Imaging prices at Brooks-TLC Hospital System, Inc

Dunkirk, NY · every code in this section with a posted price and a Medicare benchmark.

413 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) $3,020 $3,020 1.7×
Abdomen 1 View (74018) $186 $186 1.7×
Abdomen 2 views (74019) $354 $354 2.7×
Acute Gastrointestinal Blood Loss Imaging (78278) $964 $964 1.9×
Acute venous thrombosis imaging, peptide Non-Facility (78456) $2,199 $2,199 1.4×
Angio internal mammary (75756) $2,132 $2,132 0.5×
Angio pulmonary bilat (75743) $7,670 $7,670 1.9×
Angiography Adrenal Bilateral Slctv Rs&I (75733) $6,608 $6,608 1.7×
Angiography extremity bilateral rs&i (75716) $5,994 $5,994 1.5×
Angiography extremity unilateral rs&i (75710) $5,994 $5,994 1.5×
Angiography pulmonary unilateral slctv rs&i (75741) $5,026 $5,026 1.3×
Angrph pulmonary nonslctv cath/ven njx rs&i (75746) $2,132 $2,132 0.5×
Ankle 2 views (73600)
range across 6 matching MRF lines		 $163–$245 $163–$245 varies
Aortography thoracic serialography rs&i (75605) $6,956 $6,956 1.0×
Aortography thoracic w/o serialography rs&i (75600) $6,956 $6,956 1.8×
Artery X-Rays Abdomen (75726) $13,436 $13,436 1.9×
Artery X-Rays Adrenal Gland (75731) $4,687 $4,687 1.2×
Artery X-Rays Pelvis (75736) $17,041 $17,041 2.5×
Artery X-Rays Spine (75705) $6,608 $6,608 1.0×
Arthrogram ankle (73615) $840 $840 1.9×
Arthrogram hip (73525) $691 $691 1.6×
Arthrogram Wrist (73115) $502 $502 1.2×
Basic radiation dosimetry calculation (77300) $342 $342 2.0×
Bone age studies (77072) $192 $192 1.5×
Bone Imaging 3 Phase (78315) $1,875 $1,875 3.8×
Bone Imaging Limited Area (78300) $1,193 $1,193 2.4×
Bone Imaging Multiple Areas (78305) $1,773 $1,773 3.6×
Bone Imaging Whole Body (78306) $1,825 $1,825 3.7×
Bone marrow imaging; whole body (78104) $1,031 $1,031 2.1×
Bone survey infant (77076) $271 $271 2.1×
Brain Flow Imaging Only (78610) $1,588 $1,588 2.3×
Brain Imaging Min 4 Static Views W Vascular Flow (78606) $1,688 $1,688 2.5×
Brain Imaging Minimum 4 Static Views (78605) $1,588 $1,588 2.3×
Brain Imaging Pet Metabolic Evaluation (78608) $3,902 $3,902 2.2×
Cardiac blood pool imaging, first pass technique; multiple studies, resting and with stress (exercise and/or… (78483) $1,141 $1,141 1.7×
Cardiac MRI w/w/o contrast & further seq (75561) $1,468 $1,468 3.4×
Cat Scan Follow-Up Study (76380) $279 $279 2.6×
Cerebrospinal Fluid Flow W/O Matl Shunt Evaltj (78645) $1,588 $1,588 2.3×
Cerebrospinal Fluid Scan (78630) $1,588 $1,588 2.3×
Chest 1 view (71045) $186 $186 1.7×
Chest 2 views (71046) $186 $186 1.7×
Chest 3 views (71047) $328 $328 3.0×
Chest 4 or more views (71048) $354 $354 2.7×
Cholecystography Oral Contrast (74290) $304 $304 1.4×
Clavicle complete (73000) $181 $181 1.7×
Computed Tomography Thorax Lw Dose Lng Ca Scr C- (71271) $465 $465 3.6×
Continuing medical physics consltj pr wk (77336) $580 $580 3.5×
Contrast Exam Abdominl Aorta (75625) $6,956 $6,956 1.8×
Contrast X-Ray Bladder (74430) $767 $767 1.8×
Contrast X-Ray Of Elbow (73085) $465 $465 1.1×
Contrast X-Ray Of Knee Joint (73580) $597 $597 1.4×
CT abdomen and pelvis without and with contrast (74178) $2,266 $2,266 5.2×
CT abdomen and pelvis without contrast (74176) $1,788 $1,788 6.0×
CT abdomen w contrast (74160) $1,098 $1,098 5.0×
CT abdomen w wo contrast (74170) $1,264 $1,264 5.8×
CT abdomen w/o contrast (74150) $1,053 $1,053 8.1×
CT Angio Abdomen and Pelvis (74174) $1,162 $1,162 2.7×
CT Angio Chest (71275) $2,077 $2,077 9.5×
CT Angio Head (70496) $1,484 $1,484 6.8×
CT angio hrt w/3d image (75574) $765 $765 1.8×
Ct Angio Lwr Extr W/O&W/Dye (73706) $1,559 $1,559 7.1×
CT Angio Neck (70498) $1,484 $1,484 6.8×
Ct Angio Upr Extrm W/O&W/Dye (73206) $1,559 $1,559 7.1×
CT cervical spine w/ contrast (72126) $1,257 $1,257 2.9×
CT cervical spine w/o contrast (72125) $1,120 $1,120 8.6×
CT cervical spine w/wo cont (72127) $1,648 $1,648 7.5×
CT chest w contrast (71260) $1,445 $1,445 6.6×
CT chest w/wo contrast (71270) $1,648 $1,648 7.5×
CT colonography screening (74263) $2,465 $2,465 8.3×
CT colonogrphy dx image postprocess w/o contrast (74261) $1,713 $1,713 13.1×
CT head/brain with contrast (70460) $982 $982 4.5×
CT head/brain without and with contrast (70470) $1,484 $1,484 6.8×
CT heart contrast eval cardiac structure&morph (75572) $765 $765 1.8×
CT heart no contrast quant eval coronry calcium (75571) $465 $465 4.3×
CT hrt w/3d image congen (75573) $652 $652 1.5×
CT iac w contrast (70481) $960 $960 4.4×
CT l-spine w&w/o contrast (72133) $1,648 $1,648 7.5×
CT lower ext w/o (73700) $896 $896 6.9×
CT lower extremity w/contrast material (73701) $1,098 $1,098 5.0×
CT lumbar spine w contrast (72132) $1,445 $1,445 3.3×
CT lumbar spine w/o contrast (72131) $1,120 $1,120 8.6×
CT maxillofacial w contrast (70487) $1,530 $1,530 7.0×
CT maxillofacial wo contrast (70486) $728 $728 5.6×
CT neck tissue combo (70492) $1,291 $1,291 5.9×
Ct Orbit/Ear/Fossa W/O&W/Dye (70482) $1,250 $1,250 5.7×
CT orbits w/o contrast (70480) $906 $906 6.9×
CT pelvis w&w/o contrast (72194) $1,003 $1,003 4.6×
CT pelvis w/o contrast (72192) $735 $735 5.6×
CT scan of leg combo (73702) $1,344 $1,344 6.1×
CT scans face/jaw combo (70488) $1,756 $1,756 8.0×
CT soft tissue neck w contrast (70491) $1,113 $1,113 5.1×
CT soft tissue neck w/o contrast (70490) $377 $377 2.9×
CT thoracic spine w contrast (72129) $1,257 $1,257 5.7×
CT thoracic spine w/o contrast (72128) $1,120 $1,120 8.6×
CT thoracic spine w/wo cont (72130) $1,648 $1,648 7.5×
CT thorax w/o contrast (71250) $1,053 $1,053 8.1×
CT upper ext wo (73200)
range across 3 matching MRF lines		 $896–$1,344 $896–$1,344 varies
CT upper extremity w/o & w/contrast material (73202) $1,103 $1,103 5.0×
CT upper extremity with contrast (73201) $1,035 $1,035 2.4×
Cta Abdl Aorta&Bi Iliofem W/Contrast&Postp (75635) $1,783 $1,783 8.1×
Cta Abdomen (74175) $1,783 $1,783 8.1×
CTA pelvis (72191) $1,783 $1,783 8.1×
Dilation ureters/urethra rs&i (74485) $3,587 $3,587 1.4×
Discography Cerv/Thor Spine (72285) $498 $498 0.2×
Diskography lumbar (72295) $7,611 $7,611 3.1×
Doppler Echo Fetal Spectral Display Complete (76827) $292 $292 2.2×
Dxa Bone Density Axial (77080) $343 $343 2.6×
Dxa bone density study (77085) $398 $398 3.0×
Dxa bone density study 1/>sites appendiclr skel (77081) $153 $153 1.4×
Echo exam of fetal heart (76825) $747 $747 1.1×
Echo exam uterus (76831) $692 $692 2.3×
Echo Guide For Artery Repair (76936) $391 $391 1.5×
Echocardiography, fetal, cardiovascular system, real time with image documentation (2D), with or without M-mode… (76826) $747 $747 2.5×
Echograp Trans R Pros Study (76873) $533 $533 4.1×
Esophageal Motility Study (78258) $992 $992 2.0×
Esophagram (74220) $346 $346 1.6×
Fetal Biophys Profile W/Nst (76818) $401 $401 3.1×
Fetal Biophysical Profile W/O Non-Stress Testing (76819) $401 $401 3.1×
Fetal MRI w/placntl matrnl plvc img sing/1st ges (74712) $815 $815 2.7×
Fluoroscopy up to 1 hr (76000) $467 $467 1.6×
Follow-Up Angiography (75898) $2,462 $2,462 0.6×
Foot 2 views (73620) $179 $179 1.6×
Forearm 2 views (73090) $181 $181 1.7×
Gastric emptying imaging study (78264) $964 $964 1.9×
Gastric Emptyng Imag Std W/Sm Bwl Transit (78265) $991 $991 2.0×
Gastroesophageal Reflux Exam (78262) $964 $964 1.9×
Gated Heart Planar Single (78472) $1,045 $1,045 2.1×
Gated Heart, Multiple (78473) $1,141 $1,141 2.3×
Gstrc Emptng Imag Std W/Sm Bwl Col Trnst Mlt Day (78266) $1,314 $1,314 1.9×
Hand 2 views (73120)
range across 5 matching MRF lines		 $298–$447 $298–$447 varies
Heart first pass single,planar (78481) $1,045 $1,045 1.5×
Hepatobil Syst Image W/Drug (78227) $1,110 $1,110 1.6×
Hepatobiliary System Imaging (78226) $1,110 $1,110 2.2×
Ht Muscle Image Spect Sing (78451) $3,434 $3,434 2.1×
Hysterosalpingogram (74740) $947 $947 3.2×
Image fusion (77399)
range across 2 matching MRF lines		 $105–$342 $105–$342 varies
Infant hip ultrasound with hip movement (dynamic) (76885) $725 $725 6.7×
Infant hip ultrasound, limited static exam (76886) $458 $458 4.2×
Infusion Ivp (74410) $767 $767 3.5×
Interstitial radiation source applic complex (77778) $2,607 $2,607 3.0×
Intracavitary Radiation Source Applic Complex (77763) $1,076 $1,076 1.2×
Intracavitary Radiation Source Applic Intermed (77762) $1,076 $1,076 1.6×
Intracavitary radiation source applic simple (77761) $1,025 $1,025 1.5×
Joint Survey Single View (77077) $380 $380 2.9×
K Flow/Funct Image Multiple (78709) $1,339 $1,339 2.0×
K Flow/Funct Image W/Drug (78708) $1,264 $1,264 1.9×
K Flow/Funct Image W/O Drug (78707) $1,242 $1,242 1.8×
Kidney Imaging Morphol (78700) $1,242 $1,242 2.5×
Kidney Imaging Morphoogy W/Vascular Flow (78701) $1,242 $1,242 2.5×
Knee 3 Views (73562)
range across 5 matching MRF lines		 $157–$236 $157–$236 varies
Leveen/Shunt Patency Exam (78291) $964 $964 1.9×
Liver & Spleen Imaging Static Only (78215) $1,110 $1,110 2.2×
Liver & Spleen Imaging W/Vascular Flow (78216) $1,315 $1,315 2.6×
Liver imaging static only (78201) $1,110 $1,110 1.6×
Lung Perf&Ventilat Diferentl (78598) $1,283 $1,283 1.9×
Lung perfusion differential (78597) $911 $911 1.8×
Lung Ventilat&Perfus Imaging (78582) $1,283 $1,283 1.9×
Lung Ventilation Imaging (78579) $911 $911 1.8×
Lymph System Imaging (78195) $1,031 $1,031 1.5×
Magnetic Image Jaw Joint (70336) $1,390 $1,390 4.7×
Mammary ductogram or galactogram multiple (77054) $456 $456 1.5×
Mammary ductogram or galactogram single (77053) $412 $412 1.4×
Meckels Divert Exam (78290) $964 $964 1.9×
Mlc imrt design & construction per imrt plan (77338) $893 $893 1.9×
Mra Head W/O & W/Contrast Material (70546) $1,833 $1,833 4.2×
MRA head w/o contrast (70544) $1,599 $1,599 5.4×
MRA head with contrast (70545) $1,669 $1,669 3.8×
MRA neck w contrast (70548) $1,718 $1,718 3.9×
Mra Neck W/O &W/Contrast Material (70549) $1,919 $1,919 4.4×
MRA neck w/o contrast (70547) $1,517 $1,517 5.1×
MRI abdomen w contrast (74182) $1,270 $1,270 2.9×
MRI abdomen w/o contrast (74181) $878 $878 2.9×
MRI any jt lower extrem w/contrast material (73722) $1,799 $1,799 1.8×
MRI any jt lower extrem w/o & w/contrast matrl (73723) $1,895 $1,895 4.4×
MRI any jt upper extremity w/contrast matrl (73222) $1,625 $1,625 1.7×
MRI bone marrow blood supply (77084) $1,225 $1,225 4.1×
MRI Breast W/O Contrast Bilateral (77047) $687 $687 2.3×
MRI Breast Without Contrast Material Unilateral (77046) $687 $687 2.3×
MRI cardiac w/o contrast (75557) $1,413 $1,413 4.7×
MRI cervical spine w contrast (72142) $1,799 $1,799 4.1×
MRI cervical spine w/o cont (72141) $1,599 $1,599 5.4×
MRI chest w/o contrast (71550) $1,390 $1,390 4.7×
MRI chest with contrast (71551) $1,517 $1,517 1.6×
MRI chest wo w contrast (71552) $1,906 $1,906 4.4×
MRI lower extrem oth/thn jt w/contrast matrl (73719) $1,517 $1,517 3.5×
MRI lower extrem oth/thn jt w/o & w/contr matr (73720) $1,599 $1,599 3.7×
MRI lower extrem oth/thn jt w/o contr matrl (73718) $1,390 $1,390 4.7×
MRI lumbar spine w contrast (72149) $1,850 $1,850 4.2×
Mri Neck Spine W/O & W/Dye (72156) $2,441 $2,441 5.6×
MRI orbit face &/neck w/o contrast (70540) $1,390 $1,390 4.7×
MRI orbit face neck w contrast (70542) $1,468 $1,468 3.4×
Mri Orbt/Fac/Nck W/O &W/Dye (70543) $1,919 $1,919 4.4×
MRI pelvis w contrast (72196) $1,599 $1,599 3.7×
MRI pelvis w/o & w contrast (72197) $1,965 $1,965 4.5×
MRI pelvis w/o contrast (72195) $1,390 $1,390 4.7×
MRI thoracic spine w/o contrast (72146) $1,390 $1,390 4.7×
MRI upper extremity oth than jt w/contr matrl (73219) $1,517 $1,517 3.5×
MRI upper extremity oth than jt w/o contr matrl (73218) $1,390 $1,390 4.7×
Mri Uppr Extremity W/O&W/Dye (73220) $1,599 $1,599 3.7×
MRI, abdomen, combo (74183) $1,468 $1,468 3.4×
MRI, dorsal spine combo (72157) $2,441 $2,441 5.6×
MRI, dorsal spine contrast (72147) $1,850 $1,850 4.2×
MRI, joint upper extrem (73221) $1,599 $1,599 5.4×
MRI, joint upper extrem combo (73223) $1,669 $1,669 3.8×
MRI, lumbar spine combo (72158) $2,352 $2,352 5.4×
Myelogram cervical (72240) $1,779 $1,779 1.8×
Myelogram Lumbar (72265) $1,779 $1,779 1.8×
Myelography thoracic (72255) $1,779 $1,779 1.8×
Myelograpy 2/more regions rs&i (72270) $1,779 $1,779 1.8×
Myocardial Imaging Infarct Avid Planar Qual/Quan (78466) $1,141 $1,141 2.3×
Myocardial Imaging Pet Metabolic Evaluation (78459) $3,902 $3,902 2.4×
Myocardial Spect Multiple Studies (78452) $3,434 $3,434 2.1×
Myocrd Img Pet Prfuj Mlt Std Rst&Strs Cncrnt CT (78431) $7,444 $7,444 2.7×
Myocrd Img Pet Prfuj W/Metab 2rtracer Cncrnt CT (78433) $9,098 $9,098 3.3×
Myocrd Img Pet Prfuj W/Metab Dual Radiotracer (78432) $9,098 $9,098 4.8×
N-invas est c ffr sw aly CTA (75580) $3,052 $3,052 2.8×
Neck soft tissue (70360) $171 $171 1.6×
Nm myocard infarct spect (78469) $1,348 $1,348 2.0×
Nonvascular Shunt X-Ray (75809) $271 $271 2.1×
Ntsty modul radthx pln dose-vol histos (77301) $3,086 $3,086 1.8×
Nuclear medicine study of endocrine organs (78099) $331 $331 0.7×
Nuclear Rx Oral Admin (79005) $762 $762 2.6×
Ob us nuchal meas 1 gest (76813) $401 $401 3.1×
Ophthalmic ultrasound dx b-scan w/wo a-scan (76512) $368 $368 2.8×
Optic foramina (70190) $178 $178 1.6×
Parathyroid imaging w/tomographic spect & CT (78072) $2,199 $2,199 3.2×
Parathyroid Planar Imaging (78070) $855 $855 1.7×
Parathyroid planar imaging w/wo subtraction (78071) $2,199 $2,199 4.4×
Pelvis 1 or 2 views (72170) $376 $376 2.9×
Pet Image W/Ct Lmtd (78814) $3,830 $3,830 2.1×
PET image w/CT, full body (78816) $3,830 $3,830 2.1×
PET imaging CT attenuation skull base mid-thigh (78815) $3,830 $3,830 2.1×
Pet Imaging Limited Area Chest Head/Neck (78811) $3,758 $3,758 2.3×
PET whole body (78813) $3,902 $3,902 2.2×
Plasma Vol Radiopharm Vol Dilute Spx Mult Smples (78111) $455 $455 0.3×
Plasma volume, radiopharmaceutical volume-dilution technique (separate procedure); single sampling Non-Facility (78110) $217 $217 0.1×
Pulmonary Perfusion Imaging Particulate (78580) $911 $911 1.8×
Radex Abd Compl Aqt Abd W/S/E/D Views 1 View Ch (74022) $375 $375 2.9×
Radex abscess/fistula/sinus tract rs&i (76080) $1,048 $1,048 1.5×
Radex Ankle Complete Minimum 3 Views (73610)
range across 6 matching MRF lines		 $231–$350 $231–$350 varies
Radex Calcaneus Minimum 2 Views (73650) $181 $181 1.7×
Radex elbow complete minimum 3 views (73080) $308 $308 2.8×
Radex Facial Bones Complete Minimum 3 Views (70150) $271 $271 2.1×
Radex fingr minimum 2 views (73140) $154 $154 1.4×
Radex foot complete minimum 3 views (73630)
range across 5 matching MRF lines		 $177–$266 $177–$266 varies
Radex Hand Minimum 3 Views (73130)
range across 5 matching MRF lines		 $310–$465 $310–$465 varies
Radex lower extremity infant minimum 2 views (73592) $171 $171 1.6×
Radex Mastoids Compl Minimum 3 Views PR Side (70130) $207 $207 1.6×
Radex Nasal Bones Complete Minimum 3 Views (70160) $171 $171 1.6×
Radex Pharynx/Larx W/Fluor&/Magnification Tq (70370) $467 $467 4.3×
Radex Ribs Unilateral 2 Views (71100) $191 $191 1.8×
Radex shoulder complete minimum 2 views (73030)
range across 5 matching MRF lines		 $163–$244 $163–$244 varies
Radex Sinuses Paransl < 3 Views (70210) $171 $171 1.6×
Radex sm int w/mlt srl imges via enteroclss tube (74251) $411 $411 1.9×
Radex Spine 1 View Specify Level (72020) $152 $152 1.4×
Radex Sternum Minimum 2 Views (71120) $171 $171 1.6×
Radex Temporomandble Jt Opn & Clsd Mouth Bilat (70330) $192 $192 1.8×
Radex Toe Minimum 2 Views (73660) $154 $154 1.4×
Radex upper extremity infant minimum 2 views (73092) $78 $78 0.6×
Radex Wrist Complete Minimum 3 Views (73110)
range across 5 matching MRF lines		 $280–$350 $280–$350 varies
Radex X-Ray Exam Entire Spi 6/> Vw - Xr Entire Spine 6+ Vw (72084) $572 $572 4.4×
Radiation treatment delivery level 1 (77402) $270 $270 2.1×
Radiation treatment delivery level 2 (77407) $282 $282 0.6×
Radiation treatment delivery level 3 (77412) $522 $522 0.8×
Radiolog exam mandible compl minimum 4 views (70110) $271 $271 2.1×
Radiologic Exam Abdomen 3+ Views - Xr Abdomen 3+ Views (74021) $354 $354 2.7×
Radiologic exam colon double contrast study (74280) $451 $451 2.1×
Radiologic exam colon single contrast study (74270) $414 $414 1.9×
Radiologic exam knee complete 4/more views (73564)
range across 5 matching MRF lines		 $321–$482 $321–$482 varies
Radiologic exam pelvis compl minimum 3 views (72190) $392 $392 3.0×
Radiologic Exam Small Int Single Contrast Study (74250) $304 $304 1.4×
Radiologic exam swallow function contrast study (74230) $304 $304 1.4×
Radiologic exam upr gi trc double contrast study (74246) $621 $621 2.8×
Radiologic examination femur 1 view (73551) $181 $181 1.7×
Radiologic examination femur minimum 2 views (73552)
range across 5 matching MRF lines		 $181–$272 $181–$272 varies
Radiologic examination knee 1/2 views (73560)
range across 5 matching MRF lines		 $153–$229 $153–$229 varies
Radiologic Examination Osseous Survey Limited (77074) $380 $380 2.9×
Radiologic Examination Salivary Gland Calculus (70380) $110 $110 1.0×
Radiologic examination tibia & fibula 2 views (73590) $162 $162 1.5×
Radiologic examination, internal auditory meati, complete Non-Facility (70134) $171 $171 0.3×
Red Cell Volume Determination Spx 1 Sampling (78120) $341 $341 0.7×
Red Cell Volume Determination Spx Mult Samplings (78121) $455 $455 0.7×
Ribs bilateral 3 views (71110) $262 $262 2.0×
Rp loclzj tum plnr 1 area single day imaging (78800) $1,140 $1,140 2.3×
Rp loclzj tum plnr 2+area 1+d img/1 area img>2+d (78801) $1,140 $1,140 2.3×
Rp Loclzj Tum Plnr Whole Body 2+ Days Imaging (78804) $3,446 $3,446 5.1×
Rp Loclzj Tum Plnr Whole Body Single Day Imaging (78802) $1,956 $1,956 2.9×
Rp Loclzj Tum Spect 1 Area Single Day Imaging (78803) $4,549 $4,549 6.7×
Rp loclzj tum spect 2 area/sep acquisj img (78831) $4,549 $4,549 2.8×
Rp loclzj tum spect w/CT 1 area/acquisj 1day img (78830) $4,549 $4,549 2.8×
Rp Ther Radiolbld Monoclonal Antibody IV Infus (79403) $1,687 $1,687 5.8×
Rp Therapy Intravenous Administration (79101) $956 $956 3.3×
Salivary Gland Imaging (78230) $450 $450 0.9×
Salivary Gland Imaging Serial Images (78231) $964 $964 1.9×
Scapula (73010) $146 $146 1.1×
Screening Digital Breast Tomosynthesis Bi (77063) $145 $145 6.2×
Sella turcica (70240) $171 $171 1.6×
Shoulder 1 view (73020) $85 $85 0.8×
Shoulder Arthrography (73040) $691 $691 1.6×
Sialogram (70390) $602 $602 2.0×
Skull less than 4 views (70250) $198 $198 1.5×
Special dosimetry (77331) $325 $325 1.9×
Special Physics Consult (77370) $308 $308 1.8×
Special teletherapy port plan (77321) $927 $927 2.0×
Special treatment procedure (77470) $1,240 $1,240 1.8×
Speech evaluation, complex (70371) $467 $467 1.6×
Sternoclavicular joints (71130) $171 $171 1.6×
Telethx isodose pln cplx w/basic dosimetry (77307) $664 $664 1.4×
Telethx isodose pln smpl w/dosimetry calculation (77306) $337 $337 0.7×
Testicular Imaging W/Flow (78761) $1,242 $1,242 2.5×
Ther Rad Simulaj-Aided Field Setting Complex (77290) $927 $927 2.0×
Ther Rad Simulaj-Aided Field Setting Intermed (77285) $927 $927 2.0×
Ther rad simulaj-aided field setting simple (77280) $395 $395 2.4×
Therapeutic Enema Rdctj Intussusception/Obstrcj (74283) $423 $423 1.9×
Thoracic spine 2 views (72070) $200 $200 1.5×
Thoracic spine 3 views (72072) $304 $304 2.3×
Thoracolumbar 2 views (72080) $171 $171 1.6×
Thyroid Carcinoma Metastases Img Lmtd Area (78015) $1,140 $1,140 2.3×
Thyroid Imaging With Vascular Flow (78013) $447 $447 0.9×
Thyroid Met Imaging Body (78018) $2,653 $2,653 3.9×
Thyroid Uptake Measurement (78012) $662 $662 1.3×
Thyroid Uptake W/Blood Flow Sngle/Mult Quan Meas (78014) $741 $741 1.5×
Tx Devices Design & Construction Complex (77334) $664 $664 1.4×
Tx devices design & construction intermediate (77333) $636 $636 3.8×
Tx devices design & construction simple (77332) $636 $636 3.8×
Ultrasound Breast Limited (76642)
range across 3 matching MRF lines		 $273–$410 $273–$410 varies
Ultrasound Exam Aaa Screen (76706) $376 $376 2.9×
Ultrasound, abdomen limited (76705) $328 $328 2.5×
Umbilical-artery Doppler (OB) (76820) $268 $268 2.1×
Unlisted Dx Radiographic Procedure (76499)
range across 7 matching MRF lines		 $23–$279 $23–$279 varies
Unlisted Miscellaneous Px Dx Nuclear Medicine (78999) $418 $418 0.8×
Unlisted us procedure (76999) $269 $269 2.5×
Upper gi w/o kub (74240) $575 $575 2.6×
Ureteral Reflux Study (78740) $1,242 $1,242 2.5×
Urethrocystogram voiding (74455) $767 $767 2.6×
Urethrocystography retrograde (74450) $767 $767 2.6×
Us breast unilateral complete (76641)
range across 3 matching MRF lines		 $319–$479 $319–$479 varies
Us chest (76604) $464 $464 3.6×
Us complete joint (76881) $402 $402 3.1×
Us exam, pelvic, limited (76857) $243 $243 1.9×
Us head (76506) $401 $401 3.1×
Us kidney transplant (76776) $401 $401 3.1×
Us lmtd joint/oth nonvasc xtr strux r-t w/img (76882) $273 $273 2.1×
Us ob detailed single fetus (76811) $677 $677 2.3×
Us ob limited 1 or more fetuses (76815) $401 $401 3.1×
Us ob transvaginal (76817) $364 $364 2.8×
Us pelvic non ob complete (76856) $363 $363 2.8×
Us pg uter img f&mat 14 wk tabdl 1/1st gestation (76801) $506 $506 3.9×
Us preg uterus real time f/u trnsabdl per fetus (76816) $300 $300 2.3×
Us retroperitoneal complete (76770) $401 $401 3.1×
Us retroperitoneal limited (76775) $363 $363 2.8×
Us scrotum and contents (76870) $401 $401 3.1×
Us spinal canal and contents (76800) $256 $256 2.0×
Us thyroid (76536) $401 $401 3.1×
Us transrectal (76872) $179 $179 1.4×
Vascular Flow Imaging (78445) $947 $947 1.9×
Vein X-Ray Chest (75827) $2,462 $2,462 1.3×
Vein X-Ray Liver W/O Hemodyn (75887) $10,223 $10,223 2.6×
Venogram Sinus/Jugular (75860) $2,462 $2,462 0.6×
Venography caval inferior serialography rs&i (75825) $7,670 $7,670 1.9×
Venography extremity bilateral rs&i (75822) $2,199 $2,199 1.1×
Venography extremity unilateral rs&i (75820) $1,898 $1,898 1.0×
Venography Renal Bilateral (75833) $7,670 $7,670 1.9×
Venography Renal Unilateral (75831) $6,608 $6,608 1.7×
Venous sampling by catheter (75893) $6,608 $6,608 1.0×
Venous thrombosis imaging (78457) $706 $706 1.0×
Venous Thrombosis Imaging Venogram Bilateral (78458) $706 $706 1.4×
Wrist 2 views (73100)
range across 5 matching MRF lines		 $261–$326 $261–$326 varies
X-Ray Ac Jts - Xr Acromioclavicular Joints Bilateral (73050) $171 $171 1.6×
X-ray antegrade pyelogram tube (74425) $180 $180 0.4×
X-Ray Aorta Leg Arteries (75630) $6,956 $6,956 1.8×
X-Ray Bend Only L-S Spine (72120) $271 $271 2.1×
X-Ray Elbow 2 Vw - Xr Elbow 1-2 Views Right (73070) $203 $203 1.9×
X-Ray Exam Breast Specimen (76098) $681 $681 1.0×
X-Ray Exam Entire Spi 1 Vw (72081) $181 $181 1.7×
X-Ray Exam Entire Spi 2/3 Vw (72082) $300 $300 2.3×
X-Ray Exam Entire Spi 4/5 Vw (72083) $572 $572 4.4×
X-Ray Exam Hip Uni 1 View (73501) $181 $181 1.7×
X-Ray Exam Hip Uni 2-3 Views (73502) $181 $181 1.7×
X-Ray Exam Hip Uni 4/> Views (73503) $300 $300 2.3×
X-Ray Exam Hips Bi 2 Views (73521) $300 $300 2.3×
X-Ray Exam Hips Bi 3-4 Views (73522) $300 $300 2.3×
X-Ray Exam Hips Bi 5/> Views (73523) $572 $572 4.4×
X-Ray Exam L-S Spine Bending (72114) $500 $500 3.8×
X-Ray Exam Neck Spine 2-3 Vw (72040) $271 $271 2.5×
X-Ray Exam Neck Spine 6/>Vws (72052) $293 $293 2.2×
X-Ray Exam Unilat Ribs/Chest (71101) $206 $206 1.6×
X-ray eye for foreign body (70030) $171 $171 1.6×
X-ray head for orthodontia (70350) $171 $171 1.6×
X-ray humerus (73060)
range across 4 matching MRF lines		 $154–$163 $154–$163 varies
X-ray IV pyelogram (ivp) (74400) $767 $767 3.5×
X-ray IV pyelogram+tomography (74415) $767 $767 3.5×
X-Ray Jaw <4 Vw - Xr Mandible < 4 Views (70100) $171 $171 1.6×
X-Ray Knee Bilat Standing - Xr Knees Anteroposterior Standing Bilat (73565) $171 $171 1.6×
X-Ray Lumbar Spine 2/3 Vw - Xr Lumbar Spine 2-3 Views (72100) $300 $300 2.3×
X-ray nose-rectum child f.b. (76010) $171 $171 1.6×
X-Ray Ribs, Chest 4+ Vw - Xr Ribs 3 Vws Bil W/ Chest Posteroanterior (71111) $271 $271 2.1×
X-Ray Sacroiliac Jts 3+ Vw - Xr Sacroiliac Joints 3+ Views (72202) $218 $218 1.7×
X-Ray Sacroiliac Jts <3 Vw - Xr Sacroiliac Joints 1-2 Views (72200) $198 $198 1.5×
X-Ray Sacrum/Coccyx 2+ Vw - Xr Sacrum Coccyx 2+ Views (72220) $162 $162 1.5×
X-Ray Sinuses 3+ Vw - Xr Paranasal Sinuses 3+ Views (70220) $191 $191 1.8×
X-Ray Skull 4+ Vw - Xr Skull Complete 4+ Views (70260)
range across 3 matching MRF lines		 $47–$304 $47–$304 varies
X-Ray Stress View (77071) $171 $171 1.6×
X-ray thoracic spine 4 vw (72074) $364 $364 2.8×
X-Ray Tmj Unilat (70328) $145 $145 1.3×
X-Ray Urinary Tract Exam With Contrast Material (74420)
range across 3 matching MRF lines		 $1,047–$1,571 $1,047–$1,571 varies
X-Rays Bone Length Studies (77073) $171 $171 1.3×
X-Rays Bone Survey Complete (77075) $506 $506 3.9×
Xr c-spine 4 or 5 views (72050) $283 $283 2.2×
Xr facial bones less than 3 views (70140) $171 $171 1.6×
XR Mastoids < 3 Views Bilateral (70120) $171 $171 1.3×
Xr orbits complete 4 views (70200) $192 $192 1.5×
Xr Tomogram Single Plane (76100) $271 $271 2.1×

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.