Imaging prices at UNM Hospital
Albuquerque, NM · every code in this section with a posted price and a Medicare benchmark.
456 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) | $2,486 | $4,520 | 1.8× |
| Abdomen 1 View (74018) | $133.38 | $242.50 | 1.5× |
| Abdomen 2 views (74019) range across 2 matching MRF lines |
$142.45–$178.06 | $259–$323.75 | varies |
| Acute Gastrointestinal Blood Loss Imaging (78278) | $457.17 | $831.21 | 1.2× |
| Angio internal mammary (75756) | $642.41 | $1,168.02 | 0.2× |
| Angio pulmonary bilat (75743) | $2,618.93 | $4,761.69 | 0.8× |
| Angiography Adrenal Bilateral Slctv Rs&I (75733) | $1,135.52 | $2,064.58 | 0.4× |
| Angiography extremity bilateral rs&i (75716) range across 2 matching MRF lines |
$2,542.65–$2,618.93 | $4,623–$4,761.69 | varies |
| Angiography extremity unilateral rs&i (75710) range across 5 matching MRF lines |
$1,138.28–$2,618.93 | $2,069.60–$4,761.69 | varies |
| Angiography pulmonary unilateral slctv rs&i (75741) | $2,618.93 | $4,761.69 | 0.8× |
| Angrph pulmonary nonslctv cath/ven njx rs&i (75746) | $585.90 | $1,065.28 | 0.2× |
| Ankle 2 views (73600) range across 3 matching MRF lines |
$103.40–$147.95 | $188–$269 | varies |
| Aortography thoracic serialography rs&i (75605) | $4,338.82 | $7,888.77 | 0.8× |
| Aortography thoracic w/o serialography rs&i (75600) | $2,618.93 | $4,761.69 | 0.8× |
| Artery X-Rays Abdomen (75726) range across 3 matching MRF lines |
$1,578.72–$3,045.50 | $2,870.40–$5,537.28 | varies |
| Artery X-Rays Adrenal Gland (75731) range across 2 matching MRF lines |
$1,081.99–$1,136.12 | $1,967.25–$2,065.67 | varies |
| Artery X-Rays Pelvis (75736) | $4,338.82 | $7,888.77 | 0.8× |
| Artery X-Rays Spine (75705) range across 3 matching MRF lines |
$4,140.13–$20,700.63 | $7,527.50–$37,637.50 | varies |
| Arthrogram ankle (73615) | $233.96 | $425.39 | 0.7× |
| Arthrogram hip (73525) | $310.44 | $564.44 | 0.9× |
| Arthrogram Wrist (73115) | $320.64 | $582.98 | 0.9× |
| Basic radiation dosimetry calculation (77300) range across 3 matching MRF lines |
$246.40–$739.20 | $448–$1,344 | varies |
| Bone age studies (77072) range across 2 matching MRF lines |
$96.25–$99.14 | $175–$180.25 | varies |
| Bone Imaging 3 Phase (78315) range across 2 matching MRF lines |
$579.70–$600.88 | $1,054–$1,092.50 | varies |
| Bone Imaging Limited Area (78300) range across 2 matching MRF lines |
$278.72–$521.30 | $506.76–$947.81 | varies |
| Bone Imaging Multiple Areas (78305) | $682 | $1,240 | 1.7× |
| Bone Imaging Whole Body (78306) | $643.50 | $1,170 | 1.6× |
| Bone marrow imaging limited area (78102) | $270.79 | $492.34 | 0.7× |
| Bone marrow imaging; multiple areas (78103) | $338.77 | $615.94 | 0.9× |
| Bone marrow imaging; whole body (78104) | $439.60 | $799.28 | 1.1× |
| Bone survey infant (77076) range across 3 matching MRF lines |
$101.97–$107.07 | $185.40–$194.67 | varies |
| Brachytx isodose complex (77318) | $590.15 | $1,073 | 1.6× |
| Brachytx isodose intermed (77317) | $514.80 | $936 | 1.4× |
| Brachytx Isodose Plan Simple (77316) range across 3 matching MRF lines |
$281.60–$290.05 | $512–$527.36 | varies |
| Brain Flow Imaging Only (78610) | $338.62 | $615.68 | 0.6× |
| Brain Image W/Flow < 4 Views (78601) | $354.63 | $644.78 | 0.9× |
| Brain Imaging Min 4 Static Views W Vascular Flow (78606) | $355.20 | $645.81 | 0.7× |
| Brain Imaging Minimum 4 Static Views (78605) | $331.97 | $603.58 | 0.6× |
| Brain Imaging Pet Metabolic Evaluation (78608) | $2,303.40 | $4,188 | 1.6× |
| Card Bl Pool Gated Spect Rest Wal Motn Ejct Frct (78494) range across 2 matching MRF lines |
$461.45–$475.29 | $839–$864.17 | varies |
| Cardiac MRI w/w/o contrast & further seq (75561) | $1,632.40 | $2,968 | 4.7× |
| Cardiac MRI w/w/o contrast w/stress (75563) | $1,795.75 | $3,265 | 2.3× |
| Cardiac Shunt Detection (78428) | $206.21 | $374.92 | 0.5× |
| Cat Scan Follow-Up Study (76380) | $260.70 | $474 | 3.0× |
| Cerebrospinal Fluid Scan (78630) | $696.23 | $1,265.87 | 1.3× |
| Chest 1 view (71045) range across 2 matching MRF lines |
$85.39–$87.95 | $155.25–$159.91 | varies |
| Chest 2 views (71046) range across 6 matching MRF lines |
$87.95–$204.93 | $159.91–$372.60 | varies |
| Chest 3 views (71047) | $123.20 | $224 | 1.4× |
| Chest 4 or more views (71048) | $147.95 | $269 | 1.4× |
| Chg us nrv&acc strux 1 xtr compre w/img pr extremity (76883) | $146.96 | $267.20 | 1.4× |
| Cisternography Positive Contrast Rs&I (70015) | $678.10 | $1,232.91 | 0.9× |
| Clavicle complete (73000) range across 3 matching MRF lines |
$80.85–$161.70 | $147–$294 | varies |
| Computed Tomography Thorax Lw Dose Lng Ca Scr C- (71271) | $139.05 | $252.81 | 1.3× |
| Continuing medical physics consltj pr wk (77336) | $275.55 | $501 | 2.1× |
| Contrast Exam Abdominl Aorta (75625) range across 2 matching MRF lines |
$2,542.65–$2,618.93 | $4,623–$4,761.69 | varies |
| Contrast X-Ray Bladder (74430) range across 2 matching MRF lines |
$213.81–$220.23 | $388.75–$400.41 | varies |
| Contrast X-Ray Of Elbow (73085) | $233.96 | $425.39 | 0.7× |
| Contrast X-Ray Of Knee Joint (73580) | $264.56 | $481.01 | 0.8× |
| CT abdomen and pelvis without and with contrast (74178) | $1,218.80 | $2,216 | 3.5× |
| CT abdomen and pelvis without contrast (74176) range across 2 matching MRF lines |
$811.80–$893.20 | $1,476–$1,624 | varies |
| CT abdomen w contrast (74160) | $963.05 | $1,751 | 5.5× |
| CT abdomen w wo contrast (74170) | $1,218.80 | $2,216 | 7.0× |
| CT abdomen w/o contrast (74150) | $811.80 | $1,476 | 7.8× |
| CT Angio Abdomen and Pelvis (74174) | $1,702.25 | $3,095 | 4.9× |
| CT Angio Chest (71275) | $1,569.98 | $2,854.50 | 9.0× |
| CT Angio Head (70496) | $1,498.06 | $2,723.75 | 8.6× |
| CT angio hrt w/3d image (75574) range across 2 matching MRF lines |
$450.31–$463.82 | $818.75–$843.31 | varies |
| Ct Angio Lwr Extr W/O&W/Dye (73706) | $1,064.80 | $1,936 | 6.1× |
| CT Angio Neck (70498) | $1,318.30 | $2,396.90 | 7.6× |
| Ct Angio Upr Extrm W/O&W/Dye (73206) | $1,041.15 | $1,893 | 6.0× |
| CT Cere Prfuj Alys C+ W/O CT/Cta Same Anatomy (70473) | $700.76 | $1,274.11 | 4.0× |
| CT cervical spine w/ contrast (72126) | $1,122.55 | $2,041 | 3.3× |
| CT cervical spine w/o contrast (72125) | $898.15 | $1,633 | 8.7× |
| CT cervical spine w/wo cont (72127) | $1,684.10 | $3,062 | 9.7× |
| CT chest w contrast (71260) | $963.60 | $1,752 | 5.5× |
| CT chest w/wo contrast (71270) | $1,168.75 | $2,125 | 6.7× |
| CT colonography screening (74263) | $707.85 | $1,287 | 3.0× |
| CT head/brain with contrast (70460) | $868.45 | $1,579 | 5.0× |
| CT head/brain without and with contrast (70470) | $1,012 | $1,840 | 5.8× |
| CT heart contrast eval cardiac structure&morph (75572) | $402.22 | $731.30 | 1.2× |
| CT heart no contrast quant eval coronry calcium (75571) range across 3 matching MRF lines |
$41.25–$43.17 | $75–$78.49 | varies |
| CT hrt w/3d image congen (75573) | $333.10 | $605.64 | 1.0× |
| CT iac w contrast (70481) | $834.90 | $1,518 | 4.8× |
| CT l-spine w&w/o contrast (72133) | $1,401.95 | $2,549 | 8.1× |
| CT lower ext w/o (73700) | $728.20 | $1,324 | 7.0× |
| CT lower extremity w/contrast material (73701) | $1,000.45 | $1,819 | 5.8× |
| CT lumbar spine w contrast (72132) | $1,358.50 | $2,470 | 3.9× |
| CT lumbar spine w/o contrast (72131) | $934.45 | $1,699 | 9.0× |
| CT maxillofacial w contrast (70487) | $832.15 | $1,513 | 4.8× |
| CT maxillofacial wo contrast (70486) | $687.50 | $1,250 | 6.6× |
| CT neck tissue combo (70492) | $1,115.95 | $2,029 | 6.4× |
| Ct Orbit/Ear/Fossa W/O&W/Dye (70482) | $1,069.20 | $1,944 | 6.2× |
| CT orbits w/o contrast (70480) | $723.80 | $1,316 | 7.0× |
| CT pelvis w&w/o contrast (72194) | $1,177 | $2,140 | 6.8× |
| CT pelvis w/o contrast (72192) | $643.50 | $1,170 | 6.2× |
| CT scan of leg combo (73702) | $1,275.45 | $2,319 | 7.3× |
| CT scans face/jaw combo (70488) | $983.40 | $1,788 | 5.7× |
| CT soft tissue neck w contrast (70491) | $900.90 | $1,638 | 5.2× |
| CT soft tissue neck w/o contrast (70490) | $778.25 | $1,415 | 7.5× |
| CT thoracic spine w contrast (72129) | $1,004.30 | $1,826 | 5.8× |
| CT thoracic spine w/o contrast (72128) | $803.55 | $1,461 | 7.8× |
| CT thoracic spine w/wo cont (72130) | $1,205.60 | $2,192 | 6.9× |
| CT thorax w/o contrast (71250) | $811.25 | $1,475 | 7.8× |
| CT upper ext wo (73200) range across 2 matching MRF lines |
$719.95–$1,439.90 | $1,309–$2,618 | varies |
| CT upper extremity w/o & w/contrast material (73202) | $949.85 | $1,727 | 5.5× |
| CT upper extremity with contrast (73201) | $858 | $1,560 | 2.5× |
| Cta Abdl Aorta&Bi Iliofem W/Contrast&Postp (75635) | $1,489.95 | $2,709 | 8.6× |
| Cta Abdomen (74175) | $1,427.25 | $2,595 | 8.2× |
| CTA head&neck c+ w/noncontrast img&post-pxessing (70471) | $700.76 | $1,274.11 | 2.0× |
| CTA pelvis (72191) | $1,089 | $1,980 | 6.3× |
| Dacryocystography, nasolacrimal duct, radiological supervision and interpretation Non-Facility (70170) | $190.91 | $347.11 | 0.8× |
| Dilation ureters/urethra rs&i (74485) range across 2 matching MRF lines |
$758.99–$797.07 | $1,379.99–$1,449.21 | varies |
| Discography Cerv/Thor Spine (72285) | $1,026.50 | $1,866.36 | 0.5× |
| Diskography lumbar (72295) | $1,026.50 | $1,866.36 | 0.5× |
| Doppler Echo Fetal Puls Spectral F/U/Repeat (76828) range across 2 matching MRF lines |
$119.35–$122.93 | $217–$223.51 | varies |
| Doppler Echo Fetal Spectral Display Complete (76827) | $204.19 | $371.25 | 2.0× |
| Doppler Fetal Mid Cerebral Artery (76821) range across 3 matching MRF lines |
$105.88–$211.75 | $192.50–$385 | varies |
| Dxa Bone Density Axial (77080) | $149.60 | $272 | 1.4× |
| Dxa bone density study 1/>sites appendiclr skel (77081) range across 2 matching MRF lines |
$47.30–$48.72 | $86–$88.58 | varies |
| Echo exam of fetal heart (76825) range across 2 matching MRF lines |
$457.19–$470.90 | $831.25–$856.19 | varies |
| Echo exam uterus (76831) | $361.02 | $656.40 | 1.5× |
| Echo Guide For Artery Repair (76936) | $528 | $960 | 2.5× |
| Echocardiography, fetal, cardiovascular system, real time with image documentation (2D), with or without M-mode… (76826) range across 2 matching MRF lines |
$268.40–$276.45 | $488–$502.64 | varies |
| Echograp Trans R Pros Study (76873) | $99.14 | $180.25 | 1.0× |
| Esophagram (74220) range across 2 matching MRF lines |
$223.85–$230.57 | $407–$419.21 | varies |
| Fetal Biophys Profile W/Nst (76818) | $212.52 | $386.40 | 2.1× |
| Fetal Biophysical Profile W/O Non-Stress Testing (76819) | $221.10 | $402 | 2.1× |
| Fetal MRI w/placntl matrnl plvc img sing/1st ges (74712) | $320.39 | $582.53 | 1.4× |
| Fluoroscopy up to 1 hr (76000) range across 3 matching MRF lines |
$248.82–$497.64 | $452.40–$904.80 | varies |
| Follow-Up Angiography (75898) range across 2 matching MRF lines |
$1,075.80–$1,163.48 | $1,956–$2,115.41 | varies |
| Foot 2 views (73620) range across 4 matching MRF lines |
$98.45–$147.95 | $179–$269 | varies |
| Forearm 2 views (73090) | $159.72 | $290.40 | 1.9× |
| Gastric emptying imaging study (78264) | $668.94 | $1,216.25 | 1.7× |
| Gastroesophageal Reflux Exam (78262) | $253.65 | $461.18 | 0.6× |
| Gated Heart Planar Single (78472) range across 2 matching MRF lines |
$499.81–$514.81 | $908.75–$936.01 | varies |
| Gated Heart, Multiple (78473) | $454.90 | $827.09 | 1.1× |
| GI Endoscopic US S&I (76975) | $594 | $1,080 | 2.5× |
| Hand 2 views (73120) range across 4 matching MRF lines |
$103.95–$148.50 | $189–$270 | varies |
| Hdr Rdncl Ntrstl/Icav Brchtx (77772) | $2,333.65 | $4,243 | 3.4× |
| Hdr Rdncl Ntrstl/Icav Brchtx (77771) | $902 | $1,640 | 1.3× |
| Hdr Rdncl Ntrstl/Icav Brchtx 1 Channel (77770) range across 3 matching MRF lines |
$739.20–$761.38 | $1,344–$1,384.32 | varies |
| Heart Image (Pet) Multiple (78492) | $1,984.13 | $3,607.50 | 1.4× |
| Hepatc Vngrph Wdg/Fr Hemodyn Eval Rs&I (75889) range across 2 matching MRF lines |
$3,178.31–$3,273.66 | $5,778.75–$5,952.11 | varies |
| Hepatc Vngrph Wdg/Fr W/O Hemodyn Eval Rs&I (75891) | $2,618.93 | $4,761.69 | 0.8× |
| Hepatobil Syst Image W/Drug (78227) range across 2 matching MRF lines |
$583.55–$601.06 | $1,061–$1,092.83 | varies |
| Hepatobiliary System Imaging (78226) | $583.55 | $1,061 | 1.5× |
| Ht Musc Image Planar Mult (78454) | $1,321.64 | $2,402.99 | 1.0× |
| Ht Muscle Image Spect Sing (78451) | $852.73 | $1,550.41 | 0.7× |
| Hyperthermia external generated superficial (77600) | $331.97 | $603.58 | 0.9× |
| Hyperthermia generated by interstitial probe(s); 5 or fewer interstitial applicators Non-Facility (77610) | $262.86 | $477.92 | 0.5× |
| Hyperthermia generated by interstitial probe(s); more than 5 interstitial applicators Non-Facility (77615) | $365.39 | $664.35 | 0.7× |
| Hyperthermia, externally generated; deep (ie, heating to depths greater than 4 cm) Non-Facility (77605) | $444.70 | $808.55 | 0.6× |
| Hysterosalpingogram (74740) | $265.12 | $482.04 | 1.1× |
| Infant hip ultrasound with hip movement (dynamic) (76885) | $302.50 | $550 | 3.5× |
| Infant hip ultrasound, limited static exam (76886) | $167.06 | $303.75 | 1.9× |
| Interstitial radiation source applic complex (77778) | $1,718.20 | $3,124 | 2.5× |
| Intracavitary Radiation Source Applic Complex (77763) | $404.48 | $735.42 | 0.6× |
| Intracavitary Radiation Source Applic Intermed (77762) | $295.71 | $537.66 | 0.5× |
| Intracavitary radiation source applic simple (77761) | $1,027.95 | $1,869 | 1.9× |
| Joint Survey Single View (77077) | $111.60 | $202.91 | 1.1× |
| K Flow/Funct Image Multiple (78709) | $550.64 | $1,001.16 | 1.0× |
| K Flow/Funct Image W/Drug (78708) | $917.13 | $1,667.50 | 1.7× |
| K Flow/Funct Image W/O Drug (78707) range across 2 matching MRF lines |
$385.28–$396.84 | $700.50–$721.52 | varies |
| Kidney Imaging Morphol (78700) | $318.94 | $579.89 | 0.8× |
| Kidney Imaging Morphoogy W/Vascular Flow (78701) | $357.46 | $649.93 | 0.9× |
| Knee 3 Views (73562) range across 2 matching MRF lines |
$168.96–$337.92 | $307.20–$614.40 | varies |
| Labeled RBC Sequestration Differntl Organ/Tissue (78140) | $472.46 | $859.02 | 1.2× |
| Leveen/Shunt Patency Exam (78291) | $183.12 | $332.95 | 0.5× |
| Liver & Spleen Imaging Static Only (78215) range across 2 matching MRF lines |
$347.74–$358.17 | $632.25–$651.22 | varies |
| Liver imaging static only (78201) range across 2 matching MRF lines |
$316.39–$325.88 | $575.25–$592.51 | varies |
| Lung Perf&Ventilat Diferentl (78598) | $717.20 | $1,304 | 1.3× |
| Lung perfusion differential (78597) range across 2 matching MRF lines |
$298.10–$307.04 | $542–$558.26 | varies |
| Lung Ventilat&Perfus Imaging (78582) | $717.20 | $1,304 | 1.3× |
| Lung Ventilation Imaging (78579) | $307.04 | $558.26 | 0.8× |
| Lymph System Imaging (78195) range across 4 matching MRF lines |
$497.39–$3,348.49 | $904.34–$6,088.16 | varies |
| Lymphangiography Extremity Only Bilateral Rs&I (75803) | $390.80 | $710.55 | 0.3× |
| Lymphangiography extremity only unilateral rs&i (75801) | $257.56 | $468.29 | 0.4× |
| Lymphangiography Pelvic/Abdominal Bilateral Rs&I (75807) | $340.24 | $618.62 | 0.1× |
| Lymphangiography, pelvic/abdominal, unilateral (75805) range across 2 matching MRF lines |
$583.52–$591.26 | $1,060.95–$1,075.01 | varies |
| Magnetic Image Jaw Joint (70336) | $1,205.88 | $2,192.50 | 5.1× |
| Magnetic Resonance Elastography (76391) | $320.39 | $582.53 | 1.4× |
| Mammary ductogram or galactogram multiple (77054) | $201.11 | $365.65 | 0.9× |
| Mammary ductogram or galactogram single (77053) | $142.76 | $259.56 | 0.6× |
| Meckels Divert Exam (78290) range across 2 matching MRF lines |
$315.70–$325.17 | $574–$591.22 | varies |
| Mlc imrt design & construction per imrt plan (77338) range across 2 matching MRF lines |
$233.20–$240.20 | $424–$436.72 | varies |
| Mra Head W/O & W/Contrast Material (70546) | $1,925.55 | $3,501 | 5.6× |
| MRA head w/o contrast (70544) | $1,513.05 | $2,751 | 6.4× |
| MRA head with contrast (70545) | $1,788.05 | $3,251 | 5.2× |
| MRA neck w contrast (70548) | $1,788.05 | $3,251 | 5.2× |
| Mra Neck W/O &W/Contrast Material (70549) | $1,925.55 | $3,501 | 5.6× |
| MRA neck w/o contrast (70547) | $1,513.05 | $2,751 | 6.4× |
| MRI abdomen w contrast (74182) | $1,512.50 | $2,750 | 4.4× |
| MRI abdomen w/o contrast (74181) | $1,045 | $1,900 | 4.4× |
| MRI any jt lower extrem w/contrast material (73722) | $1,291.40 | $2,348 | 1.7× |
| MRI any jt lower extrem w/o & w/contrast matrl (73723) | $1,397 | $2,540 | 4.0× |
| MRI any jt upper extremity w/contrast matrl (73222) | $1,395.90 | $2,538 | 1.8× |
| MRI bone marrow blood supply (77084) | $1,763.30 | $3,206 | 7.5× |
| MRI brain functional w/o physician admnistration (70554) | $1,518.55 | $2,761 | 6.4× |
| MRI brain functional w/physician admnistration (70555) | $1,543.30 | $2,806 | 6.5× |
| MRI Breast W/O Contrast Bilateral (77047) | $760.49 | $1,382.70 | 3.2× |
| MRI Breast Without Contrast Material Unilateral (77046) | $317.02 | $576.40 | 1.3× |
| MRI cardiac w/o cont stress (75559) | $1,795.75 | $3,265 | 3.3× |
| MRI cardiac w/o contrast (75557) | $1,390.13 | $2,527.50 | 5.9× |
| MRI cervical spine w contrast (72142) | $1,467.95 | $2,669 | 4.3× |
| MRI cervical spine w/o cont (72141) | $1,178.10 | $2,142 | 5.0× |
| MRI chest w/o contrast (71550) | $1,045 | $1,900 | 4.4× |
| MRI chest with contrast (71551) | $1,536.15 | $2,793 | 2.0× |
| MRI chest wo w contrast (71552) | $1,923.90 | $3,498 | 5.6× |
| MRI lower extrem oth/thn jt w/contrast matrl (73719) range across 2 matching MRF lines |
$1,410.64–$1,763.30 | $2,564.80–$3,206 | varies |
| MRI lower extrem oth/thn jt w/o & w/contr matr (73720) | $1,536.70 | $2,794 | 4.4× |
| MRI lower extrem oth/thn jt w/o contr matrl (73718) | $1,178.10 | $2,142 | 5.0× |
| MRI lumbar spine w contrast (72149) | $1,397 | $2,540 | 4.0× |
| Mri Neck Spine W/O & W/Dye (72156) | $1,648.90 | $2,998 | 4.8× |
| MRI orbit face &/neck w/o contrast (70540) | $1,213.30 | $2,206 | 5.1× |
| MRI orbit face neck w contrast (70542) | $1,397 | $2,540 | 4.0× |
| Mri Orbt/Fac/Nck W/O &W/Dye (70543) | $1,632.40 | $2,968 | 4.7× |
| MRI pelvis w contrast (72196) | $1,446.50 | $2,630 | 4.2× |
| MRI pelvis w/o & w contrast (72197) | $1,632.40 | $2,968 | 4.7× |
| MRI pelvis w/o contrast (72195) | $1,397 | $2,540 | 5.9× |
| MRI spectroscopy (76390) | $624.80 | $1,136 | 7.3× |
| MRI thoracic spine w/o contrast (72146) | $1,178.10 | $2,142 | 5.0× |
| MRI upper extremity oth than jt w/contr matrl (73219) range across 2 matching MRF lines |
$1,152.11–$1,536.15 | $2,094.75–$2,793 | varies |
| MRI upper extremity oth than jt w/o contr matrl (73218) | $1,060.29 | $1,927.80 | 4.5× |
| Mri Uppr Extremity W/O&W/Dye (73220) | $1,306.25 | $2,375 | 3.8× |
| MRI, abdomen, combo (74183) | $1,632.40 | $2,968 | 4.7× |
| MRI, dorsal spine combo (72157) | $1,632.40 | $2,968 | 4.7× |
| MRI, dorsal spine contrast (72147) | $1,397 | $2,540 | 4.0× |
| MRI, joint upper extrem (73221) | $645.70 | $1,174 | 2.7× |
| MRI, joint upper extrem combo (73223) | $1,676.40 | $3,048 | 4.9× |
| MRI, lumbar spine combo (72158) | $1,632.40 | $2,968 | 4.7× |
| Myelogram cervical (72240) | $621.45 | $1,129.91 | 0.8× |
| Myelogram Lumbar (72265) | $641.28 | $1,165.96 | 0.8× |
| Myelography thoracic (72255) | $411.28 | $747.78 | 0.5× |
| Myelograpy 2/more regions rs&i (72270) | $435.64 | $792.07 | 0.6× |
| Myocardial Imaging Infarct Avid Planar Qual/Quan (78466) | $315.54 | $573.71 | 0.8× |
| Myocardial Imaging Pet Metabolic Evaluation (78459) | $2,533.30 | $4,606 | 2.0× |
| Myocardial Perfusion Planar 1 Study Rest/Stress (78453) | $639.86 | $1,163.39 | 0.5× |
| Myocardial Spect Multiple Studies (78452) range across 2 matching MRF lines |
$1,510.30–$1,555.61 | $2,746–$2,828.38 | varies |
| Myocrd Img Pet Metab Eval Single Study Cncrnt CT (78429) | $1,984.13 | $3,607.50 | 1.4× |
| Myocrd img PET prfuj 1std rest/stress cncrnt CT (78430) | $1,984.13 | $3,607.50 | 1.4× |
| Myocrd Img Pet Prfuj Mlt Std Rst&Strs Cncrnt CT (78431) | $3,094.44 | $5,626.25 | 1.4× |
| Myocrd Img Pet Prfuj W/Metab 2rtracer Cncrnt CT (78433) | $3,781.94 | $6,876.25 | 1.7× |
| Myocrd Img Pet Prfuj W/Metab Dual Radiotracer (78432) | $3,781.94 | $6,876.25 | 2.5× |
| Neck soft tissue (70360) | $118.05 | $214.64 | 1.4× |
| Nm csf leak detection (78650) | $951.15 | $1,729.37 | 0.7× |
| Nm myocard infarct spect (78469) | $453.20 | $824 | 0.8× |
| Nonvascular Shunt X-Ray (75809) | $213.95 | $389 | 2.1× |
| Ntsty modul radthx pln dose-vol histos (77301) | $2,355.65 | $4,283 | 1.7× |
| Nuclear Rx Intra-Arterial (79445) | $456.23 | $829.50 | 2.0× |
| Nuclear Rx Oral Admin (79005) | $389.95 | $709 | 1.7× |
| Ob us nuchal meas 1 gest (76813) range across 2 matching MRF lines |
$250.14–$500.28 | $454.80–$909.60 | varies |
| Oph bmtry us echograpy a-scan io lens pwr cal (76519) range across 3 matching MRF lines |
$90.20–$116.13 | $164–$211.15 | varies |
| Oph us dx ant sgm us immersion b-scan/hr biom (76513) | $92.91 | $168.92 | 0.9× |
| Oph US Dx B-Scan&Quan a-Scan Sm Pt Enctr (76510) range across 3 matching MRF lines |
$180.95–$271.43 | $329–$493.50 | varies |
| Ophthalmic Biometry US Echograpy a-Scan (76516) | $139.72 | $254.03 | 1.3× |
| Ophthalmic ultrasound dx b-scan w/wo a-scan (76512) range across 7 matching MRF lines |
$97.90–$195.80 | $178–$356 | varies |
| Ophthalmic US Dx Corneal Pachymetry Uni/Bi (76514) | $57.75 | $105 | 2.0× |
| Optic foramina (70190) | $104.80 | $190.55 | 1.2× |
| Panoramic X-ray of jaws (70355) range across 2 matching MRF lines |
$35.75–$38.67 | $65–$70.30 | varies |
| Parathyroid imaging w/tomographic spect & CT (78072) | $916.30 | $1,666 | 1.7× |
| Parathyroid planar imaging w/wo subtraction (78071) | $570.35 | $1,037 | 1.4× |
| Pelvis 1 or 2 views (72170) range across 2 matching MRF lines |
$125.95–$129.73 | $229–$235.87 | varies |
| Perineogram (74775) | $107.64 | $195.70 | 0.5× |
| Pet Image Skull-Thigh (78812) | $1,889.80 | $3,436 | 1.3× |
| Pet Image W/Ct Lmtd (78814) | $2,585.69 | $4,701.25 | 1.8× |
| PET image w/CT, full body (78816) | $3,216.81 | $5,848.75 | 2.3× |
| PET imaging CT attenuation skull base mid-thigh (78815) | $2,861.10 | $5,202 | 2.0× |
| Pet Imaging Limited Area Chest Head/Neck (78811) | $1,667.60 | $3,032 | 1.3× |
| Pet Myocardial Sngl Study (78491) | $1,717.63 | $3,122.96 | 1.2× |
| Prq Transhepatc Portograpy Hemodyn Eval Rs&I (75885) | $2,618.93 | $4,761.69 | 0.8× |
| Pulmonary Perfusion Imaging Particulate (78580) | $521.13 | $947.50 | 1.3× |
| Radex Abd Compl Aqt Abd W/S/E/D Views 1 View Ch (74022) | $200.20 | $364 | 1.9× |
| Radex abscess/fistula/sinus tract rs&i (76080) range across 2 matching MRF lines |
$267.30–$275.32 | $486–$500.58 | varies |
| Radex Ankle Complete Minimum 3 Views (73610) range across 4 matching MRF lines |
$130.90–$261.80 | $238–$476 | varies |
| Radex Calcaneus Minimum 2 Views (73650) range across 3 matching MRF lines |
$86.63–$173.25 | $157.50–$315 | varies |
| Radex elbow complete minimum 3 views (73080) range across 2 matching MRF lines |
$160.38–$200.75 | $291.60–$365 | varies |
| Radex Facial Bones Complete Minimum 3 Views (70150) | $173.80 | $316 | 1.7× |
| Radex fingr minimum 2 views (73140) | $114.84 | $208.80 | 1.3× |
| Radex foot complete minimum 3 views (73630) range across 2 matching MRF lines |
$121–$242 | $220–$440 | varies |
| Radex Hand Minimum 3 Views (73130) range across 3 matching MRF lines |
$124.30–$248.60 | $226–$452 | varies |
| Radex lower extremity infant minimum 2 views (73592) range across 3 matching MRF lines |
$139.56–$159.50 | $253.75–$290 | varies |
| Radex Mastoids Compl Minimum 3 Views PR Side (70130) | $135.96 | $247.20 | 1.3× |
| Radex Nasal Bones Complete Minimum 3 Views (70160) range across 2 matching MRF lines |
$101.20–$104.24 | $184–$189.52 | varies |
| Radex Ribs Unilateral 2 Views (71100) | $147.40 | $268 | 1.7× |
| Radex shoulder complete minimum 2 views (73030) range across 3 matching MRF lines |
$134.75–$201.30 | $245–$366 | varies |
| Radex Sinuses Paransl < 3 Views (70210) | $116.60 | $212 | 1.4× |
| Radex sm int w/mlt srl imges via enteroclss tube (74251) | $250.53 | $455.50 | 1.4× |
| Radex Spine 1 View Specify Level (72020) range across 4 matching MRF lines |
$100.46–$104.24 | $182.65–$189.52 | varies |
| Radex Sternum Minimum 2 Views (71120) | $171.19 | $311.25 | 2.0× |
| Radex Temporomandble Jt Opn & Clsd Mouth Bilat (70330) | $217.25 | $395 | 2.5× |
| Radex Toe Minimum 2 Views (73660) range across 2 matching MRF lines |
$120.12–$150.15 | $218.40–$273 | varies |
| Radex upper extremity infant minimum 2 views (73092) range across 3 matching MRF lines |
$111.65–$159.50 | $203–$290 | varies |
| Radex Wrist Complete Minimum 3 Views (73110) range across 2 matching MRF lines |
$143.88–$287.76 | $261.60–$523.20 | varies |
| Radex X-Ray Exam Entire Spi 6/> Vw - Xr Entire Spine 6+ Vw (72084) | $146.30 | $266 | 1.4× |
| Radiation Delivery Stereotactic Cranial Linear (77372) range across 2 matching MRF lines |
$8,010.20–$8,250.51 | $14,564–$15,000.92 | varies |
| Radiation treatment delivery level 1 (77402) | $241.36 | $438.84 | 2.4× |
| Radiation treatment delivery level 2 (77407) | $106.47 | $193.59 | 0.3× |
| Radiation treatment delivery level 3 (77412) range across 2 matching MRF lines |
$178.20–$183.55 | $324–$333.72 | varies |
| Radiolog exam mandible compl minimum 4 views (70110) | $225.50 | $410 | 2.2× |
| Radiologic Exam Abdomen 3+ Views - Xr Abdomen 3+ Views (74021) | $178.06 | $323.75 | 1.7× |
| Radiologic exam colon double contrast study (74280) | $442.06 | $803.75 | 2.5× |
| Radiologic exam colon single contrast study (74270) | $349.25 | $635 | 2.0× |
| Radiologic Exam Esophagus Double Contrast Study (74221) | $250.53 | $455.50 | 1.4× |
| Radiologic exam knee complete 4/more views (73564) range across 2 matching MRF lines |
$213.84–$427.68 | $388.80–$777.60 | varies |
| Radiologic exam pelvis compl minimum 3 views (72190) | $154 | $280 | 1.5× |
| Radiologic Exam Small Int Single Contrast Study (74250) | $255.75 | $465 | 1.5× |
| Radiologic exam swallow function contrast study (74230) | $262.90 | $478 | 1.5× |
| Radiologic Exam Teeth Prtl Exam < Full Mouth (70310) | $104.09 | $189.26 | 0.4× |
| Radiologic exam upr gi trc double contrast study (74246) | $287.65 | $523 | 1.7× |
| Radiologic examination femur 1 view (73551) | $166.38 | $302.50 | 1.9× |
| Radiologic examination femur minimum 2 views (73552) range across 2 matching MRF lines |
$166.38–$199.65 | $302.50–$363 | varies |
| Radiologic examination knee 1/2 views (73560) range across 2 matching MRF lines |
$130.02–$260.04 | $236.40–$472.80 | varies |
| Radiologic Examination Osseous Survey Limited (77074) | $145.20 | $264 | 1.4× |
| Radiologic Examination Salivary Gland Calculus (70380) | $114.95 | $209 | 1.3× |
| Radiologic examination tibia & fibula 2 views (73590) range across 3 matching MRF lines |
$145.20–$363 | $264–$660 | varies |
| Radiopharmaceutical therapy, by intracavitary administration Non-Facility (79200) | $554.40 | $1,008 | 2.4× |
| Renal Cyst Study (74470) | $190.34 | $346.08 | 0.4× |
| Ribs bilateral 3 views (71110) | $151.25 | $275 | 1.5× |
| Rp loclzj tum plnr 1 area single day imaging (78800) | $305.49 | $555.43 | 0.8× |
| Rp loclzj tum plnr 2+area 1+d img/1 area img>2+d (78801) | $356.47 | $648.13 | 0.9× |
| Rp Loclzj Tum Plnr Whole Body 2+ Days Imaging (78804) range across 2 matching MRF lines |
$697.95–$718.89 | $1,269–$1,307.07 | varies |
| Rp Loclzj Tum Plnr Whole Body Single Day Imaging (78802) range across 2 matching MRF lines |
$1,183.05–$1,218.54 | $2,151–$2,215.53 | varies |
| Rp Loclzj Tum Spect 1 Area Single Day Imaging (78803) range across 2 matching MRF lines |
$742.50–$764.78 | $1,350–$1,390.50 | varies |
| Rp loclzj tum spect 2 area/sep acquisj img (78831) | $1,749.07 | $3,180.12 | 1.4× |
| Rp loclzj tum spect CT 2area 1d img/1 ar img>2+d (78832) | $1,984.13 | $3,607.50 | 1.4× |
| Rp loclzj tum spect w/CT 1 area/acquisj 1day img (78830) | $1,749.07 | $3,180.12 | 1.4× |
| Rp Ther Radiolbld Monoclonal Antibody IV Infus (79403) | $527.45 | $959 | 2.3× |
| Rp Therapy Intravenous Administration (79101) | $422.13 | $767.50 | 1.8× |
| Salivary Gland Function Study (78232) | $254.36 | $462.47 | 0.6× |
| Salivary Gland Imaging (78230) | $217.54 | $395.52 | 0.5× |
| Salivary Gland Imaging Serial Images (78231) | $217.54 | $395.52 | 0.5× |
| Scapula (73010) range across 2 matching MRF lines |
$173.94–$209 | $316.25–$380 | varies |
| Screening Digital Breast Tomosynthesis Bi (77063) range across 4 matching MRF lines |
$34.65–$71.38 | $63–$129.78 | varies |
| Sella turcica (70240) | $112.17 | $203.94 | 1.3× |
| Shoulder 1 view (73020) range across 3 matching MRF lines |
$107.80–$161.70 | $196–$294 | varies |
| Shoulder Arthrography (73040) | $346.70 | $630.36 | 1.0× |
| Sialogram (70390) | $303.08 | $551.05 | 1.3× |
| Skull less than 4 views (70250) | $140.25 | $255 | 1.4× |
| Special dosimetry (77331) range across 2 matching MRF lines |
$202.40–$4,048 | $368–$7,360 | varies |
| Special Physics Consult (77370) | $339.90 | $618 | 2.6× |
| Special teletherapy port plan (77321) | $435.64 | $792.07 | 1.2× |
| Special treatment procedure (77470) | $1,450.90 | $2,638 | 2.7× |
| Speech evaluation, complex (70371) | $296.85 | $539.72 | 1.3× |
| Stereotactic Body Radiation Delivery (77373) range across 4 matching MRF lines |
$1,107.70–$3,846.70 | $2,014–$6,994 | varies |
| Sternoclavicular joints (71130) | $120.45 | $219 | 1.4× |
| Superior sagittal sinus venogram (75870) | $662.49 | $1,204.52 | 0.2× |
| Surface Applic Low Dose Rate Radionuclide Source (77789) | $80.44 | $146.26 | 0.8× |
| Tbs technical calculation only (77091) | $113.85 | $207 | 1.3× |
| Telethx isodose pln cplx w/basic dosimetry (77307) | $653.40 | $1,188 | 1.8× |
| Telethx isodose pln smpl w/dosimetry calculation (77306) | $290.61 | $528.39 | 0.8× |
| Ther Rad Simulaj-Aided Field Setting Complex (77290) | $1,108.80 | $2,016 | 3.0× |
| Ther Rad Simulaj-Aided Field Setting Intermed (77285) | $853.60 | $1,552 | 2.3× |
| Ther rad simulaj-aided field setting simple (77280) | $590.70 | $1,074 | 4.4× |
| Therapeutic Enema Rdctj Intussusception/Obstrcj (74283) | $279.95 | $509 | 1.6× |
| Thoracic spine 2 views (72070) | $138.05 | $251 | 1.3× |
| Thoracic spine 3 views (72072) | $174.90 | $318 | 1.7× |
| Thoracolumbar 2 views (72080) range across 3 matching MRF lines |
$101.20–$104.24 | $184–$189.52 | varies |
| Thyroid Carcinoma Metastases Img Lmtd Area (78015) | $186.95 | $339.90 | 0.5× |
| Thyroid Imaging With Vascular Flow (78013) | $217.54 | $395.52 | 0.5× |
| Thyroid Met Imaging Body (78018) range across 2 matching MRF lines |
$534.60–$550.64 | $972–$1,001.16 | varies |
| Thyroid Uptake Measurement (78012) | $243.03 | $441.87 | 0.6× |
| Thyroid Uptake W/Blood Flow Sngle/Mult Quan Meas (78014) | $525.80 | $956 | 1.3× |
| Tx Devices Design & Construction Complex (77334) | $541.20 | $984 | 1.5× |
| Tx devices design & construction intermediate (77333) | $272.25 | $495 | 2.0× |
| Tx devices design & construction simple (77332) | $246.95 | $449 | 1.9× |
| Ultrasound Breast Limited (76642) range across 2 matching MRF lines |
$173.58–$347.16 | $315.60–$631.20 | varies |
| Ultrasound elastography first target lesion (76982) | $154.10 | $280.18 | 1.5× |
| Ultrasound Elastography Parenchyma (76981) | $154.10 | $280.18 | 1.5× |
| Ultrasound Exam Aaa Screen (76706) | $155 | $281.82 | 1.5× |
| Ultrasound, abdomen limited (76705) range across 2 matching MRF lines |
$268.40–$536.80 | $488–$976 | varies |
| Umbilical-artery Doppler (OB) (76820) range across 2 matching MRF lines |
$103.13–$106.22 | $187.50–$193.13 | varies |
| Unlisted Dx Radiographic Procedure (76499) range across 3 matching MRF lines |
$85.42–$127.05 | $155.30–$231 | varies |
| Unlisted fluoroscopic procedure (76496) | $128.70 | $234 | 1.5× |
| Unlisted magnetic resonance procedure (76498) | $1,296.35 | $2,357 | 15.0× |
| Unlisted Procedure Clinical Brachytherapy (77799) range across 2 matching MRF lines |
$284.90–$555.50 | $518–$1,010 | varies |
| Unlisted us procedure (76999) | $214.71 | $390.38 | 2.5× |
| Upper gi w/o kub (74240) | $314.19 | $571.25 | 1.8× |
| Urea Breath Test C-14 Isotopic Acquisj Analysis (78267) | $107.64 | $195.70 | 9.7× |
| Urea breath test c-14 isotopic analysis (78268) | $255.20 | $464 | 2.7× |
| Ureteral Reflux Study (78740) | $199.97 | $363.59 | 0.5× |
| Urethrocystogram voiding (74455) range across 2 matching MRF lines |
$292.19–$300.95 | $531.25–$547.19 | varies |
| Urethrocystography retrograde (74450) range across 2 matching MRF lines |
$167.43–$172.45 | $304.42–$313.55 | varies |
| Us breast unilateral complete (76641) range across 3 matching MRF lines |
$180.81–$361.63 | $328.75–$657.50 | varies |
| Us chest (76604) | $211.20 | $384 | 2.0× |
| Us complete joint (76881) range across 3 matching MRF lines |
$304.15–$608.30 | $553–$1,106 | varies |
| Us exam, pelvic, limited (76857) | $139.70 | $254 | 1.3× |
| Us head (76506) | $226.05 | $411 | 2.2× |
| Us kidney transplant (76776) | $301.94 | $548.98 | 2.9× |
| Us lmtd joint/oth nonvasc xtr strux r-t w/img (76882) range across 3 matching MRF lines |
$198–$396 | $360–$720 | varies |
| Us ob detailed single fetus (76811) | $458.04 | $832.80 | 1.9× |
| Us ob limited 1 or more fetuses (76815) | $246.18 | $447.60 | 2.4× |
| Us ob transvaginal (76817) | $220.78 | $401.42 | 2.1× |
| Us pelvic non ob complete (76856) | $221.10 | $402 | 2.1× |
| Us pg uter img f&mat 14 wk tabdl 1/1st gestation (76801) | $253.13 | $460.24 | 2.4× |
| Us preg uterus real time f/u trnsabdl per fetus (76816) | $219.31 | $398.75 | 2.1× |
| Us retroperitoneal complete (76770) | $293.70 | $534 | 2.8× |
| Us retroperitoneal limited (76775) | $273.90 | $498 | 2.6× |
| Us scrotum and contents (76870) range across 2 matching MRF lines |
$258.50–$310.20 | $470–$564 | varies |
| Us spinal canal and contents (76800) | $261.80 | $476 | 2.5× |
| Us thyroid (76536) | $287.76 | $523.20 | 2.8× |
| Us transrectal (76872) range across 2 matching MRF lines |
$440.88–$1,347.06 | $801.60–$2,449.20 | varies |
| Vein X-Ray Chest (75827) range across 2 matching MRF lines |
$964.56–$993.50 | $1,753.75–$1,806.36 | varies |
| Vein X-Ray Liver W/O Hemodyn (75887) | $970.76 | $1,765.01 | 0.3× |
| Vein X-Ray Skull Epidural (75872) | $823.01 | $1,496.38 | 1.3× |
| Vein X-Ray Spleen/Liver (75810) | $1,136.12 | $2,065.67 | 0.4× |
| Venogram Sinus/Jugular (75860) range across 2 matching MRF lines |
$3,178.31–$3,273.66 | $5,778.75–$5,952.11 | varies |
| Venography Adrenal Unilateral (75840) | $1,135.52 | $2,064.58 | 0.4× |
| Venography caval inferior serialography rs&i (75825) range across 2 matching MRF lines |
$3,178.31–$3,273.66 | $5,778.75–$5,952.11 | varies |
| Venography extremity bilateral rs&i (75822) range across 2 matching MRF lines |
$1,052.70–$1,084.28 | $1,914–$1,971.42 | varies |
| Venography extremity unilateral rs&i (75820) range across 4 matching MRF lines |
$404.25–$437.20 | $735–$794.90 | varies |
| Venography Orbital Rs&I (75880) | $514.38 | $935.24 | 0.8× |
| Venography Renal Bilateral (75833) | $1,192.63 | $2,168.41 | 0.4× |
| Venography Renal Unilateral (75831) range across 2 matching MRF lines |
$2,542.65–$2,618.93 | $4,623–$4,761.69 | varies |
| Venous sampling by catheter (75893) | $4,338.82 | $7,888.77 | 0.8× |
| Wrist 2 views (73100) | $120.78 | $219.60 | 1.4× |
| X-Ray Ac Jts - Xr Acromioclavicular Joints Bilateral (73050) | $186.31 | $338.75 | 2.2× |
| X-ray antegrade pyelogram tube (74425) range across 2 matching MRF lines |
$281.84–$321.77 | $512.43–$585.04 | varies |
| X-Ray Aorta Leg Arteries (75630) range across 3 matching MRF lines |
$1,796.08–$3,339.05 | $3,265.60–$6,071 | varies |
| X-Ray Bend Only L-S Spine (72120) | $135.96 | $247.20 | 1.3× |
| X-Ray Elbow 2 Vw - Xr Elbow 1-2 Views Right (73070) | $118.14 | $214.80 | 1.4× |
| X-Ray Exam Breast Specimen (76098) range across 5 matching MRF lines |
$616.78–$1,796.44 | $1,121.41–$3,266.25 | varies |
| X-Ray Exam Entire Spi 1 Vw (72081) range across 2 matching MRF lines |
$72.08–$74.24 | $131.05–$134.98 | varies |
| X-Ray Exam Entire Spi 2/3 Vw (72082) | $182.88 | $332.50 | 1.8× |
| X-Ray Exam Entire Spi 4/5 Vw (72083) | $182.88 | $332.50 | 1.8× |
| X-Ray Exam Hip Uni 1 View (73501) | $130.63 | $237.50 | 1.5× |
| X-Ray Exam Hip Uni 2-3 Views (73502) | $180.81 | $328.75 | 2.1× |
| X-Ray Exam Hip Uni 4/> Views (73503) | $180.81 | $328.75 | 1.7× |
| X-Ray Exam Hips Bi 2 Views (73521) | $144.65 | $263 | 1.4× |
| X-Ray Exam Hips Bi 3-4 Views (73522) range across 2 matching MRF lines |
$108.49–$111.74 | $197.25–$203.17 | varies |
| X-Ray Exam Hips Bi 5/> Views (73523) | $180.81 | $328.75 | 1.7× |
| X-Ray Exam L-S Spine Bending (72114) | $225.50 | $410 | 2.2× |
| X-Ray Exam Neck Spine 2-3 Vw (72040) | $142.45 | $259 | 1.7× |
| X-Ray Exam Neck Spine 6/>Vws (72052) | $256.85 | $467 | 2.5× |
| X-Ray Exam Unilat Ribs/Chest (71101) | $232.65 | $423 | 2.2× |
| X-ray eye for foreign body (70030) | $130.35 | $237 | 1.5× |
| X-ray humerus (73060) | $153.31 | $278.75 | 1.8× |
| X-ray IV pyelogram (ivp) (74400) | $320.65 | $583 | 1.8× |
| X-Ray Jaw <4 Vw - Xr Mandible < 4 Views (70100) | $155.10 | $282 | 1.8× |
| X-Ray Knee Bilat Standing - Xr Knees Anteroposterior Standing Bilat (73565) | $114.40 | $208 | 1.3× |
| X-Ray Lumbar Spine 2/3 Vw - Xr Lumbar Spine 2-3 Views (72100) | $166.65 | $303 | 1.6× |
| X-Ray Ribs, Chest 4+ Vw - Xr Ribs 3 Vws Bil W/ Chest Posteroanterior (71111) | $326.15 | $593 | 3.2× |
| X-Ray Sacroiliac Jts 3+ Vw - Xr Sacroiliac Joints 3+ Views (72202) | $169.95 | $309 | 1.6× |
| X-Ray Sacroiliac Jts <3 Vw - Xr Sacroiliac Joints 1-2 Views (72200) | $104.24 | $189.52 | 1.0× |
| X-Ray Sacrum/Coccyx 2+ Vw - Xr Sacrum Coccyx 2+ Views (72220) | $180.81 | $328.75 | 2.1× |
| X-Ray Sinuses 3+ Vw - Xr Paranasal Sinuses 3+ Views (70220) | $204.05 | $371 | 2.4× |
| X-Ray Skull 4+ Vw - Xr Skull Complete 4+ Views (70260) | $148.50 | $270 | 1.4× |
| X-ray thoracic spine 4 vw (72074) | $211.75 | $385 | 2.0× |
| X-Ray Tmj Unilat (70328) | $133.65 | $243 | 1.6× |
| X-Ray Urinary Tract Exam With Contrast Material (74420) | $242.46 | $440.84 | 0.7× |
| X-Rays Bone Length Studies (77073) | $157.44 | $286.25 | 1.5× |
| X-Rays Bone Survey Complete (77075) | $265.10 | $482 | 2.6× |
| Xr c-spine 4 or 5 views (72050) | $211.75 | $385 | 2.0× |
| Xr facial bones less than 3 views (70140) | $137.50 | $250 | 1.6× |
| XR Mastoids < 3 Views Bilateral (70120) | $120.66 | $219.39 | 1.2× |
| Xr myelogram posterior fossa (70010) | $461.45 | $839 | 1.3× |
| Xr orbits complete 4 views (70200) | $148.50 | $270 | 1.4× |
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.