Imaging prices at Asante Three Rivers Medical Center
Grants Pass, OR · every code in this section with a posted price and a Medicare benchmark.
398 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) | $5,580.18 | $8,584.90 | 3.4× |
| Abdomen 1 View (74018) | $267.48 | $411.50 | 2.6× |
| Abdomen 2 views (74019) | $323.57 | $497.80 | 2.6× |
| Acute Gastrointestinal Blood Loss Imaging (78278) | $1,638.78 | $2,521.20 | 3.5× |
| Angio internal mammary (75756) | $9,378.66 | $14,428.70 | 2.5× |
| Angio pulmonary bilat (75743) | $9,378.66 | $14,428.70 | 2.5× |
| Angiography Adrenal Bilateral Slctv Rs&I (75733) | $9,378.66 | $14,428.70 | 2.5× |
| Angiography extremity bilateral rs&i (75716) | $9,378.66 | $14,428.70 | 2.5× |
| Angiography extremity unilateral rs&i (75710) range across 2 matching MRF lines |
$2,695.36–$9,378.66 | $4,146.70–$14,428.70 | varies |
| Angiography pulmonary unilateral slctv rs&i (75741) | $9,378.66 | $14,428.70 | 2.5× |
| Ankle 2 views (73600) | $267.48 | $411.50 | 2.6× |
| Aortography thoracic serialography rs&i (75605) | $16,169.14 | $24,875.60 | 2.5× |
| Artery X-Rays Abdomen (75726) | $16,169.14 | $24,875.60 | 2.5× |
| Artery X-Rays Adrenal Gland (75731) | $8,619.06 | $13,260.10 | 2.3× |
| Artery X-Rays Pelvis (75736) | $16,169.14 | $24,875.60 | 2.5× |
| Artery X-Rays Spine (75705) | $16,169.14 | $24,875.60 | 2.5× |
| Arthrogram ankle (73615) | $1,131.58 | $1,740.90 | 2.8× |
| Arthrogram hip (73525) range across 4 matching MRF lines |
$305.82–$1,131.58 | $470.50–$1,740.90 | varies |
| Arthrogram Wrist (73115) range across 4 matching MRF lines |
$305.82–$1,131.58 | $470.50–$1,740.90 | varies |
| Basic radiation dosimetry calculation (77300) | $541.52 | $833.10 | 3.4× |
| Bone age studies (77072) | $323.57 | $497.80 | 2.6× |
| Bone Imaging 3 Phase (78315) | $1,638.78 | $2,521.20 | 3.5× |
| Bone Imaging Limited Area (78300) | $1,638.78 | $2,521.20 | 3.5× |
| Bone Imaging Multiple Areas (78305) | $1,638.78 | $2,521.20 | 3.5× |
| Bone Imaging Whole Body (78306) range across 2 matching MRF lines |
$475.28–$1,638.78 | $731.20–$2,521.20 | varies |
| Bone survey infant (77076) | $323.57 | $497.80 | 2.6× |
| Brain Imaging Min 4 Static Views W Vascular Flow (78606) | $1,638.78 | $2,521.20 | 2.6× |
| Card Bl Pool Gated Spect Rest Wal Motn Ejct Frct (78494) range across 2 matching MRF lines |
$125.64–$1,638.78 | $193.30–$2,521.20 | varies |
| Cat Scan Follow-Up Study (76380) | $503.36 | $774.40 | 4.9× |
| Cerebrospinal Fluid Flow W/O Matl Shunt Evaltj (78645) | $2,195.24 | $3,377.30 | 3.4× |
| Cerebrospinal fluid flow, imaging (not including introduction of material); ventriculography Non-Facility (78635) | $2,195.24 | $3,377.30 | 3.4× |
| Cerebrospinal Fluid Scan (78630) | $2,195.24 | $3,377.30 | 3.4× |
| Chest 1 view (71045) | $342.81 | $527.40 | 3.4× |
| Chest 2 views (71046) | $342.81 | $527.40 | 3.4× |
| Chest 3 views (71047) | $267.48 | $411.50 | 2.6× |
| Chest 4 or more views (71048) | $323.57 | $497.80 | 2.6× |
| Cholecystography Oral Contrast (74290) | $540.67 | $831.80 | 2.6× |
| Cineradiograpy/vidradiograpy xcpt where spec (76120) | $323.57 | $497.80 | 2.6× |
| Clavicle complete (73000) | $267.48 | $411.50 | 2.6× |
| Computed Tomography Thorax Lw Dose Lng Ca Scr C- (71271) | $433.74 | $667.30 | 3.5× |
| Continuing medical physics consltj pr wk (77336) | $541.52 | $833.10 | 3.4× |
| Contrast Exam Abdominl Aorta (75625) | $9,378.66 | $14,428.70 | 2.5× |
| Contrast X-Ray Bladder (74430) | $1,131.58 | $1,740.90 | 2.8× |
| Contrast X-Ray Of Elbow (73085) | $1,131.58 | $1,740.90 | 2.8× |
| Contrast X-Ray Of Knee Joint (73580) range across 4 matching MRF lines |
$305.82–$1,131.58 | $470.50–$1,740.90 | varies |
| Contrast Xray Throat/Cerv Esopha (74210) | $540.67 | $831.80 | 2.6× |
| CT abdomen and pelvis without and with contrast (74178) | $2,248.68 | $3,459.50 | 5.5× |
| CT abdomen and pelvis without contrast (74176) | $1,424.74 | $2,191.90 | 5.1× |
| CT abdomen w contrast (74160) range across 2 matching MRF lines |
$733.52–$1,023.88 | $1,128.50–$1,575.20 | varies |
| CT abdomen w wo contrast (74170) | $1,261.32 | $1,940.50 | 6.1× |
| CT abdomen w/o contrast (74150) range across 2 matching MRF lines |
$402.61–$696.02 | $619.40–$1,070.80 | varies |
| CT Angio Abdomen and Pelvis (74174) | $2,818.27 | $4,335.80 | 6.9× |
| CT Angio Chest (71275) | $1,469.98 | $2,261.50 | 7.1× |
| CT Angio Head (70496) range across 2 matching MRF lines |
$685.42–$1,503.45 | $1,054.50–$2,313 | varies |
| CT angio hrt w/3d image (75574) | $1,493.05 | $2,297 | 3.6× |
| Ct Angio Lwr Extr W/O&W/Dye (73706) | $1,439.49 | $2,214.60 | 7.0× |
| CT Angio Neck (70498) | $1,503.45 | $2,313 | 7.3× |
| Ct Angio Upr Extrm W/O&W/Dye (73206) | $1,305.59 | $2,008.60 | 6.3× |
| CT Cere Prfuj Alys C+ W/O CT/Cta Same Anatomy (70473) | $1,680.38 | $2,585.20 | 8.2× |
| CT cervical spine w/ contrast (72126) | $1,332.50 | $2,050 | 3.3× |
| CT cervical spine w/o contrast (72125) | $1,027.72 | $1,581.10 | 8.4× |
| CT cervical spine w/wo cont (72127) | $1,492.14 | $2,295.60 | 7.2× |
| CT chest w contrast (71260) range across 2 matching MRF lines |
$692.12–$1,140.36 | $1,064.80–$1,754.40 | varies |
| CT chest w/wo contrast (71270) | $1,273.48 | $1,959.20 | 6.2× |
| CT colonography screening (74263) | $1,836.06 | $2,824.70 | 6.6× |
| CT colonogrphy dx image postprocess w/o contrast (74261) | $870.48 | $1,339.20 | 7.1× |
| CT head/brain with contrast (70460) | $1,075.68 | $1,654.90 | 5.2× |
| CT head/brain without and with contrast (70470) | $1,296.94 | $1,995.30 | 6.3× |
| CT heart contrast eval cardiac structure&morph (75572) | $1,456.52 | $2,240.80 | 3.6× |
| CT heart no contrast quant eval coronry calcium (75571) range across 3 matching MRF lines |
$97.50–$1,031.22 | $150–$1,586.50 | varies |
| CT hrt w/3d image congen (75573) | $1,456.52 | $2,240.80 | 3.6× |
| CT iac w contrast (70481) | $1,311.90 | $2,018.30 | 6.4× |
| CT l-spine w&w/o contrast (72133) | $1,417.52 | $2,180.80 | 6.9× |
| CT lower ext w/o (73700) range across 4 matching MRF lines |
$424.97–$849.88 | $653.80–$1,307.50 | varies |
| CT lower extremity w/contrast material (73701) range across 4 matching MRF lines |
$641.88–$1,131.39 | $987.50–$1,740.60 | varies |
| CT lumbar spine w contrast (72132) | $1,299.48 | $1,999.20 | 3.2× |
| CT lumbar spine w/o contrast (72131) | $985.86 | $1,516.70 | 8.0× |
| CT maxillofacial w contrast (70487) | $925.28 | $1,423.50 | 4.5× |
| CT maxillofacial wo contrast (70486) range across 2 matching MRF lines |
$402.61–$657.86 | $619.40–$1,012.10 | varies |
| CT neck tissue combo (70492) | $1,482.32 | $2,280.50 | 7.2× |
| Ct Orbit/Ear/Fossa W/O&W/Dye (70482) | $1,486.68 | $2,287.20 | 7.2× |
| CT orbits w/o contrast (70480) | $1,040 | $1,600 | 8.5× |
| CT pelvis w&w/o contrast (72194) | $1,139.71 | $1,753.40 | 5.5× |
| CT pelvis w/o contrast (72192) range across 2 matching MRF lines |
$418.21–$728.91 | $643.40–$1,121.40 | varies |
| CT scan of leg combo (73702) | $1,260.74 | $1,939.60 | 6.1× |
| CT scans face/jaw combo (70488) | $1,168.70 | $1,798 | 5.7× |
| CT soft tissue neck w contrast (70491) | $1,277.84 | $1,965.90 | 6.2× |
| CT soft tissue neck w/o contrast (70490) | $1,031.88 | $1,587.50 | 8.4× |
| CT thoracic spine w contrast (72129) | $1,299.48 | $1,999.20 | 6.3× |
| CT thoracic spine w/o contrast (72128) | $967.98 | $1,489.20 | 7.9× |
| CT thoracic spine w/wo cont (72130) | $1,417.52 | $2,180.80 | 6.9× |
| CT thorax w/o contrast (71250) range across 3 matching MRF lines |
$414.76–$858.84 | $638.10–$1,321.30 | varies |
| CT upper ext wo (73200) | $849.88 | $1,307.50 | 6.9× |
| CT upper extremity w/o & w/contrast material (73202) | $1,260.74 | $1,939.60 | 6.1× |
| CT upper extremity with contrast (73201) | $1,352.06 | $2,080.10 | 3.3× |
| Cta Abdl Aorta&Bi Iliofem W/Contrast&Postp (75635) | $1,661.08 | $2,555.50 | 8.1× |
| Cta Abdomen (74175) | $1,503.45 | $2,313 | 7.3× |
| CTA head&neck c+ w/noncontrast img&post-pxessing (70471) | $3,006.90 | $4,626 | 7.3× |
| CTA pelvis (72191) | $1,503.45 | $2,313 | 7.3× |
| Dilation ureters/urethra rs&i (74485) | $6,049.10 | $9,306.30 | 2.5× |
| Discography Cerv/Thor Spine (72285) | $5,766.34 | $8,871.30 | 2.5× |
| Diskography lumbar (72295) | $5,766.34 | $8,871.30 | 2.5× |
| Doppler Echo Fetal Puls Spectral F/U/Repeat (76828) | $323.57 | $497.80 | 2.6× |
| Doppler Echo Fetal Spectral Display Complete (76827) | $323.57 | $497.80 | 2.6× |
| Doppler Fetal Mid Cerebral Artery (76821) | $314.02 | $483.10 | 2.6× |
| Dxa Bone Density Axial (77080) | $433.74 | $667.30 | 3.5× |
| Dxa bone density study (77085) | $323.57 | $497.80 | 2.6× |
| Dxa bone density study 1/>sites appendiclr skel (77081) | $359.12 | $552.50 | 3.5× |
| Echo exam of fetal heart (76825) | $2,236.13 | $3,440.20 | 3.5× |
| Echo exam uterus (76831) | $924.36 | $1,422.10 | 3.3× |
| Echo Guide For Artery Repair (76936) | $1,270.04 | $1,953.90 | 5.0× |
| Echocardiography, fetal, cardiovascular system, real time with image documentation (2D), with or without M-mode… (76826) | $985.86 | $1,516.70 | 3.5× |
| Esophagram (74220) range across 2 matching MRF lines |
$152.49–$540.67 | $234.60–$831.80 | varies |
| Fetal Biophys Profile W/Nst (76818) | $433.74 | $667.30 | 3.5× |
| Fetal Biophysical Profile W/O Non-Stress Testing (76819) | $433.74 | $667.30 | 3.5× |
| Fluoroscopy up to 1 hr (76000) | $985.86 | $1,516.70 | 3.5× |
| Follow-Up Angiography (75898) | $8,619.06 | $13,260.10 | 2.3× |
| Foot 2 views (73620) | $267.48 | $411.50 | 2.6× |
| Forearm 2 views (73090) | $267.48 | $411.50 | 2.6× |
| Gastric emptying imaging study (78264) | $1,638.78 | $2,521.20 | 3.5× |
| Gastroesophageal Reflux Exam (78262) | $1,638.78 | $2,521.20 | 3.5× |
| Gated Heart Planar Single (78472) range across 2 matching MRF lines |
$103.42–$1,638.78 | $159.10–$2,521.20 | varies |
| Hand 2 views (73120) | $323.57 | $497.80 | 2.6× |
| Heart first pass single,planar (78481) | $2,195.24 | $3,377.30 | 3.4× |
| Hepatc Vngrph Wdg/Fr Hemodyn Eval Rs&I (75889) | $9,378.66 | $14,428.70 | 2.5× |
| Hepatobil Syst Image W/Drug (78227) | $2,195.24 | $3,377.30 | 3.4× |
| Hepatobiliary System Imaging (78226) | $1,638.78 | $2,521.20 | 3.5× |
| Ht Muscle Image Spect Sing (78451) range across 3 matching MRF lines |
$144.76–$5,356.46 | $222.70–$8,240.70 | varies |
| Hysterosalpingogram (74740) | $721.04 | $1,109.30 | 2.6× |
| Image fusion (77399) | $541.52 | $833.10 | 3.4× |
| Infant hip ultrasound with hip movement (dynamic) (76885) | $267.48 | $411.50 | 2.6× |
| Infusion Ivp (74410) | $726.05 | $1,117 | 3.5× |
| Joint Survey Single View (77077) | $323.57 | $497.80 | 2.6× |
| K Flow/Funct Image W/Drug (78708) | $2,195.24 | $3,377.30 | 3.4× |
| K Flow/Funct Image W/O Drug (78707) | $2,195.24 | $3,377.30 | 3.4× |
| Kidney Imaging Morphol (78700) | $1,638.78 | $2,521.20 | 3.5× |
| Kidney Imaging Morphoogy W/Vascular Flow (78701) | $1,638.78 | $2,521.20 | 3.5× |
| Knee 3 Views (73562) | $267.48 | $411.50 | 2.6× |
| Labeled RBC Sequestration Differntl Organ/Tissue (78140) | $1,638.78 | $2,521.20 | 3.5× |
| Leveen/Shunt Patency Exam (78291) | $1,638.78 | $2,521.20 | 3.5× |
| Liver & Spleen Imaging Static Only (78215) | $1,638.78 | $2,521.20 | 3.5× |
| Lung Perf&Ventilat Diferentl (78598) | $2,195.24 | $3,377.30 | 3.4× |
| Lung Ventilat&Perfus Imaging (78582) | $2,195.24 | $3,377.30 | 3.4× |
| Lung Ventilation Imaging (78579) | $1,638.78 | $2,521.20 | 3.5× |
| Lymph System Imaging (78195) | $2,195.24 | $3,377.30 | 3.4× |
| Magnetic Image Jaw Joint (70336) | $936.06 | $1,440.10 | 3.3× |
| Mammary ductogram or galactogram multiple (77054) | $721.04 | $1,109.30 | 2.6× |
| Mammary ductogram or galactogram single (77053) range across 3 matching MRF lines |
$207.02–$721.04 | $318.50–$1,109.30 | varies |
| Meckels Divert Exam (78290) | $1,638.78 | $2,521.20 | 3.5× |
| Mlc imrt design & construction per imrt plan (77338) | $1,492.98 | $2,296.90 | 3.4× |
| Mr safety determination physician/other qhp (76016) | $260 | $400 | 2.5× |
| Mr safety implant&/fb assmt clin staf 1st 15 min (76014) | $74.75 | $115 | 2.2× |
| Mra Head W/O & W/Contrast Material (70546) | $1,725.62 | $2,654.80 | 4.2× |
| MRA head w/o contrast (70544) range across 2 matching MRF lines |
$924.36–$1,101.10 | $1,422.10–$1,694 | varies |
| MRA head with contrast (70545) | $1,288.69 | $1,982.60 | 3.1× |
| MRA neck w contrast (70548) | $1,288.69 | $1,982.60 | 3.1× |
| Mra Neck W/O &W/Contrast Material (70549) | $1,752.08 | $2,695.50 | 4.3× |
| MRA neck w/o contrast (70547) range across 2 matching MRF lines |
$265.40–$1,101.10 | $408.30–$1,694 | varies |
| MRI abdomen w contrast (74182) | $1,431.24 | $2,201.90 | 3.5× |
| MRI abdomen w/o contrast (74181) range across 2 matching MRF lines |
$265.40–$1,232.86 | $408.30–$1,896.70 | varies |
| MRI any jt lower extrem w/contrast material (73722) range across 4 matching MRF lines |
$867.42–$3,020.42 | $1,334.50–$4,646.80 | varies |
| MRI any jt lower extrem w/o & w/contrast matrl (73723) | $1,871.80 | $2,879.70 | 4.6× |
| MRI any jt upper extremity w/contrast matrl (73222) range across 4 matching MRF lines |
$867.42–$3,020.42 | $1,334.50–$4,646.80 | varies |
| MRI bone marrow blood supply (77084) | $1,416.68 | $2,179.50 | 5.1× |
| MRI brain functional w/physician admnistration (70555) | $985.86 | $1,516.70 | 3.5× |
| MRI Breast W/O Contrast Bilateral (77047) | $1,452.04 | $2,233.90 | 5.2× |
| MRI Breast Without Contrast Material Unilateral (77046) | $1,292.72 | $1,988.80 | 4.6× |
| MRI cervical spine w contrast (72142) | $1,481.28 | $2,278.90 | 3.6× |
| MRI cervical spine w/o cont (72141) range across 2 matching MRF lines |
$915.14–$1,254.56 | $1,407.90–$1,930.10 | varies |
| MRI chest w/o contrast (71550) range across 2 matching MRF lines |
$924.36–$1,223.36 | $1,422.10–$1,882.10 | varies |
| MRI chest with contrast (71551) | $3,020.42 | $4,646.80 | 3.3× |
| MRI chest wo w contrast (71552) | $1,861.80 | $2,864.30 | 4.5× |
| MRI lower extrem oth/thn jt w/contrast matrl (73719) range across 4 matching MRF lines |
$1,326.58–$1,428.44 | $2,040.90–$2,197.60 | varies |
| MRI lower extrem oth/thn jt w/o & w/contr matr (73720) | $1,773.46 | $2,728.40 | 4.3× |
| MRI lower extrem oth/thn jt w/o contr matrl (73718) range across 3 matching MRF lines |
$265.40–$1,230.32 | $408.30–$1,892.80 | varies |
| MRI lumbar spine w contrast (72149) | $1,481.28 | $2,278.90 | 3.6× |
| Mri Neck Spine W/O & W/Dye (72156) range across 2 matching MRF lines |
$1,326.58–$1,942.26 | $2,040.90–$2,988.10 | varies |
| MRI orbit face &/neck w/o contrast (70540) range across 2 matching MRF lines |
$265.40–$1,230.32 | $408.30–$1,892.80 | varies |
| MRI orbit face neck w contrast (70542) | $1,428.50 | $2,197.70 | 3.5× |
| Mri Orbt/Fac/Nck W/O &W/Dye (70543) | $1,871.80 | $2,879.70 | 4.6× |
| MRI pelvis w contrast (72196) | $1,431.24 | $2,201.90 | 3.5× |
| MRI pelvis w/o & w contrast (72197) range across 3 matching MRF lines |
$1,326.58–$1,875.51 | $2,040.90–$2,885.40 | varies |
| MRI pelvis w/o contrast (72195) range across 3 matching MRF lines |
$924.36–$1,232.86 | $1,422.10–$1,896.70 | varies |
| MRI spectroscopy (76390) | $844.02 | $1,298.50 | 8.3× |
| MRI thoracic spine w/o contrast (72146) range across 2 matching MRF lines |
$915.14–$1,279.20 | $1,407.90–$1,968 | varies |
| MRI upper extremity oth than jt w/contr matrl (73219) range across 4 matching MRF lines |
$1,330.10–$1,352.06 | $2,046.30–$2,080.10 | varies |
| MRI upper extremity oth than jt w/o contr matrl (73218) range across 4 matching MRF lines |
$265.40–$1,230.32 | $408.30–$1,892.80 | varies |
| Mri Uppr Extremity W/O&W/Dye (73220) | $1,871.80 | $2,879.70 | 4.6× |
| MRI, abdomen, combo (74183) | $1,875.51 | $2,885.40 | 4.6× |
| MRI, dorsal spine combo (72157) range across 2 matching MRF lines |
$1,326.58–$1,942.26 | $2,040.90–$2,988.10 | varies |
| MRI, dorsal spine contrast (72147) | $1,481.28 | $2,278.90 | 3.6× |
| MRI, joint upper extrem (73221) range across 4 matching MRF lines |
$949.39–$1,230.32 | $1,460.60–$1,892.80 | varies |
| MRI, joint upper extrem combo (73223) | $1,871.80 | $2,879.70 | 4.6× |
| MRI, lumbar spine combo (72158) range across 2 matching MRF lines |
$1,326.58–$1,942.26 | $2,040.90–$2,988.10 | varies |
| Myelogram cervical (72240) | $2,355.86 | $3,624.40 | 2.6× |
| Myelogram Lumbar (72265) | $2,355.86 | $3,624.40 | 2.6× |
| Myelography thoracic (72255) | $2,355.86 | $3,624.40 | 2.6× |
| Myelograpy 2/more regions rs&i (72270) | $2,355.86 | $3,624.40 | 2.6× |
| Myocardial Imaging Infarct Avid Planar Qual/Quan (78466) | $1,638.78 | $2,521.20 | 3.5× |
| Myocardial Spect Multiple Studies (78452) range across 2 matching MRF lines |
$170.82–$5,356.46 | $262.80–$8,240.70 | varies |
| N-invas est c ffr sw aly CTA (75580) | $4,149.21 | $6,383.40 | 4.1× |
| Neck soft tissue (70360) | $267.48 | $411.50 | 2.6× |
| Nfs/Instlj Radioelmnt Sln 3 Mo Follow-Up Care (77750) | $1,072.56 | $1,650.10 | 2.4× |
| Njx Rp Loclzj Non-Img Probe Study Intravenous (78808) | $1,213.62 | $1,867.10 | 2.6× |
| Nm csf leak detection (78650) | $5,356.46 | $8,240.70 | 3.5× |
| Nm myocard infarct spect (78469) | $2,195.24 | $3,377.30 | 3.4× |
| Nm red cell survival study (78130) | $1,638.78 | $2,521.20 | 3.5× |
| Nonvascular Shunt X-Ray (75809) | $323.57 | $497.80 | 2.6× |
| Ntsty modul radthx pln dose-vol histos (77301) | $5,580.18 | $8,584.90 | 3.4× |
| Nuclear Rx Intra-Arterial (79445) | $938.54 | $1,443.90 | 3.4× |
| Nuclear Rx Oral Admin (79005) | $938.54 | $1,443.90 | 3.4× |
| Ob us nuchal meas 1 gest (76813) | $323.57 | $497.80 | 2.6× |
| Optic foramina (70190) | $267.48 | $411.50 | 2.6× |
| Parathyroid imaging w/tomographic spect & CT (78072) | $2,195.24 | $3,377.30 | 3.4× |
| Parathyroid Planar Imaging (78070) | $1,638.78 | $2,521.20 | 3.5× |
| Pelvis 1 or 2 views (72170) | $323.57 | $497.80 | 2.6× |
| Pet Image W/Ct Lmtd (78814) | $5,948.54 | $9,151.60 | 3.5× |
| PET image w/CT, full body (78816) | $5,948.54 | $9,151.60 | 3.5× |
| PET imaging CT attenuation skull base mid-thigh (78815) | $5,948.54 | $9,151.60 | 3.5× |
| Plasma volume, radiopharmaceutical volume-dilution technique (separate procedure); single sampling Non-Facility (78110) | $5,356.46 | $8,240.70 | 3.5× |
| Prq Transhepatc Portograpy Hemodyn Eval Rs&I (75885) | $9,378.66 | $14,428.70 | 2.5× |
| Pulmonary Perfusion Imaging Particulate (78580) | $1,638.78 | $2,521.20 | 3.5× |
| Radex Abd Compl Aqt Abd W/S/E/D Views 1 View Ch (74022) | $323.57 | $497.80 | 2.6× |
| Radex abscess/fistula/sinus tract rs&i (76080) | $1,623.24 | $2,497.30 | 2.5× |
| Radex Ankle Complete Minimum 3 Views (73610) | $267.48 | $411.50 | 2.6× |
| Radex Calcaneus Minimum 2 Views (73650) | $267.48 | $411.50 | 2.6× |
| Radex elbow complete minimum 3 views (73080) | $267.48 | $411.50 | 2.6× |
| Radex Facial Bones Complete Minimum 3 Views (70150) | $323.57 | $497.80 | 2.6× |
| Radex fingr minimum 2 views (73140) | $267.48 | $411.50 | 2.6× |
| Radex foot complete minimum 3 views (73630) | $267.48 | $411.50 | 2.6× |
| Radex Hand Minimum 3 Views (73130) | $267.48 | $411.50 | 2.6× |
| Radex lower extremity infant minimum 2 views (73592) | $267.48 | $411.50 | 2.6× |
| Radex Mastoids Compl Minimum 3 Views PR Side (70130) | $323.57 | $497.80 | 2.6× |
| Radex Nasal Bones Complete Minimum 3 Views (70160) | $267.48 | $411.50 | 2.6× |
| Radex Pharynx/Larx W/Fluor&/Magnification Tq (70370) | $267.48 | $411.50 | 2.6× |
| Radex Ribs Unilateral 2 Views (71100) | $267.48 | $411.50 | 2.6× |
| Radex shoulder complete minimum 2 views (73030) | $267.48 | $411.50 | 2.6× |
| Radex Sinuses Paransl < 3 Views (70210) | $267.48 | $411.50 | 2.6× |
| Radex sm int w/mlt srl imges via enteroclss tube (74251) | $729.10 | $1,121.70 | 3.5× |
| Radex Spine 1 View Specify Level (72020) | $267.48 | $411.50 | 2.6× |
| Radex Sternum Minimum 2 Views (71120) | $267.48 | $411.50 | 2.6× |
| Radex Temporomandble Jt Opn & Clsd Mouth Bilat (70330) | $267.48 | $411.50 | 2.6× |
| Radex Toe Minimum 2 Views (73660) | $267.48 | $411.50 | 2.6× |
| Radex upper extremity infant minimum 2 views (73092) | $323.57 | $497.80 | 2.6× |
| Radex Wrist Complete Minimum 3 Views (73110) | $267.48 | $411.50 | 2.6× |
| Radex X-Ray Exam Entire Spi 6/> Vw - Xr Entire Spine 6+ Vw (72084) | $433.74 | $667.30 | 3.5× |
| Radiation Delivery Stereotactic Cranial Linear (77372) | $21,755.63 | $33,470.20 | 2.5× |
| Radiation treatment delivery level 1 (77402) | $452.40 | $696 | 3.8× |
| Radiation treatment delivery level 2 (77407) | $1,072.56 | $1,650.10 | 2.4× |
| Radiation treatment delivery level 3 (77412) | $1,072.56 | $1,650.10 | 1.7× |
| Radiolog exam mandible compl minimum 4 views (70110) | $323.57 | $497.80 | 2.6× |
| Radiologic Exam Abdomen 3+ Views - Xr Abdomen 3+ Views (74021) | $323.57 | $497.80 | 2.6× |
| Radiologic exam colon double contrast study (74280) | $540.67 | $831.80 | 2.6× |
| Radiologic exam colon single contrast study (74270) range across 3 matching MRF lines |
$152.49–$540.67 | $234.60–$831.80 | varies |
| Radiologic Exam Esophagus Double Contrast Study (74221) | $540.67 | $831.80 | 2.6× |
| Radiologic exam knee complete 4/more views (73564) | $323.57 | $497.80 | 2.6× |
| Radiologic exam pelvis compl minimum 3 views (72190) | $323.57 | $497.80 | 2.6× |
| Radiologic Exam Small Int Single Contrast Study (74250) | $540.67 | $831.80 | 2.6× |
| Radiologic exam swallow function contrast study (74230) | $540.67 | $831.80 | 2.6× |
| Radiologic Exam Teeth Prtl Exam < Full Mouth (70310) | $721.04 | $1,109.30 | 2.6× |
| Radiologic exam upr gi trc double contrast study (74246) | $540.67 | $831.80 | 2.6× |
| Radiologic examination femur 1 view (73551) | $267.48 | $411.50 | 2.6× |
| Radiologic examination femur minimum 2 views (73552) | $267.48 | $411.50 | 2.6× |
| Radiologic examination knee 1/2 views (73560) | $267.48 | $411.50 | 2.6× |
| Radiologic Examination Osseous Survey Limited (77074) | $323.57 | $497.80 | 2.6× |
| Radiologic examination tibia & fibula 2 views (73590) | $267.48 | $411.50 | 2.6× |
| Radiologic examination, teeth; single view Non-Facility (70300) | $267.48 | $411.50 | 2.6× |
| Radiopharmaceutical therapy, by intracavitary administration Non-Facility (79200) | $938.54 | $1,443.90 | 3.4× |
| Red Cell Volume Determination Spx 1 Sampling (78120) | $1,638.78 | $2,521.20 | 3.5× |
| Renal Cyst Study (74470) | $1,623.24 | $2,497.30 | 2.5× |
| Ribs bilateral 3 views (71110) | $323.57 | $497.80 | 2.6× |
| Rp loclzj tum plnr 1 area single day imaging (78800) | $1,638.78 | $2,521.20 | 3.5× |
| Rp loclzj tum plnr 2+area 1+d img/1 area img>2+d (78801) | $1,638.78 | $2,521.20 | 3.5× |
| Rp Loclzj Tum Plnr Whole Body 2+ Days Imaging (78804) | $5,356.46 | $8,240.70 | 8.4× |
| Rp Loclzj Tum Plnr Whole Body Single Day Imaging (78802) | $5,356.46 | $8,240.70 | 8.4× |
| Rp Loclzj Tum Spect 1 Area Single Day Imaging (78803) | $5,356.46 | $8,240.70 | 8.4× |
| Rp loclzj tum spect 2 area/sep acquisj img (78831) | $5,356.46 | $8,240.70 | 3.5× |
| Rp loclzj tum spect CT 2area 1d img/1 ar img>2+d (78832) | $5,948.54 | $9,151.60 | 3.5× |
| Rp loclzj tum spect w/CT 1 area/acquisj 1day img (78830) | $5,356.46 | $8,240.70 | 3.5× |
| Rp Ther Radiolbld Monoclonal Antibody IV Infus (79403) | $938.54 | $1,443.90 | 3.4× |
| Rp Therapy Intravenous Administration (79101) range across 2 matching MRF lines |
$210.60–$938.54 | $324–$1,443.90 | varies |
| Salivary Gland Imaging (78230) | $1,638.78 | $2,521.20 | 3.5× |
| Scapula (73010) | $323.57 | $497.80 | 2.6× |
| Screening Digital Breast Tomosynthesis Bi (77063) | $73 | $112.30 | 3.1× |
| Sella turcica (70240) | $267.48 | $411.50 | 2.6× |
| Shoulder 1 view (73020) | $267.48 | $411.50 | 2.6× |
| Shoulder Arthrography (73040) range across 4 matching MRF lines |
$305.82–$1,131.58 | $470.50–$1,740.90 | varies |
| Sialogram (70390) | $721.04 | $1,109.30 | 2.6× |
| Skull less than 4 views (70250) | $323.57 | $497.80 | 2.6× |
| Special dosimetry (77331) | $541.52 | $833.10 | 3.4× |
| Special Physics Consult (77370) | $541.52 | $833.10 | 3.4× |
| Special teletherapy port plan (77321) | $1,492.98 | $2,296.90 | 3.4× |
| Special treatment procedure (77470) | $2,359.18 | $3,629.50 | 3.6× |
| Stereotactic Body Radiation Delivery (77373) | $7,161.12 | $11,017.10 | 3.4× |
| Sternoclavicular joints (71130) | $267.48 | $411.50 | 2.6× |
| Telethx isodose pln cplx w/basic dosimetry (77307) | $1,492.98 | $2,296.90 | 3.4× |
| Telethx isodose pln smpl w/dosimetry calculation (77306) | $1,492.98 | $2,296.90 | 3.4× |
| Testicular Imaging W/Flow (78761) | $1,638.78 | $2,521.20 | 3.5× |
| Ther Rad Simulaj-Aided Field Setting Complex (77290) | $1,492.98 | $2,296.90 | 3.4× |
| Ther Rad Simulaj-Aided Field Setting Intermed (77285) | $1,492.98 | $2,296.90 | 3.4× |
| Ther rad simulaj-aided field setting simple (77280) | $704.86 | $1,084.40 | 4.5× |
| Therapeutic Enema Rdctj Intussusception/Obstrcj (74283) | $726.05 | $1,117 | 3.5× |
| Thoracic spine 2 views (72070) | $323.57 | $497.80 | 2.6× |
| Thoracic spine 3 views (72072) | $323.57 | $497.80 | 2.6× |
| Thoracolumbar 2 views (72080) | $267.48 | $411.50 | 2.6× |
| Thyroid Carcinoma Metastases Img Lmtd Area (78015) | $1,638.78 | $2,521.20 | 3.5× |
| Thyroid Met Imaging Body (78018) | $2,195.24 | $3,377.30 | 3.4× |
| Thyroid Uptake Measurement (78012) | $1,638.78 | $2,521.20 | 3.5× |
| Thyroid Uptake W/Blood Flow Sngle/Mult Quan Meas (78014) | $1,638.78 | $2,521.20 | 3.5× |
| Tx Devices Design & Construction Complex (77334) | $1,492.98 | $2,296.90 | 3.4× |
| Tx devices design & construction intermediate (77333) | $541.52 | $833.10 | 3.4× |
| Tx devices design & construction simple (77332) | $541.52 | $833.10 | 3.4× |
| Ultrasound Breast Limited (76642) range across 3 matching MRF lines |
$267.48–$353.14 | $411.50–$543.30 | varies |
| Ultrasound elastography first target lesion (76982) | $414.76 | $638.10 | 3.4× |
| Ultrasound Elastography Parenchyma (76981) | $414.76 | $638.10 | 3.4× |
| Ultrasound Exam Aaa Screen (76706) | $433.74 | $667.30 | 3.5× |
| Ultrasound, abdomen limited (76705) range across 6 matching MRF lines |
$63.57–$528.52 | $97.80–$813.10 | varies |
| Umbilical-artery Doppler (OB) (76820) | $323.57 | $497.80 | 2.6× |
| Unlisted Dx Radiographic Procedure (76499) | $720.72 | $1,108.80 | 7.1× |
| Unlisted Procedure Clinical Brachytherapy (77799) | $452.40 | $696 | 3.8× |
| Unlisted us procedure (76999) | $267.48 | $411.50 | 2.6× |
| Upper gi w/o kub (74240) | $540.67 | $831.80 | 2.6× |
| Ureteral Reflux Study (78740) | $1,638.78 | $2,521.20 | 3.5× |
| Urethrocystogram voiding (74455) range across 2 matching MRF lines |
$207.02–$721.04 | $318.50–$1,109.30 | varies |
| Urethrocystography retrograde (74450) | $721.04 | $1,109.30 | 2.6× |
| Us breast unilateral complete (76641) range across 3 matching MRF lines |
$314.02–$529.68 | $483.10–$814.90 | varies |
| Us chest (76604) range across 4 matching MRF lines |
$62.08–$323.57 | $95.50–$497.80 | varies |
| Us complete joint (76881) | $433.74 | $667.30 | 3.5× |
| Us exam, pelvic, limited (76857) | $414.76 | $638.10 | 3.4× |
| Us head (76506) | $429.84 | $661.30 | 3.5× |
| Us kidney transplant (76776) range across 4 matching MRF lines |
$116.80–$414.76 | $179.70–$638.10 | varies |
| Us lmtd joint/oth nonvasc xtr strux r-t w/img (76882) | $323.57 | $497.80 | 2.6× |
| Us ob detailed single fetus (76811) | $985.86 | $1,516.70 | 3.5× |
| Us ob limited 1 or more fetuses (76815) range across 4 matching MRF lines |
$70.46–$323.57 | $108.40–$497.80 | varies |
| Us ob transvaginal (76817) | $323.57 | $497.80 | 2.6× |
| Us pelvic non ob complete (76856) range across 2 matching MRF lines |
$402.61–$406.64 | $619.40–$625.60 | varies |
| Us pg uter img f&mat 14 wk tabdl 1/1st gestation (76801) | $433.74 | $667.30 | 3.5× |
| Us preg uterus real time f/u trnsabdl per fetus (76816) | $323.57 | $497.80 | 2.6× |
| Us retroperitoneal complete (76770) range across 8 matching MRF lines |
$116.80–$558.09 | $179.70–$858.60 | varies |
| Us retroperitoneal limited (76775) range across 5 matching MRF lines |
$62.86–$323.57 | $96.70–$497.80 | varies |
| Us scrotum and contents (76870) | $314.02 | $483.10 | 2.6× |
| Us spinal canal and contents (76800) | $314.02 | $483.10 | 2.6× |
| Us thyroid (76536) | $312.72 | $481.10 | 2.5× |
| Us transrectal (76872) | $494.78 | $761.20 | 4.0× |
| Vein X-Ray Chest (75827) | $4,712.30 | $7,249.70 | 2.6× |
| Venogram Sinus/Jugular (75860) | $9,378.66 | $14,428.70 | 2.5× |
| Venography Adrenal Unilateral (75840) | $9,378.66 | $14,428.70 | 2.5× |
| Venography caval inferior serialography rs&i (75825) | $9,378.66 | $14,428.70 | 2.5× |
| Venography extremity bilateral rs&i (75822) | $4,253.92 | $6,544.50 | 2.3× |
| Venography extremity unilateral rs&i (75820) | $4,712.30 | $7,249.70 | 2.6× |
| Venography Renal Bilateral (75833) | $9,378.66 | $14,428.70 | 2.5× |
| Venography Renal Unilateral (75831) | $9,378.66 | $14,428.70 | 2.5× |
| Venous sampling by catheter (75893) | $16,169.14 | $24,875.60 | 2.5× |
| Venous thrombosis imaging (78457) | $2,195.24 | $3,377.30 | 3.4× |
| Venous Thrombosis Imaging Venogram Bilateral (78458) | $1,638.78 | $2,521.20 | 3.5× |
| Vertebral fracture assessment via dxa (77086) | $267.48 | $411.50 | 2.6× |
| Wrist 2 views (73100) | $267.48 | $411.50 | 2.6× |
| X-Ray Ac Jts - Xr Acromioclavicular Joints Bilateral (73050) | $267.48 | $411.50 | 2.6× |
| X-ray antegrade pyelogram tube (74425) range across 2 matching MRF lines |
$305.82–$1,131.58 | $470.50–$1,740.90 | varies |
| X-Ray Aorta Leg Arteries (75630) | $9,378.66 | $14,428.70 | 2.5× |
| X-Ray Bend Only L-S Spine (72120) | $323.57 | $497.80 | 2.6× |
| X-Ray Elbow 2 Vw - Xr Elbow 1-2 Views Right (73070) | $267.48 | $411.50 | 2.6× |
| X-Ray Exam Breast Specimen (76098) | $1,623.24 | $2,497.30 | 2.5× |
| X-Ray Exam Entire Spi 1 Vw (72081) | $267.48 | $411.50 | 2.6× |
| X-Ray Exam Entire Spi 2/3 Vw (72082) | $323.57 | $497.80 | 2.6× |
| X-Ray Exam Entire Spi 4/5 Vw (72083) | $433.74 | $667.30 | 3.5× |
| X-Ray Exam Hip Uni 1 View (73501) | $267.48 | $411.50 | 2.6× |
| X-Ray Exam Hip Uni 2-3 Views (73502) | $267.48 | $411.50 | 2.6× |
| X-Ray Exam Hip Uni 4/> Views (73503) | $323.57 | $497.80 | 2.6× |
| X-Ray Exam Hips Bi 2 Views (73521) | $323.57 | $497.80 | 2.6× |
| X-Ray Exam Hips Bi 3-4 Views (73522) | $323.57 | $497.80 | 2.6× |
| X-Ray Exam Hips Bi 5/> Views (73523) | $433.74 | $667.30 | 3.5× |
| X-Ray Exam L-S Spine Bending (72114) | $323.57 | $497.80 | 2.6× |
| X-Ray Exam Neck Spine 2-3 Vw (72040) | $267.48 | $411.50 | 2.6× |
| X-Ray Exam Neck Spine 6/>Vws (72052) | $323.57 | $497.80 | 2.6× |
| X-Ray Exam Unilat Ribs/Chest (71101) | $323.57 | $497.80 | 2.6× |
| X-ray eye for foreign body (70030) range across 3 matching MRF lines |
$130.06–$267.48 | $200.10–$411.50 | varies |
| X-ray humerus (73060) | $267.48 | $411.50 | 2.6× |
| X-ray IV pyelogram (ivp) (74400) | $726.05 | $1,117 | 3.5× |
| X-ray IV pyelogram+tomography (74415) range across 2 matching MRF lines |
$210.60–$726.05 | $324–$1,117 | varies |
| X-Ray Jaw <4 Vw - Xr Mandible < 4 Views (70100) | $267.48 | $411.50 | 2.6× |
| X-Ray Knee Bilat Standing - Xr Knees Anteroposterior Standing Bilat (73565) | $267.48 | $411.50 | 2.6× |
| X-Ray Lumbar Spine 2/3 Vw - Xr Lumbar Spine 2-3 Views (72100) | $323.57 | $497.80 | 2.6× |
| X-ray nose-rectum child f.b. (76010) | $267.48 | $411.50 | 2.6× |
| X-Ray Ribs, Chest 4+ Vw - Xr Ribs 3 Vws Bil W/ Chest Posteroanterior (71111) | $323.57 | $497.80 | 2.6× |
| X-Ray Sacroiliac Jts 3+ Vw - Xr Sacroiliac Joints 3+ Views (72202) | $323.57 | $497.80 | 2.6× |
| X-Ray Sacrum/Coccyx 2+ Vw - Xr Sacrum Coccyx 2+ Views (72220) | $267.48 | $411.50 | 2.6× |
| X-Ray Sinuses 3+ Vw - Xr Paranasal Sinuses 3+ Views (70220) | $267.48 | $411.50 | 2.6× |
| X-Ray Skull 4+ Vw - Xr Skull Complete 4+ Views (70260) | $323.57 | $497.80 | 2.6× |
| X-ray thoracic spine 4 vw (72074) | $323.57 | $497.80 | 2.6× |
| X-Ray Urinary Tract Exam With Contrast Material (74420) | $1,456.52 | $2,240.80 | 3.6× |
| X-Rays Bone Length Studies (77073) | $323.57 | $497.80 | 2.6× |
| X-Rays Bone Survey Complete (77075) | $323.57 | $497.80 | 2.6× |
| Xr c-spine 4 or 5 views (72050) | $323.57 | $497.80 | 2.6× |
| Xr facial bones less than 3 views (70140) | $267.48 | $411.50 | 2.6× |
| XR Mastoids < 3 Views Bilateral (70120) | $323.57 | $497.80 | 2.6× |
| Xr orbits complete 4 views (70200) | $323.57 | $497.80 | 2.6× |
| Xr Tomogram Single Plane (76100) | $323.57 | $497.80 | 2.6× |
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.