Imaging prices at Southeastern Medical Center
Cambridge, OH · every code in this section with a posted price and a Medicare benchmark.
422 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) | $2,585.70 | $3,978 | 2.0× |
| Abdomen 1 View (74018) | $254.80 | $392 | 3.1× |
| Abdomen 2 views (74019) | $326.30 | $502 | 3.3× |
| Acute Gastrointestinal Blood Loss Imaging (78278) | $969.80 | $1,492 | 2.6× |
| Adrenal Cortex & Medulla Img (78075) | $1,818.05 | $2,797 | 1.5× |
| Angio internal mammary (75756) | $1,650.35 | $2,539 | 0.6× |
| Angio pulmonary bilat (75743) | $3,122.60 | $4,804 | 1.0× |
| Angiography Adrenal Bilateral Slctv Rs&I (75733) | $3,080.35 | $4,739 | 1.0× |
| Angiography extremity bilateral rs&i (75716) | $4,090.45 | $6,293 | 1.4× |
| Angiography extremity unilateral rs&i (75710) | $3,099.20 | $4,768 | 1.0× |
| Angiography pulmonary unilateral slctv rs&i (75741) | $3,080.35 | $4,739 | 1.0× |
| Angrph pulmonary nonslctv cath/ven njx rs&i (75746) | $2,879.50 | $4,430 | 1.0× |
| Ankle 2 views (73600) range across 2 matching MRF lines |
$201.50–$403 | $310–$620 | varies |
| Aortography thoracic serialography rs&i (75605) | $2,821.65 | $4,341 | 0.5× |
| Artery X-Rays Abdomen (75726) | $2,797.60 | $4,304 | 0.5× |
| Artery X-Rays Adrenal Gland (75731) | $2,032.55 | $3,127 | 0.7× |
| Artery X-Rays Pelvis (75736) | $5,108.35 | $7,859 | 1.0× |
| Artery X-Rays Spine (75705) | $5,108.35 | $7,859 | 1.0× |
| Arthrogram ankle (73615) range across 2 matching MRF lines |
$826.15–$1,652.30 | $1,271–$2,542 | varies |
| Arthrogram hip (73525) range across 2 matching MRF lines |
$978.90–$1,957.80 | $1,506–$3,012 | varies |
| Arthrogram Wrist (73115) range across 2 matching MRF lines |
$1,266.85–$2,533.05 | $1,949–$3,897 | varies |
| Basic radiation dosimetry calculation (77300) | $339.30 | $522 | 2.7× |
| Bone age studies (77072) | $269.75 | $415 | 2.7× |
| Bone Imaging 3 Phase (78315) | $1,420.25 | $2,185 | 3.8× |
| Bone Imaging Limited Area (78300) | $753.35 | $1,159 | 2.0× |
| Bone Imaging Multiple Areas (78305) | $1,038.05 | $1,597 | 2.7× |
| Bone Imaging Whole Body (78306) | $1,290.90 | $1,986 | 3.4× |
| Bone marrow imaging limited area (78102) | $729.30 | $1,122 | 1.9× |
| Bone marrow imaging; multiple areas (78103) | $923 | $1,420 | 2.4× |
| Bone marrow imaging; whole body (78104) | $1,116.70 | $1,718 | 3.0× |
| Bone survey infant (77076) | $315.90 | $486 | 3.2× |
| Brachytx isodose complex (77318) | $1,751.75 | $2,695 | 4.9× |
| Brachytx isodose intermed (77317) | $1,751.75 | $2,695 | 4.9× |
| Brachytx Isodose Plan Simple (77316) | $1,004.25 | $1,545 | 2.8× |
| Brain Flow Imaging Only (78610) | $801.45 | $1,233 | 1.6× |
| Brain Image W/Flow < 4 Views (78601) | $1,115.40 | $1,716 | 2.9× |
| Brain imaging < 4 static views (78600) | $974.35 | $1,499 | 2.6× |
| Brain Imaging Min 4 Static Views W Vascular Flow (78606) | $1,396.20 | $2,148 | 2.7× |
| Brain Imaging Minimum 4 Static Views (78605) | $1,255.80 | $1,932 | 2.4× |
| Brain Imaging Pet Metabolic Evaluation (78608) | $5,480.80 | $8,432 | 4.1× |
| Card Bl Pool Gated Spect Rest Wal Motn Ejct Frct (78494) | $999.70 | $1,538 | 2.6× |
| Cardiac Shunt Detection (78428) | $635.70 | $978 | 1.7× |
| Cat Scan Follow-Up Study (76380) | $630.50 | $970 | 7.7× |
| Cerebrospinal Fluid Flow W/O Matl Shunt Evaltj (78645) | $801.45 | $1,233 | 1.6× |
| Cerebrospinal Fluid Scan (78630) | $1,004.25 | $1,545 | 2.0× |
| Chest 1 view (71045) | $276.25 | $425 | 3.4× |
| Chest 2 views (71046) | $303.55 | $467 | 3.7× |
| Chest 3 views (71047) | $334.10 | $514 | 4.1× |
| Chest 4 or more views (71048) | $367.25 | $565 | 3.7× |
| Clavicle complete (73000) range across 2 matching MRF lines |
$290.55–$581.10 | $447–$894 | varies |
| Computed Tomography Thorax Lw Dose Lng Ca Scr C- (71271) | $311.35 | $479 | 3.1× |
| Continuing medical physics consltj pr wk (77336) | $315.25 | $485 | 2.5× |
| Contrast Exam Abdominl Aorta (75625) | $4,434.95 | $6,823 | 1.5× |
| Contrast X-Ray Bladder (74430) | $518.05 | $797 | 1.6× |
| Contrast X-Ray Of Elbow (73085) range across 2 matching MRF lines |
$1,151.80–$2,303.60 | $1,772–$3,544 | varies |
| Contrast X-Ray Of Knee Joint (73580) range across 2 matching MRF lines |
$1,266.85–$2,533.05 | $1,949–$3,897 | varies |
| Corpora cavernosography (74445) | $1,034.80 | $1,592 | 10.5× |
| CT abdomen and pelvis without and with contrast (74178) | $2,555.80 | $3,932 | 7.7× |
| CT abdomen and pelvis without contrast (74176) | $1,649.70 | $2,538 | 7.3× |
| CT abdomen w contrast (74160) | $1,858.35 | $2,859 | 11.2× |
| CT abdomen w wo contrast (74170) | $2,126.15 | $3,271 | 12.8× |
| CT abdomen w/o contrast (74150) | $1,589.90 | $2,446 | 16.1× |
| CT Angio Abdomen and Pelvis (74174) | $2,026.05 | $3,117 | 6.1× |
| CT Angio Chest (71275) | $2,529.15 | $3,891 | 15.2× |
| CT Angio Head (70496) | $1,474.20 | $2,268 | 8.9× |
| CT angio hrt w/3d image (75574) | $2,301.65 | $3,541 | 7.0× |
| Ct Angio Lwr Extr W/O&W/Dye (73706) range across 2 matching MRF lines |
$1,603.55–$3,207.10 | $2,467–$4,934 | varies |
| CT Angio Neck (70498) | $1,708.85 | $2,629 | 10.3× |
| Ct Angio Upr Extrm W/O&W/Dye (73206) | $1,697.80 | $2,612 | 10.2× |
| CT cervical spine w/ contrast (72126) | $1,471.60 | $2,264 | 4.5× |
| CT cervical spine w/o contrast (72125) | $1,337.70 | $2,058 | 13.5× |
| CT cervical spine w/wo cont (72127) | $1,618.50 | $2,490 | 9.8× |
| CT chest w contrast (71260) | $2,178.80 | $3,352 | 13.1× |
| CT chest w/wo contrast (71270) | $2,529.15 | $3,891 | 15.2× |
| CT colonography screening (74263) | $709.80 | $1,092 | 3.1× |
| CT colonogrphy dx image postprocess w/o contrast (74261) | $1,122.55 | $1,727 | 11.3× |
| CT head/brain with contrast (70460) | $1,264.25 | $1,945 | 7.6× |
| CT head/brain without and with contrast (70470) | $1,474.20 | $2,268 | 8.9× |
| CT heart contrast eval cardiac structure&morph (75572) | $865.80 | $1,332 | 2.6× |
| CT heart no contrast quant eval coronry calcium (75571) | $112.45 | $173 | 1.4× |
| CT hrt w/3d image congen (75573) | $897 | $1,380 | 2.7× |
| CT iac w contrast (70481) | $1,489.15 | $2,291 | 9.0× |
| CT l-spine w&w/o contrast (72133) | $2,297.75 | $3,535 | 13.8× |
| CT lower ext w/o (73700) range across 2 matching MRF lines |
$1,390.35–$2,780.70 | $2,139–$4,278 | varies |
| CT lower extremity w/contrast material (73701) range across 2 matching MRF lines |
$1,483.30–$2,966.60 | $2,282–$4,564 | varies |
| CT lumbar spine w contrast (72132) | $1,896.70 | $2,918 | 5.7× |
| CT lumbar spine w/o contrast (72131) | $1,666.60 | $2,564 | 16.8× |
| CT maxillofacial w contrast (70487) | $1,550.90 | $2,386 | 9.3× |
| CT maxillofacial wo contrast (70486) | $1,409.85 | $2,169 | 14.3× |
| CT neck tissue combo (70492) | $1,672.45 | $2,573 | 10.1× |
| Ct Orbit/Ear/Fossa W/O&W/Dye (70482) | $1,599 | $2,460 | 9.6× |
| CT orbits w/o contrast (70480) | $1,379.95 | $2,123 | 14.0× |
| CT pelvis w&w/o contrast (72194) | $1,932.45 | $2,973 | 11.6× |
| CT pelvis w/o contrast (72192) | $1,384.50 | $2,130 | 14.0× |
| CT scan of leg combo (73702) range across 2 matching MRF lines |
$1,743.95–$3,487.90 | $2,683–$5,366 | varies |
| CT scans face/jaw combo (70488) | $1,706.25 | $2,625 | 10.3× |
| CT soft tissue neck w contrast (70491) | $1,472.90 | $2,266 | 8.9× |
| CT soft tissue neck w/o contrast (70490) | $1,273.35 | $1,959 | 12.9× |
| CT thoracic spine w contrast (72129) | $1,786.20 | $2,748 | 10.8× |
| CT thoracic spine w/o contrast (72128) | $1,718.60 | $2,644 | 17.4× |
| CT thoracic spine w/wo cont (72130) | $2,236 | $3,440 | 13.5× |
| CT thorax w/o contrast (71250) | $1,640.60 | $2,524 | 16.6× |
| CT unlisted procedure (76497) | $1,645.80 | $2,532 | 20.0× |
| CT upper ext wo (73200) range across 2 matching MRF lines |
$1,344.85–$2,689.70 | $2,069–$4,138 | varies |
| CT upper extremity w/o & w/contrast material (73202) range across 2 matching MRF lines |
$1,627.60–$3,255.20 | $2,504–$5,008 | varies |
| CT upper extremity with contrast (73201) range across 2 matching MRF lines |
$1,479.40–$2,958.80 | $2,276–$4,552 | varies |
| Cta Abdl Aorta&Bi Iliofem W/Contrast&Postp (75635) | $1,647.10 | $2,534 | 9.9× |
| Cta Abdomen (74175) | $1,567.15 | $2,411 | 9.4× |
| CTA pelvis (72191) | $1,977.30 | $3,042 | 11.9× |
| Dilation ureters/urethra rs&i (74485) | $2,289.30 | $3,522 | 1.2× |
| Discography Cerv/Thor Spine (72285) | $3,316.30 | $5,102 | 1.8× |
| Diskography lumbar (72295) | $3,316.30 | $5,102 | 1.8× |
| Dxa Bone Density Axial (77080) | $429.65 | $661 | 4.3× |
| Dxa bone density study (77085) | $530.40 | $816 | 5.4× |
| Dxa bone density study 1/>sites appendiclr skel (77081) | $369.20 | $568 | 4.5× |
| Echo Guide For Artery Repair (76936) | $1,056.90 | $1,626 | 5.2× |
| Esophagram (74220) | $546 | $840 | 3.3× |
| Fetal Biophys Profile W/Nst (76818) | $918.45 | $1,413 | 9.3× |
| Fetal Biophysical Profile W/O Non-Stress Testing (76819) | $670.80 | $1,032 | 6.8× |
| Fluoroscopy up to 1 hr (76000) | $396.50 | $610 | 1.8× |
| Follow-Up Angiography (75898) | $1,655.55 | $2,547 | 0.6× |
| Foot 2 views (73620) range across 2 matching MRF lines |
$226.85–$453.70 | $349–$698 | varies |
| Forearm 2 views (73090) range across 2 matching MRF lines |
$277.55–$554.45 | $427–$853 | varies |
| Gastric emptying imaging study (78264) | $1,166.10 | $1,794 | 3.1× |
| Gastric Emptyng Imag Std W/Sm Bwl Transit (78265) | $1,849.25 | $2,845 | 4.9× |
| Gated Heart Planar Single (78472) | $1,327.95 | $2,043 | 3.5× |
| Gated Heart, Multiple (78473) | $1,511.25 | $2,325 | 4.0× |
| Gstrc Emptng Imag Std W/Sm Bwl Col Trnst Mlt Day (78266) | $1,849.25 | $2,845 | 3.6× |
| Hand 2 views (73120) range across 2 matching MRF lines |
$274.95–$550.55 | $423–$847 | varies |
| Hdr Rdncl Ntrstl/Icav Brchtx (77772) | $3,164.85 | $4,869 | 4.8× |
| Hdr Rdncl Ntrstl/Icav Brchtx (77771) | $3,164.85 | $4,869 | 4.8× |
| Hdr Rdncl Ntrstl/Icav Brchtx 1 Channel (77770) | $3,164.85 | $4,869 | 4.8× |
| Heart first pass single,planar (78481) | $1,119.95 | $1,723 | 2.2× |
| Hepatc Vngrph Wdg/Fr Hemodyn Eval Rs&I (75889) | $3,080.35 | $4,739 | 1.0× |
| Hepatc Vngrph Wdg/Fr W/O Hemodyn Eval Rs&I (75891) | $3,080.35 | $4,739 | 1.0× |
| Hepatobil Syst Image W/Drug (78227) | $1,164.15 | $1,791 | 2.3× |
| Hepatobiliary System Imaging (78226) | $786.50 | $1,210 | 2.1× |
| Ht Musc Image Planar Mult (78454) | $1,896.70 | $2,918 | 1.5× |
| Ht Muscle Image Spect Sing (78451) | $1,795.95 | $2,763 | 1.5× |
| Hyperthermia, externally generated; deep (ie, heating to depths greater than 4 cm) Non-Facility (77605) | $3,357.90 | $5,166 | 5.1× |
| Hysterosalpingogram (74740) | $412.10 | $634 | 1.8× |
| Interstitial radiation source applic complex (77778) | $2,034.50 | $3,130 | 3.1× |
| Joint Survey Single View (77077) | $230.75 | $355 | 2.3× |
| K Flow/Funct Image Multiple (78709) | $1,025.70 | $1,578 | 2.0× |
| K Flow/Funct Image W/Drug (78708) | $843.70 | $1,298 | 1.6× |
| K Flow/Funct Image W/O Drug (78707) | $767 | $1,180 | 1.5× |
| Kidney Imaging Morphol (78700) | $650.65 | $1,001 | 1.7× |
| Kidney Imaging Morphoogy W/Vascular Flow (78701) | $690.30 | $1,062 | 1.8× |
| Knee 3 Views (73562) range across 2 matching MRF lines |
$388.70–$777.40 | $598–$1,196 | varies |
| Labeled RBC Sequestration Differntl Organ/Tissue (78140) | $620.10 | $954 | 1.6× |
| Leveen/Shunt Patency Exam (78291) | $637 | $980 | 1.7× |
| Liver & Spleen Imaging Static Only (78215) | $655.20 | $1,008 | 1.7× |
| Liver imaging static only (78201) | $986.70 | $1,518 | 1.9× |
| Liver imaging w/vascular flow (78202) | $1,134.90 | $1,746 | 2.2× |
| Lung perfusion differential (78597) | $651.30 | $1,002 | 1.7× |
| Lung Ventilat&Perfus Imaging (78582) | $841.75 | $1,295 | 1.6× |
| Lung Ventilation Imaging (78579) | $579.80 | $892 | 1.5× |
| Lymph System Imaging (78195) | $937.30 | $1,442 | 1.8× |
| Lymphangiography Extremity Only Bilateral Rs&I (75803) | $1,814.15 | $2,791 | 1.2× |
| Lymphangiography extremity only unilateral rs&i (75801) | $753.35 | $1,159 | 1.3× |
| Lymphangiography Pelvic/Abdominal Bilateral Rs&I (75807) | $3,080.35 | $4,739 | 1.0× |
| Lymphangiography, pelvic/abdominal, unilateral (75805) | $2,107.95 | $3,243 | 0.7× |
| Magnetic Image Jaw Joint (70336) range across 2 matching MRF lines |
$1,720.55–$3,441.10 | $2,647–$5,294 | varies |
| Mammary ductogram or galactogram multiple (77054) | $712.40 | $1,096 | 3.2× |
| Mammary ductogram or galactogram single (77053) | $527.15 | $811 | 2.3× |
| Meckels Divert Exam (78290) | $478.40 | $736 | 1.3× |
| Medical physics dose eval radiation expos w/rprt (76145) | $1,328.60 | $2,044 | 3.8× |
| Mlc imrt design & construction per imrt plan (77338) | $714.35 | $1,099 | 2.0× |
| Mr safety determination physician/other qhp (76016) | $172.25 | $265 | 2.1× |
| Mr safety implant&/fb assmt clin staf 1st 15 min (76014) | $48.75 | $75 | 1.8× |
| Mr safety implt electronics prepj supvj phys/qhp (76018) | $178.75 | $275 | 2.0× |
| Mr safety implt pos&/immoblj (76019) | $117 | $180 | 2.1× |
| Mra Head W/O & W/Contrast Material (70546) | $2,851.55 | $4,387 | 8.6× |
| MRA head w/o contrast (70544) | $2,356.90 | $3,626 | 10.4× |
| MRA head with contrast (70545) | $2,592.20 | $3,988 | 7.9× |
| MRA neck w contrast (70548) | $2,003.30 | $3,082 | 6.1× |
| Mra Neck W/O &W/Contrast Material (70549) | $2,330.25 | $3,585 | 7.1× |
| MRA neck w/o contrast (70547) | $1,675.70 | $2,578 | 7.4× |
| MRI abdomen w contrast (74182) | $2,787.85 | $4,289 | 8.4× |
| MRI abdomen w/o contrast (74181) | $2,214.55 | $3,407 | 9.8× |
| MRI any jt lower extrem w/contrast material (73722) range across 2 matching MRF lines |
$2,483–$4,966 | $3,820–$7,640 | varies |
| MRI any jt lower extrem w/o & w/contrast matrl (73723) range across 2 matching MRF lines |
$2,979.60–$5,960.50 | $4,584–$9,170 | varies |
| MRI any jt upper extremity w/contrast matrl (73222) range across 2 matching MRF lines |
$2,379–$4,758 | $3,660–$7,320 | varies |
| MRI bone marrow blood supply (77084) | $1,421.55 | $2,187 | 6.3× |
| MRI Breast W/O Contrast Bilateral (77047) | $3,155.75 | $4,855 | 14.0× |
| MRI Breast Without Contrast Material Unilateral (77046) | $2,832.05 | $4,357 | 12.5× |
| MRI cervical spine w contrast (72142) | $2,842.45 | $4,373 | 8.6× |
| MRI cervical spine w/o cont (72141) | $2,707.25 | $4,165 | 12.0× |
| MRI chest w/o contrast (71550) | $1,925.30 | $2,962 | 8.5× |
| MRI chest with contrast (71551) | $2,519.40 | $3,876 | 3.4× |
| MRI chest wo w contrast (71552) | $3,112.85 | $4,789 | 9.4× |
| MRI lower extrem oth/thn jt w/contrast matrl (73719) range across 2 matching MRF lines |
$2,624.05–$5,248.10 | $4,037–$8,074 | varies |
| MRI lower extrem oth/thn jt w/o & w/contr matr (73720) range across 2 matching MRF lines |
$2,965.95–$5,931.90 | $4,563–$9,126 | varies |
| MRI lower extrem oth/thn jt w/o contr matrl (73718) range across 2 matching MRF lines |
$2,281.50–$4,563 | $3,510–$7,020 | varies |
| MRI lumbar spine w contrast (72149) | $2,970.50 | $4,570 | 9.0× |
| Mri Neck Spine W/O & W/Dye (72156) | $2,977.65 | $4,581 | 9.0× |
| MRI orbit face &/neck w/o contrast (70540) | $2,406.95 | $3,703 | 10.7× |
| MRI orbit face neck w contrast (70542) | $2,676.05 | $4,117 | 8.1× |
| Mri Orbt/Fac/Nck W/O &W/Dye (70543) | $2,945.15 | $4,531 | 8.9× |
| MRI pelvis w contrast (72196) | $2,128.10 | $3,274 | 6.4× |
| MRI pelvis w/o & w contrast (72197) | $2,561.65 | $3,941 | 7.8× |
| MRI pelvis w/o contrast (72195) | $1,694.55 | $2,607 | 7.5× |
| MRI spectroscopy (76390) | $2,065.05 | $3,177 | 25.1× |
| MRI thoracic spine w/o contrast (72146) | $2,761.20 | $4,248 | 12.2× |
| MRI upper extremity oth than jt w/contr matrl (73219) range across 2 matching MRF lines |
$2,330.90–$4,661.80 | $3,586–$7,172 | varies |
| MRI upper extremity oth than jt w/o contr matrl (73218) range across 2 matching MRF lines |
$2,026.70–$4,053.40 | $3,118–$6,236 | varies |
| Mri Uppr Extremity W/O&W/Dye (73220) range across 2 matching MRF lines |
$2,634.45–$5,268.90 | $4,053–$8,106 | varies |
| MRI, abdomen, combo (74183) | $3,360.50 | $5,170 | 10.2× |
| MRI, dorsal spine combo (72157) | $3,036.80 | $4,672 | 9.2× |
| MRI, dorsal spine contrast (72147) | $2,899 | $4,460 | 8.8× |
| MRI, joint upper extrem (73221) range across 2 matching MRF lines |
$2,162.55–$4,325.10 | $3,327–$6,654 | varies |
| MRI, joint upper extrem combo (73223) range across 2 matching MRF lines |
$2,616.90–$5,233.80 | $4,026–$8,052 | varies |
| MRI, lumbar spine combo (72158) | $3,138.85 | $4,829 | 9.5× |
| Myelogram cervical (72240) | $851.50 | $1,310 | 1.1× |
| Myelogram Lumbar (72265) | $1,030.25 | $1,585 | 1.4× |
| Myelography thoracic (72255) | $936 | $1,440 | 1.3× |
| Myelograpy 2/more regions rs&i (72270) | $1,091.35 | $1,679 | 1.5× |
| Myocardial Imaging Infarct Avid Planar Qual/Quan (78466) | $1,463.80 | $2,252 | 3.9× |
| Myocardial imaging, infarct avid, planar; with ejection fraction by first pass technique Non-Facility (78468) | $1,463.80 | $2,252 | 2.8× |
| Myocardial Perfusion Planar 1 Study Rest/Stress (78453) | $1,186.90 | $1,826 | 1.0× |
| Myocardial Spect Multiple Studies (78452) | $2,878.20 | $4,428 | 2.3× |
| Myocrd Img Pet Metab Eval Single Study Cncrnt CT (78429) | $1,629.55 | $2,507 | 1.2× |
| Myocrd img PET prfuj 1std rest/stress cncrnt CT (78430) | $5,218.85 | $8,029 | 3.9× |
| Myocrd Img Pet Prfuj Mlt Std Rst&Strs Cncrnt CT (78431) | $5,218.85 | $8,029 | 2.5× |
| Myocrd Img Pet Prfuj W/Metab 2rtracer Cncrnt CT (78433) | $5,088.85 | $7,829 | 2.4× |
| N-invas est c ffr sw aly CTA (75580) | $2,446.60 | $3,764 | 3.0× |
| Neck soft tissue (70360) | $323.70 | $498 | 3.9× |
| Njx Rp Loclzj Non-Img Probe Study Intravenous (78808) | $451.75 | $695 | 1.2× |
| Nm csf leak detection (78650) | $1,940.90 | $2,986 | 1.6× |
| Nm myocard infarct spect (78469) | $1,463.80 | $2,252 | 2.8× |
| Nonvascular Shunt X-Ray (75809) | $503.75 | $775 | 5.1× |
| Ntsty modul radthx pln dose-vol histos (77301) | $2,585.70 | $3,978 | 2.0× |
| Nuclear Rx Intra-Arterial (79445) | $1,027.65 | $1,581 | 4.7× |
| Nuclear Rx Oral Admin (79005) | $1,273.35 | $1,959 | 5.8× |
| Optic foramina (70190) range across 2 matching MRF lines |
$263.90–$527.80 | $406–$812 | varies |
| Panoramic X-ray of jaws (70355) | $176.15 | $271 | 2.1× |
| Parathyroid imaging w/tomographic spect & CT (78072) | $975.65 | $1,501 | 1.9× |
| Parathyroid Planar Imaging (78070) | $430.30 | $662 | 1.1× |
| Parathyroid planar imaging w/wo subtraction (78071) | $848.25 | $1,305 | 2.2× |
| Pelvis 1 or 2 views (72170) | $236.60 | $364 | 2.4× |
| Perineogram (74775) | $577.85 | $889 | 2.6× |
| Peritoneogram Rs&I (74190) | $776.75 | $1,195 | 1.5× |
| Pet Image W/Ct Lmtd (78814) | $4,610.45 | $7,093 | 3.4× |
| PET image w/CT, full body (78816) | $5,245.50 | $8,070 | 3.9× |
| PET imaging CT attenuation skull base mid-thigh (78815) | $4,927.65 | $7,581 | 3.6× |
| Prq Transhepatc Portograpy Hemodyn Eval Rs&I (75885) | $3,080.35 | $4,739 | 1.0× |
| Pulmonary Perfusion Imaging Particulate (78580) | $624 | $960 | 1.6× |
| Radex Abd Compl Aqt Abd W/S/E/D Views 1 View Ch (74022) | $486.85 | $749 | 4.9× |
| Radex abscess/fistula/sinus tract rs&i (76080) | $525.85 | $809 | 1.0× |
| Radex Ankle Complete Minimum 3 Views (73610) range across 2 matching MRF lines |
$308.75–$617.50 | $475–$950 | varies |
| Radex Calcaneus Minimum 2 Views (73650) range across 2 matching MRF lines |
$271.05–$542.10 | $417–$834 | varies |
| Radex elbow complete minimum 3 views (73080) range across 2 matching MRF lines |
$287.95–$575.25 | $443–$885 | varies |
| Radex Facial Bones Complete Minimum 3 Views (70150) | $417.95 | $643 | 4.2× |
| Radex fingr minimum 2 views (73140) range across 2 matching MRF lines |
$233.35–$466.05 | $359–$717 | varies |
| Radex foot complete minimum 3 views (73630) range across 2 matching MRF lines |
$260–$519.35 | $400–$799 | varies |
| Radex Hand Minimum 3 Views (73130) range across 2 matching MRF lines |
$287.95–$575.25 | $443–$885 | varies |
| Radex lower extremity infant minimum 2 views (73592) range across 2 matching MRF lines |
$162.50–$325 | $250–$500 | varies |
| Radex Mastoids Compl Minimum 3 Views PR Side (70130) range across 2 matching MRF lines |
$456.30–$913.25 | $702–$1,405 | varies |
| Radex Nasal Bones Complete Minimum 3 Views (70160) | $309.40 | $476 | 3.8× |
| Radex Ribs Unilateral 2 Views (71100) | $253.50 | $390 | 3.1× |
| Radex shoulder complete minimum 2 views (73030) range across 2 matching MRF lines |
$311.35–$623.35 | $479–$959 | varies |
| Radex Sinuses Paransl < 3 Views (70210) | $243.75 | $375 | 3.0× |
| Radex sm int w/mlt srl imges via enteroclss tube (74251) | $897 | $1,380 | 5.4× |
| Radex Spine 1 View Specify Level (72020) | $273 | $420 | 3.3× |
| Radex Sternum Minimum 2 Views (71120) | $351.65 | $541 | 4.3× |
| Radex Temporomandble Jt Opn & Clsd Mouth Bilat (70330) | $354.90 | $546 | 4.3× |
| Radex Toe Minimum 2 Views (73660) range across 2 matching MRF lines |
$212.55–$425.75 | $327–$655 | varies |
| Radex upper extremity infant minimum 2 views (73092) range across 2 matching MRF lines |
$385.45–$771.55 | $593–$1,187 | varies |
| Radex Wrist Complete Minimum 3 Views (73110) range across 2 matching MRF lines |
$272.35–$544.70 | $419–$838 | varies |
| Radex X-Ray Exam Entire Spi 6/> Vw - Xr Entire Spine 6+ Vw (72084) | $427.05 | $657 | 4.3× |
| Radiation Delivery Stereotactic Cranial Linear (77372) unusually low: confirm this is the full procedure |
$3,019.25 | $4,645 | 0.4× |
| Radiation treatment delivery level 1 (77402) | $270.40 | $416 | 2.8× |
| Radiation treatment delivery level 2 (77407) | $276.90 | $426 | 0.8× |
| Radiation treatment delivery level 3 (77412) | $458.25 | $705 | 0.9× |
| Radiolog exam mandible compl minimum 4 views (70110) | $450.45 | $693 | 4.6× |
| Radiologic Exam Abdomen 3+ Views - Xr Abdomen 3+ Views (74021) | $358.80 | $552 | 3.6× |
| Radiologic exam colon double contrast study (74280) | $928.20 | $1,428 | 5.6× |
| Radiologic exam colon single contrast study (74270) | $618.80 | $952 | 3.7× |
| Radiologic Exam Esophagus Double Contrast Study (74221) | $737.75 | $1,135 | 4.4× |
| Radiologic exam knee complete 4/more views (73564) range across 2 matching MRF lines |
$423.15–$845.65 | $651–$1,301 | varies |
| Radiologic exam pelvis compl minimum 3 views (72190) | $323.05 | $497 | 3.3× |
| Radiologic Exam Small Int Single Contrast Study (74250) | $747.50 | $1,150 | 4.5× |
| Radiologic exam swallow function contrast study (74230) | $652.60 | $1,004 | 3.9× |
| Radiologic exam upr gi trc double contrast study (74246) | $1,001 | $1,540 | 6.0× |
| Radiologic examination femur 1 view (73551) range across 2 matching MRF lines |
$142.35–$284.05 | $219–$437 | varies |
| Radiologic examination femur minimum 2 views (73552) range across 2 matching MRF lines |
$335.40–$670.80 | $516–$1,032 | varies |
| Radiologic examination knee 1/2 views (73560) range across 2 matching MRF lines |
$293.15–$586.95 | $451–$903 | varies |
| Radiologic Examination Osseous Survey Limited (77074) | $302.90 | $466 | 3.1× |
| Radiologic examination tibia & fibula 2 views (73590) range across 2 matching MRF lines |
$293.15–$586.95 | $451–$903 | varies |
| Radiologic examination, internal auditory meati, complete Non-Facility (70134) | $213.85 | $329 | 0.4× |
| Renal Cyst Study (74470) | $637 | $980 | 1.2× |
| Ribs bilateral 3 views (71110) | $337.35 | $519 | 3.4× |
| Rp loclzj tum plnr 1 area single day imaging (78800) | $1,088.75 | $1,675 | 2.9× |
| Rp loclzj tum plnr 2+area 1+d img/1 area img>2+d (78801) | $1,197.30 | $1,842 | 3.2× |
| Rp Loclzj Tum Plnr Whole Body 2+ Days Imaging (78804) | $1,454.70 | $2,238 | 2.8× |
| Rp Loclzj Tum Plnr Whole Body Single Day Imaging (78802) | $1,316.90 | $2,026 | 2.6× |
| Rp Loclzj Tum Spect 1 Area Single Day Imaging (78803) | $1,593.80 | $2,452 | 3.1× |
| Rp loclzj tum spect 2 area/sep acquisj img (78831) | $1,927.90 | $2,966 | 1.6× |
| Rp loclzj tum spect CT 2area 1d img/1 ar img>2+d (78832) | $2,121.60 | $3,264 | 1.6× |
| Rp loclzj tum spect w/CT 1 area/acquisj 1day img (78830) | $1,753.70 | $2,698 | 1.4× |
| Rp Ther Radiolbld Monoclonal Antibody IV Infus (79403) | $2,065.70 | $3,178 | 9.4× |
| Rp Therapy Intravenous Administration (79101) | $1,268.15 | $1,951 | 5.7× |
| Salivary Gland Imaging (78230) | $1,476.80 | $2,272 | 3.9× |
| Scapula (73010) range across 2 matching MRF lines |
$290.55–$581.10 | $447–$894 | varies |
| Screening Digital Breast Tomosynthesis Bi (77063) | $61.75 | $95 | 2.6× |
| Sella turcica (70240) | $190.45 | $293 | 2.3× |
| Shoulder 1 view (73020) range across 2 matching MRF lines |
$206.05–$411.45 | $317–$633 | varies |
| Shoulder Arthrography (73040) range across 2 matching MRF lines |
$1,363.05–$2,726.10 | $2,097–$4,194 | varies |
| Sialogram (70390) | $499.20 | $768 | 2.2× |
| Skull less than 4 views (70250) | $261.95 | $403 | 2.6× |
| Special dosimetry (77331) | $290.55 | $447 | 2.3× |
| Special Physics Consult (77370) | $290.55 | $447 | 2.3× |
| Special teletherapy port plan (77321) | $714.35 | $1,099 | 2.0× |
| Special treatment procedure (77470) | $1,038.05 | $1,597 | 2.0× |
| Stereotactic Body Radiation Delivery (77373) | $2,135.25 | $3,285 | 1.3× |
| Sternoclavicular joints (71130) | $232.05 | $357 | 2.8× |
| Superior sagittal sinus venogram (75870) | $2,307.50 | $3,550 | 0.8× |
| Telethx isodose pln cplx w/basic dosimetry (77307) | $626.60 | $964 | 1.8× |
| Telethx isodose pln smpl w/dosimetry calculation (77306) | $349.70 | $538 | 1.0× |
| Testicular Imaging W/Flow (78761) | $588.25 | $905 | 1.6× |
| Ther Rad Simulaj-Aided Field Setting Complex (77290) | $1,435.20 | $2,208 | 4.1× |
| Ther Rad Simulaj-Aided Field Setting Intermed (77285) | $603.20 | $928 | 1.7× |
| Ther rad simulaj-aided field setting simple (77280) | $356.20 | $548 | 2.8× |
| Therapeutic Enema Rdctj Intussusception/Obstrcj (74283) | $741.65 | $1,141 | 4.5× |
| Thoracic spine 2 views (72070) | $302.25 | $465 | 3.1× |
| Thoracic spine 3 views (72072) | $419.90 | $646 | 4.2× |
| Thoracolumbar 2 views (72080) | $289.25 | $445 | 3.5× |
| Thyroid Imaging With Vascular Flow (78013) | $603.20 | $928 | 1.6× |
| Thyroid Met Imaging Body (78018) | $860.60 | $1,324 | 1.7× |
| Thyroid Uptake Measurement (78012) | $517.40 | $796 | 1.4× |
| Thyroid Uptake W/Blood Flow Sngle/Mult Quan Meas (78014) | $688.35 | $1,059 | 1.8× |
| Tx Devices Design & Construction Complex (77334) | $758.55 | $1,167 | 2.1× |
| Tx devices design & construction intermediate (77333) | $517.40 | $796 | 4.1× |
| Tx devices design & construction simple (77332) | $332.15 | $511 | 2.6× |
| Ultrasound Breast Limited (76642) range across 2 matching MRF lines |
$445.25–$890.50 | $685–$1,370 | varies |
| Ultrasound Elastography Parenchyma (76981) | $330.20 | $508 | 3.3× |
| Ultrasound Exam Aaa Screen (76706) | $518.05 | $797 | 5.2× |
| Ultrasound, abdomen limited (76705) | $709.15 | $1,091 | 7.2× |
| Unlisted fluoroscopic procedure (76496) | $247.65 | $381 | 3.0× |
| Unlisted magnetic resonance procedure (76498) | $273.65 | $421 | 3.3× |
| Unlisted Procedure Clinical Brachytherapy (77799) | $670.15 | $1,031 | 6.9× |
| Unlisted us procedure (76999) | $480.35 | $739 | 5.8× |
| Upper gi w/o kub (74240) | $934.70 | $1,438 | 5.6× |
| Ureteral Reflux Study (78740) | $1,962.35 | $3,019 | 5.2× |
| Urethrocystogram voiding (74455) | $737.10 | $1,134 | 3.3× |
| Urethrocystography retrograde (74450) | $932.10 | $1,434 | 4.1× |
| Us breast unilateral complete (76641) range across 5 matching MRF lines |
$172.90–$1,056.25 | $266–$1,625 | varies |
| Us chest (76604) | $581.10 | $894 | 5.9× |
| Us complete joint (76881) | $771.55 | $1,187 | 7.8× |
| Us exam, pelvic, limited (76857) | $549.25 | $845 | 5.6× |
| Us head (76506) | $542.10 | $834 | 5.5× |
| Us lmtd joint/oth nonvasc xtr strux r-t w/img (76882) | $567.45 | $873 | 5.7× |
| Us ob detailed single fetus (76811) | $847.60 | $1,304 | 3.8× |
| Us ob limited 1 or more fetuses (76815) | $655.85 | $1,009 | 6.6× |
| Us ob transvaginal (76817) | $656.50 | $1,010 | 6.6× |
| Us pelvic non ob complete (76856) | $736.45 | $1,133 | 7.4× |
| Us pg uter img f&mat 14 wk tabdl 1/1st gestation (76801) | $664.30 | $1,022 | 6.7× |
| Us preg uterus real time f/u trnsabdl per fetus (76816) | $638.30 | $982 | 6.5× |
| Us retroperitoneal complete (76770) | $834.60 | $1,284 | 8.4× |
| Us retroperitoneal limited (76775) | $750.10 | $1,154 | 7.6× |
| Us scrotum and contents (76870) | $834.60 | $1,284 | 8.4× |
| Us spinal canal and contents (76800) | $625.30 | $962 | 6.3× |
| Us thyroid (76536) | $746.85 | $1,149 | 7.6× |
| Us transrectal (76872) | $719.55 | $1,107 | 7.3× |
| Vascular Flow Imaging (78445) | $666.90 | $1,026 | 1.8× |
| Vein X-Ray Chest (75827) | $1,320.15 | $2,031 | 0.9× |
| Vein X-Ray Liver W/O Hemodyn (75887) | $3,080.35 | $4,739 | 1.0× |
| Vein X-Ray Skull Epidural (75872) | $1,314.30 | $2,022 | 2.2× |
| Vein X-Ray Spleen/Liver (75810) | $2,990.65 | $4,601 | 1.0× |
| Venogram Sinus/Jugular (75860) | $3,420.30 | $5,262 | 1.1× |
| Venography Adrenal Unilateral (75840) | $1,112.15 | $1,711 | 0.4× |
| Venography caval inferior serialography rs&i (75825) | $2,656.55 | $4,087 | 0.9× |
| Venography extremity bilateral rs&i (75822) | $1,673.75 | $2,575 | 1.1× |
| Venography extremity unilateral rs&i (75820) | $1,285.70 | $1,978 | 0.9× |
| Venography Renal Bilateral (75833) | $3,408.60 | $5,244 | 1.1× |
| Venography Renal Unilateral (75831) | $3,080.35 | $4,739 | 1.0× |
| Venous sampling by catheter (75893) | $4,539.60 | $6,984 | 0.9× |
| Venous Thrombosis Imaging Venogram Bilateral (78458) | $1,049.10 | $1,614 | 2.8× |
| Vertebral fracture assessment via dxa (77086) | $169 | $260 | 2.1× |
| Wrist 2 views (73100) range across 2 matching MRF lines |
$230.75–$462.15 | $355–$711 | varies |
| X-Ray Ac Jts - Xr Acromioclavicular Joints Bilateral (73050) | $301.60 | $464 | 3.7× |
| X-ray antegrade pyelogram tube (74425) | $561.60 | $864 | 1.7× |
| X-Ray Aorta Leg Arteries (75630) | $4,978.35 | $7,659 | 1.7× |
| X-Ray Bend Only L-S Spine (72120) | $373.75 | $575 | 3.8× |
| X-Ray Elbow 2 Vw - Xr Elbow 1-2 Views Right (73070) range across 2 matching MRF lines |
$269.10–$537.55 | $414–$827 | varies |
| X-Ray Exam Breast Specimen (76098) | $668.20 | $1,028 | 1.3× |
| X-Ray Exam Entire Spi 1 Vw (72081) | $293.80 | $452 | 3.6× |
| X-Ray Exam Entire Spi 2/3 Vw (72082) | $352.95 | $543 | 3.6× |
| X-Ray Exam Entire Spi 4/5 Vw (72083) | $388.05 | $597 | 3.9× |
| X-Ray Exam Hip Uni 1 View (73501) | $221.65 | $341 | 2.7× |
| X-Ray Exam Hip Uni 2-3 Views (73502) | $273.65 | $421 | 3.3× |
| X-Ray Exam Hip Uni 4/> Views (73503) | $391.30 | $602 | 4.0× |
| X-Ray Exam Hips Bi 2 Views (73521) | $230.10 | $354 | 2.3× |
| X-Ray Exam Hips Bi 3-4 Views (73522) | $337.35 | $519 | 3.4× |
| X-Ray Exam Hips Bi 5/> Views (73523) | $447.20 | $688 | 4.5× |
| X-Ray Exam L-S Spine Bending (72114) | $570.05 | $877 | 5.8× |
| X-Ray Exam Neck Spine 2-3 Vw (72040) | $324.35 | $499 | 3.9× |
| X-Ray Exam Neck Spine 6/>Vws (72052) | $487.50 | $750 | 4.9× |
| X-Ray Exam Unilat Ribs/Chest (71101) | $292.50 | $450 | 3.0× |
| X-ray eye for foreign body (70030) range across 2 matching MRF lines |
$180.05–$360.10 | $277–$554 | varies |
| X-ray humerus (73060) | $305.50 | $470 | 3.7× |
| X-ray IV pyelogram (ivp) (74400) | $929.50 | $1,430 | 5.6× |
| X-Ray Jaw <4 Vw - Xr Mandible < 4 Views (70100) | $176.15 | $271 | 2.1× |
| X-Ray Knee Bilat Standing - Xr Knees Anteroposterior Standing Bilat (73565) | $224.25 | $345 | 2.7× |
| X-Ray Lumbar Spine 2/3 Vw - Xr Lumbar Spine 2-3 Views (72100) | $317.85 | $489 | 3.2× |
| X-ray nose-rectum child f.b. (76010) | $326.95 | $503 | 4.0× |
| X-Ray Ribs, Chest 4+ Vw - Xr Ribs 3 Vws Bil W/ Chest Posteroanterior (71111) | $375.05 | $577 | 3.8× |
| X-Ray Sacroiliac Jts 3+ Vw - Xr Sacroiliac Joints 3+ Views (72202) | $313.95 | $483 | 3.2× |
| X-Ray Sacroiliac Jts <3 Vw - Xr Sacroiliac Joints 1-2 Views (72200) | $186.55 | $287 | 1.9× |
| X-Ray Sacrum/Coccyx 2+ Vw - Xr Sacrum Coccyx 2+ Views (72220) | $332.80 | $512 | 4.0× |
| X-Ray Sinuses 3+ Vw - Xr Paranasal Sinuses 3+ Views (70220) | $409.50 | $630 | 5.0× |
| X-Ray Skull 4+ Vw - Xr Skull Complete 4+ Views (70260) | $399.10 | $614 | 4.0× |
| X-Ray Stress View (77071) | $168.35 | $259 | 2.0× |
| X-ray thoracic spine 4 vw (72074) | $500.50 | $770 | 5.1× |
| X-Ray Tmj Unilat (70328) | $157.95 | $243 | 1.9× |
| X-Ray Urinary Tract Exam With Contrast Material (74420) | $716.95 | $1,103 | 2.2× |
| X-Rays Bone Length Studies (77073) | $305.50 | $470 | 3.1× |
| X-Rays Bone Survey Complete (77075) | $545.35 | $839 | 5.5× |
| Xr c-spine 4 or 5 views (72050) | $432.25 | $665 | 4.4× |
| Xr facial bones less than 3 views (70140) | $203.45 | $313 | 2.5× |
| Xr orbits complete 4 views (70200) | $364 | $560 | 3.7× |
| Xr Tomogram Single Plane (76100) | $513.50 | $790 | 5.2× |
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.