Imaging prices at Intermountain Health Intermountain Medical Center
Murray, UT · every code in this section with a posted price and a Medicare benchmark.
412 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) | $5,268.93 | $7,025.24 | 3.8× |
| Abdomen 1 View (74018) | $305.65 | $407.53 | 3.5× |
| Abdomen 2 views (74019) | $360.43 | $480.57 | 3.4× |
| Acute Gastrointestinal Blood Loss Imaging (78278) | $1,643.74 | $2,191.65 | 4.1× |
| Angio internal mammary (75756) | $5,702.99 | $7,603.99 | 1.8× |
| Angio pulmonary bilat (75743) | $3,141.10 | $4,188.13 | 1.0× |
| Angiography Adrenal Bilateral Slctv Rs&I (75733) | $5,535.61 | $7,380.81 | 1.7× |
| Angiography extremity bilateral rs&i (75716) | $3,116.62 | $4,155.49 | 1.0× |
| Angiography extremity unilateral rs&i (75710) | $2,760.02 | $3,680.03 | 0.9× |
| Angiography pulmonary unilateral slctv rs&i (75741) | $2,837.23 | $3,782.97 | 0.9× |
| Angrph pulmonary nonslctv cath/ven njx rs&i (75746) | $2,620.46 | $3,493.95 | 0.8× |
| Ankle 2 views (73600) range across 2 matching MRF lines |
$221.64–$246.26 | $295.52–$328.35 | varies |
| Aortography thoracic serialography rs&i (75605) | $12,274.16 | $16,365.54 | 2.2× |
| Aortography thoracic w/o serialography rs&i (75600) | $2,102.86 | $2,803.81 | 0.7× |
| Artery X-Rays Abdomen (75726) likely a partial charge, not the full procedure |
$1,547.13 | $2,062.84 | 0.3× |
| Artery X-Rays Adrenal Gland (75731) | $2,436.68 | $3,248.91 | 0.8× |
| Artery X-Rays Pelvis (75736) | $2,944.89 | $3,926.52 | 0.5× |
| Artery X-Rays Spine (75705) | $3,031.38 | $4,041.84 | 0.5× |
| Arthrogram ankle (73615) | $677.39 | $903.19 | 1.9× |
| Arthrogram hip (73525) | $717.74 | $956.99 | 2.0× |
| Arthrogram Wrist (73115) | $746.03 | $994.71 | 2.1× |
| Basic radiation dosimetry calculation (77300) | $423.43 | $564.57 | 3.1× |
| Bone age studies (77072) | $249.63 | $332.84 | 2.4× |
| Bone Imaging 3 Phase (78315) | $2,059.17 | $2,745.56 | 5.1× |
| Bone Imaging Limited Area (78300) | $1,666.66 | $2,222.21 | 4.1× |
| Bone Imaging Multiple Areas (78305) | $2,040.25 | $2,720.33 | 5.0× |
| Bone Imaging Whole Body (78306) | $1,854.01 | $2,472.01 | 4.6× |
| Bone marrow imaging limited area (78102) | $657.73 | $876.97 | 1.6× |
| Bone marrow imaging; whole body (78104) | $901.89 | $1,202.52 | 2.2× |
| Bone survey infant (77076) | $963.03 | $1,284.04 | 9.1× |
| Brachytx isodose complex (77318) | $3,107.50 | $4,143.33 | 8.2× |
| Brachytx Isodose Plan Simple (77316) | $1,687.17 | $2,249.56 | 4.5× |
| Brain Flow Imaging Only (78610) | $1,732.35 | $2,309.80 | 3.2× |
| Brain Imaging Min 4 Static Views W Vascular Flow (78606) | $1,256.14 | $1,674.86 | 2.3× |
| Brain Imaging Pet Metabolic Evaluation (78608) | $8,532.76 | $11,377.02 | 5.9× |
| Cardiac MRI w/w/o contrast & further seq (75561) | $3,332.05 | $4,442.73 | 9.4× |
| Cardiac MRI w/w/o contrast w/stress (75563) | $4,416.27 | $5,888.36 | 5.6× |
| Cerebrospinal Fluid Flow W/O Matl Shunt Evaltj (78645) | $1,110.11 | $1,480.15 | 2.0× |
| Cerebrospinal Fluid Scan (78630) | $1,754.99 | $2,339.99 | 3.2× |
| Chest 1 view (71045) | $302.71 | $403.62 | 3.4× |
| Chest 2 views (71046) | $357.84 | $477.12 | 4.1× |
| Chest 3 views (71047) | $350.97 | $467.96 | 4.0× |
| Chest 4 or more views (71048) | $427.52 | $570.02 | 4.0× |
| Clavicle complete (73000) range across 2 matching MRF lines |
$292.83–$333.51 | $390.44–$444.68 | varies |
| Computed Tomography Thorax Lw Dose Lng Ca Scr C- (71271) | $1,794.44 | $2,392.59 | 17.0× |
| Continuing medical physics consltj pr wk (77336) | $447.02 | $596.02 | 3.3× |
| Contrast Exam Abdominl Aorta (75625) | $2,974.09 | $3,965.45 | 0.9× |
| Contrast X-Ray Bladder (74430) | $494.28 | $659.04 | 1.4× |
| Contrast X-Ray Of Elbow (73085) | $508.16 | $677.54 | 1.4× |
| Contrast X-Ray Of Knee Joint (73580) | $559.76 | $746.35 | 1.6× |
| CT abdomen and pelvis without and with contrast (74178) | $4,794.50 | $6,392.67 | 13.6× |
| CT abdomen and pelvis without contrast (74176) | $2,808.44 | $3,744.58 | 11.6× |
| CT abdomen w contrast (74160) | $2,337.77 | $3,117.03 | 13.2× |
| CT abdomen w wo contrast (74170) | $2,453.05 | $3,270.73 | 13.8× |
| CT abdomen w/o contrast (74150) | $1,784.28 | $2,379.04 | 16.9× |
| CT Angio Abdomen and Pelvis (74174) | $2,651.20 | $3,534.94 | 7.5× |
| CT Angio Chest (71275) | $2,637.86 | $3,517.15 | 14.9× |
| CT Angio Head (70496) | $2,260.40 | $3,013.86 | 12.7× |
| CT angio hrt w/3d image (75574) | $2,773.31 | $3,697.75 | 7.9× |
| Ct Angio Lwr Extr W/O&W/Dye (73706) | $2,522.39 | $3,363.19 | 14.2× |
| CT Angio Neck (70498) | $2,223.65 | $2,964.87 | 12.5× |
| Ct Angio Upr Extrm W/O&W/Dye (73206) | $2,230.67 | $2,974.23 | 12.6× |
| CT cervical spine w/ contrast (72126) | $2,189.13 | $2,918.84 | 6.2× |
| CT cervical spine w/o contrast (72125) | $1,643.75 | $2,191.67 | 15.5× |
| CT cervical spine w/wo cont (72127) | $2,356.90 | $3,142.53 | 13.3× |
| CT chest w contrast (71260) | $2,648 | $3,530.67 | 14.9× |
| CT chest w/wo contrast (71270) | $3,215.71 | $4,287.61 | 18.1× |
| CT colonography screening (74263) | $308.23 | $410.97 | 1.3× |
| CT colonogrphy dx image postprocess w/o contrast (74261) | $2,187.65 | $2,916.87 | 20.7× |
| CT head/brain with contrast (70460) | $1,574.13 | $2,098.84 | 8.9× |
| CT head/brain without and with contrast (70470) | $2,009.62 | $2,679.50 | 11.3× |
| CT heart contrast eval cardiac structure&morph (75572) | $5,099.79 | $6,799.72 | 14.4× |
| CT heart no contrast quant eval coronry calcium (75571) | $319.70 | $426.26 | 3.6× |
| CT hrt w/3d image congen (75573) | $4,897.29 | $6,529.72 | 13.9× |
| CT iac w contrast (70481) | $1,512.88 | $2,017.18 | 8.5× |
| CT l-spine w&w/o contrast (72133) | $2,415.64 | $3,220.86 | 13.6× |
| CT lower ext w/o (73700) | $1,584.96 | $2,113.28 | 15.0× |
| CT lower extremity w/contrast material (73701) | $1,950.97 | $2,601.29 | 11.0× |
| CT lumbar spine w contrast (72132) | $2,210 | $2,946.67 | 6.3× |
| CT lumbar spine w/o contrast (72131) | $1,862.72 | $2,483.62 | 17.6× |
| CT maxillofacial w contrast (70487) | $2,118.53 | $2,824.71 | 11.9× |
| CT maxillofacial wo contrast (70486) | $1,546.95 | $2,062.60 | 14.6× |
| CT neck tissue combo (70492) | $2,178.53 | $2,904.71 | 12.3× |
| Ct Orbit/Ear/Fossa W/O&W/Dye (70482) | $1,572.87 | $2,097.16 | 8.9× |
| CT orbits w/o contrast (70480) | $1,318.72 | $1,758.29 | 12.5× |
| CT pelvis w&w/o contrast (72194) | $2,628.98 | $3,505.30 | 14.8× |
| CT pelvis w/o contrast (72192) | $1,823.56 | $2,431.42 | 17.2× |
| CT scan of leg combo (73702) | $2,097.97 | $2,797.29 | 11.8× |
| CT scans face/jaw combo (70488) | $2,204.55 | $2,939.40 | 12.4× |
| CT soft tissue neck w contrast (70491) | $1,831.22 | $2,441.63 | 10.3× |
| CT soft tissue neck w/o contrast (70490) | $1,500.88 | $2,001.18 | 14.2× |
| CT thoracic spine w contrast (72129) | $2,279.98 | $3,039.98 | 12.8× |
| CT thoracic spine w/o contrast (72128) | $1,604.89 | $2,139.85 | 15.2× |
| CT thoracic spine w/wo cont (72130) | $2,811.78 | $3,749.04 | 15.8× |
| CT thorax w/o contrast (71250) | $1,644.57 | $2,192.76 | 15.5× |
| CT upper ext wo (73200) | $1,479.14 | $1,972.19 | 14.0× |
| CT upper extremity w/o & w/contrast material (73202) | $2,016.71 | $2,688.95 | 11.4× |
| CT upper extremity with contrast (73201) | $1,781.14 | $2,374.85 | 5.0× |
| Cta Abdl Aorta&Bi Iliofem W/Contrast&Postp (75635) | $1,923.82 | $2,565.10 | 10.8× |
| Cta Abdomen (74175) | $2,136.25 | $2,848.33 | 12.0× |
| CTA pelvis (72191) | $2,145.58 | $2,860.78 | 12.1× |
| Dilation ureters/urethra rs&i (74485) | $2,556.20 | $3,408.26 | 1.2× |
| Doppler Echo Fetal Puls Spectral F/U/Repeat (76828) | $672.50 | $896.67 | 6.4× |
| Doppler Echo Fetal Spectral Display Complete (76827) | $614.28 | $819.04 | 5.8× |
| Doppler Fetal Mid Cerebral Artery (76821) | $517.30 | $689.73 | 4.9× |
| Dxa Bone Density Axial (77080) | $455.71 | $607.61 | 4.3× |
| Dxa bone density study (77085) | $468.98 | $625.31 | 4.4× |
| Dxa bone density study 1/>sites appendiclr skel (77081) | $378.20 | $504.26 | 4.3× |
| Echo exam of fetal heart (76825) | $905.58 | $1,207.44 | 1.6× |
| Echo exam uterus (76831) | $822.46 | $1,096.61 | 3.4× |
| Echo Guide For Artery Repair (76936) | $249.52 | $332.70 | 1.1× |
| Echocardiography, fetal, cardiovascular system, real time with image documentation (2D), with or without M-mode… (76826) | $672.50 | $896.67 | 2.8× |
| Echograp Trans R Pros Study (76873) | $701.49 | $935.32 | 6.6× |
| Esophagram (74220) | $613.96 | $818.62 | 3.5× |
| Fetal Biophys Profile W/Nst (76818) range across 2 matching MRF lines |
$414.71–$450.96 | $552.95–$601.28 | varies |
| Fetal Biophysical Profile W/O Non-Stress Testing (76819) range across 2 matching MRF lines |
$365.42–$385.47 | $487.22–$513.96 | varies |
| Fluoroscopy up to 1 hr (76000) | $554.66 | $739.55 | 2.3× |
| Follow-Up Angiography (75898) | $1,547.13 | $2,062.84 | 0.5× |
| Foot 2 views (73620) | $243.81 | $325.08 | 2.8× |
| Forearm 2 views (73090) | $321.96 | $429.28 | 3.7× |
| Gastric emptying imaging study (78264) | $1,612.77 | $2,150.36 | 4.0× |
| Gastroesophageal Reflux Exam (78262) | $1,599.76 | $2,133.02 | 4.0× |
| Gated Heart Planar Single (78472) | $1,861.20 | $2,481.60 | 4.6× |
| Gstrc Emptng Imag Std W/Sm Bwl Col Trnst Mlt Day (78266) | $401.20 | $534.93 | 0.7× |
| Hand 2 views (73120) | $244.94 | $326.59 | 2.3× |
| Hdr Rdncl Ntrstl/Icav Brchtx (77772) | $4,794.45 | $6,392.60 | 6.8× |
| Hdr Rdncl Ntrstl/Icav Brchtx (77771) | $3,755.42 | $5,007.23 | 5.3× |
| Hdr Rdncl Ntrstl/Icav Brchtx 1 Channel (77770) | $3,616.10 | $4,821.46 | 5.1× |
| Heart Image (Pet) Multiple (78492) | $4,711.05 | $6,281.40 | 3.3× |
| Hepatc Vngrph Wdg/Fr Hemodyn Eval Rs&I (75889) | $2,726.91 | $3,635.88 | 0.9× |
| Hepatc Vngrph Wdg/Fr W/O Hemodyn Eval Rs&I (75891) | $2,210.31 | $2,947.08 | 0.7× |
| Hepatobil Syst Image W/Drug (78227) | $1,925.42 | $2,567.22 | 3.5× |
| Hepatobiliary System Imaging (78226) | $1,910.47 | $2,547.29 | 4.7× |
| Ht Muscle Image Spect Sing (78451) | $3,874.07 | $5,165.43 | 3.0× |
| Hysterosalpingogram (74740) | $673.39 | $897.85 | 2.8× |
| Infant hip ultrasound with hip movement (dynamic) (76885) | $613.31 | $817.75 | 7.0× |
| Infant hip ultrasound, limited static exam (76886) | $33 | $44 | 0.4× |
| Interstitial radiation source applic complex (77778) | $3,969.92 | $5,293.22 | 5.6× |
| Intracavitary Radiation Source Applic Complex (77763) | $2,446.70 | $3,262.26 | 3.5× |
| Intracavitary Radiation Source Applic Intermed (77762) | $1,766.80 | $2,355.73 | 3.2× |
| Intracavitary radiation source applic simple (77761) | $1,146.75 | $1,529 | 2.0× |
| Joint Survey Single View (77077) | $330.80 | $441.06 | 3.1× |
| K Flow/Funct Image Multiple (78709) | $1,806.29 | $2,408.39 | 3.3× |
| K Flow/Funct Image W/Drug (78708) | $1,896.15 | $2,528.20 | 3.4× |
| K Flow/Funct Image W/O Drug (78707) | $1,545.25 | $2,060.33 | 2.8× |
| Kidney Funcj Study Non-Img Radioisotopic Study (78725) | $620.33 | $827.11 | 1.5× |
| Knee 3 Views (73562) | $361.94 | $482.58 | 4.1× |
| Liver & Spleen Imaging Static Only (78215) | $764.86 | $1,019.82 | 1.9× |
| Liver & Spleen Imaging W/Vascular Flow (78216) | $4,193.12 | $5,590.83 | 10.4× |
| Liver imaging static only (78201) | $675.67 | $900.89 | 1.2× |
| Lung Perf&Ventilat Diferentl (78598) | $1,610.80 | $2,147.73 | 2.9× |
| Lung perfusion differential (78597) | $1,456.61 | $1,942.15 | 3.6× |
| Lung Ventilat&Perfus Imaging (78582) | $1,903.50 | $2,538 | 3.5× |
| Lung Ventilation Imaging (78579) | $890.48 | $1,187.30 | 2.2× |
| Lymph System Imaging (78195) | $1,669.18 | $2,225.58 | 3.0× |
| Lymphangiography Pelvic/Abdominal Bilateral Rs&I (75807) | $3,204.76 | $4,273.01 | 1.0× |
| Lymphangiography, pelvic/abdominal, unilateral (75805) | $1,856.06 | $2,474.75 | 0.6× |
| Magnetic Image Jaw Joint (70336) | $2,649.52 | $3,532.70 | 11.0× |
| Magnetic Resonance Elastography (76391) | $1,491.28 | $1,988.37 | 6.2× |
| Meckels Divert Exam (78290) | $1,822.57 | $2,430.09 | 4.5× |
| Mlc imrt design & construction per imrt plan (77338) | $5,451.87 | $7,269.16 | 14.4× |
| Mra Head W/O & W/Contrast Material (70546) | $4,087.96 | $5,450.62 | 11.6× |
| MRA head w/o contrast (70544) | $2,973.66 | $3,964.88 | 12.3× |
| MRA head with contrast (70545) | $2,598.64 | $3,464.86 | 7.4× |
| MRA neck w contrast (70548) | $3,414.92 | $4,553.22 | 9.7× |
| Mra Neck W/O &W/Contrast Material (70549) | $4,625.21 | $6,166.95 | 13.1× |
| MRA neck w/o contrast (70547) | $2,926.07 | $3,901.43 | 12.1× |
| MRI abdomen w contrast (74182) | $3,569.20 | $4,758.93 | 10.1× |
| MRI abdomen w/o contrast (74181) | $3,098.08 | $4,130.78 | 12.8× |
| MRI any jt lower extrem w/contrast material (73722) | $3,351.30 | $4,468.40 | 4.2× |
| MRI any jt lower extrem w/o & w/contrast matrl (73723) | $3,809.81 | $5,079.75 | 10.8× |
| MRI any jt upper extremity w/contrast matrl (73222) | $3,325.66 | $4,434.21 | 4.2× |
| MRI brain functional w/o physician admnistration (70554) | $3,658.54 | $4,878.06 | 15.1× |
| MRI brain functional w/physician admnistration (70555) | $3,960.17 | $5,280.23 | 16.4× |
| MRI Breast W/O Contrast Bilateral (77047) | $3,209.41 | $4,279.21 | 13.3× |
| MRI Breast Without Contrast Material Unilateral (77046) | $1,682.26 | $2,243.01 | 7.0× |
| MRI cardiac w/o cont stress (75559) | $3,222.30 | $4,296.40 | 5.8× |
| MRI cardiac w/o contrast (75557) | $1,917.37 | $2,556.49 | 7.9× |
| MRI cervical spine w contrast (72142) | $3,648.86 | $4,865.15 | 10.3× |
| MRI cervical spine w/o cont (72141) | $3,569.36 | $4,759.14 | 14.8× |
| MRI chest w/o contrast (71550) | $3,115.09 | $4,153.45 | 12.9× |
| MRI chest with contrast (71551) | $2,981.07 | $3,974.76 | 3.8× |
| MRI chest wo w contrast (71552) | $4,507.60 | $6,010.14 | 12.8× |
| MRI lower extrem oth/thn jt w/contrast matrl (73719) | $2,654.52 | $3,539.36 | 7.5× |
| MRI lower extrem oth/thn jt w/o & w/contr matr (73720) | $3,764.74 | $5,019.66 | 10.7× |
| MRI lower extrem oth/thn jt w/o contr matrl (73718) | $2,800.44 | $3,733.92 | 11.6× |
| MRI lumbar spine w contrast (72149) | $3,781.82 | $5,042.43 | 10.7× |
| Mri Neck Spine W/O & W/Dye (72156) | $4,999.68 | $6,666.24 | 14.2× |
| MRI orbit face &/neck w/o contrast (70540) | $3,287.58 | $4,383.44 | 13.6× |
| MRI orbit face neck w contrast (70542) | $4,073.78 | $5,431.71 | 11.5× |
| Mri Orbt/Fac/Nck W/O &W/Dye (70543) | $4,949.84 | $6,599.79 | 14.0× |
| MRI pelvis w contrast (72196) | $3,052.96 | $4,070.62 | 8.6× |
| MRI pelvis w/o & w contrast (72197) | $3,115.82 | $4,154.42 | 8.8× |
| MRI pelvis w/o contrast (72195) | $3,169.33 | $4,225.77 | 13.1× |
| MRI spectroscopy (76390) | $766.10 | $1,021.46 | 8.7× |
| MRI thoracic spine w/o contrast (72146) | $3,299.29 | $4,399.05 | 13.7× |
| MRI upper extremity oth than jt w/contr matrl (73219) | $3,136.07 | $4,181.43 | 8.9× |
| MRI upper extremity oth than jt w/o contr matrl (73218) | $2,996.67 | $3,995.56 | 12.4× |
| Mri Uppr Extremity W/O&W/Dye (73220) | $4,449.73 | $5,932.97 | 12.6× |
| MRI, abdomen, combo (74183) | $4,429.18 | $5,905.57 | 12.5× |
| MRI, dorsal spine combo (72157) | $4,760.02 | $6,346.70 | 13.5× |
| MRI, dorsal spine contrast (72147) | $3,532.08 | $4,709.44 | 10.0× |
| MRI, joint upper extrem (73221) | $2,747.78 | $3,663.70 | 11.4× |
| MRI, joint upper extrem combo (73223) | $3,984.83 | $5,313.11 | 11.3× |
| MRI, lumbar spine combo (72158) range across 2 matching MRF lines |
$4,138.44–$4,979.91 | $5,517.92–$6,639.88 | varies |
| Myelogram cervical (72240) | $896.37 | $1,195.16 | 1.1× |
| Myelogram Lumbar (72265) | $1,272.32 | $1,696.43 | 1.6× |
| Myelography thoracic (72255) | $1,423.04 | $1,897.38 | 1.8× |
| Myelograpy 2/more regions rs&i (72270) | $1,841.78 | $2,455.70 | 2.3× |
| Myocardial Imaging Pet Metabolic Evaluation (78459) | $6,902.95 | $9,203.93 | 5.3× |
| Myocardial Spect Multiple Studies (78452) | $4,448.68 | $5,931.57 | 3.4× |
| Myocrd Img Pet Metab Eval Single Study Cncrnt CT (78429) | $5,751.41 | $7,668.55 | 4.0× |
| Myocrd img PET prfuj 1std rest/stress cncrnt CT (78430) | $5,946.83 | $7,929.11 | 4.1× |
| Myocrd Img Pet Prfuj Mlt Std Rst&Strs Cncrnt CT (78431) | $8,515.16 | $11,353.55 | 3.8× |
| Myocrd Img Pet Prfuj W/Metab 2rtracer Cncrnt CT (78433) | $6,433.10 | $8,577.47 | 2.9× |
| Neck soft tissue (70360) | $284.13 | $378.84 | 3.2× |
| Njx Rp Loclzj Non-Img Probe Study Intravenous (78808) | $367.12 | $489.49 | 0.9× |
| Nm csf leak detection (78650) | $1,212.82 | $1,617.09 | 0.9× |
| Nm myocard infarct spect (78469) | $1,748.78 | $2,331.70 | 3.2× |
| Nonvascular Shunt X-Ray (75809) | $627.68 | $836.91 | 5.9× |
| Ntsty modul radthx pln dose-vol histos (77301) | $9,644.90 | $12,859.86 | 6.9× |
| Nuclear Rx Intra-Arterial (79445) | $2,151.94 | $2,869.25 | 9.1× |
| Nuclear Rx Oral Admin (79005) | $2,737.87 | $3,650.49 | 11.6× |
| Ob us nuchal meas 1 gest (76813) | $1,051.91 | $1,402.55 | 9.9× |
| Ophthalmic ultrasound dx b-scan w/wo a-scan (76512) | $200.91 | $267.88 | 1.9× |
| Panoramic X-ray of jaws (70355) | $161.14 | $214.85 | 1.8× |
| Parathyroid imaging w/tomographic spect & CT (78072) | $2,688.51 | $3,584.68 | 4.9× |
| Parathyroid Planar Imaging (78070) | $1,405.36 | $1,873.81 | 3.5× |
| Parathyroid planar imaging w/wo subtraction (78071) | $1,756.74 | $2,342.32 | 4.3× |
| Pelvis 1 or 2 views (72170) | $307.82 | $410.42 | 2.9× |
| Perineogram (74775) | $898.22 | $1,197.62 | 3.7× |
| Peritoneogram Rs&I (74190) | $378.37 | $504.49 | 0.7× |
| Pet Image W/Ct Lmtd (78814) | $5,672.23 | $7,562.97 | 3.9× |
| PET image w/CT, full body (78816) | $9,877.96 | $13,170.61 | 6.8× |
| PET imaging CT attenuation skull base mid-thigh (78815) | $8,636.65 | $11,515.53 | 6.0× |
| Pet Myocardial Sngl Study (78491) | $5,125.06 | $6,833.41 | 3.5× |
| Prq Transhepatc Portograpy Hemodyn Eval Rs&I (75885) | $2,639.58 | $3,519.44 | 0.8× |
| Pulmonary Perfusion Imaging Particulate (78580) | $1,107.30 | $1,476.40 | 2.7× |
| Radex Abd Compl Aqt Abd W/S/E/D Views 1 View Ch (74022) | $483.59 | $644.79 | 4.6× |
| Radex abscess/fistula/sinus tract rs&i (76080) | $831.26 | $1,108.34 | 1.5× |
| Radex Ankle Complete Minimum 3 Views (73610) | $400.81 | $534.41 | 4.5× |
| Radex Calcaneus Minimum 2 Views (73650) range across 2 matching MRF lines |
$295.97–$328.87 | $394.63–$438.49 | varies |
| Radex elbow complete minimum 3 views (73080) | $418.03 | $557.37 | 4.7× |
| Radex Facial Bones Complete Minimum 3 Views (70150) | $473.90 | $631.87 | 4.5× |
| Radex fingr minimum 2 views (73140) range across 2 matching MRF lines |
$275.51–$306.13 | $367.35–$408.17 | varies |
| Radex foot complete minimum 3 views (73630) | $400.46 | $533.95 | 4.5× |
| Radex Hand Minimum 3 Views (73130) | $351.39 | $468.52 | 4.0× |
| Radex lower extremity infant minimum 2 views (73592) range across 2 matching MRF lines |
$253.53–$286.12 | $338.04–$381.49 | varies |
| Radex Mastoids Compl Minimum 3 Views PR Side (70130) | $255.39 | $340.52 | 2.4× |
| Radex Nasal Bones Complete Minimum 3 Views (70160) | $344.24 | $458.99 | 3.9× |
| Radex Ribs Unilateral 2 Views (71100) | $310.11 | $413.48 | 3.5× |
| Radex shoulder complete minimum 2 views (73030) | $411.69 | $548.92 | 4.7× |
| Radex Sinuses Paransl < 3 Views (70210) | $332.24 | $442.99 | 3.8× |
| Radex sm int w/mlt srl imges via enteroclss tube (74251) | $921.68 | $1,228.90 | 5.2× |
| Radex Spine 1 View Specify Level (72020) | $316.52 | $422.02 | 3.6× |
| Radex Sternum Minimum 2 Views (71120) | $375.51 | $500.68 | 4.3× |
| Radex Temporomandble Jt Opn & Clsd Mouth Bilat (70330) | $428.54 | $571.38 | 4.9× |
| Radex Toe Minimum 2 Views (73660) | $328.63 | $438.17 | 3.7× |
| Radex upper extremity infant minimum 2 views (73092) range across 2 matching MRF lines |
$243.64–$270.68 | $324.85–$360.91 | varies |
| Radex Wrist Complete Minimum 3 Views (73110) | $368.31 | $491.08 | 4.2× |
| Radex X-Ray Exam Entire Spi 6/> Vw - Xr Entire Spine 6+ Vw (72084) | $802.34 | $1,069.78 | 7.6× |
| Radiation Delivery Stereotactic Cranial Linear (77372) | $13,285.36 | $17,713.81 | 1.8× |
| Radiation treatment delivery level 1 (77402) | $282.43 | $376.57 | 2.7× |
| Radiation treatment delivery level 2 (77407) | $244.15 | $325.53 | 0.6× |
| Radiation treatment delivery level 3 (77412) | $777.48 | $1,036.64 | 1.4× |
| Radiolog exam mandible compl minimum 4 views (70110) | $476.26 | $635.02 | 4.5× |
| Radiologic Exam Abdomen 3+ Views - Xr Abdomen 3+ Views (74021) | $332.26 | $443.01 | 3.1× |
| Radiologic exam colon double contrast study (74280) | $971.48 | $1,295.31 | 5.5× |
| Radiologic exam colon single contrast study (74270) | $914.24 | $1,218.99 | 5.1× |
| Radiologic Exam Esophagus Double Contrast Study (74221) | $580.21 | $773.61 | 3.3× |
| Radiologic exam knee complete 4/more views (73564) | $384.98 | $513.30 | 3.6× |
| Radiologic exam pelvis compl minimum 3 views (72190) | $401.81 | $535.75 | 3.8× |
| Radiologic Exam Small Int Single Contrast Study (74250) | $836.66 | $1,115.55 | 4.7× |
| Radiologic exam swallow function contrast study (74230) | $781.93 | $1,042.57 | 4.4× |
| Radiologic exam upr gi trc double contrast study (74246) range across 2 matching MRF lines |
$1,141.09–$1,207.52 | $1,521.45–$1,610.03 | varies |
| Radiologic examination femur 1 view (73551) | $245.80 | $327.74 | 2.8× |
| Radiologic examination femur minimum 2 views (73552) | $332.70 | $443.60 | 3.8× |
| Radiologic examination knee 1/2 views (73560) | $254.22 | $338.96 | 2.9× |
| Radiologic Examination Osseous Survey Limited (77074) | $595.07 | $793.43 | 5.6× |
| Radiologic examination tibia & fibula 2 views (73590) range across 2 matching MRF lines |
$286.61–$326.44 | $382.15–$435.25 | varies |
| Remote afterloading high dose rate radionuclide skin surface brachytherapy, includes basic dosimetry, when performed;… (77768) | $1,265.02 | $1,686.69 | 3.2× |
| Remote afterloading high dose rate radionuclide skin surface brachytherapy, includes basic dosimetry, when performed;… (77767) | $976.86 | $1,302.48 | 2.5× |
| Ribs bilateral 3 views (71110) | $496.23 | $661.64 | 4.7× |
| Rp Loclzj Tum Plnr Whole Body 2+ Days Imaging (78804) | $2,319.61 | $3,092.81 | 4.2× |
| Rp Loclzj Tum Plnr Whole Body Single Day Imaging (78802) | $1,214.74 | $1,619.65 | 2.2× |
| Rp Loclzj Tum Spect 1 Area Single Day Imaging (78803) | $2,316.76 | $3,089.01 | 4.2× |
| Rp loclzj tum spect 2 area/sep acquisj img (78831) | $1,920.62 | $2,560.82 | 1.5× |
| Rp loclzj tum spect CT 2area 1d img/1 ar img>2+d (78832) | $2,237.01 | $2,982.68 | 1.5× |
| Rp loclzj tum spect w/CT 1 area/acquisj 1day img (78830) | $2,316.76 | $3,089.01 | 1.8× |
| Rp Therapy Intravenous Administration (79101) | $1,013.36 | $1,351.14 | 4.3× |
| Scapula (73010) | $356.38 | $475.17 | 3.4× |
| Screening Digital Breast Tomosynthesis Bi (77063) range across 2 matching MRF lines |
$86.89–$173.78 | $115.85–$231.70 | varies |
| Sella turcica (70240) | $155.97 | $207.96 | 1.8× |
| Shoulder 1 view (73020) | $278.73 | $371.64 | 3.2× |
| Shoulder Arthrography (73040) | $760.52 | $1,014.02 | 2.2× |
| Sialogram (70390) range across 2 matching MRF lines |
$543.12–$1,206.91 | $724.16–$1,609.21 | varies |
| Skull less than 4 views (70250) | $416.03 | $554.71 | 3.9× |
| Special dosimetry (77331) | $431.30 | $575.07 | 3.2× |
| Special Physics Consult (77370) | $733.65 | $978.20 | 5.4× |
| Special teletherapy port plan (77321) | $1,111.41 | $1,481.88 | 2.9× |
| Special treatment procedure (77470) | $1,348.20 | $1,797.60 | 2.4× |
| Srs Multisource (77371) | $56,637.20 | $75,516.27 | 7.6× |
| Stereotactic Body Radiation Delivery (77373) | $3,984.23 | $5,312.31 | 2.2× |
| Sternoclavicular joints (71130) | $411.76 | $549.02 | 4.7× |
| Superior sagittal sinus venogram (75870) | $2,059.16 | $2,745.55 | 0.6× |
| Surface Applic Low Dose Rate Radionuclide Source (77789) | $458.67 | $611.56 | 4.4× |
| Tbs techl prep&transmis data alys pfrmd elsewhr (77090) | $175.88 | $234.50 | 2.0× |
| Tbs technical calculation only (77091) | $168.78 | $225.04 | 1.9× |
| Telethx isodose pln cplx w/basic dosimetry (77307) | $2,442.69 | $3,256.92 | 6.4× |
| Telethx isodose pln smpl w/dosimetry calculation (77306) | $1,463.98 | $1,951.97 | 3.9× |
| Temporomandble Jt Arthrography Rs&I (70332) | $872.49 | $1,163.32 | 3.6× |
| Ther Rad Simulaj-Aided Field Setting Complex (77290) | $2,119.70 | $2,826.27 | 5.6× |
| Ther rad simulaj-aided field setting simple (77280) | $1,228.96 | $1,638.62 | 9.0× |
| Therapeutic Enema Rdctj Intussusception/Obstrcj (74283) | $691.16 | $921.55 | 3.9× |
| Thoracic spine 2 views (72070) | $362.98 | $483.98 | 3.4× |
| Thoracic spine 3 views (72072) | $371.96 | $495.95 | 3.5× |
| Thoracolumbar 2 views (72080) | $447.82 | $597.09 | 5.1× |
| Thyroid Carcinoma Metastases Img Lmtd Area (78015) | $1,709.12 | $2,278.82 | 4.2× |
| Thyroid Imaging With Vascular Flow (78013) | $1,528.78 | $2,038.38 | 3.8× |
| Thyroid Met Imaging Body (78018) | $2,092.36 | $2,789.82 | 3.8× |
| Thyroid Uptake Measurement (78012) | $652.67 | $870.23 | 1.6× |
| Thyroid Uptake W/Blood Flow Sngle/Mult Quan Meas (78014) | $2,205.46 | $2,940.62 | 5.4× |
| Tx Devices Design & Construction Complex (77334) | $1,049.44 | $1,399.25 | 2.8× |
| Tx devices design & construction intermediate (77333) | $545.21 | $726.95 | 4.0× |
| Tx devices design & construction simple (77332) | $494.36 | $659.15 | 3.6× |
| Ultrasound Breast Limited (76642) range across 2 matching MRF lines |
$618.61–$1,175.21 | $824.81–$1,566.95 | varies |
| Ultrasound elastography first target lesion (76982) | $673.52 | $898.03 | 6.4× |
| Ultrasound Elastography Parenchyma (76981) | $1,075.61 | $1,434.15 | 10.2× |
| Ultrasound Exam Aaa Screen (76706) | $318.43 | $424.57 | 3.0× |
| Ultrasound trgt dynamic microbubble 1st lesion (76978) | $574.82 | $766.43 | 1.6× |
| Ultrasound, abdomen limited (76705) | $632.21 | $842.95 | 6.0× |
| Umbilical-artery Doppler (OB) (76820) | $477 | $636 | 4.5× |
| Unlisted Dx Radiographic Procedure (76499) range across 3 matching MRF lines |
$91.88–$541.17 | $122.51–$721.56 | varies |
| Unlisted fluoroscopic procedure (76496) | $1,951.31 | $2,601.75 | 22.1× |
| Unlisted magnetic resonance procedure (76498) range across 5 matching MRF lines |
$3,429.53–$4,481.21 | $4,572.71–$5,974.95 | varies |
| Unlisted us procedure (76999) range across 4 matching MRF lines |
$294.09–$353.89 | $392.12–$471.85 | varies |
| Upper gi w/o kub (74240) range across 2 matching MRF lines |
$507.40–$1,141.16 | $676.53–$1,521.54 | varies |
| Ureteral Reflux Study (78740) | $1,043.87 | $1,391.83 | 2.6× |
| Urethrocystogram voiding (74455) | $545.44 | $727.25 | 2.3× |
| Urethrocystography retrograde (74450) | $593.08 | $790.78 | 2.5× |
| Us breast unilateral complete (76641) range across 2 matching MRF lines |
$1,017.95–$2,035.90 | $1,357.27–$2,714.54 | varies |
| Us chest (76604) | $532.10 | $709.46 | 5.0× |
| Us complete joint (76881) | $596.81 | $795.75 | 5.6× |
| Us exam, pelvic, limited (76857) | $578.78 | $771.70 | 5.5× |
| Us head (76506) | $709.22 | $945.62 | 6.7× |
| Us kidney transplant (76776) | $667.72 | $890.29 | 6.3× |
| Us lmtd joint/oth nonvasc xtr strux r-t w/img (76882) range across 2 matching MRF lines |
$350.77–$701.54 | $467.69–$935.39 | varies |
| Us ob detailed single fetus (76811) | $1,003.06 | $1,337.41 | 4.2× |
| Us ob limited 1 or more fetuses (76815) | $353.12 | $470.82 | 3.3× |
| Us ob transvaginal (76817) | $547.82 | $730.43 | 5.2× |
| Us pelvic non ob complete (76856) | $613.55 | $818.07 | 5.8× |
| Us pg uter img f&mat 14 wk tabdl 1/1st gestation (76801) | $641.40 | $855.20 | 6.1× |
| Us preg uterus real time f/u trnsabdl per fetus (76816) | $526.02 | $701.36 | 5.0× |
| Us retroperitoneal complete (76770) | $687.66 | $916.88 | 6.5× |
| Us retroperitoneal limited (76775) | $530.22 | $706.96 | 5.0× |
| Us scrotum and contents (76870) | $574.02 | $765.36 | 5.4× |
| Us spinal canal and contents (76800) | $836.49 | $1,115.32 | 7.9× |
| Us thyroid (76536) | $616.76 | $822.34 | 5.8× |
| Us transrectal (76872) | $571.65 | $762.20 | 5.4× |
| Vascular Flow Imaging (78445) | $1,401.29 | $1,868.39 | 3.5× |
| Vein X-Ray Chest (75827) | $1,633.66 | $2,178.22 | 1.0× |
| Vein X-Ray Liver W/O Hemodyn (75887) | $2,301.64 | $3,068.85 | 0.7× |
| Vein X-Ray Spleen/Liver (75810) | $2,277.80 | $3,037.07 | 0.7× |
| Venogram Sinus/Jugular (75860) | $1,462.22 | $1,949.63 | 0.5× |
| Venography Adrenal Unilateral (75840) | $2,019.20 | $2,692.26 | 0.6× |
| Venography caval inferior serialography rs&i (75825) | $6,005.38 | $8,007.17 | 1.9× |
| Venography extremity bilateral rs&i (75822) | $1,794.62 | $2,392.83 | 1.1× |
| Venography extremity unilateral rs&i (75820) | $1,387.54 | $1,850.05 | 0.9× |
| Venography Renal Bilateral (75833) | $2,770.65 | $3,694.20 | 0.9× |
| Venography Renal Unilateral (75831) | $2,879.37 | $3,839.16 | 0.9× |
| Venous sampling by catheter (75893) likely a partial charge, not the full procedure |
$1,346.70 | $1,795.60 | 0.2× |
| Wrist 2 views (73100) range across 2 matching MRF lines |
$232.28–$258.09 | $309.71–$344.12 | varies |
| X-Ray Ac Jts - Xr Acromioclavicular Joints Bilateral (73050) | $393.76 | $525.01 | 4.5× |
| X-ray antegrade pyelogram tube (74425) | $647.41 | $863.21 | 1.8× |
| X-Ray Aorta Leg Arteries (75630) | $4,460.19 | $5,946.92 | 1.4× |
| X-Ray Bend Only L-S Spine (72120) | $394.72 | $526.29 | 3.7× |
| X-Ray Elbow 2 Vw - Xr Elbow 1-2 Views Right (73070) range across 2 matching MRF lines |
$215.70–$245.66 | $287.60–$327.55 | varies |
| X-Ray Exam Breast Specimen (76098) | $271.60 | $362.13 | 0.5× |
| X-Ray Exam Entire Spi 1 Vw (72081) | $286.15 | $381.54 | 3.2× |
| X-Ray Exam Entire Spi 2/3 Vw (72082) | $452.08 | $602.78 | 4.3× |
| X-Ray Exam Entire Spi 4/5 Vw (72083) | $459.39 | $612.52 | 4.3× |
| X-Ray Exam Hip Uni 1 View (73501) | $357.72 | $476.96 | 4.1× |
| X-Ray Exam Hip Uni 2-3 Views (73502) | $824.77 | $1,099.69 | 9.4× |
| X-Ray Exam Hip Uni 4/> Views (73503) | $1,003.79 | $1,338.39 | 9.5× |
| X-Ray Exam Hips Bi 2 Views (73521) | $833.53 | $1,111.37 | 7.9× |
| X-Ray Exam Hips Bi 3-4 Views (73522) | $870.38 | $1,160.51 | 8.2× |
| X-Ray Exam Hips Bi 5/> Views (73523) | $1,452.97 | $1,937.29 | 13.7× |
| X-Ray Exam L-S Spine Bending (72114) | $494.32 | $659.09 | 4.7× |
| X-Ray Exam Neck Spine 2-3 Vw (72040) | $373.44 | $497.92 | 4.2× |
| X-Ray Exam Neck Spine 6/>Vws (72052) | $675.55 | $900.73 | 6.4× |
| X-Ray Exam Unilat Ribs/Chest (71101) | $392.25 | $523 | 3.7× |
| X-ray eye for foreign body (70030) | $25.96 | $34.61 | 0.3× |
| X-ray humerus (73060) range across 2 matching MRF lines |
$332.06–$378.18 | $442.75–$504.24 | varies |
| X-ray IV pyelogram (ivp) (74400) | $794.60 | $1,059.46 | 4.5× |
| X-ray IV pyelogram+tomography (74415) | $1,213.90 | $1,618.54 | 6.8× |
| X-Ray Jaw <4 Vw - Xr Mandible < 4 Views (70100) | $363.60 | $484.80 | 4.1× |
| X-Ray Knee Bilat Standing - Xr Knees Anteroposterior Standing Bilat (73565) | $302.98 | $403.98 | 3.4× |
| X-Ray Lumbar Spine 2/3 Vw - Xr Lumbar Spine 2-3 Views (72100) | $371.07 | $494.76 | 3.5× |
| X-ray nose-rectum child f.b. (76010) | $230.72 | $307.62 | 2.6× |
| X-Ray Ribs, Chest 4+ Vw - Xr Ribs 3 Vws Bil W/ Chest Posteroanterior (71111) | $552.14 | $736.19 | 5.2× |
| X-Ray Sacroiliac Jts 3+ Vw - Xr Sacroiliac Joints 3+ Views (72202) | $445.16 | $593.54 | 4.2× |
| X-Ray Sacroiliac Jts <3 Vw - Xr Sacroiliac Joints 1-2 Views (72200) | $394.40 | $525.86 | 3.7× |
| X-Ray Sacrum/Coccyx 2+ Vw - Xr Sacrum Coccyx 2+ Views (72220) | $403.82 | $538.42 | 4.6× |
| X-Ray Sinuses 3+ Vw - Xr Paranasal Sinuses 3+ Views (70220) | $477.52 | $636.70 | 5.4× |
| X-Ray Skull 4+ Vw - Xr Skull Complete 4+ Views (70260) | $472.03 | $629.37 | 4.5× |
| X-ray thoracic spine 4 vw (72074) | $384.38 | $512.50 | 3.6× |
| X-Ray Urinary Tract Exam With Contrast Material (74420) | $716.43 | $955.24 | 2.0× |
| X-Rays Bone Length Studies (77073) | $491.37 | $655.16 | 4.6× |
| X-Rays Bone Survey Complete (77075) | $963.85 | $1,285.13 | 9.1× |
| Xr c-spine 4 or 5 views (72050) | $447.52 | $596.69 | 4.2× |
| Xr facial bones less than 3 views (70140) | $389.76 | $519.68 | 4.4× |
| Xr orbits complete 4 views (70200) range across 2 matching MRF lines |
$588.16–$653.48 | $784.21–$871.30 | varies |
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.