Imaging prices at Sentara Albemarle Medical Center
Elizabeth City, NC · every code in this section with a posted price and a Medicare benchmark.
441 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) | $1,550 | $3,100 | 1.2× |
| Abdomen 1 View (74018) range across 2 matching MRF lines |
$183–$258.50 | $366–$517 | varies |
| Abdomen 2 views (74019) range across 2 matching MRF lines |
$215–$374 | $430–$748 | varies |
| Acute Gastrointestinal Blood Loss Imaging (78278) | $646.50 | $1,293 | 1.7× |
| Adrenal Cortex & Medulla Img (78075) | $1,350 | $2,700 | 1.1× |
| Angio internal mammary (75756) | $1,622.50 | $3,245 | 0.5× |
| Angio pulmonary bilat (75743) | $4,578 | $9,156 | 1.5× |
| Angiography Adrenal Bilateral Slctv Rs&I (75733) | $3,662.50 | $7,325 | 1.2× |
| Angiography extremity bilateral rs&i (75716) | $3,837.50 | $7,675 | 1.3× |
| Angiography extremity unilateral rs&i (75710) | $3,837.50 | $7,675 | 1.3× |
| Angiography pulmonary unilateral slctv rs&i (75741) | $4,578 | $9,156 | 1.5× |
| Angrph pulmonary nonslctv cath/ven njx rs&i (75746) | $2,268.50 | $4,537 | 0.8× |
| Ankle 2 views (73600) range across 2 matching MRF lines |
$191.50–$269 | $383–$538 | varies |
| Aortography thoracic serialography rs&i (75605) | $2,851.50 | $5,703 | 0.5× |
| Aortography thoracic w/o serialography rs&i (75600) | $2,746.50 | $5,493 | 0.9× |
| Artery X-Rays Abdomen (75726) | $7,980 | $15,960 | 1.5× |
| Artery X-Rays Adrenal Gland (75731) | $2,615.50 | $5,231 | 0.9× |
| Artery X-Rays Pelvis (75736) | $2,716 | $5,432 | 0.5× |
| Artery X-Rays Spine (75705) | $2,851.50 | $5,703 | 0.5× |
| Arthrogram ankle (73615) | $798 | $1,596 | 2.4× |
| Arthrogram hip (73525) | $672 | $1,344 | 2.0× |
| Arthrogram Wrist (73115) | $388 | $776 | 1.2× |
| Basic radiation dosimetry calculation (77300) | $135.50 | $271 | 1.1× |
| Bone age studies (77072) | $163.50 | $327 | 1.6× |
| Bone Imaging 3 Phase (78315) | $958 | $1,916 | 2.5× |
| Bone Imaging Limited Area (78300) | $537.50 | $1,075 | 1.4× |
| Bone Imaging Multiple Areas (78305) | $740 | $1,480 | 1.9× |
| Bone Imaging Whole Body (78306) | $1,003 | $2,006 | 2.6× |
| Bone marrow imaging limited area (78102) | $868 | $1,736 | 2.3× |
| Bone marrow imaging; multiple areas (78103) | $999.50 | $1,999 | 2.6× |
| Bone marrow imaging; whole body (78104) | $1,247 | $2,494 | 3.3× |
| Bone survey infant (77076) | $360.50 | $721 | 3.6× |
| Brachytx isodose complex (77318) | $2,544.50 | $5,089 | 7.1× |
| Brachytx isodose intermed (77317) | $2,105 | $4,210 | 5.9× |
| Brachytx Isodose Plan Simple (77316) | $1,664 | $3,328 | 4.6× |
| Brain Flow Imaging Only (78610) | $467 | $934 | 0.9× |
| Brain Image W/Flow < 4 Views (78601) | $2,412 | $4,824 | 6.3× |
| Brain Imaging Min 4 Static Views W Vascular Flow (78606) | $4,544.50 | $9,089 | 8.8× |
| Brain Imaging Minimum 4 Static Views (78605) | $2,412 | $4,824 | 4.6× |
| Brain Imaging Pet Metabolic Evaluation (78608) | $2,500 | $5,000 | 1.8× |
| Cardiac MRI w/w/o contrast & further seq (75561) | $2,459.50 | $4,919 | 7.4× |
| Cardiac MRI w/w/o contrast w/stress (75563) | $2,798 | $5,596 | 3.7× |
| Cardiac Shunt Detection (78428) | $717 | $1,434 | 1.9× |
| Cat Scan Follow-Up Study (76380) | $904.50 | $1,809 | 10.9× |
| Cerebrospinal Fluid Flow W/O Matl Shunt Evaltj (78645) | $796.50 | $1,593 | 1.5× |
| Cerebrospinal Fluid Scan (78630) | $1,164.50 | $2,329 | 2.2× |
| Chest 1 view (71045) range across 2 matching MRF lines |
$123.50–$211 | $247–$422 | varies |
| Chest 2 views (71046) range across 2 matching MRF lines |
$154.50–$263 | $309–$526 | varies |
| Chest 3 views (71047) range across 2 matching MRF lines |
$223.50–$380 | $447–$760 | varies |
| Chest 4 or more views (71048) range across 2 matching MRF lines |
$277.50–$475 | $555–$950 | varies |
| Chg us nrv&acc strux 1 xtr compre w/img pr extremity (76883) | $404 | $808 | 4.0× |
| Cisternography Positive Contrast Rs&I (70015) | $1,062.50 | $2,125 | 1.4× |
| Clavicle complete (73000) range across 2 matching MRF lines |
$165.50–$296.50 | $331–$593 | varies |
| Computed Tomography Thorax Lw Dose Lng Ca Scr C- (71271) range across 2 matching MRF lines |
$188–$558 | $376–$1,116 | varies |
| Continuing medical physics consltj pr wk (77336) | $199 | $398 | 1.5× |
| Contrast Exam Abdominl Aorta (75625) | $2,044 | $4,088 | 0.7× |
| Contrast X-Ray Bladder (74430) | $301.50 | $603 | 0.9× |
| Contrast X-Ray Of Elbow (73085) | $746 | $1,492 | 2.2× |
| Contrast X-Ray Of Knee Joint (73580) | $798 | $1,596 | 2.4× |
| CT abdomen and pelvis without and with contrast (74178) | $2,224.50 | $4,449 | 6.7× |
| CT abdomen and pelvis without contrast (74176) | $1,880 | $3,760 | 8.2× |
| CT abdomen w contrast (74160) | $1,600 | $3,200 | 9.5× |
| CT abdomen w wo contrast (74170) | $1,897 | $3,794 | 11.3× |
| CT abdomen w/o contrast (74150) | $1,378 | $2,756 | 13.8× |
| CT Angio Abdomen and Pelvis (74174) | $1,634 | $3,268 | 4.9× |
| CT Angio Chest (71275) | $1,528.50 | $3,057 | 9.1× |
| CT Angio Head (70496) | $1,503.50 | $3,007 | 9.0× |
| CT angio hrt w/3d image (75574) | $375 | $750 | 1.1× |
| Ct Angio Lwr Extr W/O&W/Dye (73706) | $1,979.50 | $3,959 | 11.8× |
| CT Angio Neck (70498) | $1,503.50 | $3,007 | 9.0× |
| Ct Angio Upr Extrm W/O&W/Dye (73206) | $1,848.50 | $3,697 | 11.0× |
| CT cervical spine w/ contrast (72126) | $1,514 | $3,028 | 4.5× |
| CT cervical spine w/o contrast (72125) | $1,365.50 | $2,731 | 13.7× |
| CT cervical spine w/wo cont (72127) | $1,555 | $3,110 | 9.3× |
| CT chest w contrast (71260) | $1,699.50 | $3,399 | 10.1× |
| CT chest w/wo contrast (71270) | $1,846 | $3,692 | 11.0× |
| CT colonography screening (74263) | $567.50 | $1,135 | 2.5× |
| CT Colonogrphy Dx Image Postprocess W/Contrast (74262) | $612.50 | $1,225 | 3.7× |
| CT colonogrphy dx image postprocess w/o contrast (74261) | $567.50 | $1,135 | 5.7× |
| CT head/brain with contrast (70460) | $1,322 | $2,644 | 7.9× |
| CT head/brain without and with contrast (70470) | $1,455 | $2,910 | 8.7× |
| CT heart contrast eval cardiac structure&morph (75572) | $1,400.50 | $2,801 | 4.2× |
| CT heart no contrast quant eval coronry calcium (75571) range across 2 matching MRF lines |
$45–$293 | $90–$586 | varies |
| CT hrt w/3d image congen (75573) | $1,400.50 | $2,801 | 4.2× |
| CT iac w contrast (70481) | $1,333.50 | $2,667 | 8.0× |
| CT l-spine w&w/o contrast (72133) | $2,374 | $4,748 | 14.2× |
| CT lower ext w/o (73700) | $1,495.50 | $2,991 | 15.0× |
| CT lower extremity w/contrast material (73701) | $2,511 | $5,022 | 15.0× |
| CT lumbar spine w contrast (72132) | $2,192.50 | $4,385 | 6.6× |
| CT lumbar spine w/o contrast (72131) | $1,327 | $2,654 | 13.3× |
| CT maxillofacial w contrast (70487) | $1,476 | $2,952 | 8.8× |
| CT maxillofacial wo contrast (70486) | $1,229.50 | $2,459 | 12.3× |
| CT neck tissue combo (70492) | $1,549.50 | $3,099 | 9.2× |
| Ct Orbit/Ear/Fossa W/O&W/Dye (70482) | $1,530 | $3,060 | 9.1× |
| CT orbits w/o contrast (70480) | $1,041 | $2,082 | 10.4× |
| CT pelvis w&w/o contrast (72194) | $1,927.50 | $3,855 | 11.5× |
| CT pelvis w/o contrast (72192) | $1,418.50 | $2,837 | 14.2× |
| CT scan of leg combo (73702) | $2,624.50 | $5,249 | 15.7× |
| CT scans face/jaw combo (70488) | $1,530 | $3,060 | 9.1× |
| CT soft tissue neck w contrast (70491) | $1,397.50 | $2,795 | 8.3× |
| CT soft tissue neck w/o contrast (70490) | $1,220.50 | $2,441 | 12.2× |
| CT thoracic spine w contrast (72129) | $2,130 | $4,260 | 12.7× |
| CT thoracic spine w/o contrast (72128) | $1,569.50 | $3,139 | 15.7× |
| CT thoracic spine w/wo cont (72130) | $2,282 | $4,564 | 13.6× |
| CT thorax w/o contrast (71250) | $1,090.50 | $2,181 | 10.9× |
| CT upper ext wo (73200) | $1,411 | $2,822 | 14.1× |
| CT upper extremity w/o & w/contrast material (73202) | $2,511 | $5,022 | 15.0× |
| CT upper extremity with contrast (73201) | $2,406 | $4,812 | 7.2× |
| Cta Abdl Aorta&Bi Iliofem W/Contrast&Postp (75635) | $1,151.50 | $2,303 | 6.9× |
| Cta Abdomen (74175) | $1,979.50 | $3,959 | 11.8× |
| CTA pelvis (72191) | $1,979.50 | $3,959 | 11.8× |
| Dacryocystography, nasolacrimal duct, radiological supervision and interpretation Non-Facility (70170) | $320.50 | $641 | 1.4× |
| Dilation ureters/urethra rs&i (74485) | $2,003.50 | $4,007 | 1.0× |
| Discography Cerv/Thor Spine (72285) | $2,008.50 | $4,017 | 1.1× |
| Diskography lumbar (72295) | $2,108.50 | $4,217 | 1.1× |
| Doppler Echo Fetal Puls Spectral F/U/Repeat (76828) | $142 | $284 | 1.4× |
| Doppler Echo Fetal Spectral Display Complete (76827) | $142 | $284 | 1.4× |
| Doppler Fetal Mid Cerebral Artery (76821) | $346 | $692 | 3.5× |
| Dxa Bone Density Axial (77080) range across 2 matching MRF lines |
$367.50–$549.50 | $735–$1,099 | varies |
| Dxa bone density study (77085) | $179 | $358 | 1.8× |
| Dxa bone density study 1/>sites appendiclr skel (77081) range across 2 matching MRF lines |
$120.50–$331.50 | $241–$663 | varies |
| Echo exam of fetal heart (76825) range across 2 matching MRF lines |
$965–$1,114.50 | $1,930–$2,229 | varies |
| Echo exam uterus (76831) range across 2 matching MRF lines |
$593.50–$615 | $1,187–$1,230 | varies |
| Echo Guide For Artery Repair (76936) | $472.50 | $945 | 2.3× |
| Echocardiography, fetal, cardiovascular system, real time with image documentation (2D), with or without M-mode… (76826) | $299.50 | $599 | 1.3× |
| Echograp Trans R Pros Study (76873) | $588.50 | $1,177 | 5.9× |
| Esophagram (74220) range across 2 matching MRF lines |
$272.50–$436.50 | $545–$873 | varies |
| Fetal Biophys Profile W/Nst (76818) range across 2 matching MRF lines |
$349.50–$399.50 | $699–$799 | varies |
| Fetal Biophysical Profile W/O Non-Stress Testing (76819) range across 2 matching MRF lines |
$313.50–$356 | $627–$712 | varies |
| Fetal MRI w/placntl matrnl plvc img sing/1st ges (74712) | $575.50 | $1,151 | 2.5× |
| Fluoroscopy up to 1 hr (76000) | $443.50 | $887 | 1.9× |
| Follow-Up Angiography (75898) | $1,513.50 | $3,027 | 0.5× |
| Foot 2 views (73620) range across 2 matching MRF lines |
$147.50–$269 | $295–$538 | varies |
| Forearm 2 views (73090) range across 2 matching MRF lines |
$173–$308 | $346–$616 | varies |
| Gastric emptying imaging study (78264) | $650.50 | $1,301 | 1.7× |
| Gastric Emptyng Imag Std W/Sm Bwl Transit (78265) | $1,098.50 | $2,197 | 2.9× |
| Gastroesophageal Reflux Exam (78262) | $696.50 | $1,393 | 1.8× |
| Gated Heart Planar Single (78472) range across 2 matching MRF lines |
$906–$1,348 | $1,812–$2,696 | varies |
| Gated Heart, Multiple (78473) | $1,220 | $2,440 | 3.2× |
| Gstrc Emptng Imag Std W/Sm Bwl Col Trnst Mlt Day (78266) | $1,313.50 | $2,627 | 2.5× |
| Hand 2 views (73120) range across 2 matching MRF lines |
$144–$195.50 | $288–$391 | varies |
| Hdr Rdncl Ntrstl/Icav Brchtx (77772) | $2,957 | $5,914 | 4.4× |
| Hdr Rdncl Ntrstl/Icav Brchtx (77771) | $2,729 | $5,458 | 4.1× |
| Hdr Rdncl Ntrstl/Icav Brchtx 1 Channel (77770) | $2,374 | $4,748 | 3.6× |
| Hepatc Vngrph Wdg/Fr Hemodyn Eval Rs&I (75889) | $3,662.50 | $7,325 | 1.2× |
| Hepatc Vngrph Wdg/Fr W/O Hemodyn Eval Rs&I (75891) | $2,746.50 | $5,493 | 0.9× |
| Hepatobil Syst Image W/Drug (78227) | $708.50 | $1,417 | 1.4× |
| Hepatobiliary System Imaging (78226) | $708.50 | $1,417 | 1.9× |
| Ht Musc Image Planar Mult (78454) | $1,811.50 | $3,623 | 1.5× |
| Ht Muscle Image Spect Sing (78451) range across 2 matching MRF lines |
$1,693–$1,711.50 | $3,386–$3,423 | varies |
| Hysterosalpingogram (74740) | $636 | $1,272 | 2.8× |
| Infant hip ultrasound with hip movement (dynamic) (76885) | $273 | $546 | 3.3× |
| Infant hip ultrasound, limited static exam (76886) | $165.50 | $331 | 2.0× |
| Interstitial radiation source applic complex (77778) | $2,957 | $5,914 | 4.4× |
| Intracavitary Radiation Source Applic Complex (77763) | $1,813.50 | $3,627 | 2.7× |
| Intracavitary Radiation Source Applic Intermed (77762) | $1,592 | $3,184 | 3.0× |
| Intracavitary radiation source applic simple (77761) | $1,376 | $2,752 | 2.6× |
| Intraop radiaj tx deliver xray single tx session (77424) | $3,906.50 | $7,813 | 0.6× |
| Joint Survey Single View (77077) | $390 | $780 | 3.9× |
| K Flow/Funct Image Multiple (78709) | $1,969.50 | $3,939 | 3.8× |
| K Flow/Funct Image W/Drug (78708) | $1,590.50 | $3,181 | 3.1× |
| K Flow/Funct Image W/O Drug (78707) | $1,383 | $2,766 | 2.7× |
| Kidney Imaging Morphol (78700) | $914 | $1,828 | 2.4× |
| Kidney Imaging Morphoogy W/Vascular Flow (78701) | $986 | $1,972 | 2.6× |
| Knee 3 Views (73562) range across 2 matching MRF lines |
$217–$335 | $434–$670 | varies |
| Leveen/Shunt Patency Exam (78291) | $696.50 | $1,393 | 1.8× |
| Liver & Spleen Imaging Static Only (78215) | $532 | $1,064 | 1.4× |
| Liver & Spleen Imaging W/Vascular Flow (78216) | $621.50 | $1,243 | 1.6× |
| Liver imaging static only (78201) | $1,223 | $2,446 | 2.4× |
| Liver imaging w/vascular flow (78202) | $1,223 | $2,446 | 2.4× |
| Lung Perf&Ventilat Diferentl (78598) | $1,357 | $2,714 | 2.6× |
| Lung perfusion differential (78597) | $1,357 | $2,714 | 3.6× |
| Lung Ventilat&Perfus Imaging (78582) | $755.50 | $1,511 | 1.5× |
| Lymph System Imaging (78195) | $888.50 | $1,777 | 1.7× |
| Lymphangiography extremity only unilateral rs&i (75801) | $1,024.50 | $2,049 | 1.7× |
| Lymphangiography Pelvic/Abdominal Bilateral Rs&I (75807) | $1,666 | $3,332 | 0.6× |
| Lymphangiography, pelvic/abdominal, unilateral (75805) | $1,666 | $3,332 | 0.6× |
| Magnetic Image Jaw Joint (70336) | $1,778.50 | $3,557 | 7.8× |
| Magnetic Resonance Elastography (76391) | $1,207 | $2,414 | 5.3× |
| Mammary ductogram or galactogram multiple (77054) | $715 | $1,430 | 3.1× |
| Mammary ductogram or galactogram single (77053) | $452.50 | $905 | 2.0× |
| Meckels Divert Exam (78290) | $508 | $1,016 | 1.3× |
| Mlc imrt design & construction per imrt plan (77338) | $1,487.50 | $2,975 | 4.2× |
| Mra Head W/O & W/Contrast Material (70546) | $3,814.50 | $7,629 | 11.4× |
| MRA head w/o contrast (70544) | $1,798.50 | $3,597 | 7.9× |
| MRA head with contrast (70545) | $3,319 | $6,638 | 10.0× |
| MRA neck w contrast (70548) | $2,429 | $4,858 | 7.3× |
| Mra Neck W/O &W/Contrast Material (70549) | $3,722.50 | $7,445 | 11.2× |
| MRA neck w/o contrast (70547) | $1,698.50 | $3,397 | 7.4× |
| MRI abdomen w contrast (74182) | $1,832 | $3,664 | 5.5× |
| MRI abdomen w/o contrast (74181) | $1,410.50 | $2,821 | 6.2× |
| MRI any jt lower extrem w/contrast material (73722) | $1,960 | $3,920 | 2.6× |
| MRI any jt lower extrem w/o & w/contrast matrl (73723) | $2,015 | $4,030 | 6.0× |
| MRI any jt upper extremity w/contrast matrl (73222) | $1,904 | $3,808 | 2.5× |
| MRI brain functional w/o physician admnistration (70554) | $2,866 | $5,732 | 12.6× |
| MRI brain functional w/physician admnistration (70555) | $2,309 | $4,618 | 10.1× |
| MRI Breast W/O Contrast Bilateral (77047) | $3,520.50 | $7,041 | 15.4× |
| MRI Breast Without Contrast Material Unilateral (77046) | $3,151.50 | $6,303 | 13.8× |
| MRI cardiac w/o contrast (75557) | $1,742.50 | $3,485 | 7.6× |
| MRI cervical spine w contrast (72142) | $1,798.50 | $3,597 | 5.4× |
| MRI cervical spine w/o cont (72141) | $1,410.50 | $2,821 | 6.2× |
| MRI chest w/o contrast (71550) | $1,525 | $3,050 | 6.7× |
| MRI chest with contrast (71551) | $1,832 | $3,664 | 2.4× |
| MRI chest wo w contrast (71552) | $2,394.50 | $4,789 | 7.2× |
| MRI lower extrem oth/thn jt w/contrast matrl (73719) | $1,960 | $3,920 | 5.9× |
| MRI lower extrem oth/thn jt w/o & w/contr matr (73720) | $1,978.50 | $3,957 | 5.9× |
| MRI lower extrem oth/thn jt w/o contr matrl (73718) | $1,501.50 | $3,003 | 6.6× |
| MRI lumbar spine w contrast (72149) | $1,798.50 | $3,597 | 5.4× |
| Mri Neck Spine W/O & W/Dye (72156) | $1,861.50 | $3,723 | 5.6× |
| MRI orbit face &/neck w/o contrast (70540) | $1,480.50 | $2,961 | 6.5× |
| MRI orbit face neck w contrast (70542) | $1,511.50 | $3,023 | 4.5× |
| Mri Orbt/Fac/Nck W/O &W/Dye (70543) | $1,814 | $3,628 | 5.4× |
| MRI pelvis w contrast (72196) | $1,832 | $3,664 | 5.5× |
| MRI pelvis w/o & w contrast (72197) | $2,224.50 | $4,449 | 6.7× |
| MRI pelvis w/o contrast (72195) | $1,410.50 | $2,821 | 6.2× |
| MRI spectroscopy (76390) | $2,199 | $4,398 | 26.4× |
| MRI thoracic spine w/o contrast (72146) | $1,410.50 | $2,821 | 6.2× |
| MRI upper extremity oth than jt w/contr matrl (73219) | $1,978.50 | $3,957 | 5.9× |
| MRI upper extremity oth than jt w/o contr matrl (73218) | $1,960 | $3,920 | 8.6× |
| Mri Uppr Extremity W/O&W/Dye (73220) | $2,527.50 | $5,055 | 7.6× |
| MRI, abdomen, combo (74183) | $2,224.50 | $4,449 | 6.7× |
| MRI, dorsal spine combo (72157) | $1,861.50 | $3,723 | 5.6× |
| MRI, dorsal spine contrast (72147) | $1,778.50 | $3,557 | 5.3× |
| MRI, joint upper extrem (73221) | $1,501.50 | $3,003 | 6.6× |
| MRI, joint upper extrem combo (73223) | $1,960 | $3,920 | 5.9× |
| MRI, lumbar spine combo (72158) | $1,861.50 | $3,723 | 5.6× |
| Myelogram cervical (72240) | $1,160.50 | $2,321 | 1.5× |
| Myelogram Lumbar (72265) | $1,438.50 | $2,877 | 1.9× |
| Myocardial Perfusion Planar 1 Study Rest/Stress (78453) | $1,449 | $2,898 | 1.2× |
| Myocardial Spect Multiple Studies (78452) range across 2 matching MRF lines |
$2,340.50–$3,168 | $4,681–$6,336 | varies |
| Myocrd Img Pet Prfuj W/Metab 2rtracer Cncrnt CT (78433) | $2,263 | $4,526 | 1.1× |
| Neck soft tissue (70360) range across 2 matching MRF lines |
$119.50–$409.50 | $239–$819 | varies |
| Nfs/Instlj Radioelmnt Sln 3 Mo Follow-Up Care (77750) | $931 | $1,862 | 2.5× |
| Njx Rp Loclzj Non-Img Probe Study Intravenous (78808) | $395.50 | $791 | 1.0× |
| Ntsty modul radthx pln dose-vol histos (77301) | $2,074 | $4,148 | 1.6× |
| Nuclear Rx Intra-Arterial (79445) | $935.50 | $1,871 | 4.2× |
| Nuclear Rx Oral Admin (79005) | $425 | $850 | 1.9× |
| Ob us nuchal meas 1 gest (76813) range across 2 matching MRF lines |
$472.50–$490.50 | $945–$981 | varies |
| Oph bmtry us echograpy a-scan io lens pwr cal (76519) | $412 | $824 | 4.1× |
| Ophthalmic Ultrasonic Foreign Body Localization (76529) | $251 | $502 | 3.0× |
| Ophthalmic ultrasound dx b-scan w/wo a-scan (76512) | $322 | $644 | 3.2× |
| Panoramic X-ray of jaws (70355) | $379 | $758 | 4.6× |
| Parathyroid imaging w/tomographic spect & CT (78072) | $1,682 | $3,364 | 3.2× |
| Parathyroid Planar Imaging (78070) | $632.50 | $1,265 | 1.7× |
| Parathyroid planar imaging w/wo subtraction (78071) | $1,367.50 | $2,735 | 3.6× |
| Pelvis 1 or 2 views (72170) range across 2 matching MRF lines |
$174–$306.50 | $348–$613 | varies |
| Pet Image Skull-Thigh (78812) | $5,425.50 | $10,851 | 4.0× |
| Pet Image W/Ct Lmtd (78814) | $4,409 | $8,818 | 3.2× |
| PET image w/CT, full body (78816) | $4,409 | $8,818 | 3.2× |
| PET imaging CT attenuation skull base mid-thigh (78815) | $4,409 | $8,818 | 3.2× |
| Pet Imaging Limited Area Chest Head/Neck (78811) | $5,425.50 | $10,851 | 4.4× |
| PET whole body (78813) | $5,425.50 | $10,851 | 4.0× |
| Prq Transhepatc Portograpy Hemodyn Eval Rs&I (75885) | $3,662.50 | $7,325 | 1.2× |
| Pulmonary Perfusion Imaging Particulate (78580) | $528.50 | $1,057 | 1.4× |
| Radex Abd Compl Aqt Abd W/S/E/D Views 1 View Ch (74022) range across 2 matching MRF lines |
$326.50–$462 | $653–$924 | varies |
| Radex abscess/fistula/sinus tract rs&i (76080) | $410 | $820 | 0.8× |
| Radex Ankle Complete Minimum 3 Views (73610) range across 2 matching MRF lines |
$225–$315.50 | $450–$631 | varies |
| Radex Calcaneus Minimum 2 Views (73650) range across 2 matching MRF lines |
$183.50–$251 | $367–$502 | varies |
| Radex elbow complete minimum 3 views (73080) range across 2 matching MRF lines |
$201–$421.50 | $402–$843 | varies |
| Radex Facial Bones Complete Minimum 3 Views (70150) range across 2 matching MRF lines |
$279.50–$534 | $559–$1,068 | varies |
| Radex fingr minimum 2 views (73140) range across 2 matching MRF lines |
$125–$195.50 | $250–$391 | varies |
| Radex foot complete minimum 3 views (73630) range across 2 matching MRF lines |
$206.50–$315.50 | $413–$631 | varies |
| Radex Hand Minimum 3 Views (73130) range across 2 matching MRF lines |
$198–$281.50 | $396–$563 | varies |
| Radex lower extremity infant minimum 2 views (73592) | $115 | $230 | 1.4× |
| Radex Mastoids Compl Minimum 3 Views PR Side (70130) | $259 | $518 | 2.6× |
| Radex Nasal Bones Complete Minimum 3 Views (70160) range across 2 matching MRF lines |
$175.50–$298 | $351–$596 | varies |
| Radex Ribs Unilateral 2 Views (71100) range across 2 matching MRF lines |
$191–$336.50 | $382–$673 | varies |
| Radex shoulder complete minimum 2 views (73030) range across 2 matching MRF lines |
$201–$288 | $402–$576 | varies |
| Radex Sinuses Paransl < 3 Views (70210) range across 2 matching MRF lines |
$283–$476.50 | $566–$953 | varies |
| Radex sm int w/mlt srl imges via enteroclss tube (74251) | $480.50 | $961 | 2.9× |
| Radex Spine 1 View Specify Level (72020) range across 2 matching MRF lines |
$187–$281 | $374–$562 | varies |
| Radex Sternum Minimum 2 Views (71120) range across 2 matching MRF lines |
$168.50–$347 | $337–$694 | varies |
| Radex Temporomandble Jt Opn & Clsd Mouth Bilat (70330) range across 2 matching MRF lines |
$344–$365.50 | $688–$731 | varies |
| Radex Toe Minimum 2 Views (73660) range across 2 matching MRF lines |
$125.50–$251 | $251–$502 | varies |
| Radex upper extremity infant minimum 2 views (73092) | $121.50 | $243 | 1.2× |
| Radex Wrist Complete Minimum 3 Views (73110) range across 2 matching MRF lines |
$211.50–$299 | $423–$598 | varies |
| Radex X-Ray Exam Entire Spi 6/> Vw - Xr Entire Spine 6+ Vw (72084) range across 2 matching MRF lines |
$322–$325.50 | $644–$651 | varies |
| Radiation Delivery Stereotactic Cranial Linear (77372) | $10,508.50 | $21,017 | 1.5× |
| Radiation treatment delivery level 1 (77402) | $175 | $350 | 1.8× |
| Radiation treatment delivery level 2 (77407) | $185.50 | $371 | 0.5× |
| Radiation treatment delivery level 3 (77412) | $352 | $704 | 0.7× |
| Radiolog exam mandible compl minimum 4 views (70110) range across 2 matching MRF lines |
$265–$411 | $530–$822 | varies |
| Radiologic Exam Abdomen 3+ Views - Xr Abdomen 3+ Views (74021) range across 2 matching MRF lines |
$276.50–$425 | $553–$850 | varies |
| Radiologic exam colon double contrast study (74280) | $529 | $1,058 | 3.2× |
| Radiologic exam colon single contrast study (74270) | $375.50 | $751 | 2.2× |
| Radiologic Exam Esophagus Double Contrast Study (74221) | $272.50 | $545 | 1.6× |
| Radiologic exam knee complete 4/more views (73564) range across 2 matching MRF lines |
$230.50–$398 | $461–$796 | varies |
| Radiologic exam pelvis compl minimum 3 views (72190) range across 2 matching MRF lines |
$434–$438 | $868–$876 | varies |
| Radiologic Exam Small Int Single Contrast Study (74250) | $313.50 | $627 | 1.9× |
| Radiologic exam swallow function contrast study (74230) | $391 | $782 | 2.3× |
| Radiologic exam teeth complete full mouth (70320) | $167 | $334 | 0.7× |
| Radiologic Exam Teeth Prtl Exam < Full Mouth (70310) | $167 | $334 | 0.7× |
| Radiologic exam upr gi trc double contrast study (74246) | $744 | $1,488 | 4.4× |
| Radiologic examination femur 1 view (73551) range across 2 matching MRF lines |
$98.50–$380 | $197–$760 | varies |
| Radiologic examination femur minimum 2 views (73552) range across 2 matching MRF lines |
$300.50–$312 | $601–$624 | varies |
| Radiologic examination knee 1/2 views (73560) range across 2 matching MRF lines |
$154.50–$209.50 | $309–$419 | varies |
| Radiologic Examination Osseous Survey Limited (77074) range across 2 matching MRF lines |
$394–$762 | $788–$1,524 | varies |
| Radiologic examination tibia & fibula 2 views (73590) range across 2 matching MRF lines |
$200–$284 | $400–$568 | varies |
| Radiologic examination, teeth; single view Non-Facility (70300) | $74.50 | $149 | 0.9× |
| Remote afterloading high dose rate radionuclide skin surface brachytherapy, includes basic dosimetry, when performed;… (77768) | $2,729 | $5,458 | 7.4× |
| Remote afterloading high dose rate radionuclide skin surface brachytherapy, includes basic dosimetry, when performed;… (77767) | $2,374 | $4,748 | 6.4× |
| Renal Cyst Study (74470) | $330 | $660 | 0.6× |
| Ribs bilateral 3 views (71110) range across 2 matching MRF lines |
$284–$612.50 | $568–$1,225 | varies |
| Rp loclzj tum plnr 1 area single day imaging (78800) | $1,206.50 | $2,413 | 3.2× |
| Rp loclzj tum plnr 2+area 1+d img/1 area img>2+d (78801) | $1,791 | $3,582 | 4.7× |
| Rp Loclzj Tum Plnr Whole Body 2+ Days Imaging (78804) | $2,619.50 | $5,239 | 5.0× |
| Rp Loclzj Tum Spect 1 Area Single Day Imaging (78803) | $2,914.50 | $5,829 | 5.6× |
| Rp loclzj tum spect 2 area/sep acquisj img (78831) | $4,121 | $8,242 | 3.3× |
| Rp loclzj tum spect CT 2area 1d img/1 ar img>2+d (78832) | $4,634.50 | $9,269 | 3.4× |
| Rp loclzj tum spect w/CT 1 area/acquisj 1day img (78830) | $3,543 | $7,086 | 2.9× |
| Rp Ther Radiolbld Monoclonal Antibody IV Infus (79403) | $874.50 | $1,749 | 3.9× |
| Rp Therapy Intravenous Administration (79101) | $658 | $1,316 | 3.0× |
| Salivary Gland Imaging Serial Images (78231) | $696.50 | $1,393 | 1.8× |
| Scapula (73010) range across 2 matching MRF lines |
$191.50–$388 | $383–$776 | varies |
| Screening Digital Breast Tomosynthesis Bi (77063) range across 4 matching MRF lines |
$13.50–$18.50 | $27–$37 | varies |
| Sella turcica (70240) | $160 | $320 | 1.9× |
| Shoulder 1 view (73020) range across 2 matching MRF lines |
$130.50–$222.50 | $261–$445 | varies |
| Shoulder Arthrography (73040) | $672 | $1,344 | 2.0× |
| Sialogram (70390) | $548.50 | $1,097 | 2.4× |
| Skull less than 4 views (70250) range across 2 matching MRF lines |
$227–$529 | $454–$1,058 | varies |
| Special dosimetry (77331) | $154 | $308 | 1.2× |
| Special Physics Consult (77370) | $404 | $808 | 3.1× |
| Special teletherapy port plan (77321) | $270 | $540 | 0.8× |
| Special treatment procedure (77470) | $667.50 | $1,335 | 1.3× |
| Spleen Imaging (78185) | $726.50 | $1,453 | 1.9× |
| Srs Multisource (77371) | $14,869 | $29,738 | 2.1× |
| Stereotactic Body Radiation Delivery (77373) | $10,508.50 | $21,017 | 6.1× |
| Sternoclavicular joints (71130) range across 2 matching MRF lines |
$167–$399.50 | $334–$799 | varies |
| Superior sagittal sinus venogram (75870) | $1,513.50 | $3,027 | 0.5× |
| Surface Applic Low Dose Rate Radionuclide Source (77789) | $246 | $492 | 2.5× |
| Telethx isodose pln cplx w/basic dosimetry (77307) | $455 | $910 | 1.3× |
| Telethx isodose pln smpl w/dosimetry calculation (77306) | $406 | $812 | 1.1× |
| Testicular Imaging W/Flow (78761) | $828 | $1,656 | 2.2× |
| Ther Rad Simulaj-Aided Field Setting Complex (77290) | $519 | $1,038 | 1.5× |
| Ther Rad Simulaj-Aided Field Setting Intermed (77285) | $409 | $818 | 1.1× |
| Ther rad simulaj-aided field setting simple (77280) | $198 | $396 | 1.5× |
| Thoracic spine 2 views (72070) range across 2 matching MRF lines |
$238.50–$375 | $477–$750 | varies |
| Thoracic spine 3 views (72072) range across 2 matching MRF lines |
$277–$400 | $554–$800 | varies |
| Thoracolumbar 2 views (72080) range across 2 matching MRF lines |
$231–$480 | $462–$960 | varies |
| Thyroid Carcinoma Metastases Img Lmtd Area (78015) | $813 | $1,626 | 2.1× |
| Thyroid Imaging With Vascular Flow (78013) | $613.50 | $1,227 | 1.6× |
| Thyroid Met Imaging Body (78018) | $1,869.50 | $3,739 | 3.6× |
| Thyroid Uptake Measurement (78012) | $270.50 | $541 | 0.7× |
| Thyroid Uptake W/Blood Flow Sngle/Mult Quan Meas (78014) | $741.50 | $1,483 | 1.9× |
| Tx Devices Design & Construction Complex (77334) | $868 | $1,736 | 2.4× |
| Tx devices design & construction intermediate (77333) | $359 | $718 | 2.8× |
| Tx devices design & construction simple (77332) | $305 | $610 | 2.4× |
| Ultrasound Breast Limited (76642) range across 3 matching MRF lines |
$466–$686.50 | $932–$1,373 | varies |
| Ultrasound elastography first target lesion (76982) | $336.50 | $673 | 3.4× |
| Ultrasound Elastography Parenchyma (76981) | $336.50 | $673 | 3.4× |
| Ultrasound Exam Aaa Screen (76706) range across 2 matching MRF lines |
$198.50–$649.50 | $397–$1,299 | varies |
| Ultrasound trgt dynamic microbubble 1st lesion (76978) | $687.50 | $1,375 | 2.1× |
| Ultrasound, abdomen limited (76705) range across 5 matching MRF lines |
$320.50–$634.50 | $641–$1,269 | varies |
| Umbilical-artery Doppler (OB) (76820) | $389.50 | $779 | 3.9× |
| Unlisted magnetic resonance procedure (76498) | $1,331.50 | $2,663 | 16.0× |
| Unlisted us procedure (76999) | $121 | $242 | 1.5× |
| Upper gi w/o kub (74240) | $744 | $1,488 | 4.4× |
| Ureteral Reflux Study (78740) | $914 | $1,828 | 2.4× |
| Urethrocystogram voiding (74455) | $448 | $896 | 2.0× |
| Urethrocystography retrograde (74450) | $371 | $742 | 1.6× |
| Us breast unilateral complete (76641) range across 2 matching MRF lines |
$405.50–$634 | $811–$1,268 | varies |
| Us chest (76604) range across 5 matching MRF lines |
$365.50–$579 | $731–$1,158 | varies |
| Us complete joint (76881) range across 2 matching MRF lines |
$365.50–$736.50 | $731–$1,473 | varies |
| Us exam, pelvic, limited (76857) range across 3 matching MRF lines |
$174–$410 | $348–$820 | varies |
| Us head (76506) | $782.50 | $1,565 | 7.8× |
| Us kidney transplant (76776) range across 2 matching MRF lines |
$559–$604 | $1,118–$1,208 | varies |
| Us lmtd joint/oth nonvasc xtr strux r-t w/img (76882) range across 5 matching MRF lines |
$138.50–$323.50 | $277–$647 | varies |
| Us ob detailed single fetus (76811) range across 2 matching MRF lines |
$624–$693 | $1,248–$1,386 | varies |
| Us ob limited 1 or more fetuses (76815) range across 4 matching MRF lines |
$214.50–$416.50 | $429–$833 | varies |
| Us ob transvaginal (76817) range across 3 matching MRF lines |
$214.50–$442 | $429–$884 | varies |
| Us pelvic non ob complete (76856) range across 2 matching MRF lines |
$510.50–$647 | $1,021–$1,294 | varies |
| Us pg uter img f&mat 14 wk tabdl 1/1st gestation (76801) range across 2 matching MRF lines |
$267–$421.50 | $534–$843 | varies |
| Us preg uterus real time f/u trnsabdl per fetus (76816) range across 2 matching MRF lines |
$155.50–$241 | $311–$482 | varies |
| Us retroperitoneal complete (76770) range across 2 matching MRF lines |
$572–$666 | $1,144–$1,332 | varies |
| Us retroperitoneal limited (76775) range across 4 matching MRF lines |
$434.50–$533 | $869–$1,066 | varies |
| Us scrotum and contents (76870) range across 3 matching MRF lines |
$522–$665.50 | $1,044–$1,331 | varies |
| Us spinal canal and contents (76800) | $553.50 | $1,107 | 5.5× |
| Us thyroid (76536) range across 4 matching MRF lines |
$278–$537.50 | $556–$1,075 | varies |
| Us transrectal (76872) range across 2 matching MRF lines |
$392–$621.50 | $784–$1,243 | varies |
| Vascular Flow Imaging (78445) | $468.50 | $937 | 1.2× |
| Vasogram (74440) | $526.50 | $1,053 | 2.3× |
| Vein X-Ray Chest (75827) | $1,200.50 | $2,401 | 0.8× |
| Vein X-Ray Liver W/O Hemodyn (75887) | $1,513.50 | $3,027 | 0.5× |
| Vein X-Ray Spleen/Liver (75810) | $2,615.50 | $5,231 | 0.9× |
| Venogram Sinus/Jugular (75860) | $1,666 | $3,332 | 0.6× |
| Venography Adrenal Unilateral (75840) | $3,662.50 | $7,325 | 1.2× |
| Venography caval inferior serialography rs&i (75825) | $3,837.50 | $7,675 | 1.3× |
| Venography extremity bilateral rs&i (75822) | $1,627 | $3,254 | 1.1× |
| Venography extremity unilateral rs&i (75820) | $1,241.50 | $2,483 | 0.8× |
| Venography Orbital Rs&I (75880) | $2,268.50 | $4,537 | 3.8× |
| Venography Renal Bilateral (75833) | $3,654.50 | $7,309 | 1.2× |
| Venography Renal Unilateral (75831) | $3,654.50 | $7,309 | 1.2× |
| Venous sampling by catheter (75893) | $3,654.50 | $7,309 | 0.7× |
| Venous thrombosis imaging (78457) | $852.50 | $1,705 | 1.6× |
| Venous Thrombosis Imaging Venogram Bilateral (78458) | $978 | $1,956 | 2.6× |
| Vertebral fracture assessment via dxa (77086) | $112.50 | $225 | 1.4× |
| Wrist 2 views (73100) range across 2 matching MRF lines |
$146.50–$254.50 | $293–$509 | varies |
| X-Ray Ac Jts - Xr Acromioclavicular Joints Bilateral (73050) range across 2 matching MRF lines |
$157–$308.50 | $314–$617 | varies |
| X-ray antegrade pyelogram tube (74425) | $464.50 | $929 | 1.4× |
| X-Ray Aorta Leg Arteries (75630) | $2,248 | $4,496 | 0.7× |
| X-Ray Bend Only L-S Spine (72120) range across 2 matching MRF lines |
$570.50–$575 | $1,141–$1,150 | varies |
| X-Ray Elbow 2 Vw - Xr Elbow 1-2 Views Right (73070) range across 2 matching MRF lines |
$160–$251 | $320–$502 | varies |
| X-Ray Exam Breast Specimen (76098) | $1,073.50 | $2,147 | 2.1× |
| X-Ray Exam Entire Spi 1 Vw (72081) | $162.50 | $325 | 2.0× |
| X-Ray Exam Entire Spi 2/3 Vw (72082) range across 2 matching MRF lines |
$169.50–$236.50 | $339–$473 | varies |
| X-Ray Exam Entire Spi 4/5 Vw (72083) range across 2 matching MRF lines |
$322–$325.50 | $644–$651 | varies |
| X-Ray Exam Hip Uni 1 View (73501) range across 2 matching MRF lines |
$136.50–$175.50 | $273–$351 | varies |
| X-Ray Exam Hip Uni 2-3 Views (73502) range across 3 matching MRF lines |
$166.50–$250.50 | $333–$501 | varies |
| X-Ray Exam Hip Uni 4/> Views (73503) range across 3 matching MRF lines |
$228.50–$340.50 | $457–$681 | varies |
| X-Ray Exam Hips Bi 2 Views (73521) range across 2 matching MRF lines |
$257.50–$313.50 | $515–$627 | varies |
| X-Ray Exam Hips Bi 3-4 Views (73522) range across 2 matching MRF lines |
$272.50–$357.50 | $545–$715 | varies |
| X-Ray Exam Hips Bi 5/> Views (73523) range across 2 matching MRF lines |
$313–$417.50 | $626–$835 | varies |
| X-Ray Exam L-S Spine Bending (72114) range across 2 matching MRF lines |
$497–$779.50 | $994–$1,559 | varies |
| X-Ray Exam Neck Spine 2-3 Vw (72040) range across 2 matching MRF lines |
$229.50–$365 | $459–$730 | varies |
| X-Ray Exam Neck Spine 6/>Vws (72052) range across 2 matching MRF lines |
$501–$597.50 | $1,002–$1,195 | varies |
| X-Ray Exam Unilat Ribs/Chest (71101) range across 2 matching MRF lines |
$264–$417.50 | $528–$835 | varies |
| X-ray eye for foreign body (70030) range across 2 matching MRF lines |
$158.50–$169.50 | $317–$339 | varies |
| X-ray head for orthodontia (70350) | $160 | $320 | 1.9× |
| X-ray humerus (73060) range across 2 matching MRF lines |
$172.50–$337 | $345–$674 | varies |
| X-ray IV pyelogram (ivp) (74400) | $1,046 | $2,092 | 6.2× |
| X-ray IV pyelogram+tomography (74415) | $1,178 | $2,356 | 7.0× |
| X-Ray Jaw <4 Vw - Xr Mandible < 4 Views (70100) | $118 | $236 | 1.4× |
| X-Ray Knee Bilat Standing - Xr Knees Anteroposterior Standing Bilat (73565) range across 2 matching MRF lines |
$173–$184 | $346–$368 | varies |
| X-Ray Lumbar Spine 2/3 Vw - Xr Lumbar Spine 2-3 Views (72100) range across 2 matching MRF lines |
$264.50–$366.50 | $529–$733 | varies |
| X-ray nose-rectum child f.b. (76010) | $131.50 | $263 | 1.6× |
| X-Ray Ribs, Chest 4+ Vw - Xr Ribs 3 Vws Bil W/ Chest Posteroanterior (71111) range across 2 matching MRF lines |
$299.50–$705 | $599–$1,410 | varies |
| X-Ray Sacroiliac Jts 3+ Vw - Xr Sacroiliac Joints 3+ Views (72202) range across 2 matching MRF lines |
$420.50–$452.50 | $841–$905 | varies |
| X-Ray Sacroiliac Jts <3 Vw - Xr Sacroiliac Joints 1-2 Views (72200) range across 2 matching MRF lines |
$244.50–$246.50 | $489–$493 | varies |
| X-Ray Sacrum/Coccyx 2+ Vw - Xr Sacrum Coccyx 2+ Views (72220) range across 2 matching MRF lines |
$160–$419.50 | $320–$839 | varies |
| X-Ray Sinuses 3+ Vw - Xr Paranasal Sinuses 3+ Views (70220) range across 2 matching MRF lines |
$295–$803.50 | $590–$1,607 | varies |
| X-Ray Skull 4+ Vw - Xr Skull Complete 4+ Views (70260) range across 2 matching MRF lines |
$285–$704.50 | $570–$1,409 | varies |
| X-ray thoracic spine 4 vw (72074) range across 2 matching MRF lines |
$341–$588.50 | $682–$1,177 | varies |
| X-Ray Tmj Unilat (70328) range across 2 matching MRF lines |
$207–$341.50 | $414–$683 | varies |
| X-Ray Urinary Tract Exam With Contrast Material (74420) | $514 | $1,028 | 1.5× |
| X-Rays Bone Length Studies (77073) | $280.50 | $561 | 2.8× |
| X-Rays Bone Survey Complete (77075) range across 2 matching MRF lines |
$551–$897 | $1,102–$1,794 | varies |
| Xr c-spine 4 or 5 views (72050) range across 2 matching MRF lines |
$388–$444 | $776–$888 | varies |
| Xr facial bones less than 3 views (70140) range across 2 matching MRF lines |
$142–$314.50 | $284–$629 | varies |
| XR Mastoids < 3 Views Bilateral (70120) | $140 | $280 | 1.4× |
| Xr orbits complete 4 views (70200) range across 2 matching MRF lines |
$285–$533.50 | $570–$1,067 | varies |
| Xr Tomogram Single Plane (76100) | $135 | $270 | 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.