Imaging prices at M Health Fairview St. John's Hospital
Maplewood, MN · every code in this section with a posted price and a Medicare benchmark.
363 codes. Prices are the hospital's own posted facility charges.
Compare against other hospitals interactively →
| Procedure | Posted cash | Posted gross | × Medicare |
|---|---|---|---|
| 3-D radiotherapy plan dose-volume histograms (77295) range across 4 matching MRF lines |
$1,741.30–$5,479.67 | $4,342.38–$13,665 | varies |
| Abdomen 1 View (74018) | $100.25 | $250 | 1.1× |
| Abdomen 2 views (74019) | $138.35 | $345 | 1.3× |
| Acute Gastrointestinal Blood Loss Imaging (78278) | $589.07 | $1,469 | 1.4× |
| Angio internal mammary (75756) | $3,446.20 | $8,594 | 1.1× |
| Angio pulmonary bilat (75743) range across 2 matching MRF lines |
$3,446.20–$3,448.65 | $8,594–$8,600.12 | varies |
| Angiography extremity bilateral rs&i (75716) | $3,446.20 | $8,594 | 1.1× |
| Angiography extremity unilateral rs&i (75710) range across 7 matching MRF lines |
$3,439.05–$3,452.58 | $8,576.17–$8,609.92 | varies |
| Angiography pulmonary unilateral slctv rs&i (75741) range across 2 matching MRF lines |
$3,446.20–$3,469.69 | $8,594–$8,652.57 | varies |
| Angrph pulmonary nonslctv cath/ven njx rs&i (75746) range across 2 matching MRF lines |
$2,791.66–$2,803.80 | $6,961.73–$6,992 | varies |
| Ankle 2 views (73600) range across 6 matching MRF lines |
$142.74–$214.14 | $355.94–$534 | varies |
| Aortography thoracic serialography rs&i (75605) range across 2 matching MRF lines |
$5,916.52–$5,944.83 | $14,754.40–$14,825 | varies |
| Artery X-Rays Abdomen (75726) range across 5 matching MRF lines |
$5,661.72–$5,949.21 | $14,119–$14,835.92 | varies |
| Artery X-Rays Pelvis (75736) range across 4 matching MRF lines |
$5,661.72–$5,978.14 | $14,119–$14,908.06 | varies |
| Artery X-Rays Spine (75705) | $5,944.83 | $14,825 | 1.0× |
| Arthrogram hip (73525) | $550.98 | $1,374 | 1.5× |
| Basic radiation dosimetry calculation (77300) range across 3 matching MRF lines |
$227.01–$267.47 | $566.09–$667 | varies |
| Bone age studies (77072) | $137.14 | $341.99 | 1.3× |
| Bone Imaging 3 Phase (78315) | $572.23 | $1,427 | 1.4× |
| Bone Imaging Limited Area (78300) | $575.84 | $1,436 | 1.4× |
| Bone Imaging Whole Body (78306) | $637.89 | $1,590.73 | 1.5× |
| Bone survey infant (77076) | $211.33 | $527 | 2.0× |
| Brachytx isodose complex (77318) | $1,796.31 | $4,479.56 | 4.6× |
| Brachytx isodose intermed (77317) | $1,655.73 | $4,129 | 4.3× |
| Brain Imaging Min 4 Static Views W Vascular Flow (78606) | $659.25 | $1,644 | 1.2× |
| Brain Imaging Pet Metabolic Evaluation (78608) | $2,122.90 | $5,294 | 1.4× |
| Cardiac MRI w/w/o contrast & further seq (75561) | $637.59 | $1,590 | 1.8× |
| Cardiac MRI w/w/o contrast w/stress (75563) | $1,213.83 | $3,027 | 1.5× |
| Cat Scan Follow-Up Study (76380) range across 2 matching MRF lines |
$286.72–$291.13 | $715–$726 | varies |
| Cerebrospinal Fluid Flow W/O Matl Shunt Evaltj (78645) | $610.33 | $1,522 | 1.1× |
| Cerebrospinal Fluid Scan (78630) | $906.26 | $2,260 | 1.6× |
| Chest 1 view (71045) range across 8 matching MRF lines |
$103.46–$129.55 | $258–$323.07 | varies |
| Chest 2 views (71046) range across 3 matching MRF lines |
$138.60–$143.16 | $345.61–$357 | varies |
| Chest 3 views (71047) | $93.84 | $234 | 1.0× |
| Clavicle complete (73000) range across 2 matching MRF lines |
$148.78–$223.16 | $371–$556.50 | varies |
| Computed Tomography Thorax Lw Dose Lng Ca Scr C- (71271) range across 3 matching MRF lines |
$278.26–$297.55 | $693.90–$742 | varies |
| Continuing medical physics consltj pr wk (77336) range across 3 matching MRF lines |
$303.22–$307.17 | $756.15–$766 | varies |
| Contrast Exam Abdominl Aorta (75625) range across 2 matching MRF lines |
$3,442.46–$3,458.85 | $8,584.68–$8,625.54 | varies |
| Contrast X-Ray Bladder (74430) | $534.54 | $1,333 | 1.5× |
| CT abdomen and pelvis without and with contrast (74178) range across 2 matching MRF lines |
$817.24–$817.32 | $2,038–$2,038.20 | varies |
| CT abdomen and pelvis without contrast (74176) range across 3 matching MRF lines |
$511.25–$515.78 | $1,274.92–$1,286.21 | varies |
| CT abdomen w contrast (74160) | $623.96 | $1,556 | 3.4× |
| CT abdomen w wo contrast (74170) | $719.40 | $1,794 | 4.0× |
| CT abdomen w/o contrast (74150) | $470.78 | $1,174 | 4.4× |
| CT Angio Abdomen and Pelvis (74174) range across 3 matching MRF lines |
$810.23–$838.50 | $2,020.50–$2,091 | varies |
| CT Angio Chest (71275) range across 5 matching MRF lines |
$536.54–$642.81 | $1,338–$1,603 | varies |
| CT Angio Head (70496) range across 6 matching MRF lines |
$453.54–$567.84 | $1,131–$1,416.05 | varies |
| CT angio hrt w/3d image (75574) | $1,008.12 | $2,514 | 2.8× |
| Ct Angio Lwr Extr W/O&W/Dye (73706) range across 2 matching MRF lines |
$410.23–$615.34 | $1,023–$1,534.50 | varies |
| CT Angio Neck (70498) range across 5 matching MRF lines |
$453.54–$651.26 | $1,131–$1,624.08 | varies |
| Ct Angio Upr Extrm W/O&W/Dye (73206) range across 2 matching MRF lines |
$525.72–$788.57 | $1,311–$1,966.50 | varies |
| CT cervical spine w/ contrast (72126) | $550.98 | $1,374 | 1.5× |
| CT cervical spine w/o contrast (72125) range across 2 matching MRF lines |
$472.34–$472.38 | $1,177.90–$1,178 | varies |
| CT cervical spine w/wo cont (72127) | $349.28 | $871 | 1.9× |
| CT chest w contrast (71260) range across 5 matching MRF lines |
$391.78–$579.14 | $977–$1,444.22 | varies |
| CT chest w/wo contrast (71270) | $391.78 | $977 | 2.2× |
| CT colonography screening (74263) | $1,401.50 | $3,495 | 5.7× |
| CT colonogrphy dx image postprocess w/o contrast (74261) | $678.90 | $1,693 | 6.3× |
| CT head/brain with contrast (70460) | $480.40 | $1,198 | 2.7× |
| CT head/brain without and with contrast (70470) | $480.40 | $1,198 | 2.7× |
| CT heart contrast eval cardiac structure&morph (75572) | $1,123.21 | $2,801 | 3.1× |
| CT heart no contrast quant eval coronry calcium (75571) | $111.48 | $278 | 1.2× |
| CT hrt w/3d image congen (75573) | $528.12 | $1,317 | 1.5× |
| CT iac w contrast (70481) range across 3 matching MRF lines |
$460.35–$532.69 | $1,148–$1,328.38 | varies |
| CT l-spine w&w/o contrast (72133) | $369.73 | $922 | 2.0× |
| CT lower ext w/o (73700) range across 6 matching MRF lines |
$522.81–$796.99 | $1,303.75–$1,987.50 | varies |
| CT lower extremity w/contrast material (73701) range across 3 matching MRF lines |
$684.63–$1,039.40 | $1,707.30–$2,592 | varies |
| CT lumbar spine w contrast (72132) | $627.17 | $1,564 | 1.7× |
| CT lumbar spine w/o contrast (72131) range across 3 matching MRF lines |
$343.26–$470.78 | $856–$1,174 | varies |
| CT maxillofacial w contrast (70487) | $573.03 | $1,429 | 3.2× |
| CT maxillofacial wo contrast (70486) range across 3 matching MRF lines |
$542.93–$561.40 | $1,353.92–$1,400 | varies |
| CT neck tissue combo (70492) | $573.43 | $1,430 | 3.2× |
| Ct Orbit/Ear/Fossa W/O&W/Dye (70482) | $531.73 | $1,326 | 2.9× |
| CT orbits w/o contrast (70480) range across 4 matching MRF lines |
$496.04–$533.25 | $1,237–$1,329.78 | varies |
| CT pelvis w&w/o contrast (72194) range across 2 matching MRF lines |
$400.30–$414.29 | $998.25–$1,033.13 | varies |
| CT pelvis w/o contrast (72192) range across 3 matching MRF lines |
$479–$503 | $1,194.50–$1,254.35 | varies |
| CT scan of leg combo (73702) | $415.04 | $1,035 | 2.3× |
| CT scans face/jaw combo (70488) | $573.03 | $1,429 | 3.2× |
| CT soft tissue neck w contrast (70491) range across 2 matching MRF lines |
$562.21–$562.25 | $1,402–$1,402.10 | varies |
| CT soft tissue neck w/o contrast (70490) range across 3 matching MRF lines |
$564.23–$574.70 | $1,407.04–$1,433.16 | varies |
| CT thoracic spine w contrast (72129) | $329.63 | $822 | 1.8× |
| CT thoracic spine w/o contrast (72128) | $465.57 | $1,161 | 4.3× |
| CT thoracic spine w/wo cont (72130) | $384.56 | $959 | 2.1× |
| CT thorax w/o contrast (71250) range across 3 matching MRF lines |
$467.85–$470.82 | $1,166.70–$1,174.10 | varies |
| CT upper ext wo (73200) range across 3 matching MRF lines |
$516.09–$734.95 | $1,287–$1,832.79 | varies |
| CT upper extremity w/o & w/contrast material (73202) range across 2 matching MRF lines |
$322.41–$483.61 | $804–$1,206 | varies |
| CT upper extremity with contrast (73201) range across 2 matching MRF lines |
$550.98–$826.47 | $1,374–$2,061 | varies |
| Cta Abdl Aorta&Bi Iliofem W/Contrast&Postp (75635) | $619.95 | $1,546 | 3.4× |
| Cta Abdomen (74175) | $506.87 | $1,264 | 2.8× |
| CTA pelvis (72191) | $662.06 | $1,651 | 3.7× |
| Doppler Echo Fetal Puls Spectral F/U/Repeat (76828) range across 3 matching MRF lines |
$179.06–$179.25 | $446.51–$447 | varies |
| Doppler Echo Fetal Spectral Display Complete (76827) | $222.96 | $556 | 2.1× |
| Doppler Fetal Mid Cerebral Artery (76821) | $213.74 | $533 | 2.0× |
| Dxa Bone Density Axial (77080) range across 3 matching MRF lines |
$149.38–$158.40 | $372.50–$395 | varies |
| Dxa bone density study (77085) | $175.24 | $437 | 1.6× |
| Dxa bone density study 1/>sites appendiclr skel (77081) range across 3 matching MRF lines |
$199.52–$200.60 | $497.53–$500.24 | varies |
| Echo exam of fetal heart (76825) range across 3 matching MRF lines |
$595.89–$600.72 | $1,486–$1,498.04 | varies |
| Echo exam uterus (76831) | $445.52 | $1,111 | 1.8× |
| Echo Guide For Artery Repair (76936) | $374.14 | $933 | 1.7× |
| Echocardiography, fetal, cardiovascular system, real time with image documentation (2D), with or without M-mode… (76826) | $446.32 | $1,113 | 1.8× |
| Esophagram (74220) range across 2 matching MRF lines |
$292.30–$292.33 | $728.91–$729 | varies |
| Fetal Biophys Profile W/Nst (76818) range across 3 matching MRF lines |
$565.41–$566.16 | $1,410–$1,411.86 | varies |
| Fetal Biophysical Profile W/O Non-Stress Testing (76819) range across 3 matching MRF lines |
$251.79–$251.83 | $627.89–$628 | varies |
| Fetal MRI w/placntl matrnl plvc img sing/1st ges (74712) | $555.39 | $1,385 | 2.3× |
| Fluoroscopy up to 1 hr (76000) range across 3 matching MRF lines |
$331.41–$378.15 | $826.45–$943 | varies |
| Follow-Up Angiography (75898) | $1,962.90 | $4,895 | 0.6× |
| Foot 2 views (73620) range across 7 matching MRF lines |
$100.25–$229.68 | $250–$572.75 | varies |
| Forearm 2 views (73090) range across 4 matching MRF lines |
$119.70–$214.14 | $298.50–$534 | varies |
| Gastric emptying imaging study (78264) | $566.22 | $1,412 | 1.4× |
| Gated Heart Planar Single (78472) | $572.63 | $1,428 | 1.4× |
| Hand 2 views (73120) range across 9 matching MRF lines |
$149.13–$228.42 | $371.88–$569.60 | varies |
| Hdr Rdncl Ntrstl/Icav Brchtx (77772) | $943.56 | $2,353 | 1.3× |
| Hdr Rdncl Ntrstl/Icav Brchtx (77771) | $943.56 | $2,353 | 1.3× |
| Hdr Rdncl Ntrstl/Icav Brchtx 1 Channel (77770) | $943.56 | $2,353 | 1.3× |
| Hepatc Vngrph Wdg/Fr Hemodyn Eval Rs&I (75889) | $3,446.20 | $8,594 | 1.1× |
| Hepatc Vngrph Wdg/Fr W/O Hemodyn Eval Rs&I (75891) | $3,446.20 | $8,594 | 1.1× |
| Hepatobil Syst Image W/Drug (78227) | $722.61 | $1,802 | 1.3× |
| Hepatobiliary System Imaging (78226) | $572.63 | $1,428 | 1.4× |
| Ht Muscle Image Spect Sing (78451) range across 2 matching MRF lines |
$1,546.26–$1,546.54 | $3,856–$3,856.69 | varies |
| Hysterosalpingogram (74740) | $446.32 | $1,113 | 1.8× |
| Infant hip ultrasound with hip movement (dynamic) (76885) | $178.45 | $445 | 2.0× |
| Infant hip ultrasound, limited static exam (76886) | $173.24 | $432 | 1.9× |
| Interstitial radiation source applic complex (77778) | $3,591.76 | $8,957 | 5.0× |
| Intracavitary Radiation Source Applic Complex (77763) | $920.10 | $2,294.50 | 1.3× |
| K Flow/Funct Image W/Drug (78708) | $650.83 | $1,623 | 1.2× |
| K Flow/Funct Image W/O Drug (78707) | $588.67 | $1,468 | 1.1× |
| Kidney Funcj Study Non-Img Radioisotopic Study (78725) | $1,022.15 | $2,549 | 2.5× |
| Kidney Imaging Morphol (78700) | $449.12 | $1,120 | 1.1× |
| Knee 3 Views (73562) range across 2 matching MRF lines |
$154.79–$232.18 | $386–$578.99 | varies |
| Leveen/Shunt Patency Exam (78291) | $492.83 | $1,229 | 1.2× |
| Liver & Spleen Imaging Static Only (78215) | $487.22 | $1,215 | 1.2× |
| Lung perfusion differential (78597) | $492.83 | $1,229 | 1.2× |
| Lung Ventilat&Perfus Imaging (78582) | $589.07 | $1,469 | 1.1× |
| Lung Ventilation Imaging (78579) | $589.07 | $1,469 | 1.4× |
| Lymph System Imaging (78195) range across 2 matching MRF lines |
$555.79–$589.07 | $1,386–$1,469 | varies |
| Lymphangiography Extremity Only Bilateral Rs&I (75803) | $1,721.50 | $4,293 | 1.1× |
| Lymphangiography extremity only unilateral rs&i (75801) | $729.02 | $1,818 | 1.1× |
| Lymphangiography Pelvic/Abdominal Bilateral Rs&I (75807) | $3,470.66 | $8,655 | 1.1× |
| Lymphangiography, pelvic/abdominal, unilateral (75805) | $1,786.06 | $4,454 | 0.5× |
| Magnetic Image Jaw Joint (70336) | $490.43 | $1,223 | 2.0× |
| Meckels Divert Exam (78290) | $534.94 | $1,334 | 1.3× |
| Mlc imrt design & construction per imrt plan (77338) range across 3 matching MRF lines |
$482.25–$503.77 | $1,202.62–$1,256.27 | varies |
| Mra Head W/O & W/Contrast Material (70546) range across 5 matching MRF lines |
$550.98–$781.46 | $1,374–$1,948.76 | varies |
| MRA head w/o contrast (70544) range across 7 matching MRF lines |
$550.98–$798.32 | $1,374–$1,990.80 | varies |
| MRA head with contrast (70545) range across 3 matching MRF lines |
$766.66–$781.60 | $1,911.85–$1,949.12 | varies |
| MRA neck w contrast (70548) | $610.73 | $1,523 | 1.7× |
| Mra Neck W/O &W/Contrast Material (70549) range across 4 matching MRF lines |
$565.82–$612.77 | $1,411–$1,528.09 | varies |
| MRA neck w/o contrast (70547) | $610.73 | $1,523 | 2.5× |
| MRI abdomen w contrast (74182) | $609.12 | $1,519 | 1.7× |
| MRI abdomen w/o contrast (74181) range across 3 matching MRF lines |
$757.76–$833.25 | $1,889.67–$2,077.92 | varies |
| MRI any jt lower extrem w/contrast material (73722) range across 2 matching MRF lines |
$680.50–$1,020.75 | $1,697–$2,545.50 | varies |
| MRI any jt lower extrem w/o & w/contrast matrl (73723) range across 6 matching MRF lines |
$577.44–$1,719.69 | $1,440–$4,288.50 | varies |
| MRI any jt upper extremity w/contrast matrl (73222) | $963.61 | $2,403 | 1.2× |
| MRI brain functional w/o physician admnistration (70554) | $640 | $1,596 | 2.6× |
| MRI Breast W/O Contrast Bilateral (77047) range across 2 matching MRF lines |
$510.88–$536.54 | $1,274–$1,338 | varies |
| MRI cardiac w/o cont stress (75559) | $738.65 | $1,842 | 1.3× |
| MRI cardiac w/o contrast (75557) | $637.59 | $1,590 | 2.6× |
| MRI cervical spine w contrast (72142) | $578.65 | $1,443 | 1.6× |
| MRI cervical spine w/o cont (72141) range across 2 matching MRF lines |
$752.97–$753.08 | $1,877.73–$1,878 | varies |
| MRI chest w/o contrast (71550) | $622.36 | $1,552 | 2.5× |
| MRI chest with contrast (71551) | $622.36 | $1,552 | 0.8× |
| MRI chest wo w contrast (71552) range across 2 matching MRF lines |
$622.36–$622.48 | $1,552–$1,552.32 | varies |
| MRI lower extrem oth/thn jt w/contrast matrl (73719) range across 2 matching MRF lines |
$698.95–$1,048.42 | $1,743–$2,614.50 | varies |
| MRI lower extrem oth/thn jt w/o & w/contr matr (73720) range across 4 matching MRF lines |
$577.44–$1,741.95 | $1,440–$4,344 | varies |
| MRI lower extrem oth/thn jt w/o contr matrl (73718) range across 2 matching MRF lines |
$873.38–$1,310.07 | $2,178–$3,267 | varies |
| MRI lumbar spine w contrast (72149) | $560.60 | $1,398 | 1.6× |
| Mri Neck Spine W/O & W/Dye (72156) | $1,162.10 | $2,898 | 3.2× |
| MRI orbit face &/neck w/o contrast (70540) | $567.82 | $1,416 | 2.3× |
| MRI orbit face neck w contrast (70542) | $579.05 | $1,444 | 1.6× |
| Mri Orbt/Fac/Nck W/O &W/Dye (70543) | $567.82 | $1,416 | 1.6× |
| MRI pelvis w contrast (72196) | $686.92 | $1,713 | 1.9× |
| MRI pelvis w/o & w contrast (72197) range across 3 matching MRF lines |
$1,193.97–$1,239.90 | $2,977.47–$3,092 | varies |
| MRI pelvis w/o contrast (72195) | $804.81 | $2,007 | 3.3× |
| MRI spectroscopy (76390) | $594.69 | $1,483 | 6.6× |
| MRI thoracic spine w/o contrast (72146) | $722.21 | $1,801 | 2.9× |
| MRI upper extremity oth than jt w/contr matrl (73219) | $873.38 | $2,178 | 2.4× |
| MRI upper extremity oth than jt w/o contr matrl (73218) range across 2 matching MRF lines |
$873.38–$1,310.07 | $2,178–$3,267 | varies |
| Mri Uppr Extremity W/O&W/Dye (73220) range across 3 matching MRF lines |
$1,162.90–$1,614.09 | $2,900–$4,025.14 | varies |
| MRI, abdomen, combo (74183) | $1,253.53 | $3,126 | 3.5× |
| MRI, dorsal spine combo (72157) | $1,159.30 | $2,891 | 3.2× |
| MRI, dorsal spine contrast (72147) | $550.98 | $1,374 | 1.5× |
| MRI, joint upper extrem (73221) range across 3 matching MRF lines |
$823.26–$1,219.55 | $2,053–$3,041.26 | varies |
| MRI, joint upper extrem combo (73223) range across 3 matching MRF lines |
$1,111.98–$1,528.72 | $2,773–$3,812.25 | varies |
| MRI, lumbar spine combo (72158) range across 2 matching MRF lines |
$1,162.10–$1,282.40 | $2,898–$3,198 | varies |
| Myocardial Spect Multiple Studies (78452) range across 3 matching MRF lines |
$1,401.90–$1,477.69 | $3,496–$3,685 | varies |
| Myocrd Img Pet Metab Eval Single Study Cncrnt CT (78429) | $1,903.95 | $4,748 | 1.3× |
| N-invas est c ffr sw aly CTA (75580) | $2,063.55 | $5,146 | 2.3× |
| Neck soft tissue (70360) | $136.75 | $341 | 1.5× |
| Nm csf leak detection (78650) | $1,546.26 | $3,856 | 1.2× |
| Ntsty modul radthx pln dose-vol histos (77301) | $4,110.77 | $10,251.29 | 2.9× |
| Nuclear Rx Intra-Arterial (79445) | $283.11 | $706 | 1.2× |
| Nuclear Rx Oral Admin (79005) | $311.58 | $777 | 1.3× |
| Ob us nuchal meas 1 gest (76813) range across 2 matching MRF lines |
$306.61–$387.37 | $764.61–$966 | varies |
| Oph bmtry us echograpy a-scan io lens pwr cal (76519) | $178.85 | $446 | 1.7× |
| Oph us dx ant sgm us immersion b-scan/hr biom (76513) | $235.79 | $588 | 2.2× |
| Oph US Dx B-Scan&Quan a-Scan Sm Pt Enctr (76510) | $235.79 | $588 | 1.7× |
| Ophthalmic Biometry US Echograpy a-Scan (76516) | $178.45 | $445 | 1.7× |
| Ophthalmic ultrasound dx b-scan w/wo a-scan (76512) range across 5 matching MRF lines |
$198.10–$297.15 | $494–$741 | varies |
| Ophthalmic US Dx Corneal Pachymetry Uni/Bi (76514) range across 2 matching MRF lines |
$243.01–$243.42 | $606–$607.03 | varies |
| Ophthalmic us dx quantitative a-scan only (76511) | $193.69 | $483 | 1.8× |
| Parathyroid imaging w/tomographic spect & CT (78072) | $1,061.05 | $2,646 | 1.9× |
| Parathyroid Planar Imaging (78070) | $500.05 | $1,247 | 1.2× |
| Parathyroid planar imaging w/wo subtraction (78071) | $872.18 | $2,175 | 2.1× |
| Pelvis 1 or 2 views (72170) range across 3 matching MRF lines |
$144.98–$145.17 | $361.55–$362.01 | varies |
| Perineogram (74775) | $446.32 | $1,113 | 1.8× |
| Peritoneogram Rs&I (74190) | $600.70 | $1,498 | 1.1× |
| Pet Image Skull-Thigh (78812) range across 2 matching MRF lines |
$1,785.97–$1,812.52 | $4,453.78–$4,520 | varies |
| PET image w/CT, full body (78816) range across 4 matching MRF lines |
$1,991.62–$1,992.50 | $4,966.63–$4,968.82 | varies |
| PET imaging CT attenuation skull base mid-thigh (78815) range across 3 matching MRF lines |
$2,499.04–$2,499.84 | $6,232–$6,233.99 | varies |
| PET whole body (78813) range across 3 matching MRF lines |
$1,800.23–$1,812.52 | $4,489.33–$4,520 | varies |
| Prq Transhepatc Portograpy Hemodyn Eval Rs&I (75885) | $3,446.20 | $8,594 | 1.1× |
| Pulmonary Perfusion Imaging Particulate (78580) | $492.83 | $1,229 | 1.2× |
| Radex abscess/fistula/sinus tract rs&i (76080) range across 3 matching MRF lines |
$573.31–$574.33 | $1,429.70–$1,432.22 | varies |
| Radex Ankle Complete Minimum 3 Views (73610) range across 5 matching MRF lines |
$145.57–$218.35 | $363–$544.50 | varies |
| Radex Calcaneus Minimum 2 Views (73650) range across 4 matching MRF lines |
$143.03–$214.74 | $356.68–$535.50 | varies |
| Radex elbow complete minimum 3 views (73080) range across 2 matching MRF lines |
$146.37–$219.36 | $365–$547.02 | varies |
| Radex Facial Bones Complete Minimum 3 Views (70150) | $138.35 | $345 | 1.3× |
| Radex fingr minimum 2 views (73140) range across 3 matching MRF lines |
$128.73–$217.75 | $321–$543 | varies |
| Radex foot complete minimum 3 views (73630) range across 4 matching MRF lines |
$138.08–$220.83 | $344.33–$550.68 | varies |
| Radex Hand Minimum 3 Views (73130) range across 4 matching MRF lines |
$130.20–$214.74 | $324.67–$535.50 | varies |
| Radex lower extremity infant minimum 2 views (73592) range across 2 matching MRF lines |
$143.16–$214.74 | $357–$535.50 | varies |
| Radex Mastoids Compl Minimum 3 Views PR Side (70130) | $113.89 | $284 | 1.1× |
| Radex Nasal Bones Complete Minimum 3 Views (70160) | $112.69 | $281 | 1.3× |
| Radex Ribs Unilateral 2 Views (71100) | $111.08 | $277 | 1.2× |
| Radex shoulder complete minimum 2 views (73030) range across 3 matching MRF lines |
$148.46–$223.15 | $370.20–$556.47 | varies |
| Radex Sinuses Paransl < 3 Views (70210) | $99.45 | $248 | 1.1× |
| Radex Spine 1 View Specify Level (72020) | $155.19 | $387 | 1.7× |
| Radex Sternum Minimum 2 Views (71120) | $158.40 | $395 | 1.8× |
| Radex Temporomandble Jt Opn & Clsd Mouth Bilat (70330) | $127.92 | $319 | 1.4× |
| Radex Toe Minimum 2 Views (73660) range across 3 matching MRF lines |
$92.23–$215.34 | $230–$537 | varies |
| Radex upper extremity infant minimum 2 views (73092) range across 2 matching MRF lines |
$142.36–$213.54 | $355–$532.50 | varies |
| Radex Wrist Complete Minimum 3 Views (73110) range across 2 matching MRF lines |
$145.99–$218.71 | $364.05–$545.41 | varies |
| Radiation Delivery Stereotactic Cranial Linear (77372) | $8,479.15 | $21,145 | 1.1× |
| Radiation treatment delivery level 1 (77402) | $199.30 | $497 | 1.9× |
| Radiation treatment delivery level 2 (77407) | $431.08 | $1,075 | 1.1× |
| Radiation treatment delivery level 3 (77412) range across 3 matching MRF lines |
$382.49–$382.56 | $953.83–$954 | varies |
| Radiolog exam mandible compl minimum 4 views (70110) | $198.50 | $495 | 1.8× |
| Radiologic Exam Abdomen 3+ Views - Xr Abdomen 3+ Views (74021) | $134.34 | $335 | 1.2× |
| Radiologic exam colon double contrast study (74280) | $341.26 | $851 | 1.9× |
| Radiologic exam colon single contrast study (74270) | $320.80 | $800 | 1.8× |
| Radiologic Exam Esophagus Double Contrast Study (74221) | $301.16 | $751 | 1.7× |
| Radiologic exam knee complete 4/more views (73564) range across 2 matching MRF lines |
$193.29–$289.93 | $482–$723 | varies |
| Radiologic exam pelvis compl minimum 3 views (72190) | $281.91 | $703 | 2.6× |
| Radiologic Exam Small Int Single Contrast Study (74250) | $653.63 | $1,630 | 3.6× |
| Radiologic exam swallow function contrast study (74230) | $297.15 | $741 | 1.6× |
| Radiologic exam upr gi trc double contrast study (74246) | $301.16 | $751 | 1.7× |
| Radiologic examination femur minimum 2 views (73552) range across 2 matching MRF lines |
$110.28–$165.42 | $275–$412.50 | varies |
| Radiologic examination knee 1/2 views (73560) range across 4 matching MRF lines |
$151.08–$226.81 | $376.74–$565.59 | varies |
| Radiologic Examination Osseous Survey Limited (77074) | $302.76 | $755 | 2.8× |
| Radiologic examination tibia & fibula 2 views (73590) range across 7 matching MRF lines |
$119.70–$214.14 | $298.50–$534 | varies |
| Ribs bilateral 3 views (71110) | $138.35 | $345 | 1.3× |
| Rp loclzj tum plnr 1 area single day imaging (78800) range across 2 matching MRF lines |
$491.04–$494.92 | $1,224.53–$1,234.19 | varies |
| Rp Loclzj Tum Plnr Whole Body Single Day Imaging (78802) range across 2 matching MRF lines |
$1,544.39–$1,546.26 | $3,851.33–$3,856 | varies |
| Rp Loclzj Tum Spect 1 Area Single Day Imaging (78803) | $1,546.26 | $3,856 | 2.8× |
| Rp loclzj tum spect CT 2area 1d img/1 ar img>2+d (78832) | $1,703.45 | $4,248 | 1.2× |
| Rp loclzj tum spect w/CT 1 area/acquisj 1day img (78830) | $1,588.37 | $3,961 | 1.2× |
| Rp Therapy Intravenous Administration (79101) | $312.78 | $780 | 1.3× |
| Salivary Gland Imaging Serial Images (78231) | $492.83 | $1,229 | 1.2× |
| Scapula (73010) range across 2 matching MRF lines |
$138.35–$207.52 | $345–$517.50 | varies |
| Screening Digital Breast Tomosynthesis Bi (77063) | $42.91 | $107 | 1.8× |
| Shoulder 1 view (73020) range across 2 matching MRF lines |
$99.85–$149.78 | $249–$373.50 | varies |
| Shoulder Arthrography (73040) | $534.54 | $1,333 | 1.5× |
| Skull less than 4 views (70250) | $138.35 | $345 | 1.3× |
| Special dosimetry (77331) | $393.03 | $980.10 | 2.8× |
| Special Physics Consult (77370) range across 2 matching MRF lines |
$369.73–$372.23 | $922–$928.24 | varies |
| Special teletherapy port plan (77321) range across 2 matching MRF lines |
$690.48–$690.93 | $1,721.89–$1,723 | varies |
| Special treatment procedure (77470) range across 3 matching MRF lines |
$884.43–$912.68 | $2,205.56–$2,276 | varies |
| Spleen Imaging (78185) | $449.12 | $1,120 | 1.1× |
| Srs Multisource (77371) | $10,391.36 | $25,913.61 | 1.4× |
| Stereotactic Body Radiation Delivery (77373) range across 2 matching MRF lines |
$2,065.56–$3,121.83 | $5,151–$7,785.09 | varies |
| Sternoclavicular joints (71130) | $143.56 | $358 | 1.6× |
| Superior sagittal sinus venogram (75870) range across 4 matching MRF lines |
$1,777.52–$2,679.09 | $4,432.70–$6,681 | varies |
| Tbs technical calculation only (77091) | $93.81 | $233.94 | 1.0× |
| Telethx isodose pln cplx w/basic dosimetry (77307) range across 2 matching MRF lines |
$387.70–$388.57 | $966.81–$969 | varies |
| Telethx isodose pln smpl w/dosimetry calculation (77306) | $365.32 | $911 | 0.9× |
| Ther Rad Simulaj-Aided Field Setting Complex (77290) | $1,059.79 | $2,642.87 | 2.7× |
| Ther Rad Simulaj-Aided Field Setting Intermed (77285) | $582.26 | $1,452 | 1.5× |
| Ther rad simulaj-aided field setting simple (77280) | $964.01 | $2,404 | 6.9× |
| Therapeutic Enema Rdctj Intussusception/Obstrcj (74283) | $313.19 | $781 | 1.7× |
| Thoracic spine 2 views (72070) | $151.18 | $377 | 1.4× |
| Thoracic spine 3 views (72072) | $182.46 | $455 | 1.7× |
| Thoracolumbar 2 views (72080) | $108.68 | $271 | 1.2× |
| Thyroid Met Imaging Body (78018) | $589.07 | $1,469 | 1.1× |
| Thyroid Uptake W/Blood Flow Sngle/Mult Quan Meas (78014) | $471.18 | $1,175 | 1.1× |
| Tx Devices Design & Construction Complex (77334) range across 2 matching MRF lines |
$447.33–$448.59 | $1,115.53–$1,118.67 | varies |
| Tx devices design & construction intermediate (77333) range across 3 matching MRF lines |
$285.05–$293.35 | $710.83–$731.53 | varies |
| Tx devices design & construction simple (77332) range across 2 matching MRF lines |
$262.43–$265.85 | $654.43–$662.95 | varies |
| Ultrasound Breast Limited (76642) range across 2 matching MRF lines |
$198.10–$297.15 | $494–$741 | varies |
| Ultrasound Elastography Parenchyma (76981) range across 3 matching MRF lines |
$161.49–$164.01 | $402.71–$409 | varies |
| Ultrasound Exam Aaa Screen (76706) range across 2 matching MRF lines |
$161.21–$161.24 | $402–$402.09 | varies |
| Ultrasound, abdomen limited (76705) range across 9 matching MRF lines |
$202.31–$219.29 | $504.50–$546.85 | varies |
| Umbilical-artery Doppler (OB) (76820) range across 3 matching MRF lines |
$213.73–$213.74 | $532.98–$533 | varies |
| Unlisted Dx Radiographic Procedure (76499) range across 2 matching MRF lines |
$31.28–$625.56 | $78–$1,560 | varies |
| Unlisted fluoroscopic procedure (76496) | $402.61 | $1,004 | 4.5× |
| Unlisted magnetic resonance procedure (76498) range across 2 matching MRF lines |
$832.08–$2,440.09 | $2,075–$6,085 | varies |
| Upper gi w/o kub (74240) | $302.36 | $754 | 1.7× |
| Urethrocystogram voiding (74455) | $439.10 | $1,095 | 1.8× |
| Urethrocystography retrograde (74450) | $445.52 | $1,111 | 1.8× |
| Us breast unilateral complete (76641) range across 2 matching MRF lines |
$145.57–$218.35 | $363–$544.50 | varies |
| Us chest (76604) range across 3 matching MRF lines |
$177.77–$178.45 | $443.31–$445 | varies |
| Us exam, pelvic, limited (76857) range across 3 matching MRF lines |
$220.87–$227.37 | $550.78–$567 | varies |
| Us head (76506) | $170.03 | $424 | 1.6× |
| Us kidney transplant (76776) range across 3 matching MRF lines |
$223.35–$223.66 | $556.96–$557.75 | varies |
| Us lmtd joint/oth nonvasc xtr strux r-t w/img (76882) range across 7 matching MRF lines |
$211.13–$378.95 | $526.50–$945 | varies |
| Us ob detailed single fetus (76811) range across 2 matching MRF lines |
$354.47–$450.33 | $883.96–$1,123 | varies |
| Us ob limited 1 or more fetuses (76815) range across 4 matching MRF lines |
$192.62–$256.65 | $480.33–$640.01 | varies |
| Us ob transvaginal (76817) | $230.98 | $576 | 2.1× |
| Us pelvic non ob complete (76856) range across 4 matching MRF lines |
$229.38–$236.61 | $572–$590.05 | varies |
| Us pg uter img f&mat 14 wk tabdl 1/1st gestation (76801) range across 2 matching MRF lines |
$266.26–$266.27 | $663.97–$664 | varies |
| Us preg uterus real time f/u trnsabdl per fetus (76816) | $392.18 | $978 | 3.6× |
| Us retroperitoneal complete (76770) range across 5 matching MRF lines |
$215.94–$344.66 | $538.50–$859.50 | varies |
| Us retroperitoneal limited (76775) range across 3 matching MRF lines |
$228.15–$232.30 | $568.94–$579.30 | varies |
| Us scrotum and contents (76870) range across 2 matching MRF lines |
$248.20–$248.22 | $618.94–$619 | varies |
| Us spinal canal and contents (76800) | $178.45 | $445 | 1.7× |
| Us thyroid (76536) range across 3 matching MRF lines |
$244.82–$259.85 | $610.50–$648 | varies |
| Vein X-Ray Chest (75827) | $1,452.03 | $3,621 | 0.9× |
| Vein X-Ray Liver W/O Hemodyn (75887) | $1,928.41 | $4,809 | 0.6× |
| Vein X-Ray Spleen/Liver (75810) | $3,470.66 | $8,655 | 1.1× |
| Venogram Sinus/Jugular (75860) range across 3 matching MRF lines |
$3,435.92–$5,204.53 | $8,568.38–$12,978.86 | varies |
| Venography caval inferior serialography rs&i (75825) | $3,446.20 | $8,594 | 1.1× |
| Venography extremity bilateral rs&i (75822) | $1,721.50 | $4,293 | 1.1× |
| Venography extremity unilateral rs&i (75820) range across 3 matching MRF lines |
$1,450.37–$1,452.59 | $3,616.88–$3,622.42 | varies |
| Venography Renal Bilateral (75833) | $3,446.20 | $8,594 | 1.1× |
| Venography Renal Unilateral (75831) range across 3 matching MRF lines |
$3,427.93–$3,469.69 | $8,548.44–$8,652.57 | varies |
| Venous sampling by catheter (75893) range across 4 matching MRF lines |
$5,888.21–$8,917.24 | $14,683.80–$22,237.50 | varies |
| Wrist 2 views (73100) range across 7 matching MRF lines |
$124.05–$262.26 | $309.33–$654 | varies |
| X-Ray Ac Jts - Xr Acromioclavicular Joints Bilateral (73050) | $175.64 | $438 | 2.0× |
| X-ray antegrade pyelogram tube (74425) | $446.32 | $1,113 | 1.2× |
| X-Ray Aorta Leg Arteries (75630) | $3,446.20 | $8,594 | 1.1× |
| X-Ray Bend Only L-S Spine (72120) | $138.35 | $345 | 1.3× |
| X-Ray Elbow 2 Vw - Xr Elbow 1-2 Views Right (73070) range across 5 matching MRF lines |
$130.06–$220.15 | $324.33–$549 | varies |
| X-Ray Exam Breast Specimen (76098) | $574.24 | $1,432 | 1.0× |
| X-Ray Exam Entire Spi 1 Vw (72081) | $108.68 | $271 | 1.2× |
| X-Ray Exam Entire Spi 2/3 Vw (72082) | $153.59 | $383 | 1.4× |
| X-Ray Exam Entire Spi 4/5 Vw (72083) | $208.12 | $519 | 1.9× |
| X-Ray Exam Hip Uni 1 View (73501) | $95.44 | $238 | 1.1× |
| X-Ray Exam Hip Uni 2-3 Views (73502) range across 3 matching MRF lines |
$101.05–$151.58 | $251.98–$378 | varies |
| X-Ray Exam Hips Bi 2 Views (73521) | $147.17 | $367 | 1.4× |
| X-Ray Exam Hips Bi 3-4 Views (73522) | $164.41 | $410 | 1.5× |
| X-Ray Exam L-S Spine Bending (72114) | $149.58 | $373 | 1.4× |
| X-Ray Exam Neck Spine 2-3 Vw (72040) | $150.78 | $376 | 1.7× |
| X-Ray Exam Neck Spine 6/>Vws (72052) | $144.77 | $361 | 1.3× |
| X-Ray Exam Unilat Ribs/Chest (71101) | $184.46 | $460 | 1.7× |
| X-ray eye for foreign body (70030) | $121.91 | $304 | 1.4× |
| X-ray humerus (73060) range across 2 matching MRF lines |
$122.71–$184.06 | $306–$459 | varies |
| X-Ray Jaw <4 Vw - Xr Mandible < 4 Views (70100) | $143.56 | $358 | 1.6× |
| X-Ray Knee Bilat Standing - Xr Knees Anteroposterior Standing Bilat (73565) | $263.86 | $658 | 2.9× |
| X-Ray Lumbar Spine 2/3 Vw - Xr Lumbar Spine 2-3 Views (72100) range across 2 matching MRF lines |
$151.28–$155.59 | $377.25–$388 | varies |
| X-ray nose-rectum child f.b. (76010) | $122.71 | $306 | 1.4× |
| X-Ray Ribs, Chest 4+ Vw - Xr Ribs 3 Vws Bil W/ Chest Posteroanterior (71111) | $230.18 | $574 | 2.1× |
| X-Ray Sacroiliac Jts 3+ Vw - Xr Sacroiliac Joints 3+ Views (72202) | $134.34 | $335 | 1.2× |
| X-Ray Sacroiliac Jts <3 Vw - Xr Sacroiliac Joints 1-2 Views (72200) | $214.54 | $535 | 2.0× |
| X-Ray Sacrum/Coccyx 2+ Vw - Xr Sacrum Coccyx 2+ Views (72220) range across 2 matching MRF lines |
$97.84–$97.85 | $243.97–$244 | varies |
| X-Ray Sinuses 3+ Vw - Xr Paranasal Sinuses 3+ Views (70220) | $155.59 | $388 | 1.7× |
| X-Ray Skull 4+ Vw - Xr Skull Complete 4+ Views (70260) | $254.64 | $635 | 2.4× |
| X-ray thoracic spine 4 vw (72074) | $140.35 | $350 | 1.3× |
| X-Ray Tmj Unilat (70328) | $127.92 | $319 | 1.4× |
| X-Ray Urinary Tract Exam With Contrast Material (74420) | $446.32 | $1,113 | 1.2× |
| X-Rays Bone Length Studies (77073) | $178.45 | $445 | 1.7× |
| X-Rays Bone Survey Complete (77075) | $240.60 | $600 | 2.2× |
| Xr c-spine 4 or 5 views (72050) | $200.91 | $501 | 1.9× |
| Xr facial bones less than 3 views (70140) | $140.76 | $351 | 1.6× |
| Xr orbits complete 4 views (70200) | $137.55 | $343 | 1.3× |
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.