Imaging prices at Osf Saint Elizabeth Medical Center
Peru, IL · every code in this section with a posted price and a Medicare benchmark.
362 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) range across 2 matching MRF lines |
$1,819.20–$6,102.60 | $3,032–$10,171 | varies |
| Abdomen 1 View (74018) | $277.20 | $462 | 3.0× |
| Abdomen 2 views (74019) | $337.80 | $563 | 3.0× |
| Acute Gastrointestinal Blood Loss Imaging (78278) | $1,910.40 | $3,184 | 4.5× |
| Angio pulmonary bilat (75743) | $1,983 | $3,305 | 0.6× |
| Angiography extremity unilateral rs&i (75710) | $5,361.60 | $8,936 | 1.6× |
| Ankle 2 views (73600) range across 3 matching MRF lines |
$334.20–$456.60 | $557–$761 | varies |
| Aortography thoracic serialography rs&i (75605) | $5,028.60 | $8,381 | 0.8× |
| Arthrogram ankle (73615) | $1,090.80 | $1,818 | 2.9× |
| Arthrogram hip (73525) | $1,090.80 | $1,818 | 2.9× |
| Arthrogram Wrist (73115) | $822.60 | $1,371 | 2.2× |
| Basic radiation dosimetry calculation (77300) range across 2 matching MRF lines |
$260.40–$539.40 | $434–$899 | varies |
| Bone age studies (77072) | $324.60 | $541 | 2.9× |
| Bone Imaging 3 Phase (78315) | $1,876.20 | $3,127 | 4.4× |
| Bone Imaging Limited Area (78300) | $976.20 | $1,627 | 2.3× |
| Bone Imaging Multiple Areas (78305) | $1,298.40 | $2,164 | 3.0× |
| Bone Imaging Whole Body (78306) | $1,542 | $2,570 | 3.6× |
| Bone survey infant (77076) | $455.40 | $759 | 4.1× |
| Brachytx isodose complex (77318) range across 2 matching MRF lines |
$570.60–$1,358.40 | $951–$2,264 | varies |
| Brachytx isodose intermed (77317) range across 2 matching MRF lines |
$570.60–$915.60 | $951–$1,526 | varies |
| Brachytx Isodose Plan Simple (77316) range across 2 matching MRF lines |
$640.20–$1,039.80 | $1,067–$1,733 | varies |
| Brain Flow Imaging Only (78610) | $1,509 | $2,515 | 2.6× |
| Brain Imaging Pet Metabolic Evaluation (78608) | $5,666.40 | $9,444 | 3.7× |
| Cat Scan Follow-Up Study (76380) | $988.20 | $1,647 | 10.6× |
| Chest 1 view (71045) | $236.40 | $394 | 2.5× |
| Chest 2 views (71046) | $279.60 | $466 | 3.0× |
| Chest 3 views (71047) | $332.40 | $554 | 3.6× |
| Chest 4 or more views (71048) range across 3 matching MRF lines |
$375.60–$617.40 | $626–$1,029 | varies |
| Clavicle complete (73000) range across 3 matching MRF lines |
$324.60–$484.80 | $541–$808 | varies |
| Computed Tomography Thorax Lw Dose Lng Ca Scr C- (71271) | $176.40 | $294 | 1.6× |
| Continuing medical physics consltj pr wk (77336) | $1,166.40 | $1,944 | 8.1× |
| Contrast Exam Abdominl Aorta (75625) | $5,272.80 | $8,788 | 1.6× |
| Contrast X-Ray Bladder (74430) | $500.40 | $834 | 1.3× |
| Contrast X-Ray Of Elbow (73085) | $690.60 | $1,151 | 1.8× |
| Contrast X-Ray Of Knee Joint (73580) | $1,356 | $2,260 | 3.6× |
| CT abdomen and pelvis without and with contrast (74178) | $5,998.20 | $9,997 | 16.0× |
| CT abdomen and pelvis without contrast (74176) | $4,202.40 | $7,004 | 16.4× |
| CT abdomen w contrast (74160) | $2,606.40 | $4,344 | 13.9× |
| CT abdomen w wo contrast (74170) | $3,060 | $5,100 | 16.3× |
| CT abdomen w/o contrast (74150) | $2,139 | $3,565 | 19.1× |
| CT Angio Abdomen and Pelvis (74174) | $4,326.60 | $7,211 | 11.6× |
| CT Angio Chest (71275) | $2,796.60 | $4,661 | 14.9× |
| CT Angio Head (70496) | $3,283.80 | $5,473 | 17.5× |
| CT angio hrt w/3d image (75574) | $3,765 | $6,275 | 10.1× |
| Ct Angio Lwr Extr W/O&W/Dye (73706) range across 3 matching MRF lines |
$2,622–$3,933 | $4,370–$6,555 | varies |
| CT Angio Neck (70498) | $3,287.40 | $5,479 | 17.5× |
| Ct Angio Upr Extrm W/O&W/Dye (73206) range across 3 matching MRF lines |
$3,098.40–$4,648.20 | $5,164–$7,747 | varies |
| CT cervical spine w/ contrast (72126) | $2,365.80 | $3,943 | 6.3× |
| CT cervical spine w/o contrast (72125) | $1,966.80 | $3,278 | 17.6× |
| CT cervical spine w/wo cont (72127) | $2,960.40 | $4,934 | 15.8× |
| CT chest w contrast (71260) | $2,532.60 | $4,221 | 13.5× |
| CT chest w/wo contrast (71270) | $2,859.60 | $4,766 | 15.2× |
| CT head/brain with contrast (70460) | $2,132.40 | $3,554 | 11.3× |
| CT head/brain without and with contrast (70470) | $2,661 | $4,435 | 14.2× |
| CT heart no contrast quant eval coronry calcium (75571) | $117 | $195 | 1.3× |
| CT iac w contrast (70481) | $2,613 | $4,355 | 13.9× |
| CT l-spine w&w/o contrast (72133) | $3,219 | $5,365 | 17.1× |
| CT lower ext w/o (73700) range across 3 matching MRF lines |
$2,086.80–$3,130.80 | $3,478–$5,218 | varies |
| CT lower extremity w/contrast material (73701) range across 3 matching MRF lines |
$2,430–$3,645 | $4,050–$6,075 | varies |
| CT lumbar spine w contrast (72132) | $2,994.60 | $4,991 | 8.0× |
| CT lumbar spine w/o contrast (72131) | $2,403.60 | $4,006 | 21.5× |
| CT maxillofacial w contrast (70487) | $2,311.80 | $3,853 | 12.3× |
| CT maxillofacial wo contrast (70486) | $2,035.80 | $3,393 | 18.2× |
| CT neck tissue combo (70492) | $2,908.20 | $4,847 | 15.5× |
| Ct Orbit/Ear/Fossa W/O&W/Dye (70482) | $3,055.20 | $5,092 | 16.3× |
| CT orbits w/o contrast (70480) | $2,520 | $4,200 | 22.5× |
| CT pelvis w&w/o contrast (72194) | $2,910.60 | $4,851 | 15.5× |
| CT pelvis w/o contrast (72192) | $1,881 | $3,135 | 16.8× |
| CT scan of leg combo (73702) range across 3 matching MRF lines |
$2,481.60–$3,721.20 | $4,136–$6,202 | varies |
| CT scans face/jaw combo (70488) | $2,938.80 | $4,898 | 15.6× |
| CT soft tissue neck w contrast (70491) | $2,594.40 | $4,324 | 13.8× |
| CT soft tissue neck w/o contrast (70490) | $2,038.20 | $3,397 | 18.2× |
| CT thoracic spine w contrast (72129) | $2,701.80 | $4,503 | 14.4× |
| CT thoracic spine w/o contrast (72128) | $2,283 | $3,805 | 20.4× |
| CT thoracic spine w/wo cont (72130) | $2,973.60 | $4,956 | 15.8× |
| CT thorax w/o contrast (71250) | $1,960.80 | $3,268 | 17.5× |
| CT upper ext wo (73200) range across 3 matching MRF lines |
$2,002.80–$3,004.20 | $3,338–$5,007 | varies |
| CT upper extremity w/o & w/contrast material (73202) range across 3 matching MRF lines |
$3,259.80–$4,890 | $5,433–$8,150 | varies |
| CT upper extremity with contrast (73201) range across 3 matching MRF lines |
$2,760.60–$4,141.20 | $4,601–$6,902 | varies |
| Cta Abdl Aorta&Bi Iliofem W/Contrast&Postp (75635) | $2,863.20 | $4,772 | 15.2× |
| Cta Abdomen (74175) | $3,222.60 | $5,371 | 17.1× |
| CTA head&neck c+ w/noncontrast img&post-pxessing (70471) | $2,250 | $3,750 | 6.0× |
| CTA pelvis (72191) | $2,651.40 | $4,419 | 14.1× |
| Dilation ureters/urethra rs&i (74485) | $1,478.40 | $2,464 | 0.7× |
| Discography Cerv/Thor Spine (72285) | $5,983.80 | $9,973 | 2.9× |
| Diskography lumbar (72295) | $5,983.80 | $9,973 | 2.9× |
| Doppler Fetal Mid Cerebral Artery (76821) | $446.40 | $744 | 4.0× |
| Dxa Bone Density Axial (77080) | $540 | $900 | 4.8× |
| Dxa bone density study 1/>sites appendiclr skel (77081) | $466.80 | $778 | 5.0× |
| Echo exam uterus (76831) | $603 | $1,005 | 2.4× |
| Echograp Trans R Pros Study (76873) | $1,224 | $2,040 | 10.9× |
| Esophagram (74220) | $539.40 | $899 | 2.9× |
| Fetal Biophys Profile W/Nst (76818) range across 2 matching MRF lines |
$441.60–$637.80 | $736–$1,063 | varies |
| Fetal Biophysical Profile W/O Non-Stress Testing (76819) | $630 | $1,050 | 5.6× |
| Fluoroscopy up to 1 hr (76000) | $685.20 | $1,142 | 2.7× |
| Follow-Up Angiography (75898) | $1,983 | $3,305 | 0.6× |
| Foot 2 views (73620) range across 3 matching MRF lines |
$306–$456.60 | $510–$761 | varies |
| Forearm 2 views (73090) range across 3 matching MRF lines |
$306–$484.80 | $510–$808 | varies |
| Gastric emptying imaging study (78264) | $1,490.40 | $2,484 | 3.5× |
| Gastric Emptyng Imag Std W/Sm Bwl Transit (78265) | $2,430.60 | $4,051 | 5.7× |
| Gastroesophageal Reflux Exam (78262) | $1,666.20 | $2,777 | 3.9× |
| Gated Heart Planar Single (78472) | $2,161.20 | $3,602 | 5.0× |
| Gated Heart, Multiple (78473) | $3,232.20 | $5,387 | 7.5× |
| Gstrc Emptng Imag Std W/Sm Bwl Col Trnst Mlt Day (78266) | $4,859.40 | $8,099 | 8.4× |
| Hand 2 views (73120) range across 3 matching MRF lines |
$306–$456.60 | $510–$761 | varies |
| Hdr Rdncl Ntrstl/Icav Brchtx (77772) range across 2 matching MRF lines |
$1,303.20–$6,836.40 | $2,172–$11,394 | varies |
| Hdr Rdncl Ntrstl/Icav Brchtx (77771) range across 2 matching MRF lines |
$909.60–$6,836.40 | $1,516–$11,394 | varies |
| Hdr Rdncl Ntrstl/Icav Brchtx 1 Channel (77770) range across 2 matching MRF lines |
$609–$6,836.40 | $1,015–$11,394 | varies |
| Hepatobil Syst Image W/Drug (78227) | $3,230.40 | $5,384 | 5.6× |
| Hepatobiliary System Imaging (78226) | $1,324.20 | $2,207 | 3.1× |
| Ht Muscle Image Spect Sing (78451) | $2,770.80 | $4,618 | 2.0× |
| Hysterosalpingogram (74740) | $620.40 | $1,034 | 2.4× |
| Interstitial radiation source applic complex (77778) range across 2 matching MRF lines |
$2,107.20–$4,429.20 | $3,512–$7,382 | varies |
| Intracavitary Radiation Source Applic Complex (77763) range across 2 matching MRF lines |
$1,378.20–$2,682.60 | $2,297–$4,471 | varies |
| Intracavitary Radiation Source Applic Intermed (77762) range across 2 matching MRF lines |
$1,522.20–$2,113.80 | $2,537–$3,523 | varies |
| Intracavitary radiation source applic simple (77761) range across 2 matching MRF lines |
$970.80–$1,197.60 | $1,618–$1,996 | varies |
| Joint Survey Single View (77077) | $484.20 | $807 | 4.3× |
| K Flow/Funct Image Multiple (78709) | $2,252.40 | $3,754 | 3.9× |
| K Flow/Funct Image W/Drug (78708) | $1,615.20 | $2,692 | 2.8× |
| K Flow/Funct Image W/O Drug (78707) | $1,755.60 | $2,926 | 3.0× |
| Kidney Imaging Morphol (78700) | $920.40 | $1,534 | 2.1× |
| Kidney Imaging Morphoogy W/Vascular Flow (78701) | $1,399.20 | $2,332 | 3.3× |
| Knee 3 Views (73562) range across 3 matching MRF lines |
$354–$531.60 | $590–$886 | varies |
| Liver & Spleen Imaging Static Only (78215) | $1,156.20 | $1,927 | 2.7× |
| Lung Perf&Ventilat Diferentl (78598) | $2,770.80 | $4,618 | 4.8× |
| Lung perfusion differential (78597) | $4,003.20 | $6,672 | 9.3× |
| Lung Ventilat&Perfus Imaging (78582) | $1,615.80 | $2,693 | 2.8× |
| Lung Ventilation Imaging (78579) | $1,102.20 | $1,837 | 2.6× |
| Lymph System Imaging (78195) | $1,411.80 | $2,353 | 2.4× |
| Magnetic Image Jaw Joint (70336) | $2,445.60 | $4,076 | 9.6× |
| Mammary ductogram or galactogram multiple (77054) | $1,705.80 | $2,843 | 6.7× |
| Mammary ductogram or galactogram single (77053) | $1,219.20 | $2,032 | 4.8× |
| Meckels Divert Exam (78290) | $2,671.20 | $4,452 | 6.2× |
| Mlc imrt design & construction per imrt plan (77338) range across 2 matching MRF lines |
$615.60–$2,875.20 | $1,026–$4,792 | varies |
| Mr safety determination physician/other qhp (76016) | $134.40 | $224 | 1.4× |
| Mr safety implant&/fb assmt clin staf 1st 15 min (76014) | $37.80 | $63 | 1.2× |
| Mr safety implt electronics prepj supvj phys/qhp (76018) | $140.40 | $234 | 1.4× |
| Mr safety implt pos&/immoblj (76019) | $90.60 | $151 | 1.4× |
| Mr safety med physics xm customization plng&mntr (76017) | $369.60 | $616 | 1.4× |
| Mra Head W/O & W/Contrast Material (70546) | $4,085.40 | $6,809 | 10.9× |
| MRA head w/o contrast (70544) | $2,464.20 | $4,107 | 9.6× |
| MRA head with contrast (70545) | $2,824.80 | $4,708 | 7.6× |
| MRA neck w contrast (70548) | $2,819.40 | $4,699 | 7.5× |
| Mra Neck W/O &W/Contrast Material (70549) | $4,264.80 | $7,108 | 11.4× |
| MRA neck w/o contrast (70547) | $2,350.80 | $3,918 | 9.2× |
| MRI abdomen w contrast (74182) | $3,446.40 | $5,744 | 9.2× |
| MRI abdomen w/o contrast (74181) | $2,784.60 | $4,641 | 10.9× |
| MRI any jt lower extrem w/contrast material (73722) range across 3 matching MRF lines |
$3,672.60–$5,509.20 | $6,121–$9,182 | varies |
| MRI any jt lower extrem w/o & w/contrast matrl (73723) range across 3 matching MRF lines |
$3,814.80–$5,722.20 | $6,358–$9,537 | varies |
| MRI any jt upper extremity w/contrast matrl (73222) range across 3 matching MRF lines |
$3,683.40–$5,496.60 | $6,139–$9,161 | varies |
| MRI bone marrow blood supply (77084) | $2,445 | $4,075 | 9.6× |
| MRI Breast W/O Contrast Bilateral (77047) | $3,157.20 | $5,262 | 12.3× |
| MRI Breast Without Contrast Material Unilateral (77046) | $2,104.80 | $3,508 | 8.2× |
| MRI cervical spine w contrast (72142) | $3,531.60 | $5,886 | 9.4× |
| MRI cervical spine w/o cont (72141) | $3,187.20 | $5,312 | 12.5× |
| MRI chest w/o contrast (71550) | $2,575.20 | $4,292 | 10.1× |
| MRI chest with contrast (71551) | $3,087 | $5,145 | 3.7× |
| MRI chest wo w contrast (71552) | $4,258.20 | $7,097 | 11.4× |
| MRI lower extrem oth/thn jt w/contrast matrl (73719) range across 3 matching MRF lines |
$3,024.60–$4,536.60 | $5,041–$7,561 | varies |
| MRI lower extrem oth/thn jt w/o & w/contr matr (73720) range across 3 matching MRF lines |
$3,439.20–$5,158.20 | $5,732–$8,597 | varies |
| MRI lower extrem oth/thn jt w/o contr matrl (73718) range across 3 matching MRF lines |
$2,589.60–$3,884.40 | $4,316–$6,474 | varies |
| MRI lumbar spine w contrast (72149) | $3,491.40 | $5,819 | 9.3× |
| Mri Neck Spine W/O & W/Dye (72156) | $4,348.80 | $7,248 | 11.6× |
| MRI orbit face &/neck w/o contrast (70540) | $2,560.20 | $4,267 | 10.0× |
| MRI orbit face neck w contrast (70542) | $3,101.40 | $5,169 | 8.3× |
| Mri Orbt/Fac/Nck W/O &W/Dye (70543) | $3,930.60 | $6,551 | 10.5× |
| MRI pelvis w contrast (72196) | $2,931.60 | $4,886 | 7.8× |
| MRI pelvis w/o & w contrast (72197) | $4,281 | $7,135 | 11.5× |
| MRI pelvis w/o contrast (72195) | $2,685.60 | $4,476 | 10.5× |
| MRI thoracic spine w/o contrast (72146) | $2,982.60 | $4,971 | 11.7× |
| MRI upper extremity oth than jt w/contr matrl (73219) range across 3 matching MRF lines |
$3,037.80–$4,556.40 | $5,063–$7,594 | varies |
| MRI upper extremity oth than jt w/o contr matrl (73218) range across 3 matching MRF lines |
$2,746.20–$4,119.60 | $4,577–$6,866 | varies |
| Mri Uppr Extremity W/O&W/Dye (73220) range across 3 matching MRF lines |
$3,489.60–$5,233.80 | $5,816–$8,723 | varies |
| MRI, abdomen, combo (74183) | $4,239 | $7,065 | 11.3× |
| MRI, dorsal spine combo (72157) | $4,239 | $7,065 | 11.3× |
| MRI, dorsal spine contrast (72147) | $3,531.60 | $5,886 | 9.4× |
| MRI, joint upper extrem (73221) range across 3 matching MRF lines |
$2,819.40–$3,946.20 | $4,699–$6,577 | varies |
| MRI, joint upper extrem combo (73223) range across 3 matching MRF lines |
$4,169.40–$6,254.40 | $6,949–$10,424 | varies |
| MRI, lumbar spine combo (72158) | $4,239 | $7,065 | 11.3× |
| Myelogram cervical (72240) | $2,451.60 | $4,086 | 2.9× |
| Myelogram Lumbar (72265) | $2,100.60 | $3,501 | 2.5× |
| Myelography thoracic (72255) | $2,235.60 | $3,726 | 2.7× |
| Myelograpy 2/more regions rs&i (72270) | $3,148.80 | $5,248 | 3.7× |
| Myocardial Perfusion Planar 1 Study Rest/Stress (78453) | $1,779 | $2,965 | 1.3× |
| Myocardial Spect Multiple Studies (78452) | $3,485.40 | $5,809 | 2.5× |
| Neck soft tissue (70360) | $325.80 | $543 | 3.5× |
| Nfs/Instlj Radioelmnt Sln 3 Mo Follow-Up Care (77750) range across 2 matching MRF lines |
$564–$1,810.20 | $940–$3,017 | varies |
| Nm csf leak detection (78650) | $2,916.60 | $4,861 | 2.1× |
| Ntsty modul radthx pln dose-vol histos (77301) range across 2 matching MRF lines |
$1,676.40–$6,172.80 | $2,794–$10,288 | varies |
| Nuclear Rx Oral Admin (79005) | $1,071 | $1,785 | 4.3× |
| Ophthalmic ultrasound dx b-scan w/wo a-scan (76512) | $705 | $1,175 | 6.3× |
| Parathyroid imaging w/tomographic spect & CT (78072) | $2,200.80 | $3,668 | 3.8× |
| Parathyroid Planar Imaging (78070) | $1,677 | $2,795 | 3.9× |
| Parathyroid planar imaging w/wo subtraction (78071) | $1,765.20 | $2,942 | 4.1× |
| Pelvis 1 or 2 views (72170) range across 2 matching MRF lines |
$324.60–$343.80 | $541–$573 | varies |
| Pet Image W/Ct Lmtd (78814) | $5,480.40 | $9,134 | 3.6× |
| PET image w/CT, full body (78816) | $6,991.80 | $11,653 | 4.6× |
| PET imaging CT attenuation skull base mid-thigh (78815) | $6,394.80 | $10,658 | 4.2× |
| Prq Transhepatc Portograpy Hemodyn Eval Rs&I (75885) | $1,983 | $3,305 | 0.6× |
| Pulmonary Perfusion Imaging Particulate (78580) | $1,349.40 | $2,249 | 3.1× |
| Radex Abd Compl Aqt Abd W/S/E/D Views 1 View Ch (74022) | $558.60 | $931 | 5.0× |
| Radex abscess/fistula/sinus tract rs&i (76080) | $500.40 | $834 | 0.9× |
| Radex Ankle Complete Minimum 3 Views (73610) range across 3 matching MRF lines |
$334.20–$484.80 | $557–$808 | varies |
| Radex Calcaneus Minimum 2 Views (73650) range across 3 matching MRF lines |
$295.20–$443.40 | $492–$739 | varies |
| Radex elbow complete minimum 3 views (73080) range across 3 matching MRF lines |
$354–$531.60 | $590–$886 | varies |
| Radex Facial Bones Complete Minimum 3 Views (70150) | $484.20 | $807 | 4.3× |
| Radex fingr minimum 2 views (73140) range across 4 matching MRF lines |
$267–$399.60 | $445–$666 | varies |
| Radex foot complete minimum 3 views (73630) range across 3 matching MRF lines |
$334.20–$500.40 | $557–$834 | varies |
| Radex Hand Minimum 3 Views (73130) range across 3 matching MRF lines |
$334.20–$500.40 | $557–$834 | varies |
| Radex lower extremity infant minimum 2 views (73592) range across 3 matching MRF lines |
$306–$456.60 | $510–$761 | varies |
| Radex Mastoids Compl Minimum 3 Views PR Side (70130) range across 3 matching MRF lines |
$483.60–$723.60 | $806–$1,206 | varies |
| Radex Nasal Bones Complete Minimum 3 Views (70160) | $324.60 | $541 | 3.5× |
| Radex Pharynx/Larx W/Fluor&/Magnification Tq (70370) | $620.40 | $1,034 | 6.7× |
| Radex Ribs Unilateral 2 Views (71100) | $354 | $590 | 3.8× |
| Radex shoulder complete minimum 2 views (73030) range across 3 matching MRF lines |
$354–$531.60 | $590–$886 | varies |
| Radex Sinuses Paransl < 3 Views (70210) | $354 | $590 | 3.8× |
| Radex sm int w/mlt srl imges via enteroclss tube (74251) | $620.40 | $1,034 | 3.3× |
| Radex Spine 1 View Specify Level (72020) range across 6 matching MRF lines |
$301.80–$324 | $503–$540 | varies |
| Radex Sternum Minimum 2 Views (71120) | $405 | $675 | 4.3× |
| Radex Temporomandble Jt Opn & Clsd Mouth Bilat (70330) | $521.40 | $869 | 5.6× |
| Radex Toe Minimum 2 Views (73660) range across 4 matching MRF lines |
$267–$399.60 | $445–$666 | varies |
| Radex upper extremity infant minimum 2 views (73092) range across 3 matching MRF lines |
$306–$456.60 | $510–$761 | varies |
| Radex Wrist Complete Minimum 3 Views (73110) range across 3 matching MRF lines |
$334.20–$500.40 | $557–$834 | varies |
| Radex X-Ray Exam Entire Spi 6/> Vw - Xr Entire Spine 6+ Vw (72084) | $385.20 | $642 | 3.4× |
| Radiation Delivery Stereotactic Cranial Linear (77372) | $16,381.20 | $27,302 | 2.1× |
| Radiation treatment delivery level 1 (77402) | $1,002.60 | $1,671 | 9.2× |
| Radiation treatment delivery level 2 (77407) | $3,790.80 | $6,318 | 9.2× |
| Radiation treatment delivery level 3 (77412) | $3,790.80 | $6,318 | 6.4× |
| Radiolog exam mandible compl minimum 4 views (70110) | $389.40 | $649 | 3.5× |
| Radiologic Exam Abdomen 3+ Views - Xr Abdomen 3+ Views (74021) | $389.40 | $649 | 3.5× |
| Radiologic exam colon double contrast study (74280) | $1,050.60 | $1,751 | 5.6× |
| Radiologic exam colon single contrast study (74270) | $766.80 | $1,278 | 4.1× |
| Radiologic Exam Esophagus Double Contrast Study (74221) | $816.60 | $1,361 | 4.3× |
| Radiologic exam knee complete 4/more views (73564) range across 3 matching MRF lines |
$389.40–$580.80 | $649–$968 | varies |
| Radiologic exam pelvis compl minimum 3 views (72190) | $420 | $700 | 3.7× |
| Radiologic Exam Small Int Single Contrast Study (74250) | $591.60 | $986 | 3.1× |
| Radiologic exam swallow function contrast study (74230) | $622.80 | $1,038 | 3.3× |
| Radiologic exam upr gi trc double contrast study (74246) | $1,114.80 | $1,858 | 5.9× |
| Radiologic examination femur 1 view (73551) | $221.40 | $369 | 2.4× |
| Radiologic examination femur minimum 2 views (73552) range across 3 matching MRF lines |
$354–$531.60 | $590–$886 | varies |
| Radiologic examination knee 1/2 views (73560) range across 3 matching MRF lines |
$324.60–$484.80 | $541–$808 | varies |
| Radiologic Examination Osseous Survey Limited (77074) | $371.40 | $619 | 3.3× |
| Radiologic examination tibia & fibula 2 views (73590) range across 3 matching MRF lines |
$324.60–$484.80 | $541–$808 | varies |
| Remote afterloading high dose rate radionuclide skin surface brachytherapy, includes basic dosimetry, when performed;… (77768) range across 2 matching MRF lines |
$161.40–$469.20 | $269–$782 | varies |
| Remote afterloading high dose rate radionuclide skin surface brachytherapy, includes basic dosimetry, when performed;… (77767) range across 2 matching MRF lines |
$161.40–$469.20 | $269–$782 | varies |
| Ribs bilateral 3 views (71110) | $484.20 | $807 | 4.3× |
| Rp loclzj tum plnr 1 area single day imaging (78800) | $1,568.40 | $2,614 | 3.7× |
| Rp loclzj tum plnr 2+area 1+d img/1 area img>2+d (78801) | $1,497.60 | $2,496 | 3.5× |
| Rp Loclzj Tum Plnr Whole Body 2+ Days Imaging (78804) | $3,051.60 | $5,086 | 5.2× |
| Rp Loclzj Tum Plnr Whole Body Single Day Imaging (78802) | $2,094 | $3,490 | 3.6× |
| Rp Loclzj Tum Spect 1 Area Single Day Imaging (78803) | $2,350.20 | $3,917 | 4.0× |
| Rp loclzj tum spect 2 area/sep acquisj img (78831) | $3,525.60 | $5,876 | 2.5× |
| Rp loclzj tum spect CT 2area 1d img/1 ar img>2+d (78832) | $4,700.40 | $7,834 | 3.1× |
| Rp loclzj tum spect w/CT 1 area/acquisj 1day img (78830) | $3,133.20 | $5,222 | 2.3× |
| Scapula (73010) range across 3 matching MRF lines |
$324.60–$484.80 | $541–$808 | varies |
| Screening Digital Breast Tomosynthesis Bi (77063) | $93 | $155 | 4.0× |
| Shoulder 1 view (73020) range across 3 matching MRF lines |
$295.20–$443.40 | $492–$739 | varies |
| Shoulder Arthrography (73040) | $1,090.80 | $1,818 | 2.9× |
| Sialogram (70390) | $840.60 | $1,401 | 3.3× |
| Skull less than 4 views (70250) | $389.40 | $649 | 3.5× |
| Special dosimetry (77331) range across 2 matching MRF lines |
$201.60–$358.80 | $336–$598 | varies |
| Special Physics Consult (77370) | $1,452.60 | $2,421 | 10.1× |
| Special teletherapy port plan (77321) range across 2 matching MRF lines |
$442.20–$1,606.80 | $737–$2,678 | varies |
| Special treatment procedure (77470) range across 2 matching MRF lines |
$850.20–$4,299.60 | $1,417–$7,166 | varies |
| Speech evaluation, complex (70371) | $988.20 | $1,647 | 3.9× |
| Srs Multisource (77371) | $34,026.60 | $56,711 | 4.3× |
| Stereotactic Body Radiation Delivery (77373) range across 2 matching MRF lines |
$8,506.80–$11,055.60 | $14,178–$18,426 | varies |
| Sternoclavicular joints (71130) | $441.60 | $736 | 4.7× |
| Surface Applic Low Dose Rate Radionuclide Source (77789) range across 2 matching MRF lines |
$195–$487.80 | $325–$813 | varies |
| Telethx isodose pln cplx w/basic dosimetry (77307) range across 2 matching MRF lines |
$640.20–$1,039.80 | $1,067–$1,733 | varies |
| Telethx isodose pln smpl w/dosimetry calculation (77306) range across 2 matching MRF lines |
$487.80–$979.80 | $813–$1,633 | varies |
| Testicular Imaging W/Flow (78761) | $1,256.40 | $2,094 | 2.9× |
| Ther Rad Simulaj-Aided Field Setting Complex (77290) range across 2 matching MRF lines |
$640.20–$2,512.20 | $1,067–$4,187 | varies |
| Ther Rad Simulaj-Aided Field Setting Intermed (77285) range across 2 matching MRF lines |
$456–$2,443.20 | $760–$4,072 | varies |
| Ther rad simulaj-aided field setting simple (77280) range across 2 matching MRF lines |
$288–$1,358.40 | $480–$2,264 | varies |
| Therapeutic Enema Rdctj Intussusception/Obstrcj (74283) | $1,325.40 | $2,209 | 7.1× |
| Thoracic spine 2 views (72070) | $405 | $675 | 3.6× |
| Thoracic spine 3 views (72072) | $465.60 | $776 | 4.2× |
| Thoracolumbar 2 views (72080) | $198 | $330 | 2.1× |
| Thyroid Carcinoma Metastases Img Lmtd Area (78015) | $1,051.80 | $1,753 | 2.5× |
| Thyroid Imaging With Vascular Flow (78013) | $895.80 | $1,493 | 2.1× |
| Thyroid Met Imaging Body (78018) | $2,125.80 | $3,543 | 3.7× |
| Thyroid Uptake Measurement (78012) | $499.80 | $833 | 1.2× |
| Thyroid Uptake W/Blood Flow Sngle/Mult Quan Meas (78014) | $962.40 | $1,604 | 2.2× |
| Tx Devices Design & Construction Complex (77334) range across 2 matching MRF lines |
$499.80–$1,271.40 | $833–$2,119 | varies |
| Tx devices design & construction intermediate (77333) range across 4 matching MRF lines |
$90–$850.80 | $150–$1,418 | varies |
| Tx devices design & construction simple (77332) range across 4 matching MRF lines |
$84.60–$539.40 | $141–$899 | varies |
| Ultrasound Breast Limited (76642) range across 3 matching MRF lines |
$370.80–$599.40 | $618–$999 | varies |
| Ultrasound Elastography Parenchyma (76981) | $355.20 | $592 | 3.2× |
| Ultrasound Exam Aaa Screen (76706) | $555 | $925 | 5.0× |
| Ultrasound, abdomen limited (76705) range across 3 matching MRF lines |
$555–$890.40 | $925–$1,484 | varies |
| Umbilical-artery Doppler (OB) (76820) | $161.40 | $269 | 1.4× |
| Unlisted Procedure Clinical Brachytherapy (77799) range across 4 matching MRF lines |
$969.60–$2,436.60 | $1,616–$4,061 | varies |
| Unlisted us procedure (76999) | $410.40 | $684 | 4.4× |
| Upper gi w/o kub (74240) | $894.60 | $1,491 | 4.8× |
| Ureteral Reflux Study (78740) | $834.60 | $1,391 | 1.9× |
| Urethrocystogram voiding (74455) | $710.40 | $1,184 | 2.8× |
| Urethrocystography retrograde (74450) | $690.60 | $1,151 | 2.7× |
| Us breast unilateral complete (76641) range across 3 matching MRF lines |
$414–$666 | $690–$1,110 | varies |
| Us chest (76604) | $511.80 | $853 | 4.6× |
| Us complete joint (76881) range across 3 matching MRF lines |
$562.80–$844.80 | $938–$1,408 | varies |
| Us exam, pelvic, limited (76857) | $669 | $1,115 | 6.0× |
| Us head (76506) | $555 | $925 | 5.0× |
| Us kidney transplant (76776) | $762.60 | $1,271 | 6.8× |
| Us lmtd joint/oth nonvasc xtr strux r-t w/img (76882) range across 3 matching MRF lines |
$555–$806.40 | $925–$1,344 | varies |
| Us ob detailed single fetus (76811) | $867 | $1,445 | 3.4× |
| Us ob limited 1 or more fetuses (76815) | $555 | $925 | 5.0× |
| Us ob transvaginal (76817) | $594.60 | $991 | 5.3× |
| Us pelvic non ob complete (76856) | $967.80 | $1,613 | 8.6× |
| Us pg uter img f&mat 14 wk tabdl 1/1st gestation (76801) | $814.80 | $1,358 | 7.3× |
| Us preg uterus real time f/u trnsabdl per fetus (76816) | $435 | $725 | 3.9× |
| Us retroperitoneal complete (76770) | $973.20 | $1,622 | 8.7× |
| Us retroperitoneal limited (76775) | $976.20 | $1,627 | 8.7× |
| Us scrotum and contents (76870) | $594.60 | $991 | 5.3× |
| Us spinal canal and contents (76800) | $693 | $1,155 | 6.2× |
| Us thyroid (76536) | $800.40 | $1,334 | 7.1× |
| Us transrectal (76872) | $793.80 | $1,323 | 7.1× |
| Vein X-Ray Liver W/O Hemodyn (75887) | $1,983 | $3,305 | 0.6× |
| Venogram Sinus/Jugular (75860) | $1,983 | $3,305 | 0.6× |
| Venography extremity bilateral rs&i (75822) | $2,121.60 | $3,536 | 1.3× |
| Venography extremity unilateral rs&i (75820) | $1,631.40 | $2,719 | 1.0× |
| Wrist 2 views (73100) range across 3 matching MRF lines |
$306–$456.60 | $510–$761 | varies |
| X-Ray Ac Jts - Xr Acromioclavicular Joints Bilateral (73050) | $420 | $700 | 4.5× |
| X-Ray Aorta Leg Arteries (75630) | $5,272.80 | $8,788 | 1.6× |
| X-Ray Bend Only L-S Spine (72120) | $415.80 | $693 | 3.7× |
| X-Ray Elbow 2 Vw - Xr Elbow 1-2 Views Right (73070) range across 3 matching MRF lines |
$295.20–$443.40 | $492–$739 | varies |
| X-Ray Exam Breast Specimen (76098) | $444.60 | $741 | 0.8× |
| X-Ray Exam Entire Spi 1 Vw (72081) | $260.40 | $434 | 2.8× |
| X-Ray Exam Entire Spi 2/3 Vw (72082) | $301.80 | $503 | 2.7× |
| X-Ray Exam Entire Spi 4/5 Vw (72083) | $334.20 | $557 | 3.0× |
| X-Ray Exam Hip Uni 1 View (73501) | $295.20 | $492 | 3.2× |
| X-Ray Exam Hip Uni 2-3 Views (73502) | $354 | $590 | 3.8× |
| X-Ray Exam Hip Uni 4/> Views (73503) | $474 | $790 | 4.2× |
| X-Ray Exam Hips Bi 2 Views (73521) | $420 | $700 | 3.7× |
| X-Ray Exam Hips Bi 3-4 Views (73522) | $838.20 | $1,397 | 7.5× |
| X-Ray Exam Hips Bi 5/> Views (73523) | $1,048.20 | $1,747 | 9.4× |
| X-Ray Exam L-S Spine Bending (72114) | $540.60 | $901 | 4.8× |
| X-Ray Exam Neck Spine 2-3 Vw (72040) | $412.80 | $688 | 4.4× |
| X-Ray Exam Neck Spine 6/>Vws (72052) | $560.40 | $934 | 5.0× |
| X-Ray Exam Unilat Ribs/Chest (71101) | $420 | $700 | 3.7× |
| X-ray eye for foreign body (70030) | $486.60 | $811 | 5.2× |
| X-ray humerus (73060) range across 3 matching MRF lines |
$354–$531.60 | $590–$886 | varies |
| X-ray IV pyelogram (ivp) (74400) range across 4 matching MRF lines |
$181.80–$793.20 | $303–$1,322 | varies |
| X-Ray Jaw <4 Vw - Xr Mandible < 4 Views (70100) | $331.20 | $552 | 3.6× |
| X-Ray Knee Bilat Standing - Xr Knees Anteroposterior Standing Bilat (73565) | $306 | $510 | 3.3× |
| X-Ray Lumbar Spine 2/3 Vw - Xr Lumbar Spine 2-3 Views (72100) | $415.80 | $693 | 3.7× |
| X-ray nose-rectum child f.b. (76010) | $416.40 | $694 | 4.5× |
| X-Ray Ribs, Chest 4+ Vw - Xr Ribs 3 Vws Bil W/ Chest Posteroanterior (71111) | $552.60 | $921 | 4.9× |
| X-Ray Sacroiliac Jts 3+ Vw - Xr Sacroiliac Joints 3+ Views (72202) | $389.40 | $649 | 3.5× |
| X-Ray Sacroiliac Jts <3 Vw - Xr Sacroiliac Joints 1-2 Views (72200) | $298.80 | $498 | 2.7× |
| X-Ray Sacrum/Coccyx 2+ Vw - Xr Sacrum Coccyx 2+ Views (72220) | $354 | $590 | 3.8× |
| X-Ray Sinuses 3+ Vw - Xr Paranasal Sinuses 3+ Views (70220) | $483.60 | $806 | 5.2× |
| X-Ray Skull 4+ Vw - Xr Skull Complete 4+ Views (70260) | $552.60 | $921 | 4.9× |
| X-Ray Stress View (77071) | $117.60 | $196 | 1.3× |
| X-ray thoracic spine 4 vw (72074) | $502.20 | $837 | 4.5× |
| X-Ray Tmj Unilat (70328) | $348 | $580 | 3.7× |
| X-Ray Urinary Tract Exam With Contrast Material (74420) | $1,171.20 | $1,952 | 3.1× |
| X-Rays Bone Length Studies (77073) | $484.20 | $807 | 4.3× |
| X-Rays Bone Survey Complete (77075) | $530.40 | $884 | 4.7× |
| Xr c-spine 4 or 5 views (72050) | $510 | $850 | 4.6× |
| Xr facial bones less than 3 views (70140) | $389.40 | $649 | 4.2× |
| Xr orbits complete 4 views (70200) | $484.20 | $807 | 4.3× |
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.