Imaging prices at Mercy Hospital Fort Smith
Fort Smith, AR · every code in this section with a posted price and a Medicare benchmark.
409 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 2 matching MRF lines |
$5,177.25–$27,452.10 | $7,965–$42,234 | varies |
| Abdomen 1 View (74018) | $234 | $360 | 2.8× |
| Abdomen 2 views (74019) | $258.05 | $397 | 2.5× |
| Acute Gastrointestinal Blood Loss Imaging (78278) | $786.50 | $1,210 | 2.0× |
| Acute venous thrombosis imaging, peptide Non-Facility (78456) | $775.45 | $1,193 | 0.6× |
| Adrenal Cortex & Medulla Img (78075) | $1,214.85 | $1,869 | 1.0× |
| Angio internal mammary (75756) | $995.80 | $1,532 | 0.3× |
| Angio pulmonary bilat (75743) | $2,085.20 | $3,208 | 0.7× |
| Angiography Adrenal Bilateral Slctv Rs&I (75733) | $2,247.70 | $3,458 | 0.7× |
| Angiography extremity bilateral rs&i (75716) | $2,437.50 | $3,750 | 0.8× |
| Angiography extremity unilateral rs&i (75710) | $1,921.40 | $2,956 | 0.6× |
| Angiography pulmonary unilateral slctv rs&i (75741) | $1,861.60 | $2,864 | 0.6× |
| Angrph pulmonary nonslctv cath/ven njx rs&i (75746) | $1,472.90 | $2,266 | 0.5× |
| Ankle 2 views (73600) range across 6 matching MRF lines |
$144.95–$322.40 | $223–$496 | varies |
| Aortography thoracic serialography rs&i (75605) | $3,289.65 | $5,061 | 0.6× |
| Artery X-Rays Abdomen (75726) | $3,718.65 | $5,721 | 0.7× |
| Artery X-Rays Adrenal Gland (75731) | $1,592.50 | $2,450 | 0.5× |
| Artery X-Rays Pelvis (75736) unusually low: confirm this is the full procedure |
$2,598.05 | $3,997 | 0.5× |
| Artery X-Rays Spine (75705) | $2,748.85 | $4,229 | 0.5× |
| Arthrogram ankle (73615) | $438.75 | $675 | 1.3× |
| Arthrogram hip (73525) range across 3 matching MRF lines |
$507.65–$761.15 | $781–$1,171 | varies |
| Arthrogram Wrist (73115) | $301.60 | $464 | 0.9× |
| Basic radiation dosimetry calculation (77300) range across 2 matching MRF lines |
$417.30–$31,278 | $642–$48,120 | varies |
| Bone age studies (77072) | $168.35 | $259 | 1.7× |
| Bone Imaging 3 Phase (78315) range across 2 matching MRF lines |
$1,313.65–$1,352 | $2,021–$2,080 | varies |
| Bone Imaging Limited Area (78300) range across 2 matching MRF lines |
$701.35–$739.70 | $1,079–$1,138 | varies |
| Bone Imaging Multiple Areas (78305) | $987.35 | $1,519 | 2.5× |
| Bone Imaging Whole Body (78306) range across 2 matching MRF lines |
$991.90–$1,030.25 | $1,526–$1,585 | varies |
| Bone marrow imaging; multiple areas (78103) | $672.75 | $1,035 | 1.7× |
| Bone survey infant (77076) | $265.20 | $408 | 2.6× |
| Brachytx isodose complex (77318) | $2,568.80 | $3,952 | 7.1× |
| Brachytx isodose intermed (77317) | $1,491.75 | $2,295 | 4.1× |
| Brachytx Isodose Plan Simple (77316) range across 2 matching MRF lines |
$743.60–$10,860.20 | $1,144–$16,708 | varies |
| Brain Flow Imaging Only (78610) | $531.70 | $818 | 1.0× |
| Brain Image W/Flow < 4 Views (78601) | $932.10 | $1,434 | 2.4× |
| Brain Imaging Min 4 Static Views W Vascular Flow (78606) | $1,291.55 | $1,987 | 2.5× |
| Brain Imaging Minimum 4 Static Views (78605) | $744.25 | $1,145 | 1.4× |
| Brain Imaging Pet Metabolic Evaluation (78608) range across 2 matching MRF lines |
$3,166.80–$3,473.60 | $4,872–$5,344 | varies |
| Cat Scan Follow-Up Study (76380) | $618.80 | $952 | 7.3× |
| Cerebrospinal Fluid Flow W/O Matl Shunt Evaltj (78645) | $743.60 | $1,144 | 1.4× |
| Cerebrospinal Fluid Scan (78630) | $1,641.90 | $2,526 | 3.1× |
| Chest 1 view (71045) | $145.60 | $224 | 1.7× |
| Chest 2 views (71046) | $265.85 | $409 | 3.2× |
| Chest 3 views (71047) | $282.10 | $434 | 3.3× |
| Chest 4 or more views (71048) | $286.65 | $441 | 2.8× |
| Cholecystography Oral Contrast (74290) | $233.35 | $359 | 1.4× |
| Clavicle complete (73000) range across 3 matching MRF lines |
$203.45–$305.50 | $313–$470 | varies |
| Computed Tomography Thorax Lw Dose Lng Ca Scr C- (71271) | $241.15 | $371 | 2.4× |
| Continuing medical physics consltj pr wk (77336) range across 2 matching MRF lines |
$471.25–$28,574.66 | $725–$43,961.02 | varies |
| Contrast Exam Abdominl Aorta (75625) | $2,467.40 | $3,796 | 0.8× |
| Contrast X-Ray Bladder (74430) | $246.35 | $379 | 0.7× |
| Contrast X-Ray Of Elbow (73085) | $419.90 | $646 | 1.2× |
| Contrast X-Ray Of Knee Joint (73580) | $447.85 | $689 | 1.3× |
| Contrast Xray Throat/Cerv Esopha (74210) | $233.35 | $359 | 1.4× |
| CT abdomen and pelvis without and with contrast (74178) | $3,849.95 | $5,923 | 11.4× |
| CT abdomen and pelvis without contrast (74176) | $2,460.90 | $3,786 | 10.6× |
| CT abdomen w contrast (74160) | $1,397.50 | $2,150 | 8.2× |
| CT abdomen w wo contrast (74170) | $1,758.25 | $2,705 | 10.3× |
| CT abdomen w/o contrast (74150) | $982.15 | $1,511 | 9.7× |
| CT Angio Abdomen and Pelvis (74174) | $3,463.20 | $5,328 | 10.2× |
| CT Angio Chest (71275) | $1,756.95 | $2,703 | 10.3× |
| CT Angio Head (70496) | $1,124.50 | $1,730 | 6.6× |
| CT angio hrt w/3d image (75574) | $2,144.35 | $3,299 | 6.3× |
| Ct Angio Lwr Extr W/O&W/Dye (73706) range across 3 matching MRF lines |
$780–$1,170 | $1,200–$1,800 | varies |
| CT Angio Neck (70498) | $1,894.10 | $2,914 | 11.1× |
| Ct Angio Upr Extrm W/O&W/Dye (73206) range across 3 matching MRF lines |
$886.60–$1,329.90 | $1,364–$2,046 | varies |
| CT bone density (77078) | $292.50 | $450 | 3.5× |
| CT Cere Prfuj Alys C+ W/O CT/Cta Same Anatomy (70473) | $1,495 | $2,300 | 8.8× |
| CT cervical spine w/ contrast (72126) | $1,433.25 | $2,205 | 4.2× |
| CT cervical spine w/o contrast (72125) | $1,324.70 | $2,038 | 13.1× |
| CT cervical spine w/wo cont (72127) | $1,519.70 | $2,338 | 8.9× |
| CT chest w contrast (71260) | $1,519.70 | $2,338 | 8.9× |
| CT chest w/wo contrast (71270) | $1,790.75 | $2,755 | 10.5× |
| CT head/brain with contrast (70460) | $1,402.70 | $2,158 | 8.3× |
| CT head/brain without and with contrast (70470) | $1,688.70 | $2,598 | 9.9× |
| CT heart no contrast quant eval coronry calcium (75571) | $64.35 | $99 | 0.8× |
| CT hrt w/3d image congen (75573) | $1,177.80 | $1,812 | 3.5× |
| CT iac w contrast (70481) | $646.10 | $994 | 3.8× |
| CT l-spine w&w/o contrast (72133) | $1,737.45 | $2,673 | 10.2× |
| CT lower ext w/o (73700) range across 3 matching MRF lines |
$847.60–$1,271.40 | $1,304–$1,956 | varies |
| CT lower extremity w/contrast material (73701) range across 3 matching MRF lines |
$881.40–$1,372.15 | $1,356–$2,111 | varies |
| CT lumbar spine w contrast (72132) | $1,657.50 | $2,550 | 4.9× |
| CT lumbar spine w/o contrast (72131) | $1,472.25 | $2,265 | 14.5× |
| CT maxillofacial w contrast (70487) | $1,015.30 | $1,562 | 6.0× |
| CT maxillofacial wo contrast (70486) | $807.95 | $1,243 | 8.0× |
| CT neck tissue combo (70492) | $1,655.55 | $2,547 | 9.7× |
| Ct Orbit/Ear/Fossa W/O&W/Dye (70482) | $892.45 | $1,373 | 5.3× |
| CT orbits w/o contrast (70480) | $611.65 | $941 | 6.0× |
| CT pelvis w&w/o contrast (72194) | $1,738.75 | $2,675 | 10.2× |
| CT pelvis w/o contrast (72192) | $1,396.85 | $2,149 | 13.8× |
| CT scan of leg combo (73702) | $963.95 | $1,483 | 5.7× |
| CT scans face/jaw combo (70488) | $1,179.10 | $1,814 | 6.9× |
| CT soft tissue neck w contrast (70491) | $1,430 | $2,200 | 8.4× |
| CT soft tissue neck w/o contrast (70490) | $1,015.95 | $1,563 | 10.0× |
| CT thoracic spine w contrast (72129) | $1,652.95 | $2,543 | 9.7× |
| CT thoracic spine w/o contrast (72128) | $1,470.95 | $2,263 | 14.5× |
| CT thoracic spine w/wo cont (72130) | $1,796.60 | $2,764 | 10.6× |
| CT thorax w/o contrast (71250) | $982.15 | $1,511 | 9.7× |
| CT upper ext wo (73200) range across 3 matching MRF lines |
$668.85–$1,136.85 | $1,029–$1,749 | varies |
| CT upper extremity w/o & w/contrast material (73202) | $865.80 | $1,332 | 5.1× |
| CT upper extremity with contrast (73201) range across 3 matching MRF lines |
$718.90–$1,078.35 | $1,106–$1,659 | varies |
| Cta Abdl Aorta&Bi Iliofem W/Contrast&Postp (75635) | $2,178.80 | $3,352 | 12.8× |
| Cta Abdomen (74175) | $1,587.95 | $2,443 | 9.3× |
| CTA head&neck c+ w/noncontrast img&post-pxessing (70471) | $2,678.65 | $4,121 | 7.9× |
| CTA pelvis (72191) | $1,517.75 | $2,335 | 8.9× |
| Dacryocystography, nasolacrimal duct, radiological supervision and interpretation Non-Facility (70170) | $349.70 | $538 | 1.5× |
| Dilation ureters/urethra rs&i (74485) | $1,214.85 | $1,869 | 0.6× |
| Discography Cerv/Thor Spine (72285) | $1,330.55 | $2,047 | 0.7× |
| Diskography lumbar (72295) | $1,230.45 | $1,893 | 0.7× |
| Doppler Echo Fetal Puls Spectral F/U/Repeat (76828) | $240.50 | $370 | 2.4× |
| Doppler Echo Fetal Spectral Display Complete (76827) | $260.65 | $401 | 2.6× |
| Dxa Bone Density Axial (77080) | $321.10 | $494 | 3.2× |
| Echo exam uterus (76831) | $323.70 | $498 | 1.4× |
| Echo Guide For Artery Repair (76936) | $599.30 | $922 | 2.9× |
| Echograp Trans R Pros Study (76873) | $523.90 | $806 | 5.2× |
| Esophagram (74220) | $245.05 | $377 | 1.4× |
| Fetal Biophys Profile W/Nst (76818) | $278.85 | $429 | 2.8× |
| Fetal Biophysical Profile W/O Non-Stress Testing (76819) | $245.05 | $377 | 2.4× |
| Fluoroscopy up to 1 hr (76000) | $354.25 | $545 | 1.5× |
| Follow-Up Angiography (75898) | $1,203.80 | $1,852 | 0.4× |
| Foot 2 views (73620) range across 6 matching MRF lines |
$212.55–$375.70 | $327–$578 | varies |
| Forearm 2 views (73090) range across 3 matching MRF lines |
$171.60–$257.40 | $264–$396 | varies |
| Gastric emptying imaging study (78264) range across 2 matching MRF lines |
$1,093.30–$1,223.95 | $1,682–$1,883 | varies |
| Gastric Emptyng Imag Std W/Sm Bwl Transit (78265) | $1,291.55 | $1,987 | 3.3× |
| Gastroesophageal Reflux Exam (78262) | $802.75 | $1,235 | 2.1× |
| Gated Heart Planar Single (78472) range across 2 matching MRF lines |
$1,167.40–$1,352.65 | $1,796–$2,081 | varies |
| Gated Heart, Multiple (78473) | $1,649.05 | $2,537 | 4.3× |
| Gstrc Emptng Imag Std W/Sm Bwl Col Trnst Mlt Day (78266) | $1,714.70 | $2,638 | 3.3× |
| Hand 2 views (73120) range across 6 matching MRF lines |
$141.70–$258.05 | $218–$397 | varies |
| Hdr Rdncl Ntrstl/Icav Brchtx (77772) | $4,440.15 | $6,831 | 6.6× |
| Hdr Rdncl Ntrstl/Icav Brchtx (77771) | $3,645.85 | $5,609 | 5.4× |
| Hdr Rdncl Ntrstl/Icav Brchtx 1 Channel (77770) | $2,863.90 | $4,406 | 4.2× |
| Heart first pass single,planar (78481) | $545.35 | $839 | 1.0× |
| Heart Image (Pet) Multiple (78492) | $4,627.35 | $7,119 | 3.3× |
| Hepatc Vngrph Wdg/Fr Hemodyn Eval Rs&I (75889) | $2,376.40 | $3,656 | 0.8× |
| Hepatc Vngrph Wdg/Fr W/O Hemodyn Eval Rs&I (75891) | $2,246.40 | $3,456 | 0.7× |
| Hepatobil Syst Image W/Drug (78227) | $1,026.35 | $1,579 | 2.0× |
| Hepatobiliary System Imaging (78226) range across 2 matching MRF lines |
$1,086.80–$1,192.10 | $1,672–$1,834 | varies |
| Ht Muscle Image Spect Sing (78451) | $828.10 | $1,274 | 0.7× |
| Hysterosalpingogram (74740) | $453.70 | $698 | 2.0× |
| Infant hip ultrasound with hip movement (dynamic) (76885) | $247.65 | $381 | 2.9× |
| Infant hip ultrasound, limited static exam (76886) | $161.20 | $248 | 1.9× |
| Interstitial radiation source applic complex (77778) | $2,910.05 | $4,477 | 4.3× |
| Intracavitary Radiation Source Applic Complex (77763) | $2,747.55 | $4,227 | 4.1× |
| Intracavitary Radiation Source Applic Intermed (77762) | $2,185.30 | $3,362 | 4.1× |
| Intracavitary radiation source applic simple (77761) | $1,639.95 | $2,523 | 3.1× |
| Joint Survey Single View (77077) | $241.15 | $371 | 2.4× |
| K Flow/Funct Image Multiple (78709) | $750.10 | $1,154 | 1.4× |
| K Flow/Funct Image W/Drug (78708) range across 2 matching MRF lines |
$536.25–$935.80 | $825–$1,439.70 | varies |
| K Flow/Funct Image W/O Drug (78707) range across 2 matching MRF lines |
$789.10–$1,401.20 | $1,214–$2,155.70 | varies |
| Kidney Funcj Study Non-Img Radioisotopic Study (78725) | $513.50 | $790 | 1.3× |
| Kidney Imaging Morphol (78700) | $394.55 | $607 | 1.0× |
| Kidney Imaging Morphoogy W/Vascular Flow (78701) | $499.20 | $768 | 1.3× |
| Knee 3 Views (73562) range across 3 matching MRF lines |
$238.55–$357.50 | $367–$550 | varies |
| Labeled RBC Sequestration Differntl Organ/Tissue (78140) | $618.80 | $952 | 1.6× |
| Leveen/Shunt Patency Exam (78291) | $662.35 | $1,019 | 1.7× |
| Liver & Spleen Imaging Static Only (78215) | $855.40 | $1,316 | 2.2× |
| Liver & Spleen Imaging W/Vascular Flow (78216) | $818.35 | $1,259 | 2.1× |
| Liver imaging static only (78201) | $826.15 | $1,271 | 1.6× |
| Liver imaging w/vascular flow (78202) | $913.25 | $1,405 | 1.7× |
| Lung Ventilat&Perfus Imaging (78582) range across 2 matching MRF lines |
$1,332.50–$1,847.30 | $2,050–$2,842 | varies |
| Lymph System Imaging (78195) range across 2 matching MRF lines |
$989.30–$10,154.79 | $1,522–$15,622.76 | varies |
| Lymphangiography Pelvic/Abdominal Bilateral Rs&I (75807) | $1,797.25 | $2,765 | 0.6× |
| Lymphangiography, pelvic/abdominal, unilateral (75805) | $1,145.95 | $1,763 | 0.4× |
| Magnetic Image Jaw Joint (70336) | $1,103.70 | $1,698 | 4.8× |
| Mammary ductogram or galactogram multiple (77054) | $351.65 | $541 | 1.5× |
| Mammary ductogram or galactogram single (77053) | $216.45 | $333 | 0.9× |
| Meckels Divert Exam (78290) | $880.10 | $1,354 | 2.3× |
| Mlc imrt design & construction per imrt plan (77338) range across 2 matching MRF lines |
$3,387.15–$35,160.48 | $5,211–$54,093.04 | varies |
| Mra Head W/O & W/Contrast Material (70546) | $2,308.80 | $3,552 | 6.8× |
| MRA head w/o contrast (70544) | $1,574.30 | $2,422 | 6.8× |
| MRA head with contrast (70545) | $1,795.95 | $2,763 | 5.3× |
| MRA neck w contrast (70548) | $1,187.55 | $1,827 | 3.5× |
| Mra Neck W/O &W/Contrast Material (70549) | $1,617.85 | $2,489 | 4.8× |
| MRA neck w/o contrast (70547) | $1,160.90 | $1,786 | 5.0× |
| MRI abdomen w contrast (74182) | $1,963 | $3,020 | 5.8× |
| MRI abdomen w/o contrast (74181) | $1,806.35 | $2,779 | 7.8× |
| MRI any jt lower extrem w/contrast material (73722) range across 3 matching MRF lines |
$1,452.75–$2,265.90 | $2,235–$3,486 | varies |
| MRI any jt lower extrem w/o & w/contrast matrl (73723) range across 3 matching MRF lines |
$1,560.65–$2,653.30 | $2,401–$4,082 | varies |
| MRI any jt upper extremity w/contrast matrl (73222) | $1,404.65 | $2,161 | 1.8× |
| MRI Breast W/O Contrast Bilateral (77047) | $1,685.45 | $2,593 | 7.3× |
| MRI cervical spine w contrast (72142) | $2,405.65 | $3,701 | 7.1× |
| MRI cervical spine w/o cont (72141) | $2,153.45 | $3,313 | 9.3× |
| MRI chest w/o contrast (71550) | $1,066.65 | $1,641 | 4.6× |
| MRI chest with contrast (71551) | $1,378 | $2,120 | 1.8× |
| MRI chest wo w contrast (71552) | $2,087.80 | $3,212 | 6.2× |
| MRI lower extrem oth/thn jt w/contrast matrl (73719) | $1,168.70 | $1,798 | 3.5× |
| MRI lower extrem oth/thn jt w/o & w/contr matr (73720) range across 3 matching MRF lines |
$1,435.20–$2,439.45 | $2,208–$3,753 | varies |
| MRI lower extrem oth/thn jt w/o contr matrl (73718) range across 3 matching MRF lines |
$1,071.85–$1,607.45 | $1,649–$2,473 | varies |
| MRI lumbar spine w contrast (72149) | $2,356.25 | $3,625 | 7.0× |
| Mri Neck Spine W/O & W/Dye (72156) | $2,869.75 | $4,415 | 8.5× |
| MRI orbit face &/neck w/o contrast (70540) | $1,371.50 | $2,110 | 5.9× |
| MRI orbit face neck w contrast (70542) | $2,119.65 | $3,261 | 6.3× |
| Mri Orbt/Fac/Nck W/O &W/Dye (70543) | $2,451.15 | $3,771 | 7.3× |
| MRI pelvis w contrast (72196) | $1,505.40 | $2,316 | 4.5× |
| MRI pelvis w/o & w contrast (72197) | $1,702.35 | $2,619 | 5.0× |
| MRI pelvis w/o contrast (72195) | $1,184.95 | $1,823 | 5.1× |
| MRI thoracic spine w/o contrast (72146) | $1,976 | $3,040 | 8.6× |
| MRI upper extremity oth than jt w/contr matrl (73219) | $1,207.05 | $1,857 | 3.6× |
| MRI upper extremity oth than jt w/o contr matrl (73218) | $1,159.60 | $1,784 | 5.0× |
| Mri Uppr Extremity W/O&W/Dye (73220) | $1,394.25 | $2,145 | 4.1× |
| MRI, abdomen, combo (74183) | $2,334.15 | $3,591 | 6.9× |
| MRI, dorsal spine combo (72157) | $2,886 | $4,440 | 8.5× |
| MRI, dorsal spine contrast (72147) | $2,338.70 | $3,598 | 6.9× |
| MRI, joint upper extrem (73221) range across 3 matching MRF lines |
$1,262.30–$2,145.65 | $1,942–$3,301 | varies |
| MRI, joint upper extrem combo (73223) | $1,519.70 | $2,338 | 4.5× |
| MRI, lumbar spine combo (72158) | $2,952.30 | $4,542 | 8.7× |
| Myelogram cervical (72240) | $780.65 | $1,201 | 1.0× |
| Myelogram Lumbar (72265) | $963.30 | $1,482 | 1.3× |
| Myelography thoracic (72255) | $888.55 | $1,367 | 1.2× |
| Myelograpy 2/more regions rs&i (72270) | $887.25 | $1,365 | 1.2× |
| Myocardial Imaging Infarct Avid Planar Qual/Quan (78466) range across 2 matching MRF lines |
$446.55–$1,160.90 | $687–$1,786 | varies |
| Myocardial Imaging Pet Metabolic Evaluation (78459) | $3,610.75 | $5,555 | 2.9× |
| Myocardial Spect Multiple Studies (78452) range across 2 matching MRF lines |
$2,078.05–$3,597.42 | $3,197–$5,534.50 | varies |
| Myocrd Img Pet Metab Eval Single Study Cncrnt CT (78429) | $4,577.95 | $7,043 | 3.3× |
| Myocrd img PET prfuj 1std rest/stress cncrnt CT (78430) | $3,363.75 | $5,175 | 2.4× |
| Myocrd Img Pet Prfuj Mlt Std Rst&Strs Cncrnt CT (78431) range across 2 matching MRF lines |
$3,701.75–$5,301.72 | $5,695–$8,156.50 | varies |
| Myocrd Img Pet Prfuj W/Metab 2rtracer Cncrnt CT (78433) | $7,019.35 | $10,799 | 3.3× |
| Myocrd Img Pet Prfuj W/Metab Dual Radiotracer (78432) | $5,291 | $8,140 | 3.6× |
| N-invas est c ffr sw aly CTA (75580) | $2,665 | $4,100 | 3.2× |
| Neck soft tissue (70360) | $192.40 | $296 | 2.3× |
| Nm csf leak detection (78650) | $1,319.50 | $2,030 | 1.1× |
| Nm myocard infarct spect (78469) range across 2 matching MRF lines |
$613.60–$1,160.90 | $944–$1,786 | varies |
| Nm red cell survival study (78130) | $558.35 | $859 | 1.4× |
| Nm whole blood volume (78122) | $755.95 | $1,163 | 1.4× |
| Nonvascular Shunt X-Ray (75809) | $408.85 | $629 | 4.0× |
| Ntsty modul radthx pln dose-vol histos (77301) range across 2 matching MRF lines |
$4,176.25–$33,706.40 | $6,425–$51,856 | varies |
| Nuclear Rx Oral Admin (79005) range across 2 matching MRF lines |
$739.05–$2,871.05 | $1,137–$4,417 | varies |
| Ophthalmic us dx quantitative a-scan only (76511) | $274.30 | $422 | 2.7× |
| Optic foramina (70190) | $128.05 | $197 | 1.5× |
| Panoramic X-ray of jaws (70355) | $190.45 | $293 | 2.3× |
| Parathyroid Planar Imaging (78070) range across 2 matching MRF lines |
$1,067.30–$1,297.40 | $1,642–$1,996 | varies |
| Parathyroid planar imaging w/wo subtraction (78071) range across 2 matching MRF lines |
$1,287–$1,517.10 | $1,980–$2,334 | varies |
| Pelvis 1 or 2 views (72170) | $241.15 | $371 | 2.4× |
| Pet Image W/Ct Lmtd (78814) | $3,623.10 | $5,574 | 2.6× |
| PET image w/CT, full body (78816) range across 2 matching MRF lines |
$4,700.15–$5,006.95 | $7,231–$7,703 | varies |
| PET imaging CT attenuation skull base mid-thigh (78815) range across 2 matching MRF lines |
$3,997.50–$4,304.30 | $6,150–$6,622 | varies |
| Pet Imaging Limited Area Chest Head/Neck (78811) | $3,518.45 | $5,413 | 2.8× |
| Pet Myocardial Sngl Study (78491) | $3,500.90 | $5,386 | 2.5× |
| Pulmonary Perfusion Imaging Particulate (78580) range across 2 matching MRF lines |
$1,244.75–$1,498.90 | $1,915–$2,306 | varies |
| Radex Abd Compl Aqt Abd W/S/E/D Views 1 View Ch (74022) | $417.30 | $642 | 4.1× |
| Radex abscess/fistula/sinus tract rs&i (76080) | $389.35 | $599 | 0.7× |
| Radex Ankle Complete Minimum 3 Views (73610) range across 3 matching MRF lines |
$264.55–$396.50 | $407–$610 | varies |
| Radex Calcaneus Minimum 2 Views (73650) range across 3 matching MRF lines |
$165.75–$248.95 | $255–$383 | varies |
| Radex elbow complete minimum 3 views (73080) range across 3 matching MRF lines |
$217.75–$326.95 | $335–$503 | varies |
| Radex Facial Bones Complete Minimum 3 Views (70150) | $205.40 | $316 | 2.0× |
| Radex fingr minimum 2 views (73140) range across 3 matching MRF lines |
$150.80–$226.20 | $232–$348 | varies |
| Radex foot complete minimum 3 views (73630) range across 3 matching MRF lines |
$269.10–$403 | $414–$620 | varies |
| Radex Hand Minimum 3 Views (73130) range across 3 matching MRF lines |
$215.80–$323.70 | $332–$498 | varies |
| Radex lower extremity infant minimum 2 views (73592) range across 3 matching MRF lines |
$146.90–$220.35 | $226–$339 | varies |
| Radex Mastoids Compl Minimum 3 Views PR Side (70130) | $234.65 | $361 | 2.3× |
| Radex Nasal Bones Complete Minimum 3 Views (70160) | $211.25 | $325 | 2.5× |
| Radex Ribs Unilateral 2 Views (71100) | $189.80 | $292 | 2.3× |
| Radex shoulder complete minimum 2 views (73030) range across 3 matching MRF lines |
$232.70–$348.40 | $358–$536 | varies |
| Radex Sinuses Paransl < 3 Views (70210) | $150.15 | $231 | 1.8× |
| Radex sm int w/mlt srl imges via enteroclss tube (74251) | $545.35 | $839 | 3.2× |
| Radex Spine 1 View Specify Level (72020) | $145.60 | $224 | 1.7× |
| Radex Sternum Minimum 2 Views (71120) | $130.65 | $201 | 1.6× |
| Radex Temporomandble Jt Opn & Clsd Mouth Bilat (70330) | $168.35 | $259 | 2.0× |
| Radex Toe Minimum 2 Views (73660) range across 3 matching MRF lines |
$137.15–$206.05 | $211–$317 | varies |
| Radex upper extremity infant minimum 2 views (73092) | $66.95 | $103 | 0.7× |
| Radex Wrist Complete Minimum 3 Views (73110) range across 3 matching MRF lines |
$312–$468 | $480–$720 | varies |
| Radex X-Ray Exam Entire Spi 6/> Vw - Xr Entire Spine 6+ Vw (72084) | $604.50 | $930 | 6.0× |
| Radiation Delivery Stereotactic Cranial Linear (77372) range across 2 matching MRF lines |
$11,933.35–$30,236.70 | $18,359–$46,518 | varies |
| Radiation treatment delivery level 1 (77402) range across 2 matching MRF lines |
$293.15–$9,324.25 | $451–$14,345 | varies |
| Radiation treatment delivery level 2 (77407) range across 2 matching MRF lines |
$1,929.85–$29,071.90 | $2,969–$44,726 | varies |
| Radiation treatment delivery level 3 (77412) range across 2 matching MRF lines |
$2,355.60–$17,482.40 | $3,624–$26,896 | varies |
| Radiolog exam mandible compl minimum 4 views (70110) | $215.80 | $332 | 2.1× |
| Radiologic Exam Abdomen 3+ Views - Xr Abdomen 3+ Views (74021) | $301.60 | $464 | 3.0× |
| Radiologic exam colon double contrast study (74280) | $559.65 | $861 | 3.3× |
| Radiologic exam colon single contrast study (74270) | $456.30 | $702 | 2.7× |
| Radiologic exam knee complete 4/more views (73564) range across 3 matching MRF lines |
$258.70–$388.05 | $398–$597 | varies |
| Radiologic exam pelvis compl minimum 3 views (72190) | $252.85 | $389 | 2.5× |
| Radiologic Exam Small Int Single Contrast Study (74250) | $337.35 | $519 | 2.0× |
| Radiologic exam swallow function contrast study (74230) | $396.50 | $610 | 2.3× |
| Radiologic exam upr gi trc double contrast study (74246) | $471.25 | $725 | 2.8× |
| Radiologic examination femur 1 view (73551) | $153.40 | $236 | 1.8× |
| Radiologic examination femur minimum 2 views (73552) range across 3 matching MRF lines |
$284.05–$426.40 | $437–$656 | varies |
| Radiologic examination knee 1/2 views (73560) range across 3 matching MRF lines |
$181.35–$271.70 | $279–$418 | varies |
| Radiologic Examination Osseous Survey Limited (77074) | $336.70 | $518 | 3.3× |
| Radiologic Examination Salivary Gland Calculus (70380) | $137.80 | $212 | 1.6× |
| Radiologic examination tibia & fibula 2 views (73590) range across 3 matching MRF lines |
$200.20–$300.30 | $308–$462 | varies |
| Radiologic examination, internal auditory meati, complete Non-Facility (70134) | $324.35 | $499 | 0.6× |
| Renal Cyst Study (74470) | $704.60 | $1,084 | 1.3× |
| Ribs bilateral 3 views (71110) | $239.20 | $368 | 2.4× |
| Rp loclzj tum plnr 1 area single day imaging (78800) | $612.95 | $943 | 1.6× |
| Rp loclzj tum plnr 2+area 1+d img/1 area img>2+d (78801) | $629.20 | $968 | 1.6× |
| Rp Loclzj Tum Plnr Whole Body 2+ Days Imaging (78804) | $2,174.25 | $3,345 | 4.1× |
| Rp Loclzj Tum Plnr Whole Body Single Day Imaging (78802) range across 2 matching MRF lines |
$885.30–$1,070.55 | $1,362–$1,647 | varies |
| Rp Loclzj Tum Spect 1 Area Single Day Imaging (78803) range across 2 matching MRF lines |
$781.30–$5,034.90 | $1,202–$7,746 | varies |
| Rp Therapy Intravenous Administration (79101) | $625.30 | $962 | 2.8× |
| Salivary Gland Imaging Serial Images (78231) range across 2 matching MRF lines |
$894.40–$1,264.90 | $1,376–$1,946 | varies |
| Scapula (73010) range across 3 matching MRF lines |
$188.50–$349.05 | $290–$537 | varies |
| Screening Digital Breast Tomosynthesis Bi (77063) | $73.45 | $113 | 3.1× |
| Sella turcica (70240) | $124.15 | $191 | 1.5× |
| Shoulder 1 view (73020) range across 3 matching MRF lines |
$182.65–$274.30 | $281–$422 | varies |
| Shoulder Arthrography (73040) range across 3 matching MRF lines |
$650–$975.65 | $1,000–$1,501 | varies |
| Sialogram (70390) | $532.35 | $819 | 2.3× |
| Skull less than 4 views (70250) | $177.45 | $273 | 1.8× |
| Special dosimetry (77331) range across 2 matching MRF lines |
$338–$15,778.75 | $520–$24,275 | varies |
| Special Physics Consult (77370) range across 2 matching MRF lines |
$607.75–$35,338.55 | $935–$54,367 | varies |
| Special teletherapy port plan (77321) range across 2 matching MRF lines |
$711.10–$19,228.30 | $1,094–$29,582 | varies |
| Special treatment procedure (77470) range across 2 matching MRF lines |
$1,787.50–$29,123.90 | $2,750–$44,806 | varies |
| Spleen Imaging (78185) | $614.25 | $945 | 1.6× |
| Stereotactic Body Radiation Delivery (77373) range across 2 matching MRF lines |
$6,801.60–$35,338.55 | $10,464–$54,367 | varies |
| Sternoclavicular joints (71130) | $177.45 | $273 | 2.1× |
| Superior sagittal sinus venogram (75870) | $1,904.50 | $2,930 | 0.6× |
| Telethx isodose pln cplx w/basic dosimetry (77307) range across 2 matching MRF lines |
$1,571.05–$30,207.45 | $2,417–$46,473 | varies |
| Telethx isodose pln smpl w/dosimetry calculation (77306) range across 2 matching MRF lines |
$776.75–$5,317.65 | $1,195–$8,181 | varies |
| Temporomandble Jt Arthrography Rs&I (70332) | $286 | $440 | 1.2× |
| Testicular Imaging W/Flow (78761) | $641.55 | $987 | 1.7× |
| Ther Rad Simulaj-Aided Field Setting Complex (77290) range across 2 matching MRF lines |
$1,336.40–$29,764.80 | $2,056–$45,792 | varies |
| Ther Rad Simulaj-Aided Field Setting Intermed (77285) | $1,025.70 | $1,578 | 2.8× |
| Ther rad simulaj-aided field setting simple (77280) range across 2 matching MRF lines |
$566.15–$29,071.90 | $871–$44,726 | varies |
| Therapeutic Enema Rdctj Intussusception/Obstrcj (74283) | $757.25 | $1,165 | 4.5× |
| Thoracic spine 2 views (72070) | $202.15 | $311 | 2.0× |
| Thoracic spine 3 views (72072) | $218.40 | $336 | 2.2× |
| Thoracolumbar 2 views (72080) | $187.85 | $289 | 2.2× |
| Thyroid Met Imaging Body (78018) | $1,354.60 | $2,084 | 2.6× |
| Thyroid Uptake W/Blood Flow Sngle/Mult Quan Meas (78014) range across 2 matching MRF lines |
$897.65–$1,166.10 | $1,381–$1,794 | varies |
| Tx Devices Design & Construction Complex (77334) range across 2 matching MRF lines |
$1,166.10–$29,252.60 | $1,794–$45,004 | varies |
| Tx devices design & construction intermediate (77333) range across 2 matching MRF lines |
$655.85–$44,874.70 | $1,009–$69,038 | varies |
| Tx devices design & construction simple (77332) range across 2 matching MRF lines |
$512.20–$27,283.10 | $788–$41,974 | varies |
| Ultrasound Breast Limited (76642) range across 3 matching MRF lines |
$208–$312 | $320–$480 | varies |
| Ultrasound Exam Aaa Screen (76706) | $286.65 | $441 | 2.8× |
| Ultrasound, abdomen limited (76705) | $482.30 | $742 | 4.8× |
| Unlisted magnetic resonance procedure (76498) | $1,032.20 | $1,588 | 12.2× |
| Upper gi w/o kub (74240) | $612.30 | $942 | 3.6× |
| Ureteral Reflux Study (78740) | $514.15 | $791 | 1.3× |
| Urethrocystogram voiding (74455) | $460.85 | $709 | 2.0× |
| Urethrocystography retrograde (74450) | $303.55 | $467 | 1.3× |
| Us bone density measurement (76977) | $100.75 | $155 | 1.0× |
| Us breast unilateral complete (76641) range across 3 matching MRF lines |
$248.95–$460.20 | $383–$708 | varies |
| Us chest (76604) | $430.30 | $662 | 4.2× |
| Us complete joint (76881) range across 3 matching MRF lines |
$371.15–$557.05 | $571–$857 | varies |
| Us exam, pelvic, limited (76857) | $274.95 | $423 | 2.7× |
| Us head (76506) | $440.05 | $677 | 4.3× |
| Us kidney transplant (76776) | $478.40 | $736 | 4.7× |
| Us lmtd joint/oth nonvasc xtr strux r-t w/img (76882) range across 3 matching MRF lines |
$408.20–$612.30 | $628–$942 | varies |
| Us ob detailed single fetus (76811) | $413.40 | $636 | 1.8× |
| Us ob limited 1 or more fetuses (76815) | $310.70 | $478 | 3.1× |
| Us ob transvaginal (76817) | $356.20 | $548 | 3.5× |
| Us pelvic non ob complete (76856) | $403 | $620 | 4.0× |
| Us pg uter img f&mat 14 wk tabdl 1/1st gestation (76801) | $386.10 | $594 | 3.8× |
| Us preg uterus real time f/u trnsabdl per fetus (76816) | $228.15 | $351 | 2.3× |
| Us retroperitoneal complete (76770) | $553.80 | $852 | 5.5× |
| Us retroperitoneal limited (76775) | $193.70 | $298 | 1.9× |
| Us scrotum and contents (76870) | $411.45 | $633 | 4.1× |
| Us spinal canal and contents (76800) | $414.70 | $638 | 4.1× |
| Us thyroid (76536) | $403.65 | $621 | 4.0× |
| Us transrectal (76872) | $278.20 | $428 | 2.7× |
| Vascular Flow Imaging (78445) | $616.20 | $948 | 1.6× |
| Vasogram (74440) | $197.60 | $304 | 0.9× |
| Vein X-Ray Chest (75827) | $1,251.25 | $1,925 | 0.8× |
| Vein X-Ray Spleen/Liver (75810) | $1,444.30 | $2,222 | 0.5× |
| Venogram Sinus/Jugular (75860) | $2,327.65 | $3,581 | 0.8× |
| Venography Adrenal Unilateral (75840) | $2,160.60 | $3,324 | 0.7× |
| Venography caval inferior serialography rs&i (75825) | $2,594.80 | $3,992 | 0.8× |
| Venography extremity bilateral rs&i (75822) | $1,702.35 | $2,619 | 1.1× |
| Venography extremity unilateral rs&i (75820) | $1,138.15 | $1,751 | 0.7× |
| Venography Orbital Rs&I (75880) | $1,182.35 | $1,819 | 1.9× |
| Venography Renal Bilateral (75833) | $2,398.50 | $3,690 | 0.8× |
| Venography Renal Unilateral (75831) | $2,209.35 | $3,399 | 0.7× |
| Venous sampling by catheter (75893) unusually low: confirm this is the full procedure |
$2,241.85 | $3,449 | 0.4× |
| Venous Thrombosis Imaging Venogram Bilateral (78458) | $744.90 | $1,146 | 1.9× |
| Wrist 2 views (73100) range across 6 matching MRF lines |
$241.15–$403 | $371–$620 | varies |
| X-Ray Ac Jts - Xr Acromioclavicular Joints Bilateral (73050) | $174.20 | $268 | 2.1× |
| X-ray antegrade pyelogram tube (74425) range across 4 matching MRF lines |
$541.45–$879.45 | $833–$1,353 | varies |
| X-Ray Aorta Leg Arteries (75630) | $2,061.15 | $3,171 | 0.7× |
| X-Ray Bend Only L-S Spine (72120) | $117.65 | $181 | 1.2× |
| X-Ray Elbow 2 Vw - Xr Elbow 1-2 Views Right (73070) range across 6 matching MRF lines |
$58.50–$297.70 | $90–$458 | varies |
| X-Ray Exam Breast Specimen (76098) range across 3 matching MRF lines |
$206.05–$308.75 | $317–$475 | varies |
| X-Ray Exam Entire Spi 1 Vw (72081) | $164.45 | $253 | 2.0× |
| X-Ray Exam Entire Spi 2/3 Vw (72082) | $359.45 | $553 | 3.5× |
| X-Ray Exam Entire Spi 4/5 Vw (72083) | $499.20 | $768 | 4.9× |
| X-Ray Exam Hip Uni 1 View (73501) | $131.95 | $203 | 1.6× |
| X-Ray Exam Hip Uni 2-3 Views (73502) | $199.55 | $307 | 2.4× |
| X-Ray Exam Hip Uni 4/> Views (73503) | $260.65 | $401 | 2.6× |
| X-Ray Exam Hips Bi 2 Views (73521) | $170.95 | $263 | 1.7× |
| X-Ray Exam Hips Bi 3-4 Views (73522) | $204.75 | $315 | 2.0× |
| X-Ray Exam Hips Bi 5/> Views (73523) | $333.45 | $513 | 3.3× |
| X-Ray Exam L-S Spine Bending (72114) | $393.90 | $606 | 3.9× |
| X-Ray Exam Neck Spine 2-3 Vw (72040) range across 2 matching MRF lines |
$58.50–$178.75 | $90–$275 | varies |
| X-Ray Exam Neck Spine 6/>Vws (72052) | $464.75 | $715 | 4.6× |
| X-Ray Exam Unilat Ribs/Chest (71101) | $213.85 | $329 | 2.1× |
| X-ray eye for foreign body (70030) range across 3 matching MRF lines |
$155.35–$233.35 | $239–$359 | varies |
| X-ray humerus (73060) range across 3 matching MRF lines |
$221–$331.50 | $340–$510 | varies |
| X-ray IV pyelogram (ivp) (74400) | $911.30 | $1,402 | 5.4× |
| X-ray IV pyelogram+tomography (74415) | $883.35 | $1,359 | 5.2× |
| X-Ray Jaw <4 Vw - Xr Mandible < 4 Views (70100) | $159.25 | $245 | 1.9× |
| X-Ray Knee Bilat Standing - Xr Knees Anteroposterior Standing Bilat (73565) | $169 | $260 | 2.0× |
| X-Ray Lumbar Spine 2/3 Vw - Xr Lumbar Spine 2-3 Views (72100) | $248.95 | $383 | 2.5× |
| X-ray nose-rectum child f.b. (76010) | $135.20 | $208 | 1.6× |
| X-Ray Ribs, Chest 4+ Vw - Xr Ribs 3 Vws Bil W/ Chest Posteroanterior (71111) | $265.85 | $409 | 2.6× |
| X-Ray Sacroiliac Jts 3+ Vw - Xr Sacroiliac Joints 3+ Views (72202) | $167.05 | $257 | 1.6× |
| X-Ray Sacroiliac Jts <3 Vw - Xr Sacroiliac Joints 1-2 Views (72200) | $131.95 | $203 | 1.3× |
| X-Ray Sacrum/Coccyx 2+ Vw - Xr Sacrum Coccyx 2+ Views (72220) | $213.85 | $329 | 2.5× |
| X-Ray Sinuses 3+ Vw - Xr Paranasal Sinuses 3+ Views (70220) | $189.80 | $292 | 2.3× |
| X-Ray Skull 4+ Vw - Xr Skull Complete 4+ Views (70260) | $321.10 | $494 | 3.2× |
| X-ray thoracic spine 4 vw (72074) | $269.10 | $414 | 2.7× |
| X-Ray Tmj Unilat (70328) | $120.25 | $185 | 1.4× |
| X-Ray Urinary Tract Exam With Contrast Material (74420) | $317.20 | $488 | 0.9× |
| X-Rays Bone Length Studies (77073) | $186.55 | $287 | 1.8× |
| X-Rays Bone Survey Complete (77075) | $440.70 | $678 | 4.4× |
| Xr c-spine 4 or 5 views (72050) | $289.25 | $445 | 2.9× |
| Xr facial bones less than 3 views (70140) | $189.80 | $292 | 2.3× |
| XR Mastoids < 3 Views Bilateral (70120) | $123.50 | $190 | 1.2× |
| Xr orbits complete 4 views (70200) | $254.15 | $391 | 2.5× |
| Xr Tomogram Single Plane (76100) | $339.95 | $523 | 3.4× |
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.