Imaging prices at Graham Hospital Association
Canton, IL · every code in this section with a posted price and a Medicare benchmark.
463 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) | — | $2,608.75 | — |
| Abdomen 1 View (74018) range across 2 matching MRF lines |
— | $20.26–$415.61 | — |
| Abdomen 2 views (74019) range across 2 matching MRF lines |
— | $25.67–$627 | — |
| Acute Gastrointestinal Blood Loss Imaging (78278) range across 3 matching MRF lines |
— | $106.79–$1,676.22 | — |
| Acute venous thrombosis imaging, peptide Non-Facility (78456) | — | $599.02 | — |
| Adrenal Cortex & Medulla Img (78075) | — | $867.32 | — |
| Angio internal mammary (75756) | — | $1,082.08 | — |
| Angio pulmonary bilat (75743) | — | $1,133.36 | — |
| Angiography Adrenal Bilateral Slctv Rs&I (75733) | — | $1,096.78 | — |
| Angiography extremity bilateral rs&i (75716) | — | $1,096.78 | — |
| Angiography extremity unilateral rs&i (75710) | — | $1,079.69 | — |
| Angiography pulmonary unilateral slctv rs&i (75741) | — | $1,096.78 | — |
| Angrph pulmonary nonslctv cath/ven njx rs&i (75746) | — | $1,078.05 | — |
| Ankle 2 views (73600) range across 6 matching MRF lines |
— | $17.96–$530 | — |
| Aortography thoracic serialography rs&i (75605) | — | $1,079.48 | — |
| Aortography thoracic w/o serialography rs&i (75600) | — | $1,009.80 | — |
| Artery X-Rays Abdomen (75726) | — | $1,078.05 | — |
| Artery X-Rays Adrenal Gland (75731) | — | $1,078.05 | — |
| Artery X-Rays Pelvis (75736) | — | $1,078.05 | — |
| Artery X-Rays Spine (75705) | — | $1,192.87 | — |
| Arthrogram ankle (73615) | — | $225.64 | — |
| Arthrogram hip (73525) | — | $219.34 | — |
| Arthrogram Wrist (73115) | — | $224.78 | — |
| Basic radiation dosimetry calculation (77300) | — | $169.37 | — |
| Bone age studies (77072) | — | $46.56 | — |
| Bone Imaging 3 Phase (78315) range across 4 matching MRF lines |
— | $109.17–$2,087.06 | — |
| Bone Imaging Limited Area (78300) | — | $444.04 | — |
| Bone Imaging Multiple Areas (78305) | — | $541.74 | — |
| Bone Imaging Whole Body (78306) range across 4 matching MRF lines |
— | $92.15–$2,175.11 | — |
| Bone marrow imaging limited area (78102) | — | $328.38 | — |
| Bone marrow imaging; multiple areas (78103) | — | $420.96 | — |
| Bone marrow imaging; whole body (78104) | — | $479.74 | — |
| Bone survey infant (77076) range across 4 matching MRF lines |
— | $77.30–$251.43 | — |
| Brain Flow Imaging Only (78610) | — | $336.64 | — |
| Brain Image W/Flow < 4 Views (78601) | — | $418.22 | — |
| Brain imaging < 4 static views (78600) | — | $356.22 | — |
| Brain Imaging Min 4 Static Views W Vascular Flow (78606) | — | $634.48 | — |
| Brain Imaging Minimum 4 Static Views (78605) | — | $384.56 | — |
| Brain Imaging Pet Metabolic Evaluation (78608) | — | $2,165.35 | — |
| Card Bl Pool Gated Spect Rest Wal Motn Ejct Frct (78494) | — | $659.06 | — |
| Cardiac blood pool imaging, first pass technique; multiple studies, resting and with stress (exercise and/or… (78483) | — | $757.72 | — |
| Cardiac MRI w/w/o contrast & further seq (75561) | — | $814.96 | — |
| Cardiac MRI w/w/o contrast w/stress (75563) | — | $965.02 | — |
| Cardiac Shunt Detection (78428) | — | $356.22 | — |
| Cat Scan Follow-Up Study (76380) | — | $371.36 | — |
| Cerebrospinal Fluid Flow W/O Matl Shunt Evaltj (78645) | — | $625.46 | — |
| Cerebrospinal fluid flow, imaging (not including introduction of material); ventriculography Non-Facility (78635) | — | $652.40 | — |
| Cerebrospinal Fluid Scan (78630) | — | $650.82 | — |
| Chest 1 view (71045) range across 2 matching MRF lines |
— | $20.26–$349.57 | — |
| Chest 2 views (71046) range across 2 matching MRF lines |
— | $24.16–$415.61 | — |
| Cholecystography Oral Contrast (74290) | — | $144.90 | — |
| Cineradiograpy/vidradiograpy xcpt where spec (76120) | — | $192.96 | — |
| Cisternography Positive Contrast Rs&I (70015) | — | $296.76 | — |
| Clavicle complete (73000) range across 8 matching MRF lines |
— | $18.68–$623.42 | — |
| Computed Tomography Thorax Lw Dose Lng Ca Scr C- (71271) range across 2 matching MRF lines |
— | $118.48–$132.61 | — |
| Continuing medical physics consltj pr wk (77336) | — | $226.60 | — |
| Contrast Exam Abdominl Aorta (75625) | — | $1,078.77 | — |
| Contrast X-Ray Bladder (74430) range across 4 matching MRF lines |
— | $34.25–$1,254 | — |
| Contrast X-Ray Of Elbow (73085) | — | $220.04 | — |
| Contrast X-Ray Of Knee Joint (73580) | — | $258.02 | — |
| Contrast Xray Throat/Cerv Esopha (74210) | — | $169.22 | — |
| Corpora cavernosography (74445) | — | $208.18 | — |
| CT abdomen and pelvis without and with contrast (74178) range across 2 matching MRF lines |
— | $219.79–$4,834.01 | — |
| CT abdomen and pelvis without contrast (74176) range across 2 matching MRF lines |
— | $191.16–$3,907.32 | — |
| CT abdomen w contrast (74160) range across 3 matching MRF lines |
— | $140.47–$3,385.88 | — |
| CT abdomen w wo contrast (74170) range across 4 matching MRF lines |
— | $154.60–$3,675.51 | — |
| CT abdomen w/o contrast (74150) range across 3 matching MRF lines |
— | $131.96–$2,976 | — |
| CT Angio Abdomen and Pelvis (74174) range across 2 matching MRF lines |
— | $239.61–$3,973.62 | — |
| CT Angio Chest (71275) range across 4 matching MRF lines |
— | $199.67–$2,853.31 | — |
| CT Angio Head (70496) range across 4 matching MRF lines |
— | $191.95–$2,853.31 | — |
| Ct Angio Lwr Extr W/O&W/Dye (73706) range across 4 matching MRF lines |
— | $206.01–$2,853.31 | — |
| CT Angio Neck (70498) range across 4 matching MRF lines |
— | $191.95–$2,853.31 | — |
| Ct Angio Upr Extrm W/O&W/Dye (73206) range across 4 matching MRF lines |
— | $196.71–$2,394.48 | — |
| CT bone density (77078) | — | $216.50 | — |
| CT cervical spine w/ contrast (72126) range across 3 matching MRF lines |
— | $134.34–$3,501.79 | — |
| CT cervical spine w/o contrast (72125) range across 3 matching MRF lines |
— | $109.97–$3,385.88 | — |
| CT cervical spine w/wo cont (72127) | — | $808.24 | — |
| CT chest w contrast (71260) range across 3 matching MRF lines |
— | $126.99–$2,654.43 | — |
| CT chest w/wo contrast (71270) range across 4 matching MRF lines |
— | $138.16–$3,675.51 | — |
| CT colonogrphy dx image postprocess w/o contrast (74261) range across 2 matching MRF lines |
— | $262.69–$2,148 | — |
| CT head/brain with contrast (70460) | — | $551.17 | — |
| CT head/brain without and with contrast (70470) range across 4 matching MRF lines |
— | $140.47–$2,775.60 | — |
| CT iac w contrast (70481) | — | $577.67 | — |
| CT l-spine w&w/o contrast (72133) | — | $808.96 | — |
| CT lower ext w/o (73700) range across 3 matching MRF lines |
— | $109.97–$2,843.61 | — |
| CT lower extremity w/contrast material (73701) range across 3 matching MRF lines |
— | $126.99–$2,487.03 | — |
| CT lumbar spine w contrast (72132) range across 3 matching MRF lines |
— | $134.34–$3,478.45 | — |
| CT lumbar spine w/o contrast (72131) range across 3 matching MRF lines |
— | $109.97–$2,245.88 | — |
| CT maxillofacial w contrast (70487) range across 3 matching MRF lines |
— | $123.16–$2,644.58 | — |
| CT maxillofacial wo contrast (70486) range across 5 matching MRF lines |
— | $93.53–$2,517.01 | — |
| CT neck tissue combo (70492) range across 4 matching MRF lines |
— | $178.04–$3,347.96 | — |
| Ct Orbit/Ear/Fossa W/O&W/Dye (70482) | — | $692.41 | — |
| CT orbits w/o contrast (70480) range across 3 matching MRF lines |
— | $141.26–$1,859.25 | — |
| CT pelvis w&w/o contrast (72194) range across 4 matching MRF lines |
— | $134.34–$3,347.96 | — |
| CT pelvis w/o contrast (72192) range across 3 matching MRF lines |
— | $119.27–$2,982 | — |
| CT scan of leg combo (73702) | — | $694.89 | — |
| CT scans face/jaw combo (70488) | — | $689.33 | — |
| CT soft tissue neck w contrast (70491) range across 3 matching MRF lines |
— | $152.08–$3,039.76 | — |
| CT soft tissue neck w/o contrast (70490) range across 3 matching MRF lines |
— | $141.26–$1,859.25 | — |
| CT thoracic spine w contrast (72129) | — | $667.51 | — |
| CT thoracic spine w/o contrast (72128) range across 3 matching MRF lines |
— | $109.97–$1,859.25 | — |
| CT thoracic spine w/wo cont (72130) | — | $808.24 | — |
| CT thorax w/o contrast (71250) range across 3 matching MRF lines |
— | $118.48–$2,517.01 | — |
| CT upper ext wo (73200) range across 5 matching MRF lines |
— | $109.97–$1,859.25 | — |
| CT upper extremity w/o & w/contrast material (73202) | — | $695.81 | — |
| CT upper extremity with contrast (73201) | — | $573.60 | — |
| Cta Abdl Aorta&Bi Iliofem W/Contrast&Postp (75635) range across 3 matching MRF lines |
— | $321.99–$2,853.31 | — |
| Cta Abdomen (74175) range across 4 matching MRF lines |
— | $198.22–$2,853.31 | — |
| CTA pelvis (72191) | — | $1,083.96 | — |
| Dacryocystography, nasolacrimal duct, radiological supervision and interpretation Non-Facility (70170) | — | $104.74 | — |
| Determination of central c-v hemodynamics (non-imaging) (eg, ejection fraction with probe technique) with or without… (78414) | — | $163.48 | — |
| Dilation ureters/urethra rs&i (74485) | — | $299.76 | — |
| Discography Cerv/Thor Spine (72285) | — | $759.89 | — |
| Diskography lumbar (72295) | — | $685.05 | — |
| Doppler Echo Fetal Puls Spectral F/U/Repeat (76828) | — | $148.78 | — |
| Doppler Echo Fetal Spectral Display Complete (76827) | — | $197.29 | — |
| Doppler Fetal Mid Cerebral Artery (76821) | — | $178.44 | — |
| Dxa Bone Density Axial (77080) range across 4 matching MRF lines |
— | $21.85–$688 | — |
| Dxa bone density study 1/>sites appendiclr skel (77081) | — | $63.84 | — |
| Echo exam of fetal heart (76825) | — | $528.26 | — |
| Echo exam uterus (76831) range across 4 matching MRF lines |
— | $194.52–$227.36 | — |
| Echo Guide For Artery Repair (76936) | — | $696.49 | — |
| Echocardiography, fetal, cardiovascular system, real time with image documentation (2D), with or without M-mode… (76826) | — | $311.92 | — |
| Echograp Trans R Pros Study (76873) | — | $335.74 | — |
| Esophageal Motility Study (78258) | — | $423.76 | — |
| Esophagram (74220) range across 4 matching MRF lines |
— | $66.48–$769.95 | — |
| Fetal Biophys Profile W/Nst (76818) | — | $239.20 | — |
| Fetal Biophysical Profile W/O Non-Stress Testing (76819) range across 3 matching MRF lines |
— | $85.74–$861 | — |
| Fluoroscopy up to 1 hr (76000) range across 4 matching MRF lines |
— | $35.48–$608.16 | — |
| Follow-Up Angiography (75898) | — | $258.44 | — |
| Foot 2 views (73620) range across 3 matching MRF lines |
— | $15.95–$533 | — |
| Forearm 2 views (73090) range across 8 matching MRF lines |
— | $16.71–$883.95 | — |
| Gastric emptying imaging study (78264) range across 4 matching MRF lines |
— | $85.88–$1,676.22 | — |
| Gastric Mucosa Imaging (78261) | — | $391.04 | — |
| Gastroesophageal Reflux Exam (78262) | — | $465.58 | — |
| Gastrointestinal Protein Loss (78282) | — | $227.63 | — |
| Gated Heart Planar Single (78472) | — | $526.97 | — |
| Gated Heart, Multiple (78473) | — | $784.82 | — |
| GI Endoscopic US S&I (76975) | — | $204.98 | — |
| Hand 2 views (73120) range across 5 matching MRF lines |
— | $17.38–$882 | — |
| Heart first pass single,planar (78481) | — | $505.05 | — |
| Heart Image (Pet) Multiple (78492) | — | $2,183.57 | — |
| Hepatc Vngrph Wdg/Fr Hemodyn Eval Rs&I (75889) | — | $1,078.05 | — |
| Hepatc Vngrph Wdg/Fr W/O Hemodyn Eval Rs&I (75891) | — | $1,078.05 | — |
| Hepatobil Syst Image W/Drug (78227) range across 2 matching MRF lines |
— | $97.49–$2,387.56 | — |
| Hepatobiliary System Imaging (78226) range across 2 matching MRF lines |
— | $80.47–$2,052.05 | — |
| High energy neutron radj tx dlvr 1/> isocenter (77423) | — | $266.09 | — |
| Hyperthermia external generated superficial (77600) | — | $854.96 | — |
| Hyperthermia generated by interstitial probe(s); 5 or fewer interstitial applicators Non-Facility (77610) | — | $1,308.04 | — |
| Hyperthermia generated by interstitial probe(s); more than 5 interstitial applicators Non-Facility (77615) | — | $2,007.64 | — |
| Hyperthermia generated by intracavitary probe(s) Non-Facility (77620) | — | $988.14 | — |
| Hyperthermia, externally generated; deep (ie, heating to depths greater than 4 cm) Non-Facility (77605) | — | $1,478.84 | — |
| Hysterosalpingogram (74740) range across 4 matching MRF lines |
— | $140.60–$156.52 | — |
| Infant hip ultrasound with hip movement (dynamic) (76885) | — | $273.64 | — |
| Infant hip ultrasound, limited static exam (76886) | — | $201.40 | — |
| Infusion Ivp (74410) | — | $229.58 | — |
| Interstitial radiation source applic complex (77778) | — | $1,655.86 | — |
| Intracavitary Radiation Source Applic Complex (77763) | — | $1,476.06 | — |
| Intracavitary Radiation Source Applic Intermed (77762) | — | $1,033.68 | — |
| Intracavitary radiation source applic simple (77761) | — | $777.34 | — |
| Joint Survey Single View (77077) range across 6 matching MRF lines |
— | $32.70–$349.57 | — |
| K Flow/Funct Image Multiple (78709) | — | $712.66 | — |
| K Flow/Funct Image W/Drug (78708) range across 4 matching MRF lines |
— | $129.50–$2,655.16 | — |
| K Flow/Funct Image W/O Drug (78707) | — | $450.42 | — |
| Kidney Funcj Study Non-Img Radioisotopic Study (78725) | — | $209.26 | — |
| Kidney Imaging Morphol (78700) | — | $329.56 | — |
| Kidney Imaging Morphoogy W/Vascular Flow (78701) | — | $418.78 | — |
| Knee 3 Views (73562) range across 8 matching MRF lines |
— | $20.99–$1,032 | — |
| Labeled RBC Sequestration Differntl Organ/Tissue (78140) | — | $365.68 | — |
| Leveen/Shunt Patency Exam (78291) | — | $496.10 | — |
| Liver & Spleen Imaging Static Only (78215) | — | $375.72 | — |
| Liver & Spleen Imaging W/Vascular Flow (78216) | — | $325.29 | — |
| Liver imaging static only (78201) | — | $367.26 | — |
| Liver imaging w/vascular flow (78202) | — | $389.54 | — |
| Lung Ventilat&Perfus Imaging (78582) range across 2 matching MRF lines |
— | $114.58–$2,196.06 | — |
| Lymph System Imaging (78195) range across 4 matching MRF lines |
— | $440.28–$689.58 | — |
| Lymphangiography Extremity Only Bilateral Rs&I (75803) | — | $537.85 | — |
| Lymphangiography extremity only unilateral rs&i (75801) | — | $501.38 | — |
| Lymphangiography Pelvic/Abdominal Bilateral Rs&I (75807) | — | $589.71 | — |
| Lymphangiography, pelvic/abdominal, unilateral (75805) | — | $552.36 | — |
| Magnetic Image Jaw Joint (70336) | — | $1,010.08 | — |
| Magnetic resonance (eg, proton) imaging, brain (including brain stem andskull base), during open intracranial procedure… (70558) | — | $2,356.94 | — |
| Magnetic resonance (eg, proton) imaging, brain (including brain stem andskull base), during open intracranial procedure… (70557) | — | $2,140.72 | — |
| Magnetic resonance (eg, proton) imaging, brain (including brain stem andskull base), during open intracranial procedure… (70559) | — | $2,213.34 | — |
| Mammary ductogram or galactogram multiple (77054) | — | $143.88 | — |
| Mammary ductogram or galactogram single (77053) | — | $110.04 | — |
| Meckels Divert Exam (78290) | — | $636.90 | — |
| Mra Head W/O & W/Contrast Material (70546) range across 4 matching MRF lines |
— | $163.11–$4,932.41 | — |
| MRA head w/o contrast (70544) range across 3 matching MRF lines |
— | $132.75–$3,435.75 | — |
| MRA head with contrast (70545) | — | $979.55 | — |
| MRA neck w contrast (70548) | — | $979.55 | — |
| Mra Neck W/O &W/Contrast Material (70549) range across 4 matching MRF lines |
— | $198.09–$5,085 | — |
| MRA neck w/o contrast (70547) range across 3 matching MRF lines |
— | $132.75–$2,847.48 | — |
| MRI abdomen w contrast (74182) | — | $1,187.42 | — |
| MRI abdomen w/o contrast (74181) range across 3 matching MRF lines |
— | $160.80–$3,435.75 | — |
| MRI any jt lower extrem w/contrast material (73722) range across 3 matching MRF lines |
— | $180.20–$3,754.55 | — |
| MRI any jt lower extrem w/o & w/contrast matrl (73723) range across 4 matching MRF lines |
— | $235.44–$5,451.72 | — |
| MRI any jt upper extremity w/contrast matrl (73222) | — | $1,170.91 | — |
| MRI bone marrow blood supply (77084) | — | $721.72 | — |
| MRI brain functional w/o physician admnistration (70554) | — | $836.82 | — |
| MRI brain functional w/physician admnistration (70555) | — | $1,098 | — |
| MRI cardiac w/o cont stress (75559) | — | $866.02 | — |
| MRI cardiac w/o contrast (75557) | — | $622.98 | — |
| MRI cervical spine w contrast (72142) | — | $1,229.50 | — |
| MRI cervical spine w/o cont (72141) range across 3 matching MRF lines |
— | $162.58–$3,435.75 | — |
| MRI chest w/o contrast (71550) range across 3 matching MRF lines |
— | $158.93–$2,616.45 | — |
| MRI chest with contrast (71551) | — | $1,188.12 | — |
| MRI chest wo w contrast (71552) | — | $2,073.39 | — |
| MRI lower extrem oth/thn jt w/contrast matrl (73719) | — | $1,170.91 | — |
| MRI lower extrem oth/thn jt w/o & w/contr matr (73720) range across 6 matching MRF lines |
— | $235.44–$8,012.21 | — |
| MRI lower extrem oth/thn jt w/o contr matrl (73718) range across 5 matching MRF lines |
— | $148.26–$3,435.75 | — |
| MRI lumbar spine w contrast (72149) | — | $1,214.83 | — |
| Mri Neck Spine W/O & W/Dye (72156) range across 4 matching MRF lines |
— | $251.08–$5,451.72 | — |
| MRI orbit face &/neck w/o contrast (70540) range across 3 matching MRF lines |
— | $148.26–$2,816.45 | — |
| MRI orbit face neck w contrast (70542) | — | $1,170.91 | — |
| Mri Orbt/Fac/Nck W/O &W/Dye (70543) range across 4 matching MRF lines |
— | $234.71–$4,270.67 | — |
| MRI pelvis w contrast (72196) | — | $1,187.20 | — |
| MRI pelvis w/o & w contrast (72197) range across 4 matching MRF lines |
— | $240.85–$4,497.18 | — |
| MRI pelvis w/o contrast (72195) range across 3 matching MRF lines |
— | $161.53–$3,435.75 | — |
| MRI thoracic spine w/o contrast (72146) range across 3 matching MRF lines |
— | $144.57–$3,435.75 | — |
| MRI upper extremity oth than jt w/contr matrl (73219) | — | $1,170.91 | — |
| MRI upper extremity oth than jt w/o contr matrl (73218) range across 3 matching MRF lines |
— | $149.70–$3,435.75 | — |
| Mri Uppr Extremity W/O&W/Dye (73220) range across 4 matching MRF lines |
— | $236.16–$4,497.18 | — |
| MRI, abdomen, combo (74183) range across 4 matching MRF lines |
— | $240.12–$5,451.72 | — |
| MRI, dorsal spine combo (72157) range across 4 matching MRF lines |
— | $251.08–$5,451.72 | — |
| MRI, dorsal spine contrast (72147) | — | $1,228.78 | — |
| MRI, joint upper extrem (73221) range across 3 matching MRF lines |
— | $150.64–$3,435.75 | — |
| MRI, joint upper extrem combo (73223) range across 4 matching MRF lines |
— | $236.16–$4,497.18 | — |
| MRI, lumbar spine combo (72158) range across 4 matching MRF lines |
— | $251.08–$5,451.72 | — |
| Myelogram cervical (72240) | — | $458.66 | — |
| Myelogram Lumbar (72265) | — | $399.22 | — |
| Myelography thoracic (72255) | — | $424.71 | — |
| Myelograpy 2/more regions rs&i (72270) | — | $606.46 | — |
| Myocardial Imaging Infarct Avid Planar Qual/Quan (78466) | — | $380.86 | — |
| Myocardial Imaging Pet Metabolic Evaluation (78459) | — | $2,164.25 | — |
| Myocardial imaging, infarct avid, planar; with ejection fraction by first pass technique Non-Facility (78468) | — | $395.62 | — |
| Myocardial Spect Multiple Studies (78452) | — | $5,558.32 | — |
| Neck soft tissue (70360) range across 6 matching MRF lines |
— | $20.26–$349.57 | — |
| Nfs/Instlj Radioelmnt Sln 3 Mo Follow-Up Care (77750) | — | $749.12 | — |
| Nm csf leak detection (78650) | — | $527.24 | — |
| Nm myocard infarct spect (78469) | — | $496.73 | — |
| Nm red cell survival study (78130) | — | $282.71 | — |
| Nm whole blood volume (78122) | — | $398.48 | — |
| Nonvascular Shunt X-Ray (75809) | — | $181.76 | — |
| Ntsty modul radthx pln dose-vol histos (77301) | — | $3,705.24 | — |
| Nuclear Rx Intra-Arterial (79445) | — | $309.50 | — |
| Nuclear Rx Oral Admin (79005) | — | $271.58 | — |
| Ob us nuchal meas 1 gest (76813) | — | $237.70 | — |
| Oph bmtry us echograpy a-scan io lens pwr cal (76519) | — | $159.50 | — |
| Oph us dx ant sgm us immersion b-scan/hr biom (76513) | — | $193.08 | — |
| Oph US Dx B-Scan&Quan a-Scan Sm Pt Enctr (76510) | — | $213.16 | — |
| Ophthalmic Biometry US Echograpy a-Scan (76516) | — | $153.10 | — |
| Ophthalmic Ultrasonic Foreign Body Localization (76529) | — | $158.08 | — |
| Ophthalmic ultrasound dx b-scan w/wo a-scan (76512) | — | $186.72 | — |
| Ophthalmic US Dx Corneal Pachymetry Uni/Bi (76514) | — | $25.32 | — |
| Ophthalmic us dx quantitative a-scan only (76511) | — | $212.78 | — |
| Optic foramina (70190) | — | $70.25 | — |
| Panoramic X-ray of jaws (70355) | — | $66.63 | — |
| Parathyroid Planar Imaging (78070) | — | $576.46 | — |
| Pelvis 1 or 2 views (72170) range across 5 matching MRF lines |
— | $19.47–$428.08 | — |
| Perineogram (74775) | — | $185.41 | — |
| Peritoneogram Rs&I (74190) | — | $150.68 | — |
| Pet Image Skull-Thigh (78812) range across 4 matching MRF lines |
— | $206.01–$7,618.32 | — |
| Pet Image W/Ct Lmtd (78814) | — | $2,724.22 | — |
| PET image w/CT, full body (78816) range across 4 matching MRF lines |
— | $262.96–$7,968.42 | — |
| PET imaging CT attenuation skull base mid-thigh (78815) range across 4 matching MRF lines |
— | $260.59–$7,848.75 | — |
| Pet Imaging Limited Area Chest Head/Neck (78811) | — | $2,169.85 | — |
| Pet Myocardial Sngl Study (78491) | — | $2,156.64 | — |
| PET whole body (78813) range across 4 matching MRF lines |
— | $207–$7,571.64 | — |
| Plasma Vol Radiopharm Vol Dilute Spx Mult Smples (78111) | — | $220.55 | — |
| Plasma volume, radiopharmaceutical volume-dilution technique (separate procedure); single sampling Non-Facility (78110) | — | $133.76 | — |
| Platelet survival study Non-Facility (78191) | — | $622.03 | — |
| Prq Transhepatc Portograpy Hemodyn Eval Rs&I (75885) | — | $1,109.95 | — |
| Pulmonary Perfusion Imaging Particulate (78580) | — | $460.84 | — |
| Radex Abd Compl Aqt Abd W/S/E/D Views 1 View Ch (74022) range across 4 matching MRF lines |
— | $34.97–$659.09 | — |
| Radex abscess/fistula/sinus tract rs&i (76080) | — | $138.24 | — |
| Radex Ankle Complete Minimum 3 Views (73610) range across 7 matching MRF lines |
— | $18.02–$985.50 | — |
| Radex Calcaneus Minimum 2 Views (73650) range across 7 matching MRF lines |
— | $17.96–$415.61 | — |
| Radex elbow complete minimum 3 views (73080) range across 8 matching MRF lines |
— | $18.12–$987.75 | — |
| Radex Facial Bones Complete Minimum 3 Views (70150) range across 6 matching MRF lines |
— | $28.77–$539.21 | — |
| Radex fingr minimum 2 views (73140) range across 8 matching MRF lines |
— | $14.50–$727.50 | — |
| Radex foot complete minimum 3 views (73630) range across 7 matching MRF lines |
— | $17.35–$963 | — |
| Radex Hand Minimum 3 Views (73130) range across 8 matching MRF lines |
— | $18.12–$981 | — |
| Radex lower extremity infant minimum 2 views (73592) | — | $55 | — |
| Radex Mastoids Compl Minimum 3 Views PR Side (70130) range across 4 matching MRF lines |
— | $96.38–$109.26 | — |
| Radex Nasal Bones Complete Minimum 3 Views (70160) range across 6 matching MRF lines |
— | $19.47–$415.61 | — |
| Radex Pharynx/Larx W/Fluor&/Magnification Tq (70370) | — | $152.64 | — |
| Radex Ribs Unilateral 2 Views (71100) range across 6 matching MRF lines |
— | $24.88–$415.61 | — |
| Radex shoulder complete minimum 2 views (73030) range across 8 matching MRF lines |
— | $19.53–$990 | — |
| Radex Sinuses Paransl < 3 Views (70210) | — | $66.35 | — |
| Radex sm int w/mlt srl imges via enteroclss tube (74251) | — | $810.54 | — |
| Radex Spine 1 View Specify Level (72020) | — | $47.32 | — |
| Radex Sternum Minimum 2 Views (71120) range across 6 matching MRF lines |
— | $21.85–$415.61 | — |
| Radex Temporomandble Jt Opn & Clsd Mouth Bilat (70330) range across 4 matching MRF lines |
— | $90.56–$93.90 | — |
| Radex Toe Minimum 2 Views (73660) range across 6 matching MRF lines |
— | $14.85–$415.61 | — |
| Radex upper extremity infant minimum 2 views (73092) | — | $55 | — |
| Radex Wrist Complete Minimum 3 Views (73110) range across 7 matching MRF lines |
— | $18.12–$973.50 | — |
| Radiation Delivery Stereotactic Cranial Linear (77372) | — | $2,006.42 | — |
| Radiation treatment delivery level 1 (77402) | — | $199.31 | — |
| Radiation treatment delivery level 2 (77407) | — | $292.39 | — |
| Radiation treatment delivery level 3 (77412) | — | $394.04 | — |
| Radiolog exam mandible compl minimum 4 views (70110) range across 6 matching MRF lines |
— | $27.26–$710 | — |
| Radiologic exam colon double contrast study (74280) | — | $431.84 | — |
| Radiologic exam colon single contrast study (74270) range across 3 matching MRF lines |
— | $113.86–$935.45 | — |
| Radiologic Exam Esophagus Double Contrast Study (74221) range across 2 matching MRF lines |
— | $77.30–$769.95 | — |
| Radiologic exam knee complete 4/more views (73564) range across 10 matching MRF lines |
— | $24.88–$1,220.61 | — |
| Radiologic exam pelvis compl minimum 3 views (72190) range across 3 matching MRF lines |
— | $27.98–$503.13 | — |
| Radiologic Exam Small Int Single Contrast Study (74250) | — | $214.22 | — |
| Radiologic exam swallow function contrast study (74230) range across 4 matching MRF lines |
— | $59.49–$630.17 | — |
| Radiologic exam teeth complete full mouth (70320) | — | $103.26 | — |
| Radiologic Exam Teeth Prtl Exam < Full Mouth (70310) | — | $71.56 | — |
| Radiologic exam upr gi trc double contrast study (74246) range across 3 matching MRF lines |
— | $98.21–$1,143.65 | — |
| Radiologic examination femur 1 view (73551) range across 2 matching MRF lines |
— | $17.04–$54.34 | — |
| Radiologic examination femur minimum 2 views (73552) range across 6 matching MRF lines |
— | $18.48–$905.18 | — |
| Radiologic examination knee 1/2 views (73560) range across 8 matching MRF lines |
— | $18.68–$842.18 | — |
| Radiologic Examination Osseous Survey Limited (77074) | — | $129.98 | — |
| Radiologic Examination Salivary Gland Calculus (70380) | — | $69.89 | — |
| Radiologic examination tibia & fibula 2 views (73590) range across 8 matching MRF lines |
— | $17.96–$910.50 | — |
| Radiologic examination, internal auditory meati, complete Non-Facility (70134) | — | $102.42 | — |
| Radiologic examination, teeth; single view Non-Facility (70300) | — | $33.42 | — |
| Radiopharm Dacryocystography (78660) | — | $352.56 | — |
| Radiopharmaceutical therapy, by interstitial radioactive colloid administration Facility (79300) | — | $290.57 | — |
| Radiopharmaceutical therapy, by intra-articular administration Non-Facility (79440) | — | $417.32 | — |
| Radiopharmaceutical therapy, by intracavitary administration Non-Facility (79200) | — | $413.32 | — |
| Red Cell Volume Determination Spx 1 Sampling (78120) | — | $158.36 | — |
| Red Cell Volume Determination Spx Mult Samplings (78121) | — | $253.97 | — |
| Renal Cyst Study (74470) | — | $152.65 | — |
| Ribs bilateral 3 views (71110) range across 6 matching MRF lines |
— | $39.21–$988.64 | — |
| Rp loclzj tum plnr 1 area single day imaging (78800) | — | $377.54 | — |
| Rp loclzj tum plnr 2+area 1+d img/1 area img>2+d (78801) | — | $497.98 | — |
| Rp Loclzj Tum Plnr Whole Body 2+ Days Imaging (78804) | — | $1,093.76 | — |
| Rp Loclzj Tum Plnr Whole Body Single Day Imaging (78802) | — | $622.06 | — |
| Rp Loclzj Tum Spect 1 Area Single Day Imaging (78803) | — | $658.06 | — |
| Rp Ther Radiolbld Monoclonal Antibody IV Infus (79403) | — | $568.96 | — |
| Rp Therapy Intravenous Administration (79101) | — | $290.40 | — |
| Salivary Gland Function Study (78232) | — | $318.51 | — |
| Salivary Gland Imaging (78230) | — | $337.06 | — |
| Salivary Gland Imaging Serial Images (78231) | — | $297.71 | — |
| Scapula (73010) range across 5 matching MRF lines |
— | $20.19–$587 | — |
| Screening Digital Breast Tomosynthesis Bi (77063) range across 4 matching MRF lines |
— | $57.74–$232.32 | — |
| Sella turcica (70240) | — | $60.48 | — |
| Shoulder 1 view (73020) range across 3 matching MRF lines |
— | $17.16–$349.57 | — |
| Shoulder Arthrography (73040) range across 2 matching MRF lines |
— | $58.12–$219.34 | — |
| Sialogram (70390) | — | $194.94 | — |
| Skull less than 4 views (70250) range across 3 matching MRF lines |
— | $20.26–$428.08 | — |
| Special dosimetry (77331) | — | $131.04 | — |
| Special Physics Consult (77370) | — | $264.58 | — |
| Special teletherapy port plan (77321) | — | $409.28 | — |
| Special treatment procedure (77470) | — | $1,070.63 | — |
| Speech evaluation, complex (70371) | — | $251.25 | — |
| Spleen Imaging (78185) | — | $325.76 | — |
| Srs Multisource (77371) | — | $1,806.39 | — |
| Stereotactic Body Radiation Delivery (77373) | — | $2,429.20 | — |
| Sternoclavicular joints (71130) | — | $77.41 | — |
| Superior sagittal sinus venogram (75870) | — | $1,080.41 | — |
| Surface Applic Low Dose Rate Radionuclide Source (77789) | — | $239.08 | — |
| Temporomandble Jt Arthrography Rs&I (70332) | — | $218.90 | — |
| Testicular Imaging W/Flow (78761) | — | $408.34 | — |
| Ther Rad Simulaj-Aided Field Setting Complex (77290) | — | $966.62 | — |
| Ther Rad Simulaj-Aided Field Setting Intermed (77285) | — | $866.30 | — |
| Ther rad simulaj-aided field setting simple (77280) | — | $524.24 | — |
| Therapeutic Enema Rdctj Intussusception/Obstrcj (74283) | — | $452.34 | — |
| Thoracic spine 2 views (72070) | — | $73.16 | — |
| Thoracic spine 3 views (72072) range across 6 matching MRF lines |
— | $24.95–$659.09 | — |
| Thoracolumbar 2 views (72080) | — | $75.51 | — |
| Thyroid carcinoma metastases imaging; with additional studies (eg, urinary recovery) Non-Facility (78016) | — | $543.70 | — |
| Thyroid Carcinoma Metastases Img Lmtd Area (78015) | — | $433.94 | — |
| Thyroid Met Imaging Body (78018) | — | $604.84 | — |
| Tx Devices Design & Construction Complex (77334) | — | $378.60 | — |
| Tx devices design & construction intermediate (77333) | — | $235.44 | — |
| Tx devices design & construction simple (77332) | — | $159 | — |
| Ultrasound Breast Limited (76642) range across 5 matching MRF lines |
— | $67–$531 | — |
| Ultrasound Exam Aaa Screen (76706) | — | $725 | — |
| Ultrasound, abdomen limited (76705) range across 8 matching MRF lines |
— | $65.69–$924.58 | — |
| Umbilical-artery Doppler (OB) (76820) | — | $93.38 | — |
| Unlisted us procedure (76999) | — | $195 | — |
| Upper gi w/o kub (74240) | — | $233.60 | — |
| Ureteral Reflux Study (78740) | — | $421.02 | — |
| Urethrocystogram voiding (74455) | — | $171.46 | — |
| Urethrocystography retrograde (74450) | — | $146.77 | — |
| Us bone density measurement (76977) | — | $69.74 | — |
| Us breast unilateral complete (76641) range across 2 matching MRF lines |
— | $112.49–$1,470.60 | — |
| Us chest (76604) range across 4 matching MRF lines |
— | $64.24–$492.26 | — |
| Us complete joint (76881) range across 2 matching MRF lines |
— | $85.48–$650.33 | — |
| Us exam, pelvic, limited (76857) range across 4 matching MRF lines |
— | $53.79–$492.26 | — |
| Us head (76506) | — | $220.86 | — |
| Us kidney transplant (76776) | — | $295.60 | — |
| Us lmtd joint/oth nonvasc xtr strux r-t w/img (76882) range across 3 matching MRF lines |
— | $49.86–$492.26 | — |
| Us ob detailed single fetus (76811) | — | $505.61 | — |
| Us ob limited 1 or more fetuses (76815) range across 5 matching MRF lines |
— | $71.89–$492.26 | — |
| Us ob transvaginal (76817) range across 6 matching MRF lines |
— | $83.43–$600.74 | — |
| Us pelvic non ob complete (76856) range across 5 matching MRF lines |
— | $76.51–$924.58 | — |
| Us pg uter img f&mat 14 wk tabdl 1/1st gestation (76801) range across 6 matching MRF lines |
— | $108.24–$924.58 | — |
| Us preg uterus real time f/u trnsabdl per fetus (76816) range across 4 matching MRF lines |
— | $94.25–$600.74 | — |
| Us retroperitoneal complete (76770) range across 4 matching MRF lines |
— | $81.19–$924.58 | — |
| Us retroperitoneal limited (76775) range across 4 matching MRF lines |
— | $64.18–$756.69 | — |
| Us scrotum and contents (76870) range across 4 matching MRF lines |
— | $71.10–$924.58 | — |
| Us spinal canal and contents (76800) | — | $277.54 | — |
| Us thyroid (76536) range across 3 matching MRF lines |
— | $63.31–$924.58 | — |
| Us transrectal (76872) range across 4 matching MRF lines |
— | $216.91–$1,095.51 | — |
| Vascular Flow Imaging (78445) | — | $360.68 | — |
| Vasogram (74440) | — | $164.26 | — |
| Vein X-Ray Chest (75827) | — | $1,078.05 | — |
| Vein X-Ray Liver W/O Hemodyn (75887) | — | $1,109.95 | — |
| Vein X-Ray Skull Epidural (75872) | — | $1,078.05 | — |
| Vein X-Ray Spleen/Liver (75810) | — | $1,078.99 | — |
| Venogram Sinus/Jugular (75860) | — | $1,080.41 | — |
| Venography Adrenal Unilateral (75840) | — | $1,079.91 | — |
| Venography caval inferior serialography rs&i (75825) | — | $1,078.99 | — |
| Venography extremity bilateral rs&i (75822) range across 3 matching MRF lines |
— | $227.01–$252.04 | — |
| Venography extremity unilateral rs&i (75820) range across 3 matching MRF lines |
— | $148.62–$214.20 | — |
| Venography Orbital Rs&I (75880) | — | $233 | — |
| Venography Renal Bilateral (75833) | — | $1,116.28 | — |
| Venography Renal Unilateral (75831) | — | $1,078.05 | — |
| Venous sampling by catheter (75893) | — | $1,013.09 | — |
| Venous thrombosis imaging (78457) | — | $372.22 | — |
| Venous Thrombosis Imaging Venogram Bilateral (78458) | — | $404.35 | — |
| Wrist 2 views (73100) range across 5 matching MRF lines |
— | $17.38–$804 | — |
| X-Ray Ac Jts - Xr Acromioclavicular Joints Bilateral (73050) range across 6 matching MRF lines |
— | $19.53–$415.61 | — |
| X-ray antegrade pyelogram tube (74425) | — | $138.33 | — |
| X-Ray Aorta Leg Arteries (75630) | — | $1,191.79 | — |
| X-Ray Bend Only L-S Spine (72120) range across 4 matching MRF lines |
— | $24.88–$539.21 | — |
| X-Ray Elbow 2 Vw - Xr Elbow 1-2 Views Right (73070) range across 5 matching MRF lines |
— | $17.38–$789 | — |
| X-Ray Exam Breast Specimen (76098) range across 4 matching MRF lines |
— | $35.12–$789.31 | — |
| X-Ray Exam Entire Spi 1 Vw (72081) range across 2 matching MRF lines |
— | $28.77–$522.52 | — |
| X-Ray Exam Entire Spi 2/3 Vw (72082) | — | $123.66 | — |
| X-Ray Exam Hip Uni 1 View (73501) range across 6 matching MRF lines |
— | $19.14–$479 | — |
| X-Ray Exam Hip Uni 2-3 Views (73502) range across 6 matching MRF lines |
— | $21.72–$610.82 | — |
| X-Ray Exam Hip Uni 4/> Views (73503) range across 4 matching MRF lines |
— | $28.48–$800 | — |
| X-Ray Exam Hips Bi 2 Views (73521) range across 6 matching MRF lines |
— | $37.32–$916.23 | — |
| X-Ray Exam Hips Bi 3-4 Views (73522) range across 6 matching MRF lines |
— | $30.60–$1,225.50 | — |
| X-Ray Exam Hips Bi 5/> Views (73523) range across 4 matching MRF lines |
— | $32.70–$1,474.50 | — |
| X-Ray Exam L-S Spine Bending (72114) range across 4 matching MRF lines |
— | $30.82–$659.09 | — |
| X-Ray Exam Neck Spine 2-3 Vw (72040) range across 6 matching MRF lines |
— | $23.02–$428.08 | — |
| X-Ray Exam Neck Spine 6/>Vws (72052) range across 6 matching MRF lines |
— | $30.22–$659.09 | — |
| X-Ray Exam Unilat Ribs/Chest (71101) range across 4 matching MRF lines |
— | $29.57–$659.09 | — |
| X-ray eye for foreign body (70030) range across 3 matching MRF lines |
— | $20.26–$449 | — |
| X-ray head for orthodontia (70350) | — | $47.49 | — |
| X-ray humerus (73060) range across 8 matching MRF lines |
— | $16.71–$880.50 | — |
| X-ray IV pyelogram (ivp) (74400) | — | $226.26 | — |
| X-ray IV pyelogram+tomography (74415) | — | $273.30 | — |
| X-Ray Jaw <4 Vw - Xr Mandible < 4 Views (70100) | — | $65.72 | — |
| X-Ray Knee Bilat Standing - Xr Knees Anteroposterior Standing Bilat (73565) range across 5 matching MRF lines |
— | $19.40–$495 | — |
| X-Ray Lumbar Spine 2/3 Vw - Xr Lumbar Spine 2-3 Views (72100) range across 6 matching MRF lines |
— | $22.97–$428.08 | — |
| X-ray nose-rectum child f.b. (76010) range across 6 matching MRF lines |
— | $20.26–$349.57 | — |
| X-Ray Ribs, Chest 4+ Vw - Xr Ribs 3 Vws Bil W/ Chest Posteroanterior (71111) range across 4 matching MRF lines |
— | $44.34–$988.64 | — |
| X-Ray Sacroiliac Jts 3+ Vw - Xr Sacroiliac Joints 3+ Views (72202) range across 6 matching MRF lines |
— | $24.95–$614 | — |
| X-Ray Sacroiliac Jts <3 Vw - Xr Sacroiliac Joints 1-2 Views (72200) range across 4 matching MRF lines |
— | $18.75–$482.57 | — |
| X-Ray Sacrum/Coccyx 2+ Vw - Xr Sacrum Coccyx 2+ Views (72220) range across 6 matching MRF lines |
— | $19.47–$415.61 | — |
| X-Ray Sinuses 3+ Vw - Xr Paranasal Sinuses 3+ Views (70220) range across 6 matching MRF lines |
— | $24.16–$539.21 | — |
| X-Ray Skull 4+ Vw - Xr Skull Complete 4+ Views (70260) | — | $104.41 | — |
| X-Ray Stress View (77071) | — | $98.58 | — |
| X-ray thoracic spine 4 vw (72074) | — | $93.42 | — |
| X-Ray Tmj Unilat (70328) | — | $60.42 | — |
| X-Ray Urinary Tract Exam With Contrast Material (74420) range across 6 matching MRF lines |
— | $56.10–$1,927.97 | — |
| X-Rays Bone Length Studies (77073) | — | $72.42 | — |
| X-Rays Bone Survey Complete (77075) | — | $176.20 | — |
| Xr c-spine 4 or 5 views (72050) | — | $102.26 | — |
| Xr facial bones less than 3 views (70140) | — | $67.96 | — |
| XR Mastoids < 3 Views Bilateral (70120) | — | $67.15 | — |
| Xr myelogram posterior fossa (70010) | — | $456.69 | — |
| Xr orbits complete 4 views (70200) range across 6 matching MRF lines |
— | $31.08–$539.21 | — |
| Xr Tomogram Single Plane (76100) | — | $181.50 | — |
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.