Imaging prices at Soin Medical Center

Beaver Creek, OH · every code in this section with a posted price and a Medicare benchmark.

445 codes. Prices are the hospital's own posted facility charges.

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ProcedurePosted cashPosted gross× Medicare
3-D radiotherapy plan dose-volume histograms (77295) $4,965.20 $12,413 3.6×
Abdomen 1 View (74018) $166.80 $417 1.9×
Abdomen 2 views (74019) $201.60 $504 2.0×
Acute Gastrointestinal Blood Loss Imaging (78278) $793.20 $1,983 2.0×
Adrenal Cortex & Medulla Img (78075) $1,869.20 $4,673 1.5×
Angio internal mammary (75756) $1,202 $3,005 0.4×
Angio pulmonary bilat (75743) $1,565.20 $3,913 0.5×
Angiography extremity bilateral rs&i (75716) $1,872.40 $4,681 0.6×
Angiography extremity unilateral rs&i (75710) $1,702 $4,255 0.5×
Angiography pulmonary unilateral slctv rs&i (75741) $1,404.80 $3,512 0.5×
Angrph pulmonary nonslctv cath/ven njx rs&i (75746) $1,586 $3,965 0.5×
Ankle 2 views (73600) $166.80 $417 1.9×
Aortography thoracic serialography rs&i (75605)
unusually low: confirm this is the full procedure		 $2,003.60 $5,009 0.4×
Aortography thoracic w/o serialography rs&i (75600) $1,227.60 $3,069 0.4×
Artery X-Rays Abdomen (75726)
unusually low: confirm this is the full procedure		 $2,255.20 $5,638 0.4×
Artery X-Rays Adrenal Gland (75731) $1,677.20 $4,193 0.5×
Artery X-Rays Pelvis (75736)
unusually low: confirm this is the full procedure		 $2,003.60 $5,009 0.4×
Artery X-Rays Spine (75705) $3,624 $9,060 0.7×
Arthrogram ankle (73615) $676.80 $1,692 2.0×
Arthrogram hip (73525) $676.80 $1,692 2.0×
Arthrogram Wrist (73115) $676.80 $1,692 2.0×
Basic radiation dosimetry calculation (77300) $496.80 $1,242 3.8×
Bone age studies (77072) $201.60 $504 2.0×
Bone Imaging 3 Phase (78315) $1,518.40 $3,796 3.9×
Bone Imaging Limited Area (78300) $704.40 $1,761 1.8×
Bone Imaging Multiple Areas (78305) $767.20 $1,918 1.9×
Bone Imaging Whole Body (78306) $897.20 $2,243 2.3×
Bone marrow imaging limited area (78102) $329.20 $823 0.8×
Bone marrow imaging; multiple areas (78103) $432 $1,080 1.1×
Bone marrow imaging; whole body (78104) $657.60 $1,644 1.7×
Bone survey infant (77076) $201.60 $504 2.0×
Brachytx isodose complex (77318) $6,234.40 $15,586 16.9×
Brachytx isodose intermed (77317)
range across 2 matching MRF lines		 $2,262–$6,234.40 $5,655–$15,586 varies
Brachytx Isodose Plan Simple (77316) $1,269.20 $3,173 3.4×
Brain Flow Imaging Only (78610) $364 $910 0.7×
Brain Image W/Flow < 4 Views (78601) $532 $1,330 1.4×
Brain Imaging Min 4 Static Views W Vascular Flow (78606) $1,047.60 $2,619 2.0×
Brain Imaging Pet Metabolic Evaluation (78608) $5,815.60 $14,539 4.1×
Cardiac MRI w/w/o contrast & further seq (75561) $1,333.60 $3,334 3.9×
Cardiac MRI w/w/o contrast w/stress (75563) $1,496 $3,740 1.9×
Cardiac Shunt Detection (78428) $1,265.60 $3,164 3.2×
Cat Scan Follow-Up Study (76380) $517.20 $1,293 6.0×
Cerebrospinal Fluid Flow W/O Matl Shunt Evaltj (78645) $809.20 $2,023 1.5×
Cerebrospinal Fluid Scan (78630) $1,100 $2,750 2.1×
Chest 1 view (71045) $166.80 $417 1.9×
Chest 2 views (71046) $183.60 $459 2.1×
Chest 3 views (71047) $202 $505 2.4×
Chg us nrv&acc strux 1 xtr compre w/img pr extremity (76883) $192 $480 1.9×
Cisternography Positive Contrast Rs&I (70015) $1,497.20 $3,743 1.9×
Clavicle complete (73000) $166.80 $417 1.9×
Computed Tomography Thorax Lw Dose Lng Ca Scr C- (71271) $708 $1,770 6.9×
Continuing medical physics consltj pr wk (77336) $540.40 $1,351 4.1×
Contrast Exam Abdominl Aorta (75625) $1,866.40 $4,666 0.6×
Contrast X-Ray Bladder (74430) $676.80 $1,692 2.0×
Contrast X-Ray Of Elbow (73085) $676.80 $1,692 2.0×
Contrast X-Ray Of Knee Joint (73580) $676.80 $1,692 2.0×
CT abdomen and pelvis without and with contrast (74178) $1,764.80 $4,412 5.1×
CT abdomen and pelvis without contrast (74176) $1,022.40 $2,556 4.3×
CT abdomen w contrast (74160) $1,078 $2,695 6.2×
CT abdomen w wo contrast (74170) $1,137.20 $2,843 6.6×
CT abdomen w/o contrast (74150) $1,049.60 $2,624 10.2×
CT Angio Abdomen and Pelvis (74174) $1,280.40 $3,201 3.7×
CT Angio Chest (71275) $1,414.40 $3,536 8.2×
CT Angio Head (70496) $1,596.40 $3,991 9.2×
CT angio hrt w/3d image (75574) $1,049.60 $2,624 3.1×
Ct Angio Lwr Extr W/O&W/Dye (73706) $1,414.40 $3,536 8.2×
CT Angio Neck (70498) $1,304.40 $3,261 7.5×
Ct Angio Upr Extrm W/O&W/Dye (73206) $1,414.40 $3,536 8.2×
CT cervical spine w/ contrast (72126) $948.80 $2,372 2.8×
CT cervical spine w/o contrast (72125) $790.80 $1,977 7.7×
CT cervical spine w/wo cont (72127) $992 $2,480 5.7×
CT chest w contrast (71260) $946 $2,365 5.5×
CT chest w/wo contrast (71270) $1,218 $3,045 7.0×
CT colonography screening (74263) $395.20 $988 1.7×
CT Colonogrphy Dx Image Postprocess W/Contrast (74262) $1,276.80 $3,192 7.4×
CT colonogrphy dx image postprocess w/o contrast (74261) $1,110.40 $2,776 10.8×
CT head/brain with contrast (70460) $795.20 $1,988 4.6×
CT head/brain without and with contrast (70470) $908.80 $2,272 5.3×
CT heart contrast eval cardiac structure&morph (75572) $1,140.80 $2,852 3.3×
CT heart no contrast quant eval coronry calcium (75571) $850.40 $2,126 9.9×
CT hrt w/3d image congen (75573) $1,140.80 $2,852 3.3×
CT iac w contrast (70481) $939.60 $2,349 5.4×
CT l-spine w&w/o contrast (72133) $1,340.80 $3,352 7.8×
CT lower ext w/o (73700) $944.40 $2,361 9.2×
CT lower extremity w/contrast material (73701) $948.40 $2,371 5.5×
CT lumbar spine w contrast (72132) $1,282.80 $3,207 3.7×
CT lumbar spine w/o contrast (72131) $1,166 $2,915 11.3×
CT maxillofacial w contrast (70487) $868.80 $2,172 5.0×
CT maxillofacial wo contrast (70486) $724.80 $1,812 7.0×
CT neck tissue combo (70492) $786 $1,965 4.5×
Ct Orbit/Ear/Fossa W/O&W/Dye (70482) $983.20 $2,458 5.7×
CT orbits w/o contrast (70480) $854 $2,135 8.3×
CT pelvis w&w/o contrast (72194) $1,406.40 $3,516 8.1×
CT pelvis w/o contrast (72192) $944.40 $2,361 9.2×
CT scan of leg combo (73702) $1,083.20 $2,708 6.3×
CT scans face/jaw combo (70488) $894 $2,235 5.2×
CT soft tissue neck w contrast (70491) $751.60 $1,879 4.3×
CT soft tissue neck w/o contrast (70490) $627.60 $1,569 6.1×
CT thoracic spine w contrast (72129) $965.60 $2,414 5.6×
CT thoracic spine w/o contrast (72128) $852.80 $2,132 8.3×
CT thoracic spine w/wo cont (72130) $979.60 $2,449 5.7×
CT thorax w/o contrast (71250) $708 $1,770 6.9×
CT upper ext wo (73200) $944.40 $2,361 9.2×
CT upper extremity w/o & w/contrast material (73202) $1,085.20 $2,713 6.3×
CT upper extremity with contrast (73201) $1,068.80 $2,672 3.1×
Cta Abdl Aorta&Bi Iliofem W/Contrast&Postp (75635) $1,570.80 $3,927 9.1×
Cta Abdomen (74175) $1,414.40 $3,536 8.2×
CTA pelvis (72191) $1,414.40 $3,536 8.2×
Dilation ureters/urethra rs&i (74485) $816 $2,040 0.4×
Discography Cerv/Thor Spine (72285) $1,360 $3,400 0.7×
Diskography lumbar (72295) $1,360 $3,400 0.7×
Doppler Echo Fetal Puls Spectral F/U/Repeat (76828) $202.80 $507 2.0×
Doppler Echo Fetal Spectral Display Complete (76827) $212.80 $532 2.1×
Doppler Fetal Mid Cerebral Artery (76821) $205.60 $514 2.0×
Dxa Bone Density Axial (77080) $452.80 $1,132 4.4×
Dxa bone density study (77085) $167.60 $419 1.6×
Dxa bone density study 1/>sites appendiclr skel (77081) $132 $330 1.5×
Echo exam of fetal heart (76825) $904.80 $2,262 1.7×
Echo exam uterus (76831) $538.80 $1,347 2.3×
Echo Guide For Artery Repair (76936) $1,700 $4,250 8.0×
Echocardiography, fetal, cardiovascular system, real time with image documentation (2D), with or without M-mode… (76826) $415.20 $1,038 1.8×
Esophageal Motility Study (78258) $624.80 $1,562 1.6×
Esophagram (74220) $337.20 $843 2.0×
Fetal Biophys Profile W/Nst (76818)
range across 2 matching MRF lines		 $98.80–$596.80 $247–$1,492 varies
Fetal Biophysical Profile W/O Non-Stress Testing (76819) $240.80 $602 2.3×
Fluoroscopy up to 1 hr (76000) $300.80 $752 1.3×
Follow-Up Angiography (75898) $1,202 $3,005 0.4×
Foot 2 views (73620) $166.80 $417 1.9×
Forearm 2 views (73090) $166.80 $417 1.9×
Gastric emptying imaging study (78264) $741.60 $1,854 1.9×
Gastric Emptyng Imag Std W/Sm Bwl Transit (78265) $794 $1,985 2.0×
Gastroesophageal Reflux Exam (78262) $1,031.60 $2,579 2.6×
Gated Heart Planar Single (78472) $914.80 $2,287 2.3×
Gated Heart, Multiple (78473) $1,294.80 $3,237 3.3×
Gstrc Emptng Imag Std W/Sm Bwl Col Trnst Mlt Day (78266) $1,053.20 $2,633 2.0×
Hand 2 views (73120) $166.80 $417 1.6×
Hdr Rdncl Ntrstl/Icav Brchtx (77772) $3,694.80 $9,237 5.4×
Hdr Rdncl Ntrstl/Icav Brchtx (77771) $3,312.40 $8,281 4.8×
Hdr Rdncl Ntrstl/Icav Brchtx 1 Channel (77770) $2,931.20 $7,328 4.3×
Heart Image (Pet) Multiple (78492) $3,840.40 $9,601 2.7×
Hepatc Vngrph Wdg/Fr Hemodyn Eval Rs&I (75889) $1,454.80 $3,637 0.5×
Hepatc Vngrph Wdg/Fr W/O Hemodyn Eval Rs&I (75891) $1,454.80 $3,637 0.5×
Hepatobil Syst Image W/Drug (78227) $799.20 $1,998 1.5×
Hepatobiliary System Imaging (78226) $799.20 $1,998 2.0×
Ht Musc Image Planar Mult (78454) $2,920.40 $7,301 2.3×
Ht Muscle Image Spect Sing (78451) $2,920.40 $7,301 2.3×
Hysterosalpingogram (74740) $458 $1,145 1.9×
Infant hip ultrasound with hip movement (dynamic) (76885) $214.80 $537 2.5×
Infusion Ivp (74410) $337.20 $843 2.0×
Interstitial radiation source applic complex (77778) $7,488.80 $18,722 10.9×
Intracavitary Radiation Source Applic Complex (77763) $1,939.60 $4,849 2.8×
Intracavitary Radiation Source Applic Intermed (77762) $1,368.40 $3,421 2.5×
Intracavitary radiation source applic simple (77761) $923.20 $2,308 1.7×
Joint Survey Single View (77077) $106.40 $266 1.0×
K Flow/Funct Image Multiple (78709) $1,129.20 $2,823 2.1×
K Flow/Funct Image W/Drug (78708) $624 $1,560 1.2×
K Flow/Funct Image W/O Drug (78707) $1,001.60 $2,504 1.9×
Kidney Imaging Morphol (78700) $697.60 $1,744 1.8×
Knee 3 Views (73562) $183.60 $459 2.1×
Leveen/Shunt Patency Exam (78291) $603.20 $1,508 1.5×
Liver & Spleen Imaging Static Only (78215) $692.40 $1,731 1.8×
Liver imaging w/vascular flow (78202) $716.40 $1,791 1.3×
Lung Perf&Ventilat Diferentl (78598) $862.40 $2,156 1.6×
Lung perfusion differential (78597) $552.80 $1,382 1.4×
Lung Ventilat&Perfus Imaging (78582) $862.40 $2,156 1.6×
Lung Ventilation Imaging (78579) $552.80 $1,382 1.4×
Lymph System Imaging (78195) $791.20 $1,978 1.5×
Magnetic Image Jaw Joint (70336) $994 $2,485 4.2×
Mammary ductogram or galactogram multiple (77054) $504 $1,260 2.1×
Mammary ductogram or galactogram single (77053) $458 $1,145 1.9×
Meckels Divert Exam (78290) $452.40 $1,131 1.1×
Medical physics dose eval radiation expos w/rprt (76145) $203.20 $508 0.6×
Mlc imrt design & construction per imrt plan (77338) $472 $1,180 1.3×
Mr safety determination physician/other qhp (76016) $141.20 $353 1.6×
Mr safety implant&/fb assmt clin staf 1st 15 min (76014) $39.20 $98 1.4×
Mr safety implt electronics prepj supvj phys/qhp (76018) $147.20 $368 1.6×
Mr safety implt pos&/immoblj (76019) $95.20 $238 1.6×
Mr safety med physics xm customization plng&mntr (76017) $386.80 $967 1.6×
Mra Head W/O & W/Contrast Material (70546) $1,295.60 $3,239 3.8×
MRA head w/o contrast (70544) $1,033.20 $2,583 4.4×
MRA head with contrast (70545) $1,132 $2,830 3.3×
MRA neck w contrast (70548) $1,238.80 $3,097 3.6×
Mra Neck W/O &W/Contrast Material (70549) $1,326.40 $3,316 3.9×
MRA neck w/o contrast (70547) $1,033.20 $2,583 4.4×
MRI abdomen w contrast (74182) $1,136 $2,840 3.3×
MRI abdomen w/o contrast (74181) $1,032.80 $2,582 4.4×
MRI any jt lower extrem w/contrast material (73722) $1,215.20 $3,038 1.6×
MRI any jt lower extrem w/o & w/contrast matrl (73723) $1,325.60 $3,314 3.9×
MRI any jt upper extremity w/contrast matrl (73222) $1,146.80 $2,867 1.5×
MRI bone marrow blood supply (77084) $430.80 $1,077 1.8×
MRI brain functional w/o physician admnistration (70554) $1,033.20 $2,583 4.4×
MRI brain functional w/physician admnistration (70555) $1,064 $2,660 4.5×
MRI Breast W/O Contrast Bilateral (77047) $1,186.80 $2,967 5.0×
MRI Breast Without Contrast Material Unilateral (77046) $999.20 $2,498 4.3×
MRI cardiac w/o contrast (75557) $908.80 $2,272 3.9×
MRI cervical spine w contrast (72142) $1,216 $3,040 3.5×
MRI cervical spine w/o cont (72141) $1,033.20 $2,583 4.4×
MRI chest w/o contrast (71550) $965.20 $2,413 4.1×
MRI chest with contrast (71551) $1,093.60 $2,734 1.4×
MRI chest wo w contrast (71552) $1,239.60 $3,099 3.6×
MRI lower extrem oth/thn jt w/contrast matrl (73719) $1,258.40 $3,146 3.7×
MRI lower extrem oth/thn jt w/o & w/contr matr (73720) $1,452.40 $3,631 4.2×
MRI lower extrem oth/thn jt w/o contr matrl (73718) $1,110.40 $2,776 4.7×
MRI lumbar spine w contrast (72149) $1,062 $2,655 3.1×
Mri Neck Spine W/O & W/Dye (72156) $1,351.20 $3,378 3.9×
MRI orbit face &/neck w/o contrast (70540) $1,033.20 $2,583 4.4×
MRI orbit face neck w contrast (70542) $1,238.80 $3,097 3.6×
Mri Orbt/Fac/Nck W/O &W/Dye (70543) $1,351.20 $3,378 3.9×
MRI pelvis w contrast (72196) $1,061.60 $2,654 3.1×
MRI pelvis w/o & w contrast (72197) $1,262.80 $3,157 3.7×
MRI pelvis w/o contrast (72195) $1,013.60 $2,534 4.3×
MRI spectroscopy (76390) $860 $2,150 10.0×
MRI thoracic spine w/o contrast (72146) $1,032.80 $2,582 4.4×
MRI upper extremity oth than jt w/contr matrl (73219) $1,168.40 $2,921 3.4×
MRI upper extremity oth than jt w/o contr matrl (73218) $1,052 $2,630 4.5×
Mri Uppr Extremity W/O&W/Dye (73220) $1,502.80 $3,757 4.4×
MRI, abdomen, combo (74183) $1,238.40 $3,096 3.6×
MRI, dorsal spine combo (72157) $1,603.20 $4,008 4.7×
MRI, dorsal spine contrast (72147) $1,093.60 $2,734 3.2×
MRI, joint upper extrem (73221) $974 $2,435 4.1×
MRI, joint upper extrem combo (73223) $1,274.40 $3,186 3.7×
MRI, lumbar spine combo (72158) $1,496 $3,740 4.4×
Myelogram cervical (72240) $733.20 $1,833 0.9×
Myelogram Lumbar (72265) $640 $1,600 0.8×
Myelography thoracic (72255) $613.60 $1,534 0.8×
Myelograpy 2/more regions rs&i (72270) $959.20 $2,398 1.2×
Myocardial Imaging Infarct Avid Planar Qual/Quan (78466) $552 $1,380 1.4×
Myocardial Imaging Pet Metabolic Evaluation (78459) $3,840.40 $9,601 3.0×
Myocardial Perfusion Planar 1 Study Rest/Stress (78453) $2,776.40 $6,941 2.2×
Myocardial Spect Multiple Studies (78452) $3,528 $8,820 2.8×
Myocrd Img Pet Metab Eval Single Study Cncrnt CT (78429) $3,941.60 $9,854 2.8×
Myocrd img PET prfuj 1std rest/stress cncrnt CT (78430) $2,792 $6,980 2.0×
Myocrd Img Pet Prfuj Mlt Std Rst&Strs Cncrnt CT (78431) $4,055.60 $10,139 1.9×
Myocrd Img Pet Prfuj W/Metab 2rtracer Cncrnt CT (78433) $4,956 $12,390 2.3×
Myocrd Img Pet Prfuj W/Metab Dual Radiotracer (78432) $4,956 $12,390 3.3×
Neck soft tissue (70360) $166.80 $417 1.9×
Nm csf leak detection (78650) $976.40 $2,441 0.8×
Nm myocard infarct spect (78469) $820.40 $2,051 1.5×
Nm red cell survival study (78130) $1,263.60 $3,159 3.2×
Nonvascular Shunt X-Ray (75809) $201.60 $504 2.0×
Ntsty modul radthx pln dose-vol histos (77301) $1,390.40 $3,476 1.0×
Nuclear Rx Intra-Arterial (79445) $618.80 $1,547 2.7×
Nuclear Rx Oral Admin (79005) $995.20 $2,488 4.3×
Ob us nuchal meas 1 gest (76813) $202.80 $507 2.0×
Oph bmtry us echograpy a-scan io lens pwr cal (76519) $95.60 $239 0.9×
Oph us dx ant sgm us immersion b-scan/hr biom (76513) $98.80 $247 1.0×
Ophthalmic Biometry US Echograpy a-Scan (76516) $95.60 $239 0.9×
Ophthalmic ultrasound dx b-scan w/wo a-scan (76512) $88 $220 0.9×
Ophthalmic US Dx Corneal Pachymetry Uni/Bi (76514) $22.40 $56 0.8×
Parathyroid imaging w/tomographic spect & CT (78072) $1,490.40 $3,726 2.8×
Parathyroid Planar Imaging (78070) $707.60 $1,769 1.8×
Parathyroid planar imaging w/wo subtraction (78071) $868.40 $2,171 2.2×
Pelvis 1 or 2 views (72170) $201.60 $504 2.0×
Perineogram (74775) $458 $1,145 1.9×
Pet Image Skull-Thigh (78812) $3,175.60 $7,939 2.3×
Pet Image W/Ct Lmtd (78814)
range across 2 matching MRF lines		 $2,080–$3,332 $5,200–$8,330 varies
PET image w/CT, full body (78816) $3,175.60 $7,939 2.3×
PET imaging CT attenuation skull base mid-thigh (78815) $3,175.60 $7,939 2.3×
Pet Myocardial Sngl Study (78491) $2,600.40 $6,501 1.8×
PET whole body (78813) $4,010 $10,025 2.8×
Prq Transhepatc Portograpy Hemodyn Eval Rs&I (75885) $4,766.40 $11,916 1.5×
Pulmonary Perfusion Imaging Particulate (78580) $796.80 $1,992 2.0×
Radex Abd Compl Aqt Abd W/S/E/D Views 1 View Ch (74022) $221.60 $554 2.2×
Radex abscess/fistula/sinus tract rs&i (76080) $1,096.40 $2,741 2.0×
Radex Ankle Complete Minimum 3 Views (73610) $183.60 $459 2.1×
Radex Calcaneus Minimum 2 Views (73650) $166.80 $417 1.9×
Radex elbow complete minimum 3 views (73080) $183.60 $459 2.1×
Radex Facial Bones Complete Minimum 3 Views (70150) $201.60 $504 2.0×
Radex fingr minimum 2 views (73140) $166.80 $417 1.9×
Radex foot complete minimum 3 views (73630) $183.60 $459 2.1×
Radex Hand Minimum 3 Views (73130) $201.60 $504 2.4×
Radex lower extremity infant minimum 2 views (73592) $166.80 $417 1.9×
Radex Nasal Bones Complete Minimum 3 Views (70160) $166.80 $417 1.9×
Radex Ribs Unilateral 2 Views (71100) $166.80 $417 1.9×
Radex shoulder complete minimum 2 views (73030) $183.60 $459 2.1×
Radex Sinuses Paransl < 3 Views (70210) $166.80 $417 1.9×
Radex Spine 1 View Specify Level (72020) $166.80 $417 1.9×
Radex Sternum Minimum 2 Views (71120) $166.80 $417 1.9×
Radex Temporomandble Jt Opn & Clsd Mouth Bilat (70330) $183.60 $459 2.1×
Radex Toe Minimum 2 Views (73660) $166.80 $417 1.9×
Radex upper extremity infant minimum 2 views (73092) $201.60 $504 2.0×
Radex Wrist Complete Minimum 3 Views (73110) $183.60 $459 2.1×
Radex X-Ray Exam Entire Spi 6/> Vw - Xr Entire Spine 6+ Vw (72084) $243.60 $609 2.4×
Radiation Delivery Stereotactic Cranial Linear (77372) $7,806 $19,515 1.1×
Radiation treatment delivery level 1 (77402) $437.20 $1,093 4.3×
Radiation treatment delivery level 2 (77407) $495.20 $1,238 1.3×
Radiation treatment delivery level 3 (77412) $877.20 $2,193 1.6×
Radiolog exam mandible compl minimum 4 views (70110) $201.60 $504 2.0×
Radiologic exam colon double contrast study (74280) $370.80 $927 2.1×
Radiologic exam colon single contrast study (74270) $337.20 $843 2.0×
Radiologic Exam Esophagus Double Contrast Study (74221) $370.80 $927 2.1×
Radiologic exam knee complete 4/more views (73564) $201.60 $504 2.0×
Radiologic exam pelvis compl minimum 3 views (72190) $221.60 $554 2.2×
Radiologic Exam Small Int Single Contrast Study (74250) $337.20 $843 2.0×
Radiologic exam swallow function contrast study (74230) $337.20 $843 2.0×
Radiologic exam upr gi trc double contrast study (74246) $370.80 $927 2.1×
Radiologic examination femur 1 view (73551) $166.80 $417 1.9×
Radiologic examination femur minimum 2 views (73552) $183.60 $459 2.1×
Radiologic examination knee 1/2 views (73560) $166.80 $417 1.9×
Radiologic Examination Osseous Survey Limited (77074) $201.60 $504 2.0×
Radiologic Examination Salivary Gland Calculus (70380) $166.80 $417 1.9×
Radiologic examination tibia & fibula 2 views (73590) $166.80 $417 1.9×
Radiopharm Dacryocystography (78660) $344 $860 0.9×
Radiopharmaceutical therapy, by interstitial radioactive colloid administration Facility (79300) $1,556.40 $3,891 6.8×
Radiopharmaceutical therapy, by intracavitary administration Non-Facility (79200) $1,193.20 $2,983 5.2×
Red Cell Volume Determination Spx Mult Samplings (78121) $635.60 $1,589 1.2×
Remote afterloading high dose rate radionuclide skin surface brachytherapy, includes basic dosimetry, when performed;… (77768) $3,694.80 $9,237 9.7×
Remote afterloading high dose rate radionuclide skin surface brachytherapy, includes basic dosimetry, when performed;… (77767) $2,931.20 $7,328 7.7×
Ribs bilateral 3 views (71110) $201.60 $504 2.0×
Rp loclzj tum plnr 1 area single day imaging (78800) $663.20 $1,658 1.7×
Rp loclzj tum plnr 2+area 1+d img/1 area img>2+d (78801) $1,118.40 $2,796 2.8×
Rp Loclzj Tum Plnr Whole Body 2+ Days Imaging (78804) $1,306 $3,265 2.4×
Rp Loclzj Tum Plnr Whole Body Single Day Imaging (78802) $1,278.40 $3,196 2.4×
Rp Loclzj Tum Spect 1 Area Single Day Imaging (78803) $1,338.80 $3,347 2.5×
Rp loclzj tum spect 2 area/sep acquisj img (78831) $2,292 $5,730 1.8×
Rp loclzj tum spect CT 2area 1d img/1 ar img>2+d (78832) $2,600.40 $6,501 1.8×
Rp loclzj tum spect w/CT 1 area/acquisj 1day img (78830) $1,623.20 $4,058 1.3×
Rp Ther Radiolbld Monoclonal Antibody IV Infus (79403) $688 $1,720 3.0×
Rp Therapy Intravenous Administration (79101) $841.20 $2,103 3.7×
Salivary Gland Imaging (78230) $455.60 $1,139 1.2×
Scapula (73010) $201.60 $504 2.0×
Screening Digital Breast Tomosynthesis Bi (77063) $90 $225 3.8×
Shoulder 1 view (73020) $166.80 $417 1.9×
Shoulder Arthrography (73040) $676.80 $1,692 2.0×
Sialogram (70390) $458 $1,145 1.9×
Skull less than 4 views (70250) $201.60 $504 2.0×
Special dosimetry (77331) $221.20 $553 1.7×
Special Physics Consult (77370) $1,733.60 $4,334 13.1×
Special teletherapy port plan (77321) $1,197.60 $2,994 3.2×
Special treatment procedure (77470) $2,562.80 $6,407 4.7×
Spleen Imaging (78185) $628.80 $1,572 1.6×
Srs Multisource (77371) $34,165.20 $85,413 4.7×
Stereotactic Body Radiation Delivery (77373) $5,736.80 $14,342 3.3×
Sternoclavicular joints (71130) $166.80 $417 1.9×
Superior sagittal sinus venogram (75870) $1,388.80 $3,472 0.4×
Tbs techl prep&transmis data alys pfrmd elsewhr (77090) $150.80 $377 1.8×
Tbs technical calculation only (77091) $150.80 $377 1.8×
Telethx isodose pln cplx w/basic dosimetry (77307) $4,149.20 $10,373 11.2×
Telethx isodose pln smpl w/dosimetry calculation (77306) $1,785.60 $4,464 4.8×
Testicular Imaging W/Flow (78761) $676.40 $1,691 1.7×
Ther Rad Simulaj-Aided Field Setting Complex (77290) $1,843.60 $4,609 5.0×
Ther Rad Simulaj-Aided Field Setting Intermed (77285) $1,749.60 $4,374 4.7×
Ther rad simulaj-aided field setting simple (77280) $726.80 $1,817 5.5×
Therapeutic Enema Rdctj Intussusception/Obstrcj (74283) $337.20 $843 2.0×
Thoracic spine 2 views (72070) $201.60 $504 2.0×
Thoracic spine 3 views (72072) $221.60 $554 2.2×
Thoracolumbar 2 views (72080) $166.80 $417 1.9×
Thyroid Carcinoma Metastases Img Lmtd Area (78015) $1,086 $2,715 2.8×
Thyroid Imaging With Vascular Flow (78013) $466.40 $1,166 1.2×
Thyroid Met Imaging Body (78018) $1,193.20 $2,983 2.2×
Thyroid Uptake Measurement (78012) $340 $850 0.9×
Thyroid Uptake W/Blood Flow Sngle/Mult Quan Meas (78014) $630 $1,575 1.6×
Tx Devices Design & Construction Complex (77334) $818.40 $2,046 2.2×
Tx devices design & construction intermediate (77333) $387.60 $969 2.9×
Tx devices design & construction simple (77332) $334.40 $836 2.5×
Ultrasound Breast Limited (76642) $224 $560 2.6×
Ultrasound elastography first target lesion (76982) $538.80 $1,347 5.2×
Ultrasound Elastography Parenchyma (76981) $538.80 $1,347 5.2×
Ultrasound Exam Aaa Screen (76706) $212.40 $531 2.1×
Ultrasound, abdomen limited (76705) $552 $1,380 5.4×
Umbilical-artery Doppler (OB) (76820) $205.60 $514 2.0×
Unlis px ther radiol clinical tx planning (77299) $588.40 $1,471 4.4×
Unlisted Dx Radiographic Procedure (76499)
range across 3 matching MRF lines		 $39.60–$242.80 $99–$607 varies
Upper gi w/o kub (74240) $337.20 $843 2.0×
Urea Breath Test C-14 Isotopic Acquisj Analysis (78267) $224.80 $562 20.3×
Urea breath test c-14 isotopic analysis (78268) $435.60 $1,089 4.6×
Ureteral Reflux Study (78740) $940 $2,350 2.4×
Urethrocystogram voiding (74455) $458 $1,145 1.9×
Urethrocystography retrograde (74450) $458 $1,145 1.9×
Us breast unilateral complete (76641) $483.20 $1,208 4.7×
Us chest (76604) $790.40 $1,976 7.7×
Us complete joint (76881) $514.40 $1,286 5.0×
Us exam, pelvic, limited (76857)
range across 2 matching MRF lines		 $94–$368.40 $235–$921 varies
Us head (76506) $340 $850 3.3×
Us kidney transplant (76776) $418.80 $1,047 4.1×
Us lmtd joint/oth nonvasc xtr strux r-t w/img (76882) $356.80 $892 3.5×
Us ob detailed single fetus (76811) $247.20 $618 1.1×
Us ob limited 1 or more fetuses (76815) $479.60 $1,199 4.7×
Us ob transvaginal (76817) $501.60 $1,254 4.9×
Us pelvic non ob complete (76856) $520 $1,300 5.0×
Us pg uter img f&mat 14 wk tabdl 1/1st gestation (76801) $550 $1,375 5.3×
Us preg uterus real time f/u trnsabdl per fetus (76816) $425.60 $1,064 4.1×
Us retroperitoneal complete (76770) $766.40 $1,916 7.4×
Us retroperitoneal limited (76775) $538 $1,345 5.2×
Us scrotum and contents (76870) $448 $1,120 4.3×
Us thyroid (76536) $436 $1,090 4.2×
Us transrectal (76872) $834.40 $2,086 8.1×
Vein X-Ray Chest (75827) $1,709.20 $4,273 1.1×
Vein X-Ray Liver W/O Hemodyn (75887) $1,269.20 $3,173 0.4×
Vein X-Ray Skull Epidural (75872) $1,282.40 $3,206 2.1×
Venogram Sinus/Jugular (75860) $1,454.80 $3,637 0.5×
Venography Adrenal Unilateral (75840) $1,517.20 $3,793 0.5×
Venography caval inferior serialography rs&i (75825) $1,354 $3,385 0.4×
Venography extremity bilateral rs&i (75822) $590.80 $1,477 0.4×
Venography extremity unilateral rs&i (75820) $590.80 $1,477 0.4×
Venography Renal Bilateral (75833) $1,938.80 $4,847 0.6×
Venography Renal Unilateral (75831) $1,683.20 $4,208 0.5×
Venous sampling by catheter (75893)
unusually low: confirm this is the full procedure		 $2,003.60 $5,009 0.4×
Venous thrombosis imaging (78457) $716.40 $1,791 1.3×
Venous Thrombosis Imaging Venogram Bilateral (78458) $779.20 $1,948 2.0×
Vertebral fracture assessment via dxa (77086) $105.20 $263 1.2×
Wrist 2 views (73100) $166.80 $417 1.9×
X-Ray Ac Jts - Xr Acromioclavicular Joints Bilateral (73050) $166.80 $417 1.9×
X-ray antegrade pyelogram tube (74425) $676.80 $1,692 2.0×
X-Ray Aorta Leg Arteries (75630) $2,026.80 $5,067 0.7×
X-Ray Bend Only L-S Spine (72120) $201.60 $504 2.0×
X-Ray Elbow 2 Vw - Xr Elbow 1-2 Views Right (73070) $166.80 $417 1.9×
X-Ray Exam Breast Specimen (76098) $1,096.40 $2,741 2.0×
X-Ray Exam Entire Spi 1 Vw (72081) $166.80 $417 1.9×
X-Ray Exam Entire Spi 2/3 Vw (72082) $201.60 $504 2.0×
X-Ray Exam Entire Spi 4/5 Vw (72083) $221.60 $554 2.2×
X-Ray Exam Hip Uni 1 View (73501) $166.80 $417 1.9×
X-Ray Exam Hip Uni 2-3 Views (73502) $183.60 $459 2.1×
X-Ray Exam Hip Uni 4/> Views (73503) $202 $505 2.0×
X-Ray Exam Hips Bi 2 Views (73521) $201.60 $504 2.0×
X-Ray Exam Hips Bi 3-4 Views (73522) $221.60 $554 2.2×
X-Ray Exam Hips Bi 5/> Views (73523) $243.60 $609 2.4×
X-Ray Exam L-S Spine Bending (72114) $243.60 $609 2.4×
X-Ray Exam Neck Spine 2-3 Vw (72040) $166.80 $417 1.9×
X-Ray Exam Neck Spine 6/>Vws (72052) $221.60 $554 2.2×
X-Ray Exam Unilat Ribs/Chest (71101) $183.60 $459 1.8×
X-ray eye for foreign body (70030) $166.80 $417 1.9×
X-ray head for orthodontia (70350) $166.80 $417 1.9×
X-ray humerus (73060) $166.80 $417 1.9×
X-ray IV pyelogram+tomography (74415) $370.80 $927 2.1×
X-Ray Jaw <4 Vw - Xr Mandible < 4 Views (70100) $166.80 $417 1.9×
X-Ray Knee Bilat Standing - Xr Knees Anteroposterior Standing Bilat (73565) $166.80 $417 1.9×
X-Ray Lumbar Spine 2/3 Vw - Xr Lumbar Spine 2-3 Views (72100) $201.60 $504 2.0×
X-ray nose-rectum child f.b. (76010) $166.80 $417 1.9×
X-Ray Ribs, Chest 4+ Vw - Xr Ribs 3 Vws Bil W/ Chest Posteroanterior (71111) $221.60 $554 2.2×
X-Ray Sacroiliac Jts 3+ Vw - Xr Sacroiliac Joints 3+ Views (72202) $221.60 $554 2.2×
X-Ray Sacroiliac Jts <3 Vw - Xr Sacroiliac Joints 1-2 Views (72200) $201.60 $504 2.0×
X-Ray Sacrum/Coccyx 2+ Vw - Xr Sacrum Coccyx 2+ Views (72220) $166.80 $417 1.9×
X-Ray Sinuses 3+ Vw - Xr Paranasal Sinuses 3+ Views (70220) $183.60 $459 2.1×
X-Ray Skull 4+ Vw - Xr Skull Complete 4+ Views (70260) $221.60 $554 2.2×
X-Ray Stress View (77071) $166.80 $417 1.9×
X-ray thoracic spine 4 vw (72074) $243.60 $609 2.4×
X-Ray Tmj Unilat (70328) $166.80 $417 1.9×
X-Ray Urinary Tract Exam With Contrast Material (74420) $676.40 $1,691 2.0×
X-Rays Bone Length Studies (77073) $201.60 $504 2.0×
X-Rays Bone Survey Complete (77075) $221.60 $554 2.2×
Xr c-spine 4 or 5 views (72050) $201.60 $504 2.0×
Xr facial bones less than 3 views (70140) $166.80 $417 1.9×
Xr orbits complete 4 views (70200) $201.60 $504 2.0×
Xr Tomogram Single Plane (76100) $201.60 $504 2.0×

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.