Imaging prices at San Gorgonio Memorial Hospital
Banning, CA · every code in this section with a posted price and a Medicare benchmark.
250 codes. Prices are the hospital's own posted facility charges.
Compare against other hospitals interactively →
| Procedure | Posted cash | Posted gross | × Medicare |
|---|---|---|---|
| Abdomen 1 View (74018) range across 2 matching MRF lines |
$117.42–$121.53 | $587.10–$607.65 | varies |
| Abdomen 2 views (74019) range across 2 matching MRF lines |
$158.05–$163.58 | $790.24–$817.90 | varies |
| Acute Gastrointestinal Blood Loss Imaging (78278) | $566.38 | $2,831.90 | 1.1× |
| Ankle 2 views (73600) range across 2 matching MRF lines |
$117.42–$121.53 | $587.10–$607.65 | varies |
| Arthrogram Wrist (73115) | $81.38 | $406.90 | 0.2× |
| Bone age studies (77072) | $163.58 | $817.90 | 1.2× |
| Bone Imaging 3 Phase (78315) | $566.38 | $2,831.90 | 1.1× |
| Bone Imaging Limited Area (78300) | $566.38 | $2,831.90 | 1.1× |
| Bone Imaging Multiple Areas (78305) | $566.38 | $2,831.90 | 1.1× |
| Bone Imaging Whole Body (78306) range across 2 matching MRF lines |
$549.88–$566.38 | $2,749.42–$2,831.90 | varies |
| Bone survey infant (77076) | $163.58 | $817.90 | 1.2× |
| Brain Image W/Flow < 4 Views (78601) | $549.88 | $2,749.42 | 1.1× |
| Brain imaging < 4 static views (78600) | $549.88 | $2,749.42 | 1.1× |
| Brain Imaging Minimum 4 Static Views (78605) | $551 | $2,755.01 | 0.8× |
| Cat Scan Follow-Up Study (76380) | $420.05 | $2,100.23 | 3.8× |
| Cerebrospinal Fluid Scan (78630) | $742.81 | $3,714.06 | 1.1× |
| Chest 1 view (71045) range across 5 matching MRF lines |
$114.99–$121.53 | $574.93–$607.65 | varies |
| Chest 2 views (71046) range across 3 matching MRF lines |
$117.42–$121.53 | $587.10–$607.65 | varies |
| Chest 3 views (71047) | $121.53 | $607.65 | 1.1× |
| Chest 4 or more views (71048) | $163.58 | $817.90 | 1.2× |
| Clavicle complete (73000) range across 3 matching MRF lines |
$117.42–$121.53 | $587.10–$607.65 | varies |
| Computed Tomography Thorax Lw Dose Lng Ca Scr C- (71271) range across 3 matching MRF lines |
$684.87–$708.84 | $3,424.36–$3,544.22 | varies |
| Contrast X-Ray Bladder (74430) | $291.62 | $1,458.08 | 0.6× |
| Contrast Xray Throat/Cerv Esopha (74210) | $200.06 | $1,000.32 | 0.9× |
| CT abdomen and pelvis without and with contrast (74178) range across 3 matching MRF lines |
$2,316.47–$2,397.55 | $11,582.35–$11,987.74 | varies |
| CT abdomen and pelvis without contrast (74176) range across 3 matching MRF lines |
$1,447.46–$1,498.12 | $7,237.30–$7,490.61 | varies |
| CT abdomen w contrast (74160) range across 2 matching MRF lines |
$1,123.64–$1,162.96 | $5,618.18–$5,814.82 | varies |
| CT abdomen w wo contrast (74170) | $1,162.96 | $5,814.82 | 5.2× |
| CT abdomen w/o contrast (74150) range across 3 matching MRF lines |
$684.87–$708.84 | $3,424.36–$3,544.22 | varies |
| CT Angio Abdomen and Pelvis (74174) range across 2 matching MRF lines |
$2,316.47–$2,397.55 | $11,582.35–$11,987.74 | varies |
| CT Angio Chest (71275) range across 3 matching MRF lines |
$1,123.64–$1,162.96 | $5,618.18–$5,814.82 | varies |
| CT Angio Head (70496) range across 2 matching MRF lines |
$1,123.64–$1,162.96 | $5,618.18–$5,814.82 | varies |
| Ct Angio Lwr Extr W/O&W/Dye (73706) range across 2 matching MRF lines |
$1,123.64–$1,162.96 | $5,618.18–$5,814.82 | varies |
| CT Angio Neck (70498) range across 2 matching MRF lines |
$1,123.64–$1,162.96 | $5,618.18–$5,814.82 | varies |
| Ct Angio Upr Extrm W/O&W/Dye (73206) range across 2 matching MRF lines |
$1,123.64–$1,162.96 | $5,618.18–$5,814.82 | varies |
| CT bone density (77078) | $544.98 | $2,724.91 | 4.9× |
| CT cervical spine w/ contrast (72126) range across 2 matching MRF lines |
$2,316.47–$2,397.55 | $11,582.35–$11,987.74 | varies |
| CT cervical spine w/o contrast (72125) range across 2 matching MRF lines |
$684.87–$708.84 | $3,424.36–$3,544.22 | varies |
| CT cervical spine w/wo cont (72127) | $1,162.96 | $5,814.82 | 5.2× |
| CT chest w contrast (71260) range across 2 matching MRF lines |
$1,123.64–$1,162.96 | $5,618.18–$5,814.82 | varies |
| CT chest w/wo contrast (71270) range across 2 matching MRF lines |
$1,123.64–$1,162.96 | $5,618.18–$5,814.82 | varies |
| CT head/brain with contrast (70460) range across 2 matching MRF lines |
$1,123.64–$1,162.96 | $5,618.18–$5,814.82 | varies |
| CT head/brain without and with contrast (70470) range across 2 matching MRF lines |
$1,123.64–$1,162.96 | $5,618.18–$5,814.82 | varies |
| CT iac w contrast (70481) range across 4 matching MRF lines |
$664.13–$1,162.96 | $3,320.64–$5,814.82 | varies |
| CT l-spine w&w/o contrast (72133) range across 2 matching MRF lines |
$1,123.64–$1,162.96 | $5,618.18–$5,814.82 | varies |
| CT lower ext w/o (73700) range across 4 matching MRF lines |
$684.87–$1,369.74 | $3,424.36–$6,848.72 | varies |
| CT lower extremity w/contrast material (73701) range across 4 matching MRF lines |
$1,123.64–$2,247.27 | $5,618.18–$11,236.36 | varies |
| CT lumbar spine w contrast (72132) range across 2 matching MRF lines |
$2,316.47–$2,397.55 | $11,582.35–$11,987.74 | varies |
| CT lumbar spine w/o contrast (72131) range across 2 matching MRF lines |
$684.87–$708.84 | $3,424.36–$3,544.22 | varies |
| CT maxillofacial w contrast (70487) range across 2 matching MRF lines |
$1,123.64–$1,162.96 | $5,618.18–$5,814.82 | varies |
| CT maxillofacial wo contrast (70486) range across 2 matching MRF lines |
$684.87–$708.84 | $3,424.36–$3,544.22 | varies |
| CT neck tissue combo (70492) | $1,162.96 | $5,814.82 | 5.2× |
| Ct Orbit/Ear/Fossa W/O&W/Dye (70482) range across 3 matching MRF lines |
$1,067.72–$1,162.96 | $5,338.58–$5,814.82 | varies |
| CT orbits w/o contrast (70480) range across 4 matching MRF lines |
$581.32–$708.84 | $2,906.60–$3,544.22 | varies |
| CT pelvis w&w/o contrast (72194) | $1,162.96 | $5,814.82 | 5.2× |
| CT pelvis w/o contrast (72192) range across 3 matching MRF lines |
$684.87–$708.84 | $3,424.36–$3,544.22 | varies |
| CT scan of leg combo (73702) | $1,162.96 | $5,814.82 | 5.2× |
| CT scans face/jaw combo (70488) | $1,162.96 | $5,814.82 | 5.2× |
| CT soft tissue neck w contrast (70491) range across 2 matching MRF lines |
$1,123.64–$1,162.96 | $5,618.18–$5,814.82 | varies |
| CT soft tissue neck w/o contrast (70490) range across 3 matching MRF lines |
$684.87–$708.84 | $3,424.36–$3,544.22 | varies |
| CT thoracic spine w contrast (72129) range across 2 matching MRF lines |
$1,123.64–$1,162.96 | $5,618.18–$5,814.82 | varies |
| CT thoracic spine w/o contrast (72128) range across 2 matching MRF lines |
$684.87–$708.84 | $3,424.36–$3,544.22 | varies |
| CT thoracic spine w/wo cont (72130) | $1,162.96 | $5,814.82 | 5.2× |
| CT thorax w/o contrast (71250) range across 3 matching MRF lines |
$684.87–$708.84 | $3,424.36–$3,544.22 | varies |
| CT upper ext wo (73200) range across 5 matching MRF lines |
$255.74–$708.84 | $1,278.70–$3,544.22 | varies |
| CT upper extremity w/o & w/contrast material (73202) range across 2 matching MRF lines |
$1,123.64–$1,162.96 | $5,618.18–$5,814.82 | varies |
| CT upper extremity with contrast (73201) range across 3 matching MRF lines |
$2,316.47–$2,397.55 | $11,582.35–$11,987.74 | varies |
| Cta Abdl Aorta&Bi Iliofem W/Contrast&Postp (75635) range across 4 matching MRF lines |
$1,068.81–$1,116.17 | $5,344.07–$5,580.87 | varies |
| Cta Abdomen (74175) | $1,162.96 | $5,814.82 | 5.2× |
| CTA pelvis (72191) | $1,162.96 | $5,814.82 | 5.2× |
| Esophagram (74220) range across 2 matching MRF lines |
$259.30–$268.38 | $1,296.50–$1,341.88 | varies |
| Fetal Biophys Profile W/Nst (76818) range across 2 matching MRF lines |
$263.41–$272.63 | $1,317.06–$1,363.16 | varies |
| Fluoroscopy up to 1 hr (76000) range across 3 matching MRF lines |
$334.03–$345.72 | $1,670.15–$1,728.61 | varies |
| Foot 2 views (73620) range across 2 matching MRF lines |
$117.42–$121.53 | $587.10–$607.65 | varies |
| Forearm 2 views (73090) range across 2 matching MRF lines |
$117.42–$121.53 | $587.10–$607.65 | varies |
| Gastric emptying imaging study (78264) | $566.38 | $2,831.90 | 1.1× |
| Gastroesophageal Reflux Exam (78262) | $566.38 | $2,831.90 | 1.1× |
| Gated Heart Planar Single (78472) | $934.97 | $4,674.86 | 1.8× |
| Hand 2 views (73120) range across 2 matching MRF lines |
$158.05–$163.58 | $790.24–$817.90 | varies |
| Hepatobiliary System Imaging (78226) | $566.38 | $2,831.90 | 1.1× |
| Ht Muscle Image Spect Sing (78451) | $1,963.42 | $9,817.10 | 1.2× |
| Joint Survey Single View (77077) | $163.58 | $817.90 | 1.2× |
| K Flow/Funct Image W/Drug (78708) | $735.25 | $3,676.27 | 1.1× |
| K Flow/Funct Image W/O Drug (78707) range across 2 matching MRF lines |
$713.84–$735.25 | $3,569.20–$3,676.27 | varies |
| Knee 3 Views (73562) range across 2 matching MRF lines |
$117.42–$121.53 | $587.10–$607.65 | varies |
| Labeled RBC Sequestration Differntl Organ/Tissue (78140) | $566.38 | $2,831.90 | 1.1× |
| Liver & Spleen Imaging Static Only (78215) | $566.38 | $2,831.90 | 1.1× |
| Liver & Spleen Imaging W/Vascular Flow (78216) | $566.38 | $2,831.90 | 1.1× |
| Lung Ventilat&Perfus Imaging (78582) | $735.25 | $3,676.27 | 1.1× |
| Lung Ventilation Imaging (78579) | $566.38 | $2,831.90 | 1.1× |
| Lymph System Imaging (78195) | $735.26 | $3,676.28 | 1.1× |
| Magnetic Image Jaw Joint (70336) | $864.30 | $4,321.50 | 2.8× |
| Mammary ductogram or galactogram multiple (77054) | $212.01 | $1,060.05 | 0.7× |
| Mammary ductogram or galactogram single (77053) | $288.10 | $1,440.51 | 0.9× |
| Meckels Divert Exam (78290) | $566.38 | $2,831.90 | 1.1× |
| Mra Head W/O & W/Contrast Material (70546) | $1,383.20 | $6,916.01 | 3.1× |
| MRA head w/o contrast (70544) range across 3 matching MRF lines |
$835.07–$1,078.55 | $4,175.36–$5,392.76 | varies |
| MRA head with contrast (70545) | $1,383.20 | $6,916.01 | 3.1× |
| MRA neck w contrast (70548) | $1,383.20 | $6,916.01 | 3.1× |
| Mra Neck W/O &W/Contrast Material (70549) | $1,383.20 | $6,916.01 | 3.1× |
| MRA neck w/o contrast (70547) | $864.30 | $4,321.50 | 2.8× |
| MRI abdomen w contrast (74182) range across 2 matching MRF lines |
$1,342.91–$1,383.20 | $6,714.57–$6,916.01 | varies |
| MRI abdomen w/o contrast (74181) range across 2 matching MRF lines |
$835.07–$864.30 | $4,175.36–$4,321.50 | varies |
| MRI any jt lower extrem w/contrast material (73722) range across 3 matching MRF lines |
$2,467.38–$2,687.31 | $12,336.90–$13,436.55 | varies |
| MRI any jt lower extrem w/o & w/contrast matrl (73723) range across 4 matching MRF lines |
$1,314.47–$2,540.04 | $6,572.36–$12,700.20 | varies |
| MRI any jt upper extremity w/contrast matrl (73222) range across 2 matching MRF lines |
$2,553.74–$2,687.31 | $12,768.70–$13,436.55 | varies |
| MRI cervical spine w contrast (72142) range across 3 matching MRF lines |
$931.19–$1,314.47 | $4,655.93–$6,572.36 | varies |
| MRI cervical spine w/o cont (72141) range across 3 matching MRF lines |
$591.69–$821.74 | $2,958.46–$4,108.70 | varies |
| MRI chest w/o contrast (71550) | $864.30 | $4,321.50 | 2.8× |
| MRI chest with contrast (71551) | $2,687.31 | $13,436.55 | 2.7× |
| MRI chest wo w contrast (71552) | $1,383.20 | $6,916.01 | 3.1× |
| MRI lower extrem oth/thn jt w/contrast matrl (73719) range across 3 matching MRF lines |
$1,314.47–$1,383.20 | $6,572.36–$6,916.01 | varies |
| MRI lower extrem oth/thn jt w/o & w/contr matr (73720) range across 3 matching MRF lines |
$1,314.47–$1,383.20 | $6,572.36–$6,916.01 | varies |
| MRI lower extrem oth/thn jt w/o contr matrl (73718) range across 5 matching MRF lines |
$672.34–$864.30 | $3,361.68–$4,321.50 | varies |
| MRI lumbar spine w contrast (72149) | $1,383.20 | $6,916.01 | 3.1× |
| Mri Neck Spine W/O & W/Dye (72156) range across 3 matching MRF lines |
$1,047.38–$1,314.47 | $5,236.91–$6,572.36 | varies |
| MRI orbit face &/neck w/o contrast (70540) | $864.30 | $4,321.50 | 2.8× |
| MRI orbit face neck w contrast (70542) | $1,383.20 | $6,916.01 | 3.1× |
| Mri Orbt/Fac/Nck W/O &W/Dye (70543) range across 2 matching MRF lines |
$1,336.43–$1,383.20 | $6,682.13–$6,916.01 | varies |
| MRI pelvis w contrast (72196) | $1,383.20 | $6,916.01 | 3.1× |
| MRI pelvis w/o & w contrast (72197) range across 2 matching MRF lines |
$1,336.43–$1,383.20 | $6,682.13–$6,916.01 | varies |
| MRI pelvis w/o contrast (72195) range across 2 matching MRF lines |
$835.07–$864.30 | $4,175.36–$4,321.50 | varies |
| MRI thoracic spine w/o contrast (72146) range across 2 matching MRF lines |
$835.07–$864.30 | $4,175.36–$4,321.50 | varies |
| MRI upper extremity oth than jt w/contr matrl (73219) range across 3 matching MRF lines |
$821.74–$1,383.20 | $4,108.70–$6,916.01 | varies |
| MRI upper extremity oth than jt w/o contr matrl (73218) range across 6 matching MRF lines |
$793.95–$1,116.30 | $3,969.75–$5,581.51 | varies |
| Mri Uppr Extremity W/O&W/Dye (73220) range across 3 matching MRF lines |
$1,314.47–$1,609.04 | $6,572.36–$8,045.22 | varies |
| MRI, abdomen, combo (74183) range across 3 matching MRF lines |
$1,336.43–$1,383.20 | $6,682.13–$6,916.01 | varies |
| MRI, dorsal spine combo (72157) | $1,383.20 | $6,916.01 | 3.1× |
| MRI, dorsal spine contrast (72147) | $1,383.20 | $6,916.01 | 3.1× |
| MRI, joint upper extrem (73221) range across 5 matching MRF lines |
$664.81–$864.30 | $3,324.04–$4,321.50 | varies |
| MRI, joint upper extrem combo (73223) range across 3 matching MRF lines |
$1,314.47–$1,383.20 | $6,572.36–$6,916.01 | varies |
| MRI, lumbar spine combo (72158) | $1,383.20 | $6,916.01 | 3.1× |
| Myelogram Lumbar (72265) | $434.50 | $2,172.48 | 0.4× |
| Myocardial Perfusion Planar 1 Study Rest/Stress (78453) | $1,906.24 | $9,531.18 | 1.1× |
| Myocardial Spect Multiple Studies (78452) | $1,963.42 | $9,817.10 | 1.2× |
| Neck soft tissue (70360) range across 2 matching MRF lines |
$117.42–$121.53 | $587.10–$607.65 | varies |
| Parathyroid Planar Imaging (78070) | $566.38 | $2,831.90 | 1.1× |
| Pelvis 1 or 2 views (72170) range across 3 matching MRF lines |
$158.05–$163.58 | $790.24–$817.90 | varies |
| Pulmonary Perfusion Imaging Particulate (78580) | $566.38 | $2,831.90 | 1.1× |
| Radex Abd Compl Aqt Abd W/S/E/D Views 1 View Ch (74022) range across 2 matching MRF lines |
$158.05–$163.58 | $790.24–$817.90 | varies |
| Radex abscess/fistula/sinus tract rs&i (76080) | $725.98 | $3,629.91 | 1.0× |
| Radex Ankle Complete Minimum 3 Views (73610) range across 2 matching MRF lines |
$117.42–$121.53 | $587.10–$607.65 | varies |
| Radex Calcaneus Minimum 2 Views (73650) | $121.53 | $607.65 | 1.1× |
| Radex elbow complete minimum 3 views (73080) range across 2 matching MRF lines |
$117.42–$121.53 | $587.10–$607.65 | varies |
| Radex Facial Bones Complete Minimum 3 Views (70150) range across 2 matching MRF lines |
$158.05–$163.58 | $790.24–$817.90 | varies |
| Radex fingr minimum 2 views (73140) range across 2 matching MRF lines |
$117.42–$121.53 | $587.10–$607.65 | varies |
| Radex foot complete minimum 3 views (73630) range across 2 matching MRF lines |
$117.42–$121.53 | $587.10–$607.65 | varies |
| Radex Hand Minimum 3 Views (73130) range across 2 matching MRF lines |
$117.42–$121.53 | $587.10–$607.65 | varies |
| Radex lower extremity infant minimum 2 views (73592) range across 3 matching MRF lines |
$121.53–$166.37 | $607.65–$831.84 | varies |
| Radex Mastoids Compl Minimum 3 Views PR Side (70130) | $190.18 | $950.88 | 1.4× |
| Radex Nasal Bones Complete Minimum 3 Views (70160) range across 2 matching MRF lines |
$117.42–$121.53 | $587.10–$607.65 | varies |
| Radex shoulder complete minimum 2 views (73030) range across 3 matching MRF lines |
$117.42–$161.33 | $587.10–$806.64 | varies |
| Radex Sinuses Paransl < 3 Views (70210) | $121.53 | $607.65 | 1.1× |
| Radex Sternum Minimum 2 Views (71120) | $121.53 | $607.65 | 1.1× |
| Radex Temporomandble Jt Opn & Clsd Mouth Bilat (70330) range across 2 matching MRF lines |
$121.53–$150.67 | $607.65–$753.36 | varies |
| Radex Toe Minimum 2 Views (73660) range across 2 matching MRF lines |
$117.42–$121.53 | $587.10–$607.65 | varies |
| Radex upper extremity infant minimum 2 views (73092) range across 2 matching MRF lines |
$158.05–$163.58 | $790.24–$817.90 | varies |
| Radex Wrist Complete Minimum 3 Views (73110) range across 3 matching MRF lines |
$117.42–$243.52 | $587.10–$1,217.61 | varies |
| Radiolog exam mandible compl minimum 4 views (70110) | $163.58 | $817.90 | 1.2× |
| Radiologic exam colon double contrast study (74280) range across 2 matching MRF lines |
$268.38–$1,940.47 | $1,341.88–$9,702.36 | varies |
| Radiologic exam colon single contrast study (74270) | $268.38 | $1,341.88 | 1.2× |
| Radiologic Exam Esophagus Double Contrast Study (74221) | $268.38 | $1,341.88 | 1.2× |
| Radiologic exam knee complete 4/more views (73564) range across 3 matching MRF lines |
$158.05–$273.50 | $790.24–$1,367.52 | varies |
| Radiologic exam pelvis compl minimum 3 views (72190) range across 3 matching MRF lines |
$158.05–$163.58 | $790.24–$817.90 | varies |
| Radiologic Exam Small Int Single Contrast Study (74250) range across 2 matching MRF lines |
$259.30–$268.38 | $1,296.50–$1,341.88 | varies |
| Radiologic exam swallow function contrast study (74230) range across 2 matching MRF lines |
$146.84–$268.38 | $734.21–$1,341.88 | varies |
| Radiologic exam upr gi trc double contrast study (74246) | $268.38 | $1,341.88 | 1.2× |
| Radiologic examination femur minimum 2 views (73552) range across 2 matching MRF lines |
$117.42–$121.53 | $587.10–$607.65 | varies |
| Radiologic examination knee 1/2 views (73560) range across 3 matching MRF lines |
$117.42–$121.53 | $587.10–$607.65 | varies |
| Radiologic Examination Osseous Survey Limited (77074) | $163.58 | $817.90 | 1.2× |
| Radiologic examination tibia & fibula 2 views (73590) range across 2 matching MRF lines |
$117.42–$121.53 | $587.10–$607.65 | varies |
| Rp loclzj tum plnr 1 area single day imaging (78800) | $549.88 | $2,749.42 | 1.1× |
| Rp loclzj tum plnr 2+area 1+d img/1 area img>2+d (78801) | $566.38 | $2,831.90 | 1.1× |
| Rp Loclzj Tum Plnr Whole Body Single Day Imaging (78802) | $1,963.42 | $9,817.10 | 2.8× |
| Rp Loclzj Tum Spect 1 Area Single Day Imaging (78803) | $1,801.56 | $9,007.80 | 2.6× |
| Rp loclzj tum spect CT 2area 1d img/1 ar img>2+d (78832) | $2,012.86 | $10,064.28 | 1.1× |
| Rp loclzj tum spect w/CT 1 area/acquisj 1day img (78830) | $1,801.56 | $9,007.80 | 1.1× |
| Scapula (73010) range across 3 matching MRF lines |
$161.33–$305.60 | $806.64–$1,528 | varies |
| Shoulder 1 view (73020) range across 3 matching MRF lines |
$106.18–$121.53 | $530.88–$607.65 | varies |
| Shoulder Arthrography (73040) | $282.56 | $1,412.80 | 0.6× |
| Skull less than 4 views (70250) range across 2 matching MRF lines |
$158.05–$163.58 | $790.24–$817.90 | varies |
| Sternoclavicular joints (71130) range across 2 matching MRF lines |
$117.42–$121.53 | $587.10–$607.65 | varies |
| Thoracic spine 2 views (72070) range across 2 matching MRF lines |
$158.05–$163.58 | $790.24–$817.90 | varies |
| Thoracic spine 3 views (72072) | $150.67 | $753.36 | 1.1× |
| Thoracolumbar 2 views (72080) range across 2 matching MRF lines |
$117.42–$121.53 | $587.10–$607.65 | varies |
| Thyroid Uptake Measurement (78012) | $566.38 | $2,831.90 | 1.1× |
| Thyroid Uptake W/Blood Flow Sngle/Mult Quan Meas (78014) | $566.38 | $2,831.90 | 1.1× |
| Ultrasound Breast Limited (76642) | $190 | $950 | 1.7× |
| Ultrasound Exam Aaa Screen (76706) range across 3 matching MRF lines |
$245.82–$254.42 | $1,229.10–$1,272.12 | varies |
| Ultrasound, abdomen limited (76705) range across 3 matching MRF lines |
$263.41–$526.82 | $1,317.06–$2,634.12 | varies |
| Unlisted Dx Radiographic Procedure (76499) | $154.56 | $772.80 | 1.4× |
| Unlisted us procedure (76999) | $190 | $950 | 1.7× |
| Upper gi w/o kub (74240) | $268.38 | $1,341.88 | 1.2× |
| Ureteral Reflux Study (78740) | $549.88 | $2,749.42 | 1.1× |
| Urethrocystogram voiding (74455) | $345.72 | $1,728.61 | 1.1× |
| Urethrocystography retrograde (74450) | $160.63 | $803.16 | 0.5× |
| Us breast unilateral complete (76641) range across 2 matching MRF lines |
$263.41–$272.63 | $1,317.06–$1,363.16 | varies |
| Us chest (76604) range across 2 matching MRF lines |
$263.41–$272.63 | $1,317.06–$1,363.16 | varies |
| Us complete joint (76881) range across 2 matching MRF lines |
$263.41–$272.63 | $1,317.06–$1,363.16 | varies |
| Us exam, pelvic, limited (76857) range across 2 matching MRF lines |
$263.41–$272.63 | $1,317.06–$1,363.16 | varies |
| Us kidney transplant (76776) range across 2 matching MRF lines |
$263.41–$272.63 | $1,317.06–$1,363.16 | varies |
| Us lmtd joint/oth nonvasc xtr strux r-t w/img (76882) range across 2 matching MRF lines |
$263.41–$272.63 | $1,317.06–$1,363.16 | varies |
| Us ob limited 1 or more fetuses (76815) range across 3 matching MRF lines |
$263.41–$272.63 | $1,317.06–$1,363.16 | varies |
| Us ob transvaginal (76817) range across 2 matching MRF lines |
$263.41–$272.63 | $1,317.06–$1,363.16 | varies |
| Us pelvic non ob complete (76856) range across 2 matching MRF lines |
$263.41–$272.63 | $1,317.06–$1,363.16 | varies |
| Us pg uter img f&mat 14 wk tabdl 1/1st gestation (76801) range across 2 matching MRF lines |
$263.41–$272.63 | $1,317.06–$1,363.16 | varies |
| Us preg uterus real time f/u trnsabdl per fetus (76816) | $272.63 | $1,363.16 | 2.0× |
| Us retroperitoneal complete (76770) range across 3 matching MRF lines |
$255.74–$272.63 | $1,278.70–$1,363.16 | varies |
| Us retroperitoneal limited (76775) range across 3 matching MRF lines |
$255.74–$272.63 | $1,278.70–$1,363.16 | varies |
| Us scrotum and contents (76870) range across 2 matching MRF lines |
$272.63–$526.82 | $1,363.16–$2,634.12 | varies |
| Us spinal canal and contents (76800) | $272.63 | $1,363.16 | 2.0× |
| Us thyroid (76536) range across 4 matching MRF lines |
$255.74–$272.63 | $1,278.70–$1,363.16 | varies |
| Us transrectal (76872) | $272.63 | $1,363.16 | 2.0× |
| Vein X-Ray Chest (75827) range across 2 matching MRF lines |
$947.18–$2,051.26 | $4,735.92–$10,256.32 | varies |
| Venography caval inferior serialography rs&i (75825) | $4,301.09 | $21,505.45 | 1.1× |
| Venography extremity bilateral rs&i (75822) | $571.54 | $2,857.68 | 0.3× |
| Venography extremity unilateral rs&i (75820) | $2,112.80 | $10,564 | 1.0× |
| Wrist 2 views (73100) range across 3 matching MRF lines |
$117.42–$121.53 | $587.10–$607.65 | varies |
| X-Ray Ac Jts - Xr Acromioclavicular Joints Bilateral (73050) range across 4 matching MRF lines |
$75.52–$121.53 | $377.60–$607.65 | varies |
| X-ray antegrade pyelogram tube (74425) | $553.28 | $2,766.40 | 1.2× |
| X-Ray Elbow 2 Vw - Xr Elbow 1-2 Views Right (73070) range across 2 matching MRF lines |
$117.42–$121.53 | $587.10–$607.65 | varies |
| X-Ray Exam Breast Specimen (76098) range across 3 matching MRF lines |
$567.50–$587.36 | $2,837.50–$2,936.82 | varies |
| X-Ray Exam Entire Spi 1 Vw (72081) | $121.53 | $607.65 | 1.1× |
| X-Ray Exam Entire Spi 2/3 Vw (72082) range across 4 matching MRF lines |
$158.05–$255.74 | $790.24–$1,278.70 | varies |
| X-Ray Exam Hip Uni 1 View (73501) range across 4 matching MRF lines |
$82.66–$121.53 | $413.28–$607.65 | varies |
| X-Ray Exam Hip Uni 2-3 Views (73502) range across 2 matching MRF lines |
$117.42–$121.53 | $587.10–$607.65 | varies |
| X-Ray Exam Hip Uni 4/> Views (73503) | $160.32 | $801.60 | 1.2× |
| X-Ray Exam Hips Bi 2 Views (73521) range across 2 matching MRF lines |
$158.05–$163.58 | $790.24–$817.90 | varies |
| X-Ray Exam L-S Spine Bending (72114) range across 2 matching MRF lines |
$158.05–$163.58 | $790.24–$817.90 | varies |
| X-Ray Exam Neck Spine 2-3 Vw (72040) range across 2 matching MRF lines |
$117.42–$121.53 | $587.10–$607.65 | varies |
| X-Ray Exam Neck Spine 6/>Vws (72052) range across 2 matching MRF lines |
$158.05–$163.58 | $790.24–$817.90 | varies |
| X-Ray Exam Unilat Ribs/Chest (71101) range across 2 matching MRF lines |
$158.05–$163.58 | $790.24–$817.90 | varies |
| X-ray eye for foreign body (70030) range across 2 matching MRF lines |
$117.42–$121.53 | $587.10–$607.65 | varies |
| X-ray humerus (73060) range across 2 matching MRF lines |
$117.42–$121.53 | $587.10–$607.65 | varies |
| X-ray IV pyelogram (ivp) (74400) | $268.38 | $1,341.88 | 1.2× |
| X-Ray Knee Bilat Standing - Xr Knees Anteroposterior Standing Bilat (73565) range across 2 matching MRF lines |
$117.42–$121.53 | $587.10–$607.65 | varies |
| X-Ray Lumbar Spine 2/3 Vw - Xr Lumbar Spine 2-3 Views (72100) range across 3 matching MRF lines |
$153.44–$163.58 | $767.22–$817.90 | varies |
| X-ray nose-rectum child f.b. (76010) range across 2 matching MRF lines |
$117.42–$121.53 | $587.10–$607.65 | varies |
| X-Ray Ribs, Chest 4+ Vw - Xr Ribs 3 Vws Bil W/ Chest Posteroanterior (71111) range across 2 matching MRF lines |
$158.05–$163.58 | $790.24–$817.90 | varies |
| X-Ray Sacroiliac Jts 3+ Vw - Xr Sacroiliac Joints 3+ Views (72202) range across 2 matching MRF lines |
$150.67–$158.05 | $753.36–$790.24 | varies |
| X-Ray Sacroiliac Jts <3 Vw - Xr Sacroiliac Joints 1-2 Views (72200) | $163.58 | $817.90 | 1.2× |
| X-Ray Sacrum/Coccyx 2+ Vw - Xr Sacrum Coccyx 2+ Views (72220) range across 2 matching MRF lines |
$117.42–$121.53 | $587.10–$607.65 | varies |
| X-Ray Sinuses 3+ Vw - Xr Paranasal Sinuses 3+ Views (70220) range across 2 matching MRF lines |
$117.42–$121.53 | $587.10–$607.65 | varies |
| X-Ray Skull 4+ Vw - Xr Skull Complete 4+ Views (70260) range across 2 matching MRF lines |
$158.05–$163.58 | $790.24–$817.90 | varies |
| X-Ray Urinary Tract Exam With Contrast Material (74420) | $553.28 | $2,766.40 | 1.2× |
| X-Rays Bone Length Studies (77073) | $163.58 | $817.90 | 1.2× |
| X-Rays Bone Survey Complete (77075) | $163.58 | $817.90 | 1.2× |
| Xr c-spine 4 or 5 views (72050) range across 2 matching MRF lines |
$158.05–$163.58 | $790.24–$817.90 | varies |
| Xr facial bones less than 3 views (70140) range across 2 matching MRF lines |
$117.42–$121.53 | $587.10–$607.65 | varies |
| Xr orbits complete 4 views (70200) | $163.58 | $817.90 | 1.2× |
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.