Imaging prices at SSM Health St. Mary's Hospital - Jefferson City
Jefferson City, MO · every code in this section with a posted price and a Medicare benchmark.
342 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) | $3,723.75 | $6,770.46 | 2.7× |
| Abdomen 1 View (74018) | $187 | $340 | 2.1× |
| Abdomen 2 views (74019) | $315.70 | $574 | 3.0× |
| Acute Gastrointestinal Blood Loss Imaging (78278) | $1,124.64 | $2,044.80 | 2.8× |
| Angio pulmonary bilat (75743) | $4,470.84 | $8,128.80 | 1.4× |
| Angiography extremity bilateral rs&i (75716) | $3,649.14 | $6,634.80 | 1.2× |
| Angiography extremity unilateral rs&i (75710) | $2,816.88 | $5,121.60 | 0.9× |
| Angiography pulmonary unilateral slctv rs&i (75741) | $2,235.42 | $4,064.40 | 0.7× |
| Ankle 2 views (73600) range across 2 matching MRF lines |
$212.85–$225.50 | $387–$410 | varies |
| Aortography thoracic serialography rs&i (75605) | $2,929.74 | $5,326.80 | 0.5× |
| Aortography thoracic w/o serialography rs&i (75600) | $2,929.74 | $5,326.80 | 0.9× |
| Artery X-Rays Abdomen (75726) | $5,216.64 | $9,484.80 | 0.9× |
| Artery X-Rays Pelvis (75736) | $3,719.76 | $6,763.20 | 0.7× |
| Artery X-Rays Spine (75705) | $3,113 | $5,660 | 0.6× |
| Arthrogram hip (73525) | $708.18 | $1,287.60 | 2.0× |
| Arthrogram Wrist (73115) | $506 | $920 | 1.4× |
| Basic radiation dosimetry calculation (77300) | $358.05 | $651 | 2.7× |
| Bone age studies (77072) | $610.50 | $1,110 | 5.8× |
| Bone Imaging 3 Phase (78315) | $1,124.64 | $2,044.80 | 2.8× |
| Bone Imaging Limited Area (78300) | $784.08 | $1,425.60 | 2.0× |
| Bone Imaging Multiple Areas (78305) | $827.64 | $1,504.80 | 2.1× |
| Bone Imaging Whole Body (78306) | $999.90 | $1,818 | 2.5× |
| Bone survey infant (77076) | $695.64 | $1,264.80 | 6.6× |
| Brachytx isodose complex (77318) | $540.97 | $983.58 | 1.4× |
| Brachytx isodose intermed (77317) | $540.97 | $983.58 | 1.4× |
| Brachytx Isodose Plan Simple (77316) | $232.49 | $422.71 | 0.6× |
| Brain Flow Imaging Only (78610) | $981.42 | $1,784.40 | 1.8× |
| Brain Imaging Min 4 Static Views W Vascular Flow (78606) | $1,061.94 | $1,930.80 | 2.0× |
| Brain Imaging Pet Metabolic Evaluation (78608) | $4,161.30 | $7,566 | 2.9× |
| Cat Scan Follow-Up Study (76380) | $339.24 | $616.80 | 3.9× |
| Cerebrospinal Fluid Scan (78630) | $1,175.46 | $2,137.20 | 2.2× |
| Chest 1 view (71045) | $263.64 | $479.35 | 3.0× |
| Chest 2 views (71046) | $278.97 | $507.22 | 3.2× |
| Chest 3 views (71047) | $317.60 | $577.46 | 3.6× |
| Chest 4 or more views (71048) | $348.87 | $634.31 | 3.3× |
| Clavicle complete (73000) | $308.88 | $561.60 | 3.5× |
| Computed Tomography Thorax Lw Dose Lng Ca Scr C- (71271) | $293.04 | $532.80 | 2.8× |
| Continuing medical physics consltj pr wk (77336) | $419.94 | $763.53 | 3.1× |
| Contrast Exam Abdominl Aorta (75625) | $3,502.62 | $6,368.40 | 1.1× |
| Contrast X-Ray Bladder (74430) range across 2 matching MRF lines |
$639.54–$798.60 | $1,162.80–$1,452 | varies |
| Contrast X-Ray Of Elbow (73085) | $1,046.10 | $1,902 | 3.0× |
| Contrast X-Ray Of Knee Joint (73580) | $487.85 | $887 | 1.4× |
| CT abdomen and pelvis without and with contrast (74178) | $2,362.14 | $4,294.80 | 6.8× |
| CT abdomen and pelvis without contrast (74176) | $1,873.08 | $3,405.60 | 7.8× |
| CT abdomen w contrast (74160) | $1,058.64 | $1,924.80 | 6.0× |
| CT abdomen w wo contrast (74170) | $1,302.84 | $2,368.80 | 7.4× |
| CT abdomen w/o contrast (74150) | $895.62 | $1,628.40 | 8.6× |
| CT Angio Abdomen and Pelvis (74174) | $1,302.84 | $2,368.80 | 3.7× |
| CT Angio Chest (71275) | $1,873.08 | $3,405.60 | 10.7× |
| CT Angio Head (70496) | $1,191.96 | $2,167.20 | 6.8× |
| CT angio hrt w/3d image (75574) | $648.12 | $1,178.40 | 1.9× |
| Ct Angio Lwr Extr W/O&W/Dye (73706) | $1,302.84 | $2,368.80 | 7.4× |
| CT Angio Neck (70498) | $968.88 | $1,761.60 | 5.5× |
| Ct Angio Upr Extrm W/O&W/Dye (73206) | $1,302.84 | $2,368.80 | 7.4× |
| CT cervical spine w/ contrast (72126) | $968.88 | $1,761.60 | 2.8× |
| CT cervical spine w/o contrast (72125) | $819.72 | $1,490.40 | 7.8× |
| CT cervical spine w/wo cont (72127) | $1,191.96 | $2,167.20 | 6.8× |
| CT chest w contrast (71260) | $1,058.64 | $1,924.80 | 6.0× |
| CT chest w/wo contrast (71270) | $1,302.84 | $2,368.80 | 7.4× |
| CT head/brain with contrast (70460) | $1,043.46 | $1,897.20 | 5.9× |
| CT head/brain without and with contrast (70470) | $1,191.96 | $2,167.20 | 6.8× |
| CT heart no contrast quant eval coronry calcium (75571) | $81.18 | $147.60 | 0.9× |
| CT iac w contrast (70481) | $968.88 | $1,761.60 | 5.5× |
| CT l-spine w&w/o contrast (72133) | $1,302.84 | $2,368.80 | 7.4× |
| CT lower ext w/o (73700) | $844.80 | $1,536 | 8.1× |
| CT lower extremity w/contrast material (73701) | $998.58 | $1,815.60 | 5.7× |
| CT lumbar spine w contrast (72132) | $1,058.64 | $1,924.80 | 3.0× |
| CT lumbar spine w/o contrast (72131) | $895.62 | $1,628.40 | 8.6× |
| CT maxillofacial w contrast (70487) | $968.88 | $1,761.60 | 5.5× |
| CT maxillofacial wo contrast (70486) | $819.72 | $1,490.40 | 7.8× |
| CT neck tissue combo (70492) | $1,228.92 | $2,234.40 | 7.0× |
| Ct Orbit/Ear/Fossa W/O&W/Dye (70482) | $1,191.96 | $2,167.20 | 6.8× |
| CT orbits w/o contrast (70480) | $819.72 | $1,490.40 | 7.8× |
| CT pelvis w&w/o contrast (72194) | $1,085.70 | $1,974 | 6.2× |
| CT pelvis w/o contrast (72192) | $746.35 | $1,357 | 7.1× |
| CT scan of leg combo (73702) | $1,228.92 | $2,234.40 | 7.0× |
| CT scans face/jaw combo (70488) | $1,191.96 | $2,167.20 | 6.8× |
| CT soft tissue neck w contrast (70491) | $998.58 | $1,815.60 | 5.7× |
| CT soft tissue neck w/o contrast (70490) | $844.80 | $1,536 | 8.1× |
| CT thoracic spine w contrast (72129) | $998.58 | $1,815.60 | 5.7× |
| CT thoracic spine w/o contrast (72128) | $844.80 | $1,536 | 8.1× |
| CT thoracic spine w/wo cont (72130) | $1,228.92 | $2,234.40 | 7.0× |
| CT thorax w/o contrast (71250) range across 2 matching MRF lines |
$197.45–$895.62 | $359–$1,628.40 | varies |
| CT upper ext wo (73200) | $895.62 | $1,628.40 | 8.6× |
| CT upper extremity w/o & w/contrast material (73202) | $1,302.84 | $2,368.80 | 7.4× |
| CT upper extremity with contrast (73201) | $1,058.64 | $1,924.80 | 3.0× |
| Cta Abdl Aorta&Bi Iliofem W/Contrast&Postp (75635) | $1,791.90 | $3,258 | 10.2× |
| Cta Abdomen (74175) | $1,302.84 | $2,368.80 | 7.4× |
| CTA pelvis (72191) | $895.62 | $1,628.40 | 5.1× |
| Dilation ureters/urethra rs&i (74485) | $1,980.66 | $3,601.20 | 0.9× |
| Discography Cerv/Thor Spine (72285) | $6,099.72 | $11,090.40 | 3.1× |
| Diskography lumbar (72295) | $6,102.36 | $11,095.20 | 3.1× |
| Dxa Bone Density Axial (77080) | $224.40 | $408 | 2.1× |
| Dxa bone density study 1/>sites appendiclr skel (77081) | $166.98 | $303.60 | 1.9× |
| Echo Guide For Artery Repair (76936) | $607.20 | $1,104 | 2.8× |
| Echograp Trans R Pros Study (76873) | $615.34 | $1,118.80 | 5.9× |
| Esophagram (74220) | $422.95 | $769 | 2.4× |
| Fetal Biophys Profile W/Nst (76818) | $509.99 | $927.26 | 4.9× |
| Fetal Biophysical Profile W/O Non-Stress Testing (76819) | $509.99 | $927.26 | 4.9× |
| Fluoroscopy up to 1 hr (76000) | $551.76 | $1,003.20 | 2.3× |
| Follow-Up Angiography (75898) | $752.40 | $1,368 | 0.2× |
| Foot 2 views (73620) | $151.80 | $276 | 1.7× |
| Forearm 2 views (73090) | $225.50 | $410 | 2.6× |
| Gastric emptying imaging study (78264) | $999.90 | $1,818 | 2.5× |
| Gated Heart Planar Single (78472) | $1,626.24 | $2,956.80 | 4.1× |
| Hand 2 views (73120) | $166.65 | $303 | 1.6× |
| Hdr Rdncl Ntrstl/Icav Brchtx (77772) | $2,251.70 | $4,094 | 3.2× |
| Hdr Rdncl Ntrstl/Icav Brchtx (77771) | $1,958.98 | $3,561.78 | 2.8× |
| Hdr Rdncl Ntrstl/Icav Brchtx 1 Channel (77770) | $1,607.15 | $2,922.09 | 2.3× |
| Hepatobil Syst Image W/Drug (78227) | $1,118.04 | $2,032.80 | 2.1× |
| Hepatobiliary System Imaging (78226) | $869.22 | $1,580.40 | 2.2× |
| Ht Musc Image Planar Mult (78454) | $2,090.88 | $3,801.60 | 1.6× |
| Ht Muscle Image Spect Sing (78451) | $2,432.76 | $4,423.20 | 1.9× |
| Hysterosalpingogram (74740) | $1,044.78 | $1,899.60 | 4.4× |
| Image fusion (77399) | $252.75 | $459.55 | 1.9× |
| Infant hip ultrasound with hip movement (dynamic) (76885) | $337 | $612.73 | 3.9× |
| Infant hip ultrasound, limited static exam (76886) | $304.68 | $553.96 | 3.5× |
| Interstitial radiation source applic complex (77778) | $7,309.59 | $13,290.16 | 10.5× |
| Joint Survey Single View (77077) | $121.44 | $220.80 | 1.2× |
| K Flow/Funct Image W/Drug (78708) | $1,061.94 | $1,930.80 | 2.0× |
| K Flow/Funct Image W/O Drug (78707) | $1,061.94 | $1,930.80 | 2.0× |
| Kidney Imaging Morphol (78700) | $498.30 | $906 | 1.2× |
| Kidney Imaging Morphoogy W/Vascular Flow (78701) | $767.58 | $1,395.60 | 1.9× |
| Knee 3 Views (73562) | $253.55 | $461 | 2.9× |
| Leveen/Shunt Patency Exam (78291) | $807.84 | $1,468.80 | 2.0× |
| Liver & Spleen Imaging Static Only (78215) | $884.40 | $1,608 | 2.2× |
| Liver imaging static only (78201) | $693.66 | $1,261.20 | 1.3× |
| Lung Perf&Ventilat Diferentl (78598) | $817.08 | $1,485.60 | 1.5× |
| Lung Ventilat&Perfus Imaging (78582) | $1,061.94 | $1,930.80 | 2.0× |
| Lung Ventilation Imaging (78579) | $772.86 | $1,405.20 | 1.9× |
| Lymph System Imaging (78195) | $1,088.34 | $1,978.80 | 2.0× |
| Magnetic Image Jaw Joint (70336) | $1,149.06 | $2,089.20 | 4.8× |
| Mammary ductogram or galactogram single (77053) | $273.45 | $497.19 | 1.1× |
| Meckels Divert Exam (78290) | $969.54 | $1,762.80 | 2.4× |
| Mlc imrt design & construction per imrt plan (77338) | $1,477.68 | $2,686.69 | 3.9× |
| Mra Head W/O & W/Contrast Material (70546) | $1,399.86 | $2,545.20 | 4.0× |
| MRA head w/o contrast (70544) | $957.66 | $1,741.20 | 4.0× |
| MRA head with contrast (70545) | $1,179.42 | $2,144.40 | 3.4× |
| MRA neck w contrast (70548) | $1,399.86 | $2,545.20 | 4.0× |
| Mra Neck W/O &W/Contrast Material (70549) | $1,842.72 | $3,350.40 | 5.3× |
| MRA neck w/o contrast (70547) | $957.66 | $1,741.20 | 4.0× |
| MRI abdomen w/o contrast (74181) | $1,180.08 | $2,145.60 | 4.9× |
| MRI any jt lower extrem w/contrast material (73722) | $1,366.20 | $2,484 | 1.7× |
| MRI any jt lower extrem w/o & w/contrast matrl (73723) | $1,552.32 | $2,822.40 | 4.4× |
| MRI any jt upper extremity w/contrast matrl (73222) | $1,366.20 | $2,484 | 1.7× |
| MRI Breast W/O Contrast Bilateral (77047) | $778.80 | $1,416 | 3.3× |
| MRI Breast Without Contrast Material Unilateral (77046) | $467.28 | $849.60 | 2.0× |
| MRI cervical spine w contrast (72142) range across 2 matching MRF lines |
$1,326.60–$1,547.04 | $2,412–$2,812.80 | varies |
| MRI cervical spine w/o cont (72141) | $1,399.86 | $2,545.20 | 5.9× |
| MRI chest w/o contrast (71550) range across 2 matching MRF lines |
$1,118.04–$1,149.06 | $2,032.80–$2,089.20 | varies |
| MRI chest with contrast (71551) | $1,304.16 | $2,371.20 | 1.7× |
| MRI chest wo w contrast (71552) | $1,521.96 | $2,767.20 | 4.4× |
| MRI lower extrem oth/thn jt w/contrast matrl (73719) | $1,304.16 | $2,371.20 | 3.7× |
| MRI lower extrem oth/thn jt w/o & w/contr matr (73720) | $1,552.32 | $2,822.40 | 4.4× |
| MRI lower extrem oth/thn jt w/o contr matrl (73718) | $1,180.08 | $2,145.60 | 4.9× |
| MRI lumbar spine w contrast (72149) | $1,086.80 | $1,976 | 3.1× |
| Mri Neck Spine W/O & W/Dye (72156) | $1,842.72 | $3,350.40 | 5.3× |
| MRI orbit face &/neck w/o contrast (70540) | $957.66 | $1,741.20 | 4.0× |
| MRI orbit face neck w contrast (70542) | $1,326.60 | $2,412 | 3.8× |
| Mri Orbt/Fac/Nck W/O &W/Dye (70543) | $1,842.72 | $3,350.40 | 5.3× |
| MRI pelvis w contrast (72196) | $1,304.16 | $2,371.20 | 3.7× |
| MRI pelvis w/o & w contrast (72197) | $1,552.32 | $2,822.40 | 4.4× |
| MRI pelvis w/o contrast (72195) range across 2 matching MRF lines |
$1,118.04–$1,180.08 | $2,032.80–$2,145.60 | varies |
| MRI thoracic spine w/o contrast (72146) | $1,180.08 | $2,145.60 | 4.9× |
| MRI upper extremity oth than jt w/o contr matrl (73218) | $1,180.08 | $2,145.60 | 4.9× |
| Mri Uppr Extremity W/O&W/Dye (73220) | $1,552.32 | $2,822.40 | 4.4× |
| MRI, abdomen, combo (74183) | $1,552.32 | $2,822.40 | 4.4× |
| MRI, dorsal spine combo (72157) | $1,552.32 | $2,822.40 | 4.4× |
| MRI, dorsal spine contrast (72147) range across 2 matching MRF lines |
$1,118.04–$1,304.16 | $2,032.80–$2,371.20 | varies |
| MRI, joint upper extrem (73221) | $1,180.08 | $2,145.60 | 4.9× |
| MRI, joint upper extrem combo (73223) | $1,552.32 | $2,822.40 | 4.4× |
| MRI, lumbar spine combo (72158) | $1,293.60 | $2,352 | 3.7× |
| Myelogram cervical (72240) | $938.52 | $1,706.40 | 1.2× |
| Myelogram Lumbar (72265) | $815.10 | $1,482 | 1.0× |
| Myelography thoracic (72255) | $938.52 | $1,706.40 | 1.2× |
| Myelograpy 2/more regions rs&i (72270) | $979.44 | $1,780.80 | 1.2× |
| Myocardial Imaging Infarct Avid Planar Qual/Quan (78466) | $605.22 | $1,100.40 | 1.5× |
| Myocardial Imaging Pet Metabolic Evaluation (78459) | $2,090.88 | $3,801.60 | 1.6× |
| Myocardial Spect Multiple Studies (78452) | $2,880.90 | $5,238 | 2.2× |
| Neck soft tissue (70360) | $317.46 | $577.20 | 3.6× |
| Nfs/Instlj Radioelmnt Sln 3 Mo Follow-Up Care (77750) | $379.97 | $690.86 | 1.0× |
| Nm myocard infarct spect (78469) | $808.50 | $1,470 | 1.5× |
| Nm unlisted gi procedure (78299) | $596.64 | $1,084.80 | 1.5× |
| Ntsty modul radthx pln dose-vol histos (77301) | $4,196.61 | $7,630.20 | 3.0× |
| Nuclear Rx Oral Admin (79005) | $1,061.94 | $1,930.80 | 4.5× |
| Panoramic X-ray of jaws (70355) | $278.52 | $506.40 | 3.2× |
| Parathyroid imaging w/tomographic spect & CT (78072) | $839.52 | $1,526.40 | 1.5× |
| Parathyroid Planar Imaging (78070) | $694.98 | $1,263.60 | 1.7× |
| Parathyroid planar imaging w/wo subtraction (78071) | $812.46 | $1,477.20 | 2.0× |
| Pelvis 1 or 2 views (72170) | $253.55 | $461 | 2.4× |
| Pet Image W/Ct Lmtd (78814) | $2,447.94 | $4,450.80 | 1.7× |
| PET image w/CT, full body (78816) | $3,841.20 | $6,984 | 2.7× |
| PET imaging CT attenuation skull base mid-thigh (78815) | $3,521.10 | $6,402 | 2.5× |
| Plasma volume, radiopharmaceutical volume-dilution technique (separate procedure); single sampling Non-Facility (78110) | $1,197.90 | $2,178 | 0.9× |
| Pulmonary Perfusion Imaging Particulate (78580) | $812.46 | $1,477.20 | 2.0× |
| Radex Abd Compl Aqt Abd W/S/E/D Views 1 View Ch (74022) | $347.60 | $632 | 3.3× |
| Radex abscess/fistula/sinus tract rs&i (76080) | $362.34 | $658.80 | 0.7× |
| Radex Ankle Complete Minimum 3 Views (73610) | $244.75 | $445 | 2.8× |
| Radex Calcaneus Minimum 2 Views (73650) | $209 | $380 | 2.4× |
| Radex elbow complete minimum 3 views (73080) | $253.55 | $461 | 2.9× |
| Radex Facial Bones Complete Minimum 3 Views (70150) | $409.86 | $745.20 | 3.9× |
| Radex fingr minimum 2 views (73140) range across 2 matching MRF lines |
$193.05–$199.65 | $351–$363 | varies |
| Radex foot complete minimum 3 views (73630) | $272.25 | $495 | 3.1× |
| Radex Hand Minimum 3 Views (73130) | $247.50 | $450 | 2.8× |
| Radex lower extremity infant minimum 2 views (73592) | $186.78 | $339.60 | 2.1× |
| Radex Nasal Bones Complete Minimum 3 Views (70160) | $293.70 | $534 | 3.4× |
| Radex Ribs Unilateral 2 Views (71100) | $244.75 | $445 | 2.8× |
| Radex shoulder complete minimum 2 views (73030) | $257.40 | $468 | 3.0× |
| Radex Sinuses Paransl < 3 Views (70210) | $275.22 | $500.40 | 3.2× |
| Radex sm int w/mlt srl imges via enteroclss tube (74251) | $689.70 | $1,254 | 3.9× |
| Radex Spine 1 View Specify Level (72020) | $246.84 | $448.80 | 2.8× |
| Radex Sternum Minimum 2 Views (71120) | $293.70 | $534 | 3.4× |
| Radex Temporomandble Jt Opn & Clsd Mouth Bilat (70330) | $267.30 | $486 | 3.1× |
| Radex Toe Minimum 2 Views (73660) range across 2 matching MRF lines |
$163.68–$200.64 | $297.60–$364.80 | varies |
| Radex upper extremity infant minimum 2 views (73092) | $229.02 | $416.40 | 2.2× |
| Radex Wrist Complete Minimum 3 Views (73110) | $246.95 | $449 | 2.8× |
| Radiation Delivery Stereotactic Cranial Linear (77372) | $7,703.07 | $14,005.58 | 1.0× |
| Radiation treatment delivery level 1 (77402) | $184.80 | $336 | 1.8× |
| Radiation treatment delivery level 2 (77407) | $193.60 | $352 | 0.5× |
| Radiation treatment delivery level 3 (77412) | $375.65 | $683 | 0.7× |
| Radiolog exam mandible compl minimum 4 views (70110) | $378.84 | $688.80 | 3.6× |
| Radiologic exam colon double contrast study (74280) | $1,032.90 | $1,878 | 5.9× |
| Radiologic exam colon single contrast study (74270) | $590.04 | $1,072.80 | 3.4× |
| Radiologic exam knee complete 4/more views (73564) | $336.05 | $611 | 3.2× |
| Radiologic exam pelvis compl minimum 3 views (72190) | $255.20 | $464 | 2.4× |
| Radiologic Exam Small Int Single Contrast Study (74250) | $648.12 | $1,178.40 | 3.7× |
| Radiologic exam swallow function contrast study (74230) | $468.60 | $852 | 2.7× |
| Radiologic exam upr gi trc double contrast study (74246) | $989.34 | $1,798.80 | 5.6× |
| Radiologic examination femur 1 view (73551) | $101.20 | $184 | 1.2× |
| Radiologic examination femur minimum 2 views (73552) | $253.55 | $461 | 2.9× |
| Radiologic examination knee 1/2 views (73560) | $190.30 | $346 | 2.2× |
| Radiologic Examination Osseous Survey Limited (77074) | $456.06 | $829.20 | 4.4× |
| Radiologic examination tibia & fibula 2 views (73590) | $250.80 | $456 | 2.9× |
| Red Cell Volume Determination Spx 1 Sampling (78120) | $1,705.44 | $3,100.80 | 4.3× |
| Ribs bilateral 3 views (71110) | $401.28 | $729.60 | 3.8× |
| Rp loclzj tum plnr 1 area single day imaging (78800) | $687.72 | $1,250.40 | 1.7× |
| Rp loclzj tum plnr 2+area 1+d img/1 area img>2+d (78801) | $1,004.52 | $1,826.40 | 2.5× |
| Rp Loclzj Tum Plnr Whole Body 2+ Days Imaging (78804) | $1,499.52 | $2,726.40 | 2.8× |
| Rp Loclzj Tum Spect 1 Area Single Day Imaging (78803) | $1,837.44 | $3,340.80 | 3.4× |
| Rp loclzj tum spect 2 area/sep acquisj img (78831) | $2,811.60 | $5,112 | 2.2× |
| Rp loclzj tum spect w/CT 1 area/acquisj 1day img (78830) | $1,999.14 | $3,634.80 | 1.5× |
| Rp Therapy Intravenous Administration (79101) | $1,114.74 | $2,026.80 | 4.8× |
| Scapula (73010) | $285.78 | $519.60 | 2.7× |
| Screening Digital Breast Tomosynthesis Bi (77063) range across 2 matching MRF lines |
$42.31–$84.61 | $76.92–$153.84 | varies |
| Shoulder 1 view (73020) | $145.75 | $265 | 1.7× |
| Shoulder Arthrography (73040) | $588.06 | $1,069.20 | 1.7× |
| Sialogram (70390) | $842.82 | $1,532.40 | 3.5× |
| Skull less than 4 views (70250) | $440.22 | $800.40 | 4.2× |
| Special dosimetry (77331) | $329.31 | $598.75 | 2.4× |
| Special Physics Consult (77370) | $372.66 | $677.56 | 2.8× |
| Special teletherapy port plan (77321) | $709.29 | $1,289.61 | 1.9× |
| Special treatment procedure (77470) | $1,595.89 | $2,901.62 | 2.9× |
| Stereotactic Body Radiation Delivery (77373) | $6,930 | $12,600 | 3.9× |
| Sternoclavicular joints (71130) | $308.88 | $561.60 | 3.5× |
| Telethx isodose pln cplx w/basic dosimetry (77307) | $514.51 | $935.48 | 1.4× |
| Telethx isodose pln smpl w/dosimetry calculation (77306) | $289.90 | $527.10 | 0.8× |
| Ther Rad Simulaj-Aided Field Setting Complex (77290) | $1,182.14 | $2,149.35 | 3.2× |
| Ther Rad Simulaj-Aided Field Setting Intermed (77285) | $567.43 | $1,031.69 | 1.5× |
| Ther rad simulaj-aided field setting simple (77280) | $542.10 | $985.63 | 4.0× |
| Thoracic spine 2 views (72070) | $165 | $300 | 1.6× |
| Thoracic spine 3 views (72072) | $302.50 | $550 | 2.9× |
| Thoracolumbar 2 views (72080) | $269.94 | $490.80 | 3.1× |
| Thyroid Imaging With Vascular Flow (78013) | $344.52 | $626.40 | 0.9× |
| Thyroid Met Imaging Body (78018) | $1,499.52 | $2,726.40 | 2.8× |
| Thyroid Uptake Measurement (78012) | $463.98 | $843.60 | 1.2× |
| Thyroid Uptake W/Blood Flow Sngle/Mult Quan Meas (78014) | $999.90 | $1,818 | 2.5× |
| Tx Devices Design & Construction Complex (77334) | $768.39 | $1,397.08 | 2.0× |
| Tx devices design & construction intermediate (77333) | $502.69 | $913.99 | 3.7× |
| Tx devices design & construction simple (77332) | $472.86 | $859.74 | 3.5× |
| Ultrasound Breast Limited (76642) | $258.50 | $470 | 3.0× |
| Ultrasound Elastography Parenchyma (76981) | $574.04 | $1,043.71 | 5.5× |
| Ultrasound Exam Aaa Screen (76706) | $313.65 | $570.28 | 3.0× |
| Ultrasound, abdomen limited (76705) | $574.04 | $1,043.71 | 5.5× |
| Unlisted Procedure Clinical Brachytherapy (77799) range across 2 matching MRF lines |
$201.53–$759.38 | $366.41–$1,380.70 | varies |
| Unlisted us procedure (76999) | $354.96 | $645.38 | 4.1× |
| Upper gi w/o kub (74240) | $653.40 | $1,188 | 3.7× |
| Ureteral Reflux Study (78740) | $349.14 | $634.80 | 0.9× |
| Urethrocystogram voiding (74455) | $671.22 | $1,220.40 | 2.8× |
| Urethrocystography retrograde (74450) | $527.34 | $958.80 | 2.2× |
| Us breast unilateral complete (76641) | $302.50 | $550 | 2.9× |
| Us chest (76604) | $444.15 | $807.54 | 4.2× |
| Us complete joint (76881) | $514.80 | $936 | 4.9× |
| Us exam, pelvic, limited (76857) | $283.80 | $516 | 2.7× |
| Us head (76506) | $711.71 | $1,294.02 | 6.8× |
| Us kidney transplant (76776) | $423.80 | $770.54 | 4.0× |
| Us lmtd joint/oth nonvasc xtr strux r-t w/img (76882) | $468.60 | $852 | 4.5× |
| Us ob limited 1 or more fetuses (76815) | $357.50 | $650 | 3.4× |
| Us ob transvaginal (76817) | $416.61 | $757.48 | 4.0× |
| Us pelvic non ob complete (76856) | $547.80 | $996 | 5.2× |
| Us pg uter img f&mat 14 wk tabdl 1/1st gestation (76801) | $467.50 | $850 | 4.5× |
| Us preg uterus real time f/u trnsabdl per fetus (76816) | $484 | $880 | 4.6× |
| Us retroperitoneal complete (76770) | $498.85 | $907 | 4.8× |
| Us retroperitoneal limited (76775) | $492.25 | $895 | 4.7× |
| Us scrotum and contents (76870) | $603.37 | $1,097.04 | 5.8× |
| Us spinal canal and contents (76800) | $398.06 | $723.74 | 3.8× |
| Us thyroid (76536) | $567.46 | $1,031.74 | 5.4× |
| Us transrectal (76872) | $541.12 | $983.85 | 5.2× |
| Vein X-Ray Chest (75827) | $1,171.50 | $2,130 | 0.7× |
| Venography caval inferior serialography rs&i (75825) | $3,204.30 | $5,826 | 1.0× |
| Venography extremity bilateral rs&i (75822) | $938.52 | $1,706.40 | 0.6× |
| Venography extremity unilateral rs&i (75820) | $469.26 | $853.20 | 0.3× |
| Wrist 2 views (73100) | $203.50 | $370 | 2.3× |
| X-Ray Ac Jts - Xr Acromioclavicular Joints Bilateral (73050) | $363.66 | $661.20 | 4.2× |
| X-ray antegrade pyelogram tube (74425) | $591.36 | $1,075.20 | 1.7× |
| X-Ray Aorta Leg Arteries (75630) | $4,666.86 | $8,485.20 | 1.5× |
| X-Ray Bend Only L-S Spine (72120) | $378.84 | $688.80 | 3.6× |
| X-Ray Elbow 2 Vw - Xr Elbow 1-2 Views Right (73070) range across 2 matching MRF lines |
$111.10–$190.30 | $202–$346 | varies |
| X-Ray Exam Breast Specimen (76098) | $488.66 | $888.48 | 0.9× |
| X-Ray Exam Entire Spi 1 Vw (72081) | $285.78 | $519.60 | 3.3× |
| X-Ray Exam Entire Spi 2/3 Vw (72082) | $324.72 | $590.40 | 3.1× |
| X-Ray Exam Hip Uni 1 View (73501) | $246.84 | $448.80 | 2.8× |
| X-Ray Exam Hip Uni 2-3 Views (73502) | $308.88 | $561.60 | 3.5× |
| X-Ray Exam Hip Uni 4/> Views (73503) | $386.10 | $702 | 3.7× |
| X-Ray Exam Hips Bi 2 Views (73521) | $357.50 | $650 | 3.4× |
| X-Ray Exam Hips Bi 3-4 Views (73522) | $447.15 | $813 | 4.3× |
| X-Ray Exam Hips Bi 5/> Views (73523) | $558.80 | $1,016 | 5.3× |
| X-Ray Exam L-S Spine Bending (72114) | $475.86 | $865.20 | 4.5× |
| X-Ray Exam Neck Spine 2-3 Vw (72040) | $238.15 | $433 | 2.7× |
| X-Ray Exam Neck Spine 6/>Vws (72052) | $463.65 | $843 | 4.4× |
| X-Ray Exam Unilat Ribs/Chest (71101) | $287.10 | $522 | 2.7× |
| X-ray eye for foreign body (70030) | $281.16 | $511.20 | 3.2× |
| X-ray head for orthodontia (70350) | $168.30 | $306 | 1.9× |
| X-ray humerus (73060) range across 2 matching MRF lines |
$154.44–$270.60 | $280.80–$492 | varies |
| X-ray IV pyelogram (ivp) (74400) | $780.12 | $1,418.40 | 4.4× |
| X-Ray Jaw <4 Vw - Xr Mandible < 4 Views (70100) | $79.86 | $145.20 | 0.9× |
| X-Ray Knee Bilat Standing - Xr Knees Anteroposterior Standing Bilat (73565) | $235.62 | $428.40 | 2.7× |
| X-Ray Lumbar Spine 2/3 Vw - Xr Lumbar Spine 2-3 Views (72100) | $363.66 | $661.20 | 3.5× |
| X-Ray Ribs, Chest 4+ Vw - Xr Ribs 3 Vws Bil W/ Chest Posteroanterior (71111) | $450.78 | $819.60 | 4.3× |
| X-Ray Sacroiliac Jts 3+ Vw - Xr Sacroiliac Joints 3+ Views (72202) | $300.96 | $547.20 | 2.9× |
| X-Ray Sacroiliac Jts <3 Vw - Xr Sacroiliac Joints 1-2 Views (72200) | $216.48 | $393.60 | 2.1× |
| X-Ray Sacrum/Coccyx 2+ Vw - Xr Sacrum Coccyx 2+ Views (72220) | $316.80 | $576 | 3.6× |
| X-Ray Sinuses 3+ Vw - Xr Paranasal Sinuses 3+ Views (70220) | $378.84 | $688.80 | 4.3× |
| X-Ray Skull 4+ Vw - Xr Skull Complete 4+ Views (70260) | $447.48 | $813.60 | 4.3× |
| X-ray thoracic spine 4 vw (72074) | $324.50 | $590 | 3.1× |
| X-Ray Urinary Tract Exam With Contrast Material (74420) | $848.76 | $1,543.20 | 2.4× |
| X-Rays Bone Length Studies (77073) | $316.80 | $576 | 3.0× |
| X-Rays Bone Survey Complete (77075) | $517.44 | $940.80 | 4.9× |
| Xr c-spine 4 or 5 views (72050) | $411.95 | $749 | 3.9× |
| Xr facial bones less than 3 views (70140) | $374.22 | $680.40 | 4.3× |
| XR Mastoids < 3 Views Bilateral (70120) | $302.28 | $549.60 | 2.9× |
| Xr orbits complete 4 views (70200) | $401.28 | $729.60 | 3.8× |
| Xr Tomogram Single Plane (76100) | $747.78 | $1,359.60 | 7.1× |
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.