Imaging prices at Chi St. Luke's Health Brazosport
Lake Jackson, TX · every code in this section with a posted price and a Medicare benchmark.
333 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) | $7,729.75 | $22,085 | 5.6× |
| Abdomen 1 View (74018) | $498.40 | $1,424 | 5.7× |
| Abdomen 2 views (74019) range across 2 matching MRF lines |
$580.06–$620.90 | $1,657.29–$1,774 | varies |
| Acute Gastrointestinal Blood Loss Imaging (78278) | $626.12 | $1,788.89 | 1.6× |
| Angio internal mammary (75756) | $739.62 | $2,113.20 | 0.2× |
| Angio pulmonary bilat (75743) | $1,007.37 | $2,878.20 | 0.3× |
| Angiography Adrenal Bilateral Slctv Rs&I (75733) | $1,037.93 | $2,965.50 | 0.3× |
| Angiography extremity bilateral rs&i (75716) | $2,727.20 | $7,792 | 0.9× |
| Angiography extremity unilateral rs&i (75710) | $1,254.40 | $3,584 | 0.4× |
| Angiography pulmonary unilateral slctv rs&i (75741) | $1,037.93 | $2,965.50 | 0.3× |
| Angrph pulmonary nonslctv cath/ven njx rs&i (75746) | $717.89 | $2,051.10 | 0.2× |
| Ankle 2 views (73600) range across 2 matching MRF lines |
$291.55–$571.90 | $833–$1,634 | varies |
| Aortography thoracic serialography rs&i (75605) likely a partial charge, not the full procedure |
$1,037.93 | $2,965.50 | 0.2× |
| Aortography thoracic w/o serialography rs&i (75600) | $991.31 | $2,832.30 | 0.3× |
| Artery X-Rays Abdomen (75726) likely a partial charge, not the full procedure |
$1,037.93 | $2,965.50 | 0.2× |
| Artery X-Rays Adrenal Gland (75731) | $1,037.93 | $2,965.50 | 0.3× |
| Artery X-Rays Pelvis (75736) likely a partial charge, not the full procedure |
$1,037.93 | $2,965.50 | 0.2× |
| Arthrogram ankle (73615) | $575.82 | $1,645.20 | 1.6× |
| Arthrogram hip (73525) | $525.11 | $1,500.30 | 1.5× |
| Arthrogram Wrist (73115) | $475.65 | $1,359 | 1.4× |
| Basic radiation dosimetry calculation (77300) | $584.77 | $1,670.76 | 4.3× |
| Bone age studies (77072) | $206.35 | $589.56 | 2.0× |
| Bone Imaging 3 Phase (78315) | $1,629.60 | $4,656 | 4.1× |
| Bone Imaging Limited Area (78300) | $1,063.65 | $3,039 | 2.6× |
| Bone Imaging Whole Body (78306) | $1,381.10 | $3,946 | 3.4× |
| Bone marrow imaging; whole body (78104) | $1,011.78 | $2,890.80 | 2.5× |
| Bone survey infant (77076) | $121.28 | $346.50 | 1.2× |
| Brain Flow Imaging Only (78610) | $381.78 | $1,090.80 | 0.7× |
| Brain Image W/Flow < 4 Views (78601) | $488.88 | $1,396.80 | 1.2× |
| Brain imaging < 4 static views (78600) | $438.80 | $1,253.70 | 1.1× |
| Brain Imaging Min 4 Static Views W Vascular Flow (78606) | $572.67 | $1,636.20 | 1.0× |
| Brain Imaging Minimum 4 Static Views (78605) | $469.98 | $1,342.80 | 0.9× |
| Card Bl Pool Gated Spect Rest Wal Motn Ejct Frct (78494) | $674.73 | $1,927.80 | 1.7× |
| Cat Scan Follow-Up Study (76380) | $291.69 | $833.40 | 3.3× |
| Chest 1 view (71045) | $484.40 | $1,384 | 5.5× |
| Chest 2 views (71046) range across 2 matching MRF lines |
$534.80–$634.55 | $1,528–$1,813 | varies |
| Chest 4 or more views (71048) | $402.85 | $1,151 | 3.8× |
| Cholecystography Oral Contrast (74290) | $232.16 | $663.30 | 1.3× |
| Cisternography Positive Contrast Rs&I (70015) | $1,185.03 | $3,385.80 | 1.5× |
| Clavicle complete (73000) | $417.55 | $1,193 | 4.8× |
| Computed Tomography Thorax Lw Dose Lng Ca Scr C- (71271) | $112.14 | $320.38 | 1.1× |
| Continuing medical physics consltj pr wk (77336) | $706.15 | $2,017.56 | 5.2× |
| Contrast Exam Abdominl Aorta (75625) | $1,190 | $3,400 | 0.4× |
| Contrast X-Ray Bladder (74430) | $477.40 | $1,364 | 1.4× |
| Contrast X-Ray Of Elbow (73085) | $575.82 | $1,645.20 | 1.6× |
| Contrast X-Ray Of Knee Joint (73580) | $613.31 | $1,752.30 | 1.8× |
| Contrast Xray Throat/Cerv Esopha (74210) | $226.80 | $648 | 1.3× |
| CT abdomen and pelvis without and with contrast (74178) | $7,633.85 | $21,811 | 21.8× |
| CT abdomen and pelvis without contrast (74176) | $5,937.40 | $16,964 | 24.8× |
| CT abdomen w contrast (74160) | $4,113.09 | $11,751.66 | 23.3× |
| CT abdomen w wo contrast (74170) | $4,648 | $13,280 | 26.4× |
| CT abdomen w/o contrast (74150) | $2,385.60 | $6,816 | 22.7× |
| CT Angio Abdomen and Pelvis (74174) | $4,230.80 | $12,088 | 12.1× |
| CT Angio Chest (71275) | $3,489.68 | $9,970.50 | 19.8× |
| CT Angio Head (70496) | $3,920 | $11,200 | 22.2× |
| Ct Angio Lwr Extr W/O&W/Dye (73706) | $3,450.47 | $9,858.47 | 19.6× |
| CT Angio Neck (70498) | $3,920 | $11,200 | 22.2× |
| Ct Angio Upr Extrm W/O&W/Dye (73206) | $3,546.82 | $10,133.75 | 20.1× |
| CT cervical spine w/ contrast (72126) | $4,040.40 | $11,544 | 11.5× |
| CT cervical spine w/o contrast (72125) | $3,108 | $8,880 | 29.6× |
| CT cervical spine w/wo cont (72127) | $4,723.95 | $13,497 | 26.8× |
| CT chest w contrast (71260) | $3,569.65 | $10,199 | 20.3× |
| CT chest w/wo contrast (71270) | $4,193 | $11,980 | 23.8× |
| CT head/brain with contrast (70460) | $3,529.05 | $10,083 | 20.0× |
| CT head/brain without and with contrast (70470) | $4,134.20 | $11,812 | 23.5× |
| CT iac w contrast (70481) | $1,720.60 | $4,916 | 9.8× |
| CT l-spine w&w/o contrast (72133) | $5,453.35 | $15,581 | 30.9× |
| CT lower ext w/o (73700) | $1,802.85 | $5,151 | 17.2× |
| CT lower extremity w/contrast material (73701) | $2,325.75 | $6,645 | 13.2× |
| CT lumbar spine w contrast (72132) | $4,638.90 | $13,254 | 13.2× |
| CT lumbar spine w/o contrast (72131) | $3,541.09 | $10,117.38 | 33.7× |
| CT maxillofacial w contrast (70487) | $2,936.15 | $8,389 | 16.7× |
| CT maxillofacial wo contrast (70486) | $2,467.15 | $7,049 | 23.5× |
| CT neck tissue combo (70492) | $3,293.85 | $9,411 | 18.7× |
| Ct Orbit/Ear/Fossa W/O&W/Dye (70482) | $2,007.25 | $5,735 | 11.4× |
| CT orbits w/o contrast (70480) | $1,509.20 | $4,312 | 14.4× |
| CT pelvis w&w/o contrast (72194) | $4,617.55 | $13,193 | 26.2× |
| CT pelvis w/o contrast (72192) | $2,758.35 | $7,881 | 26.3× |
| CT scan of leg combo (73702) | $2,722.65 | $7,779 | 15.5× |
| CT scans face/jaw combo (70488) | $3,552.85 | $10,151 | 20.2× |
| CT soft tissue neck w contrast (70491) | $2,744.70 | $7,842 | 15.6× |
| CT soft tissue neck w/o contrast (70490) | $2,223.20 | $6,352 | 21.2× |
| CT thoracic spine w contrast (72129) | $4,420.85 | $12,631 | 25.1× |
| CT thoracic spine w/o contrast (72128) | $3,374.46 | $9,641.30 | 32.1× |
| CT thoracic spine w/wo cont (72130) | $5,196.80 | $14,848 | 29.5× |
| CT thorax w/o contrast (71250) range across 2 matching MRF lines |
$2,832.89–$2,832.90 | $8,093.96–$8,094 | varies |
| CT upper ext wo (73200) | $1,337.42 | $3,821.20 | 12.7× |
| CT upper extremity w/o & w/contrast material (73202) | $2,073.05 | $5,923 | 11.8× |
| CT upper extremity with contrast (73201) | $1,671.95 | $4,777 | 4.8× |
| Cta Abdl Aorta&Bi Iliofem W/Contrast&Postp (75635) | $4,274.66 | $12,213.30 | 24.3× |
| Cta Abdomen (74175) | $3,254.30 | $9,298 | 18.5× |
| CTA pelvis (72191) | $1,865.33 | $5,329.50 | 10.6× |
| Dacryocystography, nasolacrimal duct, radiological supervision and interpretation Non-Facility (70170) | $849.24 | $2,426.40 | 3.5× |
| Discography Cerv/Thor Spine (72285) | $936.81 | $2,676.60 | 0.5× |
| Diskography lumbar (72295) | $865.62 | $2,473.20 | 0.4× |
| Dxa Bone Density Axial (77080) | $399.70 | $1,142 | 3.8× |
| Dxa bone density study 1/>sites appendiclr skel (77081) | $36.05 | $103 | 0.4× |
| Echo Guide For Artery Repair (76936) | $229.32 | $655.20 | 1.1× |
| Esophagram (74220) | $905.71 | $2,587.74 | 5.1× |
| Fetal Biophysical Profile W/O Non-Stress Testing (76819) | $189.93 | $542.64 | 1.8× |
| Fluoroscopy up to 1 hr (76000) | $605.84 | $1,730.95 | 2.5× |
| Foot 2 views (73620) | $428.05 | $1,223 | 4.9× |
| Forearm 2 views (73090) | $482.97 | $1,379.91 | 5.5× |
| Gastric emptying imaging study (78264) | $860.65 | $2,459 | 2.1× |
| Gated Heart Planar Single (78472) | $276.57 | $790.20 | 0.7× |
| Hand 2 views (73120) | $369.25 | $1,055 | 3.5× |
| Hepatobil Syst Image W/Drug (78227) | $895.60 | $2,558.85 | 1.6× |
| Hepatobiliary System Imaging (78226) | $797.30 | $2,278 | 2.0× |
| Ht Muscle Image Spect Sing (78451) | $3,809.05 | $10,883 | 2.9× |
| Hysterosalpingogram (74740) | $312.90 | $894 | 1.3× |
| Image fusion (77399) | $1,032.50 | $2,950 | 7.6× |
| Infant hip ultrasound with hip movement (dynamic) (76885) | $460.53 | $1,315.80 | 5.3× |
| Infant hip ultrasound, limited static exam (76886) | $301.46 | $861.30 | 3.4× |
| Joint Survey Single View (77077) | $121.28 | $346.50 | 1.2× |
| K Flow/Funct Image W/Drug (78708) | $1,614.20 | $4,612 | 3.0× |
| K Flow/Funct Image W/O Drug (78707) | $869.09 | $2,483.10 | 1.6× |
| Kidney Imaging Morphol (78700) | $491.09 | $1,403.10 | 1.2× |
| Kidney Imaging Morphoogy W/Vascular Flow (78701) | $725.13 | $2,071.80 | 1.8× |
| Knee 3 Views (73562) | $583.23 | $1,666.36 | 6.7× |
| Leveen/Shunt Patency Exam (78291) | $474.39 | $1,355.40 | 1.2× |
| Liver & Spleen Imaging Static Only (78215) | $466.83 | $1,333.80 | 1.2× |
| Liver imaging static only (78201) | $459.59 | $1,313.10 | 0.8× |
| Liver imaging w/vascular flow (78202) | $703.71 | $2,010.60 | 1.3× |
| Lung perfusion differential (78597) | $490.77 | $1,402.20 | 1.2× |
| Lung Ventilat&Perfus Imaging (78582) | $1,103.61 | $3,153.15 | 2.0× |
| Lung Ventilation Imaging (78579) | $596.05 | $1,703 | 1.5× |
| Lymph System Imaging (78195) | $888.99 | $2,539.95 | 1.6× |
| Magnetic Image Jaw Joint (70336) | $1,185.03 | $3,385.80 | 4.9× |
| Meckels Divert Exam (78290) | $807.98 | $2,308.50 | 2.0× |
| Mlc imrt design & construction per imrt plan (77338) | $2,198.79 | $6,282.25 | 5.8× |
| Mra Head W/O & W/Contrast Material (70546) | $922.04 | $2,634.39 | 2.6× |
| MRA head w/o contrast (70544) range across 2 matching MRF lines |
$1,874.61–$1,930.95 | $5,356.02–$5,517 | varies |
| MRA head with contrast (70545) | $1,102.82 | $3,150.90 | 3.1× |
| MRA neck w contrast (70548) | $1,599.15 | $4,569 | 4.6× |
| Mra Neck W/O &W/Contrast Material (70549) | $2,252.27 | $6,435.05 | 6.4× |
| MRA neck w/o contrast (70547) | $1,396.50 | $3,990 | 5.8× |
| MRI abdomen w contrast (74182) | $4,531.45 | $12,947 | 12.9× |
| MRI abdomen w/o contrast (74181) | $2,920.40 | $8,344 | 12.2× |
| MRI any jt lower extrem w/contrast material (73722) | $4,036.90 | $11,534 | 5.1× |
| MRI any jt lower extrem w/o & w/contrast matrl (73723) | $4,974.55 | $14,213 | 14.2× |
| MRI any jt upper extremity w/contrast matrl (73222) | $4,442.55 | $12,693 | 5.6× |
| MRI bone marrow blood supply (77084) | $1,858.19 | $5,309.10 | 7.8× |
| MRI brain functional w/o physician admnistration (70554) | $1,207.40 | $3,449.70 | 5.0× |
| MRI Breast W/O Contrast Bilateral (77047) | $1,304.10 | $3,726 | 5.4× |
| MRI Breast Without Contrast Material Unilateral (77046) range across 2 matching MRF lines |
$837.27–$896 | $2,392.20–$2,560 | varies |
| MRI cervical spine w contrast (72142) | $4,277.70 | $12,222 | 12.2× |
| MRI cervical spine w/o cont (72141) | $3,453.45 | $9,867 | 14.4× |
| MRI chest w/o contrast (71550) range across 2 matching MRF lines |
$1,194.67–$1,778.35 | $3,413.34–$5,081 | varies |
| MRI chest with contrast (71551) | $1,421.28 | $4,060.80 | 1.8× |
| MRI chest wo w contrast (71552) | $1,772.51 | $5,064.30 | 5.1× |
| MRI lower extrem oth/thn jt w/contrast matrl (73719) | $3,025.05 | $8,643 | 8.6× |
| MRI lower extrem oth/thn jt w/o & w/contr matr (73720) | $3,871 | $11,060 | 11.0× |
| MRI lower extrem oth/thn jt w/o contr matrl (73718) range across 2 matching MRF lines |
$2,563.45–$3,871 | $7,324.14–$11,060 | varies |
| MRI lumbar spine w contrast (72149) | $5,840.10 | $16,686 | 16.7× |
| Mri Neck Spine W/O & W/Dye (72156) | $5,102.30 | $14,578 | 14.6× |
| MRI orbit face &/neck w/o contrast (70540) | $1,778.35 | $5,081 | 7.4× |
| MRI orbit face neck w contrast (70542) | $2,096.50 | $5,990 | 6.0× |
| Mri Orbt/Fac/Nck W/O &W/Dye (70543) | $2,654.05 | $7,583 | 7.6× |
| MRI pelvis w contrast (72196) | $3,423.70 | $9,782 | 9.8× |
| MRI pelvis w/o & w contrast (72197) | $5,034.60 | $14,384.55 | 14.4× |
| MRI pelvis w/o contrast (72195) | $3,423.70 | $9,782 | 14.3× |
| MRI thoracic spine w/o contrast (72146) | $3,322.90 | $9,494 | 13.9× |
| MRI upper extremity oth than jt w/contr matrl (73219) | $2,100.70 | $6,002 | 6.0× |
| MRI upper extremity oth than jt w/o contr matrl (73218) range across 2 matching MRF lines |
$1,927.10–$2,601.90 | $5,506–$7,434 | varies |
| Mri Uppr Extremity W/O&W/Dye (73220) | $2,601.90 | $7,434 | 7.4× |
| MRI, abdomen, combo (74183) | $5,034.60 | $14,384.55 | 14.4× |
| MRI, dorsal spine combo (72157) | $5,615.75 | $16,045 | 16.0× |
| MRI, dorsal spine contrast (72147) | $4,785.20 | $13,672 | 13.7× |
| MRI, joint upper extrem (73221) | $4,316.85 | $12,333.84 | 18.0× |
| MRI, joint upper extrem combo (73223) | $6,097.70 | $17,422 | 17.4× |
| MRI, lumbar spine combo (72158) | $6,868.40 | $19,624 | 19.6× |
| Myocardial Imaging Infarct Avid Planar Qual/Quan (78466) | $449.82 | $1,285.20 | 1.1× |
| Myocardial Spect Multiple Studies (78452) | $4,588.98 | $13,111.35 | 3.5× |
| Neck soft tissue (70360) | $179.60 | $513.14 | 2.1× |
| Nm myocard infarct spect (78469) | $725.13 | $2,071.80 | 1.3× |
| Nonvascular Shunt X-Ray (75809) | $341.67 | $976.19 | 3.3× |
| Ntsty modul radthx pln dose-vol histos (77301) | $8,681.53 | $24,804.36 | 6.2× |
| Ob us nuchal meas 1 gest (76813) | $295.60 | $844.56 | 2.8× |
| Optic foramina (70190) | $166.95 | $477 | 1.9× |
| Panoramic X-ray of jaws (70355) | $187.74 | $536.40 | 2.1× |
| Parathyroid Planar Imaging (78070) | $869.05 | $2,483 | 2.2× |
| Pelvis 1 or 2 views (72170) | $466.61 | $1,333.16 | 4.4× |
| Peritoneogram Rs&I (74190) | $600.08 | $1,714.50 | 1.1× |
| Pet Image W/Ct Lmtd (78814) | $3,868.55 | $11,053 | 2.7× |
| PET image w/CT, full body (78816) | $4,384.45 | $12,527 | 3.1× |
| PET imaging CT attenuation skull base mid-thigh (78815) | $4,298.35 | $12,281 | 3.0× |
| Pulmonary Perfusion Imaging Particulate (78580) | $419.65 | $1,199 | 1.0× |
| Radex Abd Compl Aqt Abd W/S/E/D Views 1 View Ch (74022) | $580.30 | $1,658 | 5.5× |
| Radex abscess/fistula/sinus tract rs&i (76080) | $497.24 | $1,420.66 | 0.9× |
| Radex Ankle Complete Minimum 3 Views (73610) | $582.45 | $1,664.13 | 6.7× |
| Radex Calcaneus Minimum 2 Views (73650) | $357.35 | $1,021 | 4.1× |
| Radex elbow complete minimum 3 views (73080) | $552.30 | $1,578 | 6.3× |
| Radex Facial Bones Complete Minimum 3 Views (70150) | $504.70 | $1,442 | 4.8× |
| Radex fingr minimum 2 views (73140) | $292.60 | $836 | 3.3× |
| Radex foot complete minimum 3 views (73630) | $563.15 | $1,609 | 6.4× |
| Radex Hand Minimum 3 Views (73130) | $559.30 | $1,598 | 6.4× |
| Radex lower extremity infant minimum 2 views (73592) | $140.66 | $401.88 | 1.6× |
| Radex Mastoids Compl Minimum 3 Views PR Side (70130) | $205.07 | $585.90 | 2.0× |
| Radex Nasal Bones Complete Minimum 3 Views (70160) | $306.95 | $877 | 3.5× |
| Radex Ribs Unilateral 2 Views (71100) | $566.65 | $1,619 | 6.5× |
| Radex shoulder complete minimum 2 views (73030) | $617.40 | $1,764 | 7.1× |
| Radex Sinuses Paransl < 3 Views (70210) | $193.41 | $552.60 | 2.2× |
| Radex Spine 1 View Specify Level (72020) | $314.30 | $898 | 3.6× |
| Radex Sternum Minimum 2 Views (71120) | $336.35 | $961 | 3.8× |
| Radex Temporomandble Jt Opn & Clsd Mouth Bilat (70330) | $202.23 | $577.80 | 2.3× |
| Radex Toe Minimum 2 Views (73660) | $121.59 | $347.40 | 1.4× |
| Radex upper extremity infant minimum 2 views (73092) | $145.30 | $415.14 | 1.4× |
| Radex Wrist Complete Minimum 3 Views (73110) | $517.65 | $1,479 | 5.9× |
| Radex X-Ray Exam Entire Spi 6/> Vw - Xr Entire Spine 6+ Vw (72084) | $900.55 | $2,573 | 8.6× |
| Radiation treatment delivery level 1 (77402) | $120.65 | $344.70 | 1.2× |
| Radiation treatment delivery level 2 (77407) | $371.70 | $1,062 | 1.0× |
| Radiation treatment delivery level 3 (77412) | $436.10 | $1,246 | 0.8× |
| Radiolog exam mandible compl minimum 4 views (70110) | $166.95 | $477 | 1.6× |
| Radiologic Exam Abdomen 3+ Views - Xr Abdomen 3+ Views (74021) | $387.45 | $1,107 | 3.7× |
| Radiologic exam colon double contrast study (74280) | $505.75 | $1,445 | 2.9× |
| Radiologic exam colon single contrast study (74270) | $903 | $2,580 | 5.1× |
| Radiologic exam knee complete 4/more views (73564) | $670.95 | $1,917 | 6.4× |
| Radiologic exam pelvis compl minimum 3 views (72190) | $466.90 | $1,334 | 4.4× |
| Radiologic Exam Small Int Single Contrast Study (74250) | $703.50 | $2,010 | 4.0× |
| Radiologic exam swallow function contrast study (74230) | $956.74 | $2,733.54 | 5.4× |
| Radiologic exam upr gi trc double contrast study (74246) | $545.74 | $1,559.25 | 3.1× |
| Radiologic examination femur minimum 2 views (73552) | $504.35 | $1,441 | 5.8× |
| Radiologic examination knee 1/2 views (73560) | $484.40 | $1,384 | 5.5× |
| Radiologic Examination Salivary Gland Calculus (70380) | $164.75 | $470.70 | 1.9× |
| Radiologic examination tibia & fibula 2 views (73590) | $601.65 | $1,719 | 6.9× |
| Radiologic examination, internal auditory meati, complete Non-Facility (70134) | $190.26 | $543.60 | 0.3× |
| Ribs bilateral 3 views (71110) | $562.80 | $1,608 | 5.4× |
| Rp loclzj tum plnr 1 area single day imaging (78800) | $427.77 | $1,222.20 | 1.1× |
| Rp loclzj tum plnr 2+area 1+d img/1 area img>2+d (78801) | $662.76 | $1,893.60 | 1.7× |
| Rp Loclzj Tum Plnr Whole Body 2+ Days Imaging (78804) | $1,185.10 | $3,386 | 2.2× |
| Rp Loclzj Tum Plnr Whole Body Single Day Imaging (78802) | $1,185.10 | $3,386 | 2.2× |
| Rp Loclzj Tum Spect 1 Area Single Day Imaging (78803) | $1,185.10 | $3,386 | 2.2× |
| Scapula (73010) | $406.35 | $1,161 | 3.9× |
| Screening Digital Breast Tomosynthesis Bi (77063) | $36.75 | $105 | 1.6× |
| Sella turcica (70240) | $132.30 | $378 | 1.5× |
| Shoulder 1 view (73020) | $339.50 | $970 | 3.9× |
| Shoulder Arthrography (73040) | $683.20 | $1,952 | 1.9× |
| Sialogram (70390) | $561.96 | $1,605.60 | 2.3× |
| Skull less than 4 views (70250) | $428.75 | $1,225 | 4.1× |
| Special dosimetry (77331) | $267.75 | $765 | 2.0× |
| Special Physics Consult (77370) | $282.80 | $808 | 2.1× |
| Special teletherapy port plan (77321) | $987.57 | $2,821.61 | 2.6× |
| Special treatment procedure (77470) | $2,992.02 | $8,548.62 | 5.4× |
| Speech evaluation, complex (70371) | $352.80 | $1,008 | 1.5× |
| Spleen Imaging (78185) | $513.45 | $1,467 | 1.3× |
| Stereotactic Body Radiation Delivery (77373) | $3,238.55 | $9,253 | 1.8× |
| Sternoclavicular joints (71130) | $184.28 | $526.50 | 2.1× |
| Telethx isodose pln cplx w/basic dosimetry (77307) | $402.57 | $1,150.20 | 1.1× |
| Temporomandble Jt Arthrography Rs&I (70332) | $558.50 | $1,595.70 | 2.3× |
| Testicular Imaging W/Flow (78761) | $412.34 | $1,178.10 | 1.0× |
| Ther Rad Simulaj-Aided Field Setting Complex (77290) | $2,995.95 | $8,559.84 | 8.0× |
| Ther Rad Simulaj-Aided Field Setting Intermed (77285) | $2,966.25 | $8,475 | 7.9× |
| Ther rad simulaj-aided field setting simple (77280) | $1,797.60 | $5,136 | 13.3× |
| Therapeutic Enema Rdctj Intussusception/Obstrcj (74283) | $425.57 | $1,215.90 | 2.4× |
| Thoracic spine 2 views (72070) | $439.95 | $1,257 | 4.2× |
| Thoracic spine 3 views (72072) | $782.95 | $2,237 | 7.5× |
| Thoracolumbar 2 views (72080) | $368.79 | $1,053.66 | 4.2× |
| Thyroid Imaging With Vascular Flow (78013) | $527.29 | $1,506.54 | 1.3× |
| Tx Devices Design & Construction Complex (77334) | $1,704.68 | $4,870.50 | 4.5× |
| Tx devices design & construction intermediate (77333) | $1,858.15 | $5,309 | 13.8× |
| Tx devices design & construction simple (77332) | $528.50 | $1,510 | 3.9× |
| Ultrasound Breast Limited (76642) | $700.35 | $2,001 | 8.0× |
| Ultrasound Exam Aaa Screen (76706) | $716.45 | $2,047 | 6.8× |
| Ultrasound, abdomen limited (76705) | $923.65 | $2,639 | 8.8× |
| Unlisted magnetic resonance procedure (76498) | $2,516.85 | $7,191 | 28.8× |
| Upper gi w/o kub (74240) | $679.70 | $1,942 | 3.9× |
| Urethrocystogram voiding (74455) | $568.05 | $1,623 | 2.4× |
| Urethrocystography retrograde (74450) | $567.88 | $1,622.50 | 2.4× |
| Us breast unilateral complete (76641) | $864.50 | $2,470 | 8.2× |
| Us chest (76604) | $530.67 | $1,516.20 | 5.1× |
| Us complete joint (76881) | $1,101.10 | $3,146 | 10.5× |
| Us exam, pelvic, limited (76857) | $492.45 | $1,407 | 4.7× |
| Us head (76506) | $461.79 | $1,319.40 | 4.4× |
| Us lmtd joint/oth nonvasc xtr strux r-t w/img (76882) | $980 | $2,800 | 9.3× |
| Us ob limited 1 or more fetuses (76815) | $337.75 | $965 | 3.2× |
| Us ob transvaginal (76817) | $383.67 | $1,096.20 | 3.7× |
| Us pelvic non ob complete (76856) | $1,094.45 | $3,127 | 10.4× |
| Us pg uter img f&mat 14 wk tabdl 1/1st gestation (76801) | $1,052.80 | $3,008 | 10.0× |
| Us preg uterus real time f/u trnsabdl per fetus (76816) | $456.75 | $1,305 | 4.3× |
| Us retroperitoneal complete (76770) | $1,243.20 | $3,552 | 11.8× |
| Us retroperitoneal limited (76775) | $969.85 | $2,771 | 9.2× |
| Us scrotum and contents (76870) | $954.45 | $2,727 | 9.1× |
| Us spinal canal and contents (76800) | $408.70 | $1,167.70 | 3.9× |
| Us thyroid (76536) | $1,078.35 | $3,081 | 10.3× |
| Vascular Flow Imaging (78445) | $513.45 | $1,467 | 1.3× |
| Venogram Sinus/Jugular (75860) | $3,364.90 | $9,614 | 1.1× |
| Venography extremity bilateral rs&i (75822) | $752.22 | $2,149.20 | 0.5× |
| Venography extremity unilateral rs&i (75820) | $420.53 | $1,201.50 | 0.3× |
| Venography Renal Bilateral (75833) | $2,128.35 | $6,081 | 0.7× |
| Venous thrombosis imaging (78457) | $425.57 | $1,215.90 | 0.8× |
| Venous Thrombosis Imaging Venogram Bilateral (78458) | $520.70 | $1,487.70 | 1.3× |
| Wrist 2 views (73100) | $641.90 | $1,834 | 7.3× |
| X-Ray Ac Jts - Xr Acromioclavicular Joints Bilateral (73050) | $146.79 | $419.40 | 1.7× |
| X-ray antegrade pyelogram tube (74425) | $415.80 | $1,188 | 1.2× |
| X-Ray Aorta Leg Arteries (75630) | $3,305.05 | $9,443 | 1.0× |
| X-Ray Bend Only L-S Spine (72120) | $593.60 | $1,696 | 5.7× |
| X-Ray Elbow 2 Vw - Xr Elbow 1-2 Views Right (73070) | $364.70 | $1,042 | 4.2× |
| X-Ray Exam Breast Specimen (76098) | $497.24 | $1,420.66 | 0.9× |
| X-Ray Exam Entire Spi 2/3 Vw (72082) | $252.35 | $721 | 2.4× |
| X-Ray Exam Hip Uni 1 View (73501) | $285.95 | $817 | 3.3× |
| X-Ray Exam Hip Uni 2-3 Views (73502) | $571.92 | $1,634.04 | 6.5× |
| X-Ray Exam Hips Bi 2 Views (73521) | $568.05 | $1,623 | 5.4× |
| X-Ray Exam L-S Spine Bending (72114) | $890.40 | $2,544 | 8.5× |
| X-Ray Exam Neck Spine 2-3 Vw (72040) | $576.10 | $1,646 | 6.6× |
| X-Ray Exam Neck Spine 6/>Vws (72052) | $679.70 | $1,942 | 6.5× |
| X-Ray Exam Unilat Ribs/Chest (71101) | $542.50 | $1,550 | 5.2× |
| X-ray eye for foreign body (70030) | $111.20 | $317.70 | 1.3× |
| X-ray head for orthodontia (70350) | $111.51 | $318.60 | 1.3× |
| X-ray humerus (73060) | $468.30 | $1,338 | 5.4× |
| X-ray IV pyelogram (ivp) (74400) | $382.03 | $1,091.50 | 2.2× |
| X-ray IV pyelogram+tomography (74415) | $526.68 | $1,504.80 | 3.0× |
| X-Ray Jaw <4 Vw - Xr Mandible < 4 Views (70100) | $395.50 | $1,130 | 4.5× |
| X-Ray Knee Bilat Standing - Xr Knees Anteroposterior Standing Bilat (73565) | $571.90 | $1,634 | 6.5× |
| X-Ray Lumbar Spine 2/3 Vw - Xr Lumbar Spine 2-3 Views (72100) | $582.05 | $1,663 | 5.5× |
| X-ray nose-rectum child f.b. (76010) | $178.42 | $509.75 | 2.0× |
| X-Ray Ribs, Chest 4+ Vw - Xr Ribs 3 Vws Bil W/ Chest Posteroanterior (71111) | $677.95 | $1,937 | 6.5× |
| X-Ray Sacroiliac Jts 3+ Vw - Xr Sacroiliac Joints 3+ Views (72202) | $528.85 | $1,511 | 5.0× |
| X-Ray Sacroiliac Jts <3 Vw - Xr Sacroiliac Joints 1-2 Views (72200) | $449.40 | $1,284 | 4.3× |
| X-Ray Sacrum/Coccyx 2+ Vw - Xr Sacrum Coccyx 2+ Views (72220) | $440.65 | $1,259 | 5.0× |
| X-Ray Sinuses 3+ Vw - Xr Paranasal Sinuses 3+ Views (70220) | $798.79 | $2,282.25 | 9.1× |
| X-Ray Skull 4+ Vw - Xr Skull Complete 4+ Views (70260) | $436.72 | $1,247.75 | 4.2× |
| X-Ray Stress View (77071) | $114.35 | $326.70 | 1.3× |
| X-ray thoracic spine 4 vw (72074) | $273 | $780 | 2.6× |
| X-Ray Tmj Unilat (70328) | $164.75 | $470.70 | 1.9× |
| X-Ray Urinary Tract Exam With Contrast Material (74420) | $1,772.15 | $5,063.26 | 5.1× |
| X-Rays Bone Length Studies (77073) | $361.29 | $1,032.24 | 3.4× |
| X-Rays Bone Survey Complete (77075) | $1,177.93 | $3,365.50 | 11.2× |
| Xr c-spine 4 or 5 views (72050) | $662.55 | $1,893 | 6.3× |
| Xr facial bones less than 3 views (70140) | $292.95 | $837 | 3.4× |
| XR Mastoids < 3 Views Bilateral (70120) | $147.74 | $422.10 | 1.4× |
| Xr myelogram posterior fossa (70010) | $1,150.70 | $3,287.70 | 3.3× |
| Xr orbits complete 4 views (70200) | $218.30 | $623.70 | 2.1× |
| Xr Tomogram Single Plane (76100) | $421.47 | $1,204.20 | 4.0× |
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.