Imaging prices at San Juan Regional Medical Center Inc
Farmington, NM · every code in this section with a posted price and a Medicare benchmark.
325 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) | $3,356 | $6,712 | 2.4× |
| Abdomen 1 View (74018) | $225 | $450 | 2.6× |
| Abdomen 2 views (74019) | $246 | $492 | 2.4× |
| Acute Gastrointestinal Blood Loss Imaging (78278) | $1,008.50 | $2,017 | 2.5× |
| Angio pulmonary bilat (75743) | $2,768.50 | $5,537 | 0.9× |
| Angiography extremity bilateral rs&i (75716) range across 2 matching MRF lines |
$4,717–$7,075.50 | $9,434–$14,151 | varies |
| Angiography extremity unilateral rs&i (75710) | $2,900 | $5,800 | 0.9× |
| Ankle 2 views (73600) range across 2 matching MRF lines |
$230.50–$346 | $461–$692 | varies |
| Aortography thoracic serialography rs&i (75605) | $5,915 | $11,830 | 1.1× |
| Aortography thoracic w/o serialography rs&i (75600) | $3,000 | $6,000 | 1.0× |
| Artery X-Rays Abdomen (75726) | $6,824.50 | $13,649 | 1.2× |
| Artery X-Rays Pelvis (75736) | $6,309.50 | $12,619 | 1.1× |
| Arthrogram hip (73525) | $811 | $1,622 | 2.3× |
| Arthrogram Wrist (73115) | $301 | $602 | 0.9× |
| Basic radiation dosimetry calculation (77300) | $537 | $1,074 | 4.0× |
| Bone age studies (77072) | $163.50 | $327 | 1.6× |
| Bone Imaging 3 Phase (78315) | $1,226 | $2,452 | 3.1× |
| Bone Imaging Whole Body (78306) | $1,096 | $2,192 | 2.8× |
| Bone survey infant (77076) | $428 | $856 | 4.1× |
| Brachytx isodose complex (77318) | $627 | $1,254 | 1.7× |
| Brachytx isodose intermed (77317) | $474.50 | $949 | 1.3× |
| Brachytx Isodose Plan Simple (77316) | $528 | $1,056 | 1.4× |
| Brain Imaging Min 4 Static Views W Vascular Flow (78606) | $613.50 | $1,227 | 1.1× |
| Brain Imaging Pet Metabolic Evaluation (78608) | $2,738 | $5,476 | 1.9× |
| Cat Scan Follow-Up Study (76380) | $371.50 | $743 | 4.3× |
| Cerebrospinal Fluid Flow W/O Matl Shunt Evaltj (78645) | $586 | $1,172 | 1.1× |
| Cerebrospinal Fluid Scan (78630) | $1,123 | $2,246 | 2.1× |
| Chest 1 view (71045) | $196.50 | $393 | 2.3× |
| Chest 2 views (71046) | $249.50 | $499 | 2.9× |
| Chest 3 views (71047) | $298.50 | $597 | 3.4× |
| Chest 4 or more views (71048) | $436 | $872 | 4.2× |
| Clavicle complete (73000) range across 2 matching MRF lines |
$262–$393 | $524–$786 | varies |
| Computed Tomography Thorax Lw Dose Lng Ca Scr C- (71271) | $330 | $660 | 3.2× |
| Continuing medical physics consltj pr wk (77336) | $890.50 | $1,781 | 6.6× |
| Contrast Exam Abdominl Aorta (75625) | $3,307.50 | $6,615 | 1.1× |
| Contrast X-Ray Bladder (74430) | $705 | $1,410 | 2.0× |
| Contrast X-Ray Of Elbow (73085) | $301 | $602 | 0.9× |
| Contrast X-Ray Of Knee Joint (73580) | $734.50 | $1,469 | 2.1× |
| CT abdomen and pelvis without and with contrast (74178) | $3,257.50 | $6,515 | 9.4× |
| CT abdomen and pelvis without contrast (74176) | $2,315 | $4,630 | 9.7× |
| CT abdomen w contrast (74160) | $1,873.50 | $3,747 | 10.7× |
| CT abdomen w wo contrast (74170) | $2,077 | $4,154 | 11.9× |
| CT abdomen w/o contrast (74150) | $1,543 | $3,086 | 14.8× |
| CT Angio Abdomen and Pelvis (74174) | $2,905 | $5,810 | 8.4× |
| CT Angio Chest (71275) | $2,243.50 | $4,487 | 12.8× |
| CT Angio Head (70496) | $1,973.50 | $3,947 | 11.3× |
| CT angio hrt w/3d image (75574) | $1,744.50 | $3,489 | 5.0× |
| Ct Angio Lwr Extr W/O&W/Dye (73706) range across 2 matching MRF lines |
$2,132.50–$3,199 | $4,265–$6,398 | varies |
| CT Angio Neck (70498) | $2,087.50 | $4,175 | 11.9× |
| Ct Angio Upr Extrm W/O&W/Dye (73206) range across 2 matching MRF lines |
$1,993.50–$2,990.50 | $3,987–$5,981 | varies |
| CT cervical spine w/ contrast (72126) | $2,209.50 | $4,419 | 6.4× |
| CT cervical spine w/o contrast (72125) | $1,826 | $3,652 | 17.5× |
| CT cervical spine w/wo cont (72127) | $2,810.50 | $5,621 | 16.1× |
| CT chest w contrast (71260) | $1,836 | $3,672 | 10.5× |
| CT chest w/wo contrast (71270) | $2,001 | $4,002 | 11.4× |
| CT head/brain with contrast (70460) | $1,797.50 | $3,595 | 10.3× |
| CT head/brain without and with contrast (70470) | $1,927 | $3,854 | 11.0× |
| CT heart contrast eval cardiac structure&morph (75572) | $1,013 | $2,026 | 2.9× |
| CT heart no contrast quant eval coronry calcium (75571) | $397 | $794 | 4.6× |
| CT hrt w/3d image congen (75573) | $888.50 | $1,777 | 2.6× |
| CT iac w contrast (70481) | $1,861.50 | $3,723 | 10.6× |
| CT l-spine w&w/o contrast (72133) | $2,296.50 | $4,593 | 13.1× |
| CT lower ext w/o (73700) range across 2 matching MRF lines |
$1,379.50–$2,069.50 | $2,759–$4,139 | varies |
| CT lower extremity w/contrast material (73701) range across 2 matching MRF lines |
$1,960.50–$2,941 | $3,921–$5,882 | varies |
| CT lumbar spine w contrast (72132) | $1,865 | $3,730 | 5.4× |
| CT lumbar spine w/o contrast (72131) | $1,527 | $3,054 | 14.7× |
| CT maxillofacial w contrast (70487) | $1,838.50 | $3,677 | 10.5× |
| CT maxillofacial wo contrast (70486) | $1,293.50 | $2,587 | 12.4× |
| CT neck tissue combo (70492) | $2,069 | $4,138 | 11.8× |
| Ct Orbit/Ear/Fossa W/O&W/Dye (70482) | $1,678.50 | $3,357 | 9.6× |
| CT orbits w/o contrast (70480) | $1,368 | $2,736 | 13.1× |
| CT pelvis w&w/o contrast (72194) | $2,726.50 | $5,453 | 15.6× |
| CT pelvis w/o contrast (72192) | $1,674.50 | $3,349 | 16.1× |
| CT scan of leg combo (73702) range across 2 matching MRF lines |
$2,160.50–$3,241 | $4,321–$6,482 | varies |
| CT scans face/jaw combo (70488) | $2,020.50 | $4,041 | 11.6× |
| CT soft tissue neck w contrast (70491) | $1,663 | $3,326 | 9.5× |
| CT soft tissue neck w/o contrast (70490) | $1,469 | $2,938 | 14.1× |
| CT thoracic spine w contrast (72129) | $2,016.50 | $4,033 | 11.5× |
| CT thoracic spine w/o contrast (72128) | $1,538.50 | $3,077 | 14.8× |
| CT thoracic spine w/wo cont (72130) | $2,250 | $4,500 | 12.9× |
| CT thorax w/o contrast (71250) | $1,397.50 | $2,795 | 13.4× |
| CT unlisted procedure (76497) | $144.50 | $289 | 1.7× |
| CT upper ext wo (73200) range across 2 matching MRF lines |
$1,308–$1,962 | $2,616–$3,924 | varies |
| CT upper extremity w/o & w/contrast material (73202) range across 2 matching MRF lines |
$2,133–$3,199.50 | $4,266–$6,399 | varies |
| CT upper extremity with contrast (73201) range across 2 matching MRF lines |
$1,935.50–$2,903.50 | $3,871–$5,807 | varies |
| Cta Abdl Aorta&Bi Iliofem W/Contrast&Postp (75635) | $2,337 | $4,674 | 13.4× |
| Cta Abdomen (74175) | $2,008 | $4,016 | 11.5× |
| CTA head&neck c+ w/noncontrast img&post-pxessing (70471) | $3,074 | $6,148 | 8.8× |
| CTA pelvis (72191) | $2,285 | $4,570 | 13.1× |
| Diskography lumbar (72295) | $1,822 | $3,644 | 0.9× |
| Dxa Bone Density Axial (77080) | $363 | $726 | 3.5× |
| Dxa bone density study 1/>sites appendiclr skel (77081) | $273 | $546 | 3.1× |
| Echo exam uterus (76831) | $255 | $510 | 1.1× |
| Echograp Trans R Pros Study (76873) | $346.50 | $693 | 3.3× |
| Esophagram (74220) | $673 | $1,346 | 3.8× |
| Fetal Biophysical Profile W/O Non-Stress Testing (76819) | $430.50 | $861 | 4.1× |
| Fluoroscopy up to 1 hr (76000) range across 2 matching MRF lines |
$200–$498.50 | $400–$997 | varies |
| Follow-Up Angiography (75898) | $2,250 | $4,500 | 0.7× |
| Foot 2 views (73620) range across 2 matching MRF lines |
$226–$339 | $452–$678 | varies |
| Forearm 2 views (73090) range across 2 matching MRF lines |
$258.50–$388 | $517–$776 | varies |
| Gastric emptying imaging study (78264) | $1,000 | $2,000 | 2.5× |
| Gated Heart Planar Single (78472) | $1,377.50 | $2,755 | 3.5× |
| Hand 2 views (73120) range across 2 matching MRF lines |
$192.50–$289 | $385–$578 | varies |
| Hepatobil Syst Image W/Drug (78227) | $1,104.50 | $2,209 | 2.0× |
| Hepatobiliary System Imaging (78226) | $1,027.50 | $2,055 | 2.6× |
| Ht Muscle Image Spect Sing (78451) | $2,032 | $4,064 | 1.6× |
| Hysterosalpingogram (74740) | $434.50 | $869 | 1.8× |
| Image fusion (77399) | $113 | $226 | 0.8× |
| Infant hip ultrasound with hip movement (dynamic) (76885) | $205 | $410 | 2.4× |
| Infusion Ivp (74410) | $616.50 | $1,233 | 3.5× |
| Interstitial radiation source applic complex (77778) | $1,161 | $2,322 | 1.7× |
| Joint Survey Single View (77077) | $145.50 | $291 | 1.4× |
| K Flow/Funct Image W/Drug (78708) | $1,277 | $2,554 | 2.4× |
| Knee 3 Views (73562) range across 2 matching MRF lines |
$274.50–$412 | $549–$824 | varies |
| Leveen/Shunt Patency Exam (78291) | $362.50 | $725 | 0.9× |
| Liver & Spleen Imaging W/Vascular Flow (78216) | $518 | $1,036 | 1.3× |
| Lung Ventilat&Perfus Imaging (78582) | $1,425.50 | $2,851 | 2.6× |
| Lymph System Imaging (78195) | $1,070.50 | $2,141 | 2.0× |
| Magnetic Image Jaw Joint (70336) | $1,605 | $3,210 | 6.7× |
| Mammary ductogram or galactogram single (77053) range across 2 matching MRF lines |
$498–$747 | $996–$1,494 | varies |
| Meckels Divert Exam (78290) | $471 | $942 | 1.2× |
| Medical physics dose eval radiation expos w/rprt (76145) | $300 | $600 | 0.8× |
| Mlc imrt design & construction per imrt plan (77338) | $3,220.50 | $6,441 | 8.6× |
| Mr safety implant&/fb assmt clin staf 1st 15 min (76014) | $40 | $80 | 1.4× |
| Mr safety implt electronics prepj supvj phys/qhp (76018) | $110.50 | $221 | 1.2× |
| Mr safety implt pos&/immoblj (76019) | $71.50 | $143 | 1.2× |
| Mr safety med physics xm customization plng&mntr (76017) | $291.50 | $583 | 1.2× |
| Mra Head W/O & W/Contrast Material (70546) | $2,169 | $4,338 | 6.2× |
| MRA head w/o contrast (70544) | $1,797.50 | $3,595 | 7.6× |
| MRA head with contrast (70545) | $1,975 | $3,950 | 5.7× |
| MRA neck w contrast (70548) | $2,450 | $4,900 | 7.0× |
| Mra Neck W/O &W/Contrast Material (70549) | $2,639.50 | $5,279 | 7.6× |
| MRA neck w/o contrast (70547) | $1,761 | $3,522 | 7.4× |
| MRI abdomen w contrast (74182) | $2,454.50 | $4,909 | 7.1× |
| MRI abdomen w/o contrast (74181) | $1,965 | $3,930 | 8.3× |
| MRI any jt lower extrem w/contrast material (73722) range across 2 matching MRF lines |
$2,192–$3,288 | $4,384–$6,576 | varies |
| MRI any jt lower extrem w/o & w/contrast matrl (73723) range across 2 matching MRF lines |
$2,442.50–$3,664 | $4,885–$7,328 | varies |
| MRI any jt upper extremity w/contrast matrl (73222) range across 2 matching MRF lines |
$2,096.50–$3,145 | $4,193–$6,290 | varies |
| MRI Breast W/O Contrast Bilateral (77047) | $1,368.50 | $2,737 | 5.8× |
| MRI Breast Without Contrast Material Unilateral (77046) | $912.50 | $1,825 | 3.8× |
| MRI cardiac w/o contrast (75557) | $1,832.50 | $3,665 | 7.7× |
| MRI cervical spine w/o cont (72141) | $1,915 | $3,830 | 8.1× |
| MRI chest w/o contrast (71550) | $1,812.50 | $3,625 | 7.6× |
| MRI chest with contrast (71551) | $2,241.50 | $4,483 | 2.9× |
| MRI chest wo w contrast (71552) | $2,750 | $5,500 | 7.9× |
| MRI lower extrem oth/thn jt w/contrast matrl (73719) range across 2 matching MRF lines |
$2,000–$3,000 | $4,000–$6,000 | varies |
| MRI lower extrem oth/thn jt w/o & w/contr matr (73720) range across 2 matching MRF lines |
$2,477–$3,715.50 | $4,954–$7,431 | varies |
| MRI lower extrem oth/thn jt w/o contr matrl (73718) range across 2 matching MRF lines |
$1,789–$2,683.50 | $3,578–$5,367 | varies |
| MRI lumbar spine w contrast (72149) | $2,503 | $5,006 | 7.2× |
| Mri Neck Spine W/O & W/Dye (72156) | $2,766 | $5,532 | 8.0× |
| MRI orbit face &/neck w/o contrast (70540) | $1,791.50 | $3,583 | 7.5× |
| MRI orbit face neck w contrast (70542) | $2,019 | $4,038 | 5.8× |
| Mri Orbt/Fac/Nck W/O &W/Dye (70543) | $2,436 | $4,872 | 7.0× |
| MRI pelvis w/o & w contrast (72197) | $2,456 | $4,912 | 7.1× |
| MRI pelvis w/o contrast (72195) | $1,984 | $3,968 | 8.3× |
| MRI spectroscopy (76390) | $596.50 | $1,193 | 6.9× |
| MRI thoracic spine w/o contrast (72146) | $1,975 | $3,950 | 8.3× |
| MRI upper extremity oth than jt w/contr matrl (73219) range across 2 matching MRF lines |
$2,044–$3,066 | $4,088–$6,132 | varies |
| MRI upper extremity oth than jt w/o contr matrl (73218) range across 2 matching MRF lines |
$1,761–$2,641.50 | $3,522–$5,283 | varies |
| Mri Uppr Extremity W/O&W/Dye (73220) range across 2 matching MRF lines |
$2,346–$3,519 | $4,692–$7,038 | varies |
| MRI, abdomen, combo (74183) | $2,650 | $5,300 | 7.6× |
| MRI, dorsal spine combo (72157) | $2,920 | $5,840 | 8.4× |
| MRI, joint upper extrem (73221) range across 2 matching MRF lines |
$1,774–$2,661 | $3,548–$5,322 | varies |
| MRI, joint upper extrem combo (73223) range across 2 matching MRF lines |
$2,623–$3,513 | $5,246–$7,026 | varies |
| MRI, lumbar spine combo (72158) | $2,912 | $5,824 | 8.4× |
| Myocardial Spect Multiple Studies (78452) | $3,131 | $6,262 | 2.4× |
| Myocrd img PET prfuj 1std rest/stress cncrnt CT (78430) | $1,756.50 | $3,513 | 1.2× |
| Myocrd Img Pet Prfuj Mlt Std Rst&Strs Cncrnt CT (78431) | $2,710 | $5,420 | 1.2× |
| Myocrd Img Pet Prfuj W/Metab 2rtracer Cncrnt CT (78433) | $2,854 | $5,708 | 1.3× |
| Neck soft tissue (70360) | $238 | $476 | 2.7× |
| Njx Rp Loclzj Non-Img Probe Study Intravenous (78808) | $785 | $1,570 | 2.0× |
| Nonvascular Shunt X-Ray (75809) | $251.50 | $503 | 2.4× |
| Ntsty modul radthx pln dose-vol histos (77301) | $5,788 | $11,576 | 4.2× |
| Nuclear Rx Intra-Arterial (79445) | $446 | $892 | 1.9× |
| Nuclear Rx Oral Admin (79005) | $1,042 | $2,084 | 4.5× |
| Ob us nuchal meas 1 gest (76813) | $281.50 | $563 | 2.7× |
| Panoramic X-ray of jaws (70355) | $139 | $278 | 1.6× |
| Parathyroid imaging w/tomographic spect & CT (78072) | $834.50 | $1,669 | 1.5× |
| Parathyroid Planar Imaging (78070) | $958.50 | $1,917 | 2.4× |
| Pelvis 1 or 2 views (72170) | $252.50 | $505 | 2.4× |
| Pet Image W/Ct Lmtd (78814) | $1,935.50 | $3,871 | 1.4× |
| PET image w/CT, full body (78816) | $4,331.50 | $8,663 | 3.0× |
| PET imaging CT attenuation skull base mid-thigh (78815) | $4,228.50 | $8,457 | 3.0× |
| PET whole body (78813) | $3,627 | $7,254 | 2.5× |
| Prq Transhepatc Portograpy Hemodyn Eval Rs&I (75885) | $1,694 | $3,388 | 0.5× |
| Pulmonary Perfusion Imaging Particulate (78580) | $751 | $1,502 | 1.9× |
| Radex Abd Compl Aqt Abd W/S/E/D Views 1 View Ch (74022) | $329 | $658 | 3.2× |
| Radex abscess/fistula/sinus tract rs&i (76080) | $665 | $1,330 | 1.2× |
| Radex Ankle Complete Minimum 3 Views (73610) range across 2 matching MRF lines |
$268.50–$403 | $537–$806 | varies |
| Radex Calcaneus Minimum 2 Views (73650) range across 2 matching MRF lines |
$189–$283.50 | $378–$567 | varies |
| Radex elbow complete minimum 3 views (73080) range across 2 matching MRF lines |
$259.50–$389.50 | $519–$779 | varies |
| Radex Facial Bones Complete Minimum 3 Views (70150) | $260 | $520 | 2.5× |
| Radex fingr minimum 2 views (73140) range across 2 matching MRF lines |
$209–$313.50 | $418–$627 | varies |
| Radex foot complete minimum 3 views (73630) range across 2 matching MRF lines |
$264.50–$397 | $529–$794 | varies |
| Radex Hand Minimum 3 Views (73130) range across 2 matching MRF lines |
$263–$394.50 | $526–$789 | varies |
| Radex lower extremity infant minimum 2 views (73592) range across 2 matching MRF lines |
$71–$106.50 | $142–$213 | varies |
| Radex Mastoids Compl Minimum 3 Views PR Side (70130) | $285.50 | $571 | 2.7× |
| Radex Nasal Bones Complete Minimum 3 Views (70160) | $235.50 | $471 | 2.7× |
| Radex shoulder complete minimum 2 views (73030) range across 2 matching MRF lines |
$258–$387 | $516–$774 | varies |
| Radex Sinuses Paransl < 3 Views (70210) | $199.50 | $399 | 2.3× |
| Radex sm int w/mlt srl imges via enteroclss tube (74251) | $160 | $320 | 0.9× |
| Radex Spine 1 View Specify Level (72020) | $242.50 | $485 | 2.8× |
| Radex Sternum Minimum 2 Views (71120) | $241.50 | $483 | 2.8× |
| Radex Temporomandble Jt Opn & Clsd Mouth Bilat (70330) | $244 | $488 | 2.8× |
| Radex Toe Minimum 2 Views (73660) range across 2 matching MRF lines |
$189.50–$284.50 | $379–$569 | varies |
| Radex upper extremity infant minimum 2 views (73092) range across 2 matching MRF lines |
$96.50–$145 | $193–$290 | varies |
| Radex Wrist Complete Minimum 3 Views (73110) range across 2 matching MRF lines |
$264.50–$397 | $529–$794 | varies |
| Radiation Delivery Stereotactic Cranial Linear (77372) | $10,874.50 | $21,749 | 1.5× |
| Radiation treatment delivery level 1 (77402) | $304.50 | $609 | 3.0× |
| Radiation treatment delivery level 2 (77407) | $336 | $672 | 0.9× |
| Radiation treatment delivery level 3 (77412) | $918 | $1,836 | 1.7× |
| Radiolog exam mandible compl minimum 4 views (70110) | $376.50 | $753 | 3.6× |
| Radiologic exam colon double contrast study (74280) | $798 | $1,596 | 4.6× |
| Radiologic exam colon single contrast study (74270) | $674 | $1,348 | 3.9× |
| Radiologic Exam Esophagus Double Contrast Study (74221) | $284 | $568 | 1.6× |
| Radiologic exam knee complete 4/more views (73564) range across 2 matching MRF lines |
$325.50–$488.50 | $651–$977 | varies |
| Radiologic exam pelvis compl minimum 3 views (72190) | $273 | $546 | 2.6× |
| Radiologic Exam Small Int Single Contrast Study (74250) | $661 | $1,322 | 3.8× |
| Radiologic exam swallow function contrast study (74230) | $481 | $962 | 2.8× |
| Radiologic exam upr gi trc double contrast study (74246) | $537.50 | $1,075 | 3.1× |
| Radiologic examination femur 1 view (73551) range across 2 matching MRF lines |
$232.50–$349 | $465–$698 | varies |
| Radiologic examination femur minimum 2 views (73552) range across 2 matching MRF lines |
$267.50–$401.50 | $535–$803 | varies |
| Radiologic examination knee 1/2 views (73560) range across 2 matching MRF lines |
$214–$321 | $428–$642 | varies |
| Radiologic Examination Osseous Survey Limited (77074) | $200 | $400 | 1.9× |
| Radiologic examination tibia & fibula 2 views (73590) range across 2 matching MRF lines |
$257–$385.50 | $514–$771 | varies |
| Radiopharmaceutical therapy, by intracavitary administration Non-Facility (79200) | $459 | $918 | 2.0× |
| Rp Loclzj Tum Plnr Whole Body 2+ Days Imaging (78804) | $1,888 | $3,776 | 3.5× |
| Rp Loclzj Tum Plnr Whole Body Single Day Imaging (78802) | $2,041 | $4,082 | 3.8× |
| Rp Loclzj Tum Spect 1 Area Single Day Imaging (78803) | $1,877.50 | $3,755 | 3.5× |
| Rp Ther Radiolbld Monoclonal Antibody IV Infus (79403) | $442 | $884 | 1.9× |
| Rp Therapy Intravenous Administration (79101) | $836.50 | $1,673 | 3.6× |
| Scapula (73010) range across 2 matching MRF lines |
$216–$324 | $432–$648 | varies |
| Screening Digital Breast Tomosynthesis Bi (77063) range across 2 matching MRF lines |
$101.50–$176 | $203–$352 | varies |
| Sella turcica (70240) | $122 | $244 | 1.4× |
| Shoulder 1 view (73020) range across 2 matching MRF lines |
$239.50–$359.50 | $479–$719 | varies |
| Shoulder Arthrography (73040) | $641.50 | $1,283 | 1.8× |
| Sialogram (70390) | $373.50 | $747 | 1.6× |
| Skull less than 4 views (70250) | $307 | $614 | 2.9× |
| Special dosimetry (77331) | $421 | $842 | 3.1× |
| Special Physics Consult (77370) | $887.50 | $1,775 | 6.6× |
| Special teletherapy port plan (77321) | $1,106 | $2,212 | 3.0× |
| Special treatment procedure (77470) | $1,387 | $2,774 | 2.5× |
| Srs Multisource (77371) | $14,822.50 | $29,645 | 2.0× |
| Stereotactic Body Radiation Delivery (77373) | $3,306 | $6,612 | 1.9× |
| Sternoclavicular joints (71130) | $191.50 | $383 | 2.2× |
| Telethx isodose pln cplx w/basic dosimetry (77307) | $1,419.50 | $2,839 | 3.8× |
| Telethx isodose pln smpl w/dosimetry calculation (77306) | $246.50 | $493 | 0.7× |
| Testicular Imaging W/Flow (78761) | $434 | $868 | 1.1× |
| Ther Rad Simulaj-Aided Field Setting Complex (77290) | $2,445 | $4,890 | 6.6× |
| Ther Rad Simulaj-Aided Field Setting Intermed (77285) | $1,008 | $2,016 | 2.7× |
| Ther rad simulaj-aided field setting simple (77280) | $829.50 | $1,659 | 6.2× |
| Thoracic spine 2 views (72070) | $294.50 | $589 | 2.8× |
| Thoracic spine 3 views (72072) | $319 | $638 | 3.1× |
| Thoracolumbar 2 views (72080) | $241 | $482 | 2.8× |
| Thyroid Imaging With Vascular Flow (78013) | $714 | $1,428 | 1.8× |
| Thyroid Met Imaging Body (78018) | $1,478 | $2,956 | 2.7× |
| Thyroid Uptake Measurement (78012) | $1,192 | $2,384 | 3.0× |
| Tx Devices Design & Construction Complex (77334) | $1,241.50 | $2,483 | 3.3× |
| Tx devices design & construction intermediate (77333) | $427 | $854 | 3.2× |
| Tx devices design & construction simple (77332) | $526 | $1,052 | 3.9× |
| Ultrasound Breast Limited (76642) range across 2 matching MRF lines |
$294.50–$442 | $589–$884 | varies |
| Ultrasound elastography first target lesion (76982) | $168 | $336 | 1.6× |
| Ultrasound Elastography Parenchyma (76981) | $335 | $670 | 3.2× |
| Ultrasound, abdomen limited (76705) | $460.50 | $921 | 4.4× |
| Umbilical-artery Doppler (OB) (76820) | $173 | $346 | 1.7× |
| Unlis px ther radiol clinical tx planning (77299) | $107.50 | $215 | 0.8× |
| Upper gi w/o kub (74240) | $599 | $1,198 | 3.4× |
| Ureteral Reflux Study (78740) | $343.50 | $687 | 0.9× |
| Urethrocystogram voiding (74455) | $700 | $1,400 | 2.9× |
| Urethrocystography retrograde (74450) | $613.50 | $1,227 | 2.6× |
| Us breast unilateral complete (76641) range across 2 matching MRF lines |
$324.50–$487 | $649–$974 | varies |
| Us chest (76604) | $406.50 | $813 | 3.9× |
| Us complete joint (76881) range across 2 matching MRF lines |
$396.50–$595 | $793–$1,190 | varies |
| Us head (76506) | $129 | $258 | 1.2× |
| Us kidney transplant (76776) | $448.50 | $897 | 4.3× |
| Us lmtd joint/oth nonvasc xtr strux r-t w/img (76882) range across 2 matching MRF lines |
$506.50–$750 | $1,013–$1,500 | varies |
| Us ob limited 1 or more fetuses (76815) | $475 | $950 | 4.6× |
| Us ob transvaginal (76817) | $466.50 | $933 | 4.5× |
| Us pelvic non ob complete (76856) | $474 | $948 | 4.5× |
| Us pg uter img f&mat 14 wk tabdl 1/1st gestation (76801) | $439 | $878 | 4.2× |
| Us preg uterus real time f/u trnsabdl per fetus (76816) | $230 | $460 | 2.2× |
| Us retroperitoneal complete (76770) | $496 | $992 | 4.8× |
| Us retroperitoneal limited (76775) | $520 | $1,040 | 5.0× |
| Us scrotum and contents (76870) | $523.50 | $1,047 | 5.0× |
| Us spinal canal and contents (76800) | $220 | $440 | 2.1× |
| Us thyroid (76536) | $437 | $874 | 4.2× |
| Vein X-Ray Chest (75827) | $2,173 | $4,346 | 1.4× |
| Venography caval inferior serialography rs&i (75825) | $3,596 | $7,192 | 1.1× |
| Venography extremity bilateral rs&i (75822) range across 2 matching MRF lines |
$1,379.50–$2,069.50 | $2,759–$4,139 | varies |
| Venography extremity unilateral rs&i (75820) | $1,198.50 | $2,397 | 0.8× |
| Wrist 2 views (73100) range across 2 matching MRF lines |
$228–$342 | $456–$684 | varies |
| X-Ray Ac Jts - Xr Acromioclavicular Joints Bilateral (73050) | $223 | $446 | 2.6× |
| X-ray antegrade pyelogram tube (74425) | $724 | $1,448 | 2.1× |
| X-Ray Aorta Leg Arteries (75630) | $3,694 | $7,388 | 1.2× |
| X-Ray Bend Only L-S Spine (72120) | $288.50 | $577 | 2.8× |
| X-Ray Elbow 2 Vw - Xr Elbow 1-2 Views Right (73070) range across 2 matching MRF lines |
$232.50–$349 | $465–$698 | varies |
| X-Ray Exam Breast Specimen (76098) range across 2 matching MRF lines |
$545.50–$818.50 | $1,091–$1,637 | varies |
| X-Ray Exam Entire Spi 2/3 Vw (72082) | $376 | $752 | 3.6× |
| X-Ray Exam Hip Uni 1 View (73501) range across 2 matching MRF lines |
$213–$319.50 | $426–$639 | varies |
| X-Ray Exam Hip Uni 2-3 Views (73502) | $260 | $520 | 3.0× |
| X-Ray Exam Hips Bi 2 Views (73521) | $323.50 | $647 | 3.1× |
| X-Ray Exam L-S Spine Bending (72114) | $458 | $916 | 4.4× |
| X-Ray Exam Neck Spine 2-3 Vw (72040) | $275 | $550 | 3.2× |
| X-Ray Exam Neck Spine 6/>Vws (72052) | $413.50 | $827 | 4.0× |
| X-Ray Exam Unilat Ribs/Chest (71101) | $304.50 | $609 | 2.9× |
| X-ray eye for foreign body (70030) | $232 | $464 | 2.7× |
| X-ray humerus (73060) range across 2 matching MRF lines |
$259.50–$389.50 | $519–$779 | varies |
| X-Ray Jaw <4 Vw - Xr Mandible < 4 Views (70100) | $212.50 | $425 | 2.5× |
| X-Ray Knee Bilat Standing - Xr Knees Anteroposterior Standing Bilat (73565) | $242.50 | $485 | 2.8× |
| X-Ray Lumbar Spine 2/3 Vw - Xr Lumbar Spine 2-3 Views (72100) | $305 | $610 | 2.9× |
| X-ray nose-rectum child f.b. (76010) | $144 | $288 | 1.7× |
| X-Ray Ribs, Chest 4+ Vw - Xr Ribs 3 Vws Bil W/ Chest Posteroanterior (71111) | $425.50 | $851 | 4.1× |
| X-Ray Sacroiliac Jts 3+ Vw - Xr Sacroiliac Joints 3+ Views (72202) | $259.50 | $519 | 2.5× |
| X-Ray Sacroiliac Jts <3 Vw - Xr Sacroiliac Joints 1-2 Views (72200) | $228.50 | $457 | 2.2× |
| X-Ray Sacrum/Coccyx 2+ Vw - Xr Sacrum Coccyx 2+ Views (72220) | $251 | $502 | 2.9× |
| X-Ray Sinuses 3+ Vw - Xr Paranasal Sinuses 3+ Views (70220) | $307.50 | $615 | 3.5× |
| X-Ray Skull 4+ Vw - Xr Skull Complete 4+ Views (70260) | $344 | $688 | 3.3× |
| X-Ray Stress View (77071) | $238.50 | $477 | 2.7× |
| X-ray thoracic spine 4 vw (72074) | $395.50 | $791 | 3.8× |
| X-Ray Urinary Tract Exam With Contrast Material (74420) | $1,068.50 | $2,137 | 3.1× |
| X-Rays Bone Length Studies (77073) | $329.50 | $659 | 3.2× |
| X-Rays Bone Survey Complete (77075) | $540 | $1,080 | 5.2× |
| Xr c-spine 4 or 5 views (72050) | $349.50 | $699 | 3.4× |
| Xr facial bones less than 3 views (70140) | $219 | $438 | 2.5× |
| Xr orbits complete 4 views (70200) | $363 | $726 | 3.5× |
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.