Imaging prices at Legacy Good Samaritan Medical Center
Portland, OR · every code in this section with a posted price and a Medicare benchmark.
408 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) range across 2 matching MRF lines |
$7,367.10–$9,208.55 | $11,334–$14,167 | varies |
| Abdomen 1 View (74018) | $263.25 | $405 | 2.7× |
| Abdomen 2 views (74019) | $323.05 | $497 | 2.8× |
| Acute Gastrointestinal Blood Loss Imaging (78278) | $859.30 | $1,322 | 1.9× |
| Angio internal mammary (75756) | $4,262.05 | $6,557 | 1.2× |
| Angio pulmonary bilat (75743) | $6,392.10 | $9,834 | 1.8× |
| Angiography extremity bilateral rs&i (75716) | $5,668 | $8,720 | 1.6× |
| Angiography extremity unilateral rs&i (75710) | $4,961.45 | $7,633 | 1.4× |
| Angiography pulmonary unilateral slctv rs&i (75741) | $4,262.05 | $6,557 | 1.2× |
| Ankle 2 views (73600) | $180.05 | $277 | 1.9× |
| Aortography thoracic serialography rs&i (75605) | $5,528.25 | $8,505 | 0.9× |
| Artery X-Rays Abdomen (75726) | $8,469.50 | $13,030 | 1.4× |
| Artery X-Rays Pelvis (75736) | $5,528.25 | $8,505 | 0.9× |
| Artery X-Rays Spine (75705) | $8,469.50 | $13,030 | 1.4× |
| Arthrogram ankle (73615) | $396.50 | $610 | 1.0× |
| Arthrogram hip (73525) | $707.20 | $1,088 | 1.8× |
| Arthrogram Wrist (73115) | $390 | $600 | 1.0× |
| Basic radiation dosimetry calculation (77300) range across 2 matching MRF lines |
$369.20–$385.45 | $568–$593 | varies |
| Bone age studies (77072) | $145.60 | $224 | 1.3× |
| Bone Imaging 3 Phase (78315) | $776.10 | $1,194 | 1.7× |
| Bone Imaging Limited Area (78300) | $581.75 | $895 | 1.3× |
| Bone Imaging Multiple Areas (78305) | $639.60 | $984 | 1.4× |
| Bone Imaging Whole Body (78306) | $917.80 | $1,412 | 2.1× |
| Bone marrow imaging; whole body (78104) | $822.90 | $1,266 | 1.9× |
| Bone survey infant (77076) | $532.35 | $819 | 4.6× |
| Brachytx isodose complex (77318) | $1,167.40 | $1,796 | 2.8× |
| Brachytx isodose intermed (77317) | $1,118 | $1,720 | 2.7× |
| Brachytx Isodose Plan Simple (77316) | $1,068.60 | $1,644 | 2.6× |
| Brain Flow Imaging Only (78610) | $678.60 | $1,044 | 1.1× |
| Brain Imaging Pet Metabolic Evaluation (78608) | $2,691 | $4,140 | 1.7× |
| Cardiac MRI w/w/o contrast & further seq (75561) | $1,347.45 | $2,073 | 3.5× |
| Cardiac MRI w/w/o contrast w/stress (75563) | $1,996.15 | $3,071 | 2.3× |
| Cat Scan Follow-Up Study (76380) range across 2 matching MRF lines |
$551.20–$587.60 | $848–$904 | varies |
| Cerebrospinal Fluid Flow W/O Matl Shunt Evaltj (78645) | $986.05 | $1,517 | 1.6× |
| Cerebrospinal Fluid Scan (78630) | $828.75 | $1,275 | 1.4× |
| Chest 1 view (71045) range across 2 matching MRF lines |
$148.20–$245.70 | $228–$378 | varies |
| Chest 2 views (71046) | $157.95 | $243 | 1.6× |
| Chest 3 views (71047) | $254.15 | $391 | 2.6× |
| Chest 4 or more views (71048) | $266.50 | $410 | 2.3× |
| Clavicle complete (73000) | $155.35 | $239 | 1.6× |
| Computed Tomography Thorax Lw Dose Lng Ca Scr C- (71271) | $202.15 | $311 | 1.7× |
| Continuing medical physics consltj pr wk (77336) | $432.90 | $666 | 2.9× |
| Contrast Exam Abdominl Aorta (75625) | $4,904.25 | $7,545 | 1.4× |
| Contrast X-Ray Bladder (74430) | $390.65 | $601 | 1.0× |
| Contrast X-Ray Of Elbow (73085) | $682.50 | $1,050 | 1.8× |
| Contrast X-Ray Of Knee Joint (73580) | $396.50 | $610 | 1.0× |
| CT abdomen and pelvis without and with contrast (74178) | $2,282.15 | $3,511 | 5.9× |
| CT abdomen and pelvis without contrast (74176) | $1,674.40 | $2,576 | 6.3× |
| CT abdomen w contrast (74160) range across 2 matching MRF lines |
$551.20–$974.35 | $848–$1,499 | varies |
| CT abdomen w wo contrast (74170) | $1,121.90 | $1,726 | 5.8× |
| CT abdomen w/o contrast (74150) range across 3 matching MRF lines |
$512.20–$903.50 | $788–$1,390 | varies |
| CT Angio Abdomen and Pelvis (74174) | $1,944.80 | $2,992 | 5.0× |
| CT Angio Chest (71275) range across 2 matching MRF lines |
$982.80–$1,002.95 | $1,512–$1,543 | varies |
| CT Angio Head (70496) | $1,416.35 | $2,179 | 7.3× |
| CT angio hrt w/3d image (75574) | $1,002.95 | $1,543 | 2.6× |
| Ct Angio Lwr Extr W/O&W/Dye (73706) range across 3 matching MRF lines |
$611–$1,311.05 | $940–$2,017 | varies |
| CT Angio Neck (70498) | $1,420.90 | $2,186 | 7.3× |
| Ct Angio Upr Extrm W/O&W/Dye (73206) | $873.60 | $1,344 | 4.5× |
| CT Cere Prfuj Alys C+ W/O CT/Cta Same Anatomy (70473) | $1,130.35 | $1,739 | 5.8× |
| CT cervical spine w/ contrast (72126) | $848.90 | $1,306 | 2.2× |
| CT cervical spine w/o contrast (72125) | $770.90 | $1,186 | 6.6× |
| CT cervical spine w/wo cont (72127) | $1,026.35 | $1,579 | 5.3× |
| CT chest w contrast (71260) range across 2 matching MRF lines |
$566.15–$967.20 | $871–$1,488 | varies |
| CT chest w/wo contrast (71270) | $1,261 | $1,940 | 6.5× |
| CT colonography screening (74263) | $590.20 | $908 | 2.2× |
| CT Colonogrphy Dx Image Postprocess W/Contrast (74262) | $752.05 | $1,157 | 3.9× |
| CT colonogrphy dx image postprocess w/o contrast (74261) | $513.50 | $790 | 4.4× |
| CT head/brain with contrast (70460) range across 2 matching MRF lines |
$546–$868.40 | $840–$1,336 | varies |
| CT head/brain without and with contrast (70470) | $1,073.80 | $1,652 | 5.5× |
| CT heart contrast eval cardiac structure&morph (75572) | $924.30 | $1,422 | 2.4× |
| CT heart no contrast quant eval coronry calcium (75571) | $65.65 | $101 | 0.7× |
| CT hrt w/3d image congen (75573) | $924.30 | $1,422 | 2.4× |
| CT iac w contrast (70481) | $737.75 | $1,135 | 3.8× |
| CT l-spine w&w/o contrast (72133) | $1,026.35 | $1,579 | 5.3× |
| CT lower ext w/o (73700) range across 2 matching MRF lines |
$679.25–$810.55 | $1,045–$1,247 | varies |
| CT lower extremity w/contrast material (73701) | $1,013.35 | $1,559 | 5.2× |
| CT lumbar spine w contrast (72132) | $991.25 | $1,525 | 2.6× |
| CT lumbar spine w/o contrast (72131) | $956.15 | $1,471 | 8.2× |
| CT maxillofacial w contrast (70487) | $868.40 | $1,336 | 4.5× |
| CT maxillofacial wo contrast (70486) range across 2 matching MRF lines |
$643.50–$857.35 | $990–$1,319 | varies |
| CT neck tissue combo (70492) | $1,086.80 | $1,672 | 5.6× |
| Ct Orbit/Ear/Fossa W/O&W/Dye (70482) | $1,155.05 | $1,777 | 5.9× |
| CT orbits w/o contrast (70480) | $663.65 | $1,021 | 5.7× |
| CT pelvis w&w/o contrast (72194) | $1,275.95 | $1,963 | 6.5× |
| CT pelvis w/o contrast (72192) range across 4 matching MRF lines |
$533.65–$857.35 | $821–$1,319 | varies |
| CT scan of leg combo (73702) | $1,215.50 | $1,870 | 6.2× |
| CT scans face/jaw combo (70488) | $1,073.80 | $1,652 | 5.5× |
| CT soft tissue neck w contrast (70491) | $953.55 | $1,467 | 4.9× |
| CT soft tissue neck w/o contrast (70490) | $881.40 | $1,356 | 7.6× |
| CT thoracic spine w contrast (72129) | $994.50 | $1,530 | 5.1× |
| CT thoracic spine w/o contrast (72128) | $963.95 | $1,483 | 8.3× |
| CT thoracic spine w/wo cont (72130) | $1,026.35 | $1,579 | 5.3× |
| CT thorax w/o contrast (71250) range across 2 matching MRF lines |
$533.65–$913.90 | $821–$1,406 | varies |
| CT unlisted procedure (76497) | $188.50 | $290 | 1.9× |
| CT upper ext wo (73200) | $810.55 | $1,247 | 7.0× |
| CT upper extremity w/o & w/contrast material (73202) | $1,289.60 | $1,984 | 6.6× |
| CT upper extremity with contrast (73201) | $1,049.75 | $1,615 | 2.7× |
| Cta Abdl Aorta&Bi Iliofem W/Contrast&Postp (75635) | $1,062.10 | $1,634 | 5.4× |
| Cta Abdomen (74175) | $971.10 | $1,494 | 5.0× |
| CTA head&neck c+ w/noncontrast img&post-pxessing (70471) | $2,986.75 | $4,595 | 7.7× |
| CTA pelvis (72191) | $971.10 | $1,494 | 5.0× |
| Diskography lumbar (72295) | $2,964.65 | $4,561 | 1.4× |
| Doppler Echo Fetal Puls Spectral F/U/Repeat (76828) | $220.35 | $339 | 1.9× |
| Doppler Echo Fetal Spectral Display Complete (76827) | $476.45 | $733 | 4.1× |
| Doppler Fetal Mid Cerebral Artery (76821) | $183.95 | $283 | 1.6× |
| Dxa Bone Density Axial (77080) | $396.50 | $610 | 3.4× |
| Dxa bone density study (77085) | $846.95 | $1,303 | 7.3× |
| Dxa bone density study 1/>sites appendiclr skel (77081) | $294.45 | $453 | 3.0× |
| Echo exam of fetal heart (76825) | $658.45 | $1,013 | 1.1× |
| Echo exam uterus (76831) | $329.55 | $507 | 1.2× |
| Echo Guide For Artery Repair (76936) | $2,085.20 | $3,208 | 8.7× |
| Echocardiography, fetal, cardiovascular system, real time with image documentation (2D), with or without M-mode… (76826) | $471.25 | $725 | 1.8× |
| Echograp Trans R Pros Study (76873) | $544.70 | $838 | 4.7× |
| Esophagram (74220) | $481.65 | $741 | 2.5× |
| Fetal Biophys Profile W/Nst (76818) | $377 | $580 | 3.2× |
| Fetal Biophysical Profile W/O Non-Stress Testing (76819) | $377 | $580 | 3.2× |
| Fetal MRI w/placntl matrnl plvc img sing/1st ges (74712) | $1,348.75 | $2,075 | 5.1× |
| Fluoroscopy up to 1 hr (76000) range across 2 matching MRF lines |
$607.75–$972.40 | $935–$1,496 | varies |
| Follow-Up Angiography (75898) | $3,317.60 | $5,104 | 0.9× |
| Foot 2 views (73620) range across 3 matching MRF lines |
$113.10–$178.10 | $174–$274 | varies |
| Forearm 2 views (73090) | $218.40 | $336 | 2.3× |
| Gastric emptying imaging study (78264) | $721.50 | $1,110 | 1.6× |
| Gastric Emptyng Imag Std W/Sm Bwl Transit (78265) | $1,082.25 | $1,665 | 2.4× |
| Gastroesophageal Reflux Exam (78262) | $698.75 | $1,075 | 1.6× |
| Gated Heart Planar Single (78472) | $736.45 | $1,133 | 1.7× |
| Gated Heart, Multiple (78473) | $1,090.05 | $1,677 | 2.5× |
| Gstrc Emptng Imag Std W/Sm Bwl Col Trnst Mlt Day (78266) | $1,441.05 | $2,217 | 2.4× |
| Hand 2 views (73120) range across 3 matching MRF lines |
$90.35–$160.55 | $139–$247 | varies |
| Hdr Rdncl Ntrstl/Icav Brchtx (77772) | $5,051.80 | $7,772 | 6.5× |
| Hdr Rdncl Ntrstl/Icav Brchtx (77771) | $4,735.90 | $7,286 | 6.1× |
| Hdr Rdncl Ntrstl/Icav Brchtx 1 Channel (77770) | $3,156.40 | $4,856 | 4.1× |
| Hepatc Vngrph Wdg/Fr Hemodyn Eval Rs&I (75889) | $4,262.05 | $6,557 | 1.2× |
| Hepatc Vngrph Wdg/Fr W/O Hemodyn Eval Rs&I (75891) | $4,262.05 | $6,557 | 1.2× |
| Hepatobil Syst Image W/Drug (78227) | $859.30 | $1,322 | 1.4× |
| Hepatobiliary System Imaging (78226) | $859.30 | $1,322 | 1.9× |
| Ht Musc Image Planar Mult (78454) | $2,137.20 | $3,288 | 1.5× |
| Ht Muscle Image Spect Sing (78451) | $2,034.50 | $3,130 | 1.4× |
| Hysterosalpingogram (74740) | $394.55 | $607 | 1.5× |
| Infant hip ultrasound with hip movement (dynamic) (76885) | $317.85 | $489 | 3.3× |
| Infant hip ultrasound, limited static exam (76886) range across 2 matching MRF lines |
$160.55–$196.95 | $247–$303 | varies |
| Interstitial radiation source applic complex (77778) | $2,674.10 | $4,114 | 3.5× |
| Intracavitary Radiation Source Applic Complex (77763) | $5,229.90 | $8,046 | 6.8× |
| Intracavitary Radiation Source Applic Intermed (77762) | $4,485 | $6,900 | 7.3× |
| Intracavitary radiation source applic simple (77761) | $3,735.55 | $5,747 | 6.1× |
| Intraop radiaj tx deliver xray single tx session (77424) | $5,996.25 | $9,225 | 0.7× |
| Joint Survey Single View (77077) | $96.20 | $148 | 0.8× |
| K Flow/Funct Image Multiple (78709) | $802.10 | $1,234 | 1.3× |
| K Flow/Funct Image W/Drug (78708) | $768.30 | $1,182 | 1.3× |
| K Flow/Funct Image W/O Drug (78707) | $736.45 | $1,133 | 1.2× |
| Kidney Imaging Morphol (78700) | $491.40 | $756 | 1.1× |
| Kidney Imaging Morphoogy W/Vascular Flow (78701) | $495.95 | $763 | 1.1× |
| Knee 3 Views (73562) | $206.05 | $317 | 2.1× |
| Leveen/Shunt Patency Exam (78291) | $736.45 | $1,133 | 1.7× |
| Liver & Spleen Imaging Static Only (78215) | $686.40 | $1,056 | 1.5× |
| Liver & Spleen Imaging W/Vascular Flow (78216) | $880.10 | $1,354 | 2.0× |
| Liver imaging static only (78201) | $804.05 | $1,237 | 1.3× |
| Liver imaging w/vascular flow (78202) | $804.05 | $1,237 | 1.3× |
| Lung Perf&Ventilat Diferentl (78598) | $1,859.65 | $2,861 | 3.1× |
| Lung perfusion differential (78597) | $1,422.20 | $2,188 | 3.2× |
| Lung Ventilat&Perfus Imaging (78582) | $1,043.90 | $1,606 | 1.7× |
| Lung Ventilation Imaging (78579) | $532.35 | $819 | 1.2× |
| Lymph System Imaging (78195) | $736.45 | $1,133 | 1.2× |
| Magnetic Image Jaw Joint (70336) | $1,054.30 | $1,622 | 4.0× |
| Mammary ductogram or galactogram single (77053) | $413.40 | $636 | 1.6× |
| Meckels Divert Exam (78290) | $698.75 | $1,075 | 1.6× |
| Mlc imrt design & construction per imrt plan (77338) | $897.65 | $1,381 | 2.2× |
| Mr safety implant&/fb assmt clin staf 1st 15 min (76014) | $21.45 | $33 | 0.7× |
| Mr safety implt electronics prepj supvj phys/qhp (76018) | $67.60 | $104 | 0.6× |
| Mr safety implt pos&/immoblj (76019) | $43.55 | $67 | 0.7× |
| Mr safety med physics xm customization plng&mntr (76017) | $178.10 | $274 | 0.7× |
| Mra Head W/O & W/Contrast Material (70546) | $2,343.90 | $3,606 | 6.0× |
| MRA head w/o contrast (70544) | $1,085.50 | $1,670 | 4.1× |
| MRA head with contrast (70545) | $1,234.35 | $1,899 | 3.2× |
| MRA neck w contrast (70548) | $1,234.35 | $1,899 | 3.2× |
| Mra Neck W/O &W/Contrast Material (70549) | $2,343.90 | $3,606 | 6.0× |
| MRA neck w/o contrast (70547) | $1,015.30 | $1,562 | 3.8× |
| MRI abdomen w contrast (74182) | $1,444.30 | $2,222 | 3.7× |
| MRI abdomen w/o contrast (74181) | $1,228.50 | $1,890 | 4.6× |
| MRI any jt lower extrem w/contrast material (73722) | $1,425.45 | $2,193 | 1.6× |
| MRI any jt lower extrem w/o & w/contrast matrl (73723) | $2,561.65 | $3,941 | 6.6× |
| MRI any jt upper extremity w/contrast matrl (73222) | $1,425.45 | $2,193 | 1.6× |
| MRI bone marrow blood supply (77084) | $841.10 | $1,294 | 3.2× |
| MRI brain functional w/o physician admnistration (70554) | $1,118 | $1,720 | 4.2× |
| MRI Breast W/O Contrast Bilateral (77047) | $2,130.70 | $3,278 | 8.0× |
| MRI Breast Without Contrast Material Unilateral (77046) | $1,466.40 | $2,256 | 5.5× |
| MRI cardiac w/o cont stress (75559) | $1,501.50 | $2,310 | 2.5× |
| MRI cardiac w/o contrast (75557) | $952.25 | $1,465 | 3.6× |
| MRI cervical spine w contrast (72142) | $1,852.50 | $2,850 | 4.8× |
| MRI cervical spine w/o cont (72141) range across 2 matching MRF lines |
$373.10–$1,294.80 | $574–$1,992 | varies |
| MRI chest w/o contrast (71550) | $1,331.85 | $2,049 | 5.0× |
| MRI chest wo w contrast (71552) | $2,563.60 | $3,944 | 6.6× |
| MRI lower extrem oth/thn jt w/contrast matrl (73719) | $1,425.45 | $2,193 | 3.7× |
| MRI lower extrem oth/thn jt w/o & w/contr matr (73720) | $2,258.75 | $3,475 | 5.8× |
| MRI lower extrem oth/thn jt w/o contr matrl (73718) | $997.75 | $1,535 | 3.8× |
| MRI lumbar spine w contrast (72149) | $1,294.80 | $1,992 | 3.3× |
| Mri Neck Spine W/O & W/Dye (72156) | $2,408.90 | $3,706 | 6.2× |
| MRI orbit face &/neck w/o contrast (70540) | $1,417 | $2,180 | 5.3× |
| MRI orbit face neck w contrast (70542) | $1,425.45 | $2,193 | 3.7× |
| Mri Orbt/Fac/Nck W/O &W/Dye (70543) | $2,213.25 | $3,405 | 5.7× |
| MRI pelvis w contrast (72196) | $2,076.10 | $3,194 | 5.4× |
| MRI pelvis w/o & w contrast (72197) | $2,583.75 | $3,975 | 6.7× |
| MRI pelvis w/o contrast (72195) | $1,348.75 | $2,075 | 5.1× |
| MRI spectroscopy (76390) | $1,025.70 | $1,578 | 10.6× |
| MRI thoracic spine w/o contrast (72146) | $1,259.70 | $1,938 | 4.7× |
| MRI upper extremity oth than jt w/contr matrl (73219) | $1,314.95 | $2,023 | 3.4× |
| MRI upper extremity oth than jt w/o contr matrl (73218) | $1,051.70 | $1,618 | 4.0× |
| Mri Uppr Extremity W/O&W/Dye (73220) range across 5 matching MRF lines |
$2,083.90–$2,260.05 | $3,206–$3,477 | varies |
| MRI, abdomen, combo (74183) | $2,382.90 | $3,666 | 6.1× |
| MRI, dorsal spine combo (72157) | $2,408.90 | $3,706 | 6.2× |
| MRI, dorsal spine contrast (72147) | $1,275.30 | $1,962 | 3.3× |
| MRI, joint upper extrem (73221) | $1,017.25 | $1,565 | 3.8× |
| MRI, joint upper extrem combo (73223) | $2,537.60 | $3,904 | 6.5× |
| MRI, lumbar spine combo (72158) | $2,408.90 | $3,706 | 6.2× |
| Myelogram cervical (72240) | $1,384.50 | $2,130 | 1.6× |
| Myelogram Lumbar (72265) | $1,139.45 | $1,753 | 1.3× |
| Myelography thoracic (72255) | $1,384.50 | $2,130 | 1.6× |
| Myelograpy 2/more regions rs&i (72270) | $1,394.25 | $2,145 | 1.6× |
| Myocardial Perfusion Planar 1 Study Rest/Stress (78453) | $2,045.55 | $3,147 | 1.4× |
| Myocardial Spect Multiple Studies (78452) | $2,604.55 | $4,007 | 1.8× |
| Myocrd Img Pet Metab Eval Single Study Cncrnt CT (78429) | $2,585.05 | $3,977 | 1.6× |
| Myocrd Img Pet Prfuj W/Metab 2rtracer Cncrnt CT (78433) | $4,927.65 | $7,581 | 2.0× |
| N-invas est c ffr sw aly CTA (75580) | $741 | $1,140 | 0.8× |
| Neck soft tissue (70360) | $172.90 | $266 | 1.8× |
| Njx Rp Loclzj Non-Img Probe Study Intravenous (78808) | $300.30 | $462 | 0.7× |
| Nm csf leak detection (78650) | $880.10 | $1,354 | 0.6× |
| Nm myocard infarct spect (78469) | $830.70 | $1,278 | 1.4× |
| Nonvascular Shunt X-Ray (75809) | $233.35 | $359 | 2.0× |
| Ntsty modul radthx pln dose-vol histos (77301) range across 2 matching MRF lines |
$7,918.95–$9,169.55 | $12,183–$14,107 | varies |
| Nuclear Rx Intra-Arterial (79445) range across 2 matching MRF lines |
$321.10–$453.05 | $494–$697 | varies |
| Nuclear Rx Oral Admin (79005) | $336.70 | $518 | 1.3× |
| Ob us nuchal meas 1 gest (76813) | $238.55 | $367 | 2.1× |
| Ophthalmic ultrasound dx b-scan w/wo a-scan (76512) | $180.05 | $277 | 1.5× |
| Panoramic X-ray of jaws (70355) | $198.25 | $305 | 2.0× |
| Parathyroid imaging w/tomographic spect & CT (78072) | $1,593.15 | $2,451 | 2.6× |
| Parathyroid Planar Imaging (78070) | $561.60 | $864 | 1.3× |
| Parathyroid planar imaging w/wo subtraction (78071) | $1,448.20 | $2,228 | 3.3× |
| Pelvis 1 or 2 views (72170) | $188.50 | $290 | 1.6× |
| Pet Image W/Ct Lmtd (78814) range across 3 matching MRF lines |
$3,091.40–$3,248.05 | $4,756–$4,997 | varies |
| PET image w/CT, full body (78816) range across 3 matching MRF lines |
$3,588–$3,770 | $5,520–$5,800 | varies |
| PET imaging CT attenuation skull base mid-thigh (78815) | $3,452.15 | $5,311 | 2.2× |
| Prq Transhepatc Portograpy Hemodyn Eval Rs&I (75885) | $4,262.05 | $6,557 | 1.2× |
| Pulmonary Perfusion Imaging Particulate (78580) | $690.30 | $1,062 | 1.6× |
| Radex Abd Compl Aqt Abd W/S/E/D Views 1 View Ch (74022) | $408.20 | $628 | 3.5× |
| Radex abscess/fistula/sinus tract rs&i (76080) | $503.75 | $775 | 0.8× |
| Radex Ankle Complete Minimum 3 Views (73610) | $206.05 | $317 | 2.1× |
| Radex Calcaneus Minimum 2 Views (73650) | $178.10 | $274 | 1.8× |
| Radex elbow complete minimum 3 views (73080) | $198.25 | $305 | 2.0× |
| Radex Facial Bones Complete Minimum 3 Views (70150) | $254.15 | $391 | 2.2× |
| Radex fingr minimum 2 views (73140) | $159.25 | $245 | 1.6× |
| Radex foot complete minimum 3 views (73630) | $204.75 | $315 | 2.1× |
| Radex Hand Minimum 3 Views (73130) | $172.90 | $266 | 1.8× |
| Radex lower extremity infant minimum 2 views (73592) | $218.40 | $336 | 2.3× |
| Radex Nasal Bones Complete Minimum 3 Views (70160) | $204.75 | $315 | 2.1× |
| Radex Ribs Unilateral 2 Views (71100) | $198.25 | $305 | 2.0× |
| Radex shoulder complete minimum 2 views (73030) | $232.70 | $358 | 2.4× |
| Radex Sinuses Paransl < 3 Views (70210) | $81.90 | $126 | 0.8× |
| Radex sm int w/mlt srl imges via enteroclss tube (74251) | $627.90 | $966 | 3.2× |
| Radex Spine 1 View Specify Level (72020) | $219.70 | $338 | 2.3× |
| Radex Sternum Minimum 2 Views (71120) | $224.90 | $346 | 2.3× |
| Radex Temporomandble Jt Opn & Clsd Mouth Bilat (70330) | $276.90 | $426 | 2.9× |
| Radex Toe Minimum 2 Views (73660) | $157.30 | $242 | 1.6× |
| Radex upper extremity infant minimum 2 views (73092) | $218.40 | $336 | 1.9× |
| Radex Wrist Complete Minimum 3 Views (73110) | $219.70 | $338 | 2.3× |
| Radex X-Ray Exam Entire Spi 6/> Vw - Xr Entire Spine 6+ Vw (72084) | $1,011.40 | $1,556 | 8.7× |
| Radiation treatment delivery level 1 (77402) | $585 | $900 | 5.2× |
| Radiation treatment delivery level 2 (77407) | $1,755 | $2,700 | 4.1× |
| Radiation treatment delivery level 3 (77412) | $2,632.50 | $4,050 | 4.3× |
| Radiolog exam mandible compl minimum 4 views (70110) | $271.05 | $417 | 2.3× |
| Radiologic Exam Abdomen 3+ Views - Xr Abdomen 3+ Views (74021) | $419.90 | $646 | 3.6× |
| Radiologic exam colon double contrast study (74280) | $593.45 | $913 | 3.0× |
| Radiologic exam colon single contrast study (74270) | $467.35 | $719 | 2.4× |
| Radiologic exam knee complete 4/more views (73564) | $248.30 | $382 | 2.1× |
| Radiologic exam pelvis compl minimum 3 views (72190) | $282.10 | $434 | 2.4× |
| Radiologic Exam Small Int Single Contrast Study (74250) | $593.45 | $913 | 3.0× |
| Radiologic exam swallow function contrast study (74230) | $358.80 | $552 | 1.8× |
| Radiologic exam upr gi trc double contrast study (74246) range across 2 matching MRF lines |
$517.40–$578.50 | $796–$890 | varies |
| Radiologic examination femur 1 view (73551) | $192.40 | $296 | 2.0× |
| Radiologic examination femur minimum 2 views (73552) | $254.15 | $391 | 2.6× |
| Radiologic examination knee 1/2 views (73560) | $184.60 | $284 | 1.9× |
| Radiologic Examination Osseous Survey Limited (77074) | $516.10 | $794 | 4.4× |
| Radiologic examination tibia & fibula 2 views (73590) | $218.40 | $336 | 2.3× |
| Red Cell Volume Determination Spx Mult Samplings (78121) | $512.20 | $788 | 0.8× |
| Ribs bilateral 3 views (71110) | $248.30 | $382 | 2.1× |
| Rp loclzj tum plnr 1 area single day imaging (78800) range across 2 matching MRF lines |
$324.35–$698.75 | $499–$1,075 | varies |
| Rp loclzj tum plnr 2+area 1+d img/1 area img>2+d (78801) range across 2 matching MRF lines |
$410.80–$839.80 | $632–$1,292 | varies |
| Rp Loclzj Tum Plnr Whole Body 2+ Days Imaging (78804) | $897.65 | $1,381 | 1.5× |
| Rp Loclzj Tum Plnr Whole Body Single Day Imaging (78802) | $892.45 | $1,373 | 1.5× |
| Rp Loclzj Tum Spect 1 Area Single Day Imaging (78803) range across 7 matching MRF lines |
$892.45–$1,111.50 | $1,373–$1,710 | varies |
| Rp loclzj tum spect 2 area/sep acquisj img (78831) range across 2 matching MRF lines |
$934.70–$1,311.05 | $1,438–$2,017 | varies |
| Rp loclzj tum spect CT 2area 1d img/1 ar img>2+d (78832) | $984.75 | $1,515 | 0.6× |
| Rp loclzj tum spect w/CT 1 area/acquisj 1day img (78830) | $892.45 | $1,373 | 0.6× |
| Rp Therapy Intravenous Administration (79101) | $390.65 | $601 | 1.5× |
| Scapula (73010) | $196.30 | $302 | 1.7× |
| Screening Digital Breast Tomosynthesis Bi (77063) | $46.80 | $72 | 2.0× |
| Shoulder 1 view (73020) | $139.10 | $214 | 1.4× |
| Shoulder Arthrography (73040) | $707.20 | $1,088 | 1.8× |
| Skull less than 4 views (70250) | $218.40 | $336 | 1.9× |
| Special dosimetry (77331) | $612.30 | $942 | 4.1× |
| Special Physics Consult (77370) | $741.65 | $1,141 | 5.0× |
| Special teletherapy port plan (77321) | $670.15 | $1,031 | 1.6× |
| Special treatment procedure (77470) | $2,315.95 | $3,563 | 3.8× |
| Srs Multisource (77371) | $37,734.45 | $58,053 | 4.6× |
| Stereotactic Body Radiation Delivery (77373) | $7,809.75 | $12,015 | 3.9× |
| Sternoclavicular joints (71130) | $182.65 | $281 | 1.9× |
| Surface Applic Low Dose Rate Radionuclide Source (77789) | $192.40 | $296 | 1.7× |
| Tbs technical calculation only (77091) | $118.30 | $182 | 1.2× |
| Telethx isodose pln cplx w/basic dosimetry (77307) | $1,915.55 | $2,947 | 4.6× |
| Telethx isodose pln smpl w/dosimetry calculation (77306) | $1,725.10 | $2,654 | 4.1× |
| Ther Rad Simulaj-Aided Field Setting Complex (77290) | $991.90 | $1,526 | 2.4× |
| Ther Rad Simulaj-Aided Field Setting Intermed (77285) | $793 | $1,220 | 1.9× |
| Ther rad simulaj-aided field setting simple (77280) | $594.10 | $914 | 4.0× |
| Therapeutic Enema Rdctj Intussusception/Obstrcj (74283) | $626.60 | $964 | 3.2× |
| Thoracic spine 2 views (72070) | $219.70 | $338 | 1.9× |
| Thoracic spine 3 views (72072) | $294.45 | $453 | 2.5× |
| Thoracolumbar 2 views (72080) | $267.80 | $412 | 2.8× |
| Thyroid Imaging With Vascular Flow (78013) | $628.55 | $967 | 1.4× |
| Thyroid Met Imaging Body (78018) | $920.40 | $1,416 | 1.5× |
| Thyroid Uptake Measurement (78012) | $351 | $540 | 0.8× |
| Thyroid Uptake W/Blood Flow Sngle/Mult Quan Meas (78014) | $551.20 | $848 | 1.2× |
| Tx Devices Design & Construction Complex (77334) | $833.95 | $1,283 | 2.0× |
| Tx devices design & construction intermediate (77333) | $703.95 | $1,083 | 4.7× |
| Tx devices design & construction simple (77332) | $531.70 | $818 | 3.6× |
| Ultrasound Breast Limited (76642) range across 2 matching MRF lines |
$318.50–$477.75 | $490–$735 | varies |
| Ultrasound elastography first target lesion (76982) | $299.65 | $461 | 2.6× |
| Ultrasound Elastography Parenchyma (76981) | $299.65 | $461 | 2.6× |
| Ultrasound Exam Aaa Screen (76706) | $303.55 | $467 | 2.6× |
| Ultrasound, abdomen limited (76705) | $314.60 | $484 | 2.7× |
| Umbilical-artery Doppler (OB) (76820) | $349.05 | $537 | 3.0× |
| Unlisted Dx Radiographic Procedure (76499) | $848.25 | $1,305 | 8.8× |
| Unlisted magnetic resonance procedure (76498) | $343.85 | $529 | 3.6× |
| Unlisted Procedure Clinical Brachytherapy (77799) | $1,222 | $1,880 | 10.8× |
| Unlisted us procedure (76999) | $157.95 | $243 | 1.6× |
| Upper gi w/o kub (74240) | $517.40 | $796 | 2.7× |
| Urea Breath Test C-14 Isotopic Acquisj Analysis (78267) range across 2 matching MRF lines |
$115.05–$117 | $177–$180 | varies |
| Urea breath test c-14 isotopic analysis (78268) range across 2 matching MRF lines |
$252.20–$270.40 | $388–$416 | varies |
| Urethrocystogram voiding (74455) | $394.55 | $607 | 1.5× |
| Urethrocystography retrograde (74450) | $369.20 | $568 | 1.4× |
| Us breast unilateral complete (76641) range across 2 matching MRF lines |
$318.50–$477.75 | $490–$735 | varies |
| Us chest (76604) | $389.35 | $599 | 3.4× |
| Us complete joint (76881) | $556.40 | $856 | 4.8× |
| Us exam, pelvic, limited (76857) | $263.25 | $405 | 2.3× |
| Us head (76506) | $401.05 | $617 | 3.5× |
| Us kidney transplant (76776) | $417.95 | $643 | 3.6× |
| Us lmtd joint/oth nonvasc xtr strux r-t w/img (76882) | $421.85 | $649 | 3.6× |
| Us ob detailed single fetus (76811) | $537.55 | $827 | 2.0× |
| Us ob limited 1 or more fetuses (76815) range across 4 matching MRF lines |
$313.95–$354.90 | $483–$546 | varies |
| Us ob transvaginal (76817) | $215.80 | $332 | 1.9× |
| Us pelvic non ob complete (76856) | $496.60 | $764 | 4.3× |
| Us pg uter img f&mat 14 wk tabdl 1/1st gestation (76801) | $445.25 | $685 | 3.8× |
| Us preg uterus real time f/u trnsabdl per fetus (76816) range across 2 matching MRF lines |
$157.95–$280.15 | $243–$431 | varies |
| Us retroperitoneal complete (76770) | $382.20 | $588 | 3.3× |
| Us retroperitoneal limited (76775) | $339.95 | $523 | 2.9× |
| Us scrotum and contents (76870) | $421.85 | $649 | 3.6× |
| Us spinal canal and contents (76800) | $445.25 | $685 | 3.8× |
| Us thyroid (76536) | $421.85 | $649 | 3.6× |
| Us transrectal (76872) | $521.30 | $802 | 4.5× |
| Vein X-Ray Chest (75827) | $3,511.95 | $5,403 | 2.0× |
| Vein X-Ray Liver W/O Hemodyn (75887) | $3,317.60 | $5,104 | 0.9× |
| Venogram Sinus/Jugular (75860) | $4,262.05 | $6,557 | 1.2× |
| Venography caval inferior serialography rs&i (75825) | $4,262.05 | $6,557 | 1.2× |
| Venography extremity bilateral rs&i (75822) | $1,629.55 | $2,507 | 0.9× |
| Venography extremity unilateral rs&i (75820) | $1,629.55 | $2,507 | 0.9× |
| Venography Renal Bilateral (75833) | $6,392.10 | $9,834 | 1.8× |
| Venography Renal Unilateral (75831) | $4,262.05 | $6,557 | 1.2× |
| Venous sampling by catheter (75893) | $5,528.25 | $8,505 | 0.9× |
| Wrist 2 views (73100) range across 3 matching MRF lines |
$120.90–$172.90 | $186–$266 | varies |
| X-Ray Ac Jts - Xr Acromioclavicular Joints Bilateral (73050) | $263.25 | $405 | 2.7× |
| X-ray antegrade pyelogram tube (74425) range across 2 matching MRF lines |
$434.20–$474.50 | $668–$730 | varies |
| X-Ray Aorta Leg Arteries (75630) | $6,253 | $9,620 | 1.8× |
| X-Ray Bend Only L-S Spine (72120) | $280.80 | $432 | 2.4× |
| X-Ray Elbow 2 Vw - Xr Elbow 1-2 Views Right (73070) | $168.35 | $259 | 1.7× |
| X-Ray Exam Breast Specimen (76098) | $437.45 | $673 | 0.7× |
| X-Ray Exam Entire Spi 1 Vw (72081) | $219.70 | $338 | 2.3× |
| X-Ray Exam Entire Spi 2/3 Vw (72082) | $384.15 | $591 | 3.3× |
| X-Ray Exam Entire Spi 4/5 Vw (72083) | $674.05 | $1,037 | 5.8× |
| X-Ray Exam Hip Uni 1 View (73501) | $165.10 | $254 | 1.7× |
| X-Ray Exam Hip Uni 2-3 Views (73502) range across 2 matching MRF lines |
$402.35–$721.50 | $619–$1,110 | varies |
| X-Ray Exam Hip Uni 4/> Views (73503) | $941.85 | $1,449 | 8.1× |
| X-Ray Exam Hips Bi 2 Views (73521) | $463.45 | $713 | 4.0× |
| X-Ray Exam Hips Bi 3-4 Views (73522) | $808.60 | $1,244 | 7.0× |
| X-Ray Exam Hips Bi 5/> Views (73523) | $1,416.35 | $2,179 | 12.2× |
| X-Ray Exam L-S Spine Bending (72114) | $312.65 | $481 | 2.7× |
| X-Ray Exam Neck Spine 2-3 Vw (72040) | $243.10 | $374 | 2.5× |
| X-Ray Exam Neck Spine 6/>Vws (72052) | $365.30 | $562 | 3.1× |
| X-Ray Exam Unilat Ribs/Chest (71101) | $242.45 | $373 | 2.1× |
| X-ray eye for foreign body (70030) | $179.40 | $276 | 1.9× |
| X-ray humerus (73060) | $208.65 | $321 | 2.2× |
| X-ray IV pyelogram (ivp) (74400) | $531.70 | $818 | 2.7× |
| X-Ray Jaw <4 Vw - Xr Mandible < 4 Views (70100) | $172.90 | $266 | 1.8× |
| X-Ray Knee Bilat Standing - Xr Knees Anteroposterior Standing Bilat (73565) | $184.60 | $284 | 1.9× |
| X-Ray Lumbar Spine 2/3 Vw - Xr Lumbar Spine 2-3 Views (72100) | $267.80 | $412 | 2.3× |
| X-ray nose-rectum child f.b. (76010) | $217.10 | $334 | 2.2× |
| X-Ray Ribs, Chest 4+ Vw - Xr Ribs 3 Vws Bil W/ Chest Posteroanterior (71111) | $390 | $600 | 3.4× |
| X-Ray Sacroiliac Jts 3+ Vw - Xr Sacroiliac Joints 3+ Views (72202) | $289.90 | $446 | 2.5× |
| X-Ray Sacroiliac Jts <3 Vw - Xr Sacroiliac Joints 1-2 Views (72200) | $214.50 | $330 | 1.8× |
| X-Ray Sacrum/Coccyx 2+ Vw - Xr Sacrum Coccyx 2+ Views (72220) | $224.90 | $346 | 2.3× |
| X-Ray Sinuses 3+ Vw - Xr Paranasal Sinuses 3+ Views (70220) | $234.65 | $361 | 2.4× |
| X-Ray Skull 4+ Vw - Xr Skull Complete 4+ Views (70260) | $280.80 | $432 | 2.4× |
| X-Ray Stress View (77071) | $121.55 | $187 | 1.3× |
| X-ray thoracic spine 4 vw (72074) | $323.05 | $497 | 2.8× |
| X-Ray Tmj Unilat (70328) | $230.75 | $355 | 2.4× |
| X-Ray Urinary Tract Exam With Contrast Material (74420) | $560.30 | $862 | 1.4× |
| X-Rays Bone Length Studies (77073) | $132.60 | $204 | 1.1× |
| X-Rays Bone Survey Complete (77075) | $516.10 | $794 | 4.4× |
| Xr c-spine 4 or 5 views (72050) | $304.20 | $468 | 2.6× |
| Xr facial bones less than 3 views (70140) | $220.35 | $339 | 2.3× |
| Xr orbits complete 4 views (70200) | $206.05 | $317 | 1.8× |
| Xr Tomogram Single Plane (76100) | $509.60 | $784 | 4.4× |
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.