Imaging prices at Goshen Hospital
Goshen, IN · every code in this section with a posted price and a Medicare benchmark.
293 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) | $5,471.20 | $7,816 | 3.7× |
| Abdomen 1 View (74018) | $203 | $290 | 2.2× |
| Abdomen 2 views (74019) | $326.20 | $466 | 2.9× |
| Acute Gastrointestinal Blood Loss Imaging (78278) | $1,552.60 | $2,218 | 3.7× |
| Angio internal mammary (75756) | $3,197.60 | $4,568 | 1.0× |
| Angio pulmonary bilat (75743) | $6,605.20 | $9,436 | 2.0× |
| Angiography extremity bilateral rs&i (75716) | $6,605.20 | $9,436 | 2.0× |
| Angiography extremity unilateral rs&i (75710) | $6,605.20 | $9,436 | 2.0× |
| Angiography pulmonary unilateral slctv rs&i (75741) | $6,605.20 | $9,436 | 2.0× |
| Ankle 2 views (73600) range across 4 matching MRF lines |
$193.20–$290.50 | $276–$415 | varies |
| Aortography thoracic serialography rs&i (75605) | $11,100.60 | $15,858 | 1.9× |
| Aortography thoracic w/o serialography rs&i (75600) | $5,793.90 | $8,277 | 1.7× |
| Artery X-Rays Abdomen (75726) | $11,396 | $16,280 | 1.9× |
| Artery X-Rays Pelvis (75736) | $11,396 | $16,280 | 1.9× |
| Arthrogram hip (73525) | $816.90 | $1,167 | 2.2× |
| Arthrogram Wrist (73115) | $816.90 | $1,167 | 2.2× |
| Basic radiation dosimetry calculation (77300) | $547.40 | $782 | 3.8× |
| Bone age studies (77072) | $419.30 | $599 | 3.8× |
| Bone Imaging 3 Phase (78315) | $1,676.50 | $2,395 | 4.0× |
| Bone Imaging Limited Area (78300) | $1,157.10 | $1,653 | 2.7× |
| Bone Imaging Multiple Areas (78305) | $1,319.50 | $1,885 | 3.1× |
| Bone Imaging Whole Body (78306) | $1,653.40 | $2,362 | 3.9× |
| Bone survey infant (77076) | $264.60 | $378 | 2.4× |
| Cat Scan Follow-Up Study (76380) | $954.10 | $1,363 | 10.4× |
| Chest 1 view (71045) | $214.20 | $306 | 2.3× |
| Chest 2 views (71046) | $256.20 | $366 | 2.8× |
| Chest 3 views (71047) | $298.90 | $427 | 3.2× |
| Chest 4 or more views (71048) | $320.60 | $458 | 2.9× |
| Clavicle complete (73000) range across 4 matching MRF lines |
$194.60–$291.90 | $278–$417 | varies |
| Computed Tomography Thorax Lw Dose Lng Ca Scr C- (71271) | $140 | $200 | 1.3× |
| Continuing medical physics consltj pr wk (77336) | $686.70 | $981 | 4.8× |
| Contrast Exam Abdominl Aorta (75625) | $6,605.20 | $9,436 | 2.0× |
| Contrast X-Ray Bladder (74430) | $816.90 | $1,167 | 2.2× |
| Contrast X-Ray Of Elbow (73085) | $320.60 | $458 | 0.9× |
| Contrast X-Ray Of Knee Joint (73580) | $816.90 | $1,167 | 2.2× |
| CT abdomen and pelvis without and with contrast (74178) | $3,290 | $4,700 | 8.9× |
| CT abdomen and pelvis without contrast (74176) | $2,303 | $3,290 | 9.1× |
| CT abdomen w contrast (74160) | $1,565.90 | $2,237 | 8.4× |
| CT abdomen w wo contrast (74170) | $1,892.80 | $2,704 | 10.2× |
| CT abdomen w/o contrast (74150) | $1,238.30 | $1,769 | 11.2× |
| CT Angio Abdomen and Pelvis (74174) | $1,892.80 | $2,704 | 5.1× |
| CT Angio Chest (71275) | $1,892.80 | $2,704 | 10.2× |
| CT Angio Head (70496) | $1,892.80 | $2,704 | 10.2× |
| CT angio hrt w/3d image (75574) | $1,892.80 | $2,704 | 5.1× |
| Ct Angio Lwr Extr W/O&W/Dye (73706) | $1,892.80 | $2,704 | 10.2× |
| CT Angio Neck (70498) | $1,892.80 | $2,704 | 10.2× |
| Ct Angio Upr Extrm W/O&W/Dye (73206) | $1,892.80 | $2,704 | 10.2× |
| CT cervical spine w/ contrast (72126) | $1,565.90 | $2,237 | 4.2× |
| CT cervical spine w/o contrast (72125) | $1,238.30 | $1,769 | 11.2× |
| CT cervical spine w/wo cont (72127) | $1,892.80 | $2,704 | 10.2× |
| CT chest w contrast (71260) | $1,565.90 | $2,237 | 8.4× |
| CT chest w/wo contrast (71270) | $1,892.80 | $2,704 | 10.2× |
| CT colonogrphy dx image postprocess w/o contrast (74261) | $256.90 | $367 | 2.3× |
| CT head/brain with contrast (70460) | $1,565.90 | $2,237 | 8.4× |
| CT head/brain without and with contrast (70470) | $1,892.80 | $2,704 | 10.2× |
| CT heart no contrast quant eval coronry calcium (75571) | $93.75 | $133.93 | 1.0× |
| CT iac w contrast (70481) | $1,565.90 | $2,237 | 8.4× |
| CT l-spine w&w/o contrast (72133) | $1,892.80 | $2,704 | 10.2× |
| CT lower ext w/o (73700) | $1,238.30 | $1,769 | 11.2× |
| CT lower extremity w/contrast material (73701) | $1,565.90 | $2,237 | 8.4× |
| CT lumbar spine w contrast (72132) | $1,565.90 | $2,237 | 4.2× |
| CT lumbar spine w/o contrast (72131) | $1,238.30 | $1,769 | 11.2× |
| CT maxillofacial w contrast (70487) | $1,565.90 | $2,237 | 8.4× |
| CT maxillofacial wo contrast (70486) | $1,238.30 | $1,769 | 11.2× |
| CT neck tissue combo (70492) | $1,892.80 | $2,704 | 10.2× |
| Ct Orbit/Ear/Fossa W/O&W/Dye (70482) | $1,891.40 | $2,702 | 10.2× |
| CT orbits w/o contrast (70480) | $1,238.30 | $1,769 | 11.2× |
| CT pelvis w&w/o contrast (72194) | $1,892.80 | $2,704 | 10.2× |
| CT pelvis w/o contrast (72192) | $1,238.30 | $1,769 | 11.2× |
| CT scan of leg combo (73702) | $1,892.80 | $2,704 | 10.2× |
| CT scans face/jaw combo (70488) | $1,892.80 | $2,704 | 10.2× |
| CT soft tissue neck w contrast (70491) | $1,565.90 | $2,237 | 8.4× |
| CT soft tissue neck w/o contrast (70490) | $1,238.30 | $1,769 | 11.2× |
| CT thoracic spine w contrast (72129) | $1,565.90 | $2,237 | 8.4× |
| CT thoracic spine w/o contrast (72128) | $1,238.30 | $1,769 | 11.2× |
| CT thoracic spine w/wo cont (72130) | $1,891.40 | $2,702 | 10.2× |
| CT thorax w/o contrast (71250) | $1,238.30 | $1,769 | 11.2× |
| CT upper ext wo (73200) | $1,238.30 | $1,769 | 11.2× |
| CT upper extremity w/o & w/contrast material (73202) | $1,892.80 | $2,704 | 10.2× |
| CT upper extremity with contrast (73201) | $1,565.90 | $2,237 | 4.2× |
| Cta Abdl Aorta&Bi Iliofem W/Contrast&Postp (75635) | $1,892.80 | $2,704 | 10.2× |
| Cta Abdomen (74175) | $1,892.80 | $2,704 | 10.2× |
| CTA pelvis (72191) | $1,892.80 | $2,704 | 10.2× |
| Dxa Bone Density Axial (77080) | $338.10 | $483 | 3.1× |
| Echo exam uterus (76831) | $1,063.30 | $1,519 | 4.2× |
| Echo Guide For Artery Repair (76936) | $567.70 | $811 | 2.5× |
| Echograp Trans R Pros Study (76873) | $784.70 | $1,121 | 7.1× |
| Esophagram (74220) | $399.70 | $571 | 2.2× |
| Fetal Biophysical Profile W/O Non-Stress Testing (76819) | $443.80 | $634 | 4.0× |
| Fluoroscopy up to 1 hr (76000) | $764.40 | $1,092 | 3.0× |
| Foot 2 views (73620) range across 4 matching MRF lines |
$193.20–$290.50 | $276–$415 | varies |
| Forearm 2 views (73090) range across 4 matching MRF lines |
$228.90–$343.70 | $327–$491 | varies |
| Gastric emptying imaging study (78264) | $1,474.90 | $2,107 | 3.5× |
| Gated Heart Planar Single (78472) | $1,498.70 | $2,141 | 3.5× |
| Hand 2 views (73120) range across 4 matching MRF lines |
$238–$357 | $340–$510 | varies |
| Hdr Rdncl Ntrstl/Icav Brchtx (77772) | $5,316.50 | $7,595 | 7.2× |
| Hdr Rdncl Ntrstl/Icav Brchtx (77771) | $3,577.70 | $5,111 | 4.9× |
| Hdr Rdncl Ntrstl/Icav Brchtx 1 Channel (77770) | $1,955.80 | $2,794 | 2.7× |
| Hepatc Vngrph Wdg/Fr W/O Hemodyn Eval Rs&I (75891) | $2,849.70 | $4,071 | 0.9× |
| Hepatobil Syst Image W/Drug (78227) | $1,978.90 | $2,827 | 3.4× |
| Hepatobiliary System Imaging (78226) | $1,691.90 | $2,417 | 4.0× |
| Ht Muscle Image Spect Sing (78451) | $2,942.80 | $4,204 | 2.1× |
| Infant hip ultrasound, limited static exam (76886) | $216.30 | $309 | 2.3× |
| Intraop radiaj tx deliver xray single tx session (77424) | $17,051.30 | $24,359 | 2.2× |
| K Flow/Funct Image W/Drug (78708) | $1,700.30 | $2,429 | 3.0× |
| K Flow/Funct Image W/O Drug (78707) | $1,645.70 | $2,351 | 2.9× |
| Knee 3 Views (73562) range across 4 matching MRF lines |
$338.10–$507.50 | $483–$725 | varies |
| Lung perfusion differential (78597) | $1,861.30 | $2,659 | 4.4× |
| Lymph System Imaging (78195) | $1,218.70 | $1,741 | 2.1× |
| Meckels Divert Exam (78290) | $1,684.20 | $2,406 | 4.0× |
| Mlc imrt design & construction per imrt plan (77338) | $1,451.80 | $2,074 | 3.7× |
| Mr safety implant&/fb assmt clin staf 1st 15 min (76014) | $64.40 | $92 | 2.1× |
| Mr safety implt electronics prepj supvj phys/qhp (76018) | $211.40 | $302 | 2.1× |
| Mr safety implt pos&/immoblj (76019) | $130.20 | $186 | 2.1× |
| Mra Head W/O & W/Contrast Material (70546) | $816.90 | $1,167 | 2.2× |
| MRA head w/o contrast (70544) | $518.70 | $741 | 2.1× |
| Mra Neck W/O &W/Contrast Material (70549) | $697.20 | $996 | 1.9× |
| MRA neck w/o contrast (70547) | $518.70 | $741 | 2.1× |
| MRI abdomen w/o contrast (74181) | $961.10 | $1,373 | 3.8× |
| MRI any jt lower extrem w/contrast material (73722) | $1,741.60 | $2,488 | 2.1× |
| MRI any jt lower extrem w/o & w/contrast matrl (73723) range across 4 matching MRF lines |
$961.10–$1,442 | $1,373–$2,060 | varies |
| MRI any jt upper extremity w/contrast matrl (73222) | $1,642.90 | $2,347 | 2.0× |
| MRI Breast W/O Contrast Bilateral (77047) | $961.10 | $1,373 | 3.8× |
| MRI cervical spine w contrast (72142) | $697.20 | $996 | 1.9× |
| MRI cervical spine w/o cont (72141) | $961.10 | $1,373 | 3.8× |
| MRI chest w/o contrast (71550) | $961.10 | $1,373 | 3.8× |
| MRI chest wo w contrast (71552) | $961.10 | $1,373 | 2.6× |
| MRI lower extrem oth/thn jt w/o & w/contr matr (73720) range across 4 matching MRF lines |
$961.10–$1,442 | $1,373–$2,060 | varies |
| MRI lower extrem oth/thn jt w/o contr matrl (73718) range across 4 matching MRF lines |
$961.10–$1,442 | $1,373–$2,060 | varies |
| MRI lumbar spine w contrast (72149) | $697.20 | $996 | 1.9× |
| Mri Neck Spine W/O & W/Dye (72156) | $961.10 | $1,373 | 2.6× |
| MRI orbit face &/neck w/o contrast (70540) | $961.10 | $1,373 | 3.8× |
| Mri Orbt/Fac/Nck W/O &W/Dye (70543) | $961.10 | $1,373 | 2.6× |
| MRI pelvis w/o & w contrast (72197) | $961.10 | $1,373 | 2.6× |
| MRI pelvis w/o contrast (72195) | $961.10 | $1,373 | 3.8× |
| MRI thoracic spine w/o contrast (72146) | $961.10 | $1,373 | 3.8× |
| MRI upper extremity oth than jt w/contr matrl (73219) | $697.20 | $996 | 1.9× |
| MRI upper extremity oth than jt w/o contr matrl (73218) | $961.10 | $1,373 | 3.8× |
| Mri Uppr Extremity W/O&W/Dye (73220) | $961.10 | $1,373 | 2.6× |
| MRI, abdomen, combo (74183) | $961.10 | $1,373 | 2.6× |
| MRI, dorsal spine combo (72157) | $961.10 | $1,373 | 2.6× |
| MRI, joint upper extrem (73221) range across 4 matching MRF lines |
$961.10–$1,442 | $1,373–$2,060 | varies |
| MRI, joint upper extrem combo (73223) | $961.10 | $1,373 | 2.6× |
| MRI, lumbar spine combo (72158) | $961.10 | $1,373 | 2.6× |
| Myocardial Imaging Pet Metabolic Evaluation (78459) | $5,103 | $7,290 | 3.7× |
| Myocardial Spect Multiple Studies (78452) | $4,244.80 | $6,064 | 3.1× |
| Neck soft tissue (70360) | $202.30 | $289 | 2.2× |
| Njx Rp Loclzj Non-Img Probe Study Intravenous (78808) | $833.70 | $1,191 | 2.0× |
| Ntsty modul radthx pln dose-vol histos (77301) | $5,199.60 | $7,428 | 3.6× |
| Nuclear Rx Intra-Arterial (79445) | $1,072.40 | $1,532 | 4.3× |
| Nuclear Rx Oral Admin (79005) | $1,645.70 | $2,351 | 6.7× |
| Parathyroid imaging w/tomographic spect & CT (78072) | $1,552.60 | $2,218 | 2.7× |
| Pelvis 1 or 2 views (72170) | $245 | $350 | 2.2× |
| Peritoneogram Rs&I (74190) | $1,148 | $1,640 | 2.0× |
| Pet Image W/Ct Lmtd (78814) | $5,287.10 | $7,553 | 3.5× |
| PET image w/CT, full body (78816) | $5,086.90 | $7,267 | 3.4× |
| PET imaging CT attenuation skull base mid-thigh (78815) | $5,086.90 | $7,267 | 3.4× |
| Pulmonary Perfusion Imaging Particulate (78580) | $1,319.50 | $1,885 | 3.1× |
| Radex Abd Compl Aqt Abd W/S/E/D Views 1 View Ch (74022) | $593.60 | $848 | 5.4× |
| Radex abscess/fistula/sinus tract rs&i (76080) | $1,115.10 | $1,593 | 1.9× |
| Radex Ankle Complete Minimum 3 Views (73610) range across 4 matching MRF lines |
$221.20–$331.80 | $316–$474 | varies |
| Radex Calcaneus Minimum 2 Views (73650) range across 4 matching MRF lines |
$193.20–$290.50 | $276–$415 | varies |
| Radex elbow complete minimum 3 views (73080) range across 4 matching MRF lines |
$256.20–$385 | $366–$550 | varies |
| Radex Facial Bones Complete Minimum 3 Views (70150) | $329.70 | $471 | 3.0× |
| Radex fingr minimum 2 views (73140) range across 4 matching MRF lines |
$193.20–$290.50 | $276–$415 | varies |
| Radex foot complete minimum 3 views (73630) range across 4 matching MRF lines |
$228.90–$343.70 | $327–$491 | varies |
| Radex Hand Minimum 3 Views (73130) range across 4 matching MRF lines |
$237.30–$355.60 | $339–$508 | varies |
| Radex lower extremity infant minimum 2 views (73592) range across 4 matching MRF lines |
$194.60–$291.90 | $278–$417 | varies |
| Radex Mastoids Compl Minimum 3 Views PR Side (70130) | $240.10 | $343 | 2.2× |
| Radex Nasal Bones Complete Minimum 3 Views (70160) | $203 | $290 | 2.2× |
| Radex Ribs Unilateral 2 Views (71100) | $237.30 | $339 | 2.6× |
| Radex shoulder complete minimum 2 views (73030) range across 4 matching MRF lines |
$245–$367.50 | $350–$525 | varies |
| Radex Sinuses Paransl < 3 Views (70210) | $194.60 | $278 | 2.1× |
| Radex Spine 1 View Specify Level (72020) | $193.20 | $276 | 2.1× |
| Radex Sternum Minimum 2 Views (71120) | $194.60 | $278 | 2.1× |
| Radex Temporomandble Jt Opn & Clsd Mouth Bilat (70330) | $329.70 | $471 | 3.6× |
| Radex Toe Minimum 2 Views (73660) range across 4 matching MRF lines |
$193.20–$290.50 | $276–$415 | varies |
| Radex upper extremity infant minimum 2 views (73092) | $238 | $340 | 2.2× |
| Radex Wrist Complete Minimum 3 Views (73110) range across 4 matching MRF lines |
$256.20–$385 | $366–$550 | varies |
| Radiation Delivery Stereotactic Cranial Linear (77372) | $17,051.30 | $24,359 | 2.2× |
| Radiation treatment delivery level 1 (77402) | $479.50 | $685 | 4.4× |
| Radiation treatment delivery level 2 (77407) | $827.40 | $1,182 | 2.0× |
| Radiation treatment delivery level 3 (77412) | $869.40 | $1,242 | 1.5× |
| Radiolog exam mandible compl minimum 4 views (70110) | $245 | $350 | 2.2× |
| Radiologic Exam Abdomen 3+ Views - Xr Abdomen 3+ Views (74021) | $326.20 | $466 | 2.9× |
| Radiologic exam colon double contrast study (74280) | $669.90 | $957 | 3.6× |
| Radiologic exam colon single contrast study (74270) | $413 | $590 | 2.2× |
| Radiologic Exam Esophagus Double Contrast Study (74221) | $527.80 | $754 | 2.8× |
| Radiologic exam knee complete 4/more views (73564) range across 4 matching MRF lines |
$388.50–$583.10 | $555–$833 | varies |
| Radiologic exam pelvis compl minimum 3 views (72190) | $245 | $350 | 2.2× |
| Radiologic Exam Small Int Single Contrast Study (74250) | $399.70 | $571 | 2.2× |
| Radiologic exam swallow function contrast study (74230) | $399.70 | $571 | 2.2× |
| Radiologic exam upr gi trc double contrast study (74246) | $822.50 | $1,175 | 4.4× |
| Radiologic examination femur minimum 2 views (73552) range across 4 matching MRF lines |
$228.90–$343.70 | $327–$491 | varies |
| Radiologic examination knee 1/2 views (73560) range across 4 matching MRF lines |
$288.40–$432.60 | $412–$618 | varies |
| Radiologic examination tibia & fibula 2 views (73590) range across 4 matching MRF lines |
$322.70–$483.70 | $461–$691 | varies |
| Ribs bilateral 3 views (71110) | $799.40 | $1,142 | 7.2× |
| Rp loclzj tum plnr 1 area single day imaging (78800) | $2,398.20 | $3,426 | 5.7× |
| Rp Loclzj Tum Plnr Whole Body 2+ Days Imaging (78804) | $3,647.70 | $5,211 | 6.3× |
| Rp Loclzj Tum Plnr Whole Body Single Day Imaging (78802) | $2,942.80 | $4,204 | 5.1× |
| Rp Loclzj Tum Spect 1 Area Single Day Imaging (78803) | $2,942.80 | $4,204 | 5.1× |
| Rp loclzj tum spect w/CT 1 area/acquisj 1day img (78830) | $2,942.80 | $4,204 | 2.1× |
| Rp Therapy Intravenous Administration (79101) | $609.70 | $871 | 2.5× |
| Scapula (73010) range across 4 matching MRF lines |
$238–$357 | $340–$510 | varies |
| Screening Digital Breast Tomosynthesis Bi (77063) | $68.60 | $98 | 2.9× |
| Shoulder 1 view (73020) | $193.20 | $276 | 2.1× |
| Shoulder Arthrography (73040) | $816.90 | $1,167 | 2.2× |
| Skull less than 4 views (70250) | $238 | $340 | 2.2× |
| Special dosimetry (77331) | $446.60 | $638 | 3.1× |
| Special Physics Consult (77370) | $830.90 | $1,187 | 5.8× |
| Special teletherapy port plan (77321) | $822.50 | $1,175 | 2.1× |
| Special treatment procedure (77470) | $2,359.70 | $3,371 | 4.0× |
| Stereotactic Body Radiation Delivery (77373) | $5,199.60 | $7,428 | 2.7× |
| Sternoclavicular joints (71130) | $214.20 | $306 | 2.3× |
| Telethx isodose pln cplx w/basic dosimetry (77307) | $1,723.40 | $2,462 | 4.4× |
| Ther Rad Simulaj-Aided Field Setting Complex (77290) | $1,707.30 | $2,439 | 4.3× |
| Ther Rad Simulaj-Aided Field Setting Intermed (77285) | $946.40 | $1,352 | 2.4× |
| Ther rad simulaj-aided field setting simple (77280) | $791.70 | $1,131 | 5.6× |
| Thoracic spine 2 views (72070) | $238 | $340 | 2.2× |
| Thoracic spine 3 views (72072) | $275.80 | $394 | 2.5× |
| Thoracolumbar 2 views (72080) | $193.20 | $276 | 2.1× |
| Thyroid Met Imaging Body (78018) | $1,925 | $2,750 | 3.4× |
| Thyroid Uptake Measurement (78012) | $862.40 | $1,232 | 2.0× |
| Thyroid Uptake W/Blood Flow Sngle/Mult Quan Meas (78014) | $962.50 | $1,375 | 2.3× |
| Tx Devices Design & Construction Complex (77334) | $993.30 | $1,419 | 2.5× |
| Tx devices design & construction intermediate (77333) | $578.20 | $826 | 4.1× |
| Tx devices design & construction simple (77332) | $527.80 | $754 | 3.7× |
| Ultrasound Breast Limited (76642) range across 4 matching MRF lines |
$312.20–$469 | $446–$670 | varies |
| Ultrasound Exam Aaa Screen (76706) | $367.50 | $525 | 3.3× |
| Ultrasound, abdomen limited (76705) | $766.50 | $1,095 | 6.9× |
| Umbilical-artery Doppler (OB) (76820) | $255.50 | $365 | 2.3× |
| Unlisted fluoroscopic procedure (76496) | $423.50 | $605 | 4.6× |
| Upper gi w/o kub (74240) | $399.70 | $571 | 2.2× |
| Urethrocystogram voiding (74455) | $633.50 | $905 | 2.5× |
| Urethrocystography retrograde (74450) | $469.70 | $671 | 1.9× |
| Us chest (76604) | $427 | $610 | 3.9× |
| Us complete joint (76881) | $255.50 | $365 | 2.3× |
| Us exam, pelvic, limited (76857) | $255.50 | $365 | 2.3× |
| Us kidney transplant (76776) | $559.30 | $799 | 5.1× |
| Us lmtd joint/oth nonvasc xtr strux r-t w/img (76882) | $440.30 | $629 | 4.0× |
| Us ob limited 1 or more fetuses (76815) | $423.50 | $605 | 3.8× |
| Us ob transvaginal (76817) | $423.50 | $605 | 3.8× |
| Us pelvic non ob complete (76856) | $658.70 | $941 | 6.0× |
| Us pg uter img f&mat 14 wk tabdl 1/1st gestation (76801) | $611.10 | $873 | 5.5× |
| Us preg uterus real time f/u trnsabdl per fetus (76816) | $507.50 | $725 | 4.6× |
| Us retroperitoneal complete (76770) | $699.30 | $999 | 6.3× |
| Us retroperitoneal limited (76775) | $663.60 | $948 | 6.0× |
| Us scrotum and contents (76870) | $742.70 | $1,061 | 6.7× |
| Us spinal canal and contents (76800) | $475.30 | $679 | 4.3× |
| Us thyroid (76536) | $658 | $940 | 5.9× |
| Vein X-Ray Chest (75827) | $3,299.10 | $4,713 | 2.0× |
| Vein X-Ray Liver W/O Hemodyn (75887) | $2,552.20 | $3,646 | 0.8× |
| Venography caval inferior serialography rs&i (75825) | $6,605.20 | $9,436 | 2.0× |
| Venography extremity bilateral rs&i (75822) | $3,299.10 | $4,713 | 2.0× |
| Venography extremity unilateral rs&i (75820) | $3,299.10 | $4,713 | 2.0× |
| Venography Renal Bilateral (75833) | $5,435.50 | $7,765 | 1.6× |
| Venography Renal Unilateral (75831) | $5,416.60 | $7,738 | 1.6× |
| Venous sampling by catheter (75893) | $11,396 | $16,280 | 1.9× |
| Wrist 2 views (73100) range across 4 matching MRF lines |
$203–$304.50 | $290–$435 | varies |
| X-Ray Ac Jts - Xr Acromioclavicular Joints Bilateral (73050) | $295.40 | $422 | 3.2× |
| X-ray antegrade pyelogram tube (74425) | $816.90 | $1,167 | 2.2× |
| X-Ray Aorta Leg Arteries (75630) | $6,605.20 | $9,436 | 2.0× |
| X-Ray Bend Only L-S Spine (72120) | $288.40 | $412 | 2.6× |
| X-Ray Elbow 2 Vw - Xr Elbow 1-2 Views Right (73070) range across 4 matching MRF lines |
$193.20–$290.50 | $276–$415 | varies |
| X-Ray Exam Breast Specimen (76098) | $1,115.10 | $1,593 | 1.9× |
| X-Ray Exam Entire Spi 1 Vw (72081) | $319.20 | $456 | 3.5× |
| X-Ray Exam Entire Spi 2/3 Vw (72082) | $392 | $560 | 3.5× |
| X-Ray Exam Hip Uni 1 View (73501) | $193.20 | $276 | 2.1× |
| X-Ray Exam Hip Uni 2-3 Views (73502) range across 4 matching MRF lines |
$385–$807.80 | $550–$1,154 | varies |
| X-Ray Exam Hips Bi 2 Views (73521) | $577.50 | $825 | 5.2× |
| X-Ray Exam L-S Spine Bending (72114) | $520.80 | $744 | 4.7× |
| X-Ray Exam Neck Spine 2-3 Vw (72040) | $288.40 | $412 | 3.1× |
| X-Ray Exam Neck Spine 6/>Vws (72052) | $508.90 | $727 | 4.6× |
| X-Ray Exam Unilat Ribs/Chest (71101) | $399.70 | $571 | 3.6× |
| X-ray eye for foreign body (70030) | $287 | $410 | 3.1× |
| X-ray humerus (73060) range across 4 matching MRF lines |
$221.20–$331.80 | $316–$474 | varies |
| X-Ray Jaw <4 Vw - Xr Mandible < 4 Views (70100) | $194.60 | $278 | 2.1× |
| X-Ray Knee Bilat Standing - Xr Knees Anteroposterior Standing Bilat (73565) | $578.20 | $826 | 6.3× |
| X-Ray Lumbar Spine 2/3 Vw - Xr Lumbar Spine 2-3 Views (72100) | $288.40 | $412 | 2.6× |
| X-ray nose-rectum child f.b. (76010) | $288.40 | $412 | 3.1× |
| X-Ray Ribs, Chest 4+ Vw - Xr Ribs 3 Vws Bil W/ Chest Posteroanterior (71111) | $799.40 | $1,142 | 7.2× |
| X-Ray Sacroiliac Jts 3+ Vw - Xr Sacroiliac Joints 3+ Views (72202) | $365.40 | $522 | 3.3× |
| X-Ray Sacrum/Coccyx 2+ Vw - Xr Sacrum Coccyx 2+ Views (72220) | $306.60 | $438 | 3.3× |
| X-Ray Sinuses 3+ Vw - Xr Paranasal Sinuses 3+ Views (70220) | $256.20 | $366 | 2.8× |
| X-Ray Skull 4+ Vw - Xr Skull Complete 4+ Views (70260) | $272.30 | $389 | 2.5× |
| X-ray thoracic spine 4 vw (72074) | $388.50 | $555 | 3.5× |
| X-Ray Tmj Unilat (70328) | $151.90 | $217 | 1.6× |
| X-Ray Urinary Tract Exam With Contrast Material (74420) range across 3 matching MRF lines |
$816.90–$1,225.70 | $1,167–$1,751 | varies |
| X-Rays Bone Length Studies (77073) | $360.50 | $515 | 3.3× |
| X-Rays Bone Survey Complete (77075) | $946.40 | $1,352 | 8.6× |
| Xr c-spine 4 or 5 views (72050) | $422.80 | $604 | 3.8× |
| Xr facial bones less than 3 views (70140) | $196 | $280 | 2.1× |
| Xr orbits complete 4 views (70200) | $322.70 | $461 | 2.9× |
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.