Imaging prices at Ellett Memorial Hospital
Appleton City, MO · every code in this section with a posted price and a Medicare benchmark.
256 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) | $30.94 | $41.25 | 0.4× |
| Abdomen 2 views (74019) | $45.56 | $60.75 | 0.4× |
| Acute Gastrointestinal Blood Loss Imaging (78278) range across 2 matching MRF lines |
$167.62–$168 | $223.50–$224 | varies |
| Ankle 2 views (73600) range across 3 matching MRF lines |
$27–$282.75 | $36–$377 | varies |
| Bone age studies (77072) range across 2 matching MRF lines |
$33.56–$33.75 | $44.75–$45 | varies |
| Bone Imaging 3 Phase (78315) range across 2 matching MRF lines |
$171.56–$171.75 | $228.75–$229 | varies |
| Bone Imaging Limited Area (78300) range across 2 matching MRF lines |
$108.19–$108.75 | $144.25–$145 | varies |
| Bone Imaging Multiple Areas (78305) | $141.75 | $189 | 0.4× |
| Bone Imaging Whole Body (78306) | $145.50 | $194 | 0.4× |
| Bone survey infant (77076) range across 2 matching MRF lines |
$118.12–$118.50 | $157.50–$158 | varies |
| Brain Imaging Min 4 Static Views W Vascular Flow (78606) range across 2 matching MRF lines |
$108.94–$109.50 | $145.25–$146 | varies |
| Brain Imaging Minimum 4 Static Views (78605) | $90 | $120 | 0.2× |
| Cat Scan Follow-Up Study (76380) | $164.25 | $219 | 1.9× |
| Chest 1 view (71045) | $30.94 | $41.25 | 0.4× |
| Chest 2 views (71046) | $38.25 | $51 | 0.4× |
| Chest 3 views (71047) range across 3 matching MRF lines |
$45.56–$64.50 | $60.75–$86 | varies |
| Chest 4 or more views (71048) | $53.06 | $70.75 | 0.5× |
| Cholecystography Oral Contrast (74290) | $55.50 | $74 | 0.3× |
| Clavicle complete (73000) range across 5 matching MRF lines |
$27–$597 | $36–$796 | varies |
| Computed Tomography Thorax Lw Dose Lng Ca Scr C- (71271) | $1,085.25 | $1,447 | 10.4× |
| Contrast X-Ray Bladder (74430) | $55.50 | $74 | 0.2× |
| Contrast X-Ray Of Knee Joint (73580) | $93 | $124 | 0.3× |
| Corpora cavernosography (74445) | $197.25 | $263 | 1.9× |
| CT abdomen and pelvis without and with contrast (74178) range across 2 matching MRF lines |
$223.88–$224.25 | $298.50–$299 | varies |
| CT abdomen and pelvis without contrast (74176) range across 2 matching MRF lines |
$192.94–$193.50 | $257.25–$258 | varies |
| CT abdomen w contrast (74160) range across 2 matching MRF lines |
$215.06–$215.25 | $286.75–$287 | varies |
| CT abdomen w wo contrast (74170) range across 2 matching MRF lines |
$237.38–$237.75 | $316.50–$317 | varies |
| CT abdomen w/o contrast (74150) range across 2 matching MRF lines |
$201.38–$201.75 | $268.50–$269 | varies |
| CT Angio Abdomen and Pelvis (74174) | $296.25 | $395 | 0.8× |
| CT Angio Chest (71275) | $210.75 | $281 | 1.2× |
| CT Angio Head (70496) range across 3 matching MRF lines |
$248.62–$1,444.69 | $331.50–$1,926.25 | varies |
| Ct Angio Lwr Extr W/O&W/Dye (73706) range across 2 matching MRF lines |
$319.31–$319.50 | $425.75–$426 | varies |
| CT Angio Neck (70498) range across 2 matching MRF lines |
$248.62–$249 | $331.50–$332 | varies |
| Ct Angio Upr Extrm W/O&W/Dye (73206) range across 2 matching MRF lines |
$293.44–$294 | $391.25–$392 | varies |
| CT cervical spine w/ contrast (72126) | $204.75 | $273 | 0.6× |
| CT cervical spine w/o contrast (72125) range across 2 matching MRF lines |
$196.12–$196.50 | $261.50–$262 | varies |
| CT cervical spine w/wo cont (72127) range across 2 matching MRF lines |
$215.06–$215.25 | $286.75–$287 | varies |
| CT chest w contrast (71260) | $210.75 | $281 | 1.2× |
| CT chest w/wo contrast (71270) | $233.25 | $311 | 1.3× |
| CT head/brain with contrast (70460) range across 2 matching MRF lines |
$192.38–$192.75 | $256.50–$257 | varies |
| CT head/brain without and with contrast (70470) range across 2 matching MRF lines |
$215.06–$215.25 | $286.75–$287 | varies |
| CT iac w contrast (70481) range across 3 matching MRF lines |
$93.75–$573.19 | $125–$764.25 | varies |
| CT l-spine w&w/o contrast (72133) range across 2 matching MRF lines |
$215.06–$215.25 | $286.75–$287 | varies |
| CT lower ext w/o (73700) range across 5 matching MRF lines |
$185.44–$1,560.38 | $247.25–$2,080.50 | varies |
| CT lower extremity w/contrast material (73701) range across 3 matching MRF lines |
$196.12–$1,444.69 | $261.50–$1,926.25 | varies |
| CT lumbar spine w contrast (72132) | $204.75 | $273 | 0.6× |
| CT lumbar spine w/o contrast (72131) range across 2 matching MRF lines |
$196.12–$196.50 | $261.50–$262 | varies |
| CT maxillofacial w contrast (70487) range across 2 matching MRF lines |
$220.12–$220.50 | $293.50–$294 | varies |
| CT maxillofacial wo contrast (70486) range across 2 matching MRF lines |
$192.38–$192.75 | $256.50–$257 | varies |
| CT neck tissue combo (70492) | $244.50 | $326 | 1.4× |
| Ct Orbit/Ear/Fossa W/O&W/Dye (70482) | $244.50 | $326 | 1.4× |
| CT orbits w/o contrast (70480) range across 2 matching MRF lines |
$216–$1,777.31 | $288–$2,369.75 | varies |
| CT pelvis w&w/o contrast (72194) | $204.75 | $273 | 1.2× |
| CT pelvis w/o contrast (72192) range across 2 matching MRF lines |
$185.44–$186 | $247.25–$248 | varies |
| CT scan of leg combo (73702) | $204.75 | $273 | 1.2× |
| CT scans face/jaw combo (70488) range across 2 matching MRF lines |
$238.31–$238.50 | $317.75–$318 | varies |
| CT soft tissue neck w contrast (70491) | $233.25 | $311 | 1.3× |
| CT soft tissue neck w/o contrast (70490) | $216 | $288 | 2.1× |
| CT thoracic spine w contrast (72129) | $204.75 | $273 | 1.2× |
| CT thoracic spine w/o contrast (72128) range across 2 matching MRF lines |
$196.12–$196.50 | $261.50–$262 | varies |
| CT thoracic spine w/wo cont (72130) range across 2 matching MRF lines |
$215.06–$215.25 | $286.75–$287 | varies |
| CT thorax w/o contrast (71250) range across 2 matching MRF lines |
$196.12–$196.50 | $261.50–$262 | varies |
| CT upper ext wo (73200) range across 5 matching MRF lines |
$185.44–$1,300.12 | $247.25–$1,733.50 | varies |
| CT upper extremity w/o & w/contrast material (73202) | $204.75 | $273 | 1.2× |
| CT upper extremity with contrast (73201) range across 3 matching MRF lines |
$196.12–$1,444.69 | $261.50–$1,926.25 | varies |
| Cta Abdl Aorta&Bi Iliofem W/Contrast&Postp (75635) range across 2 matching MRF lines |
$419.62–$420 | $559.50–$560 | varies |
| Cta Abdomen (74175) range across 2 matching MRF lines |
$273.56–$273.75 | $364.75–$365 | varies |
| Dxa Bone Density Axial (77080) | $38.25 | $51 | 0.4× |
| Esophagram (74220) range across 3 matching MRF lines |
$79.31–$85.50 | $105.75–$114 | varies |
| Fetal Biophys Profile W/Nst (76818) | $181.50 | $242 | 1.7× |
| Fetal Biophysical Profile W/O Non-Stress Testing (76819) | $130.88 | $174.50 | 1.2× |
| Fluoroscopy up to 1 hr (76000) range across 2 matching MRF lines |
$115.88–$116.25 | $154.50–$155 | varies |
| Foot 2 views (73620) range across 3 matching MRF lines |
$27–$245.25 | $36–$327 | varies |
| Forearm 2 views (73090) range across 3 matching MRF lines |
$27–$245.25 | $36–$327 | varies |
| Gastric emptying imaging study (78264) range across 2 matching MRF lines |
$130.88–$131.25 | $174.50–$175 | varies |
| Gastric Mucosa Imaging (78261) range across 2 matching MRF lines |
$118.12–$118.50 | $157.50–$158 | varies |
| Gastroesophageal Reflux Exam (78262) range across 2 matching MRF lines |
$115.88–$116.25 | $154.50–$155 | varies |
| Gated Heart Planar Single (78472) range across 2 matching MRF lines |
$170.44–$171 | $227.25–$228 | varies |
| Hand 2 views (73120) range across 5 matching MRF lines |
$27–$415.69 | $36–$554.25 | varies |
| Heart first pass single,planar (78481) range across 2 matching MRF lines |
$173.81–$174 | $231.75–$232 | varies |
| Hepatobil Syst Image W/Drug (78227) range across 2 matching MRF lines |
$144.38–$144.75 | $192.50–$193 | varies |
| Hepatobiliary System Imaging (78226) range across 2 matching MRF lines |
$144.38–$144.75 | $192.50–$193 | varies |
| Ht Muscle Image Spect Sing (78451) range across 2 matching MRF lines |
$190.12–$190.50 | $253.50–$254 | varies |
| Hysterosalpingogram (74740) | $66.75 | $89 | 0.3× |
| Infant hip ultrasound with hip movement (dynamic) (76885) | $126 | $168 | 1.4× |
| Infusion Ivp (74410) | $82.50 | $110 | 0.5× |
| K Flow/Funct Image Multiple (78709) range across 2 matching MRF lines |
$238.31–$238.50 | $317.75–$318 | varies |
| K Flow/Funct Image W/Drug (78708) | $204.75 | $273 | 0.4× |
| K Flow/Funct Image W/O Drug (78707) range across 2 matching MRF lines |
$162.94–$163.50 | $217.25–$218 | varies |
| Kidney Funcj Study Non-Img Radioisotopic Study (78725) | $66.75 | $89 | 0.2× |
| Kidney Imaging Morphol (78700) range across 2 matching MRF lines |
$77.62–$78 | $103.50–$104 | varies |
| Knee 3 Views (73562) range across 4 matching MRF lines |
$30.94–$685.88 | $41.25–$914.50 | varies |
| Liver & Spleen Imaging Static Only (78215) | $82.50 | $110 | 0.2× |
| Liver & Spleen Imaging W/Vascular Flow (78216) range across 2 matching MRF lines |
$96.38–$96.75 | $128.50–$129 | varies |
| Liver imaging static only (78201) range across 2 matching MRF lines |
$75.38–$75.75 | $100.50–$101 | varies |
| Lung perfusion differential (78597) range across 2 matching MRF lines |
$211.88–$212.25 | $282.50–$283 | varies |
| Lung Ventilat&Perfus Imaging (78582) range across 2 matching MRF lines |
$188.62–$189 | $251.50–$252 | varies |
| Lung Ventilation Imaging (78579) | $82.50 | $110 | 0.2× |
| Lymph System Imaging (78195) | $204.75 | $273 | 0.4× |
| Magnetic Image Jaw Joint (70336) | $249.75 | $333 | 1.0× |
| Meckels Divert Exam (78290) range across 2 matching MRF lines |
$115.88–$116.25 | $154.50–$155 | varies |
| Mra Head W/O & W/Contrast Material (70546) range across 2 matching MRF lines |
$303.56–$303.75 | $404.75–$405 | varies |
| MRA head w/o contrast (70544) range across 2 matching MRF lines |
$203.62–$204 | $271.50–$272 | varies |
| MRA head with contrast (70545) range across 2 matching MRF lines |
$201.38–$201.75 | $268.50–$269 | varies |
| MRA neck w contrast (70548) range across 2 matching MRF lines |
$201.38–$201.75 | $268.50–$269 | varies |
| Mra Neck W/O &W/Contrast Material (70549) range across 2 matching MRF lines |
$303.56–$303.75 | $404.75–$405 | varies |
| MRA neck w/o contrast (70547) range across 2 matching MRF lines |
$201.38–$201.75 | $268.50–$269 | varies |
| MRI abdomen w contrast (74182) range across 2 matching MRF lines |
$292.69–$293.25 | $390.25–$391 | varies |
| MRI abdomen w/o contrast (74181) | $244.50 | $326 | 1.0× |
| MRI any jt lower extrem w/contrast material (73722) range across 2 matching MRF lines |
$274.12–$274.50 | $365.50–$366 | varies |
| MRI any jt lower extrem w/o & w/contrast matrl (73723) range across 4 matching MRF lines |
$362.81–$2,918.06 | $483.75–$3,890.75 | varies |
| MRI any jt upper extremity w/contrast matrl (73222) range across 2 matching MRF lines |
$274.12–$274.50 | $365.50–$366 | varies |
| MRI bone marrow blood supply (77084) range across 2 matching MRF lines |
$270.38–$270.75 | $360.50–$361 | varies |
| MRI Breast W/O Contrast Bilateral (77047) range across 2 matching MRF lines |
$224.81–$225 | $299.75–$300 | varies |
| MRI cardiac w/o contrast (75557) range across 2 matching MRF lines |
$271.31–$271.50 | $361.75–$362 | varies |
| MRI cervical spine w contrast (72142) range across 2 matching MRF lines |
$325.88–$326.25 | $434.50–$435 | varies |
| MRI cervical spine w/o cont (72141) range across 2 matching MRF lines |
$270.38–$270.75 | $360.50–$361 | varies |
| MRI chest w/o contrast (71550) | $244.50 | $326 | 1.0× |
| MRI chest wo w contrast (71552) range across 2 matching MRF lines |
$297.38–$297.75 | $396.50–$397 | varies |
| MRI lower extrem oth/thn jt w/contrast matrl (73719) range across 2 matching MRF lines |
$271.31–$271.50 | $361.75–$362 | varies |
| MRI lower extrem oth/thn jt w/o & w/contr matr (73720) range across 2 matching MRF lines |
$360.75–$1,877.62 | $481–$2,503.50 | varies |
| MRI lower extrem oth/thn jt w/o contr matrl (73718) range across 5 matching MRF lines |
$227.06–$1,589.44 | $302.75–$2,119.25 | varies |
| MRI lumbar spine w contrast (72149) | $301.50 | $402 | 0.9× |
| Mri Neck Spine W/O & W/Dye (72156) range across 2 matching MRF lines |
$430.69–$431.25 | $574.25–$575 | varies |
| MRI orbit face &/neck w/o contrast (70540) range across 2 matching MRF lines |
$227.06–$227.25 | $302.75–$303 | varies |
| MRI orbit face neck w contrast (70542) range across 2 matching MRF lines |
$271.31–$271.50 | $361.75–$362 | varies |
| Mri Orbt/Fac/Nck W/O &W/Dye (70543) range across 3 matching MRF lines |
$362.81–$1,589.44 | $483.75–$2,119.25 | varies |
| MRI pelvis w contrast (72196) range across 2 matching MRF lines |
$292.69–$293.25 | $390.25–$391 | varies |
| MRI pelvis w/o & w contrast (72197) range across 2 matching MRF lines |
$379.12–$379.50 | $505.50–$506 | varies |
| MRI pelvis w/o contrast (72195) range across 2 matching MRF lines |
$245.62–$246 | $327.50–$328 | varies |
| MRI thoracic spine w/o contrast (72146) range across 2 matching MRF lines |
$270.38–$270.75 | $360.50–$361 | varies |
| MRI upper extremity oth than jt w/contr matrl (73219) range across 2 matching MRF lines |
$274.12–$274.50 | $365.50–$366 | varies |
| MRI upper extremity oth than jt w/o contr matrl (73218) range across 4 matching MRF lines |
$227.06–$2,381.25 | $302.75–$3,175 | varies |
| Mri Uppr Extremity W/O&W/Dye (73220) range across 4 matching MRF lines |
$362.81–$3,295.31 | $483.75–$4,393.75 | varies |
| MRI, abdomen, combo (74183) range across 2 matching MRF lines |
$379.12–$379.50 | $505.50–$506 | varies |
| MRI, dorsal spine combo (72157) range across 2 matching MRF lines |
$430.69–$431.25 | $574.25–$575 | varies |
| MRI, dorsal spine contrast (72147) range across 2 matching MRF lines |
$323.62–$324 | $431.50–$432 | varies |
| MRI, joint upper extrem (73221) range across 6 matching MRF lines |
$227.06–$2,608.50 | $302.75–$3,478 | varies |
| MRI, joint upper extrem combo (73223) range across 3 matching MRF lines |
$362.81–$1,714.88 | $483.75–$2,286.50 | varies |
| MRI, lumbar spine combo (72158) | $396 | $528 | 1.1× |
| Myelogram Lumbar (72265) | $119.25 | $159 | 0.2× |
| Myocardial Imaging Infarct Avid Planar Qual/Quan (78466) range across 2 matching MRF lines |
$119.81–$120 | $159.75–$160 | varies |
| Myocardial Spect Multiple Studies (78452) range across 2 matching MRF lines |
$410.44–$411 | $547.25–$548 | varies |
| Neck soft tissue (70360) | $30.94 | $41.25 | 0.4× |
| Nm myocard infarct spect (78469) range across 2 matching MRF lines |
$160.31–$160.50 | $213.75–$214 | varies |
| Ophthalmic US Dx Corneal Pachymetry Uni/Bi (76514) | $30.75 | $41 | 1.1× |
| Parathyroid Planar Imaging (78070) range across 2 matching MRF lines |
$140.44–$141 | $187.25–$188 | varies |
| Pelvis 1 or 2 views (72170) | $30.94 | $41.25 | 0.3× |
| Pulmonary Perfusion Imaging Particulate (78580) | $126 | $168 | 0.3× |
| Radex Abd Compl Aqt Abd W/S/E/D Views 1 View Ch (74022) | $55.50 | $74 | 0.5× |
| Radex abscess/fistula/sinus tract rs&i (76080) | $93 | $124 | 0.2× |
| Radex Ankle Complete Minimum 3 Views (73610) range across 3 matching MRF lines |
$30.94–$326.06 | $41.25–$434.75 | varies |
| Radex Calcaneus Minimum 2 Views (73650) range across 2 matching MRF lines |
$27–$176.06 | $36–$234.75 | varies |
| Radex elbow complete minimum 3 views (73080) range across 3 matching MRF lines |
$30.94–$358.69 | $41.25–$478.25 | varies |
| Radex Facial Bones Complete Minimum 3 Views (70150) | $44.62 | $59.50 | 0.4× |
| Radex fingr minimum 2 views (73140) range across 4 matching MRF lines |
$23.25–$325.50 | $31–$434 | varies |
| Radex foot complete minimum 3 views (73630) range across 4 matching MRF lines |
$30.94–$501 | $41.25–$668 | varies |
| Radex Hand Minimum 3 Views (73130) range across 4 matching MRF lines |
$30.94–$487.50 | $41.25–$650 | varies |
| Radex lower extremity infant minimum 2 views (73592) range across 3 matching MRF lines |
$27–$54 | $36–$72 | varies |
| Radex Mastoids Compl Minimum 3 Views PR Side (70130) range across 2 matching MRF lines |
$51–$60.75 | $68–$81 | varies |
| Radex Nasal Bones Complete Minimum 3 Views (70160) | $30.94 | $41.25 | 0.4× |
| Radex Ribs Unilateral 2 Views (71100) range across 2 matching MRF lines |
$38.25–$372.75 | $51–$497 | varies |
| Radex shoulder complete minimum 2 views (73030) range across 4 matching MRF lines |
$30.94–$711.56 | $41.25–$948.75 | varies |
| Radex Sinuses Paransl < 3 Views (70210) range across 2 matching MRF lines |
$30.94–$31.50 | $41.25–$42 | varies |
| Radex Spine 1 View Specify Level (72020) | $27 | $36 | 0.3× |
| Radex Sternum Minimum 2 Views (71120) | $36.94 | $49.25 | 0.4× |
| Radex Temporomandble Jt Opn & Clsd Mouth Bilat (70330) range across 3 matching MRF lines |
$41.81–$47.25 | $55.75–$63 | varies |
| Radex Toe Minimum 2 Views (73660) range across 2 matching MRF lines |
$23.25–$275.06 | $31–$366.75 | varies |
| Radex upper extremity infant minimum 2 views (73092) range across 4 matching MRF lines |
$27–$268.50 | $36–$358 | varies |
| Radex Wrist Complete Minimum 3 Views (73110) range across 5 matching MRF lines |
$27–$376.31 | $36–$501.75 | varies |
| Radiolog exam mandible compl minimum 4 views (70110) | $41.81 | $55.75 | 0.4× |
| Radiologic exam colon double contrast study (74280) range across 2 matching MRF lines |
$166.88–$167.25 | $222.50–$223 | varies |
| Radiologic exam colon single contrast study (74270) range across 2 matching MRF lines |
$115.88–$116.25 | $154.50–$155 | varies |
| Radiologic exam knee complete 4/more views (73564) range across 4 matching MRF lines |
$38.25–$904.12 | $51–$1,205.50 | varies |
| Radiologic exam pelvis compl minimum 3 views (72190) | $36.94 | $49.25 | 0.4× |
| Radiologic Exam Small Int Single Contrast Study (74250) range across 2 matching MRF lines |
$79.31–$79.50 | $105.75–$106 | varies |
| Radiologic exam swallow function contrast study (74230) range across 2 matching MRF lines |
$90–$141 | $120–$188 | varies |
| Radiologic exam upr gi trc double contrast study (74246) range across 2 matching MRF lines |
$115.88–$116.25 | $154.50–$155 | varies |
| Radiologic examination femur minimum 2 views (73552) range across 3 matching MRF lines |
$30.94–$278.06 | $41.25–$370.75 | varies |
| Radiologic examination knee 1/2 views (73560) range across 4 matching MRF lines |
$30.94–$607.31 | $41.25–$809.75 | varies |
| Radiologic Examination Osseous Survey Limited (77074) range across 2 matching MRF lines |
$77.62–$78 | $103.50–$104 | varies |
| Radiologic examination tibia & fibula 2 views (73590) range across 4 matching MRF lines |
$30.94–$326.25 | $41.25–$435 | varies |
| Radiologic examination, teeth; single view Non-Facility (70300) range across 2 matching MRF lines |
$22.12–$22.50 | $29.50–$30 | varies |
| Ribs bilateral 3 views (71110) range across 2 matching MRF lines |
$45.56–$45.75 | $60.75–$61 | varies |
| Scapula (73010) range across 2 matching MRF lines |
$30.94–$739.50 | $41.25–$986 | varies |
| Shoulder 1 view (73020) range across 3 matching MRF lines |
$27–$130.50 | $36–$174 | varies |
| Shoulder Arthrography (73040) | $93 | $124 | 0.3× |
| Skull less than 4 views (70250) range across 2 matching MRF lines |
$41.81–$42 | $55.75–$56 | varies |
| Testicular Imaging W/Flow (78761) range across 2 matching MRF lines |
$122.06–$122.25 | $162.75–$163 | varies |
| Thoracic spine 2 views (72070) | $38.25 | $51 | 0.4× |
| Thoracic spine 3 views (72072) | $38.25 | $51 | 0.4× |
| Thoracolumbar 2 views (72080) range across 2 matching MRF lines |
$72.19–$72.75 | $96.25–$97 | varies |
| Thyroid Imaging With Vascular Flow (78013) range across 2 matching MRF lines |
$67.88–$68.25 | $90.50–$91 | varies |
| Thyroid Uptake Measurement (78012) range across 2 matching MRF lines |
$45.56–$45.75 | $60.75–$61 | varies |
| Thyroid Uptake W/Blood Flow Sngle/Mult Quan Meas (78014) | $82.50 | $110 | 0.2× |
| Ultrasound Breast Limited (76642) range across 3 matching MRF lines |
$93–$186 | $124–$248 | varies |
| Ultrasound Exam Aaa Screen (76706) | $93.75 | $125 | 0.9× |
| Ultrasound, abdomen limited (76705) range across 2 matching MRF lines |
$101.06–$101.25 | $134.75–$135 | varies |
| Upper gi w/o kub (74240) range across 2 matching MRF lines |
$115.88–$116.25 | $154.50–$155 | varies |
| Urethrocystogram voiding (74455) range across 2 matching MRF lines |
$59.44–$60 | $79.25–$80 | varies |
| Us chest (76604) | $93 | $124 | 0.9× |
| Us exam, pelvic, limited (76857) | $66.75 | $89 | 0.6× |
| Us head (76506) range across 2 matching MRF lines |
$114.94–$115.50 | $153.25–$154 | varies |
| Us lmtd joint/oth nonvasc xtr strux r-t w/img (76882) range across 3 matching MRF lines |
$46.31–$766.69 | $61.75–$1,022.25 | varies |
| Us ob detailed single fetus (76811) range across 2 matching MRF lines |
$240.56–$240.75 | $320.75–$321 | varies |
| Us ob limited 1 or more fetuses (76815) | $110.81 | $147.75 | 1.1× |
| Us ob transvaginal (76817) | $115.88 | $154.50 | 1.1× |
| Us pelvic non ob complete (76856) range across 2 matching MRF lines |
$118.12–$118.50 | $157.50–$158 | varies |
| Us pg uter img f&mat 14 wk tabdl 1/1st gestation (76801) | $160.50 | $214 | 1.5× |
| Us preg uterus real time f/u trnsabdl per fetus (76816) | $147.75 | $197 | 1.4× |
| Us retroperitoneal complete (76770) | $126 | $168 | 1.2× |
| Us retroperitoneal limited (76775) | $99.75 | $133 | 1.0× |
| Us scrotum and contents (76870) range across 2 matching MRF lines |
$110.81–$111 | $147.75–$148 | varies |
| Us spinal canal and contents (76800) range across 2 matching MRF lines |
$188.62–$189 | $251.50–$252 | varies |
| Us thyroid (76536) | $93.75 | $125 | 0.9× |
| Us transrectal (76872) | $119.81 | $159.75 | 1.1× |
| Vascular Flow Imaging (78445) range across 2 matching MRF lines |
$85.12–$85.50 | $113.50–$114 | varies |
| Venogram Sinus/Jugular (75860) | $197.25 | $263 | 0.1× |
| Venography extremity unilateral rs&i (75820) | $119.81 | $159.75 | 0.1× |
| Wrist 2 views (73100) range across 4 matching MRF lines |
$27–$566.25 | $36–$755 | varies |
| X-Ray Ac Jts - Xr Acromioclavicular Joints Bilateral (73050) | $36.94 | $49.25 | 0.4× |
| X-ray antegrade pyelogram tube (74425) | $60 | $80 | 0.2× |
| X-Ray Elbow 2 Vw - Xr Elbow 1-2 Views Right (73070) range across 3 matching MRF lines |
$27–$278.06 | $36–$370.75 | varies |
| X-Ray Exam Breast Specimen (76098) range across 3 matching MRF lines |
$27–$27.75 | $36–$37 | varies |
| X-Ray Exam Entire Spi 2/3 Vw (72082) | $48 | $64 | 0.5× |
| X-Ray Exam Hip Uni 1 View (73501) range across 2 matching MRF lines |
$30.94–$282.75 | $41.25–$377 | varies |
| X-Ray Exam Hip Uni 2-3 Views (73502) | $66.75 | $89 | 0.8× |
| X-Ray Exam Hips Bi 2 Views (73521) | $135 | $180 | 1.3× |
| X-Ray Exam Hips Bi 3-4 Views (73522) | $73.69 | $98.25 | 0.7× |
| X-Ray Exam Hips Bi 5/> Views (73523) range across 2 matching MRF lines |
$104.62–$373.12 | $139.50–$497.50 | varies |
| X-Ray Exam L-S Spine Bending (72114) range across 2 matching MRF lines |
$62.81–$63 | $83.75–$84 | varies |
| X-Ray Exam Neck Spine 2-3 Vw (72040) | $38.25 | $51 | 0.4× |
| X-Ray Exam Neck Spine 6/>Vws (72052) | $62.81 | $83.75 | 0.6× |
| X-Ray Exam Unilat Ribs/Chest (71101) range across 3 matching MRF lines |
$39–$45.75 | $52–$61 | varies |
| X-ray eye for foreign body (70030) range across 2 matching MRF lines |
$30.94–$31.50 | $41.25–$42 | varies |
| X-ray humerus (73060) range across 3 matching MRF lines |
$30.94–$275.06 | $41.25–$366.75 | varies |
| X-ray IV pyelogram (ivp) (74400) | $82.50 | $110 | 0.5× |
| X-ray IV pyelogram+tomography (74415) range across 2 matching MRF lines |
$82.50–$145.50 | $110–$194 | varies |
| X-Ray Knee Bilat Standing - Xr Knees Anteroposterior Standing Bilat (73565) | $30.94 | $41.25 | 0.4× |
| X-Ray Lumbar Spine 2/3 Vw - Xr Lumbar Spine 2-3 Views (72100) | $38.25 | $51 | 0.4× |
| X-ray nose-rectum child f.b. (76010) range across 2 matching MRF lines |
$26.62–$27 | $35.50–$36 | varies |
| X-Ray Ribs, Chest 4+ Vw - Xr Ribs 3 Vws Bil W/ Chest Posteroanterior (71111) range across 3 matching MRF lines |
$49.50–$76.50 | $66–$102 | varies |
| X-Ray Sacroiliac Jts 3+ Vw - Xr Sacroiliac Joints 3+ Views (72202) | $33.56 | $44.75 | 0.3× |
| X-Ray Sacroiliac Jts <3 Vw - Xr Sacroiliac Joints 1-2 Views (72200) | $30.94 | $41.25 | 0.3× |
| X-Ray Sacrum/Coccyx 2+ Vw - Xr Sacrum Coccyx 2+ Views (72220) | $30.94 | $41.25 | 0.4× |
| X-Ray Sinuses 3+ Vw - Xr Paranasal Sinuses 3+ Views (70220) | $41.81 | $55.75 | 0.5× |
| X-Ray Skull 4+ Vw - Xr Skull Complete 4+ Views (70260) range across 2 matching MRF lines |
$44.25–$60.75 | $59–$81 | varies |
| X-ray thoracic spine 4 vw (72074) | $38.25 | $51 | 0.4× |
| X-Ray Urinary Tract Exam With Contrast Material (74420) | $62.81 | $83.75 | 0.2× |
| X-Rays Bone Length Studies (77073) range across 3 matching MRF lines |
$35.25–$45.75 | $47–$61 | varies |
| X-Rays Bone Survey Complete (77075) range across 2 matching MRF lines |
$85.50–$93 | $114–$124 | varies |
| Xr c-spine 4 or 5 views (72050) | $53.06 | $70.75 | 0.5× |
| Xr facial bones less than 3 views (70140) range across 2 matching MRF lines |
$33.56–$33.75 | $44.75–$45 | varies |
| XR Mastoids < 3 Views Bilateral (70120) range across 2 matching MRF lines |
$30.94–$31.50 | $41.25–$42 | varies |
| Xr orbits complete 4 views (70200) | $48 | $64 | 0.5× |
| Xr Tomogram Single Plane (76100) | $99.75 | $133 | 1.0× |
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.