Imaging prices at Riverside Smithfield Hospital

Smithfield, VA · every code in this section with a posted price and a Medicare benchmark.

391 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) $2,849.55 $5,699.10 2.1×
Abdomen 1 View (74018) $206 $412 2.4×
Abdomen 2 views (74019) $206 $412 2.0×
Acute Gastrointestinal Blood Loss Imaging (78278) $794.25 $1,588.50 2.0×
Angio pulmonary bilat (75743) $1,471 $2,942 0.5×
Angiography extremity bilateral rs&i (75716) $1,622.86 $3,245.72 0.5×
Angiography extremity unilateral rs&i (75710) $1,622.86 $3,245.72 0.5×
Angiography pulmonary unilateral slctv rs&i (75741) $1,622.86 $3,245.72 0.5×
Angrph pulmonary nonslctv cath/ven njx rs&i (75746) $1,622.86 $3,245.72 0.5×
Ankle 2 views (73600) $218 $436 2.6×
Aortography thoracic serialography rs&i (75605) $2,787.20 $5,574.39 0.5×
Artery X-Rays Abdomen (75726) $2,787.20 $5,574.39 0.5×
Artery X-Rays Pelvis (75736) $2,787.20 $5,574.39 0.5×
Artery X-Rays Spine (75705) $2,787.20 $5,574.39 0.5×
Arthrogram ankle (73615) $233.50 $467 0.7×
Arthrogram hip (73525) $327.88 $655.75 1.0×
Arthrogram Wrist (73115) $347 $694 1.0×
Basic radiation dosimetry calculation (77300) $261.11 $522.21 2.0×
Bone age studies (77072) $206 $412 2.0×
Bone Imaging 3 Phase (78315) $1,018.38 $2,036.75 2.6×
Bone Imaging Limited Area (78300) $601.88 $1,203.75 1.5×
Bone Imaging Multiple Areas (78305) $694.50 $1,389 1.8×
Bone Imaging Whole Body (78306) $999.50 $1,999 2.6×
Bone marrow imaging limited area (78102) $248.05 $496.10 0.6×
Bone marrow imaging; whole body (78104) $415.64 $831.27 1.1×
Bone survey infant (77076) $206 $412 2.0×
Brachytx isodose complex (77318) $956.03 $1,912.05 2.6×
Brachytx isodose intermed (77317) $956.03 $1,912.05 2.6×
Brachytx Isodose Plan Simple (77316) $956.03 $1,912.05 2.6×
Brain Image W/Flow < 4 Views (78601) $347.88 $695.75 0.9×
Brain imaging < 4 static views (78600) $293.43 $586.85 0.8×
Brain Imaging Pet Metabolic Evaluation (78608) $5,905.41 $11,810.81 4.2×
Cardiac MRI w/w/o contrast & further seq (75561) $1,818 $3,636 5.3×
Cardiac MRI w/w/o contrast w/stress (75563) $2,265.88 $4,531.75 3.0×
Cardiac Shunt Detection (78428) $237.88 $475.75 0.6×
Cat Scan Follow-Up Study (76380) $600 $1,200 7.1×
Cerebrospinal Fluid Scan (78630) $513.04 $1,026.08 1.0×
Chest 1 view (71045) $95.75 $191.50 1.1×
Chest 2 views (71046) $168.95 $337.89 2.0×
Chest 3 views (71047) $207 $414 2.4×
Chest 4 or more views (71048) $222.50 $445 2.2×
Clavicle complete (73000) $206 $412 2.4×
Computed Tomography Thorax Lw Dose Lng Ca Scr C- (71271) $427.60 $855.19 4.2×
Continuing medical physics consltj pr wk (77336) $350.50 $701 2.7×
Contrast Exam Abdominl Aorta (75625) $1,622.86 $3,245.72 0.5×
Contrast X-Ray Bladder (74430) $417.88 $835.75 1.2×
Contrast X-Ray Of Elbow (73085) $374.50 $749 1.1×
Contrast X-Ray Of Knee Joint (73580) $272.70 $545.40 0.8×
CT abdomen and pelvis without and with contrast (74178) $1,746.50 $3,493 5.1×
CT abdomen and pelvis without contrast (74176) $1,272.50 $2,545 5.5×
CT abdomen w contrast (74160) $1,272.50 $2,545 7.4×
CT abdomen w wo contrast (74170) $1,272.50 $2,545 7.4×
CT abdomen w/o contrast (74150) $1,272.50 $2,545 12.5×
CT Angio Abdomen and Pelvis (74174) $1,526.42 $3,052.83 4.5×
CT Angio Chest (71275) $1,272.50 $2,545 7.4×
CT Angio Head (70496) $1,129 $2,258 6.6×
CT angio hrt w/3d image (75574) $1,300.43 $2,600.85 3.8×
Ct Angio Lwr Extr W/O&W/Dye (73706) $1,272.50 $2,545 7.4×
CT Angio Neck (70498) $1,272.50 $2,545 7.4×
Ct Angio Upr Extrm W/O&W/Dye (73206) $1,272.50 $2,545 7.4×
CT cervical spine w/ contrast (72126) $1,272.50 $2,545 3.7×
CT cervical spine w/o contrast (72125) $1,272.50 $2,545 12.5×
CT cervical spine w/wo cont (72127) $1,272.50 $2,545 7.4×
CT chest w contrast (71260) $1,401 $2,802 8.2×
CT chest w/wo contrast (71270) $1,272.50 $2,545 7.4×
CT head/brain with contrast (70460) $1,272.50 $2,545 7.4×
CT head/brain without and with contrast (70470) $1,272.50 $2,545 7.4×
CT heart contrast eval cardiac structure&morph (75572) $1,300.43 $2,600.85 3.8×
CT heart no contrast quant eval coronry calcium (75571) $55.50 $111 0.7×
CT hrt w/3d image congen (75573) $1,300.43 $2,600.85 3.8×
CT iac w contrast (70481) $1,272.50 $2,545 7.4×
CT l-spine w&w/o contrast (72133) $1,272.50 $2,545 7.4×
CT lower ext w/o (73700) $1,225 $2,450 12.0×
CT lower extremity w/contrast material (73701) $1,272.50 $2,545 7.4×
CT lumbar spine w contrast (72132) $1,272.50 $2,545 3.7×
CT lumbar spine w/o contrast (72131) $1,272.50 $2,545 12.5×
CT maxillofacial w contrast (70487) $1,272.50 $2,545 7.4×
CT maxillofacial wo contrast (70486) $1,102.50 $2,205 10.8×
CT neck tissue combo (70492) $1,272.50 $2,545 7.4×
Ct Orbit/Ear/Fossa W/O&W/Dye (70482) $1,272.50 $2,545 7.4×
CT orbits w/o contrast (70480) $1,272.50 $2,545 12.5×
CT pelvis w&w/o contrast (72194) $1,272.50 $2,545 7.4×
CT pelvis w/o contrast (72192) $1,272.50 $2,545 12.5×
CT scan of leg combo (73702) $1,272.50 $2,545 7.4×
CT scans face/jaw combo (70488) $1,272.50 $2,545 7.4×
CT soft tissue neck w contrast (70491) $1,272.50 $2,545 7.4×
CT soft tissue neck w/o contrast (70490) $999 $1,998 9.8×
CT thoracic spine w contrast (72129) $1,272.50 $2,545 7.4×
CT thoracic spine w/o contrast (72128) $1,272.50 $2,545 12.5×
CT thoracic spine w/wo cont (72130) $1,272.50 $2,545 7.4×
CT thorax w/o contrast (71250) $1,272.50 $2,545 12.5×
CT upper ext wo (73200) $1,212.50 $2,425 11.9×
CT upper extremity w/o & w/contrast material (73202) $1,272.50 $2,545 7.4×
CT upper extremity with contrast (73201) $1,272.50 $2,545 3.7×
Cta Abdl Aorta&Bi Iliofem W/Contrast&Postp (75635) $1,272.50 $2,545 7.4×
Cta Abdomen (74175) $1,272.50 $2,545 7.4×
CTA pelvis (72191) $1,272.50 $2,545 7.4×
Dilation ureters/urethra rs&i (74485) $1,056.22 $2,112.43 0.5×
Discography Cerv/Thor Spine (72285) $1,006.86 $2,013.71 0.5×
Diskography lumbar (72295) $1,006.86 $2,013.71 0.5×
Doppler Echo Fetal Spectral Display Complete (76827) $160 $320 1.6×
Doppler Fetal Mid Cerebral Artery (76821) $222.50 $445 2.2×
Dxa Bone Density Axial (77080) $309 $618 3.0×
Dxa bone density study 1/>sites appendiclr skel (77081) $91.51 $183.01 1.1×
Echo exam of fetal heart (76825) $640 $1,280 1.2×
Echo exam uterus (76831) $196.38 $392.75 0.8×
Echocardiography, fetal, cardiovascular system, real time with image documentation (2D), with or without M-mode… (76826) $320 $640 1.4×
Echograp Trans R Pros Study (76873) $339.15 $678.30 3.3×
Esophagram (74220) $329.69 $659.38 1.9×
Fetal Biophys Profile W/Nst (76818) $206 $412 2.0×
Fetal Biophysical Profile W/O Non-Stress Testing (76819) $206 $412 2.0×
Fetal MRI w/placntl matrnl plvc img sing/1st ges (74712) $538 $1,076 2.3×
Fluoroscopy up to 1 hr (76000) $425.25 $850.50 1.8×
Follow-Up Angiography (75898) $1,622.86 $3,245.72 0.5×
Foot 2 views (73620) $206 $412 2.4×
Forearm 2 views (73090) $227.38 $454.75 2.7×
Gastric emptying imaging study (78264) $720.42 $1,440.83 1.8×
Gated Heart Planar Single (78472) $1,313.13 $2,626.25 3.4×
Hand 2 views (73120) $206 $412 2.0×
Hdr Rdncl Ntrstl/Icav Brchtx (77772) $1,684.69 $3,369.37 2.5×
Hdr Rdncl Ntrstl/Icav Brchtx (77771) $1,086.08 $2,172.15 1.6×
Hdr Rdncl Ntrstl/Icav Brchtx 1 Channel (77770) $1,428.38 $2,856.75 2.1×
Hepatc Vngrph Wdg/Fr Hemodyn Eval Rs&I (75889) $1,622.86 $3,245.72 0.5×
Hepatc Vngrph Wdg/Fr W/O Hemodyn Eval Rs&I (75891) $1,622.86 $3,245.72 0.5×
Hepatobil Syst Image W/Drug (78227) $1,503.50 $3,007 2.8×
Hepatobiliary System Imaging (78226) $1,083 $2,166 2.8×
Ht Musc Image Planar Mult (78454) $1,040 $2,079.99 0.8×
Ht Muscle Image Spect Sing (78451) $1,040 $2,079.99 0.8×
Hysterosalpingogram (74740) $526.50 $1,053 2.3×
Image fusion (77399) $348.13 $696.25 2.7×
Infant hip ultrasound with hip movement (dynamic) (76885) $174.88 $349.75 2.1×
Infant hip ultrasound, limited static exam (76886) $339.15 $678.30 4.0×
Infusion Ivp (74410) $209.50 $419 1.2×
Interstitial radiation source applic complex (77778) $1,357.50 $2,715 2.0×
Intracavitary Radiation Source Applic Complex (77763) $910.50 $1,821 1.3×
Intracavitary Radiation Source Applic Intermed (77762) $956.03 $1,912.05 1.8×
Intracavitary radiation source applic simple (77761) $956.03 $1,912.05 1.8×
K Flow/Funct Image Multiple (78709) $986.88 $1,973.75 1.9×
K Flow/Funct Image W/O Drug (78707) $613.13 $1,226.25 1.2×
Knee 3 Views (73562) $247.38 $494.75 2.9×
Labeled RBC Sequestration Differntl Organ/Tissue (78140) $401.12 $802.23 1.0×
Leveen/Shunt Patency Exam (78291) $312.18 $624.36 0.8×
Liver & Spleen Imaging Static Only (78215) $552.25 $1,104.50 1.4×
Liver & Spleen Imaging W/Vascular Flow (78216) $1,337.50 $2,675 3.4×
Liver imaging static only (78201) $735.13 $1,470.25 1.4×
Liver imaging w/vascular flow (78202) $735.13 $1,470.25 1.4×
Lung Perf&Ventilat Diferentl (78598) $879.67 $1,759.34 1.7×
Lung perfusion differential (78597) $542.69 $1,085.37 1.4×
Lung Ventilat&Perfus Imaging (78582) $908.11 $1,816.21 1.7×
Lung Ventilation Imaging (78579) $506.39 $1,012.77 1.3×
Lymph System Imaging (78195) $771.88 $1,543.75 1.5×
Lymphangiography Extremity Only Bilateral Rs&I (75803) $1,125 $2,250 0.7×
Lymphangiography extremity only unilateral rs&i (75801) $942.50 $1,885 1.5×
Lymphangiography Pelvic/Abdominal Bilateral Rs&I (75807) $1,537.13 $3,074.25 0.5×
Lymphangiography, pelvic/abdominal, unilateral (75805) $1,622.86 $3,245.72 0.5×
Magnetic Image Jaw Joint (70336) $1,430.63 $2,861.25 6.1×
Magnetic Resonance Elastography (76391) $803.38 $1,606.75 3.5×
Mammary ductogram or galactogram multiple (77054) $381 $762 1.6×
Mammary ductogram or galactogram single (77053) $258.63 $517.25 1.1×
Meckels Divert Exam (78290) $312 $624 0.8×
Medical physics dose eval radiation expos w/rprt (76145) $327.75 $655.50 0.9×
Mlc imrt design & construction per imrt plan (77338) $819.44 $1,638.88 2.2×
Mra Head W/O & W/Contrast Material (70546) $2,274.51 $4,549.01 6.7×
MRA head w/o contrast (70544) $1,430.63 $2,861.25 6.1×
MRA head with contrast (70545) $1,150 $2,300 3.4×
MRA neck w contrast (70548) $1,430.88 $2,861.75 4.2×
Mra Neck W/O &W/Contrast Material (70549) $2,274.51 $4,549.01 6.7×
MRA neck w/o contrast (70547) $1,430.63 $2,861.25 6.1×
MRI abdomen w contrast (74182) $1,430.63 $2,861.25 4.2×
MRI abdomen w/o contrast (74181) $1,430.63 $2,861.25 6.1×
MRI any jt lower extrem w/contrast material (73722) $1,430.63 $2,861.25 1.9×
MRI any jt lower extrem w/o & w/contrast matrl (73723) $2,542.28 $5,084.55 7.5×
MRI any jt upper extremity w/contrast matrl (73222) $1,430.63 $2,861.25 1.9×
MRI Breast W/O Contrast Bilateral (77047) $3,133.38 $6,266.75 13.5×
MRI Breast Without Contrast Material Unilateral (77046) $1,430.63 $2,861.25 6.1×
MRI cardiac w/o cont stress (75559) $1,928.13 $3,856.25 3.6×
MRI cardiac w/o contrast (75557) $1,280 $2,560 5.5×
MRI cervical spine w contrast (72142) $1,430.63 $2,861.25 4.2×
MRI cervical spine w/o cont (72141) $1,430.63 $2,861.25 6.1×
MRI chest w/o contrast (71550) $1,430.63 $2,861.25 6.1×
MRI chest with contrast (71551) $1,430.63 $2,861.25 1.9×
MRI chest wo w contrast (71552) $2,527.50 $5,055 7.4×
MRI lower extrem oth/thn jt w/contrast matrl (73719) $1,430.63 $2,861.25 4.2×
MRI lower extrem oth/thn jt w/o & w/contr matr (73720) $2,542.28 $5,084.55 7.5×
MRI lower extrem oth/thn jt w/o contr matrl (73718) $1,430.63 $2,861.25 6.1×
MRI lumbar spine w contrast (72149) $1,430.63 $2,861.25 4.2×
Mri Neck Spine W/O & W/Dye (72156) $2,582.90 $5,165.80 7.6×
MRI orbit face &/neck w/o contrast (70540) $1,609 $3,218 6.9×
MRI orbit face neck w contrast (70542) $1,430.63 $2,861.25 4.2×
Mri Orbt/Fac/Nck W/O &W/Dye (70543) $2,542.28 $5,084.55 7.5×
MRI pelvis w contrast (72196) $1,430.88 $2,861.75 4.2×
MRI pelvis w/o & w contrast (72197) $2,548.43 $5,096.86 7.5×
MRI pelvis w/o contrast (72195) $1,430.63 $2,861.25 6.1×
MRI thoracic spine w/o contrast (72146) $1,430.63 $2,861.25 6.1×
MRI upper extremity oth than jt w/contr matrl (73219) $1,430.63 $2,861.25 4.2×
MRI upper extremity oth than jt w/o contr matrl (73218) $1,430.63 $2,861.25 6.1×
Mri Uppr Extremity W/O&W/Dye (73220) $2,542.28 $5,084.55 7.5×
MRI, abdomen, combo (74183) $2,548.43 $5,096.86 7.5×
MRI, dorsal spine combo (72157) $2,582.90 $5,165.80 7.6×
MRI, dorsal spine contrast (72147) $1,430.63 $2,861.25 4.2×
MRI, joint upper extrem (73221) $1,430.63 $2,861.25 6.1×
MRI, joint upper extrem combo (73223) $2,542.28 $5,084.55 7.5×
MRI, lumbar spine combo (72158) $2,582.90 $5,165.80 7.6×
Myelogram cervical (72240) $493.07 $986.13 0.6×
Myelogram Lumbar (72265) $632.38 $1,264.75 0.8×
Myelography thoracic (72255) $448.13 $896.26 0.6×
Myelograpy 2/more regions rs&i (72270) $632.80 $1,265.60 0.8×
Myocardial Spect Multiple Studies (78452) $2,043.83 $4,087.65 1.6×
Neck soft tissue (70360) $206 $412 2.4×
Njx Rp Loclzj Non-Img Probe Study Intravenous (78808) $457.13 $914.25 1.2×
Nm myocard infarct spect (78469) $633.13 $1,266.25 1.2×
Nonvascular Shunt X-Ray (75809) $206 $412 2.0×
Ntsty modul radthx pln dose-vol histos (77301) $2,849.55 $5,699.10 2.1×
Nuclear Rx Intra-Arterial (79445) $377.13 $754.25 1.7×
Nuclear Rx Oral Admin (79005) $839.38 $1,678.75 3.7×
Ob us nuchal meas 1 gest (76813) $276 $552 2.7×
Ophthalmic Ultrasonic Foreign Body Localization (76529) $339.15 $678.30 4.0×
Ophthalmic ultrasound dx b-scan w/wo a-scan (76512) $293.63 $587.25 2.9×
Optic foramina (70190) $206 $412 2.4×
Parathyroid imaging w/tomographic spect & CT (78072) $964.57 $1,929.13 1.8×
Parathyroid Planar Imaging (78070) $207.19 $414.37 0.5×
Parathyroid planar imaging w/wo subtraction (78071) $1,056.28 $2,112.55 2.7×
Pelvis 1 or 2 views (72170) $206 $412 2.0×
Perineogram (74775) $362.32 $724.63 1.6×
Pet Image W/Ct Lmtd (78814) $5,520.98 $11,041.96 4.0×
PET image w/CT, full body (78816) $5,520.98 $11,041.96 4.0×
PET imaging CT attenuation skull base mid-thigh (78815) $5,520.98 $11,041.96 4.0×
Prq Transhepatc Portograpy Hemodyn Eval Rs&I (75885) $1,622.86 $3,245.72 0.5×
Pulmonary Perfusion Imaging Particulate (78580) $625.25 $1,250.50 1.6×
Radex Abd Compl Aqt Abd W/S/E/D Views 1 View Ch (74022) $226.63 $453.25 2.2×
Radex abscess/fistula/sinus tract rs&i (76080) $342.63 $685.25 0.6×
Radex Ankle Complete Minimum 3 Views (73610) $237.63 $475.25 2.8×
Radex Calcaneus Minimum 2 Views (73650) $206 $412 2.4×
Radex elbow complete minimum 3 views (73080) $248.63 $497.25 2.9×
Radex Facial Bones Complete Minimum 3 Views (70150) $206 $412 2.0×
Radex fingr minimum 2 views (73140) $206 $412 2.4×
Radex foot complete minimum 3 views (73630) $222.38 $444.75 2.6×
Radex Hand Minimum 3 Views (73130) $206 $412 2.4×
Radex lower extremity infant minimum 2 views (73592) $206 $412 2.4×
Radex Mastoids Compl Minimum 3 Views PR Side (70130) $206 $412 2.0×
Radex Nasal Bones Complete Minimum 3 Views (70160) $206 $412 2.4×
Radex Ribs Unilateral 2 Views (71100) $206 $412 2.4×
Radex shoulder complete minimum 2 views (73030) $187.50 $375 2.2×
Radex Sinuses Paransl < 3 Views (70210) $213 $426 2.5×
Radex Spine 1 View Specify Level (72020) $206 $412 2.4×
Radex Sternum Minimum 2 Views (71120) $206 $412 2.4×
Radex Temporomandble Jt Opn & Clsd Mouth Bilat (70330) $206 $412 2.4×
Radex Toe Minimum 2 Views (73660) $206 $412 2.4×
Radex upper extremity infant minimum 2 views (73092) $206 $412 2.0×
Radex Wrist Complete Minimum 3 Views (73110) $210.75 $421.50 2.5×
Radex X-Ray Exam Entire Spi 6/> Vw - Xr Entire Spine 6+ Vw (72084) $206 $412 2.0×
Radiation treatment delivery level 1 (77402) $341.42 $682.83 3.4×
Radiation treatment delivery level 2 (77407) $346.42 $692.83 0.9×
Radiation treatment delivery level 3 (77412) $527.75 $1,055.50 1.0×
Radiolog exam mandible compl minimum 4 views (70110) $225.75 $451.50 2.2×
Radiologic Exam Abdomen 3+ Views - Xr Abdomen 3+ Views (74021) $216.75 $433.50 2.1×
Radiologic exam colon double contrast study (74280) $552 $1,104 3.2×
Radiologic exam colon single contrast study (74270) $417.88 $835.75 2.4×
Radiologic Exam Esophagus Double Contrast Study (74221) $288.77 $577.54 1.7×
Radiologic exam knee complete 4/more views (73564) $295.50 $591 2.9×
Radiologic exam pelvis compl minimum 3 views (72190) $253 $506 2.5×
Radiologic Exam Small Int Single Contrast Study (74250) $341.13 $682.25 2.0×
Radiologic exam swallow function contrast study (74230) $224.97 $449.93 1.3×
Radiologic exam upr gi trc double contrast study (74246) $355.38 $710.75 2.1×
Radiologic examination femur 1 view (73551) $206 $412 2.4×
Radiologic examination femur minimum 2 views (73552) $291.63 $583.25 3.4×
Radiologic examination knee 1/2 views (73560) $206 $412 2.4×
Radiologic Examination Osseous Survey Limited (77074) $206 $412 2.0×
Radiologic examination tibia & fibula 2 views (73590) $206 $412 2.4×
Remote afterloading high dose rate radionuclide skin surface brachytherapy, includes basic dosimetry, when performed;… (77768) $744.66 $1,489.32 2.0×
Remote afterloading high dose rate radionuclide skin surface brachytherapy, includes basic dosimetry, when performed;… (77767) $453.03 $906.05 1.2×
Ribs bilateral 3 views (71110) $206 $412 2.0×
Rp loclzj tum plnr 1 area single day imaging (78800) $559.59 $1,119.17 1.4×
Rp loclzj tum plnr 2+area 1+d img/1 area img>2+d (78801) $734.63 $1,469.25 1.9×
Rp Loclzj Tum Plnr Whole Body 2+ Days Imaging (78804) $2,101 $4,202 4.0×
Rp Loclzj Tum Plnr Whole Body Single Day Imaging (78802) $683.65 $1,367.30 1.3×
Rp Loclzj Tum Spect 1 Area Single Day Imaging (78803) $1,310.29 $2,620.58 2.5×
Rp loclzj tum spect 2 area/sep acquisj img (78831) $673.11 $1,346.22 0.5×
Rp Therapy Intravenous Administration (79101) $360.25 $720.50 1.6×
Scapula (73010) $206 $412 2.0×
Screening Digital Breast Tomosynthesis Bi (77063) $15 $30 0.6×
Sella turcica (70240) $206 $412 2.4×
Shoulder 1 view (73020) $206 $412 2.4×
Shoulder Arthrography (73040) $455.13 $910.25 1.3×
Skull less than 4 views (70250) $228.88 $457.75 2.2×
Special dosimetry (77331) $151 $302 1.2×
Special Physics Consult (77370) $412.64 $825.27 3.1×
Special teletherapy port plan (77321) $556.13 $1,112.25 1.5×
Special treatment procedure (77470) $1,225.38 $2,450.75 2.3×
Srs Multisource (77371) $16,141.39 $32,282.78 2.2×
Stereotactic Body Radiation Delivery (77373) $11,529.57 $23,059.13 6.6×
Sternoclavicular joints (71130) $206 $412 2.4×
Superior sagittal sinus venogram (75870) $1,622.86 $3,245.72 0.5×
Surface Applic Low Dose Rate Radionuclide Source (77789) $176 $352 1.8×
Telethx isodose pln cplx w/basic dosimetry (77307) $558.38 $1,116.75 1.5×
Telethx isodose pln smpl w/dosimetry calculation (77306) $457.13 $914.25 1.3×
Ther Rad Simulaj-Aided Field Setting Complex (77290) $793.80 $1,587.60 2.2×
Ther Rad Simulaj-Aided Field Setting Intermed (77285) $585.76 $1,171.52 1.6×
Ther rad simulaj-aided field setting simple (77280) $365.17 $730.33 2.8×
Therapeutic Enema Rdctj Intussusception/Obstrcj (74283) $279 $558 1.6×
Thoracic spine 2 views (72070) $274.50 $549 2.7×
Thoracolumbar 2 views (72080) $206 $412 2.4×
Thyroid Imaging With Vascular Flow (78013) $645.54 $1,291.07 1.7×
Thyroid Met Imaging Body (78018) $1,036.50 $2,073 2.0×
Thyroid Uptake Measurement (78012) $248.05 $496.10 0.6×
Thyroid Uptake W/Blood Flow Sngle/Mult Quan Meas (78014) $777 $1,554 2.0×
Tx Devices Design & Construction Complex (77334) $454.23 $908.46 1.2×
Tx devices design & construction intermediate (77333) $344.67 $689.33 2.6×
Tx devices design & construction simple (77332) $235.23 $470.45 1.8×
Ultrasound Breast Limited (76642) $274.50 $549 3.2×
Ultrasound elastography first target lesion (76982) $265.50 $531 2.6×
Ultrasound Elastography Parenchyma (76981) $265.50 $531 2.6×
Ultrasound Exam Aaa Screen (76706)
range across 2 matching MRF lines		 $183.29–$296.13 $366.58–$592.25 varies
Ultrasound, abdomen limited (76705) $452.13 $904.25 4.4×
Umbilical-artery Doppler (OB) (76820) $222.50 $445 2.2×
Unlisted genitourinary px dx nuclear medicine (78799) $557.21 $1,114.41 1.4×
Unlisted Procedure Clinical Brachytherapy (77799)
range across 2 matching MRF lines		 $1,183.99–$1,204.66 $2,367.97–$2,409.31 varies
Unlisted us procedure (76999) $179.25 $358.50 2.1×
Upper gi w/o kub (74240) $338.50 $677 2.0×
Urethrocystogram voiding (74455) $487.50 $975 2.1×
Urethrocystography retrograde (74450) $362.38 $724.75 1.6×
Us breast unilateral complete (76641) $379.63 $759.25 3.7×
Us chest (76604) $193.63 $387.25 1.9×
Us complete joint (76881) $325.25 $650.50 3.2×
Us exam, pelvic, limited (76857) $291.88 $583.75 2.9×
Us head (76506) $286.25 $572.50 2.8×
Us kidney transplant (76776) $264.99 $529.98 2.6×
Us lmtd joint/oth nonvasc xtr strux r-t w/img (76882) $303.13 $606.25 3.0×
Us ob detailed single fetus (76811) $454.50 $909 2.0×
Us ob limited 1 or more fetuses (76815) $221.50 $443 2.2×
Us ob transvaginal (76817) $356.38 $712.75 3.5×
Us pelvic non ob complete (76856) $549.88 $1,099.75 5.4×
Us pg uter img f&mat 14 wk tabdl 1/1st gestation (76801) $380.75 $761.50 3.7×
Us preg uterus real time f/u trnsabdl per fetus (76816) $339.15 $678.30 3.3×
Us retroperitoneal complete (76770) $312 $624 3.1×
Us retroperitoneal limited (76775) $280.13 $560.25 2.7×
Us scrotum and contents (76870) $384.38 $768.75 3.8×
Us spinal canal and contents (76800) $244.88 $489.75 2.4×
Us thyroid (76536) $420 $840 4.1×
Us transrectal (76872) $251.75 $503.50 2.5×
Vein X-Ray Chest (75827) $1,305.61 $2,611.21 0.9×
Venogram Sinus/Jugular (75860) $1,622.86 $3,245.72 0.5×
Venography caval inferior serialography rs&i (75825) $1,622.86 $3,245.72 0.5×
Venography extremity bilateral rs&i (75822) $753.63 $1,507.25 0.5×
Venography extremity unilateral rs&i (75820) $800.96 $1,601.92 0.5×
Venography Orbital Rs&I (75880) $498.40 $996.80 0.8×
Venography Renal Bilateral (75833) $1,622.86 $3,245.72 0.5×
Venography Renal Unilateral (75831) $1,622.86 $3,245.72 0.5×
Venous sampling by catheter (75893) $2,787.20 $5,574.39 0.5×
Vertebral fracture assessment via dxa (77086) $206 $412 2.4×
Wrist 2 views (73100) $206 $412 2.4×
X-Ray Ac Jts - Xr Acromioclavicular Joints Bilateral (73050) $206 $412 2.4×
X-ray antegrade pyelogram tube (74425) $397.80 $795.60 1.2×
X-Ray Aorta Leg Arteries (75630) $1,622.86 $3,245.72 0.5×
X-Ray Bend Only L-S Spine (72120) $206 $412 2.0×
X-Ray Elbow 2 Vw - Xr Elbow 1-2 Views Right (73070) $206 $412 2.4×
X-Ray Exam Breast Specimen (76098) $329.88 $659.75 0.6×
X-Ray Exam Entire Spi 1 Vw (72081) $206 $412 2.4×
X-Ray Exam Entire Spi 2/3 Vw (72082) $206 $412 2.0×
X-Ray Exam Entire Spi 4/5 Vw (72083) $206 $412 2.0×
X-Ray Exam Hip Uni 1 View (73501) $206 $412 2.4×
X-Ray Exam Hip Uni 2-3 Views (73502) $241.88 $483.75 2.8×
X-Ray Exam Hip Uni 4/> Views (73503) $387.75 $775.50 3.8×
X-Ray Exam Hips Bi 2 Views (73521) $212.75 $425.50 2.1×
X-Ray Exam Hips Bi 3-4 Views (73522) $274 $548 2.7×
X-Ray Exam Hips Bi 5/> Views (73523) $392.25 $784.50 3.8×
X-Ray Exam L-S Spine Bending (72114) $319.38 $638.75 3.1×
X-Ray Exam Neck Spine 2-3 Vw (72040) $206 $412 2.4×
X-Ray Exam Neck Spine 6/>Vws (72052) $250.75 $501.50 2.5×
X-Ray Exam Unilat Ribs/Chest (71101) $248.88 $497.75 2.4×
X-ray eye for foreign body (70030) $155 $310 1.8×
X-ray humerus (73060) $206 $412 2.4×
X-ray IV pyelogram (ivp) (74400) $528.75 $1,057.50 3.1×
X-ray IV pyelogram+tomography (74415) $227.75 $455.50 1.3×
X-Ray Jaw <4 Vw - Xr Mandible < 4 Views (70100) $206 $412 2.4×
X-Ray Knee Bilat Standing - Xr Knees Anteroposterior Standing Bilat (73565) $206 $412 2.4×
X-Ray Lumbar Spine 2/3 Vw - Xr Lumbar Spine 2-3 Views (72100) $248.13 $496.25 2.4×
X-ray nose-rectum child f.b. (76010) $206 $412 2.4×
X-Ray Ribs, Chest 4+ Vw - Xr Ribs 3 Vws Bil W/ Chest Posteroanterior (71111) $274.25 $548.50 2.7×
X-Ray Sacroiliac Jts 3+ Vw - Xr Sacroiliac Joints 3+ Views (72202) $206 $412 2.0×
X-Ray Sacroiliac Jts <3 Vw - Xr Sacroiliac Joints 1-2 Views (72200) $206 $412 2.0×
X-Ray Sacrum/Coccyx 2+ Vw - Xr Sacrum Coccyx 2+ Views (72220) $220.25 $440.50 2.6×
X-Ray Sinuses 3+ Vw - Xr Paranasal Sinuses 3+ Views (70220) $261.75 $523.50 3.1×
X-Ray Skull 4+ Vw - Xr Skull Complete 4+ Views (70260) $249.50 $499 2.4×
X-Ray Tmj Unilat (70328) $206 $412 2.4×
X-Ray Urinary Tract Exam With Contrast Material (74420) $739.98 $1,479.95 2.2×
X-Rays Bone Length Studies (77073) $185.88 $371.75 1.8×
X-Rays Bone Survey Complete (77075) $276.75 $553.50 2.7×
Xr c-spine 4 or 5 views (72050) $206 $412 2.0×
Xr facial bones less than 3 views (70140) $206 $412 2.4×
Xr orbits complete 4 views (70200) $206 $412 2.0×

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.