Imaging prices at Aurora Medical Center

Grafton, WI · every code in this section with a posted price and a Medicare benchmark.

405 codes. Prices are the hospital's own posted facility charges.

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ProcedurePosted cashPosted gross× Medicare
3-D radiotherapy plan dose-volume histograms (77295) $7,855 $15,710 5.7×
Abdomen 1 View (74018) $255 $510 2.9×
Abdomen 2 views (74019) $322.50 $645 3.1×
Acute Gastrointestinal Blood Loss Imaging (78278) $1,150 $2,300 2.9×
Angio internal mammary (75756) $1,480 $2,960 0.5×
Angio pulmonary bilat (75743) $2,460 $4,920 0.8×
Angiography extremity bilateral rs&i (75716) $3,465 $6,930 1.1×
Angiography extremity unilateral rs&i (75710) $2,310 $4,620 0.7×
Angiography pulmonary unilateral slctv rs&i (75741) $1,640 $3,280 0.5×
Angrph pulmonary nonslctv cath/ven njx rs&i (75746) $1,225 $2,450 0.4×
Ankle 2 views (73600)
range across 3 matching MRF lines		 $265–$530 $530–$1,060 varies
Aortography thoracic serialography rs&i (75605)
unusually low: confirm this is the full procedure		 $2,235 $4,470 0.4×
Artery X-Rays Abdomen (75726) $2,865 $5,730 0.5×
Artery X-Rays Pelvis (75736)
unusually low: confirm this is the full procedure		 $2,735 $5,470 0.5×
Artery X-Rays Spine (75705) $2,855 $5,710 0.5×
Arthrogram hip (73525) $965 $1,930 2.8×
Arthrogram Wrist (73115) $655 $1,310 1.9×
Basic radiation dosimetry calculation (77300) $525 $1,050 3.9×
Bone age studies (77072) $292.50 $585 2.8×
Bone Imaging 3 Phase (78315) $1,475 $2,950 3.7×
Bone Imaging Limited Area (78300) $960 $1,920 2.4×
Bone Imaging Multiple Areas (78305) $1,110 $2,220 2.8×
Bone Imaging Whole Body (78306) $1,400 $2,800 3.5×
Bone marrow imaging limited area (78102) $865 $1,730 2.2×
Bone marrow imaging; multiple areas (78103) $1,035 $2,070 2.6×
Bone marrow imaging; whole body (78104) $1,295 $2,590 3.3×
Bone survey infant (77076) $525 $1,050 5.0×
Brain Flow Imaging Only (78610) $620 $1,240 1.1×
Brain Image W/Flow < 4 Views (78601) $775 $1,550 1.9×
Brain Imaging Min 4 Static Views W Vascular Flow (78606) $1,330 $2,660 2.5×
Brain Imaging Minimum 4 Static Views (78605) $640 $1,280 1.2×
Brain Imaging Pet Metabolic Evaluation (78608) $4,060 $8,120 2.9×
Card Bl Pool Gated Spect Rest Wal Motn Ejct Frct (78494) $1,590 $3,180 4.0×
Cardiac MRI w/w/o contrast & further seq (75561) $3,295 $6,590 9.5×
Cardiac Shunt Detection (78428) $1,285 $2,570 3.2×
Cat Scan Follow-Up Study (76380) $945 $1,890 10.9×
Cerebrospinal Fluid Flow W/O Matl Shunt Evaltj (78645) $1,255 $2,510 2.3×
Cerebrospinal Fluid Scan (78630) $1,155 $2,310 2.1×
Chest 1 view (71045) $232.50 $465 2.7×
Chest 2 views (71046) $280 $560 3.2×
Chest 3 views (71047) $347.50 $695 4.0×
Chest 4 or more views (71048) $395 $790 3.8×
Chg us nrv&acc strux 1 xtr compre w/img pr extremity (76883) $355 $710 3.4×
Cholecystography Oral Contrast (74290) $412.50 $825 2.4×
Cisternography Positive Contrast Rs&I (70015) $915 $1,830 1.2×
Clavicle complete (73000)
range across 2 matching MRF lines		 $287.50–$575 $575–$1,150 varies
Computed Tomography Thorax Lw Dose Lng Ca Scr C- (71271) $445 $890 4.3×
Continuing medical physics consltj pr wk (77336) $785 $1,570 5.9×
Contrast Exam Abdominl Aorta (75625) $2,590 $5,180 0.8×
Contrast X-Ray Bladder (74430) $510 $1,020 1.5×
Contrast X-Ray Of Knee Joint (73580) $965 $1,930 2.8×
CT abdomen and pelvis without and with contrast (74178) $4,610 $9,220 13.3×
CT abdomen and pelvis without contrast (74176) $2,940 $5,880 12.4×
CT abdomen w contrast (74160) $1,570 $3,140 9.0×
CT abdomen w wo contrast (74170) $2,305 $4,610 13.2×
CT abdomen w/o contrast (74150) $1,470 $2,940 14.1×
CT Angio Abdomen and Pelvis (74174) $2,910 $5,820 8.4×
CT Angio Chest (71275) $1,940 $3,880 11.1×
CT Angio Head (70496) $1,940 $3,880 11.1×
CT angio hrt w/3d image (75574) $1,675 $3,350 4.8×
Ct Angio Lwr Extr W/O&W/Dye (73706) $1,940 $3,880 11.1×
CT Angio Neck (70498) $1,940 $3,880 11.1×
Ct Angio Upr Extrm W/O&W/Dye (73206)
range across 2 matching MRF lines		 $1,940–$3,880 $3,880–$7,760 varies
CT cervical spine w/ contrast (72126) $1,570 $3,140 4.5×
CT cervical spine w/o contrast (72125) $1,470 $2,940 14.1×
CT cervical spine w/wo cont (72127) $2,305 $4,610 13.2×
CT chest w contrast (71260) $1,570 $3,140 9.0×
CT chest w/wo contrast (71270) $2,305 $4,610 13.2×
CT colonography screening (74263) $500 $1,000 2.1×
CT Colonogrphy Dx Image Postprocess W/Contrast (74262) $1,570 $3,140 9.0×
CT colonogrphy dx image postprocess w/o contrast (74261) $1,470 $2,940 14.1×
CT head/brain with contrast (70460) $1,570 $3,140 9.0×
CT head/brain without and with contrast (70470) $2,305 $4,610 13.2×
CT heart contrast eval cardiac structure&morph (75572) $1,675 $3,350 4.8×
CT hrt w/3d image congen (75573) $1,675 $3,350 4.8×
CT iac w contrast (70481) $1,570 $3,140 9.0×
CT l-spine w&w/o contrast (72133) $2,305 $4,610 13.2×
CT lower ext w/o (73700) $1,470 $2,940 14.1×
CT lower extremity w/contrast material (73701) $1,570 $3,140 9.0×
CT lumbar spine w contrast (72132) $1,570 $3,140 4.5×
CT lumbar spine w/o contrast (72131) $1,470 $2,940 14.1×
CT maxillofacial w contrast (70487) $1,570 $3,140 9.0×
CT maxillofacial wo contrast (70486) $1,470 $2,940 14.1×
CT neck tissue combo (70492) $2,305 $4,610 13.2×
Ct Orbit/Ear/Fossa W/O&W/Dye (70482) $2,305 $4,610 13.2×
CT orbits w/o contrast (70480) $1,470 $2,940 14.1×
CT pelvis w&w/o contrast (72194) $2,305 $4,610 13.2×
CT pelvis w/o contrast (72192) $1,470 $2,940 14.1×
CT scan of leg combo (73702) $2,305 $4,610 13.2×
CT scans face/jaw combo (70488) $2,305 $4,610 13.2×
CT soft tissue neck w contrast (70491) $1,570 $3,140 9.0×
CT soft tissue neck w/o contrast (70490) $1,470 $2,940 14.1×
CT thoracic spine w contrast (72129) $1,570 $3,140 9.0×
CT thoracic spine w/o contrast (72128) $1,470 $2,940 14.1×
CT thoracic spine w/wo cont (72130) $2,305 $4,610 13.2×
CT thorax w/o contrast (71250) $1,470 $2,940 14.1×
CT unlisted procedure (76497) $1,540 $3,080 17.8×
CT upper ext wo (73200) $1,470 $2,940 14.1×
CT upper extremity w/o & w/contrast material (73202) $2,305 $4,610 13.2×
CT upper extremity with contrast (73201) $1,570 $3,140 4.5×
Cta Abdl Aorta&Bi Iliofem W/Contrast&Postp (75635) $1,940 $3,880 11.1×
Cta Abdomen (74175) $1,940 $3,880 11.1×
CTA pelvis (72191) $1,940 $3,880 11.1×
Dacryocystography, nasolacrimal duct, radiological supervision and interpretation Non-Facility (70170) $467.50 $935 2.0×
Dilation ureters/urethra rs&i (74485) $1,380 $2,760 0.7×
Discography Cerv/Thor Spine (72285) $1,940 $3,880 1.0×
Diskography lumbar (72295) $1,940 $3,880 1.0×
Doppler Fetal Mid Cerebral Artery (76821) $285 $570 2.7×
Dxa Bone Density Axial (77080) $447.50 $895 4.3×
Dxa bone density study (77085) $457.50 $915 4.4×
Dxa bone density study 1/>sites appendiclr skel (77081) $270 $540 3.1×
Echo exam of fetal heart (76825) $690 $1,380 1.3×
Echo exam uterus (76831) $475 $950 2.0×
Echo Guide For Artery Repair (76936) $660 $1,320 3.1×
Echograp Trans R Pros Study (76873) $670 $1,340 6.4×
Esophagram (74220) $505 $1,010 2.9×
Fetal Biophys Profile W/Nst (76818)
range across 2 matching MRF lines		 $307.50–$615 $615–$1,230 varies
Fetal Biophysical Profile W/O Non-Stress Testing (76819)
range across 2 matching MRF lines		 $240–$482.50 $480–$965 varies
Fluoroscopy up to 1 hr (76000) $460 $920 1.9×
Follow-Up Angiography (75898) $590 $1,180 0.2×
Foot 2 views (73620)
range across 4 matching MRF lines		 $270–$540 $540–$1,080 varies
Forearm 2 views (73090)
range across 3 matching MRF lines		 $280–$560 $560–$1,120 varies
Gastric emptying imaging study (78264) $1,290 $2,580 3.2×
Gated Heart Planar Single (78472) $1,330 $2,660 3.3×
Hand 2 views (73120)
range across 4 matching MRF lines		 $247.50–$495 $495–$990 varies
Heart first pass single,planar (78481) $1,590 $3,180 2.9×
Heart Image (Pet) Multiple (78492) $4,060 $8,120 2.9×
Hepatc Vngrph Wdg/Fr Hemodyn Eval Rs&I (75889) $2,515 $5,030 0.8×
Hepatc Vngrph Wdg/Fr W/O Hemodyn Eval Rs&I (75891) $2,095 $4,190 0.7×
Hepatobil Syst Image W/Drug (78227) $1,615 $3,230 3.0×
Hepatobiliary System Imaging (78226) $1,375 $2,750 3.5×
Ht Musc Image Planar Mult (78454) $3,050 $6,100 2.4×
Ht Muscle Image Spect Sing (78451) $2,505 $5,010 1.9×
Hysterosalpingogram (74740) $585 $1,170 2.5×
Image fusion (77399) $495 $990 3.7×
Infant hip ultrasound, limited static exam (76886) $247.50 $495 2.9×
Interstitial radiation source applic complex (77778) $6,590 $13,180 9.5×
Joint Survey Single View (77077) $295 $590 2.8×
K Flow/Funct Image Multiple (78709) $2,525 $5,050 4.7×
K Flow/Funct Image W/Drug (78708) $1,730 $3,460 3.2×
K Flow/Funct Image W/O Drug (78707) $1,595 $3,190 2.9×
Kidney Funcj Study Non-Img Radioisotopic Study (78725) $1,595 $3,190 4.0×
Knee 3 Views (73562)
range across 2 matching MRF lines		 $270–$540 $540–$1,080 varies
Liver & Spleen Imaging Static Only (78215) $1,380 $2,760 3.5×
Liver imaging static only (78201) $1,255 $2,510 2.3×
Lung Perf&Ventilat Diferentl (78598) $1,285 $2,570 2.4×
Lung perfusion differential (78597) $870 $1,740 2.2×
Lung Ventilat&Perfus Imaging (78582) $1,590 $3,180 2.9×
Lung Ventilation Imaging (78579) $1,225 $2,450 3.1×
Lymph System Imaging (78195) $1,385 $2,770 2.6×
Lymphangiography Extremity Only Bilateral Rs&I (75803) $1,225 $2,450 0.8×
Lymphangiography extremity only unilateral rs&i (75801) $815 $1,630 1.3×
Lymphangiography Pelvic/Abdominal Bilateral Rs&I (75807) $1,225 $2,450 0.4×
Lymphangiography, pelvic/abdominal, unilateral (75805) $815 $1,630 0.3×
Magnetic Image Jaw Joint (70336) $2,315 $4,630 9.7×
Mammary ductogram or galactogram multiple (77054) $342.50 $685 1.4×
Mammary ductogram or galactogram single (77053) $302.50 $605 1.3×
Meckels Divert Exam (78290) $985 $1,970 2.5×
Medical physics dose eval radiation expos w/rprt (76145) $675 $1,350 1.8×
Mlc imrt design & construction per imrt plan (77338) $1,785 $3,570 4.8×
Mr safety determination physician/other qhp (76016) $260 $520 3.0×
Mr safety implant&/fb assmt clin staf 1st 15 min (76014) $50 $100 1.7×
Mr safety implt electronics prepj supvj phys/qhp (76018) $462.50 $925 4.9×
Mr safety implt pos&/immoblj (76019) $705 $1,410 12.0×
Mr safety med physics xm customization plng&mntr (76017) $1,095 $2,190 4.6×
Mra Head W/O & W/Contrast Material (70546) $3,265 $6,530 9.4×
MRA head w/o contrast (70544) $2,110 $4,220 8.9×
MRA head with contrast (70545) $2,210 $4,420 6.4×
MRA neck w contrast (70548) $2,210 $4,420 6.4×
Mra Neck W/O &W/Contrast Material (70549) $3,265 $6,530 9.4×
MRA neck w/o contrast (70547) $2,110 $4,220 8.9×
MRI abdomen w contrast (74182) $2,210 $4,420 6.4×
MRI abdomen w/o contrast (74181) $2,110 $4,220 8.9×
MRI any jt lower extrem w/contrast material (73722) $2,210 $4,420 2.8×
MRI any jt lower extrem w/o & w/contrast matrl (73723) $3,265 $6,530 9.4×
MRI any jt upper extremity w/contrast matrl (73222) $2,210 $4,420 2.8×
MRI bone marrow blood supply (77084) $2,075 $4,150 8.7×
MRI brain functional w/o physician admnistration (70554) $1,260 $2,520 5.3×
MRI Breast W/O Contrast Bilateral (77047) $2,010 $4,020 8.5×
MRI Breast Without Contrast Material Unilateral (77046) $1,340 $2,680 5.6×
MRI cardiac w/o contrast (75557) $2,130 $4,260 9.0×
MRI cervical spine w contrast (72142) $2,210 $4,420 6.4×
MRI cervical spine w/o cont (72141) $2,110 $4,220 8.9×
MRI chest w/o contrast (71550) $2,110 $4,220 8.9×
MRI chest with contrast (71551) $2,210 $4,420 2.8×
MRI chest wo w contrast (71552) $3,265 $6,530 9.4×
MRI lower extrem oth/thn jt w/contrast matrl (73719) $2,210 $4,420 6.4×
MRI lower extrem oth/thn jt w/o & w/contr matr (73720) $3,265 $6,530 9.4×
MRI lower extrem oth/thn jt w/o contr matrl (73718) $2,110 $4,220 8.9×
MRI lumbar spine w contrast (72149) $2,210 $4,420 6.4×
Mri Neck Spine W/O & W/Dye (72156) $3,265 $6,530 9.4×
MRI orbit face &/neck w/o contrast (70540) $2,110 $4,220 8.9×
MRI orbit face neck w contrast (70542) $2,210 $4,420 6.4×
Mri Orbt/Fac/Nck W/O &W/Dye (70543) $3,265 $6,530 9.4×
MRI pelvis w contrast (72196) $2,210 $4,420 6.4×
MRI pelvis w/o & w contrast (72197) $3,265 $6,530 9.4×
MRI pelvis w/o contrast (72195) $2,110 $4,220 8.9×
MRI spectroscopy (76390) $1,340 $2,680 15.5×
MRI thoracic spine w/o contrast (72146) $2,110 $4,220 8.9×
MRI upper extremity oth than jt w/contr matrl (73219) $2,210 $4,420 6.4×
MRI upper extremity oth than jt w/o contr matrl (73218) $2,110 $4,220 8.9×
Mri Uppr Extremity W/O&W/Dye (73220) $3,265 $6,530 9.4×
MRI, abdomen, combo (74183) $3,265 $6,530 9.4×
MRI, dorsal spine combo (72157) $3,265 $6,530 9.4×
MRI, dorsal spine contrast (72147) $2,210 $4,420 6.4×
MRI, joint upper extrem (73221) $2,110 $4,220 8.9×
MRI, joint upper extrem combo (73223) $3,265 $6,530 9.4×
MRI, lumbar spine combo (72158) $3,265 $6,530 9.4×
Myelogram cervical (72240) $1,255 $2,510 1.6×
Myelogram Lumbar (72265) $1,255 $2,510 1.6×
Myelography thoracic (72255) $1,255 $2,510 1.6×
Myocardial Imaging Pet Metabolic Evaluation (78459) $4,060 $8,120 3.1×
Myocardial Spect Multiple Studies (78452) $3,765 $7,530 2.9×
Myocrd Img Pet Metab Eval Single Study Cncrnt CT (78429) $4,060 $8,120 2.9×
Myocrd img PET prfuj 1std rest/stress cncrnt CT (78430) $4,520 $9,040 3.2×
Myocrd Img Pet Prfuj W/Metab 2rtracer Cncrnt CT (78433) $5,370 $10,740 2.4×
Myocrd Img Pet Prfuj W/Metab Dual Radiotracer (78432) $4,880 $9,760 3.2×
N-invas est c ffr sw aly CTA (75580) $1,675 $3,350 2.0×
Neck soft tissue (70360) $280 $560 3.2×
Nonvascular Shunt X-Ray (75809) $302.50 $605 2.9×
Ntsty modul radthx pln dose-vol histos (77301) $12,155 $24,310 8.8×
Nuclear Rx Intra-Arterial (79445) $765 $1,530 3.3×
Nuclear Rx Oral Admin (79005) $600 $1,200 2.6×
Panoramic X-ray of jaws (70355) $280 $560 3.2×
Parathyroid imaging w/tomographic spect & CT (78072) $1,510 $3,020 2.8×
Parathyroid Planar Imaging (78070) $1,000 $2,000 2.5×
Parathyroid planar imaging w/wo subtraction (78071) $1,345 $2,690 3.4×
Pelvis 1 or 2 views (72170) $270 $540 2.6×
Peritoneogram Rs&I (74190) $845 $1,690 1.6×
Pet Image Skull-Thigh (78812) $4,060 $8,120 2.9×
Pet Image W/Ct Lmtd (78814) $4,060 $8,120 2.9×
PET image w/CT, full body (78816) $4,060 $8,120 2.9×
PET imaging CT attenuation skull base mid-thigh (78815) $4,060 $8,120 2.9×
Pet Myocardial Sngl Study (78491) $4,060 $8,120 2.9×
Prq Transhepatc Portograpy Hemodyn Eval Rs&I (75885) $2,365 $4,730 0.8×
Pulmonary Perfusion Imaging Particulate (78580) $1,095 $2,190 2.7×
Radex Abd Compl Aqt Abd W/S/E/D Views 1 View Ch (74022) $450 $900 4.3×
Radex abscess/fistula/sinus tract rs&i (76080) $417.50 $835 0.8×
Radex Ankle Complete Minimum 3 Views (73610)
range across 2 matching MRF lines		 $315–$630 $630–$1,260 varies
Radex Calcaneus Minimum 2 Views (73650)
range across 3 matching MRF lines		 $255–$510 $510–$1,020 varies
Radex elbow complete minimum 3 views (73080)
range across 2 matching MRF lines		 $297.50–$595 $595–$1,190 varies
Radex Facial Bones Complete Minimum 3 Views (70150) $402.50 $805 3.9×
Radex fingr minimum 2 views (73140) $272.50 $545 3.1×
Radex foot complete minimum 3 views (73630)
range across 2 matching MRF lines		 $325–$650 $650–$1,300 varies
Radex Hand Minimum 3 Views (73130)
range across 2 matching MRF lines		 $285–$570 $570–$1,140 varies
Radex lower extremity infant minimum 2 views (73592)
range across 2 matching MRF lines		 $222.50–$445 $445–$890 varies
Radex Nasal Bones Complete Minimum 3 Views (70160) $332.50 $665 3.8×
Radex Ribs Unilateral 2 Views (71100) $370 $740 4.3×
Radex shoulder complete minimum 2 views (73030)
range across 2 matching MRF lines		 $290–$580 $580–$1,160 varies
Radex Sinuses Paransl < 3 Views (70210) $282.50 $565 3.3×
Radex sm int w/mlt srl imges via enteroclss tube (74251) $705 $1,410 4.0×
Radex Spine 1 View Specify Level (72020) $282.50 $565 3.3×
Radex Sternum Minimum 2 Views (71120) $290 $580 3.3×
Radex Temporomandble Jt Opn & Clsd Mouth Bilat (70330) $390 $780 4.5×
Radex Toe Minimum 2 Views (73660) $265 $530 3.1×
Radex upper extremity infant minimum 2 views (73092) $220 $440 2.1×
Radex Wrist Complete Minimum 3 Views (73110)
range across 2 matching MRF lines		 $285–$570 $570–$1,140 varies
Radex X-Ray Exam Entire Spi 6/> Vw - Xr Entire Spine 6+ Vw (72084) $845 $1,690 8.1×
Radiation treatment delivery level 1 (77402) $715 $1,430 7.0×
Radiation treatment delivery level 2 (77407) $880 $1,760 2.3×
Radiation treatment delivery level 3 (77412) $1,100 $2,200 2.0×
Radiolog exam mandible compl minimum 4 views (70110) $392.50 $785 3.8×
Radiologic Exam Abdomen 3+ Views - Xr Abdomen 3+ Views (74021) $385 $770 3.7×
Radiologic exam colon double contrast study (74280) $615 $1,230 3.5×
Radiologic exam colon single contrast study (74270) $472.50 $945 2.7×
Radiologic Exam Esophagus Double Contrast Study (74221) $645 $1,290 3.7×
Radiologic exam knee complete 4/more views (73564)
range across 2 matching MRF lines		 $335–$670 $670–$1,340 varies
Radiologic exam pelvis compl minimum 3 views (72190) $360 $720 3.5×
Radiologic Exam Small Int Single Contrast Study (74250) $530 $1,060 3.0×
Radiologic exam swallow function contrast study (74230) $437.50 $875 2.5×
Radiologic exam teeth complete full mouth (70320) $222.50 $445 0.9×
Radiologic Exam Teeth Prtl Exam < Full Mouth (70310) $222.50 $445 0.9×
Radiologic exam upr gi trc double contrast study (74246) $705 $1,410 4.0×
Radiologic examination femur 1 view (73551)
range across 2 matching MRF lines		 $235–$470 $470–$940 varies
Radiologic examination femur minimum 2 views (73552)
range across 2 matching MRF lines		 $347.50–$695 $695–$1,390 varies
Radiologic examination knee 1/2 views (73560)
range across 2 matching MRF lines		 $225–$450 $450–$900 varies
Radiologic examination tibia & fibula 2 views (73590)
range across 4 matching MRF lines		 $295–$590 $590–$1,180 varies
Renal Cyst Study (74470) $760 $1,520 1.4×
Ribs bilateral 3 views (71110) $555 $1,110 5.3×
Rp loclzj tum plnr 1 area single day imaging (78800) $875 $1,750 2.2×
Rp loclzj tum plnr 2+area 1+d img/1 area img>2+d (78801) $1,310 $2,620 3.3×
Rp Loclzj Tum Plnr Whole Body 2+ Days Imaging (78804) $1,760 $3,520 3.3×
Rp Loclzj Tum Plnr Whole Body Single Day Imaging (78802) $1,315 $2,630 2.4×
Rp Loclzj Tum Spect 1 Area Single Day Imaging (78803) $1,505 $3,010 2.8×
Rp loclzj tum spect 2 area/sep acquisj img (78831) $1,905 $3,810 1.5×
Rp loclzj tum spect CT 2area 1d img/1 ar img>2+d (78832) $2,180 $4,360 1.5×
Rp loclzj tum spect w/CT 1 area/acquisj 1day img (78830) $1,650 $3,300 1.3×
Rp Ther Radiolbld Monoclonal Antibody IV Infus (79403) $1,285 $2,570 5.5×
Rp Therapy Intravenous Administration (79101) $760 $1,520 3.3×
Scapula (73010) $285 $570 2.7×
Screening Digital Breast Tomosynthesis Bi (77063) $62.50 $125 2.7×
Shoulder 1 view (73020) $232.50 $465 2.7×
Shoulder Arthrography (73040) $965 $1,930 2.8×
Sialogram (70390) $605 $1,210 2.5×
Skull less than 4 views (70250) $280 $560 2.7×
Special dosimetry (77331) $392.50 $785 2.9×
Special Physics Consult (77370) $725 $1,450 5.4×
Special teletherapy port plan (77321) $1,900 $3,800 5.1×
Special treatment procedure (77470) $3,595 $7,190 6.5×
Spleen Imaging (78185) $980 $1,960 2.5×
Stereotactic Body Radiation Delivery (77373) $7,205 $14,410 4.0×
Sternoclavicular joints (71130) $267.50 $535 3.1×
Telethx isodose pln cplx w/basic dosimetry (77307) $5,785 $11,570 15.5×
Telethx isodose pln smpl w/dosimetry calculation (77306) $1,780 $3,560 4.8×
Testicular Imaging W/Flow (78761) $1,080 $2,160 2.7×
Ther Rad Simulaj-Aided Field Setting Complex (77290) $3,360 $6,720 9.0×
Ther Rad Simulaj-Aided Field Setting Intermed (77285) $2,010 $4,020 5.4×
Ther rad simulaj-aided field setting simple (77280) $1,380 $2,760 10.3×
Therapeutic Enema Rdctj Intussusception/Obstrcj (74283) $322.50 $645 1.8×
Thoracic spine 2 views (72070) $340 $680 3.3×
Thoracic spine 3 views (72072) $392.50 $785 3.8×
Thoracolumbar 2 views (72080) $367.50 $735 4.2×
Thyroid Imaging With Vascular Flow (78013) $715 $1,430 1.8×
Thyroid Met Imaging Body (78018) $1,760 $3,520 3.3×
Thyroid Uptake Measurement (78012) $715 $1,430 1.8×
Thyroid Uptake W/Blood Flow Sngle/Mult Quan Meas (78014) $1,070 $2,140 2.7×
Tx Devices Design & Construction Complex (77334) $1,955 $3,910 5.2×
Tx devices design & construction intermediate (77333) $1,040 $2,080 7.8×
Tx devices design & construction simple (77332) $550 $1,100 4.1×
Ultrasound Breast Limited (76642)
range across 2 matching MRF lines		 $425–$850 $850–$1,700 varies
Ultrasound elastography first target lesion (76982) $360 $720 3.5×
Ultrasound Elastography Parenchyma (76981) $362.50 $725 3.5×
Ultrasound Exam Aaa Screen (76706) $380 $760 3.6×
Ultrasound trgt dynamic microbubble 1st lesion (76978) $685 $1,370 2.0×
Ultrasound, abdomen limited (76705) $675 $1,350 6.5×
Umbilical-artery Doppler (OB) (76820) $285 $570 2.7×
Unlisted Dx Radiographic Procedure (76499) $590 $1,180 6.8×
Unlisted fluoroscopic procedure (76496) $460 $920 5.3×
Unlisted magnetic resonance procedure (76498) $1,385 $2,770 16.0×
Unlisted Miscellaneous Px Dx Nuclear Medicine (78999) $1,355 $2,710 3.4×
Unlisted us procedure (76999) $75 $150 0.9×
Upper gi w/o kub (74240) $655 $1,310 3.7×
Urethrocystogram voiding (74455) $690 $1,380 2.9×
Urethrocystography retrograde (74450) $515 $1,030 2.2×
Us breast unilateral complete (76641)
range across 2 matching MRF lines		 $570–$1,140 $1,140–$2,280 varies
Us chest (76604)
range across 2 matching MRF lines		 $352.50–$470 $705–$940 varies
Us complete joint (76881)
range across 2 matching MRF lines		 $375–$750 $750–$1,500 varies
Us exam, pelvic, limited (76857) $505 $1,010 4.8×
Us head (76506) $570 $1,140 5.5×
Us kidney transplant (76776) $670 $1,340 6.4×
Us lmtd joint/oth nonvasc xtr strux r-t w/img (76882)
range across 2 matching MRF lines		 $282.50–$565 $565–$1,130 varies
Us ob detailed single fetus (76811) $535 $1,070 2.3×
Us ob limited 1 or more fetuses (76815) $387.50 $775 3.7×
Us ob transvaginal (76817) $452.50 $905 4.3×
Us pelvic non ob complete (76856) $780 $1,560 7.5×
Us pg uter img f&mat 14 wk tabdl 1/1st gestation (76801) $535 $1,070 5.1×
Us preg uterus real time f/u trnsabdl per fetus (76816) $387.50 $775 3.7×
Us retroperitoneal complete (76770) $780 $1,560 7.5×
Us retroperitoneal limited (76775) $580 $1,160 5.6×
Us scrotum and contents (76870) $595 $1,190 5.7×
Us spinal canal and contents (76800) $405 $810 3.9×
Us thyroid (76536) $655 $1,310 6.3×
Us transrectal (76872) $790 $1,580 7.6×
Vascular Flow Imaging (78445) $515 $1,030 1.3×
Vein X-Ray Chest (75827) $2,095 $4,190 1.3×
Vein X-Ray Liver W/O Hemodyn (75887) $1,575 $3,150 0.5×
Venogram Sinus/Jugular (75860) $1,315 $2,630 0.4×
Venography caval inferior serialography rs&i (75825) $2,095 $4,190 0.7×
Venography extremity bilateral rs&i (75822) $1,575 $3,150 1.0×
Venography extremity unilateral rs&i (75820) $1,050 $2,100 0.7×
Venography Renal Bilateral (75833) $3,145 $6,290 1.0×
Venography Renal Unilateral (75831) $2,095 $4,190 0.7×
Venous sampling by catheter (75893) $3,085 $6,170 0.6×
Wrist 2 views (73100)
range across 3 matching MRF lines		 $247.50–$495 $495–$990 varies
X-Ray Ac Jts - Xr Acromioclavicular Joints Bilateral (73050) $295 $590 3.4×
X-ray antegrade pyelogram tube (74425) $560 $1,120 1.6×
X-Ray Aorta Leg Arteries (75630) $2,515 $5,030 0.8×
X-Ray Bend Only L-S Spine (72120) $395 $790 3.8×
X-Ray Elbow 2 Vw - Xr Elbow 1-2 Views Right (73070)
range across 3 matching MRF lines		 $237.50–$475 $475–$950 varies
X-Ray Exam Breast Specimen (76098) $375 $750 0.7×
X-Ray Exam Entire Spi 1 Vw (72081) $247.50 $495 2.9×
X-Ray Exam Entire Spi 2/3 Vw (72082) $375 $750 3.6×
X-Ray Exam Entire Spi 4/5 Vw (72083) $565 $1,130 5.4×
X-Ray Exam Hip Uni 1 View (73501) $287.50 $575 3.3×
X-Ray Exam Hip Uni 2-3 Views (73502) $345 $690 4.0×
X-Ray Exam Hip Uni 4/> Views (73503) $432.50 $865 4.2×
X-Ray Exam Hips Bi 2 Views (73521) $432.50 $865 4.2×
X-Ray Exam Hips Bi 3-4 Views (73522) $515 $1,030 4.9×
X-Ray Exam Hips Bi 5/> Views (73523) $655 $1,310 6.3×
X-Ray Exam L-S Spine Bending (72114) $550 $1,100 5.3×
X-Ray Exam Neck Spine 2-3 Vw (72040) $340 $680 3.9×
X-Ray Exam Neck Spine 6/>Vws (72052) $565 $1,130 5.4×
X-Ray Exam Unilat Ribs/Chest (71101) $555 $1,110 5.3×
X-ray eye for foreign body (70030)
range across 2 matching MRF lines		 $137.50–$275 $275–$550 varies
X-ray humerus (73060)
range across 2 matching MRF lines		 $295–$590 $590–$1,180 varies
X-ray IV pyelogram (ivp) (74400) $670 $1,340 3.8×
X-Ray Jaw <4 Vw - Xr Mandible < 4 Views (70100) $292.50 $585 3.4×
X-Ray Knee Bilat Standing - Xr Knees Anteroposterior Standing Bilat (73565) $252.50 $505 2.9×
X-Ray Lumbar Spine 2/3 Vw - Xr Lumbar Spine 2-3 Views (72100) $367.50 $735 3.5×
X-ray nose-rectum child f.b. (76010) $147.50 $295 1.7×
X-Ray Ribs, Chest 4+ Vw - Xr Ribs 3 Vws Bil W/ Chest Posteroanterior (71111) $655 $1,310 6.3×
X-Ray Sacroiliac Jts 3+ Vw - Xr Sacroiliac Joints 3+ Views (72202) $322.50 $645 3.1×
X-Ray Sacroiliac Jts <3 Vw - Xr Sacroiliac Joints 1-2 Views (72200) $252.50 $505 2.4×
X-Ray Sacrum/Coccyx 2+ Vw - Xr Sacrum Coccyx 2+ Views (72220) $332.50 $665 3.8×
X-Ray Sinuses 3+ Vw - Xr Paranasal Sinuses 3+ Views (70220) $425 $850 4.9×
X-Ray Skull 4+ Vw - Xr Skull Complete 4+ Views (70260) $417.50 $835 4.0×
X-ray thoracic spine 4 vw (72074) $452.50 $905 4.3×
X-Ray Tmj Unilat (70328) $260 $520 3.0×
X-Ray Urinary Tract Exam With Contrast Material (74420) $925 $1,850 2.7×
X-Rays Bone Length Studies (77073) $350 $700 3.4×
X-Rays Bone Survey Complete (77075) $885 $1,770 8.5×
Xr c-spine 4 or 5 views (72050) $500 $1,000 4.8×
Xr facial bones less than 3 views (70140) $272.50 $545 3.1×
XR Mastoids < 3 Views Bilateral (70120) $227.50 $455 2.2×
Xr orbits complete 4 views (70200) $327.50 $655 3.1×

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.