Imaging prices at Providence Holy Family Hospital

Spokane, WA · every code in this section with a posted price and a Medicare benchmark.

425 codes. Prices are the hospital's own posted facility charges.

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ProcedurePosted cashPosted gross× Medicare
3-D radiotherapy plan dose-volume histograms (77295) $1,820 $2,600 1.2×
Abdomen 1 View (74018) $172.90 $247 1.8×
Abdomen 2 views (74019) $172.90 $247 1.5×
Acute Gastrointestinal Blood Loss Imaging (78278) $1,008 $1,440 2.3×
Adrenal Cortex & Medulla Img (78075) $3,599.40 $5,142 2.5×
Angio internal mammary (75756) $4,883.20 $6,976 1.4×
Angio pulmonary bilat (75743) $7,200.20 $10,286 2.0×
Angiography Adrenal Bilateral Slctv Rs&I (75733) $10,756.20 $15,366 3.1×
Angiography extremity bilateral rs&i (75716) $7,200.20 $10,286 2.0×
Angiography extremity unilateral rs&i (75710) $7,200.20 $10,286 2.0×
Angiography pulmonary unilateral slctv rs&i (75741) $7,200.20 $10,286 2.0×
Angrph pulmonary nonslctv cath/ven njx rs&i (75746) $3,838.80 $5,484 1.1×
Ankle 2 views (73600) $161.70 $231 1.7×
Aortography thoracic serialography rs&i (75605) $19,433.40 $27,762 3.1×
Aortography thoracic w/o serialography rs&i (75600) $7,200.20 $10,286 2.0×
Artery X-Rays Abdomen (75726) $13,421.10 $19,173 2.2×
Artery X-Rays Adrenal Gland (75731) $10,756.20 $15,366 3.1×
Artery X-Rays Pelvis (75736) $7,200.20 $10,286 1.2×
Artery X-Rays Spine (75705) $8,827 $12,610 1.4×
Arthrogram ankle (73615) $1,169.70 $1,671 3.0×
Arthrogram hip (73525) $1,208.20 $1,726 3.1×
Arthrogram Wrist (73115) $1,191.40 $1,702 3.1×
Basic radiation dosimetry calculation (77300) $204.40 $292 1.4×
Bone age studies (77072) $338.10 $483 2.9×
Bone Imaging 3 Phase (78315) $1,009.40 $1,442 2.3×
Bone Imaging Limited Area (78300) $1,009.40 $1,442 2.3×
Bone Imaging Multiple Areas (78305) $1,009.40 $1,442 2.3×
Bone Imaging Whole Body (78306) $1,009.40 $1,442 2.3×
Bone marrow imaging limited area (78102) $1,343.30 $1,919 3.0×
Bone marrow imaging; multiple areas (78103) $1,603.70 $2,291 3.6×
Bone marrow imaging; whole body (78104) $1,076.60 $1,538 2.4×
Bone survey infant (77076) $256.20 $366 2.2×
Brain Flow Imaging Only (78610) $1,238.30 $1,769 2.0×
Brain Imaging Min 4 Static Views W Vascular Flow (78606) $1,355.20 $1,936 2.2×
Brain Imaging Pet Metabolic Evaluation (78608) $5,198.20 $7,426 3.3×
Card Bl Pool Gated Spect Rest Wal Motn Ejct Frct (78494) $1,191.40 $1,702 2.7×
Cardiac MRI w/w/o contrast & further seq (75561) $1,267.70 $1,811 3.3×
Cardiac MRI w/w/o contrast w/stress (75563) $2,249.80 $3,214 2.6×
Cardiac Shunt Detection (78428) $2,047.50 $2,925 4.6×
Cat Scan Follow-Up Study (76380) $1,103.20 $1,576 11.4×
Cerebrospinal Fluid Flow W/O Matl Shunt Evaltj (78645) $1,659.70 $2,371 2.7×
Cerebrospinal fluid flow, imaging (not including introduction of material); ventriculography Non-Facility (78635) $1,878.10 $2,683 3.1×
Cerebrospinal Fluid Scan (78630) $2,095.80 $2,994 3.5×
Chest 1 view (71045) $123.90 $177 1.3×
Chest 2 views (71046) $123.90 $177 1.3×
Chest 3 views (71047) $310.80 $444 3.2×
Chest 4 or more views (71048) $702.80 $1,004 6.0×
Cholecystography Oral Contrast (74290) $1,005.90 $1,437 5.1×
Cisternography Positive Contrast Rs&I (70015) $2,966.60 $4,238 3.4×
Clavicle complete (73000) $161.70 $231 1.7×
Computed Tomography Thorax Lw Dose Lng Ca Scr C- (71271) $196 $280 1.7×
Continuing medical physics consltj pr wk (77336) $204.40 $292 1.4×
Contrast Exam Abdominl Aorta (75625) $7,200.20 $10,286 2.0×
Contrast X-Ray Bladder (74430) $1,268.40 $1,812 3.3×
Contrast X-Ray Of Elbow (73085) $1,169 $1,670 3.0×
Contrast X-Ray Of Knee Joint (73580) $1,439.90 $2,057 3.7×
Corpora cavernosography (74445) $1,662.50 $2,375 14.3×
CT abdomen and pelvis without and with contrast (74178) $1,050 $1,500 2.7×
CT abdomen and pelvis without contrast (74176) $592.20 $846 2.2×
CT abdomen w contrast (74160) $609.70 $871 3.1×
CT abdomen w wo contrast (74170) $686 $980 3.5×
CT abdomen w/o contrast (74150) $310.10 $443 2.7×
CT Angio Abdomen and Pelvis (74174) $954.80 $1,364 2.5×
CT Angio Chest (71275) $714.70 $1,021 3.7×
CT Angio Head (70496) $800.10 $1,143 4.1×
CT angio hrt w/3d image (75574) $1,755.60 $2,508 4.5×
Ct Angio Lwr Extr W/O&W/Dye (73706) $714.70 $1,021 3.7×
CT Angio Neck (70498) $800.10 $1,143 4.1×
Ct Angio Upr Extrm W/O&W/Dye (73206) $1,432.20 $2,046 7.3×
CT cervical spine w/ contrast (72126) $683.90 $977 1.8×
CT cervical spine w/o contrast (72125) $347.20 $496 3.0×
CT cervical spine w/wo cont (72127) $2,742.60 $3,918 14.0×
CT chest w contrast (71260) $609.70 $871 3.1×
CT chest w/wo contrast (71270) $686 $980 3.5×
CT Colonogrphy Dx Image Postprocess W/Contrast (74262) $1,551.20 $2,216 7.9×
CT colonogrphy dx image postprocess w/o contrast (74261) $1,036.70 $1,481 8.9×
CT head/brain with contrast (70460) $683.90 $977 3.5×
CT head/brain without and with contrast (70470) $770 $1,100 3.9×
CT heart contrast eval cardiac structure&morph (75572) $2,321.90 $3,317 6.0×
CT heart no contrast quant eval coronry calcium (75571) $1,520.40 $2,172 15.7×
CT hrt w/3d image congen (75573) $1,755.60 $2,508 4.5×
CT iac w contrast (70481) $683.90 $977 3.5×
CT l-spine w&w/o contrast (72133) $2,447.90 $3,497 12.5×
CT lower ext w/o (73700) $310.10 $443 2.7×
CT lower extremity w/contrast material (73701) $609.70 $871 3.1×
CT lumbar spine w contrast (72132) $609.70 $871 1.6×
CT lumbar spine w/o contrast (72131) $310.10 $443 2.7×
CT maxillofacial w contrast (70487) $683.90 $977 3.5×
CT maxillofacial wo contrast (70486) $347.20 $496 3.0×
CT neck tissue combo (70492) $3,650.50 $5,215 18.7×
Ct Orbit/Ear/Fossa W/O&W/Dye (70482) $3,189.20 $4,556 16.3×
CT orbits w/o contrast (70480) $347.20 $496 3.0×
CT pelvis w&w/o contrast (72194) $2,688.70 $3,841 13.8×
CT pelvis w/o contrast (72192) $310.10 $443 2.7×
CT scan of leg combo (73702) $2,085.30 $2,979 10.7×
CT scans face/jaw combo (70488) $770 $1,100 3.9×
CT soft tissue neck w contrast (70491) $683.90 $977 3.5×
CT soft tissue neck w/o contrast (70490) $347.20 $496 3.0×
CT thoracic spine w contrast (72129) $609.70 $871 3.1×
CT thoracic spine w/o contrast (72128) $310.10 $443 2.7×
CT thoracic spine w/wo cont (72130) $1,512.70 $2,161 7.7×
CT thorax w/o contrast (71250) $310.10 $443 2.7×
CT unlisted procedure (76497) $265.30 $379 2.7×
CT upper ext wo (73200) $310.10 $443 2.7×
CT upper extremity w/o & w/contrast material (73202) $1,699.60 $2,428 8.7×
CT upper extremity with contrast (73201) $609.70 $871 1.6×
Cta Abdl Aorta&Bi Iliofem W/Contrast&Postp (75635) $714.70 $1,021 3.7×
Cta Abdomen (74175) $714.70 $1,021 3.7×
CTA head&neck c+ w/noncontrast img&post-pxessing (70471) $3,304 $4,720 8.5×
CTA pelvis (72191) $3,317.30 $4,739 17.0×
Dilation ureters/urethra rs&i (74485) $5,821.20 $8,316 2.5×
Discography Cerv/Thor Spine (72285) $7,161.70 $10,231 3.3×
Diskography lumbar (72295) $4,657.80 $6,654 2.1×
Doppler Echo Fetal Puls Spectral F/U/Repeat (76828) $171.50 $245 1.5×
Doppler Echo Fetal Spectral Display Complete (76827) $130.90 $187 1.1×
Dxa Bone Density Axial (77080) $510.30 $729 4.4×
Echo exam uterus (76831) $362.60 $518 1.4×
Echo Guide For Artery Repair (76936) $1,429.40 $2,042 5.9×
Esophagram (74220) $507.50 $725 2.6×
Fetal Biophys Profile W/Nst (76818) $256.20 $366 2.2×
Fetal Biophysical Profile W/O Non-Stress Testing (76819) $256.20 $366 2.2×
Fluoroscopy up to 1 hr (76000) $482.30 $689 1.8×
Follow-Up Angiography (75898) $6,045.90 $8,637 1.7×
Foot 2 views (73620) $161.70 $231 1.7×
Forearm 2 views (73090) $161.70 $231 1.7×
Gastric emptying imaging study (78264) $1,008 $1,440 2.3×
Gastric Emptyng Imag Std W/Sm Bwl Transit (78265) $1,415.40 $2,022 3.2×
Gastroesophageal Reflux Exam (78262) $1,670.20 $2,386 3.7×
Gated Heart Planar Single (78472) $1,191.40 $1,702 2.7×
Gstrc Emptng Imag Std W/Sm Bwl Col Trnst Mlt Day (78266) $1,878.10 $2,683 3.1×
Hand 2 views (73120) $161.70 $231 1.4×
Heart first pass single,planar (78481) $2,114.70 $3,021 3.5×
Heart Image (Pet) Multiple (78492) $4,074 $5,820 2.6×
Hepatc Vngrph Wdg/Fr Hemodyn Eval Rs&I (75889) $11,729.20 $16,756 3.3×
Hepatc Vngrph Wdg/Fr W/O Hemodyn Eval Rs&I (75891) $11,729.20 $16,756 3.3×
Hepatobil Syst Image W/Drug (78227) $1,159.20 $1,656 1.9×
Hepatobiliary System Imaging (78226) $1,159.20 $1,656 2.6×
Ht Musc Image Planar Mult (78454) $3,586.10 $5,123 2.5×
Ht Muscle Image Spect Sing (78451) $3,586.10 $5,123 2.5×
Hysterosalpingogram (74740) $2,020.90 $2,887 7.6×
Infant hip ultrasound with hip movement (dynamic) (76885) $787.50 $1,125 8.1×
Infant hip ultrasound, limited static exam (76886) $171.50 $245 1.8×
Intracavitary Radiation Source Applic Complex (77763) $933.80 $1,334 1.2×
Intracavitary Radiation Source Applic Intermed (77762) $889.70 $1,271 1.4×
Intracavitary radiation source applic simple (77761) $847 $1,210 1.4×
Joint Survey Single View (77077) $214.20 $306 1.8×
K Flow/Funct Image Multiple (78709) $1,556.10 $2,223 2.6×
K Flow/Funct Image W/Drug (78708) $1,297.80 $1,854 2.1×
K Flow/Funct Image W/O Drug (78707) $1,556.10 $2,223 2.6×
Kidney Funcj Study Non-Img Radioisotopic Study (78725) $1,321.60 $1,888 3.0×
Kidney Imaging Morphoogy W/Vascular Flow (78701) $1,327.90 $1,897 3.0×
Knee 3 Views (73562) $161.70 $231 1.7×
Leveen/Shunt Patency Exam (78291) $1,768.90 $2,527 4.0×
Liver & Spleen Imaging Static Only (78215) $1,159.20 $1,656 2.6×
Liver & Spleen Imaging W/Vascular Flow (78216) $2,370.20 $3,386 5.3×
Liver imaging static only (78201) $4,571 $6,530 7.6×
Lung Perf&Ventilat Diferentl (78598) $3,364.20 $4,806 5.6×
Lung perfusion differential (78597) $952 $1,360 2.1×
Lung Ventilat&Perfus Imaging (78582) $1,342.60 $1,918 2.2×
Lymph System Imaging (78195) $1,076.60 $1,538 1.8×
Lymphangiography Extremity Only Bilateral Rs&I (75803) $3,521 $5,030 2.0×
Lymphangiography extremity only unilateral rs&i (75801) $1,778.70 $2,541 2.5×
Lymphangiography Pelvic/Abdominal Bilateral Rs&I (75807) $3,521 $5,030 1.0×
Lymphangiography, pelvic/abdominal, unilateral (75805) $3,521 $5,030 1.0×
Magnetic Image Jaw Joint (70336) $2,054.50 $2,935 7.7×
Mammary ductogram or galactogram multiple (77054) $1,510.60 $2,158 5.7×
Mammary ductogram or galactogram single (77053) $730.10 $1,043 2.7×
Meckels Divert Exam (78290) $1,008 $1,440 2.3×
Mlc imrt design & construction per imrt plan (77338) $551.60 $788 1.3×
Mra Head W/O & W/Contrast Material (70546) $1,219.40 $1,742 3.1×
MRA head w/o contrast (70544) $730.10 $1,043 2.7×
MRA head with contrast (70545) $1,054.90 $1,507 2.7×
MRA neck w contrast (70548) $1,054.90 $1,507 2.7×
Mra Neck W/O &W/Contrast Material (70549) $1,219.40 $1,742 3.1×
MRA neck w/o contrast (70547) $730.10 $1,043 2.7×
MRI abdomen w contrast (74182) $3,583.30 $5,119 9.2×
MRI abdomen w/o contrast (74181) $758.10 $1,083 2.9×
MRI any jt lower extrem w/contrast material (73722) $1,096.20 $1,566 1.3×
MRI any jt lower extrem w/o & w/contrast matrl (73723) $1,267.70 $1,811 3.3×
MRI any jt upper extremity w/contrast matrl (73222) $3,240.30 $4,629 3.7×
MRI bone marrow blood supply (77084) $1,848.70 $2,641 7.0×
MRI cardiac w/o cont stress (75559) $1,801.10 $2,573 3.0×
MRI cardiac w/o contrast (75557) $1,801.10 $2,573 6.8×
MRI cervical spine w contrast (72142) $1,054.90 $1,507 2.7×
MRI cervical spine w/o cont (72141) $730.10 $1,043 2.7×
MRI chest w/o contrast (71550) $2,816.80 $4,024 10.6×
MRI chest with contrast (71551) $3,033.10 $4,333 3.5×
MRI chest wo w contrast (71552) $4,168.50 $5,955 10.7×
MRI lower extrem oth/thn jt w/contrast matrl (73719) $1,096.20 $1,566 2.8×
MRI lower extrem oth/thn jt w/o & w/contr matr (73720) $1,267.70 $1,811 3.3×
MRI lower extrem oth/thn jt w/o contr matrl (73718) $758.10 $1,083 2.9×
MRI lumbar spine w contrast (72149) $1,096.20 $1,566 2.8×
Mri Neck Spine W/O & W/Dye (72156) $1,219.40 $1,742 3.1×
MRI orbit face &/neck w/o contrast (70540) $730.10 $1,043 2.7×
MRI orbit face neck w contrast (70542) $2,615.20 $3,736 6.7×
Mri Orbt/Fac/Nck W/O &W/Dye (70543) $1,219.40 $1,742 3.1×
MRI pelvis w contrast (72196) $2,809.80 $4,014 7.2×
MRI pelvis w/o & w contrast (72197) $1,267.70 $1,811 3.3×
MRI pelvis w/o contrast (72195) $758.10 $1,083 2.9×
MRI spectroscopy (76390) $2,121 $3,030 21.9×
MRI thoracic spine w/o contrast (72146) $758.10 $1,083 2.9×
MRI upper extremity oth than jt w/contr matrl (73219) $1,096.20 $1,566 2.8×
MRI upper extremity oth than jt w/o contr matrl (73218) $758.10 $1,083 2.9×
Mri Uppr Extremity W/O&W/Dye (73220) $1,267.70 $1,811 3.3×
MRI, abdomen, combo (74183) $1,267.70 $1,811 3.3×
MRI, dorsal spine combo (72157) $1,267.70 $1,811 3.3×
MRI, dorsal spine contrast (72147) $1,096.20 $1,566 2.8×
MRI, joint upper extrem (73221) $758.10 $1,083 2.9×
MRI, joint upper extrem combo (73223) $1,267.70 $1,811 3.3×
MRI, lumbar spine combo (72158) $1,267.70 $1,811 3.3×
Myelogram cervical (72240) $3,353 $4,790 3.8×
Myelogram Lumbar (72265) $3,175.90 $4,537 3.6×
Myelography thoracic (72255) $2,549.40 $3,642 2.9×
Myelograpy 2/more regions rs&i (72270) $4,027.80 $5,754 4.6×
Myocardial Imaging Pet Metabolic Evaluation (78459) $4,444.30 $6,349 3.1×
Myocardial Perfusion Planar 1 Study Rest/Stress (78453) $3,586.10 $5,123 2.5×
Myocardial Spect Multiple Studies (78452) $3,586.10 $5,123 2.5×
Myocrd Img Pet Metab Eval Single Study Cncrnt CT (78429) $5,101.60 $7,288 3.2×
Myocrd img PET prfuj 1std rest/stress cncrnt CT (78430) $5,343.80 $7,634 3.4×
Myocrd Img Pet Prfuj Mlt Std Rst&Strs Cncrnt CT (78431) $7,956.20 $11,366 3.2×
Myocrd Img Pet Prfuj W/Metab 2rtracer Cncrnt CT (78433) $9,723 $13,890 4.0×
Myocrd Img Pet Prfuj W/Metab Dual Radiotracer (78432) $9,723 $13,890 5.7×
Neck soft tissue (70360) $286.30 $409 3.0×
Njx Rp Loclzj Non-Img Probe Study Intravenous (78808) $719.60 $1,028 1.6×
Nm csf leak detection (78650) $1,341.20 $1,916 0.9×
Nonvascular Shunt X-Ray (75809) $452.20 $646 3.9×
Ntsty modul radthx pln dose-vol histos (77301) $1,820 $2,600 1.2×
Nuclear Rx Intra-Arterial (79445) $1,106.70 $1,581 4.3×
Nuclear Rx Oral Admin (79005) $884.80 $1,264 3.4×
Ob us nuchal meas 1 gest (76813) $525.70 $751 4.5×
Ophthalmic ultrasound dx b-scan w/wo a-scan (76512)
range across 2 matching MRF lines		 $185.50–$213.50 $265–$305 varies
Parathyroid imaging w/tomographic spect & CT (78072) $3,361.40 $4,802 5.6×
Parathyroid Planar Imaging (78070) $895.30 $1,279 2.0×
Parathyroid planar imaging w/wo subtraction (78071) $2,193.80 $3,134 4.9×
Pelvis 1 or 2 views (72170) $161.70 $231 1.4×
Peritoneogram Rs&I (74190) $3,502.10 $5,003 5.8×
Pet Image Skull-Thigh (78812) $4,074 $5,820 2.6×
Pet Image W/Ct Lmtd (78814) $6,400.10 $9,143 4.0×
PET image w/CT, full body (78816) $4,074 $5,820 2.6×
PET imaging CT attenuation skull base mid-thigh (78815) $7,681.10 $10,973 4.8×
Pet Imaging Limited Area Chest Head/Neck (78811) $4,140.50 $5,915 2.9×
Pet Myocardial Sngl Study (78491) $4,074 $5,820 2.6×
PET whole body (78813) $4,074 $5,820 2.6×
Prq Transhepatc Portograpy Hemodyn Eval Rs&I (75885) $10,756.20 $15,366 3.1×
Pulmonary Perfusion Imaging Particulate (78580) $952 $1,360 2.1×
Radex Abd Compl Aqt Abd W/S/E/D Views 1 View Ch (74022) $452.20 $646 3.9×
Radex abscess/fistula/sinus tract rs&i (76080) $1,540.70 $2,201 2.5×
Radex Ankle Complete Minimum 3 Views (73610) $161.70 $231 1.7×
Radex Calcaneus Minimum 2 Views (73650) $161.70 $231 1.7×
Radex elbow complete minimum 3 views (73080) $161.70 $231 1.7×
Radex Facial Bones Complete Minimum 3 Views (70150) $256.20 $366 2.2×
Radex fingr minimum 2 views (73140) $161.70 $231 1.7×
Radex foot complete minimum 3 views (73630) $161.70 $231 1.7×
Radex Hand Minimum 3 Views (73130) $161.70 $231 1.7×
Radex lower extremity infant minimum 2 views (73592) $161.70 $231 1.7×
Radex Mastoids Compl Minimum 3 Views PR Side (70130) $744.10 $1,063 6.4×
Radex Nasal Bones Complete Minimum 3 Views (70160) $161.70 $231 1.7×
Radex Ribs Unilateral 2 Views (71100) $161.70 $231 1.7×
Radex shoulder complete minimum 2 views (73030) $161.70 $231 1.7×
Radex Sinuses Paransl < 3 Views (70210) $161.70 $231 1.7×
Radex sm int w/mlt srl imges via enteroclss tube (74251) $1,845.20 $2,636 9.4×
Radex Spine 1 View Specify Level (72020) $161.70 $231 1.7×
Radex Sternum Minimum 2 Views (71120) $161.70 $231 1.7×
Radex Temporomandble Jt Opn & Clsd Mouth Bilat (70330) $161.70 $231 1.7×
Radex Toe Minimum 2 Views (73660) $161.70 $231 1.7×
Radex upper extremity infant minimum 2 views (73092) $256.20 $366 2.2×
Radex Wrist Complete Minimum 3 Views (73110) $170.10 $243 1.8×
Radex X-Ray Exam Entire Spi 6/> Vw - Xr Entire Spine 6+ Vw (72084) $730.80 $1,044 6.3×
Radiation treatment delivery level 1 (77402) $176.40 $252 1.6×
Radiation treatment delivery level 2 (77407) $179.90 $257 0.4×
Radiation treatment delivery level 3 (77412) $369.60 $528 0.6×
Radiolog exam mandible compl minimum 4 views (70110) $256.20 $366 2.2×
Radiologic Exam Abdomen 3+ Views - Xr Abdomen 3+ Views (74021) $172.90 $247 1.5×
Radiologic exam colon double contrast study (74280) $2,693.60 $3,848 13.8×
Radiologic exam colon single contrast study (74270) $751.10 $1,073 3.8×
Radiologic Exam Esophagus Double Contrast Study (74221) $1,481.90 $2,117 7.6×
Radiologic exam knee complete 4/more views (73564) $161.70 $231 1.4×
Radiologic exam pelvis compl minimum 3 views (72190) $161.70 $231 1.4×
Radiologic Exam Small Int Single Contrast Study (74250) $507.50 $725 2.6×
Radiologic exam swallow function contrast study (74230) $507.50 $725 2.6×
Radiologic exam upr gi trc double contrast study (74246) $751.10 $1,073 3.8×
Radiologic examination femur 1 view (73551) $284.20 $406 2.9×
Radiologic examination femur minimum 2 views (73552) $284.20 $406 2.9×
Radiologic examination knee 1/2 views (73560) $161.70 $231 1.7×
Radiologic Examination Osseous Survey Limited (77074) $256.20 $366 2.2×
Radiologic Examination Salivary Gland Calculus (70380) $286.30 $409 3.0×
Radiologic examination tibia & fibula 2 views (73590) $161.70 $231 1.7×
Renal Cyst Study (74470) $797.30 $1,139 1.3×
Ribs bilateral 3 views (71110) $256.20 $366 2.2×
Rp loclzj tum plnr 1 area single day imaging (78800) $1,191.40 $1,702 2.7×
Rp loclzj tum plnr 2+area 1+d img/1 area img>2+d (78801) $1,792.70 $2,561 4.0×
Rp Loclzj Tum Plnr Whole Body 2+ Days Imaging (78804) $3,599.40 $5,142 5.9×
Rp Loclzj Tum Plnr Whole Body Single Day Imaging (78802) $4,498.20 $6,426 7.4×
Rp Loclzj Tum Spect 1 Area Single Day Imaging (78803) $3,599.40 $5,142 5.9×
Rp loclzj tum spect 2 area/sep acquisj img (78831) $4,498.20 $6,426 3.1×
Rp loclzj tum spect CT 2area 1d img/1 ar img>2+d (78832) $4,498.20 $6,426 2.8×
Rp loclzj tum spect w/CT 1 area/acquisj 1day img (78830) $4,498.20 $6,426 3.1×
Rp Ther Radiolbld Monoclonal Antibody IV Infus (79403) $1,458.80 $2,084 5.6×
Rp Therapy Intravenous Administration (79101) $1,094.10 $1,563 4.2×
Salivary Gland Imaging Serial Images (78231) $1,008 $1,440 2.3×
Scapula (73010) $161.70 $231 1.4×
Sella turcica (70240) $184.80 $264 1.9×
Shoulder 1 view (73020) $161.70 $231 1.7×
Shoulder Arthrography (73040) $1,068.90 $1,527 2.7×
Sialogram (70390) $934.50 $1,335 3.5×
Skull less than 4 views (70250) $161.70 $231 1.4×
Special dosimetry (77331) $204.40 $292 1.4×
Special Physics Consult (77370) $204.40 $292 1.4×
Special teletherapy port plan (77321) $827.40 $1,182 2.0×
Special treatment procedure (77470) $731.50 $1,045 1.2×
Speech evaluation, complex (70371) $2,405.90 $3,437 9.0×
Spleen Imaging (78185) $1,421.70 $2,031 3.2×
Stereotactic Body Radiation Delivery (77373) $3,398.50 $4,855 1.7×
Sternoclavicular joints (71130) $161.70 $231 1.7×
Superior sagittal sinus venogram (75870) $3,838.80 $5,484 1.1×
Tbs techl prep&transmis data alys pfrmd elsewhr (77090) $356.30 $509 3.7×
Tbs technical calculation only (77091) $356.30 $509 3.7×
Telethx isodose pln cplx w/basic dosimetry (77307) $565.60 $808 1.4×
Testicular Imaging W/Flow (78761) $1,829.80 $2,614 4.1×
Ther Rad Simulaj-Aided Field Setting Complex (77290) $551.60 $788 1.3×
Ther Rad Simulaj-Aided Field Setting Intermed (77285) $551.60 $788 1.3×
Ther rad simulaj-aided field setting simple (77280) $204.40 $292 1.4×
Therapeutic Enema Rdctj Intussusception/Obstrcj (74283) $2,161.60 $3,088 11.1×
Thoracic spine 2 views (72070) $161.70 $231 1.4×
Thoracic spine 3 views (72072) $256.20 $366 2.2×
Thoracolumbar 2 views (72080) $161.70 $231 1.7×
Thyroid Carcinoma Metastases Img Lmtd Area (78015) $1,191.40 $1,702 2.7×
Thyroid Imaging With Vascular Flow (78013) $722.40 $1,032 1.6×
Thyroid Met Imaging Body (78018) $1,191.40 $1,702 2.0×
Thyroid Uptake Measurement (78012) $1,131.20 $1,616 2.5×
Thyroid Uptake W/Blood Flow Sngle/Mult Quan Meas (78014) $895.30 $1,279 2.0×
Tx Devices Design & Construction Complex (77334) $378.70 $541 0.9×
Tx devices design & construction intermediate (77333) $378.70 $541 2.5×
Tx devices design & construction simple (77332) $378.70 $541 2.5×
Ultrasound Breast Limited (76642)
range across 2 matching MRF lines		 $201.60–$231.70 $288–$331 varies
Ultrasound Elastography Parenchyma (76981) $270.20 $386 2.3×
Ultrasound Exam Aaa Screen (76706) $92.40 $132 0.8×
Ultrasound, abdomen limited (76705) $256.20 $366 2.2×
Umbilical-artery Doppler (OB) (76820) $302.40 $432 2.6×
Unlisted Dx Radiographic Procedure (76499) $289.80 $414 3.0×
Unlisted fluoroscopic procedure (76496) $1,098.30 $1,569 11.3×
Unlisted us procedure (76999) $171.50 $245 1.8×
Upper gi w/o kub (74240) $751.10 $1,073 3.8×
Urea Breath Test C-14 Isotopic Acquisj Analysis (78267) $553 $790 50.0×
Ureteral Reflux Study (78740) $1,365.70 $1,951 3.1×
Urethrocystogram voiding (74455) $1,701.70 $2,431 6.4×
Urethrocystography retrograde (74450) $1,268.40 $1,812 4.8×
Us breast unilateral complete (76641) $231.70 $331 2.0×
Us chest (76604) $256.20 $366 2.2×
Us complete joint (76881) $256.20 $366 2.2×
Us exam, pelvic, limited (76857) $171.50 $245 1.5×
Us head (76506) $256.20 $366 2.2×
Us kidney transplant (76776) $623.70 $891 5.4×
Us lmtd joint/oth nonvasc xtr strux r-t w/img (76882) $171.50 $245 1.5×
Us ob detailed single fetus (76811) $362.60 $518 1.4×
Us ob limited 1 or more fetuses (76815) $256.20 $366 2.2×
Us ob transvaginal (76817) $256.20 $366 2.2×
Us pelvic non ob complete (76856) $256.20 $366 2.2×
Us pg uter img f&mat 14 wk tabdl 1/1st gestation (76801) $256.20 $366 2.2×
Us preg uterus real time f/u trnsabdl per fetus (76816) $171.50 $245 1.5×
Us retroperitoneal complete (76770) $256.20 $366 2.2×
Us retroperitoneal limited (76775) $256.20 $366 2.2×
Us scrotum and contents (76870) $256.20 $366 2.2×
Us spinal canal and contents (76800) $171.50 $245 1.5×
Us thyroid (76536) $256.20 $366 2.2×
Us transrectal (76872) $256.20 $366 2.2×
Vascular Flow Imaging (78445) $965.30 $1,379 2.2×
Vasogram (74440) $1,662.50 $2,375 6.3×
Vein X-Ray Chest (75827) $2,390.50 $3,415 1.4×
Vein X-Ray Liver W/O Hemodyn (75887) $6,171.90 $8,817 1.8×
Vein X-Ray Skull Epidural (75872) $3,570.70 $5,101 5.1×
Vein X-Ray Spleen/Liver (75810) $10,756.20 $15,366 3.1×
Venogram Sinus/Jugular (75860) $2,390.50 $3,415 0.7×
Venography Adrenal Unilateral (75840) $10,756.20 $15,366 3.1×
Venography caval inferior serialography rs&i (75825) $5,189.80 $7,414 1.5×
Venography extremity bilateral rs&i (75822) $3,570.70 $5,101 2.0×
Venography extremity unilateral rs&i (75820) $2,390.50 $3,415 1.4×
Venography Orbital Rs&I (75880) $3,570.70 $5,101 5.1×
Venography Renal Bilateral (75833) $6,528.20 $9,326 1.9×
Venography Renal Unilateral (75831) $6,233.50 $8,905 1.8×
Venous sampling by catheter (75893) $6,233.50 $8,905 1.0×
Wrist 2 views (73100) $161.70 $231 1.7×
X-Ray Ac Jts - Xr Acromioclavicular Joints Bilateral (73050) $161.70 $231 1.7×
X-ray antegrade pyelogram tube (74425) $1,268.40 $1,812 3.3×
X-Ray Aorta Leg Arteries (75630) $10,756.20 $15,366 3.1×
X-Ray Bend Only L-S Spine (72120) $379.40 $542 3.3×
X-Ray Elbow 2 Vw - Xr Elbow 1-2 Views Right (73070) $161.70 $231 1.7×
X-Ray Exam Breast Specimen (76098) $2,086.70 $2,981 3.4×
X-Ray Exam Entire Spi 1 Vw (72081) $631.40 $902 6.5×
X-Ray Exam Entire Spi 2/3 Vw (72082) $662.90 $947 5.7×
X-Ray Exam Entire Spi 4/5 Vw (72083) $696.50 $995 6.0×
X-Ray Exam Hip Uni 1 View (73501) $241.50 $345 2.5×
X-Ray Exam Hip Uni 2-3 Views (73502) $266 $380 2.7×
X-Ray Exam Hip Uni 4/> Views (73503) $284.20 $406 2.4×
X-Ray Exam Hips Bi 2 Views (73521) $469 $670 4.0×
X-Ray Exam Hips Bi 3-4 Views (73522) $469 $670 4.0×
X-Ray Exam Hips Bi 5/> Views (73523) $894.60 $1,278 7.7×
X-Ray Exam L-S Spine Bending (72114) $1,143.80 $1,634 9.8×
X-Ray Exam Neck Spine 2-3 Vw (72040) $161.70 $231 1.7×
X-Ray Exam Neck Spine 6/>Vws (72052) $268.80 $384 2.3×
X-Ray Exam Unilat Ribs/Chest (71101) $256.20 $366 2.2×
X-ray eye for foreign body (70030) $286.30 $409 3.0×
X-ray humerus (73060) $161.70 $231 1.7×
X-ray IV pyelogram (ivp) (74400) $1,918 $2,740 9.8×
X-ray IV pyelogram+tomography (74415) $1,268.40 $1,812 6.5×
X-Ray Jaw <4 Vw - Xr Mandible < 4 Views (70100) $161.70 $231 1.7×
X-Ray Knee Bilat Standing - Xr Knees Anteroposterior Standing Bilat (73565) $161.70 $231 1.7×
X-Ray Lumbar Spine 2/3 Vw - Xr Lumbar Spine 2-3 Views (72100) $161.70 $231 1.4×
X-ray nose-rectum child f.b. (76010) $286.30 $409 3.0×
X-Ray Ribs, Chest 4+ Vw - Xr Ribs 3 Vws Bil W/ Chest Posteroanterior (71111) $268.80 $384 2.3×
X-Ray Sacroiliac Jts 3+ Vw - Xr Sacroiliac Joints 3+ Views (72202) $683.20 $976 5.9×
X-Ray Sacroiliac Jts <3 Vw - Xr Sacroiliac Joints 1-2 Views (72200) $597.80 $854 5.1×
X-Ray Sacrum/Coccyx 2+ Vw - Xr Sacrum Coccyx 2+ Views (72220) $161.70 $231 1.7×
X-Ray Sinuses 3+ Vw - Xr Paranasal Sinuses 3+ Views (70220) $161.70 $231 1.7×
X-Ray Skull 4+ Vw - Xr Skull Complete 4+ Views (70260) $991.20 $1,416 8.5×
X-Ray Stress View (77071) $168.70 $241 1.7×
X-ray thoracic spine 4 vw (72074) $849.80 $1,214 7.3×
X-Ray Tmj Unilat (70328) $161.70 $231 1.7×
X-Ray Urinary Tract Exam With Contrast Material (74420) $1,268.40 $1,812 3.3×
X-Rays Bone Length Studies (77073) $504 $720 4.3×
X-Rays Bone Survey Complete (77075) $256.20 $366 2.2×
Xr c-spine 4 or 5 views (72050) $256.20 $366 2.2×
Xr facial bones less than 3 views (70140) $161.70 $231 1.7×
Xr orbits complete 4 views (70200) $161.70 $231 1.4×
Xr Tomogram Single Plane (76100) $1,138.90 $1,627 9.8×

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.