Imaging prices at Franciscan Health Lafayette
Lafayette, IN · every code in this section with a posted price and a Medicare benchmark.
369 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) | $2,540.40 | $11,495 | 1.7× |
| Abdomen 1 View (74018) range across 2 matching MRF lines |
$77.13–$159.12 | $349–$720 | varies |
| Abdomen 2 views (74019) | $221 | $1,000 | 2.0× |
| Acute Gastrointestinal Blood Loss Imaging (78278) | $579.90 | $2,624 | 1.4× |
| Angio internal mammary (75756) | $1,035.83 | $4,687 | 0.3× |
| Angio pulmonary bilat (75743) | $2,070.77 | $9,370 | 0.6× |
| Angiography extremity bilateral rs&i (75716) | $2,588.57 | $11,713 | 0.8× |
| Angiography extremity unilateral rs&i (75710) | $1,725.79 | $7,809 | 0.5× |
| Angiography pulmonary unilateral slctv rs&i (75741) | $1,381.03 | $6,249 | 0.4× |
| Angrph pulmonary nonslctv cath/ven njx rs&i (75746) | $1,725.79 | $7,809 | 0.5× |
| Ankle 2 views (73600) range across 2 matching MRF lines |
$141.88–$283.76 | $642–$1,284 | varies |
| Aortography thoracic serialography rs&i (75605) unusually low: confirm this is the full procedure |
$1,864.36 | $8,436 | 0.3× |
| Artery X-Rays Abdomen (75726) unusually low: confirm this is the full procedure |
$1,933.09 | $8,747 | 0.3× |
| Artery X-Rays Adrenal Gland (75731) | $1,311.64 | $5,935 | 0.4× |
| Artery X-Rays Pelvis (75736) range across 2 matching MRF lines |
$1,933.09–$3,866.17 | $8,747–$17,494 | varies |
| Artery X-Rays Spine (75705) likely a partial charge, not the full procedure |
$1,346.33 | $6,092 | 0.2× |
| Arthrogram ankle (73615) | $379.68 | $1,718 | 1.0× |
| Arthrogram hip (73525) | $414.38 | $1,875 | 1.1× |
| Arthrogram Wrist (73115) | $345.42 | $1,563 | 0.9× |
| Basic radiation dosimetry calculation (77300) | $186.52 | $844 | 1.3× |
| Bone age studies (77072) | $152.49 | $690 | 1.4× |
| Bone Imaging 3 Phase (78315) | $1,031.19 | $4,666 | 2.4× |
| Bone Imaging Limited Area (78300) | $547.64 | $2,478 | 1.3× |
| Bone Imaging Multiple Areas (78305) | $418.80 | $1,895 | 1.0× |
| Bone Imaging Whole Body (78306) | $1,031.19 | $4,666 | 2.4× |
| Bone marrow imaging limited area (78102) | $232.27 | $1,051 | 0.5× |
| Bone survey infant (77076) | $159.12 | $720 | 1.4× |
| Brain Imaging Min 4 Static Views W Vascular Flow (78606) | $644.44 | $2,916 | 1.1× |
| Brain Imaging Pet Metabolic Evaluation (78608) | $1,868.33 | $8,454 | 1.2× |
| Cardiac Shunt Detection (78428) | $354.26 | $1,603 | 0.8× |
| Cat Scan Follow-Up Study (76380) | $647.09 | $2,928 | 7.0× |
| Cerebrospinal Fluid Flow W/O Matl Shunt Evaltj (78645) | $386.97 | $1,751 | 0.7× |
| Cerebrospinal Fluid Scan (78630) | $547.64 | $2,478 | 1.0× |
| Chest 1 view (71045) range across 2 matching MRF lines |
$77.13–$148.73 | $349–$673 | varies |
| Chest 2 views (71046) | $165.97 | $751 | 1.8× |
| Chest 3 views (71047) | $203.98 | $923 | 2.2× |
| Chest 4 or more views (71048) | $293.71 | $1,329 | 2.7× |
| Clavicle complete (73000) range across 2 matching MRF lines |
$207.52–$415.04 | $939–$1,878 | varies |
| Computed Tomography Thorax Lw Dose Lng Ca Scr C- (71271) | $10.83 | $49 | 0.1× |
| Continuing medical physics consltj pr wk (77336) | $312.27 | $1,413 | 2.2× |
| Contrast Exam Abdominl Aorta (75625) | $1,622.36 | $7,341 | 0.5× |
| Contrast X-Ray Bladder (74430) | $256.14 | $1,159 | 0.7× |
| Contrast X-Ray Of Elbow (73085) | $341.89 | $1,547 | 0.9× |
| Contrast X-Ray Of Knee Joint (73580) | $483.55 | $2,188 | 1.3× |
| CT abdomen and pelvis without and with contrast (74178) | $1,163.79 | $5,266 | 3.2× |
| CT abdomen and pelvis without contrast (74176) | $636.04 | $2,878 | 2.5× |
| CT abdomen w contrast (74160) | $595.82 | $2,696 | 3.2× |
| CT abdomen w wo contrast (74170) | $699.02 | $3,163 | 3.8× |
| CT abdomen w/o contrast (74150) | $491.95 | $2,226 | 4.4× |
| CT Angio Abdomen and Pelvis (74174) | $699.02 | $3,163 | 1.9× |
| CT Angio Chest (71275) | $854.17 | $3,865 | 4.6× |
| CT Angio Head (70496) | $854.17 | $3,865 | 4.6× |
| CT angio hrt w/3d image (75574) | $595.82 | $2,696 | 1.6× |
| Ct Angio Lwr Extr W/O&W/Dye (73706) range across 2 matching MRF lines |
$699.02–$1,398.05 | $3,163–$6,326 | varies |
| CT Angio Neck (70498) | $854.17 | $3,865 | 4.6× |
| Ct Angio Upr Extrm W/O&W/Dye (73206) | $699.02 | $3,163 | 3.8× |
| CT Cere Prfuj Alys C+ W/O CT/Cta Same Anatomy (70473) | $203.98 | $923 | 1.1× |
| CT cervical spine w/ contrast (72126) | $595.82 | $2,696 | 1.6× |
| CT cervical spine w/o contrast (72125) | $491.95 | $2,226 | 4.4× |
| CT cervical spine w/wo cont (72127) | $699.02 | $3,163 | 3.8× |
| CT chest w contrast (71260) | $595.82 | $2,696 | 3.2× |
| CT chest w/wo contrast (71270) | $699.02 | $3,163 | 3.8× |
| CT Colonogrphy Dx Image Postprocess W/Contrast (74262) | $595.82 | $2,696 | 3.2× |
| CT colonogrphy dx image postprocess w/o contrast (74261) | $362.66 | $1,641 | 3.3× |
| CT head/brain with contrast (70460) | $447.97 | $2,027 | 2.4× |
| CT head/brain without and with contrast (70470) | $512.28 | $2,318 | 2.8× |
| CT heart contrast eval cardiac structure&morph (75572) | $491.95 | $2,226 | 1.3× |
| CT heart no contrast quant eval coronry calcium (75571) | $10.83 | $49 | 0.1× |
| CT hrt w/3d image congen (75573) | $491.95 | $2,226 | 1.3× |
| CT iac w contrast (70481) | $595.82 | $2,696 | 3.2× |
| CT l-spine w&w/o contrast (72133) | $699.02 | $3,163 | 3.8× |
| CT lower ext w/o (73700) | $491.95 | $2,226 | 4.4× |
| CT lower extremity w/contrast material (73701) | $595.82 | $2,696 | 3.2× |
| CT lumbar spine w contrast (72132) | $595.82 | $2,696 | 1.6× |
| CT lumbar spine w/o contrast (72131) | $491.95 | $2,226 | 4.4× |
| CT maxillofacial w contrast (70487) | $595.82 | $2,696 | 3.2× |
| CT maxillofacial wo contrast (70486) | $491.95 | $2,226 | 4.4× |
| CT neck tissue combo (70492) | $699.02 | $3,163 | 3.8× |
| Ct Orbit/Ear/Fossa W/O&W/Dye (70482) | $699.02 | $3,163 | 3.8× |
| CT orbits w/o contrast (70480) | $491.95 | $2,226 | 4.4× |
| CT pelvis w&w/o contrast (72194) | $819.25 | $3,707 | 4.4× |
| CT pelvis w/o contrast (72192) | $384.10 | $1,738 | 3.5× |
| CT scan of leg combo (73702) | $699.02 | $3,163 | 3.8× |
| CT scans face/jaw combo (70488) | $699.02 | $3,163 | 3.8× |
| CT soft tissue neck w contrast (70491) | $595.82 | $2,696 | 3.2× |
| CT soft tissue neck w/o contrast (70490) | $491.95 | $2,226 | 4.4× |
| CT thoracic spine w contrast (72129) | $595.82 | $2,696 | 3.2× |
| CT thoracic spine w/o contrast (72128) | $491.95 | $2,226 | 4.4× |
| CT thoracic spine w/wo cont (72130) | $699.02 | $3,163 | 3.8× |
| CT thorax w/o contrast (71250) | $491.95 | $2,226 | 4.4× |
| CT upper ext wo (73200) | $491.95 | $2,226 | 4.4× |
| CT upper extremity w/o & w/contrast material (73202) | $725.10 | $3,281 | 3.9× |
| CT upper extremity with contrast (73201) | $595.82 | $2,696 | 1.6× |
| Cta Abdl Aorta&Bi Iliofem W/Contrast&Postp (75635) | $906.10 | $4,100 | 4.9× |
| Cta Abdomen (74175) | $699.02 | $3,163 | 3.8× |
| CTA head&neck c+ w/noncontrast img&post-pxessing (70471) | $1,708.33 | $7,730 | 4.6× |
| CTA pelvis (72191) | $699.02 | $3,163 | 3.8× |
| Doppler Fetal Mid Cerebral Artery (76821) | $196.91 | $891 | 1.8× |
| Dxa Bone Density Axial (77080) | $118.01 | $534 | 1.1× |
| Dxa bone density study (77085) | $118.01 | $534 | 1.1× |
| Dxa bone density study 1/>sites appendiclr skel (77081) | $93.70 | $424 | 1.0× |
| Echo exam uterus (76831) | $265.20 | $1,200 | 1.1× |
| Echo Guide For Artery Repair (76936) | $491.95 | $2,226 | 2.2× |
| Esophagram (74220) | $379.68 | $1,718 | 2.0× |
| Fetal Biophys Profile W/Nst (76818) | $382.77 | $1,732 | 3.5× |
| Fetal Biophysical Profile W/O Non-Stress Testing (76819) | $273.38 | $1,237 | 2.5× |
| Fluoroscopy up to 1 hr (76000) | $310.95 | $1,407 | 1.2× |
| Follow-Up Angiography (75898) | $186.97 | $846 | 0.1× |
| Foot 2 views (73620) range across 2 matching MRF lines |
$118.01–$236.03 | $534–$1,068 | varies |
| Forearm 2 views (73090) range across 2 matching MRF lines |
$141.88–$283.76 | $642–$1,284 | varies |
| Gastric emptying imaging study (78264) | $1,063.01 | $4,810 | 2.5× |
| Gastroesophageal Reflux Exam (78262) | $676.70 | $3,062 | 1.6× |
| Gated Heart Planar Single (78472) | $1,707.45 | $7,726 | 4.0× |
| Gstrc Emptng Imag Std W/Sm Bwl Col Trnst Mlt Day (78266) | $386.97 | $1,751 | 0.7× |
| Hand 2 views (73120) range across 2 matching MRF lines |
$172.38–$344.76 | $780–$1,560 | varies |
| Hepatc Vngrph Wdg/Fr Hemodyn Eval Rs&I (75889) | $1,553.41 | $7,029 | 0.5× |
| Hepatc Vngrph Wdg/Fr W/O Hemodyn Eval Rs&I (75891) | $1,656.84 | $7,497 | 0.5× |
| Hepatobil Syst Image W/Drug (78227) | $451.28 | $2,042 | 0.8× |
| Hepatobiliary System Imaging (78226) | $966.65 | $4,374 | 2.3× |
| Ht Muscle Image Spect Sing (78451) | $1,964.91 | $8,891 | 1.4× |
| Hysterosalpingogram (74740) | $321.11 | $1,453 | 1.3× |
| Infant hip ultrasound with hip movement (dynamic) (76885) | $464.54 | $2,102 | 5.0× |
| Infant hip ultrasound, limited static exam (76886) | $76.69 | $347 | 0.8× |
| Intraop radiaj tx deliver xray single tx session (77424) | $5,468.20 | $24,743 | 0.7× |
| Joint Survey Single View (77077) | $118.01 | $534 | 1.1× |
| K Flow/Funct Image Multiple (78709) | $1,127.54 | $5,102 | 2.0× |
| K Flow/Funct Image W/Drug (78708) | $1,127.54 | $5,102 | 2.0× |
| K Flow/Funct Image W/O Drug (78707) | $966.65 | $4,374 | 1.7× |
| Knee 3 Views (73562) range across 2 matching MRF lines |
$200.23–$400.45 | $906–$1,812 | varies |
| Liver & Spleen Imaging Static Only (78215) | $451.28 | $2,042 | 1.1× |
| Liver & Spleen Imaging W/Vascular Flow (78216) | $354.26 | $1,603 | 0.8× |
| Liver imaging static only (78201) | $255.26 | $1,155 | 0.4× |
| Lung Perf&Ventilat Diferentl (78598) | $1,031.19 | $4,666 | 1.8× |
| Lung perfusion differential (78597) | $515.59 | $2,333 | 1.2× |
| Lung Ventilat&Perfus Imaging (78582) | $1,031.19 | $4,666 | 1.8× |
| Lung Ventilation Imaging (78579) | $451.28 | $2,042 | 1.1× |
| Lymph System Imaging (78195) | $644.44 | $2,916 | 1.1× |
| Magnetic Image Jaw Joint (70336) | $874.50 | $3,957 | 3.5× |
| Magnetic Resonance Elastography (76391) | $191.61 | $867 | 0.8× |
| Mammary ductogram or galactogram single (77053) | $759.14 | $3,435 | 3.0× |
| Meckels Divert Exam (78290) | $579.90 | $2,624 | 1.4× |
| Medical physics dose eval radiation expos w/rprt (76145) | $95.69 | $433 | 0.2× |
| Mlc imrt design & construction per imrt plan (77338) | $909.64 | $4,116 | 2.3× |
| Mr safety implant&/fb assmt clin staf 1st 15 min (76014) | $17.02 | $77 | 0.6× |
| Mr safety implt electronics prepj supvj phys/qhp (76018) | $55.47 | $251 | 0.6× |
| Mra Head W/O & W/Contrast Material (70546) | $874.50 | $3,957 | 2.4× |
| MRA head w/o contrast (70544) | $737.70 | $3,338 | 2.9× |
| MRA head with contrast (70545) | $792.29 | $3,585 | 2.1× |
| MRA neck w contrast (70548) | $792.29 | $3,585 | 2.1× |
| Mra Neck W/O &W/Contrast Material (70549) | $874.50 | $3,957 | 2.4× |
| MRA neck w/o contrast (70547) | $737.70 | $3,338 | 2.9× |
| MRI abdomen w contrast (74182) | $792.29 | $3,585 | 2.1× |
| MRI abdomen w/o contrast (74181) | $737.70 | $3,338 | 2.9× |
| MRI any jt lower extrem w/contrast material (73722) | $884.44 | $4,002 | 1.1× |
| MRI any jt lower extrem w/o & w/contrast matrl (73723) range across 2 matching MRF lines |
$975.94–$1,951.87 | $4,416–$8,832 | varies |
| MRI any jt upper extremity w/contrast matrl (73222) | $792.29 | $3,585 | 1.0× |
| MRI bone marrow blood supply (77084) | $1,093.07 | $4,946 | 4.3× |
| MRI Breast W/O Contrast Bilateral (77047) | $191.61 | $867 | 0.8× |
| MRI Breast Without Contrast Material Unilateral (77046) | $191.61 | $867 | 0.8× |
| MRI cardiac w/o contrast (75557) | $409.96 | $1,855 | 1.6× |
| MRI cervical spine w contrast (72142) | $792.29 | $3,585 | 2.1× |
| MRI cervical spine w/o cont (72141) | $737.70 | $3,338 | 2.9× |
| MRI chest w/o contrast (71550) | $737.70 | $3,338 | 2.9× |
| MRI chest with contrast (71551) | $792.29 | $3,585 | 1.0× |
| MRI chest wo w contrast (71552) | $874.50 | $3,957 | 2.4× |
| MRI lower extrem oth/thn jt w/contrast matrl (73719) | $792.29 | $3,585 | 2.1× |
| MRI lower extrem oth/thn jt w/o & w/contr matr (73720) | $874.50 | $3,957 | 2.4× |
| MRI lower extrem oth/thn jt w/o contr matrl (73718) | $737.70 | $3,338 | 2.9× |
| MRI lumbar spine w contrast (72149) | $792.29 | $3,585 | 2.1× |
| Mri Neck Spine W/O & W/Dye (72156) | $874.50 | $3,957 | 2.4× |
| MRI orbit face &/neck w/o contrast (70540) | $737.70 | $3,338 | 2.9× |
| MRI orbit face neck w contrast (70542) | $847.31 | $3,834 | 2.3× |
| Mri Orbt/Fac/Nck W/O &W/Dye (70543) | $874.50 | $3,957 | 2.4× |
| MRI pelvis w contrast (72196) | $792.29 | $3,585 | 2.1× |
| MRI pelvis w/o & w contrast (72197) | $874.50 | $3,957 | 2.4× |
| MRI pelvis w/o contrast (72195) | $737.70 | $3,338 | 2.9× |
| MRI thoracic spine w/o contrast (72146) | $737.70 | $3,338 | 2.9× |
| MRI upper extremity oth than jt w/contr matrl (73219) | $792.29 | $3,585 | 2.1× |
| MRI upper extremity oth than jt w/o contr matrl (73218) | $737.70 | $3,338 | 2.9× |
| Mri Uppr Extremity W/O&W/Dye (73220) | $874.50 | $3,957 | 2.4× |
| MRI, abdomen, combo (74183) | $874.50 | $3,957 | 2.4× |
| MRI, dorsal spine combo (72157) | $874.50 | $3,957 | 2.4× |
| MRI, dorsal spine contrast (72147) | $792.29 | $3,585 | 2.1× |
| MRI, joint upper extrem (73221) | $737.70 | $3,338 | 2.9× |
| MRI, joint upper extrem combo (73223) | $874.50 | $3,957 | 2.4× |
| MRI, lumbar spine combo (72158) | $975.94 | $4,416 | 2.6× |
| Myocardial Imaging Pet Metabolic Evaluation (78459) | $2,061.93 | $9,330 | 1.5× |
| Myocardial Spect Multiple Studies (78452) | $2,448.46 | $11,079 | 1.8× |
| N-invas est c ffr sw aly CTA (75580) | $1,225.89 | $5,547 | 1.3× |
| Neck soft tissue (70360) | $148.73 | $673 | 1.6× |
| Njx Rp Loclzj Non-Img Probe Study Intravenous (78808) | $260.78 | $1,180 | 0.6× |
| Nm myocard infarct spect (78469) | $934.39 | $4,228 | 1.6× |
| Ntsty modul radthx pln dose-vol histos (77301) | $3,228.15 | $14,607 | 2.2× |
| Nuclear Rx Intra-Arterial (79445) | $174.81 | $791 | 0.7× |
| Nuclear Rx Oral Admin (79005) | $483.33 | $2,187 | 2.0× |
| Ob us nuchal meas 1 gest (76813) | $114.92 | $520 | 1.0× |
| Ophthalmic ultrasound dx b-scan w/wo a-scan (76512) range across 2 matching MRF lines |
$70.94–$141.88 | $321–$642 | varies |
| Parathyroid Planar Imaging (78070) | $322.22 | $1,458 | 0.8× |
| Parathyroid planar imaging w/wo subtraction (78071) | $418.80 | $1,895 | 1.0× |
| Pelvis 1 or 2 views (72170) | $224.76 | $1,017 | 2.0× |
| Peritoneogram Rs&I (74190) | $300.78 | $1,361 | 0.5× |
| Pet Image W/Ct Lmtd (78814) | $1,964.91 | $8,891 | 1.3× |
| PET image w/CT, full body (78816) | $2,126.02 | $9,620 | 1.4× |
| PET imaging CT attenuation skull base mid-thigh (78815) | $1,964.91 | $8,891 | 1.3× |
| Prq Transhepatc Portograpy Hemodyn Eval Rs&I (75885) | $1,622.36 | $7,341 | 0.5× |
| Pulmonary Perfusion Imaging Particulate (78580) | $708.75 | $3,207 | 1.7× |
| Radex Abd Compl Aqt Abd W/S/E/D Views 1 View Ch (74022) | $379.68 | $1,718 | 3.4× |
| Radex abscess/fistula/sinus tract rs&i (76080) | $155.14 | $702 | 0.3× |
| Radex Ankle Complete Minimum 3 Views (73610) range across 2 matching MRF lines |
$186.97–$373.93 | $846–$1,692 | varies |
| Radex Calcaneus Minimum 2 Views (73650) range across 2 matching MRF lines |
$172.38–$344.76 | $780–$1,560 | varies |
| Radex elbow complete minimum 3 views (73080) range across 2 matching MRF lines |
$169.51–$339.01 | $767–$1,534 | varies |
| Radex Facial Bones Complete Minimum 3 Views (70150) | $186.97 | $846 | 1.7× |
| Radex fingr minimum 2 views (73140) range across 2 matching MRF lines |
$162.44–$324.87 | $735–$1,470 | varies |
| Radex foot complete minimum 3 views (73630) range across 2 matching MRF lines |
$172.38–$344.76 | $780–$1,560 | varies |
| Radex Hand Minimum 3 Views (73130) range across 3 matching MRF lines |
$190.06–$380.12 | $860–$1,720 | varies |
| Radex lower extremity infant minimum 2 views (73592) range across 2 matching MRF lines |
$155.14–$310.28 | $702–$1,404 | varies |
| Radex Mastoids Compl Minimum 3 Views PR Side (70130) | $138.13 | $625 | 1.2× |
| Radex Nasal Bones Complete Minimum 3 Views (70160) | $179.89 | $814 | 2.0× |
| Radex Ribs Unilateral 2 Views (71100) | $169.51 | $767 | 1.8× |
| Radex shoulder complete minimum 2 views (73030) range across 2 matching MRF lines |
$196.91–$393.82 | $891–$1,782 | varies |
| Radex Sinuses Paransl < 3 Views (70210) | $172.38 | $780 | 1.9× |
| Radex Spine 1 View Specify Level (72020) | $120.89 | $547 | 1.3× |
| Radex Sternum Minimum 2 Views (71120) | $148.73 | $673 | 1.6× |
| Radex Temporomandble Jt Opn & Clsd Mouth Bilat (70330) | $169.51 | $767 | 1.8× |
| Radex Toe Minimum 2 Views (73660) | $110.94 | $502 | 1.2× |
| Radex upper extremity infant minimum 2 views (73092) range across 2 matching MRF lines |
$131.50–$262.99 | $595–$1,190 | varies |
| Radex Wrist Complete Minimum 3 Views (73110) range across 2 matching MRF lines |
$152.49–$304.98 | $690–$1,380 | varies |
| Radex X-Ray Exam Entire Spi 6/> Vw - Xr Entire Spine 6+ Vw (72084) | $186.97 | $846 | 1.7× |
| Radiation Delivery Stereotactic Cranial Linear (77372) | $6,635.08 | $30,023 | 0.9× |
| Radiation treatment delivery level 1 (77402) | $1,086.44 | $4,916 | 10.1× |
| Radiation treatment delivery level 2 (77407) | $1,289.31 | $5,834 | 3.2× |
| Radiation treatment delivery level 3 (77412) | $1,495.29 | $6,766 | 2.6× |
| Radiolog exam mandible compl minimum 4 views (70110) | $172.38 | $780 | 1.6× |
| Radiologic Exam Abdomen 3+ Views - Xr Abdomen 3+ Views (74021) | $245.53 | $1,111 | 2.2× |
| Radiologic exam colon double contrast study (74280) | $586.98 | $2,656 | 3.2× |
| Radiologic exam colon single contrast study (74270) | $448.63 | $2,030 | 2.4× |
| Radiologic Exam Esophagus Double Contrast Study (74221) | $414.38 | $1,875 | 2.2× |
| Radiologic exam knee complete 4/more views (73564) range across 2 matching MRF lines |
$245.53–$491.06 | $1,111–$2,222 | varies |
| Radiologic exam pelvis compl minimum 3 views (72190) | $259.01 | $1,172 | 2.3× |
| Radiologic Exam Small Int Single Contrast Study (74250) | $345.42 | $1,563 | 1.9× |
| Radiologic exam swallow function contrast study (74230) | $259.01 | $1,172 | 1.4× |
| Radiologic exam upr gi trc double contrast study (74246) | $414.38 | $1,875 | 2.2× |
| Radiologic examination femur 1 view (73551) | $65.86 | $298 | 0.7× |
| Radiologic examination femur minimum 2 views (73552) range across 2 matching MRF lines |
$69.17–$138.35 | $313–$626 | varies |
| Radiologic examination knee 1/2 views (73560) range across 2 matching MRF lines |
$165.97–$331.94 | $751–$1,502 | varies |
| Radiologic Examination Osseous Survey Limited (77074) | $293.71 | $1,329 | 2.7× |
| Radiologic examination tibia & fibula 2 views (73590) range across 2 matching MRF lines |
$169.51–$339.01 | $767–$1,534 | varies |
| Ribs bilateral 3 views (71110) | $217.91 | $986 | 2.0× |
| Rp loclzj tum plnr 1 area single day imaging (78800) | $547.64 | $2,478 | 1.3× |
| Rp loclzj tum plnr 2+area 1+d img/1 area img>2+d (78801) | $644.44 | $2,916 | 1.5× |
| Rp Loclzj Tum Plnr Whole Body 2+ Days Imaging (78804) | $2,415.75 | $10,931 | 4.2× |
| Rp Loclzj Tum Plnr Whole Body Single Day Imaging (78802) | $966.65 | $4,374 | 1.7× |
| Rp Loclzj Tum Spect 1 Area Single Day Imaging (78803) range across 2 matching MRF lines |
$1,063.45–$1,288.65 | $4,812–$5,831 | varies |
| Rp loclzj tum spect 2 area/sep acquisj img (78831) | $1,063.45 | $4,812 | 0.8× |
| Rp loclzj tum spect CT 2area 1d img/1 ar img>2+d (78832) | $1,215.72 | $5,501 | 0.8× |
| Rp loclzj tum spect w/CT 1 area/acquisj 1day img (78830) | $950.08 | $4,299 | 0.7× |
| Rp Therapy Intravenous Administration (79101) | $483.33 | $2,187 | 2.0× |
| Scapula (73010) | $224.76 | $1,017 | 2.0× |
| Screening Digital Breast Tomosynthesis Bi (77063) | $22.10 | $100 | 0.9× |
| Shoulder 1 view (73020) | $127.96 | $579 | 1.4× |
| Shoulder Arthrography (73040) | $552.50 | $2,500 | 1.5× |
| Sialogram (70390) | $379.68 | $1,718 | 1.5× |
| Skull less than 4 views (70250) | $172.38 | $780 | 1.6× |
| Special dosimetry (77331) | $175.03 | $792 | 1.2× |
| Special Physics Consult (77370) | $345.64 | $1,564 | 2.4× |
| Special teletherapy port plan (77321) | $213.49 | $966 | 0.5× |
| Special treatment procedure (77470) | $538.58 | $2,437 | 0.9× |
| Stereotactic Body Radiation Delivery (77373) | $6,411.65 | $29,012 | 3.4× |
| Sternoclavicular joints (71130) | $169.51 | $767 | 1.8× |
| Telethx isodose pln cplx w/basic dosimetry (77307) | $361.34 | $1,635 | 0.9× |
| Telethx isodose pln smpl w/dosimetry calculation (77306) | $212.60 | $962 | 0.5× |
| Testicular Imaging W/Flow (78761) | $483.33 | $2,187 | 1.1× |
| Ther Rad Simulaj-Aided Field Setting Complex (77290) | $1,345.67 | $6,089 | 3.4× |
| Ther Rad Simulaj-Aided Field Setting Intermed (77285) | $1,106.11 | $5,005 | 2.8× |
| Ther rad simulaj-aided field setting simple (77280) | $717.15 | $3,245 | 5.0× |
| Therapeutic Enema Rdctj Intussusception/Obstrcj (74283) | $227.63 | $1,030 | 1.2× |
| Thoracic spine 2 views (72070) | $169.51 | $767 | 1.5× |
| Thoracic spine 3 views (72072) | $238.46 | $1,079 | 2.2× |
| Thoracolumbar 2 views (72080) | $186.97 | $846 | 2.0× |
| Thyroid Imaging With Vascular Flow (78013) | $354.26 | $1,603 | 0.8× |
| Thyroid Met Imaging Body (78018) | $1,127.54 | $5,102 | 2.0× |
| Thyroid Uptake W/Blood Flow Sngle/Mult Quan Meas (78014) | $547.64 | $2,478 | 1.3× |
| Tx Devices Design & Construction Complex (77334) | $450.62 | $2,039 | 1.1× |
| Tx devices design & construction intermediate (77333) | $261 | $1,181 | 1.8× |
| Tx devices design & construction simple (77332) | $167.30 | $757 | 1.2× |
| Ultrasound Breast Limited (76642) range across 2 matching MRF lines |
$272.27–$544.54 | $1,232–$2,464 | varies |
| Ultrasound elastography first target lesion (76982) | $93.26 | $422 | 0.8× |
| Ultrasound Elastography Parenchyma (76981) | $93.26 | $422 | 0.8× |
| Ultrasound Exam Aaa Screen (76706) range across 3 matching MRF lines |
$238.02 | $23–$1,077 | 2.2× |
| Ultrasound trgt dynamic microbubble 1st lesion (76978) | $114.04 | $516 | 0.3× |
| Ultrasound, abdomen limited (76705) | $328.19 | $1,485 | 3.0× |
| Umbilical-artery Doppler (OB) (76820) | $202.44 | $916 | 1.8× |
| Unlisted fluoroscopic procedure (76496) | $379.68 | $1,718 | 4.1× |
| Upper gi w/o kub (74240) | $379.68 | $1,718 | 2.0× |
| Urea Breath Test C-14 Isotopic Acquisj Analysis (78267) | $322.22 | $1,458 | 29.1× |
| Urethrocystogram voiding (74455) | $196.91 | $891 | 0.8× |
| Urethrocystography retrograde (74450) | $259.01 | $1,172 | 1.0× |
| Us breast unilateral complete (76641) range across 2 matching MRF lines |
$272.27–$544.54 | $1,232–$2,464 | varies |
| Us chest (76604) | $169.73 | $768 | 1.5× |
| Us complete joint (76881) | $235.14 | $1,064 | 2.1× |
| Us exam, pelvic, limited (76857) | $232.49 | $1,052 | 2.1× |
| Us head (76506) | $300.34 | $1,359 | 2.7× |
| Us kidney transplant (76776) | $382.77 | $1,732 | 3.5× |
| Us lmtd joint/oth nonvasc xtr strux r-t w/img (76882) range across 4 matching MRF lines |
$148.07–$296.14 | $670–$1,340 | varies |
| Us ob detailed single fetus (76811) | $194.48 | $880 | 0.8× |
| Us ob limited 1 or more fetuses (76815) | $191.61 | $867 | 1.7× |
| Us ob transvaginal (76817) | $191.61 | $867 | 1.7× |
| Us pelvic non ob complete (76856) | $355.15 | $1,607 | 3.2× |
| Us pg uter img f&mat 14 wk tabdl 1/1st gestation (76801) | $216.58 | $980 | 2.0× |
| Us preg uterus real time f/u trnsabdl per fetus (76816) | $131.27 | $594 | 1.2× |
| Us retroperitoneal complete (76770) | $270.73 | $1,225 | 2.4× |
| Us retroperitoneal limited (76775) | $270.73 | $1,225 | 2.4× |
| Us scrotum and contents (76870) | $355.15 | $1,607 | 3.2× |
| Us spinal canal and contents (76800) | $210.83 | $954 | 1.9× |
| Us thyroid (76536) | $355.15 | $1,607 | 3.2× |
| Us transrectal (76872) | $273.38 | $1,237 | 2.5× |
| Vein X-Ray Chest (75827) | $1,484.24 | $6,716 | 0.9× |
| Vein X-Ray Liver W/O Hemodyn (75887) | $1,553.41 | $7,029 | 0.5× |
| Venogram Sinus/Jugular (75860) | $862.78 | $3,904 | 0.3× |
| Venography caval inferior serialography rs&i (75825) | $1,484.24 | $6,716 | 0.4× |
| Venography extremity bilateral rs&i (75822) | $262.99 | $1,190 | 0.2× |
| Venography extremity unilateral rs&i (75820) | $172.38 | $780 | 0.1× |
| Venography Renal Bilateral (75833) | $1,622.36 | $7,341 | 0.5× |
| Venography Renal Unilateral (75831) | $1,173.73 | $5,311 | 0.4× |
| Venous sampling by catheter (75893) likely a partial charge, not the full procedure |
$483.55 | $2,188 | 0.1× |
| Venous Thrombosis Imaging Venogram Bilateral (78458) | $483.33 | $2,187 | 1.1× |
| Vertebral fracture assessment via dxa (77086) | $93.70 | $424 | 1.0× |
| Wrist 2 views (73100) range across 2 matching MRF lines |
$118.01–$236.03 | $534–$1,068 | varies |
| X-Ray Ac Jts - Xr Acromioclavicular Joints Bilateral (73050) | $165.97 | $751 | 1.8× |
| X-ray antegrade pyelogram tube (74425) | $83.32 | $377 | 0.2× |
| X-Ray Aorta Leg Arteries (75630) | $2,174.64 | $9,840 | 0.7× |
| X-Ray Bend Only L-S Spine (72120) | $248.85 | $1,126 | 2.2× |
| X-Ray Elbow 2 Vw - Xr Elbow 1-2 Views Right (73070) | $141.88 | $642 | 1.5× |
| X-Ray Exam Breast Specimen (76098) | $217.91 | $986 | 0.4× |
| X-Ray Exam Entire Spi 1 Vw (72081) | $69.17 | $313 | 0.8× |
| X-Ray Exam Entire Spi 2/3 Vw (72082) | $107.19 | $485 | 1.0× |
| X-Ray Exam Entire Spi 4/5 Vw (72083) | $186.97 | $846 | 1.7× |
| X-Ray Exam Hip Uni 1 View (73501) | $69.17 | $313 | 0.8× |
| X-Ray Exam Hip Uni 2-3 Views (73502) | $341.89 | $1,547 | 3.7× |
| X-Ray Exam Hip Uni 4/> Views (73503) | $341.89 | $1,547 | 3.1× |
| X-Ray Exam Hips Bi 2 Views (73521) | $552.50 | $2,500 | 5.0× |
| X-Ray Exam Hips Bi 3-4 Views (73522) | $552.50 | $2,500 | 5.0× |
| X-Ray Exam Hips Bi 5/> Views (73523) | $552.50 | $2,500 | 5.0× |
| X-Ray Exam L-S Spine Bending (72114) | $112.05 | $507 | 1.0× |
| X-Ray Exam Neck Spine 2-3 Vw (72040) | $203.98 | $923 | 2.2× |
| X-Ray Exam Neck Spine 6/>Vws (72052) | $341.89 | $1,547 | 3.1× |
| X-Ray Exam Unilat Ribs/Chest (71101) | $227.63 | $1,030 | 2.1× |
| X-ray eye for foreign body (70030) | $100.33 | $454 | 1.1× |
| X-ray humerus (73060) range across 2 matching MRF lines |
$169.51–$339.01 | $767–$1,534 | varies |
| X-ray IV pyelogram (ivp) (74400) | $517.58 | $2,342 | 2.8× |
| X-Ray Jaw <4 Vw - Xr Mandible < 4 Views (70100) | $152.49 | $690 | 1.7× |
| X-Ray Knee Bilat Standing - Xr Knees Anteroposterior Standing Bilat (73565) | $310.95 | $1,407 | 3.4× |
| X-Ray Lumbar Spine 2/3 Vw - Xr Lumbar Spine 2-3 Views (72100) | $173.49 | $785 | 1.6× |
| X-ray nose-rectum child f.b. (76010) | $100.33 | $454 | 1.1× |
| X-Ray Ribs, Chest 4+ Vw - Xr Ribs 3 Vws Bil W/ Chest Posteroanterior (71111) | $238.46 | $1,079 | 2.2× |
| X-Ray Sacroiliac Jts 3+ Vw - Xr Sacroiliac Joints 3+ Views (72202) | $283.32 | $1,282 | 2.6× |
| X-Ray Sacroiliac Jts <3 Vw - Xr Sacroiliac Joints 1-2 Views (72200) | $152.49 | $690 | 1.4× |
| X-Ray Sacrum/Coccyx 2+ Vw - Xr Sacrum Coccyx 2+ Views (72220) | $214.37 | $970 | 2.3× |
| X-Ray Sinuses 3+ Vw - Xr Paranasal Sinuses 3+ Views (70220) | $341.89 | $1,547 | 3.7× |
| X-Ray Skull 4+ Vw - Xr Skull Complete 4+ Views (70260) | $231.83 | $1,049 | 2.1× |
| X-Ray Stress View (77071) | $65.86 | $298 | 0.7× |
| X-ray thoracic spine 4 vw (72074) | $259.01 | $1,172 | 2.3× |
| X-Ray Urinary Tract Exam With Contrast Material (74420) | $621.67 | $2,813 | 1.7× |
| X-Rays Bone Length Studies (77073) | $217.91 | $986 | 2.0× |
| X-Rays Bone Survey Complete (77075) | $379.68 | $1,718 | 3.4× |
| Xr c-spine 4 or 5 views (72050) | $248.85 | $1,126 | 2.2× |
| Xr facial bones less than 3 views (70140) | $172.38 | $780 | 1.9× |
| XR Mastoids < 3 Views Bilateral (70120) | $90.17 | $408 | 0.8× |
| Xr orbits complete 4 views (70200) | $217.91 | $986 | 2.0× |
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.