Imaging prices at ProHealth Oconomowoc Memorial Hospital
Oconomowoc, WI · every code in this section with a posted price and a Medicare benchmark.
349 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) | $6,444.90 | $11,718 | 4.7× |
| Abdomen 1 View (74018) | $211.75 | $385 | 2.4× |
| Abdomen 2 views (74019) | $259.60 | $472 | 2.5× |
| Acute Gastrointestinal Blood Loss Imaging (78278) | $1,169.85 | $2,127 | 2.9× |
| Adrenal Cortex & Medulla Img (78075) | $2,439.80 | $4,436 | 1.9× |
| Angio pulmonary bilat (75743) | $7,630.70 | $13,874 | 2.4× |
| Angiography Adrenal Bilateral Slctv Rs&I (75733) | $8,053.65 | $14,643 | 2.6× |
| Angiography extremity bilateral rs&i (75716) | $5,801.40 | $10,548 | 1.8× |
| Angiography extremity unilateral rs&i (75710) | $3,858.80 | $7,016 | 1.2× |
| Angiography pulmonary unilateral slctv rs&i (75741) | $5,370.75 | $9,765 | 1.7× |
| Ankle 2 views (73600) | $254.65 | $463 | 2.9× |
| Aortography thoracic serialography rs&i (75605) | $8,270.35 | $15,037 | 1.5× |
| Artery X-Rays Abdomen (75726) | $4,832.30 | $8,786 | 0.9× |
| Artery X-Rays Adrenal Gland (75731) | $5,362.50 | $9,750 | 1.7× |
| Artery X-Rays Pelvis (75736) | $6,948.70 | $12,634 | 1.3× |
| Basic radiation dosimetry calculation (77300) | $771.65 | $1,403 | 5.8× |
| Bone age studies (77072) | $310.75 | $565 | 3.0× |
| Bone Imaging 3 Phase (78315) | $1,443.20 | $2,624 | 3.6× |
| Bone Imaging Limited Area (78300) | $1,158.30 | $2,106 | 2.9× |
| Bone Imaging Whole Body (78306) | $1,443.20 | $2,624 | 3.6× |
| Bone marrow imaging limited area (78102) | $1,149.50 | $2,090 | 2.9× |
| Bone survey infant (77076) | $259.60 | $472 | 2.5× |
| Brachytx isodose complex (77318) | $1,368.95 | $2,489 | 3.7× |
| Brain Imaging Min 4 Static Views W Vascular Flow (78606) | $1,801.25 | $3,275 | 3.3× |
| Brain Imaging Pet Metabolic Evaluation (78608) | $5,370.20 | $9,764 | 3.8× |
| Cardiac MRI w/w/o contrast & further seq (75561) | $3,242.25 | $5,895 | 9.3× |
| Cat Scan Follow-Up Study (76380) | $942.15 | $1,713 | 10.9× |
| Cerebrospinal Fluid Flow W/O Matl Shunt Evaltj (78645) | $1,518.55 | $2,761 | 2.8× |
| Cerebrospinal Fluid Scan (78630) | $1,893.65 | $3,443 | 3.5× |
| Chest 1 view (71045) | $211.75 | $385 | 2.4× |
| Chest 2 views (71046) | $248.05 | $451 | 2.9× |
| Chest 3 views (71047) | $293.15 | $533 | 3.4× |
| Chest 4 or more views (71048) | $305.25 | $555 | 2.9× |
| Cisternography Positive Contrast Rs&I (70015) | $1,782 | $3,240 | 2.3× |
| Clavicle complete (73000) | $253.55 | $461 | 2.9× |
| Computed Tomography Thorax Lw Dose Lng Ca Scr C- (71271) | $326.70 | $594 | 3.1× |
| Continuing medical physics consltj pr wk (77336) | $771.65 | $1,403 | 5.8× |
| Contrast Exam Abdominl Aorta (75625) | $5,939.45 | $10,799 | 1.9× |
| Contrast X-Ray Bladder (74430) | $772.75 | $1,405 | 2.2× |
| CT abdomen and pelvis without and with contrast (74178) | $3,947.90 | $7,178 | 11.4× |
| CT abdomen and pelvis without contrast (74176) | $3,416.05 | $6,211 | 14.4× |
| CT abdomen w contrast (74160) | $2,075.70 | $3,774 | 11.9× |
| CT abdomen w wo contrast (74170) | $2,442.55 | $4,441 | 14.0× |
| CT abdomen w/o contrast (74150) | $1,577.95 | $2,869 | 15.2× |
| CT Angio Abdomen and Pelvis (74174) | $3,986.40 | $7,248 | 11.5× |
| CT Angio Chest (71275) | $2,465.10 | $4,482 | 14.1× |
| CT Angio Head (70496) | $2,355.65 | $4,283 | 13.5× |
| CT angio hrt w/3d image (75574) | $1,953.05 | $3,551 | 5.6× |
| Ct Angio Lwr Extr W/O&W/Dye (73706) | $2,316.05 | $4,211 | 13.3× |
| CT Angio Neck (70498) | $2,361.15 | $4,293 | 13.5× |
| Ct Angio Upr Extrm W/O&W/Dye (73206) | $1,744.05 | $3,171 | 10.0× |
| CT Cere Prfuj Alys C+ W/O CT/Cta Same Anatomy (70473) | $1,243 | $2,260 | 7.1× |
| CT cervical spine w/ contrast (72126) | $2,325.95 | $4,229 | 6.7× |
| CT cervical spine w/o contrast (72125) | $1,906.30 | $3,466 | 18.3× |
| CT cervical spine w/wo cont (72127) | $1,933.80 | $3,516 | 11.1× |
| CT chest w contrast (71260) | $2,450.25 | $4,455 | 14.0× |
| CT chest w/wo contrast (71270) | $2,418.90 | $4,398 | 13.8× |
| CT head/brain with contrast (70460) | $1,890.90 | $3,438 | 10.8× |
| CT head/brain without and with contrast (70470) | $2,189.55 | $3,981 | 12.5× |
| CT heart no contrast quant eval coronry calcium (75571) | $45 | $81.81 | 0.5× |
| CT iac w contrast (70481) | $2,071.85 | $3,767 | 11.9× |
| CT l-spine w&w/o contrast (72133) | $1,933.80 | $3,516 | 11.1× |
| CT lower ext w/o (73700) | $1,565.85 | $2,847 | 15.0× |
| CT lower extremity w/contrast material (73701) | $1,889.25 | $3,435 | 10.8× |
| CT lumbar spine w contrast (72132) | $2,347.95 | $4,269 | 6.8× |
| CT lumbar spine w/o contrast (72131) | $1,828.75 | $3,325 | 17.6× |
| CT maxillofacial w contrast (70487) | $2,027.85 | $3,687 | 11.6× |
| CT maxillofacial wo contrast (70486) | $1,530.10 | $2,782 | 14.7× |
| CT neck tissue combo (70492) | $2,274.25 | $4,135 | 13.0× |
| Ct Orbit/Ear/Fossa W/O&W/Dye (70482) | $2,339.70 | $4,254 | 13.4× |
| CT orbits w/o contrast (70480) | $1,695.65 | $3,083 | 16.3× |
| CT pelvis w&w/o contrast (72194) | $1,933.80 | $3,516 | 11.1× |
| CT pelvis w/o contrast (72192) | $1,647.80 | $2,996 | 15.8× |
| CT scan of leg combo (73702) | $2,091.65 | $3,803 | 12.0× |
| CT scans face/jaw combo (70488) | $2,324.30 | $4,226 | 13.3× |
| CT soft tissue neck w contrast (70491) | $1,965.70 | $3,574 | 11.3× |
| CT soft tissue neck w/o contrast (70490) | $1,639.55 | $2,981 | 15.7× |
| CT thoracic spine w contrast (72129) | $2,250.05 | $4,091 | 12.9× |
| CT thoracic spine w/o contrast (72128) | $1,804.55 | $3,281 | 17.3× |
| CT thoracic spine w/wo cont (72130) | $1,933.80 | $3,516 | 11.1× |
| CT thorax w/o contrast (71250) | $1,614.25 | $2,935 | 15.5× |
| CT upper ext wo (73200) | $1,585.10 | $2,882 | 15.2× |
| CT upper extremity w/o & w/contrast material (73202) | $2,393.05 | $4,351 | 13.7× |
| CT upper extremity with contrast (73201) | $1,967.90 | $3,578 | 5.7× |
| Cta Abdl Aorta&Bi Iliofem W/Contrast&Postp (75635) | $2,580.05 | $4,691 | 14.8× |
| Cta Abdomen (74175) | $2,436.50 | $4,430 | 13.9× |
| CTA head&neck c+ w/noncontrast img&post-pxessing (70471) | $668.80 | $1,216 | 1.9× |
| CTA pelvis (72191) | $2,355.65 | $4,283 | 13.5× |
| Discography Cerv/Thor Spine (72285) | $2,509.65 | $4,563 | 1.3× |
| Diskography lumbar (72295) | $4,321.35 | $7,857 | 2.2× |
| Doppler Echo Fetal Puls Spectral F/U/Repeat (76828) | $515.90 | $938 | 5.0× |
| Doppler Echo Fetal Spectral Display Complete (76827) | $577.50 | $1,050 | 5.5× |
| Doppler Fetal Mid Cerebral Artery (76821) | $589.60 | $1,072 | 5.7× |
| Dxa Bone Density Axial (77080) | $418.55 | $761 | 4.0× |
| Dxa bone density study (77085) | $461.45 | $839 | 4.4× |
| Dxa bone density study 1/>sites appendiclr skel (77081) | $182.60 | $332 | 2.1× |
| Echo exam of fetal heart (76825) | $1,252.35 | $2,277 | 2.3× |
| Echo exam uterus (76831) | $881.10 | $1,602 | 3.7× |
| Echograp Trans R Pros Study (76873) | $485.65 | $883 | 4.7× |
| Esophagram (74220) | $435.60 | $792 | 2.5× |
| Fetal Biophys Profile W/Nst (76818) | $651.75 | $1,185 | 6.3× |
| Fetal Biophysical Profile W/O Non-Stress Testing (76819) | $615.45 | $1,119 | 5.9× |
| Fluoroscopy up to 1 hr (76000) | $563.75 | $1,025 | 2.4× |
| Follow-Up Angiography (75898) | $4,721.75 | $8,585 | 1.5× |
| Foot 2 views (73620) | $260.70 | $474 | 3.0× |
| Forearm 2 views (73090) | $253.55 | $461 | 2.9× |
| Gastric emptying imaging study (78264) | $1,674.75 | $3,045 | 4.2× |
| Gated Heart Planar Single (78472) | $1,668.70 | $3,034 | 4.2× |
| Gated Heart, Multiple (78473) | $2,155.45 | $3,919 | 5.4× |
| Hand 2 views (73120) | $310.75 | $565 | 3.0× |
| Hdr Rdncl Ntrstl/Icav Brchtx (77772) | $5,445 | $9,900 | 7.8× |
| Hdr Rdncl Ntrstl/Icav Brchtx (77771) | $4,668.40 | $8,488 | 6.7× |
| Hdr Rdncl Ntrstl/Icav Brchtx 1 Channel (77770) | $4,165.15 | $7,573 | 6.0× |
| Heart Image (Pet) Multiple (78492) | $4,803.70 | $8,734 | 3.4× |
| Hepatobil Syst Image W/Drug (78227) | $1,628.55 | $2,961 | 3.0× |
| Hepatobiliary System Imaging (78226) | $1,300.75 | $2,365 | 3.3× |
| Ht Muscle Image Spect Sing (78451) | $2,699.95 | $4,909 | 2.1× |
| Hysterosalpingogram (74740) | $943.25 | $1,715 | 4.0× |
| Infant hip ultrasound with hip movement (dynamic) (76885) | $503.80 | $916 | 5.8× |
| K Flow/Funct Image Multiple (78709) | $2,005.85 | $3,647 | 3.7× |
| K Flow/Funct Image W/Drug (78708) | $1,821.05 | $3,311 | 3.4× |
| K Flow/Funct Image W/O Drug (78707) | $1,525.15 | $2,773 | 2.8× |
| Knee 3 Views (73562) range across 2 matching MRF lines |
$269.50–$539 | $490–$980 | varies |
| Lung Perf&Ventilat Diferentl (78598) | $1,437.15 | $2,613 | 2.7× |
| Lung perfusion differential (78597) | $1,073.05 | $1,951 | 2.7× |
| Lung Ventilat&Perfus Imaging (78582) | $1,884.85 | $3,427 | 3.5× |
| Lung Ventilation Imaging (78579) | $1,169.85 | $2,127 | 2.9× |
| Lymph System Imaging (78195) | $1,427.25 | $2,595 | 2.6× |
| Magnetic Image Jaw Joint (70336) | $2,360.05 | $4,291 | 9.9× |
| Magnetic Resonance Elastography (76391) | $1,966.25 | $3,575 | 8.3× |
| Mammary ductogram or galactogram single (77053) | $563.75 | $1,025 | 2.4× |
| Meckels Divert Exam (78290) | $1,169.30 | $2,126 | 2.9× |
| Medical physics dose eval radiation expos w/rprt (76145) | $663.85 | $1,207 | 1.8× |
| Mlc imrt design & construction per imrt plan (77338) | $2,725.25 | $4,955 | 7.3× |
| Mr safety determination physician/other qhp (76016) | $199.10 | $362 | 2.3× |
| Mr safety implant&/fb assmt clin staf 1st 15 min (76014) | $57.20 | $104 | 2.0× |
| Mra Head W/O & W/Contrast Material (70546) | $3,306.60 | $6,012 | 9.5× |
| MRA head w/o contrast (70544) | $2,306.15 | $4,193 | 9.7× |
| MRA head with contrast (70545) | $2,671.90 | $4,858 | 7.7× |
| MRA neck w contrast (70548) | $2,584.45 | $4,699 | 7.4× |
| Mra Neck W/O &W/Contrast Material (70549) | $3,718.55 | $6,761 | 10.7× |
| MRA neck w/o contrast (70547) | $2,200.55 | $4,001 | 9.3× |
| MRI abdomen w contrast (74182) | $2,950.20 | $5,364 | 8.5× |
| MRI abdomen w/o contrast (74181) | $2,433.75 | $4,425 | 10.2× |
| MRI any jt lower extrem w/contrast material (73722) | $2,864.40 | $5,208 | 3.7× |
| MRI any jt lower extrem w/o & w/contrast matrl (73723) | $3,364.35 | $6,117 | 9.7× |
| MRI any jt upper extremity w/contrast matrl (73222) | $2,775.85 | $5,047 | 3.6× |
| MRI Breast W/O Contrast Bilateral (77047) | $2,490.40 | $4,528 | 10.5× |
| MRI Breast Without Contrast Material Unilateral (77046) | $1,422.85 | $2,587 | 6.0× |
| MRI cardiac w/o contrast (75557) | $2,144.45 | $3,899 | 9.0× |
| MRI cervical spine w contrast (72142) | $3,560.70 | $6,474 | 10.2× |
| MRI cervical spine w/o cont (72141) | $2,448.05 | $4,451 | 10.3× |
| MRI chest w/o contrast (71550) | $2,336.95 | $4,249 | 9.8× |
| MRI chest with contrast (71551) | $2,414.50 | $4,390 | 3.1× |
| MRI chest wo w contrast (71552) | $3,647.05 | $6,631 | 10.5× |
| MRI lower extrem oth/thn jt w/contrast matrl (73719) | $2,787.40 | $5,068 | 8.0× |
| MRI lower extrem oth/thn jt w/o & w/contr matr (73720) | $3,169.10 | $5,762 | 9.1× |
| MRI lower extrem oth/thn jt w/o contr matrl (73718) | $2,329.25 | $4,235 | 9.8× |
| MRI lumbar spine w contrast (72149) | $2,861.10 | $5,202 | 8.2× |
| Mri Neck Spine W/O & W/Dye (72156) | $3,721.30 | $6,766 | 10.7× |
| MRI orbit face &/neck w/o contrast (70540) | $2,427.15 | $4,413 | 10.2× |
| MRI orbit face neck w contrast (70542) | $2,709.85 | $4,927 | 7.8× |
| Mri Orbt/Fac/Nck W/O &W/Dye (70543) | $3,367.10 | $6,122 | 9.7× |
| MRI pelvis w contrast (72196) | $2,884.75 | $5,245 | 8.3× |
| MRI pelvis w/o & w contrast (72197) | $3,384.70 | $6,154 | 9.7× |
| MRI pelvis w/o contrast (72195) | $2,360.05 | $4,291 | 9.9× |
| MRI spectroscopy (76390) | $1,272.70 | $2,314 | 14.7× |
| MRI thoracic spine w/o contrast (72146) | $2,443.65 | $4,443 | 10.3× |
| MRI upper extremity oth than jt w/contr matrl (73219) | $3,100.90 | $5,638 | 8.9× |
| MRI upper extremity oth than jt w/o contr matrl (73218) | $2,200.55 | $4,001 | 9.3× |
| Mri Uppr Extremity W/O&W/Dye (73220) | $3,711.40 | $6,748 | 10.7× |
| MRI, abdomen, combo (74183) | $3,387.45 | $6,159 | 9.7× |
| MRI, dorsal spine combo (72157) | $3,561.80 | $6,476 | 10.3× |
| MRI, dorsal spine contrast (72147) | $3,101.45 | $5,639 | 8.9× |
| MRI, joint upper extrem (73221) range across 2 matching MRF lines |
$2,319.35–$4,638.70 | $4,217–$8,434 | varies |
| MRI, joint upper extrem combo (73223) | $3,284.60 | $5,972 | 9.5× |
| MRI, lumbar spine combo (72158) | $3,513.95 | $6,389 | 10.1× |
| Myocardial Imaging Pet Metabolic Evaluation (78459) | $4,237.20 | $7,704 | 3.3× |
| Myocardial Spect Multiple Studies (78452) | $3,989.15 | $7,253 | 3.1× |
| Myocrd Img Pet Metab Eval Single Study Cncrnt CT (78429) | $4,475.35 | $8,137 | 3.1× |
| Myocrd img PET prfuj 1std rest/stress cncrnt CT (78430) | $4,475.35 | $8,137 | 3.1× |
| Myocrd Img Pet Prfuj Mlt Std Rst&Strs Cncrnt CT (78431) | $5,860.80 | $10,656 | 2.7× |
| Myocrd Img Pet Prfuj W/Metab 2rtracer Cncrnt CT (78433) | $5,610.55 | $10,201 | 2.6× |
| Myocrd Img Pet Prfuj W/Metab Dual Radiotracer (78432) | $5,507.15 | $10,013 | 3.6× |
| N-invas est c ffr sw aly CTA (75580) | $2,456.85 | $4,467 | 2.9× |
| Neck soft tissue (70360) | $253.55 | $461 | 2.9× |
| Ntsty modul radthx pln dose-vol histos (77301) | $7,733 | $14,060 | 5.6× |
| Nuclear Rx Intra-Arterial (79445) | $1,049.40 | $1,908 | 4.5× |
| Nuclear Rx Oral Admin (79005) | $1,489.40 | $2,708 | 6.4× |
| Ob us nuchal meas 1 gest (76813) | $456.50 | $830 | 4.4× |
| Ophthalmic ultrasound dx b-scan w/wo a-scan (76512) | $353.10 | $642 | 3.4× |
| Optic foramina (70190) | $211.75 | $385 | 2.4× |
| Panoramic X-ray of jaws (70355) | $211.75 | $385 | 2.4× |
| Parathyroid imaging w/tomographic spect & CT (78072) | $1,425.60 | $2,592 | 2.6× |
| Parathyroid Planar Imaging (78070) | $1,283.70 | $2,334 | 3.2× |
| Parathyroid planar imaging w/wo subtraction (78071) | $1,472.35 | $2,677 | 3.7× |
| Pelvis 1 or 2 views (72170) | $259.60 | $472 | 2.5× |
| Pet Image W/Ct Lmtd (78814) | $3,973.75 | $7,225 | 2.8× |
| PET image w/CT, full body (78816) | $4,756.40 | $8,648 | 3.3× |
| PET imaging CT attenuation skull base mid-thigh (78815) | $4,756.40 | $8,648 | 3.3× |
| Pet Myocardial Sngl Study (78491) | $4,052.40 | $7,368 | 2.8× |
| Pulmonary Perfusion Imaging Particulate (78580) | $1,169.85 | $2,127 | 2.9× |
| Quan&Charac C Atherosclerotc Plaq Asses Sev C Ds (75577) | $1,783.65 | $3,243 | 1.9× |
| Radex Abd Compl Aqt Abd W/S/E/D Views 1 View Ch (74022) | $394.35 | $717 | 3.8× |
| Radex abscess/fistula/sinus tract rs&i (76080) | $865.70 | $1,574 | 1.6× |
| Radex Ankle Complete Minimum 3 Views (73610) range across 2 matching MRF lines |
$261.25–$522.50 | $475–$950 | varies |
| Radex Calcaneus Minimum 2 Views (73650) | $204.60 | $372 | 2.4× |
| Radex elbow complete minimum 3 views (73080) | $303.60 | $552 | 3.5× |
| Radex Facial Bones Complete Minimum 3 Views (70150) | $321.75 | $585 | 3.1× |
| Radex fingr minimum 2 views (73140) | $260.70 | $474 | 3.0× |
| Radex foot complete minimum 3 views (73630) range across 2 matching MRF lines |
$269.50–$539 | $490–$980 | varies |
| Radex Hand Minimum 3 Views (73130) range across 2 matching MRF lines |
$372.90–$745.80 | $678–$1,356 | varies |
| Radex lower extremity infant minimum 2 views (73592) | $211.75 | $385 | 2.4× |
| Radex Ribs Unilateral 2 Views (71100) | $253.55 | $461 | 2.9× |
| Radex shoulder complete minimum 2 views (73030) range across 2 matching MRF lines |
$254.10–$508.20 | $462–$924 | varies |
| Radex Sinuses Paransl < 3 Views (70210) | $211.75 | $385 | 2.4× |
| Radex Spine 1 View Specify Level (72020) | $217.80 | $396 | 2.5× |
| Radex Sternum Minimum 2 Views (71120) | $226.60 | $412 | 2.6× |
| Radex Temporomandble Jt Opn & Clsd Mouth Bilat (70330) | $420.75 | $765 | 4.9× |
| Radex Toe Minimum 2 Views (73660) | $233.75 | $425 | 2.7× |
| Radex upper extremity infant minimum 2 views (73092) | $310.75 | $565 | 3.0× |
| Radex Wrist Complete Minimum 3 Views (73110) range across 2 matching MRF lines |
$253.55–$507.10 | $461–$922 | varies |
| Radex X-Ray Exam Entire Spi 6/> Vw - Xr Entire Spine 6+ Vw (72084) | $461.45 | $839 | 4.4× |
| Radiation Delivery Stereotactic Cranial Linear (77372) | $19,735.10 | $35,882 | 2.7× |
| Radiation treatment delivery level 1 (77402) | $1,612.60 | $2,932 | 15.9× |
| Radiation treatment delivery level 2 (77407) | $2,219.25 | $4,035 | 5.8× |
| Radiation treatment delivery level 3 (77412) | $2,961.20 | $5,384 | 5.4× |
| Radiolog exam mandible compl minimum 4 views (70110) | $310.75 | $565 | 3.0× |
| Radiologic Exam Abdomen 3+ Views - Xr Abdomen 3+ Views (74021) | $310.75 | $565 | 3.0× |
| Radiologic exam colon double contrast study (74280) | $710.60 | $1,292 | 4.1× |
| Radiologic exam colon single contrast study (74270) | $564.30 | $1,026 | 3.2× |
| Radiologic Exam Esophagus Double Contrast Study (74221) | $640.20 | $1,164 | 3.7× |
| Radiologic exam knee complete 4/more views (73564) range across 2 matching MRF lines |
$325.60–$651.20 | $592–$1,184 | varies |
| Radiologic Exam Small Int Single Contrast Study (74250) | $508.75 | $925 | 2.9× |
| Radiologic exam swallow function contrast study (74230) | $523.05 | $951 | 3.0× |
| Radiologic exam upr gi trc double contrast study (74246) | $600.05 | $1,091 | 3.4× |
| Radiologic examination femur minimum 2 views (73552) | $284.35 | $517 | 3.3× |
| Radiologic examination knee 1/2 views (73560) | $260.70 | $474 | 3.0× |
| Radiologic examination tibia & fibula 2 views (73590) range across 2 matching MRF lines |
$218.35–$436.70 | $397–$794 | varies |
| Remote afterloading high dose rate radionuclide skin surface brachytherapy, includes basic dosimetry, when performed;… (77768) | $2,712.60 | $4,932 | 7.1× |
| Remote afterloading high dose rate radionuclide skin surface brachytherapy, includes basic dosimetry, when performed;… (77767) | $1,867.25 | $3,395 | 4.9× |
| Ribs bilateral 3 views (71110) | $503.80 | $916 | 4.8× |
| Rp loclzj tum plnr 1 area single day imaging (78800) | $1,225.95 | $2,229 | 3.1× |
| Rp loclzj tum plnr 2+area 1+d img/1 area img>2+d (78801) | $1,290.30 | $2,346 | 3.2× |
| Rp Loclzj Tum Plnr Whole Body 2+ Days Imaging (78804) | $3,229.05 | $5,871 | 6.0× |
| Rp Loclzj Tum Plnr Whole Body Single Day Imaging (78802) | $2,778.05 | $5,051 | 5.1× |
| Rp Loclzj Tum Spect 1 Area Single Day Imaging (78803) | $2,406.80 | $4,376 | 4.5× |
| Rp loclzj tum spect 2 area/sep acquisj img (78831) | $3,874.75 | $7,045 | 3.0× |
| Rp loclzj tum spect CT 2area 1d img/1 ar img>2+d (78832) | $4,475.35 | $8,137 | 3.1× |
| Rp loclzj tum spect w/CT 1 area/acquisj 1day img (78830) | $2,938.65 | $5,343 | 2.3× |
| Rp Therapy Intravenous Administration (79101) | $1,080.20 | $1,964 | 4.6× |
| Scapula (73010) | $259.60 | $472 | 2.5× |
| Screening Digital Breast Tomosynthesis Bi (77063) | $70.95 | $129 | 3.0× |
| Shoulder 1 view (73020) | $211.75 | $385 | 2.4× |
| Shoulder Arthrography (73040) | $880 | $1,600 | 2.5× |
| Skull less than 4 views (70250) | $310.75 | $565 | 3.0× |
| Special dosimetry (77331) | $578.60 | $1,052 | 4.3× |
| Special Physics Consult (77370) | $705.10 | $1,282 | 5.3× |
| Special teletherapy port plan (77321) | $1,727 | $3,140 | 4.6× |
| Special treatment procedure (77470) | $2,632.30 | $4,786 | 4.8× |
| Stereotactic Body Radiation Delivery (77373) | $13,185.70 | $23,974 | 7.4× |
| Sternoclavicular joints (71130) | $295.90 | $538 | 3.4× |
| Surface Applic Low Dose Rate Radionuclide Source (77789) | $590.70 | $1,074 | 5.8× |
| Tbs technical calculation only (77091) | $147.95 | $269 | 1.7× |
| Telethx isodose pln cplx w/basic dosimetry (77307) | $2,043.80 | $3,716 | 5.5× |
| Telethx isodose pln smpl w/dosimetry calculation (77306) | $1,727 | $3,140 | 4.6× |
| Ther Rad Simulaj-Aided Field Setting Complex (77290) | $1,744.60 | $3,172 | 4.7× |
| Ther Rad Simulaj-Aided Field Setting Intermed (77285) | $1,726.45 | $3,139 | 4.6× |
| Ther rad simulaj-aided field setting simple (77280) | $789.25 | $1,435 | 5.9× |
| Thoracic spine 2 views (72070) | $259.60 | $472 | 2.5× |
| Thoracic spine 3 views (72072) | $333.85 | $607 | 3.2× |
| Thoracolumbar 2 views (72080) | $260.70 | $474 | 3.0× |
| Thyroid Met Imaging Body (78018) | $1,653.85 | $3,007 | 3.1× |
| Thyroid Uptake Measurement (78012) | $1,284.25 | $2,335 | 3.2× |
| Thyroid Uptake W/Blood Flow Sngle/Mult Quan Meas (78014) | $1,275.45 | $2,319 | 3.2× |
| Tx Devices Design & Construction Complex (77334) | $1,419.55 | $2,581 | 3.8× |
| Tx devices design & construction intermediate (77333) | $744.15 | $1,353 | 5.6× |
| Tx devices design & construction simple (77332) | $676.50 | $1,230 | 5.1× |
| Ultrasound Breast Limited (76642) range across 4 matching MRF lines |
$473.55–$947.10 | $861–$1,722 | varies |
| Ultrasound elastography first target lesion (76982) | $334.95 | $609 | 3.2× |
| Ultrasound Elastography Parenchyma (76981) | $387.75 | $705 | 3.7× |
| Ultrasound Exam Aaa Screen (76706) | $398.75 | $725 | 3.8× |
| Ultrasound, abdomen limited (76705) | $666.60 | $1,212 | 6.4× |
| Umbilical-artery Doppler (OB) (76820) | $529.10 | $962 | 5.1× |
| Unlisted Dx Radiographic Procedure (76499) | $211.75 | $385 | 2.4× |
| Unlisted magnetic resonance procedure (76498) range across 2 matching MRF lines |
$171.05–$1,674.75 | $311–$3,045 | varies |
| Upper gi w/o kub (74240) | $588.50 | $1,070 | 3.4× |
| Urethrocystogram voiding (74455) | $789.80 | $1,436 | 3.3× |
| Urethrocystography retrograde (74450) | $760.65 | $1,383 | 3.2× |
| Us breast unilateral complete (76641) range across 4 matching MRF lines |
$510.95–$1,021.90 | $929–$1,858 | varies |
| Us chest (76604) | $618.75 | $1,125 | 5.9× |
| Us complete joint (76881) | $549.45 | $999 | 5.3× |
| Us exam, pelvic, limited (76857) | $395.45 | $719 | 3.8× |
| Us head (76506) | $515.90 | $938 | 5.0× |
| Us lmtd joint/oth nonvasc xtr strux r-t w/img (76882) range across 2 matching MRF lines |
$618.75–$1,237.50 | $1,125–$2,250 | varies |
| Us ob detailed single fetus (76811) | $874.50 | $1,590 | 3.7× |
| Us ob limited 1 or more fetuses (76815) | $446.60 | $812 | 4.3× |
| Us ob transvaginal (76817) | $501.60 | $912 | 4.8× |
| Us pelvic non ob complete (76856) | $685.30 | $1,246 | 6.6× |
| Us pg uter img f&mat 14 wk tabdl 1/1st gestation (76801) | $572 | $1,040 | 5.5× |
| Us preg uterus real time f/u trnsabdl per fetus (76816) | $618.75 | $1,125 | 5.9× |
| Us retroperitoneal complete (76770) | $549.45 | $999 | 5.3× |
| Us retroperitoneal limited (76775) | $515.90 | $938 | 5.0× |
| Us scrotum and contents (76870) | $685.30 | $1,246 | 6.6× |
| Us spinal canal and contents (76800) | $618.75 | $1,125 | 5.9× |
| Us thyroid (76536) | $640.75 | $1,165 | 6.2× |
| Us transrectal (76872) | $685.30 | $1,246 | 6.6× |
| Vein X-Ray Chest (75827) | $3,577.75 | $6,505 | 2.3× |
| Venography caval inferior serialography rs&i (75825) | $6,849.15 | $12,453 | 2.2× |
| Venography extremity bilateral rs&i (75822) | $3,353.90 | $6,098 | 2.1× |
| Venography extremity unilateral rs&i (75820) | $2,237.40 | $4,068 | 1.4× |
| Wrist 2 views (73100) | $246.95 | $449 | 2.8× |
| X-Ray Ac Jts - Xr Acromioclavicular Joints Bilateral (73050) | $250.80 | $456 | 2.9× |
| X-ray antegrade pyelogram tube (74425) | $887.70 | $1,614 | 2.6× |
| X-Ray Aorta Leg Arteries (75630) | $5,943.30 | $10,806 | 1.9× |
| X-Ray Bend Only L-S Spine (72120) | $351.45 | $639 | 3.4× |
| X-Ray Elbow 2 Vw - Xr Elbow 1-2 Views Right (73070) | $253.55 | $461 | 2.9× |
| X-Ray Exam Entire Spi 1 Vw (72081) | $284.35 | $517 | 3.3× |
| X-Ray Exam Entire Spi 2/3 Vw (72082) | $299.75 | $545 | 2.9× |
| X-Ray Exam Entire Spi 4/5 Vw (72083) | $376.75 | $685 | 3.6× |
| X-Ray Exam Hip Uni 1 View (73501) | $280.50 | $510 | 3.2× |
| X-Ray Exam Hip Uni 2-3 Views (73502) | $291.50 | $530 | 3.4× |
| X-Ray Exam Hips Bi 2 Views (73521) | $435.05 | $791 | 4.2× |
| X-Ray Exam Hips Bi 3-4 Views (73522) | $485.65 | $883 | 4.7× |
| X-Ray Exam Hips Bi 5/> Views (73523) | $612.15 | $1,113 | 5.9× |
| X-Ray Exam L-S Spine Bending (72114) | $422.40 | $768 | 4.1× |
| X-Ray Exam Neck Spine 2-3 Vw (72040) | $254.10 | $462 | 2.9× |
| X-Ray Exam Neck Spine 6/>Vws (72052) | $405.90 | $738 | 3.9× |
| X-Ray Exam Unilat Ribs/Chest (71101) | $321.75 | $585 | 3.1× |
| X-ray eye for foreign body (70030) | $211.75 | $385 | 2.4× |
| X-ray humerus (73060) | $240.35 | $437 | 2.8× |
| X-ray IV pyelogram (ivp) (74400) | $906.40 | $1,648 | 5.2× |
| X-Ray Jaw <4 Vw - Xr Mandible < 4 Views (70100) | $211.75 | $385 | 2.4× |
| X-Ray Knee Bilat Standing - Xr Knees Anteroposterior Standing Bilat (73565) | $253.55 | $461 | 2.9× |
| X-Ray Lumbar Spine 2/3 Vw - Xr Lumbar Spine 2-3 Views (72100) | $271.15 | $493 | 2.6× |
| X-ray nose-rectum child f.b. (76010) | $289.85 | $527 | 3.3× |
| X-Ray Ribs, Chest 4+ Vw - Xr Ribs 3 Vws Bil W/ Chest Posteroanterior (71111) | $551.10 | $1,002 | 5.3× |
| X-Ray Sacroiliac Jts 3+ Vw - Xr Sacroiliac Joints 3+ Views (72202) | $259.60 | $472 | 2.5× |
| X-Ray Sacrum/Coccyx 2+ Vw - Xr Sacrum Coccyx 2+ Views (72220) | $229.90 | $418 | 2.7× |
| X-Ray Sinuses 3+ Vw - Xr Paranasal Sinuses 3+ Views (70220) | $310.75 | $565 | 3.6× |
| X-Ray Skull 4+ Vw - Xr Skull Complete 4+ Views (70260) | $372.90 | $678 | 3.6× |
| X-ray thoracic spine 4 vw (72074) | $373.45 | $679 | 3.6× |
| X-Ray Tmj Unilat (70328) | $211.75 | $385 | 2.4× |
| X-Ray Urinary Tract Exam With Contrast Material (74420) | $887.70 | $1,614 | 2.6× |
| X-Rays Bone Length Studies (77073) | $321.75 | $585 | 3.1× |
| X-Rays Bone Survey Complete (77075) | $508.20 | $924 | 4.9× |
| Xr c-spine 4 or 5 views (72050) | $341.55 | $621 | 3.3× |
| Xr facial bones less than 3 views (70140) | $253.55 | $461 | 2.9× |
| Xr orbits complete 4 views (70200) | $319 | $580 | 3.1× |
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.