Imaging prices at Good Samaritan Hospital
San Jose, CA · every code in this section with a posted price and a Medicare benchmark.
371 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) range across 2 matching MRF lines |
$4,532.05–$34,779.68 | $4,532.05–$34,779.68 | varies |
| Abdomen 1 View (74018) | $1,549.38 | $1,549.38 | 12.1× |
| Abdomen 2 views (74019) | $2,206.89 | $2,206.89 | 14.4× |
| Acute Gastrointestinal Blood Loss Imaging (78278) | $3,429.69 | $3,429.69 | 5.8× |
| Angio internal mammary (75756) range across 2 matching MRF lines |
$8,661.56–$12,556.71 | $8,661.56–$12,556.71 | varies |
| Angio pulmonary bilat (75743) range across 2 matching MRF lines |
$12,918.01–$31,687.43 | $12,918.01–$31,687.43 | varies |
| Angiography extremity bilateral rs&i (75716) range across 2 matching MRF lines |
$16,781.70–$22,749.20 | $16,781.70–$22,749.20 | varies |
| Angiography extremity unilateral rs&i (75710) range across 5 matching MRF lines |
$10,945.48–$16,541.91 | $10,945.48–$16,541.91 | varies |
| Angiography pulmonary unilateral slctv rs&i (75741) | $12,556.71 | $12,556.71 | 2.7× |
| Angrph pulmonary nonslctv cath/ven njx rs&i (75746) | $10,015.64 | $10,015.64 | 2.2× |
| Ankle 2 views (73600) range across 3 matching MRF lines |
$1,677.41–$2,512.86 | $1,677.41–$2,512.86 | varies |
| Aortography thoracic serialography rs&i (75605) range across 2 matching MRF lines |
$11,113.66–$12,556.71 | $11,113.66–$12,556.71 | varies |
| Artery X-Rays Abdomen (75726) range across 2 matching MRF lines |
$12,182.38–$17,226.55 | $12,182.38–$17,226.55 | varies |
| Artery X-Rays Adrenal Gland (75731) | $31,687.43 | $31,687.43 | 6.8× |
| Artery X-Rays Pelvis (75736) range across 2 matching MRF lines |
$12,556.71–$16,288.02 | $12,556.71–$16,288.02 | varies |
| Artery X-Rays Spine (75705) range across 2 matching MRF lines |
$17,687.67–$34,639.71 | $17,687.67–$34,639.71 | varies |
| Arthrogram ankle (73615) | $1,741.43 | $1,741.43 | 3.4× |
| Arthrogram hip (73525) range across 5 matching MRF lines |
$1,891.16–$4,423.55 | $1,891.16–$4,423.55 | varies |
| Arthrogram Wrist (73115) | $1,475.60 | $1,475.60 | 2.9× |
| Basic radiation dosimetry calculation (77300) | $3,631.50 | $3,631.50 | 18.4× |
| Bone age studies (77072) | $2,219.91 | $2,219.91 | 14.4× |
| Bone Imaging 3 Phase (78315) | $13,873.90 | $13,873.90 | 23.6× |
| Bone Imaging Limited Area (78300) | $5,765.69 | $5,765.69 | 9.8× |
| Bone Imaging Whole Body (78306) | $15,238.83 | $15,238.83 | 25.9× |
| Bone survey infant (77076) | $4,095.88 | $4,095.88 | 26.6× |
| Brachytx isodose complex (77318) | $12,287.63 | $12,287.63 | 22.3× |
| Brachytx isodose intermed (77317) | $10,958.50 | $10,958.50 | 19.9× |
| Brachytx Isodose Plan Simple (77316) | $9,626.12 | $9,626.12 | 17.5× |
| Brain Imaging Min 4 Static Views W Vascular Flow (78606) | $8,886.15 | $8,886.15 | 11.1× |
| Card Bl Pool Gated Spect Rest Wal Motn Ejct Frct (78494) | $14,550.94 | $14,550.94 | 24.7× |
| Cardiac MRI w/w/o contrast & further seq (75561) | $25,030.95 | $25,030.95 | 48.8× |
| Cat Scan Follow-Up Study (76380) range across 5 matching MRF lines |
$3,447.05–$21,302.89 | $3,447.05–$21,302.89 | varies |
| Cerebrospinal Fluid Flow W/O Matl Shunt Evaltj (78645) | $4,890.10 | $4,890.10 | 6.1× |
| Cerebrospinal Fluid Scan (78630) | $7,461.55 | $7,461.55 | 9.3× |
| Chest 1 view (71045) | $1,964.94 | $1,964.94 | 15.4× |
| Chest 2 views (71046) | $2,704.91 | $2,704.91 | 21.1× |
| Chest 3 views (71047) | $4,408.36 | $4,408.36 | 34.4× |
| Chest 4 or more views (71048) | $5,150.50 | $5,150.50 | 33.5× |
| Chg us nrv&acc strux 1 xtr compre w/img pr extremity (76883) | $4,694.80 | $4,694.80 | 30.5× |
| Cholecystography Oral Contrast (74290) | $3,928.79 | $3,928.79 | 15.2× |
| Cisternography Positive Contrast Rs&I (70015) | $7,972.58 | $7,972.58 | 6.9× |
| Clavicle complete (73000) range across 3 matching MRF lines |
$2,447.76–$3,669.47 | $2,447.76–$3,669.47 | varies |
| Computed Tomography Thorax Lw Dose Lng Ca Scr C- (71271) | $529.48 | $529.48 | 3.4× |
| Continuing medical physics consltj pr wk (77336) | $5,908.91 | $5,908.91 | 29.9× |
| Contrast Exam Abdominl Aorta (75625) range across 2 matching MRF lines |
$11,113.66–$19,304.32 | $11,113.66–$19,304.32 | varies |
| Contrast X-Ray Bladder (74430) | $4,433.31 | $4,433.31 | 8.6× |
| Contrast X-Ray Of Elbow (73085) | $8,351.25 | $8,351.25 | 16.3× |
| Contrast X-Ray Of Knee Joint (73580) | $1,879.22 | $1,879.22 | 3.7× |
| CT abdomen and pelvis without and with contrast (74178) | $40,053.86 | $40,053.86 | 78.1× |
| CT abdomen and pelvis without contrast (74176) | $31,816.54 | $31,816.54 | 90.7× |
| CT abdomen w contrast (74160) | $23,995.86 | $23,995.86 | 93.0× |
| CT abdomen w wo contrast (74170) | $28,397.71 | $28,397.71 | 110.1× |
| CT abdomen w/o contrast (74150) | $22,084.09 | $22,084.09 | 143.6× |
| CT Angio Abdomen and Pelvis (74174) | $33,658.87 | $33,658.87 | 65.6× |
| CT Angio Chest (71275) | $22,436.72 | $22,436.72 | 87.0× |
| CT Angio Head (70496) range across 3 matching MRF lines |
$22,436.72–$25,228.42 | $22,436.72–$25,228.42 | varies |
| CT angio hrt w/3d image (75574) | $1,192.42 | $1,192.42 | 2.3× |
| Ct Angio Lwr Extr W/O&W/Dye (73706) range across 3 matching MRF lines |
$22,436.72–$33,658.87 | $22,436.72–$33,658.87 | varies |
| CT Angio Neck (70498) | $22,436.72 | $22,436.72 | 87.0× |
| Ct Angio Upr Extrm W/O&W/Dye (73206) | $22,436.72 | $22,436.72 | 87.0× |
| CT bone density (77078) | $5,401.13 | $5,401.13 | 42.2× |
| CT cervical spine w/ contrast (72126) | $20,835.26 | $20,835.26 | 40.6× |
| CT cervical spine w/o contrast (72125) | $20,952.44 | $20,952.44 | 136.3× |
| CT cervical spine w/wo cont (72127) | $28,670.04 | $28,670.04 | 111.1× |
| CT chest w contrast (71260) | $24,660.97 | $24,660.97 | 95.6× |
| CT chest w/wo contrast (71270) | $25,540.90 | $25,540.90 | 99.0× |
| CT colonography screening (74263) | $5,632.24 | $5,632.24 | 16.0× |
| CT Colonogrphy Dx Image Postprocess W/Contrast (74262) | $8,696.28 | $8,696.28 | 33.7× |
| CT colonogrphy dx image postprocess w/o contrast (74261) | $6,626.10 | $6,626.10 | 43.1× |
| CT head/brain with contrast (70460) | $23,063.85 | $23,063.85 | 89.4× |
| CT head/brain without and with contrast (70470) | $26,605.29 | $26,605.29 | 103.1× |
| CT heart contrast eval cardiac structure&morph (75572) | $16,919.49 | $16,919.49 | 33.0× |
| CT heart no contrast quant eval coronry calcium (75571) | $300 | $300 | 2.3× |
| CT hrt w/3d image congen (75573) | $21,103.25 | $21,103.25 | 41.1× |
| CT iac w contrast (70481) range across 2 matching MRF lines |
$32,171.34–$36,834.67 | $32,171.34–$36,834.67 | varies |
| CT l-spine w&w/o contrast (72133) | $28,836.05 | $28,836.05 | 111.8× |
| CT lower ext w/o (73700) range across 3 matching MRF lines |
$20,355.69–$33,576.41 | $20,355.69–$33,576.41 | varies |
| CT lower extremity w/contrast material (73701) range across 3 matching MRF lines |
$22,382.47–$33,576.41 | $22,382.47–$33,576.41 | varies |
| CT lumbar spine w contrast (72132) | $22,934.73 | $22,934.73 | 44.7× |
| CT lumbar spine w/o contrast (72131) range across 2 matching MRF lines |
$10,494.12–$21,070.70 | $10,494.12–$21,070.70 | varies |
| CT maxillofacial w contrast (70487) range across 3 matching MRF lines |
$8,765.72–$24,511.24 | $8,765.72–$24,511.24 | varies |
| CT maxillofacial wo contrast (70486) range across 6 matching MRF lines |
$4,701.31–$61,121.31 | $4,701.31–$61,121.31 | varies |
| CT neck tissue combo (70492) | $25,000.57 | $25,000.57 | 96.9× |
| Ct Orbit/Ear/Fossa W/O&W/Dye (70482) range across 2 matching MRF lines |
$34,254.54–$39,254.22 | $34,254.54–$39,254.22 | varies |
| CT orbits w/o contrast (70480) range across 2 matching MRF lines |
$27,334.41–$31,322.87 | $27,334.41–$31,322.87 | varies |
| CT pelvis w&w/o contrast (72194) | $23,318.82 | $23,318.82 | 90.4× |
| CT pelvis w/o contrast (72192) range across 3 matching MRF lines |
$8,347.99–$19,462.73 | $8,347.99–$19,462.73 | varies |
| CT scan of leg combo (73702) range across 3 matching MRF lines |
$24,941.98–$36,239 | $24,941.98–$36,239 | varies |
| CT scans face/jaw combo (70488) range across 2 matching MRF lines |
$10,422.51–$24,142.34 | $10,422.51–$24,142.34 | varies |
| CT soft tissue neck w contrast (70491) | $24,190.08 | $24,190.08 | 93.8× |
| CT soft tissue neck w/o contrast (70490) | $22,124.24 | $22,124.24 | 143.9× |
| CT thoracic spine w contrast (72129) | $28,256.66 | $28,256.66 | 109.5× |
| CT thoracic spine w/o contrast (72128) range across 2 matching MRF lines |
$12,949.48–$25,957.54 | $12,949.48–$25,957.54 | varies |
| CT thoracic spine w/wo cont (72130) | $35,523.99 | $35,523.99 | 137.7× |
| CT thorax w/o contrast (71250) | $22,591.87 | $22,591.87 | 146.9× |
| CT upper ext wo (73200) range across 3 matching MRF lines |
$17,869.95–$26,807.10 | $17,869.95–$26,807.10 | varies |
| CT upper extremity w/o & w/contrast material (73202) range across 3 matching MRF lines |
$20,437.06–$30,653.42 | $20,437.06–$30,653.42 | varies |
| CT upper extremity with contrast (73201) range across 3 matching MRF lines |
$19,526.75–$29,279.81 | $19,526.75–$29,279.81 | varies |
| Cta Abdl Aorta&Bi Iliofem W/Contrast&Postp (75635) | $22,436.72 | $22,436.72 | 87.0× |
| Cta Abdomen (74175) | $22,436.72 | $22,436.72 | 87.0× |
| CTA pelvis (72191) | $22,436.72 | $22,436.72 | 87.0× |
| Dilation ureters/urethra rs&i (74485) | $2,405.45 | $2,405.45 | 0.8× |
| Discography Cerv/Thor Spine (72285) range across 2 matching MRF lines |
$15,693.44–$17,546.62 | $15,693.44–$17,546.62 | varies |
| Diskography lumbar (72295) range across 2 matching MRF lines |
$14,802.66–$17,546.62 | $14,802.66–$17,546.62 | varies |
| Dxa Bone Density Axial (77080) | $991.69 | $991.69 | 6.4× |
| Dxa bone density study (77085) | $1,224.97 | $1,224.97 | 8.0× |
| Dxa bone density study 1/>sites appendiclr skel (77081) | $991.69 | $991.69 | 7.7× |
| Echo exam uterus (76831) | $2,615.94 | $2,615.94 | 7.5× |
| Echograp Trans R Pros Study (76873) | $3,028.24 | $3,028.24 | 19.7× |
| Esophagram (74220) | $3,488.28 | $3,488.28 | 13.5× |
| Fetal Biophys Profile W/Nst (76818) | $922.25 | $922.25 | 6.0× |
| Fetal Biophysical Profile W/O Non-Stress Testing (76819) | $922.25 | $922.25 | 6.0× |
| Fetal MRI w/placntl matrnl plvc img sing/1st ges (74712) | $1,477.77 | $1,477.77 | 4.2× |
| Fluoroscopy up to 1 hr (76000) range across 4 matching MRF lines |
$1,590.61–$10,596.11 | $1,590.61–$10,596.11 | varies |
| Follow-Up Angiography (75898) range across 2 matching MRF lines |
$6,572.93–$12,556.71 | $6,572.93–$12,556.71 | varies |
| Foot 2 views (73620) range across 3 matching MRF lines |
$1,567.83–$2,352.28 | $1,567.83–$2,352.28 | varies |
| Forearm 2 views (73090) range across 3 matching MRF lines |
$3,058.62–$4,587.38 | $3,058.62–$4,587.38 | varies |
| Gastric emptying imaging study (78264) | $13,727.42 | $13,727.42 | 23.3× |
| Gated Heart Planar Single (78472) range across 2 matching MRF lines |
$13,167.56–$14,550.94 | $13,167.56–$14,550.94 | varies |
| Hand 2 views (73120) range across 3 matching MRF lines |
$1,816.29–$3,047.77 | $1,816.29–$3,047.77 | varies |
| Hdr Rdncl Ntrstl/Icav Brchtx (77772) | $27,807.47 | $27,807.47 | 27.1× |
| Hdr Rdncl Ntrstl/Icav Brchtx (77771) | $25,389 | $25,389 | 24.8× |
| Hdr Rdncl Ntrstl/Icav Brchtx 1 Channel (77770) | $21,502.53 | $21,502.53 | 21.0× |
| Hepatc Vngrph Wdg/Fr Hemodyn Eval Rs&I (75889) range across 2 matching MRF lines |
$16,843.54–$34,635.37 | $16,843.54–$34,635.37 | varies |
| Hepatc Vngrph Wdg/Fr W/O Hemodyn Eval Rs&I (75891) | $16,843.54 | $16,843.54 | 3.6× |
| Hepatobil Syst Image W/Drug (78227) | $13,727.42 | $13,727.42 | 17.2× |
| Hepatobiliary System Imaging (78226) | $9,465.54 | $9,465.54 | 16.1× |
| Hysterosalpingogram (74740) | $5,183.05 | $5,183.05 | 14.8× |
| Image fusion (77399) | $11,566.10 | $11,566.10 | 58.5× |
| Infant hip ultrasound with hip movement (dynamic) (76885) | $6,242.01 | $6,242.01 | 48.8× |
| Interstitial radiation source applic complex (77778) | $15,548.05 | $15,548.05 | 15.2× |
| K Flow/Funct Image Multiple (78709) | $17,753.86 | $17,753.86 | 22.2× |
| K Flow/Funct Image W/Drug (78708) | $13,540.80 | $13,540.80 | 17.0× |
| K Flow/Funct Image W/O Drug (78707) | $13,540.80 | $13,540.80 | 17.0× |
| Knee 3 Views (73562) range across 3 matching MRF lines |
$3,183.39–$4,782.68 | $3,183.39–$4,782.68 | varies |
| Leveen/Shunt Patency Exam (78291) | $5,536.76 | $5,536.76 | 9.4× |
| Liver & Spleen Imaging Static Only (78215) | $11,221.07 | $11,221.07 | 19.1× |
| Liver imaging static only (78201) | $18,539.40 | $18,539.40 | 23.2× |
| Liver imaging w/vascular flow (78202) | $20,846.11 | $20,846.11 | 26.1× |
| Lung Perf&Ventilat Diferentl (78598) | $17,306.84 | $17,306.84 | 21.7× |
| Lung Ventilat&Perfus Imaging (78582) | $16,042.81 | $16,042.81 | 20.1× |
| Lung Ventilation Imaging (78579) | $8,549.80 | $8,549.80 | 14.5× |
| Lymph System Imaging (78195) | $12,631.57 | $12,631.57 | 15.8× |
| Lymphangiography Extremity Only Bilateral Rs&I (75803) | $11,643.14 | $11,643.14 | 5.0× |
| Lymphangiography extremity only unilateral rs&i (75801) | $7,761.01 | $7,761.01 | 8.4× |
| Lymphangiography Pelvic/Abdominal Bilateral Rs&I (75807) range across 2 matching MRF lines |
$7,229.36–$11,643.14 | $7,229.36–$11,643.14 | varies |
| Lymphangiography, pelvic/abdominal, unilateral (75805) | $7,761.01 | $7,761.01 | 1.7× |
| Magnetic Image Jaw Joint (70336) range across 2 matching MRF lines |
$21,518.81–$32,280.92 | $21,518.81–$32,280.92 | varies |
| Mammary ductogram or galactogram multiple (77054) | $5,881.79 | $5,881.79 | 16.8× |
| Mammary ductogram or galactogram single (77053) | $4,228.25 | $4,228.25 | 12.0× |
| Meckels Divert Exam (78290) | $10,429.02 | $10,429.02 | 17.7× |
| Mlc imrt design & construction per imrt plan (77338) | $8,421.77 | $8,421.77 | 15.3× |
| Mr safety implant&/fb assmt clin staf 1st 15 min (76014) | $81.38 | $81.38 | 1.9× |
| Mra Head W/O & W/Contrast Material (70546) | $30,837.87 | $30,837.87 | 60.1× |
| MRA head w/o contrast (70544) | $25,339.09 | $25,339.09 | 72.2× |
| MRA head with contrast (70545) | $28,629.90 | $28,629.90 | 55.8× |
| MRA neck w contrast (70548) | $28,629.90 | $28,629.90 | 55.8× |
| Mra Neck W/O &W/Contrast Material (70549) | $30,837.87 | $30,837.87 | 60.1× |
| MRA neck w/o contrast (70547) | $25,339.09 | $25,339.09 | 72.2× |
| MRI abdomen w contrast (74182) | $29,031.35 | $29,031.35 | 56.6× |
| MRI abdomen w/o contrast (74181) | $21,995.12 | $21,995.12 | 62.7× |
| MRI any jt lower extrem w/contrast material (73722) range across 3 matching MRF lines |
$18,703.23–$44,072.70 | $18,703.23–$44,072.70 | varies |
| MRI any jt lower extrem w/o & w/contrast matrl (73723) range across 6 matching MRF lines |
$20,470.70–$46,260.06 | $20,470.70–$46,260.06 | varies |
| MRI any jt upper extremity w/contrast matrl (73222) range across 3 matching MRF lines |
$28,050.51–$42,074.13 | $28,050.51–$42,074.13 | varies |
| MRI Breast W/O Contrast Bilateral (77047) range across 3 matching MRF lines |
$12,839.89–$23,582.48 | $12,839.89–$23,582.48 | varies |
| MRI Breast Without Contrast Material Unilateral (77046) | $20,721.33 | $20,721.33 | 59.0× |
| MRI cardiac w/o contrast (75557) | $20,353.52 | $20,353.52 | 58.0× |
| MRI cervical spine w contrast (72142) | $25,664.59 | $25,664.59 | 50.0× |
| MRI cervical spine w/o cont (72141) | $22,079.75 | $22,079.75 | 62.9× |
| MRI chest w/o contrast (71550) | $20,784.26 | $20,784.26 | 59.2× |
| MRI chest with contrast (71551) | $28,068.95 | $28,068.95 | 24.3× |
| MRI chest wo w contrast (71552) | $28,951.06 | $28,951.06 | 56.4× |
| MRI lower extrem oth/thn jt w/contrast matrl (73719) range across 3 matching MRF lines |
$28,050.51–$42,074.13 | $28,050.51–$42,074.13 | varies |
| MRI lower extrem oth/thn jt w/o & w/contr matr (73720) range across 4 matching MRF lines |
$30,837.87–$46,260.06 | $30,837.87–$46,260.06 | varies |
| MRI lower extrem oth/thn jt w/o contr matrl (73718) range across 3 matching MRF lines |
$25,339.09–$38,002.13 | $25,339.09–$38,002.13 | varies |
| MRI lumbar spine w contrast (72149) | $29,304.77 | $29,304.77 | 57.1× |
| Mri Neck Spine W/O & W/Dye (72156) | $25,664.59 | $25,664.59 | 50.0× |
| MRI orbit face &/neck w/o contrast (70540) range across 2 matching MRF lines |
$19,547.36–$19,893.48 | $19,547.36–$19,893.48 | varies |
| MRI orbit face neck w contrast (70542) range across 2 matching MRF lines |
$20,766.90–$22,456.25 | $20,766.90–$22,456.25 | varies |
| Mri Orbt/Fac/Nck W/O &W/Dye (70543) range across 3 matching MRF lines |
$24,709.79–$27,183.59 | $24,709.79–$27,183.59 | varies |
| MRI pelvis w contrast (72196) | $21,561.12 | $21,561.12 | 42.0× |
| MRI pelvis w/o & w contrast (72197) | $21,561.12 | $21,561.12 | 42.0× |
| MRI pelvis w/o contrast (72195) | $21,033.81 | $21,033.81 | 59.9× |
| MRI spectroscopy (76390) range across 2 matching MRF lines |
$10,549.46–$10,598.28 | $10,549.46–$10,598.28 | varies |
| MRI thoracic spine w/o contrast (72146) | $24,611.06 | $24,611.06 | 70.1× |
| MRI upper extremity oth than jt w/contr matrl (73219) range across 3 matching MRF lines |
$28,050.51–$42,074.13 | $28,050.51–$42,074.13 | varies |
| MRI upper extremity oth than jt w/o contr matrl (73218) range across 3 matching MRF lines |
$25,339.09–$38,002.13 | $25,339.09–$38,002.13 | varies |
| Mri Uppr Extremity W/O&W/Dye (73220) range across 3 matching MRF lines |
$30,837.87–$37,153.66 | $30,837.87–$37,153.66 | varies |
| MRI, abdomen, combo (74183) | $33,436.45 | $33,436.45 | 65.2× |
| MRI, dorsal spine combo (72157) | $28,309.82 | $28,309.82 | 55.2× |
| MRI, dorsal spine contrast (72147) | $28,309.82 | $28,309.82 | 55.2× |
| MRI, joint upper extrem (73221) range across 3 matching MRF lines |
$25,339.09–$37,153.66 | $25,339.09–$37,153.66 | varies |
| MRI, joint upper extrem combo (73223) range across 3 matching MRF lines |
$30,837.87–$44,072.70 | $30,837.87–$44,072.70 | varies |
| MRI, lumbar spine combo (72158) | $29,304.77 | $29,304.77 | 57.1× |
| Myelogram Lumbar (72265) | $6,825.74 | $6,825.74 | 5.9× |
| Myocardial Perfusion Planar 1 Study Rest/Stress (78453) range across 2 matching MRF lines |
$11,619.27–$19,469.24 | $11,619.27–$19,469.24 | varies |
| Myocardial Spect Multiple Studies (78452) | $33,948.57 | $33,948.57 | 17.8× |
| N-invas est c ffr sw aly CTA (75580) | $4,963.88 | $4,963.88 | 3.9× |
| Neck soft tissue (70360) | $2,321.90 | $2,321.90 | 18.1× |
| Njx Rp Loclzj Non-Img Probe Study Intravenous (78808) | $6,843.10 | $6,843.10 | 11.6× |
| Nm csf leak detection (78650) | $4,408.36 | $4,408.36 | 2.3× |
| Nonvascular Shunt X-Ray (75809) | $13,909.70 | $13,909.70 | 90.5× |
| Ntsty modul radthx pln dose-vol histos (77301) | $41,040.13 | $41,040.13 | 20.2× |
| Nuclear Rx Intra-Arterial (79445) | $9,973.32 | $9,973.32 | 29.1× |
| Nuclear Rx Oral Admin (79005) range across 2 matching MRF lines |
$14,242.80–$15,149.86 | $14,242.80–$15,149.86 | varies |
| Optic foramina (70190) range across 3 matching MRF lines |
$2,267.65–$3,398.22 | $2,267.65–$3,398.22 | varies |
| Parathyroid Planar Imaging (78070) | $13,794.69 | $13,794.69 | 23.5× |
| Parathyroid planar imaging w/wo subtraction (78071) | $2,241.61 | $2,241.61 | 3.8× |
| Pelvis 1 or 2 views (72170) range across 2 matching MRF lines |
$2,092.97–$2,227.51 | $2,092.97–$2,227.51 | varies |
| Prq Transhepatc Portograpy Hemodyn Eval Rs&I (75885) | $14,220.01 | $14,220.01 | 3.1× |
| Pulmonary Perfusion Imaging Particulate (78580) | $8,549.80 | $8,549.80 | 14.5× |
| Radex abscess/fistula/sinus tract rs&i (76080) | $2,479.23 | $2,479.23 | 3.1× |
| Radex Ankle Complete Minimum 3 Views (73610) range across 3 matching MRF lines |
$3,000.03–$4,503.84 | $3,000.03–$4,503.84 | varies |
| Radex Calcaneus Minimum 2 Views (73650) range across 3 matching MRF lines |
$1,931.30–$2,899.12 | $1,931.30–$2,899.12 | varies |
| Radex elbow complete minimum 3 views (73080) range across 3 matching MRF lines |
$3,079.23–$4,626.44 | $3,079.23–$4,626.44 | varies |
| Radex fingr minimum 2 views (73140) range across 3 matching MRF lines |
$2,026.78–$3,036.92 | $2,026.78–$3,036.92 | varies |
| Radex foot complete minimum 3 views (73630) range across 3 matching MRF lines |
$3,007.62–$4,513.60 | $3,007.62–$4,513.60 | varies |
| Radex Hand Minimum 3 Views (73130) range across 3 matching MRF lines |
$2,623.53–$3,934.21 | $2,623.53–$3,934.21 | varies |
| Radex lower extremity infant minimum 2 views (73592) range across 3 matching MRF lines |
$2,855.72–$4,281.41 | $2,855.72–$4,281.41 | varies |
| Radex Nasal Bones Complete Minimum 3 Views (70160) | $2,479.23 | $2,479.23 | 19.4× |
| Radex Ribs Unilateral 2 Views (71100) range across 4 matching MRF lines |
$3,100.93–$3,398.22 | $3,100.93–$3,398.22 | varies |
| Radex shoulder complete minimum 2 views (73030) range across 3 matching MRF lines |
$2,648.49–$3,983.04 | $2,648.49–$3,983.04 | varies |
| Radex Sinuses Paransl < 3 Views (70210) | $2,172.17 | $2,172.17 | 17.0× |
| Radex sm int w/mlt srl imges via enteroclss tube (74251) | $5,729.89 | $5,729.89 | 22.2× |
| Radex Spine 1 View Specify Level (72020) range across 3 matching MRF lines |
$2,032.21–$2,191.70 | $2,032.21–$2,191.70 | varies |
| Radex Sternum Minimum 2 Views (71120) | $2,785.20 | $2,785.20 | 21.8× |
| Radex Temporomandble Jt Opn & Clsd Mouth Bilat (70330) | $3,530.59 | $3,530.59 | 27.6× |
| Radex Toe Minimum 2 Views (73660) range across 3 matching MRF lines |
$1,462.58–$2,192.79 | $1,462.58–$2,192.79 | varies |
| Radex upper extremity infant minimum 2 views (73092) range across 3 matching MRF lines |
$2,643.06–$3,951.57 | $2,643.06–$3,951.57 | varies |
| Radex Wrist Complete Minimum 3 Views (73110) range across 3 matching MRF lines |
$2,733.12–$4,111.07 | $2,733.12–$4,111.07 | varies |
| Radex X-Ray Exam Entire Spi 6/> Vw - Xr Entire Spine 6+ Vw (72084) | $2,142.88 | $2,142.88 | 13.9× |
| Radiation Delivery Stereotactic Cranial Linear (77372) | $93,791.74 | $93,791.74 | 8.7× |
| Radiation treatment delivery level 1 (77402) | $4,704.56 | $4,704.56 | 31.3× |
| Radiation treatment delivery level 2 (77407) | $5,522.65 | $5,522.65 | 9.7× |
| Radiation treatment delivery level 3 (77412) | $6,231.16 | $6,231.16 | 7.7× |
| Radiologic Exam Abdomen 3+ Views - Xr Abdomen 3+ Views (74021) | $2,495.50 | $2,495.50 | 16.2× |
| Radiologic exam colon double contrast study (74280) | $7,507.12 | $7,507.12 | 29.1× |
| Radiologic exam colon single contrast study (74270) range across 3 matching MRF lines |
$6,345.08–$9,741.13 | $6,345.08–$9,741.13 | varies |
| Radiologic exam knee complete 4/more views (73564) range across 3 matching MRF lines |
$3,983.04–$5,969.67 | $3,983.04–$5,969.67 | varies |
| Radiologic exam pelvis compl minimum 3 views (72190) | $3,221.37 | $3,221.37 | 20.9× |
| Radiologic Exam Small Int Single Contrast Study (74250) | $5,729.89 | $5,729.89 | 22.2× |
| Radiologic exam swallow function contrast study (74230) range across 2 matching MRF lines |
$4,657.91–$5,332.78 | $4,657.91–$5,332.78 | varies |
| Radiologic exam upr gi trc double contrast study (74246) | $6,428.63 | $6,428.63 | 24.9× |
| Radiologic examination femur 1 view (73551) range across 3 matching MRF lines |
$1,849.93–$2,773.26 | $1,849.93–$2,773.26 | varies |
| Radiologic examination femur minimum 2 views (73552) range across 3 matching MRF lines |
$2,692.97–$4,036.20 | $2,692.97–$4,036.20 | varies |
| Radiologic examination knee 1/2 views (73560) range across 3 matching MRF lines |
$1,589.53–$2,381.58 | $1,589.53–$2,381.58 | varies |
| Radiologic Examination Osseous Survey Limited (77074) | $1,683.92 | $1,683.92 | 11.0× |
| Radiologic examination tibia & fibula 2 views (73590) range across 3 matching MRF lines |
$3,270.19–$4,906.37 | $3,270.19–$4,906.37 | varies |
| Renal Cyst Study (74470) | $1,219.54 | $1,219.54 | 1.5× |
| Ribs bilateral 3 views (71110) | $3,802.93 | $3,802.93 | 24.7× |
| Rp loclzj tum plnr 1 area single day imaging (78800) | $5,341.46 | $5,341.46 | 9.1× |
| Rp loclzj tum plnr 2+area 1+d img/1 area img>2+d (78801) | $6,967.87 | $6,967.87 | 11.8× |
| Rp Loclzj Tum Plnr Whole Body 2+ Days Imaging (78804) | $11,549.83 | $11,549.83 | 14.5× |
| Rp Loclzj Tum Plnr Whole Body Single Day Imaging (78802) range across 6 matching MRF lines |
$6,704.22–$17,672.48 | $6,704.22–$17,672.48 | varies |
| Rp Loclzj Tum Spect 1 Area Single Day Imaging (78803) range across 5 matching MRF lines |
$5,402.22–$13,241.34 | $5,402.22–$13,241.34 | varies |
| Rp loclzj tum spect 2 area/sep acquisj img (78831) | $22,652.63 | $22,652.63 | 11.9× |
| Scapula (73010) range across 3 matching MRF lines |
$2,595.32–$3,889.73 | $2,595.32–$3,889.73 | varies |
| Screening Digital Breast Tomosynthesis Bi (77063) | $212.66 | $212.66 | 9.1× |
| Sella turcica (70240) | $3,476.34 | $3,476.34 | 27.2× |
| Shoulder 1 view (73020) range across 3 matching MRF lines |
$1,906.35–$2,861.15 | $1,906.35–$2,861.15 | varies |
| Shoulder Arthrography (73040) | $5,573.65 | $5,573.65 | 10.9× |
| Sialogram (70390) | $2,048.48 | $2,048.48 | 5.8× |
| Skull less than 4 views (70250) | $2,183.02 | $2,183.02 | 14.2× |
| Special dosimetry (77331) | $4,175.08 | $4,175.08 | 21.1× |
| Special Physics Consult (77370) range across 2 matching MRF lines |
$439.43–$4,883.59 | $439.43–$4,883.59 | varies |
| Special teletherapy port plan (77321) | $10,497.38 | $10,497.38 | 19.1× |
| Special treatment procedure (77470) | $10,917.27 | $10,917.27 | 13.4× |
| Stereotactic Body Radiation Delivery (77373) | $75,036.43 | $75,036.43 | 28.5× |
| Sternoclavicular joints (71130) | $2,785.20 | $2,785.20 | 21.8× |
| Superior sagittal sinus venogram (75870) | $7,905.31 | $7,905.31 | 1.7× |
| Telethx isodose pln cplx w/basic dosimetry (77307) range across 2 matching MRF lines |
$1,211.95–$12,408.06 | $1,211.95–$12,408.06 | varies |
| Telethx isodose pln smpl w/dosimetry calculation (77306) | $9,626.12 | $9,626.12 | 17.5× |
| Temporomandble Jt Arthrography Rs&I (70332) range across 3 matching MRF lines |
$2,183.02–$3,270.19 | $2,183.02–$3,270.19 | varies |
| Testicular Imaging W/Flow (78761) | $5,180.88 | $5,180.88 | 8.8× |
| Ther Rad Simulaj-Aided Field Setting Complex (77290) | $13,051.47 | $13,051.47 | 23.7× |
| Ther Rad Simulaj-Aided Field Setting Intermed (77285) | $10,082.91 | $10,082.91 | 18.3× |
| Ther rad simulaj-aided field setting simple (77280) | $7,348.71 | $7,348.71 | 37.2× |
| Therapeutic Enema Rdctj Intussusception/Obstrcj (74283) | $8,849.26 | $8,849.26 | 34.3× |
| Thoracic spine 2 views (72070) | $3,543.61 | $3,543.61 | 23.0× |
| Thoracic spine 3 views (72072) | $3,543.61 | $3,543.61 | 23.0× |
| Thoracolumbar 2 views (72080) | $2,664.76 | $2,664.76 | 20.8× |
| Thyroid Imaging With Vascular Flow (78013) | $2,894.78 | $2,894.78 | 4.9× |
| Thyroid Met Imaging Body (78018) | $10,426.85 | $10,426.85 | 13.1× |
| Thyroid Uptake Measurement (78012) | $2,980.50 | $2,980.50 | 5.1× |
| Thyroid Uptake W/Blood Flow Sngle/Mult Quan Meas (78014) | $3,738.91 | $3,738.91 | 6.4× |
| Tx Devices Design & Construction Complex (77334) | $8,421.77 | $8,421.77 | 15.3× |
| Tx devices design & construction intermediate (77333) | $6,131.34 | $6,131.34 | 31.0× |
| Tx devices design & construction simple (77332) | $3,952.66 | $3,952.66 | 20.0× |
| Ultrasound Breast Limited (76642) range across 3 matching MRF lines |
$1,763.13–$2,644.15 | $1,763.13–$2,644.15 | varies |
| Ultrasound elastography first target lesion (76982) | $486.08 | $486.08 | 3.2× |
| Ultrasound Elastography Parenchyma (76981) | $547.93 | $547.93 | 3.6× |
| Ultrasound, abdomen limited (76705) range across 3 matching MRF lines |
$613.03–$7,424.66 | $613.03–$7,424.66 | varies |
| Umbilical-artery Doppler (OB) (76820) | $922.25 | $922.25 | 6.0× |
| Unlisted Dx Radiographic Procedure (76499) | $3,543.61 | $3,543.61 | 27.7× |
| Unlisted Procedure Clinical Brachytherapy (77799) | $871.26 | $871.26 | 5.8× |
| Upper gi w/o kub (74240) | $6,521.94 | $6,521.94 | 25.3× |
| Ureteral Reflux Study (78740) | $7,752.33 | $7,752.33 | 13.2× |
| Urethrocystogram voiding (74455) | $5,612.71 | $5,612.71 | 16.0× |
| Urethrocystography retrograde (74450) range across 2 matching MRF lines |
$1,732.75–$11,880.75 | $1,732.75–$11,880.75 | varies |
| Us breast unilateral complete (76641) range across 3 matching MRF lines |
$3,592.44–$4,655.74 | $3,592.44–$4,655.74 | varies |
| Us chest (76604) range across 2 matching MRF lines |
$4,571.11–$8,333.89 | $4,571.11–$8,333.89 | varies |
| Us complete joint (76881) | $7,040.57 | $7,040.57 | 45.8× |
| Us exam, pelvic, limited (76857) range across 2 matching MRF lines |
$4,665.50–$6,746.53 | $4,665.50–$6,746.53 | varies |
| Us head (76506) | $5,721.21 | $5,721.21 | 37.2× |
| Us lmtd joint/oth nonvasc xtr strux r-t w/img (76882) | $4,694.80 | $4,694.80 | 30.5× |
| Us ob limited 1 or more fetuses (76815) | $6,640.20 | $6,640.20 | 43.2× |
| Us ob transvaginal (76817) | $5,167.86 | $5,167.86 | 33.6× |
| Us pelvic non ob complete (76856) | $6,762.81 | $6,762.81 | 44.0× |
| Us pg uter img f&mat 14 wk tabdl 1/1st gestation (76801) | $2,468.38 | $2,468.38 | 16.1× |
| Us preg uterus real time f/u trnsabdl per fetus (76816) | $922.25 | $922.25 | 6.0× |
| Us retroperitoneal complete (76770) | $7,466.97 | $7,466.97 | 48.6× |
| Us retroperitoneal limited (76775) | $2,733.12 | $2,733.12 | 17.8× |
| Us scrotum and contents (76870) | $5,669.13 | $5,669.13 | 36.9× |
| Us spinal canal and contents (76800) | $3,028.24 | $3,028.24 | 19.7× |
| Us thyroid (76536) range across 2 matching MRF lines |
$3,573.99–$7,141.47 | $3,573.99–$7,141.47 | varies |
| Us transrectal (76872) | $5,635.49 | $5,635.49 | 36.6× |
| Vein X-Ray Chest (75827) | $16,644.99 | $16,644.99 | 7.2× |
| Vein X-Ray Liver W/O Hemodyn (75887) | $11,671.35 | $11,671.35 | 2.5× |
| Vein X-Ray Skull Epidural (75872) range across 2 matching MRF lines |
$7,229.36–$13,655.81 | $7,229.36–$13,655.81 | varies |
| Vein X-Ray Spleen/Liver (75810) | $8,661.56 | $8,661.56 | 1.9× |
| Venogram Sinus/Jugular (75860) | $11,738.62 | $11,738.62 | 2.5× |
| Venography Adrenal Unilateral (75840) | $10,741.50 | $10,741.50 | 2.3× |
| Venography caval inferior serialography rs&i (75825) range across 2 matching MRF lines |
$16,644.99–$19,311.92 | $16,644.99–$19,311.92 | varies |
| Venography extremity bilateral rs&i (75822) range across 2 matching MRF lines |
$12,681.48–$14,426.16 | $12,681.48–$14,426.16 | varies |
| Venography extremity unilateral rs&i (75820) range across 5 matching MRF lines |
$8,222.13–$13,214.22 | $8,222.13–$13,214.22 | varies |
| Venography Renal Bilateral (75833) range across 2 matching MRF lines |
$7,362.81–$8,928.47 | $7,362.81–$8,928.47 | varies |
| Venography Renal Unilateral (75831) range across 5 matching MRF lines |
$7,330.26–$8,661.56 | $7,330.26–$8,661.56 | varies |
| Venous sampling by catheter (75893) | $8,193.92 | $8,193.92 | 1.0× |
| Venous Thrombosis Imaging Venogram Bilateral (78458) | $12,673.89 | $12,673.89 | 21.6× |
| Vertebral fracture assessment via dxa (77086) | $1,166.38 | $1,166.38 | 9.1× |
| Wrist 2 views (73100) range across 6 matching MRF lines |
$518.63–$2,415.21 | $518.63–$2,415.21 | varies |
| X-Ray Ac Jts - Xr Acromioclavicular Joints Bilateral (73050) | $2,837.28 | $2,837.28 | 22.2× |
| X-ray antegrade pyelogram tube (74425) range across 7 matching MRF lines |
$2,111.41–$3,462.24 | $2,111.41–$3,462.24 | varies |
| X-Ray Aorta Leg Arteries (75630) | $15,788.92 | $15,788.92 | 3.4× |
| X-Ray Bend Only L-S Spine (72120) | $3,292.98 | $3,292.98 | 21.4× |
| X-Ray Elbow 2 Vw - Xr Elbow 1-2 Views Right (73070) range across 3 matching MRF lines |
$2,345.77–$3,516.49 | $2,345.77–$3,516.49 | varies |
| X-Ray Exam Breast Specimen (76098) range across 2 matching MRF lines |
$1,741.43–$2,206.89 | $1,741.43–$2,206.89 | varies |
| X-Ray Exam Entire Spi 1 Vw (72081) | $1,175.06 | $1,175.06 | 9.2× |
| X-Ray Exam Entire Spi 2/3 Vw (72082) | $1,541.79 | $1,541.79 | 10.0× |
| X-Ray Exam Entire Spi 4/5 Vw (72083) | $1,819.55 | $1,819.55 | 11.8× |
| X-Ray Exam Hip Uni 1 View (73501) | $1,944.32 | $1,944.32 | 15.2× |
| X-Ray Exam Hip Uni 2-3 Views (73502) | $2,767.84 | $2,767.84 | 21.6× |
| X-Ray Exam Hip Uni 4/> Views (73503) | $2,973.99 | $2,973.99 | 19.3× |
| X-Ray Exam Hips Bi 2 Views (73521) | $4,152.30 | $4,152.30 | 27.0× |
| X-Ray Exam Hips Bi 3-4 Views (73522) | $4,067.67 | $4,067.67 | 26.5× |
| X-Ray Exam Hips Bi 5/> Views (73523) | $4,204.38 | $4,204.38 | 27.3× |
| X-Ray Exam L-S Spine Bending (72114) range across 2 matching MRF lines |
$5,081.06–$6,707.47 | $5,081.06–$6,707.47 | varies |
| X-Ray Exam Neck Spine 2-3 Vw (72040) | $2,899.12 | $2,899.12 | 22.6× |
| X-Ray Exam Neck Spine 6/>Vws (72052) | $5,236.21 | $5,236.21 | 34.1× |
| X-Ray Exam Unilat Ribs/Chest (71101) | $3,802.93 | $3,802.93 | 24.7× |
| X-ray eye for foreign body (70030) range across 3 matching MRF lines |
$3,784.48–$5,670.21 | $3,784.48–$5,670.21 | varies |
| X-ray humerus (73060) | $2,940.35 | $2,940.35 | 23.0× |
| X-ray IV pyelogram (ivp) (74400) range across 2 matching MRF lines |
$5,081.06–$6,996.08 | $5,081.06–$6,996.08 | varies |
| X-ray IV pyelogram+tomography (74415) | $10,960.67 | $10,960.67 | 42.5× |
| X-Ray Jaw <4 Vw - Xr Mandible < 4 Views (70100) | $2,704.91 | $2,704.91 | 21.1× |
| X-Ray Lumbar Spine 2/3 Vw - Xr Lumbar Spine 2-3 Views (72100) | $3,202.92 | $3,202.92 | 20.8× |
| X-ray nose-rectum child f.b. (76010) | $1,677.41 | $1,677.41 | 13.1× |
| X-Ray Ribs, Chest 4+ Vw - Xr Ribs 3 Vws Bil W/ Chest Posteroanterior (71111) | $4,414.87 | $4,414.87 | 28.7× |
| X-Ray Sacroiliac Jts 3+ Vw - Xr Sacroiliac Joints 3+ Views (72202) | $3,613.05 | $3,613.05 | 23.5× |
| X-Ray Sacrum/Coccyx 2+ Vw - Xr Sacrum Coccyx 2+ Views (72220) | $2,623.53 | $2,623.53 | 20.5× |
| X-Ray Sinuses 3+ Vw - Xr Paranasal Sinuses 3+ Views (70220) | $4,341.09 | $4,341.09 | 33.9× |
| X-Ray Skull 4+ Vw - Xr Skull Complete 4+ Views (70260) | $2,979.41 | $2,979.41 | 19.4× |
| X-Ray Urinary Tract Exam With Contrast Material (74420) | $8,246 | $8,246 | 16.1× |
| X-Rays Bone Length Studies (77073) | $3,270.19 | $3,270.19 | 21.3× |
| X-Rays Bone Survey Complete (77075) | $8,293.74 | $8,293.74 | 53.9× |
| Xr c-spine 4 or 5 views (72050) range across 3 matching MRF lines |
$3,154.10–$4,534.22 | $3,154.10–$4,534.22 | varies |
| Xr facial bones less than 3 views (70140) | $2,664.76 | $2,664.76 | 20.8× |
| XR Mastoids < 3 Views Bilateral (70120) range across 3 matching MRF lines |
$2,054.99–$3,078.15 | $2,054.99–$3,078.15 | varies |
| Xr myelogram posterior fossa (70010) | $11,020.35 | $11,020.35 | 21.5× |
| Xr orbits complete 4 views (70200) | $3,495.87 | $3,495.87 | 22.7× |
| Xr Tomogram Single Plane (76100) | $5,835.13 | $5,835.13 | 37.9× |
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.