Imaging prices at Fairfield Medical Center
Lancaster, OH · every code in this section with a posted price and a Medicare benchmark.
333 codes. Prices are the hospital's own posted facility charges.
Compare against other hospitals interactively →
| Procedure | Posted cash | Posted gross | × Medicare |
|---|---|---|---|
| 3-D radiotherapy plan dose-volume histograms (77295) range across 2 matching MRF lines |
$1,865.70–$2,057.40 | $4,146–$4,572 | varies |
| Abdomen 1 View (74018) | $204.30 | $454 | 2.4× |
| Abdomen 2 views (74019) | $204.30 | $454 | 2.0× |
| Acute Gastrointestinal Blood Loss Imaging (78278) | $1,305.90 | $2,902 | 3.4× |
| Adrenal Cortex & Medulla Img (78075) | $1,899.45 | $4,221 | 1.5× |
| Angio internal mammary (75756) | $1,756.80 | $3,904 | 0.6× |
| Angio pulmonary bilat (75743) | $2,160.90 | $4,802 | 0.7× |
| Angiography extremity bilateral rs&i (75716) | $2,160.90 | $4,802 | 0.7× |
| Angiography extremity unilateral rs&i (75710) | $3,058.65 | $6,797 | 1.0× |
| Angiography pulmonary unilateral slctv rs&i (75741) | $3,451.95 | $7,671 | 1.1× |
| Angrph pulmonary nonslctv cath/ven njx rs&i (75746) | $1,508.85 | $3,353 | 0.5× |
| Ankle 2 views (73600) range across 3 matching MRF lines |
$184.05–$367.65 | $409–$817 | varies |
| Aortography thoracic serialography rs&i (75605) unusually low: confirm this is the full procedure |
$2,601 | $5,780 | 0.5× |
| Aortography thoracic w/o serialography rs&i (75600) | $2,143.35 | $4,763 | 0.7× |
| Artery X-Rays Abdomen (75726) unusually low: confirm this is the full procedure |
$2,601 | $5,780 | 0.5× |
| Artery X-Rays Pelvis (75736) unusually low: confirm this is the full procedure |
$2,601 | $5,780 | 0.5× |
| Artery X-Rays Spine (75705) | $3,503.70 | $7,786 | 0.7× |
| Arthrogram ankle (73615) | $338.85 | $753 | 1.0× |
| Arthrogram hip (73525) | $562.50 | $1,250 | 1.7× |
| Arthrogram Wrist (73115) | $485.55 | $1,079 | 1.4× |
| Basic radiation dosimetry calculation (77300) range across 2 matching MRF lines |
$200.70–$221.40 | $446–$492 | varies |
| Bone age studies (77072) | $184.05 | $409 | 1.8× |
| Bone Imaging 3 Phase (78315) | $1,308.60 | $2,908 | 3.4× |
| Bone Imaging Limited Area (78300) range across 4 matching MRF lines |
$369.90–$1,089.90 | $822–$2,422 | varies |
| Bone Imaging Multiple Areas (78305) | $1,308.60 | $2,908 | 3.4× |
| Bone Imaging Whole Body (78306) range across 2 matching MRF lines |
$1,308.60–$2,898 | $2,908–$6,440 | varies |
| Bone marrow imaging limited area (78102) | $1,354.05 | $3,009 | 3.5× |
| Bone survey infant (77076) | $184.05 | $409 | 1.8× |
| Brachytx Isodose Plan Simple (77316) | $507.60 | $1,128 | 1.4× |
| Brain Imaging Min 4 Static Views W Vascular Flow (78606) | $3,038.40 | $6,752 | 5.8× |
| Brain Imaging Pet Metabolic Evaluation (78608) | $1,380.60 | $3,068 | 1.0× |
| Cat Scan Follow-Up Study (76380) | $370.80 | $824 | 4.4× |
| Cerebrospinal Fluid Scan (78630) | $3,038.40 | $6,752 | 5.8× |
| Chest 1 view (71045) | $189.90 | $422 | 2.3× |
| Chest 2 views (71046) | $244.35 | $543 | 2.9× |
| Chest 4 or more views (71048) | $244.35 | $543 | 2.4× |
| Cholecystography Oral Contrast (74290) | $165.60 | $368 | 1.0× |
| Clavicle complete (73000) | $184.05 | $409 | 2.2× |
| Computed Tomography Thorax Lw Dose Lng Ca Scr C- (71271) | $738 | $1,640 | 7.3× |
| Continuing medical physics consltj pr wk (77336) | $221.40 | $492 | 1.7× |
| Contrast Exam Abdominl Aorta (75625) | $2,218.50 | $4,930 | 0.7× |
| Contrast X-Ray Bladder (74430) | $296.10 | $658 | 0.9× |
| Contrast X-Ray Of Elbow (73085) | $485.55 | $1,079 | 1.4× |
| Contrast X-Ray Of Knee Joint (73580) | $548.10 | $1,218 | 1.6× |
| CT abdomen and pelvis without and with contrast (74178) range across 3 matching MRF lines |
$1,377.45–$3,058.65 | $3,061–$6,797 | varies |
| CT abdomen and pelvis without contrast (74176) | $918.45 | $2,041 | 4.0× |
| CT abdomen w contrast (74160) | $738 | $1,640 | 4.4× |
| CT abdomen w wo contrast (74170) | $1,102.05 | $2,449 | 6.5× |
| CT abdomen w/o contrast (74150) | $738 | $1,640 | 7.3× |
| CT Angio Abdomen and Pelvis (74174) | $1,039.05 | $2,309 | 3.1× |
| CT Angio Chest (71275) | $797.85 | $1,773 | 4.7× |
| CT Angio Head (70496) | $797.85 | $1,773 | 4.7× |
| CT angio hrt w/3d image (75574) | $806.85 | $1,793 | 2.4× |
| Ct Angio Lwr Extr W/O&W/Dye (73706) | $797.85 | $1,773 | 4.7× |
| CT Angio Neck (70498) | $843.75 | $1,875 | 5.0× |
| Ct Angio Upr Extrm W/O&W/Dye (73206) | $797.85 | $1,773 | 4.7× |
| CT cervical spine w/ contrast (72126) | $738 | $1,640 | 2.2× |
| CT cervical spine w/o contrast (72125) | $738 | $1,640 | 7.3× |
| CT cervical spine w/wo cont (72127) | $1,102.05 | $2,449 | 6.5× |
| CT chest w contrast (71260) | $738 | $1,640 | 4.4× |
| CT colonography screening (74263) | $3,058.65 | $6,797 | 13.3× |
| CT colonogrphy dx image postprocess w/o contrast (74261) | $717.75 | $1,595 | 7.1× |
| CT head/brain with contrast (70460) | $738 | $1,640 | 4.4× |
| CT head/brain without and with contrast (70470) | $1,102.05 | $2,449 | 6.5× |
| CT heart no contrast quant eval coronry calcium (75571) | $59.40 | $132 | 0.7× |
| CT iac w contrast (70481) | $738 | $1,640 | 4.4× |
| CT l-spine w&w/o contrast (72133) | $1,102.05 | $2,449 | 6.5× |
| CT lower ext w/o (73700) range across 4 matching MRF lines |
$702.45–$738 | $1,561–$1,640 | varies |
| CT lower extremity w/contrast material (73701) range across 3 matching MRF lines |
$786.60–$826.65 | $1,748–$1,837 | varies |
| CT lumbar spine w contrast (72132) | $738 | $1,640 | 2.2× |
| CT lumbar spine w/o contrast (72131) | $738 | $1,640 | 7.3× |
| CT maxillofacial w contrast (70487) | $738 | $1,640 | 4.4× |
| CT maxillofacial wo contrast (70486) | $738 | $1,640 | 7.3× |
| CT neck tissue combo (70492) | $1,102.05 | $2,449 | 6.5× |
| Ct Orbit/Ear/Fossa W/O&W/Dye (70482) | $1,102.05 | $2,449 | 6.5× |
| CT orbits w/o contrast (70480) | $738 | $1,640 | 7.3× |
| CT pelvis w&w/o contrast (72194) | $1,102.05 | $2,449 | 6.5× |
| CT pelvis w/o contrast (72192) | $738 | $1,640 | 7.3× |
| CT scan of leg combo (73702) | $511.65 | $1,137 | 3.0× |
| CT scans face/jaw combo (70488) | $1,102.05 | $2,449 | 6.5× |
| CT soft tissue neck w contrast (70491) | $738 | $1,640 | 4.4× |
| CT soft tissue neck w/o contrast (70490) | $738 | $1,640 | 7.3× |
| CT thoracic spine w contrast (72129) | $738 | $1,640 | 4.4× |
| CT thoracic spine w/o contrast (72128) | $734.40 | $1,632 | 7.3× |
| CT thoracic spine w/wo cont (72130) | $1,102.05 | $2,449 | 6.5× |
| CT thorax w/o contrast (71250) | $738 | $1,640 | 7.3× |
| CT upper ext wo (73200) | $738 | $1,640 | 7.3× |
| CT upper extremity w/o & w/contrast material (73202) | $1,102.05 | $2,449 | 6.5× |
| CT upper extremity with contrast (73201) | $738 | $1,640 | 2.2× |
| Cta Abdl Aorta&Bi Iliofem W/Contrast&Postp (75635) | $797.85 | $1,773 | 4.7× |
| Cta Abdomen (74175) | $797.85 | $1,773 | 4.7× |
| CTA pelvis (72191) | $797.85 | $1,773 | 4.7× |
| Dilation ureters/urethra rs&i (74485) | $1,825.20 | $4,056 | 0.9× |
| Diskography lumbar (72295) | $2,746.35 | $6,103 | 1.5× |
| Dxa Bone Density Axial (77080) | $138.15 | $307 | 1.4× |
| Echo Guide For Artery Repair (76936) | $800.55 | $1,779 | 3.8× |
| Esophagram (74220) | $402.30 | $894 | 2.4× |
| Fetal Biophysical Profile W/O Non-Stress Testing (76819) | $126.90 | $282 | 1.3× |
| Fluoroscopy up to 1 hr (76000) | $252.45 | $561 | 1.1× |
| Follow-Up Angiography (75898) | $1,508.85 | $3,353 | 0.5× |
| Foot 2 views (73620) range across 3 matching MRF lines |
$184.05–$367.65 | $409–$817 | varies |
| Forearm 2 views (73090) range across 3 matching MRF lines |
$184.05–$367.65 | $409–$817 | varies |
| Gastric emptying imaging study (78264) | $1,305.90 | $2,902 | 3.4× |
| Gated Heart Planar Single (78472) | $921.60 | $2,048 | 2.4× |
| Hand 2 views (73120) | $184.05 | $409 | 1.8× |
| Hdr Rdncl Ntrstl/Icav Brchtx (77772) | $1,462.95 | $3,251 | 2.2× |
| Hdr Rdncl Ntrstl/Icav Brchtx (77771) | $1,348.20 | $2,996 | 2.0× |
| Hdr Rdncl Ntrstl/Icav Brchtx 1 Channel (77770) | $1,124.10 | $2,498 | 1.7× |
| Hepatobil Syst Image W/Drug (78227) | $1,607.40 | $3,572 | 3.1× |
| Hepatobiliary System Imaging (78226) | $1,435.05 | $3,189 | 3.7× |
| High energy neutron radj tx dlvr 1/> isocenter (77423) | $906.30 | $2,014 | 1.7× |
| Ht Muscle Image Spect Sing (78451) | $1,406.25 | $3,125 | 1.1× |
| Hyperthermia external generated superficial (77600) | $346.50 | $770 | 0.9× |
| Hyperthermia generated by interstitial probe(s); 5 or fewer interstitial applicators Non-Facility (77610) | $822.15 | $1,827 | 1.5× |
| Hyperthermia generated by interstitial probe(s); more than 5 interstitial applicators Non-Facility (77615) | $822.15 | $1,827 | 1.5× |
| Hyperthermia generated by intracavitary probe(s) Non-Facility (77620) | $822.15 | $1,827 | 1.5× |
| Hyperthermia, externally generated; deep (ie, heating to depths greater than 4 cm) Non-Facility (77605) | $1,124.10 | $2,498 | 1.7× |
| Hysterosalpingogram (74740) | $445.50 | $990 | 1.9× |
| Interstitial radiation source applic complex (77778) | $1,124.10 | $2,498 | 1.7× |
| Intracavitary Radiation Source Applic Complex (77763) | $1,124.10 | $2,498 | 1.7× |
| Intracavitary Radiation Source Applic Intermed (77762) | $822.15 | $1,827 | 1.5× |
| Intracavitary radiation source applic simple (77761) | $822.15 | $1,827 | 1.5× |
| Intraop radiaj tx deliver electrons sngl tx sess (77425) | $13,077 | $29,060 | 1.8× |
| Intraop radiaj tx deliver xray single tx session (77424) | $13,077 | $29,060 | 1.8× |
| K Flow/Funct Image Multiple (78709) | $1,750.50 | $3,890 | 3.3× |
| K Flow/Funct Image W/Drug (78708) | $1,750.50 | $3,890 | 3.3× |
| K Flow/Funct Image W/O Drug (78707) | $1,750.50 | $3,890 | 3.3× |
| Knee 3 Views (73562) | $184.05 | $409 | 2.2× |
| Liver & Spleen Imaging Static Only (78215) | $1,234.80 | $2,744 | 3.2× |
| Liver imaging static only (78201) | $1,491.75 | $3,315 | 2.8× |
| Lung perfusion differential (78597) | $287.10 | $638 | 0.7× |
| Lung Ventilat&Perfus Imaging (78582) | $447.75 | $995 | 0.9× |
| Lymph System Imaging (78195) | $565.65 | $1,257 | 1.1× |
| Magnetic Image Jaw Joint (70336) | $958.95 | $2,131 | 4.2× |
| Meckels Divert Exam (78290) | $1,305.90 | $2,902 | 3.4× |
| Mlc imrt design & construction per imrt plan (77338) range across 2 matching MRF lines |
$507.60–$559.80 | $1,128–$1,244 | varies |
| Mr safety implant&/fb assmt clin staf 1st 15 min (76014) | $23.85 | $53 | 0.9× |
| Mr safety implt electronics prepj supvj phys/qhp (76018) | $85.05 | $189 | 0.9× |
| Mra Head W/O & W/Contrast Material (70546) | $1,409.40 | $3,132 | 4.2× |
| MRA head w/o contrast (70544) | $918.45 | $2,041 | 4.0× |
| MRA head with contrast (70545) | $1,409.40 | $3,132 | 4.2× |
| Mra Neck W/O &W/Contrast Material (70549) | $1,409.40 | $3,132 | 4.2× |
| MRA neck w/o contrast (70547) | $918.45 | $2,041 | 4.0× |
| MRI abdomen w contrast (74182) | $1,214.10 | $2,698 | 3.6× |
| MRI abdomen w/o contrast (74181) | $958.95 | $2,131 | 4.2× |
| MRI any jt lower extrem w/contrast material (73722) | $1,214.10 | $2,698 | 1.6× |
| MRI any jt lower extrem w/o & w/contrast matrl (73723) | $1,468.80 | $3,264 | 4.4× |
| MRI any jt upper extremity w/contrast matrl (73222) | $1,214.10 | $2,698 | 1.6× |
| MRI brain functional w/o physician admnistration (70554) | $244.35 | $543 | 1.1× |
| MRI Breast W/O Contrast Bilateral (77047) range across 2 matching MRF lines |
$918.45–$958.95 | $2,041–$2,131 | varies |
| MRI Breast Without Contrast Material Unilateral (77046) | $918.45 | $2,041 | 4.0× |
| MRI cervical spine w contrast (72142) | $1,214.10 | $2,698 | 3.6× |
| MRI cervical spine w/o cont (72141) | $958.95 | $2,131 | 4.2× |
| MRI chest w/o contrast (71550) | $958.95 | $2,131 | 4.2× |
| MRI chest with contrast (71551) | $1,214.10 | $2,698 | 1.6× |
| MRI chest wo w contrast (71552) | $1,469.25 | $3,265 | 4.4× |
| MRI lower extrem oth/thn jt w/contrast matrl (73719) | $1,214.10 | $2,698 | 3.6× |
| MRI lower extrem oth/thn jt w/o & w/contr matr (73720) | $1,468.80 | $3,264 | 4.4× |
| MRI lower extrem oth/thn jt w/o contr matrl (73718) | $958.95 | $2,131 | 4.2× |
| MRI lumbar spine w contrast (72149) | $1,214.10 | $2,698 | 3.6× |
| Mri Neck Spine W/O & W/Dye (72156) | $1,469.25 | $3,265 | 4.4× |
| MRI orbit face &/neck w/o contrast (70540) | $958.95 | $2,131 | 4.2× |
| MRI orbit face neck w contrast (70542) | $1,214.10 | $2,698 | 3.6× |
| Mri Orbt/Fac/Nck W/O &W/Dye (70543) | $1,469.25 | $3,265 | 4.4× |
| MRI pelvis w contrast (72196) | $1,214.10 | $2,698 | 3.6× |
| MRI pelvis w/o & w contrast (72197) | $1,469.25 | $3,265 | 4.4× |
| MRI pelvis w/o contrast (72195) | $958.95 | $2,131 | 4.2× |
| MRI thoracic spine w/o contrast (72146) | $958.95 | $2,131 | 4.2× |
| MRI upper extremity oth than jt w/contr matrl (73219) | $1,214.10 | $2,698 | 3.6× |
| MRI upper extremity oth than jt w/o contr matrl (73218) | $958.95 | $2,131 | 4.2× |
| Mri Uppr Extremity W/O&W/Dye (73220) | $1,468.80 | $3,264 | 4.4× |
| MRI, abdomen, combo (74183) | $1,469.25 | $3,265 | 4.4× |
| MRI, dorsal spine combo (72157) | $1,469.25 | $3,265 | 4.4× |
| MRI, dorsal spine contrast (72147) | $1,214.10 | $2,698 | 3.6× |
| MRI, joint upper extrem (73221) | $958.95 | $2,131 | 4.2× |
| MRI, joint upper extrem combo (73223) | $1,468.80 | $3,264 | 4.4× |
| MRI, lumbar spine combo (72158) | $1,469.25 | $3,265 | 4.4× |
| Myelogram Lumbar (72265) | $663.30 | $1,474 | 0.9× |
| Myelography thoracic (72255) | $637.20 | $1,416 | 0.8× |
| Myocardial Spect Multiple Studies (78452) | $1,443.15 | $3,207 | 1.2× |
| Neck soft tissue (70360) | $204.30 | $454 | 2.4× |
| Nfs/Instlj Radioelmnt Sln 3 Mo Follow-Up Care (77750) | $346.50 | $770 | 0.9× |
| Nonvascular Shunt X-Ray (75809) | $131.85 | $293 | 1.3× |
| Ntsty modul radthx pln dose-vol histos (77301) range across 2 matching MRF lines |
$1,865.70–$2,057.40 | $4,146–$4,572 | varies |
| Nuclear Rx Oral Admin (79005) | $1,311.30 | $2,914 | 5.8× |
| Parathyroid imaging w/tomographic spect & CT (78072) | $1,308.60 | $2,908 | 2.5× |
| Pelvis 1 or 2 views (72170) | $184.05 | $409 | 1.8× |
| Pet Image W/Ct Lmtd (78814) | $1,354.05 | $3,009 | 1.0× |
| PET image w/CT, full body (78816) | $1,380.60 | $3,068 | 1.0× |
| PET imaging CT attenuation skull base mid-thigh (78815) | $1,380.60 | $3,068 | 1.0× |
| Prq Transhepatc Portograpy Hemodyn Eval Rs&I (75885) | $3,623.85 | $8,053 | 1.2× |
| Pulmonary Perfusion Imaging Particulate (78580) | $402.30 | $894 | 1.0× |
| Radex Abd Compl Aqt Abd W/S/E/D Views 1 View Ch (74022) | $338.85 | $753 | 3.4× |
| Radex abscess/fistula/sinus tract rs&i (76080) | $329.85 | $733 | 0.6× |
| Radex Ankle Complete Minimum 3 Views (73610) | $184.05 | $409 | 2.2× |
| Radex Calcaneus Minimum 2 Views (73650) range across 3 matching MRF lines |
$184.05–$367.65 | $409–$817 | varies |
| Radex elbow complete minimum 3 views (73080) | $184.05 | $409 | 2.2× |
| Radex Facial Bones Complete Minimum 3 Views (70150) | $175.95 | $391 | 1.7× |
| Radex fingr minimum 2 views (73140) | $184.05 | $409 | 2.2× |
| Radex foot complete minimum 3 views (73630) | $184.05 | $409 | 2.2× |
| Radex Hand Minimum 3 Views (73130) range across 3 matching MRF lines |
$184.05–$361.80 | $409–$804 | varies |
| Radex lower extremity infant minimum 2 views (73592) | $184.05 | $409 | 2.2× |
| Radex Mastoids Compl Minimum 3 Views PR Side (70130) | $175.95 | $391 | 1.7× |
| Radex Nasal Bones Complete Minimum 3 Views (70160) | $175.95 | $391 | 2.1× |
| Radex Ribs Unilateral 2 Views (71100) | $184.05 | $409 | 2.2× |
| Radex shoulder complete minimum 2 views (73030) range across 3 matching MRF lines |
$184.05–$361.80 | $409–$804 | varies |
| Radex Sinuses Paransl < 3 Views (70210) | $175.95 | $391 | 2.1× |
| Radex Spine 1 View Specify Level (72020) | $184.05 | $409 | 2.2× |
| Radex Sternum Minimum 2 Views (71120) | $184.05 | $409 | 2.2× |
| Radex Temporomandble Jt Opn & Clsd Mouth Bilat (70330) | $175.95 | $391 | 2.1× |
| Radex Toe Minimum 2 Views (73660) | $184.05 | $409 | 2.2× |
| Radex upper extremity infant minimum 2 views (73092) | $184.05 | $409 | 1.8× |
| Radex Wrist Complete Minimum 3 Views (73110) | $184.05 | $409 | 2.2× |
| Radiation Delivery Stereotactic Cranial Linear (77372) | $13,077 | $29,060 | 1.8× |
| Radiation treatment delivery level 1 (77402) | $221.40 | $492 | 2.3× |
| Radiation treatment delivery level 2 (77407) | $221.40 | $492 | 0.6× |
| Radiation treatment delivery level 3 (77412) | $382.50 | $850 | 0.7× |
| Radiolog exam mandible compl minimum 4 views (70110) | $175.95 | $391 | 1.7× |
| Radiologic Exam Abdomen 3+ Views - Xr Abdomen 3+ Views (74021) | $204.30 | $454 | 2.0× |
| Radiologic exam colon double contrast study (74280) | $646.20 | $1,436 | 3.8× |
| Radiologic exam colon single contrast study (74270) | $359.10 | $798 | 2.1× |
| Radiologic Exam Esophagus Double Contrast Study (74221) | $383.40 | $852 | 2.3× |
| Radiologic exam knee complete 4/more views (73564) range across 3 matching MRF lines |
$229.95–$459 | $511–$1,020 | varies |
| Radiologic Exam Small Int Single Contrast Study (74250) | $402.30 | $894 | 2.4× |
| Radiologic exam swallow function contrast study (74230) | $387 | $860 | 2.3× |
| Radiologic exam upr gi trc double contrast study (74246) | $402.30 | $894 | 2.4× |
| Radiologic examination femur minimum 2 views (73552) range across 3 matching MRF lines |
$184.05–$367.65 | $409–$817 | varies |
| Radiologic examination knee 1/2 views (73560) range across 5 matching MRF lines |
$184.05–$367.65 | $409–$817 | varies |
| Radiologic Examination Osseous Survey Limited (77074) | $305.10 | $678 | 3.0× |
| Radiologic examination tibia & fibula 2 views (73590) range across 3 matching MRF lines |
$184.05–$367.65 | $409–$817 | varies |
| Ribs bilateral 3 views (71110) | $367.65 | $817 | 3.6× |
| Rp loclzj tum plnr 1 area single day imaging (78800) | $402.30 | $894 | 1.0× |
| Rp Loclzj Tum Plnr Whole Body 2+ Days Imaging (78804) | $2,785.05 | $6,189 | 5.3× |
| Rp Loclzj Tum Spect 1 Area Single Day Imaging (78803) range across 6 matching MRF lines |
$1,308.60–$5,299.20 | $2,908–$11,776 | varies |
| Rp loclzj tum spect w/CT 1 area/acquisj 1day img (78830) | $1,445.85 | $3,213 | 1.2× |
| Rp Therapy Intravenous Administration (79101) | $257.85 | $573 | 1.1× |
| Scapula (73010) | $184.05 | $409 | 1.8× |
| Sella turcica (70240) | $175.95 | $391 | 2.1× |
| Shoulder 1 view (73020) | $184.05 | $409 | 2.2× |
| Shoulder Arthrography (73040) | $562.50 | $1,250 | 1.7× |
| Skull less than 4 views (70250) | $175.95 | $391 | 1.7× |
| Special dosimetry (77331) range across 2 matching MRF lines |
$200.70–$221.40 | $446–$492 | varies |
| Special Physics Consult (77370) | $221.40 | $492 | 1.7× |
| Special teletherapy port plan (77321) range across 2 matching MRF lines |
$608.85–$671.85 | $1,353–$1,493 | varies |
| Special treatment procedure (77470) range across 2 matching MRF lines |
$822.15–$906.30 | $1,827–$2,014 | varies |
| Srs Multisource (77371) | $13,077 | $29,060 | 1.8× |
| Stereotactic Body Radiation Delivery (77373) | $2,903.85 | $6,453 | 1.7× |
| Sternoclavicular joints (71130) | $184.05 | $409 | 2.2× |
| Surf radj ther orthvlt dlvr>150-500 kv per fxj (77438) | $92.25 | $205 | 0.9× |
| Surf radj ther supfc dlvr<=150 kv per fraction (77437) | $92.25 | $205 | 0.9× |
| Surf radj ther supfc/orthvlt treatment planning (77436) | $33.75 | $75 | 0.9× |
| Surface Applic Low Dose Rate Radionuclide Source (77789) | $200.70 | $446 | 2.0× |
| Telethx isodose pln cplx w/basic dosimetry (77307) range across 2 matching MRF lines |
$608.85–$671.85 | $1,353–$1,493 | varies |
| Telethx isodose pln smpl w/dosimetry calculation (77306) range across 2 matching MRF lines |
$507.60–$559.80 | $1,128–$1,244 | varies |
| Ther Rad Simulaj-Aided Field Setting Complex (77290) range across 2 matching MRF lines |
$507.60–$559.80 | $1,128–$1,244 | varies |
| Ther Rad Simulaj-Aided Field Setting Intermed (77285) range across 2 matching MRF lines |
$507.60–$559.80 | $1,128–$1,244 | varies |
| Ther rad simulaj-aided field setting simple (77280) range across 2 matching MRF lines |
$200.70–$221.40 | $446–$492 | varies |
| Thoracic spine 2 views (72070) | $184.05 | $409 | 1.8× |
| Thoracic spine 3 views (72072) | $184.05 | $409 | 1.8× |
| Thyroid Met Imaging Body (78018) | $1,552.05 | $3,449 | 3.0× |
| Thyroid Uptake Measurement (78012) | $774.90 | $1,722 | 2.0× |
| Thyroid Uptake W/Blood Flow Sngle/Mult Quan Meas (78014) | $1,043.10 | $2,318 | 2.7× |
| Tx Devices Design & Construction Complex (77334) range across 2 matching MRF lines |
$608.85–$671.85 | $1,353–$1,493 | varies |
| Tx devices design & construction intermediate (77333) range across 2 matching MRF lines |
$130.50–$144.45 | $290–$321 | varies |
| Tx devices design & construction simple (77332) range across 2 matching MRF lines |
$200.70–$221.40 | $446–$492 | varies |
| Ultrasound Breast Limited (76642) range across 3 matching MRF lines |
$118.35–$236.25 | $263–$525 | varies |
| Ultrasound Elastography Parenchyma (76981) | $330.30 | $734 | 3.3× |
| Ultrasound Exam Aaa Screen (76706) | $131.85 | $293 | 1.3× |
| Ultrasound, abdomen limited (76705) | $418.95 | $931 | 4.2× |
| Unlisted us procedure (76999) | $75.15 | $167 | 0.9× |
| Upper gi w/o kub (74240) | $402.30 | $894 | 2.4× |
| Ureteral Reflux Study (78740) | $1,750.50 | $3,890 | 4.5× |
| Urethrocystogram voiding (74455) | $757.35 | $1,683 | 3.3× |
| Urethrocystography retrograde (74450) | $338.85 | $753 | 1.5× |
| Us breast unilateral complete (76641) | $118.35 | $263 | 1.2× |
| Us chest (76604) | $267.30 | $594 | 2.7× |
| Us complete joint (76881) | $86.85 | $193 | 0.9× |
| Us exam, pelvic, limited (76857) range across 2 matching MRF lines |
$341.55–$418.95 | $759–$931 | varies |
| Us lmtd joint/oth nonvasc xtr strux r-t w/img (76882) | $86.85 | $193 | 0.9× |
| Us ob limited 1 or more fetuses (76815) | $281.70 | $626 | 2.8× |
| Us ob transvaginal (76817) | $439.20 | $976 | 4.4× |
| Us pelvic non ob complete (76856) | $424.80 | $944 | 4.2× |
| Us preg uterus real time f/u trnsabdl per fetus (76816) | $124.65 | $277 | 1.2× |
| Us retroperitoneal complete (76770) | $418.95 | $931 | 4.2× |
| Us retroperitoneal limited (76775) | $418.95 | $931 | 4.2× |
| Us scrotum and contents (76870) | $418.95 | $931 | 4.2× |
| Us thyroid (76536) range across 2 matching MRF lines |
$112.05–$418.95 | $249–$931 | varies |
| Us transrectal (76872) | $126.90 | $282 | 1.3× |
| Vein X-Ray Chest (75827) | $1,615.50 | $3,590 | 1.1× |
| Vein X-Ray Liver W/O Hemodyn (75887) | $1,508.85 | $3,353 | 0.5× |
| Venogram Sinus/Jugular (75860) | $3,182.40 | $7,072 | 1.0× |
| Venography Adrenal Unilateral (75840) | $3,534.30 | $7,854 | 1.2× |
| Venography caval inferior serialography rs&i (75825) | $3,058.65 | $6,797 | 1.0× |
| Venography extremity bilateral rs&i (75822) | $758.25 | $1,685 | 0.5× |
| Venography extremity unilateral rs&i (75820) | $763.65 | $1,697 | 0.5× |
| Venography Renal Bilateral (75833) | $3,534.30 | $7,854 | 1.2× |
| Venography Renal Unilateral (75831) | $3,534.30 | $7,854 | 1.2× |
| Venous sampling by catheter (75893) | $3,451.95 | $7,671 | 0.6× |
| Venous thrombosis imaging (78457) | $864 | $1,920 | 1.7× |
| Wrist 2 views (73100) range across 3 matching MRF lines |
$184.05–$367.65 | $409–$817 | varies |
| X-Ray Ac Jts - Xr Acromioclavicular Joints Bilateral (73050) | $367.65 | $817 | 4.4× |
| X-ray antegrade pyelogram tube (74425) | $835.20 | $1,856 | 2.5× |
| X-Ray Aorta Leg Arteries (75630) | $2,160.90 | $4,802 | 0.7× |
| X-Ray Bend Only L-S Spine (72120) | $305.10 | $678 | 3.0× |
| X-Ray Elbow 2 Vw - Xr Elbow 1-2 Views Right (73070) range across 3 matching MRF lines |
$184.05–$367.65 | $409–$817 | varies |
| X-Ray Exam Breast Specimen (76098) | $750.15 | $1,667 | 1.4× |
| X-Ray Exam Entire Spi 2/3 Vw (72082) | $184.05 | $409 | 1.8× |
| X-Ray Exam Hip Uni 1 View (73501) | $80.55 | $179 | 1.0× |
| X-Ray Exam Hip Uni 2-3 Views (73502) | $184.05 | $409 | 2.2× |
| X-Ray Exam Hip Uni 4/> Views (73503) | $320.85 | $713 | 3.2× |
| X-Ray Exam Hips Bi 3-4 Views (73522) | $305.10 | $678 | 3.0× |
| X-Ray Exam L-S Spine Bending (72114) | $305.10 | $678 | 3.0× |
| X-Ray Exam Neck Spine 2-3 Vw (72040) | $184.05 | $409 | 2.2× |
| X-Ray Exam Neck Spine 6/>Vws (72052) | $305.10 | $678 | 3.0× |
| X-Ray Exam Unilat Ribs/Chest (71101) | $184.05 | $409 | 1.8× |
| X-ray humerus (73060) range across 3 matching MRF lines |
$184.05–$367.65 | $409–$817 | varies |
| X-ray IV pyelogram (ivp) (74400) | $757.35 | $1,683 | 4.5× |
| X-ray IV pyelogram+tomography (74415) | $757.35 | $1,683 | 4.5× |
| X-Ray Lumbar Spine 2/3 Vw - Xr Lumbar Spine 2-3 Views (72100) | $184.05 | $409 | 1.8× |
| X-ray nose-rectum child f.b. (76010) | $204.30 | $454 | 2.4× |
| X-Ray Ribs, Chest 4+ Vw - Xr Ribs 3 Vws Bil W/ Chest Posteroanterior (71111) | $305.10 | $678 | 3.0× |
| X-Ray Sacroiliac Jts 3+ Vw - Xr Sacroiliac Joints 3+ Views (72202) | $184.05 | $409 | 1.8× |
| X-Ray Sacrum/Coccyx 2+ Vw - Xr Sacrum Coccyx 2+ Views (72220) | $184.05 | $409 | 2.2× |
| X-Ray Sinuses 3+ Vw - Xr Paranasal Sinuses 3+ Views (70220) | $175.95 | $391 | 2.1× |
| X-Ray Skull 4+ Vw - Xr Skull Complete 4+ Views (70260) | $293.85 | $653 | 2.9× |
| X-ray thoracic spine 4 vw (72074) | $320.85 | $713 | 3.2× |
| X-Ray Urinary Tract Exam With Contrast Material (74420) | $336.60 | $748 | 1.0× |
| X-Rays Bone Length Studies (77073) | $184.05 | $409 | 1.8× |
| X-Rays Bone Survey Complete (77075) | $305.10 | $678 | 3.0× |
| Xr c-spine 4 or 5 views (72050) | $293.85 | $653 | 2.9× |
| Xr facial bones less than 3 views (70140) | $175.95 | $391 | 2.1× |
| Xr orbits complete 4 views (70200) | $175.95 | $391 | 1.7× |
| Xr Tomogram Single Plane (76100) | $100.35 | $223 | 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.