Imaging prices at Ascension St. John Medical Center
Tulsa, OK · every code in this section with a posted price and a Medicare benchmark.
383 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) | $1,942.50 | $5,250 | 1.5× |
| Abdomen 1 View (74018) | $116.83 | $315.75 | 1.4× |
| Abdomen 2 views (74019) | $158.73 | $429 | 1.6× |
| Acute Gastrointestinal Blood Loss Imaging (78278) | $417.92 | $1,129.50 | 1.1× |
| Adrenal Cortex & Medulla Img (78075) | $716.04 | $1,935.25 | 0.6× |
| Angio internal mammary (75756) | $2,895.07 | $7,824.50 | 1.0× |
| Angio pulmonary bilat (75743) | $1,898.93 | $5,132.25 | 0.6× |
| Angiography Adrenal Bilateral Slctv Rs&I (75733) | $2,119.92 | $5,729.50 | 0.7× |
| Angiography extremity bilateral rs&i (75716) | $3,674.84 | $9,932 | 1.2× |
| Angiography extremity unilateral rs&i (75710) | $1,500.35 | $4,055 | 0.5× |
| Angiography pulmonary unilateral slctv rs&i (75741) | $1,190.85 | $3,218.50 | 0.4× |
| Angrph pulmonary nonslctv cath/ven njx rs&i (75746) | $703.56 | $1,901.50 | 0.2× |
| Ankle 2 views (73600) range across 6 matching MRF lines |
$115.26–$230.51 | $311.50–$623 | varies |
| Aortography thoracic serialography rs&i (75605) | $2,701.56 | $7,301.50 | 0.5× |
| Artery X-Rays Abdomen (75726) unusually low: confirm this is the full procedure |
$2,633.29 | $7,117 | 0.5× |
| Artery X-Rays Adrenal Gland (75731) | $1,134.14 | $3,065.25 | 0.4× |
| Artery X-Rays Pelvis (75736) likely a partial charge, not the full procedure |
$1,274.28 | $3,444 | 0.2× |
| Artery X-Rays Spine (75705) unusually low: confirm this is the full procedure |
$2,633.29 | $7,117 | 0.5× |
| Arthrogram ankle (73615) range across 3 matching MRF lines |
$258.63–$517.26 | $699–$1,398 | varies |
| Arthrogram hip (73525) range across 3 matching MRF lines |
$248.64–$497.28 | $672–$1,344 | varies |
| Arthrogram Wrist (73115) range across 3 matching MRF lines |
$248.64–$497.28 | $672–$1,344 | varies |
| Basic radiation dosimetry calculation (77300) | $139.21 | $376.25 | 1.1× |
| Bone age studies (77072) | $170.57 | $461 | 1.7× |
| Bone Imaging 3 Phase (78315) | $591.91 | $1,599.75 | 1.5× |
| Bone Imaging Limited Area (78300) | $378.88 | $1,024 | 1.0× |
| Bone Imaging Multiple Areas (78305) | $295.17 | $797.75 | 0.8× |
| Bone Imaging Whole Body (78306) | $606.15 | $1,638.25 | 1.6× |
| Bone marrow imaging limited area (78102) | $350.95 | $948.50 | 0.9× |
| Bone marrow imaging; multiple areas (78103) | $395.44 | $1,068.75 | 1.0× |
| Bone survey infant (77076) | $158.36 | $428 | 1.6× |
| Brain Flow Imaging Only (78610) | $500.89 | $1,353.75 | 1.0× |
| Brain Imaging Min 4 Static Views W Vascular Flow (78606) | $657.95 | $1,778.25 | 1.3× |
| Brain Imaging Pet Metabolic Evaluation (78608) | $1,792.56 | $4,844.75 | 1.3× |
| Cardiac MRI w/w/o contrast & further seq (75561) | $884.49 | $2,390.50 | 2.6× |
| Cardiac Shunt Detection (78428) | $332.54 | $898.75 | 0.9× |
| Cat Scan Follow-Up Study (76380) | $275 | $743.25 | 3.3× |
| Cerebrospinal Fluid Flow W/O Matl Shunt Evaltj (78645) | $350.02 | $946 | 0.7× |
| Cerebrospinal Fluid Scan (78630) | $440.30 | $1,190 | 0.8× |
| Chest 1 view (71045) | $86.03 | $232.50 | 1.0× |
| Chest 2 views (71046) | $118.40 | $320 | 1.4× |
| Chest 3 views (71047) | $130.80 | $353.50 | 1.6× |
| Chest 4 or more views (71048) | $119.33 | $322.50 | 1.2× |
| Cineradiograpy/vidradiograpy xcpt where spec (76120) | $187.41 | $506.50 | 1.9× |
| Clavicle complete (73000) range across 5 matching MRF lines |
$121.18–$242.35 | $327.50–$655 | varies |
| Computed Tomography Thorax Lw Dose Lng Ca Scr C- (71271) | $952.66 | $2,574.75 | 9.5× |
| Continuing medical physics consltj pr wk (77336) | $147.45 | $398.50 | 1.1× |
| Contrast Exam Abdominl Aorta (75625) | $1,568.06 | $4,238 | 0.5× |
| Contrast X-Ray Bladder (74430) | $265.85 | $718.50 | 0.8× |
| Contrast X-Ray Of Elbow (73085) range across 3 matching MRF lines |
$258.63–$517.26 | $699–$1,398 | varies |
| Contrast X-Ray Of Knee Joint (73580) range across 4 matching MRF lines |
$248.64–$497.28 | $672–$1,344 | varies |
| CT abdomen and pelvis without and with contrast (74178) | $1,216.01 | $3,286.50 | 3.6× |
| CT abdomen and pelvis without contrast (74176) | $920.93 | $2,489 | 4.0× |
| CT abdomen w contrast (74160) | $1,019.81 | $2,756.25 | 6.0× |
| CT abdomen w wo contrast (74170) | $1,093.17 | $2,954.50 | 6.5× |
| CT abdomen w/o contrast (74150) | $954.97 | $2,581 | 9.5× |
| CT Angio Abdomen and Pelvis (74174) | $2,483.63 | $6,712.50 | 7.4× |
| CT Angio Chest (71275) | $1,499.24 | $4,052 | 8.9× |
| CT Angio Head (70496) | $1,328.95 | $3,591.75 | 7.9× |
| CT angio hrt w/3d image (75574) | $1,166.70 | $3,153.25 | 3.5× |
| Ct Angio Lwr Extr W/O&W/Dye (73706) range across 3 matching MRF lines |
$1,329.13–$2,658.27 | $3,592.25–$7,184.50 | varies |
| CT Angio Neck (70498) | $1,315.72 | $3,556 | 7.8× |
| Ct Angio Upr Extrm W/O&W/Dye (73206) | $1,229.70 | $3,323.50 | 7.3× |
| CT cervical spine w/ contrast (72126) | $855.16 | $2,311.25 | 2.5× |
| CT cervical spine w/o contrast (72125) | $826.21 | $2,233 | 8.2× |
| CT cervical spine w/wo cont (72127) | $920.65 | $2,488.25 | 5.5× |
| CT chest w contrast (71260) | $1,108.34 | $2,995.50 | 6.6× |
| CT chest w/wo contrast (71270) | $1,043.49 | $2,820.25 | 6.2× |
| CT head/brain with contrast (70460) | $883.28 | $2,387.25 | 5.2× |
| CT head/brain without and with contrast (70470) | $1,065.14 | $2,878.75 | 6.3× |
| CT heart contrast eval cardiac structure&morph (75572) | $514.67 | $1,391 | 1.5× |
| CT heart no contrast quant eval coronry calcium (75571) | $277.50 | $750 | 3.3× |
| CT iac w contrast (70481) | $753.23 | $2,035.75 | 4.5× |
| CT l-spine w&w/o contrast (72133) | $715.30 | $1,933.25 | 4.2× |
| CT lower ext w/o (73700) range across 4 matching MRF lines |
$823.25–$1,646.50 | $2,225–$4,450 | varies |
| CT lower extremity w/contrast material (73701) range across 3 matching MRF lines |
$989.29–$1,978.58 | $2,673.75–$5,347.50 | varies |
| CT lumbar spine w contrast (72132) | $902.80 | $2,440 | 2.7× |
| CT lumbar spine w/o contrast (72131) | $843.69 | $2,280.25 | 8.4× |
| CT maxillofacial w contrast (70487) | $741.48 | $2,004 | 4.4× |
| CT maxillofacial wo contrast (70486) range across 3 matching MRF lines |
$137.55–$756 | $371.75–$2,043.25 | varies |
| CT neck tissue combo (70492) | $1,042.01 | $2,816.25 | 6.2× |
| Ct Orbit/Ear/Fossa W/O&W/Dye (70482) | $1,023.14 | $2,765.25 | 6.1× |
| CT orbits w/o contrast (70480) | $790.88 | $2,137.50 | 7.9× |
| CT pelvis w&w/o contrast (72194) | $813.08 | $2,197.50 | 4.8× |
| CT pelvis w/o contrast (72192) | $943.69 | $2,550.50 | 9.4× |
| CT scan of leg combo (73702) range across 3 matching MRF lines |
$790.69–$1,581.38 | $2,137–$4,274 | varies |
| CT scans face/jaw combo (70488) | $786.90 | $2,126.75 | 4.7× |
| CT soft tissue neck w contrast (70491) | $917.14 | $2,478.75 | 5.4× |
| CT soft tissue neck w/o contrast (70490) | $725.29 | $1,960.25 | 7.2× |
| CT thoracic spine w contrast (72129) | $859.79 | $2,323.75 | 5.1× |
| CT thoracic spine w/o contrast (72128) | $843.69 | $2,280.25 | 8.4× |
| CT thoracic spine w/wo cont (72130) | $715.30 | $1,933.25 | 4.2× |
| CT thorax w/o contrast (71250) | $952.66 | $2,574.75 | 9.5× |
| CT upper ext wo (73200) range across 3 matching MRF lines |
$793.65–$1,587.30 | $2,145–$4,290 | varies |
| CT upper extremity w/o & w/contrast material (73202) range across 3 matching MRF lines |
$738.24–$1,476.49 | $1,995.25–$3,990.50 | varies |
| CT upper extremity with contrast (73201) range across 3 matching MRF lines |
$885.60–$1,771.19 | $2,393.50–$4,787 | varies |
| Cta Abdl Aorta&Bi Iliofem W/Contrast&Postp (75635) | $1,528.75 | $4,131.75 | 9.1× |
| Cta Abdomen (74175) | $1,341.62 | $3,626 | 8.0× |
| CTA pelvis (72191) | $1,012.14 | $2,735.50 | 6.0× |
| Dilation ureters/urethra rs&i (74485) | $1,213.69 | $3,280.25 | 0.6× |
| Doppler Fetal Mid Cerebral Artery (76821) | $220.98 | $597.25 | 2.2× |
| Dxa Bone Density Axial (77080) | $109.34 | $295.50 | 1.1× |
| Dxa bone density study 1/>sites appendiclr skel (77081) | $80.11 | $216.50 | 1.0× |
| Echo exam uterus (76831) | $242.07 | $654.25 | 1.1× |
| Echo Guide For Artery Repair (76936) | $699.76 | $1,891.25 | 3.4× |
| Echograp Trans R Pros Study (76873) | $193.14 | $522 | 1.9× |
| Esophagram (74220) | $221.54 | $598.75 | 1.3× |
| Fetal Biophysical Profile W/O Non-Stress Testing (76819) | $294.06 | $794.75 | 2.9× |
| Fluoroscopy up to 1 hr (76000) | $164.47 | $444.50 | 0.7× |
| Follow-Up Angiography (75898) | $429.76 | $1,161.50 | 0.1× |
| Foot 2 views (73620) range across 6 matching MRF lines |
$116.09–$232.18 | $313.75–$627.50 | varies |
| Forearm 2 views (73090) range across 6 matching MRF lines |
$117.66–$235.32 | $318–$636 | varies |
| Gastric emptying imaging study (78264) | $557.68 | $1,507.25 | 1.5× |
| Gastric Emptyng Imag Std W/Sm Bwl Transit (78265) | $585.53 | $1,582.50 | 1.5× |
| Gastroesophageal Reflux Exam (78262) | $395.62 | $1,069.25 | 1.0× |
| Gated Heart Planar Single (78472) | $515.41 | $1,393 | 1.3× |
| Hand 2 views (73120) range across 6 matching MRF lines |
$120.16–$240.32 | $324.75–$649.50 | varies |
| Hepatc Vngrph Wdg/Fr Hemodyn Eval Rs&I (75889) | $1,274.28 | $3,444 | 0.4× |
| Hepatc Vngrph Wdg/Fr W/O Hemodyn Eval Rs&I (75891) | $1,396.01 | $3,773 | 0.5× |
| Hepatobil Syst Image W/Drug (78227) | $564.90 | $1,526.75 | 1.1× |
| Hepatobiliary System Imaging (78226) | $528.18 | $1,427.50 | 1.4× |
| Ht Muscle Image Spect Sing (78451) | $1,379.27 | $3,727.75 | 1.1× |
| Hysterosalpingogram (74740) | $252.25 | $681.75 | 1.1× |
| Infant hip ultrasound with hip movement (dynamic) (76885) | $175.75 | $475 | 2.1× |
| Infant hip ultrasound, limited static exam (76886) | $93.80 | $253.50 | 1.1× |
| Infusion Ivp (74410) | $292.12 | $789.50 | 1.7× |
| Interstitial radiation source applic complex (77778) | $2,614.70 | $7,066.75 | 3.9× |
| Intracavitary Radiation Source Applic Complex (77763) | $2,409.72 | $6,512.75 | 3.6× |
| Intracavitary Radiation Source Applic Intermed (77762) | $2,401.67 | $6,491 | 4.5× |
| Intracavitary radiation source applic simple (77761) | $2,393.99 | $6,470.25 | 4.5× |
| Joint Survey Single View (77077) | $284.16 | $768 | 2.8× |
| K Flow/Funct Image Multiple (78709) | $1,257.54 | $3,398.75 | 2.4× |
| K Flow/Funct Image W/Drug (78708) | $818.07 | $2,211 | 1.6× |
| K Flow/Funct Image W/O Drug (78707) | $782.83 | $2,115.75 | 1.5× |
| Kidney Imaging Morphol (78700) | $769.51 | $2,079.75 | 2.0× |
| Knee 3 Views (73562) range across 3 matching MRF lines |
$121.82–$243.65 | $329.25–$658.50 | varies |
| Leveen/Shunt Patency Exam (78291) | $272.41 | $736.25 | 0.7× |
| Liver & Spleen Imaging Static Only (78215) | $406.08 | $1,097.50 | 1.1× |
| Liver & Spleen Imaging W/Vascular Flow (78216) | $429.48 | $1,160.75 | 1.1× |
| Liver imaging static only (78201) | $321.62 | $869.25 | 0.6× |
| Lung Perf&Ventilat Diferentl (78598) | $664.15 | $1,795 | 1.3× |
| Lung perfusion differential (78597) | $328.56 | $888 | 0.9× |
| Lung Ventilat&Perfus Imaging (78582) | $703.19 | $1,900.50 | 1.3× |
| Lung Ventilation Imaging (78579) | $328.56 | $888 | 0.9× |
| Lymph System Imaging (78195) | $563.97 | $1,524.25 | 1.1× |
| Lymphangiography, pelvic/abdominal, unilateral (75805) | $711.05 | $1,921.75 | 0.2× |
| Magnetic Image Jaw Joint (70336) | $372.68 | $1,007.25 | 1.6× |
| Mammary ductogram or galactogram multiple (77054) | $233.56 | $631.25 | 1.0× |
| Mammary ductogram or galactogram single (77053) | $171.22 | $462.75 | 0.7× |
| Meckels Divert Exam (78290) | $314.22 | $849.25 | 0.8× |
| Mlc imrt design & construction per imrt plan (77338) | $1,282.33 | $3,465.75 | 3.6× |
| Mra Head W/O & W/Contrast Material (70546) | $838.98 | $2,267.50 | 2.5× |
| MRA head w/o contrast (70544) | $599.59 | $1,620.50 | 2.6× |
| MRA head with contrast (70545) | $686.07 | $1,854.25 | 2.0× |
| MRA neck w contrast (70548) | $624.38 | $1,687.50 | 1.9× |
| Mra Neck W/O &W/Contrast Material (70549) | $915.20 | $2,473.50 | 2.7× |
| MRA neck w/o contrast (70547) | $587.47 | $1,587.75 | 2.6× |
| MRI abdomen w contrast (74182) | $954.14 | $2,578.75 | 2.8× |
| MRI abdomen w/o contrast (74181) | $979.02 | $2,646 | 4.3× |
| MRI any jt lower extrem w/contrast material (73722) | $1,113.05 | $3,008.25 | 1.5× |
| MRI any jt lower extrem w/o & w/contrast matrl (73723) | $1,070.87 | $2,894.25 | 3.2× |
| MRI any jt upper extremity w/contrast matrl (73222) | $1,025.64 | $2,772 | 1.4× |
| MRI Breast W/O Contrast Bilateral (77047) | $869.96 | $2,351.25 | 3.8× |
| MRI Breast Without Contrast Material Unilateral (77046) | $663.69 | $1,793.75 | 2.9× |
| MRI cardiac w/o contrast (75557) | $717.52 | $1,939.25 | 3.1× |
| MRI cervical spine w contrast (72142) | $972.27 | $2,627.75 | 2.9× |
| MRI cervical spine w/o cont (72141) | $963.02 | $2,602.75 | 4.2× |
| MRI chest w/o contrast (71550) | $901.97 | $2,437.75 | 3.9× |
| MRI chest with contrast (71551) | $927.41 | $2,506.50 | 1.2× |
| MRI chest wo w contrast (71552) | $1,182.06 | $3,194.75 | 3.5× |
| MRI lower extrem oth/thn jt w/contrast matrl (73719) range across 3 matching MRF lines |
$976.80–$1,953.60 | $2,640–$5,280 | varies |
| MRI lower extrem oth/thn jt w/o & w/contr matr (73720) range across 3 matching MRF lines |
$1,070.87–$2,141.75 | $2,894.25–$5,788.50 | varies |
| MRI lower extrem oth/thn jt w/o contr matrl (73718) range across 5 matching MRF lines |
$1,025.64–$2,051.28 | $2,772–$5,544 | varies |
| MRI lumbar spine w contrast (72149) | $1,054.87 | $2,851 | 3.1× |
| Mri Neck Spine W/O & W/Dye (72156) | $1,276.04 | $3,448.75 | 3.8× |
| MRI orbit face &/neck w/o contrast (70540) | $932.86 | $2,521.25 | 4.1× |
| MRI orbit face neck w contrast (70542) | $940.26 | $2,541.25 | 2.8× |
| Mri Orbt/Fac/Nck W/O &W/Dye (70543) | $1,270.49 | $3,433.75 | 3.8× |
| MRI pelvis w contrast (72196) | $842.49 | $2,277 | 2.5× |
| MRI pelvis w/o & w contrast (72197) | $1,192.60 | $3,223.25 | 3.6× |
| MRI pelvis w/o contrast (72195) | $889.67 | $2,404.50 | 3.9× |
| MRI spectroscopy (76390) | $442.89 | $1,197 | 5.3× |
| MRI thoracic spine w/o contrast (72146) | $976.62 | $2,639.50 | 4.3× |
| MRI upper extremity oth than jt w/contr matrl (73219) range across 3 matching MRF lines |
$927.04–$1,854.07 | $2,505.50–$5,011 | varies |
| MRI upper extremity oth than jt w/o contr matrl (73218) range across 3 matching MRF lines |
$966.16–$1,932.33 | $2,611.25–$5,222.50 | varies |
| Mri Uppr Extremity W/O&W/Dye (73220) range across 3 matching MRF lines |
$1,124.43–$2,248.86 | $3,039–$6,078 | varies |
| MRI, abdomen, combo (74183) | $1,188.35 | $3,211.75 | 3.5× |
| MRI, dorsal spine combo (72157) | $1,390.28 | $3,757.50 | 4.1× |
| MRI, dorsal spine contrast (72147) | $972.27 | $2,627.75 | 2.9× |
| MRI, joint upper extrem (73221) range across 3 matching MRF lines |
$1,025.64–$2,051.28 | $2,772–$5,544 | varies |
| MRI, joint upper extrem combo (73223) | $1,070.87 | $2,894.25 | 3.2× |
| MRI, lumbar spine combo (72158) | $1,396.84 | $3,775.25 | 4.2× |
| Myelogram cervical (72240) | $436.60 | $1,180 | 0.6× |
| Myelogram Lumbar (72265) | $482.85 | $1,305 | 0.6× |
| Myelography thoracic (72255) | $464.81 | $1,256.25 | 0.6× |
| Myelograpy 2/more regions rs&i (72270) | $542.14 | $1,465.25 | 0.7× |
| Myocardial Spect Multiple Studies (78452) | $2,001.05 | $5,408.25 | 1.6× |
| Neck soft tissue (70360) | $109.15 | $295 | 1.3× |
| Njx Rp Loclzj Non-Img Probe Study Intravenous (78808) | $145.60 | $393.50 | 0.4× |
| Nm csf leak detection (78650) | $1,171.61 | $3,166.50 | 0.9× |
| Nonvascular Shunt X-Ray (75809) | $99.25 | $268.25 | 1.0× |
| Ntsty modul radthx pln dose-vol histos (77301) | $2,138.05 | $5,778.50 | 1.6× |
| Nuclear Rx Intra-Arterial (79445) | $230.05 | $621.75 | 1.0× |
| Nuclear Rx Oral Admin (79005) | $352.15 | $951.75 | 1.6× |
| Ophthalmic ultrasound dx b-scan w/wo a-scan (76512) | $256.50 | $693.25 | 2.6× |
| Parathyroid Planar Imaging (78070) | $402.84 | $1,088.75 | 1.0× |
| Pelvis 1 or 2 views (72170) | $116 | $313.50 | 1.2× |
| Perineogram (74775) | $160.95 | $435 | 0.7× |
| Peritoneogram Rs&I (74190) | $295.26 | $798 | 0.6× |
| Pet Image Skull-Thigh (78812) | $2,783.07 | $7,521.80 | 2.0× |
| Pet Image W/Ct Lmtd (78814) | $2,098.18 | $5,670.75 | 1.5× |
| PET image w/CT, full body (78816) | $2,959.91 | $7,999.75 | 2.2× |
| PET imaging CT attenuation skull base mid-thigh (78815) | $2,937.43 | $7,939 | 2.1× |
| Pet Imaging Limited Area Chest Head/Neck (78811) | $2,480.20 | $6,703.25 | 2.0× |
| PET whole body (78813) | $758.40 | $2,049.72 | 0.6× |
| Prq Transhepatc Portograpy Hemodyn Eval Rs&I (75885) | $1,213.60 | $3,280 | 0.4× |
| Pulmonary Perfusion Imaging Particulate (78580) | $394.33 | $1,065.75 | 1.0× |
| Radex Abd Compl Aqt Abd W/S/E/D Views 1 View Ch (74022) | $199.80 | $540 | 2.0× |
| Radex abscess/fistula/sinus tract rs&i (76080) | $245.22 | $662.75 | 0.5× |
| Radex Ankle Complete Minimum 3 Views (73610) range across 4 matching MRF lines |
$134.87–$269.73 | $364.50–$729 | varies |
| Radex Calcaneus Minimum 2 Views (73650) range across 3 matching MRF lines |
$110.08–$220.15 | $297.50–$595 | varies |
| Radex elbow complete minimum 3 views (73080) range across 5 matching MRF lines |
$119.14–$238.28 | $322–$644 | varies |
| Radex Facial Bones Complete Minimum 3 Views (70150) | $95.18 | $257.25 | 0.9× |
| Radex fingr minimum 2 views (73140) range across 3 matching MRF lines |
$120.16–$240.32 | $324.75–$649.50 | varies |
| Radex foot complete minimum 3 views (73630) range across 3 matching MRF lines |
$136.99–$273.99 | $370.25–$740.50 | varies |
| Radex Hand Minimum 3 Views (73130) range across 3 matching MRF lines |
$131.35–$262.70 | $355–$710 | varies |
| Radex lower extremity infant minimum 2 views (73592) range across 7 matching MRF lines |
$113.96–$227.92 | $308–$616 | varies |
| Radex Mastoids Compl Minimum 3 Views PR Side (70130) | $93.61 | $253 | 0.9× |
| Radex Nasal Bones Complete Minimum 3 Views (70160) | $95.37 | $257.75 | 1.1× |
| Radex Ribs Unilateral 2 Views (71100) | $172.88 | $467.25 | 2.1× |
| Radex shoulder complete minimum 2 views (73030) range across 3 matching MRF lines |
$131.91–$263.81 | $356.50–$713 | varies |
| Radex Sinuses Paransl < 3 Views (70210) | $70.67 | $191 | 0.8× |
| Radex sm int w/mlt srl imges via enteroclss tube (74251) | $425.78 | $1,150.75 | 2.5× |
| Radex Spine 1 View Specify Level (72020) | $120.99 | $327 | 1.4× |
| Radex Sternum Minimum 2 Views (71120) | $114.33 | $309 | 1.4× |
| Radex Temporomandble Jt Opn & Clsd Mouth Bilat (70330) | $101.47 | $274.25 | 1.2× |
| Radex Toe Minimum 2 Views (73660) range across 6 matching MRF lines |
$100.46–$200.91 | $271.50–$543 | varies |
| Radex upper extremity infant minimum 2 views (73092) range across 5 matching MRF lines |
$83.53–$167.06 | $225.75–$451.50 | varies |
| Radex Wrist Complete Minimum 3 Views (73110) range across 3 matching MRF lines |
$131.91–$263.81 | $356.50–$713 | varies |
| Radiation Delivery Stereotactic Cranial Linear (77372) | $3,766.05 | $10,178.50 | 0.5× |
| Radiation treatment delivery level 1 (77402) | $89.73 | $242.50 | 0.9× |
| Radiation treatment delivery level 2 (77407) | $150.96 | $408 | 0.4× |
| Radiation treatment delivery level 3 (77412) | $214.88 | $580.75 | 0.4× |
| Radiolog exam mandible compl minimum 4 views (70110) | $113.31 | $306.25 | 1.1× |
| Radiologic Exam Abdomen 3+ Views - Xr Abdomen 3+ Views (74021) | $158.73 | $429 | 1.6× |
| Radiologic exam colon double contrast study (74280) | $340.40 | $920 | 2.0× |
| Radiologic exam colon single contrast study (74270) | $287.68 | $777.50 | 1.7× |
| Radiologic exam knee complete 4/more views (73564) range across 3 matching MRF lines |
$151.61–$303.22 | $409.75–$819.50 | varies |
| Radiologic exam pelvis compl minimum 3 views (72190) | $127.74 | $345.25 | 1.3× |
| Radiologic Exam Small Int Single Contrast Study (74250) | $172.14 | $465.25 | 1.0× |
| Radiologic exam swallow function contrast study (74230) | $240.41 | $649.75 | 1.4× |
| Radiologic exam upr gi trc double contrast study (74246) | $321.62 | $869.25 | 1.9× |
| Radiologic examination femur 1 view (73551) | $110.54 | $298.75 | 1.3× |
| Radiologic examination femur minimum 2 views (73552) range across 3 matching MRF lines |
$116.09–$232.18 | $313.75–$627.50 | varies |
| Radiologic examination knee 1/2 views (73560) range across 4 matching MRF lines |
$103.60–$207.20 | $280–$560 | varies |
| Radiologic Examination Osseous Survey Limited (77074) | $240.22 | $649.25 | 2.4× |
| Radiologic Examination Salivary Gland Calculus (70380) | $53.47 | $144.50 | 0.6× |
| Radiologic examination tibia & fibula 2 views (73590) range across 5 matching MRF lines |
$116.09–$232.18 | $313.75–$627.50 | varies |
| Ribs bilateral 3 views (71110) | $197.49 | $533.75 | 2.0× |
| Rp loclzj tum plnr 1 area single day imaging (78800) | $398.21 | $1,076.25 | 1.0× |
| Rp loclzj tum plnr 2+area 1+d img/1 area img>2+d (78801) | $627.52 | $1,696 | 1.6× |
| Rp Loclzj Tum Plnr Whole Body 2+ Days Imaging (78804) | $809.28 | $2,187.25 | 1.5× |
| Rp Loclzj Tum Plnr Whole Body Single Day Imaging (78802) | $587.75 | $1,588.50 | 1.1× |
| Rp Loclzj Tum Spect 1 Area Single Day Imaging (78803) | $727.51 | $1,966.25 | 1.4× |
| Rp Ther Radiolbld Monoclonal Antibody IV Infus (79403) | $1,555.57 | $4,204.25 | 6.9× |
| Rp Therapy Intravenous Administration (79101) | $960.06 | $2,594.75 | 4.3× |
| Salivary Gland Imaging (78230) | $272.41 | $736.25 | 0.7× |
| Scapula (73010) range across 3 matching MRF lines |
$129.78–$259.56 | $350.75–$701.50 | varies |
| Screening Digital Breast Tomosynthesis Bi (77063) | $34.97 | $94.50 | 1.5× |
| Shoulder 1 view (73020) range across 3 matching MRF lines |
$112.02–$224.04 | $302.75–$605.50 | varies |
| Shoulder Arthrography (73040) | $267.14 | $722 | 0.8× |
| Sialogram (70390) | $168.72 | $456 | 0.7× |
| Skull less than 4 views (70250) | $95.37 | $257.75 | 0.9× |
| Special dosimetry (77331) | $138.75 | $375 | 1.1× |
| Special Physics Consult (77370) | $224.41 | $606.50 | 1.7× |
| Special teletherapy port plan (77321) | $389.33 | $1,052.25 | 1.1× |
| Special treatment procedure (77470) | $609.48 | $1,647.25 | 1.1× |
| Stereotactic Body Radiation Delivery (77373) | $2,206.50 | $5,963.50 | 1.3× |
| Sternoclavicular joints (71130) | $125.80 | $340 | 1.5× |
| Superior sagittal sinus venogram (75870) | $348.82 | $942.75 | 0.1× |
| Surface Applic Low Dose Rate Radionuclide Source (77789) | $122.66 | $331.50 | 1.2× |
| Telethx isodose pln cplx w/basic dosimetry (77307) | $277.22 | $749.25 | 0.8× |
| Telethx isodose pln smpl w/dosimetry calculation (77306) | $200.36 | $541.50 | 0.6× |
| Testicular Imaging W/Flow (78761) | $342.62 | $926 | 0.9× |
| Ther Rad Simulaj-Aided Field Setting Complex (77290) | $647.59 | $1,750.25 | 1.8× |
| Ther Rad Simulaj-Aided Field Setting Intermed (77285) | $474.62 | $1,282.75 | 1.3× |
| Ther rad simulaj-aided field setting simple (77280) | $350.76 | $948 | 2.7× |
| Therapeutic Enema Rdctj Intussusception/Obstrcj (74283) | $254.19 | $687 | 1.5× |
| Thoracic spine 2 views (72070) | $148.46 | $401.25 | 1.5× |
| Thoracic spine 3 views (72072) | $172.24 | $465.50 | 1.7× |
| Thoracolumbar 2 views (72080) | $141.43 | $382.25 | 1.7× |
| Thyroid Imaging With Vascular Flow (78013) | $176.21 | $476.25 | 0.5× |
| Thyroid Met Imaging Body (78018) | $589.32 | $1,592.75 | 1.1× |
| Thyroid Uptake Measurement (78012) | $134.03 | $362.25 | 0.3× |
| Thyroid Uptake W/Blood Flow Sngle/Mult Quan Meas (78014) | $302.48 | $817.50 | 0.8× |
| Tx Devices Design & Construction Complex (77334) | $447.24 | $1,208.75 | 1.2× |
| Tx devices design & construction intermediate (77333) | $298.50 | $806.75 | 2.3× |
| Tx devices design & construction simple (77332) | $244.76 | $661.50 | 1.9× |
| Ultrasound Breast Limited (76642) range across 3 matching MRF lines |
$347.62–$695.23 | $939.50–$1,879 | varies |
| Ultrasound elastography first target lesion (76982) | $114.33 | $309 | 1.1× |
| Ultrasound Elastography Parenchyma (76981) | $114.33 | $309 | 1.1× |
| Ultrasound, abdomen limited (76705) | $362.60 | $980 | 3.6× |
| Umbilical-artery Doppler (OB) (76820) | $340.03 | $919 | 3.4× |
| Unlisted Dx Radiographic Procedure (76499) | $59.39 | $160.50 | 0.7× |
| Unlisted us procedure (76999) | $74.09 | $200.25 | 0.9× |
| Upper gi w/o kub (74240) | $299.98 | $810.75 | 1.8× |
| Ureteral Reflux Study (78740) | $406.35 | $1,098.25 | 1.1× |
| Urethrocystogram voiding (74455) | $269.36 | $728 | 1.2× |
| Urethrocystography retrograde (74450) | $257.15 | $695 | 1.1× |
| Us breast unilateral complete (76641) range across 3 matching MRF lines |
$347.62–$695.23 | $939.50–$1,879 | varies |
| Us chest (76604) | $263.90 | $713.25 | 2.6× |
| Us complete joint (76881) | $205.63 | $555.75 | 2.0× |
| Us exam, pelvic, limited (76857) | $301.27 | $814.25 | 3.0× |
| Us head (76506) | $226.26 | $611.50 | 2.3× |
| Us kidney transplant (76776) | $398.49 | $1,077 | 4.0× |
| Us lmtd joint/oth nonvasc xtr strux r-t w/img (76882) | $154.75 | $418.25 | 1.5× |
| Us ob detailed single fetus (76811) | $479.89 | $1,297 | 2.1× |
| Us ob limited 1 or more fetuses (76815) | $350.02 | $946 | 3.5× |
| Us ob transvaginal (76817) | $272.04 | $735.25 | 2.7× |
| Us pelvic non ob complete (76856) | $485.35 | $1,311.75 | 4.8× |
| Us pg uter img f&mat 14 wk tabdl 1/1st gestation (76801) | $488.77 | $1,321 | 4.9× |
| Us preg uterus real time f/u trnsabdl per fetus (76816) | $446.22 | $1,206 | 4.4× |
| Us retroperitoneal complete (76770) | $400.16 | $1,081.50 | 4.0× |
| Us retroperitoneal limited (76775) | $277.13 | $749 | 2.8× |
| Us scrotum and contents (76870) | $299.15 | $808.50 | 3.0× |
| Us spinal canal and contents (76800) | $175.01 | $473 | 1.7× |
| Us thyroid (76536) | $408.02 | $1,102.75 | 4.1× |
| Us transrectal (76872) | $295.45 | $798.50 | 2.9× |
| Vein X-Ray Chest (75827) | $867.10 | $2,343.50 | 0.6× |
| Vein X-Ray Liver W/O Hemodyn (75887) | $766.36 | $2,071.25 | 0.3× |
| Venogram Sinus/Jugular (75860) | $2,517.48 | $6,804 | 0.8× |
| Venography Adrenal Unilateral (75840) | $1,190.85 | $3,218.50 | 0.4× |
| Venography caval inferior serialography rs&i (75825) | $1,395.64 | $3,772 | 0.5× |
| Venography extremity bilateral rs&i (75822) | $890.50 | $2,406.75 | 0.6× |
| Venography extremity unilateral rs&i (75820) | $610.50 | $1,650 | 0.4× |
| Venography Orbital Rs&I (75880) | $815.39 | $2,203.75 | 1.4× |
| Venography Renal Bilateral (75833) | $1,329.50 | $3,593.25 | 0.4× |
| Venography Renal Unilateral (75831) | $1,190.85 | $3,218.50 | 0.4× |
| Venous sampling by catheter (75893) | $4,171.01 | $11,273 | 0.8× |
| Vertebral fracture assessment via dxa (77086) | $87.14 | $235.50 | 1.0× |
| Wrist 2 views (73100) range across 5 matching MRF lines |
$123.21–$246.42 | $333–$666 | varies |
| X-Ray Ac Jts - Xr Acromioclavicular Joints Bilateral (73050) | $117.94 | $318.75 | 1.4× |
| X-ray antegrade pyelogram tube (74425) | $297.67 | $804.50 | 0.9× |
| X-Ray Aorta Leg Arteries (75630) | $2,149.24 | $5,808.75 | 0.7× |
| X-Ray Bend Only L-S Spine (72120) | $192.03 | $519 | 1.9× |
| X-Ray Elbow 2 Vw - Xr Elbow 1-2 Views Right (73070) range across 5 matching MRF lines |
$112.94–$225.89 | $305.25–$610.50 | varies |
| X-Ray Exam Breast Specimen (76098) | $209.61 | $566.50 | 0.4× |
| X-Ray Exam Entire Spi 1 Vw (72081) | $143.38 | $387.50 | 1.7× |
| X-Ray Exam Entire Spi 2/3 Vw (72082) | $148.46 | $401.25 | 1.5× |
| X-Ray Exam Entire Spi 4/5 Vw (72083) | $195.36 | $528 | 1.9× |
| X-Ray Exam Hip Uni 1 View (73501) | $100.27 | $271 | 1.2× |
| X-Ray Exam Hip Uni 2-3 Views (73502) | $122.10 | $330 | 1.5× |
| X-Ray Exam Hip Uni 4/> Views (73503) | $161.69 | $437 | 1.6× |
| X-Ray Exam Hips Bi 2 Views (73521) | $107.67 | $291 | 1.1× |
| X-Ray Exam Hips Bi 3-4 Views (73522) | $159.19 | $430.25 | 1.6× |
| X-Ray Exam L-S Spine Bending (72114) | $266.22 | $719.50 | 2.6× |
| X-Ray Exam Neck Spine 2-3 Vw (72040) | $148.46 | $401.25 | 1.8× |
| X-Ray Exam Neck Spine 6/>Vws (72052) | $217.93 | $589 | 2.2× |
| X-Ray Exam Unilat Ribs/Chest (71101) | $206.74 | $558.75 | 2.1× |
| X-ray eye for foreign body (70030) | $45.70 | $123.50 | 0.5× |
| X-ray humerus (73060) | $124.23 | $335.75 | 1.5× |
| X-ray IV pyelogram (ivp) (74400) | $330.32 | $892.75 | 2.0× |
| X-ray IV pyelogram+tomography (74415) | $322.92 | $872.75 | 1.9× |
| X-Ray Jaw <4 Vw - Xr Mandible < 4 Views (70100) | $81.12 | $219.25 | 1.0× |
| X-Ray Knee Bilat Standing - Xr Knees Anteroposterior Standing Bilat (73565) | $89.82 | $242.75 | 1.1× |
| X-Ray Lumbar Spine 2/3 Vw - Xr Lumbar Spine 2-3 Views (72100) | $148.46 | $401.25 | 1.5× |
| X-ray nose-rectum child f.b. (76010) | $66.51 | $179.75 | 0.8× |
| X-Ray Ribs, Chest 4+ Vw - Xr Ribs 3 Vws Bil W/ Chest Posteroanterior (71111) | $225.61 | $609.75 | 2.2× |
| X-Ray Sacroiliac Jts 3+ Vw - Xr Sacroiliac Joints 3+ Views (72202) | $129.04 | $348.75 | 1.3× |
| X-Ray Sacroiliac Jts <3 Vw - Xr Sacroiliac Joints 1-2 Views (72200) | $120.71 | $326.25 | 1.2× |
| X-Ray Sacrum/Coccyx 2+ Vw - Xr Sacrum Coccyx 2+ Views (72220) | $124.32 | $336 | 1.5× |
| X-Ray Sinuses 3+ Vw - Xr Paranasal Sinuses 3+ Views (70220) | $95.37 | $257.75 | 1.1× |
| X-Ray Skull 4+ Vw - Xr Skull Complete 4+ Views (70260) | $115.35 | $311.75 | 1.1× |
| X-Ray Stress View (77071) | $45.70 | $123.50 | 0.5× |
| X-ray thoracic spine 4 vw (72074) | $175.01 | $473 | 1.7× |
| X-Ray Tmj Unilat (70328) | $57.44 | $155.25 | 0.7× |
| X-Ray Urinary Tract Exam With Contrast Material (74420) | $289.25 | $781.75 | 0.9× |
| X-Rays Bone Length Studies (77073) | $150.41 | $406.50 | 1.5× |
| X-Rays Bone Survey Complete (77075) | $330.04 | $892 | 3.3× |
| Xr c-spine 4 or 5 views (72050) | $184.82 | $499.50 | 1.8× |
| Xr facial bones less than 3 views (70140) | $60.03 | $162.25 | 0.7× |
| XR Mastoids < 3 Views Bilateral (70120) | $48.01 | $129.75 | 0.5× |
| Xr orbits complete 4 views (70200) | $74.93 | $202.50 | 0.7× |
| Xr Tomogram Single Plane (76100) | $240.59 | $650.25 | 2.4× |
A range means this hospital published different amounts on matching machine-readable-file lines. We show the lowest–highest posted amount because we cannot tell from the published file which line would apply to a particular visit.