Imaging prices at SSM Health Waupun Memorial Hospital
Waupun, WI · every code in this section with a posted price and a Medicare benchmark.
368 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) | $3,637.70 | $6,614 | 2.7× |
| Abdomen 1 View (74018) | $276.65 | $503 | 3.3× |
| Abdomen 2 views (74019) | $276.65 | $503 | 2.7× |
| Acute Gastrointestinal Blood Loss Imaging (78278) | $1,936 | $3,520 | 5.0× |
| Angio pulmonary bilat (75743) | $5,560.50 | $10,110 | 1.8× |
| Angiography extremity bilateral rs&i (75716) | $6,262.85 | $11,387 | 2.0× |
| Angiography extremity unilateral rs&i (75710) | $6,262.85 | $11,387 | 2.0× |
| Angiography pulmonary unilateral slctv rs&i (75741) | $3,296.15 | $5,993 | 1.1× |
| Angrph pulmonary nonslctv cath/ven njx rs&i (75746) | $1,094.50 | $1,990 | 0.4× |
| Ankle 2 views (73600) | $304.15 | $553 | 3.6× |
| Aortography thoracic serialography rs&i (75605) | $3,418.80 | $6,216 | 0.6× |
| Artery X-Rays Abdomen (75726) | $3,287.35 | $5,977 | 0.6× |
| Artery X-Rays Pelvis (75736) unusually low: confirm this is the full procedure |
$1,778.15 | $3,233 | 0.3× |
| Artery X-Rays Spine (75705) | $6,262.85 | $11,387 | 1.2× |
| Arthrogram ankle (73615) | $1,024.65 | $1,863 | 3.0× |
| Arthrogram hip (73525) | $1,229.80 | $2,236 | 3.6× |
| Arthrogram Wrist (73115) | $1,024.65 | $1,863 | 3.0× |
| Basic radiation dosimetry calculation (77300) | $380.60 | $692 | 2.9× |
| Bone age studies (77072) | $304.15 | $553 | 3.0× |
| Bone Imaging 3 Phase (78315) | $1,936 | $3,520 | 5.0× |
| Bone Imaging Limited Area (78300) | $1,936 | $3,520 | 5.0× |
| Bone Imaging Whole Body (78306) | $1,936 | $3,520 | 5.0× |
| Bone marrow imaging limited area (78102) | $1,936 | $3,520 | 5.0× |
| Bone marrow imaging; whole body (78104) | $1,936 | $3,520 | 5.0× |
| Bone survey infant (77076) | $304.15 | $553 | 3.0× |
| Brain Flow Imaging Only (78610) | $1,936 | $3,520 | 3.7× |
| Brain Imaging Min 4 Static Views W Vascular Flow (78606) | $1,936 | $3,520 | 3.7× |
| Brain Imaging Pet Metabolic Evaluation (78608) | $3,657.50 | $6,650 | 2.6× |
| Cardiac MRI w/w/o contrast & further seq (75561) | $2,305.60 | $4,192 | 6.8× |
| Cat Scan Follow-Up Study (76380) | $536.25 | $975 | 6.3× |
| Cerebrospinal Fluid Flow W/O Matl Shunt Evaltj (78645) | $855.80 | $1,556 | 1.6× |
| Cerebrospinal Fluid Scan (78630) | $1,936 | $3,520 | 3.7× |
| Chest 1 view (71045) | $261.25 | $475 | 3.1× |
| Chest 2 views (71046) | $261.25 | $475 | 3.1× |
| Chest 3 views (71047) | $261.25 | $475 | 3.1× |
| Chest 4 or more views (71048) | $261.25 | $475 | 2.6× |
| Cholecystography Oral Contrast (74290) | $276.65 | $503 | 1.6× |
| Cisternography Positive Contrast Rs&I (70015) | $880 | $1,600 | 1.2× |
| Clavicle complete (73000) | $304.15 | $553 | 3.6× |
| Computed Tomography Thorax Lw Dose Lng Ca Scr C- (71271) | $113.30 | $206 | 1.1× |
| Continuing medical physics consltj pr wk (77336) | $554.40 | $1,008 | 4.2× |
| Contrast Exam Abdominl Aorta (75625) | $2,526.70 | $4,594 | 0.8× |
| Contrast X-Ray Bladder (74430) | $471.90 | $858 | 1.4× |
| Contrast X-Ray Of Elbow (73085) | $1,229.80 | $2,236 | 3.6× |
| Contrast X-Ray Of Knee Joint (73580) | $1,024.65 | $1,863 | 3.0× |
| Contrast Xray Throat/Cerv Esopha (74210) | $276.65 | $503 | 1.6× |
| CT abdomen and pelvis without and with contrast (74178) | $1,799.05 | $3,271 | 5.3× |
| CT abdomen and pelvis without contrast (74176) | $1,631.85 | $2,967 | 7.0× |
| CT abdomen w contrast (74160) | $1,632.95 | $2,969 | 9.6× |
| CT abdomen w wo contrast (74170) | $1,714.35 | $3,117 | 10.1× |
| CT abdomen w/o contrast (74150) | $1,554.85 | $2,827 | 15.3× |
| CT Angio Abdomen and Pelvis (74174) | $1,693.45 | $3,079 | 5.0× |
| CT Angio Chest (71275) | $1,693.45 | $3,079 | 9.9× |
| CT Angio Head (70496) | $1,375 | $2,500 | 8.1× |
| CT angio hrt w/3d image (75574) | $1,543.85 | $2,807 | 4.6× |
| Ct Angio Lwr Extr W/O&W/Dye (73706) | $1,498.20 | $2,724 | 8.8× |
| CT Angio Neck (70498) | $1,375 | $2,500 | 8.1× |
| Ct Angio Upr Extrm W/O&W/Dye (73206) | $1,498.20 | $2,724 | 8.8× |
| CT cervical spine w/ contrast (72126) | $1,443.75 | $2,625 | 4.3× |
| CT cervical spine w/o contrast (72125) | $1,375 | $2,500 | 13.5× |
| CT cervical spine w/wo cont (72127) | $1,515.80 | $2,756 | 8.9× |
| CT chest w contrast (71260) | $1,632.95 | $2,969 | 9.6× |
| CT chest w/wo contrast (71270) | $1,714.35 | $3,117 | 10.1× |
| CT colonography screening (74263) | $1,543.85 | $2,807 | 6.7× |
| CT Colonogrphy Dx Image Postprocess W/Contrast (74262) | $1,648.35 | $2,997 | 9.7× |
| CT colonogrphy dx image postprocess w/o contrast (74261) | $1,498.20 | $2,724 | 14.8× |
| CT head/brain with contrast (70460) | $1,443.75 | $2,625 | 8.5× |
| CT head/brain without and with contrast (70470) | $1,515.80 | $2,756 | 8.9× |
| CT heart contrast eval cardiac structure&morph (75572) | $1,543.85 | $2,807 | 4.6× |
| CT heart no contrast quant eval coronry calcium (75571) | $13.75 | $25 | 0.2× |
| CT hrt w/3d image congen (75573) | $1,543.85 | $2,807 | 4.6× |
| CT iac w contrast (70481) | $1,386 | $2,520 | 8.1× |
| CT l-spine w&w/o contrast (72133) | $1,648.90 | $2,998 | 9.7× |
| CT lower ext w/o (73700) | $1,484.45 | $2,699 | 14.6× |
| CT lower extremity w/contrast material (73701) | $1,558.15 | $2,833 | 9.1× |
| CT lumbar spine w contrast (72132) | $1,570.25 | $2,855 | 4.6× |
| CT lumbar spine w/o contrast (72131) | $1,495.45 | $2,719 | 14.7× |
| CT maxillofacial w contrast (70487) | $1,434.95 | $2,609 | 8.4× |
| CT maxillofacial wo contrast (70486) | $1,366.75 | $2,485 | 13.5× |
| CT neck tissue combo (70492) | $1,449.80 | $2,636 | 8.5× |
| Ct Orbit/Ear/Fossa W/O&W/Dye (70482) | $1,455.30 | $2,646 | 8.5× |
| CT orbits w/o contrast (70480) | $1,320 | $2,400 | 13.0× |
| CT pelvis w&w/o contrast (72194) | $1,636.25 | $2,975 | 9.6× |
| CT pelvis w/o contrast (72192) | $1,484.45 | $2,699 | 14.6× |
| CT scan of leg combo (73702) | $1,636.25 | $2,975 | 9.6× |
| CT scans face/jaw combo (70488) | $1,506.45 | $2,739 | 8.8× |
| CT soft tissue neck w contrast (70491) | $1,380.50 | $2,510 | 8.1× |
| CT soft tissue neck w/o contrast (70490) | $1,314.50 | $2,390 | 12.9× |
| CT thoracic spine w contrast (72129) | $1,570.25 | $2,855 | 9.2× |
| CT thoracic spine w/o contrast (72128) | $1,495.45 | $2,719 | 14.7× |
| CT thoracic spine w/wo cont (72130) | $1,648.90 | $2,998 | 9.7× |
| CT thorax w/o contrast (71250) | $1,554.85 | $2,827 | 15.3× |
| CT unlisted procedure (76497) | $136.95 | $249 | 1.6× |
| CT upper ext wo (73200) | $1,484.45 | $2,699 | 14.6× |
| CT upper extremity w/o & w/contrast material (73202) | $1,636.25 | $2,975 | 9.6× |
| CT upper extremity with contrast (73201) | $1,558.15 | $2,833 | 4.6× |
| Cta Abdl Aorta&Bi Iliofem W/Contrast&Postp (75635) | $1,693.45 | $3,079 | 9.9× |
| Cta Abdomen (74175) | $1,693.45 | $3,079 | 9.9× |
| CTA pelvis (72191) | $1,498.20 | $2,724 | 8.8× |
| Dilation ureters/urethra rs&i (74485) | $254.10 | $462 | 0.1× |
| Discography Cerv/Thor Spine (72285) | $3,359.40 | $6,108 | 1.8× |
| Diskography lumbar (72295) | $3,359.40 | $6,108 | 1.8× |
| Doppler Echo Fetal Spectral Display Complete (76827) | $301.40 | $548 | 3.0× |
| Doppler Fetal Mid Cerebral Artery (76821) | $485.10 | $882 | 4.8× |
| Dxa Bone Density Axial (77080) | $304.15 | $553 | 3.0× |
| Dxa bone density study 1/>sites appendiclr skel (77081) | $304.15 | $553 | 3.6× |
| Echo exam uterus (76831) | $409.20 | $744 | 1.8× |
| Echo Guide For Artery Repair (76936) | $455.95 | $829 | 2.2× |
| Esophageal Motility Study (78258) | $1,936 | $3,520 | 5.0× |
| Esophagram (74220) | $276.65 | $503 | 1.6× |
| Fetal Biophys Profile W/Nst (76818) | $409.20 | $744 | 4.0× |
| Fetal Biophysical Profile W/O Non-Stress Testing (76819) range across 2 matching MRF lines |
$377.85–$409.20 | $687–$744 | varies |
| Fluoroscopy up to 1 hr (76000) | $603.90 | $1,098 | 2.6× |
| Follow-Up Angiography (75898) | $673.75 | $1,225 | 0.2× |
| Foot 2 views (73620) | $304.15 | $553 | 3.6× |
| Forearm 2 views (73090) | $304.15 | $553 | 3.6× |
| Gastric emptying imaging study (78264) | $1,936 | $3,520 | 5.0× |
| Gastroesophageal Reflux Exam (78262) | $1,936 | $3,520 | 5.0× |
| Gated Heart Planar Single (78472) | $2,038.30 | $3,706 | 5.2× |
| Hand 2 views (73120) | $304.15 | $553 | 3.0× |
| Hepatc Vngrph Wdg/Fr Hemodyn Eval Rs&I (75889) | $3,719.10 | $6,762 | 1.2× |
| Hepatc Vngrph Wdg/Fr W/O Hemodyn Eval Rs&I (75891) | $3,305.50 | $6,010 | 1.1× |
| Hepatobil Syst Image W/Drug (78227) | $1,936 | $3,520 | 3.7× |
| Hepatobiliary System Imaging (78226) | $1,936 | $3,520 | 5.0× |
| Ht Muscle Image Spect Sing (78451) | $2,038.30 | $3,706 | 1.6× |
| Hysterosalpingogram (74740) | $457.60 | $832 | 2.0× |
| Infant hip ultrasound with hip movement (dynamic) (76885) | $400.95 | $729 | 4.7× |
| Joint Survey Single View (77077) | $304.15 | $553 | 3.0× |
| K Flow/Funct Image Multiple (78709) | $2,038.30 | $3,706 | 3.9× |
| K Flow/Funct Image W/Drug (78708) | $1,936 | $3,520 | 3.7× |
| K Flow/Funct Image W/O Drug (78707) | $1,898.05 | $3,451 | 3.6× |
| Knee 3 Views (73562) | $304.15 | $553 | 3.6× |
| Leveen/Shunt Patency Exam (78291) | $1,936 | $3,520 | 5.0× |
| Liver & Spleen Imaging Static Only (78215) | $1,936 | $3,520 | 5.0× |
| Liver & Spleen Imaging W/Vascular Flow (78216) | $1,936 | $3,520 | 5.0× |
| Liver imaging w/vascular flow (78202) | $2,256.65 | $4,103 | 4.3× |
| Lung Perf&Ventilat Diferentl (78598) | $1,936 | $3,520 | 3.7× |
| Lung perfusion differential (78597) | $1,936 | $3,520 | 5.0× |
| Lung Ventilat&Perfus Imaging (78582) | $1,936 | $3,520 | 3.7× |
| Lung Ventilation Imaging (78579) | $1,936 | $3,520 | 5.0× |
| Lymph System Imaging (78195) | $1,936 | $3,520 | 3.7× |
| Magnetic Image Jaw Joint (70336) | $2,137.30 | $3,886 | 9.2× |
| Mammary ductogram or galactogram multiple (77054) | $443.30 | $806 | 1.9× |
| Mammary ductogram or galactogram single (77053) | $443.30 | $806 | 1.9× |
| Meckels Divert Exam (78290) | $1,936 | $3,520 | 5.0× |
| Mlc imrt design & construction per imrt plan (77338) | $2,324.30 | $4,226 | 6.4× |
| Mra Head W/O & W/Contrast Material (70546) | $1,857.35 | $3,377 | 5.5× |
| MRA head w/o contrast (70544) | $1,685.20 | $3,064 | 7.3× |
| MRA head with contrast (70545) | $1,769.35 | $3,217 | 5.2× |
| MRA neck w contrast (70548) | $1,736.35 | $3,157 | 5.1× |
| Mra Neck W/O &W/Contrast Material (70549) | $1,823.25 | $3,315 | 5.4× |
| MRA neck w/o contrast (70547) | $1,653.85 | $3,007 | 7.1× |
| MRI abdomen w contrast (74182) | $2,200.55 | $4,001 | 6.5× |
| MRI abdomen w/o contrast (74181) | $2,095.50 | $3,810 | 9.0× |
| MRI any jt lower extrem w/contrast material (73722) | $2,411.75 | $4,385 | 3.2× |
| MRI any jt lower extrem w/o & w/contrast matrl (73723) | $2,532.20 | $4,604 | 7.5× |
| MRI any jt upper extremity w/contrast matrl (73222) | $2,394.70 | $4,354 | 3.1× |
| MRI brain functional w/o physician admnistration (70554) | $1,824.90 | $3,318 | 7.9× |
| MRI Breast W/O Contrast Bilateral (77047) | $4,191 | $7,620 | 18.1× |
| MRI Breast Without Contrast Material Unilateral (77046) | $2,244 | $4,080 | 9.7× |
| MRI cardiac w/o contrast (75557) | $2,105.40 | $3,828 | 9.1× |
| MRI cervical spine w contrast (72142) | $1,873.85 | $3,407 | 5.5× |
| MRI cervical spine w/o cont (72141) | $1,784.20 | $3,244 | 7.7× |
| MRI chest w/o contrast (71550) | $1,980 | $3,600 | 8.5× |
| MRI chest with contrast (71551) | $2,079 | $3,780 | 2.7× |
| MRI chest wo w contrast (71552) | $2,183.50 | $3,970 | 6.4× |
| MRI lower extrem oth/thn jt w/o & w/contr matr (73720) | $2,450.80 | $4,456 | 7.2× |
| MRI lower extrem oth/thn jt w/o contr matrl (73718) | $2,227.50 | $4,050 | 9.6× |
| MRI lumbar spine w contrast (72149) | $2,369.95 | $4,309 | 7.0× |
| Mri Neck Spine W/O & W/Dye (72156) | $1,967.35 | $3,577 | 5.8× |
| MRI orbit face &/neck w/o contrast (70540) | $1,658.80 | $3,016 | 7.2× |
| MRI orbit face neck w contrast (70542) | $1,741.85 | $3,167 | 5.1× |
| Mri Orbt/Fac/Nck W/O &W/Dye (70543) | $1,829.30 | $3,326 | 5.4× |
| MRI pelvis w contrast (72196) | $2,224.75 | $4,045 | 6.6× |
| MRI pelvis w/o & w contrast (72197) | $2,336.40 | $4,248 | 6.9× |
| MRI pelvis w/o contrast (72195) | $2,118.60 | $3,852 | 9.1× |
| MRI spectroscopy (76390) | $2,237.95 | $4,069 | 26.5× |
| MRI thoracic spine w/o contrast (72146) | $2,194.50 | $3,990 | 9.5× |
| MRI upper extremity oth than jt w/contr matrl (73219) | $2,303.95 | $4,189 | 6.8× |
| MRI upper extremity oth than jt w/o contr matrl (73218) | $2,194.50 | $3,990 | 9.5× |
| Mri Uppr Extremity W/O&W/Dye (73220) | $2,419.45 | $4,399 | 7.1× |
| MRI, abdomen, combo (74183) | $2,310.55 | $4,201 | 6.8× |
| MRI, dorsal spine combo (72157) | $2,419.45 | $4,399 | 7.1× |
| MRI, dorsal spine contrast (72147) | $2,303.95 | $4,189 | 6.8× |
| MRI, joint upper extrem (73221) | $2,280.30 | $4,146 | 9.8× |
| MRI, joint upper extrem combo (73223) | $2,514.05 | $4,571 | 7.4× |
| MRI, lumbar spine combo (72158) | $2,488.75 | $4,525 | 7.3× |
| Myocardial Imaging Pet Metabolic Evaluation (78459) | $2,375.45 | $4,319 | 1.9× |
| Myocardial Spect Multiple Studies (78452) | $2,445.30 | $4,446 | 1.9× |
| N-invas est c ffr sw aly CTA (75580) | $1,882.10 | $3,422 | 2.3× |
| Neck soft tissue (70360) | $276.65 | $503 | 3.3× |
| Nm csf leak detection (78650) | $1,936 | $3,520 | 1.5× |
| Nm myocard infarct spect (78469) | $2,256.65 | $4,103 | 4.3× |
| Nonvascular Shunt X-Ray (75809) | $222.20 | $404 | 2.2× |
| Ntsty modul radthx pln dose-vol histos (77301) | $5,955.40 | $10,828 | 4.4× |
| Nuclear Rx Intra-Arterial (79445) | $545.60 | $992 | 2.4× |
| Nuclear Rx Oral Admin (79005) | $1,936 | $3,520 | 8.5× |
| Ob us nuchal meas 1 gest (76813) | $291.50 | $530 | 2.9× |
| Ophthalmic ultrasound dx b-scan w/wo a-scan (76512) range across 2 matching MRF lines |
$368.50–$424.05 | $670–$771 | varies |
| Ophthalmic us dx quantitative a-scan only (76511) | $336.60 | $612 | 3.3× |
| Panoramic X-ray of jaws (70355) | $304.15 | $553 | 3.6× |
| Parathyroid imaging w/tomographic spect & CT (78072) | $1,936 | $3,520 | 3.7× |
| Parathyroid Planar Imaging (78070) | $911.35 | $1,657 | 2.3× |
| Parathyroid planar imaging w/wo subtraction (78071) | $1,936 | $3,520 | 5.0× |
| Pelvis 1 or 2 views (72170) | $304.15 | $553 | 3.0× |
| Peritoneogram Rs&I (74190) | $932.25 | $1,695 | 1.8× |
| Pet Image W/Ct Lmtd (78814) | $3,488.65 | $6,343 | 2.5× |
| PET image w/CT, full body (78816) | $3,722.95 | $6,769 | 2.7× |
| PET imaging CT attenuation skull base mid-thigh (78815) | $3,657.50 | $6,650 | 2.6× |
| Pet Myocardial Sngl Study (78491) | $3,722.95 | $6,769 | 2.7× |
| Prq Transhepatc Portograpy Hemodyn Eval Rs&I (75885) | $7,461.85 | $13,567 | 2.4× |
| Pulmonary Perfusion Imaging Particulate (78580) | $1,936 | $3,520 | 5.0× |
| Radex Abd Compl Aqt Abd W/S/E/D Views 1 View Ch (74022) | $276.65 | $503 | 2.7× |
| Radex abscess/fistula/sinus tract rs&i (76080) | $932.25 | $1,695 | 1.8× |
| Radex Ankle Complete Minimum 3 Views (73610) | $304.15 | $553 | 3.6× |
| Radex Calcaneus Minimum 2 Views (73650) | $304.15 | $553 | 3.6× |
| Radex elbow complete minimum 3 views (73080) | $304.15 | $553 | 3.6× |
| Radex Facial Bones Complete Minimum 3 Views (70150) | $304.15 | $553 | 3.0× |
| Radex fingr minimum 2 views (73140) | $304.15 | $553 | 3.6× |
| Radex foot complete minimum 3 views (73630) | $304.15 | $553 | 3.6× |
| Radex Hand Minimum 3 Views (73130) | $304.15 | $553 | 3.6× |
| Radex lower extremity infant minimum 2 views (73592) | $304.15 | $553 | 3.6× |
| Radex Nasal Bones Complete Minimum 3 Views (70160) | $304.15 | $553 | 3.6× |
| Radex Ribs Unilateral 2 Views (71100) | $304.15 | $553 | 3.6× |
| Radex shoulder complete minimum 2 views (73030) | $304.15 | $553 | 3.6× |
| Radex Sinuses Paransl < 3 Views (70210) | $304.15 | $553 | 3.6× |
| Radex Spine 1 View Specify Level (72020) | $304.15 | $553 | 3.6× |
| Radex Sternum Minimum 2 Views (71120) | $304.15 | $553 | 3.6× |
| Radex Temporomandble Jt Opn & Clsd Mouth Bilat (70330) | $304.15 | $553 | 3.6× |
| Radex Toe Minimum 2 Views (73660) | $304.15 | $553 | 3.6× |
| Radex upper extremity infant minimum 2 views (73092) | $304.15 | $553 | 3.0× |
| Radex Wrist Complete Minimum 3 Views (73110) | $304.15 | $553 | 3.6× |
| Radiation Delivery Stereotactic Cranial Linear (77372) | $8,030 | $14,600 | 1.1× |
| Radiation treatment delivery level 1 (77402) | $421.30 | $766 | 4.3× |
| Radiation treatment delivery level 3 (77412) | $676.50 | $1,230 | 1.3× |
| Radiolog exam mandible compl minimum 4 views (70110) | $304.15 | $553 | 3.0× |
| Radiologic Exam Abdomen 3+ Views - Xr Abdomen 3+ Views (74021) | $276.65 | $503 | 2.7× |
| Radiologic exam colon double contrast study (74280) | $276.65 | $503 | 1.6× |
| Radiologic exam colon single contrast study (74270) | $276.65 | $503 | 1.6× |
| Radiologic Exam Esophagus Double Contrast Study (74221) | $276.65 | $503 | 1.6× |
| Radiologic exam knee complete 4/more views (73564) | $304.15 | $553 | 3.0× |
| Radiologic exam pelvis compl minimum 3 views (72190) | $304.15 | $553 | 3.0× |
| Radiologic Exam Small Int Single Contrast Study (74250) | $276.65 | $503 | 1.6× |
| Radiologic exam swallow function contrast study (74230) | $276.65 | $503 | 1.6× |
| Radiologic exam upr gi trc double contrast study (74246) | $276.65 | $503 | 1.6× |
| Radiologic examination femur minimum 2 views (73552) | $304.15 | $553 | 3.6× |
| Radiologic examination knee 1/2 views (73560) | $304.15 | $553 | 3.6× |
| Radiologic Examination Osseous Survey Limited (77074) | $304.15 | $553 | 3.0× |
| Radiologic examination tibia & fibula 2 views (73590) | $304.15 | $553 | 3.6× |
| Ribs bilateral 3 views (71110) | $304.15 | $553 | 3.0× |
| Rp loclzj tum plnr 1 area single day imaging (78800) | $697.95 | $1,269 | 1.8× |
| Rp loclzj tum plnr 2+area 1+d img/1 area img>2+d (78801) | $784.85 | $1,427 | 2.0× |
| Rp Loclzj Tum Plnr Whole Body 2+ Days Imaging (78804) range across 2 matching MRF lines |
$2,023.45–$2,524.50 | $3,679–$4,590 | varies |
| Rp Loclzj Tum Plnr Whole Body Single Day Imaging (78802) | $1,936 | $3,520 | 3.7× |
| Rp Loclzj Tum Spect 1 Area Single Day Imaging (78803) | $2,015.20 | $3,664 | 3.8× |
| Rp loclzj tum spect 2 area/sep acquisj img (78831) | $2,660.90 | $4,838 | 2.1× |
| Rp loclzj tum spect w/CT 1 area/acquisj 1day img (78830) | $2,264.90 | $4,118 | 1.8× |
| Rp Ther Radiolbld Monoclonal Antibody IV Infus (79403) | $2,461.80 | $4,476 | 10.9× |
| Rp Therapy Intravenous Administration (79101) | $1,936 | $3,520 | 8.5× |
| Scapula (73010) | $304.15 | $553 | 3.0× |
| Screening Digital Breast Tomosynthesis Bi (77063) | $19.25 | $35 | 0.8× |
| Shoulder 1 view (73020) | $304.15 | $553 | 3.6× |
| Shoulder Arthrography (73040) | $619.30 | $1,126 | 1.8× |
| Sialogram (70390) | $469.15 | $853 | 2.0× |
| Skull less than 4 views (70250) | $304.15 | $553 | 3.0× |
| Special dosimetry (77331) | $445.50 | $810 | 3.4× |
| Special Physics Consult (77370) | $444.95 | $809 | 3.4× |
| Special teletherapy port plan (77321) | $949.30 | $1,726 | 2.6× |
| Special treatment procedure (77470) | $1,618.65 | $2,943 | 3.0× |
| Stereotactic Body Radiation Delivery (77373) | $5,894.35 | $10,717 | 3.4× |
| Tbs techl prep&transmis data alys pfrmd elsewhr (77090) | $144.65 | $263 | 1.7× |
| Tbs technical calculation only (77091) | $144.65 | $263 | 1.7× |
| Telethx isodose pln cplx w/basic dosimetry (77307) | $2,137.30 | $3,886 | 5.9× |
| Telethx isodose pln smpl w/dosimetry calculation (77306) | $1,590.05 | $2,891 | 4.4× |
| Testicular Imaging W/Flow (78761) | $1,936 | $3,520 | 5.0× |
| Ther Rad Simulaj-Aided Field Setting Complex (77290) | $1,352.45 | $2,459 | 3.7× |
| Ther Rad Simulaj-Aided Field Setting Intermed (77285) | $1,033.45 | $1,879 | 2.8× |
| Ther rad simulaj-aided field setting simple (77280) | $633.05 | $1,151 | 4.8× |
| Therapeutic Enema Rdctj Intussusception/Obstrcj (74283) | $365.20 | $664 | 2.1× |
| Thoracic spine 2 views (72070) | $304.15 | $553 | 3.0× |
| Thoracic spine 3 views (72072) | $304.15 | $553 | 3.0× |
| Thoracolumbar 2 views (72080) | $304.15 | $553 | 3.6× |
| Thyroid Imaging With Vascular Flow (78013) | $1,936 | $3,520 | 5.0× |
| Thyroid Met Imaging Body (78018) | $1,936 | $3,520 | 3.7× |
| Thyroid Uptake W/Blood Flow Sngle/Mult Quan Meas (78014) | $1,936 | $3,520 | 5.0× |
| Tx Devices Design & Construction Complex (77334) | $972.95 | $1,769 | 2.7× |
| Tx devices design & construction intermediate (77333) | $430.65 | $783 | 3.3× |
| Tx devices design & construction simple (77332) | $336.05 | $611 | 2.6× |
| Ultrasound Breast Limited (76642) range across 2 matching MRF lines |
$409.20–$449.35 | $744–$817 | varies |
| Ultrasound elastography first target lesion (76982) | $207.35 | $377 | 2.0× |
| Ultrasound Elastography Parenchyma (76981) | $207.35 | $377 | 2.0× |
| Ultrasound Exam Aaa Screen (76706) range across 3 matching MRF lines |
$25.30–$409.20 | $46–$744 | varies |
| Ultrasound, abdomen limited (76705) range across 2 matching MRF lines |
$400.95–$616 | $729–$1,120 | varies |
| Umbilical-artery Doppler (OB) (76820) | $485.10 | $882 | 4.8× |
| Unlisted fluoroscopic procedure (76496) | $502.15 | $913 | 5.9× |
| Unlisted magnetic resonance procedure (76498) range across 2 matching MRF lines |
$164.45–$2,305.60 | $299–$4,192 | varies |
| Unlisted us procedure (76999) | $400.95 | $729 | 4.7× |
| Upper gi w/o kub (74240) | $276.65 | $503 | 1.6× |
| Ureteral Reflux Study (78740) | $1,936 | $3,520 | 5.0× |
| Urethrocystogram voiding (74455) | $457.60 | $832 | 2.0× |
| Urethrocystography retrograde (74450) | $457.60 | $832 | 2.0× |
| Us breast unilateral complete (76641) | $436.70 | $794 | 4.3× |
| Us chest (76604) range across 2 matching MRF lines |
$409.20–$470.80 | $744–$856 | varies |
| Us complete joint (76881) range across 2 matching MRF lines |
$409.20–$470.80 | $744–$856 | varies |
| Us exam, pelvic, limited (76857) range across 2 matching MRF lines |
$400.95–$460.90 | $729–$838 | varies |
| Us head (76506) | $409.20 | $744 | 4.0× |
| Us kidney transplant (76776) | $409.20 | $744 | 4.0× |
| Us lmtd joint/oth nonvasc xtr strux r-t w/img (76882) range across 2 matching MRF lines |
$409.20–$470.80 | $744–$856 | varies |
| Us ob detailed single fetus (76811) | $400.95 | $729 | 1.7× |
| Us ob limited 1 or more fetuses (76815) range across 2 matching MRF lines |
$409.20–$470.80 | $744–$856 | varies |
| Us ob transvaginal (76817) | $409.20 | $744 | 4.0× |
| Us pelvic non ob complete (76856) | $400.95 | $729 | 3.9× |
| Us pg uter img f&mat 14 wk tabdl 1/1st gestation (76801) | $460.90 | $838 | 4.5× |
| Us preg uterus real time f/u trnsabdl per fetus (76816) | $409.20 | $744 | 4.0× |
| Us retroperitoneal complete (76770) | $489.50 | $890 | 4.8× |
| Us retroperitoneal limited (76775) range across 2 matching MRF lines |
$400.95–$460.90 | $729–$838 | varies |
| Us scrotum and contents (76870) range across 2 matching MRF lines |
$400.95–$460.90 | $729–$838 | varies |
| Us spinal canal and contents (76800) | $409.20 | $744 | 4.0× |
| Us thyroid (76536) | $409.20 | $744 | 4.0× |
| Us transrectal (76872) | $443.27 | $805.95 | 4.4× |
| Vein X-Ray Chest (75827) | $1,815 | $3,300 | 1.2× |
| Vein X-Ray Liver W/O Hemodyn (75887) | $3,963.30 | $7,206 | 1.3× |
| Venogram Sinus/Jugular (75860) | $1,096.70 | $1,994 | 0.4× |
| Venography caval inferior serialography rs&i (75825) | $2,500.30 | $4,546 | 0.8× |
| Venography extremity bilateral rs&i (75822) | $1,870 | $3,400 | 1.2× |
| Venography extremity unilateral rs&i (75820) | $1,870 | $3,400 | 1.2× |
| Venography Renal Bilateral (75833) | $4,480.30 | $8,146 | 1.5× |
| Venography Renal Unilateral (75831) | $1,946.45 | $3,539 | 0.6× |
| Vertebral fracture assessment via dxa (77086) | $172.15 | $313 | 2.0× |
| Wrist 2 views (73100) | $304.15 | $553 | 3.6× |
| X-Ray Ac Jts - Xr Acromioclavicular Joints Bilateral (73050) | $304.15 | $553 | 3.6× |
| X-ray antegrade pyelogram tube (74425) | $366.30 | $666 | 1.1× |
| X-Ray Aorta Leg Arteries (75630) | $2,954.60 | $5,372 | 1.0× |
| X-Ray Bend Only L-S Spine (72120) | $304.15 | $553 | 3.0× |
| X-Ray Elbow 2 Vw - Xr Elbow 1-2 Views Right (73070) | $304.15 | $553 | 3.6× |
| X-Ray Exam Breast Specimen (76098) | $854.70 | $1,554 | 1.6× |
| X-Ray Exam Entire Spi 1 Vw (72081) | $304.15 | $553 | 3.6× |
| X-Ray Exam Entire Spi 2/3 Vw (72082) | $304.15 | $553 | 3.0× |
| X-Ray Exam Hip Uni 1 View (73501) | $304.15 | $553 | 3.6× |
| X-Ray Exam Hip Uni 2-3 Views (73502) | $304.15 | $553 | 3.6× |
| X-Ray Exam Hips Bi 2 Views (73521) | $272.25 | $495 | 2.7× |
| X-Ray Exam Hips Bi 3-4 Views (73522) | $304.15 | $553 | 3.0× |
| X-Ray Exam Hips Bi 5/> Views (73523) | $336.05 | $611 | 3.3× |
| X-Ray Exam L-S Spine Bending (72114) | $304.15 | $553 | 3.0× |
| X-Ray Exam Neck Spine 2-3 Vw (72040) | $304.15 | $553 | 3.6× |
| X-Ray Exam Neck Spine 6/>Vws (72052) | $304.15 | $553 | 3.0× |
| X-Ray Exam Unilat Ribs/Chest (71101) | $304.15 | $553 | 3.0× |
| X-ray eye for foreign body (70030) | $276.65 | $503 | 3.3× |
| X-ray humerus (73060) | $304.15 | $553 | 3.6× |
| X-ray IV pyelogram (ivp) (74400) | $437.80 | $796 | 2.6× |
| X-ray IV pyelogram+tomography (74415) | $469.15 | $853 | 2.8× |
| X-Ray Jaw <4 Vw - Xr Mandible < 4 Views (70100) | $304.15 | $553 | 3.6× |
| X-Ray Knee Bilat Standing - Xr Knees Anteroposterior Standing Bilat (73565) | $304.15 | $553 | 3.6× |
| X-Ray Lumbar Spine 2/3 Vw - Xr Lumbar Spine 2-3 Views (72100) | $304.15 | $553 | 3.0× |
| X-ray nose-rectum child f.b. (76010) | $276.65 | $503 | 3.3× |
| X-Ray Ribs, Chest 4+ Vw - Xr Ribs 3 Vws Bil W/ Chest Posteroanterior (71111) | $304.15 | $553 | 3.0× |
| X-Ray Sacroiliac Jts 3+ Vw - Xr Sacroiliac Joints 3+ Views (72202) | $304.15 | $553 | 3.0× |
| X-Ray Sacroiliac Jts <3 Vw - Xr Sacroiliac Joints 1-2 Views (72200) | $304.15 | $553 | 3.0× |
| X-Ray Sacrum/Coccyx 2+ Vw - Xr Sacrum Coccyx 2+ Views (72220) | $304.15 | $553 | 3.6× |
| X-Ray Sinuses 3+ Vw - Xr Paranasal Sinuses 3+ Views (70220) | $304.15 | $553 | 3.6× |
| X-Ray Skull 4+ Vw - Xr Skull Complete 4+ Views (70260) | $304.15 | $553 | 3.0× |
| X-ray thoracic spine 4 vw (72074) | $304.15 | $553 | 3.0× |
| X-Ray Urinary Tract Exam With Contrast Material (74420) | $275 | $500 | 0.8× |
| X-Rays Bone Length Studies (77073) | $304.15 | $553 | 3.0× |
| X-Rays Bone Survey Complete (77075) | $304.15 | $553 | 3.0× |
| Xr c-spine 4 or 5 views (72050) | $304.15 | $553 | 3.0× |
| Xr facial bones less than 3 views (70140) | $304.15 | $553 | 3.6× |
| Xr orbits complete 4 views (70200) | $304.15 | $553 | 3.0× |
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.