Imaging prices at Memorial Medical Center

Springfield, IL · every code in this section with a posted price and a Medicare benchmark.

382 codes. Prices are the hospital's own posted facility charges.

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ProcedurePosted cashPosted gross× Medicare
3-D radiotherapy plan dose-volume histograms (77295) $11,950 $11,950 8.1×
Abdomen 1 View (74018) $665 $665 7.1×
Abdomen 2 views (74019) $804 $804 7.2×
Acute Gastrointestinal Blood Loss Imaging (78278) $1,324 $1,324 3.1×
Angio internal mammary (75756) $5,456 $5,456 1.6×
Angio pulmonary bilat (75743) $8,070 $8,070 2.4×
Angiography Adrenal Bilateral Slctv Rs&I (75733) $5,456 $5,456 1.6×
Angiography extremity bilateral rs&i (75716) $8,184 $8,184 2.4×
Angiography extremity unilateral rs&i (75710) $5,456 $5,456 1.6×
Angiography pulmonary unilateral slctv rs&i (75741) $5,380 $5,380 1.6×
Ankle 2 views (73600) $753 $753 8.1×
Aortography thoracic serialography rs&i (75605) $9,439 $9,439 1.6×
Artery X-Rays Abdomen (75726) $8,650 $8,650 1.5×
Artery X-Rays Pelvis (75736) $9,439 $9,439 1.6×
Artery X-Rays Spine (75705) $9,098 $9,098 1.5×
Arthrogram ankle (73615) $757 $757 2.0×
Arthrogram hip (73525) $1,068 $1,068 2.9×
Arthrogram Wrist (73115) $746 $746 2.0×
Basic radiation dosimetry calculation (77300) $1,172 $1,172 8.1×
Bone age studies (77072) $897 $897 8.0×
Bone Imaging 3 Phase (78315) $3,276 $3,276 7.6×
Bone Imaging Limited Area (78300) $2,066 $2,066 4.8×
Bone Imaging Whole Body (78306) $2,995 $2,995 7.0×
Bone marrow imaging limited area (78102) $985 $985 2.3×
Bone survey infant (77076) $755 $755 6.7×
Brachytx isodose complex (77318) $2,170 $2,170 5.4×
Brachytx isodose intermed (77317) $1,273 $1,273 3.2×
Brachytx Isodose Plan Simple (77316) $878 $878 2.2×
Brain Imaging Min 4 Static Views W Vascular Flow (78606) $1,635 $1,635 2.8×
Brain Imaging Pet Metabolic Evaluation (78608) $7,548 $7,548 4.9×
Cardiac MRI w/w/o contrast & further seq (75561) $6,683 $6,683 17.9×
Cat Scan Follow-Up Study (76380) $2,176 $2,176 23.3×
Cerebrospinal Fluid Flow W/O Matl Shunt Evaltj (78645) $2,253 $2,253 3.9×
Cerebrospinal Fluid Scan (78630) $1,916 $1,916 3.3×
Chest 1 view (71045) $604 $604 6.5×
Chest 2 views (71046)
range across 5 matching MRF lines		 $92–$667 $92–$667 varies
Chest 3 views (71047) $686 $686 7.4×
Chest 4 or more views (71048) $753 $753 6.7×
Cholecystography Oral Contrast (74290) $757 $757 4.0×
Cineradiograpy/vidradiograpy xcpt where spec (76120) $378 $378 3.4×
Clavicle complete (73000) $664 $664 7.1×
Computed Tomography Thorax Lw Dose Lng Ca Scr C- (71271) $652 $652 5.8×
Continuing medical physics consltj pr wk (77336) $1,444 $1,444 10.0×
Contrast Exam Abdominl Aorta (75625) $5,456 $5,456 1.6×
Contrast X-Ray Bladder (74430) $1,647 $1,647 4.4×
Contrast X-Ray Of Elbow (73085) $1,103 $1,103 3.0×
Contrast X-Ray Of Knee Joint (73580) $1,351 $1,351 3.6×
CT abdomen and pelvis without and with contrast (74178) $8,657 $8,657 23.2×
CT abdomen and pelvis without contrast (74176) $6,425 $6,425 25.1×
CT abdomen w contrast (74160) $4,883 $4,883 26.0×
CT abdomen w wo contrast (74170) $5,529 $5,529 29.4×
CT abdomen w/o contrast (74150) $3,948 $3,948 35.2×
CT Angio Abdomen and Pelvis (74174) $4,562 $4,562 12.2×
CT Angio Chest (71275) $4,454 $4,454 23.7×
CT Angio Head (70496) $3,556 $3,556 18.9×
CT angio hrt w/3d image (75574) $5,110 $5,110 13.7×
Ct Angio Lwr Extr W/O&W/Dye (73706) $3,989 $3,989 21.2×
CT Angio Neck (70498) $4,337 $4,337 23.1×
Ct Angio Upr Extrm W/O&W/Dye (73206) $6,126 $6,126 32.6×
CT cervical spine w/ contrast (72126) $5,162 $5,162 13.8×
CT cervical spine w/o contrast (72125) $4,681 $4,681 41.8×
CT cervical spine w/wo cont (72127) $5,547 $5,547 29.5×
CT chest w contrast (71260) $4,742 $4,742 25.2×
CT chest w/wo contrast (71270) $4,760 $4,760 25.3×
CT colonography screening (74263) $1,445 $1,445 5.7×
CT colonogrphy dx image postprocess w/o contrast (74261) $5,152 $5,152 46.0×
CT head/brain with contrast (70460) $3,304 $3,304 17.6×
CT head/brain without and with contrast (70470) $3,859 $3,859 20.5×
CT heart contrast eval cardiac structure&morph (75572) $1,461 $1,461 3.9×
CT heart no contrast quant eval coronry calcium (75571)
range across 3 matching MRF lines		 $112–$593 $112–$593 varies
CT iac w contrast (70481) $4,528 $4,528 24.1×
CT l-spine w&w/o contrast (72133) $6,045 $6,045 32.2×
CT lower ext w/o (73700) $3,010 $3,010 26.9×
CT lower extremity w/contrast material (73701) $3,144 $3,144 16.7×
CT lumbar spine w contrast (72132) $5,443 $5,443 14.6×
CT lumbar spine w/o contrast (72131) $4,706 $4,706 42.0×
CT maxillofacial w contrast (70487) $4,347 $4,347 23.1×
CT maxillofacial wo contrast (70486) $3,613 $3,613 32.3×
CT neck tissue combo (70492) $4,932 $4,932 26.2×
Ct Orbit/Ear/Fossa W/O&W/Dye (70482) $4,718 $4,718 25.1×
CT orbits w/o contrast (70480) $4,396 $4,396 39.2×
CT pelvis w&w/o contrast (72194) $4,936 $4,936 26.3×
CT pelvis w/o contrast (72192) $2,971 $2,971 26.5×
CT scan of leg combo (73702) $3,577 $3,577 19.0×
CT scans face/jaw combo (70488) $5,182 $5,182 27.6×
CT soft tissue neck w contrast (70491) $4,206 $4,206 22.4×
CT soft tissue neck w/o contrast (70490) $3,490 $3,490 31.2×
CT thoracic spine w contrast (72129) $5,026 $5,026 26.7×
CT thoracic spine w/o contrast (72128) $4,569 $4,569 40.8×
CT thoracic spine w/wo cont (72130) $5,154 $5,154 27.4×
CT thorax w/o contrast (71250) $4,443 $4,443 39.7×
CT upper ext wo (73200) $3,279 $3,279 29.3×
CT upper extremity w/o & w/contrast material (73202) $5,440 $5,440 28.9×
CT upper extremity with contrast (73201) $4,181 $4,181 11.2×
Cta Abdl Aorta&Bi Iliofem W/Contrast&Postp (75635) $3,444 $3,444 18.3×
Cta Abdomen (74175) $4,782 $4,782 25.4×
CTA pelvis (72191) $6,085 $6,085 32.4×
Dilation ureters/urethra rs&i (74485) $3,930 $3,930 1.8×
Discography Cerv/Thor Spine (72285) $4,028 $4,028 1.9×
Diskography lumbar (72295) $4,852 $4,852 2.3×
Dxa Bone Density Axial (77080) $923 $923 8.2×
Dxa bone density study 1/>sites appendiclr skel (77081) $353 $353 3.8×
Echo exam uterus (76831) $809 $809 3.2×
Echo Guide For Artery Repair (76936) $1,841 $1,841 8.0×
Echograp Trans R Pros Study (76873) $796 $796 7.1×
Esophageal Motility Study (78258) $1,304 $1,304 3.0×
Esophagram (74220) $1,274 $1,274 6.8×
Fetal Biophys Profile W/Nst (76818) $1,248 $1,248 11.1×
Fetal MRI w/placntl matrnl plvc img sing/1st ges (74712) $4,637 $4,637 18.1×
Fluoroscopy up to 1 hr (76000) $1,086 $1,086 4.2×
Follow-Up Angiography (75898) $3,255 $3,255 1.0×
Foot 2 views (73620) $785 $785 8.4×
Forearm 2 views (73090) $726 $726 7.8×
Gastric emptying imaging study (78264) $3,099 $3,099 7.2×
Gated Heart Planar Single (78472) $4,193 $4,193 9.8×
Hand 2 views (73120) $779 $779 7.0×
Hdr Rdncl Ntrstl/Icav Brchtx (77772) $8,539 $8,539 11.4×
Hdr Rdncl Ntrstl/Icav Brchtx (77771) $8,005 $8,005 10.7×
Hdr Rdncl Ntrstl/Icav Brchtx 1 Channel (77770) $5,732 $5,732 7.7×
Hepatc Vngrph Wdg/Fr Hemodyn Eval Rs&I (75889) $5,456 $5,456 1.6×
Hepatc Vngrph Wdg/Fr W/O Hemodyn Eval Rs&I (75891) $5,456 $5,456 1.6×
Hepatobil Syst Image W/Drug (78227) $3,553 $3,553 6.1×
Hepatobiliary System Imaging (78226) $2,862 $2,862 6.7×
Hysterosalpingogram (74740)
range across 6 matching MRF lines		 $734–$1,467 $734–$1,467 varies
Infant hip ultrasound with hip movement (dynamic) (76885) $1,266 $1,266 13.6×
Interstitial radiation source applic complex (77778) $4,882 $4,882 6.5×
K Flow/Funct Image W/Drug (78708) $3,035 $3,035 5.2×
K Flow/Funct Image W/O Drug (78707) $2,031 $2,031 3.5×
Kidney Imaging Morphol (78700) $1,739 $1,739 4.1×
Knee 3 Views (73562) $898 $898 9.6×
Liver & Spleen Imaging Static Only (78215) $1,516 $1,516 3.5×
Liver imaging static only (78201) $2,236 $2,236 3.8×
Lung Perf&Ventilat Diferentl (78598) $1,935 $1,935 3.3×
Lung Ventilat&Perfus Imaging (78582) $1,967 $1,967 3.4×
Lung Ventilation Imaging (78579) $1,919 $1,919 4.5×
Lymph System Imaging (78195) $2,969 $2,969 5.1×
Lymphangiography Extremity Only Bilateral Rs&I (75803) $1,871 $1,871 1.1×
Lymphangiography extremity only unilateral rs&i (75801) $1,247 $1,247 1.9×
Lymphangiography Pelvic/Abdominal Bilateral Rs&I (75807) $8,184 $8,184 2.4×
Lymphangiography, pelvic/abdominal, unilateral (75805) $5,456 $5,456 1.6×
Magnetic Image Jaw Joint (70336) $4,602 $4,602 18.0×
Magnetic Resonance Elastography (76391) $2,666 $2,666 10.4×
Mammary ductogram or galactogram multiple (77054) $1,201 $1,201 4.7×
Mammary ductogram or galactogram single (77053) $717 $717 2.8×
Meckels Divert Exam (78290) $2,277 $2,277 5.3×
Mlc imrt design & construction per imrt plan (77338) $3,909 $3,909 9.7×
Mr safety determination physician/other qhp (76016) $229 $229 2.5×
Mr safety implant&/fb assmt clin staf 1st 15 min (76014) $64 $64 2.1×
Mr safety implt electronics prepj supvj phys/qhp (76018) $239 $239 2.3×
Mr safety implt pos&/immoblj (76019) $155 $155 2.5×
Mr safety med physics xm customization plng&mntr (76017) $630 $630 2.5×
Mra Head W/O & W/Contrast Material (70546) $8,297 $8,297 22.2×
MRA head w/o contrast (70544) $5,360 $5,360 21.0×
MRA head with contrast (70545) $5,766 $5,766 15.4×
MRA neck w contrast (70548) $4,533 $4,533 12.1×
Mra Neck W/O &W/Contrast Material (70549) $8,650 $8,650 23.1×
MRA neck w/o contrast (70547) $4,259 $4,259 16.7×
MRI abdomen w contrast (74182) $7,459 $7,459 20.0×
MRI abdomen w/o contrast (74181) $5,697 $5,697 22.3×
MRI any jt lower extrem w/contrast material (73722) $7,112 $7,112 8.5×
MRI any jt lower extrem w/o & w/contrast matrl (73723) $7,407 $7,407 19.8×
MRI any jt upper extremity w/contrast matrl (73222) $7,713 $7,713 9.2×
MRI brain functional w/o physician admnistration (70554) $2,707 $2,707 10.6×
MRI Breast W/O Contrast Bilateral (77047) $5,389 $5,389 21.1×
MRI Breast Without Contrast Material Unilateral (77046) $5,413 $5,413 21.2×
MRI cardiac w/o contrast (75557) $1,936 $1,936 7.6×
MRI cervical spine w contrast (72142) $7,070 $7,070 18.9×
MRI cervical spine w/o cont (72141) $6,218 $6,218 24.3×
MRI chest w/o contrast (71550) $5,065 $5,065 19.8×
MRI chest with contrast (71551) $5,502 $5,502 6.5×
MRI chest wo w contrast (71552) $6,887 $6,887 18.4×
MRI lower extrem oth/thn jt w/contrast matrl (73719) $7,421 $7,421 19.8×
MRI lower extrem oth/thn jt w/o & w/contr matr (73720) $9,101 $9,101 24.3×
MRI lower extrem oth/thn jt w/o contr matrl (73718) $6,359 $6,359 24.9×
MRI lumbar spine w contrast (72149) $7,911 $7,911 21.2×
Mri Neck Spine W/O & W/Dye (72156) $9,224 $9,224 24.7×
MRI orbit face &/neck w/o contrast (70540) $5,745 $5,745 22.5×
MRI orbit face neck w contrast (70542) $6,749 $6,749 18.1×
Mri Orbt/Fac/Nck W/O &W/Dye (70543) $8,387 $8,387 22.4×
MRI pelvis w contrast (72196) $6,845 $6,845 18.3×
MRI pelvis w/o & w contrast (72197) $8,503 $8,503 22.7×
MRI pelvis w/o contrast (72195) $5,820 $5,820 22.8×
MRI spectroscopy (76390) $3,988 $3,988 42.8×
MRI thoracic spine w/o contrast (72146) $5,186 $5,186 20.3×
MRI upper extremity oth than jt w/contr matrl (73219) $6,811 $6,811 18.2×
MRI upper extremity oth than jt w/o contr matrl (73218) $6,786 $6,786 26.5×
Mri Uppr Extremity W/O&W/Dye (73220) $8,341 $8,341 22.3×
MRI, abdomen, combo (74183) $7,777 $7,777 20.8×
MRI, dorsal spine combo (72157) $8,858 $8,858 23.7×
MRI, dorsal spine contrast (72147) $5,288 $5,288 14.1×
MRI, joint upper extrem (73221) $6,707 $6,707 26.2×
MRI, joint upper extrem combo (73223) $7,940 $7,940 21.2×
MRI, lumbar spine combo (72158) $8,886 $8,886 23.8×
Myelograpy 2/more regions rs&i (72270) $2,238 $2,238 2.7×
Myocardial Perfusion Planar 1 Study Rest/Stress (78453) $4,158 $4,158 3.0×
Myocardial Spect Multiple Studies (78452) $7,649 $7,649 5.5×
N-invas est c ffr sw aly CTA (75580) $2,810 $2,810 3.1×
Neck soft tissue (70360) $709 $709 7.6×
Nonvascular Shunt X-Ray (75809) $1,130 $1,130 10.1×
Ntsty modul radthx pln dose-vol histos (77301) $11,211 $11,211 7.6×
Nuclear Rx Intra-Arterial (79445) $1,141 $1,141 4.6×
Nuclear Rx Oral Admin (79005) $3,359 $3,359 13.4×
Ob us nuchal meas 1 gest (76813) $668 $668 6.0×
Panoramic X-ray of jaws (70355) $586 $586 6.3×
Parathyroid imaging w/tomographic spect & CT (78072) $3,794 $3,794 6.5×
Parathyroid Planar Imaging (78070) $1,264 $1,264 3.0×
Pelvis 1 or 2 views (72170) $543 $543 4.8×
Peritoneogram Rs&I (74190) $1,144 $1,144 2.0×
Pet Image Skull-Thigh (78812) $11,898 $11,898 7.8×
Pet Image W/Ct Lmtd (78814) $9,673 $9,673 6.3×
PET image w/CT, full body (78816) $11,685 $11,685 7.6×
PET imaging CT attenuation skull base mid-thigh (78815) $11,247 $11,247 7.3×
PET whole body (78813) $8,846 $8,846 5.8×
Prq Transhepatc Portograpy Hemodyn Eval Rs&I (75885) $5,456 $5,456 1.6×
Pulmonary Perfusion Imaging Particulate (78580) $1,432 $1,432 3.3×
Radex abscess/fistula/sinus tract rs&i (76080) $2,256 $2,256 3.9×
Radex Ankle Complete Minimum 3 Views (73610) $854 $854 9.2×
Radex Calcaneus Minimum 2 Views (73650) $589 $589 6.3×
Radex elbow complete minimum 3 views (73080) $757 $757 8.1×
Radex Facial Bones Complete Minimum 3 Views (70150) $1,026 $1,026 9.2×
Radex fingr minimum 2 views (73140) $664 $664 7.1×
Radex foot complete minimum 3 views (73630) $834 $834 8.9×
Radex Hand Minimum 3 Views (73130) $786 $786 8.4×
Radex lower extremity infant minimum 2 views (73592) $498 $498 5.3×
Radex Mastoids Compl Minimum 3 Views PR Side (70130) $853 $853 7.6×
Radex Nasal Bones Complete Minimum 3 Views (70160) $806 $806 8.6×
Radex Ribs Unilateral 2 Views (71100) $739 $739 7.9×
Radex shoulder complete minimum 2 views (73030) $769 $769 8.2×
Radex Sinuses Paransl < 3 Views (70210) $581 $581 6.2×
Radex sm int w/mlt srl imges via enteroclss tube (74251) $926 $926 4.9×
Radex Spine 1 View Specify Level (72020) $697 $697 7.5×
Radex Sternum Minimum 2 Views (71120) $659 $659 7.1×
Radex Temporomandble Jt Opn & Clsd Mouth Bilat (70330) $837 $837 9.0×
Radex Toe Minimum 2 Views (73660) $646 $646 6.9×
Radex upper extremity infant minimum 2 views (73092) $375 $375 3.3×
Radex Wrist Complete Minimum 3 Views (73110) $787 $787 8.4×
Radex X-Ray Exam Entire Spi 6/> Vw - Xr Entire Spine 6+ Vw (72084) $1,300 $1,300 11.6×
Radiation Delivery Stereotactic Cranial Linear (77372) $28,260 $28,260 3.6×
Radiation treatment delivery level 1 (77402) $732 $732 6.7×
Radiation treatment delivery level 2 (77407) $943 $943 2.3×
Radiation treatment delivery level 3 (77412) $1,881 $1,881 3.2×
Radiolog exam mandible compl minimum 4 views (70110) $1,055 $1,055 9.4×
Radiologic Exam Abdomen 3+ Views - Xr Abdomen 3+ Views (74021) $813 $813 7.3×
Radiologic exam colon double contrast study (74280) $1,530 $1,530 8.1×
Radiologic exam colon single contrast study (74270) $1,464 $1,464 7.8×
Radiologic Exam Esophagus Double Contrast Study (74221) $1,307 $1,307 7.0×
Radiologic exam knee complete 4/more views (73564) $966 $966 8.6×
Radiologic exam pelvis compl minimum 3 views (72190) $739 $739 6.6×
Radiologic Exam Small Int Single Contrast Study (74250) $800 $800 4.3×
Radiologic exam swallow function contrast study (74230) $725 $725 3.9×
Radiologic exam teeth complete full mouth (70320) $504 $504 2.0×
Radiologic exam upr gi trc double contrast study (74246) $1,495 $1,495 8.0×
Radiologic examination femur 1 view (73551) $400 $400 4.3×
Radiologic examination femur minimum 2 views (73552) $498 $498 5.3×
Radiologic examination knee 1/2 views (73560) $730 $730 7.8×
Radiologic Examination Osseous Survey Limited (77074) $558 $558 5.0×
Radiologic Examination Salivary Gland Calculus (70380) $261 $261 2.8×
Radiologic examination tibia & fibula 2 views (73590) $747 $747 8.0×
Radiopharm Dacryocystography (78660) $1,165 $1,165 2.7×
Ribs bilateral 3 views (71110) $924 $924 8.2×
Rp loclzj tum plnr 1 area single day imaging (78800) $2,298 $2,298 5.4×
Rp loclzj tum plnr 2+area 1+d img/1 area img>2+d (78801) $2,449 $2,449 5.7×
Rp Loclzj Tum Plnr Whole Body Single Day Imaging (78802) $2,771 $2,771 4.8×
Rp Loclzj Tum Spect 1 Area Single Day Imaging (78803) $3,356 $3,356 5.8×
Rp loclzj tum spect 2 area/sep acquisj img (78831) $4,638 $4,638 3.3×
Rp loclzj tum spect CT 2area 1d img/1 ar img>2+d (78832) $5,841 $5,841 3.8×
Rp loclzj tum spect w/CT 1 area/acquisj 1day img (78830) $4,528 $4,528 3.3×
Rp Ther Radiolbld Monoclonal Antibody IV Infus (79403) $647 $647 2.6×
Rp Therapy Intravenous Administration (79101) $1,129 $1,129 4.5×
Salivary Gland Imaging Serial Images (78231) $1,298 $1,298 3.0×
Scapula (73010) $808 $808 7.2×
Screening Digital Breast Tomosynthesis Bi (77063) $165 $165 7.1×
Sella turcica (70240) $339 $339 3.6×
Shoulder 1 view (73020) $368 $368 3.9×
Shoulder Arthrography (73040) $1,777 $1,777 4.8×
Sialogram (70390) $1,068 $1,068 4.2×
Skull less than 4 views (70250) $851 $851 7.6×
Special dosimetry (77331) $609 $609 4.2×
Special Physics Consult (77370) $2,313 $2,313 16.1×
Special teletherapy port plan (77321) $1,542 $1,542 3.8×
Special treatment procedure (77470) $3,687 $3,687 6.2×
Spleen Imaging (78185) $839 $839 2.0×
Stereotactic Body Radiation Delivery (77373) $8,246 $8,246 4.3×
Sternoclavicular joints (71130) $764 $764 8.2×
Superior sagittal sinus venogram (75870) $5,456 $5,456 1.6×
Telethx isodose pln cplx w/basic dosimetry (77307) $1,014 $1,014 2.5×
Telethx isodose pln smpl w/dosimetry calculation (77306) $814 $814 2.0×
Testicular Imaging W/Flow (78761) $1,308 $1,308 3.1×
Ther Rad Simulaj-Aided Field Setting Complex (77290) $4,059 $4,059 10.1×
Ther Rad Simulaj-Aided Field Setting Intermed (77285) $2,048 $2,048 5.1×
Ther rad simulaj-aided field setting simple (77280) $2,038 $2,038 14.1×
Thoracic spine 2 views (72070) $784 $784 7.0×
Thoracic spine 3 views (72072) $1,024 $1,024 9.1×
Thoracolumbar 2 views (72080) $807 $807 8.7×
Thyroid Imaging With Vascular Flow (78013) $1,290 $1,290 3.0×
Thyroid Met Imaging Body (78018) $3,310 $3,310 5.7×
Thyroid Uptake Measurement (78012) $839 $839 2.0×
Thyroid Uptake W/Blood Flow Sngle/Mult Quan Meas (78014) $2,063 $2,063 4.8×
Tx Devices Design & Construction Complex (77334) $2,956 $2,956 7.4×
Tx devices design & construction intermediate (77333) $1,807 $1,807 12.5×
Tx devices design & construction simple (77332) $1,530 $1,530 10.6×
Ultrasound Breast Limited (76642)
range across 4 matching MRF lines		 $1,156–$2,312 $1,156–$2,312 varies
Ultrasound elastography first target lesion (76982) $387 $387 3.5×
Ultrasound Elastography Parenchyma (76981) $560 $560 5.0×
Ultrasound Exam Aaa Screen (76706) $687 $687 6.1×
Ultrasound trgt dynamic microbubble 1st lesion (76978) $774 $774 2.1×
Ultrasound, abdomen limited (76705) $1,643 $1,643 14.7×
Umbilical-artery Doppler (OB) (76820) $543 $543 4.8×
Unlisted Dx Radiographic Procedure (76499)
range across 3 matching MRF lines		 $135–$713 $135–$713 varies
Unlisted fluoroscopic procedure (76496) $1,551 $1,551 16.6×
Unlisted magnetic resonance procedure (76498)
range across 5 matching MRF lines		 $3,205–$8,886 $3,205–$8,886 varies
Upper gi w/o kub (74240) $1,310 $1,310 7.0×
Urethrocystogram voiding (74455) $1,201 $1,201 4.7×
Urethrocystography retrograde (74450) $1,639 $1,639 6.4×
Us breast unilateral complete (76641)
range across 6 matching MRF lines		 $2,394–$4,788 $2,394–$4,788 varies
Us chest (76604) $1,144 $1,144 10.2×
Us complete joint (76881) $1,430 $1,430 12.8×
Us exam, pelvic, limited (76857) $1,022 $1,022 9.1×
Us head (76506) $1,216 $1,216 10.9×
Us kidney transplant (76776) $680 $680 6.1×
Us lmtd joint/oth nonvasc xtr strux r-t w/img (76882) $1,350 $1,350 12.1×
Us ob detailed single fetus (76811) $1,037 $1,037 4.1×
Us ob limited 1 or more fetuses (76815) $1,216 $1,216 10.9×
Us ob transvaginal (76817) $1,618 $1,618 14.4×
Us pelvic non ob complete (76856) $1,858 $1,858 16.6×
Us pg uter img f&mat 14 wk tabdl 1/1st gestation (76801) $1,404 $1,404 12.5×
Us preg uterus real time f/u trnsabdl per fetus (76816) $976 $976 8.7×
Us retroperitoneal complete (76770) $1,976 $1,976 17.6×
Us retroperitoneal limited (76775) $1,565 $1,565 14.0×
Us scrotum and contents (76870) $1,490 $1,490 13.3×
Us spinal canal and contents (76800) $763 $763 6.8×
Us thyroid (76536) $1,411 $1,411 12.6×
Us transrectal (76872) $1,741 $1,741 15.5×
Vasogram (74440) $504 $504 2.0×
Vein X-Ray Chest (75827) $3,297 $3,297 2.0×
Vein X-Ray Liver W/O Hemodyn (75887) $5,456 $5,456 1.6×
Venogram Sinus/Jugular (75860) $5,456 $5,456 1.6×
Venography Adrenal Unilateral (75840) $5,456 $5,456 1.6×
Venography caval inferior serialography rs&i (75825) $6,719 $6,719 2.0×
Venography extremity bilateral rs&i (75822) $5,061 $5,061 3.0×
Venography extremity unilateral rs&i (75820) $3,374 $3,374 2.0×
Venography Renal Bilateral (75833) $7,705 $7,705 2.3×
Venography Renal Unilateral (75831) $5,571 $5,571 1.6×
Venous sampling by catheter (75893) $9,439 $9,439 1.6×
Wrist 2 views (73100) $698 $698 7.5×
X-Ray Ac Jts - Xr Acromioclavicular Joints Bilateral (73050) $823 $823 8.8×
X-ray antegrade pyelogram tube (74425) $864 $864 2.3×
X-Ray Aorta Leg Arteries (75630) $5,456 $5,456 1.6×
X-Ray Bend Only L-S Spine (72120) $866 $866 7.7×
X-Ray Elbow 2 Vw - Xr Elbow 1-2 Views Right (73070) $711 $711 7.6×
X-Ray Exam Breast Specimen (76098) $1,144 $1,144 2.0×
X-Ray Exam Entire Spi 1 Vw (72081) $683 $683 7.3×
X-Ray Exam Entire Spi 2/3 Vw (72082) $1,245 $1,245 11.1×
X-Ray Exam Entire Spi 4/5 Vw (72083) $1,083 $1,083 9.7×
X-Ray Exam Hip Uni 1 View (73501) $332 $332 3.6×
X-Ray Exam Hip Uni 2-3 Views (73502) $860 $860 9.2×
X-Ray Exam Hip Uni 4/> Views (73503) $1,002 $1,002 8.9×
X-Ray Exam Hips Bi 2 Views (73521) $892 $892 8.0×
X-Ray Exam Hips Bi 3-4 Views (73522) $971 $971 8.7×
X-Ray Exam L-S Spine Bending (72114) $1,360 $1,360 12.1×
X-Ray Exam Neck Spine 2-3 Vw (72040) $831 $831 8.9×
X-Ray Exam Neck Spine 6/>Vws (72052) $1,391 $1,391 12.4×
X-Ray Exam Unilat Ribs/Chest (71101) $893 $893 8.0×
X-ray humerus (73060) $749 $749 8.0×
X-ray IV pyelogram (ivp) (74400) $1,214 $1,214 6.5×
X-Ray Jaw <4 Vw - Xr Mandible < 4 Views (70100) $760 $760 8.1×
X-Ray Knee Bilat Standing - Xr Knees Anteroposterior Standing Bilat (73565) $834 $834 8.9×
X-Ray Lumbar Spine 2/3 Vw - Xr Lumbar Spine 2-3 Views (72100) $890 $890 7.9×
X-ray nose-rectum child f.b. (76010) $583 $583 6.3×
X-Ray Ribs, Chest 4+ Vw - Xr Ribs 3 Vws Bil W/ Chest Posteroanterior (71111) $1,049 $1,049 9.4×
X-Ray Sacroiliac Jts 3+ Vw - Xr Sacroiliac Joints 3+ Views (72202) $832 $832 7.4×
X-Ray Sacrum/Coccyx 2+ Vw - Xr Sacrum Coccyx 2+ Views (72220) $750 $750 8.0×
X-Ray Sinuses 3+ Vw - Xr Paranasal Sinuses 3+ Views (70220) $1,018 $1,018 10.9×
X-Ray Skull 4+ Vw - Xr Skull Complete 4+ Views (70260) $1,090 $1,090 9.7×
X-Ray Stress View (77071) $414 $414 4.4×
X-ray thoracic spine 4 vw (72074) $1,156 $1,156 10.3×
X-Ray Urinary Tract Exam With Contrast Material (74420) $1,573 $1,573 4.2×
X-Rays Bone Length Studies (77073) $1,158 $1,158 10.3×
X-Rays Bone Survey Complete (77075) $1,018 $1,018 9.1×
Xr c-spine 4 or 5 views (72050) $1,011 $1,011 9.0×
Xr facial bones less than 3 views (70140) $563 $563 6.0×
Xr orbits complete 4 views (70200) $932 $932 8.3×

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.