Imaging prices at Iredell Memorial Hospital
Statesville, NC · every code in this section with a posted price and a Medicare benchmark.
322 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) | $1,392.93 | $5,159 | 1.0× |
| Abdomen 1 View (74018) | $105.03 | $389 | 1.2× |
| Abdomen 2 views (74019) | $105.03 | $389 | 1.0× |
| Acute Gastrointestinal Blood Loss Imaging (78278) | $265.14 | $982 | 0.7× |
| Angio internal mammary (75756) | $505.44 | $1,872 | 0.2× |
| Angio pulmonary bilat (75743) | $1,572.48 | $5,824 | 0.5× |
| Angiography Adrenal Bilateral Slctv Rs&I (75733) | $1,572.48 | $5,824 | 0.5× |
| Angiography extremity bilateral rs&i (75716) | $9,179.19 | $33,997 | 3.0× |
| Angiography extremity unilateral rs&i (75710) | $1,535.49 | $5,687 | 0.5× |
| Angiography pulmonary unilateral slctv rs&i (75741) | $1,550.02 | $5,740.80 | 0.5× |
| Angrph pulmonary nonslctv cath/ven njx rs&i (75746) | $505.44 | $1,872 | 0.2× |
| Aortography thoracic serialography rs&i (75605) likely a partial charge, not the full procedure |
$1,512 | $5,600 | 0.3× |
| Aortography thoracic w/o serialography rs&i (75600) | $1,490.40 | $5,520 | 0.5× |
| Artery X-Rays Abdomen (75726) likely a partial charge, not the full procedure |
$1,490.40 | $5,520 | 0.3× |
| Artery X-Rays Adrenal Gland (75731) | $1,550.02 | $5,740.80 | 0.5× |
| Artery X-Rays Pelvis (75736) likely a partial charge, not the full procedure |
$1,520.37 | $5,631 | 0.3× |
| Artery X-Rays Spine (75705) unusually low: confirm this is the full procedure |
$2,308.50 | $8,550 | 0.4× |
| Arthrogram ankle (73615) range across 2 matching MRF lines |
$41.35–$41.76 | $153.15–$154.68 | varies |
| Arthrogram hip (73525) | $121.50 | $450 | 0.4× |
| Arthrogram Wrist (73115) | $41.76 | $154.68 | 0.1× |
| Basic radiation dosimetry calculation (77300) | $122.04 | $452 | 0.9× |
| Bone age studies (77072) | $96.12 | $356 | 0.9× |
| Bone Imaging 3 Phase (78315) | $462.51 | $1,713 | 1.2× |
| Bone Imaging Limited Area (78300) | $161.77 | $599.15 | 0.4× |
| Bone Imaging Multiple Areas (78305) | $449.44 | $1,664.60 | 1.2× |
| Bone Imaging Whole Body (78306) | $463.05 | $1,715 | 1.2× |
| Bone survey infant (77076) | $127.71 | $473 | 1.3× |
| Brachytx isodose complex (77318) | $428.72 | $1,587.87 | 1.2× |
| Brain Flow Imaging Only (78610) | $135.89 | $503.30 | 0.3× |
| Brain Imaging Min 4 Static Views W Vascular Flow (78606) | $324.31 | $1,201.15 | 0.6× |
| Brain Imaging Pet Metabolic Evaluation (78608) | $985.53 | $3,650.10 | 0.7× |
| Cat Scan Follow-Up Study (76380) range across 2 matching MRF lines |
$66.76–$87.12 | $247.25–$322.65 | varies |
| Cerebrospinal Fluid Scan (78630) | $194.21 | $719.30 | 0.4× |
| Chest 1 view (71045) range across 5 matching MRF lines |
$40.50–$112.59 | $150–$417 | varies |
| Chest 2 views (71046) range across 3 matching MRF lines |
$85.51–$127.71 | $316.70–$473 | varies |
| Chest 3 views (71047) | $88.29 | $327 | 1.0× |
| Cisternography Positive Contrast Rs&I (70015) | $721.18 | $2,671.04 | 0.9× |
| Clavicle complete (73000) | $91.80 | $340 | 1.1× |
| Computed Tomography Thorax Lw Dose Lng Ca Scr C- (71271) | $151.20 | $560 | 1.5× |
| Continuing medical physics consltj pr wk (77336) | $208.17 | $771 | 1.6× |
| Contrast Exam Abdominl Aorta (75625) range across 2 matching MRF lines |
$1,557.90 | $234–$5,770 | 0.5× |
| Contrast X-Ray Bladder (74430) | $64.26 | $238 | 0.2× |
| Contrast X-Ray Of Elbow (73085) | $406.32 | $1,504.89 | 1.2× |
| Contrast X-Ray Of Knee Joint (73580) | $121.50 | $450 | 0.4× |
| CT abdomen and pelvis without and with contrast (74178) | $1,346.49 | $4,987 | 4.0× |
| CT abdomen and pelvis without contrast (74176) range across 2 matching MRF lines |
$602.82–$810 | $2,232.67–$3,000 | varies |
| CT abdomen w contrast (74160) range across 2 matching MRF lines |
$494.64–$727.38 | $1,832–$2,694 | varies |
| CT abdomen w wo contrast (74170) | $673.11 | $2,493 | 3.9× |
| CT abdomen w/o contrast (74150) | $307.53 | $1,139 | 3.0× |
| CT Angio Abdomen and Pelvis (74174) | $832.95 | $3,085 | 2.5× |
| CT Angio Chest (71275) | $810 | $3,000 | 4.8× |
| CT Angio Head (70496) | $946.08 | $3,504 | 5.6× |
| CT angio hrt w/3d image (75574) | $765.18 | $2,834 | 2.3× |
| Ct Angio Lwr Extr W/O&W/Dye (73706) range across 2 matching MRF lines |
$819.80–$836.46 | $3,036.29–$3,098 | varies |
| CT Angio Neck (70498) | $821.07 | $3,041 | 4.8× |
| Ct Angio Upr Extrm W/O&W/Dye (73206) range across 3 matching MRF lines |
$597.24–$679.86 | $2,212–$2,518 | varies |
| CT cervical spine w/ contrast (72126) | $758.16 | $2,808 | 2.2× |
| CT cervical spine w/o contrast (72125) | $675 | $2,500 | 6.6× |
| CT cervical spine w/wo cont (72127) | $706.60 | $2,617.05 | 4.1× |
| CT chest w contrast (71260) | $800.55 | $2,965 | 4.7× |
| CT chest w/wo contrast (71270) range across 2 matching MRF lines |
$750.52–$880.47 | $2,779.70–$3,261 | varies |
| CT head/brain with contrast (70460) | $647.19 | $2,397 | 3.8× |
| CT head/brain without and with contrast (70470) | $925.83 | $3,429 | 5.4× |
| CT heart no contrast quant eval coronry calcium (75571) | $118.53 | $439 | 1.4× |
| CT iac w contrast (70481) range across 2 matching MRF lines |
$647.19–$788.13 | $2,397–$2,919 | varies |
| CT l-spine w&w/o contrast (72133) | $803.36 | $2,975.40 | 4.7× |
| CT lower ext w/o (73700) range across 16 matching MRF lines |
$230.31–$264.87 | $853–$981 | varies |
| CT lower extremity w/contrast material (73701) range across 16 matching MRF lines |
$296.07–$347.49 | $1,096.55–$1,287 | varies |
| CT lumbar spine w contrast (72132) | $758.16 | $2,808 | 2.2× |
| CT lumbar spine w/o contrast (72131) | $591.57 | $2,191 | 5.8× |
| CT maxillofacial w contrast (70487) | $646.92 | $2,396 | 3.8× |
| CT maxillofacial wo contrast (70486) range across 3 matching MRF lines |
$225.60–$509.49 | $835.55–$1,887 | varies |
| CT neck tissue combo (70492) | $682.83 | $2,529 | 4.0× |
| Ct Orbit/Ear/Fossa W/O&W/Dye (70482) | $820.53 | $3,039 | 4.8× |
| CT orbits w/o contrast (70480) range across 2 matching MRF lines |
$585.63–$647.19 | $2,169–$2,397 | varies |
| CT pelvis w&w/o contrast (72194) | $439.72 | $1,628.60 | 2.6× |
| CT pelvis w/o contrast (72192) range across 2 matching MRF lines |
$262.09–$307.53 | $970.70–$1,139 | varies |
| CT scan of leg combo (73702) | $331.30 | $1,227.05 | 1.9× |
| CT scans face/jaw combo (70488) | $789.16 | $2,922.80 | 4.6× |
| CT soft tissue neck w contrast (70491) | $647.19 | $2,397 | 3.8× |
| CT soft tissue neck w/o contrast (70490) | $477.09 | $1,767 | 4.7× |
| CT thoracic spine w contrast (72129) | $758.16 | $2,808 | 4.4× |
| CT thoracic spine w/o contrast (72128) | $591.57 | $2,191 | 5.8× |
| CT thoracic spine w/wo cont (72130) | $713.67 | $2,643.22 | 4.2× |
| CT thorax w/o contrast (71250) range across 3 matching MRF lines |
$151.20–$513.27 | $560–$1,901 | varies |
| CT upper ext wo (73200) range across 13 matching MRF lines |
$227.86–$232.47 | $843.91–$861 | varies |
| CT upper extremity w/o & w/contrast material (73202) range across 13 matching MRF lines |
$331.30–$334.62 | $1,227.05–$1,239.32 | varies |
| CT upper extremity with contrast (73201) range across 13 matching MRF lines |
$299.03–$347.49 | $1,107.52–$1,287 | varies |
| Cta Abdl Aorta&Bi Iliofem W/Contrast&Postp (75635) | $877.50 | $3,250 | 5.1× |
| Cta Abdomen (74175) | $679.86 | $2,518 | 4.0× |
| Diskography lumbar (72295) | $1,700.89 | $6,299.60 | 0.9× |
| Dxa Bone Density Axial (77080) | $139.32 | $516 | 1.4× |
| Dxa bone density study 1/>sites appendiclr skel (77081) | $86.67 | $321 | 1.0× |
| Echo Guide For Artery Repair (76936) | $272.97 | $1,011 | 1.3× |
| Echograp Trans R Pros Study (76873) | $206.28 | $764 | 2.0× |
| Esophagram (74220) | $81.27 | $301 | 0.5× |
| Fetal Biophys Profile W/Nst (76818) | $80.73 | $299 | 0.8× |
| Fetal Biophysical Profile W/O Non-Stress Testing (76819) range across 2 matching MRF lines |
$79.92–$88.95 | $296–$329.44 | varies |
| Fluoroscopy up to 1 hr (76000) range across 4 matching MRF lines |
$50.22–$243.81 | $186–$903 | varies |
| Follow-Up Angiography (75898) | $144.61 | $535.60 | 0.0× |
| Forearm 2 views (73090) | $89.91 | $333 | 1.1× |
| Gastric emptying imaging study (78264) | $341.82 | $1,266 | 0.9× |
| Gated Heart Planar Single (78472) | $476.01 | $1,763 | 1.2× |
| Hepatc Vngrph Wdg/Fr Hemodyn Eval Rs&I (75889) | $1,550.02 | $5,740.80 | 0.5× |
| Hepatc Vngrph Wdg/Fr W/O Hemodyn Eval Rs&I (75891) | $1,572.48 | $5,824 | 0.5× |
| Hepatobil Syst Image W/Drug (78227) | $438.75 | $1,625 | 0.8× |
| Hepatobiliary System Imaging (78226) | $376.92 | $1,396 | 1.0× |
| Ht Musc Image Planar Mult (78454) range across 2 matching MRF lines |
$666.35–$679.86 | $2,467.95–$2,518 | varies |
| Ht Muscle Image Spect Sing (78451) range across 3 matching MRF lines |
$481.22–$490.86 | $1,782.30–$1,818 | varies |
| Hysterosalpingogram (74740) | $91.26 | $338 | 0.4× |
| Infant hip ultrasound with hip movement (dynamic) (76885) | $233.55 | $865 | 2.8× |
| Infant hip ultrasound, limited static exam (76886) | $271.62 | $1,006 | 3.2× |
| Interstitial radiation source applic complex (77778) | $962.21 | $3,563.73 | 1.4× |
| Intracavitary Radiation Source Applic Complex (77763) | $697.94 | $2,584.95 | 1.0× |
| Intracavitary Radiation Source Applic Intermed (77762) | $523.56 | $1,939.10 | 1.0× |
| Intracavitary radiation source applic simple (77761) | $349.15 | $1,293.15 | 0.7× |
| K Flow/Funct Image W/Drug (78708) | $579.15 | $2,145 | 1.1× |
| K Flow/Funct Image W/O Drug (78707) range across 2 matching MRF lines |
$379.62–$543.71 | $1,406–$2,013.74 | varies |
| Knee 3 Views (73562) range across 3 matching MRF lines |
$99.66–$101.79 | $369.10–$377 | varies |
| Leveen/Shunt Patency Exam (78291) | $300.50 | $1,112.96 | 0.8× |
| Liver imaging static only (78201) | $305.98 | $1,133.25 | 0.6× |
| Liver imaging w/vascular flow (78202) | $427.86 | $1,584.65 | 0.8× |
| Lung Ventilat&Perfus Imaging (78582) | $713.61 | $2,643 | 1.4× |
| Lung Ventilation Imaging (78579) | $389.48 | $1,442.50 | 1.0× |
| Lymph System Imaging (78195) | $140.67 | $521 | 0.3× |
| Lymphangiography Extremity Only Bilateral Rs&I (75803) | $287.82 | $1,066 | 0.2× |
| Lymphangiography extremity only unilateral rs&i (75801) | $287.82 | $1,066 | 0.5× |
| Lymphangiography Pelvic/Abdominal Bilateral Rs&I (75807) | $287.82 | $1,066 | 0.1× |
| Lymphangiography, pelvic/abdominal, unilateral (75805) | $287.82 | $1,066 | 0.1× |
| Magnetic Image Jaw Joint (70336) | $738.71 | $2,735.95 | 3.2× |
| Meckels Divert Exam (78290) | $269.74 | $999.04 | 0.7× |
| Mlc imrt design & construction per imrt plan (77338) | $1,709.10 | $6,330 | 4.7× |
| Mra Head W/O & W/Contrast Material (70546) | $965.52 | $3,576 | 2.8× |
| MRA head w/o contrast (70544) | $547.29 | $2,027 | 2.4× |
| MRA head with contrast (70545) | $644.22 | $2,386 | 1.9× |
| MRA neck w contrast (70548) | $644.22 | $2,386 | 1.9× |
| Mra Neck W/O &W/Contrast Material (70549) | $761.13 | $2,819 | 2.2× |
| MRA neck w/o contrast (70547) | $547.29 | $2,027 | 2.4× |
| MRI abdomen w contrast (74182) | $835.38 | $3,094 | 2.5× |
| MRI abdomen w/o contrast (74181) | $777.06 | $2,878 | 3.4× |
| MRI any jt lower extrem w/contrast material (73722) range across 8 matching MRF lines |
$613.44–$931.89 | $2,272–$3,451.44 | varies |
| MRI any jt lower extrem w/o & w/contrast matrl (73723) range across 7 matching MRF lines |
$850.72–$867.78 | $3,150.82–$3,214 | varies |
| MRI any jt upper extremity w/contrast matrl (73222) range across 7 matching MRF lines |
$653.94–$950.67 | $2,422–$3,521 | varies |
| MRI Breast W/O Contrast Bilateral (77047) range across 4 matching MRF lines |
$520.29–$580.51 | $1,927–$2,150.04 | varies |
| MRI Breast Without Contrast Material Unilateral (77046) | $520.29 | $1,927 | 2.2× |
| MRI cervical spine w contrast (72142) | $769.50 | $2,850 | 2.3× |
| MRI cervical spine w/o cont (72141) | $653.94 | $2,422 | 2.8× |
| MRI chest w/o contrast (71550) | $652.86 | $2,418 | 2.8× |
| MRI chest with contrast (71551) | $841.01 | $3,114.85 | 1.1× |
| MRI chest wo w contrast (71552) | $866.43 | $3,209 | 2.6× |
| MRI lower extrem oth/thn jt w/contrast matrl (73719) range across 6 matching MRF lines |
$634.76–$777.33 | $2,350.95–$2,879 | varies |
| MRI lower extrem oth/thn jt w/o & w/contr matr (73720) range across 6 matching MRF lines |
$867.78–$1,031.13 | $3,214–$3,819 | varies |
| MRI lower extrem oth/thn jt w/o contr matrl (73718) range across 6 matching MRF lines |
$653.94–$777.06 | $2,422–$2,878 | varies |
| MRI lumbar spine w contrast (72149) | $792.99 | $2,937 | 2.3× |
| Mri Neck Spine W/O & W/Dye (72156) | $953.10 | $3,530 | 2.8× |
| MRI orbit face &/neck w/o contrast (70540) range across 3 matching MRF lines |
$634.76–$842.31 | $2,350.95–$3,119.65 | varies |
| MRI orbit face neck w contrast (70542) range across 3 matching MRF lines |
$688.50–$842.31 | $2,550–$3,119.65 | varies |
| Mri Orbt/Fac/Nck W/O &W/Dye (70543) range across 3 matching MRF lines |
$859.41–$1,031.13 | $3,183–$3,819 | varies |
| MRI pelvis w contrast (72196) | $842.31 | $3,119.65 | 2.5× |
| MRI pelvis w/o & w contrast (72197) | $1,031.13 | $3,819 | 3.0× |
| MRI pelvis w/o contrast (72195) | $777.06 | $2,878 | 3.4× |
| MRI thoracic spine w/o contrast (72146) | $653.94 | $2,422 | 2.8× |
| MRI upper extremity oth than jt w/contr matrl (73219) range across 6 matching MRF lines |
$776.57–$859.13 | $2,876.20–$3,181.95 | varies |
| MRI upper extremity oth than jt w/o contr matrl (73218) | $653.94 | $2,422 | 2.8× |
| Mri Uppr Extremity W/O&W/Dye (73220) range across 6 matching MRF lines |
$850.73–$1,121.31 | $3,150.85–$4,153 | varies |
| MRI, abdomen, combo (74183) | $1,110.51 | $4,113 | 3.3× |
| MRI, dorsal spine combo (72157) | $1,066.50 | $3,950 | 3.1× |
| MRI, dorsal spine contrast (72147) | $792.99 | $2,937 | 2.3× |
| MRI, joint upper extrem (73221) range across 6 matching MRF lines |
$653.94–$777.06 | $2,422–$2,878 | varies |
| MRI, joint upper extrem combo (73223) range across 6 matching MRF lines |
$749.93–$930.69 | $2,777.50–$3,447 | varies |
| MRI, lumbar spine combo (72158) | $1,066.50 | $3,950 | 3.1× |
| Myocardial Imaging Infarct Avid Planar Qual/Quan (78466) range across 2 matching MRF lines |
$280.65–$286.47 | $1,039.45–$1,061 | varies |
| Myocardial Imaging Pet Metabolic Evaluation (78459) | $698.09 | $2,585.50 | 0.6× |
| Myocardial Perfusion Planar 1 Study Rest/Stress (78453) | $333.18 | $1,234 | 0.3× |
| Myocardial Spect Multiple Studies (78452) range across 5 matching MRF lines |
$799.35–$888.30 | $2,960.55–$3,290 | varies |
| Myocrd Img Pet Metab Eval Single Study Cncrnt CT (78429) | $366.27 | $1,356.56 | 0.3× |
| Neck soft tissue (70360) | $64.26 | $238 | 0.8× |
| Njx Rp Loclzj Non-Img Probe Study Intravenous (78808) | $101.09 | $374.40 | 0.3× |
| Nm csf leak detection (78650) | $618.65 | $2,291.30 | 0.5× |
| Ntsty modul radthx pln dose-vol histos (77301) | $2,376 | $8,800 | 1.8× |
| Nuclear Rx Oral Admin (79005) | $189.57 | $702.10 | 0.8× |
| Ophthalmic Ultrasonic Foreign Body Localization (76529) | $64.95 | $240.56 | 0.8× |
| Ophthalmic ultrasound dx b-scan w/wo a-scan (76512) | $120.96 | $448 | 1.2× |
| Parathyroid Planar Imaging (78070) | $187.65 | $695 | 0.5× |
| Pelvis 1 or 2 views (72170) | $91.26 | $338 | 0.9× |
| Pet Image W/Ct Lmtd (78814) | $691.17 | $2,559.90 | 0.5× |
| PET image w/CT, full body (78816) | $1,390.77 | $5,151 | 1.0× |
| PET imaging CT attenuation skull base mid-thigh (78815) | $1,499.85 | $5,555 | 1.1× |
| Prq Transhepatc Portograpy Hemodyn Eval Rs&I (75885) | $1,550.02 | $5,740.80 | 0.5× |
| Pulmonary Perfusion Imaging Particulate (78580) | $395.28 | $1,464 | 1.0× |
| Radex Abd Compl Aqt Abd W/S/E/D Views 1 View Ch (74022) | $126.09 | $467 | 1.2× |
| Radex abscess/fistula/sinus tract rs&i (76080) range across 2 matching MRF lines |
$139–$141.75 | $514.80–$525 | varies |
| Radex Ankle Complete Minimum 3 Views (73610) | $95.31 | $353 | 1.1× |
| Radex Calcaneus Minimum 2 Views (73650) | $90.99 | $337 | 1.1× |
| Radex elbow complete minimum 3 views (73080) | $92.61 | $343 | 1.1× |
| Radex Facial Bones Complete Minimum 3 Views (70150) | $86.94 | $322 | 0.9× |
| Radex fingr minimum 2 views (73140) | $78.30 | $290 | 0.9× |
| Radex foot complete minimum 3 views (73630) | $90.99 | $337 | 1.1× |
| Radex Hand Minimum 3 Views (73130) | $89.64 | $332 | 1.1× |
| Radex Mastoids Compl Minimum 3 Views PR Side (70130) | $117.30 | $434.43 | 1.2× |
| Radex Nasal Bones Complete Minimum 3 Views (70160) | $79.11 | $293 | 0.9× |
| Radex Ribs Unilateral 2 Views (71100) | $61.29 | $227 | 0.7× |
| Radex shoulder complete minimum 2 views (73030) | $90.99 | $337 | 1.1× |
| Radex sm int w/mlt srl imges via enteroclss tube (74251) | $217.80 | $806.65 | 1.3× |
| Radex Spine 1 View Specify Level (72020) range across 4 matching MRF lines |
$61.02–$78.57 | $226–$291 | varies |
| Radex Sternum Minimum 2 Views (71120) | $84.51 | $313 | 1.0× |
| Radex Temporomandble Jt Opn & Clsd Mouth Bilat (70330) | $85.23 | $315.68 | 1.0× |
| Radex Toe Minimum 2 Views (73660) | $68.85 | $255 | 0.8× |
| Radex Wrist Complete Minimum 3 Views (73110) | $86.94 | $322 | 1.0× |
| Radex X-Ray Exam Entire Spi 6/> Vw - Xr Entire Spine 6+ Vw (72084) | $528.93 | $1,959 | 5.2× |
| Radiation treatment delivery level 1 (77402) | $139.32 | $516 | 1.4× |
| Radiation treatment delivery level 2 (77407) | $151.20 | $560 | 0.4× |
| Radiation treatment delivery level 3 (77412) | $289.98 | $1,074 | 0.5× |
| Radiolog exam mandible compl minimum 4 views (70110) | $86.94 | $322 | 0.9× |
| Radiologic exam colon double contrast study (74280) | $247.71 | $917.45 | 1.5× |
| Radiologic exam colon single contrast study (74270) | $191.70 | $710 | 1.1× |
| Radiologic Exam Esophagus Double Contrast Study (74221) | $184.99 | $685.16 | 1.1× |
| Radiologic Exam Small Int Single Contrast Study (74250) | $130.68 | $484 | 0.8× |
| Radiologic exam swallow function contrast study (74230) | $125.55 | $465 | 0.7× |
| Radiologic exam upr gi trc double contrast study (74246) range across 2 matching MRF lines |
$217.51–$271.86 | $805.58–$1,006.90 | varies |
| Radiologic examination femur 1 view (73551) | $165.80 | $614.08 | 2.0× |
| Radiologic examination femur minimum 2 views (73552) | $182.52 | $676 | 2.2× |
| Radiologic examination knee 1/2 views (73560) | $82.89 | $307 | 1.0× |
| Radiologic examination tibia & fibula 2 views (73590) | $90.99 | $337 | 1.1× |
| Ribs bilateral 3 views (71110) | $76.41 | $283 | 0.8× |
| Rp loclzj tum plnr 1 area single day imaging (78800) | $373.71 | $1,384.12 | 1.0× |
| Rp Loclzj Tum Plnr Whole Body 2+ Days Imaging (78804) | $1,304.43 | $4,831.23 | 2.5× |
| Rp Loclzj Tum Plnr Whole Body Single Day Imaging (78802) | $1,330.56 | $4,928 | 2.5× |
| Rp Loclzj Tum Spect 1 Area Single Day Imaging (78803) range across 6 matching MRF lines |
$265.59–$1,304.43 | $983.65–$4,831.23 | varies |
| Rp Therapy Intravenous Administration (79101) | $160.46 | $594.28 | 0.7× |
| Scapula (73010) | $90.99 | $337 | 0.9× |
| Screening Digital Breast Tomosynthesis Bi (77063) | $27 | $100 | 1.2× |
| Shoulder 1 view (73020) | $53.46 | $198 | 0.6× |
| Shoulder Arthrography (73040) | $121.50 | $450 | 0.4× |
| Skull less than 4 views (70250) range across 3 matching MRF lines |
$88.61–$90.45 | $328.20–$335 | varies |
| Special dosimetry (77331) | $118.05 | $437.23 | 0.9× |
| Special Physics Consult (77370) | $183.06 | $678 | 1.4× |
| Special teletherapy port plan (77321) range across 2 matching MRF lines |
$244.67–$252.18 | $906.20–$934 | varies |
| Special treatment procedure (77470) | $594.27 | $2,201 | 1.1× |
| Stereotactic Body Radiation Delivery (77373) | $1,939.95 | $7,185 | 1.1× |
| Sternoclavicular joints (71130) | $66.42 | $246 | 0.8× |
| Superior sagittal sinus venogram (75870) | $520.44 | $1,927.55 | 0.2× |
| Telethx isodose pln cplx w/basic dosimetry (77307) | $786.78 | $2,914 | 2.2× |
| Telethx isodose pln smpl w/dosimetry calculation (77306) | $467.37 | $1,731 | 1.3× |
| Testicular Imaging W/Flow (78761) | $355.16 | $1,315.40 | 0.9× |
| Ther Rad Simulaj-Aided Field Setting Complex (77290) | $372.60 | $1,380 | 1.0× |
| Ther Rad Simulaj-Aided Field Setting Intermed (77285) | $223.28 | $826.95 | 0.6× |
| Ther rad simulaj-aided field setting simple (77280) range across 2 matching MRF lines |
$203.05–$209.25 | $752.05–$775 | varies |
| Thoracic spine 2 views (72070) | $88.56 | $328 | 0.9× |
| Thyroid Imaging With Vascular Flow (78013) | $148.93 | $551.60 | 0.4× |
| Thyroid Met Imaging Body (78018) | $430.23 | $1,593.45 | 0.8× |
| Thyroid Uptake Measurement (78012) | $93.58 | $346.60 | 0.2× |
| Thyroid Uptake W/Blood Flow Sngle/Mult Quan Meas (78014) | $261.63 | $969 | 0.7× |
| Tx Devices Design & Construction Complex (77334) | $341.82 | $1,266 | 0.9× |
| Tx devices design & construction intermediate (77333) | $225.72 | $836 | 1.7× |
| Tx devices design & construction simple (77332) | $173.61 | $643 | 1.3× |
| Ultrasound Breast Limited (76642) range across 4 matching MRF lines |
$73.44–$145.34 | $271.99–$538.30 | varies |
| Ultrasound Exam Aaa Screen (76706) | $127.17 | $471 | 1.3× |
| Ultrasound, abdomen limited (76705) | $271.62 | $1,006 | 2.7× |
| Unlisted Procedure Clinical Brachytherapy (77799) range across 2 matching MRF lines |
$412.18–$697.94 | $1,526.60–$2,584.95 | varies |
| Unlisted us procedure (76999) | $66.96 | $248 | 0.8× |
| Upper gi w/o kub (74240) | $686.61 | $2,543 | 4.0× |
| Urethrocystogram voiding (74455) | $89.24 | $330.50 | 0.4× |
| Urethrocystography retrograde (74450) range across 2 matching MRF lines |
$73.02–$75.33 | $270.45–$279 | varies |
| Us breast unilateral complete (76641) range across 3 matching MRF lines |
$75.06–$145.34 | $278–$538.30 | varies |
| Us chest (76604) range across 3 matching MRF lines |
$274.34–$279.99 | $1,016.06–$1,037 | varies |
| Us exam, pelvic, limited (76857) range across 2 matching MRF lines |
$53.65–$54.81 | $198.72–$203 | varies |
| Us lmtd joint/oth nonvasc xtr strux r-t w/img (76882) range across 6 matching MRF lines |
$140.40–$280.53 | $520–$1,039 | varies |
| Us ob limited 1 or more fetuses (76815) range across 3 matching MRF lines |
$63.45–$135.81 | $235–$503 | varies |
| Us ob transvaginal (76817) range across 3 matching MRF lines |
$63.45–$193.86 | $235–$718 | varies |
| Us pelvic non ob complete (76856) range across 2 matching MRF lines |
$271.62–$279.99 | $1,006–$1,037 | varies |
| Us pg uter img f&mat 14 wk tabdl 1/1st gestation (76801) | $163.89 | $607 | 1.6× |
| Us preg uterus real time f/u trnsabdl per fetus (76816) range across 5 matching MRF lines |
$61.55–$91.80 | $227.95–$340 | varies |
| Us retroperitoneal complete (76770) | $101.25 | $375 | 1.0× |
| Us retroperitoneal limited (76775) range across 11 matching MRF lines |
$271.62–$301.05 | $1,006–$1,115 | varies |
| Us scrotum and contents (76870) range across 2 matching MRF lines |
$271.07–$279.45 | $1,003.95–$1,035 | varies |
| Us thyroid (76536) range across 3 matching MRF lines |
$274.34–$279.99 | $1,016.06–$1,037 | varies |
| Vein X-Ray Chest (75827) | $486 | $1,800 | 0.3× |
| Vein X-Ray Skull Epidural (75872) | $505.44 | $1,872 | 0.8× |
| Vein X-Ray Spleen/Liver (75810) | $1,550.02 | $5,740.80 | 0.5× |
| Venogram Sinus/Jugular (75860) | $486 | $1,800 | 0.2× |
| Venography Adrenal Unilateral (75840) | $1,550.02 | $5,740.80 | 0.5× |
| Venography caval inferior serialography rs&i (75825) | $1,520.37 | $5,631 | 0.5× |
| Venography extremity bilateral rs&i (75822) | $502.63 | $1,861.60 | 0.3× |
| Venography extremity unilateral rs&i (75820) range across 5 matching MRF lines |
$329.97–$486 | $1,222.10–$1,800 | varies |
| Venography Orbital Rs&I (75880) | $505.44 | $1,872 | 0.8× |
| Venography Renal Bilateral (75833) | $1,572.48 | $5,824 | 0.5× |
| Venography Renal Unilateral (75831) | $1,550.02 | $5,740.80 | 0.5× |
| Venous sampling by catheter (75893) likely a partial charge, not the full procedure |
$1,550.02 | $5,740.80 | 0.3× |
| X-Ray Ac Jts - Xr Acromioclavicular Joints Bilateral (73050) | $89.04 | $329.77 | 1.1× |
| X-ray antegrade pyelogram tube (74425) range across 2 matching MRF lines |
$91.26–$140.40 | $338–$520 | varies |
| X-Ray Aorta Leg Arteries (75630) | $1,542.24 | $5,712 | 0.5× |
| X-Ray Bend Only L-S Spine (72120) | $62.10 | $230 | 0.6× |
| X-Ray Exam Breast Specimen (76098) range across 3 matching MRF lines |
$90.13–$92.07 | $333.81–$341 | varies |
| X-Ray Exam Entire Spi 1 Vw (72081) | $164.16 | $608 | 1.9× |
| X-Ray Exam Entire Spi 2/3 Vw (72082) range across 2 matching MRF lines |
$153.09–$280.26 | $567–$1,038 | varies |
| X-Ray Exam Entire Spi 4/5 Vw (72083) | $518.32 | $1,919.70 | 5.1× |
| X-Ray Exam Hip Uni 1 View (73501) range across 4 matching MRF lines |
$164.16–$169.29 | $608–$627 | varies |
| X-Ray Exam Hip Uni 2-3 Views (73502) range across 7 matching MRF lines |
$79.45–$182.52 | $294.25–$676 | varies |
| X-Ray Exam Hip Uni 4/> Views (73503) | $274.58 | $1,016.97 | 2.7× |
| X-Ray Exam Hips Bi 2 Views (73521) | $103.68 | $384 | 1.0× |
| X-Ray Exam Hips Bi 3-4 Views (73522) | $280.26 | $1,038 | 2.8× |
| X-Ray Exam Hips Bi 5/> Views (73523) | $534.06 | $1,978 | 5.3× |
| X-Ray Exam L-S Spine Bending (72114) | $144.72 | $536 | 1.4× |
| X-Ray Exam Neck Spine 2-3 Vw (72040) | $74.25 | $275 | 0.9× |
| X-Ray Exam Neck Spine 6/>Vws (72052) | $143.10 | $530 | 1.4× |
| X-Ray Exam Unilat Ribs/Chest (71101) | $86.67 | $321 | 0.9× |
| X-ray eye for foreign body (70030) | $74.52 | $276 | 0.9× |
| X-ray humerus (73060) | $83.70 | $310 | 1.0× |
| X-ray IV pyelogram+tomography (74415) | $353.93 | $1,310.85 | 2.1× |
| X-Ray Knee Bilat Standing - Xr Knees Anteroposterior Standing Bilat (73565) | $70.47 | $261 | 0.8× |
| X-Ray Lumbar Spine 2/3 Vw - Xr Lumbar Spine 2-3 Views (72100) | $110.70 | $410 | 1.1× |
| X-ray nose-rectum child f.b. (76010) | $87.75 | $325 | 1.0× |
| X-Ray Ribs, Chest 4+ Vw - Xr Ribs 3 Vws Bil W/ Chest Posteroanterior (71111) | $115.83 | $429 | 1.1× |
| X-Ray Sacroiliac Jts 3+ Vw - Xr Sacroiliac Joints 3+ Views (72202) | $73.17 | $271 | 0.7× |
| X-Ray Sacrum/Coccyx 2+ Vw - Xr Sacrum Coccyx 2+ Views (72220) range across 3 matching MRF lines |
$73.83–$75.33 | $273.46–$279 | varies |
| X-Ray Sinuses 3+ Vw - Xr Paranasal Sinuses 3+ Views (70220) | $86.94 | $322 | 1.0× |
| X-Ray Skull 4+ Vw - Xr Skull Complete 4+ Views (70260) range across 2 matching MRF lines |
$132.72–$135.54 | $491.55–$502 | varies |
| X-Ray Urinary Tract Exam With Contrast Material (74420) | $92.07 | $341 | 0.3× |
| X-Rays Bone Survey Complete (77075) | $185.76 | $688 | 1.8× |
| Xr c-spine 4 or 5 views (72050) | $120.15 | $445 | 1.2× |
| Xr Tomogram Single Plane (76100) | $142.60 | $528.15 | 1.4× |
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.