Imaging prices at United Hospital
Saint Paul, MN · every code in this section with a posted price and a Medicare benchmark.
461 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) | $2,239.73 | $4,666.10 | 1.5× |
| Abdomen 1 View (74018) range across 3 matching MRF lines |
$138.43–$207.79 | $288.40–$432.90 | varies |
| Abdomen 2 views (74019) range across 2 matching MRF lines |
$138.43–$207.79 | $288.40–$432.90 | varies |
| Acute Gastrointestinal Blood Loss Imaging (78278) | $1,785.46 | $3,719.70 | 4.3× |
| Acute venous thrombosis imaging, peptide Non-Facility (78456) | $683.38 | $1,423.70 | 0.5× |
| Adrenal Cortex & Medulla Img (78075) | $1,190.40 | $2,480 | 0.9× |
| Angio internal mammary (75756) | $2,785.15 | $5,802.40 | 0.8× |
| Angio pulmonary bilat (75743) | $2,802.62 | $5,838.80 | 0.8× |
| Angiography extremity bilateral rs&i (75716) | $3,099.65 | $6,457.60 | 0.9× |
| Angiography extremity unilateral rs&i (75710) | $2,515.20 | $5,240 | 0.8× |
| Angiography pulmonary unilateral slctv rs&i (75741) | $2,746.66 | $5,722.20 | 0.8× |
| Angrph pulmonary nonslctv cath/ven njx rs&i (75746) | $2,346.43 | $4,888.40 | 0.7× |
| Ankle 2 views (73600) range across 2 matching MRF lines |
$138.43–$207.79 | $288.40–$432.90 | varies |
| Aortography thoracic serialography rs&i (75605) unusually low: confirm this is the full procedure |
$2,124.67 | $4,426.40 | 0.4× |
| Aortography thoracic w/o serialography rs&i (75600) | $1,577.18 | $3,285.80 | 0.5× |
| Artery X-Rays Abdomen (75726) | $3,050.98 | $6,356.20 | 0.5× |
| Artery X-Rays Adrenal Gland (75731) | $2,000.78 | $4,168.30 | 0.6× |
| Artery X-Rays Pelvis (75736) unusually low: confirm this is the full procedure |
$2,789.57 | $5,811.60 | 0.5× |
| Artery X-Rays Spine (75705) | $3,597.50 | $7,494.80 | 0.6× |
| Arthrogram ankle (73615) | $277.34 | $577.80 | 0.8× |
| Arthrogram hip (73525) | $277.06 | $577.20 | 0.8× |
| Arthrogram Wrist (73115) | $277.06 | $577.20 | 0.8× |
| Basic radiation dosimetry calculation (77300) | $279.98 | $583.30 | 2.0× |
| Bone age studies (77072) | $138.43 | $288.40 | 1.3× |
| Bone Imaging 3 Phase (78315) | $744 | $1,550 | 1.8× |
| Bone Imaging Limited Area (78300) | $595.10 | $1,239.80 | 1.4× |
| Bone Imaging Multiple Areas (78305) | $896.16 | $1,867 | 2.1× |
| Bone Imaging Whole Body (78306) | $595.10 | $1,239.80 | 1.4× |
| Bone marrow imaging limited area (78102) | $509.04 | $1,060.50 | 1.2× |
| Bone marrow imaging; multiple areas (78103) | $553.39 | $1,152.90 | 1.3× |
| Bone marrow imaging; whole body (78104) | $600.96 | $1,252 | 1.4× |
| Bone survey infant (77076) | $277.06 | $577.20 | 2.5× |
| Brachytx isodose complex (77318) | $4,759.39 | $9,915.40 | 12.1× |
| Brachytx isodose intermed (77317) | $3,639.60 | $7,582.50 | 9.3× |
| Brachytx Isodose Plan Simple (77316) | $2,519.71 | $5,249.40 | 6.4× |
| Brain Flow Imaging Only (78610) | $597.46 | $1,244.70 | 1.1× |
| Brain Image W/Flow < 4 Views (78601) | $597.46 | $1,244.70 | 1.4× |
| Brain imaging < 4 static views (78600) | $597.46 | $1,244.70 | 1.4× |
| Brain Imaging Min 4 Static Views W Vascular Flow (78606) | $892.80 | $1,860 | 1.6× |
| Brain Imaging Minimum 4 Static Views (78605) | $597.46 | $1,244.70 | 1.1× |
| Brain Imaging Pet Metabolic Evaluation (78608) | $2,851.58 | $5,940.80 | 1.9× |
| Card Bl Pool Gated Spect Rest Wal Motn Ejct Frct (78494) | $896.16 | $1,867 | 2.1× |
| Cardiac blood pool imaging, first pass technique; multiple studies, resting and with stress (exercise and/or… (78483) | $448.22 | $933.80 | 0.8× |
| Cardiac MRI w/w/o contrast & further seq (75561) | $1,276.99 | $2,660.40 | 3.5× |
| Cardiac MRI w/w/o contrast w/stress (75563) | $1,553.76 | $3,237 | 1.9× |
| Cat Scan Follow-Up Study (76380) | $430.75 | $897.40 | 4.7× |
| Cerebrospinal Fluid Flow W/O Matl Shunt Evaltj (78645) | $1,190.40 | $2,480 | 2.1× |
| Cerebrospinal fluid flow, imaging (not including introduction of material); ventriculography Non-Facility (78635) | $425.18 | $885.80 | 0.7× |
| Cerebrospinal Fluid Scan (78630) | $2,380.75 | $4,959.90 | 4.2× |
| Chest 1 view (71045) range across 2 matching MRF lines |
$138.43–$207.79 | $288.40–$432.90 | varies |
| Chest 2 views (71046) range across 2 matching MRF lines |
$138.43–$207.79 | $288.40–$432.90 | varies |
| Chest 3 views (71047) | $138.43 | $288.40 | 1.5× |
| Chest 4 or more views (71048) | $138.43 | $288.40 | 1.3× |
| Cholecystography Oral Contrast (74290) | $190.42 | $396.70 | 1.0× |
| Clavicle complete (73000) range across 4 matching MRF lines |
$138.43–$207.79 | $288.40–$432.90 | varies |
| Computed Tomography Thorax Lw Dose Lng Ca Scr C- (71271) | $431.81 | $899.60 | 3.9× |
| Continuing medical physics consltj pr wk (77336) | $279.98 | $583.30 | 2.0× |
| Contrast Exam Abdominl Aorta (75625) | $3,103.92 | $6,466.50 | 0.9× |
| Contrast X-Ray Bladder (74430) | $696.43 | $1,450.90 | 1.9× |
| Contrast X-Ray Of Elbow (73085) | $298.22 | $621.30 | 0.8× |
| Contrast X-Ray Of Knee Joint (73580) | $277.06 | $577.20 | 0.8× |
| Contrast Xray Throat/Cerv Esopha (74210) | $160.80 | $335 | 0.9× |
| CT abdomen and pelvis without and with contrast (74178) | $1,079.57 | $2,249.10 | 3.0× |
| CT abdomen and pelvis without contrast (74176) | $647.76 | $1,349.50 | 2.6× |
| CT abdomen w contrast (74160) | $647.76 | $1,349.50 | 3.5× |
| CT abdomen w wo contrast (74170) | $863.71 | $1,799.40 | 4.7× |
| CT abdomen w/o contrast (74150) range across 2 matching MRF lines |
$331.10–$431.81 | $689.80–$899.60 | varies |
| CT Angio Abdomen and Pelvis (74174) | $1,511.52 | $3,149 | 4.1× |
| CT Angio Chest (71275) | $431.81 | $899.60 | 2.4× |
| CT Angio Head (70496) | $863.71 | $1,799.40 | 4.7× |
| CT angio hrt w/3d image (75574) | $2,159.28 | $4,498.50 | 5.9× |
| Ct Angio Lwr Extr W/O&W/Dye (73706) | $1,079.57 | $2,249.10 | 5.9× |
| CT Angio Neck (70498) | $647.76 | $1,349.50 | 3.5× |
| Ct Angio Upr Extrm W/O&W/Dye (73206) | $863.71 | $1,799.40 | 4.7× |
| CT cervical spine w/ contrast (72126) | $647.76 | $1,349.50 | 1.8× |
| CT cervical spine w/o contrast (72125) | $431.81 | $899.60 | 3.9× |
| CT cervical spine w/wo cont (72127) | $863.71 | $1,799.40 | 4.7× |
| CT chest w contrast (71260) range across 2 matching MRF lines |
$215.90–$431.81 | $449.80–$899.60 | varies |
| CT chest w/wo contrast (71270) range across 2 matching MRF lines |
$215.90–$647.76 | $449.80–$1,349.50 | varies |
| CT colonography screening (74263) | $1,079.57 | $2,249.10 | 4.3× |
| CT Colonogrphy Dx Image Postprocess W/Contrast (74262) | $1,079.57 | $2,249.10 | 5.9× |
| CT colonogrphy dx image postprocess w/o contrast (74261) | $1,079.57 | $2,249.10 | 9.9× |
| CT head/brain with contrast (70460) | $647.76 | $1,349.50 | 3.5× |
| CT head/brain without and with contrast (70470) | $863.71 | $1,799.40 | 4.7× |
| CT heart contrast eval cardiac structure&morph (75572) | $359.86 | $749.70 | 1.0× |
| CT heart no contrast quant eval coronry calcium (75571) | $431.81 | $899.60 | 4.7× |
| CT hrt w/3d image congen (75573) | $2,159.28 | $4,498.50 | 5.9× |
| CT iac w contrast (70481) | $647.76 | $1,349.50 | 3.5× |
| CT l-spine w&w/o contrast (72133) | $861.41 | $1,794.60 | 4.7× |
| CT lower ext w/o (73700) | $719.86 | $1,499.70 | 6.6× |
| CT lower extremity w/contrast material (73701) | $935.71 | $1,949.40 | 5.1× |
| CT lumbar spine w contrast (72132) | $647.76 | $1,349.50 | 1.8× |
| CT lumbar spine w/o contrast (72131) | $431.81 | $899.60 | 3.9× |
| CT maxillofacial w contrast (70487) | $647.76 | $1,349.50 | 3.5× |
| CT maxillofacial wo contrast (70486) range across 2 matching MRF lines |
$431.81–$863.71 | $899.60–$1,799.40 | varies |
| CT neck tissue combo (70492) | $647.76 | $1,349.50 | 3.5× |
| Ct Orbit/Ear/Fossa W/O&W/Dye (70482) | $863.71 | $1,799.40 | 4.7× |
| CT orbits w/o contrast (70480) range across 2 matching MRF lines |
$323.95–$431.81 | $674.90–$899.60 | varies |
| CT pelvis w&w/o contrast (72194) | $863.71 | $1,799.40 | 4.7× |
| CT pelvis w/o contrast (72192) | $647.76 | $1,349.50 | 5.9× |
| CT scan of leg combo (73702) | $1,151.62 | $2,399.20 | 6.3× |
| CT scans face/jaw combo (70488) | $863.71 | $1,799.40 | 4.7× |
| CT soft tissue neck w contrast (70491) | $431.81 | $899.60 | 2.4× |
| CT soft tissue neck w/o contrast (70490) | $287.90 | $599.80 | 2.6× |
| CT thoracic spine w contrast (72129) | $647.76 | $1,349.50 | 3.5× |
| CT thoracic spine w/o contrast (72128) | $431.81 | $899.60 | 3.9× |
| CT thoracic spine w/wo cont (72130) | $861.41 | $1,794.60 | 4.7× |
| CT thorax w/o contrast (71250) range across 4 matching MRF lines |
$144–$431.81 | $300–$899.60 | varies |
| CT upper ext wo (73200) | $647.76 | $1,349.50 | 5.9× |
| CT upper extremity w/o & w/contrast material (73202) | $1,079.71 | $2,249.40 | 5.9× |
| CT upper extremity with contrast (73201) | $863.71 | $1,799.40 | 2.4× |
| Cta Abdl Aorta&Bi Iliofem W/Contrast&Postp (75635) | $863.71 | $1,799.40 | 4.7× |
| Cta Abdomen (74175) | $863.71 | $1,799.40 | 4.7× |
| CTA head&neck c+ w/noncontrast img&post-pxessing (70471) | $863.71 | $1,799.40 | 2.4× |
| CTA pelvis (72191) | $647.76 | $1,349.50 | 3.5× |
| Dacryocystography, nasolacrimal duct, radiological supervision and interpretation Non-Facility (70170) | $350.69 | $730.60 | 1.4× |
| Dilation ureters/urethra rs&i (74485) | $431.38 | $898.70 | 0.2× |
| Discography Cerv/Thor Spine (72285) | $546.96 | $1,139.50 | 0.3× |
| Diskography lumbar (72295) | $568.03 | $1,183.40 | 0.3× |
| Doppler Echo Fetal Puls Spectral F/U/Repeat (76828) | $455.28 | $948.50 | 4.2× |
| Doppler Echo Fetal Spectral Display Complete (76827) range across 2 matching MRF lines |
$460.90–$881.71 | $960.20–$1,836.90 | varies |
| Doppler Fetal Mid Cerebral Artery (76821) range across 2 matching MRF lines |
$113.86–$126.82 | $237.20–$264.20 | varies |
| Dxa Bone Density Axial (77080) | $144.43 | $300.90 | 1.3× |
| Dxa bone density study (77085) | $288.24 | $600.50 | 2.6× |
| Dxa bone density study 1/>sites appendiclr skel (77081) | $92.50 | $192.70 | 1.0× |
| Echo exam of fetal heart (76825) range across 2 matching MRF lines |
$113.86–$170.74 | $237.20–$355.70 | varies |
| Echo exam uterus (76831) | $455.28 | $948.50 | 1.8× |
| Echo Guide For Artery Repair (76936) range across 2 matching MRF lines |
$341.47–$493.15 | $711.40–$1,027.40 | varies |
| Echocardiography, fetal, cardiovascular system, real time with image documentation (2D), with or without M-mode… (76826) range across 2 matching MRF lines |
$113.86–$826.66 | $237.20–$1,722.20 | varies |
| Echograp Trans R Pros Study (76873) | $227.57 | $474.10 | 2.1× |
| Esophageal Motility Study (78258) | $259.15 | $539.90 | 0.6× |
| Esophagram (74220) | $207.79 | $432.90 | 1.1× |
| Fetal Biophys Profile W/Nst (76818) range across 3 matching MRF lines |
$341.47–$761.66 | $711.40–$1,586.80 | varies |
| Fetal Biophysical Profile W/O Non-Stress Testing (76819) range across 3 matching MRF lines |
$341.47–$380.83 | $711.40–$793.40 | varies |
| Fetal MRI w/placntl matrnl plvc img sing/1st ges (74712) | $1,094.50 | $2,280.20 | 4.4× |
| Fluoroscopy up to 1 hr (76000) range across 9 matching MRF lines |
$295.34–$2,491.58 | $615.30–$5,190.80 | varies |
| Follow-Up Angiography (75898) range across 2 matching MRF lines |
$956.74–$1,663.78 | $1,993.20–$3,466.20 | varies |
| Foot 2 views (73620) range across 4 matching MRF lines |
$103.92–$207.79 | $216.50–$432.90 | varies |
| Forearm 2 views (73090) range across 3 matching MRF lines |
$17.28–$207.79 | $36–$432.90 | varies |
| Gastric emptying imaging study (78264) | $1,339.15 | $2,789.90 | 3.2× |
| Gastric Mucosa Imaging (78261) | $609.94 | $1,270.70 | 1.5× |
| Gastroesophageal Reflux Exam (78262) | $1,792.32 | $3,734 | 4.3× |
| Gastrointestinal Protein Loss (78282) | $486.72 | $1,014 | 1.2× |
| Gated Heart Planar Single (78472) | $892.80 | $1,860 | 2.1× |
| Gated Heart, Multiple (78473) | $896.16 | $1,867 | 2.1× |
| Hand 2 views (73120) range across 3 matching MRF lines |
$103.92–$207.79 | $216.50–$432.90 | varies |
| Hdr Rdncl Ntrstl/Icav Brchtx (77772) | $331.68 | $691 | 0.5× |
| Hdr Rdncl Ntrstl/Icav Brchtx (77771) range across 2 matching MRF lines |
$331.68–$333.02 | $691–$693.80 | varies |
| Hdr Rdncl Ntrstl/Icav Brchtx 1 Channel (77770) range across 2 matching MRF lines |
$331.68–$333.02 | $691–$693.80 | varies |
| Heart first pass single,planar (78481) | $448.22 | $933.80 | 0.8× |
| Hepatc Vngrph Wdg/Fr Hemodyn Eval Rs&I (75889) | $862.85 | $1,797.60 | 0.3× |
| Hepatc Vngrph Wdg/Fr W/O Hemodyn Eval Rs&I (75891) | $862.85 | $1,797.60 | 0.3× |
| Hepatobil Syst Image W/Drug (78227) | $1,190.40 | $2,480 | 2.1× |
| Hepatobiliary System Imaging (78226) | $1,041.46 | $2,169.70 | 2.5× |
| Ht Musc Image Planar Mult (78454) | $1,653.12 | $3,444 | 1.2× |
| Ht Muscle Image Spect Sing (78451) | $1,785.46 | $3,719.70 | 1.3× |
| Hysterosalpingogram (74740) | $209.38 | $436.20 | 0.8× |
| Image fusion (77399) range across 3 matching MRF lines |
$1,679.86–$5,039.52 | $3,499.70–$10,499 | varies |
| Infant hip ultrasound with hip movement (dynamic) (76885) | $341.47 | $711.40 | 3.7× |
| Infant hip ultrasound, limited static exam (76886) | $455.57 | $949.10 | 5.0× |
| Infusion Ivp (74410) | $277.34 | $577.80 | 1.5× |
| Interstitial radiation source applic complex (77778) | $878.83 | $1,830.90 | 1.2× |
| Intracavitary Radiation Source Applic Complex (77763) | $832.22 | $1,733.80 | 1.1× |
| Intracavitary Radiation Source Applic Intermed (77762) | $680.83 | $1,418.40 | 1.2× |
| Intracavitary radiation source applic simple (77761) | $529.63 | $1,103.40 | 0.9× |
| Joint Survey Single View (77077) | $138.62 | $288.80 | 1.3× |
| K Flow/Funct Image Multiple (78709) | $744 | $1,550 | 1.3× |
| K Flow/Funct Image W/Drug (78708) | $892.80 | $1,860 | 1.6× |
| K Flow/Funct Image W/O Drug (78707) | $892.80 | $1,860 | 1.6× |
| Kidney Imaging Morphol (78700) | $746.88 | $1,556 | 1.8× |
| Kidney Imaging Morphoogy W/Vascular Flow (78701) | $746.88 | $1,556 | 1.8× |
| Knee 3 Views (73562) range across 2 matching MRF lines |
$138.43–$207.79 | $288.40–$432.90 | varies |
| Leveen/Shunt Patency Exam (78291) | $1,190.40 | $2,480 | 2.8× |
| Liver & Spleen Imaging Static Only (78215) | $597.46 | $1,244.70 | 1.4× |
| Liver & Spleen Imaging W/Vascular Flow (78216) | $746.88 | $1,556 | 1.8× |
| Liver imaging static only (78201) | $597.46 | $1,244.70 | 1.1× |
| Liver imaging w/vascular flow (78202) | $611.81 | $1,274.60 | 1.1× |
| Lung Perf&Ventilat Diferentl (78598) | $595.10 | $1,239.80 | 1.0× |
| Lung perfusion differential (78597) | $1,074.14 | $2,237.80 | 2.6× |
| Lung Ventilat&Perfus Imaging (78582) | $595.10 | $1,239.80 | 1.0× |
| Lung Ventilation Imaging (78579) | $597.46 | $1,244.70 | 1.4× |
| Lymph System Imaging (78195) | $1,487.90 | $3,099.80 | 2.6× |
| Lymphangiography Extremity Only Bilateral Rs&I (75803) | $1,006.18 | $2,096.20 | 0.6× |
| Lymphangiography extremity only unilateral rs&i (75801) | $921.98 | $1,920.80 | 1.4× |
| Lymphangiography Pelvic/Abdominal Bilateral Rs&I (75807) | $1,104.43 | $2,300.90 | 0.3× |
| Lymphangiography, pelvic/abdominal, unilateral (75805) | $950.16 | $1,979.50 | 0.3× |
| Magnetic Image Jaw Joint (70336) | $820.99 | $1,710.40 | 3.3× |
| Magnetic resonance (eg, proton) imaging, brain (including brain stem andskull base), during open intracranial procedure… (70558) | $4,387.20 | $9,140 | 23.9× |
| Magnetic resonance (eg, proton) imaging, brain (including brain stem andskull base), during open intracranial procedure… (70557) | $4,378.18 | $9,121.20 | 7.7× |
| Magnetic resonance (eg, proton) imaging, brain (including brain stem andskull base), during open intracranial procedure… (70559) | $4,378.18 | $9,121.20 | 23.8× |
| Magnetic Resonance Elastography (76391) | $969.07 | $2,018.90 | 3.9× |
| Mammary ductogram or galactogram single (77053) | $277.34 | $577.80 | 1.1× |
| Meckels Divert Exam (78290) | $595.10 | $1,239.80 | 1.4× |
| Mlc imrt design & construction per imrt plan (77338) range across 2 matching MRF lines |
$559.97–$4,421.14 | $1,166.60–$9,210.70 | varies |
| Mra Head W/O & W/Contrast Material (70546) | $1,094.50 | $2,280.20 | 3.0× |
| MRA head w/o contrast (70544) | $729.74 | $1,520.30 | 2.9× |
| MRA head with contrast (70545) | $912 | $1,900 | 2.5× |
| MRA neck w contrast (70548) | $731.28 | $1,523.50 | 2.0× |
| Mra Neck W/O &W/Contrast Material (70549) | $912 | $1,900 | 2.5× |
| MRA neck w/o contrast (70547) | $547.30 | $1,140.20 | 2.2× |
| MRI abdomen w contrast (74182) | $1,231.34 | $2,565.30 | 3.4× |
| MRI abdomen w/o contrast (74181) | $1,094.50 | $2,280.20 | 4.4× |
| MRI any jt lower extrem w/contrast material (73722) | $1,641.79 | $3,420.40 | 2.0× |
| MRI any jt lower extrem w/o & w/contrast matrl (73723) | $1,276.99 | $2,660.40 | 3.5× |
| MRI any jt upper extremity w/contrast matrl (73222) | $1,276.99 | $2,660.40 | 1.6× |
| MRI brain functional w/o physician admnistration (70554) | $2,189.04 | $4,560.50 | 8.8× |
| MRI brain functional w/physician admnistration (70555) | $2,193.55 | $4,569.90 | 8.8× |
| MRI Breast W/O Contrast Bilateral (77047) | $456.05 | $950.10 | 1.8× |
| MRI Breast Without Contrast Material Unilateral (77046) | $364.85 | $760.10 | 1.5× |
| MRI cardiac w/o cont stress (75559) | $1,327.97 | $2,766.60 | 2.3× |
| MRI cardiac w/o contrast (75557) | $1,094.50 | $2,280.20 | 4.4× |
| MRI cervical spine w contrast (72142) range across 2 matching MRF lines |
$547.30–$729.74 | $1,140.20–$1,520.30 | varies |
| MRI cervical spine w/o cont (72141) range across 2 matching MRF lines |
$410.50–$547.30 | $855.20–$1,140.20 | varies |
| MRI chest w/o contrast (71550) | $820.99 | $1,710.40 | 3.3× |
| MRI chest with contrast (71551) | $1,003.30 | $2,090.20 | 1.2× |
| MRI chest wo w contrast (71552) | $1,185.79 | $2,470.40 | 3.2× |
| MRI lower extrem oth/thn jt w/contrast matrl (73719) | $751.39 | $1,565.40 | 2.1× |
| MRI lower extrem oth/thn jt w/o & w/contr matr (73720) | $1,368.19 | $2,850.40 | 3.7× |
| MRI lower extrem oth/thn jt w/o contr matrl (73718) | $1,094.50 | $2,280.20 | 4.4× |
| MRI lumbar spine w contrast (72149) | $729.74 | $1,520.30 | 2.0× |
| Mri Neck Spine W/O & W/Dye (72156) range across 2 matching MRF lines |
$685.49–$912 | $1,428.10–$1,900 | varies |
| MRI orbit face &/neck w/o contrast (70540) | $729.74 | $1,520.30 | 2.9× |
| MRI orbit face neck w contrast (70542) | $912 | $1,900 | 2.5× |
| Mri Orbt/Fac/Nck W/O &W/Dye (70543) | $1,459.39 | $3,040.40 | 4.0× |
| MRI pelvis w contrast (72196) | $1,003.30 | $2,090.20 | 2.7× |
| MRI pelvis w/o & w contrast (72197) | $1,276.99 | $2,660.40 | 3.5× |
| MRI pelvis w/o contrast (72195) | $912 | $1,900 | 3.6× |
| MRI spectroscopy (76390) | $1,096.80 | $2,285 | 12.0× |
| MRI thoracic spine w/o contrast (72146) range across 2 matching MRF lines |
$411.26–$547.30 | $856.80–$1,140.20 | varies |
| MRI upper extremity oth than jt w/o contr matrl (73218) | $1,094.50 | $2,280.20 | 4.4× |
| Mri Uppr Extremity W/O&W/Dye (73220) | $1,459.39 | $3,040.40 | 4.0× |
| MRI, abdomen, combo (74183) | $1,368.19 | $2,850.40 | 3.7× |
| MRI, dorsal spine combo (72157) range across 2 matching MRF lines |
$685.49–$912 | $1,428.10–$1,900 | varies |
| MRI, dorsal spine contrast (72147) range across 2 matching MRF lines |
$547.30–$729.74 | $1,140.20–$1,520.30 | varies |
| MRI, joint upper extrem (73221) | $912 | $1,900 | 3.6× |
| MRI, joint upper extrem combo (73223) | $1,276.99 | $2,660.40 | 3.5× |
| MRI, lumbar spine combo (72158) range across 2 matching MRF lines |
$685.49–$912 | $1,428.10–$1,900 | varies |
| Myelogram cervical (72240) | $277.34 | $577.80 | 0.3× |
| Myelogram Lumbar (72265) | $282.67 | $588.90 | 0.3× |
| Myelography thoracic (72255) | $277.34 | $577.80 | 0.3× |
| Myocardial Imaging Infarct Avid Planar Qual/Quan (78466) | $597.46 | $1,244.70 | 1.4× |
| Myocardial imaging, infarct avid, planar; with ejection fraction by first pass technique Non-Facility (78468) | $597.46 | $1,244.70 | 1.1× |
| Myocardial Perfusion Planar 1 Study Rest/Stress (78453) | $2,091.02 | $4,356.30 | 1.5× |
| Myocardial Spect Multiple Studies (78452) | $1,785.55 | $3,719.90 | 1.3× |
| Myocrd Img Pet Metab Eval Single Study Cncrnt CT (78429) | $4,399.30 | $9,165.20 | 2.9× |
| Myocrd img PET prfuj 1std rest/stress cncrnt CT (78430) | $2,830.51 | $5,896.90 | 1.9× |
| Myocrd Img Pet Prfuj Mlt Std Rst&Strs Cncrnt CT (78431) | $5,256.72 | $10,951.50 | 2.3× |
| Myocrd Img Pet Prfuj W/Metab 2rtracer Cncrnt CT (78433) | $8,201.42 | $17,086.30 | 3.6× |
| Myocrd Img Pet Prfuj W/Metab Dual Radiotracer (78432) | $7,229.90 | $15,062.30 | 4.5× |
| N-invas est c ffr sw aly CTA (75580) | $3,630.10 | $7,562.70 | 4.0× |
| Neck soft tissue (70360) range across 2 matching MRF lines |
$138.43–$207.79 | $288.40–$432.90 | varies |
| Nfs/Instlj Radioelmnt Sln 3 Mo Follow-Up Care (77750) | $264.58 | $551.20 | 0.7× |
| Nm csf leak detection (78650) | $1,785.46 | $3,719.70 | 1.3× |
| Nm myocard infarct spect (78469) | $896.16 | $1,867 | 1.6× |
| Nm unlisted gi procedure (78299) | $412.18 | $858.70 | 1.0× |
| Nm whole blood volume (78122) | $1,487.90 | $3,099.80 | 2.6× |
| Nonvascular Shunt X-Ray (75809) | $862.85 | $1,797.60 | 7.9× |
| Ntsty modul radthx pln dose-vol histos (77301) | $12,885.79 | $26,845.40 | 8.9× |
| Nuclear Rx Intra-Arterial (79445) | $1,007.04 | $2,098 | 4.1× |
| Nuclear Rx Oral Admin (79005) | $55.63 | $115.90 | 0.2× |
| Ob us nuchal meas 1 gest (76813) range across 2 matching MRF lines |
$227.57–$379.44 | $474.10–$790.50 | varies |
| Oph bmtry us echograpy a-scan io lens pwr cal (76519) | $415.20 | $865 | 3.8× |
| Ophthalmic us dx quantitative a-scan only (76511) | $158.74 | $330.70 | 1.4× |
| Panoramic X-ray of jaws (70355) range across 2 matching MRF lines |
$203.23–$203.42 | $423.40–$423.80 | varies |
| Parathyroid imaging w/tomographic spect & CT (78072) | $2,182.27 | $4,546.40 | 3.8× |
| Parathyroid Planar Imaging (78070) | $1,785.46 | $3,719.70 | 4.3× |
| Parathyroid planar imaging w/wo subtraction (78071) | $2,190.62 | $4,563.80 | 5.2× |
| Pelvis 1 or 2 views (72170) range across 2 matching MRF lines |
$138.43–$207.79 | $288.40–$432.90 | varies |
| Perineogram (74775) | $207.98 | $433.30 | 0.8× |
| Peritoneogram Rs&I (74190) | $647.18 | $1,348.30 | 1.1× |
| Pet Image W/Ct Lmtd (78814) range across 3 matching MRF lines |
$2,841.26–$2,851.58 | $5,919.30–$5,940.80 | varies |
| PET image w/CT, full body (78816) | $2,851.58 | $5,940.80 | 1.9× |
| PET imaging CT attenuation skull base mid-thigh (78815) | $2,851.58 | $5,940.80 | 1.9× |
| Plasma Vol Radiopharm Vol Dilute Spx Mult Smples (78111) | $1,140.77 | $2,376.60 | 0.8× |
| Prq Transhepatc Portograpy Hemodyn Eval Rs&I (75885) | $903.41 | $1,882.10 | 0.3× |
| Pulmonary Perfusion Imaging Particulate (78580) | $446.45 | $930.10 | 1.1× |
| Quan&Charac C Atherosclerotc Plaq Asses Sev C Ds (75577) | $1,596.86 | $3,326.80 | 1.6× |
| Radex Abd Compl Aqt Abd W/S/E/D Views 1 View Ch (74022) | $138.62 | $288.80 | 1.3× |
| Radex abscess/fistula/sinus tract rs&i (76080) | $553.97 | $1,154.10 | 1.0× |
| Radex Ankle Complete Minimum 3 Views (73610) range across 2 matching MRF lines |
$138.43–$207.79 | $288.40–$432.90 | varies |
| Radex Calcaneus Minimum 2 Views (73650) range across 2 matching MRF lines |
$101.66–$138.43 | $211.80–$288.40 | varies |
| Radex elbow complete minimum 3 views (73080) | $138.43 | $288.40 | 1.5× |
| Radex Facial Bones Complete Minimum 3 Views (70150) | $138.43 | $288.40 | 1.3× |
| Radex fingr minimum 2 views (73140) range across 2 matching MRF lines |
$138.43–$207.79 | $288.40–$432.90 | varies |
| Radex foot complete minimum 3 views (73630) range across 2 matching MRF lines |
$138.43–$207.79 | $288.40–$432.90 | varies |
| Radex Hand Minimum 3 Views (73130) | $138.43 | $288.40 | 1.5× |
| Radex lower extremity infant minimum 2 views (73592) | $138.43 | $288.40 | 1.5× |
| Radex Mastoids Compl Minimum 3 Views PR Side (70130) | $135.70 | $282.70 | 1.2× |
| Radex Nasal Bones Complete Minimum 3 Views (70160) | $138.43 | $288.40 | 1.5× |
| Radex Ribs Unilateral 2 Views (71100) | $138.43 | $288.40 | 1.5× |
| Radex shoulder complete minimum 2 views (73030) range across 2 matching MRF lines |
$138.43–$207.79 | $288.40–$432.90 | varies |
| Radex Sinuses Paransl < 3 Views (70210) | $138.43 | $288.40 | 1.5× |
| Radex sm int w/mlt srl imges via enteroclss tube (74251) | $571.15 | $1,189.90 | 3.1× |
| Radex Spine 1 View Specify Level (72020) range across 3 matching MRF lines |
$138.43–$207.79 | $288.40–$432.90 | varies |
| Radex Sternum Minimum 2 Views (71120) | $138.43 | $288.40 | 1.5× |
| Radex Temporomandble Jt Opn & Clsd Mouth Bilat (70330) | $138.43 | $288.40 | 1.5× |
| Radex Toe Minimum 2 Views (73660) range across 2 matching MRF lines |
$138.43–$207.79 | $288.40–$432.90 | varies |
| Radex upper extremity infant minimum 2 views (73092) range across 2 matching MRF lines |
$138.43–$138.62 | $288.40–$288.80 | varies |
| Radex Wrist Complete Minimum 3 Views (73110) range across 2 matching MRF lines |
$138.43–$207.79 | $288.40–$432.90 | varies |
| Radex X-Ray Exam Entire Spi 6/> Vw - Xr Entire Spine 6+ Vw (72084) | $317.42 | $661.30 | 2.9× |
| Radiation Delivery Stereotactic Cranial Linear (77372) | $4,479.55 | $9,332.40 | 0.6× |
| Radiation treatment delivery level 1 (77402) range across 2 matching MRF lines |
$511.20–$513.31 | $1,065–$1,069.40 | varies |
| Radiation treatment delivery level 2 (77407) | $4,262.35 | $8,879.90 | 10.6× |
| Radiation treatment delivery level 3 (77412) | $748.13 | $1,558.60 | 1.3× |
| Radiolog exam mandible compl minimum 4 views (70110) | $138.43 | $288.40 | 1.3× |
| Radiologic Exam Abdomen 3+ Views - Xr Abdomen 3+ Views (74021) | $138.43 | $288.40 | 1.3× |
| Radiologic exam colon double contrast study (74280) | $277.06 | $577.20 | 1.5× |
| Radiologic exam colon single contrast study (74270) | $286.66 | $597.20 | 1.6× |
| Radiologic Exam Esophagus Double Contrast Study (74221) | $207.79 | $432.90 | 1.1× |
| Radiologic exam knee complete 4/more views (73564) | $138.43 | $288.40 | 1.3× |
| Radiologic exam pelvis compl minimum 3 views (72190) | $138.43 | $288.40 | 1.3× |
| Radiologic Exam Small Int Single Contrast Study (74250) | $415.54 | $865.70 | 2.3× |
| Radiologic exam swallow function contrast study (74230) | $207.79 | $432.90 | 1.1× |
| Radiologic exam upr gi trc double contrast study (74246) | $207.79 | $432.90 | 1.1× |
| Radiologic examination femur 1 view (73551) range across 2 matching MRF lines |
$138.43–$207.79 | $288.40–$432.90 | varies |
| Radiologic examination femur minimum 2 views (73552) range across 3 matching MRF lines |
$103.92–$230.88 | $216.50–$481 | varies |
| Radiologic examination knee 1/2 views (73560) range across 2 matching MRF lines |
$138.43–$207.79 | $288.40–$432.90 | varies |
| Radiologic Examination Osseous Survey Limited (77074) | $207.79 | $432.90 | 1.9× |
| Radiologic examination tibia & fibula 2 views (73590) range across 4 matching MRF lines |
$103.87–$207.79 | $216.40–$432.90 | varies |
| Radiopharm Dacryocystography (78660) | $268.99 | $560.40 | 0.6× |
| Radiopharmaceutical therapy, by intracavitary administration Non-Facility (79200) | $597.46 | $1,244.70 | 2.4× |
| Red Cell Volume Determination Spx Mult Samplings (78121) | $1,140.77 | $2,376.60 | 2.0× |
| Renal Cyst Study (74470) | $791.52 | $1,649 | 1.4× |
| Ribs bilateral 3 views (71110) | $138.43 | $288.40 | 1.3× |
| Rp loclzj tum plnr 1 area single day imaging (78800) range across 2 matching MRF lines |
$177.50–$396.82 | $369.80–$826.70 | varies |
| Rp loclzj tum plnr 2+area 1+d img/1 area img>2+d (78801) | $597.46 | $1,244.70 | 1.4× |
| Rp Loclzj Tum Plnr Whole Body 2+ Days Imaging (78804) | $1,884.77 | $3,926.60 | 3.3× |
| Rp Loclzj Tum Plnr Whole Body Single Day Imaging (78802) | $1,587.12 | $3,306.50 | 2.8× |
| Rp Loclzj Tum Spect 1 Area Single Day Imaging (78803) | $744 | $1,550 | 1.3× |
| Rp loclzj tum spect CT 2area 1d img/1 ar img>2+d (78832) | $3,125.23 | $6,510.90 | 2.1× |
| Rp loclzj tum spect w/CT 1 area/acquisj 1day img (78830) | $892.80 | $1,860 | 0.7× |
| Rp Ther Radiolbld Monoclonal Antibody IV Infus (79403) | $1,140.72 | $2,376.50 | 4.7× |
| Rp Therapy Intravenous Administration (79101) | $595.10 | $1,239.80 | 2.4× |
| Salivary Gland Imaging (78230) | $597.46 | $1,244.70 | 1.4× |
| Scapula (73010) | $138.43 | $288.40 | 1.3× |
| Screening Digital Breast Tomosynthesis Bi (77063) range across 2 matching MRF lines |
$33.36–$35.71 | $69.50–$74.40 | varies |
| Shoulder 1 view (73020) range across 2 matching MRF lines |
$138.43–$207.79 | $288.40–$432.90 | varies |
| Shoulder Arthrography (73040) range across 2 matching MRF lines |
$277.06–$277.34 | $577.20–$577.80 | varies |
| Sialogram (70390) | $862.85 | $1,797.60 | 3.5× |
| Skull less than 4 views (70250) range across 2 matching MRF lines |
$138.43–$207.79 | $288.40–$432.90 | varies |
| Special dosimetry (77331) range across 2 matching MRF lines |
$285.60–$286.85 | $595–$597.60 | varies |
| Special Physics Consult (77370) | $1,679.86 | $3,499.70 | 11.9× |
| Special teletherapy port plan (77321) | $335.04 | $698 | 0.9× |
| Special treatment procedure (77470) | $1,200.14 | $2,500.30 | 2.1× |
| Spleen Imaging (78185) | $537.79 | $1,120.40 | 1.3× |
| Stereotactic Body Radiation Delivery (77373) | $1,119.94 | $2,333.20 | 0.6× |
| Sternoclavicular joints (71130) | $138.43 | $288.40 | 1.5× |
| Superior sagittal sinus venogram (75870) | $1,294.22 | $2,696.30 | 0.4× |
| Surface Applic Low Dose Rate Radionuclide Source (77789) | $339.31 | $706.90 | 3.2× |
| Telethx isodose pln cplx w/basic dosimetry (77307) | $1,399.82 | $2,916.30 | 3.6× |
| Telethx isodose pln smpl w/dosimetry calculation (77306) | $839.90 | $1,749.80 | 2.1× |
| Testicular Imaging W/Flow (78761) | $448.22 | $933.80 | 1.1× |
| Ther Rad Simulaj-Aided Field Setting Complex (77290) | $2,239.73 | $4,666.10 | 5.7× |
| Ther Rad Simulaj-Aided Field Setting Intermed (77285) | $2,230.56 | $4,647 | 5.7× |
| Ther rad simulaj-aided field setting simple (77280) | $2,239.73 | $4,666.10 | 15.9× |
| Therapeutic Enema Rdctj Intussusception/Obstrcj (74283) | $277.06 | $577.20 | 1.5× |
| Thoracic spine 2 views (72070) range across 2 matching MRF lines |
$138.43–$207.79 | $288.40–$432.90 | varies |
| Thoracic spine 3 views (72072) | $138.43 | $288.40 | 1.3× |
| Thoracolumbar 2 views (72080) range across 2 matching MRF lines |
$138.43–$207.79 | $288.40–$432.90 | varies |
| Thyroid Carcinoma Metastases Img Lmtd Area (78015) | $509.04 | $1,060.50 | 1.2× |
| Thyroid Imaging With Vascular Flow (78013) | $448.22 | $933.80 | 1.1× |
| Thyroid Met Imaging Body (78018) | $595.10 | $1,239.80 | 1.0× |
| Thyroid Uptake Measurement (78012) | $896.16 | $1,867 | 2.1× |
| Thyroid Uptake W/Blood Flow Sngle/Mult Quan Meas (78014) | $595.10 | $1,239.80 | 1.4× |
| Tx Devices Design & Construction Complex (77334) range across 3 matching MRF lines |
$557.66–$559.97 | $1,161.80–$1,166.60 | varies |
| Tx devices design & construction intermediate (77333) | $365.47 | $761.40 | 2.6× |
| Tx devices design & construction simple (77332) | $279.98 | $583.30 | 2.0× |
| Ultrasound Breast Limited (76642) | $172.08 | $358.50 | 1.9× |
| Ultrasound elastography first target lesion (76982) | $238.70 | $497.30 | 2.2× |
| Ultrasound Elastography Parenchyma (76981) | $238.70 | $497.30 | 2.2× |
| Ultrasound Exam Aaa Screen (76706) | $151.73 | $316.10 | 1.4× |
| Ultrasound trgt dynamic microbubble 1st lesion (76978) | $249.22 | $519.20 | 0.7× |
| Ultrasound, abdomen limited (76705) range across 7 matching MRF lines |
$170.69–$379.44 | $355.60–$790.50 | varies |
| Umbilical-artery Doppler (OB) (76820) range across 2 matching MRF lines |
$113.86–$126.82 | $237.20–$264.20 | varies |
| Unlisted Dx Radiographic Procedure (76499) range across 4 matching MRF lines |
$138.62–$1,618.08 | $288.80–$3,371 | varies |
| Unlisted magnetic resonance procedure (76498) | $1,094.50 | $2,280.20 | 12.0× |
| Unlisted Procedure Clinical Brachytherapy (77799) range across 2 matching MRF lines |
$278.83–$680.83 | $580.90–$1,418.40 | varies |
| Unlisted us procedure (76999) range across 2 matching MRF lines |
$341.47–$730.51 | $711.40–$1,521.90 | varies |
| Upper gi w/o kub (74240) range across 2 matching MRF lines |
$207.79–$207.98 | $432.90–$433.30 | varies |
| Ureteral Reflux Study (78740) | $597.46 | $1,244.70 | 1.4× |
| Urethrocystogram voiding (74455) | $416.02 | $866.70 | 1.7× |
| Us breast unilateral complete (76641) | $229.44 | $478 | 2.1× |
| Us chest (76604) range across 5 matching MRF lines |
$170.74–$379.44 | $355.70–$790.50 | varies |
| Us complete joint (76881) | $341.47 | $711.40 | 3.1× |
| Us exam, pelvic, limited (76857) range across 6 matching MRF lines |
$227.57–$379.44 | $474.10–$790.50 | varies |
| Us head (76506) range across 3 matching MRF lines |
$227.57–$379.44 | $474.10–$790.50 | varies |
| Us kidney transplant (76776) range across 2 matching MRF lines |
$455.28–$755.86 | $948.50–$1,574.70 | varies |
| Us lmtd joint/oth nonvasc xtr strux r-t w/img (76882) | $227.18 | $473.30 | 2.1× |
| Us ob detailed single fetus (76811) range across 3 matching MRF lines |
$341.47–$761.66 | $711.40–$1,586.80 | varies |
| Us ob limited 1 or more fetuses (76815) range across 5 matching MRF lines |
$222.77–$493.15 | $464.10–$1,027.40 | varies |
| Us ob transvaginal (76817) range across 4 matching MRF lines |
$170.74–$380.83 | $355.70–$793.40 | varies |
| Us pelvic non ob complete (76856) range across 2 matching MRF lines |
$227.57–$379.44 | $474.10–$790.50 | varies |
| Us pg uter img f&mat 14 wk tabdl 1/1st gestation (76801) range across 3 matching MRF lines |
$312.67–$380.83 | $651.40–$793.40 | varies |
| Us preg uterus real time f/u trnsabdl per fetus (76816) range across 3 matching MRF lines |
$186.58–$380.83 | $388.70–$793.40 | varies |
| Us retroperitoneal complete (76770) range across 3 matching MRF lines |
$227.57–$379.44 | $474.10–$790.50 | varies |
| Us retroperitoneal limited (76775) range across 5 matching MRF lines |
$215.71–$359.52 | $449.40–$749 | varies |
| Us scrotum and contents (76870) range across 2 matching MRF lines |
$341.47–$590.69 | $711.40–$1,230.60 | varies |
| Us spinal canal and contents (76800) | $349.44 | $728 | 3.2× |
| Us thyroid (76536) range across 3 matching MRF lines |
$256.08–$341.47 | $533.50–$711.40 | varies |
| Us transrectal (76872) | $455.28 | $948.50 | 4.2× |
| Vascular Flow Imaging (78445) | $298.66 | $622.20 | 0.7× |
| Vein X-Ray Chest (75827) | $1,291.06 | $2,689.70 | 0.8× |
| Vein X-Ray Liver W/O Hemodyn (75887) | $862.85 | $1,797.60 | 0.3× |
| Vein X-Ray Skull Epidural (75872) | $1,219.06 | $2,539.70 | 1.9× |
| Vein X-Ray Spleen/Liver (75810) | $1,727.52 | $3,599 | 0.5× |
| Venogram Sinus/Jugular (75860) range across 3 matching MRF lines |
$965.33–$1,285.63 | $2,011.10–$2,678.40 | varies |
| Venography Adrenal Unilateral (75840) | $2,947.68 | $6,141 | 0.9× |
| Venography caval inferior serialography rs&i (75825) | $1,293.94 | $2,695.70 | 0.4× |
| Venography extremity bilateral rs&i (75822) | $1,291.92 | $2,691.50 | 0.8× |
| Venography extremity unilateral rs&i (75820) | $767.62 | $1,599.20 | 0.5× |
| Venography Orbital Rs&I (75880) | $364.32 | $759 | 0.6× |
| Venography Renal Bilateral (75833) range across 2 matching MRF lines |
$862.85–$863.81 | $1,797.60–$1,799.60 | varies |
| Venography Renal Unilateral (75831) | $862.85 | $1,797.60 | 0.3× |
| Venous sampling by catheter (75893) range across 2 matching MRF lines |
$860.45–$861.36 | $1,792.60–$1,794.50 | varies |
| Venous thrombosis imaging (78457) | $369.55 | $769.90 | 0.6× |
| Venous Thrombosis Imaging Venogram Bilateral (78458) | $740.21 | $1,542.10 | 1.8× |
| Vertebral fracture assessment via dxa (77086) | $144.19 | $300.40 | 1.6× |
| Wrist 2 views (73100) range across 2 matching MRF lines |
$138.43–$207.79 | $288.40–$432.90 | varies |
| X-Ray Ac Jts - Xr Acromioclavicular Joints Bilateral (73050) | $138.43 | $288.40 | 1.5× |
| X-ray antegrade pyelogram tube (74425) | $831.70 | $1,732.70 | 2.3× |
| X-Ray Aorta Leg Arteries (75630) range across 3 matching MRF lines |
$2,722.13–$3,629.42 | $5,671.10–$7,561.30 | varies |
| X-Ray Bend Only L-S Spine (72120) | $138.43 | $288.40 | 1.3× |
| X-Ray Elbow 2 Vw - Xr Elbow 1-2 Views Right (73070) range across 4 matching MRF lines |
$103.92–$207.79 | $216.50–$432.90 | varies |
| X-Ray Exam Breast Specimen (76098) | $69.26 | $144.30 | 0.1× |
| X-Ray Exam Entire Spi 1 Vw (72081) range across 3 matching MRF lines |
$207.79–$311.66 | $432.90–$649.30 | varies |
| X-Ray Exam Entire Spi 2/3 Vw (72082) range across 3 matching MRF lines |
$251.47–$377.86 | $523.90–$787.20 | varies |
| X-Ray Exam Entire Spi 4/5 Vw (72083) | $273.65 | $570.10 | 2.5× |
| X-Ray Exam Hip Uni 1 View (73501) range across 2 matching MRF lines |
$277.01–$415.54 | $577.10–$865.70 | varies |
| X-Ray Exam Hip Uni 2-3 Views (73502) range across 3 matching MRF lines |
$184.90–$415.54 | $385.20–$865.70 | varies |
| X-Ray Exam Hip Uni 4/> Views (73503) range across 3 matching MRF lines |
$236.93–$533.04 | $493.60–$1,110.50 | varies |
| X-Ray Exam Hips Bi 2 Views (73521) range across 3 matching MRF lines |
$285.70–$428.54 | $595.20–$892.80 | varies |
| X-Ray Exam Hips Bi 3-4 Views (73522) | $372.67 | $776.40 | 3.4× |
| X-Ray Exam Hips Bi 5/> Views (73523) | $597.36 | $1,244.50 | 5.5× |
| X-Ray Exam L-S Spine Bending (72114) | $138.43 | $288.40 | 1.3× |
| X-Ray Exam Neck Spine 2-3 Vw (72040) range across 2 matching MRF lines |
$138.43–$207.79 | $288.40–$432.90 | varies |
| X-Ray Exam Neck Spine 6/>Vws (72052) | $207.79 | $432.90 | 1.9× |
| X-Ray Exam Unilat Ribs/Chest (71101) | $138.43 | $288.40 | 1.3× |
| X-ray eye for foreign body (70030) | $138.43 | $288.40 | 1.5× |
| X-ray humerus (73060) range across 3 matching MRF lines |
$17.28–$207.79 | $36–$432.90 | varies |
| X-ray IV pyelogram (ivp) (74400) | $207.98 | $433.30 | 1.1× |
| X-ray IV pyelogram+tomography (74415) | $277.34 | $577.80 | 1.5× |
| X-Ray Jaw <4 Vw - Xr Mandible < 4 Views (70100) | $138.43 | $288.40 | 1.5× |
| X-Ray Knee Bilat Standing - Xr Knees Anteroposterior Standing Bilat (73565) | $138.43 | $288.40 | 1.5× |
| X-Ray Lumbar Spine 2/3 Vw - Xr Lumbar Spine 2-3 Views (72100) range across 2 matching MRF lines |
$138.43–$207.79 | $288.40–$432.90 | varies |
| X-ray nose-rectum child f.b. (76010) | $138.43 | $288.40 | 1.5× |
| X-Ray Ribs, Chest 4+ Vw - Xr Ribs 3 Vws Bil W/ Chest Posteroanterior (71111) | $138.43 | $288.40 | 1.3× |
| X-Ray Sacroiliac Jts 3+ Vw - Xr Sacroiliac Joints 3+ Views (72202) | $138.43 | $288.40 | 1.3× |
| X-Ray Sacroiliac Jts <3 Vw - Xr Sacroiliac Joints 1-2 Views (72200) | $135.50 | $282.30 | 1.2× |
| X-Ray Sacrum/Coccyx 2+ Vw - Xr Sacrum Coccyx 2+ Views (72220) | $138.43 | $288.40 | 1.5× |
| X-Ray Sinuses 3+ Vw - Xr Paranasal Sinuses 3+ Views (70220) | $138.43 | $288.40 | 1.5× |
| X-Ray Skull 4+ Vw - Xr Skull Complete 4+ Views (70260) | $138.43 | $288.40 | 1.3× |
| X-Ray Stress View (77071) | $138.62 | $288.80 | 1.5× |
| X-ray thoracic spine 4 vw (72074) | $138.62 | $288.80 | 1.3× |
| X-Ray Tmj Unilat (70328) | $138.62 | $288.80 | 1.5× |
| X-Ray Urinary Tract Exam With Contrast Material (74420) | $277.06 | $577.20 | 0.8× |
| X-Rays Bone Length Studies (77073) | $231.79 | $482.90 | 2.1× |
| X-Rays Bone Survey Complete (77075) | $207.79 | $432.90 | 1.9× |
| Xr c-spine 4 or 5 views (72050) | $138.43 | $288.40 | 1.3× |
| Xr facial bones less than 3 views (70140) | $138.43 | $288.40 | 1.5× |
| Xr orbits complete 4 views (70200) range across 2 matching MRF lines |
$103.92–$138.43 | $216.50–$288.40 | varies |
| Xr Tomogram Single Plane (76100) | $207.79 | $432.90 | 1.9× |
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.