Imaging prices at Holzer Medical Center - Gallipolis

Gallipolis, OH · every code in this section with a posted price and a Medicare benchmark.

357 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) $2,717 $5,434 2.1×
Abdomen 1 View (74018) $170.50 $341 2.1×
Abdomen 2 views (74019) $226.50 $453 2.3×
Acute Gastrointestinal Blood Loss Imaging (78278) $385 $770 1.0×
Adrenal Cortex & Medulla Img (78075) $1,763 $3,526 1.4×
Angio internal mammary (75756) $633 $1,266 0.2×
Angio pulmonary bilat (75743) $760 $1,520 0.3×
Angiography Adrenal Bilateral Slctv Rs&I (75733) $633 $1,266 0.2×
Angiography extremity bilateral rs&i (75716) $1,135.50 $2,271 0.4×
Angiography extremity unilateral rs&i (75710) $977 $1,954 0.3×
Angiography pulmonary unilateral slctv rs&i (75741) $633 $1,266 0.2×
Angrph pulmonary nonslctv cath/ven njx rs&i (75746) $633 $1,266 0.2×
Ankle 2 views (73600) $170 $340 2.1×
Aortography thoracic serialography rs&i (75605)
likely a partial charge, not the full procedure		 $633 $1,266 0.1×
Artery X-Rays Abdomen (75726)
likely a partial charge, not the full procedure		 $507 $1,014 0.1×
Artery X-Rays Adrenal Gland (75731) $572 $1,144 0.2×
Artery X-Rays Pelvis (75736)
likely a partial charge, not the full procedure		 $760 $1,520 0.1×
Artery X-Rays Spine (75705)
likely a partial charge, not the full procedure		 $702 $1,404 0.1×
Arthrogram hip (73525) $246 $492 0.7×
Arthrogram Wrist (73115) $522 $1,044 1.6×
Basic radiation dosimetry calculation (77300) $184.50 $369 1.5×
Bone age studies (77072) $165.50 $331 1.7×
Bone Imaging 3 Phase (78315) $938.50 $1,877 2.5×
Bone Imaging Limited Area (78300) $444.50 $889 1.2×
Bone Imaging Whole Body (78306) $967.50 $1,935 2.6×
Bone survey infant (77076) $252.50 $505 2.6×
Brachytx isodose complex (77318) $529.50 $1,059 1.5×
Brachytx isodose intermed (77317) $529.50 $1,059 1.5×
Brachytx Isodose Plan Simple (77316) $190 $380 0.5×
Brain Imaging Min 4 Static Views W Vascular Flow (78606) $740.50 $1,481 1.4×
Brain Imaging Pet Metabolic Evaluation (78608) $3,711 $7,422 2.7×
Cat Scan Follow-Up Study (76380) $93 $186 1.1×
Cerebrospinal fluid flow, imaging (not including introduction of material); ventriculography Non-Facility (78635) $849 $1,698 1.7×
Chest 1 view (71045) $138.50 $277 1.7×
Chest 2 views (71046) $199 $398 2.4×
Chest 3 views (71047) $199 $398 2.4×
Chest 4 or more views (71048) $199 $398 2.0×
Cholecystography Oral Contrast (74290) $157.50 $315 0.9×
Clavicle complete (73000) $170 $340 2.1×
Computed Tomography Thorax Lw Dose Lng Ca Scr C- (71271) $149 $298 1.5×
Continuing medical physics consltj pr wk (77336) $240.50 $481 1.9×
Contrast Exam Abdominl Aorta (75625) $2,389 $4,778 0.8×
Contrast X-Ray Bladder (74430) $304.50 $609 0.9×
Contrast X-Ray Of Elbow (73085) $812.50 $1,625 2.5×
Contrast X-Ray Of Knee Joint (73580) $769.50 $1,539 2.3×
CT abdomen and pelvis without and with contrast (74178) $2,275 $4,550 6.9×
CT abdomen and pelvis without contrast (74176) $1,747.50 $3,495 7.7×
CT abdomen w contrast (74160) $1,523 $3,046 9.2×
CT abdomen w wo contrast (74170) $1,591.50 $3,183 9.6×
CT abdomen w/o contrast (74150) $1,038 $2,076 10.5×
CT Angio Abdomen and Pelvis (74174) $2,223.50 $4,447 6.7×
CT Angio Chest (71275) $1,561 $3,122 9.4×
CT Angio Head (70496) $1,561 $3,122 9.4×
CT angio hrt w/3d image (75574) $210.50 $421 0.6×
Ct Angio Lwr Extr W/O&W/Dye (73706) $1,561 $3,122 9.4×
CT Angio Neck (70498) $1,561 $3,122 9.4×
Ct Angio Upr Extrm W/O&W/Dye (73206) $1,561 $3,122 9.4×
CT cervical spine w/ contrast (72126) $1,538 $3,076 4.7×
CT cervical spine w/o contrast (72125) $1,463 $2,926 14.8×
CT cervical spine w/wo cont (72127) $1,836 $3,672 11.1×
CT chest w contrast (71260) $1,385.50 $2,771 8.3×
CT chest w/wo contrast (71270) $1,453.50 $2,907 8.8×
CT head/brain with contrast (70460) $1,400 $2,800 8.4×
CT head/brain without and with contrast (70470) $1,638.50 $3,277 9.9×
CT heart contrast eval cardiac structure&morph (75572) $1,394.50 $2,789 4.2×
CT heart no contrast quant eval coronry calcium (75571) $109 $218 1.3×
CT hrt w/3d image congen (75573) $210.50 $421 0.6×
CT iac w contrast (70481) $1,674 $3,348 10.1×
CT l-spine w&w/o contrast (72133) $1,836 $3,672 11.1×
CT lower ext w/o (73700) $780.50 $1,561 7.9×
CT lower extremity w/contrast material (73701) $874 $1,748 5.3×
CT lumbar spine w contrast (72132) $1,538 $3,076 4.7×
CT lumbar spine w/o contrast (72131) $1,463 $2,926 14.8×
CT maxillofacial w contrast (70487) $1,800 $3,600 10.8×
CT maxillofacial wo contrast (70486) $986.50 $1,973 10.0×
CT neck tissue combo (70492) $1,493 $2,986 9.0×
Ct Orbit/Ear/Fossa W/O&W/Dye (70482) $1,492.50 $2,985 9.0×
CT orbits w/o contrast (70480) $1,246 $2,492 12.6×
CT pelvis w&w/o contrast (72194) $1,051 $2,102 6.3×
CT pelvis w/o contrast (72192) $826.50 $1,653 8.4×
CT scan of leg combo (73702) $1,006.50 $2,013 6.1×
CT scans face/jaw combo (70488) $2,257 $4,514 13.6×
CT soft tissue neck w contrast (70491) $1,241 $2,482 7.5×
CT soft tissue neck w/o contrast (70490) $1,028 $2,056 10.4×
CT thoracic spine w contrast (72129) $1,538 $3,076 9.3×
CT thoracic spine w/o contrast (72128) $1,463 $2,926 14.8×
CT thoracic spine w/wo cont (72130) $1,636 $3,272 9.9×
CT thorax w/o contrast (71250) $1,111.50 $2,223 11.2×
CT unlisted procedure (76497) $111 $222 1.3×
CT upper ext wo (73200) $1,246 $2,492 12.6×
CT upper extremity w/o & w/contrast material (73202) $1,264 $2,528 7.6×
CT upper extremity with contrast (73201)
range across 6 matching MRF lines		 $1,283.50–$1,322 $2,567–$2,644 varies
Cta Abdl Aorta&Bi Iliofem W/Contrast&Postp (75635) $1,790 $3,580 10.8×
Cta Abdomen (74175) $1,561 $3,122 9.4×
CTA pelvis (72191) $1,561 $3,122 9.4×
Dacryocystography, nasolacrimal duct, radiological supervision and interpretation Non-Facility (70170) $379.50 $759 1.7×
Dilation ureters/urethra rs&i (74485) $410.50 $821 0.2×
Discography Cerv/Thor Spine (72285) $360 $720 0.2×
Diskography lumbar (72295) $360 $720 0.2×
Dxa Bone Density Axial (77080) $187.50 $375 1.9×
Dxa bone density study 1/>sites appendiclr skel (77081) $139.50 $279 1.7×
Echo exam uterus (76831) $460 $920 2.0×
Echo Guide For Artery Repair (76936) $341 $682 1.7×
Echograp Trans R Pros Study (76873) $199 $398 2.0×
Esophagram (74220) $396.50 $793 2.4×
Fetal Biophysical Profile W/O Non-Stress Testing (76819) $518 $1,036 5.2×
Fluoroscopy up to 1 hr (76000) $432 $864 1.9×
Follow-Up Angiography (75898) $456 $912 0.2×
Foot 2 views (73620) $170 $340 2.1×
Forearm 2 views (73090) $163.50 $327 2.0×
Gastric emptying imaging study (78264) $1,221 $2,442 3.2×
Gastroesophageal Reflux Exam (78262) $810 $1,620 2.1×
Gated Heart Planar Single (78472) $1,012 $2,024 2.7×
Hand 2 views (73120) $157 $314 1.6×
Heart Image (Pet) Multiple (78492) $3,711 $7,422 2.7×
Hepatc Vngrph Wdg/Fr W/O Hemodyn Eval Rs&I (75891) $855.50 $1,711 0.3×
Hepatobil Syst Image W/Drug (78227) $1,113 $2,226 2.2×
Hepatobiliary System Imaging (78226) $952 $1,904 2.5×
Ht Muscle Image Spect Sing (78451) $1,335.50 $2,671 1.1×
Hysterosalpingogram (74740) $292.50 $585 1.3×
Image fusion (77399) $175 $350 1.4×
Infant hip ultrasound with hip movement (dynamic) (76885) $205 $410 2.5×
Infant hip ultrasound, limited static exam (76886) $258.50 $517 3.1×
Infusion Ivp (74410) $339.50 $679 2.0×
Interstitial radiation source applic complex (77778) $1,475.50 $2,951 2.2×
Intracavitary Radiation Source Applic Complex (77763) $762.50 $1,525 1.2×
Intracavitary Radiation Source Applic Intermed (77762) $692.50 $1,385 1.3×
Intracavitary radiation source applic simple (77761) $620.50 $1,241 1.2×
Joint Survey Single View (77077) $224 $448 2.3×
K Flow/Funct Image Multiple (78709) $784 $1,568 1.5×
K Flow/Funct Image W/Drug (78708) $784 $1,568 1.5×
K Flow/Funct Image W/O Drug (78707) $434 $868 0.8×
Knee 3 Views (73562) $224 $448 2.7×
Liver & Spleen Imaging Static Only (78215) $449 $898 1.2×
Lung Perf&Ventilat Diferentl (78598) $341 $682 0.7×
Lung perfusion differential (78597) $341 $682 0.9×
Lung Ventilat&Perfus Imaging (78582) $975.50 $1,951 1.9×
Lung Ventilation Imaging (78579) $341 $682 0.9×
Lymph System Imaging (78195) $896 $1,792 1.7×
Lymphangiography Extremity Only Bilateral Rs&I (75803) $919.50 $1,839 0.6×
Lymphangiography extremity only unilateral rs&i (75801) $664.50 $1,329 1.1×
Magnetic Image Jaw Joint (70336) $802.50 $1,605 3.6×
Meckels Divert Exam (78290) $552.50 $1,105 1.5×
Mlc imrt design & construction per imrt plan (77338) $490.50 $981 1.4×
Mra Head W/O & W/Contrast Material (70546)
range across 4 matching MRF lines		 $1,366–$1,730.50 $2,732–$3,461 varies
MRA head w/o contrast (70544) $1,033 $2,066 4.6×
MRA head with contrast (70545) $828 $1,656 2.5×
MRA neck w contrast (70548) $1,200.50 $2,401 3.6×
Mra Neck W/O &W/Contrast Material (70549) $1,782.50 $3,565 5.4×
MRA neck w/o contrast (70547) $802.50 $1,605 3.6×
MRI abdomen w contrast (74182) $914 $1,828 2.8×
MRI abdomen w/o contrast (74181) $1,017 $2,034 4.5×
MRI any jt lower extrem w/contrast material (73722) $1,417.50 $2,835 1.9×
MRI any jt lower extrem w/o & w/contrast matrl (73723) $1,779 $3,558 5.4×
MRI any jt upper extremity w/contrast matrl (73222) $1,427.50 $2,855 1.9×
MRI Breast W/O Contrast Bilateral (77047) $1,928 $3,856 8.5×
MRI Breast Without Contrast Material Unilateral (77046) $788 $1,576 3.5×
MRI cervical spine w contrast (72142) $1,236.50 $2,473 3.7×
MRI cervical spine w/o cont (72141) $1,075 $2,150 4.8×
MRI chest w/o contrast (71550) $812.50 $1,625 3.6×
MRI chest wo w contrast (71552) $1,779 $3,558 5.4×
MRI lower extrem oth/thn jt w/o & w/contr matr (73720) $1,951 $3,902 5.9×
MRI lower extrem oth/thn jt w/o contr matrl (73718) $1,006 $2,012 4.5×
MRI lumbar spine w contrast (72149) $906 $1,812 2.7×
Mri Neck Spine W/O & W/Dye (72156) $2,043 $4,086 6.2×
MRI orbit face &/neck w/o contrast (70540) $812.50 $1,625 3.6×
MRI orbit face neck w contrast (70542) $743 $1,486 2.3×
Mri Orbt/Fac/Nck W/O &W/Dye (70543) $1,779 $3,558 5.4×
MRI pelvis w contrast (72196) $764.50 $1,529 2.3×
MRI pelvis w/o & w contrast (72197) $2,015 $4,030 6.1×
MRI pelvis w/o contrast (72195) $1,017 $2,034 4.5×
MRI thoracic spine w/o contrast (72146) $1,192 $2,384 5.3×
MRI upper extremity oth than jt w/contr matrl (73219) $941.50 $1,883 2.9×
MRI upper extremity oth than jt w/o contr matrl (73218) $846 $1,692 3.7×
Mri Uppr Extremity W/O&W/Dye (73220)
range across 13 matching MRF lines		 $1,062.50–$1,561 $2,125–$3,122 varies
MRI, abdomen, combo (74183) $1,814 $3,628 5.5×
MRI, dorsal spine combo (72157) $1,852.50 $3,705 5.6×
MRI, dorsal spine contrast (72147) $781.50 $1,563 2.4×
MRI, joint upper extrem (73221) $1,058 $2,116 4.7×
MRI, joint upper extrem combo (73223) $1,868.50 $3,737 5.7×
MRI, lumbar spine combo (72158) $1,782.50 $3,565 5.4×
Myelogram cervical (72240) $717.50 $1,435 1.0×
Myelogram Lumbar (72265) $717.50 $1,435 1.0×
Myelography thoracic (72255) $855.50 $1,711 1.2×
Myelograpy 2/more regions rs&i (72270) $1,028 $2,056 1.4×
Myocardial Imaging Pet Metabolic Evaluation (78459) $3,711 $7,422 3.0×
Myocardial Spect Multiple Studies (78452) $2,210 $4,420 1.8×
Neck soft tissue (70360) $177.50 $355 2.2×
Nfs/Instlj Radioelmnt Sln 3 Mo Follow-Up Care (77750) $430 $860 1.2×
Nm csf leak detection (78650) $854 $1,708 0.7×
Nm myocard infarct spect (78469) $618.50 $1,237 1.2×
Ntsty modul radthx pln dose-vol histos (77301) $3,017.50 $6,035 2.3×
Nuclear Rx Oral Admin (79005) $976.50 $1,953 4.4×
Ob us nuchal meas 1 gest (76813) $351.50 $703 3.6×
Optic foramina (70190) $166.50 $333 2.0×
Parathyroid Planar Imaging (78070) $730 $1,460 1.9×
Pelvis 1 or 2 views (72170) $167 $334 1.7×
Pet Image W/Ct Lmtd (78814) $2,928 $5,856 2.2×
PET image w/CT, full body (78816) $3,711 $7,422 2.7×
PET imaging CT attenuation skull base mid-thigh (78815) $3,711 $7,422 2.7×
Pet Myocardial Sngl Study (78491) $3,168 $6,336 2.3×
Pulmonary Perfusion Imaging Particulate (78580) $635 $1,270 1.7×
Radex Abd Compl Aqt Abd W/S/E/D Views 1 View Ch (74022) $341.50 $683 3.5×
Radex abscess/fistula/sinus tract rs&i (76080) $281 $562 0.5×
Radex Ankle Complete Minimum 3 Views (73610) $180.50 $361 2.2×
Radex Calcaneus Minimum 2 Views (73650) $192.50 $385 2.3×
Radex elbow complete minimum 3 views (73080) $176 $352 2.1×
Radex Facial Bones Complete Minimum 3 Views (70150) $292.50 $585 3.0×
Radex fingr minimum 2 views (73140) $152.50 $305 1.9×
Radex foot complete minimum 3 views (73630) $232 $464 2.8×
Radex Hand Minimum 3 Views (73130) $175.50 $351 2.1×
Radex lower extremity infant minimum 2 views (73592) $95.50 $191 1.2×
Radex Mastoids Compl Minimum 3 Views PR Side (70130) $232 $464 2.3×
Radex Nasal Bones Complete Minimum 3 Views (70160) $175 $350 2.1×
Radex Ribs Unilateral 2 Views (71100) $181.50 $363 2.2×
Radex shoulder complete minimum 2 views (73030) $176.50 $353 2.1×
Radex Sinuses Paransl < 3 Views (70210) $126 $252 1.5×
Radex Spine 1 View Specify Level (72020) $124.50 $249 1.5×
Radex Sternum Minimum 2 Views (71120) $223.50 $447 2.7×
Radex Temporomandble Jt Opn & Clsd Mouth Bilat (70330) $268 $536 3.3×
Radex Toe Minimum 2 Views (73660) $155.50 $311 1.9×
Radex upper extremity infant minimum 2 views (73092) $107 $214 1.1×
Radex Wrist Complete Minimum 3 Views (73110) $176 $352 2.1×
Radiation treatment delivery level 1 (77402) $169 $338 1.8×
Radiation treatment delivery level 2 (77407) $322.50 $645 0.9×
Radiation treatment delivery level 3 (77412) $451.50 $903 0.9×
Radiolog exam mandible compl minimum 4 views (70110) $186 $372 1.9×
Radiologic Exam Abdomen 3+ Views - Xr Abdomen 3+ Views (74021) $158 $316 1.6×
Radiologic exam colon double contrast study (74280) $740.50 $1,481 4.5×
Radiologic exam colon single contrast study (74270) $570 $1,140 3.4×
Radiologic Exam Esophagus Double Contrast Study (74221) $272.50 $545 1.6×
Radiologic exam knee complete 4/more views (73564) $226.50 $453 2.3×
Radiologic exam pelvis compl minimum 3 views (72190) $208 $416 2.1×
Radiologic Exam Small Int Single Contrast Study (74250) $408.50 $817 2.5×
Radiologic exam swallow function contrast study (74230) $147 $294 0.9×
Radiologic exam upr gi trc double contrast study (74246) $503 $1,006 3.0×
Radiologic examination femur 1 view (73551) $110.50 $221 1.3×
Radiologic examination femur minimum 2 views (73552) $175 $350 2.1×
Radiologic examination knee 1/2 views (73560) $168.50 $337 2.0×
Radiologic Examination Osseous Survey Limited (77074) $165.50 $331 1.7×
Radiologic Examination Salivary Gland Calculus (70380) $126 $252 1.5×
Radiologic examination tibia & fibula 2 views (73590) $171 $342 2.1×
Radiologic examination, internal auditory meati, complete Non-Facility (70134) $277.50 $555 0.5×
Ribs bilateral 3 views (71110) $204 $408 2.1×
Rp loclzj tum plnr 1 area single day imaging (78800) $520.50 $1,041 1.4×
Rp loclzj tum plnr 2+area 1+d img/1 area img>2+d (78801) $831.50 $1,663 2.2×
Rp Loclzj Tum Plnr Whole Body 2+ Days Imaging (78804) $838.50 $1,677 1.6×
Rp Loclzj Tum Plnr Whole Body Single Day Imaging (78802) $671.50 $1,343 1.3×
Rp Loclzj Tum Spect 1 Area Single Day Imaging (78803)
range across 2 matching MRF lines		 $765–$955.50 $1,530–$1,911 varies
Salivary Gland Imaging (78230) $379.50 $759 1.0×
Salivary Gland Imaging Serial Images (78231) $379.50 $759 1.0×
Scapula (73010) $99 $198 1.0×
Screening Digital Breast Tomosynthesis Bi (77063) $30.50 $61 1.3×
Sella turcica (70240) $101.50 $203 1.2×
Shoulder 1 view (73020) $107.50 $215 1.3×
Shoulder Arthrography (73040) $522 $1,044 1.6×
Skull less than 4 views (70250) $135 $270 1.4×
Special dosimetry (77331) $184.50 $369 1.5×
Special Physics Consult (77370) $184.50 $369 1.5×
Special teletherapy port plan (77321) $515 $1,030 1.5×
Special treatment procedure (77470) $860.50 $1,721 1.6×
Stereotactic Body Radiation Delivery (77373) $2,448 $4,896 1.4×
Sternoclavicular joints (71130) $112 $224 1.4×
Surface Applic Low Dose Rate Radionuclide Source (77789) $161 $322 1.7×
Telethx isodose pln cplx w/basic dosimetry (77307) $381.50 $763 1.1×
Telethx isodose pln smpl w/dosimetry calculation (77306) $190 $380 0.5×
Testicular Imaging W/Flow (78761) $581.50 $1,163 1.5×
Ther Rad Simulaj-Aided Field Setting Complex (77290) $837 $1,674 2.4×
Ther Rad Simulaj-Aided Field Setting Intermed (77285) $491 $982 1.4×
Ther rad simulaj-aided field setting simple (77280) $457 $914 3.6×
Therapeutic Enema Rdctj Intussusception/Obstrcj (74283) $171 $342 1.0×
Thoracic spine 2 views (72070) $171.50 $343 1.7×
Thoracic spine 3 views (72072) $275.50 $551 2.8×
Thyroid Imaging With Vascular Flow (78013) $536 $1,072 1.4×
Thyroid Met Imaging Body (78018) $882.50 $1,765 1.7×
Thyroid Uptake Measurement (78012) $393 $786 1.0×
Thyroid Uptake W/Blood Flow Sngle/Mult Quan Meas (78014) $603 $1,206 1.6×
Tx Devices Design & Construction Complex (77334) $425 $850 1.2×
Tx devices design & construction intermediate (77333) $374.50 $749 2.9×
Tx devices design & construction simple (77332) $340.50 $681 2.7×
Ultrasound Breast Limited (76642) $289.50 $579 3.5×
Ultrasound Exam Aaa Screen (76706) $175.50 $351 1.8×
Ultrasound, abdomen limited (76705) $498 $996 5.0×
Umbilical-artery Doppler (OB) (76820) $356 $712 3.6×
Unlisted Procedure Clinical Brachytherapy (77799) $692.50 $1,385 7.2×
Upper gi w/o kub (74240) $510 $1,020 3.1×
Ureteral Reflux Study (78740) $548 $1,096 1.4×
Urethrocystogram voiding (74455) $193.50 $387 0.9×
Urethrocystography retrograde (74450) $267.50 $535 1.2×
Us breast unilateral complete (76641) $579 $1,158 5.9×
Us chest (76604) $289.50 $579 2.9×
Us complete joint (76881) $472.50 $945 4.8×
Us exam, pelvic, limited (76857) $195 $390 2.0×
Us head (76506) $370.50 $741 3.7×
Us kidney transplant (76776) $381.50 $763 3.9×
Us lmtd joint/oth nonvasc xtr strux r-t w/img (76882) $426 $852 4.3×
Us ob detailed single fetus (76811) $639.50 $1,279 2.8×
Us ob limited 1 or more fetuses (76815) $448.50 $897 4.5×
Us ob transvaginal (76817) $483.50 $967 4.9×
Us pelvic non ob complete (76856) $460 $920 4.7×
Us pg uter img f&mat 14 wk tabdl 1/1st gestation (76801) $673 $1,346 6.8×
Us preg uterus real time f/u trnsabdl per fetus (76816) $307 $614 3.1×
Us retroperitoneal complete (76770) $455.50 $911 4.6×
Us retroperitoneal limited (76775) $341.50 $683 3.5×
Us scrotum and contents (76870) $520 $1,040 5.3×
Us thyroid (76536) $406 $812 4.1×
Us transrectal (76872) $584.50 $1,169 5.9×
Vein X-Ray Chest (75827) $1,027.50 $2,055 0.7×
Venogram Sinus/Jugular (75860) $1,027.50 $2,055 0.3×
Venography Adrenal Unilateral (75840) $727 $1,454 0.2×
Venography caval inferior serialography rs&i (75825) $1,027.50 $2,055 0.3×
Venography extremity bilateral rs&i (75822) $719 $1,438 0.5×
Venography extremity unilateral rs&i (75820) $513.50 $1,027 0.3×
Venography Renal Bilateral (75833) $855.50 $1,711 0.3×
Venography Renal Unilateral (75831) $727 $1,454 0.2×
Venous sampling by catheter (75893)
likely a partial charge, not the full procedure		 $791 $1,582 0.2×
Wrist 2 views (73100) $160 $320 1.9×
X-Ray Ac Jts - Xr Acromioclavicular Joints Bilateral (73050) $134 $268 1.6×
X-ray antegrade pyelogram tube (74425) $443.50 $887 1.3×
X-Ray Aorta Leg Arteries (75630) $633 $1,266 0.2×
X-Ray Bend Only L-S Spine (72120) $259.50 $519 2.6×
X-Ray Elbow 2 Vw - Xr Elbow 1-2 Views Right (73070) $188 $376 2.3×
X-Ray Exam Breast Specimen (76098) $342.50 $685 0.7×
X-Ray Exam Entire Spi 1 Vw (72081) $114.50 $229 1.4×
X-Ray Exam Entire Spi 2/3 Vw (72082) $292.50 $585 3.0×
X-Ray Exam Hip Uni 1 View (73501) $109 $218 1.3×
X-Ray Exam Hip Uni 2-3 Views (73502) $124.50 $249 1.5×
X-Ray Exam Hips Bi 2 Views (73521) $147 $294 1.5×
X-Ray Exam Hips Bi 3-4 Views (73522) $122.50 $245 1.2×
X-Ray Exam L-S Spine Bending (72114) $494.50 $989 5.0×
X-Ray Exam Neck Spine 2-3 Vw (72040) $210.50 $421 2.6×
X-Ray Exam Neck Spine 6/>Vws (72052) $359.50 $719 3.6×
X-Ray Exam Unilat Ribs/Chest (71101) $220 $440 2.2×
X-ray eye for foreign body (70030) $146.50 $293 1.8×
X-ray humerus (73060) $198 $396 2.4×
X-ray IV pyelogram (ivp) (74400) $443.50 $887 2.7×
X-ray IV pyelogram+tomography (74415) $432 $864 2.6×
X-Ray Jaw <4 Vw - Xr Mandible < 4 Views (70100) $134 $268 1.6×
X-Ray Knee Bilat Standing - Xr Knees Anteroposterior Standing Bilat (73565) $181.50 $363 2.2×
X-Ray Lumbar Spine 2/3 Vw - Xr Lumbar Spine 2-3 Views (72100) $224.50 $449 2.3×
X-ray nose-rectum child f.b. (76010) $75.50 $151 0.9×
X-Ray Ribs, Chest 4+ Vw - Xr Ribs 3 Vws Bil W/ Chest Posteroanterior (71111) $313 $626 3.2×
X-Ray Sacroiliac Jts 3+ Vw - Xr Sacroiliac Joints 3+ Views (72202) $181 $362 1.8×
X-Ray Sacroiliac Jts <3 Vw - Xr Sacroiliac Joints 1-2 Views (72200) $92.50 $185 0.9×
X-Ray Sacrum/Coccyx 2+ Vw - Xr Sacrum Coccyx 2+ Views (72220) $211.50 $423 2.6×
X-Ray Sinuses 3+ Vw - Xr Paranasal Sinuses 3+ Views (70220) $281 $562 3.4×
X-Ray Skull 4+ Vw - Xr Skull Complete 4+ Views (70260) $281 $562 2.8×
X-ray thoracic spine 4 vw (72074) $235.50 $471 2.4×
X-Ray Tmj Unilat (70328) $104.50 $209 1.3×
X-Ray Urinary Tract Exam With Contrast Material (74420) $447 $894 1.4×
X-Rays Bone Length Studies (77073) $175 $350 1.8×
X-Rays Bone Survey Complete (77075) $406.50 $813 4.1×
Xr c-spine 4 or 5 views (72050) $310.50 $621 3.1×
Xr facial bones less than 3 views (70140) $140 $280 1.7×
XR Mastoids < 3 Views Bilateral (70120) $184 $368 1.9×
Xr orbits complete 4 views (70200) $204.50 $409 2.1×
Xr Tomogram Single Plane (76100) $560.50 $1,121 5.7×

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.