Imaging prices at Major Hospital
Shelbyville, IN · every code in this section with a posted price and a Medicare benchmark.
277 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) | $5,168.94 | $16,674 | 3.5× |
| Abdomen 1 View (74018) | $131.75 | $425 | 1.4× |
| Abdomen 2 views (74019) | $161.20 | $520 | 1.5× |
| Acute Gastrointestinal Blood Loss Imaging (78278) | $799.18 | $2,578 | 1.9× |
| Ankle 2 views (73600) range across 2 matching MRF lines |
$124–$186 | $400–$600 | varies |
| Arthrogram ankle (73615) range across 2 matching MRF lines |
$144.77–$217.31 | $467–$701 | varies |
| Arthrogram hip (73525) range across 2 matching MRF lines |
$296.36–$444.85 | $956–$1,435 | varies |
| Arthrogram Wrist (73115) range across 2 matching MRF lines |
$322.40–$483.29 | $1,040–$1,559 | varies |
| Basic radiation dosimetry calculation (77300) | $377.27 | $1,217 | 2.7× |
| Bone age studies (77072) | $41.54 | $134 | 0.4× |
| Bone Imaging 3 Phase (78315) | $1,265.73 | $4,083 | 3.0× |
| Bone Imaging Limited Area (78300) | $460.66 | $1,486 | 1.1× |
| Bone Imaging Whole Body (78306) | $1,120.65 | $3,615 | 2.6× |
| Bone survey infant (77076) | $163.99 | $529 | 1.5× |
| Cardiac Shunt Detection (78428) | $535.68 | $1,728 | 1.3× |
| Cat Scan Follow-Up Study (76380) | $81.53 | $263 | 0.9× |
| Chest 1 view (71045) | $123.07 | $397 | 1.3× |
| Chest 2 views (71046) | $137.95 | $445 | 1.5× |
| Chest 3 views (71047) | $144.46 | $466 | 1.6× |
| Chest 4 or more views (71048) | $156.24 | $504 | 1.4× |
| Clavicle complete (73000) range across 2 matching MRF lines |
$145.39–$218.24 | $469–$704 | varies |
| Computed Tomography Thorax Lw Dose Lng Ca Scr C- (71271) | $86.18 | $278 | 0.8× |
| Continuing medical physics consltj pr wk (77336) | $543.12 | $1,752 | 3.8× |
| Contrast X-Ray Bladder (74430) | $252.65 | $815 | 0.7× |
| Contrast X-Ray Of Elbow (73085) range across 2 matching MRF lines |
$144.77–$217.31 | $467–$701 | varies |
| Contrast X-Ray Of Knee Joint (73580) range across 2 matching MRF lines |
$381.92–$572.88 | $1,232–$1,848 | varies |
| CT abdomen and pelvis without and with contrast (74178) | $1,244.03 | $4,013 | 3.4× |
| CT abdomen and pelvis without contrast (74176) | $859.63 | $2,773 | 3.4× |
| CT abdomen w contrast (74160) | $656.58 | $2,118 | 3.5× |
| CT abdomen w wo contrast (74170) | $787.40 | $2,540 | 4.2× |
| CT abdomen w/o contrast (74150) | $516.46 | $1,666 | 4.7× |
| CT Angio Abdomen and Pelvis (74174) | $1,428.17 | $4,607 | 3.9× |
| CT Angio Chest (71275) | $927.21 | $2,991 | 5.0× |
| CT Angio Head (70496) | $927.83 | $2,993 | 5.0× |
| Ct Angio Lwr Extr W/O&W/Dye (73706) range across 2 matching MRF lines |
$981.77–$1,472.50 | $3,167–$4,750 | varies |
| CT Angio Neck (70498) | $929.69 | $2,999 | 5.0× |
| Ct Angio Upr Extrm W/O&W/Dye (73206) | $868.31 | $2,801 | 4.7× |
| CT cervical spine w/ contrast (72126) | $696.57 | $2,247 | 1.9× |
| CT cervical spine w/o contrast (72125) | $599.23 | $1,933 | 5.4× |
| CT cervical spine w/wo cont (72127) | $792.36 | $2,556 | 4.3× |
| CT chest w contrast (71260) | $646.97 | $2,087 | 3.5× |
| CT chest w/wo contrast (71270) | $821.19 | $2,649 | 4.4× |
| CT colonogrphy dx image postprocess w/o contrast (74261) | $523.59 | $1,689 | 4.7× |
| CT head/brain with contrast (70460) | $605.12 | $1,952 | 3.3× |
| CT head/brain without and with contrast (70470) | $705.25 | $2,275 | 3.8× |
| CT iac w contrast (70481) | $712.07 | $2,297 | 3.8× |
| CT l-spine w&w/o contrast (72133) | $934.34 | $3,014 | 5.0× |
| CT lower ext w/o (73700) range across 2 matching MRF lines |
$540.64–$810.96 | $1,744–$2,616 | varies |
| CT lower extremity w/contrast material (73701) range across 2 matching MRF lines |
$701.53–$1,052.45 | $2,263–$3,395 | varies |
| CT lumbar spine w contrast (72132) | $746.17 | $2,407 | 2.0× |
| CT lumbar spine w/o contrast (72131) range across 2 matching MRF lines |
$604.19–$622.17 | $1,949–$2,007 | varies |
| CT maxillofacial w contrast (70487) | $647.90 | $2,090 | 3.5× |
| CT maxillofacial wo contrast (70486) | $524.52 | $1,692 | 4.7× |
| CT neck tissue combo (70492) | $790.81 | $2,551 | 4.3× |
| Ct Orbit/Ear/Fossa W/O&W/Dye (70482) | $840.10 | $2,710 | 4.5× |
| CT orbits w/o contrast (70480) | $607.91 | $1,961 | 5.5× |
| CT pelvis w&w/o contrast (72194) | $697.81 | $2,251 | 3.8× |
| CT pelvis w/o contrast (72192) | $500.03 | $1,613 | 4.5× |
| CT scan of leg combo (73702) range across 2 matching MRF lines |
$862.11–$1,293.32 | $2,781–$4,172 | varies |
| CT scans face/jaw combo (70488) | $781.82 | $2,522 | 4.2× |
| CT soft tissue neck w contrast (70491) | $644.18 | $2,078 | 3.5× |
| CT soft tissue neck w/o contrast (70490) | $551.49 | $1,779 | 5.0× |
| CT thoracic spine w contrast (72129) | $692.85 | $2,235 | 3.7× |
| CT thoracic spine w/o contrast (72128) | $649.14 | $2,094 | 5.9× |
| CT thoracic spine w/wo cont (72130) | $812.20 | $2,620 | 4.4× |
| CT thorax w/o contrast (71250) | $520.80 | $1,680 | 4.7× |
| CT upper ext wo (73200) range across 2 matching MRF lines |
$563.27–$845.06 | $1,817–$2,726 | varies |
| CT upper extremity w/o & w/contrast material (73202) range across 2 matching MRF lines |
$783.06–$1,174.28 | $2,526–$3,788 | varies |
| CT upper extremity with contrast (73201) range across 2 matching MRF lines |
$690.37–$1,035.71 | $2,227–$3,341 | varies |
| Cta Abdl Aorta&Bi Iliofem W/Contrast&Postp (75635) | $1,153.82 | $3,722 | 6.2× |
| Cta Abdomen (74175) | $837.62 | $2,702 | 4.5× |
| CTA pelvis (72191) | $705.87 | $2,277 | 3.8× |
| Discography Cerv/Thor Spine (72285) | $653.17 | $2,107 | 0.3× |
| Diskography lumbar (72295) | $653.17 | $2,107 | 0.3× |
| Dxa Bone Density Axial (77080) | $188.48 | $608 | 1.7× |
| Dxa bone density study (77085) | $221.03 | $713 | 2.0× |
| Dxa bone density study 1/>sites appendiclr skel (77081) | $120.59 | $389 | 1.3× |
| Echo exam uterus (76831) | $270.94 | $874 | 1.1× |
| Fetal Biophys Profile W/Nst (76818) | $281.79 | $909 | 2.5× |
| Fetal Biophysical Profile W/O Non-Stress Testing (76819) | $240.87 | $777 | 2.2× |
| Fluoroscopy up to 1 hr (76000) | $376.03 | $1,213 | 1.5× |
| Foot 2 views (73620) range across 2 matching MRF lines |
$107.26–$160.89 | $346–$519 | varies |
| Forearm 2 views (73090) range across 2 matching MRF lines |
$148.49–$222.89 | $479–$719 | varies |
| Gastric emptying imaging study (78264) | $988.28 | $3,188 | 2.3× |
| Gated Heart Planar Single (78472) | $1,165.91 | $3,761 | 2.8× |
| Hand 2 views (73120) range across 2 matching MRF lines |
$135.47–$203.36 | $437–$656 | varies |
| Hepatobil Syst Image W/Drug (78227) | $1,154.75 | $3,725 | 2.0× |
| Hepatobiliary System Imaging (78226) | $1,298.28 | $4,188 | 3.1× |
| Ht Muscle Image Spect Sing (78451) | $2,255.87 | $7,277 | 1.6× |
| Hysterosalpingogram (74740) | $201.81 | $651 | 0.8× |
| Infant hip ultrasound with hip movement (dynamic) (76885) | $205.22 | $662 | 2.2× |
| K Flow/Funct Image W/Drug (78708) | $882.57 | $2,847 | 1.5× |
| K Flow/Funct Image W/O Drug (78707) | $724.16 | $2,336 | 1.3× |
| Knee 3 Views (73562) range across 2 matching MRF lines |
$182.59–$274.04 | $589–$884 | varies |
| Liver imaging w/vascular flow (78202) | $387.19 | $1,249 | 0.7× |
| Lung Perf&Ventilat Diferentl (78598) | $1,106.08 | $3,568 | 1.9× |
| Lung perfusion differential (78597) | $746.79 | $2,409 | 1.8× |
| Lung Ventilat&Perfus Imaging (78582) | $1,350.05 | $4,355 | 2.4× |
| Lung Ventilation Imaging (78579) | $240.25 | $775 | 0.6× |
| Lymph System Imaging (78195) | $793.29 | $2,559 | 1.4× |
| Magnetic Image Jaw Joint (70336) | $1,057.41 | $3,411 | 4.2× |
| Meckels Divert Exam (78290) | $436.17 | $1,407 | 1.0× |
| Mlc imrt design & construction per imrt plan (77338) | $2,329.65 | $7,515 | 5.9× |
| Mr safety implant&/fb assmt clin staf 1st 15 min (76014) | $34.10 | $110 | 1.1× |
| MRA head w/o contrast (70544) | $813.44 | $2,624 | 3.2× |
| MRA neck w/o contrast (70547) | $751.75 | $2,425 | 3.0× |
| MRI abdomen w contrast (74182) | $973.40 | $3,140 | 2.6× |
| MRI abdomen w/o contrast (74181) | $904.89 | $2,919 | 3.6× |
| MRI any jt lower extrem w/contrast material (73722) range across 2 matching MRF lines |
$1,066.09–$1,768.55 | $3,439–$5,705 | varies |
| MRI any jt lower extrem w/o & w/contrast matrl (73723) range across 2 matching MRF lines |
$1,178.93–$1,768.55 | $3,803–$5,705 | varies |
| MRI any jt upper extremity w/contrast matrl (73222) range across 2 matching MRF lines |
$1,025.17–$1,537.91 | $3,307–$4,961 | varies |
| MRI Breast W/O Contrast Bilateral (77047) | $651.31 | $2,101 | 2.6× |
| MRI Breast Without Contrast Material Unilateral (77046) | $465 | $1,500 | 1.8× |
| MRI cervical spine w contrast (72142) | $920.08 | $2,968 | 2.5× |
| MRI cervical spine w/o cont (72141) | $857.15 | $2,765 | 3.4× |
| MRI chest w/o contrast (71550) | $1,066.40 | $3,440 | 4.2× |
| MRI chest with contrast (71551) | $1,155.99 | $3,729 | 1.4× |
| MRI chest wo w contrast (71552) | $1,268.52 | $4,092 | 3.4× |
| MRI lower extrem oth/thn jt w/contrast matrl (73719) range across 2 matching MRF lines |
$987.66–$1,481.49 | $3,186–$4,779 | varies |
| MRI lower extrem oth/thn jt w/o & w/contr matr (73720) range across 2 matching MRF lines |
$1,148.86–$1,723.29 | $3,706–$5,559 | varies |
| MRI lower extrem oth/thn jt w/o contr matrl (73718) range across 2 matching MRF lines |
$894.04–$1,341.06 | $2,884–$4,326 | varies |
| MRI lumbar spine w contrast (72149) | $946.43 | $3,053 | 2.6× |
| Mri Neck Spine W/O & W/Dye (72156) | $1,110.11 | $3,581 | 3.0× |
| MRI orbit face &/neck w/o contrast (70540) | $988.59 | $3,189 | 3.9× |
| MRI orbit face neck w contrast (70542) | $1,067.95 | $3,445 | 2.9× |
| Mri Orbt/Fac/Nck W/O &W/Dye (70543) | $1,187.61 | $3,831 | 3.2× |
| MRI pelvis w contrast (72196) | $1,025.17 | $3,307 | 2.8× |
| MRI pelvis w/o & w contrast (72197) range across 2 matching MRF lines |
$1,126.54–$1,149.17 | $3,634–$3,707 | varies |
| MRI pelvis w/o contrast (72195) | $941.16 | $3,036 | 3.7× |
| MRI thoracic spine w/o contrast (72146) | $907.99 | $2,929 | 3.6× |
| MRI upper extremity oth than jt w/contr matrl (73219) range across 2 matching MRF lines |
$924.42–$1,386.63 | $2,982–$4,473 | varies |
| MRI upper extremity oth than jt w/o contr matrl (73218) range across 2 matching MRF lines |
$859.94–$1,289.91 | $2,774–$4,161 | varies |
| Mri Uppr Extremity W/O&W/Dye (73220) range across 2 matching MRF lines |
$1,161.26–$1,741.89 | $3,746–$5,619 | varies |
| MRI, abdomen, combo (74183) | $1,139.25 | $3,675 | 3.1× |
| MRI, dorsal spine combo (72157) | $1,129.33 | $3,643 | 3.1× |
| MRI, dorsal spine contrast (72147) | $981.77 | $3,167 | 2.7× |
| MRI, joint upper extrem (73221) range across 2 matching MRF lines |
$894.04–$1,341.06 | $2,884–$4,326 | varies |
| MRI, joint upper extrem combo (73223) range across 2 matching MRF lines |
$1,218.92–$1,828.38 | $3,932–$5,898 | varies |
| MRI, lumbar spine combo (72158) | $1,049.35 | $3,385 | 2.8× |
| Myocardial Imaging Infarct Avid Planar Qual/Quan (78466) | $249.86 | $806 | 0.6× |
| Myocardial Perfusion Planar 1 Study Rest/Stress (78453) | $436.79 | $1,409 | 0.3× |
| Myocardial Spect Multiple Studies (78452) | $2,300.20 | $7,420 | 1.7× |
| Neck soft tissue (70360) | $127.10 | $410 | 1.4× |
| Ntsty modul radthx pln dose-vol histos (77301) | $8,575.22 | $27,662 | 5.9× |
| Nuclear Rx Oral Admin (79005) | $977.12 | $3,152 | 4.0× |
| Parathyroid Planar Imaging (78070) | $501.58 | $1,618 | 1.2× |
| Parathyroid planar imaging w/wo subtraction (78071) | $944.57 | $3,047 | 2.2× |
| Pelvis 1 or 2 views (72170) | $154.38 | $498 | 1.4× |
| PET image w/CT, full body (78816) | $2,826.89 | $9,119 | 1.9× |
| PET imaging CT attenuation skull base mid-thigh (78815) | $2,807.98 | $9,058 | 1.9× |
| Pulmonary Perfusion Imaging Particulate (78580) | $674.25 | $2,175 | 1.6× |
| Radex Abd Compl Aqt Abd W/S/E/D Views 1 View Ch (74022) | $240.56 | $776 | 2.2× |
| Radex abscess/fistula/sinus tract rs&i (76080) | $252.65 | $815 | 0.4× |
| Radex Ankle Complete Minimum 3 Views (73610) range across 2 matching MRF lines |
$161.20–$241.80 | $520–$780 | varies |
| Radex Calcaneus Minimum 2 Views (73650) range across 2 matching MRF lines |
$154.69–$231.88 | $499–$748 | varies |
| Radex elbow complete minimum 3 views (73080) range across 2 matching MRF lines |
$171.74–$257.61 | $554–$831 | varies |
| Radex Facial Bones Complete Minimum 3 Views (70150) | $214.52 | $692 | 1.9× |
| Radex fingr minimum 2 views (73140) range across 2 matching MRF lines |
$137.95–$207.08 | $445–$668 | varies |
| Radex foot complete minimum 3 views (73630) range across 2 matching MRF lines |
$143.53–$215.45 | $463–$695 | varies |
| Radex Hand Minimum 3 Views (73130) range across 2 matching MRF lines |
$156.24–$234.36 | $504–$756 | varies |
| Radex lower extremity infant minimum 2 views (73592) range across 2 matching MRF lines |
$136.09–$204.29 | $439–$659 | varies |
| Radex Nasal Bones Complete Minimum 3 Views (70160) | $155 | $500 | 1.7× |
| Radex Ribs Unilateral 2 Views (71100) | $137.33 | $443 | 1.5× |
| Radex shoulder complete minimum 2 views (73030) range across 2 matching MRF lines |
$170.81–$256.37 | $551–$827 | varies |
| Radex Sinuses Paransl < 3 Views (70210) | $128.34 | $414 | 1.4× |
| Radex Spine 1 View Specify Level (72020) | $166.47 | $537 | 1.8× |
| Radex Sternum Minimum 2 Views (71120) | $146.63 | $473 | 1.6× |
| Radex Temporomandble Jt Opn & Clsd Mouth Bilat (70330) | $199.64 | $644 | 2.2× |
| Radex Toe Minimum 2 Views (73660) range across 2 matching MRF lines |
$125.86–$188.79 | $406–$609 | varies |
| Radex upper extremity infant minimum 2 views (73092) range across 2 matching MRF lines |
$65.10–$97.65 | $210–$315 | varies |
| Radex Wrist Complete Minimum 3 Views (73110) range across 2 matching MRF lines |
$157.17–$235.91 | $507–$761 | varies |
| Radiation Delivery Stereotactic Cranial Linear (77372) | $9,526.30 | $30,730 | 1.2× |
| Radiation treatment delivery level 1 (77402) | $549.94 | $1,774 | 5.1× |
| Radiation treatment delivery level 2 (77407) | $1,489.55 | $4,805 | 3.7× |
| Radiation treatment delivery level 3 (77412) | $1,663.15 | $5,365 | 2.8× |
| Radiolog exam mandible compl minimum 4 views (70110) | $210.49 | $679 | 1.9× |
| Radiologic exam colon double contrast study (74280) | $510.26 | $1,646 | 2.7× |
| Radiologic exam colon single contrast study (74270) | $339.14 | $1,094 | 1.8× |
| Radiologic Exam Esophagus Double Contrast Study (74221) | $317.75 | $1,025 | 1.7× |
| Radiologic exam knee complete 4/more views (73564) range across 2 matching MRF lines |
$200.57–$301.01 | $647–$971 | varies |
| Radiologic exam pelvis compl minimum 3 views (72190) | $170.50 | $550 | 1.5× |
| Radiologic Exam Small Int Single Contrast Study (74250) | $262.57 | $847 | 1.4× |
| Radiologic exam swallow function contrast study (74230) range across 2 matching MRF lines |
$219.48–$262.88 | $708–$848 | varies |
| Radiologic exam upr gi trc double contrast study (74246) | $395.87 | $1,277 | 2.1× |
| Radiologic examination femur 1 view (73551) | $94.86 | $306 | 1.0× |
| Radiologic examination femur minimum 2 views (73552) range across 2 matching MRF lines |
$167.71–$251.72 | $541–$812 | varies |
| Radiologic examination knee 1/2 views (73560) range across 2 matching MRF lines |
$155–$232.50 | $500–$750 | varies |
| Radiologic examination tibia & fibula 2 views (73590) range across 2 matching MRF lines |
$151.59–$227.54 | $489–$734 | varies |
| Ribs bilateral 3 views (71110) | $206.15 | $665 | 1.9× |
| Rp loclzj tum plnr 1 area single day imaging (78800) | $704.63 | $2,273 | 1.7× |
| Rp loclzj tum plnr 2+area 1+d img/1 area img>2+d (78801) | $1,016.18 | $3,278 | 2.4× |
| Rp Loclzj Tum Plnr Whole Body 2+ Days Imaging (78804) | $1,115.69 | $3,599 | 1.9× |
| Rp Loclzj Tum Spect 1 Area Single Day Imaging (78803) | $1,156.61 | $3,731 | 2.0× |
| Rp Therapy Intravenous Administration (79101) range across 2 matching MRF lines |
$403–$934.03 | $1,300–$3,013 | varies |
| Scapula (73010) range across 2 matching MRF lines |
$142.29–$213.59 | $459–$689 | varies |
| Screening Digital Breast Tomosynthesis Bi (77063) range across 2 matching MRF lines |
$21.39–$28.52 | $69–$92 | varies |
| Shoulder 1 view (73020) range across 2 matching MRF lines |
$105.71–$158.72 | $341–$512 | varies |
| Shoulder Arthrography (73040) range across 2 matching MRF lines |
$394.63–$592.10 | $1,273–$1,910 | varies |
| Skull less than 4 views (70250) | $187.86 | $606 | 1.7× |
| Special dosimetry (77331) | $263.19 | $849 | 1.9× |
| Special Physics Consult (77370) | $549.63 | $1,773 | 3.9× |
| Special teletherapy port plan (77321) | $871.72 | $2,812 | 2.2× |
| Special treatment procedure (77470) | $2,495.81 | $8,051 | 4.3× |
| Stereotactic Body Radiation Delivery (77373) | $2,566.18 | $8,278 | 1.4× |
| Sternoclavicular joints (71130) | $169.88 | $548 | 1.8× |
| Telethx isodose pln cplx w/basic dosimetry (77307) | $909.23 | $2,933 | 2.3× |
| Telethx isodose pln smpl w/dosimetry calculation (77306) | $441.13 | $1,423 | 1.1× |
| Ther Rad Simulaj-Aided Field Setting Complex (77290) | $1,834.27 | $5,917 | 4.6× |
| Ther Rad Simulaj-Aided Field Setting Intermed (77285) | $1,074.77 | $3,467 | 2.7× |
| Ther rad simulaj-aided field setting simple (77280) | $919.15 | $2,965 | 6.5× |
| Therapeutic Enema Rdctj Intussusception/Obstrcj (74283) | $164.30 | $530 | 0.9× |
| Thoracic spine 2 views (72070) | $156.24 | $504 | 1.4× |
| Thyroid Imaging With Vascular Flow (78013) | $171.43 | $553 | 0.4× |
| Thyroid Met Imaging Body (78018) | $1,324.32 | $4,272 | 2.3× |
| Thyroid Uptake Measurement (78012) | $463.14 | $1,494 | 1.1× |
| Thyroid Uptake W/Blood Flow Sngle/Mult Quan Meas (78014) | $719.82 | $2,322 | 1.7× |
| Tx Devices Design & Construction Complex (77334) | $777.17 | $2,507 | 2.0× |
| Tx devices design & construction intermediate (77333) | $542.50 | $1,750 | 3.8× |
| Tx devices design & construction simple (77332) | $419.43 | $1,353 | 2.9× |
| Ultrasound Breast Limited (76642) range across 2 matching MRF lines |
$208.01–$312.17 | $671–$1,007 | varies |
| Ultrasound Elastography Parenchyma (76981) | $304.73 | $983 | 2.8× |
| Ultrasound Exam Aaa Screen (76706) | $180.73 | $583 | 1.6× |
| Ultrasound, abdomen limited (76705) | $309.38 | $998 | 2.8× |
| Upper gi w/o kub (74240) | $342.86 | $1,106 | 1.8× |
| Urea Breath Test C-14 Isotopic Acquisj Analysis (78267) | $161.20 | $520 | 14.6× |
| Urea breath test c-14 isotopic analysis (78268) | $190.34 | $614 | 2.0× |
| Urethrocystogram voiding (74455) | $195.61 | $631 | 0.8× |
| Urethrocystography retrograde (74450) | $307.21 | $991 | 1.2× |
| Us breast unilateral complete (76641) range across 2 matching MRF lines |
$221.34–$332.01 | $714–$1,071 | varies |
| Us chest (76604) | $224.13 | $723 | 2.0× |
| Us complete joint (76881) | $167.40 | $540 | 1.5× |
| Us exam, pelvic, limited (76857) | $253.58 | $818 | 2.3× |
| Us head (76506) | $194.37 | $627 | 1.8× |
| Us lmtd joint/oth nonvasc xtr strux r-t w/img (76882) range across 2 matching MRF lines |
$203.98–$305.97 | $658–$987 | varies |
| Us ob limited 1 or more fetuses (76815) | $277.76 | $896 | 2.5× |
| Us ob transvaginal (76817) | $208.63 | $673 | 1.9× |
| Us pelvic non ob complete (76856) | $302.87 | $977 | 2.7× |
| Us pg uter img f&mat 14 wk tabdl 1/1st gestation (76801) | $348.44 | $1,124 | 3.2× |
| Us preg uterus real time f/u trnsabdl per fetus (76816) | $279 | $900 | 2.5× |
| Us retroperitoneal complete (76770) | $324.26 | $1,046 | 2.9× |
| Us retroperitoneal limited (76775) | $292.64 | $944 | 2.6× |
| Us scrotum and contents (76870) | $336.35 | $1,085 | 3.0× |
| Us spinal canal and contents (76800) | $110.05 | $355 | 1.0× |
| Us thyroid (76536) | $287.06 | $926 | 2.6× |
| Vertebral fracture assessment via dxa (77086) | $95.48 | $308 | 1.0× |
| Wrist 2 views (73100) range across 2 matching MRF lines |
$117.18–$175.77 | $378–$567 | varies |
| X-Ray Ac Jts - Xr Acromioclavicular Joints Bilateral (73050) | $178.56 | $576 | 1.9× |
| X-Ray Bend Only L-S Spine (72120) | $197.16 | $636 | 1.8× |
| X-Ray Elbow 2 Vw - Xr Elbow 1-2 Views Right (73070) range across 2 matching MRF lines |
$144.15–$216.38 | $465–$698 | varies |
| X-Ray Exam Breast Specimen (76098) | $236.53 | $763 | 0.4× |
| X-Ray Exam Entire Spi 1 Vw (72081) | $148.80 | $480 | 1.6× |
| X-Ray Exam Entire Spi 2/3 Vw (72082) | $245.52 | $792 | 2.2× |
| X-Ray Exam Entire Spi 4/5 Vw (72083) | $248 | $800 | 2.2× |
| X-Ray Exam Hip Uni 1 View (73501) | $85.87 | $277 | 0.9× |
| X-Ray Exam Hip Uni 2-3 Views (73502) range across 2 matching MRF lines |
$154.07–$231.26 | $497–$746 | varies |
| X-Ray Exam Hip Uni 4/> Views (73503) | $180.73 | $583 | 1.6× |
| X-Ray Exam Hips Bi 2 Views (73521) | $144.46 | $466 | 1.3× |
| X-Ray Exam Hips Bi 3-4 Views (73522) | $184.45 | $595 | 1.7× |
| X-Ray Exam L-S Spine Bending (72114) | $230.33 | $743 | 2.1× |
| X-Ray Exam Neck Spine 2-3 Vw (72040) | $201.19 | $649 | 2.2× |
| X-Ray Exam Neck Spine 6/>Vws (72052) | $246.45 | $795 | 2.2× |
| X-Ray Exam Unilat Ribs/Chest (71101) | $160.27 | $517 | 1.4× |
| X-ray eye for foreign body (70030) | $121.52 | $392 | 1.3× |
| X-ray humerus (73060) range across 2 matching MRF lines |
$147.25–$221.03 | $475–$713 | varies |
| X-ray IV pyelogram (ivp) (74400) | $461.28 | $1,488 | 2.5× |
| X-Ray Knee Bilat Standing - Xr Knees Anteroposterior Standing Bilat (73565) | $171.12 | $552 | 1.9× |
| X-Ray Lumbar Spine 2/3 Vw - Xr Lumbar Spine 2-3 Views (72100) | $188.48 | $608 | 1.7× |
| X-ray nose-rectum child f.b. (76010) | $87.11 | $281 | 0.9× |
| X-Ray Ribs, Chest 4+ Vw - Xr Ribs 3 Vws Bil W/ Chest Posteroanterior (71111) | $188.48 | $608 | 1.7× |
| X-Ray Sacroiliac Jts 3+ Vw - Xr Sacroiliac Joints 3+ Views (72202) | $170.50 | $550 | 1.5× |
| X-Ray Sacrum/Coccyx 2+ Vw - Xr Sacrum Coccyx 2+ Views (72220) | $151.28 | $488 | 1.6× |
| X-Ray Sinuses 3+ Vw - Xr Paranasal Sinuses 3+ Views (70220) | $192.82 | $622 | 2.1× |
| X-Ray Urinary Tract Exam With Contrast Material (74420) | $326.43 | $1,053 | 0.9× |
| X-Rays Bone Length Studies (77073) | $226.61 | $731 | 2.0× |
| X-Rays Bone Survey Complete (77075) | $382.23 | $1,233 | 3.5× |
| Xr c-spine 4 or 5 views (72050) | $233.43 | $753 | 2.1× |
| Xr orbits complete 4 views (70200) | $215.14 | $694 | 1.9× |
A range means this hospital published different amounts on matching machine-readable-file lines. We show the lowest–highest posted amount because we cannot tell from the published file which line would apply to a particular visit.