Imaging prices at Lakeside Women's Hospital, A Member of INTEGRIS He
Oklahoma City, OK · every code in this section with a posted price and a Medicare benchmark.
340 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) | $2,573.20 | $12,866 | 1.9× |
| Abdomen 1 View (74018) | $151.20 | $756 | 1.8× |
| Abdomen 2 views (74019) | $183.20 | $916 | 1.8× |
| Acute Gastrointestinal Blood Loss Imaging (78278) | $247.60 | $1,238 | 0.6× |
| Angio pulmonary bilat (75743) | $1,362.20 | $6,811 | 0.4× |
| Angiography extremity bilateral rs&i (75716) | $1,551.80 | $7,759 | 0.5× |
| Angiography extremity unilateral rs&i (75710) range across 2 matching MRF lines |
$1,345.80–$2,047.60 | $6,729–$10,238 | varies |
| Angiography pulmonary unilateral slctv rs&i (75741) | $1,345.80 | $6,729 | 0.4× |
| Angrph pulmonary nonslctv cath/ven njx rs&i (75746) | $1,490 | $7,450 | 0.5× |
| Ankle 2 views (73600) range across 2 matching MRF lines |
$165.80–$290 | $829–$1,450 | varies |
| Aortography thoracic serialography rs&i (75605) unusually low: confirm this is the full procedure |
$2,484.20 | $12,421 | 0.5× |
| Artery X-Rays Abdomen (75726) unusually low: confirm this is the full procedure |
$2,484.20 | $12,421 | 0.5× |
| Artery X-Rays Pelvis (75736) unusually low: confirm this is the full procedure |
$2,484.20 | $12,421 | 0.5× |
| Arthrogram ankle (73615) | $253.60 | $1,268 | 0.8× |
| Arthrogram hip (73525) | $319.20 | $1,596 | 1.0× |
| Arthrogram Wrist (73115) | $163.80 | $819 | 0.5× |
| Basic radiation dosimetry calculation (77300) | $287 | $1,435 | 2.2× |
| Bone age studies (77072) | $86.40 | $432 | 0.9× |
| Bone Imaging 3 Phase (78315) | $750.40 | $3,752 | 2.0× |
| Bone Imaging Limited Area (78300) | $157 | $785 | 0.4× |
| Bone Imaging Multiple Areas (78305) | $303.20 | $1,516 | 0.8× |
| Bone Imaging Whole Body (78306) | $404.60 | $2,023 | 1.1× |
| Bone marrow imaging; whole body (78104) | $746 | $3,730 | 1.9× |
| Bone survey infant (77076) | $175.80 | $879 | 1.7× |
| Brachytx isodose complex (77318) | $1,717.80 | $8,589 | 4.8× |
| Brachytx isodose intermed (77317) | $921.20 | $4,606 | 2.6× |
| Brachytx Isodose Plan Simple (77316) | $754.60 | $3,773 | 2.1× |
| Brain Flow Imaging Only (78610) | $249.80 | $1,249 | 0.5× |
| Brain Imaging Min 4 Static Views W Vascular Flow (78606) | $568.40 | $2,842 | 1.1× |
| Brain Imaging Pet Metabolic Evaluation (78608) | $1,081 | $5,405 | 0.8× |
| Cat Scan Follow-Up Study (76380) | $134.40 | $672 | 1.6× |
| Cerebrospinal Fluid Flow W/O Matl Shunt Evaltj (78645) | $203.60 | $1,018 | 0.4× |
| Cerebrospinal Fluid Scan (78630) | $279.80 | $1,399 | 0.5× |
| Chest 1 view (71045) | $129.60 | $648 | 1.5× |
| Chest 2 views (71046) | $161.40 | $807 | 1.9× |
| Chest 3 views (71047) | $169.20 | $846 | 2.0× |
| Chest 4 or more views (71048) | $221.60 | $1,108 | 2.2× |
| Cholecystography Oral Contrast (74290) | $162.40 | $812 | 1.0× |
| Clavicle complete (73000) range across 2 matching MRF lines |
$192.80–$337.60 | $964–$1,688 | varies |
| Computed Tomography Thorax Lw Dose Lng Ca Scr C- (71271) | $106 | $530 | 1.1× |
| Continuing medical physics consltj pr wk (77336) | $276.40 | $1,382 | 2.1× |
| Contrast Exam Abdominl Aorta (75625) | $1,345.80 | $6,729 | 0.4× |
| Contrast X-Ray Bladder (74430) | $245.60 | $1,228 | 0.7× |
| Contrast X-Ray Of Elbow (73085) | $511.40 | $2,557 | 1.5× |
| Contrast X-Ray Of Knee Joint (73580) | $264.20 | $1,321 | 0.8× |
| CT abdomen and pelvis without and with contrast (74178) | $2,272 | $11,360 | 6.8× |
| CT abdomen and pelvis without contrast (74176) | $1,018.20 | $5,091 | 4.4× |
| CT abdomen w contrast (74160) | $705.20 | $3,526 | 4.2× |
| CT abdomen w wo contrast (74170) | $881.60 | $4,408 | 5.2× |
| CT abdomen w/o contrast (74150) | $564.20 | $2,821 | 5.6× |
| CT Angio Abdomen and Pelvis (74174) | $1,181.40 | $5,907 | 3.5× |
| CT Angio Chest (71275) | $1,024.20 | $5,121 | 6.1× |
| CT Angio Head (70496) | $567.60 | $2,838 | 3.4× |
| CT angio hrt w/3d image (75574) | $568.40 | $2,842 | 1.7× |
| Ct Angio Lwr Extr W/O&W/Dye (73706) | $935 | $4,675 | 5.5× |
| CT Angio Neck (70498) | $514 | $2,570 | 3.0× |
| Ct Angio Upr Extrm W/O&W/Dye (73206) | $633.20 | $3,166 | 3.8× |
| CT cervical spine w/ contrast (72126) | $686.60 | $3,433 | 2.0× |
| CT cervical spine w/o contrast (72125) | $549.20 | $2,746 | 5.5× |
| CT cervical spine w/wo cont (72127) | $858.40 | $4,292 | 5.1× |
| CT chest w contrast (71260) | $630.40 | $3,152 | 3.7× |
| CT chest w/wo contrast (71270) | $788.20 | $3,941 | 4.7× |
| CT head/brain with contrast (70460) | $823.40 | $4,117 | 4.9× |
| CT head/brain without and with contrast (70470) | $990.60 | $4,953 | 5.9× |
| CT heart contrast eval cardiac structure&morph (75572) | $455.80 | $2,279 | 1.4× |
| CT heart no contrast quant eval coronry calcium (75571) | $33.60 | $168 | 0.4× |
| CT hrt w/3d image congen (75573) | $640.60 | $3,203 | 1.9× |
| CT iac w contrast (70481) | $547 | $2,735 | 3.2× |
| CT l-spine w&w/o contrast (72133) | $1,032.40 | $5,162 | 6.1× |
| CT lower ext w/o (73700) range across 2 matching MRF lines |
$887.80–$1,708.60 | $4,439–$8,543 | varies |
| CT lower extremity w/contrast material (73701) | $976 | $4,880 | 5.8× |
| CT lumbar spine w contrast (72132) | $825.80 | $4,129 | 2.5× |
| CT lumbar spine w/o contrast (72131) | $660.60 | $3,303 | 6.6× |
| CT maxillofacial w contrast (70487) | $1,145.80 | $5,729 | 6.8× |
| CT maxillofacial wo contrast (70486) | $931.40 | $4,657 | 9.3× |
| CT neck tissue combo (70492) | $1,208.40 | $6,042 | 7.2× |
| Ct Orbit/Ear/Fossa W/O&W/Dye (70482) | $630.60 | $3,153 | 3.7× |
| CT orbits w/o contrast (70480) | $522 | $2,610 | 5.2× |
| CT pelvis w&w/o contrast (72194) | $798.40 | $3,992 | 4.7× |
| CT pelvis w/o contrast (72192) | $511 | $2,555 | 5.1× |
| CT scan of leg combo (73702) | $1,387.20 | $6,936 | 8.2× |
| CT scans face/jaw combo (70488) | $1,262.80 | $6,314 | 7.5× |
| CT soft tissue neck w contrast (70491) | $1,070.80 | $5,354 | 6.3× |
| CT soft tissue neck w/o contrast (70490) | $871.40 | $4,357 | 8.7× |
| CT thoracic spine w contrast (72129) | $690.60 | $3,453 | 4.1× |
| CT thoracic spine w/o contrast (72128) | $552.40 | $2,762 | 5.5× |
| CT thoracic spine w/wo cont (72130) | $863.20 | $4,316 | 5.1× |
| CT thorax w/o contrast (71250) | $504.20 | $2,521 | 5.0× |
| CT upper ext wo (73200) | $738.60 | $3,693 | 7.3× |
| CT upper extremity w/o & w/contrast material (73202) | $1,154 | $5,770 | 6.8× |
| CT upper extremity with contrast (73201) | $923 | $4,615 | 2.8× |
| Cta Abdl Aorta&Bi Iliofem W/Contrast&Postp (75635) | $1,161 | $5,805 | 6.9× |
| Cta Abdomen (74175) | $1,020.20 | $5,101 | 6.0× |
| CTA head&neck c+ w/noncontrast img&post-pxessing (70471) | $424.40 | $2,122 | 1.3× |
| CTA pelvis (72191) | $402.20 | $2,011 | 2.4× |
| Diskography lumbar (72295) | $852.80 | $4,264 | 0.5× |
| Dxa Bone Density Axial (77080) | $154.80 | $774 | 1.5× |
| Dxa bone density study 1/>sites appendiclr skel (77081) | $80.40 | $402 | 1.0× |
| Echo exam uterus (76831) | $156.60 | $783 | 0.7× |
| Echo Guide For Artery Repair (76936) | $308.40 | $1,542 | 1.5× |
| Esophageal Motility Study (78258) | $258 | $1,290 | 0.7× |
| Esophagram (74220) | $376.20 | $1,881 | 2.2× |
| Fetal Biophys Profile W/Nst (76818) | $318.40 | $1,592 | 3.2× |
| Fetal Biophysical Profile W/O Non-Stress Testing (76819) | $253.40 | $1,267 | 2.5× |
| Fluoroscopy up to 1 hr (76000) | $170.40 | $852 | 0.7× |
| Foot 2 views (73620) range across 2 matching MRF lines |
$191.20–$334.60 | $956–$1,673 | varies |
| Forearm 2 views (73090) range across 2 matching MRF lines |
$155.80–$272.80 | $779–$1,364 | varies |
| Gastric emptying imaging study (78264) | $359.60 | $1,798 | 0.9× |
| Gated Heart Planar Single (78472) | $891.60 | $4,458 | 2.3× |
| Hand 2 views (73120) range across 2 matching MRF lines |
$165.40–$289.60 | $827–$1,448 | varies |
| Hepatobil Syst Image W/Drug (78227) | $1,021 | $5,105 | 2.0× |
| Hepatobiliary System Imaging (78226) | $421 | $2,105 | 1.1× |
| Ht Muscle Image Spect Sing (78451) | $748 | $3,740 | 0.6× |
| Hysterosalpingogram (74740) | $500 | $2,500 | 2.2× |
| Infant hip ultrasound with hip movement (dynamic) (76885) | $87.40 | $437 | 1.0× |
| Intracavitary Radiation Source Applic Intermed (77762) | $1,413.20 | $7,066 | 2.7× |
| Joint Survey Single View (77077) | $105.80 | $529 | 1.1× |
| K Flow/Funct Image Multiple (78709) | $846.20 | $4,231 | 1.6× |
| K Flow/Funct Image W/Drug (78708) | $846.20 | $4,231 | 1.6× |
| K Flow/Funct Image W/O Drug (78707) | $519 | $2,595 | 1.0× |
| Kidney Imaging Morphol (78700) | $415.40 | $2,077 | 1.1× |
| Knee 3 Views (73562) range across 2 matching MRF lines |
$231.40–$405.40 | $1,157–$2,027 | varies |
| Liver & Spleen Imaging Static Only (78215) | $276 | $1,380 | 0.7× |
| Liver & Spleen Imaging W/Vascular Flow (78216) | $375.40 | $1,877 | 1.0× |
| Liver imaging static only (78201) | $540 | $2,700 | 1.0× |
| Lung Perf&Ventilat Diferentl (78598) | $439.40 | $2,197 | 0.8× |
| Lung perfusion differential (78597) | $309.80 | $1,549 | 0.8× |
| Lung Ventilat&Perfus Imaging (78582) | $374 | $1,870 | 0.7× |
| Lung Ventilation Imaging (78579) | $367.60 | $1,838 | 1.0× |
| Lymph System Imaging (78195) | $668.80 | $3,344 | 1.3× |
| Magnetic Image Jaw Joint (70336) | $391.40 | $1,957 | 1.7× |
| Mammary ductogram or galactogram single (77053) | $193.80 | $969 | 0.8× |
| Meckels Divert Exam (78290) | $265 | $1,325 | 0.7× |
| Mlc imrt design & construction per imrt plan (77338) | $615.20 | $3,076 | 1.7× |
| Mr safety implant&/fb assmt clin staf 1st 15 min (76014) | $20.60 | $103 | 0.7× |
| Mra Head W/O & W/Contrast Material (70546) | $900.60 | $4,503 | 2.7× |
| MRA head w/o contrast (70544) | $576.40 | $2,882 | 2.5× |
| MRA head with contrast (70545) | $720.60 | $3,603 | 2.1× |
| MRA neck w contrast (70548) | $447 | $2,235 | 1.3× |
| Mra Neck W/O &W/Contrast Material (70549) | $558.80 | $2,794 | 1.7× |
| MRA neck w/o contrast (70547) | $357.60 | $1,788 | 1.6× |
| MRI abdomen w contrast (74182) | $566.60 | $2,833 | 1.7× |
| MRI abdomen w/o contrast (74181) | $453.20 | $2,266 | 2.0× |
| MRI any jt lower extrem w/contrast material (73722) | $557.20 | $2,786 | 0.7× |
| MRI any jt lower extrem w/o & w/contrast matrl (73723) | $696.40 | $3,482 | 2.1× |
| MRI any jt upper extremity w/contrast matrl (73222) | $552.60 | $2,763 | 0.7× |
| MRI Breast W/O Contrast Bilateral (77047) | $313 | $1,565 | 1.4× |
| MRI Breast Without Contrast Material Unilateral (77046) | $230.60 | $1,153 | 1.0× |
| MRI cervical spine w contrast (72142) | $629.60 | $3,148 | 1.9× |
| MRI cervical spine w/o cont (72141) | $503.60 | $2,518 | 2.2× |
| MRI chest w/o contrast (71550) | $456 | $2,280 | 2.0× |
| MRI chest with contrast (71551) | $570 | $2,850 | 0.8× |
| MRI chest wo w contrast (71552) | $712.60 | $3,563 | 2.1× |
| MRI lower extrem oth/thn jt w/contrast matrl (73719) | $576 | $2,880 | 1.7× |
| MRI lower extrem oth/thn jt w/o & w/contr matr (73720) | $720 | $3,600 | 2.1× |
| MRI lower extrem oth/thn jt w/o contr matrl (73718) | $460.80 | $2,304 | 2.0× |
| MRI lumbar spine w contrast (72149) | $640.20 | $3,201 | 1.9× |
| Mri Neck Spine W/O & W/Dye (72156) | $787 | $3,935 | 2.3× |
| MRI orbit face &/neck w/o contrast (70540) | $439 | $2,195 | 1.9× |
| MRI orbit face neck w contrast (70542) | $548.80 | $2,744 | 1.6× |
| Mri Orbt/Fac/Nck W/O &W/Dye (70543) | $685.80 | $3,429 | 2.0× |
| MRI pelvis w contrast (72196) | $624.80 | $3,124 | 1.9× |
| MRI pelvis w/o & w contrast (72197) | $781 | $3,905 | 2.3× |
| MRI pelvis w/o contrast (72195) | $499.80 | $2,499 | 2.2× |
| MRI thoracic spine w/o contrast (72146) | $494.20 | $2,471 | 2.2× |
| MRI upper extremity oth than jt w/contr matrl (73219) | $587 | $2,935 | 1.7× |
| MRI upper extremity oth than jt w/o contr matrl (73218) | $469.60 | $2,348 | 2.0× |
| Mri Uppr Extremity W/O&W/Dye (73220) | $733.80 | $3,669 | 2.2× |
| MRI, abdomen, combo (74183) | $708.40 | $3,542 | 2.1× |
| MRI, dorsal spine combo (72157) | $772 | $3,860 | 2.3× |
| MRI, dorsal spine contrast (72147) | $617.60 | $3,088 | 1.8× |
| MRI, joint upper extrem (73221) | $442 | $2,210 | 1.9× |
| MRI, joint upper extrem combo (73223) | $690.60 | $3,453 | 2.1× |
| MRI, lumbar spine combo (72158) | $793 | $3,965 | 2.4× |
| Myocardial Imaging Infarct Avid Planar Qual/Quan (78466) | $353.60 | $1,768 | 0.9× |
| Myocardial Spect Multiple Studies (78452) | $1,836.60 | $9,183 | 1.5× |
| Neck soft tissue (70360) | $236.80 | $1,184 | 2.8× |
| Njx Rp Loclzj Non-Img Probe Study Intravenous (78808) | $145.60 | $728 | 0.4× |
| Nm myocard infarct spect (78469) | $617.60 | $3,088 | 1.2× |
| Ntsty modul radthx pln dose-vol histos (77301) | $1,587 | $7,935 | 1.2× |
| Nuclear Rx Oral Admin (79005) | $378.20 | $1,891 | 1.7× |
| Ob us nuchal meas 1 gest (76813) | $105 | $525 | 1.0× |
| Parathyroid Planar Imaging (78070) | $593.60 | $2,968 | 1.5× |
| Parathyroid planar imaging w/wo subtraction (78071) | $610.20 | $3,051 | 1.6× |
| Pelvis 1 or 2 views (72170) | $107 | $535 | 1.1× |
| Peritoneogram Rs&I (74190) | $596 | $2,980 | 1.1× |
| Pet Image W/Ct Lmtd (78814) | $892.40 | $4,462 | 0.6× |
| PET image w/CT, full body (78816) | $2,284.60 | $11,423 | 1.7× |
| PET imaging CT attenuation skull base mid-thigh (78815) | $2,138.40 | $10,692 | 1.6× |
| Pulmonary Perfusion Imaging Particulate (78580) | $336.60 | $1,683 | 0.9× |
| Radex Abd Compl Aqt Abd W/S/E/D Views 1 View Ch (74022) | $296.60 | $1,483 | 2.9× |
| Radex abscess/fistula/sinus tract rs&i (76080) | $199.20 | $996 | 0.4× |
| Radex Ankle Complete Minimum 3 Views (73610) range across 2 matching MRF lines |
$189–$330.60 | $945–$1,653 | varies |
| Radex Calcaneus Minimum 2 Views (73650) range across 2 matching MRF lines |
$193.20–$338.20 | $966–$1,691 | varies |
| Radex elbow complete minimum 3 views (73080) range across 2 matching MRF lines |
$191.20–$334.60 | $956–$1,673 | varies |
| Radex Facial Bones Complete Minimum 3 Views (70150) | $245.60 | $1,228 | 2.4× |
| Radex fingr minimum 2 views (73140) range across 2 matching MRF lines |
$151.60–$265.20 | $758–$1,326 | varies |
| Radex foot complete minimum 3 views (73630) range across 2 matching MRF lines |
$222.60–$389 | $1,113–$1,945 | varies |
| Radex Hand Minimum 3 Views (73130) range across 2 matching MRF lines |
$177–$309.40 | $885–$1,547 | varies |
| Radex lower extremity infant minimum 2 views (73592) | $113 | $565 | 1.4× |
| Radex Mastoids Compl Minimum 3 Views PR Side (70130) | $152.40 | $762 | 1.5× |
| Radex Nasal Bones Complete Minimum 3 Views (70160) | $189.40 | $947 | 2.3× |
| Radex Ribs Unilateral 2 Views (71100) | $215.60 | $1,078 | 2.6× |
| Radex shoulder complete minimum 2 views (73030) range across 2 matching MRF lines |
$249–$435.60 | $1,245–$2,178 | varies |
| Radex Sinuses Paransl < 3 Views (70210) | $68.60 | $343 | 0.8× |
| Radex Spine 1 View Specify Level (72020) | $174.80 | $874 | 2.1× |
| Radex Sternum Minimum 2 Views (71120) | $88.20 | $441 | 1.1× |
| Radex Temporomandble Jt Opn & Clsd Mouth Bilat (70330) | $70.60 | $353 | 0.8× |
| Radex Toe Minimum 2 Views (73660) | $168.20 | $841 | 2.0× |
| Radex upper extremity infant minimum 2 views (73092) | $172 | $860 | 1.7× |
| Radex Wrist Complete Minimum 3 Views (73110) range across 2 matching MRF lines |
$179.20–$313.20 | $896–$1,566 | varies |
| Radex X-Ray Exam Entire Spi 6/> Vw - Xr Entire Spine 6+ Vw (72084) | $313 | $1,565 | 3.1× |
| Radiation Delivery Stereotactic Cranial Linear (77372) | $12,776.20 | $63,881 | 1.8× |
| Radiation treatment delivery level 1 (77402) | $190.60 | $953 | 1.9× |
| Radiation treatment delivery level 2 (77407) | $251.80 | $1,259 | 0.7× |
| Radiation treatment delivery level 3 (77412) | $299.20 | $1,496 | 0.6× |
| Radiolog exam mandible compl minimum 4 views (70110) | $218 | $1,090 | 2.2× |
| Radiologic Exam Abdomen 3+ Views - Xr Abdomen 3+ Views (74021) | $296.60 | $1,483 | 2.9× |
| Radiologic exam colon double contrast study (74280) | $614.20 | $3,071 | 3.6× |
| Radiologic exam colon single contrast study (74270) | $517.20 | $2,586 | 3.1× |
| Radiologic exam knee complete 4/more views (73564) range across 2 matching MRF lines |
$250.60–$438 | $1,253–$2,190 | varies |
| Radiologic exam pelvis compl minimum 3 views (72190) | $289 | $1,445 | 2.9× |
| Radiologic Exam Small Int Single Contrast Study (74250) | $458.40 | $2,292 | 2.7× |
| Radiologic exam swallow function contrast study (74230) | $286.20 | $1,431 | 1.7× |
| Radiologic exam upr gi trc double contrast study (74246) | $482.60 | $2,413 | 2.9× |
| Radiologic examination femur minimum 2 views (73552) range across 2 matching MRF lines |
$235.60–$411.40 | $1,178–$2,057 | varies |
| Radiologic examination knee 1/2 views (73560) range across 2 matching MRF lines |
$170.60–$298.80 | $853–$1,494 | varies |
| Radiologic Examination Osseous Survey Limited (77074) | $139 | $695 | 1.4× |
| Radiologic examination tibia & fibula 2 views (73590) range across 2 matching MRF lines |
$201–$352.20 | $1,005–$1,761 | varies |
| Ribs bilateral 3 views (71110) | $162.40 | $812 | 1.6× |
| Rp loclzj tum plnr 1 area single day imaging (78800) | $267 | $1,335 | 0.7× |
| Rp loclzj tum plnr 2+area 1+d img/1 area img>2+d (78801) | $375.40 | $1,877 | 1.0× |
| Rp Loclzj Tum Plnr Whole Body 2+ Days Imaging (78804) | $1,275.80 | $6,379 | 2.4× |
| Rp Loclzj Tum Plnr Whole Body Single Day Imaging (78802) | $757.40 | $3,787 | 1.5× |
| Rp Loclzj Tum Spect 1 Area Single Day Imaging (78803) | $880.20 | $4,401 | 1.7× |
| Rp loclzj tum spect 2 area/sep acquisj img (78831) | $1,275.80 | $6,379 | 1.0× |
| Rp loclzj tum spect w/CT 1 area/acquisj 1day img (78830) | $829.40 | $4,147 | 0.7× |
| Scapula (73010) | $210.80 | $1,054 | 2.1× |
| Screening Digital Breast Tomosynthesis Bi (77063) | $23 | $115 | 1.0× |
| Shoulder 1 view (73020) range across 2 matching MRF lines |
$98–$172 | $490–$860 | varies |
| Shoulder Arthrography (73040) | $310.80 | $1,554 | 0.9× |
| Skull less than 4 views (70250) | $161.40 | $807 | 1.6× |
| Special dosimetry (77331) | $394.20 | $1,971 | 3.0× |
| Special Physics Consult (77370) | $480.80 | $2,404 | 3.7× |
| Special teletherapy port plan (77321) | $562.20 | $2,811 | 1.6× |
| Special treatment procedure (77470) | $1,160.80 | $5,804 | 2.2× |
| Stereotactic Body Radiation Delivery (77373) | $6,978.80 | $34,894 | 4.1× |
| Sternoclavicular joints (71130) | $167.40 | $837 | 2.0× |
| Surface Applic Low Dose Rate Radionuclide Source (77789) | $207.60 | $1,038 | 2.1× |
| Telethx isodose pln cplx w/basic dosimetry (77307) | $760.40 | $3,802 | 2.1× |
| Telethx isodose pln smpl w/dosimetry calculation (77306) | $665 | $3,325 | 1.8× |
| Ther Rad Simulaj-Aided Field Setting Complex (77290) range across 2 matching MRF lines |
$734.80–$1,287.80 | $3,674–$6,439 | varies |
| Ther Rad Simulaj-Aided Field Setting Intermed (77285) | $527.80 | $2,639 | 1.5× |
| Ther rad simulaj-aided field setting simple (77280) | $410.40 | $2,052 | 3.2× |
| Thoracic spine 2 views (72070) | $106.80 | $534 | 1.1× |
| Thoracic spine 3 views (72072) | $112.20 | $561 | 1.1× |
| Thoracolumbar 2 views (72080) | $105.60 | $528 | 1.3× |
| Thyroid Met Imaging Body (78018) | $324.20 | $1,621 | 0.6× |
| Thyroid Uptake W/Blood Flow Sngle/Mult Quan Meas (78014) | $676 | $3,380 | 1.8× |
| Tx Devices Design & Construction Complex (77334) | $754.60 | $3,773 | 2.1× |
| Tx devices design & construction intermediate (77333) | $404.20 | $2,021 | 3.1× |
| Tx devices design & construction simple (77332) | $353 | $1,765 | 2.7× |
| Ultrasound Breast Limited (76642) range across 2 matching MRF lines |
$343–$571.60 | $1,715–$2,858 | varies |
| Ultrasound Exam Aaa Screen (76706) | $277.20 | $1,386 | 2.8× |
| Ultrasound, abdomen limited (76705) | $389.80 | $1,949 | 3.9× |
| Umbilical-artery Doppler (OB) (76820) | $352.40 | $1,762 | 3.5× |
| Unlisted Dx Radiographic Procedure (76499) | $195.80 | $979 | 2.3× |
| Unlisted respiratory px dx nuclear medicine (78599) | $365.80 | $1,829 | 1.0× |
| Unlisted us procedure (76999) | $94.20 | $471 | 1.1× |
| Upper gi w/o kub (74240) | $485.20 | $2,426 | 2.9× |
| Urethrocystogram voiding (74455) | $218.40 | $1,092 | 1.0× |
| Urethrocystography retrograde (74450) | $264.40 | $1,322 | 1.2× |
| Us breast unilateral complete (76641) range across 2 matching MRF lines |
$469.60–$782.20 | $2,348–$3,911 | varies |
| Us chest (76604) | $130 | $650 | 1.3× |
| Us complete joint (76881) | $233.20 | $1,166 | 2.3× |
| Us exam, pelvic, limited (76857) | $318 | $1,590 | 3.2× |
| Us head (76506) | $100.80 | $504 | 1.0× |
| Us kidney transplant (76776) | $255.40 | $1,277 | 2.5× |
| Us lmtd joint/oth nonvasc xtr strux r-t w/img (76882) | $151.40 | $757 | 1.5× |
| Us ob detailed single fetus (76811) | $396.40 | $1,982 | 1.7× |
| Us ob limited 1 or more fetuses (76815) | $307.60 | $1,538 | 3.1× |
| Us ob transvaginal (76817) | $334.80 | $1,674 | 3.3× |
| Us pelvic non ob complete (76856) | $415.80 | $2,079 | 4.1× |
| Us pg uter img f&mat 14 wk tabdl 1/1st gestation (76801) | $352.20 | $1,761 | 3.5× |
| Us preg uterus real time f/u trnsabdl per fetus (76816) | $308.20 | $1,541 | 3.1× |
| Us retroperitoneal complete (76770) | $409.60 | $2,048 | 4.1× |
| Us retroperitoneal limited (76775) | $155.60 | $778 | 1.5× |
| Us scrotum and contents (76870) | $377.60 | $1,888 | 3.8× |
| Us spinal canal and contents (76800) | $296.40 | $1,482 | 2.9× |
| Us thyroid (76536) | $364.20 | $1,821 | 3.6× |
| Us transrectal (76872) | $284.40 | $1,422 | 2.8× |
| Vein X-Ray Chest (75827) | $820 | $4,100 | 0.5× |
| Venogram Sinus/Jugular (75860) | $1,345.80 | $6,729 | 0.4× |
| Venography caval inferior serialography rs&i (75825) | $1,345.80 | $6,729 | 0.4× |
| Venography extremity bilateral rs&i (75822) | $739.80 | $3,699 | 0.5× |
| Venography extremity unilateral rs&i (75820) | $597.20 | $2,986 | 0.4× |
| Venography Renal Bilateral (75833) | $1,345.80 | $6,729 | 0.4× |
| Venography Renal Unilateral (75831) | $1,228.20 | $6,141 | 0.4× |
| Venous sampling by catheter (75893) unusually low: confirm this is the full procedure |
$2,484.20 | $12,421 | 0.5× |
| Vertebral fracture assessment via dxa (77086) | $188.20 | $941 | 2.2× |
| Wrist 2 views (73100) range across 2 matching MRF lines |
$95.80–$167.80 | $479–$839 | varies |
| X-Ray Ac Jts - Xr Acromioclavicular Joints Bilateral (73050) | $246.60 | $1,233 | 2.9× |
| X-ray antegrade pyelogram tube (74425) | $278 | $1,390 | 0.8× |
| X-Ray Aorta Leg Arteries (75630) | $1,467.80 | $7,339 | 0.5× |
| X-Ray Bend Only L-S Spine (72120) | $254.60 | $1,273 | 2.5× |
| X-Ray Elbow 2 Vw - Xr Elbow 1-2 Views Right (73070) range across 2 matching MRF lines |
$164.20–$287.40 | $821–$1,437 | varies |
| X-Ray Exam Breast Specimen (76098) | $305.20 | $1,526 | 0.6× |
| X-Ray Exam Entire Spi 1 Vw (72081) | $157.60 | $788 | 1.9× |
| X-Ray Exam Entire Spi 2/3 Vw (72082) | $186 | $930 | 1.8× |
| X-Ray Exam Hip Uni 1 View (73501) | $77.60 | $388 | 0.9× |
| X-Ray Exam Hip Uni 2-3 Views (73502) | $198.60 | $993 | 2.4× |
| X-Ray Exam Hips Bi 2 Views (73521) | $234 | $1,170 | 2.3× |
| X-Ray Exam Hips Bi 3-4 Views (73522) | $237.40 | $1,187 | 2.4× |
| X-Ray Exam Hips Bi 5/> Views (73523) | $332.20 | $1,661 | 3.3× |
| X-Ray Exam L-S Spine Bending (72114) | $389.40 | $1,947 | 3.9× |
| X-Ray Exam Neck Spine 2-3 Vw (72040) | $205 | $1,025 | 2.4× |
| X-Ray Exam Neck Spine 6/>Vws (72052) | $399 | $1,995 | 4.0× |
| X-Ray Exam Unilat Ribs/Chest (71101) | $233.20 | $1,166 | 2.3× |
| X-ray eye for foreign body (70030) | $40.20 | $201 | 0.5× |
| X-ray humerus (73060) range across 2 matching MRF lines |
$108–$189.20 | $540–$946 | varies |
| X-ray IV pyelogram (ivp) (74400) | $373 | $1,865 | 2.2× |
| X-ray IV pyelogram+tomography (74415) | $383.20 | $1,916 | 2.3× |
| X-Ray Jaw <4 Vw - Xr Mandible < 4 Views (70100) | $181.40 | $907 | 2.2× |
| X-Ray Knee Bilat Standing - Xr Knees Anteroposterior Standing Bilat (73565) | $88.20 | $441 | 1.1× |
| X-Ray Lumbar Spine 2/3 Vw - Xr Lumbar Spine 2-3 Views (72100) | $219.20 | $1,096 | 2.2× |
| X-ray nose-rectum child f.b. (76010) | $92.60 | $463 | 1.1× |
| X-Ray Ribs, Chest 4+ Vw - Xr Ribs 3 Vws Bil W/ Chest Posteroanterior (71111) | $177.40 | $887 | 1.8× |
| X-Ray Sacroiliac Jts 3+ Vw - Xr Sacroiliac Joints 3+ Views (72202) | $140 | $700 | 1.4× |
| X-Ray Sacroiliac Jts <3 Vw - Xr Sacroiliac Joints 1-2 Views (72200) | $117 | $585 | 1.2× |
| X-Ray Sacrum/Coccyx 2+ Vw - Xr Sacrum Coccyx 2+ Views (72220) | $161.20 | $806 | 1.9× |
| X-Ray Sinuses 3+ Vw - Xr Paranasal Sinuses 3+ Views (70220) | $249.40 | $1,247 | 3.0× |
| X-Ray Skull 4+ Vw - Xr Skull Complete 4+ Views (70260) | $225.40 | $1,127 | 2.2× |
| X-ray thoracic spine 4 vw (72074) | $132.40 | $662 | 1.3× |
| X-Ray Tmj Unilat (70328) | $47.20 | $236 | 0.6× |
| X-Ray Urinary Tract Exam With Contrast Material (74420) | $292.40 | $1,462 | 0.9× |
| X-Rays Bone Length Studies (77073) | $61.60 | $308 | 0.6× |
| X-Rays Bone Survey Complete (77075) | $243.40 | $1,217 | 2.4× |
| Xr c-spine 4 or 5 views (72050) | $298 | $1,490 | 3.0× |
| Xr facial bones less than 3 views (70140) | $95 | $475 | 1.1× |
| Xr orbits complete 4 views (70200) | $106 | $530 | 1.1× |
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.