Imaging prices at Ascension Via Christi Hospital Manhattan, Inc
Manhattan, KS · every code in this section with a posted price and a Medicare benchmark.
292 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) | $778 | $1,945 | 0.6× |
| Abdomen 1 View (74018) range across 3 matching MRF lines |
$59.20–$248 | $148–$620 | varies |
| Abdomen 2 views (74019) range across 4 matching MRF lines |
$66–$330.80 | $165–$827 | varies |
| Acute Gastrointestinal Blood Loss Imaging (78278) | $642 | $1,605 | 1.7× |
| Adrenal Cortex & Medulla Img (78075) | $1,044.40 | $2,611 | 0.9× |
| Angiography extremity bilateral rs&i (75716) | $1,929.20 | $4,823 | 0.7× |
| Angiography extremity unilateral rs&i (75710) | $2,387.20 | $5,968 | 0.8× |
| Ankle 2 views (73600) range across 6 matching MRF lines |
$47.20–$218.80 | $118–$547 | varies |
| Arthrogram hip (73525) | $628.80 | $1,572 | 2.0× |
| Basic radiation dosimetry calculation (77300) | $79.20 | $198 | 0.6× |
| Bone age studies (77072) | $61.20 | $153 | 0.6× |
| Bone Imaging 3 Phase (78315) | $985.60 | $2,464 | 2.7× |
| Bone Imaging Limited Area (78300) | $689.20 | $1,723 | 1.9× |
| Bone Imaging Multiple Areas (78305) | $704.40 | $1,761 | 1.9× |
| Bone Imaging Whole Body (78306) | $971.20 | $2,428 | 2.6× |
| Bone survey infant (77076) range across 2 matching MRF lines |
$57.20–$281.60 | $143–$704 | varies |
| Brain Flow Imaging Only (78610) | $936.40 | $2,341 | 1.9× |
| Brain Imaging Pet Metabolic Evaluation (78608) | $1,717.20 | $4,293 | 1.3× |
| Cat Scan Follow-Up Study (76380) | $236 | $590 | 2.9× |
| Cerebrospinal Fluid Scan (78630) | $725.60 | $1,814 | 1.5× |
| Chest 1 view (71045) range across 4 matching MRF lines |
$54.40–$168.80 | $136–$422 | varies |
| Chest 2 views (71046) range across 5 matching MRF lines |
$35.20–$291.20 | $88–$728 | varies |
| Chest 3 views (71047) | $71.20 | $178 | 0.9× |
| Chest 4 or more views (71048) | $71.20 | $178 | 0.7× |
| Clavicle complete (73000) range across 6 matching MRF lines |
$50.40–$240.80 | $126–$602 | varies |
| Computed Tomography Thorax Lw Dose Lng Ca Scr C- (71271) range across 2 matching MRF lines |
$206–$534 | $515–$1,335 | varies |
| Continuing medical physics consltj pr wk (77336) | $79.20 | $198 | 0.6× |
| Contrast Exam Abdominl Aorta (75625) | $2,088.80 | $5,222 | 0.7× |
| Contrast X-Ray Bladder (74430) range across 2 matching MRF lines |
$200–$496 | $500–$1,240 | varies |
| Contrast X-Ray Of Elbow (73085) | $628.80 | $1,572 | 2.0× |
| CT abdomen and pelvis without and with contrast (74178) range across 2 matching MRF lines |
$206–$2,551.20 | $515–$6,378 | varies |
| CT abdomen and pelvis without contrast (74176) range across 2 matching MRF lines |
$206–$2,138.40 | $515–$5,346 | varies |
| CT abdomen w contrast (74160) range across 2 matching MRF lines |
$206–$1,400.80 | $515–$3,502 | varies |
| CT abdomen w wo contrast (74170) range across 4 matching MRF lines |
$206–$1,490.80 | $515–$3,727 | varies |
| CT abdomen w/o contrast (74150) range across 2 matching MRF lines |
$206–$1,014.40 | $515–$2,536 | varies |
| CT Angio Abdomen and Pelvis (74174) | $2,402.40 | $6,006 | 7.5× |
| CT Angio Chest (71275) range across 2 matching MRF lines |
$206–$1,201.20 | $515–$3,003 | varies |
| CT Angio Head (70496) range across 2 matching MRF lines |
$206–$925.20 | $515–$2,313 | varies |
| CT angio hrt w/3d image (75574) | $737.20 | $1,843 | 2.3× |
| Ct Angio Lwr Extr W/O&W/Dye (73706) range across 3 matching MRF lines |
$943.60–$1,876 | $2,359–$4,690 | varies |
| CT Angio Neck (70498) range across 2 matching MRF lines |
$206–$1,398 | $515–$3,495 | varies |
| Ct Angio Upr Extrm W/O&W/Dye (73206) range across 3 matching MRF lines |
$943.60–$1,876 | $2,359–$4,690 | varies |
| CT cervical spine w/ contrast (72126) | $887.20 | $2,218 | 2.8× |
| CT cervical spine w/o contrast (72125) range across 2 matching MRF lines |
$206–$887.20 | $515–$2,218 | varies |
| CT chest w contrast (71260) range across 2 matching MRF lines |
$206–$1,015.20 | $515–$2,538 | varies |
| CT chest w/wo contrast (71270) range across 2 matching MRF lines |
$734.40–$896.40 | $1,836–$2,241 | varies |
| CT colonogrphy dx image postprocess w/o contrast (74261) | $518.40 | $1,296 | 5.4× |
| CT head/brain with contrast (70460) range across 2 matching MRF lines |
$206–$1,162.80 | $515–$2,907 | varies |
| CT head/brain without and with contrast (70470) range across 2 matching MRF lines |
$206–$1,344.40 | $515–$3,361 | varies |
| CT heart no contrast quant eval coronry calcium (75571) | $236 | $590 | 2.9× |
| CT iac w contrast (70481) range across 2 matching MRF lines |
$206–$974.80 | $515–$2,437 | varies |
| CT l-spine w&w/o contrast (72133) | $1,342.40 | $3,356 | 8.3× |
| CT lower ext w/o (73700) range across 4 matching MRF lines |
$206–$836.40 | $515–$2,091 | varies |
| CT lower extremity w/contrast material (73701) range across 4 matching MRF lines |
$206–$730 | $515–$1,825 | varies |
| CT lumbar spine w contrast (72132) range across 2 matching MRF lines |
$206–$1,362 | $515–$3,405 | varies |
| CT lumbar spine w/o contrast (72131) range across 2 matching MRF lines |
$206–$1,206 | $515–$3,015 | varies |
| CT maxillofacial w contrast (70487) range across 2 matching MRF lines |
$206–$690 | $515–$1,725 | varies |
| CT maxillofacial wo contrast (70486) range across 2 matching MRF lines |
$206–$947.20 | $515–$2,368 | varies |
| CT neck tissue combo (70492) range across 2 matching MRF lines |
$206–$1,154.80 | $515–$2,887 | varies |
| Ct Orbit/Ear/Fossa W/O&W/Dye (70482) range across 2 matching MRF lines |
$206–$1,004 | $515–$2,510 | varies |
| CT orbits w/o contrast (70480) range across 2 matching MRF lines |
$206–$1,045.20 | $515–$2,613 | varies |
| CT pelvis w&w/o contrast (72194) | $1,107.20 | $2,768 | 6.9× |
| CT pelvis w/o contrast (72192) range across 2 matching MRF lines |
$206–$1,058 | $515–$2,645 | varies |
| CT scan of leg combo (73702) | $1,039.60 | $2,599 | 6.4× |
| CT scans face/jaw combo (70488) | $756.80 | $1,892 | 4.7× |
| CT soft tissue neck w contrast (70491) range across 2 matching MRF lines |
$206–$1,178.40 | $515–$2,946 | varies |
| CT soft tissue neck w/o contrast (70490) range across 2 matching MRF lines |
$206–$887.20 | $515–$2,218 | varies |
| CT thoracic spine w contrast (72129) | $1,127.20 | $2,818 | 7.0× |
| CT thoracic spine w/o contrast (72128) range across 2 matching MRF lines |
$206–$887.20 | $515–$2,218 | varies |
| CT thorax w/o contrast (71250) range across 2 matching MRF lines |
$206–$454 | $515–$1,135 | varies |
| CT upper ext wo (73200) range across 4 matching MRF lines |
$206–$981.60 | $515–$2,454 | varies |
| CT upper extremity w/o & w/contrast material (73202) | $1,058.80 | $2,647 | 6.6× |
| CT upper extremity with contrast (73201) | $939.20 | $2,348 | 2.9× |
| Cta Abdl Aorta&Bi Iliofem W/Contrast&Postp (75635) | $1,346.40 | $3,366 | 8.3× |
| Cta Abdomen (74175) range across 2 matching MRF lines |
$206–$832 | $515–$2,080 | varies |
| CTA pelvis (72191) range across 2 matching MRF lines |
$206–$832 | $515–$2,080 | varies |
| Dilation ureters/urethra rs&i (74485) | $1,129.20 | $2,823 | 0.6× |
| Diskography lumbar (72295) range across 3 matching MRF lines |
$1,502–$1,578 | $3,755–$3,945 | varies |
| Dxa Bone Density Axial (77080) | $87.20 | $218 | 0.9× |
| Echo exam uterus (76831) | $300 | $750 | 1.4× |
| Esophagram (74220) range across 3 matching MRF lines |
$118.80–$440.80 | $297–$1,102 | varies |
| Fetal Biophys Profile W/Nst (76818) | $365.60 | $914 | 3.8× |
| Fetal Biophysical Profile W/O Non-Stress Testing (76819) | $502.40 | $1,256 | 5.2× |
| Fluoroscopy up to 1 hr (76000) range across 3 matching MRF lines |
$127.60–$298 | $319–$745 | varies |
| Foot 2 views (73620) range across 6 matching MRF lines |
$47.20–$198.40 | $118–$496 | varies |
| Forearm 2 views (73090) range across 4 matching MRF lines |
$54.80–$196.40 | $137–$491 | varies |
| Gastric emptying imaging study (78264) | $1,112.80 | $2,782 | 3.0× |
| Gated Heart Planar Single (78472) | $1,037.20 | $2,593 | 2.8× |
| Hand 2 views (73120) range across 6 matching MRF lines |
$57.20–$183.20 | $143–$458 | varies |
| Hepatobil Syst Image W/Drug (78227) | $1,196.40 | $2,991 | 2.4× |
| Hepatobiliary System Imaging (78226) | $1,118.40 | $2,796 | 3.0× |
| Ht Muscle Image Spect Sing (78451) | $2,024 | $5,060 | 1.7× |
| Hysterosalpingogram (74740) | $529.60 | $1,324 | 2.4× |
| Infant hip ultrasound with hip movement (dynamic) (76885) | $776.80 | $1,942 | 9.7× |
| Infant hip ultrasound, limited static exam (76886) | $420.40 | $1,051 | 5.3× |
| K Flow/Funct Image Multiple (78709) | $1,024 | $2,560 | 2.1× |
| K Flow/Funct Image W/Drug (78708) | $1,122.40 | $2,806 | 2.2× |
| K Flow/Funct Image W/O Drug (78707) | $982.40 | $2,456 | 2.0× |
| Kidney Imaging Morphol (78700) | $740 | $1,850 | 2.0× |
| Kidney Imaging Morphoogy W/Vascular Flow (78701) | $693.20 | $1,733 | 1.9× |
| Knee 3 Views (73562) range across 5 matching MRF lines |
$66–$292.80 | $165–$732 | varies |
| Lung Ventilat&Perfus Imaging (78582) | $1,044.40 | $2,611 | 2.1× |
| Lung Ventilation Imaging (78579) | $586.80 | $1,467 | 1.6× |
| Lymph System Imaging (78195) | $964.80 | $2,412 | 1.9× |
| Magnetic Image Jaw Joint (70336) range across 2 matching MRF lines |
$230–$1,214 | $575–$3,035 | varies |
| Mammary ductogram or galactogram single (77053) | $304.40 | $761 | 1.4× |
| Meckels Divert Exam (78290) | $642 | $1,605 | 1.7× |
| Mra Head W/O & W/Contrast Material (70546) range across 2 matching MRF lines |
$276–$1,363.20 | $690–$3,408 | varies |
| MRA head w/o contrast (70544) range across 4 matching MRF lines |
$230–$1,348.80 | $575–$3,372 | varies |
| MRA head with contrast (70545) range across 4 matching MRF lines |
$276–$1,376 | $690–$3,440 | varies |
| MRA neck w contrast (70548) range across 2 matching MRF lines |
$276–$1,063.20 | $690–$2,658 | varies |
| Mra Neck W/O &W/Contrast Material (70549) range across 2 matching MRF lines |
$276–$1,702.80 | $690–$4,257 | varies |
| MRA neck w/o contrast (70547) range across 2 matching MRF lines |
$276–$1,033.20 | $690–$2,583 | varies |
| MRI abdomen w contrast (74182) range across 2 matching MRF lines |
$230–$1,376 | $575–$3,440 | varies |
| MRI abdomen w/o contrast (74181) range across 2 matching MRF lines |
$230–$1,386.40 | $575–$3,466 | varies |
| MRI any jt lower extrem w/contrast material (73722) range across 18 matching MRF lines |
$230–$2,490.80 | $575–$6,227 | varies |
| MRI any jt lower extrem w/o & w/contrast matrl (73723) range across 10 matching MRF lines |
$230–$1,247.60 | $575–$3,119 | varies |
| MRI any jt upper extremity w/contrast matrl (73222) range across 11 matching MRF lines |
$230–$1,646 | $575–$4,115 | varies |
| MRI Breast W/O Contrast Bilateral (77047) | $230 | $575 | 1.0× |
| MRI cervical spine w contrast (72142) range across 2 matching MRF lines |
$230–$1,606 | $575–$4,015 | varies |
| MRI cervical spine w/o cont (72141) range across 2 matching MRF lines |
$230–$1,466 | $575–$3,665 | varies |
| MRI chest w/o contrast (71550) | $1,394.80 | $3,487 | 6.4× |
| MRI chest with contrast (71551) | $1,500.80 | $3,752 | 2.1× |
| MRI chest wo w contrast (71552) range across 2 matching MRF lines |
$230–$1,615.20 | $575–$4,038 | varies |
| MRI lower extrem oth/thn jt w/contrast matrl (73719) | $1,438.40 | $3,596 | 4.5× |
| MRI lower extrem oth/thn jt w/o & w/contr matr (73720) range across 5 matching MRF lines |
$230–$1,615.20 | $575–$4,038 | varies |
| MRI lower extrem oth/thn jt w/o contr matrl (73718) range across 4 matching MRF lines |
$230–$1,404 | $575–$3,510 | varies |
| MRI lumbar spine w contrast (72149) range across 2 matching MRF lines |
$230–$1,606 | $575–$4,015 | varies |
| Mri Neck Spine W/O & W/Dye (72156) range across 2 matching MRF lines |
$230–$1,688.40 | $575–$4,221 | varies |
| MRI orbit face &/neck w/o contrast (70540) range across 4 matching MRF lines |
$230–$1,033.20 | $575–$2,583 | varies |
| MRI orbit face neck w contrast (70542) range across 2 matching MRF lines |
$230–$1,250.80 | $575–$3,127 | varies |
| Mri Orbt/Fac/Nck W/O &W/Dye (70543) range across 3 matching MRF lines |
$230–$1,570.80 | $575–$3,927 | varies |
| MRI pelvis w contrast (72196) | $1,338 | $3,345 | 4.2× |
| MRI pelvis w/o & w contrast (72197) range across 4 matching MRF lines |
$230–$1,624.80 | $575–$4,062 | varies |
| MRI pelvis w/o contrast (72195) range across 2 matching MRF lines |
$230–$1,033.20 | $575–$2,583 | varies |
| MRI thoracic spine w/o contrast (72146) range across 2 matching MRF lines |
$230–$1,343.20 | $575–$3,358 | varies |
| MRI upper extremity oth than jt w/contr matrl (73219) | $1,396 | $3,490 | 4.4× |
| MRI upper extremity oth than jt w/o contr matrl (73218) range across 4 matching MRF lines |
$230–$1,414.40 | $575–$3,536 | varies |
| Mri Uppr Extremity W/O&W/Dye (73220) range across 4 matching MRF lines |
$230–$1,615.20 | $575–$4,038 | varies |
| MRI, abdomen, combo (74183) range across 2 matching MRF lines |
$230–$1,762 | $575–$4,405 | varies |
| MRI, dorsal spine combo (72157) range across 2 matching MRF lines |
$230–$1,688.40 | $575–$4,221 | varies |
| MRI, dorsal spine contrast (72147) | $1,500.80 | $3,752 | 4.7× |
| MRI, joint upper extrem (73221) range across 14 matching MRF lines |
$230–$1,404 | $575–$3,510 | varies |
| MRI, joint upper extrem combo (73223) range across 13 matching MRF lines |
$230–$1,840 | $575–$4,600 | varies |
| MRI, lumbar spine combo (72158) range across 2 matching MRF lines |
$230–$1,806.40 | $575–$4,516 | varies |
| Myocardial Perfusion Planar 1 Study Rest/Stress (78453) | $1,231.60 | $3,079 | 1.0× |
| Myocardial Spect Multiple Studies (78452) | $2,024 | $5,060 | 1.7× |
| Neck soft tissue (70360) range across 2 matching MRF lines |
$56.80–$228.80 | $142–$572 | varies |
| Nonvascular Shunt X-Ray (75809) range across 3 matching MRF lines |
$57.20–$451.60 | $143–$1,129 | varies |
| Nuclear Rx Oral Admin (79005) | $548.80 | $1,372 | 2.6× |
| Parathyroid Planar Imaging (78070) | $626.80 | $1,567 | 1.7× |
| Parathyroid planar imaging w/wo subtraction (78071) | $713.20 | $1,783 | 1.9× |
| Pelvis 1 or 2 views (72170) range across 3 matching MRF lines |
$55.60–$260.80 | $139–$652 | varies |
| Pet Image W/Ct Lmtd (78814) | $1,832.80 | $4,582 | 1.4× |
| PET image w/CT, full body (78816) | $1,981.60 | $4,954 | 1.5× |
| PET imaging CT attenuation skull base mid-thigh (78815) | $1,981.60 | $4,954 | 1.5× |
| Pulmonary Perfusion Imaging Particulate (78580) | $623.20 | $1,558 | 1.7× |
| Radex Abd Compl Aqt Abd W/S/E/D Views 1 View Ch (74022) range across 3 matching MRF lines |
$116–$307.60 | $290–$769 | varies |
| Radex abscess/fistula/sinus tract rs&i (76080) range across 3 matching MRF lines |
$287.20–$429.60 | $718–$1,074 | varies |
| Radex Ankle Complete Minimum 3 Views (73610) range across 6 matching MRF lines |
$61.20–$262 | $153–$655 | varies |
| Radex Calcaneus Minimum 2 Views (73650) range across 4 matching MRF lines |
$50.40–$198.40 | $126–$496 | varies |
| Radex elbow complete minimum 3 views (73080) range across 6 matching MRF lines |
$66.80–$233.60 | $167–$584 | varies |
| Radex Facial Bones Complete Minimum 3 Views (70150) range across 3 matching MRF lines |
$78.80–$316.80 | $197–$792 | varies |
| Radex fingr minimum 2 views (73140) range across 6 matching MRF lines |
$47.20–$175.60 | $118–$439 | varies |
| Radex foot complete minimum 3 views (73630) range across 6 matching MRF lines |
$47.20–$233.60 | $118–$584 | varies |
| Radex Hand Minimum 3 Views (73130) range across 6 matching MRF lines |
$60–$226 | $150–$565 | varies |
| Radex lower extremity infant minimum 2 views (73592) | $60.80 | $152 | 0.8× |
| Radex Mastoids Compl Minimum 3 Views PR Side (70130) | $57.20 | $143 | 0.6× |
| Radex Nasal Bones Complete Minimum 3 Views (70160) range across 2 matching MRF lines |
$65.20–$241.60 | $163–$604 | varies |
| Radex Ribs Unilateral 2 Views (71100) range across 6 matching MRF lines |
$58.80–$238.80 | $147–$597 | varies |
| Radex shoulder complete minimum 2 views (73030) range across 6 matching MRF lines |
$61.60–$257.60 | $154–$644 | varies |
| Radex Sinuses Paransl < 3 Views (70210) | $47.20 | $118 | 0.6× |
| Radex Spine 1 View Specify Level (72020) | $75.20 | $188 | 0.9× |
| Radex Sternum Minimum 2 Views (71120) range across 3 matching MRF lines |
$63.60–$211.20 | $159–$528 | varies |
| Radex Temporomandble Jt Opn & Clsd Mouth Bilat (70330) | $47.20 | $118 | 0.6× |
| Radex Toe Minimum 2 Views (73660) range across 6 matching MRF lines |
$47.60–$175.60 | $119–$439 | varies |
| Radex upper extremity infant minimum 2 views (73092) | $57.20 | $143 | 0.6× |
| Radex Wrist Complete Minimum 3 Views (73110) range across 6 matching MRF lines |
$62.80–$226 | $157–$565 | varies |
| Radiation treatment delivery level 1 (77402) | $76.40 | $191 | 0.8× |
| Radiation treatment delivery level 2 (77407) | $148 | $370 | 0.4× |
| Radiation treatment delivery level 3 (77412) | $148 | $370 | 0.3× |
| Radiolog exam mandible compl minimum 4 views (70110) range across 2 matching MRF lines |
$92.80–$281.60 | $232–$704 | varies |
| Radiologic exam colon double contrast study (74280) range across 3 matching MRF lines |
$443.20–$726.40 | $1,108–$1,816 | varies |
| Radiologic exam colon single contrast study (74270) range across 3 matching MRF lines |
$443.20–$566.40 | $1,108–$1,416 | varies |
| Radiologic exam knee complete 4/more views (73564) range across 6 matching MRF lines |
$95.20–$336.80 | $238–$842 | varies |
| Radiologic exam pelvis compl minimum 3 views (72190) range across 2 matching MRF lines |
$59.60–$260.40 | $149–$651 | varies |
| Radiologic Exam Small Int Single Contrast Study (74250) range across 2 matching MRF lines |
$136.80–$463.60 | $342–$1,159 | varies |
| Radiologic exam swallow function contrast study (74230) | $594.80 | $1,487 | 3.7× |
| Radiologic exam teeth complete full mouth (70320) | $196.40 | $491 | 0.9× |
| Radiologic Exam Teeth Prtl Exam < Full Mouth (70310) | $148.80 | $372 | 0.7× |
| Radiologic exam upr gi trc double contrast study (74246) range across 6 matching MRF lines |
$156.40–$796 | $391–$1,990 | varies |
| Radiologic examination femur 1 view (73551) range across 6 matching MRF lines |
$47.20–$166.40 | $118–$416 | varies |
| Radiologic examination femur minimum 2 views (73552) range across 6 matching MRF lines |
$47.20–$275.60 | $118–$689 | varies |
| Radiologic examination knee 1/2 views (73560) range across 6 matching MRF lines |
$47.60–$179.60 | $119–$449 | varies |
| Radiologic examination tibia & fibula 2 views (73590) range across 4 matching MRF lines |
$62.40–$238 | $156–$595 | varies |
| Ribs bilateral 3 views (71110) range across 2 matching MRF lines |
$59.20–$364.40 | $148–$911 | varies |
| Rp Loclzj Tum Plnr Whole Body 2+ Days Imaging (78804) | $876.80 | $2,192 | 1.8× |
| Rp Loclzj Tum Plnr Whole Body Single Day Imaging (78802) | $922.40 | $2,306 | 1.8× |
| Rp Loclzj Tum Spect 1 Area Single Day Imaging (78803) | $898.80 | $2,247 | 1.8× |
| Rp loclzj tum spect 2 area/sep acquisj img (78831) | $950.40 | $2,376 | 0.8× |
| Scapula (73010) range across 6 matching MRF lines |
$57.20–$211.20 | $143–$528 | varies |
| Screening Digital Breast Tomosynthesis Bi (77063) | $40.80 | $102 | 1.7× |
| Shoulder 1 view (73020) range across 6 matching MRF lines |
$47.20–$147.60 | $118–$369 | varies |
| Shoulder Arthrography (73040) | $628.80 | $1,572 | 2.0× |
| Sialogram (70390) | $127.60 | $319 | 0.6× |
| Skull less than 4 views (70250) range across 2 matching MRF lines |
$62.80–$211.20 | $157–$528 | varies |
| Special dosimetry (77331) | $79.20 | $198 | 0.6× |
| Special teletherapy port plan (77321) | $209.60 | $524 | 0.6× |
| Special treatment procedure (77470) | $336.80 | $842 | 0.7× |
| Sternoclavicular joints (71130) range across 2 matching MRF lines |
$47.20–$126.40 | $118–$316 | varies |
| Tbs techl prep&transmis data alys pfrmd elsewhr (77090) | $53.20 | $133 | 0.7× |
| Tbs technical calculation only (77091) | $53.20 | $133 | 0.7× |
| Telethx isodose pln cplx w/basic dosimetry (77307) | $209.60 | $524 | 0.6× |
| Ther Rad Simulaj-Aided Field Setting Complex (77290) | $209.60 | $524 | 0.6× |
| Ther Rad Simulaj-Aided Field Setting Intermed (77285) | $209.60 | $524 | 0.6× |
| Thoracic spine 2 views (72070) range across 2 matching MRF lines |
$58.80–$296.40 | $147–$741 | varies |
| Thoracic spine 3 views (72072) range across 2 matching MRF lines |
$88.80–$337.60 | $222–$844 | varies |
| Thoracolumbar 2 views (72080) | $84.80 | $212 | 1.1× |
| Thyroid Met Imaging Body (78018) | $628.40 | $1,571 | 1.3× |
| Thyroid Uptake Measurement (78012) | $440.40 | $1,101 | 1.2× |
| Thyroid Uptake W/Blood Flow Sngle/Mult Quan Meas (78014) | $587.60 | $1,469 | 1.6× |
| Tx Devices Design & Construction Complex (77334) | $209.60 | $524 | 0.6× |
| Tx devices design & construction intermediate (77333) | $87.60 | $219 | 0.7× |
| Tx devices design & construction simple (77332) | $79.20 | $198 | 0.6× |
| Ultrasound Breast Limited (76642) range across 5 matching MRF lines |
$251.20–$376.40 | $628–$941 | varies |
| Ultrasound Exam Aaa Screen (76706) | $485.20 | $1,213 | 5.0× |
| Ultrasound, abdomen limited (76705) | $519.20 | $1,298 | 5.4× |
| Unlisted fluoroscopic procedure (76496) | $414 | $1,035 | 5.2× |
| Unlisted us procedure (76999) | $307.60 | $769 | 3.8× |
| Upper gi w/o kub (74240) range across 7 matching MRF lines |
$187.60–$699.60 | $469–$1,749 | varies |
| Urethrocystogram voiding (74455) | $526 | $1,315 | 2.4× |
| Urethrocystography retrograde (74450) | $422 | $1,055 | 1.9× |
| Us chest (76604) | $242.40 | $606 | 2.5× |
| Us complete joint (76881) | $484.80 | $1,212 | 5.0× |
| Us exam, pelvic, limited (76857) | $444 | $1,110 | 4.6× |
| Us head (76506) | $353.60 | $884 | 3.7× |
| Us kidney transplant (76776) | $325.60 | $814 | 3.4× |
| Us lmtd joint/oth nonvasc xtr strux r-t w/img (76882) | $239.20 | $598 | 2.5× |
| Us ob limited 1 or more fetuses (76815) range across 2 matching MRF lines |
$260–$286 | $650–$715 | varies |
| Us ob transvaginal (76817) | $345.60 | $864 | 3.6× |
| Us pelvic non ob complete (76856) | $807.60 | $2,019 | 8.4× |
| Us pg uter img f&mat 14 wk tabdl 1/1st gestation (76801) | $594.80 | $1,487 | 6.2× |
| Us preg uterus real time f/u trnsabdl per fetus (76816) | $414.40 | $1,036 | 4.3× |
| Us retroperitoneal complete (76770) | $676.40 | $1,691 | 7.0× |
| Us retroperitoneal limited (76775) | $236 | $590 | 2.5× |
| Us scrotum and contents (76870) | $533.20 | $1,333 | 5.5× |
| Us spinal canal and contents (76800) | $136.80 | $342 | 1.4× |
| Us thyroid (76536) | $560.80 | $1,402 | 5.8× |
| Venogram Sinus/Jugular (75860) | $1,574 | $3,935 | 0.5× |
| Venography caval inferior serialography rs&i (75825) | $1,653.60 | $4,134 | 0.6× |
| Venography extremity bilateral rs&i (75822) | $926.40 | $2,316 | 0.6× |
| Venography extremity unilateral rs&i (75820) range across 4 matching MRF lines |
$733.20–$822.80 | $1,833–$2,057 | varies |
| Venography Renal Bilateral (75833) | $3,204.80 | $8,012 | 1.1× |
| Wrist 2 views (73100) range across 6 matching MRF lines |
$47.20–$183.20 | $118–$458 | varies |
| X-Ray Ac Jts - Xr Acromioclavicular Joints Bilateral (73050) | $205.20 | $513 | 2.6× |
| X-ray antegrade pyelogram tube (74425) range across 3 matching MRF lines |
$200–$422 | $500–$1,055 | varies |
| X-Ray Aorta Leg Arteries (75630) | $3,256.80 | $8,142 | 1.1× |
| X-Ray Bend Only L-S Spine (72120) range across 3 matching MRF lines |
$102.80–$337.60 | $257–$844 | varies |
| X-Ray Elbow 2 Vw - Xr Elbow 1-2 Views Right (73070) | $196.40 | $491 | 2.5× |
| X-Ray Exam Breast Specimen (76098) | $307.20 | $768 | 0.6× |
| X-Ray Exam Entire Spi 1 Vw (72081) | $47.20 | $118 | 0.6× |
| X-Ray Exam Entire Spi 2/3 Vw (72082) range across 3 matching MRF lines |
$57.20–$498 | $143–$1,245 | varies |
| X-Ray Exam Entire Spi 4/5 Vw (72083) | $462.40 | $1,156 | 4.8× |
| X-Ray Exam Hip Uni 1 View (73501) range across 6 matching MRF lines |
$62.40–$202 | $156–$505 | varies |
| X-Ray Exam Hip Uni 2-3 Views (73502) range across 10 matching MRF lines |
$76.40–$212.40 | $191–$531 | varies |
| X-Ray Exam Hips Bi 2 Views (73521) range across 2 matching MRF lines |
$57.20–$330.80 | $143–$827 | varies |
| X-Ray Exam Hips Bi 3-4 Views (73522) range across 3 matching MRF lines |
$57.20–$331.60 | $143–$829 | varies |
| X-Ray Exam L-S Spine Bending (72114) range across 3 matching MRF lines |
$57.20–$394.80 | $143–$987 | varies |
| X-Ray Exam Neck Spine 2-3 Vw (72040) range across 3 matching MRF lines |
$70.40–$370.80 | $176–$927 | varies |
| X-Ray Exam Neck Spine 6/>Vws (72052) range across 3 matching MRF lines |
$119.20–$422 | $298–$1,055 | varies |
| X-Ray Exam Unilat Ribs/Chest (71101) range across 6 matching MRF lines |
$88–$404 | $220–$1,010 | varies |
| X-ray eye for foreign body (70030) range across 2 matching MRF lines |
$47.20–$64.40 | $118–$161 | varies |
| X-ray humerus (73060) range across 6 matching MRF lines |
$60.40–$226 | $151–$565 | varies |
| X-ray IV pyelogram (ivp) (74400) | $636.80 | $1,592 | 3.9× |
| X-Ray Jaw <4 Vw - Xr Mandible < 4 Views (70100) range across 2 matching MRF lines |
$47.20–$198.40 | $118–$496 | varies |
| X-Ray Knee Bilat Standing - Xr Knees Anteroposterior Standing Bilat (73565) range across 3 matching MRF lines |
$48.40–$211.20 | $121–$528 | varies |
| X-Ray Lumbar Spine 2/3 Vw - Xr Lumbar Spine 2-3 Views (72100) range across 2 matching MRF lines |
$76.80–$317.20 | $192–$793 | varies |
| X-ray nose-rectum child f.b. (76010) | $209.60 | $524 | 2.6× |
| X-Ray Ribs, Chest 4+ Vw - Xr Ribs 3 Vws Bil W/ Chest Posteroanterior (71111) range across 3 matching MRF lines |
$108–$364.40 | $270–$911 | varies |
| X-Ray Sacroiliac Jts 3+ Vw - Xr Sacroiliac Joints 3+ Views (72202) | $63.60 | $159 | 0.7× |
| X-Ray Sacroiliac Jts <3 Vw - Xr Sacroiliac Joints 1-2 Views (72200) | $62.40 | $156 | 0.6× |
| X-Ray Sacrum/Coccyx 2+ Vw - Xr Sacrum Coccyx 2+ Views (72220) range across 2 matching MRF lines |
$62.80–$317.20 | $157–$793 | varies |
| X-Ray Sinuses 3+ Vw - Xr Paranasal Sinuses 3+ Views (70220) range across 2 matching MRF lines |
$85.60–$316.80 | $214–$792 | varies |
| X-Ray Skull 4+ Vw - Xr Skull Complete 4+ Views (70260) | $92.80 | $232 | 1.0× |
| X-Ray Tmj Unilat (70328) | $47.20 | $118 | 0.6× |
| X-Ray Urinary Tract Exam With Contrast Material (74420) range across 2 matching MRF lines |
$601.20–$661.20 | $1,503–$1,653 | varies |
| X-Rays Bone Length Studies (77073) range across 3 matching MRF lines |
$105.60–$211.20 | $264–$528 | varies |
| X-Rays Bone Survey Complete (77075) range across 2 matching MRF lines |
$222.80–$708 | $557–$1,770 | varies |
| Xr c-spine 4 or 5 views (72050) range across 3 matching MRF lines |
$101.20–$394.80 | $253–$987 | varies |
| Xr facial bones less than 3 views (70140) | $78.80 | $197 | 1.0× |
| XR Mastoids < 3 Views Bilateral (70120) | $57.20 | $143 | 0.6× |
| Xr orbits complete 4 views (70200) | $80 | $200 | 0.8× |
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.