Imaging prices at Dupont Hospital LLC
Fort Wayne, IN · every code in this section with a posted price and a Medicare benchmark.
336 codes. Prices are the hospital's own posted facility charges.
Compare against other hospitals interactively →
| Procedure | Posted cash | Posted gross | × Medicare |
|---|---|---|---|
| Abdomen 1 View (74018) range across 5 matching MRF lines |
$78.57–$247.86 | $291–$918 | varies |
| Abdomen 2 views (74019) range across 4 matching MRF lines |
$125.82–$357.21 | $466–$1,323 | varies |
| Acute Gastrointestinal Blood Loss Imaging (78278) | $498.96 | $1,848 | 1.2× |
| Adrenal Cortex & Medulla Img (78075) | $845.37 | $3,131 | 0.6× |
| Angio internal mammary (75756) range across 5 matching MRF lines |
$1,334.34–$2,978.10 | $4,942–$11,030 | varies |
| Angio pulmonary bilat (75743) range across 6 matching MRF lines |
$3,532.28–$3,968.73 | $13,082.52–$14,699 | varies |
| Angiography Adrenal Bilateral Slctv Rs&I (75733) range across 3 matching MRF lines |
$2,016.85–$2,266.11 | $7,469.82–$8,393 | varies |
| Angiography extremity bilateral rs&i (75716) range across 10 matching MRF lines |
$184.14–$3,968.73 | $167–$14,699 | varies |
| Angiography extremity unilateral rs&i (75710) range across 11 matching MRF lines |
$3,532.28–$3,968.73 | $533–$14,699 | varies |
| Angiography pulmonary unilateral slctv rs&i (75741) range across 9 matching MRF lines |
$2,130.84–$3,945.24 | $7,892–$14,612 | varies |
| Angrph pulmonary nonslctv cath/ven njx rs&i (75746) range across 6 matching MRF lines |
$2,033.91–$2,642.76 | $7,533–$9,788 | varies |
| Ankle 2 views (73600) range across 9 matching MRF lines |
$5.94–$133.38 | $22–$494 | varies |
| Aortography thoracic serialography rs&i (75605) range across 7 matching MRF lines |
$4,934.25–$6,536.97 | $544–$24,211 | varies |
| Artery X-Rays Abdomen (75726) range across 5 matching MRF lines |
$6,697.89–$7,525.71 | $24,807–$27,873 | varies |
| Artery X-Rays Adrenal Gland (75731) range across 6 matching MRF lines |
$2,287.98–$2,570.67 | $8,474–$9,521 | varies |
| Artery X-Rays Pelvis (75736) range across 6 matching MRF lines |
$1,876.77–$6,536.97 | $6,951–$24,211 | varies |
| Artery X-Rays Spine (75705) range across 3 matching MRF lines |
$5,817.96–$6,536.97 | $21,548–$24,211 | varies |
| Arthrogram ankle (73615) | $522.99 | $1,937 | 1.4× |
| Arthrogram hip (73525) range across 4 matching MRF lines |
$522.99–$622.89 | $1,937–$2,307 | varies |
| Arthrogram Wrist (73115) range across 4 matching MRF lines |
$237.33–$522.99 | $879–$1,937 | varies |
| Bone age studies (77072) range across 4 matching MRF lines |
$108.54–$133.38 | $402–$494 | varies |
| Bone Imaging 3 Phase (78315) | $1,288.17 | $4,771 | 3.0× |
| Bone Imaging Limited Area (78300) | $952.02 | $3,526 | 2.3× |
| Bone Imaging Whole Body (78306) | $1,174.23 | $4,349 | 2.8× |
| Bone marrow imaging limited area (78102) | $833.76 | $3,088 | 2.0× |
| Bone marrow imaging; multiple areas (78103) | $216 | $800 | 0.5× |
| Bone marrow imaging; whole body (78104) | $1,174.23 | $4,349 | 2.8× |
| Bone survey infant (77076) range across 2 matching MRF lines |
$221.94–$470.88 | $822–$1,744 | varies |
| Brain Image W/Flow < 4 Views (78601) | $913.95 | $3,385 | 2.2× |
| Brain Imaging Min 4 Static Views W Vascular Flow (78606) | $780.57 | $2,891 | 1.4× |
| Card Bl Pool Gated Spect Rest Wal Motn Ejct Frct (78494) | $590.22 | $2,186 | 1.4× |
| Cardiac MRI w/w/o contrast & further seq (75561) | $90.45 | $335 | 0.2× |
| Cardiac MRI w/w/o contrast w/stress (75563) range across 3 matching MRF lines |
$103.95–$469.53 | $385–$1,739 | varies |
| Cat Scan Follow-Up Study (76380) | $148.77 | $551 | 1.6× |
| Cerebrospinal Fluid Scan (78630) | $821.61 | $3,043 | 1.4× |
| Chest 1 view (71045) range across 9 matching MRF lines |
$5.94–$131.76 | $22–$488 | varies |
| Chest 2 views (71046) range across 6 matching MRF lines |
$10.80–$236.79 | $40–$877 | varies |
| Chest 3 views (71047) range across 2 matching MRF lines |
$264.87–$280.80 | $981–$1,040 | varies |
| Cineradiograpy/vidradiograpy xcpt where spec (76120) | $14.04 | $52 | 0.1× |
| Clavicle complete (73000) range across 9 matching MRF lines |
$6.21–$176.58 | $23–$654 | varies |
| Computed Tomography Thorax Lw Dose Lng Ca Scr C- (71271) range across 4 matching MRF lines |
$37.26–$174.96 | $138–$648 | varies |
| Contrast Exam Abdominl Aorta (75625) range across 6 matching MRF lines |
$3,532.28–$3,968.73 | $544–$14,699 | varies |
| Contrast X-Ray Bladder (74430) range across 5 matching MRF lines |
$37.80–$396.90 | $140–$1,470 | varies |
| Contrast X-Ray Of Elbow (73085) range across 6 matching MRF lines |
$191.70–$522.99 | $710–$1,937 | varies |
| Contrast X-Ray Of Knee Joint (73580) | $522.99 | $1,937 | 1.4× |
| Corpora cavernosography (74445) | $93.15 | $345 | 0.8× |
| CT abdomen and pelvis without and with contrast (74178) range across 7 matching MRF lines |
$1,165.86–$2,177.01 | $4,318–$8,063 | varies |
| CT abdomen and pelvis without contrast (74176) range across 6 matching MRF lines |
$573.21–$1,149.66 | $2,123–$4,258 | varies |
| CT abdomen w contrast (74160) range across 6 matching MRF lines |
$443.07–$985.23 | $1,641–$3,649 | varies |
| CT abdomen w wo contrast (74170) range across 4 matching MRF lines |
$582.93–$1,126.71 | $2,159–$4,173 | varies |
| CT abdomen w/o contrast (74150) range across 2 matching MRF lines |
$326.16–$845.10 | $1,208–$3,130 | varies |
| CT Angio Abdomen and Pelvis (74174) range across 5 matching MRF lines |
$629.64–$2,384.37 | $2,332–$8,831 | varies |
| CT Angio Chest (71275) range across 6 matching MRF lines |
$630.45–$1,138.05 | $2,335–$4,215 | varies |
| CT Angio Head (70496) range across 4 matching MRF lines |
$630.45–$1,215.27 | $2,335–$4,501 | varies |
| CT angio hrt w/3d image (75574) range across 6 matching MRF lines |
$78.30–$612.36 | $290–$2,268 | varies |
| Ct Angio Lwr Extr W/O&W/Dye (73706) range across 4 matching MRF lines |
$1,040.85–$1,213.11 | $3,855–$4,493 | varies |
| CT Angio Neck (70498) range across 3 matching MRF lines |
$630.45–$1,215.27 | $2,335–$4,501 | varies |
| Ct Angio Upr Extrm W/O&W/Dye (73206) range across 4 matching MRF lines |
$1,003.05–$1,169.91 | $3,715–$4,333 | varies |
| CT cervical spine w/ contrast (72126) range across 2 matching MRF lines |
$1,217.43–$1,449.90 | $4,509–$5,370 | varies |
| CT cervical spine w/o contrast (72125) range across 3 matching MRF lines |
$326.16–$1,403.73 | $1,208–$5,199 | varies |
| CT cervical spine w/wo cont (72127) | $1,449.36 | $5,368 | 7.8× |
| CT chest w contrast (71260) range across 5 matching MRF lines |
$443.07–$938.52 | $1,641–$3,476 | varies |
| CT chest w/wo contrast (71270) range across 2 matching MRF lines |
$559.44–$1,093.77 | $2,072–$4,051 | varies |
| CT colonography screening (74263) | $905.04 | $3,352 | 3.6× |
| CT Colonogrphy Dx Image Postprocess W/Contrast (74262) | $456.84 | $1,692 | 2.5× |
| CT colonogrphy dx image postprocess w/o contrast (74261) | $416.61 | $1,543 | 3.8× |
| CT head/brain with contrast (70460) range across 2 matching MRF lines |
$494.37–$772.47 | $1,831–$2,861 | varies |
| CT head/brain without and with contrast (70470) range across 2 matching MRF lines |
$559.44–$1,057.32 | $2,072–$3,916 | varies |
| CT heart contrast eval cardiac structure&morph (75572) range across 3 matching MRF lines |
$61.29–$612.36 | $227–$2,268 | varies |
| CT heart no contrast quant eval coronry calcium (75571) range across 6 matching MRF lines |
$15.12–$168.48 | $56–$624 | varies |
| CT hrt w/3d image congen (75573) range across 3 matching MRF lines |
$88.29–$612.36 | $327–$2,268 | varies |
| CT iac w contrast (70481) range across 8 matching MRF lines |
$443.07–$1,406.70 | $1,641–$5,210 | varies |
| CT l-spine w&w/o contrast (72133) | $1,449.36 | $5,368 | 7.8× |
| CT lower ext w/o (73700) range across 26 matching MRF lines |
$326.16–$720.09 | $1,208–$2,667 | varies |
| CT lower extremity w/contrast material (73701) range across 26 matching MRF lines |
$443.07–$738.18 | $1,641–$2,734 | varies |
| CT lumbar spine w contrast (72132) range across 2 matching MRF lines |
$434.97–$1,569.24 | $1,611–$5,812 | varies |
| CT lumbar spine w/o contrast (72131) range across 2 matching MRF lines |
$326.16–$1,569.24 | $1,208–$5,812 | varies |
| CT maxillofacial w contrast (70487) range across 4 matching MRF lines |
$443.07–$913.14 | $1,641–$3,382 | varies |
| CT maxillofacial wo contrast (70486) range across 4 matching MRF lines |
$443.07–$656.64 | $1,641–$2,432 | varies |
| CT neck tissue combo (70492) range across 2 matching MRF lines |
$559.44–$1,288.71 | $2,072–$4,773 | varies |
| Ct Orbit/Ear/Fossa W/O&W/Dye (70482) range across 8 matching MRF lines |
$559.44–$1,109.43 | $2,072–$4,109 | varies |
| CT orbits w/o contrast (70480) range across 8 matching MRF lines |
$326.16–$871.29 | $1,208–$3,227 | varies |
| CT pelvis w&w/o contrast (72194) range across 3 matching MRF lines |
$559.44–$1,126.71 | $2,072–$4,173 | varies |
| CT pelvis w/o contrast (72192) range across 3 matching MRF lines |
$326.16–$845.10 | $1,208–$3,130 | varies |
| CT scan of leg combo (73702) range across 26 matching MRF lines |
$559.44–$757.89 | $2,072–$2,807 | varies |
| CT scans face/jaw combo (70488) range across 4 matching MRF lines |
$559.44–$1,294.65 | $2,072–$4,795 | varies |
| CT soft tissue neck w contrast (70491) range across 2 matching MRF lines |
$443.07–$1,288.71 | $1,641–$4,773 | varies |
| CT soft tissue neck w/o contrast (70490) range across 2 matching MRF lines |
$326.16–$1,288.71 | $1,208–$4,773 | varies |
| CT thoracic spine w contrast (72129) range across 2 matching MRF lines |
$443.07–$911.52 | $1,641–$3,376 | varies |
| CT thoracic spine w/o contrast (72128) range across 2 matching MRF lines |
$326.16–$1,036.26 | $1,208–$3,838 | varies |
| CT thoracic spine w/wo cont (72130) | $1,260.09 | $4,667 | 6.8× |
| CT thorax w/o contrast (71250) range across 6 matching MRF lines |
$26.73–$779.49 | $99–$2,887 | varies |
| CT upper ext wo (73200) range across 26 matching MRF lines |
$326.16–$720.09 | $1,208–$2,667 | varies |
| CT upper extremity w/o & w/contrast material (73202) | $559.44 | $2,072 | 3.0× |
| CT upper extremity with contrast (73201) range across 26 matching MRF lines |
$443.07–$738.18 | $1,641–$2,734 | varies |
| Cta Abdl Aorta&Bi Iliofem W/Contrast&Postp (75635) range across 2 matching MRF lines |
$630.45–$2,593.35 | $2,335–$9,605 | varies |
| Cta Abdomen (74175) range across 2 matching MRF lines |
$629.64–$1,456.38 | $2,332–$5,394 | varies |
| CTA pelvis (72191) range across 2 matching MRF lines |
$1,012.23–$1,180.17 | $3,749–$4,371 | varies |
| Dacryocystography, nasolacrimal duct, radiological supervision and interpretation Non-Facility (70170) | $60.75 | $225 | 0.2× |
| Dilation ureters/urethra rs&i (74485) | $2,598.48 | $9,624 | 1.2× |
| Diskography lumbar (72295) range across 6 matching MRF lines |
$2,529.72–$2,842.56 | $9,369.34–$10,528 | varies |
| Dxa Bone Density Axial (77080) range across 4 matching MRF lines |
$9.99–$282.42 | $37–$1,046 | varies |
| Dxa bone density study (77085) | $162 | $600 | 1.5× |
| Dxa bone density study 1/>sites appendiclr skel (77081) range across 4 matching MRF lines |
$9.99–$70.47 | $37–$261 | varies |
| Echo exam uterus (76831) range across 5 matching MRF lines |
$56.97–$294.30 | $211–$1,090 | varies |
| Esophagram (74220) range across 4 matching MRF lines |
$233.55–$380.43 | $865–$1,409 | varies |
| Fetal Biophys Profile W/Nst (76818) range across 5 matching MRF lines |
$38.34–$484.92 | $142–$1,796 | varies |
| Fetal Biophysical Profile W/O Non-Stress Testing (76819) range across 5 matching MRF lines |
$33.21–$493.83 | $123–$1,829 | varies |
| Fluoroscopy up to 1 hr (76000) range across 12 matching MRF lines |
$53.19–$663.12 | $20–$2,456 | varies |
| Follow-Up Angiography (75898) range across 8 matching MRF lines |
$964.17–$1,632.69 | $219–$6,047 | varies |
| Foot 2 views (73620) range across 10 matching MRF lines |
$17.55–$218.43 | $65–$809 | varies |
| Forearm 2 views (73090) range across 9 matching MRF lines |
$5.94–$169.83 | $22–$629 | varies |
| Gastric emptying imaging study (78264) | $991.98 | $3,674 | 2.3× |
| Gastroesophageal Reflux Exam (78262) | $498.96 | $1,848 | 1.2× |
| Gated Heart Planar Single (78472) range across 3 matching MRF lines |
$31.86–$1,182.33 | $118–$4,379 | varies |
| Gated Heart, Multiple (78473) | $707.67 | $2,621 | 1.7× |
| Hand 2 views (73120) range across 8 matching MRF lines |
$125.82–$166.59 | $466–$617 | varies |
| Hepatc Vngrph Wdg/Fr Hemodyn Eval Rs&I (75889) range across 5 matching MRF lines |
$2,978.10–$3,968.73 | $11,030–$14,699 | varies |
| Hepatc Vngrph Wdg/Fr W/O Hemodyn Eval Rs&I (75891) range across 3 matching MRF lines |
$3,532.28–$3,968.73 | $13,082.52–$14,699 | varies |
| Hepatobil Syst Image W/Drug (78227) | $1,198.53 | $4,439 | 2.1× |
| Hepatobiliary System Imaging (78226) | $1,186.92 | $4,396 | 2.8× |
| Ht Musc Image Planar Mult (78454) | $46.71 | $173 | 0.0× |
| Ht Muscle Image Spect Sing (78451) range across 7 matching MRF lines |
$235.44–$3,189.24 | $164–$11,812 | varies |
| Hysterosalpingogram (74740) range across 2 matching MRF lines |
$260.28–$489.78 | $964–$1,814 | varies |
| Infant hip ultrasound with hip movement (dynamic) (76885) range across 2 matching MRF lines |
$151.74–$210.33 | $562–$779 | varies |
| Joint Survey Single View (77077) range across 5 matching MRF lines |
$26.19–$167.13 | $97–$619 | varies |
| K Flow/Funct Image Multiple (78709) | $910.98 | $3,374 | 1.6× |
| K Flow/Funct Image W/Drug (78708) | $642.33 | $2,379 | 1.1× |
| K Flow/Funct Image W/O Drug (78707) | $751.68 | $2,784 | 1.3× |
| Kidney Imaging Morphol (78700) | $642.33 | $2,379 | 1.5× |
| Knee 3 Views (73562) range across 11 matching MRF lines |
$7.02–$272.16 | $26–$1,008 | varies |
| Liver & Spleen Imaging Static Only (78215) | $902.07 | $3,341 | 2.1× |
| Liver & Spleen Imaging W/Vascular Flow (78216) | $762.75 | $2,825 | 1.8× |
| Liver imaging static only (78201) | $882.09 | $3,267 | 1.5× |
| Lung Perf&Ventilat Diferentl (78598) | $1,401.84 | $5,192 | 2.4× |
| Lung Ventilat&Perfus Imaging (78582) | $1,401.84 | $5,192 | 2.4× |
| Lung Ventilation Imaging (78579) | $637.20 | $2,360 | 1.5× |
| Lymph System Imaging (78195) range across 2 matching MRF lines |
$41.31–$833.76 | $153–$3,088 | varies |
| Magnetic Image Jaw Joint (70336) range across 2 matching MRF lines |
$512.46–$966.87 | $1,898–$3,581 | varies |
| Mammary ductogram or galactogram multiple (77054) | $250.56 | $928 | 1.0× |
| Mammary ductogram or galactogram single (77053) range across 4 matching MRF lines |
$260.28–$489.78 | $964–$1,814 | varies |
| Meckels Divert Exam (78290) | $592.65 | $2,195 | 1.4× |
| Mr safety determination physician/other qhp (76016) | $124.47 | $461 | 1.4× |
| Mr safety implant&/fb assmt clin staf 1st 15 min (76014) | $34.56 | $128 | 1.1× |
| Mr safety implt electronics prepj supvj phys/qhp (76018) | $129.60 | $480 | 1.3× |
| Mr safety implt pos&/immoblj (76019) | $83.97 | $311 | 1.3× |
| Mr safety med physics xm customization plng&mntr (76017) | $341.28 | $1,264 | 1.4× |
| Mra Head W/O & W/Contrast Material (70546) range across 2 matching MRF lines |
$1,178.82–$1,639.98 | $4,366–$6,074 | varies |
| MRA head w/o contrast (70544) range across 5 matching MRF lines |
$483.57–$1,065.69 | $1,791–$3,947 | varies |
| MRA head with contrast (70545) | $668.52 | $2,476 | 1.8× |
| MRA neck w contrast (70548) range across 2 matching MRF lines |
$1,010.34–$1,086.75 | $3,742–$4,025 | varies |
| Mra Neck W/O &W/Contrast Material (70549) range across 2 matching MRF lines |
$864.54–$1,533.06 | $3,202–$5,678 | varies |
| MRA neck w/o contrast (70547) range across 2 matching MRF lines |
$512.46–$1,065.69 | $1,898–$3,947 | varies |
| MRI abdomen w contrast (74182) range across 2 matching MRF lines |
$757.89–$1,046.52 | $2,807–$3,876 | varies |
| MRI abdomen w/o contrast (74181) range across 4 matching MRF lines |
$512.46–$966.87 | $1,898–$3,581 | varies |
| MRI any jt lower extrem w/contrast material (73722) range across 12 matching MRF lines |
$780.03–$1,129.68 | $2,889–$4,184 | varies |
| MRI any jt lower extrem w/o & w/contrast matrl (73723) range across 12 matching MRF lines |
$864.54–$1,214.46 | $3,202–$4,498 | varies |
| MRI any jt upper extremity w/contrast matrl (73222) range across 12 matching MRF lines |
$780.03–$1,129.68 | $2,889–$4,184 | varies |
| MRI Breast W/O Contrast Bilateral (77047) range across 2 matching MRF lines |
$597.78–$1,533.06 | $2,214–$5,678 | varies |
| MRI Breast Without Contrast Material Unilateral (77046) range across 4 matching MRF lines |
$699.84–$980.64 | $2,592–$3,632 | varies |
| MRI cardiac w/o cont stress (75559) | $100.98 | $374 | 0.2× |
| MRI cardiac w/o contrast (75557) | $76.68 | $284 | 0.3× |
| MRI cervical spine w contrast (72142) range across 2 matching MRF lines |
$757.89–$1,046.52 | $2,807–$3,876 | varies |
| MRI cervical spine w/o cont (72141) range across 4 matching MRF lines |
$292.14–$1,051.92 | $1,082–$3,896 | varies |
| MRI chest w/o contrast (71550) range across 4 matching MRF lines |
$512.46–$1,020.60 | $1,898–$3,780 | varies |
| MRI chest with contrast (71551) range across 4 matching MRF lines |
$757.89–$1,046.52 | $2,807–$3,876 | varies |
| MRI chest wo w contrast (71552) range across 4 matching MRF lines |
$864.54–$1,579.23 | $3,202–$5,849 | varies |
| MRI lower extrem oth/thn jt w/contrast matrl (73719) range across 12 matching MRF lines |
$1,075.41–$1,081.62 | $3,983–$4,006 | varies |
| MRI lower extrem oth/thn jt w/o & w/contr matr (73720) range across 12 matching MRF lines |
$864.54–$1,214.46 | $3,202–$4,498 | varies |
| MRI lower extrem oth/thn jt w/o contr matrl (73718) range across 12 matching MRF lines |
$512.46–$971.46 | $1,898–$3,598 | varies |
| MRI lumbar spine w contrast (72149) range across 2 matching MRF lines |
$668.52–$1,129.68 | $2,476–$4,184 | varies |
| Mri Neck Spine W/O & W/Dye (72156) range across 3 matching MRF lines |
$864.54–$1,579.23 | $3,202–$5,849 | varies |
| MRI orbit face &/neck w/o contrast (70540) range across 14 matching MRF lines |
$757.89–$1,020.60 | $2,807–$3,780 | varies |
| MRI orbit face neck w contrast (70542) range across 8 matching MRF lines |
$757.89–$966.33 | $2,807–$3,579 | varies |
| Mri Orbt/Fac/Nck W/O &W/Dye (70543) range across 14 matching MRF lines |
$864.27–$1,533.06 | $3,201–$5,678 | varies |
| MRI pelvis w contrast (72196) range across 2 matching MRF lines |
$612.36–$1,081.62 | $2,268–$4,006 | varies |
| MRI pelvis w/o & w contrast (72197) range across 5 matching MRF lines |
$864.54–$1,579.23 | $3,202–$5,849 | varies |
| MRI pelvis w/o contrast (72195) range across 2 matching MRF lines |
$512.46–$1,051.92 | $1,898–$3,896 | varies |
| MRI thoracic spine w/o contrast (72146) range across 6 matching MRF lines |
$173.88–$929.61 | $644–$3,443 | varies |
| MRI upper extremity oth than jt w/contr matrl (73219) range across 14 matching MRF lines |
$971.46–$1,202.31 | $3,598–$4,453 | varies |
| MRI upper extremity oth than jt w/o contr matrl (73218) range across 14 matching MRF lines |
$512.46–$971.46 | $1,898–$3,598 | varies |
| Mri Uppr Extremity W/O&W/Dye (73220) range across 14 matching MRF lines |
$864.54–$1,214.46 | $3,202–$4,498 | varies |
| MRI, abdomen, combo (74183) range across 5 matching MRF lines |
$864.54–$1,579.23 | $3,202–$5,849 | varies |
| MRI, dorsal spine combo (72157) range across 3 matching MRF lines |
$864.54–$1,579.23 | $3,202–$5,849 | varies |
| MRI, dorsal spine contrast (72147) range across 2 matching MRF lines |
$668.52–$1,046.52 | $2,476–$3,876 | varies |
| MRI, joint upper extrem (73221) range across 12 matching MRF lines |
$512.46–$971.46 | $1,898–$3,598 | varies |
| MRI, joint upper extrem combo (73223) range across 12 matching MRF lines |
$864.54–$1,214.46 | $3,202–$4,498 | varies |
| MRI, lumbar spine combo (72158) range across 3 matching MRF lines |
$864.54–$1,579.23 | $3,202–$5,849 | varies |
| Myocardial Imaging Infarct Avid Planar Qual/Quan (78466) | $24.57 | $91 | 0.1× |
| Myocardial Perfusion Planar 1 Study Rest/Stress (78453) | $34.56 | $128 | 0.0× |
| Myocardial Spect Multiple Studies (78452) range across 9 matching MRF lines |
$325.62–$3,814.83 | $180–$14,129 | varies |
| Neck soft tissue (70360) range across 8 matching MRF lines |
$5.94–$161.73 | $22–$599 | varies |
| Nm myocard infarct spect (78469) | $590.22 | $2,186 | 1.0× |
| Nonvascular Shunt X-Ray (75809) range across 3 matching MRF lines |
$140.13–$196.02 | $519–$726 | varies |
| Nuclear Rx Oral Admin (79005) | $61.56 | $228 | 0.2× |
| Ob us nuchal meas 1 gest (76813) range across 2 matching MRF lines |
$82.89–$116.91 | $307–$433 | varies |
| Oph bmtry us echograpy a-scan io lens pwr cal (76519) | $21.87 | $81 | 0.2× |
| Ophthalmic ultrasound dx b-scan w/wo a-scan (76512) | $63.72 | $236 | 0.6× |
| Ophthalmic US Dx Corneal Pachymetry Uni/Bi (76514) | $10.53 | $39 | 0.3× |
| Panoramic X-ray of jaws (70355) | $47.25 | $175 | 0.5× |
| Parathyroid Planar Imaging (78070) | $637.20 | $2,360 | 1.5× |
| Pelvis 1 or 2 views (72170) range across 7 matching MRF lines |
$6.48–$214.38 | $24–$794 | varies |
| Prq Transhepatc Portograpy Hemodyn Eval Rs&I (75885) range across 3 matching MRF lines |
$1,838.43–$2,065.77 | $6,809–$7,651 | varies |
| Pulmonary Perfusion Imaging Particulate (78580) | $764.91 | $2,833 | 1.8× |
| Radex Abd Compl Aqt Abd W/S/E/D Views 1 View Ch (74022) range across 6 matching MRF lines |
$11.34–$405.27 | $42–$1,501 | varies |
| Radex abscess/fistula/sinus tract rs&i (76080) range across 7 matching MRF lines |
$357.21–$489.78 | $1,323–$1,814 | varies |
| Radex Ankle Complete Minimum 3 Views (73610) range across 10 matching MRF lines |
$6.48–$182.79 | $24–$677 | varies |
| Radex Calcaneus Minimum 2 Views (73650) range across 9 matching MRF lines |
$5.67–$139.59 | $21–$517 | varies |
| Radex elbow complete minimum 3 views (73080) range across 10 matching MRF lines |
$6.48–$190.89 | $24–$707 | varies |
| Radex Facial Bones Complete Minimum 3 Views (70150) range across 11 matching MRF lines |
$9.45–$204.93 | $35–$759 | varies |
| Radex fingr minimum 2 views (73140) range across 41 matching MRF lines |
$5.13–$134.19 | $19–$497 | varies |
| Radex foot complete minimum 3 views (73630) range across 10 matching MRF lines |
$5.94–$218.43 | $22–$809 | varies |
| Radex Hand Minimum 3 Views (73130) range across 9 matching MRF lines |
$6.21–$176.58 | $23–$654 | varies |
| Radex lower extremity infant minimum 2 views (73592) range across 10 matching MRF lines |
$19.44–$191.43 | $72–$709 | varies |
| Radex Nasal Bones Complete Minimum 3 Views (70160) range across 7 matching MRF lines |
$6.21–$149.31 | $23–$553 | varies |
| Radex Ribs Unilateral 2 Views (71100) range across 9 matching MRF lines |
$8.10–$243.54 | $30–$902 | varies |
| Radex shoulder complete minimum 2 views (73030) range across 9 matching MRF lines |
$7.02–$210.87 | $26–$781 | varies |
| Radex Sinuses Paransl < 3 Views (70210) range across 8 matching MRF lines |
$6.21–$152.82 | $23–$566 | varies |
| Radex Spine 1 View Specify Level (72020) range across 18 matching MRF lines |
$5.67–$229.50 | $21–$850 | varies |
| Radex Sternum Minimum 2 Views (71120) range across 6 matching MRF lines |
$7.29–$223.02 | $27–$826 | varies |
| Radex Temporomandble Jt Opn & Clsd Mouth Bilat (70330) | $146.07 | $541 | 1.6× |
| Radex Toe Minimum 2 Views (73660) range across 41 matching MRF lines |
$4.86–$125.82 | $18–$466 | varies |
| Radex upper extremity infant minimum 2 views (73092) range across 4 matching MRF lines |
$83.16–$153.90 | $308–$570 | varies |
| Radex Wrist Complete Minimum 3 Views (73110) range across 18 matching MRF lines |
$6.48–$176.58 | $24–$654 | varies |
| Radex X-Ray Exam Entire Spi 6/> Vw - Xr Entire Spine 6+ Vw (72084) | $367.74 | $1,362 | 3.3× |
| Radiolog exam mandible compl minimum 4 views (70110) range across 6 matching MRF lines |
$8.91–$246.24 | $33–$912 | varies |
| Radiologic Exam Abdomen 3+ Views - Xr Abdomen 3+ Views (74021) range across 8 matching MRF lines |
$113.67–$375.30 | $421–$1,390 | varies |
| Radiologic exam colon double contrast study (74280) | $615.87 | $2,281 | 3.3× |
| Radiologic exam colon single contrast study (74270) | $472.50 | $1,750 | 2.5× |
| Radiologic exam knee complete 4/more views (73564) range across 28 matching MRF lines |
$8.37–$324.54 | $31–$1,202 | varies |
| Radiologic exam pelvis compl minimum 3 views (72190) range across 5 matching MRF lines |
$7.83–$244.62 | $29–$906 | varies |
| Radiologic Exam Small Int Single Contrast Study (74250) range across 5 matching MRF lines |
$69.66–$489.24 | $258–$1,812 | varies |
| Radiologic exam swallow function contrast study (74230) | $243.54 | $902 | 1.3× |
| Radiologic exam upr gi trc double contrast study (74246) range across 3 matching MRF lines |
$654.48–$767.88 | $2,424–$2,844 | varies |
| Radiologic examination femur minimum 2 views (73552) range across 8 matching MRF lines |
$78.57–$210.87 | $291–$781 | varies |
| Radiologic examination knee 1/2 views (73560) range across 10 matching MRF lines |
$6.75–$249.21 | $25–$923 | varies |
| Radiologic Examination Osseous Survey Limited (77074) | $409.59 | $1,517 | 3.7× |
| Radiologic examination tibia & fibula 2 views (73590) range across 9 matching MRF lines |
$6.21–$207.63 | $23–$769 | varies |
| Radiologic examination, teeth; single view Non-Facility (70300) | $11.07 | $41 | 0.1× |
| Renal Cyst Study (74470) range across 6 matching MRF lines |
$1,012.86–$1,138.05 | $3,751.34–$4,215 | varies |
| Ribs bilateral 3 views (71110) range across 8 matching MRF lines |
$9.72–$296.73 | $36–$1,099 | varies |
| Rp loclzj tum plnr 1 area single day imaging (78800) range across 4 matching MRF lines |
$23.22–$1,012.23 | $86–$3,749 | varies |
| Rp Loclzj Tum Plnr Whole Body Single Day Imaging (78802) | $1,365.66 | $5,058 | 2.4× |
| Rp Loclzj Tum Spect 1 Area Single Day Imaging (78803) range across 11 matching MRF lines |
$34.83–$1,365.66 | $129–$5,058 | varies |
| Scapula (73010) range across 10 matching MRF lines |
$20.25–$278.64 | $75–$1,032 | varies |
| Screening Digital Breast Tomosynthesis Bi (77063) range across 7 matching MRF lines |
$18.09–$28.62 | $67–$106 | varies |
| Shoulder 1 view (73020) | $159.57 | $591 | 1.7× |
| Shoulder Arthrography (73040) range across 3 matching MRF lines |
$448.20–$590.49 | $1,660–$2,187 | varies |
| Skull less than 4 views (70250) range across 7 matching MRF lines |
$8.91–$294.84 | $33–$1,092 | varies |
| Sternoclavicular joints (71130) range across 7 matching MRF lines |
$8.10–$192.24 | $30–$712 | varies |
| Superior sagittal sinus venogram (75870) range across 3 matching MRF lines |
$1,731.80–$1,945.89 | $6,414.06–$7,207 | varies |
| Thoracic spine 2 views (72070) range across 5 matching MRF lines |
$8.10–$133.38 | $30–$494 | varies |
| Thoracic spine 3 views (72072) range across 7 matching MRF lines |
$7.83–$332.91 | $29–$1,233 | varies |
| Thoracolumbar 2 views (72080) range across 7 matching MRF lines |
$8.37–$223.56 | $31–$828 | varies |
| Thyroid Imaging With Vascular Flow (78013) | $382.05 | $1,415 | 0.9× |
| Thyroid Met Imaging Body (78018) | $775.71 | $2,873 | 1.4× |
| Thyroid Uptake Measurement (78012) | $216.27 | $801 | 0.5× |
| Thyroid Uptake W/Blood Flow Sngle/Mult Quan Meas (78014) | $890.73 | $3,299 | 2.1× |
| Ultrasound Breast Limited (76642) range across 10 matching MRF lines |
$22.41–$285.12 | $83–$1,056 | varies |
| Ultrasound Exam Aaa Screen (76706) | $138.78 | $514 | 1.3× |
| Ultrasound, abdomen limited (76705) range across 21 matching MRF lines |
$20.79–$702.27 | $77–$2,601 | varies |
| Unlisted us procedure (76999) | $18.09 | $67 | 0.2× |
| Upper gi w/o kub (74240) range across 6 matching MRF lines |
$555.12–$612.09 | $2,056–$2,267 | varies |
| Ureteral Reflux Study (78740) | $642.06 | $2,378 | 1.5× |
| Urethrocystogram voiding (74455) range across 2 matching MRF lines |
$396.90–$516.78 | $1,470–$1,914 | varies |
| Us breast unilateral complete (76641) range across 8 matching MRF lines |
$233.55–$402.84 | $865–$1,492 | varies |
| Us chest (76604) range across 3 matching MRF lines |
$19.44–$314.82 | $72–$1,166 | varies |
| Us complete joint (76881) range across 10 matching MRF lines |
$22.41–$575.10 | $83–$2,130 | varies |
| Us exam, pelvic, limited (76857) range across 10 matching MRF lines |
$40.77–$405.54 | $151–$1,502 | varies |
| Us head (76506) | $567.81 | $2,103 | 5.1× |
| Us kidney transplant (76776) range across 9 matching MRF lines |
$26.73–$832.95 | $99–$3,085 | varies |
| Us lmtd joint/oth nonvasc xtr strux r-t w/img (76882) range across 15 matching MRF lines |
$17.28–$352.08 | $64–$1,304 | varies |
| Us ob detailed single fetus (76811) range across 3 matching MRF lines |
$124.20–$588.87 | $460–$2,181 | varies |
| Us ob limited 1 or more fetuses (76815) range across 14 matching MRF lines |
$57.51–$396.90 | $213–$1,470 | varies |
| Us ob transvaginal (76817) range across 7 matching MRF lines |
$40.77–$407.97 | $151–$1,511 | varies |
| Us pelvic non ob complete (76856) range across 4 matching MRF lines |
$78.30–$612.36 | $290–$2,268 | varies |
| Us pg uter img f&mat 14 wk tabdl 1/1st gestation (76801) range across 8 matching MRF lines |
$84.24–$414.45 | $312–$1,535 | varies |
| Us preg uterus real time f/u trnsabdl per fetus (76816) range across 5 matching MRF lines |
$78.03–$374.49 | $289–$1,387 | varies |
| Us retroperitoneal complete (76770) range across 2 matching MRF lines |
$288.90–$611.28 | $1,070–$2,264 | varies |
| Us retroperitoneal limited (76775) range across 18 matching MRF lines |
$18.36–$443.34 | $68–$1,642 | varies |
| Us scrotum and contents (76870) range across 2 matching MRF lines |
$233.55–$485.73 | $865–$1,799 | varies |
| Us spinal canal and contents (76800) range across 2 matching MRF lines |
$215.46–$237.33 | $798–$879 | varies |
| Us thyroid (76536) range across 9 matching MRF lines |
$19.71–$505.44 | $73–$1,872 | varies |
| Us transrectal (76872) range across 4 matching MRF lines |
$23.76–$1,338.39 | $88–$4,957 | varies |
| Vasogram (74440) | $41.04 | $152 | 0.2× |
| Vein X-Ray Chest (75827) range across 10 matching MRF lines |
$142.83–$1,932.66 | $144–$7,158 | varies |
| Vein X-Ray Liver W/O Hemodyn (75887) range across 3 matching MRF lines |
$1,261.86–$1,417.77 | $4,673.54–$5,251 | varies |
| Venogram Sinus/Jugular (75860) range across 5 matching MRF lines |
$1,829.52–$3,945.24 | $6,776–$14,612 | varies |
| Venography Adrenal Unilateral (75840) range across 6 matching MRF lines |
$1,533.46–$1,722.87 | $5,679.48–$6,381 | varies |
| Venography caval inferior serialography rs&i (75825) range across 5 matching MRF lines |
$2,978.10–$3,945.24 | $11,030–$14,612 | varies |
| Venography extremity bilateral rs&i (75822) range across 12 matching MRF lines |
$550.53–$1,633.50 | $136–$6,050 | varies |
| Venography extremity unilateral rs&i (75820) range across 25 matching MRF lines |
$86.13–$926.10 | $91–$3,430 | varies |
| Venography Renal Bilateral (75833) range across 4 matching MRF lines |
$3,532.28–$3,968.73 | $194–$14,699 | varies |
| Venography Renal Unilateral (75831) range across 6 matching MRF lines |
$3,532.28–$3,968.73 | $13,082.52–$14,699 | varies |
| Venous sampling by catheter (75893) range across 5 matching MRF lines |
$4,934.25–$6,536.97 | $18,275–$24,211 | varies |
| Wrist 2 views (73100) range across 10 matching MRF lines |
$20.25–$139.59 | $75–$517 | varies |
| X-Ray Ac Jts - Xr Acromioclavicular Joints Bilateral (73050) range across 8 matching MRF lines |
$7.56–$320.49 | $28–$1,187 | varies |
| X-ray antegrade pyelogram tube (74425) | $396.90 | $1,470 | 1.1× |
| X-Ray Aorta Leg Arteries (75630) range across 10 matching MRF lines |
$171.99–$3,968.73 | $230–$14,699 | varies |
| X-Ray Bend Only L-S Spine (72120) range across 6 matching MRF lines |
$8.37–$339.12 | $31–$1,256 | varies |
| X-Ray Elbow 2 Vw - Xr Elbow 1-2 Views Right (73070) range across 9 matching MRF lines |
$5.94–$167.13 | $22–$619 | varies |
| X-Ray Exam Breast Specimen (76098) | $489.78 | $1,814 | 0.8× |
| X-Ray Exam Entire Spi 1 Vw (72081) range across 4 matching MRF lines |
$73.98–$366.93 | $274–$1,359 | varies |
| X-Ray Exam Entire Spi 2/3 Vw (72082) range across 4 matching MRF lines |
$198.99–$645.03 | $737–$2,389 | varies |
| X-Ray Exam Entire Spi 4/5 Vw (72083) range across 2 matching MRF lines |
$349.92–$370.98 | $1,296–$1,374 | varies |
| X-Ray Exam Hip Uni 1 View (73501) range across 17 matching MRF lines |
$7.02–$147.69 | $26–$547 | varies |
| X-Ray Exam Hip Uni 2-3 Views (73502) range across 17 matching MRF lines |
$8.10–$231.66 | $30–$858 | varies |
| X-Ray Exam Hips Bi 2 Views (73521) range across 12 matching MRF lines |
$8.37–$202.23 | $31–$749 | varies |
| X-Ray Exam Hips Bi 3-4 Views (73522) range across 10 matching MRF lines |
$11.07–$506.25 | $41–$1,875 | varies |
| X-Ray Exam L-S Spine Bending (72114) range across 6 matching MRF lines |
$12.15–$408.51 | $45–$1,513 | varies |
| X-Ray Exam Neck Spine 2-3 Vw (72040) range across 7 matching MRF lines |
$8.10–$339.93 | $30–$1,259 | varies |
| X-Ray Exam Neck Spine 6/>Vws (72052) range across 7 matching MRF lines |
$13.23–$507.33 | $49–$1,879 | varies |
| X-Ray Exam Unilat Ribs/Chest (71101) range across 9 matching MRF lines |
$9.45–$254.34 | $35–$942 | varies |
| X-ray eye for foreign body (70030) range across 11 matching MRF lines |
$48.87–$180.36 | $181–$668 | varies |
| X-ray humerus (73060) range across 10 matching MRF lines |
$18.36–$183.06 | $68–$678 | varies |
| X-ray IV pyelogram (ivp) (74400) range across 3 matching MRF lines |
$319.41–$497.61 | $1,183–$1,843 | varies |
| X-Ray Jaw <4 Vw - Xr Mandible < 4 Views (70100) range across 6 matching MRF lines |
$6.48–$82.08 | $24–$304 | varies |
| X-Ray Knee Bilat Standing - Xr Knees Anteroposterior Standing Bilat (73565) range across 8 matching MRF lines |
$6.75–$254.07 | $25–$941 | varies |
| X-Ray Lumbar Spine 2/3 Vw - Xr Lumbar Spine 2-3 Views (72100) range across 7 matching MRF lines |
$8.10–$372.06 | $30–$1,378 | varies |
| X-ray nose-rectum child f.b. (76010) range across 7 matching MRF lines |
$6.48–$243.54 | $24–$902 | varies |
| X-Ray Ribs, Chest 4+ Vw - Xr Ribs 3 Vws Bil W/ Chest Posteroanterior (71111) range across 7 matching MRF lines |
$11.61–$282.42 | $43–$1,046 | varies |
| X-Ray Sacroiliac Jts 3+ Vw - Xr Sacroiliac Joints 3+ Views (72202) range across 7 matching MRF lines |
$6.75–$238.68 | $25–$884 | varies |
| X-Ray Sacroiliac Jts <3 Vw - Xr Sacroiliac Joints 1-2 Views (72200) | $197.10 | $730 | 1.8× |
| X-Ray Sacrum/Coccyx 2+ Vw - Xr Sacrum Coccyx 2+ Views (72220) range across 7 matching MRF lines |
$6.21–$210.87 | $23–$781 | varies |
| X-Ray Sinuses 3+ Vw - Xr Paranasal Sinuses 3+ Views (70220) range across 9 matching MRF lines |
$8.91–$289.71 | $33–$1,073 | varies |
| X-Ray Skull 4+ Vw - Xr Skull Complete 4+ Views (70260) range across 9 matching MRF lines |
$12.42–$409.59 | $46–$1,517 | varies |
| X-ray thoracic spine 4 vw (72074) range across 2 matching MRF lines |
$125.82–$133.38 | $466–$494 | varies |
| X-Ray Tmj Unilat (70328) | $28.62 | $106 | 0.3× |
| X-Ray Urinary Tract Exam With Contrast Material (74420) range across 4 matching MRF lines |
$81.54–$396.90 | $47–$1,470 | varies |
| X-Rays Bone Length Studies (77073) range across 4 matching MRF lines |
$24.30–$224.37 | $90–$831 | varies |
| X-Rays Bone Survey Complete (77075) range across 4 matching MRF lines |
$209.25–$470.88 | $775–$1,744 | varies |
| Xr c-spine 4 or 5 views (72050) range across 7 matching MRF lines |
$11.34–$453.06 | $42–$1,678 | varies |
| Xr facial bones less than 3 views (70140) range across 6 matching MRF lines |
$7.56–$257.04 | $28–$952 | varies |
| XR Mastoids < 3 Views Bilateral (70120) | $53.46 | $198 | 0.5× |
| Xr orbits complete 4 views (70200) | $180.36 | $668 | 1.6× |
| Xr Tomogram Single Plane (76100) | $443.34 | $1,642 | 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.