Imaging prices at Salem Health West Valley

Dallas, OR · every code in this section with a posted price and a Medicare benchmark.

402 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) $4,808.16 $9,072 3.1×
Abdomen 1 View (74018) $183.91 $347 1.9×
Abdomen 2 views (74019) $291.50 $550 2.5×
Acute Gastrointestinal Blood Loss Imaging (78278) $834.22 $1,574 1.9×
Acute venous thrombosis imaging, peptide Non-Facility (78456) $1,107.70 $2,090 0.8×
Angio internal mammary (75756) $3,096.26 $5,842 0.9×
Angio pulmonary bilat (75743) $5,178.10 $9,770 1.5×
Angiography Adrenal Bilateral Slctv Rs&I (75733) $5,178.10 $9,770 1.5×
Angiography extremity bilateral rs&i (75716) $5,178.10 $9,770 1.5×
Angiography extremity unilateral rs&i (75710) $5,178.10 $9,770 1.5×
Angiography pulmonary unilateral slctv rs&i (75741) $5,178.10 $9,770 1.5×
Angrph pulmonary nonslctv cath/ven njx rs&i (75746) $2,994.50 $5,650 0.8×
Ankle 2 views (73600) $165.89 $313 1.7×
Aortography thoracic serialography rs&i (75605) $5,178.10 $9,770 0.8×
Artery X-Rays Abdomen (75726) $5,178.10 $9,770 0.8×
Artery X-Rays Adrenal Gland (75731) $4,142.48 $7,816 1.2×
Artery X-Rays Pelvis (75736) $5,178.10 $9,770 0.8×
Artery X-Rays Spine (75705) $9,059.29 $17,093 1.4×
Arthrogram ankle (73615) $304.75 $575 0.8×
Arthrogram hip (73525) $628.05 $1,185 1.6×
Arthrogram Wrist (73115) $296.80 $560 0.8×
Basic radiation dosimetry calculation (77300) $416.05 $785 2.8×
Bone age studies (77072) $305.28 $576 2.6×
Bone Imaging 3 Phase (78315) $834.22 $1,574 1.9×
Bone Imaging Limited Area (78300) $280.90 $530 0.6×
Bone Imaging Multiple Areas (78305) $834.22 $1,574 1.9×
Bone Imaging Whole Body (78306) $834.22 $1,574 1.9×
Bone marrow imaging limited area (78102) $420.82 $794 0.9×
Bone marrow imaging; multiple areas (78103) $420.82 $794 0.9×
Bone marrow imaging; whole body (78104) $834.22 $1,574 1.9×
Bone survey infant (77076) $305.28 $576 2.6×
Brachytx isodose complex (77318) $1,928.67 $3,639 4.6×
Brachytx isodose intermed (77317) $1,217.41 $2,297 2.9×
Brachytx Isodose Plan Simple (77316) $930.68 $1,756 2.2×
Brain Flow Imaging Only (78610) $645.01 $1,217 1.1×
Brain Image W/Flow < 4 Views (78601) $1,272.53 $2,401 2.8×
Brain imaging < 4 static views (78600) $834.22 $1,574 1.9×
Brain Imaging Min 4 Static Views W Vascular Flow (78606) $1,416.69 $2,673 2.3×
Brain Imaging Minimum 4 Static Views (78605) $1,249.21 $2,357 2.0×
Brain Imaging Pet Metabolic Evaluation (78608) $3,496.94 $6,598 2.2×
Cardiac MRI w/w/o contrast & further seq (75561) $2,007.11 $3,787 5.1×
Cardiac MRI w/w/o contrast w/stress (75563) $2,714.66 $5,122 3.1×
Cardiac Shunt Detection (78428) $834.22 $1,574 1.9×
Cat Scan Follow-Up Study (76380) $331.78 $626 3.4×
Cerebrospinal Fluid Flow W/O Matl Shunt Evaltj (78645) $1,081.73 $2,041 1.8×
Cerebrospinal Fluid Scan (78630) $1,081.73 $2,041 1.8×
Chest 1 view (71045) $170.13 $321 1.7×
Chest 2 views (71046) $264.47 $499 2.7×
Chest 3 views (71047) $279.84 $528 2.9×
Chest 4 or more views (71048) $320.65 $605 2.7×
Cholecystography Oral Contrast (74290) $217.83 $411 1.1×
Clavicle complete (73000) $165.89 $313 1.7×
Computed Tomography Thorax Lw Dose Lng Ca Scr C- (71271) $458.45 $865 3.9×
Continuing medical physics consltj pr wk (77336) $480.18 $906 3.2×
Contrast Exam Abdominl Aorta (75625) $5,178.10 $9,770 1.5×
Contrast X-Ray Bladder (74430) $426.12 $804 1.1×
Contrast X-Ray Of Elbow (73085) $436.72 $824 1.1×
Contrast X-Ray Of Knee Joint (73580) $559.15 $1,055 1.4×
CT abdomen and pelvis without and with contrast (74178) $1,634.52 $3,084 4.2×
CT abdomen and pelvis without contrast (74176) $1,240.73 $2,341 4.6×
CT abdomen w contrast (74160) $1,485.06 $2,802 7.5×
CT abdomen w wo contrast (74170) $1,634.52 $3,084 8.3×
CT abdomen w/o contrast (74150) $611.09 $1,153 5.2×
CT Angio Abdomen and Pelvis (74174) $1,428.88 $2,696 3.6×
CT Angio Chest (71275) $1,428.88 $2,696 7.3×
CT Angio Head (70496) $1,735.22 $3,274 8.8×
CT angio hrt w/3d image (75574) $1,428.88 $2,696 3.6×
Ct Angio Lwr Extr W/O&W/Dye (73706) $1,428.88 $2,696 7.3×
CT Angio Neck (70498) $1,735.22 $3,274 8.8×
Ct Angio Upr Extrm W/O&W/Dye (73206) $1,428.88 $2,696 7.3×
CT cervical spine w/ contrast (72126) $2,794.69 $5,273 7.1×
CT cervical spine w/o contrast (72125) $737.76 $1,392 6.3×
CT cervical spine w/wo cont (72127) $3,071.88 $5,796 15.6×
CT chest w contrast (71260) $1,485.06 $2,802 7.5×
CT chest w/wo contrast (71270) $1,634.52 $3,084 8.3×
CT colonography screening (74263) $1,040.92 $1,964 3.9×
CT colonogrphy dx image postprocess w/o contrast (74261) $1,040.92 $1,964 8.9×
CT head/brain with contrast (70460) $1,735.22 $3,274 8.8×
CT head/brain without and with contrast (70470) $1,908.53 $3,601 9.7×
CT heart contrast eval cardiac structure&morph (75572) $1,428.88 $2,696 3.6×
CT heart no contrast quant eval coronry calcium (75571) $112.89 $213 1.2×
CT hrt w/3d image congen (75573) $834.22 $1,574 2.1×
CT iac w contrast (70481) $1,735.22 $3,274 8.8×
CT l-spine w&w/o contrast (72133) $2,682.33 $5,061 13.6×
CT lower ext w/o (73700) $975.73 $1,841 8.3×
CT lower extremity w/contrast material (73701) $1,485.06 $2,802 7.5×
CT lumbar spine w contrast (72132) $2,528.10 $4,770 6.5×
CT lumbar spine w/o contrast (72131) $975.73 $1,841 8.3×
CT maxillofacial w contrast (70487) $1,735.22 $3,274 8.8×
CT maxillofacial wo contrast (70486) $737.76 $1,392 6.3×
CT neck tissue combo (70492) $1,908.53 $3,601 9.7×
Ct Orbit/Ear/Fossa W/O&W/Dye (70482) $1,908.53 $3,601 9.7×
CT orbits w/o contrast (70480) $737.76 $1,392 6.3×
CT pelvis w&w/o contrast (72194) $1,634.52 $3,084 8.3×
CT pelvis w/o contrast (72192) $975.73 $1,841 8.3×
CT scan of leg combo (73702) $1,634.52 $3,084 8.3×
CT scans face/jaw combo (70488) $1,908.53 $3,601 9.7×
CT soft tissue neck w contrast (70491) $1,735.22 $3,274 8.8×
CT soft tissue neck w/o contrast (70490) $737.76 $1,392 6.3×
CT thoracic spine w contrast (72129) $1,485.06 $2,802 7.5×
CT thoracic spine w/o contrast (72128) $975.73 $1,841 8.3×
CT thoracic spine w/wo cont (72130) $1,634.52 $3,084 8.3×
CT thorax w/o contrast (71250) $975.73 $1,841 8.3×
CT upper ext wo (73200) $975.73 $1,841 8.3×
CT upper extremity w/o & w/contrast material (73202) $3,096.79 $5,843 15.7×
CT upper extremity with contrast (73201) $1,485.06 $2,802 3.8×
Cta Abdl Aorta&Bi Iliofem W/Contrast&Postp (75635) $1,771.26 $3,342 9.0×
Cta Abdomen (74175) $1,428.88 $2,696 7.3×
CTA pelvis (72191) $1,428.88 $2,696 7.3×
Dacryocystography, nasolacrimal duct, radiological supervision and interpretation Non-Facility (70170) $396.97 $749 1.5×
Dilation ureters/urethra rs&i (74485) $2,613.43 $4,931 1.1×
Discography Cerv/Thor Spine (72285) $3,640.57 $6,869 1.7×
Diskography lumbar (72295) $3,640.57 $6,869 1.7×
Doppler Echo Fetal Puls Spectral F/U/Repeat (76828) $270.30 $510 2.3×
Doppler Echo Fetal Spectral Display Complete (76827) $405.45 $765 3.5×
Doppler Fetal Mid Cerebral Artery (76821) $349.80 $660 3.0×
Dxa Bone Density Axial (77080) $364.11 $687 3.1×
Dxa bone density study (77085) $286.73 $541 2.4×
Echo exam of fetal heart (76825) $1,235.96 $2,332 2.0×
Echo exam uterus (76831) $473.82 $894 1.8×
Echo Guide For Artery Repair (76936) $757.90 $1,430 3.1×
Echocardiography, fetal, cardiovascular system, real time with image documentation (2D), with or without M-mode… (76826) $636 $1,200 2.4×
Esophagram (74220) $383.19 $723 1.9×
Fetal Biophysical Profile W/O Non-Stress Testing (76819) $419.23 $791 3.6×
Fluoroscopy up to 1 hr (76000) $453.15 $855 1.7×
Follow-Up Angiography (75898) $1,471.28 $2,776 0.4×
Foot 2 views (73620) $165.89 $313 1.7×
Forearm 2 views (73090) $165.89 $313 1.7×
Gastric emptying imaging study (78264) $834.22 $1,574 1.9×
Gastroesophageal Reflux Exam (78262) $834.22 $1,574 1.9×
Gated Heart Planar Single (78472) $834.22 $1,574 1.9×
Hand 2 views (73120) $165.89 $313 1.4×
Hdr Rdncl Ntrstl/Icav Brchtx (77772) $1,857.12 $3,504 2.4×
Hdr Rdncl Ntrstl/Icav Brchtx (77771) $1,857.12 $3,504 2.4×
Hdr Rdncl Ntrstl/Icav Brchtx 1 Channel (77770) $1,857.12 $3,504 2.4×
Hepatc Vngrph Wdg/Fr Hemodyn Eval Rs&I (75889) $5,178.10 $9,770 1.5×
Hepatc Vngrph Wdg/Fr W/O Hemodyn Eval Rs&I (75891) $5,178.10 $9,770 1.5×
Hepatobil Syst Image W/Drug (78227) $1,081.73 $2,041 1.8×
Hepatobiliary System Imaging (78226) $834.22 $1,574 1.9×
Ht Musc Image Planar Mult (78454) $2,869.95 $5,415 2.0×
Ht Muscle Image Spect Sing (78451) $2,869.95 $5,415 2.0×
Hysterosalpingogram (74740) $625.93 $1,181 2.3×
Image fusion (77399) $328.60 $620 2.2×
Infant hip ultrasound with hip movement (dynamic) (76885) $324.36 $612 3.3×
Infusion Ivp (74410) $680.52 $1,284 3.5×
Joint Survey Single View (77077) $305.28 $576 2.6×
K Flow/Funct Image Multiple (78709) $1,081.73 $2,041 1.8×
K Flow/Funct Image W/Drug (78708) $1,081.73 $2,041 1.8×
K Flow/Funct Image W/O Drug (78707) $1,081.73 $2,041 1.8×
Kidney Funcj Study Non-Img Radioisotopic Study (78725) $313.23 $591 0.7×
Kidney Imaging Morphol (78700) $834.22 $1,574 1.9×
Knee 3 Views (73562) $186.56 $352 1.9×
Leveen/Shunt Patency Exam (78291) $332.31 $627 0.7×
Liver & Spleen Imaging Static Only (78215) $834.22 $1,574 1.9×
Liver imaging static only (78201) $732.99 $1,383 1.2×
Lung Perf&Ventilat Diferentl (78598) $1,081.73 $2,041 1.8×
Lung perfusion differential (78597) $834.22 $1,574 1.9×
Lung Ventilat&Perfus Imaging (78582) $1,081.73 $2,041 1.8×
Lung Ventilation Imaging (78579) $440.96 $832 1.0×
Lymph System Imaging (78195) $1,081.73 $2,041 1.8×
Lymphangiography Pelvic/Abdominal Bilateral Rs&I (75807) $3,096.26 $5,842 0.9×
Magnetic Image Jaw Joint (70336) $995.87 $1,879 3.7×
Mammary ductogram or galactogram multiple (77054) $366.76 $692 1.4×
Mammary ductogram or galactogram single (77053) $263.94 $498 1.0×
Meckels Divert Exam (78290) $834.22 $1,574 1.9×
Mlc imrt design & construction per imrt plan (77338) $843.23 $1,591 2.0×
Mra Head W/O & W/Contrast Material (70546) $2,154.98 $4,066 5.5×
MRA head w/o contrast (70544) $1,198.33 $2,261 4.5×
MRA head with contrast (70545) $1,729.39 $3,263 4.4×
MRA neck w contrast (70548) $1,580.46 $2,982 4.0×
Mra Neck W/O &W/Contrast Material (70549) $2,154.98 $4,066 5.5×
MRA neck w/o contrast (70547) $1,036.68 $1,956 3.9×
MRI abdomen w contrast (74182) $2,197.38 $4,146 5.6×
MRI abdomen w/o contrast (74181) $1,307.51 $2,467 4.9×
MRI any jt lower extrem w/contrast material (73722) $2,616.08 $4,936 3.0×
MRI any jt lower extrem w/o & w/contrast matrl (73723) $3,348.01 $6,317 8.5×
MRI any jt upper extremity w/contrast matrl (73222) $2,406.20 $4,540 2.7×
MRI Breast W/O Contrast Bilateral (77047) $1,548.13 $2,921 5.8×
MRI cardiac w/o cont stress (75559) $1,756.42 $3,314 2.9×
MRI cardiac w/o contrast (75557) $1,694.94 $3,198 6.3×
MRI cervical spine w contrast (72142) $1,958.88 $3,696 5.0×
MRI cervical spine w/o cont (72141) $1,288.96 $2,432 4.8×
MRI chest w/o contrast (71550) $995.87 $1,879 3.7×
MRI chest with contrast (71551) $2,054.81 $3,877 2.3×
MRI chest wo w contrast (71552) $2,368.57 $4,469 6.0×
MRI lower extrem oth/thn jt w/contrast matrl (73719) $1,831.15 $3,455 4.7×
MRI lower extrem oth/thn jt w/o & w/contr matr (73720) $2,354.79 $4,443 6.0×
MRI lower extrem oth/thn jt w/o contr matrl (73718) $1,569.33 $2,961 5.9×
MRI lumbar spine w contrast (72149) $2,154.98 $4,066 5.5×
Mri Neck Spine W/O & W/Dye (72156) $2,628.80 $4,960 6.7×
MRI orbit face &/neck w/o contrast (70540) $1,036.68 $1,956 3.9×
MRI orbit face neck w contrast (70542) $1,958.88 $3,696 5.0×
Mri Orbt/Fac/Nck W/O &W/Dye (70543) $2,154.98 $4,066 5.5×
MRI pelvis w contrast (72196) $2,305.50 $4,350 5.9×
MRI pelvis w/o & w contrast (72197) $2,393.48 $4,516 6.1×
MRI pelvis w/o contrast (72195) $1,569.33 $2,961 5.9×
MRI thoracic spine w/o contrast (72146) $1,569.33 $2,961 5.9×
MRI upper extremity oth than jt w/contr matrl (73219) $2,154.98 $4,066 5.5×
MRI upper extremity oth than jt w/o contr matrl (73218) $1,724.62 $3,254 6.4×
Mri Uppr Extremity W/O&W/Dye (73220) $2,616.08 $4,936 6.7×
MRI, abdomen, combo (74183) $2,616.08 $4,936 6.7×
MRI, dorsal spine combo (72157) $2,368.57 $4,469 6.0×
MRI, dorsal spine contrast (72147) $2,154.98 $4,066 5.5×
MRI, joint upper extrem (73221) $1,569.33 $2,961 5.9×
MRI, joint upper extrem combo (73223) $3,662.30 $6,910 9.3×
MRI, lumbar spine combo (72158) $2,368.57 $4,469 6.0×
Myelogram cervical (72240) $686.88 $1,296 0.8×
Myelogram Lumbar (72265) $614.27 $1,159 0.7×
Myelography thoracic (72255) $686.88 $1,296 0.8×
Myelograpy 2/more regions rs&i (72270) $686.88 $1,296 0.8×
Myocardial Imaging Infarct Avid Planar Qual/Quan (78466) $464.28 $876 1.0×
Myocardial Imaging Pet Metabolic Evaluation (78459) $1,366.34 $2,578 0.9×
Myocardial Spect Multiple Studies (78452) $2,869.95 $5,415 2.0×
Myocrd Img Pet Metab Eval Single Study Cncrnt CT (78429) $2,283.24 $4,308 1.4×
Neck soft tissue (70360) $168.54 $318 1.7×
Nm csf leak detection (78650) $2,869.95 $5,415 2.0×
Nm myocard infarct spect (78469) $748.89 $1,413 1.2×
Nonvascular Shunt X-Ray (75809) $163.77 $309 1.4×
Ntsty modul radthx pln dose-vol histos (77301) $4,551.64 $8,588 2.9×
Nuclear Rx Intra-Arterial (79445) $339.20 $640 1.3×
Nuclear Rx Oral Admin (79005) $487.07 $919 1.9×
Ob us nuchal meas 1 gest (76813) $622.22 $1,174 5.3×
Panoramic X-ray of jaws (70355) $165.89 $313 1.7×
Parathyroid imaging w/tomographic spect & CT (78072) $1,081.73 $2,041 1.8×
Parathyroid Planar Imaging (78070) $834.22 $1,574 1.9×
Parathyroid planar imaging w/wo subtraction (78071) $834.22 $1,574 1.9×
Pelvis 1 or 2 views (72170) $186.56 $352 1.6×
Pet Image Skull-Thigh (78812) $3,208.62 $6,054 2.0×
Pet Image W/Ct Lmtd (78814) $3,401.54 $6,418 2.1×
PET image w/CT, full body (78816) $4,661.35 $8,795 2.9×
PET imaging CT attenuation skull base mid-thigh (78815) $4,661.35 $8,795 2.9×
Pet Imaging Limited Area Chest Head/Neck (78811) $3,055.98 $5,766 2.1×
PET whole body (78813) $4,661.35 $8,795 2.9×
Prq Transhepatc Portograpy Hemodyn Eval Rs&I (75885) $5,178.10 $9,770 1.5×
Pulmonary Perfusion Imaging Particulate (78580) $834.22 $1,574 1.9×
Radex Abd Compl Aqt Abd W/S/E/D Views 1 View Ch (74022) $351.39 $663 3.0×
Radex abscess/fistula/sinus tract rs&i (76080) $437.78 $826 0.7×
Radex Ankle Complete Minimum 3 Views (73610) $165.89 $313 1.7×
Radex Calcaneus Minimum 2 Views (73650) $165.89 $313 1.7×
Radex elbow complete minimum 3 views (73080) $165.89 $313 1.7×
Radex Facial Bones Complete Minimum 3 Views (70150) $305.28 $576 2.6×
Radex fingr minimum 2 views (73140) $104.41 $197 1.1×
Radex foot complete minimum 3 views (73630) $165.89 $313 1.7×
Radex Hand Minimum 3 Views (73130) $176.49 $333 1.8×
Radex lower extremity infant minimum 2 views (73592) $165.89 $313 1.7×
Radex Nasal Bones Complete Minimum 3 Views (70160) $165.89 $313 1.7×
Radex Ribs Unilateral 2 Views (71100) $165.89 $313 1.7×
Radex shoulder complete minimum 2 views (73030) $165.89 $313 1.7×
Radex Sinuses Paransl < 3 Views (70210) $165.89 $313 1.7×
Radex sm int w/mlt srl imges via enteroclss tube (74251) $314.29 $593 1.6×
Radex Spine 1 View Specify Level (72020) $165.89 $313 1.7×
Radex Sternum Minimum 2 Views (71120) $165.89 $313 1.7×
Radex Temporomandble Jt Opn & Clsd Mouth Bilat (70330) $165.89 $313 1.7×
Radex Toe Minimum 2 Views (73660) $128.26 $242 1.3×
Radex upper extremity infant minimum 2 views (73092) $305.28 $576 2.6×
Radex Wrist Complete Minimum 3 Views (73110) $165.89 $313 1.7×
Radiation Delivery Stereotactic Cranial Linear (77372) $10,700.70 $20,190 1.3×
Radiation treatment delivery level 1 (77402) $352.98 $666 3.1×
Radiation treatment delivery level 2 (77407) $372.06 $702 0.9×
Radiation treatment delivery level 3 (77412) $598.90 $1,130 1.0×
Radiolog exam mandible compl minimum 4 views (70110) $305.28 $576 2.6×
Radiologic Exam Abdomen 3+ Views - Xr Abdomen 3+ Views (74021) $309.52 $584 2.6×
Radiologic exam colon double contrast study (74280) $383.19 $723 1.9×
Radiologic exam colon single contrast study (74270) $383.19 $723 1.9×
Radiologic exam knee complete 4/more views (73564) $227.37 $429 1.9×
Radiologic exam pelvis compl minimum 3 views (72190) $225.25 $425 1.9×
Radiologic Exam Small Int Single Contrast Study (74250) $217.83 $411 1.1×
Radiologic exam swallow function contrast study (74230) $309.52 $584 1.6×
Radiologic exam upr gi trc double contrast study (74246) $383.19 $723 1.9×
Radiologic examination femur 1 view (73551) $165.89 $313 1.7×
Radiologic examination femur minimum 2 views (73552) $165.89 $313 1.7×
Radiologic examination knee 1/2 views (73560) $165.89 $313 1.7×
Radiologic Examination Osseous Survey Limited (77074) $305.28 $576 2.6×
Radiologic Examination Salivary Gland Calculus (70380) $98.05 $185 1.0×
Radiologic examination tibia & fibula 2 views (73590) $165.89 $313 1.7×
Radiopharmaceutical therapy, by interstitial radioactive colloid administration Facility (79300) $218.36 $412 0.8×
Radiopharmaceutical therapy, by intra-articular administration Non-Facility (79440) $262.35 $495 1.0×
Radiopharmaceutical therapy, by intracavitary administration Non-Facility (79200) $262.35 $495 1.0×
Remote afterloading high dose rate radionuclide skin surface brachytherapy, includes basic dosimetry, when performed;… (77768) $518.87 $979 1.2×
Remote afterloading high dose rate radionuclide skin surface brachytherapy, includes basic dosimetry, when performed;… (77767) $518.87 $979 1.2×
Ribs bilateral 3 views (71110) $305.28 $576 2.6×
Rp loclzj tum plnr 1 area single day imaging (78800) $464.28 $876 1.0×
Rp loclzj tum plnr 2+area 1+d img/1 area img>2+d (78801) $580.35 $1,095 1.3×
Rp Loclzj Tum Plnr Whole Body 2+ Days Imaging (78804) $1,849.17 $3,489 3.0×
Rp Loclzj Tum Plnr Whole Body Single Day Imaging (78802) $1,479.23 $2,791 2.4×
Rp Loclzj Tum Spect 1 Area Single Day Imaging (78803) $2,145.97 $4,049 3.5×
Rp loclzj tum spect 2 area/sep acquisj img (78831) $2,705.65 $5,105 1.9×
Rp loclzj tum spect CT 2area 1d img/1 ar img>2+d (78832) $2,815.89 $5,313 1.8×
Rp loclzj tum spect w/CT 1 area/acquisj 1day img (78830) $2,443.30 $4,610 1.7×
Rp Ther Radiolbld Monoclonal Antibody IV Infus (79403) $556.50 $1,050 2.1×
Rp Therapy Intravenous Administration (79101) $339.20 $640 1.3×
Scapula (73010) $199.81 $377 1.7×
Screening Digital Breast Tomosynthesis Bi (77063) $59.89 $113 2.6×
Shoulder 1 view (73020) $165.89 $313 1.7×
Shoulder Arthrography (73040) $412.34 $778 1.1×
Sialogram (70390) $363.05 $685 1.4×
Skull less than 4 views (70250) $305.28 $576 2.6×
Special dosimetry (77331) $500.85 $945 3.3×
Special Physics Consult (77370) $859.13 $1,621 5.7×
Special teletherapy port plan (77321) $1,151.69 $2,173 2.7×
Special treatment procedure (77470) $1,425.17 $2,689 2.3×
Spleen Imaging (78185) $420.82 $794 0.9×
Srs Multisource (77371) $10,700.70 $20,190 1.3×
Stereotactic Body Radiation Delivery (77373) $5,725.06 $10,802 2.9×
Sternoclavicular joints (71130) $165.89 $313 1.7×
Surf radj ther orthvlt dlvr>150-500 kv per fxj (77438) $159 $300 1.4×
Surf radj ther supfc dlvr<=150 kv per fraction (77437) $159 $300 1.4×
Surf radj ther supfc/orthvlt treatment planning (77436) $58.30 $110 1.4×
Telethx isodose pln cplx w/basic dosimetry (77307) $1,375.88 $2,596 3.3×
Telethx isodose pln smpl w/dosimetry calculation (77306) $959.30 $1,810 2.3×
Temporomandble Jt Arthrography Rs&I (70332) $458.98 $866 1.7×
Testicular Imaging W/Flow (78761) $504.56 $952 1.1×
Ther Rad Simulaj-Aided Field Setting Complex (77290) $1,105.58 $2,086 2.6×
Ther Rad Simulaj-Aided Field Setting Intermed (77285) $991.10 $1,870 2.4×
Ther rad simulaj-aided field setting simple (77280) $480.18 $906 3.2×
Thoracic spine 2 views (72070) $305.28 $576 2.6×
Thoracic spine 3 views (72072) $305.28 $576 2.6×
Thoracolumbar 2 views (72080) $165.89 $313 1.7×
Thyroid Carcinoma Metastases Img Lmtd Area (78015) $647.66 $1,222 1.4×
Thyroid Imaging With Vascular Flow (78013) $834.22 $1,574 1.9×
Thyroid Met Imaging Body (78018) $1,081.73 $2,041 1.8×
Thyroid Uptake Measurement (78012) $834.22 $1,574 1.9×
Thyroid Uptake W/Blood Flow Sngle/Mult Quan Meas (78014) $834.22 $1,574 1.9×
Tx Devices Design & Construction Complex (77334) $1,754.30 $3,310 4.2×
Tx devices design & construction intermediate (77333) $1,143.21 $2,157 7.6×
Tx devices design & construction simple (77332) $686.35 $1,295 4.5×
Ultrasound Breast Limited (76642) $356.16 $672 3.6×
Ultrasound Elastography Parenchyma (76981) $162.71 $307 1.4×
Ultrasound Exam Aaa Screen (76706)
range across 2 matching MRF lines		 $35.51–$419.23 $67–$791 varies
Ultrasound, abdomen limited (76705)
range across 2 matching MRF lines		 $38.69–$430.89 $73–$813 varies
Umbilical-artery Doppler (OB) (76820) $349.80 $660 3.0×
Upper gi w/o kub (74240) $383.19 $723 1.9×
Urea Breath Test C-14 Isotopic Acquisj Analysis (78267) $24.91 $47 2.3×
Urea breath test c-14 isotopic analysis (78268) $206.17 $389 2.2×
Ureteral Reflux Study (78740) $834.22 $1,574 1.9×
Urethrocystogram voiding (74455) $625.93 $1,181 2.3×
Urethrocystography retrograde (74450) $625.93 $1,181 2.3×
Us breast unilateral complete (76641) $419.23 $791 3.6×
Us chest (76604) $330.72 $624 2.8×
Us complete joint (76881) $491.31 $927 4.2×
Us exam, pelvic, limited (76857) $419.23 $791 3.6×
Us head (76506) $360.93 $681 3.1×
Us kidney transplant (76776) $454.74 $858 3.9×
Us lmtd joint/oth nonvasc xtr strux r-t w/img (76882) $360.93 $681 3.1×
Us ob detailed single fetus (76811) $953.47 $1,799 3.6×
Us ob limited 1 or more fetuses (76815) $419.23 $791 3.6×
Us ob transvaginal (76817) $447.85 $845 3.8×
Us pelvic non ob complete (76856) $484.95 $915 4.1×
Us pg uter img f&mat 14 wk tabdl 1/1st gestation (76801) $394.85 $745 3.4×
Us preg uterus real time f/u trnsabdl per fetus (76816) $345.03 $651 2.9×
Us retroperitoneal complete (76770) $502.97 $949 4.3×
Us retroperitoneal limited (76775) $419.23 $791 3.6×
Us scrotum and contents (76870) $419.23 $791 3.6×
Us spinal canal and contents (76800) $360.93 $681 3.1×
Us thyroid (76536) $419.23 $791 3.6×
Us transrectal (76872) $419.23 $791 3.6×
Vascular Flow Imaging (78445) $834.22 $1,574 1.9×
Vein X-Ray Chest (75827) $1,670.56 $3,152 0.9×
Vein X-Ray Liver W/O Hemodyn (75887) $1,670.56 $3,152 0.5×
Venogram Sinus/Jugular (75860) $3,096.26 $5,842 0.9×
Venography Adrenal Unilateral (75840) $5,178.10 $9,770 1.5×
Venography caval inferior serialography rs&i (75825) $5,178.10 $9,770 1.5×
Venography extremity bilateral rs&i (75822) $1,670.56 $3,152 0.9×
Venography extremity unilateral rs&i (75820) $1,670.56 $3,152 0.9×
Venography Renal Bilateral (75833) $5,178.10 $9,770 1.5×
Venography Renal Unilateral (75831) $5,178.10 $9,770 1.5×
Venous sampling by catheter (75893) $5,178.10 $9,770 0.8×
Vertebral fracture assessment via dxa (77086) $179.67 $339 1.8×
Wrist 2 views (73100) $165.89 $313 1.7×
X-Ray Ac Jts - Xr Acromioclavicular Joints Bilateral (73050) $165.89 $313 1.7×
X-ray antegrade pyelogram tube (74425) $583.53 $1,101 1.5×
X-Ray Aorta Leg Arteries (75630) $5,178.10 $9,770 1.5×
X-Ray Bend Only L-S Spine (72120) $199.81 $377 1.7×
X-Ray Elbow 2 Vw - Xr Elbow 1-2 Views Right (73070) $165.89 $313 1.7×
X-Ray Exam Breast Specimen (76098) $1,282.60 $2,420 2.1×
X-Ray Exam Entire Spi 1 Vw (72081) $165.89 $313 1.7×
X-Ray Exam Entire Spi 2/3 Vw (72082) $305.28 $576 2.6×
X-Ray Exam Entire Spi 4/5 Vw (72083) $604.73 $1,141 5.2×
X-Ray Exam Hip Uni 1 View (73501) $165.89 $313 1.7×
X-Ray Exam Hip Uni 2-3 Views (73502) $165.89 $313 1.7×
X-Ray Exam Hips Bi 2 Views (73521) $305.28 $576 2.6×
X-Ray Exam Hips Bi 3-4 Views (73522) $305.28 $576 2.6×
X-Ray Exam L-S Spine Bending (72114) $305.28 $576 2.6×
X-Ray Exam Neck Spine 2-3 Vw (72040) $165.89 $313 1.7×
X-Ray Exam Neck Spine 6/>Vws (72052) $305.28 $576 2.6×
X-Ray Exam Unilat Ribs/Chest (71101) $305.28 $576 2.6×
X-ray humerus (73060) $165.89 $313 1.7×
X-ray IV pyelogram+tomography (74415) $680.52 $1,284 3.5×
X-Ray Lumbar Spine 2/3 Vw - Xr Lumbar Spine 2-3 Views (72100) $305.28 $576 2.6×
X-ray nose-rectum child f.b. (76010) $168.54 $318 1.7×
X-Ray Ribs, Chest 4+ Vw - Xr Ribs 3 Vws Bil W/ Chest Posteroanterior (71111) $305.28 $576 2.6×
X-Ray Sacroiliac Jts 3+ Vw - Xr Sacroiliac Joints 3+ Views (72202) $305.28 $576 2.6×
X-Ray Sacrum/Coccyx 2+ Vw - Xr Sacrum Coccyx 2+ Views (72220) $165.89 $313 1.7×
X-Ray Sinuses 3+ Vw - Xr Paranasal Sinuses 3+ Views (70220) $165.89 $313 1.7×
X-Ray Skull 4+ Vw - Xr Skull Complete 4+ Views (70260) $305.28 $576 2.6×
X-Ray Urinary Tract Exam With Contrast Material (74420) $1,230.66 $2,322 3.1×
X-Rays Bone Length Studies (77073) $199.81 $377 1.7×
X-Rays Bone Survey Complete (77075) $305.28 $576 2.6×
Xr c-spine 4 or 5 views (72050) $305.28 $576 2.6×
Xr facial bones less than 3 views (70140) $165.89 $313 1.7×
Xr orbits complete 4 views (70200) $237.97 $449 2.0×
Xr Tomogram Single Plane (76100) $309.52 $584 2.6×

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.