Imaging prices at Advocate Good Samaritan Hospital
Downers Grove, IL · every code in this section with a posted price and a Medicare benchmark.
408 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) | $4,400 | $8,800 | 3.0× |
| Abdomen 1 View (74018) | $255 | $510 | 2.7× |
| Abdomen 2 views (74019) | $320 | $640 | 2.9× |
| Acute Gastrointestinal Blood Loss Imaging (78278) | $1,125 | $2,250 | 2.6× |
| Acute venous thrombosis imaging, peptide Non-Facility (78456) | $4,550 | $9,100 | 3.3× |
| Adrenal Cortex & Medulla Img (78075) | $2,040 | $4,080 | 1.5× |
| Angio internal mammary (75756) | $3,870 | $7,740 | 1.1× |
| Angio pulmonary bilat (75743) | $2,990 | $5,980 | 0.9× |
| Angiography Adrenal Bilateral Slctv Rs&I (75733) | $3,995 | $7,990 | 1.2× |
| Angiography extremity bilateral rs&i (75716) | $4,425 | $8,850 | 1.3× |
| Angiography extremity unilateral rs&i (75710) | $3,540 | $7,080 | 1.0× |
| Angiography pulmonary unilateral slctv rs&i (75741) | $2,390 | $4,780 | 0.7× |
| Angrph pulmonary nonslctv cath/ven njx rs&i (75746) | $2,610 | $5,220 | 0.8× |
| Ankle 2 views (73600) range across 4 matching MRF lines |
$217.50–$275 | $435–$550 | varies |
| Aortography thoracic serialography rs&i (75605) | $3,160 | $6,320 | 0.5× |
| Artery X-Rays Abdomen (75726) | $4,110 | $8,220 | 0.7× |
| Artery X-Rays Adrenal Gland (75731) | $3,195 | $6,390 | 0.9× |
| Artery X-Rays Pelvis (75736) | $3,825 | $7,650 | 0.6× |
| Artery X-Rays Spine (75705) | $3,260 | $6,520 | 0.5× |
| Arthrogram ankle (73615) | $885 | $1,770 | 2.4× |
| Arthrogram hip (73525) | $885 | $1,770 | 2.4× |
| Arthrogram Wrist (73115) | $885 | $1,770 | 2.4× |
| Basic radiation dosimetry calculation (77300) | $565 | $1,130 | 3.9× |
| Bone age studies (77072) | $270 | $540 | 2.4× |
| Bone Imaging 3 Phase (78315) | $1,870 | $3,740 | 4.4× |
| Bone Imaging Limited Area (78300) | $935 | $1,870 | 2.2× |
| Bone Imaging Multiple Areas (78305) | $1,265 | $2,530 | 3.0× |
| Bone Imaging Whole Body (78306) | $1,405 | $2,810 | 3.3× |
| Bone marrow imaging limited area (78102) | $1,065 | $2,130 | 2.5× |
| Bone marrow imaging; whole body (78104) | $1,175 | $2,350 | 2.7× |
| Bone survey infant (77076) | $460 | $920 | 4.1× |
| Brachytx isodose complex (77318) | $1,270 | $2,540 | 3.2× |
| Brachytx isodose intermed (77317) | $1,020 | $2,040 | 2.5× |
| Brachytx Isodose Plan Simple (77316) | $810 | $1,620 | 2.0× |
| Brain Image W/Flow < 4 Views (78601) | $1,295 | $2,590 | 3.0× |
| Brain Imaging Min 4 Static Views W Vascular Flow (78606) | $1,180 | $2,360 | 2.0× |
| Brain Imaging Pet Metabolic Evaluation (78608) | $4,850 | $9,700 | 3.2× |
| Cardiac MRI w/w/o contrast & further seq (75561) | $2,115 | $4,230 | 5.7× |
| Cardiac MRI w/w/o contrast w/stress (75563) | $2,115 | $4,230 | 2.5× |
| Cat Scan Follow-Up Study (76380) | $605 | $1,210 | 6.5× |
| Cerebrospinal Fluid Flow W/O Matl Shunt Evaltj (78645) | $1,125 | $2,250 | 1.9× |
| Cerebrospinal Fluid Scan (78630) | $1,660 | $3,320 | 2.9× |
| Chest 1 view (71045) | $192.50 | $385 | 2.1× |
| Chest 2 views (71046) | $232.50 | $465 | 2.5× |
| Chest 3 views (71047) | $307.50 | $615 | 3.3× |
| Chest 4 or more views (71048) | $337.50 | $675 | 3.0× |
| Chg us nrv&acc strux 1 xtr compre w/img pr extremity (76883) | $402.50 | $805 | 3.6× |
| Cisternography Positive Contrast Rs&I (70015) | $900 | $1,800 | 1.1× |
| Clavicle complete (73000) range across 2 matching MRF lines |
$225–$280 | $450–$560 | varies |
| Computed Tomography Thorax Lw Dose Lng Ca Scr C- (71271) | $565 | $1,130 | 5.0× |
| Continuing medical physics consltj pr wk (77336) | $525 | $1,050 | 3.6× |
| Contrast Exam Abdominl Aorta (75625) | $3,490 | $6,980 | 1.0× |
| Contrast X-Ray Bladder (74430) | $675 | $1,350 | 1.8× |
| Contrast X-Ray Of Elbow (73085) | $750 | $1,500 | 2.0× |
| Contrast X-Ray Of Knee Joint (73580) | $885 | $1,770 | 2.4× |
| Contrast Xray Throat/Cerv Esopha (74210) | $467.50 | $935 | 2.5× |
| CT abdomen and pelvis without and with contrast (74178) | $2,570 | $5,140 | 6.9× |
| CT abdomen and pelvis without contrast (74176) | $1,570 | $3,140 | 6.1× |
| CT abdomen w contrast (74160) | $890 | $1,780 | 4.7× |
| CT abdomen w wo contrast (74170) | $1,285 | $2,570 | 6.8× |
| CT abdomen w/o contrast (74150) | $785 | $1,570 | 7.0× |
| CT Angio Abdomen and Pelvis (74174) | $2,580 | $5,160 | 6.9× |
| CT Angio Chest (71275) | $1,720 | $3,440 | 9.2× |
| CT Angio Head (70496) | $1,720 | $3,440 | 9.2× |
| CT angio hrt w/3d image (75574) | $1,700 | $3,400 | 4.5× |
| Ct Angio Lwr Extr W/O&W/Dye (73706) range across 2 matching MRF lines |
$1,720–$2,150 | $3,440–$4,300 | varies |
| CT Angio Neck (70498) | $1,720 | $3,440 | 9.2× |
| Ct Angio Upr Extrm W/O&W/Dye (73206) range across 2 matching MRF lines |
$1,720–$2,150 | $3,440–$4,300 | varies |
| CT cervical spine w/ contrast (72126) | $890 | $1,780 | 2.4× |
| CT cervical spine w/o contrast (72125) | $785 | $1,570 | 7.0× |
| CT cervical spine w/wo cont (72127) | $1,285 | $2,570 | 6.8× |
| CT chest w contrast (71260) | $890 | $1,780 | 4.7× |
| CT chest w/wo contrast (71270) | $1,285 | $2,570 | 6.8× |
| CT head/brain with contrast (70460) | $890 | $1,780 | 4.7× |
| CT head/brain without and with contrast (70470) | $1,285 | $2,570 | 6.8× |
| CT heart contrast eval cardiac structure&morph (75572) | $1,450 | $2,900 | 3.9× |
| CT heart no contrast quant eval coronry calcium (75571) range across 2 matching MRF lines |
$24.50–$287.50 | $49–$575 | varies |
| CT hrt w/3d image congen (75573) | $1,615 | $3,230 | 4.3× |
| CT iac w contrast (70481) | $890 | $1,780 | 4.7× |
| CT l-spine w&w/o contrast (72133) | $1,285 | $2,570 | 6.8× |
| CT lower ext w/o (73700) range across 2 matching MRF lines |
$785–$980 | $1,570–$1,960 | varies |
| CT lower extremity w/contrast material (73701) range across 2 matching MRF lines |
$890–$1,110 | $1,780–$2,220 | varies |
| CT lumbar spine w contrast (72132) | $890 | $1,780 | 2.4× |
| CT lumbar spine w/o contrast (72131) | $785 | $1,570 | 7.0× |
| CT maxillofacial w contrast (70487) | $890 | $1,780 | 4.7× |
| CT maxillofacial wo contrast (70486) | $785 | $1,570 | 7.0× |
| CT neck tissue combo (70492) | $1,285 | $2,570 | 6.8× |
| Ct Orbit/Ear/Fossa W/O&W/Dye (70482) | $1,285 | $2,570 | 6.8× |
| CT orbits w/o contrast (70480) | $785 | $1,570 | 7.0× |
| CT pelvis w&w/o contrast (72194) | $1,285 | $2,570 | 6.8× |
| CT pelvis w/o contrast (72192) | $785 | $1,570 | 7.0× |
| CT scan of leg combo (73702) range across 2 matching MRF lines |
$1,285–$1,600 | $2,570–$3,200 | varies |
| CT scans face/jaw combo (70488) | $1,285 | $2,570 | 6.8× |
| CT soft tissue neck w contrast (70491) | $890 | $1,780 | 4.7× |
| CT soft tissue neck w/o contrast (70490) | $785 | $1,570 | 7.0× |
| CT thoracic spine w contrast (72129) | $890 | $1,780 | 4.7× |
| CT thoracic spine w/o contrast (72128) | $785 | $1,570 | 7.0× |
| CT thoracic spine w/wo cont (72130) | $1,285 | $2,570 | 6.8× |
| CT thorax w/o contrast (71250) | $785 | $1,570 | 7.0× |
| CT upper ext wo (73200) range across 2 matching MRF lines |
$785–$980 | $1,570–$1,960 | varies |
| CT upper extremity w/o & w/contrast material (73202) range across 2 matching MRF lines |
$1,285–$1,600 | $2,570–$3,200 | varies |
| CT upper extremity with contrast (73201) range across 2 matching MRF lines |
$890–$1,110 | $1,780–$2,220 | varies |
| Cta Abdl Aorta&Bi Iliofem W/Contrast&Postp (75635) | $1,720 | $3,440 | 9.2× |
| Cta Abdomen (74175) | $1,720 | $3,440 | 9.2× |
| CTA pelvis (72191) | $1,720 | $3,440 | 9.2× |
| Dilation ureters/urethra rs&i (74485) | $1,585 | $3,170 | 0.7× |
| Discography Cerv/Thor Spine (72285) | $2,565 | $5,130 | 1.2× |
| Diskography lumbar (72295) | $3,420 | $6,840 | 1.6× |
| Doppler Echo Fetal Puls Spectral F/U/Repeat (76828) | $437.50 | $875 | 3.9× |
| Doppler Echo Fetal Spectral Display Complete (76827) | $580 | $1,160 | 5.2× |
| Doppler Fetal Mid Cerebral Artery (76821) | $367.50 | $735 | 3.3× |
| Dxa Bone Density Axial (77080) | $395 | $790 | 3.5× |
| Echo exam of fetal heart (76825) | $1,115 | $2,230 | 1.9× |
| Echo exam uterus (76831) | $610 | $1,220 | 2.4× |
| Echo Guide For Artery Repair (76936) | $1,040 | $2,080 | 4.5× |
| Echocardiography, fetal, cardiovascular system, real time with image documentation (2D), with or without M-mode… (76826) | $835 | $1,670 | 3.3× |
| Echograp Trans R Pros Study (76873) | $580 | $1,160 | 5.2× |
| Esophagram (74220) | $415 | $830 | 2.2× |
| Fetal Biophys Profile W/Nst (76818) | $460 | $920 | 4.1× |
| Fetal Biophysical Profile W/O Non-Stress Testing (76819) | $392.50 | $785 | 3.5× |
| Fetal MRI w/placntl matrnl plvc img sing/1st ges (74712) | $1,560 | $3,120 | 6.1× |
| Fluoroscopy up to 1 hr (76000) | $610 | $1,220 | 2.4× |
| Follow-Up Angiography (75898) | $1,575 | $3,150 | 0.5× |
| Foot 2 views (73620) range across 4 matching MRF lines |
$225–$280 | $450–$560 | varies |
| Forearm 2 views (73090) range across 4 matching MRF lines |
$322.50–$405 | $645–$810 | varies |
| Gastric emptying imaging study (78264) | $1,310 | $2,620 | 3.1× |
| Gastroesophageal Reflux Exam (78262) | $1,130 | $2,260 | 2.6× |
| Gated Heart Planar Single (78472) | $1,145 | $2,290 | 2.7× |
| Hand 2 views (73120) range across 4 matching MRF lines |
$250–$310 | $500–$620 | varies |
| Hdr Rdncl Ntrstl/Icav Brchtx (77772) | $4,595 | $9,190 | 6.2× |
| Hdr Rdncl Ntrstl/Icav Brchtx (77771) | $4,180 | $8,360 | 5.6× |
| Hdr Rdncl Ntrstl/Icav Brchtx 1 Channel (77770) | $3,345 | $6,690 | 4.5× |
| Heart first pass single,planar (78481) | $1,070 | $2,140 | 1.8× |
| Hepatc Vngrph Wdg/Fr Hemodyn Eval Rs&I (75889) | $3,040 | $6,080 | 0.9× |
| Hepatc Vngrph Wdg/Fr W/O Hemodyn Eval Rs&I (75891) | $2,740 | $5,480 | 0.8× |
| Hepatobil Syst Image W/Drug (78227) | $1,410 | $2,820 | 2.4× |
| Hepatobiliary System Imaging (78226) | $1,280 | $2,560 | 3.0× |
| Ht Muscle Image Spect Sing (78451) | $2,035 | $4,070 | 1.5× |
| Hysterosalpingogram (74740) | $865 | $1,730 | 3.4× |
| Interstitial radiation source applic complex (77778) | $3,970 | $7,940 | 5.3× |
| Intracavitary Radiation Source Applic Complex (77763) | $3,060 | $6,120 | 4.1× |
| Intracavitary Radiation Source Applic Intermed (77762) | $2,550 | $5,100 | 4.3× |
| Intracavitary radiation source applic simple (77761) | $2,040 | $4,080 | 3.4× |
| Joint Survey Single View (77077) | $257.50 | $515 | 2.3× |
| K Flow/Funct Image Multiple (78709) | $1,625 | $3,250 | 2.8× |
| K Flow/Funct Image W/Drug (78708) | $1,475 | $2,950 | 2.5× |
| Kidney Imaging Morphol (78700) | $1,430 | $2,860 | 3.3× |
| Kidney Imaging Morphoogy W/Vascular Flow (78701) | $955 | $1,910 | 2.2× |
| Knee 3 Views (73562) range across 2 matching MRF lines |
$295–$370 | $590–$740 | varies |
| Liver & Spleen Imaging Static Only (78215) | $1,090 | $2,180 | 2.5× |
| Liver imaging static only (78201) | $1,260 | $2,520 | 2.2× |
| Liver imaging w/vascular flow (78202) | $1,310 | $2,620 | 2.3× |
| Lung Perf&Ventilat Diferentl (78598) | $1,705 | $3,410 | 2.9× |
| Lung perfusion differential (78597) | $1,705 | $3,410 | 4.0× |
| Lung Ventilat&Perfus Imaging (78582) | $1,605 | $3,210 | 2.8× |
| Lung Ventilation Imaging (78579) | $1,005 | $2,010 | 2.3× |
| Lymph System Imaging (78195) | $1,330 | $2,660 | 2.3× |
| Lymphangiography, pelvic/abdominal, unilateral (75805) | $1,580 | $3,160 | 0.5× |
| Magnetic Image Jaw Joint (70336) | $1,370 | $2,740 | 5.4× |
| Mammary ductogram or galactogram multiple (77054) | $800 | $1,600 | 3.1× |
| Mammary ductogram or galactogram single (77053) | $670 | $1,340 | 2.6× |
| Meckels Divert Exam (78290) | $1,065 | $2,130 | 2.5× |
| Medical physics dose eval radiation expos w/rprt (76145) | $210 | $420 | 0.5× |
| Mlc imrt design & construction per imrt plan (77338) | $1,345 | $2,690 | 3.4× |
| Mr safety determination physician/other qhp (76016) | $260 | $520 | 2.8× |
| Mr safety implant&/fb assmt clin staf 1st 15 min (76014) | $50 | $100 | 1.6× |
| Mr safety implt electronics prepj supvj phys/qhp (76018) | $462.50 | $925 | 4.5× |
| Mr safety implt pos&/immoblj (76019) | $705 | $1,410 | 11.2× |
| Mr safety med physics xm customization plng&mntr (76017) | $1,095 | $2,190 | 4.3× |
| Mra Head W/O & W/Contrast Material (70546) | $2,360 | $4,720 | 6.3× |
| MRA head w/o contrast (70544) | $1,505 | $3,010 | 5.9× |
| MRA head with contrast (70545) | $1,605 | $3,210 | 4.3× |
| MRA neck w contrast (70548) | $1,605 | $3,210 | 4.3× |
| Mra Neck W/O &W/Contrast Material (70549) | $2,360 | $4,720 | 6.3× |
| MRA neck w/o contrast (70547) | $1,505 | $3,010 | 5.9× |
| MRI abdomen w contrast (74182) | $1,605 | $3,210 | 4.3× |
| MRI abdomen w/o contrast (74181) | $1,505 | $3,010 | 5.9× |
| MRI any jt lower extrem w/contrast material (73722) range across 2 matching MRF lines |
$1,605–$2,010 | $3,210–$4,020 | varies |
| MRI any jt lower extrem w/o & w/contrast matrl (73723) range across 2 matching MRF lines |
$2,360–$2,950 | $4,720–$5,900 | varies |
| MRI any jt upper extremity w/contrast matrl (73222) | $1,605 | $3,210 | 1.9× |
| MRI brain functional w/o physician admnistration (70554) | $1,500 | $3,000 | 5.9× |
| MRI brain functional w/physician admnistration (70555) | $1,500 | $3,000 | 5.9× |
| MRI Breast W/O Contrast Bilateral (77047) | $2,425 | $4,850 | 9.5× |
| MRI Breast Without Contrast Material Unilateral (77046) | $1,940 | $3,880 | 7.6× |
| MRI cardiac w/o cont stress (75559) | $1,340 | $2,680 | 2.3× |
| MRI cardiac w/o contrast (75557) | $1,340 | $2,680 | 5.2× |
| MRI cervical spine w contrast (72142) | $1,605 | $3,210 | 4.3× |
| MRI cervical spine w/o cont (72141) | $1,505 | $3,010 | 5.9× |
| MRI chest w/o contrast (71550) | $1,505 | $3,010 | 5.9× |
| MRI chest with contrast (71551) | $1,605 | $3,210 | 1.9× |
| MRI chest wo w contrast (71552) | $2,360 | $4,720 | 6.3× |
| MRI lower extrem oth/thn jt w/contrast matrl (73719) | $1,605 | $3,210 | 4.3× |
| MRI lower extrem oth/thn jt w/o & w/contr matr (73720) | $2,360 | $4,720 | 6.3× |
| MRI lower extrem oth/thn jt w/o contr matrl (73718) | $1,505 | $3,010 | 5.9× |
| MRI lumbar spine w contrast (72149) | $1,605 | $3,210 | 4.3× |
| Mri Neck Spine W/O & W/Dye (72156) | $2,360 | $4,720 | 6.3× |
| MRI orbit face &/neck w/o contrast (70540) | $1,505 | $3,010 | 5.9× |
| MRI orbit face neck w contrast (70542) | $1,605 | $3,210 | 4.3× |
| Mri Orbt/Fac/Nck W/O &W/Dye (70543) | $2,360 | $4,720 | 6.3× |
| MRI pelvis w contrast (72196) | $1,605 | $3,210 | 4.3× |
| MRI pelvis w/o & w contrast (72197) | $2,360 | $4,720 | 6.3× |
| MRI pelvis w/o contrast (72195) | $1,505 | $3,010 | 5.9× |
| MRI spectroscopy (76390) | $950 | $1,900 | 10.2× |
| MRI thoracic spine w/o contrast (72146) | $1,505 | $3,010 | 5.9× |
| MRI upper extremity oth than jt w/contr matrl (73219) | $1,605 | $3,210 | 4.3× |
| MRI upper extremity oth than jt w/o contr matrl (73218) range across 2 matching MRF lines |
$1,505–$1,880 | $3,010–$3,760 | varies |
| Mri Uppr Extremity W/O&W/Dye (73220) | $2,360 | $4,720 | 6.3× |
| MRI, abdomen, combo (74183) | $2,360 | $4,720 | 6.3× |
| MRI, dorsal spine combo (72157) | $2,360 | $4,720 | 6.3× |
| MRI, dorsal spine contrast (72147) | $1,605 | $3,210 | 4.3× |
| MRI, joint upper extrem (73221) range across 2 matching MRF lines |
$1,505–$1,880 | $3,010–$3,760 | varies |
| MRI, joint upper extrem combo (73223) | $2,360 | $4,720 | 6.3× |
| MRI, lumbar spine combo (72158) | $2,360 | $4,720 | 6.3× |
| Myocardial Imaging Infarct Avid Planar Qual/Quan (78466) | $1,240 | $2,480 | 2.9× |
| Myocardial Imaging Pet Metabolic Evaluation (78459) | $4,850 | $9,700 | 3.5× |
| Myocardial Spect Multiple Studies (78452) | $3,250 | $6,500 | 2.3× |
| Myocrd Img Pet Metab Eval Single Study Cncrnt CT (78429) | $4,850 | $9,700 | 3.2× |
| Myocrd img PET prfuj 1std rest/stress cncrnt CT (78430) | $2,810 | $5,620 | 1.8× |
| Myocrd Img Pet Prfuj Mlt Std Rst&Strs Cncrnt CT (78431) | $4,300 | $8,600 | 1.8× |
| N-invas est c ffr sw aly CTA (75580) | $1,640 | $3,280 | 1.8× |
| Neck soft tissue (70360) | $232.50 | $465 | 2.5× |
| Njx Rp Loclzj Non-Img Probe Study Intravenous (78808) | $740 | $1,480 | 1.7× |
| Nm myocard infarct spect (78469) | $1,855 | $3,710 | 3.2× |
| Nonvascular Shunt X-Ray (75809) | $345 | $690 | 3.1× |
| Ntsty modul radthx pln dose-vol histos (77301) | $7,055 | $14,110 | 4.8× |
| Nuclear Rx Intra-Arterial (79445) | $735 | $1,470 | 2.9× |
| Nuclear Rx Oral Admin (79005) | $905 | $1,810 | 3.6× |
| Ob us nuchal meas 1 gest (76813) | $435 | $870 | 3.9× |
| Ophthalmic ultrasound dx b-scan w/wo a-scan (76512) | $150 | $300 | 1.3× |
| Panoramic X-ray of jaws (70355) | $215 | $430 | 2.3× |
| Parathyroid Planar Imaging (78070) | $1,035 | $2,070 | 2.4× |
| Parathyroid planar imaging w/wo subtraction (78071) | $1,295 | $2,590 | 3.0× |
| Pelvis 1 or 2 views (72170) | $412.50 | $825 | 3.7× |
| Peritoneogram Rs&I (74190) | $640 | $1,280 | 1.1× |
| Pet Image W/Ct Lmtd (78814) | $4,850 | $9,700 | 3.2× |
| PET image w/CT, full body (78816) | $4,850 | $9,700 | 3.2× |
| PET imaging CT attenuation skull base mid-thigh (78815) | $4,850 | $9,700 | 3.2× |
| Pet Myocardial Sngl Study (78491) | $4,850 | $9,700 | 3.2× |
| Prq Transhepatc Portograpy Hemodyn Eval Rs&I (75885) | $3,940 | $7,880 | 1.2× |
| Pulmonary Perfusion Imaging Particulate (78580) | $855 | $1,710 | 2.0× |
| Radex Abd Compl Aqt Abd W/S/E/D Views 1 View Ch (74022) | $382.50 | $765 | 3.4× |
| Radex abscess/fistula/sinus tract rs&i (76080) | $910 | $1,820 | 1.6× |
| Radex Ankle Complete Minimum 3 Views (73610) range across 2 matching MRF lines |
$272.50–$345 | $545–$690 | varies |
| Radex Calcaneus Minimum 2 Views (73650) range across 3 matching MRF lines |
$215–$270 | $430–$540 | varies |
| Radex elbow complete minimum 3 views (73080) range across 2 matching MRF lines |
$285–$360 | $570–$720 | varies |
| Radex Facial Bones Complete Minimum 3 Views (70150) | $342.50 | $685 | 3.1× |
| Radex fingr minimum 2 views (73140) range across 2 matching MRF lines |
$272.50–$345 | $545–$690 | varies |
| Radex foot complete minimum 3 views (73630) range across 2 matching MRF lines |
$282.50–$355 | $565–$710 | varies |
| Radex Hand Minimum 3 Views (73130) range across 2 matching MRF lines |
$312.50–$390 | $625–$780 | varies |
| Radex lower extremity infant minimum 2 views (73592) range across 3 matching MRF lines |
$297.50–$370 | $595–$740 | varies |
| Radex Nasal Bones Complete Minimum 3 Views (70160) | $220 | $440 | 2.4× |
| Radex Ribs Unilateral 2 Views (71100) | $327.50 | $655 | 3.5× |
| Radex shoulder complete minimum 2 views (73030) range across 2 matching MRF lines |
$272.50–$345 | $545–$690 | varies |
| Radex Sinuses Paransl < 3 Views (70210) | $160 | $320 | 1.7× |
| Radex sm int w/mlt srl imges via enteroclss tube (74251) | $1,090 | $2,180 | 5.8× |
| Radex Spine 1 View Specify Level (72020) | $220 | $440 | 2.4× |
| Radex Sternum Minimum 2 Views (71120) | $230 | $460 | 2.5× |
| Radex Temporomandble Jt Opn & Clsd Mouth Bilat (70330) | $232.50 | $465 | 2.5× |
| Radex Toe Minimum 2 Views (73660) range across 2 matching MRF lines |
$212.50–$265 | $425–$530 | varies |
| Radex upper extremity infant minimum 2 views (73092) range across 2 matching MRF lines |
$285–$360 | $570–$720 | varies |
| Radex Wrist Complete Minimum 3 Views (73110) range across 2 matching MRF lines |
$285–$360 | $570–$720 | varies |
| Radex X-Ray Exam Entire Spi 6/> Vw - Xr Entire Spine 6+ Vw (72084) | $615 | $1,230 | 5.5× |
| Radiation Delivery Stereotactic Cranial Linear (77372) | $16,170 | $32,340 | 2.0× |
| Radiation treatment delivery level 1 (77402) | $590 | $1,180 | 5.4× |
| Radiation treatment delivery level 2 (77407) | $735 | $1,470 | 1.8× |
| Radiation treatment delivery level 3 (77412) | $920 | $1,840 | 1.6× |
| Radiolog exam mandible compl minimum 4 views (70110) | $295 | $590 | 2.6× |
| Radiologic Exam Abdomen 3+ Views - Xr Abdomen 3+ Views (74021) | $342.50 | $685 | 3.1× |
| Radiologic exam colon double contrast study (74280) | $700 | $1,400 | 3.7× |
| Radiologic exam colon single contrast study (74270) | $467.50 | $935 | 2.5× |
| Radiologic Exam Esophagus Double Contrast Study (74221) | $445 | $890 | 2.4× |
| Radiologic exam knee complete 4/more views (73564) range across 2 matching MRF lines |
$410–$515 | $820–$1,030 | varies |
| Radiologic exam pelvis compl minimum 3 views (72190) | $515 | $1,030 | 4.6× |
| Radiologic Exam Small Int Single Contrast Study (74250) | $397.50 | $795 | 2.1× |
| Radiologic exam swallow function contrast study (74230) | $385 | $770 | 2.0× |
| Radiologic exam upr gi trc double contrast study (74246) | $440 | $880 | 2.3× |
| Radiologic examination femur 1 view (73551) range across 2 matching MRF lines |
$217.50–$275 | $435–$550 | varies |
| Radiologic examination femur minimum 2 views (73552) range across 2 matching MRF lines |
$272.50–$345 | $545–$690 | varies |
| Radiologic examination knee 1/2 views (73560) range across 2 matching MRF lines |
$235–$290 | $470–$580 | varies |
| Radiologic Examination Osseous Survey Limited (77074) | $307.50 | $615 | 2.7× |
| Radiologic examination tibia & fibula 2 views (73590) range across 4 matching MRF lines |
$270–$340 | $540–$680 | varies |
| Renal Cyst Study (74470) | $735 | $1,470 | 1.3× |
| Ribs bilateral 3 views (71110) | $540 | $1,080 | 4.8× |
| Rp loclzj tum plnr 1 area single day imaging (78800) | $820 | $1,640 | 1.9× |
| Rp loclzj tum plnr 2+area 1+d img/1 area img>2+d (78801) | $1,110 | $2,220 | 2.6× |
| Rp Loclzj Tum Plnr Whole Body 2+ Days Imaging (78804) | $2,465 | $4,930 | 4.2× |
| Rp Loclzj Tum Plnr Whole Body Single Day Imaging (78802) | $1,645 | $3,290 | 2.8× |
| Rp Loclzj Tum Spect 1 Area Single Day Imaging (78803) | $1,645 | $3,290 | 2.8× |
| Rp loclzj tum spect 2 area/sep acquisj img (78831) | $2,495 | $4,990 | 1.8× |
| Rp loclzj tum spect CT 2area 1d img/1 ar img>2+d (78832) | $3,330 | $6,660 | 2.2× |
| Rp loclzj tum spect w/CT 1 area/acquisj 1day img (78830) | $1,665 | $3,330 | 1.2× |
| Rp Ther Radiolbld Monoclonal Antibody IV Infus (79403) | $920 | $1,840 | 3.7× |
| Rp Therapy Intravenous Administration (79101) | $995 | $1,990 | 4.0× |
| Scapula (73010) range across 3 matching MRF lines |
$225–$280 | $450–$560 | varies |
| Screening Digital Breast Tomosynthesis Bi (77063) | $152.50 | $305 | 6.5× |
| Sella turcica (70240) | $162.50 | $325 | 1.7× |
| Shoulder 1 view (73020) range across 2 matching MRF lines |
$202.50–$255 | $405–$510 | varies |
| Shoulder Arthrography (73040) | $885 | $1,770 | 2.4× |
| Sialogram (70390) | $472.50 | $945 | 1.8× |
| Skull less than 4 views (70250) | $290 | $580 | 2.6× |
| Special dosimetry (77331) | $525 | $1,050 | 3.6× |
| Special Physics Consult (77370) | $485 | $970 | 3.4× |
| Special teletherapy port plan (77321) | $1,205 | $2,410 | 3.0× |
| Special treatment procedure (77470) | $1,945 | $3,890 | 3.3× |
| Stereotactic Body Radiation Delivery (77373) | $8,285 | $16,570 | 4.3× |
| Sternoclavicular joints (71130) | $285 | $570 | 3.1× |
| Superior sagittal sinus venogram (75870) | $2,330 | $4,660 | 0.7× |
| Telethx isodose pln cplx w/basic dosimetry (77307) | $1,655 | $3,310 | 4.1× |
| Telethx isodose pln smpl w/dosimetry calculation (77306) | $970 | $1,940 | 2.4× |
| Temporomandble Jt Arthrography Rs&I (70332) | $885 | $1,770 | 3.5× |
| Ther Rad Simulaj-Aided Field Setting Complex (77290) | $2,130 | $4,260 | 5.3× |
| Ther Rad Simulaj-Aided Field Setting Intermed (77285) | $1,415 | $2,830 | 3.5× |
| Ther rad simulaj-aided field setting simple (77280) | $945 | $1,890 | 6.6× |
| Therapeutic Enema Rdctj Intussusception/Obstrcj (74283) | $500 | $1,000 | 2.7× |
| Thoracic spine 2 views (72070) | $470 | $940 | 4.2× |
| Thoracic spine 3 views (72072) | $510 | $1,020 | 4.6× |
| Thoracolumbar 2 views (72080) | $200 | $400 | 2.1× |
| Thyroid Imaging With Vascular Flow (78013) | $795 | $1,590 | 1.9× |
| Thyroid Met Imaging Body (78018) | $1,320 | $2,640 | 2.3× |
| Thyroid Uptake Measurement (78012) | $720 | $1,440 | 1.7× |
| Thyroid Uptake W/Blood Flow Sngle/Mult Quan Meas (78014) | $1,075 | $2,150 | 2.5× |
| Tx Devices Design & Construction Complex (77334) | $1,215 | $2,430 | 3.0× |
| Tx devices design & construction intermediate (77333) | $695 | $1,390 | 4.8× |
| Tx devices design & construction simple (77332) | $580 | $1,160 | 4.0× |
| Ultrasound Breast Limited (76642) range across 2 matching MRF lines |
$397.50–$595 | $795–$1,190 | varies |
| Ultrasound Exam Aaa Screen (76706) | $375 | $750 | 3.3× |
| Ultrasound, abdomen limited (76705) | $730 | $1,460 | 6.5× |
| Umbilical-artery Doppler (OB) (76820) | $355 | $710 | 3.2× |
| Unlisted Dx Radiographic Procedure (76499) | $310 | $620 | 3.3× |
| Unlisted magnetic resonance procedure (76498) | $72.50 | $145 | 0.8× |
| Unlisted us procedure (76999) | $545 | $1,090 | 5.8× |
| Upper gi w/o kub (74240) | $387.50 | $775 | 2.1× |
| Ureteral Reflux Study (78740) | $1,165 | $2,330 | 2.7× |
| Urethrocystogram voiding (74455) | $695 | $1,390 | 2.7× |
| Urethrocystography retrograde (74450) | $510 | $1,020 | 2.0× |
| Us breast unilateral complete (76641) range across 2 matching MRF lines |
$497.50–$745 | $995–$1,490 | varies |
| Us chest (76604) | $585 | $1,170 | 5.2× |
| Us complete joint (76881) range across 2 matching MRF lines |
$540–$675 | $1,080–$1,350 | varies |
| Us exam, pelvic, limited (76857) | $660 | $1,320 | 5.9× |
| Us head (76506) | $520 | $1,040 | 4.6× |
| Us kidney transplant (76776) | $515 | $1,030 | 4.6× |
| Us lmtd joint/oth nonvasc xtr strux r-t w/img (76882) range across 2 matching MRF lines |
$405–$510 | $810–$1,020 | varies |
| Us ob detailed single fetus (76811) | $1,025 | $2,050 | 4.0× |
| Us ob limited 1 or more fetuses (76815) | $362.50 | $725 | 3.2× |
| Us ob transvaginal (76817) | $595 | $1,190 | 5.3× |
| Us pelvic non ob complete (76856) | $880 | $1,760 | 7.9× |
| Us pg uter img f&mat 14 wk tabdl 1/1st gestation (76801) | $555 | $1,110 | 5.0× |
| Us preg uterus real time f/u trnsabdl per fetus (76816) | $362.50 | $725 | 3.2× |
| Us retroperitoneal complete (76770) | $980 | $1,960 | 8.7× |
| Us retroperitoneal limited (76775) | $735 | $1,470 | 6.6× |
| Us scrotum and contents (76870) | $715 | $1,430 | 6.4× |
| Us spinal canal and contents (76800) | $415 | $830 | 3.7× |
| Us thyroid (76536) | $695 | $1,390 | 6.2× |
| Us transrectal (76872) | $530 | $1,060 | 4.7× |
| Vein X-Ray Chest (75827) | $1,485 | $2,970 | 0.9× |
| Vein X-Ray Liver W/O Hemodyn (75887) | $2,365 | $4,730 | 0.7× |
| Vein X-Ray Skull Epidural (75872) | $2,830 | $5,660 | 4.2× |
| Vein X-Ray Spleen/Liver (75810) | $2,645 | $5,290 | 0.8× |
| Venogram Sinus/Jugular (75860) | $3,295 | $6,590 | 1.0× |
| Venography Adrenal Unilateral (75840) | $3,900 | $7,800 | 1.2× |
| Venography caval inferior serialography rs&i (75825) | $2,975 | $5,950 | 0.9× |
| Venography extremity bilateral rs&i (75822) | $1,935 | $3,870 | 1.1× |
| Venography extremity unilateral rs&i (75820) | $1,290 | $2,580 | 0.8× |
| Venography Orbital Rs&I (75880) | $1,825 | $3,650 | 2.7× |
| Venography Renal Bilateral (75833) | $3,250 | $6,500 | 1.0× |
| Venography Renal Unilateral (75831) | $2,600 | $5,200 | 0.8× |
| Venous sampling by catheter (75893) unusually low: confirm this is the full procedure |
$2,775 | $5,550 | 0.5× |
| Wrist 2 views (73100) range across 4 matching MRF lines |
$230–$285 | $460–$570 | varies |
| X-Ray Ac Jts - Xr Acromioclavicular Joints Bilateral (73050) | $202.50 | $405 | 2.2× |
| X-ray antegrade pyelogram tube (74425) | $965 | $1,930 | 2.6× |
| X-Ray Aorta Leg Arteries (75630) | $3,850 | $7,700 | 1.1× |
| X-Ray Bend Only L-S Spine (72120) | $497.50 | $995 | 4.4× |
| X-Ray Elbow 2 Vw - Xr Elbow 1-2 Views Right (73070) range across 3 matching MRF lines |
$230–$285 | $460–$570 | varies |
| X-Ray Exam Breast Specimen (76098) | $390 | $780 | 0.7× |
| X-Ray Exam Entire Spi 1 Vw (72081) | $272.50 | $545 | 2.9× |
| X-Ray Exam Entire Spi 2/3 Vw (72082) | $510 | $1,020 | 4.6× |
| X-Ray Exam Hip Uni 1 View (73501) | $235 | $470 | 2.5× |
| X-Ray Exam Hip Uni 2-3 Views (73502) | $270 | $540 | 2.9× |
| X-Ray Exam Hip Uni 4/> Views (73503) | $312.50 | $625 | 2.8× |
| X-Ray Exam Hips Bi 2 Views (73521) | $350 | $700 | 3.1× |
| X-Ray Exam Hips Bi 3-4 Views (73522) | $470 | $940 | 4.2× |
| X-Ray Exam Hips Bi 5/> Views (73523) | $700 | $1,400 | 6.2× |
| X-Ray Exam L-S Spine Bending (72114) | $745 | $1,490 | 6.7× |
| X-Ray Exam Neck Spine 2-3 Vw (72040) | $272.50 | $545 | 2.9× |
| X-Ray Exam Neck Spine 6/>Vws (72052) | $560 | $1,120 | 5.0× |
| X-Ray Exam Unilat Ribs/Chest (71101) | $492.50 | $985 | 4.4× |
| X-ray eye for foreign body (70030) range across 2 matching MRF lines |
$187.50–$235 | $375–$470 | varies |
| X-ray humerus (73060) range across 3 matching MRF lines |
$272.50–$345 | $545–$690 | varies |
| X-ray IV pyelogram (ivp) (74400) | $745 | $1,490 | 4.0× |
| X-Ray Jaw <4 Vw - Xr Mandible < 4 Views (70100) | $235 | $470 | 2.5× |
| X-Ray Knee Bilat Standing - Xr Knees Anteroposterior Standing Bilat (73565) | $257.50 | $515 | 2.8× |
| X-Ray Lumbar Spine 2/3 Vw - Xr Lumbar Spine 2-3 Views (72100) | $452.50 | $905 | 4.0× |
| X-ray nose-rectum child f.b. (76010) | $230 | $460 | 2.5× |
| X-Ray Ribs, Chest 4+ Vw - Xr Ribs 3 Vws Bil W/ Chest Posteroanterior (71111) | $600 | $1,200 | 5.4× |
| X-Ray Sacroiliac Jts 3+ Vw - Xr Sacroiliac Joints 3+ Views (72202) | $362.50 | $725 | 3.2× |
| X-Ray Sacroiliac Jts <3 Vw - Xr Sacroiliac Joints 1-2 Views (72200) | $287.50 | $575 | 2.6× |
| X-Ray Sacrum/Coccyx 2+ Vw - Xr Sacrum Coccyx 2+ Views (72220) | $237.50 | $475 | 2.5× |
| X-Ray Sinuses 3+ Vw - Xr Paranasal Sinuses 3+ Views (70220) | $242.50 | $485 | 2.6× |
| X-Ray Skull 4+ Vw - Xr Skull Complete 4+ Views (70260) | $437.50 | $875 | 3.9× |
| X-ray thoracic spine 4 vw (72074) | $560 | $1,120 | 5.0× |
| X-Ray Tmj Unilat (70328) | $185 | $370 | 2.0× |
| X-Ray Urinary Tract Exam With Contrast Material (74420) | $855 | $1,710 | 2.3× |
| X-Rays Bone Length Studies (77073) | $237.50 | $475 | 2.1× |
| X-Rays Bone Survey Complete (77075) | $460 | $920 | 4.1× |
| Xr c-spine 4 or 5 views (72050) | $510 | $1,020 | 4.6× |
| Xr facial bones less than 3 views (70140) | $230 | $460 | 2.5× |
| XR Mastoids < 3 Views Bilateral (70120) | $225 | $450 | 2.0× |
| Xr orbits complete 4 views (70200) | $322.50 | $645 | 2.9× |
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.