Imaging prices at Pih Health Good Samaritan Hospital
Los Angeles, CA · every code in this section with a posted price and a Medicare benchmark.
352 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) | $9,371 | $9,371 | 5.3× |
| Abdomen 1 View (74018) range across 3 matching MRF lines |
$360–$728 | $360–$728 | varies |
| Abdomen 2 views (74019) | $866 | $866 | 6.4× |
| Acute Gastrointestinal Blood Loss Imaging (78278) | $2,586 | $2,586 | 5.0× |
| Angio internal mammary (75756) | $2,074 | $2,074 | 0.5× |
| Angio pulmonary bilat (75743) range across 2 matching MRF lines |
$6,223.70–$6,224 | $6,223.70–$6,224 | varies |
| Angiography extremity bilateral rs&i (75716) range across 3 matching MRF lines |
$5,175–$6,224 | $5,175–$6,224 | varies |
| Angiography extremity unilateral rs&i (75710) range across 3 matching MRF lines |
$4,177–$4,179 | $4,177–$4,179 | varies |
| Angiography pulmonary unilateral slctv rs&i (75741) range across 2 matching MRF lines |
$3,487–$3,487.40 | $3,487–$3,487.40 | varies |
| Angrph pulmonary nonslctv cath/ven njx rs&i (75746) range across 2 matching MRF lines |
$3,487–$3,487.40 | $3,487–$3,487.40 | varies |
| Ankle 2 views (73600) range across 6 matching MRF lines |
$360–$628 | $360–$628 | varies |
| Aortography thoracic serialography rs&i (75605) range across 3 matching MRF lines |
$4,145–$6,224 | $4,145–$6,224 | varies |
| Artery X-Rays Abdomen (75726) | $4,908 | $4,908 | 0.7× |
| Artery X-Rays Pelvis (75736) | $6,368 | $6,368 | 0.9× |
| Artery X-Rays Spine (75705) | $4,179 | $4,179 | 0.6× |
| Basic radiation dosimetry calculation (77300) range across 2 matching MRF lines |
$631.85–$1,487 | $631.85–$1,487 | varies |
| Bone age studies (77072) | $294 | $294 | 2.2× |
| Bone Imaging 3 Phase (78315) | $3,204 | $3,204 | 6.2× |
| Bone Imaging Limited Area (78300) | $1,670 | $1,670 | 3.2× |
| Bone Imaging Multiple Areas (78305) | $2,122 | $2,122 | 4.1× |
| Bone Imaging Whole Body (78306) | $3,415 | $3,415 | 6.6× |
| Bone marrow imaging; whole body (78104) | $1,686 | $1,686 | 3.3× |
| Bone survey infant (77076) | $894 | $894 | 6.6× |
| Brachytx isodose complex (77318) | $3,076 | $3,076 | 6.4× |
| Brachytx isodose intermed (77317) | $2,096 | $2,096 | 4.4× |
| Brachytx Isodose Plan Simple (77316) | $1,560 | $1,560 | 3.2× |
| Brain Flow Imaging Only (78610) | $2,122 | $2,122 | 3.0× |
| Brain Imaging Min 4 Static Views W Vascular Flow (78606) | $3,913 | $3,913 | 5.6× |
| Brain Imaging Pet Metabolic Evaluation (78608) | $7,631 | $7,631 | 4.1× |
| Cardiac MRI w/w/o contrast & further seq (75561) | $9,572 | $9,572 | 21.3× |
| Cat Scan Follow-Up Study (76380) | $333 | $333 | 3.0× |
| Cerebrospinal Fluid Flow W/O Matl Shunt Evaltj (78645) | $1,393 | $1,393 | 2.0× |
| Cerebrospinal Fluid Scan (78630) | $3,687 | $3,687 | 5.3× |
| Chest 1 view (71045) range across 6 matching MRF lines |
$571–$745 | $571–$745 | varies |
| Chest 2 views (71046) range across 2 matching MRF lines |
$882–$914 | $882–$914 | varies |
| Chest 3 views (71047) | $771 | $771 | 6.9× |
| Chest 4 or more views (71048) | $868 | $868 | 6.5× |
| Cholecystography Oral Contrast (74290) | $597 | $597 | 2.6× |
| Cineradiograpy/vidradiograpy xcpt where spec (76120) range across 2 matching MRF lines |
$1,120–$1,856 | $1,120–$1,856 | varies |
| Clavicle complete (73000) | $597 | $597 | 5.3× |
| Computed Tomography Thorax Lw Dose Lng Ca Scr C- (71271) | $4,000 | $4,000 | 29.7× |
| Continuing medical physics consltj pr wk (77336) | $1,480 | $1,480 | 8.6× |
| Contrast Exam Abdominl Aorta (75625) | $4,630 | $4,630 | 1.1× |
| Contrast X-Ray Bladder (74430) | $1,313 | $1,313 | 2.9× |
| CT abdomen and pelvis without and with contrast (74178) range across 2 matching MRF lines |
$7,650–$9,246 | $7,650–$9,246 | varies |
| CT abdomen and pelvis without contrast (74176) range across 3 matching MRF lines |
$7,487–$10,965 | $7,487–$10,965 | varies |
| CT abdomen w contrast (74160) | $5,150 | $5,150 | 22.8× |
| CT abdomen w wo contrast (74170) | $5,932 | $5,932 | 26.3× |
| CT abdomen w/o contrast (74150) | $4,725 | $4,725 | 35.1× |
| CT Angio Abdomen and Pelvis (74174) | $5,932 | $5,932 | 13.2× |
| CT Angio Chest (71275) | $5,932 | $5,932 | 26.3× |
| CT Angio Head (70496) range across 2 matching MRF lines |
$4,831–$5,932 | $4,831–$5,932 | varies |
| CT angio hrt w/3d image (75574) range across 2 matching MRF lines |
$5,150–$6,564 | $5,150–$6,564 | varies |
| Ct Angio Lwr Extr W/O&W/Dye (73706) range across 2 matching MRF lines |
$4,591–$5,932 | $4,591–$5,932 | varies |
| CT Angio Neck (70498) | $5,932 | $5,932 | 26.3× |
| Ct Angio Upr Extrm W/O&W/Dye (73206) | $4,407 | $4,407 | 19.5× |
| CT Cere Prfuj Alys C+ W/O CT/Cta Same Anatomy (70473) | $5,697 | $5,697 | 25.3× |
| CT cervical spine w/ contrast (72126) | $5,150 | $5,150 | 11.5× |
| CT cervical spine w/o contrast (72125) | $4,725 | $4,725 | 35.1× |
| CT cervical spine w/wo cont (72127) | $5,932 | $5,932 | 26.3× |
| CT chest w contrast (71260) | $5,150 | $5,150 | 22.8× |
| CT chest w/wo contrast (71270) | $5,932 | $5,932 | 26.3× |
| CT head/brain with contrast (70460) | $5,150 | $5,150 | 22.8× |
| CT head/brain without and with contrast (70470) | $5,932 | $5,932 | 26.3× |
| CT heart contrast eval cardiac structure&morph (75572) | $6,564 | $6,564 | 14.6× |
| CT heart no contrast quant eval coronry calcium (75571) | $4,650 | $4,650 | 41.5× |
| CT hrt w/3d image congen (75573) | $4,725 | $4,725 | 10.5× |
| CT iac w contrast (70481) | $5,150 | $5,150 | 22.8× |
| CT l-spine w&w/o contrast (72133) | $5,932 | $5,932 | 26.3× |
| CT lower ext w/o (73700) range across 10 matching MRF lines |
$4,725–$5,932 | $4,725–$5,932 | varies |
| CT lower extremity w/contrast material (73701) range across 10 matching MRF lines |
$5,150–$5,514 | $5,150–$5,514 | varies |
| CT lumbar spine w contrast (72132) | $5,150 | $5,150 | 11.5× |
| CT lumbar spine w/o contrast (72131) range across 2 matching MRF lines |
$4,725–$5,932 | $4,725–$5,932 | varies |
| CT maxillofacial w contrast (70487) | $5,150 | $5,150 | 22.8× |
| CT maxillofacial wo contrast (70486) | $4,725 | $4,725 | 35.1× |
| CT neck tissue combo (70492) | $5,932 | $5,932 | 26.3× |
| Ct Orbit/Ear/Fossa W/O&W/Dye (70482) | $5,932 | $5,932 | 26.3× |
| CT orbits w/o contrast (70480) range across 3 matching MRF lines |
$3,417–$4,725 | $3,417–$4,725 | varies |
| CT pelvis w&w/o contrast (72194) | $5,932 | $5,932 | 26.3× |
| CT pelvis w/o contrast (72192) | $4,725 | $4,725 | 35.1× |
| CT scan of leg combo (73702) range across 9 matching MRF lines |
$3,860–$5,932 | $3,860–$5,932 | varies |
| CT scans face/jaw combo (70488) | $5,932 | $5,932 | 26.3× |
| CT soft tissue neck w contrast (70491) | $5,150 | $5,150 | 22.8× |
| CT soft tissue neck w/o contrast (70490) | $4,725 | $4,725 | 35.1× |
| CT thoracic spine w contrast (72129) | $5,150 | $5,150 | 22.8× |
| CT thoracic spine w/o contrast (72128) | $5,932 | $5,932 | 44.1× |
| CT thoracic spine w/wo cont (72130) | $5,932 | $5,932 | 26.3× |
| CT thorax w/o contrast (71250) range across 3 matching MRF lines |
$4,000–$4,725 | $4,000–$4,725 | varies |
| CT upper ext wo (73200) | $4,725 | $4,725 | 35.1× |
| CT upper extremity w/o & w/contrast material (73202) | $5,932 | $5,932 | 26.3× |
| CT upper extremity with contrast (73201) range across 6 matching MRF lines |
$5,150–$5,290 | $5,150–$5,290 | varies |
| Cta Abdl Aorta&Bi Iliofem W/Contrast&Postp (75635) | $5,932 | $5,932 | 26.3× |
| Cta Abdomen (74175) | $5,932 | $5,932 | 26.3× |
| CTA pelvis (72191) | $5,932 | $5,932 | 26.3× |
| Discography Cerv/Thor Spine (72285) | $3,375.40 | $3,375.40 | 1.3× |
| Doppler Echo Fetal Spectral Display Complete (76827) | $3,152 | $3,152 | 23.4× |
| Dxa Bone Density Axial (77080) | $687 | $687 | 5.1× |
| Dxa bone density study 1/>sites appendiclr skel (77081) | $627 | $627 | 5.6× |
| Echo exam of fetal heart (76825) | $4,721 | $4,721 | 6.7× |
| Echo exam uterus (76831) | $2,448 | $2,448 | 8.0× |
| Esophagram (74220) | $842 | $842 | 3.7× |
| Fetal Biophys Profile W/Nst (76818) range across 3 matching MRF lines |
$1,339–$1,912 | $1,339–$1,912 | varies |
| Fetal Biophysical Profile W/O Non-Stress Testing (76819) range across 2 matching MRF lines |
$925–$1,072 | $925–$1,072 | varies |
| Fluoroscopy up to 1 hr (76000) range across 3 matching MRF lines |
$1,346–$6,965 | $1,346–$6,965 | varies |
| Follow-Up Angiography (75898) range across 2 matching MRF lines |
$2,055–$6,709 | $2,055–$6,709 | varies |
| Foot 2 views (73620) range across 4 matching MRF lines |
$360–$628 | $360–$628 | varies |
| Forearm 2 views (73090) | $628 | $628 | 5.6× |
| Gastric emptying imaging study (78264) | $2,586 | $2,586 | 5.0× |
| Gated Heart Planar Single (78472) | $3,316 | $3,316 | 6.4× |
| Gated Heart, Multiple (78473) | $2,088 | $2,088 | 4.1× |
| Hand 2 views (73120) range across 6 matching MRF lines |
$378–$628 | $378–$628 | varies |
| Hdr Rdncl Ntrstl/Icav Brchtx (77772) | $8,636 | $8,636 | 9.6× |
| Hdr Rdncl Ntrstl/Icav Brchtx (77771) | $7,676 | $7,676 | 8.6× |
| Hdr Rdncl Ntrstl/Icav Brchtx 1 Channel (77770) | $6,492 | $6,492 | 7.2× |
| Heart Image (Pet) Multiple (78492) | $2,917 | $2,917 | 1.6× |
| Hepatc Vngrph Wdg/Fr Hemodyn Eval Rs&I (75889) | $3,487.40 | $3,487.40 | 0.9× |
| Hepatobil Syst Image W/Drug (78227) | $2,520 | $2,520 | 3.6× |
| Hepatobiliary System Imaging (78226) | $1,817 | $1,817 | 3.5× |
| Ht Muscle Image Spect Sing (78451) range across 2 matching MRF lines |
$2,917–$5,195 | $2,917–$5,195 | varies |
| Hysterosalpingogram (74740) | $1,041 | $1,041 | 3.4× |
| Infant hip ultrasound with hip movement (dynamic) (76885) | $393 | $393 | 3.5× |
| Infant hip ultrasound, limited static exam (76886) | $1,700 | $1,700 | 15.2× |
| Intracavitary Radiation Source Applic Complex (77763) | $3,651 | $3,651 | 4.1× |
| Intracavitary radiation source applic simple (77761) | $1,560 | $1,560 | 2.2× |
| Joint Survey Single View (77077) | $597 | $597 | 4.4× |
| K Flow/Funct Image Multiple (78709) | $2,255 | $2,255 | 3.2× |
| K Flow/Funct Image W/Drug (78708) | $2,094 | $2,094 | 3.0× |
| K Flow/Funct Image W/O Drug (78707) | $3,648 | $3,648 | 5.2× |
| Kidney Funcj Study Non-Img Radioisotopic Study (78725) | $3,913 | $3,913 | 7.6× |
| Kidney Imaging Morphol (78700) | $1,278 | $1,278 | 2.5× |
| Kidney Imaging Morphoogy W/Vascular Flow (78701) | $2,255 | $2,255 | 4.4× |
| Knee 3 Views (73562) | $783 | $783 | 7.0× |
| Leveen/Shunt Patency Exam (78291) | $1,590 | $1,590 | 3.1× |
| Liver & Spleen Imaging Static Only (78215) | $2,200 | $2,200 | 4.3× |
| Liver & Spleen Imaging W/Vascular Flow (78216) | $1,736 | $1,736 | 3.4× |
| Liver imaging static only (78201) | $1,736 | $1,736 | 2.5× |
| Liver imaging w/vascular flow (78202) | $1,736 | $1,736 | 2.5× |
| Lung Perf&Ventilat Diferentl (78598) | $2,785 | $2,785 | 4.0× |
| Lung perfusion differential (78597) | $2,720 | $2,720 | 5.3× |
| Lung Ventilat&Perfus Imaging (78582) | $2,321 | $2,321 | 3.3× |
| Lung Ventilation Imaging (78579) | $2,321 | $2,321 | 4.5× |
| Lymph System Imaging (78195) range across 4 matching MRF lines |
$2,037–$3,363 | $2,037–$3,363 | varies |
| Lymphangiography Extremity Only Bilateral Rs&I (75803) | $1,489 | $1,489 | 0.7× |
| Lymphangiography extremity only unilateral rs&i (75801) | $1,346 | $1,346 | 1.7× |
| Lymphangiography Pelvic/Abdominal Bilateral Rs&I (75807) | $1,489 | $1,489 | 0.4× |
| Lymphangiography, pelvic/abdominal, unilateral (75805) | $2,760.80 | $2,760.80 | 0.7× |
| Magnetic Image Jaw Joint (70336) range across 3 matching MRF lines |
$5,500–$6,800 | $5,500–$6,800 | varies |
| Mammary ductogram or galactogram single (77053) | $1,036 | $1,036 | 3.4× |
| Meckels Divert Exam (78290) | $1,292 | $1,292 | 2.5× |
| Mlc imrt design & construction per imrt plan (77338) | $6,254 | $6,254 | 13.0× |
| Mra Head W/O & W/Contrast Material (70546) | $6,800 | $6,800 | 15.2× |
| MRA head w/o contrast (70544) | $5,500 | $5,500 | 17.9× |
| MRA head with contrast (70545) range across 2 matching MRF lines |
$5,800–$6,995 | $5,800–$6,995 | varies |
| MRA neck w contrast (70548) | $5,800 | $5,800 | 12.9× |
| Mra Neck W/O &W/Contrast Material (70549) range across 2 matching MRF lines |
$6,800–$6,995 | $6,800–$6,995 | varies |
| MRA neck w/o contrast (70547) | $5,500 | $5,500 | 17.9× |
| MRI abdomen w contrast (74182) | $5,800 | $5,800 | 12.9× |
| MRI abdomen w/o contrast (74181) range across 3 matching MRF lines |
$5,500–$6,995 | $5,500–$6,995 | varies |
| MRI any jt lower extrem w/contrast material (73722) | $5,800 | $5,800 | 5.8× |
| MRI any jt lower extrem w/o & w/contrast matrl (73723) | $6,800 | $6,800 | 15.2× |
| MRI any jt upper extremity w/contrast matrl (73222) | $5,800 | $5,800 | 5.8× |
| MRI Breast W/O Contrast Bilateral (77047) | $9,572 | $9,572 | 31.2× |
| MRI Breast Without Contrast Material Unilateral (77046) | $9,572 | $9,572 | 31.2× |
| MRI cervical spine w contrast (72142) | $5,800 | $5,800 | 12.9× |
| MRI cervical spine w/o cont (72141) | $5,500 | $5,500 | 17.9× |
| MRI chest w/o contrast (71550) range across 3 matching MRF lines |
$5,500–$6,995 | $5,500–$6,995 | varies |
| MRI chest with contrast (71551) | $5,800 | $5,800 | 5.8× |
| MRI chest wo w contrast (71552) range across 2 matching MRF lines |
$6,800–$6,995 | $6,800–$6,995 | varies |
| MRI lower extrem oth/thn jt w/contrast matrl (73719) | $5,800 | $5,800 | 12.9× |
| MRI lower extrem oth/thn jt w/o & w/contr matr (73720) range across 7 matching MRF lines |
$6,800–$6,995 | $6,800–$6,995 | varies |
| MRI lower extrem oth/thn jt w/o contr matrl (73718) range across 7 matching MRF lines |
$5,500–$6,995 | $5,500–$6,995 | varies |
| MRI lumbar spine w contrast (72149) | $5,800 | $5,800 | 12.9× |
| Mri Neck Spine W/O & W/Dye (72156) | $6,800 | $6,800 | 15.2× |
| MRI orbit face &/neck w/o contrast (70540) range across 4 matching MRF lines |
$4,452–$6,995 | $4,452–$6,995 | varies |
| Mri Orbt/Fac/Nck W/O &W/Dye (70543) range across 4 matching MRF lines |
$6,800–$8,151 | $6,800–$8,151 | varies |
| MRI pelvis w contrast (72196) | $5,800 | $5,800 | 12.9× |
| MRI pelvis w/o & w contrast (72197) range across 3 matching MRF lines |
$6,800–$6,995 | $6,800–$6,995 | varies |
| MRI pelvis w/o contrast (72195) range across 3 matching MRF lines |
$5,500–$6,995 | $5,500–$6,995 | varies |
| MRI spectroscopy (76390) | $9,572 | $9,572 | 85.5× |
| MRI thoracic spine w/o contrast (72146) | $5,500 | $5,500 | 17.9× |
| MRI upper extremity oth than jt w/o contr matrl (73218) range across 9 matching MRF lines |
$5,500–$9,668 | $5,500–$9,668 | varies |
| Mri Uppr Extremity W/O&W/Dye (73220) range across 8 matching MRF lines |
$6,800–$9,668 | $6,800–$9,668 | varies |
| MRI, abdomen, combo (74183) | $6,800 | $6,800 | 15.2× |
| MRI, dorsal spine combo (72157) | $6,800 | $6,800 | 15.2× |
| MRI, dorsal spine contrast (72147) | $5,800 | $5,800 | 12.9× |
| MRI, joint upper extrem (73221) | $5,500 | $5,500 | 17.9× |
| MRI, joint upper extrem combo (73223) range across 6 matching MRF lines |
$6,800–$9,668 | $6,800–$9,668 | varies |
| MRI, lumbar spine combo (72158) | $6,800 | $6,800 | 15.2× |
| Myocardial Imaging Pet Metabolic Evaluation (78459) | $8,088 | $8,088 | 4.9× |
| Myocardial Spect Multiple Studies (78452) | $3,664 | $3,664 | 2.2× |
| N-invas est c ffr sw aly CTA (75580) | $5,600 | $5,600 | 5.1× |
| Neck soft tissue (70360) | $597 | $597 | 5.3× |
| Nm csf leak detection (78650) | $2,055 | $2,055 | 1.2× |
| Nm unlisted gi procedure (78299) | $1,590 | $1,590 | 3.1× |
| Nonvascular Shunt X-Ray (75809) | $580 | $580 | 4.3× |
| Ntsty modul radthx pln dose-vol histos (77301) | $11,226 | $11,226 | 6.3× |
| Nuclear Rx Intra-Arterial (79445) | $1,470 | $1,470 | 4.9× |
| Nuclear Rx Oral Admin (79005) range across 2 matching MRF lines |
$2,161–$3,204 | $2,161–$3,204 | varies |
| Ob us nuchal meas 1 gest (76813) | $2,517 | $2,517 | 18.7× |
| Optic foramina (70190) | $369 | $369 | 3.3× |
| Parathyroid Planar Imaging (78070) | $1,978 | $1,978 | 3.8× |
| Parathyroid planar imaging w/wo subtraction (78071) | $3,050 | $3,050 | 5.9× |
| Pelvis 1 or 2 views (72170) | $681 | $681 | 5.1× |
| Perineogram (74775) | $741.30 | $741.30 | 2.4× |
| Peritoneogram Rs&I (74190) | $1,231.30 | $1,231.30 | 1.8× |
| Pet Image W/Ct Lmtd (78814) | $4,918 | $4,918 | 2.7× |
| PET image w/CT, full body (78816) range across 2 matching MRF lines |
$8,085–$11,163 | $8,085–$11,163 | varies |
| PET imaging CT attenuation skull base mid-thigh (78815) range across 2 matching MRF lines |
$8,085–$11,163 | $8,085–$11,163 | varies |
| Pet Myocardial Sngl Study (78491) | $8,492 | $8,492 | 4.6× |
| Prq Transhepatc Portograpy Hemodyn Eval Rs&I (75885) | $5,153.40 | $5,153.40 | 1.3× |
| Pulmonary Perfusion Imaging Particulate (78580) | $2,255 | $2,255 | 4.4× |
| Radex Abd Compl Aqt Abd W/S/E/D Views 1 View Ch (74022) | $1,219 | $1,219 | 9.1× |
| Radex abscess/fistula/sinus tract rs&i (76080) range across 2 matching MRF lines |
$760–$894 | $760–$894 | varies |
| Radex Ankle Complete Minimum 3 Views (73610) | $754 | $754 | 6.7× |
| Radex Calcaneus Minimum 2 Views (73650) | $681 | $681 | 6.1× |
| Radex elbow complete minimum 3 views (73080) | $754 | $754 | 6.7× |
| Radex Facial Bones Complete Minimum 3 Views (70150) range across 3 matching MRF lines |
$1,120–$1,226 | $1,120–$1,226 | varies |
| Radex fingr minimum 2 views (73140) | $597 | $597 | 5.3× |
| Radex foot complete minimum 3 views (73630) | $597 | $597 | 5.3× |
| Radex Hand Minimum 3 Views (73130) | $597 | $597 | 5.3× |
| Radex lower extremity infant minimum 2 views (73592) | $509 | $509 | 4.5× |
| Radex Mastoids Compl Minimum 3 Views PR Side (70130) | $754 | $754 | 5.6× |
| Radex Nasal Bones Complete Minimum 3 Views (70160) | $853 | $853 | 7.6× |
| Radex Ribs Unilateral 2 Views (71100) | $681 | $681 | 6.1× |
| Radex shoulder complete minimum 2 views (73030) range across 4 matching MRF lines |
$207–$842 | $207–$842 | varies |
| Radex Sinuses Paransl < 3 Views (70210) | $724 | $724 | 6.5× |
| Radex Spine 1 View Specify Level (72020) | $628 | $628 | 5.6× |
| Radex Sternum Minimum 2 Views (71120) | $728 | $728 | 6.5× |
| Radex Temporomandble Jt Opn & Clsd Mouth Bilat (70330) | $936 | $936 | 8.4× |
| Radex Toe Minimum 2 Views (73660) | $597 | $597 | 5.3× |
| Radex upper extremity infant minimum 2 views (73092) | $681 | $681 | 5.1× |
| Radex Wrist Complete Minimum 3 Views (73110) | $842 | $842 | 7.5× |
| Radiation Delivery Stereotactic Cranial Linear (77372) | $29,925 | $29,925 | 3.2× |
| Radiation treatment delivery level 1 (77402) | $2,901 | $2,901 | 22.1× |
| Radiation treatment delivery level 2 (77407) | $4,024 | $4,024 | 8.1× |
| Radiation treatment delivery level 3 (77412) | $4,024 | $4,024 | 5.7× |
| Radiolog exam mandible compl minimum 4 views (70110) | $948 | $948 | 7.1× |
| Radiologic Exam Abdomen 3+ Views - Xr Abdomen 3+ Views (74021) | $1,075 | $1,075 | 8.0× |
| Radiologic exam colon double contrast study (74280) | $1,703 | $1,703 | 7.5× |
| Radiologic exam colon single contrast study (74270) | $1,346 | $1,346 | 6.0× |
| Radiologic exam knee complete 4/more views (73564) | $842 | $842 | 6.3× |
| Radiologic Exam Small Int Single Contrast Study (74250) | $1,614 | $1,614 | 7.2× |
| Radiologic exam swallow function contrast study (74230) | $1,120 | $1,120 | 5.0× |
| Radiologic examination femur 1 view (73551) | $590 | $590 | 5.3× |
| Radiologic examination femur minimum 2 views (73552) | $628 | $628 | 5.6× |
| Radiologic examination knee 1/2 views (73560) range across 8 matching MRF lines |
$360–$681 | $360–$681 | varies |
| Radiologic Examination Osseous Survey Limited (77074) | $1,557 | $1,557 | 11.6× |
| Radiologic examination tibia & fibula 2 views (73590) range across 6 matching MRF lines |
$360–$699 | $360–$699 | varies |
| Renal Cyst Study (74470) | $4,066 | $4,066 | 5.8× |
| Ribs bilateral 3 views (71110) | $854 | $854 | 6.4× |
| Rp loclzj tum plnr 1 area single day imaging (78800) | $2,088 | $2,088 | 4.1× |
| Rp Loclzj Tum Plnr Whole Body 2+ Days Imaging (78804) range across 3 matching MRF lines |
$3,067–$5,665 | $3,067–$5,665 | varies |
| Rp Loclzj Tum Plnr Whole Body Single Day Imaging (78802) | $3,070 | $3,070 | 4.4× |
| Rp Loclzj Tum Spect 1 Area Single Day Imaging (78803) range across 4 matching MRF lines |
$1,278–$4,071 | $1,278–$4,071 | varies |
| Rp Therapy Intravenous Administration (79101) | $885 | $885 | 2.9× |
| Scapula (73010) | $597 | $597 | 4.4× |
| Screening Digital Breast Tomosynthesis Bi (77063) | $161 | $161 | 6.9× |
| Sella turcica (70240) | $224 | $224 | 2.0× |
| Shoulder 1 view (73020) range across 4 matching MRF lines |
$207–$597 | $207–$597 | varies |
| Sialogram (70390) | $948 | $948 | 3.1× |
| Skull less than 4 views (70250) | $853 | $853 | 6.3× |
| Special dosimetry (77331) | $1,235 | $1,235 | 7.1× |
| Special Physics Consult (77370) | $2,480 | $2,480 | 14.3× |
| Special teletherapy port plan (77321) | $2,690 | $2,690 | 5.6× |
| Special treatment procedure (77470) | $7,904 | $7,904 | 11.1× |
| Stereotactic Body Radiation Delivery (77373) | $6,405 | $6,405 | 2.8× |
| Sternoclavicular joints (71130) | $597 | $597 | 5.3× |
| Superior sagittal sinus venogram (75870) range across 2 matching MRF lines |
$6,244.70–$6,708 | $6,244.70–$6,708 | varies |
| Telethx isodose pln cplx w/basic dosimetry (77307) | $2,366 | $2,366 | 4.9× |
| Testicular Imaging W/Flow (78761) | $2,255 | $2,255 | 4.4× |
| Ther Rad Simulaj-Aided Field Setting Complex (77290) | $3,008 | $3,008 | 6.2× |
| Ther Rad Simulaj-Aided Field Setting Intermed (77285) | $2,271 | $2,271 | 4.7× |
| Ther rad simulaj-aided field setting simple (77280) | $1,656 | $1,656 | 9.6× |
| Therapeutic Enema Rdctj Intussusception/Obstrcj (74283) | $620 | $620 | 2.7× |
| Thoracic spine 3 views (72072) | $948 | $948 | 7.1× |
| Thyroid Met Imaging Body (78018) | $2,088 | $2,088 | 3.0× |
| Thyroid Uptake Measurement (78012) | $842 | $842 | 1.6× |
| Thyroid Uptake W/Blood Flow Sngle/Mult Quan Meas (78014) | $2,387 | $2,387 | 4.6× |
| Tx Devices Design & Construction Complex (77334) | $1,928 | $1,928 | 4.0× |
| Tx devices design & construction intermediate (77333) | $1,134 | $1,134 | 6.6× |
| Tx devices design & construction simple (77332) | $1,095 | $1,095 | 6.3× |
| Ultrasound Breast Limited (76642) range across 4 matching MRF lines |
$797.30–$2,278 | $797.30–$2,278 | varies |
| Ultrasound Exam Aaa Screen (76706) | $1,508 | $1,508 | 11.2× |
| Ultrasound, abdomen limited (76705) range across 9 matching MRF lines |
$1,507–$2,275 | $1,507–$2,275 | varies |
| Umbilical-artery Doppler (OB) (76820) | $557 | $557 | 4.1× |
| Unlisted fluoroscopic procedure (76496) | $716.80 | $716.80 | 6.4× |
| Upper gi w/o kub (74240) range across 4 matching MRF lines |
$559–$1,984 | $559–$1,984 | varies |
| Ureteral Reflux Study (78740) | $2,122 | $2,122 | 4.1× |
| Urethrocystogram voiding (74455) | $1,120 | $1,120 | 3.6× |
| Urethrocystography retrograde (74450) | $1,313 | $1,313 | 4.3× |
| Us breast unilateral complete (76641) range across 3 matching MRF lines |
$797.30–$1,594.60 | $797.30–$1,594.60 | varies |
| Us chest (76604) range across 2 matching MRF lines |
$1,220–$1,700 | $1,220–$1,700 | varies |
| Us complete joint (76881) range across 2 matching MRF lines |
$1,700–$2,448 | $1,700–$2,448 | varies |
| Us exam, pelvic, limited (76857) | $1,150 | $1,150 | 8.6× |
| Us head (76506) | $2,275 | $2,275 | 16.9× |
| Us kidney transplant (76776) | $2,275 | $2,275 | 16.9× |
| Us lmtd joint/oth nonvasc xtr strux r-t w/img (76882) range across 4 matching MRF lines |
$660–$2,058 | $660–$2,058 | varies |
| Us ob detailed single fetus (76811) | $2,735 | $2,735 | 8.9× |
| Us ob limited 1 or more fetuses (76815) range across 7 matching MRF lines |
$812–$1,160 | $812–$1,160 | varies |
| Us ob transvaginal (76817) range across 2 matching MRF lines |
$1,491–$1,700 | $1,491–$1,700 | varies |
| Us pelvic non ob complete (76856) | $2,275 | $2,275 | 16.9× |
| Us pg uter img f&mat 14 wk tabdl 1/1st gestation (76801) range across 2 matching MRF lines |
$2,275–$2,517 | $2,275–$2,517 | varies |
| Us preg uterus real time f/u trnsabdl per fetus (76816) | $1,491 | $1,491 | 11.1× |
| Us retroperitoneal complete (76770) | $2,275 | $2,275 | 16.9× |
| Us retroperitoneal limited (76775) | $1,508 | $1,508 | 11.2× |
| Us scrotum and contents (76870) | $2,275 | $2,275 | 16.9× |
| Us spinal canal and contents (76800) | $2,275 | $2,275 | 16.9× |
| Us thyroid (76536) range across 4 matching MRF lines |
$1,668–$2,275 | $1,668–$2,275 | varies |
| Us transrectal (76872) | $1,692 | $1,692 | 12.6× |
| Vein X-Ray Chest (75827) range across 2 matching MRF lines |
$4,295–$5,181 | $4,295–$5,181 | varies |
| Vein X-Ray Liver W/O Hemodyn (75887) | $5,153.40 | $5,153.40 | 1.3× |
| Venogram Sinus/Jugular (75860) range across 2 matching MRF lines |
$4,177–$6,245 | $4,177–$6,245 | varies |
| Venography caval inferior serialography rs&i (75825) | $5,181 | $5,181 | 1.3× |
| Venography extremity bilateral rs&i (75822) | $3,351 | $3,351 | 1.7× |
| Venography extremity unilateral rs&i (75820) range across 3 matching MRF lines |
$2,950–$3,349 | $2,950–$3,349 | varies |
| Venography Renal Bilateral (75833) range across 2 matching MRF lines |
$3,939.60–$3,940 | $3,939.60–$3,940 | varies |
| Venography Renal Unilateral (75831) range across 2 matching MRF lines |
$3,316.60–$3,317 | $3,316.60–$3,317 | varies |
| Venous sampling by catheter (75893) range across 2 matching MRF lines |
$2,992.50–$18,903 | $2,992.50–$18,903 | varies |
| Wrist 2 views (73100) range across 6 matching MRF lines |
$207–$628 | $207–$628 | varies |
| X-Ray Ac Jts - Xr Acromioclavicular Joints Bilateral (73050) | $369 | $369 | 3.3× |
| X-ray antegrade pyelogram tube (74425) range across 3 matching MRF lines |
$1,193–$1,459 | $1,193–$1,459 | varies |
| X-Ray Aorta Leg Arteries (75630) range across 3 matching MRF lines |
$5,843–$11,235 | $5,843–$11,235 | varies |
| X-Ray Bend Only L-S Spine (72120) | $948 | $948 | 7.1× |
| X-Ray Elbow 2 Vw - Xr Elbow 1-2 Views Right (73070) range across 6 matching MRF lines |
$207–$681 | $207–$681 | varies |
| X-Ray Exam Breast Specimen (76098) | $424.20 | $424.20 | 0.6× |
| X-Ray Exam Entire Spi 2/3 Vw (72082) range across 2 matching MRF lines |
$728–$1,417 | $728–$1,417 | varies |
| X-Ray Exam Hip Uni 1 View (73501) range across 4 matching MRF lines |
$503–$597 | $503–$597 | varies |
| X-Ray Exam Hip Uni 2-3 Views (73502) range across 3 matching MRF lines |
$681–$754 | $681–$754 | varies |
| X-Ray Exam Hips Bi 2 Views (73521) range across 2 matching MRF lines |
$590–$595 | $590–$595 | varies |
| X-Ray Exam Hips Bi 3-4 Views (73522) | $948 | $948 | 7.1× |
| X-Ray Exam L-S Spine Bending (72114) | $1,710 | $1,710 | 12.7× |
| X-Ray Exam Neck Spine 2-3 Vw (72040) | $771 | $771 | 6.9× |
| X-Ray Exam Neck Spine 6/>Vws (72052) | $1,212 | $1,212 | 9.0× |
| X-Ray Exam Unilat Ribs/Chest (71101) | $1,396 | $1,396 | 10.4× |
| X-ray eye for foreign body (70030) range across 3 matching MRF lines |
$597–$1,010 | $597–$1,010 | varies |
| X-ray humerus (73060) | $681 | $681 | 6.1× |
| X-ray IV pyelogram (ivp) (74400) range across 2 matching MRF lines |
$1,459–$2,301 | $1,459–$2,301 | varies |
| X-Ray Jaw <4 Vw - Xr Mandible < 4 Views (70100) | $728 | $728 | 6.5× |
| X-Ray Knee Bilat Standing - Xr Knees Anteroposterior Standing Bilat (73565) | $754 | $754 | 6.7× |
| X-Ray Lumbar Spine 2/3 Vw - Xr Lumbar Spine 2-3 Views (72100) | $794 | $794 | 5.9× |
| X-ray nose-rectum child f.b. (76010) | $241 | $241 | 2.2× |
| X-Ray Ribs, Chest 4+ Vw - Xr Ribs 3 Vws Bil W/ Chest Posteroanterior (71111) | $1,120 | $1,120 | 8.3× |
| X-Ray Sacroiliac Jts 3+ Vw - Xr Sacroiliac Joints 3+ Views (72202) | $728 | $728 | 5.4× |
| X-Ray Sacrum/Coccyx 2+ Vw - Xr Sacrum Coccyx 2+ Views (72220) | $728 | $728 | 6.5× |
| X-Ray Sinuses 3+ Vw - Xr Paranasal Sinuses 3+ Views (70220) | $948 | $948 | 8.5× |
| X-Ray Skull 4+ Vw - Xr Skull Complete 4+ Views (70260) | $1,120 | $1,120 | 8.3× |
| X-Ray Urinary Tract Exam With Contrast Material (74420) | $1,424 | $1,424 | 3.2× |
| X-Rays Bone Length Studies (77073) | $310 | $310 | 2.3× |
| X-Rays Bone Survey Complete (77075) range across 2 matching MRF lines |
$1,039–$3,198 | $1,039–$3,198 | varies |
| Xr c-spine 4 or 5 views (72050) | $882 | $882 | 6.6× |
| Xr facial bones less than 3 views (70140) | $986 | $986 | 8.8× |
| Xr orbits complete 4 views (70200) range across 2 matching MRF lines |
$820–$1,100 | $820–$1,100 | varies |
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.