Imaging prices at SSM Health St. Mary's Hospital - Madison
Madison, WI · every code in this section with a posted price and a Medicare benchmark.
360 codes. Prices are the hospital's own posted facility charges.
Compare against other hospitals interactively →
| Procedure | Posted cash | Posted gross | × Medicare |
|---|---|---|---|
| 3-D radiotherapy plan dose-volume histograms (77295) | $1,989.90 | $3,618 | 1.5× |
| Abdomen 1 View (74018) | $355.30 | $646 | 4.2× |
| Abdomen 2 views (74019) | $454.85 | $827 | 4.5× |
| Acute Gastrointestinal Blood Loss Imaging (78278) | $1,555.95 | $2,829 | 4.0× |
| Angio internal mammary (75756) | $2,587.20 | $4,704 | 0.8× |
| Angio pulmonary bilat (75743) | $3,598.65 | $6,543 | 1.2× |
| Angiography extremity bilateral rs&i (75716) | $2,684 | $4,880 | 0.9× |
| Angiography extremity unilateral rs&i (75710) | $2,477.75 | $4,505 | 0.8× |
| Angiography pulmonary unilateral slctv rs&i (75741) | $1,799.60 | $3,272 | 0.6× |
| Angrph pulmonary nonslctv cath/ven njx rs&i (75746) | $1,804 | $3,280 | 0.6× |
| Ankle 2 views (73600) | $266.20 | $484 | 3.1× |
| Aortography thoracic serialography rs&i (75605) | $3,215.85 | $5,847 | 0.6× |
| Artery X-Rays Abdomen (75726) | $3,335.75 | $6,065 | 0.6× |
| Artery X-Rays Adrenal Gland (75731) | $9,879.65 | $17,963 | 3.2× |
| Artery X-Rays Pelvis (75736) | $3,287.90 | $5,978 | 0.6× |
| Artery X-Rays Spine (75705) | $3,549.15 | $6,453 | 0.7× |
| Arthrogram ankle (73615) | $410.85 | $747 | 1.2× |
| Arthrogram hip (73525) | $487.30 | $886 | 1.4× |
| Arthrogram Wrist (73115) | $620.95 | $1,129 | 1.8× |
| Basic radiation dosimetry calculation (77300) | $129.80 | $236 | 1.0× |
| Bone age studies (77072) | $194.15 | $353 | 1.9× |
| Bone Imaging 3 Phase (78315) | $1,418.45 | $2,579 | 3.7× |
| Bone Imaging Limited Area (78300) | $861.85 | $1,567 | 2.2× |
| Bone Imaging Whole Body (78306) | $1,195.70 | $2,174 | 3.1× |
| Bone survey infant (77076) | $435.05 | $791 | 4.3× |
| Brain Imaging Min 4 Static Views W Vascular Flow (78606) | $1,378.30 | $2,506 | 2.6× |
| Brain Imaging Pet Metabolic Evaluation (78608) | $2,122.45 | $3,859 | 1.5× |
| Cardiac MRI w/w/o contrast & further seq (75561) | $2,593.80 | $4,716 | 7.7× |
| Cat Scan Follow-Up Study (76380) | $943.25 | $1,715 | 11.2× |
| Cerebrospinal Fluid Flow W/O Matl Shunt Evaltj (78645) | $1,186.35 | $2,157 | 2.2× |
| Cerebrospinal Fluid Scan (78630) | $1,177.55 | $2,141 | 2.2× |
| Chest 1 view (71045) | $244.20 | $444 | 2.9× |
| Chest 2 views (71046) | $266.20 | $484 | 3.1× |
| Chest 3 views (71047) | $309.65 | $563 | 3.7× |
| Chest 4 or more views (71048) | $330.55 | $601 | 3.3× |
| Clavicle complete (73000) | $309.10 | $562 | 3.7× |
| Continuing medical physics consltj pr wk (77336) | $283.25 | $515 | 2.2× |
| Contrast Exam Abdominl Aorta (75625) | $2,730.20 | $4,964 | 0.9× |
| Contrast X-Ray Bladder (74430) | $539.55 | $981 | 1.6× |
| Contrast X-Ray Of Elbow (73085) | $625.35 | $1,137 | 1.8× |
| Contrast X-Ray Of Knee Joint (73580) | $650.10 | $1,182 | 1.9× |
| CT abdomen and pelvis without and with contrast (74178) | $3,329.15 | $6,053 | 9.8× |
| CT abdomen and pelvis without contrast (74176) | $2,774.75 | $5,045 | 12.0× |
| CT abdomen w contrast (74160) | $1,727 | $3,140 | 10.1× |
| CT abdomen w wo contrast (74170) | $1,885.40 | $3,428 | 11.1× |
| CT abdomen w/o contrast (74150) | $1,570.25 | $2,855 | 15.5× |
| CT Angio Abdomen and Pelvis (74174) | $4,757.50 | $8,650 | 14.0× |
| CT Angio Chest (71275) | $3,617.90 | $6,578 | 21.2× |
| CT Angio Head (70496) | $2,058.65 | $3,743 | 12.1× |
| CT angio hrt w/3d image (75574) | $2,200 | $4,000 | 6.5× |
| Ct Angio Lwr Extr W/O&W/Dye (73706) | $2,340.80 | $4,256 | 13.7× |
| CT Angio Neck (70498) | $2,058.65 | $3,743 | 12.1× |
| Ct Angio Upr Extrm W/O&W/Dye (73206) | $2,583.35 | $4,697 | 15.2× |
| CT cervical spine w/ contrast (72126) | $1,673.65 | $3,043 | 4.9× |
| CT cervical spine w/o contrast (72125) | $1,593.90 | $2,898 | 15.7× |
| CT cervical spine w/wo cont (72127) | $1,775.40 | $3,228 | 10.4× |
| CT chest w contrast (71260) | $1,628.55 | $2,961 | 9.6× |
| CT chest w/wo contrast (71270) | $1,942.60 | $3,532 | 11.4× |
| CT colonography screening (74263) | $1,412.40 | $2,568 | 6.1× |
| CT Colonogrphy Dx Image Postprocess W/Contrast (74262) | $1,824.35 | $3,317 | 10.7× |
| CT colonogrphy dx image postprocess w/o contrast (74261) | $1,520.75 | $2,765 | 15.0× |
| CT head/brain with contrast (70460) | $1,138.50 | $2,070 | 6.7× |
| CT head/brain without and with contrast (70470) | $1,421.75 | $2,585 | 8.3× |
| CT heart contrast eval cardiac structure&morph (75572) | $4,446.20 | $8,084 | 13.1× |
| CT heart no contrast quant eval coronry calcium (75571) | $90.75 | $165 | 1.1× |
| CT iac w contrast (70481) | $1,146.75 | $2,085 | 6.7× |
| CT l-spine w&w/o contrast (72133) | $2,717.55 | $4,941 | 16.0× |
| CT lower ext w/o (73700) | $1,472.90 | $2,678 | 14.5× |
| CT lower extremity w/contrast material (73701) | $1,619.20 | $2,944 | 9.5× |
| CT lumbar spine w contrast (72132) | $2,491.50 | $4,530 | 7.4× |
| CT lumbar spine w/o contrast (72131) | $2,265.45 | $4,119 | 22.3× |
| CT maxillofacial w contrast (70487) | $1,459.70 | $2,654 | 8.6× |
| CT maxillofacial wo contrast (70486) | $1,048.30 | $1,906 | 10.3× |
| CT neck tissue combo (70492) | $1,074.70 | $1,954 | 6.3× |
| Ct Orbit/Ear/Fossa W/O&W/Dye (70482) | $1,282.05 | $2,331 | 7.5× |
| CT orbits w/o contrast (70480) | $1,068.10 | $1,942 | 10.5× |
| CT pelvis w&w/o contrast (72194) | $1,901.90 | $3,458 | 11.2× |
| CT pelvis w/o contrast (72192) | $1,585.65 | $2,883 | 15.6× |
| CT scan of leg combo (73702) | $1,765.50 | $3,210 | 10.4× |
| CT scans face/jaw combo (70488) | $1,713.25 | $3,115 | 10.1× |
| CT soft tissue neck w contrast (70491) | $860.20 | $1,564 | 5.0× |
| CT soft tissue neck w/o contrast (70490) | $784.85 | $1,427 | 7.7× |
| CT thoracic spine w contrast (72129) | $2,609.20 | $4,744 | 15.3× |
| CT thoracic spine w/o contrast (72128) | $2,371.60 | $4,312 | 23.4× |
| CT thoracic spine w/wo cont (72130) | $2,845.70 | $5,174 | 16.7× |
| CT thorax w/o contrast (71250) | $1,546.05 | $2,811 | 15.2× |
| CT upper ext wo (73200) | $1,543.30 | $2,806 | 15.2× |
| CT upper extremity w/o & w/contrast material (73202) | $1,851.30 | $3,366 | 10.9× |
| CT upper extremity with contrast (73201) | $1,697.85 | $3,087 | 5.0× |
| Cta Abdl Aorta&Bi Iliofem W/Contrast&Postp (75635) | $3,716.90 | $6,758 | 21.8× |
| Cta Abdomen (74175) | $2,859.45 | $5,199 | 16.8× |
| CTA pelvis (72191) | $2,859.45 | $5,199 | 16.8× |
| Dilation ureters/urethra rs&i (74485) | $1,531.20 | $2,784 | 0.8× |
| Discography Cerv/Thor Spine (72285) | $1,162.15 | $2,113 | 0.6× |
| Diskography lumbar (72295) | $1,260.05 | $2,291 | 0.7× |
| Doppler Echo Fetal Puls Spectral F/U/Repeat (76828) | $392.15 | $713 | 3.9× |
| Doppler Echo Fetal Spectral Display Complete (76827) | $910.80 | $1,656 | 9.0× |
| Doppler Fetal Mid Cerebral Artery (76821) | $925.65 | $1,683 | 9.1× |
| Echo exam of fetal heart (76825) | $1,251.80 | $2,276 | 2.4× |
| Echo exam uterus (76831) | $846.45 | $1,539 | 3.7× |
| Echo Guide For Artery Repair (76936) | $1,291.40 | $2,348 | 6.2× |
| Echocardiography, fetal, cardiovascular system, real time with image documentation (2D), with or without M-mode… (76826) | $916.85 | $1,667 | 4.0× |
| Esophagram (74220) | $518.65 | $943 | 3.0× |
| Fetal Biophysical Profile W/O Non-Stress Testing (76819) | $1,018.05 | $1,851 | 10.0× |
| Fetal MRI w/placntl matrnl plvc img sing/1st ges (74712) | $2,063.60 | $3,752 | 8.9× |
| Fluoroscopy up to 1 hr (76000) | $382.80 | $696 | 1.7× |
| Follow-Up Angiography (75898) | $547.80 | $996 | 0.2× |
| Foot 2 views (73620) | $218.90 | $398 | 2.6× |
| Forearm 2 views (73090) | $294.25 | $535 | 3.5× |
| Gastric emptying imaging study (78264) | $1,359.60 | $2,472 | 3.5× |
| Gated Heart Planar Single (78472) | $1,627.45 | $2,959 | 4.2× |
| Gated Heart, Multiple (78473) | $2,061.40 | $3,748 | 5.3× |
| Hand 2 views (73120) | $266.20 | $484 | 2.6× |
| Hepatc Vngrph Wdg/Fr Hemodyn Eval Rs&I (75889) | $3,683.90 | $6,698 | 1.2× |
| Hepatc Vngrph Wdg/Fr W/O Hemodyn Eval Rs&I (75891) | $3,683.90 | $6,698 | 1.2× |
| Hepatobil Syst Image W/Drug (78227) | $1,439.90 | $2,618 | 2.7× |
| Hepatobiliary System Imaging (78226) | $1,068.10 | $1,942 | 2.8× |
| Ht Musc Image Planar Mult (78454) | $1,016.95 | $1,849 | 0.8× |
| Ht Muscle Image Spect Sing (78451) | $2,270.95 | $4,129 | 1.8× |
| Hysterosalpingogram (74740) | $683.10 | $1,242 | 2.9× |
| Infant hip ultrasound with hip movement (dynamic) (76885) | $1,096.15 | $1,993 | 13.0× |
| Infant hip ultrasound, limited static exam (76886) | $860.20 | $1,564 | 10.2× |
| Joint Survey Single View (77077) | $295.90 | $538 | 2.9× |
| K Flow/Funct Image Multiple (78709) | $1,727.55 | $3,141 | 3.3× |
| K Flow/Funct Image W/Drug (78708) | $1,482.25 | $2,695 | 2.8× |
| K Flow/Funct Image W/O Drug (78707) | $1,176.45 | $2,139 | 2.2× |
| Kidney Imaging Morphol (78700) | $552.20 | $1,004 | 1.4× |
| Knee 3 Views (73562) | $359.15 | $653 | 4.2× |
| Leveen/Shunt Patency Exam (78291) | $1,021.90 | $1,858 | 2.6× |
| Liver & Spleen Imaging Static Only (78215) | $1,108.80 | $2,016 | 2.9× |
| Liver imaging static only (78201) | $1,013.65 | $1,843 | 1.9× |
| Lung Perf&Ventilat Diferentl (78598) | $2,002.55 | $3,641 | 3.8× |
| Lung perfusion differential (78597) | $1,256.75 | $2,285 | 3.2× |
| Lung Ventilat&Perfus Imaging (78582) | $2,048.20 | $3,724 | 3.9× |
| Lung Ventilation Imaging (78579) | $1,171.50 | $2,130 | 3.0× |
| Lymph System Imaging (78195) | $1,414.60 | $2,572 | 2.7× |
| Magnetic Image Jaw Joint (70336) | $2,533.30 | $4,606 | 10.9× |
| Mammary ductogram or galactogram multiple (77054) | $569.25 | $1,035 | 2.5× |
| Mammary ductogram or galactogram single (77053) | $408.10 | $742 | 1.8× |
| Meckels Divert Exam (78290) | $834.90 | $1,518 | 2.2× |
| Mlc imrt design & construction per imrt plan (77338) | $1,971.20 | $3,584 | 5.4× |
| Mra Head W/O & W/Contrast Material (70546) | $3,458.95 | $6,289 | 10.2× |
| MRA head w/o contrast (70544) | $2,425.50 | $4,410 | 10.5× |
| MRA head with contrast (70545) | $2,882.55 | $5,241 | 8.5× |
| Mra Neck W/O &W/Contrast Material (70549) | $2,746.70 | $4,994 | 8.1× |
| MRA neck w/o contrast (70547) | $1,947 | $3,540 | 8.4× |
| MRI abdomen w contrast (74182) | $2,490.40 | $4,528 | 7.3× |
| MRI abdomen w/o contrast (74181) | $2,357.30 | $4,286 | 10.2× |
| MRI any jt lower extrem w/contrast material (73722) | $2,396.90 | $4,358 | 3.1× |
| MRI any jt lower extrem w/o & w/contrast matrl (73723) | $2,614.70 | $4,754 | 7.7× |
| MRI any jt upper extremity w/contrast matrl (73222) | $2,982.10 | $5,422 | 3.9× |
| MRI brain functional w/o physician admnistration (70554) | $2,265.45 | $4,119 | 9.8× |
| MRI Breast W/O Contrast Bilateral (77047) | $907.50 | $1,650 | 3.9× |
| MRI Breast Without Contrast Material Unilateral (77046) | $454.30 | $826 | 2.0× |
| MRI cardiac w/o contrast (75557) | $2,439.80 | $4,436 | 10.5× |
| MRI cervical spine w contrast (72142) range across 2 matching MRF lines |
$1,959.10–$2,611.40 | $3,562–$4,748 | varies |
| MRI cervical spine w/o cont (72141) range across 2 matching MRF lines |
$1,780.90–$2,373.80 | $3,238–$4,316 | varies |
| MRI chest w/o contrast (71550) range across 2 matching MRF lines |
$2,537.70–$3,382.50 | $4,614–$6,150 | varies |
| MRI chest with contrast (71551) | $3,721.30 | $6,766 | 4.9× |
| MRI chest wo w contrast (71552) | $4,059 | $7,380 | 12.0× |
| MRI lower extrem oth/thn jt w/contrast matrl (73719) | $2,685.10 | $4,882 | 7.9× |
| MRI lower extrem oth/thn jt w/o & w/contr matr (73720) | $3,136.10 | $5,702 | 9.3× |
| MRI lower extrem oth/thn jt w/o contr matrl (73718) range across 2 matching MRF lines |
$1,529–$2,174.70 | $2,780–$3,954 | varies |
| MRI lumbar spine w contrast (72149) range across 2 matching MRF lines |
$2,068.55–$2,757.70 | $3,761–$5,014 | varies |
| Mri Neck Spine W/O & W/Dye (72156) | $2,849.55 | $5,181 | 8.4× |
| MRI orbit face &/neck w/o contrast (70540) | $2,217.05 | $4,031 | 9.6× |
| Mri Orbt/Fac/Nck W/O &W/Dye (70543) | $3,478.75 | $6,325 | 10.3× |
| MRI pelvis w contrast (72196) | $3,291.20 | $5,984 | 9.7× |
| MRI pelvis w/o & w contrast (72197) | $3,417.15 | $6,213 | 10.1× |
| MRI pelvis w/o contrast (72195) range across 2 matching MRF lines |
$1,426.70–$1,901.90 | $2,594–$3,458 | varies |
| MRI spectroscopy (76390) | $1,941.50 | $3,530 | 23.0× |
| MRI thoracic spine w/o contrast (72146) | $2,506.90 | $4,558 | 10.8× |
| MRI upper extremity oth than jt w/o contr matrl (73218) range across 2 matching MRF lines |
$1,529.55–$2,175.80 | $2,781–$3,956 | varies |
| Mri Uppr Extremity W/O&W/Dye (73220) | $3,223.55 | $5,861 | 9.5× |
| MRI, abdomen, combo (74183) | $2,999.15 | $5,453 | 8.9× |
| MRI, dorsal spine combo (72157) | $3,009.05 | $5,471 | 8.9× |
| MRI, dorsal spine contrast (72147) range across 2 matching MRF lines |
$2,068.55–$2,757.70 | $3,761–$5,014 | varies |
| MRI, joint upper extrem (73221) | $2,175.80 | $3,956 | 9.4× |
| MRI, joint upper extrem combo (73223) | $3,045.35 | $5,537 | 9.0× |
| MRI, lumbar spine combo (72158) | $3,009.05 | $5,471 | 8.9× |
| Myelogram cervical (72240) | $1,992.65 | $3,623 | 2.6× |
| Myelogram Lumbar (72265) | $2,086.70 | $3,794 | 2.7× |
| Myelography thoracic (72255) | $1,846.35 | $3,357 | 2.4× |
| Myelograpy 2/more regions rs&i (72270) | $2,252.80 | $4,096 | 3.0× |
| Myocardial Imaging Infarct Avid Planar Qual/Quan (78466) | $592.35 | $1,077 | 1.5× |
| Myocardial Spect Multiple Studies (78452) | $2,974.40 | $5,408 | 2.4× |
| Myocrd img PET prfuj 1std rest/stress cncrnt CT (78430) | $4,314.20 | $7,844 | 3.1× |
| Myocrd Img Pet Prfuj Mlt Std Rst&Strs Cncrnt CT (78431) | $4,713.50 | $8,570 | 2.2× |
| N-invas est c ffr sw aly CTA (75580) | $1,945.90 | $3,538 | 2.3× |
| Neck soft tissue (70360) | $243.10 | $442 | 2.9× |
| Nm csf leak detection (78650) | $1,317.80 | $2,396 | 1.0× |
| Ntsty modul radthx pln dose-vol histos (77301) | $7,544.90 | $13,718 | 5.6× |
| Nuclear Rx Intra-Arterial (79445) | $1,082.40 | $1,968 | 4.8× |
| Nuclear Rx Oral Admin (79005) | $1,833.15 | $3,333 | 8.1× |
| Ob us nuchal meas 1 gest (76813) | $574.75 | $1,045 | 5.7× |
| Panoramic X-ray of jaws (70355) | $406.45 | $739 | 4.8× |
| Parathyroid imaging w/tomographic spect & CT (78072) | $2,861.65 | $5,203 | 5.4× |
| Parathyroid Planar Imaging (78070) | $1,431.65 | $2,603 | 3.7× |
| Pelvis 1 or 2 views (72170) | $315.15 | $573 | 3.1× |
| Peritoneogram Rs&I (74190) | $735.35 | $1,337 | 1.4× |
| Pet Image W/Ct Lmtd (78814) | $4,085.40 | $7,428 | 2.9× |
| PET image w/CT, full body (78816) | $4,920.30 | $8,946 | 3.5× |
| PET imaging CT attenuation skull base mid-thigh (78815) | $4,848.80 | $8,816 | 3.5× |
| Pet Myocardial Sngl Study (78491) | $3,558.50 | $6,470 | 2.6× |
| Prq Transhepatc Portograpy Hemodyn Eval Rs&I (75885) | $3,170.75 | $5,765 | 1.0× |
| Pulmonary Perfusion Imaging Particulate (78580) | $1,065.35 | $1,937 | 2.7× |
| Radex Abd Compl Aqt Abd W/S/E/D Views 1 View Ch (74022) | $620.95 | $1,129 | 6.1× |
| Radex abscess/fistula/sinus tract rs&i (76080) | $521.40 | $948 | 1.0× |
| Radex Ankle Complete Minimum 3 Views (73610) | $351.45 | $639 | 4.2× |
| Radex Calcaneus Minimum 2 Views (73650) | $299.75 | $545 | 3.5× |
| Radex elbow complete minimum 3 views (73080) | $350.90 | $638 | 4.2× |
| Radex Facial Bones Complete Minimum 3 Views (70150) | $458.70 | $834 | 4.5× |
| Radex fingr minimum 2 views (73140) | $220.55 | $401 | 2.6× |
| Radex foot complete minimum 3 views (73630) | $356.95 | $649 | 4.2× |
| Radex Hand Minimum 3 Views (73130) | $282.15 | $513 | 3.3× |
| Radex lower extremity infant minimum 2 views (73592) | $255.75 | $465 | 3.0× |
| Radex Nasal Bones Complete Minimum 3 Views (70160) | $336.60 | $612 | 4.0× |
| Radex Ribs Unilateral 2 Views (71100) | $398.20 | $724 | 4.7× |
| Radex shoulder complete minimum 2 views (73030) | $386.10 | $702 | 4.6× |
| Radex Sinuses Paransl < 3 Views (70210) | $280.50 | $510 | 3.3× |
| Radex sm int w/mlt srl imges via enteroclss tube (74251) | $784.85 | $1,427 | 4.6× |
| Radex Spine 1 View Specify Level (72020) | $268.95 | $489 | 3.2× |
| Radex Sternum Minimum 2 Views (71120) | $326.15 | $593 | 3.9× |
| Radex Temporomandble Jt Opn & Clsd Mouth Bilat (70330) | $602.25 | $1,095 | 7.1× |
| Radex Toe Minimum 2 Views (73660) | $229.35 | $417 | 2.7× |
| Radex upper extremity infant minimum 2 views (73092) | $309.65 | $563 | 3.0× |
| Radex Wrist Complete Minimum 3 Views (73110) | $356.95 | $649 | 4.2× |
| Radiation treatment delivery level 1 (77402) | $289.30 | $526 | 2.9× |
| Radiation treatment delivery level 3 (77412) | $422.40 | $768 | 0.8× |
| Radiolog exam mandible compl minimum 4 views (70110) | $615.45 | $1,119 | 6.1× |
| Radiologic Exam Abdomen 3+ Views - Xr Abdomen 3+ Views (74021) | $568.15 | $1,033 | 5.6× |
| Radiologic exam colon double contrast study (74280) | $1,156.10 | $2,102 | 6.8× |
| Radiologic exam colon single contrast study (74270) | $871.75 | $1,585 | 5.1× |
| Radiologic Exam Esophagus Double Contrast Study (74221) | $571.45 | $1,039 | 3.4× |
| Radiologic exam knee complete 4/more views (73564) | $406.45 | $739 | 4.0× |
| Radiologic exam pelvis compl minimum 3 views (72190) | $473.55 | $861 | 4.7× |
| Radiologic Exam Small Int Single Contrast Study (74250) | $746.90 | $1,358 | 4.4× |
| Radiologic exam swallow function contrast study (74230) | $662.75 | $1,205 | 3.9× |
| Radiologic exam teeth complete full mouth (70320) | $362.45 | $659 | 1.6× |
| Radiologic Exam Teeth Prtl Exam < Full Mouth (70310) | $231 | $420 | 1.0× |
| Radiologic exam upr gi trc double contrast study (74246) | $652.85 | $1,187 | 3.8× |
| Radiologic examination femur 1 view (73551) | $245.30 | $446 | 2.9× |
| Radiologic examination femur minimum 2 views (73552) | $371.25 | $675 | 4.4× |
| Radiologic examination knee 1/2 views (73560) | $294.25 | $535 | 3.5× |
| Radiologic Examination Osseous Survey Limited (77074) | $405.35 | $737 | 4.0× |
| Radiologic Examination Salivary Gland Calculus (70380) | $394.90 | $718 | 4.7× |
| Radiologic examination tibia & fibula 2 views (73590) | $371.25 | $675 | 4.4× |
| Radiologic examination, teeth; single view Non-Facility (70300) | $80.30 | $146 | 0.9× |
| Red Cell Volume Determination Spx 1 Sampling (78120) | $626.45 | $1,139 | 1.6× |
| Renal Cyst Study (74470) | $424.05 | $771 | 0.8× |
| Ribs bilateral 3 views (71110) | $485.10 | $882 | 4.8× |
| Rp loclzj tum plnr 1 area single day imaging (78800) | $955.90 | $1,738 | 2.5× |
| Rp Loclzj Tum Plnr Whole Body 2+ Days Imaging (78804) | $1,492.15 | $2,713 | 2.8× |
| Rp Loclzj Tum Plnr Whole Body Single Day Imaging (78802) | $1,115.95 | $2,029 | 2.1× |
| Rp Loclzj Tum Spect 1 Area Single Day Imaging (78803) | $1,274.90 | $2,318 | 2.4× |
| Rp loclzj tum spect 2 area/sep acquisj img (78831) | $1,562 | $2,840 | 1.2× |
| Rp loclzj tum spect CT 2area 1d img/1 ar img>2+d (78832) | $1,975.60 | $3,592 | 1.4× |
| Rp loclzj tum spect w/CT 1 area/acquisj 1day img (78830) | $1,338.70 | $2,434 | 1.1× |
| Rp Therapy Intravenous Administration (79101) | $557.70 | $1,014 | 2.5× |
| Salivary Gland Imaging Serial Images (78231) | $649 | $1,180 | 1.7× |
| Scapula (73010) | $468.60 | $852 | 4.6× |
| Shoulder 1 view (73020) | $211.75 | $385 | 2.5× |
| Shoulder Arthrography (73040) | $625.35 | $1,137 | 1.8× |
| Skull less than 4 views (70250) | $376.75 | $685 | 3.7× |
| Special Physics Consult (77370) | $382.25 | $695 | 2.9× |
| Special treatment procedure (77470) | $400.40 | $728 | 0.7× |
| Stereotactic Body Radiation Delivery (77373) | $6,302.45 | $11,459 | 3.6× |
| Sternoclavicular joints (71130) | $366.30 | $666 | 4.3× |
| Superior sagittal sinus venogram (75870) | $1,721.50 | $3,130 | 0.6× |
| Telethx isodose pln cplx w/basic dosimetry (77307) | $388.85 | $707 | 1.1× |
| Telethx isodose pln smpl w/dosimetry calculation (77306) | $276.65 | $503 | 0.8× |
| Temporomandble Jt Arthrography Rs&I (70332) | $175.45 | $319 | 0.8× |
| Testicular Imaging W/Flow (78761) | $765.60 | $1,392 | 2.0× |
| Ther Rad Simulaj-Aided Field Setting Complex (77290) | $2,560.80 | $4,656 | 7.0× |
| Ther rad simulaj-aided field setting simple (77280) | $1,056 | $1,920 | 8.1× |
| Therapeutic Enema Rdctj Intussusception/Obstrcj (74283) | $1,012 | $1,840 | 5.9× |
| Thoracic spine 2 views (72070) | $403.70 | $734 | 4.0× |
| Thoracic spine 3 views (72072) | $414.15 | $753 | 4.1× |
| Thoracolumbar 2 views (72080) | $297.55 | $541 | 3.5× |
| Thyroid Imaging With Vascular Flow (78013) | $1,084.60 | $1,972 | 2.8× |
| Thyroid Met Imaging Body (78018) | $1,126.95 | $2,049 | 2.1× |
| Thyroid Uptake Measurement (78012) | $295.90 | $538 | 0.8× |
| Thyroid Uptake W/Blood Flow Sngle/Mult Quan Meas (78014) | $705.10 | $1,282 | 1.8× |
| Tx Devices Design & Construction Complex (77334) | $295.35 | $537 | 0.8× |
| Ultrasound Breast Limited (76642) range across 2 matching MRF lines |
$675.40–$1,349.70 | $1,228–$2,454 | varies |
| Ultrasound Exam Aaa Screen (76706) | $597.85 | $1,087 | 5.9× |
| Ultrasound, abdomen limited (76705) range across 2 matching MRF lines |
$822.25–$945.45 | $1,495–$1,719 | varies |
| Umbilical-artery Doppler (OB) (76820) | $830.50 | $1,510 | 8.2× |
| Unlisted fluoroscopic procedure (76496) | $364.10 | $662 | 4.3× |
| Unlisted magnetic resonance procedure (76498) | $2,706 | $4,920 | 32.0× |
| Unlisted us procedure (76999) | $227.15 | $413 | 2.7× |
| Upper gi w/o kub (74240) | $528.55 | $961 | 3.1× |
| Ureteral Reflux Study (78740) | $1,021.90 | $1,858 | 2.6× |
| Urethrocystogram voiding (74455) | $855.80 | $1,556 | 3.7× |
| Urethrocystography retrograde (74450) | $468.05 | $851 | 2.0× |
| Us breast unilateral complete (76641) | $723.80 | $1,316 | 7.1× |
| Us chest (76604) range across 2 matching MRF lines |
$650.65–$748 | $1,183–$1,360 | varies |
| Us complete joint (76881) | $770.55 | $1,401 | 7.6× |
| Us exam, pelvic, limited (76857) range across 2 matching MRF lines |
$415.80–$477.95 | $756–$869 | varies |
| Us head (76506) | $549.45 | $999 | 5.4× |
| Us kidney transplant (76776) | $1,045.55 | $1,901 | 10.3× |
| Us lmtd joint/oth nonvasc xtr strux r-t w/img (76882) range across 2 matching MRF lines |
$477.40–$548.90 | $868–$998 | varies |
| Us ob detailed single fetus (76811) | $2,101.55 | $3,821 | 9.1× |
| Us ob limited 1 or more fetuses (76815) | $677.05 | $1,231 | 6.7× |
| Us ob transvaginal (76817) | $812.90 | $1,478 | 8.0× |
| Us pelvic non ob complete (76856) | $1,041.15 | $1,893 | 10.3× |
| Us pg uter img f&mat 14 wk tabdl 1/1st gestation (76801) range across 2 matching MRF lines |
$676.50–$778.25 | $1,230–$1,415 | varies |
| Us preg uterus real time f/u trnsabdl per fetus (76816) | $644.05 | $1,171 | 6.3× |
| Us retroperitoneal complete (76770) | $1,012.55 | $1,841 | 10.0× |
| Us retroperitoneal limited (76775) | $777.15 | $1,413 | 7.7× |
| Us scrotum and contents (76870) | $785.40 | $1,428 | 7.7× |
| Us spinal canal and contents (76800) | $417.45 | $759 | 4.1× |
| Us thyroid (76536) | $859.65 | $1,563 | 8.5× |
| Us transrectal (76872) | $675.95 | $1,229 | 6.7× |
| Vein X-Ray Chest (75827) | $2,214.30 | $4,026 | 1.4× |
| Vein X-Ray Liver W/O Hemodyn (75887) | $2,166.45 | $3,939 | 0.7× |
| Vein X-Ray Spleen/Liver (75810) | $4,866.40 | $8,848 | 1.6× |
| Venogram Sinus/Jugular (75860) | $2,037.75 | $3,705 | 0.7× |
| Venography caval inferior serialography rs&i (75825) | $3,176.80 | $5,776 | 1.0× |
| Venography extremity bilateral rs&i (75822) | $3,388.55 | $6,161 | 2.2× |
| Venography extremity unilateral rs&i (75820) | $1,694.55 | $3,081 | 1.1× |
| Venography Renal Bilateral (75833) | $3,342.35 | $6,077 | 1.1× |
| Venography Renal Unilateral (75831) | $1,671.45 | $3,039 | 0.5× |
| Venous sampling by catheter (75893) | $2,858.90 | $5,198 | 0.5× |
| Wrist 2 views (73100) | $266.20 | $484 | 3.1× |
| X-Ray Ac Jts - Xr Acromioclavicular Joints Bilateral (73050) | $362.45 | $659 | 4.3× |
| X-ray antegrade pyelogram tube (74425) | $542.30 | $986 | 1.6× |
| X-Ray Aorta Leg Arteries (75630) | $4,286.70 | $7,794 | 1.4× |
| X-Ray Bend Only L-S Spine (72120) | $282.15 | $513 | 2.8× |
| X-Ray Elbow 2 Vw - Xr Elbow 1-2 Views Right (73070) | $266.20 | $484 | 3.1× |
| X-Ray Exam Breast Specimen (76098) | $288.20 | $524 | 0.5× |
| X-Ray Exam Entire Spi 1 Vw (72081) | $793.65 | $1,443 | 9.4× |
| X-Ray Exam Entire Spi 2/3 Vw (72082) | $1,119.80 | $2,036 | 11.0× |
| X-Ray Exam Hip Uni 1 View (73501) | $172.70 | $314 | 2.0× |
| X-Ray Exam Hip Uni 2-3 Views (73502) | $336.60 | $612 | 4.0× |
| X-Ray Exam Hip Uni 4/> Views (73503) | $359.15 | $653 | 3.5× |
| X-Ray Exam Hips Bi 2 Views (73521) | $287.65 | $523 | 2.8× |
| X-Ray Exam Hips Bi 3-4 Views (73522) | $436.15 | $793 | 4.3× |
| X-Ray Exam Hips Bi 5/> Views (73523) | $466.95 | $849 | 4.6× |
| X-Ray Exam Neck Spine 2-3 Vw (72040) | $426.80 | $776 | 5.0× |
| X-Ray Exam Neck Spine 6/>Vws (72052) | $663.30 | $1,206 | 6.5× |
| X-Ray Exam Unilat Ribs/Chest (71101) | $519.20 | $944 | 5.1× |
| X-ray eye for foreign body (70030) | $342.10 | $622 | 4.0× |
| X-ray humerus (73060) | $342.10 | $622 | 4.0× |
| X-ray IV pyelogram+tomography (74415) | $1,610.40 | $2,928 | 9.5× |
| X-Ray Jaw <4 Vw - Xr Mandible < 4 Views (70100) | $442.75 | $805 | 5.2× |
| X-Ray Knee Bilat Standing - Xr Knees Anteroposterior Standing Bilat (73565) | $261.80 | $476 | 3.1× |
| X-Ray Lumbar Spine 2/3 Vw - Xr Lumbar Spine 2-3 Views (72100) | $454.85 | $827 | 4.5× |
| X-ray nose-rectum child f.b. (76010) | $377.85 | $687 | 4.5× |
| X-Ray Ribs, Chest 4+ Vw - Xr Ribs 3 Vws Bil W/ Chest Posteroanterior (71111) | $519.75 | $945 | 5.1× |
| X-Ray Sacroiliac Jts 3+ Vw - Xr Sacroiliac Joints 3+ Views (72202) | $419.10 | $762 | 4.1× |
| X-Ray Sacrum/Coccyx 2+ Vw - Xr Sacrum Coccyx 2+ Views (72220) | $372.35 | $677 | 4.4× |
| X-Ray Sinuses 3+ Vw - Xr Paranasal Sinuses 3+ Views (70220) | $491.70 | $894 | 5.8× |
| X-Ray Skull 4+ Vw - Xr Skull Complete 4+ Views (70260) | $551.10 | $1,002 | 5.4× |
| X-Ray Urinary Tract Exam With Contrast Material (74420) | $801.35 | $1,457 | 2.4× |
| X-Rays Bone Length Studies (77073) | $504.90 | $918 | 5.0× |
| X-Rays Bone Survey Complete (77075) | $805.75 | $1,465 | 7.9× |
| Xr c-spine 4 or 5 views (72050) | $554.40 | $1,008 | 5.5× |
| Xr facial bones less than 3 views (70140) | $282.15 | $513 | 3.3× |
| Xr Tomogram Single Plane (76100) | $943.25 | $1,715 | 9.3× |
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.