Imaging prices at TriStar Summit Medical Center
Hermitage, TN · every code in this section with a posted price and a Medicare benchmark.
294 codes. Prices are the hospital's own posted facility charges.
Compare against other hospitals interactively →
| Procedure | Cash price | Gross charge | × Medicare |
|---|---|---|---|
| 3-D radiotherapy plan dose-volume histograms (77295) | $14,372.65 | $14,372.65 | 10.8× |
| Abdomen 2 views (74019) | $1,731.70 | $1,731.70 | 17.3× |
| Acute gastrointestinal blood loss imaging (78278) | $3,496.48 | $3,496.48 | 9.1× |
| Angiography extremity bilateral rs&i (75716) | $10,091.66 | $10,091.66 | 3.3× |
| Angiography extremity unilateral rs&i (75710) | $7,212.66 | $7,212.66 | 2.4× |
| Angiography pelvic slctv/supraslctv rs&i (75736) | $8,939.37 | $8,939.37 | 1.7× |
| Angiography pulmonary bilateral slctv rs&i (75743) | $8,445.24 | $8,445.24 | 2.8× |
| Angiography pulmonary unilateral slctv rs&i (75741) | $8,606.97 | $8,606.97 | 2.8× |
| Angiography Spinal Selective Rs&I (75705) | $6,734.06 | $6,734.06 | 1.3× |
| Angiography visceral slctv/supraslctv rs&i (75726) | $9,514.38 | $9,514.38 | 1.8× |
| Angrph Cath F-Up Std Tcat Other Than Thrombylsis (75898) | $3,182.68 | $3,182.68 | 1.1× |
| Ankle 2 views (73600) | $1,356.62 | $1,356.62 | 16.2× |
| Antegrade urography radiological supvj & interpj (74425) | $1,563.26 | $1,563.26 | 4.7× |
| Aortography abdl bi iliofem low extrem cath rs&i (75630) | $13,388.87 | $13,388.87 | 4.4× |
| Aortography abdominal serialography rs&i (75625) | $9,491.93 | $9,491.93 | 3.1× |
| Artery X-Rays Adrenal Gland (75731) | $12,876.92 | $12,876.92 | 4.3× |
| Arthrogram shoulder (73040) | $3,595.98 | $3,595.98 | 10.7× |
| Basic radiation dosimetry calculation (77300) | $1,805.30 | $1,805.30 | 14.0× |
| Bone &/joint imaging whole body (78306) | $6,474.03 | $6,474.03 | 16.9× |
| Bone age studies (77072) | $1,194.90 | $1,194.90 | 11.9× |
| Bone Imaging 3 Phase (78315) | $6,975.69 | $6,975.69 | 18.2× |
| Bone survey complete (77075) | $2,358.37 | $2,358.37 | 23.5× |
| Brain Imaging Pet Metabolic Evaluation (78608) | $7,027.80 | $7,027.80 | 5.1× |
| Brain Imaging Vascular Flow Only (78610) | $4,867.41 | $4,867.41 | 9.3× |
| Cardiac MRI w/w/o contrast & further seq (75561) | $1,389.85 | $1,389.85 | 4.2× |
| Cervical spine 2 or 3 views (72040) | $1,012.96 | $1,012.96 | 12.1× |
| Chest 1 view (71045) | $1,120.76 | $1,120.76 | 13.4× |
| Chest 3 views (71047) | $1,531.77 | $1,531.77 | 18.3× |
| Cine/Vid X-Ray Throat/Esoph - Fl Esoph Barium Swlw W/ Video & Speech (74230) | $1,495.86 | $1,495.86 | 8.9× |
| Clavicle complete (73000) | $1,255.55 | $1,255.55 | 15.0× |
| Computed Tomography Thorax Lw Dose Lng Ca Scr C- (71271) | $905.60 | $905.60 | 9.0× |
| Continuing medical physics consltj pr wk (77336) | $2,410.94 | $2,410.94 | 18.7× |
| CT abdomen and pelvis without and with contrast (74178) | $20,221.68 | $20,221.68 | 60.4× |
| CT abdomen and pelvis without contrast (74176) | $17,165.50 | $17,165.50 | 75.0× |
| CT abdomen w contrast (74160) | $10,296.70 | $10,296.70 | 61.2× |
| CT abdomen w wo contrast (74170) | $11,272.63 | $11,272.63 | 67.0× |
| CT abdomen w/o contrast (74150) | $9,496.78 | $9,496.78 | 94.7× |
| CT angio hrt w/3d image (75574) | $4,199.52 | $4,199.52 | 12.5× |
| CT angiography upper extremity lt (73206) | $12,737.71 | $12,737.71 | 75.7× |
| CT c-spine w/o contrast (72125) | $9,253.30 | $9,253.30 | 92.3× |
| CT cere prfuj alys c+ w/o CT/CTA same anatomy (70473) | $14,870.09 | $14,870.09 | 88.4× |
| CT cervical spine w&w/o contrast (72127) | $8,406.14 | $8,406.14 | 50.0× |
| CT cervical spine with contrast (72126) | $8,614.23 | $8,614.23 | 25.7× |
| CT chest w/wo contrast (71270) | $8,888.03 | $8,888.03 | 52.8× |
| CT chest with contrast (71260) | $9,235.92 | $9,235.92 | 54.9× |
| CT colonography w/o cntrst (74261) | $4,199.52 | $4,199.52 | 41.9× |
| CT head/brain with contrast (70460) | $8,583.80 | $8,583.80 | 51.0× |
| CT head/brain without and with contrast (70470) | $9,418.51 | $9,418.51 | 56.0× |
| CT heart no contrast quant eval coronry calcium (75571) | $270.62 | $270.62 | 3.2× |
| CT iac w contrast (70481) | $3,911.04 | $3,911.04 | 23.2× |
| CT limited/localized follow up study (76380) | $3,508.29 | $3,508.29 | 42.0× |
| CT lower ext w/o (73700) | $5,642.83 | $5,642.83 | 56.3× |
| CT lower extremity w wo contrast (73702) | $8,644.68 | $8,644.68 | 51.4× |
| CT lower extremity with contrast (73701) | $7,751.34 | $7,751.34 | 46.1× |
| CT lumbar spine w & w/o contrast (72133) | $9,647 | $9,647 | 57.3× |
| CT lumbar spine w/o contrast (72131) | $6,523.20 | $6,523.20 | 65.0× |
| CT lumbar spine with contrast (72132) | $7,279.64 | $7,279.64 | 21.7× |
| CT maxillofacial w contrast (70487) | $7,914.31 | $7,914.31 | 47.0× |
| CT maxillofacial w/o contrast (70486) | $7,673.07 | $7,673.07 | 76.5× |
| CT maxillofacial w/wo contrast (70488) | $8,064.32 | $8,064.32 | 47.9× |
| CT neck soft tissue w contrast (70491) | $7,751.34 | $7,751.34 | 46.1× |
| CT orbit sella/post fossa/ear w/o & w/contr matr (70482) | $7,655.68 | $7,655.68 | 45.5× |
| CT orbits w/o contrast (70480) | $7,712.18 | $7,712.18 | 76.9× |
| CT pelvis w & w/o contrast (72194) | $8,955.53 | $8,955.53 | 53.2× |
| CT pelvis w/o contrast (72192) | $7,673.07 | $7,673.07 | 76.5× |
| CT soft tissue neck w/o & w/contrast material (70492) | $9,153.33 | $9,153.33 | 54.4× |
| CT soft tissue neck w/o contrast (70490) | $6,523.20 | $6,523.20 | 65.0× |
| CT thoracic spine w/contrast (72129) | $7,193.90 | $7,193.90 | 42.7× |
| CT thoracic spine w/o contrast (72128) | $6,838.34 | $6,838.34 | 68.2× |
| CT thoracic spine w/wo contrast (72130) | $8,868.66 | $8,868.66 | 52.7× |
| CT thorax w/o contrast (71250) | $8,614.23 | $8,614.23 | 85.9× |
| CT upper extremity w/o & w/contrast material (73202) | $8,644.68 | $8,644.68 | 51.4× |
| CT upper extremity w/o contrast rt (73200) | $6,212.36 | $6,212.36 | 61.9× |
| CT upper extremity with contrast (73201) | $7,531.96 | $7,531.96 | 22.5× |
| Cta Abdl Aorta&Bi Iliofem W/Contrast&Postp (75635) | $16,609.04 | $16,609.04 | 98.7× |
| Cta Abdomen (74175) | $13,920.21 | $13,920.21 | 82.7× |
| CTA abdomen pelvis (74174) | $18,390 | $18,390 | 54.9× |
| CTA chest (71275) | $13,920.21 | $13,920.21 | 82.7× |
| Cta Head (70496) | $14,872.27 | $14,872.27 | 88.4× |
| CTA head&neck c+ w/noncontrast img&post-pxessing (70471) | $29,744.54 | $29,744.54 | 88.9× |
| CTA lwr ext w&w/o contrast (73706) | $12,737.71 | $12,737.71 | 75.7× |
| Cta Neck (70498) | $14,872.27 | $14,872.27 | 88.4× |
| Cta Pelvis (72191) | $13,920.21 | $13,920.21 | 82.7× |
| Cystography minimum 3 views rs&i (74430) | $1,457.68 | $1,457.68 | 4.4× |
| Diskography lumbar (72295) | $6,053.18 | $6,053.18 | 3.2× |
| Dxa bone density study 1/> sites axial skel (77080) | $1,237.57 | $1,237.57 | 12.3× |
| Dxa bone density study 1/>sites appendiclr skel (77081) | $1,237.57 | $1,237.57 | 14.8× |
| Dxa bone density study axial skeleton (77085) | $1,665.68 | $1,665.68 | 16.6× |
| Echoencephalography real time imaging (76506) | $2,574.78 | $2,574.78 | 25.7× |
| Esophagus (74220) | $1,983.27 | $1,983.27 | 11.8× |
| Fetal biophysical profile non-stress testing (76818) | $2,318.84 | $2,318.84 | 23.1× |
| Fluoroscopy up to 1 hr (76000) | $1,983.75 | $1,983.75 | 8.7× |
| Foot 2 views (73620) | $1,906.90 | $1,906.90 | 22.8× |
| Forearm 2 views (73090) | $1,998.99 | $1,998.99 | 23.9× |
| Gated Heart Planar Single (78472) | $5,598.02 | $5,598.02 | 14.6× |
| Hand 2 views (73120) | $1,127.51 | $1,127.51 | 11.2× |
| Hand 3 views (73130) | $2,064.13 | $2,064.13 | 24.7× |
| Hepatobil Syst Imag Inc Gb W/Pharma Intervenj (78227) | $7,587.63 | $7,587.63 | 14.6× |
| Hepatobiliary syst imaging including gallbladder (78226) | $7,587.63 | $7,587.63 | 19.8× |
| Ht muscle image spect sing (78451) | $10,874.41 | $10,874.41 | 8.8× |
| Humerus Min 2 Views Left (73060) | $2,214.60 | $2,214.60 | 26.5× |
| Hysterosalpingogram (74740) | $2,670.56 | $2,670.56 | 11.7× |
| Kidney Img Morphology Vascular Flow 1 W/O Rx (78707) | $6,115.06 | $6,115.06 | 11.7× |
| Kidney Img Morphology Vascular Flow Multiple (78709) | $6,115.06 | $6,115.06 | 11.7× |
| Knee 3 views (73562) | $1,920.37 | $1,920.37 | 23.0× |
| Liver & spleen imaging static only (78215) | $4,375.20 | $4,375.20 | 11.4× |
| Liver imaging static only (78201) | $2,811.22 | $2,811.22 | 5.4× |
| Lung perf&ventilat diferentl (78598) | $2,088.80 | $2,088.80 | 4.0× |
| Lung perfusion differential (78597) | $1,381.69 | $1,381.69 | 3.6× |
| Lymphoscintigraphy (78195) | $5,669.64 | $5,669.64 | 10.9× |
| Mammary ductogram or galactogram multiple (77054) | $1,693.84 | $1,693.84 | 7.4× |
| Mammary ductogram or galactogram single (77053) | $2,616.24 | $2,616.24 | 11.4× |
| Mlc imrt design & construction per imrt plan (77338) | $11,321.08 | $11,321.08 | 31.5× |
| Mr elastography (76391) | $1,425.86 | $1,425.86 | 6.2× |
| Mr safety determination physician/other qhp (76016) | $373.33 | $373.33 | 4.5× |
| Mr safety implant pos&/immoblj supvj phys/qhp (76019) | $251.86 | $251.86 | 4.4× |
| Mr safety implant&/fb assmt clin staf 1st 15 min (76014) | $103.84 | $103.84 | 3.7× |
| Mr safety implt electronics prepj supvj phys/qhp (76018) | $389.19 | $389.19 | 4.3× |
| Mr safety med physics xm customization plng&mntr (76017) | $1,024.89 | $1,024.89 | 4.5× |
| MRA head w/o contrast (70544) | $8,847.21 | $8,847.21 | 38.6× |
| MRA head with contrast (70545) | $7,787.06 | $7,787.06 | 23.3× |
| Mra Neck W/O &W/Contrast Material (70549) | $11,027.58 | $11,027.58 | 32.9× |
| MRA neck w/o contrast (70547) | $8,847.21 | $8,847.21 | 38.6× |
| MRI abdomen w/o & w/contrast material (74183) | $19,972.64 | $19,972.64 | 59.7× |
| MRI abdomen w/o contrast (74181) | $12,786.29 | $12,786.29 | 55.9× |
| MRI any jnt lwr ext with con lt (73722) | $14,824.56 | $14,824.56 | 19.7× |
| MRI any jt upper extremity w/contrast matrl (73222) | $14,824.56 | $14,824.56 | 19.7× |
| MRI breast w/o contrast bilateral (77047) | $9,919.77 | $9,919.77 | 43.3× |
| MRI breast w/o contrast unilat (77046) | $8,194.43 | $8,194.43 | 35.8× |
| MRI c-spine with contrast (72142) | $16,872.17 | $16,872.17 | 50.4× |
| MRI cardiac w/o cont stress (75559) | $2,261.27 | $2,261.27 | 4.3× |
| MRI cardiac w/o contrast (75557) | $868.86 | $868.86 | 3.8× |
| MRI cervical spine w/o contrast (72141) | $12,709.43 | $12,709.43 | 55.5× |
| MRI chest w/o & w/contrast material (71552) | $13,603.92 | $13,603.92 | 40.6× |
| MRI chest w/o contrast (71550) | $12,534.72 | $12,534.72 | 54.8× |
| MRI chest with contrast (71551) | $9,488.06 | $9,488.06 | 12.6× |
| MRI Forearm w/ Contrast Bilateral 73219 (73219) | $14,562.70 | $14,562.70 | 43.5× |
| MRI lower extrem oth/thn jt w/contrast matrl (73719) | $11,771.23 | $11,771.23 | 35.2× |
| MRI lower extrem oth/thn jt w/o contr matrl (73718) | $11,682.15 | $11,682.15 | 51.0× |
| MRI orbit face &/neck w/o contrast (70540) | $12,425.22 | $12,425.22 | 54.3× |
| MRI orbit/face/neck w&w/o cont (70543) | $19,972.64 | $19,972.64 | 59.7× |
| MRI pelvis w/o & w/contrast material (72197) | $20,172.97 | $20,172.97 | 60.3× |
| MRI pelvis w/o contrast (72195) | $12,707.09 | $12,707.09 | 55.5× |
| MRI scan of arm joint before and after contrast (73223) | $19,972.64 | $19,972.64 | 59.7× |
| MRI scan of heart before and after contrast with stress imaging (75563) | $2,700.17 | $2,700.17 | 3.6× |
| MRI scan of leg joint before and after contrast (73723) | $19,972.64 | $19,972.64 | 59.7× |
| MRI spinal canal cervical w/o & w/contr matrl (72156) | $16,438.85 | $16,438.85 | 49.1× |
| MRI spinal canal lumbar w/contrast material (72149) | $15,341.70 | $15,341.70 | 45.8× |
| MRI spinal canal lumbar w/o & w/contr matrl (72158) | $20,105.43 | $20,105.43 | 60.1× |
| MRI spinal canal thoracic w/contrast matrl (72147) | $13,708.77 | $13,708.77 | 41.0× |
| MRI spinal canal thoracic w/o & w/contr matrl (72157) | $21,531.05 | $21,531.05 | 64.3× |
| MRI thoracic spine w/o contrast (72146) | $11,581.99 | $11,581.99 | 50.6× |
| MRI tmj (70336) | $17,293.76 | $17,293.76 | 75.5× |
| MRI upper ext joint w/o contrast (73221) | $11,682.15 | $11,682.15 | 51.0× |
| MRI upper extrem other than jt w/o & w/contras (73220) | $19,972.64 | $19,972.64 | 59.7× |
| MRI upper extremity oth than jt w/o contr matrl (73218) | $11,682.15 | $11,682.15 | 51.0× |
| Myelogram thoracic (72255) | $5,794.77 | $5,794.77 | 7.7× |
| Myocardial Spect Multiple Studies (78452) | $10,874.41 | $10,874.41 | 8.8× |
| Neck soft tissue (70360) | $1,507.11 | $1,507.11 | 18.1× |
| Nm gastric emptying study (78264) | $5,669.64 | $5,669.64 | 14.8× |
| Ntsty modul radthx pln dose-vol histos (77301) | $8,858.87 | $8,858.87 | 6.7× |
| Nuclear medicine study from skull base to mid-thigh (78812) | $7,027.80 | $7,027.80 | 5.1× |
| Ob Us Follow-Up Per Fetus - Us Ob Follow Up Transabdominal Approach (76816) | $1,517.22 | $1,517.22 | 15.1× |
| Osseous survey infant (77076) | $902.90 | $902.90 | 9.0× |
| Osseous survey limited (77074) | $1,113 | $1,113 | 11.1× |
| Parathyrd planar w/wo subtrj (78071) | $3,336.62 | $3,336.62 | 8.7× |
| Parathyroid imaging (78070) | $2,004.46 | $2,004.46 | 5.2× |
| Pelvis 1 or 2 views (72170) | $2,142.76 | $2,142.76 | 21.4× |
| PET image w/CT, skull-thigh (78815) | $7,027.80 | $7,027.80 | 5.1× |
| PET imaging for CT attenuation whole body (78816) | $7,027.80 | $7,027.80 | 5.1× |
| Pr MRI, lower extr, w/o contrast f/u by contrast (73720) | $19,972.64 | $19,972.64 | 59.7× |
| Prq Transhepatc Portograpy Hemodyn Eval Rs&I (75885) | $6,679.12 | $6,679.12 | 2.2× |
| Prq transhepatc portograpy w/o hemodyn evl intrp (75887) | $10,316.15 | $10,316.15 | 3.4× |
| Pulmonary Perfusion Imaging Particulate (78580) | $4,774.44 | $4,774.44 | 12.4× |
| Pulmonary Ventilation & Perfusion Imaging (78582) | $2,160.16 | $2,160.16 | 4.1× |
| Radex abscess/fistula/sinus tract rs&i (76080) | $2,030.45 | $2,030.45 | 3.9× |
| Radex Entir Thrc Lmbr Crv Sac Spi W/Skull 1 Vw - Xr Scoliosis 1 Vw (72081) | $505.77 | $505.77 | 6.1× |
| Radex entir thrc lmbr crv sac spi w/skull 2/3 vw (72082) | $836.75 | $836.75 | 8.3× |
| Radex hips bilateral with pelvis 2 views (73521) | $837.59 | $837.59 | 8.4× |
| Radiation Delivery Stereotactic Cranial Linear (77372) | $35,047.03 | $35,047.03 | 5.0× |
| Radiation treatment delivery 1 mev >= complex (77412) | $3,009.60 | $3,009.60 | 5.7× |
| Radiation treatment delivery 1 mev >= simple (77402) | $6,543.39 | $6,543.39 | 66.8× |
| Radiation tx delivery 1 mev >= intermediate (77407) | $7,798.96 | $7,798.96 | 21.1× |
| Radiolog exam mandible compl minimum 4 views (70110) | $1,956.30 | $1,956.30 | 19.5× |
| Radiologic Exam Abdomen 1 View - Xr Abdomen 1 View (74018) | $1,143.82 | $1,143.82 | 13.7× |
| Radiologic Exam Chest 2 Views - Xr Chest 2 Views (71046) | $1,435.22 | $1,435.22 | 17.2× |
| Radiologic exam colon single contrast study (74270) | $3,023.19 | $3,023.19 | 18.0× |
| Radiologic Exam Esophagus Double Contrast Study (74221) | $901.07 | $901.07 | 5.4× |
| Radiologic exam upr gi trc double contrast study (74246) | $2,908.64 | $2,908.64 | 17.3× |
| Radiologic exam upr gi trc single contrast study (74240) | $3,164.70 | $3,164.70 | 18.8× |
| Radiologic Examination Femur Minimum 2 Views - Xr Femur 2+ Vw Lt (73552) | $505.77 | $505.77 | 6.1× |
| Radiological examination surgical specimen (76098) | $1,776.63 | $1,776.63 | 3.4× |
| Review by radiologist of liver vein image with assessment of blood flow (75889) | $277 | $277 | 0.1× |
| Ribs bilateral 3 views (71110) | $2,324.65 | $2,324.65 | 23.2× |
| Rp loclzj tum spect 1 area single day imaging (78803) | $5,972.10 | $5,972.10 | 11.5× |
| Rp therapy intra-arterial particulate admn (79445) | $987.13 | $987.13 | 4.4× |
| Sacroiliac Joints < 3 Views (72200) | $1,581.22 | $1,581.22 | 15.8× |
| Saline Infus Sonohysterography W/Color Doppler (76831) | $2,182.18 | $2,182.18 | 9.5× |
| Scanogram (77073) | $723.74 | $723.74 | 7.2× |
| Scapula complete (73010) | $1,370.08 | $1,370.08 | 13.7× |
| Screening digital breast tomosynthesis (77063) | $254.60 | $254.60 | 10.9× |
| Shuntogram indwelling nonvascular shunt rs&i (75809) | $5,067.38 | $5,067.38 | 50.5× |
| Small bowel series (74250) | $2,607.68 | $2,607.68 | 15.5× |
| Spec medical radj physics consltj (77370) | $4,810.29 | $4,810.29 | 37.3× |
| Spec telethx port pln parts hemibdy tot bdy (77321) | $6,000.64 | $6,000.64 | 16.7× |
| Special dosimetry (77331) | $1,327.28 | $1,327.28 | 10.3× |
| Special treatment procedure (77470) | $6,000.64 | $6,000.64 | 11.3× |
| Spine thoracic 3 views (72072) | $1,792.36 | $1,792.36 | 17.9× |
| Stereotactic body radiation delivery (77373) | $8,579.11 | $8,579.11 | 5.0× |
| Telethx isodose pln cplx w/basic dosimetry (77307) | $9,611.28 | $9,611.28 | 26.8× |
| Ther rad simulaj-aided field setting complex (77290) | $7,796.64 | $7,796.64 | 21.7× |
| Ther rad simulaj-aided field setting simple (77280) | $3,603.63 | $3,603.63 | 27.9× |
| Thyroid Imaging With Vascular Flow (78013) | $3,892.19 | $3,892.19 | 10.1× |
| Thyroid uptake measurement (78012) | $2,808.62 | $2,808.62 | 7.3× |
| Thyroid Uptake W/Blood Flow Sngle/Mult Quan Meas (78014) | $4,125.72 | $4,125.72 | 10.8× |
| Tmj unilateral (70328) | $1,483.45 | $1,483.45 | 17.8× |
| Treatment devices simple (77332) | $1,805.30 | $1,805.30 | 14.0× |
| Tumor Imaging Whole Body - Nm Tumor Local Whole Body Mult Days (78804) | $12,974.02 | $12,974.02 | 24.9× |
| Tx devices design & construction complex (77334) | $4,950.03 | $4,950.03 | 13.8× |
| Ultrasound, abdomen limited (76705) | $2,755.92 | $2,755.92 | 27.5× |
| Umbilical-artery Doppler (OB) (76820) | $1,557.98 | $1,557.98 | 15.5× |
| Upper Extremity Infant (73092) | $2,192.14 | $2,192.14 | 21.9× |
| Urethrocystography retrograde rs&i (74450) | $2,497.62 | $2,497.62 | 10.9× |
| Urethrocystography voiding (74455) | $3,108.56 | $3,108.56 | 13.6× |
| Us abdl aorta screen aaa (76706) | $875.11 | $875.11 | 8.7× |
| Us breast unilateral complete (76641) | $2,774.72 | $2,774.72 | 27.7× |
| Us breast unilateral limited (76642) | $1,428.90 | $1,428.90 | 17.1× |
| Us chest (76604) | $1,822.92 | $1,822.92 | 18.2× |
| Us compl joint r-t w/image documentation (76881) | $1,413.04 | $1,413.04 | 14.1× |
| Us ob detailed single fetus (76811) | $2,075.39 | $2,075.39 | 9.1× |
| Us ob transvaginal (76817) | $2,796.68 | $2,796.68 | 27.9× |
| Us pelvic non ob complete (76856) | $2,986.90 | $2,986.90 | 29.8× |
| Us pelvic nonobstetric image dcmtn limited/f/u (76857) | $1,034.87 | $1,034.87 | 10.3× |
| Us pregnancy ltd (76815) | $2,026.74 | $2,026.74 | 20.2× |
| Us pregnant uterus 14 wk transabdl 1/1st gestat (76801) | $2,796.68 | $2,796.68 | 27.9× |
| Us retroperitoneal complete (76770) | $2,964.26 | $2,964.26 | 29.6× |
| Us retroperitoneal limited (76775) | $2,991 | $2,991 | 29.8× |
| Us scrotum and contents (76870) | $2,678.91 | $2,678.91 | 26.7× |
| Us soft tissue head/neck (76536) | $2,583.81 | $2,583.81 | 25.8× |
| Us spinal canal and contents (76800) | $2,004.08 | $2,004.08 | 20.0× |
| Us transrectal (76872) | $2,678.91 | $2,678.91 | 26.7× |
| Us xtr non-vasc lmtd (76882) | $1,413.04 | $1,413.04 | 14.1× |
| Venogram extremity bilateral (75822) | $6,598.88 | $6,598.88 | 4.4× |
| Venography caval inferior serialography rs&i (75825) | $381 | $381 | 0.1× |
| Venography caval superior serialography rs&i (75827) | $70 | $70 | 0.0× |
| Venography extremity unilateral rs&i (75820) | $5,031.22 | $5,031.22 | 3.3× |
| Venography venous sinus/jugular cath rs&i (75860) | $4,820.74 | $4,820.74 | 1.6× |
| Wrist 2 views (73100) | $1,125.25 | $1,125.25 | 13.5× |
| X-Ray Abdomen,Comp Acute Series - Xr Abdomen 2 Vws With Chest 1 View (74022) | $2,109.03 | $2,109.03 | 21.0× |
| X-Ray Ankle 3+ Vw - Xr Ankle 3+ Views Right (73610) | $1,356.62 | $1,356.62 | 16.2× |
| X-Ray Colon Air Contrast - Fl Barium Enema Air Contrast (74280) | $3,043.42 | $3,043.42 | 18.1× |
| X-Ray Elbow 2 Vw - Xr Elbow 1-2 Views Right (73070) | $1,998.99 | $1,998.99 | 23.9× |
| X-Ray Elbow 3+ Vw - Xr Elbow 3+ Views Right (73080) | $774.87 | $774.87 | 9.3× |
| X-ray exam entire spi 4/5 vw (72083) | $1,596.94 | $1,596.94 | 15.9× |
| X-ray exam hip uni 1 view (73501) | $447.65 | $447.65 | 5.4× |
| X-Ray Exam Hip Uni 2-3 Views (73502) | $505.77 | $505.77 | 6.1× |
| X-ray exam hip uni 4/> views (73503) | $837.59 | $837.59 | 8.4× |
| X-Ray Exam Hips Bi 3-4 Views (73522) | $837.59 | $837.59 | 8.4× |
| X-Ray Exam Hips Bi 5/> Views (73523) | $1,596.94 | $1,596.94 | 15.9× |
| X-ray exam of femur 1 (73551) | $505.77 | $505.77 | 6.1× |
| X-ray eye for foreign body (70030) | $1,291.49 | $1,291.49 | 15.5× |
| X-Ray Facial Bones 3+ Vw - Xr Facial Bones 3+ Views (70150) | $1,956.30 | $1,956.30 | 19.5× |
| X-Ray Foot 3+ Vw - Xr Foot 3+ Views Right (73630) | $1,906.90 | $1,906.90 | 22.8× |
| X-Ray Heel - Xr Calcaneus 2 Views Right (73650) | $1,183.64 | $1,183.64 | 14.2× |
| X-Ray Knee 4+ View - Xr Knee 4+ Views Right (73564) | $1,239.78 | $1,239.78 | 12.4× |
| X-Ray Knee Bilat Standing - Xr Knees Anteroposterior Standing Bilat (73565) | $1,075.86 | $1,075.86 | 12.9× |
| X-Ray Leg, Infant - Xr Lower Extremity 2+ Views Infant Left (73592) | $2,192.14 | $2,192.14 | 26.3× |
| X-Ray Lumbar Spine 2/3 Vw - Xr Lumbar Spine 2-3 Views (72100) | $1,499 | $1,499 | 14.9× |
| X-Ray Lumbar Spine 6+ Vw - Xr Lumbar Spine 6+ Vws Including Bending (72114) | $2,908.64 | $2,908.64 | 29.0× |
| X-Ray Nasal Bones - Xr Nasal Bones (70160) | $1,399.30 | $1,399.30 | 16.8× |
| X-Ray Nose-Rectum Child F.B. - Xr Nose to Rectum Foreign Body Peds (76010) | $723.22 | $723.22 | 8.7× |
| X-Ray Orbits - Xr Orbits Complete 4+ Views (70200) | $1,808.06 | $1,808.06 | 18.0× |
| X-Ray Pelvis 3+ Vw - Xr Pelvis 3+ Views (72190) | $1,251.05 | $1,251.05 | 12.5× |
| X-Ray Ribs 2 Vw Unilat - Xr Ribs 2 Views Right (71100) | $1,563.26 | $1,563.26 | 18.7× |
| X-Ray Ribs, Chest 3+ Vw - Xr Ribs 2 Vws Lt W/ Chest Anteroposterior (71101) | $2,192.14 | $2,192.14 | 21.9× |
| X-Ray Ribs, Chest 4+ Vw - Xr Ribs 3 Vws Bil W/ Chest Posteroanterior (71111) | $2,466.16 | $2,466.16 | 24.6× |
| X-Ray Sacrum/Coccyx 2+ Vw - Xr Sacrum Coccyx 2+ Views (72220) | $1,480.15 | $1,480.15 | 17.7× |
| X-Ray Shoulder 2+ Vw - Xr Shoulder 2+ Views Right (73030) | $2,183.15 | $2,183.15 | 26.1× |
| X-Ray Sinuses 3+ Vw - Xr Paranasal Sinuses 3+ Views (70220) | $1,976.52 | $1,976.52 | 23.7× |
| X-Ray Skull 4+ Vw - Xr Skull Complete 4+ Views (70260) | $2,203.39 | $2,203.39 | 22.0× |
| X-Ray Skull <4 Vw - Xr Skull 1-3 Views (70250) | $2,553.77 | $2,553.77 | 25.5× |
| X-Ray Spine One View - Xr Spine (72020) | $947.80 | $947.80 | 11.4× |
| X-Ray Sternum 2+ Vw - Xr Sternum 2+ Views (71120) | $1,435.22 | $1,435.22 | 17.2× |
| X-Ray Thoracic Spine 2 Vw - Xr Thoracic Spine 2 Views (72070) | $1,949.59 | $1,949.59 | 19.4× |
| X-Ray Thoracic Spine 4 Vw - Xr Thoracic Spine Complete 4+ Views (72074) | $1,792.36 | $1,792.36 | 17.9× |
| X-Ray Toe(S) - Xr Toes 2+ Views Right (73660) | $1,055.64 | $1,055.64 | 12.6× |
| X-Ray Wrist 3+ Vw - Xr Wrist 3+ Views Right (73110) | $2,021.43 | $2,021.43 | 24.2× |
| Xr c-spine 6 or more views (72052) | $1,208.37 | $1,208.37 | 12.0× |
| Xr chest 4+ views (71048) | $1,531.77 | $1,531.77 | 15.3× |
| Xr finger(s) 2+ views (73140) | $1,127.51 | $1,127.51 | 13.5× |
| Xr shoulder 1 view (73020) | $557.01 | $557.01 | 6.7× |
| Xr spine cervical 4 or 5 views (72050) | $2,668.33 | $2,668.33 | 26.6× |
| Xr tibia/fibula 2 views (73590) | $2,192.14 | $2,192.14 | 26.3× |
| Xray knee 1 or 2 views rt (73560) | $2,021.43 | $2,021.43 | 24.2× |