Imaging prices at SSM Health Monroe Hospital
Monroe, WI · every code in this section with a posted price and a Medicare benchmark.
333 codes. Prices are the hospital's own posted facility charges.
Compare against other hospitals interactively →
| Procedure | Posted cash | Posted gross | × Medicare |
|---|---|---|---|
| Abdomen 1 View (74018) | $122.10 | $222 | 1.4× |
| Abdomen 2 views (74019) | $140.80 | $256 | 1.4× |
| Acute Gastrointestinal Blood Loss Imaging (78278) | $1,432.75 | $2,605 | 3.7× |
| Angio internal mammary (75756) | $2,082.85 | $3,787 | 0.7× |
| Angio pulmonary bilat (75743) | $3,388.55 | $6,161 | 1.1× |
| Angiography extremity bilateral rs&i (75716) | $2,691.15 | $4,893 | 0.9× |
| Angiography extremity unilateral rs&i (75710) | $1,102.20 | $2,004 | 0.4× |
| Angiography pulmonary unilateral slctv rs&i (75741) | $1,694 | $3,080 | 0.6× |
| Angrph pulmonary nonslctv cath/ven njx rs&i (75746) | $2,200 | $4,000 | 0.7× |
| Ankle 2 views (73600) | $234.85 | $427 | 2.8× |
| Aortography thoracic serialography rs&i (75605) unusually low: confirm this is the full procedure |
$1,665.40 | $3,028 | 0.3× |
| Artery X-Rays Abdomen (75726) | $9,303.80 | $16,916 | 1.7× |
| Artery X-Rays Pelvis (75736) likely a partial charge, not the full procedure |
$1,350.25 | $2,455 | 0.2× |
| Artery X-Rays Spine (75705) unusually low: confirm this is the full procedure |
$2,158.75 | $3,925 | 0.4× |
| Arthrogram ankle (73615) | $796.95 | $1,449 | 2.4× |
| Arthrogram hip (73525) | $612.15 | $1,113 | 1.8× |
| Arthrogram Wrist (73115) | $514.80 | $936 | 1.5× |
| Bone age studies (77072) | $166.10 | $302 | 1.6× |
| Bone Imaging 3 Phase (78315) | $1,261.15 | $2,293 | 3.2× |
| Bone Imaging Limited Area (78300) | $471.90 | $858 | 1.2× |
| Bone Imaging Multiple Areas (78305) | $635.80 | $1,156 | 1.6× |
| Bone Imaging Whole Body (78306) | $1,189.10 | $2,162 | 3.1× |
| Bone survey infant (77076) | $320.65 | $583 | 3.2× |
| Brain Imaging Pet Metabolic Evaluation (78608) | $4,789.40 | $8,708 | 3.4× |
| Cardiac MRI w/w/o contrast & further seq (75561) | $2,591.60 | $4,712 | 7.6× |
| Cat Scan Follow-Up Study (76380) | $394.90 | $718 | 4.7× |
| Cerebrospinal Fluid Flow W/O Matl Shunt Evaltj (78645) | $1,563.65 | $2,843 | 3.0× |
| Cerebrospinal Fluid Scan (78630) | $1,658.25 | $3,015 | 3.1× |
| Chest 1 view (71045) | $75.90 | $138 | 0.9× |
| Chest 2 views (71046) range across 2 matching MRF lines |
$77.55–$106.70 | $141–$194 | varies |
| Chest 3 views (71047) | $130.90 | $238 | 1.5× |
| Chest 4 or more views (71048) | $520.30 | $946 | 5.1× |
| Cineradiograpy/vidradiograpy xcpt where spec (76120) | $374 | $680 | 3.7× |
| Clavicle complete (73000) | $179.85 | $327 | 2.1× |
| Computed Tomography Thorax Lw Dose Lng Ca Scr C- (71271) | $244.20 | $444 | 2.4× |
| Continuing medical physics consltj pr wk (77336) | $350.35 | $637 | 2.7× |
| Contrast Exam Abdominl Aorta (75625) | $2,781.35 | $5,057 | 0.9× |
| Contrast X-Ray Bladder (74430) | $543.40 | $988 | 1.6× |
| Contrast X-Ray Of Elbow (73085) | $582.45 | $1,059 | 1.7× |
| Contrast X-Ray Of Knee Joint (73580) | $939.95 | $1,709 | 2.8× |
| CT abdomen and pelvis without and with contrast (74178) | $4,869.15 | $8,853 | 14.4× |
| CT abdomen and pelvis without contrast (74176) | $2,693.35 | $4,897 | 11.6× |
| CT abdomen w contrast (74160) | $1,619.20 | $2,944 | 9.5× |
| CT abdomen w wo contrast (74170) | $1,882.10 | $3,422 | 11.0× |
| CT abdomen w/o contrast (74150) | $1,480.05 | $2,691 | 14.6× |
| CT Angio Abdomen and Pelvis (74174) | $2,791.80 | $5,076 | 8.2× |
| CT Angio Chest (71275) | $1,955.80 | $3,556 | 11.5× |
| CT Angio Head (70496) | $1,635.70 | $2,974 | 9.6× |
| CT angio hrt w/3d image (75574) | $1,464.10 | $2,662 | 4.3× |
| Ct Angio Lwr Extr W/O&W/Dye (73706) | $265.65 | $483 | 1.6× |
| CT Angio Neck (70498) | $1,760.55 | $3,201 | 10.3× |
| Ct Angio Upr Extrm W/O&W/Dye (73206) | $2,266 | $4,120 | 13.3× |
| CT cervical spine w/ contrast (72126) | $601.15 | $1,093 | 1.8× |
| CT cervical spine w/o contrast (72125) | $553.30 | $1,006 | 5.4× |
| CT cervical spine w/wo cont (72127) | $2,610.85 | $4,747 | 15.3× |
| CT chest w contrast (71260) | $1,955.80 | $3,556 | 11.5× |
| CT chest w/wo contrast (71270) | $2,300.65 | $4,183 | 13.5× |
| CT colonography screening (74263) | $1,437.70 | $2,614 | 6.2× |
| CT colonogrphy dx image postprocess w/o contrast (74261) | $1,877.70 | $3,414 | 18.5× |
| CT head/brain with contrast (70460) | $1,316.70 | $2,394 | 7.7× |
| CT head/brain without and with contrast (70470) | $1,426.70 | $2,594 | 8.4× |
| CT heart no contrast quant eval coronry calcium (75571) | $55 | $100 | 0.7× |
| CT iac w contrast (70481) | $1,516.35 | $2,757 | 8.9× |
| CT l-spine w&w/o contrast (72133) | $2,919.40 | $5,308 | 17.1× |
| CT lower ext w/o (73700) | $1,883.20 | $3,424 | 18.5× |
| CT lower extremity w/contrast material (73701) | $2,030.05 | $3,691 | 11.9× |
| CT lumbar spine w contrast (72132) | $2,601.50 | $4,730 | 7.7× |
| CT lumbar spine w/o contrast (72131) | $2,190.10 | $3,982 | 21.6× |
| CT maxillofacial w contrast (70487) | $1,426.70 | $2,594 | 8.4× |
| CT maxillofacial wo contrast (70486) | $1,349.15 | $2,453 | 13.3× |
| CT neck tissue combo (70492) | $1,750.10 | $3,182 | 10.3× |
| Ct Orbit/Ear/Fossa W/O&W/Dye (70482) | $1,750.10 | $3,182 | 10.3× |
| CT orbits w/o contrast (70480) | $1,392.60 | $2,532 | 13.7× |
| CT pelvis w&w/o contrast (72194) | $1,955.80 | $3,556 | 11.5× |
| CT pelvis w/o contrast (72192) | $1,463.55 | $2,661 | 14.4× |
| CT scan of leg combo (73702) | $2,515.70 | $4,574 | 14.8× |
| CT scans face/jaw combo (70488) | $1,481.15 | $2,693 | 8.7× |
| CT soft tissue neck w contrast (70491) | $1,697.30 | $3,086 | 10.0× |
| CT soft tissue neck w/o contrast (70490) | $1,392.60 | $2,532 | 13.7× |
| CT thoracic spine w contrast (72129) | $2,765.40 | $5,028 | 16.2× |
| CT thoracic spine w/o contrast (72128) | $2,429.90 | $4,418 | 23.9× |
| CT thoracic spine w/wo cont (72130) | $2,919.40 | $5,308 | 17.1× |
| CT thorax w/o contrast (71250) | $1,557.05 | $2,831 | 15.3× |
| CT upper ext wo (73200) | $1,447.05 | $2,631 | 14.2× |
| CT upper extremity with contrast (73201) | $1,536.15 | $2,793 | 4.5× |
| Cta Abdl Aorta&Bi Iliofem W/Contrast&Postp (75635) | $3,165.80 | $5,756 | 18.6× |
| Cta Abdomen (74175) | $1,882.10 | $3,422 | 11.0× |
| CTA pelvis (72191) | $1,696.75 | $3,085 | 10.0× |
| Dacryocystography, nasolacrimal duct, radiological supervision and interpretation Non-Facility (70170) | $217.80 | $396 | 0.9× |
| Dilation ureters/urethra rs&i (74485) | $1,081.85 | $1,967 | 0.5× |
| Diskography lumbar (72295) | $2,878.15 | $5,233 | 1.5× |
| Doppler Echo Fetal Puls Spectral F/U/Repeat (76828) | $330.55 | $601 | 3.3× |
| Doppler Echo Fetal Spectral Display Complete (76827) | $398.20 | $724 | 3.9× |
| Dxa Bone Density Axial (77080) | $151.65 | $275.73 | 1.5× |
| Dxa bone density study (77085) | $386.65 | $703 | 3.8× |
| Dxa bone density study 1/>sites appendiclr skel (77081) | $162.52 | $295.50 | 1.9× |
| Echo Guide For Artery Repair (76936) | $1,124.75 | $2,045 | 5.4× |
| Esophagram (74220) | $270.60 | $492 | 1.6× |
| Fetal Biophys Profile W/Nst (76818) | $603.35 | $1,097 | 5.9× |
| Fetal Biophysical Profile W/O Non-Stress Testing (76819) | $550.55 | $1,001 | 5.4× |
| Fetal MRI w/placntl matrnl plvc img sing/1st ges (74712) | $1,020.25 | $1,855 | 4.4× |
| Fluoroscopy up to 1 hr (76000) | $323.95 | $589 | 1.4× |
| Follow-Up Angiography (75898) | $1,009.80 | $1,836 | 0.3× |
| Foot 2 views (73620) range across 2 matching MRF lines |
$63.80–$248.60 | $116–$452 | varies |
| Forearm 2 views (73090) | $161.70 | $294 | 1.9× |
| Gastric emptying imaging study (78264) | $396 | $720 | 1.0× |
| Gastric Emptyng Imag Std W/Sm Bwl Transit (78265) | $517.55 | $941 | 1.3× |
| Gated Heart Planar Single (78472) | $1,494.35 | $2,717 | 3.8× |
| Gstrc Emptng Imag Std W/Sm Bwl Col Trnst Mlt Day (78266) | $996.60 | $1,812 | 1.9× |
| Hand 2 views (73120) range across 2 matching MRF lines |
$195.80–$211.75 | $356–$385 | varies |
| Hepatc Vngrph Wdg/Fr Hemodyn Eval Rs&I (75889) | $3,422.65 | $6,223 | 1.1× |
| Hepatc Vngrph Wdg/Fr W/O Hemodyn Eval Rs&I (75891) | $1,483.35 | $2,697 | 0.5× |
| Hepatobil Syst Image W/Drug (78227) | $2,093.85 | $3,807 | 4.0× |
| Hepatobiliary System Imaging (78226) | $1,529.55 | $2,781 | 3.9× |
| Ht Muscle Image Spect Sing (78451) | $1,573 | $2,860 | 1.3× |
| Hysterosalpingogram (74740) | $380.05 | $691 | 1.6× |
| Infant hip ultrasound with hip movement (dynamic) (76885) | $695.20 | $1,264 | 8.2× |
| Infant hip ultrasound, limited static exam (76886) | $595.10 | $1,082 | 7.0× |
| K Flow/Funct Image Multiple (78709) | $3,643.75 | $6,625 | 6.9× |
| K Flow/Funct Image W/Drug (78708) | $548.90 | $998 | 1.0× |
| K Flow/Funct Image W/O Drug (78707) | $524.15 | $953 | 1.0× |
| Knee 3 Views (73562) | $140.80 | $256 | 1.7× |
| Liver & Spleen Imaging Static Only (78215) | $1,032.35 | $1,877 | 2.7× |
| Lung perfusion differential (78597) | $1,139.05 | $2,071 | 2.9× |
| Lung Ventilat&Perfus Imaging (78582) | $1,364.55 | $2,481 | 2.6× |
| Lung Ventilation Imaging (78579) | $1,013.65 | $1,843 | 2.6× |
| Lymph System Imaging (78195) | $1,432.75 | $2,605 | 2.7× |
| Magnetic Image Jaw Joint (70336) | $2,055.35 | $3,737 | 8.9× |
| Mammary ductogram or galactogram single (77053) | $968 | $1,760 | 4.2× |
| Meckels Divert Exam (78290) | $540.65 | $983 | 1.4× |
| Mra Head W/O & W/Contrast Material (70546) | $5,194.75 | $9,445 | 15.3× |
| MRA head w/o contrast (70544) | $2,979.35 | $5,417 | 12.9× |
| MRA head with contrast (70545) | $3,615.15 | $6,573 | 10.7× |
| MRA neck w contrast (70548) | $3,445.75 | $6,265 | 10.2× |
| Mra Neck W/O &W/Contrast Material (70549) | $5,181 | $9,420 | 15.3× |
| MRA neck w/o contrast (70547) | $3,143.80 | $5,716 | 13.6× |
| MRI abdomen w contrast (74182) | $3,714.70 | $6,754 | 11.0× |
| MRI abdomen w/o contrast (74181) | $2,900.70 | $5,274 | 12.5× |
| MRI any jt lower extrem w/contrast material (73722) | $2,806.65 | $5,103 | 3.7× |
| MRI any jt lower extrem w/o & w/contrast matrl (73723) | $3,228.50 | $5,870 | 9.5× |
| MRI any jt upper extremity w/contrast matrl (73222) | $3,223 | $5,860 | 4.2× |
| MRI Breast W/O Contrast Bilateral (77047) | $694.10 | $1,262 | 3.0× |
| MRI Breast Without Contrast Material Unilateral (77046) | $347.05 | $631 | 1.5× |
| MRI cardiac w/o contrast (75557) | $2,202.75 | $4,005 | 9.5× |
| MRI cervical spine w contrast (72142) | $3,480.40 | $6,328 | 10.3× |
| MRI cervical spine w/o cont (72141) | $3,048.65 | $5,543 | 13.2× |
| MRI chest w/o contrast (71550) | $3,080 | $5,600 | 13.3× |
| MRI chest wo w contrast (71552) | $3,752.65 | $6,823 | 11.1× |
| MRI lower extrem oth/thn jt w/contrast matrl (73719) | $2,483.25 | $4,515 | 7.3× |
| MRI lower extrem oth/thn jt w/o & w/contr matr (73720) | $2,613.05 | $4,751 | 7.7× |
| MRI lower extrem oth/thn jt w/o contr matrl (73718) | $2,360.05 | $4,291 | 10.2× |
| MRI lumbar spine w contrast (72149) | $3,281.30 | $5,966 | 9.7× |
| Mri Neck Spine W/O & W/Dye (72156) | $4,462.70 | $8,114 | 13.2× |
| MRI orbit face &/neck w/o contrast (70540) | $3,355 | $6,100 | 14.5× |
| Mri Orbt/Fac/Nck W/O &W/Dye (70543) | $4,268.55 | $7,761 | 12.6× |
| MRI pelvis w contrast (72196) | $2,858.90 | $5,198 | 8.4× |
| MRI pelvis w/o & w contrast (72197) | $3,556.85 | $6,467 | 10.5× |
| MRI pelvis w/o contrast (72195) | $2,541.55 | $4,621 | 11.0× |
| MRI spectroscopy (76390) | $264.55 | $481 | 3.1× |
| MRI thoracic spine w/o contrast (72146) | $2,748.90 | $4,998 | 11.9× |
| MRI upper extremity oth than jt w/contr matrl (73219) | $2,993.10 | $5,442 | 8.8× |
| MRI upper extremity oth than jt w/o contr matrl (73218) | $2,466.75 | $4,485 | 10.6× |
| Mri Uppr Extremity W/O&W/Dye (73220) | $3,556.85 | $6,467 | 10.5× |
| MRI, abdomen, combo (74183) | $4,324.65 | $7,863 | 12.8× |
| MRI, dorsal spine combo (72157) | $3,719.10 | $6,762 | 11.0× |
| MRI, dorsal spine contrast (72147) | $3,234 | $5,880 | 9.5× |
| MRI, joint upper extrem (73221) | $2,343 | $4,260 | 10.1× |
| MRI, joint upper extrem combo (73223) | $3,639.90 | $6,618 | 10.7× |
| MRI, lumbar spine combo (72158) | $3,555.20 | $6,464 | 10.5× |
| Myelogram cervical (72240) | $907.50 | $1,650 | 1.2× |
| Myelogram Lumbar (72265) | $825.55 | $1,501 | 1.1× |
| Myelography thoracic (72255) | $854.70 | $1,554 | 1.1× |
| Myelograpy 2/more regions rs&i (72270) | $1,138.50 | $2,070 | 1.5× |
| Myocardial Imaging Pet Metabolic Evaluation (78459) | $4,789.40 | $8,708 | 3.8× |
| Myocardial Spect Multiple Studies (78452) | $2,555.85 | $4,647 | 2.0× |
| N-invas est c ffr sw aly CTA (75580) | $1,702.25 | $3,095 | 2.0× |
| Neck soft tissue (70360) | $100.10 | $182 | 1.2× |
| Njx Rp Loclzj Non-Img Probe Study Intravenous (78808) | $303.60 | $552 | 0.8× |
| Nm unlisted gi procedure (78299) | $1,818.30 | $3,306 | 4.7× |
| Nonvascular Shunt X-Ray (75809) | $243.65 | $443 | 2.4× |
| Nuclear Rx Oral Admin (79005) | $1,032.35 | $1,877 | 4.6× |
| Panoramic X-ray of jaws (70355) | $212.30 | $386 | 2.5× |
| Parathyroid imaging w/tomographic spect & CT (78072) | $1,363.45 | $2,479 | 2.6× |
| Parathyroid Planar Imaging (78070) | $673.75 | $1,225 | 1.7× |
| Pelvis 1 or 2 views (72170) | $177.65 | $323 | 1.7× |
| Peritoneogram Rs&I (74190) | $689.15 | $1,253 | 1.3× |
| PET image w/CT, full body (78816) | $5,267.35 | $9,577 | 3.8× |
| PET imaging CT attenuation skull base mid-thigh (78815) | $4,789.40 | $8,708 | 3.4× |
| Pet Myocardial Sngl Study (78491) | $4,789.40 | $8,708 | 3.4× |
| Prq Transhepatc Portograpy Hemodyn Eval Rs&I (75885) | $3,610.20 | $6,564 | 1.2× |
| Pulmonary Perfusion Imaging Particulate (78580) | $1,301.30 | $2,366 | 3.4× |
| Radex Abd Compl Aqt Abd W/S/E/D Views 1 View Ch (74022) | $212.30 | $386 | 2.1× |
| Radex abscess/fistula/sinus tract rs&i (76080) | $299.20 | $544 | 0.6× |
| Radex Ankle Complete Minimum 3 Views (73610) | $256.85 | $467 | 3.0× |
| Radex Calcaneus Minimum 2 Views (73650) | $190.85 | $347 | 2.3× |
| Radex elbow complete minimum 3 views (73080) | $203.50 | $370 | 2.4× |
| Radex Facial Bones Complete Minimum 3 Views (70150) | $250.25 | $455 | 2.5× |
| Radex fingr minimum 2 views (73140) | $149.05 | $271 | 1.8× |
| Radex foot complete minimum 3 views (73630) range across 2 matching MRF lines |
$103.95–$264 | $189–$480 | varies |
| Radex Hand Minimum 3 Views (73130) | $220.55 | $401 | 2.6× |
| Radex lower extremity infant minimum 2 views (73592) | $190.85 | $347 | 2.3× |
| Radex Mastoids Compl Minimum 3 Views PR Side (70130) | $251.90 | $458 | 2.5× |
| Radex Nasal Bones Complete Minimum 3 Views (70160) | $179.85 | $327 | 2.1× |
| Radex Ribs Unilateral 2 Views (71100) | $135.85 | $247 | 1.6× |
| Radex shoulder complete minimum 2 views (73030) | $208.45 | $379 | 2.5× |
| Radex Sinuses Paransl < 3 Views (70210) | $222.20 | $404 | 2.6× |
| Radex sm int w/mlt srl imges via enteroclss tube (74251) | $684.20 | $1,244 | 4.0× |
| Radex Spine 1 View Specify Level (72020) | $199.65 | $363 | 2.4× |
| Radex Sternum Minimum 2 Views (71120) | $250.25 | $455 | 3.0× |
| Radex Temporomandble Jt Opn & Clsd Mouth Bilat (70330) | $294.80 | $536 | 3.5× |
| Radex Toe Minimum 2 Views (73660) range across 2 matching MRF lines |
$149.60–$221.65 | $272–$403 | varies |
| Radex upper extremity infant minimum 2 views (73092) | $166.10 | $302 | 1.6× |
| Radex Wrist Complete Minimum 3 Views (73110) | $238.15 | $433 | 2.8× |
| Radex X-Ray Exam Entire Spi 6/> Vw - Xr Entire Spine 6+ Vw (72084) | $586.30 | $1,066 | 5.8× |
| Radiation treatment delivery level 3 (77412) | $781.55 | $1,421 | 1.5× |
| Radiolog exam mandible compl minimum 4 views (70110) | $222.20 | $404 | 2.2× |
| Radiologic Exam Abdomen 3+ Views - Xr Abdomen 3+ Views (74021) | $196.35 | $357 | 1.9× |
| Radiologic exam colon double contrast study (74280) | $537.90 | $978 | 3.2× |
| Radiologic exam colon single contrast study (74270) | $410.85 | $747 | 2.4× |
| Radiologic Exam Esophagus Double Contrast Study (74221) | $548.90 | $998 | 3.2× |
| Radiologic exam knee complete 4/more views (73564) | $191.40 | $348 | 1.9× |
| Radiologic exam pelvis compl minimum 3 views (72190) | $253.55 | $461 | 2.5× |
| Radiologic Exam Small Int Single Contrast Study (74250) | $265.65 | $483 | 1.6× |
| Radiologic exam swallow function contrast study (74230) | $279.95 | $509 | 1.6× |
| Radiologic exam upr gi trc double contrast study (74246) | $330.55 | $601 | 1.9× |
| Radiologic examination femur 1 view (73551) | $89.65 | $163 | 1.1× |
| Radiologic examination femur minimum 2 views (73552) | $102.30 | $186 | 1.2× |
| Radiologic examination knee 1/2 views (73560) | $94.60 | $172 | 1.1× |
| Radiologic examination tibia & fibula 2 views (73590) range across 2 matching MRF lines |
$177.10–$318.45 | $322–$579 | varies |
| Renal Cyst Study (74470) | $299.20 | $544 | 0.6× |
| Ribs bilateral 3 views (71110) | $331.65 | $603 | 3.3× |
| Rp loclzj tum plnr 1 area single day imaging (78800) | $634.15 | $1,153 | 1.6× |
| Rp loclzj tum plnr 2+area 1+d img/1 area img>2+d (78801) | $782.10 | $1,422 | 2.0× |
| Rp Loclzj Tum Plnr Whole Body 2+ Days Imaging (78804) | $1,332.10 | $2,422 | 2.5× |
| Rp Loclzj Tum Plnr Whole Body Single Day Imaging (78802) | $1,032.35 | $1,877 | 2.0× |
| Rp Loclzj Tum Spect 1 Area Single Day Imaging (78803) | $1,508.65 | $2,743 | 2.9× |
| Rp loclzj tum spect w/CT 1 area/acquisj 1day img (78830) | $1,841.95 | $3,349 | 1.5× |
| Scapula (73010) | $179.85 | $327 | 1.8× |
| Screening Digital Breast Tomosynthesis Bi (77063) range across 2 matching MRF lines |
$123.75–$247.50 | $225–$450 | varies |
| Sella turcica (70240) | $160.05 | $291 | 1.9× |
| Shoulder 1 view (73020) | $199.10 | $362 | 2.4× |
| Shoulder Arthrography (73040) | $605.55 | $1,101 | 1.8× |
| Sialogram (70390) | $366.30 | $666 | 1.6× |
| Skull less than 4 views (70250) | $199.10 | $362 | 2.0× |
| Special treatment procedure (77470) | $1,721.50 | $3,130 | 3.2× |
| Sternoclavicular joints (71130) | $253.55 | $461 | 3.0× |
| Superior sagittal sinus venogram (75870) | $3,181.75 | $5,785 | 1.0× |
| Tbs techl prep&transmis data alys pfrmd elsewhr (77090) | $63.25 | $115 | 0.7× |
| Tbs technical calculation only (77091) | $139.15 | $253 | 1.6× |
| Ther Rad Simulaj-Aided Field Setting Complex (77290) | $1,112.65 | $2,023 | 3.1× |
| Ther rad simulaj-aided field setting simple (77280) | $759 | $1,380 | 5.8× |
| Thoracic spine 2 views (72070) | $244.75 | $445 | 2.4× |
| Thoracic spine 3 views (72072) | $264 | $480 | 2.6× |
| Thoracolumbar 2 views (72080) | $251.35 | $457 | 3.0× |
| Thyroid Imaging With Vascular Flow (78013) | $863.50 | $1,570 | 2.2× |
| Thyroid Met Imaging Body (78018) | $1,032.35 | $1,877 | 2.0× |
| Thyroid Uptake Measurement (78012) | $332.20 | $604 | 0.9× |
| Thyroid Uptake W/Blood Flow Sngle/Mult Quan Meas (78014) | $985.60 | $1,792 | 2.5× |
| Tx Devices Design & Construction Complex (77334) | $381.15 | $693 | 1.0× |
| Ultrasound Breast Limited (76642) | $489.50 | $890 | 5.8× |
| Ultrasound Exam Aaa Screen (76706) | $106.15 | $193 | 1.0× |
| Ultrasound, abdomen limited (76705) range across 2 matching MRF lines |
$528–$607.75 | $960–$1,105 | varies |
| Umbilical-artery Doppler (OB) (76820) | $370.70 | $674 | 3.7× |
| Unlisted Dx Radiographic Procedure (76499) | $634.15 | $1,153 | 7.5× |
| Unlisted magnetic resonance procedure (76498) | $1,512.50 | $2,750 | 17.9× |
| Upper gi w/o kub (74240) | $279.95 | $509 | 1.6× |
| Ureteral Reflux Study (78740) | $1,032.35 | $1,877 | 2.7× |
| Urethrocystogram voiding (74455) | $361.35 | $657 | 1.6× |
| Urethrocystography retrograde (74450) | $383.35 | $697 | 1.7× |
| Us breast unilateral complete (76641) | $639.10 | $1,162 | 6.3× |
| Us chest (76604) | $489.50 | $890 | 4.8× |
| Us complete joint (76881) | $543.40 | $988 | 5.4× |
| Us exam, pelvic, limited (76857) range across 2 matching MRF lines |
$455.95–$524.70 | $829–$954 | varies |
| Us head (76506) | $577.50 | $1,050 | 5.7× |
| Us lmtd joint/oth nonvasc xtr strux r-t w/img (76882) | $374 | $680 | 3.7× |
| Us ob limited 1 or more fetuses (76815) | $454.85 | $827 | 4.5× |
| Us ob transvaginal (76817) | $436.70 | $794 | 4.3× |
| Us pelvic non ob complete (76856) | $617.65 | $1,123 | 6.1× |
| Us pg uter img f&mat 14 wk tabdl 1/1st gestation (76801) | $595.10 | $1,082 | 5.9× |
| Us preg uterus real time f/u trnsabdl per fetus (76816) | $319 | $580 | 3.1× |
| Us retroperitoneal complete (76770) | $693.55 | $1,261 | 6.8× |
| Us retroperitoneal limited (76775) | $463.10 | $842 | 4.6× |
| Us scrotum and contents (76870) | $568.15 | $1,033 | 5.6× |
| Us spinal canal and contents (76800) | $481.25 | $875 | 4.7× |
| Us thyroid (76536) | $491.70 | $894 | 4.8× |
| Vascular Flow Imaging (78445) | $400.95 | $729 | 1.0× |
| Vein X-Ray Chest (75827) | $3,434.75 | $6,245 | 2.2× |
| Venogram Sinus/Jugular (75860) | $2,986.50 | $5,430 | 1.0× |
| Venography caval inferior serialography rs&i (75825) | $3,188.90 | $5,798 | 1.0× |
| Venography extremity bilateral rs&i (75822) | $1,265.55 | $2,301 | 0.8× |
| Venography extremity unilateral rs&i (75820) | $633.05 | $1,151 | 0.4× |
| Venography Renal Bilateral (75833) | $5,167.80 | $9,396 | 1.7× |
| Venography Renal Unilateral (75831) | $2,584.45 | $4,699 | 0.8× |
| Venous sampling by catheter (75893) | $3,616.80 | $6,576 | 0.7× |
| Vertebral fracture assessment via dxa (77086) | $252.45 | $459 | 3.0× |
| Wrist 2 views (73100) | $216.15 | $393 | 2.6× |
| X-Ray Ac Jts - Xr Acromioclavicular Joints Bilateral (73050) | $486.75 | $885 | 5.8× |
| X-ray antegrade pyelogram tube (74425) | $323.40 | $588 | 1.0× |
| X-Ray Aorta Leg Arteries (75630) | $2,898.50 | $5,270 | 0.9× |
| X-Ray Elbow 2 Vw - Xr Elbow 1-2 Views Right (73070) | $178.75 | $325 | 2.1× |
| X-Ray Exam Breast Specimen (76098) | $138.60 | $252 | 0.3× |
| X-Ray Exam Entire Spi 1 Vw (72081) | $360.80 | $656 | 4.3× |
| X-Ray Exam Entire Spi 2/3 Vw (72082) | $450.45 | $819 | 4.4× |
| X-Ray Exam Entire Spi 4/5 Vw (72083) | $540.65 | $983 | 5.3× |
| X-Ray Exam Hip Uni 1 View (73501) | $89.65 | $163 | 1.1× |
| X-Ray Exam Hip Uni 2-3 Views (73502) range across 2 matching MRF lines |
$121–$128.70 | $220–$234 | varies |
| X-Ray Exam Hip Uni 4/> Views (73503) | $180.40 | $328 | 1.8× |
| X-Ray Exam Hips Bi 2 Views (73521) | $132.55 | $241 | 1.3× |
| X-Ray Exam Hips Bi 3-4 Views (73522) | $149.60 | $272 | 1.5× |
| X-Ray Exam Hips Bi 5/> Views (73523) | $188.10 | $342 | 1.9× |
| X-Ray Exam L-S Spine Bending (72114) | $298.10 | $542 | 2.9× |
| X-Ray Exam Neck Spine 2-3 Vw (72040) | $192.50 | $350 | 2.3× |
| X-Ray Exam Neck Spine 6/>Vws (72052) | $344.30 | $626 | 3.4× |
| X-Ray Exam Unilat Ribs/Chest (71101) | $152.35 | $277 | 1.5× |
| X-ray eye for foreign body (70030) | $117.70 | $214 | 1.4× |
| X-ray humerus (73060) | $193.05 | $351 | 2.3× |
| X-ray IV pyelogram+tomography (74415) | $507.10 | $922 | 3.0× |
| X-Ray Jaw <4 Vw - Xr Mandible < 4 Views (70100) | $184.80 | $336 | 2.2× |
| X-Ray Lumbar Spine 2/3 Vw - Xr Lumbar Spine 2-3 Views (72100) | $232.10 | $422 | 2.3× |
| X-ray nose-rectum child f.b. (76010) | $101.20 | $184 | 1.2× |
| X-Ray Ribs, Chest 4+ Vw - Xr Ribs 3 Vws Bil W/ Chest Posteroanterior (71111) | $486.75 | $885 | 4.8× |
| X-Ray Sacroiliac Jts 3+ Vw - Xr Sacroiliac Joints 3+ Views (72202) | $239.25 | $435 | 2.4× |
| X-Ray Sacroiliac Jts <3 Vw - Xr Sacroiliac Joints 1-2 Views (72200) | $199.65 | $363 | 2.0× |
| X-Ray Sacrum/Coccyx 2+ Vw - Xr Sacrum Coccyx 2+ Views (72220) | $211.20 | $384 | 2.5× |
| X-Ray Sinuses 3+ Vw - Xr Paranasal Sinuses 3+ Views (70220) | $293.70 | $534 | 3.5× |
| X-Ray Skull 4+ Vw - Xr Skull Complete 4+ Views (70260) | $301.95 | $549 | 3.0× |
| X-Ray Urinary Tract Exam With Contrast Material (74420) | $595.10 | $1,082 | 1.8× |
| X-Rays Bone Length Studies (77073) | $452.10 | $822 | 4.5× |
| X-Rays Bone Survey Complete (77075) | $733.70 | $1,334 | 7.2× |
| Xr c-spine 4 or 5 views (72050) | $253.55 | $461 | 2.5× |
| Xr facial bones less than 3 views (70140) | $187.55 | $341 | 2.2× |
| Xr orbits complete 4 views (70200) | $287.10 | $522 | 2.8× |
| Xr Tomogram Single Plane (76100) | $299.20 | $544 | 2.9× |
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.