Imaging prices at Faith Health
Norfolk, NE · every code in this section with a posted price and a Medicare benchmark.
313 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) | $6,600.17 | $10,767 | 4.6× |
| Abdomen 1 View (74018) | $277.69 | $453 | 3.1× |
| Abdomen 2 views (74019) | $260.53 | $425 | 2.4× |
| Acute Gastrointestinal Blood Loss Imaging (78278) | $2,616.28 | $4,268 | 6.3× |
| Angio internal mammary (75756) | $5,064.61 | $8,262 | 1.5× |
| Angio pulmonary bilat (75743) | $4,724.39 | $7,707 | 1.4× |
| Angiography extremity bilateral rs&i (75716) | $4,724.39 | $7,707 | 1.4× |
| Angiography extremity unilateral rs&i (75710) range across 2 matching MRF lines |
$4,499.42–$4,724.39 | $7,340–$7,707 | varies |
| Angiography pulmonary unilateral slctv rs&i (75741) | $4,724.39 | $7,707 | 1.4× |
| Angrph pulmonary nonslctv cath/ven njx rs&i (75746) | $5,064.61 | $8,262 | 1.5× |
| Ankle 2 views (73600) range across 4 matching MRF lines |
$229.88–$459.75 | $375–$750 | varies |
| Aortography thoracic serialography rs&i (75605) | $8,113.06 | $13,235 | 1.4× |
| Aortography thoracic w/o serialography rs&i (75600) | $5,023.54 | $8,195 | 1.5× |
| Artery X-Rays Abdomen (75726) range across 2 matching MRF lines |
$6,162.49–$8,113.06 | $10,053–$13,235 | varies |
| Artery X-Rays Pelvis (75736) range across 2 matching MRF lines |
$8,284.70–$8,699.08 | $13,515–$14,191 | varies |
| Artery X-Rays Spine (75705) | $8,113.06 | $13,235 | 1.4× |
| Arthrogram hip (73525) range across 3 matching MRF lines |
$574.99–$1,094.82 | $938–$1,786 | varies |
| Arthrogram Wrist (73115) | $545.57 | $890 | 1.5× |
| Basic radiation dosimetry calculation (77300) range across 4 matching MRF lines |
$213.94–$4,024.96 | $349–$6,566 | varies |
| Bone age studies (77072) | $200.45 | $327 | 1.8× |
| Bone Imaging 3 Phase (78315) | $1,776.47 | $2,898 | 4.3× |
| Bone Imaging Limited Area (78300) | $986.32 | $1,609 | 2.4× |
| Bone Imaging Whole Body (78306) range across 2 matching MRF lines |
$1,409.90–$1,480.40 | $2,300–$2,415 | varies |
| Bone survey infant (77076) | $397.22 | $648 | 3.7× |
| Cat Scan Follow-Up Study (76380) range across 2 matching MRF lines |
$613.61–$643.65 | $1,001–$1,050 | varies |
| Chest 1 view (71045) range across 4 matching MRF lines |
$204.74–$614.23 | $334–$1,002 | varies |
| Chest 2 views (71046) | $237.23 | $387 | 2.6× |
| Chest 3 views (71047) | $256.85 | $419 | 2.8× |
| Chest 4 or more views (71048) | $272.79 | $445 | 2.5× |
| Clavicle complete (73000) | $225.58 | $368 | 2.5× |
| Computed Tomography Thorax Lw Dose Lng Ca Scr C- (71271) | $247.04 | $403 | 2.3× |
| Continuing medical physics consltj pr wk (77336) range across 3 matching MRF lines |
$797.51–$1,519.01 | $1,301–$2,478 | varies |
| Contrast Exam Abdominl Aorta (75625) range across 2 matching MRF lines |
$4,823.70–$5,064.61 | $7,869–$8,262 | varies |
| Contrast X-Ray Bladder (74430) | $788.32 | $1,286 | 2.2× |
| Contrast X-Ray Of Elbow (73085) | $619.74 | $1,011 | 1.7× |
| Contrast X-Ray Of Knee Joint (73580) range across 2 matching MRF lines |
$547.41–$574.99 | $893–$938 | varies |
| CT abdomen and pelvis without and with contrast (74178) | $5,632.24 | $9,188 | 15.5× |
| CT abdomen and pelvis without contrast (74176) range across 2 matching MRF lines |
$2,816.74–$5,633.47 | $4,595–$9,190 | varies |
| CT abdomen w contrast (74160) | $2,123.43 | $3,464 | 11.7× |
| CT abdomen w wo contrast (74170) | $2,899.49 | $4,730 | 15.9× |
| CT abdomen w/o contrast (74150) | $1,690.65 | $2,758 | 15.6× |
| CT Angio Abdomen and Pelvis (74174) | $3,110.36 | $5,074 | 8.6× |
| CT Angio Chest (71275) | $2,390.09 | $3,899 | 13.1× |
| CT Angio Head (70496) range across 2 matching MRF lines |
$1,913.79–$4,694.35 | $3,122–$7,658 | varies |
| CT angio hrt w/3d image (75574) | $2,181.05 | $3,558 | 6.0× |
| Ct Angio Lwr Extr W/O&W/Dye (73706) | $2,464.26 | $4,020 | 13.5× |
| CT Angio Neck (70498) range across 2 matching MRF lines |
$1,913.79–$2,464.26 | $3,122–$4,020 | varies |
| Ct Angio Upr Extrm W/O&W/Dye (73206) | $2,346.56 | $3,828 | 12.9× |
| CT cervical spine w/ contrast (72126) | $1,480.40 | $2,415 | 4.1× |
| CT cervical spine w/o contrast (72125) | $1,639.16 | $2,674 | 15.1× |
| CT cervical spine w/wo cont (72127) | $1,776.47 | $2,898 | 9.8× |
| CT chest w contrast (71260) | $1,872.10 | $3,054 | 10.3× |
| CT chest w/wo contrast (71270) | $2,154.08 | $3,514 | 11.8× |
| CT head/brain with contrast (70460) | $1,480.40 | $2,415 | 8.1× |
| CT head/brain without and with contrast (70470) | $1,918.69 | $3,130 | 10.5× |
| CT heart contrast eval cardiac structure&morph (75572) | $2,066.42 | $3,371 | 5.7× |
| CT heart no contrast quant eval coronry calcium (75571) | $111.57 | $182 | 1.2× |
| CT iac w contrast (70481) range across 2 matching MRF lines |
$1,409.90–$1,480.40 | $2,300–$2,415 | varies |
| CT l-spine w&w/o contrast (72133) | $1,776.47 | $2,898 | 9.8× |
| CT lower ext w/o (73700) range across 4 matching MRF lines |
$1,422.77–$2,987.76 | $2,321–$4,874 | varies |
| CT lower extremity w/contrast material (73701) range across 2 matching MRF lines |
$1,409.90–$1,480.40 | $2,300–$2,415 | varies |
| CT lumbar spine w contrast (72132) | $1,645.29 | $2,684 | 4.5× |
| CT lumbar spine w/o contrast (72131) | $1,691.88 | $2,760 | 15.6× |
| CT maxillofacial w contrast (70487) | $1,749.50 | $2,854 | 9.6× |
| CT maxillofacial wo contrast (70486) | $1,439.94 | $2,349 | 13.3× |
| CT neck tissue combo (70492) | $2,056.62 | $3,355 | 11.3× |
| Ct Orbit/Ear/Fossa W/O&W/Dye (70482) | $1,776.47 | $2,898 | 9.8× |
| CT orbits w/o contrast (70480) range across 2 matching MRF lines |
$1,897.85–$1,992.86 | $3,096–$3,251 | varies |
| CT pelvis w&w/o contrast (72194) | $1,776.47 | $2,898 | 9.8× |
| CT pelvis w/o contrast (72192) range across 2 matching MRF lines |
$1,512.27–$1,587.67 | $2,467–$2,590 | varies |
| CT scan of leg combo (73702) | $1,776.47 | $2,898 | 9.8× |
| CT scans face/jaw combo (70488) | $1,776.47 | $2,898 | 9.8× |
| CT soft tissue neck w contrast (70491) | $1,946.28 | $3,175 | 10.7× |
| CT soft tissue neck w/o contrast (70490) | $1,940.15 | $3,165 | 17.9× |
| CT thoracic spine w contrast (72129) range across 2 matching MRF lines |
$1,409.90–$1,480.40 | $2,300–$2,415 | varies |
| CT thoracic spine w/o contrast (72128) range across 2 matching MRF lines |
$1,775.86–$1,864.75 | $2,897–$3,042 | varies |
| CT thoracic spine w/wo cont (72130) | $1,715.17 | $2,798 | 9.4× |
| CT thorax w/o contrast (71250) | $1,471.20 | $2,400 | 13.6× |
| CT unlisted procedure (76497) | $1,056.81 | $1,724 | 11.7× |
| CT upper ext wo (73200) | $1,422.77 | $2,321 | 13.1× |
| CT upper extremity w/o & w/contrast material (73202) | $1,776.47 | $2,898 | 9.8× |
| CT upper extremity with contrast (73201) | $2,146.73 | $3,502 | 5.9× |
| Cta Abdl Aorta&Bi Iliofem W/Contrast&Postp (75635) | $2,464.26 | $4,020 | 13.5× |
| Cta Abdomen (74175) range across 2 matching MRF lines |
$2,347.18–$2,464.26 | $3,829–$4,020 | varies |
| CTA pelvis (72191) | $2,346.56 | $3,828 | 12.9× |
| Dxa Bone Density Axial (77080) | $451.17 | $736 | 4.2× |
| Echo exam of fetal heart (76825) range across 2 matching MRF lines |
$306.50–$1,149.99 | $500–$1,876 | varies |
| Echo Guide For Artery Repair (76936) | $467.72 | $763 | 2.1× |
| Echograp Trans R Pros Study (76873) | $527.18 | $860 | 4.9× |
| Esophagram (74220) | $518.60 | $846 | 2.8× |
| Fetal Biophys Profile W/Nst (76818) range across 2 matching MRF lines |
$153.25–$433.39 | $250–$707 | varies |
| Fetal Biophysical Profile W/O Non-Stress Testing (76819) range across 2 matching MRF lines |
$153.25–$437.07 | $250–$713 | varies |
| Fluoroscopy up to 1 hr (76000) range across 2 matching MRF lines |
$578.06–$606.87 | $943–$990 | varies |
| Foot 2 views (73620) range across 5 matching MRF lines |
$200.45–$381.29 | $327–$622 | varies |
| Forearm 2 views (73090) range across 3 matching MRF lines |
$246.43–$258.69 | $402–$422 | varies |
| Gastric emptying imaging study (78264) | $1,776.47 | $2,898 | 4.3× |
| Gated Heart Planar Single (78472) range across 2 matching MRF lines |
$1,409.90–$1,480.40 | $2,300–$2,415 | varies |
| Hand 2 views (73120) range across 4 matching MRF lines |
$237.84–$473.24 | $388–$772 | varies |
| Hepatobil Syst Image W/Drug (78227) | $4,016.38 | $6,552 | 7.1× |
| Hepatobiliary System Imaging (78226) | $2,930.14 | $4,780 | 7.1× |
| Ht Muscle Image Spect Sing (78451) | $3,381.31 | $5,516 | 2.5× |
| Hysterosalpingogram (74740) | $779.74 | $1,272 | 3.1× |
| Image fusion (77399) | $445.65 | $727 | 3.2× |
| Infant hip ultrasound with hip movement (dynamic) (76885) range across 2 matching MRF lines |
$214.55–$931.15 | $350–$1,519 | varies |
| Infant hip ultrasound, limited static exam (76886) range across 2 matching MRF lines |
$183.90–$626.49 | $300–$1,022 | varies |
| K Flow/Funct Image Multiple (78709) | $1,971.41 | $3,216 | 3.5× |
| K Flow/Funct Image W/Drug (78708) | $1,536.18 | $2,506 | 2.7× |
| K Flow/Funct Image W/O Drug (78707) | $986.32 | $1,609 | 1.7× |
| Knee 3 Views (73562) range across 5 matching MRF lines |
$305.27–$745.41 | $498–$1,216 | varies |
| Liver & Spleen Imaging Static Only (78215) | $986.32 | $1,609 | 2.4× |
| Lung perfusion differential (78597) | $1,185.54 | $1,934 | 2.9× |
| Lung Ventilat&Perfus Imaging (78582) | $2,819.19 | $4,599 | 5.0× |
| Lymph System Imaging (78195) range across 2 matching MRF lines |
$1,504.30–$1,579.70 | $2,454–$2,577 | varies |
| Magnetic Image Jaw Joint (70336) | $1,776.47 | $2,898 | 7.2× |
| Mammary ductogram or galactogram multiple (77054) | $593.38 | $968 | 2.4× |
| Mammary ductogram or galactogram single (77053) | $468.33 | $764 | 1.9× |
| Meckels Divert Exam (78290) | $2,625.48 | $4,283 | 6.3× |
| Mlc imrt design & construction per imrt plan (77338) range across 2 matching MRF lines |
$2,610.77–$2,741.34 | $4,259–$4,472 | varies |
| Mra Head W/O & W/Contrast Material (70546) | $438.30 | $715 | 1.2× |
| MRA head w/o contrast (70544) | $2,504.72 | $4,086 | 10.1× |
| MRA neck w contrast (70548) | $2,170.02 | $3,540 | 6.0× |
| Mra Neck W/O &W/Contrast Material (70549) | $5,197.01 | $8,478 | 14.3× |
| MRA neck w/o contrast (70547) | $1,971.41 | $3,216 | 8.0× |
| MRI abdomen w/o contrast (74181) | $2,211.70 | $3,608 | 8.9× |
| MRI any jt lower extrem w/contrast material (73722) range across 3 matching MRF lines |
$2,170.02–$4,132.85 | $3,540–$6,742 | varies |
| MRI any jt lower extrem w/o & w/contrast matrl (73723) range across 3 matching MRF lines |
$695.14–$2,464.26 | $1,134–$4,020 | varies |
| MRI any jt upper extremity w/contrast matrl (73222) | $1,971.41 | $3,216 | 2.4× |
| MRI Breast W/O Contrast Bilateral (77047) range across 2 matching MRF lines |
$2,129.56–$2,236.22 | $3,474–$3,648 | varies |
| MRI Breast Without Contrast Material Unilateral (77046) | $1,653.26 | $2,697 | 6.7× |
| MRI cervical spine w contrast (72142) | $1,971.41 | $3,216 | 5.4× |
| MRI cervical spine w/o cont (72141) | $2,483.88 | $4,052 | 10.0× |
| MRI chest w/o contrast (71550) | $3,415.02 | $5,571 | 13.8× |
| MRI chest wo w contrast (71552) range across 2 matching MRF lines |
$4,526.39–$4,752.59 | $7,384–$7,753 | varies |
| MRI lower extrem oth/thn jt w/contrast matrl (73719) | $2,170.02 | $3,540 | 6.0× |
| MRI lower extrem oth/thn jt w/o & w/contr matr (73720) range across 3 matching MRF lines |
$2,860.87–$5,449.57 | $4,667–$8,890 | varies |
| MRI lower extrem oth/thn jt w/o contr matrl (73718) range across 3 matching MRF lines |
$1,691.88–$1,776.47 | $2,760–$2,898 | varies |
| MRI lumbar spine w contrast (72149) | $2,170.02 | $3,540 | 6.0× |
| Mri Neck Spine W/O & W/Dye (72156) | $3,602.60 | $5,877 | 9.9× |
| MRI orbit face &/neck w/o contrast (70540) | $1,971.41 | $3,216 | 8.0× |
| MRI orbit face neck w contrast (70542) | $1,971.41 | $3,216 | 5.4× |
| Mri Orbt/Fac/Nck W/O &W/Dye (70543) range across 2 matching MRF lines |
$3,061.94–$3,215.80 | $4,995–$5,246 | varies |
| MRI pelvis w contrast (72196) | $2,367.41 | $3,862 | 6.5× |
| MRI pelvis w/o & w contrast (72197) | $2,883.55 | $4,704 | 8.0× |
| MRI pelvis w/o contrast (72195) range across 3 matching MRF lines |
$156.32–$2,404.80 | $255–$3,923 | varies |
| MRI thoracic spine w/o contrast (72146) | $2,804.48 | $4,575 | 11.3× |
| MRI upper extremity oth than jt w/contr matrl (73219) | $2,346.56 | $3,828 | 6.5× |
| MRI upper extremity oth than jt w/o contr matrl (73218) | $1,776.47 | $2,898 | 7.2× |
| Mri Uppr Extremity W/O&W/Dye (73220) | $2,464.26 | $4,020 | 6.8× |
| MRI, abdomen, combo (74183) | $3,171.66 | $5,174 | 8.8× |
| MRI, dorsal spine combo (72157) | $3,176.57 | $5,182 | 8.8× |
| MRI, dorsal spine contrast (72147) | $1,971.41 | $3,216 | 5.4× |
| MRI, joint upper extrem (73221) range across 3 matching MRF lines |
$1,875.17–$1,968.96 | $3,059–$3,212 | varies |
| MRI, joint upper extrem combo (73223) | $2,464.26 | $4,020 | 6.8× |
| MRI, lumbar spine combo (72158) | $3,462.84 | $5,649 | 9.6× |
| Myelogram cervical (72240) | $1,271.98 | $2,075 | 1.6× |
| Myelography thoracic (72255) | $1,271.98 | $2,075 | 1.6× |
| Myocardial Spect Multiple Studies (78452) range across 2 matching MRF lines |
$4,290.39–$4,504.94 | $6,999–$7,349 | varies |
| Neck soft tissue (70360) | $229.88 | $375 | 2.5× |
| Nonvascular Shunt X-Ray (75809) | $513.08 | $837 | 4.7× |
| Ntsty modul radthx pln dose-vol histos (77301) | $15,190.14 | $24,780 | 10.6× |
| Nuclear Rx Intra-Arterial (79445) | $336.54 | $549 | 1.4× |
| Nuclear Rx Oral Admin (79005) | $1,423.39 | $2,322 | 5.9× |
| Parathyroid Planar Imaging (78070) | $1,776.47 | $2,898 | 4.3× |
| Parathyroid planar imaging w/wo subtraction (78071) | $1,468.75 | $2,396 | 3.5× |
| Pelvis 1 or 2 views (72170) range across 3 matching MRF lines |
$249.49–$475.69 | $407–$776 | varies |
| Pet Image W/Ct Lmtd (78814) | $12,784.12 | $20,855 | 8.6× |
| PET image w/CT, full body (78816) range across 3 matching MRF lines |
$12,175.41–$12,784.12 | $19,862–$20,855 | varies |
| PET imaging CT attenuation skull base mid-thigh (78815) | $5,768.33 | $9,410 | 3.9× |
| Pulmonary Perfusion Imaging Particulate (78580) | $1,149.99 | $1,876 | 2.8× |
| Radex Abd Compl Aqt Abd W/S/E/D Views 1 View Ch (74022) | $458.52 | $748 | 4.2× |
| Radex abscess/fistula/sinus tract rs&i (76080) | $1,892.33 | $3,087 | 3.3× |
| Radex Ankle Complete Minimum 3 Views (73610) range across 2 matching MRF lines |
$252.56–$265.43 | $412–$433 | varies |
| Radex Calcaneus Minimum 2 Views (73650) | $200.45 | $327 | 2.2× |
| Radex elbow complete minimum 3 views (73080) | $300.98 | $491 | 3.3× |
| Radex Facial Bones Complete Minimum 3 Views (70150) range across 2 matching MRF lines |
$317.53–$333.47 | $518–$544 | varies |
| Radex fingr minimum 2 views (73140) range across 3 matching MRF lines |
$190.64–$381.29 | $311–$622 | varies |
| Radex foot complete minimum 3 views (73630) range across 2 matching MRF lines |
$280.75–$534.54 | $458–$872 | varies |
| Radex Hand Minimum 3 Views (73130) range across 6 matching MRF lines |
$84.59–$594 | $138–$969 | varies |
| Radex lower extremity infant minimum 2 views (73592) | $175.93 | $287 | 1.9× |
| Radex Mastoids Compl Minimum 3 Views PR Side (70130) | $249.49 | $407 | 2.3× |
| Radex Nasal Bones Complete Minimum 3 Views (70160) | $297.31 | $485 | 3.3× |
| Radex Ribs Unilateral 2 Views (71100) range across 3 matching MRF lines |
$237.84–$249.49 | $388–$407 | varies |
| Radex shoulder complete minimum 2 views (73030) range across 3 matching MRF lines |
$260.53–$546.80 | $425–$892 | varies |
| Radex Sinuses Paransl < 3 Views (70210) | $200.45 | $327 | 2.2× |
| Radex Spine 1 View Specify Level (72020) | $249.49 | $407 | 2.8× |
| Radex Sternum Minimum 2 Views (71120) range across 2 matching MRF lines |
$260.53–$273.40 | $425–$446 | varies |
| Radex Temporomandble Jt Opn & Clsd Mouth Bilat (70330) | $322.44 | $526 | 3.6× |
| Radex Toe Minimum 2 Views (73660) | $200.45 | $327 | 2.2× |
| Radex upper extremity infant minimum 2 views (73092) | $171.03 | $279 | 1.6× |
| Radex Wrist Complete Minimum 3 Views (73110) range across 3 matching MRF lines |
$272.79–$292.40 | $445–$477 | varies |
| Radiation treatment delivery level 1 (77402) range across 3 matching MRF lines |
$2,773.83–$5,547.65 | $4,525–$9,050 | varies |
| Radiation treatment delivery level 2 (77407) range across 3 matching MRF lines |
$2,835.13–$5,670.25 | $4,625–$9,250 | varies |
| Radiation treatment delivery level 3 (77412) range across 3 matching MRF lines |
$2,892.13–$5,784.27 | $4,718–$9,436 | varies |
| Radiolog exam mandible compl minimum 4 views (70110) | $333.47 | $544 | 3.1× |
| Radiologic Exam Abdomen 3+ Views - Xr Abdomen 3+ Views (74021) | $283.21 | $462 | 2.6× |
| Radiologic exam colon double contrast study (74280) | $695.14 | $1,134 | 3.8× |
| Radiologic exam colon single contrast study (74270) | $720.89 | $1,176 | 4.0× |
| Radiologic Exam Esophagus Double Contrast Study (74221) | $521.66 | $851 | 2.9× |
| Radiologic exam knee complete 4/more views (73564) | $322.44 | $526 | 3.0× |
| Radiologic exam pelvis compl minimum 3 views (72190) range across 2 matching MRF lines |
$284.43–$298.53 | $464–$487 | varies |
| Radiologic Exam Small Int Single Contrast Study (74250) | $516.15 | $842 | 2.8× |
| Radiologic exam swallow function contrast study (74230) | $547.41 | $893 | 3.0× |
| Radiologic exam upr gi trc double contrast study (74246) | $597.68 | $975 | 3.3× |
| Radiologic examination femur 1 view (73551) | $142.22 | $232 | 1.6× |
| Radiologic examination femur minimum 2 views (73552) | $241.52 | $394 | 2.7× |
| Radiologic examination knee 1/2 views (73560) range across 4 matching MRF lines |
$247.65–$495.30 | $404–$808 | varies |
| Radiologic Examination Osseous Survey Limited (77074) range across 2 matching MRF lines |
$378.22–$397.22 | $617–$648 | varies |
| Radiologic examination tibia & fibula 2 views (73590) range across 4 matching MRF lines |
$265.43–$530.86 | $433–$866 | varies |
| Ribs bilateral 3 views (71110) | $348.18 | $568 | 3.2× |
| Rp loclzj tum plnr 2+area 1+d img/1 area img>2+d (78801) | $1,783.83 | $2,910 | 4.3× |
| Rp Loclzj Tum Plnr Whole Body Single Day Imaging (78802) | $1,971.41 | $3,216 | 3.5× |
| Rp Loclzj Tum Spect 1 Area Single Day Imaging (78803) range across 2 matching MRF lines |
$1,877.62–$1,971.41 | $3,063–$3,216 | varies |
| Rp loclzj tum spect 2 area/sep acquisj img (78831) | $2,100.75 | $3,427 | 1.6× |
| Rp loclzj tum spect w/CT 1 area/acquisj 1day img (78830) | $2,100.75 | $3,427 | 1.6× |
| Scapula (73010) | $249.49 | $407 | 2.3× |
| Screening Digital Breast Tomosynthesis Bi (77063) range across 2 matching MRF lines |
$39.85–$41.68 | $65–$68 | varies |
| Shoulder 1 view (73020) range across 4 matching MRF lines |
$190.64–$400.90 | $311–$654 | varies |
| Shoulder Arthrography (73040) range across 3 matching MRF lines |
$637.52–$669.40 | $1,040–$1,092 | varies |
| Skull less than 4 views (70250) | $265.43 | $433 | 2.4× |
| Special dosimetry (77331) | $551.09 | $899 | 3.9× |
| Special Physics Consult (77370) | $1,298.95 | $2,119 | 9.3× |
| Special teletherapy port plan (77321) | $1,401.93 | $2,287 | 3.6× |
| Special treatment procedure (77470) | $2,643.87 | $4,313 | 4.6× |
| Stereotactic Body Radiation Delivery (77373) | $12,086.52 | $19,717 | 6.5× |
| Sternoclavicular joints (71130) | $249.49 | $407 | 2.8× |
| Telethx isodose pln cplx w/basic dosimetry (77307) | $1,872.10 | $3,054 | 4.8× |
| Telethx isodose pln smpl w/dosimetry calculation (77306) | $1,835.94 | $2,995 | 4.7× |
| Ther Rad Simulaj-Aided Field Setting Complex (77290) | $3,643.67 | $5,944 | 9.4× |
| Ther rad simulaj-aided field setting simple (77280) range across 2 matching MRF lines |
$1,170.83–$1,229.68 | $1,910–$2,006 | varies |
| Thoracic spine 2 views (72070) range across 2 matching MRF lines |
$284.43–$298.53 | $464–$487 | varies |
| Thoracic spine 3 views (72072) | $383.74 | $626 | 3.5× |
| Thoracolumbar 2 views (72080) | $298.53 | $487 | 3.3× |
| Thyroid Imaging With Vascular Flow (78013) | $1,601.77 | $2,613 | 3.9× |
| Thyroid Met Imaging Body (78018) range across 2 matching MRF lines |
$1,877.62–$1,971.41 | $3,063–$3,216 | varies |
| Thyroid Uptake W/Blood Flow Sngle/Mult Quan Meas (78014) | $1,829.19 | $2,984 | 4.4× |
| Tx Devices Design & Construction Complex (77334) range across 3 matching MRF lines |
$1,181.86–$7,878.28 | $1,928–$12,852 | varies |
| Tx devices design & construction intermediate (77333) range across 3 matching MRF lines |
$962.41–$3,665.74 | $1,570–$5,980 | varies |
| Tx devices design & construction simple (77332) range across 3 matching MRF lines |
$692.08–$1,317.95 | $1,129–$2,150 | varies |
| Ultrasound Breast Limited (76642) range across 4 matching MRF lines |
$153.25–$663.27 | $250–$1,082 | varies |
| Ultrasound Elastography Parenchyma (76981) range across 2 matching MRF lines |
$137.93–$165.51 | $225–$270 | varies |
| Ultrasound Exam Aaa Screen (76706) | $434.62 | $709 | 4.0× |
| Ultrasound, abdomen limited (76705) range across 2 matching MRF lines |
$593.38–$1,130.37 | $968–$1,844 | varies |
| Umbilical-artery Doppler (OB) (76820) range across 2 matching MRF lines |
$122.60–$170.41 | $200–$278 | varies |
| Unlisted fluoroscopic procedure (76496) | $1,117.50 | $1,823 | 12.4× |
| Unlisted magnetic resonance procedure (76498) | $283.82 | $463 | 3.1× |
| Upper gi w/o kub (74240) | $530.25 | $865 | 2.9× |
| Urethrocystogram voiding (74455) | $599.51 | $978 | 2.4× |
| Us breast unilateral complete (76641) range across 2 matching MRF lines |
$183.90–$446.26 | $300–$728 | varies |
| Us chest (76604) | $467.11 | $762 | 4.3× |
| Us complete joint (76881) range across 2 matching MRF lines |
$1,607.29–$1,687.59 | $2,622–$2,753 | varies |
| Us exam, pelvic, limited (76857) range across 3 matching MRF lines |
$122.60–$628.33 | $200–$1,025 | varies |
| Us head (76506) | $813.45 | $1,327 | 7.5× |
| Us kidney transplant (76776) | $643.65 | $1,050 | 5.9× |
| Us lmtd joint/oth nonvasc xtr strux r-t w/img (76882) range across 2 matching MRF lines |
$455.46–$478.14 | $743–$780 | varies |
| Us ob detailed single fetus (76811) range across 2 matching MRF lines |
$196.16–$225.58 | $320–$368 | varies |
| Us ob limited 1 or more fetuses (76815) range across 2 matching MRF lines |
$153.25–$331.63 | $250–$541 | varies |
| Us ob transvaginal (76817) range across 3 matching MRF lines |
$196.16–$424.81 | $320–$693 | varies |
| Us pelvic non ob complete (76856) range across 2 matching MRF lines |
$214.55–$717.82 | $350–$1,171 | varies |
| Us pg uter img f&mat 14 wk tabdl 1/1st gestation (76801) range across 2 matching MRF lines |
$196.16–$494.08 | $320–$806 | varies |
| Us preg uterus real time f/u trnsabdl per fetus (76816) range across 2 matching MRF lines |
$109.73–$196.16 | $179–$320 | varies |
| Us retroperitoneal complete (76770) range across 2 matching MRF lines |
$658.98–$692.08 | $1,075–$1,129 | varies |
| Us retroperitoneal limited (76775) range across 2 matching MRF lines |
$496.53–$521.66 | $810–$851 | varies |
| Us scrotum and contents (76870) | $593.38 | $968 | 5.5× |
| Us spinal canal and contents (76800) | $397.22 | $648 | 3.7× |
| Us thyroid (76536) range across 2 matching MRF lines |
$521.66–$1,043.33 | $851–$1,702 | varies |
| Us transrectal (76872) range across 2 matching MRF lines |
$214.55–$494.08 | $350–$806 | varies |
| Vein X-Ray Chest (75827) | $2,331.85 | $3,804 | 1.4× |
| Vein X-Ray Liver W/O Hemodyn (75887) | $4,724.39 | $7,707 | 1.4× |
| Venogram Sinus/Jugular (75860) | $5,064.61 | $8,262 | 1.5× |
| Venography caval inferior serialography rs&i (75825) | $4,724.39 | $7,707 | 1.4× |
| Venography extremity bilateral rs&i (75822) | $2,331.85 | $3,804 | 1.4× |
| Venography extremity unilateral rs&i (75820) range across 2 matching MRF lines |
$2,779.96–$2,919.11 | $4,535–$4,762 | varies |
| Venography Renal Bilateral (75833) | $5,064.61 | $8,262 | 1.5× |
| Venography Renal Unilateral (75831) | $5,064.61 | $8,262 | 1.5× |
| Wrist 2 views (73100) range across 4 matching MRF lines |
$190.64–$381.29 | $311–$622 | varies |
| X-Ray Ac Jts - Xr Acromioclavicular Joints Bilateral (73050) | $234.78 | $383 | 2.6× |
| X-Ray Aorta Leg Arteries (75630) | $4,724.39 | $7,707 | 1.4× |
| X-Ray Bend Only L-S Spine (72120) | $402.13 | $656 | 3.7× |
| X-Ray Elbow 2 Vw - Xr Elbow 1-2 Views Right (73070) range across 3 matching MRF lines |
$278.30–$794.45 | $454–$1,296 | varies |
| X-Ray Exam Breast Specimen (76098) range across 2 matching MRF lines |
$465.27–$886.40 | $759–$1,446 | varies |
| X-Ray Exam Entire Spi 1 Vw (72081) | $335.92 | $548 | 3.7× |
| X-Ray Exam Entire Spi 2/3 Vw (72082) | $516.15 | $842 | 4.8× |
| X-Ray Exam Hip Uni 1 View (73501) range across 3 matching MRF lines |
$354.93–$745.41 | $579–$1,216 | varies |
| X-Ray Exam Hip Uni 2-3 Views (73502) range across 3 matching MRF lines |
$304.05–$868.01 | $496–$1,416 | varies |
| X-Ray Exam Hip Uni 4/> Views (73503) | $302.82 | $494 | 2.8× |
| X-Ray Exam Hips Bi 2 Views (73521) range across 3 matching MRF lines |
$294.85–$465.27 | $481–$759 | varies |
| X-Ray Exam Hips Bi 3-4 Views (73522) range across 2 matching MRF lines |
$399.06–$419.29 | $651–$684 | varies |
| X-Ray Exam Hips Bi 5/> Views (73523) | $734.37 | $1,198 | 6.8× |
| X-Ray Exam L-S Spine Bending (72114) | $716.60 | $1,169 | 6.6× |
| X-Ray Exam Neck Spine 2-3 Vw (72040) range across 2 matching MRF lines |
$284.43–$298.53 | $464–$487 | varies |
| X-Ray Exam Neck Spine 6/>Vws (72052) | $614.23 | $1,002 | 5.7× |
| X-Ray Exam Unilat Ribs/Chest (71101) | $348.18 | $568 | 3.2× |
| X-ray eye for foreign body (70030) | $200.45 | $327 | 2.2× |
| X-ray humerus (73060) range across 3 matching MRF lines |
$269.72–$283.21 | $440–$462 | varies |
| X-ray IV pyelogram+tomography (74415) | $820.19 | $1,338 | 4.5× |
| X-Ray Jaw <4 Vw - Xr Mandible < 4 Views (70100) | $210.26 | $343 | 2.3× |
| X-Ray Knee Bilat Standing - Xr Knees Anteroposterior Standing Bilat (73565) | $247.65 | $404 | 2.7× |
| X-Ray Lumbar Spine 2/3 Vw - Xr Lumbar Spine 2-3 Views (72100) | $402.13 | $656 | 3.7× |
| X-ray nose-rectum child f.b. (76010) | $265.43 | $433 | 2.9× |
| X-Ray Ribs, Chest 4+ Vw - Xr Ribs 3 Vws Bil W/ Chest Posteroanterior (71111) range across 2 matching MRF lines |
$424.81–$446.26 | $693–$728 | varies |
| X-Ray Sacroiliac Jts 3+ Vw - Xr Sacroiliac Joints 3+ Views (72202) | $249.49 | $407 | 2.3× |
| X-Ray Sacroiliac Jts <3 Vw - Xr Sacroiliac Joints 1-2 Views (72200) | $200.45 | $327 | 1.8× |
| X-Ray Sacrum/Coccyx 2+ Vw - Xr Sacrum Coccyx 2+ Views (72220) | $249.49 | $407 | 2.8× |
| X-Ray Sinuses 3+ Vw - Xr Paranasal Sinuses 3+ Views (70220) | $348.18 | $568 | 3.9× |
| X-Ray Skull 4+ Vw - Xr Skull Complete 4+ Views (70260) range across 2 matching MRF lines |
$378.22–$397.22 | $617–$648 | varies |
| X-Ray Tmj Unilat (70328) | $268.49 | $438 | 3.0× |
| X-Ray Urinary Tract Exam With Contrast Material (74420) range across 2 matching MRF lines |
$1,254.20–$2,254.92 | $2,046–$3,678.50 | varies |
| X-Rays Bone Length Studies (77073) | $322.44 | $526 | 3.0× |
| X-Rays Bone Survey Complete (77075) | $731.92 | $1,194 | 6.7× |
| Xr c-spine 4 or 5 views (72050) | $462.20 | $754 | 4.3× |
| Xr facial bones less than 3 views (70140) range across 2 matching MRF lines |
$214.55–$225.58 | $350–$368 | varies |
| XR Mastoids < 3 Views Bilateral (70120) | $333.47 | $544 | 3.1× |
| Xr orbits complete 4 views (70200) | $298.53 | $487 | 2.7× |
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.