Imaging prices at Monument Health Custer Hospital
Custer, SD · every code in this section with a posted price and a Medicare benchmark.
361 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) | $6,745.60 | $8,432 | 4.8× |
| Abdomen 1 View (74018) | $326.40 | $408 | 3.7× |
| Abdomen 2 views (74019) | $472.80 | $591 | 4.4× |
| Acute Gastrointestinal Blood Loss Imaging (78278) | $1,425.60 | $1,782 | 3.5× |
| Angio internal mammary (75756) | $6,593.60 | $8,242 | 2.0× |
| Angio pulmonary bilat (75743) | $6,792 | $8,490 | 2.1× |
| Angiography extremity bilateral rs&i (75716) | $5,149.60 | $6,437 | 1.6× |
| Angiography extremity unilateral rs&i (75710) | $5,100 | $6,375 | 1.6× |
| Angiography pulmonary unilateral slctv rs&i (75741) | $7,198.40 | $8,998 | 2.2× |
| Angrph pulmonary nonslctv cath/ven njx rs&i (75746) | $4,444.80 | $5,556 | 1.4× |
| Ankle 2 views (73600) | $286.40 | $358 | 3.2× |
| Aortography thoracic serialography rs&i (75605) | $10,717.60 | $13,397 | 1.9× |
| Aortography thoracic w/o serialography rs&i (75600) | $6,792 | $8,490 | 2.1× |
| Artery X-Rays Abdomen (75726) | $10,588.80 | $13,236 | 1.9× |
| Artery X-Rays Pelvis (75736) | $10,717.60 | $13,397 | 1.9× |
| Artery X-Rays Spine (75705) | $11,576.80 | $14,471 | 2.0× |
| Arthrogram ankle (73615) | $1,207.20 | $1,509 | 3.4× |
| Arthrogram hip (73525) | $840.80 | $1,051 | 2.4× |
| Arthrogram Wrist (73115) | $668.80 | $836 | 1.9× |
| Basic radiation dosimetry calculation (77300) | $756 | $945 | 5.5× |
| Bone age studies (77072) | $316 | $395 | 3.0× |
| Bone Imaging 3 Phase (78315) | $2,380.80 | $2,976 | 5.8× |
| Bone Imaging Limited Area (78300) | $1,692.80 | $2,116 | 4.1× |
| Bone Imaging Whole Body (78306) | $2,284.80 | $2,856 | 5.6× |
| Bone survey infant (77076) | $370.40 | $463 | 3.5× |
| Brachytx isodose complex (77318) | $1,976 | $2,470 | 5.2× |
| Brachytx isodose intermed (77317) | $2,166.40 | $2,708 | 5.7× |
| Brachytx Isodose Plan Simple (77316) | $1,533.60 | $1,917 | 4.0× |
| Brain Imaging Min 4 Static Views W Vascular Flow (78606) | $1,234.40 | $1,543 | 2.2× |
| Cardiac MRI w/w/o contrast & further seq (75561) | $3,344.80 | $4,181 | 9.4× |
| Cat Scan Follow-Up Study (76380) | $1,038.40 | $1,298 | 11.7× |
| Cerebrospinal Fluid Flow W/O Matl Shunt Evaltj (78645) | $1,234.40 | $1,543 | 2.2× |
| Cerebrospinal fluid flow, imaging (not including introduction of material); ventriculography Non-Facility (78635) | $1,335.20 | $1,669 | 2.4× |
| Cerebrospinal Fluid Scan (78630) | $1,198.40 | $1,498 | 2.2× |
| Chest 1 view (71045) | $349.60 | $437 | 3.9× |
| Chest 2 views (71046) | $374.40 | $468 | 4.2× |
| Chest 3 views (71047) | $391.20 | $489 | 4.4× |
| Chest 4 or more views (71048) | $442.40 | $553 | 4.1× |
| Clavicle complete (73000) | $251.20 | $314 | 2.8× |
| Computed Tomography Thorax Lw Dose Lng Ca Scr C- (71271) | $177.60 | $222 | 1.7× |
| Continuing medical physics consltj pr wk (77336) | $843.20 | $1,054 | 6.1× |
| Contrast Exam Abdominl Aorta (75625) | $6,197.60 | $7,747 | 1.9× |
| Contrast X-Ray Bladder (74430) | $842.40 | $1,053 | 2.4× |
| Contrast X-Ray Of Elbow (73085) | $1,207.20 | $1,509 | 3.4× |
| Contrast X-Ray Of Knee Joint (73580) | $1,207.20 | $1,509 | 3.4× |
| Corpora cavernosography (74445) | $298.40 | $373 | 2.8× |
| CT abdomen and pelvis without and with contrast (74178) | $4,544 | $5,680 | 12.7× |
| CT abdomen and pelvis without contrast (74176) | $3,567.20 | $4,459 | 14.6× |
| CT abdomen w contrast (74160) | $3,043.20 | $3,804 | 17.0× |
| CT abdomen w wo contrast (74170) | $3,413.60 | $4,267 | 19.0× |
| CT abdomen w/o contrast (74150) | $1,937.60 | $2,422 | 18.1× |
| CT Angio Abdomen and Pelvis (74174) | $4,052.80 | $5,066 | 11.4× |
| CT Angio Chest (71275) | $2,736 | $3,420 | 15.3× |
| CT Angio Head (70496) | $2,649.60 | $3,312 | 14.8× |
| CT angio hrt w/3d image (75574) | $3,602.40 | $4,503 | 10.1× |
| Ct Angio Lwr Extr W/O&W/Dye (73706) | $2,803.20 | $3,504 | 15.6× |
| CT Angio Neck (70498) | $2,803.20 | $3,504 | 15.6× |
| Ct Angio Upr Extrm W/O&W/Dye (73206) | $2,076 | $2,595 | 11.6× |
| CT Cere Prfuj Alys C+ W/O CT/Cta Same Anatomy (70473) | $3,272.80 | $4,091 | 18.3× |
| CT cervical spine w/ contrast (72126) | $2,449.60 | $3,062 | 6.9× |
| CT cervical spine w/o contrast (72125) | $1,991.20 | $2,489 | 18.6× |
| CT cervical spine w/wo cont (72127) | $2,543.20 | $3,179 | 14.2× |
| CT chest w contrast (71260) | $2,668.80 | $3,336 | 14.9× |
| CT chest w/wo contrast (71270) | $2,924.80 | $3,656 | 16.3× |
| CT head/brain with contrast (70460) | $2,232.80 | $2,791 | 12.5× |
| CT head/brain without and with contrast (70470) | $2,804 | $3,505 | 15.6× |
| CT heart contrast eval cardiac structure&morph (75572) | $451.20 | $564 | 1.3× |
| CT heart no contrast quant eval coronry calcium (75571) | $261.60 | $327 | 2.9× |
| CT iac w contrast (70481) | $2,584.80 | $3,231 | 14.4× |
| CT l-spine w&w/o contrast (72133) | $2,441.60 | $3,052 | 13.6× |
| CT lower ext w/o (73700) | $1,991.20 | $2,489 | 18.6× |
| CT lower extremity w/contrast material (73701) | $2,315.20 | $2,894 | 12.9× |
| CT lumbar spine w contrast (72132) | $2,239.20 | $2,799 | 6.3× |
| CT lumbar spine w/o contrast (72131) | $1,947.20 | $2,434 | 18.2× |
| CT maxillofacial w contrast (70487) | $2,336 | $2,920 | 13.0× |
| CT maxillofacial wo contrast (70486) | $1,789.60 | $2,237 | 16.8× |
| CT neck tissue combo (70492) | $2,739.20 | $3,424 | 15.3× |
| Ct Orbit/Ear/Fossa W/O&W/Dye (70482) | $2,844 | $3,555 | 15.9× |
| CT orbits w/o contrast (70480) | $1,991.20 | $2,489 | 18.6× |
| CT pelvis w&w/o contrast (72194) | $2,356.80 | $2,946 | 13.2× |
| CT pelvis w/o contrast (72192) | $1,802.40 | $2,253 | 16.9× |
| CT scan of leg combo (73702) | $2,382.40 | $2,978 | 13.3× |
| CT scans face/jaw combo (70488) | $2,671.20 | $3,339 | 14.9× |
| CT soft tissue neck w contrast (70491) | $2,516 | $3,145 | 14.0× |
| CT soft tissue neck w/o contrast (70490) | $1,956 | $2,445 | 18.3× |
| CT thoracic spine w contrast (72129) | $2,350.40 | $2,938 | 13.1× |
| CT thoracic spine w/o contrast (72128) | $1,991.20 | $2,489 | 18.6× |
| CT thoracic spine w/wo cont (72130) | $2,620 | $3,275 | 14.6× |
| CT thorax w/o contrast (71250) | $1,991.20 | $2,489 | 18.6× |
| CT upper ext wo (73200) | $2,068 | $2,585 | 19.4× |
| CT upper extremity w/o & w/contrast material (73202) | $2,632.80 | $3,291 | 14.7× |
| CT upper extremity with contrast (73201) | $2,538.40 | $3,173 | 7.1× |
| Cta Abdl Aorta&Bi Iliofem W/Contrast&Postp (75635) | $3,372 | $4,215 | 18.8× |
| Cta Abdomen (74175) | $2,858.40 | $3,573 | 16.0× |
| CTA head&neck c+ w/noncontrast img&post-pxessing (70471) | $4,950.40 | $6,188 | 13.9× |
| CTA pelvis (72191) | $2,108 | $2,635 | 11.8× |
| Dilation ureters/urethra rs&i (74485) | $4,261.60 | $5,327 | 2.0× |
| Discography Cerv/Thor Spine (72285) | $1,619.20 | $2,024 | 0.8× |
| Doppler Echo Fetal Spectral Display Complete (76827) | $379.20 | $474 | 3.6× |
| Doppler Fetal Mid Cerebral Artery (76821) | $336 | $420 | 3.1× |
| Dxa Bone Density Axial (77080) range across 2 matching MRF lines |
$278.40–$588 | $348–$735 | varies |
| Dxa bone density study (77085) range across 2 matching MRF lines |
$179.20–$216 | $224–$270 | varies |
| Dxa bone density study 1/>sites appendiclr skel (77081) range across 2 matching MRF lines |
$116.80–$180.80 | $146–$226 | varies |
| Echo exam of fetal heart (76825) | $1,203.20 | $1,504 | 2.2× |
| Echo exam uterus (76831) | $578.40 | $723 | 2.4× |
| Echo Guide For Artery Repair (76936) | $736.80 | $921 | 3.3× |
| Echograp Trans R Pros Study (76873) | $832 | $1,040 | 7.8× |
| Esophagram (74220) | $875.20 | $1,094 | 4.9× |
| Fetal Biophysical Profile W/O Non-Stress Testing (76819) | $542.40 | $678 | 5.1× |
| Fetal MRI w/placntl matrnl plvc img sing/1st ges (74712) | $1,258.40 | $1,573 | 5.2× |
| Fluoroscopy up to 1 hr (76000) | $732.80 | $916 | 3.0× |
| Follow-Up Angiography (75898) | $2,820 | $3,525 | 0.9× |
| Foot 2 views (73620) | $281.60 | $352 | 3.2× |
| Forearm 2 views (73090) | $310.40 | $388 | 3.5× |
| Gastric emptying imaging study (78264) | $2,250.40 | $2,813 | 5.5× |
| Gated Heart Planar Single (78472) | $1,830.40 | $2,288 | 4.5× |
| Gated Heart, Multiple (78473) | $1,028.80 | $1,286 | 2.5× |
| Hand 2 views (73120) | $291.20 | $364 | 2.7× |
| Hdr Rdncl Ntrstl/Icav Brchtx (77772) | $4,977.60 | $6,222 | 7.0× |
| Hdr Rdncl Ntrstl/Icav Brchtx (77771) | $5,198.40 | $6,498 | 7.3× |
| Hdr Rdncl Ntrstl/Icav Brchtx 1 Channel (77770) | $5,358.40 | $6,698 | 7.5× |
| Hepatc Vngrph Wdg/Fr Hemodyn Eval Rs&I (75889) | $6,452 | $8,065 | 2.0× |
| Hepatc Vngrph Wdg/Fr W/O Hemodyn Eval Rs&I (75891) | $6,593.60 | $8,242 | 2.0× |
| Hepatobil Syst Image W/Drug (78227) | $2,360.80 | $2,951 | 4.3× |
| Hepatobiliary System Imaging (78226) | $2,430.40 | $3,038 | 6.0× |
| Ht Muscle Image Spect Sing (78451) | $2,895.20 | $3,619 | 2.2× |
| Hysterosalpingogram (74740) | $1,104.80 | $1,381 | 4.5× |
| Infant hip ultrasound, limited static exam (76886) | $284.80 | $356 | 3.2× |
| Interstitial radiation source applic complex (77778) | $3,928.80 | $4,911 | 5.5× |
| Intracavitary radiation source applic simple (77761) | $1,382.40 | $1,728 | 2.4× |
| Joint Survey Single View (77077) | $367.20 | $459 | 3.4× |
| K Flow/Funct Image W/Drug (78708) | $2,469.60 | $3,087 | 4.5× |
| K Flow/Funct Image W/O Drug (78707) | $1,592 | $1,990 | 2.9× |
| Kidney Imaging Morphol (78700) | $973.60 | $1,217 | 2.4× |
| Kidney Imaging Morphoogy W/Vascular Flow (78701) | $1,031.20 | $1,289 | 2.5× |
| Knee 3 Views (73562) range across 2 matching MRF lines |
$156–$304 | $195–$380 | varies |
| Leveen/Shunt Patency Exam (78291) | $935.20 | $1,169 | 2.3× |
| Liver & Spleen Imaging Static Only (78215) | $1,559.20 | $1,949 | 3.8× |
| Liver imaging static only (78201) | $3,148.80 | $3,936 | 5.7× |
| Lung perfusion differential (78597) | $1,358.40 | $1,698 | 3.3× |
| Lung Ventilat&Perfus Imaging (78582) | $1,988 | $2,485 | 3.6× |
| Lung Ventilation Imaging (78579) | $973.60 | $1,217 | 2.4× |
| Lymph System Imaging (78195) | $2,452 | $3,065 | 4.4× |
| Magnetic Image Jaw Joint (70336) | $2,737.60 | $3,422 | 11.2× |
| Meckels Divert Exam (78290) | $1,276.80 | $1,596 | 3.1× |
| Mlc imrt design & construction per imrt plan (77338) | $3,107.20 | $3,884 | 8.1× |
| Mra Head W/O & W/Contrast Material (70546) | $3,666.40 | $4,583 | 10.3× |
| MRA head w/o contrast (70544) | $3,258.40 | $4,073 | 13.4× |
| MRA neck w contrast (70548) | $3,414.40 | $4,268 | 9.6× |
| Mra Neck W/O &W/Contrast Material (70549) | $3,897.60 | $4,872 | 10.9× |
| MRA neck w/o contrast (70547) | $2,974.40 | $3,718 | 12.2× |
| MRI abdomen w contrast (74182) | $3,672 | $4,590 | 10.3× |
| MRI abdomen w/o contrast (74181) | $3,580.80 | $4,476 | 14.7× |
| MRI any jt lower extrem w/contrast material (73722) | $3,603.20 | $4,504 | 4.5× |
| MRI any jt lower extrem w/o & w/contrast matrl (73723) | $4,168 | $5,210 | 11.7× |
| MRI any jt upper extremity w/contrast matrl (73222) | $3,838.40 | $4,798 | 4.8× |
| MRI cervical spine w contrast (72142) | $3,513.60 | $4,392 | 9.9× |
| MRI cervical spine w/o cont (72141) | $3,269.60 | $4,087 | 13.4× |
| MRI chest w/o contrast (71550) | $2,909.60 | $3,637 | 11.9× |
| MRI chest wo w contrast (71552) | $4,476.80 | $5,596 | 12.6× |
| MRI lower extrem oth/thn jt w/contrast matrl (73719) | $3,600 | $4,500 | 10.1× |
| MRI lower extrem oth/thn jt w/o & w/contr matr (73720) | $4,490.40 | $5,613 | 12.6× |
| MRI lower extrem oth/thn jt w/o contr matrl (73718) | $3,300 | $4,125 | 13.5× |
| MRI lumbar spine w contrast (72149) | $3,513.60 | $4,392 | 9.9× |
| Mri Neck Spine W/O & W/Dye (72156) | $4,293.60 | $5,367 | 12.0× |
| MRI orbit face &/neck w/o contrast (70540) | $4,427.20 | $5,534 | 18.2× |
| Mri Orbt/Fac/Nck W/O &W/Dye (70543) | $4,786.40 | $5,983 | 13.4× |
| MRI pelvis w contrast (72196) | $3,904 | $4,880 | 11.0× |
| MRI pelvis w/o & w contrast (72197) | $4,309.60 | $5,387 | 12.1× |
| MRI pelvis w/o contrast (72195) | $3,821.60 | $4,777 | 15.7× |
| MRI thoracic spine w/o contrast (72146) | $3,269.60 | $4,087 | 13.4× |
| MRI upper extremity oth than jt w/contr matrl (73219) | $3,300 | $4,125 | 9.3× |
| MRI upper extremity oth than jt w/o contr matrl (73218) | $2,948.80 | $3,686 | 12.1× |
| Mri Uppr Extremity W/O&W/Dye (73220) | $4,346.40 | $5,433 | 12.2× |
| MRI, abdomen, combo (74183) | $4,354.40 | $5,443 | 12.2× |
| MRI, dorsal spine combo (72157) | $4,321.60 | $5,402 | 12.1× |
| MRI, dorsal spine contrast (72147) | $3,513.60 | $4,392 | 9.9× |
| MRI, joint upper extrem (73221) range across 2 matching MRF lines |
$1,198.40–$3,590.40 | $1,498–$4,488 | varies |
| MRI, joint upper extrem combo (73223) | $4,272.80 | $5,341 | 12.0× |
| MRI, lumbar spine combo (72158) | $4,410.40 | $5,513 | 12.4× |
| Myocardial Imaging Infarct Avid Planar Qual/Quan (78466) | $774.40 | $968 | 1.9× |
| Myocardial Spect Multiple Studies (78452) | $3,480.80 | $4,351 | 2.6× |
| N-invas est c ffr sw aly CTA (75580) | $5,985.60 | $7,482 | 6.8× |
| Neck soft tissue (70360) | $386.40 | $483 | 4.3× |
| Njx Rp Loclzj Non-Img Probe Study Intravenous (78808) | $916 | $1,145 | 2.2× |
| Nm csf leak detection (78650) | $3,511.20 | $4,389 | 2.7× |
| Nonvascular Shunt X-Ray (75809) | $304 | $380 | 2.8× |
| Ntsty modul radthx pln dose-vol histos (77301) | $10,000.80 | $12,501 | 7.1× |
| Nuclear Rx Intra-Arterial (79445) | $909.60 | $1,137 | 3.8× |
| Nuclear Rx Oral Admin (79005) | $1,768.80 | $2,211 | 7.4× |
| Oph US Dx B-Scan&Quan a-Scan Sm Pt Enctr (76510) | $428 | $535 | 3.1× |
| Optic foramina (70190) | $168 | $210 | 1.9× |
| Panoramic X-ray of jaws (70355) | $425.60 | $532 | 4.8× |
| Parathyroid imaging w/tomographic spect & CT (78072) | $1,332 | $1,665 | 2.4× |
| Parathyroid Planar Imaging (78070) | $1,797.60 | $2,247 | 4.4× |
| Parathyroid planar imaging w/wo subtraction (78071) | $1,488 | $1,860 | 3.6× |
| Pelvis 1 or 2 views (72170) range across 2 matching MRF lines |
$106.40–$316.80 | $133–$396 | varies |
| Peritoneogram Rs&I (74190) | $1,260 | $1,575 | 2.3× |
| Prq Transhepatc Portograpy Hemodyn Eval Rs&I (75885) | $6,593.60 | $8,242 | 2.0× |
| Pulmonary Perfusion Imaging Particulate (78580) | $1,290.40 | $1,613 | 3.2× |
| Radex Abd Compl Aqt Abd W/S/E/D Views 1 View Ch (74022) | $675.20 | $844 | 6.3× |
| Radex abscess/fistula/sinus tract rs&i (76080) | $904 | $1,130 | 1.6× |
| Radex Ankle Complete Minimum 3 Views (73610) range across 2 matching MRF lines |
$140–$280 | $175–$350 | varies |
| Radex Calcaneus Minimum 2 Views (73650) range across 2 matching MRF lines |
$110.40–$204.80 | $138–$256 | varies |
| Radex elbow complete minimum 3 views (73080) range across 2 matching MRF lines |
$124.80–$336.80 | $156–$421 | varies |
| Radex Facial Bones Complete Minimum 3 Views (70150) | $354.40 | $443 | 3.3× |
| Radex fingr minimum 2 views (73140) | $219.20 | $274 | 2.5× |
| Radex foot complete minimum 3 views (73630) range across 2 matching MRF lines |
$131.20–$289.60 | $164–$362 | varies |
| Radex Hand Minimum 3 Views (73130) range across 2 matching MRF lines |
$140.80–$300 | $176–$375 | varies |
| Radex lower extremity infant minimum 2 views (73592) | $215.20 | $269 | 2.4× |
| Radex Nasal Bones Complete Minimum 3 Views (70160) | $252 | $315 | 2.8× |
| Radex Ribs Unilateral 2 Views (71100) | $322.40 | $403 | 3.6× |
| Radex shoulder complete minimum 2 views (73030) range across 2 matching MRF lines |
$132–$342.40 | $165–$428 | varies |
| Radex Sinuses Paransl < 3 Views (70210) | $299.20 | $374 | 3.4× |
| Radex Spine 1 View Specify Level (72020) | $391.20 | $489 | 4.4× |
| Radex Sternum Minimum 2 Views (71120) | $236.80 | $296 | 2.7× |
| Radex Temporomandble Jt Opn & Clsd Mouth Bilat (70330) | $227.20 | $284 | 2.6× |
| Radex Toe Minimum 2 Views (73660) | $248.80 | $311 | 2.8× |
| Radex upper extremity infant minimum 2 views (73092) | $312.80 | $391 | 2.9× |
| Radex Wrist Complete Minimum 3 Views (73110) range across 2 matching MRF lines |
$159.20–$298.40 | $199–$373 | varies |
| Radiation Delivery Stereotactic Cranial Linear (77372) | $26,212 | $32,765 | 3.5× |
| Radiation treatment delivery level 1 (77402) | $550.40 | $688 | 5.3× |
| Radiation treatment delivery level 2 (77407) | $591.20 | $739 | 1.5× |
| Radiation treatment delivery level 3 (77412) | $1,239.20 | $1,549 | 2.2× |
| Radiolog exam mandible compl minimum 4 views (70110) | $362.40 | $453 | 3.4× |
| Radiologic Exam Abdomen 3+ Views - Xr Abdomen 3+ Views (74021) | $485.60 | $607 | 4.5× |
| Radiologic exam colon double contrast study (74280) | $1,420.80 | $1,776 | 7.9× |
| Radiologic exam colon single contrast study (74270) | $1,100 | $1,375 | 6.1× |
| Radiologic exam knee complete 4/more views (73564) range across 2 matching MRF lines |
$176–$328 | $220–$410 | varies |
| Radiologic exam pelvis compl minimum 3 views (72190) | $331.20 | $414 | 3.1× |
| Radiologic Exam Small Int Single Contrast Study (74250) | $829.60 | $1,037 | 4.6× |
| Radiologic exam swallow function contrast study (74230) | $783.20 | $979 | 4.4× |
| Radiologic exam upr gi trc double contrast study (74246) | $1,266.40 | $1,583 | 7.1× |
| Radiologic examination femur 1 view (73551) | $175.20 | $219 | 2.0× |
| Radiologic examination femur minimum 2 views (73552) range across 2 matching MRF lines |
$133.60–$252 | $167–$315 | varies |
| Radiologic examination knee 1/2 views (73560) range across 2 matching MRF lines |
$132–$270.40 | $165–$338 | varies |
| Radiologic Examination Osseous Survey Limited (77074) | $563.20 | $704 | 5.3× |
| Radiologic examination tibia & fibula 2 views (73590) range across 2 matching MRF lines |
$120.80–$335.20 | $151–$419 | varies |
| Remote afterloading high dose rate radionuclide skin surface brachytherapy, includes basic dosimetry, when performed;… (77768) | $634.40 | $793 | 1.6× |
| Remote afterloading high dose rate radionuclide skin surface brachytherapy, includes basic dosimetry, when performed;… (77767) | $634.40 | $793 | 1.6× |
| Ribs bilateral 3 views (71110) | $532.80 | $666 | 5.0× |
| Rp loclzj tum plnr 1 area single day imaging (78800) | $1,088.80 | $1,361 | 2.7× |
| Rp loclzj tum plnr 2+area 1+d img/1 area img>2+d (78801) | $1,129.60 | $1,412 | 2.8× |
| Rp Loclzj Tum Plnr Whole Body 2+ Days Imaging (78804) | $5,026.40 | $6,283 | 9.1× |
| Rp Loclzj Tum Spect 1 Area Single Day Imaging (78803) | $2,576 | $3,220 | 4.6× |
| Rp loclzj tum spect 2 area/sep acquisj img (78831) | $3,869.60 | $4,837 | 2.9× |
| Rp loclzj tum spect w/CT 1 area/acquisj 1day img (78830) | $3,344.80 | $4,181 | 2.5× |
| Rp Therapy Intravenous Administration (79101) | $1,466.40 | $1,833 | 6.2× |
| Scapula (73010) | $333.60 | $417 | 3.1× |
| Screening Digital Breast Tomosynthesis Bi (77063) | $70.40 | $88 | 3.0× |
| Shoulder 1 view (73020) | $313.60 | $392 | 3.5× |
| Shoulder Arthrography (73040) | $1,312 | $1,640 | 3.7× |
| Sialogram (70390) | $736 | $920 | 3.0× |
| Skull less than 4 views (70250) | $473.60 | $592 | 4.4× |
| Special dosimetry (77331) | $640.80 | $801 | 4.7× |
| Special Physics Consult (77370) | $1,305.60 | $1,632 | 9.5× |
| Special teletherapy port plan (77321) | $2,319.20 | $2,899 | 6.1× |
| Special treatment procedure (77470) | $3,961.60 | $4,952 | 7.0× |
| Stereotactic Body Radiation Delivery (77373) | $8,728 | $10,910 | 4.8× |
| Sternoclavicular joints (71130) | $317.60 | $397 | 3.6× |
| Superior sagittal sinus venogram (75870) | $7,733.60 | $9,667 | 2.4× |
| Tbs techl prep&transmis data alys pfrmd elsewhr (77090) | $9.60 | $12 | 0.1× |
| Tbs technical calculation only (77091) | $218.40 | $273 | 2.5× |
| Telethx isodose pln cplx w/basic dosimetry (77307) | $3,567.20 | $4,459 | 9.3× |
| Telethx isodose pln smpl w/dosimetry calculation (77306) | $1,748.80 | $2,186 | 4.6× |
| Ther Rad Simulaj-Aided Field Setting Complex (77290) | $2,332.80 | $2,916 | 6.1× |
| Ther Rad Simulaj-Aided Field Setting Intermed (77285) | $1,060.80 | $1,326 | 2.8× |
| Ther rad simulaj-aided field setting simple (77280) | $1,258.40 | $1,573 | 9.2× |
| Thoracic spine 2 views (72070) | $351.20 | $439 | 3.3× |
| Thoracic spine 3 views (72072) | $471.20 | $589 | 4.4× |
| Thoracolumbar 2 views (72080) | $448.80 | $561 | 5.0× |
| Thyroid Imaging With Vascular Flow (78013) | $1,215.20 | $1,519 | 3.0× |
| Thyroid Met Imaging Body (78018) | $2,563.20 | $3,204 | 4.6× |
| Thyroid Uptake Measurement (78012) | $1,012 | $1,265 | 2.5× |
| Thyroid Uptake W/Blood Flow Sngle/Mult Quan Meas (78014) | $1,757.60 | $2,197 | 4.3× |
| Tx Devices Design & Construction Complex (77334) | $1,788 | $2,235 | 4.7× |
| Tx devices design & construction intermediate (77333) | $626.40 | $783 | 4.6× |
| Tx devices design & construction simple (77332) | $567.20 | $709 | 4.1× |
| Ultrasound Breast Limited (76642) | $562.40 | $703 | 6.3× |
| Ultrasound Elastography Parenchyma (76981) | $273.60 | $342 | 2.6× |
| Ultrasound Exam Aaa Screen (76706) | $580.80 | $726 | 5.4× |
| Ultrasound, abdomen limited (76705) | $880.80 | $1,101 | 8.2× |
| Umbilical-artery Doppler (OB) (76820) | $405.60 | $507 | 3.8× |
| Unlisted fluoroscopic procedure (76496) | $267.20 | $334 | 3.0× |
| Unlisted magnetic resonance procedure (76498) | $323.20 | $404 | 3.6× |
| Unlisted us procedure (76999) | $475.20 | $594 | 5.3× |
| Upper gi w/o kub (74240) | $983.20 | $1,229 | 5.5× |
| Urethrocystogram voiding (74455) | $1,230.40 | $1,538 | 5.0× |
| Urethrocystography retrograde (74450) | $906.40 | $1,133 | 3.7× |
| Us breast unilateral complete (76641) | $563.20 | $704 | 5.3× |
| Us chest (76604) | $736.80 | $921 | 6.9× |
| Us complete joint (76881) | $580.80 | $726 | 5.4× |
| Us exam, pelvic, limited (76857) | $405.60 | $507 | 3.8× |
| Us head (76506) | $399.20 | $499 | 3.7× |
| Us kidney transplant (76776) | $1,075.20 | $1,344 | 10.1× |
| Us lmtd joint/oth nonvasc xtr strux r-t w/img (76882) | $630.40 | $788 | 5.9× |
| Us ob detailed single fetus (76811) | $583.20 | $729 | 2.4× |
| Us ob limited 1 or more fetuses (76815) | $408.80 | $511 | 3.8× |
| Us ob transvaginal (76817) | $512 | $640 | 4.8× |
| Us pelvic non ob complete (76856) | $1,029.60 | $1,287 | 9.6× |
| Us pg uter img f&mat 14 wk tabdl 1/1st gestation (76801) | $496 | $620 | 4.6× |
| Us preg uterus real time f/u trnsabdl per fetus (76816) | $350.40 | $438 | 3.3× |
| Us retroperitoneal complete (76770) | $880.80 | $1,101 | 8.2× |
| Us retroperitoneal limited (76775) range across 2 matching MRF lines |
$216.80–$761.60 | $271–$952 | varies |
| Us scrotum and contents (76870) | $984.80 | $1,231 | 9.2× |
| Us spinal canal and contents (76800) | $399.20 | $499 | 3.7× |
| Us thyroid (76536) | $821.60 | $1,027 | 7.7× |
| Us transrectal (76872) | $430.40 | $538 | 4.0× |
| Vein X-Ray Chest (75827) | $2,697.60 | $3,372 | 1.7× |
| Venogram Sinus/Jugular (75860) | $6,792 | $8,490 | 2.1× |
| Venography Adrenal Unilateral (75840) | $8,116.80 | $10,146 | 2.5× |
| Venography caval inferior serialography rs&i (75825) | $6,197.60 | $7,747 | 1.9× |
| Venography extremity bilateral rs&i (75822) | $1,881.60 | $2,352 | 1.2× |
| Venography extremity unilateral rs&i (75820) | $1,671.20 | $2,089 | 1.0× |
| Venography Renal Bilateral (75833) | $6,988 | $8,735 | 2.2× |
| Venography Renal Unilateral (75831) | $6,792 | $8,490 | 2.1× |
| Venous sampling by catheter (75893) | $12,883.20 | $16,104 | 2.3× |
| Vertebral fracture assessment via dxa (77086) | $100.80 | $126 | 1.1× |
| Wrist 2 views (73100) | $239.20 | $299 | 2.7× |
| X-Ray Ac Jts - Xr Acromioclavicular Joints Bilateral (73050) | $441.60 | $552 | 5.0× |
| X-ray antegrade pyelogram tube (74425) | $886.40 | $1,108 | 2.5× |
| X-Ray Aorta Leg Arteries (75630) | $6,129.60 | $7,662 | 1.9× |
| X-Ray Bend Only L-S Spine (72120) | $420 | $525 | 3.9× |
| X-Ray Elbow 2 Vw - Xr Elbow 1-2 Views Right (73070) range across 2 matching MRF lines |
$110.40–$270.40 | $138–$338 | varies |
| X-Ray Exam Breast Specimen (76098) | $1,211.20 | $1,514 | 2.2× |
| X-Ray Exam Entire Spi 1 Vw (72081) | $320.80 | $401 | 3.6× |
| X-Ray Exam Entire Spi 2/3 Vw (72082) | $474.40 | $593 | 4.4× |
| X-Ray Exam Entire Spi 4/5 Vw (72083) | $552.80 | $691 | 5.2× |
| X-Ray Exam Hip Uni 1 View (73501) | $238.40 | $298 | 2.7× |
| X-Ray Exam Hip Uni 2-3 Views (73502) range across 2 matching MRF lines |
$181.60–$256 | $227–$320 | varies |
| X-Ray Exam Hip Uni 4/> Views (73503) | $297.60 | $372 | 2.8× |
| X-Ray Exam Hips Bi 2 Views (73521) | $402.40 | $503 | 3.8× |
| X-Ray Exam Hips Bi 3-4 Views (73522) | $460 | $575 | 4.3× |
| X-Ray Exam Hips Bi 5/> Views (73523) | $500.80 | $626 | 4.7× |
| X-Ray Exam L-S Spine Bending (72114) | $188.80 | $236 | 1.8× |
| X-Ray Exam Neck Spine 2-3 Vw (72040) | $354.40 | $443 | 4.0× |
| X-Ray Exam Neck Spine 6/>Vws (72052) | $664 | $830 | 6.2× |
| X-Ray Exam Unilat Ribs/Chest (71101) | $428 | $535 | 4.0× |
| X-ray eye for foreign body (70030) | $214.40 | $268 | 2.4× |
| X-ray humerus (73060) range across 2 matching MRF lines |
$120.80–$293.60 | $151–$367 | varies |
| X-ray IV pyelogram (ivp) (74400) | $877.60 | $1,097 | 4.9× |
| X-Ray Jaw <4 Vw - Xr Mandible < 4 Views (70100) | $287.20 | $359 | 3.2× |
| X-Ray Knee Bilat Standing - Xr Knees Anteroposterior Standing Bilat (73565) range across 2 matching MRF lines |
$153.60–$224 | $192–$280 | varies |
| X-Ray Lumbar Spine 2/3 Vw - Xr Lumbar Spine 2-3 Views (72100) | $388.80 | $486 | 3.6× |
| X-ray nose-rectum child f.b. (76010) | $316 | $395 | 3.6× |
| X-Ray Ribs, Chest 4+ Vw - Xr Ribs 3 Vws Bil W/ Chest Posteroanterior (71111) | $625.60 | $782 | 5.9× |
| X-Ray Sacroiliac Jts 3+ Vw - Xr Sacroiliac Joints 3+ Views (72202) | $396 | $495 | 3.7× |
| X-Ray Sacroiliac Jts <3 Vw - Xr Sacroiliac Joints 1-2 Views (72200) | $359.20 | $449 | 3.4× |
| X-Ray Sacrum/Coccyx 2+ Vw - Xr Sacrum Coccyx 2+ Views (72220) | $276 | $345 | 3.1× |
| X-Ray Sinuses 3+ Vw - Xr Paranasal Sinuses 3+ Views (70220) | $345.60 | $432 | 3.9× |
| X-Ray Skull 4+ Vw - Xr Skull Complete 4+ Views (70260) | $458.40 | $573 | 4.3× |
| X-ray thoracic spine 4 vw (72074) | $602.40 | $753 | 5.6× |
| X-Ray Tmj Unilat (70328) | $195.20 | $244 | 2.2× |
| X-Ray Urinary Tract Exam With Contrast Material (74420) | $1,084.80 | $1,356 | 3.0× |
| X-Rays Bone Length Studies (77073) | $395.20 | $494 | 3.7× |
| X-Rays Bone Survey Complete (77075) | $1,306.40 | $1,633 | 12.2× |
| Xr c-spine 4 or 5 views (72050) | $532.80 | $666 | 5.0× |
| Xr facial bones less than 3 views (70140) | $316 | $395 | 3.6× |
| XR Mastoids < 3 Views Bilateral (70120) | $184.80 | $231 | 1.7× |
| Xr orbits complete 4 views (70200) | $796 | $995 | 7.5× |
| Xr Tomogram Single Plane (76100) | $406.40 | $508 | 3.8× |
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.