Imaging prices at Summerlin Hospital Medical Center
Las Vegas, NV · every code in this section with a posted price and a Medicare benchmark.
399 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) | $2,119.20 | $5,298 | 1.4× |
| Abdomen 1 View (74018) | $437.20 | $1,093 | 4.6× |
| Abdomen 2 views (74019) | $806.40 | $2,016 | 7.1× |
| Acute Gastrointestinal Blood Loss Imaging (78278) range across 2 matching MRF lines |
$1,927.60–$3,029.20 | $4,819–$7,573 | varies |
| Adrenal Cortex & Medulla Img (78075) | $3,389.60 | $8,474 | 2.4× |
| Angio internal mammary (75756) | $1,214.40 | $3,036 | 0.4× |
| Angio pulmonary bilat (75743) range across 2 matching MRF lines |
$2,461.20–$7,788.40 | $6,153–$19,471 | varies |
| Angiography Adrenal Bilateral Slctv Rs&I (75733) | $7,214.80 | $18,037 | 2.1× |
| Angiography extremity bilateral rs&i (75716) range across 5 matching MRF lines |
$3,696–$7,803.60 | $9,240–$19,509 | varies |
| Angiography extremity unilateral rs&i (75710) range across 11 matching MRF lines |
$2,823.60–$6,490.40 | $7,059–$16,226 | varies |
| Angiography pulmonary unilateral slctv rs&i (75741) | $3,500.80 | $8,752 | 1.0× |
| Angrph pulmonary nonslctv cath/ven njx rs&i (75746) | $5,194.40 | $12,986 | 1.5× |
| Ankle 2 views (73600) range across 3 matching MRF lines |
$664.80–$747.20 | $1,662–$1,868 | varies |
| Aortography thoracic serialography rs&i (75605) range across 3 matching MRF lines |
$2,461.20–$12,917.60 | $6,153–$32,294 | varies |
| Aortography thoracic w/o serialography rs&i (75600) range across 2 matching MRF lines |
$3,763.60–$3,802.40 | $9,409–$9,506 | varies |
| Artery X-Rays Abdomen (75726) range across 3 matching MRF lines |
$5,082–$10,764.80 | $12,705–$26,912 | varies |
| Artery X-Rays Adrenal Gland (75731) | $3,387.20 | $8,468 | 1.0× |
| Artery X-Rays Pelvis (75736) range across 5 matching MRF lines |
$2,617.20–$10,764.80 | $6,543–$26,912 | varies |
| Artery X-Rays Spine (75705) range across 2 matching MRF lines |
$2,461.20–$10,764.80 | $6,153–$26,912 | varies |
| Arthrogram ankle (73615) | $1,050 | $2,625 | 2.8× |
| Arthrogram hip (73525) range across 2 matching MRF lines |
$2,310.40–$2,443.60 | $5,776–$6,109 | varies |
| Arthrogram Wrist (73115) | $1,073.20 | $2,683 | 2.8× |
| Basic radiation dosimetry calculation (77300) | $2,119.20 | $5,298 | 14.4× |
| Bone age studies (77072) range across 2 matching MRF lines |
$310.40–$496.40 | $776–$1,241 | varies |
| Bone Imaging 3 Phase (78315) | $2,966.80 | $7,417 | 6.8× |
| Bone Imaging Limited Area (78300) | $1,763.20 | $4,408 | 4.0× |
| Bone Imaging Multiple Areas (78305) | $2,177.60 | $5,444 | 5.0× |
| Bone Imaging Whole Body (78306) | $2,898.80 | $7,247 | 6.6× |
| Bone marrow imaging limited area (78102) | $2,309.60 | $5,774 | 5.3× |
| Bone marrow imaging; whole body (78104) | $3,389.60 | $8,474 | 7.8× |
| Bone survey infant (77076) | $1,466 | $3,665 | 12.8× |
| Brain Flow Imaging Only (78610) | $3,321.60 | $8,304 | 5.6× |
| Brain Image W/Flow < 4 Views (78601) | $1,953.20 | $4,883 | 4.5× |
| Brain Imaging Min 4 Static Views W Vascular Flow (78606) | $3,426.80 | $8,567 | 5.8× |
| Brain Imaging Minimum 4 Static Views (78605) | $2,461.20 | $6,153 | 4.1× |
| Brain Imaging Pet Metabolic Evaluation (78608) | $6,154.80 | $15,387 | 3.9× |
| Cardiac blood pool imaging, first pass technique; multiple studies, resting and with stress (exercise and/or… (78483) | $2,028 | $5,070 | 3.4× |
| Cat Scan Follow-Up Study (76380) | $2,914.40 | $7,286 | 30.6× |
| Cerebrospinal Fluid Flow W/O Matl Shunt Evaltj (78645) | $2,617.20 | $6,543 | 4.4× |
| Cerebrospinal Fluid Scan (78630) | $2,888.80 | $7,222 | 4.9× |
| Chest 1 view (71045) range across 3 matching MRF lines |
$570.40–$638.80 | $1,426–$1,597 | varies |
| Chest 2 views (71046) range across 3 matching MRF lines |
$604.40–$770 | $1,511–$1,925 | varies |
| Chest 3 views (71047) | $759.20 | $1,898 | 8.0× |
| Chest 4 or more views (71048) range across 2 matching MRF lines |
$724.40–$983.60 | $1,811–$2,459 | varies |
| Cineradiograpy/vidradiograpy xcpt where spec (76120) | $144 | $360 | 1.3× |
| Cisternography Positive Contrast Rs&I (70015) | $3,157.20 | $7,893 | 3.7× |
| Clavicle complete (73000) range across 3 matching MRF lines |
$517.60–$747.20 | $1,294–$1,868 | varies |
| Continuing medical physics consltj pr wk (77336) range across 2 matching MRF lines |
$1,412–$2,119.20 | $3,530–$5,298 | varies |
| Contrast Exam Abdominl Aorta (75625) range across 3 matching MRF lines |
$2,309.60–$7,225.60 | $5,774–$18,064 | varies |
| Contrast X-Ray Bladder (74430) range across 3 matching MRF lines |
$762.40–$1,073.20 | $1,906–$2,683 | varies |
| Contrast X-Ray Of Elbow (73085) | $1,073.20 | $2,683 | 2.8× |
| Contrast X-Ray Of Knee Joint (73580) | $1,784.40 | $4,461 | 4.7× |
| Contrast Xray Throat/Cerv Esopha (74210) | $526.40 | $1,316 | 2.7× |
| CT abdomen and pelvis without and with contrast (74178) | $9,082.80 | $22,707 | 23.8× |
| CT abdomen and pelvis without contrast (74176) | $6,249.60 | $15,624 | 24.0× |
| CT abdomen w contrast (74160) range across 2 matching MRF lines |
$2,546–$4,301.20 | $6,365–$10,753 | varies |
| CT abdomen w wo contrast (74170) range across 2 matching MRF lines |
$3,080.80–$5,643.60 | $7,702–$14,109 | varies |
| CT abdomen w/o contrast (74150) range across 2 matching MRF lines |
$3,038.80–$3,959.20 | $7,597–$9,898 | varies |
| CT Angio Abdomen and Pelvis (74174) | $16,285.60 | $40,714 | 42.7× |
| CT Angio Chest (71275) range across 2 matching MRF lines |
$4,160–$7,681.20 | $10,400–$19,203 | varies |
| CT Angio Head (70496) range across 3 matching MRF lines |
$3,852.40–$4,862.80 | $9,631–$12,157 | varies |
| CT angio hrt w/3d image (75574) | $8,679.60 | $21,699 | 22.8× |
| Ct Angio Lwr Extr W/O&W/Dye (73706) range across 5 matching MRF lines |
$4,150.80–$8,966.80 | $10,377–$22,417 | varies |
| CT Angio Neck (70498) range across 2 matching MRF lines |
$3,852.40–$4,862.80 | $9,631–$12,157 | varies |
| Ct Angio Upr Extrm W/O&W/Dye (73206) | $7,697.20 | $19,243 | 40.1× |
| CT cervical spine w/ contrast (72126) | $3,879.60 | $9,699 | 10.2× |
| CT cervical spine w/o contrast (72125) range across 2 matching MRF lines |
$2,245.20–$3,565.20 | $5,613–$8,913 | varies |
| CT cervical spine w/wo cont (72127) range across 2 matching MRF lines |
$3,080.80–$4,188 | $7,702–$10,470 | varies |
| CT chest w contrast (71260) range across 2 matching MRF lines |
$3,478.40–$4,473.20 | $8,696–$11,183 | varies |
| CT chest w/wo contrast (71270) | $5,716.80 | $14,292 | 29.8× |
| CT head/brain with contrast (70460) | $4,305.20 | $10,763 | 22.5× |
| CT head/brain without and with contrast (70470) range across 2 matching MRF lines |
$3,080.80–$5,284.40 | $7,702–$13,211 | varies |
| CT heart contrast eval cardiac structure&morph (75572) | $5,269.60 | $13,174 | 13.8× |
| CT heart no contrast quant eval coronry calcium (75571) | $6,080 | $15,200 | 63.9× |
| CT hrt w/3d image congen (75573) | $5,217.20 | $13,043 | 13.7× |
| CT iac w contrast (70481) range across 2 matching MRF lines |
$2,461.20–$3,263.20 | $6,153–$8,158 | varies |
| CT l-spine w&w/o contrast (72133) | $4,989.60 | $12,474 | 26.0× |
| CT lower ext w/o (73700) range across 5 matching MRF lines |
$2,416.40–$5,914.40 | $6,041–$14,786 | varies |
| CT lower extremity w/contrast material (73701) range across 5 matching MRF lines |
$2,520–$6,690.80 | $6,300–$16,727 | varies |
| CT lumbar spine w contrast (72132) | $4,350.40 | $10,876 | 11.4× |
| CT lumbar spine w/o contrast (72131) range across 2 matching MRF lines |
$2,100.40–$3,615.60 | $5,251–$9,039 | varies |
| CT maxillofacial w contrast (70487) range across 2 matching MRF lines |
$2,461.20–$3,537.20 | $6,153–$8,843 | varies |
| CT maxillofacial wo contrast (70486) range across 2 matching MRF lines |
$2,245.20–$3,033.20 | $5,613–$7,583 | varies |
| CT neck tissue combo (70492) | $5,167.60 | $12,919 | 27.0× |
| Ct Orbit/Ear/Fossa W/O&W/Dye (70482) | $5,366.40 | $13,416 | 28.0× |
| CT orbits w/o contrast (70480) | $3,168.80 | $7,922 | 27.7× |
| CT pelvis w&w/o contrast (72194) | $4,710.40 | $11,776 | 24.6× |
| CT pelvis w/o contrast (72192) range across 2 matching MRF lines |
$2,374.80–$2,986.80 | $5,937–$7,467 | varies |
| CT scan of leg combo (73702) range across 3 matching MRF lines |
$4,103.20–$8,711.60 | $10,258–$21,779 | varies |
| CT scans face/jaw combo (70488) | $4,014.40 | $10,036 | 20.9× |
| CT soft tissue neck w contrast (70491) range across 2 matching MRF lines |
$2,461.20–$4,007.20 | $6,153–$10,018 | varies |
| CT soft tissue neck w/o contrast (70490) range across 2 matching MRF lines |
$2,309.60–$2,931.60 | $5,774–$7,329 | varies |
| CT thoracic spine w contrast (72129) | $3,874.40 | $9,686 | 20.2× |
| CT thoracic spine w/o contrast (72128) range across 2 matching MRF lines |
$1,846.80–$3,123.20 | $4,617–$7,808 | varies |
| CT thoracic spine w/wo cont (72130) | $4,394 | $10,985 | 22.9× |
| CT thorax w/o contrast (71250) range across 2 matching MRF lines |
$2,382.40–$3,262.80 | $5,956–$8,157 | varies |
| CT upper ext wo (73200) range across 5 matching MRF lines |
$2,461.20–$5,456.40 | $6,153–$13,641 | varies |
| CT upper extremity w/o & w/contrast material (73202) range across 3 matching MRF lines |
$4,692–$8,730.80 | $11,730–$21,827 | varies |
| CT upper extremity with contrast (73201) range across 3 matching MRF lines |
$3,560.80–$7,100.80 | $8,902–$17,752 | varies |
| Cta Abdl Aorta&Bi Iliofem W/Contrast&Postp (75635) range across 2 matching MRF lines |
$7,261.60–$8,966.80 | $18,154–$22,417 | varies |
| Cta Abdomen (74175) | $7,261.60 | $18,154 | 37.9× |
| CTA pelvis (72191) | $7,261.60 | $18,154 | 37.9× |
| Diskography lumbar (72295) range across 3 matching MRF lines |
$2,226–$3,560.80 | $5,565–$8,902 | varies |
| Dxa Bone Density Axial (77080) range across 2 matching MRF lines |
$478.80–$584.40 | $1,197–$1,461 | varies |
| Dxa bone density study 1/>sites appendiclr skel (77081) | $378 | $945 | 4.0× |
| Echo exam uterus (76831) | $1,842.80 | $4,607 | 7.1× |
| Echo Guide For Artery Repair (76936) | $2,172.80 | $5,432 | 9.2× |
| Esophagram (74220) range across 2 matching MRF lines |
$568–$1,028.80 | $1,420–$2,572 | varies |
| Fetal Biophys Profile W/Nst (76818) range across 4 matching MRF lines |
$765.20–$1,368.40 | $1,913–$3,421 | varies |
| Fetal Biophysical Profile W/O Non-Stress Testing (76819) range across 3 matching MRF lines |
$721.60–$1,290 | $1,804–$3,225 | varies |
| Fluoroscopy up to 1 hr (76000) range across 2 matching MRF lines |
$856.40–$1,300.80 | $2,141–$3,252 | varies |
| Follow-Up Angiography (75898) | $4,584 | $11,460 | 1.3× |
| Foot 2 views (73620) range across 5 matching MRF lines |
$665.60–$830.40 | $1,664–$2,076 | varies |
| Forearm 2 views (73090) range across 3 matching MRF lines |
$662.40–$757.60 | $1,656–$1,894 | varies |
| Gastric emptying imaging study (78264) | $3,198.40 | $7,996 | 7.3× |
| Gastroesophageal Reflux Exam (78262) | $1,846.80 | $4,617 | 4.2× |
| Gated Heart Planar Single (78472) | $2,696.80 | $6,742 | 6.2× |
| Gated Heart, Multiple (78473) | $2,388.80 | $5,972 | 5.5× |
| Hand 2 views (73120) range across 4 matching MRF lines |
$493.60–$714 | $1,234–$1,785 | varies |
| Heart first pass single,planar (78481) | $1,792 | $4,480 | 3.0× |
| Hepatc Vngrph Wdg/Fr Hemodyn Eval Rs&I (75889) range across 2 matching MRF lines |
$2,769.20–$4,730 | $6,923–$11,825 | varies |
| Hepatc Vngrph Wdg/Fr W/O Hemodyn Eval Rs&I (75891) range across 2 matching MRF lines |
$2,156.40–$3,923.60 | $5,391–$9,809 | varies |
| Hepatobil Syst Image W/Drug (78227) range across 2 matching MRF lines |
$2,928.80–$3,660.80 | $7,322–$9,152 | varies |
| Hepatobiliary System Imaging (78226) range across 2 matching MRF lines |
$2,807.20–$3,125.20 | $7,018–$7,813 | varies |
| Ht Musc Image Planar Mult (78454) | $4,594 | $11,485 | 3.2× |
| Ht Muscle Image Spect Sing (78451) | $4,160.80 | $10,402 | 2.9× |
| Hyperthermia external generated superficial (77600) range across 2 matching MRF lines |
$1,412–$2,119.20 | $3,530–$5,298 | varies |
| Hyperthermia generated by interstitial probe(s); 5 or fewer interstitial applicators Non-Facility (77610) | $2,119.20 | $5,298 | 3.5× |
| Hyperthermia generated by interstitial probe(s); more than 5 interstitial applicators Non-Facility (77615) | $2,119.20 | $5,298 | 3.5× |
| Hyperthermia generated by intracavitary probe(s) Non-Facility (77620) | $2,119.20 | $5,298 | 3.5× |
| Hyperthermia, externally generated; deep (ie, heating to depths greater than 4 cm) Non-Facility (77605) | $2,119.20 | $5,298 | 2.8× |
| Hysterosalpingogram (74740) range across 2 matching MRF lines |
$1,588.40–$1,699.20 | $3,971–$4,248 | varies |
| Image fusion (77399) | $2,309.60 | $5,774 | 15.7× |
| Infant hip ultrasound with hip movement (dynamic) (76885) | $1,331.20 | $3,328 | 14.0× |
| Infant hip ultrasound, limited static exam (76886) | $1,024.40 | $2,561 | 10.8× |
| Infusion Ivp (74410) range across 2 matching MRF lines |
$826.40–$1,184 | $2,066–$2,960 | varies |
| Interstitial radiation source applic complex (77778) | $2,119.20 | $5,298 | 2.8× |
| Intracavitary Radiation Source Applic Complex (77763) | $2,119.20 | $5,298 | 2.8× |
| Intracavitary Radiation Source Applic Intermed (77762) | $2,119.20 | $5,298 | 3.5× |
| Intracavitary radiation source applic simple (77761) range across 2 matching MRF lines |
$1,412–$2,119.20 | $3,530–$5,298 | varies |
| K Flow/Funct Image Multiple (78709) | $4,437.20 | $11,093 | 7.5× |
| K Flow/Funct Image W/Drug (78708) | $4,497.20 | $11,243 | 7.6× |
| K Flow/Funct Image W/O Drug (78707) | $2,938.40 | $7,346 | 5.0× |
| Kidney Funcj Study Non-Img Radioisotopic Study (78725) range across 2 matching MRF lines |
$1,452–$2,035.60 | $3,630–$5,089 | varies |
| Kidney Imaging Morphol (78700) | $2,550 | $6,375 | 5.8× |
| Kidney Imaging Morphoogy W/Vascular Flow (78701) range across 2 matching MRF lines |
$2,130.40–$3,723.20 | $5,326–$9,308 | varies |
| Knee 3 Views (73562) range across 3 matching MRF lines |
$823.60–$1,235.60 | $2,059–$3,089 | varies |
| Leveen/Shunt Patency Exam (78291) | $1,679.20 | $4,198 | 3.8× |
| Liver & Spleen Imaging Static Only (78215) | $2,101.60 | $5,254 | 4.8× |
| Liver & Spleen Imaging W/Vascular Flow (78216) | $2,546 | $6,365 | 5.8× |
| Liver imaging static only (78201) | $2,090.80 | $5,227 | 3.5× |
| Liver imaging w/vascular flow (78202) | $1,971.60 | $4,929 | 3.3× |
| Lung Perf&Ventilat Diferentl (78598) | $2,873.60 | $7,184 | 4.8× |
| Lung perfusion differential (78597) | $1,846.80 | $4,617 | 4.2× |
| Lung Ventilat&Perfus Imaging (78582) | $4,726.40 | $11,816 | 8.0× |
| Lung Ventilation Imaging (78579) | $1,846.80 | $4,617 | 4.2× |
| Lymph System Imaging (78195) range across 2 matching MRF lines |
$5,861.20–$8,429.60 | $14,653–$21,074 | varies |
| Lymphangiography Extremity Only Bilateral Rs&I (75803) range across 2 matching MRF lines |
$3,696–$5,867.60 | $9,240–$14,669 | varies |
| Lymphangiography extremity only unilateral rs&i (75801) | $5,849.20 | $14,623 | 8.5× |
| Lymphangiography Pelvic/Abdominal Bilateral Rs&I (75807) range across 2 matching MRF lines |
$3,849.20–$5,867.60 | $9,623–$14,669 | varies |
| Lymphangiography, pelvic/abdominal, unilateral (75805) | $4,192 | $10,480 | 1.2× |
| Magnetic Image Jaw Joint (70336) | $3,920 | $9,800 | 15.0× |
| Mammary ductogram or galactogram multiple (77054) | $1,592.40 | $3,981 | 6.1× |
| Mammary ductogram or galactogram single (77053) | $843.20 | $2,108 | 3.2× |
| Meckels Divert Exam (78290) | $2,646.40 | $6,616 | 6.1× |
| Mra Head W/O & W/Contrast Material (70546) | $5,312.40 | $13,281 | 13.9× |
| MRA head w/o contrast (70544) range across 3 matching MRF lines |
$840–$3,268 | $2,100–$8,170 | varies |
| MRA head with contrast (70545) range across 2 matching MRF lines |
$3,916.80–$4,692 | $9,792–$11,730 | varies |
| MRA neck w contrast (70548) range across 2 matching MRF lines |
$1,399.60–$3,696.40 | $3,499–$9,241 | varies |
| Mra Neck W/O &W/Contrast Material (70549) | $4,862.80 | $12,157 | 12.8× |
| MRA neck w/o contrast (70547) range across 2 matching MRF lines |
$1,470–$3,163.20 | $3,675–$7,908 | varies |
| MRI abdomen w contrast (74182) range across 2 matching MRF lines |
$2,681.20–$4,269.60 | $6,703–$10,674 | varies |
| MRI abdomen w/o contrast (74181) range across 3 matching MRF lines |
$3,010.40–$4,144 | $7,526–$10,360 | varies |
| MRI any jt lower extrem w/contrast material (73722) range across 3 matching MRF lines |
$4,998.40–$9,456.80 | $12,496–$23,642 | varies |
| MRI any jt lower extrem w/o & w/contrast matrl (73723) range across 3 matching MRF lines |
$5,832–$11,671.60 | $14,580–$29,179 | varies |
| MRI any jt upper extremity w/contrast matrl (73222) range across 3 matching MRF lines |
$4,725.60–$9,456.80 | $11,814–$23,642 | varies |
| MRI bone marrow blood supply (77084) | $2,681.20 | $6,703 | 10.3× |
| MRI Breast Without Contrast Material Unilateral (77046) | $1,087.20 | $2,718 | 4.2× |
| MRI cervical spine w contrast (72142) range across 2 matching MRF lines |
$2,437.60–$6,200.80 | $6,094–$15,502 | varies |
| MRI cervical spine w/o cont (72141) range across 2 matching MRF lines |
$3,132.40–$4,770 | $7,831–$11,925 | varies |
| MRI chest w/o contrast (71550) range across 2 matching MRF lines |
$2,874–$5,411.60 | $7,185–$13,529 | varies |
| MRI chest with contrast (71551) | $5,212.40 | $13,031 | 6.1× |
| MRI chest wo w contrast (71552) | $7,206.80 | $18,017 | 18.9× |
| MRI lower extrem oth/thn jt w/contrast matrl (73719) range across 3 matching MRF lines |
$5,998–$9,456.80 | $14,995–$23,642 | varies |
| MRI lower extrem oth/thn jt w/o & w/contr matr (73720) range across 3 matching MRF lines |
$4,584.80–$9,175.20 | $11,462–$22,938 | varies |
| MRI lower extrem oth/thn jt w/o contr matrl (73718) range across 5 matching MRF lines |
$2,534.40–$10,409.60 | $6,336–$26,024 | varies |
| MRI lumbar spine w contrast (72149) range across 2 matching MRF lines |
$3,696.40–$6,200.80 | $9,241–$15,502 | varies |
| Mri Neck Spine W/O & W/Dye (72156) | $6,828 | $17,070 | 17.9× |
| MRI orbit face &/neck w/o contrast (70540) range across 2 matching MRF lines |
$3,217.60–$4,307.20 | $8,044–$10,768 | varies |
| MRI orbit face neck w contrast (70542) range across 2 matching MRF lines |
$2,681.20–$4,975.60 | $6,703–$12,439 | varies |
| Mri Orbt/Fac/Nck W/O &W/Dye (70543) range across 2 matching MRF lines |
$2,681.20–$4,162 | $6,703–$10,405 | varies |
| MRI pelvis w contrast (72196) range across 2 matching MRF lines |
$2,606.40–$5,473.20 | $6,516–$13,683 | varies |
| MRI pelvis w/o & w contrast (72197) range across 2 matching MRF lines |
$2,681.20–$5,743.20 | $6,703–$14,358 | varies |
| MRI pelvis w/o contrast (72195) range across 2 matching MRF lines |
$2,534.40–$4,770 | $6,336–$11,925 | varies |
| MRI spectroscopy (76390) range across 2 matching MRF lines |
$4,307.60–$6,154.80 | $10,769–$15,387 | varies |
| MRI thoracic spine w/o contrast (72146) range across 2 matching MRF lines |
$2,681.20–$3,727.60 | $6,703–$9,319 | varies |
| MRI upper extremity oth than jt w/contr matrl (73219) range across 3 matching MRF lines |
$4,725.60–$9,456.80 | $11,814–$23,642 | varies |
| MRI upper extremity oth than jt w/o contr matrl (73218) range across 3 matching MRF lines |
$5,501.60–$10,409.60 | $13,754–$26,024 | varies |
| Mri Uppr Extremity W/O&W/Dye (73220) range across 3 matching MRF lines |
$6,004.80–$12,003.20 | $15,012–$30,008 | varies |
| MRI, abdomen, combo (74183) range across 2 matching MRF lines |
$2,681.20–$4,528.40 | $6,703–$11,321 | varies |
| MRI, dorsal spine combo (72157) range across 2 matching MRF lines |
$4,180–$6,828 | $10,450–$17,070 | varies |
| MRI, dorsal spine contrast (72147) range across 2 matching MRF lines |
$4,002.40–$6,200.80 | $10,006–$15,502 | varies |
| MRI, joint upper extrem (73221) range across 5 matching MRF lines |
$3,048.80–$9,175.20 | $7,622–$22,938 | varies |
| MRI, joint upper extrem combo (73223) range across 4 matching MRF lines |
$2,730.80–$10,402.40 | $6,827–$26,006 | varies |
| MRI, lumbar spine combo (72158) range across 2 matching MRF lines |
$4,429.60–$6,828 | $11,074–$17,070 | varies |
| Myelogram cervical (72240) | $3,113.20 | $7,783 | 3.6× |
| Myelogram Lumbar (72265) range across 2 matching MRF lines |
$2,541.60–$2,694.40 | $6,354–$6,736 | varies |
| Myelography thoracic (72255) | $2,047.20 | $5,118 | 2.4× |
| Myelograpy 2/more regions rs&i (72270) | $3,718 | $9,295 | 4.3× |
| Myocardial Imaging Infarct Avid Planar Qual/Quan (78466) | $1,549.60 | $3,874 | 3.5× |
| Myocardial Imaging Pet Metabolic Evaluation (78459) | $5,698.40 | $14,246 | 4.0× |
| Myocardial imaging, infarct avid, planar; with ejection fraction by first pass technique Non-Facility (78468) | $1,539.20 | $3,848 | 2.6× |
| Myocardial Perfusion Planar 1 Study Rest/Stress (78453) | $2,905.20 | $7,263 | 2.1× |
| Myocardial Spect Multiple Studies (78452) | $10,845.60 | $27,114 | 7.7× |
| Neck soft tissue (70360) range across 2 matching MRF lines |
$329.60–$724 | $824–$1,810 | varies |
| Nfs/Instlj Radioelmnt Sln 3 Mo Follow-Up Care (77750) range across 2 matching MRF lines |
$1,306–$1,960.80 | $3,265–$4,902 | varies |
| Nm csf leak detection (78650) | $3,219.20 | $8,048 | 2.3× |
| Nm myocard infarct spect (78469) | $3,696 | $9,240 | 6.2× |
| Nonvascular Shunt X-Ray (75809) | $788 | $1,970 | 6.9× |
| Nuclear Rx Intra-Arterial (79445) | $4,032 | $10,080 | 15.8× |
| Nuclear Rx Oral Admin (79005) | $8,801.60 | $22,004 | 34.5× |
| Ophthalmic ultrasound dx b-scan w/wo a-scan (76512) range across 3 matching MRF lines |
$771.20–$1,156.80 | $1,928–$2,892 | varies |
| Panoramic X-ray of jaws (70355) | $574.40 | $1,436 | 6.0× |
| Parathyroid imaging w/tomographic spect & CT (78072) | $762.40 | $1,906 | 1.3× |
| Parathyroid Planar Imaging (78070) | $1,034.40 | $2,586 | 2.4× |
| Parathyroid planar imaging w/wo subtraction (78071) | $762.40 | $1,906 | 1.7× |
| Pelvis 1 or 2 views (72170) | $569.20 | $1,423 | 5.0× |
| Perineogram (74775) | $2,617.60 | $6,544 | 10.0× |
| Peritoneogram Rs&I (74190) | $2,726.40 | $6,816 | 4.6× |
| Proton tx delivery complex (77525) | $2,647.20 | $6,618 | 1.9× |
| Proton tx delivery simple w/o compensation (77520) range across 2 matching MRF lines |
$2,119.20–$2,215.60 | $5,298–$5,539 | varies |
| Prq Transhepatc Portograpy Hemodyn Eval Rs&I (75885) | $4,054.80 | $10,137 | 1.2× |
| Pulmonary Perfusion Imaging Particulate (78580) range across 2 matching MRF lines |
$1,306–$1,915.20 | $3,265–$4,788 | varies |
| Radex Abd Compl Aqt Abd W/S/E/D Views 1 View Ch (74022) range across 2 matching MRF lines |
$936–$1,054 | $2,340–$2,635 | varies |
| Radex abscess/fistula/sinus tract rs&i (76080) range across 5 matching MRF lines |
$1,560.40–$1,872.40 | $3,901–$4,681 | varies |
| Radex Ankle Complete Minimum 3 Views (73610) range across 3 matching MRF lines |
$750.40–$1,110 | $1,876–$2,775 | varies |
| Radex Calcaneus Minimum 2 Views (73650) range across 3 matching MRF lines |
$605.20–$747.20 | $1,513–$1,868 | varies |
| Radex elbow complete minimum 3 views (73080) range across 3 matching MRF lines |
$682–$935.20 | $1,705–$2,338 | varies |
| Radex Facial Bones Complete Minimum 3 Views (70150) | $1,206.80 | $3,017 | 10.6× |
| Radex fingr minimum 2 views (73140) range across 12 matching MRF lines |
$383.20–$564.40 | $958–$1,411 | varies |
| Radex foot complete minimum 3 views (73630) range across 3 matching MRF lines |
$663.20–$995.60 | $1,658–$2,489 | varies |
| Radex Hand Minimum 3 Views (73130) range across 3 matching MRF lines |
$662.40–$1,026.40 | $1,656–$2,566 | varies |
| Radex lower extremity infant minimum 2 views (73592) range across 3 matching MRF lines |
$464.80–$716.40 | $1,162–$1,791 | varies |
| Radex Mastoids Compl Minimum 3 Views PR Side (70130) | $1,090 | $2,725 | 9.5× |
| Radex Nasal Bones Complete Minimum 3 Views (70160) range across 2 matching MRF lines |
$439.60–$630.40 | $1,099–$1,576 | varies |
| Radex Pharynx/Larx W/Fluor&/Magnification Tq (70370) | $468 | $1,170 | 4.9× |
| Radex Ribs Unilateral 2 Views (71100) | $843.60 | $2,109 | 8.9× |
| Radex shoulder complete minimum 2 views (73030) range across 3 matching MRF lines |
$693.60–$757.60 | $1,734–$1,894 | varies |
| Radex Sinuses Paransl < 3 Views (70210) | $495.20 | $1,238 | 5.2× |
| Radex sm int w/mlt srl imges via enteroclss tube (74251) | $1,305.60 | $3,264 | 6.8× |
| Radex Spine 1 View Specify Level (72020) | $606 | $1,515 | 6.4× |
| Radex Sternum Minimum 2 Views (71120) range across 2 matching MRF lines |
$329.60–$857.20 | $824–$2,143 | varies |
| Radex Temporomandble Jt Opn & Clsd Mouth Bilat (70330) range across 2 matching MRF lines |
$904.40–$1,250.40 | $2,261–$3,126 | varies |
| Radex Toe Minimum 2 Views (73660) range across 12 matching MRF lines |
$352.40–$550.80 | $881–$1,377 | varies |
| Radex upper extremity infant minimum 2 views (73092) range across 3 matching MRF lines |
$708–$716.40 | $1,770–$1,791 | varies |
| Radex Wrist Complete Minimum 3 Views (73110) range across 3 matching MRF lines |
$733.20–$995.60 | $1,833–$2,489 | varies |
| Radex X-Ray Exam Entire Spi 6/> Vw - Xr Entire Spine 6+ Vw (72084) | $2,726.80 | $6,817 | 23.9× |
| Radiolog exam mandible compl minimum 4 views (70110) | $938.40 | $2,346 | 8.2× |
| Radiologic Exam Abdomen 3+ Views - Xr Abdomen 3+ Views (74021) range across 2 matching MRF lines |
$484.40–$739.60 | $1,211–$1,849 | varies |
| Radiologic exam colon double contrast study (74280) range across 2 matching MRF lines |
$826.40–$1,252.40 | $2,066–$3,131 | varies |
| Radiologic exam colon single contrast study (74270) range across 2 matching MRF lines |
$826.40–$1,637.20 | $2,066–$4,093 | varies |
| Radiologic Exam Esophagus Double Contrast Study (74221) range across 2 matching MRF lines |
$568–$979.60 | $1,420–$2,449 | varies |
| Radiologic exam knee complete 4/more views (73564) range across 3 matching MRF lines |
$867.20–$1,028.80 | $2,168–$2,572 | varies |
| Radiologic exam pelvis compl minimum 3 views (72190) | $1,120.40 | $2,801 | 9.8× |
| Radiologic Exam Small Int Single Contrast Study (74250) range across 2 matching MRF lines |
$826.40–$1,146.40 | $2,066–$2,866 | varies |
| Radiologic exam swallow function contrast study (74230) range across 2 matching MRF lines |
$1,021.60–$1,160.40 | $2,554–$2,901 | varies |
| Radiologic exam teeth complete full mouth (70320) | $1,221.20 | $3,053 | 4.7× |
| Radiologic Exam Teeth Prtl Exam < Full Mouth (70310) | $904.40 | $2,261 | 3.5× |
| Radiologic exam upr gi trc double contrast study (74246) range across 6 matching MRF lines |
$660.80–$1,566 | $1,652–$3,915 | varies |
| Radiologic examination femur minimum 2 views (73552) range across 3 matching MRF lines |
$748.80–$936 | $1,872–$2,340 | varies |
| Radiologic examination knee 1/2 views (73560) range across 3 matching MRF lines |
$608.40–$816.80 | $1,521–$2,042 | varies |
| Radiologic Examination Osseous Survey Limited (77074) | $744.80 | $1,862 | 6.5× |
| Radiologic examination tibia & fibula 2 views (73590) range across 3 matching MRF lines |
$678.80–$1,079.20 | $1,697–$2,698 | varies |
| Radiopharmaceutical therapy, by intracavitary administration Non-Facility (79200) | $4,618.80 | $11,547 | 18.1× |
| Renal Cyst Study (74470) | $1,452 | $3,630 | 2.4× |
| Ribs bilateral 3 views (71110) range across 2 matching MRF lines |
$660.80–$986 | $1,652–$2,465 | varies |
| Rp loclzj tum plnr 1 area single day imaging (78800) | $3,837.20 | $9,593 | 8.8× |
| Rp loclzj tum plnr 2+area 1+d img/1 area img>2+d (78801) | $3,201.20 | $8,003 | 7.3× |
| Rp Loclzj Tum Plnr Whole Body 2+ Days Imaging (78804) | $7,752.40 | $19,381 | 13.1× |
| Rp Loclzj Tum Plnr Whole Body Single Day Imaging (78802) | $3,950.40 | $9,876 | 6.7× |
| Rp Loclzj Tum Spect 1 Area Single Day Imaging (78803) range across 6 matching MRF lines |
$1,210–$5,135.60 | $3,025–$12,839 | varies |
| Rp Therapy Intravenous Administration (79101) | $4,274.80 | $10,687 | 16.8× |
| Salivary Gland Imaging (78230) | $1,318.40 | $3,296 | 3.0× |
| Scapula (73010) range across 3 matching MRF lines |
$755.20–$807.60 | $1,888–$2,019 | varies |
| Sella turcica (70240) | $810 | $2,025 | 8.5× |
| Shoulder 1 view (73020) range across 3 matching MRF lines |
$462.40–$544 | $1,156–$1,360 | varies |
| Shoulder Arthrography (73040) | $2,474.40 | $6,186 | 6.5× |
| Sialogram (70390) | $904.40 | $2,261 | 3.5× |
| Skull less than 4 views (70250) | $729.60 | $1,824 | 6.4× |
| Special dosimetry (77331) | $2,119.20 | $5,298 | 14.4× |
| Special Physics Consult (77370) range across 2 matching MRF lines |
$1,412–$2,119.20 | $3,530–$5,298 | varies |
| Special teletherapy port plan (77321) | $2,119.20 | $5,298 | 5.2× |
| Special treatment procedure (77470) | $2,119.20 | $5,298 | 3.5× |
| Speech evaluation, complex (70371) | $1,277.20 | $3,193 | 4.9× |
| Sternoclavicular joints (71130) range across 2 matching MRF lines |
$329.60–$484.40 | $824–$1,211 | varies |
| Superior sagittal sinus venogram (75870) range across 2 matching MRF lines |
$2,387.20–$3,696 | $5,968–$9,240 | varies |
| Surface Applic Low Dose Rate Radionuclide Source (77789) range across 2 matching MRF lines |
$1,412–$2,119.20 | $3,530–$5,298 | varies |
| Telethx isodose pln cplx w/basic dosimetry (77307) | $2,119.20 | $5,298 | 5.2× |
| Telethx isodose pln smpl w/dosimetry calculation (77306) | $2,119.20 | $5,298 | 5.2× |
| Testicular Imaging W/Flow (78761) | $2,139.60 | $5,349 | 4.9× |
| Ther Rad Simulaj-Aided Field Setting Complex (77290) | $2,119.20 | $5,298 | 5.2× |
| Ther Rad Simulaj-Aided Field Setting Intermed (77285) | $2,119.20 | $5,298 | 5.2× |
| Ther rad simulaj-aided field setting simple (77280) range across 2 matching MRF lines |
$1,412–$2,119.20 | $3,530–$5,298 | varies |
| Thoracic spine 2 views (72070) | $838.40 | $2,096 | 7.3× |
| Thoracic spine 3 views (72072) | $885.20 | $2,213 | 7.7× |
| Thoracolumbar 2 views (72080) | $701.60 | $1,754 | 7.4× |
| Thyroid Imaging With Vascular Flow (78013) | $1,153.20 | $2,883 | 2.6× |
| Thyroid Met Imaging Body (78018) | $2,975.20 | $7,438 | 5.0× |
| Thyroid Uptake Measurement (78012) range across 3 matching MRF lines |
$615.60–$713.20 | $1,539–$1,783 | varies |
| Thyroid Uptake W/Blood Flow Sngle/Mult Quan Meas (78014) range across 2 matching MRF lines |
$924–$1,230.80 | $2,310–$3,077 | varies |
| Tx Devices Design & Construction Complex (77334) | $2,119.20 | $5,298 | 5.2× |
| Tx devices design & construction intermediate (77333) | $2,119.20 | $5,298 | 14.4× |
| Tx devices design & construction simple (77332) range across 2 matching MRF lines |
$1,412–$2,119.20 | $3,530–$5,298 | varies |
| Ultrasound Breast Limited (76642) range across 3 matching MRF lines |
$729.60–$743.20 | $1,824–$1,858 | varies |
| Ultrasound, abdomen limited (76705) range across 8 matching MRF lines |
$1,351.20–$1,641.60 | $3,378–$4,104 | varies |
| Unlis px ther radiol clinical tx planning (77299) | $2,309.60 | $5,774 | 15.7× |
| Unlisted Dx Radiographic Procedure (76499) | $118.80 | $297 | 1.2× |
| Unlisted fluoroscopic procedure (76496) | $395.60 | $989 | 4.2× |
| Unlisted Miscellaneous Px Dx Nuclear Medicine (78999) | $1,868.40 | $4,671 | 4.3× |
| Unlisted Procedure Clinical Brachytherapy (77799) | $2,309.60 | $5,774 | 20.7× |
| Unlisted us procedure (76999) | $684.40 | $1,711 | 7.2× |
| Upper gi w/o kub (74240) range across 6 matching MRF lines |
$782.40–$1,508.40 | $1,956–$3,771 | varies |
| Urea Breath Test C-14 Isotopic Acquisj Analysis (78267) | $2,576.40 | $6,441 | 232.9× |
| Ureteral Reflux Study (78740) | $2,550 | $6,375 | 5.8× |
| Urethrocystogram voiding (74455) | $1,240.40 | $3,101 | 4.8× |
| Urethrocystography retrograde (74450) range across 2 matching MRF lines |
$660.80–$915.60 | $1,652–$2,289 | varies |
| Us breast unilateral complete (76641) | $1,401.60 | $3,504 | 12.3× |
| Us chest (76604) range across 2 matching MRF lines |
$746.40–$881.20 | $1,866–$2,203 | varies |
| Us complete joint (76881) | $1,063.60 | $2,659 | 9.3× |
| Us exam, pelvic, limited (76857) | $913.60 | $2,284 | 8.0× |
| Us head (76506) range across 2 matching MRF lines |
$845.20–$1,145.60 | $2,113–$2,864 | varies |
| Us kidney transplant (76776) | $1,975.20 | $4,938 | 17.3× |
| Us lmtd joint/oth nonvasc xtr strux r-t w/img (76882) range across 4 matching MRF lines |
$731.20–$842.80 | $1,828–$2,107 | varies |
| Us ob detailed single fetus (76811) | $2,160 | $5,400 | 8.3× |
| Us ob limited 1 or more fetuses (76815) range across 3 matching MRF lines |
$599.60–$1,199.20 | $1,499–$2,998 | varies |
| Us ob transvaginal (76817) range across 2 matching MRF lines |
$1,662–$1,758 | $4,155–$4,395 | varies |
| Us pelvic non ob complete (76856) range across 4 matching MRF lines |
$1,160–$1,685.20 | $2,900–$4,213 | varies |
| Us pg uter img f&mat 14 wk tabdl 1/1st gestation (76801) | $1,287.20 | $3,218 | 11.3× |
| Us preg uterus real time f/u trnsabdl per fetus (76816) | $1,006 | $2,515 | 8.8× |
| Us retroperitoneal complete (76770) | $1,559.20 | $3,898 | 13.6× |
| Us retroperitoneal limited (76775) range across 5 matching MRF lines |
$994.80–$1,975.20 | $2,487–$4,938 | varies |
| Us scrotum and contents (76870) range across 2 matching MRF lines |
$1,077.60–$1,483.60 | $2,694–$3,709 | varies |
| Us spinal canal and contents (76800) range across 2 matching MRF lines |
$894.80–$1,161.60 | $2,237–$2,904 | varies |
| Us thyroid (76536) range across 3 matching MRF lines |
$1,066.40–$1,384 | $2,666–$3,460 | varies |
| Us transrectal (76872) range across 2 matching MRF lines |
$1,302–$1,842.80 | $3,255–$4,607 | varies |
| Vascular Flow Imaging (78445) | $1,719.60 | $4,299 | 3.9× |
| Vein X-Ray Chest (75827) range across 3 matching MRF lines |
$2,931.60–$5,543.20 | $7,329–$13,858 | varies |
| Vein X-Ray Liver W/O Hemodyn (75887) | $3,466.80 | $8,667 | 1.0× |
| Vein X-Ray Spleen/Liver (75810) | $3,810 | $9,525 | 1.1× |
| Venogram Sinus/Jugular (75860) range across 2 matching MRF lines |
$2,252.40–$6,490.40 | $5,631–$16,226 | varies |
| Venography Adrenal Unilateral (75840) | $3,387.20 | $8,468 | 1.0× |
| Venography caval inferior serialography rs&i (75825) range across 3 matching MRF lines |
$2,266–$7,788.40 | $5,665–$19,471 | varies |
| Venography extremity bilateral rs&i (75822) range across 4 matching MRF lines |
$1,983.60–$3,820 | $4,959–$9,550 | varies |
| Venography extremity unilateral rs&i (75820) range across 10 matching MRF lines |
$1,140.40–$1,795.60 | $2,851–$4,489 | varies |
| Venography Renal Bilateral (75833) range across 4 matching MRF lines |
$2,309.60–$3,304.80 | $5,774–$8,262 | varies |
| Venography Renal Unilateral (75831) range across 3 matching MRF lines |
$2,245.20–$3,260 | $5,613–$8,150 | varies |
| Venous sampling by catheter (75893) unusually low: confirm this is the full procedure |
$2,471.20 | $6,178 | 0.4× |
| Venous Thrombosis Imaging Venogram Bilateral (78458) | $2,754 | $6,885 | 6.3× |
| Wrist 2 views (73100) range across 4 matching MRF lines |
$344–$757.60 | $860–$1,894 | varies |
| X-Ray Ac Jts - Xr Acromioclavicular Joints Bilateral (73050) range across 2 matching MRF lines |
$329.60–$526.40 | $824–$1,316 | varies |
| X-ray antegrade pyelogram tube (74425) range across 3 matching MRF lines |
$1,425.60–$2,658.80 | $3,564–$6,647 | varies |
| X-Ray Aorta Leg Arteries (75630) range across 4 matching MRF lines |
$2,461.20–$8,233.20 | $6,153–$20,583 | varies |
| X-Ray Bend Only L-S Spine (72120) | $634.40 | $1,586 | 5.6× |
| X-Ray Elbow 2 Vw - Xr Elbow 1-2 Views Right (73070) range across 5 matching MRF lines |
$594.80–$757.60 | $1,487–$1,894 | varies |
| X-Ray Exam Breast Specimen (76098) | $1,127.60 | $2,819 | 1.9× |
| X-Ray Exam Entire Spi 2/3 Vw (72082) range across 2 matching MRF lines |
$446–$634.40 | $1,115–$1,586 | varies |
| X-Ray Exam Entire Spi 4/5 Vw (72083) | $787.20 | $1,968 | 6.9× |
| X-Ray Exam Hip Uni 1 View (73501) | $848 | $2,120 | 8.9× |
| X-Ray Exam Hip Uni 2-3 Views (73502) | $720.80 | $1,802 | 7.6× |
| X-Ray Exam Hips Bi 2 Views (73521) | $630 | $1,575 | 5.5× |
| X-Ray Exam Hips Bi 3-4 Views (73522) | $855.20 | $2,138 | 7.5× |
| X-Ray Exam L-S Spine Bending (72114) | $1,994 | $4,985 | 17.4× |
| X-Ray Exam Neck Spine 2-3 Vw (72040) | $732.80 | $1,832 | 7.7× |
| X-Ray Exam Neck Spine 6/>Vws (72052) | $894 | $2,235 | 7.8× |
| X-Ray Exam Unilat Ribs/Chest (71101) | $749.20 | $1,873 | 6.6× |
| X-ray eye for foreign body (70030) range across 3 matching MRF lines |
$660.80–$1,201.60 | $1,652–$3,004 | varies |
| X-ray humerus (73060) range across 3 matching MRF lines |
$628–$747.20 | $1,570–$1,868 | varies |
| X-ray IV pyelogram (ivp) (74400) range across 2 matching MRF lines |
$1,318.40–$1,673.60 | $3,296–$4,184 | varies |
| X-ray IV pyelogram+tomography (74415) range across 2 matching MRF lines |
$1,318.40–$1,932.40 | $3,296–$4,831 | varies |
| X-Ray Jaw <4 Vw - Xr Mandible < 4 Views (70100) | $689.20 | $1,723 | 7.2× |
| X-Ray Knee Bilat Standing - Xr Knees Anteroposterior Standing Bilat (73565) | $433.60 | $1,084 | 4.6× |
| X-Ray Lumbar Spine 2/3 Vw - Xr Lumbar Spine 2-3 Views (72100) | $774.80 | $1,937 | 6.8× |
| X-ray nose-rectum child f.b. (76010) | $2,009.60 | $5,024 | 21.1× |
| X-Ray Ribs, Chest 4+ Vw - Xr Ribs 3 Vws Bil W/ Chest Posteroanterior (71111) | $1,248.80 | $3,122 | 10.9× |
| X-Ray Sacroiliac Jts 3+ Vw - Xr Sacroiliac Joints 3+ Views (72202) | $519.20 | $1,298 | 4.5× |
| X-Ray Sacroiliac Jts <3 Vw - Xr Sacroiliac Joints 1-2 Views (72200) | $506 | $1,265 | 4.4× |
| X-Ray Sacrum/Coccyx 2+ Vw - Xr Sacrum Coccyx 2+ Views (72220) | $826.80 | $2,067 | 8.7× |
| X-Ray Sinuses 3+ Vw - Xr Paranasal Sinuses 3+ Views (70220) | $821.60 | $2,054 | 8.6× |
| X-Ray Skull 4+ Vw - Xr Skull Complete 4+ Views (70260) | $1,171.60 | $2,929 | 10.3× |
| X-ray thoracic spine 4 vw (72074) | $1,117.60 | $2,794 | 9.8× |
| X-Ray Tmj Unilat (70328) | $778.80 | $1,947 | 8.2× |
| X-Ray Urinary Tract Exam With Contrast Material (74420) range across 2 matching MRF lines |
$810–$2,596.80 | $2,025–$6,492 | varies |
| X-Rays Bone Length Studies (77073) | $958.40 | $2,396 | 8.4× |
| X-Rays Bone Survey Complete (77075) | $1,644 | $4,110 | 14.4× |
| Xr c-spine 4 or 5 views (72050) | $991.60 | $2,479 | 8.7× |
| Xr facial bones less than 3 views (70140) | $600 | $1,500 | 6.3× |
| XR Mastoids < 3 Views Bilateral (70120) | $526.40 | $1,316 | 4.6× |
| Xr orbits complete 4 views (70200) range across 2 matching MRF lines |
$642.40–$1,102.40 | $1,606–$2,756 | varies |
| Xr Tomogram Single Plane (76100) | $1,210 | $3,025 | 10.6× |
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.