Imaging prices at Carle Bromenn Medical Center

Normal, IL · every code in this section with a posted price and a Medicare benchmark.

454 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) $7,607 $7,607 5.1×
Abdomen 1 View (74018) $340 $340 3.6×
Abdomen 2 views (74019) $405 $405 3.6×
Acute Gastrointestinal Blood Loss Imaging (78278) $740 $740 1.7×
Angio internal mammary (75756) $9,443 $9,443 2.8×
Angio pulmonary bilat (75743) $4,542 $4,542 1.3×
Angiography Adrenal Bilateral Slctv Rs&I (75733) $3,232 $3,232 1.0×
Angiography extremity bilateral rs&i (75716) $4,115 $4,115 1.2×
Angiography extremity unilateral rs&i (75710) $9,443 $9,443 2.8×
Angiography pulmonary unilateral slctv rs&i (75741) $9,443 $9,443 2.8×
Angrph pulmonary nonslctv cath/ven njx rs&i (75746) $9,443 $9,443 2.8×
Ankle 2 views (73600) $412 $412 4.4×
Aortography thoracic serialography rs&i (75605) $16,217 $16,217 2.7×
Artery X-Rays Abdomen (75726) $16,217 $16,217 2.7×
Artery X-Rays Adrenal Gland (75731) $3,519 $3,519 1.0×
Artery X-Rays Pelvis (75736) $9,122 $9,122 1.5×
Artery X-Rays Spine (75705) $16,217 $16,217 2.7×
Arthrogram ankle (73615) $2,182 $2,182 5.8×
Arthrogram hip (73525) $2,052 $2,052 5.5×
Arthrogram Wrist (73115) $2,182 $2,182 5.8×
Basic radiation dosimetry calculation (77300) $823 $823 5.7×
Bone age studies (77072) $632 $632 5.6×
Bone Imaging 3 Phase (78315) $2,266 $2,266 5.3×
Bone Imaging Limited Area (78300) $1,883 $1,883 4.4×
Bone Imaging Multiple Areas (78305) $1,717 $1,717 4.0×
Bone Imaging Whole Body (78306) $2,111 $2,111 4.9×
Bone marrow imaging limited area (78102) $859 $859 2.0×
Bone marrow imaging; whole body (78104) $1,204 $1,204 2.8×
Bone survey infant (77076) $608 $608 5.4×
Brachytx isodose complex (77318) $2,099 $2,099 5.2×
Brachytx isodose intermed (77317) $1,062 $1,062 2.6×
Brachytx Isodose Plan Simple (77316) $872 $872 2.2×
Brain Flow Imaging Only (78610) $1,240 $1,240 2.1×
Brain Image W/Flow < 4 Views (78601) $1,049 $1,049 2.4×
Brain Imaging Minimum 4 Static Views (78605) $1,097 $1,097 1.9×
Brain Imaging Pet Metabolic Evaluation (78608) $8,132 $8,132 5.3×
Card Bl Pool Gated Spect Rest Wal Motn Ejct Frct (78494) $1,168 $1,168 2.7×
Cardiac MRI w/w/o contrast & further seq (75561) $2,301 $2,301 6.2×
Cardiac MRI w/w/o contrast w/stress (75563) $2,349 $2,349 2.8×
Cat Scan Follow-Up Study (76380) $1,670 $1,670 17.9×
Cerebrospinal Fluid Flow W/O Matl Shunt Evaltj (78645) $859 $859 1.5×
Cerebrospinal Fluid Scan (78630) $1,919 $1,919 3.3×
Chest 1 view (71045) $340 $340 3.6×
Chest 2 views (71046) $340 $340 3.6×
Chest 3 views (71047) $375 $375 4.0×
Chest 4 or more views (71048) $412 $412 3.7×
Cholecystography Oral Contrast (74290) $554 $554 2.9×
Cineradiograpy/vidradiograpy xcpt where spec (76120) $656 $656 5.9×
Cisternography Positive Contrast Rs&I (70015) $3,983 $3,983 4.7×
Clavicle complete (73000) $412 $412 4.4×
Computed Tomography Thorax Lw Dose Lng Ca Scr C- (71271) $668 $668 6.0×
Continuing medical physics consltj pr wk (77336) $776 $776 5.4×
Contrast Exam Abdominl Aorta (75625) $8,705 $8,705 2.6×
Contrast X-Ray Bladder (74430) $1,419 $1,419 3.8×
Contrast X-Ray Of Elbow (73085) $2,028 $2,028 5.4×
Contrast X-Ray Of Knee Joint (73580) $2,290 $2,290 6.1×
CT abdomen and pelvis without and with contrast (74178) $7,202 $7,202 19.3×
CT abdomen and pelvis without contrast (74176) $5,390 $5,390 21.1×
CT abdomen w contrast (74160) $4,328 $4,328 23.0×
CT abdomen w wo contrast (74170) $4,769 $4,769 25.4×
CT abdomen w/o contrast (74150)
range across 2 matching MRF lines		 $1,384–$3,602 $1,384–$3,602 varies
CT Angio Abdomen and Pelvis (74174) $4,519 $4,519 12.1×
CT Angio Chest (71275) $4,388 $4,388 23.3×
CT Angio Head (70496) $3,232 $3,232 17.2×
CT angio hrt w/3d image (75574) $1,597 $1,597 4.3×
Ct Angio Lwr Extr W/O&W/Dye (73706) $3,363 $3,363 17.9×
CT Angio Neck (70498) $4,328 $4,328 23.0×
Ct Angio Upr Extrm W/O&W/Dye (73206) $4,043 $4,043 21.5×
CT cervical spine w/ contrast (72126) $4,317 $4,317 11.5×
CT cervical spine w/o contrast (72125) $3,827 $3,827 34.2×
CT cervical spine w/wo cont (72127) $5,855 $5,855 31.2×
CT chest w contrast (71260) $4,317 $4,317 23.0×
CT chest w/wo contrast (71270) $4,865 $4,865 25.9×
CT colonography screening (74263) $1,778 $1,778 7.0×
CT Colonogrphy Dx Image Postprocess W/Contrast (74262) $1,788 $1,788 9.5×
CT colonogrphy dx image postprocess w/o contrast (74261) $1,384 $1,384 12.4×
CT head/brain with contrast (70460) $3,077 $3,077 16.4×
CT head/brain without and with contrast (70470) $3,542 $3,542 18.8×
CT heart contrast eval cardiac structure&morph (75572) $1,597 $1,597 4.3×
CT heart no contrast quant eval coronry calcium (75571) $644 $644 6.9×
CT hrt w/3d image congen (75573) $1,323 $1,323 3.5×
CT iac w contrast (70481) $3,028 $3,028 16.1×
CT l-spine w&w/o contrast (72133) $4,806 $4,806 25.6×
CT lower ext w/o (73700) $3,052 $3,052 27.2×
CT lower extremity w/contrast material (73701) $2,802 $2,802 14.9×
CT lumbar spine w contrast (72132) $4,507 $4,507 12.1×
CT lumbar spine w/o contrast (72131) $3,232 $3,232 28.8×
CT maxillofacial w contrast (70487) $3,768 $3,768 20.0×
CT maxillofacial wo contrast (70486)
range across 2 matching MRF lines		 $1,384–$3,088 $1,384–$3,088 varies
CT neck tissue combo (70492) $3,827 $3,827 20.4×
Ct Orbit/Ear/Fossa W/O&W/Dye (70482) $3,482 $3,482 18.5×
CT orbits w/o contrast (70480) $3,280 $3,280 29.3×
CT pelvis w&w/o contrast (72194) $3,971 $3,971 21.1×
CT pelvis w/o contrast (72192) $3,589 $3,589 32.0×
CT scan of leg combo (73702) $3,017 $3,017 16.1×
CT scans face/jaw combo (70488) $4,030 $4,030 21.4×
CT soft tissue neck w contrast (70491) $3,816 $3,816 20.3×
CT soft tissue neck w/o contrast (70490) $2,647 $2,647 23.6×
CT thoracic spine w contrast (72129) $3,482 $3,482 18.5×
CT thoracic spine w/o contrast (72128) $3,161 $3,161 28.2×
CT thoracic spine w/wo cont (72130) $3,768 $3,768 20.0×
CT thorax w/o contrast (71250) $3,399 $3,399 30.3×
CT unlisted procedure (76497) $3,172 $3,172 34.0×
CT upper ext wo (73200) $3,529 $3,529 31.5×
CT upper extremity w/o & w/contrast material (73202) $4,304 $4,304 22.9×
CT upper extremity with contrast (73201) $3,172 $3,172 8.5×
Cta Abdl Aorta&Bi Iliofem W/Contrast&Postp (75635) $4,162 $4,162 22.1×
Cta Abdomen (74175) $4,769 $4,769 25.4×
CTA pelvis (72191) $3,756 $3,756 20.0×
Dilation ureters/urethra rs&i (74485) $6,153 $6,153 2.7×
Diskography lumbar (72295) $8,120 $8,120 3.9×
Doppler Echo Fetal Puls Spectral F/U/Repeat (76828) $906 $906 8.1×
Doppler Echo Fetal Spectral Display Complete (76827) $740 $740 6.6×
Doppler Fetal Mid Cerebral Artery (76821) $906 $906 8.1×
Dxa Bone Density Axial (77080) $776 $776 6.9×
Dxa bone density study (77085) $596 $596 5.3×
Dxa bone density study 1/>sites appendiclr skel (77081) $431 $431 4.6×
Echo exam of fetal heart (76825) $1,347 $1,347 2.3×
Echo exam uterus (76831) $1,109 $1,109 4.3×
Echo Guide For Artery Repair (76936) $2,038 $2,038 8.8×
Echocardiography, fetal, cardiovascular system, real time with image documentation (2D), with or without M-mode… (76826) $1,014 $1,014 4.0×
Echograp Trans R Pros Study (76873) $896 $896 8.0×
Esophagram (74220) $776 $776 4.1×
Fetal Biophys Profile W/Nst (76818)
range across 2 matching MRF lines		 $929–$990 $929–$990 varies
Fetal Biophysical Profile W/O Non-Stress Testing (76819) $799 $799 7.1×
Fetal MRI w/placntl matrnl plvc img sing/1st ges (74712) $5,102 $5,102 20.0×
Fluoroscopy up to 1 hr (76000)
range across 3 matching MRF lines		 $715–$978 $715–$978 varies
Follow-Up Angiography (75898) $9,443 $9,443 2.8×
Foot 2 views (73620) $340 $340 3.6×
Forearm 2 views (73090) $412 $412 4.4×
Gastric emptying imaging study (78264) $1,670 $1,670 3.9×
Gastric Emptyng Imag Std W/Sm Bwl Transit (78265) $2,873 $2,873 6.7×
Gastroesophageal Reflux Exam (78262) $1,597 $1,597 3.7×
Gastrointestinal Protein Loss (78282) $1,491 $1,491 3.5×
Gated Heart Planar Single (78472) $1,849 $1,849 4.3×
Gated Heart, Multiple (78473) $2,276 $2,276 5.3×
Gstrc Emptng Imag Std W/Sm Bwl Col Trnst Mlt Day (78266) $4,043 $4,043 6.9×
Hand 2 views (73120) $478 $478 4.3×
Hdr Rdncl Ntrstl/Icav Brchtx (77772) $7,405 $7,405 9.9×
Hdr Rdncl Ntrstl/Icav Brchtx (77771) $3,995 $3,995 5.4×
Hdr Rdncl Ntrstl/Icav Brchtx 1 Channel (77770) $2,445 $2,445 3.3×
Hepatc Vngrph Wdg/Fr Hemodyn Eval Rs&I (75889) $9,443 $9,443 2.8×
Hepatc Vngrph Wdg/Fr W/O Hemodyn Eval Rs&I (75891) $9,443 $9,443 2.8×
Hepatobil Syst Image W/Drug (78227) $2,611 $2,611 4.5×
Hepatobiliary System Imaging (78226) $2,611 $2,611 6.1×
Ht Musc Image Planar Mult (78454) $4,185 $4,185 3.0×
Ht Muscle Image Spect Sing (78451) $2,802 $2,802 2.0×
Hysterosalpingogram (74740) $1,561 $1,561 6.1×
Image fusion (77399) $1,001 $1,001 6.9×
Infant hip ultrasound with hip movement (dynamic) (76885) $579 $579 6.2×
Infant hip ultrasound, limited static exam (76886) $579 $579 6.2×
Interstitial radiation source applic complex (77778) $4,304 $4,304 5.8×
Intracavitary Radiation Source Applic Complex (77763) $2,636 $2,636 3.5×
Intracavitary Radiation Source Applic Intermed (77762) $2,266 $2,266 3.8×
Intracavitary radiation source applic simple (77761) $1,778 $1,778 3.0×
Joint Survey Single View (77077) $632 $632 5.6×
K Flow/Funct Image Multiple (78709) $1,778 $1,778 3.1×
K Flow/Funct Image W/Drug (78708) $1,801 $1,801 3.1×
K Flow/Funct Image W/O Drug (78707) $2,528 $2,528 4.3×
Kidney Imaging Morphol (78700) $1,287 $1,287 3.0×
Knee 3 Views (73562) $382 $382 4.1×
Leveen/Shunt Patency Exam (78291) $1,049 $1,049 2.4×
Liver & Spleen Imaging Static Only (78215) $1,919 $1,919 4.5×
Liver imaging static only (78201) $2,052 $2,052 3.5×
Liver imaging w/vascular flow (78202) $3,519 $3,519 6.0×
Lung Perf&Ventilat Diferentl (78598) $3,768 $3,768 6.5×
Lung perfusion differential (78597) $1,788 $1,788 4.2×
Lung Ventilat&Perfus Imaging (78582) $1,503 $1,503 2.6×
Lymph System Imaging (78195) $1,049 $1,049 1.8×
Lymphangiography Extremity Only Bilateral Rs&I (75803) $4,660 $4,660 2.8×
Lymphangiography extremity only unilateral rs&i (75801) $906 $906 1.3×
Lymphangiography Pelvic/Abdominal Bilateral Rs&I (75807) $9,443 $9,443 2.8×
Lymphangiography, pelvic/abdominal, unilateral (75805) $9,443 $9,443 2.8×
Magnetic Image Jaw Joint (70336) $5,688 $5,688 22.2×
Magnetic Resonance Elastography (76391)
range across 2 matching MRF lines		 $4,519–$5,318 $4,519–$5,318 varies
Mammary ductogram or galactogram multiple (77054) $1,204 $1,204 4.7×
Mammary ductogram or galactogram single (77053) $1,049 $1,049 4.1×
Meckels Divert Exam (78290) $1,835 $1,835 4.3×
Medical physics dose eval radiation expos w/rprt (76145) $727 $727 1.8×
Mlc imrt design & construction per imrt plan (77338) $1,574 $1,574 3.9×
Mra Head W/O & W/Contrast Material (70546) $6,869 $6,869 18.4×
MRA head w/o contrast (70544) $4,197 $4,197 16.4×
MRA head with contrast (70545) $7,905 $7,905 21.1×
MRA neck w contrast (70548) $7,238 $7,238 19.4×
Mra Neck W/O &W/Contrast Material (70549) $6,869 $6,869 18.4×
MRA neck w/o contrast (70547) $4,197 $4,197 16.4×
MRI abdomen w contrast (74182) $6,869 $6,869 18.4×
MRI abdomen w/o contrast (74181) $4,459 $4,459 17.4×
MRI any jt lower extrem w/contrast material (73722) $8,538 $8,538 10.2×
MRI any jt lower extrem w/o & w/contrast matrl (73723) $6,869 $6,869 18.4×
MRI any jt upper extremity w/contrast matrl (73222) $7,429 $7,429 8.8×
MRI brain functional w/o physician admnistration (70554) $3,314 $3,314 13.0×
MRI Breast W/O Contrast Bilateral (77047) $2,135 $2,135 8.3×
MRI Breast Without Contrast Material Unilateral (77046) $2,135 $2,135 8.3×
MRI cardiac w/o cont stress (75559) $1,944 $1,944 3.3×
MRI cardiac w/o contrast (75557) $1,670 $1,670 6.5×
MRI cervical spine w contrast (72142) $7,905 $7,905 21.1×
MRI cervical spine w/o cont (72141) $4,675 $4,675 18.3×
MRI chest w/o contrast (71550) $4,830 $4,830 18.9×
MRI chest with contrast (71551) $5,569 $5,569 6.6×
MRI chest wo w contrast (71552) $7,905 $7,905 21.1×
MRI lower extrem oth/thn jt w/contrast matrl (73719) $7,905 $7,905 21.1×
MRI lower extrem oth/thn jt w/o & w/contr matr (73720) $6,869 $6,869 18.4×
MRI lower extrem oth/thn jt w/o contr matrl (73718) $4,830 $4,830 18.9×
MRI lumbar spine w contrast (72149) $7,905 $7,905 21.1×
Mri Neck Spine W/O & W/Dye (72156) $6,869 $6,869 18.4×
MRI orbit face &/neck w/o contrast (70540) $4,197 $4,197 16.4×
MRI orbit face neck w contrast (70542) $4,816 $4,816 12.9×
Mri Orbt/Fac/Nck W/O &W/Dye (70543) $7,905 $7,905 21.1×
MRI pelvis w contrast (72196) $7,905 $7,905 21.1×
MRI pelvis w/o & w contrast (72197) $7,905 $7,905 21.1×
MRI pelvis w/o contrast (72195) $4,830 $4,830 18.9×
MRI spectroscopy (76390) $4,412 $4,412 47.3×
MRI thoracic spine w/o contrast (72146) $4,401 $4,401 17.2×
MRI upper extremity oth than jt w/contr matrl (73219) $5,593 $5,593 15.0×
MRI upper extremity oth than jt w/o contr matrl (73218) $4,830 $4,830 18.9×
Mri Uppr Extremity W/O&W/Dye (73220) $7,905 $7,905 21.1×
MRI, abdomen, combo (74183) $6,869 $6,869 18.4×
MRI, dorsal spine combo (72157) $6,869 $6,869 18.4×
MRI, dorsal spine contrast (72147) $5,783 $5,783 15.5×
MRI, joint upper extrem (73221) $4,830 $4,830 18.9×
MRI, joint upper extrem combo (73223) $6,869 $6,869 18.4×
MRI, lumbar spine combo (72158) $6,869 $6,869 18.4×
Myelogram cervical (72240) $3,338 $3,338 4.0×
Myelogram Lumbar (72265) $2,540 $2,540 3.0×
Myelography thoracic (72255) $1,597 $1,597 1.9×
Myelograpy 2/more regions rs&i (72270) $2,815 $2,815 3.4×
Myocardial Imaging Infarct Avid Planar Qual/Quan (78466) $1,526 $1,526 3.6×
Myocardial Perfusion Planar 1 Study Rest/Stress (78453) $3,077 $3,077 2.2×
Myocardial Spect Multiple Studies (78452) $4,245 $4,245 3.1×
Myocrd Img Pet Metab Eval Single Study Cncrnt CT (78429) $3,077 $3,077 2.0×
Myocrd img PET prfuj 1std rest/stress cncrnt CT (78430) $3,542 $3,542 2.3×
Myocrd Img Pet Prfuj Mlt Std Rst&Strs Cncrnt CT (78431) $5,520 $5,520 2.3×
Myocrd Img Pet Prfuj W/Metab 2rtracer Cncrnt CT (78433) $6,749 $6,749 2.9×
Myocrd Img Pet Prfuj W/Metab Dual Radiotracer (78432) $6,749 $6,749 4.1×
N-invas est c ffr sw aly CTA (75580) $3,299 $3,299 3.6×
Neck soft tissue (70360) $412 $412 4.4×
Nfs/Instlj Radioelmnt Sln 3 Mo Follow-Up Care (77750) $1,133 $1,133 2.7×
Njx Rp Loclzj Non-Img Probe Study Intravenous (78808) $919 $919 2.1×
Nm myocard infarct spect (78469) $3,111 $3,111 5.3×
Nonvascular Shunt X-Ray (75809) $835 $835 7.5×
Ntsty modul radthx pln dose-vol histos (77301) $7,607 $7,607 5.1×
Nuclear Rx Intra-Arterial (79445) $1,860 $1,860 7.4×
Nuclear Rx Oral Admin (79005) $1,276 $1,276 5.1×
Ob us nuchal meas 1 gest (76813) $953 $953 8.5×
Oph bmtry us echograpy a-scan io lens pwr cal (76519)
range across 2 matching MRF lines		 $507–$811 $507–$811 varies
Oph us dx ant sgm us immersion b-scan/hr biom (76513) $543 $543 4.8×
Ophthalmic ultrasound dx b-scan w/wo a-scan (76512) $394 $394 3.5×
Ophthalmic US Dx Corneal Pachymetry Uni/Bi (76514) $106 $106 3.4×
Optic foramina (70190) $328 $328 3.5×
Panoramic X-ray of jaws (70355) $412 $412 4.4×
Parathyroid imaging w/tomographic spect & CT (78072) $2,135 $2,135 3.7×
Parathyroid Planar Imaging (78070) $1,384 $1,384 3.2×
Parathyroid planar imaging w/wo subtraction (78071) $1,778 $1,778 4.2×
Pelvis 1 or 2 views (72170) $632 $632 5.6×
Perineogram (74775) $543 $543 2.1×
Peritoneogram Rs&I (74190) $859 $859 1.5×
Pet Image W/Ct Lmtd (78814) $8,132 $8,132 5.3×
PET image w/CT, full body (78816) $8,132 $8,132 5.3×
PET imaging CT attenuation skull base mid-thigh (78815) $8,132 $8,132 5.3×
Prq Transhepatc Portograpy Hemodyn Eval Rs&I (75885) $9,443 $9,443 2.8×
Pulmonary Perfusion Imaging Particulate (78580) $2,421 $2,421 5.7×
Radex Abd Compl Aqt Abd W/S/E/D Views 1 View Ch (74022) $632 $632 5.6×
Radex abscess/fistula/sinus tract rs&i (76080) $1,360 $1,360 2.3×
Radex Ankle Complete Minimum 3 Views (73610) $412 $412 4.4×
Radex Calcaneus Minimum 2 Views (73650) $412 $412 4.4×
Radex elbow complete minimum 3 views (73080) $412 $412 4.4×
Radex Facial Bones Complete Minimum 3 Views (70150) $776 $776 6.9×
Radex fingr minimum 2 views (73140) $412 $412 4.4×
Radex foot complete minimum 3 views (73630) $412 $412 4.4×
Radex Hand Minimum 3 Views (73130) $483 $483 5.2×
Radex lower extremity infant minimum 2 views (73592) $405 $405 4.3×
Radex Mastoids Compl Minimum 3 Views PR Side (70130) $776 $776 6.9×
Radex Nasal Bones Complete Minimum 3 Views (70160) $412 $412 4.4×
Radex Ribs Unilateral 2 Views (71100) $364 $364 3.9×
Radex shoulder complete minimum 2 views (73030) $412 $412 4.4×
Radex Sinuses Paransl < 3 Views (70210) $412 $412 4.4×
Radex sm int w/mlt srl imges via enteroclss tube (74251) $872 $872 4.6×
Radex Spine 1 View Specify Level (72020) $340 $340 3.6×
Radex Sternum Minimum 2 Views (71120) $340 $340 3.6×
Radex Temporomandble Jt Opn & Clsd Mouth Bilat (70330) $470 $470 5.0×
Radex Toe Minimum 2 Views (73660) $412 $412 4.4×
Radex upper extremity infant minimum 2 views (73092) $454 $454 4.1×
Radex Wrist Complete Minimum 3 Views (73110) $483 $483 5.2×
Radex X-Ray Exam Entire Spi 6/> Vw - Xr Entire Spine 6+ Vw (72084) $1,467 $1,467 13.1×
Radiation Delivery Stereotactic Cranial Linear (77372) $19,125 $19,125 2.4×
Radiation treatment delivery level 1 (77402) $1,203 $1,203 11.0×
Radiation treatment delivery level 2 (77407) $4,547 $4,547 11.0×
Radiation treatment delivery level 3 (77412) $6,513 $6,513 11.0×
Radiolog exam mandible compl minimum 4 views (70110) $632 $632 5.6×
Radiologic Exam Abdomen 3+ Views - Xr Abdomen 3+ Views (74021) $644 $644 5.7×
Radiologic exam colon double contrast study (74280) $859 $859 4.6×
Radiologic exam colon single contrast study (74270) $776 $776 4.1×
Radiologic Exam Esophagus Double Contrast Study (74221) $929 $929 4.9×
Radiologic exam knee complete 4/more views (73564) $776 $776 6.9×
Radiologic exam pelvis compl minimum 3 views (72190) $632 $632 5.6×
Radiologic Exam Small Int Single Contrast Study (74250) $776 $776 4.1×
Radiologic exam swallow function contrast study (74230) $776 $776 4.1×
Radiologic exam teeth complete full mouth (70320) $245 $245 1.0×
Radiologic exam upr gi trc double contrast study (74246) $632 $632 3.4×
Radiologic examination femur 1 view (73551) $269 $269 2.9×
Radiologic examination femur minimum 2 views (73552) $340 $340 3.6×
Radiologic examination knee 1/2 views (73560) $340 $340 3.6×
Radiologic Examination Osseous Survey Limited (77074) $632 $632 5.6×
Radiologic Examination Salivary Gland Calculus (70380) $704 $704 7.5×
Radiologic examination tibia & fibula 2 views (73590) $412 $412 4.4×
Radiologic examination, internal auditory meati, complete Non-Facility (70134) $608 $608 1.0×
Radiopharmaceutical therapy, by intra-articular administration Non-Facility (79440) $1,670 $1,670 6.7×
Radiopharmaceutical therapy, by intracavitary administration Non-Facility (79200) $1,394 $1,394 5.6×
Remote afterloading high dose rate radionuclide skin surface brachytherapy, includes basic dosimetry, when performed;… (77768) $3,291 $3,291 8.0×
Remote afterloading high dose rate radionuclide skin surface brachytherapy, includes basic dosimetry, when performed;… (77767) $2,003 $2,003 4.8×
Renal Cyst Study (74470) $906 $906 1.5×
Ribs bilateral 3 views (71110) $632 $632 5.6×
Rp loclzj tum plnr 1 area single day imaging (78800) $2,611 $2,611 6.1×
Rp loclzj tum plnr 2+area 1+d img/1 area img>2+d (78801) $2,015 $2,015 4.7×
Rp Loclzj Tum Plnr Whole Body 2+ Days Imaging (78804) $5,641 $5,641 9.7×
Rp Loclzj Tum Plnr Whole Body Single Day Imaging (78802) $4,197 $4,197 7.2×
Rp Loclzj Tum Spect 1 Area Single Day Imaging (78803) $3,303 $3,303 5.7×
Rp loclzj tum spect 2 area/sep acquisj img (78831) $3,135 $3,135 2.3×
Rp loclzj tum spect CT 2area 1d img/1 ar img>2+d (78832) $3,983 $3,983 2.6×
Rp loclzj tum spect w/CT 1 area/acquisj 1day img (78830) $2,802 $2,802 2.0×
Rp Ther Radiolbld Monoclonal Antibody IV Infus (79403) $1,694 $1,694 6.8×
Rp Therapy Intravenous Administration (79101) $1,168 $1,168 4.7×
Scapula (73010) $340 $340 3.0×
Screening Digital Breast Tomosynthesis Bi (77063) $191 $191 8.2×
Sella turcica (70240) $375 $375 4.0×
Shoulder 1 view (73020) $340 $340 3.6×
Shoulder Arthrography (73040) $1,276 $1,276 3.4×
Skull less than 4 views (70250) $525 $525 4.7×
Special dosimetry (77331) $823 $823 5.7×
Special Physics Consult (77370) $1,145 $1,145 7.9×
Special teletherapy port plan (77321) $2,349 $2,349 5.9×
Special treatment procedure (77470) $3,291 $3,291 5.6×
Spleen Imaging (78185) $896 $896 2.1×
Stereotactic Body Radiation Delivery (77373) $11,052 $11,052 5.8×
Sternoclavicular joints (71130) $340 $340 3.6×
Superior sagittal sinus venogram (75870) $9,443 $9,443 2.8×
Surface Applic Low Dose Rate Radionuclide Source (77789) $478 $478 4.4×
Tbs techl prep&transmis data alys pfrmd elsewhr (77090) $418 $418 4.5×
Tbs technical calculation only (77091) $256 $256 2.7×
Telethx isodose pln cplx w/basic dosimetry (77307) $2,052 $2,052 5.1×
Telethx isodose pln smpl w/dosimetry calculation (77306) $1,478 $1,478 3.7×
Ther Rad Simulaj-Aided Field Setting Complex (77290) $2,670 $2,670 6.7×
Ther Rad Simulaj-Aided Field Setting Intermed (77285) $2,052 $2,052 5.1×
Ther rad simulaj-aided field setting simple (77280) $1,253 $1,253 8.7×
Therapeutic Enema Rdctj Intussusception/Obstrcj (74283) $635 $635 3.4×
Thoracic spine 2 views (72070) $632 $632 5.6×
Thoracic spine 3 views (72072) $776 $776 6.9×
Thoracolumbar 2 views (72080) $502 $502 5.4×
Thyroid Carcinoma Metastases Img Lmtd Area (78015) $1,313 $1,313 3.1×
Thyroid Imaging With Vascular Flow (78013) $1,670 $1,670 3.9×
Thyroid Met Imaging Body (78018) $2,349 $2,349 4.0×
Thyroid Uptake Measurement (78012) $537 $537 1.3×
Thyroid Uptake W/Blood Flow Sngle/Mult Quan Meas (78014) $1,347 $1,347 3.1×
Tx Devices Design & Construction Complex (77334) $2,052 $2,052 5.1×
Tx devices design & construction intermediate (77333) $1,026 $1,026 7.1×
Tx devices design & construction simple (77332) $896 $896 6.2×
Ultrasound Breast Limited (76642) $579 $579 6.2×
Ultrasound elastography first target lesion (76982) $389 $389 3.5×
Ultrasound Elastography Parenchyma (76981) $389 $389 3.5×
Ultrasound Exam Aaa Screen (76706) $1,062 $1,062 9.5×
Ultrasound trgt dynamic microbubble 1st lesion (76978) $1,168 $1,168 3.1×
Ultrasound, abdomen limited (76705) $896 $896 8.0×
Umbilical-artery Doppler (OB) (76820) $846 $846 7.6×
Unlisted Dx Radiographic Procedure (76499) $412 $412 4.4×
Unlisted fluoroscopic procedure (76496) $352 $352 3.8×
Unlisted magnetic resonance procedure (76498) $1,181 $1,181 12.7×
Unlisted us procedure (76999) $525 $525 5.6×
Upper gi w/o kub (74240) $811 $811 4.3×
Urea Breath Test C-14 Isotopic Acquisj Analysis (78267) $44 $44 4.0×
Urea breath test c-14 isotopic analysis (78268) $322 $322 3.4×
Ureteral Reflux Study (78740) $2,015 $2,015 4.7×
Urethrocystogram voiding (74455) $1,491 $1,491 5.8×
Urethrocystography retrograde (74450) $1,360 $1,360 5.3×
Us bone density measurement (76977) $352 $352 3.1×
Us breast unilateral complete (76641) $872 $872 7.8×
Us chest (76604) $896 $896 8.0×
Us complete joint (76881) $554 $554 4.9×
Us exam, pelvic, limited (76857) $704 $704 6.3×
Us head (76506) $776 $776 6.9×
Us kidney transplant (76776) $1,193 $1,193 10.6×
Us lmtd joint/oth nonvasc xtr strux r-t w/img (76882) $292 $292 2.6×
Us ob detailed single fetus (76811) $896 $896 3.5×
Us ob limited 1 or more fetuses (76815) $919 $919 8.2×
Us ob transvaginal (76817) $1,085 $1,085 9.7×
Us pelvic non ob complete (76856) $1,085 $1,085 9.7×
Us pg uter img f&mat 14 wk tabdl 1/1st gestation (76801) $1,085 $1,085 9.7×
Us preg uterus real time f/u trnsabdl per fetus (76816) $1,037 $1,037 9.3×
Us retroperitoneal complete (76770) $1,085 $1,085 9.7×
Us retroperitoneal limited (76775) $896 $896 8.0×
Us scrotum and contents (76870) $1,085 $1,085 9.7×
Us spinal canal and contents (76800) $470 $470 4.2×
Us thyroid (76536) $1,085 $1,085 9.7×
Us transrectal (76872) $990 $990 8.8×
Vascular Flow Imaging (78445) $1,491 $1,491 3.5×
Vein X-Ray Chest (75827) $2,229 $2,229 1.3×
Vein X-Ray Liver W/O Hemodyn (75887) $9,443 $9,443 2.8×
Vein X-Ray Skull Epidural (75872) $1,694 $1,694 2.5×
Vein X-Ray Spleen/Liver (75810) $9,443 $9,443 2.8×
Venogram Sinus/Jugular (75860) $9,443 $9,443 2.8×
Venography Adrenal Unilateral (75840) $9,443 $9,443 2.8×
Venography caval inferior serialography rs&i (75825) $6,403 $6,403 1.9×
Venography extremity bilateral rs&i (75822) $3,482 $3,482 2.1×
Venography extremity unilateral rs&i (75820) $3,184 $3,184 1.9×
Venography Orbital Rs&I (75880) $1,526 $1,526 2.3×
Venography Renal Bilateral (75833) $4,626 $4,626 1.4×
Venography Renal Unilateral (75831) $9,443 $9,443 2.8×
Venous sampling by catheter (75893) $16,217 $16,217 2.7×
Vertebral fracture assessment via dxa (77086) $269 $269 2.9×
Wrist 2 views (73100) $238 $238 2.6×
X-Ray Ac Jts - Xr Acromioclavicular Joints Bilateral (73050) $412 $412 4.4×
X-ray antegrade pyelogram tube (74425) $1,764 $1,764 4.7×
X-Ray Aorta Leg Arteries (75630) $4,388 $4,388 1.3×
X-Ray Bend Only L-S Spine (72120) $412 $412 3.7×
X-Ray Elbow 2 Vw - Xr Elbow 1-2 Views Right (73070) $340 $340 3.6×
X-Ray Exam Breast Specimen (76098) $751 $751 1.3×
X-Ray Exam Entire Spi 1 Vw (72081) $632 $632 6.8×
X-Ray Exam Entire Spi 2/3 Vw (72082) $776 $776 6.9×
X-Ray Exam Entire Spi 4/5 Vw (72083) $1,229 $1,229 11.0×
X-Ray Exam Hip Uni 1 View (73501) $340 $340 3.6×
X-Ray Exam Hip Uni 2-3 Views (73502) $412 $412 4.4×
X-Ray Exam Hip Uni 4/> Views (73503) $823 $823 7.3×
X-Ray Exam Hips Bi 2 Views (73521) $776 $776 6.9×
X-Ray Exam Hips Bi 3-4 Views (73522) $632 $632 5.6×
X-Ray Exam Hips Bi 5/> Views (73523) $1,442 $1,442 12.9×
X-Ray Exam L-S Spine Bending (72114) $632 $632 5.6×
X-Ray Exam Neck Spine 2-3 Vw (72040) $412 $412 4.4×
X-Ray Exam Neck Spine 6/>Vws (72052) $632 $632 5.6×
X-Ray Exam Unilat Ribs/Chest (71101) $608 $608 5.4×
X-ray eye for foreign body (70030) $502 $502 5.4×
X-ray head for orthodontia (70350) $375 $375 4.0×
X-ray humerus (73060) $412 $412 4.4×
X-ray IV pyelogram (ivp) (74400) $1,478 $1,478 7.9×
X-Ray Jaw <4 Vw - Xr Mandible < 4 Views (70100) $375 $375 4.0×
X-Ray Knee Bilat Standing - Xr Knees Anteroposterior Standing Bilat (73565) $399 $399 4.3×
X-Ray Lumbar Spine 2/3 Vw - Xr Lumbar Spine 2-3 Views (72100) $632 $632 5.6×
X-ray nose-rectum child f.b. (76010) $340 $340 3.6×
X-Ray Ribs, Chest 4+ Vw - Xr Ribs 3 Vws Bil W/ Chest Posteroanterior (71111) $679 $679 6.1×
X-Ray Sacroiliac Jts 3+ Vw - Xr Sacroiliac Joints 3+ Views (72202) $632 $632 5.6×
X-Ray Sacroiliac Jts <3 Vw - Xr Sacroiliac Joints 1-2 Views (72200) $621 $621 5.5×
X-Ray Sacrum/Coccyx 2+ Vw - Xr Sacrum Coccyx 2+ Views (72220) $340 $340 3.6×
X-Ray Sinuses 3+ Vw - Xr Paranasal Sinuses 3+ Views (70220) $340 $340 3.6×
X-Ray Skull 4+ Vw - Xr Skull Complete 4+ Views (70260) $776 $776 6.9×
X-Ray Stress View (77071) $352 $352 3.8×
X-ray thoracic spine 4 vw (72074) $704 $704 6.3×
X-Ray Tmj Unilat (70328) $423 $423 4.5×
X-Ray Urinary Tract Exam With Contrast Material (74420) $1,694 $1,694 4.5×
X-Rays Bone Length Studies (77073) $537 $537 4.8×
X-Rays Bone Survey Complete (77075) $668 $668 6.0×
Xr c-spine 4 or 5 views (72050) $776 $776 6.9×
Xr facial bones less than 3 views (70140) $507 $507 5.4×
XR Mastoids < 3 Views Bilateral (70120) $679 $679 6.1×
Xr orbits complete 4 views (70200) $776 $776 6.9×
Xr Tomogram Single Plane (76100) $966 $966 8.6×

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.