31 codes. Prices are the hospital's own posted facility charges.
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| Procedure | Cash price | Gross charge | × Medicare |
|---|
| Angiography extremity bilateral rs&i (75716) |
$2,350.48 |
$2,671 |
0.7× |
| Angiography extremity unilateral rs&i (75710) |
$1,125.96 |
$1,279.50 |
0.3× |
| Angiography visceral slctv/supraslctv rs&i (75726) |
$3,616.80 |
$4,110 |
0.6× |
| Aortography abdominal serialography rs&i (75625) |
$1,240.80 |
$1,410 |
0.4× |
| Continuing medical physics consltj pr wk (77336) |
$665.28 |
$756 |
4.8× |
| Cystography minimum 3 views rs&i (74430) |
$322.96 |
$367 |
0.9× |
| Fluoroscopy up to 1 hr (76000) |
$367.84 |
$418 |
1.5× |
| Ntsty modul radthx pln dose-vol histos (77301) |
$6,715.28 |
$7,631 |
4.7× |
| PET image w/CT, skull-thigh (78815) |
$6,527.84 |
$7,418 |
4.4× |
| Radiation treatment delivery level 2 (77407) |
$3,149.96 |
$3,579.50 |
7.9× |
| Radiation treatment delivery level 3 (77412) |
$1,210.88 |
$1,376 |
2.1× |
| Radiologic exam chest 2 views (71046) |
$142.56 |
$162 |
1.6× |
| Rp therapy intra-arterial particulate admn (79445) |
$1,559.36 |
$1,772 |
6.5× |
| Special Physics Consult (77370) |
$826.32 |
$939 |
6.0× |
| Stereotactic Body Radiation Delivery (77373) |
$10,577.60 |
$12,020 |
5.7× |
| Tbs technical calculation only (77091) |
$227.04 |
$258 |
2.5× |
| Ultrasound, abdomen limited (76705) |
$381.92 |
$434 |
3.5× |
| Unlisted fluoroscopic procedure (76496) |
$1,136.96 |
$1,292 |
12.7× |
| Us breast unilateral limited (76642) |
$286 |
$325 |
3.2× |
| Us chest (76604) |
$281.60 |
$320 |
2.6× |
| Us lmtd joint/oth nonvasc xtr strux r-t w/img (76882) |
$212.96 |
$242 |
2.0× |
| Us nrv&acc strux 1 xtr compre w/img pr extremity (76883) |
$765.60 |
$870 |
7.1× |
| Us ob limited (76815) |
$302.72 |
$344 |
2.8× |
| Us pelvic nonobstetric image dcmtn limited/f/u (76857) |
$214.72 |
$244 |
2.0× |
| Us retroperitoneal complete (76770) |
$425.04 |
$483 |
3.9× |
| Us retroperitoneal limited (76775) |
$234.08 |
$266 |
2.2× |
| Us soft tissue head/neck (76536) |
$395.12 |
$449 |
3.7× |
| Us, eye b-scan (76512) |
$237.60 |
$270 |
2.2× |
| Venogram extremity bilateral (75822) |
$990 |
$1,125 |
0.6× |
| Venography renal unilateral selective rs&i (75831) |
$2,953.28 |
$3,356 |
0.9× |
| X-ray retrograde pyelogram (74420) |
$484 |
$550 |
1.3× |