Imaging prices at Pali Momi Medical Center
Aiea, HI · every code in this section with a posted price and a Medicare benchmark.
354 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) | $192 | $320 | 1.9× |
| Abdomen 2 views (74019) | $204 | $340 | 1.7× |
| Acute Gastrointestinal Blood Loss Imaging (78278) | $754.20 | $1,257 | 1.6× |
| Angio internal mammary (75756) | $1,633.20 | $2,722 | 0.4× |
| Angio pulmonary bilat (75743) | $2,553.60 | $4,256 | 0.7× |
| Angiography extremity bilateral rs&i (75716) | $3,288.60 | $5,481 | 0.9× |
| Angiography extremity unilateral rs&i (75710) | $1,989 | $3,315 | 0.5× |
| Angiography pulmonary unilateral slctv rs&i (75741) | $2,816.40 | $4,694 | 0.8× |
| Angrph pulmonary nonslctv cath/ven njx rs&i (75746) | $1,633.20 | $2,722 | 0.4× |
| Ankle 2 views (73600) range across 4 matching MRF lines |
$161.40–$225.60 | $269–$376 | varies |
| Aortography thoracic serialography rs&i (75605) unusually low: confirm this is the full procedure |
$2,577 | $4,295 | 0.4× |
| Aortography thoracic w/o serialography rs&i (75600) | $1,119.60 | $1,866 | 0.3× |
| Artery X-Rays Abdomen (75726) | $4,746.60 | $7,911 | 0.7× |
| Artery X-Rays Adrenal Gland (75731) | $1,155 | $1,925 | 0.3× |
| Artery X-Rays Pelvis (75736) unusually low: confirm this is the full procedure |
$2,926.80 | $4,878 | 0.4× |
| Artery X-Rays Spine (75705) | $4,520.40 | $7,534 | 0.7× |
| Arthrogram hip (73525) | $535.80 | $893 | 1.3× |
| Arthrogram Wrist (73115) | $535.80 | $893 | 1.3× |
| Bone age studies (77072) | $223.80 | $373 | 1.8× |
| Bone Imaging 3 Phase (78315) | $936.60 | $1,561 | 2.0× |
| Bone Imaging Limited Area (78300) | $743.40 | $1,239 | 1.6× |
| Bone Imaging Multiple Areas (78305) | $812.40 | $1,354 | 1.7× |
| Bone Imaging Whole Body (78306) | $908.40 | $1,514 | 1.9× |
| Bone marrow imaging limited area (78102) | $743.40 | $1,239 | 1.6× |
| Bone marrow imaging; multiple areas (78103) | $810.60 | $1,351 | 1.7× |
| Bone survey infant (77076) | $350.40 | $584 | 2.8× |
| Brain Imaging Min 4 Static Views W Vascular Flow (78606) | $978.60 | $1,631 | 1.5× |
| Cardiac MRI w/w/o contrast & further seq (75561) | $1,533 | $2,555 | 3.7× |
| Cardiac MRI w/w/o contrast w/stress (75563) | $1,723.20 | $2,872 | 1.9× |
| Cat Scan Follow-Up Study (76380) | $330 | $550 | 3.2× |
| Cerebrospinal Fluid Flow W/O Matl Shunt Evaltj (78645) | $964.80 | $1,608 | 1.5× |
| Cerebrospinal Fluid Scan (78630) | $964.80 | $1,608 | 1.5× |
| Chest 1 view (71045) | $204.60 | $341 | 2.0× |
| Chest 2 views (71046) | $237 | $395 | 2.3× |
| Chest 3 views (71047) | $265.80 | $443 | 2.6× |
| Chest 4 or more views (71048) | $306.60 | $511 | 2.5× |
| Clavicle complete (73000) | $198 | $330 | 1.9× |
| Computed Tomography Thorax Lw Dose Lng Ca Scr C- (71271) | $549.60 | $916 | 4.5× |
| Contrast Exam Abdominl Aorta (75625) range across 2 matching MRF lines |
$2,338.20–$2,861.40 | $3,897–$4,769 | varies |
| Contrast X-Ray Bladder (74430) | $448.80 | $748 | 1.1× |
| Contrast X-Ray Of Elbow (73085) | $535.80 | $893 | 1.3× |
| Contrast Xray Throat/Cerv Esopha (74210) | $449.40 | $749 | 2.2× |
| CT abdomen and pelvis without and with contrast (74178) range across 4 matching MRF lines |
$2,515.80–$2,584.20 | $4,193–$4,307 | varies |
| CT abdomen and pelvis without contrast (74176) range across 5 matching MRF lines |
$1,338.60–$1,996.20 | $2,231–$3,327 | varies |
| CT abdomen w contrast (74160) | $1,359.60 | $2,266 | 6.6× |
| CT abdomen w wo contrast (74170) | $1,435.20 | $2,392 | 6.9× |
| CT abdomen w/o contrast (74150) | $1,183.80 | $1,973 | 9.6× |
| CT Angio Abdomen and Pelvis (74174) | $2,261.40 | $3,769 | 5.5× |
| CT Angio Chest (71275) range across 3 matching MRF lines |
$1,160.40–$1,570.80 | $1,934–$2,618 | varies |
| CT Angio Head (70496) range across 3 matching MRF lines |
$1,619.40–$1,861.20 | $2,699–$3,102 | varies |
| CT angio hrt w/3d image (75574) | $1,159.80 | $1,933 | 2.8× |
| Ct Angio Lwr Extr W/O&W/Dye (73706) range across 2 matching MRF lines |
$1,341.60–$1,518 | $2,236–$2,530 | varies |
| CT Angio Neck (70498) range across 3 matching MRF lines |
$1,771.20–$1,864.20 | $2,952–$3,107 | varies |
| Ct Angio Upr Extrm W/O&W/Dye (73206) range across 2 matching MRF lines |
$1,146–$1,221 | $1,910–$2,035 | varies |
| CT Cere Prfuj Alys C+ W/O CT/Cta Same Anatomy (70473) | $1,364.40 | $2,274 | 6.6× |
| CT cervical spine w/ contrast (72126) | $1,424.40 | $2,374 | 3.5× |
| CT cervical spine w/o contrast (72125) | $1,327.20 | $2,212 | 10.7× |
| CT cervical spine w/wo cont (72127) | $1,374.60 | $2,291 | 6.6× |
| CT chest w contrast (71260) | $1,353 | $2,255 | 6.5× |
| CT chest w/wo contrast (71270) | $1,481.40 | $2,469 | 7.1× |
| CT colonography screening (74263) | $1,270.20 | $2,117 | 4.5× |
| CT Colonogrphy Dx Image Postprocess W/Contrast (74262) | $1,007.40 | $1,679 | 4.9× |
| CT colonogrphy dx image postprocess w/o contrast (74261) | $809.40 | $1,349 | 6.6× |
| CT head/brain with contrast (70460) | $1,249.20 | $2,082 | 6.0× |
| CT head/brain without and with contrast (70470) | $1,338 | $2,230 | 6.5× |
| CT heart contrast eval cardiac structure&morph (75572) | $799.80 | $1,333 | 1.9× |
| CT heart no contrast quant eval coronry calcium (75571) | $125.40 | $209 | 1.2× |
| CT iac w contrast (70481) | $1,224 | $2,040 | 5.9× |
| CT l-spine w&w/o contrast (72133) | $1,352.40 | $2,254 | 6.5× |
| CT lower ext w/o (73700) range across 2 matching MRF lines |
$1,176–$1,645.20 | $1,960–$2,742 | varies |
| CT lower extremity w/contrast material (73701) range across 5 matching MRF lines |
$1,256.40–$1,280.40 | $2,094–$2,134 | varies |
| CT lumbar spine w contrast (72132) | $1,428.60 | $2,381 | 3.5× |
| CT lumbar spine w/o contrast (72131) range across 2 matching MRF lines |
$931.20–$1,305 | $1,552–$2,175 | varies |
| CT maxillofacial w contrast (70487) | $1,183.80 | $1,973 | 5.7× |
| CT maxillofacial wo contrast (70486) | $1,047 | $1,745 | 8.5× |
| CT neck tissue combo (70492) | $1,374.60 | $2,291 | 6.6× |
| Ct Orbit/Ear/Fossa W/O&W/Dye (70482) | $1,374.60 | $2,291 | 6.6× |
| CT orbits w/o contrast (70480) | $1,141.80 | $1,903 | 9.2× |
| CT pelvis w&w/o contrast (72194) | $1,335 | $2,225 | 6.4× |
| CT pelvis w/o contrast (72192) | $1,081.20 | $1,802 | 8.8× |
| CT scan of leg combo (73702) | $1,374.60 | $2,291 | 6.6× |
| CT scans face/jaw combo (70488) | $1,338 | $2,230 | 6.5× |
| CT soft tissue neck w contrast (70491) | $1,297.20 | $2,162 | 6.3× |
| CT soft tissue neck w/o contrast (70490) | $1,253.40 | $2,089 | 10.1× |
| CT thoracic spine w contrast (72129) | $1,291.80 | $2,153 | 6.2× |
| CT thoracic spine w/o contrast (72128) | $1,279.20 | $2,132 | 10.4× |
| CT thoracic spine w/wo cont (72130) | $1,374.60 | $2,291 | 6.6× |
| CT thorax w/o contrast (71250) range across 4 matching MRF lines |
$975–$1,278.60 | $1,625–$2,131 | varies |
| CT unlisted procedure (76497) | $1,053.60 | $1,756 | 10.2× |
| CT upper ext wo (73200) range across 2 matching MRF lines |
$1,324.80–$1,609.80 | $2,208–$2,683 | varies |
| CT upper extremity w/o & w/contrast material (73202) | $1,396.20 | $2,327 | 6.7× |
| CT upper extremity with contrast (73201) range across 2 matching MRF lines |
$1,381.20–$1,549.20 | $2,302–$2,582 | varies |
| Cta Abdl Aorta&Bi Iliofem W/Contrast&Postp (75635) | $1,726.20 | $2,877 | 8.3× |
| Cta Abdomen (74175) range across 2 matching MRF lines |
$1,692–$1,773.60 | $2,820–$2,956 | varies |
| CTA head&neck c+ w/noncontrast img&post-pxessing (70471) | $1,364.40 | $2,274 | 3.3× |
| CTA pelvis (72191) range across 2 matching MRF lines |
$1,404.60–$1,642.80 | $2,341–$2,738 | varies |
| Dilation ureters/urethra rs&i (74485) | $1,962.60 | $3,271 | 0.8× |
| Diskography lumbar (72295) | $1,519.80 | $2,533 | 0.7× |
| Doppler Echo Fetal Puls Spectral F/U/Repeat (76828) | $522 | $870 | 4.2× |
| Doppler Echo Fetal Spectral Display Complete (76827) | $522 | $870 | 4.2× |
| Doppler Fetal Mid Cerebral Artery (76821) range across 2 matching MRF lines |
$336–$400.80 | $560–$668 | varies |
| Dxa Bone Density Axial (77080) | $249.60 | $416 | 2.0× |
| Dxa bone density study 1/>sites appendiclr skel (77081) | $146.40 | $244 | 1.4× |
| Echo exam of fetal heart (76825) | $567.60 | $946 | 0.9× |
| Echo exam uterus (76831) | $516 | $860 | 1.8× |
| Echocardiography, fetal, cardiovascular system, real time with image documentation (2D), with or without M-mode… (76826) | $473.40 | $789 | 1.7× |
| Esophagram (74220) | $257.40 | $429 | 1.2× |
| Fetal Biophys Profile W/Nst (76818) range across 2 matching MRF lines |
$367.20–$455.40 | $612–$759 | varies |
| Fetal Biophysical Profile W/O Non-Stress Testing (76819) range across 2 matching MRF lines |
$296.40–$371.40 | $494–$619 | varies |
| Fluoroscopy up to 1 hr (76000) | $470.40 | $784 | 1.7× |
| Follow-Up Angiography (75898) | $1,140.60 | $1,901 | 0.3× |
| Foot 2 views (73620) range across 4 matching MRF lines |
$174.60–$301.80 | $291–$503 | varies |
| Forearm 2 views (73090) range across 4 matching MRF lines |
$215.40–$351 | $359–$585 | varies |
| Gastric emptying imaging study (78264) | $754.20 | $1,257 | 1.6× |
| Gated Heart Planar Single (78472) | $754.20 | $1,257 | 1.6× |
| Gated Heart, Multiple (78473) | $876.60 | $1,461 | 1.9× |
| Hand 2 views (73120) range across 4 matching MRF lines |
$221.40–$354 | $369–$590 | varies |
| Hepatc Vngrph Wdg/Fr Hemodyn Eval Rs&I (75889) | $2,314.80 | $3,858 | 0.6× |
| Hepatc Vngrph Wdg/Fr W/O Hemodyn Eval Rs&I (75891) | $2,816.40 | $4,694 | 0.8× |
| Hepatobil Syst Image W/Drug (78227) | $978.60 | $1,631 | 1.5× |
| Hepatobiliary System Imaging (78226) | $754.20 | $1,257 | 1.6× |
| Ht Muscle Image Spect Sing (78451) range across 3 matching MRF lines |
$2,575.80–$2,612.40 | $4,293–$4,354 | varies |
| Hysterosalpingogram (74740) | $543.60 | $906 | 1.9× |
| Infusion Ivp (74410) | $688.80 | $1,148 | 3.3× |
| K Flow/Funct Image W/Drug (78708) | $1,224 | $2,040 | 1.9× |
| K Flow/Funct Image W/O Drug (78707) | $978.60 | $1,631 | 1.5× |
| Kidney Imaging Morphol (78700) | $743.40 | $1,239 | 1.6× |
| Knee 3 Views (73562) range across 5 matching MRF lines |
$291.60–$480 | $486–$800 | varies |
| Labeled RBC Sequestration Differntl Organ/Tissue (78140) | $743.40 | $1,239 | 1.6× |
| Leveen/Shunt Patency Exam (78291) | $743.40 | $1,239 | 1.6× |
| Liver & Spleen Imaging Static Only (78215) | $743.40 | $1,239 | 1.6× |
| Liver & Spleen Imaging W/Vascular Flow (78216) | $857.40 | $1,429 | 1.8× |
| Lung Perf&Ventilat Diferentl (78598) | $964.80 | $1,608 | 1.5× |
| Lung perfusion differential (78597) | $743.40 | $1,239 | 1.6× |
| Lung Ventilat&Perfus Imaging (78582) | $978.60 | $1,631 | 1.5× |
| Lung Ventilation Imaging (78579) | $743.40 | $1,239 | 1.6× |
| Lymph System Imaging (78195) range across 2 matching MRF lines |
$964.80–$978.60 | $1,608–$1,631 | varies |
| Lymphangiography Pelvic/Abdominal Bilateral Rs&I (75807) | $1,920 | $3,200 | 0.5× |
| Magnetic Image Jaw Joint (70336) | $1,242 | $2,070 | 4.4× |
| Mammary ductogram or galactogram multiple (77054) | $423 | $705 | 1.5× |
| Mammary ductogram or galactogram single (77053) | $337.80 | $563 | 1.2× |
| Meckels Divert Exam (78290) | $743.40 | $1,239 | 1.6× |
| Mr safety determination physician/other qhp (76016) | $202.20 | $337 | 2.0× |
| Mr safety implant&/fb assmt clin staf 1st 15 min (76014) | $56.40 | $94 | 1.7× |
| Mr safety implt electronics prepj supvj phys/qhp (76018) | $222.60 | $371 | 2.0× |
| Mr safety implt pos&/immoblj (76019) | $151.20 | $252 | 2.2× |
| Mr safety med physics xm customization plng&mntr (76017) | $555 | $925 | 2.0× |
| Mra Head W/O & W/Contrast Material (70546) | $2,258.40 | $3,764 | 5.5× |
| MRA head w/o contrast (70544) range across 2 matching MRF lines |
$1,286.40–$1,528.80 | $2,144–$2,548 | varies |
| MRA head with contrast (70545) | $1,760.40 | $2,934 | 4.3× |
| MRA neck w contrast (70548) | $1,648.20 | $2,747 | 4.0× |
| Mra Neck W/O &W/Contrast Material (70549) | $1,702.80 | $2,838 | 4.1× |
| MRA neck w/o contrast (70547) | $1,619.40 | $2,699 | 5.7× |
| MRI abdomen w contrast (74182) | $1,640.40 | $2,734 | 4.0× |
| MRI abdomen w/o contrast (74181) | $1,518 | $2,530 | 5.4× |
| MRI any jt lower extrem w/contrast material (73722) range across 2 matching MRF lines |
$1,686–$1,858.20 | $2,810–$3,097 | varies |
| MRI any jt lower extrem w/o & w/contrast matrl (73723) range across 2 matching MRF lines |
$1,830.60–$2,069.40 | $3,051–$3,449 | varies |
| MRI any jt upper extremity w/contrast matrl (73222) range across 2 matching MRF lines |
$1,788–$1,926.60 | $2,980–$3,211 | varies |
| MRI Breast W/O Contrast Bilateral (77047) | $2,031.60 | $3,386 | 7.2× |
| MRI Breast Without Contrast Material Unilateral (77046) | $1,410 | $2,350 | 5.0× |
| MRI cardiac w/o cont stress (75559) | $1,242 | $2,070 | 1.9× |
| MRI cardiac w/o contrast (75557) | $1,395 | $2,325 | 4.9× |
| MRI cervical spine w contrast (72142) | $1,414.20 | $2,357 | 3.4× |
| MRI cervical spine w/o cont (72141) | $1,423.20 | $2,372 | 5.0× |
| MRI chest w/o contrast (71550) range across 2 matching MRF lines |
$1,355.40–$1,528.20 | $2,259–$2,547 | varies |
| MRI chest with contrast (71551) | $1,686 | $2,810 | 1.8× |
| MRI chest wo w contrast (71552) range across 2 matching MRF lines |
$1,648.20–$1,859.40 | $2,747–$3,099 | varies |
| MRI lower extrem oth/thn jt w/contrast matrl (73719) range across 2 matching MRF lines |
$1,414.80–$1,829.40 | $2,358–$3,049 | varies |
| MRI lower extrem oth/thn jt w/o & w/contr matr (73720) range across 2 matching MRF lines |
$1,597.80–$2,130.60 | $2,663–$3,551 | varies |
| MRI lower extrem oth/thn jt w/o contr matrl (73718) range across 2 matching MRF lines |
$1,530.60–$1,807.80 | $2,551–$3,013 | varies |
| MRI lumbar spine w contrast (72149) | $1,568.40 | $2,614 | 3.8× |
| Mri Neck Spine W/O & W/Dye (72156) | $1,919.40 | $3,199 | 4.7× |
| MRI orbit face &/neck w/o contrast (70540) | $1,395 | $2,325 | 4.9× |
| MRI orbit face neck w contrast (70542) | $1,323.60 | $2,206 | 3.2× |
| Mri Orbt/Fac/Nck W/O &W/Dye (70543) | $1,638 | $2,730 | 4.0× |
| MRI pelvis w contrast (72196) | $1,333.20 | $2,222 | 3.2× |
| MRI pelvis w/o & w contrast (72197) range across 2 matching MRF lines |
$1,895.40–$1,951.80 | $3,159–$3,253 | varies |
| MRI pelvis w/o contrast (72195) range across 2 matching MRF lines |
$1,591.20–$1,798.80 | $2,652–$2,998 | varies |
| MRI spectroscopy (76390) | $1,196.40 | $1,994 | 11.6× |
| MRI thoracic spine w/o contrast (72146) | $1,493.40 | $2,489 | 5.3× |
| MRI upper extremity oth than jt w/contr matrl (73219) range across 2 matching MRF lines |
$1,306.80–$1,742.40 | $2,178–$2,904 | varies |
| MRI upper extremity oth than jt w/o contr matrl (73218) range across 2 matching MRF lines |
$1,806.60–$1,852.20 | $3,011–$3,087 | varies |
| Mri Uppr Extremity W/O&W/Dye (73220) range across 2 matching MRF lines |
$2,069.40–$2,121.60 | $3,449–$3,536 | varies |
| MRI, abdomen, combo (74183) | $2,185.80 | $3,643 | 5.3× |
| MRI, dorsal spine combo (72157) | $1,783.20 | $2,972 | 4.3× |
| MRI, dorsal spine contrast (72147) | $1,555.80 | $2,593 | 3.8× |
| MRI, joint upper extrem (73221) range across 2 matching MRF lines |
$1,700.40–$1,806.60 | $2,834–$3,011 | varies |
| MRI, joint upper extrem combo (73223) range across 2 matching MRF lines |
$1,831.80–$2,069.40 | $3,053–$3,449 | varies |
| MRI, lumbar spine combo (72158) | $1,939.80 | $3,233 | 4.7× |
| Myocardial Imaging Infarct Avid Planar Qual/Quan (78466) | $743.40 | $1,239 | 1.6× |
| Myocardial Spect Multiple Studies (78452) range across 3 matching MRF lines |
$2,735.40–$2,774.40 | $4,559–$4,624 | varies |
| N-invas est c ffr sw aly CTA (75580) | $1,431 | $2,385 | 1.4× |
| Neck soft tissue (70360) | $213 | $355 | 2.1× |
| Nm csf leak detection (78650) | $2,575.80 | $4,293 | 1.7× |
| Nm myocard infarct spect (78469) | $1,902 | $3,170 | 3.0× |
| Nonvascular Shunt X-Ray (75809) | $483 | $805 | 3.9× |
| Nuclear Rx Oral Admin (79005) range across 3 matching MRF lines |
$471.60–$478.20 | $786–$797 | varies |
| Ob us nuchal meas 1 gest (76813) | $153.60 | $256 | 1.2× |
| Ophthalmic ultrasound dx b-scan w/wo a-scan (76512) | $179.40 | $299 | 1.5× |
| Parathyroid imaging w/tomographic spect & CT (78072) | $978.60 | $1,631 | 1.5× |
| Parathyroid Planar Imaging (78070) | $743.40 | $1,239 | 1.6× |
| Parathyroid planar imaging w/wo subtraction (78071) | $743.40 | $1,239 | 1.6× |
| Pelvis 1 or 2 views (72170) | $178.80 | $298 | 1.4× |
| Prq Transhepatc Portograpy Hemodyn Eval Rs&I (75885) | $2,816.40 | $4,694 | 0.8× |
| Pulmonary Perfusion Imaging Particulate (78580) | $743.40 | $1,239 | 1.6× |
| Radex Abd Compl Aqt Abd W/S/E/D Views 1 View Ch (74022) | $435.60 | $726 | 3.5× |
| Radex abscess/fistula/sinus tract rs&i (76080) | $511.80 | $853 | 0.8× |
| Radex Ankle Complete Minimum 3 Views (73610) range across 5 matching MRF lines |
$241.80–$387 | $403–$645 | varies |
| Radex Calcaneus Minimum 2 Views (73650) | $156.60 | $261 | 1.5× |
| Radex elbow complete minimum 3 views (73080) range across 5 matching MRF lines |
$251.40–$402 | $419–$670 | varies |
| Radex Facial Bones Complete Minimum 3 Views (70150) | $372.60 | $621 | 3.0× |
| Radex fingr minimum 2 views (73140) range across 3 matching MRF lines |
$142.20–$143.40 | $237–$239 | varies |
| Radex foot complete minimum 3 views (73630) range across 5 matching MRF lines |
$233.40–$373.80 | $389–$623 | varies |
| Radex Hand Minimum 3 Views (73130) range across 5 matching MRF lines |
$271.20–$433.80 | $452–$723 | varies |
| Radex lower extremity infant minimum 2 views (73592) | $208.20 | $347 | 2.0× |
| Radex Mastoids Compl Minimum 3 Views PR Side (70130) | $291.60 | $486 | 2.4× |
| Radex Nasal Bones Complete Minimum 3 Views (70160) | $213.60 | $356 | 2.1× |
| Radex Ribs Unilateral 2 Views (71100) | $220.80 | $368 | 2.1× |
| Radex shoulder complete minimum 2 views (73030) range across 4 matching MRF lines |
$214.80–$295.80 | $358–$493 | varies |
| Radex Sinuses Paransl < 3 Views (70210) | $180 | $300 | 1.8× |
| Radex Spine 1 View Specify Level (72020) | $198 | $330 | 1.9× |
| Radex Sternum Minimum 2 Views (71120) | $253.80 | $423 | 2.5× |
| Radex Temporomandble Jt Opn & Clsd Mouth Bilat (70330) | $444 | $740 | 4.3× |
| Radex Toe Minimum 2 Views (73660) range across 3 matching MRF lines |
$145.20–$145.80 | $242–$243 | varies |
| Radex upper extremity infant minimum 2 views (73092) | $208.20 | $347 | 1.7× |
| Radex Wrist Complete Minimum 3 Views (73110) range across 3 matching MRF lines |
$207.60–$254.40 | $346–$424 | varies |
| Radex X-Ray Exam Entire Spi 6/> Vw - Xr Entire Spine 6+ Vw (72084) | $497.40 | $829 | 4.0× |
| Radiolog exam mandible compl minimum 4 views (70110) | $400.80 | $668 | 3.2× |
| Radiologic Exam Abdomen 3+ Views - Xr Abdomen 3+ Views (74021) | $220.80 | $368 | 1.8× |
| Radiologic exam colon double contrast study (74280) | $513.60 | $856 | 2.5× |
| Radiologic exam colon single contrast study (74270) range across 2 matching MRF lines |
$504.60–$513.60 | $841–$856 | varies |
| Radiologic Exam Esophagus Double Contrast Study (74221) | $297 | $495 | 1.4× |
| Radiologic exam knee complete 4/more views (73564) range across 3 matching MRF lines |
$250.80–$308.40 | $418–$514 | varies |
| Radiologic exam pelvis compl minimum 3 views (72190) | $295.80 | $493 | 2.4× |
| Radiologic Exam Small Int Single Contrast Study (74250) | $483 | $805 | 2.3× |
| Radiologic exam swallow function contrast study (74230) | $364.20 | $607 | 1.8× |
| Radiologic exam upr gi trc double contrast study (74246) | $297 | $495 | 1.4× |
| Radiologic examination femur 1 view (73551) | $192 | $320 | 1.9× |
| Radiologic examination femur minimum 2 views (73552) range across 3 matching MRF lines |
$223.20–$252 | $372–$420 | varies |
| Radiologic examination knee 1/2 views (73560) range across 5 matching MRF lines |
$214.20–$333 | $357–$555 | varies |
| Radiologic examination tibia & fibula 2 views (73590) range across 3 matching MRF lines |
$202.80–$220.80 | $338–$368 | varies |
| Ribs bilateral 3 views (71110) | $351 | $585 | 2.8× |
| Rp loclzj tum plnr 1 area single day imaging (78800) | $754.20 | $1,257 | 1.6× |
| Rp loclzj tum plnr 2+area 1+d img/1 area img>2+d (78801) | $904.20 | $1,507 | 1.9× |
| Rp Loclzj Tum Plnr Whole Body 2+ Days Imaging (78804) | $2,285.40 | $3,809 | 3.6× |
| Rp Loclzj Tum Plnr Whole Body Single Day Imaging (78802) | $1,970.40 | $3,284 | 3.1× |
| Rp Loclzj Tum Spect 1 Area Single Day Imaging (78803) | $1,633.20 | $2,722 | 2.5× |
| Rp loclzj tum spect 2 area/sep acquisj img (78831) | $2,785.80 | $4,643 | 1.8× |
| Rp loclzj tum spect CT 2area 1d img/1 ar img>2+d (78832) | $2,544 | $4,240 | 1.5× |
| Rp loclzj tum spect w/CT 1 area/acquisj 1day img (78830) | $2,685 | $4,475 | 1.8× |
| Rp Therapy Intravenous Administration (79101) | $498.60 | $831 | 1.8× |
| Salivary Gland Imaging (78230) | $743.40 | $1,239 | 1.6× |
| Scapula (73010) | $223.80 | $373 | 1.8× |
| Screening Digital Breast Tomosynthesis Bi (77063) range across 2 matching MRF lines |
$45–$72 | $75–$120 | varies |
| Sella turcica (70240) | $367.20 | $612 | 3.6× |
| Shoulder 1 view (73020) | $171.60 | $286 | 1.7× |
| Shoulder Arthrography (73040) range across 2 matching MRF lines |
$736.20–$763.20 | $1,227–$1,272 | varies |
| Skull less than 4 views (70250) | $273.60 | $456 | 2.2× |
| Spleen Imaging (78185) | $743.40 | $1,239 | 1.6× |
| Sternoclavicular joints (71130) | $165.60 | $276 | 1.6× |
| Superior sagittal sinus venogram (75870) | $1,301.40 | $2,169 | 0.3× |
| Testicular Imaging W/Flow (78761) | $743.40 | $1,239 | 1.6× |
| Thoracic spine 2 views (72070) | $235.80 | $393 | 1.9× |
| Thoracic spine 3 views (72072) | $328.20 | $547 | 2.7× |
| Thoracolumbar 2 views (72080) | $215.40 | $359 | 2.1× |
| Thyroid Imaging With Vascular Flow (78013) | $823.80 | $1,373 | 1.7× |
| Thyroid Met Imaging Body (78018) | $978.60 | $1,631 | 1.5× |
| Thyroid Uptake Measurement (78012) | $743.40 | $1,239 | 1.6× |
| Thyroid Uptake W/Blood Flow Sngle/Mult Quan Meas (78014) | $1,015.80 | $1,693 | 2.2× |
| Ultrasound Breast Limited (76642) range across 4 matching MRF lines |
$273.60–$538.80 | $456–$898 | varies |
| Ultrasound elastography first target lesion (76982) | $273.60 | $456 | 2.2× |
| Ultrasound Elastography Parenchyma (76981) | $253.80 | $423 | 2.1× |
| Ultrasound Exam Aaa Screen (76706) | $159.60 | $266 | 1.3× |
| Ultrasound, abdomen limited (76705) range across 2 matching MRF lines |
$247.20–$412.80 | $412–$688 | varies |
| Umbilical-artery Doppler (OB) (76820) range across 2 matching MRF lines |
$336–$420 | $560–$700 | varies |
| Unlisted fluoroscopic procedure (76496) | $312 | $520 | 3.0× |
| Unlisted magnetic resonance procedure (76498) | $1,174.20 | $1,957 | 11.4× |
| Upper gi w/o kub (74240) | $221.40 | $369 | 1.1× |
| Urea Breath Test C-14 Isotopic Acquisj Analysis (78267) | $220.20 | $367 | 19.9× |
| Ureteral Reflux Study (78740) | $743.40 | $1,239 | 1.6× |
| Urethrocystogram voiding (74455) | $549 | $915 | 1.9× |
| Urethrocystography retrograde (74450) | $615 | $1,025 | 2.2× |
| Us breast unilateral complete (76641) range across 4 matching MRF lines |
$326.40–$643.20 | $544–$1,072 | varies |
| Us chest (76604) range across 2 matching MRF lines |
$277.80–$377.40 | $463–$629 | varies |
| Us complete joint (76881) | $333 | $555 | 2.7× |
| Us exam, pelvic, limited (76857) range across 2 matching MRF lines |
$167.40–$380.40 | $279–$634 | varies |
| Us kidney transplant (76776) | $341.40 | $569 | 2.8× |
| Us lmtd joint/oth nonvasc xtr strux r-t w/img (76882) range across 2 matching MRF lines |
$215.40–$279.60 | $359–$466 | varies |
| Us ob detailed single fetus (76811) | $562.80 | $938 | 2.0× |
| Us ob limited 1 or more fetuses (76815) range across 2 matching MRF lines |
$265.20–$403.80 | $442–$673 | varies |
| Us ob transvaginal (76817) range across 2 matching MRF lines |
$220.20–$403.80 | $367–$673 | varies |
| Us pelvic non ob complete (76856) | $468 | $780 | 3.8× |
| Us pg uter img f&mat 14 wk tabdl 1/1st gestation (76801) | $445.20 | $742 | 3.6× |
| Us preg uterus real time f/u trnsabdl per fetus (76816) range across 3 matching MRF lines |
$264–$403.80 | $440–$673 | varies |
| Us retroperitoneal complete (76770) | $448.20 | $747 | 3.6× |
| Us retroperitoneal limited (76775) range across 2 matching MRF lines |
$247.20–$433.20 | $412–$722 | varies |
| Us scrotum and contents (76870) | $327 | $545 | 2.6× |
| Us thyroid (76536) range across 2 matching MRF lines |
$348.60–$413.40 | $581–$689 | varies |
| Us transrectal (76872) | $261.60 | $436 | 2.1× |
| Vein X-Ray Chest (75827) | $805.80 | $1,343 | 0.4× |
| Vein X-Ray Liver W/O Hemodyn (75887) | $1,301.40 | $2,169 | 0.3× |
| Vein X-Ray Skull Epidural (75872) | $815.40 | $1,359 | 1.1× |
| Venogram Sinus/Jugular (75860) | $1,973.40 | $3,289 | 0.5× |
| Venography Adrenal Unilateral (75840) | $2,816.40 | $4,694 | 0.8× |
| Venography caval inferior serialography rs&i (75825) | $2,336.40 | $3,894 | 0.6× |
| Venography extremity bilateral rs&i (75822) | $829.80 | $1,383 | 0.4× |
| Venography extremity unilateral rs&i (75820) | $722.40 | $1,204 | 0.4× |
| Venography Orbital Rs&I (75880) | $815.40 | $1,359 | 1.1× |
| Venography Renal Bilateral (75833) | $2,509.80 | $4,183 | 0.7× |
| Venography Renal Unilateral (75831) | $2,816.40 | $4,694 | 0.8× |
| Venous sampling by catheter (75893) | $4,675.80 | $7,793 | 0.7× |
| Venous Thrombosis Imaging Venogram Bilateral (78458) | $1,648.80 | $2,748 | 3.5× |
| Wrist 2 views (73100) range across 4 matching MRF lines |
$130.20–$218.40 | $217–$364 | varies |
| X-Ray Ac Jts - Xr Acromioclavicular Joints Bilateral (73050) | $343.80 | $573 | 3.3× |
| X-ray antegrade pyelogram tube (74425) | $547.20 | $912 | 1.3× |
| X-Ray Aorta Leg Arteries (75630) | $2,503.20 | $4,172 | 0.7× |
| X-Ray Bend Only L-S Spine (72120) | $206.40 | $344 | 1.7× |
| X-Ray Elbow 2 Vw - Xr Elbow 1-2 Views Right (73070) range across 4 matching MRF lines |
$182.40–$284.40 | $304–$474 | varies |
| X-Ray Exam Breast Specimen (76098) | $469.20 | $782 | 0.7× |
| X-Ray Exam Entire Spi 1 Vw (72081) | $201 | $335 | 2.0× |
| X-Ray Exam Entire Spi 2/3 Vw (72082) | $360.60 | $601 | 2.9× |
| X-Ray Exam Entire Spi 4/5 Vw (72083) | $376.20 | $627 | 3.0× |
| X-Ray Exam Hip Uni 1 View (73501) | $212.40 | $354 | 2.1× |
| X-Ray Exam Hip Uni 2-3 Views (73502) | $291 | $485 | 2.8× |
| X-Ray Exam Hip Uni 4/> Views (73503) | $310.20 | $517 | 2.5× |
| X-Ray Exam Hips Bi 2 Views (73521) | $325.20 | $542 | 2.6× |
| X-Ray Exam Hips Bi 3-4 Views (73522) | $505.20 | $842 | 4.1× |
| X-Ray Exam Hips Bi 5/> Views (73523) | $531 | $885 | 4.3× |
| X-Ray Exam L-S Spine Bending (72114) | $389.40 | $649 | 3.2× |
| X-Ray Exam Neck Spine 2-3 Vw (72040) | $249.60 | $416 | 2.4× |
| X-Ray Exam Neck Spine 6/>Vws (72052) | $311.40 | $519 | 2.5× |
| X-Ray Exam Unilat Ribs/Chest (71101) | $249.60 | $416 | 2.0× |
| X-ray eye for foreign body (70030) | $165 | $275 | 1.6× |
| X-ray humerus (73060) range across 7 matching MRF lines |
$135–$309.60 | $225–$516 | varies |
| X-ray IV pyelogram+tomography (74415) | $583.20 | $972 | 2.8× |
| X-Ray Jaw <4 Vw - Xr Mandible < 4 Views (70100) | $237.60 | $396 | 2.3× |
| X-Ray Knee Bilat Standing - Xr Knees Anteroposterior Standing Bilat (73565) | $217.20 | $362 | 2.1× |
| X-Ray Lumbar Spine 2/3 Vw - Xr Lumbar Spine 2-3 Views (72100) | $249.60 | $416 | 2.0× |
| X-ray nose-rectum child f.b. (76010) | $208.20 | $347 | 2.0× |
| X-Ray Ribs, Chest 4+ Vw - Xr Ribs 3 Vws Bil W/ Chest Posteroanterior (71111) | $421.20 | $702 | 3.4× |
| X-Ray Sacroiliac Jts 3+ Vw - Xr Sacroiliac Joints 3+ Views (72202) | $207 | $345 | 1.7× |
| X-Ray Sacroiliac Jts <3 Vw - Xr Sacroiliac Joints 1-2 Views (72200) | $186 | $310 | 1.5× |
| X-Ray Sacrum/Coccyx 2+ Vw - Xr Sacrum Coccyx 2+ Views (72220) | $210 | $350 | 2.0× |
| X-Ray Sinuses 3+ Vw - Xr Paranasal Sinuses 3+ Views (70220) | $291 | $485 | 2.8× |
| X-Ray Skull 4+ Vw - Xr Skull Complete 4+ Views (70260) | $321.60 | $536 | 2.6× |
| X-ray thoracic spine 4 vw (72074) | $395.40 | $659 | 3.2× |
| X-Ray Tmj Unilat (70328) | $257.40 | $429 | 2.5× |
| X-Ray Urinary Tract Exam With Contrast Material (74420) | $762 | $1,270 | 1.8× |
| X-Rays Bone Length Studies (77073) | $241.80 | $403 | 2.0× |
| X-Rays Bone Survey Complete (77075) | $538.20 | $897 | 4.4× |
| Xr c-spine 4 or 5 views (72050) | $291 | $485 | 2.4× |
| Xr facial bones less than 3 views (70140) | $231.60 | $386 | 2.3× |
| Xr orbits complete 4 views (70200) | $250.20 | $417 | 2.0× |
| Xr Tomogram Single Plane (76100) | $354.60 | $591 | 2.9× |
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.