Imaging prices at FirstHealth Montgomery Memorial Hospital
Troy, NC · every code in this section with a posted price and a Medicare benchmark.
321 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) | $7,552.25 | $7,552.25 | 5.7× |
| Abdomen 1 View (74018) | $613.75 | $613.75 | 7.4× |
| Abdomen 2 views (74019) | $844 | $844 | 8.4× |
| Acute Gastrointestinal Blood Loss Imaging (78278) | $1,570.50 | $1,570.50 | 4.1× |
| Angio pulmonary bilat (75743) | $8,531 | $8,531 | 2.8× |
| Angiography extremity bilateral rs&i (75716) | $4,709.50 | $4,709.50 | 1.6× |
| Angiography extremity unilateral rs&i (75710) | $3,992.75 | $3,992.75 | 1.3× |
| Angiography pulmonary unilateral slctv rs&i (75741) | $9,130.75 | $9,130.75 | 3.0× |
| Ankle 2 views (73600) range across 3 matching MRF lines |
$488.50–$1,023.25 | $488.50–$1,023.25 | varies |
| Artery X-Rays Abdomen (75726) | $11,291.25 | $11,291.25 | 2.1× |
| Artery X-Rays Pelvis (75736) | $9,483 | $9,483 | 1.8× |
| Basic radiation dosimetry calculation (77300) | $669.50 | $669.50 | 5.2× |
| Bone age studies (77072) range across 2 matching MRF lines |
$431.25–$696.25 | $431.25–$696.25 | varies |
| Bone Imaging 3 Phase (78315) | $2,547.75 | $2,547.75 | 6.7× |
| Bone Imaging Limited Area (78300) range across 2 matching MRF lines |
$2,252.50–$2,310.50 | $2,252.50–$2,310.50 | varies |
| Bone Imaging Multiple Areas (78305) | $2,310.50 | $2,310.50 | 6.0× |
| Bone Imaging Whole Body (78306) range across 2 matching MRF lines |
$2,390.75–$2,451.50 | $2,390.75–$2,451.50 | varies |
| Bone survey infant (77076) | $841.75 | $841.75 | 8.4× |
| Brachytx isodose intermed (77317) | $1,594.25 | $1,594.25 | 4.5× |
| Brachytx Isodose Plan Simple (77316) | $1,476 | $1,476 | 4.1× |
| Brain Image W/Flow < 4 Views (78601) | $1,355.25 | $1,355.25 | 3.5× |
| Cardiac MRI w/w/o contrast & further seq (75561) | $4,157.25 | $4,157.25 | 12.5× |
| Cardiac MRI w/w/o contrast w/stress (75563) | $1,974 | $1,974 | 2.6× |
| Cat Scan Follow-Up Study (76380) | $1,722.25 | $1,722.25 | 20.7× |
| Cerebrospinal Fluid Flow W/O Matl Shunt Evaltj (78645) | $752.50 | $752.50 | 1.4× |
| Cerebrospinal Fluid Scan (78630) | $2,337.50 | $2,337.50 | 4.5× |
| Chest 1 view (71045) | $460.75 | $460.75 | 5.5× |
| Chest 2 views (71046) | $690.50 | $690.50 | 8.3× |
| Chest 3 views (71047) | $920.25 | $920.25 | 11.1× |
| Chest 4 or more views (71048) | $1,150.75 | $1,150.75 | 11.5× |
| Clavicle complete (73000) range across 3 matching MRF lines |
$541.25–$1,433.25 | $541.25–$1,433.25 | varies |
| Computed Tomography Thorax Lw Dose Lng Ca Scr C- (71271) range across 2 matching MRF lines |
$424.25–$445.50 | $424.25–$445.50 | varies |
| Continuing medical physics consltj pr wk (77336) | $802.25 | $802.25 | 6.2× |
| Contrast Exam Abdominl Aorta (75625) | $6,372 | $6,372 | 2.1× |
| Contrast X-Ray Bladder (74430) | $600.50 | $600.50 | 1.8× |
| CT abdomen and pelvis without and with contrast (74178) range across 2 matching MRF lines |
$9,373.25–$9,831.75 | $9,373.25–$9,831.75 | varies |
| CT abdomen and pelvis without contrast (74176) range across 2 matching MRF lines |
$6,690–$7,189.25 | $6,690–$7,189.25 | varies |
| CT abdomen w contrast (74160) range across 2 matching MRF lines |
$4,109–$4,275.75 | $4,109–$4,275.75 | varies |
| CT abdomen w wo contrast (74170) range across 2 matching MRF lines |
$4,687.25–$5,275.25 | $4,687.25–$5,275.25 | varies |
| CT abdomen w/o contrast (74150) range across 2 matching MRF lines |
$3,344.25–$3,596.25 | $3,344.25–$3,596.25 | varies |
| CT Angio Abdomen and Pelvis (74174) | $11,743.25 | $11,743.25 | 35.2× |
| CT Angio Chest (71275) range across 2 matching MRF lines |
$5,780–$5,871.50 | $5,780–$5,871.50 | varies |
| CT Angio Head (70496) | $5,871.50 | $5,871.50 | 35.0× |
| CT angio hrt w/3d image (75574) | $5,300.50 | $5,300.50 | 15.9× |
| Ct Angio Lwr Extr W/O&W/Dye (73706) | $5,871.50 | $5,871.50 | 35.0× |
| CT Angio Neck (70498) | $5,871.50 | $5,871.50 | 35.0× |
| Ct Angio Upr Extrm W/O&W/Dye (73206) | $5,871.50 | $5,871.50 | 35.0× |
| CT cervical spine w/ contrast (72126) | $6,025.50 | $6,025.50 | 18.1× |
| CT cervical spine w/o contrast (72125) range across 2 matching MRF lines |
$3,015.50–$5,741.50 | $3,015.50–$5,741.50 | varies |
| CT cervical spine w/wo cont (72127) | $5,784.25 | $5,784.25 | 34.5× |
| CT chest w contrast (71260) range across 2 matching MRF lines |
$3,828.50–$4,277.75 | $3,828.50–$4,277.75 | varies |
| CT chest w/wo contrast (71270) | $5,300.50 | $5,300.50 | 31.6× |
| CT head/brain with contrast (70460) range across 2 matching MRF lines |
$3,828.50–$4,275.75 | $3,828.50–$4,275.75 | varies |
| CT head/brain without and with contrast (70470) range across 2 matching MRF lines |
$4,404.75–$4,557 | $4,404.75–$4,557 | varies |
| CT heart contrast eval cardiac structure&morph (75572) | $5,300.50 | $5,300.50 | 15.9× |
| CT heart no contrast quant eval coronry calcium (75571) | $150 | $150 | 1.8× |
| CT hrt w/3d image congen (75573) | $435.50 | $435.50 | 1.3× |
| CT iac w contrast (70481) range across 2 matching MRF lines |
$2,850.25–$3,282 | $2,850.25–$3,282 | varies |
| CT l-spine w&w/o contrast (72133) | $6,073.50 | $6,073.50 | 36.2× |
| CT lower ext w/o (73700) range across 3 matching MRF lines |
$2,744.50–$5,489 | $2,744.50–$5,489 | varies |
| CT lower extremity w/contrast material (73701) range across 3 matching MRF lines |
$2,859–$5,717.50 | $2,859–$5,717.50 | varies |
| CT lumbar spine w contrast (72132) range across 2 matching MRF lines |
$3,534.75–$6,025.50 | $3,534.75–$6,025.50 | varies |
| CT lumbar spine w/o contrast (72131) range across 2 matching MRF lines |
$3,015.50–$5,741.50 | $3,015.50–$5,741.50 | varies |
| CT maxillofacial w contrast (70487) range across 2 matching MRF lines |
$2,575.75–$2,859 | $2,575.75–$2,859 | varies |
| CT maxillofacial wo contrast (70486) range across 2 matching MRF lines |
$2,744.50–$3,448.50 | $2,744.50–$3,448.50 | varies |
| CT neck tissue combo (70492) range across 2 matching MRF lines |
$5,058.75–$5,140.50 | $5,058.75–$5,140.50 | varies |
| Ct Orbit/Ear/Fossa W/O&W/Dye (70482) | $6,369.25 | $6,369.25 | 38.0× |
| CT orbits w/o contrast (70480) range across 2 matching MRF lines |
$2,765.50–$3,308.75 | $2,765.50–$3,308.75 | varies |
| CT pelvis w&w/o contrast (72194) | $4,557 | $4,557 | 27.2× |
| CT pelvis w/o contrast (72192) range across 2 matching MRF lines |
$3,344.25–$3,593 | $3,344.25–$3,593 | varies |
| CT scan of leg combo (73702) | $2,951 | $2,951 | 17.6× |
| CT scans face/jaw combo (70488) | $2,951 | $2,951 | 17.6× |
| CT soft tissue neck w contrast (70491) range across 2 matching MRF lines |
$4,457–$4,507.50 | $4,457–$4,507.50 | varies |
| CT soft tissue neck w/o contrast (70490) range across 2 matching MRF lines |
$4,136.75–$4,180.50 | $4,136.75–$4,180.50 | varies |
| CT thoracic spine w contrast (72129) | $6,025.50 | $6,025.50 | 35.9× |
| CT thoracic spine w/o contrast (72128) range across 2 matching MRF lines |
$2,779–$5,741.50 | $2,779–$5,741.50 | varies |
| CT thoracic spine w/wo cont (72130) | $478.75 | $478.75 | 2.9× |
| CT thorax w/o contrast (71250) range across 2 matching MRF lines |
$3,308.75–$3,344.25 | $3,308.75–$3,344.25 | varies |
| CT upper ext wo (73200) range across 4 matching MRF lines |
$2,610.50–$5,489 | $2,610.50–$5,489 | varies |
| CT upper extremity w/o & w/contrast material (73202) | $2,951 | $2,951 | 17.6× |
| CT upper extremity with contrast (73201) range across 3 matching MRF lines |
$2,814.50–$5,717.50 | $2,814.50–$5,717.50 | varies |
| Cta Abdl Aorta&Bi Iliofem W/Contrast&Postp (75635) | $6,544.50 | $6,544.50 | 39.0× |
| Cta Abdomen (74175) range across 2 matching MRF lines |
$5,780–$5,871.50 | $5,780–$5,871.50 | varies |
| CTA pelvis (72191) | $5,871.50 | $5,871.50 | 35.0× |
| Diskography lumbar (72295) | $2,911.75 | $2,911.75 | 1.6× |
| Doppler Echo Fetal Puls Spectral F/U/Repeat (76828) | $429 | $429 | 4.3× |
| Doppler Echo Fetal Spectral Display Complete (76827) | $429 | $429 | 4.3× |
| Doppler Fetal Mid Cerebral Artery (76821) | $429 | $429 | 4.3× |
| Dxa Bone Density Axial (77080) range across 2 matching MRF lines |
$519.25–$532.25 | $519.25–$532.25 | varies |
| Dxa bone density study (77085) | $777.25 | $777.25 | 7.8× |
| Dxa bone density study 1/>sites appendiclr skel (77081) | $540.75 | $540.75 | 6.5× |
| Echo exam of fetal heart (76825) | $1,074.25 | $1,074.25 | 2.1× |
| Echo Guide For Artery Repair (76936) | $1,610.75 | $1,610.75 | 7.8× |
| Echocardiography, fetal, cardiovascular system, real time with image documentation (2D), with or without M-mode… (76826) | $1,074.25 | $1,074.25 | 4.7× |
| Esophagram (74220) | $921.75 | $921.75 | 5.5× |
| Fetal Biophys Profile W/Nst (76818) range across 2 matching MRF lines |
$1,139.25–$1,150.50 | $1,139.25–$1,150.50 | varies |
| Fetal Biophysical Profile W/O Non-Stress Testing (76819) | $913.50 | $913.50 | 9.1× |
| Fluoroscopy up to 1 hr (76000) | $1,902 | $1,902 | 8.3× |
| Follow-Up Angiography (75898) | $3,531.75 | $3,531.75 | 1.2× |
| Foot 2 views (73620) range across 2 matching MRF lines |
$600.50–$1,201.25 | $600.50–$1,201.25 | varies |
| Forearm 2 views (73090) range across 3 matching MRF lines |
$541.25–$1,493.25 | $541.25–$1,493.25 | varies |
| Gastric emptying imaging study (78264) | $1,854.25 | $1,854.25 | 4.9× |
| Gated Heart Planar Single (78472) | $1,587 | $1,587 | 4.2× |
| Hand 2 views (73120) range across 2 matching MRF lines |
$406–$812 | $406–$812 | varies |
| Hdr Rdncl Ntrstl/Icav Brchtx (77772) | $3,057 | $3,057 | 4.6× |
| Hdr Rdncl Ntrstl/Icav Brchtx (77771) | $3,057 | $3,057 | 4.6× |
| Hdr Rdncl Ntrstl/Icav Brchtx 1 Channel (77770) | $3,057 | $3,057 | 4.6× |
| Hepatobil Syst Image W/Drug (78227) range across 2 matching MRF lines |
$1,870.25–$2,447.50 | $1,870.25–$2,447.50 | varies |
| Hepatobiliary System Imaging (78226) range across 2 matching MRF lines |
$1,870.25–$2,299.75 | $1,870.25–$2,299.75 | varies |
| Ht Muscle Image Spect Sing (78451) | $4,922.50 | $4,922.50 | 4.0× |
| Hysterosalpingogram (74740) | $1,241.75 | $1,241.75 | 5.4× |
| Image fusion (77399) | $1,242.25 | $1,242.25 | 9.7× |
| Infant hip ultrasound with hip movement (dynamic) (76885) | $1,093.75 | $1,093.75 | 13.1× |
| Infant hip ultrasound, limited static exam (76886) | $250 | $250 | 3.0× |
| K Flow/Funct Image W/Drug (78708) | $1,790.25 | $1,790.25 | 3.4× |
| K Flow/Funct Image W/O Drug (78707) | $1,277.50 | $1,277.50 | 2.5× |
| Knee 3 Views (73562) range across 4 matching MRF lines |
$668–$1,771 | $668–$1,771 | varies |
| Liver & Spleen Imaging Static Only (78215) | $1,071.50 | $1,071.50 | 2.8× |
| Lung perfusion differential (78597) | $1,782.50 | $1,782.50 | 4.7× |
| Lung Ventilat&Perfus Imaging (78582) | $2,450.75 | $2,450.75 | 4.7× |
| Lung Ventilation Imaging (78579) | $1,097.75 | $1,097.75 | 2.9× |
| Lymph System Imaging (78195) | $907.50 | $907.50 | 1.7× |
| Magnetic Image Jaw Joint (70336) | $5,140.50 | $5,140.50 | 22.5× |
| Mammary ductogram or galactogram single (77053) | $568.50 | $568.50 | 2.5× |
| Meckels Divert Exam (78290) | $1,136 | $1,136 | 3.0× |
| Mlc imrt design & construction per imrt plan (77338) | $1,683 | $1,683 | 4.7× |
| Mra Head W/O & W/Contrast Material (70546) | $1,083.25 | $1,083.25 | 3.2× |
| MRA head w/o contrast (70544) range across 2 matching MRF lines |
$1,263.50–$1,296.50 | $1,263.50–$1,296.50 | varies |
| MRA head with contrast (70545) | $1,557.50 | $1,557.50 | 4.7× |
| Mra Neck W/O &W/Contrast Material (70549) | $6,307.25 | $6,307.25 | 18.9× |
| MRA neck w/o contrast (70547) | $1,782.75 | $1,782.75 | 7.8× |
| MRI abdomen w/o contrast (74181) range across 2 matching MRF lines |
$4,993.75–$5,121.50 | $4,993.75–$5,121.50 | varies |
| MRI any jt lower extrem w/contrast material (73722) | $5,138 | $5,138 | 6.9× |
| MRI any jt lower extrem w/o & w/contrast matrl (73723) range across 2 matching MRF lines |
$5,838.75–$11,677.50 | $5,838.75–$11,677.50 | varies |
| MRI any jt upper extremity w/contrast matrl (73222) | $5,138 | $5,138 | 6.9× |
| MRI Breast W/O Contrast Bilateral (77047) | $772.25 | $772.25 | 3.4× |
| MRI cardiac w/o cont stress (75559) | $1,370 | $1,370 | 2.6× |
| MRI cardiac w/o contrast (75557) | $3,243 | $3,243 | 14.2× |
| MRI cervical spine w contrast (72142) | $5,550.75 | $5,550.75 | 16.6× |
| MRI cervical spine w/o cont (72141) range across 2 matching MRF lines |
$5,393–$5,533 | $5,393–$5,533 | varies |
| MRI chest w/o contrast (71550) | $5,533 | $5,533 | 24.3× |
| MRI chest wo w contrast (71552) | $6,307.25 | $6,307.25 | 18.9× |
| MRI lower extrem oth/thn jt w/contrast matrl (73719) | $978 | $978 | 2.9× |
| MRI lower extrem oth/thn jt w/o & w/contr matr (73720) range across 2 matching MRF lines |
$6,541.25–$13,082.25 | $6,541.25–$13,082.25 | varies |
| MRI lower extrem oth/thn jt w/o contr matrl (73718) range across 3 matching MRF lines |
$5,593.25–$11,475 | $5,593.25–$11,475 | varies |
| MRI lumbar spine w contrast (72149) | $5,550.75 | $5,550.75 | 16.6× |
| Mri Neck Spine W/O & W/Dye (72156) range across 2 matching MRF lines |
$6,148.75–$6,307.25 | $6,148.75–$6,307.25 | varies |
| MRI orbit face &/neck w/o contrast (70540) | $5,533 | $5,533 | 24.3× |
| Mri Orbt/Fac/Nck W/O &W/Dye (70543) range across 2 matching MRF lines |
$6,148.75–$6,307.25 | $6,148.75–$6,307.25 | varies |
| MRI pelvis w contrast (72196) | $5,550.75 | $5,550.75 | 16.6× |
| MRI pelvis w/o & w contrast (72197) range across 2 matching MRF lines |
$6,148.75–$6,307.25 | $6,148.75–$6,307.25 | varies |
| MRI pelvis w/o contrast (72195) range across 2 matching MRF lines |
$5,393–$5,533 | $5,393–$5,533 | varies |
| MRI thoracic spine w/o contrast (72146) range across 2 matching MRF lines |
$5,393–$5,533 | $5,393–$5,533 | varies |
| MRI upper extremity oth than jt w/contr matrl (73219) | $5,756.75 | $5,756.75 | 17.3× |
| MRI upper extremity oth than jt w/o contr matrl (73218) range across 2 matching MRF lines |
$5,593.25–$5,737.50 | $5,593.25–$5,737.50 | varies |
| Mri Uppr Extremity W/O&W/Dye (73220) | $6,541.25 | $6,541.25 | 19.6× |
| MRI, abdomen, combo (74183) range across 2 matching MRF lines |
$5,693.25–$5,838.75 | $5,693.25–$5,838.75 | varies |
| MRI, dorsal spine combo (72157) range across 2 matching MRF lines |
$6,148.75–$6,307.25 | $6,148.75–$6,307.25 | varies |
| MRI, dorsal spine contrast (72147) | $5,550.75 | $5,550.75 | 16.6× |
| MRI, joint upper extrem (73221) range across 3 matching MRF lines |
$4,993.75–$10,242.75 | $4,993.75–$10,242.75 | varies |
| MRI, joint upper extrem combo (73223) | $5,838.75 | $5,838.75 | 17.5× |
| MRI, lumbar spine combo (72158) range across 2 matching MRF lines |
$6,148.75–$6,307.25 | $6,148.75–$6,307.25 | varies |
| Myocardial Spect Multiple Studies (78452) range across 2 matching MRF lines |
$7,001.25–$7,479.75 | $7,001.25–$7,479.75 | varies |
| N-invas est c ffr sw aly CTA (75580) | $2,542 | $2,542 | 3.1× |
| Neck soft tissue (70360) range across 2 matching MRF lines |
$646–$863.25 | $646–$863.25 | varies |
| Nonvascular Shunt X-Ray (75809) | $840 | $840 | 8.4× |
| Ntsty modul radthx pln dose-vol histos (77301) | $4,996.25 | $4,996.25 | 3.8× |
| Nuclear Rx Oral Admin (79005) | $1,637.25 | $1,637.25 | 7.3× |
| Ob us nuchal meas 1 gest (76813) | $729 | $729 | 7.3× |
| Ophthalmic Ultrasonic Foreign Body Localization (76529) | $860.25 | $860.25 | 10.3× |
| Panoramic X-ray of jaws (70355) | $1,235.75 | $1,235.75 | 14.9× |
| Parathyroid Planar Imaging (78070) | $1,431 | $1,431 | 3.7× |
| Parathyroid planar imaging w/wo subtraction (78071) | $1,083.50 | $1,083.50 | 2.8× |
| Pelvis 1 or 2 views (72170) range across 2 matching MRF lines |
$330.50–$541.25 | $330.50–$541.25 | varies |
| Pulmonary Perfusion Imaging Particulate (78580) | $1,355.25 | $1,355.25 | 3.5× |
| Radex Abd Compl Aqt Abd W/S/E/D Views 1 View Ch (74022) range across 2 matching MRF lines |
$885.75–$1,411.50 | $885.75–$1,411.50 | varies |
| Radex abscess/fistula/sinus tract rs&i (76080) | $1,370 | $1,370 | 2.6× |
| Radex Ankle Complete Minimum 3 Views (73610) range across 3 matching MRF lines |
$619.25–$1,764.50 | $619.25–$1,764.50 | varies |
| Radex Calcaneus Minimum 2 Views (73650) range across 3 matching MRF lines |
$541.25–$1,783.50 | $541.25–$1,783.50 | varies |
| Radex elbow complete minimum 3 views (73080) range across 3 matching MRF lines |
$619.25–$2,228.75 | $619.25–$2,228.75 | varies |
| Radex Facial Bones Complete Minimum 3 Views (70150) range across 2 matching MRF lines |
$541.25–$794 | $541.25–$794 | varies |
| Radex fingr minimum 2 views (73140) range across 3 matching MRF lines |
$464–$1,284 | $464–$1,284 | varies |
| Radex foot complete minimum 3 views (73630) range across 3 matching MRF lines |
$619.25–$1,783.50 | $619.25–$1,783.50 | varies |
| Radex Hand Minimum 3 Views (73130) range across 3 matching MRF lines |
$619.25–$1,544 | $619.25–$1,544 | varies |
| Radex lower extremity infant minimum 2 views (73592) range across 3 matching MRF lines |
$440.25–$880.50 | $440.25–$880.50 | varies |
| Radex Mastoids Compl Minimum 3 Views PR Side (70130) | $863.25 | $863.25 | 8.6× |
| Radex Nasal Bones Complete Minimum 3 Views (70160) range across 2 matching MRF lines |
$431.25–$868.50 | $431.25–$868.50 | varies |
| Radex Ribs Unilateral 2 Views (71100) range across 2 matching MRF lines |
$570.75–$585.75 | $570.75–$585.75 | varies |
| Radex shoulder complete minimum 2 views (73030) range across 4 matching MRF lines |
$676.25–$1,445.25 | $676.25–$1,445.25 | varies |
| Radex Sinuses Paransl < 3 Views (70210) range across 2 matching MRF lines |
$401.75–$411.75 | $401.75–$411.75 | varies |
| Radex Spine 1 View Specify Level (72020) range across 2 matching MRF lines |
$505–$738.25 | $505–$738.25 | varies |
| Radex Sternum Minimum 2 Views (71120) range across 2 matching MRF lines |
$594.75–$746.50 | $594.75–$746.50 | varies |
| Radex Temporomandble Jt Opn & Clsd Mouth Bilat (70330) | $961 | $961 | 11.6× |
| Radex Toe Minimum 2 Views (73660) range across 3 matching MRF lines |
$323.50–$1,783.50 | $323.50–$1,783.50 | varies |
| Radex upper extremity infant minimum 2 views (73092) range across 3 matching MRF lines |
$440.25–$880.50 | $440.25–$880.50 | varies |
| Radex Wrist Complete Minimum 3 Views (73110) range across 4 matching MRF lines |
$619.25–$1,493.25 | $619.25–$1,493.25 | varies |
| Radiation Delivery Stereotactic Cranial Linear (77372) | $13,643.75 | $13,643.75 | 1.9× |
| Radiation treatment delivery level 1 (77402) | $750.75 | $750.75 | 7.7× |
| Radiation treatment delivery level 2 (77407) | $828.75 | $828.75 | 2.2× |
| Radiation treatment delivery level 3 (77412) | $938.25 | $938.25 | 1.8× |
| Radiolog exam mandible compl minimum 4 views (70110) range across 2 matching MRF lines |
$541.25–$1,536 | $541.25–$1,536 | varies |
| Radiologic Exam Abdomen 3+ Views - Xr Abdomen 3+ Views (74021) | $1,074.25 | $1,074.25 | 10.8× |
| Radiologic exam colon double contrast study (74280) | $2,303.75 | $2,303.75 | 13.7× |
| Radiologic exam colon single contrast study (74270) | $1,386.50 | $1,386.50 | 8.3× |
| Radiologic Exam Esophagus Double Contrast Study (74221) | $921.75 | $921.75 | 5.5× |
| Radiologic exam knee complete 4/more views (73564) range across 4 matching MRF lines |
$583–$1,764.50 | $583–$1,764.50 | varies |
| Radiologic exam pelvis compl minimum 3 views (72190) range across 2 matching MRF lines |
$547.50–$971 | $547.50–$971 | varies |
| Radiologic Exam Small Int Single Contrast Study (74250) | $1,519 | $1,519 | 9.1× |
| Radiologic exam swallow function contrast study (74230) | $1,457.50 | $1,457.50 | 8.7× |
| Radiologic exam upr gi trc double contrast study (74246) | $1,706.25 | $1,706.25 | 10.2× |
| Radiologic examination femur 1 view (73551) | $267.50 | $267.50 | 3.2× |
| Radiologic examination femur minimum 2 views (73552) range across 2 matching MRF lines |
$267.50–$534.75 | $267.50–$534.75 | varies |
| Radiologic examination knee 1/2 views (73560) range across 3 matching MRF lines |
$472.25–$944.25 | $472.25–$944.25 | varies |
| Radiologic Examination Osseous Survey Limited (77074) | $877.75 | $877.75 | 8.8× |
| Radiologic examination tibia & fibula 2 views (73590) range across 4 matching MRF lines |
$619.25–$1,726.50 | $619.25–$1,726.50 | varies |
| Ribs bilateral 3 views (71110) | $709.25 | $709.25 | 7.1× |
| Rp loclzj tum plnr 1 area single day imaging (78800) | $1,153.75 | $1,153.75 | 3.0× |
| Rp Loclzj Tum Plnr Whole Body 2+ Days Imaging (78804) | $4,513.25 | $4,513.25 | 8.7× |
| Rp Loclzj Tum Plnr Whole Body Single Day Imaging (78802) | $3,987.75 | $3,987.75 | 7.7× |
| Rp Loclzj Tum Spect 1 Area Single Day Imaging (78803) | $1,403 | $1,403 | 2.7× |
| Rp loclzj tum spect 2 area/sep acquisj img (78831) | $4,569.25 | $4,569.25 | 3.7× |
| Rp Therapy Intravenous Administration (79101) | $1,428.50 | $1,428.50 | 6.4× |
| Scapula (73010) range across 3 matching MRF lines |
$594.75–$1,329 | $594.75–$1,329 | varies |
| Screening Digital Breast Tomosynthesis Bi (77063) | $104 | $104 | 4.4× |
| Shoulder 1 view (73020) range across 3 matching MRF lines |
$541.25–$1,433.25 | $541.25–$1,433.25 | varies |
| Shoulder Arthrography (73040) | $1,974 | $1,974 | 5.9× |
| Skull less than 4 views (70250) range across 2 matching MRF lines |
$549.25–$727.50 | $549.25–$727.50 | varies |
| Special dosimetry (77331) | $524.25 | $524.25 | 4.1× |
| Special Physics Consult (77370) | $1,242.25 | $1,242.25 | 9.7× |
| Special teletherapy port plan (77321) | $1,250.50 | $1,250.50 | 3.5× |
| Special treatment procedure (77470) | $4,492.25 | $4,492.25 | 8.5× |
| Stereotactic Body Radiation Delivery (77373) | $4,477.25 | $4,477.25 | 2.6× |
| Sternoclavicular joints (71130) | $353 | $353 | 4.2× |
| Surface Applic Low Dose Rate Radionuclide Source (77789) | $438.75 | $438.75 | 4.5× |
| Telethx isodose pln cplx w/basic dosimetry (77307) | $1,949.25 | $1,949.25 | 5.4× |
| Telethx isodose pln smpl w/dosimetry calculation (77306) | $996.50 | $996.50 | 2.8× |
| Ther Rad Simulaj-Aided Field Setting Complex (77290) | $2,202.75 | $2,202.75 | 6.2× |
| Ther Rad Simulaj-Aided Field Setting Intermed (77285) | $1,720.25 | $1,720.25 | 4.8× |
| Ther rad simulaj-aided field setting simple (77280) | $1,172.75 | $1,172.75 | 9.1× |
| Therapeutic Enema Rdctj Intussusception/Obstrcj (74283) | $1,876 | $1,876 | 11.2× |
| Thoracic spine 2 views (72070) range across 2 matching MRF lines |
$541.25–$886 | $541.25–$886 | varies |
| Thoracic spine 3 views (72072) | $1,049 | $1,049 | 10.5× |
| Thoracolumbar 2 views (72080) | $672 | $672 | 8.1× |
| Thyroid Imaging With Vascular Flow (78013) | $2,063.50 | $2,063.50 | 5.4× |
| Thyroid Met Imaging Body (78018) | $2,147.75 | $2,147.75 | 4.1× |
| Thyroid Uptake Measurement (78012) | $575.50 | $575.50 | 1.5× |
| Thyroid Uptake W/Blood Flow Sngle/Mult Quan Meas (78014) | $2,308 | $2,308 | 6.0× |
| Tx Devices Design & Construction Complex (77334) | $1,683 | $1,683 | 4.7× |
| Tx devices design & construction intermediate (77333) | $1,599.50 | $1,599.50 | 12.5× |
| Tx devices design & construction simple (77332) | $687.50 | $687.50 | 5.4× |
| Ultrasound Breast Limited (76642) range across 4 matching MRF lines |
$559.25–$2,236.50 | $559.25–$2,236.50 | varies |
| Ultrasound Elastography Parenchyma (76981) | $261.75 | $261.75 | 2.6× |
| Ultrasound Exam Aaa Screen (76706) range across 2 matching MRF lines |
$717.25–$729 | $717.25–$729 | varies |
| Ultrasound, abdomen limited (76705) range across 2 matching MRF lines |
$1,035.75–$1,294.50 | $1,035.75–$1,294.50 | varies |
| Umbilical-artery Doppler (OB) (76820) | $746 | $746 | 7.5× |
| Unlisted magnetic resonance procedure (76498) | $5,550.75 | $5,550.75 | 66.7× |
| Upper gi w/o kub (74240) | $1,014.25 | $1,014.25 | 6.0× |
| Ureteral Reflux Study (78740) | $2,157 | $2,157 | 5.6× |
| Urethrocystogram voiding (74455) | $2,145.50 | $2,145.50 | 9.4× |
| Urethrocystography retrograde (74450) | $1,376 | $1,376 | 6.0× |
| Us breast unilateral complete (76641) range across 3 matching MRF lines |
$671–$2,683.50 | $671–$2,683.50 | varies |
| Us chest (76604) range across 2 matching MRF lines |
$752.75–$1,197 | $752.75–$1,197 | varies |
| Us complete joint (76881) | $928 | $928 | 9.3× |
| Us exam, pelvic, limited (76857) | $1,293.75 | $1,293.75 | 12.9× |
| Us head (76506) | $1,160 | $1,160 | 11.6× |
| Us kidney transplant (76776) | $363.50 | $363.50 | 3.6× |
| Us lmtd joint/oth nonvasc xtr strux r-t w/img (76882) | $598.75 | $598.75 | 6.0× |
| Us ob detailed single fetus (76811) | $2,191.50 | $2,191.50 | 9.6× |
| Us ob limited 1 or more fetuses (76815) range across 2 matching MRF lines |
$1,035.75–$1,566 | $1,035.75–$1,566 | varies |
| Us ob transvaginal (76817) range across 2 matching MRF lines |
$1,001.50–$1,018.50 | $1,001.50–$1,018.50 | varies |
| Us pelvic non ob complete (76856) range across 2 matching MRF lines |
$1,294.50–$1,348.50 | $1,294.50–$1,348.50 | varies |
| Us pg uter img f&mat 14 wk tabdl 1/1st gestation (76801) range across 2 matching MRF lines |
$1,461–$1,485.25 | $1,461–$1,485.25 | varies |
| Us preg uterus real time f/u trnsabdl per fetus (76816) | $1,485.25 | $1,485.25 | 14.9× |
| Us retroperitoneal complete (76770) range across 2 matching MRF lines |
$1,140.75–$2,015.25 | $1,140.75–$2,015.25 | varies |
| Us retroperitoneal limited (76775) range across 2 matching MRF lines |
$948.50–$971.75 | $948.50–$971.75 | varies |
| Us scrotum and contents (76870) range across 2 matching MRF lines |
$934–$1,868 | $934–$1,868 | varies |
| Us spinal canal and contents (76800) | $920 | $920 | 9.2× |
| Us thyroid (76536) range across 2 matching MRF lines |
$940–$1,706.50 | $940–$1,706.50 | varies |
| Us transrectal (76872) | $1,227 | $1,227 | 12.3× |
| Vein X-Ray Chest (75827) | $2,002.50 | $2,002.50 | 1.3× |
| Venography caval inferior serialography rs&i (75825) | $4,985.75 | $4,985.75 | 1.7× |
| Venography extremity bilateral rs&i (75822) | $6,036.25 | $6,036.25 | 4.0× |
| Venography extremity unilateral rs&i (75820) | $3,402.25 | $3,402.25 | 2.3× |
| Venography Renal Unilateral (75831) | $6,753.75 | $6,753.75 | 2.2× |
| Wrist 2 views (73100) range across 3 matching MRF lines |
$434.25–$868.25 | $434.25–$868.25 | varies |
| X-Ray Ac Jts - Xr Acromioclavicular Joints Bilateral (73050) | $1,035.25 | $1,035.25 | 12.4× |
| X-ray antegrade pyelogram tube (74425) | $739 | $739 | 2.2× |
| X-Ray Aorta Leg Arteries (75630) | $6,365 | $6,365 | 2.1× |
| X-Ray Bend Only L-S Spine (72120) | $849.25 | $849.25 | 8.5× |
| X-Ray Elbow 2 Vw - Xr Elbow 1-2 Views Right (73070) range across 3 matching MRF lines |
$646–$1,544 | $646–$1,544 | varies |
| X-Ray Exam Breast Specimen (76098) | $1,203.75 | $1,203.75 | 2.3× |
| X-Ray Exam Entire Spi 1 Vw (72081) | $267.50 | $267.50 | 3.2× |
| X-Ray Exam Entire Spi 2/3 Vw (72082) | $1,004.50 | $1,004.50 | 10.1× |
| X-Ray Exam Entire Spi 4/5 Vw (72083) | $866.75 | $866.75 | 8.7× |
| X-Ray Exam Hip Uni 1 View (73501) | $267.50 | $267.50 | 3.2× |
| X-Ray Exam Hip Uni 2-3 Views (73502) | $267.50 | $267.50 | 3.2× |
| X-Ray Exam Hip Uni 4/> Views (73503) | $443 | $443 | 4.4× |
| X-Ray Exam Hips Bi 2 Views (73521) | $443 | $443 | 4.4× |
| X-Ray Exam Hips Bi 3-4 Views (73522) | $443 | $443 | 4.4× |
| X-Ray Exam Hips Bi 5/> Views (73523) | $843.50 | $843.50 | 8.4× |
| X-Ray Exam L-S Spine Bending (72114) | $1,699 | $1,699 | 17.0× |
| X-Ray Exam Neck Spine 2-3 Vw (72040) range across 2 matching MRF lines |
$916.50–$1,563.25 | $916.50–$1,563.25 | varies |
| X-Ray Exam Neck Spine 6/>Vws (72052) range across 2 matching MRF lines |
$1,148.50–$2,055.75 | $1,148.50–$2,055.75 | varies |
| X-Ray Exam Unilat Ribs/Chest (71101) range across 2 matching MRF lines |
$656.50–$739 | $656.50–$739 | varies |
| X-ray eye for foreign body (70030) range across 2 matching MRF lines |
$541.25–$1,172.75 | $541.25–$1,172.75 | varies |
| X-ray humerus (73060) range across 3 matching MRF lines |
$541.25–$1,201.25 | $541.25–$1,201.25 | varies |
| X-ray IV pyelogram (ivp) (74400) | $2,310.50 | $2,310.50 | 13.8× |
| X-ray IV pyelogram+tomography (74415) | $723 | $723 | 4.3× |
| X-Ray Knee Bilat Standing - Xr Knees Anteroposterior Standing Bilat (73565) range across 2 matching MRF lines |
$353–$765.75 | $353–$765.75 | varies |
| X-Ray Lumbar Spine 2/3 Vw - Xr Lumbar Spine 2-3 Views (72100) range across 2 matching MRF lines |
$619.25–$1,977.50 | $619.25–$1,977.50 | varies |
| X-ray nose-rectum child f.b. (76010) | $316.50 | $316.50 | 3.8× |
| X-Ray Ribs, Chest 4+ Vw - Xr Ribs 3 Vws Bil W/ Chest Posteroanterior (71111) range across 2 matching MRF lines |
$797.25–$841.75 | $797.25–$841.75 | varies |
| X-Ray Sacroiliac Jts 3+ Vw - Xr Sacroiliac Joints 3+ Views (72202) | $1,036.50 | $1,036.50 | 10.4× |
| X-Ray Sacrum/Coccyx 2+ Vw - Xr Sacrum Coccyx 2+ Views (72220) range across 2 matching MRF lines |
$541.25–$1,122 | $541.25–$1,122 | varies |
| X-Ray Sinuses 3+ Vw - Xr Paranasal Sinuses 3+ Views (70220) range across 2 matching MRF lines |
$619.25–$1,187.25 | $619.25–$1,187.25 | varies |
| X-Ray Skull 4+ Vw - Xr Skull Complete 4+ Views (70260) | $780.25 | $780.25 | 7.8× |
| X-Ray Urinary Tract Exam With Contrast Material (74420) | $1,019.25 | $1,019.25 | 3.1× |
| X-Rays Bone Length Studies (77073) | $600.50 | $600.50 | 6.0× |
| X-Rays Bone Survey Complete (77075) | $1,359 | $1,359 | 13.6× |
| Xr c-spine 4 or 5 views (72050) range across 2 matching MRF lines |
$1,061.25–$2,033.25 | $1,061.25–$2,033.25 | varies |
| Xr orbits complete 4 views (70200) range across 2 matching MRF lines |
$541.25–$868.50 | $541.25–$868.50 | varies |
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.