Imaging prices at SSM Health St. Mary's Hospital -centralia
Centralia, IL · every code in this section with a posted price and a Medicare benchmark.
351 codes. Prices are the hospital's own posted facility charges.
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| Procedure | Posted cash | Posted gross | × Medicare |
|---|---|---|---|
| 3-D radiotherapy plan dose-volume histograms (77295) | $6,734.75 | $12,245 | 4.5× |
| Abdomen 1 View (74018) | $368.50 | $670 | 4.0× |
| Abdomen 2 views (74019) | $491.70 | $894 | 4.4× |
| Acute Gastrointestinal Blood Loss Imaging (78278) | $1,571.35 | $2,857 | 3.7× |
| Adrenal Cortex & Medulla Img (78075) | $1,987.70 | $3,614 | 1.4× |
| Angio pulmonary bilat (75743) | $10,000.10 | $18,182 | 3.0× |
| Angiography extremity bilateral rs&i (75716) | $4,612.30 | $8,386 | 1.4× |
| Angiography extremity unilateral rs&i (75710) | $4,513.30 | $8,206 | 1.3× |
| Angiography pulmonary unilateral slctv rs&i (75741) | $5,000.05 | $9,091 | 1.5× |
| Ankle 2 views (73600) range across 2 matching MRF lines |
$326.15–$351.45 | $593–$639 | varies |
| Aortography thoracic serialography rs&i (75605) | $7,183.55 | $13,061 | 1.2× |
| Artery X-Rays Abdomen (75726) | $9,543.60 | $17,352 | 1.6× |
| Arthrogram ankle (73615) | $723.25 | $1,315 | 1.9× |
| Arthrogram hip (73525) | $1,327.15 | $2,413 | 3.5× |
| Arthrogram Wrist (73115) | $723.25 | $1,315 | 1.9× |
| Basic radiation dosimetry calculation (77300) | $821.15 | $1,493 | 5.7× |
| Bone age studies (77072) | $400.40 | $728 | 3.6× |
| Bone Imaging 3 Phase (78315) | $2,072.40 | $3,768 | 4.8× |
| Bone Imaging Limited Area (78300) | $1,383.25 | $2,515 | 3.2× |
| Bone Imaging Whole Body (78306) | $1,902.45 | $3,459 | 4.4× |
| Bone marrow imaging limited area (78102) | $563.20 | $1,024 | 1.3× |
| Bone marrow imaging; whole body (78104) | $650.10 | $1,182 | 1.5× |
| Bone survey infant (77076) | $448.80 | $816 | 4.0× |
| Brain Flow Imaging Only (78610) | $921.80 | $1,676 | 1.6× |
| Brain Imaging Min 4 Static Views W Vascular Flow (78606) | $1,053.80 | $1,916 | 1.8× |
| Brain Imaging Minimum 4 Static Views (78605) | $1,005.95 | $1,829 | 1.7× |
| Brain Imaging Pet Metabolic Evaluation (78608) | $3,062.95 | $5,569 | 2.0× |
| Cardiac MRI w/w/o contrast & further seq (75561) | $1,343.10 | $2,442 | 3.6× |
| Cat Scan Follow-Up Study (76380) | $990 | $1,800 | 10.6× |
| Cerebrospinal Fluid Scan (78630) | $1,240.80 | $2,256 | 2.1× |
| Chest 1 view (71045) | $260.70 | $474 | 2.8× |
| Chest 2 views (71046) | $391.05 | $711 | 4.2× |
| Chest 3 views (71047) | $520.30 | $946 | 5.6× |
| Chest 4 or more views (71048) | $651.20 | $1,184 | 5.8× |
| Clavicle complete (73000) | $366.30 | $666 | 3.9× |
| Computed Tomography Thorax Lw Dose Lng Ca Scr C- (71271) | $295.35 | $537 | 2.6× |
| Continuing medical physics consltj pr wk (77336) | $775.50 | $1,410 | 5.4× |
| Contrast Exam Abdominl Aorta (75625) | $4,217.40 | $7,668 | 1.2× |
| Contrast X-Ray Bladder (74430) range across 2 matching MRF lines |
$531.85–$629.20 | $967–$1,144 | varies |
| Contrast X-Ray Of Elbow (73085) | $964.70 | $1,754 | 2.6× |
| Contrast X-Ray Of Knee Joint (73580) | $1,075.25 | $1,955 | 2.9× |
| Contrast Xray Throat/Cerv Esopha (74210) | $180.40 | $328 | 1.0× |
| CT abdomen and pelvis without and with contrast (74178) | $5,618.25 | $10,215 | 15.0× |
| CT abdomen and pelvis without contrast (74176) | $4,173.95 | $7,589 | 16.3× |
| CT abdomen w contrast (74160) | $2,809.40 | $5,108 | 14.9× |
| CT abdomen w wo contrast (74170) | $3,010.15 | $5,473 | 16.0× |
| CT abdomen w/o contrast (74150) | $2,608.65 | $4,743 | 23.3× |
| CT Angio Abdomen and Pelvis (74174) | $5,082 | $9,240 | 13.6× |
| CT Angio Chest (71275) | $3,864.85 | $7,027 | 20.6× |
| CT Angio Head (70496) | $3,260.40 | $5,928 | 17.3× |
| CT angio hrt w/3d image (75574) | $1,824.35 | $3,317 | 4.9× |
| Ct Angio Lwr Extr W/O&W/Dye (73706) | $3,114.65 | $5,663 | 16.6× |
| CT Angio Neck (70498) | $2,917.20 | $5,304 | 15.5× |
| Ct Angio Upr Extrm W/O&W/Dye (73206) | $3,144.90 | $5,718 | 16.7× |
| CT cervical spine w/ contrast (72126) | $2,434.30 | $4,426 | 6.5× |
| CT cervical spine w/o contrast (72125) | $2,282.50 | $4,150 | 20.4× |
| CT cervical spine w/wo cont (72127) | $2,586.65 | $4,703 | 13.8× |
| CT chest w contrast (71260) | $2,178.55 | $3,961 | 11.6× |
| CT chest w/wo contrast (71270) | $2,359.50 | $4,290 | 12.6× |
| CT head/brain with contrast (70460) | $2,059.20 | $3,744 | 11.0× |
| CT head/brain without and with contrast (70470) | $2,230.80 | $4,056 | 11.9× |
| CT heart no contrast quant eval coronry calcium (75571) | $95.70 | $174 | 1.0× |
| CT iac w contrast (70481) | $2,334.20 | $4,244 | 12.4× |
| CT l-spine w&w/o contrast (72133) | $2,729.65 | $4,963 | 14.5× |
| CT lower ext w/o (73700) | $1,941.50 | $3,530 | 17.3× |
| CT lower extremity w/contrast material (73701) | $2,477.20 | $4,504 | 13.2× |
| CT lumbar spine w contrast (72132) | $2,568.50 | $4,670 | 6.9× |
| CT lumbar spine w/o contrast (72131) | $2,407.90 | $4,378 | 21.5× |
| CT maxillofacial w contrast (70487) | $2,059.20 | $3,744 | 11.0× |
| CT maxillofacial wo contrast (70486) | $1,887.60 | $3,432 | 16.8× |
| CT neck tissue combo (70492) | $2,230.80 | $4,056 | 11.9× |
| Ct Orbit/Ear/Fossa W/O&W/Dye (70482) | $2,973.30 | $5,406 | 15.8× |
| CT orbits w/o contrast (70480) | $1,972.85 | $3,587 | 17.6× |
| CT pelvis w&w/o contrast (72194) | $2,642.20 | $4,804 | 14.1× |
| CT pelvis w/o contrast (72192) | $1,965.70 | $3,574 | 17.5× |
| CT scan of leg combo (73702) | $2,781.35 | $5,057 | 14.8× |
| CT scans face/jaw combo (70488) | $2,230.80 | $4,056 | 11.9× |
| CT soft tissue neck w contrast (70491) | $2,059.20 | $3,744 | 11.0× |
| CT soft tissue neck w/o contrast (70490) | $1,887.60 | $3,432 | 16.8× |
| CT thoracic spine w contrast (72129) | $2,568.50 | $4,670 | 13.7× |
| CT thoracic spine w/o contrast (72128) | $2,407.90 | $4,378 | 21.5× |
| CT thoracic spine w/wo cont (72130) | $2,654.85 | $4,827 | 14.1× |
| CT thorax w/o contrast (71250) | $1,996.50 | $3,630 | 17.8× |
| CT upper ext wo (73200) | $1,994.85 | $3,627 | 17.8× |
| CT upper extremity w/o & w/contrast material (73202) | $3,144.90 | $5,718 | 16.7× |
| CT upper extremity with contrast (73201) | $2,668.05 | $4,851 | 7.1× |
| Cta Abdl Aorta&Bi Iliofem W/Contrast&Postp (75635) | $3,507.90 | $6,378 | 18.7× |
| Cta Abdomen (74175) | $5,082 | $9,240 | 27.0× |
| CTA pelvis (72191) | $2,191.75 | $3,985 | 11.7× |
| Discography Cerv/Thor Spine (72285) | $4,674.45 | $8,499 | 2.2× |
| Diskography lumbar (72295) | $4,674.45 | $8,499 | 2.2× |
| Doppler Echo Fetal Puls Spectral F/U/Repeat (76828) | $353.65 | $643 | 3.2× |
| Doppler Echo Fetal Spectral Display Complete (76827) | $468.05 | $851 | 4.2× |
| Doppler Fetal Mid Cerebral Artery (76821) | $303.60 | $552 | 2.7× |
| Dxa Bone Density Axial (77080) | $538.45 | $979 | 4.8× |
| Dxa bone density study 1/>sites appendiclr skel (77081) | $243.65 | $443 | 2.6× |
| Echo exam uterus (76831) | $977.35 | $1,777 | 3.8× |
| Echo Guide For Artery Repair (76936) | $677.60 | $1,232 | 2.9× |
| Esophagram (74220) | $894.85 | $1,627 | 4.8× |
| Fetal Biophysical Profile W/O Non-Stress Testing (76819) | $848.10 | $1,542 | 7.6× |
| Fluoroscopy up to 1 hr (76000) | $776.05 | $1,411 | 3.0× |
| Follow-Up Angiography (75898) | $1,575.20 | $2,864 | 0.5× |
| Foot 2 views (73620) range across 2 matching MRF lines |
$207.90–$332.20 | $378–$604 | varies |
| Forearm 2 views (73090) range across 2 matching MRF lines |
$254.10–$360.80 | $462–$656 | varies |
| Gastric emptying imaging study (78264) | $2,825.35 | $5,137 | 6.6× |
| Gated Heart Planar Single (78472) | $3,878.05 | $7,051 | 9.1× |
| Hand 2 views (73120) | $325.60 | $592 | 2.9× |
| Hepatobil Syst Image W/Drug (78227) | $2,861.65 | $5,203 | 4.9× |
| Hepatobiliary System Imaging (78226) | $2,806.65 | $5,103 | 6.6× |
| Ht Musc Image Planar Mult (78454) | $2,589.95 | $4,709 | 1.9× |
| Ht Muscle Image Spect Sing (78451) | $2,752.20 | $5,004 | 2.0× |
| Hysterosalpingogram (74740) | $1,144.55 | $2,081 | 4.5× |
| Infant hip ultrasound with hip movement (dynamic) (76885) | $711.15 | $1,293 | 7.6× |
| Infant hip ultrasound, limited static exam (76886) | $677.05 | $1,231 | 7.3× |
| Joint Survey Single View (77077) | $184.80 | $336 | 1.6× |
| K Flow/Funct Image Multiple (78709) | $1,965.70 | $3,574 | 3.4× |
| K Flow/Funct Image W/Drug (78708) | $1,921.15 | $3,493 | 3.3× |
| K Flow/Funct Image W/O Drug (78707) | $1,566.40 | $2,848 | 2.7× |
| Kidney Imaging Morphol (78700) | $1,189.10 | $2,162 | 2.8× |
| Kidney Imaging Morphoogy W/Vascular Flow (78701) | $1,401.95 | $2,549 | 3.3× |
| Knee 3 Views (73562) | $487.85 | $887 | 5.2× |
| Leveen/Shunt Patency Exam (78291) | $862.40 | $1,568 | 2.0× |
| Liver & Spleen Imaging Static Only (78215) | $846.45 | $1,539 | 2.0× |
| Liver & Spleen Imaging W/Vascular Flow (78216) | $987.25 | $1,795 | 2.3× |
| Liver imaging static only (78201) | $1,963.50 | $3,570 | 3.4× |
| Liver imaging w/vascular flow (78202) | $1,963.50 | $3,570 | 3.4× |
| Lung Perf&Ventilat Diferentl (78598) | $583.55 | $1,061 | 1.0× |
| Lung perfusion differential (78597) | $1,058.75 | $1,925 | 2.5× |
| Lung Ventilat&Perfus Imaging (78582) | $1,286.45 | $2,339 | 2.2× |
| Lymph System Imaging (78195) | $2,136.20 | $3,884 | 3.7× |
| Magnetic Image Jaw Joint (70336) | $2,938.10 | $5,342 | 11.5× |
| Mammary ductogram or galactogram multiple (77054) | $925.10 | $1,682 | 3.6× |
| Mammary ductogram or galactogram single (77053) | $860.20 | $1,564 | 3.4× |
| Meckels Divert Exam (78290) | $1,629.10 | $2,962 | 3.8× |
| Mlc imrt design & construction per imrt plan (77338) | $1,323.85 | $2,407 | 3.3× |
| Mra Head W/O & W/Contrast Material (70546) | $3,102 | $5,640 | 8.3× |
| MRA head w/o contrast (70544) | $2,946.90 | $5,358 | 11.5× |
| MRA neck w contrast (70548) | $3,164.15 | $5,753 | 8.5× |
| Mra Neck W/O &W/Contrast Material (70549) | $3,405.05 | $6,191 | 9.1× |
| MRA neck w/o contrast (70547) | $2,637.80 | $4,796 | 10.3× |
| MRI abdomen w contrast (74182) | $3,150.40 | $5,728 | 8.4× |
| MRI abdomen w/o contrast (74181) | $2,746.15 | $4,993 | 10.7× |
| MRI any jt lower extrem w/contrast material (73722) | $3,097.05 | $5,631 | 3.7× |
| MRI any jt lower extrem w/o & w/contrast matrl (73723) | $3,598.10 | $6,542 | 9.6× |
| MRI any jt upper extremity w/contrast matrl (73222) | $3,148.20 | $5,724 | 3.7× |
| MRI bone marrow blood supply (77084) | $2,097.70 | $3,814 | 8.2× |
| MRI Breast W/O Contrast Bilateral (77047) | $2,104.85 | $3,827 | 8.2× |
| MRI Breast Without Contrast Material Unilateral (77046) | $2,643.30 | $4,806 | 10.3× |
| MRI cardiac w/o contrast (75557) | $839.30 | $1,526 | 3.3× |
| MRI cervical spine w contrast (72142) range across 2 matching MRF lines |
$2,485.45–$3,664.65 | $4,519–$6,663 | varies |
| MRI cervical spine w/o cont (72141) | $3,529.90 | $6,418 | 13.8× |
| MRI chest w/o contrast (71550) range across 2 matching MRF lines |
$553.30–$2,960.65 | $1,006–$5,383 | varies |
| MRI chest with contrast (71551) | $3,356.65 | $6,103 | 4.0× |
| MRI chest wo w contrast (71552) | $4,110.15 | $7,473 | 11.0× |
| MRI lower extrem oth/thn jt w/contrast matrl (73719) | $3,239.50 | $5,890 | 8.7× |
| MRI lower extrem oth/thn jt w/o & w/contr matr (73720) | $3,895.65 | $7,083 | 10.4× |
| MRI lower extrem oth/thn jt w/o contr matrl (73718) | $3,027.75 | $5,505 | 11.8× |
| MRI lumbar spine w contrast (72149) | $3,097.05 | $5,631 | 8.3× |
| Mri Neck Spine W/O & W/Dye (72156) | $4,480.85 | $8,147 | 12.0× |
| MRI orbit face &/neck w/o contrast (70540) | $2,630.65 | $4,783 | 10.3× |
| MRI orbit face neck w contrast (70542) | $3,143.25 | $5,715 | 8.4× |
| Mri Orbt/Fac/Nck W/O &W/Dye (70543) | $4,704.15 | $8,553 | 12.6× |
| MRI pelvis w contrast (72196) | $3,305.50 | $6,010 | 8.8× |
| MRI pelvis w/o & w contrast (72197) | $4,220.15 | $7,673 | 11.3× |
| MRI pelvis w/o contrast (72195) range across 2 matching MRF lines |
$2,487.10–$3,012.35 | $4,522–$5,477 | varies |
| MRI thoracic spine w/o contrast (72146) | $3,092.65 | $5,623 | 12.1× |
| MRI upper extremity oth than jt w/contr matrl (73219) | $3,239.50 | $5,890 | 8.7× |
| MRI upper extremity oth than jt w/o contr matrl (73218) | $2,960.65 | $5,383 | 11.6× |
| Mri Uppr Extremity W/O&W/Dye (73220) | $4,110.15 | $7,473 | 11.0× |
| MRI, abdomen, combo (74183) | $4,158 | $7,560 | 11.1× |
| MRI, dorsal spine combo (72157) | $4,352.15 | $7,913 | 11.6× |
| MRI, dorsal spine contrast (72147) range across 2 matching MRF lines |
$2,690.05–$3,239.50 | $4,891–$5,890 | varies |
| MRI, joint upper extrem (73221) | $2,954.60 | $5,372 | 11.6× |
| MRI, joint upper extrem combo (73223) | $3,598.10 | $6,542 | 9.6× |
| MRI, lumbar spine combo (72158) | $4,299.35 | $7,817 | 11.5× |
| Myelogram cervical (72240) | $1,563.10 | $2,842 | 1.9× |
| Myelogram Lumbar (72265) | $1,514.15 | $2,753 | 1.8× |
| Myelography thoracic (72255) | $3,340.70 | $6,074 | 4.0× |
| Myelograpy 2/more regions rs&i (72270) | $4,173.40 | $7,588 | 5.0× |
| Myocardial Imaging Infarct Avid Planar Qual/Quan (78466) | $674.30 | $1,226 | 1.6× |
| Myocardial Perfusion Planar 1 Study Rest/Stress (78453) | $1,963.50 | $3,570 | 1.4× |
| Myocardial Spect Multiple Studies (78452) | $4,735.50 | $8,610 | 3.4× |
| Neck soft tissue (70360) | $373.45 | $679 | 4.0× |
| Nm csf leak detection (78650) | $1,963.50 | $3,570 | 1.4× |
| Nonvascular Shunt X-Ray (75809) | $411.40 | $748 | 3.7× |
| Ntsty modul radthx pln dose-vol histos (77301) | $7,157.15 | $13,013 | 4.8× |
| Nuclear Rx Oral Admin (79005) | $1,043.35 | $1,897 | 4.2× |
| Optic foramina (70190) | $99.55 | $181 | 1.1× |
| Parathyroid Planar Imaging (78070) | $1,529 | $2,780 | 3.6× |
| Parathyroid planar imaging w/wo subtraction (78071) | $1,629.10 | $2,962 | 3.8× |
| Pelvis 1 or 2 views (72170) | $349.25 | $635 | 3.1× |
| Peritoneogram Rs&I (74190) | $1,337.60 | $2,432 | 2.3× |
| PET image w/CT, full body (78816) | $4,723.40 | $8,588 | 3.1× |
| PET imaging CT attenuation skull base mid-thigh (78815) | $4,385.70 | $7,974 | 2.9× |
| Pulmonary Perfusion Imaging Particulate (78580) | $994.95 | $1,809 | 2.3× |
| Radex Abd Compl Aqt Abd W/S/E/D Views 1 View Ch (74022) | $598.95 | $1,089 | 5.3× |
| Radex abscess/fistula/sinus tract rs&i (76080) | $998.80 | $1,816 | 1.7× |
| Radex Ankle Complete Minimum 3 Views (73610) | $449.35 | $817 | 4.8× |
| Radex Calcaneus Minimum 2 Views (73650) | $322.85 | $587 | 3.5× |
| Radex elbow complete minimum 3 views (73080) | $470.80 | $856 | 5.0× |
| Radex Facial Bones Complete Minimum 3 Views (70150) | $633.60 | $1,152 | 5.7× |
| Radex fingr minimum 2 views (73140) range across 2 matching MRF lines |
$215.05–$400.95 | $391–$729 | varies |
| Radex foot complete minimum 3 views (73630) | $394.35 | $717 | 4.2× |
| Radex Hand Minimum 3 Views (73130) | $416.35 | $757 | 4.5× |
| Radex lower extremity infant minimum 2 views (73592) | $326.15 | $593 | 3.5× |
| Radex Mastoids Compl Minimum 3 Views PR Side (70130) | $180.95 | $329 | 1.6× |
| Radex Nasal Bones Complete Minimum 3 Views (70160) | $493.35 | $897 | 5.3× |
| Radex Ribs Unilateral 2 Views (71100) | $460.35 | $837 | 4.9× |
| Radex shoulder complete minimum 2 views (73030) | $418.55 | $761 | 4.5× |
| Radex Sinuses Paransl < 3 Views (70210) | $108.35 | $197 | 1.2× |
| Radex sm int w/mlt srl imges via enteroclss tube (74251) | $2,064.70 | $3,754 | 11.0× |
| Radex Spine 1 View Specify Level (72020) | $401.50 | $730 | 4.3× |
| Radex Sternum Minimum 2 Views (71120) | $343.20 | $624 | 3.7× |
| Radex Temporomandble Jt Opn & Clsd Mouth Bilat (70330) | $435.60 | $792 | 4.7× |
| Radex Toe Minimum 2 Views (73660) range across 2 matching MRF lines |
$254.10–$366.30 | $462–$666 | varies |
| Radex upper extremity infant minimum 2 views (73092) | $646.80 | $1,176 | 5.8× |
| Radex Wrist Complete Minimum 3 Views (73110) | $427.35 | $777 | 4.6× |
| Radiation treatment delivery level 1 (77402) | $332.20 | $604 | 3.0× |
| Radiation treatment delivery level 2 (77407) | $568.70 | $1,034 | 1.4× |
| Radiation treatment delivery level 3 (77412) | $877.25 | $1,595 | 1.5× |
| Radiolog exam mandible compl minimum 4 views (70110) | $532.95 | $969 | 4.8× |
| Radiologic Exam Abdomen 3+ Views - Xr Abdomen 3+ Views (74021) | $522.50 | $950 | 4.7× |
| Radiologic exam colon double contrast study (74280) | $1,361.80 | $2,476 | 7.2× |
| Radiologic exam colon single contrast study (74270) | $716.10 | $1,302 | 3.8× |
| Radiologic Exam Esophagus Double Contrast Study (74221) | $1,790.25 | $3,255 | 9.5× |
| Radiologic exam knee complete 4/more views (73564) | $509.30 | $926 | 4.5× |
| Radiologic exam pelvis compl minimum 3 views (72190) | $379.50 | $690 | 3.4× |
| Radiologic Exam Small Int Single Contrast Study (74250) | $1,031.80 | $1,876 | 5.5× |
| Radiologic exam swallow function contrast study (74230) | $670.45 | $1,219 | 3.6× |
| Radiologic exam upr gi trc double contrast study (74246) | $838.20 | $1,524 | 4.5× |
| Radiologic examination femur 1 view (73551) | $105.05 | $191 | 1.1× |
| Radiologic examination femur minimum 2 views (73552) | $285.45 | $519 | 3.1× |
| Radiologic examination knee 1/2 views (73560) | $377.30 | $686 | 4.0× |
| Radiologic Examination Osseous Survey Limited (77074) | $580.80 | $1,056 | 5.2× |
| Radiologic examination tibia & fibula 2 views (73590) range across 2 matching MRF lines |
$330.55–$453.20 | $601–$824 | varies |
| Radiopharmaceutical therapy, by interstitial radioactive colloid administration Facility (79300) | $479.05 | $871 | 1.9× |
| Ribs bilateral 3 views (71110) | $397.10 | $722 | 3.5× |
| Rp loclzj tum plnr 1 area single day imaging (78800) | $1,763.30 | $3,206 | 4.1× |
| Rp loclzj tum plnr 2+area 1+d img/1 area img>2+d (78801) | $1,813.90 | $3,298 | 4.2× |
| Rp Loclzj Tum Plnr Whole Body 2+ Days Imaging (78804) | $3,365.45 | $6,119 | 5.8× |
| Rp Loclzj Tum Plnr Whole Body Single Day Imaging (78802) | $2,552.55 | $4,641 | 4.4× |
| Rp Loclzj Tum Spect 1 Area Single Day Imaging (78803) | $2,968.35 | $5,397 | 5.1× |
| Rp Therapy Intravenous Administration (79101) | $1,032.90 | $1,878 | 4.1× |
| Salivary Gland Imaging (78230) | $950.40 | $1,728 | 2.2× |
| Scapula (73010) | $315.15 | $573 | 2.8× |
| Screening Digital Breast Tomosynthesis Bi (77063) range across 2 matching MRF lines |
$37.95–$74.80 | $69–$136 | varies |
| Sella turcica (70240) | $99.55 | $181 | 1.1× |
| Shoulder 1 view (73020) | $279.40 | $508 | 3.0× |
| Shoulder Arthrography (73040) | $755.15 | $1,373 | 2.0× |
| Sialogram (70390) | $842.05 | $1,531 | 3.3× |
| Skull less than 4 views (70250) | $493.35 | $897 | 4.4× |
| Special dosimetry (77331) | $233.20 | $424 | 1.6× |
| Special Physics Consult (77370) | $751.30 | $1,366 | 5.2× |
| Special teletherapy port plan (77321) | $1,095.05 | $1,991 | 2.7× |
| Special treatment procedure (77470) | $2,302.85 | $4,187 | 3.9× |
| Spleen Imaging (78185) | $1,157.20 | $2,104 | 2.7× |
| Stereotactic Body Radiation Delivery (77373) | $13,475 | $24,500 | 7.0× |
| Sternoclavicular joints (71130) | $444.95 | $809 | 4.8× |
| Telethx isodose pln cplx w/basic dosimetry (77307) | $1,617 | $2,940 | 4.0× |
| Telethx isodose pln smpl w/dosimetry calculation (77306) | $470.80 | $856 | 1.2× |
| Testicular Imaging W/Flow (78761) | $862.40 | $1,568 | 2.0× |
| Ther Rad Simulaj-Aided Field Setting Complex (77290) | $1,778.15 | $3,233 | 4.4× |
| Ther rad simulaj-aided field setting simple (77280) | $1,008.70 | $1,834 | 7.0× |
| Thoracic spine 2 views (72070) | $427.90 | $778 | 3.8× |
| Thoracic spine 3 views (72072) | $583.55 | $1,061 | 5.2× |
| Thoracolumbar 2 views (72080) | $130.90 | $238 | 1.4× |
| Thyroid Imaging With Vascular Flow (78013) | $926.20 | $1,684 | 2.2× |
| Thyroid Met Imaging Body (78018) | $1,482.80 | $2,696 | 2.5× |
| Thyroid Uptake Measurement (78012) | $732.60 | $1,332 | 1.7× |
| Thyroid Uptake W/Blood Flow Sngle/Mult Quan Meas (78014) | $2,033.90 | $3,698 | 4.7× |
| Tx Devices Design & Construction Complex (77334) | $1,213.30 | $2,206 | 3.0× |
| Tx devices design & construction simple (77332) | $264 | $480 | 1.8× |
| Ultrasound Breast Limited (76642) | $358.60 | $652 | 3.8× |
| Ultrasound Exam Aaa Screen (76706) | $432.85 | $787 | 3.9× |
| Ultrasound, abdomen limited (76705) | $1,010.35 | $1,837 | 9.0× |
| Umbilical-artery Doppler (OB) (76820) | $333.30 | $606 | 3.0× |
| Unlisted Dx Radiographic Procedure (76499) | $646.80 | $1,176 | 6.9× |
| Upper gi w/o kub (74240) | $838.20 | $1,524 | 4.5× |
| Urea Breath Test C-14 Isotopic Acquisj Analysis (78267) | $243.65 | $443 | 22.0× |
| Urea breath test c-14 isotopic analysis (78268) | $386.10 | $702 | 4.1× |
| Ureteral Reflux Study (78740) | $694.10 | $1,262 | 1.6× |
| Urethrocystogram voiding (74455) | $1,093.95 | $1,989 | 4.3× |
| Urethrocystography retrograde (74450) | $1,093.95 | $1,989 | 4.3× |
| Us breast unilateral complete (76641) | $505.45 | $919 | 4.5× |
| Us chest (76604) | $517.55 | $941 | 4.6× |
| Us complete joint (76881) | $849.20 | $1,544 | 7.6× |
| Us exam, pelvic, limited (76857) | $668.25 | $1,215 | 6.0× |
| Us head (76506) | $698.50 | $1,270 | 6.2× |
| Us kidney transplant (76776) | $904.20 | $1,644 | 8.1× |
| Us lmtd joint/oth nonvasc xtr strux r-t w/img (76882) | $405.90 | $738 | 3.6× |
| Us ob detailed single fetus (76811) | $799.70 | $1,454 | 3.1× |
| Us ob limited 1 or more fetuses (76815) | $662.75 | $1,205 | 5.9× |
| Us ob transvaginal (76817) | $488.95 | $889 | 4.4× |
| Us pelvic non ob complete (76856) | $1,009.25 | $1,835 | 9.0× |
| Us pg uter img f&mat 14 wk tabdl 1/1st gestation (76801) | $928.40 | $1,688 | 8.3× |
| Us preg uterus real time f/u trnsabdl per fetus (76816) range across 2 matching MRF lines |
$147.95–$633.60 | $269–$1,152 | varies |
| Us retroperitoneal complete (76770) | $933.90 | $1,698 | 8.3× |
| Us retroperitoneal limited (76775) | $628.10 | $1,142 | 5.6× |
| Us scrotum and contents (76870) | $996.05 | $1,811 | 8.9× |
| Us spinal canal and contents (76800) | $440 | $800 | 3.9× |
| Us thyroid (76536) | $1,102.20 | $2,004 | 9.8× |
| Us transrectal (76872) | $722.70 | $1,314 | 6.5× |
| Vascular Flow Imaging (78445) | $1,064.80 | $1,936 | 2.5× |
| Vein X-Ray Chest (75827) | $1,746.80 | $3,176 | 1.0× |
| Venogram Sinus/Jugular (75860) | $4,965.40 | $9,028 | 1.5× |
| Venography caval inferior serialography rs&i (75825) | $5,000.05 | $9,091 | 1.5× |
| Venography extremity bilateral rs&i (75822) | $3,475.45 | $6,319 | 2.1× |
| Venography extremity unilateral rs&i (75820) | $1,738 | $3,160 | 1.0× |
| Wrist 2 views (73100) range across 2 matching MRF lines |
$184.80–$350.35 | $336–$637 | varies |
| X-Ray Ac Jts - Xr Acromioclavicular Joints Bilateral (73050) | $371.80 | $676 | 4.0× |
| X-ray antegrade pyelogram tube (74425) | $696.30 | $1,266 | 1.9× |
| X-Ray Aorta Leg Arteries (75630) | $4,356 | $7,920 | 1.3× |
| X-Ray Bend Only L-S Spine (72120) | $355.85 | $647 | 3.2× |
| X-Ray Elbow 2 Vw - Xr Elbow 1-2 Views Right (73070) | $289.30 | $526 | 3.1× |
| X-Ray Exam Breast Specimen (76098) | $706.75 | $1,285 | 1.2× |
| X-Ray Exam Entire Spi 1 Vw (72081) | $606.10 | $1,102 | 6.5× |
| X-Ray Exam Entire Spi 2/3 Vw (72082) | $785.40 | $1,428 | 7.0× |
| X-Ray Exam Hip Uni 1 View (73501) | $285.45 | $519 | 3.1× |
| X-Ray Exam Hip Uni 2-3 Views (73502) | $376.20 | $684 | 4.0× |
| X-Ray Exam Hip Uni 4/> Views (73503) | $548.35 | $997 | 4.9× |
| X-Ray Exam Hips Bi 2 Views (73521) | $336.60 | $612 | 3.0× |
| X-Ray Exam Hips Bi 3-4 Views (73522) | $424.05 | $771 | 3.8× |
| X-Ray Exam Hips Bi 5/> Views (73523) | $655.05 | $1,191 | 5.8× |
| X-Ray Exam L-S Spine Bending (72114) | $882.20 | $1,604 | 7.9× |
| X-Ray Exam Neck Spine 2-3 Vw (72040) | $553.30 | $1,006 | 5.9× |
| X-Ray Exam Neck Spine 6/>Vws (72052) | $957 | $1,740 | 8.5× |
| X-Ray Exam Unilat Ribs/Chest (71101) | $460.35 | $837 | 4.1× |
| X-ray eye for foreign body (70030) | $264 | $480 | 2.8× |
| X-ray humerus (73060) range across 2 matching MRF lines |
$275–$410.30 | $500–$746 | varies |
| X-ray IV pyelogram (ivp) (74400) | $1,317.80 | $2,396 | 7.0× |
| X-ray IV pyelogram+tomography (74415) | $1,150.05 | $2,091 | 6.1× |
| X-Ray Jaw <4 Vw - Xr Mandible < 4 Views (70100) | $427.35 | $777 | 4.6× |
| X-Ray Knee Bilat Standing - Xr Knees Anteroposterior Standing Bilat (73565) | $512.60 | $932 | 5.5× |
| X-Ray Lumbar Spine 2/3 Vw - Xr Lumbar Spine 2-3 Views (72100) | $584.10 | $1,062 | 5.2× |
| X-ray nose-rectum child f.b. (76010) | $354.20 | $644 | 3.8× |
| X-Ray Ribs, Chest 4+ Vw - Xr Ribs 3 Vws Bil W/ Chest Posteroanterior (71111) | $775.50 | $1,410 | 6.9× |
| X-Ray Sacroiliac Jts 3+ Vw - Xr Sacroiliac Joints 3+ Views (72202) | $461.45 | $839 | 4.1× |
| X-Ray Sacroiliac Jts <3 Vw - Xr Sacroiliac Joints 1-2 Views (72200) | $422.95 | $769 | 3.8× |
| X-Ray Sacrum/Coccyx 2+ Vw - Xr Sacrum Coccyx 2+ Views (72220) | $440.55 | $801 | 4.7× |
| X-Ray Sinuses 3+ Vw - Xr Paranasal Sinuses 3+ Views (70220) | $432.85 | $787 | 4.6× |
| X-Ray Skull 4+ Vw - Xr Skull Complete 4+ Views (70260) | $585.75 | $1,065 | 5.2× |
| X-Ray Stress View (77071) | $569.80 | $1,036 | 6.1× |
| X-ray thoracic spine 4 vw (72074) | $613.25 | $1,115 | 5.5× |
| X-Ray Tmj Unilat (70328) | $218.90 | $398 | 2.3× |
| X-Ray Urinary Tract Exam With Contrast Material (74420) | $955.90 | $1,738 | 2.6× |
| X-Rays Bone Length Studies (77073) | $610.50 | $1,110 | 5.4× |
| X-Rays Bone Survey Complete (77075) | $666.05 | $1,211 | 5.9× |
| Xr c-spine 4 or 5 views (72050) | $757.90 | $1,378 | 6.8× |
| Xr facial bones less than 3 views (70140) | $422.95 | $769 | 4.5× |
| Xr orbits complete 4 views (70200) | $504.90 | $918 | 4.5× |
| Xr Tomogram Single Plane (76100) | $906.95 | $1,649 | 8.1× |
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.