Imaging prices at Mountain View Hospital
Idaho Falls, ID · every code in this section with a posted price and a Medicare benchmark.
323 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) | $3,000 | $3,000 | 2.2× |
| Abdomen 1 View (74018) range across 2 matching MRF lines |
$160–$240 | $160–$240 | varies |
| Abdomen 2 views (74019) range across 3 matching MRF lines |
$112–$142 | $112–$142 | varies |
| Acute Gastrointestinal Blood Loss Imaging (78278) | $835 | $835 | 2.1× |
| Angio internal mammary (75756) | $2,500 | $2,500 | 0.8× |
| Angio pulmonary bilat (75743) | $3,500 | $3,500 | 1.1× |
| Angiography extremity bilateral rs&i (75716) | $4,000 | $4,000 | 1.3× |
| Angiography extremity unilateral rs&i (75710) | $4,000 | $4,000 | 1.3× |
| Angiography pulmonary unilateral slctv rs&i (75741) | $3,500 | $3,500 | 1.1× |
| Angrph pulmonary nonslctv cath/ven njx rs&i (75746) | $3,500 | $3,500 | 1.1× |
| Ankle 2 views (73600) range across 4 matching MRF lines |
$135–$165 | $135–$165 | varies |
| Aortography thoracic serialography rs&i (75605) | $4,900 | $4,900 | 0.9× |
| Artery X-Rays Abdomen (75726) range across 2 matching MRF lines |
$4,500–$5,000 | $4,500–$5,000 | varies |
| Artery X-Rays Pelvis (75736) | $5,280 | $5,280 | 1.0× |
| Arthrogram hip (73525) range across 2 matching MRF lines |
$500–$580 | $500–$580 | varies |
| Basic radiation dosimetry calculation (77300) range across 3 matching MRF lines |
$510–$1,020 | $510–$1,020 | varies |
| Bone age studies (77072) | $350 | $350 | 3.4× |
| Bone Imaging 3 Phase (78315) | $915 | $915 | 2.3× |
| Bone Imaging Limited Area (78300) | $730 | $730 | 1.8× |
| Bone Imaging Whole Body (78306) | $915 | $915 | 2.3× |
| Bone survey infant (77076) | $228 | $228 | 2.2× |
| Brain Imaging Pet Metabolic Evaluation (78608) | $3,126 | $3,126 | 2.2× |
| Cat Scan Follow-Up Study (76380) range across 4 matching MRF lines |
$494–$630 | $494–$630 | varies |
| Cerebrospinal Fluid Flow W/O Matl Shunt Evaltj (78645) | $748 | $748 | 1.4× |
| Cerebrospinal Fluid Scan (78630) | $1,500 | $1,500 | 2.8× |
| Chest 1 view (71045) range across 2 matching MRF lines |
$90–$135 | $90–$135 | varies |
| Chest 2 views (71046) range across 4 matching MRF lines |
$95–$720 | $95–$720 | varies |
| Clavicle complete (73000) range across 4 matching MRF lines |
$102–$142 | $102–$142 | varies |
| Computed Tomography Thorax Lw Dose Lng Ca Scr C- (71271) | $582 | $582 | 5.6× |
| Continuing medical physics consltj pr wk (77336) | $698 | $698 | 5.3× |
| Contrast Exam Abdominl Aorta (75625) range across 2 matching MRF lines |
$4,900–$5,200 | $4,900–$5,200 | varies |
| Contrast X-Ray Bladder (74430) | $362 | $362 | 1.1× |
| Corpora cavernosography (74445) | $800 | $800 | 7.7× |
| CT abdomen and pelvis without and with contrast (74178) | $1,585 | $1,585 | 4.6× |
| CT abdomen and pelvis without contrast (74176) | $1,252 | $1,252 | 5.3× |
| CT abdomen w contrast (74160) | $899 | $899 | 5.2× |
| CT abdomen w wo contrast (74170) | $1,003 | $1,003 | 5.8× |
| CT abdomen w/o contrast (74150) | $582 | $582 | 5.6× |
| CT Angio Abdomen and Pelvis (74174) | $1,585 | $1,585 | 4.6× |
| CT Angio Chest (71275) | $1,016 | $1,016 | 5.9× |
| CT Angio Head (70496) range across 2 matching MRF lines |
$1,016–$1,069 | $1,016–$1,069 | varies |
| CT angio hrt w/3d image (75574) | $1,016 | $1,016 | 2.9× |
| Ct Angio Lwr Extr W/O&W/Dye (73706) | $1,016 | $1,016 | 5.9× |
| CT Angio Neck (70498) range across 2 matching MRF lines |
$1,016–$1,069 | $1,016–$1,069 | varies |
| Ct Angio Upr Extrm W/O&W/Dye (73206) | $1,003 | $1,003 | 5.8× |
| CT Cere Prfuj Alys C+ W/O CT/Cta Same Anatomy (70473) | $950 | $950 | 5.5× |
| CT cervical spine w/ contrast (72126) | $1,133 | $1,133 | 3.3× |
| CT cervical spine w/o contrast (72125) | $737 | $737 | 7.1× |
| CT cervical spine w/wo cont (72127) | $1,003 | $1,003 | 5.8× |
| CT chest w contrast (71260) | $899 | $899 | 5.2× |
| CT chest w/wo contrast (71270) | $1,003 | $1,003 | 5.8× |
| CT head/brain with contrast (70460) | $899 | $899 | 5.2× |
| CT head/brain without and with contrast (70470) | $1,003 | $1,003 | 5.8× |
| CT heart contrast eval cardiac structure&morph (75572) | $1,016 | $1,016 | 2.9× |
| CT heart no contrast quant eval coronry calcium (75571) | $80 | $80 | 0.9× |
| CT hrt w/3d image congen (75573) | $1,016 | $1,016 | 2.9× |
| CT iac w contrast (70481) | $899 | $899 | 5.2× |
| CT l-spine w&w/o contrast (72133) | $1,003 | $1,003 | 5.8× |
| CT lower ext w/o (73700) range across 3 matching MRF lines |
$619–$737 | $619–$737 | varies |
| CT lower extremity w/contrast material (73701) | $899 | $899 | 5.2× |
| CT lumbar spine w contrast (72132) range across 2 matching MRF lines |
$899–$970 | $899–$970 | varies |
| CT lumbar spine w/o contrast (72131) | $737 | $737 | 7.1× |
| CT maxillofacial w contrast (70487) | $899 | $899 | 5.2× |
| CT maxillofacial wo contrast (70486) range across 2 matching MRF lines |
$604–$737 | $604–$737 | varies |
| CT neck tissue combo (70492) range across 2 matching MRF lines |
$992–$1,162.90 | $992–$1,162.90 | varies |
| Ct Orbit/Ear/Fossa W/O&W/Dye (70482) | $1,003 | $1,003 | 5.8× |
| CT orbits w/o contrast (70480) range across 2 matching MRF lines |
$570–$735 | $570–$735 | varies |
| CT pelvis w&w/o contrast (72194) | $1,003 | $1,003 | 5.8× |
| CT pelvis w/o contrast (72192) | $582 | $582 | 5.6× |
| CT scans face/jaw combo (70488) | $1,003 | $1,003 | 5.8× |
| CT soft tissue neck w contrast (70491) | $899 | $899 | 5.2× |
| CT soft tissue neck w/o contrast (70490) | $720 | $720 | 7.0× |
| CT thoracic spine w contrast (72129) | $899 | $899 | 5.2× |
| CT thoracic spine w/o contrast (72128) | $720 | $720 | 7.0× |
| CT thoracic spine w/wo cont (72130) | $1,003 | $1,003 | 5.8× |
| CT thorax w/o contrast (71250) | $737 | $737 | 7.1× |
| CT upper ext wo (73200) | $737 | $737 | 7.1× |
| CT upper extremity with contrast (73201) | $899 | $899 | 2.6× |
| Cta Abdl Aorta&Bi Iliofem W/Contrast&Postp (75635) | $1,281 | $1,281 | 7.4× |
| Cta Abdomen (74175) range across 2 matching MRF lines |
$1,016–$1,069 | $1,016–$1,069 | varies |
| CTA head&neck c+ w/noncontrast img&post-pxessing (70471) | $1,750 | $1,750 | 5.1× |
| CTA pelvis (72191) | $1,016 | $1,016 | 5.9× |
| Discography Cerv/Thor Spine (72285) | $2,264 | $2,264 | 1.2× |
| Diskography lumbar (72295) | $2,264 | $2,264 | 1.2× |
| Doppler Echo Fetal Puls Spectral F/U/Repeat (76828) | $333 | $333 | 3.2× |
| Doppler Echo Fetal Spectral Display Complete (76827) | $333 | $333 | 3.2× |
| Doppler Fetal Mid Cerebral Artery (76821) | $204 | $204 | 2.0× |
| Dxa Bone Density Axial (77080) range across 2 matching MRF lines |
$222–$246 | $222–$246 | varies |
| Dxa bone density study 1/>sites appendiclr skel (77081) | $135 | $135 | 1.6× |
| Echo exam of fetal heart (76825) | $1,362 | $1,362 | 2.5× |
| Echo exam uterus (76831) | $426 | $426 | 1.8× |
| Echo Guide For Artery Repair (76936) | $440 | $440 | 2.1× |
| Echocardiography, fetal, cardiovascular system, real time with image documentation (2D), with or without M-mode… (76826) | $650 | $650 | 2.8× |
| Echograp Trans R Pros Study (76873) | $470 | $470 | 4.6× |
| Esophagram (74220) | $355 | $355 | 2.0× |
| Fetal Biophys Profile W/Nst (76818) | $247 | $247 | 2.4× |
| Fetal Biophysical Profile W/O Non-Stress Testing (76819) | $370 | $370 | 3.6× |
| Fetal MRI w/placntl matrnl plvc img sing/1st ges (74712) | $1,097 | $1,097 | 4.7× |
| Fluoroscopy up to 1 hr (76000) range across 6 matching MRF lines |
$288–$1,742.33 | $288–$1,742.33 | varies |
| Follow-Up Angiography (75898) | $3,000 | $3,000 | 1.0× |
| Foot 2 views (73620) range across 3 matching MRF lines |
$164–$165 | $164–$165 | varies |
| Forearm 2 views (73090) range across 3 matching MRF lines |
$95–$142 | $95–$142 | varies |
| Gastric emptying imaging study (78264) | $835 | $835 | 2.1× |
| Gastroesophageal Reflux Exam (78262) | $928 | $928 | 2.3× |
| Gated Heart Planar Single (78472) | $900 | $900 | 2.3× |
| Hand 2 views (73120) range across 3 matching MRF lines |
$95–$142 | $95–$142 | varies |
| Hepatc Vngrph Wdg/Fr Hemodyn Eval Rs&I (75889) range across 2 matching MRF lines |
$3,250–$3,769 | $3,250–$3,769 | varies |
| Hepatc Vngrph Wdg/Fr W/O Hemodyn Eval Rs&I (75891) range across 2 matching MRF lines |
$2,627–$3,000 | $2,627–$3,000 | varies |
| Hepatobil Syst Image W/Drug (78227) | $1,035 | $1,035 | 1.9× |
| Hepatobiliary System Imaging (78226) | $1,035 | $1,035 | 2.6× |
| Hysterosalpingogram (74740) | $350 | $350 | 1.5× |
| Infant hip ultrasound with hip movement (dynamic) (76885) | $290 | $290 | 3.4× |
| Interstitial radiation source applic complex (77778) | $7,000 | $7,000 | 10.2× |
| Joint Survey Single View (77077) | $154 | $154 | 1.5× |
| K Flow/Funct Image Multiple (78709) | $870 | $870 | 1.6× |
| K Flow/Funct Image W/Drug (78708) range across 2 matching MRF lines |
$555–$870 | $555–$870 | varies |
| Knee 3 Views (73562) range across 4 matching MRF lines |
$94–$142 | $94–$142 | varies |
| Liver & Spleen Imaging Static Only (78215) | $835 | $835 | 2.1× |
| Lung Perf&Ventilat Diferentl (78598) | $1,010 | $1,010 | 1.9× |
| Lung perfusion differential (78597) | $650 | $650 | 1.6× |
| Lung Ventilat&Perfus Imaging (78582) | $1,576.86 | $1,576.86 | 2.9× |
| Lung Ventilation Imaging (78579) | $620 | $620 | 1.6× |
| Lymph System Imaging (78195) | $880 | $880 | 1.6× |
| Magnetic Image Jaw Joint (70336) | $1,470 | $1,470 | 6.2× |
| Meckels Divert Exam (78290) | $835 | $835 | 2.1× |
| Mlc imrt design & construction per imrt plan (77338) range across 2 matching MRF lines |
$1,666–$1,749 | $1,666–$1,749 | varies |
| Mra Head W/O & W/Contrast Material (70546) range across 2 matching MRF lines |
$1,708–$1,823 | $1,708–$1,823 | varies |
| MRA head w/o contrast (70544) | $1,469 | $1,469 | 6.2× |
| MRA head with contrast (70545) | $1,398 | $1,398 | 4.1× |
| MRA neck w contrast (70548) | $1,398 | $1,398 | 4.1× |
| Mra Neck W/O &W/Contrast Material (70549) | $2,148 | $2,148 | 6.2× |
| MRA neck w/o contrast (70547) | $1,384 | $1,384 | 5.9× |
| MRI abdomen w/o contrast (74181) | $1,097 | $1,097 | 4.7× |
| MRI any jt lower extrem w/contrast material (73722) | $1,810 | $1,810 | 2.3× |
| MRI any jt lower extrem w/o & w/contrast matrl (73723) range across 2 matching MRF lines |
$1,708–$1,826 | $1,708–$1,826 | varies |
| MRI any jt upper extremity w/contrast matrl (73222) range across 3 matching MRF lines |
$1,765–$3,530 | $1,765–$3,530 | varies |
| MRI cervical spine w contrast (72142) | $1,398 | $1,398 | 4.1× |
| MRI cervical spine w/o cont (72141) | $1,097 | $1,097 | 4.7× |
| MRI chest w/o contrast (71550) | $1,385 | $1,385 | 5.9× |
| MRI chest wo w contrast (71552) range across 2 matching MRF lines |
$1,708–$1,831 | $1,708–$1,831 | varies |
| MRI lower extrem oth/thn jt w/contrast matrl (73719) | $1,398 | $1,398 | 4.1× |
| MRI lower extrem oth/thn jt w/o & w/contr matr (73720) | $2,912 | $2,912 | 8.4× |
| MRI lower extrem oth/thn jt w/o contr matrl (73718) range across 2 matching MRF lines |
$1,097–$1,153 | $1,097–$1,153 | varies |
| MRI lumbar spine w contrast (72149) | $1,398 | $1,398 | 4.1× |
| Mri Neck Spine W/O & W/Dye (72156) range across 2 matching MRF lines |
$1,708–$1,814 | $1,708–$1,814 | varies |
| MRI orbit face &/neck w/o contrast (70540) | $1,097 | $1,097 | 4.7× |
| Mri Orbt/Fac/Nck W/O &W/Dye (70543) | $1,708 | $1,708 | 5.0× |
| MRI pelvis w contrast (72196) | $1,398 | $1,398 | 4.1× |
| MRI pelvis w/o & w contrast (72197) range across 2 matching MRF lines |
$1,708–$1,829 | $1,708–$1,829 | varies |
| MRI pelvis w/o contrast (72195) range across 4 matching MRF lines |
$1,097–$1,270 | $1,097–$1,270 | varies |
| MRI thoracic spine w/o contrast (72146) | $1,097 | $1,097 | 4.7× |
| MRI upper extremity oth than jt w/contr matrl (73219) | $1,398 | $1,398 | 4.1× |
| MRI upper extremity oth than jt w/o contr matrl (73218) range across 2 matching MRF lines |
$1,097–$1,162 | $1,097–$1,162 | varies |
| Mri Uppr Extremity W/O&W/Dye (73220) | $1,708 | $1,708 | 5.0× |
| MRI, abdomen, combo (74183) | $1,708 | $1,708 | 5.0× |
| MRI, dorsal spine combo (72157) | $1,708 | $1,708 | 5.0× |
| MRI, dorsal spine contrast (72147) | $1,398 | $1,398 | 4.1× |
| MRI, joint upper extrem (73221) | $1,097 | $1,097 | 4.7× |
| MRI, joint upper extrem combo (73223) | $1,708 | $1,708 | 5.0× |
| MRI, lumbar spine combo (72158) | $1,708 | $1,708 | 5.0× |
| Myocardial Spect Multiple Studies (78452) | $2,000 | $2,000 | 1.6× |
| Neck soft tissue (70360) | $172 | $172 | 2.0× |
| Njx Rp Loclzj Non-Img Probe Study Intravenous (78808) range across 2 matching MRF lines |
$425–$450 | $425–$450 | varies |
| Nonvascular Shunt X-Ray (75809) range across 2 matching MRF lines |
$445–$459 | $445–$459 | varies |
| Ntsty modul radthx pln dose-vol histos (77301) | $5,775 | $5,775 | 4.2× |
| Nuclear Rx Oral Admin (79005) | $1,050 | $1,050 | 4.6× |
| Ob us nuchal meas 1 gest (76813) | $216 | $216 | 2.1× |
| Ophthalmic Ultrasonic Foreign Body Localization (76529) | $187 | $187 | 2.2× |
| Parathyroid imaging w/tomographic spect & CT (78072) | $955 | $955 | 1.8× |
| Parathyroid Planar Imaging (78070) | $635 | $635 | 1.6× |
| Parathyroid planar imaging w/wo subtraction (78071) | $955 | $955 | 2.4× |
| Pelvis 1 or 2 views (72170) range across 2 matching MRF lines |
$135–$170 | $135–$170 | varies |
| Pet Image W/Ct Lmtd (78814) | $3,126 | $3,126 | 2.2× |
| PET image w/CT, full body (78816) | $4,000 | $4,000 | 2.8× |
| PET imaging CT attenuation skull base mid-thigh (78815) | $3,675 | $3,675 | 2.6× |
| Prq Transhepatc Portograpy Hemodyn Eval Rs&I (75885) | $3,250 | $3,250 | 1.0× |
| Pulmonary Perfusion Imaging Particulate (78580) | $710 | $710 | 1.8× |
| Radex Abd Compl Aqt Abd W/S/E/D Views 1 View Ch (74022) range across 3 matching MRF lines |
$160–$228 | $160–$228 | varies |
| Radex abscess/fistula/sinus tract rs&i (76080) range across 2 matching MRF lines |
$488–$490 | $488–$490 | varies |
| Radex Ankle Complete Minimum 3 Views (73610) range across 3 matching MRF lines |
$135–$164 | $135–$164 | varies |
| Radex Calcaneus Minimum 2 Views (73650) range across 2 matching MRF lines |
$90–$164 | $90–$164 | varies |
| Radex elbow complete minimum 3 views (73080) range across 4 matching MRF lines |
$102–$142 | $102–$142 | varies |
| Radex Facial Bones Complete Minimum 3 Views (70150) | $170 | $170 | 1.6× |
| Radex fingr minimum 2 views (73140) range across 3 matching MRF lines |
$105–$142 | $105–$142 | varies |
| Radex foot complete minimum 3 views (73630) range across 3 matching MRF lines |
$100–$164 | $100–$164 | varies |
| Radex Hand Minimum 3 Views (73130) range across 5 matching MRF lines |
$37–$270 | $37–$270 | varies |
| Radex lower extremity infant minimum 2 views (73592) | $135 | $135 | 1.6× |
| Radex Nasal Bones Complete Minimum 3 Views (70160) range across 2 matching MRF lines |
$135–$172 | $135–$172 | varies |
| Radex Ribs Unilateral 2 Views (71100) range across 3 matching MRF lines |
$75–$172 | $75–$172 | varies |
| Radex shoulder complete minimum 2 views (73030) range across 4 matching MRF lines |
$100–$169 | $100–$169 | varies |
| Radex Sinuses Paransl < 3 Views (70210) | $135 | $135 | 1.6× |
| Radex Sternum Minimum 2 Views (71120) | $172 | $172 | 2.0× |
| Radex Temporomandble Jt Opn & Clsd Mouth Bilat (70330) | $205 | $205 | 2.4× |
| Radex Toe Minimum 2 Views (73660) range across 3 matching MRF lines |
$90–$142 | $90–$142 | varies |
| Radex upper extremity infant minimum 2 views (73092) | $142 | $142 | 1.4× |
| Radex Wrist Complete Minimum 3 Views (73110) range across 3 matching MRF lines |
$95–$142 | $95–$142 | varies |
| Radex X-Ray Exam Entire Spi 6/> Vw - Xr Entire Spine 6+ Vw (72084) | $228 | $228 | 2.2× |
| Radiation Delivery Stereotactic Cranial Linear (77372) | $26,007 | $26,007 | 3.6× |
| Radiation treatment delivery level 3 (77412) | $735 | $735 | 1.3× |
| Radiolog exam mandible compl minimum 4 views (70110) range across 3 matching MRF lines |
$125–$161 | $125–$161 | varies |
| Radiologic exam colon double contrast study (74280) | $456 | $456 | 2.6× |
| Radiologic exam colon single contrast study (74270) | $323 | $323 | 1.9× |
| Radiologic exam knee complete 4/more views (73564) range across 3 matching MRF lines |
$109–$223 | $109–$223 | varies |
| Radiologic exam pelvis compl minimum 3 views (72190) | $190 | $190 | 1.8× |
| Radiologic Exam Small Int Single Contrast Study (74250) | $260 | $260 | 1.5× |
| Radiologic exam swallow function contrast study (74230) range across 2 matching MRF lines |
$301–$330 | $301–$330 | varies |
| Radiologic exam upr gi trc double contrast study (74246) | $413 | $413 | 2.4× |
| Radiologic examination femur 1 view (73551) | $161 | $161 | 1.9× |
| Radiologic examination femur minimum 2 views (73552) range across 3 matching MRF lines |
$100–$142 | $100–$142 | varies |
| Radiologic examination knee 1/2 views (73560) range across 4 matching MRF lines |
$101–$172 | $101–$172 | varies |
| Radiologic Examination Osseous Survey Limited (77074) range across 2 matching MRF lines |
$228–$246 | $228–$246 | varies |
| Radiologic examination tibia & fibula 2 views (73590) range across 4 matching MRF lines |
$105–$270 | $105–$270 | varies |
| Ribs bilateral 3 views (71110) | $150 | $150 | 1.5× |
| Rp loclzj tum plnr 1 area single day imaging (78800) | $865 | $865 | 2.2× |
| Rp Loclzj Tum Plnr Whole Body 2+ Days Imaging (78804) | $1,610 | $1,610 | 3.0× |
| Rp Loclzj Tum Plnr Whole Body Single Day Imaging (78802) range across 2 matching MRF lines |
$1,000–$2,000 | $1,000–$2,000 | varies |
| Rp Loclzj Tum Spect 1 Area Single Day Imaging (78803) range across 4 matching MRF lines |
$1,000–$2,035 | $1,000–$2,035 | varies |
| Rp loclzj tum spect 2 area/sep acquisj img (78831) | $2,400 | $2,400 | 1.9× |
| Rp Therapy Intravenous Administration (79101) | $800 | $800 | 3.5× |
| Scapula (73010) range across 3 matching MRF lines |
$115–$142 | $115–$142 | varies |
| Screening Digital Breast Tomosynthesis Bi (77063) range across 2 matching MRF lines |
$10–$87 | $10–$87 | varies |
| Shoulder 1 view (73020) range across 3 matching MRF lines |
$81–$137 | $81–$137 | varies |
| Shoulder Arthrography (73040) | $580 | $580 | 1.7× |
| Sialogram (70390) | $338 | $338 | 1.4× |
| Skull less than 4 views (70250) range across 2 matching MRF lines |
$135–$142 | $135–$142 | varies |
| Special dosimetry (77331) | $484 | $484 | 3.6× |
| Special Physics Consult (77370) | $850 | $850 | 6.4× |
| Special teletherapy port plan (77321) | $1,098 | $1,098 | 3.0× |
| Special treatment procedure (77470) | $1,320 | $1,320 | 2.4× |
| Stereotactic Body Radiation Delivery (77373) | $7,500 | $7,500 | 4.2× |
| Sternoclavicular joints (71130) | $159 | $159 | 1.8× |
| Superior sagittal sinus venogram (75870) | $1,500 | $1,500 | 0.5× |
| Telethx isodose pln cplx w/basic dosimetry (77307) | $1,000 | $1,000 | 2.7× |
| Ther Rad Simulaj-Aided Field Setting Complex (77290) | $1,500 | $1,500 | 4.1× |
| Ther rad simulaj-aided field setting simple (77280) | $500 | $500 | 3.8× |
| Thoracic spine 2 views (72070) range across 2 matching MRF lines |
$120–$170 | $120–$170 | varies |
| Thoracic spine 3 views (72072) range across 3 matching MRF lines |
$116–$169 | $116–$169 | varies |
| Thoracolumbar 2 views (72080) range across 3 matching MRF lines |
$125–$135 | $125–$135 | varies |
| Thyroid Imaging With Vascular Flow (78013) | $425 | $425 | 1.1× |
| Thyroid Met Imaging Body (78018) range across 2 matching MRF lines |
$1,600–$1,800 | $1,600–$1,800 | varies |
| Thyroid Uptake Measurement (78012) | $425 | $425 | 1.1× |
| Thyroid Uptake W/Blood Flow Sngle/Mult Quan Meas (78014) | $635 | $635 | 1.6× |
| Tx Devices Design & Construction Complex (77334) range across 3 matching MRF lines |
$700–$2,940 | $700–$2,940 | varies |
| Tx devices design & construction intermediate (77333) | $500 | $500 | 3.8× |
| Tx devices design & construction simple (77332) range across 2 matching MRF lines |
$500–$529 | $500–$529 | varies |
| Ultrasound Breast Limited (76642) range across 5 matching MRF lines |
$296–$592 | $296–$592 | varies |
| Ultrasound Exam Aaa Screen (76706) | $365 | $365 | 3.5× |
| Ultrasound, abdomen limited (76705) | $333 | $333 | 3.2× |
| Umbilical-artery Doppler (OB) (76820) range across 2 matching MRF lines |
$87–$333 | $87–$333 | varies |
| Unlisted Dx Radiographic Procedure (76499) | $63 | $63 | 0.7× |
| Unlisted fluoroscopic procedure (76496) | $375 | $375 | 4.4× |
| Unlisted us procedure (76999) | $407 | $407 | 4.7× |
| Upper gi w/o kub (74240) range across 2 matching MRF lines |
$323–$343 | $323–$343 | varies |
| Urea Breath Test C-14 Isotopic Acquisj Analysis (78267) | $40 | $40 | 3.6× |
| Urethrocystogram voiding (74455) | $528 | $528 | 2.2× |
| Urethrocystography retrograde (74450) | $645 | $645 | 2.7× |
| Us breast unilateral complete (76641) range across 3 matching MRF lines |
$284–$285 | $284–$285 | varies |
| Us chest (76604) range across 2 matching MRF lines |
$247–$257 | $247–$257 | varies |
| Us complete joint (76881) | $340 | $340 | 3.3× |
| Us exam, pelvic, limited (76857) | $290 | $290 | 2.8× |
| Us head (76506) | $242 | $242 | 2.3× |
| Us lmtd joint/oth nonvasc xtr strux r-t w/img (76882) | $183 | $183 | 1.8× |
| Us ob detailed single fetus (76811) | $393 | $393 | 1.7× |
| Us ob limited 1 or more fetuses (76815) range across 5 matching MRF lines |
$245–$525 | $245–$525 | varies |
| Us ob transvaginal (76817) range across 3 matching MRF lines |
$247–$250 | $247–$250 | varies |
| Us pelvic non ob complete (76856) | $368 | $368 | 3.6× |
| Us pg uter img f&mat 14 wk tabdl 1/1st gestation (76801) range across 2 matching MRF lines |
$275–$276 | $275–$276 | varies |
| Us preg uterus real time f/u trnsabdl per fetus (76816) range across 3 matching MRF lines |
$259–$360 | $259–$360 | varies |
| Us retroperitoneal complete (76770) range across 2 matching MRF lines |
$347–$370 | $347–$370 | varies |
| Us retroperitoneal limited (76775) range across 2 matching MRF lines |
$252–$273 | $252–$273 | varies |
| Us scrotum and contents (76870) | $384 | $384 | 3.7× |
| Us spinal canal and contents (76800) | $239 | $239 | 2.3× |
| Us thyroid (76536) range across 3 matching MRF lines |
$35–$402 | $35–$402 | varies |
| Us transrectal (76872) | $330 | $330 | 3.2× |
| Vein X-Ray Chest (75827) | $2,000 | $2,000 | 1.3× |
| Vein X-Ray Liver W/O Hemodyn (75887) | $3,250 | $3,250 | 1.0× |
| Vein X-Ray Skull Epidural (75872) | $1,500 | $1,500 | 2.4× |
| Venogram Sinus/Jugular (75860) | $1,500 | $1,500 | 0.5× |
| Venography Adrenal Unilateral (75840) | $3,000 | $3,000 | 1.0× |
| Venography caval inferior serialography rs&i (75825) | $3,000 | $3,000 | 1.0× |
| Venography extremity bilateral rs&i (75822) | $1,500 | $1,500 | 1.0× |
| Venography extremity unilateral rs&i (75820) | $1,500 | $1,500 | 1.0× |
| Venography Orbital Rs&I (75880) | $1,500 | $1,500 | 2.4× |
| Venography Renal Bilateral (75833) | $4,500 | $4,500 | 1.4× |
| Venography Renal Unilateral (75831) range across 2 matching MRF lines |
$2,000–$3,000 | $2,000–$3,000 | varies |
| Venous sampling by catheter (75893) | $8,100 | $8,100 | 1.5× |
| Wrist 2 views (73100) range across 3 matching MRF lines |
$70–$142 | $70–$142 | varies |
| X-Ray Ac Jts - Xr Acromioclavicular Joints Bilateral (73050) range across 2 matching MRF lines |
$106–$172 | $106–$172 | varies |
| X-ray antegrade pyelogram tube (74425) | $680 | $680 | 2.0× |
| X-Ray Aorta Leg Arteries (75630) | $4,000 | $4,000 | 1.3× |
| X-Ray Elbow 2 Vw - Xr Elbow 1-2 Views Right (73070) range across 5 matching MRF lines |
$135–$172 | $135–$172 | varies |
| X-Ray Exam Breast Specimen (76098) range across 3 matching MRF lines |
$845–$971 | $845–$971 | varies |
| X-Ray Exam Entire Spi 1 Vw (72081) | $228 | $228 | 2.7× |
| X-Ray Exam Entire Spi 2/3 Vw (72082) | $228 | $228 | 2.2× |
| X-Ray Exam Entire Spi 4/5 Vw (72083) | $228 | $228 | 2.2× |
| X-Ray Exam Hip Uni 1 View (73501) | $172 | $172 | 2.0× |
| X-Ray Exam Hip Uni 2-3 Views (73502) range across 4 matching MRF lines |
$87–$142 | $87–$142 | varies |
| X-Ray Exam Hip Uni 4/> Views (73503) range across 2 matching MRF lines |
$137–$197 | $137–$197 | varies |
| X-Ray Exam Hips Bi 2 Views (73521) range across 3 matching MRF lines |
$95–$142 | $95–$142 | varies |
| X-Ray Exam Hips Bi 3-4 Views (73522) range across 2 matching MRF lines |
$110–$222 | $110–$222 | varies |
| X-Ray Exam L-S Spine Bending (72114) range across 2 matching MRF lines |
$238–$251 | $238–$251 | varies |
| X-Ray Exam Neck Spine 2-3 Vw (72040) range across 3 matching MRF lines |
$110–$173 | $110–$173 | varies |
| X-Ray Exam Neck Spine 6/>Vws (72052) range across 2 matching MRF lines |
$228–$247 | $228–$247 | varies |
| X-Ray Exam Unilat Ribs/Chest (71101) range across 3 matching MRF lines |
$125–$172 | $125–$172 | varies |
| X-ray eye for foreign body (70030) | $160 | $160 | 1.9× |
| X-ray humerus (73060) range across 4 matching MRF lines |
$95–$142 | $95–$142 | varies |
| X-ray IV pyelogram (ivp) (74400) | $1,699 | $1,699 | 9.8× |
| X-Ray Jaw <4 Vw - Xr Mandible < 4 Views (70100) | $161 | $161 | 1.9× |
| X-Ray Knee Bilat Standing - Xr Knees Anteroposterior Standing Bilat (73565) range across 3 matching MRF lines |
$99–$140 | $99–$140 | varies |
| X-Ray Lumbar Spine 2/3 Vw - Xr Lumbar Spine 2-3 Views (72100) | $143 | $143 | 1.4× |
| X-ray nose-rectum child f.b. (76010) | $175 | $175 | 2.0× |
| X-Ray Ribs, Chest 4+ Vw - Xr Ribs 3 Vws Bil W/ Chest Posteroanterior (71111) range across 2 matching MRF lines |
$155–$228 | $155–$228 | varies |
| X-Ray Sacroiliac Jts 3+ Vw - Xr Sacroiliac Joints 3+ Views (72202) | $168 | $168 | 1.6× |
| X-Ray Sacroiliac Jts <3 Vw - Xr Sacroiliac Joints 1-2 Views (72200) | $168 | $168 | 1.6× |
| X-Ray Sacrum/Coccyx 2+ Vw - Xr Sacrum Coccyx 2+ Views (72220) range across 2 matching MRF lines |
$105–$142 | $105–$142 | varies |
| X-Ray Sinuses 3+ Vw - Xr Paranasal Sinuses 3+ Views (70220) | $135 | $135 | 1.6× |
| X-Ray Skull 4+ Vw - Xr Skull Complete 4+ Views (70260) | $238 | $238 | 2.3× |
| X-Ray Urinary Tract Exam With Contrast Material (74420) range across 2 matching MRF lines |
$680–$700 | $680–$700 | varies |
| X-Rays Bone Length Studies (77073) range across 3 matching MRF lines |
$135–$161 | $135–$161 | varies |
| X-Rays Bone Survey Complete (77075) | $298 | $298 | 2.9× |
| Xr c-spine 4 or 5 views (72050) | $290 | $290 | 2.8× |
| Xr facial bones less than 3 views (70140) range across 2 matching MRF lines |
$135–$142 | $135–$142 | varies |
| Xr orbits complete 4 views (70200) | $135 | $135 | 1.3× |
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.