Imaging prices at Loyola Gottlieb Memorial Hospital

Melrose Park, IL · every code in this section with a posted price and a Medicare benchmark.

466 codes. Prices are the hospital's own posted facility charges.

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ProcedurePosted cashPosted gross× Medicare
3-D radiotherapy plan dose-volume histograms (77295) $1,803.67 $9,493 1.2×
Abdomen 1 View (74018) $106.97 $563 1.1×
Abdomen 2 views (74019) $127.87 $673 1.1×
Acute Gastrointestinal Blood Loss Imaging (78278) $421.61 $2,219 1.0×
Acute venous thrombosis imaging, peptide Non-Facility (78456) $311.60 $1,640 0.2×
Adrenal Cortex & Medulla Img (78075) $498.18 $2,622 0.4×
Angio internal mammary (75756) $1,217.14 $6,406 0.4×
Angio pulmonary bilat (75743) $1,266.16 $6,664 0.4×
Angiography Adrenal Bilateral Slctv Rs&I (75733) $1,332.47 $7,013 0.4×
Angiography extremity bilateral rs&i (75716) $1,289.15 $6,785 0.4×
Angiography extremity unilateral rs&i (75710) $1,002.06 $5,274 0.3×
Angiography pulmonary unilateral slctv rs&i (75741) $844.17 $4,443 0.2×
Angrph pulmonary nonslctv cath/ven njx rs&i (75746) $663.10 $3,490 0.2×
Ankle 2 views (73600)
range across 7 matching MRF lines
$98.80–$148.20 $520–$780 varies
Aortography thoracic serialography rs&i (75605)
unusually low: confirm this is the full procedure
$2,100.07 $11,053 0.4×
Aortography thoracic w/o serialography rs&i (75600) $1,177.43 $6,197 0.3×
Artery X-Rays Abdomen (75726)
likely a partial charge, not the full procedure
$1,146.84 $6,036 0.2×
Artery X-Rays Adrenal Gland (75731) $888.25 $4,675 0.3×
Artery X-Rays Pelvis (75736)
unusually low: confirm this is the full procedure
$2,100.07 $11,053 0.4×
Artery X-Rays Spine (75705)
unusually low: confirm this is the full procedure
$2,100.07 $11,053 0.4×
Arthrogram ankle (73615)
range across 3 matching MRF lines
$123.50–$185.25 $650–$975 varies
Arthrogram hip (73525)
range across 3 matching MRF lines
$148.01–$221.92 $779–$1,168 varies
Arthrogram Wrist (73115)
range across 3 matching MRF lines
$186.96–$280.63 $984–$1,477 varies
Basic radiation dosimetry calculation (77300) $176.70 $930 1.2×
Bone age studies (77072) $76.76 $404 0.7×
Bone Imaging 3 Phase (78315) $572.09 $3,011 1.3×
Bone Imaging Limited Area (78300) $300.58 $1,582 0.7×
Bone Imaging Multiple Areas (78305) $345.61 $1,819 0.8×
Bone Imaging Whole Body (78306) $521.36 $2,744 1.2×
Bone marrow imaging limited area (78102) $195.51 $1,029 0.5×
Bone marrow imaging; whole body (78104) $244.34 $1,286 0.6×
Bone survey infant (77076) $68.78 $362 0.6×
Brachytx isodose complex (77318) $448.59 $2,361 1.1×
Brachytx isodose intermed (77317) $397.86 $2,094 1.0×
Brachytx Isodose Plan Simple (77316) $255.17 $1,343 0.6×
Brain Flow Imaging Only (78610) $346.37 $1,823 0.6×
Brain Imaging Min 4 Static Views W Vascular Flow (78606) $555.56 $2,924 1.0×
Brain Imaging Minimum 4 Static Views (78605) $311.60 $1,640 0.5×
Brain Imaging Pet Metabolic Evaluation (78608) $1,679.79 $8,841 1.1×
Cardiac MRI w/w/o contrast & further seq (75561) $913.52 $4,808 2.4×
Cardiac MRI w/w/o contrast w/stress (75563) $961.02 $5,058 1.1×
Cardiac Shunt Detection (78428) $154.28 $812 0.4×
Cat Scan Follow-Up Study (76380) $295.83 $1,557 3.2×
Cerebrospinal Fluid Flow W/O Matl Shunt Evaltj (78645) $325.66 $1,714 0.6×
Cerebrospinal Fluid Scan (78630) $481.08 $2,532 0.8×
Chest 1 view (71045) $97.09 $511 1.0×
Chest 2 views (71046) $106.97 $563 1.1×
Chest 3 views (71047) $111.72 $588 1.2×
Chest 4 or more views (71048) $129.39 $681 1.2×
Cineradiograpy/vidradiograpy xcpt where spec (76120) $80.18 $422 0.7×
Cisternography Positive Contrast Rs&I (70015) $271.89 $1,431 0.3×
Clavicle complete (73000)
range across 3 matching MRF lines
$112.48–$168.72 $592–$888 varies
Computed Tomography Thorax Lw Dose Lng Ca Scr C- (71271) $73.34 $386 0.7×
Continuing medical physics consltj pr wk (77336) $189.62 $998 1.3×
Contrast Exam Abdominl Aorta (75625) $837.90 $4,410 0.2×
Contrast X-Ray Bladder (74430) $205.77 $1,083 0.6×
Contrast X-Ray Of Elbow (73085)
range across 3 matching MRF lines
$123.50–$185.25 $650–$975 varies
Contrast X-Ray Of Knee Joint (73580)
range across 3 matching MRF lines
$144.97–$217.36 $763–$1,144 varies
Corpora cavernosography (74445) $97.66 $514 0.9×
CT abdomen and pelvis without and with contrast (74178) $1,274.33 $6,707 3.4×
CT abdomen and pelvis without contrast (74176) $879.51 $4,629 3.4×
CT abdomen w contrast (74160) $593.18 $3,122 3.2×
CT abdomen w wo contrast (74170) $699.20 $3,680 3.7×
CT abdomen w/o contrast (74150) $483.17 $2,543 4.3×
CT Angio Abdomen and Pelvis (74174) $769.31 $4,049 2.1×
CT Angio Chest (71275) $610.85 $3,215 3.2×
CT Angio Head (70496) $579.88 $3,052 3.1×
CT angio hrt w/3d image (75574) $964.25 $5,075 2.6×
Ct Angio Lwr Extr W/O&W/Dye (73706)
range across 2 matching MRF lines
$372.40–$558.60 $1,960–$2,940 varies
CT Angio Neck (70498) $575.32 $3,028 3.1×
Ct Angio Upr Extrm W/O&W/Dye (73206) $584.25 $3,075 3.1×
CT cervical spine w/ contrast (72126) $573.42 $3,018 1.5×
CT cervical spine w/o contrast (72125) $507.49 $2,671 4.5×
CT cervical spine w/wo cont (72127) $630.80 $3,320 3.4×
CT chest w contrast (71260) $582.92 $3,068 3.1×
CT chest w/wo contrast (71270) $643.34 $3,386 3.4×
CT colonography screening (74263) $382.47 $2,013 1.5×
CT Colonogrphy Dx Image Postprocess W/Contrast (74262) $365.75 $1,925 1.9×
CT colonogrphy dx image postprocess w/o contrast (74261) $400.14 $2,106 3.6×
CT head/brain with contrast (70460) $509.77 $2,683 2.7×
CT head/brain without and with contrast (70470) $671.08 $3,532 3.6×
CT heart contrast eval cardiac structure&morph (75572) $720.48 $3,792 1.9×
CT heart no contrast quant eval coronry calcium (75571)
range across 2 matching MRF lines
$48.94–$99.18 $257.58–$522 varies
CT hrt w/3d image congen (75573) $720.48 $3,792 1.9×
CT iac w contrast (70481) $549.29 $2,891 2.9×
CT l-spine w&w/o contrast (72133) $628.33 $3,307 3.3×
CT lower ext w/o (73700)
range across 4 matching MRF lines
$419.71–$629.66 $2,209–$3,314 varies
CT lower extremity w/contrast material (73701)
range across 3 matching MRF lines
$469.30–$703.95 $2,470–$3,705 varies
CT lumbar spine w contrast (72132) $614.46 $3,234 1.6×
CT lumbar spine w/o contrast (72131) $529.15 $2,785 4.7×
CT maxillofacial w contrast (70487) $524.97 $2,763 2.8×
CT maxillofacial wo contrast (70486)
range across 7 matching MRF lines
$417.24–$439.28 $2,196–$2,312 varies
CT neck tissue combo (70492) $592.80 $3,120 3.2×
Ct Orbit/Ear/Fossa W/O&W/Dye (70482) $594.51 $3,129 3.2×
CT orbits w/o contrast (70480) $409.45 $2,155 3.7×
CT pelvis w&w/o contrast (72194) $704.90 $3,710 3.8×
CT pelvis w/o contrast (72192) $455.05 $2,395 4.1×
CT scan of leg combo (73702)
range across 3 matching MRF lines
$523.83–$785.84 $2,757–$4,136 varies
CT scans face/jaw combo (70488) $666.90 $3,510 3.5×
CT soft tissue neck w contrast (70491) $572.09 $3,011 3.0×
CT soft tissue neck w/o contrast (70490) $485.64 $2,556 4.3×
CT thoracic spine w contrast (72129) $542.07 $2,853 2.9×
CT thoracic spine w/o contrast (72128) $493.81 $2,599 4.4×
CT thoracic spine w/wo cont (72130) $630.61 $3,319 3.4×
CT thorax w/o contrast (71250) $462.65 $2,435 4.1×
CT upper ext wo (73200)
range across 3 matching MRF lines
$466.45–$699.77 $2,455–$3,683 varies
CT upper extremity w/o & w/contrast material (73202)
range across 3 matching MRF lines
$534.47–$801.61 $2,813–$4,219 varies
CT upper extremity with contrast (73201)
range across 3 matching MRF lines
$507.11–$760.76 $2,669–$4,004 varies
Cta Abdl Aorta&Bi Iliofem W/Contrast&Postp (75635) $568.10 $2,990 3.0×
Cta Abdomen (74175) $464.36 $2,444 2.5×
CTA pelvis (72191) $494.19 $2,601 2.6×
Dacryocystography, nasolacrimal duct, radiological supervision and interpretation Non-Facility (70170) $114.95 $605 0.4×
Determination of central c-v hemodynamics (non-imaging) (eg, ejection fraction with probe technique) with or without… (78414) $311.60 $1,640 0.5×
Dilation ureters/urethra rs&i (74485) $757.91 $3,989 0.3×
Discography Cerv/Thor Spine (72285) $493.81 $2,599 0.2×
Diskography lumbar (72295) $406.03 $2,137 0.2×
Doppler Echo Fetal Puls Spectral F/U/Repeat (76828) $137.75 $725 1.2×
Doppler Echo Fetal Spectral Display Complete (76827) $190.95 $1,005 1.7×
Doppler Fetal Mid Cerebral Artery (76821) $94.24 $496 0.8×
Dxa Bone Density Axial (77080) $150.86 $794 1.3×
Dxa bone density study (77085) $65.93 $347 0.6×
Dxa bone density study 1/>sites appendiclr skel (77081) $69.35 $365 0.7×
Echo exam of fetal heart (76825) $267.71 $1,409 0.5×
Echo exam uterus (76831) $252.51 $1,329 1.0×
Echo Guide For Artery Repair (76936) $350.17 $1,843 1.5×
Echocardiography, fetal, cardiovascular system, real time with image documentation (2D), with or without M-mode… (76826) $190.95 $1,005 0.7×
Echograp Trans R Pros Study (76873) $193.61 $1,019 1.7×
Esophagram (74220) $158.46 $834 0.8×
Fetal Biophys Profile W/Nst (76818) $193.80 $1,020 1.7×
Fetal Biophysical Profile W/O Non-Stress Testing (76819) $151.81 $799 1.4×
Fetal MRI w/placntl matrnl plvc img sing/1st ges (74712) $119.13 $627 0.5×
Fluoroscopy up to 1 hr (76000) $199.12 $1,048 0.8×
Follow-Up Angiography (75898) $1,217.14 $6,406 0.4×
Foot 2 views (73620)
range across 13 matching MRF lines
$83.22–$124.83 $438–$657 varies
Forearm 2 views (73090)
range across 3 matching MRF lines
$118.18–$177.27 $622–$933 varies
Gastric emptying imaging study (78264) $582.73 $3,067 1.4×
Gastric Emptyng Imag Std W/Sm Bwl Transit (78265) $198.93 $1,047 0.5×
Gastroesophageal Reflux Exam (78262) $311.60 $1,640 0.7×
Gated Heart Planar Single (78472) $550.62 $2,898 1.3×
Gated Heart, Multiple (78473) $598.12 $3,148 1.4×
GI Endoscopic US S&I (76975) $268.09 $1,411 1.0×
Gstrc Emptng Imag Std W/Sm Bwl Col Trnst Mlt Day (78266) $263.91 $1,389 0.5×
Hand 2 views (73120)
range across 3 matching MRF lines
$93.67–$140.60 $493–$740 varies
Hdr Rdncl Ntrstl/Icav Brchtx (77772) $1,110.93 $5,847 1.5×
Hdr Rdncl Ntrstl/Icav Brchtx (77771) $989.71 $5,209 1.3×
Hdr Rdncl Ntrstl/Icav Brchtx 1 Channel (77770) $989.71 $5,209 1.3×
Heart Image (Pet) Multiple (78492) $879.70 $4,630 0.6×
Hepatc Vngrph Wdg/Fr Hemodyn Eval Rs&I (75889) $770.64 $4,056 0.2×
Hepatc Vngrph Wdg/Fr W/O Hemodyn Eval Rs&I (75891) $756.01 $3,979 0.2×
Hepatobil Syst Image W/Drug (78227) $444.98 $2,342 0.8×
Hepatobiliary System Imaging (78226) $402.99 $2,121 0.9×
Ht Musc Image Planar Mult (78454) $929.48 $4,892 0.7×
Ht Muscle Image Spect Sing (78451) $757.91 $3,989 0.5×
Hyperthermia external generated superficial (77600) $285 $1,500 0.7×
Hysterosalpingogram (74740) $245.29 $1,291 1.0×
Infant hip ultrasound with hip movement (dynamic) (76885) $124.07 $653 1.3×
Infant hip ultrasound, limited static exam (76886) $114.95 $605 1.2×
Interstitial radiation source applic complex (77778) $1,128.41 $5,939 1.5×
Intracavitary Radiation Source Applic Complex (77763) $1,047.09 $5,511 1.4×
Intracavitary Radiation Source Applic Intermed (77762) $403.37 $2,123 0.7×
Intracavitary radiation source applic simple (77761) $251.94 $1,326 0.4×
Intraop radiaj tx deliver electrons sngl tx sess (77425)
likely a partial charge, not the full procedure
$2,147 $11,300 0.3×
Intraop radiaj tx deliver xray single tx session (77424)
likely a partial charge, not the full procedure
$2,147 $11,300 0.3×
Joint Survey Single View (77077) $62.70 $330 0.6×
K Flow/Funct Image Multiple (78709) $676.78 $3,562 1.2×
K Flow/Funct Image W/Drug (78708) $451.25 $2,375 0.8×
K Flow/Funct Image W/O Drug (78707) $431.30 $2,270 0.7×
Kidney Funcj Study Non-Img Radioisotopic Study (78725) $264.67 $1,393 0.6×
Kidney Imaging Morphoogy W/Vascular Flow (78701) $308.94 $1,626 0.7×
Knee 3 Views (73562)
range across 10 matching MRF lines
$102.98–$154.47 $542–$813 varies
Leveen/Shunt Patency Exam (78291) $358.15 $1,885 0.8×
Liver & Spleen Imaging Static Only (78215) $154.28 $812 0.4×
Liver imaging w/vascular flow (78202) $311.60 $1,640 0.5×
Lung Perf&Ventilat Diferentl (78598) $414.39 $2,181 0.7×
Lung perfusion differential (78597) $299.82 $1,578 0.7×
Lung Ventilat&Perfus Imaging (78582) $434.53 $2,287 0.7×
Lung Ventilation Imaging (78579) $264.67 $1,393 0.6×
Lymph System Imaging (78195) $494.19 $2,601 0.8×
Lymphangiography Extremity Only Bilateral Rs&I (75803) $355.49 $1,871 0.2×
Lymphangiography extremity only unilateral rs&i (75801) $236.93 $1,247 0.4×
Lymphangiography Pelvic/Abdominal Bilateral Rs&I (75807) $1,217.14 $6,406 0.4×
Lymphangiography, pelvic/abdominal, unilateral (75805) $1,217.14 $6,406 0.4×
Magnetic Image Jaw Joint (70336) $716.30 $3,770 2.8×
Magnetic Resonance Elastography (76391) $75.43 $397 0.3×
Mammary ductogram or galactogram multiple (77054) $182.97 $963 0.7×
Mammary ductogram or galactogram single (77053) $111.53 $587 0.4×
Meckels Divert Exam (78290) $360.62 $1,898 0.8×
Mlc imrt design & construction per imrt plan (77338) $318.63 $1,677 0.8×
Mr safety determination physician/other qhp (76016) $33.63 $177 0.4×
Mr safety implant&/fb assmt clin staf 1st 15 min (76014) $14.06 $74 0.5×
Mr safety implt pos&/immoblj (76019) $22.61 $119 0.4×
Mr safety med physics xm customization plng&mntr (76017) $91.96 $484 0.4×
Mra Head W/O & W/Contrast Material (70546) $855.38 $4,502 2.3×
MRA head w/o contrast (70544) $655.50 $3,450 2.6×
MRA head with contrast (70545) $710.03 $3,737 1.9×
MRA neck w contrast (70548) $621.68 $3,272 1.7×
Mra Neck W/O &W/Contrast Material (70549) $828.02 $4,358 2.2×
MRA neck w/o contrast (70547) $578.17 $3,043 2.3×
MRI abdomen w contrast (74182) $802.18 $4,222 2.1×
MRI abdomen w/o contrast (74181) $739.67 $3,893 2.9×
MRI any jt lower extrem w/contrast material (73722)
range across 3 matching MRF lines
$867.54–$1,301.31 $4,566–$6,849 varies
MRI any jt lower extrem w/o & w/contrast matrl (73723)
range across 3 matching MRF lines
$955.89–$1,433.93 $5,031–$7,547 varies
MRI any jt upper extremity w/contrast matrl (73222)
range across 3 matching MRF lines
$1,039.11–$1,558.76 $5,469–$8,204 varies
MRI bone marrow blood supply (77084) $494.38 $2,602 1.9×
MRI brain functional w/o physician admnistration (70554) $658.54 $3,466 2.6×
MRI brain functional w/physician admnistration (70555) $724.28 $3,812 2.8×
MRI Breast W/O Contrast Bilateral (77047) $831.06 $4,374 3.3×
MRI Breast Without Contrast Material Unilateral (77046) $559.55 $2,945 2.2×
MRI cardiac w/o cont stress (75559) $892.24 $4,696 1.5×
MRI cardiac w/o contrast (75557) $888.06 $4,674 3.5×
MRI cervical spine w contrast (72142) $898.51 $4,729 2.4×
MRI cervical spine w/o cont (72141) $754.49 $3,971 3.0×
MRI chest w/o contrast (71550) $592.61 $3,119 2.3×
MRI chest with contrast (71551) $705.85 $3,715 0.8×
MRI chest wo w contrast (71552) $825.55 $4,345 2.2×
MRI lower extrem oth/thn jt w/contrast matrl (73719)
range across 4 matching MRF lines
$766.27–$1,149.50 $4,033–$6,050 varies
MRI lower extrem oth/thn jt w/o & w/contr matr (73720)
range across 3 matching MRF lines
$842.08–$1,263.12 $4,432–$6,648 varies
MRI lower extrem oth/thn jt w/o contr matrl (73718)
range across 3 matching MRF lines
$715.73–$1,073.69 $3,767–$5,651 varies
MRI lumbar spine w contrast (72149) $931.57 $4,903 2.5×
Mri Neck Spine W/O & W/Dye (72156) $993.89 $5,231 2.7×
MRI orbit face &/neck w/o contrast (70540) $615.79 $3,241 2.4×
MRI orbit face neck w contrast (70542) $679.82 $3,578 1.8×
Mri Orbt/Fac/Nck W/O &W/Dye (70543) $932.33 $4,907 2.5×
MRI pelvis w contrast (72196) $784.51 $4,129 2.1×
MRI pelvis w/o & w contrast (72197) $1,032.46 $5,434 2.8×
MRI pelvis w/o contrast (72195) $707.18 $3,722 2.8×
MRI spectroscopy (76390) $395.58 $2,082 4.2×
MRI thoracic spine w/o contrast (72146) $744.04 $3,916 2.9×
MRI upper extremity oth than jt w/contr matrl (73219)
range across 3 matching MRF lines
$775.20–$1,162.99 $4,080–$6,121 varies
MRI upper extremity oth than jt w/o contr matrl (73218)
range across 4 matching MRF lines
$694.26–$1,041.39 $3,654–$5,481 varies
Mri Uppr Extremity W/O&W/Dye (73220)
range across 3 matching MRF lines
$849.11–$1,273.76 $4,469–$6,704 varies
MRI, abdomen, combo (74183) $1,048.23 $5,517 2.8×
MRI, dorsal spine combo (72157) $1,011.56 $5,324 2.7×
MRI, dorsal spine contrast (72147) $902.12 $4,748 2.4×
MRI, joint upper extrem (73221)
range across 3 matching MRF lines
$781.47–$1,172.30 $4,113–$6,170 varies
MRI, joint upper extrem combo (73223)
range across 3 matching MRF lines
$1,068.18–$1,602.27 $5,622–$8,433 varies
MRI, lumbar spine combo (72158) $1,002.06 $5,274 2.7×
Myelogram cervical (72240) $390.07 $2,053 0.5×
Myelogram Lumbar (72265) $343.52 $1,808 0.4×
Myelography thoracic (72255) $359.67 $1,893 0.4×
Myelograpy 2/more regions rs&i (72270) $456.38 $2,402 0.5×
Myocardial Imaging Infarct Avid Planar Qual/Quan (78466) $311.60 $1,640 0.7×
Myocardial Imaging Pet Metabolic Evaluation (78459) $991.80 $5,220 0.7×
Myocardial Perfusion Planar 1 Study Rest/Stress (78453) $639.54 $3,366 0.5×
Myocardial Spect Multiple Studies (78452) $1,263.31 $6,649 0.9×
Myocrd Img Pet Metab Eval Single Study Cncrnt CT (78429) $613.32 $3,228 0.4×
Myocrd Img Pet Prfuj W/Metab Dual Radiotracer (78432) $3,462.75 $18,225 2.1×
N-invas est c ffr sw aly CTA (75580) $523.07 $2,753 0.6×
Neck soft tissue (70360) $111.91 $589 1.2×
Nfs/Instlj Radioelmnt Sln 3 Mo Follow-Up Care (77750) $290.32 $1,528 0.7×
Njx Rp Loclzj Non-Img Probe Study Intravenous (78808) $114.57 $603 0.3×
Nm csf leak detection (78650) $311.60 $1,640 0.2×
Nm myocard infarct spect (78469) $493.05 $2,595 0.8×
Nm red cell survival study (78130) $311.60 $1,640 0.7×
Nm whole blood volume (78122) $311.60 $1,640 0.5×
Ntsty modul radthx pln dose-vol histos (77301) $1,724.82 $9,078 1.2×
Nuclear Rx Intra-Arterial (79445) $314.45 $1,655 1.3×
Nuclear Rx Oral Admin (79005) $314.45 $1,655 1.3×
Ob us nuchal meas 1 gest (76813) $114.95 $605 1.0×
Oph bmtry us echograpy a-scan io lens pwr cal (76519) $141.93 $747 1.3×
Oph US Dx B-Scan&Quan a-Scan Sm Pt Enctr (76510) $154.28 $812 1.1×
Ophthalmic Biometry US Echograpy a-Scan (76516) $132.05 $695 1.2×
Ophthalmic ultrasound dx b-scan w/wo a-scan (76512)
range across 3 matching MRF lines
$116.66–$174.99 $614–$921 varies
Ophthalmic US Dx Corneal Pachymetry Uni/Bi (76514) $12.35 $65 0.4×
Ophthalmic us dx quantitative a-scan only (76511) $113.24 $596 1.0×
Panoramic X-ray of jaws (70355) $104.31 $549 1.1×
Parathyroid imaging w/tomographic spect & CT (78072) $807.69 $4,251 1.4×
Parathyroid Planar Imaging (78070) $418.76 $2,204 1.0×
Parathyroid planar imaging w/wo subtraction (78071) $466.26 $2,454 1.1×
Pelvis 1 or 2 views (72170) $114.57 $603 1.0×
Perineogram (74775) $157.32 $828 0.6×
Peritoneogram Rs&I (74190) $302.48 $1,592 0.5×
Pet Image W/Ct Lmtd (78814) $1,480.67 $7,793 1.0×
PET image w/CT, full body (78816) $2,099.12 $11,048 1.4×
PET imaging CT attenuation skull base mid-thigh (78815) $2,205.90 $11,610 1.4×
Pet Imaging Limited Area Chest Head/Neck (78811)
range across 2 matching MRF lines
$1,557.62–$1,713.80 $8,198–$9,020 varies
Pet Myocardial Sngl Study (78491) $677.92 $3,568 0.4×
Plasma volume, radiopharmaceutical volume-dilution technique (separate procedure); single sampling Non-Facility (78110) $311.60 $1,640 0.2×
Prq Transhepatc Portograpy Hemodyn Eval Rs&I (75885) $913.52 $4,808 0.3×
Pulmonary Perfusion Imaging Particulate (78580) $274.17 $1,443 0.6×
Radex Abd Compl Aqt Abd W/S/E/D Views 1 View Ch (74022) $171.95 $905 1.5×
Radex abscess/fistula/sinus tract rs&i (76080) $245.10 $1,290 0.4×
Radex Ankle Complete Minimum 3 Views (73610)
range across 16 matching MRF lines
$110.58–$165.87 $582–$873 varies
Radex Calcaneus Minimum 2 Views (73650)
range across 7 matching MRF lines
$109.06–$163.78 $574–$862 varies
Radex elbow complete minimum 3 views (73080)
range across 10 matching MRF lines
$118.18–$177.27 $622–$933 varies
Radex Facial Bones Complete Minimum 3 Views (70150) $127.49 $671 1.1×
Radex fingr minimum 2 views (73140)
range across 19 matching MRF lines
$68.02–$102.03 $358–$537 varies
Radex foot complete minimum 3 views (73630)
range across 13 matching MRF lines
$122.93–$184.49 $647–$971 varies
Radex Hand Minimum 3 Views (73130)
range across 3 matching MRF lines
$109.06–$163.59 $574–$861 varies
Radex lower extremity infant minimum 2 views (73592)
range across 3 matching MRF lines
$117.04–$175.75 $616–$925 varies
Radex Mastoids Compl Minimum 3 Views PR Side (70130) $113.81 $599 1.0×
Radex Nasal Bones Complete Minimum 3 Views (70160) $121.60 $640 1.3×
Radex Ribs Unilateral 2 Views (71100) $116.28 $612 1.2×
Radex shoulder complete minimum 2 views (73030)
range across 13 matching MRF lines
$139.27–$209.19 $733–$1,101 varies
Radex Sinuses Paransl < 3 Views (70210) $86.45 $455 0.9×
Radex sm int w/mlt srl imges via enteroclss tube (74251) $115.71 $609 0.6×
Radex Spine 1 View Specify Level (72020) $102.98 $542 1.1×
Radex Sternum Minimum 2 Views (71120) $93.29 $491 1.0×
Radex Temporomandble Jt Opn & Clsd Mouth Bilat (70330) $144.02 $758 1.5×
Radex Toe Minimum 2 Views (73660)
range across 14 matching MRF lines
$70.87–$106.40 $373–$560 varies
Radex upper extremity infant minimum 2 views (73092)
range across 3 matching MRF lines
$58.90–$88.54 $310–$466 varies
Radex Wrist Complete Minimum 3 Views (73110)
range across 13 matching MRF lines
$120.65–$181.07 $635–$953 varies
Radex X-Ray Exam Entire Spi 6/> Vw - Xr Entire Spine 6+ Vw (72084) $182.97 $963 1.6×
Radiation Delivery Stereotactic Cranial Linear (77372) $4,498.82 $23,678 0.6×
Radiation treatment delivery level 1 (77402) $178.22 $938 1.6×
Radiation treatment delivery level 2 (77407) $193.42 $1,018 0.5×
Radiation treatment delivery level 3 (77412) $253.84 $1,336 0.4×
Radiolog exam mandible compl minimum 4 views (70110) $124.26 $654 1.1×
Radiologic Exam Abdomen 3+ Views - Xr Abdomen 3+ Views (74021) $135.66 $714 1.2×
Radiologic exam colon double contrast study (74280) $299.06 $1,574 1.6×
Radiologic exam colon single contrast study (74270) $253.84 $1,336 1.4×
Radiologic Exam Esophagus Double Contrast Study (74221) $80.18 $422 0.4×
Radiologic exam knee complete 4/more views (73564)
range across 10 matching MRF lines
$151.81–$227.81 $799–$1,199 varies
Radiologic exam pelvis compl minimum 3 views (72190) $160.36 $844 1.4×
Radiologic Exam Small Int Single Contrast Study (74250) $194.18 $1,022 1.0×
Radiologic exam swallow function contrast study (74230) $165.68 $872 0.9×
Radiologic exam upr gi trc double contrast study (74246) $231.99 $1,221 1.2×
Radiologic examination femur 1 view (73551)
range across 9 matching MRF lines
$60.42–$91.01 $318–$479 varies
Radiologic examination femur minimum 2 views (73552)
range across 10 matching MRF lines
$72.96–$109.44 $384–$576 varies
Radiologic examination knee 1/2 views (73560)
range across 13 matching MRF lines
$83.98–$125.97 $442–$663 varies
Radiologic Examination Osseous Survey Limited (77074) $135.09 $711 1.2×
Radiologic Examination Salivary Gland Calculus (70380) $27.36 $144 0.3×
Radiologic examination tibia & fibula 2 views (73590)
range across 3 matching MRF lines
$122.55–$183.92 $645–$968 varies
Radiopharm Dacryocystography (78660) $311.60 $1,640 0.7×
Radiopharmaceutical therapy, by interstitial radioactive colloid administration Facility (79300) $314.45 $1,655 1.3×
Radiopharmaceutical therapy, by intracavitary administration Non-Facility (79200) $345.99 $1,821 1.4×
Red Cell Volume Determination Spx 1 Sampling (78120) $311.60 $1,640 0.7×
Remote afterloading high dose rate radionuclide skin surface brachytherapy, includes basic dosimetry, when performed;… (77768) $111.15 $585 0.3×
Remote afterloading high dose rate radionuclide skin surface brachytherapy, includes basic dosimetry, when performed;… (77767) $96.71 $509 0.2×
Renal Cyst Study (74470) $232.75 $1,225 0.4×
Ribs bilateral 3 views (71110) $152 $800 1.4×
Rp loclzj tum plnr 1 area single day imaging (78800) $271.89 $1,431 0.6×
Rp loclzj tum plnr 2+area 1+d img/1 area img>2+d (78801) $368.98 $1,942 0.9×
Rp Loclzj Tum Plnr Whole Body 2+ Days Imaging (78804) $691.60 $3,640 1.2×
Rp Loclzj Tum Plnr Whole Body Single Day Imaging (78802) $679.82 $3,578 1.2×
Rp Loclzj Tum Spect 1 Area Single Day Imaging (78803) $661.77 $3,483 1.1×
Rp loclzj tum spect 2 area/sep acquisj img (78831) $675.83 $3,557 0.5×
Rp loclzj tum spect CT 2area 1d img/1 ar img>2+d (78832) $766.46 $4,034 0.5×
Rp loclzj tum spect w/CT 1 area/acquisj 1day img (78830) $675.83 $3,557 0.5×
Rp Ther Radiolbld Monoclonal Antibody IV Infus (79403) $382.47 $2,013 1.5×
Rp Therapy Intravenous Administration (79101) $314.45 $1,655 1.3×
Salivary Gland Imaging Serial Images (78231) $311.60 $1,640 0.7×
Scapula (73010)
range across 3 matching MRF lines
$125.97–$189.05 $663–$995 varies
Screening Digital Breast Tomosynthesis Bi (77063)
range across 2 matching MRF lines
$37.43–$56.24 $197–$296 varies
Sella turcica (70240) $27.36 $144 0.3×
Shoulder 1 view (73020)
range across 3 matching MRF lines
$65.17–$97.85 $343–$515 varies
Shoulder Arthrography (73040)
range across 3 matching MRF lines
$239.78–$359.67 $1,262–$1,893 varies
Sialogram (70390) $232.37 $1,223 0.9×
Skull less than 4 views (70250) $104.12 $548 0.9×
Special dosimetry (77331) $234.84 $1,236 1.6×
Special Physics Consult (77370) $226.48 $1,192 1.6×
Special teletherapy port plan (77321) $289.37 $1,523 0.7×
Special treatment procedure (77470) $548.34 $2,886 0.9×
Spleen Imaging (78185) $311.60 $1,640 0.7×
Stereotactic Body Radiation Delivery (77373) $1,774.03 $9,337 0.9×
Sternoclavicular joints (71130) $93.67 $493 1.0×
Superior sagittal sinus venogram (75870) $1,217.14 $6,406 0.4×
Surface Applic Low Dose Rate Radionuclide Source (77789) $115.52 $608 1.1×
Tbs techl prep&transmis data alys pfrmd elsewhr (77090) $35.53 $187 0.4×
Tbs technical calculation only (77091) $35.53 $187 0.4×
Telethx isodose pln cplx w/basic dosimetry (77307) $442.13 $2,327 1.1×
Telethx isodose pln smpl w/dosimetry calculation (77306) $251.94 $1,326 0.6×
Testicular Imaging W/Flow (78761) $264.67 $1,393 0.6×
Ther Rad Simulaj-Aided Field Setting Complex (77290) $573.99 $3,021 1.4×
Ther Rad Simulaj-Aided Field Setting Intermed (77285) $409.64 $2,156 1.0×
Ther rad simulaj-aided field setting simple (77280) $295.26 $1,554 2.0×
Therapeutic Enema Rdctj Intussusception/Obstrcj (74283) $171.76 $904 0.9×
Thoracic spine 2 views (72070) $124.45 $655 1.1×
Thoracic spine 3 views (72072) $164.92 $868 1.5×
Thoracolumbar 2 views (72080) $99.75 $525 1.1×
Thyroid Imaging With Vascular Flow (78013) $311.60 $1,640 0.7×
Thyroid Met Imaging Body (78018) $548.15 $2,885 0.9×
Thyroid Uptake Measurement (78012) $152.95 $805 0.4×
Thyroid Uptake W/Blood Flow Sngle/Mult Quan Meas (78014) $398.81 $2,099 0.9×
Tx Devices Design & Construction Complex (77334) $330.22 $1,738 0.8×
Tx devices design & construction intermediate (77333) $221.35 $1,165 1.5×
Tx devices design & construction simple (77332) $203.87 $1,073 1.4×
Ultrasound Breast Limited (76642)
range across 8 matching MRF lines
$121.41–$182.21 $639–$959 varies
Ultrasound elastography first target lesion (76982) $91.77 $483 0.8×
Ultrasound Elastography Parenchyma (76981) $91.77 $483 0.8×
Ultrasound Exam Aaa Screen (76706) $133.57 $703 1.2×
Ultrasound trgt dynamic microbubble 1st lesion (76978) $125.78 $662 0.3×
Ultrasound, abdomen limited (76705) $239.21 $1,259 2.1×
Umbilical-artery Doppler (OB) (76820) $137.75 $725 1.2×
Unlisted fluoroscopic procedure (76496) $27.36 $144 0.3×
Unlisted magnetic resonance procedure (76498)
range across 3 matching MRF lines
$462.08–$786.41 $2,432–$4,139 varies
Upper gi w/o kub (74240) $221.92 $1,168 1.2×
Ureteral Reflux Study (78740) $264.67 $1,393 0.6×
Urethrocystogram voiding (74455) $194.18 $1,022 0.8×
Urethrocystography retrograde (74450) $193.80 $1,020 0.8×
Us breast unilateral complete (76641)
range across 5 matching MRF lines
$129.58–$194.37 $682–$1,023 varies
Us chest (76604) $125.78 $662 1.1×
Us complete joint (76881)
range across 6 matching MRF lines
$241.11–$361.76 $1,269–$1,904 varies
Us exam, pelvic, limited (76857) $156.37 $823 1.4×
Us head (76506) $132.05 $695 1.2×
Us kidney transplant (76776) $255.17 $1,343 2.3×
Us lmtd joint/oth nonvasc xtr strux r-t w/img (76882)
range across 9 matching MRF lines
$132.24–$198.17 $696–$1,043 varies
Us ob detailed single fetus (76811) $239.59 $1,261 0.9×
Us ob limited 1 or more fetuses (76815) $117.61 $619 1.0×
Us ob transvaginal (76817) $122.17 $643 1.1×
Us pelvic non ob complete (76856) $314.45 $1,655 2.8×
Us pg uter img f&mat 14 wk tabdl 1/1st gestation (76801) $127.30 $670 1.1×
Us preg uterus real time f/u trnsabdl per fetus (76816) $132.43 $697 1.2×
Us retroperitoneal complete (76770) $237.88 $1,252 2.1×
Us retroperitoneal limited (76775) $220.02 $1,158 2.0×
Us scrotum and contents (76870) $233.32 $1,228 2.1×
Us spinal canal and contents (76800) $105.64 $556 0.9×
Us thyroid (76536) $279.49 $1,471 2.5×
Us transrectal (76872) $260.68 $1,372 2.3×
Vascular Flow Imaging (78445) $311.60 $1,640 0.7×
Vein X-Ray Chest (75827) $596.79 $3,141 0.4×
Vein X-Ray Liver W/O Hemodyn (75887) $897.56 $4,724 0.3×
Vein X-Ray Skull Epidural (75872) $560.69 $2,951 0.8×
Vein X-Ray Spleen/Liver (75810) $1,054.12 $5,548 0.3×
Venogram Sinus/Jugular (75860) $644.67 $3,393 0.2×
Venography Adrenal Unilateral (75840) $913.90 $4,810 0.3×
Venography caval inferior serialography rs&i (75825) $824.41 $4,339 0.2×
Venography extremity bilateral rs&i (75822) $476.90 $2,510 0.3×
Venography extremity unilateral rs&i (75820) $394.25 $2,075 0.2×
Venography Orbital Rs&I (75880) $271.70 $1,430 0.4×
Venography Renal Bilateral (75833) $1,024.10 $5,390 0.3×
Venography Renal Unilateral (75831) $1,217.14 $6,406 0.4×
Venous sampling by catheter (75893)
unusually low: confirm this is the full procedure
$2,100.07 $11,053 0.4×
Venous Thrombosis Imaging Venogram Bilateral (78458) $311.60 $1,640 0.7×
Wrist 2 views (73100)
range across 7 matching MRF lines
$91.01–$136.61 $479–$719 varies
X-Ray Ac Jts - Xr Acromioclavicular Joints Bilateral (73050) $116.85 $615 1.3×
X-ray antegrade pyelogram tube (74425) $251.56 $1,324 0.7×
X-Ray Aorta Leg Arteries (75630) $972.61 $5,119 0.3×
X-Ray Bend Only L-S Spine (72120) $129.58 $682 1.2×
X-Ray Elbow 2 Vw - Xr Elbow 1-2 Views Right (73070)
range across 3 matching MRF lines
$78.28–$117.42 $412–$618 varies
X-Ray Exam Breast Specimen (76098) $138.70 $730 0.2×
X-Ray Exam Entire Spi 1 Vw (72081) $66.88 $352 0.7×
X-Ray Exam Entire Spi 2/3 Vw (72082) $115.52 $608 1.0×
X-Ray Exam Entire Spi 4/5 Vw (72083) $166.25 $875 1.5×
X-Ray Exam Hip Uni 1 View (73501) $68.40 $360 0.7×
X-Ray Exam Hip Uni 2-3 Views (73502) $73.15 $385 0.8×
X-Ray Exam Hip Uni 4/> Views (73503) $87.21 $459 0.8×
X-Ray Exam Hips Bi 2 Views (73521) $95 $500 0.8×
X-Ray Exam Hips Bi 3-4 Views (73522) $113.24 $596 1.0×
X-Ray Exam Hips Bi 5/> Views (73523) $166.25 $875 1.5×
X-Ray Exam L-S Spine Bending (72114) $198.36 $1,044 1.8×
X-Ray Exam Neck Spine 2-3 Vw (72040) $117.99 $621 1.3×
X-Ray Exam Neck Spine 6/>Vws (72052) $219.45 $1,155 2.0×
X-Ray Exam Unilat Ribs/Chest (71101) $148.77 $783 1.3×
X-ray eye for foreign body (70030) $36.29 $191 0.4×
X-ray humerus (73060)
range across 7 matching MRF lines
$117.99–$176.89 $621–$931 varies
X-ray IV pyelogram (ivp) (74400) $210.52 $1,108 1.1×
X-ray IV pyelogram+tomography (74415) $324.90 $1,710 1.7×
X-Ray Jaw <4 Vw - Xr Mandible < 4 Views (70100) $44.84 $236 0.5×
X-Ray Knee Bilat Standing - Xr Knees Anteroposterior Standing Bilat (73565) $94.05 $495 1.0×
X-Ray Lumbar Spine 2/3 Vw - Xr Lumbar Spine 2-3 Views (72100) $133 $700 1.2×
X-ray nose-rectum child f.b. (76010) $31.35 $165 0.3×
X-Ray Ribs, Chest 4+ Vw - Xr Ribs 3 Vws Bil W/ Chest Posteroanterior (71111) $238.64 $1,256 2.1×
X-Ray Sacroiliac Jts 3+ Vw - Xr Sacroiliac Joints 3+ Views (72202) $149.72 $788 1.3×
X-Ray Sacrum/Coccyx 2+ Vw - Xr Sacrum Coccyx 2+ Views (72220) $132.05 $695 1.4×
X-Ray Sinuses 3+ Vw - Xr Paranasal Sinuses 3+ Views (70220) $142.31 $749 1.5×
X-Ray Skull 4+ Vw - Xr Skull Complete 4+ Views (70260) $194.94 $1,026 1.7×
X-Ray Stress View (77071) $58.14 $306 0.6×
X-ray thoracic spine 4 vw (72074) $173.28 $912 1.5×
X-Ray Urinary Tract Exam With Contrast Material (74420) $215.84 $1,136 0.6×
X-Rays Bone Length Studies (77073) $121.41 $639 1.1×
X-Rays Bone Survey Complete (77075) $277.40 $1,460 2.5×
Xr c-spine 4 or 5 views (72050) $186.01 $979 1.7×
Xr facial bones less than 3 views (70140) $84.93 $447 0.9×
Xr orbits complete 4 views (70200) $136.04 $716 1.2×
Xr Tomogram Single Plane (76100) $207.86 $1,094 1.9×

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.