Imaging prices at Ascension St. Vincent Kokomo
Kokomo, IN · every code in this section with a posted price and a Medicare benchmark.
331 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) | $6,682.20 | $11,137 | 4.6× |
| Abdomen 1 View (74018) | $258 | $430 | 2.8× |
| Abdomen 2 views (74019) | $270 | $450 | 2.4× |
| Acute Gastrointestinal Blood Loss Imaging (78278) | $1,630.80 | $2,718 | 3.9× |
| Angio internal mammary (75756) | $1,302 | $2,170 | 0.4× |
| Angiography extremity bilateral rs&i (75716) | $3,936 | $6,560 | 1.2× |
| Angiography extremity unilateral rs&i (75710) | $1,968 | $3,280 | 0.6× |
| Ankle 2 views (73600) range across 2 matching MRF lines |
$147.60–$295.20 | $246–$492 | varies |
| Aortography thoracic serialography rs&i (75605) unusually low: confirm this is the full procedure |
$2,476.20 | $4,127 | 0.4× |
| Artery X-Rays Abdomen (75726) | $3,103.80 | $5,173 | 0.5× |
| Artery X-Rays Pelvis (75736) unusually low: confirm this is the full procedure |
$2,248.80 | $3,748 | 0.4× |
| Arthrogram hip (73525) | $964.80 | $1,608 | 2.6× |
| Arthrogram Wrist (73115) | $760.80 | $1,268 | 2.1× |
| Basic radiation dosimetry calculation (77300) | $625.20 | $1,042 | 4.4× |
| Bone age studies (77072) | $172.80 | $288 | 1.6× |
| Bone Imaging 3 Phase (78315) | $2,642.40 | $4,404 | 6.2× |
| Bone Imaging Limited Area (78300) | $1,399.20 | $2,332 | 3.3× |
| Bone Imaging Multiple Areas (78305) | $1,446 | $2,410 | 3.4× |
| Bone Imaging Whole Body (78306) | $2,310 | $3,850 | 5.5× |
| Bone marrow imaging limited area (78102) | $1,168.80 | $1,948 | 2.8× |
| Bone marrow imaging; multiple areas (78103) | $1,573.80 | $2,623 | 3.7× |
| Bone marrow imaging; whole body (78104) | $1,605.60 | $2,676 | 3.8× |
| Bone survey infant (77076) | $427.80 | $713 | 3.9× |
| Brain Flow Imaging Only (78610) | $2,406.60 | $4,011 | 4.2× |
| Brain Image W/Flow < 4 Views (78601) | $910.20 | $1,517 | 2.2× |
| Brain Imaging Pet Metabolic Evaluation (78608) | $3,780 | $6,300 | 2.5× |
| Cerebrospinal Fluid Flow W/O Matl Shunt Evaltj (78645) | $1,503 | $2,505 | 2.6× |
| Cerebrospinal Fluid Scan (78630) | $1,949.40 | $3,249 | 3.4× |
| Chest 1 view (71045) | $162.60 | $271 | 1.8× |
| Chest 2 views (71046) | $185.40 | $309 | 2.0× |
| Chest 3 views (71047) | $195.60 | $326 | 2.1× |
| Chest 4 or more views (71048) | $210 | $350 | 1.9× |
| Clavicle complete (73000) range across 2 matching MRF lines |
$192–$384 | $320–$640 | varies |
| Computed Tomography Thorax Lw Dose Lng Ca Scr C- (71271) | $542.40 | $904 | 4.9× |
| Continuing medical physics consltj pr wk (77336) | $786.60 | $1,311 | 5.5× |
| Contrast Exam Abdominl Aorta (75625) | $2,476.20 | $4,127 | 0.7× |
| Contrast X-Ray Bladder (74430) | $315.60 | $526 | 0.9× |
| Contrast X-Ray Of Elbow (73085) | $903.60 | $1,506 | 2.4× |
| Contrast X-Ray Of Knee Joint (73580) | $914.40 | $1,524 | 2.5× |
| CT abdomen and pelvis without and with contrast (74178) | $542.40 | $904 | 1.5× |
| CT abdomen and pelvis without contrast (74176) | $542.40 | $904 | 2.1× |
| CT abdomen w contrast (74160) | $542.40 | $904 | 2.9× |
| CT abdomen w wo contrast (74170) | $542.40 | $904 | 2.9× |
| CT abdomen w/o contrast (74150) | $542.40 | $904 | 4.9× |
| CT Angio Abdomen and Pelvis (74174) | $542.40 | $904 | 1.5× |
| CT Angio Chest (71275) | $542.40 | $904 | 2.9× |
| CT Angio Head (70496) range across 2 matching MRF lines |
$542.40–$1,206 | $904–$2,010 | varies |
| CT angio hrt w/3d image (75574) | $542.40 | $904 | 1.5× |
| Ct Angio Lwr Extr W/O&W/Dye (73706) range across 2 matching MRF lines |
$542.40–$1,084.80 | $904–$1,808 | varies |
| CT Angio Neck (70498) | $542.40 | $904 | 2.9× |
| Ct Angio Upr Extrm W/O&W/Dye (73206) | $542.40 | $904 | 2.9× |
| CT cervical spine w/ contrast (72126) | $542.40 | $904 | 1.5× |
| CT cervical spine w/o contrast (72125) | $542.40 | $904 | 4.9× |
| CT cervical spine w/wo cont (72127) | $542.40 | $904 | 2.9× |
| CT chest w contrast (71260) | $542.40 | $904 | 2.9× |
| CT chest w/wo contrast (71270) | $542.40 | $904 | 2.9× |
| CT head/brain with contrast (70460) | $542.40 | $904 | 2.9× |
| CT head/brain without and with contrast (70470) | $542.40 | $904 | 2.9× |
| CT heart no contrast quant eval coronry calcium (75571) | $231.60 | $386 | 2.5× |
| CT iac w contrast (70481) | $542.40 | $904 | 2.9× |
| CT l-spine w&w/o contrast (72133) | $542.40 | $904 | 2.9× |
| CT lower ext w/o (73700) range across 2 matching MRF lines |
$542.40–$1,084.80 | $904–$1,808 | varies |
| CT lower extremity w/contrast material (73701) range across 2 matching MRF lines |
$542.40–$1,084.80 | $904–$1,808 | varies |
| CT lumbar spine w contrast (72132) | $542.40 | $904 | 1.5× |
| CT lumbar spine w/o contrast (72131) | $542.40 | $904 | 4.9× |
| CT maxillofacial w contrast (70487) | $542.40 | $904 | 2.9× |
| CT maxillofacial wo contrast (70486) | $542.40 | $904 | 4.9× |
| CT neck tissue combo (70492) | $542.40 | $904 | 2.9× |
| Ct Orbit/Ear/Fossa W/O&W/Dye (70482) | $542.40 | $904 | 2.9× |
| CT orbits w/o contrast (70480) | $542.40 | $904 | 4.9× |
| CT pelvis w&w/o contrast (72194) | $542.40 | $904 | 2.9× |
| CT pelvis w/o contrast (72192) | $542.40 | $904 | 4.9× |
| CT scan of leg combo (73702) range across 2 matching MRF lines |
$542.40–$1,084.80 | $904–$1,808 | varies |
| CT scans face/jaw combo (70488) | $542.40 | $904 | 2.9× |
| CT soft tissue neck w contrast (70491) | $542.40 | $904 | 2.9× |
| CT soft tissue neck w/o contrast (70490) | $542.40 | $904 | 4.9× |
| CT thoracic spine w contrast (72129) | $542.40 | $904 | 2.9× |
| CT thoracic spine w/o contrast (72128) | $542.40 | $904 | 4.9× |
| CT thoracic spine w/wo cont (72130) | $542.40 | $904 | 2.9× |
| CT thorax w/o contrast (71250) | $542.40 | $904 | 4.9× |
| CT upper ext wo (73200) range across 2 matching MRF lines |
$542.40–$1,084.80 | $904–$1,808 | varies |
| CT upper extremity w/o & w/contrast material (73202) range across 2 matching MRF lines |
$542.40–$1,084.80 | $904–$1,808 | varies |
| CT upper extremity with contrast (73201) range across 2 matching MRF lines |
$542.40–$1,084.80 | $904–$1,808 | varies |
| Cta Abdl Aorta&Bi Iliofem W/Contrast&Postp (75635) | $542.40 | $904 | 2.9× |
| Cta Abdomen (74175) | $542.40 | $904 | 2.9× |
| CTA pelvis (72191) | $542.40 | $904 | 2.9× |
| Dxa Bone Density Axial (77080) | $290.40 | $484 | 2.6× |
| Dxa bone density study (77085) | $466.80 | $778 | 4.2× |
| Dxa bone density study 1/>sites appendiclr skel (77081) | $145.20 | $242 | 1.6× |
| Echo exam uterus (76831) | $325.80 | $543 | 1.3× |
| Echo Guide For Artery Repair (76936) | $324.60 | $541 | 1.4× |
| Esophagram (74220) | $484.80 | $808 | 2.6× |
| Fetal Biophys Profile W/Nst (76818) | $480 | $800 | 4.3× |
| Fetal Biophysical Profile W/O Non-Stress Testing (76819) | $306 | $510 | 2.8× |
| Fluoroscopy up to 1 hr (76000) | $439.20 | $732 | 1.7× |
| Follow-Up Angiography (75898) | $687.60 | $1,146 | 0.2× |
| Foot 2 views (73620) range across 2 matching MRF lines |
$145.20–$290.40 | $242–$484 | varies |
| Forearm 2 views (73090) range across 2 matching MRF lines |
$183.60–$367.20 | $306–$612 | varies |
| Gastric emptying imaging study (78264) | $1,265.40 | $2,109 | 3.0× |
| Gastroesophageal Reflux Exam (78262) | $1,156.80 | $1,928 | 2.7× |
| Gated Heart Planar Single (78472) | $2,447.40 | $4,079 | 5.8× |
| Hand 2 views (73120) range across 2 matching MRF lines |
$171.60–$343.20 | $286–$572 | varies |
| Hepatobil Syst Image W/Drug (78227) | $2,638.20 | $4,397 | 4.6× |
| Hepatobiliary System Imaging (78226) | $2,638.20 | $4,397 | 6.2× |
| Ht Muscle Image Spect Sing (78451) | $3,483.60 | $5,806 | 2.5× |
| Hysterosalpingogram (74740) | $325.80 | $543 | 1.3× |
| K Flow/Funct Image Multiple (78709) | $2,314.20 | $3,857 | 4.0× |
| K Flow/Funct Image W/Drug (78708) | $2,026.20 | $3,377 | 3.5× |
| K Flow/Funct Image W/O Drug (78707) | $1,968 | $3,280 | 3.4× |
| Kidney Imaging Morphol (78700) | $1,155.60 | $1,926 | 2.7× |
| Kidney Imaging Morphoogy W/Vascular Flow (78701) | $1,533.60 | $2,556 | 3.6× |
| Knee 3 Views (73562) range across 2 matching MRF lines |
$229.20–$458.40 | $382–$764 | varies |
| Leveen/Shunt Patency Exam (78291) | $1,377 | $2,295 | 3.3× |
| Liver & Spleen Imaging Static Only (78215) | $1,794.60 | $2,991 | 4.2× |
| Lung Perf&Ventilat Diferentl (78598) | $3,846 | $6,410 | 6.7× |
| Lung perfusion differential (78597) | $2,181.60 | $3,636 | 5.2× |
| Lung Ventilat&Perfus Imaging (78582) | $2,726.40 | $4,544 | 4.7× |
| Lung Ventilation Imaging (78579) | $1,564.80 | $2,608 | 3.7× |
| Magnetic Image Jaw Joint (70336) | $582.60 | $971 | 2.3× |
| Mammary ductogram or galactogram multiple (77054) | $258 | $430 | 1.0× |
| Mammary ductogram or galactogram single (77053) | $481.80 | $803 | 1.9× |
| Meckels Divert Exam (78290) | $1,489.80 | $2,483 | 3.5× |
| Mlc imrt design & construction per imrt plan (77338) | $1,154.40 | $1,924 | 2.9× |
| Mra Head W/O & W/Contrast Material (70546) | $582.60 | $971 | 1.6× |
| MRA head w/o contrast (70544) | $582.60 | $971 | 2.3× |
| MRA head with contrast (70545) | $582.60 | $971 | 1.6× |
| MRA neck w contrast (70548) | $582.60 | $971 | 1.6× |
| Mra Neck W/O &W/Contrast Material (70549) | $582.60 | $971 | 1.6× |
| MRA neck w/o contrast (70547) | $582.60 | $971 | 2.3× |
| MRI abdomen w contrast (74182) | $582.60 | $971 | 1.6× |
| MRI abdomen w/o contrast (74181) | $582.60 | $971 | 2.3× |
| MRI any jt lower extrem w/contrast material (73722) range across 2 matching MRF lines |
$582.60–$1,165.20 | $971–$1,942 | varies |
| MRI any jt lower extrem w/o & w/contrast matrl (73723) range across 2 matching MRF lines |
$582.60–$1,165.20 | $971–$1,942 | varies |
| MRI any jt upper extremity w/contrast matrl (73222) range across 2 matching MRF lines |
$582.60–$1,165.20 | $971–$1,942 | varies |
| MRI bone marrow blood supply (77084) | $582.60 | $971 | 2.3× |
| MRI Breast W/O Contrast Bilateral (77047) | $582.60 | $971 | 2.3× |
| MRI Breast Without Contrast Material Unilateral (77046) | $582.60 | $971 | 2.3× |
| MRI cervical spine w contrast (72142) | $582.60 | $971 | 1.6× |
| MRI cervical spine w/o cont (72141) | $582.60 | $971 | 2.3× |
| MRI chest w/o contrast (71550) | $582.60 | $971 | 2.3× |
| MRI chest wo w contrast (71552) | $582.60 | $971 | 1.6× |
| MRI lower extrem oth/thn jt w/contrast matrl (73719) range across 2 matching MRF lines |
$582.60–$1,165.20 | $971–$1,942 | varies |
| MRI lower extrem oth/thn jt w/o & w/contr matr (73720) range across 2 matching MRF lines |
$582.60–$1,165.20 | $971–$1,942 | varies |
| MRI lower extrem oth/thn jt w/o contr matrl (73718) range across 2 matching MRF lines |
$582.60–$1,165.20 | $971–$1,942 | varies |
| MRI lumbar spine w contrast (72149) | $582.60 | $971 | 1.6× |
| Mri Neck Spine W/O & W/Dye (72156) | $582.60 | $971 | 1.6× |
| MRI orbit face &/neck w/o contrast (70540) | $582.60 | $971 | 2.3× |
| MRI orbit face neck w contrast (70542) | $582.60 | $971 | 1.6× |
| Mri Orbt/Fac/Nck W/O &W/Dye (70543) | $582.60 | $971 | 1.6× |
| MRI pelvis w contrast (72196) | $582.60 | $971 | 1.6× |
| MRI pelvis w/o & w contrast (72197) | $582.60 | $971 | 1.6× |
| MRI pelvis w/o contrast (72195) | $582.60 | $971 | 2.3× |
| MRI thoracic spine w/o contrast (72146) | $582.60 | $971 | 2.3× |
| MRI upper extremity oth than jt w/o contr matrl (73218) range across 2 matching MRF lines |
$582.60–$1,165.20 | $971–$1,942 | varies |
| Mri Uppr Extremity W/O&W/Dye (73220) range across 2 matching MRF lines |
$582.60–$1,165.20 | $971–$1,942 | varies |
| MRI, abdomen, combo (74183) | $582.60 | $971 | 1.6× |
| MRI, dorsal spine combo (72157) | $582.60 | $971 | 1.6× |
| MRI, dorsal spine contrast (72147) | $582.60 | $971 | 1.6× |
| MRI, joint upper extrem (73221) range across 2 matching MRF lines |
$582.60–$1,165.20 | $971–$1,942 | varies |
| MRI, joint upper extrem combo (73223) range across 2 matching MRF lines |
$582.60–$1,165.20 | $971–$1,942 | varies |
| MRI, lumbar spine combo (72158) | $582.60 | $971 | 1.6× |
| Myocardial Spect Multiple Studies (78452) | $4,249.80 | $7,083 | 3.1× |
| Myocrd Img Pet Metab Eval Single Study Cncrnt CT (78429) | $4,323 | $7,205 | 2.9× |
| N-invas est c ffr sw aly CTA (75580) | $3,553.80 | $5,923 | 3.9× |
| Neck soft tissue (70360) | $172.80 | $288 | 1.9× |
| Nfs/Instlj Radioelmnt Sln 3 Mo Follow-Up Care (77750) | $1,332.60 | $2,221 | 3.3× |
| Nm csf leak detection (78650) | $2,113.80 | $3,523 | 1.5× |
| Ntsty modul radthx pln dose-vol histos (77301) | $7,347.60 | $12,246 | 5.0× |
| Nuclear Rx Oral Admin (79005) | $2,230.20 | $3,717 | 9.0× |
| Optic foramina (70190) | $303.60 | $506 | 3.3× |
| Parathyroid imaging w/tomographic spect & CT (78072) | $2,166 | $3,610 | 3.8× |
| Parathyroid Planar Imaging (78070) | $1,189.20 | $1,982 | 2.8× |
| Parathyroid planar imaging w/wo subtraction (78071) | $1,531.80 | $2,553 | 3.6× |
| Pelvis 1 or 2 views (72170) | $186 | $310 | 1.7× |
| Pet Image W/Ct Lmtd (78814) | $4,926.60 | $8,211 | 3.3× |
| PET image w/CT, full body (78816) | $7,389 | $12,315 | 4.9× |
| PET imaging CT attenuation skull base mid-thigh (78815) | $6,157.20 | $10,262 | 4.1× |
| Pulmonary Perfusion Imaging Particulate (78580) | $2,010 | $3,350 | 4.8× |
| Radex Abd Compl Aqt Abd W/S/E/D Views 1 View Ch (74022) | $340.20 | $567 | 3.1× |
| Radex abscess/fistula/sinus tract rs&i (76080) | $263.40 | $439 | 0.5× |
| Radex Ankle Complete Minimum 3 Views (73610) range across 2 matching MRF lines |
$196.20–$392.40 | $327–$654 | varies |
| Radex Calcaneus Minimum 2 Views (73650) range across 2 matching MRF lines |
$258–$516 | $430–$860 | varies |
| Radex elbow complete minimum 3 views (73080) range across 2 matching MRF lines |
$258–$516 | $430–$860 | varies |
| Radex Facial Bones Complete Minimum 3 Views (70150) | $273 | $455 | 2.5× |
| Radex fingr minimum 2 views (73140) range across 2 matching MRF lines |
$151.80–$303.60 | $253–$506 | varies |
| Radex foot complete minimum 3 views (73630) range across 2 matching MRF lines |
$195–$390 | $325–$650 | varies |
| Radex Hand Minimum 3 Views (73130) range across 2 matching MRF lines |
$201.60–$403.20 | $336–$672 | varies |
| Radex lower extremity infant minimum 2 views (73592) range across 2 matching MRF lines |
$135.60–$271.20 | $226–$452 | varies |
| Radex Mastoids Compl Minimum 3 Views PR Side (70130) range across 2 matching MRF lines |
$195–$390 | $325–$650 | varies |
| Radex Nasal Bones Complete Minimum 3 Views (70160) | $193.20 | $322 | 2.1× |
| Radex Ribs Unilateral 2 Views (71100) | $204.60 | $341 | 2.2× |
| Radex shoulder complete minimum 2 views (73030) range across 2 matching MRF lines |
$195.60–$391.20 | $326–$652 | varies |
| Radex Sinuses Paransl < 3 Views (70210) | $192 | $320 | 2.1× |
| Radex sm int w/mlt srl imges via enteroclss tube (74251) | $258 | $430 | 1.4× |
| Radex Spine 1 View Specify Level (72020) | $171.60 | $286 | 1.9× |
| Radex Sternum Minimum 2 Views (71120) | $195 | $325 | 2.1× |
| Radex Temporomandble Jt Opn & Clsd Mouth Bilat (70330) | $262.20 | $437 | 2.8× |
| Radex Toe Minimum 2 Views (73660) range across 2 matching MRF lines |
$148.20–$296.40 | $247–$494 | varies |
| Radex upper extremity infant minimum 2 views (73092) range across 2 matching MRF lines |
$100.20–$200.40 | $167–$334 | varies |
| Radex Wrist Complete Minimum 3 Views (73110) range across 2 matching MRF lines |
$258–$516 | $430–$860 | varies |
| Radex X-Ray Exam Entire Spi 6/> Vw - Xr Entire Spine 6+ Vw (72084) | $517.80 | $863 | 4.7× |
| Radiation Delivery Stereotactic Cranial Linear (77372) | $18,443.40 | $30,739 | 2.4× |
| Radiation treatment delivery level 1 (77402) | $782.40 | $1,304 | 7.2× |
| Radiation treatment delivery level 2 (77407) | $946.80 | $1,578 | 2.3× |
| Radiation treatment delivery level 3 (77412) | $1,092 | $1,820 | 1.9× |
| Radiolog exam mandible compl minimum 4 views (70110) | $259.20 | $432 | 2.3× |
| Radiologic Exam Abdomen 3+ Views - Xr Abdomen 3+ Views (74021) | $291 | $485 | 2.6× |
| Radiologic exam colon double contrast study (74280) | $856.20 | $1,427 | 4.6× |
| Radiologic exam colon single contrast study (74270) | $674.40 | $1,124 | 3.6× |
| Radiologic Exam Esophagus Double Contrast Study (74221) | $520.80 | $868 | 2.8× |
| Radiologic exam knee complete 4/more views (73564) range across 2 matching MRF lines |
$261.60–$523.20 | $436–$872 | varies |
| Radiologic exam pelvis compl minimum 3 views (72190) | $226.20 | $377 | 2.0× |
| Radiologic Exam Small Int Single Contrast Study (74250) | $258 | $430 | 1.4× |
| Radiologic exam swallow function contrast study (74230) | $258 | $430 | 1.4× |
| Radiologic exam upr gi trc double contrast study (74246) | $704.40 | $1,174 | 3.8× |
| Radiologic examination femur 1 view (73551) range across 2 matching MRF lines |
$97.20–$194.40 | $162–$324 | varies |
| Radiologic examination femur minimum 2 views (73552) range across 2 matching MRF lines |
$195–$390 | $325–$650 | varies |
| Radiologic examination knee 1/2 views (73560) range across 2 matching MRF lines |
$208.80–$417.60 | $348–$696 | varies |
| Radiologic Examination Osseous Survey Limited (77074) | $501 | $835 | 4.5× |
| Radiologic Examination Salivary Gland Calculus (70380) | $162.60 | $271 | 1.8× |
| Radiologic examination tibia & fibula 2 views (73590) range across 2 matching MRF lines |
$198.60–$397.20 | $331–$662 | varies |
| Ribs bilateral 3 views (71110) | $292.20 | $487 | 2.6× |
| Rp loclzj tum plnr 2+area 1+d img/1 area img>2+d (78801) | $2,089.80 | $3,483 | 4.9× |
| Rp Loclzj Tum Plnr Whole Body 2+ Days Imaging (78804) | $3,451.80 | $5,753 | 6.0× |
| Rp Loclzj Tum Plnr Whole Body Single Day Imaging (78802) | $2,690.40 | $4,484 | 4.7× |
| Rp Loclzj Tum Spect 1 Area Single Day Imaging (78803) | $2,507.40 | $4,179 | 4.4× |
| Rp loclzj tum spect 2 area/sep acquisj img (78831) | $2,874 | $4,790 | 2.1× |
| Rp loclzj tum spect CT 2area 1d img/1 ar img>2+d (78832) | $4,692.60 | $7,821 | 3.1× |
| Rp loclzj tum spect w/CT 1 area/acquisj 1day img (78830) | $3,360.60 | $5,601 | 2.5× |
| Rp Therapy Intravenous Administration (79101) | $819.60 | $1,366 | 3.3× |
| Scapula (73010) range across 2 matching MRF lines |
$222–$444 | $370–$740 | varies |
| Screening Digital Breast Tomosynthesis Bi (77063) | $53.40 | $89 | 2.3× |
| Shoulder 1 view (73020) range across 2 matching MRF lines |
$162.60–$325.20 | $271–$542 | varies |
| Shoulder Arthrography (73040) range across 2 matching MRF lines |
$505.20–$1,010.40 | $842–$1,684 | varies |
| Skull less than 4 views (70250) | $232.80 | $388 | 2.1× |
| Special dosimetry (77331) | $733.80 | $1,223 | 5.2× |
| Special Physics Consult (77370) | $1,156.80 | $1,928 | 8.1× |
| Special teletherapy port plan (77321) | $1,464.60 | $2,441 | 3.7× |
| Special treatment procedure (77470) | $2,591.40 | $4,319 | 4.4× |
| Stereotactic Body Radiation Delivery (77373) | $6,023.40 | $10,039 | 3.2× |
| Sternoclavicular joints (71130) | $223.80 | $373 | 2.4× |
| Tbs technical calculation only (77091) | $153.60 | $256 | 1.7× |
| Telethx isodose pln cplx w/basic dosimetry (77307) | $1,236.60 | $2,061 | 3.1× |
| Telethx isodose pln smpl w/dosimetry calculation (77306) | $687 | $1,145 | 1.7× |
| Testicular Imaging W/Flow (78761) | $831.60 | $1,386 | 2.0× |
| Ther Rad Simulaj-Aided Field Setting Complex (77290) | $2,328 | $3,880 | 5.9× |
| Ther Rad Simulaj-Aided Field Setting Intermed (77285) | $1,914.60 | $3,191 | 4.8× |
| Ther rad simulaj-aided field setting simple (77280) | $1,293 | $2,155 | 9.1× |
| Therapeutic Enema Rdctj Intussusception/Obstrcj (74283) | $258 | $430 | 1.4× |
| Thoracic spine 2 views (72070) | $238.20 | $397 | 2.2× |
| Thoracic spine 3 views (72072) | $283.80 | $473 | 2.6× |
| Thoracolumbar 2 views (72080) | $234.60 | $391 | 2.5× |
| Thyroid Imaging With Vascular Flow (78013) | $894 | $1,490 | 2.1× |
| Thyroid Met Imaging Body (78018) | $2,442 | $4,070 | 4.3× |
| Thyroid Uptake Measurement (78012) | $580.20 | $967 | 1.4× |
| Thyroid Uptake W/Blood Flow Sngle/Mult Quan Meas (78014) | $1,977 | $3,295 | 4.7× |
| Tx Devices Design & Construction Complex (77334) | $1,186.80 | $1,978 | 3.0× |
| Tx devices design & construction intermediate (77333) | $876 | $1,460 | 6.2× |
| Tx devices design & construction simple (77332) | $706.20 | $1,177 | 5.0× |
| Ultrasound Breast Limited (76642) range across 2 matching MRF lines |
$337.20–$674.40 | $562–$1,124 | varies |
| Ultrasound Exam Aaa Screen (76706) | $331.20 | $552 | 3.0× |
| Ultrasound, abdomen limited (76705) | $329.40 | $549 | 3.0× |
| Upper gi w/o kub (74240) | $659.40 | $1,099 | 3.6× |
| Ureteral Reflux Study (78740) | $603.60 | $1,006 | 1.4× |
| Urethrocystogram voiding (74455) | $258 | $430 | 1.0× |
| Urethrocystography retrograde (74450) | $258 | $430 | 1.0× |
| Us breast unilateral complete (76641) range across 3 matching MRF lines |
$588–$1,176 | $980–$1,960 | varies |
| Us chest (76604) range across 2 matching MRF lines |
$117.60–$235.20 | $196–$392 | varies |
| Us complete joint (76881) | $334.80 | $558 | 3.0× |
| Us exam, pelvic, limited (76857) | $295.20 | $492 | 2.7× |
| Us head (76506) | $324.60 | $541 | 2.9× |
| Us kidney transplant (76776) | $405 | $675 | 3.7× |
| Us lmtd joint/oth nonvasc xtr strux r-t w/img (76882) | $281.40 | $469 | 2.5× |
| Us ob detailed single fetus (76811) | $541.80 | $903 | 2.1× |
| Us ob limited 1 or more fetuses (76815) | $293.40 | $489 | 2.7× |
| Us ob transvaginal (76817) | $330.60 | $551 | 3.0× |
| Us pelvic non ob complete (76856) | $343.20 | $572 | 3.1× |
| Us pg uter img f&mat 14 wk tabdl 1/1st gestation (76801) | $478.20 | $797 | 4.3× |
| Us preg uterus real time f/u trnsabdl per fetus (76816) | $301.80 | $503 | 2.7× |
| Us retroperitoneal complete (76770) | $319.20 | $532 | 2.9× |
| Us retroperitoneal limited (76775) | $239.40 | $399 | 2.2× |
| Us scrotum and contents (76870) | $382.20 | $637 | 3.5× |
| Us spinal canal and contents (76800) | $324.60 | $541 | 2.9× |
| Us thyroid (76536) | $348.60 | $581 | 3.2× |
| Vein X-Ray Chest (75827) | $1,908 | $3,180 | 1.1× |
| Venography caval inferior serialography rs&i (75825) | $1,770 | $2,950 | 0.5× |
| Venography extremity unilateral rs&i (75820) | $607.20 | $1,012 | 0.4× |
| Venography Renal Bilateral (75833) | $2,242.20 | $3,737 | 0.7× |
| Venography Renal Unilateral (75831) | $1,419.60 | $2,366 | 0.4× |
| Venous sampling by catheter (75893) likely a partial charge, not the full procedure |
$1,651.20 | $2,752 | 0.3× |
| Vertebral fracture assessment via dxa (77086) | $180.60 | $301 | 2.0× |
| Wrist 2 views (73100) range across 2 matching MRF lines |
$145.20–$290.40 | $242–$484 | varies |
| X-Ray Ac Jts - Xr Acromioclavicular Joints Bilateral (73050) | $234.60 | $391 | 2.5× |
| X-ray antegrade pyelogram tube (74425) | $351 | $585 | 1.0× |
| X-Ray Aorta Leg Arteries (75630) | $2,476.20 | $4,127 | 0.7× |
| X-Ray Bend Only L-S Spine (72120) | $258 | $430 | 2.3× |
| X-Ray Elbow 2 Vw - Xr Elbow 1-2 Views Right (73070) range across 2 matching MRF lines |
$160.20–$320.40 | $267–$534 | varies |
| X-Ray Exam Breast Specimen (76098) | $258 | $430 | 0.4× |
| X-Ray Exam Entire Spi 1 Vw (72081) | $244.20 | $407 | 2.7× |
| X-Ray Exam Entire Spi 2/3 Vw (72082) | $386.40 | $644 | 3.5× |
| X-Ray Exam Entire Spi 4/5 Vw (72083) | $397.80 | $663 | 3.6× |
| X-Ray Exam Hip Uni 1 View (73501) | $172.80 | $288 | 1.9× |
| X-Ray Exam Hip Uni 2-3 Views (73502) | $274.80 | $458 | 3.0× |
| X-Ray Exam Hip Uni 4/> Views (73503) | $376.80 | $628 | 3.4× |
| X-Ray Exam Hips Bi 2 Views (73521) | $274.80 | $458 | 2.5× |
| X-Ray Exam Hips Bi 3-4 Views (73522) | $376.80 | $628 | 3.4× |
| X-Ray Exam Hips Bi 5/> Views (73523) | $478.80 | $798 | 4.3× |
| X-Ray Exam L-S Spine Bending (72114) | $362.40 | $604 | 3.3× |
| X-Ray Exam Neck Spine 2-3 Vw (72040) | $249.60 | $416 | 2.7× |
| X-Ray Exam Neck Spine 6/>Vws (72052) | $367.80 | $613 | 3.3× |
| X-Ray Exam Unilat Ribs/Chest (71101) | $226.80 | $378 | 2.1× |
| X-ray eye for foreign body (70030) range across 2 matching MRF lines |
$258–$516 | $430–$860 | varies |
| X-ray humerus (73060) range across 2 matching MRF lines |
$181.20–$362.40 | $302–$604 | varies |
| X-Ray Jaw <4 Vw - Xr Mandible < 4 Views (70100) | $162.60 | $271 | 1.8× |
| X-Ray Knee Bilat Standing - Xr Knees Anteroposterior Standing Bilat (73565) | $208.80 | $348 | 2.3× |
| X-Ray Lumbar Spine 2/3 Vw - Xr Lumbar Spine 2-3 Views (72100) | $240 | $400 | 2.2× |
| X-ray nose-rectum child f.b. (76010) | $258 | $430 | 2.8× |
| X-Ray Ribs, Chest 4+ Vw - Xr Ribs 3 Vws Bil W/ Chest Posteroanterior (71111) | $309.60 | $516 | 2.8× |
| X-Ray Sacroiliac Jts 3+ Vw - Xr Sacroiliac Joints 3+ Views (72202) | $236.40 | $394 | 2.1× |
| X-Ray Sacroiliac Jts <3 Vw - Xr Sacroiliac Joints 1-2 Views (72200) | $265.80 | $443 | 2.4× |
| X-Ray Sacrum/Coccyx 2+ Vw - Xr Sacrum Coccyx 2+ Views (72220) | $219 | $365 | 2.4× |
| X-Ray Sinuses 3+ Vw - Xr Paranasal Sinuses 3+ Views (70220) | $283.80 | $473 | 3.1× |
| X-Ray Skull 4+ Vw - Xr Skull Complete 4+ Views (70260) | $306.60 | $511 | 2.8× |
| X-ray thoracic spine 4 vw (72074) | $258 | $430 | 2.3× |
| X-Ray Urinary Tract Exam With Contrast Material (74420) | $258 | $430 | 0.7× |
| X-Rays Bone Length Studies (77073) | $277.80 | $463 | 2.5× |
| X-Rays Bone Survey Complete (77075) | $660 | $1,100 | 6.0× |
| Xr c-spine 4 or 5 views (72050) | $348 | $580 | 3.1× |
| Xr facial bones less than 3 views (70140) | $208.20 | $347 | 2.3× |
| XR Mastoids < 3 Views Bilateral (70120) range across 2 matching MRF lines |
$155.40–$310.80 | $259–$518 | varies |
| Xr orbits complete 4 views (70200) | $247.80 | $413 | 2.2× |
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.