Imaging prices at Banner Wyoming Medical Center

Casper, WY · every code in this section with a posted price and a Medicare benchmark.

401 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) $2,831.64 $6,742 2.0×
Abdomen 1 View (74018) $71.82 $171 0.8×
Abdomen 2 views (74019) $85.68 $204 0.8×
Acute Gastrointestinal Blood Loss Imaging (78278) $664.86 $1,583 1.6×
Angio internal mammary (75756) $1,648.50 $3,925 0.5×
Angio pulmonary bilat (75743) $5,677.14 $13,517 1.8×
Angiography Adrenal Bilateral Slctv Rs&I (75733) $3,682.56 $8,768 1.1×
Angiography extremity bilateral rs&i (75716) $2,436.42 $5,801 0.8×
Angiography extremity unilateral rs&i (75710) $1,985.34 $4,727 0.6×
Angiography pulmonary unilateral slctv rs&i (75741) $3,368.40 $8,020 1.0×
Angrph pulmonary nonslctv cath/ven njx rs&i (75746) $3,406.20 $8,110 1.1×
Ankle 2 views (73600) $73.50 $175 0.8×
Aortography thoracic serialography rs&i (75605) $3,202.92 $7,626 0.6×
Aortography thoracic w/o serialography rs&i (75600) $2,978.64 $7,092 0.9×
Artery X-Rays Abdomen (75726) $2,985.78 $7,109 0.5×
Artery X-Rays Adrenal Gland (75731) $2,454.90 $5,845 0.8×
Artery X-Rays Pelvis (75736) $2,852.22 $6,791 0.5×
Artery X-Rays Spine (75705) $2,852.22 $6,791 0.5×
Arthrogram ankle (73615) $281.82 $671 0.8×
Arthrogram hip (73525) $230.58 $549 0.6×
Arthrogram Wrist (73115) $236.46 $563 0.7×
Basic radiation dosimetry calculation (77300) $275.94 $657 2.0×
Bone age studies (77072) $67.20 $160 0.6×
Bone Imaging 3 Phase (78315) $1,307.04 $3,112 3.2×
Bone Imaging Limited Area (78300) $745.92 $1,776 1.8×
Bone Imaging Multiple Areas (78305) $760.20 $1,810 1.9×
Bone Imaging Whole Body (78306) $1,035.30 $2,465 2.5×
Bone marrow imaging limited area (78102) $343.98 $819 0.8×
Bone marrow imaging; multiple areas (78103) $440.16 $1,048 1.1×
Bone marrow imaging; whole body (78104) $501.90 $1,195 1.2×
Bone survey infant (77076) $97.44 $232 0.9×
Brachytx isodose complex (77318) $687.96 $1,638 1.8×
Brachytx isodose intermed (77317) $651.84 $1,552 1.7×
Brachytx Isodose Plan Simple (77316) $494.34 $1,177 1.3×
Brain Image W/Flow < 4 Views (78601) $385.14 $917 0.9×
Brain imaging < 4 static views (78600) $328.02 $781 0.8×
Brain Imaging Min 4 Static Views W Vascular Flow (78606) $583.80 $1,390 1.1×
Brain Imaging Minimum 4 Static Views (78605) $351.54 $837 0.6×
Cardiac MRI w/w/o contrast & further seq (75561) $658.56 $1,568 1.8×
Cardiac Shunt Detection (78428) $636.30 $1,515 1.6×
Cat Scan Follow-Up Study (76380) $245.70 $585 2.8×
Cerebrospinal Fluid Flow W/O Matl Shunt Evaltj (78645) $514.50 $1,225 0.9×
Cerebrospinal Fluid Scan (78630) $550.62 $1,311 1.0×
Chest 1 view (71045) $78.96 $188 0.9×
Chest 2 views (71046) $99.96 $238 1.1×
Chest 3 views (71047) $132.30 $315 1.5×
Chest 4 or more views (71048) $141.54 $337 1.3×
Clavicle complete (73000) $78.96 $188 0.9×
Continuing medical physics consltj pr wk (77336) $279.72 $666 2.0×
Contrast Exam Abdominl Aorta (75625) $1,921.92 $4,576 0.6×
Contrast X-Ray Bladder (74430) $315.42 $751 0.9×
Contrast X-Ray Of Elbow (73085) $230.58 $549 0.6×
Contrast X-Ray Of Knee Joint (73580) $230.58 $549 0.6×
CT abdomen and pelvis without and with contrast (74178) $1,275.96 $3,038 3.6×
CT abdomen and pelvis without contrast (74176) $850.50 $2,025 3.5×
CT abdomen w contrast (74160) $490.14 $1,167 2.7×
CT abdomen w wo contrast (74170) $588 $1,400 3.3×
CT abdomen w/o contrast (74150) $391.86 $933 3.7×
CT Angio Abdomen and Pelvis (74174) $1,339.80 $3,190 3.8×
CT Angio Chest (71275) $729.12 $1,736 4.1×
CT Angio Head (70496) $1,022.70 $2,435 5.7×
CT angio hrt w/3d image (75574) $523.74 $1,247 1.5×
Ct Angio Lwr Extr W/O&W/Dye (73706) $1,022.70 $2,435 5.7×
CT Angio Neck (70498) $1,025.64 $2,442 5.7×
Ct Angio Upr Extrm W/O&W/Dye (73206) $727.44 $1,732 4.1×
CT cervical spine w/ contrast (72126) $811.86 $1,933 2.3×
CT cervical spine w/o contrast (72125) $649.32 $1,546 6.1×
CT cervical spine w/wo cont (72127) $973.98 $2,319 5.4×
CT chest w contrast (71260) $578.76 $1,378 3.2×
CT chest w/wo contrast (71270) $694.26 $1,653 3.9×
CT colonography screening (74263) $576.24 $1,372 2.4×
CT Colonogrphy Dx Image Postprocess W/Contrast (74262) $430.50 $1,025 2.4×
CT colonogrphy dx image postprocess w/o contrast (74261) $344.40 $820 3.2×
CT head/brain with contrast (70460) $811.86 $1,933 4.5×
CT head/brain without and with contrast (70470) $973.98 $2,319 5.4×
CT heart contrast eval cardiac structure&morph (75572) $415.38 $989 1.2×
CT heart no contrast quant eval coronry calcium (75571) $73.08 $174 0.8×
CT hrt w/3d image congen (75573) $498.54 $1,187 1.4×
CT iac w contrast (70481) $811.86 $1,933 4.5×
CT l-spine w&w/o contrast (72133) $963.48 $2,294 5.4×
CT lower ext w/o (73700) $649.32 $1,546 6.1×
CT lower extremity w/contrast material (73701) $811.86 $1,933 4.5×
CT lumbar spine w contrast (72132) $803.04 $1,912 2.3×
CT lumbar spine w/o contrast (72131) $642.18 $1,529 6.0×
CT maxillofacial w contrast (70487) $811.86 $1,933 4.5×
CT maxillofacial wo contrast (70486) $649.32 $1,546 6.1×
CT neck tissue combo (70492) $976.50 $2,325 5.4×
Ct Orbit/Ear/Fossa W/O&W/Dye (70482) $973.98 $2,319 5.4×
CT orbits w/o contrast (70480) $649.32 $1,546 6.1×
CT pelvis w&w/o contrast (72194) $577.92 $1,376 3.2×
CT pelvis w/o contrast (72192) $385.14 $917 3.6×
CT scan of leg combo (73702) $973.98 $2,319 5.4×
CT scans face/jaw combo (70488) $973.98 $2,319 5.4×
CT soft tissue neck w contrast (70491) $813.96 $1,938 4.5×
CT soft tissue neck w/o contrast (70490) $651 $1,550 6.1×
CT thoracic spine w contrast (72129) $809.34 $1,927 4.5×
CT thoracic spine w/o contrast (72128) $647.22 $1,541 6.1×
CT thoracic spine w/wo cont (72130) $971.04 $2,312 5.4×
CT thorax w/o contrast (71250) $462.84 $1,102 4.3×
CT upper ext wo (73200) $461.58 $1,099 4.3×
CT upper extremity w/o & w/contrast material (73202) $692.58 $1,649 3.9×
CT upper extremity with contrast (73201) $577.08 $1,374 1.6×
Cta Abdl Aorta&Bi Iliofem W/Contrast&Postp (75635) $685.86 $1,633 3.8×
Cta Abdomen (74175) $617.40 $1,470 3.4×
CTA pelvis (72191) $606.90 $1,445 3.4×
Dilation ureters/urethra rs&i (74485) $644.28 $1,534 0.3×
Discography Cerv/Thor Spine (72285) $2,344.44 $5,582 1.2×
Diskography lumbar (72295) $1,344 $3,200 0.7×
Echo Guide For Artery Repair (76936) $328.02 $781 1.5×
Echograp Trans R Pros Study (76873) $228.48 $544 2.1×
Esophagram (74220) $143.22 $341 0.8×
Fetal Biophys Profile W/Nst (76818) $226.80 $540 2.1×
Fetal Biophysical Profile W/O Non-Stress Testing (76819) $162.54 $387 1.5×
Fluoroscopy up to 1 hr (76000) $385.56 $918 1.6×
Follow-Up Angiography (75898) $927.36 $2,208 0.3×
Foot 2 views (73620) $68.04 $162 0.8×
Forearm 2 views (73090) $70.98 $169 0.8×
Gastric emptying imaging study (78264) $956.34 $2,277 2.3×
Gastroesophageal Reflux Exam (78262) $590.10 $1,405 1.4×
Gated Heart Planar Single (78472) $781.62 $1,861 1.9×
Hand 2 views (73120) $68.88 $164 0.6×
Hdr Rdncl Ntrstl/Icav Brchtx (77772) $2,376.78 $5,659 3.3×
Hdr Rdncl Ntrstl/Icav Brchtx (77771) $2,285.22 $5,441 3.2×
Hdr Rdncl Ntrstl/Icav Brchtx 1 Channel (77770) $1,834.56 $4,368 2.6×
Heart first pass single,planar (78481) $728.70 $1,735 1.3×
Hepatc Vngrph Wdg/Fr Hemodyn Eval Rs&I (75889) $2,171.82 $5,171 0.7×
Hepatc Vngrph Wdg/Fr W/O Hemodyn Eval Rs&I (75891) $1,954.68 $4,654 0.6×
Hepatobil Syst Image W/Drug (78227) $1,071.84 $2,552 1.9×
Hepatobiliary System Imaging (78226) $758.10 $1,805 1.9×
Ht Musc Image Planar Mult (78454) $671.16 $1,598 0.5×
Ht Muscle Image Spect Sing (78451) $556.50 $1,325 0.4×
Hysterosalpingogram (74740) $290.22 $691 1.2×
Infant hip ultrasound with hip movement (dynamic) (76885) $107.94 $257 1.2×
Infant hip ultrasound, limited static exam (76886) $78.96 $188 0.9×
Infusion Ivp (74410) $464.94 $1,107 2.6×
Interstitial radiation source applic complex (77778) $1,666.56 $3,968 2.3×
Intracavitary Radiation Source Applic Complex (77763) $1,125.18 $2,679 1.6×
Intracavitary Radiation Source Applic Intermed (77762) $787.50 $1,875 1.4×
Intracavitary radiation source applic simple (77761) $596.40 $1,420 1.1×
Joint Survey Single View (77077) $67.20 $160 0.6×
K Flow/Funct Image Multiple (78709) $868.14 $2,067 1.6×
K Flow/Funct Image W/Drug (78708) $790.44 $1,882 1.4×
K Flow/Funct Image W/O Drug (78707) $837.48 $1,994 1.5×
Knee 3 Views (73562) $78.96 $188 0.9×
Liver & Spleen Imaging Static Only (78215) $557.76 $1,328 1.4×
Liver & Spleen Imaging W/Vascular Flow (78216) $362.88 $864 0.9×
Lung Perf&Ventilat Diferentl (78598) $768.60 $1,830 1.4×
Lung perfusion differential (78597) $499.38 $1,189 1.2×
Lung Ventilat&Perfus Imaging (78582) $1,298.22 $3,091 2.3×
Lung Ventilation Imaging (78579) $430.92 $1,026 1.1×
Lymph System Imaging (78195) $961.80 $2,290 1.7×
Lymphangiography Extremity Only Bilateral Rs&I (75803) $1,492.26 $3,553 0.9×
Lymphangiography extremity only unilateral rs&i (75801) $705.60 $1,680 1.1×
Lymphangiography Pelvic/Abdominal Bilateral Rs&I (75807) $1,648.50 $3,925 0.5×
Lymphangiography, pelvic/abdominal, unilateral (75805) $952.56 $2,268 0.3×
Magnetic Image Jaw Joint (70336)
range across 3 matching MRF lines		 $602.70–$904.26 $1,435–$2,153 varies
Mammary ductogram or galactogram multiple (77054) $231.42 $551 0.9×
Mammary ductogram or galactogram single (77053) $175.98 $419 0.7×
Meckels Divert Exam (78290) $632.52 $1,506 1.5×
Mlc imrt design & construction per imrt plan (77338) $459.48 $1,094 1.2×
Mr safety determination physician/other qhp (76016) $55.44 $132 0.6×
Mr safety implant&/fb assmt clin staf 1st 15 min (76014) $15.96 $38 0.5×
Mr safety implt electronics prepj supvj phys/qhp (76018) $81.90 $195 0.8×
Mr safety implt pos&/immoblj (76019) $125.16 $298 2.1×
Mr safety med physics xm customization plng&mntr (76017) $194.04 $462 0.8×
Mra Head W/O & W/Contrast Material (70546) $859.32 $2,046 2.4×
MRA head w/o contrast (70544) $572.88 $1,364 2.4×
MRA head with contrast (70545) $716.10 $1,705 2.0×
MRA neck w contrast (70548) $777.84 $1,852 2.2×
Mra Neck W/O &W/Contrast Material (70549) $933.24 $2,222 2.6×
MRA neck w/o contrast (70547) $622.02 $1,481 2.6×
MRI abdomen w contrast (74182) $982.38 $2,339 2.8×
MRI abdomen w/o contrast (74181) $785.82 $1,871 3.2×
MRI any jt lower extrem w/contrast material (73722) $1,000.86 $2,383 1.2×
MRI any jt lower extrem w/o & w/contrast matrl (73723) $1,200.78 $2,859 3.4×
MRI any jt upper extremity w/contrast matrl (73222) $1,000.86 $2,383 1.2×
MRI bone marrow blood supply (77084) $640.50 $1,525 2.6×
MRI Breast W/O Contrast Bilateral (77047) $668.22 $1,591 2.7×
MRI Breast Without Contrast Material Unilateral (77046) $445.62 $1,061 1.8×
MRI cardiac w/o contrast (75557) $438.90 $1,045 1.8×
MRI cervical spine w contrast (72142) $998.34 $2,377 2.8×
MRI cervical spine w/o cont (72141) $798.42 $1,901 3.3×
MRI chest w/o contrast (71550) $800.94 $1,907 3.3×
MRI chest with contrast (71551) $1,001.28 $2,384 1.3×
MRI chest wo w contrast (71552) $1,201.62 $2,861 3.4×
MRI lower extrem oth/thn jt w/contrast matrl (73719) $1,000.86 $2,383 2.8×
MRI lower extrem oth/thn jt w/o & w/contr matr (73720) $1,200.78 $2,859 3.4×
MRI lower extrem oth/thn jt w/o contr matrl (73718) $800.52 $1,906 3.3×
MRI lumbar spine w contrast (72149) $1,000.86 $2,383 2.8×
Mri Neck Spine W/O & W/Dye (72156) $1,197.84 $2,852 3.4×
MRI orbit face &/neck w/o contrast (70540) $646.38 $1,539 2.7×
MRI orbit face neck w contrast (70542) $808.08 $1,924 2.3×
Mri Orbt/Fac/Nck W/O &W/Dye (70543) $969.78 $2,309 2.7×
MRI pelvis w contrast (72196) $994.14 $2,367 2.8×
MRI pelvis w/o & w contrast (72197) $1,192.80 $2,840 3.3×
MRI pelvis w/o contrast (72195) $795.06 $1,893 3.3×
MRI thoracic spine w/o contrast (72146) $796.32 $1,896 3.3×
MRI upper extremity oth than jt w/contr matrl (73219) $771.96 $1,838 2.2×
MRI upper extremity oth than jt w/o contr matrl (73218) $617.40 $1,470 2.5×
Mri Uppr Extremity W/O&W/Dye (73220) $926.10 $2,205 2.6×
MRI, abdomen, combo (74183) $1,178.94 $2,807 3.3×
MRI, dorsal spine combo (72157) $1,194.48 $2,844 3.4×
MRI, dorsal spine contrast (72147) $995.40 $2,370 2.8×
MRI, joint upper extrem (73221) $800.52 $1,906 3.3×
MRI, joint upper extrem combo (73223) $1,200.78 $2,859 3.4×
MRI, lumbar spine combo (72158) $1,200.78 $2,859 3.4×
Myelogram cervical (72240) $693.42 $1,651 0.9×
Myelogram Lumbar (72265) $609.84 $1,452 0.8×
Myelography thoracic (72255) $640.50 $1,525 0.8×
Myelograpy 2/more regions rs&i (72270) $619.92 $1,476 0.8×
Myocardial Imaging Infarct Avid Planar Qual/Quan (78466) $452.34 $1,077 1.1×
Myocardial Perfusion Planar 1 Study Rest/Stress (78453) $556.50 $1,325 0.4×
Myocardial Spect Multiple Studies (78452) $671.16 $1,598 0.5×
Neck soft tissue (70360) $78.96 $188 0.9×
Njx Rp Loclzj Non-Img Probe Study Intravenous (78808) $234.36 $558 0.6×
Nm csf leak detection (78650) $900.06 $2,143 0.7×
Nonvascular Shunt X-Ray (75809) $285.60 $680 2.7×
Ntsty modul radthx pln dose-vol histos (77301) $3,102.12 $7,386 2.2×
Nuclear Rx Intra-Arterial (79445) $257.46 $613 1.1×
Nuclear Rx Oral Admin (79005) $1,077.72 $2,566 4.5×
Optic foramina (70190) $55.44 $132 0.6×
Panoramic X-ray of jaws (70355) $53.34 $127 0.6×
Parathyroid imaging w/tomographic spect & CT (78072) $801.78 $1,909 1.4×
Parathyroid Planar Imaging (78070) $538.44 $1,282 1.3×
Parathyroid planar imaging w/wo subtraction (78071) $484.26 $1,153 1.2×
Pelvis 1 or 2 views (72170) $78.96 $188 0.7×
Peritoneogram Rs&I (74190) $345.66 $823 0.6×
PET imaging CT attenuation skull base mid-thigh (78815) $2,877 $6,850 2.0×
Prq Transhepatc Portograpy Hemodyn Eval Rs&I (75885) $2,669.10 $6,355 0.8×
Pulmonary Perfusion Imaging Particulate (78580) $594.30 $1,415 1.5×
Radex Abd Compl Aqt Abd W/S/E/D Views 1 View Ch (74022) $130.62 $311 1.2×
Radex abscess/fistula/sinus tract rs&i (76080) $345.66 $823 0.6×
Radex Ankle Complete Minimum 3 Views (73610) $78.96 $188 0.9×
Radex Calcaneus Minimum 2 Views (73650) $72.24 $172 0.8×
Radex elbow complete minimum 3 views (73080) $78.96 $188 0.9×
Radex Facial Bones Complete Minimum 3 Views (70150) $67.20 $160 0.6×
Radex fingr minimum 2 views (73140) $78.96 $188 0.9×
Radex foot complete minimum 3 views (73630) $78.96 $188 0.9×
Radex Hand Minimum 3 Views (73130) $78.96 $188 0.9×
Radex lower extremity infant minimum 2 views (73592) $58.38 $139 0.7×
Radex Mastoids Compl Minimum 3 Views PR Side (70130) $73.92 $176 0.7×
Radex Nasal Bones Complete Minimum 3 Views (70160) $78.96 $188 0.9×
Radex Ribs Unilateral 2 Views (71100) $71.82 $171 0.8×
Radex shoulder complete minimum 2 views (73030) $78.96 $188 0.9×
Radex Sinuses Paransl < 3 Views (70210) $55.44 $132 0.6×
Radex sm int w/mlt srl imges via enteroclss tube (74251) $412.86 $983 2.3×
Radex Spine 1 View Specify Level (72020) $63 $150 0.7×
Radex Sternum Minimum 2 Views (71120) $58.38 $139 0.7×
Radex Temporomandble Jt Opn & Clsd Mouth Bilat (70330) $103.74 $247 1.2×
Radex Toe Minimum 2 Views (73660) $78.96 $188 0.9×
Radex upper extremity infant minimum 2 views (73092) $77.70 $185 0.7×
Radex Wrist Complete Minimum 3 Views (73110) $78.96 $188 0.9×
Radex X-Ray Exam Entire Spi 6/> Vw - Xr Entire Spine 6+ Vw (72084) $106.26 $253 1.0×
Radiation Delivery Stereotactic Cranial Linear (77372) $6,318.48 $15,044 0.8×
Radiation treatment delivery level 1 (77402) $236.04 $562 2.3×
Radiation treatment delivery level 2 (77407) $294 $700 0.7×
Radiation treatment delivery level 3 (77412) $329.70 $785 0.6×
Radiolog exam mandible compl minimum 4 views (70110) $78.96 $188 0.7×
Radiologic Exam Abdomen 3+ Views - Xr Abdomen 3+ Views (74021) $99.96 $238 0.9×
Radiologic exam colon double contrast study (74280) $188.58 $449 1.1×
Radiologic exam colon single contrast study (74270) $181.44 $432 1.0×
Radiologic Exam Esophagus Double Contrast Study (74221) $150.78 $359 0.8×
Radiologic exam knee complete 4/more views (73564) $87.36 $208 0.8×
Radiologic exam pelvis compl minimum 3 views (72190) $94.50 $225 0.9×
Radiologic Exam Small Int Single Contrast Study (74250) $181.44 $432 1.0×
Radiologic exam swallow function contrast study (74230) $181.44 $432 1.0×
Radiologic exam upr gi trc double contrast study (74246) $229.32 $546 1.3×
Radiologic examination femur 1 view (73551) $60.06 $143 0.7×
Radiologic examination femur minimum 2 views (73552) $78.96 $188 0.9×
Radiologic examination knee 1/2 views (73560) $55.44 $132 0.6×
Radiologic Examination Osseous Survey Limited (77074) $67.20 $160 0.6×
Radiologic examination tibia & fibula 2 views (73590) $78.96 $188 0.9×
Radiopharmaceutical therapy, by intra-articular administration Non-Facility (79440) $183.12 $436 0.8×
Ribs bilateral 3 views (71110) $94.92 $226 0.9×
Rp loclzj tum plnr 1 area single day imaging (78800) $386.40 $920 0.9×
Rp loclzj tum plnr 2+area 1+d img/1 area img>2+d (78801) $515.34 $1,227 1.3×
Rp Loclzj Tum Plnr Whole Body 2+ Days Imaging (78804) $1,504.44 $3,582 2.7×
Rp Loclzj Tum Plnr Whole Body Single Day Imaging (78802) $822.78 $1,959 1.5×
Rp Loclzj Tum Spect 1 Area Single Day Imaging (78803) $1,367.52 $3,256 2.5×
Rp loclzj tum spect 2 area/sep acquisj img (78831) $1,178.52 $2,806 0.9×
Rp loclzj tum spect CT 2area 1d img/1 ar img>2+d (78832) $1,220.52 $2,906 0.8×
Rp loclzj tum spect w/CT 1 area/acquisj 1day img (78830) $1,103.34 $2,627 0.8×
Rp Ther Radiolbld Monoclonal Antibody IV Infus (79403) $567 $1,350 2.4×
Scapula (73010) $63 $150 0.6×
Sella turcica (70240) $55.44 $132 0.6×
Shoulder 1 view (73020) $62.58 $149 0.7×
Shoulder Arthrography (73040) $413.28 $984 1.2×
Skull less than 4 views (70250) $78.96 $188 0.7×
Special dosimetry (77331) $381.78 $909 2.8×
Special Physics Consult (77370) $480.06 $1,143 3.5×
Special teletherapy port plan (77321) $701.40 $1,670 1.8×
Special treatment procedure (77470) $813.96 $1,938 1.4×
Speech evaluation, complex (70371) $152.46 $363 0.6×
Spleen Imaging (78185) $284.76 $678 0.7×
Stereotactic Body Radiation Delivery (77373) $3,062.22 $7,291 1.7×
Sternoclavicular joints (71130) $74.76 $178 0.8×
Superior sagittal sinus venogram (75870) $1,575.84 $3,752 0.5×
Telethx isodose pln cplx w/basic dosimetry (77307) $667.80 $1,590 1.7×
Telethx isodose pln smpl w/dosimetry calculation (77306) $277.62 $661 0.7×
Temporomandble Jt Arthrography Rs&I (70332) $152.46 $363 0.6×
Testicular Imaging W/Flow (78761) $253.26 $603 0.6×
Ther Rad Simulaj-Aided Field Setting Complex (77290) $807.66 $1,923 2.1×
Ther Rad Simulaj-Aided Field Setting Intermed (77285) $696.78 $1,659 1.8×
Ther rad simulaj-aided field setting simple (77280) $464.52 $1,106 3.4×
Therapeutic Enema Rdctj Intussusception/Obstrcj (74283) $172.20 $410 1.0×
Thoracic spine 2 views (72070) $78.96 $188 0.7×
Thoracic spine 3 views (72072) $84 $200 0.8×
Thoracolumbar 2 views (72080) $78.96 $188 0.9×
Thyroid Carcinoma Metastases Img Lmtd Area (78015) $404.04 $962 1.0×
Thyroid Imaging With Vascular Flow (78013) $480.48 $1,144 1.2×
Thyroid Met Imaging Body (78018) $947.10 $2,255 1.7×
Thyroid Uptake Measurement (78012) $278.46 $663 0.7×
Thyroid Uptake W/Blood Flow Sngle/Mult Quan Meas (78014) $1,013.88 $2,414 2.5×
Tx Devices Design & Construction Complex (77334) $547.68 $1,304 1.4×
Tx devices design & construction intermediate (77333) $362.88 $864 2.6×
Tx devices design & construction simple (77332) $232.68 $554 1.7×
Ultrasound Breast Limited (76642)
range across 3 matching MRF lines		 $140.28–$210.42 $334–$501 varies
Ultrasound, abdomen limited (76705) $281.40 $670 2.6×
Unlisted magnetic resonance procedure (76498)
range across 3 matching MRF lines		 $962.22–$1,249.50 $2,291–$2,975 varies
Upper gi w/o kub (74240) $200.76 $478 1.1×
Urea Breath Test C-14 Isotopic Acquisj Analysis (78267) $251.16 $598 22.7×
Urea breath test c-14 isotopic analysis (78268) $2,089.50 $4,975 22.1×
Ureteral Reflux Study (78740) $253.26 $603 0.6×
Urethrocystogram voiding (74455) $220.08 $524 0.9×
Urethrocystography retrograde (74450) $206.22 $491 0.8×
Us breast unilateral complete (76641)
range across 3 matching MRF lines		 $171.36–$257.04 $408–$612 varies
Us chest (76604) $171.36 $408 1.6×
Us complete joint (76881) $282.66 $673 2.6×
Us exam, pelvic, limited (76857) $225.12 $536 2.1×
Us head (76506) $107.94 $257 1.0×
Us kidney transplant (76776) $281.40 $670 2.6×
Us lmtd joint/oth nonvasc xtr strux r-t w/img (76882) $182.28 $434 1.7×
Us ob detailed single fetus (76811) $265.02 $631 1.1×
Us ob limited 1 or more fetuses (76815) $161.70 $385 1.5×
Us ob transvaginal (76817) $186.06 $443 1.7×
Us pelvic non ob complete (76856) $281.40 $670 2.6×
Us pg uter img f&mat 14 wk tabdl 1/1st gestation (76801) $281.40 $670 2.6×
Us preg uterus real time f/u trnsabdl per fetus (76816) $129.78 $309 1.2×
Us retroperitoneal complete (76770) $281.40 $670 2.6×
Us retroperitoneal limited (76775) $147 $350 1.4×
Us scrotum and contents (76870) $281.40 $670 2.6×
Us spinal canal and contents (76800) $166.74 $397 1.6×
Us thyroid (76536) $169.26 $403 1.6×
Us transrectal (76872) $269.64 $642 2.5×
Vein X-Ray Chest (75827) $995.40 $2,370 0.6×
Vein X-Ray Liver W/O Hemodyn (75887) $2,639.28 $6,284 0.8×
Vein X-Ray Skull Epidural (75872) $2,441.88 $5,814 3.8×
Vein X-Ray Spleen/Liver (75810) $1,648.50 $3,925 0.5×
Venogram Sinus/Jugular (75860) $1,575.84 $3,752 0.5×
Venography Adrenal Unilateral (75840) $2,441.88 $5,814 0.8×
Venography caval inferior serialography rs&i (75825) $1,648.50 $3,925 0.5×
Venography extremity bilateral rs&i (75822) $1,171.38 $2,789 0.7×
Venography extremity unilateral rs&i (75820) $1,020.60 $2,430 0.6×
Venography Orbital Rs&I (75880) $2,291.94 $5,457 3.6×
Venography Renal Bilateral (75833) $3,837.96 $9,138 1.2×
Venography Renal Unilateral (75831) $2,168.46 $5,163 0.7×
Venous sampling by catheter (75893) $2,852.22 $6,791 0.5×
Wrist 2 views (73100) $68.88 $164 0.8×
X-Ray Ac Jts - Xr Acromioclavicular Joints Bilateral (73050) $55.44 $132 0.6×
X-ray antegrade pyelogram tube (74425) $278.46 $663 0.8×
X-Ray Aorta Leg Arteries (75630) $2,342.34 $5,577 0.7×
X-Ray Bend Only L-S Spine (72120) $68.88 $164 0.6×
X-Ray Elbow 2 Vw - Xr Elbow 1-2 Views Right (73070) $70.98 $169 0.8×
X-Ray Exam Breast Specimen (76098) $168 $400 0.3×
X-Ray Exam Entire Spi 1 Vw (72081) $60.06 $143 0.7×
X-Ray Exam Entire Spi 2/3 Vw (72082) $94.08 $224 0.9×
X-Ray Exam Entire Spi 4/5 Vw (72083) $105.84 $252 1.0×
X-Ray Exam Hip Uni 1 View (73501) $102.90 $245 1.2×
X-Ray Exam Hip Uni 2-3 Views (73502) $111.30 $265 1.3×
X-Ray Exam Hip Uni 4/> Views (73503) $166.32 $396 1.6×
X-Ray Exam Hips Bi 2 Views (73521) $112.98 $269 1.1×
X-Ray Exam Hips Bi 3-4 Views (73522) $150.78 $359 1.4×
X-Ray Exam Hips Bi 5/> Views (73523) $242.76 $578 2.3×
X-Ray Exam L-S Spine Bending (72114) $127.26 $303 1.2×
X-Ray Exam Neck Spine 2-3 Vw (72040) $78.96 $188 0.9×
X-Ray Exam Neck Spine 6/>Vws (72052) $129.36 $308 1.2×
X-Ray Exam Unilat Ribs/Chest (71101) $81.90 $195 0.8×
X-ray eye for foreign body (70030) $78.96 $188 0.9×
X-ray humerus (73060) $78.96 $188 0.9×
X-ray IV pyelogram (ivp) (74400) $444.78 $1,059 2.5×
X-ray IV pyelogram+tomography (74415) $542.64 $1,292 3.0×
X-Ray Jaw <4 Vw - Xr Mandible < 4 Views (70100) $55.44 $132 0.6×
X-Ray Knee Bilat Standing - Xr Knees Anteroposterior Standing Bilat (73565) $87.78 $209 1.0×
X-Ray Lumbar Spine 2/3 Vw - Xr Lumbar Spine 2-3 Views (72100) $78.96 $188 0.7×
X-ray nose-rectum child f.b. (76010) $55.44 $132 0.6×
X-Ray Ribs, Chest 4+ Vw - Xr Ribs 3 Vws Bil W/ Chest Posteroanterior (71111) $112.56 $268 1.1×
X-Ray Sacroiliac Jts 3+ Vw - Xr Sacroiliac Joints 3+ Views (72202) $90.30 $215 0.8×
X-Ray Sacroiliac Jts <3 Vw - Xr Sacroiliac Joints 1-2 Views (72200) $67.20 $160 0.6×
X-Ray Sacrum/Coccyx 2+ Vw - Xr Sacrum Coccyx 2+ Views (72220) $78.96 $188 0.9×
X-Ray Sinuses 3+ Vw - Xr Paranasal Sinuses 3+ Views (70220) $67.20 $160 0.8×
X-Ray Skull 4+ Vw - Xr Skull Complete 4+ Views (70260) $82.32 $196 0.8×
X-Ray Stress View (77071) $99.54 $237 1.1×
X-ray thoracic spine 4 vw (72074) $92.40 $220 0.9×
X-Ray Tmj Unilat (70328) $55.44 $132 0.6×
X-Ray Urinary Tract Exam With Contrast Material (74420) $278.46 $663 0.8×
X-Rays Bone Length Studies (77073) $67.20 $160 0.6×
X-Rays Bone Survey Complete (77075) $130.62 $311 1.2×
Xr c-spine 4 or 5 views (72050) $108.36 $258 1.0×
Xr facial bones less than 3 views (70140) $55.44 $132 0.6×
Xr orbits complete 4 views (70200) $78.96 $188 0.7×
Xr Tomogram Single Plane (76100) $77.28 $184 0.7×

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.