Imaging prices at Samaritan Medical Center
Watertown, NY · every code in this section with a posted price and a Medicare benchmark.
352 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) | $3,722 | $3,722 | 2.2× |
| Abdomen 1 View (74018) range across 2 matching MRF lines |
$289.50–$301.50 | $289.50–$301.50 | varies |
| Abdomen 2 views (74019) range across 2 matching MRF lines |
$315–$328 | $315–$328 | varies |
| Acute Gastrointestinal Blood Loss Imaging (78278) | $1,652.50 | $1,652.50 | 3.3× |
| Acute venous thrombosis imaging, peptide Non-Facility (78456) | $2,824.50 | $2,824.50 | 1.7× |
| Angio internal mammary (75756) | $5,102 | $5,102 | 1.3× |
| Angio pulmonary bilat (75743) | $6,361 | $6,361 | 1.6× |
| Angiography Adrenal Bilateral Slctv Rs&I (75733) | $4,734.50 | $4,734.50 | 1.2× |
| Angiography extremity bilateral rs&i (75716) range across 2 matching MRF lines |
$5,078.50–$6,809 | $5,078.50–$6,809 | varies |
| Angiography extremity unilateral rs&i (75710) | $5,078.50 | $5,078.50 | 1.3× |
| Angiography pulmonary unilateral slctv rs&i (75741) | $4,870 | $4,870 | 1.2× |
| Angrph pulmonary nonslctv cath/ven njx rs&i (75746) | $3,629 | $3,629 | 0.9× |
| Ankle 2 views (73600) range across 2 matching MRF lines |
$265–$276 | $265–$276 | varies |
| Aortography thoracic serialography rs&i (75605) | $5,850 | $5,850 | 0.8× |
| Artery X-Rays Abdomen (75726) | $5,937.50 | $5,937.50 | 0.9× |
| Artery X-Rays Adrenal Gland (75731) | $6,809 | $6,809 | 1.7× |
| Artery X-Rays Pelvis (75736) | $11,694 | $11,694 | 1.7× |
| Artery X-Rays Spine (75705) | $11,694 | $11,694 | 1.7× |
| Arthrogram ankle (73615) | $1,200 | $1,200 | 2.8× |
| Arthrogram hip (73525) | $825 | $825 | 1.9× |
| Arthrogram Wrist (73115) | $1,257.50 | $1,257.50 | 2.9× |
| Basic radiation dosimetry calculation (77300) | $288 | $288 | 1.7× |
| Bone age studies (77072) range across 2 matching MRF lines |
$359.50–$373.50 | $359.50–$373.50 | varies |
| Bone Imaging 3 Phase (78315) | $2,649.50 | $2,649.50 | 5.3× |
| Bone Imaging Limited Area (78300) | $1,498.50 | $1,498.50 | 3.0× |
| Bone Imaging Multiple Areas (78305) | $1,867 | $1,867 | 3.7× |
| Bone Imaging Whole Body (78306) | $2,120 | $2,120 | 4.2× |
| Bone survey infant (77076) range across 2 matching MRF lines |
$361–$375 | $361–$375 | varies |
| Brain Imaging Min 4 Static Views W Vascular Flow (78606) | $1,578.50 | $1,578.50 | 2.3× |
| Brain Imaging Pet Metabolic Evaluation (78608) | $3,172 | $3,172 | 1.8× |
| Cerebrospinal Fluid Scan (78630) | $2,812 | $2,812 | 4.1× |
| Chest 1 view (71045) range across 2 matching MRF lines |
$271.50–$282 | $271.50–$282 | varies |
| Chest 2 views (71046) range across 2 matching MRF lines |
$321–$334 | $321–$334 | varies |
| Chest 3 views (71047) range across 2 matching MRF lines |
$357–$371 | $357–$371 | varies |
| Chest 4 or more views (71048) range across 2 matching MRF lines |
$415–$431.50 | $415–$431.50 | varies |
| Clavicle complete (73000) range across 2 matching MRF lines |
$221–$230 | $221–$230 | varies |
| Computed Tomography Thorax Lw Dose Lng Ca Scr C- (71271) | $3,524.50 | $3,524.50 | 27.0× |
| Continuing medical physics consltj pr wk (77336) | $288 | $288 | 1.7× |
| Contrast Exam Abdominl Aorta (75625) | $4,870 | $4,870 | 1.2× |
| Contrast X-Ray Bladder (74430) | $622 | $622 | 1.4× |
| Contrast X-Ray Of Elbow (73085) | $1,257.50 | $1,257.50 | 2.9× |
| Contrast X-Ray Of Knee Joint (73580) | $1,257.50 | $1,257.50 | 2.9× |
| CT abdomen and pelvis without and with contrast (74178) | $4,190 | $4,190 | 9.6× |
| CT abdomen and pelvis without contrast (74176) | $3,100 | $3,100 | 10.4× |
| CT abdomen w contrast (74160) | $3,547.50 | $3,547.50 | 16.2× |
| CT abdomen w wo contrast (74170) | $4,190 | $4,190 | 19.1× |
| CT abdomen w/o contrast (74150) | $3,100 | $3,100 | 23.8× |
| CT Angio Abdomen and Pelvis (74174) | $3,607 | $3,607 | 8.3× |
| CT Angio Chest (71275) | $4,899 | $4,899 | 22.4× |
| CT Angio Head (70496) | $4,502 | $4,502 | 20.6× |
| Ct Angio Lwr Extr W/O&W/Dye (73706) | $1,317 | $1,317 | 6.0× |
| CT Angio Neck (70498) | $4,496 | $4,496 | 20.5× |
| Ct Angio Upr Extrm W/O&W/Dye (73206) | $3,639.50 | $3,639.50 | 16.6× |
| CT cervical spine w/ contrast (72126) | $2,936 | $2,936 | 6.7× |
| CT cervical spine w/o contrast (72125) | $3,501.50 | $3,501.50 | 26.8× |
| CT cervical spine w/wo cont (72127) | $4,767.50 | $4,767.50 | 21.8× |
| CT chest w contrast (71260) | $3,866 | $3,866 | 17.7× |
| CT chest w/wo contrast (71270) | $1,693.50 | $1,693.50 | 7.7× |
| CT head/brain with contrast (70460) | $1,317 | $1,317 | 6.0× |
| CT head/brain without and with contrast (70470) | $4,432 | $4,432 | 20.2× |
| CT iac w contrast (70481) | $1,317 | $1,317 | 6.0× |
| CT l-spine w&w/o contrast (72133) | $4,604.50 | $4,604.50 | 21.0× |
| CT lower ext w/o (73700) | $1,317 | $1,317 | 10.1× |
| CT lower extremity w/contrast material (73701) | $3,004 | $3,004 | 13.7× |
| CT lumbar spine w contrast (72132) | $2,689 | $2,689 | 6.2× |
| CT lumbar spine w/o contrast (72131) | $1,003.50 | $1,003.50 | 7.7× |
| CT maxillofacial w contrast (70487) | $1,317 | $1,317 | 6.0× |
| CT maxillofacial wo contrast (70486) | $3,501.50 | $3,501.50 | 26.8× |
| CT neck tissue combo (70492) | $4,548 | $4,548 | 20.8× |
| Ct Orbit/Ear/Fossa W/O&W/Dye (70482) | $2,916.50 | $2,916.50 | 13.3× |
| CT orbits w/o contrast (70480) | $3,030.50 | $3,030.50 | 23.2× |
| CT pelvis w&w/o contrast (72194) | $4,073.50 | $4,073.50 | 18.6× |
| CT pelvis w/o contrast (72192) | $1,003.50 | $1,003.50 | 7.7× |
| CT scans face/jaw combo (70488) | $1,693.50 | $1,693.50 | 7.7× |
| CT soft tissue neck w contrast (70491) | $3,869.50 | $3,869.50 | 17.7× |
| CT soft tissue neck w/o contrast (70490) | $1,003.50 | $1,003.50 | 7.7× |
| CT thoracic spine w contrast (72129) | $3,758 | $3,758 | 17.2× |
| CT thoracic spine w/o contrast (72128) | $1,003.50 | $1,003.50 | 7.7× |
| CT thoracic spine w/wo cont (72130) | $4,455.50 | $4,455.50 | 20.3× |
| CT thorax w/o contrast (71250) | $3,524.50 | $3,524.50 | 27.0× |
| CT upper ext wo (73200) | $2,922.50 | $2,922.50 | 22.4× |
| CT upper extremity w/o & w/contrast material (73202) | $3,724.50 | $3,724.50 | 17.0× |
| CT upper extremity with contrast (73201) | $3,248 | $3,248 | 7.5× |
| Cta Abdl Aorta&Bi Iliofem W/Contrast&Postp (75635) | $1,317 | $1,317 | 6.0× |
| Cta Abdomen (74175) | $4,211.50 | $4,211.50 | 19.2× |
| CTA pelvis (72191) | $1,693.50 | $1,693.50 | 7.7× |
| Dacryocystography, nasolacrimal duct, radiological supervision and interpretation Non-Facility (70170) | $651 | $651 | 2.2× |
| Dilation ureters/urethra rs&i (74485) | $4,431.50 | $4,431.50 | 1.7× |
| Discography Cerv/Thor Spine (72285) range across 2 matching MRF lines |
$2,839.50–$4,224.50 | $2,839.50–$4,224.50 | varies |
| Diskography lumbar (72295) range across 2 matching MRF lines |
$2,839.50–$4,224.50 | $2,839.50–$4,224.50 | varies |
| Doppler Fetal Mid Cerebral Artery (76821) | $636.50 | $636.50 | 4.9× |
| Dxa Bone Density Axial (77080) | $1,094.50 | $1,094.50 | 8.4× |
| Dxa bone density study (77085) | $843.50 | $843.50 | 6.5× |
| Dxa bone density study 1/>sites appendiclr skel (77081) | $278 | $278 | 2.6× |
| Echo exam of fetal heart (76825) | $636.50 | $636.50 | 0.9× |
| Echo exam uterus (76831) | $756.50 | $756.50 | 2.5× |
| Echo Guide For Artery Repair (76936) | $4,086.50 | $4,086.50 | 15.2× |
| Echograp Trans R Pros Study (76873) | $483 | $483 | 3.7× |
| Esophagram (74220) | $550.50 | $550.50 | 2.5× |
| Fetal Biophys Profile W/Nst (76818) | $1,187 | $1,187 | 9.1× |
| Fetal Biophysical Profile W/O Non-Stress Testing (76819) range across 2 matching MRF lines |
$496–$516 | $496–$516 | varies |
| Fluoroscopy up to 1 hr (76000) | $549 | $549 | 1.8× |
| Follow-Up Angiography (75898) | $6,809 | $6,809 | 1.7× |
| Foot 2 views (73620) range across 2 matching MRF lines |
$265–$276 | $265–$276 | varies |
| Forearm 2 views (73090) range across 2 matching MRF lines |
$261.50–$271.50 | $261.50–$271.50 | varies |
| Gastric emptying imaging study (78264) | $1,418 | $1,418 | 2.8× |
| Gastroesophageal Reflux Exam (78262) | $1,951.50 | $1,951.50 | 3.9× |
| Gated Heart Planar Single (78472) | $2,686.50 | $2,686.50 | 5.4× |
| Hand 2 views (73120) range across 2 matching MRF lines |
$265–$276 | $265–$276 | varies |
| Hepatc Vngrph Wdg/Fr Hemodyn Eval Rs&I (75889) | $6,809 | $6,809 | 1.7× |
| Hepatc Vngrph Wdg/Fr W/O Hemodyn Eval Rs&I (75891) | $6,809 | $6,809 | 1.7× |
| Hepatobil Syst Image W/Drug (78227) | $2,227 | $2,227 | 3.3× |
| Hepatobiliary System Imaging (78226) | $1,592.50 | $1,592.50 | 3.2× |
| Ht Musc Image Planar Mult (78454) | $2,927.50 | $2,927.50 | 1.8× |
| Ht Muscle Image Spect Sing (78451) | $2,927.50 | $2,927.50 | 1.8× |
| Hysterosalpingogram (74740) | $1,331 | $1,331 | 4.5× |
| Infant hip ultrasound with hip movement (dynamic) (76885) | $554.50 | $554.50 | 5.1× |
| Infant hip ultrasound, limited static exam (76886) | $402.50 | $402.50 | 3.7× |
| Infusion Ivp (74410) | $1,128 | $1,128 | 5.2× |
| K Flow/Funct Image Multiple (78709) | $1,910.50 | $1,910.50 | 2.8× |
| K Flow/Funct Image W/Drug (78708) | $1,720.50 | $1,720.50 | 2.5× |
| K Flow/Funct Image W/O Drug (78707) | $2,349.50 | $2,349.50 | 3.5× |
| Kidney Imaging Morphol (78700) | $958.50 | $958.50 | 1.9× |
| Kidney Imaging Morphoogy W/Vascular Flow (78701) | $689 | $689 | 1.4× |
| Liver & Spleen Imaging Static Only (78215) | $2,062 | $2,062 | 4.1× |
| Lung Perf&Ventilat Diferentl (78598) | $810.50 | $810.50 | 1.2× |
| Lung Ventilat&Perfus Imaging (78582) | $1,750 | $1,750 | 2.6× |
| Lung Ventilation Imaging (78579) | $1,882 | $1,882 | 3.8× |
| Lymph System Imaging (78195) | $1,414.50 | $1,414.50 | 2.1× |
| Magnetic Image Jaw Joint (70336) | $2,647.50 | $2,647.50 | 8.9× |
| Mammary ductogram or galactogram multiple (77054) | $1,511.50 | $1,511.50 | 5.1× |
| Mammary ductogram or galactogram single (77053) | $1,281.50 | $1,281.50 | 4.3× |
| Meckels Divert Exam (78290) | $1,792 | $1,792 | 3.6× |
| Mlc imrt design & construction per imrt plan (77338) | $1,933 | $1,933 | 4.1× |
| Mra Head W/O & W/Contrast Material (70546) | $2,689 | $2,689 | 6.2× |
| MRA head w/o contrast (70544) | $5,131 | $5,131 | 17.2× |
| MRA head with contrast (70545) | $5,131 | $5,131 | 11.8× |
| MRA neck w contrast (70548) | $5,131 | $5,131 | 11.8× |
| Mra Neck W/O &W/Contrast Material (70549) | $5,131 | $5,131 | 11.8× |
| MRA neck w/o contrast (70547) | $5,131 | $5,131 | 17.2× |
| MRI abdomen w contrast (74182) | $2,689 | $2,689 | 6.2× |
| MRI abdomen w/o contrast (74181) | $4,751 | $4,751 | 16.0× |
| MRI any jt lower extrem w/contrast material (73722) | $4,270 | $4,270 | 4.4× |
| MRI any jt lower extrem w/o & w/contrast matrl (73723) | $4,969.50 | $4,969.50 | 11.4× |
| MRI any jt upper extremity w/contrast matrl (73222) | $4,751 | $4,751 | 4.9× |
| MRI Breast W/O Contrast Bilateral (77047) | $1,189.50 | $1,189.50 | 4.0× |
| MRI Breast Without Contrast Material Unilateral (77046) | $1,212.50 | $1,212.50 | 4.1× |
| MRI cervical spine w contrast (72142) | $2,689 | $2,689 | 6.2× |
| MRI cervical spine w/o cont (72141) | $5,866.50 | $5,866.50 | 19.7× |
| MRI chest w/o contrast (71550) | $6,216 | $6,216 | 20.9× |
| MRI chest with contrast (71551) | $7,145 | $7,145 | 7.3× |
| MRI chest wo w contrast (71552) | $8,578 | $8,578 | 19.7× |
| MRI lower extrem oth/thn jt w/contrast matrl (73719) | $2,689 | $2,689 | 6.2× |
| MRI lower extrem oth/thn jt w/o & w/contr matr (73720) | $5,131 | $5,131 | 11.8× |
| MRI lower extrem oth/thn jt w/o contr matrl (73718) | $3,808 | $3,808 | 12.8× |
| MRI lumbar spine w contrast (72149) | $2,689 | $2,689 | 6.2× |
| Mri Neck Spine W/O & W/Dye (72156) | $7,440 | $7,440 | 17.1× |
| MRI orbit face &/neck w/o contrast (70540) | $5,584 | $5,584 | 18.7× |
| MRI orbit face neck w contrast (70542) | $2,689 | $2,689 | 6.2× |
| Mri Orbt/Fac/Nck W/O &W/Dye (70543) | $7,390.50 | $7,390.50 | 17.0× |
| MRI pelvis w contrast (72196) | $5,749 | $5,749 | 13.2× |
| MRI pelvis w/o & w contrast (72197) | $6,897.50 | $6,897.50 | 15.8× |
| MRI pelvis w/o contrast (72195) | $1,705.50 | $1,705.50 | 5.7× |
| MRI thoracic spine w/o contrast (72146) | $1,705.50 | $1,705.50 | 5.7× |
| MRI upper extremity oth than jt w/contr matrl (73219) | $3,817 | $3,817 | 8.8× |
| MRI upper extremity oth than jt w/o contr matrl (73218) | $1,705.50 | $1,705.50 | 5.7× |
| Mri Uppr Extremity W/O&W/Dye (73220) | $4,751 | $4,751 | 10.9× |
| MRI, abdomen, combo (74183) | $4,751 | $4,751 | 10.9× |
| MRI, dorsal spine combo (72157) | $7,935.50 | $7,935.50 | 18.2× |
| MRI, dorsal spine contrast (72147) | $2,689 | $2,689 | 6.2× |
| MRI, joint upper extrem (73221) | $4,751 | $4,751 | 16.0× |
| MRI, joint upper extrem combo (73223) | $2,689 | $2,689 | 6.2× |
| MRI, lumbar spine combo (72158) | $2,689 | $2,689 | 6.2× |
| Myelogram cervical (72240) | $2,549.50 | $2,549.50 | 2.6× |
| Myelogram Lumbar (72265) | $2,644 | $2,644 | 2.7× |
| Myelography thoracic (72255) | $2,549.50 | $2,549.50 | 2.6× |
| Myelograpy 2/more regions rs&i (72270) | $3,301 | $3,301 | 3.4× |
| Myocardial Perfusion Planar 1 Study Rest/Stress (78453) | $2,927.50 | $2,927.50 | 1.8× |
| Myocardial Spect Multiple Studies (78452) | $2,927.50 | $2,927.50 | 1.8× |
| Neck soft tissue (70360) range across 2 matching MRF lines |
$208–$216 | $208–$216 | varies |
| Nm csf leak detection (78650) | $1,789.50 | $1,789.50 | 1.1× |
| Nonvascular Shunt X-Ray (75809) range across 2 matching MRF lines |
$633–$658.50 | $633–$658.50 | varies |
| Ntsty modul radthx pln dose-vol histos (77301) | $2,960 | $2,960 | 1.7× |
| Nuclear Rx Oral Admin (79005) range across 2 matching MRF lines |
$354–$950 | $354–$950 | varies |
| Ob us nuchal meas 1 gest (76813) range across 3 matching MRF lines |
$401–$417.50 | $401–$417.50 | varies |
| Panoramic X-ray of jaws (70355) | $341.50 | $341.50 | 3.1× |
| Parathyroid Planar Imaging (78070) | $478 | $478 | 1.0× |
| Parathyroid planar imaging w/wo subtraction (78071) | $1,367 | $1,367 | 2.7× |
| Pelvis 1 or 2 views (72170) range across 2 matching MRF lines |
$310.50–$323 | $310.50–$323 | varies |
| Peritoneogram Rs&I (74190) | $2,472.50 | $2,472.50 | 3.6× |
| Pet Image Skull-Thigh (78812) | $7,627 | $7,627 | 4.3× |
| Pet Image W/Ct Lmtd (78814) | $7,627 | $7,627 | 4.3× |
| PET image w/CT, full body (78816) | $7,627 | $7,627 | 4.3× |
| PET imaging CT attenuation skull base mid-thigh (78815) range across 21 matching MRF lines |
$3,034–$7,627 | $3,034–$7,627 | varies |
| Pet Imaging Limited Area Chest Head/Neck (78811) | $7,627 | $7,627 | 4.7× |
| PET whole body (78813) | $7,627 | $7,627 | 4.3× |
| Prq Transhepatc Portograpy Hemodyn Eval Rs&I (75885) | $6,809 | $6,809 | 1.7× |
| Pulmonary Perfusion Imaging Particulate (78580) | $1,799.50 | $1,799.50 | 3.6× |
| Radex Abd Compl Aqt Abd W/S/E/D Views 1 View Ch (74022) range across 3 matching MRF lines |
$553–$575.50 | $553–$575.50 | varies |
| Radex abscess/fistula/sinus tract rs&i (76080) | $738 | $738 | 1.1× |
| Radex Ankle Complete Minimum 3 Views (73610) range across 2 matching MRF lines |
$314.50–$327.50 | $314.50–$327.50 | varies |
| Radex Calcaneus Minimum 2 Views (73650) range across 2 matching MRF lines |
$208–$216 | $208–$216 | varies |
| Radex elbow complete minimum 3 views (73080) range across 2 matching MRF lines |
$304–$316 | $304–$316 | varies |
| Radex Facial Bones Complete Minimum 3 Views (70150) range across 2 matching MRF lines |
$523.50–$544.50 | $523.50–$544.50 | varies |
| Radex fingr minimum 2 views (73140) range across 2 matching MRF lines |
$207.50–$215.50 | $207.50–$215.50 | varies |
| Radex foot complete minimum 3 views (73630) range across 2 matching MRF lines |
$314.50–$327.50 | $314.50–$327.50 | varies |
| Radex Hand Minimum 3 Views (73130) range across 2 matching MRF lines |
$286–$297 | $286–$297 | varies |
| Radex lower extremity infant minimum 2 views (73592) range across 2 matching MRF lines |
$240–$249.50 | $240–$249.50 | varies |
| Radex Mastoids Compl Minimum 3 Views PR Side (70130) range across 2 matching MRF lines |
$529.50–$550.50 | $529.50–$550.50 | varies |
| Radex Nasal Bones Complete Minimum 3 Views (70160) range across 2 matching MRF lines |
$312–$324 | $312–$324 | varies |
| Radex Ribs Unilateral 2 Views (71100) range across 2 matching MRF lines |
$321–$334 | $321–$334 | varies |
| Radex shoulder complete minimum 2 views (73030) range across 2 matching MRF lines |
$310–$322.50 | $310–$322.50 | varies |
| Radex Sinuses Paransl < 3 Views (70210) range across 2 matching MRF lines |
$265–$276 | $265–$276 | varies |
| Radex Spine 1 View Specify Level (72020) | $136.50 | $136.50 | 1.3× |
| Radex Sternum Minimum 2 Views (71120) range across 2 matching MRF lines |
$312–$324 | $312–$324 | varies |
| Radex Temporomandble Jt Opn & Clsd Mouth Bilat (70330) range across 2 matching MRF lines |
$445.50–$463.50 | $445.50–$463.50 | varies |
| Radex Toe Minimum 2 Views (73660) range across 2 matching MRF lines |
$180.50–$188 | $180.50–$188 | varies |
| Radex upper extremity infant minimum 2 views (73092) range across 2 matching MRF lines |
$240–$249.50 | $240–$249.50 | varies |
| Radex Wrist Complete Minimum 3 Views (73110) range across 2 matching MRF lines |
$286–$297 | $286–$297 | varies |
| Radex X-Ray Exam Entire Spi 6/> Vw - Xr Entire Spine 6+ Vw (72084) range across 2 matching MRF lines |
$872–$906 | $872–$906 | varies |
| Radiation treatment delivery level 1 (77402) | $459 | $459 | 3.6× |
| Radiation treatment delivery level 2 (77407) | $834 | $834 | 1.7× |
| Radiation treatment delivery level 3 (77412) | $1,013 | $1,013 | 1.5× |
| Radiolog exam mandible compl minimum 4 views (70110) range across 2 matching MRF lines |
$485–$504 | $485–$504 | varies |
| Radiologic Exam Abdomen 3+ Views - Xr Abdomen 3+ Views (74021) range across 3 matching MRF lines |
$400–$415.50 | $400–$415.50 | varies |
| Radiologic exam colon double contrast study (74280) | $1,334 | $1,334 | 6.1× |
| Radiologic exam colon single contrast study (74270) | $1,043 | $1,043 | 4.8× |
| Radiologic exam knee complete 4/more views (73564) range across 2 matching MRF lines |
$312–$324 | $312–$324 | varies |
| Radiologic exam pelvis compl minimum 3 views (72190) range across 2 matching MRF lines |
$361–$375 | $361–$375 | varies |
| Radiologic Exam Small Int Single Contrast Study (74250) | $647.50 | $647.50 | 3.0× |
| Radiologic exam swallow function contrast study (74230) | $353.50 | $353.50 | 1.6× |
| Radiologic exam teeth complete full mouth (70320) | $498 | $498 | 1.7× |
| Radiologic Exam Teeth Prtl Exam < Full Mouth (70310) | $523.50 | $523.50 | 1.8× |
| Radiologic exam upr gi trc double contrast study (74246) range across 2 matching MRF lines |
$436.50–$1,090.50 | $436.50–$1,090.50 | varies |
| Radiologic examination femur minimum 2 views (73552) range across 2 matching MRF lines |
$324.50–$337.50 | $324.50–$337.50 | varies |
| Radiologic examination knee 1/2 views (73560) range across 2 matching MRF lines |
$300.50–$312 | $300.50–$312 | varies |
| Radiologic Examination Salivary Gland Calculus (70380) | $324 | $324 | 3.0× |
| Radiologic examination tibia & fibula 2 views (73590) range across 2 matching MRF lines |
$324.50–$337.50 | $324.50–$337.50 | varies |
| Radiologic examination, teeth; single view Non-Facility (70300) | $134.50 | $134.50 | 1.2× |
| Renal Cyst Study (74470) | $994 | $994 | 1.5× |
| Ribs bilateral 3 views (71110) range across 2 matching MRF lines |
$368–$382.50 | $368–$382.50 | varies |
| Rp loclzj tum plnr 1 area single day imaging (78800) | $873 | $873 | 1.7× |
| Rp loclzj tum plnr 2+area 1+d img/1 area img>2+d (78801) | $1,100 | $1,100 | 2.2× |
| Rp Loclzj Tum Plnr Whole Body 2+ Days Imaging (78804) | $1,850.50 | $1,850.50 | 2.7× |
| Rp Loclzj Tum Plnr Whole Body Single Day Imaging (78802) | $1,798.50 | $1,798.50 | 2.7× |
| Rp Loclzj Tum Spect 1 Area Single Day Imaging (78803) | $2,824.50 | $2,824.50 | 4.2× |
| Rp Ther Radiolbld Monoclonal Antibody IV Infus (79403) | $1,577 | $1,577 | 5.4× |
| Rp Therapy Intravenous Administration (79101) | $603 | $603 | 2.1× |
| Scapula (73010) range across 2 matching MRF lines |
$312–$324 | $312–$324 | varies |
| Screening Digital Breast Tomosynthesis Bi (77063) | $146 | $146 | 6.2× |
| Shoulder 1 view (73020) range across 2 matching MRF lines |
$265–$276 | $265–$276 | varies |
| Shoulder Arthrography (73040) | $825 | $825 | 1.9× |
| Sialogram (70390) | $651 | $651 | 2.2× |
| Skull less than 4 views (70250) range across 2 matching MRF lines |
$294–$305.50 | $294–$305.50 | varies |
| Special dosimetry (77331) | $334 | $334 | 2.0× |
| Special Physics Consult (77370) | $288 | $288 | 1.7× |
| Stereotactic Body Radiation Delivery (77373) | $7,938.50 | $7,938.50 | 3.6× |
| Sternoclavicular joints (71130) range across 2 matching MRF lines |
$415–$431.50 | $415–$431.50 | varies |
| Superior sagittal sinus venogram (75870) | $6,809 | $6,809 | 1.7× |
| Telethx isodose pln cplx w/basic dosimetry (77307) | $1,794 | $1,794 | 3.8× |
| Testicular Imaging W/Flow (78761) | $1,142.50 | $1,142.50 | 2.3× |
| Ther Rad Simulaj-Aided Field Setting Complex (77290) | $792 | $792 | 1.7× |
| Ther Rad Simulaj-Aided Field Setting Intermed (77285) | $3,251 | $3,251 | 7.0× |
| Ther rad simulaj-aided field setting simple (77280) | $288 | $288 | 1.7× |
| Thoracic spine 2 views (72070) range across 2 matching MRF lines |
$183–$189.50 | $183–$189.50 | varies |
| Thoracic spine 3 views (72072) range across 2 matching MRF lines |
$502–$522 | $502–$522 | varies |
| Thoracolumbar 2 views (72080) range across 2 matching MRF lines |
$389.50–$405.50 | $389.50–$405.50 | varies |
| Thyroid Imaging With Vascular Flow (78013) | $795.50 | $795.50 | 1.6× |
| Thyroid Met Imaging Body (78018) | $1,720.50 | $1,720.50 | 2.5× |
| Thyroid Uptake Measurement (78012) | $622 | $622 | 1.2× |
| Thyroid Uptake W/Blood Flow Sngle/Mult Quan Meas (78014) | $1,308 | $1,308 | 2.6× |
| Tx Devices Design & Construction Complex (77334) | $1,354.50 | $1,354.50 | 2.9× |
| Tx devices design & construction simple (77332) | $532.50 | $532.50 | 3.2× |
| Ultrasound Breast Limited (76642) range across 4 matching MRF lines |
$194.50–$486 | $194.50–$486 | varies |
| Ultrasound Elastography Parenchyma (76981) | $227 | $227 | 1.7× |
| Ultrasound Exam Aaa Screen (76706) | $796.50 | $796.50 | 6.1× |
| Ultrasound, abdomen limited (76705) range across 2 matching MRF lines |
$766–$796.50 | $766–$796.50 | varies |
| Umbilical-artery Doppler (OB) (76820) range across 3 matching MRF lines |
$612–$636.50 | $612–$636.50 | varies |
| Upper gi w/o kub (74240) range across 2 matching MRF lines |
$392–$1,029.50 | $392–$1,029.50 | varies |
| Ureteral Reflux Study (78740) | $1,245 | $1,245 | 2.5× |
| Urethrocystogram voiding (74455) | $968.50 | $968.50 | 3.3× |
| Urethrocystography retrograde (74450) | $832 | $832 | 2.8× |
| Us breast unilateral complete (76641) range across 2 matching MRF lines |
$467–$486 | $467–$486 | varies |
| Us chest (76604) | $696.50 | $696.50 | 5.3× |
| Us complete joint (76881) range across 4 matching MRF lines |
$780–$1,387.50 | $780–$1,387.50 | varies |
| Us exam, pelvic, limited (76857) range across 3 matching MRF lines |
$478.50–$497.50 | $478.50–$497.50 | varies |
| Us head (76506) | $766 | $766 | 5.9× |
| Us kidney transplant (76776) | $823.50 | $823.50 | 6.3× |
| Us lmtd joint/oth nonvasc xtr strux r-t w/img (76882) range across 2 matching MRF lines |
$1,171.50–$1,218 | $1,171.50–$1,218 | varies |
| Us ob detailed single fetus (76811) range across 2 matching MRF lines |
$525–$546 | $525–$546 | varies |
| Us ob limited 1 or more fetuses (76815) range across 4 matching MRF lines |
$239.50–$731.50 | $239.50–$731.50 | varies |
| Us ob transvaginal (76817) range across 4 matching MRF lines |
$239.50–$496 | $239.50–$496 | varies |
| Us pelvic non ob complete (76856) range across 2 matching MRF lines |
$949–$986.50 | $949–$986.50 | varies |
| Us pg uter img f&mat 14 wk tabdl 1/1st gestation (76801) range across 3 matching MRF lines |
$239.50–$496 | $239.50–$496 | varies |
| Us preg uterus real time f/u trnsabdl per fetus (76816) range across 2 matching MRF lines |
$332–$345 | $332–$345 | varies |
| Us retroperitoneal complete (76770) | $1,128 | $1,128 | 8.6× |
| Us retroperitoneal limited (76775) range across 4 matching MRF lines |
$758.50–$788.50 | $758.50–$788.50 | varies |
| Us scrotum and contents (76870) range across 2 matching MRF lines |
$865.50–$900.50 | $865.50–$900.50 | varies |
| Us spinal canal and contents (76800) | $865.50 | $865.50 | 6.6× |
| Us thyroid (76536) range across 3 matching MRF lines |
$239.50–$1,007.50 | $239.50–$1,007.50 | varies |
| Us transrectal (76872) | $574 | $574 | 4.4× |
| Vein X-Ray Chest (75827) | $4,870 | $4,870 | 2.5× |
| Vein X-Ray Liver W/O Hemodyn (75887) | $6,809 | $6,809 | 1.7× |
| Venogram Sinus/Jugular (75860) | $6,809 | $6,809 | 1.7× |
| Venography Adrenal Unilateral (75840) | $6,809 | $6,809 | 1.7× |
| Venography caval inferior serialography rs&i (75825) | $4,870 | $4,870 | 1.2× |
| Venography extremity bilateral rs&i (75822) | $2,700.50 | $2,700.50 | 1.4× |
| Venography extremity unilateral rs&i (75820) | $3,361 | $3,361 | 1.7× |
| Venography Renal Bilateral (75833) | $4,734.50 | $4,734.50 | 1.2× |
| Venography Renal Unilateral (75831) | $6,809 | $6,809 | 1.7× |
| Venous sampling by catheter (75893) range across 2 matching MRF lines |
$11,692.50–$11,694 | $11,692.50–$11,694 | varies |
| Vertebral fracture assessment via dxa (77086) | $695 | $695 | 6.4× |
| Wrist 2 views (73100) range across 2 matching MRF lines |
$265–$276 | $265–$276 | varies |
| X-Ray Ac Jts - Xr Acromioclavicular Joints Bilateral (73050) range across 2 matching MRF lines |
$364–$379 | $364–$379 | varies |
| X-ray antegrade pyelogram tube (74425) | $622 | $622 | 1.4× |
| X-Ray Aorta Leg Arteries (75630) | $5,714.50 | $5,714.50 | 1.4× |
| X-Ray Elbow 2 Vw - Xr Elbow 1-2 Views Right (73070) range across 2 matching MRF lines |
$265–$276 | $265–$276 | varies |
| X-Ray Exam Breast Specimen (76098) | $1,186.50 | $1,186.50 | 1.7× |
| X-Ray Exam Entire Spi 1 Vw (72081) range across 2 matching MRF lines |
$790.50–$822 | $790.50–$822 | varies |
| X-Ray Exam Entire Spi 2/3 Vw (72082) range across 2 matching MRF lines |
$830–$863 | $830–$863 | varies |
| X-Ray Exam Entire Spi 4/5 Vw (72083) range across 2 matching MRF lines |
$872–$906 | $872–$906 | varies |
| X-Ray Exam Hip Uni 1 View (73501) range across 2 matching MRF lines |
$321–$333.50 | $321–$333.50 | varies |
| X-Ray Exam Hip Uni 2-3 Views (73502) range across 2 matching MRF lines |
$336.50–$350 | $336.50–$350 | varies |
| X-Ray Exam Hip Uni 4/> Views (73503) range across 2 matching MRF lines |
$354–$368.50 | $354–$368.50 | varies |
| X-Ray Exam Hips Bi 2 Views (73521) range across 2 matching MRF lines |
$613–$638 | $613–$638 | varies |
| X-Ray Exam Hips Bi 3-4 Views (73522) range across 2 matching MRF lines |
$628–$653 | $628–$653 | varies |
| X-Ray Exam Hips Bi 5/> Views (73523) range across 2 matching MRF lines |
$582.50–$605.50 | $582.50–$605.50 | varies |
| X-Ray Exam L-S Spine Bending (72114) range across 2 matching MRF lines |
$602–$626 | $602–$626 | varies |
| X-Ray Exam Neck Spine 2-3 Vw (72040) range across 2 matching MRF lines |
$410.50–$427 | $410.50–$427 | varies |
| X-Ray Exam Neck Spine 6/>Vws (72052) range across 3 matching MRF lines |
$672.50–$699.50 | $672.50–$699.50 | varies |
| X-Ray Exam Unilat Ribs/Chest (71101) range across 2 matching MRF lines |
$383–$398 | $383–$398 | varies |
| X-ray eye for foreign body (70030) range across 2 matching MRF lines |
$415–$431.50 | $415–$431.50 | varies |
| X-ray humerus (73060) range across 2 matching MRF lines |
$265–$276 | $265–$276 | varies |
| X-ray IV pyelogram (ivp) (74400) | $738 | $738 | 3.4× |
| X-ray IV pyelogram+tomography (74415) | $1,012.50 | $1,012.50 | 4.6× |
| X-Ray Jaw <4 Vw - Xr Mandible < 4 Views (70100) range across 2 matching MRF lines |
$312–$324 | $312–$324 | varies |
| X-Ray Knee Bilat Standing - Xr Knees Anteroposterior Standing Bilat (73565) range across 2 matching MRF lines |
$133.50–$139 | $133.50–$139 | varies |
| X-Ray Lumbar Spine 2/3 Vw - Xr Lumbar Spine 2-3 Views (72100) range across 2 matching MRF lines |
$397.50–$413 | $397.50–$413 | varies |
| X-ray nose-rectum child f.b. (76010) range across 2 matching MRF lines |
$480–$499.50 | $480–$499.50 | varies |
| X-Ray Ribs, Chest 4+ Vw - Xr Ribs 3 Vws Bil W/ Chest Posteroanterior (71111) range across 2 matching MRF lines |
$704.50–$732.50 | $704.50–$732.50 | varies |
| X-Ray Sacroiliac Jts 3+ Vw - Xr Sacroiliac Joints 3+ Views (72202) range across 2 matching MRF lines |
$361–$375 | $361–$375 | varies |
| X-Ray Sacrum/Coccyx 2+ Vw - Xr Sacrum Coccyx 2+ Views (72220) range across 2 matching MRF lines |
$312–$324 | $312–$324 | varies |
| X-Ray Sinuses 3+ Vw - Xr Paranasal Sinuses 3+ Views (70220) range across 2 matching MRF lines |
$480.50–$500 | $480.50–$500 | varies |
| X-Ray Skull 4+ Vw - Xr Skull Complete 4+ Views (70260) range across 2 matching MRF lines |
$560.50–$583 | $560.50–$583 | varies |
| X-ray thoracic spine 4 vw (72074) | $264 | $264 | 2.0× |
| X-Ray Urinary Tract Exam With Contrast Material (74420) | $498 | $498 | 1.1× |
| X-Rays Bone Length Studies (77073) range across 2 matching MRF lines |
$499–$519 | $499–$519 | varies |
| X-Rays Bone Survey Complete (77075) range across 3 matching MRF lines |
$780–$1,659 | $780–$1,659 | varies |
| Xr c-spine 4 or 5 views (72050) range across 3 matching MRF lines |
$289–$300.50 | $289–$300.50 | varies |
| Xr facial bones less than 3 views (70140) range across 2 matching MRF lines |
$318–$331 | $318–$331 | varies |
| XR Mastoids < 3 Views Bilateral (70120) range across 2 matching MRF lines |
$361–$375 | $361–$375 | varies |
| Xr orbits complete 4 views (70200) range across 3 matching MRF lines |
$190.50–$199 | $190.50–$199 | varies |
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.