Imaging prices at Ochsner LSU Health - St. Mary Medical Center
Shreveport, LA · every code in this section with a posted price and a Medicare benchmark.
398 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) | $534.52 | $1,909 | 0.4× |
| Abdomen 1 View (74018) | $113.68 | $406 | 1.4× |
| Abdomen 2 views (74019) | $119.56 | $427 | 1.3× |
| Acute Gastrointestinal Blood Loss Imaging (78278) | $437.64 | $1,563 | 1.2× |
| Angio internal mammary (75756) | $193.20 | $690 | 0.1× |
| Angio pulmonary bilat (75743) | $900.48 | $3,216 | 0.3× |
| Angiography Adrenal Bilateral Slctv Rs&I (75733) | $900.48 | $3,216 | 0.3× |
| Angiography extremity bilateral rs&i (75716) | $900.48 | $3,216 | 0.3× |
| Angiography extremity unilateral rs&i (75710) | $900.48 | $3,216 | 0.3× |
| Angiography pulmonary unilateral slctv rs&i (75741) | $900.48 | $3,216 | 0.3× |
| Angrph pulmonary nonslctv cath/ven njx rs&i (75746) | $900.48 | $3,216 | 0.3× |
| Ankle 2 views (73600) range across 4 matching MRF lines |
$113.68–$227.36 | $406–$812 | varies |
| Aortography thoracic serialography rs&i (75605) likely a partial charge, not the full procedure |
$1,500.24 | $5,358 | 0.3× |
| Aortography thoracic w/o serialography rs&i (75600) | $194.88 | $696 | 0.1× |
| Artery X-Rays Abdomen (75726) likely a partial charge, not the full procedure |
$1,500.24 | $5,358 | 0.3× |
| Artery X-Rays Adrenal Gland (75731) | $900.48 | $3,216 | 0.3× |
| Artery X-Rays Pelvis (75736) likely a partial charge, not the full procedure |
$1,500.24 | $5,358 | 0.3× |
| Artery X-Rays Spine (75705) likely a partial charge, not the full procedure |
$1,500.24 | $5,358 | 0.3× |
| Arthrogram hip (73525) | $188.16 | $672 | 0.6× |
| Arthrogram Wrist (73115) | $125.72 | $449 | 0.4× |
| Basic radiation dosimetry calculation (77300) | $54.88 | $196 | 0.5× |
| Bone age studies (77072) | $113.68 | $406 | 1.2× |
| Bone Imaging 3 Phase (78315) | $437.64 | $1,563 | 1.2× |
| Bone Imaging Limited Area (78300) | $231.84 | $828 | 0.6× |
| Bone Imaging Whole Body (78306) | $340.48 | $1,216 | 0.9× |
| Bone marrow imaging limited area (78102) | $224.28 | $801 | 0.6× |
| Bone survey infant (77076) | $113.68 | $406 | 1.2× |
| Brachytx isodose intermed (77317) | $188.44 | $673 | 0.6× |
| Brain Image W/Flow < 4 Views (78601) | $301.56 | $1,077 | 0.8× |
| Brain Imaging Min 4 Static Views W Vascular Flow (78606) | $465.08 | $1,661 | 0.9× |
| Brain Imaging Pet Metabolic Evaluation (78608) | $2,117.92 | $7,564 | 1.6× |
| Card Bl Pool Gated Spect Rest Wal Motn Ejct Frct (78494) range across 2 matching MRF lines |
$353.36–$356.72 | $1,262–$1,274 | varies |
| Cardiac MRI w/w/o contrast & further seq (75561) | $688.24 | $2,458 | 2.2× |
| Cardiac MRI w/w/o contrast w/stress (75563) | $789.60 | $2,820 | 1.1× |
| Cat Scan Follow-Up Study (76380) | $194.32 | $694 | 2.5× |
| Cerebrospinal Fluid Flow W/O Matl Shunt Evaltj (78645) | $348.04 | $1,243 | 0.7× |
| Cerebrospinal Fluid Scan (78630) | $483 | $1,725 | 1.0× |
| Chest 1 view (71045) | $113.68 | $406 | 1.4× |
| Chest 2 views (71046) | $119.56 | $427 | 1.5× |
| Chest 3 views (71047) | $125.72 | $449 | 1.6× |
| Chg us nrv&acc strux 1 xtr compre w/img pr extremity (76883) | $129.92 | $464 | 1.4× |
| Cisternography Positive Contrast Rs&I (70015) | $255.92 | $914 | 0.4× |
| Clavicle complete (73000) range across 4 matching MRF lines |
$113.68–$227.36 | $406–$812 | varies |
| Computed Tomography Thorax Lw Dose Lng Ca Scr C- (71271) | $278.88 | $996 | 2.9× |
| Continuing medical physics consltj pr wk (77336) | $78.96 | $282 | 0.6× |
| Contrast Exam Abdominl Aorta (75625) | $900.48 | $3,216 | 0.3× |
| Contrast X-Ray Bladder (74430) | $113.68 | $406 | 0.4× |
| Contrast X-Ray Of Elbow (73085) | $113.68 | $406 | 0.4× |
| Contrast X-Ray Of Knee Joint (73580) | $179.20 | $640 | 0.6× |
| Contrast Xray Throat/Cerv Esopha (74210) | $113.68 | $406 | 0.7× |
| CT abdomen and pelvis without and with contrast (74178) | $858.76 | $3,067 | 2.7× |
| CT abdomen and pelvis without contrast (74176) | $485.24 | $1,733 | 2.2× |
| CT abdomen w contrast (74160) | $458.08 | $1,636 | 2.9× |
| CT abdomen w wo contrast (74170) | $590.24 | $2,108 | 3.7× |
| CT abdomen w/o contrast (74150) | $321.44 | $1,148 | 3.4× |
| CT Angio Abdomen and Pelvis (74174) | $856.52 | $3,059 | 2.7× |
| CT Angio Chest (71275) | $602.56 | $2,152 | 3.8× |
| CT Angio Head (70496) | $602.56 | $2,152 | 3.8× |
| CT angio hrt w/3d image (75574) | $476 | $1,700 | 1.5× |
| Ct Angio Lwr Extr W/O&W/Dye (73706) range across 2 matching MRF lines |
$602.56–$1,205.12 | $2,152–$4,304 | varies |
| CT Angio Neck (70498) | $602.56 | $2,152 | 3.8× |
| Ct Angio Upr Extrm W/O&W/Dye (73206) | $602.56 | $2,152 | 3.8× |
| CT cervical spine w/ contrast (72126) | $425.60 | $1,520 | 1.3× |
| CT cervical spine w/o contrast (72125) | $343.84 | $1,228 | 3.6× |
| CT cervical spine w/wo cont (72127) | $534.80 | $1,910 | 3.4× |
| CT chest w contrast (71260) | $424.20 | $1,515 | 2.7× |
| CT chest w/wo contrast (71270) | $535.36 | $1,912 | 3.4× |
| CT head/brain with contrast (70460) | $341.88 | $1,221 | 2.2× |
| CT head/brain without and with contrast (70470) | $421.12 | $1,504 | 2.7× |
| CT heart contrast eval cardiac structure&morph (75572) | $388.36 | $1,387 | 1.2× |
| CT heart no contrast quant eval coronry calcium (75571) | $80.08 | $286 | 1.0× |
| CT hrt w/3d image congen (75573) | $476.56 | $1,702 | 1.5× |
| CT iac w contrast (70481) | $493.92 | $1,764 | 3.1× |
| CT l-spine w&w/o contrast (72133) | $535.36 | $1,912 | 3.4× |
| CT lower ext w/o (73700) range across 2 matching MRF lines |
$330.40–$660.80 | $1,180–$2,360 | varies |
| CT lower extremity w/contrast material (73701) range across 2 matching MRF lines |
$411.32–$822.64 | $1,469–$2,938 | varies |
| CT lumbar spine w contrast (72132) | $424.20 | $1,515 | 1.3× |
| CT lumbar spine w/o contrast (72131) | $341.88 | $1,221 | 3.6× |
| CT maxillofacial w contrast (70487) | $422.24 | $1,508 | 2.7× |
| CT maxillofacial wo contrast (70486) | $344.96 | $1,232 | 3.6× |
| CT neck tissue combo (70492) | $511 | $1,825 | 3.2× |
| Ct Orbit/Ear/Fossa W/O&W/Dye (70482) | $573.72 | $2,049 | 3.6× |
| CT orbits w/o contrast (70480) | $345.52 | $1,234 | 3.6× |
| CT pelvis w&w/o contrast (72194) | $537.32 | $1,919 | 3.4× |
| CT pelvis w/o contrast (72192) | $324.52 | $1,159 | 3.4× |
| CT scan of leg combo (73702) range across 2 matching MRF lines |
$546.28–$1,092.56 | $1,951–$3,902 | varies |
| CT scans face/jaw combo (70488) | $527.80 | $1,885 | 3.3× |
| CT soft tissue neck w contrast (70491) | $406.28 | $1,451 | 2.6× |
| CT soft tissue neck w/o contrast (70490) | $327.04 | $1,168 | 3.5× |
| CT thoracic spine w contrast (72129) | $425.60 | $1,520 | 2.7× |
| CT thoracic spine w/o contrast (72128) | $342.44 | $1,223 | 3.6× |
| CT thoracic spine w/wo cont (72130) | $536.76 | $1,917 | 3.4× |
| CT thorax w/o contrast (71250) | $342.44 | $1,223 | 3.6× |
| CT unlisted procedure (76497) | $340.76 | $1,217 | 4.3× |
| CT upper ext wo (73200) range across 4 matching MRF lines |
$329.56–$659.12 | $1,177–$2,354 | varies |
| CT upper extremity w/o & w/contrast material (73202) range across 2 matching MRF lines |
$544.88–$1,089.76 | $1,946–$3,892 | varies |
| CT upper extremity with contrast (73201) range across 4 matching MRF lines |
$407.68–$815.36 | $1,456–$2,912 | varies |
| Cta Abdl Aorta&Bi Iliofem W/Contrast&Postp (75635) | $603.12 | $2,154 | 3.8× |
| Cta Abdomen (74175) | $602.56 | $2,152 | 3.8× |
| CTA pelvis (72191) | $602.56 | $2,152 | 3.8× |
| Doppler Echo Fetal Puls Spectral F/U/Repeat (76828) | $37.80 | $135 | 0.4× |
| Doppler Echo Fetal Spectral Display Complete (76827) | $66.64 | $238 | 0.7× |
| Doppler Fetal Mid Cerebral Artery (76821) range across 2 matching MRF lines |
$88.48–$103.04 | $316–$368 | varies |
| Dxa Bone Density Axial (77080) | $113.68 | $406 | 1.2× |
| Dxa bone density study (77085) | $113.68 | $406 | 1.2× |
| Dxa bone density study 1/>sites appendiclr skel (77081) | $113.68 | $406 | 1.4× |
| Echo exam of fetal heart (76825) | $216.72 | $774 | 0.4× |
| Echo exam uterus (76831) | $98.84 | $353 | 0.5× |
| Echo Guide For Artery Repair (76936) | $192.36 | $687 | 1.0× |
| Echocardiography, fetal, cardiovascular system, real time with image documentation (2D), with or without M-mode… (76826) | $132.44 | $473 | 0.6× |
| Esophageal Motility Study (78258) | $310.52 | $1,109 | 0.9× |
| Esophagram (74220) | $113.68 | $406 | 0.7× |
| Fetal Biophys Profile W/Nst (76818) | $115.08 | $411 | 1.2× |
| Fetal Biophysical Profile W/O Non-Stress Testing (76819) | $89.60 | $320 | 0.9× |
| Fetal MRI w/placntl matrnl plvc img sing/1st ges (74712) | $258.72 | $924 | 1.2× |
| Fluoroscopy up to 1 hr (76000) | $113.68 | $406 | 0.5× |
| Follow-Up Angiography (75898) | $1,139.32 | $4,069 | 0.4× |
| Foot 2 views (73620) range across 4 matching MRF lines |
$113.68–$227.36 | $406–$812 | varies |
| Forearm 2 views (73090) range across 4 matching MRF lines |
$113.68–$227.36 | $406–$812 | varies |
| Gastric emptying imaging study (78264) | $395.36 | $1,412 | 1.1× |
| Gastric Emptyng Imag Std W/Sm Bwl Transit (78265) | $591.36 | $2,112 | 1.6× |
| Gastroesophageal Reflux Exam (78262) | $341.04 | $1,218 | 0.9× |
| Gated Heart Planar Single (78472) | $338.52 | $1,209 | 0.9× |
| Hand 2 views (73120) range across 4 matching MRF lines |
$113.68–$227.36 | $406–$812 | varies |
| Hdr Rdncl Ntrstl/Icav Brchtx (77772) | $950.04 | $3,393 | 1.5× |
| Hdr Rdncl Ntrstl/Icav Brchtx (77771) | $602 | $2,150 | 1.0× |
| Heart Image (Pet) Multiple (78492) | $2,525.04 | $9,018 | 2.0× |
| Hepatc Vngrph Wdg/Fr Hemodyn Eval Rs&I (75889) | $900.48 | $3,216 | 0.3× |
| Hepatc Vngrph Wdg/Fr W/O Hemodyn Eval Rs&I (75891) | $900.48 | $3,216 | 0.3× |
| Hepatobil Syst Image W/Drug (78227) | $759.36 | $2,712 | 1.5× |
| Hepatobiliary System Imaging (78226) | $550.48 | $1,966 | 1.5× |
| Ht Musc Image Planar Mult (78454) | $467.32 | $1,669 | 0.4× |
| Ht Muscle Image Spect Sing (78451) | $467.32 | $1,669 | 0.4× |
| Hysterosalpingogram (74740) | $113.68 | $406 | 0.5× |
| Infant hip ultrasound with hip movement (dynamic) (76885) | $110.60 | $395 | 1.4× |
| Infant hip ultrasound, limited static exam (76886) | $110.60 | $395 | 1.4× |
| Interstitial radiation source applic complex (77778) | $373.52 | $1,334 | 0.6× |
| Joint Survey Single View (77077) | $113.68 | $406 | 1.2× |
| K Flow/Funct Image Multiple (78709) | $474.60 | $1,695 | 1.0× |
| K Flow/Funct Image W/Drug (78708) | $175 | $625 | 0.4× |
| K Flow/Funct Image W/O Drug (78707) | $311.64 | $1,113 | 0.6× |
| Kidney Imaging Morphoogy W/Vascular Flow (78701) | $356.72 | $1,274 | 1.0× |
| Knee 3 Views (73562) range across 4 matching MRF lines |
$119.56–$239.12 | $427–$854 | varies |
| Leveen/Shunt Patency Exam (78291) | $332.08 | $1,186 | 0.9× |
| Liver & Spleen Imaging Static Only (78215) | $269.08 | $961 | 0.7× |
| Liver & Spleen Imaging W/Vascular Flow (78216) | $174.44 | $623 | 0.5× |
| Liver imaging static only (78201) | $259.28 | $926 | 0.5× |
| Liver imaging w/vascular flow (78202) | $356.72 | $1,274 | 0.7× |
| Lung perfusion differential (78597) | $304.64 | $1,088 | 0.8× |
| Lung Ventilat&Perfus Imaging (78582) | $509.88 | $1,821 | 1.0× |
| Lymph System Imaging (78195) | $457.52 | $1,634 | 0.9× |
| Lymphangiography extremity only unilateral rs&i (75801) | $440.44 | $1,573 | 0.8× |
| Lymphangiography, pelvic/abdominal, unilateral (75805) | $1,139.32 | $4,069 | 0.4× |
| Magnetic Image Jaw Joint (70336) | $515.48 | $1,841 | 2.4× |
| Mammary ductogram or galactogram single (77053) | $113.68 | $406 | 0.5× |
| Meckels Divert Exam (78290) | $437.64 | $1,563 | 1.2× |
| Mlc imrt design & construction per imrt plan (77338) | $371 | $1,325 | 1.1× |
| Mra Head W/O & W/Contrast Material (70546) | $789.60 | $2,820 | 2.5× |
| MRA head w/o contrast (70544) | $515.48 | $1,841 | 2.4× |
| MRA head with contrast (70545) | $625.52 | $2,234 | 2.0× |
| MRA neck w contrast (70548) | $625.52 | $2,234 | 2.0× |
| Mra Neck W/O &W/Contrast Material (70549) | $789.60 | $2,820 | 2.5× |
| MRA neck w/o contrast (70547) | $515.48 | $1,841 | 2.4× |
| MRI abdomen w contrast (74182) | $625.52 | $2,234 | 2.0× |
| MRI abdomen w/o contrast (74181) | $515.48 | $1,841 | 2.4× |
| MRI any jt lower extrem w/contrast material (73722) range across 2 matching MRF lines |
$624.96–$1,249.92 | $2,232–$4,464 | varies |
| MRI any jt lower extrem w/o & w/contrast matrl (73723) range across 2 matching MRF lines |
$789.60–$1,579.20 | $2,820–$5,640 | varies |
| MRI any jt upper extremity w/contrast matrl (73222) | $624.96 | $2,232 | 0.9× |
| MRI brain functional w/o physician admnistration (70554) | $653.24 | $2,333 | 3.0× |
| MRI Breast W/O Contrast Bilateral (77047) | $662.20 | $2,365 | 3.1× |
| MRI Breast Without Contrast Material Unilateral (77046) | $381.08 | $1,361 | 1.8× |
| MRI cardiac w/o contrast (75557) | $475.44 | $1,698 | 2.2× |
| MRI cervical spine w contrast (72142) | $624.96 | $2,232 | 2.0× |
| MRI cervical spine w/o cont (72141) | $515.48 | $1,841 | 2.4× |
| MRI chest w/o contrast (71550) | $515.48 | $1,841 | 2.4× |
| MRI chest with contrast (71551) | $625.52 | $2,234 | 0.9× |
| MRI chest wo w contrast (71552) | $789.60 | $2,820 | 2.5× |
| MRI lower extrem oth/thn jt w/contrast matrl (73719) range across 2 matching MRF lines |
$624.96–$1,249.92 | $2,232–$4,464 | varies |
| MRI lower extrem oth/thn jt w/o & w/contr matr (73720) range across 2 matching MRF lines |
$789.60–$1,579.20 | $2,820–$5,640 | varies |
| MRI lower extrem oth/thn jt w/o contr matrl (73718) range across 4 matching MRF lines |
$515.48–$1,030.96 | $1,841–$3,682 | varies |
| MRI lumbar spine w contrast (72149) | $624.96 | $2,232 | 2.0× |
| Mri Neck Spine W/O & W/Dye (72156) | $789.60 | $2,820 | 2.5× |
| MRI orbit face &/neck w/o contrast (70540) | $515.48 | $1,841 | 2.4× |
| MRI orbit face neck w contrast (70542) | $624.96 | $2,232 | 2.0× |
| Mri Orbt/Fac/Nck W/O &W/Dye (70543) | $789.60 | $2,820 | 2.5× |
| MRI pelvis w contrast (72196) | $624.96 | $2,232 | 2.0× |
| MRI pelvis w/o & w contrast (72197) | $789.60 | $2,820 | 2.5× |
| MRI pelvis w/o contrast (72195) | $515.48 | $1,841 | 2.4× |
| MRI spectroscopy (76390) | $546.28 | $1,951 | 6.9× |
| MRI thoracic spine w/o contrast (72146) | $515.48 | $1,841 | 2.4× |
| MRI upper extremity oth than jt w/contr matrl (73219) | $624.96 | $2,232 | 2.0× |
| MRI upper extremity oth than jt w/o contr matrl (73218) | $515.48 | $1,841 | 2.4× |
| Mri Uppr Extremity W/O&W/Dye (73220) | $789.60 | $2,820 | 2.5× |
| MRI, abdomen, combo (74183) | $789.60 | $2,820 | 2.5× |
| MRI, dorsal spine combo (72157) | $789.60 | $2,820 | 2.5× |
| MRI, dorsal spine contrast (72147) | $615.44 | $2,198 | 1.9× |
| MRI, joint upper extrem (73221) range across 4 matching MRF lines |
$515.48–$1,030.96 | $1,841–$3,682 | varies |
| MRI, joint upper extrem combo (73223) range across 2 matching MRF lines |
$789.60–$1,579.20 | $2,820–$5,640 | varies |
| MRI, lumbar spine combo (72158) | $789.60 | $2,820 | 2.5× |
| Myelogram Lumbar (72265) | $225.12 | $804 | 0.3× |
| Myocardial Imaging Pet Metabolic Evaluation (78459) | $2,719.64 | $9,713 | 2.3× |
| Myocardial Spect Multiple Studies (78452) | $467.32 | $1,669 | 0.4× |
| Myocrd Img Pet Metab Eval Single Study Cncrnt CT (78429) | $3,315.20 | $11,840 | 2.6× |
| Myocrd img PET prfuj 1std rest/stress cncrnt CT (78430) | $3,315.20 | $11,840 | 2.6× |
| Myocrd Img Pet Prfuj Mlt Std Rst&Strs Cncrnt CT (78431) | $5,169.64 | $18,463 | 2.6× |
| Myocrd Img Pet Prfuj W/Metab 2rtracer Cncrnt CT (78433) | $6,318.20 | $22,565 | 3.2× |
| Myocrd Img Pet Prfuj W/Metab Dual Radiotracer (78432) | $6,318.20 | $22,565 | 4.6× |
| Neck soft tissue (70360) | $113.68 | $406 | 1.4× |
| Njx Rp Loclzj Non-Img Probe Study Intravenous (78808) | $145.04 | $518 | 0.4× |
| Nm csf leak detection (78650) | $467.32 | $1,669 | 0.4× |
| Nm myocard infarct spect (78469) | $341.04 | $1,218 | 0.7× |
| Nonvascular Shunt X-Ray (75809) | $113.68 | $406 | 1.2× |
| Ntsty modul radthx pln dose-vol histos (77301) | $2,590.28 | $9,251 | 2.1× |
| Nuclear Rx Intra-Arterial (79445) | $145.04 | $518 | 0.7× |
| Nuclear Rx Oral Admin (79005) | $145.04 | $518 | 0.7× |
| Ob us nuchal meas 1 gest (76813) | $114.52 | $409 | 1.2× |
| Oph bmtry us echograpy a-scan io lens pwr cal (76519) | $75.60 | $270 | 0.8× |
| Oph US Dx B-Scan&Quan a-Scan Sm Pt Enctr (76510) range across 2 matching MRF lines |
$118.16–$236.32 | $422–$844 | varies |
| Ophthalmic Biometry US Echograpy a-Scan (76516) | $67.76 | $242 | 0.7× |
| Ophthalmic Ultrasonic Foreign Body Localization (76529) range across 2 matching MRF lines |
$65.80–$131.60 | $235–$470 | varies |
| Ophthalmic ultrasound dx b-scan w/wo a-scan (76512) range across 2 matching MRF lines |
$67.20–$134.40 | $240–$480 | varies |
| Ophthalmic US Dx Corneal Pachymetry Uni/Bi (76514) | $7 | $25 | 0.3× |
| Ophthalmic us dx quantitative a-scan only (76511) range across 2 matching MRF lines |
$80.08–$160.16 | $286–$572 | varies |
| Panoramic X-ray of jaws (70355) | $113.68 | $406 | 1.4× |
| Parathyroid imaging w/tomographic spect & CT (78072) | $797.72 | $2,849 | 1.6× |
| Parathyroid Planar Imaging (78070) | $211.40 | $755 | 0.6× |
| Parathyroid planar imaging w/wo subtraction (78071) | $576.24 | $2,058 | 1.6× |
| Pelvis 1 or 2 views (72170) | $113.68 | $406 | 1.2× |
| Peritoneogram Rs&I (74190) | $336.56 | $1,202 | 0.7× |
| Prq Transhepatc Portograpy Hemodyn Eval Rs&I (75885) | $900.48 | $3,216 | 0.3× |
| Pulmonary Perfusion Imaging Particulate (78580) | $283.64 | $1,013 | 0.8× |
| Radex Abd Compl Aqt Abd W/S/E/D Views 1 View Ch (74022) | $132.16 | $472 | 1.4× |
| Radex abscess/fistula/sinus tract rs&i (76080) | $152.04 | $543 | 0.3× |
| Radex Ankle Complete Minimum 3 Views (73610) range across 4 matching MRF lines |
$119.56–$239.12 | $427–$854 | varies |
| Radex Calcaneus Minimum 2 Views (73650) range across 4 matching MRF lines |
$113.68–$227.36 | $406–$812 | varies |
| Radex elbow complete minimum 3 views (73080) range across 4 matching MRF lines |
$119.56–$239.12 | $427–$854 | varies |
| Radex Facial Bones Complete Minimum 3 Views (70150) | $119.56 | $427 | 1.3× |
| Radex fingr minimum 2 views (73140) range across 3 matching MRF lines |
$113.68–$227.36 | $406–$812 | varies |
| Radex foot complete minimum 3 views (73630) range across 4 matching MRF lines |
$119.56–$239.12 | $427–$854 | varies |
| Radex Hand Minimum 3 Views (73130) range across 4 matching MRF lines |
$119.56–$239.12 | $427–$854 | varies |
| Radex lower extremity infant minimum 2 views (73592) range across 2 matching MRF lines |
$113.68–$227.36 | $406–$812 | varies |
| Radex Mastoids Compl Minimum 3 Views PR Side (70130) | $119.56 | $427 | 1.3× |
| Radex Nasal Bones Complete Minimum 3 Views (70160) | $125.72 | $449 | 1.6× |
| Radex Ribs Unilateral 2 Views (71100) | $113.68 | $406 | 1.4× |
| Radex shoulder complete minimum 2 views (73030) range across 4 matching MRF lines |
$119.56–$239.12 | $427–$854 | varies |
| Radex Sinuses Paransl < 3 Views (70210) | $113.68 | $406 | 1.4× |
| Radex sm int w/mlt srl imges via enteroclss tube (74251) | $353.36 | $1,262 | 2.2× |
| Radex Spine 1 View Specify Level (72020) | $113.68 | $406 | 1.4× |
| Radex Sternum Minimum 2 Views (71120) | $113.68 | $406 | 1.4× |
| Radex Temporomandble Jt Opn & Clsd Mouth Bilat (70330) | $170.52 | $609 | 2.2× |
| Radex Toe Minimum 2 Views (73660) range across 3 matching MRF lines |
$113.68–$227.36 | $406–$812 | varies |
| Radex upper extremity infant minimum 2 views (73092) range across 2 matching MRF lines |
$113.68–$227.36 | $406–$812 | varies |
| Radex Wrist Complete Minimum 3 Views (73110) range across 4 matching MRF lines |
$119.56–$239.12 | $427–$854 | varies |
| Radex X-Ray Exam Entire Spi 6/> Vw - Xr Entire Spine 6+ Vw (72084) | $82.32 | $294 | 0.9× |
| Radiation treatment delivery level 1 (77402) | $200.20 | $715 | 2.2× |
| Radiation treatment delivery level 3 (77412) | $309.40 | $1,105 | 0.6× |
| Radiolog exam mandible compl minimum 4 views (70110) | $119.56 | $427 | 1.3× |
| Radiologic Exam Abdomen 3+ Views - Xr Abdomen 3+ Views (74021) | $125.72 | $449 | 1.3× |
| Radiologic exam colon double contrast study (74280) | $163.52 | $584 | 1.0× |
| Radiologic exam colon single contrast study (74270) | $113.68 | $406 | 0.7× |
| Radiologic Exam Esophagus Double Contrast Study (74221) | $230.44 | $823 | 1.5× |
| Radiologic exam knee complete 4/more views (73564) range across 4 matching MRF lines |
$125.72–$251.44 | $449–$898 | varies |
| Radiologic exam pelvis compl minimum 3 views (72190) | $119.56 | $427 | 1.3× |
| Radiologic Exam Small Int Single Contrast Study (74250) | $113.68 | $406 | 0.7× |
| Radiologic exam swallow function contrast study (74230) | $113.68 | $406 | 0.7× |
| Radiologic exam teeth complete full mouth (70320) | $113.68 | $406 | 0.5× |
| Radiologic exam upr gi trc double contrast study (74246) | $119.56 | $427 | 0.8× |
| Radiologic examination femur 1 view (73551) | $113.68 | $406 | 1.4× |
| Radiologic examination femur minimum 2 views (73552) range across 4 matching MRF lines |
$119.56–$239.12 | $427–$854 | varies |
| Radiologic examination knee 1/2 views (73560) range across 4 matching MRF lines |
$113.68–$239.12 | $406–$854 | varies |
| Radiologic Examination Osseous Survey Limited (77074) | $82.32 | $294 | 0.9× |
| Radiologic examination tibia & fibula 2 views (73590) range across 4 matching MRF lines |
$113.68–$227.36 | $406–$812 | varies |
| Radiologic examination, internal auditory meati, complete Non-Facility (70134) | $82.32 | $294 | 0.2× |
| Renal Cyst Study (74470) | $336.56 | $1,202 | 0.7× |
| Ribs bilateral 3 views (71110) | $170.52 | $609 | 1.8× |
| Rp loclzj tum plnr 1 area single day imaging (78800) | $250.32 | $894 | 0.7× |
| Rp Loclzj Tum Plnr Whole Body 2+ Days Imaging (78804) | $859.60 | $3,070 | 1.7× |
| Rp Loclzj Tum Plnr Whole Body Single Day Imaging (78802) | $467.32 | $1,669 | 1.0× |
| Rp Loclzj Tum Spect 1 Area Single Day Imaging (78803) | $467.32 | $1,669 | 1.0× |
| Rp loclzj tum spect 2 area/sep acquisj img (78831) | $4,383.68 | $15,656 | 3.7× |
| Rp loclzj tum spect CT 2area 1d img/1 ar img>2+d (78832) | $4,972.80 | $17,760 | 3.8× |
| Rp loclzj tum spect w/CT 1 area/acquisj 1day img (78830) | $4,383.68 | $15,656 | 3.7× |
| Rp Therapy Intravenous Administration (79101) | $145.04 | $518 | 0.7× |
| Salivary Gland Function Study (78232) | $169.96 | $607 | 0.5× |
| Scapula (73010) range across 4 matching MRF lines |
$113.68–$227.36 | $406–$812 | varies |
| Screening Digital Breast Tomosynthesis Bi (77063) | $24.64 | $88 | 1.1× |
| Shoulder 1 view (73020) range across 2 matching MRF lines |
$113.68–$227.36 | $406–$812 | varies |
| Shoulder Arthrography (73040) | $113.68 | $406 | 0.4× |
| Skull less than 4 views (70250) | $113.68 | $406 | 1.2× |
| Special dosimetry (77331) | $91.56 | $327 | 0.8× |
| Special Physics Consult (77370) | $331.80 | $1,185 | 2.7× |
| Special teletherapy port plan (77321) | $91.56 | $327 | 0.3× |
| Special treatment procedure (77470) | $165.76 | $592 | 0.3× |
| Speech evaluation, complex (70371) | $82.32 | $294 | 0.4× |
| Srs Multisource (77371) unusually low: confirm this is the full procedure |
$2,780.12 | $9,929 | 0.4× |
| Stereotactic Body Radiation Delivery (77373) | $2,200.52 | $7,859 | 1.4× |
| Sternoclavicular joints (71130) | $119.56 | $427 | 1.5× |
| Superior sagittal sinus venogram (75870) | $900.48 | $3,216 | 0.3× |
| Tbs technical calculation only (77091) | $100.52 | $359 | 1.3× |
| Telethx isodose pln cplx w/basic dosimetry (77307) | $93.80 | $335 | 0.3× |
| Telethx isodose pln smpl w/dosimetry calculation (77306) | $47.60 | $170 | 0.1× |
| Ther Rad Simulaj-Aided Field Setting Complex (77290) | $608.44 | $2,173 | 1.8× |
| Ther rad simulaj-aided field setting simple (77280) | $211.96 | $757 | 1.7× |
| Therapeutic Enema Rdctj Intussusception/Obstrcj (74283) | $148.96 | $532 | 0.9× |
| Thoracic spine 2 views (72070) | $113.68 | $406 | 1.2× |
| Thoracic spine 3 views (72072) | $119.56 | $427 | 1.3× |
| Thoracolumbar 2 views (72080) | $131.88 | $471 | 1.7× |
| Thyroid Imaging With Vascular Flow (78013) | $362.32 | $1,294 | 1.0× |
| Thyroid Met Imaging Body (78018) | $447.72 | $1,599 | 0.9× |
| Thyroid Uptake Measurement (78012) | $145.04 | $518 | 0.4× |
| Thyroid Uptake W/Blood Flow Sngle/Mult Quan Meas (78014) | $413.28 | $1,476 | 1.1× |
| Tx Devices Design & Construction Complex (77334) | $130.48 | $466 | 0.4× |
| Tx devices design & construction intermediate (77333) | $29.96 | $107 | 0.2× |
| Tx devices design & construction simple (77332) | $71.40 | $255 | 0.6× |
| Ultrasound Breast Limited (76642) range across 4 matching MRF lines |
$110.04–$220.08 | $393–$786 | varies |
| Ultrasound Elastography Parenchyma (76981) | $387.80 | $1,385 | 4.1× |
| Ultrasound Exam Aaa Screen (76706) | $120.68 | $431 | 1.3× |
| Ultrasound, abdomen limited (76705) | $125.16 | $447 | 1.3× |
| Umbilical-artery Doppler (OB) (76820) | $40.88 | $146 | 0.4× |
| Unlisted Dx Radiographic Procedure (76499) range across 2 matching MRF lines |
$68.04–$82.32 | $243–$294 | varies |
| Unlisted fluoroscopic procedure (76496) range across 3 matching MRF lines |
$115.64–$137.20 | $413–$490 | varies |
| Unlisted magnetic resonance procedure (76498) | $363.72 | $1,299 | 4.6× |
| Unlisted Miscellaneous Px Dx Nuclear Medicine (78999) | $316.96 | $1,132 | 0.9× |
| Unlisted us procedure (76999) | $57.68 | $206 | 0.7× |
| Upper gi w/o kub (74240) | $113.68 | $406 | 0.7× |
| Ureteral Reflux Study (78740) | $302.12 | $1,079 | 0.8× |
| Urethrocystogram voiding (74455) | $113.68 | $406 | 0.5× |
| Urethrocystography retrograde (74450) | $162.96 | $582 | 0.8× |
| Us breast unilateral complete (76641) range across 4 matching MRF lines |
$110.04–$220.08 | $393–$786 | varies |
| Us chest (76604) | $98.56 | $352 | 1.0× |
| Us complete joint (76881) | $162.96 | $582 | 1.7× |
| Us exam, pelvic, limited (76857) | $110.60 | $395 | 1.2× |
| Us head (76506) | $110.60 | $395 | 1.2× |
| Us kidney transplant (76776) | $182.84 | $653 | 1.9× |
| Us lmtd joint/oth nonvasc xtr strux r-t w/img (76882) range across 3 matching MRF lines |
$46.76–$93.52 | $167–$334 | varies |
| Us ob detailed single fetus (76811) | $168 | $600 | 0.8× |
| Us ob limited 1 or more fetuses (76815) | $97.72 | $349 | 1.0× |
| Us ob transvaginal (76817) | $108.64 | $388 | 1.1× |
| Us pelvic non ob complete (76856) | $145.88 | $521 | 1.5× |
| Us pg uter img f&mat 14 wk tabdl 1/1st gestation (76801) | $134.12 | $479 | 1.4× |
| Us preg uterus real time f/u trnsabdl per fetus (76816) | $110.60 | $395 | 1.2× |
| Us retroperitoneal complete (76770) | $157.36 | $562 | 1.7× |
| Us retroperitoneal limited (76775) | $136.08 | $486 | 1.4× |
| Us scrotum and contents (76870) | $147.56 | $527 | 1.6× |
| Us spinal canal and contents (76800) | $120.12 | $429 | 1.3× |
| Us thyroid (76536) | $143.08 | $511 | 1.5× |
| Us transrectal (76872) | $172.48 | $616 | 1.8× |
| Vein X-Ray Chest (75827) | $442.40 | $1,580 | 0.3× |
| Vein X-Ray Liver W/O Hemodyn (75887) | $900.48 | $3,216 | 0.3× |
| Venogram Sinus/Jugular (75860) | $900.48 | $3,216 | 0.3× |
| Venography Adrenal Unilateral (75840) | $900.48 | $3,216 | 0.3× |
| Venography caval inferior serialography rs&i (75825) | $900.48 | $3,216 | 0.3× |
| Venography extremity bilateral rs&i (75822) | $442.40 | $1,580 | 0.3× |
| Venography extremity unilateral rs&i (75820) | $442.40 | $1,580 | 0.3× |
| Venography Renal Bilateral (75833) | $900.48 | $3,216 | 0.3× |
| Venography Renal Unilateral (75831) | $900.48 | $3,216 | 0.3× |
| Venous sampling by catheter (75893) likely a partial charge, not the full procedure |
$1,500.24 | $5,358 | 0.3× |
| Wrist 2 views (73100) range across 4 matching MRF lines |
$113.68–$227.36 | $406–$812 | varies |
| X-Ray Ac Jts - Xr Acromioclavicular Joints Bilateral (73050) | $113.68 | $406 | 1.4× |
| X-ray antegrade pyelogram tube (74425) | $113.68 | $406 | 0.4× |
| X-Ray Aorta Leg Arteries (75630) | $900.48 | $3,216 | 0.3× |
| X-Ray Bend Only L-S Spine (72120) | $125.72 | $449 | 1.3× |
| X-Ray Elbow 2 Vw - Xr Elbow 1-2 Views Right (73070) range across 4 matching MRF lines |
$113.68–$227.36 | $406–$812 | varies |
| X-Ray Exam Breast Specimen (76098) | $152.04 | $543 | 0.3× |
| X-Ray Exam Entire Spi 1 Vw (72081) | $113.68 | $406 | 1.4× |
| X-Ray Exam Entire Spi 2/3 Vw (72082) | $119.56 | $427 | 1.3× |
| X-Ray Exam Entire Spi 4/5 Vw (72083) | $125.72 | $449 | 1.3× |
| X-Ray Exam Hip Uni 1 View (73501) | $113.68 | $406 | 1.4× |
| X-Ray Exam Hip Uni 2-3 Views (73502) | $119.56 | $427 | 1.5× |
| X-Ray Exam Hip Uni 4/> Views (73503) | $125.72 | $449 | 1.3× |
| X-Ray Exam Hips Bi 2 Views (73521) | $170.52 | $609 | 1.8× |
| X-Ray Exam Hips Bi 3-4 Views (73522) | $179.20 | $640 | 1.9× |
| X-Ray Exam L-S Spine Bending (72114) | $131.88 | $471 | 1.4× |
| X-Ray Exam Neck Spine 2-3 Vw (72040) | $119.56 | $427 | 1.5× |
| X-Ray Exam Neck Spine 6/>Vws (72052) | $131.88 | $471 | 1.4× |
| X-Ray Exam Unilat Ribs/Chest (71101) | $119.56 | $427 | 1.3× |
| X-ray eye for foreign body (70030) range across 2 matching MRF lines |
$113.68–$227.36 | $406–$812 | varies |
| X-ray humerus (73060) | $113.68 | $406 | 1.4× |
| X-Ray Jaw <4 Vw - Xr Mandible < 4 Views (70100) | $113.68 | $406 | 1.4× |
| X-Ray Knee Bilat Standing - Xr Knees Anteroposterior Standing Bilat (73565) | $170.52 | $609 | 2.2× |
| X-Ray Lumbar Spine 2/3 Vw - Xr Lumbar Spine 2-3 Views (72100) | $113.68 | $406 | 1.2× |
| X-ray nose-rectum child f.b. (76010) | $113.68 | $406 | 1.4× |
| X-Ray Ribs, Chest 4+ Vw - Xr Ribs 3 Vws Bil W/ Chest Posteroanterior (71111) | $179.20 | $640 | 1.9× |
| X-Ray Sacroiliac Jts 3+ Vw - Xr Sacroiliac Joints 3+ Views (72202) | $119.56 | $427 | 1.3× |
| X-Ray Sacroiliac Jts <3 Vw - Xr Sacroiliac Joints 1-2 Views (72200) | $113.68 | $406 | 1.2× |
| X-Ray Sacrum/Coccyx 2+ Vw - Xr Sacrum Coccyx 2+ Views (72220) | $125.72 | $449 | 1.6× |
| X-Ray Sinuses 3+ Vw - Xr Paranasal Sinuses 3+ Views (70220) | $119.56 | $427 | 1.5× |
| X-Ray Skull 4+ Vw - Xr Skull Complete 4+ Views (70260) | $119.56 | $427 | 1.3× |
| X-Ray Stress View (77071) | $113.68 | $406 | 1.4× |
| X-ray thoracic spine 4 vw (72074) | $125.72 | $449 | 1.3× |
| X-Ray Tmj Unilat (70328) | $113.68 | $406 | 1.4× |
| X-Ray Urinary Tract Exam With Contrast Material (74420) | $113.68 | $406 | 0.4× |
| X-Rays Bone Length Studies (77073) | $113.68 | $406 | 1.2× |
| X-Rays Bone Survey Complete (77075) | $113.68 | $406 | 1.2× |
| Xr c-spine 4 or 5 views (72050) | $125.72 | $449 | 1.3× |
| Xr facial bones less than 3 views (70140) | $113.68 | $406 | 1.4× |
| XR Mastoids < 3 Views Bilateral (70120) | $113.68 | $406 | 1.2× |
| Xr orbits complete 4 views (70200) | $119.56 | $427 | 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.