Imaging prices at Novant Health Forsyth Medical Center
Winston-Salem, NC · every code in this section with a posted price and a Medicare benchmark.
422 codes. Prices are the hospital's own posted facility charges.
Compare against other hospitals interactively →
| Procedure | Posted cash | Posted gross | × Medicare |
|---|---|---|---|
| Abdomen 1 View (74018) | $169.80 | $283 | 2.0× |
| Abdomen 2 views (74019) | $201 | $335 | 2.0× |
| Acute Gastrointestinal Blood Loss Imaging (78278) | $897 | $1,495 | 2.3× |
| Acute venous thrombosis imaging, peptide Non-Facility (78456) | $1,561.82 | $2,603.04 | 1.2× |
| Angio internal mammary (75756) range across 2 matching MRF lines |
$2,435.40–$2,801.40 | $4,059–$4,669 | varies |
| Angio pulmonary bilat (75743) | $3,079.80 | $5,133 | 1.0× |
| Angiography Adrenal Bilateral Slctv Rs&I (75733) | $3,220.20 | $5,367 | 1.1× |
| Angiography extremity bilateral rs&i (75716) | $3,712.20 | $6,187 | 1.2× |
| Angiography extremity unilateral rs&i (75710) | $3,373.20 | $5,622 | 1.1× |
| Angiography pulmonary unilateral slctv rs&i (75741) | $2,300.40 | $3,834 | 0.8× |
| Angrph pulmonary nonslctv cath/ven njx rs&i (75746) | $1,964.40 | $3,274 | 0.6× |
| Ankle 2 views (73600) range across 2 matching MRF lines |
$123–$201 | $205–$335 | varies |
| Aortography thoracic serialography rs&i (75605) range across 2 matching MRF lines |
$3,525–$8,433 | $5,875–$14,055 | varies |
| Artery X-Rays Abdomen (75726) | $3,712.20 | $6,187 | 0.7× |
| Artery X-Rays Adrenal Gland (75731) | $2,611.80 | $4,353 | 0.9× |
| Artery X-Rays Pelvis (75736) | $3,373.20 | $5,622 | 0.6× |
| Artery X-Rays Spine (75705) | $3,373.20 | $5,622 | 0.6× |
| Arthrogram ankle (73615) | $326.40 | $544 | 1.0× |
| Arthrogram hip (73525) | $384.60 | $641 | 1.1× |
| Arthrogram Wrist (73115) | $540 | $900 | 1.6× |
| Bone age studies (77072) | $140.40 | $234 | 1.4× |
| Bone Imaging 3 Phase (78315) | $1,206 | $2,010 | 3.1× |
| Bone Imaging Limited Area (78300) | $603 | $1,005 | 1.6× |
| Bone Imaging Multiple Areas (78305) | $724.20 | $1,207 | 1.9× |
| Bone Imaging Whole Body (78306) | $1,193.40 | $1,989 | 3.1× |
| Bone marrow imaging limited area (78102) | $921 | $1,535 | 2.4× |
| Bone marrow imaging; multiple areas (78103) | $1,237.20 | $2,062 | 3.2× |
| Bone marrow imaging; whole body (78104) | $522 | $870 | 1.3× |
| Bone survey infant (77076) | $201 | $335 | 2.0× |
| Brain Flow Imaging Only (78610) | $1,309.80 | $2,183 | 2.5× |
| Brain Image W/Flow < 4 Views (78601) | $1,135.80 | $1,893 | 2.9× |
| Brain imaging < 4 static views (78600) | $540 | $900 | 1.4× |
| Brain Imaging Min 4 Static Views W Vascular Flow (78606) | $1,217.40 | $2,029 | 2.3× |
| Brain Imaging Minimum 4 Static Views (78605) | $873.60 | $1,456 | 1.7× |
| Card Bl Pool Gated Spect Rest Wal Motn Ejct Frct (78494) | $924 | $1,540 | 2.4× |
| Cardiac MRI w/w/o contrast & further seq (75561) range across 2 matching MRF lines |
$1,650–$1,764 | $2,750–$2,940 | varies |
| Cardiac MRI w/w/o contrast w/stress (75563) | $1,800.60 | $3,001 | 2.4× |
| Cardiac Shunt Detection (78428) | $979.80 | $1,633 | 2.5× |
| Cat Scan Follow-Up Study (76380) | $305.40 | $509 | 3.6× |
| Cerebrospinal Fluid Flow W/O Matl Shunt Evaltj (78645) | $1,217.40 | $2,029 | 2.3× |
| Cerebrospinal Fluid Scan (78630) | $1,144.20 | $1,907 | 2.2× |
| Chest 1 view (71045) | $169.80 | $283 | 2.0× |
| Chest 2 views (71046) range across 2 matching MRF lines |
$201–$1,569.60 | $335–$2,616 | varies |
| Chest 3 views (71047) | $241.80 | $403 | 2.9× |
| Chest 4 or more views (71048) | $256.80 | $428 | 2.5× |
| Cholecystography Oral Contrast (74290) | $266.40 | $444 | 1.6× |
| Cineradiograpy/vidradiograpy xcpt where spec (76120) | $225.60 | $376 | 2.2× |
| Clavicle complete (73000) | $169.80 | $283 | 2.0× |
| Computed Tomography Thorax Lw Dose Lng Ca Scr C- (71271) | $219.60 | $366 | 2.2× |
| Contrast Exam Abdominl Aorta (75625) | $2,318.40 | $3,864 | 0.8× |
| Contrast X-Ray Bladder (74430) | $241.80 | $403 | 0.7× |
| Contrast X-Ray Of Elbow (73085) | $465.60 | $776 | 1.4× |
| Contrast X-Ray Of Knee Joint (73580) | $461.40 | $769 | 1.4× |
| Corpora cavernosography (74445) | $452.40 | $754 | 4.5× |
| CT abdomen and pelvis without and with contrast (74178) | $2,782.20 | $4,637 | 8.2× |
| CT abdomen and pelvis without contrast (74176) | $1,963.80 | $3,273 | 8.5× |
| CT abdomen w contrast (74160) | $1,377 | $2,295 | 8.1× |
| CT abdomen w wo contrast (74170) range across 2 matching MRF lines |
$1,580.40–$1,585.80 | $2,634–$2,643 | varies |
| CT abdomen w/o contrast (74150) | $1,065.60 | $1,776 | 10.5× |
| CT Angio Abdomen and Pelvis (74174) | $2,282.40 | $3,804 | 6.7× |
| CT Angio Chest (71275) | $1,882.80 | $3,138 | 11.1× |
| CT Angio Head (70496) | $1,671 | $2,785 | 9.8× |
| CT angio hrt w/3d image (75574) range across 3 matching MRF lines |
$856.80–$1,182.60 | $1,428–$1,971 | varies |
| Ct Angio Lwr Extr W/O&W/Dye (73706) | $1,816.80 | $3,028 | 10.7× |
| CT Angio Neck (70498) | $1,687.80 | $2,813 | 9.9× |
| Ct Angio Upr Extrm W/O&W/Dye (73206) range across 2 matching MRF lines |
$1,500–$1,798.80 | $2,500–$2,998 | varies |
| CT bone density (77078) | $294.60 | $491 | 3.5× |
| CT cervical spine w/ contrast (72126) | $1,441.20 | $2,402 | 4.3× |
| CT cervical spine w/o contrast (72125) | $1,143 | $1,905 | 11.3× |
| CT cervical spine w/wo cont (72127) | $1,639.20 | $2,732 | 9.6× |
| CT chest w contrast (71260) | $1,269 | $2,115 | 7.5× |
| CT chest w/wo contrast (71270) | $1,653.60 | $2,756 | 9.7× |
| CT colonography screening (74263) range across 2 matching MRF lines |
$1,357.20–$1,429.80 | $2,262–$2,383 | varies |
| CT colonogrphy dx image postprocess w/o contrast (74261) range across 2 matching MRF lines |
$1,155–$1,414.20 | $1,925–$2,357 | varies |
| CT head/brain with contrast (70460) | $1,092 | $1,820 | 6.4× |
| CT head/brain without and with contrast (70470) | $1,254 | $2,090 | 7.4× |
| CT heart contrast eval cardiac structure&morph (75572) | $423.60 | $706 | 1.3× |
| CT heart no contrast quant eval coronry calcium (75571) | $115.39 | $192.31 | 1.4× |
| CT hrt w/3d image congen (75573) | $458.40 | $764 | 1.4× |
| CT iac w contrast (70481) | $1,227 | $2,045 | 7.2× |
| CT l-spine w&w/o contrast (72133) | $1,831.20 | $3,052 | 10.8× |
| CT lower ext w/o (73700) | $996.60 | $1,661 | 9.8× |
| CT lower extremity w/contrast material (73701) | $1,304.40 | $2,174 | 7.7× |
| CT lumbar spine w contrast (72132) | $1,468.80 | $2,448 | 4.3× |
| CT lumbar spine w/o contrast (72131) | $1,185.60 | $1,976 | 11.7× |
| CT maxillofacial w contrast (70487) | $1,074 | $1,790 | 6.3× |
| CT maxillofacial wo contrast (70486) range across 2 matching MRF lines |
$935.40–$999 | $1,559–$1,665 | varies |
| CT neck tissue combo (70492) | $1,407.60 | $2,346 | 8.3× |
| Ct Orbit/Ear/Fossa W/O&W/Dye (70482) | $1,371.60 | $2,286 | 8.1× |
| CT orbits w/o contrast (70480) | $1,086 | $1,810 | 10.7× |
| CT pelvis w&w/o contrast (72194) range across 2 matching MRF lines |
$1,221–$1,363.80 | $2,035–$2,273 | varies |
| CT pelvis w/o contrast (72192) range across 2 matching MRF lines |
$973.80–$1,018.20 | $1,623–$1,697 | varies |
| CT scan of leg combo (73702) | $1,488.60 | $2,481 | 8.8× |
| CT scans face/jaw combo (70488) | $1,475.40 | $2,459 | 8.7× |
| CT soft tissue neck w contrast (70491) | $1,275 | $2,125 | 7.5× |
| CT soft tissue neck w/o contrast (70490) | $1,036.20 | $1,727 | 10.2× |
| CT thoracic spine w contrast (72129) | $1,441.20 | $2,402 | 8.5× |
| CT thoracic spine w/o contrast (72128) | $1,143 | $1,905 | 11.3× |
| CT thoracic spine w/wo cont (72130) | $1,539 | $2,565 | 9.0× |
| CT thorax w/o contrast (71250) range across 2 matching MRF lines |
$772.80–$995.40 | $1,288–$1,659 | varies |
| CT unlisted procedure (76497) | $313.20 | $522 | 3.7× |
| CT upper ext wo (73200) | $1,143 | $1,905 | 11.3× |
| CT upper extremity w/o & w/contrast material (73202) | $1,398 | $2,330 | 8.2× |
| CT upper extremity with contrast (73201) | $1,284 | $2,140 | 3.8× |
| Cta Abdl Aorta&Bi Iliofem W/Contrast&Postp (75635) | $1,548.60 | $2,581 | 9.1× |
| Cta Abdomen (74175) | $1,430.40 | $2,384 | 8.4× |
| CTA pelvis (72191) | $1,528.20 | $2,547 | 9.0× |
| Dacryocystography, nasolacrimal duct, radiological supervision and interpretation Non-Facility (70170) range across 2 matching MRF lines |
$392.40–$426.60 | $654–$711 | varies |
| Dilation ureters/urethra rs&i (74485) range across 2 matching MRF lines |
$1,543.80–$2,314.20 | $2,573–$3,857 | varies |
| Discography Cerv/Thor Spine (72285) | $2,264.40 | $3,774 | 1.2× |
| Diskography lumbar (72295) | $3,022.80 | $5,038 | 1.6× |
| Doppler Echo Fetal Puls Spectral F/U/Repeat (76828) | $241.20 | $402 | 2.4× |
| Doppler Echo Fetal Spectral Display Complete (76827) | $523.20 | $872 | 5.2× |
| Doppler Fetal Mid Cerebral Artery (76821) | $247.20 | $412 | 2.4× |
| Dxa Bone Density Axial (77080) | $198 | $330 | 2.0× |
| Dxa bone density study (77085) | $128.40 | $214 | 1.3× |
| Dxa bone density study 1/>sites appendiclr skel (77081) | $220.80 | $368 | 2.6× |
| Echo exam of fetal heart (76825) | $1,455 | $2,425 | 2.7× |
| Echo exam uterus (76831) | $348 | $580 | 1.5× |
| Echo Guide For Artery Repair (76936) | $432.60 | $721 | 2.1× |
| Echograp Trans R Pros Study (76873) | $1,196.40 | $1,994 | 11.8× |
| Esophagram (74220) | $248.40 | $414 | 1.5× |
| Fetal Biophys Profile W/Nst (76818) range across 3 matching MRF lines |
$336–$561 | $560–$935 | varies |
| Fetal Biophysical Profile W/O Non-Stress Testing (76819) range across 3 matching MRF lines |
$307.20–$432.60 | $512–$721 | varies |
| Fetal MRI w/placntl matrnl plvc img sing/1st ges (74712) | $558 | $930 | 2.4× |
| Fluoroscopy up to 1 hr (76000) | $411 | $685 | 1.8× |
| Follow-Up Angiography (75898) | $2,454.60 | $4,091 | 0.8× |
| Foot 2 views (73620) range across 2 matching MRF lines |
$123–$201 | $205–$335 | varies |
| Forearm 2 views (73090) range across 2 matching MRF lines |
$109.20–$201 | $182–$335 | varies |
| Gastric emptying imaging study (78264) | $1,282.80 | $2,138 | 3.3× |
| Gastric Emptyng Imag Std W/Sm Bwl Transit (78265) | $1,113.60 | $1,856 | 2.9× |
| Gastroesophageal Reflux Exam (78262) | $580.20 | $967 | 1.5× |
| Gated Heart Planar Single (78472) | $1,239.60 | $2,066 | 3.2× |
| Gated Heart, Multiple (78473) | $924 | $1,540 | 2.4× |
| Gstrc Emptng Imag Std W/Sm Bwl Col Trnst Mlt Day (78266) | $3,072.60 | $5,121 | 5.8× |
| Hand 2 views (73120) range across 2 matching MRF lines |
$107.40–$201 | $179–$335 | varies |
| Hepatc Vngrph Wdg/Fr Hemodyn Eval Rs&I (75889) | $2,871.60 | $4,786 | 0.9× |
| Hepatc Vngrph Wdg/Fr W/O Hemodyn Eval Rs&I (75891) | $4,023 | $6,705 | 1.3× |
| Hepatobil Syst Image W/Drug (78227) | $1,572.60 | $2,621 | 3.0× |
| Hepatobiliary System Imaging (78226) | $1,544.40 | $2,574 | 4.0× |
| Ht Musc Image Planar Mult (78454) | $2,863.20 | $4,772 | 2.3× |
| Ht Muscle Image Spect Sing (78451) | $1,850.40 | $3,084 | 1.5× |
| Hysterosalpingogram (74740) | $514.20 | $857 | 2.2× |
| Infant hip ultrasound with hip movement (dynamic) (76885) | $240.60 | $401 | 2.9× |
| Infant hip ultrasound, limited static exam (76886) | $240.60 | $401 | 2.9× |
| Infusion Ivp (74410) | $475.20 | $792 | 2.8× |
| Joint Survey Single View (77077) range across 2 matching MRF lines |
$169.80–$184.20 | $283–$307 | varies |
| K Flow/Funct Image Multiple (78709) | $1,647 | $2,745 | 3.1× |
| K Flow/Funct Image W/Drug (78708) | $1,138.20 | $1,897 | 2.2× |
| K Flow/Funct Image W/O Drug (78707) | $1,018.20 | $1,697 | 1.9× |
| Kidney Imaging Morphol (78700) | $821.40 | $1,369 | 2.1× |
| Kidney Imaging Morphoogy W/Vascular Flow (78701) | $1,743.60 | $2,906 | 4.5× |
| Knee 3 Views (73562) | $241.80 | $403 | 2.9× |
| Labeled RBC Sequestration Differntl Organ/Tissue (78140) | $1,021.80 | $1,703 | 2.6× |
| Leveen/Shunt Patency Exam (78291) | $755.40 | $1,259 | 1.9× |
| Liver & Spleen Imaging Static Only (78215) | $762 | $1,270 | 2.0× |
| Liver & Spleen Imaging W/Vascular Flow (78216) | $927.60 | $1,546 | 2.4× |
| Liver imaging static only (78201) | $1,085.40 | $1,809 | 2.1× |
| Liver imaging w/vascular flow (78202) | $1,551 | $2,585 | 2.9× |
| Lung Perf&Ventilat Diferentl (78598) | $1,255.80 | $2,093 | 2.4× |
| Lung perfusion differential (78597) | $1,028.40 | $1,714 | 2.7× |
| Lung Ventilat&Perfus Imaging (78582) | $1,239.60 | $2,066 | 2.4× |
| Lung Ventilation Imaging (78579) | $1,080 | $1,800 | 2.8× |
| Lymph System Imaging (78195) | $1,498.20 | $2,497 | 2.8× |
| Lymphangiography Extremity Only Bilateral Rs&I (75803) | $969.60 | $1,616 | 0.6× |
| Lymphangiography extremity only unilateral rs&i (75801) | $723.60 | $1,206 | 1.2× |
| Lymphangiography Pelvic/Abdominal Bilateral Rs&I (75807) | $2,006.40 | $3,344 | 0.7× |
| Lymphangiography, pelvic/abdominal, unilateral (75805) | $1,964.40 | $3,274 | 0.6× |
| Magnetic Image Jaw Joint (70336) range across 6 matching MRF lines |
$826.80–$1,826.40 | $1,378–$3,044 | varies |
| Magnetic Resonance Elastography (76391) | $306.60 | $511 | 1.3× |
| Mammary ductogram or galactogram multiple (77054) | $468.60 | $781 | 2.0× |
| Mammary ductogram or galactogram single (77053) | $292.20 | $487 | 1.3× |
| Meckels Divert Exam (78290) | $736.80 | $1,228 | 1.9× |
| Mr safety implant&/fb assmt clin staf 1st 15 min (76014) range across 2 matching MRF lines |
$52.20–$61.20 | $87–$102 | varies |
| Mr safety implt electronics prepj supvj phys/qhp (76018) range across 2 matching MRF lines |
$195.60–$228 | $326–$380 | varies |
| Mr safety implt pos&/immoblj (76019) range across 2 matching MRF lines |
$127.20–$147 | $212–$245 | varies |
| Mr safety med physics xm customization plng&mntr (76017) range across 2 matching MRF lines |
$516–$599.40 | $860–$999 | varies |
| Mra Head W/O & W/Contrast Material (70546) range across 2 matching MRF lines |
$1,948.20–$2,263.80 | $3,247–$3,773 | varies |
| MRA head w/o contrast (70544) range across 2 matching MRF lines |
$1,429.80–$1,660.80 | $2,383–$2,768 | varies |
| MRA head with contrast (70545) range across 2 matching MRF lines |
$1,726.20–$2,006.40 | $2,877–$3,344 | varies |
| MRA neck w contrast (70548) | $2,184 | $3,640 | 6.5× |
| Mra Neck W/O &W/Contrast Material (70549) range across 2 matching MRF lines |
$1,857.60–$2,158.20 | $3,096–$3,597 | varies |
| MRA neck w/o contrast (70547) range across 2 matching MRF lines |
$1,272.60–$1,479 | $2,121–$2,465 | varies |
| MRI abdomen w contrast (74182) range across 2 matching MRF lines |
$1,586.40–$1,843.20 | $2,644–$3,072 | varies |
| MRI abdomen w/o contrast (74181) range across 4 matching MRF lines |
$925.80–$1,655.40 | $1,543–$2,759 | varies |
| MRI any jt lower extrem w/contrast material (73722) range across 3 matching MRF lines |
$1,322.40–$1,568.40 | $2,204–$2,614 | varies |
| MRI any jt lower extrem w/o & w/contrast matrl (73723) range across 3 matching MRF lines |
$1,661.40–$1,930.80 | $2,769–$3,218 | varies |
| MRI any jt upper extremity w/contrast matrl (73222) range across 2 matching MRF lines |
$1,564.20–$1,818 | $2,607–$3,030 | varies |
| MRI bone marrow blood supply (77084) range across 2 matching MRF lines |
$270–$276 | $450–$460 | varies |
| MRI Breast W/O Contrast Bilateral (77047) | $2,760 | $4,600 | 11.9× |
| MRI Breast Without Contrast Material Unilateral (77046) | $2,160 | $3,600 | 9.3× |
| MRI cardiac w/o cont stress (75559) | $1,156.80 | $1,928 | 2.2× |
| MRI cardiac w/o contrast (75557) | $1,050 | $1,750 | 4.5× |
| MRI cervical spine w contrast (72142) range across 4 matching MRF lines |
$1,118.40–$1,999.80 | $1,864–$3,333 | varies |
| MRI cervical spine w/o cont (72141) range across 4 matching MRF lines |
$1,027.20–$1,835.40 | $1,712–$3,059 | varies |
| MRI chest w/o contrast (71550) range across 4 matching MRF lines |
$931.80–$1,503 | $1,553–$2,505 | varies |
| MRI chest with contrast (71551) range across 2 matching MRF lines |
$1,356.60–$1,576.20 | $2,261–$2,627 | varies |
| MRI chest wo w contrast (71552) range across 2 matching MRF lines |
$1,828.20–$2,124.60 | $3,047–$3,541 | varies |
| MRI lower extrem oth/thn jt w/contrast matrl (73719) range across 2 matching MRF lines |
$1,459.80–$1,696.20 | $2,433–$2,827 | varies |
| MRI lower extrem oth/thn jt w/o & w/contr matr (73720) range across 2 matching MRF lines |
$1,673.40–$1,944.60 | $2,789–$3,241 | varies |
| MRI lower extrem oth/thn jt w/o contr matrl (73718) range across 4 matching MRF lines |
$739.20–$1,320.60 | $1,232–$2,201 | varies |
| MRI lumbar spine w contrast (72149) range across 4 matching MRF lines |
$1,118.40–$1,999.80 | $1,864–$3,333 | varies |
| Mri Neck Spine W/O & W/Dye (72156) range across 4 matching MRF lines |
$1,303.80–$2,419.20 | $2,173–$4,032 | varies |
| MRI orbit face &/neck w/o contrast (70540) range across 4 matching MRF lines |
$912–$1,530.60 | $1,520–$2,551 | varies |
| MRI orbit face neck w contrast (70542) range across 2 matching MRF lines |
$1,434.60–$1,667.40 | $2,391–$2,779 | varies |
| Mri Orbt/Fac/Nck W/O &W/Dye (70543) range across 2 matching MRF lines |
$1,816.20–$2,110.20 | $3,027–$3,517 | varies |
| MRI pelvis w contrast (72196) range across 2 matching MRF lines |
$1,421.40–$1,651.80 | $2,369–$2,753 | varies |
| MRI pelvis w/o & w contrast (72197) range across 2 matching MRF lines |
$1,990.80–$2,313.60 | $3,318–$3,856 | varies |
| MRI pelvis w/o contrast (72195) range across 4 matching MRF lines |
$1,008.60–$1,531.80 | $1,681–$2,553 | varies |
| MRI spectroscopy (76390) | $1,015.20 | $1,692 | 12.0× |
| MRI thoracic spine w/o contrast (72146) range across 4 matching MRF lines |
$1,027.20–$1,835.40 | $1,712–$3,059 | varies |
| MRI upper extremity oth than jt w/contr matrl (73219) range across 2 matching MRF lines |
$1,502.40–$1,746 | $2,504–$2,910 | varies |
| MRI upper extremity oth than jt w/o contr matrl (73218) range across 4 matching MRF lines |
$905.40–$1,392.60 | $1,509–$2,321 | varies |
| Mri Uppr Extremity W/O&W/Dye (73220) range across 2 matching MRF lines |
$1,659–$1,928.40 | $2,765–$3,214 | varies |
| MRI, abdomen, combo (74183) range across 2 matching MRF lines |
$2,164.20–$2,515.20 | $3,607–$4,192 | varies |
| MRI, dorsal spine combo (72157) range across 4 matching MRF lines |
$1,303.80–$2,419.20 | $2,173–$4,032 | varies |
| MRI, dorsal spine contrast (72147) range across 3 matching MRF lines |
$1,118.40–$2,070 | $1,864–$3,450 | varies |
| MRI, joint upper extrem (73221) range across 4 matching MRF lines |
$894–$1,585.80 | $1,490–$2,643 | varies |
| MRI, joint upper extrem combo (73223) range across 2 matching MRF lines |
$1,967.40–$2,286.60 | $3,279–$3,811 | varies |
| MRI, lumbar spine combo (72158) range across 4 matching MRF lines |
$1,303.80–$2,419.20 | $2,173–$4,032 | varies |
| Myelogram cervical (72240) | $680.40 | $1,134 | 0.9× |
| Myelogram Lumbar (72265) range across 2 matching MRF lines |
$939–$1,205.40 | $1,565–$2,009 | varies |
| Myelography thoracic (72255) range across 2 matching MRF lines |
$547.80–$2,711.40 | $913–$4,519 | varies |
| Myelograpy 2/more regions rs&i (72270) | $766.20 | $1,277 | 1.0× |
| Myocardial Imaging Infarct Avid Planar Qual/Quan (78466) | $738.60 | $1,231 | 1.9× |
| Myocardial Perfusion Planar 1 Study Rest/Stress (78453) | $2,001.60 | $3,336 | 1.6× |
| Myocardial Spect Multiple Studies (78452) | $3,072.60 | $5,121 | 2.4× |
| Myocrd img PET prfuj 1std rest/stress cncrnt CT (78430) | $2,225.40 | $3,709 | 1.6× |
| Myocrd Img Pet Prfuj Mlt Std Rst&Strs Cncrnt CT (78431) | $3,433.20 | $5,722 | 1.6× |
| N-invas est c ffr sw aly CTA (75580) | $3,129.60 | $5,216 | 3.8× |
| Neck soft tissue (70360) | $169.80 | $283 | 2.0× |
| Nfs/Instlj Radioelmnt Sln 3 Mo Follow-Up Care (77750) | $319.56 | $532.60 | 0.9× |
| Nm csf leak detection (78650) | $1,561.82 | $2,603.04 | 1.2× |
| Nm whole blood volume (78122) | $1,322.40 | $2,204 | 2.5× |
| Nonvascular Shunt X-Ray (75809) | $168.60 | $281 | 1.7× |
| Nuclear Rx Intra-Arterial (79445) | $1,013.40 | $1,689 | 4.5× |
| Nuclear Rx Oral Admin (79005) | $742.20 | $1,237 | 3.3× |
| Ob us nuchal meas 1 gest (76813) | $318 | $530 | 3.1× |
| Ophthalmic Biometry US Echograpy a-Scan (76516) | $340.20 | $567 | 3.4× |
| Optic foramina (70190) range across 2 matching MRF lines |
$95.40–$147 | $159–$245 | varies |
| Panoramic X-ray of jaws (70355) range across 2 matching MRF lines |
$283.20–$307.80 | $472–$513 | varies |
| Parathyroid imaging w/tomographic spect & CT (78072) | $3,328.20 | $5,547 | 6.3× |
| Parathyroid Planar Imaging (78070) | $781.20 | $1,302 | 2.0× |
| Parathyroid planar imaging w/wo subtraction (78071) | $1,214.40 | $2,024 | 3.1× |
| Pelvis 1 or 2 views (72170) | $201 | $335 | 2.0× |
| Peritoneogram Rs&I (74190) | $378 | $630 | 0.7× |
| Prq Transhepatc Portograpy Hemodyn Eval Rs&I (75885) | $2,612.40 | $4,354 | 0.9× |
| Pulmonary Perfusion Imaging Particulate (78580) | $755.40 | $1,259 | 1.9× |
| Radex Abd Compl Aqt Abd W/S/E/D Views 1 View Ch (74022) | $280.20 | $467 | 2.8× |
| Radex abscess/fistula/sinus tract rs&i (76080) | $439.20 | $732 | 0.8× |
| Radex Ankle Complete Minimum 3 Views (73610) | $241.80 | $403 | 2.9× |
| Radex Calcaneus Minimum 2 Views (73650) | $201 | $335 | 2.4× |
| Radex elbow complete minimum 3 views (73080) | $241.80 | $403 | 2.9× |
| Radex Facial Bones Complete Minimum 3 Views (70150) range across 2 matching MRF lines |
$241.80–$309 | $403–$515 | varies |
| Radex fingr minimum 2 views (73140) range across 11 matching MRF lines |
$169.80–$201 | $283–$335 | varies |
| Radex foot complete minimum 3 views (73630) | $241.80 | $403 | 2.9× |
| Radex Hand Minimum 3 Views (73130) | $241.80 | $403 | 2.9× |
| Radex lower extremity infant minimum 2 views (73592) | $201 | $335 | 2.4× |
| Radex Mastoids Compl Minimum 3 Views PR Side (70130) range across 2 matching MRF lines |
$241.80–$309 | $403–$515 | varies |
| Radex Nasal Bones Complete Minimum 3 Views (70160) range across 2 matching MRF lines |
$241.80–$309 | $403–$515 | varies |
| Radex Ribs Unilateral 2 Views (71100) | $177 | $295 | 2.1× |
| Radex shoulder complete minimum 2 views (73030) | $201 | $335 | 2.4× |
| Radex Sinuses Paransl < 3 Views (70210) range across 2 matching MRF lines |
$189.60–$215.40 | $316–$359 | varies |
| Radex sm int w/mlt srl imges via enteroclss tube (74251) | $385.80 | $643 | 2.3× |
| Radex Spine 1 View Specify Level (72020) | $169.80 | $283 | 2.0× |
| Radex Sternum Minimum 2 Views (71120) | $201 | $335 | 2.4× |
| Radex Temporomandble Jt Opn & Clsd Mouth Bilat (70330) range across 2 matching MRF lines |
$192.60–$246.60 | $321–$411 | varies |
| Radex Toe Minimum 2 Views (73660) range across 11 matching MRF lines |
$186–$235.20 | $310–$392 | varies |
| Radex upper extremity infant minimum 2 views (73092) | $201 | $335 | 2.0× |
| Radex Wrist Complete Minimum 3 Views (73110) | $241.80 | $403 | 2.9× |
| Radex X-Ray Exam Entire Spi 6/> Vw - Xr Entire Spine 6+ Vw (72084) | $354 | $590 | 3.5× |
| Radiolog exam mandible compl minimum 4 views (70110) range across 2 matching MRF lines |
$256.80–$328.20 | $428–$547 | varies |
| Radiologic Exam Abdomen 3+ Views - Xr Abdomen 3+ Views (74021) | $241.80 | $403 | 2.4× |
| Radiologic exam colon double contrast study (74280) | $531 | $885 | 3.1× |
| Radiologic exam colon single contrast study (74270) range across 3 matching MRF lines |
$325.80–$737.40 | $543–$1,229 | varies |
| Radiologic Exam Esophagus Double Contrast Study (74221) | $248.40 | $414 | 1.5× |
| Radiologic exam knee complete 4/more views (73564) | $256.80 | $428 | 2.5× |
| Radiologic exam pelvis compl minimum 3 views (72190) | $241.80 | $403 | 2.4× |
| Radiologic Exam Small Int Single Contrast Study (74250) | $301.80 | $503 | 1.8× |
| Radiologic exam swallow function contrast study (74230) | $330.60 | $551 | 1.9× |
| Radiologic Exam Teeth Prtl Exam < Full Mouth (70310) range across 2 matching MRF lines |
$168–$182.40 | $280–$304 | varies |
| Radiologic exam upr gi trc double contrast study (74246) | $301.80 | $503 | 1.8× |
| Radiologic examination femur 1 view (73551) | $136.80 | $228 | 1.6× |
| Radiologic examination femur minimum 2 views (73552) | $201 | $335 | 2.4× |
| Radiologic examination knee 1/2 views (73560) range across 2 matching MRF lines |
$168.60–$201 | $281–$335 | varies |
| Radiologic Examination Osseous Survey Limited (77074) | $156 | $260 | 1.5× |
| Radiologic Examination Salivary Gland Calculus (70380) | $69 | $115 | 0.8× |
| Radiologic examination tibia & fibula 2 views (73590) range across 2 matching MRF lines |
$136.80–$201 | $228–$335 | varies |
| Radiologic examination, internal auditory meati, complete Non-Facility (70134) | $409.80 | $683 | 0.8× |
| Radiologic examination, teeth; single view Non-Facility (70300) | $56.40 | $94 | 0.7× |
| Radiopharm Dacryocystography (78660) | $408 | $680 | 1.1× |
| Radiopharmaceutical therapy, by interstitial radioactive colloid administration Facility (79300) | $556.20 | $927 | 2.5× |
| Radiopharmaceutical therapy, by intracavitary administration Non-Facility (79200) | $685.80 | $1,143 | 3.0× |
| Renal Cyst Study (74470) | $781.20 | $1,302 | 1.5× |
| Ribs bilateral 3 views (71110) | $241.80 | $403 | 2.4× |
| Rp loclzj tum plnr 1 area single day imaging (78800) | $745.80 | $1,243 | 1.9× |
| Rp loclzj tum plnr 2+area 1+d img/1 area img>2+d (78801) | $922.20 | $1,537 | 2.4× |
| Rp Loclzj Tum Plnr Whole Body 2+ Days Imaging (78804) | $2,183.40 | $3,639 | 4.1× |
| Rp Loclzj Tum Plnr Whole Body Single Day Imaging (78802) | $1,688.40 | $2,814 | 3.2× |
| Rp Loclzj Tum Spect 1 Area Single Day Imaging (78803) | $1,263.60 | $2,106 | 2.4× |
| Rp loclzj tum spect 2 area/sep acquisj img (78831) | $1,195.20 | $1,992 | 1.0× |
| Rp loclzj tum spect CT 2area 1d img/1 ar img>2+d (78832) | $1,317 | $2,195 | 0.9× |
| Rp loclzj tum spect w/CT 1 area/acquisj 1day img (78830) | $1,195.20 | $1,992 | 1.0× |
| Rp Ther Radiolbld Monoclonal Antibody IV Infus (79403) | $997.20 | $1,662 | 4.4× |
| Rp Therapy Intravenous Administration (79101) | $917.40 | $1,529 | 4.1× |
| Salivary Gland Imaging (78230) | $490.43 | $817.38 | 1.3× |
| Salivary Gland Imaging Serial Images (78231) | $508.20 | $847 | 1.3× |
| Scapula (73010) | $241.80 | $403 | 2.4× |
| Screening Digital Breast Tomosynthesis Bi (77063) | $84.60 | $141 | 3.6× |
| Sella turcica (70240) range across 2 matching MRF lines |
$113.40–$145.20 | $189–$242 | varies |
| Shoulder 1 view (73020) | $169.80 | $283 | 2.0× |
| Shoulder Arthrography (73040) | $387.60 | $646 | 1.1× |
| Sialogram (70390) | $349.20 | $582 | 1.5× |
| Skull less than 4 views (70250) range across 2 matching MRF lines |
$241.80–$309 | $403–$515 | varies |
| Spleen Imaging (78185) | $895.20 | $1,492 | 2.3× |
| Sternoclavicular joints (71130) | $241.80 | $403 | 2.9× |
| Superior sagittal sinus venogram (75870) | $2,454.60 | $4,091 | 0.8× |
| Temporomandble Jt Arthrography Rs&I (70332) range across 4 matching MRF lines |
$417.60–$868.80 | $696–$1,448 | varies |
| Testicular Imaging W/Flow (78761) | $812.40 | $1,354 | 2.1× |
| Therapeutic Enema Rdctj Intussusception/Obstrcj (74283) | $737.40 | $1,229 | 4.3× |
| Thoracic spine 2 views (72070) | $201 | $335 | 2.0× |
| Thoracic spine 3 views (72072) | $241.80 | $403 | 2.4× |
| Thoracolumbar 2 views (72080) | $201 | $335 | 2.4× |
| Thyroid Carcinoma Metastases Img Lmtd Area (78015) | $763.80 | $1,273 | 2.0× |
| Thyroid Imaging With Vascular Flow (78013) | $577.80 | $963 | 1.5× |
| Thyroid Met Imaging Body (78018) | $1,324.20 | $2,207 | 2.5× |
| Thyroid Uptake Measurement (78012) | $408 | $680 | 1.1× |
| Thyroid Uptake W/Blood Flow Sngle/Mult Quan Meas (78014) | $624 | $1,040 | 1.6× |
| Ultrasound Breast Limited (76642) range across 2 matching MRF lines |
$264–$285 | $440–$475 | varies |
| Ultrasound Elastography Parenchyma (76981) | $190.80 | $318 | 1.9× |
| Ultrasound Exam Aaa Screen (76706) | $258 | $430 | 2.5× |
| Ultrasound trgt dynamic microbubble 1st lesion (76978) | $815.40 | $1,359 | 2.4× |
| Ultrasound, abdomen limited (76705) range across 5 matching MRF lines |
$415.80–$575.40 | $693–$959 | varies |
| Umbilical-artery Doppler (OB) (76820) | $247.20 | $412 | 2.4× |
| Unlisted Dx Radiographic Procedure (76499) range across 2 matching MRF lines |
$123–$942.60 | $205–$1,571 | varies |
| Unlisted magnetic resonance procedure (76498) | $78 | $130 | 0.9× |
| Unlisted us procedure (76999) | $168 | $280 | 2.0× |
| Upper gi w/o kub (74240) | $280.20 | $467 | 1.6× |
| Urea Breath Test C-14 Isotopic Acquisj Analysis (78267) | $26.40 | $44 | 2.4× |
| Ureteral Reflux Study (78740) | $823.80 | $1,373 | 2.1× |
| Urethrocystogram voiding (74455) | $379.20 | $632 | 1.6× |
| Urethrocystography retrograde (74450) | $320.40 | $534 | 1.4× |
| Us breast unilateral complete (76641) range across 2 matching MRF lines |
$264–$285 | $440–$475 | varies |
| Us chest (76604) | $222 | $370 | 2.2× |
| Us complete joint (76881) | $328.20 | $547 | 3.2× |
| Us exam, pelvic, limited (76857) | $270 | $450 | 2.7× |
| Us head (76506) range across 2 matching MRF lines |
$252–$348.60 | $420–$581 | varies |
| Us kidney transplant (76776) range across 2 matching MRF lines |
$361.20–$499.80 | $602–$833 | varies |
| Us lmtd joint/oth nonvasc xtr strux r-t w/img (76882) | $131.40 | $219 | 1.3× |
| Us ob detailed single fetus (76811) | $487.20 | $812 | 2.1× |
| Us ob limited 1 or more fetuses (76815) | $270.60 | $451 | 2.7× |
| Us ob transvaginal (76817) | $336 | $560 | 3.3× |
| Us pelvic non ob complete (76856) | $561.60 | $936 | 5.5× |
| Us pg uter img f&mat 14 wk tabdl 1/1st gestation (76801) | $396 | $660 | 3.9× |
| Us preg uterus real time f/u trnsabdl per fetus (76816) range across 2 matching MRF lines |
$222–$307.20 | $370–$512 | varies |
| Us retroperitoneal complete (76770) | $489.60 | $816 | 4.8× |
| Us retroperitoneal limited (76775) | $300 | $500 | 3.0× |
| Us scrotum and contents (76870) | $449.40 | $749 | 4.4× |
| Us spinal canal and contents (76800) | $345.60 | $576 | 3.4× |
| Us thyroid (76536) | $397.20 | $662 | 3.9× |
| Us transrectal (76872) | $498 | $830 | 4.9× |
| Vein X-Ray Chest (75827) | $1,636.80 | $2,728 | 1.1× |
| Vein X-Ray Liver W/O Hemodyn (75887) | $2,454.60 | $4,091 | 0.8× |
| Vein X-Ray Skull Epidural (75872) | $1,159.80 | $1,933 | 1.9× |
| Vein X-Ray Spleen/Liver (75810) | $3,079.80 | $5,133 | 1.0× |
| Venogram Sinus/Jugular (75860) | $2,006.40 | $3,344 | 0.7× |
| Venography Adrenal Unilateral (75840) | $3,079.20 | $5,132 | 1.0× |
| Venography caval inferior serialography rs&i (75825) | $2,539.80 | $4,233 | 0.8× |
| Venography extremity bilateral rs&i (75822) | $1,228.80 | $2,048 | 0.8× |
| Venography extremity unilateral rs&i (75820) | $1,147.20 | $1,912 | 0.8× |
| Venography Renal Bilateral (75833) | $3,694.20 | $6,157 | 1.2× |
| Venography Renal Unilateral (75831) | $3,226.20 | $5,377 | 1.1× |
| Venous sampling by catheter (75893) | $3,942 | $6,570 | 0.7× |
| Venous Thrombosis Imaging Venogram Bilateral (78458) | $540 | $900 | 1.4× |
| Vertebral fracture assessment via dxa (77086) | $159.60 | $266 | 1.9× |
| Wrist 2 views (73100) range across 3 matching MRF lines |
$87–$201 | $145–$335 | varies |
| X-Ray Ac Jts - Xr Acromioclavicular Joints Bilateral (73050) | $241.80 | $403 | 2.9× |
| X-ray antegrade pyelogram tube (74425) range across 2 matching MRF lines |
$300–$324 | $500–$540 | varies |
| X-Ray Aorta Leg Arteries (75630) | $2,454 | $4,090 | 0.8× |
| X-Ray Bend Only L-S Spine (72120) | $256.80 | $428 | 2.5× |
| X-Ray Elbow 2 Vw - Xr Elbow 1-2 Views Right (73070) range across 2 matching MRF lines |
$109.20–$201 | $182–$335 | varies |
| X-Ray Exam Breast Specimen (76098) | $390 | $650 | 0.7× |
| X-Ray Exam Entire Spi 1 Vw (72081) | $191.40 | $319 | 2.3× |
| X-Ray Exam Entire Spi 2/3 Vw (72082) | $216 | $360 | 2.1× |
| X-Ray Exam Entire Spi 4/5 Vw (72083) | $240 | $400 | 2.4× |
| X-Ray Exam Hip Uni 1 View (73501) | $169.80 | $283 | 2.0× |
| X-Ray Exam Hip Uni 2-3 Views (73502) | $222 | $370 | 2.6× |
| X-Ray Exam Hip Uni 4/> Views (73503) | $256.80 | $428 | 2.5× |
| X-Ray Exam Hips Bi 2 Views (73521) | $201 | $335 | 2.0× |
| X-Ray Exam Hips Bi 3-4 Views (73522) | $256.80 | $428 | 2.5× |
| X-Ray Exam Hips Bi 5/> Views (73523) | $277.80 | $463 | 2.7× |
| X-Ray Exam L-S Spine Bending (72114) | $335.40 | $559 | 3.3× |
| X-Ray Exam Neck Spine 2-3 Vw (72040) | $241.80 | $403 | 2.9× |
| X-Ray Exam Neck Spine 6/>Vws (72052) | $321 | $535 | 3.2× |
| X-Ray Exam Unilat Ribs/Chest (71101) | $210 | $350 | 2.1× |
| X-ray eye for foreign body (70030) range across 2 matching MRF lines |
$169.80–$216.60 | $283–$361 | varies |
| X-ray head for orthodontia (70350) range across 2 matching MRF lines |
$121.20–$165.60 | $202–$276 | varies |
| X-ray humerus (73060) range across 2 matching MRF lines |
$109.20–$201 | $182–$335 | varies |
| X-ray IV pyelogram (ivp) (74400) | $314.40 | $524 | 1.8× |
| X-ray IV pyelogram+tomography (74415) | $394.20 | $657 | 2.3× |
| X-Ray Jaw <4 Vw - Xr Mandible < 4 Views (70100) range across 2 matching MRF lines |
$256.80–$328.20 | $428–$547 | varies |
| X-Ray Knee Bilat Standing - Xr Knees Anteroposterior Standing Bilat (73565) | $256.80 | $428 | 3.0× |
| X-Ray Lumbar Spine 2/3 Vw - Xr Lumbar Spine 2-3 Views (72100) | $241.80 | $403 | 2.4× |
| X-ray nose-rectum child f.b. (76010) | $155.40 | $259 | 1.8× |
| X-Ray Ribs, Chest 4+ Vw - Xr Ribs 3 Vws Bil W/ Chest Posteroanterior (71111) | $267 | $445 | 2.6× |
| X-Ray Sacroiliac Jts 3+ Vw - Xr Sacroiliac Joints 3+ Views (72202) | $241.80 | $403 | 2.4× |
| X-Ray Sacroiliac Jts <3 Vw - Xr Sacroiliac Joints 1-2 Views (72200) range across 2 matching MRF lines |
$241.20–$241.80 | $402–$403 | varies |
| X-Ray Sacrum/Coccyx 2+ Vw - Xr Sacrum Coccyx 2+ Views (72220) | $201 | $335 | 2.4× |
| X-Ray Sinuses 3+ Vw - Xr Paranasal Sinuses 3+ Views (70220) range across 2 matching MRF lines |
$241.80–$309 | $403–$515 | varies |
| X-Ray Skull 4+ Vw - Xr Skull Complete 4+ Views (70260) range across 2 matching MRF lines |
$256.80–$328.20 | $428–$547 | varies |
| X-Ray Stress View (77071) | $155.40 | $259 | 1.8× |
| X-ray thoracic spine 4 vw (72074) | $256.80 | $428 | 2.5× |
| X-Ray Tmj Unilat (70328) range across 2 matching MRF lines |
$201.60–$256.80 | $336–$428 | varies |
| X-Ray Urinary Tract Exam With Contrast Material (74420) | $400.80 | $668 | 1.2× |
| X-Rays Bone Length Studies (77073) | $162.60 | $271 | 1.6× |
| X-Rays Bone Survey Complete (77075) | $289.20 | $482 | 2.9× |
| Xr c-spine 4 or 5 views (72050) | $256.80 | $428 | 2.5× |
| Xr facial bones less than 3 views (70140) range across 2 matching MRF lines |
$201–$256.20 | $335–$427 | varies |
| XR Mastoids < 3 Views Bilateral (70120) range across 2 matching MRF lines |
$241.80–$279 | $403–$465 | varies |
| Xr myelogram posterior fossa (70010) range across 2 matching MRF lines |
$703.80–$765 | $1,173–$1,275 | varies |
| Xr orbits complete 4 views (70200) range across 2 matching MRF lines |
$256.80–$328.20 | $428–$547 | varies |
| Xr Tomogram Single Plane (76100) | $189.60 | $316 | 1.9× |
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.