Imaging prices at St. Catherine Hospital - Dodge City
Dodge City, KS · every code in this section with a posted price and a Medicare benchmark.
287 codes. Prices are the hospital's own posted facility charges.
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| Procedure | Posted cash | Posted gross | × Medicare |
|---|---|---|---|
| Abdomen 1 View (74018) | $246.65 | $616.62 | 3.1× |
| Abdomen 2 views (74019) | $305 | $762.48 | 3.2× |
| Acute Gastrointestinal Blood Loss Imaging (78278) | $781.70 | $1,954.23 | 2.1× |
| Angiography extremity bilateral rs&i (75716) | $2,584.61 | $6,461.51 | 0.9× |
| Angiography extremity unilateral rs&i (75710) | $2,584.61 | $6,461.51 | 0.9× |
| Ankle 2 views (73600) range across 2 matching MRF lines |
$230.05–$345.08 | $575.12–$862.68 | varies |
| Arthrogram hip (73525) | $252.34 | $630.85 | 0.8× |
| Arthrogram Wrist (73115) | $308.32 | $770.78 | 1.0× |
| Bone age studies (77072) | $180.72 | $451.80 | 1.9× |
| Bone Imaging 3 Phase (78315) | $1,065.34 | $2,663.35 | 2.9× |
| Bone Imaging Limited Area (78300) | $873.71 | $2,184.27 | 2.4× |
| Bone Imaging Whole Body (78306) | $1,065.34 | $2,663.35 | 2.9× |
| Bone survey infant (77076) | $300.73 | $751.81 | 3.1× |
| Brain Flow Imaging Only (78610) | $781.70 | $1,954.23 | 1.6× |
| Brain Imaging Min 4 Static Views W Vascular Flow (78606) | $781.70 | $1,954.23 | 1.6× |
| Card Bl Pool Gated Spect Rest Wal Motn Ejct Frct (78494) | $921.36 | $2,303.40 | 2.5× |
| Cerebrospinal Fluid Flow W/O Matl Shunt Evaltj (78645) | $1,000.83 | $2,502.07 | 2.0× |
| Cerebrospinal Fluid Scan (78630) | $1,000.83 | $2,502.07 | 2.0× |
| Chest 1 view (71045) | $270.37 | $675.91 | 3.4× |
| Chest 2 views (71046) | $286.50 | $716.24 | 3.6× |
| Cholecystography Oral Contrast (74290) | $171.71 | $429.26 | 1.1× |
| Clavicle complete (73000) range across 2 matching MRF lines |
$224.36–$336.54 | $560.89–$841.33 | varies |
| Computed Tomography Thorax Lw Dose Lng Ca Scr C- (71271) | $113.37 | $283.42 | 1.2× |
| Contrast Exam Abdominl Aorta (75625) | $1,940 | $4,849.99 | 0.7× |
| Contrast X-Ray Bladder (74430) | $359.54 | $898.85 | 1.1× |
| Contrast X-Ray Of Knee Joint (73580) | $424.05 | $1,060.12 | 1.3× |
| CT abdomen and pelvis without and with contrast (74178) | $3,415.15 | $8,537.87 | 10.6× |
| CT abdomen and pelvis without contrast (74176) | $2,690.62 | $6,726.54 | 12.2× |
| CT abdomen w contrast (74160) | $1,501.72 | $3,754.29 | 9.3× |
| CT abdomen w wo contrast (74170) | $1,724.65 | $4,311.62 | 10.7× |
| CT abdomen w/o contrast (74150) | $1,618.41 | $4,046.01 | 16.8× |
| CT Angio Abdomen and Pelvis (74174) | $3,130.08 | $7,825.20 | 9.7× |
| CT Angio Chest (71275) | $1,724.65 | $4,311.62 | 10.7× |
| CT Angio Head (70496) | $1,537.30 | $3,843.23 | 9.5× |
| Ct Angio Lwr Extr W/O&W/Dye (73706) | $1,580.93 | $3,952.32 | 9.8× |
| CT Angio Neck (70498) | $1,537.30 | $3,843.23 | 9.5× |
| Ct Angio Upr Extrm W/O&W/Dye (73206) | $1,580.93 | $3,952.32 | 9.8× |
| CT cervical spine w/ contrast (72126) | $845.25 | $2,113.12 | 2.6× |
| CT cervical spine w/o contrast (72125) | $545 | $1,362.50 | 5.7× |
| CT cervical spine w/wo cont (72127) | $845.25 | $2,113.12 | 5.2× |
| CT chest w contrast (71260) | $1,501.72 | $3,754.29 | 9.3× |
| CT chest w/wo contrast (71270) | $1,739.36 | $4,348.39 | 10.8× |
| CT head/brain with contrast (70460) | $1,576.66 | $3,941.65 | 9.8× |
| CT head/brain without and with contrast (70470) | $726.67 | $1,816.67 | 4.5× |
| CT iac w contrast (70481) range across 2 matching MRF lines |
$923.93–$1,416.34 | $2,309.81–$3,540.85 | varies |
| CT l-spine w&w/o contrast (72133) | $845.25 | $2,113.12 | 5.2× |
| CT lower ext w/o (73700) range across 2 matching MRF lines |
$1,367.49–$2,051.23 | $3,418.71–$5,128.06 | varies |
| CT lower extremity w/contrast material (73701) range across 2 matching MRF lines |
$1,380.77–$2,071.15 | $3,451.91–$5,177.87 | varies |
| CT lumbar spine w contrast (72132) | $1,443.38 | $3,608.44 | 4.5× |
| CT lumbar spine w/o contrast (72131) | $726.67 | $1,816.67 | 7.5× |
| CT maxillofacial w contrast (70487) | $526.39 | $1,315.96 | 3.3× |
| CT maxillofacial wo contrast (70486) | $1,083.84 | $2,709.59 | 11.3× |
| CT neck tissue combo (70492) | $947.28 | $2,368.18 | 5.9× |
| Ct Orbit/Ear/Fossa W/O&W/Dye (70482) range across 2 matching MRF lines |
$414.09–$1,060.79 | $1,035.22–$2,651.97 | varies |
| CT orbits w/o contrast (70480) range across 2 matching MRF lines |
$1,005.69–$1,088.58 | $2,514.21–$2,721.45 | varies |
| CT pelvis w&w/o contrast (72194) | $1,780.62 | $4,451.55 | 11.0× |
| CT pelvis w/o contrast (72192) | $1,263.61 | $3,159.02 | 13.1× |
| CT scan of leg combo (73702) | $1,439.58 | $3,598.95 | 8.9× |
| CT scans face/jaw combo (70488) | $444.01 | $1,110.02 | 2.7× |
| CT soft tissue neck w contrast (70491) | $2,043.40 | $5,108.50 | 12.6× |
| CT soft tissue neck w/o contrast (70490) | $1,453.34 | $3,633.34 | 15.1× |
| CT thoracic spine w contrast (72129) | $845.25 | $2,113.12 | 5.2× |
| CT thoracic spine w/o contrast (72128) | $1,649.71 | $4,124.26 | 17.1× |
| CT thoracic spine w/wo cont (72130) | $845.25 | $2,113.12 | 5.2× |
| CT thorax w/o contrast (71250) | $726.67 | $1,816.67 | 7.5× |
| CT upper ext wo (73200) range across 2 matching MRF lines |
$1,414.80–$2,122.20 | $3,537–$5,305.48 | varies |
| CT upper extremity w/o & w/contrast material (73202) range across 2 matching MRF lines |
$1,036.90–$1,347.96 | $2,592.23–$3,369.88 | varies |
| CT upper extremity with contrast (73201) | $1,409.23 | $3,523.06 | 4.4× |
| Cta Abdl Aorta&Bi Iliofem W/Contrast&Postp (75635) | $1,968.94 | $4,922.33 | 12.2× |
| Cta Abdomen (74175) | $1,739.36 | $4,348.39 | 10.8× |
| CTA pelvis (72191) | $1,883.55 | $4,708.87 | 11.7× |
| Diskography lumbar (72295) | $349.58 | $873.95 | 0.2× |
| Dxa Bone Density Axial (77080) | $290.29 | $725.71 | 3.0× |
| Dxa bone density study (77085) | $337.25 | $843.12 | 3.5× |
| Dxa bone density study 1/>sites appendiclr skel (77081) | $130.44 | $326.10 | 1.6× |
| Esophagram (74220) | $456.78 | $1,141.94 | 2.8× |
| Fetal Biophys Profile W/Nst (76818) | $202.54 | $506.34 | 2.1× |
| Fetal Biophysical Profile W/O Non-Stress Testing (76819) | $236.22 | $590.54 | 2.5× |
| Fluoroscopy up to 1 hr (76000) | $410.77 | $1,026.92 | 1.9× |
| Follow-Up Angiography (75898) | $130.44 | $326.10 | 0.0× |
| Foot 2 views (73620) range across 2 matching MRF lines |
$219.62–$329.42 | $549.03–$823.55 | varies |
| Forearm 2 views (73090) range across 2 matching MRF lines |
$242.38–$363.58 | $605.95–$908.93 | varies |
| Gastric emptying imaging study (78264) | $988.98 | $2,472.43 | 2.7× |
| Gated Heart Planar Single (78472) | $1,219.50 | $3,048.73 | 3.3× |
| Hand 2 views (73120) range across 2 matching MRF lines |
$222.46–$333.69 | $556.15–$834.21 | varies |
| Hepatobil Syst Image W/Drug (78227) | $940.12 | $2,350.29 | 1.9× |
| Hepatobiliary System Imaging (78226) | $769.84 | $1,924.58 | 2.1× |
| Hysterosalpingogram (74740) | $483.34 | $1,208.35 | 2.2× |
| Infant hip ultrasound with hip movement (dynamic) (76885) | $663.59 | $1,658.96 | 8.3× |
| Infant hip ultrasound, limited static exam (76886) | $124.75 | $311.87 | 1.6× |
| K Flow/Funct Image W/Drug (78708) | $850.47 | $2,126.17 | 1.7× |
| K Flow/Funct Image W/O Drug (78707) | $425.48 | $1,063.68 | 0.9× |
| Kidney Imaging Morphoogy W/Vascular Flow (78701) | $568.72 | $1,421.79 | 1.5× |
| Knee 3 Views (73562) range across 2 matching MRF lines |
$262.31–$393.46 | $655.76–$983.63 | varies |
| Liver & Spleen Imaging Static Only (78215) | $627.54 | $1,568.83 | 1.7× |
| Liver imaging static only (78201) | $627.54 | $1,568.83 | 1.3× |
| Lung Perf&Ventilat Diferentl (78598) | $947.23 | $2,368.07 | 1.9× |
| Lung perfusion differential (78597) | $922.09 | $2,305.22 | 2.5× |
| Lung Ventilat&Perfus Imaging (78582) | $397.57 | $993.92 | 0.8× |
| Lung Ventilation Imaging (78579) | $922.09 | $2,305.22 | 2.5× |
| Lymph System Imaging (78195) | $650.78 | $1,626.94 | 1.3× |
| Magnetic Image Jaw Joint (70336) range across 2 matching MRF lines |
$452.71–$905.41 | $1,131.77–$2,263.51 | varies |
| Mammary ductogram or galactogram single (77053) | $149.42 | $373.53 | 0.7× |
| Meckels Divert Exam (78290) | $781.70 | $1,954.23 | 2.1× |
| Mr safety determination physician/other qhp (76016) | $476 | $1,190 | 5.9× |
| Mr safety implant&/fb assmt clin staf 1st 15 min (76014) | $476 | $1,190 | 17.9× |
| Mr safety implt electronics prepj supvj phys/qhp (76018) | $476 | $1,190 | 5.4× |
| Mr safety implt pos&/immoblj (76019) | $476 | $1,190 | 8.8× |
| Mr safety med physics xm customization plng&mntr (76017) | $476 | $1,190 | 2.2× |
| Mra Head W/O & W/Contrast Material (70546) | $1,258.33 | $3,145.81 | 3.9× |
| MRA head w/o contrast (70544) | $975.69 | $2,439.22 | 4.4× |
| MRA head with contrast (70545) | $2,501.60 | $6,253.99 | 7.8× |
| MRA neck w contrast (70548) | $2,530.54 | $6,326.33 | 7.9× |
| Mra Neck W/O &W/Contrast Material (70549) | $1,266.46 | $3,166.13 | 3.9× |
| MRA neck w/o contrast (70547) | $2,501.60 | $6,253.99 | 11.4× |
| MRI abdomen w contrast (74182) | $1,196.39 | $2,990.96 | 3.7× |
| MRI abdomen w/o contrast (74181) | $1,078.15 | $2,695.36 | 4.9× |
| MRI any jt lower extrem w/contrast material (73722) | $1,349.55 | $3,373.87 | 1.9× |
| MRI any jt lower extrem w/o & w/contrast matrl (73723) | $1,633.67 | $4,084.17 | 5.1× |
| MRI any jt upper extremity w/contrast matrl (73222) | $564.93 | $1,412.31 | 0.8× |
| MRI Breast Without Contrast Material Unilateral (77046) | $459.91 | $1,149.77 | 2.1× |
| MRI cervical spine w contrast (72142) | $2,279.14 | $5,697.84 | 7.1× |
| MRI cervical spine w/o cont (72141) | $1,528.28 | $3,820.70 | 7.0× |
| MRI chest with contrast (71551) | $2,309.02 | $5,772.55 | 3.2× |
| MRI chest wo w contrast (71552) | $1,633.67 | $4,084.17 | 5.1× |
| MRI lower extrem oth/thn jt w/contrast matrl (73719) range across 2 matching MRF lines |
$1,196.39–$2,392.78 | $2,990.96–$5,981.93 | varies |
| MRI lower extrem oth/thn jt w/o & w/contr matr (73720) | $1,731.30 | $4,328.23 | 5.4× |
| MRI lower extrem oth/thn jt w/o contr matrl (73718) | $1,047.32 | $2,618.28 | 4.8× |
| MRI lumbar spine w contrast (72149) | $2,401.52 | $6,003.78 | 7.5× |
| Mri Neck Spine W/O & W/Dye (72156) | $1,717.54 | $4,293.84 | 5.3× |
| MRI orbit face &/neck w/o contrast (70540) | $1,963.62 | $4,909.04 | 8.9× |
| MRI orbit face neck w contrast (70542) | $1,196.39 | $2,990.96 | 3.7× |
| Mri Orbt/Fac/Nck W/O &W/Dye (70543) | $1,869.04 | $4,672.59 | 5.8× |
| MRI pelvis w/o & w contrast (72197) | $445.87 | $1,114.66 | 1.4× |
| MRI pelvis w/o contrast (72195) | $1,239.90 | $3,099.73 | 5.6× |
| MRI thoracic spine w/o contrast (72146) | $1,582.83 | $3,957.07 | 7.2× |
| MRI upper extremity oth than jt w/o contr matrl (73218) | $1,616.51 | $4,041.26 | 7.4× |
| Mri Uppr Extremity W/O&W/Dye (73220) | $1,616.51 | $4,041.26 | 5.0× |
| MRI, abdomen, combo (74183) | $445.87 | $1,114.66 | 1.4× |
| MRI, dorsal spine combo (72157) | $1,771.62 | $4,429.03 | 5.5× |
| MRI, dorsal spine contrast (72147) | $2,279.14 | $5,697.84 | 7.1× |
| MRI, joint upper extrem (73221) range across 2 matching MRF lines |
$564.93–$847.39 | $1,412.31–$2,118.46 | varies |
| MRI, joint upper extrem combo (73223) range across 2 matching MRF lines |
$1,633.67–$3,267.33 | $4,084.17–$8,168.32 | varies |
| MRI, lumbar spine combo (72158) | $1,771.62 | $4,429.03 | 5.5× |
| Myelogram cervical (72240) | $1,354.68 | $3,386.69 | 1.9× |
| Myelogram Lumbar (72265) | $2,707.93 | $6,769.82 | 3.7× |
| Myelography thoracic (72255) | $658.37 | $1,645.91 | 0.9× |
| Myelograpy 2/more regions rs&i (72270) | $2,549.51 | $6,373.77 | 3.5× |
| Myocardial Imaging Infarct Avid Planar Qual/Quan (78466) | $940.12 | $2,350.29 | 2.6× |
| Myocardial Spect Multiple Studies (78452) | $2,575.12 | $6,437.80 | 2.2× |
| N-invas est c ffr sw aly CTA (75580) | $6,755.83 | $16,889.57 | 8.5× |
| Neck soft tissue (70360) | $239.54 | $598.83 | 3.0× |
| Nm csf leak detection (78650) | $1,300.61 | $3,251.51 | 1.1× |
| Nuclear Rx Oral Admin (79005) | $252.34 | $630.85 | 1.2× |
| Ophthalmic ultrasound dx b-scan w/wo a-scan (76512) | $389.44 | $973.58 | 4.0× |
| Parathyroid Planar Imaging (78070) | $913.56 | $2,283.89 | 2.5× |
| Parathyroid planar imaging w/wo subtraction (78071) | $652.07 | $1,630.16 | 1.8× |
| Pelvis 1 or 2 views (72170) | $277.01 | $692.52 | 2.9× |
| Pulmonary Perfusion Imaging Particulate (78580) | $922.09 | $2,305.22 | 2.5× |
| Radex Abd Compl Aqt Abd W/S/E/D Views 1 View Ch (74022) | $563.98 | $1,409.94 | 5.9× |
| Radex abscess/fistula/sinus tract rs&i (76080) | $377.57 | $943.91 | 0.7× |
| Radex Ankle Complete Minimum 3 Views (73610) range across 2 matching MRF lines |
$255.19–$382.79 | $637.97–$956.96 | varies |
| Radex Calcaneus Minimum 2 Views (73650) | $239.54 | $598.83 | 3.0× |
| Radex elbow complete minimum 3 views (73080) range across 2 matching MRF lines |
$265.62–$398.44 | $664.05–$996.08 | varies |
| Radex Facial Bones Complete Minimum 3 Views (70150) | $403.66 | $1,009.13 | 4.2× |
| Radex fingr minimum 2 views (73140) range across 3 matching MRF lines |
$136.34–$204.51 | $340.85–$511.27 | varies |
| Radex foot complete minimum 3 views (73630) range across 2 matching MRF lines |
$265.62–$398.44 | $664.05–$996.08 | varies |
| Radex Hand Minimum 3 Views (73130) range across 2 matching MRF lines |
$248.08–$372.11 | $620.18–$930.27 | varies |
| Radex lower extremity infant minimum 2 views (73592) range across 2 matching MRF lines |
$238.11–$357.17 | $595.27–$892.92 | varies |
| Radex Mastoids Compl Minimum 3 Views PR Side (70130) | $265.62 | $664.05 | 2.8× |
| Radex Nasal Bones Complete Minimum 3 Views (70160) | $265.62 | $664.05 | 3.3× |
| Radex Ribs Unilateral 2 Views (71100) | $315.90 | $789.75 | 3.9× |
| Radex shoulder complete minimum 2 views (73030) range across 2 matching MRF lines |
$300.73–$451.09 | $751.81–$1,127.71 | varies |
| Radex Sinuses Paransl < 3 Views (70210) | $225.78 | $564.45 | 2.8× |
| Radex Spine 1 View Specify Level (72020) | $250.92 | $627.30 | 3.1× |
| Radex Sternum Minimum 2 Views (71120) | $277.48 | $693.70 | 3.5× |
| Radex Temporomandble Jt Opn & Clsd Mouth Bilat (70330) | $274.64 | $686.59 | 3.4× |
| Radex Toe Minimum 2 Views (73660) | $211.08 | $527.69 | 2.6× |
| Radex upper extremity infant minimum 2 views (73092) | $238.11 | $595.27 | 2.5× |
| Radex Wrist Complete Minimum 3 Views (73110) range across 2 matching MRF lines |
$239.54–$359.30 | $598.83–$898.25 | varies |
| Radex X-Ray Exam Entire Spi 6/> Vw - Xr Entire Spine 6+ Vw (72084) | $426.37 | $1,065.91 | 4.4× |
| Radiolog exam mandible compl minimum 4 views (70110) | $415.51 | $1,038.77 | 4.3× |
| Radiologic exam colon double contrast study (74280) | $761.30 | $1,903.24 | 4.7× |
| Radiologic exam colon single contrast study (74270) | $609.04 | $1,522.59 | 3.8× |
| Radiologic Exam Esophagus Double Contrast Study (74221) | $304.03 | $760.07 | 1.9× |
| Radiologic exam knee complete 4/more views (73564) range across 2 matching MRF lines |
$287.92–$431.88 | $719.79–$1,079.68 | varies |
| Radiologic exam pelvis compl minimum 3 views (72190) | $122.48 | $306.20 | 1.3× |
| Radiologic Exam Small Int Single Contrast Study (74250) | $543.11 | $1,357.76 | 3.4× |
| Radiologic exam swallow function contrast study (74230) | $408.40 | $1,020.99 | 2.5× |
| Radiologic exam upr gi trc double contrast study (74246) | $592.44 | $1,481.08 | 3.7× |
| Radiologic examination femur 1 view (73551) | $234.80 | $586.98 | 2.9× |
| Radiologic examination femur minimum 2 views (73552) range across 2 matching MRF lines |
$261.83–$392.74 | $654.57–$981.85 | varies |
| Radiologic examination knee 1/2 views (73560) range across 2 matching MRF lines |
$268.47–$402.71 | $671.17–$1,006.76 | varies |
| Radiologic examination tibia & fibula 2 views (73590) range across 2 matching MRF lines |
$267.05–$400.57 | $667.61–$1,001.42 | varies |
| Renal Cyst Study (74470) | $496.15 | $1,240.36 | 1.0× |
| Ribs bilateral 3 views (71110) | $386.11 | $965.26 | 4.0× |
| Rp loclzj tum plnr 1 area single day imaging (78800) | $940.12 | $2,350.29 | 2.6× |
| Rp Loclzj Tum Plnr Whole Body Single Day Imaging (78802) | $1,065.34 | $2,663.35 | 2.1× |
| Rp Loclzj Tum Spect 1 Area Single Day Imaging (78803) | $678.50 | $1,696.25 | 1.4× |
| Rp loclzj tum spect 2 area/sep acquisj img (78831) | $2,315.19 | $5,787.97 | 1.9× |
| Rp loclzj tum spect CT 2area 1d img/1 ar img>2+d (78832) | $2,626.35 | $6,565.86 | 2.0× |
| Rp loclzj tum spect w/CT 1 area/acquisj 1day img (78830) | $2,315.19 | $5,787.97 | 1.9× |
| Scapula (73010) | $277.01 | $692.52 | 2.9× |
| Screening Digital Breast Tomosynthesis Bi (77063) | $16 | $40 | 0.7× |
| Shoulder 1 view (73020) | $250.45 | $626.11 | 3.1× |
| Shoulder Arthrography (73040) | $284.13 | $710.31 | 0.9× |
| Skull less than 4 views (70250) | $381.84 | $954.58 | 4.0× |
| Special Physics Consult (77370) | $617.10 | $1,542.74 | 5.0× |
| Sternoclavicular joints (71130) | $221.51 | $553.77 | 2.8× |
| Testicular Imaging W/Flow (78761) | $594.33 | $1,485.82 | 1.6× |
| Thoracic spine 2 views (72070) | $310.69 | $776.71 | 3.2× |
| Thoracic spine 3 views (72072) | $336.30 | $840.75 | 3.5× |
| Thoracolumbar 2 views (72080) | $91.41 | $228.52 | 1.1× |
| Thyroid Met Imaging Body (78018) | $1,638.33 | $4,095.81 | 3.3× |
| Thyroid Uptake W/Blood Flow Sngle/Mult Quan Meas (78014) | $891.74 | $2,229.34 | 2.4× |
| Tx devices design & construction simple (77332) | $486.19 | $1,215.46 | 3.9× |
| Ultrasound Breast Limited (76642) range across 2 matching MRF lines |
$378.52–$567.77 | $946.28–$1,419.42 | varies |
| Ultrasound Exam Aaa Screen (76706) | $184.99 | $462.47 | 1.9× |
| Ultrasound, abdomen limited (76705) | $543.11 | $1,357.76 | 5.6× |
| Umbilical-artery Doppler (OB) (76820) | $69.28 | $173.20 | 0.7× |
| Unlisted Dx Radiographic Procedure (76499) | $2,307.73 | $5,769.31 | 28.8× |
| Upper gi w/o kub (74240) | $591.58 | $1,478.95 | 3.7× |
| Ureteral Reflux Study (78740) | $594.33 | $1,485.82 | 1.6× |
| Urethrocystogram voiding (74455) | $453.94 | $1,134.83 | 2.1× |
| Us breast unilateral complete (76641) range across 2 matching MRF lines |
$378.52–$567.77 | $946.28–$1,419.42 | varies |
| Us chest (76604) | $317.33 | $793.31 | 3.3× |
| Us complete joint (76881) | $475.75 | $1,189.37 | 4.9× |
| Us exam, pelvic, limited (76857) | $543.11 | $1,357.76 | 5.6× |
| Us head (76506) | $465.32 | $1,163.28 | 4.8× |
| Us kidney transplant (76776) | $130.44 | $326.10 | 1.4× |
| Us lmtd joint/oth nonvasc xtr strux r-t w/img (76882) range across 2 matching MRF lines |
$361.44–$542.16 | $903.60–$1,355.38 | varies |
| Us ob detailed single fetus (76811) | $499.47 | $1,248.66 | 2.3× |
| Us ob limited 1 or more fetuses (76815) | $236.22 | $590.54 | 2.5× |
| Us ob transvaginal (76817) | $145.15 | $362.86 | 1.5× |
| Us pelvic non ob complete (76856) | $583.43 | $1,458.56 | 6.1× |
| Us pg uter img f&mat 14 wk tabdl 1/1st gestation (76801) | $357.17 | $892.92 | 3.7× |
| Us preg uterus real time f/u trnsabdl per fetus (76816) | $236.22 | $590.54 | 2.5× |
| Us retroperitoneal complete (76770) | $543.11 | $1,357.76 | 5.6× |
| Us retroperitoneal limited (76775) | $325.43 | $813.57 | 3.4× |
| Us scrotum and contents (76870) | $609.52 | $1,523.78 | 6.3× |
| Us spinal canal and contents (76800) | $211.08 | $527.69 | 2.2× |
| Us thyroid (76536) | $543.11 | $1,357.76 | 5.6× |
| Vein X-Ray Chest (75827) | $1,810.03 | $4,525.07 | 1.2× |
| Venography caval inferior serialography rs&i (75825) | $1,810.03 | $4,525.07 | 0.6× |
| Venography extremity bilateral rs&i (75822) | $1,145.50 | $2,863.74 | 0.8× |
| Venography extremity unilateral rs&i (75820) | $396.64 | $991.60 | 0.3× |
| Vertebral fracture assessment via dxa (77086) | $130.44 | $326.10 | 1.6× |
| Wrist 2 views (73100) range across 2 matching MRF lines |
$65.60–$98.40 | $163.99–$245.98 | varies |
| X-Ray Ac Jts - Xr Acromioclavicular Joints Bilateral (73050) | $656.47 | $1,641.17 | 8.2× |
| X-ray antegrade pyelogram tube (74425) | $385.63 | $964.07 | 1.2× |
| X-Ray Aorta Leg Arteries (75630) | $2,896.72 | $7,241.78 | 1.0× |
| X-Ray Bend Only L-S Spine (72120) | $338.38 | $845.94 | 3.5× |
| X-Ray Elbow 2 Vw - Xr Elbow 1-2 Views Right (73070) range across 2 matching MRF lines |
$240.96–$361.44 | $602.39–$903.59 | varies |
| X-Ray Exam Breast Specimen (76098) | $733.79 | $1,834.46 | 1.5× |
| X-Ray Exam Entire Spi 1 Vw (72081) | $242.38 | $605.95 | 3.0× |
| X-Ray Exam Entire Spi 2/3 Vw (72082) | $268.94 | $672.35 | 2.8× |
| X-Ray Exam Entire Spi 4/5 Vw (72083) | $295.51 | $738.76 | 3.1× |
| X-Ray Exam Hip Uni 1 View (73501) | $184.99 | $462.47 | 2.3× |
| X-Ray Exam Hip Uni 2-3 Views (73502) | $209.18 | $522.95 | 2.6× |
| X-Ray Exam Hips Bi 2 Views (73521) | $78.35 | $195.86 | 0.8× |
| X-Ray Exam Hips Bi 3-4 Views (73522) | $323.50 | $808.73 | 3.4× |
| X-Ray Exam L-S Spine Bending (72114) | $193.58 | $483.93 | 2.0× |
| X-Ray Exam Neck Spine 2-3 Vw (72040) | $321.12 | $802.80 | 4.0× |
| X-Ray Exam Neck Spine 6/>Vws (72052) | $282.70 | $706.75 | 2.9× |
| X-Ray Exam Unilat Ribs/Chest (71101) | $446.82 | $1,117.04 | 4.6× |
| X-ray eye for foreign body (70030) | $270.37 | $675.91 | 3.4× |
| X-ray humerus (73060) range across 2 matching MRF lines |
$268–$401.99 | $669.98–$1,004.97 | varies |
| X-ray IV pyelogram (ivp) (74400) | $813.48 | $2,033.68 | 5.0× |
| X-Ray Jaw <4 Vw - Xr Mandible < 4 Views (70100) | $389.43 | $973.56 | 4.9× |
| X-Ray Knee Bilat Standing - Xr Knees Anteroposterior Standing Bilat (73565) | $78.75 | $196.86 | 1.0× |
| X-Ray Lumbar Spine 2/3 Vw - Xr Lumbar Spine 2-3 Views (72100) | $314.01 | $785.02 | 3.3× |
| X-ray nose-rectum child f.b. (76010) | $270.37 | $675.91 | 3.4× |
| X-Ray Ribs, Chest 4+ Vw - Xr Ribs 3 Vws Bil W/ Chest Posteroanterior (71111) | $425.48 | $1,063.68 | 4.4× |
| X-Ray Sacroiliac Jts 3+ Vw - Xr Sacroiliac Joints 3+ Views (72202) | $177.40 | $443.50 | 1.8× |
| X-Ray Sacroiliac Jts <3 Vw - Xr Sacroiliac Joints 1-2 Views (72200) | $91.98 | $229.95 | 1.0× |
| X-Ray Sacrum/Coccyx 2+ Vw - Xr Sacrum Coccyx 2+ Views (72220) | $297.40 | $743.50 | 3.7× |
| X-Ray Sinuses 3+ Vw - Xr Paranasal Sinuses 3+ Views (70220) | $356.70 | $891.74 | 4.4× |
| X-Ray Skull 4+ Vw - Xr Skull Complete 4+ Views (70260) | $575.84 | $1,439.58 | 6.0× |
| X-Ray Stress View (77071) | $238.11 | $595.27 | 3.0× |
| X-ray thoracic spine 4 vw (72074) | $361.44 | $903.60 | 3.8× |
| X-Ray Urinary Tract Exam With Contrast Material (74420) | $583.43 | $1,458.56 | 1.8× |
| X-Rays Bone Length Studies (77073) | $255.19 | $637.97 | 2.6× |
| X-Rays Bone Survey Complete (77075) | $337.25 | $843.12 | 3.5× |
| Xr c-spine 4 or 5 views (72050) | $440.18 | $1,100.43 | 4.6× |
| Xr facial bones less than 3 views (70140) | $377.57 | $943.91 | 4.7× |
| Xr orbits complete 4 views (70200) | $191.63 | $479.07 | 2.0× |
| Xr Tomogram Single Plane (76100) | $645.09 | $1,612.71 | 6.7× |
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.