Imaging prices at Good Samaritan Hospital
Vincennes, IN · every code in this section with a posted price and a Medicare benchmark.
384 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) | $3,840.60 | $6,401 | 2.6× |
| Abdomen 1 View (74018) | $238.80 | $398 | 2.6× |
| Abdomen 2 views (74019) | $331.80 | $553 | 3.0× |
| Acute Gastrointestinal Blood Loss Imaging (78278) | $1,167 | $1,945 | 2.8× |
| Angio pulmonary bilat (75743) | $3,978 | $6,630 | 1.2× |
| Angiography extremity bilateral rs&i (75716) | $4,039.20 | $6,732 | 1.2× |
| Angiography extremity unilateral rs&i (75710) | $1,989 | $3,315 | 0.6× |
| Angiography pulmonary unilateral slctv rs&i (75741) | $1,989 | $3,315 | 0.6× |
| Angrph pulmonary nonslctv cath/ven njx rs&i (75746) | $3,174 | $5,290 | 1.0× |
| Ankle 2 views (73600) range across 2 matching MRF lines |
$210–$417 | $350–$695 | varies |
| Aortography thoracic serialography rs&i (75605) | $6,726 | $11,210 | 1.1× |
| Artery X-Rays Abdomen (75726) | $3,484.20 | $5,807 | 0.6× |
| Artery X-Rays Adrenal Gland (75731) | $1,989 | $3,315 | 0.6× |
| Artery X-Rays Pelvis (75736) | $3,484.20 | $5,807 | 0.6× |
| Arthrogram ankle (73615) | $771.60 | $1,286 | 2.1× |
| Arthrogram hip (73525) | $771.60 | $1,286 | 2.1× |
| Arthrogram Wrist (73115) | $771.60 | $1,286 | 2.1× |
| Basic radiation dosimetry calculation (77300) | $419.40 | $699 | 2.9× |
| Bone age studies (77072) | $202.20 | $337 | 1.8× |
| Bone Imaging 3 Phase (78315) | $1,849.80 | $3,083 | 4.4× |
| Bone Imaging Limited Area (78300) | $890.40 | $1,484 | 2.1× |
| Bone Imaging Multiple Areas (78305) | $626.40 | $1,044 | 1.5× |
| Bone Imaging Whole Body (78306) | $1,620 | $2,700 | 3.8× |
| Bone marrow imaging limited area (78102) | $583.20 | $972 | 1.4× |
| Bone marrow imaging; multiple areas (78103) | $697.20 | $1,162 | 1.6× |
| Bone marrow imaging; whole body (78104) | $811.20 | $1,352 | 1.9× |
| Bone survey infant (77076) | $238.80 | $398 | 2.2× |
| Brachytx isodose complex (77318) | $1,389.60 | $2,316 | 3.5× |
| Brachytx isodose intermed (77317) | $993 | $1,655 | 2.5× |
| Brachytx Isodose Plan Simple (77316) | $810.60 | $1,351 | 2.0× |
| Brain Flow Imaging Only (78610) | $747.60 | $1,246 | 1.3× |
| Brain Image W/Flow < 4 Views (78601) | $776.40 | $1,294 | 1.8× |
| Brain Imaging Minimum 4 Static Views (78605) | $530.40 | $884 | 0.9× |
| Brain Imaging Pet Metabolic Evaluation (78608) | $1,788.60 | $2,981 | 1.2× |
| Cardiac Shunt Detection (78428) | $803.40 | $1,339 | 1.9× |
| Cat Scan Follow-Up Study (76380) | $804 | $1,340 | 8.7× |
| Cerebrospinal Fluid Flow W/O Matl Shunt Evaltj (78645) | $468 | $780 | 0.8× |
| Cerebrospinal Fluid Scan (78630) | $924 | $1,540 | 1.6× |
| Chest 1 view (71045) | $162 | $270 | 1.8× |
| Chest 2 views (71046) | $204 | $340 | 2.2× |
| Chest 3 views (71047) | $270.60 | $451 | 2.9× |
| Chest 4 or more views (71048) | $288 | $480 | 2.6× |
| Clavicle complete (73000) range across 2 matching MRF lines |
$213.60–$424.20 | $356–$707 | varies |
| Computed Tomography Thorax Lw Dose Lng Ca Scr C- (71271) | $891.60 | $1,486 | 8.1× |
| Continuing medical physics consltj pr wk (77336) | $448.80 | $748 | 3.2× |
| Contrast Exam Abdominl Aorta (75625) | $4,041.60 | $6,736 | 1.2× |
| Contrast X-Ray Bladder (74430) | $433.20 | $722 | 1.2× |
| Contrast X-Ray Of Elbow (73085) | $493.80 | $823 | 1.3× |
| Contrast X-Ray Of Knee Joint (73580) | $771.60 | $1,286 | 2.1× |
| CT abdomen and pelvis without and with contrast (74178) | $2,493 | $4,155 | 6.8× |
| CT abdomen and pelvis without contrast (74176) | $1,841.40 | $3,069 | 7.3× |
| CT abdomen w contrast (74160) | $1,536.60 | $2,561 | 8.3× |
| CT abdomen w wo contrast (74170) | $1,749.60 | $2,916 | 9.4× |
| CT abdomen w/o contrast (74150) | $1,020.60 | $1,701 | 9.2× |
| CT Angio Abdomen and Pelvis (74174) | $1,607.40 | $2,679 | 4.4× |
| CT Angio Chest (71275) | $1,652.40 | $2,754 | 8.9× |
| CT Angio Head (70496) | $1,505.40 | $2,509 | 8.1× |
| CT angio hrt w/3d image (75574) | $1,335 | $2,225 | 3.6× |
| Ct Angio Lwr Extr W/O&W/Dye (73706) | $1,400.40 | $2,334 | 7.5× |
| CT Angio Neck (70498) | $1,476 | $2,460 | 8.0× |
| Ct Angio Upr Extrm W/O&W/Dye (73206) | $1,400.40 | $2,334 | 7.5× |
| CT Cere Prfuj Alys C+ W/O CT/Cta Same Anatomy (70473) | $322.50 | $537.50 | 1.7× |
| CT cervical spine w/ contrast (72126) | $857.40 | $1,429 | 2.3× |
| CT cervical spine w/o contrast (72125) | $1,062 | $1,770 | 9.6× |
| CT cervical spine w/wo cont (72127) | $895.80 | $1,493 | 4.8× |
| CT chest w contrast (71260) | $1,165.80 | $1,943 | 6.3× |
| CT chest w/wo contrast (71270) | $1,422.60 | $2,371 | 7.7× |
| CT colonography screening (74263) | $804 | $1,340 | 3.2× |
| CT colonogrphy dx image postprocess w/o contrast (74261) | $804 | $1,340 | 7.3× |
| CT head/brain with contrast (70460) | $929.40 | $1,549 | 5.0× |
| CT head/brain without and with contrast (70470) | $1,501.20 | $2,502 | 8.1× |
| CT heart no contrast quant eval coronry calcium (75571) range across 2 matching MRF lines |
$59.40–$162.60 | $99–$271 | varies |
| CT iac w contrast (70481) | $1,184.40 | $1,974 | 6.4× |
| CT l-spine w&w/o contrast (72133) | $1,564.80 | $2,608 | 8.4× |
| CT lower ext w/o (73700) range across 2 matching MRF lines |
$944.40–$1,553.40 | $1,574–$2,589 | varies |
| CT lower extremity w/contrast material (73701) | $1,005 | $1,675 | 5.4× |
| CT lumbar spine w contrast (72132) | $1,378.80 | $2,298 | 3.7× |
| CT lumbar spine w/o contrast (72131) | $1,080.60 | $1,801 | 9.8× |
| CT maxillofacial w contrast (70487) | $1,007.40 | $1,679 | 5.4× |
| CT maxillofacial wo contrast (70486) | $1,130.40 | $1,884 | 10.2× |
| CT neck tissue combo (70492) | $1,090.80 | $1,818 | 5.9× |
| Ct Orbit/Ear/Fossa W/O&W/Dye (70482) | $1,336.20 | $2,227 | 7.2× |
| CT orbits w/o contrast (70480) | $1,086 | $1,810 | 9.8× |
| CT pelvis w&w/o contrast (72194) | $1,370.40 | $2,284 | 7.4× |
| CT pelvis w/o contrast (72192) | $924 | $1,540 | 8.4× |
| CT scan of leg combo (73702) range across 2 matching MRF lines |
$1,068.60–$1,891.20 | $1,781–$3,152 | varies |
| CT scans face/jaw combo (70488) | $1,070.40 | $1,784 | 5.8× |
| CT soft tissue neck w contrast (70491) | $1,048.20 | $1,747 | 5.6× |
| CT soft tissue neck w/o contrast (70490) | $942.60 | $1,571 | 8.5× |
| CT thoracic spine w contrast (72129) | $1,275.60 | $2,126 | 6.9× |
| CT thoracic spine w/o contrast (72128) | $1,023.60 | $1,706 | 9.3× |
| CT thoracic spine w/wo cont (72130) | $1,564.80 | $2,608 | 8.4× |
| CT thorax w/o contrast (71250) | $923.40 | $1,539 | 8.3× |
| CT upper ext wo (73200) range across 2 matching MRF lines |
$804–$1,497 | $1,340–$2,495 | varies |
| CT upper extremity w/o & w/contrast material (73202) | $1,087.80 | $1,813 | 5.9× |
| CT upper extremity with contrast (73201) | $942 | $1,570 | 2.6× |
| Cta Abdl Aorta&Bi Iliofem W/Contrast&Postp (75635) | $2,604 | $4,340 | 14.0× |
| Cta Abdomen (74175) | $1,530 | $2,550 | 8.2× |
| CTA head&neck c+ w/noncontrast img&post-pxessing (70471) | $641.70 | $1,069.50 | 1.7× |
| CTA pelvis (72191) | $1,457.40 | $2,429 | 7.9× |
| Dilation ureters/urethra rs&i (74485) | $1,807.20 | $3,012 | 0.8× |
| Discography Cerv/Thor Spine (72285) | $2,131.20 | $3,552 | 1.0× |
| Diskography lumbar (72295) | $2,131.20 | $3,552 | 1.0× |
| Dxa Bone Density Axial (77080) | $361.20 | $602 | 3.3× |
| Dxa bone density study 1/>sites appendiclr skel (77081) | $154.80 | $258 | 1.7× |
| Echo exam uterus (76831) | $297 | $495 | 1.2× |
| Esophagram (74220) | $402 | $670 | 2.2× |
| Fetal Biophys Profile W/Nst (76818) | $486 | $810 | 4.4× |
| Fetal Biophysical Profile W/O Non-Stress Testing (76819) | $464.40 | $774 | 4.2× |
| Fluoroscopy up to 1 hr (76000) range across 2 matching MRF lines |
$497.40–$566.40 | $829–$944 | varies |
| Follow-Up Angiography (75898) | $3,286.20 | $5,477 | 1.0× |
| Foot 2 views (73620) range across 2 matching MRF lines |
$265.80–$409.20 | $443–$682 | varies |
| Forearm 2 views (73090) range across 2 matching MRF lines |
$213.60–$424.20 | $356–$707 | varies |
| Gastric emptying imaging study (78264) | $1,161.60 | $1,936 | 2.7× |
| Gastroesophageal Reflux Exam (78262) | $599.40 | $999 | 1.4× |
| Gated Heart Planar Single (78472) | $1,125.60 | $1,876 | 2.7× |
| Hand 2 views (73120) range across 2 matching MRF lines |
$289.80–$424.20 | $483–$707 | varies |
| Hdr Rdncl Ntrstl/Icav Brchtx (77772) | $669.60 | $1,116 | 0.9× |
| Hdr Rdncl Ntrstl/Icav Brchtx (77771) | $669.60 | $1,116 | 0.9× |
| Hdr Rdncl Ntrstl/Icav Brchtx 1 Channel (77770) | $790.20 | $1,317 | 1.1× |
| Hepatc Vngrph Wdg/Fr Hemodyn Eval Rs&I (75889) | $3,169.20 | $5,282 | 0.9× |
| Hepatobil Syst Image W/Drug (78227) | $1,668.90 | $2,781.50 | 2.9× |
| Hepatobiliary System Imaging (78226) | $1,114.20 | $1,857 | 2.6× |
| Ht Muscle Image Spect Sing (78451) | $2,251.20 | $3,752 | 1.6× |
| Hysterosalpingogram (74740) | $526.80 | $878 | 2.1× |
| Image fusion (77399) | $221.40 | $369 | 1.6× |
| Infant hip ultrasound, limited static exam (76886) | $135.60 | $226 | 1.5× |
| Infusion Ivp (74410) | $661.20 | $1,102 | 3.6× |
| Interstitial radiation source applic complex (77778) | $4,582.20 | $7,637 | 6.2× |
| Intracavitary Radiation Source Applic Complex (77763) | $1,933.80 | $3,223 | 2.6× |
| Intracavitary Radiation Source Applic Intermed (77762) | $5,534.40 | $9,224 | 9.5× |
| Intracavitary radiation source applic simple (77761) | $1,546.20 | $2,577 | 2.6× |
| Joint Survey Single View (77077) | $124.20 | $207 | 1.1× |
| K Flow/Funct Image Multiple (78709) | $934.50 | $1,557.50 | 1.6× |
| K Flow/Funct Image W/Drug (78708) | $1,301.40 | $2,169 | 2.3× |
| K Flow/Funct Image W/O Drug (78707) | $974.40 | $1,624 | 1.7× |
| Kidney Imaging Morphol (78700) | $543.60 | $906 | 1.3× |
| Kidney Imaging Morphoogy W/Vascular Flow (78701) | $592.20 | $987 | 1.4× |
| Knee 3 Views (73562) range across 2 matching MRF lines |
$276.60–$441 | $461–$735 | varies |
| Leveen/Shunt Patency Exam (78291) | $846.60 | $1,411 | 2.0× |
| Liver & Spleen Imaging Static Only (78215) | $985.20 | $1,642 | 2.3× |
| Lung Perf&Ventilat Diferentl (78598) | $903.60 | $1,506 | 1.6× |
| Lung perfusion differential (78597) | $699 | $1,165 | 1.7× |
| Lung Ventilat&Perfus Imaging (78582) | $1,185 | $1,975 | 2.1× |
| Lung Ventilation Imaging (78579) | $699.60 | $1,166 | 1.7× |
| Lymph System Imaging (78195) | $1,038 | $1,730 | 1.8× |
| Lymphangiography Extremity Only Bilateral Rs&I (75803) | $1,034.40 | $1,724 | 0.6× |
| Lymphangiography extremity only unilateral rs&i (75801) | $1,173.60 | $1,956 | 1.8× |
| Lymphangiography Pelvic/Abdominal Bilateral Rs&I (75807) | $4,039.20 | $6,732 | 1.2× |
| Lymphangiography, pelvic/abdominal, unilateral (75805) | $3,286.20 | $5,477 | 1.0× |
| Magnetic Image Jaw Joint (70336) | $1,756.80 | $2,928 | 7.0× |
| Mammary ductogram or galactogram multiple (77054) | $509.40 | $849 | 2.0× |
| Mammary ductogram or galactogram single (77053) | $243 | $405 | 1.0× |
| Meckels Divert Exam (78290) | $985.80 | $1,643 | 2.3× |
| Mlc imrt design & construction per imrt plan (77338) | $1,677.60 | $2,796 | 4.2× |
| Mr safety determination physician/other qhp (76016) | $158.40 | $264 | 1.7× |
| Mr safety implant&/fb assmt clin staf 1st 15 min (76014) | $44.40 | $74 | 1.5× |
| Mr safety implt electronics prepj supvj phys/qhp (76018) | $165.60 | $276 | 1.6× |
| Mra Head W/O & W/Contrast Material (70546) | $2,244 | $3,740 | 6.1× |
| MRA head w/o contrast (70544) | $1,931.40 | $3,219 | 7.7× |
| MRA head with contrast (70545) | $1,857 | $3,095 | 5.0× |
| MRA neck w contrast (70548) | $1,094.40 | $1,824 | 3.0× |
| Mra Neck W/O &W/Contrast Material (70549) | $2,623.80 | $4,373 | 7.1× |
| MRA neck w/o contrast (70547) | $1,857 | $3,095 | 7.4× |
| MRI abdomen w contrast (74182) | $2,158.20 | $3,597 | 5.8× |
| MRI abdomen w/o contrast (74181) | $1,800.60 | $3,001 | 7.1× |
| MRI any jt lower extrem w/contrast material (73722) | $1,989 | $3,315 | 2.4× |
| MRI any jt lower extrem w/o & w/contrast matrl (73723) | $2,354.40 | $3,924 | 6.4× |
| MRI any jt upper extremity w/contrast matrl (73222) | $2,163 | $3,605 | 2.6× |
| MRI Breast W/O Contrast Bilateral (77047) | $1,642.80 | $2,738 | 6.5× |
| MRI Breast Without Contrast Material Unilateral (77046) | $1,466.40 | $2,444 | 5.8× |
| MRI cervical spine w contrast (72142) | $1,636.20 | $2,727 | 4.4× |
| MRI cervical spine w/o cont (72141) | $1,816.80 | $3,028 | 7.2× |
| MRI chest w/o contrast (71550) | $1,789.20 | $2,982 | 7.1× |
| MRI chest wo w contrast (71552) | $2,460.60 | $4,101 | 6.7× |
| MRI lower extrem oth/thn jt w/o & w/contr matr (73720) | $2,268 | $3,780 | 6.1× |
| MRI lower extrem oth/thn jt w/o contr matrl (73718) | $1,789.20 | $2,982 | 7.1× |
| MRI lumbar spine w contrast (72149) | $1,763.40 | $2,939 | 4.8× |
| Mri Neck Spine W/O & W/Dye (72156) | $2,314.80 | $3,858 | 6.3× |
| MRI orbit face &/neck w/o contrast (70540) | $1,569.60 | $2,616 | 6.2× |
| Mri Orbt/Fac/Nck W/O &W/Dye (70543) | $2,413.20 | $4,022 | 6.5× |
| MRI pelvis w/o & w contrast (72197) | $3,040.80 | $5,068 | 8.2× |
| MRI pelvis w/o contrast (72195) | $1,724.40 | $2,874 | 6.8× |
| MRI thoracic spine w/o contrast (72146) | $1,775.40 | $2,959 | 7.0× |
| MRI upper extremity oth than jt w/o contr matrl (73218) | $2,058.60 | $3,431 | 8.2× |
| Mri Uppr Extremity W/O&W/Dye (73220) | $2,140.80 | $3,568 | 5.8× |
| MRI, abdomen, combo (74183) | $2,515.20 | $4,192 | 6.8× |
| MRI, dorsal spine combo (72157) | $2,403 | $4,005 | 6.5× |
| MRI, dorsal spine contrast (72147) | $1,779.60 | $2,966 | 4.8× |
| MRI, joint upper extrem (73221) | $1,789.20 | $2,982 | 7.1× |
| MRI, joint upper extrem combo (73223) | $2,354.40 | $3,924 | 6.4× |
| MRI, lumbar spine combo (72158) | $2,359.20 | $3,932 | 6.4× |
| Myelogram cervical (72240) | $834 | $1,390 | 1.0× |
| Myelogram Lumbar (72265) | $805.80 | $1,343 | 1.0× |
| Myelography thoracic (72255) | $753 | $1,255 | 0.9× |
| Myelograpy 2/more regions rs&i (72270) | $931.80 | $1,553 | 1.1× |
| Myocardial Perfusion Planar 1 Study Rest/Stress (78453) | $1,446 | $2,410 | 1.1× |
| Myocardial Spect Multiple Studies (78452) | $3,672.60 | $6,121 | 2.7× |
| N-invas est c ffr sw aly CTA (75580) | $1,221 | $2,035 | 1.3× |
| Neck soft tissue (70360) | $238.80 | $398 | 2.6× |
| Njx Rp Loclzj Non-Img Probe Study Intravenous (78808) | $564 | $940 | 1.3× |
| Nonvascular Shunt X-Ray (75809) | $213 | $355 | 1.9× |
| Ntsty modul radthx pln dose-vol histos (77301) | $5,086.20 | $8,477 | 3.5× |
| Nuclear Rx Intra-Arterial (79445) | $786 | $1,310 | 3.2× |
| Nuclear Rx Oral Admin (79005) | $827.40 | $1,379 | 3.4× |
| Ob us nuchal meas 1 gest (76813) | $525 | $875 | 4.7× |
| Parathyroid Planar Imaging (78070) | $846.60 | $1,411 | 2.0× |
| Parathyroid planar imaging w/wo subtraction (78071) | $657 | $1,095 | 1.6× |
| Pelvis 1 or 2 views (72170) | $240 | $400 | 2.2× |
| Peritoneogram Rs&I (74190) | $655.80 | $1,093 | 1.1× |
| Pet Image W/Ct Lmtd (78814) | $3,000.60 | $5,001 | 2.0× |
| PET image w/CT, full body (78816) | $4,664.40 | $7,774 | 3.1× |
| PET imaging CT attenuation skull base mid-thigh (78815) | $3,697.80 | $6,163 | 2.4× |
| Pulmonary Perfusion Imaging Particulate (78580) | $766.80 | $1,278 | 1.8× |
| Quan&Charac C Atherosclerotc Plaq Asses Sev C Ds (75577) | $438.90 | $731.50 | 0.4× |
| Radex Abd Compl Aqt Abd W/S/E/D Views 1 View Ch (74022) | $373.20 | $622 | 3.4× |
| Radex abscess/fistula/sinus tract rs&i (76080) | $771.60 | $1,286 | 1.3× |
| Radex Ankle Complete Minimum 3 Views (73610) range across 2 matching MRF lines |
$249–$405 | $415–$675 | varies |
| Radex Calcaneus Minimum 2 Views (73650) range across 2 matching MRF lines |
$213.60–$424.20 | $356–$707 | varies |
| Radex elbow complete minimum 3 views (73080) range across 2 matching MRF lines |
$231.60–$460.80 | $386–$768 | varies |
| Radex Facial Bones Complete Minimum 3 Views (70150) | $315.60 | $526 | 2.9× |
| Radex fingr minimum 2 views (73140) | $248.40 | $414 | 2.7× |
| Radex foot complete minimum 3 views (73630) range across 2 matching MRF lines |
$216.60–$432 | $361–$720 | varies |
| Radex Hand Minimum 3 Views (73130) range across 2 matching MRF lines |
$295.80–$460.20 | $493–$767 | varies |
| Radex lower extremity infant minimum 2 views (73592) range across 2 matching MRF lines |
$158.40–$297 | $264–$495 | varies |
| Radex Mastoids Compl Minimum 3 Views PR Side (70130) | $286.20 | $477 | 2.6× |
| Radex Nasal Bones Complete Minimum 3 Views (70160) | $270 | $450 | 2.9× |
| Radex Ribs Unilateral 2 Views (71100) | $259.20 | $432 | 2.8× |
| Radex shoulder complete minimum 2 views (73030) range across 2 matching MRF lines |
$245.40–$423 | $409–$705 | varies |
| Radex Sinuses Paransl < 3 Views (70210) | $139.20 | $232 | 1.5× |
| Radex sm int w/mlt srl imges via enteroclss tube (74251) | $680.40 | $1,134 | 3.7× |
| Radex Spine 1 View Specify Level (72020) | $163.80 | $273 | 1.8× |
| Radex Sternum Minimum 2 Views (71120) | $264.60 | $441 | 2.9× |
| Radex Temporomandble Jt Opn & Clsd Mouth Bilat (70330) | $355.20 | $592 | 3.9× |
| Radex Toe Minimum 2 Views (73660) | $211.80 | $353 | 2.3× |
| Radex upper extremity infant minimum 2 views (73092) range across 2 matching MRF lines |
$128.40–$316.20 | $214–$527 | varies |
| Radex Wrist Complete Minimum 3 Views (73110) range across 2 matching MRF lines |
$285–$460.80 | $475–$768 | varies |
| Radex X-Ray Exam Entire Spi 6/> Vw - Xr Entire Spine 6+ Vw (72084) | $513.60 | $856 | 4.6× |
| Radiation Delivery Stereotactic Cranial Linear (77372) | $14,086.20 | $23,477 | 1.8× |
| Radiation treatment delivery level 1 (77402) | $1,548.30 | $2,580.50 | 14.3× |
| Radiation treatment delivery level 2 (77407) | $1,613.70 | $2,689.50 | 4.0× |
| Radiation treatment delivery level 3 (77412) | $1,845.60 | $3,076 | 3.2× |
| Radiolog exam mandible compl minimum 4 views (70110) | $315.60 | $526 | 2.9× |
| Radiologic Exam Abdomen 3+ Views - Xr Abdomen 3+ Views (74021) | $394.20 | $657 | 3.6× |
| Radiologic exam colon double contrast study (74280) | $627 | $1,045 | 3.4× |
| Radiologic exam colon single contrast study (74270) | $721.80 | $1,203 | 3.9× |
| Radiologic exam knee complete 4/more views (73564) range across 2 matching MRF lines |
$298.20–$456.60 | $497–$761 | varies |
| Radiologic exam pelvis compl minimum 3 views (72190) | $372 | $620 | 3.4× |
| Radiologic Exam Small Int Single Contrast Study (74250) | $457.20 | $762 | 2.5× |
| Radiologic exam swallow function contrast study (74230) | $378.60 | $631 | 2.0× |
| Radiologic exam upr gi trc double contrast study (74246) | $244.20 | $407 | 1.3× |
| Radiologic examination femur 1 view (73551) range across 2 matching MRF lines |
$213.60–$424.20 | $356–$707 | varies |
| Radiologic examination femur minimum 2 views (73552) | $213 | $355 | 2.3× |
| Radiologic examination knee 1/2 views (73560) range across 2 matching MRF lines |
$245.40–$424.20 | $409–$707 | varies |
| Radiologic Examination Osseous Survey Limited (77074) | $244.20 | $407 | 2.2× |
| Radiologic examination tibia & fibula 2 views (73590) range across 2 matching MRF lines |
$213.60–$432 | $356–$720 | varies |
| Remote afterloading high dose rate radionuclide skin surface brachytherapy, includes basic dosimetry, when performed;… (77768) | $187.80 | $313 | 0.5× |
| Remote afterloading high dose rate radionuclide skin surface brachytherapy, includes basic dosimetry, when performed;… (77767) | $187.80 | $313 | 0.5× |
| Ribs bilateral 3 views (71110) | $337.80 | $563 | 3.1× |
| Rp loclzj tum plnr 1 area single day imaging (78800) | $947.40 | $1,579 | 2.2× |
| Rp loclzj tum plnr 2+area 1+d img/1 area img>2+d (78801) | $1,402.20 | $2,337 | 3.3× |
| Rp Loclzj Tum Plnr Whole Body 2+ Days Imaging (78804) | $1,881 | $3,135 | 3.3× |
| Rp Loclzj Tum Plnr Whole Body Single Day Imaging (78802) | $1,446 | $2,410 | 2.5× |
| Rp Loclzj Tum Spect 1 Area Single Day Imaging (78803) | $1,703.40 | $2,839 | 3.0× |
| Rp loclzj tum spect 2 area/sep acquisj img (78831) | $1,446 | $2,410 | 1.1× |
| Rp Therapy Intravenous Administration (79101) | $579 | $965 | 2.3× |
| Scapula (73010) | $271.20 | $452 | 2.5× |
| Screening Digital Breast Tomosynthesis Bi (77063) | $45 | $75 | 1.9× |
| Sella turcica (70240) | $159.60 | $266 | 1.7× |
| Shoulder 1 view (73020) | $187.20 | $312 | 2.0× |
| Shoulder Arthrography (73040) | $385.20 | $642 | 1.0× |
| Sialogram (70390) | $246 | $410 | 1.0× |
| Skull less than 4 views (70250) | $213 | $355 | 1.9× |
| Special dosimetry (77331) | $395.40 | $659 | 2.8× |
| Special Physics Consult (77370) | $395.40 | $659 | 2.8× |
| Special teletherapy port plan (77321) | $867 | $1,445 | 2.2× |
| Special treatment procedure (77470) | $1,467.60 | $2,446 | 2.5× |
| Stereotactic Body Radiation Delivery (77373) | $6,201 | $10,335 | 3.3× |
| Sternoclavicular joints (71130) | $236.70 | $394.50 | 2.6× |
| Surface Applic Low Dose Rate Radionuclide Source (77789) | $352.80 | $588 | 3.3× |
| Tbs technical calculation only (77091) | $158.40 | $264 | 1.7× |
| Telethx isodose pln cplx w/basic dosimetry (77307) | $1,389 | $2,315 | 3.5× |
| Telethx isodose pln smpl w/dosimetry calculation (77306) | $924 | $1,540 | 2.3× |
| Temporomandble Jt Arthrography Rs&I (70332) | $282.60 | $471 | 1.1× |
| Testicular Imaging W/Flow (78761) | $985.20 | $1,642 | 2.3× |
| Ther Rad Simulaj-Aided Field Setting Complex (77290) | $1,480.80 | $2,468 | 3.7× |
| Ther Rad Simulaj-Aided Field Setting Intermed (77285) | $994.80 | $1,658 | 2.5× |
| Ther rad simulaj-aided field setting simple (77280) | $536.40 | $894 | 3.8× |
| Thoracic spine 2 views (72070) | $270 | $450 | 2.4× |
| Thoracic spine 3 views (72072) | $273.60 | $456 | 2.5× |
| Thoracolumbar 2 views (72080) | $298.20 | $497 | 3.2× |
| Thyroid Imaging With Vascular Flow (78013) | $946.20 | $1,577 | 2.2× |
| Thyroid Met Imaging Body (78018) | $1,346.40 | $2,244 | 2.3× |
| Thyroid Uptake Measurement (78012) | $946.20 | $1,577 | 2.2× |
| Thyroid Uptake W/Blood Flow Sngle/Mult Quan Meas (78014) | $1,137 | $1,895 | 2.7× |
| Tx Devices Design & Construction Complex (77334) | $730.80 | $1,218 | 1.8× |
| Tx devices design & construction intermediate (77333) | $730.80 | $1,218 | 5.1× |
| Tx devices design & construction simple (77332) | $730.80 | $1,218 | 5.1× |
| Ultrasound Breast Limited (76642) range across 3 matching MRF lines |
$326.40–$552 | $544–$920 | varies |
| Ultrasound elastography first target lesion (76982) | $192.60 | $321 | 1.7× |
| Ultrasound Elastography Parenchyma (76981) | $226.80 | $378 | 2.1× |
| Ultrasound Exam Aaa Screen (76706) | $562.20 | $937 | 5.1× |
| Ultrasound, abdomen limited (76705) | $684 | $1,140 | 6.2× |
| Unlisted magnetic resonance procedure (76498) | $182.40 | $304 | 2.0× |
| Unlisted us procedure (76999) | $480.60 | $801 | 5.2× |
| Upper gi w/o kub (74240) | $469.20 | $782 | 2.5× |
| Urea Breath Test C-14 Isotopic Acquisj Analysis (78267) | $258.60 | $431 | 23.4× |
| Urea breath test c-14 isotopic analysis (78268) | $1,022.40 | $1,704 | 10.8× |
| Ureteral Reflux Study (78740) | $462.60 | $771 | 1.1× |
| Urethrocystogram voiding (74455) | $359.40 | $599 | 1.4× |
| Urethrocystography retrograde (74450) | $372.60 | $621 | 1.5× |
| Us breast unilateral complete (76641) range across 2 matching MRF lines |
$312.60–$468 | $521–$780 | varies |
| Us chest (76604) | $293.40 | $489 | 2.7× |
| Us complete joint (76881) | $630 | $1,050 | 5.7× |
| Us exam, pelvic, limited (76857) | $363.60 | $606 | 3.3× |
| Us head (76506) | $405.60 | $676 | 3.7× |
| Us kidney transplant (76776) | $183.60 | $306 | 1.7× |
| Us lmtd joint/oth nonvasc xtr strux r-t w/img (76882) | $468 | $780 | 4.2× |
| Us ob detailed single fetus (76811) | $684.60 | $1,141 | 2.7× |
| Us ob limited 1 or more fetuses (76815) | $338.40 | $564 | 3.1× |
| Us ob transvaginal (76817) | $315 | $525 | 2.8× |
| Us pelvic non ob complete (76856) | $496.80 | $828 | 4.5× |
| Us pg uter img f&mat 14 wk tabdl 1/1st gestation (76801) | $415.20 | $692 | 3.8× |
| Us preg uterus real time f/u trnsabdl per fetus (76816) | $369 | $615 | 3.3× |
| Us retroperitoneal complete (76770) | $655.20 | $1,092 | 5.9× |
| Us retroperitoneal limited (76775) | $516 | $860 | 4.7× |
| Us scrotum and contents (76870) | $480.60 | $801 | 4.3× |
| Us spinal canal and contents (76800) | $183.60 | $306 | 1.7× |
| Us thyroid (76536) | $632.40 | $1,054 | 5.7× |
| Us transrectal (76872) | $518.40 | $864 | 4.7× |
| Vascular Flow Imaging (78445) | $599.40 | $999 | 1.4× |
| Vein X-Ray Chest (75827) | $1,383.60 | $2,306 | 0.8× |
| Vein X-Ray Liver W/O Hemodyn (75887) | $3,170.40 | $5,284 | 0.9× |
| Vein X-Ray Spleen/Liver (75810) | $2,286.60 | $3,811 | 0.7× |
| Venogram Sinus/Jugular (75860) | $4,039.20 | $6,732 | 1.2× |
| Venography caval inferior serialography rs&i (75825) | $1,989 | $3,315 | 0.6× |
| Venography extremity bilateral rs&i (75822) range across 2 matching MRF lines |
$1,034.40–$1,559.40 | $1,724–$2,599 | varies |
| Venography extremity unilateral rs&i (75820) range across 2 matching MRF lines |
$1,220.40–$1,559.40 | $2,034–$2,599 | varies |
| Venography Renal Bilateral (75833) | $1,989 | $3,315 | 0.6× |
| Venous sampling by catheter (75893) | $6,726 | $11,210 | 1.1× |
| Venous Thrombosis Imaging Venogram Bilateral (78458) | $664.80 | $1,108 | 1.6× |
| Wrist 2 views (73100) range across 2 matching MRF lines |
$255–$424.20 | $425–$707 | varies |
| X-Ray Ac Jts - Xr Acromioclavicular Joints Bilateral (73050) | $213.60 | $356 | 2.3× |
| X-ray antegrade pyelogram tube (74425) range across 2 matching MRF lines |
$523.20–$784.80 | $872–$1,308 | varies |
| X-Ray Aorta Leg Arteries (75630) | $4,039.20 | $6,732 | 1.2× |
| X-Ray Bend Only L-S Spine (72120) | $175.80 | $293 | 1.6× |
| X-Ray Elbow 2 Vw - Xr Elbow 1-2 Views Right (73070) range across 2 matching MRF lines |
$213.60–$424.20 | $356–$707 | varies |
| X-Ray Exam Breast Specimen (76098) | $418.80 | $698 | 0.7× |
| X-Ray Exam Entire Spi 1 Vw (72081) | $257.40 | $429 | 2.8× |
| X-Ray Exam Entire Spi 2/3 Vw (72082) | $320.40 | $534 | 2.9× |
| X-Ray Exam Entire Spi 4/5 Vw (72083) | $417 | $695 | 3.8× |
| X-Ray Exam Hip Uni 1 View (73501) | $322.20 | $537 | 3.5× |
| X-Ray Exam Hip Uni 2-3 Views (73502) | $343.20 | $572 | 3.7× |
| X-Ray Exam Hip Uni 4/> Views (73503) | $422.40 | $704 | 3.8× |
| X-Ray Exam Hips Bi 2 Views (73521) | $489.60 | $816 | 4.4× |
| X-Ray Exam Hips Bi 3-4 Views (73522) | $523.20 | $872 | 4.7× |
| X-Ray Exam Hips Bi 5/> Views (73523) | $556.20 | $927 | 5.0× |
| X-Ray Exam L-S Spine Bending (72114) | $490.20 | $817 | 4.4× |
| X-Ray Exam Neck Spine 2-3 Vw (72040) | $273.60 | $456 | 3.0× |
| X-Ray Exam Neck Spine 6/>Vws (72052) | $430.80 | $718 | 3.9× |
| X-Ray Exam Unilat Ribs/Chest (71101) | $352.80 | $588 | 3.2× |
| X-ray eye for foreign body (70030) | $162.60 | $271 | 1.8× |
| X-ray humerus (73060) | $213.60 | $356 | 2.3× |
| X-ray IV pyelogram (ivp) (74400) | $661.20 | $1,102 | 3.6× |
| X-ray IV pyelogram+tomography (74415) | $761.40 | $1,269 | 4.1× |
| X-Ray Jaw <4 Vw - Xr Mandible < 4 Views (70100) | $178.20 | $297 | 1.9× |
| X-Ray Knee Bilat Standing - Xr Knees Anteroposterior Standing Bilat (73565) | $424.20 | $707 | 4.6× |
| X-Ray Lumbar Spine 2/3 Vw - Xr Lumbar Spine 2-3 Views (72100) | $267.60 | $446 | 2.4× |
| X-ray nose-rectum child f.b. (76010) | $102.60 | $171 | 1.1× |
| X-Ray Ribs, Chest 4+ Vw - Xr Ribs 3 Vws Bil W/ Chest Posteroanterior (71111) | $434.40 | $724 | 3.9× |
| X-Ray Sacroiliac Jts 3+ Vw - Xr Sacroiliac Joints 3+ Views (72202) | $267.60 | $446 | 2.4× |
| X-Ray Sacroiliac Jts <3 Vw - Xr Sacroiliac Joints 1-2 Views (72200) | $232.80 | $388 | 2.1× |
| X-Ray Sacrum/Coccyx 2+ Vw - Xr Sacrum Coccyx 2+ Views (72220) | $235.20 | $392 | 2.6× |
| X-Ray Sinuses 3+ Vw - Xr Paranasal Sinuses 3+ Views (70220) | $292.20 | $487 | 3.2× |
| X-Ray Skull 4+ Vw - Xr Skull Complete 4+ Views (70260) | $328.80 | $548 | 3.0× |
| X-Ray Stress View (77071) | $210 | $350 | 2.3× |
| X-ray thoracic spine 4 vw (72074) | $380.40 | $634 | 3.4× |
| X-Ray Tmj Unilat (70328) | $154.80 | $258 | 1.7× |
| X-Ray Urinary Tract Exam With Contrast Material (74420) | $993.60 | $1,656 | 2.7× |
| X-Rays Bone Length Studies (77073) | $298.20 | $497 | 2.7× |
| X-Rays Bone Survey Complete (77075) | $427.80 | $713 | 3.9× |
| Xr c-spine 4 or 5 views (72050) | $330 | $550 | 3.0× |
| Xr orbits complete 4 views (70200) | $330 | $550 | 3.0× |
| Xr Tomogram Single Plane (76100) | $459 | $765 | 4.1× |
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.