Imaging prices at Fairfield Memorial Hospital 1
Fairfield, IL · every code in this section with a posted price and a Medicare benchmark.
285 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 2 matching MRF lines |
$112.80–$304.80 | $141–$381 | varies |
| Abdomen 2 views (74019) | $400 | $500 | 3.6× |
| Acute Gastrointestinal Blood Loss Imaging (78278) | $2,287.20 | $2,859 | 5.3× |
| Angiography extremity unilateral rs&i (75710) | $2,013.60 | $2,517 | 0.6× |
| Ankle 2 views (73600) | $278.40 | $348 | 3.0× |
| Artery X-Rays Abdomen (75726) range across 3 matching MRF lines |
$1,908.80–$3,694.40 | $2,386–$4,618 | varies |
| Arthrogram hip (73525) range across 2 matching MRF lines |
$917.60–$1,378.40 | $1,147–$1,723 | varies |
| Bone age studies (77072) | $306.40 | $383 | 2.7× |
| Bone Imaging 3 Phase (78315) | $2,263.20 | $2,829 | 5.3× |
| Bone Imaging Limited Area (78300) | $1,234.40 | $1,543 | 2.9× |
| Bone Imaging Multiple Areas (78305) | $1,760.80 | $2,201 | 4.1× |
| Bone Imaging Whole Body (78306) | $2,000 | $2,500 | 4.7× |
| Bone survey infant (77076) | $480.80 | $601 | 4.3× |
| Brain Imaging Min 4 Static Views W Vascular Flow (78606) | $955.20 | $1,194 | 1.6× |
| Brain Imaging Pet Metabolic Evaluation (78608) | $5,832 | $7,290 | 3.8× |
| Cardiac MRI w/w/o contrast & further seq (75561) range across 2 matching MRF lines |
$1,740.80–$1,764 | $2,176–$2,205 | varies |
| Cat Scan Follow-Up Study (76380) range across 2 matching MRF lines |
$910.40–$1,651.20 | $1,138–$2,064 | varies |
| Chest 1 view (71045) | $283.20 | $354 | 3.0× |
| Chest 2 views (71046) range across 2 matching MRF lines |
$49.60–$360.80 | $62–$451 | varies |
| Chest 3 views (71047) range across 2 matching MRF lines |
$282.40–$304.80 | $353–$381 | varies |
| Chest 4 or more views (71048) | $479.20 | $599 | 4.3× |
| Cholecystography Oral Contrast (74290) | $276.80 | $346 | 1.5× |
| Clavicle complete (73000) range across 2 matching MRF lines |
$160–$291.20 | $200–$364 | varies |
| Computed Tomography Thorax Lw Dose Lng Ca Scr C- (71271) | $2,536 | $3,170 | 22.6× |
| Contrast Exam Abdominl Aorta (75625) | $2,013.60 | $2,517 | 0.6× |
| Contrast X-Ray Bladder (74430) range across 4 matching MRF lines |
$209.60–$762.40 | $262–$953 | varies |
| Contrast X-Ray Of Knee Joint (73580) | $1,378.40 | $1,723 | 3.7× |
| CT abdomen and pelvis without and with contrast (74178) range across 7 matching MRF lines |
$5,316.80–$6,933.60 | $6,646–$8,667 | varies |
| CT abdomen and pelvis without contrast (74176) | $4,977.60 | $6,222 | 19.5× |
| CT abdomen w contrast (74160) | $2,907.20 | $3,634 | 15.5× |
| CT abdomen w wo contrast (74170) | $3,512.80 | $4,391 | 18.7× |
| CT abdomen w/o contrast (74150) | $2,471.20 | $3,089 | 22.1× |
| CT Angio Abdomen and Pelvis (74174) | $8,678.40 | $10,848 | 23.2× |
| CT Angio Chest (71275) | $4,764 | $5,955 | 25.3× |
| CT Angio Head (70496) | $4,339.20 | $5,424 | 23.1× |
| Ct Angio Lwr Extr W/O&W/Dye (73706) | $4,339.20 | $5,424 | 23.1× |
| CT Angio Neck (70498) | $4,339.20 | $5,424 | 23.1× |
| Ct Angio Upr Extrm W/O&W/Dye (73206) | $4,339.20 | $5,424 | 23.1× |
| CT cervical spine w/ contrast (72126) | $2,732.80 | $3,416 | 7.3× |
| CT cervical spine w/o contrast (72125) | $2,536 | $3,170 | 22.6× |
| CT cervical spine w/wo cont (72127) | $3,593.60 | $4,492 | 19.1× |
| CT chest w contrast (71260) | $2,965.60 | $3,707 | 15.8× |
| CT chest w/wo contrast (71270) | $3,896.80 | $4,871 | 20.7× |
| CT colonography screening (74263) | $3,125.60 | $3,907 | 12.2× |
| CT colonogrphy dx image postprocess w/o contrast (74261) | $3,125.60 | $3,907 | 27.9× |
| CT head/brain with contrast (70460) | $2,444.80 | $3,056 | 13.0× |
| CT head/brain without and with contrast (70470) | $2,984.80 | $3,731 | 15.9× |
| CT iac w contrast (70481) range across 2 matching MRF lines |
$2,204.80–$2,486.40 | $2,756–$3,108 | varies |
| CT l-spine w&w/o contrast (72133) | $4,516 | $5,645 | 24.0× |
| CT lower ext w/o (73700) | $2,188 | $2,735 | 19.5× |
| CT lower extremity w/contrast material (73701) | $2,536 | $3,170 | 13.5× |
| CT lumbar spine w contrast (72132) | $3,224.80 | $4,031 | 8.6× |
| CT lumbar spine w/o contrast (72131) | $2,536 | $3,170 | 22.6× |
| CT maxillofacial w contrast (70487) | $2,528 | $3,160 | 13.4× |
| CT maxillofacial wo contrast (70486) | $2,134.40 | $2,668 | 19.1× |
| Ct Orbit/Ear/Fossa W/O&W/Dye (70482) | $3,068 | $3,835 | 16.3× |
| CT orbits w/o contrast (70480) range across 4 matching MRF lines |
$2,136–$3,068 | $2,670–$3,835 | varies |
| CT pelvis w&w/o contrast (72194) | $3,420.80 | $4,276 | 18.2× |
| CT pelvis w/o contrast (72192) | $2,505.60 | $3,132 | 22.4× |
| CT scan of leg combo (73702) | $2,908.80 | $3,636 | 15.5× |
| CT scans face/jaw combo (70488) | $2,812.80 | $3,516 | 15.0× |
| CT soft tissue neck w contrast (70491) | $2,564 | $3,205 | 13.6× |
| CT soft tissue neck w/o contrast (70490) | $1,992 | $2,490 | 17.8× |
| CT thoracic spine w contrast (72129) | $2,680 | $3,350 | 14.3× |
| CT thoracic spine w/o contrast (72128) | $2,536 | $3,170 | 22.6× |
| CT thoracic spine w/wo cont (72130) | $4,516 | $5,645 | 24.0× |
| CT thorax w/o contrast (71250) range across 4 matching MRF lines |
$2,536–$2,661.60 | $3,170–$3,327 | varies |
| CT upper ext wo (73200) | $2,188 | $2,735 | 19.5× |
| CT upper extremity with contrast (73201) | $2,536 | $3,170 | 6.8× |
| Cta Abdl Aorta&Bi Iliofem W/Contrast&Postp (75635) | $5,303.20 | $6,629 | 28.2× |
| Cta Abdomen (74175) | $4,339.20 | $5,424 | 23.1× |
| CTA pelvis (72191) | $4,339.20 | $5,424 | 23.1× |
| Discography Cerv/Thor Spine (72285) | $13,572.80 | $16,966 | 6.5× |
| Dxa Bone Density Axial (77080) | $1,353.60 | $1,692 | 12.1× |
| Esophageal Motility Study (78258) | $789.60 | $987 | 1.8× |
| Esophagram (74220) | $719.20 | $899 | 3.8× |
| Fetal Biophys Profile W/Nst (76818) | $1,035.20 | $1,294 | 9.2× |
| Fluoroscopy up to 1 hr (76000) range across 3 matching MRF lines |
$330.40–$598.40 | $413–$748 | varies |
| Foot 2 views (73620) | $278.40 | $348 | 3.0× |
| Forearm 2 views (73090) | $291.20 | $364 | 3.1× |
| Gastric emptying imaging study (78264) | $1,903.20 | $2,379 | 4.4× |
| Gastric Mucosa Imaging (78261) | $1,851.20 | $2,314 | 4.3× |
| Gastroesophageal Reflux Exam (78262) | $1,044.80 | $1,306 | 2.4× |
| Gated Heart Planar Single (78472) | $2,505.60 | $3,132 | 5.8× |
| Gated Heart, Multiple (78473) | $2,066.40 | $2,583 | 4.8× |
| Hand 2 views (73120) | $278.40 | $348 | 2.5× |
| Heart first pass single,planar (78481) | $1,328.80 | $1,661 | 2.3× |
| Hepatobil Syst Image W/Drug (78227) | $1,768 | $2,210 | 3.0× |
| Hepatobiliary System Imaging (78226) | $1,596.80 | $1,996 | 3.7× |
| Ht Muscle Image Spect Sing (78451) range across 3 matching MRF lines |
$893.60–$3,122.40 | $1,117–$3,903 | varies |
| Hysterosalpingogram (74740) | $411.20 | $514 | 1.6× |
| Infusion Ivp (74410) | $576.80 | $721 | 3.1× |
| Joint Survey Single View (77077) range across 2 matching MRF lines |
$365.60–$608 | $457–$760 | varies |
| K Flow/Funct Image Multiple (78709) | $2,631.20 | $3,289 | 4.5× |
| K Flow/Funct Image W/Drug (78708) range across 2 matching MRF lines |
$1,532–$2,534.40 | $1,915–$3,168 | varies |
| K Flow/Funct Image W/O Drug (78707) | $2,115.20 | $2,644 | 3.6× |
| Kidney Funcj Study Non-Img Radioisotopic Study (78725) | $846.40 | $1,058 | 2.0× |
| Kidney Imaging Morphoogy W/Vascular Flow (78701) | $1,955.20 | $2,444 | 4.6× |
| Knee 3 Views (73562) | $325.60 | $407 | 3.5× |
| Leveen/Shunt Patency Exam (78291) | $917.60 | $1,147 | 2.1× |
| Liver & Spleen Imaging Static Only (78215) | $1,311.20 | $1,639 | 3.1× |
| Liver & Spleen Imaging W/Vascular Flow (78216) | $1,559.20 | $1,949 | 3.6× |
| Liver imaging static only (78201) | $596.80 | $746 | 1.0× |
| Liver imaging w/vascular flow (78202) | $722.40 | $903 | 1.2× |
| Lung Ventilat&Perfus Imaging (78582) | $2,280 | $2,850 | 3.9× |
| Lung Ventilation Imaging (78579) | $1,272 | $1,590 | 3.0× |
| Lymph System Imaging (78195) | $1,401.60 | $1,752 | 2.4× |
| Magnetic Image Jaw Joint (70336) | $3,208 | $4,010 | 12.5× |
| Mammary ductogram or galactogram multiple (77054) | $1,730.40 | $2,163 | 6.8× |
| Mammary ductogram or galactogram single (77053) | $1,272 | $1,590 | 5.0× |
| Meckels Divert Exam (78290) | $1,458.40 | $1,823 | 3.4× |
| Mra Head W/O & W/Contrast Material (70546) range across 2 matching MRF lines |
$3,961.60–$6,709.60 | $4,952–$8,387 | varies |
| MRA head w/o contrast (70544) | $3,355.20 | $4,194 | 13.1× |
| Mra Neck W/O &W/Contrast Material (70549) | $5,764 | $7,205 | 15.4× |
| MRA neck w/o contrast (70547) | $3,355.20 | $4,194 | 13.1× |
| MRI abdomen w contrast (74182) | $3,639.20 | $4,549 | 9.7× |
| MRI abdomen w/o contrast (74181) | $3,316.80 | $4,146 | 13.0× |
| MRI any jt lower extrem w/contrast material (73722) | $2,960.80 | $3,701 | 3.5× |
| MRI any jt lower extrem w/o & w/contrast matrl (73723) range across 2 matching MRF lines |
$3,064–$3,208 | $3,830–$4,010 | varies |
| MRI any jt upper extremity w/contrast matrl (73222) | $3,276.80 | $4,096 | 3.9× |
| MRI bone marrow blood supply (77084) | $3,316.80 | $4,146 | 13.0× |
| MRI cardiac w/o contrast (75557) | $1,709.60 | $2,137 | 6.7× |
| MRI cervical spine w contrast (72142) | $3,988 | $4,985 | 10.7× |
| MRI cervical spine w/o cont (72141) | $3,316.80 | $4,146 | 13.0× |
| MRI chest w/o contrast (71550) | $3,316.80 | $4,146 | 13.0× |
| MRI chest with contrast (71551) | $3,988 | $4,985 | 4.7× |
| MRI chest wo w contrast (71552) | $7,012.80 | $8,766 | 18.8× |
| MRI lower extrem oth/thn jt w/o & w/contr matr (73720) | $3,276.80 | $4,096 | 8.8× |
| MRI lower extrem oth/thn jt w/o contr matrl (73718) | $3,276.80 | $4,096 | 12.8× |
| MRI lumbar spine w contrast (72149) | $3,934.40 | $4,918 | 10.5× |
| Mri Neck Spine W/O & W/Dye (72156) | $7,012.80 | $8,766 | 18.8× |
| MRI orbit face &/neck w/o contrast (70540) range across 4 matching MRF lines |
$3,064–$3,276.80 | $3,830–$4,096 | varies |
| MRI orbit face neck w contrast (70542) | $3,276.80 | $4,096 | 8.8× |
| Mri Orbt/Fac/Nck W/O &W/Dye (70543) | $7,012.80 | $8,766 | 18.8× |
| MRI pelvis w contrast (72196) | $3,316.80 | $4,146 | 8.9× |
| MRI pelvis w/o & w contrast (72197) | $6,679.20 | $8,349 | 17.9× |
| MRI pelvis w/o contrast (72195) | $3,122.40 | $3,903 | 12.2× |
| MRI thoracic spine w/o contrast (72146) | $3,622.40 | $4,528 | 14.2× |
| MRI upper extremity oth than jt w/contr matrl (73219) | $2,082.40 | $2,603 | 5.6× |
| MRI upper extremity oth than jt w/o contr matrl (73218) range across 3 matching MRF lines |
$1,205.60–$4,551.20 | $1,507–$5,689 | varies |
| Mri Uppr Extremity W/O&W/Dye (73220) | $3,276.80 | $4,096 | 8.8× |
| MRI, abdomen, combo (74183) | $3,999.20 | $4,999 | 10.7× |
| MRI, dorsal spine combo (72157) | $7,012.80 | $8,766 | 18.8× |
| MRI, dorsal spine contrast (72147) | $3,988 | $4,985 | 10.7× |
| MRI, joint upper extrem (73221) | $3,208 | $4,010 | 12.5× |
| MRI, joint upper extrem combo (73223) | $3,432 | $4,290 | 9.2× |
| MRI, lumbar spine combo (72158) | $6,936.80 | $8,671 | 18.6× |
| Myelogram cervical (72240) | $2,436.80 | $3,046 | 2.9× |
| Myelogram Lumbar (72265) range across 2 matching MRF lines |
$598.40–$2,124.80 | $748–$2,656 | varies |
| Myocardial Spect Multiple Studies (78452) range across 3 matching MRF lines |
$2,378.40–$6,800 | $2,973–$8,500 | varies |
| Neck soft tissue (70360) | $263.20 | $329 | 2.8× |
| Njx Rp Loclzj Non-Img Probe Study Intravenous (78808) | $1,319.20 | $1,649 | 3.1× |
| Nonvascular Shunt X-Ray (75809) | $387.20 | $484 | 3.5× |
| Nuclear Rx Oral Admin (79005) | $936 | $1,170 | 3.7× |
| Parathyroid planar imaging w/wo subtraction (78071) | $1,063.20 | $1,329 | 2.5× |
| Pelvis 1 or 2 views (72170) range across 2 matching MRF lines |
$298.40–$1,044.80 | $373–$1,306 | varies |
| PET image w/CT, full body (78816) range across 2 matching MRF lines |
$5,398.40–$6,427.20 | $6,748–$8,034 | varies |
| PET imaging CT attenuation skull base mid-thigh (78815) | $5,832 | $7,290 | 3.8× |
| Pulmonary Perfusion Imaging Particulate (78580) | $1,632.80 | $2,041 | 3.8× |
| Radex Abd Compl Aqt Abd W/S/E/D Views 1 View Ch (74022) | $1,112 | $1,390 | 9.9× |
| Radex abscess/fistula/sinus tract rs&i (76080) | $746.40 | $933 | 1.3× |
| Radex Ankle Complete Minimum 3 Views (73610) | $304.80 | $381 | 3.3× |
| Radex Calcaneus Minimum 2 Views (73650) | $270.40 | $338 | 2.9× |
| Radex elbow complete minimum 3 views (73080) | $314.40 | $393 | 3.4× |
| Radex Facial Bones Complete Minimum 3 Views (70150) | $455.20 | $569 | 4.1× |
| Radex fingr minimum 2 views (73140) | $238.40 | $298 | 2.6× |
| Radex foot complete minimum 3 views (73630) | $304.80 | $381 | 3.3× |
| Radex Hand Minimum 3 Views (73130) | $304.80 | $381 | 3.3× |
| Radex Mastoids Compl Minimum 3 Views PR Side (70130) | $496 | $620 | 4.4× |
| Radex Nasal Bones Complete Minimum 3 Views (70160) | $302.40 | $378 | 3.2× |
| Radex Ribs Unilateral 2 Views (71100) | $349.60 | $437 | 3.7× |
| Radex shoulder complete minimum 2 views (73030) | $317.60 | $397 | 3.4× |
| Radex Sinuses Paransl < 3 Views (70210) | $337.60 | $422 | 3.6× |
| Radex sm int w/mlt srl imges via enteroclss tube (74251) | $1,904 | $2,380 | 10.1× |
| Radex Spine 1 View Specify Level (72020) range across 3 matching MRF lines |
$147.20–$254.40 | $184–$318 | varies |
| Radex Sternum Minimum 2 Views (71120) | $360.80 | $451 | 3.9× |
| Radex Temporomandble Jt Opn & Clsd Mouth Bilat (70330) | $456 | $570 | 4.9× |
| Radex Toe Minimum 2 Views (73660) | $238.40 | $298 | 2.6× |
| Radex Wrist Complete Minimum 3 Views (73110) range across 6 matching MRF lines |
$304.80–$330.40 | $381–$413 | varies |
| Radex X-Ray Exam Entire Spi 6/> Vw - Xr Entire Spine 6+ Vw (72084) | $487.20 | $609 | 4.3× |
| Radiolog exam mandible compl minimum 4 views (70110) | $384.80 | $481 | 3.4× |
| Radiologic Exam Abdomen 3+ Views - Xr Abdomen 3+ Views (74021) | $400 | $500 | 3.6× |
| Radiologic exam colon double contrast study (74280) | $1,430.40 | $1,788 | 7.6× |
| Radiologic exam colon single contrast study (74270) range across 2 matching MRF lines |
$456.80–$1,057.60 | $571–$1,322 | varies |
| Radiologic Exam Esophagus Double Contrast Study (74221) | $1,501.60 | $1,877 | 8.0× |
| Radiologic exam knee complete 4/more views (73564) range across 5 matching MRF lines |
$202.40–$424.80 | $253–$531 | varies |
| Radiologic exam pelvis compl minimum 3 views (72190) | $377.60 | $472 | 3.4× |
| Radiologic Exam Small Int Single Contrast Study (74250) | $764.80 | $956 | 4.1× |
| Radiologic exam swallow function contrast study (74230) | $808.80 | $1,011 | 4.3× |
| Radiologic exam upr gi trc double contrast study (74246) range across 4 matching MRF lines |
$1,047.20–$2,439.20 | $1,309–$3,049 | varies |
| Radiologic examination femur 1 view (73551) | $274.40 | $343 | 2.9× |
| Radiologic examination femur minimum 2 views (73552) | $441.60 | $552 | 4.7× |
| Radiologic examination knee 1/2 views (73560) | $298.40 | $373 | 3.2× |
| Radiologic Examination Osseous Survey Limited (77074) | $720 | $900 | 6.4× |
| Radiologic examination tibia & fibula 2 views (73590) | $298.40 | $373 | 3.2× |
| Red Cell Volume Determination Spx 1 Sampling (78120) | $420 | $525 | 1.0× |
| Ribs bilateral 3 views (71110) | $456 | $570 | 4.1× |
| Rp loclzj tum plnr 1 area single day imaging (78800) | $1,760.80 | $2,201 | 4.1× |
| Rp Loclzj Tum Plnr Whole Body Single Day Imaging (78802) | $1,544.80 | $1,931 | 2.7× |
| Rp Loclzj Tum Spect 1 Area Single Day Imaging (78803) range across 3 matching MRF lines |
$2,396.80–$4,683.20 | $2,996–$5,854 | varies |
| Rp Therapy Intravenous Administration (79101) | $532.80 | $666 | 2.1× |
| Scapula (73010) | $302.40 | $378 | 2.7× |
| Screening Digital Breast Tomosynthesis Bi (77063) | $260.80 | $326 | 11.2× |
| Sella turcica (70240) | $149.60 | $187 | 1.6× |
| Shoulder 1 view (73020) | $268 | $335 | 2.9× |
| Shoulder Arthrography (73040) | $1,164.80 | $1,456 | 3.1× |
| Skull less than 4 views (70250) | $377.60 | $472 | 3.4× |
| Speech evaluation, complex (70371) | $1,296 | $1,620 | 5.1× |
| Spleen Imaging (78185) | $588 | $735 | 1.4× |
| Sternoclavicular joints (71130) | $399.20 | $499 | 4.3× |
| Therapeutic Enema Rdctj Intussusception/Obstrcj (74283) | $2,141.60 | $2,677 | 11.4× |
| Thoracic spine 2 views (72070) | $378.40 | $473 | 3.4× |
| Thoracic spine 3 views (72072) | $424 | $530 | 3.8× |
| Thoracolumbar 2 views (72080) | $378.40 | $473 | 4.1× |
| Thyroid Imaging With Vascular Flow (78013) | $860 | $1,075 | 2.0× |
| Thyroid Met Imaging Body (78018) | $2,555.20 | $3,194 | 4.4× |
| Thyroid Uptake Measurement (78012) | $313.60 | $392 | 0.7× |
| Thyroid Uptake W/Blood Flow Sngle/Mult Quan Meas (78014) range across 2 matching MRF lines |
$616.80–$1,196 | $771–$1,495 | varies |
| Ultrasound Breast Limited (76642) range across 3 matching MRF lines |
$736.80–$1,104.80 | $921–$1,381 | varies |
| Ultrasound Exam Aaa Screen (76706) | $1,159.20 | $1,449 | 10.3× |
| Ultrasound, abdomen limited (76705) range across 6 matching MRF lines |
$623.20–$1,159.20 | $779–$1,449 | varies |
| Unlisted magnetic resonance procedure (76498) | $3,355.20 | $4,194 | 36.0× |
| Unlisted Miscellaneous Px Dx Nuclear Medicine (78999) range across 3 matching MRF lines |
$288–$583.20 | $360–$729 | varies |
| Unlisted us procedure (76999) | $787.20 | $984 | 8.4× |
| Urea Breath Test C-14 Isotopic Acquisj Analysis (78267) | $548.80 | $686 | 49.6× |
| Urea breath test c-14 isotopic analysis (78268) | $303.20 | $379 | 3.2× |
| Ureteral Reflux Study (78740) | $590.40 | $738 | 1.4× |
| Urethrocystogram voiding (74455) | $827.20 | $1,034 | 3.2× |
| Urethrocystography retrograde (74450) | $782.40 | $978 | 3.1× |
| Us breast unilateral complete (76641) range across 3 matching MRF lines |
$736.80–$1,104.80 | $921–$1,381 | varies |
| Us chest (76604) | $736.80 | $921 | 6.6× |
| Us complete joint (76881) range across 3 matching MRF lines |
$860–$948 | $1,075–$1,185 | varies |
| Us exam, pelvic, limited (76857) | $860 | $1,075 | 7.7× |
| Us head (76506) | $886.40 | $1,108 | 7.9× |
| Us lmtd joint/oth nonvasc xtr strux r-t w/img (76882) | $860 | $1,075 | 7.7× |
| Us ob detailed single fetus (76811) | $1,601.60 | $2,002 | 6.3× |
| Us ob limited 1 or more fetuses (76815) range across 4 matching MRF lines |
$736.80–$895.20 | $921–$1,119 | varies |
| Us ob transvaginal (76817) range across 2 matching MRF lines |
$207.20–$963.20 | $259–$1,204 | varies |
| Us pelvic non ob complete (76856) | $963.20 | $1,204 | 8.6× |
| Us preg uterus real time f/u trnsabdl per fetus (76816) | $736.80 | $921 | 6.6× |
| Us retroperitoneal limited (76775) | $1,159.20 | $1,449 | 10.3× |
| Us scrotum and contents (76870) range across 4 matching MRF lines |
$184.80–$928.80 | $231–$1,161 | varies |
| Us spinal canal and contents (76800) | $668.80 | $836 | 6.0× |
| Us thyroid (76536) | $848.80 | $1,061 | 7.6× |
| Us transrectal (76872) range across 5 matching MRF lines |
$140.80–$690.40 | $176–$863 | varies |
| Venography extremity bilateral rs&i (75822) | $1,226.40 | $1,533 | 0.7× |
| Venography extremity unilateral rs&i (75820) | $794.40 | $993 | 0.5× |
| Venous thrombosis imaging (78457) range across 2 matching MRF lines |
$756.80–$973.60 | $946–$1,217 | varies |
| Venous Thrombosis Imaging Venogram Bilateral (78458) range across 4 matching MRF lines |
$711.20–$1,421.60 | $889–$1,777 | varies |
| Wrist 2 views (73100) | $278.40 | $348 | 3.0× |
| X-Ray Ac Jts - Xr Acromioclavicular Joints Bilateral (73050) | $374.40 | $468 | 4.0× |
| X-Ray Bend Only L-S Spine (72120) | $732 | $915 | 6.5× |
| X-Ray Elbow 2 Vw - Xr Elbow 1-2 Views Right (73070) | $287.20 | $359 | 3.1× |
| X-Ray Exam Breast Specimen (76098) | $263.20 | $329 | 0.4× |
| X-Ray Exam Entire Spi 1 Vw (72081) range across 3 matching MRF lines |
$312.80–$435.20 | $391–$544 | varies |
| X-Ray Exam Entire Spi 2/3 Vw (72082) | $464 | $580 | 4.1× |
| X-Ray Exam Entire Spi 4/5 Vw (72083) | $471.20 | $589 | 4.2× |
| X-Ray Exam Hip Uni 1 View (73501) range across 2 matching MRF lines |
$272.80–$274.40 | $341–$343 | varies |
| X-Ray Exam Hip Uni 2-3 Views (73502) range across 3 matching MRF lines |
$272.80–$441.60 | $341–$552 | varies |
| X-Ray Exam Hip Uni 4/> Views (73503) range across 2 matching MRF lines |
$202.40–$452.80 | $253–$566 | varies |
| X-Ray Exam Hips Bi 2 Views (73521) | $452.80 | $566 | 4.0× |
| X-Ray Exam Hips Bi 3-4 Views (73522) | $452.80 | $566 | 4.0× |
| X-Ray Exam Hips Bi 5/> Views (73523) | $862.40 | $1,078 | 7.7× |
| X-Ray Exam L-S Spine Bending (72114) | $1,264 | $1,580 | 11.3× |
| X-Ray Exam Neck Spine 2-3 Vw (72040) | $357.60 | $447 | 3.8× |
| X-Ray Exam Neck Spine 6/>Vws (72052) | $644.80 | $806 | 5.8× |
| X-Ray Exam Unilat Ribs/Chest (71101) | $401.60 | $502 | 3.6× |
| X-ray eye for foreign body (70030) | $266.40 | $333 | 2.9× |
| X-ray humerus (73060) | $314.40 | $393 | 3.4× |
| X-ray IV pyelogram (ivp) (74400) | $922.40 | $1,153 | 4.9× |
| X-ray IV pyelogram+tomography (74415) | $1,092 | $1,365 | 5.8× |
| X-Ray Knee Bilat Standing - Xr Knees Anteroposterior Standing Bilat (73565) | $283.20 | $354 | 3.0× |
| X-Ray Lumbar Spine 2/3 Vw - Xr Lumbar Spine 2-3 Views (72100) | $378.40 | $473 | 3.4× |
| X-Ray Ribs, Chest 4+ Vw - Xr Ribs 3 Vws Bil W/ Chest Posteroanterior (71111) range across 2 matching MRF lines |
$479.20–$513.60 | $599–$642 | varies |
| X-Ray Sacroiliac Jts 3+ Vw - Xr Sacroiliac Joints 3+ Views (72202) | $349.60 | $437 | 3.1× |
| X-Ray Sacrum/Coccyx 2+ Vw - Xr Sacrum Coccyx 2+ Views (72220) | $314.40 | $393 | 3.4× |
| X-Ray Sinuses 3+ Vw - Xr Paranasal Sinuses 3+ Views (70220) | $452 | $565 | 4.8× |
| X-Ray Skull 4+ Vw - Xr Skull Complete 4+ Views (70260) | $541.60 | $677 | 4.8× |
| X-Ray Stress View (77071) | $278.40 | $348 | 3.0× |
| X-Ray Urinary Tract Exam With Contrast Material (74420) range across 3 matching MRF lines |
$796.80–$1,432 | $996–$1,790 | varies |
| X-Rays Bone Length Studies (77073) | $256 | $320 | 2.3× |
| X-Rays Bone Survey Complete (77075) | $947.20 | $1,184 | 8.5× |
| Xr c-spine 4 or 5 views (72050) | $521.60 | $652 | 4.7× |
| Xr orbits complete 4 views (70200) | $464.80 | $581 | 4.1× |
| Xr Tomogram Single Plane (76100) | $450.40 | $563 | 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.