Imaging prices at Lutheran Downtown Hospital
Fort Wayne, IN · every code in this section with a posted price and a Medicare benchmark.
395 codes. Prices are the hospital's own posted facility charges.
Compare against other hospitals interactively →
| Procedure | Posted cash | Posted gross | × Medicare |
|---|---|---|---|
| 3-D radiotherapy plan dose-volume histograms (77295) | $1,564.32 | $6,518 | 1.1× |
| Abdomen 1 View (74018) range across 4 matching MRF lines |
$9.96–$176.64 | $41.52–$736 | varies |
| Abdomen 2 views (74019) range across 2 matching MRF lines |
$12.27–$312.96 | $51.12–$1,304 | varies |
| Acute Gastrointestinal Blood Loss Imaging (78278) | $472.32 | $1,968 | 1.1× |
| Acute venous thrombosis imaging, peptide Non-Facility (78456) | $408 | $1,700 | 0.3× |
| Adrenal Cortex & Medulla Img (78075) | $1,463.28 | $6,097 | 1.1× |
| Angio internal mammary (75756) range across 5 matching MRF lines |
$1,411.68–$2,647.20 | $5,882–$11,030 | varies |
| Angio pulmonary bilat (75743) range across 6 matching MRF lines |
$3,308.40–$4,116.72 | $13,785–$17,153 | varies |
| Angiography Adrenal Bilateral Slctv Rs&I (75733) | $1,900.32 | $7,918 | 0.6× |
| Angiography extremity bilateral rs&i (75716) range across 8 matching MRF lines |
$163.68–$3,420.48 | $167–$14,252 | varies |
| Angiography extremity unilateral rs&i (75710) range across 8 matching MRF lines |
$2,647.20–$3,420.48 | $533–$14,252 | varies |
| Angiography pulmonary unilateral slctv rs&i (75741) range across 6 matching MRF lines |
$2,996.40–$3,420.48 | $12,485–$14,252 | varies |
| Angrph pulmonary nonslctv cath/ven njx rs&i (75746) range across 4 matching MRF lines |
$1,773.12–$2,216.16 | $7,388–$9,234 | varies |
| Ankle 2 views (73600) range across 5 matching MRF lines |
$5.28–$206.16 | $22–$859 | varies |
| Aortography thoracic serialography rs&i (75605) range across 6 matching MRF lines |
$3,257.52–$5,481.84 | $544–$22,841 | varies |
| Artery X-Rays Abdomen (75726) range across 5 matching MRF lines |
$5,316.96–$6,310.80 | $22,154–$26,295 | varies |
| Artery X-Rays Adrenal Gland (75731) | $2,181.12 | $9,088 | 0.7× |
| Artery X-Rays Pelvis (75736) range across 5 matching MRF lines |
$3,420.48–$5,481.84 | $14,252–$22,841 | varies |
| Artery X-Rays Spine (75705) | $5,481.84 | $22,841 | 0.9× |
| Arthrogram hip (73525) | $562.08 | $2,342 | 1.5× |
| Arthrogram Wrist (73115) | $428.64 | $1,786 | 1.2× |
| Basic radiation dosimetry calculation (77300) | $188.40 | $785 | 1.3× |
| Bone age studies (77072) | $166.56 | $694 | 1.5× |
| Bone Imaging 3 Phase (78315) | $453.60 | $1,890 | 1.1× |
| Bone Imaging Limited Area (78300) | $426.72 | $1,778 | 1.0× |
| Bone Imaging Multiple Areas (78305) | $439.92 | $1,833 | 1.0× |
| Bone Imaging Whole Body (78306) range across 2 matching MRF lines |
$56.09–$522.72 | $233.71–$2,178 | varies |
| Bone marrow imaging limited area (78102) | $444 | $1,850 | 1.0× |
| Bone marrow imaging; multiple areas (78103) | $469.44 | $1,956 | 1.1× |
| Bone marrow imaging; whole body (78104) | $522.72 | $2,178 | 1.2× |
| Bone survey infant (77076) | $296.88 | $1,237 | 2.7× |
| Brachytx isodose complex (77318) | $859.68 | $3,582 | 2.2× |
| Brachytx isodose intermed (77317) | $713.28 | $2,972 | 1.8× |
| Brachytx Isodose Plan Simple (77316) | $566.16 | $2,359 | 1.4× |
| Brain Image W/Flow < 4 Views (78601) | $708 | $2,950 | 1.7× |
| Brain Imaging Min 4 Static Views W Vascular Flow (78606) | $693.84 | $2,891 | 1.2× |
| Card Bl Pool Gated Spect Rest Wal Motn Ejct Frct (78494) | $867.84 | $3,616 | 2.1× |
| Cardiac MRI w/w/o contrast & further seq (75561) range across 3 matching MRF lines |
$80.40–$996.24 | $335–$4,151 | varies |
| Cardiac MRI w/w/o contrast w/stress (75563) range across 4 matching MRF lines |
$92.40–$998.16 | $385–$4,159 | varies |
| Cardiac Shunt Detection (78428) | $504.72 | $2,103 | 1.2× |
| Cat Scan Follow-Up Study (76380) | $254.16 | $1,059 | 2.8× |
| Cerebrospinal Fluid Flow W/O Matl Shunt Evaltj (78645) | $673.92 | $2,808 | 1.2× |
| Cerebrospinal Fluid Scan (78630) | $673.92 | $2,808 | 1.2× |
| Chest 1 view (71045) range across 11 matching MRF lines |
$4.94–$170.64 | $20.60–$711 | varies |
| Chest 2 views (71046) range across 11 matching MRF lines |
$4.80–$233.28 | $20–$972 | varies |
| Chest 3 views (71047) | $262.32 | $1,093 | 2.8× |
| Chest 4 or more views (71048) | $303.60 | $1,265 | 2.7× |
| Cineradiograpy/vidradiograpy xcpt where spec (76120) | $12.48 | $52 | 0.1× |
| Clavicle complete (73000) range across 7 matching MRF lines |
$5.52–$228.96 | $23–$954 | varies |
| Computed Tomography Thorax Lw Dose Lng Ca Scr C- (71271) | $155.76 | $649 | 1.4× |
| Continuing medical physics consltj pr wk (77336) | $224.16 | $934 | 1.6× |
| Contrast Exam Abdominl Aorta (75625) range across 6 matching MRF lines |
$2,647.20–$3,420.48 | $544–$14,252 | varies |
| Contrast X-Ray Bladder (74430) range across 3 matching MRF lines |
$33.60–$364.80 | $140–$1,520 | varies |
| Contrast X-Ray Of Elbow (73085) | $17.52 | $73 | 0.0× |
| Contrast X-Ray Of Knee Joint (73580) | $428.64 | $1,786 | 1.2× |
| CT abdomen and pelvis without and with contrast (74178) range across 6 matching MRF lines |
$2,349.60–$2,895.12 | $9,790–$12,063 | varies |
| CT abdomen and pelvis without contrast (74176) range across 6 matching MRF lines |
$1,649.76–$1,725.12 | $6,874–$7,188 | varies |
| CT abdomen w contrast (74160) | $1,158.72 | $4,828 | 6.2× |
| CT abdomen w wo contrast (74170) | $1,448.16 | $6,034 | 7.8× |
| CT abdomen w/o contrast (74150) | $863.04 | $3,596 | 7.8× |
| CT Angio Abdomen and Pelvis (74174) | $3,191.52 | $13,298 | 8.6× |
| CT Angio Chest (71275) | $1,853.52 | $7,723 | 10.0× |
| CT Angio Head (70496) | $1,597.92 | $6,658 | 8.6× |
| CT angio hrt w/3d image (75574) range across 5 matching MRF lines |
$69.60–$594 | $290–$2,475 | varies |
| Ct Angio Lwr Extr W/O&W/Dye (73706) | $1,537.44 | $6,406 | 8.3× |
| CT Angio Neck (70498) | $1,597.92 | $6,658 | 8.6× |
| Ct Angio Upr Extrm W/O&W/Dye (73206) | $1,537.44 | $6,406 | 8.3× |
| CT cervical spine w/ contrast (72126) | $929.52 | $3,873 | 2.5× |
| CT cervical spine w/o contrast (72125) | $1,237.68 | $5,157 | 11.2× |
| CT cervical spine w/wo cont (72127) | $1,303.92 | $5,433 | 7.0× |
| CT chest w contrast (71260) range across 5 matching MRF lines |
$41.88–$1,298.88 | $174.48–$5,412 | varies |
| CT chest w/wo contrast (71270) | $1,405.92 | $5,858 | 7.6× |
| CT colonography screening (74263) | $433.20 | $1,805 | 1.7× |
| CT Colonogrphy Dx Image Postprocess W/Contrast (74262) | $548.40 | $2,285 | 3.0× |
| CT colonogrphy dx image postprocess w/o contrast (74261) | $511.20 | $2,130 | 4.6× |
| CT head/brain with contrast (70460) range across 2 matching MRF lines |
$41.88–$872.64 | $174.48–$3,636 | varies |
| CT head/brain without and with contrast (70470) range across 2 matching MRF lines |
$41.88–$1,349.28 | $174.48–$5,622 | varies |
| CT heart contrast eval cardiac structure&morph (75572) range across 3 matching MRF lines |
$54.48–$594 | $227–$2,475 | varies |
| CT heart no contrast quant eval coronry calcium (75571) range across 5 matching MRF lines |
$12–$110.64 | $50–$461 | varies |
| CT hrt w/3d image congen (75573) range across 3 matching MRF lines |
$78.48–$594 | $327–$2,475 | varies |
| CT iac w contrast (70481) | $1,029.60 | $4,290 | 5.5× |
| CT l-spine w&w/o contrast (72133) | $1,288.32 | $5,368 | 6.9× |
| CT lower ext w/o (73700) | $829.68 | $3,457 | 7.5× |
| CT lower extremity w/contrast material (73701) | $983.04 | $4,096 | 5.3× |
| CT lumbar spine w contrast (72132) | $876.24 | $3,651 | 2.4× |
| CT lumbar spine w/o contrast (72131) | $1,577.28 | $6,572 | 14.3× |
| CT maxillofacial w contrast (70487) | $1,699.20 | $7,080 | 9.2× |
| CT maxillofacial wo contrast (70486) | $1,177.92 | $4,908 | 10.6× |
| CT neck tissue combo (70492) | $1,414.56 | $5,894 | 7.6× |
| Ct Orbit/Ear/Fossa W/O&W/Dye (70482) | $1,013.76 | $4,224 | 5.5× |
| CT orbits w/o contrast (70480) | $969.12 | $4,038 | 8.8× |
| CT pelvis w&w/o contrast (72194) range across 3 matching MRF lines |
$1,171.44–$1,461.60 | $4,881–$6,090 | varies |
| CT pelvis w/o contrast (72192) range across 3 matching MRF lines |
$781.44–$789.60 | $3,256–$3,290 | varies |
| CT scan of leg combo (73702) | $1,091.28 | $4,547 | 5.9× |
| CT scans face/jaw combo (70488) | $1,548 | $6,450 | 8.3× |
| CT soft tissue neck w contrast (70491) range across 2 matching MRF lines |
$41.88–$1,020.96 | $174.48–$4,254 | varies |
| CT soft tissue neck w/o contrast (70490) | $1,225.68 | $5,107 | 11.1× |
| CT thoracic spine w contrast (72129) | $1,096.80 | $4,570 | 5.9× |
| CT thoracic spine w/o contrast (72128) | $825.84 | $3,441 | 7.5× |
| CT thoracic spine w/wo cont (72130) | $1,120.08 | $4,667 | 6.0× |
| CT thorax w/o contrast (71250) | $999.84 | $4,166 | 9.0× |
| CT upper ext wo (73200) | $1,181.52 | $4,923 | 10.7× |
| CT upper extremity w/o & w/contrast material (73202) | $1,410.96 | $5,879 | 7.6× |
| CT upper extremity with contrast (73201) | $859.68 | $3,582 | 2.3× |
| Cta Abdl Aorta&Bi Iliofem W/Contrast&Postp (75635) | $3,638.88 | $15,162 | 19.6× |
| Cta Abdomen (74175) | $1,915.20 | $7,980 | 10.3× |
| CTA pelvis (72191) | $1,402.80 | $5,845 | 7.6× |
| Dilation ureters/urethra rs&i (74485) | $2,178.96 | $9,079 | 1.0× |
| Diskography lumbar (72295) range across 3 matching MRF lines |
$2,383.44–$3,665.28 | $9,931–$15,272 | varies |
| Doppler Echo Fetal Spectral Display Complete (76827) | $525.12 | $2,188 | 4.7× |
| Dxa Bone Density Axial (77080) range across 4 matching MRF lines |
$8.88–$361.92 | $37–$1,508 | varies |
| Dxa bone density study (77085) | $155.76 | $649 | 1.4× |
| Dxa bone density study 1/>sites appendiclr skel (77081) range across 3 matching MRF lines |
$8.88–$141.12 | $37–$588 | varies |
| Echo exam of fetal heart (76825) | $392.40 | $1,635 | 0.7× |
| Echo exam uterus (76831) range across 3 matching MRF lines |
$50.64–$115.68 | $211–$482 | varies |
| Echo Guide For Artery Repair (76936) | $242.16 | $1,009 | 1.1× |
| Esophageal Motility Study (78258) | $678 | $2,825 | 1.6× |
| Esophagram (74220) | $278.40 | $1,160 | 1.5× |
| Fetal Biophys Profile W/Nst (76818) range across 4 matching MRF lines |
$34.08–$402 | $142–$1,675 | varies |
| Fetal Biophysical Profile W/O Non-Stress Testing (76819) range across 4 matching MRF lines |
$29.52–$417.84 | $123–$1,741 | varies |
| Fluoroscopy up to 1 hr (76000) range across 12 matching MRF lines |
$47.28–$685.68 | $20–$2,857 | varies |
| Follow-Up Angiography (75898) range across 4 matching MRF lines |
$857.04–$1,369.20 | $219–$5,705 | varies |
| Foot 2 views (73620) range across 6 matching MRF lines |
$15.60–$178.80 | $65–$745 | varies |
| Forearm 2 views (73090) range across 7 matching MRF lines |
$5.28–$251.04 | $22–$1,046 | varies |
| Gastric emptying imaging study (78264) | $429.84 | $1,791 | 1.0× |
| Gastroesophageal Reflux Exam (78262) | $603.12 | $2,513 | 1.4× |
| Gated Heart Planar Single (78472) range across 4 matching MRF lines |
$26.40–$508.56 | $110–$2,119 | varies |
| Gated Heart, Multiple (78473) | $992.16 | $4,134 | 2.3× |
| Hand 2 views (73120) range across 6 matching MRF lines |
$10.96–$162.96 | $45.66–$679 | varies |
| Hdr Rdncl Ntrstl/Icav Brchtx (77772) | $2,844.96 | $11,854 | 3.9× |
| Hdr Rdncl Ntrstl/Icav Brchtx (77771) | $1,755.36 | $7,314 | 2.4× |
| Hdr Rdncl Ntrstl/Icav Brchtx 1 Channel (77770) | $810.72 | $3,378 | 1.1× |
| Hepatc Vngrph Wdg/Fr Hemodyn Eval Rs&I (75889) range across 3 matching MRF lines |
$2,497.44–$2,647.20 | $10,406–$11,030 | varies |
| Hepatc Vngrph Wdg/Fr W/O Hemodyn Eval Rs&I (75891) | $1,844.16 | $7,684 | 0.6× |
| Hepatobil Syst Image W/Drug (78227) | $1,109.28 | $4,622 | 1.9× |
| Hepatobiliary System Imaging (78226) | $1,081.68 | $4,507 | 2.6× |
| Ht Musc Image Planar Mult (78454) range across 2 matching MRF lines |
$1,458.24 | $173–$6,076 | 1.1× |
| Ht Muscle Image Spect Sing (78451) range across 7 matching MRF lines |
$209.28–$2,083.68 | $164–$8,682 | varies |
| Hysterosalpingogram (74740) | $581.52 | $2,423 | 2.3× |
| Infant hip ultrasound with hip movement (dynamic) (76885) | $171.12 | $713 | 1.9× |
| Infant hip ultrasound, limited static exam (76886) | $196.56 | $819 | 2.1× |
| Interstitial radiation source applic complex (77778) | $2,883.84 | $12,016 | 3.9× |
| Intracavitary Radiation Source Applic Complex (77763) | $596.64 | $2,486 | 0.8× |
| Intracavitary Radiation Source Applic Intermed (77762) | $601.44 | $2,506 | 1.0× |
| Intracavitary radiation source applic simple (77761) | $601.44 | $2,506 | 1.0× |
| Intraop radiaj tx deliver xray single tx session (77424) unusually low: confirm this is the full procedure |
$3,603.84 | $15,016 | 0.5× |
| Joint Survey Single View (77077) range across 3 matching MRF lines |
$23.28–$159.36 | $97–$664 | varies |
| K Flow/Funct Image Multiple (78709) | $624.24 | $2,601 | 1.1× |
| K Flow/Funct Image W/Drug (78708) | $567.84 | $2,366 | 1.0× |
| K Flow/Funct Image W/O Drug (78707) | $506.88 | $2,112 | 0.9× |
| Kidney Imaging Morphol (78700) | $527.04 | $2,196 | 1.2× |
| Knee 3 Views (73562) range across 8 matching MRF lines |
$6.24–$241.92 | $26–$1,008 | varies |
| Leveen/Shunt Patency Exam (78291) | $637.20 | $2,655 | 1.5× |
| Liver & Spleen Imaging Static Only (78215) | $494.88 | $2,062 | 1.2× |
| Liver & Spleen Imaging W/Vascular Flow (78216) | $515.28 | $2,147 | 1.2× |
| Liver imaging static only (78201) | $657.12 | $2,738 | 1.1× |
| Lung Perf&Ventilat Diferentl (78598) | $863.76 | $3,599 | 1.5× |
| Lung Ventilat&Perfus Imaging (78582) | $637.20 | $2,655 | 1.1× |
| Lung Ventilation Imaging (78579) | $386.88 | $1,612 | 0.9× |
| Lymph System Imaging (78195) range across 2 matching MRF lines |
$36.72–$448.32 | $153–$1,868 | varies |
| Lymphangiography Extremity Only Bilateral Rs&I (75803) | $1,790.16 | $7,459 | 1.1× |
| Lymphangiography extremity only unilateral rs&i (75801) | $689.76 | $2,874 | 1.0× |
| Lymphangiography Pelvic/Abdominal Bilateral Rs&I (75807) | $3,643.20 | $15,180 | 1.1× |
| Lymphangiography, pelvic/abdominal, unilateral (75805) | $3,643.20 | $15,180 | 1.1× |
| Magnetic Image Jaw Joint (70336) | $455.52 | $1,898 | 1.8× |
| Mammary ductogram or galactogram single (77053) | $231.36 | $964 | 0.9× |
| Meckels Divert Exam (78290) | $440.88 | $1,837 | 1.0× |
| Mlc imrt design & construction per imrt plan (77338) | $1,170 | $4,875 | 3.0× |
| Mra Head W/O & W/Contrast Material (70546) | $1,047.84 | $4,366 | 2.8× |
| MRA head w/o contrast (70544) | $673.68 | $2,807 | 2.7× |
| MRA head with contrast (70545) | $594.24 | $2,476 | 1.6× |
| MRA neck w contrast (70548) | $898.32 | $3,743 | 2.4× |
| Mra Neck W/O &W/Contrast Material (70549) | $1,047.84 | $4,366 | 2.8× |
| MRA neck w/o contrast (70547) | $673.68 | $2,807 | 2.7× |
| MRI abdomen w contrast (74182) | $673.68 | $2,807 | 1.8× |
| MRI abdomen w/o contrast (74181) | $715.92 | $2,983 | 2.8× |
| MRI any jt lower extrem w/contrast material (73722) | $956.40 | $3,985 | 1.2× |
| MRI any jt lower extrem w/o & w/contrast matrl (73723) | $1,433.52 | $5,973 | 3.9× |
| MRI any jt upper extremity w/contrast matrl (73222) | $1,014.48 | $4,227 | 1.2× |
| MRI Breast W/O Contrast Bilateral (77047) | $1,673.76 | $6,974 | 6.6× |
| MRI Breast Without Contrast Material Unilateral (77046) | $979.20 | $4,080 | 3.9× |
| MRI cardiac w/o cont stress (75559) range across 2 matching MRF lines |
$89.76–$898.32 | $374–$3,743 | varies |
| MRI cardiac w/o contrast (75557) range across 3 matching MRF lines |
$68.16–$899.52 | $284–$3,748 | varies |
| MRI cervical spine w contrast (72142) | $673.68 | $2,807 | 1.8× |
| MRI cervical spine w/o cont (72141) range across 3 matching MRF lines |
$429.84–$1,047.84 | $1,791–$4,366 | varies |
| MRI chest w/o contrast (71550) | $673.68 | $2,807 | 2.7× |
| MRI chest with contrast (71551) | $673.68 | $2,807 | 0.8× |
| MRI chest wo w contrast (71552) | $1,047.84 | $4,366 | 2.8× |
| MRI lower extrem oth/thn jt w/contrast matrl (73719) range across 7 matching MRF lines |
$902.16–$956.40 | $3,759–$3,985 | varies |
| MRI lower extrem oth/thn jt w/o & w/contr matr (73720) | $1,433.52 | $5,973 | 3.9× |
| MRI lower extrem oth/thn jt w/o contr matrl (73718) | $903.60 | $3,765 | 3.6× |
| MRI lumbar spine w contrast (72149) | $673.68 | $2,807 | 1.8× |
| Mri Neck Spine W/O & W/Dye (72156) | $998.16 | $4,159 | 2.7× |
| MRI orbit face &/neck w/o contrast (70540) | $673.68 | $2,807 | 2.7× |
| MRI orbit face neck w contrast (70542) | $673.68 | $2,807 | 1.8× |
| Mri Orbt/Fac/Nck W/O &W/Dye (70543) | $673.68 | $2,807 | 1.8× |
| MRI pelvis w contrast (72196) | $544.32 | $2,268 | 1.5× |
| MRI pelvis w/o & w contrast (72197) range across 5 matching MRF lines |
$85.55–$1,132.08 | $356.45–$4,717 | varies |
| MRI pelvis w/o contrast (72195) | $673.68 | $2,807 | 2.7× |
| MRI spectroscopy (76390) | $331.44 | $1,381 | 3.6× |
| MRI thoracic spine w/o contrast (72146) range across 4 matching MRF lines |
$231.36–$723.60 | $964–$3,015 | varies |
| MRI upper extremity oth than jt w/contr matrl (73219) | $1,068.72 | $4,453 | 2.9× |
| MRI upper extremity oth than jt w/o contr matrl (73218) | $1,068.96 | $4,454 | 4.2× |
| Mri Uppr Extremity W/O&W/Dye (73220) | $1,086.96 | $4,529 | 2.9× |
| MRI, abdomen, combo (74183) | $995.76 | $4,149 | 2.7× |
| MRI, dorsal spine combo (72157) | $998.16 | $4,159 | 2.7× |
| MRI, dorsal spine contrast (72147) | $738 | $3,075 | 2.0× |
| MRI, joint upper extrem (73221) | $1,089.36 | $4,539 | 4.3× |
| MRI, joint upper extrem combo (73223) | $1,089.36 | $4,539 | 3.0× |
| MRI, lumbar spine combo (72158) | $1,406.64 | $5,861 | 3.8× |
| Myocardial Imaging Infarct Avid Planar Qual/Quan (78466) range across 3 matching MRF lines |
$21.84–$692.16 | $91–$2,884 | varies |
| Myocardial Perfusion Planar 1 Study Rest/Stress (78453) | $30.72 | $128 | 0.0× |
| Myocardial Spect Multiple Studies (78452) range across 9 matching MRF lines |
$289.44–$2,945.76 | $180–$12,274 | varies |
| N-invas est c ffr sw aly CTA (75580) | $1,370.88 | $5,712 | 1.5× |
| Neck soft tissue (70360) range across 7 matching MRF lines |
$5.28–$189.84 | $22–$791 | varies |
| Nfs/Instlj Radioelmnt Sln 3 Mo Follow-Up Care (77750) | $301.92 | $1,258 | 0.7× |
| Njx Rp Loclzj Non-Img Probe Study Intravenous (78808) | $354.24 | $1,476 | 0.8× |
| Nm csf leak detection (78650) | $673.92 | $2,808 | 0.5× |
| Nm myocard infarct spect (78469) | $657.12 | $2,738 | 1.1× |
| Ntsty modul radthx pln dose-vol histos (77301) | $7,231.44 | $30,131 | 4.9× |
| Nuclear Rx Intra-Arterial (79445) range across 3 matching MRF lines |
$270–$286.32 | $1,125–$1,193 | varies |
| Nuclear Rx Oral Admin (79005) range across 2 matching MRF lines |
$54.72–$1,222.08 | $228–$5,092 | varies |
| Ob us nuchal meas 1 gest (76813) range across 2 matching MRF lines |
$73.68–$103.92 | $307–$433 | varies |
| Oph bmtry us echograpy a-scan io lens pwr cal (76519) | $19.44 | $81 | 0.2× |
| Ophthalmic ultrasound dx b-scan w/wo a-scan (76512) | $56.64 | $236 | 0.5× |
| Ophthalmic US Dx Corneal Pachymetry Uni/Bi (76514) | $9.36 | $39 | 0.3× |
| Parathyroid Planar Imaging (78070) | $414.48 | $1,727 | 1.0× |
| Pelvis 1 or 2 views (72170) range across 6 matching MRF lines |
$5.76–$177.84 | $24–$741 | varies |
| PET imaging CT attenuation skull base mid-thigh (78815) | $3,645.12 | $15,188 | 2.4× |
| Prq Transhepatc Portograpy Hemodyn Eval Rs&I (75885) | $1,732.32 | $7,218 | 0.5× |
| Pulmonary Perfusion Imaging Particulate (78580) | $406.32 | $1,693 | 1.0× |
| Radex Abd Compl Aqt Abd W/S/E/D Views 1 View Ch (74022) range across 4 matching MRF lines |
$10.08–$356.40 | $42–$1,485 | varies |
| Radex abscess/fistula/sinus tract rs&i (76080) range across 5 matching MRF lines |
$422.40–$470.40 | $1,760–$1,960 | varies |
| Radex Ankle Complete Minimum 3 Views (73610) range across 7 matching MRF lines |
$5.76–$237.60 | $24–$990 | varies |
| Radex Calcaneus Minimum 2 Views (73650) range across 6 matching MRF lines |
$5.04–$234.96 | $21–$979 | varies |
| Radex elbow complete minimum 3 views (73080) range across 7 matching MRF lines |
$5.76–$222.96 | $24–$929 | varies |
| Radex Facial Bones Complete Minimum 3 Views (70150) range across 8 matching MRF lines |
$8.40–$283.20 | $35–$1,180 | varies |
| Radex fingr minimum 2 views (73140) range across 29 matching MRF lines |
$4.56–$159.36 | $19–$664 | varies |
| Radex foot complete minimum 3 views (73630) range across 7 matching MRF lines |
$5.28–$235.44 | $22–$981 | varies |
| Radex Hand Minimum 3 Views (73130) range across 7 matching MRF lines |
$5.52–$192.48 | $23–$802 | varies |
| Radex lower extremity infant minimum 2 views (73592) range across 4 matching MRF lines |
$17.28–$187.92 | $72–$783 | varies |
| Radex Mastoids Compl Minimum 3 Views PR Side (70130) | $194.16 | $809 | 1.8× |
| Radex Nasal Bones Complete Minimum 3 Views (70160) range across 6 matching MRF lines |
$5.52–$165.84 | $23–$691 | varies |
| Radex Ribs Unilateral 2 Views (71100) range across 7 matching MRF lines |
$7.20–$242.64 | $30–$1,011 | varies |
| Radex shoulder complete minimum 2 views (73030) range across 8 matching MRF lines |
$6.24–$287.52 | $26–$1,198 | varies |
| Radex Sinuses Paransl < 3 Views (70210) range across 7 matching MRF lines |
$5.52–$119.52 | $23–$498 | varies |
| Radex sm int w/mlt srl imges via enteroclss tube (74251) range across 3 matching MRF lines |
$229.68–$243.36 | $957–$1,014 | varies |
| Radex Spine 1 View Specify Level (72020) range across 15 matching MRF lines |
$5.04–$190.56 | $21–$794 | varies |
| Radex Sternum Minimum 2 Views (71120) range across 5 matching MRF lines |
$6.48–$215.76 | $27–$899 | varies |
| Radex Temporomandble Jt Opn & Clsd Mouth Bilat (70330) range across 2 matching MRF lines |
$20.01–$268.56 | $83.38–$1,119 | varies |
| Radex Toe Minimum 2 Views (73660) range across 22 matching MRF lines |
$10.79–$156.72 | $18–$653 | varies |
| Radex upper extremity infant minimum 2 views (73092) | $196.56 | $819 | 1.8× |
| Radex Wrist Complete Minimum 3 Views (73110) range across 13 matching MRF lines |
$5.76–$208.32 | $24–$868 | varies |
| Radex X-Ray Exam Entire Spi 6/> Vw - Xr Entire Spine 6+ Vw (72084) range across 2 matching MRF lines |
$37.14–$364.80 | $154.74–$1,520 | varies |
| Radiation Delivery Stereotactic Cranial Linear (77372) likely a partial charge, not the full procedure |
$868.32 | $3,618 | 0.1× |
| Radiation treatment delivery level 1 (77402) | $700.56 | $2,919 | 6.5× |
| Radiation treatment delivery level 2 (77407) | $32.16 | $134 | 0.1× |
| Radiation treatment delivery level 3 (77412) | $1,047.84 | $4,366 | 1.8× |
| Radiolog exam mandible compl minimum 4 views (70110) range across 5 matching MRF lines |
$7.92–$285.84 | $33–$1,191 | varies |
| Radiologic Exam Abdomen 3+ Views - Xr Abdomen 3+ Views (74021) | $284.64 | $1,186 | 2.6× |
| Radiologic exam colon double contrast study (74280) | $661.20 | $2,755 | 3.6× |
| Radiologic exam colon single contrast study (74270) | $276.96 | $1,154 | 1.5× |
| Radiologic Exam Esophagus Double Contrast Study (74221) | $2,895.12 | $12,063 | 15.6× |
| Radiologic exam knee complete 4/more views (73564) range across 19 matching MRF lines |
$7.44–$288.48 | $31–$1,202 | varies |
| Radiologic exam pelvis compl minimum 3 views (72190) range across 6 matching MRF lines |
$6.96–$289.20 | $29–$1,205 | varies |
| Radiologic Exam Small Int Single Contrast Study (74250) range across 3 matching MRF lines |
$61.92–$295.68 | $258–$1,232 | varies |
| Radiologic exam swallow function contrast study (74230) | $223.68 | $932 | 1.2× |
| Radiologic exam upr gi trc double contrast study (74246) range across 4 matching MRF lines |
$643.92–$654.72 | $2,683–$2,728 | varies |
| Radiologic examination femur 1 view (73551) | $102.72 | $428 | 1.1× |
| Radiologic examination femur minimum 2 views (73552) | $162.96 | $679 | 1.8× |
| Radiologic examination knee 1/2 views (73560) range across 6 matching MRF lines |
$6–$221.52 | $25–$923 | varies |
| Radiologic Examination Osseous Survey Limited (77074) | $311.28 | $1,297 | 2.8× |
| Radiologic examination tibia & fibula 2 views (73590) range across 5 matching MRF lines |
$5.52–$148.56 | $23–$619 | varies |
| Radiopharmaceutical therapy, by intracavitary administration Non-Facility (79200) | $991.92 | $4,133 | 4.0× |
| Remote afterloading high dose rate radionuclide skin surface brachytherapy, includes basic dosimetry, when performed;… (77768) | $301.92 | $1,258 | 0.7× |
| Remote afterloading high dose rate radionuclide skin surface brachytherapy, includes basic dosimetry, when performed;… (77767) | $301.92 | $1,258 | 0.7× |
| Ribs bilateral 3 views (71110) range across 6 matching MRF lines |
$8.64–$252.96 | $36–$1,054 | varies |
| Rp loclzj tum plnr 1 area single day imaging (78800) range across 7 matching MRF lines |
$20.64–$1,009.44 | $86–$4,206 | varies |
| Rp loclzj tum plnr 2+area 1+d img/1 area img>2+d (78801) | $407.52 | $1,698 | 1.0× |
| Rp Loclzj Tum Plnr Whole Body 2+ Days Imaging (78804) range across 3 matching MRF lines |
$1,584.72–$2,395.68 | $6,603–$9,982 | varies |
| Rp Loclzj Tum Plnr Whole Body Single Day Imaging (78802) range across 6 matching MRF lines |
$1,187.52–$1,213.92 | $4,948–$5,058 | varies |
| Rp Loclzj Tum Spect 1 Area Single Day Imaging (78803) range across 20 matching MRF lines |
$30.96–$1,213.92 | $129–$5,058 | varies |
| Rp loclzj tum spect 2 area/sep acquisj img (78831) range across 2 matching MRF lines |
$1,408.08–$1,492.56 | $5,867–$6,219 | varies |
| Rp Ther Radiolbld Monoclonal Antibody IV Infus (79403) | $6,354.48 | $26,477 | 25.7× |
| Rp Therapy Intravenous Administration (79101) | $265.44 | $1,106 | 1.1× |
| Scapula (73010) range across 8 matching MRF lines |
$7–$297.36 | $29.16–$1,239 | varies |
| Screening Digital Breast Tomosynthesis Bi (77063) range across 11 matching MRF lines |
$16.08–$25.44 | $67–$106 | varies |
| Shoulder 1 view (73020) range across 4 matching MRF lines |
$6.67–$131.76 | $27.78–$549 | varies |
| Shoulder Arthrography (73040) | $470.40 | $1,960 | 1.3× |
| Sialogram (70390) | $401.76 | $1,674 | 1.6× |
| Skull less than 4 views (70250) range across 6 matching MRF lines |
$7.92–$162.48 | $33–$677 | varies |
| Special dosimetry (77331) | $188.40 | $785 | 1.3× |
| Special Physics Consult (77370) | $498.96 | $2,079 | 3.5× |
| Special teletherapy port plan (77321) | $475.92 | $1,983 | 1.2× |
| Special treatment procedure (77470) | $566.16 | $2,359 | 1.0× |
| Stereotactic Body Radiation Delivery (77373) | $1,694.64 | $7,061 | 0.9× |
| Sternoclavicular joints (71130) range across 5 matching MRF lines |
$7.20–$146.40 | $30–$610 | varies |
| Superior sagittal sinus venogram (75870) | $1,614.72 | $6,728 | 0.5× |
| Telethx isodose pln cplx w/basic dosimetry (77307) | $962.88 | $4,012 | 2.4× |
| Telethx isodose pln smpl w/dosimetry calculation (77306) | $696.72 | $2,903 | 1.8× |
| Testicular Imaging W/Flow (78761) | $700.08 | $2,917 | 1.7× |
| Ther Rad Simulaj-Aided Field Setting Complex (77290) | $1,939.44 | $8,081 | 4.9× |
| Ther Rad Simulaj-Aided Field Setting Intermed (77285) | $1,095.60 | $4,565 | 2.8× |
| Ther rad simulaj-aided field setting simple (77280) | $660.72 | $2,753 | 4.6× |
| Therapeutic Enema Rdctj Intussusception/Obstrcj (74283) | $479.52 | $1,998 | 2.6× |
| Thoracic spine 2 views (72070) range across 6 matching MRF lines |
$7.20–$216.24 | $30–$901 | varies |
| Thoracic spine 3 views (72072) range across 6 matching MRF lines |
$6.96–$307.20 | $29–$1,280 | varies |
| Thoracolumbar 2 views (72080) range across 7 matching MRF lines |
$7.44–$179.04 | $31–$746 | varies |
| Thyroid Imaging With Vascular Flow (78013) | $472.32 | $1,968 | 1.1× |
| Thyroid Met Imaging Body (78018) | $904.56 | $3,769 | 1.6× |
| Thyroid Uptake Measurement (78012) | $189.84 | $791 | 0.4× |
| Thyroid Uptake W/Blood Flow Sngle/Mult Quan Meas (78014) | $1,100.64 | $4,586 | 2.6× |
| Tx Devices Design & Construction Complex (77334) | $394.32 | $1,643 | 1.0× |
| Tx devices design & construction intermediate (77333) | $352.56 | $1,469 | 2.5× |
| Tx devices design & construction simple (77332) | $352.32 | $1,468 | 2.5× |
| Ultrasound Breast Limited (76642) range across 6 matching MRF lines |
$19.92–$214.56 | $83–$894 | varies |
| Ultrasound Elastography Parenchyma (76981) range across 3 matching MRF lines |
$155.76–$541.44 | $649–$2,256 | varies |
| Ultrasound Exam Aaa Screen (76706) range across 2 matching MRF lines |
$104.40–$155.76 | $435–$649 | varies |
| Ultrasound, abdomen limited (76705) range across 12 matching MRF lines |
$18.48–$504.48 | $77–$2,102 | varies |
| Unlisted us procedure (76999) | $49.20 | $205 | 0.5× |
| Upper gi w/o kub (74240) range across 9 matching MRF lines |
$405.36–$513.36 | $1,689–$2,139 | varies |
| Ureteral Reflux Study (78740) | $527.04 | $2,196 | 1.2× |
| Urethrocystogram voiding (74455) | $552.96 | $2,304 | 2.2× |
| Urethrocystography retrograde (74450) | $747.84 | $3,116 | 3.0× |
| Us breast unilateral complete (76641) range across 7 matching MRF lines |
$24.82–$324.72 | $103.40–$1,353 | varies |
| Us chest (76604) range across 2 matching MRF lines |
$17.28–$343.92 | $72–$1,433 | varies |
| Us complete joint (76881) range across 8 matching MRF lines |
$19.92–$473.52 | $83–$1,973 | varies |
| Us exam, pelvic, limited (76857) range across 6 matching MRF lines |
$53.04–$360.96 | $221–$1,504 | varies |
| Us head (76506) | $178.80 | $745 | 1.6× |
| Us kidney transplant (76776) range across 6 matching MRF lines |
$23.76–$729.84 | $99–$3,041 | varies |
| Us lmtd joint/oth nonvasc xtr strux r-t w/img (76882) range across 8 matching MRF lines |
$15.36–$313.68 | $64–$1,307 | varies |
| Us ob detailed single fetus (76811) range across 3 matching MRF lines |
$110.40–$523.92 | $460–$2,183 | varies |
| Us ob limited 1 or more fetuses (76815) range across 11 matching MRF lines |
$51.12–$233.28 | $213–$972 | varies |
| Us ob transvaginal (76817) range across 5 matching MRF lines |
$58.80–$357.84 | $245–$1,491 | varies |
| Us pelvic non ob complete (76856) range across 3 matching MRF lines |
$69.60–$492.48 | $290–$2,052 | varies |
| Us pg uter img f&mat 14 wk tabdl 1/1st gestation (76801) range across 6 matching MRF lines |
$74.88–$497.52 | $312–$2,073 | varies |
| Us preg uterus real time f/u trnsabdl per fetus (76816) range across 5 matching MRF lines |
$69.36–$246 | $289–$1,025 | varies |
| Us retroperitoneal complete (76770) | $629.28 | $2,622 | 5.7× |
| Us retroperitoneal limited (76775) range across 10 matching MRF lines |
$16.32–$441.60 | $68–$1,840 | varies |
| Us scrotum and contents (76870) | $558 | $2,325 | 5.0× |
| Us spinal canal and contents (76800) range across 2 matching MRF lines |
$198.96–$209.28 | $829–$872 | varies |
| Us thyroid (76536) range across 5 matching MRF lines |
$17.52–$486.24 | $73–$2,026 | varies |
| Us transrectal (76872) range across 3 matching MRF lines |
$21.12–$66.24 | $88–$276 | varies |
| Vein X-Ray Chest (75827) range across 9 matching MRF lines |
$126.96–$1,620.72 | $144–$6,753 | varies |
| Vein X-Ray Liver W/O Hemodyn (75887) | $1,166.64 | $4,861 | 0.3× |
| Venogram Sinus/Jugular (75860) range across 5 matching MRF lines |
$1,609.20–$3,308.40 | $6,705–$13,785 | varies |
| Venography Adrenal Unilateral (75840) | $1,444.80 | $6,020 | 0.4× |
| Venography caval inferior serialography rs&i (75825) range across 5 matching MRF lines |
$2,346.96–$3,420.48 | $9,779–$14,252 | varies |
| Venography extremity bilateral rs&i (75822) range across 9 matching MRF lines |
$1,095.84–$1,369.92 | $136–$5,708 | varies |
| Venography extremity unilateral rs&i (75820) range across 13 matching MRF lines |
$621.36–$1,097.76 | $91–$4,574 | varies |
| Venography Renal Bilateral (75833) range across 2 matching MRF lines |
$1,707.60 | $194–$7,115 | 0.5× |
| Venography Renal Unilateral (75831) | $3,308.40 | $13,785 | 1.0× |
| Venous sampling by catheter (75893) range across 3 matching MRF lines |
$4,386–$5,481.84 | $18,275–$22,841 | varies |
| Venous thrombosis imaging (78457) | $468.72 | $1,953 | 0.8× |
| Venous Thrombosis Imaging Venogram Bilateral (78458) | $1,375.44 | $5,731 | 3.3× |
| Vertebral fracture assessment via dxa (77086) | $209.28 | $872 | 2.3× |
| Wrist 2 views (73100) range across 8 matching MRF lines |
$12.27–$166.80 | $51.12–$695 | varies |
| X-Ray Ac Jts - Xr Acromioclavicular Joints Bilateral (73050) range across 6 matching MRF lines |
$6.72–$225.12 | $28–$938 | varies |
| X-ray antegrade pyelogram tube (74425) | $467.52 | $1,948 | 1.3× |
| X-Ray Aorta Leg Arteries (75630) range across 8 matching MRF lines |
$2,652.96–$3,315.84 | $230–$13,816 | varies |
| X-Ray Bend Only L-S Spine (72120) range across 5 matching MRF lines |
$7.44–$165.84 | $31–$691 | varies |
| X-Ray Elbow 2 Vw - Xr Elbow 1-2 Views Right (73070) range across 8 matching MRF lines |
$5.28–$222 | $22–$925 | varies |
| X-Ray Exam Breast Specimen (76098) | $386.64 | $1,611 | 0.7× |
| X-Ray Exam Entire Spi 1 Vw (72081) range across 3 matching MRF lines |
$14.09–$249.60 | $58.70–$1,040 | varies |
| X-Ray Exam Entire Spi 2/3 Vw (72082) range across 2 matching MRF lines |
$26.27–$610.56 | $109.46–$2,544 | varies |
| X-Ray Exam Entire Spi 4/5 Vw (72083) range across 2 matching MRF lines |
$29.56–$346.80 | $123.18–$1,445 | varies |
| X-Ray Exam Hip Uni 1 View (73501) range across 5 matching MRF lines |
$6.24–$210.24 | $26–$876 | varies |
| X-Ray Exam Hip Uni 2-3 Views (73502) range across 12 matching MRF lines |
$7.20–$209.28 | $30–$872 | varies |
| X-Ray Exam Hips Bi 2 Views (73521) range across 9 matching MRF lines |
$7.44–$282.24 | $31–$1,176 | varies |
| X-Ray Exam Hips Bi 3-4 Views (73522) range across 6 matching MRF lines |
$9.84–$162.96 | $41–$679 | varies |
| X-Ray Exam L-S Spine Bending (72114) range across 5 matching MRF lines |
$10.80–$401.52 | $45–$1,673 | varies |
| X-Ray Exam Neck Spine 2-3 Vw (72040) range across 6 matching MRF lines |
$7.20–$276.72 | $30–$1,153 | varies |
| X-Ray Exam Neck Spine 6/>Vws (72052) range across 5 matching MRF lines |
$11.76–$434.16 | $49–$1,809 | varies |
| X-Ray Exam Unilat Ribs/Chest (71101) range across 7 matching MRF lines |
$8.40–$313.92 | $35–$1,308 | varies |
| X-ray eye for foreign body (70030) range across 5 matching MRF lines |
$11.12–$176.40 | $46.32–$735 | varies |
| X-ray humerus (73060) range across 8 matching MRF lines |
$11.45–$170.40 | $47.70–$710 | varies |
| X-ray IV pyelogram (ivp) (74400) | $462 | $1,925 | 2.5× |
| X-ray IV pyelogram+tomography (74415) | $552.48 | $2,302 | 3.0× |
| X-Ray Jaw <4 Vw - Xr Mandible < 4 Views (70100) range across 4 matching MRF lines |
$5.76–$272.64 | $24–$1,136 | varies |
| X-Ray Knee Bilat Standing - Xr Knees Anteroposterior Standing Bilat (73565) range across 6 matching MRF lines |
$6–$206.40 | $25–$860 | varies |
| X-Ray Lumbar Spine 2/3 Vw - Xr Lumbar Spine 2-3 Views (72100) range across 6 matching MRF lines |
$7.20–$321.12 | $30–$1,338 | varies |
| X-ray nose-rectum child f.b. (76010) range across 3 matching MRF lines |
$5.76–$100.80 | $24–$420 | varies |
| X-Ray Ribs, Chest 4+ Vw - Xr Ribs 3 Vws Bil W/ Chest Posteroanterior (71111) range across 6 matching MRF lines |
$10.32–$365.04 | $43–$1,521 | varies |
| X-Ray Sacroiliac Jts 3+ Vw - Xr Sacroiliac Joints 3+ Views (72202) range across 6 matching MRF lines |
$6–$135.36 | $25–$564 | varies |
| X-Ray Sacrum/Coccyx 2+ Vw - Xr Sacrum Coccyx 2+ Views (72220) range across 6 matching MRF lines |
$5.52–$234.72 | $23–$978 | varies |
| X-Ray Sinuses 3+ Vw - Xr Paranasal Sinuses 3+ Views (70220) range across 8 matching MRF lines |
$7.92–$322.80 | $33–$1,345 | varies |
| X-Ray Skull 4+ Vw - Xr Skull Complete 4+ Views (70260) range across 8 matching MRF lines |
$11.04–$285.60 | $46–$1,190 | varies |
| X-ray thoracic spine 4 vw (72074) range across 2 matching MRF lines |
$15.57–$304.56 | $64.86–$1,269 | varies |
| X-Ray Tmj Unilat (70328) | $148.32 | $618 | 1.6× |
| X-Ray Urinary Tract Exam With Contrast Material (74420) range across 4 matching MRF lines |
$72.48–$747.84 | $47–$3,116 | varies |
| X-Rays Bone Length Studies (77073) range across 3 matching MRF lines |
$21.60–$321.84 | $90–$1,341 | varies |
| X-Rays Bone Survey Complete (77075) range across 2 matching MRF lines |
$36.72–$390 | $153–$1,625 | varies |
| Xr c-spine 4 or 5 views (72050) range across 6 matching MRF lines |
$10.08–$373.68 | $42–$1,557 | varies |
| Xr facial bones less than 3 views (70140) range across 5 matching MRF lines |
$6.72–$223.92 | $28–$933 | varies |
| Xr orbits complete 4 views (70200) range across 7 matching MRF lines |
$16.56–$169.68 | $68.98–$707 | varies |
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.