Imaging prices at San Antonio Regional Hospital
Upland, CA · every code in this section with a posted price and a Medicare benchmark.
336 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) | $933 | $18,658 | 0.5× |
| Abdomen 1 View (74018) | $281 | $1,191 | 2.5× |
| Abdomen 2 views (74019) | $281 | $1,328 | 2.1× |
| Acute Gastrointestinal Blood Loss Imaging (78278) | $809 | $4,876 | 1.6× |
| Angio internal mammary (75756) | $281 | $4,102 | 0.1× |
| Angio pulmonary bilat (75743) | $281 | $9,092 | 0.1× |
| Angiography extremity bilateral rs&i (75716) range across 2 matching MRF lines |
$281–$312 | $14,903 | varies |
| Angiography extremity unilateral rs&i (75710) | $281 | $12,761 | 0.1× |
| Angiography pulmonary unilateral slctv rs&i (75741) range across 2 matching MRF lines |
$281–$2,444 | $4,888 | varies |
| Ankle 2 views (73600) | $281 | $1,112 | 2.5× |
| Aortography thoracic serialography rs&i (75605) likely a partial charge, not the full procedure |
$281 | $12,667 | 0.0× |
| Artery X-Rays Abdomen (75726) | $8,986.50 | $17,973 | 1.3× |
| Artery X-Rays Pelvis (75736) range across 2 matching MRF lines |
$281–$4,625 | $9,250 | varies |
| Artery X-Rays Spine (75705) likely a partial charge, not the full procedure |
$281 | $8,769 | 0.0× |
| Arthrogram ankle (73615) | $281 | $1,601 | 0.6× |
| Arthrogram hip (73525) | $281 | $2,543 | 0.6× |
| Arthrogram Wrist (73115) | $281 | $1,291 | 0.6× |
| Basic radiation dosimetry calculation (77300) | $933 | $1,638 | 5.4× |
| Bone age studies (77072) | $281 | $542 | 2.1× |
| Bone Imaging 3 Phase (78315) | $809 | $6,089 | 1.6× |
| Bone Imaging Limited Area (78300) | $809 | $2,982 | 1.6× |
| Bone Imaging Whole Body (78306) | $809 | $5,951 | 1.6× |
| Bone marrow imaging limited area (78102) | $809 | $2,505 | 1.6× |
| Bone survey infant (77076) | $281 | $642 | 2.1× |
| Brachytx isodose complex (77318) | $933 | $5,655 | 1.9× |
| Brachytx isodose intermed (77317) | $933 | $5,386 | 1.9× |
| Brachytx Isodose Plan Simple (77316) | $933 | $4,530 | 1.9× |
| Brain Imaging Min 4 Static Views W Vascular Flow (78606) | $809 | $3,736 | 1.2× |
| Brain Imaging Pet Metabolic Evaluation (78608) | $2,910 | $12,061 | 1.6× |
| Cardiac MRI w/w/o contrast & further seq (75561) | $1,461 | $6,304 | 3.3× |
| Cardiac Shunt Detection (78428) | $809 | $1,835 | 1.6× |
| Cat Scan Follow-Up Study (76380) | $1,243 | $2,021 | 11.1× |
| Cerebrospinal Fluid Flow W/O Matl Shunt Evaltj (78645) | $809 | $1,588 | 1.2× |
| Cerebrospinal Fluid Scan (78630) | $809 | $4,104 | 1.2× |
| Chest 1 view (71045) range across 2 matching MRF lines |
$281 | $530–$1,009 | 2.5× |
| Chest 2 views (71046) | $281 | $1,506 | 2.5× |
| Chest 3 views (71047) | $281 | $1,520 | 2.5× |
| Chest 4 or more views (71048) | $281 | $1,670 | 2.1× |
| Cineradiograpy/vidradiograpy xcpt where spec (76120) | $281 | $589 | 2.1× |
| Clavicle complete (73000) range across 2 matching MRF lines |
$281 | $1,017–$1,526 | 2.5× |
| Computed Tomography Thorax Lw Dose Lng Ca Scr C- (71271) | $1,243 | $6,485 | 9.2× |
| Continuing medical physics consltj pr wk (77336) | $933 | $2,133 | 5.4× |
| Contrast Exam Abdominl Aorta (75625) | $281 | $15,239 | 0.1× |
| Contrast X-Ray Bladder (74430) | $281 | $1,928 | 0.6× |
| Contrast X-Ray Of Elbow (73085) | $281 | $1,032 | 0.6× |
| Contrast X-Ray Of Knee Joint (73580) | $281 | $1,715 | 0.6× |
| CT abdomen and pelvis without and with contrast (74178) | $1,243 | $22,214 | 2.8× |
| CT abdomen and pelvis without contrast (74176) | $1,243 | $15,400 | 4.1× |
| CT abdomen w contrast (74160) | $1,243 | $12,242 | 5.5× |
| CT abdomen w wo contrast (74170) | $1,243 | $13,428 | 5.5× |
| CT abdomen w/o contrast (74150) | $1,243 | $9,334 | 9.2× |
| CT Angio Abdomen and Pelvis (74174) | $1,243 | $17,310 | 2.8× |
| CT Angio Chest (71275) range across 2 matching MRF lines |
$1,243 | $3,565–$8,812 | 5.5× |
| CT Angio Head (70496) | $1,243 | $10,976 | 5.5× |
| CT angio hrt w/3d image (75574) | $1,243 | $6,135 | 2.8× |
| Ct Angio Lwr Extr W/O&W/Dye (73706) range across 2 matching MRF lines |
$1,243 | $9,618–$14,427 | 5.5× |
| CT Angio Neck (70498) | $1,243 | $11,217 | 5.5× |
| Ct Angio Upr Extrm W/O&W/Dye (73206) range across 2 matching MRF lines |
$1,243 | $10,311–$15,467 | 5.5× |
| CT cervical spine w/ contrast (72126) | $1,243 | $13,559 | 2.8× |
| CT cervical spine w/o contrast (72125) | $1,243 | $10,230 | 9.2× |
| CT cervical spine w/wo cont (72127) | $1,243 | $14,400 | 5.5× |
| CT chest w contrast (71260) | $1,243 | $11,580 | 5.5× |
| CT chest w/wo contrast (71270) | $1,243 | $13,350 | 5.5× |
| CT head/brain with contrast (70460) | $1,243 | $11,596 | 5.5× |
| CT head/brain without and with contrast (70470) | $1,243 | $13,586 | 5.5× |
| CT heart contrast eval cardiac structure&morph (75572) | $1,243 | $7,451 | 2.8× |
| CT heart no contrast quant eval coronry calcium (75571) | $1,243 | $11,982 | 11.1× |
| CT hrt w/3d image congen (75573) | $1,243 | $4,098 | 2.8× |
| CT iac w contrast (70481) | $1,243 | $11,276 | 5.5× |
| CT l-spine w&w/o contrast (72133) range across 2 matching MRF lines |
$1,243–$3,629.50 | $7,259–$15,953 | varies |
| CT lower ext w/o (73700) range across 2 matching MRF lines |
$1,243 | $9,069–$13,604 | 9.2× |
| CT lower extremity w/contrast material (73701) range across 2 matching MRF lines |
$1,243 | $10,583–$15,875 | 5.5× |
| CT lumbar spine w contrast (72132) | $1,243 | $12,457 | 2.8× |
| CT lumbar spine w/o contrast (72131) | $1,243 | $10,205 | 9.2× |
| CT maxillofacial w contrast (70487) | $1,243 | $11,098 | 5.5× |
| CT maxillofacial wo contrast (70486) | $1,243 | $8,539 | 9.2× |
| CT neck tissue combo (70492) | $1,243 | $11,403 | 5.5× |
| Ct Orbit/Ear/Fossa W/O&W/Dye (70482) | $1,243 | $12,250 | 5.5× |
| CT orbits w/o contrast (70480) | $1,243 | $8,916 | 9.2× |
| CT pelvis w&w/o contrast (72194) | $1,243 | $13,605 | 5.5× |
| CT pelvis w/o contrast (72192) | $1,243 | $9,776 | 9.2× |
| CT scan of leg combo (73702) range across 3 matching MRF lines |
$1,243–$3,851.50 | $7,703–$17,556 | varies |
| CT scans face/jaw combo (70488) | $1,243 | $17,119 | 5.5× |
| CT soft tissue neck w contrast (70491) | $1,243 | $10,014 | 5.5× |
| CT soft tissue neck w/o contrast (70490) | $1,243 | $8,768 | 9.2× |
| CT thoracic spine w contrast (72129) | $1,243 | $13,365 | 5.5× |
| CT thoracic spine w/o contrast (72128) | $1,243 | $10,284 | 9.2× |
| CT thorax w/o contrast (71250) | $1,243 | $9,682 | 9.2× |
| CT unlisted procedure (76497) | $1,243 | $2,990 | 11.1× |
| CT upper ext wo (73200) range across 2 matching MRF lines |
$1,243 | $7,888–$11,832 | 9.2× |
| CT upper extremity with contrast (73201) range across 2 matching MRF lines |
$1,243 | $10,275–$15,413 | 2.8× |
| Cta Abdl Aorta&Bi Iliofem W/Contrast&Postp (75635) | $1,243 | $10,876 | 5.5× |
| Cta Abdomen (74175) | $1,243 | $9,535 | 5.5× |
| CTA pelvis (72191) | $1,243 | $11,768 | 5.5× |
| Dilation ureters/urethra rs&i (74485) | $281 | $2,621 | 0.1× |
| Diskography lumbar (72295) | $281 | $6,403 | 0.1× |
| Doppler Fetal Mid Cerebral Artery (76821) | $312 | $687 | 2.3× |
| Dxa Bone Density Axial (77080) | $281 | $1,261 | 2.1× |
| Echo exam uterus (76831) | $312 | $1,547 | 1.0× |
| Echo Guide For Artery Repair (76936) | $312 | $2,791 | 1.1× |
| Echograp Trans R Pros Study (76873) | $312 | $867 | 2.3× |
| Esophagram (74220) | $281 | $1,755 | 1.2× |
| Fetal Biophysical Profile W/O Non-Stress Testing (76819) | $312 | $1,136 | 2.3× |
| Fluoroscopy up to 1 hr (76000) range across 2 matching MRF lines |
$281 | $1,724–$2,561 | 0.9× |
| Follow-Up Angiography (75898) | $281 | $5,086 | 0.1× |
| Foot 2 views (73620) | $281 | $1,008 | 2.5× |
| Forearm 2 views (73090) | $281 | $1,112 | 2.5× |
| Gastric emptying imaging study (78264) | $809 | $5,062 | 1.6× |
| Gastroesophageal Reflux Exam (78262) | $809 | $1,768 | 1.6× |
| Gated Heart Planar Single (78472) | $809 | $6,473 | 1.6× |
| GI Endoscopic US S&I (76975) | $392.50 | $785 | 1.3× |
| Hand 2 views (73120) | $281 | $1,010 | 2.1× |
| Hdr Rdncl Ntrstl/Icav Brchtx (77772) | $933 | $843 | 1.0× |
| Hdr Rdncl Ntrstl/Icav Brchtx 1 Channel (77770) | $933 | $14,118 | 1.0× |
| Hepatc Vngrph Wdg/Fr Hemodyn Eval Rs&I (75889) | $281 | $9,423 | 0.1× |
| Hepatobil Syst Image W/Drug (78227) | $809 | $3,329 | 1.2× |
| Hepatobiliary System Imaging (78226) | $809 | $5,573 | 1.6× |
| Ht Muscle Image Spect Sing (78451) | $809 | $11,169 | 0.5× |
| Hysterosalpingogram (74740) | $281 | $1,630 | 0.9× |
| Infant hip ultrasound with hip movement (dynamic) (76885) | $312 | $911 | 2.8× |
| Infant hip ultrasound, limited static exam (76886) | $312 | $456 | 2.8× |
| Interstitial radiation source applic complex (77778) | $933 | $2,897 | 1.0× |
| Intracavitary Radiation Source Applic Complex (77763) | $933 | $1,127 | 1.0× |
| Intracavitary Radiation Source Applic Intermed (77762) | $933 | $977 | 1.3× |
| Intracavitary radiation source applic simple (77761) | $933 | $809 | 1.3× |
| Joint Survey Single View (77077) | $281 | $2,909 | 2.1× |
| K Flow/Funct Image Multiple (78709) | $809 | $5,126 | 1.2× |
| K Flow/Funct Image W/Drug (78708) | $809 | $5,825 | 1.2× |
| K Flow/Funct Image W/O Drug (78707) | $809 | $6,741 | 1.2× |
| Kidney Imaging Morphol (78700) | $809 | $1,448 | 1.6× |
| Knee 3 Views (73562) | $281 | $1,170 | 2.5× |
| Leveen/Shunt Patency Exam (78291) | $809 | $1,656 | 1.6× |
| Liver & Spleen Imaging Static Only (78215) | $809 | $3,972 | 1.6× |
| Liver imaging w/vascular flow (78202) | $809 | $1,656 | 1.2× |
| Lung Perf&Ventilat Diferentl (78598) | $809 | $5,370 | 1.2× |
| Lung perfusion differential (78597) | $809 | $5,382 | 1.6× |
| Lung Ventilat&Perfus Imaging (78582) | $809 | $8,228 | 1.2× |
| Lung Ventilation Imaging (78579) | $809 | $1,729 | 1.6× |
| Lymph System Imaging (78195) | $809 | $4,838 | 1.2× |
| Magnetic Image Jaw Joint (70336) | $1,461 | $8,107 | 4.8× |
| Mammary ductogram or galactogram multiple (77054) | $187 | $1,949 | 0.6× |
| Mammary ductogram or galactogram single (77053) | $281 | $1,275 | 0.9× |
| Meckels Divert Exam (78290) | $809 | $1,335 | 1.6× |
| Mlc imrt design & construction per imrt plan (77338) | $933 | $12,665 | 1.9× |
| Mra Head W/O & W/Contrast Material (70546) | $1,461 | $16,119 | 3.3× |
| MRA head w/o contrast (70544) | $1,461 | $10,570 | 4.8× |
| MRA head with contrast (70545) | $1,461 | $11,833 | 3.3× |
| MRA neck w contrast (70548) | $1,461 | $10,101 | 3.3× |
| Mra Neck W/O &W/Contrast Material (70549) | $1,461 | $13,314 | 3.3× |
| MRA neck w/o contrast (70547) | $1,461 | $8,498 | 4.8× |
| MRI abdomen w contrast (74182) | $1,461 | $10,662 | 3.3× |
| MRI abdomen w/o contrast (74181) range across 2 matching MRF lines |
$1,461 | $2,480–$9,990 | 4.8× |
| MRI any jt lower extrem w/contrast material (73722) range across 2 matching MRF lines |
$1,461 | $10,505–$15,758 | 1.4× |
| MRI any jt lower extrem w/o & w/contrast matrl (73723) range across 2 matching MRF lines |
$1,461 | $12,103–$18,155 | 3.3× |
| MRI any jt upper extremity w/contrast matrl (73222) | $1,461 | $10,831 | 1.4× |
| MRI Breast W/O Contrast Bilateral (77047) | $1,461 | $9,278 | 4.8× |
| MRI Breast Without Contrast Material Unilateral (77046) | $1,461 | $4,452 | 4.8× |
| MRI cardiac w/o contrast (75557) | $1,461 | $4,098 | 4.8× |
| MRI cervical spine w contrast (72142) | $1,461 | $13,429 | 3.3× |
| MRI cervical spine w/o cont (72141) | $1,461 | $11,439 | 4.8× |
| MRI chest w/o contrast (71550) | $1,461 | $12,456 | 4.8× |
| MRI chest with contrast (71551) | $1,461 | $13,948 | 1.4× |
| MRI chest wo w contrast (71552) | $1,461 | $16,706 | 3.3× |
| MRI lower extrem oth/thn jt w/contrast matrl (73719) range across 2 matching MRF lines |
$1,461 | $11,420–$17,130 | 3.3× |
| MRI lower extrem oth/thn jt w/o & w/contr matr (73720) range across 2 matching MRF lines |
$1,461 | $12,516–$18,774 | 3.3× |
| MRI lower extrem oth/thn jt w/o contr matrl (73718) range across 2 matching MRF lines |
$1,461 | $10,324–$15,486 | 4.8× |
| MRI lumbar spine w contrast (72149) | $1,461 | $13,333 | 3.3× |
| Mri Neck Spine W/O & W/Dye (72156) | $1,461 | $15,824 | 3.3× |
| MRI orbit face &/neck w/o contrast (70540) | $1,461 | $10,228 | 4.8× |
| MRI orbit face neck w contrast (70542) | $1,461 | $11,575 | 3.3× |
| Mri Orbt/Fac/Nck W/O &W/Dye (70543) | $1,461 | $14,885 | 3.3× |
| MRI pelvis w contrast (72196) | $1,461 | $12,500 | 3.3× |
| MRI pelvis w/o & w contrast (72197) | $1,461 | $14,482 | 3.3× |
| MRI pelvis w/o contrast (72195) | $1,461 | $11,431 | 4.8× |
| MRI spectroscopy (76390) | $1,461 | $7,730 | 13.1× |
| MRI thoracic spine w/o contrast (72146) | $1,461 | $11,087 | 4.8× |
| MRI upper extremity oth than jt w/contr matrl (73219) | $1,461 | $10,500 | 3.3× |
| MRI upper extremity oth than jt w/o contr matrl (73218) | $1,461 | $9,963 | 4.8× |
| Mri Uppr Extremity W/O&W/Dye (73220) | $1,461 | $11,256 | 3.3× |
| MRI, abdomen, combo (74183) | $1,461 | $15,157 | 3.3× |
| MRI, dorsal spine combo (72157) | $1,461 | $15,758 | 3.3× |
| MRI, dorsal spine contrast (72147) | $1,461 | $13,000 | 3.3× |
| MRI, joint upper extrem (73221) | $1,461 | $9,013 | 4.8× |
| MRI, joint upper extrem combo (73223) | $1,461 | $12,372 | 3.3× |
| MRI, lumbar spine combo (72158) | $1,461 | $16,320 | 3.3× |
| Myocardial Spect Multiple Studies (78452) | $809 | $12,832 | 0.5× |
| Neck soft tissue (70360) | $281 | $1,026 | 2.5× |
| Nonvascular Shunt X-Ray (75809) | $281 | $5,027 | 2.1× |
| Ntsty modul radthx pln dose-vol histos (77301) | $933 | $12,522 | 0.5× |
| Nuclear Rx Oral Admin (79005) | $809 | $7,879 | 2.7× |
| Ophthalmic Ultrasonic Foreign Body Localization (76529) | $312 | $330 | 2.8× |
| Parathyroid Planar Imaging (78070) | $809 | $3,374 | 1.6× |
| Pelvis 1 or 2 views (72170) | $281 | $1,132 | 2.1× |
| PET image w/CT, full body (78816) | $2,910 | $25,750 | 1.6× |
| PET imaging CT attenuation skull base mid-thigh (78815) | $2,910 | $23,750 | 1.6× |
| Prq Transhepatc Portograpy Hemodyn Eval Rs&I (75885) | $281 | $4,573 | 0.1× |
| Pulmonary Perfusion Imaging Particulate (78580) | $809 | $4,442 | 1.6× |
| Radex Abd Compl Aqt Abd W/S/E/D Views 1 View Ch (74022) | $281 | $1,788 | 2.1× |
| Radex abscess/fistula/sinus tract rs&i (76080) | $281 | $2,483 | 0.4× |
| Radex Ankle Complete Minimum 3 Views (73610) | $281 | $1,293 | 2.5× |
| Radex Calcaneus Minimum 2 Views (73650) range across 2 matching MRF lines |
$281 | $850–$1,275 | 2.5× |
| Radex elbow complete minimum 3 views (73080) range across 2 matching MRF lines |
$281 | $1,259–$1,889 | 2.5× |
| Radex Facial Bones Complete Minimum 3 Views (70150) | $281 | $1,456 | 2.1× |
| Radex fingr minimum 2 views (73140) range across 2 matching MRF lines |
$281 | $947–$1,421 | 2.5× |
| Radex foot complete minimum 3 views (73630) | $281 | $1,405 | 2.5× |
| Radex Hand Minimum 3 Views (73130) | $281 | $1,238 | 2.5× |
| Radex lower extremity infant minimum 2 views (73592) range across 2 matching MRF lines |
$281 | $412–$618 | 2.5× |
| Radex Mastoids Compl Minimum 3 Views PR Side (70130) | $281 | $871 | 2.1× |
| Radex Nasal Bones Complete Minimum 3 Views (70160) | $281 | $1,127 | 2.5× |
| Radex Ribs Unilateral 2 Views (71100) | $281 | $1,284 | 2.5× |
| Radex shoulder complete minimum 2 views (73030) range across 2 matching MRF lines |
$281 | $1,310–$1,965 | 2.5× |
| Radex Sinuses Paransl < 3 Views (70210) | $281 | $1,690 | 2.5× |
| Radex Spine 1 View Specify Level (72020) | $281 | $1,133 | 2.5× |
| Radex Sternum Minimum 2 Views (71120) | $281 | $1,064 | 2.5× |
| Radex Toe Minimum 2 Views (73660) range across 2 matching MRF lines |
$281 | $873–$1,310 | 2.5× |
| Radex upper extremity infant minimum 2 views (73092) range across 2 matching MRF lines |
$281 | $515–$773 | 2.1× |
| Radex Wrist Complete Minimum 3 Views (73110) | $281 | $1,345 | 2.5× |
| Radiation treatment delivery level 1 (77402) | $933 | $728 | 7.1× |
| Radiation treatment delivery level 2 (77407) | $933 | $2,100 | 1.9× |
| Radiation treatment delivery level 3 (77412) | $933 | $2,405 | 1.3× |
| Radiolog exam mandible compl minimum 4 views (70110) | $281 | $1,902 | 2.1× |
| Radiologic exam colon double contrast study (74280) | $281 | $4,042 | 1.2× |
| Radiologic exam colon single contrast study (74270) | $281 | $2,680 | 1.2× |
| Radiologic exam knee complete 4/more views (73564) | $281 | $1,479 | 2.1× |
| Radiologic Exam Small Int Single Contrast Study (74250) | $281 | $2,281 | 1.2× |
| Radiologic exam swallow function contrast study (74230) | $281 | $2,121 | 1.2× |
| Radiologic exam upr gi trc double contrast study (74246) | $281 | $2,962 | 1.2× |
| Radiologic examination femur minimum 2 views (73552) range across 2 matching MRF lines |
$281 | $1,094–$1,641 | 2.5× |
| Radiologic examination knee 1/2 views (73560) | $281 | $990 | 2.5× |
| Radiologic Examination Osseous Survey Limited (77074) | $281 | $3,186 | 2.1× |
| Radiologic examination tibia & fibula 2 views (73590) range across 2 matching MRF lines |
$281 | $1,156–$1,734 | 2.5× |
| Remote afterloading high dose rate radionuclide skin surface brachytherapy, includes basic dosimetry, when performed;… (77768) | $933 | $4,661 | 1.9× |
| Remote afterloading high dose rate radionuclide skin surface brachytherapy, includes basic dosimetry, when performed;… (77767) | $933 | $575 | 1.9× |
| Ribs bilateral 3 views (71110) | $281 | $1,752 | 2.1× |
| Rp loclzj tum plnr 1 area single day imaging (78800) | $809 | $2,058 | 1.6× |
| Rp loclzj tum plnr 2+area 1+d img/1 area img>2+d (78801) | $809 | $4,881 | 1.6× |
| Rp Loclzj Tum Plnr Whole Body 2+ Days Imaging (78804) | $809 | $11,069 | 1.2× |
| Rp Loclzj Tum Plnr Whole Body Single Day Imaging (78802) | $809 | $6,561 | 1.2× |
| Rp Loclzj Tum Spect 1 Area Single Day Imaging (78803) | $809 | $6,995 | 1.2× |
| Rp Therapy Intravenous Administration (79101) | $809 | $2,513 | 2.7× |
| Scapula (73010) range across 2 matching MRF lines |
$281 | $1,261–$1,892 | 2.1× |
| Screening Digital Breast Tomosynthesis Bi (77063) range across 2 matching MRF lines |
$187 | $611–$917 | 8.0× |
| Shoulder 1 view (73020) range across 2 matching MRF lines |
$281 | $1,026–$1,539 | 2.5× |
| Shoulder Arthrography (73040) | $281 | $3,628 | 0.6× |
| Skull less than 4 views (70250) | $281 | $1,668 | 2.1× |
| Special dosimetry (77331) | $933 | $787 | 5.4× |
| Special Physics Consult (77370) | $933 | $2,895 | 5.4× |
| Special teletherapy port plan (77321) | $933 | $3,431 | 1.9× |
| Srs Multisource (77371) | $19,049 | $40,518 | 2.0× |
| Sternoclavicular joints (71130) | $281 | $962 | 2.5× |
| Superior sagittal sinus venogram (75870) | $281 | $4,102 | 0.1× |
| Surface Applic Low Dose Rate Radionuclide Source (77789) | $933 | $196 | 7.1× |
| Ther Rad Simulaj-Aided Field Setting Complex (77290) | $933 | $5,642 | 1.9× |
| Ther Rad Simulaj-Aided Field Setting Intermed (77285) | $933 | $3,696 | 1.9× |
| Ther rad simulaj-aided field setting simple (77280) | $933 | $2,340 | 5.4× |
| Therapeutic Enema Rdctj Intussusception/Obstrcj (74283) | $281 | $830 | 1.2× |
| Thoracic spine 2 views (72070) | $281 | $1,373 | 2.1× |
| Thoracic spine 3 views (72072) | $281 | $1,464 | 2.1× |
| Thoracolumbar 2 views (72080) | $281 | $1,259 | 2.5× |
| Thyroid Imaging With Vascular Flow (78013) | $809 | $531 | 1.6× |
| Thyroid Met Imaging Body (78018) | $809 | $6,638 | 1.2× |
| Thyroid Uptake W/Blood Flow Sngle/Mult Quan Meas (78014) | $809 | $2,626 | 1.6× |
| Tx Devices Design & Construction Complex (77334) | $933 | $3,586 | 1.9× |
| Tx devices design & construction intermediate (77333) | $933 | $1,988 | 5.4× |
| Tx devices design & construction simple (77332) | $933 | $1,405 | 5.4× |
| Ultrasound Breast Limited (76642) | $312 | $1,058 | 2.8× |
| Ultrasound, abdomen limited (76705) | $312 | $3,141 | 2.3× |
| Umbilical-artery Doppler (OB) (76820) | $312 | $687 | 2.3× |
| Unlisted magnetic resonance procedure (76498) | $1,461 | $3,248 | 13.1× |
| Upper gi w/o kub (74240) | $281 | $2,420 | 1.2× |
| Ureteral Reflux Study (78740) | $809 | $1,569 | 1.6× |
| Urethrocystogram voiding (74455) | $281 | $2,502 | 0.9× |
| Urethrocystography retrograde (74450) | $281 | $2,017 | 0.9× |
| Us breast unilateral complete (76641) range across 2 matching MRF lines |
$312 | $1,550–$2,325 | 2.3× |
| Us chest (76604) | $312 | $1,947 | 2.3× |
| Us complete joint (76881) range across 2 matching MRF lines |
$312 | $3,622–$5,433 | 2.3× |
| Us exam, pelvic, limited (76857) | $312 | $2,165 | 2.3× |
| Us head (76506) | $312 | $911 | 2.3× |
| Us kidney transplant (76776) | $312 | $3,487 | 2.3× |
| Us lmtd joint/oth nonvasc xtr strux r-t w/img (76882) | $312 | $2,373 | 2.3× |
| Us ob detailed single fetus (76811) | $312 | $4,058 | 1.0× |
| Us ob limited 1 or more fetuses (76815) range across 2 matching MRF lines |
$312 | $1,907–$7,230 | 2.3× |
| Us ob transvaginal (76817) | $312 | $2,047 | 2.3× |
| Us pelvic non ob complete (76856) | $312 | $6,984 | 2.3× |
| Us pg uter img f&mat 14 wk tabdl 1/1st gestation (76801) | $312 | $3,302 | 2.3× |
| Us preg uterus real time f/u trnsabdl per fetus (76816) | $312 | $1,924 | 2.3× |
| Us retroperitoneal complete (76770) | $312 | $3,310 | 2.3× |
| Us scrotum and contents (76870) | $312 | $3,144 | 2.3× |
| Us spinal canal and contents (76800) | $312 | $911 | 2.3× |
| Us thyroid (76536) | $312 | $2,373 | 2.3× |
| Us transrectal (76872) | $312 | $3,281 | 2.3× |
| Vascular Flow Imaging (78445) | $809 | $1,749 | 1.6× |
| Vein X-Ray Chest (75827) | $281 | $7,566 | 0.1× |
| Venogram Sinus/Jugular (75860) | $2,543 | $5,086 | 0.6× |
| Venography caval inferior serialography rs&i (75825) | $281 | $8,580 | 0.1× |
| Venography extremity bilateral rs&i (75822) | $281 | $6,354 | 0.1× |
| Venography extremity unilateral rs&i (75820) | $281 | $5,625 | 0.1× |
| Venography Renal Bilateral (75833) | $281 | $4,626 | 0.1× |
| Venography Renal Unilateral (75831) | $281 | $4,102 | 0.1× |
| Venous sampling by catheter (75893) likely a partial charge, not the full procedure |
$281 | $7,072 | 0.0× |
| Wrist 2 views (73100) | $281 | $1,065 | 2.5× |
| X-Ray Ac Jts - Xr Acromioclavicular Joints Bilateral (73050) | $281 | $1,025 | 2.5× |
| X-ray antegrade pyelogram tube (74425) | $281 | $1,903 | 0.6× |
| X-Ray Aorta Leg Arteries (75630) | $281 | $17,708 | 0.1× |
| X-Ray Bend Only L-S Spine (72120) | $281 | $1,558 | 2.1× |
| X-Ray Elbow 2 Vw - Xr Elbow 1-2 Views Right (73070) range across 2 matching MRF lines |
$281 | $1,034–$1,551 | 2.5× |
| X-Ray Exam Breast Specimen (76098) | $281 | $3,612 | 0.4× |
| X-Ray Exam Entire Spi 1 Vw (72081) | $281 | $1,984 | 2.5× |
| X-Ray Exam Entire Spi 2/3 Vw (72082) | $281 | $1,680 | 2.1× |
| X-Ray Exam Hip Uni 1 View (73501) | $281 | $760 | 2.5× |
| X-Ray Exam Hip Uni 2-3 Views (73502) | $281 | $1,261 | 2.5× |
| X-Ray Exam Hips Bi 2 Views (73521) | $281 | $1,652 | 2.1× |
| X-Ray Exam L-S Spine Bending (72114) | $281 | $2,799 | 2.1× |
| X-Ray Exam Neck Spine 2-3 Vw (72040) | $281 | $1,344 | 2.5× |
| X-Ray Exam Neck Spine 6/>Vws (72052) | $281 | $2,405 | 2.1× |
| X-Ray Exam Unilat Ribs/Chest (71101) | $281 | $1,656 | 2.1× |
| X-ray humerus (73060) range across 2 matching MRF lines |
$281 | $1,159–$1,739 | 2.5× |
| X-ray IV pyelogram (ivp) (74400) | $281 | $2,862 | 1.2× |
| X-ray IV pyelogram+tomography (74415) | $281 | $1,399 | 1.2× |
| X-Ray Jaw <4 Vw - Xr Mandible < 4 Views (70100) | $281 | $1,096 | 2.5× |
| X-Ray Knee Bilat Standing - Xr Knees Anteroposterior Standing Bilat (73565) | $281 | $1,138 | 2.5× |
| X-Ray Lumbar Spine 2/3 Vw - Xr Lumbar Spine 2-3 Views (72100) | $281 | $1,343 | 2.1× |
| X-ray nose-rectum child f.b. (76010) | $281 | $245 | 2.5× |
| X-Ray Ribs, Chest 4+ Vw - Xr Ribs 3 Vws Bil W/ Chest Posteroanterior (71111) | $281 | $2,105 | 2.1× |
| X-Ray Sacroiliac Jts 3+ Vw - Xr Sacroiliac Joints 3+ Views (72202) | $281 | $1,455 | 2.1× |
| X-Ray Sacroiliac Jts <3 Vw - Xr Sacroiliac Joints 1-2 Views (72200) | $281 | $600 | 2.1× |
| X-Ray Sacrum/Coccyx 2+ Vw - Xr Sacrum Coccyx 2+ Views (72220) | $281 | $1,114 | 2.5× |
| X-Ray Sinuses 3+ Vw - Xr Paranasal Sinuses 3+ Views (70220) | $281 | $1,630 | 2.5× |
| X-Ray Skull 4+ Vw - Xr Skull Complete 4+ Views (70260) | $281 | $1,766 | 2.1× |
| X-ray thoracic spine 4 vw (72074) | $281 | $1,957 | 2.1× |
| X-Ray Urinary Tract Exam With Contrast Material (74420) | $281 | $3,612 | 0.6× |
| X-Rays Bone Length Studies (77073) range across 2 matching MRF lines |
$281–$1,243 | $1,972 | varies |
| X-Rays Bone Survey Complete (77075) | $281 | $3,379 | 2.1× |
| Xr c-spine 4 or 5 views (72050) | $281 | $1,853 | 2.1× |
| Xr facial bones less than 3 views (70140) | $281 | $1,162 | 2.5× |
| Xr orbits complete 4 views (70200) | $281 | $1,243 | 2.1× |
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.