Imaging prices at Hilo Benioff Medical Center

Hilo, HI · every code in this section with a posted price and a Medicare benchmark.

354 codes. Prices are the hospital's own posted facility charges.

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ProcedurePosted cashPosted gross× Medicare
3-D radiotherapy plan dose-volume histograms (77295) $3,267 $5,445 2.0×
Abdomen 1 View (74018) $262.80 $438 2.6×
Abdomen 2 views (74019) $317.40 $529 2.6×
Acute Gastrointestinal Blood Loss Imaging (78278) $1,199.40 $1,999 2.5×
Adrenal Cortex & Medulla Img (78075) $3,896.40 $6,494 2.5×
Angio internal mammary (75756) $9,394.80 $15,658 2.5×
Angio pulmonary bilat (75743) $9,394.80 $15,658 2.5×
Angiography extremity bilateral rs&i (75716) $9,394.80 $15,658 2.5×
Angiography extremity unilateral rs&i (75710) $9,394.80 $15,658 2.5×
Ankle 2 views (73600) $262.80 $438 2.6×
Aortography thoracic serialography rs&i (75605) $16,134.60 $26,891 2.5×
Artery X-Rays Abdomen (75726) $16,134.60 $26,891 2.5×
Artery X-Rays Pelvis (75736) $16,134.60 $26,891 2.5×
Artery X-Rays Spine (75705) $16,134.60 $26,891 2.5×
Arthrogram ankle (73615) $1,065.60 $1,776 2.6×
Arthrogram hip (73525) $1,065.60 $1,776 2.6×
Arthrogram Wrist (73115) $1,065.60 $1,776 2.6×
Basic radiation dosimetry calculation (77300) $316.80 $528 2.0×
Bone age studies (77072) $317.40 $529 2.6×
Bone Imaging 3 Phase (78315) $1,199.40 $1,999 2.5×
Bone Imaging Limited Area (78300) $1,199.40 $1,999 2.5×
Bone Imaging Multiple Areas (78305) $1,199.40 $1,999 2.5×
Bone Imaging Whole Body (78306) $1,199.40 $1,999 2.5×
Bone marrow imaging limited area (78102) $939.60 $1,566 2.0×
Bone marrow imaging; multiple areas (78103) $939.60 $1,566 2.0×
Bone marrow imaging; whole body (78104) $939.60 $1,566 2.0×
Bone survey infant (77076) $317.40 $529 2.6×
Brain Flow Imaging Only (78610) $1,606.80 $2,678 2.5×
Brain Image W/Flow < 4 Views (78601) $1,199.40 $1,999 2.5×
Brain imaging < 4 static views (78600) $939.60 $1,566 2.0×
Brain Imaging Min 4 Static Views W Vascular Flow (78606) $1,606.80 $2,678 2.5×
Brain Imaging Minimum 4 Static Views (78605) $1,606.80 $2,678 2.5×
Card Bl Pool Gated Spect Rest Wal Motn Ejct Frct (78494) $939.60 $1,566 2.0×
Cardiac blood pool imaging, first pass technique; multiple studies, resting and with stress (exercise and/or… (78483) $1,258.20 $2,097 2.0×
Cardiac MRI w/w/o contrast & further seq (75561) $1,065.60 $1,776 2.6×
Cardiac Shunt Detection (78428) $1,199.40 $1,999 2.5×
Cat Scan Follow-Up Study (76380) $262.80 $438 2.6×
Cerebrospinal Fluid Flow W/O Matl Shunt Evaltj (78645) $1,606.80 $2,678 2.5×
Cerebrospinal fluid flow, imaging (not including introduction of material); ventriculography Non-Facility (78635) $1,606.80 $2,678 2.5×
Cerebrospinal Fluid Scan (78630) $1,606.80 $2,678 2.5×
Chest 1 view (71045) $262.80 $438 2.6×
Chest 2 views (71046) $262.80 $438 2.6×
Chest 3 views (71047) $262.80 $438 2.6×
Cisternography Positive Contrast Rs&I (70015) $1,847.40 $3,079 2.0×
Clavicle complete (73000) $262.80 $438 2.6×
Computed Tomography Thorax Lw Dose Lng Ca Scr C- (71271) $317.40 $529 2.6×
Continuing medical physics consltj pr wk (77336) $316.80 $528 2.0×
Contrast Exam Abdominl Aorta (75625) $9,394.80 $15,658 2.5×
Contrast X-Ray Bladder (74430) $1,065.60 $1,776 2.6×
Contrast X-Ray Of Elbow (73085) $1,065.60 $1,776 2.6×
Contrast X-Ray Of Knee Joint (73580) $1,065.60 $1,776 2.6×
CT abdomen and pelvis without and with contrast (74178) $1,065.60 $1,776 2.6×
CT abdomen and pelvis without contrast (74176) $721.80 $1,203 2.6×
CT abdomen w contrast (74160) $531 $885 2.6×
CT abdomen w wo contrast (74170) $531 $885 2.6×
CT abdomen w/o contrast (74150) $317.40 $529 2.6×
CT Angio Abdomen and Pelvis (74174) $1,065.60 $1,776 2.6×
CT Angio Chest (71275) $531 $885 2.6×
CT Angio Head (70496) $531 $885 2.6×
CT angio hrt w/3d image (75574) $1,065.60 $1,776 2.6×
Ct Angio Lwr Extr W/O&W/Dye (73706)
range across 2 matching MRF lines		 $531–$1,062 $885–$1,770 varies
CT Angio Neck (70498) $531 $885 2.6×
Ct Angio Upr Extrm W/O&W/Dye (73206) $531 $885 2.6×
CT Cere Prfuj Alys C+ W/O CT/Cta Same Anatomy (70473) $362.40 $604 1.7×
CT cervical spine w/ contrast (72126) $1,065.60 $1,776 2.6×
CT cervical spine w/o contrast (72125) $317.40 $529 2.6×
CT chest w contrast (71260) $531 $885 2.6×
CT chest w/wo contrast (71270) $531 $885 2.6×
CT Colonogrphy Dx Image Postprocess W/Contrast (74262) $531 $885 2.6×
CT colonogrphy dx image postprocess w/o contrast (74261) $317.40 $529 2.6×
CT head/brain with contrast (70460) $531 $885 2.6×
CT head/brain without and with contrast (70470) $531 $885 2.6×
CT heart contrast eval cardiac structure&morph (75572) $1,065.60 $1,776 2.6×
CT heart no contrast quant eval coronry calcium (75571) $262.80 $438 2.6×
CT iac w contrast (70481) $531 $885 2.6×
CT lower ext w/o (73700) $317.40 $529 2.6×
CT lower extremity w/contrast material (73701) $531 $885 2.6×
CT lumbar spine w contrast (72132) $1,065.60 $1,776 2.6×
CT lumbar spine w/o contrast (72131) $317.40 $529 2.6×
CT maxillofacial w contrast (70487) $531 $885 2.6×
CT maxillofacial wo contrast (70486) $317.40 $529 2.6×
CT neck tissue combo (70492) $531 $885 2.6×
Ct Orbit/Ear/Fossa W/O&W/Dye (70482) $531 $885 2.6×
CT orbits w/o contrast (70480) $317.40 $529 2.6×
CT pelvis w&w/o contrast (72194) $531 $885 2.6×
CT pelvis w/o contrast (72192) $317.40 $529 2.6×
CT scan of leg combo (73702) $531 $885 2.6×
CT scans face/jaw combo (70488) $531 $885 2.6×
CT soft tissue neck w contrast (70491) $531 $885 2.6×
CT soft tissue neck w/o contrast (70490) $317.40 $529 2.6×
CT thoracic spine w contrast (72129) $531 $885 2.6×
CT thoracic spine w/o contrast (72128) $317.40 $529 2.6×
CT thorax w/o contrast (71250) $317.40 $529 2.6×
CT upper ext wo (73200) $317.40 $529 2.6×
CT upper extremity w/o & w/contrast material (73202) $531 $885 2.6×
CT upper extremity with contrast (73201) $1,065.60 $1,776 2.6×
Cta Abdl Aorta&Bi Iliofem W/Contrast&Postp (75635) $531 $885 2.6×
Cta Abdomen (74175) $531 $885 2.6×
CTA pelvis (72191) $531 $885 2.6×
Discography Cerv/Thor Spine (72285) $4,565.40 $7,609 2.0×
Diskography lumbar (72295) $4,565.40 $7,609 2.0×
Echo Guide For Artery Repair (76936) $929.40 $1,549 3.6×
Esophageal Motility Study (78258) $1,199.40 $1,999 2.5×
Esophagram (74220) $531 $885 2.6×
Fetal Biophys Profile W/Nst (76818) $317.40 $529 2.6×
Fetal Biophysical Profile W/O Non-Stress Testing (76819) $317.40 $529 2.6×
Fluoroscopy up to 1 hr (76000) $721.80 $1,203 2.6×
Foot 2 views (73620) $262.80 $438 2.6×
Forearm 2 views (73090) $262.80 $438 2.6×
Gastric emptying imaging study (78264) $1,199.40 $1,999 2.5×
Gastric Mucosa Imaging (78261) $1,199.40 $1,999 2.5×
Gastroesophageal Reflux Exam (78262) $1,199.40 $1,999 2.5×
Gated Heart Planar Single (78472) $1,199.40 $1,999 2.5×
Gated Heart, Multiple (78473) $1,199.40 $1,999 2.5×
Hand 2 views (73120) $317.40 $529 2.6×
Heart first pass single,planar (78481) $1,258.20 $2,097 2.0×
Heart Image (Pet) Multiple (78492) $3,410.40 $5,684 2.0×
Hepatobil Syst Image W/Drug (78227) $1,606.80 $2,678 2.5×
Hepatobiliary System Imaging (78226) $1,199.40 $1,999 2.5×
Ht Musc Image Planar Mult (78454) $3,896.40 $6,494 2.5×
Ht Muscle Image Spect Sing (78451) $3,896.40 $6,494 2.5×
Hysterosalpingogram (74740) $721.80 $1,203 2.6×
Infant hip ultrasound with hip movement (dynamic) (76885) $262.80 $438 2.6×
Infant hip ultrasound, limited static exam (76886) $262.80 $438 2.6×
Joint Survey Single View (77077) $317.40 $529 2.6×
K Flow/Funct Image Multiple (78709) $1,606.80 $2,678 2.5×
K Flow/Funct Image W/Drug (78708) $1,606.80 $2,678 2.5×
K Flow/Funct Image W/O Drug (78707) $1,606.80 $2,678 2.5×
Kidney Funcj Study Non-Img Radioisotopic Study (78725) $1,199.40 $1,999 2.5×
Kidney Imaging Morphol (78700) $1,199.40 $1,999 2.5×
Kidney Imaging Morphoogy W/Vascular Flow (78701) $1,199.40 $1,999 2.5×
Knee 3 Views (73562) $262.80 $438 2.6×
Liver & Spleen Imaging Static Only (78215) $1,199.40 $1,999 2.5×
Liver & Spleen Imaging W/Vascular Flow (78216) $1,199.40 $1,999 2.5×
Liver imaging static only (78201) $1,606.80 $2,678 2.5×
Liver imaging w/vascular flow (78202) $1,606.80 $2,678 2.5×
Lung Perf&Ventilat Diferentl (78598) $1,606.80 $2,678 2.5×
Lung perfusion differential (78597) $1,199.40 $1,999 2.5×
Lung Ventilat&Perfus Imaging (78582) $1,606.80 $2,678 2.5×
Lung Ventilation Imaging (78579) $1,199.40 $1,999 2.5×
Lymph System Imaging (78195) $1,606.80 $2,678 2.5×
Lymphangiography extremity only unilateral rs&i (75801) $1,845 $3,075 2.5×
Meckels Divert Exam (78290) $1,199.40 $1,999 2.5×
Mlc imrt design & construction per imrt plan (77338) $874.20 $1,457 2.0×
Mra Head W/O & W/Contrast Material (70546) $1,065.60 $1,776 2.6×
MRA head w/o contrast (70544) $721.80 $1,203 2.6×
Mra Neck W/O &W/Contrast Material (70549) $1,065.60 $1,776 2.6×
MRA neck w/o contrast (70547) $721.80 $1,203 2.6×
MRI abdomen w contrast (74182) $1,065.60 $1,776 2.6×
MRI abdomen w/o contrast (74181) $721.80 $1,203 2.6×
MRI any jt lower extrem w/contrast material (73722) $2,358 $3,930 2.5×
MRI any jt lower extrem w/o & w/contrast matrl (73723) $1,065.60 $1,776 2.6×
MRI any jt upper extremity w/contrast matrl (73222) $2,358 $3,930 2.5×
MRI bone marrow blood supply (77084) $721.80 $1,203 2.6×
MRI Breast W/O Contrast Bilateral (77047) $721.80 $1,203 2.6×
MRI Breast Without Contrast Material Unilateral (77046) $721.80 $1,203 2.6×
MRI cardiac w/o contrast (75557) $721.80 $1,203 2.6×
MRI cervical spine w contrast (72142) $1,065.60 $1,776 2.6×
MRI cervical spine w/o cont (72141) $721.80 $1,203 2.6×
MRI chest w/o contrast (71550) $721.80 $1,203 2.6×
MRI chest wo w contrast (71552) $1,065.60 $1,776 2.6×
MRI lower extrem oth/thn jt w/contrast matrl (73719) $1,065.60 $1,776 2.6×
MRI lower extrem oth/thn jt w/o & w/contr matr (73720) $1,065.60 $1,776 2.6×
MRI lower extrem oth/thn jt w/o contr matrl (73718) $721.80 $1,203 2.6×
Mri Neck Spine W/O & W/Dye (72156) $1,065.60 $1,776 2.6×
MRI orbit face &/neck w/o contrast (70540) $721.80 $1,203 2.6×
MRI orbit face neck w contrast (70542) $835.20 $1,392 2.0×
Mri Orbt/Fac/Nck W/O &W/Dye (70543) $1,065.60 $1,776 2.6×
MRI pelvis w contrast (72196) $1,065.60 $1,776 2.6×
MRI pelvis w/o & w contrast (72197) $1,065.60 $1,776 2.6×
MRI pelvis w/o contrast (72195) $721.80 $1,203 2.6×
MRI spectroscopy (76390) $262.80 $438 2.6×
MRI thoracic spine w/o contrast (72146) $721.80 $1,203 2.6×
MRI upper extremity oth than jt w/contr matrl (73219) $2,131.80 $3,553 5.2×
MRI upper extremity oth than jt w/o contr matrl (73218) $721.80 $1,203 2.6×
Mri Uppr Extremity W/O&W/Dye (73220) $1,065.60 $1,776 2.6×
MRI, abdomen, combo (74183) $1,065.60 $1,776 2.6×
MRI, dorsal spine combo (72157) $1,065.60 $1,776 2.6×
MRI, dorsal spine contrast (72147) $1,065.60 $1,776 2.6×
MRI, joint upper extrem (73221) $721.80 $1,203 2.6×
MRI, joint upper extrem combo (73223) $1,065.60 $1,776 2.6×
MRI, lumbar spine combo (72158) $1,065.60 $1,776 2.6×
Myelogram cervical (72240) $2,358 $3,930 2.5×
Myelogram Lumbar (72265) $2,358 $3,930 2.5×
Myelography thoracic (72255) $2,358 $3,930 2.5×
Myocardial Imaging Infarct Avid Planar Qual/Quan (78466) $1,199.40 $1,999 2.5×
Myocardial Imaging Pet Metabolic Evaluation (78459) $3,052.20 $5,087 2.0×
Myocardial imaging, infarct avid, planar; with ejection fraction by first pass technique Non-Facility (78468) $1,258.20 $2,097 2.0×
Myocardial Perfusion Planar 1 Study Rest/Stress (78453) $3,896.40 $6,494 2.5×
Myocardial Spect Multiple Studies (78452) $3,896.40 $6,494 2.5×
Neck soft tissue (70360) $262.80 $438 2.6×
Njx Rp Loclzj Non-Img Probe Study Intravenous (78808) $1,199.40 $1,999 2.5×
Nm csf leak detection (78650) $3,896.40 $6,494 2.5×
Nm myocard infarct spect (78469) $1,606.80 $2,678 2.5×
Ntsty modul radthx pln dose-vol histos (77301) $3,656.40 $6,094 2.2×
Nuclear Rx Intra-Arterial (79445) $669 $1,115 2.4×
Nuclear Rx Oral Admin (79005) $669 $1,115 2.4×
Ob us nuchal meas 1 gest (76813) $317.40 $529 2.6×
Ophthalmic us dx quantitative a-scan only (76511) $317.40 $529 2.6×
Parathyroid Planar Imaging (78070) $1,199.40 $1,999 2.5×
Parathyroid planar imaging w/wo subtraction (78071) $1,199.40 $1,999 2.5×
Pelvis 1 or 2 views (72170) $317.40 $529 2.6×
Peritoneogram Rs&I (74190) $1,282.20 $2,137 2.0×
Pet Myocardial Sngl Study (78491) $3,410.40 $5,684 2.0×
Prq Transhepatc Portograpy Hemodyn Eval Rs&I (75885) $9,394.80 $15,658 2.5×
Pulmonary Perfusion Imaging Particulate (78580) $1,199.40 $1,999 2.5×
Radex Abd Compl Aqt Abd W/S/E/D Views 1 View Ch (74022) $317.40 $529 2.6×
Radex abscess/fistula/sinus tract rs&i (76080) $1,636.80 $2,728 2.5×
Radex Ankle Complete Minimum 3 Views (73610) $262.80 $438 2.6×
Radex Calcaneus Minimum 2 Views (73650) $262.80 $438 2.6×
Radex elbow complete minimum 3 views (73080) $262.80 $438 2.6×
Radex Facial Bones Complete Minimum 3 Views (70150) $317.40 $529 2.6×
Radex fingr minimum 2 views (73140) $262.80 $438 2.6×
Radex foot complete minimum 3 views (73630) $262.80 $438 2.6×
Radex Hand Minimum 3 Views (73130) $262.80 $438 2.6×
Radex lower extremity infant minimum 2 views (73592) $262.80 $438 2.6×
Radex Nasal Bones Complete Minimum 3 Views (70160) $262.80 $438 2.6×
Radex Ribs Unilateral 2 Views (71100) $262.80 $438 2.6×
Radex shoulder complete minimum 2 views (73030) $262.80 $438 2.6×
Radex sm int w/mlt srl imges via enteroclss tube (74251) $531 $885 2.6×
Radex Spine 1 View Specify Level (72020) $262.80 $438 2.6×
Radex Sternum Minimum 2 Views (71120) $262.80 $438 2.6×
Radex Temporomandble Jt Opn & Clsd Mouth Bilat (70330) $262.80 $438 2.6×
Radex Toe Minimum 2 Views (73660) $262.80 $438 2.6×
Radex upper extremity infant minimum 2 views (73092) $317.40 $529 2.6×
Radex Wrist Complete Minimum 3 Views (73110) $262.80 $438 2.6×
Radiation treatment delivery level 1 (77402) $261.60 $436 2.2×
Radiation treatment delivery level 2 (77407) $628.20 $1,047 1.4×
Radiation treatment delivery level 3 (77412) $628.20 $1,047 1.0×
Radiolog exam mandible compl minimum 4 views (70110) $317.40 $529 2.6×
Radiologic Exam Abdomen 3+ Views - Xr Abdomen 3+ Views (74021) $317.40 $529 2.6×
Radiologic exam colon double contrast study (74280) $531 $885 2.6×
Radiologic exam colon single contrast study (74270) $531 $885 2.6×
Radiologic Exam Esophagus Double Contrast Study (74221) $531 $885 2.6×
Radiologic exam knee complete 4/more views (73564) $317.40 $529 2.6×
Radiologic exam pelvis compl minimum 3 views (72190) $317.40 $529 2.6×
Radiologic Exam Small Int Single Contrast Study (74250) $531 $885 2.6×
Radiologic exam swallow function contrast study (74230) $531 $885 2.6×
Radiologic exam upr gi trc double contrast study (74246) $531 $885 2.6×
Radiologic examination femur 1 view (73551) $262.80 $438 2.6×
Radiologic examination femur minimum 2 views (73552) $262.80 $438 2.6×
Radiologic examination knee 1/2 views (73560) $262.80 $438 2.6×
Radiologic Examination Osseous Survey Limited (77074) $317.40 $529 2.6×
Radiologic examination tibia & fibula 2 views (73590) $262.80 $438 2.6×
Renal Cyst Study (74470) $1,636.80 $2,728 2.5×
Ribs bilateral 3 views (71110) $317.40 $529 2.6×
Rp loclzj tum plnr 1 area single day imaging (78800) $1,199.40 $1,999 2.5×
Rp loclzj tum plnr 2+area 1+d img/1 area img>2+d (78801) $1,199.40 $1,999 2.5×
Rp Loclzj Tum Plnr Whole Body 2+ Days Imaging (78804) $3,896.40 $6,494 6.1×
Rp Loclzj Tum Plnr Whole Body Single Day Imaging (78802) $3,896.40 $6,494 6.1×
Rp Loclzj Tum Spect 1 Area Single Day Imaging (78803) $3,896.40 $6,494 6.1×
Rp Therapy Intravenous Administration (79101) $669 $1,115 2.4×
Salivary Gland Function Study (78232) $1,199.40 $1,999 2.5×
Salivary Gland Imaging (78230) $1,199.40 $1,999 2.5×
Salivary Gland Imaging Serial Images (78231) $1,199.40 $1,999 2.5×
Scapula (73010) $317.40 $529 2.6×
Shoulder 1 view (73020) $262.80 $438 2.6×
Shoulder Arthrography (73040) $1,065.60 $1,776 2.6×
Skull less than 4 views (70250) $317.40 $529 2.6×
Special dosimetry (77331) $316.80 $528 2.0×
Special Physics Consult (77370) $316.80 $528 2.0×
Special teletherapy port plan (77321) $874.20 $1,457 2.0×
Special treatment procedure (77470) $1,381.20 $2,302 2.1×
Spleen Imaging (78185) $1,199.40 $1,999 2.5×
Stereotactic Body Radiation Delivery (77373) $4,192.80 $6,988 2.0×
Telethx isodose pln cplx w/basic dosimetry (77307) $874.20 $1,457 2.0×
Telethx isodose pln smpl w/dosimetry calculation (77306) $874.20 $1,457 2.0×
Testicular Imaging W/Flow (78761) $1,199.40 $1,999 2.5×
Ther Rad Simulaj-Aided Field Setting Complex (77290) $893.40 $1,489 2.0×
Ther Rad Simulaj-Aided Field Setting Intermed (77285) $934.20 $1,557 2.1×
Ther rad simulaj-aided field setting simple (77280) $558.60 $931 3.5×
Therapeutic Enema Rdctj Intussusception/Obstrcj (74283) $531 $885 2.6×
Thoracic spine 2 views (72070) $317.40 $529 2.6×
Thoracic spine 3 views (72072) $317.40 $529 2.6×
Thoracolumbar 2 views (72080) $262.80 $438 2.6×
Thyroid Carcinoma Metastases Img Lmtd Area (78015) $1,199.40 $1,999 2.5×
Thyroid Met Imaging Body (78018) $1,606.80 $2,678 2.5×
Thyroid Uptake W/Blood Flow Sngle/Mult Quan Meas (78014) $1,199.40 $1,999 2.5×
Tx Devices Design & Construction Complex (77334) $874.20 $1,457 2.0×
Tx devices design & construction intermediate (77333) $316.80 $528 2.0×
Tx devices design & construction simple (77332)
range across 2 matching MRF lines		 $63–$316.80 $105–$528 varies
Ultrasound Breast Limited (76642) $262.80 $438 2.6×
Ultrasound Elastography Parenchyma (76981) $317.40 $529 2.6×
Ultrasound Exam Aaa Screen (76706) $317.40 $529 2.6×
Ultrasound, abdomen limited (76705) $317.40 $529 2.6×
Umbilical-artery Doppler (OB) (76820) $317.40 $529 2.6×
Unlisted Dx Radiographic Procedure (76499) $262.80 $438 2.6×
Upper gi w/o kub (74240) $531 $885 2.6×
Ureteral Reflux Study (78740) $1,199.40 $1,999 2.5×
Urethrocystogram voiding (74455) $721.80 $1,203 2.6×
Urethrocystography retrograde (74450) $721.80 $1,203 2.6×
Us breast unilateral complete (76641) $317.40 $529 2.6×
Us chest (76604) $317.40 $529 2.6×
Us exam, pelvic, limited (76857) $317.40 $529 2.6×
Us head (76506) $317.40 $529 2.6×
Us kidney transplant (76776) $317.40 $529 2.6×
Us lmtd joint/oth nonvasc xtr strux r-t w/img (76882) $317.40 $529 2.6×
Us ob detailed single fetus (76811) $721.80 $1,203 2.6×
Us ob limited 1 or more fetuses (76815) $317.40 $529 2.6×
Us ob transvaginal (76817) $317.40 $529 2.6×
Us pelvic non ob complete (76856) $317.40 $529 2.6×
Us pg uter img f&mat 14 wk tabdl 1/1st gestation (76801) $317.40 $529 2.6×
Us preg uterus real time f/u trnsabdl per fetus (76816) $317.40 $529 2.6×
Us retroperitoneal complete (76770) $317.40 $529 2.6×
Us retroperitoneal limited (76775) $317.40 $529 2.6×
Us scrotum and contents (76870) $317.40 $529 2.6×
Us spinal canal and contents (76800) $317.40 $529 2.6×
Us thyroid (76536) $317.40 $529 2.6×
Vein X-Ray Chest (75827) $4,636.80 $7,728 2.5×
Venography caval inferior serialography rs&i (75825) $9,394.80 $15,658 2.5×
Venography extremity bilateral rs&i (75822) $4,636.80 $7,728 2.5×
Venography extremity unilateral rs&i (75820) $4,636.80 $7,728 2.5×
Venography Renal Bilateral (75833) $9,394.80 $15,658 2.5×
Venography Renal Unilateral (75831) $9,394.80 $15,658 2.5×
Wrist 2 views (73100) $262.80 $438 2.6×
X-Ray Ac Jts - Xr Acromioclavicular Joints Bilateral (73050) $262.80 $438 2.6×
X-ray antegrade pyelogram tube (74425) $1,065.60 $1,776 2.6×
X-Ray Bend Only L-S Spine (72120) $317.40 $529 2.6×
X-Ray Elbow 2 Vw - Xr Elbow 1-2 Views Right (73070) $262.80 $438 2.6×
X-Ray Exam Breast Specimen (76098) $1,636.80 $2,728 2.5×
X-Ray Exam Entire Spi 1 Vw (72081) $262.80 $438 2.6×
X-Ray Exam Entire Spi 2/3 Vw (72082) $317.40 $529 2.6×
X-Ray Exam Hip Uni 1 View (73501) $262.80 $438 2.6×
X-Ray Exam Hip Uni 2-3 Views (73502) $262.80 $438 2.6×
X-Ray Exam Hip Uni 4/> Views (73503) $317.40 $529 2.6×
X-Ray Exam Hips Bi 2 Views (73521) $317.40 $529 2.6×
X-Ray Exam Hips Bi 3-4 Views (73522) $317.40 $529 2.6×
X-Ray Exam Hips Bi 5/> Views (73523) $317.40 $529 2.6×
X-Ray Exam L-S Spine Bending (72114) $317.40 $529 2.6×
X-Ray Exam Neck Spine 2-3 Vw (72040) $262.80 $438 2.6×
X-Ray Exam Neck Spine 6/>Vws (72052) $317.40 $529 2.6×
X-Ray Exam Unilat Ribs/Chest (71101) $317.40 $529 2.6×
X-ray eye for foreign body (70030) $262.80 $438 2.6×
X-ray humerus (73060) $262.80 $438 2.6×
X-ray IV pyelogram (ivp) (74400) $531 $885 2.6×
X-Ray Jaw <4 Vw - Xr Mandible < 4 Views (70100) $262.80 $438 2.6×
X-Ray Knee Bilat Standing - Xr Knees Anteroposterior Standing Bilat (73565) $262.80 $438 2.6×
X-Ray Lumbar Spine 2/3 Vw - Xr Lumbar Spine 2-3 Views (72100) $317.40 $529 2.6×
X-ray nose-rectum child f.b. (76010) $262.80 $438 2.6×
X-Ray Ribs, Chest 4+ Vw - Xr Ribs 3 Vws Bil W/ Chest Posteroanterior (71111) $317.40 $529 2.6×
X-Ray Sacroiliac Jts 3+ Vw - Xr Sacroiliac Joints 3+ Views (72202) $317.40 $529 2.6×
X-Ray Sacroiliac Jts <3 Vw - Xr Sacroiliac Joints 1-2 Views (72200) $317.40 $529 2.6×
X-Ray Sacrum/Coccyx 2+ Vw - Xr Sacrum Coccyx 2+ Views (72220) $262.80 $438 2.6×
X-Ray Sinuses 3+ Vw - Xr Paranasal Sinuses 3+ Views (70220) $262.80 $438 2.6×
X-Ray Skull 4+ Vw - Xr Skull Complete 4+ Views (70260) $317.40 $529 2.6×
X-Ray Stress View (77071) $205.80 $343 2.0×
X-ray thoracic spine 4 vw (72074) $317.40 $529 2.6×
X-Ray Tmj Unilat (70328) $262.80 $438 2.6×
X-Ray Urinary Tract Exam With Contrast Material (74420) $1,065.60 $1,776 2.6×
X-Rays Bone Length Studies (77073) $317.40 $529 2.6×
X-Rays Bone Survey Complete (77075) $317.40 $529 2.6×
Xr c-spine 4 or 5 views (72050) $317.40 $529 2.6×
Xr facial bones less than 3 views (70140) $262.80 $438 2.6×
Xr orbits complete 4 views (70200) $317.40 $529 2.6×

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.