Imaging prices at MyMichigan Medical Center West Branch

West Branch, MI · every code in this section with a posted price and a Medicare benchmark.

357 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) $2,628 $4,380 1.9×
Abdomen 1 View (74018) $93.60 $156 1.1×
Abdomen 2 views (74019) $93.60 $156 0.9×
Acute Gastrointestinal Blood Loss Imaging (78278) $427.80 $713 1.1×
Acute venous thrombosis imaging, peptide Non-Facility (78456) $1,606.80 $2,678 1.2×
Angio pulmonary bilat (75743) $704.40 $1,174 0.2×
Angiography extremity bilateral rs&i (75716) $679.80 $1,133 0.2×
Angiography extremity unilateral rs&i (75710) $679.80 $1,133 0.2×
Angiography pulmonary unilateral slctv rs&i (75741) $679.80 $1,133 0.2×
Angrph pulmonary nonslctv cath/ven njx rs&i (75746) $679.80 $1,133 0.2×
Ankle 2 views (73600) $93.60 $156 1.1×
Aortography thoracic serialography rs&i (75605)
likely a partial charge, not the full procedure		 $679.80 $1,133 0.1×
Artery X-Rays Abdomen (75726)
likely a partial charge, not the full procedure		 $679.80 $1,133 0.1×
Artery X-Rays Adrenal Gland (75731) $1,284.60 $2,141 0.4×
Artery X-Rays Pelvis (75736)
likely a partial charge, not the full procedure		 $679.80 $1,133 0.1×
Artery X-Rays Spine (75705) $5,640 $9,400 1.0×
Arthrogram ankle (73615) $201.60 $336 0.6×
Arthrogram hip (73525) $201.60 $336 0.6×
Arthrogram Wrist (73115) $201.60 $336 0.6×
Basic radiation dosimetry calculation (77300) $232.20 $387 1.7×
Bone age studies (77072) $120.60 $201 1.2×
Bone Imaging 3 Phase (78315) $427.80 $713 1.1×
Bone Imaging Limited Area (78300) $252 $420 0.6×
Bone Imaging Whole Body (78306) $332.40 $554 0.8×
Bone marrow imaging limited area (78102) $352.80 $588 0.9×
Bone marrow imaging; multiple areas (78103) $546.60 $911 1.4×
Bone marrow imaging; whole body (78104) $514.20 $857 1.3×
Bone survey infant (77076) $120.60 $201 1.2×
Brachytx isodose complex (77318) $837.60 $1,396 2.2×
Brachytx isodose intermed (77317) $742.80 $1,238 2.0×
Brachytx Isodose Plan Simple (77316) $600 $1,000 1.6×
Brain Flow Imaging Only (78610) $658.80 $1,098 1.2×
Brain Imaging Min 4 Static Views W Vascular Flow (78606) $658.80 $1,098 1.2×
Brain Imaging Pet Metabolic Evaluation (78608) $3,069 $5,115 2.2×
Cardiac blood pool imaging, first pass technique; multiple studies, resting and with stress (exercise and/or… (78483) $658.80 $1,098 1.2×
Cat Scan Follow-Up Study (76380) $423 $705 4.9×
Cerebrospinal Fluid Scan (78630) $442.80 $738 0.8×
Chest 1 view (71045) $93.60 $156 1.1×
Chest 2 views (71046)
range across 3 matching MRF lines		 $90–$93.60 $150–$156 varies
Chest 3 views (71047) $105.60 $176 1.2×
Chest 4 or more views (71048) $177.60 $296 1.7×
Clavicle complete (73000) $93.60 $156 1.1×
Computed Tomography Thorax Lw Dose Lng Ca Scr C- (71271) $275.40 $459 2.6×
Continuing medical physics consltj pr wk (77336) $238.80 $398 1.8×
Contrast Exam Abdominl Aorta (75625) $679.80 $1,133 0.2×
Contrast X-Ray Bladder (74430) $352.20 $587 1.0×
Contrast X-Ray Of Elbow (73085) $201.60 $336 0.6×
Contrast X-Ray Of Knee Joint (73580) $201.60 $336 0.6×
CT abdomen and pelvis without and with contrast (74178) $1,408.80 $2,348 4.1×
CT abdomen and pelvis without contrast (74176) $845.40 $1,409 3.6×
CT abdomen w contrast (74160) $704.40 $1,174 4.0×
CT abdomen w wo contrast (74170) $965.40 $1,609 5.5×
CT abdomen w/o contrast (74150) $535.20 $892 5.1×
CT Angio Abdomen and Pelvis (74174) $1,057.20 $1,762 3.0×
CT Angio Chest (71275) $1,057.20 $1,762 6.0×
CT Angio Head (70496) $1,323.60 $2,206 7.6×
CT angio hrt w/3d image (75574) $789.60 $1,316 2.3×
Ct Angio Lwr Extr W/O&W/Dye (73706) $1,021.20 $1,702 5.8×
CT Angio Neck (70498) $1,331.40 $2,219 7.6×
Ct Angio Upr Extrm W/O&W/Dye (73206) $916.20 $1,527 5.2×
CT bone density (77078) $90 $150 1.0×
CT cervical spine w/ contrast (72126) $982.80 $1,638 2.8×
CT cervical spine w/o contrast (72125) $564 $940 5.4×
CT cervical spine w/wo cont (72127) $852.60 $1,421 4.9×
CT chest w contrast (71260) $676.80 $1,128 3.9×
CT chest w/wo contrast (71270) $852.60 $1,421 4.9×
CT head/brain with contrast (70460) $592.20 $987 3.4×
CT head/brain without and with contrast (70470) $669.60 $1,116 3.8×
CT heart contrast eval cardiac structure&morph (75572) $292.80 $488 0.8×
CT heart no contrast quant eval coronry calcium (75571)
range across 2 matching MRF lines		 $59.40–$352.80 $99–$588 varies
CT hrt w/3d image congen (75573) $289.80 $483 0.8×
CT iac w contrast (70481) $754.20 $1,257 4.3×
CT l-spine w&w/o contrast (72133) $852.60 $1,421 4.9×
CT lower ext w/o (73700) $514.20 $857 4.9×
CT lower extremity w/contrast material (73701) $634.20 $1,057 3.6×
CT lumbar spine w contrast (72132) $676.80 $1,128 1.9×
CT lumbar spine w/o contrast (72131) $564 $940 5.4×
CT maxillofacial w contrast (70487) $655.20 $1,092 3.7×
CT maxillofacial wo contrast (70486) $493.80 $823 4.7×
CT neck tissue combo (70492) $789.60 $1,316 4.5×
Ct Orbit/Ear/Fossa W/O&W/Dye (70482) $880.20 $1,467 5.0×
CT orbits w/o contrast (70480) $634.20 $1,057 6.1×
CT pelvis w&w/o contrast (72194) $838.20 $1,397 4.8×
CT pelvis w/o contrast (72192) $543.60 $906 5.2×
CT scan of leg combo (73702) $845.40 $1,409 4.8×
CT scans face/jaw combo (70488) $817.20 $1,362 4.7×
CT soft tissue neck w contrast (70491) $634.20 $1,057 3.6×
CT soft tissue neck w/o contrast (70490) $508.20 $847 4.9×
CT thoracic spine w contrast (72129) $676.80 $1,128 3.9×
CT thoracic spine w/o contrast (72128) $564 $940 5.4×
CT thoracic spine w/wo cont (72130) $845.40 $1,409 4.8×
CT thorax w/o contrast (71250) $549 $915 5.3×
CT upper ext wo (73200) $514.20 $857 4.9×
CT upper extremity w/o & w/contrast material (73202) $845.40 $1,409 4.8×
CT upper extremity with contrast (73201) $634.20 $1,057 1.8×
Cta Abdl Aorta&Bi Iliofem W/Contrast&Postp (75635) $1,162.80 $1,938 6.7×
Cta Abdomen (74175) $1,057.20 $1,762 6.0×
CTA pelvis (72191) $986.40 $1,644 5.6×
Discography Cerv/Thor Spine (72285) $2,797.20 $4,662 1.4×
Diskography lumbar (72295) $2,797.20 $4,662 1.4×
Dxa Bone Density Axial (77080) $198 $330 1.9×
Dxa bone density study (77085) $164.40 $274 1.6×
Dxa bone density study 1/>sites appendiclr skel (77081) $90 $150 1.0×
Echo exam uterus (76831) $334.20 $557 1.4×
Echo Guide For Artery Repair (76936) $366 $610 1.7×
Esophagram (74220) $183.60 $306 1.1×
Fetal Biophys Profile W/Nst (76818) $164.40 $274 1.6×
Fetal Biophysical Profile W/O Non-Stress Testing (76819) $164.40 $274 1.6×
Fluoroscopy up to 1 hr (76000) $90.60 $151 0.4×
Foot 2 views (73620) $93.60 $156 1.1×
Forearm 2 views (73090) $93.60 $156 1.1×
Gastric emptying imaging study (78264) $362.40 $604 0.9×
Gastric Emptyng Imag Std W/Sm Bwl Transit (78265) $514.20 $857 1.3×
Gated Heart Planar Single (78472) $453 $755 1.1×
Gstrc Emptng Imag Std W/Sm Bwl Col Trnst Mlt Day (78266) $658.80 $1,098 1.2×
Hand 2 views (73120) $93.60 $156 0.9×
Hdr Rdncl Ntrstl/Icav Brchtx (77772) $2,803.80 $4,673 4.0×
Hdr Rdncl Ntrstl/Icav Brchtx (77771) $2,583.60 $4,306 3.7×
Hdr Rdncl Ntrstl/Icav Brchtx 1 Channel (77770) $2,292 $3,820 3.3×
Heart first pass single,planar (78481) $658.80 $1,098 1.2×
Hepatobil Syst Image W/Drug (78227) $388.20 $647 0.7×
Hepatobiliary System Imaging (78226) $514.20 $857 1.3×
Ht Muscle Image Spect Sing (78451) $453 $755 0.4×
Hysterosalpingogram (74740) $367.20 $612 1.5×
Infant hip ultrasound with hip movement (dynamic) (76885) $274.80 $458 3.2×
Infant hip ultrasound, limited static exam (76886) $197.40 $329 2.3×
K Flow/Funct Image Multiple (78709)
range across 2 matching MRF lines		 $423–$658.80 $705–$1,098 varies
K Flow/Funct Image W/Drug (78708) $658.80 $1,098 1.2×
K Flow/Funct Image W/O Drug (78707) $307.20 $512 0.6×
Kidney Imaging Morphol (78700) $514.20 $857 1.3×
Kidney Imaging Morphoogy W/Vascular Flow (78701) $286.80 $478 0.7×
Knee 3 Views (73562) $93.60 $156 1.1×
Liver & Spleen Imaging Static Only (78215) $252 $420 0.6×
Liver imaging static only (78201) $1,606.80 $2,678 3.0×
Lung perfusion differential (78597) $514.20 $857 1.3×
Lung Ventilat&Perfus Imaging (78582) $271.80 $453 0.5×
Lung Ventilation Imaging (78579) $514.20 $857 1.3×
Lymph System Imaging (78195) $403.20 $672 0.7×
Magnetic Image Jaw Joint (70336) $1,812 $3,020 7.6×
Mammary ductogram or galactogram multiple (77054) $334.20 $557 1.4×
Mammary ductogram or galactogram single (77053) $334.20 $557 1.4×
Meckels Divert Exam (78290) $427.80 $713 1.1×
Mlc imrt design & construction per imrt plan (77338) $4,208.40 $7,014 11.3×
Mr safety determination physician/other qhp (76016) $137.40 $229 1.6×
Mr safety implant&/fb assmt clin staf 1st 15 min (76014) $37.20 $62 1.3×
Mr safety implt electronics prepj supvj phys/qhp (76018) $140.40 $234 1.5×
Mr safety implt pos&/immoblj (76019) $90.60 $151 1.5×
Mr safety med physics xm customization plng&mntr (76017) $371.40 $619 1.6×
Mra Head W/O & W/Contrast Material (70546) $1,711.20 $2,852 4.9×
MRA head w/o contrast (70544) $906 $1,510 3.8×
MRA head with contrast (70545) $1,233 $2,055 3.5×
MRA neck w contrast (70548) $1,233 $2,055 3.5×
Mra Neck W/O &W/Contrast Material (70549) $1,711.20 $2,852 4.9×
MRA neck w/o contrast (70547) $906 $1,510 3.8×
MRI abdomen w contrast (74182) $1,479.60 $2,466 4.3×
MRI abdomen w/o contrast (74181) $1,092 $1,820 4.6×
MRI any jt lower extrem w/contrast material (73722) $1,479.60 $2,466 1.9×
MRI any jt lower extrem w/o & w/contrast matrl (73723) $1,912.80 $3,188 5.5×
MRI any jt upper extremity w/contrast matrl (73222) $1,479.60 $2,466 1.9×
MRI cervical spine w contrast (72142) $1,310.40 $2,184 3.8×
MRI cervical spine w/o cont (72141) $1,092 $1,820 4.6×
MRI chest w/o contrast (71550) $1,233 $2,055 5.2×
MRI chest with contrast (71551) $1,479.60 $2,466 1.9×
MRI chest wo w contrast (71552) $1,886.40 $3,144 5.4×
MRI lower extrem oth/thn jt w/contrast matrl (73719) $1,479.60 $2,466 4.3×
MRI lower extrem oth/thn jt w/o & w/contr matr (73720) $1,912.80 $3,188 5.5×
MRI lower extrem oth/thn jt w/o contr matrl (73718) $1,267.80 $2,113 5.3×
MRI lumbar spine w contrast (72149) $1,338.60 $2,231 3.9×
Mri Neck Spine W/O & W/Dye (72156) $1,987.20 $3,312 5.7×
MRI orbit face &/neck w/o contrast (70540) $931.20 $1,552 3.9×
MRI orbit face neck w contrast (70542) $1,057.20 $1,762 3.0×
Mri Orbt/Fac/Nck W/O &W/Dye (70543) $1,635.60 $2,726 4.7×
MRI pelvis w contrast (72196) $1,338.60 $2,231 3.9×
MRI pelvis w/o & w contrast (72197) $1,912.80 $3,188 5.5×
MRI pelvis w/o contrast (72195) $1,148.40 $1,914 4.8×
MRI thoracic spine w/o contrast (72146) $1,197.60 $1,996 5.0×
MRI upper extremity oth than jt w/contr matrl (73219) $1,479.60 $2,466 4.3×
MRI upper extremity oth than jt w/o contr matrl (73218)
range across 3 matching MRF lines		 $627–$1,436.40 $1,045–$2,394 varies
Mri Uppr Extremity W/O&W/Dye (73220)
range across 3 matching MRF lines		 $1,573.80–$1,912.80 $2,623–$3,188 varies
MRI, abdomen, combo (74183) $1,912.80 $3,188 5.5×
MRI, dorsal spine combo (72157) $1,987.20 $3,312 5.7×
MRI, dorsal spine contrast (72147) $1,310.40 $2,184 3.8×
MRI, joint upper extrem (73221) $1,107 $1,845 4.7×
MRI, joint upper extrem combo (73223) $1,912.80 $3,188 5.5×
MRI, lumbar spine combo (72158) $1,987.20 $3,312 5.7×
Myocardial Imaging Infarct Avid Planar Qual/Quan (78466) $514.20 $857 1.3×
Myocardial Spect Multiple Studies (78452) $805.20 $1,342 0.6×
Neck soft tissue (70360) $93.60 $156 1.1×
Nm myocard infarct spect (78469) $1,606.80 $2,678 3.0×
Ntsty modul radthx pln dose-vol histos (77301) $3,688.80 $6,148 2.7×
Nuclear Rx Oral Admin (79005)
range across 3 matching MRF lines		 $420.60–$561.60 $701–$936 varies
Panoramic X-ray of jaws (70355) $90 $150 1.0×
Parathyroid imaging w/tomographic spect & CT (78072) $840.60 $1,401 1.6×
Parathyroid Planar Imaging (78070) $552 $920 1.4×
Parathyroid planar imaging w/wo subtraction (78071) $514.20 $857 1.3×
Pelvis 1 or 2 views (72170) $93.60 $156 0.9×
Pet Image W/Ct Lmtd (78814) $3,946.20 $6,577 2.8×
PET image w/CT, full body (78816) $4,043.40 $6,739 2.8×
PET imaging CT attenuation skull base mid-thigh (78815) $4,043.40 $6,739 2.8×
Pulmonary Perfusion Imaging Particulate (78580) $271.80 $453 0.7×
Radex Abd Compl Aqt Abd W/S/E/D Views 1 View Ch (74022) $156.60 $261 1.5×
Radex abscess/fistula/sinus tract rs&i (76080) $198 $330 0.4×
Radex Ankle Complete Minimum 3 Views (73610) $93.60 $156 1.1×
Radex Calcaneus Minimum 2 Views (73650) $93.60 $156 1.1×
Radex elbow complete minimum 3 views (73080) $93.60 $156 1.1×
Radex Facial Bones Complete Minimum 3 Views (70150) $93.60 $156 0.9×
Radex fingr minimum 2 views (73140) $93.60 $156 1.1×
Radex foot complete minimum 3 views (73630) $93.60 $156 1.1×
Radex Hand Minimum 3 Views (73130) $93.60 $156 1.1×
Radex lower extremity infant minimum 2 views (73592) $93.60 $156 1.1×
Radex Mastoids Compl Minimum 3 Views PR Side (70130) $93.60 $156 0.9×
Radex Nasal Bones Complete Minimum 3 Views (70160) $93.60 $156 1.1×
Radex Ribs Unilateral 2 Views (71100) $93.60 $156 1.1×
Radex shoulder complete minimum 2 views (73030) $93.60 $156 1.1×
Radex Sinuses Paransl < 3 Views (70210) $90 $150 1.0×
Radex sm int w/mlt srl imges via enteroclss tube (74251) $303 $505 1.7×
Radex Spine 1 View Specify Level (72020) $93.60 $156 1.1×
Radex Sternum Minimum 2 Views (71120) $93.60 $156 1.1×
Radex Temporomandble Jt Opn & Clsd Mouth Bilat (70330) $93.60 $156 1.1×
Radex Toe Minimum 2 Views (73660) $93.60 $156 1.1×
Radex upper extremity infant minimum 2 views (73092) $93.60 $156 0.9×
Radex Wrist Complete Minimum 3 Views (73110) $93.60 $156 1.1×
Radiation Delivery Stereotactic Cranial Linear (77372) $9,354 $15,590 1.3×
Radiation treatment delivery level 1 (77402) $237 $395 2.3×
Radiation treatment delivery level 2 (77407) $301.80 $503 0.8×
Radiation treatment delivery level 3 (77412) $346.80 $578 0.6×
Radiolog exam mandible compl minimum 4 views (70110) $93.60 $156 0.9×
Radiologic exam colon double contrast study (74280) $422.40 $704 2.4×
Radiologic exam colon single contrast study (74270) $303 $505 1.7×
Radiologic Exam Esophagus Double Contrast Study (74221) $283.80 $473 1.6×
Radiologic exam knee complete 4/more views (73564) $124.80 $208 1.2×
Radiologic exam pelvis compl minimum 3 views (72190) $164.40 $274 1.6×
Radiologic Exam Small Int Single Contrast Study (74250) $190.80 $318 1.1×
Radiologic exam upr gi trc double contrast study (74246) $246.60 $411 1.4×
Radiologic examination femur 1 view (73551) $90 $150 1.0×
Radiologic examination femur minimum 2 views (73552) $93.60 $156 1.1×
Radiologic examination knee 1/2 views (73560) $93.60 $156 1.1×
Radiologic Examination Osseous Survey Limited (77074) $120.60 $201 1.2×
Radiologic examination tibia & fibula 2 views (73590) $93.60 $156 1.1×
Remote afterloading high dose rate radionuclide skin surface brachytherapy, includes basic dosimetry, when performed;… (77768) $379.80 $633 1.0×
Remote afterloading high dose rate radionuclide skin surface brachytherapy, includes basic dosimetry, when performed;… (77767) $379.80 $633 1.0×
Ribs bilateral 3 views (71110) $127.20 $212 1.2×
Rp loclzj tum plnr 1 area single day imaging (78800)
range across 3 matching MRF lines		 $271.80–$704.40 $453–$1,174 varies
Rp loclzj tum plnr 2+area 1+d img/1 area img>2+d (78801) $591.60 $986 1.5×
Rp Loclzj Tum Plnr Whole Body 2+ Days Imaging (78804)
range across 3 matching MRF lines		 $1,606.80–$2,043.60 $2,678–$3,406 varies
Rp Loclzj Tum Plnr Whole Body Single Day Imaging (78802)
range across 2 matching MRF lines		 $442.80–$704.40 $738–$1,174 varies
Rp Loclzj Tum Spect 1 Area Single Day Imaging (78803)
range across 9 matching MRF lines		 $407.40–$2,043.60 $679–$3,406 varies
Rp loclzj tum spect 2 area/sep acquisj img (78831) $2,043.60 $3,406 1.6×
Rp loclzj tum spect CT 2area 1d img/1 ar img>2+d (78832) $2,319 $3,865 1.6×
Rp loclzj tum spect w/CT 1 area/acquisj 1day img (78830)
range across 8 matching MRF lines		 $1,956–$2,043.60 $3,260–$3,406 varies
Rp Ther Radiolbld Monoclonal Antibody IV Infus (79403) $420.60 $701 1.8×
Rp Therapy Intravenous Administration (79101) $194.40 $324 0.8×
Scapula (73010) $93.60 $156 0.9×
Screening Digital Breast Tomosynthesis Bi (77063) $40.80 $68 1.7×
Shoulder 1 view (73020) $93.60 $156 1.1×
Shoulder Arthrography (73040) $201.60 $336 0.6×
Skull less than 4 views (70250) $93.60 $156 0.9×
Special dosimetry (77331) $237.60 $396 1.8×
Special Physics Consult (77370) $385.20 $642 2.9×
Special teletherapy port plan (77321) $461.40 $769 1.2×
Special treatment procedure (77470) $1,035 $1,725 1.9×
Speech evaluation, complex (70371) $251.40 $419 1.1×
Spleen Imaging (78185) $514.20 $857 1.3×
Stereotactic Body Radiation Delivery (77373) $6,832.80 $11,388 3.8×
Sternoclavicular joints (71130) $93.60 $156 1.1×
Tbs technical calculation only (77091) $135 $225 1.6×
Telethx isodose pln cplx w/basic dosimetry (77307) $1,900.20 $3,167 5.1×
Telethx isodose pln smpl w/dosimetry calculation (77306) $808.20 $1,347 2.2×
Testicular Imaging W/Flow (78761) $640.20 $1,067 1.6×
Ther Rad Simulaj-Aided Field Setting Complex (77290) $560.40 $934 1.5×
Ther Rad Simulaj-Aided Field Setting Intermed (77285) $457.80 $763 1.2×
Ther rad simulaj-aided field setting simple (77280) $402.60 $671 3.0×
Therapeutic Enema Rdctj Intussusception/Obstrcj (74283) $292.80 $488 1.7×
Thoracic spine 2 views (72070) $93.60 $156 0.9×
Thoracic spine 3 views (72072) $121.80 $203 1.2×
Thyroid Met Imaging Body (78018) $823.80 $1,373 1.5×
Thyroid Uptake Measurement (78012) $574.20 $957 1.4×
Thyroid Uptake W/Blood Flow Sngle/Mult Quan Meas (78014) $271.80 $453 0.7×
Tx Devices Design & Construction Complex (77334) $481.80 $803 1.3×
Tx devices design & construction intermediate (77333) $396 $660 3.0×
Tx devices design & construction simple (77332) $350.40 $584 2.6×
Ultrasound Breast Limited (76642) $90 $150 1.0×
Ultrasound Elastography Parenchyma (76981) $162 $270 1.6×
Ultrasound Exam Aaa Screen (76706) $352.80 $588 3.4×
Ultrasound, abdomen limited (76705) $267.60 $446 2.6×
Umbilical-artery Doppler (OB) (76820) $164.40 $274 1.6×
Unlisted Dx Radiographic Procedure (76499) $95.40 $159 1.1×
Unlisted fluoroscopic procedure (76496) $90 $150 1.0×
Upper gi w/o kub (74240)
range across 2 matching MRF lines		 $183.60–$292.80 $306–$488 varies
Ureteral Reflux Study (78740) $246.60 $411 0.6×
Urethrocystogram voiding (74455) $352.20 $587 1.5×
Urethrocystography retrograde (74450) $334.20 $557 1.4×
Us breast unilateral complete (76641) $175.80 $293 1.7×
Us chest (76604) $175.80 $293 1.7×
Us complete joint (76881) $267.60 $446 2.6×
Us exam, pelvic, limited (76857) $164.40 $274 1.6×
Us head (76506) $211.80 $353 2.0×
Us kidney transplant (76776) $164.40 $274 1.6×
Us lmtd joint/oth nonvasc xtr strux r-t w/img (76882) $267.60 $446 2.6×
Us ob detailed single fetus (76811) $334.20 $557 1.4×
Us ob limited 1 or more fetuses (76815) $155.40 $259 1.5×
Us ob transvaginal (76817) $164.40 $274 1.6×
Us pelvic non ob complete (76856) $239.40 $399 2.3×
Us pg uter img f&mat 14 wk tabdl 1/1st gestation (76801) $164.40 $274 1.6×
Us preg uterus real time f/u trnsabdl per fetus (76816) $136.80 $228 1.3×
Us retroperitoneal complete (76770) $246.60 $411 2.4×
Us retroperitoneal limited (76775) $164.40 $274 1.6×
Us scrotum and contents (76870) $246.60 $411 2.4×
Us spinal canal and contents (76800) $190.80 $318 1.8×
Us thyroid (76536) $232.80 $388 2.2×
Us transrectal (76872) $296.40 $494 2.8×
Vein X-Ray Chest (75827) $679.80 $1,133 0.4×
Vein X-Ray Spleen/Liver (75810) $679.80 $1,133 0.2×
Venography caval inferior serialography rs&i (75825) $679.80 $1,133 0.2×
Venography extremity bilateral rs&i (75822) $151.80 $253 0.1×
Venography extremity unilateral rs&i (75820) $106.20 $177 0.1×
Venography Renal Bilateral (75833) $704.40 $1,174 0.2×
Venography Renal Unilateral (75831) $679.80 $1,133 0.2×
Vertebral fracture assessment via dxa (77086) $211.80 $353 2.4×
Wrist 2 views (73100) $93.60 $156 1.1×
X-Ray Ac Jts - Xr Acromioclavicular Joints Bilateral (73050) $93.60 $156 1.1×
X-ray antegrade pyelogram tube (74425) $352.20 $587 1.0×
X-Ray Aorta Leg Arteries (75630) $704.40 $1,174 0.2×
X-Ray Bend Only L-S Spine (72120) $135 $225 1.3×
X-Ray Elbow 2 Vw - Xr Elbow 1-2 Views Right (73070) $93.60 $156 1.1×
X-Ray Exam Breast Specimen (76098) $70.80 $118 0.1×
X-Ray Exam Entire Spi 1 Vw (72081) $156 $260 1.8×
X-Ray Exam Entire Spi 2/3 Vw (72082) $135 $225 1.3×
X-Ray Exam Hip Uni 1 View (73501)
range across 2 matching MRF lines		 $93.60–$120.60 $156–$201 varies
X-Ray Exam Hip Uni 2-3 Views (73502)
range across 2 matching MRF lines		 $90–$93.60 $150–$156 varies
X-Ray Exam Hips Bi 2 Views (73521) $164.40 $274 1.6×
X-Ray Exam Hips Bi 5/> Views (73523) $155.40 $259 1.5×
X-Ray Exam L-S Spine Bending (72114) $135 $225 1.3×
X-Ray Exam Neck Spine 2-3 Vw (72040) $93.60 $156 1.1×
X-Ray Exam Neck Spine 6/>Vws (72052) $156.60 $261 1.5×
X-Ray Exam Unilat Ribs/Chest (71101) $127.20 $212 1.2×
X-ray eye for foreign body (70030) $90 $150 1.0×
X-ray humerus (73060) $93.60 $156 1.1×
X-ray IV pyelogram (ivp) (74400) $352.20 $587 2.0×
X-ray IV pyelogram+tomography (74415) $352.20 $587 2.0×
X-Ray Jaw <4 Vw - Xr Mandible < 4 Views (70100) $93.60 $156 1.1×
X-Ray Knee Bilat Standing - Xr Knees Anteroposterior Standing Bilat (73565) $90 $150 1.0×
X-Ray Lumbar Spine 2/3 Vw - Xr Lumbar Spine 2-3 Views (72100) $93.60 $156 0.9×
X-ray nose-rectum child f.b. (76010) $90 $150 1.0×
X-Ray Ribs, Chest 4+ Vw - Xr Ribs 3 Vws Bil W/ Chest Posteroanterior (71111) $127.20 $212 1.2×
X-Ray Sacroiliac Jts 3+ Vw - Xr Sacroiliac Joints 3+ Views (72202) $93.60 $156 0.9×
X-Ray Sacrum/Coccyx 2+ Vw - Xr Sacrum Coccyx 2+ Views (72220) $93.60 $156 1.1×
X-Ray Sinuses 3+ Vw - Xr Paranasal Sinuses 3+ Views (70220) $93.60 $156 1.1×
X-Ray Skull 4+ Vw - Xr Skull Complete 4+ Views (70260) $155.40 $259 1.5×
X-Ray Stress View (77071) $90.60 $151 1.0×
X-Ray Urinary Tract Exam With Contrast Material (74420) $352.20 $587 1.0×
X-Rays Bone Length Studies (77073)
range across 2 matching MRF lines		 $121.80–$160.80 $203–$268 varies
X-Rays Bone Survey Complete (77075) $164.40 $274 1.6×
Xr c-spine 4 or 5 views (72050) $156.60 $261 1.5×
Xr facial bones less than 3 views (70140) $90 $150 1.0×
Xr orbits complete 4 views (70200) $93.60 $156 0.9×
Xr Tomogram Single Plane (76100) $135 $225 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.