Imaging prices at Corewell Health Grand Rapids Hospitals Butterworth (Grand Rapids, MI)

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

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Procedure	Posted cash	Posted gross	× Medicare
3-D radiotherapy plan dose-volume histograms (77295)	$5,508	$5,508	4.0×
Abdomen 1 View (74018) range across 2 matching MRF lines	$152–$217	$152–$217	varies
Abdomen 2 views (74019) range across 2 matching MRF lines	$175–$250	$175–$250	varies
Acute Gastrointestinal Blood Loss Imaging (78278)	$555	$555	1.4×
Angio pulmonary bilat (75743)	$4,566	$4,566	1.5×
Angiography extremity bilateral rs&i (75716)	$6,102	$6,102	1.9×
Angiography extremity unilateral rs&i (75710)	$5,305	$5,305	1.7×
Angiography pulmonary unilateral slctv rs&i (75741)	$4,566	$4,566	1.5×
Angrph pulmonary nonslctv cath/ven njx rs&i (75746)	$3,723	$3,723	1.2×
Ankle 2 views (73600) range across 2 matching MRF lines	$221–$277	$221–$277	varies
Aortography thoracic serialography rs&i (75605)	$7,607	$7,607	1.4×
Artery X-Rays Abdomen (75726) range across 2 matching MRF lines	$6,104–$7,607	$6,104–$7,607	varies
Artery X-Rays Pelvis (75736)	$7,607	$7,607	1.4×
Artery X-Rays Spine (75705)	$7,607	$7,607	1.4×
Basic radiation dosimetry calculation (77300)	$464	$464	3.5×
Bone age studies (77072) range across 2 matching MRF lines	$246–$366	$246–$366	varies
Bone Imaging 3 Phase (78315)	$1,004	$1,004	2.5×
Bone Imaging Limited Area (78300)	$661	$661	1.7×
Bone Imaging Whole Body (78306)	$874	$874	2.2×
Bone marrow imaging limited area (78102)	$489	$489	1.2×
Bone survey infant (77076)	$281	$281	2.7×
Brachytx isodose intermed (77317)	$1,120	$1,120	3.0×
Brain Imaging Min 4 Static Views W Vascular Flow (78606)	$696	$696	1.3×
Brain Imaging Pet Metabolic Evaluation (78608)	$8,705	$8,705	6.1×
Cardiac MRI w/w/o contrast & further seq (75561) range across 2 matching MRF lines	$1,708–$2,441	$1,708–$2,441	varies
Cardiac MRI w/w/o contrast w/stress (75563) range across 2 matching MRF lines	$2,335–$4,741	$2,335–$4,741	varies
Cat Scan Follow-Up Study (76380) range across 2 matching MRF lines	$440–$628	$440–$628	varies
Cerebrospinal Fluid Flow W/O Matl Shunt Evaltj (78645)	$975	$975	1.8×
Cerebrospinal Fluid Scan (78630)	$618	$618	1.1×
Chest 1 view (71045) range across 2 matching MRF lines	$178–$254	$178–$254	varies
Chest 2 views (71046) range across 4 matching MRF lines	$205–$292	$205–$292	varies
Chest 3 views (71047) range across 2 matching MRF lines	$210–$337	$210–$337	varies
Chest 4 or more views (71048) range across 4 matching MRF lines	$270–$388	$270–$388	varies
Chg us nrv&acc strux 1 xtr compre w/img pr extremity (76883)	$578	$578	5.5×
Clavicle complete (73000) range across 2 matching MRF lines	$154–$243	$154–$243	varies
Computed Tomography Thorax Lw Dose Lng Ca Scr C- (71271) range across 2 matching MRF lines	$382–$546	$382–$546	varies
Continuing medical physics consltj pr wk (77336)	$464	$464	3.5×
Contrast Exam Abdominl Aorta (75625)	$5,313	$5,313	1.7×
Contrast X-Ray Bladder (74430)	$546	$546	1.6×
Contrast Xray Throat/Cerv Esopha (74210)	$651	$651	3.7×
CT abdomen and pelvis without and with contrast (74178) range across 2 matching MRF lines	$2,313–$3,304	$2,313–$3,304	varies
CT abdomen and pelvis without contrast (74176) range across 2 matching MRF lines	$1,250–$1,786	$1,250–$1,786	varies
CT abdomen w contrast (74160) range across 2 matching MRF lines	$916–$1,313	$916–$1,313	varies
CT abdomen w wo contrast (74170) range across 2 matching MRF lines	$1,095–$1,565	$1,095–$1,565	varies
CT abdomen w/o contrast (74150) range across 2 matching MRF lines	$592–$846	$592–$846	varies
CT Angio Abdomen and Pelvis (74174) range across 2 matching MRF lines	$2,000–$2,858	$2,000–$2,858	varies
CT Angio Chest (71275) range across 2 matching MRF lines	$970–$1,385	$970–$1,385	varies
CT Angio Head (70496) range across 2 matching MRF lines	$970–$1,385	$970–$1,385	varies
CT angio hrt w/3d image (75574)	$1,385	$1,385	4.0×
Ct Angio Lwr Extr W/O&W/Dye (73706) range across 2 matching MRF lines	$970–$1,385	$970–$1,385	varies
CT Angio Neck (70498) range across 2 matching MRF lines	$970–$1,385	$970–$1,385	varies
Ct Angio Upr Extrm W/O&W/Dye (73206) range across 2 matching MRF lines	$970–$1,385	$970–$1,385	varies
CT cervical spine w/ contrast (72126) range across 2 matching MRF lines	$916–$1,313	$916–$1,313	varies
CT cervical spine w/o contrast (72125) range across 2 matching MRF lines	$592–$846	$592–$846	varies
CT cervical spine w/wo cont (72127) range across 2 matching MRF lines	$1,095–$1,565	$1,095–$1,565	varies
CT chest w contrast (71260) range across 2 matching MRF lines	$916–$1,313	$916–$1,313	varies
CT chest w/wo contrast (71270) range across 2 matching MRF lines	$1,095–$1,565	$1,095–$1,565	varies
CT colonography screening (74263) range across 2 matching MRF lines	$1,134–$1,455	$1,134–$1,455	varies
CT Colonogrphy Dx Image Postprocess W/Contrast (74262) range across 2 matching MRF lines	$890–$1,276	$890–$1,276	varies
CT colonogrphy dx image postprocess w/o contrast (74261) range across 2 matching MRF lines	$592–$846	$592–$846	varies
CT head/brain with contrast (70460) range across 2 matching MRF lines	$916–$1,313	$916–$1,313	varies
CT head/brain without and with contrast (70470) range across 2 matching MRF lines	$1,095–$1,565	$1,095–$1,565	varies
CT heart contrast eval cardiac structure&morph (75572)	$1,385	$1,385	4.0×
CT heart no contrast quant eval coronry calcium (75571)	$150	$150	1.7×
CT hrt w/3d image congen (75573)	$1,385	$1,385	4.0×
CT iac w contrast (70481) range across 2 matching MRF lines	$916–$1,313	$916–$1,313	varies
CT l-spine w&w/o contrast (72133) range across 2 matching MRF lines	$1,095–$1,565	$1,095–$1,565	varies
CT lower ext w/o (73700) range across 2 matching MRF lines	$592–$846	$592–$846	varies
CT lower extremity w/contrast material (73701) range across 2 matching MRF lines	$1,095–$1,313	$1,095–$1,313	varies
CT lumbar spine w contrast (72132) range across 2 matching MRF lines	$916–$1,313	$916–$1,313	varies
CT lumbar spine w/o contrast (72131) range across 2 matching MRF lines	$592–$846	$592–$846	varies
CT maxillofacial w contrast (70487) range across 2 matching MRF lines	$916–$1,313	$916–$1,313	varies
CT maxillofacial wo contrast (70486) range across 2 matching MRF lines	$592–$846	$592–$846	varies
CT neck tissue combo (70492) range across 2 matching MRF lines	$1,095–$1,565	$1,095–$1,565	varies
Ct Orbit/Ear/Fossa W/O&W/Dye (70482) range across 2 matching MRF lines	$1,095–$1,565	$1,095–$1,565	varies
CT orbits w/o contrast (70480) range across 2 matching MRF lines	$592–$846	$592–$846	varies
CT pelvis w&w/o contrast (72194) range across 2 matching MRF lines	$1,095–$1,565	$1,095–$1,565	varies
CT pelvis w/o contrast (72192) range across 2 matching MRF lines	$592–$846	$592–$846	varies
CT scan of leg combo (73702) range across 2 matching MRF lines	$1,360–$1,565	$1,360–$1,565	varies
CT scans face/jaw combo (70488) range across 2 matching MRF lines	$1,095–$1,565	$1,095–$1,565	varies
CT soft tissue neck w contrast (70491) range across 2 matching MRF lines	$916–$1,313	$916–$1,313	varies
CT soft tissue neck w/o contrast (70490) range across 2 matching MRF lines	$592–$846	$592–$846	varies
CT thoracic spine w contrast (72129) range across 2 matching MRF lines	$916–$1,313	$916–$1,313	varies
CT thoracic spine w/o contrast (72128) range across 2 matching MRF lines	$592–$846	$592–$846	varies
CT thoracic spine w/wo cont (72130) range across 2 matching MRF lines	$1,096–$1,565	$1,096–$1,565	varies
CT thorax w/o contrast (71250) range across 2 matching MRF lines	$592–$846	$592–$846	varies
CT unlisted procedure (76497)	$128	$128	1.5×
CT upper ext wo (73200) range across 2 matching MRF lines	$592–$846	$592–$846	varies
CT upper extremity w/o & w/contrast material (73202) range across 2 matching MRF lines	$1,095–$1,565	$1,095–$1,565	varies
CT upper extremity with contrast (73201) range across 2 matching MRF lines	$916–$1,313	$916–$1,313	varies
Cta Abdl Aorta&Bi Iliofem W/Contrast&Postp (75635) range across 2 matching MRF lines	$970–$1,385	$970–$1,385	varies
Cta Abdomen (74175) range across 2 matching MRF lines	$970–$1,385	$970–$1,385	varies
CTA head&neck c+ w/noncontrast img&post-pxessing (70471) range across 2 matching MRF lines	$1,165–$1,294	$1,165–$1,294	varies
CTA pelvis (72191) range across 2 matching MRF lines	$970–$1,385	$970–$1,385	varies
Diskography lumbar (72295)	$1,807	$1,807	0.9×
Doppler Fetal Mid Cerebral Artery (76821)	$649	$649	6.2×
Dxa Bone Density Axial (77080) range across 2 matching MRF lines	$246–$352	$246–$352	varies
Dxa bone density study (77085) range across 2 matching MRF lines	$538–$621	$538–$621	varies
Dxa bone density study 1/>sites appendiclr skel (77081)	$144	$144	1.7×
Echo exam uterus (76831) range across 2 matching MRF lines	$312–$347	$312–$347	varies
Echo Guide For Artery Repair (76936)	$1,072	$1,072	5.0×
Esophagram (74220)	$242	$242	1.4×
Fetal Biophys Profile W/Nst (76818)	$929	$929	8.9×
Fetal Biophysical Profile W/O Non-Stress Testing (76819) range across 2 matching MRF lines	$466–$808	$466–$808	varies
Fetal MRI w/placntl matrnl plvc img sing/1st ges (74712)	$1,514	$1,514	6.4×
Fluoroscopy up to 1 hr (76000)	$367	$367	1.5×
Follow-Up Angiography (75898)	$4,566	$4,566	1.5×
Foot 2 views (73620) range across 2 matching MRF lines	$154–$235	$154–$235	varies
Forearm 2 views (73090) range across 2 matching MRF lines	$154–$240	$154–$240	varies
Gastric emptying imaging study (78264)	$842	$842	2.1×
Gated Heart Planar Single (78472) range across 2 matching MRF lines	$952–$1,076	$952–$1,076	varies
Hand 2 views (73120) range across 2 matching MRF lines	$168–$239	$168–$239	varies
Hdr Rdncl Ntrstl/Icav Brchtx (77771)	$4,453	$4,453	6.4×
Hdr Rdncl Ntrstl/Icav Brchtx 1 Channel (77770)	$3,872	$3,872	5.6×
Hepatc Vngrph Wdg/Fr Hemodyn Eval Rs&I (75889)	$4,566	$4,566	1.5×
Hepatc Vngrph Wdg/Fr W/O Hemodyn Eval Rs&I (75891)	$4,566	$4,566	1.5×
Hepatobil Syst Image W/Drug (78227)	$1,491	$1,491	2.8×
Hepatobiliary System Imaging (78226)	$691	$691	1.7×
Ht Muscle Image Spect Sing (78451)	$1,859	$1,859	1.4×
Hysterosalpingogram (74740)	$406	$406	1.7×
Image fusion (77399)	$422	$422	3.2×
Infant hip ultrasound, limited static exam (76886)	$367	$367	4.2×
Interstitial radiation source applic complex (77778)	$1,758	$1,758	2.5×
Joint Survey Single View (77077)	$133	$133	1.3×
K Flow/Funct Image W/Drug (78708)	$1,645	$1,645	3.0×
K Flow/Funct Image W/O Drug (78707)	$832	$832	1.5×
Knee 3 Views (73562) range across 2 matching MRF lines	$246–$259	$246–$259	varies
Lung Perf&Ventilat Diferentl (78598)	$1,038	$1,038	1.9×
Lung perfusion differential (78597)	$1,238	$1,238	3.1×
Lung Ventilat&Perfus Imaging (78582)	$1,066	$1,066	2.0×
Lymph System Imaging (78195)	$761	$761	1.4×
Lymphangiography Pelvic/Abdominal Bilateral Rs&I (75807)	$4,566	$4,566	1.5×
Lymphangiography, pelvic/abdominal, unilateral (75805)	$4,517	$4,517	1.4×
Magnetic Image Jaw Joint (70336) range across 2 matching MRF lines	$1,068–$1,526	$1,068–$1,526	varies
Magnetic resonance (eg, proton) imaging, brain (including brain stem andskull base), during open intracranial procedure… (70557)	$1,620	$1,620	3.0×
Magnetic Resonance Elastography (76391)	$1,523	$1,523	6.4×
Mammary ductogram or galactogram single (77053)	$485	$485	2.0×
Meckels Divert Exam (78290)	$644	$644	1.6×
Mlc imrt design & construction per imrt plan (77338)	$1,232	$1,232	3.3×
Mra Head W/O & W/Contrast Material (70546) range across 2 matching MRF lines	$1,975–$2,823	$1,975–$2,823	varies
MRA head w/o contrast (70544) range across 2 matching MRF lines	$1,068–$1,526	$1,068–$1,526	varies
MRA head with contrast (70545) range across 2 matching MRF lines	$1,654–$2,366	$1,654–$2,366	varies
Mra Neck W/O &W/Contrast Material (70549) range across 2 matching MRF lines	$1,975–$2,823	$1,975–$2,823	varies
MRA neck w/o contrast (70547) range across 2 matching MRF lines	$1,068–$1,526	$1,068–$1,526	varies
MRI abdomen w contrast (74182) range across 2 matching MRF lines	$1,422–$2,256	$1,422–$2,256	varies
MRI abdomen w/o contrast (74181) range across 2 matching MRF lines	$1,068–$1,526	$1,068–$1,526	varies
MRI any jt lower extrem w/contrast material (73722) range across 2 matching MRF lines	$1,655–$2,366	$1,655–$2,366	varies
MRI any jt lower extrem w/o & w/contrast matrl (73723) range across 2 matching MRF lines	$1,975–$2,823	$1,975–$2,823	varies
MRI any jt upper extremity w/contrast matrl (73222) range across 2 matching MRF lines	$1,422–$2,366	$1,422–$2,366	varies
MRI brain functional w/o physician admnistration (70554) range across 2 matching MRF lines	$1,068–$1,526	$1,068–$1,526	varies
MRI Breast W/O Contrast Bilateral (77047)	$1,526	$1,526	6.4×
MRI cardiac w/o cont stress (75559) range across 2 matching MRF lines	$1,620–$3,201	$1,620–$3,201	varies
MRI cardiac w/o contrast (75557) range across 2 matching MRF lines	$1,068–$1,526	$1,068–$1,526	varies
MRI cervical spine w contrast (72142) range across 2 matching MRF lines	$1,655–$2,366	$1,655–$2,366	varies
MRI cervical spine w/o cont (72141) range across 2 matching MRF lines	$1,068–$1,526	$1,068–$1,526	varies
MRI chest w/o contrast (71550) range across 2 matching MRF lines	$1,068–$1,526	$1,068–$1,526	varies
MRI chest wo w contrast (71552) range across 2 matching MRF lines	$1,975–$2,823	$1,975–$2,823	varies
MRI lower extrem oth/thn jt w/contrast matrl (73719) range across 2 matching MRF lines	$1,655–$2,366	$1,655–$2,366	varies
MRI lower extrem oth/thn jt w/o & w/contr matr (73720) range across 2 matching MRF lines	$1,975–$2,823	$1,975–$2,823	varies
MRI lower extrem oth/thn jt w/o contr matrl (73718) range across 2 matching MRF lines	$1,068–$1,526	$1,068–$1,526	varies
MRI lumbar spine w contrast (72149) range across 2 matching MRF lines	$1,655–$2,366	$1,655–$2,366	varies
Mri Neck Spine W/O & W/Dye (72156) range across 2 matching MRF lines	$1,975–$2,823	$1,975–$2,823	varies
MRI orbit face &/neck w/o contrast (70540) range across 2 matching MRF lines	$1,068–$1,526	$1,068–$1,526	varies
MRI orbit face neck w contrast (70542) range across 2 matching MRF lines	$1,853–$2,060	$1,853–$2,060	varies
Mri Orbt/Fac/Nck W/O &W/Dye (70543) range across 2 matching MRF lines	$1,975–$2,823	$1,975–$2,823	varies
MRI pelvis w contrast (72196) range across 2 matching MRF lines	$1,422–$2,299	$1,422–$2,299	varies
MRI pelvis w/o & w contrast (72197) range across 2 matching MRF lines	$1,975–$2,823	$1,975–$2,823	varies
MRI pelvis w/o contrast (72195) range across 2 matching MRF lines	$1,068–$1,526	$1,068–$1,526	varies
MRI spectroscopy (76390)	$3,219	$3,219	37.1×
MRI thoracic spine w/o contrast (72146) range across 2 matching MRF lines	$1,068–$1,526	$1,068–$1,526	varies
MRI upper extremity oth than jt w/o contr matrl (73218) range across 2 matching MRF lines	$1,068–$1,526	$1,068–$1,526	varies
Mri Uppr Extremity W/O&W/Dye (73220) range across 2 matching MRF lines	$1,975–$2,823	$1,975–$2,823	varies
MRI, abdomen, combo (74183) range across 2 matching MRF lines	$1,975–$2,823	$1,975–$2,823	varies
MRI, dorsal spine combo (72157) range across 2 matching MRF lines	$1,975–$2,823	$1,975–$2,823	varies
MRI, dorsal spine contrast (72147) range across 2 matching MRF lines	$1,655–$2,366	$1,655–$2,366	varies
MRI, joint upper extrem (73221) range across 2 matching MRF lines	$1,068–$1,526	$1,068–$1,526	varies
MRI, joint upper extrem combo (73223) range across 2 matching MRF lines	$1,975–$2,823	$1,975–$2,823	varies
MRI, lumbar spine combo (72158) range across 2 matching MRF lines	$1,975–$2,823	$1,975–$2,823	varies
Myocardial Spect Multiple Studies (78452) range across 2 matching MRF lines	$3,480–$4,049	$3,480–$4,049	varies
Myocrd img PET prfuj 1std rest/stress cncrnt CT (78430)	$6,343	$6,343	4.5×
Myocrd Img Pet Prfuj Mlt Std Rst&Strs Cncrnt CT (78431)	$9,893	$9,893	4.5×
Myocrd Img Pet Prfuj W/Metab 2rtracer Cncrnt CT (78433)	$12,091	$12,091	5.5×
N-invas est c ffr sw aly CTA (75580)	$4,819	$4,819	5.6×
Neck soft tissue (70360) range across 2 matching MRF lines	$154–$215	$154–$215	varies
Nonvascular Shunt X-Ray (75809)	$549	$549	5.3×
Ntsty modul radthx pln dose-vol histos (77301)	$5,837	$5,837	4.2×
Nuclear Rx Intra-Arterial (79445)	$781	$781	3.4×
Nuclear Rx Oral Admin (79005)	$915	$915	3.9×
Ophthalmic ultrasound dx b-scan w/wo a-scan (76512)	$613	$613	5.9×
Optic foramina (70190)	$84	$84	1.0×
Panoramic X-ray of jaws (70355)	$106	$106	1.2×
Parathyroid imaging w/tomographic spect & CT (78072)	$1,182	$1,182	2.2×
Pelvis 1 or 2 views (72170) range across 2 matching MRF lines	$221–$345	$221–$345	varies
Perineogram (74775)	$436	$436	1.8×
Pet Image W/Ct Lmtd (78814)	$6,315	$6,315	4.4×
PET image w/CT, full body (78816)	$7,249	$7,249	5.1×
PET imaging CT attenuation skull base mid-thigh (78815)	$6,524	$6,524	4.6×
Prq Transhepatc Portograpy Hemodyn Eval Rs&I (75885)	$4,566	$4,566	1.5×
Pulmonary Perfusion Imaging Particulate (78580)	$536	$536	1.3×
Radex Abd Compl Aqt Abd W/S/E/D Views 1 View Ch (74022) range across 2 matching MRF lines	$231–$329	$231–$329	varies
Radex abscess/fistula/sinus tract rs&i (76080) range across 2 matching MRF lines	$643–$860	$643–$860	varies
Radex Ankle Complete Minimum 3 Views (73610) range across 2 matching MRF lines	$246–$319	$246–$319	varies
Radex Calcaneus Minimum 2 Views (73650) range across 2 matching MRF lines	$154–$243	$154–$243	varies
Radex elbow complete minimum 3 views (73080) range across 2 matching MRF lines	$154–$239	$154–$239	varies
Radex Facial Bones Complete Minimum 3 Views (70150) range across 2 matching MRF lines	$246–$383	$246–$383	varies
Radex fingr minimum 2 views (73140) range across 2 matching MRF lines	$154–$197	$154–$197	varies
Radex foot complete minimum 3 views (73630) range across 2 matching MRF lines	$154–$238	$154–$238	varies
Radex Hand Minimum 3 Views (73130) range across 2 matching MRF lines	$193–$276	$193–$276	varies
Radex lower extremity infant minimum 2 views (73592) range across 2 matching MRF lines	$106–$148	$106–$148	varies
Radex Mastoids Compl Minimum 3 Views PR Side (70130) range across 2 matching MRF lines	$144–$158	$144–$158	varies
Radex Nasal Bones Complete Minimum 3 Views (70160) range across 2 matching MRF lines	$154–$237	$154–$237	varies
Radex Pharynx/Larx W/Fluor&/Magnification Tq (70370)	$320	$320	3.7×
Radex Ribs Unilateral 2 Views (71100) range across 2 matching MRF lines	$154–$236	$154–$236	varies
Radex shoulder complete minimum 2 views (73030) range across 2 matching MRF lines	$246–$315	$246–$315	varies
Radex Sinuses Paransl < 3 Views (70210) range across 2 matching MRF lines	$154–$220	$154–$220	varies
Radex Spine 1 View Specify Level (72020)	$210	$210	2.4×
Radex Sternum Minimum 2 Views (71120) range across 2 matching MRF lines	$154–$236	$154–$236	varies
Radex Temporomandble Jt Opn & Clsd Mouth Bilat (70330) range across 2 matching MRF lines	$307–$474	$307–$474	varies
Radex Toe Minimum 2 Views (73660) range across 2 matching MRF lines	$154–$238	$154–$238	varies
Radex upper extremity infant minimum 2 views (73092) range across 2 matching MRF lines	$144–$148	$144–$148	varies
Radex Wrist Complete Minimum 3 Views (73110) range across 2 matching MRF lines	$154–$238	$154–$238	varies
Radiation Delivery Stereotactic Cranial Linear (77372)	$20,111	$20,111	2.7×
Radiation treatment delivery level 1 (77402)	$2,064	$2,064	20.3×
Radiation treatment delivery level 2 (77407)	$2,148	$2,148	5.6×
Radiation treatment delivery level 3 (77412)	$2,558	$2,558	4.6×
Radiolog exam mandible compl minimum 4 views (70110) range across 2 matching MRF lines	$246–$377	$246–$377	varies
Radiologic Exam Abdomen 3+ Views - Xr Abdomen 3+ Views (74021) range across 2 matching MRF lines	$201–$353	$201–$353	varies
Radiologic exam colon single contrast study (74270)	$354	$354	2.0×
Radiologic Exam Esophagus Double Contrast Study (74221)	$414	$414	2.4×
Radiologic exam knee complete 4/more views (73564) range across 2 matching MRF lines	$246–$298	$246–$298	varies
Radiologic exam pelvis compl minimum 3 views (72190) range across 2 matching MRF lines	$306–$355	$306–$355	varies
Radiologic Exam Small Int Single Contrast Study (74250)	$290	$290	1.7×
Radiologic exam swallow function contrast study (74230)	$339	$339	1.9×
Radiologic exam upr gi trc double contrast study (74246)	$235	$235	1.3×
Radiologic examination femur 1 view (73551) range across 2 matching MRF lines	$175–$198	$175–$198	varies
Radiologic examination femur minimum 2 views (73552) range across 2 matching MRF lines	$194–$263	$194–$263	varies
Radiologic examination knee 1/2 views (73560) range across 2 matching MRF lines	$154–$225	$154–$225	varies
Radiologic Examination Osseous Survey Limited (77074)	$332	$332	3.2×
Radiologic examination tibia & fibula 2 views (73590) range across 2 matching MRF lines	$154–$240	$154–$240	varies
Renal Cyst Study (74470)	$491	$491	0.9×
Ribs bilateral 3 views (71110) range across 2 matching MRF lines	$246–$376	$246–$376	varies
Rp loclzj tum plnr 1 area single day imaging (78800)	$999	$999	2.5×
Rp Loclzj Tum Plnr Whole Body Single Day Imaging (78802)	$1,646	$1,646	3.0×
Rp Loclzj Tum Spect 1 Area Single Day Imaging (78803)	$2,177	$2,177	4.0×
Rp loclzj tum spect 2 area/sep acquisj img (78831)	$5,592	$5,592	4.3×
Rp loclzj tum spect CT 2area 1d img/1 ar img>2+d (78832)	$6,343	$6,343	4.5×
Rp loclzj tum spect w/CT 1 area/acquisj 1day img (78830)	$2,505	$2,505	1.9×
Scapula (73010) range across 2 matching MRF lines	$154–$242	$154–$242	varies
Screening Digital Breast Tomosynthesis Bi (77063) range across 2 matching MRF lines	$261–$268	$261–$268	varies
Shoulder 1 view (73020) range across 2 matching MRF lines	$154–$231	$154–$231	varies
Sialogram (70390)	$356	$356	1.5×
Skull less than 4 views (70250) range across 2 matching MRF lines	$246–$344	$246–$344	varies
Special dosimetry (77331)	$539	$539	4.0×
Special Physics Consult (77370)	$464	$464	3.5×
Special teletherapy port plan (77321)	$1,120	$1,120	3.0×
Special treatment procedure (77470)	$2,001	$2,001	3.6×
Stereotactic Body Radiation Delivery (77373)	$5,938	$5,938	3.3×
Sternoclavicular joints (71130) range across 2 matching MRF lines	$154–$245	$154–$245	varies
Superior sagittal sinus venogram (75870)	$4,566	$4,566	1.5×
Surface Applic Low Dose Rate Radionuclide Source (77789)	$299	$299	2.9×
Telethx isodose pln cplx w/basic dosimetry (77307)	$1,232	$1,232	3.3×
Ther Rad Simulaj-Aided Field Setting Complex (77290)	$1,232	$1,232	3.3×
Ther Rad Simulaj-Aided Field Setting Intermed (77285)	$1,351.54	$1,351.54	3.6×
Ther rad simulaj-aided field setting simple (77280)	$464	$464	3.5×
Therapeutic Enema Rdctj Intussusception/Obstrcj (74283)	$419	$419	2.4×
Thoracic spine 2 views (72070) range across 2 matching MRF lines	$168–$239	$168–$239	varies
Thoracic spine 3 views (72072) range across 2 matching MRF lines	$193–$276	$193–$276	varies
Thoracolumbar 2 views (72080) range across 2 matching MRF lines	$206–$244	$206–$244	varies
Thyroid Imaging With Vascular Flow (78013)	$466	$466	1.2×
Thyroid Met Imaging Body (78018)	$1,034	$1,034	1.9×
Thyroid Uptake W/Blood Flow Sngle/Mult Quan Meas (78014)	$953	$953	2.4×
Tx Devices Design & Construction Complex (77334)	$1,120	$1,120	3.0×
Tx devices design & construction intermediate (77333)	$576	$576	4.3×
Tx devices design & construction simple (77332)	$464	$464	3.5×
Ultrasound Breast Limited (76642)	$575	$575	6.6×
Ultrasound Elastography Parenchyma (76981)	$937	$937	9.0×
Ultrasound Exam Aaa Screen (76706) range across 2 matching MRF lines	$552–$591	$552–$591	varies
Ultrasound, abdomen limited (76705) range across 2 matching MRF lines	$542–$836	$542–$836	varies
Umbilical-artery Doppler (OB) (76820) range across 2 matching MRF lines	$426–$645	$426–$645	varies
Unlisted Dx Radiographic Procedure (76499)	$314	$314	3.6×
Unlisted fluoroscopic procedure (76496) range across 2 matching MRF lines	$113–$411	$113–$411	varies
Unlisted magnetic resonance procedure (76498)	$3,333	$3,333	38.4×
Unlisted Miscellaneous Px Dx Nuclear Medicine (78999)	$476	$476	1.2×
Unlisted Procedure Clinical Brachytherapy (77799)	$4,053.08	$4,053.08	39.9×
Upper gi w/o kub (74240)	$362	$362	2.1×
Urethrocystogram voiding (74455)	$670	$670	2.8×
Urethrocystography retrograde (74450)	$375	$375	1.6×
Us breast unilateral complete (76641)	$766	$766	7.4×
Us chest (76604) range across 2 matching MRF lines	$794–$851	$794–$851	varies
Us complete joint (76881)	$891	$891	8.6×
Us exam, pelvic, limited (76857) range across 2 matching MRF lines	$386–$595	$386–$595	varies
Us head (76506)	$710	$710	6.8×
Us kidney transplant (76776)	$938	$938	9.0×
Us lmtd joint/oth nonvasc xtr strux r-t w/img (76882) range across 2 matching MRF lines	$444–$596	$444–$596	varies
Us ob detailed single fetus (76811) range across 2 matching MRF lines	$1,117–$1,697	$1,117–$1,697	varies
Us ob limited 1 or more fetuses (76815) range across 2 matching MRF lines	$569–$867	$569–$867	varies
Us ob transvaginal (76817) range across 2 matching MRF lines	$569–$743	$569–$743	varies
Us pelvic non ob complete (76856) range across 2 matching MRF lines	$569–$886	$569–$886	varies
Us pg uter img f&mat 14 wk tabdl 1/1st gestation (76801) range across 2 matching MRF lines	$569–$896	$569–$896	varies
Us preg uterus real time f/u trnsabdl per fetus (76816) range across 2 matching MRF lines	$386–$612	$386–$612	varies
Us retroperitoneal complete (76770) range across 2 matching MRF lines	$842–$879	$842–$879	varies
Us retroperitoneal limited (76775) range across 2 matching MRF lines	$733–$861	$733–$861	varies
Us scrotum and contents (76870) range across 2 matching MRF lines	$569–$874	$569–$874	varies
Us thyroid (76536) range across 2 matching MRF lines	$569–$866	$569–$866	varies
Us transrectal (76872)	$591	$591	5.7×
Vein X-Ray Chest (75827) range across 2 matching MRF lines	$1,799–$2,199	$1,799–$2,199	varies
Vein X-Ray Liver W/O Hemodyn (75887)	$4,566	$4,566	1.5×
Venogram Sinus/Jugular (75860)	$4,566	$4,566	1.5×
Venography caval inferior serialography rs&i (75825) range across 2 matching MRF lines	$3,664–$4,651	$3,664–$4,651	varies
Venography extremity bilateral rs&i (75822) range across 2 matching MRF lines	$2,032–$2,717	$2,032–$2,717	varies
Venography extremity unilateral rs&i (75820) range across 2 matching MRF lines	$1,799–$2,242	$1,799–$2,242	varies
Venography Renal Bilateral (75833)	$8,510	$8,510	2.7×
Venography Renal Unilateral (75831)	$5,673	$5,673	1.8×
Venous sampling by catheter (75893)	$7,795	$7,795	1.4×
Vertebral fracture assessment via dxa (77086) range across 2 matching MRF lines	$244–$271	$244–$271	varies
Wrist 2 views (73100) range across 2 matching MRF lines	$106–$117	$106–$117	varies
X-Ray Ac Jts - Xr Acromioclavicular Joints Bilateral (73050) range across 2 matching MRF lines	$246–$355	$246–$355	varies
X-ray antegrade pyelogram tube (74425)	$546	$546	1.6×
X-Ray Aorta Leg Arteries (75630)	$6,111	$6,111	1.9×
X-Ray Elbow 2 Vw - Xr Elbow 1-2 Views Right (73070) range across 2 matching MRF lines	$154–$208	$154–$208	varies
X-Ray Exam Breast Specimen (76098) range across 2 matching MRF lines	$635–$720	$635–$720	varies
X-Ray Exam Entire Spi 1 Vw (72081) range across 2 matching MRF lines	$155–$222	$155–$222	varies
X-Ray Exam Entire Spi 2/3 Vw (72082) range across 2 matching MRF lines	$230–$255	$230–$255	varies
X-Ray Exam Entire Spi 4/5 Vw (72083) range across 2 matching MRF lines	$264–$293	$264–$293	varies
X-Ray Exam Hip Uni 1 View (73501) range across 2 matching MRF lines	$194–$236	$194–$236	varies
X-Ray Exam Hip Uni 2-3 Views (73502) range across 2 matching MRF lines	$207–$273	$207–$273	varies
X-Ray Exam Hip Uni 4/> Views (73503)	$342	$342	3.3×
X-Ray Exam Hips Bi 2 Views (73521) range across 2 matching MRF lines	$344–$389	$344–$389	varies
X-Ray Exam Hips Bi 3-4 Views (73522) range across 2 matching MRF lines	$344–$424	$344–$424	varies
X-Ray Exam Hips Bi 5/> Views (73523) range across 2 matching MRF lines	$462–$475	$462–$475	varies
X-Ray Exam L-S Spine Bending (72114) range across 2 matching MRF lines	$246–$366	$246–$366	varies
X-Ray Exam Neck Spine 2-3 Vw (72040) range across 2 matching MRF lines	$246–$345	$246–$345	varies
X-Ray Exam Neck Spine 6/>Vws (72052) range across 2 matching MRF lines	$246–$457	$246–$457	varies
X-Ray Exam Unilat Ribs/Chest (71101) range across 2 matching MRF lines	$246–$382	$246–$382	varies
X-ray eye for foreign body (70030) range across 2 matching MRF lines	$197–$212	$197–$212	varies
X-ray humerus (73060) range across 2 matching MRF lines	$154–$240	$154–$240	varies
X-Ray Jaw <4 Vw - Xr Mandible < 4 Views (70100) range across 2 matching MRF lines	$106–$107	$106–$107	varies
X-Ray Knee Bilat Standing - Xr Knees Anteroposterior Standing Bilat (73565) range across 2 matching MRF lines	$154–$228	$154–$228	varies
X-Ray Lumbar Spine 2/3 Vw - Xr Lumbar Spine 2-3 Views (72100) range across 2 matching MRF lines	$246–$308	$246–$308	varies
X-ray nose-rectum child f.b. (76010) range across 2 matching MRF lines	$106–$171	$106–$171	varies
X-Ray Ribs, Chest 4+ Vw - Xr Ribs 3 Vws Bil W/ Chest Posteroanterior (71111) range across 2 matching MRF lines	$284–$389	$284–$389	varies
X-Ray Sacroiliac Jts 3+ Vw - Xr Sacroiliac Joints 3+ Views (72202) range across 2 matching MRF lines	$246–$334	$246–$334	varies
X-Ray Sacroiliac Jts <3 Vw - Xr Sacroiliac Joints 1-2 Views (72200) range across 2 matching MRF lines	$177–$215	$177–$215	varies
X-Ray Sacrum/Coccyx 2+ Vw - Xr Sacrum Coccyx 2+ Views (72220) range across 2 matching MRF lines	$154–$236	$154–$236	varies
X-Ray Sinuses 3+ Vw - Xr Paranasal Sinuses 3+ Views (70220) range across 2 matching MRF lines	$246–$369	$246–$369	varies
X-Ray Skull 4+ Vw - Xr Skull Complete 4+ Views (70260) range across 2 matching MRF lines	$246–$380	$246–$380	varies
X-Ray Stress View (77071)	$155	$155	1.8×
X-Ray Tmj Unilat (70328)	$275	$275	3.2×
X-Rays Bone Length Studies (77073)	$194	$194	1.9×
X-Rays Bone Survey Complete (77075) range across 2 matching MRF lines	$242–$361	$242–$361	varies
Xr c-spine 4 or 5 views (72050) range across 2 matching MRF lines	$246–$398	$246–$398	varies
Xr facial bones less than 3 views (70140) range across 2 matching MRF lines	$90–$128	$90–$128	varies
Xr orbits complete 4 views (70200) range across 2 matching MRF lines	$246–$380	$246–$380	varies

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.