Imaging prices at Portneuf Medical Center
Pocatello, ID · every code in this section with a posted price and a Medicare benchmark.
350 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) | $7,352.40 | $12,254 | 5.4× |
| Abdomen 1 View (74018) | $233.40 | $389 | 2.7× |
| Abdomen 2 views (74019) | $418.80 | $698 | 4.1× |
| Acute Gastrointestinal Blood Loss Imaging (78278) | $1,585.20 | $2,642 | 4.0× |
| Angio pulmonary bilat (75743) | $5,134.08 | $8,556.80 | 1.6× |
| Angiography Adrenal Bilateral Slctv Rs&I (75733) | $7,097.40 | $11,829 | 2.3× |
| Angiography extremity bilateral rs&i (75716) | $5,134.08 | $8,556.80 | 1.6× |
| Angiography extremity unilateral rs&i (75710) | $5,134.08 | $8,556.80 | 1.6× |
| Angiography pulmonary unilateral slctv rs&i (75741) | $7,334.40 | $12,224 | 2.4× |
| Angrph pulmonary nonslctv cath/ven njx rs&i (75746) | $2,693.40 | $4,489 | 0.9× |
| Ankle 2 views (73600) range across 2 matching MRF lines |
$426.60–$639.90 | $711–$1,066.50 | varies |
| Aortography thoracic serialography rs&i (75605) | $5,134.08 | $8,556.80 | 0.9× |
| Artery X-Rays Abdomen (75726) | $15,252 | $25,420 | 2.8× |
| Artery X-Rays Adrenal Gland (75731) | $2,938.80 | $4,898 | 0.9× |
| Artery X-Rays Pelvis (75736) | $4,052.16 | $6,753.60 | 0.7× |
| Artery X-Rays Spine (75705) | $11,472 | $19,120 | 2.1× |
| Arthrogram hip (73525) | $789 | $1,315 | 2.3× |
| Arthrogram Wrist (73115) | $970.20 | $1,617 | 2.8× |
| Basic radiation dosimetry calculation (77300) | $721.80 | $1,203 | 5.4× |
| Bone age studies (77072) | $273 | $455 | 2.6× |
| Bone Imaging 3 Phase (78315) | $1,803 | $3,005 | 4.6× |
| Bone Imaging Limited Area (78300) | $1,464 | $2,440 | 3.7× |
| Bone Imaging Whole Body (78306) | $1,695.60 | $2,826 | 4.3× |
| Bone survey infant (77076) | $280.20 | $467 | 2.7× |
| Brain Image W/Flow < 4 Views (78601) | $764.40 | $1,274 | 1.9× |
| Brain Imaging Min 4 Static Views W Vascular Flow (78606) | $2,454 | $4,090 | 4.6× |
| Brain Imaging Pet Metabolic Evaluation (78608) | $9,652.20 | $16,087 | 6.8× |
| Card Bl Pool Gated Spect Rest Wal Motn Ejct Frct (78494) | $919.20 | $1,532 | 2.3× |
| Cardiac MRI w/w/o contrast & further seq (75561) | $5,172.24 | $8,620.40 | 15.0× |
| Cardiac MRI w/w/o contrast w/stress (75563) | $4,947 | $8,245 | 6.4× |
| Cat Scan Follow-Up Study (76380) | $1,198.20 | $1,997 | 13.9× |
| Cerebrospinal Fluid Scan (78630) | $2,230.20 | $3,717 | 4.2× |
| Chest 1 view (71045) | $239.40 | $399 | 2.8× |
| Chest 2 views (71046) | $295.20 | $492 | 3.4× |
| Chest 3 views (71047) | $363.60 | $606 | 4.2× |
| Chest 4 or more views (71048) | $433.20 | $722 | 4.2× |
| Clavicle complete (73000) range across 2 matching MRF lines |
$587.40–$881.10 | $979–$1,468.50 | varies |
| Computed Tomography Thorax Lw Dose Lng Ca Scr C- (71271) | $241.20 | $402 | 2.3× |
| Continuing medical physics consltj pr wk (77336) | $783.72 | $1,306.20 | 5.9× |
| Contrast Exam Abdominl Aorta (75625) | $5,134.08 | $8,556.80 | 1.6× |
| Contrast X-Ray Bladder (74430) | $1,168.20 | $1,947 | 3.4× |
| Contrast X-Ray Of Knee Joint (73580) | $970.20 | $1,617 | 2.8× |
| CT abdomen and pelvis without and with contrast (74178) | $2,179.80 | $3,633 | 6.3× |
| CT abdomen and pelvis without contrast (74176) | $1,258.20 | $2,097 | 5.3× |
| CT abdomen w contrast (74160) | $1,178.58 | $1,964.30 | 6.8× |
| CT abdomen w wo contrast (74170) | $684.60 | $1,141 | 4.0× |
| CT abdomen w/o contrast (74150) | $822.60 | $1,371 | 8.0× |
| CT Angio Abdomen and Pelvis (74174) | $1,456.20 | $2,427 | 4.2× |
| CT Angio Chest (71275) | $1,233.60 | $2,056 | 7.1× |
| CT Angio Head (70496) | $2,275.20 | $3,792 | 13.1× |
| CT angio hrt w/3d image (75574) | $1,128.66 | $1,881.10 | 3.3× |
| Ct Angio Lwr Extr W/O&W/Dye (73706) range across 2 matching MRF lines |
$1,881–$2,821.50 | $3,135–$4,702.50 | varies |
| CT Angio Neck (70498) | $2,275.20 | $3,792 | 13.1× |
| Ct Angio Upr Extrm W/O&W/Dye (73206) range across 2 matching MRF lines |
$1,315.44–$1,973.16 | $2,192.40–$3,288.60 | varies |
| CT bone density (77078) | $216.60 | $361 | 2.5× |
| CT Cere Prfuj Alys C+ W/O CT/Cta Same Anatomy (70473) | $322.80 | $538 | 1.9× |
| CT cervical spine w/ contrast (72126) | $1,804.20 | $3,007 | 5.2× |
| CT cervical spine w/o contrast (72125) | $2,233.92 | $3,723.20 | 21.6× |
| CT cervical spine w/wo cont (72127) | $1,985.40 | $3,309 | 11.5× |
| CT chest w contrast (71260) | $906.60 | $1,511 | 5.2× |
| CT chest w/wo contrast (71270) | $978 | $1,630 | 5.6× |
| CT head/brain with contrast (70460) | $1,692.60 | $2,821 | 9.8× |
| CT head/brain without and with contrast (70470) | $1,257.48 | $2,095.80 | 7.3× |
| CT heart contrast eval cardiac structure&morph (75572) | $790.02 | $1,316.70 | 2.3× |
| CT heart no contrast quant eval coronry calcium (75571) | $75.18 | $125.30 | 0.9× |
| CT iac w contrast (70481) | $2,173.86 | $3,623.10 | 12.5× |
| CT l-spine w&w/o contrast (72133) | $2,440.80 | $4,068 | 14.1× |
| CT lower ext w/o (73700) range across 2 matching MRF lines |
$1,648.80–$2,473.20 | $2,748–$4,122 | varies |
| CT lower extremity w/contrast material (73701) | $3,115.80 | $5,193 | 18.0× |
| CT lumbar spine w contrast (72132) | $2,883.66 | $4,806.10 | 8.4× |
| CT lumbar spine w/o contrast (72131) | $1,913.40 | $3,189 | 18.5× |
| CT maxillofacial w contrast (70487) | $1,800.60 | $3,001 | 10.4× |
| CT maxillofacial wo contrast (70486) | $1,796.34 | $2,993.90 | 17.4× |
| CT neck tissue combo (70492) | $2,513.40 | $4,189 | 14.5× |
| Ct Orbit/Ear/Fossa W/O&W/Dye (70482) | $2,211 | $3,685 | 12.8× |
| CT orbits w/o contrast (70480) | $992.04 | $1,653.40 | 9.6× |
| CT pelvis w&w/o contrast (72194) | $978 | $1,630 | 5.6× |
| CT pelvis w/o contrast (72192) | $822.60 | $1,371 | 8.0× |
| CT scan of leg combo (73702) | $4,993.20 | $8,322 | 28.8× |
| CT scans face/jaw combo (70488) | $459 | $765 | 2.6× |
| CT soft tissue neck w contrast (70491) | $1,791.60 | $2,986 | 10.3× |
| CT soft tissue neck w/o contrast (70490) | $1,341.60 | $2,236 | 13.0× |
| CT thoracic spine w contrast (72129) | $1,733.40 | $2,889 | 10.0× |
| CT thoracic spine w/o contrast (72128) | $1,635.60 | $2,726 | 15.8× |
| CT thoracic spine w/wo cont (72130) | $1,918.20 | $3,197 | 11.1× |
| CT thorax w/o contrast (71250) | $822.60 | $1,371 | 8.0× |
| CT upper ext wo (73200) | $2,678.52 | $4,464.20 | 25.9× |
| CT upper extremity w/o & w/contrast material (73202) | $3,132 | $5,220 | 18.1× |
| CT upper extremity with contrast (73201) | $1,891.26 | $3,152.10 | 5.5× |
| Cta Abdl Aorta&Bi Iliofem W/Contrast&Postp (75635) | $863.52 | $1,439.20 | 5.0× |
| Cta Abdomen (74175) | $1,233.60 | $2,056 | 7.1× |
| CTA head&neck c+ w/noncontrast img&post-pxessing (70471) | $4,550.40 | $7,584 | 13.2× |
| CTA pelvis (72191) | $1,233.60 | $2,056 | 7.1× |
| Diskography lumbar (72295) | $4,330.20 | $7,217 | 2.2× |
| Doppler Echo Fetal Spectral Display Complete (76827) | $207.60 | $346 | 2.0× |
| Doppler Fetal Mid Cerebral Artery (76821) | $262.80 | $438 | 2.5× |
| Dxa Bone Density Axial (77080) | $280.80 | $468 | 2.7× |
| Dxa bone density study 1/>sites appendiclr skel (77081) | $208.20 | $347 | 2.4× |
| Echo exam of fetal heart (76825) | $1,054.80 | $1,758 | 2.0× |
| Echo exam uterus (76831) | $1,083 | $1,805 | 4.6× |
| Echo Guide For Artery Repair (76936) | $285.60 | $476 | 1.3× |
| Esophagram (74220) | $825 | $1,375 | 4.8× |
| Fetal Biophys Profile W/Nst (76818) | $565.20 | $942 | 5.5× |
| Fetal Biophysical Profile W/O Non-Stress Testing (76819) | $303.60 | $506 | 2.9× |
| Fluoroscopy up to 1 hr (76000) | $457.20 | $762 | 1.9× |
| Follow-Up Angiography (75898) | $7,347.60 | $12,246 | 2.4× |
| Foot 2 views (73620) range across 2 matching MRF lines |
$352.80–$529.20 | $588–$882 | varies |
| Forearm 2 views (73090) range across 2 matching MRF lines |
$556.80–$835.20 | $928–$1,392 | varies |
| Gastric emptying imaging study (78264) | $1,788.54 | $2,980.90 | 4.5× |
| Gated Heart Planar Single (78472) | $2,011.20 | $3,352 | 5.1× |
| Hand 2 views (73120) range across 2 matching MRF lines |
$360.60–$540.90 | $601–$901.50 | varies |
| Hepatc Vngrph Wdg/Fr Hemodyn Eval Rs&I (75889) | $6,916.80 | $11,528 | 2.2× |
| Hepatc Vngrph Wdg/Fr W/O Hemodyn Eval Rs&I (75891) | $7,334.40 | $12,224 | 2.4× |
| Hepatobil Syst Image W/Drug (78227) | $2,135.64 | $3,559.40 | 4.0× |
| Hepatobiliary System Imaging (78226) | $1,149.96 | $1,916.60 | 2.9× |
| Ht Musc Image Planar Mult (78454) | $2,841 | $4,735 | 2.2× |
| Ht Muscle Image Spect Sing (78451) | $2,136.12 | $3,560.20 | 1.7× |
| Hysterosalpingogram (74740) | $1,485 | $2,475 | 6.3× |
| Infant hip ultrasound with hip movement (dynamic) (76885) | $416.40 | $694 | 4.8× |
| Infant hip ultrasound, limited static exam (76886) | $156.60 | $261 | 1.8× |
| Intracavitary Radiation Source Applic Complex (77763) | $2,377.80 | $3,963 | 3.5× |
| K Flow/Funct Image W/Drug (78708) | $1,136.40 | $1,894 | 2.1× |
| K Flow/Funct Image W/O Drug (78707) | $1,954.89 | $3,258.15 | 3.6× |
| Kidney Funcj Study Non-Img Radioisotopic Study (78725) | $919.20 | $1,532 | 2.3× |
| Kidney Imaging Morphol (78700) | $1,853.40 | $3,089 | 4.7× |
| Kidney Imaging Morphoogy W/Vascular Flow (78701) | $1,853.40 | $3,089 | 4.7× |
| Knee 3 Views (73562) range across 2 matching MRF lines |
$652.80–$979.20 | $1,088–$1,632 | varies |
| Leveen/Shunt Patency Exam (78291) | $1,440.60 | $2,401 | 3.6× |
| Liver & Spleen Imaging Static Only (78215) | $881.40 | $1,469 | 2.2× |
| Liver & Spleen Imaging W/Vascular Flow (78216) | $1,686 | $2,810 | 4.3× |
| Lung Perf&Ventilat Diferentl (78598) | $1,940.40 | $3,234 | 3.6× |
| Lung perfusion differential (78597) | $1,391.40 | $2,319 | 3.5× |
| Lung Ventilat&Perfus Imaging (78582) | $1,358.28 | $2,263.80 | 2.5× |
| Lung Ventilation Imaging (78579) | $1,391.40 | $2,319 | 3.5× |
| Lymph System Imaging (78195) | $1,916.46 | $3,194.10 | 3.6× |
| Magnetic Image Jaw Joint (70336) range across 2 matching MRF lines |
$3,835.20–$5,752.80 | $6,392–$9,588 | varies |
| Mammary ductogram or galactogram single (77053) | $415.20 | $692 | 1.8× |
| Meckels Divert Exam (78290) | $1,319.40 | $2,199 | 3.3× |
| Mlc imrt design & construction per imrt plan (77338) | $2,679 | $4,465 | 7.2× |
| Mra Head W/O & W/Contrast Material (70546) | $2,299.20 | $3,832 | 6.7× |
| MRA head w/o contrast (70544) | $4,200 | $7,000 | 17.8× |
| MRA head with contrast (70545) | $4,847.85 | $8,079.75 | 14.1× |
| MRA neck w contrast (70548) | $4,395.60 | $7,326 | 12.8× |
| Mra Neck W/O &W/Contrast Material (70549) | $5,309.40 | $8,849 | 15.4× |
| MRA neck w/o contrast (70547) | $2,940 | $4,900 | 12.5× |
| MRI abdomen w contrast (74182) | $962.40 | $1,604 | 2.8× |
| MRI abdomen w/o contrast (74181) | $1,878.24 | $3,130.40 | 8.0× |
| MRI any jt lower extrem w/contrast material (73722) | $5,911.23 | $9,852.05 | 7.6× |
| MRI any jt lower extrem w/o & w/contrast matrl (73723) | $7,537.80 | $12,563 | 21.9× |
| MRI any jt upper extremity w/contrast matrl (73222) | $6,208.02 | $10,346.70 | 8.0× |
| MRI Breast W/O Contrast Bilateral (77047) | $582.60 | $971 | 2.5× |
| MRI Breast Without Contrast Material Unilateral (77046) | $532.80 | $888 | 2.3× |
| MRI cardiac w/o cont stress (75559) | $1,104.60 | $1,841 | 2.0× |
| MRI cardiac w/o contrast (75557) | $582.60 | $971 | 2.5× |
| MRI cervical spine w contrast (72142) | $1,680.60 | $2,801 | 4.9× |
| MRI cervical spine w/o cont (72141) | $1,640.34 | $2,733.90 | 7.0× |
| MRI chest w/o contrast (71550) | $3,509.40 | $5,849 | 14.9× |
| MRI chest wo w contrast (71552) | $5,285.40 | $8,809 | 15.3× |
| MRI lower extrem oth/thn jt w/o & w/contr matr (73720) | $3,927 | $6,545 | 11.4× |
| MRI lower extrem oth/thn jt w/o contr matrl (73718) | $2,571.60 | $4,286 | 10.9× |
| MRI lumbar spine w contrast (72149) | $1,825.20 | $3,042 | 5.3× |
| Mri Neck Spine W/O & W/Dye (72156) | $2,096.40 | $3,494 | 6.1× |
| MRI orbit face &/neck w/o contrast (70540) | $4,882.20 | $8,137 | 20.7× |
| MRI orbit face neck w contrast (70542) | $5,257.80 | $8,763 | 15.3× |
| Mri Orbt/Fac/Nck W/O &W/Dye (70543) | $6,594.60 | $10,991 | 19.1× |
| MRI pelvis w contrast (72196) | $962.40 | $1,604 | 2.8× |
| MRI pelvis w/o & w contrast (72197) | $3,342 | $5,570 | 9.7× |
| MRI pelvis w/o contrast (72195) | $2,421 | $4,035 | 10.3× |
| MRI spectroscopy (76390) | $1,289.40 | $2,149 | 15.0× |
| MRI thoracic spine w/o contrast (72146) | $1,371 | $2,285 | 5.8× |
| MRI upper extremity oth than jt w/contr matrl (73219) | $4,627.80 | $7,713 | 13.4× |
| MRI upper extremity oth than jt w/o contr matrl (73218) | $2,259.60 | $3,766 | 9.6× |
| Mri Uppr Extremity W/O&W/Dye (73220) | $5,668.80 | $9,448 | 16.4× |
| MRI, abdomen, combo (74183) | $3,250.20 | $5,417 | 9.4× |
| MRI, dorsal spine combo (72157) | $2,960.10 | $4,933.50 | 8.6× |
| MRI, dorsal spine contrast (72147) | $1,825.20 | $3,042 | 5.3× |
| MRI, joint upper extrem (73221) range across 3 matching MRF lines |
$2,895–$4,342.50 | $4,825–$7,237.50 | varies |
| MRI, joint upper extrem combo (73223) | $3,875.34 | $6,458.90 | 11.2× |
| MRI, lumbar spine combo (72158) | $2,277 | $3,795 | 6.6× |
| Myelogram cervical (72240) | $1,760.40 | $2,934 | 2.3× |
| Myelogram Lumbar (72265) | $1,760.40 | $2,934 | 2.3× |
| Myocardial Spect Multiple Studies (78452) | $4,204.80 | $7,008 | 3.3× |
| Myocrd Img Pet Prfuj Mlt Std Rst&Strs Cncrnt CT (78431) | $4,051.20 | $6,752 | 1.9× |
| Myocrd Img Pet Prfuj W/Metab 2rtracer Cncrnt CT (78433) | $3,511.20 | $5,852 | 1.6× |
| Myocrd Img Pet Prfuj W/Metab Dual Radiotracer (78432) | $3,331.20 | $5,552 | 2.2× |
| Neck soft tissue (70360) | $376.80 | $628 | 4.4× |
| Nonvascular Shunt X-Ray (75809) | $654.60 | $1,091 | 6.3× |
| Ntsty modul radthx pln dose-vol histos (77301) | $8,172 | $13,620 | 6.0× |
| Nuclear Rx Intra-Arterial (79445) | $955.20 | $1,592 | 4.1× |
| Nuclear Rx Oral Admin (79005) | $2,004 | $3,340 | 8.7× |
| Ophthalmic ultrasound dx b-scan w/wo a-scan (76512) | $594 | $990 | 5.8× |
| Panoramic X-ray of jaws (70355) | $168 | $280 | 2.0× |
| Parathyroid Planar Imaging (78070) | $1,635 | $2,725 | 4.1× |
| Pelvis 1 or 2 views (72170) | $273 | $455 | 2.6× |
| Pet Image W/Ct Lmtd (78814) | $6,944.40 | $11,574 | 4.9× |
| PET image w/CT, full body (78816) | $6,944.40 | $11,574 | 4.9× |
| PET imaging CT attenuation skull base mid-thigh (78815) | $6,944.40 | $11,574 | 4.9× |
| Prq Transhepatc Portograpy Hemodyn Eval Rs&I (75885) | $7,334.40 | $12,224 | 2.4× |
| Pulmonary Perfusion Imaging Particulate (78580) | $1,301.40 | $2,169 | 3.3× |
| Radex Abd Compl Aqt Abd W/S/E/D Views 1 View Ch (74022) | $511.80 | $853 | 5.0× |
| Radex abscess/fistula/sinus tract rs&i (76080) | $1,485 | $2,475 | 2.8× |
| Radex Ankle Complete Minimum 3 Views (73610) range across 2 matching MRF lines |
$637.80–$956.70 | $1,063–$1,594.50 | varies |
| Radex Calcaneus Minimum 2 Views (73650) range across 2 matching MRF lines |
$351–$526.50 | $585–$877.50 | varies |
| Radex elbow complete minimum 3 views (73080) range across 2 matching MRF lines |
$815.88–$1,223.82 | $1,359.80–$2,039.70 | varies |
| Radex Facial Bones Complete Minimum 3 Views (70150) | $384 | $640 | 3.7× |
| Radex fingr minimum 2 views (73140) range across 2 matching MRF lines |
$435–$652.50 | $725–$1,087.50 | varies |
| Radex foot complete minimum 3 views (73630) range across 2 matching MRF lines |
$594.60–$891.90 | $991–$1,486.50 | varies |
| Radex Hand Minimum 3 Views (73130) range across 2 matching MRF lines |
$792.48–$1,188.72 | $1,320.80–$1,981.20 | varies |
| Radex lower extremity infant minimum 2 views (73592) | $320.40 | $534 | 3.7× |
| Radex Nasal Bones Complete Minimum 3 Views (70160) | $285.60 | $476 | 3.3× |
| Radex Ribs Unilateral 2 Views (71100) | $171 | $285 | 2.0× |
| Radex shoulder complete minimum 2 views (73030) range across 2 matching MRF lines |
$694.20–$1,041.30 | $1,157–$1,735.50 | varies |
| Radex Sinuses Paransl < 3 Views (70210) | $171 | $285 | 2.0× |
| Radex Spine 1 View Specify Level (72020) | $546 | $910 | 6.4× |
| Radex Sternum Minimum 2 Views (71120) | $349.20 | $582 | 4.1× |
| Radex Temporomandble Jt Opn & Clsd Mouth Bilat (70330) | $280.20 | $467 | 3.3× |
| Radex Toe Minimum 2 Views (73660) range across 2 matching MRF lines |
$223.80–$335.70 | $373–$559.50 | varies |
| Radex upper extremity infant minimum 2 views (73092) | $273 | $455 | 2.6× |
| Radex Wrist Complete Minimum 3 Views (73110) range across 2 matching MRF lines |
$639–$958.50 | $1,065–$1,597.50 | varies |
| Radex X-Ray Exam Entire Spi 6/> Vw - Xr Entire Spine 6+ Vw (72084) | $756 | $1,260 | 7.3× |
| Radiation Delivery Stereotactic Cranial Linear (77372) | $15,220.38 | $25,367.30 | 2.1× |
| Radiation treatment delivery level 1 (77402) | $664.20 | $1,107 | 6.6× |
| Radiation treatment delivery level 2 (77407) | $2,760 | $4,600 | 7.2× |
| Radiation treatment delivery level 3 (77412) | $3,660 | $6,100 | 6.7× |
| Radiolog exam mandible compl minimum 4 views (70110) | $393.60 | $656 | 3.8× |
| Radiologic Exam Abdomen 3+ Views - Xr Abdomen 3+ Views (74021) | $865.20 | $1,442 | 8.4× |
| Radiologic exam colon double contrast study (74280) | $1,236 | $2,060 | 7.1× |
| Radiologic exam colon single contrast study (74270) | $549.60 | $916 | 3.2× |
| Radiologic exam knee complete 4/more views (73564) range across 2 matching MRF lines |
$1,344–$2,016 | $2,240–$3,360 | varies |
| Radiologic exam pelvis compl minimum 3 views (72190) | $303.60 | $506 | 2.9× |
| Radiologic Exam Small Int Single Contrast Study (74250) | $305.76 | $509.60 | 1.8× |
| Radiologic exam swallow function contrast study (74230) | $417.60 | $696 | 2.4× |
| Radiologic exam upr gi trc double contrast study (74246) | $547.20 | $912 | 3.2× |
| Radiologic examination femur 1 view (73551) | $372 | $620 | 4.3× |
| Radiologic examination femur minimum 2 views (73552) range across 2 matching MRF lines |
$483.60–$725.40 | $806–$1,209 | varies |
| Radiologic examination knee 1/2 views (73560) range across 2 matching MRF lines |
$416.40–$624.60 | $694–$1,041 | varies |
| Radiologic Examination Osseous Survey Limited (77074) | $319.20 | $532 | 3.1× |
| Radiologic examination tibia & fibula 2 views (73590) range across 2 matching MRF lines |
$619.20–$928.80 | $1,032–$1,548 | varies |
| Radiologic examination, teeth; single view Non-Facility (70300) | $208.20 | $347 | 2.4× |
| Renal Cyst Study (74470) | $647.40 | $1,079 | 1.2× |
| Ribs bilateral 3 views (71110) | $273 | $455 | 2.6× |
| Rp loclzj tum plnr 1 area single day imaging (78800) | $872.40 | $1,454 | 2.2× |
| Rp Loclzj Tum Plnr Whole Body 2+ Days Imaging (78804) | $5,235.60 | $8,726 | 9.8× |
| Rp Loclzj Tum Plnr Whole Body Single Day Imaging (78802) | $3,114 | $5,190 | 5.8× |
| Rp Loclzj Tum Spect 1 Area Single Day Imaging (78803) | $2,179.80 | $3,633 | 4.1× |
| Rp Therapy Intravenous Administration (79101) | $1,578.60 | $2,631 | 6.8× |
| Scapula (73010) | $358.20 | $597 | 3.5× |
| Screening Digital Breast Tomosynthesis Bi (77063) | $269.10 | $448.50 | 11.5× |
| Shoulder 1 view (73020) | $169.80 | $283 | 2.0× |
| Shoulder Arthrography (73040) | $970.20 | $1,617 | 2.8× |
| Sialogram (70390) | $1,485 | $2,475 | 6.3× |
| Skull less than 4 views (70250) | $288 | $480 | 2.8× |
| Special dosimetry (77331) | $472.80 | $788 | 3.6× |
| Special Physics Consult (77370) | $1,146.60 | $1,911 | 8.6× |
| Special teletherapy port plan (77321) | $1,602 | $2,670 | 4.3× |
| Special treatment procedure (77470) | $3,689.40 | $6,149 | 6.8× |
| Stereotactic Body Radiation Delivery (77373) | $10,648.80 | $17,748 | 6.0× |
| Sternoclavicular joints (71130) | $375 | $625 | 4.4× |
| Telethx isodose pln cplx w/basic dosimetry (77307) | $3,029.40 | $5,049 | 8.2× |
| Telethx isodose pln smpl w/dosimetry calculation (77306) | $1,461.60 | $2,436 | 4.0× |
| Testicular Imaging W/Flow (78761) | $1,853.40 | $3,089 | 4.7× |
| Ther Rad Simulaj-Aided Field Setting Complex (77290) | $2,977.20 | $4,962 | 8.0× |
| Ther rad simulaj-aided field setting simple (77280) | $1,580.40 | $2,634 | 11.9× |
| Thoracic spine 2 views (72070) | $250.80 | $418 | 2.4× |
| Thoracic spine 3 views (72072) | $454.80 | $758 | 4.4× |
| Thoracolumbar 2 views (72080) | $186.48 | $310.80 | 2.2× |
| Thyroid Imaging With Vascular Flow (78013) | $837.60 | $1,396 | 2.1× |
| Thyroid Met Imaging Body (78018) | $2,580.60 | $4,301 | 4.8× |
| Thyroid Uptake Measurement (78012) | $833.40 | $1,389 | 2.1× |
| Thyroid Uptake W/Blood Flow Sngle/Mult Quan Meas (78014) | $1,242.60 | $2,071 | 3.1× |
| Tx Devices Design & Construction Complex (77334) | $1,578 | $2,630 | 4.3× |
| Tx devices design & construction intermediate (77333) | $674.40 | $1,124 | 5.1× |
| Tx devices design & construction simple (77332) | $1,578 | $2,630 | 11.9× |
| Ultrasound Breast Limited (76642) range across 2 matching MRF lines |
$1,041.60–$1,562.40 | $1,736–$2,604 | varies |
| Ultrasound Elastography Parenchyma (76981) | $207.60 | $346 | 2.0× |
| Ultrasound Exam Aaa Screen (76706) | $594 | $990 | 5.8× |
| Ultrasound, abdomen limited (76705) | $594 | $990 | 5.8× |
| Umbilical-artery Doppler (OB) (76820) | $262.80 | $438 | 2.5× |
| Unlisted fluoroscopic procedure (76496) | $5,806.80 | $9,678 | 67.5× |
| Upper gi w/o kub (74240) | $666 | $1,110 | 3.8× |
| Urethrocystogram voiding (74455) | $1,168.20 | $1,947 | 5.0× |
| Urethrocystography retrograde (74450) | $1,168.20 | $1,947 | 5.0× |
| Us breast unilateral complete (76641) range across 2 matching MRF lines |
$1,041.60–$1,562.40 | $1,736–$2,604 | varies |
| Us chest (76604) | $415.80 | $693 | 4.0× |
| Us complete joint (76881) | $751.20 | $1,252 | 7.3× |
| Us exam, pelvic, limited (76857) | $403.80 | $673 | 3.9× |
| Us head (76506) | $385.56 | $642.60 | 3.7× |
| Us kidney transplant (76776) | $510 | $850 | 4.9× |
| Us lmtd joint/oth nonvasc xtr strux r-t w/img (76882) range across 2 matching MRF lines |
$678–$1,017 | $1,130–$1,695 | varies |
| Us ob detailed single fetus (76811) | $1,066.20 | $1,777 | 4.5× |
| Us ob limited 1 or more fetuses (76815) | $780 | $1,300 | 7.6× |
| Us ob transvaginal (76817) | $1,024.80 | $1,708 | 9.9× |
| Us pelvic non ob complete (76856) | $594 | $990 | 5.8× |
| Us pg uter img f&mat 14 wk tabdl 1/1st gestation (76801) | $876.60 | $1,461 | 8.5× |
| Us preg uterus real time f/u trnsabdl per fetus (76816) | $580.86 | $968.10 | 5.6× |
| Us retroperitoneal complete (76770) | $658.80 | $1,098 | 6.4× |
| Us retroperitoneal limited (76775) | $594 | $990 | 5.8× |
| Us scrotum and contents (76870) | $917.28 | $1,528.80 | 8.9× |
| Us spinal canal and contents (76800) | $707.40 | $1,179 | 6.8× |
| Us thyroid (76536) | $772.20 | $1,287 | 7.5× |
| Us transrectal (76872) | $594 | $990 | 5.8× |
| Vein X-Ray Chest (75827) | $1,487.22 | $2,478.70 | 1.0× |
| Vein X-Ray Liver W/O Hemodyn (75887) | $6,119.40 | $10,199 | 2.0× |
| Venography caval inferior serialography rs&i (75825) | $7,334.40 | $12,224 | 2.4× |
| Venography extremity bilateral rs&i (75822) | $4,445.40 | $7,409 | 2.9× |
| Venography extremity unilateral rs&i (75820) | $3,081.78 | $5,136.30 | 2.0× |
| Venography Renal Bilateral (75833) | $6,582 | $10,970 | 2.1× |
| Venography Renal Unilateral (75831) | $5,806.80 | $9,678 | 1.9× |
| Venous sampling by catheter (75893) | $11,758.20 | $19,597 | 2.1× |
| Wrist 2 views (73100) range across 2 matching MRF lines |
$509.34–$764.01 | $848.90–$1,273.35 | varies |
| X-Ray Ac Jts - Xr Acromioclavicular Joints Bilateral (73050) | $297 | $495 | 3.5× |
| X-ray antegrade pyelogram tube (74425) | $1,168.20 | $1,947 | 3.4× |
| X-Ray Aorta Leg Arteries (75630) | $7,097.40 | $11,829 | 2.3× |
| X-Ray Bend Only L-S Spine (72120) | $400.20 | $667 | 3.9× |
| X-Ray Elbow 2 Vw - Xr Elbow 1-2 Views Right (73070) range across 2 matching MRF lines |
$508.56–$762.84 | $847.60–$1,271.40 | varies |
| X-Ray Exam Breast Specimen (76098) | $1,485 | $2,475 | 2.8× |
| X-Ray Exam Entire Spi 1 Vw (72081) | $189 | $315 | 2.2× |
| X-Ray Exam Entire Spi 2/3 Vw (72082) | $288.60 | $481 | 2.8× |
| X-Ray Exam Entire Spi 4/5 Vw (72083) | $550.20 | $917 | 5.3× |
| X-Ray Exam Hip Uni 1 View (73501) | $189 | $315 | 2.2× |
| X-Ray Exam Hip Uni 2-3 Views (73502) | $189 | $315 | 2.2× |
| X-Ray Exam Hip Uni 4/> Views (73503) | $288.60 | $481 | 2.8× |
| X-Ray Exam Hips Bi 2 Views (73521) | $202.02 | $336.70 | 2.0× |
| X-Ray Exam Hips Bi 3-4 Views (73522) | $288.60 | $481 | 2.8× |
| X-Ray Exam Hips Bi 5/> Views (73523) | $550.20 | $917 | 5.3× |
| X-Ray Exam L-S Spine Bending (72114) | $784.20 | $1,307 | 7.6× |
| X-Ray Exam Neck Spine 2-3 Vw (72040) | $325.80 | $543 | 3.8× |
| X-Ray Exam Neck Spine 6/>Vws (72052) | $644.40 | $1,074 | 6.2× |
| X-Ray Exam Unilat Ribs/Chest (71101) | $385.80 | $643 | 3.7× |
| X-ray eye for foreign body (70030) | $435.60 | $726 | 5.1× |
| X-ray humerus (73060) range across 2 matching MRF lines |
$552.60–$828.90 | $921–$1,381.50 | varies |
| X-ray IV pyelogram (ivp) (74400) | $1,168.20 | $1,947 | 6.7× |
| X-Ray Jaw <4 Vw - Xr Mandible < 4 Views (70100) | $363 | $605 | 4.2× |
| X-Ray Knee Bilat Standing - Xr Knees Anteroposterior Standing Bilat (73565) | $193.20 | $322 | 2.2× |
| X-Ray Lumbar Spine 2/3 Vw - Xr Lumbar Spine 2-3 Views (72100) | $385.80 | $643 | 3.7× |
| X-ray nose-rectum child f.b. (76010) | $174.60 | $291 | 2.0× |
| X-Ray Ribs, Chest 4+ Vw - Xr Ribs 3 Vws Bil W/ Chest Posteroanterior (71111) | $471.60 | $786 | 4.6× |
| X-Ray Sacroiliac Jts 3+ Vw - Xr Sacroiliac Joints 3+ Views (72202) | $273 | $455 | 2.6× |
| X-Ray Sacroiliac Jts <3 Vw - Xr Sacroiliac Joints 1-2 Views (72200) | $141 | $235 | 1.4× |
| X-Ray Sacrum/Coccyx 2+ Vw - Xr Sacrum Coccyx 2+ Views (72220) | $342.60 | $571 | 4.0× |
| X-Ray Sinuses 3+ Vw - Xr Paranasal Sinuses 3+ Views (70220) | $252.60 | $421 | 2.9× |
| X-Ray Skull 4+ Vw - Xr Skull Complete 4+ Views (70260) | $499.20 | $832 | 4.8× |
| X-ray thoracic spine 4 vw (72074) | $303.60 | $506 | 2.9× |
| X-Ray Tmj Unilat (70328) | $208.20 | $347 | 2.4× |
| X-Ray Urinary Tract Exam With Contrast Material (74420) | $1,158 | $1,930 | 3.4× |
| X-Rays Bone Length Studies (77073) | $366 | $610 | 3.5× |
| X-Rays Bone Survey Complete (77075) | $592.20 | $987 | 5.7× |
| Xr c-spine 4 or 5 views (72050) | $404.40 | $674 | 3.9× |
| Xr facial bones less than 3 views (70140) | $262.20 | $437 | 3.0× |
| Xr orbits complete 4 views (70200) | $257.40 | $429 | 2.5× |
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.