Imaging prices at Memorial Hospital of South Bend
South Bend, IN · every code in this section with a posted price and a Medicare benchmark.
385 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) | $4,053.40 | $6,236 | 2.8× |
| Abdomen 1 View (74018) | $179.40 | $276 | 1.9× |
| Abdomen 2 views (74019) | $254.15 | $391 | 2.3× |
| Acute Gastrointestinal Blood Loss Imaging (78278) | $884.65 | $1,361 | 2.1× |
| Acute venous thrombosis imaging, peptide Non-Facility (78456) | $1,454.70 | $2,238 | 1.1× |
| Angio internal mammary (75756) | $2,751.45 | $4,233 | 0.8× |
| Angio pulmonary bilat (75743) | $5,762.90 | $8,866 | 1.7× |
| Angiography Adrenal Bilateral Slctv Rs&I (75733) | $5,507.45 | $8,473 | 1.6× |
| Angiography extremity bilateral rs&i (75716) | $5,577 | $8,580 | 1.7× |
| Angiography extremity unilateral rs&i (75710) | $5,211.70 | $8,018 | 1.6× |
| Angiography pulmonary unilateral slctv rs&i (75741) | $5,762.90 | $8,866 | 1.7× |
| Angrph pulmonary nonslctv cath/ven njx rs&i (75746) | $2,671.50 | $4,110 | 0.8× |
| Ankle 2 views (73600) range across 3 matching MRF lines |
$159.90–$310.70 | $246–$478 | varies |
| Aortography thoracic serialography rs&i (75605) | $5,507.45 | $8,473 | 0.9× |
| Artery X-Rays Abdomen (75726) | $5,762.90 | $8,866 | 1.0× |
| Artery X-Rays Adrenal Gland (75731) | $5,507.45 | $8,473 | 1.6× |
| Artery X-Rays Pelvis (75736) | $5,762.90 | $8,866 | 1.0× |
| Artery X-Rays Spine (75705) | $5,430.75 | $8,355 | 0.9× |
| Arthrogram ankle (73615) | $744.25 | $1,145 | 2.0× |
| Arthrogram hip (73525) | $744.25 | $1,145 | 2.0× |
| Arthrogram Wrist (73115) | $766.35 | $1,179 | 2.1× |
| Basic radiation dosimetry calculation (77300) | $410.80 | $632 | 2.9× |
| Bone age studies (77072) | $159.90 | $246 | 1.4× |
| Bone Imaging 3 Phase (78315) | $1,067.95 | $1,643 | 2.5× |
| Bone Imaging Limited Area (78300) | $622.05 | $957 | 1.5× |
| Bone Imaging Multiple Areas (78305) | $862.55 | $1,327 | 2.0× |
| Bone Imaging Whole Body (78306) | $1,272.70 | $1,958 | 3.0× |
| Bone marrow imaging limited area (78102) | $673.40 | $1,036 | 1.6× |
| Bone marrow imaging; multiple areas (78103) | $735.80 | $1,132 | 1.7× |
| Bone survey infant (77076) | $191.10 | $294 | 1.7× |
| Brachytx isodose complex (77318) | $946.40 | $1,456 | 2.4× |
| Brachytx isodose intermed (77317) | $696.15 | $1,071 | 1.8× |
| Brachytx Isodose Plan Simple (77316) | $345.15 | $531 | 0.9× |
| Brain Image W/Flow < 4 Views (78601) | $1,157 | $1,780 | 2.7× |
| Brain Imaging Min 4 Static Views W Vascular Flow (78606) | $1,508 | $2,320 | 2.6× |
| Brain Imaging Pet Metabolic Evaluation (78608) | $4,082 | $6,280 | 2.7× |
| Cardiac MRI w/w/o contrast & further seq (75561) | $1,651.65 | $2,541 | 4.5× |
| Cardiac MRI w/w/o contrast w/stress (75563) | $1,573 | $2,420 | 1.9× |
| Cardiac Shunt Detection (78428) | $798.20 | $1,228 | 1.9× |
| Cat Scan Follow-Up Study (76380) range across 2 matching MRF lines |
$166.40–$176.80 | $256–$272 | varies |
| Cerebrospinal Fluid Flow W/O Matl Shunt Evaltj (78645) | $592.15 | $911 | 1.0× |
| Cerebrospinal Fluid Scan (78630) range across 2 matching MRF lines |
$1,129.70–$1,183.65 | $1,738–$1,821 | varies |
| Chest 1 view (71045) | $220.35 | $339 | 2.4× |
| Chest 2 views (71046) | $196.30 | $302 | 2.1× |
| Chest 3 views (71047) | $209.30 | $322 | 2.3× |
| Chest 4 or more views (71048) | $266.50 | $410 | 2.4× |
| Clavicle complete (73000) range across 3 matching MRF lines |
$187.85–$365.30 | $289–$562 | varies |
| Computed Tomography Thorax Lw Dose Lng Ca Scr C- (71271) | $141.70 | $218 | 1.3× |
| Continuing medical physics consltj pr wk (77336) | $482.95 | $743 | 3.4× |
| Contrast Exam Abdominl Aorta (75625) | $5,408 | $8,320 | 1.6× |
| Contrast X-Ray Bladder (74430) | $599.30 | $922 | 1.6× |
| Contrast X-Ray Of Elbow (73085) | $744.25 | $1,145 | 2.0× |
| Contrast X-Ray Of Knee Joint (73580) | $744.25 | $1,145 | 2.0× |
| CT abdomen and pelvis without and with contrast (74178) | $3,665.35 | $5,639 | 9.9× |
| CT abdomen and pelvis without contrast (74176) | $2,224.30 | $3,422 | 8.8× |
| CT abdomen w contrast (74160) | $1,883.70 | $2,898 | 10.2× |
| CT abdomen w wo contrast (74170) | $2,141.75 | $3,295 | 11.5× |
| CT abdomen w/o contrast (74150) | $1,140.75 | $1,755 | 10.3× |
| CT Angio Abdomen and Pelvis (74174) | $2,337.40 | $3,596 | 6.3× |
| CT Angio Chest (71275) | $1,695.85 | $2,609 | 9.1× |
| CT Angio Head (70496) | $1,780.35 | $2,739 | 9.6× |
| CT angio hrt w/3d image (75574) | $787.80 | $1,212 | 2.1× |
| Ct Angio Lwr Extr W/O&W/Dye (73706) | $1,261.65 | $1,941 | 6.8× |
| CT Angio Neck (70498) | $1,132.30 | $1,742 | 6.1× |
| Ct Angio Upr Extrm W/O&W/Dye (73206) | $1,276.60 | $1,964 | 6.9× |
| CT cervical spine w/ contrast (72126) | $2,094.30 | $3,222 | 5.7× |
| CT cervical spine w/o contrast (72125) | $1,611.35 | $2,479 | 14.6× |
| CT cervical spine w/wo cont (72127) | $2,145 | $3,300 | 11.6× |
| CT chest w contrast (71260) | $1,659.45 | $2,553 | 8.9× |
| CT chest w/wo contrast (71270) | $1,847.30 | $2,842 | 10.0× |
| CT Colonogrphy Dx Image Postprocess W/Contrast (74262) | $3,235.70 | $4,978 | 17.4× |
| CT colonogrphy dx image postprocess w/o contrast (74261) | $2,252.90 | $3,466 | 20.4× |
| CT head/brain with contrast (70460) | $1,220.05 | $1,877 | 6.6× |
| CT head/brain without and with contrast (70470) | $1,584.05 | $2,437 | 8.5× |
| CT heart contrast eval cardiac structure&morph (75572) | $787.80 | $1,212 | 2.1× |
| CT heart no contrast quant eval coronry calcium (75571) | $72.15 | $111 | 0.8× |
| CT iac w contrast (70481) | $1,584.05 | $2,437 | 8.5× |
| CT l-spine w&w/o contrast (72133) | $1,584.05 | $2,437 | 8.5× |
| CT lower ext w/o (73700) | $1,207.05 | $1,857 | 10.9× |
| CT lower extremity w/contrast material (73701) | $1,517.75 | $2,335 | 8.2× |
| CT lumbar spine w contrast (72132) | $1,407.90 | $2,166 | 3.8× |
| CT lumbar spine w/o contrast (72131) | $1,083.55 | $1,667 | 9.8× |
| CT maxillofacial w contrast (70487) | $1,337.05 | $2,057 | 7.2× |
| CT maxillofacial wo contrast (70486) | $966.55 | $1,487 | 8.7× |
| CT neck tissue combo (70492) | $1,600.30 | $2,462 | 8.6× |
| Ct Orbit/Ear/Fossa W/O&W/Dye (70482) | $1,584.05 | $2,437 | 8.5× |
| CT orbits w/o contrast (70480) | $989.95 | $1,523 | 8.9× |
| CT pelvis w&w/o contrast (72194) | $1,584.05 | $2,437 | 8.5× |
| CT pelvis w/o contrast (72192) | $1,080.95 | $1,663 | 9.8× |
| CT scan of leg combo (73702) | $1,669.20 | $2,568 | 9.0× |
| CT scans face/jaw combo (70488) | $1,452.10 | $2,234 | 7.8× |
| CT soft tissue neck w contrast (70491) | $1,591.85 | $2,449 | 8.6× |
| CT soft tissue neck w/o contrast (70490) | $1,207.05 | $1,857 | 10.9× |
| CT thoracic spine w contrast (72129) | $1,948.70 | $2,998 | 10.5× |
| CT thoracic spine w/o contrast (72128) | $1,574.95 | $2,423 | 14.2× |
| CT thoracic spine w/wo cont (72130) | $2,252.25 | $3,465 | 12.1× |
| CT thorax w/o contrast (71250) | $1,207.05 | $1,857 | 10.9× |
| CT upper ext wo (73200) | $1,207.05 | $1,857 | 10.9× |
| CT upper extremity w/o & w/contrast material (73202) | $1,276.60 | $1,964 | 6.9× |
| CT upper extremity with contrast (73201) | $1,584.05 | $2,437 | 4.3× |
| Cta Abdl Aorta&Bi Iliofem W/Contrast&Postp (75635) | $2,478.45 | $3,813 | 13.4× |
| Cta Abdomen (74175) | $1,806.35 | $2,779 | 9.7× |
| CTA pelvis (72191) | $1,806.35 | $2,779 | 9.7× |
| Dilation ureters/urethra rs&i (74485) | $3,223.35 | $4,959 | 1.5× |
| Discography Cerv/Thor Spine (72285) | $4,891.90 | $7,526 | 2.4× |
| Diskography lumbar (72295) | $4,891.90 | $7,526 | 2.4× |
| Doppler Echo Fetal Spectral Display Complete (76827) | $227.50 | $350 | 2.1× |
| Doppler Fetal Mid Cerebral Artery (76821) | $192.40 | $296 | 1.7× |
| Dxa Bone Density Axial (77080) | $217.10 | $334 | 2.0× |
| Dxa bone density study (77085) | $146.25 | $225 | 1.3× |
| Dxa bone density study 1/>sites appendiclr skel (77081) | $84.50 | $130 | 0.9× |
| Echo exam of fetal heart (76825) | $972.40 | $1,496 | 1.7× |
| Echo exam uterus (76831) | $413.40 | $636 | 1.6× |
| Echo Guide For Artery Repair (76936) | $826.80 | $1,272 | 3.6× |
| Echograp Trans R Pros Study (76873) | $401.70 | $618 | 3.6× |
| Esophagram (74220) | $310.05 | $477 | 1.7× |
| Fetal Biophysical Profile W/O Non-Stress Testing (76819) | $666.90 | $1,026 | 6.0× |
| Fetal MRI w/placntl matrnl plvc img sing/1st ges (74712) | $872.95 | $1,343 | 3.5× |
| Follow-Up Angiography (75898) | $805.35 | $1,239 | 0.2× |
| Foot 2 views (73620) range across 3 matching MRF lines |
$141.70–$275.60 | $218–$424 | varies |
| Forearm 2 views (73090) range across 3 matching MRF lines |
$188.50–$366.60 | $290–$564 | varies |
| Gastric emptying imaging study (78264) | $1,071.85 | $1,649 | 2.5× |
| Gastroesophageal Reflux Exam (78262) | $779.35 | $1,199 | 1.8× |
| Gated Heart Planar Single (78472) | $1,261 | $1,940 | 3.0× |
| Hand 2 views (73120) range across 3 matching MRF lines |
$184.60–$358.80 | $284–$552 | varies |
| Hdr Rdncl Ntrstl/Icav Brchtx (77772) | $4,085.90 | $6,286 | 5.5× |
| Hdr Rdncl Ntrstl/Icav Brchtx (77771) | $3,488.55 | $5,367 | 4.7× |
| Hdr Rdncl Ntrstl/Icav Brchtx 1 Channel (77770) | $3,357.90 | $5,166 | 4.6× |
| Heart first pass single,planar (78481) | $850.85 | $1,309 | 1.5× |
| Hepatc Vngrph Wdg/Fr Hemodyn Eval Rs&I (75889) | $5,507.45 | $8,473 | 1.6× |
| Hepatc Vngrph Wdg/Fr W/O Hemodyn Eval Rs&I (75891) | $5,507.45 | $8,473 | 1.6× |
| Hepatobil Syst Image W/Drug (78227) | $991.90 | $1,526 | 1.7× |
| Hepatobiliary System Imaging (78226) | $843.05 | $1,297 | 2.0× |
| Ht Musc Image Planar Mult (78454) | $1,513.20 | $2,328 | 1.1× |
| Ht Muscle Image Spect Sing (78451) | $1,804.40 | $2,776 | 1.3× |
| Hysterosalpingogram (74740) | $516.10 | $794 | 2.0× |
| Infant hip ultrasound with hip movement (dynamic) (76885) | $279.50 | $430 | 3.0× |
| Interstitial radiation source applic complex (77778) | $4,506.45 | $6,933 | 6.1× |
| Intracavitary Radiation Source Applic Complex (77763) | $4,232.15 | $6,511 | 5.7× |
| Intracavitary Radiation Source Applic Intermed (77762) | $4,232.15 | $6,511 | 7.2× |
| Intracavitary radiation source applic simple (77761) | $4,232.15 | $6,511 | 7.2× |
| Joint Survey Single View (77077) | $156.65 | $241 | 1.4× |
| K Flow/Funct Image W/Drug (78708) | $948.35 | $1,459 | 1.7× |
| K Flow/Funct Image W/O Drug (78707) | $1,018.55 | $1,567 | 1.8× |
| Kidney Funcj Study Non-Img Radioisotopic Study (78725) | $471.25 | $725 | 1.1× |
| Kidney Imaging Morphol (78700) | $728 | $1,120 | 1.7× |
| Kidney Imaging Morphoogy W/Vascular Flow (78701) | $846.95 | $1,303 | 2.0× |
| Knee 3 Views (73562) range across 3 matching MRF lines |
$210.60–$409.50 | $324–$630 | varies |
| Labeled RBC Sequestration Differntl Organ/Tissue (78140) | $1,017.25 | $1,565 | 2.4× |
| Leveen/Shunt Patency Exam (78291) | $670.15 | $1,031 | 1.6× |
| Liver & Spleen Imaging Static Only (78215) | $672.75 | $1,035 | 1.6× |
| Liver & Spleen Imaging W/Vascular Flow (78216) | $640.90 | $986 | 1.5× |
| Liver imaging static only (78201) | $1,454.70 | $2,238 | 2.5× |
| Lung Perf&Ventilat Diferentl (78598) | $790.40 | $1,216 | 1.4× |
| Lung perfusion differential (78597) | $586.30 | $902 | 1.4× |
| Lung Ventilat&Perfus Imaging (78582) | $808.60 | $1,244 | 1.4× |
| Lung Ventilation Imaging (78579) | $596.05 | $917 | 1.4× |
| Lymph System Imaging (78195) | $1,018.55 | $1,567 | 1.8× |
| Lymphangiography Extremity Only Bilateral Rs&I (75803) | $2,766.40 | $4,256 | 1.7× |
| Lymphangiography extremity only unilateral rs&i (75801) | $1,075.75 | $1,655 | 1.6× |
| Lymphangiography Pelvic/Abdominal Bilateral Rs&I (75807) | $5,538 | $8,520 | 1.7× |
| Lymphangiography, pelvic/abdominal, unilateral (75805) | $5,538 | $8,520 | 1.7× |
| Magnetic Image Jaw Joint (70336) | $1,320.80 | $2,032 | 5.2× |
| Mammary ductogram or galactogram single (77053) | $533 | $820 | 2.1× |
| Meckels Divert Exam (78290) | $699.40 | $1,076 | 1.7× |
| Mlc imrt design & construction per imrt plan (77338) | $1,332.50 | $2,050 | 3.4× |
| Mr safety determination physician/other qhp (76016) | $157.30 | $242 | 1.7× |
| Mr safety implant&/fb assmt clin staf 1st 15 min (76014) | $43.55 | $67 | 1.4× |
| Mr safety implt electronics prepj supvj phys/qhp (76018) | $163.80 | $252 | 1.6× |
| Mra Head W/O & W/Contrast Material (70546) | $1,651.65 | $2,541 | 4.5× |
| MRA head w/o contrast (70544) | $1,320.80 | $2,032 | 5.2× |
| Mra Neck W/O &W/Contrast Material (70549) | $1,651.65 | $2,541 | 4.5× |
| MRA neck w/o contrast (70547) | $1,320.80 | $2,032 | 5.2× |
| MRI abdomen w/o contrast (74181) | $1,320.80 | $2,032 | 5.2× |
| MRI any jt lower extrem w/contrast material (73722) | $1,651.65 | $2,541 | 2.0× |
| MRI any jt lower extrem w/o & w/contrast matrl (73723) | $1,651.65 | $2,541 | 4.5× |
| MRI any jt upper extremity w/contrast matrl (73222) | $1,651.65 | $2,541 | 2.0× |
| MRI Breast W/O Contrast Bilateral (77047) | $1,365.65 | $2,101 | 5.4× |
| MRI Breast Without Contrast Material Unilateral (77046) | $1,104.35 | $1,699 | 4.4× |
| MRI cardiac w/o cont stress (75559) | $1,573 | $2,420 | 2.7× |
| MRI cardiac w/o contrast (75557) | $1,320.80 | $2,032 | 5.2× |
| MRI cervical spine w/o cont (72141) | $1,320.80 | $2,032 | 5.2× |
| MRI chest w/o contrast (71550) | $1,320.80 | $2,032 | 5.2× |
| MRI chest wo w contrast (71552) | $1,651.65 | $2,541 | 4.5× |
| MRI lower extrem oth/thn jt w/o & w/contr matr (73720) | $1,651.65 | $2,541 | 4.5× |
| MRI lower extrem oth/thn jt w/o contr matrl (73718) | $1,320.80 | $2,032 | 5.2× |
| Mri Neck Spine W/O & W/Dye (72156) | $1,651.65 | $2,541 | 4.5× |
| MRI orbit face &/neck w/o contrast (70540) | $1,320.80 | $2,032 | 5.2× |
| Mri Orbt/Fac/Nck W/O &W/Dye (70543) | $1,651.65 | $2,541 | 4.5× |
| MRI pelvis w/o & w contrast (72197) | $1,651.65 | $2,541 | 4.5× |
| MRI pelvis w/o contrast (72195) | $1,320.80 | $2,032 | 5.2× |
| MRI thoracic spine w/o contrast (72146) | $1,320.80 | $2,032 | 5.2× |
| MRI upper extremity oth than jt w/o contr matrl (73218) | $1,320.80 | $2,032 | 5.2× |
| Mri Uppr Extremity W/O&W/Dye (73220) | $1,651.65 | $2,541 | 4.5× |
| MRI, abdomen, combo (74183) | $1,651.65 | $2,541 | 4.5× |
| MRI, dorsal spine combo (72157) | $1,651.65 | $2,541 | 4.5× |
| MRI, joint upper extrem (73221) | $1,320.80 | $2,032 | 5.2× |
| MRI, joint upper extrem combo (73223) | $1,651.65 | $2,541 | 4.5× |
| MRI, lumbar spine combo (72158) | $1,651.65 | $2,541 | 4.5× |
| Myelogram cervical (72240) | $1,368.25 | $2,105 | 1.6× |
| Myelogram Lumbar (72265) | $1,368.25 | $2,105 | 1.6× |
| Myelography thoracic (72255) | $1,368.25 | $2,105 | 1.6× |
| Myelograpy 2/more regions rs&i (72270) | $1,409.20 | $2,168 | 1.7× |
| Myocardial Perfusion Planar 1 Study Rest/Stress (78453) | $1,454.70 | $2,238 | 1.1× |
| Myocardial Spect Multiple Studies (78452) | $2,490.80 | $3,832 | 1.8× |
| N-invas est c ffr sw aly CTA (75580) | $2,910.05 | $4,477 | 3.2× |
| Neck soft tissue (70360) | $147.55 | $227 | 1.6× |
| Njx Rp Loclzj Non-Img Probe Study Intravenous (78808) | $734.50 | $1,130 | 1.7× |
| Nm csf leak detection (78650) | $1,456 | $2,240 | 1.1× |
| Nm myocard infarct spect (78469) | $1,454.70 | $2,238 | 2.5× |
| Ntsty modul radthx pln dose-vol histos (77301) | $4,384.90 | $6,746 | 3.0× |
| Nuclear Rx Oral Admin (79005) | $819 | $1,260 | 3.3× |
| Ob us nuchal meas 1 gest (76813) | $153.40 | $236 | 1.4× |
| Panoramic X-ray of jaws (70355) | $195 | $300 | 2.1× |
| Parathyroid imaging w/tomographic spect & CT (78072) | $1,365 | $2,100 | 2.4× |
| Parathyroid Planar Imaging (78070) | $611 | $940 | 1.4× |
| Parathyroid planar imaging w/wo subtraction (78071) | $1,179.75 | $1,815 | 2.8× |
| Pelvis 1 or 2 views (72170) | $163.80 | $252 | 1.5× |
| Peritoneogram Rs&I (74190) | $976.30 | $1,502 | 1.7× |
| Pet Image W/Ct Lmtd (78814) | $4,069.65 | $6,261 | 2.7× |
| PET image w/CT, full body (78816) | $4,245.15 | $6,531 | 2.8× |
| PET imaging CT attenuation skull base mid-thigh (78815) | $4,245.15 | $6,531 | 2.8× |
| Prq Transhepatc Portograpy Hemodyn Eval Rs&I (75885) | $5,507.45 | $8,473 | 1.6× |
| Pulmonary Perfusion Imaging Particulate (78580) | $657.80 | $1,012 | 1.6× |
| Radex Abd Compl Aqt Abd W/S/E/D Views 1 View Ch (74022) | $328.90 | $506 | 3.0× |
| Radex abscess/fistula/sinus tract rs&i (76080) | $906.75 | $1,395 | 1.6× |
| Radex Ankle Complete Minimum 3 Views (73610) range across 3 matching MRF lines |
$190.45–$369.20 | $293–$568 | varies |
| Radex Calcaneus Minimum 2 Views (73650) range across 3 matching MRF lines |
$180.70–$351 | $278–$540 | varies |
| Radex elbow complete minimum 3 views (73080) range across 3 matching MRF lines |
$209.95–$408.20 | $323–$628 | varies |
| Radex Facial Bones Complete Minimum 3 Views (70150) | $273 | $420 | 2.5× |
| Radex fingr minimum 2 views (73140) | $160.55 | $247 | 1.7× |
| Radex foot complete minimum 3 views (73630) range across 3 matching MRF lines |
$190.45–$369.20 | $293–$568 | varies |
| Radex Hand Minimum 3 Views (73130) range across 3 matching MRF lines |
$203.45–$395.20 | $313–$608 | varies |
| Radex lower extremity infant minimum 2 views (73592) | $158.60 | $244 | 1.7× |
| Radex Nasal Bones Complete Minimum 3 Views (70160) | $189.15 | $291 | 2.1× |
| Radex Ribs Unilateral 2 Views (71100) | $199.55 | $307 | 2.2× |
| Radex shoulder complete minimum 2 views (73030) range across 3 matching MRF lines |
$197.60–$383.50 | $304–$590 | varies |
| Radex Sinuses Paransl < 3 Views (70210) | $170.95 | $263 | 1.9× |
| Radex sm int w/mlt srl imges via enteroclss tube (74251) | $410.15 | $631 | 2.2× |
| Radex Spine 1 View Specify Level (72020) | $203.45 | $313 | 2.2× |
| Radex Sternum Minimum 2 Views (71120) | $212.55 | $327 | 2.3× |
| Radex Toe Minimum 2 Views (73660) | $160.55 | $247 | 1.7× |
| Radex upper extremity infant minimum 2 views (73092) | $162.50 | $250 | 1.5× |
| Radex Wrist Complete Minimum 3 Views (73110) range across 3 matching MRF lines |
$203.45–$395.20 | $313–$608 | varies |
| Radex X-Ray Exam Entire Spi 6/> Vw - Xr Entire Spine 6+ Vw (72084) | $451.10 | $694 | 4.1× |
| Radiation Delivery Stereotactic Cranial Linear (77372) | $15,811.25 | $24,325 | 2.0× |
| Radiation treatment delivery level 1 (77402) | $276.90 | $426 | 2.6× |
| Radiation treatment delivery level 2 (77407) | $336.70 | $518 | 0.8× |
| Radiation treatment delivery level 3 (77412) | $475.15 | $731 | 0.8× |
| Radiolog exam mandible compl minimum 4 views (70110) | $237.25 | $365 | 2.1× |
| Radiologic Exam Abdomen 3+ Views - Xr Abdomen 3+ Views (74021) | $241.80 | $372 | 2.2× |
| Radiologic exam colon double contrast study (74280) | $696.15 | $1,071 | 3.8× |
| Radiologic exam colon single contrast study (74270) | $425.10 | $654 | 2.3× |
| Radiologic Exam Esophagus Double Contrast Study (74221) | $400.40 | $616 | 2.2× |
| Radiologic exam knee complete 4/more views (73564) range across 3 matching MRF lines |
$243.10–$471.90 | $374–$726 | varies |
| Radiologic exam pelvis compl minimum 3 views (72190) | $224.90 | $346 | 2.0× |
| Radiologic Exam Small Int Single Contrast Study (74250) | $373.10 | $574 | 2.0× |
| Radiologic exam swallow function contrast study (74230) | $283.40 | $436 | 1.5× |
| Radiologic exam upr gi trc double contrast study (74246) | $588.25 | $905 | 3.2× |
| Radiologic examination femur 1 view (73551) | $200.85 | $309 | 2.2× |
| Radiologic examination femur minimum 2 views (73552) range across 3 matching MRF lines |
$204.10–$396.50 | $314–$610 | varies |
| Radiologic examination knee 1/2 views (73560) range across 3 matching MRF lines |
$181.35–$352.30 | $279–$542 | varies |
| Radiologic Examination Osseous Survey Limited (77074) | $1,121.90 | $1,726 | 10.1× |
| Radiologic examination tibia & fibula 2 views (73590) range across 3 matching MRF lines |
$193.05–$374.40 | $297–$576 | varies |
| Radiopharmaceutical therapy, by intracavitary administration Non-Facility (79200) | $912.60 | $1,404 | 3.7× |
| Renal Cyst Study (74470) | $590.85 | $909 | 1.0× |
| Ribs bilateral 3 views (71110) | $263.25 | $405 | 2.4× |
| Rp loclzj tum plnr 1 area single day imaging (78800) | $859.30 | $1,322 | 2.0× |
| Rp loclzj tum plnr 2+area 1+d img/1 area img>2+d (78801) | $1,132.30 | $1,742 | 2.7× |
| Rp Loclzj Tum Plnr Whole Body 2+ Days Imaging (78804) | $1,807 | $2,780 | 3.1× |
| Rp Loclzj Tum Plnr Whole Body Single Day Imaging (78802) | $1,815.45 | $2,793 | 3.2× |
| Rp Loclzj Tum Spect 1 Area Single Day Imaging (78803) | $1,253.85 | $1,929 | 2.2× |
| Rp loclzj tum spect 2 area/sep acquisj img (78831) | $2,659.15 | $4,091 | 1.9× |
| Rp loclzj tum spect CT 2area 1d img/1 ar img>2+d (78832) | $3,138.20 | $4,828 | 2.1× |
| Rp loclzj tum spect w/CT 1 area/acquisj 1day img (78830) | $2,659.15 | $4,091 | 1.9× |
| Rp Ther Radiolbld Monoclonal Antibody IV Infus (79403) | $1,587.95 | $2,443 | 6.4× |
| Rp Therapy Intravenous Administration (79101) | $640.25 | $985 | 2.6× |
| Salivary Gland Imaging Serial Images (78231) | $644.15 | $991 | 1.5× |
| Scapula (73010) | $176.15 | $271 | 1.6× |
| Screening Digital Breast Tomosynthesis Bi (77063) | $43.55 | $67 | 1.9× |
| Shoulder 1 view (73020) | $163.80 | $252 | 1.8× |
| Shoulder Arthrography (73040) | $766.35 | $1,179 | 2.1× |
| Sialogram (70390) | $590.85 | $909 | 2.3× |
| Skull less than 4 views (70250) | $182 | $280 | 1.6× |
| Special dosimetry (77331) | $411.45 | $633 | 2.9× |
| Special Physics Consult (77370) | $639.60 | $984 | 4.5× |
| Special teletherapy port plan (77321) | $731.25 | $1,125 | 1.8× |
| Special treatment procedure (77470) | $1,693.25 | $2,605 | 2.9× |
| Stereotactic Body Radiation Delivery (77373) | $8,414.25 | $12,945 | 4.4× |
| Sternoclavicular joints (71130) | $335.40 | $516 | 3.6× |
| Superior sagittal sinus venogram (75870) | $5,493.15 | $8,451 | 1.6× |
| Telethx isodose pln cplx w/basic dosimetry (77307) | $1,600.95 | $2,463 | 4.0× |
| Telethx isodose pln smpl w/dosimetry calculation (77306) | $731.90 | $1,126 | 1.8× |
| Testicular Imaging W/Flow (78761) | $846.95 | $1,303 | 2.0× |
| Ther Rad Simulaj-Aided Field Setting Complex (77290) | $1,193.40 | $1,836 | 3.0× |
| Ther Rad Simulaj-Aided Field Setting Intermed (77285) | $949.65 | $1,461 | 2.4× |
| Ther rad simulaj-aided field setting simple (77280) | $627.25 | $965 | 4.4× |
| Thoracic spine 2 views (72070) | $185.90 | $286 | 1.7× |
| Thoracic spine 3 views (72072) | $237.25 | $365 | 2.1× |
| Thoracolumbar 2 views (72080) | $204.10 | $314 | 2.2× |
| Thyroid Imaging With Vascular Flow (78013) | $419.90 | $646 | 1.0× |
| Thyroid Met Imaging Body (78018) | $1,290.90 | $1,986 | 2.2× |
| Thyroid Uptake Measurement (78012) | $422.50 | $650 | 1.0× |
| Thyroid Uptake W/Blood Flow Sngle/Mult Quan Meas (78014) | $883.35 | $1,359 | 2.1× |
| Tx Devices Design & Construction Complex (77334) | $871 | $1,340 | 2.2× |
| Tx devices design & construction intermediate (77333) | $626.60 | $964 | 4.4× |
| Tx devices design & construction simple (77332) | $538.20 | $828 | 3.8× |
| Ultrasound Breast Limited (76642) range across 6 matching MRF lines |
$156–$312 | $240–$480 | varies |
| Ultrasound Elastography Parenchyma (76981) | $402.35 | $619 | 3.6× |
| Ultrasound Exam Aaa Screen (76706) | $187.20 | $288 | 1.7× |
| Ultrasound, abdomen limited (76705) | $417.30 | $642 | 3.8× |
| Umbilical-artery Doppler (OB) (76820) | $174.85 | $269 | 1.6× |
| Unlisted Dx Radiographic Procedure (76499) | $87.10 | $134 | 0.9× |
| Upper gi w/o kub (74240) | $435.50 | $670 | 2.3× |
| Ureteral Reflux Study (78740) | $587.60 | $904 | 1.4× |
| Urethrocystogram voiding (74455) | $566.80 | $872 | 2.2× |
| Urethrocystography retrograde (74450) | $692.25 | $1,065 | 2.7× |
| Us breast unilateral complete (76641) | $235.95 | $363 | 2.1× |
| Us chest (76604) | $325.65 | $501 | 2.9× |
| Us complete joint (76881) | $195 | $300 | 1.8× |
| Us exam, pelvic, limited (76857) | $235.95 | $363 | 2.1× |
| Us head (76506) | $507 | $780 | 4.6× |
| Us kidney transplant (76776) | $410.15 | $631 | 3.7× |
| Us lmtd joint/oth nonvasc xtr strux r-t w/img (76882) | $388.05 | $597 | 3.5× |
| Us ob detailed single fetus (76811) | $435.50 | $670 | 1.7× |
| Us ob limited 1 or more fetuses (76815) | $303.55 | $467 | 2.7× |
| Us ob transvaginal (76817) | $458.25 | $705 | 4.1× |
| Us pelvic non ob complete (76856) | $464.10 | $714 | 4.2× |
| Us pg uter img f&mat 14 wk tabdl 1/1st gestation (76801) | $458.25 | $705 | 4.1× |
| Us preg uterus real time f/u trnsabdl per fetus (76816) | $357.50 | $550 | 3.2× |
| Us retroperitoneal complete (76770) | $585.65 | $901 | 5.3× |
| Us retroperitoneal limited (76775) | $370.50 | $570 | 3.3× |
| Us scrotum and contents (76870) | $568.10 | $874 | 5.1× |
| Us spinal canal and contents (76800) | $308.75 | $475 | 2.8× |
| Us thyroid (76536) | $352.95 | $543 | 3.2× |
| Us transrectal (76872) | $557.70 | $858 | 5.0× |
| Vascular Flow Imaging (78445) | $542.75 | $835 | 1.3× |
| Vein X-Ray Chest (75827) | $2,005.25 | $3,085 | 1.2× |
| Vein X-Ray Liver W/O Hemodyn (75887) | $1,658.15 | $2,551 | 0.5× |
| Vein X-Ray Skull Epidural (75872) | $2,553.20 | $3,928 | 3.8× |
| Venogram Sinus/Jugular (75860) | $2,553.20 | $3,928 | 0.8× |
| Venography caval inferior serialography rs&i (75825) | $5,762.90 | $8,866 | 1.7× |
| Venography extremity bilateral rs&i (75822) | $2,037.10 | $3,134 | 1.2× |
| Venography extremity unilateral rs&i (75820) | $2,037.10 | $3,134 | 1.2× |
| Venography Renal Bilateral (75833) | $5,507.45 | $8,473 | 1.6× |
| Venography Renal Unilateral (75831) | $5,507.45 | $8,473 | 1.6× |
| Venous sampling by catheter (75893) | $5,507.45 | $8,473 | 0.9× |
| Vertebral fracture assessment via dxa (77086) | $106.60 | $164 | 1.2× |
| Wrist 2 views (73100) range across 3 matching MRF lines |
$172.25–$334.10 | $265–$514 | varies |
| X-Ray Ac Jts - Xr Acromioclavicular Joints Bilateral (73050) | $241.80 | $372 | 2.6× |
| X-ray antegrade pyelogram tube (74425) | $497.25 | $765 | 1.3× |
| X-Ray Aorta Leg Arteries (75630) | $5,762.90 | $8,866 | 1.7× |
| X-Ray Bend Only L-S Spine (72120) | $280.80 | $432 | 2.5× |
| X-Ray Elbow 2 Vw - Xr Elbow 1-2 Views Right (73070) range across 3 matching MRF lines |
$176.80–$343.20 | $272–$528 | varies |
| X-Ray Exam Breast Specimen (76098) | $483.60 | $744 | 0.8× |
| X-Ray Exam Entire Spi 1 Vw (72081) | $153.40 | $236 | 1.7× |
| X-Ray Exam Entire Spi 2/3 Vw (72082) | $233.35 | $359 | 2.1× |
| X-Ray Exam Entire Spi 4/5 Vw (72083) | $233.35 | $359 | 2.1× |
| X-Ray Exam Hip Uni 1 View (73501) | $147.55 | $227 | 1.6× |
| X-Ray Exam Hip Uni 2-3 Views (73502) | $187.85 | $289 | 2.0× |
| X-Ray Exam Hips Bi 2 Views (73521) | $385.45 | $593 | 3.5× |
| X-Ray Exam Hips Bi 5/> Views (73523) | $216.45 | $333 | 2.0× |
| X-Ray Exam L-S Spine Bending (72114) | $469.30 | $722 | 4.2× |
| X-Ray Exam Neck Spine 2-3 Vw (72040) | $201.50 | $310 | 2.2× |
| X-Ray Exam Neck Spine 6/>Vws (72052) | $525.85 | $809 | 4.8× |
| X-Ray Exam Unilat Ribs/Chest (71101) | $260 | $400 | 2.4× |
| X-ray eye for foreign body (70030) | $239.20 | $368 | 2.6× |
| X-ray humerus (73060) range across 3 matching MRF lines |
$186.55–$362.70 | $287–$558 | varies |
| X-ray IV pyelogram (ivp) (74400) | $1,072.50 | $1,650 | 5.8× |
| X-Ray Jaw <4 Vw - Xr Mandible < 4 Views (70100) | $180.05 | $277 | 2.0× |
| X-Ray Knee Bilat Standing - Xr Knees Anteroposterior Standing Bilat (73565) | $183.30 | $282 | 2.0× |
| X-Ray Lumbar Spine 2/3 Vw - Xr Lumbar Spine 2-3 Views (72100) | $280.80 | $432 | 2.5× |
| X-ray nose-rectum child f.b. (76010) | $179.40 | $276 | 1.9× |
| X-Ray Ribs, Chest 4+ Vw - Xr Ribs 3 Vws Bil W/ Chest Posteroanterior (71111) | $360.75 | $555 | 3.3× |
| X-Ray Sacroiliac Jts 3+ Vw - Xr Sacroiliac Joints 3+ Views (72202) | $204.75 | $315 | 1.9× |
| X-Ray Sacrum/Coccyx 2+ Vw - Xr Sacrum Coccyx 2+ Views (72220) | $196.30 | $302 | 2.1× |
| X-Ray Sinuses 3+ Vw - Xr Paranasal Sinuses 3+ Views (70220) | $247 | $380 | 2.7× |
| X-Ray Skull 4+ Vw - Xr Skull Complete 4+ Views (70260) | $288.60 | $444 | 2.6× |
| X-ray thoracic spine 4 vw (72074) | $229.45 | $353 | 2.1× |
| X-Ray Urinary Tract Exam With Contrast Material (74420) | $794.95 | $1,223 | 2.2× |
| X-Rays Bone Length Studies (77073) | $261.30 | $402 | 2.4× |
| Xr c-spine 4 or 5 views (72050) | $325.65 | $501 | 2.9× |
| Xr facial bones less than 3 views (70140) | $189.15 | $291 | 2.1× |
| Xr orbits complete 4 views (70200) | $261.30 | $402 | 2.4× |
| Xr Tomogram Single Plane (76100) | $298.35 | $459 | 2.7× |
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.