1,135.80 | $1,108–$1,893 | varies |
| Brain Flow Imaging Only (78610) | $1,197.60 | $1,996 | 2.1× |
| Brain Imaging Min 4 Static Views W Vascular Flow (78606) | $940.80 | $1,568 | 1.6× |
| Brain Imaging Pet Metabolic Evaluation (78608) | $8,011.80 | $13,353 | 5.2× |
| Cardiac blood pool imaging, first pass technique; multiple studies, resting and with stress (exercise and/or… (78483) | $2,563.20 | $4,272 | 4.4× |
| Cardiac MRI w/w/o contrast & further seq (75561) | $3,613.20 | $6,022 | 9.7× |
| Cardiac MRI w/w/o contrast w/stress (75563) | $3,613.20 | $6,022 | 4.3× |
| Cardiac Shunt Detection (78428) | $1,302 | $2,170 | 3.0× |
| Cat Scan Follow-Up Study (76380) | $1,098 | $1,830 | 11.8× |
| Cerebrospinal Fluid Flow W/O Matl Shunt Evaltj (78645) | $1,195.80 | $1,993 | 2.1× |
| Cerebrospinal Fluid Scan (78630) | $2,001 | $3,335 | 3.4× |
| Chest 1 view (71045) | $279 | $465 | 3.0× |
| Chest 2 views (71046) | $328.80 | $548 | 3.5× |
| Chest 3 views (71047) | $391.20 | $652 | 4.2× |
| Chest 4 or more views (71048) range across 3 matching MRF lines |
$441.60–$647.40 | $736–$1,079 | varies |
| Cholecystography Oral Contrast (74290) | $405.60 | $676 | 2.2× |
| Cineradiograpy/vidradiograpy xcpt where spec (76120) | $201.60 | $336 | 1.8× |
| Cisternography Positive Contrast Rs&I (70015) | $1,182 | $1,970 | 1.4× |
| Clavicle complete (73000) range across 3 matching MRF lines |
$452.40–$679.20 | $754–$1,132 | varies |
| Computed Tomography Thorax Lw Dose Lng Ca Scr C- (71271) | $176.40 | $294 | 1.6× |
| Continuing medical physics consltj pr wk (77336) | $1,045.80 | $1,743 | 7.3× |
| Contrast Exam Abdominl Aorta (75625) | $7,126.20 | $11,877 | 2.1× |
| Contrast X-Ray Bladder (74430) | $963.60 | $1,606 | 2.6× |
| Contrast X-Ray Of Elbow (73085) | $1,021.20 | $1,702 | 2.7× |
| Contrast X-Ray Of Knee Joint (73580) | $1,021.20 | $1,702 | 2.7× |
| Contrast Xray Throat/Cerv Esopha (74210) | $624 | $1,040 | 3.3× |
| Corpora cavernosography (74445) | $1,950 | $3,250 | 17.4× |
| CT abdomen and pelvis without and with contrast (74178) | $2,253 | $3,755 | 6.0× |
| CT abdomen and pelvis without contrast (74176) | $2,253 | $3,755 | 8.8× |
| CT abdomen w contrast (74160) | $2,253 | $3,755 | 12.0× |
| CT abdomen w wo contrast (74170) | $2,424.60 | $4,041 | 12.9× |
| CT abdomen w/o contrast (74150) | $2,253 | $3,755 | 20.1× |
| CT Angio Abdomen and Pelvis (74174) | $2,736.60 | $4,561 | 7.3× |
| CT Angio Chest (71275) | $2,736.60 | $4,561 | 14.6× |
| CT Angio Head (70496) | $2,736.60 | $4,561 | 14.6× |
| CT angio hrt w/3d image (75574) | $2,736.60 | $4,561 | 7.3× |
| Ct Angio Lwr Extr W/O&W/Dye (73706) range across 3 matching MRF lines |
$2,736.60–$4,105.20 | $4,561–$6,842 | varies |
| CT Angio Neck (70498) | $2,736.60 | $4,561 | 14.6× |
| Ct Angio Upr Extrm W/O&W/Dye (73206) range across 3 matching MRF lines |
$2,736.60–$4,105.20 | $4,561–$6,842 | varies |
| CT bone density (77078) | $647.40 | $1,079 | 6.9× |
| CT Cere Prfuj Alys C+ W/O CT/Cta Same Anatomy (70473) | $2,121.60 | $3,536 | 11.3× |
| CT cervical spine w/ contrast (72126) | $2,446.20 | $4,077 | 6.5× |
| CT cervical spine w/o contrast (72125) | $2,265.60 | $3,776 | 20.2× |
| CT cervical spine w/wo cont (72127) | $2,754.60 | $4,591 | 14.7× |
| CT chest w contrast (71260) | $2,253 | $3,755 | 12.0× |
| CT chest w/wo contrast (71270) | $2,424.60 | $4,041 | 12.9× |
| CT colonography screening (74263) | $2,253 | $3,755 | 8.8× |
| CT Colonogrphy Dx Image Postprocess W/Contrast (74262) | $2,253 | $3,755 | 12.0× |
| CT colonogrphy dx image postprocess w/o contrast (74261) | $2,253 | $3,755 | 20.1× |
| CT head/brain with contrast (70460) | $2,253 | $3,755 | 12.0× |
| CT head/brain without and with contrast (70470) | $2,424.60 | $4,041 | 12.9× |
| CT heart contrast eval cardiac structure&morph (75572) | $2,253 | $3,755 | 6.0× |
| CT heart no contrast quant eval coronry calcium (75571) | $117 | $195 | 1.3× |
| CT hrt w/3d image congen (75573) | $2,253 | $3,755 | 6.0× |
| CT iac w contrast (70481) | $2,253 | $3,755 | 12.0× |
| CT l-spine w&w/o contrast (72133) | $2,754.60 | $4,591 | 14.7× |
| CT lower ext w/o (73700) range across 3 matching MRF lines |
$2,253–$3,379.80 | $3,755–$5,633 | varies |
| CT lower extremity w/contrast material (73701) range across 3 matching MRF lines |
$2,253–$3,379.80 | $3,755–$5,633 | varies |
| CT lumbar spine w contrast (72132) | $2,446.20 | $4,077 | 6.5× |
| CT lumbar spine w/o contrast (72131) | $2,265.60 | $3,776 | 20.2× |
| CT maxillofacial w contrast (70487) | $2,253 | $3,755 | 12.0× |
| CT maxillofacial wo contrast (70486) | $2,253 | $3,755 | 20.1× |
| CT neck tissue combo (70492) | $2,424.60 | $4,041 | 12.9× |
| Ct Orbit/Ear/Fossa W/O&W/Dye (70482) | $2,424.60 | $4,041 | 12.9× |
| CT orbits w/o contrast (70480) | $2,253 | $3,755 | 20.1× |
| CT pelvis w&w/o contrast (72194) | $2,424.60 | $4,041 | 12.9× |
| CT pelvis w/o contrast (72192) | $2,253 | $3,755 | 20.1× |
| CT scan of leg combo (73702) range across 3 matching MRF lines |
$2,424.60–$3,636.60 | $4,041–$6,061 | varies |
| CT scans face/jaw combo (70488) | $2,424.60 | $4,041 | 12.9× |
| CT soft tissue neck w contrast (70491) | $2,253 | $3,755 | 12.0× |
| CT soft tissue neck w/o contrast (70490) | $2,253 | $3,755 | 20.1× |
| CT thoracic spine w contrast (72129) | $2,446.20 | $4,077 | 13.0× |
| CT thoracic spine w/o contrast (72128) | $2,265.60 | $3,776 | 20.2× |
| CT thoracic spine w/wo cont (72130) | $2,754.60 | $4,591 | 14.7× |
| CT thorax w/o contrast (71250) | $2,253 | $3,755 | 20.1× |
| CT unlisted procedure (76497) | $2,253 | $3,755 | 24.2× |
| CT upper ext wo (73200) range across 3 matching MRF lines |
$2,253–$3,379.80 | $3,755–$5,633 | varies |
| CT upper extremity w/o & w/contrast material (73202) range across 3 matching MRF lines |
$2,424.60–$3,636.60 | $4,041–$6,061 | varies |
| CT upper extremity with contrast (73201) range across 3 matching MRF lines |
$2,253–$3,379.80 | $3,755–$5,633 | varies |
| Cta Abdl Aorta&Bi Iliofem W/Contrast&Postp (75635) | $2,736.60 | $4,561 | 14.6× |
| Cta Abdomen (74175) | $2,736.60 | $4,561 | 14.6× |
| CTA head&neck c+ w/noncontrast img&post-pxessing (70471) | $2,253 | $3,755 | 6.0× |
| CTA pelvis (72191) | $3,380.40 | $5,634 | 18.0× |
| Dilation ureters/urethra rs&i (74485) | $3,862.20 | $6,437 | 1.7× |
| Discography Cerv/Thor Spine (72285) | $5,913.60 | $9,856 | 2.8× |
| Diskography lumbar (72295) | $5,913.60 | $9,856 | 2.8× |
| Doppler Echo Fetal Puls Spectral F/U/Repeat (76828) | $683.40 | $1,139 | 6.1× |
| Doppler Echo Fetal Spectral Display Complete (76827) | $756 | $1,260 | 6.7× |
| Doppler Fetal Mid Cerebral Artery (76821) | $593.40 | $989 | 5.3× |
| Dxa Bone Density Axial (77080) | $423 | $705 | 3.8× |
| Dxa bone density study (77085) | $270.60 | $451 | 2.4× |
| Dxa bone density study 1/>sites appendiclr skel (77081) | $272.40 | $454 | 2.9× |
| Echo exam of fetal heart (76825) | $1,368 | $2,280 | 2.3× |
| Echo exam uterus (76831) | $1,683 | $2,805 | 6.6× |
| Echo Guide For Artery Repair (76936) | $1,764 | $2,940 | 7.6× |
| Echocardiography, fetal, cardiovascular system, real time with image documentation (2D), with or without M-mode… (76826) | $756 | $1,260 | 3.0× |
| Echograp Trans R Pros Study (76873) | $2,797.80 | $4,663 | 25.0× |
| Esophageal Motility Study (78258) | $1,563.60 | $2,606 | 3.6× |
| Esophagram (74220) | $624 | $1,040 | 3.3× |
| Fetal Biophys Profile W/Nst (76818) range across 2 matching MRF lines |
$480.60–$695.40 | $801–$1,159 | varies |
| Fetal Biophysical Profile W/O Non-Stress Testing (76819) | $647.40 | $1,079 | 5.8× |
| Fetal MRI w/placntl matrnl plvc img sing/1st ges (74712) | $3,379.80 | $5,633 | 13.2× |
| Fluoroscopy up to 1 hr (76000) | $732 | $1,220 | 2.9× |
| Follow-Up Angiography (75898) | $3,442.80 | $5,738 | 1.0× |
| Foot 2 views (73620) range across 3 matching MRF lines |
$520.80–$781.80 | $868–$1,303 | varies |
| Forearm 2 views (73090) range across 3 matching MRF lines |
$520.80–$781.80 | $868–$1,303 | varies |
| Gastric emptying imaging study (78264) | $1,376.40 | $2,294 | 3.2× |
| Gastric Emptyng Imag Std W/Sm Bwl Transit (78265) | $1,376.40 | $2,294 | 3.2× |
| Gastroesophageal Reflux Exam (78262) | $1,027.20 | $1,712 | 2.4× |
| Gated Heart Planar Single (78472) | $2,048.40 | $3,414 | 4.8× |
| Gated Heart, Multiple (78473) | $1,807.20 | $3,012 | 4.2× |
| GI Endoscopic US S&I (76975) | $642.60 | $1,071 | 2.5× |
| Gstrc Emptng Imag Std W/Sm Bwl Col Trnst Mlt Day (78266) | $1,376.40 | $2,294 | 2.4× |
| Hand 2 views (73120) range across 3 matching MRF lines |
$520.80–$781.80 | $868–$1,303 | varies |
| Hdr Rdncl Ntrstl/Icav Brchtx (77772) range across 2 matching MRF lines |
$1,351.80–$7,453.20 | $2,253–$12,422 | varies |
| Hdr Rdncl Ntrstl/Icav Brchtx (77771) range across 2 matching MRF lines |
$944.40–$6,943.20 | $1,574–$11,572 | varies |
| Hdr Rdncl Ntrstl/Icav Brchtx 1 Channel (77770) range across 2 matching MRF lines |
$632.40–$6,223.80 | $1,054–$10,373 | varies |
| Heart first pass single,planar (78481) | $1,302 | $2,170 | 2.2× |
| Hepatc Vngrph Wdg/Fr Hemodyn Eval Rs&I (75889) | $3,756.60 | $6,261 | 1.1× |
| Hepatc Vngrph Wdg/Fr W/O Hemodyn Eval Rs&I (75891) | $4,261.20 | $7,102 | 1.3× |
| Hepatobil Syst Image W/Drug (78227) | $2,014.80 | $3,358 | 3.5× |
| Hepatobiliary System Imaging (78226) | $1,539 | $2,565 | 3.6× |
| Ht Musc Image Planar Mult (78454) | $5,118 | $8,530 | 3.7× |
| Ht Muscle Image Spect Sing (78451) | $3,172.80 | $5,288 | 2.3× |
| Hysterosalpingogram (74740) | $1,012.20 | $1,687 | 4.0× |
| Infant hip ultrasound with hip movement (dynamic) (76885) | $789.60 | $1,316 | 8.5× |
| Infant hip ultrasound, limited static exam (76886) | $763.20 | $1,272 | 8.2× |
| Interstitial radiation source applic complex (77778) range across 2 matching MRF lines |
$2,298.60–$4,596.60 | $3,831–$7,661 | varies |
| Intracavitary Radiation Source Applic Complex (77763) range across 2 matching MRF lines |
$1,503.60–$2,784 | $2,506–$4,640 | varies |
| Intracavitary Radiation Source Applic Intermed (77762) range across 2 matching MRF lines |
$1,660.20–$2,193 | $2,767–$3,655 | varies |
| Intracavitary radiation source applic simple (77761) range across 2 matching MRF lines |
$1,057.80–$1,243.20 | $1,763–$2,072 | varies |
| Joint Survey Single View (77077) | $553.80 | $923 | 4.9× |
| K Flow/Funct Image Multiple (78709) | $1,482.60 | $2,471 | 2.5× |
| K Flow/Funct Image W/Drug (78708) | $1,344 | $2,240 | 2.3× |
| K Flow/Funct Image W/O Drug (78707) | $1,344 | $2,240 | 2.3× |
| Kidney Imaging Morphol (78700) | $1,050 | $1,750 | 2.5× |
| Kidney Imaging Morphoogy W/Vascular Flow (78701) | $1,333.20 | $2,222 | 3.1× |
| Knee 3 Views (73562) range across 3 matching MRF lines |
$567.60–$851.40 | $946–$1,419 | varies |
| Leveen/Shunt Patency Exam (78291) | $1,195.80 | $1,993 | 2.8× |
| Liver & Spleen Imaging Static Only (78215) | $838.20 | $1,397 | 2.0× |
| Lung Perf&Ventilat Diferentl (78598) | $2,069.40 | $3,449 | 3.6× |
| Lung perfusion differential (78597) | $2,069.40 | $3,449 | 4.8× |
| Lung Ventilat&Perfus Imaging (78582) | $2,340 | $3,900 | 4.0× |
| Lung Ventilation Imaging (78579) | $1,396.80 | $2,328 | 3.3× |
| Lymph System Imaging (78195) | $1,948.20 | $3,247 | 3.3× |
| Lymphangiography Pelvic/Abdominal Bilateral Rs&I (75807) | $5,833.20 | $9,722 | 1.7× |
| Magnetic Image Jaw Joint (70336) | $3,379.80 | $5,633 | 13.2× |
| Magnetic resonance (eg, proton) imaging, brain (including brain stem andskull base), during open intracranial procedure… (70558) | $3,379.80 | $5,633 | 18.0× |
| Magnetic resonance (eg, proton) imaging, brain (including brain stem andskull base), during open intracranial procedure… (70557) | $3,379.80 | $5,633 | 5.8× |
| Magnetic resonance (eg, proton) imaging, brain (including brain stem andskull base), during open intracranial procedure… (70559) | $3,613.20 | $6,022 | 19.2× |
| Magnetic Resonance Elastography (76391) | $3,285 | $5,475 | 12.8× |
| Mammary ductogram or galactogram multiple (77054) | $1,041 | $1,735 | 4.1× |
| Mammary ductogram or galactogram single (77053) range across 2 matching MRF lines |
$307.80–$598.80 | $513–$998 | varies |
| Meckels Divert Exam (78290) | $2,992.20 | $4,987 | 7.0× |
| Mlc imrt design & construction per imrt plan (77338) range across 2 matching MRF lines |
$639–$3,135 | $1,065–$5,225 | 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) | $3,974.40 | $6,624 | 10.6× |
| MRA head w/o contrast (70544) | $3,613.20 | $6,022 | 14.1× |
| MRA head with contrast (70545) | $3,613.20 | $6,022 | 9.7× |
| MRA neck w contrast (70548) | $3,613.20 | $6,022 | 9.7× |
| Mra Neck W/O &W/Contrast Material (70549) | $3,974.40 | $6,624 | 10.6× |
| MRA neck w/o contrast (70547) | $3,613.20 | $6,022 | 14.1× |
| MRI abdomen w contrast (74182) | $3,379.80 | $5,633 | 9.0× |
| MRI abdomen w/o contrast (74181) | $3,379.80 | $5,633 | 13.2× |
| MRI any jt lower extrem w/contrast material (73722) range across 3 matching MRF lines |
$3,379.80–$5,069.40 | $5,633–$8,449 | varies |
| MRI any jt lower extrem w/o & w/contrast matrl (73723) range across 3 matching MRF lines |
$3,613.20–$5,420.40 | $6,022–$9,034 | varies |
| MRI any jt upper extremity w/contrast matrl (73222) range across 3 matching MRF lines |
$3,379.80–$5,069.40 | $5,633–$8,449 | varies |
| MRI bone marrow blood supply (77084) | $3,379.80 | $5,633 | 13.2× |
| MRI brain functional w/o physician admnistration (70554) | $3,379.80 | $5,633 | 13.2× |
| MRI brain functional w/physician admnistration (70555) | $3,379.80 | $5,633 | 13.2× |
| MRI Breast W/O Contrast Bilateral (77047) | $5,069.40 | $8,449 | 19.8× |
| MRI Breast Without Contrast Material Unilateral (77046) | $3,379.80 | $5,633 | 13.2× |
| MRI cardiac w/o cont stress (75559) | $3,379.80 | $5,633 | 5.8× |
| MRI cardiac w/o contrast (75557) | $3,379.80 | $5,633 | 13.2× |
| MRI cervical spine w contrast (72142) | $3,379.80 | $5,633 | 9.0× |
| MRI cervical spine w/o cont (72141) | $3,379.80 | $5,633 | 13.2× |
| MRI chest w/o contrast (71550) | $3,379.80 | $5,633 | 13.2× |
| MRI chest with contrast (71551) | $3,588.60 | $5,981 | 4.3× |
| MRI chest wo w contrast (71552) | $3,887.40 | $6,479 | 10.4× |
| MRI lower extrem oth/thn jt w/contrast matrl (73719) range across 3 matching MRF lines |
$3,379.80–$5,069.40 | $5,633–$8,449 | varies |
| MRI lower extrem oth/thn jt w/o & w/contr matr (73720) range across 3 matching MRF lines |
$3,613.20–$5,420.40 | $6,022–$9,034 | varies |
| MRI lower extrem oth/thn jt w/o contr matrl (73718) range across 3 matching MRF lines |
$3,379.80–$5,069.40 | $5,633–$8,449 | varies |
| MRI lumbar spine w contrast (72149) | $3,379.80 | $5,633 | 9.0× |
| Mri Neck Spine W/O & W/Dye (72156) | $3,613.20 | $6,022 | 9.7× |
| MRI orbit face &/neck w/o contrast (70540) | $3,379.80 | $5,633 | 13.2× |
| MRI orbit face neck w contrast (70542) | $3,379.80 | $5,633 | 9.0× |
| Mri Orbt/Fac/Nck W/O &W/Dye (70543) | $3,613.20 | $6,022 | 9.7× |
| MRI pelvis w contrast (72196) | $3,379.80 | $5,633 | 9.0× |
| MRI pelvis w/o & w contrast (72197) | $3,613.20 | $6,022 | 9.7× |
| MRI pelvis w/o contrast (72195) | $3,379.80 | $5,633 | 13.2× |
| MRI spectroscopy (76390) | $3,379.80 | $5,633 | 36.2× |
| MRI thoracic spine w/o contrast (72146) | $3,379.80 | $5,633 | 13.2× |
| MRI upper extremity oth than jt w/contr matrl (73219) range across 3 matching MRF lines |
$3,379.80–$5,069.40 | $5,633–$8,449 | varies |
| MRI upper extremity oth than jt w/o contr matrl (73218) range across 3 matching MRF lines |
$3,379.80–$5,069.40 | $5,633–$8,449 | varies |
| Mri Uppr Extremity W/O&W/Dye (73220) range across 3 matching MRF lines |
$3,613.20–$5,420.40 | $6,022–$9,034 | varies |
| MRI, abdomen, combo (74183) | $3,613.20 | $6,022 | 9.7× |
| MRI, dorsal spine combo (72157) | $3,613.20 | $6,022 | 9.7× |
| MRI, dorsal spine contrast (72147) | $3,379.80 | $5,633 | 9.0× |
| MRI, joint upper extrem (73221) range across 3 matching MRF lines |
$3,379.80–$5,069.40 | $5,633–$8,449 | varies |
| MRI, joint upper extrem combo (73223) range across 3 matching MRF lines |
$3,613.20–$5,420.40 | $6,022–$9,034 | varies |
| MRI, lumbar spine combo (72158) | $3,613.20 | $6,022 | 9.7× |
| Myelogram cervical (72240) | $1,384.80 | $2,308 | 1.6× |
| Myelogram Lumbar (72265) | $1,384.80 | $2,308 | 1.6× |
| Myelography thoracic (72255) | $1,384.80 | $2,308 | 1.6× |
| Myelograpy 2/more regions rs&i (72270) | $1,384.80 | $2,308 | 1.6× |
| Myocardial Imaging Infarct Avid Planar Qual/Quan (78466) | $1,503.60 | $2,506 | 3.5× |
| Myocardial Imaging Pet Metabolic Evaluation (78459) range across 2 matching MRF lines |
$8,011.80–$11,664.60 | $13,353–$19,441 | varies |
| Myocardial Perfusion Planar 1 Study Rest/Stress (78453) | $2,656.20 | $4,427 | 1.9× |
| Myocardial Spect Multiple Studies (78452) | $5,287.80 | $8,813 | 3.8× |
| Myocrd Img Pet Metab Eval Single Study Cncrnt CT (78429) | $3,912 | $6,520 | 2.6× |
| Myocrd img PET prfuj 1std rest/stress cncrnt CT (78430) | $3,912 | $6,520 | 2.6× |
| Myocrd Img Pet Prfuj Mlt Std Rst&Strs Cncrnt CT (78431) | $6,511.80 | $10,853 | 2.8× |
| Myocrd Img Pet Prfuj W/Metab 2rtracer Cncrnt CT (78433) | $7,455.60 | $12,426 | 3.2× |
| Myocrd Img Pet Prfuj W/Metab Dual Radiotracer (78432) | $7,455.60 | $12,426 | 4.6× |
| N-invas est c ffr sw aly CTA (75580) | $2,151 | $3,585 | 2.3× |
| Neck soft tissue (70360) | $519.60 | $866 | 5.6× |
| Nfs/Instlj Radioelmnt Sln 3 Mo Follow-Up Care (77750) range across 2 matching MRF lines |
$616.20–$1,878.60 | $1,027–$3,131 | varies |
| Njx Rp Loclzj Non-Img Probe Study Intravenous (78808) | $567 | $945 | 1.3× |
| Nm csf leak detection (78650) | $1,195.80 | $1,993 | 0.9× |
| Nm unlisted gi procedure (78299) | $1,150.80 | $1,918 | 2.7× |
| Nm whole blood volume (78122) | $1,039.20 | $1,732 | 1.8× |
| Nonvascular Shunt X-Ray (75809) range across 2 matching MRF lines |
$1,122.60–$2,260.20 | $1,871–$3,767 | varies |
| Ntsty modul radthx pln dose-vol histos (77301) range across 2 matching MRF lines |
$1,739.40–$7,473 | $2,899–$12,455 | varies |
| Nuclear medicine study of endocrine organs (78099) | $907.20 | $1,512 | 2.1× |
| Nuclear Rx Intra-Arterial (79445) | $1,896 | $3,160 | 7.6× |
| Nuclear Rx Oral Admin (79005) | $2,536.20 | $4,227 | 10.1× |
| Ob us nuchal meas 1 gest (76813) | $683.40 | $1,139 | 6.1× |
| Ophthalmic Ultrasonic Foreign Body Localization (76529) | $399 | $665 | 4.3× |
| Ophthalmic ultrasound dx b-scan w/wo a-scan (76512) range across 3 matching MRF lines |
$111.60–$489 | $186–$815 | varies |
| Panoramic X-ray of jaws (70355) | $364.80 | $608 | 3.9× |
| Parathyroid imaging w/tomographic spect & CT (78072) | $2,652 | $4,420 | 4.6× |
| Parathyroid Planar Imaging (78070) | $1,125 | $1,875 | 2.6× |
| Parathyroid planar imaging w/wo subtraction (78071) | $1,204.20 | $2,007 | 2.8× |
| Pelvis 1 or 2 views (72170) | $568.20 | $947 | 5.1× |
| Peritoneogram Rs&I (74190) | $513 | $855 | 0.9× |
| Pet Image W/Ct Lmtd (78814) | $8,011.80 | $13,353 | 5.2× |
| PET image w/CT, full body (78816) | $8,011.80 | $13,353 | 5.2× |
| PET imaging CT attenuation skull base mid-thigh (78815) | $8,011.80 | $13,353 | 5.2× |
| Proton trmt simple w/comp (77522) | $3,331.80 | $5,553 | 2.5× |
| Proton tx delivery complex (77525) | $3,331.80 | $5,553 | 2.5× |
| Proton tx delivery intermediate (77523) | $3,331.80 | $5,553 | 2.5× |
| Proton tx delivery simple w/o compensation (77520) | $1,441.80 | $2,403 | 2.4× |
| Prq Transhepatc Portograpy Hemodyn Eval Rs&I (75885) | $2,098.20 | $3,497 | 0.6× |
| Pulmonary Perfusion Imaging Particulate (78580) | $1,299.60 | $2,166 | 3.0× |
| Quan&Charac C Atherosclerotc Plaq Asses Sev C Ds (75577) | $1,711.20 | $2,852 | 1.7× |
| Radex Abd Compl Aqt Abd W/S/E/D Views 1 View Ch (74022) | $562.20 | $937 | 5.0× |
| Radex abscess/fistula/sinus tract rs&i (76080) | $1,540.20 | $2,567 | 2.6× |
| Radex Ankle Complete Minimum 3 Views (73610) range across 3 matching MRF lines |
$567.60–$851.40 | $946–$1,419 | varies |
| Radex Calcaneus Minimum 2 Views (73650) range across 3 matching MRF lines |
$520.80–$781.80 | $868–$1,303 | varies |
| Radex elbow complete minimum 3 views (73080) range across 3 matching MRF lines |
$567.60–$851.40 | $946–$1,419 | varies |
| Radex Facial Bones Complete Minimum 3 Views (70150) | $676.80 | $1,128 | 6.0× |
| Radex fingr minimum 2 views (73140) range across 4 matching MRF lines |
$406.80–$610.20 | $678–$1,017 | varies |
| Radex foot complete minimum 3 views (73630) range across 3 matching MRF lines |
$567.60–$851.40 | $946–$1,419 | varies |
| Radex Hand Minimum 3 Views (73130) range across 3 matching MRF lines |
$567.60–$851.40 | $946–$1,419 | varies |
| Radex lower extremity infant minimum 2 views (73592) range across 3 matching MRF lines |
$606.60–$909.60 | $1,011–$1,516 | varies |
| Radex Mastoids Compl Minimum 3 Views PR Side (70130) range across 3 matching MRF lines |
$394.80–$591.60 | $658–$986 | varies |
| Radex Nasal Bones Complete Minimum 3 Views (70160) | $676.80 | $1,128 | 7.3× |
| Radex Pharynx/Larx W/Fluor&/Magnification Tq (70370) | $348 | $580 | 3.7× |
| Radex Ribs Unilateral 2 Views (71100) | $538.20 | $897 | 5.8× |
| Radex shoulder complete minimum 2 views (73030) range across 3 matching MRF lines |
$520.80–$781.80 | $868–$1,303 | varies |
| Radex Sinuses Paransl < 3 Views (70210) | $659.40 | $1,099 | 7.1× |
| Radex sm int w/mlt srl imges via enteroclss tube (74251) | $1,050 | $1,750 | 5.6× |
| 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) | $565.80 | $943 | 6.1× |
| Radex Temporomandble Jt Opn & Clsd Mouth Bilat (70330) | $729.60 | $1,216 | 7.8× |
| Radex Toe Minimum 2 Views (73660) range across 4 matching MRF lines |
$406.80–$610.20 | $678–$1,017 | varies |
| Radex upper extremity infant minimum 2 views (73092) range across 3 matching MRF lines |
$645.60–$968.40 | $1,076–$1,614 | varies |
| Radex Wrist Complete Minimum 3 Views (73110) range across 3 matching MRF lines |
$567.60–$851.40 | $946–$1,419 | 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) | $21,586.20 | $35,977 | 2.7× |
| Radiation treatment delivery level 1 (77402) | $1,093.20 | $1,822 | 10.0× |
| Radiation treatment delivery level 2 (77407) | $4,132.20 | $6,887 | 10.0× |
| Radiation treatment delivery level 3 (77412) | $4,749 | $7,915 | 8.0× |
| Radiolog exam mandible compl minimum 4 views (70110) | $804 | $1,340 | 7.2× |
| Radiologic Exam Abdomen 3+ Views - Xr Abdomen 3+ Views (74021) | $457.80 | $763 | 4.1× |
| Radiologic exam colon double contrast study (74280) | $1,050 | $1,750 | 5.6× |
| Radiologic exam colon single contrast study (74270) | $1,050 | $1,750 | 5.6× |
| Radiologic Exam Esophagus Double Contrast Study (74221) | $936 | $1,560 | 5.0× |
| Radiologic exam knee complete 4/more views (73564) range across 3 matching MRF lines |
$615–$921.60 | $1,025–$1,536 | varies |
| Radiologic exam pelvis compl minimum 3 views (72190) | $663.60 | $1,106 | 5.9× |
| Radiologic Exam Small Int Single Contrast Study (74250) | $811.20 | $1,352 | 4.3× |
| Radiologic exam swallow function contrast study (74230) | $624 | $1,040 | 3.3× |
| Radiologic Exam Teeth Prtl Exam < Full Mouth (70310) | $276 | $460 | 1.1× |
| Radiologic exam upr gi trc double contrast study (74246) | $1,043.40 | $1,739 | 5.6× |
| Radiologic examination femur 1 view (73551) range across 3 matching MRF lines |
$406.80–$520.80 | $678–$868 | varies |
| Radiologic examination femur minimum 2 views (73552) range across 3 matching MRF lines |
$520.80–$781.80 | $868–$1,303 | varies |
| Radiologic examination knee 1/2 views (73560) range across 3 matching MRF lines |
$520.80–$781.80 | $868–$1,303 | varies |
| Radiologic Examination Osseous Survey Limited (77074) | $691.20 | $1,152 | 6.2× |
| Radiologic Examination Salivary Gland Calculus (70380) | $346.20 | $577 | 3.7× |
| Radiologic examination tibia & fibula 2 views (73590) range across 3 matching MRF lines |
$520.80–$781.80 | $868–$1,303 | varies |
| Radiologic examination, teeth; single view Non-Facility (70300) | $276 | $460 | 3.0× |
| Radiopharm Dacryocystography (78660) | $664.80 | $1,108 | 1.6× |
| Radiopharmaceutical therapy, by intracavitary administration Non-Facility (79200) | $1,453.80 | $2,423 | 5.8× |
| Remote afterloading high dose rate radionuclide skin surface brachytherapy, includes basic dosimetry, when performed;… (77768) range across 2 matching MRF lines |
$165.60–$469.20 | $276–$782 | varies |
| Remote afterloading high dose rate radionuclide skin surface brachytherapy, includes basic dosimetry, when performed;… (77767) range across 2 matching MRF lines |
$165.60–$469.20 | $276–$782 | varies |
| Renal Cyst Study (74470) | $4,382.40 | $7,304 | 7.5× |
| Ribs bilateral 3 views (71110) | $602.40 | $1,004 | 5.4× |
| Rp loclzj tum plnr 1 area single day imaging (78800) | $1,147.20 | $1,912 | 2.7× |
| Rp loclzj tum plnr 2+area 1+d img/1 area img>2+d (78801) | $1,297.80 | $2,163 | 3.0× |
| Rp Loclzj Tum Plnr Whole Body 2+ Days Imaging (78804) | $4,605.60 | $7,676 | 7.9× |
| Rp Loclzj Tum Plnr Whole Body Single Day Imaging (78802) | $2,719.20 | $4,532 | 4.7× |
| Rp Loclzj Tum Spect 1 Area Single Day Imaging (78803) | $2,364.60 | $3,941 | 4.1× |
| Rp loclzj tum spect 2 area/sep acquisj img (78831) | $3,546.60 | $5,911 | 2.6× |
| Rp loclzj tum spect CT 2area 1d img/1 ar img>2+d (78832) | $4,729.20 | $7,882 | 3.1× |
| Rp loclzj tum spect w/CT 1 area/acquisj 1day img (78830) | $3,151.80 | $5,253 | 2.3× |
| Rp Ther Radiolbld Monoclonal Antibody IV Infus (79403) | $3,702 | $6,170 | 14.8× |
| Rp Therapy Intravenous Administration (79101) | $1,550.40 | $2,584 | 6.2× |
| Rp Therapy Unlisted Procedure (79999) | $1,400.40 | $2,334 | 5.6× |
| Salivary Gland Function Study (78232) | $1,434 | $2,390 | 3.3× |
| Salivary Gland Imaging Serial Images (78231) | $1,434 | $2,390 | 3.3× |
| Scapula (73010) range across 3 matching MRF lines |
$543.60–$814.80 | $906–$1,358 | varies |
| Screening Digital Breast Tomosynthesis Bi (77063) | $86.40 | $144 | 3.7× |
| Shoulder 1 view (73020) range across 3 matching MRF lines |
$520.80–$781.80 | $868–$1,303 | varies |
| Shoulder Arthrography (73040) | $1,021.20 | $1,702 | 2.7× |
| Sialogram (70390) | $4,133.40 | $6,889 | 16.2× |
| Skull less than 4 views (70250) | $659.40 | $1,099 | 5.9× |
| Special dosimetry (77331) range across 2 matching MRF lines |
$219–$372.60 | $365–$621 | varies |
| Special Physics Consult (77370) | $1,584.60 | $2,641 | 11.0× |
| Special teletherapy port plan (77321) range across 2 matching MRF lines |
$459–$1,750.20 | $765–$2,917 | varies |
| Special treatment procedure (77470) range across 2 matching MRF lines |
$882.60–$4,687.20 | $1,471–$7,812 | varies |
| Speech evaluation, complex (70371) | $624 | $1,040 | 2.4× |
| Spleen Imaging (78185) | $882.60 | $1,471 | 2.1× |
| Srs Multisource (77371) | $44,838 | $74,730 | 5.7× |
| Stereotactic Body Radiation Delivery (77373) range across 2 matching MRF lines |
$11,209.20–$21,586.20 | $18,682–$35,977 | varies |
| Sternoclavicular joints (71130) | $565.80 | $943 | 6.1× |
| Superior sagittal sinus venogram (75870) | $2,583.60 | $4,306 | 0.8× |
| Surface Applic Low Dose Rate Radionuclide Source (77789) range across 2 matching MRF lines |
$214.80–$506.40 | $358–$844 | varies |
| Tbs technical calculation only (77091) | $111 | $185 | 1.2× |
| Telethx isodose pln cplx w/basic dosimetry (77307) range across 2 matching MRF lines |
$664.80–$1,135.80 | $1,108–$1,893 | varies |
| Telethx isodose pln smpl w/dosimetry calculation (77306) range across 2 matching MRF lines |
$506.40–$1,068 | $844–$1,780 | varies |
| Testicular Imaging W/Flow (78761) | $1,257 | $2,095 | 2.9× |
| Ther Rad Simulaj-Aided Field Setting Complex (77290) range across 2 matching MRF lines |
$664.80–$3,736.20 | $1,108–$6,227 | varies |
| Ther Rad Simulaj-Aided Field Setting Intermed (77285) range across 2 matching MRF lines |
$473.40–$2,664.60 | $789–$4,441 | varies |
| Ther rad simulaj-aided field setting simple (77280) range across 2 matching MRF lines |
$299.40–$1,480.20 | $499–$2,467 | varies |
| Therapeutic Enema Rdctj Intussusception/Obstrcj (74283) | $1,021.20 | $1,702 | 5.4× |
| 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) | $1,221.60 | $2,036 | 2.9× |
| Thyroid Imaging With Vascular Flow (78013) | $874.80 | $1,458 | 2.0× |
| Thyroid Met Imaging Body (78018) | $2,172 | $3,620 | 3.7× |
| Thyroid Uptake Measurement (78012) | $857.40 | $1,429 | 2.0× |
| Thyroid Uptake W/Blood Flow Sngle/Mult Quan Meas (78014) | $1,143 | $1,905 | 2.7× |
| Tx Devices Design & Construction Complex (77334) range across 2 matching MRF lines |
$519–$2,092.20 | $865–$3,487 | varies |
| Tx devices design & construction intermediate (77333) range across 4 matching MRF lines |
$93.60–$928.20 | $156–$1,547 | varies |
| Tx devices design & construction simple (77332) range across 4 matching MRF lines |
$87–$586.80 | $145–$978 | varies |
| Ultrasound Breast Limited (76642) range across 3 matching MRF lines |
$414–$557.40 | $690–$929 | varies |
| Ultrasound elastography first target lesion (76982) | $396.60 | $661 | 3.5× |
| Ultrasound Elastography Parenchyma (76981) | $396.60 | $661 | 3.5× |
| Ultrasound Exam Aaa Screen (76706) | $543.60 | $906 | 4.9× |
| Ultrasound trgt dynamic microbubble 1st lesion (76978) | $747 | $1,245 | 2.0× |
| Ultrasound, abdomen limited (76705) range across 3 matching MRF lines |
$672–$1,112.40 | $1,120–$1,854 | varies |
| Umbilical-artery Doppler (OB) (76820) | $593.40 | $989 | 5.3× |
| Unlisted Dx Radiographic Procedure (76499) | $274.80 | $458 | 2.9× |
| Unlisted magnetic resonance procedure (76498) | $3,379.80 | $5,633 | 36.2× |
| Unlisted Miscellaneous Px Dx Nuclear Medicine (78999) | $1,195.80 | $1,993 | 2.8× |
| Unlisted Procedure Clinical Brachytherapy (77799) range across 4 matching MRF lines |
$1,057.20–$2,528.40 | $1,762–$4,214 | varies |
| Unlisted respiratory px dx nuclear medicine (78599) | $1,195.80 | $1,993 | 2.8× |
| Unlisted us procedure (76999) | $1,436.40 | $2,394 | 15.4× |
| Upper gi w/o kub (74240) | $929.40 | $1,549 | 4.9× |
| Ureteral Reflux Study (78740) | $1,623.60 | $2,706 | 3.8× |
| Urethrocystogram voiding (74455) | $847.80 | $1,413 | 3.3× |
| Urethrocystography retrograde (74450) | $963.60 | $1,606 | 3.8× |
| Us breast unilateral complete (76641) range across 3 matching MRF lines |
$629.40–$774 | $1,049–$1,290 | varies |
| Us chest (76604) | $863.40 | $1,439 | 7.7× |
| Us complete joint (76881) range across 3 matching MRF lines |
$853.80–$1,279.80 | $1,423–$2,133 | varies |
| Us exam, pelvic, limited (76857) | $617.40 | $1,029 | 5.5× |
| Us head (76506) | $1,317.60 | $2,196 | 11.8× |
| Us kidney transplant (76776) | $1,321.80 | $2,203 | 11.8× |
| Us lmtd joint/oth nonvasc xtr strux r-t w/img (76882) range across 3 matching MRF lines |
$672–$1,071 | $1,120–$1,785 | varies |
| Us ob detailed single fetus (76811) | $1,693.20 | $2,822 | 6.6× |
| Us ob limited 1 or more fetuses (76815) | $683.40 | $1,139 | 6.1× |
| Us ob transvaginal (76817) | $1,015.20 | $1,692 | 9.1× |
| Us pelvic non ob complete (76856) | $1,282.20 | $2,137 | 11.4× |
| Us pg uter img f&mat 14 wk tabdl 1/1st gestation (76801) | $855 | $1,425 | 7.6× |
| Us preg uterus real time f/u trnsabdl per fetus (76816) | $1,015.20 | $1,692 | 9.1× |
| Us retroperitoneal complete (76770) | $1,317.60 | $2,196 | 11.8× |
| Us retroperitoneal limited (76775) | $1,145.40 | $1,909 | 10.2× |
| Us scrotum and contents (76870) | $935.40 | $1,559 | 8.3× |
| Us spinal canal and contents (76800) | $792.60 | $1,321 | 7.1× |
| Us thyroid (76536) | $863.40 | $1,439 | 7.7× |
| Us transrectal (76872) | $1,269.60 | $2,116 | 11.3× |
| Vascular Flow Imaging (78445) | $1,603.20 | $2,672 | 3.7× |
| Vein X-Ray Chest (75827) | $2,799.60 | $4,666 | 1.7× |
| Vein X-Ray Liver W/O Hemodyn (75887) | $1,998 | $3,330 | 0.6× |
| Venogram Sinus/Jugular (75860) | $2,098.20 | $3,497 | 0.6× |
| Venography Adrenal Unilateral (75840) | $2,347.20 | $3,912 | 0.7× |
| Venography caval inferior serialography rs&i (75825) | $5,121.60 | $8,536 | 1.5× |
| Venography extremity bilateral rs&i (75822) range across 3 matching MRF lines |
$1,633.20–$4,593.60 | $2,722–$7,656 | varies |
| Venography extremity unilateral rs&i (75820) | $3,501.60 | $5,836 | 2.1× |
| Venography Renal Bilateral (75833) | $3,874.20 | $6,457 | 1.1× |
| Venography Renal Unilateral (75831) | $3,363.60 | $5,606 | 1.0× |
| Venous sampling by catheter (75893) | $5,668.20 | $9,447 | 1.0× |
| Vertebral fracture assessment via dxa (77086) | $373.80 | $623 | 4.0× |
| Wrist 2 views (73100) range across 3 matching MRF lines |
$520.80–$781.80 | $868–$1,303 | varies |
| X-Ray Ac Jts - Xr Acromioclavicular Joints Bilateral (73050) | $520.80 | $868 | 5.6× |
| X-ray antegrade pyelogram tube (74425) | $2,260.20 | $3,767 | 6.0× |
| X-Ray Aorta Leg Arteries (75630) | $7,126.20 | $11,877 | 2.1× |
| 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 |
$520.80–$781.80 | $868–$1,303 | varies |
| X-Ray Exam Breast Specimen (76098) range across 2 matching MRF lines |
$495–$633.60 | $825–$1,056 | varies |
| 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) | $365.40 | $609 | 3.9× |
| X-Ray Exam Hip Uni 2-3 Views (73502) | $615 | $1,025 | 6.6× |
| X-Ray Exam Hip Uni 4/> Views (73503) | $921.60 | $1,536 | 8.2× |
| X-Ray Exam Hips Bi 2 Views (73521) | $921.60 | $1,536 | 8.2× |
| X-Ray Exam Hips Bi 3-4 Views (73522) | $1,295.40 | $2,159 | 11.6× |
| X-Ray Exam Hips Bi 5/> Views (73523) | $1,454.40 | $2,424 | 13.0× |
| 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) | $624.60 | $1,041 | 5.6× |
| X-ray eye for foreign body (70030) | $289.80 | $483 | 3.1× |
| X-ray humerus (73060) range across 3 matching MRF lines |
$520.80–$781.80 | $868–$1,303 | varies |
| X-ray IV pyelogram (ivp) (74400) | $874.80 | $1,458 | 4.7× |
| X-Ray Jaw <4 Vw - Xr Mandible < 4 Views (70100) | $676.80 | $1,128 | 7.3× |
| X-Ray Knee Bilat Standing - Xr Knees Anteroposterior Standing Bilat (73565) | $406.80 | $678 | 4.4× |
| 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) | $405.60 | $676 | 4.3× |
| X-Ray Ribs, Chest 4+ Vw - Xr Ribs 3 Vws Bil W/ Chest Posteroanterior (71111) | $624.60 | $1,041 | 5.6× |
| X-Ray Sacroiliac Jts 3+ Vw - Xr Sacroiliac Joints 3+ Views (72202) | $545.40 | $909 | 4.9× |
| X-Ray Sacroiliac Jts <3 Vw - Xr Sacroiliac Joints 1-2 Views (72200) | $519.60 | $866 | 4.6× |
| X-Ray Sacrum/Coccyx 2+ Vw - Xr Sacrum Coccyx 2+ Views (72220) | $519.60 | $866 | 5.6× |
| X-Ray Sinuses 3+ Vw - Xr Paranasal Sinuses 3+ Views (70220) | $676.80 | $1,128 | 7.3× |
| X-Ray Skull 4+ Vw - Xr Skull Complete 4+ Views (70260) | $716.40 | $1,194 | 6.4× |
| X-Ray Stress View (77071) | $372.60 | $621 | 4.0× |
| X-ray thoracic spine 4 vw (72074) | $591.60 | $986 | 5.3× |
| X-Ray Tmj Unilat (70328) | $486.60 | $811 | 5.2× |
| X-Ray Urinary Tract Exam With Contrast Material (74420) | $912.60 | $1,521 | 2.4× |
| X-Rays Bone Length Studies (77073) | $520.80 | $868 | 4.6× |
| X-Rays Bone Survey Complete (77075) | $860.40 | $1,434 | 7.7× |
| Xr c-spine 4 or 5 views (72050) | $599.40 | $999 | 5.4× |
| Xr facial bones less than 3 views (70140) | $659.40 | $1,099 | 7.1× |
| XR Mastoids < 3 Views Bilateral (70120) range across 3 matching MRF lines |
$332.40–$484.20 | $554–$807 | varies |
| Xr orbits complete 4 views (70200) | $716.40 | $1,194 | 6.4× |
| Xr Tomogram Single Plane (76100) range across 4 matching MRF lines |
$1,050–$2,482.20 | $1,750–$4,137 | 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.