Imaging prices at Stony Brook University Hospital
Stony Brook, NY · every code in this section with a posted price and a Medicare benchmark.
464 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 3 matching MRF lines |
$14,247–$15,244 | $14,247–$15,244 | varies |
| Abdomen 1 View (74018) range across 3 matching MRF lines |
$747–$799 | $747–$799 | varies |
| Abdomen 2 views (74019) range across 2 matching MRF lines |
$873–$934 | $873–$934 | varies |
| Acute Gastrointestinal Blood Loss Imaging (78278) | $1,637 | $1,637 | 3.3× |
| Acute venous thrombosis imaging, peptide Non-Facility (78456) | $3,862 | $3,862 | 2.4× |
| Adrenal Cortex & Medulla Img (78075) | $5,555 | $5,555 | 3.4× |
| Angio internal mammary (75756) range across 2 matching MRF lines |
$5,736–$6,138 | $5,736–$6,138 | varies |
| Angio pulmonary bilat (75743) range across 2 matching MRF lines |
$7,484–$8,008 | $7,484–$8,008 | varies |
| Angiography Adrenal Bilateral Slctv Rs&I (75733) | $8,008 | $8,008 | 2.0× |
| Angiography extremity bilateral rs&i (75716) range across 2 matching MRF lines |
$10,522–$11,259 | $10,522–$11,259 | varies |
| Angiography extremity unilateral rs&i (75710) range across 3 matching MRF lines |
$199–$8,417 | $199–$8,417 | varies |
| Angiography pulmonary unilateral slctv rs&i (75741) range across 2 matching MRF lines |
$7,484–$8,008 | $7,484–$8,008 | varies |
| Angrph pulmonary nonslctv cath/ven njx rs&i (75746) | $7,747 | $7,747 | 2.0× |
| Ankle 2 views (73600) range across 4 matching MRF lines |
$689–$2,067 | $689–$2,067 | varies |
| Aortography thoracic serialography rs&i (75605) | $13,696 | $13,696 | 2.0× |
| Aortography thoracic w/o serialography rs&i (75600) | $8,008 | $8,008 | 2.0× |
| Artery X-Rays Abdomen (75726) range across 3 matching MRF lines |
$10,339–$20,678 | $10,339–$20,678 | varies |
| Artery X-Rays Adrenal Gland (75731) | $7,870 | $7,870 | 2.0× |
| Artery X-Rays Pelvis (75736) range across 2 matching MRF lines |
$8,943–$16,716 | $8,943–$16,716 | varies |
| Artery X-Rays Spine (75705) range across 2 matching MRF lines |
$371.67–$8,417 | $371.67–$8,417 | varies |
| Arthrogram ankle (73615) | $2,297 | $2,297 | 5.3× |
| Arthrogram hip (73525) | $2,467 | $2,467 | 5.7× |
| Arthrogram Wrist (73115) | $2,467 | $2,467 | 5.7× |
| Basic radiation dosimetry calculation (77300) range across 4 matching MRF lines |
$1,457–$6,232 | $1,457–$6,232 | varies |
| Bone age studies (77072) range across 2 matching MRF lines |
$737–$789 | $737–$789 | varies |
| Bone Imaging 3 Phase (78315) range across 2 matching MRF lines |
$4,129–$4,418 | $4,129–$4,418 | varies |
| Bone Imaging Limited Area (78300) | $1,623 | $1,623 | 3.3× |
| Bone Imaging Multiple Areas (78305) | $3,259 | $3,259 | 6.5× |
| Bone Imaging Whole Body (78306) range across 2 matching MRF lines |
$3,551–$3,800 | $3,551–$3,800 | varies |
| Bone marrow imaging limited area (78102) | $2,096 | $2,096 | 4.2× |
| Bone marrow imaging; multiple areas (78103) | $1,165 | $1,165 | 2.3× |
| Bone survey infant (77076) range across 2 matching MRF lines |
$765–$819 | $765–$819 | varies |
| Brachytx isodose complex (77318) range across 2 matching MRF lines |
$3,723–$3,984 | $3,723–$3,984 | varies |
| Brachytx isodose intermed (77317) range across 2 matching MRF lines |
$2,097–$2,244 | $2,097–$2,244 | varies |
| Brachytx Isodose Plan Simple (77316) range across 2 matching MRF lines |
$2,089–$2,235 | $2,089–$2,235 | varies |
| Brain imaging < 4 static views (78600) | $2,072 | $2,072 | 4.2× |
| Brain Imaging Minimum 4 Static Views (78605) | $2,602 | $2,602 | 3.8× |
| Brain Imaging Pet Metabolic Evaluation (78608) range across 3 matching MRF lines |
$2,242–$11,903 | $2,242–$11,903 | varies |
| Card Bl Pool Gated Spect Rest Wal Motn Ejct Frct (78494) | $1,692 | $1,692 | 3.4× |
| Cardiac MRI w/w/o contrast & further seq (75561) range across 2 matching MRF lines |
$9,864–$10,554 | $9,864–$10,554 | varies |
| Cardiac MRI w/w/o contrast w/stress (75563) | $10,554 | $10,554 | 10.8× |
| Cardiac Shunt Detection (78428) | $2,233 | $2,233 | 4.5× |
| Cat Scan Follow-Up Study (76380) range across 2 matching MRF lines |
$974–$1,042 | $974–$1,042 | varies |
| Cerebrospinal Fluid Flow W/O Matl Shunt Evaltj (78645) range across 2 matching MRF lines |
$2,378–$2,544 | $2,378–$2,544 | varies |
| Cerebrospinal fluid flow, imaging (not including introduction of material); ventriculography Non-Facility (78635) | $2,801 | $2,801 | 4.1× |
| Cerebrospinal Fluid Scan (78630) | $2,982 | $2,982 | 4.4× |
| Chest 1 view (71045) range across 4 matching MRF lines |
$745.86–$799 | $745.86–$799 | varies |
| Chest 2 views (71046) range across 3 matching MRF lines |
$745.86–$799 | $745.86–$799 | varies |
| Chest 3 views (71047) range across 2 matching MRF lines |
$873–$934 | $873–$934 | varies |
| Chest 4 or more views (71048) | $934 | $934 | 7.2× |
| Chg us nrv&acc strux 1 xtr compre w/img pr extremity (76883) | $896 | $896 | 6.9× |
| Cholecystography Oral Contrast (74290) | $851 | $851 | 3.9× |
| Cineradiograpy/vidradiograpy xcpt where spec (76120) | $1,471 | $1,471 | 11.3× |
| Clavicle complete (73000) range across 4 matching MRF lines |
$472.50–$1,011 | $472.50–$1,011 | varies |
| Computed Tomography Thorax Lw Dose Lng Ca Scr C- (71271) range across 2 matching MRF lines |
$42.32–$1,184 | $42.32–$1,184 | varies |
| Continuing medical physics consltj pr wk (77336) range across 3 matching MRF lines |
$1,925–$2,060 | $1,925–$2,060 | varies |
| Contrast Exam Abdominl Aorta (75625) range across 3 matching MRF lines |
$12,800–$13,696 | $12,800–$13,696 | varies |
| Contrast X-Ray Bladder (74430) | $2,091 | $2,091 | 4.8× |
| Contrast X-Ray Of Elbow (73085) | $2,467 | $2,467 | 5.7× |
| Contrast X-Ray Of Knee Joint (73580) | $2,467 | $2,467 | 5.7× |
| Corpora cavernosography (74445) | $1,344 | $1,344 | 10.3× |
| CT abdomen and pelvis without and with contrast (74178) range across 2 matching MRF lines |
$8,632–$9,236 | $8,632–$9,236 | varies |
| CT abdomen and pelvis without contrast (74176) range across 4 matching MRF lines |
$5,527.20–$5,915 | $5,527.20–$5,915 | varies |
| CT abdomen w contrast (74160) range across 3 matching MRF lines |
$5,170–$5,532 | $5,170–$5,532 | varies |
| CT abdomen w wo contrast (74170) range across 3 matching MRF lines |
$5,797–$6,203 | $5,797–$6,203 | varies |
| CT abdomen w/o contrast (74150) range across 2 matching MRF lines |
$3,339–$3,573 | $3,339–$3,573 | varies |
| CT Angio Abdomen and Pelvis (74174) range across 4 matching MRF lines |
$7,007–$7,497 | $7,007–$7,497 | varies |
| CT Angio Chest (71275) range across 4 matching MRF lines |
$6,089–$6,515 | $6,089–$6,515 | varies |
| CT Angio Head (70496) range across 3 matching MRF lines |
$5,719.75–$6,438 | $5,719.75–$6,438 | varies |
| CT angio hrt w/3d image (75574) range across 3 matching MRF lines |
$3,820–$4,087 | $3,820–$4,087 | varies |
| Ct Angio Lwr Extr W/O&W/Dye (73706) range across 2 matching MRF lines |
$3,529–$3,776 | $3,529–$3,776 | varies |
| CT Angio Neck (70498) range across 3 matching MRF lines |
$5,502–$5,887 | $5,502–$5,887 | varies |
| Ct Angio Upr Extrm W/O&W/Dye (73206) range across 3 matching MRF lines |
$3,109–$3,327 | $3,109–$3,327 | varies |
| CT Cere Prfuj Alys C+ W/O CT/Cta Same Anatomy (70473) | $5,000 | $5,000 | 22.8× |
| CT cervical spine w/ contrast (72126) range across 2 matching MRF lines |
$4,717–$5,047 | $4,717–$5,047 | varies |
| CT cervical spine w/o contrast (72125) range across 4 matching MRF lines |
$3,102.02–$3,320 | $3,102.02–$3,320 | varies |
| CT cervical spine w/wo cont (72127) | $5,092 | $5,092 | 23.3× |
| CT chest w contrast (71260) range across 4 matching MRF lines |
$5,128–$5,488 | $5,128–$5,488 | varies |
| CT chest w/wo contrast (71270) range across 2 matching MRF lines |
$6,038–$6,461 | $6,038–$6,461 | varies |
| CT colonography screening (74263) | $1,761 | $1,761 | 5.9× |
| CT Colonogrphy Dx Image Postprocess W/Contrast (74262) | $2,343 | $2,343 | 10.7× |
| CT colonogrphy dx image postprocess w/o contrast (74261) | $2,343 | $2,343 | 18.0× |
| CT head/brain with contrast (70460) range across 2 matching MRF lines |
$3,998–$4,278 | $3,998–$4,278 | varies |
| CT head/brain without and with contrast (70470) range across 3 matching MRF lines |
$4,525–$7,521 | $4,525–$7,521 | varies |
| CT heart contrast eval cardiac structure&morph (75572) range across 2 matching MRF lines |
$1,684–$1,802 | $1,684–$1,802 | varies |
| CT heart no contrast quant eval coronry calcium (75571) range across 2 matching MRF lines |
$122–$131 | $122–$131 | varies |
| CT hrt w/3d image congen (75573) range across 2 matching MRF lines |
$1,684–$1,802 | $1,684–$1,802 | varies |
| CT iac w contrast (70481) range across 4 matching MRF lines |
$2,064.50–$4,418 | $2,064.50–$4,418 | varies |
| CT l-spine w&w/o contrast (72133) | $4,051 | $4,051 | 18.5× |
| CT lower ext w/o (73700) range across 2 matching MRF lines |
$2,685–$2,873 | $2,685–$2,873 | varies |
| CT lower extremity w/contrast material (73701) range across 3 matching MRF lines |
$1,933.50–$4,138 | $1,933.50–$4,138 | varies |
| CT lumbar spine w contrast (72132) range across 2 matching MRF lines |
$3,786–$4,051 | $3,786–$4,051 | varies |
| CT lumbar spine w/o contrast (72131) range across 3 matching MRF lines |
$2,540.74–$2,719 | $2,540.74–$2,719 | varies |
| CT maxillofacial w contrast (70487) range across 3 matching MRF lines |
$4,970–$5,318 | $4,970–$5,318 | varies |
| CT maxillofacial wo contrast (70486) range across 5 matching MRF lines |
$4,054.97–$5,318 | $4,054.97–$5,318 | varies |
| CT neck tissue combo (70492) range across 2 matching MRF lines |
$4,495–$4,810 | $4,495–$4,810 | varies |
| Ct Orbit/Ear/Fossa W/O&W/Dye (70482) | $4,464 | $4,464 | 20.4× |
| CT orbits w/o contrast (70480) range across 4 matching MRF lines |
$2,946–$3,153.75 | $2,946–$3,153.75 | varies |
| CT pelvis w&w/o contrast (72194) | $4,546 | $4,546 | 20.8× |
| CT pelvis w/o contrast (72192) range across 2 matching MRF lines |
$3,119–$3,337 | $3,119–$3,337 | varies |
| CT scan of leg combo (73702) | $4,138 | $4,138 | 18.9× |
| CT scans face/jaw combo (70488) | $5,934 | $5,934 | 27.1× |
| CT soft tissue neck w contrast (70491) range across 3 matching MRF lines |
$4,196.05–$4,491 | $4,196.05–$4,491 | varies |
| CT soft tissue neck w/o contrast (70490) range across 4 matching MRF lines |
$3,141.04–$3,363 | $3,141.04–$3,363 | varies |
| CT thoracic spine w contrast (72129) | $3,389 | $3,389 | 15.5× |
| CT thoracic spine w/o contrast (72128) range across 3 matching MRF lines |
$2,552–$2,731 | $2,552–$2,731 | varies |
| CT thoracic spine w/wo cont (72130) | $3,573 | $3,573 | 16.3× |
| CT thorax w/o contrast (71250) range across 4 matching MRF lines |
$3,560–$3,809 | $3,560–$3,809 | varies |
| CT unlisted procedure (76497) | $430 | $430 | 4.0× |
| CT upper ext wo (73200) range across 2 matching MRF lines |
$2,404–$2,572 | $2,404–$2,572 | varies |
| CT upper extremity w/o & w/contrast material (73202) range across 2 matching MRF lines |
$2,357–$2,522 | $2,357–$2,522 | varies |
| CT upper extremity with contrast (73201) range across 2 matching MRF lines |
$2,957–$3,164 | $2,957–$3,164 | varies |
| Cta Abdl Aorta&Bi Iliofem W/Contrast&Postp (75635) range across 4 matching MRF lines |
$4,337–$4,641 | $4,337–$4,641 | varies |
| Cta Abdomen (74175) range across 3 matching MRF lines |
$5,605–$5,997 | $5,605–$5,997 | varies |
| CTA head&neck c+ w/noncontrast img&post-pxessing (70471) | $10,000 | $10,000 | 23.0× |
| CTA pelvis (72191) range across 2 matching MRF lines |
$4,370–$4,676 | $4,370–$4,676 | varies |
| Dacryocystography, nasolacrimal duct, radiological supervision and interpretation Non-Facility (70170) | $895 | $895 | 3.0× |
| Dilation ureters/urethra rs&i (74485) | $4,780 | $4,780 | 1.8× |
| Discography Cerv/Thor Spine (72285) | $9,215 | $9,215 | 3.8× |
| Diskography lumbar (72295) | $3,448 | $3,448 | 1.4× |
| Doppler Echo Fetal Puls Spectral F/U/Repeat (76828) range across 2 matching MRF lines |
$345–$369 | $345–$369 | varies |
| Doppler Echo Fetal Spectral Display Complete (76827) range across 2 matching MRF lines |
$345–$369 | $345–$369 | varies |
| Doppler Fetal Mid Cerebral Artery (76821) range across 3 matching MRF lines |
$651–$697 | $651–$697 | varies |
| Dxa Bone Density Axial (77080) range across 3 matching MRF lines |
$1,299–$1,524 | $1,299–$1,524 | varies |
| Dxa bone density study (77085) range across 2 matching MRF lines |
$386–$413 | $386–$413 | varies |
| Dxa bone density study 1/>sites appendiclr skel (77081) range across 3 matching MRF lines |
$454–$486 | $454–$486 | varies |
| Echo exam of fetal heart (76825) range across 2 matching MRF lines |
$3,224–$3,450 | $3,224–$3,450 | varies |
| Echo exam uterus (76831) | $3,213 | $3,213 | 10.8× |
| Echocardiography, fetal, cardiovascular system, real time with image documentation (2D), with or without M-mode… (76826) range across 2 matching MRF lines |
$699–$748 | $699–$748 | varies |
| Echograp Trans R Pros Study (76873) | $402 | $402 | 3.1× |
| Esophagram (74220) range across 2 matching MRF lines |
$1,222–$1,308 | $1,222–$1,308 | varies |
| Fetal Biophys Profile W/Nst (76818) range across 2 matching MRF lines |
$1,265–$1,354 | $1,265–$1,354 | varies |
| Fetal Biophysical Profile W/O Non-Stress Testing (76819) range across 2 matching MRF lines |
$1,097–$1,174 | $1,097–$1,174 | varies |
| Fetal MRI w/placntl matrnl plvc img sing/1st ges (74712) | $5,047 | $5,047 | 16.9× |
| Fluoroscopy up to 1 hr (76000) range across 4 matching MRF lines |
$1,213–$1,701 | $1,213–$1,701 | varies |
| Follow-Up Angiography (75898) range across 3 matching MRF lines |
$2,340–$4,680 | $2,340–$4,680 | varies |
| Foot 2 views (73620) range across 2 matching MRF lines |
$607–$649 | $607–$649 | varies |
| Forearm 2 views (73090) range across 5 matching MRF lines |
$720.35–$771 | $720.35–$771 | varies |
| Gastric emptying imaging study (78264) range across 3 matching MRF lines |
$4,645–$4,970 | $4,645–$4,970 | varies |
| Gastric Emptyng Imag Std W/Sm Bwl Transit (78265) | $1,124 | $1,124 | 2.3× |
| Gastroesophageal Reflux Exam (78262) | $1,122 | $1,122 | 2.2× |
| Gated Heart Planar Single (78472) | $4,194 | $4,194 | 8.4× |
| Gated Heart, Multiple (78473) | $4,007 | $4,007 | 8.0× |
| GI Endoscopic US S&I (76975) | $1,084 | $1,084 | 3.6× |
| Gstrc Emptng Imag Std W/Sm Bwl Col Trnst Mlt Day (78266) | $1,455 | $1,455 | 2.1× |
| Hand 2 views (73120) range across 2 matching MRF lines |
$1,296–$1,387 | $1,296–$1,387 | varies |
| Hdr Rdncl Ntrstl/Icav Brchtx (77772) range across 2 matching MRF lines |
$4,535–$4,852 | $4,535–$4,852 | varies |
| Hdr Rdncl Ntrstl/Icav Brchtx (77771) range across 2 matching MRF lines |
$4,535–$4,852 | $4,535–$4,852 | varies |
| Hdr Rdncl Ntrstl/Icav Brchtx 1 Channel (77770) range across 2 matching MRF lines |
$4,535–$4,852 | $4,535–$4,852 | varies |
| Heart first pass single,planar (78481) | $1,455 | $1,455 | 2.1× |
| Heart Image (Pet) Multiple (78492) | $4,422 | $4,422 | 2.5× |
| Hepatc Vngrph Wdg/Fr Hemodyn Eval Rs&I (75889) | $8,003 | $8,003 | 2.0× |
| Hepatc Vngrph Wdg/Fr W/O Hemodyn Eval Rs&I (75891) | $8,003 | $8,003 | 2.0× |
| Hepatobil Syst Image W/Drug (78227) range across 2 matching MRF lines |
$2,524–$2,701 | $2,524–$2,701 | varies |
| Hepatobiliary System Imaging (78226) range across 2 matching MRF lines |
$2,830–$3,028 | $2,830–$3,028 | varies |
| Ht Muscle Image Spect Sing (78451) range across 2 matching MRF lines |
$4,007–$4,287 | $4,007–$4,287 | varies |
| Hysterosalpingogram (74740) range across 2 matching MRF lines |
$1,227–$1,313 | $1,227–$1,313 | varies |
| Infant hip ultrasound with hip movement (dynamic) (76885) range across 3 matching MRF lines |
$747–$799 | $747–$799 | varies |
| Infant hip ultrasound, limited static exam (76886) range across 2 matching MRF lines |
$747–$799 | $747–$799 | varies |
| Infusion Ivp (74410) | $809 | $809 | 3.7× |
| Interstitial radiation source applic complex (77778) | $9,978 | $9,978 | 11.5× |
| K Flow/Funct Image Multiple (78709) | $5,823 | $5,823 | 8.6× |
| K Flow/Funct Image W/Drug (78708) range across 2 matching MRF lines |
$3,048–$3,690 | $3,048–$3,690 | varies |
| K Flow/Funct Image W/O Drug (78707) range across 2 matching MRF lines |
$2,643–$2,828 | $2,643–$2,828 | varies |
| Kidney Funcj Study Non-Img Radioisotopic Study (78725) | $1,122 | $1,122 | 2.2× |
| Kidney Imaging Morphol (78700) | $1,799 | $1,799 | 3.6× |
| Knee 3 Views (73562) range across 2 matching MRF lines |
$735–$786 | $735–$786 | varies |
| Leveen/Shunt Patency Exam (78291) | $2,072 | $2,072 | 4.2× |
| Liver & Spleen Imaging Static Only (78215) | $3,240 | $3,240 | 6.5× |
| Liver imaging static only (78201) | $1,859 | $1,859 | 2.7× |
| Liver imaging w/vascular flow (78202) | $1,866 | $1,866 | 2.8× |
| Lung Perf&Ventilat Diferentl (78598) range across 2 matching MRF lines |
$3,348–$3,582 | $3,348–$3,582 | varies |
| Lung perfusion differential (78597) range across 3 matching MRF lines |
$492.29–$2,018 | $492.29–$2,018 | varies |
| Lung Ventilat&Perfus Imaging (78582) | $3,199 | $3,199 | 4.7× |
| Lung Ventilation Imaging (78579) | $1,080 | $1,080 | 2.2× |
| Lymph System Imaging (78195) range across 2 matching MRF lines |
$2,356–$2,521 | $2,356–$2,521 | varies |
| Lymphangiography Extremity Only Bilateral Rs&I (75803) | $2,839 | $2,839 | 1.4× |
| Lymphangiography extremity only unilateral rs&i (75801) | $1,891 | $1,891 | 2.4× |
| Lymphangiography Pelvic/Abdominal Bilateral Rs&I (75807) | $2,110 | $2,110 | 0.5× |
| Lymphangiography, pelvic/abdominal, unilateral (75805) | $1,405 | $1,405 | 0.4× |
| Magnetic Image Jaw Joint (70336) range across 2 matching MRF lines |
$3,018–$3,229 | $3,018–$3,229 | varies |
| Magnetic Resonance Elastography (76391) | $710 | $710 | 2.4× |
| Mammary ductogram or galactogram multiple (77054) | $1,422 | $1,422 | 4.8× |
| Mammary ductogram or galactogram single (77053) | $1,360 | $1,360 | 4.6× |
| Meckels Divert Exam (78290) range across 2 matching MRF lines |
$2,794–$2,990 | $2,794–$2,990 | varies |
| Mlc imrt design & construction per imrt plan (77338) range across 2 matching MRF lines |
$4,614–$4,937 | $4,614–$4,937 | varies |
| Mra Head W/O & W/Contrast Material (70546) range across 2 matching MRF lines |
$9,954–$10,651 | $9,954–$10,651 | varies |
| MRA head w/o contrast (70544) range across 2 matching MRF lines |
$6,880–$7,362 | $6,880–$7,362 | varies |
| MRA head with contrast (70545) | $7,954 | $7,954 | 18.3× |
| MRA neck w contrast (70548) | $5,445 | $5,445 | 12.5× |
| Mra Neck W/O &W/Contrast Material (70549) range across 4 matching MRF lines |
$6,745–$7,478 | $6,745–$7,478 | varies |
| MRA neck w/o contrast (70547) range across 3 matching MRF lines |
$5,414–$5,793 | $5,414–$5,793 | varies |
| MRI abdomen w contrast (74182) | $7,947 | $7,947 | 18.2× |
| MRI abdomen w/o contrast (74181) range across 2 matching MRF lines |
$2,787–$2,982 | $2,787–$2,982 | varies |
| MRI any jt lower extrem w/contrast material (73722) | $6,401 | $6,401 | 6.5× |
| MRI any jt lower extrem w/o & w/contrast matrl (73723) range across 3 matching MRF lines |
$8,116–$8,684 | $8,116–$8,684 | varies |
| MRI any jt upper extremity w/contrast matrl (73222) | $6,408 | $6,408 | 6.5× |
| MRI bone marrow blood supply (77084) | $6,610 | $6,610 | 22.2× |
| MRI brain functional w/o physician admnistration (70554) range across 3 matching MRF lines |
$1,700–$1,819 | $1,700–$1,819 | varies |
| MRI brain functional w/physician admnistration (70555) range across 2 matching MRF lines |
$1,175–$1,257 | $1,175–$1,257 | varies |
| MRI Breast W/O Contrast Bilateral (77047) range across 3 matching MRF lines |
$4,450–$4,762 | $4,450–$4,762 | varies |
| MRI Breast Without Contrast Material Unilateral (77046) range across 2 matching MRF lines |
$4,450–$4,762 | $4,450–$4,762 | varies |
| MRI cardiac w/o cont stress (75559) | $6,398 | $6,398 | 9.4× |
| MRI cardiac w/o contrast (75557) range across 2 matching MRF lines |
$3,257–$3,485 | $3,257–$3,485 | varies |
| MRI cervical spine w contrast (72142) range across 2 matching MRF lines |
$9,074–$9,709 | $9,074–$9,709 | varies |
| MRI cervical spine w/o cont (72141) range across 2 matching MRF lines |
$7,119–$7,617 | $7,119–$7,617 | varies |
| MRI chest w/o contrast (71550) range across 2 matching MRF lines |
$6,006–$6,426 | $6,006–$6,426 | varies |
| MRI chest with contrast (71551) | $7,475 | $7,475 | 7.6× |
| MRI chest wo w contrast (71552) range across 3 matching MRF lines |
$7,610–$8,143 | $7,610–$8,143 | varies |
| MRI lower extrem oth/thn jt w/contrast matrl (73719) | $7,457 | $7,457 | 17.1× |
| MRI lower extrem oth/thn jt w/o & w/contr matr (73720) range across 3 matching MRF lines |
$7,641–$15,282 | $7,641–$15,282 | varies |
| MRI lower extrem oth/thn jt w/o contr matrl (73718) range across 3 matching MRF lines |
$5,489–$5,873 | $5,489–$5,873 | varies |
| MRI lumbar spine w contrast (72149) range across 2 matching MRF lines |
$9,502–$15,910 | $9,502–$15,910 | varies |
| Mri Neck Spine W/O & W/Dye (72156) range across 2 matching MRF lines |
$8,149–$8,719 | $8,149–$8,719 | varies |
| MRI orbit face &/neck w/o contrast (70540) range across 3 matching MRF lines |
$4,606–$4,928 | $4,606–$4,928 | varies |
| MRI orbit face neck w contrast (70542) range across 2 matching MRF lines |
$4,622–$4,946 | $4,622–$4,946 | varies |
| Mri Orbt/Fac/Nck W/O &W/Dye (70543) range across 2 matching MRF lines |
$7,247–$7,754 | $7,247–$7,754 | varies |
| MRI pelvis w contrast (72196) | $6,795 | $6,795 | 15.6× |
| MRI pelvis w/o & w contrast (72197) range across 2 matching MRF lines |
$7,694–$8,233 | $7,694–$8,233 | varies |
| MRI pelvis w/o contrast (72195) range across 3 matching MRF lines |
$5,666–$6,063 | $5,666–$6,063 | varies |
| MRI spectroscopy (76390) range across 2 matching MRF lines |
$3,664–$3,920 | $3,664–$3,920 | varies |
| MRI thoracic spine w/o contrast (72146) range across 2 matching MRF lines |
$5,973–$6,391 | $5,973–$6,391 | varies |
| MRI upper extremity oth than jt w/contr matrl (73219) | $7,889 | $7,889 | 18.1× |
| MRI upper extremity oth than jt w/o contr matrl (73218) range across 3 matching MRF lines |
$5,107–$6,218 | $5,107–$6,218 | varies |
| Mri Uppr Extremity W/O&W/Dye (73220) range across 3 matching MRF lines |
$7,373–$8,431 | $7,373–$8,431 | varies |
| MRI, abdomen, combo (74183) range across 2 matching MRF lines |
$9,646–$10,321 | $9,646–$10,321 | varies |
| MRI, dorsal spine combo (72157) range across 2 matching MRF lines |
$8,281–$8,861 | $8,281–$8,861 | varies |
| MRI, dorsal spine contrast (72147) range across 2 matching MRF lines |
$8,447–$9,038 | $8,447–$9,038 | varies |
| MRI, joint upper extrem (73221) range across 2 matching MRF lines |
$5,367–$5,743 | $5,367–$5,743 | varies |
| MRI, joint upper extrem combo (73223) range across 3 matching MRF lines |
$6,267–$6,706 | $6,267–$6,706 | varies |
| MRI, lumbar spine combo (72158) range across 2 matching MRF lines |
$8,075–$8,640 | $8,075–$8,640 | varies |
| Myelogram cervical (72240) | $2,271 | $2,271 | 2.3× |
| Myelogram Lumbar (72265) | $4,766 | $4,766 | 4.9× |
| Myelography thoracic (72255) | $1,439 | $1,439 | 1.5× |
| Myelograpy 2/more regions rs&i (72270) | $2,607 | $2,607 | 2.7× |
| Myocardial Imaging Infarct Avid Planar Qual/Quan (78466) | $2,157 | $2,157 | 4.3× |
| Myocardial Imaging Pet Metabolic Evaluation (78459) | $3,862 | $3,862 | 2.4× |
| Myocardial Spect Multiple Studies (78452) range across 2 matching MRF lines |
$7,672–$8,209 | $7,672–$8,209 | varies |
| Myocrd Img Pet Metab Eval Single Study Cncrnt CT (78429) | $9,239 | $9,239 | 5.2× |
| Myocrd img PET prfuj 1std rest/stress cncrnt CT (78430) | $11,314 | $11,314 | 6.3× |
| Myocrd Img Pet Prfuj Mlt Std Rst&Strs Cncrnt CT (78431) | $11,314 | $11,314 | 4.1× |
| Myocrd Img Pet Prfuj W/Metab 2rtracer Cncrnt CT (78433) | $9,159 | $9,159 | 3.3× |
| Myocrd Img Pet Prfuj W/Metab Dual Radiotracer (78432) | $7,962 | $7,962 | 4.2× |
| N-invas est c ffr sw aly CTA (75580) | $6,961 | $6,961 | 6.5× |
| Neck soft tissue (70360) range across 2 matching MRF lines |
$559–$598 | $559–$598 | varies |
| Nm myocard infarct spect (78469) | $4,912 | $4,912 | 7.2× |
| Nonvascular Shunt X-Ray (75809) range across 2 matching MRF lines |
$1,080–$1,156 | $1,080–$1,156 | varies |
| Ntsty modul radthx pln dose-vol histos (77301) range across 2 matching MRF lines |
$11,006–$11,776 | $11,006–$11,776 | varies |
| Nuclear Rx Intra-Arterial (79445) range across 2 matching MRF lines |
$1,303–$1,394 | $1,303–$1,394 | varies |
| Nuclear Rx Oral Admin (79005) range across 2 matching MRF lines |
$3,690–$3,948 | $3,690–$3,948 | varies |
| Ob us nuchal meas 1 gest (76813) range across 2 matching MRF lines |
$363–$388 | $363–$388 | varies |
| Oph bmtry us echograpy a-scan io lens pwr cal (76519) range across 4 matching MRF lines |
$347.33–$899 | $347.33–$899 | varies |
| Oph US Dx B-Scan&Quan a-Scan Sm Pt Enctr (76510) range across 2 matching MRF lines |
$478–$511 | $478–$511 | varies |
| Ophthalmic Biometry US Echograpy a-Scan (76516) range across 2 matching MRF lines |
$388–$583 | $388–$583 | varies |
| Ophthalmic Ultrasonic Foreign Body Localization (76529) | $461 | $461 | 4.2× |
| Ophthalmic ultrasound dx b-scan w/wo a-scan (76512) range across 5 matching MRF lines |
$438–$752 | $438–$752 | varies |
| Ophthalmic US Dx Corneal Pachymetry Uni/Bi (76514) range across 3 matching MRF lines |
$102–$153 | $102–$153 | varies |
| Ophthalmic us dx quantitative a-scan only (76511) range across 4 matching MRF lines |
$535–$803 | $535–$803 | varies |
| Optic foramina (70190) range across 2 matching MRF lines |
$381–$468 | $381–$468 | varies |
| Parathyroid imaging w/tomographic spect & CT (78072) range across 2 matching MRF lines |
$1,716–$1,836 | $1,716–$1,836 | varies |
| Parathyroid Planar Imaging (78070) | $2,666 | $2,666 | 5.3× |
| Parathyroid planar imaging w/wo subtraction (78071) | $2,166 | $2,166 | 4.3× |
| Pelvis 1 or 2 views (72170) range across 4 matching MRF lines |
$618–$661.58 | $618–$661.58 | varies |
| Peritoneogram Rs&I (74190) range across 2 matching MRF lines |
$1,462–$1,564 | $1,462–$1,564 | varies |
| Pet Image Skull-Thigh (78812) range across 3 matching MRF lines |
$2,242–$16,816 | $2,242–$16,816 | varies |
| Pet Image W/Ct Lmtd (78814) range across 3 matching MRF lines |
$2,242–$17,835 | $2,242–$17,835 | varies |
| PET image w/CT, full body (78816) range across 2 matching MRF lines |
$15,865–$16,976 | $15,865–$16,976 | varies |
| PET imaging CT attenuation skull base mid-thigh (78815) range across 2 matching MRF lines |
$15,038–$16,091 | $15,038–$16,091 | varies |
| Pet Imaging Limited Area Chest Head/Neck (78811) range across 3 matching MRF lines |
$2,242–$6,009 | $2,242–$6,009 | varies |
| Pet Myocardial Sngl Study (78491) | $4,422 | $4,422 | 2.5× |
| PET whole body (78813) range across 3 matching MRF lines |
$2,242–$16,816 | $2,242–$16,816 | varies |
| Prq Transhepatc Portograpy Hemodyn Eval Rs&I (75885) | $8,008 | $8,008 | 2.0× |
| Pulmonary Perfusion Imaging Particulate (78580) | $2,235 | $2,235 | 4.5× |
| Quan&Charac C Atherosclerotc Plaq Asses Sev C Ds (75577) | $2,323 | $2,323 | 2.0× |
| Radex Abd Compl Aqt Abd W/S/E/D Views 1 View Ch (74022) range across 2 matching MRF lines |
$902–$965 | $902–$965 | varies |
| Radex abscess/fistula/sinus tract rs&i (76080) range across 2 matching MRF lines |
$1,711–$1,831 | $1,711–$1,831 | varies |
| Radex Ankle Complete Minimum 3 Views (73610) range across 3 matching MRF lines |
$897–$960 | $897–$960 | varies |
| Radex Calcaneus Minimum 2 Views (73650) range across 3 matching MRF lines |
$653–$699 | $653–$699 | varies |
| Radex elbow complete minimum 3 views (73080) range across 3 matching MRF lines |
$747–$799 | $747–$799 | varies |
| Radex Facial Bones Complete Minimum 3 Views (70150) range across 2 matching MRF lines |
$781–$836 | $781–$836 | varies |
| Radex fingr minimum 2 views (73140) range across 3 matching MRF lines |
$549.30–$829 | $549.30–$829 | varies |
| Radex foot complete minimum 3 views (73630) range across 3 matching MRF lines |
$920–$984 | $920–$984 | varies |
| Radex Hand Minimum 3 Views (73130) range across 3 matching MRF lines |
$1,405–$1,503 | $1,405–$1,503 | varies |
| Radex lower extremity infant minimum 2 views (73592) range across 2 matching MRF lines |
$873–$934 | $873–$934 | varies |
| Radex Mastoids Compl Minimum 3 Views PR Side (70130) | $491 | $491 | 3.8× |
| Radex Nasal Bones Complete Minimum 3 Views (70160) range across 3 matching MRF lines |
$648–$693 | $648–$693 | varies |
| Radex Pharynx/Larx W/Fluor&/Magnification Tq (70370) | $799 | $799 | 7.4× |
| Radex Ribs Unilateral 2 Views (71100) range across 2 matching MRF lines |
$705–$754 | $705–$754 | varies |
| Radex shoulder complete minimum 2 views (73030) range across 2 matching MRF lines |
$755–$808 | $755–$808 | varies |
| Radex Sinuses Paransl < 3 Views (70210) range across 2 matching MRF lines |
$349–$373 | $349–$373 | varies |
| Radex sm int w/mlt srl imges via enteroclss tube (74251) | $1,222 | $1,222 | 5.6× |
| Radex Spine 1 View Specify Level (72020) range across 2 matching MRF lines |
$491–$525 | $491–$525 | varies |
| Radex Sternum Minimum 2 Views (71120) | $582 | $582 | 5.4× |
| Radex Temporomandble Jt Opn & Clsd Mouth Bilat (70330) | $577 | $577 | 5.3× |
| Radex Toe Minimum 2 Views (73660) range across 3 matching MRF lines |
$516.95–$881 | $516.95–$881 | varies |
| Radex upper extremity infant minimum 2 views (73092) range across 3 matching MRF lines |
$873–$934 | $873–$934 | varies |
| Radex Wrist Complete Minimum 3 Views (73110) range across 4 matching MRF lines |
$896–$1,792 | $896–$1,792 | varies |
| Radex X-Ray Exam Entire Spi 6/> Vw - Xr Entire Spine 6+ Vw (72084) range across 2 matching MRF lines |
$1,137–$1,217 | $1,137–$1,217 | varies |
| Radiation Delivery Stereotactic Cranial Linear (77372) range across 3 matching MRF lines |
$39,461–$42,223 | $39,461–$42,223 | varies |
| Radiation treatment delivery level 1 (77402) | $1,323 | $1,323 | 10.4× |
| Radiation treatment delivery level 2 (77407) | $1,659 | $1,659 | 3.4× |
| Radiation treatment delivery level 3 (77412) range across 3 matching MRF lines |
$2,062–$2,206 | $2,062–$2,206 | varies |
| Radiolog exam mandible compl minimum 4 views (70110) range across 2 matching MRF lines |
$734–$785 | $734–$785 | varies |
| Radiologic exam colon double contrast study (74280) | $1,943 | $1,943 | 8.9× |
| Radiologic exam colon single contrast study (74270) range across 2 matching MRF lines |
$1,274–$1,363 | $1,274–$1,363 | varies |
| Radiologic Exam Esophagus Double Contrast Study (74221) range across 2 matching MRF lines |
$1,222–$1,308 | $1,222–$1,308 | varies |
| Radiologic exam knee complete 4/more views (73564) range across 2 matching MRF lines |
$1,228–$1,314 | $1,228–$1,314 | varies |
| Radiologic exam pelvis compl minimum 3 views (72190) range across 3 matching MRF lines |
$642–$687 | $642–$687 | varies |
| Radiologic Exam Small Int Single Contrast Study (74250) | $1,222 | $1,222 | 5.6× |
| Radiologic exam swallow function contrast study (74230) range across 3 matching MRF lines |
$1,140–$1,220 | $1,140–$1,220 | varies |
| Radiologic exam upr gi trc double contrast study (74246) | $1,222 | $1,222 | 5.6× |
| Radiologic examination femur 1 view (73551) | $578 | $578 | 5.3× |
| Radiologic examination femur minimum 2 views (73552) range across 3 matching MRF lines |
$547–$1,094 | $547–$1,094 | varies |
| Radiologic examination knee 1/2 views (73560) range across 2 matching MRF lines |
$637–$682 | $637–$682 | varies |
| Radiologic Examination Osseous Survey Limited (77074) | $819 | $819 | 6.3× |
| Radiologic Examination Salivary Gland Calculus (70380) | $399 | $399 | 3.7× |
| Radiologic examination tibia & fibula 2 views (73590) range across 6 matching MRF lines |
$789–$1,578 | $789–$1,578 | varies |
| Radiologic examination, internal auditory meati, complete Non-Facility (70134) | $808 | $808 | 1.2× |
| Radiopharm Dacryocystography (78660) | $1,500 | $1,500 | 3.0× |
| Remote afterloading high dose rate radionuclide skin surface brachytherapy, includes basic dosimetry, when performed;… (77768) range across 2 matching MRF lines |
$4,151–$4,442 | $4,151–$4,442 | varies |
| Remote afterloading high dose rate radionuclide skin surface brachytherapy, includes basic dosimetry, when performed;… (77767) | $4,852 | $4,852 | 10.1× |
| Renal Cyst Study (74470) | $2,287 | $2,287 | 3.4× |
| Ribs bilateral 3 views (71110) range across 3 matching MRF lines |
$949–$1,015 | $949–$1,015 | varies |
| Rp loclzj tum plnr 1 area single day imaging (78800) range across 2 matching MRF lines |
$1,648–$1,763 | $1,648–$1,763 | varies |
| Rp loclzj tum plnr 2+area 1+d img/1 area img>2+d (78801) range across 2 matching MRF lines |
$2,375–$2,541 | $2,375–$2,541 | varies |
| Rp Loclzj Tum Plnr Whole Body 2+ Days Imaging (78804) | $9,575 | $9,575 | 14.1× |
| Rp Loclzj Tum Plnr Whole Body Single Day Imaging (78802) range across 2 matching MRF lines |
$3,271–$3,500 | $3,271–$3,500 | varies |
| Rp Loclzj Tum Spect 1 Area Single Day Imaging (78803) range across 2 matching MRF lines |
$4,085–$4,371 | $4,085–$4,371 | varies |
| Rp loclzj tum spect 2 area/sep acquisj img (78831) range across 2 matching MRF lines |
$3,812–$7,648 | $3,812–$7,648 | varies |
| Rp loclzj tum spect CT 2area 1d img/1 ar img>2+d (78832) range across 2 matching MRF lines |
$3,784–$4,049 | $3,784–$4,049 | varies |
| Rp loclzj tum spect w/CT 1 area/acquisj 1day img (78830) range across 2 matching MRF lines |
$5,254–$5,622 | $5,254–$5,622 | varies |
| Rp Ther Radiolbld Monoclonal Antibody IV Infus (79403) | $3,064 | $3,064 | 10.5× |
| Rp Therapy Intravenous Administration (79101) | $2,417 | $2,417 | 8.3× |
| Salivary Gland Imaging Serial Images (78231) range across 2 matching MRF lines |
$1,049–$1,122 | $1,049–$1,122 | varies |
| Scapula (73010) range across 2 matching MRF lines |
$949–$1,015 | $949–$1,015 | varies |
| Screening Digital Breast Tomosynthesis Bi (77063) range across 3 matching MRF lines |
$275–$294 | $275–$294 | varies |
| Sella turcica (70240) | $373 | $373 | 3.4× |
| Shoulder 1 view (73020) range across 2 matching MRF lines |
$520–$556 | $520–$556 | varies |
| Shoulder Arthrography (73040) | $2,467 | $2,467 | 5.7× |
| Sialogram (70390) | $1,034 | $1,034 | 3.5× |
| Skull less than 4 views (70250) range across 3 matching MRF lines |
$800–$856 | $800–$856 | varies |
| Special dosimetry (77331) | $2,188 | $2,188 | 13.0× |
| Special Physics Consult (77370) range across 2 matching MRF lines |
$2,783–$2,978 | $2,783–$2,978 | varies |
| Special teletherapy port plan (77321) range across 2 matching MRF lines |
$3,391–$3,628 | $3,391–$3,628 | varies |
| Special treatment procedure (77470) range across 2 matching MRF lines |
$5,932–$6,347 | $5,932–$6,347 | varies |
| Speech evaluation, complex (70371) | $799 | $799 | 2.7× |
| Spleen Imaging (78185) | $1,503 | $1,503 | 3.0× |
| Stereotactic Body Radiation Delivery (77373) range across 3 matching MRF lines |
$13,114–$14,032 | $13,114–$14,032 | varies |
| Sternoclavicular joints (71130) | $423 | $423 | 3.9× |
| Superior sagittal sinus venogram (75870) | $4,840 | $4,840 | 1.2× |
| Surface Applic Low Dose Rate Radionuclide Source (77789) | $404 | $404 | 3.2× |
| Tbs technical calculation only (77091) range across 2 matching MRF lines |
$225–$241 | $225–$241 | varies |
| Telethx isodose pln cplx w/basic dosimetry (77307) range across 3 matching MRF lines |
$2,403–$2,571 | $2,403–$2,571 | varies |
| Telethx isodose pln smpl w/dosimetry calculation (77306) range across 2 matching MRF lines |
$1,508–$2,967 | $1,508–$2,967 | varies |
| Temporomandble Jt Arthrography Rs&I (70332) | $1,209 | $1,209 | 4.1× |
| Testicular Imaging W/Flow (78761) | $3,271 | $3,271 | 6.6× |
| Ther Rad Simulaj-Aided Field Setting Complex (77290) range across 2 matching MRF lines |
$3,880–$4,152 | $3,880–$4,152 | varies |
| Ther Rad Simulaj-Aided Field Setting Intermed (77285) | $4,152 | $4,152 | 8.9× |
| Ther rad simulaj-aided field setting simple (77280) range across 2 matching MRF lines |
$1,504–$1,609 | $1,504–$1,609 | varies |
| Therapeutic Enema Rdctj Intussusception/Obstrcj (74283) range across 2 matching MRF lines |
$617–$660 | $617–$660 | varies |
| Thoracic spine 2 views (72070) range across 2 matching MRF lines |
$625–$669 | $625–$669 | varies |
| Thoracic spine 3 views (72072) | $878 | $878 | 6.7× |
| Thoracolumbar 2 views (72080) range across 3 matching MRF lines |
$565–$605 | $565–$605 | varies |
| Thyroid Carcinoma Metastases Img Lmtd Area (78015) | $1,808 | $1,808 | 3.6× |
| Thyroid Imaging With Vascular Flow (78013) | $2,017 | $2,017 | 4.0× |
| Thyroid Met Imaging Body (78018) range across 2 matching MRF lines |
$3,011–$3,222 | $3,011–$3,222 | varies |
| Thyroid Uptake Measurement (78012) | $922 | $922 | 1.8× |
| Thyroid Uptake W/Blood Flow Sngle/Mult Quan Meas (78014) range across 2 matching MRF lines |
$2,592–$2,773 | $2,592–$2,773 | varies |
| Tx Devices Design & Construction Complex (77334) range across 4 matching MRF lines |
$3,467–$17,335 | $3,467–$17,335 | varies |
| Tx devices design & construction intermediate (77333) | $1,369 | $1,369 | 8.2× |
| Tx devices design & construction simple (77332) | $1,338 | $1,338 | 8.0× |
| Ultrasound Breast Limited (76642) range across 5 matching MRF lines |
$917.33–$2,130 | $917.33–$2,130 | varies |
| Ultrasound elastography first target lesion (76982) | $346 | $346 | 2.7× |
| Ultrasound Elastography Parenchyma (76981) range across 2 matching MRF lines |
$323–$346 | $323–$346 | varies |
| Ultrasound Exam Aaa Screen (76706) range across 3 matching MRF lines |
$1,266–$1,374.67 | $1,266–$1,374.67 | varies |
| Ultrasound trgt dynamic microbubble 1st lesion (76978) | $623 | $623 | 1.4× |
| Ultrasound, abdomen limited (76705) range across 5 matching MRF lines |
$1,388–$1,589 | $1,388–$1,589 | varies |
| Umbilical-artery Doppler (OB) (76820) range across 2 matching MRF lines |
$651–$697 | $651–$697 | varies |
| Unlisted Dx Radiographic Procedure (76499) | $623 | $623 | 5.7× |
| Unlisted fluoroscopic procedure (76496) | $1,135 | $1,135 | 10.4× |
| Unlisted magnetic resonance procedure (76498) range across 2 matching MRF lines |
$4,315–$4,617 | $4,315–$4,617 | varies |
| Unlisted Miscellaneous Px Dx Nuclear Medicine (78999) | $2,256 | $2,256 | 4.5× |
| Unlisted Procedure Clinical Brachytherapy (77799) | $7,111 | $7,111 | 55.8× |
| Unlisted us procedure (76999) | $984 | $984 | 9.1× |
| Upper gi w/o kub (74240) range across 2 matching MRF lines |
$1,142–$1,222 | $1,142–$1,222 | varies |
| Ureteral Reflux Study (78740) | $1,966 | $1,966 | 3.9× |
| Urethrocystogram voiding (74455) range across 2 matching MRF lines |
$2,140–$2,290 | $2,140–$2,290 | varies |
| Urethrocystography retrograde (74450) | $1,516 | $1,516 | 5.1× |
| Us breast unilateral complete (76641) range across 6 matching MRF lines |
$1,959–$4,192 | $1,959–$4,192 | varies |
| Us chest (76604) range across 3 matching MRF lines |
$1,180–$1,278 | $1,180–$1,278 | varies |
| Us complete joint (76881) | $1,128 | $1,128 | 8.6× |
| Us exam, pelvic, limited (76857) range across 2 matching MRF lines |
$921–$985 | $921–$985 | varies |
| Us head (76506) range across 3 matching MRF lines |
$795–$1,589 | $795–$1,589 | varies |
| Us kidney transplant (76776) range across 2 matching MRF lines |
$1,338–$1,432 | $1,338–$1,432 | varies |
| Us lmtd joint/oth nonvasc xtr strux r-t w/img (76882) range across 6 matching MRF lines |
$890–$1,518 | $890–$1,518 | varies |
| Us ob detailed single fetus (76811) range across 2 matching MRF lines |
$999–$1,069 | $999–$1,069 | varies |
| Us ob limited 1 or more fetuses (76815) range across 3 matching MRF lines |
$704–$753 | $704–$753 | varies |
| Us ob transvaginal (76817) range across 3 matching MRF lines |
$737–$789 | $737–$789 | varies |
| Us pelvic non ob complete (76856) range across 3 matching MRF lines |
$1,787–$1,912 | $1,787–$1,912 | varies |
| Us pg uter img f&mat 14 wk tabdl 1/1st gestation (76801) range across 2 matching MRF lines |
$1,279–$1,369 | $1,279–$1,369 | varies |
| Us preg uterus real time f/u trnsabdl per fetus (76816) range across 2 matching MRF lines |
$1,236–$1,323 | $1,236–$1,323 | varies |
| Us retroperitoneal complete (76770) range across 2 matching MRF lines |
$1,615–$1,728 | $1,615–$1,728 | varies |
| Us retroperitoneal limited (76775) range across 3 matching MRF lines |
$1,485–$1,589 | $1,485–$1,589 | varies |
| Us scrotum and contents (76870) range across 3 matching MRF lines |
$1,757–$1,880 | $1,757–$1,880 | varies |
| Us spinal canal and contents (76800) range across 2 matching MRF lines |
$792–$847 | $792–$847 | varies |
| Us thyroid (76536) range across 4 matching MRF lines |
$1,388–$1,629 | $1,388–$1,629 | varies |
| Us transrectal (76872) range across 2 matching MRF lines |
$1,070–$1,145 | $1,070–$1,145 | varies |
| Vascular Flow Imaging (78445) | $1,965 | $1,965 | 3.9× |
| Vein X-Ray Chest (75827) | $6,984 | $6,984 | 3.6× |
| Vein X-Ray Liver W/O Hemodyn (75887) | $3,170 | $3,170 | 0.8× |
| Vein X-Ray Skull Epidural (75872) | $4,840 | $4,840 | 6.2× |
| Vein X-Ray Spleen/Liver (75810) | $3,158 | $3,158 | 0.8× |
| Venogram Sinus/Jugular (75860) range across 2 matching MRF lines |
$6,584–$7,045 | $6,584–$7,045 | varies |
| Venography Adrenal Unilateral (75840) | $8,008 | $8,008 | 2.0× |
| Venography caval inferior serialography rs&i (75825) | $8,460 | $8,460 | 2.1× |
| Venography extremity bilateral rs&i (75822) | $4,812 | $4,812 | 2.4× |
| Venography extremity unilateral rs&i (75820) | $5,301 | $5,301 | 2.7× |
| Venography Orbital Rs&I (75880) | $7,870 | $7,870 | 10.1× |
| Venography Renal Bilateral (75833) | $8,008 | $8,008 | 2.0× |
| Venography Renal Unilateral (75831) | $5,612 | $5,612 | 1.4× |
| Venous sampling by catheter (75893) range across 2 matching MRF lines |
$5,836–$6,245 | $5,836–$6,245 | varies |
| Venous thrombosis imaging (78457) | $4,643 | $4,643 | 6.9× |
| Venous Thrombosis Imaging Venogram Bilateral (78458) | $1,122 | $1,122 | 2.2× |
| Wrist 2 views (73100) range across 2 matching MRF lines |
$769–$823 | $769–$823 | varies |
| X-Ray Ac Jts - Xr Acromioclavicular Joints Bilateral (73050) range across 2 matching MRF lines |
$509–$545 | $509–$545 | varies |
| X-ray antegrade pyelogram tube (74425) | $1,614 | $1,614 | 3.7× |
| X-Ray Aorta Leg Arteries (75630) | $8,402 | $8,402 | 2.1× |
| X-Ray Bend Only L-S Spine (72120) | $798 | $798 | 6.1× |
| X-Ray Elbow 2 Vw - Xr Elbow 1-2 Views Right (73070) range across 4 matching MRF lines |
$628–$1,256 | $628–$1,256 | varies |
| X-Ray Exam Breast Specimen (76098) range across 2 matching MRF lines |
$1,702–$1,821 | $1,702–$1,821 | varies |
| X-Ray Exam Entire Spi 1 Vw (72081) | $560 | $560 | 5.2× |
| X-Ray Exam Entire Spi 2/3 Vw (72082) range across 2 matching MRF lines |
$876–$937 | $876–$937 | varies |
| X-Ray Exam Entire Spi 4/5 Vw (72083) range across 2 matching MRF lines |
$1,137–$1,217 | $1,137–$1,217 | varies |
| X-Ray Exam Hip Uni 1 View (73501) range across 2 matching MRF lines |
$701–$750 | $701–$750 | varies |
| X-Ray Exam Hip Uni 2-3 Views (73502) range across 2 matching MRF lines |
$701–$750 | $701–$750 | varies |
| X-Ray Exam Hip Uni 4/> Views (73503) range across 2 matching MRF lines |
$866–$927 | $866–$927 | varies |
| X-Ray Exam Hips Bi 2 Views (73521) range across 2 matching MRF lines |
$840–$899 | $840–$899 | varies |
| X-Ray Exam Hips Bi 3-4 Views (73522) range across 2 matching MRF lines |
$855–$915 | $855–$915 | varies |
| X-Ray Exam Hips Bi 5/> Views (73523) | $1,288 | $1,288 | 9.9× |
| X-Ray Exam L-S Spine Bending (72114) | $1,396 | $1,396 | 10.7× |
| X-Ray Exam Neck Spine 2-3 Vw (72040) range across 3 matching MRF lines |
$771–$825 | $771–$825 | varies |
| X-Ray Exam Neck Spine 6/>Vws (72052) range across 2 matching MRF lines |
$1,423–$1,523 | $1,423–$1,523 | varies |
| X-Ray Exam Unilat Ribs/Chest (71101) range across 3 matching MRF lines |
$1,141–$1,221 | $1,141–$1,221 | varies |
| X-ray humerus (73060) range across 3 matching MRF lines |
$706–$755 | $706–$755 | varies |
| X-ray IV pyelogram (ivp) (74400) | $3,599 | $3,599 | 16.4× |
| X-ray IV pyelogram+tomography (74415) | $809 | $809 | 3.7× |
| X-Ray Jaw <4 Vw - Xr Mandible < 4 Views (70100) range across 2 matching MRF lines |
$231–$247 | $231–$247 | varies |
| X-Ray Knee Bilat Standing - Xr Knees Anteroposterior Standing Bilat (73565) | $559 | $559 | 5.1× |
| X-Ray Lumbar Spine 2/3 Vw - Xr Lumbar Spine 2-3 Views (72100) range across 3 matching MRF lines |
$890–$952 | $890–$952 | varies |
| X-ray nose-rectum child f.b. (76010) range across 3 matching MRF lines |
$664–$710 | $664–$710 | varies |
| X-Ray Ribs, Chest 4+ Vw - Xr Ribs 3 Vws Bil W/ Chest Posteroanterior (71111) range across 2 matching MRF lines |
$1,295–$1,386 | $1,295–$1,386 | varies |
| X-Ray Sacroiliac Jts 3+ Vw - Xr Sacroiliac Joints 3+ Views (72202) | $716 | $716 | 5.5× |
| X-Ray Sacrum/Coccyx 2+ Vw - Xr Sacrum Coccyx 2+ Views (72220) range across 2 matching MRF lines |
$640–$685 | $640–$685 | varies |
| X-Ray Sinuses 3+ Vw - Xr Paranasal Sinuses 3+ Views (70220) range across 2 matching MRF lines |
$668–$715 | $668–$715 | varies |
| X-Ray Skull 4+ Vw - Xr Skull Complete 4+ Views (70260) range across 2 matching MRF lines |
$1,122–$1,201 | $1,122–$1,201 | varies |
| X-Ray Stress View (77071) | $464 | $464 | 4.3× |
| X-ray thoracic spine 4 vw (72074) | $764 | $764 | 5.9× |
| X-Ray Urinary Tract Exam With Contrast Material (74420) | $2,169 | $2,169 | 5.0× |
| X-Rays Bone Length Studies (77073) range across 2 matching MRF lines |
$1,048–$1,121 | $1,048–$1,121 | varies |
| X-Rays Bone Survey Complete (77075) | $1,194 | $1,194 | 9.1× |
| Xr c-spine 4 or 5 views (72050) range across 3 matching MRF lines |
$1,196–$1,280 | $1,196–$1,280 | varies |
| Xr facial bones less than 3 views (70140) range across 2 matching MRF lines |
$582–$623 | $582–$623 | varies |
| Xr orbits complete 4 views (70200) range across 2 matching MRF lines |
$794–$850 | $794–$850 | varies |
| Xr Tomogram Single Plane (76100) | $975 | $975 | 7.5× |
A range means this hospital published different amounts on matching machine-readable-file lines. We show the lowest–highest posted amount because we cannot tell from the published file which line would apply to a particular visit.