Imaging prices at Northeastern Health System
Tahlequah, OK · every code in this section with a posted price and a Medicare benchmark.
289 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) | $1,545 | $2,060 | 1.2× |
| Abdomen 1 View (74018) | $103.50 | $138 | 1.2× |
| Abdomen 2 views (74019) | $240.75 | $321 | 2.4× |
| Acute Gastrointestinal Blood Loss Imaging (78278) | $642.75 | $857 | 1.7× |
| Angio pulmonary bilat (75743) | $1,621.50 | $2,162 | 0.5× |
| Angiography Adrenal Bilateral Slctv Rs&I (75733) | $2,317.50 | $3,090 | 0.8× |
| Angiography extremity bilateral rs&i (75716) | $3,213.75 | $4,285 | 1.1× |
| Angiography extremity unilateral rs&i (75710) range across 2 matching MRF lines |
$1,621.50–$2,008.50 | $2,162–$2,678 | varies |
| Angrph pulmonary nonslctv cath/ven njx rs&i (75746) | $1,262.25 | $1,683 | 0.4× |
| Ankle 2 views (73600) | $118.50 | $158 | 1.4× |
| Aortography thoracic serialography rs&i (75605) | $3,213.75 | $4,285 | 0.6× |
| Aortography thoracic w/o serialography rs&i (75600) | $2,008.50 | $2,678 | 0.7× |
| Artery X-Rays Abdomen (75726) | $3,213.75 | $4,285 | 0.6× |
| Artery X-Rays Pelvis (75736) unusually low: confirm this is the full procedure |
$2,317.50 | $3,090 | 0.4× |
| Arthrogram ankle (73615) | $522 | $696 | 1.6× |
| Arthrogram hip (73525) | $522 | $696 | 1.6× |
| Arthrogram Wrist (73115) range across 2 matching MRF lines |
$522–$2,880 | $696–$3,840 | varies |
| Basic radiation dosimetry calculation (77300) | $386.25 | $515 | 3.0× |
| Bone age studies (77072) | $118.50 | $158 | 1.2× |
| Bone Imaging 3 Phase (78315) | $494.25 | $659 | 1.3× |
| Bone Imaging Limited Area (78300) | $578.25 | $771 | 1.5× |
| Bone Imaging Multiple Areas (78305) | $600 | $800 | 1.6× |
| Bone Imaging Whole Body (78306) | $819.75 | $1,093 | 2.1× |
| Bone survey infant (77076) | $204 | $272 | 2.0× |
| Brain Flow Imaging Only (78610) | $286.50 | $382 | 0.5× |
| Brain Image W/Flow < 4 Views (78601) | $702 | $936 | 1.8× |
| Cardiac MRI w/w/o contrast & further seq (75561) | $3,200.25 | $4,267 | 9.5× |
| Cardiac MRI w/w/o contrast w/stress (75563) | $2,450.25 | $3,267 | 3.2× |
| Cerebrospinal Fluid Scan (78630) range across 2 matching MRF lines |
$749.25–$963.75 | $999–$1,285 | varies |
| Chest 1 view (71045) | $103.50 | $138 | 1.2× |
| Chest 2 views (71046) | $120.75 | $161 | 1.4× |
| Chest 4 or more views (71048) | $140.25 | $187 | 1.4× |
| Clavicle complete (73000) range across 2 matching MRF lines |
$118.50–$180 | $158–$240 | varies |
| Computed Tomography Thorax Lw Dose Lng Ca Scr C- (71271) | $231.75 | $309 | 2.3× |
| Continuing medical physics consltj pr wk (77336) | $226.50 | $302 | 1.8× |
| Contrast Exam Abdominl Aorta (75625) | $3,213.75 | $4,285 | 1.1× |
| Contrast X-Ray Bladder (74430) | $329.25 | $439 | 1.0× |
| Contrast X-Ray Of Elbow (73085) | $636 | $848 | 1.9× |
| Contrast X-Ray Of Knee Joint (73580) | $636 | $848 | 1.9× |
| CT abdomen and pelvis without and with contrast (74178) range across 3 matching MRF lines |
$2,091.75–$2,864.25 | $2,789–$3,819 | varies |
| CT abdomen and pelvis without contrast (74176) range across 2 matching MRF lines |
$1,830.75–$2,602.50 | $2,441–$3,470 | varies |
| CT abdomen w contrast (74160) | $1,175.25 | $1,567 | 7.0× |
| CT abdomen w wo contrast (74170) range across 3 matching MRF lines |
$489–$1,230 | $652–$1,640 | varies |
| CT abdomen w/o contrast (74150) range across 2 matching MRF lines |
$1,025.25–$1,026 | $1,367–$1,368 | varies |
| CT Angio Abdomen and Pelvis (74174) | $695.25 | $927 | 2.1× |
| CT Angio Chest (71275) | $695.25 | $927 | 4.1× |
| CT Angio Head (70496) | $530.25 | $707 | 3.1× |
| CT angio hrt w/3d image (75574) | $610.50 | $814 | 1.8× |
| Ct Angio Lwr Extr W/O&W/Dye (73706) | $695.25 | $927 | 4.1× |
| CT Angio Neck (70498) | $640.50 | $854 | 3.8× |
| Ct Angio Upr Extrm W/O&W/Dye (73206) | $575.25 | $767 | 3.4× |
| CT cervical spine w/ contrast (72126) | $1,113 | $1,484 | 3.3× |
| CT cervical spine w/o contrast (72125) | $1,101 | $1,468 | 10.9× |
| CT cervical spine w/wo cont (72127) | $1,130.25 | $1,507 | 6.7× |
| CT chest w contrast (71260) range across 2 matching MRF lines |
$1,182–$1,182.75 | $1,576–$1,577 | varies |
| CT chest w/wo contrast (71270) range across 2 matching MRF lines |
$1,229.25–$1,230 | $1,639–$1,640 | varies |
| CT head/brain with contrast (70460) range across 2 matching MRF lines |
$840.75–$842.25 | $1,121–$1,123 | varies |
| CT head/brain without and with contrast (70470) range across 2 matching MRF lines |
$1,005.75–$1,008 | $1,341–$1,344 | varies |
| CT heart no contrast quant eval coronry calcium (75571) | $122.25 | $163 | 1.5× |
| CT iac w contrast (70481) | $887.25 | $1,183 | 5.3× |
| CT l-spine w&w/o contrast (72133) | $1,130.25 | $1,507 | 6.7× |
| CT lower ext w/o (73700) range across 3 matching MRF lines |
$836.25–$1,492.50 | $1,115–$1,990 | varies |
| CT lower extremity w/contrast material (73701) range across 4 matching MRF lines |
$932.25–$1,492.50 | $1,243–$1,990 | varies |
| CT lumbar spine w contrast (72132) | $1,066.50 | $1,422 | 3.2× |
| CT lumbar spine w/o contrast (72131) range across 2 matching MRF lines |
$1,046.25–$1,047 | $1,395–$1,396 | varies |
| CT maxillofacial w contrast (70487) | $841.50 | $1,122 | 5.0× |
| CT maxillofacial wo contrast (70486) | $701.25 | $935 | 7.0× |
| CT neck tissue combo (70492) range across 2 matching MRF lines |
$983.25–$984 | $1,311–$1,312 | varies |
| Ct Orbit/Ear/Fossa W/O&W/Dye (70482) | $939.75 | $1,253 | 5.6× |
| CT orbits w/o contrast (70480) range across 2 matching MRF lines |
$785.63–$841.50 | $1,047.50–$1,122 | varies |
| CT pelvis w&w/o contrast (72194) | $1,182 | $1,576 | 7.0× |
| CT pelvis w/o contrast (72192) range across 2 matching MRF lines |
$1,025.25–$1,026 | $1,367–$1,368 | varies |
| CT scan of leg combo (73702) range across 3 matching MRF lines |
$932.25–$1,025.25 | $1,243–$1,367 | varies |
| CT scans face/jaw combo (70488) | $939 | $1,252 | 5.6× |
| CT soft tissue neck w contrast (70491) range across 2 matching MRF lines |
$957–$957.75 | $1,276–$1,277 | varies |
| CT soft tissue neck w/o contrast (70490) | $872.25 | $1,163 | 8.7× |
| CT thoracic spine w contrast (72129) range across 2 matching MRF lines |
$954.33–$983.25 | $1,272.44–$1,311 | varies |
| CT thoracic spine w/o contrast (72128) range across 2 matching MRF lines |
$785.25–$786 | $1,047–$1,048 | varies |
| CT thoracic spine w/wo cont (72130) | $1,066.50 | $1,422 | 6.3× |
| CT thorax w/o contrast (71250) | $1,117.50 | $1,490 | 11.1× |
| CT upper ext wo (73200) range across 2 matching MRF lines |
$661.50–$1,219.50 | $882–$1,626 | varies |
| CT upper extremity w/o & w/contrast material (73202) range across 2 matching MRF lines |
$952.50–$1,428.75 | $1,270–$1,905 | varies |
| CT upper extremity with contrast (73201) range across 2 matching MRF lines |
$876–$1,492.50 | $1,168–$1,990 | varies |
| Cta Abdl Aorta&Bi Iliofem W/Contrast&Postp (75635) | $695.25 | $927 | 4.1× |
| Cta Abdomen (74175) | $695.25 | $927 | 4.1× |
| CTA pelvis (72191) | $695.25 | $927 | 4.1× |
| Dxa Bone Density Axial (77080) | $235.50 | $314 | 2.3× |
| Dxa bone density study 1/>sites appendiclr skel (77081) | $102 | $136 | 1.2× |
| Esophagram (74220) | $134.25 | $179 | 0.8× |
| Fetal Biophysical Profile W/O Non-Stress Testing (76819) range across 2 matching MRF lines |
$224.25–$307.50 | $299–$410 | varies |
| Fluoroscopy up to 1 hr (76000) range across 3 matching MRF lines |
$24–$240.75 | $32–$321 | varies |
| Follow-Up Angiography (75898) | $1,285.50 | $1,714 | 0.4× |
| Foot 2 views (73620) | $118.50 | $158 | 1.4× |
| Forearm 2 views (73090) range across 2 matching MRF lines |
$118.50–$207 | $158–$276 | varies |
| Gastric emptying imaging study (78264) | $577.50 | $770 | 1.5× |
| Gated Heart Planar Single (78472) | $628.50 | $838 | 1.6× |
| Hand 2 views (73120) | $56.25 | $75 | 0.6× |
| Hepatobil Syst Image W/Drug (78227) | $698.25 | $931 | 1.3× |
| Hepatobiliary System Imaging (78226) | $679.50 | $906 | 1.8× |
| Ht Musc Image Planar Mult (78454) | $1,807.50 | $2,410 | 1.5× |
| Ht Muscle Image Spect Sing (78451) | $1,687.50 | $2,250 | 1.4× |
| Hysterosalpingogram (74740) | $357.75 | $477 | 1.6× |
| Image fusion (77399) | $450 | $600 | 3.5× |
| Infant hip ultrasound with hip movement (dynamic) (76885) | $184.50 | $246 | 2.2× |
| K Flow/Funct Image W/Drug (78708) | $783 | $1,044 | 1.5× |
| K Flow/Funct Image W/O Drug (78707) | $749.25 | $999 | 1.4× |
| Knee 3 Views (73562) range across 2 matching MRF lines |
$118.50–$207 | $158–$276 | varies |
| Liver & Spleen Imaging Static Only (78215) | $614.25 | $819 | 1.6× |
| Lung Ventilat&Perfus Imaging (78582) | $988.50 | $1,318 | 1.9× |
| Lymph System Imaging (78195) | $402 | $536 | 0.8× |
| Magnetic Image Jaw Joint (70336) | $2,450.25 | $3,267 | 10.7× |
| Meckels Divert Exam (78290) | $570.75 | $761 | 1.5× |
| Mlc imrt design & construction per imrt plan (77338) | $1,158.75 | $1,545 | 3.2× |
| Mra Head W/O & W/Contrast Material (70546) | $1,584 | $2,112 | 4.7× |
| MRA head w/o contrast (70544) range across 2 matching MRF lines |
$1,397.25–$2,994.75 | $1,863–$3,993 | varies |
| Mra Neck W/O &W/Contrast Material (70549) range across 2 matching MRF lines |
$1,582.50–$2,994.75 | $2,110–$3,993 | varies |
| MRA neck w/o contrast (70547) range across 2 matching MRF lines |
$1,397.25–$2,994.75 | $1,863–$3,993 | varies |
| MRI abdomen w contrast (74182) | $917.25 | $1,223 | 2.7× |
| MRI abdomen w/o contrast (74181) range across 2 matching MRF lines |
$848.25–$2,722.50 | $1,131–$3,630 | varies |
| MRI any jt lower extrem w/contrast material (73722) range across 3 matching MRF lines |
$1,236–$1,492.50 | $1,648–$1,990 | varies |
| MRI any jt lower extrem w/o & w/contrast matrl (73723) range across 4 matching MRF lines |
$1,622.25–$2,991 | $2,163–$3,988 | varies |
| MRI any jt upper extremity w/contrast matrl (73222) range across 2 matching MRF lines |
$1,446–$2,994.75 | $1,928–$3,993 | varies |
| MRI cardiac w/o contrast (75557) | $2,450.25 | $3,267 | 10.7× |
| MRI cervical spine w contrast (72142) range across 2 matching MRF lines |
$1,360.50–$2,994.75 | $1,814–$3,993 | varies |
| MRI cervical spine w/o cont (72141) | $2,450.25 | $3,267 | 10.7× |
| MRI chest w/o contrast (71550) range across 2 matching MRF lines |
$825–$2,450.25 | $1,100–$3,267 | varies |
| MRI chest wo w contrast (71552) | $888.75 | $1,185 | 2.6× |
| MRI lower extrem oth/thn jt w/contrast matrl (73719) range across 2 matching MRF lines |
$786.75–$827.25 | $1,049–$1,103 | varies |
| MRI lower extrem oth/thn jt w/o & w/contr matr (73720) range across 2 matching MRF lines |
$2,991–$2,994.75 | $3,988–$3,993 | varies |
| MRI lower extrem oth/thn jt w/o contr matrl (73718) range across 2 matching MRF lines |
$1,257–$2,450.25 | $1,676–$3,267 | varies |
| MRI lumbar spine w contrast (72149) range across 2 matching MRF lines |
$1,280.25–$2,994.75 | $1,707–$3,993 | varies |
| Mri Neck Spine W/O & W/Dye (72156) range across 2 matching MRF lines |
$1,595.25–$2,994.75 | $2,127–$3,993 | varies |
| MRI orbit face &/neck w/o contrast (70540) range across 3 matching MRF lines |
$1,155–$2,450.25 | $1,540–$3,267 | varies |
| MRI orbit face neck w contrast (70542) | $1,473 | $1,964 | 4.4× |
| Mri Orbt/Fac/Nck W/O &W/Dye (70543) range across 2 matching MRF lines |
$1,767.75–$2,994.75 | $2,357–$3,993 | varies |
| MRI pelvis w contrast (72196) range across 2 matching MRF lines |
$1,508.25–$2,994.75 | $2,011–$3,993 | varies |
| MRI pelvis w/o & w contrast (72197) range across 2 matching MRF lines |
$1,809–$2,994.75 | $2,412–$3,993 | varies |
| MRI pelvis w/o contrast (72195) range across 2 matching MRF lines |
$1,257–$2,450.25 | $1,676–$3,267 | varies |
| MRI thoracic spine w/o contrast (72146) range across 2 matching MRF lines |
$1,113.75–$2,450.25 | $1,485–$3,267 | varies |
| MRI upper extremity oth than jt w/contr matrl (73219) range across 2 matching MRF lines |
$1,639.50–$1,640.25 | $2,186–$2,187 | varies |
| MRI upper extremity oth than jt w/o contr matrl (73218) range across 2 matching MRF lines |
$1,093.50–$2,450.25 | $1,458–$3,267 | varies |
| Mri Uppr Extremity W/O&W/Dye (73220) range across 2 matching MRF lines |
$2,186.25–$2,994.75 | $2,915–$3,993 | varies |
| MRI, abdomen, combo (74183) range across 2 matching MRF lines |
$1,219.50–$2,994.75 | $1,626–$3,993 | varies |
| MRI, dorsal spine combo (72157) range across 2 matching MRF lines |
$1,730.25–$2,994.75 | $2,307–$3,993 | varies |
| MRI, dorsal spine contrast (72147) range across 2 matching MRF lines |
$1,280.25–$2,994.75 | $1,707–$3,993 | varies |
| MRI, joint upper extrem (73221) range across 2 matching MRF lines |
$2,450.25–$2,772 | $3,267–$3,696 | varies |
| MRI, joint upper extrem combo (73223) range across 2 matching MRF lines |
$1,687.50–$2,994.75 | $2,250–$3,993 | varies |
| MRI, lumbar spine combo (72158) range across 2 matching MRF lines |
$1,730.25–$2,994.75 | $2,307–$3,993 | varies |
| Myocardial Spect Multiple Studies (78452) | $2,993.25 | $3,991 | 2.4× |
| Neck soft tissue (70360) | $103.50 | $138 | 1.2× |
| Ntsty modul radthx pln dose-vol histos (77301) | $2,703.75 | $3,605 | 2.0× |
| Parathyroid Planar Imaging (78070) | $430.50 | $574 | 1.1× |
| Pelvis 1 or 2 views (72170) | $118.50 | $158 | 1.2× |
| Peritoneogram Rs&I (74190) | $891 | $1,188 | 1.7× |
| Pet Image W/Ct Lmtd (78814) | $3,615 | $4,820 | 2.6× |
| PET image w/CT, full body (78816) | $3,615 | $4,820 | 2.6× |
| PET imaging CT attenuation skull base mid-thigh (78815) | $3,615 | $4,820 | 2.6× |
| PET whole body (78813) | $3,213.75 | $4,285 | 2.3× |
| Pulmonary Perfusion Imaging Particulate (78580) | $948.75 | $1,265 | 2.5× |
| Radex abscess/fistula/sinus tract rs&i (76080) | $357 | $476 | 0.7× |
| Radex Ankle Complete Minimum 3 Views (73610) range across 2 matching MRF lines |
$118.50–$207 | $158–$276 | varies |
| Radex Calcaneus Minimum 2 Views (73650) range across 2 matching MRF lines |
$118.50–$207 | $158–$276 | varies |
| Radex elbow complete minimum 3 views (73080) | $118.50 | $158 | 1.4× |
| Radex Facial Bones Complete Minimum 3 Views (70150) range across 2 matching MRF lines |
$103.50–$225 | $138–$300 | varies |
| Radex fingr minimum 2 views (73140) | $118.50 | $158 | 1.4× |
| Radex foot complete minimum 3 views (73630) range across 2 matching MRF lines |
$118.50–$207 | $158–$276 | varies |
| Radex Hand Minimum 3 Views (73130) range across 3 matching MRF lines |
$118.50–$220.50 | $158–$294 | varies |
| Radex lower extremity infant minimum 2 views (73592) | $147.75 | $197 | 1.8× |
| Radex Mastoids Compl Minimum 3 Views PR Side (70130) | $93.75 | $125 | 0.9× |
| Radex Nasal Bones Complete Minimum 3 Views (70160) | $118.50 | $158 | 1.4× |
| Radex Ribs Unilateral 2 Views (71100) | $118.50 | $158 | 1.4× |
| Radex shoulder complete minimum 2 views (73030) range across 2 matching MRF lines |
$118.50–$220.50 | $158–$294 | varies |
| Radex Spine 1 View Specify Level (72020) | $118.50 | $158 | 1.4× |
| Radex Sternum Minimum 2 Views (71120) | $118.50 | $158 | 1.4× |
| Radex Temporomandble Jt Opn & Clsd Mouth Bilat (70330) range across 2 matching MRF lines |
$130.50–$225 | $174–$300 | varies |
| Radex Toe Minimum 2 Views (73660) range across 2 matching MRF lines |
$118.50–$207 | $158–$276 | varies |
| Radex Wrist Complete Minimum 3 Views (73110) range across 3 matching MRF lines |
$118.50–$207 | $158–$276 | varies |
| Radex X-Ray Exam Entire Spi 6/> Vw - Xr Entire Spine 6+ Vw (72084) | $135 | $180 | 1.3× |
| Radiation treatment delivery level 1 (77402) | $220.50 | $294 | 2.2× |
| Radiation treatment delivery level 2 (77407) | $423 | $564 | 1.1× |
| Radiation treatment delivery level 3 (77412) | $423 | $564 | 0.8× |
| Radiolog exam mandible compl minimum 4 views (70110) | $129 | $172 | 1.3× |
| Radiologic Exam Abdomen 3+ Views - Xr Abdomen 3+ Views (74021) | $180 | $240 | 1.8× |
| Radiologic exam colon single contrast study (74270) | $202.50 | $270 | 1.2× |
| Radiologic exam knee complete 4/more views (73564) range across 2 matching MRF lines |
$118.50–$276 | $158–$368 | varies |
| Radiologic exam pelvis compl minimum 3 views (72190) | $141 | $188 | 1.4× |
| Radiologic Exam Small Int Single Contrast Study (74250) | $191.25 | $255 | 1.1× |
| Radiologic exam swallow function contrast study (74230) | $177.75 | $237 | 1.1× |
| Radiologic exam upr gi trc double contrast study (74246) | $234 | $312 | 1.4× |
| Radiologic examination femur minimum 2 views (73552) range across 2 matching MRF lines |
$118.50–$225.75 | $158–$301 | varies |
| Radiologic examination knee 1/2 views (73560) | $118.50 | $158 | 1.4× |
| Radiologic Examination Osseous Survey Limited (77074) | $323.25 | $431 | 3.2× |
| Radiologic examination tibia & fibula 2 views (73590) range across 4 matching MRF lines |
$130.79–$230.25 | $174.38–$307 | varies |
| Ribs bilateral 3 views (71110) | $144.75 | $193 | 1.4× |
| Rp loclzj tum plnr 1 area single day imaging (78800) | $692.25 | $923 | 1.8× |
| Rp loclzj tum plnr 2+area 1+d img/1 area img>2+d (78801) | $723 | $964 | 1.9× |
| Rp Loclzj Tum Plnr Whole Body 2+ Days Imaging (78804) | $4,125 | $5,500 | 7.9× |
| Rp Loclzj Tum Plnr Whole Body Single Day Imaging (78802) | $723 | $964 | 1.4× |
| Scapula (73010) | $118.50 | $158 | 1.2× |
| Screening Digital Breast Tomosynthesis Bi (77063) | $62.25 | $83 | 2.7× |
| Shoulder 1 view (73020) | $116.25 | $155 | 1.4× |
| Shoulder Arthrography (73040) | $522 | $696 | 1.6× |
| Skull less than 4 views (70250) | $118.50 | $158 | 1.2× |
| Special dosimetry (77331) | $226.50 | $302 | 1.8× |
| Special Physics Consult (77370) | $226.50 | $302 | 1.8× |
| Special teletherapy port plan (77321) | $386.25 | $515 | 1.1× |
| Special treatment procedure (77470) | $618 | $824 | 1.2× |
| Sternoclavicular joints (71130) | $77.25 | $103 | 0.9× |
| Surface Applic Low Dose Rate Radionuclide Source (77789) | $220.50 | $294 | 2.2× |
| Telethx isodose pln cplx w/basic dosimetry (77307) | $695.25 | $927 | 1.9× |
| Telethx isodose pln smpl w/dosimetry calculation (77306) | $598.50 | $798 | 1.7× |
| Testicular Imaging W/Flow (78761) | $632.25 | $843 | 1.6× |
| Ther Rad Simulaj-Aided Field Setting Complex (77290) | $772.50 | $1,030 | 2.1× |
| Ther Rad Simulaj-Aided Field Setting Intermed (77285) | $695.25 | $927 | 1.9× |
| Ther rad simulaj-aided field setting simple (77280) | $618 | $824 | 4.8× |
| Thoracic spine 2 views (72070) | $135 | $180 | 1.3× |
| Thoracic spine 3 views (72072) | $135 | $180 | 1.3× |
| Thoracolumbar 2 views (72080) | $135 | $180 | 1.6× |
| Thyroid Uptake W/Blood Flow Sngle/Mult Quan Meas (78014) range across 2 matching MRF lines |
$399.75–$432 | $533–$576 | varies |
| Tx Devices Design & Construction Complex (77334) | $695.25 | $927 | 1.9× |
| Tx devices design & construction intermediate (77333) | $540.75 | $721 | 4.2× |
| Tx devices design & construction simple (77332) | $386.25 | $515 | 3.0× |
| Ultrasound Breast Limited (76642) range across 2 matching MRF lines |
$156.75–$310.50 | $209–$414 | varies |
| Ultrasound Elastography Parenchyma (76981) range across 2 matching MRF lines |
$203.25–$291.75 | $271–$389 | varies |
| Ultrasound Exam Aaa Screen (76706) range across 2 matching MRF lines |
$305.25–$386.25 | $407–$515 | varies |
| Ultrasound trgt dynamic microbubble 1st lesion (76978) | $432.75 | $577 | 1.3× |
| Ultrasound, abdomen limited (76705) range across 4 matching MRF lines |
$184.50–$352.50 | $246–$470 | varies |
| Umbilical-artery Doppler (OB) (76820) | $160.50 | $214 | 1.6× |
| Unlisted Dx Radiographic Procedure (76499) range across 2 matching MRF lines |
$482.25–$483 | $643–$644 | varies |
| Upper gi w/o kub (74240) | $224.25 | $299 | 1.3× |
| Urethrocystogram voiding (74455) | $329.25 | $439 | 1.4× |
| Us breast unilateral complete (76641) | $157.50 | $210 | 1.6× |
| Us chest (76604) range across 2 matching MRF lines |
$243.75–$249.75 | $325–$333 | varies |
| Us complete joint (76881) range across 2 matching MRF lines |
$262.50–$270.75 | $350–$361 | varies |
| Us exam, pelvic, limited (76857) range across 3 matching MRF lines |
$135–$212.25 | $180–$283 | varies |
| Us head (76506) | $254.25 | $339 | 2.5× |
| Us lmtd joint/oth nonvasc xtr strux r-t w/img (76882) range across 3 matching MRF lines |
$254.25–$262.50 | $339–$350 | varies |
| Us ob limited 1 or more fetuses (76815) | $307.50 | $410 | 3.1× |
| Us ob transvaginal (76817) range across 2 matching MRF lines |
$197.25–$198 | $263–$264 | varies |
| Us pelvic non ob complete (76856) | $324 | $432 | 3.2× |
| Us pg uter img f&mat 14 wk tabdl 1/1st gestation (76801) | $207.75 | $277 | 2.1× |
| Us preg uterus real time f/u trnsabdl per fetus (76816) range across 2 matching MRF lines |
$224.25–$231 | $299–$308 | varies |
| Us retroperitoneal complete (76770) range across 3 matching MRF lines |
$135–$489 | $180–$652 | varies |
| Us retroperitoneal limited (76775) range across 2 matching MRF lines |
$176.25–$209.25 | $235–$279 | varies |
| Us scrotum and contents (76870) range across 2 matching MRF lines |
$203.25–$357 | $271–$476 | varies |
| Us spinal canal and contents (76800) | $243 | $324 | 2.4× |
| Us thyroid (76536) | $277.50 | $370 | 2.8× |
| Us transrectal (76872) | $238.50 | $318 | 2.4× |
| Vein X-Ray Chest (75827) | $1,125 | $1,500 | 0.7× |
| Venogram Sinus/Jugular (75860) | $4,719.75 | $6,293 | 1.6× |
| Venography caval inferior serialography rs&i (75825) | $1,621.50 | $2,162 | 0.5× |
| Venography extremity bilateral rs&i (75822) range across 2 matching MRF lines |
$963.75–$1,004.25 | $1,285–$1,339 | varies |
| Venography extremity unilateral rs&i (75820) | $642.75 | $857 | 0.4× |
| Wrist 2 views (73100) | $120 | $160 | 1.4× |
| X-Ray Ac Jts - Xr Acromioclavicular Joints Bilateral (73050) | $225 | $300 | 2.7× |
| X-Ray Aorta Leg Arteries (75630) | $3,213.75 | $4,285 | 1.1× |
| X-Ray Bend Only L-S Spine (72120) | $118.50 | $158 | 1.2× |
| X-Ray Elbow 2 Vw - Xr Elbow 1-2 Views Right (73070) | $137.25 | $183 | 1.6× |
| X-Ray Exam Entire Spi 1 Vw (72081) | $138.75 | $185 | 1.7× |
| X-Ray Exam Entire Spi 2/3 Vw (72082) | $135 | $180 | 1.3× |
| X-Ray Exam Entire Spi 4/5 Vw (72083) | $165 | $220 | 1.6× |
| X-Ray Exam Hip Uni 1 View (73501) range across 2 matching MRF lines |
$118.50–$207 | $158–$276 | varies |
| X-Ray Exam Hip Uni 2-3 Views (73502) range across 3 matching MRF lines |
$118.50–$120 | $158–$160 | varies |
| X-Ray Exam Hips Bi 2 Views (73521) | $207 | $276 | 2.1× |
| X-Ray Exam Hips Bi 3-4 Views (73522) | $208.50 | $278 | 2.1× |
| X-Ray Exam Hips Bi 5/> Views (73523) | $507 | $676 | 5.0× |
| X-Ray Exam L-S Spine Bending (72114) | $231.75 | $309 | 2.3× |
| X-Ray Exam Neck Spine 2-3 Vw (72040) | $129 | $172 | 1.5× |
| X-Ray Exam Neck Spine 6/>Vws (72052) | $231.75 | $309 | 2.3× |
| X-Ray Exam Unilat Ribs/Chest (71101) | $162 | $216 | 1.6× |
| X-ray humerus (73060) range across 2 matching MRF lines |
$103.50–$180 | $138–$240 | varies |
| X-ray IV pyelogram (ivp) (74400) | $329.25 | $439 | 2.0× |
| X-Ray Knee Bilat Standing - Xr Knees Anteroposterior Standing Bilat (73565) | $131.25 | $175 | 1.6× |
| X-Ray Lumbar Spine 2/3 Vw - Xr Lumbar Spine 2-3 Views (72100) range across 2 matching MRF lines |
$168.75–$201 | $225–$268 | varies |
| X-Ray Ribs, Chest 4+ Vw - Xr Ribs 3 Vws Bil W/ Chest Posteroanterior (71111) | $203.25 | $271 | 2.0× |
| X-Ray Sacroiliac Jts 3+ Vw - Xr Sacroiliac Joints 3+ Views (72202) | $118.50 | $158 | 1.2× |
| X-Ray Sacroiliac Jts <3 Vw - Xr Sacroiliac Joints 1-2 Views (72200) | $193.50 | $258 | 1.9× |
| X-Ray Sacrum/Coccyx 2+ Vw - Xr Sacrum Coccyx 2+ Views (72220) | $118.50 | $158 | 1.4× |
| X-Ray Sinuses 3+ Vw - Xr Paranasal Sinuses 3+ Views (70220) | $129 | $172 | 1.5× |
| X-Ray Skull 4+ Vw - Xr Skull Complete 4+ Views (70260) | $194.25 | $259 | 1.9× |
| X-Ray Stress View (77071) range across 2 matching MRF lines |
$118.50–$144.75 | $158–$193 | varies |
| X-ray thoracic spine 4 vw (72074) | $190.50 | $254 | 1.9× |
| X-Ray Tmj Unilat (70328) range across 2 matching MRF lines |
$75–$225 | $100–$300 | varies |
| X-Ray Urinary Tract Exam With Contrast Material (74420) range across 2 matching MRF lines |
$281.25–$636 | $375–$848 | varies |
| X-Rays Bone Length Studies (77073) | $154.50 | $206 | 1.5× |
| X-Rays Bone Survey Complete (77075) | $415.50 | $554 | 4.1× |
| Xr c-spine 4 or 5 views (72050) | $181.50 | $242 | 1.8× |
| Xr facial bones less than 3 views (70140) range across 2 matching MRF lines |
$117.75–$225 | $157–$300 | varies |
| Xr orbits complete 4 views (70200) | $118.50 | $158 | 1.2× |
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.