Imaging prices at San Gabriel Valley Medical Center
San Gabriel, CA · every code in this section with a posted price and a Medicare benchmark.
353 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) | $1,814.40 | $6,048 | 1.0× |
| Abdomen 1 View (74018) | $166.20 | $554 | 1.5× |
| Acute Gastrointestinal Blood Loss Imaging (78278) | $749.10 | $2,497 | 1.5× |
| Adrenal Cortex & Medulla Img (78075) | $1,530.90 | $5,103 | 0.9× |
| Angio pulmonary bilat (75743) | $1,362.60 | $4,542 | 0.3× |
| Angiography Adrenal Bilateral Slctv Rs&I (75733) range across 2 matching MRF lines |
$926.87–$1,567.50 | $3,089.57–$5,225 | varies |
| Angiography extremity bilateral rs&i (75716) range across 3 matching MRF lines |
$719.70–$1,748.70 | $2,399–$5,829 | varies |
| Angiography extremity unilateral rs&i (75710) range across 6 matching MRF lines |
$926.87–$1,748.70 | $3,089.57–$5,829 | varies |
| Angiography pulmonary unilateral slctv rs&i (75741) range across 3 matching MRF lines |
$926.87–$1,306.20 | $3,089.57–$4,354 | varies |
| Angrph pulmonary nonslctv cath/ven njx rs&i (75746) | $416.70 | $1,389 | 0.1× |
| Ankle 2 views (73600) range across 3 matching MRF lines |
$86.10–$106.50 | $287–$355 | varies |
| Aortography thoracic serialography rs&i (75605) likely a partial charge, not the full procedure |
$1,535.66 | $5,118.87 | 0.2× |
| Aortography thoracic w/o serialography rs&i (75600) | $926.87 | $3,089.57 | 0.2× |
| Artery X-Rays Abdomen (75726) likely a partial charge, not the full procedure |
$1,535.66 | $5,118.87 | 0.2× |
| Artery X-Rays Adrenal Gland (75731) range across 3 matching MRF lines |
$719.70–$1,293.90 | $2,399–$4,313 | varies |
| Artery X-Rays Pelvis (75736) likely a partial charge, not the full procedure |
$1,535.66 | $5,118.87 | 0.2× |
| Artery X-Rays Spine (75705) likely a partial charge, not the full procedure |
$1,535.66 | $5,118.87 | 0.2× |
| Arthrogram ankle (73615) | $309.90 | $1,033 | 0.7× |
| Arthrogram hip (73525) | $425.70 | $1,419 | 0.9× |
| Arthrogram Wrist (73115) | $231 | $770 | 0.5× |
| Basic radiation dosimetry calculation (77300) | $309.30 | $1,031 | 1.8× |
| Bone age studies (77072) | $113.40 | $378 | 0.8× |
| Bone Imaging 3 Phase (78315) | $925.20 | $3,084 | 1.8× |
| Bone Imaging Limited Area (78300) | $501.60 | $1,672 | 1.0× |
| Bone Imaging Multiple Areas (78305) range across 2 matching MRF lines |
$577.20–$632.70 | $1,924–$2,109 | varies |
| Bone Imaging Whole Body (78306) | $784.20 | $2,614 | 1.5× |
| Bone survey infant (77076) | $134.40 | $448 | 1.0× |
| Brain Flow Imaging Only (78610) | $584.40 | $1,948 | 0.8× |
| Brain Imaging Min 4 Static Views W Vascular Flow (78606) | $1,012.80 | $3,376 | 1.5× |
| Brain Imaging Minimum 4 Static Views (78605) | $786.30 | $2,621 | 1.1× |
| Cardiac blood pool imaging, first pass technique; multiple studies, resting and with stress (exercise and/or… (78483) | $1,252.80 | $4,176 | 1.8× |
| Cardiac MRI w/w/o contrast & further seq (75561) | $584.40 | $1,948 | 1.3× |
| Cat Scan Follow-Up Study (76380) | $723.30 | $2,411 | 6.5× |
| Cerebrospinal Fluid Scan (78630) | $1,428.90 | $4,763 | 2.0× |
| Chest 1 view (71045) range across 6 matching MRF lines |
$21.86–$204 | $72.87–$680 | varies |
| Chest 2 views (71046) range across 3 matching MRF lines |
$121.20–$190.20 | $404–$634 | varies |
| Chest 3 views (71047) range across 2 matching MRF lines |
$138.30–$156 | $461–$520 | varies |
| Chest 4 or more views (71048) | $162.30 | $541 | 1.2× |
| Cholecystography Oral Contrast (74290) | $104.10 | $347 | 0.5× |
| Cineradiograpy/vidradiograpy xcpt where spec (76120) | $197.40 | $658 | 1.5× |
| Clavicle complete (73000) range across 4 matching MRF lines |
$86.10–$173.10 | $287–$577 | varies |
| Continuing medical physics consltj pr wk (77336) | $228.30 | $761 | 1.3× |
| Contrast Exam Abdominl Aorta (75625) range across 3 matching MRF lines |
$1,110.30–$1,748.70 | $3,701–$5,829 | varies |
| Contrast X-Ray Bladder (74430) | $223.80 | $746 | 0.5× |
| Contrast X-Ray Of Elbow (73085) range across 4 matching MRF lines |
$247.20–$404.40 | $824–$1,348 | varies |
| Contrast X-Ray Of Knee Joint (73580) | $337.80 | $1,126 | 0.8× |
| Contrast Xray Throat/Cerv Esopha (74210) | $174 | $580 | 0.8× |
| CT abdomen and pelvis without and with contrast (74178) range across 3 matching MRF lines |
$135.40–$1,491.90 | $451.33–$4,973 | varies |
| CT abdomen and pelvis without contrast (74176) | $1,453.80 | $4,846 | 4.7× |
| CT abdomen w contrast (74160) | $1,343.10 | $4,477 | 6.0× |
| CT abdomen w wo contrast (74170) range across 6 matching MRF lines |
$70.79–$1,863 | $235.96–$6,210 | varies |
| CT abdomen w/o contrast (74150) | $1,340.10 | $4,467 | 10.0× |
| CT Angio Abdomen and Pelvis (74174) | $731.70 | $2,439 | 1.6× |
| CT Angio Chest (71275) range across 4 matching MRF lines |
$70.79–$1,554.60 | $235.96–$5,182 | varies |
| CT Angio Head (70496) range across 2 matching MRF lines |
$912–$1,371.90 | $3,040–$4,573 | varies |
| CT angio hrt w/3d image (75574) | $2,589 | $8,630 | 5.8× |
| Ct Angio Lwr Extr W/O&W/Dye (73706) | $867.90 | $2,893 | 3.8× |
| CT Angio Neck (70498) | $1,524.60 | $5,082 | 6.8× |
| Ct Angio Upr Extrm W/O&W/Dye (73206) | $1,367.10 | $4,557 | 6.1× |
| CT bone density (77078) | $712.80 | $2,376 | 6.4× |
| CT cervical spine w/ contrast (72126) | $875.70 | $2,919 | 2.0× |
| CT cervical spine w/o contrast (72125) | $1,124.70 | $3,749 | 8.4× |
| CT cervical spine w/wo cont (72127) | $1,062.60 | $3,542 | 4.7× |
| CT chest w contrast (71260) range across 4 matching MRF lines |
$70.79–$1,614 | $235.96–$5,380 | varies |
| CT chest w/wo contrast (71270) | $450 | $1,500 | 2.0× |
| CT head/brain with contrast (70460) | $1,334.10 | $4,447 | 5.9× |
| CT head/brain without and with contrast (70470) | $1,334.10 | $4,447 | 5.9× |
| CT heart no contrast quant eval coronry calcium (75571) | $211.20 | $704 | 1.9× |
| CT iac w contrast (70481) | $1,207.50 | $4,025 | 5.4× |
| CT l-spine w&w/o contrast (72133) | $1,062.60 | $3,542 | 4.7× |
| CT lower ext w/o (73700) range across 20 matching MRF lines |
$749.40–$966.30 | $2,498–$3,221 | varies |
| CT lower extremity w/contrast material (73701) range across 15 matching MRF lines |
$749.40–$966.30 | $2,498–$3,221 | varies |
| CT lumbar spine w contrast (72132) | $1,313.40 | $4,378 | 2.9× |
| CT lumbar spine w/o contrast (72131) | $1,123.80 | $3,746 | 8.4× |
| CT maxillofacial w contrast (70487) | $1,174.20 | $3,914 | 5.2× |
| CT maxillofacial wo contrast (70486) | $1,021.20 | $3,404 | 7.6× |
| CT neck tissue combo (70492) | $1,446.90 | $4,823 | 6.4× |
| Ct Orbit/Ear/Fossa W/O&W/Dye (70482) | $1,446.90 | $4,823 | 6.4× |
| CT orbits w/o contrast (70480) | $1,049.70 | $3,499 | 7.8× |
| CT pelvis w&w/o contrast (72194) | $1,527.90 | $5,093 | 6.8× |
| CT pelvis w/o contrast (72192) range across 2 matching MRF lines |
$712.80–$1,337.10 | $2,376–$4,457 | varies |
| CT scan of leg combo (73702) range across 3 matching MRF lines |
$912–$1,172.40 | $3,040–$3,908 | varies |
| CT scans face/jaw combo (70488) | $1,174.20 | $3,914 | 5.2× |
| CT soft tissue neck w contrast (70491) | $1,207.50 | $4,025 | 5.4× |
| CT soft tissue neck w/o contrast (70490) | $1,049.70 | $3,499 | 7.8× |
| CT thoracic spine w contrast (72129) | $1,094.10 | $3,647 | 4.8× |
| CT thoracic spine w/o contrast (72128) | $1,123.80 | $3,746 | 8.4× |
| CT thoracic spine w/wo cont (72130) | $1,062.60 | $3,542 | 4.7× |
| CT thorax w/o contrast (71250) | $1,340.10 | $4,467 | 10.0× |
| CT upper ext wo (73200) range across 15 matching MRF lines |
$749.40–$1,011.60 | $2,498–$3,372 | varies |
| CT upper extremity w/o & w/contrast material (73202) | $912 | $3,040 | 4.0× |
| CT upper extremity with contrast (73201) range across 14 matching MRF lines |
$749.40–$1,176.90 | $2,498–$3,923 | varies |
| Cta Abdl Aorta&Bi Iliofem W/Contrast&Postp (75635) | $2,589 | $8,630 | 11.5× |
| Cta Abdomen (74175) | $1,665 | $5,550 | 7.4× |
| CTA pelvis (72191) | $1,367.10 | $4,557 | 6.1× |
| Dacryocystography, nasolacrimal duct, radiological supervision and interpretation Non-Facility (70170) | $136.80 | $456 | 0.4× |
| Dilation ureters/urethra rs&i (74485) | $610.46 | $2,034.85 | 0.2× |
| Discography Cerv/Thor Spine (72285) | $960.60 | $3,202 | 0.4× |
| Diskography lumbar (72295) | $908.70 | $3,029 | 0.4× |
| Doppler Echo Fetal Puls Spectral F/U/Repeat (76828) | $176.40 | $588 | 1.3× |
| Doppler Echo Fetal Spectral Display Complete (76827) | $282.90 | $943 | 2.1× |
| Dxa Bone Density Axial (77080) | $251.70 | $839 | 1.9× |
| Echo exam of fetal heart (76825) | $383.70 | $1,279 | 0.5× |
| Echo exam uterus (76831) | $363.30 | $1,211 | 1.2× |
| Echocardiography, fetal, cardiovascular system, real time with image documentation (2D), with or without M-mode… (76826) | $204.30 | $681 | 0.7× |
| Echograp Trans R Pros Study (76873) | $323.40 | $1,078 | 2.4× |
| Esophagram (74220) | $270 | $900 | 1.2× |
| Fetal Biophys Profile W/Nst (76818) range across 2 matching MRF lines |
$364.50–$397.80 | $1,215–$1,326 | varies |
| Fluoroscopy up to 1 hr (76000) range across 5 matching MRF lines |
$129.90–$354.30 | $433–$1,181 | varies |
| Follow-Up Angiography (75898) range across 2 matching MRF lines |
$383.74–$1,124.10 | $1,279.13–$3,747 | varies |
| Foot 2 views (73620) range across 4 matching MRF lines |
$86.10–$106.50 | $287–$355 | varies |
| Forearm 2 views (73090) range across 4 matching MRF lines |
$86.10–$111.60 | $287–$372 | varies |
| Gastric emptying imaging study (78264) | $783 | $2,610 | 1.5× |
| Gastroesophageal Reflux Exam (78262) | $522 | $1,740 | 1.0× |
| Gated Heart Planar Single (78472) | $827.40 | $2,758 | 1.6× |
| Gated Heart, Multiple (78473) | $1,035.90 | $3,453 | 2.0× |
| Hand 2 views (73120) range across 5 matching MRF lines |
$86.10–$159.60 | $287–$532 | varies |
| Heart first pass single,planar (78481) | $660.30 | $2,201 | 0.9× |
| Hepatc Vngrph Wdg/Fr Hemodyn Eval Rs&I (75889) | $926.87 | $3,089.57 | 0.2× |
| Hepatc Vngrph Wdg/Fr W/O Hemodyn Eval Rs&I (75891) | $926.87 | $3,089.57 | 0.2× |
| Hepatobil Syst Image W/Drug (78227) | $369.60 | $1,232 | 0.5× |
| Hepatobiliary System Imaging (78226) range across 2 matching MRF lines |
$369.60–$722.70 | $1,232–$2,409 | varies |
| Ht Musc Image Planar Mult (78454) | $2,781 | $9,270 | 1.7× |
| Ht Muscle Image Spect Sing (78451) | $860.70 | $2,869 | 0.5× |
| Hysterosalpingogram (74740) | $224.10 | $747 | 0.7× |
| Infant hip ultrasound with hip movement (dynamic) (76885) | $299.70 | $999 | 2.7× |
| Infant hip ultrasound, limited static exam (76886) | $335.70 | $1,119 | 3.0× |
| Infusion Ivp (74410) | $272.70 | $909 | 1.2× |
| Interstitial radiation source applic complex (77778) | $2,244.90 | $7,483 | 2.5× |
| Intraop radiaj tx deliver electrons sngl tx sess (77425) likely a partial charge, not the full procedure |
$2,682.26 | $8,940.86 | 0.3× |
| Intraop radiaj tx deliver xray single tx session (77424) likely a partial charge, not the full procedure |
$2,682.26 | $8,940.86 | 0.3× |
| Joint Survey Single View (77077) | $154.20 | $514 | 1.1× |
| K Flow/Funct Image W/Drug (78708) | $205.18 | $683.93 | 0.3× |
| Kidney Imaging Morphol (78700) | $558 | $1,860 | 1.1× |
| Kidney Imaging Morphoogy W/Vascular Flow (78701) | $920.70 | $3,069 | 1.8× |
| Knee 3 Views (73562) range across 5 matching MRF lines |
$117–$207.90 | $390–$693 | varies |
| Liver & Spleen Imaging Static Only (78215) | $739.50 | $2,465 | 1.4× |
| Liver & Spleen Imaging W/Vascular Flow (78216) | $690.90 | $2,303 | 1.3× |
| Liver imaging static only (78201) | $431.37 | $1,437.91 | 0.6× |
| Liver imaging w/vascular flow (78202) | $394.50 | $1,315 | 0.6× |
| Lung Perf&Ventilat Diferentl (78598) | $723.60 | $2,412 | 1.0× |
| Lung perfusion differential (78597) | $723.60 | $2,412 | 1.4× |
| Lung Ventilat&Perfus Imaging (78582) | $602.40 | $2,008 | 0.9× |
| Lung Ventilation Imaging (78579) | $255.30 | $851 | 0.5× |
| Lymph System Imaging (78195) | $661.20 | $2,204 | 0.9× |
| Magnetic Image Jaw Joint (70336) | $1,180.20 | $3,934 | 3.8× |
| Mammary ductogram or galactogram multiple (77054) | $296.10 | $987 | 1.0× |
| Mammary ductogram or galactogram single (77053) | $215.70 | $719 | 0.7× |
| Meckels Divert Exam (78290) | $413.10 | $1,377 | 0.8× |
| Mra Head W/O & W/Contrast Material (70546) | $2,389.50 | $7,965 | 5.3× |
| MRA head w/o contrast (70544) | $2,389.50 | $7,965 | 7.8× |
| MRA head with contrast (70545) | $2,389.50 | $7,965 | 5.3× |
| MRA neck w contrast (70548) | $1,422.90 | $4,743 | 3.2× |
| Mra Neck W/O &W/Contrast Material (70549) | $2,047.50 | $6,825 | 4.6× |
| MRA neck w/o contrast (70547) | $1,814.40 | $6,048 | 5.9× |
| MRI abdomen w contrast (74182) | $2,415 | $8,050 | 5.4× |
| MRI abdomen w/o contrast (74181) | $2,389.50 | $7,965 | 7.8× |
| MRI any jt upper extremity w/contrast matrl (73222) | $2,089.50 | $6,965 | 2.1× |
| MRI bone marrow blood supply (77084) | $1,503.90 | $5,013 | 4.9× |
| MRI Breast W/O Contrast Bilateral (77047) | $1,416.30 | $4,721 | 4.6× |
| MRI Breast Without Contrast Material Unilateral (77046) | $858.60 | $2,862 | 2.8× |
| MRI cardiac w/o cont stress (75559) | $1,221.30 | $4,071 | 1.7× |
| MRI cardiac w/o contrast (75557) | $1,500.60 | $5,002 | 4.9× |
| MRI cervical spine w contrast (72142) | $2,198.70 | $7,329 | 4.9× |
| MRI cervical spine w/o cont (72141) | $2,029.80 | $6,766 | 6.6× |
| MRI chest w/o contrast (71550) | $2,477.70 | $8,259 | 8.1× |
| MRI chest with contrast (71551) range across 2 matching MRF lines |
$2,632.20–$2,632.80 | $8,774–$8,776 | varies |
| MRI chest wo w contrast (71552) | $2,735.70 | $9,119 | 6.1× |
| MRI lower extrem oth/thn jt w/o & w/contr matr (73720) | $2,144.10 | $7,147 | 4.8× |
| MRI lumbar spine w contrast (72149) | $2,278.20 | $7,594 | 5.1× |
| Mri Neck Spine W/O & W/Dye (72156) | $2,639.10 | $8,797 | 5.9× |
| MRI orbit face &/neck w/o contrast (70540) range across 2 matching MRF lines |
$2,240.40–$2,392.80 | $7,468–$7,976 | varies |
| MRI orbit face neck w contrast (70542) | $2,061.90 | $6,873 | 4.6× |
| Mri Orbt/Fac/Nck W/O &W/Dye (70543) | $2,965.20 | $9,884 | 6.6× |
| MRI pelvis w contrast (72196) | $2,250.30 | $7,501 | 5.0× |
| MRI pelvis w/o & w contrast (72197) | $2,699.40 | $8,998 | 6.0× |
| MRI pelvis w/o contrast (72195) | $1,956.30 | $6,521 | 6.4× |
| MRI thoracic spine w/o contrast (72146) | $2,085.90 | $6,953 | 6.8× |
| Mri Uppr Extremity W/O&W/Dye (73220) range across 3 matching MRF lines |
$1,248.90–$1,560.90 | $4,163–$5,203 | varies |
| MRI, abdomen, combo (74183) | $2,415 | $8,050 | 5.4× |
| MRI, dorsal spine combo (72157) | $2,877.90 | $9,593 | 6.4× |
| MRI, dorsal spine contrast (72147) | $1,918.80 | $6,396 | 4.3× |
| MRI, joint upper extrem (73221) | $1,522.20 | $5,074 | 5.0× |
| MRI, lumbar spine combo (72158) | $2,733.90 | $9,113 | 6.1× |
| Myelogram cervical (72240) | $600.90 | $2,003 | 0.6× |
| Myelogram Lumbar (72265) | $783 | $2,610 | 0.8× |
| Myelography thoracic (72255) | $557.40 | $1,858 | 0.6× |
| Myelograpy 2/more regions rs&i (72270) | $791.40 | $2,638 | 0.8× |
| Myocardial Imaging Infarct Avid Planar Qual/Quan (78466) | $549.30 | $1,831 | 1.1× |
| Myocardial imaging, infarct avid, planar; with ejection fraction by first pass technique Non-Facility (78468) | $603.90 | $2,013 | 0.9× |
| Myocardial Perfusion Planar 1 Study Rest/Stress (78453) range across 4 matching MRF lines |
$431.37–$1,554 | $1,437.91–$5,180 | varies |
| Myocardial Spect Multiple Studies (78452) | $902.10 | $3,007 | 0.5× |
| Neck soft tissue (70360) | $108.60 | $362 | 1.0× |
| Nm myocard infarct spect (78469) | $651 | $2,170 | 0.9× |
| Nonvascular Shunt X-Ray (75809) | $308.40 | $1,028 | 2.3× |
| Nuclear Rx Oral Admin (79005) range across 4 matching MRF lines |
$285.30–$619.80 | $951–$2,066 | varies |
| Optic foramina (70190) | $176.10 | $587 | 1.6× |
| Parathyroid Planar Imaging (78070) | $419.10 | $1,397 | 0.8× |
| Parathyroid planar imaging w/wo subtraction (78071) | $137.38 | $457.94 | 0.3× |
| Pelvis 1 or 2 views (72170) range across 2 matching MRF lines |
$70.50–$152.40 | $235–$508 | varies |
| Prq Transhepatc Portograpy Hemodyn Eval Rs&I (75885) | $926.87 | $3,089.57 | 0.2× |
| Pulmonary Perfusion Imaging Particulate (78580) | $723.60 | $2,412 | 1.4× |
| Radex Abd Compl Aqt Abd W/S/E/D Views 1 View Ch (74022) | $197.10 | $657 | 1.5× |
| Radex abscess/fistula/sinus tract rs&i (76080) range across 3 matching MRF lines |
$212.40–$339 | $708–$1,130 | varies |
| Radex Ankle Complete Minimum 3 Views (73610) range across 4 matching MRF lines |
$86.10–$123 | $287–$410 | varies |
| Radex Calcaneus Minimum 2 Views (73650) range across 4 matching MRF lines |
$70.50–$102.90 | $235–$343 | varies |
| Radex elbow complete minimum 3 views (73080) | $121.20 | $404 | 1.1× |
| Radex Facial Bones Complete Minimum 3 Views (70150) | $171.60 | $572 | 1.3× |
| Radex fingr minimum 2 views (73140) range across 5 matching MRF lines |
$86.10–$120.30 | $287–$401 | varies |
| Radex foot complete minimum 3 views (73630) range across 4 matching MRF lines |
$86.10–$115.80 | $287–$386 | varies |
| Radex Hand Minimum 3 Views (73130) range across 4 matching MRF lines |
$96.30–$120.30 | $321–$401 | varies |
| Radex lower extremity infant minimum 2 views (73592) | $85.80 | $286 | 0.8× |
| Radex Mastoids Compl Minimum 3 Views PR Side (70130) | $124.50 | $415 | 0.9× |
| Radex Nasal Bones Complete Minimum 3 Views (70160) range across 2 matching MRF lines |
$86.10–$112.80 | $287–$376 | varies |
| Radex Pharynx/Larx W/Fluor&/Magnification Tq (70370) | $151.20 | $504 | 1.4× |
| Radex Ribs Unilateral 2 Views (71100) range across 3 matching MRF lines |
$86.10–$186.60 | $287–$622 | varies |
| Radex shoulder complete minimum 2 views (73030) range across 4 matching MRF lines |
$86.10–$129.90 | $287–$433 | varies |
| Radex Sinuses Paransl < 3 Views (70210) range across 3 matching MRF lines |
$86.10–$129 | $287–$430 | varies |
| Radex Spine 1 View Specify Level (72020) range across 2 matching MRF lines |
$67.50–$82.50 | $225–$275 | varies |
| Radex Sternum Minimum 2 Views (71120) range across 2 matching MRF lines |
$91.20–$139.80 | $304–$466 | varies |
| Radex Temporomandble Jt Opn & Clsd Mouth Bilat (70330) | $167.40 | $558 | 1.5× |
| Radex Toe Minimum 2 Views (73660) | $141.30 | $471 | 1.3× |
| Radex upper extremity infant minimum 2 views (73092) range across 2 matching MRF lines |
$71.10–$82.50 | $237–$275 | varies |
| Radex Wrist Complete Minimum 3 Views (73110) range across 4 matching MRF lines |
$86.10–$115.80 | $287–$386 | varies |
| Radiolog exam mandible compl minimum 4 views (70110) range across 2 matching MRF lines |
$104.10–$174 | $347–$580 | varies |
| Radiologic Exam Abdomen 3+ Views - Xr Abdomen 3+ Views (74021) | $148.80 | $496 | 1.1× |
| Radiologic exam colon double contrast study (74280) | $532.80 | $1,776 | 2.4× |
| Radiologic exam colon single contrast study (74270) | $395.70 | $1,319 | 1.8× |
| Radiologic exam knee complete 4/more views (73564) | $241.50 | $805 | 1.8× |
| Radiologic exam pelvis compl minimum 3 views (72190) range across 2 matching MRF lines |
$91.20–$121.20 | $304–$404 | varies |
| Radiologic Exam Small Int Single Contrast Study (74250) | $288.90 | $963 | 1.3× |
| Radiologic exam swallow function contrast study (74230) | $329.40 | $1,098 | 1.5× |
| Radiologic exam upr gi trc double contrast study (74246) range across 3 matching MRF lines |
$386.10–$474.30 | $1,287–$1,581 | varies |
| Radiologic examination femur 1 view (73551) | $121.20 | $404 | 1.1× |
| Radiologic examination femur minimum 2 views (73552) | $121.20 | $404 | 1.1× |
| Radiologic examination knee 1/2 views (73560) range across 5 matching MRF lines |
$70.50–$133.50 | $235–$445 | varies |
| Radiologic Examination Osseous Survey Limited (77074) | $159.60 | $532 | 1.2× |
| Radiologic Examination Salivary Gland Calculus (70380) | $211.50 | $705 | 1.9× |
| Radiologic examination tibia & fibula 2 views (73590) range across 5 matching MRF lines |
$78.60–$157.20 | $262–$524 | varies |
| Radiologic examination, internal auditory meati, complete Non-Facility (70134) | $174.60 | $582 | 0.2× |
| Renal Cyst Study (74470) | $174.60 | $582 | 0.2× |
| Ribs bilateral 3 views (71110) range across 2 matching MRF lines |
$129.90–$186.60 | $433–$622 | varies |
| Rp loclzj tum plnr 1 area single day imaging (78800) range across 2 matching MRF lines |
$313.50–$632.70 | $1,045–$2,109 | varies |
| Rp loclzj tum plnr 2+area 1+d img/1 area img>2+d (78801) | $566.10 | $1,887 | 1.1× |
| Rp Loclzj Tum Plnr Whole Body 2+ Days Imaging (78804) | $1,111.50 | $3,705 | 1.6× |
| Rp Loclzj Tum Plnr Whole Body Single Day Imaging (78802) | $889.50 | $2,965 | 1.3× |
| Rp Loclzj Tum Spect 1 Area Single Day Imaging (78803) range across 3 matching MRF lines |
$532.80–$1,530.90 | $1,776–$5,103 | varies |
| Rp Ther Radiolbld Monoclonal Antibody IV Infus (79403) range across 2 matching MRF lines |
$425.10–$568.20 | $1,417–$1,894 | varies |
| Rp Therapy Intravenous Administration (79101) | $596.70 | $1,989 | 2.0× |
| Salivary Gland Imaging (78230) | $303.90 | $1,013 | 0.6× |
| Scapula (73010) range across 5 matching MRF lines |
$70.50–$181.50 | $235–$605 | varies |
| Sella turcica (70240) | $67.50 | $225 | 0.6× |
| Shoulder 1 view (73020) range across 5 matching MRF lines |
$57.60–$106.50 | $192–$355 | varies |
| Shoulder Arthrography (73040) | $425.70 | $1,419 | 0.9× |
| Sialogram (70390) | $276.30 | $921 | 0.9× |
| Skull less than 4 views (70250) range across 2 matching MRF lines |
$86.10–$141.30 | $287–$471 | varies |
| Special dosimetry (77331) | $205.80 | $686 | 1.2× |
| Special Physics Consult (77370) | $356.10 | $1,187 | 2.1× |
| Special treatment procedure (77470) | $805.20 | $2,684 | 1.1× |
| Speech evaluation, complex (70371) | $360 | $1,200 | 1.2× |
| Sternoclavicular joints (71130) | $120.90 | $403 | 1.1× |
| Surface Applic Low Dose Rate Radionuclide Source (77789) | $154.80 | $516 | 1.2× |
| Testicular Imaging W/Flow (78761) | $526.80 | $1,756 | 1.0× |
| Ther Rad Simulaj-Aided Field Setting Complex (77290) | $1,442.10 | $4,807 | 3.0× |
| Ther Rad Simulaj-Aided Field Setting Intermed (77285) | $938.70 | $3,129 | 1.9× |
| Ther rad simulaj-aided field setting simple (77280) | $639.90 | $2,133 | 3.7× |
| Therapeutic Enema Rdctj Intussusception/Obstrcj (74283) | $301.50 | $1,005 | 1.3× |
| Thoracic spine 2 views (72070) | $141.30 | $471 | 1.1× |
| Thoracic spine 3 views (72072) | $156 | $520 | 1.2× |
| Thoracolumbar 2 views (72080) | $144.90 | $483 | 1.3× |
| Thyroid carcinoma metastases imaging; with additional studies (eg, urinary recovery) Non-Facility (78016) | $461.70 | $1,539 | 0.9× |
| Thyroid Carcinoma Metastases Img Lmtd Area (78015) | $388.80 | $1,296 | 0.8× |
| Thyroid Imaging With Vascular Flow (78013) | $490.80 | $1,636 | 1.0× |
| Thyroid Met Imaging Body (78018) | $1,000.80 | $3,336 | 1.4× |
| Thyroid Uptake Measurement (78012) | $259.50 | $865 | 0.5× |
| Thyroid Uptake W/Blood Flow Sngle/Mult Quan Meas (78014) | $311.40 | $1,038 | 0.6× |
| Tx Devices Design & Construction Complex (77334) | $652.80 | $2,176 | 1.4× |
| Tx devices design & construction intermediate (77333) | $282.30 | $941 | 1.6× |
| Tx devices design & construction simple (77332) | $230.70 | $769 | 1.3× |
| Ultrasound, abdomen limited (76705) | $325.80 | $1,086 | 2.4× |
| Unlisted us procedure (76999) range across 2 matching MRF lines |
$14.10–$433.20 | $47–$1,444 | varies |
| Upper gi w/o kub (74240) range across 3 matching MRF lines |
$358.20–$387.60 | $1,194–$1,292 | varies |
| Ureteral Reflux Study (78740) | $586.80 | $1,956 | 1.1× |
| Urethrocystogram voiding (74455) range across 2 matching MRF lines |
$271.80–$350.70 | $906–$1,169 | varies |
| Urethrocystography retrograde (74450) | $266.10 | $887 | 0.9× |
| Us breast unilateral complete (76641) range across 4 matching MRF lines |
$146.40–$265.80 | $488–$886 | varies |
| Us chest (76604) | $270 | $900 | 2.0× |
| Us complete joint (76881) range across 4 matching MRF lines |
$222.60–$391.80 | $742–$1,306 | varies |
| Us exam, pelvic, limited (76857) | $241.80 | $806 | 1.8× |
| Us head (76506) | $272.40 | $908 | 2.0× |
| Us lmtd joint/oth nonvasc xtr strux r-t w/img (76882) | $391.80 | $1,306 | 2.9× |
| Us ob limited 1 or more fetuses (76815) range across 4 matching MRF lines |
$44.70–$344.40 | $149–$1,148 | varies |
| Us ob transvaginal (76817) | $377.10 | $1,257 | 2.8× |
| Us pelvic non ob complete (76856) range across 2 matching MRF lines |
$168.60–$438.60 | $562–$1,462 | varies |
| Us pg uter img f&mat 14 wk tabdl 1/1st gestation (76801) | $512.70 | $1,709 | 3.8× |
| Us preg uterus real time f/u trnsabdl per fetus (76816) | $226.50 | $755 | 1.7× |
| Us retroperitoneal complete (76770) | $381 | $1,270 | 2.8× |
| Us retroperitoneal limited (76775) | $531 | $1,770 | 3.9× |
| Us scrotum and contents (76870) | $356.10 | $1,187 | 2.6× |
| Us spinal canal and contents (76800) | $512.40 | $1,708 | 3.8× |
| Us thyroid (76536) | $279.90 | $933 | 2.1× |
| Us transrectal (76872) | $323.40 | $1,078 | 2.4× |
| Vascular Flow Imaging (78445) range across 2 matching MRF lines |
$436.50–$1,786.50 | $1,455–$5,955 | varies |
| Vein X-Ray Chest (75827) range across 2 matching MRF lines |
$603.90–$1,001.10 | $2,013–$3,337 | varies |
| Vein X-Ray Liver W/O Hemodyn (75887) | $404.40 | $1,348 | 0.1× |
| Vein X-Ray Skull Epidural (75872) | $507 | $1,690 | 0.6× |
| Vein X-Ray Spleen/Liver (75810) range across 2 matching MRF lines |
$1,001.10–$1,108.20 | $3,337–$3,694 | varies |
| Venogram Sinus/Jugular (75860) | $926.87 | $3,089.57 | 0.2× |
| Venography Adrenal Unilateral (75840) | $926.87 | $3,089.57 | 0.2× |
| Venography caval inferior serialography rs&i (75825) | $926.87 | $3,089.57 | 0.2× |
| Venography extremity bilateral rs&i (75822) range across 2 matching MRF lines |
$491.40–$548.10 | $1,638–$1,827 | varies |
| Venography extremity unilateral rs&i (75820) range across 3 matching MRF lines |
$319.50–$326.70 | $1,065–$1,089 | varies |
| Venography Renal Bilateral (75833) range across 2 matching MRF lines |
$926.87–$1,310.40 | $3,089.57–$4,368 | varies |
| Venography Renal Unilateral (75831) range across 3 matching MRF lines |
$926.87–$975.60 | $3,089.57–$3,252 | varies |
| Venous sampling by catheter (75893) likely a partial charge, not the full procedure |
$1,535.66 | $5,118.87 | 0.2× |
| Venous thrombosis imaging (78457) | $431.37 | $1,437.91 | 0.6× |
| Wrist 2 views (73100) range across 5 matching MRF lines |
$78.60–$106.50 | $262–$355 | varies |
| X-Ray Ac Jts - Xr Acromioclavicular Joints Bilateral (73050) | $94.50 | $315 | 0.8× |
| X-ray antegrade pyelogram tube (74425) range across 3 matching MRF lines |
$255.30–$317.40 | $851–$1,058 | varies |
| X-Ray Aorta Leg Arteries (75630) range across 2 matching MRF lines |
$1,034.70–$1,959 | $3,449–$6,530 | varies |
| X-Ray Bend Only L-S Spine (72120) | $130.50 | $435 | 1.0× |
| X-Ray Elbow 2 Vw - Xr Elbow 1-2 Views Right (73070) range across 4 matching MRF lines |
$86.10–$110.40 | $287–$368 | varies |
| X-Ray Exam Breast Specimen (76098) | $174.56 | $581.87 | 0.2× |
| X-Ray Exam Entire Spi 1 Vw (72081) | $105.30 | $351 | 0.9× |
| X-Ray Exam Hip Uni 1 View (73501) range across 2 matching MRF lines |
$129–$157.20 | $430–$524 | varies |
| X-Ray Exam Hip Uni 2-3 Views (73502) | $129 | $430 | 1.2× |
| X-Ray Exam Hips Bi 5/> Views (73523) | $255 | $850 | 1.9× |
| X-Ray Exam L-S Spine Bending (72114) | $250.80 | $836 | 1.9× |
| X-Ray Exam Neck Spine 2-3 Vw (72040) range across 2 matching MRF lines |
$86.10–$161.40 | $287–$538 | varies |
| X-Ray Exam Neck Spine 6/>Vws (72052) | $243.30 | $811 | 1.8× |
| X-Ray Exam Unilat Ribs/Chest (71101) range across 2 matching MRF lines |
$156–$186.60 | $520–$622 | varies |
| X-ray humerus (73060) range across 4 matching MRF lines |
$86.10–$121.20 | $287–$404 | varies |
| X-ray IV pyelogram (ivp) (74400) | $352.50 | $1,175 | 1.6× |
| X-ray IV pyelogram+tomography (74415) | $302.40 | $1,008 | 1.3× |
| X-Ray Jaw <4 Vw - Xr Mandible < 4 Views (70100) | $96.90 | $323 | 0.9× |
| X-Ray Lumbar Spine 2/3 Vw - Xr Lumbar Spine 2-3 Views (72100) range across 2 matching MRF lines |
$96.30–$199.80 | $321–$666 | varies |
| X-ray nose-rectum child f.b. (76010) | $96.60 | $322 | 0.9× |
| X-Ray Sacroiliac Jts 3+ Vw - Xr Sacroiliac Joints 3+ Views (72202) | $110.40 | $368 | 0.8× |
| X-Ray Sacroiliac Jts <3 Vw - Xr Sacroiliac Joints 1-2 Views (72200) | $93.30 | $311 | 0.7× |
| X-Ray Sacrum/Coccyx 2+ Vw - Xr Sacrum Coccyx 2+ Views (72220) range across 2 matching MRF lines |
$96.30–$141.90 | $321–$473 | varies |
| X-Ray Sinuses 3+ Vw - Xr Paranasal Sinuses 3+ Views (70220) | $170.70 | $569 | 1.5× |
| X-Ray Skull 4+ Vw - Xr Skull Complete 4+ Views (70260) | $204 | $680 | 1.5× |
| X-Ray Stress View (77071) | $66.60 | $222 | 0.6× |
| X-ray thoracic spine 4 vw (72074) | $159.60 | $532 | 1.2× |
| X-Ray Tmj Unilat (70328) | $95.70 | $319 | 0.9× |
| X-Ray Urinary Tract Exam With Contrast Material (74420) | $471.30 | $1,571 | 1.1× |
| X-Rays Bone Length Studies (77073) | $140.40 | $468 | 1.0× |
| X-Rays Bone Survey Complete (77075) | $260.70 | $869 | 1.9× |
| Xr c-spine 4 or 5 views (72050) range across 2 matching MRF lines |
$119.40–$197.40 | $398–$658 | varies |
| Xr facial bones less than 3 views (70140) range across 2 matching MRF lines |
$86.10–$131.70 | $287–$439 | varies |
| XR Mastoids < 3 Views Bilateral (70120) | $104.70 | $349 | 0.8× |
| Xr orbits complete 4 views (70200) range across 2 matching MRF lines |
$67.50–$141.30 | $225–$471 | varies |
| Xr Tomogram Single Plane (76100) | $194.70 | $649 | 1.4× |
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.