Imaging prices at Intermountain Health Primary Children's Hospital
Salt Lake City, UT · every code in this section with a posted price and a Medicare benchmark.
380 codes. Prices are the hospital's own posted facility charges.
Compare against other hospitals interactively →
| Procedure | Posted cash | Posted gross | × Medicare |
|---|---|---|---|
| Abdomen 1 View (74018) | $152.83 | $203.77 | 1.7× |
| Abdomen 2 views (74019) | $180.22 | $240.29 | 1.7× |
| Acute Gastrointestinal Blood Loss Imaging (78278) | $821.87 | $1,095.83 | 2.0× |
| Angio internal mammary (75756) | $2,851.50 | $3,802 | 0.9× |
| Angio pulmonary bilat (75743) | $1,570.55 | $2,094.07 | 0.5× |
| Angiography Adrenal Bilateral Slctv Rs&I (75733) | $2,767.81 | $3,690.41 | 0.9× |
| Angiography extremity bilateral rs&i (75716) | $1,558.31 | $2,077.75 | 0.5× |
| Angiography extremity unilateral rs&i (75710) | $1,380.02 | $1,840.02 | 0.4× |
| Angiography pulmonary unilateral slctv rs&i (75741) | $1,418.62 | $1,891.49 | 0.4× |
| Angrph pulmonary nonslctv cath/ven njx rs&i (75746) | $1,310.23 | $1,746.98 | 0.4× |
| Ankle 2 views (73600) | $123.14 | $164.18 | 1.4× |
| Aortography thoracic serialography rs&i (75605) | $6,137.08 | $8,182.77 | 1.1× |
| Aortography thoracic w/o serialography rs&i (75600) | $1,051.43 | $1,401.91 | 0.3× |
| Artery X-Rays Abdomen (75726) likely a partial charge, not the full procedure |
$773.56 | $1,031.42 | 0.1× |
| Artery X-Rays Adrenal Gland (75731) | $1,218.34 | $1,624.46 | 0.4× |
| Artery X-Rays Pelvis (75736) likely a partial charge, not the full procedure |
$1,472.44 | $1,963.26 | 0.3× |
| Artery X-Rays Spine (75705) likely a partial charge, not the full procedure |
$1,515.69 | $2,020.92 | 0.3× |
| Arthrogram ankle (73615) | $338.70 | $451.60 | 1.0× |
| Arthrogram hip (73525) | $358.88 | $478.50 | 1.0× |
| Arthrogram Wrist (73115) | $402.32 | $536.42 | 1.1× |
| Bone age studies (77072) | $124.82 | $166.42 | 1.2× |
| Bone Imaging 3 Phase (78315) | $1,029.58 | $1,372.78 | 2.5× |
| Bone Imaging Limited Area (78300) | $833.33 | $1,111.11 | 2.1× |
| Bone Imaging Multiple Areas (78305) | $1,020.13 | $1,360.17 | 2.5× |
| Bone Imaging Whole Body (78306) | $927.01 | $1,236.01 | 2.3× |
| Bone marrow imaging limited area (78102) | $328.87 | $438.49 | 0.8× |
| Bone marrow imaging; whole body (78104) | $450.94 | $601.26 | 1.1× |
| Bone survey infant (77076) | $481.52 | $642.02 | 4.5× |
| Brain Flow Imaging Only (78610) | $866.18 | $1,154.90 | 1.6× |
| Brain Imaging Min 4 Static Views W Vascular Flow (78606) | $628.07 | $837.43 | 1.1× |
| Brain Imaging Pet Metabolic Evaluation (78608) | $4,266.38 | $5,688.51 | 2.9× |
| Card Bl Pool Gated Spect Rest Wal Motn Ejct Frct (78494) | $104.45 | $139.27 | 0.3× |
| Cardiac MRI w/w/o contrast & further seq (75561) | $1,666.03 | $2,221.37 | 4.7× |
| Cardiac MRI w/w/o contrast w/stress (75563) | $2,679.49 | $3,572.65 | 3.4× |
| Cerebrospinal Fluid Flow W/O Matl Shunt Evaltj (78645) | $555.06 | $740.08 | 1.0× |
| Cerebrospinal Fluid Scan (78630) | $877.50 | $1,170 | 1.6× |
| Chest 1 view (71045) | $153.92 | $205.23 | 1.7× |
| Chest 2 views (71046) | $181.95 | $242.60 | 2.1× |
| Chest 3 views (71047) | $178.46 | $237.94 | 2.0× |
| Chest 4 or more views (71048) | $217.37 | $289.83 | 2.1× |
| Clavicle complete (73000) | $166.76 | $222.34 | 1.9× |
| Computed Tomography Thorax Lw Dose Lng Ca Scr C- (71271) | $897.22 | $1,196.30 | 8.5× |
| Continuing medical physics consltj pr wk (77336) | $402.32 | $536.42 | 3.0× |
| Contrast Exam Abdominl Aorta (75625) | $1,487.05 | $1,982.73 | 0.5× |
| Contrast X-Ray Bladder (74430) | $247.14 | $329.52 | 0.7× |
| Contrast X-Ray Of Elbow (73085) | $324.37 | $432.49 | 0.9× |
| Contrast X-Ray Of Knee Joint (73580) | $310.97 | $414.63 | 0.9× |
| CT abdomen and pelvis without and with contrast (74178) | $2,371.22 | $3,161.63 | 6.7× |
| CT abdomen and pelvis without contrast (74176) | $1,389.58 | $1,852.77 | 5.8× |
| CT abdomen w contrast (74160) | $1,155.35 | $1,540.47 | 6.5× |
| CT abdomen w wo contrast (74170) | $1,328.32 | $1,771.10 | 7.5× |
| CT abdomen w/o contrast (74150) | $881.81 | $1,175.75 | 8.3× |
| CT Angio Abdomen and Pelvis (74174) | $1,311.21 | $1,748.28 | 3.7× |
| CT Angio Chest (71275) | $1,337.87 | $1,783.83 | 7.5× |
| CT Angio Head (70496) | $1,224.01 | $1,632.01 | 6.9× |
| CT angio hrt w/3d image (75574) | $1,386.66 | $1,848.88 | 3.9× |
| Ct Angio Lwr Extr W/O&W/Dye (73706) | $1,261.20 | $1,681.60 | 7.1× |
| CT Angio Neck (70498) | $1,204.11 | $1,605.48 | 6.8× |
| Ct Angio Upr Extrm W/O&W/Dye (73206) | $1,239.27 | $1,652.36 | 7.0× |
| CT cervical spine w/ contrast (72126) | $1,081.90 | $1,442.53 | 3.1× |
| CT cervical spine w/o contrast (72125) | $812.36 | $1,083.15 | 7.7× |
| CT cervical spine w/wo cont (72127) | $1,178.45 | $1,571.27 | 6.6× |
| CT chest w contrast (71260) | $1,308.68 | $1,744.90 | 7.4× |
| CT chest w/wo contrast (71270) | $1,590.40 | $2,120.53 | 9.0× |
| CT colonography screening (74263) | $154.12 | $205.49 | 0.6× |
| CT colonogrphy dx image postprocess w/o contrast (74261) | $1,093.83 | $1,458.44 | 10.3× |
| CT head/brain with contrast (70460) | $777.95 | $1,037.27 | 4.4× |
| CT head/brain without and with contrast (70470) | $993.90 | $1,325.20 | 5.6× |
| CT heart contrast eval cardiac structure&morph (75572) | $2,549.90 | $3,399.86 | 7.2× |
| CT heart no contrast quant eval coronry calcium (75571) | $159.85 | $213.13 | 1.8× |
| CT hrt w/3d image congen (75573) | $2,448.64 | $3,264.86 | 6.9× |
| CT iac w contrast (70481) | $756.44 | $1,008.59 | 4.3× |
| CT l-spine w&w/o contrast (72133) | $1,207.82 | $1,610.43 | 6.8× |
| CT lower ext w/o (73700) | $783.31 | $1,044.41 | 7.4× |
| CT lower extremity w/contrast material (73701) | $964.14 | $1,285.52 | 5.4× |
| CT lumbar spine w contrast (72132) | $1,092.21 | $1,456.28 | 3.1× |
| CT lumbar spine w/o contrast (72131) | $920.58 | $1,227.44 | 8.7× |
| CT maxillofacial w contrast (70487) | $1,047.01 | $1,396.01 | 5.9× |
| CT maxillofacial wo contrast (70486) | $764.53 | $1,019.37 | 7.2× |
| CT neck tissue combo (70492) | $1,089.27 | $1,452.36 | 6.1× |
| Ct Orbit/Ear/Fossa W/O&W/Dye (70482) | $786.44 | $1,048.58 | 4.4× |
| CT orbits w/o contrast (70480) | $659.36 | $879.15 | 6.2× |
| CT pelvis w&w/o contrast (72194) | $1,314.49 | $1,752.65 | 7.4× |
| CT pelvis w/o contrast (72192) | $901.23 | $1,201.64 | 8.5× |
| CT scan of leg combo (73702) | $1,048.93 | $1,398.57 | 5.9× |
| CT scans face/jaw combo (70488) | $1,090.30 | $1,453.74 | 6.1× |
| CT soft tissue neck w contrast (70491) | $905.67 | $1,207.56 | 5.1× |
| CT soft tissue neck w/o contrast (70490) | $741.76 | $989.01 | 7.0× |
| CT thoracic spine w contrast (72129) | $1,126.79 | $1,502.39 | 6.3× |
| CT thoracic spine w/o contrast (72128) | $793.16 | $1,057.54 | 7.5× |
| CT thoracic spine w/wo cont (72130) | $1,405.89 | $1,874.52 | 7.9× |
| CT thorax w/o contrast (71250) | $812.77 | $1,083.69 | 7.7× |
| CT upper ext wo (73200) | $731.01 | $974.68 | 6.9× |
| CT upper extremity w/o & w/contrast material (73202) | $1,120.34 | $1,493.78 | 6.3× |
| CT upper extremity with contrast (73201) | $880.26 | $1,173.68 | 2.5× |
| Cta Abdl Aorta&Bi Iliofem W/Contrast&Postp (75635) | $961.91 | $1,282.55 | 5.4× |
| Cta Abdomen (74175) | $1,055.76 | $1,407.68 | 5.9× |
| CTA pelvis (72191) | $1,072.79 | $1,430.39 | 6.0× |
| Dilation ureters/urethra rs&i (74485) | $1,278.10 | $1,704.13 | 0.6× |
| Doppler Echo Fetal Puls Spectral F/U/Repeat (76828) | $364.16 | $485.55 | 3.4× |
| Doppler Echo Fetal Spectral Display Complete (76827) | $332.63 | $443.51 | 3.1× |
| Doppler Fetal Mid Cerebral Artery (76821) | $397.37 | $529.83 | 3.8× |
| Dxa Bone Density Axial (77080) | $227.86 | $303.81 | 2.2× |
| Dxa bone density study (77085) | $234.50 | $312.66 | 2.2× |
| Dxa bone density study 1/>sites appendiclr skel (77081) | $189.10 | $252.13 | 2.1× |
| Echo exam of fetal heart (76825) | $490.37 | $653.83 | 0.9× |
| Echo exam uterus (76831) | $411.23 | $548.31 | 1.7× |
| Echo Guide For Artery Repair (76936) | $137.24 | $182.98 | 0.6× |
| Echocardiography, fetal, cardiovascular system, real time with image documentation (2D), with or without M-mode… (76826) | $364.16 | $485.55 | 1.5× |
| Echograp Trans R Pros Study (76873) | $332.71 | $443.61 | 3.1× |
| Esophagram (74220) | $306.98 | $409.31 | 1.7× |
| Fetal Biophys Profile W/Nst (76818) range across 2 matching MRF lines |
$207.36–$225.48 | $276.48–$300.64 | varies |
| Fetal Biophysical Profile W/O Non-Stress Testing (76819) range across 2 matching MRF lines |
$182.71–$192.74 | $243.61–$256.98 | varies |
| Fluoroscopy up to 1 hr (76000) | $277.33 | $369.78 | 1.1× |
| Follow-Up Angiography (75898) | $773.56 | $1,031.42 | 0.2× |
| Foot 2 views (73620) | $121.90 | $162.54 | 1.4× |
| Forearm 2 views (73090) | $160.98 | $214.64 | 1.8× |
| Gastric emptying imaging study (78264) | $806.38 | $1,075.18 | 2.0× |
| Gastroesophageal Reflux Exam (78262) | $799.88 | $1,066.51 | 2.0× |
| Gated Heart Planar Single (78472) | $930.60 | $1,240.80 | 2.3× |
| Gstrc Emptng Imag Std W/Sm Bwl Col Trnst Mlt Day (78266) | $220.66 | $294.22 | 0.4× |
| Hand 2 views (73120) | $122.48 | $163.30 | 1.2× |
| Heart Image (Pet) Multiple (78492) | $2,591.08 | $3,454.77 | 1.8× |
| Hepatc Vngrph Wdg/Fr Hemodyn Eval Rs&I (75889) | $1,363.46 | $1,817.94 | 0.4× |
| Hepatc Vngrph Wdg/Fr W/O Hemodyn Eval Rs&I (75891) | $1,196.89 | $1,595.85 | 0.4× |
| Hepatobil Syst Image W/Drug (78227) | $962.71 | $1,283.61 | 1.8× |
| Hepatobiliary System Imaging (78226) | $955.24 | $1,273.65 | 2.4× |
| Ht Muscle Image Spect Sing (78451) | $1,937.04 | $2,582.72 | 1.5× |
| Hysterosalpingogram (74740) | $336.70 | $448.93 | 1.4× |
| Infant hip ultrasound with hip movement (dynamic) (76885) | $306.66 | $408.88 | 3.5× |
| Infant hip ultrasound, limited static exam (76886) | $16.50 | $22 | 0.2× |
| Joint Survey Single View (77077) | $165.40 | $220.53 | 1.6× |
| K Flow/Funct Image Multiple (78709) | $903.15 | $1,204.20 | 1.6× |
| K Flow/Funct Image W/Drug (78708) | $948.08 | $1,264.10 | 1.7× |
| K Flow/Funct Image W/O Drug (78707) | $772.63 | $1,030.17 | 1.4× |
| Kidney Funcj Study Non-Img Radioisotopic Study (78725) | $310.17 | $413.56 | 0.8× |
| Knee 3 Views (73562) | $201.08 | $268.11 | 2.3× |
| Liver & Spleen Imaging Static Only (78215) | $382.43 | $509.91 | 0.9× |
| Liver & Spleen Imaging W/Vascular Flow (78216) | $2,096.56 | $2,795.42 | 5.2× |
| Liver imaging static only (78201) | $337.84 | $450.45 | 0.6× |
| Lung Perf&Ventilat Diferentl (78598) | $805.40 | $1,073.87 | 1.5× |
| Lung perfusion differential (78597) | $728.31 | $971.08 | 1.8× |
| Lung Ventilat&Perfus Imaging (78582) | $951.75 | $1,269 | 1.7× |
| Lung Ventilation Imaging (78579) | $445.24 | $593.65 | 1.1× |
| Lymph System Imaging (78195) | $834.59 | $1,112.79 | 1.5× |
| Lymphangiography Pelvic/Abdominal Bilateral Rs&I (75807) | $1,602.38 | $2,136.51 | 0.5× |
| Lymphangiography, pelvic/abdominal, unilateral (75805) | $928.04 | $1,237.38 | 0.3× |
| Magnetic Image Jaw Joint (70336) | $1,324.76 | $1,766.35 | 5.5× |
| Magnetic Resonance Elastography (76391) | $745.64 | $994.19 | 3.1× |
| Meckels Divert Exam (78290) | $911.29 | $1,215.05 | 2.3× |
| Mra Head W/O & W/Contrast Material (70546) | $2,043.98 | $2,725.31 | 5.8× |
| MRA head w/o contrast (70544) | $1,486.83 | $1,982.44 | 6.2× |
| MRA head with contrast (70545) | $1,299.32 | $1,732.43 | 3.7× |
| MRA neck w contrast (70548) | $1,707.46 | $2,276.61 | 4.8× |
| Mra Neck W/O &W/Contrast Material (70549) | $2,312.61 | $3,083.48 | 6.5× |
| MRA neck w/o contrast (70547) | $1,463.04 | $1,950.72 | 6.1× |
| MRI abdomen w contrast (74182) | $1,784.60 | $2,379.47 | 5.1× |
| MRI abdomen w/o contrast (74181) | $1,549.04 | $2,065.39 | 6.4× |
| MRI any jt lower extrem w/contrast material (73722) | $1,656.85 | $2,209.13 | 2.1× |
| MRI any jt lower extrem w/o & w/contrast matrl (73723) | $1,883.21 | $2,510.95 | 5.3× |
| MRI any jt upper extremity w/contrast matrl (73222) | $1,662.83 | $2,217.11 | 2.1× |
| MRI brain functional w/o physician admnistration (70554) | $2,032.42 | $2,709.89 | 8.4× |
| MRI brain functional w/physician admnistration (70555) | $2,200.10 | $2,933.47 | 9.1× |
| MRI Breast W/O Contrast Bilateral (77047) | $1,604.71 | $2,139.61 | 6.6× |
| MRI Breast Without Contrast Material Unilateral (77046) | $841.13 | $1,121.51 | 3.5× |
| MRI cardiac w/o cont stress (75559) | $1,611.15 | $2,148.20 | 2.9× |
| MRI cardiac w/o contrast (75557) | $1,153.55 | $1,538.07 | 4.8× |
| MRI cervical spine w contrast (72142) | $1,824.44 | $2,432.58 | 5.2× |
| MRI cervical spine w/o cont (72141) | $1,784.68 | $2,379.57 | 7.4× |
| MRI chest w/o contrast (71550) | $1,557.55 | $2,076.73 | 6.4× |
| MRI chest with contrast (71551) | $1,490.54 | $1,987.38 | 1.9× |
| MRI chest wo w contrast (71552) | $2,253.80 | $3,005.07 | 6.4× |
| MRI lower extrem oth/thn jt w/contrast matrl (73719) | $1,312.37 | $1,749.83 | 3.7× |
| MRI lower extrem oth/thn jt w/o & w/contr matr (73720) | $1,860.94 | $2,481.25 | 5.3× |
| MRI lower extrem oth/thn jt w/o contr matrl (73718) | $1,384.51 | $1,846.01 | 5.7× |
| MRI lumbar spine w contrast (72149) | $1,890.92 | $2,521.22 | 5.4× |
| Mri Neck Spine W/O & W/Dye (72156) | $2,499.84 | $3,333.12 | 7.1× |
| MRI orbit face &/neck w/o contrast (70540) | $1,643.79 | $2,191.72 | 6.8× |
| MRI orbit face neck w contrast (70542) | $2,036.90 | $2,715.86 | 5.8× |
| Mri Orbt/Fac/Nck W/O &W/Dye (70543) | $2,474.93 | $3,299.90 | 7.0× |
| MRI pelvis w contrast (72196) | $1,526.48 | $2,035.31 | 4.3× |
| MRI pelvis w/o & w contrast (72197) | $1,557.91 | $2,077.21 | 4.4× |
| MRI pelvis w/o contrast (72195) | $1,584.67 | $2,112.89 | 6.6× |
| MRI spectroscopy (76390) | $460.91 | $614.55 | 5.2× |
| MRI thoracic spine w/o contrast (72146) | $1,649.65 | $2,199.53 | 6.8× |
| MRI upper extremity oth than jt w/contr matrl (73219) | $1,568.04 | $2,090.72 | 4.4× |
| MRI upper extremity oth than jt w/o contr matrl (73218) | $1,498.34 | $1,997.78 | 6.2× |
| Mri Uppr Extremity W/O&W/Dye (73220) | $2,224.87 | $2,966.49 | 6.3× |
| MRI, abdomen, combo (74183) | $2,214.59 | $2,952.79 | 6.3× |
| MRI, dorsal spine combo (72157) | $2,380.01 | $3,173.35 | 6.7× |
| MRI, dorsal spine contrast (72147) | $1,766.04 | $2,354.72 | 5.0× |
| MRI, joint upper extrem (73221) | $1,373.89 | $1,831.85 | 5.7× |
| MRI, joint upper extrem combo (73223) | $1,992.42 | $2,656.56 | 5.6× |
| MRI, lumbar spine combo (72158) | $2,489.96 | $3,319.94 | 7.0× |
| Myelogram cervical (72240) | $448.18 | $597.58 | 0.6× |
| Myelogram Lumbar (72265) | $636.16 | $848.22 | 0.8× |
| Myelography thoracic (72255) | $711.52 | $948.69 | 0.9× |
| Myelograpy 2/more regions rs&i (72270) | $920.89 | $1,227.85 | 1.2× |
| Myocardial Imaging Pet Metabolic Evaluation (78459) | $3,451.48 | $4,601.97 | 2.6× |
| Myocardial Spect Multiple Studies (78452) | $2,224.34 | $2,965.79 | 1.7× |
| Myocrd Img Pet Metab Eval Single Study Cncrnt CT (78429) | $3,195.06 | $4,260.08 | 2.2× |
| Myocrd img PET prfuj 1std rest/stress cncrnt CT (78430) | $3,303.62 | $4,404.82 | 2.3× |
| Myocrd Img Pet Prfuj Mlt Std Rst&Strs Cncrnt CT (78431) | $4,257.58 | $5,676.78 | 1.9× |
| Myocrd Img Pet Prfuj W/Metab 2rtracer Cncrnt CT (78433) | $3,216.56 | $4,288.74 | 1.4× |
| Neck soft tissue (70360) | $142.06 | $189.42 | 1.6× |
| Njx Rp Loclzj Non-Img Probe Study Intravenous (78808) | $183.56 | $244.75 | 0.5× |
| Nm csf leak detection (78650) | $606.41 | $808.55 | 0.5× |
| Nm myocard infarct spect (78469) | $1,399.02 | $1,865.36 | 2.5× |
| Nonvascular Shunt X-Ray (75809) | $313.85 | $418.46 | 3.0× |
| Nuclear Rx Intra-Arterial (79445) | $1,075.97 | $1,434.63 | 4.6× |
| Nuclear Rx Oral Admin (79005) | $1,368.94 | $1,825.25 | 5.8× |
| Ob us nuchal meas 1 gest (76813) | $525.96 | $701.28 | 5.0× |
| Ophthalmic ultrasound dx b-scan w/wo a-scan (76512) | $110.50 | $147.33 | 1.0× |
| Panoramic X-ray of jaws (70355) | $80.57 | $107.43 | 0.9× |
| Parathyroid imaging w/tomographic spect & CT (78072) | $1,344.26 | $1,792.34 | 2.4× |
| Parathyroid Planar Imaging (78070) | $702.68 | $936.91 | 1.7× |
| Parathyroid planar imaging w/wo subtraction (78071) | $878.37 | $1,171.16 | 2.2× |
| Pelvis 1 or 2 views (72170) | $153.91 | $205.21 | 1.5× |
| Perineogram (74775) | $449.11 | $598.81 | 1.9× |
| Peritoneogram Rs&I (74190) | $189.19 | $252.25 | 0.3× |
| Pet Image W/Ct Lmtd (78814) | $3,412.79 | $4,550.39 | 2.4× |
| PET image w/CT, full body (78816) | $4,938.98 | $6,585.31 | 3.4× |
| PET imaging CT attenuation skull base mid-thigh (78815) | $4,318.33 | $5,757.77 | 3.0× |
| Pet Myocardial Sngl Study (78491) | $2,775.22 | $3,700.29 | 1.9× |
| Prq Transhepatc Portograpy Hemodyn Eval Rs&I (75885) | $1,319.79 | $1,759.72 | 0.4× |
| Pulmonary Perfusion Imaging Particulate (78580) | $553.65 | $738.20 | 1.4× |
| Radex Abd Compl Aqt Abd W/S/E/D Views 1 View Ch (74022) | $241.80 | $322.40 | 2.3× |
| Radex abscess/fistula/sinus tract rs&i (76080) | $415.63 | $554.17 | 0.8× |
| Radex Ankle Complete Minimum 3 Views (73610) | $200.41 | $267.21 | 2.3× |
| Radex Calcaneus Minimum 2 Views (73650) | $164.44 | $219.25 | 1.9× |
| Radex elbow complete minimum 3 views (73080) | $209.02 | $278.69 | 2.4× |
| Radex Facial Bones Complete Minimum 3 Views (70150) | $236.96 | $315.94 | 2.2× |
| Radex fingr minimum 2 views (73140) | $153.07 | $204.09 | 1.7× |
| Radex foot complete minimum 3 views (73630) | $200.24 | $266.98 | 2.3× |
| Radex Hand Minimum 3 Views (73130) | $200.10 | $266.80 | 2.3× |
| Radex lower extremity infant minimum 2 views (73592) | $140.84 | $187.79 | 1.6× |
| Radex Mastoids Compl Minimum 3 Views PR Side (70130) | $127.70 | $170.26 | 1.2× |
| Radex Nasal Bones Complete Minimum 3 Views (70160) | $172.12 | $229.50 | 2.0× |
| Radex Ribs Unilateral 2 Views (71100) | $176.60 | $235.47 | 2.0× |
| Radex shoulder complete minimum 2 views (73030) | $205.84 | $274.46 | 2.3× |
| Radex Sinuses Paransl < 3 Views (70210) | $166.12 | $221.50 | 1.9× |
| Radex sm int w/mlt srl imges via enteroclss tube (74251) | $460.84 | $614.45 | 2.6× |
| Radex Spine 1 View Specify Level (72020) | $158.26 | $211.01 | 1.8× |
| Radex Sternum Minimum 2 Views (71120) | $187.76 | $250.34 | 2.1× |
| Radex Temporomandble Jt Opn & Clsd Mouth Bilat (70330) | $214.27 | $285.69 | 2.4× |
| Radex Toe Minimum 2 Views (73660) | $164.32 | $219.09 | 1.9× |
| Radex upper extremity infant minimum 2 views (73092) | $135.34 | $180.46 | 1.3× |
| Radex Wrist Complete Minimum 3 Views (73110) | $184.16 | $245.54 | 2.1× |
| Radex X-Ray Exam Entire Spi 6/> Vw - Xr Entire Spine 6+ Vw (72084) | $401.17 | $534.89 | 3.8× |
| Radiolog exam mandible compl minimum 4 views (70110) | $238.13 | $317.51 | 2.2× |
| Radiologic Exam Abdomen 3+ Views - Xr Abdomen 3+ Views (74021) | $166.13 | $221.51 | 1.6× |
| Radiologic exam colon double contrast study (74280) | $485.74 | $647.66 | 2.7× |
| Radiologic exam colon single contrast study (74270) | $457.12 | $609.50 | 2.6× |
| Radiologic Exam Esophagus Double Contrast Study (74221) | $290.11 | $386.81 | 1.6× |
| Radiologic exam knee complete 4/more views (73564) | $219.22 | $292.29 | 2.1× |
| Radiologic exam pelvis compl minimum 3 views (72190) | $200.91 | $267.88 | 1.9× |
| Radiologic Exam Small Int Single Contrast Study (74250) | $418.34 | $557.78 | 2.4× |
| Radiologic exam swallow function contrast study (74230) | $390.97 | $521.29 | 2.2× |
| Radiologic exam upr gi trc double contrast study (74246) range across 2 matching MRF lines |
$570.55–$603.76 | $760.73–$805.02 | varies |
| Radiologic examination femur 1 view (73551) | $122.90 | $163.87 | 1.4× |
| Radiologic examination femur minimum 2 views (73552) | $184.83 | $246.44 | 2.1× |
| Radiologic examination knee 1/2 views (73560) | $144.76 | $193.01 | 1.6× |
| Radiologic Examination Osseous Survey Limited (77074) | $297.54 | $396.72 | 2.8× |
| Radiologic examination tibia & fibula 2 views (73590) | $163.22 | $217.63 | 1.9× |
| Ribs bilateral 3 views (71110) | $551.36 | $735.15 | 5.2× |
| Rp Loclzj Tum Plnr Whole Body 2+ Days Imaging (78804) | $1,159.81 | $1,546.41 | 2.1× |
| Rp Loclzj Tum Plnr Whole Body Single Day Imaging (78802) | $607.37 | $809.83 | 1.1× |
| Rp Loclzj Tum Spect 1 Area Single Day Imaging (78803) | $1,158.38 | $1,544.51 | 2.1× |
| Rp loclzj tum spect 2 area/sep acquisj img (78831) | $960.31 | $1,280.41 | 0.7× |
| Rp loclzj tum spect CT 2area 1d img/1 ar img>2+d (78832) | $1,118.51 | $1,491.34 | 0.8× |
| Rp loclzj tum spect w/CT 1 area/acquisj 1day img (78830) | $1,158.38 | $1,544.51 | 0.9× |
| Rp Therapy Intravenous Administration (79101) | $506.68 | $675.57 | 2.1× |
| Scapula (73010) | $178.19 | $237.59 | 1.7× |
| Screening Digital Breast Tomosynthesis Bi (77063) range across 2 matching MRF lines |
$43.45–$86.89 | $57.93–$115.85 | varies |
| Sella turcica (70240) | $77.98 | $103.98 | 0.9× |
| Shoulder 1 view (73020) | $154.85 | $206.47 | 1.8× |
| Shoulder Arthrography (73040) | $422.51 | $563.35 | 1.2× |
| Sialogram (70390) range across 2 matching MRF lines |
$301.73–$603.46 | $402.30–$804.61 | varies |
| Skull less than 4 views (70250) | $208.02 | $277.36 | 2.0× |
| Special dosimetry (77331) | $345.04 | $460.06 | 2.5× |
| Sternoclavicular joints (71130) | $205.88 | $274.51 | 2.3× |
| Superior sagittal sinus venogram (75870) | $1,029.58 | $1,372.78 | 0.3× |
| Tbs techl prep&transmis data alys pfrmd elsewhr (77090) | $87.94 | $117.25 | 1.0× |
| Temporomandble Jt Arthrography Rs&I (70332) | $436.24 | $581.66 | 1.8× |
| Therapeutic Enema Rdctj Intussusception/Obstrcj (74283) | $345.58 | $460.78 | 1.9× |
| Thoracic spine 2 views (72070) | $181.49 | $241.99 | 1.7× |
| Thoracic spine 3 views (72072) | $185.98 | $247.98 | 1.8× |
| Thoracolumbar 2 views (72080) | $223.91 | $298.55 | 2.5× |
| Thyroid Carcinoma Metastases Img Lmtd Area (78015) | $854.56 | $1,139.41 | 2.1× |
| Thyroid Imaging With Vascular Flow (78013) | $764.39 | $1,019.19 | 1.9× |
| Thyroid Met Imaging Body (78018) | $1,046.18 | $1,394.91 | 1.9× |
| Thyroid Uptake Measurement (78012) | $326.34 | $435.12 | 0.8× |
| Thyroid Uptake W/Blood Flow Sngle/Mult Quan Meas (78014) | $1,102.73 | $1,470.31 | 2.7× |
| Ultrasound Breast Limited (76642) range across 2 matching MRF lines |
$309.31–$587.61 | $412.41–$783.48 | varies |
| Ultrasound elastography first target lesion (76982) | $336.76 | $449.02 | 3.2× |
| Ultrasound Elastography Parenchyma (76981) | $537.81 | $717.08 | 5.1× |
| Ultrasound Exam Aaa Screen (76706) | $159.22 | $212.29 | 1.5× |
| Ultrasound trgt dynamic microbubble 1st lesion (76978) | $287.42 | $383.22 | 0.8× |
| Ultrasound, abdomen limited (76705) | $316.11 | $421.48 | 3.0× |
| Umbilical-artery Doppler (OB) (76820) | $397.37 | $529.83 | 3.8× |
| Unlisted Dx Radiographic Procedure (76499) range across 3 matching MRF lines |
$45.94–$270.58 | $61.26–$360.78 | varies |
| Unlisted fluoroscopic procedure (76496) range across 3 matching MRF lines |
$1,073.22–$1,756.18 | $1,430.96–$2,341.58 | varies |
| Unlisted magnetic resonance procedure (76498) range across 5 matching MRF lines |
$1,714.77–$2,240.61 | $2,286.36–$2,987.48 | varies |
| Unlisted us procedure (76999) range across 4 matching MRF lines |
$176.93–$176.95 | $235.91–$235.93 | varies |
| Upper gi w/o kub (74240) range across 2 matching MRF lines |
$253.70–$570.58 | $338.27–$760.77 | varies |
| Ureteral Reflux Study (78740) | $521.94 | $695.92 | 1.3× |
| Urethrocystogram voiding (74455) | $272.72 | $363.63 | 1.1× |
| Urethrocystography retrograde (74450) | $296.54 | $395.39 | 1.2× |
| Us breast unilateral complete (76641) range across 2 matching MRF lines |
$508.98–$1,017.95 | $678.64–$1,357.27 | varies |
| Us chest (76604) | $266.05 | $354.73 | 2.5× |
| Us complete joint (76881) | $298.41 | $397.88 | 2.8× |
| Us exam, pelvic, limited (76857) | $289.39 | $385.85 | 2.7× |
| Us head (76506) | $354.61 | $472.81 | 3.3× |
| Us kidney transplant (76776) | $333.86 | $445.15 | 3.2× |
| Us lmtd joint/oth nonvasc xtr strux r-t w/img (76882) range across 2 matching MRF lines |
$175.39–$350.78 | $233.85–$467.70 | varies |
| Us ob detailed single fetus (76811) | $816.71 | $1,088.95 | 3.4× |
| Us ob limited 1 or more fetuses (76815) | $176.56 | $235.41 | 1.7× |
| Us ob transvaginal (76817) range across 2 matching MRF lines |
$273.92–$436.40 | $365.22–$581.86 | varies |
| Us pelvic non ob complete (76856) | $306.78 | $409.04 | 2.9× |
| Us pg uter img f&mat 14 wk tabdl 1/1st gestation (76801) | $320.70 | $427.60 | 3.0× |
| Us preg uterus real time f/u trnsabdl per fetus (76816) | $263.01 | $350.68 | 2.5× |
| Us retroperitoneal complete (76770) | $343.83 | $458.44 | 3.2× |
| Us retroperitoneal limited (76775) | $265.11 | $353.48 | 2.5× |
| Us scrotum and contents (76870) | $287.01 | $382.68 | 2.7× |
| Us spinal canal and contents (76800) | $418.24 | $557.66 | 4.0× |
| Us thyroid (76536) | $308.38 | $411.17 | 2.9× |
| Us transrectal (76872) | $343.94 | $458.59 | 3.2× |
| Vascular Flow Imaging (78445) | $700.65 | $934.20 | 1.7× |
| Vein X-Ray Chest (75827) | $816.83 | $1,089.11 | 0.5× |
| Vein X-Ray Liver W/O Hemodyn (75887) | $1,150.82 | $1,534.43 | 0.4× |
| Vein X-Ray Spleen/Liver (75810) | $1,138.90 | $1,518.54 | 0.4× |
| Venogram Sinus/Jugular (75860) | $731.15 | $974.87 | 0.2× |
| Venography Adrenal Unilateral (75840) | $1,009.60 | $1,346.13 | 0.3× |
| Venography caval inferior serialography rs&i (75825) | $3,002.69 | $4,003.59 | 0.9× |
| Venography extremity bilateral rs&i (75822) | $897.32 | $1,196.42 | 0.6× |
| Venography extremity unilateral rs&i (75820) | $693.77 | $925.03 | 0.4× |
| Venography Renal Bilateral (75833) | $1,385.32 | $1,847.10 | 0.4× |
| Venography Renal Unilateral (75831) | $1,439.68 | $1,919.58 | 0.5× |
| Venous sampling by catheter (75893) likely a partial charge, not the full procedure |
$673.35 | $897.80 | 0.1× |
| Wrist 2 views (73100) | $129.04 | $172.06 | 1.5× |
| X-Ray Ac Jts - Xr Acromioclavicular Joints Bilateral (73050) | $196.88 | $262.51 | 2.2× |
| X-ray antegrade pyelogram tube (74425) | $323.71 | $431.61 | 0.9× |
| X-Ray Aorta Leg Arteries (75630) | $2,230.09 | $2,973.46 | 0.7× |
| X-Ray Bend Only L-S Spine (72120) | $197.36 | $263.15 | 1.9× |
| X-Ray Elbow 2 Vw - Xr Elbow 1-2 Views Right (73070) range across 2 matching MRF lines |
$122.83–$122.84 | $163.77–$163.78 | varies |
| X-Ray Exam Breast Specimen (76098) | $135.80 | $181.07 | 0.2× |
| X-Ray Exam Entire Spi 1 Vw (72081) | $143.08 | $190.77 | 1.6× |
| X-Ray Exam Entire Spi 2/3 Vw (72082) | $226.04 | $301.39 | 2.1× |
| X-Ray Exam Entire Spi 4/5 Vw (72083) | $229.70 | $306.26 | 2.2× |
| X-Ray Exam Hip Uni 1 View (73501) | $178.86 | $238.48 | 2.0× |
| X-Ray Exam Hip Uni 2-3 Views (73502) | $404.29 | $539.05 | 4.6× |
| X-Ray Exam Hip Uni 4/> Views (73503) | $603.95 | $805.26 | 5.7× |
| X-Ray Exam Hips Bi 2 Views (73521) | $926.14 | $1,234.86 | 8.7× |
| X-Ray Exam Hips Bi 3-4 Views (73522) | $967.10 | $1,289.47 | 9.1× |
| X-Ray Exam Hips Bi 5/> Views (73523) | $1,452.97 | $1,937.29 | 13.7× |
| X-Ray Exam L-S Spine Bending (72114) | $247.16 | $329.55 | 2.3× |
| X-Ray Exam Neck Spine 2-3 Vw (72040) | $186.72 | $248.96 | 2.1× |
| X-Ray Exam Neck Spine 6/>Vws (72052) | $337.78 | $450.37 | 3.2× |
| X-Ray Exam Unilat Ribs/Chest (71101) | $196.12 | $261.50 | 1.9× |
| X-ray eye for foreign body (70030) | $12.98 | $17.31 | 0.1× |
| X-ray humerus (73060) | $189.09 | $252.12 | 2.1× |
| X-ray IV pyelogram (ivp) (74400) | $397.30 | $529.73 | 2.2× |
| X-ray IV pyelogram+tomography (74415) | $606.95 | $809.27 | 3.4× |
| X-Ray Jaw <4 Vw - Xr Mandible < 4 Views (70100) | $181.80 | $242.40 | 2.1× |
| X-Ray Knee Bilat Standing - Xr Knees Anteroposterior Standing Bilat (73565) | $336.65 | $448.87 | 3.8× |
| X-Ray Lumbar Spine 2/3 Vw - Xr Lumbar Spine 2-3 Views (72100) | $185.54 | $247.38 | 1.8× |
| X-ray nose-rectum child f.b. (76010) | $115.36 | $153.81 | 1.3× |
| X-Ray Ribs, Chest 4+ Vw - Xr Ribs 3 Vws Bil W/ Chest Posteroanterior (71111) | $613.48 | $817.98 | 5.8× |
| X-Ray Sacroiliac Jts 3+ Vw - Xr Sacroiliac Joints 3+ Views (72202) | $222.58 | $296.77 | 2.1× |
| X-Ray Sacroiliac Jts <3 Vw - Xr Sacroiliac Joints 1-2 Views (72200) | $197.20 | $262.93 | 1.9× |
| X-Ray Sacrum/Coccyx 2+ Vw - Xr Sacrum Coccyx 2+ Views (72220) | $201.91 | $269.21 | 2.3× |
| X-Ray Sinuses 3+ Vw - Xr Paranasal Sinuses 3+ Views (70220) | $238.76 | $318.35 | 2.7× |
| X-Ray Skull 4+ Vw - Xr Skull Complete 4+ Views (70260) | $236.02 | $314.69 | 2.2× |
| X-ray thoracic spine 4 vw (72074) | $192.19 | $256.25 | 1.8× |
| X-Ray Urinary Tract Exam With Contrast Material (74420) | $358.22 | $477.62 | 1.0× |
| X-Rays Bone Length Studies (77073) | $245.68 | $327.58 | 2.3× |
| X-Rays Bone Survey Complete (77075) | $481.93 | $642.57 | 4.6× |
| Xr c-spine 4 or 5 views (72050) | $223.76 | $298.35 | 2.1× |
| Xr facial bones less than 3 views (70140) | $194.88 | $259.84 | 2.2× |
| Xr orbits complete 4 views (70200) range across 2 matching MRF lines |
$294.08–$326.74 | $392.11–$435.65 | 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.