Imaging prices at Connecticut Children's Medical Center

Hartford, CT · every code in this section with a posted price and a Medicare benchmark.

338 codes. Prices are the hospital's own posted facility charges.

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ProcedurePosted cashPosted gross× Medicare
Abdomen 1 View (74018) $136.80 $228 1.3×
Abdomen 2 views (74019) $252.60 $421 2.0×
Acute Gastrointestinal Blood Loss Imaging (78278)
range across 2 matching MRF lines		 $693–$1,183.80 $1,155–$1,973 varies
Angiography extremity bilateral rs&i (75716) $1,332 $2,220 0.4×
Angiography extremity unilateral rs&i (75710) $2,140.80 $3,568 0.6×
Ankle 2 views (73600) $136.80 $228 1.3×
Aortography thoracic serialography rs&i (75605) $3,862.80 $6,438 0.6×
Artery X-Rays Abdomen (75726)
unusually low: confirm this is the full procedure		 $2,277.60 $3,796 0.3×
Artery X-Rays Pelvis (75736)
likely a partial charge, not the full procedure		 $940.20 $1,567 0.1×
Artery X-Rays Spine (75705)
likely a partial charge, not the full procedure		 $1,949.40 $3,249 0.3×
Arthrogram ankle (73615) $532.80 $888 1.3×
Arthrogram hip (73525) $564 $940 1.3×
Arthrogram Wrist (73115) $532.80 $888 1.3×
Bone age studies (77072) $252.60 $421 2.0×
Bone Imaging 3 Phase (78315) $431.40 $719 0.9×
Bone Imaging Limited Area (78300) $758.40 $1,264 1.6×
Bone Imaging Multiple Areas (78305) $233.40 $389 0.5×
Bone Imaging Whole Body (78306) $1,529.40 $2,549 3.2×
Bone survey infant (77076) $252.60 $421 2.0×
Brain Flow Imaging Only (78610) $1,157.40 $1,929 1.8×
Cardiac MRI w/w/o contrast & further seq (75561) $2,124.60 $3,541 5.1×
Cardiac MRI w/w/o contrast w/stress (75563) $1,665 $2,775 1.8×
Cardiac Shunt Detection (78428) $700.80 $1,168 1.5×
Cat Scan Follow-Up Study (76380) $1,027.80 $1,713 9.9×
Cerebrospinal Fluid Flow W/O Matl Shunt Evaltj (78645) $632.40 $1,054 1.0×
Cerebrospinal Fluid Scan (78630) $651 $1,085 1.0×
Chest 1 view (71045) $136.80 $228 1.3×
Chest 2 views (71046) $195 $325 1.9×
Chest 3 views (71047) $223.20 $372 2.1×
Chest 4 or more views (71048) $254.40 $424 2.0×
Clavicle complete (73000) $136.80 $228 1.3×
Contrast Exam Abdominl Aorta (75625) $2,014.20 $3,357 0.5×
Contrast X-Ray Bladder (74430) $556.20 $927 1.3×
Contrast X-Ray Of Elbow (73085) $1,142.40 $1,904 2.7×
Contrast X-Ray Of Knee Joint (73580) $532.80 $888 1.3×
Contrast Xray Throat/Cerv Esopha (74210) $556.20 $927 2.6×
CT abdomen and pelvis without and with contrast (74178) $696.60 $1,161 1.7×
CT abdomen and pelvis without contrast (74176) $651 $1,085 2.3×
CT abdomen w contrast (74160) $612 $1,020 2.9×
CT abdomen w wo contrast (74170) $699.60 $1,166 3.3×
CT abdomen w/o contrast (74150) $398.40 $664 3.2×
CT Angio Abdomen and Pelvis (74174) $1,485.60 $2,476 3.6×
CT Angio Chest (71275) $723 $1,205 3.4×
CT Angio Head (70496) $722.40 $1,204 3.4×
CT angio hrt w/3d image (75574) $723.60 $1,206 1.7×
Ct Angio Lwr Extr W/O&W/Dye (73706)
range across 2 matching MRF lines		 $666.60–$722.40 $1,111–$1,204 varies
CT Angio Neck (70498) $722.40 $1,204 3.4×
Ct Angio Upr Extrm W/O&W/Dye (73206)
range across 2 matching MRF lines		 $666.60–$678.60 $1,111–$1,131 varies
CT cervical spine w/ contrast (72126) $1,166.40 $1,944 2.8×
CT cervical spine w/o contrast (72125) $402.60 $671 3.2×
CT cervical spine w/wo cont (72127) $1,345.20 $2,242 6.4×
CT chest w contrast (71260) $571.80 $953 2.7×
CT chest w/wo contrast (71270) $699 $1,165 3.3×
CT head/brain with contrast (70460) $556.20 $927 2.6×
CT head/brain without and with contrast (70470) $568.80 $948 2.7×
CT heart contrast eval cardiac structure&morph (75572) $376.80 $628 0.9×
CT heart no contrast quant eval coronry calcium (75571) $163.20 $272 1.6×
CT hrt w/3d image congen (75573) $877.80 $1,463 2.1×
CT iac w contrast (70481)
range across 2 matching MRF lines		 $632.40–$997.80 $1,054–$1,663 varies
CT l-spine w&w/o contrast (72133) $1,345.20 $2,242 6.4×
CT lower ext w/o (73700) $398.40 $664 3.2×
CT lower extremity w/contrast material (73701) $556.20 $927 2.6×
CT lumbar spine w contrast (72132) $1,005 $1,675 2.4×
CT lumbar spine w/o contrast (72131) $402.60 $671 3.2×
CT maxillofacial w contrast (70487) $559.20 $932 2.7×
CT maxillofacial wo contrast (70486) $399 $665 3.2×
CT neck tissue combo (70492) $680.40 $1,134 3.2×
Ct Orbit/Ear/Fossa W/O&W/Dye (70482)
range across 2 matching MRF lines		 $1,157.40–$1,168.80 $1,929–$1,948 varies
CT orbits w/o contrast (70480)
range across 2 matching MRF lines		 $399–$838.80 $665–$1,398 varies
CT pelvis w&w/o contrast (72194) $699.60 $1,166 3.3×
CT pelvis w/o contrast (72192) $402.60 $671 3.2×
CT scan of leg combo (73702) $1,168.80 $1,948 5.6×
CT scans face/jaw combo (70488) $699.60 $1,166 3.3×
CT soft tissue neck w contrast (70491) $556.20 $927 2.6×
CT soft tissue neck w/o contrast (70490) $398.40 $664 3.2×
CT thoracic spine w contrast (72129) $1,166.40 $1,944 5.5×
CT thoracic spine w/o contrast (72128) $402.60 $671 3.2×
CT thoracic spine w/wo cont (72130) $1,345.20 $2,242 6.4×
CT thorax w/o contrast (71250) $402.60 $671 3.2×
CT upper ext wo (73200) $398.40 $664 3.2×
CT upper extremity w/o & w/contrast material (73202) $1,168.80 $1,948 5.6×
CT upper extremity with contrast (73201) $556.20 $927 1.3×
Cta Abdl Aorta&Bi Iliofem W/Contrast&Postp (75635) $646.20 $1,077 3.1×
Cta Abdomen (74175) $723 $1,205 3.4×
CTA head&neck c+ w/noncontrast img&post-pxessing (70471) $822 $1,370 2.0×
CTA pelvis (72191) $1,192.80 $1,988 5.7×
Dilation ureters/urethra rs&i (74485) $226.20 $377 0.1×
Doppler Echo Fetal Puls Spectral F/U/Repeat (76828) $252.60 $421 2.0×
Doppler Echo Fetal Spectral Display Complete (76827) $252.60 $421 2.0×
Doppler Fetal Mid Cerebral Artery (76821) $252.60 $421 2.0×
Dxa Bone Density Axial (77080) $252.60 $421 2.0×
Dxa bone density study (77085) $319.80 $533 2.6×
Dxa bone density study 1/>sites appendiclr skel (77081) $136.80 $228 1.3×
Echo exam of fetal heart (76825) $1,072.80 $1,788 1.6×
Echocardiography, fetal, cardiovascular system, real time with image documentation (2D), with or without M-mode… (76826) $511.80 $853 1.8×
Esophagram (74220) $556.20 $927 2.6×
Fetal Biophys Profile W/Nst (76818) $255 $425 2.0×
Fetal Biophysical Profile W/O Non-Stress Testing (76819) $255 $425 2.0×
Fetal MRI w/placntl matrnl plvc img sing/1st ges (74712) $557.40 $929 1.9×
Fluoroscopy up to 1 hr (76000) $511.80 $853 1.8×
Follow-Up Angiography (75898) $1,213.80 $2,023 0.3×
Foot 2 views (73620) $136.80 $228 1.3×
Forearm 2 views (73090) $136.80 $228 1.3×
Gastric emptying imaging study (78264) $769.20 $1,282 1.6×
Gated Heart Planar Single (78472) $816.60 $1,361 1.7×
Hand 2 views (73120) $252.60 $421 2.0×
Heart first pass single,planar (78481) $816.60 $1,361 1.3×
Hepatc Vngrph Wdg/Fr Hemodyn Eval Rs&I (75889) $5,493 $9,155 1.5×
Hepatc Vngrph Wdg/Fr W/O Hemodyn Eval Rs&I (75891) $2,933.40 $4,889 0.8×
Hepatobil Syst Image W/Drug (78227) $998.40 $1,664 1.5×
Hepatobiliary System Imaging (78226)
range across 2 matching MRF lines		 $769.20–$939.60 $1,282–$1,566 varies
Ht Musc Image Planar Mult (78454) $1,112.40 $1,854 0.7×
Ht Muscle Image Spect Sing (78451) $1,112.40 $1,854 0.7×
Infant hip ultrasound with hip movement (dynamic) (76885) $136.80 $228 1.3×
Infant hip ultrasound, limited static exam (76886) $136.80 $228 1.3×
Infusion Ivp (74410) $604.80 $1,008 2.9×
Joint Survey Single View (77077) $252.60 $421 2.0×
K Flow/Funct Image W/Drug (78708) $1,512 $2,520 2.3×
K Flow/Funct Image W/O Drug (78707) $998.40 $1,664 1.5×
Kidney Imaging Morphol (78700) $961.80 $1,603 2.0×
Kidney Imaging Morphoogy W/Vascular Flow (78701) $1,653.60 $2,756 3.5×
Knee 3 Views (73562) $136.80 $228 1.3×
Labeled RBC Sequestration Differntl Organ/Tissue (78140) $552.60 $921 1.2×
Liver & Spleen Imaging Static Only (78215) $105 $175 0.2×
Lung perfusion differential (78597) $769.20 $1,282 1.6×
Lung Ventilat&Perfus Imaging (78582) $453 $755 0.7×
Lung Ventilation Imaging (78579) $721.20 $1,202 1.5×
Lymph System Imaging (78195) $497.40 $829 0.8×
Lymphangiography Extremity Only Bilateral Rs&I (75803) $697.80 $1,163 0.4×
Lymphangiography extremity only unilateral rs&i (75801) $719.40 $1,199 1.0×
Magnetic Image Jaw Joint (70336)
range across 2 matching MRF lines		 $1,296–$1,317.60 $2,160–$2,196 varies
Magnetic Resonance Elastography (76391) $381.60 $636 1.3×
Meckels Divert Exam (78290) $769.20 $1,282 1.6×
Mr safety determination physician/other qhp (76016) $211.20 $352 2.0×
Mr safety implant&/fb assmt clin staf 1st 15 min (76014) $58.80 $98 1.7×
Mr safety implt electronics prepj supvj phys/qhp (76018) $220.80 $368 1.9×
Mr safety implt pos&/immoblj (76019) $142.80 $238 2.0×
Mr safety med physics xm customization plng&mntr (76017) $580.20 $967 2.0×
Mra Head W/O & W/Contrast Material (70546) $1,561.20 $2,602 3.7×
MRA head w/o contrast (70544) $1,317.60 $2,196 4.6×
MRA head with contrast (70545) $1,317.60 $2,196 3.2×
MRA neck w contrast (70548) $1,317.60 $2,196 3.2×
Mra Neck W/O &W/Contrast Material (70549) $1,496.40 $2,494 3.6×
MRA neck w/o contrast (70547) $1,317.60 $2,196 4.6×
MRI abdomen w contrast (74182) $1,317.60 $2,196 3.2×
MRI abdomen w/o contrast (74181) $1,317.60 $2,196 4.6×
MRI any jt lower extrem w/contrast material (73722) $1,500.60 $2,501 1.6×
MRI any jt lower extrem w/o & w/contrast matrl (73723) $1,561.20 $2,602 3.7×
MRI any jt upper extremity w/contrast matrl (73222) $1,500.60 $2,501 1.6×
MRI brain functional w/o physician admnistration (70554) $1,317.60 $2,196 4.6×
MRI brain functional w/physician admnistration (70555) $1,317.60 $2,196 4.6×
MRI Breast W/O Contrast Bilateral (77047) $495.60 $826 1.7×
MRI Breast Without Contrast Material Unilateral (77046) $330 $550 1.2×
MRI cardiac w/o cont stress (75559) $1,317.60 $2,196 2.0×
MRI cardiac w/o contrast (75557) $1,512.60 $2,521 5.3×
MRI cervical spine w contrast (72142) $1,317.60 $2,196 3.2×
MRI cervical spine w/o cont (72141) $1,317.60 $2,196 4.6×
MRI chest w/o contrast (71550) $1,317.60 $2,196 4.6×
MRI chest with contrast (71551) $1,317.60 $2,196 1.4×
MRI chest wo w contrast (71552) $1,662.60 $2,771 4.0×
MRI lower extrem oth/thn jt w/contrast matrl (73719) $903.60 $1,506 2.2×
MRI lower extrem oth/thn jt w/o & w/contr matr (73720) $1,005 $1,675 2.4×
MRI lower extrem oth/thn jt w/o contr matrl (73718) $781.80 $1,303 2.7×
MRI lumbar spine w contrast (72149) $1,317.60 $2,196 3.2×
Mri Neck Spine W/O & W/Dye (72156) $1,698 $2,830 4.1×
MRI orbit face &/neck w/o contrast (70540) $1,317.60 $2,196 4.6×
MRI orbit face neck w contrast (70542)
range across 2 matching MRF lines		 $1,317.60–$1,589.40 $2,196–$2,649 varies
Mri Orbt/Fac/Nck W/O &W/Dye (70543) $1,671 $2,785 4.0×
MRI pelvis w contrast (72196) $1,317.60 $2,196 3.2×
MRI pelvis w/o & w contrast (72197) $1,675.20 $2,792 4.0×
MRI pelvis w/o contrast (72195) $1,317.60 $2,196 4.6×
MRI spectroscopy (76390) $1,320.60 $2,201 12.7×
MRI thoracic spine w/o contrast (72146) $1,317.60 $2,196 4.6×
MRI upper extremity oth than jt w/contr matrl (73219) $1,171.80 $1,953 2.8×
MRI upper extremity oth than jt w/o contr matrl (73218) $781.80 $1,303 2.7×
Mri Uppr Extremity W/O&W/Dye (73220) $1,005 $1,675 2.4×
MRI, abdomen, combo (74183) $1,675.20 $2,792 4.0×
MRI, dorsal spine combo (72157) $1,698 $2,830 4.1×
MRI, dorsal spine contrast (72147) $1,317.60 $2,196 3.2×
MRI, joint upper extrem (73221) $781.80 $1,303 2.7×
MRI, joint upper extrem combo (73223) $1,561.20 $2,602 3.7×
MRI, lumbar spine combo (72158) $1,698 $2,830 4.1×
Myelogram cervical (72240) $505.20 $842 0.5×
Myelogram Lumbar (72265) $1,500.60 $2,501 1.6×
Myelography thoracic (72255) $459.60 $766 0.5×
Myelograpy 2/more regions rs&i (72270) $1,144.80 $1,908 1.2×
Myocardial Imaging Infarct Avid Planar Qual/Quan (78466) $351.60 $586 0.7×
Myocardial Perfusion Planar 1 Study Rest/Stress (78453) $1,112.40 $1,854 0.7×
Myocardial Spect Multiple Studies (78452) $1,112.40 $1,854 0.7×
Neck soft tissue (70360) $136.80 $228 1.3×
Nm unlisted gi procedure (78299) $276.60 $461 0.6×
Nm whole blood volume (78122) $411.60 $686 0.6×
Nuclear Rx Intra-Arterial (79445) $583.80 $973 2.1×
Nuclear Rx Oral Admin (79005) $1,592.40 $2,654 5.7×
Ob us nuchal meas 1 gest (76813) $255 $425 2.0×
Ophthalmic ultrasound dx b-scan w/wo a-scan (76512) $252.60 $421 2.0×
Pelvis 1 or 2 views (72170) $252.60 $421 2.0×
Perineogram (74775) $252.60 $421 0.9×
Pet Image W/Ct Lmtd (78814) $2,073 $3,455 1.2×
PET image w/CT, full body (78816) $4,299.60 $7,166 2.5×
PET imaging CT attenuation skull base mid-thigh (78815) $3,729.60 $6,216 2.2×
Prq Transhepatc Portograpy Hemodyn Eval Rs&I (75885) $1,332 $2,220 0.4×
Pulmonary Perfusion Imaging Particulate (78580) $632.40 $1,054 1.3×
Radex abscess/fistula/sinus tract rs&i (76080) $511.80 $853 0.8×
Radex Ankle Complete Minimum 3 Views (73610) $136.80 $228 1.3×
Radex Calcaneus Minimum 2 Views (73650) $136.80 $228 1.3×
Radex elbow complete minimum 3 views (73080) $136.80 $228 1.3×
Radex Facial Bones Complete Minimum 3 Views (70150) $252.60 $421 2.0×
Radex fingr minimum 2 views (73140) $136.80 $228 1.3×
Radex foot complete minimum 3 views (73630) $136.80 $228 1.3×
Radex Hand Minimum 3 Views (73130) $136.80 $228 1.3×
Radex lower extremity infant minimum 2 views (73592) $136.80 $228 1.3×
Radex Nasal Bones Complete Minimum 3 Views (70160) $136.80 $228 1.3×
Radex Ribs Unilateral 2 Views (71100) $136.80 $228 1.3×
Radex shoulder complete minimum 2 views (73030) $136.80 $228 1.3×
Radex Sinuses Paransl < 3 Views (70210) $136.80 $228 1.3×
Radex Spine 1 View Specify Level (72020) $136.80 $228 1.3×
Radex Sternum Minimum 2 Views (71120) $136.80 $228 1.3×
Radex Temporomandble Jt Opn & Clsd Mouth Bilat (70330) $420 $700 4.0×
Radex Toe Minimum 2 Views (73660) $136.80 $228 1.3×
Radex upper extremity infant minimum 2 views (73092) $252.60 $421 2.0×
Radex Wrist Complete Minimum 3 Views (73110) $136.80 $228 1.3×
Radex X-Ray Exam Entire Spi 6/> Vw - Xr Entire Spine 6+ Vw (72084) $788.40 $1,314 6.3×
Radiolog exam mandible compl minimum 4 views (70110) $252.60 $421 2.0×
Radiologic Exam Abdomen 3+ Views - Xr Abdomen 3+ Views (74021) $327 $545 2.6×
Radiologic exam colon double contrast study (74280) $556.20 $927 2.6×
Radiologic exam colon single contrast study (74270) $556.20 $927 2.6×
Radiologic exam knee complete 4/more views (73564) $252.60 $421 2.0×
Radiologic exam pelvis compl minimum 3 views (72190) $252.60 $421 2.0×
Radiologic Exam Small Int Single Contrast Study (74250) $252.60 $421 1.2×
Radiologic exam swallow function contrast study (74230) $252.60 $421 1.2×
Radiologic exam upr gi trc double contrast study (74246) $427.80 $713 2.0×
Radiologic examination femur 1 view (73551) $136.80 $228 1.3×
Radiologic examination femur minimum 2 views (73552) $136.80 $228 1.3×
Radiologic examination knee 1/2 views (73560) $136.80 $228 1.3×
Radiologic Examination Osseous Survey Limited (77074) $252.60 $421 2.0×
Radiologic examination tibia & fibula 2 views (73590) $136.80 $228 1.3×
Ribs bilateral 3 views (71110) $252.60 $421 2.0×
Rp loclzj tum plnr 1 area single day imaging (78800) $1,260 $2,100 2.6×
Rp loclzj tum plnr 2+area 1+d img/1 area img>2+d (78801) $2,586 $4,310 5.4×
Rp Loclzj Tum Plnr Whole Body Single Day Imaging (78802) $1,549.80 $2,583 2.4×
Rp Loclzj Tum Spect 1 Area Single Day Imaging (78803) $998.40 $1,664 1.5×
Rp loclzj tum spect CT 2area 1d img/1 ar img>2+d (78832) $3,431.40 $5,719 2.0×
Rp loclzj tum spect w/CT 1 area/acquisj 1day img (78830) $3,191.40 $5,319 2.1×
Rp Therapy Intravenous Administration (79101) $3,447 $5,745 12.3×
Scapula (73010) $252.60 $421 2.0×
Shoulder 1 view (73020) $136.80 $228 1.3×
Shoulder Arthrography (73040) $532.80 $888 1.3×
Sialogram (70390) $453.60 $756 1.6×
Skull less than 4 views (70250) $252.60 $421 2.0×
Speech evaluation, complex (70371) $589.20 $982 2.1×
Sternoclavicular joints (71130) $136.80 $228 1.3×
Testicular Imaging W/Flow (78761) $1,523.40 $2,539 3.2×
Ther Rad Simulaj-Aided Field Setting Complex (77290) $454.80 $758 1.0×
Ther Rad Simulaj-Aided Field Setting Intermed (77285) $379.20 $632 0.8×
Ther rad simulaj-aided field setting simple (77280) $303 $505 1.9×
Therapeutic Enema Rdctj Intussusception/Obstrcj (74283) $556.20 $927 2.6×
Thoracic spine 2 views (72070) $252.60 $421 2.0×
Thoracic spine 3 views (72072) $252.60 $421 2.0×
Thoracolumbar 2 views (72080) $136.80 $228 1.3×
Thyroid Met Imaging Body (78018) $1,268.40 $2,114 1.9×
Thyroid Uptake Measurement (78012) $266.40 $444 0.6×
Thyroid Uptake W/Blood Flow Sngle/Mult Quan Meas (78014) $779.40 $1,299 1.6×
Ultrasound Breast Limited (76642) $379.80 $633 3.6×
Ultrasound elastography first target lesion (76982) $162.60 $271 1.3×
Ultrasound Elastography Parenchyma (76981) $217.20 $362 1.7×
Ultrasound trgt dynamic microbubble 1st lesion (76978) $162.60 $271 0.4×
Ultrasound, abdomen limited (76705) $252.60 $421 2.0×
Umbilical-artery Doppler (OB) (76820) $252.60 $421 2.0×
Unlisted fluoroscopic procedure (76496) $796.20 $1,327 7.6×
Unlisted genitourinary px dx nuclear medicine (78799) $515.40 $859 1.1×
Unlisted magnetic resonance procedure (76498) $1,718.40 $2,864 16.5×
Unlisted us procedure (76999) $208.20 $347 2.0×
Upper gi w/o kub (74240) $556.20 $927 2.6×
Urethrocystogram voiding (74455) $511.80 $853 1.8×
Urethrocystography retrograde (74450) $511.80 $853 1.8×
Us breast unilateral complete (76641) $252.60 $421 2.0×
Us chest (76604) $252.60 $421 2.0×
Us complete joint (76881) $252.60 $421 2.0×
Us exam, pelvic, limited (76857) $252.60 $421 2.0×
Us head (76506) $252.60 $421 2.0×
Us kidney transplant (76776) $252.60 $421 2.0×
Us lmtd joint/oth nonvasc xtr strux r-t w/img (76882) $252.60 $421 2.0×
Us ob detailed single fetus (76811) $580.20 $967 2.0×
Us ob limited 1 or more fetuses (76815) $255 $425 2.0×
Us ob transvaginal (76817) $258 $430 2.1×
Us pelvic non ob complete (76856) $252.60 $421 2.0×
Us pg uter img f&mat 14 wk tabdl 1/1st gestation (76801) $414 $690 3.3×
Us preg uterus real time f/u trnsabdl per fetus (76816) $258 $430 2.1×
Us retroperitoneal complete (76770) $252.60 $421 2.0×
Us retroperitoneal limited (76775) $252.60 $421 2.0×
Us scrotum and contents (76870) $252.60 $421 2.0×
Us spinal canal and contents (76800) $252.60 $421 2.0×
Us thyroid (76536) $252.60 $421 2.0×
Us transrectal (76872) $428.40 $714 3.4×
Vein X-Ray Chest (75827)
range across 2 matching MRF lines		 $1,230.60–$1,357.20 $2,051–$2,262 varies
Venogram Sinus/Jugular (75860) $1,098.60 $1,831 0.3×
Venography caval inferior serialography rs&i (75825) $2,010.60 $3,351 0.5×
Venography extremity bilateral rs&i (75822) $1,484.40 $2,474 0.8×
Venography extremity unilateral rs&i (75820) $1,141.80 $1,903 0.6×
Venography Renal Unilateral (75831) $2,166.60 $3,611 0.6×
Venous sampling by catheter (75893)
likely a partial charge, not the full procedure		 $1,325.40 $2,209 0.2×
Wrist 2 views (73100) $136.80 $228 1.3×
X-Ray Ac Jts - Xr Acromioclavicular Joints Bilateral (73050) $136.80 $228 1.3×
X-ray antegrade pyelogram tube (74425) $556.20 $927 1.3×
X-Ray Bend Only L-S Spine (72120) $144.60 $241 1.2×
X-Ray Elbow 2 Vw - Xr Elbow 1-2 Views Right (73070) $136.80 $228 1.3×
X-Ray Exam Entire Spi 1 Vw (72081) $136.80 $228 1.3×
X-Ray Exam Entire Spi 2/3 Vw (72082) $252.60 $421 2.0×
X-Ray Exam Entire Spi 4/5 Vw (72083) $252.60 $421 2.0×
X-Ray Exam Hip Uni 1 View (73501) $136.80 $228 1.3×
X-Ray Exam Hip Uni 2-3 Views (73502) $136.80 $228 1.3×
X-Ray Exam Hip Uni 4/> Views (73503) $295.80 $493 2.4×
X-Ray Exam Hips Bi 2 Views (73521) $252.60 $421 2.0×
X-Ray Exam Hips Bi 3-4 Views (73522) $252.60 $421 2.0×
X-Ray Exam Hips Bi 5/> Views (73523) $252.60 $421 2.0×
X-Ray Exam L-S Spine Bending (72114) $252.60 $421 2.0×
X-Ray Exam Neck Spine 2-3 Vw (72040) $136.80 $228 1.3×
X-Ray Exam Neck Spine 6/>Vws (72052) $252.60 $421 2.0×
X-Ray Exam Unilat Ribs/Chest (71101) $252.60 $421 2.0×
X-ray humerus (73060) $136.80 $228 1.3×
X-ray IV pyelogram (ivp) (74400) $564 $940 2.7×
X-Ray Jaw <4 Vw - Xr Mandible < 4 Views (70100) $136.80 $228 1.3×
X-Ray Knee Bilat Standing - Xr Knees Anteroposterior Standing Bilat (73565) $136.80 $228 1.3×
X-Ray Lumbar Spine 2/3 Vw - Xr Lumbar Spine 2-3 Views (72100) $252.60 $421 2.0×
X-ray nose-rectum child f.b. (76010) $136.80 $228 1.3×
X-Ray Ribs, Chest 4+ Vw - Xr Ribs 3 Vws Bil W/ Chest Posteroanterior (71111) $252.60 $421 2.0×
X-Ray Sacroiliac Jts 3+ Vw - Xr Sacroiliac Joints 3+ Views (72202) $252.60 $421 2.0×
X-Ray Sacrum/Coccyx 2+ Vw - Xr Sacrum Coccyx 2+ Views (72220) $136.80 $228 1.3×
X-Ray Sinuses 3+ Vw - Xr Paranasal Sinuses 3+ Views (70220) $136.80 $228 1.3×
X-Ray Skull 4+ Vw - Xr Skull Complete 4+ Views (70260) $252.60 $421 2.0×
X-Ray Stress View (77071) $136.80 $228 1.3×
X-Ray Urinary Tract Exam With Contrast Material (74420) $1,005 $1,675 2.4×
X-Rays Bone Length Studies (77073)
range across 3 matching MRF lines		 $252.60–$1,192.80 $421–$1,988 varies
X-Rays Bone Survey Complete (77075) $252.60 $421 2.0×
Xr c-spine 4 or 5 views (72050) $252.60 $421 2.0×
Xr facial bones less than 3 views (70140) $279.60 $466 2.7×
Xr orbits complete 4 views (70200) $252.60 $421 2.0×

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.