Imaging prices at Osf Holy Family Medical Center
Monmouth, IL · every code in this section with a posted price and a Medicare benchmark.
279 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) | $314.40 | $393 | 3.4× |
| Abdomen 2 views (74019) | $383.20 | $479 | 3.4× |
| Acute Gastrointestinal Blood Loss Imaging (78278) | $3,246.40 | $4,058 | 7.6× |
| Angio pulmonary bilat (75743) | $2,589.60 | $3,237 | 0.8× |
| Angiography extremity bilateral rs&i (75716) | $5,377.60 | $6,722 | 1.6× |
| Ankle 2 views (73600) range across 3 matching MRF lines |
$526.40–$790.40 | $658–$988 | varies |
| Arthrogram ankle (73615) | $975.20 | $1,219 | 2.6× |
| Bone age studies (77072) | $524 | $655 | 4.7× |
| Bone Imaging 3 Phase (78315) | $3,196 | $3,995 | 7.5× |
| Bone Imaging Limited Area (78300) | $2,297.60 | $2,872 | 5.4× |
| Bone Imaging Multiple Areas (78305) | $1,760 | $2,200 | 4.1× |
| Bone Imaging Whole Body (78306) | $3,220 | $4,025 | 7.5× |
| Bone survey infant (77076) | $1,033.60 | $1,292 | 9.2× |
| Brain Imaging Pet Metabolic Evaluation (78608) | $5,293.60 | $6,617 | 3.5× |
| Cat Scan Follow-Up Study (76380) | $1,518.40 | $1,898 | 16.3× |
| Chest 1 view (71045) | $268.80 | $336 | 2.9× |
| Chest 2 views (71046) | $316.80 | $396 | 3.4× |
| Chest 3 views (71047) | $376.80 | $471 | 4.0× |
| Chest 4 or more views (71048) | $426.40 | $533 | 3.8× |
| Clavicle complete (73000) range across 3 matching MRF lines |
$546.40–$820.80 | $683–$1,026 | varies |
| Computed Tomography Thorax Lw Dose Lng Ca Scr C- (71271) | $235.20 | $294 | 2.1× |
| Contrast Exam Abdominl Aorta (75625) | $5,377.60 | $6,722 | 1.6× |
| Contrast X-Ray Bladder (74430) | $920 | $1,150 | 2.5× |
| Contrast X-Ray Of Elbow (73085) | $1,276.80 | $1,596 | 3.4× |
| Contrast X-Ray Of Knee Joint (73580) | $1,000 | $1,250 | 2.7× |
| CT abdomen and pelvis without and with contrast (74178) | $6,075.20 | $7,594 | 16.2× |
| CT abdomen and pelvis without contrast (74176) | $5,098.40 | $6,373 | 19.9× |
| CT abdomen w contrast (74160) | $2,709.60 | $3,387 | 14.4× |
| CT abdomen w wo contrast (74170) | $3,264 | $4,080 | 17.4× |
| CT abdomen w/o contrast (74150) | $2,639.20 | $3,299 | 23.6× |
| CT Angio Abdomen and Pelvis (74174) | $5,332.80 | $6,666 | 14.3× |
| CT Angio Chest (71275) | $3,183.20 | $3,979 | 16.9× |
| CT Angio Head (70496) | $3,335.20 | $4,169 | 17.7× |
| CT angio hrt w/3d image (75574) | $3,183.20 | $3,979 | 8.5× |
| Ct Angio Lwr Extr W/O&W/Dye (73706) range across 3 matching MRF lines |
$3,613.60–$5,420.80 | $4,517–$6,776 | varies |
| CT Angio Neck (70498) | $3,052.80 | $3,816 | 16.2× |
| Ct Angio Upr Extrm W/O&W/Dye (73206) range across 3 matching MRF lines |
$3,108.80–$4,664 | $3,886–$5,830 | varies |
| CT cervical spine w/ contrast (72126) | $2,503.20 | $3,129 | 6.7× |
| CT cervical spine w/o contrast (72125) | $3,157.60 | $3,947 | 28.2× |
| CT cervical spine w/wo cont (72127) | $3,330.40 | $4,163 | 17.7× |
| CT chest w contrast (71260) | $2,885.60 | $3,607 | 15.4× |
| CT chest w/wo contrast (71270) | $3,305.60 | $4,132 | 17.6× |
| CT colonography screening (74263) | $2,029.60 | $2,537 | 7.9× |
| CT Colonogrphy Dx Image Postprocess W/Contrast (74262) | $3,118.40 | $3,898 | 16.6× |
| CT colonogrphy dx image postprocess w/o contrast (74261) | $3,118.40 | $3,898 | 27.8× |
| CT head/brain with contrast (70460) | $2,645.60 | $3,307 | 14.1× |
| CT head/brain without and with contrast (70470) | $2,687.20 | $3,359 | 14.3× |
| CT heart contrast eval cardiac structure&morph (75572) | $3,183.20 | $3,979 | 8.5× |
| CT heart no contrast quant eval coronry calcium (75571) | $156 | $195 | 1.7× |
| CT hrt w/3d image congen (75573) | $2,637.60 | $3,297 | 7.1× |
| CT iac w contrast (70481) | $3,754.40 | $4,693 | 20.0× |
| CT l-spine w&w/o contrast (72133) | $3,472 | $4,340 | 18.5× |
| CT lower ext w/o (73700) range across 3 matching MRF lines |
$2,733.60–$4,101.60 | $3,417–$5,127 | varies |
| CT lower extremity w/contrast material (73701) range across 3 matching MRF lines |
$3,144–$4,716.80 | $3,930–$5,896 | varies |
| CT lumbar spine w contrast (72132) | $3,303.20 | $4,129 | 8.8× |
| CT lumbar spine w/o contrast (72131) | $3,336 | $4,170 | 29.8× |
| CT maxillofacial w contrast (70487) | $2,765.60 | $3,457 | 14.7× |
| CT maxillofacial wo contrast (70486) range across 3 matching MRF lines |
$2,396.80–$3,517.60 | $2,996–$4,397 | varies |
| CT neck tissue combo (70492) | $2,773.60 | $3,467 | 14.8× |
| Ct Orbit/Ear/Fossa W/O&W/Dye (70482) | $4,162.40 | $5,203 | 22.1× |
| CT orbits w/o contrast (70480) | $3,337.60 | $4,172 | 29.8× |
| CT pelvis w&w/o contrast (72194) | $3,160 | $3,950 | 16.8× |
| CT pelvis w/o contrast (72192) | $2,573.60 | $3,217 | 23.0× |
| CT scan of leg combo (73702) range across 3 matching MRF lines |
$3,264–$4,895.20 | $4,080–$6,119 | varies |
| CT scans face/jaw combo (70488) | $3,640 | $4,550 | 19.4× |
| CT soft tissue neck w contrast (70491) | $2,696.80 | $3,371 | 14.3× |
| CT soft tissue neck w/o contrast (70490) | $2,404 | $3,005 | 21.5× |
| CT thoracic spine w contrast (72129) | $3,068.80 | $3,836 | 16.3× |
| CT thoracic spine w/o contrast (72128) | $2,865.60 | $3,582 | 25.6× |
| CT thoracic spine w/wo cont (72130) | $3,170.40 | $3,963 | 16.9× |
| CT thorax w/o contrast (71250) | $2,515.20 | $3,144 | 22.5× |
| CT upper ext wo (73200) range across 3 matching MRF lines |
$2,339.20–$3,509.60 | $2,924–$4,387 | varies |
| CT upper extremity w/o & w/contrast material (73202) range across 3 matching MRF lines |
$3,264–$4,896 | $4,080–$6,120 | varies |
| CT upper extremity with contrast (73201) range across 3 matching MRF lines |
$3,273.60–$4,911.20 | $4,092–$6,139 | varies |
| Cta Abdl Aorta&Bi Iliofem W/Contrast&Postp (75635) | $3,118.40 | $3,898 | 16.6× |
| Cta Abdomen (74175) | $3,463.20 | $4,329 | 18.4× |
| CTA head&neck c+ w/noncontrast img&post-pxessing (70471) | $2,550.40 | $3,188 | 6.8× |
| CTA pelvis (72191) | $3,264 | $4,080 | 17.4× |
| Dxa Bone Density Axial (77080) | $760.80 | $951 | 6.8× |
| Dxa bone density study (77085) | $344 | $430 | 3.1× |
| Esophagram (74220) | $1,140 | $1,425 | 6.1× |
| Fetal Biophys Profile W/Nst (76818) | $1,343.20 | $1,679 | 12.0× |
| Fetal Biophysical Profile W/O Non-Stress Testing (76819) | $786.40 | $983 | 7.0× |
| Fluoroscopy up to 1 hr (76000) | $1,859.20 | $2,324 | 7.3× |
| Follow-Up Angiography (75898) | $2,589.60 | $3,237 | 0.8× |
| Foot 2 views (73620) range across 3 matching MRF lines |
$526.40–$790.40 | $658–$988 | varies |
| Forearm 2 views (73090) range across 3 matching MRF lines |
$548.80–$821.60 | $686–$1,027 | varies |
| Gastric emptying imaging study (78264) | $1,767.20 | $2,209 | 4.1× |
| Gastroesophageal Reflux Exam (78262) | $1,372 | $1,715 | 3.2× |
| Gated Heart Planar Single (78472) | $3,491.20 | $4,364 | 8.1× |
| Hand 2 views (73120) range across 3 matching MRF lines |
$515.20–$774.40 | $644–$968 | varies |
| Hepatobil Syst Image W/Drug (78227) | $3,011.20 | $3,764 | 5.2× |
| Hepatobiliary System Imaging (78226) | $2,719.20 | $3,399 | 6.3× |
| Ht Muscle Image Spect Sing (78451) | $5,558.40 | $6,948 | 4.0× |
| Hysterosalpingogram (74740) | $1,052.80 | $1,316 | 4.1× |
| Joint Survey Single View (77077) | $498.40 | $623 | 4.4× |
| K Flow/Funct Image W/Drug (78708) | $9,596 | $11,995 | 16.5× |
| K Flow/Funct Image W/O Drug (78707) | $3,512 | $4,390 | 6.0× |
| Kidney Imaging Morphol (78700) | $1,771.20 | $2,214 | 4.1× |
| Knee 3 Views (73562) range across 3 matching MRF lines |
$622.40–$934.40 | $778–$1,168 | varies |
| Liver & Spleen Imaging Static Only (78215) | $2,201.60 | $2,752 | 5.1× |
| Lung Ventilat&Perfus Imaging (78582) | $1,983.20 | $2,479 | 3.4× |
| Lung Ventilation Imaging (78579) | $3,990.40 | $4,988 | 9.3× |
| Lymph System Imaging (78195) | $2,142.40 | $2,678 | 3.7× |
| Magnetic Image Jaw Joint (70336) | $3,568.80 | $4,461 | 14.0× |
| Mammary ductogram or galactogram multiple (77054) | $1,118.40 | $1,398 | 4.4× |
| Mammary ductogram or galactogram single (77053) | $2,071.20 | $2,589 | 8.1× |
| Meckels Divert Exam (78290) | $3,799.20 | $4,749 | 8.9× |
| Mra Head W/O & W/Contrast Material (70546) | $4,429.60 | $5,537 | 11.8× |
| MRA head w/o contrast (70544) | $4,468.80 | $5,586 | 17.5× |
| MRA neck w contrast (70548) | $2,856.80 | $3,571 | 7.6× |
| Mra Neck W/O &W/Contrast Material (70549) | $4,650.40 | $5,813 | 12.4× |
| MRA neck w/o contrast (70547) | $4,063.20 | $5,079 | 15.9× |
| MRI abdomen w contrast (74182) | $3,937.60 | $4,922 | 10.5× |
| MRI abdomen w/o contrast (74181) | $3,828 | $4,785 | 15.0× |
| MRI any jt lower extrem w/contrast material (73722) range across 3 matching MRF lines |
$4,224.80–$6,336.80 | $5,281–$7,921 | varies |
| MRI any jt lower extrem w/o & w/contrast matrl (73723) range across 3 matching MRF lines |
$5,229.60–$7,845.60 | $6,537–$9,807 | varies |
| MRI any jt upper extremity w/contrast matrl (73222) range across 3 matching MRF lines |
$4,436–$6,654.40 | $5,545–$8,318 | varies |
| MRI Breast W/O Contrast Bilateral (77047) | $5,372 | $6,715 | 21.0× |
| MRI Breast Without Contrast Material Unilateral (77046) | $3,056 | $3,820 | 12.0× |
| MRI cervical spine w contrast (72142) | $4,540.80 | $5,676 | 12.1× |
| MRI cervical spine w/o cont (72141) | $3,876.80 | $4,846 | 15.2× |
| MRI chest w/o contrast (71550) | $4,144 | $5,180 | 16.2× |
| MRI chest with contrast (71551) | $4,224.80 | $5,281 | 5.0× |
| MRI chest wo w contrast (71552) | $4,644.80 | $5,806 | 12.4× |
| MRI lower extrem oth/thn jt w/contrast matrl (73719) range across 3 matching MRF lines |
$4,608–$6,912 | $5,760–$8,640 | varies |
| MRI lower extrem oth/thn jt w/o & w/contr matr (73720) range across 3 matching MRF lines |
$5,522.40–$8,284 | $6,903–$10,355 | varies |
| MRI lower extrem oth/thn jt w/o contr matrl (73718) range across 3 matching MRF lines |
$4,463.20–$6,694.40 | $5,579–$8,368 | varies |
| MRI lumbar spine w contrast (72149) | $4,436 | $5,545 | 11.9× |
| Mri Neck Spine W/O & W/Dye (72156) | $5,042.40 | $6,303 | 13.5× |
| MRI orbit face &/neck w/o contrast (70540) | $4,252.80 | $5,316 | 16.6× |
| MRI orbit face neck w contrast (70542) | $4,768.80 | $5,961 | 12.8× |
| Mri Orbt/Fac/Nck W/O &W/Dye (70543) | $5,284.80 | $6,606 | 14.1× |
| MRI pelvis w contrast (72196) | $3,940 | $4,925 | 10.5× |
| MRI pelvis w/o & w contrast (72197) | $4,437.60 | $5,547 | 11.9× |
| MRI pelvis w/o contrast (72195) | $3,568.80 | $4,461 | 14.0× |
| MRI thoracic spine w/o contrast (72146) | $3,876.80 | $4,846 | 15.2× |
| MRI upper extremity oth than jt w/contr matrl (73219) range across 3 matching MRF lines |
$4,224.80–$6,336.80 | $5,281–$7,921 | varies |
| MRI upper extremity oth than jt w/o contr matrl (73218) range across 3 matching MRF lines |
$3,411.20–$5,116.80 | $4,264–$6,396 | varies |
| Mri Uppr Extremity W/O&W/Dye (73220) range across 3 matching MRF lines |
$4,644.80–$6,967.20 | $5,806–$8,709 | varies |
| MRI, abdomen, combo (74183) | $4,437.60 | $5,547 | 11.9× |
| MRI, dorsal spine combo (72157) | $5,282.40 | $6,603 | 14.1× |
| MRI, dorsal spine contrast (72147) | $4,036.80 | $5,046 | 10.8× |
| MRI, joint upper extrem (73221) range across 3 matching MRF lines |
$3,876.80–$5,815.20 | $4,846–$7,269 | varies |
| MRI, joint upper extrem combo (73223) range across 3 matching MRF lines |
$4,436–$6,654.40 | $5,545–$8,318 | varies |
| MRI, lumbar spine combo (72158) | $5,146.40 | $6,433 | 13.8× |
| Myelogram Lumbar (72265) | $2,186.40 | $2,733 | 2.6× |
| Myelography thoracic (72255) | $2,186.40 | $2,733 | 2.6× |
| Myocardial Imaging Infarct Avid Planar Qual/Quan (78466) | $2,068 | $2,585 | 4.8× |
| Myocardial Spect Multiple Studies (78452) | $6,214.40 | $7,768 | 4.5× |
| Neck soft tissue (70360) | $493.60 | $617 | 5.3× |
| Parathyroid Planar Imaging (78070) | $1,920 | $2,400 | 4.5× |
| Pelvis 1 or 2 views (72170) | $520.80 | $651 | 4.6× |
| Pet Image W/Ct Lmtd (78814) | $5,582.40 | $6,978 | 3.6× |
| PET image w/CT, full body (78816) | $5,968.80 | $7,461 | 3.9× |
| PET imaging CT attenuation skull base mid-thigh (78815) | $5,889.60 | $7,362 | 3.8× |
| Prq Transhepatc Portograpy Hemodyn Eval Rs&I (75885) | $2,589.60 | $3,237 | 0.8× |
| Pulmonary Perfusion Imaging Particulate (78580) | $2,148 | $2,685 | 5.0× |
| Radex Abd Compl Aqt Abd W/S/E/D Views 1 View Ch (74022) | $709.60 | $887 | 6.3× |
| Radex abscess/fistula/sinus tract rs&i (76080) | $591.20 | $739 | 1.0× |
| Radex Ankle Complete Minimum 3 Views (73610) range across 3 matching MRF lines |
$559.20–$836.80 | $699–$1,046 | varies |
| Radex Calcaneus Minimum 2 Views (73650) range across 3 matching MRF lines |
$513.60–$769.60 | $642–$962 | varies |
| Radex elbow complete minimum 3 views (73080) range across 3 matching MRF lines |
$577.60–$868 | $722–$1,085 | varies |
| Radex Facial Bones Complete Minimum 3 Views (70150) | $718.40 | $898 | 6.4× |
| Radex fingr minimum 2 views (73140) range across 4 matching MRF lines |
$368–$553.60 | $460–$692 | varies |
| Radex foot complete minimum 3 views (73630) range across 3 matching MRF lines |
$562.40–$840.80 | $703–$1,051 | varies |
| Radex Hand Minimum 3 Views (73130) range across 3 matching MRF lines |
$559.20–$836.80 | $699–$1,046 | varies |
| Radex lower extremity infant minimum 2 views (73592) range across 3 matching MRF lines |
$568.80–$851.20 | $711–$1,064 | varies |
| Radex Mastoids Compl Minimum 3 Views PR Side (70130) range across 3 matching MRF lines |
$969.60–$1,455.20 | $1,212–$1,819 | varies |
| Radex Nasal Bones Complete Minimum 3 Views (70160) | $551.20 | $689 | 5.9× |
| Radex Ribs Unilateral 2 Views (71100) | $509.60 | $637 | 5.5× |
| Radex shoulder complete minimum 2 views (73030) range across 3 matching MRF lines |
$582.40–$876 | $728–$1,095 | varies |
| Radex Spine 1 View Specify Level (72020) range across 6 matching MRF lines |
$341.60–$366.40 | $427–$458 | varies |
| Radex Sternum Minimum 2 Views (71120) | $632.80 | $791 | 6.8× |
| Radex Temporomandble Jt Opn & Clsd Mouth Bilat (70330) | $766.40 | $958 | 8.2× |
| Radex Toe Minimum 2 Views (73660) range across 4 matching MRF lines |
$384–$576 | $480–$720 | varies |
| Radex upper extremity infant minimum 2 views (73092) range across 3 matching MRF lines |
$568.80–$851.20 | $711–$1,064 | varies |
| Radex Wrist Complete Minimum 3 Views (73110) range across 3 matching MRF lines |
$652–$974.40 | $815–$1,218 | varies |
| Radex X-Ray Exam Entire Spi 6/> Vw - Xr Entire Spine 6+ Vw (72084) | $436.80 | $546 | 3.9× |
| Radiolog exam mandible compl minimum 4 views (70110) | $687.20 | $859 | 6.1× |
| Radiologic Exam Abdomen 3+ Views - Xr Abdomen 3+ Views (74021) | $441.60 | $552 | 3.9× |
| Radiologic exam colon double contrast study (74280) | $2,049.60 | $2,562 | 10.9× |
| Radiologic exam colon single contrast study (74270) | $1,314.40 | $1,643 | 7.0× |
| Radiologic Exam Esophagus Double Contrast Study (74221) | $1,527.20 | $1,909 | 8.1× |
| Radiologic exam knee complete 4/more views (73564) range across 3 matching MRF lines |
$622.40–$934.40 | $778–$1,168 | varies |
| Radiologic exam pelvis compl minimum 3 views (72190) | $781.60 | $977 | 7.0× |
| Radiologic Exam Small Int Single Contrast Study (74250) | $1,137.60 | $1,422 | 6.1× |
| Radiologic exam swallow function contrast study (74230) | $1,005.60 | $1,257 | 5.4× |
| Radiologic exam upr gi trc double contrast study (74246) | $1,228 | $1,535 | 6.5× |
| Radiologic examination femur 1 view (73551) range across 3 matching MRF lines |
$429.60–$644 | $537–$805 | varies |
| Radiologic examination femur minimum 2 views (73552) range across 3 matching MRF lines |
$541.60–$812 | $677–$1,015 | varies |
| Radiologic examination knee 1/2 views (73560) range across 3 matching MRF lines |
$520.80–$781.60 | $651–$977 | varies |
| Radiologic Examination Osseous Survey Limited (77074) | $724 | $905 | 6.5× |
| Radiologic examination tibia & fibula 2 views (73590) range across 3 matching MRF lines |
$559.20–$836.80 | $699–$1,046 | varies |
| Ribs bilateral 3 views (71110) | $677.60 | $847 | 6.0× |
| Rp loclzj tum plnr 1 area single day imaging (78800) | $2,296 | $2,870 | 5.4× |
| Rp Loclzj Tum Plnr Whole Body Single Day Imaging (78802) | $3,080.80 | $3,851 | 5.3× |
| Rp Loclzj Tum Spect 1 Area Single Day Imaging (78803) | $2,426.40 | $3,033 | 4.2× |
| Rp loclzj tum spect 2 area/sep acquisj img (78831) | $3,640 | $4,550 | 2.6× |
| Rp loclzj tum spect CT 2area 1d img/1 ar img>2+d (78832) | $4,852 | $6,065 | 3.2× |
| Rp loclzj tum spect w/CT 1 area/acquisj 1day img (78830) | $3,235.20 | $4,044 | 2.3× |
| Scapula (73010) range across 3 matching MRF lines |
$546.40–$820.80 | $683–$1,026 | varies |
| Screening Digital Breast Tomosynthesis Bi (77063) | $117.60 | $147 | 5.0× |
| Shoulder 1 view (73020) range across 3 matching MRF lines |
$511.20–$767.20 | $639–$959 | varies |
| Shoulder Arthrography (73040) | $860.80 | $1,076 | 2.3× |
| Skull less than 4 views (70250) | $536.80 | $671 | 4.8× |
| Sternoclavicular joints (71130) | $564.80 | $706 | 6.1× |
| Thoracic spine 2 views (72070) | $459.20 | $574 | 4.1× |
| Thoracic spine 3 views (72072) | $527.20 | $659 | 4.7× |
| Thoracolumbar 2 views (72080) | $224 | $280 | 2.4× |
| Thyroid Imaging With Vascular Flow (78013) | $1,302.40 | $1,628 | 3.0× |
| Thyroid Uptake W/Blood Flow Sngle/Mult Quan Meas (78014) | $1,256 | $1,570 | 2.9× |
| Ultrasound Breast Limited (76642) range across 3 matching MRF lines |
$518.40–$1,023.20 | $648–$1,279 | varies |
| Ultrasound Exam Aaa Screen (76706) | $1,445.60 | $1,807 | 12.9× |
| Ultrasound, abdomen limited (76705) | $1,161.60 | $1,452 | 10.4× |
| Unlisted us procedure (76999) | $678.40 | $848 | 7.3× |
| Upper gi w/o kub (74240) | $1,095.20 | $1,369 | 5.8× |
| Urethrocystogram voiding (74455) | $1,161.60 | $1,452 | 4.5× |
| Us breast unilateral complete (76641) range across 3 matching MRF lines |
$518.40–$1,023.20 | $648–$1,279 | varies |
| Us chest (76604) | $750.40 | $938 | 6.7× |
| Us complete joint (76881) range across 3 matching MRF lines |
$1,190.40–$1,784.80 | $1,488–$2,231 | varies |
| Us exam, pelvic, limited (76857) | $732.80 | $916 | 6.5× |
| Us kidney transplant (76776) | $877.60 | $1,097 | 7.8× |
| Us lmtd joint/oth nonvasc xtr strux r-t w/img (76882) range across 3 matching MRF lines |
$1,190.40–$1,784.80 | $1,488–$2,231 | varies |
| Us ob detailed single fetus (76811) | $1,276.80 | $1,596 | 5.0× |
| Us ob limited 1 or more fetuses (76815) | $756.80 | $946 | 6.8× |
| Us ob transvaginal (76817) | $756.80 | $946 | 6.8× |
| Us pelvic non ob complete (76856) | $1,424 | $1,780 | 12.7× |
| Us pg uter img f&mat 14 wk tabdl 1/1st gestation (76801) | $970.40 | $1,213 | 8.7× |
| Us preg uterus real time f/u trnsabdl per fetus (76816) | $1,012 | $1,265 | 9.0× |
| Us retroperitoneal complete (76770) | $1,312 | $1,640 | 11.7× |
| Us retroperitoneal limited (76775) | $988.80 | $1,236 | 8.8× |
| Us scrotum and contents (76870) | $1,424 | $1,780 | 12.7× |
| Us thyroid (76536) | $1,368 | $1,710 | 12.2× |
| Vein X-Ray Liver W/O Hemodyn (75887) | $2,589.60 | $3,237 | 0.8× |
| Venogram Sinus/Jugular (75860) | $2,589.60 | $3,237 | 0.8× |
| Venography caval inferior serialography rs&i (75825) | $2,644 | $3,305 | 0.8× |
| Venography extremity bilateral rs&i (75822) | $2,716 | $3,395 | 1.6× |
| Venography extremity unilateral rs&i (75820) | $1,304.80 | $1,631 | 0.8× |
| Wrist 2 views (73100) range across 3 matching MRF lines |
$576.80–$867.20 | $721–$1,084 | varies |
| X-Ray Ac Jts - Xr Acromioclavicular Joints Bilateral (73050) | $637.60 | $797 | 6.8× |
| X-Ray Bend Only L-S Spine (72120) | $471.20 | $589 | 4.2× |
| X-Ray Elbow 2 Vw - Xr Elbow 1-2 Views Right (73070) range across 3 matching MRF lines |
$542.40–$812 | $678–$1,015 | varies |
| X-Ray Exam Breast Specimen (76098) | $451.20 | $564 | 0.8× |
| X-Ray Exam Entire Spi 1 Vw (72081) | $295.20 | $369 | 3.2× |
| X-Ray Exam Entire Spi 2/3 Vw (72082) | $341.60 | $427 | 3.0× |
| X-Ray Exam Entire Spi 4/5 Vw (72083) | $379.20 | $474 | 3.4× |
| X-Ray Exam Hip Uni 1 View (73501) | $464 | $580 | 5.0× |
| X-Ray Exam Hip Uni 2-3 Views (73502) | $519.20 | $649 | 5.6× |
| X-Ray Exam Hip Uni 4/> Views (73503) | $587.20 | $734 | 5.2× |
| X-Ray Exam Hips Bi 2 Views (73521) | $587.20 | $734 | 5.2× |
| X-Ray Exam Hips Bi 3-4 Views (73522) | $708.80 | $886 | 6.3× |
| X-Ray Exam Hips Bi 5/> Views (73523) | $832 | $1,040 | 7.4× |
| X-Ray Exam L-S Spine Bending (72114) | $612.80 | $766 | 5.5× |
| X-Ray Exam Neck Spine 2-3 Vw (72040) | $468 | $585 | 5.0× |
| X-Ray Exam Neck Spine 6/>Vws (72052) | $635.20 | $794 | 5.7× |
| X-Ray Exam Unilat Ribs/Chest (71101) | $677.60 | $847 | 6.0× |
| X-ray eye for foreign body (70030) | $903.20 | $1,129 | 9.7× |
| X-ray humerus (73060) range across 3 matching MRF lines |
$647.20–$971.20 | $809–$1,214 | varies |
| X-ray IV pyelogram (ivp) (74400) | $1,712.80 | $2,141 | 9.1× |
| X-Ray Jaw <4 Vw - Xr Mandible < 4 Views (70100) | $687.20 | $859 | 7.4× |
| X-Ray Knee Bilat Standing - Xr Knees Anteroposterior Standing Bilat (73565) | $462.40 | $578 | 5.0× |
| X-Ray Lumbar Spine 2/3 Vw - Xr Lumbar Spine 2-3 Views (72100) | $471.20 | $589 | 4.2× |
| X-ray nose-rectum child f.b. (76010) | $472.80 | $591 | 5.1× |
| X-Ray Ribs, Chest 4+ Vw - Xr Ribs 3 Vws Bil W/ Chest Posteroanterior (71111) | $800 | $1,000 | 7.1× |
| X-Ray Sacroiliac Jts 3+ Vw - Xr Sacroiliac Joints 3+ Views (72202) | $470.40 | $588 | 4.2× |
| X-Ray Sacroiliac Jts <3 Vw - Xr Sacroiliac Joints 1-2 Views (72200) | $416 | $520 | 3.7× |
| X-Ray Sacrum/Coccyx 2+ Vw - Xr Sacrum Coccyx 2+ Views (72220) | $587.20 | $734 | 6.3× |
| X-Ray Sinuses 3+ Vw - Xr Paranasal Sinuses 3+ Views (70220) | $776 | $970 | 8.3× |
| X-Ray Skull 4+ Vw - Xr Skull Complete 4+ Views (70260) | $774.40 | $968 | 6.9× |
| X-ray thoracic spine 4 vw (72074) | $569.60 | $712 | 5.1× |
| X-Ray Tmj Unilat (70328) | $470.40 | $588 | 5.0× |
| X-Ray Urinary Tract Exam With Contrast Material (74420) | $1,614.40 | $2,018 | 4.3× |
| X-Rays Bone Length Studies (77073) | $468.80 | $586 | 4.2× |
| X-Rays Bone Survey Complete (77075) | $1,083.20 | $1,354 | 9.7× |
| Xr c-spine 4 or 5 views (72050) | $577.60 | $722 | 5.2× |
| Xr facial bones less than 3 views (70140) | $531.20 | $664 | 5.7× |
| Xr orbits complete 4 views (70200) | $718.40 | $898 | 6.4× |
| Xr Tomogram Single Plane (76100) | $1,258.40 | $1,573 | 11.2× |
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.