Imaging prices at Wellstar Douglas Medical Center
Douglasville, GA · every code in this section with a posted price and a Medicare benchmark.
484 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) | $4,672.59 | $11,981 | 3.4× |
| Abdomen 1 View (74018) range across 2 matching MRF lines |
$25.35–$285.09 | $65–$731 | varies |
| Abdomen 2 views (74019) range across 2 matching MRF lines |
$25.35–$303.81 | $65–$779 | varies |
| Acute Gastrointestinal Blood Loss Imaging (78278) | $860.34 | $2,206 | 2.1× |
| Acute venous thrombosis imaging, peptide Non-Facility (78456) | $492.57 | $1,263 | 0.4× |
| Adrenal Cortex & Medulla Img (78075) | $710.19 | $1,821 | 0.5× |
| Angio internal mammary (75756) | $2,137.59 | $5,481 | 0.7× |
| Angio pulmonary bilat (75743) | $3,392.61 | $8,699 | 1.1× |
| Angiography Adrenal Bilateral Slctv Rs&I (75733) | $2,600.91 | $6,669 | 0.8× |
| Angiography extremity bilateral rs&i (75716) | $2,554.50 | $6,550 | 0.8× |
| Angiography extremity unilateral rs&i (75710) | $1,971.06 | $5,054 | 0.6× |
| Angiography pulmonary unilateral slctv rs&i (75741) | $2,921.88 | $7,492 | 0.9× |
| Angrph pulmonary nonslctv cath/ven njx rs&i (75746) | $2,138.37 | $5,483 | 0.7× |
| Ankle 2 views (73600) range across 2 matching MRF lines |
$25.35–$197.73 | $65–$507 | varies |
| Aortography thoracic serialography rs&i (75605) | $2,944.11 | $7,549 | 0.5× |
| Aortography thoracic w/o serialography rs&i (75600) | $2,142.66 | $5,494 | 0.7× |
| Artery X-Rays Abdomen (75726) | $2,944.11 | $7,549 | 0.5× |
| Artery X-Rays Adrenal Gland (75731) | $2,464.41 | $6,319 | 0.8× |
| Artery X-Rays Pelvis (75736) | $2,944.11 | $7,549 | 0.5× |
| Artery X-Rays Spine (75705) | $2,944.11 | $7,549 | 0.5× |
| Arthrogram ankle (73615) range across 2 matching MRF lines |
$163.80–$263.25 | $420–$675 | varies |
| Arthrogram hip (73525) range across 2 matching MRF lines |
$163.80–$578.76 | $420–$1,484 | varies |
| Arthrogram Wrist (73115) range across 2 matching MRF lines |
$163.80–$242.97 | $420–$623 | varies |
| Basic radiation dosimetry calculation (77300) | $397.02 | $1,018 | 2.9× |
| Bone age studies (77072) range across 2 matching MRF lines |
$25.35–$218.40 | $65–$560 | varies |
| Bone Imaging 3 Phase (78315) range across 2 matching MRF lines |
$175.50–$1,099.02 | $450–$2,818 | varies |
| Bone Imaging Limited Area (78300) range across 2 matching MRF lines |
$175.50–$732.03 | $450–$1,877 | varies |
| Bone Imaging Multiple Areas (78305) range across 2 matching MRF lines |
$175.50–$909.48 | $450–$2,332 | varies |
| Bone Imaging Whole Body (78306) range across 2 matching MRF lines |
$175.50–$1,087.32 | $450–$2,788 | varies |
| Bone marrow imaging limited area (78102) | $591.63 | $1,517 | 1.5× |
| Bone marrow imaging; multiple areas (78103) | $610.74 | $1,566 | 1.5× |
| Bone marrow imaging; whole body (78104) | $641.94 | $1,646 | 1.6× |
| Bone survey infant (77076) range across 2 matching MRF lines |
$46.80–$559.26 | $120–$1,434 | varies |
| Brachytx isodose complex (77318) | $1,884.87 | $4,833 | 5.0× |
| Brachytx isodose intermed (77317) | $829.14 | $2,126 | 2.2× |
| Brachytx Isodose Plan Simple (77316) | $1,324.83 | $3,397 | 3.5× |
| Brain Flow Imaging Only (78610) | $187.20 | $480 | 0.3× |
| Brain Image W/Flow < 4 Views (78601) | $714.87 | $1,833 | 1.8× |
| Brain imaging < 4 static views (78600) | $262.08 | $672 | 0.7× |
| Brain Imaging Min 4 Static Views W Vascular Flow (78606) | $1,186.77 | $3,043 | 2.2× |
| Brain Imaging Minimum 4 Static Views (78605) | $1,061.19 | $2,721 | 1.9× |
| Brain Imaging Pet Metabolic Evaluation (78608) range across 4 matching MRF lines |
$939.90–$3,234.27 | $2,410–$8,293 | varies |
| Card Bl Pool Gated Spect Rest Wal Motn Ejct Frct (78494) | $497.25 | $1,275 | 1.2× |
| Cardiac MRI w/w/o contrast & further seq (75561) range across 2 matching MRF lines |
$419.25–$1,604.46 | $1,075–$4,114 | varies |
| Cardiac MRI w/w/o contrast w/stress (75563) | $1,927.38 | $4,942 | 2.4× |
| Cardiac Shunt Detection (78428) | $696.15 | $1,785 | 1.7× |
| Cat Scan Follow-Up Study (76380) range across 2 matching MRF lines |
$107.25–$831.87 | $275–$2,133 | varies |
| Cerebrospinal Fluid Flow W/O Matl Shunt Evaltj (78645) | $333.84 | $856 | 0.6× |
| Cerebrospinal fluid flow, imaging (not including introduction of material); ventriculography Non-Facility (78635) | $714.87 | $1,833 | 1.3× |
| Cerebrospinal Fluid Scan (78630) | $450.84 | $1,156 | 0.8× |
| Chest 1 view (71045) range across 2 matching MRF lines |
$25.35–$252.72 | $65–$648 | varies |
| Chest 2 views (71046) range across 2 matching MRF lines |
$25.35–$294.06 | $65–$754 | varies |
| Chest 3 views (71047) range across 2 matching MRF lines |
$25.35–$316.68 | $65–$812 | varies |
| Chest 4 or more views (71048) range across 2 matching MRF lines |
$25.35–$385.71 | $65–$989 | varies |
| Cholecystography Oral Contrast (74290) | $350.22 | $898 | 2.0× |
| Cineradiograpy/vidradiograpy xcpt where spec (76120) | $136.50 | $350 | 1.3× |
| Cisternography Positive Contrast Rs&I (70015) | $390.78 | $1,002 | 0.5× |
| Clavicle complete (73000) range across 2 matching MRF lines |
$25.35–$241.80 | $65–$620 | varies |
| Computed Tomography Thorax Lw Dose Lng Ca Scr C- (71271) range across 6 matching MRF lines |
$87.75–$331.50 | $225–$850 | varies |
| Continuing medical physics consltj pr wk (77336) | $489.84 | $1,256 | 3.6× |
| Contrast Exam Abdominl Aorta (75625) | $2,496 | $6,400 | 0.8× |
| Contrast X-Ray Bladder (74430) range across 2 matching MRF lines |
$163.80–$256.62 | $420–$658 | varies |
| Contrast X-Ray Of Elbow (73085) range across 2 matching MRF lines |
$163.80–$359.97 | $420–$923 | varies |
| Contrast X-Ray Of Knee Joint (73580) range across 2 matching MRF lines |
$163.80–$276.90 | $420–$710 | varies |
| Corpora cavernosography (74445) | $171.99 | $441 | 1.6× |
| CT abdomen and pelvis without and with contrast (74178) range across 2 matching MRF lines |
$365.82–$3,133.65 | $938–$8,035 | varies |
| CT abdomen and pelvis without contrast (74176) range across 2 matching MRF lines |
$161.07–$2,224.17 | $413–$5,703 | varies |
| CT abdomen w contrast (74160) range across 2 matching MRF lines |
$136.50–$1,683.63 | $350–$4,317 | varies |
| CT abdomen w wo contrast (74170) range across 2 matching MRF lines |
$243.75–$1,888.77 | $625–$4,843 | varies |
| CT abdomen w/o contrast (74150) range across 2 matching MRF lines |
$107.25–$1,358.76 | $275–$3,484 | varies |
| CT Angio Abdomen and Pelvis (74174) range across 2 matching MRF lines |
$365.82–$2,770.56 | $938–$7,104 | varies |
| CT Angio Chest (71275) range across 2 matching MRF lines |
$175.50–$1,347.84 | $450–$3,456 | varies |
| CT Angio Head (70496) range across 2 matching MRF lines |
$175.50–$2,136.42 | $450–$5,478 | varies |
| CT angio hrt w/3d image (75574) range across 2 matching MRF lines |
$243.75–$1,403.61 | $625–$3,599 | varies |
| Ct Angio Lwr Extr W/O&W/Dye (73706) range across 2 matching MRF lines |
$175.50–$1,760.46 | $450–$4,514 | varies |
| CT Angio Neck (70498) range across 2 matching MRF lines |
$175.50–$1,769.43 | $450–$4,537 | varies |
| Ct Angio Upr Extrm W/O&W/Dye (73206) range across 2 matching MRF lines |
$175.50–$1,380.60 | $450–$3,540 | varies |
| CT cervical spine w/ contrast (72126) range across 2 matching MRF lines |
$136.50–$1,685.58 | $350–$4,322 | varies |
| CT cervical spine w/o contrast (72125) range across 2 matching MRF lines |
$107.25–$1,598.22 | $275–$4,098 | varies |
| CT cervical spine w/wo cont (72127) range across 2 matching MRF lines |
$243.75–$1,728.48 | $625–$4,432 | varies |
| CT chest w contrast (71260) range across 2 matching MRF lines |
$136.50–$1,562.34 | $350–$4,006 | varies |
| CT chest w/wo contrast (71270) range across 2 matching MRF lines |
$243.75–$1,918.02 | $625–$4,918 | varies |
| CT head/brain with contrast (70460) range across 2 matching MRF lines |
$136.50–$1,587.69 | $350–$4,071 | varies |
| CT head/brain without and with contrast (70470) range across 2 matching MRF lines |
$243.75–$1,881.36 | $625–$4,824 | varies |
| CT heart contrast eval cardiac structure&morph (75572) range across 2 matching MRF lines |
$243.75–$2,075.58 | $625–$5,322 | varies |
| CT heart no contrast quant eval coronry calcium (75571) range across 6 matching MRF lines |
$29.06–$1,665.30 | $74.50–$4,270 | varies |
| CT hrt w/3d image congen (75573) range across 2 matching MRF lines |
$175.50–$1,769.43 | $450–$4,537 | varies |
| CT iac w contrast (70481) range across 2 matching MRF lines |
$136.50–$1,551.42 | $350–$3,978 | varies |
| CT l-spine w&w/o contrast (72133) range across 2 matching MRF lines |
$243.75–$1,958.19 | $625–$5,021 | varies |
| CT lower ext w/o (73700) range across 2 matching MRF lines |
$107.25–$1,167.27 | $275–$2,993 | varies |
| CT lower extremity w/contrast material (73701) range across 2 matching MRF lines |
$136.50–$1,269.45 | $350–$3,255 | varies |
| CT lumbar spine w contrast (72132) range across 2 matching MRF lines |
$136.50–$1,705.08 | $350–$4,372 | varies |
| CT lumbar spine w/o contrast (72131) range across 2 matching MRF lines |
$107.25–$1,610.70 | $275–$4,130 | varies |
| CT maxillofacial w contrast (70487) range across 2 matching MRF lines |
$136.50–$1,473.03 | $350–$3,777 | varies |
| CT maxillofacial wo contrast (70486) range across 2 matching MRF lines |
$107.25–$1,319.37 | $275–$3,383 | varies |
| CT neck tissue combo (70492) range across 2 matching MRF lines |
$243.75–$1,959.75 | $625–$5,025 | varies |
| Ct Orbit/Ear/Fossa W/O&W/Dye (70482) range across 2 matching MRF lines |
$243.75–$1,686.75 | $625–$4,325 | varies |
| CT orbits w/o contrast (70480) range across 2 matching MRF lines |
$107.25–$1,385.28 | $275–$3,552 | varies |
| CT pelvis w&w/o contrast (72194) range across 2 matching MRF lines |
$243.75–$1,872 | $625–$4,800 | varies |
| CT pelvis w/o contrast (72192) range across 2 matching MRF lines |
$107.25–$1,310.40 | $275–$3,360 | varies |
| CT scan of leg combo (73702) range across 2 matching MRF lines |
$243.75–$1,419.21 | $625–$3,639 | varies |
| CT scans face/jaw combo (70488) range across 2 matching MRF lines |
$243.75–$1,610.70 | $625–$4,130 | varies |
| CT soft tissue neck w contrast (70491) range across 2 matching MRF lines |
$136.50–$1,677.39 | $350–$4,301 | varies |
| CT soft tissue neck w/o contrast (70490) range across 2 matching MRF lines |
$107.25–$1,453.14 | $275–$3,726 | varies |
| CT thoracic spine w contrast (72129) range across 2 matching MRF lines |
$136.50–$1,748.37 | $350–$4,483 | varies |
| CT thoracic spine w/o contrast (72128) range across 2 matching MRF lines |
$107.25–$1,577.16 | $275–$4,044 | varies |
| CT thoracic spine w/wo cont (72130) range across 2 matching MRF lines |
$243.75–$2,033.46 | $625–$5,214 | varies |
| CT thorax w/o contrast (71250) range across 2 matching MRF lines |
$107.25–$1,540.50 | $275–$3,950 | varies |
| CT upper ext wo (73200) range across 2 matching MRF lines |
$107.25–$1,150.11 | $275–$2,949 | varies |
| CT upper extremity w/o & w/contrast material (73202) range across 2 matching MRF lines |
$243.75–$1,382.16 | $625–$3,544 | varies |
| CT upper extremity with contrast (73201) range across 2 matching MRF lines |
$136.50–$1,268.28 | $350–$3,252 | varies |
| Cta Abdl Aorta&Bi Iliofem W/Contrast&Postp (75635) range across 2 matching MRF lines |
$365.82–$3,444.87 | $938–$8,833 | varies |
| Cta Abdomen (74175) range across 2 matching MRF lines |
$175.50–$2,050.23 | $450–$5,257 | varies |
| CTA pelvis (72191) range across 2 matching MRF lines |
$175.50–$1,775.28 | $450–$4,552 | varies |
| Dacryocystography, nasolacrimal duct, radiological supervision and interpretation Non-Facility (70170) | $572.91 | $1,469 | 2.4× |
| Dilation ureters/urethra rs&i (74485) | $821.73 | $2,107 | 0.4× |
| Discography Cerv/Thor Spine (72285) | $1,921.92 | $4,928 | 1.0× |
| Diskography lumbar (72295) | $667.29 | $1,711 | 0.3× |
| Doppler Echo Fetal Puls Spectral F/U/Repeat (76828) range across 2 matching MRF lines |
$171.60–$423.54 | $440–$1,086 | varies |
| Doppler Echo Fetal Spectral Display Complete (76827) range across 3 matching MRF lines |
$171.60–$226.20 | $440–$580 | varies |
| Doppler Fetal Mid Cerebral Artery (76821) | $257.01 | $659 | 2.4× |
| Dxa Bone Density Axial (77080) range across 2 matching MRF lines |
$58.50–$407.94 | $150–$1,046 | varies |
| Dxa bone density study (77085) range across 2 matching MRF lines |
$58.50–$532.35 | $150–$1,365 | varies |
| Dxa bone density study 1/>sites appendiclr skel (77081) range across 2 matching MRF lines |
$58.50–$332.67 | $150–$853 | varies |
| Echo exam of fetal heart (76825) range across 3 matching MRF lines |
$171.60–$405.99 | $440–$1,041 | varies |
| Echo exam uterus (76831) | $448.50 | $1,150 | 1.9× |
| Echo Guide For Artery Repair (76936) range across 2 matching MRF lines |
$355.29–$1,939.47 | $911–$4,973 | varies |
| Echocardiography, fetal, cardiovascular system, real time with image documentation (2D), with or without M-mode… (76826) range across 2 matching MRF lines |
$171.60–$261.69 | $440–$671 | varies |
| Echograp Trans R Pros Study (76873) | $262.86 | $674 | 2.5× |
| Esophageal Motility Study (78258) | $517.92 | $1,328 | 1.3× |
| Esophagram (74220) range across 2 matching MRF lines |
$99.45–$456.30 | $255–$1,170 | varies |
| Fetal Biophys Profile W/Nst (76818) range across 2 matching MRF lines |
$97.50–$525.33 | $250–$1,347 | varies |
| Fetal Biophysical Profile W/O Non-Stress Testing (76819) range across 2 matching MRF lines |
$97.50–$505.44 | $250–$1,296 | varies |
| Fetal MRI w/placntl matrnl plvc img sing/1st ges (74712) | $132.21 | $339 | 0.6× |
| Fluoroscopy up to 1 hr (76000) range across 2 matching MRF lines |
$312.39–$489.84 | $801–$1,256 | varies |
| Follow-Up Angiography (75898) | $2,542.41 | $6,519 | 0.8× |
| Foot 2 views (73620) range across 2 matching MRF lines |
$25.35–$185.64 | $65–$476 | varies |
| Forearm 2 views (73090) range across 2 matching MRF lines |
$25.35–$238.68 | $65–$612 | varies |
| Gastric emptying imaging study (78264) range across 2 matching MRF lines |
$175.50–$982.80 | $450–$2,520 | varies |
| Gastric Emptyng Imag Std W/Sm Bwl Transit (78265) | $989.82 | $2,538 | 2.5× |
| Gastric Mucosa Imaging (78261) | $497.25 | $1,275 | 1.2× |
| Gastroesophageal Reflux Exam (78262) | $452.79 | $1,161 | 1.1× |
| Gated Heart Planar Single (78472) | $1,006.20 | $2,580 | 2.5× |
| Gated Heart, Multiple (78473) | $1,157.91 | $2,969 | 2.9× |
| Hand 2 views (73120) range across 2 matching MRF lines |
$25.35–$237.90 | $65–$610 | varies |
| Hdr Rdncl Ntrstl/Icav Brchtx (77772) | $4,184.70 | $10,730 | 6.0× |
| Hdr Rdncl Ntrstl/Icav Brchtx (77771) | $4,046.25 | $10,375 | 5.8× |
| Hdr Rdncl Ntrstl/Icav Brchtx 1 Channel (77770) | $3,781.83 | $9,697 | 5.4× |
| Heart first pass single,planar (78481) | $645.06 | $1,654 | 1.2× |
| Heart Image (Pet) Multiple (78492) range across 2 matching MRF lines |
$546–$2,712.06 | $1,400–$6,954 | varies |
| Hepatc Vngrph Wdg/Fr Hemodyn Eval Rs&I (75889) | $2,442.57 | $6,263 | 0.8× |
| Hepatc Vngrph Wdg/Fr W/O Hemodyn Eval Rs&I (75891) | $2,405.91 | $6,169 | 0.8× |
| Hepatobil Syst Image W/Drug (78227) range across 2 matching MRF lines |
$175.50–$1,078.74 | $450–$2,766 | varies |
| Hepatobiliary System Imaging (78226) range across 2 matching MRF lines |
$175.50–$1,078.74 | $450–$2,766 | varies |
| Ht Musc Image Planar Mult (78454) | $3,563.04 | $9,136 | 2.7× |
| Ht Muscle Image Spect Sing (78451) range across 3 matching MRF lines |
$234–$3,132.09 | $600–$8,031 | varies |
| Hysterosalpingogram (74740) range across 2 matching MRF lines |
$163.80–$321.36 | $420–$824 | varies |
| Infant hip ultrasound with hip movement (dynamic) (76885) range across 2 matching MRF lines |
$97.50–$556.14 | $250–$1,426 | varies |
| Infant hip ultrasound, limited static exam (76886) range across 2 matching MRF lines |
$97.50–$556.14 | $250–$1,426 | varies |
| Infusion Ivp (74410) range across 2 matching MRF lines |
$99.45–$599.82 | $255–$1,538 | varies |
| Interstitial radiation source applic complex (77778) range across 2 matching MRF lines |
$2,905.89–$3,329.04 | $7,451–$8,536 | varies |
| Intracavitary Radiation Source Applic Complex (77763) | $1,815.45 | $4,655 | 2.6× |
| Intracavitary Radiation Source Applic Intermed (77762) | $1,338.48 | $3,432 | 2.4× |
| Intracavitary radiation source applic simple (77761) | $1,338.48 | $3,432 | 2.4× |
| Intraop radiaj tx deliver electrons sngl tx sess (77425) | $9,332.31 | $23,929 | 1.3× |
| Intraop radiaj tx deliver xray single tx session (77424) | $11,887.20 | $30,480 | 1.6× |
| Joint Survey Single View (77077) | $187.20 | $480 | 1.8× |
| K Flow/Funct Image W/Drug (78708) | $870.48 | $2,232 | 1.6× |
| K Flow/Funct Image W/O Drug (78707) | $824.46 | $2,114 | 1.5× |
| Kidney Imaging Morphol (78700) | $553.80 | $1,420 | 1.4× |
| Kidney Imaging Morphoogy W/Vascular Flow (78701) | $755.43 | $1,937 | 1.9× |
| Knee 3 Views (73562) range across 2 matching MRF lines |
$25.35–$269.88 | $65–$692 | varies |
| Labeled RBC Sequestration Differntl Organ/Tissue (78140) | $1,057.68 | $2,712 | 2.6× |
| Leveen/Shunt Patency Exam (78291) | $580.71 | $1,489 | 1.4× |
| Liver & Spleen Imaging Static Only (78215) range across 2 matching MRF lines |
$175.50–$638.43 | $450–$1,637 | varies |
| Liver & Spleen Imaging W/Vascular Flow (78216) range across 2 matching MRF lines |
$175.50–$727.35 | $450–$1,865 | varies |
| Liver imaging static only (78201) | $453.96 | $1,164 | 0.8× |
| Liver imaging w/vascular flow (78202) | $904.41 | $2,319 | 1.7× |
| Lung Perf&Ventilat Diferentl (78598) | $640.38 | $1,642 | 1.2× |
| Lung perfusion differential (78597) | $1,503.06 | $3,854 | 3.7× |
| Lung Ventilat&Perfus Imaging (78582) | $1,503.06 | $3,854 | 2.8× |
| Lung Ventilation Imaging (78579) | $1,333.80 | $3,420 | 3.3× |
| Lymph System Imaging (78195) | $920.79 | $2,361 | 1.7× |
| Lymphangiography Extremity Only Bilateral Rs&I (75803) range across 2 matching MRF lines |
$229.32–$2,229.24 | $588–$5,716 | varies |
| Lymphangiography extremity only unilateral rs&i (75801) | $687.96 | $1,764 | 1.1× |
| Lymphangiography Pelvic/Abdominal Bilateral Rs&I (75807) | $1,775.28 | $4,552 | 0.6× |
| Lymphangiography, pelvic/abdominal, unilateral (75805) | $2,542.41 | $6,519 | 0.8× |
| Magnetic Image Jaw Joint (70336) range across 2 matching MRF lines |
$202.80–$1,276.08 | $520–$3,272 | varies |
| Magnetic Resonance Elastography (76391) | $684.06 | $1,754 | 2.8× |
| Mammary ductogram or galactogram multiple (77054) | $504.27 | $1,293 | 2.1× |
| Mammary ductogram or galactogram single (77053) | $450.06 | $1,154 | 1.9× |
| Meckels Divert Exam (78290) | $745.29 | $1,911 | 1.9× |
| Mlc imrt design & construction per imrt plan (77338) | $4,659.72 | $11,948 | 12.4× |
| Mra Head W/O & W/Contrast Material (70546) range across 2 matching MRF lines |
$419.25–$1,914.51 | $1,075–$4,909 | varies |
| MRA head w/o contrast (70544) range across 2 matching MRF lines |
$419.25–$1,429.35 | $1,075–$3,665 | varies |
| MRA head with contrast (70545) range across 2 matching MRF lines |
$419.25–$1,671.93 | $1,075–$4,287 | varies |
| MRA neck w contrast (70548) | $1,739.40 | $4,460 | 5.0× |
| Mra Neck W/O &W/Contrast Material (70549) range across 2 matching MRF lines |
$419.25–$1,900.47 | $1,075–$4,873 | varies |
| MRA neck w/o contrast (70547) range across 2 matching MRF lines |
$419.25–$1,374.75 | $1,075–$3,525 | varies |
| MRI abdomen w contrast (74182) range across 2 matching MRF lines |
$419.25–$2,077.14 | $1,075–$5,326 | varies |
| MRI abdomen w/o contrast (74181) range across 2 matching MRF lines |
$202.80–$1,883.70 | $520–$4,830 | varies |
| MRI any jt lower extrem w/contrast material (73722) range across 2 matching MRF lines |
$419.25–$1,900.86 | $1,075–$4,874 | varies |
| MRI any jt lower extrem w/o & w/contrast matrl (73723) range across 2 matching MRF lines |
$419.25–$2,072.46 | $1,075–$5,314 | varies |
| MRI any jt upper extremity w/contrast matrl (73222) range across 2 matching MRF lines |
$419.25–$1,743.30 | $1,075–$4,470 | varies |
| MRI bone marrow blood supply (77084) | $333.06 | $854 | 1.4× |
| MRI brain functional w/o physician admnistration (70554) range across 2 matching MRF lines |
$202.80–$1,703.91 | $520–$4,369 | varies |
| MRI brain functional w/physician admnistration (70555) | $414.18 | $1,062 | 1.7× |
| MRI Breast W/O Contrast Bilateral (77047) range across 2 matching MRF lines |
$347.10–$1,895.01 | $890–$4,859 | varies |
| MRI Breast Without Contrast Material Unilateral (77046) range across 2 matching MRF lines |
$347.10–$1,366.17 | $890–$3,503 | varies |
| MRI cardiac w/o cont stress (75559) | $1,474.98 | $3,782 | 2.7× |
| MRI cardiac w/o contrast (75557) range across 2 matching MRF lines |
$202.80–$1,479.66 | $520–$3,794 | varies |
| MRI cervical spine w contrast (72142) range across 2 matching MRF lines |
$419.25–$1,833.39 | $1,075–$4,701 | varies |
| MRI cervical spine w/o cont (72141) range across 2 matching MRF lines |
$202.80–$1,760.46 | $520–$4,514 | varies |
| MRI chest w/o contrast (71550) range across 2 matching MRF lines |
$202.80–$1,810.38 | $520–$4,642 | varies |
| MRI chest wo w contrast (71552) range across 2 matching MRF lines |
$419.25–$2,129.40 | $1,075–$5,460 | varies |
| MRI lower extrem oth/thn jt w/contrast matrl (73719) range across 2 matching MRF lines |
$419.25–$1,739.40 | $1,075–$4,460 | varies |
| MRI lower extrem oth/thn jt w/o & w/contr matr (73720) range across 2 matching MRF lines |
$419.25–$2,090.40 | $1,075–$5,360 | varies |
| MRI lower extrem oth/thn jt w/o contr matrl (73718) range across 2 matching MRF lines |
$202.80–$1,716.39 | $520–$4,401 | varies |
| MRI lumbar spine w contrast (72149) range across 2 matching MRF lines |
$419.25–$2,045.55 | $1,075–$5,245 | varies |
| Mri Neck Spine W/O & W/Dye (72156) range across 2 matching MRF lines |
$419.25–$2,382.51 | $1,075–$6,109 | varies |
| MRI orbit face &/neck w/o contrast (70540) range across 2 matching MRF lines |
$202.80–$1,782.69 | $520–$4,571 | varies |
| MRI orbit face neck w contrast (70542) range across 2 matching MRF lines |
$419.25–$2,132.13 | $1,075–$5,467 | varies |
| Mri Orbt/Fac/Nck W/O &W/Dye (70543) range across 2 matching MRF lines |
$419.25–$2,184 | $1,075–$5,600 | varies |
| MRI pelvis w contrast (72196) range across 2 matching MRF lines |
$419.25–$1,854.06 | $1,075–$4,754 | varies |
| MRI pelvis w/o & w contrast (72197) range across 2 matching MRF lines |
$419.25–$2,090.79 | $1,075–$5,361 | varies |
| MRI pelvis w/o contrast (72195) range across 2 matching MRF lines |
$202.80–$1,810.38 | $520–$4,642 | varies |
| MRI spectroscopy (76390) range across 2 matching MRF lines |
$202.80–$1,539.72 | $520–$3,948 | varies |
| MRI thoracic spine w/o contrast (72146) range across 2 matching MRF lines |
$202.80–$1,762.41 | $520–$4,519 | varies |
| MRI upper extremity oth than jt w/contr matrl (73219) range across 2 matching MRF lines |
$419.25–$1,905.15 | $1,075–$4,885 | varies |
| MRI upper extremity oth than jt w/o contr matrl (73218) range across 2 matching MRF lines |
$202.80–$1,741.74 | $520–$4,466 | varies |
| Mri Uppr Extremity W/O&W/Dye (73220) range across 2 matching MRF lines |
$419.25–$2,115.36 | $1,075–$5,424 | varies |
| MRI, abdomen, combo (74183) range across 2 matching MRF lines |
$419.25–$2,279.16 | $1,075–$5,844 | varies |
| MRI, dorsal spine combo (72157) range across 2 matching MRF lines |
$419.25–$2,429.31 | $1,075–$6,229 | varies |
| MRI, dorsal spine contrast (72147) range across 2 matching MRF lines |
$419.25–$2,001.87 | $1,075–$5,133 | varies |
| MRI, joint upper extrem (73221) range across 2 matching MRF lines |
$202.80–$1,549.08 | $520–$3,972 | varies |
| MRI, joint upper extrem combo (73223) range across 2 matching MRF lines |
$419.25–$2,061.54 | $1,075–$5,286 | varies |
| MRI, lumbar spine combo (72158) range across 2 matching MRF lines |
$419.25–$2,370.03 | $1,075–$6,077 | varies |
| Myelogram cervical (72240) | $1,103.70 | $2,830 | 1.4× |
| Myelogram Lumbar (72265) | $1,103.70 | $2,830 | 1.4× |
| Myelography thoracic (72255) | $1,103.70 | $2,830 | 1.4× |
| Myelograpy 2/more regions rs&i (72270) | $883.35 | $2,265 | 1.1× |
| Myocardial Imaging Pet Metabolic Evaluation (78459) | $2,460.12 | $6,308 | 1.9× |
| Myocardial imaging, infarct avid, planar; with ejection fraction by first pass technique Non-Facility (78468) | $714.87 | $1,833 | 1.3× |
| Myocardial Spect Multiple Studies (78452) range across 3 matching MRF lines |
$234–$3,563.04 | $600–$9,136 | varies |
| Myocrd Img Pet Metab Eval Single Study Cncrnt CT (78429) | $2,135.64 | $5,476 | 1.5× |
| Myocrd Img Pet Prfuj W/Metab 2rtracer Cncrnt CT (78433) | $2,543.19 | $6,521 | 1.1× |
| N-invas est c ffr sw aly CTA (75580) | $1,740.18 | $4,462 | 2.0× |
| Neck soft tissue (70360) range across 2 matching MRF lines |
$25.35–$202.02 | $65–$518 | varies |
| Nfs/Instlj Radioelmnt Sln 3 Mo Follow-Up Care (77750) | $1,240.98 | $3,182 | 3.2× |
| Njx Rp Loclzj Non-Img Probe Study Intravenous (78808) | $281.19 | $721 | 0.7× |
| Nm csf leak detection (78650) | $238.68 | $612 | 0.2× |
| Nm myocard infarct spect (78469) | $834.21 | $2,139 | 1.5× |
| Nm red cell survival study (78130) | $545.61 | $1,399 | 1.4× |
| Nonvascular Shunt X-Ray (75809) | $400.92 | $1,028 | 3.8× |
| Ntsty modul radthx pln dose-vol histos (77301) | $5,087.94 | $13,046 | 3.7× |
| Nuclear medicine study of endocrine organs (78099) | $346.71 | $889 | 0.9× |
| Nuclear Rx Intra-Arterial (79445) | $644.67 | $1,653 | 2.7× |
| Nuclear Rx Oral Admin (79005) | $702.39 | $1,801 | 3.0× |
| Ob us nuchal meas 1 gest (76813) | $148.98 | $382 | 1.4× |
| Oph bmtry us echograpy a-scan io lens pwr cal (76519) | $161.46 | $414 | 1.5× |
| Oph us dx ant sgm us immersion b-scan/hr biom (76513) | $251.94 | $646 | 2.4× |
| Ophthalmic Biometry US Echograpy a-Scan (76516) | $105.30 | $270 | 1.0× |
| Ophthalmic Ultrasonic Foreign Body Localization (76529) | $107.64 | $276 | 1.2× |
| Ophthalmic ultrasound dx b-scan w/wo a-scan (76512) | $145.08 | $372 | 1.4× |
| Ophthalmic US Dx Corneal Pachymetry Uni/Bi (76514) | $32.37 | $83 | 1.1× |
| Optic foramina (70190) | $134.55 | $345 | 1.5× |
| Panoramic X-ray of jaws (70355) range across 2 matching MRF lines |
$25.35–$248.04 | $65–$636 | varies |
| Parathyroid imaging w/tomographic spect & CT (78072) range across 2 matching MRF lines |
$175.50–$1,070.16 | $450–$2,744 | varies |
| Parathyroid Planar Imaging (78070) range across 2 matching MRF lines |
$175.50–$725.40 | $450–$1,860 | varies |
| Parathyroid planar imaging w/wo subtraction (78071) range across 2 matching MRF lines |
$175.50–$998.79 | $450–$2,561 | varies |
| Pelvis 1 or 2 views (72170) range across 2 matching MRF lines |
$25.35–$242.58 | $65–$622 | varies |
| Peritoneogram Rs&I (74190) | $223.47 | $573 | 0.4× |
| Pet Image W/Ct Lmtd (78814) range across 6 matching MRF lines |
$939.90–$3,295.89 | $2,410–$8,451 | varies |
| PET image w/CT, full body (78816) range across 6 matching MRF lines |
$939.90–$3,529.11 | $2,410–$9,049 | varies |
| PET imaging CT attenuation skull base mid-thigh (78815) range across 6 matching MRF lines |
$939.90–$3,529.11 | $2,410–$9,049 | varies |
| Pet Myocardial Sngl Study (78491) range across 2 matching MRF lines |
$546–$2,383.68 | $1,400–$6,112 | varies |
| Plasma Vol Radiopharm Vol Dilute Spx Mult Smples (78111) | $1,877.46 | $4,814 | 1.4× |
| Plasma volume, radiopharmaceutical volume-dilution technique (separate procedure); single sampling Non-Facility (78110) | $1,877.46 | $4,814 | 1.4× |
| Platelet survival study Non-Facility (78191) | $545.61 | $1,399 | 1.4× |
| Prq Transhepatc Portograpy Hemodyn Eval Rs&I (75885) | $2,358.33 | $6,047 | 0.7× |
| Pulmonary Perfusion Imaging Particulate (78580) | $650.52 | $1,668 | 1.6× |
| Radex Abd Compl Aqt Abd W/S/E/D Views 1 View Ch (74022) range across 2 matching MRF lines |
$25.35–$347.88 | $65–$892 | varies |
| Radex abscess/fistula/sinus tract rs&i (76080) | $414.96 | $1,064 | 0.8× |
| Radex Ankle Complete Minimum 3 Views (73610) range across 2 matching MRF lines |
$25.35–$261.30 | $65–$670 | varies |
| Radex Calcaneus Minimum 2 Views (73650) range across 2 matching MRF lines |
$25.35–$230.10 | $65–$590 | varies |
| Radex elbow complete minimum 3 views (73080) range across 2 matching MRF lines |
$25.35–$261.30 | $65–$670 | varies |
| Radex Facial Bones Complete Minimum 3 Views (70150) range across 2 matching MRF lines |
$25.35–$378.69 | $65–$971 | varies |
| Radex fingr minimum 2 views (73140) range across 2 matching MRF lines |
$25.35–$182.13 | $65–$467 | varies |
| Radex foot complete minimum 3 views (73630) range across 2 matching MRF lines |
$25.35–$261.30 | $65–$670 | varies |
| Radex Hand Minimum 3 Views (73130) range across 2 matching MRF lines |
$25.35–$264.42 | $65–$678 | varies |
| Radex lower extremity infant minimum 2 views (73592) range across 2 matching MRF lines |
$25.35–$256.62 | $65–$658 | varies |
| Radex Mastoids Compl Minimum 3 Views PR Side (70130) range across 2 matching MRF lines |
$25.35–$299.52 | $65–$768 | varies |
| Radex Nasal Bones Complete Minimum 3 Views (70160) range across 2 matching MRF lines |
$25.35–$260.52 | $65–$668 | varies |
| Radex Pharynx/Larx W/Fluor&/Magnification Tq (70370) | $113.10 | $290 | 1.3× |
| Radex Ribs Unilateral 2 Views (71100) range across 2 matching MRF lines |
$25.35–$283.92 | $65–$728 | varies |
| Radex shoulder complete minimum 2 views (73030) range across 2 matching MRF lines |
$25.35–$276.90 | $65–$710 | varies |
| Radex Sinuses Paransl < 3 Views (70210) range across 2 matching MRF lines |
$25.35–$218.40 | $65–$560 | varies |
| Radex sm int w/mlt srl imges via enteroclss tube (74251) | $759.72 | $1,948 | 4.3× |
| Radex Spine 1 View Specify Level (72020) range across 2 matching MRF lines |
$25.35–$182.13 | $65–$467 | varies |
| Radex Sternum Minimum 2 Views (71120) range across 2 matching MRF lines |
$25.35–$309.27 | $65–$793 | varies |
| Radex Temporomandble Jt Opn & Clsd Mouth Bilat (70330) range across 2 matching MRF lines |
$25.35–$271.44 | $65–$696 | varies |
| Radex Toe Minimum 2 Views (73660) range across 2 matching MRF lines |
$25.35–$109.98 | $65–$282 | varies |
| Radex upper extremity infant minimum 2 views (73092) range across 2 matching MRF lines |
$25.35–$248.82 | $65–$638 | varies |
| Radex Wrist Complete Minimum 3 Views (73110) range across 2 matching MRF lines |
$25.35–$235.17 | $65–$603 | varies |
| Radex X-Ray Exam Entire Spi 6/> Vw - Xr Entire Spine 6+ Vw (72084) range across 2 matching MRF lines |
$46.80–$597.48 | $120–$1,532 | varies |
| Radiation Delivery Stereotactic Cranial Linear (77372) | $18,301.53 | $46,927 | 2.5× |
| Radiation treatment delivery level 1 (77402) | $278.85 | $715 | 2.7× |
| Radiation treatment delivery level 2 (77407) | $378.69 | $971 | 1.0× |
| Radiation treatment delivery level 3 (77412) | $652.08 | $1,672 | 1.2× |
| Radiolog exam mandible compl minimum 4 views (70110) range across 2 matching MRF lines |
$25.35–$384.93 | $65–$987 | varies |
| Radiologic Exam Abdomen 3+ Views - Xr Abdomen 3+ Views (74021) range across 2 matching MRF lines |
$25.35–$329.55 | $65–$845 | varies |
| Radiologic exam colon double contrast study (74280) range across 2 matching MRF lines |
$99.45–$903.24 | $255–$2,316 | varies |
| Radiologic exam colon single contrast study (74270) range across 2 matching MRF lines |
$99.45–$770.25 | $255–$1,975 | varies |
| Radiologic Exam Esophagus Double Contrast Study (74221) range across 2 matching MRF lines |
$99.45–$770.25 | $255–$1,975 | varies |
| Radiologic exam knee complete 4/more views (73564) range across 2 matching MRF lines |
$25.35–$273 | $65–$700 | varies |
| Radiologic exam pelvis compl minimum 3 views (72190) range across 2 matching MRF lines |
$25.35–$264.42 | $65–$678 | varies |
| Radiologic Exam Small Int Single Contrast Study (74250) range across 2 matching MRF lines |
$99.45–$557.70 | $255–$1,430 | varies |
| Radiologic exam swallow function contrast study (74230) | $733.20 | $1,880 | 4.2× |
| Radiologic exam upr gi trc double contrast study (74246) range across 2 matching MRF lines |
$99.45–$738.66 | $255–$1,894 | varies |
| Radiologic examination femur 1 view (73551) range across 2 matching MRF lines |
$25.35–$168.09 | $65–$431 | varies |
| Radiologic examination femur minimum 2 views (73552) range across 2 matching MRF lines |
$25.35–$189.15 | $65–$485 | varies |
| Radiologic examination knee 1/2 views (73560) range across 2 matching MRF lines |
$25.35–$173.55 | $65–$445 | varies |
| Radiologic Examination Osseous Survey Limited (77074) range across 3 matching MRF lines |
$46.80–$217.23 | $120–$557 | varies |
| Radiologic examination tibia & fibula 2 views (73590) range across 2 matching MRF lines |
$25.35–$238.68 | $65–$612 | varies |
| Radiopharm Dacryocystography (78660) | $470.34 | $1,206 | 1.2× |
| Radiopharmaceutical therapy, by interstitial radioactive colloid administration Facility (79300) | $372.06 | $954 | 1.6× |
| Radiopharmaceutical therapy, by intracavitary administration Non-Facility (79200) | $372.06 | $954 | 1.6× |
| Red Cell Volume Determination Spx 1 Sampling (78120) | $545.61 | $1,399 | 1.4× |
| Red Cell Volume Determination Spx Mult Samplings (78121) | $657.93 | $1,687 | 1.2× |
| Remote afterloading high dose rate radionuclide skin surface brachytherapy, includes basic dosimetry, when performed;… (77768) | $2,264.34 | $5,806 | 5.8× |
| Remote afterloading high dose rate radionuclide skin surface brachytherapy, includes basic dosimetry, when performed;… (77767) | $1,545.18 | $3,962 | 4.0× |
| Renal Cyst Study (74470) | $257.40 | $660 | 0.5× |
| Ribs bilateral 3 views (71110) range across 2 matching MRF lines |
$25.35–$331.89 | $65–$851 | varies |
| Rp loclzj tum plnr 1 area single day imaging (78800) | $780 | $2,000 | 1.9× |
| Rp loclzj tum plnr 2+area 1+d img/1 area img>2+d (78801) | $877.50 | $2,250 | 2.2× |
| Rp Loclzj Tum Plnr Whole Body 2+ Days Imaging (78804) | $1,170 | $3,000 | 2.1× |
| Rp Loclzj Tum Plnr Whole Body Single Day Imaging (78802) | $975 | $2,500 | 1.8× |
| Rp Loclzj Tum Spect 1 Area Single Day Imaging (78803) | $1,209 | $3,100 | 2.2× |
| Rp loclzj tum spect 2 area/sep acquisj img (78831) range across 2 matching MRF lines |
$419.25–$1,287 | $1,075–$3,300 | varies |
| Rp loclzj tum spect CT 2area 1d img/1 ar img>2+d (78832) range across 2 matching MRF lines |
$419.25–$1,326 | $1,075–$3,400 | varies |
| Rp loclzj tum spect w/CT 1 area/acquisj 1day img (78830) range across 2 matching MRF lines |
$175.50–$1,248 | $450–$3,200 | varies |
| Rp Ther Radiolbld Monoclonal Antibody IV Infus (79403) | $928.98 | $2,382 | 4.0× |
| Rp Therapy Intravenous Administration (79101) | $892.71 | $2,289 | 3.8× |
| Rp Therapy Unlisted Procedure (79999) | $515.58 | $1,322 | 2.2× |
| Salivary Gland Function Study (78232) | $719.16 | $1,844 | 1.8× |
| Salivary Gland Imaging (78230) | $585 | $1,500 | 1.5× |
| Salivary Gland Imaging Serial Images (78231) | $585 | $1,500 | 1.5× |
| Scapula (73010) range across 2 matching MRF lines |
$25.35–$238.68 | $65–$612 | varies |
| Screening Digital Breast Tomosynthesis Bi (77063) range across 2 matching MRF lines |
$23.40–$62.79 | $60–$161 | varies |
| Sella turcica (70240) range across 2 matching MRF lines |
$25.35–$221.52 | $65–$568 | varies |
| Shoulder 1 view (73020) range across 2 matching MRF lines |
$25.35–$201.63 | $65–$517 | varies |
| Shoulder Arthrography (73040) range across 2 matching MRF lines |
$163.80–$491.01 | $420–$1,259 | varies |
| Sialogram (70390) range across 2 matching MRF lines |
$163.80–$376.35 | $420–$965 | varies |
| Skull less than 4 views (70250) range across 2 matching MRF lines |
$25.35–$276.90 | $65–$710 | varies |
| Special dosimetry (77331) | $353.34 | $906 | 2.6× |
| Special Physics Consult (77370) | $477.75 | $1,225 | 3.5× |
| Special teletherapy port plan (77321) | $696.93 | $1,787 | 1.8× |
| Special treatment procedure (77470) | $1,515.93 | $3,887 | 2.7× |
| Speech evaluation, complex (70371) | $598.26 | $1,534 | 2.5× |
| Spleen Imaging (78185) range across 2 matching MRF lines |
$550.29–$773.76 | $1,411–$1,984 | varies |
| Srs Multisource (77371) range across 2 matching MRF lines |
$9,673.95–$61,542.78 | $24,805–$157,802 | varies |
| Stereotactic Body Radiation Delivery (77373) | $14,589.12 | $37,408 | 8.1× |
| Sternoclavicular joints (71130) range across 3 matching MRF lines |
$25.35–$514.80 | $65–$1,320 | varies |
| Superior sagittal sinus venogram (75870) | $2,440.62 | $6,258 | 0.8× |
| Surface Applic Low Dose Rate Radionuclide Source (77789) | $251.55 | $645 | 2.4× |
| Telethx isodose pln cplx w/basic dosimetry (77307) | $1,526.85 | $3,915 | 4.1× |
| Telethx isodose pln smpl w/dosimetry calculation (77306) | $1,368.51 | $3,509 | 3.6× |
| Temporomandble Jt Arthrography Rs&I (70332) range across 2 matching MRF lines |
$163.80–$370.89 | $420–$951 | varies |
| Testicular Imaging W/Flow (78761) | $296.40 | $760 | 0.7× |
| Ther Rad Simulaj-Aided Field Setting Complex (77290) | $1,021.41 | $2,619 | 2.7× |
| Ther Rad Simulaj-Aided Field Setting Intermed (77285) | $845.91 | $2,169 | 2.2× |
| Ther rad simulaj-aided field setting simple (77280) | $522.99 | $1,341 | 3.9× |
| Therapeutic Enema Rdctj Intussusception/Obstrcj (74283) | $1,127.10 | $2,890 | 6.4× |
| Thoracic spine 2 views (72070) range across 2 matching MRF lines |
$25.35–$324.48 | $65–$832 | varies |
| Thoracic spine 3 views (72072) range across 2 matching MRF lines |
$25.35–$384.93 | $65–$987 | varies |
| Thoracolumbar 2 views (72080) range across 2 matching MRF lines |
$25.35–$304.20 | $65–$780 | varies |
| Thyroid carcinoma metastases imaging; with additional studies (eg, urinary recovery) Non-Facility (78016) | $607.23 | $1,557 | 1.5× |
| Thyroid Carcinoma Metastases Img Lmtd Area (78015) | $498.03 | $1,277 | 1.2× |
| Thyroid Imaging With Vascular Flow (78013) range across 2 matching MRF lines |
$175.50–$464.49 | $450–$1,191 | varies |
| Thyroid Met Imaging Body (78018) | $1,024.14 | $2,626 | 1.9× |
| Thyroid Uptake Measurement (78012) range across 2 matching MRF lines |
$175.50–$476.19 | $450–$1,221 | varies |
| Thyroid Uptake W/Blood Flow Sngle/Mult Quan Meas (78014) range across 2 matching MRF lines |
$175.50–$612.69 | $450–$1,571 | varies |
| Tx Devices Design & Construction Complex (77334) | $776.49 | $1,991 | 2.1× |
| Tx devices design & construction intermediate (77333) | $413.40 | $1,060 | 3.1× |
| Tx devices design & construction simple (77332) | $400.92 | $1,028 | 3.0× |
| Ultrasound Breast Limited (76642) range across 2 matching MRF lines |
$52.65–$382.20 | $135–$980 | varies |
| Ultrasound elastography first target lesion (76982) range across 2 matching MRF lines |
$97.50–$136.11 | $250–$349 | varies |
| Ultrasound Elastography Parenchyma (76981) range across 2 matching MRF lines |
$97.50–$136.11 | $250–$349 | varies |
| Ultrasound Exam Aaa Screen (76706) range across 2 matching MRF lines |
$97.50–$268.32 | $250–$688 | varies |
| Ultrasound, abdomen limited (76705) range across 3 matching MRF lines |
$97.50–$603.33 | $250–$1,547 | varies |
| Umbilical-artery Doppler (OB) (76820) range across 2 matching MRF lines |
$97.50–$463.32 | $250–$1,188 | varies |
| Unlisted Dx Radiographic Procedure (76499) | $146.25 | $375 | 1.7× |
| Unlisted fluoroscopic procedure (76496) | $139.23 | $357 | 1.6× |
| Unlisted magnetic resonance procedure (76498) range across 2 matching MRF lines |
$202.80–$1,316.25 | $520–$3,375 | varies |
| Unlisted Miscellaneous Px Dx Nuclear Medicine (78999) | $239.85 | $615 | 0.6× |
| Unlisted Procedure Clinical Brachytherapy (77799) | $1,866.93 | $4,787 | 18.2× |
| Unlisted respiratory px dx nuclear medicine (78599) | $545.61 | $1,399 | 1.4× |
| Unlisted us procedure (76999) | $291.33 | $747 | 3.3× |
| Upper gi w/o kub (74240) range across 2 matching MRF lines |
$99.45–$491.01 | $255–$1,259 | varies |
| Urea Breath Test C-14 Isotopic Acquisj Analysis (78267) | $257.01 | $659 | 23.2× |
| Ureteral Reflux Study (78740) | $694.20 | $1,780 | 1.7× |
| Urethrocystogram voiding (74455) range across 2 matching MRF lines |
$163.80–$390.39 | $420–$1,001 | varies |
| Urethrocystography retrograde (74450) | $253.50 | $650 | 1.1× |
| Us breast unilateral complete (76641) range across 2 matching MRF lines |
$52.65–$382.20 | $135–$980 | varies |
| Us chest (76604) range across 2 matching MRF lines |
$97.50–$377.91 | $250–$969 | varies |
| Us complete joint (76881) range across 2 matching MRF lines |
$97.50–$556.14 | $250–$1,426 | varies |
| Us exam, pelvic, limited (76857) range across 2 matching MRF lines |
$97.50–$370.11 | $250–$949 | varies |
| Us head (76506) range across 2 matching MRF lines |
$97.50–$693.03 | $250–$1,777 | varies |
| Us kidney transplant (76776) range across 2 matching MRF lines |
$97.50–$307.32 | $250–$788 | varies |
| Us lmtd joint/oth nonvasc xtr strux r-t w/img (76882) range across 2 matching MRF lines |
$97.50–$370.89 | $250–$951 | varies |
| Us ob detailed single fetus (76811) | $539.37 | $1,383 | 2.2× |
| Us ob limited 1 or more fetuses (76815) range across 3 matching MRF lines |
$97.50–$334.23 | $250–$857 | varies |
| Us ob transvaginal (76817) range across 2 matching MRF lines |
$58.50–$321.75 | $150–$825 | varies |
| Us pelvic non ob complete (76856) range across 2 matching MRF lines |
$97.50–$614.64 | $250–$1,576 | varies |
| Us pg uter img f&mat 14 wk tabdl 1/1st gestation (76801) range across 2 matching MRF lines |
$97.50–$539.37 | $250–$1,383 | varies |
| Us preg uterus real time f/u trnsabdl per fetus (76816) | $323.70 | $830 | 3.1× |
| Us retroperitoneal complete (76770) range across 2 matching MRF lines |
$97.50–$618.54 | $250–$1,586 | varies |
| Us retroperitoneal limited (76775) range across 2 matching MRF lines |
$97.50–$290.16 | $250–$744 | varies |
| Us scrotum and contents (76870) range across 2 matching MRF lines |
$97.50–$553.41 | $250–$1,419 | varies |
| Us spinal canal and contents (76800) range across 2 matching MRF lines |
$97.50–$524.55 | $250–$1,345 | varies |
| Us thyroid (76536) range across 2 matching MRF lines |
$97.50–$556.14 | $250–$1,426 | varies |
| Us transrectal (76872) range across 2 matching MRF lines |
$97.50–$595.53 | $250–$1,527 | varies |
| Vascular Flow Imaging (78445) | $384.15 | $985 | 1.0× |
| Vasogram (74440) | $205.14 | $526 | 0.9× |
| Vein X-Ray Chest (75827) | $2,159.43 | $5,537 | 1.4× |
| Vein X-Ray Liver W/O Hemodyn (75887) | $2,015.91 | $5,169 | 0.6× |
| Vein X-Ray Spleen/Liver (75810) | $2,643.81 | $6,779 | 0.8× |
| Venogram Sinus/Jugular (75860) | $1,971.06 | $5,054 | 0.6× |
| Venography Adrenal Unilateral (75840) | $1,775.28 | $4,552 | 0.6× |
| Venography caval inferior serialography rs&i (75825) | $1,994.85 | $5,115 | 0.6× |
| Venography extremity bilateral rs&i (75822) range across 2 matching MRF lines |
$163.80–$1,045.59 | $420–$2,681 | varies |
| Venography extremity unilateral rs&i (75820) range across 2 matching MRF lines |
$163.80–$1,270.23 | $420–$3,257 | varies |
| Venography Orbital Rs&I (75880) | $1,438.32 | $3,688 | 2.3× |
| Venography Renal Bilateral (75833) | $2,623.14 | $6,726 | 0.8× |
| Venography Renal Unilateral (75831) | $2,006.94 | $5,146 | 0.6× |
| Venous sampling by catheter (75893) | $2,944.11 | $7,549 | 0.5× |
| Venous thrombosis imaging (78457) | $370.89 | $951 | 0.7× |
| Venous Thrombosis Imaging Venogram Bilateral (78458) | $458.25 | $1,175 | 1.1× |
| Vertebral fracture assessment via dxa (77086) | $104.13 | $267 | 1.2× |
| Wrist 2 views (73100) range across 2 matching MRF lines |
$25.35–$197.73 | $65–$507 | varies |
| X-Ray Ac Jts - Xr Acromioclavicular Joints Bilateral (73050) range across 2 matching MRF lines |
$25.35–$271.44 | $65–$696 | varies |
| X-ray antegrade pyelogram tube (74425) | $489.45 | $1,255 | 1.4× |
| X-Ray Aorta Leg Arteries (75630) | $2,637.18 | $6,762 | 0.8× |
| X-Ray Bend Only L-S Spine (72120) range across 2 matching MRF lines |
$25.35–$342.42 | $65–$878 | varies |
| X-Ray Elbow 2 Vw - Xr Elbow 1-2 Views Right (73070) range across 2 matching MRF lines |
$25.35–$193.05 | $65–$495 | varies |
| X-Ray Exam Breast Specimen (76098) | $457.47 | $1,173 | 0.8× |
| X-Ray Exam Entire Spi 1 Vw (72081) range across 2 matching MRF lines |
$46.80–$273 | $120–$700 | varies |
| X-Ray Exam Entire Spi 2/3 Vw (72082) range across 2 matching MRF lines |
$46.80–$341.25 | $120–$875 | varies |
| X-Ray Exam Entire Spi 4/5 Vw (72083) range across 2 matching MRF lines |
$46.80–$441.48 | $120–$1,132 | varies |
| X-Ray Exam Hip Uni 1 View (73501) range across 2 matching MRF lines |
$25.35–$168.09 | $65–$431 | varies |
| X-Ray Exam Hip Uni 2-3 Views (73502) range across 2 matching MRF lines |
$25.35–$189.15 | $65–$485 | varies |
| X-Ray Exam Hip Uni 4/> Views (73503) range across 2 matching MRF lines |
$25.35–$271.05 | $65–$695 | varies |
| X-Ray Exam Hips Bi 2 Views (73521) range across 2 matching MRF lines |
$25.35–$271.05 | $65–$695 | varies |
| X-Ray Exam Hips Bi 3-4 Views (73522) range across 2 matching MRF lines |
$25.35–$304.98 | $65–$782 | varies |
| X-Ray Exam Hips Bi 5/> Views (73523) range across 2 matching MRF lines |
$25.35–$304.98 | $65–$782 | varies |
| X-Ray Exam L-S Spine Bending (72114) range across 2 matching MRF lines |
$25.35–$513.63 | $65–$1,317 | varies |
| X-Ray Exam Neck Spine 2-3 Vw (72040) range across 2 matching MRF lines |
$25.35–$326.04 | $65–$836 | varies |
| X-Ray Exam Neck Spine 6/>Vws (72052) range across 2 matching MRF lines |
$25.35–$491.79 | $65–$1,261 | varies |
| X-Ray Exam Unilat Ribs/Chest (71101) range across 2 matching MRF lines |
$25.35–$327.21 | $65–$839 | varies |
| X-ray eye for foreign body (70030) range across 2 matching MRF lines |
$25.35–$238.29 | $65–$611 | varies |
| X-ray humerus (73060) range across 2 matching MRF lines |
$25.35–$235.17 | $65–$603 | varies |
| X-ray IV pyelogram (ivp) (74400) range across 4 matching MRF lines |
$99.45–$645.84 | $255–$1,656 | varies |
| X-ray IV pyelogram+tomography (74415) range across 2 matching MRF lines |
$99.45–$862.29 | $255–$2,211 | varies |
| X-Ray Jaw <4 Vw - Xr Mandible < 4 Views (70100) range across 2 matching MRF lines |
$25.35–$213.72 | $65–$548 | varies |
| X-Ray Knee Bilat Standing - Xr Knees Anteroposterior Standing Bilat (73565) range across 2 matching MRF lines |
$50.70–$201.63 | $130–$517 | varies |
| X-Ray Lumbar Spine 2/3 Vw - Xr Lumbar Spine 2-3 Views (72100) range across 2 matching MRF lines |
$25.35–$341.64 | $65–$876 | varies |
| X-ray nose-rectum child f.b. (76010) range across 2 matching MRF lines |
$25.35–$259.74 | $65–$666 | varies |
| X-Ray Ribs, Chest 4+ Vw - Xr Ribs 3 Vws Bil W/ Chest Posteroanterior (71111) range across 2 matching MRF lines |
$25.35–$341.64 | $65–$876 | varies |
| X-Ray Sacroiliac Jts 3+ Vw - Xr Sacroiliac Joints 3+ Views (72202) range across 2 matching MRF lines |
$25.35–$276.90 | $65–$710 | varies |
| X-Ray Sacroiliac Jts <3 Vw - Xr Sacroiliac Joints 1-2 Views (72200) | $169.65 | $435 | 1.6× |
| X-Ray Sacrum/Coccyx 2+ Vw - Xr Sacrum Coccyx 2+ Views (72220) range across 2 matching MRF lines |
$25.35–$287.04 | $65–$736 | varies |
| X-Ray Sinuses 3+ Vw - Xr Paranasal Sinuses 3+ Views (70220) range across 2 matching MRF lines |
$25.35–$375.57 | $65–$963 | varies |
| X-Ray Skull 4+ Vw - Xr Skull Complete 4+ Views (70260) range across 2 matching MRF lines |
$25.35–$412.23 | $65–$1,057 | varies |
| X-ray thoracic spine 4 vw (72074) range across 2 matching MRF lines |
$25.35–$414.57 | $65–$1,063 | varies |
| X-Ray Tmj Unilat (70328) range across 2 matching MRF lines |
$25.35–$240.63 | $65–$617 | varies |
| X-Ray Urinary Tract Exam With Contrast Material (74420) | $633.36 | $1,624 | 1.8× |
| X-Rays Bone Length Studies (77073) range across 2 matching MRF lines |
$25.35–$240.63 | $65–$617 | varies |
| X-Rays Bone Survey Complete (77075) range across 2 matching MRF lines |
$46.80–$801.45 | $120–$2,055 | varies |
| Xr c-spine 4 or 5 views (72050) range across 2 matching MRF lines |
$25.35–$439.14 | $65–$1,126 | varies |
| Xr facial bones less than 3 views (70140) range across 2 matching MRF lines |
$25.35–$260.52 | $65–$668 | varies |
| XR Mastoids < 3 Views Bilateral (70120) range across 2 matching MRF lines |
$25.35–$101.40 | $65–$260 | varies |
| Xr myelogram posterior fossa (70010) | $735.93 | $1,887 | 2.1× |
| Xr orbits complete 4 views (70200) range across 2 matching MRF lines |
$25.35–$349.05 | $65–$895 | varies |
| Xr Tomogram Single Plane (76100) | $618.93 | $1,587 | 5.9× |
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.