Imaging prices at Saint Joseph Regional Medical Center - Plymouth
Plymouth, IN · every code in this section with a posted price and a Medicare benchmark.
306 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) | $5,188.95 | $7,983 | 3.5× |
| Abdomen 1 View (74018) | $312.65 | — | 3.4× |
| Abdomen 2 views (74019) | $332.80 | $512 | 3.0× |
| Acute Gastrointestinal Blood Loss Imaging (78278) | $1,552.20 | $2,388 | 3.7× |
| Angio pulmonary bilat (75743) | $3,182.40 | $4,896 | 1.0× |
| Angiography extremity bilateral rs&i (75716) | $4,752.15 | $7,311 | 1.4× |
| Angiography pulmonary unilateral slctv rs&i (75741) | $2,282.15 | $3,511 | 0.7× |
| Ankle 2 views (73600) | $24,678.71 | — | 268.0× |
| Artery X-Rays Abdomen (75726) | $4,752.80 | $7,312 | 0.8× |
| Artery X-Rays Pelvis (75736) | $2,985.45 | $4,593 | 0.5× |
| Arthrogram ankle (73615) range across 3 matching MRF lines |
$653.25–$978.90 | $1,005–$1,506 | varies |
| Arthrogram Wrist (73115) range across 3 matching MRF lines |
$1,573.65–$2,360.80 | $2,421–$3,632 | varies |
| Basic radiation dosimetry calculation (77300) | $928.20 | $1,428 | 6.5× |
| Bone age studies (77072) | $423.80 | $652 | 3.8× |
| Bone Imaging 3 Phase (78315) | $1,808.95 | $2,783 | 4.3× |
| Bone Imaging Limited Area (78300) | $1,123.85 | $1,729 | 2.7× |
| Bone Imaging Multiple Areas (78305) | $1,529.45 | $2,353 | 3.6× |
| Bone Imaging Whole Body (78306) | $1,704.30 | $2,622 | 4.0× |
| Bone marrow imaging limited area (78102) | $732.55 | $1,127 | 1.7× |
| Bone survey infant (77076) | $218.40 | $336 | 2.0× |
| Brain Imaging Min 4 Static Views W Vascular Flow (78606) | $1,610.70 | $2,478 | 2.8× |
| Cardiac MRI w/w/o contrast & further seq (75561) | $2,709.85 | $4,169 | 7.3× |
| Chest 1 view (71045) range across 2 matching MRF lines |
$3,499.83–$12,478.15 | — | varies |
| Chest 2 views (71046) | $316.55 | — | 3.4× |
| Chest 3 views (71047) | $380.25 | $585 | 4.1× |
| Chest 4 or more views (71048) | $477.75 | $735 | 4.3× |
| Clavicle complete (73000) range across 3 matching MRF lines |
$219.70–$330.20 | $338–$508 | varies |
| Computed Tomography Thorax Lw Dose Lng Ca Scr C- (71271) | $157.95 | $243 | 1.4× |
| Continuing medical physics consltj pr wk (77336) | $617.50 | $950 | 4.3× |
| Contrast Exam Abdominl Aorta (75625) | $4,430.40 | $6,816 | 1.3× |
| Contrast X-Ray Bladder (74430) | $707.85 | $1,089 | 1.9× |
| CT abdomen and pelvis without and with contrast (74178) | $5,720.65 | $8,801 | 15.5× |
| CT abdomen and pelvis without contrast (74176) | $2,712.45 | $4,173 | 10.7× |
| CT abdomen w contrast (74160) | $2,395.90 | $3,686 | 12.9× |
| CT abdomen w wo contrast (74170) | $2,702.05 | $4,157 | 14.6× |
| CT abdomen w/o contrast (74150) | $1,901.90 | $2,926 | 17.2× |
| CT Angio Abdomen and Pelvis (74174) | $3,617.90 | $5,566 | 9.8× |
| CT Angio Chest (71275) | $2,412.15 | $3,711 | 13.0× |
| CT Angio Head (70496) | $5,288.07 | — | 28.5× |
| CT angio hrt w/3d image (75574) | $1,981.85 | $3,049 | 5.4× |
| Ct Angio Lwr Extr W/O&W/Dye (73706) range across 3 matching MRF lines |
$2,573.35–$3,861 | $3,959–$5,940 | varies |
| CT Angio Neck (70498) | $2,564.90 | $3,946 | 13.8× |
| Ct Angio Upr Extrm W/O&W/Dye (73206) | $2,395.90 | $3,686 | 12.9× |
| CT cervical spine w/ contrast (72126) | $2,392.65 | $3,681 | 6.5× |
| CT cervical spine w/o contrast (72125) | $2,036.45 | $3,133 | 18.4× |
| CT cervical spine w/wo cont (72127) | $2,508.35 | $3,859 | 13.5× |
| CT chest w contrast (71260) | $2,304.25 | $3,545 | 12.4× |
| CT chest w/wo contrast (71270) | $2,609.75 | $4,015 | 14.1× |
| CT head/brain with contrast (70460) | $2,026.05 | $3,117 | 10.9× |
| CT head/brain without and with contrast (70470) | $2,533.70 | $3,898 | 13.7× |
| CT heart contrast eval cardiac structure&morph (75572) | $3,142.75 | $4,835 | 8.5× |
| CT heart no contrast quant eval coronry calcium (75571) | $457.60 | $704 | 5.0× |
| CT iac w contrast (70481) | $2,077.40 | $3,196 | 11.2× |
| CT l-spine w&w/o contrast (72133) | $3,115.45 | $4,793 | 16.8× |
| CT lower ext w/o (73700) range across 3 matching MRF lines |
$1,840.15–$2,761.20 | $2,831–$4,248 | varies |
| CT lower extremity w/contrast material (73701) range across 3 matching MRF lines |
$2,093–$3,140.15 | $3,220–$4,831 | varies |
| CT lumbar spine w contrast (72132) | $2,429.70 | $3,738 | 6.6× |
| CT lumbar spine w/o contrast (72131) | $2,059.85 | $3,169 | 18.6× |
| CT maxillofacial w contrast (70487) | $2,055.30 | $3,162 | 11.1× |
| CT maxillofacial wo contrast (70486) | $1,773.20 | $2,728 | 16.0× |
| CT neck tissue combo (70492) | $2,415.40 | $3,716 | 13.0× |
| Ct Orbit/Ear/Fossa W/O&W/Dye (70482) | $2,266.55 | $3,487 | 12.2× |
| CT orbits w/o contrast (70480) | $1,831.05 | $2,817 | 16.6× |
| CT pelvis w&w/o contrast (72194) | $2,574 | $3,960 | 13.9× |
| CT pelvis w/o contrast (72192) | $1,949.35 | $2,999 | 17.6× |
| CT scan of leg combo (73702) range across 3 matching MRF lines |
$2,686.45–$4,030 | $4,133–$6,200 | varies |
| CT scans face/jaw combo (70488) | $2,797.60 | $4,304 | 15.1× |
| CT soft tissue neck w contrast (70491) | $2,130.05 | $3,277 | 11.5× |
| CT soft tissue neck w/o contrast (70490) | $1,758.90 | $2,706 | 15.9× |
| CT thoracic spine w contrast (72129) | $2,265.90 | $3,486 | 12.2× |
| CT thoracic spine w/o contrast (72128) | $1,977.30 | $3,042 | 17.9× |
| CT thorax w/o contrast (71250) | $1,946.10 | $2,994 | 17.6× |
| CT upper ext wo (73200) range across 3 matching MRF lines |
$1,813.50–$2,720.25 | $2,790–$4,185 | varies |
| CT upper extremity w/o & w/contrast material (73202) range across 3 matching MRF lines |
$2,722.20–$4,083.30 | $4,188–$6,282 | varies |
| CT upper extremity with contrast (73201) range across 3 matching MRF lines |
$2,059.85–$3,089.45 | $3,169–$4,753 | varies |
| Cta Abdl Aorta&Bi Iliofem W/Contrast&Postp (75635) | $2,794.35 | $4,299 | 15.1× |
| Cta Abdomen (74175) | $2,613 | $4,020 | 14.1× |
| CTA head&neck c+ w/noncontrast img&post-pxessing (70471) | $3,995.55 | $6,147 | 10.8× |
| CTA pelvis (72191) | $2,090.40 | $3,216 | 11.3× |
| Dxa Bone Density Axial (77080) | $505.70 | $778 | 4.6× |
| Echo exam uterus (76831) | $1,281.80 | $1,972 | 5.1× |
| Echo Guide For Artery Repair (76936) | $774.80 | $1,192 | 3.4× |
| Esophagram (74220) | $531.70 | $818 | 2.9× |
| Fetal Biophys Profile W/Nst (76818) | $1,012.05 | $1,557 | 9.1× |
| Fetal Biophysical Profile W/O Non-Stress Testing (76819) | $874.90 | $1,346 | 7.9× |
| Fluoroscopy up to 1 hr (76000) | $1,054.95 | $1,623 | 4.2× |
| Foot 2 views (73620) range across 6 matching MRF lines |
$273.65–$410.15 | $421–$631 | varies |
| Forearm 2 views (73090) | $326.95 | — | 3.6× |
| Gastric emptying imaging study (78264) | $1,541.15 | $2,371 | 3.6× |
| Gated Heart Planar Single (78472) | $1,653.60 | $2,544 | 3.9× |
| Hand 2 views (73120) range across 2 matching MRF lines |
$804.70–$1,635.40 | — | varies |
| Hepatc Vngrph Wdg/Fr Hemodyn Eval Rs&I (75889) | $3,442.40 | $5,296 | 1.0× |
| Hepatobil Syst Image W/Drug (78227) | $3,641.30 | $5,602 | 6.3× |
| Hepatobiliary System Imaging (78226) | $2,427.10 | $3,734 | 5.7× |
| Ht Muscle Image Spect Sing (78451) | $2,616.25 | $4,025 | 1.9× |
| Hysterosalpingogram (74740) | $707.20 | $1,088 | 2.8× |
| Infant hip ultrasound with hip movement (dynamic) (76885) | $337.35 | $519 | 3.7× |
| Infusion Ivp (74410) | $1,244.75 | $1,915 | 6.7× |
| K Flow/Funct Image Multiple (78709) | $1,901.25 | $2,925 | 3.3× |
| K Flow/Funct Image W/Drug (78708) | $1,606.15 | $2,471 | 2.8× |
| K Flow/Funct Image W/O Drug (78707) | $1,536.60 | $2,364 | 2.7× |
| Kidney Imaging Morphoogy W/Vascular Flow (78701) | $1,136.85 | $1,749 | 2.7× |
| Knee 3 Views (73562) range across 3 matching MRF lines |
$347.10–$521.30 | $534–$802 | varies |
| Liver & Spleen Imaging Static Only (78215) | $1,294.80 | $1,992 | 3.1× |
| Lung perfusion differential (78597) | $973.70 | $1,498 | 2.3× |
| Lung Ventilat&Perfus Imaging (78582) | $3,365.05 | $5,177 | 5.9× |
| Lung Ventilation Imaging (78579) | $961.35 | $1,479 | 2.3× |
| Lymph System Imaging (78195) | $1,446.25 | $2,225 | 2.5× |
| Magnetic Image Jaw Joint (70336) | $585.65 | $901 | 2.3× |
| Magnetic Resonance Elastography (76391) | $357.50 | $550 | 1.4× |
| Meckels Divert Exam (78290) | $1,547.65 | $2,381 | 3.7× |
| Mlc imrt design & construction per imrt plan (77338) range across 2 matching MRF lines |
$38,806.30–$51,496.90 | — | varies |
| Mra Head W/O & W/Contrast Material (70546) | $3,165.50 | $4,870 | 8.6× |
| MRA head w/o contrast (70544) | $2,630.55 | $4,047 | 10.4× |
| MRA head with contrast (70545) | $2,847.65 | $4,381 | 7.7× |
| MRA neck w contrast (70548) | $2,707.25 | $4,165 | 7.3× |
| Mra Neck W/O &W/Contrast Material (70549) | $3,502.20 | $5,388 | 9.5× |
| MRA neck w/o contrast (70547) | $2,519.40 | $3,876 | 10.0× |
| MRI abdomen w contrast (74182) | $3,431.35 | $5,279 | 9.3× |
| MRI abdomen w/o contrast (74181) | $2,661.10 | $4,094 | 10.5× |
| MRI any jt lower extrem w/contrast material (73722) range across 3 matching MRF lines |
$2,990–$4,485 | $4,600–$6,900 | varies |
| MRI any jt lower extrem w/o & w/contrast matrl (73723) range across 3 matching MRF lines |
$3,659.50–$5,489.90 | $5,630–$8,446 | varies |
| MRI any jt upper extremity w/contrast matrl (73222) range across 3 matching MRF lines |
$3,143.40–$4,717.05 | $4,836–$7,257 | varies |
| MRI Breast W/O Contrast Bilateral (77047) | $2,981.55 | $4,587 | 11.8× |
| MRI Breast Without Contrast Material Unilateral (77046) | $1,988.35 | $3,059 | 7.9× |
| MRI cervical spine w contrast (72142) | $3,374.15 | $5,191 | 9.1× |
| MRI cervical spine w/o cont (72141) | $3,025.75 | $4,655 | 12.0× |
| MRI chest w/o contrast (71550) | $2,751.45 | $4,233 | 10.9× |
| MRI chest wo w contrast (71552) | $3,679 | $5,660 | 10.0× |
| MRI lower extrem oth/thn jt w/o & w/contr matr (73720) range across 3 matching MRF lines |
$3,729.70–$5,594.55 | $5,738–$8,607 | varies |
| MRI lower extrem oth/thn jt w/o contr matrl (73718) range across 3 matching MRF lines |
$2,662.40–$3,994.25 | $4,096–$6,145 | varies |
| MRI lumbar spine w contrast (72149) | $3,374.15 | $5,191 | 9.1× |
| Mri Neck Spine W/O & W/Dye (72156) | $3,978 | $6,120 | 10.8× |
| MRI orbit face &/neck w/o contrast (70540) | $2,860 | $4,400 | 11.3× |
| MRI orbit face neck w contrast (70542) | $3,552.25 | $5,465 | 9.6× |
| Mri Orbt/Fac/Nck W/O &W/Dye (70543) | $3,995.55 | $6,147 | 10.8× |
| MRI pelvis w contrast (72196) | $3,378.05 | $5,197 | 9.2× |
| MRI pelvis w/o & w contrast (72197) | $3,738.15 | $5,751 | 10.1× |
| MRI pelvis w/o contrast (72195) | $3,017.95 | $4,643 | 12.0× |
| MRI thoracic spine w/o contrast (72146) | $3,025.75 | $4,655 | 12.0× |
| MRI upper extremity oth than jt w/o contr matrl (73218) range across 3 matching MRF lines |
$2,535.65–$3,803.15 | $3,901–$5,851 | varies |
| Mri Uppr Extremity W/O&W/Dye (73220) range across 3 matching MRF lines |
$3,802.50–$5,705.70 | $5,850–$8,778 | varies |
| MRI, abdomen, combo (74183) | $4,037.80 | $6,212 | 10.9× |
| MRI, dorsal spine combo (72157) | $3,891.55 | $5,987 | 10.5× |
| MRI, dorsal spine contrast (72147) | $3,681.60 | $5,664 | 10.0× |
| MRI, joint upper extrem (73221) range across 3 matching MRF lines |
$2,965.95–$4,449.25 | $4,563–$6,845 | varies |
| MRI, joint upper extrem combo (73223) range across 3 matching MRF lines |
$4,037.80–$6,056.05 | $6,212–$9,317 | varies |
| MRI, lumbar spine combo (72158) | $3,630.90 | $5,586 | 9.8× |
| Myelogram cervical (72240) | $1,111.50 | $1,710 | 1.3× |
| Myelogram Lumbar (72265) | $1,512.55 | $2,327 | 1.8× |
| Myelograpy 2/more regions rs&i (72270) | $1,926.60 | $2,964 | 2.3× |
| Myocardial Spect Multiple Studies (78452) | $3,698.50 | $5,690 | 2.7× |
| Neck soft tissue (70360) | $282.75 | $435 | 3.1× |
| Nonvascular Shunt X-Ray (75809) | $590.20 | $908 | 5.3× |
| Ntsty modul radthx pln dose-vol histos (77301) | $5,651.10 | $8,694 | 3.9× |
| Nuclear Rx Oral Admin (79005) | $1,224.60 | $1,884 | 5.0× |
| Parathyroid imaging w/tomographic spect & CT (78072) | $2,109.25 | $3,245 | 3.7× |
| Parathyroid Planar Imaging (78070) | $1,220.70 | $1,878 | 2.9× |
| Parathyroid planar imaging w/wo subtraction (78071) | $1,853.80 | $2,852 | 4.4× |
| Pelvis 1 or 2 views (72170) | $284.05 | $437 | 2.6× |
| Peritoneogram Rs&I (74190) | $748.80 | $1,152 | 1.3× |
| Pulmonary Perfusion Imaging Particulate (78580) | $1,173.25 | $1,805 | 2.8× |
| Radex Abd Compl Aqt Abd W/S/E/D Views 1 View Ch (74022) | $549.25 | $845 | 5.0× |
| Radex abscess/fistula/sinus tract rs&i (76080) | $434.20 | $668 | 0.8× |
| Radex Ankle Complete Minimum 3 Views (73610) range across 2 matching MRF lines |
$325.65–$488.15 | — | varies |
| Radex Calcaneus Minimum 2 Views (73650) range across 3 matching MRF lines |
$289.90–$434.85 | $446–$669 | varies |
| Radex elbow complete minimum 3 views (73080) range across 9 matching MRF lines |
$329.55–$494.65 | $507–$761 | varies |
| Radex Facial Bones Complete Minimum 3 Views (70150) | $388.05 | $597 | 3.5× |
| Radex fingr minimum 2 views (73140) | $255.45 | — | 2.8× |
| Radex foot complete minimum 3 views (73630) range across 2 matching MRF lines |
$324.35–$485.55 | — | varies |
| Radex Hand Minimum 3 Views (73130) range across 2 matching MRF lines |
$328.25–$973.70 | — | varies |
| Radex lower extremity infant minimum 2 views (73592) range across 3 matching MRF lines |
$256.75–$384.80 | $395–$592 | varies |
| Radex Mastoids Compl Minimum 3 Views PR Side (70130) range across 3 matching MRF lines |
$520.65–$781.95 | $801–$1,203 | varies |
| Radex Nasal Bones Complete Minimum 3 Views (70160) | $302.25 | $465 | 3.3× |
| Radex Ribs Unilateral 2 Views (71100) | $331.50 | $510 | 3.6× |
| Radex shoulder complete minimum 2 views (73030) range across 2 matching MRF lines |
$362.05–$542.75 | — | varies |
| Radex Sinuses Paransl < 3 Views (70210) | $286.65 | $441 | 3.1× |
| Radex Spine 1 View Specify Level (72020) | $280.15 | $431 | 3.0× |
| Radex Sternum Minimum 2 Views (71120) | $354.25 | $545 | 3.8× |
| Radex Temporomandble Jt Opn & Clsd Mouth Bilat (70330) | $547.30 | $842 | 5.9× |
| Radex Toe Minimum 2 Views (73660) range across 3 matching MRF lines |
$249.60–$375.70 | $384–$578 | varies |
| Radex upper extremity infant minimum 2 views (73092) range across 3 matching MRF lines |
$290.55–$437.45 | $447–$673 | varies |
| Radex Wrist Complete Minimum 3 Views (73110) range across 2 matching MRF lines |
$321.10–$973.70 | — | varies |
| Radex X-Ray Exam Entire Spi 6/> Vw - Xr Entire Spine 6+ Vw (72084) | $1,031.55 | $1,587 | 9.3× |
| Radiation Delivery Stereotactic Cranial Linear (77372) | $8,062.60 | $12,404 | 1.0× |
| Radiation treatment delivery level 1 (77402) | $1,194.70 | $1,838 | 11.1× |
| Radiation treatment delivery level 2 (77407) | $1,249.30 | $1,922 | 3.1× |
| Radiation treatment delivery level 3 (77412) | $1,303.90 | $2,006 | 2.2× |
| Radiolog exam mandible compl minimum 4 views (70110) | $412.75 | $635 | 3.7× |
| Radiologic Exam Abdomen 3+ Views - Xr Abdomen 3+ Views (74021) | $524.55 | $807 | 4.7× |
| Radiologic exam colon double contrast study (74280) | $837.20 | $1,288 | 4.5× |
| Radiologic exam colon single contrast study (74270) | $657.80 | $1,012 | 3.5× |
| Radiologic Exam Esophagus Double Contrast Study (74221) | $418.60 | $644 | 2.3× |
| Radiologic exam knee complete 4/more views (73564) range across 2 matching MRF lines |
$404.95–$607.75 | — | varies |
| Radiologic exam pelvis compl minimum 3 views (72190) | $380.90 | $586 | 3.4× |
| Radiologic Exam Small Int Single Contrast Study (74250) | $484.90 | $746 | 2.6× |
| Radiologic exam swallow function contrast study (74230) | $510.90 | $786 | 2.8× |
| Radiologic exam upr gi trc double contrast study (74246) | $437.45 | $673 | 2.4× |
| Radiologic examination femur 1 view (73551) range across 3 matching MRF lines |
$186.55–$280.15 | $287–$431 | varies |
| Radiologic examination femur minimum 2 views (73552) | $621.40 | — | 6.7× |
| Radiologic examination knee 1/2 views (73560) range across 2 matching MRF lines |
$296.40–$444.60 | — | varies |
| Radiologic Examination Osseous Survey Limited (77074) | $717.60 | $1,104 | 6.5× |
| Radiologic examination tibia & fibula 2 views (73590) range across 6 matching MRF lines |
$331.50–$498.55 | $510–$767 | varies |
| Ribs bilateral 3 views (71110) | $453.70 | $698 | 4.1× |
| Rp loclzj tum plnr 1 area single day imaging (78800) | $737.10 | $1,134 | 1.7× |
| Rp loclzj tum plnr 2+area 1+d img/1 area img>2+d (78801) | $1,422.85 | $2,189 | 3.4× |
| Rp Loclzj Tum Plnr Whole Body 2+ Days Imaging (78804) | $3,038.10 | $4,674 | 5.3× |
| Rp Loclzj Tum Spect 1 Area Single Day Imaging (78803) | $2,536.30 | $3,902 | 4.4× |
| Rp loclzj tum spect 2 area/sep acquisj img (78831) | $2,536.30 | $3,902 | 1.9× |
| Rp loclzj tum spect CT 2area 1d img/1 ar img>2+d (78832) | $2,877.55 | $4,427 | 1.9× |
| Rp loclzj tum spect w/CT 1 area/acquisj 1day img (78830) | $2,663.05 | $4,097 | 1.9× |
| Rp Therapy Intravenous Administration (79101) | $785.85 | $1,209 | 3.2× |
| Scapula (73010) range across 3 matching MRF lines |
$285.35–$428.35 | $439–$659 | varies |
| Screening Digital Breast Tomosynthesis Bi (77063) range across 3 matching MRF lines |
$81.25–$96.20 | $125–$148 | varies |
| Shoulder 1 view (73020) | $47,726.96 | — | 518.4× |
| Shoulder Arthrography (73040) range across 3 matching MRF lines |
$922.35–$1,384.50 | $1,419–$2,130 | varies |
| Skull less than 4 views (70250) | $314.60 | $484 | 2.8× |
| Special dosimetry (77331) | $384.15 | $591 | 2.7× |
| Special Physics Consult (77370) | $560.95 | $863 | 3.9× |
| Special teletherapy port plan (77321) | $1,071.85 | $1,649 | 2.7× |
| Special treatment procedure (77470) | $2,565.55 | $3,947 | 4.4× |
| Stereotactic Body Radiation Delivery (77373) | $4,312.10 | $6,634 | 2.3× |
| Sternoclavicular joints (71130) | $419.25 | $645 | 4.6× |
| Telethx isodose pln cplx w/basic dosimetry (77307) | $1,205.75 | $1,855 | 3.0× |
| Telethx isodose pln smpl w/dosimetry calculation (77306) | $277.55 | $427 | 0.7× |
| Ther Rad Simulaj-Aided Field Setting Complex (77290) | $1,836.25 | $2,825 | 4.6× |
| Ther rad simulaj-aided field setting simple (77280) | $937.30 | $1,442 | 6.6× |
| Thoracic spine 2 views (72070) | $274.30 | $422 | 2.5× |
| Thoracic spine 3 views (72072) | $418.60 | $644 | 3.8× |
| Thoracolumbar 2 views (72080) | $120.90 | $186 | 1.3× |
| Thyroid Imaging With Vascular Flow (78013) | $1,255.80 | $1,932 | 3.0× |
| Thyroid Met Imaging Body (78018) | $1,918.80 | $2,952 | 3.3× |
| Thyroid Uptake W/Blood Flow Sngle/Mult Quan Meas (78014) | $1,255.80 | $1,932 | 3.0× |
| Tx Devices Design & Construction Complex (77334) | $2,235.35 | $3,439 | 5.6× |
| Tx devices design & construction intermediate (77333) | $591.50 | $910 | 4.2× |
| Tx devices design & construction simple (77332) | $473.85 | $729 | 3.3× |
| Ultrasound Breast Limited (76642) range across 3 matching MRF lines |
$488.15–$731.90 | $751–$1,126 | varies |
| Ultrasound Exam Aaa Screen (76706) | $570.05 | $877 | 5.2× |
| Ultrasound, abdomen limited (76705) range across 2 matching MRF lines |
$315.25–$744.90 | — | varies |
| Umbilical-artery Doppler (OB) (76820) | $387.40 | $596 | 3.5× |
| Upper gi w/o kub (74240) | $400.40 | $616 | 2.2× |
| Urethrocystogram voiding (74455) | $830.70 | $1,278 | 3.3× |
| Urethrocystography retrograde (74450) | $621.40 | $956 | 2.5× |
| Us breast unilateral complete (76641) range across 3 matching MRF lines |
$512.20–$768.30 | $788–$1,182 | varies |
| Us chest (76604) | $469.30 | $722 | 4.2× |
| Us complete joint (76881) | $919.10 | $1,414 | 8.3× |
| Us exam, pelvic, limited (76857) | $428.35 | $659 | 3.9× |
| Us head (76506) | $621.40 | $956 | 5.6× |
| Us kidney transplant (76776) | $591.50 | $910 | 5.3× |
| Us lmtd joint/oth nonvasc xtr strux r-t w/img (76882) | $551.85 | $849 | 5.0× |
| Us ob detailed single fetus (76811) | $749.45 | $1,153 | 3.0× |
| Us ob limited 1 or more fetuses (76815) | $575.25 | $885 | 5.2× |
| Us ob transvaginal (76817) | $594.10 | $914 | 5.4× |
| Us pelvic non ob complete (76856) | $787.80 | $1,212 | 7.1× |
| Us pg uter img f&mat 14 wk tabdl 1/1st gestation (76801) | $622.70 | $958 | 5.6× |
| Us preg uterus real time f/u trnsabdl per fetus (76816) | $434.85 | $669 | 3.9× |
| Us retroperitoneal complete (76770) | $855.40 | — | 7.7× |
| Us retroperitoneal limited (76775) | $635.70 | $978 | 5.7× |
| Us scrotum and contents (76870) | $733.20 | $1,128 | 6.6× |
| Us spinal canal and contents (76800) | $1,360.45 | $2,093 | 12.3× |
| Us thyroid (76536) | $657.80 | $1,012 | 5.9× |
| Vein X-Ray Chest (75827) | $2,754.05 | $4,237 | 1.7× |
| Venogram Sinus/Jugular (75860) | $2,546.70 | $3,918 | 0.8× |
| Venography extremity bilateral rs&i (75822) | $1,714.05 | $2,637 | 1.0× |
| Venography extremity unilateral rs&i (75820) | $1,501.50 | $2,310 | 0.9× |
| Venography Renal Bilateral (75833) | $3,953.30 | $6,082 | 1.2× |
| Venography Renal Unilateral (75831) | $3,318.90 | $5,106 | 1.0× |
| Wrist 2 views (73100) range across 2 matching MRF lines |
$371.80–$904.80 | — | varies |
| X-Ray Ac Jts - Xr Acromioclavicular Joints Bilateral (73050) | $329.55 | $507 | 3.6× |
| X-ray antegrade pyelogram tube (74425) | $501.15 | $771 | 1.4× |
| X-Ray Bend Only L-S Spine (72120) | $473.85 | $729 | 4.3× |
| X-Ray Elbow 2 Vw - Xr Elbow 1-2 Views Right (73070) | $1,428.05 | — | 15.5× |
| X-Ray Exam Breast Specimen (76098) | $346.45 | $533 | 0.6× |
| X-Ray Exam Entire Spi 1 Vw (72081) | $292.50 | $450 | 3.2× |
| X-Ray Exam Entire Spi 2/3 Vw (72082) | $418.60 | $644 | 3.8× |
| X-Ray Exam Entire Spi 4/5 Vw (72083) | $596.70 | $918 | 5.4× |
| X-Ray Exam Hip Uni 1 View (73501) | $269.10 | $414 | 2.9× |
| X-Ray Exam Hip Uni 2-3 Views (73502) | $321.10 | — | 3.5× |
| X-Ray Exam Hip Uni 4/> Views (73503) | $437.45 | $673 | 4.0× |
| X-Ray Exam Hips Bi 2 Views (73521) | $482.30 | $742 | 4.4× |
| X-Ray Exam Hips Bi 3-4 Views (73522) | $523.90 | $806 | 4.7× |
| X-Ray Exam L-S Spine Bending (72114) | $536.25 | $825 | 4.8× |
| X-Ray Exam Neck Spine 2-3 Vw (72040) | $353.60 | $544 | 3.8× |
| X-Ray Exam Neck Spine 6/>Vws (72052) | $750.10 | $1,154 | 6.8× |
| X-Ray Exam Unilat Ribs/Chest (71101) range across 2 matching MRF lines |
$406.90–$426.40 | $626–$656 | varies |
| X-ray eye for foreign body (70030) range across 3 matching MRF lines |
$204.10–$306.15 | $314–$471 | varies |
| X-ray humerus (73060) | $295.75 | $455 | 3.2× |
| X-Ray Jaw <4 Vw - Xr Mandible < 4 Views (70100) | $228.80 | $352 | 2.5× |
| X-Ray Knee Bilat Standing - Xr Knees Anteroposterior Standing Bilat (73565) | $314.60 | $484 | 3.4× |
| X-Ray Lumbar Spine 2/3 Vw - Xr Lumbar Spine 2-3 Views (72100) | $382.85 | $589 | 3.5× |
| X-ray nose-rectum child f.b. (76010) | $285.35 | $439 | 3.1× |
| X-Ray Ribs, Chest 4+ Vw - Xr Ribs 3 Vws Bil W/ Chest Posteroanterior (71111) | $568.10 | $874 | 5.1× |
| X-Ray Sacroiliac Jts 3+ Vw - Xr Sacroiliac Joints 3+ Views (72202) | $364.65 | $561 | 3.3× |
| X-Ray Sacroiliac Jts <3 Vw - Xr Sacroiliac Joints 1-2 Views (72200) | $331.50 | $510 | 3.0× |
| X-Ray Sacrum/Coccyx 2+ Vw - Xr Sacrum Coccyx 2+ Views (72220) | $254.80 | $392 | 2.8× |
| X-Ray Sinuses 3+ Vw - Xr Paranasal Sinuses 3+ Views (70220) | $321.10 | $494 | 3.5× |
| X-Ray Skull 4+ Vw - Xr Skull Complete 4+ Views (70260) | $496.60 | $764 | 4.5× |
| X-ray thoracic spine 4 vw (72074) | $568.75 | $875 | 5.1× |
| X-Ray Tmj Unilat (70328) | $337.35 | $519 | 3.7× |
| X-Ray Urinary Tract Exam With Contrast Material (74420) range across 2 matching MRF lines |
$16,784.51–$21,453.45 | — | varies |
| X-Rays Bone Length Studies (77073) | $401.70 | $618 | 3.6× |
| X-Rays Bone Survey Complete (77075) | $977.60 | $1,504 | 8.8× |
| Xr c-spine 4 or 5 views (72050) | $451.75 | $695 | 4.1× |
| Xr facial bones less than 3 views (70140) | $312.65 | $481 | 3.4× |
| XR Mastoids < 3 Views Bilateral (70120) range across 3 matching MRF lines |
$317.85–$477.10 | $489–$734 | varies |
| Xr orbits complete 4 views (70200) | $370.50 | $570 | 3.3× |
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.