Imaging prices at St. Mark's Hospital
Salt Lake City, UT · every code in this section with a posted price and a Medicare benchmark.
379 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) | $5,217.17 | $5,217.17 | 3.7× |
| Abdomen 1 View (74018) range across 2 matching MRF lines |
$615.99–$686.69 | $615.99–$686.69 | varies |
| Abdomen 2 views (74019) range across 2 matching MRF lines |
$656.65–$772.51 | $656.65–$772.51 | varies |
| Acute Gastrointestinal Blood Loss Imaging (78278) | $2,127.24 | $2,127.24 | 5.3× |
| Angio internal mammary (75756) | $12,073.13 | $12,073.13 | 3.8× |
| Angio pulmonary bilat (75743) | $12,073.13 | $12,073.13 | 3.8× |
| Angiography extremity bilateral rs&i (75716) | $12,073.13 | $12,073.13 | 3.8× |
| Angiography extremity unilateral rs&i (75710) | $12,073.13 | $12,073.13 | 3.8× |
| Angiography pulmonary unilateral slctv rs&i (75741) | $12,073.13 | $12,073.13 | 3.8× |
| Angrph pulmonary nonslctv cath/ven njx rs&i (75746) | $6,665.91 | $6,665.91 | 2.1× |
| Ankle 2 views (73600) range across 5 matching MRF lines |
$444.09–$1,083.11 | $444.09–$1,083.11 | varies |
| Aortography thoracic serialography rs&i (75605) | $20,656.59 | $20,656.59 | 3.7× |
| Artery X-Rays Abdomen (75726) | $20,656.59 | $20,656.59 | 3.7× |
| Artery X-Rays Pelvis (75736) | $20,656.59 | $20,656.59 | 3.7× |
| Artery X-Rays Spine (75705) | $20,656.59 | $20,656.59 | 3.7× |
| Arthrogram hip (73525) range across 4 matching MRF lines |
$867.91–$2,210.34 | $867.91–$2,210.34 | varies |
| Arthrogram Wrist (73115) range across 5 matching MRF lines |
$867.91–$1,733.31 | $867.91–$1,733.31 | varies |
| Basic radiation dosimetry calculation (77300) | $691.90 | $691.90 | 5.1× |
| Bone age studies (77072) range across 2 matching MRF lines |
$500.49–$610.34 | $500.49–$610.34 | varies |
| Bone Imaging 3 Phase (78315) | $4,766.42 | $4,766.42 | 11.8× |
| Bone Imaging Limited Area (78300) | $2,295.88 | $2,295.88 | 5.7× |
| Bone Imaging Whole Body (78306) | $4,145.30 | $4,145.30 | 10.2× |
| Bone survey infant (77076) | $1,968.63 | $1,968.63 | 18.6× |
| Brachytx isodose complex (77318) | $1,581.69 | $1,581.69 | 4.2× |
| Brachytx isodose intermed (77317) | $1,581.69 | $1,581.69 | 4.2× |
| Brachytx Isodose Plan Simple (77316) | $1,581.69 | $1,581.69 | 4.2× |
| Brain Image W/Flow < 4 Views (78601) | $1,485.99 | $1,485.99 | 3.7× |
| Brain Imaging Min 4 Static Views W Vascular Flow (78606) | $2,984.46 | $2,984.46 | 5.4× |
| Cardiac MRI w/w/o contrast & further seq (75561) | $5,400.14 | $5,400.14 | 15.3× |
| Cardiac MRI w/w/o contrast w/stress (75563) | $5,669.69 | $5,669.69 | 7.1× |
| Cerebrospinal Fluid Scan (78630) | $2,121.26 | $2,121.26 | 3.9× |
| Chest 1 view (71045) range across 2 matching MRF lines |
$229–$326.15 | $229–$326.15 | varies |
| Chest 2 views (71046) range across 2 matching MRF lines |
$343.50–$404.11 | $343.50–$404.11 | varies |
| Chest 3 views (71047) range across 2 matching MRF lines |
$400.67–$471.37 | $400.67–$471.37 | varies |
| Chest 4 or more views (71048) range across 2 matching MRF lines |
$615.99–$686.69 | $615.99–$686.69 | varies |
| Cisternography Positive Contrast Rs&I (70015) | $1,307.13 | $1,307.13 | 1.6× |
| Clavicle complete (73000) range across 5 matching MRF lines |
$444.09–$1,083.11 | $444.09–$1,083.11 | varies |
| Computed Tomography Thorax Lw Dose Lng Ca Scr C- (71271) range across 2 matching MRF lines |
$447.43–$477.46 | $447.43–$477.46 | varies |
| Continuing medical physics consltj pr wk (77336) | $1,383.80 | $1,383.80 | 10.2× |
| Contrast Exam Abdominl Aorta (75625) | $12,073.13 | $12,073.13 | 3.8× |
| Contrast X-Ray Bladder (74430) | $1,294.80 | $1,294.80 | 3.7× |
| Contrast X-Ray Of Elbow (73085) range across 5 matching MRF lines |
$765.21–$1,866.34 | $765.21–$1,866.34 | varies |
| Contrast X-Ray Of Knee Joint (73580) range across 6 matching MRF lines |
$809.71–$2,210.34 | $809.71–$2,210.34 | varies |
| CT abdomen and pelvis without and with contrast (74178) range across 2 matching MRF lines |
$5,046.30–$9,394.67 | $5,046.30–$9,394.67 | varies |
| CT abdomen and pelvis without contrast (74176) range across 2 matching MRF lines |
$3,918.53–$7,837.12 | $3,918.53–$7,837.12 | varies |
| CT abdomen w contrast (74160) range across 2 matching MRF lines |
$2,238.92–$4,477.82 | $2,238.92–$4,477.82 | varies |
| CT abdomen w wo contrast (74170) range across 2 matching MRF lines |
$2,461.52–$4,923.03 | $2,461.52–$4,923.03 | varies |
| CT abdomen w/o contrast (74150) range across 2 matching MRF lines |
$2,091.76–$4,183.49 | $2,091.76–$4,183.49 | varies |
| CT Angio Abdomen and Pelvis (74174) range across 2 matching MRF lines |
$5,755.52–$11,068.49 | $5,755.52–$11,068.49 | varies |
| CT Angio Chest (71275) range across 2 matching MRF lines |
$2,877.31–$5,754.55 | $2,877.31–$5,754.55 | varies |
| CT Angio Head (70496) range across 2 matching MRF lines |
$2,877.31–$5,754.55 | $2,877.31–$5,754.55 | varies |
| CT angio hrt w/3d image (75574) | $1,244.87 | $1,244.87 | 3.5× |
| Ct Angio Lwr Extr W/O&W/Dye (73706) range across 4 matching MRF lines |
$4,797.94–$5,080.16 | $4,797.94–$5,080.16 | varies |
| CT Angio Neck (70498) range across 2 matching MRF lines |
$2,877.31–$5,754.55 | $2,877.31–$5,754.55 | varies |
| Ct Angio Upr Extrm W/O&W/Dye (73206) range across 4 matching MRF lines |
$5,747.21–$6,085.27 | $5,747.21–$6,085.27 | varies |
| CT cervical spine w/ contrast (72126) range across 2 matching MRF lines |
$2,049.45–$4,098.85 | $2,049.45–$4,098.85 | varies |
| CT cervical spine w/o contrast (72125) range across 2 matching MRF lines |
$1,834.17–$3,668.34 | $1,834.17–$3,668.34 | varies |
| CT cervical spine w/wo cont (72127) range across 2 matching MRF lines |
$1,433.14–$2,298.73 | $1,433.14–$2,298.73 | varies |
| CT chest w contrast (71260) range across 2 matching MRF lines |
$1,970.32–$3,940.62 | $1,970.32–$3,940.62 | varies |
| CT chest w/wo contrast (71270) range across 2 matching MRF lines |
$2,320.76–$4,641.55 | $2,320.76–$4,641.55 | varies |
| CT colonography screening (74263) | $4,183.49 | $4,183.49 | 17.3× |
| CT Colonogrphy Dx Image Postprocess W/Contrast (74262) | $4,923.03 | $4,923.03 | 27.7× |
| CT colonogrphy dx image postprocess w/o contrast (74261) | $4,183.49 | $4,183.49 | 39.5× |
| CT head/brain with contrast (70460) range across 2 matching MRF lines |
$2,124.84–$4,249.70 | $2,124.84–$4,249.70 | varies |
| CT head/brain without and with contrast (70470) range across 2 matching MRF lines |
$2,264.70–$4,529.34 | $2,264.70–$4,529.34 | varies |
| CT heart contrast eval cardiac structure&morph (75572) | $1,786.34 | $1,786.34 | 5.1× |
| CT heart no contrast quant eval coronry calcium (75571) | $69 | $69 | 0.8× |
| CT hrt w/3d image congen (75573) | $1,244.87 | $1,244.87 | 3.5× |
| CT iac w contrast (70481) range across 2 matching MRF lines |
$1,859.95–$3,719.85 | $1,859.95–$3,719.85 | varies |
| CT l-spine w&w/o contrast (72133) range across 2 matching MRF lines |
$1,424.85–$2,849.70 | $1,424.85–$2,849.70 | varies |
| CT lower ext w/o (73700) range across 5 matching MRF lines |
$1,643.78–$6,573.22 | $1,643.78–$6,573.22 | varies |
| CT lower extremity w/contrast material (73701) range across 5 matching MRF lines |
$1,785.45–$7,143.55 | $1,785.45–$7,143.55 | varies |
| CT lumbar spine w contrast (72132) range across 2 matching MRF lines |
$2,077.94–$4,155.90 | $2,077.94–$4,155.90 | varies |
| CT lumbar spine w/o contrast (72131) range across 2 matching MRF lines |
$1,834.17–$3,668.34 | $1,834.17–$3,668.34 | varies |
| CT maxillofacial w contrast (70487) range across 2 matching MRF lines |
$1,862.72–$3,725.40 | $1,862.72–$3,725.40 | varies |
| CT maxillofacial wo contrast (70486) range across 2 matching MRF lines |
$937.32–$1,874.67 | $937.32–$1,874.67 | varies |
| CT neck tissue combo (70492) range across 2 matching MRF lines |
$2,398.97–$4,797.94 | $2,398.97–$4,797.94 | varies |
| Ct Orbit/Ear/Fossa W/O&W/Dye (70482) range across 2 matching MRF lines |
$2,020.92–$4,041.83 | $2,020.92–$4,041.83 | varies |
| CT orbits w/o contrast (70480) range across 2 matching MRF lines |
$1,698.97–$3,397.95 | $1,698.97–$3,397.95 | varies |
| CT pelvis w&w/o contrast (72194) range across 2 matching MRF lines |
$1,293.33–$5,171.39 | $1,293.33–$5,171.39 | varies |
| CT pelvis w/o contrast (72192) range across 3 matching MRF lines |
$1,423.94–$3,653.64 | $1,423.94–$3,653.64 | varies |
| CT scan of leg combo (73702) range across 5 matching MRF lines |
$2,398.97–$9,595.86 | $2,398.97–$9,595.86 | varies |
| CT scans face/jaw combo (70488) range across 2 matching MRF lines |
$2,286.73–$4,573.50 | $2,286.73–$4,573.50 | varies |
| CT soft tissue neck w contrast (70491) range across 2 matching MRF lines |
$1,787.27–$3,574.54 | $1,787.27–$3,574.54 | varies |
| CT soft tissue neck w/o contrast (70490) range across 2 matching MRF lines |
$1,628.16–$3,256.26 | $1,628.16–$3,256.26 | varies |
| CT thoracic spine w contrast (72129) range across 2 matching MRF lines |
$2,046.65–$4,093.34 | $2,046.65–$4,093.34 | varies |
| CT thoracic spine w/o contrast (72128) range across 2 matching MRF lines |
$1,834.17–$3,668.34 | $1,834.17–$3,668.34 | varies |
| CT thoracic spine w/wo cont (72130) range across 2 matching MRF lines |
$1,433.14–$2,866.26 | $1,433.14–$2,866.26 | varies |
| CT thorax w/o contrast (71250) range across 2 matching MRF lines |
$1,826.81–$3,653.64 | $1,826.81–$3,653.64 | varies |
| CT upper ext wo (73200) range across 5 matching MRF lines |
$1,643.78–$6,573.22 | $1,643.78–$6,573.22 | varies |
| CT upper extremity w/o & w/contrast material (73202) range across 5 matching MRF lines |
$2,398.97–$9,595.86 | $2,398.97–$9,595.86 | varies |
| CT upper extremity with contrast (73201) range across 5 matching MRF lines |
$1,785.45–$7,143.55 | $1,785.45–$7,143.55 | varies |
| Cta Abdl Aorta&Bi Iliofem W/Contrast&Postp (75635) range across 2 matching MRF lines |
$1,363.22–$2,726.45 | $1,363.22–$2,726.45 | varies |
| Cta Abdomen (74175) range across 2 matching MRF lines |
$2,877.31–$5,754.55 | $2,877.31–$5,754.55 | varies |
| CTA pelvis (72191) range across 2 matching MRF lines |
$2,352.65–$5,754.55 | $2,352.65–$5,754.55 | varies |
| Dilation ureters/urethra rs&i (74485) | $8,212.72 | $8,212.72 | 3.9× |
| Discography Cerv/Thor Spine (72285) | $13,452.62 | $13,452.62 | 6.8× |
| Diskography lumbar (72295) | $14,745.51 | $14,745.51 | 7.5× |
| Doppler Fetal Mid Cerebral Artery (76821) | $733.82 | $733.82 | 6.9× |
| Dxa Bone Density Axial (77080) | $523.94 | $523.94 | 4.9× |
| Dxa bone density study (77085) | $458.06 | $458.06 | 4.3× |
| Echo exam uterus (76831) | $788.94 | $788.94 | 3.3× |
| Echo Guide For Artery Repair (76936) range across 2 matching MRF lines |
$515.68–$1,034.34 | $515.68–$1,034.34 | varies |
| Esophagram (74220) | $848.50 | $848.50 | 4.8× |
| Fetal Biophys Profile W/Nst (76818) | $847.53 | $847.53 | 8.0× |
| Fetal Biophysical Profile W/O Non-Stress Testing (76819) range across 2 matching MRF lines |
$625.84–$894.06 | $625.84–$894.06 | varies |
| Fetal MRI w/placntl matrnl plvc img sing/1st ges (74712) | $1,283.22 | $1,283.22 | 5.3× |
| Fluoroscopy up to 1 hr (76000) range across 2 matching MRF lines |
$1,248.94–$2,458.04 | $1,248.94–$2,458.04 | varies |
| Follow-Up Angiography (75898) | $6,665.91 | $6,665.91 | 2.1× |
| Foot 2 views (73620) range across 5 matching MRF lines |
$444.09–$1,083.11 | $444.09–$1,083.11 | varies |
| Forearm 2 views (73090) range across 5 matching MRF lines |
$444.09–$1,083.11 | $444.09–$1,083.11 | varies |
| Gastric emptying imaging study (78264) | $3,234.49 | $3,234.49 | 8.0× |
| Gastric Emptyng Imag Std W/Sm Bwl Transit (78265) | $1,543.44 | $1,543.44 | 3.8× |
| Gastroesophageal Reflux Exam (78262) | $3,234.49 | $3,234.49 | 8.0× |
| Gated Heart Planar Single (78472) | $3,591.67 | $3,591.67 | 8.9× |
| Gstrc Emptng Imag Std W/Sm Bwl Col Trnst Mlt Day (78266) | $2,047.80 | $2,047.80 | 3.7× |
| Hand 2 views (73120) range across 6 matching MRF lines |
$444.09–$998.08 | $444.09–$998.08 | varies |
| Hdr Rdncl Ntrstl/Icav Brchtx (77772) | $2,844.94 | $2,844.94 | 4.0× |
| Hdr Rdncl Ntrstl/Icav Brchtx (77771) | $2,844.94 | $2,844.94 | 4.0× |
| Hdr Rdncl Ntrstl/Icav Brchtx 1 Channel (77770) | $2,844.94 | $2,844.94 | 4.0× |
| Hepatc Vngrph Wdg/Fr Hemodyn Eval Rs&I (75889) | $12,073.13 | $12,073.13 | 3.8× |
| Hepatc Vngrph Wdg/Fr W/O Hemodyn Eval Rs&I (75891) | $12,073.13 | $12,073.13 | 3.8× |
| Hepatobil Syst Image W/Drug (78227) | $2,440.77 | $2,440.77 | 4.4× |
| Hepatobiliary System Imaging (78226) | $2,440.77 | $2,440.77 | 6.0× |
| Ht Musc Image Planar Mult (78454) | $5,784.39 | $5,784.39 | 4.4× |
| Ht Muscle Image Spect Sing (78451) | $5,784.39 | $5,784.39 | 4.4× |
| Hyperthermia external generated superficial (77600) | $1,295.60 | $1,295.60 | 3.3× |
| Hyperthermia generated by interstitial probe(s); 5 or fewer interstitial applicators Non-Facility (77610) | $2,837.80 | $2,837.80 | 5.1× |
| Hyperthermia generated by interstitial probe(s); more than 5 interstitial applicators Non-Facility (77615) | $2,522.48 | $2,522.48 | 4.5× |
| Hyperthermia generated by intracavitary probe(s) Non-Facility (77620) | $2,811.37 | $2,811.37 | 5.0× |
| Hyperthermia, externally generated; deep (ie, heating to depths greater than 4 cm) Non-Facility (77605) | $3,456.40 | $3,456.40 | 4.9× |
| Hysterosalpingogram (74740) | $1,421.80 | $1,421.80 | 5.9× |
| Infusion Ivp (74410) | $2,243.83 | $2,243.83 | 12.6× |
| Interstitial radiation source applic complex (77778) | $6,669.40 | $6,669.40 | 9.5× |
| K Flow/Funct Image Multiple (78709) | $2,839.62 | $2,839.62 | 5.2× |
| K Flow/Funct Image W/Drug (78708) | $1,432.71 | $1,432.71 | 2.6× |
| K Flow/Funct Image W/O Drug (78707) | $2,784.03 | $2,784.03 | 5.1× |
| Knee 3 Views (73562) range across 5 matching MRF lines |
$580.04–$1,413 | $580.04–$1,413 | varies |
| Leveen/Shunt Patency Exam (78291) | $2,141.12 | $2,141.12 | 5.3× |
| Liver & Spleen Imaging Static Only (78215) | $1,485.99 | $1,485.99 | 3.7× |
| Liver & Spleen Imaging W/Vascular Flow (78216) | $1,502.16 | $1,502.16 | 3.7× |
| Liver imaging static only (78201) | $4,856.37 | $4,856.37 | 8.8× |
| Liver imaging w/vascular flow (78202) | $2,170.86 | $2,170.86 | 3.9× |
| Lung Perf&Ventilat Diferentl (78598) | $1,914.50 | $1,914.50 | 3.5× |
| Lung perfusion differential (78597) | $2,389.15 | $2,389.15 | 5.9× |
| Lung Ventilat&Perfus Imaging (78582) | $4,853.71 | $4,853.71 | 8.8× |
| Lung Ventilation Imaging (78579) | $1,736.30 | $1,736.30 | 4.3× |
| Lymph System Imaging (78195) | $2,440.77 | $2,440.77 | 4.4× |
| Lymphangiography Pelvic/Abdominal Bilateral Rs&I (75807) | $12,073.13 | $12,073.13 | 3.8× |
| Lymphangiography, pelvic/abdominal, unilateral (75805) | $6,665.91 | $6,665.91 | 2.1× |
| Magnetic Image Jaw Joint (70336) range across 2 matching MRF lines |
$1,769.88–$2,765.48 | $1,769.88–$2,765.48 | varies |
| Magnetic Resonance Elastography (76391) | $3,159.92 | $3,159.92 | 13.1× |
| Mammary ductogram or galactogram single (77053) | $1,039.01 | $1,039.01 | 4.3× |
| Meckels Divert Exam (78290) | $2,226.45 | $2,226.45 | 5.5× |
| Mlc imrt design & construction per imrt plan (77338) | $1,966.52 | $1,966.52 | 5.2× |
| Mr safety implant&/fb assmt clin staf 1st 15 min (76014) | $119.03 | $119.03 | 4.1× |
| Mr safety implt electronics prepj supvj phys/qhp (76018) | $446.10 | $446.10 | 4.6× |
| Mra Head W/O & W/Contrast Material (70546) range across 2 matching MRF lines |
$3,522.42–$5,503.77 | $3,522.42–$5,503.77 | varies |
| MRA head w/o contrast (70544) range across 2 matching MRF lines |
$3,456.09–$5,400.14 | $3,456.09–$5,400.14 | varies |
| MRA head with contrast (70545) | $4,846.37 | $4,846.37 | 13.7× |
| MRA neck w contrast (70548) | $4,846.37 | $4,846.37 | 13.7× |
| Mra Neck W/O &W/Contrast Material (70549) range across 2 matching MRF lines |
$3,566.98–$5,573.42 | $3,566.98–$5,573.42 | varies |
| MRA neck w/o contrast (70547) range across 2 matching MRF lines |
$2,484.15–$3,881.53 | $2,484.15–$3,881.53 | varies |
| MRI abdomen w contrast (74182) | $4,846.37 | $4,846.37 | 13.7× |
| MRI abdomen w/o contrast (74181) range across 2 matching MRF lines |
$3,101.68–$4,846.37 | $3,101.68–$4,846.37 | varies |
| MRI any jt lower extrem w/contrast material (73722) range across 5 matching MRF lines |
$3,101.68–$9,692.75 | $3,101.68–$9,692.75 | varies |
| MRI any jt lower extrem w/o & w/contrast matrl (73723) range across 5 matching MRF lines |
$3,101.68–$9,692.75 | $3,101.68–$9,692.75 | varies |
| MRI any jt upper extremity w/contrast matrl (73222) range across 5 matching MRF lines |
$3,101.68–$9,692.75 | $3,101.68–$9,692.75 | varies |
| MRI Breast W/O Contrast Bilateral (77047) | $3,593.74 | $3,593.74 | 14.9× |
| MRI Breast Without Contrast Material Unilateral (77046) range across 3 matching MRF lines |
$2,312.45–$2,497.45 | $2,312.45–$2,497.45 | varies |
| MRI cardiac w/o cont stress (75559) | $4,751.35 | $4,751.35 | 8.6× |
| MRI cardiac w/o contrast (75557) | $4,846.37 | $4,846.37 | 20.1× |
| MRI cervical spine w contrast (72142) | $4,846.37 | $4,846.37 | 13.7× |
| MRI cervical spine w/o cont (72141) range across 2 matching MRF lines |
$3,101.68–$4,846.37 | $3,101.68–$4,846.37 | varies |
| MRI chest w/o contrast (71550) | $4,846.37 | $4,846.37 | 20.1× |
| MRI chest with contrast (71551) | $4,846.37 | $4,846.37 | 6.1× |
| MRI chest wo w contrast (71552) range across 2 matching MRF lines |
$3,181.52–$5,400.14 | $3,181.52–$5,400.14 | varies |
| MRI lower extrem oth/thn jt w/contrast matrl (73719) range across 3 matching MRF lines |
$4,846.37–$9,692.75 | $4,846.37–$9,692.75 | varies |
| MRI lower extrem oth/thn jt w/o & w/contr matr (73720) range across 4 matching MRF lines |
$3,101.68–$4,846.37 | $3,101.68–$4,846.37 | varies |
| MRI lower extrem oth/thn jt w/o contr matrl (73718) range across 5 matching MRF lines |
$3,101.68–$9,692.75 | $3,101.68–$9,692.75 | varies |
| MRI lumbar spine w contrast (72149) range across 2 matching MRF lines |
$3,101.68–$4,846.37 | $3,101.68–$4,846.37 | varies |
| Mri Neck Spine W/O & W/Dye (72156) range across 2 matching MRF lines |
$3,456.09–$5,400.14 | $3,456.09–$5,400.14 | varies |
| MRI orbit face &/neck w/o contrast (70540) range across 2 matching MRF lines |
$3,101.68–$4,846.37 | $3,101.68–$4,846.37 | varies |
| MRI orbit face neck w contrast (70542) range across 2 matching MRF lines |
$3,320.21–$5,187.80 | $3,320.21–$5,187.80 | varies |
| Mri Orbt/Fac/Nck W/O &W/Dye (70543) range across 2 matching MRF lines |
$4,531.31–$7,080.15 | $4,531.31–$7,080.15 | varies |
| MRI pelvis w/o & w contrast (72197) range across 2 matching MRF lines |
$3,456.09–$5,400.14 | $3,456.09–$5,400.14 | varies |
| MRI pelvis w/o contrast (72195) range across 2 matching MRF lines |
$3,101.68–$4,846.37 | $3,101.68–$4,846.37 | varies |
| MRI thoracic spine w/o contrast (72146) range across 2 matching MRF lines |
$2,334.16–$3,647.08 | $2,334.16–$3,647.08 | varies |
| MRI upper extremity oth than jt w/contr matrl (73219) range across 5 matching MRF lines |
$3,101.68–$9,692.75 | $3,101.68–$9,692.75 | varies |
| MRI upper extremity oth than jt w/o contr matrl (73218) range across 5 matching MRF lines |
$3,101.68–$9,692.75 | $3,101.68–$9,692.75 | varies |
| Mri Uppr Extremity W/O&W/Dye (73220) range across 5 matching MRF lines |
$3,101.68–$9,692.75 | $3,101.68–$9,692.75 | varies |
| MRI, abdomen, combo (74183) range across 2 matching MRF lines |
$3,566.98–$5,573.42 | $3,566.98–$5,573.42 | varies |
| MRI, dorsal spine combo (72157) range across 2 matching MRF lines |
$3,456.09–$5,400.14 | $3,456.09–$5,400.14 | varies |
| MRI, dorsal spine contrast (72147) | $4,846.37 | $4,846.37 | 13.7× |
| MRI, joint upper extrem (73221) range across 5 matching MRF lines |
$3,101.68–$9,692.75 | $3,101.68–$9,692.75 | varies |
| MRI, joint upper extrem combo (73223) range across 5 matching MRF lines |
$3,101.68–$9,692.75 | $3,101.68–$9,692.75 | varies |
| MRI, lumbar spine combo (72158) range across 2 matching MRF lines |
$3,456.09–$5,400.14 | $3,456.09–$5,400.14 | varies |
| Myelogram cervical (72240) | $1,741.11 | $1,741.11 | 2.2× |
| Myelogram Lumbar (72265) | $1,695.24 | $1,695.24 | 2.1× |
| Myelography thoracic (72255) | $1,695.24 | $1,695.24 | 2.1× |
| Myelograpy 2/more regions rs&i (72270) | $3,773.27 | $3,773.27 | 4.8× |
| Myocardial Perfusion Planar 1 Study Rest/Stress (78453) | $5,784.39 | $5,784.39 | 4.4× |
| Myocardial Spect Multiple Studies (78452) | $5,784.39 | $5,784.39 | 4.4× |
| N-invas est c ffr sw aly CTA (75580) | $5,892.11 | $5,892.11 | 6.8× |
| Neck soft tissue (70360) range across 2 matching MRF lines |
$580.04–$707.39 | $580.04–$707.39 | varies |
| Nm csf leak detection (78650) | $1,529.94 | $1,529.94 | 1.2× |
| Nonvascular Shunt X-Ray (75809) range across 3 matching MRF lines |
$249.66–$554.35 | $249.66–$554.35 | varies |
| Ntsty modul radthx pln dose-vol histos (77301) | $5,931.44 | $5,931.44 | 4.2× |
| Nuclear Rx Intra-Arterial (79445) range across 2 matching MRF lines |
$1,281.85–$1,357.25 | $1,281.85–$1,357.25 | varies |
| Nuclear Rx Oral Admin (79005) | $2,226.45 | $2,226.45 | 9.4× |
| Parathyroid imaging w/tomographic spect & CT (78072) | $1,914.50 | $1,914.50 | 3.5× |
| Parathyroid Planar Imaging (78070) | $2,905.06 | $2,905.06 | 7.2× |
| Pelvis 1 or 2 views (72170) range across 2 matching MRF lines |
$475.91–$580.37 | $475.91–$580.37 | varies |
| Peritoneogram Rs&I (74190) | $1,039.01 | $1,039.01 | 1.9× |
| Prq Transhepatc Portograpy Hemodyn Eval Rs&I (75885) | $12,073.13 | $12,073.13 | 3.8× |
| Pulmonary Perfusion Imaging Particulate (78580) | $2,657.03 | $2,657.03 | 6.6× |
| Radex Abd Compl Aqt Abd W/S/E/D Views 1 View Ch (74022) | $857.33 | $857.33 | 8.1× |
| Radex abscess/fistula/sinus tract rs&i (76080) | $1,107.81 | $1,107.81 | 2.0× |
| Radex Ankle Complete Minimum 3 Views (73610) range across 5 matching MRF lines |
$551.11–$1,342.42 | $551.11–$1,342.42 | varies |
| Radex Calcaneus Minimum 2 Views (73650) range across 5 matching MRF lines |
$436.83–$1,065.46 | $436.83–$1,065.46 | varies |
| Radex elbow complete minimum 3 views (73080) range across 5 matching MRF lines |
$551.11–$1,340.69 | $551.11–$1,340.69 | varies |
| Radex Facial Bones Complete Minimum 3 Views (70150) range across 2 matching MRF lines |
$844.77–$1,030.20 | $844.77–$1,030.20 | varies |
| Radex fingr minimum 2 views (73140) range across 6 matching MRF lines |
$451.31–$1,102.53 | $451.31–$1,102.53 | varies |
| Radex foot complete minimum 3 views (73630) range across 5 matching MRF lines |
$551.11–$1,340.69 | $551.11–$1,340.69 | varies |
| Radex Hand Minimum 3 Views (73130) range across 6 matching MRF lines |
$500.49–$1,217.16 | $500.49–$1,217.16 | varies |
| Radex lower extremity infant minimum 2 views (73592) range across 5 matching MRF lines |
$390.55–$867.91 | $390.55–$867.91 | varies |
| Radex Mastoids Compl Minimum 3 Views PR Side (70130) | $889.09 | $889.09 | 8.4× |
| Radex Nasal Bones Complete Minimum 3 Views (70160) range across 2 matching MRF lines |
$568.47–$693.26 | $568.47–$693.26 | varies |
| Radex Ribs Unilateral 2 Views (71100) range across 4 matching MRF lines |
$676.94–$825.56 | $676.94–$825.56 | varies |
| Radex shoulder complete minimum 2 views (73030) range across 5 matching MRF lines |
$585.85–$1,423.58 | $585.85–$1,423.58 | varies |
| Radex Sinuses Paransl < 3 Views (70210) range across 2 matching MRF lines |
$568.47–$693.26 | $568.47–$693.26 | varies |
| Radex sm int w/mlt srl imges via enteroclss tube (74251) | $2,453.77 | $2,453.77 | 13.8× |
| Radex Spine 1 View Specify Level (72020) range across 2 matching MRF lines |
$432.50–$527.45 | $432.50–$527.45 | varies |
| Radex Sternum Minimum 2 Views (71120) range across 2 matching MRF lines |
$500.49–$610.34 | $500.49–$610.34 | varies |
| Radex Temporomandble Jt Opn & Clsd Mouth Bilat (70330) range across 2 matching MRF lines |
$705.91–$860.85 | $705.91–$860.85 | varies |
| Radex Toe Minimum 2 Views (73660) range across 3 matching MRF lines |
$326.15–$438.46 | $326.15–$438.46 | varies |
| Radex upper extremity infant minimum 2 views (73092) range across 3 matching MRF lines |
$476.28–$950.80 | $476.28–$950.80 | varies |
| Radex Wrist Complete Minimum 3 Views (73110) range across 5 matching MRF lines |
$500.49–$1,217.16 | $500.49–$1,217.16 | varies |
| Radex X-Ray Exam Entire Spi 6/> Vw - Xr Entire Spine 6+ Vw (72084) range across 2 matching MRF lines |
$766.89–$935.22 | $766.89–$935.22 | varies |
| Radiation Delivery Stereotactic Cranial Linear (77372) | $33,334.96 | $33,334.96 | 4.5× |
| Radiation treatment delivery level 3 (77412) | $1,437.70 | $1,437.70 | 2.6× |
| Radiolog exam mandible compl minimum 4 views (70110) range across 2 matching MRF lines |
$747.82–$912.01 | $747.82–$912.01 | varies |
| Radiologic Exam Abdomen 3+ Views - Xr Abdomen 3+ Views (74021) range across 2 matching MRF lines |
$762.22–$896.93 | $762.22–$896.93 | varies |
| Radiologic exam colon double contrast study (74280) | $1,915.71 | $1,915.71 | 10.8× |
| Radiologic exam colon single contrast study (74270) | $1,358.31 | $1,358.31 | 7.6× |
| Radiologic Exam Esophagus Double Contrast Study (74221) | $744.69 | $744.69 | 4.2× |
| Radiologic exam knee complete 4/more views (73564) range across 5 matching MRF lines |
$635.01–$1,545.30 | $635.01–$1,545.30 | varies |
| Radiologic exam pelvis compl minimum 3 views (72190) range across 2 matching MRF lines |
$695.79–$848.50 | $695.79–$848.50 | varies |
| Radiologic Exam Small Int Single Contrast Study (74250) | $1,255.98 | $1,255.98 | 7.1× |
| Radiologic exam swallow function contrast study (74230) | $1,039.01 | $1,039.01 | 5.9× |
| Radiologic exam upr gi trc double contrast study (74246) | $1,439.42 | $1,439.42 | 8.1× |
| Radiologic examination femur minimum 2 views (73552) range across 4 matching MRF lines |
$242.87–$326.15 | $242.87–$326.15 | varies |
| Radiologic examination knee 1/2 views (73560) range across 5 matching MRF lines |
$500.49–$1,217.16 | $500.49–$1,217.16 | varies |
| Radiologic Examination Osseous Survey Limited (77074) range across 2 matching MRF lines |
$516.39–$629.75 | $516.39–$629.75 | varies |
| Radiologic examination tibia & fibula 2 views (73590) range across 5 matching MRF lines |
$527.97–$1,289.51 | $527.97–$1,289.51 | varies |
| Remote afterloading high dose rate radionuclide skin surface brachytherapy, includes basic dosimetry, when performed;… (77768) | $1,331.20 | $1,331.20 | 3.4× |
| Remote afterloading high dose rate radionuclide skin surface brachytherapy, includes basic dosimetry, when performed;… (77767) | $1,331.20 | $1,331.20 | 3.4× |
| Ribs bilateral 3 views (71110) range across 2 matching MRF lines |
$880.95–$1,074.29 | $880.95–$1,074.29 | varies |
| Rp loclzj tum plnr 1 area single day imaging (78800) | $1,433.55 | $1,433.55 | 3.5× |
| Rp loclzj tum plnr 2+area 1+d img/1 area img>2+d (78801) | $1,890.79 | $1,890.79 | 4.7× |
| Rp Loclzj Tum Plnr Whole Body 2+ Days Imaging (78804) | $6,463.03 | $6,463.03 | 11.8× |
| Rp Loclzj Tum Plnr Whole Body Single Day Imaging (78802) | $4,856.37 | $4,856.37 | 8.8× |
| Rp Loclzj Tum Spect 1 Area Single Day Imaging (78803) | $4,856.37 | $4,856.37 | 8.8× |
| Rp loclzj tum spect 2 area/sep acquisj img (78831) | $4,953.51 | $4,953.51 | 3.8× |
| Rp loclzj tum spect CT 2area 1d img/1 ar img>2+d (78832) | $5,619.20 | $5,619.20 | 3.9× |
| Rp loclzj tum spect w/CT 1 area/acquisj 1day img (78830) | $4,953.51 | $4,953.51 | 3.8× |
| Rp Ther Radiolbld Monoclonal Antibody IV Infus (79403) | $5,472.81 | $5,472.81 | 23.2× |
| Rp Therapy Intravenous Administration (79101) | $966.67 | $966.67 | 4.1× |
| Scapula (73010) range across 5 matching MRF lines |
$551.11–$1,342.42 | $551.11–$1,342.42 | varies |
| Screening Digital Breast Tomosynthesis Bi (77063) | $77.66 | $77.66 | 3.3× |
| Shoulder 1 view (73020) range across 5 matching MRF lines |
$409.37–$1,000.23 | $409.37–$1,000.23 | varies |
| Shoulder Arthrography (73040) range across 6 matching MRF lines |
$1,559.38–$3,118.81 | $1,559.38–$3,118.81 | varies |
| Skull less than 4 views (70250) range across 2 matching MRF lines |
$676.94–$825.56 | $676.94–$825.56 | varies |
| Special Physics Consult (77370) | $1,383.80 | $1,383.80 | 10.2× |
| Special teletherapy port plan (77321) | $1,966.52 | $1,966.52 | 5.2× |
| Special treatment procedure (77470) | $2,519.88 | $2,519.88 | 4.5× |
| Stereotactic Body Radiation Delivery (77373) | $7,638.30 | $7,638.30 | 4.2× |
| Sternoclavicular joints (71130) range across 2 matching MRF lines |
$604.64–$737.36 | $604.64–$737.36 | varies |
| Superior sagittal sinus venogram (75870) | $10,537.28 | $10,537.28 | 3.3× |
| Telethx isodose pln cplx w/basic dosimetry (77307) | $1,966.52 | $1,966.52 | 5.2× |
| Telethx isodose pln smpl w/dosimetry calculation (77306) | $1,581.69 | $1,581.69 | 4.2× |
| Ther Rad Simulaj-Aided Field Setting Complex (77290) | $1,966.52 | $1,966.52 | 5.2× |
| Ther Rad Simulaj-Aided Field Setting Intermed (77285) | $1,581.69 | $1,581.69 | 4.2× |
| Ther rad simulaj-aided field setting simple (77280) | $1,383.80 | $1,383.80 | 10.2× |
| Thoracic spine 2 views (72070) range across 2 matching MRF lines |
$678.40–$827.33 | $678.40–$827.33 | varies |
| Thoracic spine 3 views (72072) range across 2 matching MRF lines |
$760.87–$927.86 | $760.87–$927.86 | varies |
| Thoracolumbar 2 views (72080) range across 2 matching MRF lines |
$663.96–$809.71 | $663.96–$809.71 | varies |
| Thyroid Met Imaging Body (78018) | $5,103.76 | $5,103.76 | 9.3× |
| Thyroid Uptake W/Blood Flow Sngle/Mult Quan Meas (78014) | $5,206.92 | $5,206.92 | 12.9× |
| Tx Devices Design & Construction Complex (77334) | $1,383.80 | $1,383.80 | 3.7× |
| Tx devices design & construction intermediate (77333) | $580.82 | $580.82 | 4.3× |
| Tx devices design & construction simple (77332) | $691.90 | $691.90 | 5.1× |
| Ultrasound Breast Limited (76642) range across 6 matching MRF lines |
$301.02–$860.01 | $301.02–$860.01 | varies |
| Ultrasound elastography first target lesion (76982) | $458.06 | $458.06 | 4.3× |
| Ultrasound Elastography Parenchyma (76981) | $458.06 | $458.06 | 4.3× |
| Ultrasound Exam Aaa Screen (76706) range across 2 matching MRF lines |
$430.13–$458.06 | $430.13–$458.06 | varies |
| Ultrasound trgt dynamic microbubble 1st lesion (76978) | $1,293.69 | $1,293.69 | 3.7× |
| Ultrasound, abdomen limited (76705) range across 3 matching MRF lines |
$446.15–$980.19 | $446.15–$980.19 | varies |
| Umbilical-artery Doppler (OB) (76820) range across 2 matching MRF lines |
$513.69–$733.82 | $513.69–$733.82 | varies |
| Unlisted Dx Radiographic Procedure (76499) | $326.15 | $326.15 | 3.7× |
| Unlisted magnetic resonance procedure (76498) range across 2 matching MRF lines |
$3,260.39–$5,094.38 | $3,260.39–$5,094.38 | varies |
| Unlisted Miscellaneous Px Dx Nuclear Medicine (78999) | $728.28 | $728.28 | 1.8× |
| Unlisted us procedure (76999) | $405.90 | $405.90 | 4.6× |
| Upper gi w/o kub (74240) | $912.01 | $912.01 | 5.1× |
| Urethrocystogram voiding (74455) | $1,294.80 | $1,294.80 | 5.4× |
| Urethrocystography retrograde (74450) | $1,294.80 | $1,294.80 | 5.4× |
| Us breast unilateral complete (76641) range across 6 matching MRF lines |
$301.02–$860.01 | $301.02–$860.01 | varies |
| Us chest (76604) range across 2 matching MRF lines |
$552.27–$788.94 | $552.27–$788.94 | varies |
| Us complete joint (76881) range across 2 matching MRF lines |
$759.67–$1,085.25 | $759.67–$1,085.25 | varies |
| Us exam, pelvic, limited (76857) range across 2 matching MRF lines |
$452.81–$646.86 | $452.81–$646.86 | varies |
| Us head (76506) | $1,316.06 | $1,316.06 | 12.4× |
| Us kidney transplant (76776) | $633.06 | $633.06 | 6.0× |
| Us lmtd joint/oth nonvasc xtr strux r-t w/img (76882) | $904.38 | $904.38 | 8.5× |
| Us ob detailed single fetus (76811) | $1,204.12 | $1,204.12 | 5.0× |
| Us ob limited 1 or more fetuses (76815) range across 3 matching MRF lines |
$500.40–$714.90 | $500.40–$714.90 | varies |
| Us ob transvaginal (76817) range across 2 matching MRF lines |
$349.66–$499.54 | $349.66–$499.54 | varies |
| Us pelvic non ob complete (76856) range across 3 matching MRF lines |
$905.57–$1,365.61 | $905.57–$1,365.61 | varies |
| Us pg uter img f&mat 14 wk tabdl 1/1st gestation (76801) range across 2 matching MRF lines |
$349.66–$499.54 | $349.66–$499.54 | varies |
| Us preg uterus real time f/u trnsabdl per fetus (76816) range across 2 matching MRF lines |
$627.03–$895.75 | $627.03–$895.75 | varies |
| Us retroperitoneal complete (76770) range across 2 matching MRF lines |
$724.73–$1,035.29 | $724.73–$1,035.29 | varies |
| Us retroperitoneal limited (76775) range across 2 matching MRF lines |
$552.27–$788.94 | $552.27–$788.94 | varies |
| Us scrotum and contents (76870) range across 2 matching MRF lines |
$724.73–$1,035.29 | $724.73–$1,035.29 | varies |
| Us spinal canal and contents (76800) | $788.94 | $788.94 | 7.5× |
| Us thyroid (76536) range across 2 matching MRF lines |
$659.59–$942.29 | $659.59–$942.29 | varies |
| Us transrectal (76872) | $935.40 | $935.40 | 8.8× |
| Vascular Flow Imaging (78445) | $2,506.23 | $2,506.23 | 6.2× |
| Vein X-Ray Chest (75827) | $5,773.38 | $5,773.38 | 3.6× |
| Vein X-Ray Liver W/O Hemodyn (75887) | $6,665.91 | $6,665.91 | 2.1× |
| Vein X-Ray Spleen/Liver (75810) | $1,080.06 | $1,080.06 | 0.3× |
| Venogram Sinus/Jugular (75860) | $15,594.65 | $15,594.65 | 4.9× |
| Venography Adrenal Unilateral (75840) | $12,073.13 | $12,073.13 | 3.8× |
| Venography caval inferior serialography rs&i (75825) | $12,073.13 | $12,073.13 | 3.8× |
| Venography extremity bilateral rs&i (75822) | $6,665.91 | $6,665.91 | 4.2× |
| Venography extremity unilateral rs&i (75820) range across 3 matching MRF lines |
$3,168.19–$3,479.70 | $3,168.19–$3,479.70 | varies |
| Venography Renal Bilateral (75833) | $13,759.78 | $13,759.78 | 4.3× |
| Venography Renal Unilateral (75831) | $13,166.09 | $13,166.09 | 4.1× |
| Venous sampling by catheter (75893) | $20,656.59 | $20,656.59 | 3.7× |
| Vertebral fracture assessment via dxa (77086) | $462.72 | $462.72 | 5.3× |
| Wrist 2 views (73100) range across 5 matching MRF lines |
$444.09–$1,083.11 | $444.09–$1,083.11 | varies |
| X-Ray Ac Jts - Xr Acromioclavicular Joints Bilateral (73050) range across 2 matching MRF lines |
$678.40–$827.33 | $678.40–$827.33 | varies |
| X-ray antegrade pyelogram tube (74425) range across 2 matching MRF lines |
$1,294.80–$1,370.95 | $1,294.80–$1,370.95 | varies |
| X-Ray Aorta Leg Arteries (75630) | $12,073.13 | $12,073.13 | 3.8× |
| X-Ray Elbow 2 Vw - Xr Elbow 1-2 Views Right (73070) range across 5 matching MRF lines |
$444.09–$1,083.11 | $444.09–$1,083.11 | varies |
| X-Ray Exam Breast Specimen (76098) | $974.43 | $974.43 | 1.8× |
| X-Ray Exam Entire Spi 1 Vw (72081) range across 2 matching MRF lines |
$242.87–$326.15 | $242.87–$326.15 | varies |
| X-Ray Exam Entire Spi 2/3 Vw (72082) range across 2 matching MRF lines |
$402.24–$490.53 | $402.24–$490.53 | varies |
| X-Ray Exam Entire Spi 4/5 Vw (72083) range across 2 matching MRF lines |
$766.89–$935.22 | $766.89–$935.22 | varies |
| X-Ray Exam Hip Uni 1 View (73501) range across 4 matching MRF lines |
$242.87–$326.15 | $242.87–$326.15 | varies |
| X-Ray Exam Hip Uni 2-3 Views (73502) range across 4 matching MRF lines |
$242.87–$326.15 | $242.87–$326.15 | varies |
| X-Ray Exam Hip Uni 4/> Views (73503) range across 4 matching MRF lines |
$402.24–$490.53 | $402.24–$490.53 | varies |
| X-Ray Exam Hips Bi 2 Views (73521) range across 3 matching MRF lines |
$402.24–$985.92 | $402.24–$985.92 | varies |
| X-Ray Exam Hips Bi 3-4 Views (73522) range across 3 matching MRF lines |
$766.89–$1,870.43 | $766.89–$1,870.43 | varies |
| X-Ray Exam Hips Bi 5/> Views (73523) range across 3 matching MRF lines |
$766.89–$1,870.43 | $766.89–$1,870.43 | varies |
| X-Ray Exam L-S Spine Bending (72114) range across 2 matching MRF lines |
$1,118.17–$1,363.62 | $1,118.17–$1,363.62 | varies |
| X-Ray Exam Neck Spine 2-3 Vw (72040) range across 2 matching MRF lines |
$432.50–$527.45 | $432.50–$527.45 | varies |
| X-Ray Exam Neck Spine 6/>Vws (72052) range across 2 matching MRF lines |
$1,029.92–$1,255.98 | $1,029.92–$1,255.98 | varies |
| X-Ray Exam Unilat Ribs/Chest (71101) range across 4 matching MRF lines |
$786.91–$959.64 | $786.91–$959.64 | varies |
| X-ray humerus (73060) range across 4 matching MRF lines |
$444.09–$541.56 | $444.09–$541.56 | varies |
| X-ray IV pyelogram (ivp) (74400) | $1,848.71 | $1,848.71 | 10.4× |
| X-ray IV pyelogram+tomography (74415) | $2,469.65 | $2,469.65 | 13.9× |
| X-Ray Jaw <4 Vw - Xr Mandible < 4 Views (70100) range across 2 matching MRF lines |
$568.47–$693.26 | $568.47–$693.26 | varies |
| X-Ray Knee Bilat Standing - Xr Knees Anteroposterior Standing Bilat (73565) range across 2 matching MRF lines |
$459.98–$560.95 | $459.98–$560.95 | varies |
| X-Ray Lumbar Spine 2/3 Vw - Xr Lumbar Spine 2-3 Views (72100) range across 2 matching MRF lines |
$661.06–$806.17 | $661.06–$806.17 | varies |
| X-ray nose-rectum child f.b. (76010) range across 2 matching MRF lines |
$594.68–$643.89 | $594.68–$643.89 | varies |
| X-Ray Ribs, Chest 4+ Vw - Xr Ribs 3 Vws Bil W/ Chest Posteroanterior (71111) range across 2 matching MRF lines |
$1,002.41–$1,222.45 | $1,002.41–$1,222.45 | varies |
| X-Ray Sacroiliac Jts 3+ Vw - Xr Sacroiliac Joints 3+ Views (72202) range across 2 matching MRF lines |
$580.04–$707.39 | $580.04–$707.39 | varies |
| X-Ray Sacrum/Coccyx 2+ Vw - Xr Sacrum Coccyx 2+ Views (72220) range across 2 matching MRF lines |
$580.04–$707.39 | $580.04–$707.39 | varies |
| X-Ray Sinuses 3+ Vw - Xr Paranasal Sinuses 3+ Views (70220) range across 2 matching MRF lines |
$786.91–$959.64 | $786.91–$959.64 | varies |
| X-Ray Skull 4+ Vw - Xr Skull Complete 4+ Views (70260) range across 2 matching MRF lines |
$859.23–$1,047.85 | $859.23–$1,047.85 | varies |
| X-ray thoracic spine 4 vw (72074) | $1,083.11 | $1,083.11 | 10.2× |
| X-Ray Tmj Unilat (70328) | $352.95 | $352.95 | 4.0× |
| X-Ray Urinary Tract Exam With Contrast Material (74420) | $1,541.75 | $1,541.75 | 4.4× |
| X-Rays Bone Length Studies (77073) range across 2 matching MRF lines |
$768.09–$936.72 | $768.09–$936.72 | varies |
| X-Rays Bone Survey Complete (77075) range across 2 matching MRF lines |
$1,614.28–$1,968.63 | $1,614.28–$1,968.63 | varies |
| Xr c-spine 4 or 5 views (72050) range across 2 matching MRF lines |
$852.01–$1,039.01 | $852.01–$1,039.01 | varies |
| Xr facial bones less than 3 views (70140) range across 2 matching MRF lines |
$568.47–$693.26 | $568.47–$693.26 | varies |
| XR Mastoids < 3 Views Bilateral (70120) | $566.25 | $566.25 | 5.3× |
| Xr orbits complete 4 views (70200) range across 2 matching MRF lines |
$747.82–$912.01 | $747.82–$912.01 | varies |
| Xr Tomogram Single Plane (76100) range across 3 matching MRF lines |
$226.02–$927.86 | $226.02–$927.86 | 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.