Hospitals report these codes with terse, inconsistent chargemaster text. This plain-English title was written by an AI model from that text and has not been reviewed by a person, so it can be wrong. The prices on this page come straight from hospital filings and do not depend on it.
Original text from hospital filings
MRI REVIEW OF OUTSIDE EXAM
Low
$0
Average
$192
Median
$169
High
$366
Each hospital's average Tricare rate, under the methodology and billing class chosen below.
27 hospitals; the 90th percentile is 5.5× the 10th. Each bar is a price range and its height is how many hospitals fall in it. Hover a bar, or a row in the ladder, for details.
Filter by billing methodology
Filter by billing class
31 hospital rates
iThe hospitals that file a Tricare rate for this code, one row per hospital and set of terms (billing class, payment method, setting). Rates under different terms are never blended, so the terms are shown under each hospital’s name. Figures are the hospital’s averages across its plans.| # | Plans | |||||||
|---|---|---|---|---|---|---|---|---|
| 1 | Anderson Hospital Maryville, IL facility · fee schedule · outpatient | 1 | $301 | $301 | — | — | — | $301 – $301 |
| 2 | Anderson Hospital Maryville, IL professional · other · outpatient | 1 | $307 | $307 | — | — | — | $307 – $307 |
| 3 | Ascension Cedar Park Park, TX fee schedule · outpatient | 1 | $169 | $169 | — | — | — | $169 – $169 |
| 4 | Ascension Seton Austin, TX fee schedule · outpatient | 1 | $169 | $169 | — | — | — | $169 – $169 |
| 5 | Ascension Seton Austin, TX fee schedule · outpatient | 1 | $169 | $169 | — | — | — | $169 – $169 |
| 6 | Ascension Seton Austin, TX fee schedule · outpatient | 1 | $169 | $169 | — | — | — | $169 – $169 |
| 7 | Ascension Seton Luling, TX fee schedule · outpatient | 1 | $169 | $169 | — | — | — | $169 – $169 |
| 8 | Ascension Seton Burnet, TX fee schedule · outpatient | 1 | $169 | $169 | — | — | — | $169 – $169 |
| 9 | Ascension Seton Smithville, TX fee schedule · outpatient | 1 | $169 | $169 | — | — | — | $169 – $169 |
| 10 | Ascension Seton Bastrop, TX fee schedule · outpatient | 1 | $169 | $169 | — | — | — | $169 – $169 |
| 11 | Ascension Seton Austin, TX fee schedule · outpatient | 1 | $169 | $169 | — | — | — | $169 – $169 |
| 12 | Austin Center for Outpatient Surgery LP, DBA Northwest Hills Surgical Hospital Austin, TX fee schedule · outpatient | 1 | $169 | $169 | — | — | — | $169 – $169 |
| 13 | Beaufort Memorial Hospital Beaufort, SC facility · fee schedule · outpatient | 1 | $274 | $274 | — | — | — | $274 – $274 |
| 14 | Beaufort Memorial Hospital Beaufort, SC facility · percent of total billed charges · inpatientfrom % of charges | 1 | $3 | $3 | — | — | — | $3 – $3 |
| 15 | Butler Healthcare Providers_ DBA Butler Memorial Hospital Butler, PA facility · fee schedule · outpatient | 1 | $308 | $308 | — | — | — | $308 – $308 |
| 16 | Clarion Hospital Clarion, PA facility · fee schedule · outpatient | 1 | $308 | $308 | — | — | — | $308 – $308 |
| 17 | Fisher-Titus Medical Center Norwalk, OH facility · percent of total billed charges · inpatientfrom % of charges | 1 | $60 | $60 | — | — | — | $60 – $60 |
| 18 | Fisher-Titus Medical Center Norwalk, OH facility · percent of total billed charges · outpatientfrom % of charges | 1 | $56 | $56 | — | — | — | $56 – $56 |
| 19 | HOULTON REGIONAL HOSPITAL HOULTON, ME percent of total billed charges · outpatientfrom % of charges | 1 | $105 | $105 | — | — | — | $105 – $105 |
| 20 | Hemet Global Medical Center Hemet, CA facility · fee schedule · outpatient | 1 | $202 | $202 | — | — | — | $202 – $202 |
| 21 | Hemet Global Medical Center Hemet, CA professional · fee schedule · outpatient | 1 | $184 | $184 | — | — | — | $184 – $184 |
| 22 | Hospital Authority of Colquitt County Moultrie, GA fee schedule · both | 1 | $54 | $54 | — | — | — | $54 – $54 |
| 23 | IHC Health Services Inc., DBA Intermountain Primary Children's Hospital City, UT facility · fee schedule · outpatient | 1 | $279 | $279 | — | — | — | $279 – $279 |
| 24 | IHC Health Services Inc., DBA Intermountain Primary Children's Hospital Lehi, UT facility · fee schedule · outpatient | 1 | $279 | $279 | — | — | — | $279 – $279 |
| 25 | Lancaster General Health Lancaster, PA facility · fee schedule · outpatient | 1 | $47 | $47 | $2 | 3% | — | $45 – $48 |
← Payers reporting CPT 76140 · Snapshot 20261113T090226Z-3ce6c0b8