Imaging prices at CHI Health Good Samaritan
Kearney, NE · every code in this section with a posted price and a Medicare benchmark.
350 codes. Prices are the hospital's own posted facility charges.
Compare against other hospitals interactively →
| Procedure | Posted cash | Posted gross | × Medicare |
|---|---|---|---|
| 3-D radiotherapy plan dose-volume histograms (77295) | $7,576.81 | $12,421 | 5.3× |
| Abdomen 1 View (74018) | $279.99 | $459 | 3.1× |
| Abdomen 2 views (74019) | $386.13 | $633 | 3.6× |
| Acute Gastrointestinal Blood Loss Imaging (78278) | $1,163.88 | $1,908 | 2.8× |
| Angio pulmonary bilat (75743) | $1,833.05 | $3,005 | 0.6× |
| Angiography extremity bilateral rs&i (75716) | $3,880.82 | $6,362 | 1.2× |
| Angiography extremity unilateral rs&i (75710) | $3,559.96 | $5,836 | 1.1× |
| Angiography pulmonary unilateral slctv rs&i (75741) | $1,529.27 | $2,507 | 0.5× |
| Ankle 2 views (73600) | $250.71 | $411 | 2.8× |
| Aortography thoracic serialography rs&i (75605) | $2,924.95 | $4,795 | 0.5× |
| Artery X-Rays Abdomen (75726) | $3,599 | $5,900 | 0.6× |
| Artery X-Rays Adrenal Gland (75731) | $1,833.05 | $3,005 | 0.6× |
| Artery X-Rays Pelvis (75736) | $3,308.03 | $5,423 | 0.6× |
| Artery X-Rays Spine (75705) | $3,273.26 | $5,366 | 0.6× |
| Arthrogram hip (73525) | $986.37 | $1,617 | 2.7× |
| Arthrogram Wrist (73115) | $574.01 | $941 | 1.6× |
| Basic radiation dosimetry calculation (77300) | $680.15 | $1,115 | 4.9× |
| Bone age studies (77072) | $148.84 | $244 | 1.4× |
| Bone Imaging 3 Phase (78315) | $1,856.23 | $3,043 | 4.5× |
| Bone Imaging Limited Area (78300) | $836.31 | $1,371 | 2.0× |
| Bone Imaging Multiple Areas (78305) | $936.35 | $1,535 | 2.3× |
| Bone Imaging Whole Body (78306) | $1,639.07 | $2,687 | 3.9× |
| Bone survey infant (77076) | $348.31 | $571 | 3.2× |
| Brachytx isodose intermed (77317) | $1,939.80 | $3,180 | 5.0× |
| Brain Imaging Min 4 Static Views W Vascular Flow (78606) | $814.96 | $1,336 | 1.4× |
| Brain Imaging Minimum 4 Static Views (78605) | $1,162.66 | $1,906 | 2.1× |
| Cat Scan Follow-Up Study (76380) | $745.42 | $1,222 | 8.2× |
| Cerebrospinal Fluid Flow W/O Matl Shunt Evaltj (78645) | $764.33 | $1,253 | 1.4× |
| Chest 1 view (71045) | $303.17 | $497 | 3.4× |
| Chest 2 views (71046) | $303.17 | $497 | 3.4× |
| Chest 3 views (71047) | $269.62 | $442 | 3.0× |
| Chest 4 or more views (71048) | $469.09 | $769 | 4.3× |
| Cisternography Positive Contrast Rs&I (70015) | $1,257.82 | $2,062 | 1.5× |
| Clavicle complete (73000) | $290.36 | $476 | 3.2× |
| Computed Tomography Thorax Lw Dose Lng Ca Scr C- (71271) | $1,212.07 | $1,987 | 11.2× |
| Continuing medical physics consltj pr wk (77336) | $1,032.73 | $1,693 | 7.4× |
| Contrast Exam Abdominl Aorta (75625) | $3,134.79 | $5,139 | 1.0× |
| Contrast X-Ray Bladder (74430) | $515.45 | $845 | 1.4× |
| Contrast X-Ray Of Knee Joint (73580) | $954.04 | $1,564 | 2.6× |
| CT abdomen and pelvis without and with contrast (74178) | $5,188.05 | $8,505 | 14.3× |
| CT abdomen and pelvis without contrast (74176) | $2,759.64 | $4,524 | 11.1× |
| CT abdomen w contrast (74160) | $2,221.62 | $3,642 | 12.2× |
| CT abdomen w wo contrast (74170) | $2,466.23 | $4,043 | 13.5× |
| CT abdomen w/o contrast (74150) | $1,666.52 | $2,732 | 15.4× |
| CT Angio Abdomen and Pelvis (74174) | $2,649.23 | $4,343 | 7.3× |
| CT Angio Chest (71275) | $2,471.72 | $4,052 | 13.6× |
| CT Angio Head (70496) | $1,993.48 | $3,268 | 10.9× |
| CT angio hrt w/3d image (75574) | $240.34 | $394 | 0.7× |
| Ct Angio Lwr Extr W/O&W/Dye (73706) | $2,067.90 | $3,390 | 11.4× |
| CT Angio Neck (70498) | $2,168.55 | $3,555 | 11.9× |
| Ct Angio Upr Extrm W/O&W/Dye (73206) | $2,072.17 | $3,397 | 11.4× |
| CT bone density (77078) | $268.40 | $440 | 3.0× |
| CT cervical spine w/ contrast (72126) | $2,028.25 | $3,325 | 5.6× |
| CT cervical spine w/o contrast (72125) | $1,603.08 | $2,628 | 14.8× |
| CT cervical spine w/wo cont (72127) | $2,142.32 | $3,512 | 11.8× |
| CT chest w contrast (71260) | $2,241.14 | $3,674 | 12.3× |
| CT chest w/wo contrast (71270) | $2,584.57 | $4,237 | 14.2× |
| CT colonography screening (74263) | $2,803.56 | $4,596 | 11.3× |
| CT Colonogrphy Dx Image Postprocess W/Contrast (74262) | $1,650.05 | $2,705 | 9.1× |
| CT colonogrphy dx image postprocess w/o contrast (74261) | $1,321.26 | $2,166 | 12.2× |
| CT head/brain with contrast (70460) | $1,632.97 | $2,677 | 9.0× |
| CT head/brain without and with contrast (70470) | $1,956.88 | $3,208 | 10.7× |
| CT heart contrast eval cardiac structure&morph (75572) | $218.38 | $358 | 0.6× |
| CT heart no contrast quant eval coronry calcium (75571) | $174.46 | $286 | 1.9× |
| CT hrt w/3d image congen (75573) | $218.38 | $358 | 0.6× |
| CT iac w contrast (70481) | $2,067.90 | $3,390 | 11.4× |
| CT l-spine w&w/o contrast (72133) | $2,027.64 | $3,324 | 11.1× |
| CT lower ext w/o (73700) | $1,442.04 | $2,364 | 13.3× |
| CT lower extremity w/contrast material (73701) | $1,859.89 | $3,049 | 10.2× |
| CT lumbar spine w contrast (72132) | $1,939.80 | $3,180 | 5.4× |
| CT lumbar spine w/o contrast (72131) | $1,747.65 | $2,865 | 16.1× |
| CT maxillofacial w contrast (70487) | $1,778.15 | $2,915 | 9.8× |
| CT maxillofacial wo contrast (70486) | $1,389.58 | $2,278 | 12.8× |
| CT neck tissue combo (70492) | $2,390.59 | $3,919 | 13.1× |
| Ct Orbit/Ear/Fossa W/O&W/Dye (70482) | $2,477.21 | $4,061 | 13.6× |
| CT orbits w/o contrast (70480) | $1,862.94 | $3,054 | 17.2× |
| CT pelvis w&w/o contrast (72194) range across 2 matching MRF lines |
$176.90–$2,223.45 | $290–$3,645 | varies |
| CT pelvis w/o contrast (72192) | $1,472.54 | $2,414 | 13.6× |
| CT scan of leg combo (73702) | $2,090.47 | $3,427 | 11.5× |
| CT scans face/jaw combo (70488) | $1,806.21 | $2,961 | 9.9× |
| CT soft tissue neck w contrast (70491) | $1,944.07 | $3,187 | 10.7× |
| CT soft tissue neck w/o contrast (70490) | $1,496.94 | $2,454 | 13.8× |
| CT thoracic spine w contrast (72129) | $1,951.39 | $3,199 | 10.7× |
| CT thoracic spine w/o contrast (72128) | $1,697.02 | $2,782 | 15.6× |
| CT thoracic spine w/wo cont (72130) | $1,968.47 | $3,227 | 10.8× |
| CT thorax w/o contrast (71250) | $1,189.50 | $1,950 | 11.0× |
| CT upper ext wo (73200) | $1,535.98 | $2,518 | 14.1× |
| CT upper extremity w/o & w/contrast material (73202) | $2,165.50 | $3,550 | 11.9× |
| CT upper extremity with contrast (73201) | $1,797.06 | $2,946 | 5.0× |
| Cta Abdl Aorta&Bi Iliofem W/Contrast&Postp (75635) | $2,602.87 | $4,267 | 14.3× |
| Cta Abdomen (74175) | $3,136.01 | $5,141 | 17.2× |
| CTA pelvis (72191) | $1,046.76 | $1,716 | 5.7× |
| Dilation ureters/urethra rs&i (74485) | $1,399.95 | $2,295 | 0.6× |
| Discography Cerv/Thor Spine (72285) | $1,180.35 | $1,935 | 0.6× |
| Diskography lumbar (72295) | $2,162.45 | $3,545 | 1.1× |
| Doppler Fetal Mid Cerebral Artery (76821) | $214.72 | $352 | 2.0× |
| Dxa Bone Density Axial (77080) | $513.62 | $842 | 4.7× |
| Dxa bone density study (77085) | $457.50 | $750 | 4.2× |
| Dxa bone density study 1/>sites appendiclr skel (77081) range across 2 matching MRF lines |
$164.70–$246.44 | $270–$404 | varies |
| Esophagram (74220) | $630.74 | $1,034 | 3.5× |
| Fetal Biophys Profile W/Nst (76818) | $529.48 | $868 | 4.9× |
| Fetal Biophysical Profile W/O Non-Stress Testing (76819) | $529.48 | $868 | 4.9× |
| Fluoroscopy up to 1 hr (76000) range across 3 matching MRF lines |
$534.97–$588.04 | $877–$964 | varies |
| Follow-Up Angiography (75898) | $924.76 | $1,516 | 0.3× |
| Foot 2 views (73620) | $203.13 | $333 | 2.2× |
| Forearm 2 views (73090) | $264.74 | $434 | 2.9× |
| Gastric emptying imaging study (78264) | $1,613.45 | $2,645 | 3.9× |
| Gated Heart Planar Single (78472) | $1,667.13 | $2,733 | 4.0× |
| Hand 2 views (73120) | $297.68 | $488 | 2.7× |
| Hdr Rdncl Ntrstl/Icav Brchtx (77772) | $1,394.46 | $2,286 | 1.9× |
| Hdr Rdncl Ntrstl/Icav Brchtx (77771) | $2,757.20 | $4,520 | 3.8× |
| Hdr Rdncl Ntrstl/Icav Brchtx 1 Channel (77770) | $3,243.37 | $5,317 | 4.5× |
| Hepatc Vngrph Wdg/Fr Hemodyn Eval Rs&I (75889) | $1,613.45 | $2,645 | 0.5× |
| Hepatobil Syst Image W/Drug (78227) | $1,629.92 | $2,672 | 2.9× |
| Hepatobiliary System Imaging (78226) | $1,438.99 | $2,359 | 3.5× |
| Ht Musc Image Planar Mult (78454) | $2,111.82 | $3,462 | 1.6× |
| Ht Muscle Image Spect Sing (78451) | $1,513.41 | $2,481 | 1.1× |
| Hysterosalpingogram (74740) | $875.35 | $1,435 | 3.5× |
| Infant hip ultrasound with hip movement (dynamic) (76885) | $421.51 | $691 | 4.7× |
| Infant hip ultrasound, limited static exam (76886) | $395.89 | $649 | 4.4× |
| K Flow/Funct Image Multiple (78709) | $1,500.60 | $2,460 | 2.7× |
| K Flow/Funct Image W/Drug (78708) | $1,485.96 | $2,436 | 2.6× |
| K Flow/Funct Image W/O Drug (78707) | $1,322.48 | $2,168 | 2.3× |
| Knee 3 Views (73562) | $387.35 | $635 | 4.3× |
| Leveen/Shunt Patency Exam (78291) | $561.81 | $921 | 1.4× |
| Liver & Spleen Imaging Static Only (78215) | $727.12 | $1,192 | 1.8× |
| Liver imaging static only (78201) | $631.35 | $1,035 | 1.1× |
| Lung Perf&Ventilat Diferentl (78598) | $1,536.59 | $2,519 | 2.7× |
| Lung perfusion differential (78597) | $844.85 | $1,385 | 2.0× |
| Lung Ventilat&Perfus Imaging (78582) | $1,461.56 | $2,396 | 2.6× |
| Lymph System Imaging (78195) | $1,537.81 | $2,521 | 2.7× |
| Lymphangiography Pelvic/Abdominal Bilateral Rs&I (75807) | $883.89 | $1,449 | 0.3× |
| Lymphangiography, pelvic/abdominal, unilateral (75805) | $977.22 | $1,602 | 0.3× |
| Magnetic Image Jaw Joint (70336) | $1,661.03 | $2,723 | 6.7× |
| Mammary ductogram or galactogram single (77053) | $506.91 | $831 | 2.0× |
| Meckels Divert Exam (78290) | $869.25 | $1,425 | 2.1× |
| Mlc imrt design & construction per imrt plan (77338) | $3,627.06 | $5,946 | 9.3× |
| Mr safety determination physician/other qhp (76016) | $75.03 | $123 | 0.8× |
| Mr safety implant&/fb assmt clin staf 1st 15 min (76014) | $20.74 | $34 | 0.7× |
| Mr safety implt electronics prepj supvj phys/qhp (76018) | $78.69 | $129 | 0.8× |
| Mr safety implt pos&/immoblj (76019) | $50.63 | $83 | 0.8× |
| Mr safety med physics xm customization plng&mntr (76017) | $206.18 | $338 | 0.8× |
| Mra Head W/O & W/Contrast Material (70546) | $3,703.31 | $6,071 | 10.2× |
| MRA head w/o contrast (70544) | $2,536.38 | $4,158 | 10.2× |
| MRA head with contrast (70545) | $2,612.63 | $4,283 | 7.2× |
| MRA neck w contrast (70548) | $2,127.68 | $3,488 | 5.9× |
| Mra Neck W/O &W/Contrast Material (70549) | $2,743.78 | $4,498 | 7.6× |
| MRA neck w/o contrast (70547) | $1,763.51 | $2,891 | 7.1× |
| MRI abdomen w contrast (74182) | $2,818.81 | $4,621 | 7.8× |
| MRI abdomen w/o contrast (74181) | $2,494.90 | $4,090 | 10.1× |
| MRI any jt lower extrem w/contrast material (73722) | $2,189.90 | $3,590 | 2.7× |
| MRI any jt lower extrem w/o & w/contrast matrl (73723) | $2,347.89 | $3,849 | 6.5× |
| MRI any jt upper extremity w/contrast matrl (73222) | $2,189.90 | $3,590 | 2.7× |
| MRI Breast W/O Contrast Bilateral (77047) | $2,827.96 | $4,636 | 11.4× |
| MRI Breast Without Contrast Material Unilateral (77046) | $1,941.02 | $3,182 | 7.8× |
| MRI cervical spine w contrast (72142) | $3,218.97 | $5,277 | 8.9× |
| MRI cervical spine w/o cont (72141) | $1,621.99 | $2,659 | 6.5× |
| MRI chest w/o contrast (71550) | $2,687.66 | $4,406 | 10.8× |
| MRI chest with contrast (71551) | $2,949.96 | $4,836 | 3.6× |
| MRI chest wo w contrast (71552) | $3,212.26 | $5,266 | 8.9× |
| MRI lower extrem oth/thn jt w/contrast matrl (73719) | $2,070.95 | $3,395 | 5.7× |
| MRI lower extrem oth/thn jt w/o & w/contr matr (73720) | $2,232.60 | $3,660 | 6.2× |
| MRI lower extrem oth/thn jt w/o contr matrl (73718) | $1,667.74 | $2,734 | 6.7× |
| MRI lumbar spine w contrast (72149) | $2,919.46 | $4,786 | 8.1× |
| Mri Neck Spine W/O & W/Dye (72156) | $2,544.92 | $4,172 | 7.0× |
| MRI orbit face &/neck w/o contrast (70540) | $3,307.42 | $5,422 | 13.3× |
| MRI orbit face neck w contrast (70542) | $3,419.05 | $5,605 | 9.4× |
| Mri Orbt/Fac/Nck W/O &W/Dye (70543) | $3,641.70 | $5,970 | 10.1× |
| MRI pelvis w contrast (72196) | $2,594.33 | $4,253 | 7.2× |
| MRI pelvis w/o & w contrast (72197) | $2,646.79 | $4,339 | 7.3× |
| MRI pelvis w/o contrast (72195) | $2,250.29 | $3,689 | 9.1× |
| MRI thoracic spine w/o contrast (72146) | $1,650.66 | $2,706 | 6.7× |
| MRI upper extremity oth than jt w/contr matrl (73219) | $1,989.82 | $3,262 | 5.5× |
| MRI upper extremity oth than jt w/o contr matrl (73218) | $1,596.98 | $2,618 | 6.4× |
| Mri Uppr Extremity W/O&W/Dye (73220) | $2,146.59 | $3,519 | 5.9× |
| MRI, abdomen, combo (74183) | $3,175.05 | $5,205 | 8.8× |
| MRI, dorsal spine combo (72157) | $2,075.83 | $3,403 | 5.7× |
| MRI, dorsal spine contrast (72147) | $2,501 | $4,100 | 6.9× |
| MRI, joint upper extrem (73221) | $1,751.92 | $2,872 | 7.1× |
| MRI, joint upper extrem combo (73223) | $2,347.89 | $3,849 | 6.5× |
| MRI, lumbar spine combo (72158) | $2,345.45 | $3,845 | 6.5× |
| Myelogram cervical (72240) | $1,044.32 | $1,712 | 1.3× |
| Myelogram Lumbar (72265) | $1,251.11 | $2,051 | 1.5× |
| Myocardial Spect Multiple Studies (78452) range across 2 matching MRF lines |
$3,665.49–$3,984.52 | $6,009–$6,532 | varies |
| N-invas est c ffr sw aly CTA (75580) | $1,088.85 | $1,785 | 1.2× |
| Neck soft tissue (70360) | $268.40 | $440 | 3.0× |
| Nm csf leak detection (78650) | $1,389.58 | $2,278 | 1.0× |
| Nonvascular Shunt X-Ray (75809) | $744.81 | $1,221 | 6.9× |
| Ntsty modul radthx pln dose-vol histos (77301) | $8,236.83 | $13,503 | 5.7× |
| Nuclear Rx Intra-Arterial (79445) range across 2 matching MRF lines |
$346.48–$437.37 | $568–$717 | varies |
| Nuclear Rx Oral Admin (79005) | $603.90 | $990 | 2.5× |
| Parathyroid imaging w/tomographic spect & CT (78072) | $879.62 | $1,442 | 1.6× |
| Parathyroid Planar Imaging (78070) | $1,107.15 | $1,815 | 2.7× |
| Parathyroid planar imaging w/wo subtraction (78071) | $1,026.63 | $1,683 | 2.5× |
| Pelvis 1 or 2 views (72170) | $281.82 | $462 | 2.6× |
| Peritoneogram Rs&I (74190) | $1,025.41 | $1,681 | 1.8× |
| Pet Image W/Ct Lmtd (78814) | $5,183.78 | $8,498 | 3.5× |
| PET image w/CT, full body (78816) | $5,677.88 | $9,308 | 3.8× |
| PET imaging CT attenuation skull base mid-thigh (78815) range across 2 matching MRF lines |
$5,801.10–$6,171.37 | $9,510–$10,117 | varies |
| Prq Transhepatc Portograpy Hemodyn Eval Rs&I (75885) | $2,673.02 | $4,382 | 0.8× |
| Pulmonary Perfusion Imaging Particulate (78580) | $1,237.69 | $2,029 | 3.0× |
| Radex Abd Compl Aqt Abd W/S/E/D Views 1 View Ch (74022) | $506.30 | $830 | 4.7× |
| Radex abscess/fistula/sinus tract rs&i (76080) | $1,055.30 | $1,730 | 1.9× |
| Radex Ankle Complete Minimum 3 Views (73610) | $330.01 | $541 | 3.7× |
| Radex Calcaneus Minimum 2 Views (73650) | $174.46 | $286 | 1.9× |
| Radex elbow complete minimum 3 views (73080) | $352.58 | $578 | 3.9× |
| Radex Facial Bones Complete Minimum 3 Views (70150) | $410.53 | $673 | 3.8× |
| Radex fingr minimum 2 views (73140) | $222.04 | $364 | 2.5× |
| Radex foot complete minimum 3 views (73630) | $336.72 | $552 | 3.7× |
| Radex Hand Minimum 3 Views (73130) | $345.87 | $567 | 3.8× |
| Radex lower extremity infant minimum 2 views (73592) | $142.74 | $234 | 1.6× |
| Radex Nasal Bones Complete Minimum 3 Views (70160) | $292.80 | $480 | 3.2× |
| Radex Ribs Unilateral 2 Views (71100) | $267.18 | $438 | 3.0× |
| Radex shoulder complete minimum 2 views (73030) | $330.01 | $541 | 3.7× |
| Radex Sinuses Paransl < 3 Views (70210) | $264.74 | $434 | 2.9× |
| Radex Spine 1 View Specify Level (72020) | $283.04 | $464 | 3.1× |
| Radex Sternum Minimum 2 Views (71120) | $121.39 | $199 | 1.3× |
| Radex Temporomandble Jt Opn & Clsd Mouth Bilat (70330) | $217.77 | $357 | 2.4× |
| Radex Toe Minimum 2 Views (73660) | $247.05 | $405 | 2.7× |
| Radex upper extremity infant minimum 2 views (73092) | $203.74 | $334 | 1.9× |
| Radex Wrist Complete Minimum 3 Views (73110) | $311.10 | $510 | 3.4× |
| Radex X-Ray Exam Entire Spi 6/> Vw - Xr Entire Spine 6+ Vw (72084) | $233.63 | $383 | 2.2× |
| Radiation Delivery Stereotactic Cranial Linear (77372) | $15,552.56 | $25,496 | 2.0× |
| Radiation treatment delivery level 3 (77412) | $1,456.07 | $2,387 | 2.5× |
| Radiolog exam mandible compl minimum 4 views (70110) | $395.89 | $649 | 3.6× |
| Radiologic exam colon double contrast study (74280) | $1,154.73 | $1,893 | 6.3× |
| Radiologic exam colon single contrast study (74270) | $900.36 | $1,476 | 4.9× |
| Radiologic Exam Esophagus Double Contrast Study (74221) | $654.53 | $1,073 | 3.6× |
| Radiologic exam knee complete 4/more views (73564) | $395.28 | $648 | 3.6× |
| Radiologic exam pelvis compl minimum 3 views (72190) | $315.37 | $517 | 2.9× |
| Radiologic Exam Small Int Single Contrast Study (74250) | $661.85 | $1,085 | 3.6× |
| Radiologic exam swallow function contrast study (74230) | $498.37 | $817 | 2.7× |
| Radiologic Exam Teeth Prtl Exam < Full Mouth (70310) | $117.12 | $192 | 0.5× |
| Radiologic exam upr gi trc double contrast study (74246) | $708.21 | $1,161 | 3.9× |
| Radiologic examination femur 1 view (73551) | $133.59 | $219 | 1.5× |
| Radiologic examination femur minimum 2 views (73552) | $278.16 | $456 | 3.1× |
| Radiologic examination knee 1/2 views (73560) | $364.17 | $597 | 4.0× |
| Radiologic Examination Osseous Survey Limited (77074) | $250.10 | $410 | 2.3× |
| Radiologic examination tibia & fibula 2 views (73590) | $301.95 | $495 | 3.3× |
| Renal Cyst Study (74470) | $883.89 | $1,449 | 1.6× |
| Ribs bilateral 3 views (71110) | $412.97 | $677 | 3.8× |
| Rp loclzj tum plnr 1 area single day imaging (78800) | $1,312.11 | $2,151 | 3.2× |
| Rp loclzj tum plnr 2+area 1+d img/1 area img>2+d (78801) | $1,343.22 | $2,202 | 3.2× |
| Rp Loclzj Tum Plnr Whole Body 2+ Days Imaging (78804) | $2,748.05 | $4,505 | 4.9× |
| Rp Loclzj Tum Plnr Whole Body Single Day Imaging (78802) | $2,316.17 | $3,797 | 4.1× |
| Rp Loclzj Tum Spect 1 Area Single Day Imaging (78803) range across 3 matching MRF lines |
$1,342.61–$2,501 | $2,201–$4,100 | varies |
| Rp Therapy Intravenous Administration (79101) | $636.23 | $1,043 | 2.6× |
| Scapula (73010) | $353.19 | $579 | 3.3× |
| Screening Digital Breast Tomosynthesis Bi (77063) | $53.68 | $88 | 2.3× |
| Shoulder 1 view (73020) | $218.38 | $358 | 2.4× |
| Shoulder Arthrography (73040) | $849.12 | $1,392 | 2.3× |
| Sialogram (70390) | $512.40 | $840 | 2.1× |
| Skull less than 4 views (70250) | $311.71 | $511 | 2.9× |
| Special Physics Consult (77370) | $1,331.63 | $2,183 | 9.5× |
| Special teletherapy port plan (77321) | $1,484.74 | $2,434 | 3.8× |
| Special treatment procedure (77470) | $2,627.88 | $4,308 | 4.6× |
| Stereotactic Body Radiation Delivery (77373) | $11,095.90 | $18,190 | 6.0× |
| Sternoclavicular joints (71130) | $220.21 | $361 | 2.4× |
| Telethx isodose pln cplx w/basic dosimetry (77307) | $2,594.94 | $4,254 | 6.7× |
| Telethx isodose pln smpl w/dosimetry calculation (77306) | $1,546.35 | $2,535 | 4.0× |
| Ther Rad Simulaj-Aided Field Setting Complex (77290) | $2,294.21 | $3,761 | 5.9× |
| Ther Rad Simulaj-Aided Field Setting Intermed (77285) | $1,598.81 | $2,621 | 4.1× |
| Ther rad simulaj-aided field setting simple (77280) | $1,297.47 | $2,127 | 9.3× |
| Thoracic spine 2 views (72070) | $277.55 | $455 | 2.6× |
| Thoracic spine 3 views (72072) | $416.63 | $683 | 3.8× |
| Thoracolumbar 2 views (72080) | $265.96 | $436 | 2.9× |
| Thyroid Imaging With Vascular Flow (78013) | $585.60 | $960 | 1.4× |
| Thyroid Met Imaging Body (78018) | $1,597.59 | $2,619 | 2.8× |
| Thyroid Uptake Measurement (78012) | $331.84 | $544 | 0.8× |
| Thyroid Uptake W/Blood Flow Sngle/Mult Quan Meas (78014) | $1,007.11 | $1,651 | 2.4× |
| Tx Devices Design & Construction Complex (77334) | $1,329.19 | $2,179 | 3.4× |
| Tx devices design & construction intermediate (77333) | $644.16 | $1,056 | 4.6× |
| Tx devices design & construction simple (77332) | $563.64 | $924 | 4.0× |
| Ultrasound Breast Limited (76642) | $491.66 | $806 | 5.4× |
| Ultrasound Exam Aaa Screen (76706) | $187.88 | $308 | 1.7× |
| Ultrasound, abdomen limited (76705) | $516.06 | $846 | 4.8× |
| Umbilical-artery Doppler (OB) (76820) | $265.35 | $435 | 2.4× |
| Unlisted Dx Radiographic Procedure (76499) | $32.94 | $54 | 0.4× |
| Unlisted fluoroscopic procedure (76496) | $958.92 | $1,572 | 10.6× |
| Unlisted magnetic resonance procedure (76498) | $655.75 | $1,075 | 7.3× |
| Unlisted us procedure (76999) | $387.35 | $635 | 4.3× |
| Upper gi w/o kub (74240) | $649.04 | $1,064 | 3.6× |
| Urethrocystogram voiding (74455) | $755.79 | $1,239 | 3.1× |
| Urethrocystography retrograde (74450) | $739.32 | $1,212 | 3.0× |
| Us breast unilateral complete (76641) | $491.66 | $806 | 4.5× |
| Us chest (76604) | $406.26 | $666 | 3.7× |
| Us complete joint (76881) | $691.74 | $1,134 | 6.4× |
| Us exam, pelvic, limited (76857) | $414.80 | $680 | 3.8× |
| Us head (76506) | $596.58 | $978 | 5.5× |
| Us kidney transplant (76776) | $709.43 | $1,163 | 6.5× |
| Us lmtd joint/oth nonvasc xtr strux r-t w/img (76882) | $571.57 | $937 | 5.3× |
| Us ob limited 1 or more fetuses (76815) | $421.51 | $691 | 3.9× |
| Us ob transvaginal (76817) | $645.38 | $1,058 | 5.9× |
| Us pelvic non ob complete (76856) | $797.27 | $1,307 | 7.3× |
| Us pg uter img f&mat 14 wk tabdl 1/1st gestation (76801) | $688.69 | $1,129 | 6.3× |
| Us preg uterus real time f/u trnsabdl per fetus (76816) | $395.28 | $648 | 3.6× |
| Us retroperitoneal complete (76770) | $804.59 | $1,319 | 7.4× |
| Us retroperitoneal limited (76775) | $522.77 | $857 | 4.8× |
| Us scrotum and contents (76870) | $719.19 | $1,179 | 6.6× |
| Us spinal canal and contents (76800) | $511.18 | $838 | 4.7× |
| Us thyroid (76536) | $612.44 | $1,004 | 5.6× |
| Vein X-Ray Chest (75827) | $1,504.26 | $2,466 | 0.9× |
| Venogram Sinus/Jugular (75860) | $499.59 | $819 | 0.2× |
| Venography caval inferior serialography rs&i (75825) | $2,425.97 | $3,977 | 0.7× |
| Venography extremity bilateral rs&i (75822) | $1,561.60 | $2,560 | 1.0× |
| Venography extremity unilateral rs&i (75820) | $1,259.04 | $2,064 | 0.8× |
| Venography Renal Bilateral (75833) | $2,305.80 | $3,780 | 0.7× |
| Venography Renal Unilateral (75831) | $1,613.45 | $2,645 | 0.5× |
| Venous sampling by catheter (75893) unusually low: confirm this is the full procedure |
$1,883.07 | $3,087 | 0.3× |
| Venous thrombosis imaging (78457) | $407.48 | $668 | 0.7× |
| Wrist 2 views (73100) | $216.55 | $355 | 2.4× |
| X-Ray Ac Jts - Xr Acromioclavicular Joints Bilateral (73050) | $308.05 | $505 | 3.4× |
| X-ray antegrade pyelogram tube (74425) | $680.76 | $1,116 | 1.9× |
| X-Ray Aorta Leg Arteries (75630) | $2,664.48 | $4,368 | 0.8× |
| X-Ray Bend Only L-S Spine (72120) | $527.04 | $864 | 4.9× |
| X-Ray Elbow 2 Vw - Xr Elbow 1-2 Views Right (73070) | $276.94 | $454 | 3.1× |
| X-Ray Exam Breast Specimen (76098) | $386.74 | $634 | 0.7× |
| X-Ray Exam Entire Spi 1 Vw (72081) | $261.08 | $428 | 2.9× |
| X-Ray Exam Entire Spi 2/3 Vw (72082) | $606.95 | $995 | 5.6× |
| X-Ray Exam Entire Spi 4/5 Vw (72083) | $230.58 | $378 | 2.1× |
| X-Ray Exam Hip Uni 1 View (73501) | $132.37 | $217 | 1.5× |
| X-Ray Exam Hip Uni 2-3 Views (73502) | $154.33 | $253 | 1.7× |
| X-Ray Exam Hip Uni 4/> Views (73503) | $197.64 | $324 | 1.8× |
| X-Ray Exam Hips Bi 2 Views (73521) | $455.67 | $747 | 4.2× |
| X-Ray Exam Hips Bi 3-4 Views (73522) | $459.94 | $754 | 4.2× |
| X-Ray Exam Hips Bi 5/> Views (73523) | $399.55 | $655 | 3.7× |
| X-Ray Exam L-S Spine Bending (72114) | $573.40 | $940 | 5.3× |
| X-Ray Exam Neck Spine 2-3 Vw (72040) | $355.63 | $583 | 3.9× |
| X-Ray Exam Neck Spine 6/>Vws (72052) | $665.51 | $1,091 | 6.1× |
| X-Ray Exam Unilat Ribs/Chest (71101) | $366 | $600 | 3.4× |
| X-ray humerus (73060) | $284.87 | $467 | 3.2× |
| X-ray IV pyelogram (ivp) (74400) | $811.91 | $1,331 | 4.5× |
| X-ray IV pyelogram+tomography (74415) | $940.62 | $1,542 | 5.2× |
| X-Ray Jaw <4 Vw - Xr Mandible < 4 Views (70100) | $190.32 | $312 | 2.1× |
| X-Ray Knee Bilat Standing - Xr Knees Anteroposterior Standing Bilat (73565) | $195.81 | $321 | 2.2× |
| X-Ray Lumbar Spine 2/3 Vw - Xr Lumbar Spine 2-3 Views (72100) | $428.83 | $703 | 4.0× |
| X-ray nose-rectum child f.b. (76010) | $235.46 | $386 | 2.6× |
| X-Ray Ribs, Chest 4+ Vw - Xr Ribs 3 Vws Bil W/ Chest Posteroanterior (71111) | $480.07 | $787 | 4.4× |
| X-Ray Sacroiliac Jts 3+ Vw - Xr Sacroiliac Joints 3+ Views (72202) | $435.54 | $714 | 4.0× |
| X-Ray Sacroiliac Jts <3 Vw - Xr Sacroiliac Joints 1-2 Views (72200) | $258.64 | $424 | 2.4× |
| X-Ray Sacrum/Coccyx 2+ Vw - Xr Sacrum Coccyx 2+ Views (72220) | $261.08 | $428 | 2.9× |
| X-Ray Sinuses 3+ Vw - Xr Paranasal Sinuses 3+ Views (70220) | $358.07 | $587 | 4.0× |
| X-Ray Skull 4+ Vw - Xr Skull Complete 4+ Views (70260) | $442.25 | $725 | 4.1× |
| X-ray thoracic spine 4 vw (72074) | $331.84 | $544 | 3.1× |
| X-Ray Urinary Tract Exam With Contrast Material (74420) | $762.50 | $1,250 | 2.1× |
| X-Rays Bone Length Studies (77073) | $289.75 | $475 | 2.7× |
| X-Rays Bone Survey Complete (77075) | $893.65 | $1,465 | 8.2× |
| Xr c-spine 4 or 5 views (72050) | $485.56 | $796 | 4.5× |
| Xr facial bones less than 3 views (70140) | $113.46 | $186 | 1.3× |
| Xr orbits complete 4 views (70200) | $418.46 | $686 | 3.9× |
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.