Imaging prices at Northwest Health- Porter
Valparaiso, IN · every code in this section with a posted price and a Medicare benchmark.
291 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) | $1,498.50 | $5,550 | 1.0× |
| Abdomen 1 View (74018) | $186.03 | $689 | 2.0× |
| Abdomen 2 views (74019) | $186.03 | $689 | 1.7× |
| Acute Gastrointestinal Blood Loss Imaging (78278) | $710.37 | $2,631 | 1.7× |
| Angio pulmonary bilat (75743) range across 6 matching MRF lines |
$2,780.50–$2,919.51 | $10,298.13–$10,813 | varies |
| Angiography extremity bilateral rs&i (75716) | $3,005.10 | $11,130 | 0.9× |
| Angiography extremity unilateral rs&i (75710) | $3,005.10 | $11,130 | 0.9× |
| Angiography pulmonary unilateral slctv rs&i (75741) range across 10 matching MRF lines |
$2,611.90–$2,742.39 | $9,673.70–$10,157 | varies |
| Angrph pulmonary nonslctv cath/ven njx rs&i (75746) range across 4 matching MRF lines |
$4,541.93–$4,769.01 | $16,821.95–$17,663 | varies |
| Ankle 2 views (73600) | $153.36 | $568 | 1.7× |
| Aortography thoracic serialography rs&i (75605) unusually low: confirm this is the full procedure |
$2,725.11 | $10,093 | 0.5× |
| Artery X-Rays Abdomen (75726) unusually low: confirm this is the full procedure |
$2,742.39 | $10,157 | 0.5× |
| Artery X-Rays Pelvis (75736) unusually low: confirm this is the full procedure |
$2,742.39 | $10,157 | 0.5× |
| Artery X-Rays Spine (75705) | $7,839.72 | $29,036 | 1.3× |
| Arthrogram ankle (73615) | $1,011.15 | $3,745 | 2.7× |
| Arthrogram hip (73525) | $730.62 | $2,706 | 2.0× |
| Arthrogram Wrist (73115) | $858.60 | $3,180 | 2.3× |
| Basic radiation dosimetry calculation (77300) | $223.56 | $828 | 1.6× |
| Bone age studies (77072) | $153.36 | $568 | 1.4× |
| Bone Imaging 3 Phase (78315) | $1,819.53 | $6,739 | 4.3× |
| Bone Imaging Limited Area (78300) | $710.10 | $2,630 | 1.7× |
| Bone Imaging Whole Body (78306) | $1,579.50 | $5,850 | 3.7× |
| Bone survey infant (77076) range across 4 matching MRF lines |
$13.50–$262.44 | $50–$972 | varies |
| Brain Image W/Flow < 4 Views (78601) | $1,030.59 | $3,817 | 2.4× |
| Brain Imaging Pet Metabolic Evaluation (78608) | $2,694.33 | $9,979 | 1.8× |
| Cardiac MRI w/w/o contrast & further seq (75561) | $1,034.10 | $3,830 | 2.8× |
| Cat Scan Follow-Up Study (76380) | $256.23 | $949 | 2.8× |
| Cerebrospinal Fluid Scan (78630) | $2,084.40 | $7,720 | 3.6× |
| Chest 1 view (71045) | $152.82 | $566 | 1.7× |
| Chest 2 views (71046) range across 7 matching MRF lines |
$268.32–$281.61 | $993.77–$1,043 | varies |
| Chest 3 views (71047) range across 4 matching MRF lines |
$346.48–$363.69 | $1,283.25–$1,347 | varies |
| Chest 4 or more views (71048) | $281.61 | $1,043 | 2.5× |
| Cineradiograpy/vidradiograpy xcpt where spec (76120) | $181.71 | $673 | 1.6× |
| Clavicle complete (73000) | $220.05 | $815 | 2.4× |
| Computed Tomography Thorax Lw Dose Lng Ca Scr C- (71271) | $147.42 | $546 | 1.3× |
| Continuing medical physics consltj pr wk (77336) | $277.56 | $1,028 | 2.0× |
| Contrast Exam Abdominl Aorta (75625) range across 5 matching MRF lines |
$2,595.43–$2,725.11 | $9,612.70–$10,093 | varies |
| Contrast X-Ray Bladder (74430) | $537.30 | $1,990 | 1.5× |
| Contrast X-Ray Of Elbow (73085) | $1,011.15 | $3,745 | 2.7× |
| Contrast X-Ray Of Knee Joint (73580) | $858.60 | $3,180 | 2.3× |
| CT abdomen and pelvis without and with contrast (74178) | $4,727.16 | $17,508 | 12.8× |
| CT abdomen and pelvis without contrast (74176) | $2,447.55 | $9,065 | 9.7× |
| CT abdomen w contrast (74160) | $1,692.90 | $6,270 | 9.1× |
| CT abdomen w wo contrast (74170) | $2,171.88 | $8,044 | 11.7× |
| CT abdomen w/o contrast (74150) | $1,224.18 | $4,534 | 11.1× |
| CT Angio Abdomen and Pelvis (74174) | $3,228.93 | $11,959 | 8.7× |
| CT Angio Chest (71275) | $1,726.92 | $6,396 | 9.3× |
| CT Angio Head (70496) range across 3 matching MRF lines |
$1,644.64–$1,726.92 | $6,091.26–$6,396 | varies |
| CT angio hrt w/3d image (75574) | $1,174.77 | $4,351 | 3.2× |
| CT Angio Neck (70498) range across 3 matching MRF lines |
$1,644.64–$1,726.92 | $6,091.26–$6,396 | varies |
| Ct Angio Upr Extrm W/O&W/Dye (73206) | $880.74 | $3,262 | 4.7× |
| CT cervical spine w/ contrast (72126) | $1,545.21 | $5,723 | 4.2× |
| CT cervical spine w/o contrast (72125) | $1,224.18 | $4,534 | 11.1× |
| CT cervical spine w/wo cont (72127) range across 2 matching MRF lines |
$2,171.88–$2,280.42 | $8,044–$8,446 | varies |
| CT chest w contrast (71260) | $1,692.90 | $6,270 | 9.1× |
| CT chest w/wo contrast (71270) | $2,171.88 | $8,044 | 11.7× |
| CT head/brain with contrast (70460) | $1,733.67 | $6,421 | 9.3× |
| CT head/brain without and with contrast (70470) | $1,820.34 | $6,742 | 9.8× |
| CT heart no contrast quant eval coronry calcium (75571) | $362.34 | $1,342 | 3.9× |
| CT iac w contrast (70481) | $1,224.18 | $4,534 | 6.6× |
| CT l-spine w&w/o contrast (72133) range across 2 matching MRF lines |
$1,093.50–$2,171.88 | $4,050–$8,044 | varies |
| CT lower ext w/o (73700) | $1,422.09 | $5,267 | 12.9× |
| CT lower extremity w/contrast material (73701) | $1,513.89 | $5,607 | 8.2× |
| CT lumbar spine w contrast (72132) | $1,545.21 | $5,723 | 4.2× |
| CT lumbar spine w/o contrast (72131) | $1,224.18 | $4,534 | 11.1× |
| CT maxillofacial w contrast (70487) | $1,096.20 | $4,060 | 5.9× |
| CT maxillofacial wo contrast (70486) | $1,224.18 | $4,534 | 11.1× |
| CT neck tissue combo (70492) | $2,171.88 | $8,044 | 11.7× |
| Ct Orbit/Ear/Fossa W/O&W/Dye (70482) | $1,545.21 | $5,723 | 8.3× |
| CT orbits w/o contrast (70480) | $1,224.18 | $4,534 | 11.1× |
| CT pelvis w&w/o contrast (72194) | $2,555.28 | $9,464 | 13.8× |
| CT pelvis w/o contrast (72192) | $1,224.18 | $4,534 | 11.1× |
| CT scan of leg combo (73702) | $1,635.39 | $6,057 | 8.8× |
| CT scans face/jaw combo (70488) | $1,456.38 | $5,394 | 7.8× |
| CT soft tissue neck w contrast (70491) | $1,540.08 | $5,704 | 8.3× |
| CT soft tissue neck w/o contrast (70490) | $1,224.18 | $4,534 | 11.1× |
| CT thoracic spine w contrast (72129) | $1,545.21 | $5,723 | 8.3× |
| CT thoracic spine w/o contrast (72128) | $1,224.18 | $4,534 | 11.1× |
| CT thoracic spine w/wo cont (72130) | $1,816.56 | $6,728 | 9.8× |
| CT thorax w/o contrast (71250) | $1,224.18 | $4,534 | 11.1× |
| CT upper ext wo (73200) | $686.07 | $2,541 | 6.2× |
| CT upper extremity w/o & w/contrast material (73202) | $1,422.09 | $5,267 | 7.7× |
| CT upper extremity with contrast (73201) | $1,422.09 | $5,267 | 3.9× |
| Cta Abdl Aorta&Bi Iliofem W/Contrast&Postp (75635) | $1,085.67 | $4,021 | 5.9× |
| Cta Abdomen (74175) | $1,726.92 | $6,396 | 9.3× |
| CTA head&neck c+ w/noncontrast img&post-pxessing (70471) | $1,813.27 | $6,715.80 | 4.9× |
| CTA pelvis (72191) | $1,726.92 | $6,396 | 9.3× |
| Dilation ureters/urethra rs&i (74485) | $2,154.06 | $7,978 | 1.0× |
| Doppler Fetal Mid Cerebral Artery (76821) | $159.84 | $592 | 1.4× |
| Dxa Bone Density Axial (77080) | $294.84 | $1,092 | 2.7× |
| Dxa bone density study 1/>sites appendiclr skel (77081) | $130.41 | $483 | 1.4× |
| Echo exam uterus (76831) | $823.23 | $3,049 | 3.3× |
| Echo Guide For Artery Repair (76936) | $796.50 | $2,950 | 3.5× |
| Esophagram (74220) | $334.53 | $1,239 | 1.8× |
| Fetal Biophys Profile W/Nst (76818) range across 2 matching MRF lines |
$171.18–$180.36 | $634–$668 | varies |
| Fetal Biophysical Profile W/O Non-Stress Testing (76819) | $718.47 | $2,661 | 6.5× |
| Fluoroscopy up to 1 hr (76000) | $549.72 | $2,036 | 2.2× |
| Foot 2 views (73620) | $153.36 | $568 | 1.7× |
| Forearm 2 views (73090) | $220.05 | $815 | 2.4× |
| Gastric emptying imaging study (78264) | $1,197.72 | $4,436 | 2.8× |
| Gated Heart Planar Single (78472) | $803.25 | $2,975 | 1.9× |
| Hand 2 views (73120) | $153.36 | $568 | 1.4× |
| Hepatc Vngrph Wdg/Fr Hemodyn Eval Rs&I (75889) range across 2 matching MRF lines |
$2,560.14–$4,769.01 | $9,482–$17,663 | varies |
| Hepatc Vngrph Wdg/Fr W/O Hemodyn Eval Rs&I (75891) | $2,560.14 | $9,482 | 0.8× |
| Hepatobil Syst Image W/Drug (78227) | $1,030.59 | $3,817 | 1.8× |
| Hepatobiliary System Imaging (78226) | $1,030.59 | $3,817 | 2.4× |
| Ht Muscle Image Spect Sing (78451) | $928.26 | $3,438 | 0.7× |
| Hysterosalpingogram (74740) | $791.64 | $2,932 | 3.1× |
| Infant hip ultrasound with hip movement (dynamic) (76885) | $340.74 | $1,262 | 3.7× |
| K Flow/Funct Image W/Drug (78708) | $960.39 | $3,557 | 1.7× |
| K Flow/Funct Image W/O Drug (78707) | $960.39 | $3,557 | 1.7× |
| Knee 3 Views (73562) | $220.05 | $815 | 2.4× |
| Lung Ventilat&Perfus Imaging (78582) | $747.63 | $2,769 | 1.3× |
| Lymph System Imaging (78195) | $798.39 | $2,957 | 1.4× |
| Magnetic Image Jaw Joint (70336) | $1,530.63 | $5,669 | 6.1× |
| Mlc imrt design & construction per imrt plan (77338) | $1,801.98 | $6,674 | 4.5× |
| Mra Head W/O & W/Contrast Material (70546) | $1,661.58 | $6,154 | 4.5× |
| MRA head w/o contrast (70544) | $1,254.69 | $4,647 | 5.0× |
| MRA neck w contrast (70548) | $1,457.19 | $5,397 | 3.9× |
| Mra Neck W/O &W/Contrast Material (70549) | $1,661.58 | $6,154 | 4.5× |
| MRA neck w/o contrast (70547) | $1,254.69 | $4,647 | 5.0× |
| MRI abdomen w contrast (74182) | $1,876.50 | $6,950 | 5.1× |
| MRI abdomen w/o contrast (74181) | $1,626.75 | $6,025 | 6.4× |
| MRI any jt lower extrem w/contrast material (73722) | $1,348.65 | $4,995 | 1.6× |
| MRI any jt lower extrem w/o & w/contrast matrl (73723) | $2,534.76 | $9,388 | 6.9× |
| MRI any jt upper extremity w/contrast matrl (73222) | $1,537.65 | $5,695 | 1.9× |
| MRI Breast W/O Contrast Bilateral (77047) | $1,513.89 | $5,607 | 6.0× |
| MRI cardiac w/o contrast (75557) | $939.33 | $3,479 | 3.7× |
| MRI cervical spine w contrast (72142) | $1,605.69 | $5,947 | 4.4× |
| MRI cervical spine w/o cont (72141) | $1,529.82 | $5,666 | 6.1× |
| MRI chest w/o contrast (71550) | $1,951.56 | $7,228 | 7.7× |
| MRI chest wo w contrast (71552) | $2,721.87 | $10,081 | 7.4× |
| MRI lower extrem oth/thn jt w/o & w/contr matr (73720) | $2,570.40 | $9,520 | 7.0× |
| MRI lower extrem oth/thn jt w/o contr matrl (73718) | $1,116.45 | $4,135 | 4.4× |
| MRI lumbar spine w contrast (72149) | $1,826.55 | $6,765 | 4.9× |
| Mri Neck Spine W/O & W/Dye (72156) | $2,640.33 | $9,779 | 7.2× |
| MRI orbit face &/neck w/o contrast (70540) range across 9 matching MRF lines |
$1,537.92–$1,677.51 | $5,696–$6,213 | varies |
| MRI orbit face neck w contrast (70542) | $2,069.55 | $7,665 | 5.6× |
| Mri Orbt/Fac/Nck W/O &W/Dye (70543) range across 7 matching MRF lines |
$2,367.63–$2,412.45 | $8,769–$8,935 | varies |
| MRI pelvis w/o & w contrast (72197) | $2,574.99 | $9,537 | 7.0× |
| MRI pelvis w/o contrast (72195) | $1,428.84 | $5,292 | 5.7× |
| MRI thoracic spine w/o contrast (72146) | $1,530.36 | $5,668 | 6.1× |
| MRI upper extremity oth than jt w/o contr matrl (73218) | $990.36 | $3,668 | 3.9× |
| Mri Uppr Extremity W/O&W/Dye (73220) | $2,526.66 | $9,358 | 6.8× |
| MRI, abdomen, combo (74183) | $2,395.71 | $8,873 | 6.5× |
| MRI, dorsal spine combo (72157) | $2,412.45 | $8,935 | 6.5× |
| MRI, dorsal spine contrast (72147) | $1,757.16 | $6,508 | 4.8× |
| MRI, joint upper extrem (73221) | $1,392.12 | $5,156 | 5.5× |
| MRI, joint upper extrem combo (73223) | $2,297.97 | $8,511 | 6.2× |
| MRI, lumbar spine combo (72158) | $2,529.36 | $9,368 | 6.9× |
| Myocardial Spect Multiple Studies (78452) | $1,859.76 | $6,888 | 1.4× |
| N-invas est c ffr sw aly CTA (75580) | $2,388.15 | $8,845 | 2.6× |
| Neck soft tissue (70360) | $153.36 | $568 | 1.7× |
| Nonvascular Shunt X-Ray (75809) | $238.95 | $885 | 2.2× |
| Ntsty modul radthx pln dose-vol histos (77301) | $2,830.95 | $10,485 | 1.9× |
| Nuclear Rx Intra-Arterial (79445) range across 4 matching MRF lines |
$343.98–$399.87 | $1,274–$1,481 | varies |
| Nuclear Rx Oral Admin (79005) | $825.93 | $3,059 | 3.3× |
| Parathyroid Planar Imaging (78070) | $989.82 | $3,666 | 2.3× |
| Pelvis 1 or 2 views (72170) | $155.52 | $576 | 1.4× |
| Pet Image W/Ct Lmtd (78814) range across 6 matching MRF lines |
$2,429.31–$2,694.33 | $8,997.45–$9,979 | varies |
| PET image w/CT, full body (78816) | $2,694.33 | $9,979 | 1.8× |
| PET imaging CT attenuation skull base mid-thigh (78815) | $2,694.33 | $9,979 | 1.8× |
| Pulmonary Perfusion Imaging Particulate (78580) | $647.73 | $2,399 | 1.5× |
| Radex Abd Compl Aqt Abd W/S/E/D Views 1 View Ch (74022) | $262.17 | $971 | 2.4× |
| Radex abscess/fistula/sinus tract rs&i (76080) | $356.94 | $1,322 | 0.6× |
| Radex Ankle Complete Minimum 3 Views (73610) range across 6 matching MRF lines |
$220.05–$439.83 | $815–$1,629 | varies |
| Radex Calcaneus Minimum 2 Views (73650) | $153.36 | $568 | 1.7× |
| Radex elbow complete minimum 3 views (73080) | $220.05 | $815 | 2.4× |
| Radex Facial Bones Complete Minimum 3 Views (70150) | $220.05 | $815 | 2.0× |
| Radex fingr minimum 2 views (73140) | $153.36 | $568 | 1.7× |
| Radex foot complete minimum 3 views (73630) | $220.05 | $815 | 2.4× |
| Radex Hand Minimum 3 Views (73130) | $220.05 | $815 | 2.4× |
| Radex lower extremity infant minimum 2 views (73592) range across 3 matching MRF lines |
$153.36–$307.53 | $568–$1,139 | varies |
| Radex Mastoids Compl Minimum 3 Views PR Side (70130) | $105.57 | $391 | 1.0× |
| Radex Nasal Bones Complete Minimum 3 Views (70160) | $220.05 | $815 | 2.4× |
| Radex Ribs Unilateral 2 Views (71100) | $237.33 | $879 | 2.6× |
| Radex shoulder complete minimum 2 views (73030) | $220.05 | $815 | 2.4× |
| Radex Sinuses Paransl < 3 Views (70210) | $294.03 | $1,089 | 3.2× |
| Radex Spine 1 View Specify Level (72020) | $201.96 | $748 | 2.2× |
| Radex Sternum Minimum 2 Views (71120) | $195.21 | $723 | 2.1× |
| Radex Temporomandble Jt Opn & Clsd Mouth Bilat (70330) | $220.05 | $815 | 2.4× |
| Radex Toe Minimum 2 Views (73660) | $153.36 | $568 | 1.7× |
| Radex upper extremity infant minimum 2 views (73092) | $153.36 | $568 | 1.4× |
| Radex Wrist Complete Minimum 3 Views (73110) | $220.05 | $815 | 2.4× |
| Radiation treatment delivery level 1 (77402) | $248.40 | $920 | 2.3× |
| Radiation treatment delivery level 3 (77412) | $402.57 | $1,491 | 0.7× |
| Radiolog exam mandible compl minimum 4 views (70110) | $269.73 | $999 | 2.4× |
| Radiologic Exam Abdomen 3+ Views - Xr Abdomen 3+ Views (74021) range across 5 matching MRF lines |
$186.03–$214.11 | $689–$793 | varies |
| Radiologic exam colon double contrast study (74280) | $733.86 | $2,718 | 4.0× |
| Radiologic exam colon single contrast study (74270) | $486 | $1,800 | 2.6× |
| Radiologic Exam Esophagus Double Contrast Study (74221) | $334.53 | $1,239 | 1.8× |
| Radiologic exam knee complete 4/more views (73564) | $245.16 | $908 | 2.2× |
| Radiologic exam pelvis compl minimum 3 views (72190) | $195.21 | $723 | 1.8× |
| Radiologic Exam Small Int Single Contrast Study (74250) | $426.60 | $1,580 | 2.3× |
| Radiologic exam swallow function contrast study (74230) | $316.44 | $1,172 | 1.7× |
| Radiologic exam upr gi trc double contrast study (74246) | $546.75 | $2,025 | 2.9× |
| Radiologic examination femur 1 view (73551) | $160.65 | $595 | 1.7× |
| Radiologic examination femur minimum 2 views (73552) range across 5 matching MRF lines |
$321.03–$640.44 | $1,189–$2,372 | varies |
| Radiologic examination knee 1/2 views (73560) | $153.36 | $568 | 1.7× |
| Radiologic examination tibia & fibula 2 views (73590) range across 6 matching MRF lines |
$153.36–$307.53 | $568–$1,139 | varies |
| Ribs bilateral 3 views (71110) | $426.60 | $1,580 | 3.9× |
| Rp Loclzj Tum Plnr Whole Body 2+ Days Imaging (78804) | $1,634.31 | $6,053 | 2.8× |
| Rp Loclzj Tum Plnr Whole Body Single Day Imaging (78802) | $2,035.53 | $7,539 | 3.5× |
| Rp Loclzj Tum Spect 1 Area Single Day Imaging (78803) | $1,228.77 | $4,551 | 2.1× |
| Scapula (73010) | $153.36 | $568 | 1.4× |
| Screening Digital Breast Tomosynthesis Bi (77063) range across 10 matching MRF lines |
$20.79–$198.99 | $77–$737 | varies |
| Shoulder 1 view (73020) | $153.36 | $568 | 1.7× |
| Shoulder Arthrography (73040) | $653.40 | $2,420 | 1.8× |
| Skull less than 4 views (70250) | $269.73 | $999 | 2.4× |
| Special dosimetry (77331) | $244.89 | $907 | 1.7× |
| Special Physics Consult (77370) | $207.63 | $769 | 1.5× |
| Special teletherapy port plan (77321) | $676.89 | $2,507 | 1.7× |
| Special treatment procedure (77470) | $611.82 | $2,266 | 1.0× |
| Stereotactic Body Radiation Delivery (77373) | $2,862 | $10,600 | 1.5× |
| Sternoclavicular joints (71130) | $205.74 | $762 | 2.2× |
| Telethx isodose pln cplx w/basic dosimetry (77307) | $445.77 | $1,651 | 1.1× |
| Ther Rad Simulaj-Aided Field Setting Complex (77290) | $783.54 | $2,902 | 2.0× |
| Ther rad simulaj-aided field setting simple (77280) | $341.55 | $1,265 | 2.4× |
| Thoracic spine 3 views (72072) | $270.81 | $1,003 | 2.4× |
| Thyroid Met Imaging Body (78018) | $953.10 | $3,530 | 1.7× |
| Thyroid Uptake W/Blood Flow Sngle/Mult Quan Meas (78014) | $742.50 | $2,750 | 1.8× |
| Tx Devices Design & Construction Complex (77334) | $582.93 | $2,159 | 1.5× |
| Ultrasound Breast Limited (76642) range across 5 matching MRF lines |
$464.67–$930.15 | $1,721–$3,445 | varies |
| Ultrasound Elastography Parenchyma (76981) | $420.93 | $1,559 | 3.8× |
| Ultrasound Exam Aaa Screen (76706) | $225.72 | $836 | 2.0× |
| Ultrasound, abdomen limited (76705) | $461.70 | $1,710 | 4.2× |
| Umbilical-artery Doppler (OB) (76820) | $315.36 | $1,168 | 2.9× |
| Upper gi w/o kub (74240) | $490.86 | $1,818 | 2.6× |
| Urethrocystogram voiding (74455) | $537.30 | $1,990 | 2.1× |
| Urethrocystography retrograde (74450) | $368.82 | $1,366 | 1.5× |
| Us breast unilateral complete (76641) range across 7 matching MRF lines |
$464.67–$930.15 | $1,721–$3,445 | varies |
| Us chest (76604) | $302.67 | $1,121 | 2.7× |
| Us complete joint (76881) range across 4 matching MRF lines |
$370.17–$740.61 | $1,371–$2,743 | varies |
| Us exam, pelvic, limited (76857) | $264.33 | $979 | 2.4× |
| Us head (76506) | $303.75 | $1,125 | 2.7× |
| Us kidney transplant (76776) | $376.38 | $1,394 | 3.4× |
| Us lmtd joint/oth nonvasc xtr strux r-t w/img (76882) range across 5 matching MRF lines |
$123.66–$246.78 | $458–$914 | varies |
| Us ob detailed single fetus (76811) | $822.96 | $3,048 | 3.3× |
| Us ob limited 1 or more fetuses (76815) | $228.96 | $848 | 2.1× |
| Us ob transvaginal (76817) | $537.03 | $1,989 | 4.9× |
| Us pelvic non ob complete (76856) | $637.47 | $2,361 | 5.8× |
| Us pg uter img f&mat 14 wk tabdl 1/1st gestation (76801) | $692.01 | $2,563 | 6.3× |
| Us preg uterus real time f/u trnsabdl per fetus (76816) | $355.05 | $1,315 | 3.2× |
| Us retroperitoneal complete (76770) | $686.07 | $2,541 | 6.2× |
| Us retroperitoneal limited (76775) | $461.70 | $1,710 | 4.2× |
| Us scrotum and contents (76870) | $303.75 | $1,125 | 2.7× |
| Us spinal canal and contents (76800) | $309.15 | $1,145 | 2.8× |
| Us thyroid (76536) | $536.49 | $1,987 | 4.9× |
| Us transrectal (76872) | $365.31 | $1,353 | 3.3× |
| Vein X-Ray Chest (75827) | $1,636.74 | $6,062 | 1.0× |
| Vein X-Ray Liver W/O Hemodyn (75887) | $2,725.11 | $10,093 | 0.8× |
| Venography caval inferior serialography rs&i (75825) | $2,742.39 | $10,157 | 0.8× |
| Venography extremity bilateral rs&i (75822) | $1,701 | $6,300 | 1.0× |
| Venography extremity unilateral rs&i (75820) range across 10 matching MRF lines |
$1,246.06–$1,308.42 | $4,615.03–$4,846 | varies |
| Venography Renal Bilateral (75833) | $3,632.58 | $13,454 | 1.1× |
| Venography Renal Unilateral (75831) | $3,632.58 | $13,454 | 1.1× |
| Wrist 2 views (73100) | $153.36 | $568 | 1.7× |
| X-Ray Ac Jts - Xr Acromioclavicular Joints Bilateral (73050) | $245.16 | $908 | 2.7× |
| X-Ray Aorta Leg Arteries (75630) | $2,725.11 | $10,093 | 0.8× |
| X-Ray Bend Only L-S Spine (72120) | $270.81 | $1,003 | 2.4× |
| X-Ray Elbow 2 Vw - Xr Elbow 1-2 Views Right (73070) range across 5 matching MRF lines |
$156.92–$164.70 | $581.18–$610 | varies |
| X-Ray Exam Breast Specimen (76098) | $235.71 | $873 | 0.4× |
| X-Ray Exam Entire Spi 1 Vw (72081) | $308.88 | $1,144 | 3.4× |
| X-Ray Exam Entire Spi 2/3 Vw (72082) | $308.88 | $1,144 | 2.8× |
| X-Ray Exam Hip Uni 1 View (73501) | $153.36 | $568 | 1.7× |
| X-Ray Exam Hip Uni 2-3 Views (73502) | $220.05 | $815 | 2.4× |
| X-Ray Exam Hip Uni 4/> Views (73503) | $330.48 | $1,224 | 3.0× |
| X-Ray Exam Hips Bi 2 Views (73521) | $367.20 | $1,360 | 3.3× |
| X-Ray Exam Hips Bi 3-4 Views (73522) | $367.20 | $1,360 | 3.3× |
| X-Ray Exam Hips Bi 5/> Views (73523) | $734.13 | $2,719 | 6.6× |
| X-Ray Exam L-S Spine Bending (72114) | $608.85 | $2,255 | 5.5× |
| X-Ray Exam Neck Spine 2-3 Vw (72040) | $250.29 | $927 | 2.7× |
| X-Ray Exam Neck Spine 6/>Vws (72052) | $388.26 | $1,438 | 3.5× |
| X-Ray Exam Unilat Ribs/Chest (71101) | $237.33 | $879 | 2.1× |
| X-ray humerus (73060) | $153.36 | $568 | 1.7× |
| X-Ray Jaw <4 Vw - Xr Mandible < 4 Views (70100) | $269.73 | $999 | 2.9× |
| X-Ray Lumbar Spine 2/3 Vw - Xr Lumbar Spine 2-3 Views (72100) | $270.81 | $1,003 | 2.4× |
| X-ray nose-rectum child f.b. (76010) | $180.36 | $668 | 2.0× |
| X-Ray Ribs, Chest 4+ Vw - Xr Ribs 3 Vws Bil W/ Chest Posteroanterior (71111) | $426.60 | $1,580 | 3.9× |
| X-Ray Sacroiliac Jts 3+ Vw - Xr Sacroiliac Joints 3+ Views (72202) | $261.36 | $968 | 2.4× |
| X-Ray Sacroiliac Jts <3 Vw - Xr Sacroiliac Joints 1-2 Views (72200) | $181.71 | $673 | 1.6× |
| X-Ray Sacrum/Coccyx 2+ Vw - Xr Sacrum Coccyx 2+ Views (72220) | $195.21 | $723 | 2.1× |
| X-Ray Sinuses 3+ Vw - Xr Paranasal Sinuses 3+ Views (70220) | $220.05 | $815 | 2.4× |
| X-Ray Skull 4+ Vw - Xr Skull Complete 4+ Views (70260) | $269.73 | $999 | 2.4× |
| X-Ray Urinary Tract Exam With Contrast Material (74420) | $602.10 | $2,230 | 1.6× |
| X-Rays Bone Length Studies (77073) | $262.17 | $971 | 2.4× |
| X-Rays Bone Survey Complete (77075) range across 3 matching MRF lines |
$13.50–$639.63 | $50–$2,369 | varies |
| Xr c-spine 4 or 5 views (72050) | $330.75 | $1,225 | 3.0× |
| Xr facial bones less than 3 views (70140) | $180.36 | $668 | 2.0× |
| XR Mastoids < 3 Views Bilateral (70120) | $105.57 | $391 | 1.0× |
| Xr orbits complete 4 views (70200) | $220.05 | $815 | 2.0× |
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.