Imaging prices at Jacksonville Memorial Hospital
Jacksonville, IL · every code in this section with a posted price and a Medicare benchmark.
382 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) | $11,427 | $11,427 | 7.7× |
| Abdomen 1 View (74018) | $504 | $504 | 5.4× |
| Abdomen 2 views (74019) | $536 | $536 | 4.8× |
| Acute Gastrointestinal Blood Loss Imaging (78278) | $1,487 | $1,487 | 3.5× |
| Angio internal mammary (75756) | $5,456 | $5,456 | 1.6× |
| Angio pulmonary bilat (75743) | $8,070 | $8,070 | 2.4× |
| Angiography Adrenal Bilateral Slctv Rs&I (75733) | $5,456 | $5,456 | 1.6× |
| Angiography extremity bilateral rs&i (75716) | $8,184 | $8,184 | 2.4× |
| Angiography extremity unilateral rs&i (75710) | $5,456 | $5,456 | 1.6× |
| Angiography pulmonary unilateral slctv rs&i (75741) | $5,380 | $5,380 | 1.6× |
| Ankle 2 views (73600) | $504 | $504 | 5.4× |
| Aortography thoracic serialography rs&i (75605) | $9,439 | $9,439 | 1.6× |
| Artery X-Rays Abdomen (75726) | $8,650 | $8,650 | 1.5× |
| Artery X-Rays Pelvis (75736) | $9,439 | $9,439 | 1.6× |
| Artery X-Rays Spine (75705) | $9,098 | $9,098 | 1.5× |
| Arthrogram ankle (73615) | $1,229 | $1,229 | 3.3× |
| Arthrogram hip (73525) range across 4 matching MRF lines |
$1,068–$1,204 | $1,068–$1,204 | varies |
| Arthrogram Wrist (73115) | $974 | $974 | 2.6× |
| Basic radiation dosimetry calculation (77300) range across 3 matching MRF lines |
$1,172–$1,175 | $1,172–$1,175 | varies |
| Bone age studies (77072) | $613 | $613 | 5.5× |
| Bone Imaging 3 Phase (78315) | $3,432 | $3,432 | 8.0× |
| Bone Imaging Limited Area (78300) | $1,386 | $1,386 | 3.2× |
| Bone Imaging Whole Body (78306) | $3,293 | $3,293 | 7.7× |
| Bone marrow imaging limited area (78102) | $892 | $892 | 2.1× |
| Bone survey infant (77076) | $1,125 | $1,125 | 10.0× |
| Brachytx isodose complex (77318) | $2,170 | $2,170 | 5.4× |
| Brachytx isodose intermed (77317) | $1,273 | $1,273 | 3.2× |
| Brachytx Isodose Plan Simple (77316) | $878 | $878 | 2.2× |
| Brain Imaging Min 4 Static Views W Vascular Flow (78606) | $2,410 | $2,410 | 4.1× |
| Brain Imaging Pet Metabolic Evaluation (78608) | $7,548 | $7,548 | 4.9× |
| Cardiac MRI w/w/o contrast & further seq (75561) | $6,683 | $6,683 | 17.9× |
| Cat Scan Follow-Up Study (76380) range across 7 matching MRF lines |
$1,649–$2,176 | $1,649–$2,176 | varies |
| Cerebrospinal Fluid Flow W/O Matl Shunt Evaltj (78645) | $2,253 | $2,253 | 3.9× |
| Cerebrospinal Fluid Scan (78630) | $1,916 | $1,916 | 3.3× |
| Chest 1 view (71045) range across 6 matching MRF lines |
$370–$604 | $370–$604 | varies |
| Chest 2 views (71046) range across 5 matching MRF lines |
$92–$676 | $92–$676 | varies |
| Chest 3 views (71047) | $840 | $840 | 9.0× |
| Chest 4 or more views (71048) | $898 | $898 | 8.0× |
| Cholecystography Oral Contrast (74290) | $599 | $599 | 3.2× |
| Cineradiograpy/vidradiograpy xcpt where spec (76120) | $378 | $378 | 3.4× |
| Clavicle complete (73000) range across 5 matching MRF lines |
$606–$664 | $606–$664 | varies |
| Computed Tomography Thorax Lw Dose Lng Ca Scr C- (71271) | $905 | $905 | 8.1× |
| Continuing medical physics consltj pr wk (77336) range across 3 matching MRF lines |
$1,404–$1,444 | $1,404–$1,444 | varies |
| Contrast Exam Abdominl Aorta (75625) | $5,456 | $5,456 | 1.6× |
| Contrast X-Ray Bladder (74430) range across 3 matching MRF lines |
$739–$1,647 | $739–$1,647 | varies |
| Contrast X-Ray Of Elbow (73085) | $1,097 | $1,097 | 2.9× |
| Contrast X-Ray Of Knee Joint (73580) | $1,426 | $1,426 | 3.8× |
| CT abdomen and pelvis without and with contrast (74178) range across 7 matching MRF lines |
$8,066–$8,657 | $8,066–$8,657 | varies |
| CT abdomen and pelvis without contrast (74176) range across 4 matching MRF lines |
$6,425–$6,573 | $6,425–$6,573 | varies |
| CT abdomen w contrast (74160) range across 3 matching MRF lines |
$4,883–$4,936 | $4,883–$4,936 | varies |
| CT abdomen w wo contrast (74170) range across 6 matching MRF lines |
$5,529–$5,580 | $5,529–$5,580 | varies |
| CT abdomen w/o contrast (74150) range across 4 matching MRF lines |
$3,948–$3,992 | $3,948–$3,992 | varies |
| CT Angio Abdomen and Pelvis (74174) range across 5 matching MRF lines |
$4,562–$8,479 | $4,562–$8,479 | varies |
| CT Angio Chest (71275) range across 11 matching MRF lines |
$4,454–$5,680 | $4,454–$5,680 | varies |
| CT Angio Head (70496) range across 5 matching MRF lines |
$3,556–$5,295 | $3,556–$5,295 | varies |
| CT angio hrt w/3d image (75574) | $5,110 | $5,110 | 13.7× |
| Ct Angio Lwr Extr W/O&W/Dye (73706) range across 6 matching MRF lines |
$3,989–$4,404 | $3,989–$4,404 | varies |
| CT Angio Neck (70498) range across 2 matching MRF lines |
$4,337–$4,982 | $4,337–$4,982 | varies |
| Ct Angio Upr Extrm W/O&W/Dye (73206) range across 6 matching MRF lines |
$4,342–$6,126 | $4,342–$6,126 | varies |
| CT cervical spine w/ contrast (72126) | $4,923 | $4,923 | 13.2× |
| CT cervical spine w/o contrast (72125) | $4,514 | $4,514 | 40.3× |
| CT cervical spine w/wo cont (72127) | $5,396 | $5,396 | 28.7× |
| CT chest w contrast (71260) range across 7 matching MRF lines |
$4,580–$4,742 | $4,580–$4,742 | varies |
| CT chest w/wo contrast (71270) | $5,325 | $5,325 | 28.3× |
| CT colonography screening (74263) | $1,445 | $1,445 | 5.7× |
| CT colonogrphy dx image postprocess w/o contrast (74261) | $5,152 | $5,152 | 46.0× |
| CT head/brain with contrast (70460) | $3,848 | $3,848 | 20.5× |
| CT head/brain without and with contrast (70470) | $4,688 | $4,688 | 24.9× |
| CT heart contrast eval cardiac structure&morph (75572) | $1,461 | $1,461 | 3.9× |
| CT heart no contrast quant eval coronry calcium (75571) range across 3 matching MRF lines |
$112–$593 | $112–$593 | varies |
| CT iac w contrast (70481) | $4,207 | $4,207 | 22.4× |
| CT l-spine w&w/o contrast (72133) | $5,166 | $5,166 | 27.5× |
| CT lower ext w/o (73700) range across 5 matching MRF lines |
$2,354–$3,010 | $2,354–$3,010 | varies |
| CT lower extremity w/contrast material (73701) | $2,814 | $2,814 | 15.0× |
| CT lumbar spine w contrast (72132) | $4,658 | $4,658 | 12.5× |
| CT lumbar spine w/o contrast (72131) | $3,847 | $3,847 | 34.3× |
| CT maxillofacial w contrast (70487) range across 3 matching MRF lines |
$4,176–$4,347 | $4,176–$4,347 | varies |
| CT maxillofacial wo contrast (70486) range across 4 matching MRF lines |
$3,613–$3,742 | $3,613–$3,742 | varies |
| CT neck tissue combo (70492) | $4,462 | $4,462 | 23.7× |
| Ct Orbit/Ear/Fossa W/O&W/Dye (70482) | $4,384 | $4,384 | 23.3× |
| CT orbits w/o contrast (70480) | $3,639 | $3,639 | 32.5× |
| CT pelvis w&w/o contrast (72194) | $5,413 | $5,413 | 28.8× |
| CT pelvis w/o contrast (72192) range across 4 matching MRF lines |
$2,637–$2,971 | $2,637–$2,971 | varies |
| CT scan of leg combo (73702) | $2,952 | $2,952 | 15.7× |
| CT scans face/jaw combo (70488) range across 3 matching MRF lines |
$5,182–$5,314 | $5,182–$5,314 | varies |
| CT soft tissue neck w contrast (70491) range across 3 matching MRF lines |
$4,206–$4,309 | $4,206–$4,309 | varies |
| CT soft tissue neck w/o contrast (70490) range across 3 matching MRF lines |
$2,189–$3,490 | $2,189–$3,490 | varies |
| CT thoracic spine w contrast (72129) | $2,385 | $2,385 | 12.7× |
| CT thoracic spine w/o contrast (72128) | $2,382 | $2,382 | 21.3× |
| CT thoracic spine w/wo cont (72130) | $3,894 | $3,894 | 20.7× |
| CT thorax w/o contrast (71250) range across 9 matching MRF lines |
$3,064–$4,443 | $3,064–$4,443 | varies |
| CT upper ext wo (73200) range across 5 matching MRF lines |
$3,279–$3,585 | $3,279–$3,585 | varies |
| CT upper extremity w/o & w/contrast material (73202) | $3,856 | $3,856 | 20.5× |
| CT upper extremity with contrast (73201) | $4,582 | $4,582 | 12.3× |
| Cta Abdl Aorta&Bi Iliofem W/Contrast&Postp (75635) | $4,365 | $4,365 | 23.2× |
| Cta Abdomen (74175) | $6,352 | $6,352 | 33.8× |
| CTA pelvis (72191) range across 2 matching MRF lines |
$5,784–$6,085 | $5,784–$6,085 | varies |
| Dilation ureters/urethra rs&i (74485) | $3,930 | $3,930 | 1.8× |
| Discography Cerv/Thor Spine (72285) | $4,721 | $4,721 | 2.3× |
| Diskography lumbar (72295) range across 7 matching MRF lines |
$3,791–$4,852 | $3,791–$4,852 | varies |
| Dxa Bone Density Axial (77080) | $969 | $969 | 8.6× |
| Dxa bone density study 1/>sites appendiclr skel (77081) | $387 | $387 | 4.1× |
| Echo exam uterus (76831) | $809 | $809 | 3.2× |
| Echo Guide For Artery Repair (76936) | $1,841 | $1,841 | 8.0× |
| Echograp Trans R Pros Study (76873) | $796 | $796 | 7.1× |
| Esophageal Motility Study (78258) | $1,304 | $1,304 | 3.0× |
| Esophagram (74220) | $1,054 | $1,054 | 5.6× |
| Fetal Biophys Profile W/Nst (76818) | $1,177 | $1,177 | 10.5× |
| Fetal MRI w/placntl matrnl plvc img sing/1st ges (74712) | $4,637 | $4,637 | 18.1× |
| Fluoroscopy up to 1 hr (76000) range across 6 matching MRF lines |
$375–$1,086 | $375–$1,086 | varies |
| Follow-Up Angiography (75898) | $3,255 | $3,255 | 1.0× |
| Foot 2 views (73620) | $485 | $485 | 5.2× |
| Forearm 2 views (73090) | $674 | $674 | 7.2× |
| Gastric emptying imaging study (78264) | $3,163 | $3,163 | 7.4× |
| Gated Heart Planar Single (78472) | $3,916 | $3,916 | 9.1× |
| Hand 2 views (73120) | $557 | $557 | 5.0× |
| Hdr Rdncl Ntrstl/Icav Brchtx (77772) | $8,539 | $8,539 | 11.4× |
| Hdr Rdncl Ntrstl/Icav Brchtx (77771) | $8,005 | $8,005 | 10.7× |
| Hdr Rdncl Ntrstl/Icav Brchtx 1 Channel (77770) | $5,732 | $5,732 | 7.7× |
| Hepatc Vngrph Wdg/Fr Hemodyn Eval Rs&I (75889) | $5,456 | $5,456 | 1.6× |
| Hepatc Vngrph Wdg/Fr W/O Hemodyn Eval Rs&I (75891) | $5,456 | $5,456 | 1.6× |
| Hepatobil Syst Image W/Drug (78227) | $4,311 | $4,311 | 7.4× |
| Hepatobiliary System Imaging (78226) | $3,170 | $3,170 | 7.4× |
| Hysterosalpingogram (74740) range across 6 matching MRF lines |
$734–$1,467 | $734–$1,467 | varies |
| Infant hip ultrasound with hip movement (dynamic) (76885) | $545 | $545 | 5.8× |
| Interstitial radiation source applic complex (77778) | $4,882 | $4,882 | 6.5× |
| K Flow/Funct Image W/Drug (78708) | $2,962 | $2,962 | 5.1× |
| K Flow/Funct Image W/O Drug (78707) | $2,987 | $2,987 | 5.1× |
| Kidney Imaging Morphol (78700) | $1,739 | $1,739 | 4.1× |
| Knee 3 Views (73562) | $801 | $801 | 8.6× |
| Liver & Spleen Imaging Static Only (78215) | $1,507 | $1,507 | 3.5× |
| Liver imaging static only (78201) | $2,236 | $2,236 | 3.8× |
| Lung Perf&Ventilat Diferentl (78598) | $1,935 | $1,935 | 3.3× |
| Lung Ventilat&Perfus Imaging (78582) | $3,542 | $3,542 | 6.1× |
| Lung Ventilation Imaging (78579) | $1,687 | $1,687 | 3.9× |
| Lymph System Imaging (78195) | $1,324 | $1,324 | 2.3× |
| Lymphangiography Extremity Only Bilateral Rs&I (75803) | $1,871 | $1,871 | 1.1× |
| Lymphangiography extremity only unilateral rs&i (75801) | $1,247 | $1,247 | 1.9× |
| Lymphangiography Pelvic/Abdominal Bilateral Rs&I (75807) | $8,184 | $8,184 | 2.4× |
| Lymphangiography, pelvic/abdominal, unilateral (75805) | $5,456 | $5,456 | 1.6× |
| Magnetic Image Jaw Joint (70336) | $4,282 | $4,282 | 16.7× |
| Magnetic Resonance Elastography (76391) | $2,666 | $2,666 | 10.4× |
| Mammary ductogram or galactogram multiple (77054) | $1,201 | $1,201 | 4.7× |
| Mammary ductogram or galactogram single (77053) | $864 | $864 | 3.4× |
| Meckels Divert Exam (78290) | $1,803 | $1,803 | 4.2× |
| Mlc imrt design & construction per imrt plan (77338) | $3,337 | $3,337 | 8.3× |
| Mr safety determination physician/other qhp (76016) | $229 | $229 | 2.5× |
| Mr safety implant&/fb assmt clin staf 1st 15 min (76014) | $64 | $64 | 2.1× |
| Mr safety implt electronics prepj supvj phys/qhp (76018) | $239 | $239 | 2.3× |
| Mr safety implt pos&/immoblj (76019) | $155 | $155 | 2.5× |
| Mr safety med physics xm customization plng&mntr (76017) | $630 | $630 | 2.5× |
| Mra Head W/O & W/Contrast Material (70546) | $4,696 | $4,696 | 12.6× |
| MRA head w/o contrast (70544) | $3,289 | $3,289 | 12.9× |
| MRA head with contrast (70545) | $5,766 | $5,766 | 15.4× |
| MRA neck w contrast (70548) | $4,533 | $4,533 | 12.1× |
| Mra Neck W/O &W/Contrast Material (70549) | $4,588 | $4,588 | 12.3× |
| MRA neck w/o contrast (70547) | $3,231 | $3,231 | 12.6× |
| MRI abdomen w contrast (74182) | $5,599 | $5,599 | 15.0× |
| MRI abdomen w/o contrast (74181) | $3,897 | $3,897 | 15.2× |
| MRI any jt lower extrem w/contrast material (73722) | $5,554 | $5,554 | 6.6× |
| MRI any jt lower extrem w/o & w/contrast matrl (73723) | $6,092 | $6,092 | 16.3× |
| MRI any jt upper extremity w/contrast matrl (73222) | $5,054 | $5,054 | 6.0× |
| MRI brain functional w/o physician admnistration (70554) | $2,707 | $2,707 | 10.6× |
| MRI Breast W/O Contrast Bilateral (77047) | $4,315 | $4,315 | 16.9× |
| MRI Breast Without Contrast Material Unilateral (77046) | $2,877 | $2,877 | 11.3× |
| MRI cardiac w/o contrast (75557) | $1,936 | $1,936 | 7.6× |
| MRI cervical spine w contrast (72142) | $5,720 | $5,720 | 15.3× |
| MRI cervical spine w/o cont (72141) | $5,199 | $5,199 | 20.3× |
| MRI chest w/o contrast (71550) | $3,902 | $3,902 | 15.3× |
| MRI chest with contrast (71551) | $4,440 | $4,440 | 5.3× |
| MRI chest wo w contrast (71552) | $4,879 | $4,879 | 13.1× |
| MRI lower extrem oth/thn jt w/contrast matrl (73719) | $7,421 | $7,421 | 19.8× |
| MRI lower extrem oth/thn jt w/o & w/contr matr (73720) | $5,496 | $5,496 | 14.7× |
| MRI lower extrem oth/thn jt w/o contr matrl (73718) | $4,937 | $4,937 | 19.3× |
| MRI lumbar spine w contrast (72149) | $6,094 | $6,094 | 16.3× |
| Mri Neck Spine W/O & W/Dye (72156) | $7,438 | $7,438 | 19.9× |
| MRI orbit face &/neck w/o contrast (70540) | $2,832 | $2,832 | 11.1× |
| MRI orbit face neck w contrast (70542) | $3,405 | $3,405 | 9.1× |
| Mri Orbt/Fac/Nck W/O &W/Dye (70543) | $5,293 | $5,293 | 14.2× |
| MRI pelvis w contrast (72196) | $4,448 | $4,448 | 11.9× |
| MRI pelvis w/o & w contrast (72197) range across 2 matching MRF lines |
$5,998–$8,503 | $5,998–$8,503 | varies |
| MRI pelvis w/o contrast (72195) range across 2 matching MRF lines |
$4,013–$5,820 | $4,013–$5,820 | varies |
| MRI spectroscopy (76390) | $3,988 | $3,988 | 42.8× |
| MRI thoracic spine w/o contrast (72146) range across 3 matching MRF lines |
$3,076–$5,186 | $3,076–$5,186 | varies |
| MRI upper extremity oth than jt w/contr matrl (73219) | $6,811 | $6,811 | 18.2× |
| MRI upper extremity oth than jt w/o contr matrl (73218) | $3,386 | $3,386 | 13.2× |
| Mri Uppr Extremity W/O&W/Dye (73220) | $4,043 | $4,043 | 10.8× |
| MRI, abdomen, combo (74183) | $7,208 | $7,208 | 19.3× |
| MRI, dorsal spine combo (72157) range across 3 matching MRF lines |
$4,868–$8,858 | $4,868–$8,858 | varies |
| MRI, dorsal spine contrast (72147) | $3,384 | $3,384 | 9.1× |
| MRI, joint upper extrem (73221) | $4,409 | $4,409 | 17.2× |
| MRI, joint upper extrem combo (73223) | $5,537 | $5,537 | 14.8× |
| MRI, lumbar spine combo (72158) | $7,665 | $7,665 | 20.5× |
| Myelograpy 2/more regions rs&i (72270) | $2,238 | $2,238 | 2.7× |
| Myocardial Perfusion Planar 1 Study Rest/Stress (78453) | $2,703 | $2,703 | 1.9× |
| Myocardial Spect Multiple Studies (78452) range across 7 matching MRF lines |
$7,649–$8,325 | $7,649–$8,325 | varies |
| N-invas est c ffr sw aly CTA (75580) | $2,810 | $2,810 | 3.1× |
| Neck soft tissue (70360) | $685 | $685 | 7.3× |
| Nonvascular Shunt X-Ray (75809) | $1,130 | $1,130 | 10.1× |
| Ntsty modul radthx pln dose-vol histos (77301) | $11,154 | $11,154 | 7.5× |
| Nuclear Rx Intra-Arterial (79445) | $1,141 | $1,141 | 4.6× |
| Nuclear Rx Oral Admin (79005) | $3,359 | $3,359 | 13.4× |
| Ob us nuchal meas 1 gest (76813) | $668 | $668 | 6.0× |
| Panoramic X-ray of jaws (70355) | $586 | $586 | 6.3× |
| Parathyroid imaging w/tomographic spect & CT (78072) | $3,579 | $3,579 | 6.2× |
| Parathyroid Planar Imaging (78070) | $1,445 | $1,445 | 3.4× |
| Pelvis 1 or 2 views (72170) | $737 | $737 | 6.6× |
| Peritoneogram Rs&I (74190) | $1,144 | $1,144 | 2.0× |
| Pet Image Skull-Thigh (78812) | $11,898 | $11,898 | 7.8× |
| Pet Image W/Ct Lmtd (78814) | $9,673 | $9,673 | 6.3× |
| PET image w/CT, full body (78816) | $11,685 | $11,685 | 7.6× |
| PET imaging CT attenuation skull base mid-thigh (78815) | $11,247 | $11,247 | 7.3× |
| PET whole body (78813) | $8,846 | $8,846 | 5.8× |
| Prq Transhepatc Portograpy Hemodyn Eval Rs&I (75885) | $5,456 | $5,456 | 1.6× |
| Pulmonary Perfusion Imaging Particulate (78580) | $2,559 | $2,559 | 6.0× |
| Radex abscess/fistula/sinus tract rs&i (76080) range across 2 matching MRF lines |
$1,286–$2,256 | $1,286–$2,256 | varies |
| Radex Ankle Complete Minimum 3 Views (73610) range across 3 matching MRF lines |
$634–$854 | $634–$854 | varies |
| Radex Calcaneus Minimum 2 Views (73650) | $494 | $494 | 5.3× |
| Radex elbow complete minimum 3 views (73080) | $705 | $705 | 7.6× |
| Radex Facial Bones Complete Minimum 3 Views (70150) | $595 | $595 | 5.3× |
| Radex fingr minimum 2 views (73140) | $470 | $470 | 5.0× |
| Radex foot complete minimum 3 views (73630) | $611 | $611 | 6.6× |
| Radex Hand Minimum 3 Views (73130) | $602 | $602 | 6.5× |
| Radex lower extremity infant minimum 2 views (73592) | $707 | $707 | 7.6× |
| Radex Mastoids Compl Minimum 3 Views PR Side (70130) | $437 | $437 | 3.9× |
| Radex Nasal Bones Complete Minimum 3 Views (70160) | $426 | $426 | 4.6× |
| Radex Ribs Unilateral 2 Views (71100) | $387 | $387 | 4.1× |
| Radex shoulder complete minimum 2 views (73030) | $620 | $620 | 6.6× |
| Radex Sinuses Paransl < 3 Views (70210) | $305 | $305 | 3.3× |
| Radex sm int w/mlt srl imges via enteroclss tube (74251) | $926 | $926 | 4.9× |
| Radex Spine 1 View Specify Level (72020) | $263 | $263 | 2.8× |
| Radex Sternum Minimum 2 Views (71120) | $440 | $440 | 4.7× |
| Radex Temporomandble Jt Opn & Clsd Mouth Bilat (70330) | $416 | $416 | 4.5× |
| Radex Toe Minimum 2 Views (73660) | $540 | $540 | 5.8× |
| Radex upper extremity infant minimum 2 views (73092) | $664 | $664 | 5.9× |
| Radex Wrist Complete Minimum 3 Views (73110) | $626 | $626 | 6.7× |
| Radex X-Ray Exam Entire Spi 6/> Vw - Xr Entire Spine 6+ Vw (72084) | $1,871 | $1,871 | 16.7× |
| Radiation Delivery Stereotactic Cranial Linear (77372) | $28,260 | $28,260 | 3.6× |
| Radiation treatment delivery level 1 (77402) | $708 | $708 | 6.5× |
| Radiation treatment delivery level 2 (77407) | $767 | $767 | 1.9× |
| Radiation treatment delivery level 3 (77412) | $1,806 | $1,806 | 3.1× |
| Radiolog exam mandible compl minimum 4 views (70110) | $581 | $581 | 5.2× |
| Radiologic Exam Abdomen 3+ Views - Xr Abdomen 3+ Views (74021) | $595 | $595 | 5.3× |
| Radiologic exam colon double contrast study (74280) | $1,348 | $1,348 | 7.2× |
| Radiologic exam colon single contrast study (74270) range across 4 matching MRF lines |
$1,083–$1,464 | $1,083–$1,464 | varies |
| Radiologic Exam Esophagus Double Contrast Study (74221) | $1,185 | $1,185 | 6.3× |
| Radiologic exam knee complete 4/more views (73564) range across 3 matching MRF lines |
$952–$966 | $952–$966 | varies |
| Radiologic exam pelvis compl minimum 3 views (72190) range across 4 matching MRF lines |
$739–$823 | $739–$823 | varies |
| Radiologic Exam Small Int Single Contrast Study (74250) range across 2 matching MRF lines |
$800–$884 | $800–$884 | varies |
| Radiologic exam swallow function contrast study (74230) | $718 | $718 | 3.8× |
| Radiologic exam teeth complete full mouth (70320) | $504 | $504 | 2.0× |
| Radiologic exam upr gi trc double contrast study (74246) | $1,554 | $1,554 | 8.3× |
| Radiologic examination femur 1 view (73551) | $275 | $275 | 2.9× |
| Radiologic examination femur minimum 2 views (73552) | $637 | $637 | 6.8× |
| Radiologic examination knee 1/2 views (73560) | $695 | $695 | 7.5× |
| Radiologic Examination Osseous Survey Limited (77074) | $876 | $876 | 7.8× |
| Radiologic Examination Salivary Gland Calculus (70380) | $583 | $583 | 6.3× |
| Radiologic examination tibia & fibula 2 views (73590) range across 10 matching MRF lines |
$717–$747 | $717–$747 | varies |
| Radiopharm Dacryocystography (78660) | $1,165 | $1,165 | 2.7× |
| Ribs bilateral 3 views (71110) | $446 | $446 | 4.0× |
| Rp loclzj tum plnr 1 area single day imaging (78800) | $1,622 | $1,622 | 3.8× |
| Rp loclzj tum plnr 2+area 1+d img/1 area img>2+d (78801) | $1,987 | $1,987 | 4.6× |
| Rp Loclzj Tum Plnr Whole Body Single Day Imaging (78802) range across 8 matching MRF lines |
$2,572–$2,771 | $2,572–$2,771 | varies |
| Rp Loclzj Tum Spect 1 Area Single Day Imaging (78803) | $2,912 | $2,912 | 5.0× |
| Rp loclzj tum spect 2 area/sep acquisj img (78831) | $4,638 | $4,638 | 3.3× |
| Rp loclzj tum spect CT 2area 1d img/1 ar img>2+d (78832) | $4,221 | $4,221 | 2.8× |
| Rp loclzj tum spect w/CT 1 area/acquisj 1day img (78830) range across 5 matching MRF lines |
$3,618–$4,528 | $3,618–$4,528 | varies |
| Rp Ther Radiolbld Monoclonal Antibody IV Infus (79403) | $647 | $647 | 2.6× |
| Rp Therapy Intravenous Administration (79101) range across 3 matching MRF lines |
$1,129–$1,234 | $1,129–$1,234 | varies |
| Salivary Gland Imaging Serial Images (78231) | $1,298 | $1,298 | 3.0× |
| Scapula (73010) | $464 | $464 | 4.1× |
| Screening Digital Breast Tomosynthesis Bi (77063) | $90 | $90 | 3.8× |
| Sella turcica (70240) | $339 | $339 | 3.6× |
| Shoulder 1 view (73020) | $370 | $370 | 4.0× |
| Shoulder Arthrography (73040) | $1,594 | $1,594 | 4.3× |
| Sialogram (70390) | $663 | $663 | 2.6× |
| Skull less than 4 views (70250) | $582 | $582 | 5.2× |
| Special dosimetry (77331) | $794 | $794 | 5.5× |
| Special Physics Consult (77370) | $1,513 | $1,513 | 10.5× |
| Special teletherapy port plan (77321) | $1,542 | $1,542 | 3.8× |
| Special treatment procedure (77470) range across 3 matching MRF lines |
$3,687–$4,804 | $3,687–$4,804 | varies |
| Spleen Imaging (78185) | $839 | $839 | 2.0× |
| Stereotactic Body Radiation Delivery (77373) | $8,246 | $8,246 | 4.3× |
| Sternoclavicular joints (71130) | $562 | $562 | 6.0× |
| Superior sagittal sinus venogram (75870) | $5,456 | $5,456 | 1.6× |
| Telethx isodose pln cplx w/basic dosimetry (77307) | $2,541 | $2,541 | 6.3× |
| Telethx isodose pln smpl w/dosimetry calculation (77306) | $1,044 | $1,044 | 2.6× |
| Testicular Imaging W/Flow (78761) | $1,812 | $1,812 | 4.2× |
| Ther Rad Simulaj-Aided Field Setting Complex (77290) | $4,077 | $4,077 | 10.2× |
| Ther Rad Simulaj-Aided Field Setting Intermed (77285) | $2,069 | $2,069 | 5.2× |
| Ther rad simulaj-aided field setting simple (77280) range across 3 matching MRF lines |
$2,038–$2,052 | $2,038–$2,052 | varies |
| Thoracic spine 2 views (72070) | $774 | $774 | 6.9× |
| Thoracic spine 3 views (72072) | $961 | $961 | 8.6× |
| Thoracolumbar 2 views (72080) | $516 | $516 | 5.5× |
| Thyroid Imaging With Vascular Flow (78013) | $1,278 | $1,278 | 3.0× |
| Thyroid Met Imaging Body (78018) | $3,310 | $3,310 | 5.7× |
| Thyroid Uptake Measurement (78012) | $839 | $839 | 2.0× |
| Thyroid Uptake W/Blood Flow Sngle/Mult Quan Meas (78014) | $2,313 | $2,313 | 5.4× |
| Tx Devices Design & Construction Complex (77334) | $2,990 | $2,990 | 7.5× |
| Tx devices design & construction intermediate (77333) | $1,682 | $1,682 | 11.7× |
| Tx devices design & construction simple (77332) | $1,362 | $1,362 | 9.5× |
| Ultrasound Breast Limited (76642) range across 4 matching MRF lines |
$756–$1,512 | $756–$1,512 | varies |
| Ultrasound elastography first target lesion (76982) | $387 | $387 | 3.5× |
| Ultrasound Elastography Parenchyma (76981) | $560 | $560 | 5.0× |
| Ultrasound Exam Aaa Screen (76706) | $783 | $783 | 7.0× |
| Ultrasound trgt dynamic microbubble 1st lesion (76978) | $774 | $774 | 2.1× |
| Ultrasound, abdomen limited (76705) range across 4 matching MRF lines |
$1,540–$1,643 | $1,540–$1,643 | varies |
| Umbilical-artery Doppler (OB) (76820) | $543 | $543 | 4.8× |
| Unlisted Dx Radiographic Procedure (76499) range across 3 matching MRF lines |
$151–$713 | $151–$713 | varies |
| Unlisted fluoroscopic procedure (76496) | $1,551 | $1,551 | 16.6× |
| Unlisted magnetic resonance procedure (76498) range across 5 matching MRF lines |
$3,044–$8,858 | $3,044–$8,858 | varies |
| Upper gi w/o kub (74240) range across 6 matching MRF lines |
$1,310–$1,356 | $1,310–$1,356 | varies |
| Urethrocystogram voiding (74455) range across 2 matching MRF lines |
$1,130–$1,201 | $1,130–$1,201 | varies |
| Urethrocystography retrograde (74450) range across 5 matching MRF lines |
$846–$1,639 | $846–$1,639 | varies |
| Us breast unilateral complete (76641) range across 6 matching MRF lines |
$2,394–$4,788 | $2,394–$4,788 | varies |
| Us chest (76604) range across 5 matching MRF lines |
$876–$1,144 | $876–$1,144 | varies |
| Us complete joint (76881) | $1,516 | $1,516 | 13.5× |
| Us exam, pelvic, limited (76857) | $1,143 | $1,143 | 10.2× |
| Us head (76506) | $839 | $839 | 7.5× |
| Us kidney transplant (76776) | $1,064 | $1,064 | 9.5× |
| Us lmtd joint/oth nonvasc xtr strux r-t w/img (76882) range across 6 matching MRF lines |
$1,325–$1,350 | $1,325–$1,350 | varies |
| Us ob detailed single fetus (76811) | $1,037 | $1,037 | 4.1× |
| Us ob limited 1 or more fetuses (76815) range across 3 matching MRF lines |
$867–$1,216 | $867–$1,216 | varies |
| Us ob transvaginal (76817) | $1,200 | $1,200 | 10.7× |
| Us pelvic non ob complete (76856) range across 2 matching MRF lines |
$1,509–$1,858 | $1,509–$1,858 | varies |
| Us pg uter img f&mat 14 wk tabdl 1/1st gestation (76801) | $1,285 | $1,285 | 11.5× |
| Us preg uterus real time f/u trnsabdl per fetus (76816) | $819 | $819 | 7.3× |
| Us retroperitoneal complete (76770) | $1,976 | $1,976 | 17.6× |
| Us retroperitoneal limited (76775) range across 5 matching MRF lines |
$790–$1,565 | $790–$1,565 | varies |
| Us scrotum and contents (76870) range across 2 matching MRF lines |
$1,464–$1,490 | $1,464–$1,490 | varies |
| Us spinal canal and contents (76800) | $386 | $386 | 3.4× |
| Us thyroid (76536) | $1,378 | $1,378 | 12.3× |
| Us transrectal (76872) | $629 | $629 | 5.6× |
| Vasogram (74440) | $504 | $504 | 2.0× |
| Vein X-Ray Chest (75827) | $3,297 | $3,297 | 2.0× |
| Vein X-Ray Liver W/O Hemodyn (75887) | $5,456 | $5,456 | 1.6× |
| Venogram Sinus/Jugular (75860) | $5,456 | $5,456 | 1.6× |
| Venography Adrenal Unilateral (75840) | $5,456 | $5,456 | 1.6× |
| Venography caval inferior serialography rs&i (75825) | $6,719 | $6,719 | 2.0× |
| Venography extremity bilateral rs&i (75822) range across 3 matching MRF lines |
$2,523–$5,061 | $2,523–$5,061 | varies |
| Venography extremity unilateral rs&i (75820) range across 4 matching MRF lines |
$2,014–$3,374 | $2,014–$3,374 | varies |
| Venography Renal Bilateral (75833) | $7,705 | $7,705 | 2.3× |
| Venography Renal Unilateral (75831) | $5,571 | $5,571 | 1.6× |
| Venous sampling by catheter (75893) | $9,439 | $9,439 | 1.6× |
| Wrist 2 views (73100) | $550 | $550 | 5.9× |
| X-Ray Ac Jts - Xr Acromioclavicular Joints Bilateral (73050) | $572 | $572 | 6.1× |
| X-ray antegrade pyelogram tube (74425) | $864 | $864 | 2.3× |
| X-Ray Aorta Leg Arteries (75630) | $5,456 | $5,456 | 1.6× |
| X-Ray Bend Only L-S Spine (72120) | $657 | $657 | 5.9× |
| X-Ray Elbow 2 Vw - Xr Elbow 1-2 Views Right (73070) | $385 | $385 | 4.1× |
| X-Ray Exam Breast Specimen (76098) | $631 | $631 | 1.1× |
| X-Ray Exam Entire Spi 1 Vw (72081) | $369 | $369 | 4.0× |
| X-Ray Exam Entire Spi 2/3 Vw (72082) | $813 | $813 | 7.3× |
| X-Ray Exam Entire Spi 4/5 Vw (72083) | $1,505 | $1,505 | 13.4× |
| X-Ray Exam Hip Uni 1 View (73501) | $280 | $280 | 3.0× |
| X-Ray Exam Hip Uni 2-3 Views (73502) | $653 | $653 | 7.0× |
| X-Ray Exam Hip Uni 4/> Views (73503) range across 5 matching MRF lines |
$677–$1,002 | $677–$1,002 | varies |
| X-Ray Exam Hips Bi 2 Views (73521) | $722 | $722 | 6.4× |
| X-Ray Exam Hips Bi 3-4 Views (73522) | $973 | $973 | 8.7× |
| X-Ray Exam L-S Spine Bending (72114) | $1,265 | $1,265 | 11.3× |
| X-Ray Exam Neck Spine 2-3 Vw (72040) | $782 | $782 | 8.4× |
| X-Ray Exam Neck Spine 6/>Vws (72052) | $1,334 | $1,334 | 11.9× |
| X-Ray Exam Unilat Ribs/Chest (71101) | $437 | $437 | 3.9× |
| X-ray humerus (73060) | $709 | $709 | 7.6× |
| X-ray IV pyelogram (ivp) (74400) | $1,214 | $1,214 | 6.5× |
| X-Ray Jaw <4 Vw - Xr Mandible < 4 Views (70100) | $388 | $388 | 4.2× |
| X-Ray Knee Bilat Standing - Xr Knees Anteroposterior Standing Bilat (73565) | $737 | $737 | 7.9× |
| X-Ray Lumbar Spine 2/3 Vw - Xr Lumbar Spine 2-3 Views (72100) | $838 | $838 | 7.5× |
| X-ray nose-rectum child f.b. (76010) | $1,039 | $1,039 | 11.1× |
| X-Ray Ribs, Chest 4+ Vw - Xr Ribs 3 Vws Bil W/ Chest Posteroanterior (71111) | $979 | $979 | 8.7× |
| X-Ray Sacroiliac Jts 3+ Vw - Xr Sacroiliac Joints 3+ Views (72202) | $698 | $698 | 6.2× |
| X-Ray Sacrum/Coccyx 2+ Vw - Xr Sacrum Coccyx 2+ Views (72220) | $768 | $768 | 8.2× |
| X-Ray Sinuses 3+ Vw - Xr Paranasal Sinuses 3+ Views (70220) | $1,050 | $1,050 | 11.3× |
| X-Ray Skull 4+ Vw - Xr Skull Complete 4+ Views (70260) | $622 | $622 | 5.6× |
| X-Ray Stress View (77071) | $202 | $202 | 2.2× |
| X-ray thoracic spine 4 vw (72074) | $1,106 | $1,106 | 9.9× |
| X-Ray Urinary Tract Exam With Contrast Material (74420) | $1,573 | $1,573 | 4.2× |
| X-Rays Bone Length Studies (77073) range across 3 matching MRF lines |
$498–$1,158 | $498–$1,158 | varies |
| X-Rays Bone Survey Complete (77075) | $1,053 | $1,053 | 9.4× |
| Xr c-spine 4 or 5 views (72050) | $1,050 | $1,050 | 9.4× |
| Xr facial bones less than 3 views (70140) range across 2 matching MRF lines |
$527–$563 | $527–$563 | varies |
| Xr orbits complete 4 views (70200) | $629 | $629 | 5.6× |
A range means this hospital published different amounts on matching machine-readable-file lines. We show the lowest–highest posted amount because we cannot tell from the published file which line would apply to a particular visit.