Imaging prices at Lutheran Kosciusko Hospital
Warsaw, IN · every code in this section with a posted price and a Medicare benchmark.
332 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) | $3,275.58 | $15,598 | 2.2× |
| Abdomen 1 View (74018) range across 9 matching MRF lines |
$6.72–$126 | $32–$600 | varies |
| Abdomen 2 views (74019) range across 4 matching MRF lines |
$6.09–$107.94 | $29–$514 | varies |
| Acute Gastrointestinal Blood Loss Imaging (78278) | $639.24 | $3,044 | 1.5× |
| Angio internal mammary (75756) | $2,316.30 | $11,030 | 0.7× |
| Angio pulmonary bilat (75743) | $2,316.30 | $11,030 | 0.7× |
| Angiography Adrenal Bilateral Slctv Rs&I (75733) | $1,762.53 | $8,393 | 0.5× |
| Angiography extremity bilateral rs&i (75716) range across 9 matching MRF lines |
$2,316.51 | $167–$11,031 | 0.7× |
| Angiography extremity unilateral rs&i (75710) range across 9 matching MRF lines |
$2,316.30–$2,316.51 | $533–$11,031 | varies |
| Angiography pulmonary unilateral slctv rs&i (75741) | $2,316.30 | $11,030 | 0.7× |
| Angrph pulmonary nonslctv cath/ven njx rs&i (75746) | $1,551.48 | $7,388 | 0.5× |
| Ankle 2 views (73600) range across 8 matching MRF lines |
$4.62–$121.80 | $22–$580 | varies |
| Aortography thoracic serialography rs&i (75605) range across 6 matching MRF lines |
$3,837.75 | $544–$18,275 | 0.7× |
| Aortography thoracic w/o serialography rs&i (75600) | $2,316.30 | $11,030 | 0.7× |
| Artery X-Rays Abdomen (75726) | $4,420.92 | $21,052 | 0.8× |
| Artery X-Rays Adrenal Gland (75731) | $1,527.12 | $7,272 | 0.5× |
| Artery X-Rays Pelvis (75736) | $3,837.75 | $18,275 | 0.7× |
| Artery X-Rays Spine (75705) | $3,837.75 | $18,275 | 0.7× |
| Arthrogram ankle (73615) | $416.22 | $1,982 | 1.1× |
| Arthrogram hip (73525) | $416.22 | $1,982 | 1.1× |
| Arthrogram Wrist (73115) | $332.64 | $1,584 | 0.9× |
| Basic radiation dosimetry calculation (77300) | $280.77 | $1,337 | 2.0× |
| Bone age studies (77072) range across 4 matching MRF lines |
$131.20–$173.88 | $624.75–$828 | varies |
| Bone Imaging 3 Phase (78315) | $852.18 | $4,058 | 2.0× |
| Bone Imaging Limited Area (78300) | $608.37 | $2,897 | 1.4× |
| Bone Imaging Whole Body (78306) | $760.20 | $3,620 | 1.8× |
| Bone survey infant (77076) range across 2 matching MRF lines |
$232.89–$305.34 | $1,109–$1,454 | varies |
| Brain Imaging Pet Metabolic Evaluation (78608) | $2,843.40 | $13,540 | 1.9× |
| Cardiac MRI w/w/o contrast & further seq (75561) | $70.35 | $335 | 0.2× |
| Cardiac MRI w/w/o contrast w/stress (75563) range across 3 matching MRF lines |
$80.85–$365.19 | $385–$1,739 | varies |
| Cat Scan Follow-Up Study (76380) | $249.27 | $1,187 | 2.7× |
| Chest 1 view (71045) range across 11 matching MRF lines |
$4.62–$130.41 | $22–$621 | varies |
| Chest 2 views (71046) range across 12 matching MRF lines |
$8.40–$137.34 | $40–$654 | varies |
| Chest 3 views (71047) range across 3 matching MRF lines |
$23.10–$174.72 | $110–$832 | varies |
| Chest 4 or more views (71048) range across 4 matching MRF lines |
$15.12–$174.72 | $72–$832 | varies |
| Cineradiograpy/vidradiograpy xcpt where spec (76120) | $10.92 | $52 | 0.1× |
| Clavicle complete (73000) range across 7 matching MRF lines |
$4.83–$171.36 | $23–$816 | varies |
| Computed Tomography Thorax Lw Dose Lng Ca Scr C- (71271) range across 4 matching MRF lines |
$15.75–$63.21 | $75–$301 | varies |
| Continuing medical physics consltj pr wk (77336) | $327.60 | $1,560 | 2.3× |
| Contrast Exam Abdominl Aorta (75625) range across 5 matching MRF lines |
$2,316.51 | $544–$11,031 | 0.7× |
| Contrast X-Ray Bladder (74430) range across 5 matching MRF lines |
$29.40–$338.31 | $140–$1,611 | varies |
| Contrast X-Ray Of Elbow (73085) | $416.22 | $1,982 | 1.1× |
| Contrast X-Ray Of Knee Joint (73580) | $416.22 | $1,982 | 1.1× |
| CT abdomen and pelvis without and with contrast (74178) range across 5 matching MRF lines |
$759.78–$2,279.97 | $3,618–$10,857 | varies |
| CT abdomen and pelvis without contrast (74176) range across 6 matching MRF lines |
$668.64–$1,881.81 | $3,184–$8,961 | varies |
| CT abdomen w contrast (74160) range across 5 matching MRF lines |
$608.16–$1,418.13 | $2,896–$6,753 | varies |
| CT abdomen w wo contrast (74170) range across 3 matching MRF lines |
$638.19–$1,624.14 | $3,039–$7,734 | varies |
| CT abdomen w/o contrast (74150) range across 2 matching MRF lines |
$608.16–$1,227.03 | $2,896–$5,843 | varies |
| CT Angio Abdomen and Pelvis (74174) | $1,632.54 | $7,774 | 4.4× |
| CT Angio Chest (71275) | $1,327.41 | $6,321 | 7.2× |
| CT Angio Head (70496) range across 3 matching MRF lines |
$1,148.91–$1,217.79 | $5,471–$5,799 | varies |
| CT angio hrt w/3d image (75574) range across 5 matching MRF lines |
$60.90–$519.75 | $290–$2,475 | varies |
| Ct Angio Lwr Extr W/O&W/Dye (73706) | $1,100.19 | $5,239 | 5.9× |
| CT Angio Neck (70498) | $1,217.79 | $5,799 | 6.6× |
| Ct Angio Upr Extrm W/O&W/Dye (73206) | $942.69 | $4,489 | 5.1× |
| CT cervical spine w/ contrast (72126) | $1,428.63 | $6,803 | 3.9× |
| CT cervical spine w/o contrast (72125) range across 4 matching MRF lines |
$420–$1,227.03 | $2,000–$5,843 | varies |
| CT cervical spine w/wo cont (72127) | $1,428.63 | $6,803 | 7.7× |
| CT chest w contrast (71260) range across 5 matching MRF lines |
$608.16–$1,276.80 | $2,896–$6,080 | varies |
| CT chest w/wo contrast (71270) range across 2 matching MRF lines |
$638.19–$1,494.15 | $3,039–$7,115 | varies |
| CT head/brain with contrast (70460) range across 2 matching MRF lines |
$608.16–$1,103.34 | $2,896–$5,254 | varies |
| CT head/brain without and with contrast (70470) range across 2 matching MRF lines |
$638.19–$1,245.30 | $3,039–$5,930 | varies |
| CT heart contrast eval cardiac structure&morph (75572) range across 3 matching MRF lines |
$47.67–$519.75 | $227–$2,475 | varies |
| CT heart no contrast quant eval coronry calcium (75571) range across 5 matching MRF lines |
$10.50–$15.96 | $50–$76 | varies |
| CT hrt w/3d image congen (75573) | $68.67 | $327 | 0.2× |
| CT iac w contrast (70481) range across 8 matching MRF lines |
$608.16–$1,200.78 | $2,896–$5,718 | varies |
| CT l-spine w&w/o contrast (72133) | $1,428.63 | $6,803 | 7.7× |
| CT lower ext w/o (73700) range across 29 matching MRF lines |
$420–$924.84 | $2,000–$4,404 | varies |
| CT lower extremity w/contrast material (73701) range across 26 matching MRF lines |
$608.16–$1,132.74 | $2,896–$5,394 | varies |
| CT lumbar spine w contrast (72132) | $1,610.91 | $7,671 | 4.4× |
| CT lumbar spine w/o contrast (72131) range across 3 matching MRF lines |
$420–$1,227.03 | $2,000–$5,843 | varies |
| CT maxillofacial w contrast (70487) range across 5 matching MRF lines |
$420–$1,094.31 | $2,000–$5,211 | varies |
| CT maxillofacial wo contrast (70486) range across 6 matching MRF lines |
$420–$972.51 | $2,000–$4,631 | varies |
| CT neck tissue combo (70492) range across 3 matching MRF lines |
$441–$1,366.05 | $2,100–$6,505 | varies |
| Ct Orbit/Ear/Fossa W/O&W/Dye (70482) range across 11 matching MRF lines |
$441–$1,459.08 | $2,100–$6,948 | varies |
| CT orbits w/o contrast (70480) range across 11 matching MRF lines |
$420–$1,121.40 | $2,000–$5,340 | varies |
| CT pelvis w&w/o contrast (72194) range across 3 matching MRF lines |
$820.89–$1,185.03 | $3,909–$5,643 | varies |
| CT pelvis w/o contrast (72192) range across 4 matching MRF lines |
$420–$974.19 | $2,000–$4,639 | varies |
| CT scans face/jaw combo (70488) range across 6 matching MRF lines |
$441–$1,185.45 | $2,100–$5,645 | varies |
| CT soft tissue neck w contrast (70491) range across 3 matching MRF lines |
$420–$1,235.64 | $2,000–$5,884 | varies |
| CT soft tissue neck w/o contrast (70490) range across 3 matching MRF lines |
$420–$1,064.07 | $2,000–$5,067 | varies |
| CT thoracic spine w contrast (72129) | $1,428.63 | $6,803 | 7.7× |
| CT thoracic spine w/o contrast (72128) range across 3 matching MRF lines |
$668.64–$1,227.03 | $3,184–$5,843 | varies |
| CT thoracic spine w/wo cont (72130) | $1,304.31 | $6,211 | 7.0× |
| CT thorax w/o contrast (71250) range across 7 matching MRF lines |
$420–$1,185.45 | $2,000–$5,645 | varies |
| CT upper ext wo (73200) range across 31 matching MRF lines |
$420–$924.84 | $2,000–$4,404 | varies |
| CT upper extremity with contrast (73201) range across 32 matching MRF lines |
$782.46–$1,132.74 | $3,726–$5,394 | varies |
| Cta Abdl Aorta&Bi Iliofem W/Contrast&Postp (75635) | $1,672.02 | $7,962 | 9.0× |
| Cta Abdomen (74175) | $1,216.11 | $5,791 | 6.6× |
| CTA pelvis (72191) | $886.20 | $4,220 | 4.8× |
| Dilation ureters/urethra rs&i (74485) | $1,525.44 | $7,264 | 0.7× |
| Diskography lumbar (72295) range across 6 matching MRF lines |
$1,767.15–$2,210.67 | $8,415–$10,527 | varies |
| Doppler Echo Fetal Puls Spectral F/U/Repeat (76828) | $26.67 | $127 | 0.2× |
| Doppler Echo Fetal Spectral Display Complete (76827) | $37.17 | $177 | 0.3× |
| Doppler Fetal Mid Cerebral Artery (76821) | $45.78 | $218 | 0.4× |
| Dxa Bone Density Axial (77080) range across 3 matching MRF lines |
$7.77–$207.90 | $37–$990 | varies |
| Dxa bone density study 1/>sites appendiclr skel (77081) range across 3 matching MRF lines |
$7.77–$177.03 | $37–$843 | varies |
| Echo exam of fetal heart (76825) | $136.71 | $651 | 0.2× |
| Echo exam uterus (76831) range across 4 matching MRF lines |
$44.31–$101.22 | $211–$482 | varies |
| Echocardiography, fetal, cardiovascular system, real time with image documentation (2D), with or without M-mode… (76826) | $81.06 | $386 | 0.3× |
| Esophagram (74220) | $233.31 | $1,111 | 1.3× |
| Fetal Biophys Profile W/Nst (76818) range across 5 matching MRF lines |
$29.82–$843.57 | $142–$4,017 | varies |
| Fetal Biophysical Profile W/O Non-Stress Testing (76819) range across 5 matching MRF lines |
$25.83–$843.57 | $123–$4,017 | varies |
| Fluoroscopy up to 1 hr (76000) range across 11 matching MRF lines |
$41.37–$389.34 | $20–$1,854 | varies |
| Follow-Up Angiography (75898) range across 7 matching MRF lines |
$2,082.36 | $219–$9,916 | 0.6× |
| Foot 2 views (73620) range across 14 matching MRF lines |
$10.71–$120.33 | $51–$573 | varies |
| Forearm 2 views (73090) range across 10 matching MRF lines |
$4.62–$145.53 | $22–$693 | varies |
| Gastric emptying imaging study (78264) | $1,141.56 | $5,436 | 2.7× |
| Gated Heart Planar Single (78472) range across 3 matching MRF lines |
$24.78–$1,582.14 | $118–$7,534 | varies |
| Hand 2 views (73120) range across 8 matching MRF lines |
$11.55–$121.80 | $55–$580 | varies |
| Hepatc Vngrph Wdg/Fr Hemodyn Eval Rs&I (75889) | $2,316.30 | $11,030 | 0.7× |
| Hepatc Vngrph Wdg/Fr W/O Hemodyn Eval Rs&I (75891) | $1,710.45 | $8,145 | 0.5× |
| Hepatobil Syst Image W/Drug (78227) | $874.44 | $4,164 | 1.5× |
| Hepatobiliary System Imaging (78226) | $443.10 | $2,110 | 1.0× |
| Ht Musc Image Planar Mult (78454) | $36.33 | $173 | 0.0× |
| Ht Muscle Image Spect Sing (78451) range across 7 matching MRF lines |
$183.12–$1,096.83 | $164–$5,223 | varies |
| Hysterosalpingogram (74740) | $661.08 | $3,148 | 2.6× |
| Infant hip ultrasound with hip movement (dynamic) (76885) | $459.27 | $2,187 | 5.0× |
| Joint Survey Single View (77077) range across 2 matching MRF lines |
$20.37–$32.34 | $97–$154 | varies |
| K Flow/Funct Image Multiple (78709) | $1,589.07 | $7,567 | 2.8× |
| K Flow/Funct Image W/Drug (78708) | $1,086.12 | $5,172 | 1.9× |
| K Flow/Funct Image W/O Drug (78707) | $950.88 | $4,528 | 1.7× |
| Kidney Imaging Morphoogy W/Vascular Flow (78701) | $702.66 | $3,346 | 1.7× |
| Knee 3 Views (73562) range across 9 matching MRF lines |
$5.46–$211.26 | $26–$1,006 | varies |
| Liver & Spleen Imaging Static Only (78215) | $782.25 | $3,725 | 1.8× |
| Lung Ventilat&Perfus Imaging (78582) | $1,239.21 | $5,901 | 2.2× |
| Lymph System Imaging (78195) range across 2 matching MRF lines |
$32.13–$1,034.67 | $153–$4,927 | varies |
| Meckels Divert Exam (78290) | $685.02 | $3,262 | 1.6× |
| Mlc imrt design & construction per imrt plan (77338) | $294.63 | $1,403 | 0.7× |
| Mra Head W/O & W/Contrast Material (70546) | $1,575.84 | $7,504 | 4.3× |
| MRA head w/o contrast (70544) range across 3 matching MRF lines |
$813.96–$1,323.84 | $3,876–$6,304 | varies |
| MRA head with contrast (70545) range across 2 matching MRF lines |
$790.44–$1,450.05 | $3,764–$6,905 | varies |
| Mra Neck W/O &W/Contrast Material (70549) | $1,575.84 | $7,504 | 4.3× |
| MRA neck w/o contrast (70547) range across 2 matching MRF lines |
$775.32–$1,323.84 | $3,692–$6,304 | varies |
| MRI abdomen w/o contrast (74181) range across 4 matching MRF lines |
$790.44–$1,526.28 | $3,764–$7,268 | varies |
| MRI any jt lower extrem w/contrast material (73722) range across 12 matching MRF lines |
$790.44–$1,459.08 | $3,764–$6,948 | varies |
| MRI any jt lower extrem w/o & w/contrast matrl (73723) range across 12 matching MRF lines |
$820.89–$958.44 | $3,909–$4,564 | varies |
| MRI any jt upper extremity w/contrast matrl (73222) range across 18 matching MRF lines |
$546–$1,762.74 | $2,600–$8,394 | varies |
| MRI Breast W/O Contrast Bilateral (77047) | $888.30 | $4,230 | 3.5× |
| MRI cardiac w/o cont stress (75559) | $78.54 | $374 | 0.1× |
| MRI cardiac w/o contrast (75557) | $59.64 | $284 | 0.2× |
| MRI cervical spine w contrast (72142) range across 3 matching MRF lines |
$790.44–$1,386.84 | $3,764–$6,604 | varies |
| MRI cervical spine w/o cont (72141) range across 3 matching MRF lines |
$546–$1,386.84 | $2,600–$6,604 | varies |
| MRI chest w/o contrast (71550) range across 3 matching MRF lines |
$790.44–$1,575.84 | $3,764–$7,504 | varies |
| MRI chest wo w contrast (71552) range across 3 matching MRF lines |
$820.68–$2,083.41 | $3,908–$9,921 | varies |
| MRI lower extrem oth/thn jt w/contrast matrl (73719) range across 9 matching MRF lines |
$790.44–$1,386.84 | $3,764–$6,604 | varies |
| MRI lower extrem oth/thn jt w/o & w/contr matr (73720) range across 12 matching MRF lines |
$820.89–$1,812.51 | $3,909–$8,631 | varies |
| MRI lower extrem oth/thn jt w/o contr matrl (73718) range across 12 matching MRF lines |
$546–$790.44 | $2,600–$3,764 | varies |
| MRI lumbar spine w contrast (72149) range across 2 matching MRF lines |
$790.44–$1,607.13 | $3,764–$7,653 | varies |
| Mri Neck Spine W/O & W/Dye (72156) range across 3 matching MRF lines |
$567–$1,954.05 | $2,700–$9,305 | varies |
| MRI orbit face &/neck w/o contrast (70540) range across 10 matching MRF lines |
$790.44–$1,922.34 | $3,764–$9,154 | varies |
| MRI orbit face neck w contrast (70542) range across 5 matching MRF lines |
$790.44–$2,017.05 | $3,764–$9,605 | varies |
| Mri Orbt/Fac/Nck W/O &W/Dye (70543) | $820.89 | $3,909 | 2.2× |
| MRI pelvis w/o & w contrast (72197) range across 6 matching MRF lines |
$820.68–$1,985.55 | $3,908–$9,455 | varies |
| MRI pelvis w/o contrast (72195) range across 2 matching MRF lines |
$790.44–$1,575.84 | $3,764–$7,504 | varies |
| MRI thoracic spine w/o contrast (72146) range across 6 matching MRF lines |
$546–$1,378.86 | $2,600–$6,566 | varies |
| MRI upper extremity oth than jt w/o contr matrl (73218) range across 20 matching MRF lines |
$546–$1,346.73 | $2,600–$6,413 | varies |
| Mri Uppr Extremity W/O&W/Dye (73220) range across 19 matching MRF lines |
$820.89–$1,954.05 | $3,909–$9,305 | varies |
| MRI, abdomen, combo (74183) range across 4 matching MRF lines |
$820.68–$1,900.71 | $3,908–$9,051 | varies |
| MRI, dorsal spine combo (72157) range across 3 matching MRF lines |
$567–$1,954.05 | $2,700–$9,305 | varies |
| MRI, dorsal spine contrast (72147) | $820.89 | $3,909 | 2.2× |
| MRI, joint upper extrem (73221) range across 18 matching MRF lines |
$546–$1,386.84 | $2,600–$6,604 | varies |
| MRI, joint upper extrem combo (73223) range across 12 matching MRF lines |
$820.89–$1,271.55 | $3,909–$6,055 | varies |
| MRI, lumbar spine combo (72158) range across 3 matching MRF lines |
$567–$1,954.05 | $2,700–$9,305 | varies |
| Myocardial Imaging Infarct Avid Planar Qual/Quan (78466) | $19.11 | $91 | 0.0× |
| Myocardial Perfusion Planar 1 Study Rest/Stress (78453) | $26.88 | $128 | 0.0× |
| Myocardial Spect Multiple Studies (78452) range across 9 matching MRF lines |
$253.26–$2,248.26 | $180–$10,706 | varies |
| N-invas est c ffr sw aly CTA (75580) | $1,185.45 | $5,645 | 1.3× |
| Neck soft tissue (70360) range across 10 matching MRF lines |
$4.62–$144.06 | $22–$686 | varies |
| Nonvascular Shunt X-Ray (75809) | $116.55 | $555 | 1.1× |
| Ntsty modul radthx pln dose-vol histos (77301) | $2,807.70 | $13,370 | 1.9× |
| Nuclear Rx Intra-Arterial (79445) | $250.53 | $1,193 | 1.0× |
| Nuclear Rx Oral Admin (79005) | $47.88 | $228 | 0.2× |
| Ob us nuchal meas 1 gest (76813) range across 3 matching MRF lines |
$60.69–$90.93 | $289–$433 | varies |
| Oph bmtry us echograpy a-scan io lens pwr cal (76519) | $17.01 | $81 | 0.2× |
| Ophthalmic ultrasound dx b-scan w/wo a-scan (76512) | $49.56 | $236 | 0.4× |
| Ophthalmic US Dx Corneal Pachymetry Uni/Bi (76514) | $8.19 | $39 | 0.3× |
| Parathyroid Planar Imaging (78070) | $902.16 | $4,296 | 2.1× |
| Pelvis 1 or 2 views (72170) range across 8 matching MRF lines |
$7.98–$143.01 | $24–$681 | varies |
| PET image w/CT, full body (78816) | $2,843.40 | $13,540 | 1.9× |
| PET imaging CT attenuation skull base mid-thigh (78815) range across 8 matching MRF lines |
$2,252.30–$2,843.40 | $10,725.23–$13,540 | varies |
| Prq Transhepatc Portograpy Hemodyn Eval Rs&I (75885) | $1,212.75 | $5,775 | 0.4× |
| Pulmonary Perfusion Imaging Particulate (78580) | $560.91 | $2,671 | 1.3× |
| Radex Abd Compl Aqt Abd W/S/E/D Views 1 View Ch (74022) range across 7 matching MRF lines |
$8.82–$304.50 | $42–$1,450 | varies |
| Radex abscess/fistula/sinus tract rs&i (76080) range across 6 matching MRF lines |
$298.41–$436.38 | $1,421–$2,078 | varies |
| Radex Ankle Complete Minimum 3 Views (73610) range across 9 matching MRF lines |
$5.04–$168.42 | $24–$802 | varies |
| Radex Calcaneus Minimum 2 Views (73650) range across 9 matching MRF lines |
$4.62–$144.06 | $21–$686 | varies |
| Radex elbow complete minimum 3 views (73080) range across 8 matching MRF lines |
$5.04–$126.84 | $24–$604 | varies |
| Radex Facial Bones Complete Minimum 3 Views (70150) range across 14 matching MRF lines |
$7.35–$212.73 | $35–$1,013 | varies |
| Radex fingr minimum 2 views (73140) range across 38 matching MRF lines |
$14.91–$106.89 | $19–$509 | varies |
| Radex foot complete minimum 3 views (73630) range across 11 matching MRF lines |
$4.62–$168.42 | $22–$802 | varies |
| Radex Hand Minimum 3 Views (73130) range across 9 matching MRF lines |
$4.83–$150.36 | $23–$716 | varies |
| Radex lower extremity infant minimum 2 views (73592) range across 10 matching MRF lines |
$15.12–$119.28 | $72–$568 | varies |
| Radex Nasal Bones Complete Minimum 3 Views (70160) range across 8 matching MRF lines |
$4.83–$144.06 | $23–$686 | varies |
| Radex Ribs Unilateral 2 Views (71100) range across 10 matching MRF lines |
$6.30–$147.21 | $30–$701 | varies |
| Radex shoulder complete minimum 2 views (73030) range across 9 matching MRF lines |
$5.46–$175.56 | $26–$836 | varies |
| Radex Sinuses Paransl < 3 Views (70210) range across 9 matching MRF lines |
$4.83–$154.35 | $23–$735 | varies |
| Radex sm int w/mlt srl imges via enteroclss tube (74251) | $378.63 | $1,803 | 2.0× |
| Radex Spine 1 View Specify Level (72020) range across 21 matching MRF lines |
$6.51–$104.58 | $21–$498 | varies |
| Radex Sternum Minimum 2 Views (71120) range across 7 matching MRF lines |
$5.67–$166.74 | $27–$794 | varies |
| Radex Temporomandble Jt Opn & Clsd Mouth Bilat (70330) range across 2 matching MRF lines |
$127.47–$184.38 | $607–$878 | varies |
| Radex Toe Minimum 2 Views (73660) range across 33 matching MRF lines |
$7.14–$106.89 | $18–$509 | varies |
| Radex upper extremity infant minimum 2 views (73092) range across 4 matching MRF lines |
$13.86–$119.28 | $66–$568 | varies |
| Radex Wrist Complete Minimum 3 Views (73110) range across 17 matching MRF lines |
$5.04–$150.36 | $24–$716 | varies |
| Radiation Delivery Stereotactic Cranial Linear (77372) | $11,807.25 | $56,225 | 1.5× |
| Radiation treatment delivery level 1 (77402) | $179.55 | $855 | 1.7× |
| Radiation treatment delivery level 2 (77407) | $236.04 | $1,124 | 0.6× |
| Radiation treatment delivery level 3 (77412) | $419.79 | $1,999 | 0.7× |
| Radiolog exam mandible compl minimum 4 views (70110) range across 7 matching MRF lines |
$6.93–$212.73 | $33–$1,013 | varies |
| Radiologic Exam Abdomen 3+ Views - Xr Abdomen 3+ Views (74021) range across 6 matching MRF lines |
$23.10–$107.94 | $110–$514 | varies |
| Radiologic exam colon double contrast study (74280) | $608.37 | $2,897 | 3.3× |
| Radiologic exam colon single contrast study (74270) | $485.31 | $2,311 | 2.6× |
| Radiologic Exam Esophagus Double Contrast Study (74221) | $233.31 | $1,111 | 1.3× |
| Radiologic exam knee complete 4/more views (73564) range across 35 matching MRF lines |
$6.51–$219.03 | $31–$1,043 | varies |
| Radiologic exam pelvis compl minimum 3 views (72190) range across 9 matching MRF lines |
$6.09–$280.77 | $29–$1,337 | varies |
| Radiologic Exam Small Int Single Contrast Study (74250) range across 3 matching MRF lines |
$54.18–$378.84 | $258–$1,804 | varies |
| Radiologic exam swallow function contrast study (74230) | $233.31 | $1,111 | 1.3× |
| Radiologic exam upr gi trc double contrast study (74246) | $478.59 | $2,279 | 2.6× |
| Radiologic examination femur 1 view (73551) range across 5 matching MRF lines |
$14.49–$90.30 | $69–$430 | varies |
| Radiologic examination femur minimum 2 views (73552) range across 9 matching MRF lines |
$17.01–$180.81 | $81–$861 | varies |
| Radiologic examination knee 1/2 views (73560) range across 10 matching MRF lines |
$5.25–$121.80 | $25–$580 | varies |
| Radiologic Examination Osseous Survey Limited (77074) | $149.31 | $711 | 1.3× |
| Radiologic examination tibia & fibula 2 views (73590) range across 7 matching MRF lines |
$4.83–$166.74 | $23–$794 | varies |
| Ribs bilateral 3 views (71110) range across 10 matching MRF lines |
$7.56–$244.02 | $36–$1,162 | varies |
| Rp loclzj tum plnr 1 area single day imaging (78800) range across 4 matching MRF lines |
$1,096.83 | $86–$5,223 | 2.6× |
| Rp Loclzj Tum Plnr Whole Body 2+ Days Imaging (78804) | $1,285.62 | $6,122 | 2.2× |
| Rp Loclzj Tum Plnr Whole Body Single Day Imaging (78802) | $1,296.96 | $6,176 | 2.3× |
| Rp Loclzj Tum Spect 1 Area Single Day Imaging (78803) range across 11 matching MRF lines |
$1,062.18 | $129–$5,058 | 1.8× |
| Scapula (73010) range across 11 matching MRF lines |
$6.09–$136.08 | $29–$648 | varies |
| Screening Digital Breast Tomosynthesis Bi (77063) range across 10 matching MRF lines |
$13.23–$19.32 | $63–$92 | varies |
| Shoulder 1 view (73020) range across 8 matching MRF lines |
$6.72–$102.48 | $32–$488 | varies |
| Shoulder Arthrography (73040) | $511.35 | $2,435 | 1.4× |
| Skull less than 4 views (70250) range across 9 matching MRF lines |
$6.93–$166.11 | $33–$791 | varies |
| Special dosimetry (77331) | $192.36 | $916 | 1.4× |
| Special Physics Consult (77370) | $514.71 | $2,451 | 3.6× |
| Special teletherapy port plan (77321) | $627.90 | $2,990 | 1.6× |
| Special treatment procedure (77470) | $935.97 | $4,457 | 1.6× |
| Stereotactic Body Radiation Delivery (77373) | $2,614.92 | $12,452 | 1.4× |
| Sternoclavicular joints (71130) range across 9 matching MRF lines |
$6.30–$176.61 | $30–$841 | varies |
| Superior sagittal sinus venogram (75870) | $1,497.72 | $7,132 | 0.4× |
| Telethx isodose pln cplx w/basic dosimetry (77307) | $746.55 | $3,555 | 1.9× |
| Telethx isodose pln smpl w/dosimetry calculation (77306) | $530.88 | $2,528 | 1.3× |
| Ther Rad Simulaj-Aided Field Setting Complex (77290) | $935.97 | $4,457 | 2.4× |
| Ther Rad Simulaj-Aided Field Setting Intermed (77285) | $595.98 | $2,838 | 1.5× |
| Ther rad simulaj-aided field setting simple (77280) | $655.20 | $3,120 | 4.6× |
| Thoracic spine 2 views (72070) range across 8 matching MRF lines |
$6.30–$182.49 | $30–$869 | varies |
| Thoracic spine 3 views (72072) range across 8 matching MRF lines |
$6.09–$262.71 | $29–$1,251 | varies |
| Thoracolumbar 2 views (72080) range across 10 matching MRF lines |
$6.51–$182.49 | $31–$869 | varies |
| Thyroid Imaging With Vascular Flow (78013) | $514.08 | $2,448 | 1.2× |
| Thyroid Uptake W/Blood Flow Sngle/Mult Quan Meas (78014) | $608.37 | $2,897 | 1.4× |
| Tx Devices Design & Construction Complex (77334) | $669.90 | $3,190 | 1.7× |
| Tx devices design & construction intermediate (77333) | $291.06 | $1,386 | 2.0× |
| Tx devices design & construction simple (77332) | $187.53 | $893 | 1.3× |
| Ultrasound Breast Limited (76642) range across 5 matching MRF lines |
$17.43–$145.11 | $83–$691 | varies |
| Ultrasound elastography first target lesion (76982) range across 2 matching MRF lines |
$88.20–$99.12 | $420–$472 | varies |
| Ultrasound Elastography Parenchyma (76981) range across 2 matching MRF lines |
$88.20–$99.12 | $420–$472 | varies |
| Ultrasound Exam Aaa Screen (76706) | $148.89 | $709 | 1.3× |
| Ultrasound, abdomen limited (76705) range across 10 matching MRF lines |
$16.17–$534.24 | $77–$2,544 | varies |
| Umbilical-artery Doppler (OB) (76820) | $23.73 | $113 | 0.2× |
| Unlisted Dx Radiographic Procedure (76499) range across 2 matching MRF lines |
$8.19–$56.49 | $39–$269 | varies |
| Upper gi w/o kub (74240) | $432.81 | $2,061 | 2.3× |
| Urethrocystogram voiding (74455) | $469.77 | $2,237 | 1.9× |
| Urethrocystography retrograde (74450) | $261.24 | $1,244 | 1.0× |
| Us breast unilateral complete (76641) | $262.71 | $1,251 | 2.4× |
| Us chest (76604) range across 2 matching MRF lines |
$15.12–$255.99 | $72–$1,219 | varies |
| Us complete joint (76881) range across 7 matching MRF lines |
$17.43–$270.69 | $83–$1,289 | varies |
| Us exam, pelvic, limited (76857) range across 9 matching MRF lines |
$24.36–$261.87 | $116–$1,247 | varies |
| Us kidney transplant (76776) range across 5 matching MRF lines |
$20.79–$386.40 | $99–$1,840 | varies |
| Us lmtd joint/oth nonvasc xtr strux r-t w/img (76882) range across 10 matching MRF lines |
$13.44–$270.69 | $64–$1,289 | varies |
| Us ob detailed single fetus (76811) range across 4 matching MRF lines |
$90.09–$475.44 | $429–$2,264 | varies |
| Us ob limited 1 or more fetuses (76815) range across 13 matching MRF lines |
$41.79–$392.28 | $199–$1,868 | varies |
| Us ob transvaginal (76817) range across 6 matching MRF lines |
$48.09–$107.94 | $229–$514 | varies |
| Us pelvic non ob complete (76856) range across 4 matching MRF lines |
$54.18–$477.54 | $258–$2,274 | varies |
| Us pg uter img f&mat 14 wk tabdl 1/1st gestation (76801) range across 8 matching MRF lines |
$60.90–$410.76 | $290–$1,956 | varies |
| Us preg uterus real time f/u trnsabdl per fetus (76816) range across 6 matching MRF lines |
$56.70–$261.87 | $270–$1,247 | varies |
| Us retroperitoneal complete (76770) | $557.55 | $2,655 | 5.0× |
| Us retroperitoneal limited (76775) range across 11 matching MRF lines |
$13.65–$348.81 | $65–$1,661 | varies |
| Us scrotum and contents (76870) | $494.97 | $2,357 | 4.5× |
| Us spinal canal and contents (76800) | $203.49 | $969 | 1.8× |
| Us thyroid (76536) range across 6 matching MRF lines |
$15.33–$582.96 | $73–$2,776 | varies |
| Us transrectal (76872) range across 3 matching MRF lines |
$18.48–$57.96 | $88–$276 | varies |
| Vein X-Ray Chest (75827) range across 9 matching MRF lines |
$111.09–$1,134.84 | $144–$5,404 | varies |
| Vein X-Ray Liver W/O Hemodyn (75887) | $1,082.13 | $5,153 | 0.3× |
| Venogram Sinus/Jugular (75860) | $2,316.30 | $11,030 | 0.7× |
| Venography Adrenal Unilateral (75840) | $1,340.01 | $6,381 | 0.4× |
| Venography caval inferior serialography rs&i (75825) | $2,316.30 | $11,030 | 0.7× |
| Venography extremity bilateral rs&i (75822) range across 8 matching MRF lines |
$958.86 | $136–$4,566 | 0.6× |
| Venography extremity unilateral rs&i (75820) range across 16 matching MRF lines |
$66.99–$543.69 | $91–$2,589 | varies |
| Venography Renal Bilateral (75833) range across 3 matching MRF lines |
$1,583.82 | $194–$7,542 | 0.5× |
| Venography Renal Unilateral (75831) | $2,316.30 | $11,030 | 0.7× |
| Venous sampling by catheter (75893) | $3,837.75 | $18,275 | 0.7× |
| Wrist 2 views (73100) range across 8 matching MRF lines |
$15.75–$121.80 | $75–$580 | varies |
| X-Ray Ac Jts - Xr Acromioclavicular Joints Bilateral (73050) range across 9 matching MRF lines |
$5.88–$182.49 | $28–$869 | varies |
| X-ray antegrade pyelogram tube (74425) | $240.45 | $1,145 | 0.7× |
| X-Ray Aorta Leg Arteries (75630) range across 9 matching MRF lines |
$2,321.34 | $230–$11,054 | 0.7× |
| X-Ray Bend Only L-S Spine (72120) range across 7 matching MRF lines |
$6.51–$156.87 | $31–$747 | varies |
| X-Ray Elbow 2 Vw - Xr Elbow 1-2 Views Right (73070) range across 7 matching MRF lines |
$4.62–$119.28 | $22–$568 | varies |
| X-Ray Exam Breast Specimen (76098) | $443.73 | $2,113 | 0.8× |
| X-Ray Exam Entire Spi 1 Vw (72081) range across 5 matching MRF lines |
$8.19–$101.64 | $39–$484 | varies |
| X-Ray Exam Entire Spi 2/3 Vw (72082) range across 3 matching MRF lines |
$27.09–$203.49 | $129–$969 | varies |
| X-Ray Exam Entire Spi 4/5 Vw (72083) range across 2 matching MRF lines |
$33.18–$44.52 | $158–$212 | varies |
| X-Ray Exam Hip Uni 1 View (73501) range across 18 matching MRF lines |
$5.25–$88.20 | $25–$420 | varies |
| X-Ray Exam Hip Uni 2-3 Views (73502) range across 19 matching MRF lines |
$6.30–$168 | $30–$800 | varies |
| X-Ray Exam Hips Bi 2 Views (73521) range across 17 matching MRF lines |
$6.51–$209.16 | $31–$996 | varies |
| X-Ray Exam Hips Bi 3-4 Views (73522) range across 15 matching MRF lines |
$8.61–$237.09 | $41–$1,129 | varies |
| X-Ray Exam L-S Spine Bending (72114) range across 7 matching MRF lines |
$9.45–$499.38 | $45–$2,378 | varies |
| X-Ray Exam Neck Spine 2-3 Vw (72040) range across 8 matching MRF lines |
$6.30–$136.92 | $30–$652 | varies |
| X-Ray Exam Neck Spine 6/>Vws (72052) range across 9 matching MRF lines |
$10.29–$286.23 | $49–$1,363 | varies |
| X-Ray Exam Unilat Ribs/Chest (71101) range across 11 matching MRF lines |
$7.35–$225.33 | $35–$1,073 | varies |
| X-ray eye for foreign body (70030) range across 8 matching MRF lines |
$2.10–$16.59 | $10–$79 | varies |
| X-ray humerus (73060) range across 12 matching MRF lines |
$14.28–$166.74 | $68–$794 | varies |
| X-ray IV pyelogram (ivp) (74400) range across 2 matching MRF lines |
$15.12–$557.76 | $72–$2,656 | varies |
| X-Ray Jaw <4 Vw - Xr Mandible < 4 Views (70100) range across 7 matching MRF lines |
$5.04–$188.37 | $24–$897 | varies |
| X-Ray Knee Bilat Standing - Xr Knees Anteroposterior Standing Bilat (73565) range across 9 matching MRF lines |
$5.25–$225.33 | $25–$1,073 | varies |
| X-Ray Lumbar Spine 2/3 Vw - Xr Lumbar Spine 2-3 Views (72100) range across 8 matching MRF lines |
$6.30–$174.72 | $30–$832 | varies |
| X-ray nose-rectum child f.b. (76010) range across 7 matching MRF lines |
$5.04–$138.39 | $24–$659 | varies |
| X-Ray Ribs, Chest 4+ Vw - Xr Ribs 3 Vws Bil W/ Chest Posteroanterior (71111) range across 10 matching MRF lines |
$9.03–$224.70 | $43–$1,070 | varies |
| X-Ray Sacroiliac Jts 3+ Vw - Xr Sacroiliac Joints 3+ Views (72202) range across 9 matching MRF lines |
$5.46–$146.16 | $25–$696 | varies |
| X-Ray Sacroiliac Jts <3 Vw - Xr Sacroiliac Joints 1-2 Views (72200) | $115.50 | $550 | 1.0× |
| X-Ray Sacrum/Coccyx 2+ Vw - Xr Sacrum Coccyx 2+ Views (72220) range across 8 matching MRF lines |
$4.83–$175.56 | $23–$836 | varies |
| X-Ray Sinuses 3+ Vw - Xr Paranasal Sinuses 3+ Views (70220) range across 10 matching MRF lines |
$6.93–$147.21 | $33–$701 | varies |
| X-Ray Skull 4+ Vw - Xr Skull Complete 4+ Views (70260) range across 10 matching MRF lines |
$9.66–$184.38 | $46–$878 | varies |
| X-ray thoracic spine 4 vw (72074) | $90.51 | $431 | 0.8× |
| X-Ray Tmj Unilat (70328) range across 4 matching MRF lines |
$155.19–$165.27 | $739–$787 | varies |
| X-Ray Urinary Tract Exam With Contrast Material (74420) range across 5 matching MRF lines |
$63.42–$556.08 | $47–$2,648 | varies |
| X-Rays Bone Length Studies (77073) range across 5 matching MRF lines |
$18.90–$341.88 | $90–$1,628 | varies |
| X-Rays Bone Survey Complete (77075) | $636.72 | $3,032 | 5.8× |
| Xr c-spine 4 or 5 views (72050) range across 9 matching MRF lines |
$8.82–$327.60 | $42–$1,560 | varies |
| Xr facial bones less than 3 views (70140) range across 7 matching MRF lines |
$5.88–$124.53 | $28–$593 | varies |
| XR Mastoids < 3 Views Bilateral (70120) range across 5 matching MRF lines |
$195.09–$206.85 | $929–$985 | varies |
| Xr orbits complete 4 views (70200) range across 9 matching MRF lines |
$7.77–$156.87 | $37–$747 | varies |
| Xr Tomogram Single Plane (76100) | $381.57 | $1,817 | 3.4× |
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.