Imaging prices at St. John's Medical Center
Jackson, WY · every code in this section with a posted price and a Medicare benchmark.
448 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) | $7,183 | $7,183 | 5.1× |
| Abdomen 1 View (74018) range across 2 matching MRF lines |
$85–$347 | $85–$347 | varies |
| Abdomen 2 views (74019) | $100 | $100 | 0.9× |
| Acute Gastrointestinal Blood Loss Imaging (78278) | $1,885 | $1,885 | 4.6× |
| Acute venous thrombosis imaging, peptide Non-Facility (78456) | $915 | $915 | 0.7× |
| Adrenal Cortex & Medulla Img (78075) | $1,105 | $1,105 | 0.8× |
| Angio internal mammary (75756) | $489 | $489 | 0.2× |
| Angio pulmonary bilat (75743) | $481 | $481 | 0.1× |
| Angiography Adrenal Bilateral Slctv Rs&I (75733) | $528 | $528 | 0.2× |
| Angiography extremity bilateral rs&i (75716) | $549 | $549 | 0.2× |
| Angiography extremity unilateral rs&i (75710) range across 2 matching MRF lines |
$457–$6,993 | $457–$6,993 | varies |
| Ankle 2 views (73600) range across 2 matching MRF lines |
$75–$339 | $75–$339 | varies |
| Artery X-Rays Abdomen (75726) likely a partial charge, not the full procedure |
$459 | $459 | 0.1× |
| Artery X-Rays Adrenal Gland (75731) | $425 | $425 | 0.1× |
| Artery X-Rays Pelvis (75736) likely a partial charge, not the full procedure |
$444 | $444 | 0.1× |
| Artery X-Rays Spine (75705) likely a partial charge, not the full procedure |
$626 | $626 | 0.1× |
| Arthrogram ankle (73615) | $452 | $452 | 1.3× |
| Arthrogram hip (73525) | $1,035 | $1,035 | 2.9× |
| Arthrogram Wrist (73115) | $643 | $643 | 1.8× |
| Basic radiation dosimetry calculation (77300) | $168 | $168 | 1.2× |
| Bone age studies (77072) | $145 | $145 | 1.4× |
| Bone Imaging 3 Phase (78315) | $2,775 | $2,775 | 6.8× |
| Bone Imaging Limited Area (78300) | $2,519 | $2,519 | 6.2× |
| Bone Imaging Multiple Areas (78305) | $855 | $855 | 2.1× |
| Bone Imaging Whole Body (78306) | $2,553 | $2,553 | 6.3× |
| Bone marrow imaging limited area (78102) | $438 | $438 | 1.1× |
| Bone marrow imaging; multiple areas (78103) | $559 | $559 | 1.4× |
| Bone marrow imaging; whole body (78104) | $640 | $640 | 1.6× |
| Bone survey infant (77076) | $270 | $270 | 2.5× |
| Brachytx isodose complex (77318) | $2,775 | $2,775 | 7.3× |
| Brachytx isodose intermed (77317) | $2,330 | $2,330 | 6.1× |
| Brachytx Isodose Plan Simple (77316) | $2,066 | $2,066 | 5.4× |
| Brain Flow Imaging Only (78610) | $456 | $456 | 0.8× |
| Brain Image W/Flow < 4 Views (78601) | $558 | $558 | 1.4× |
| Brain imaging < 4 static views (78600) | $473 | $473 | 1.2× |
| Brain Imaging Min 4 Static Views W Vascular Flow (78606) | $857 | $857 | 1.5× |
| Brain Imaging Minimum 4 Static Views (78605) | $510 | $510 | 0.9× |
| Brain Imaging Pet Metabolic Evaluation (78608) range across 2 matching MRF lines |
$178–$9,140 | $178–$9,140 | varies |
| Card Bl Pool Gated Spect Rest Wal Motn Ejct Frct (78494) | $593 | $593 | 1.5× |
| Cardiac blood pool imaging, first pass technique; multiple studies, resting and with stress (exercise and/or… (78483) | $628 | $628 | 1.1× |
| Cardiac MRI w/w/o contrast & further seq (75561) range across 2 matching MRF lines |
$1,226–$3,167 | $1,226–$3,167 | varies |
| Cardiac MRI w/w/o contrast w/stress (75563) range across 2 matching MRF lines |
$1,448–$6,937 | $1,448–$6,937 | varies |
| Cardiac Shunt Detection (78428) | $475 | $475 | 1.2× |
| Cat Scan Follow-Up Study (76380) range across 2 matching MRF lines |
$420–$838 | $420–$838 | varies |
| Cerebrospinal Fluid Flow W/O Matl Shunt Evaltj (78645) | $830 | $830 | 1.5× |
| Cerebrospinal fluid flow, imaging (not including introduction of material); ventriculography Non-Facility (78635) | $873 | $873 | 1.6× |
| Cerebrospinal Fluid Scan (78630) | $2,441 | $2,441 | 4.4× |
| Chest 1 view (71045) range across 4 matching MRF lines |
$60–$369 | $60–$369 | varies |
| Chest 2 views (71046) range across 3 matching MRF lines |
$100–$425 | $100–$425 | varies |
| Chest 3 views (71047) range across 2 matching MRF lines |
$97–$500 | $97–$500 | varies |
| Chest 4 or more views (71048) range across 2 matching MRF lines |
$118–$515 | $118–$515 | varies |
| Cholecystography Oral Contrast (74290) | $180 | $180 | 1.0× |
| Cineradiograpy/vidradiograpy xcpt where spec (76120) | $194 | $194 | 1.8× |
| Clavicle complete (73000) range across 3 matching MRF lines |
$75–$404 | $75–$404 | varies |
| Computed Tomography Thorax Lw Dose Lng Ca Scr C- (71271) | $1,051 | $1,051 | 9.8× |
| Continuing medical physics consltj pr wk (77336) | $1,006 | $1,006 | 7.3× |
| Contrast Exam Abdominl Aorta (75625) | $6,389 | $6,389 | 2.0× |
| Contrast X-Ray Bladder (74430) range across 2 matching MRF lines |
$104–$751 | $104–$751 | varies |
| Contrast X-Ray Of Elbow (73085) | $470 | $470 | 1.3× |
| Contrast X-Ray Of Knee Joint (73580) | $795 | $795 | 2.2× |
| Contrast Xray Throat/Cerv Esopha (74210) | $201 | $201 | 1.1× |
| Corpora cavernosography (74445) | $141 | $141 | 1.3× |
| CT abdomen and pelvis without and with contrast (74178) | $4,960 | $4,960 | 13.9× |
| CT abdomen and pelvis without contrast (74176) | $3,561 | $3,561 | 14.6× |
| CT abdomen w contrast (74160) | $2,262 | $2,262 | 12.6× |
| CT abdomen w wo contrast (74170) | $2,603 | $2,603 | 14.5× |
| CT abdomen w/o contrast (74150) | $1,727 | $1,727 | 16.2× |
| CT Angio Abdomen and Pelvis (74174) | $4,194 | $4,194 | 11.8× |
| CT Angio Chest (71275) | $3,271 | $3,271 | 18.3× |
| CT Angio Head (70496) | $2,956 | $2,956 | 16.5× |
| CT angio hrt w/3d image (75574) | $2,813 | $2,813 | 7.9× |
| Ct Angio Lwr Extr W/O&W/Dye (73706) | $2,927 | $2,927 | 16.3× |
| CT Angio Neck (70498) | $3,221 | $3,221 | 18.0× |
| Ct Angio Upr Extrm W/O&W/Dye (73206) range across 2 matching MRF lines |
$2,504–$2,844 | $2,504–$2,844 | varies |
| CT bone density (77078) | $335 | $335 | 3.8× |
| CT cervical spine w/ contrast (72126) | $2,425 | $2,425 | 6.8× |
| CT cervical spine w/o contrast (72125) | $2,304 | $2,304 | 21.6× |
| CT cervical spine w/wo cont (72127) | $798 | $798 | 4.5× |
| CT chest w contrast (71260) | $2,711 | $2,711 | 15.1× |
| CT chest w/wo contrast (71270) | $3,466 | $3,466 | 19.3× |
| CT colonography screening (74263) range across 2 matching MRF lines |
$415–$1,140 | $415–$1,140 | varies |
| CT Colonogrphy Dx Image Postprocess W/Contrast (74262) | $1,140 | $1,140 | 6.4× |
| CT colonogrphy dx image postprocess w/o contrast (74261) | $1,358 | $1,358 | 12.7× |
| CT head/brain with contrast (70460) | $2,400 | $2,400 | 13.4× |
| CT head/brain without and with contrast (70470) | $2,855 | $2,855 | 15.9× |
| CT heart contrast eval cardiac structure&morph (75572) | $1,895 | $1,895 | 5.3× |
| CT heart no contrast quant eval coronry calcium (75571) | $299 | $299 | 3.4× |
| CT hrt w/3d image congen (75573) | $2,621 | $2,621 | 7.4× |
| CT iac w contrast (70481) | $2,173 | $2,173 | 12.1× |
| CT l-spine w&w/o contrast (72133) | $798 | $798 | 4.5× |
| CT lower ext w/o (73700) | $1,756 | $1,756 | 16.4× |
| CT lower extremity w/contrast material (73701) | $1,920 | $1,920 | 10.7× |
| CT lumbar spine w contrast (72132) | $2,789 | $2,789 | 7.8× |
| CT lumbar spine w/o contrast (72131) | $2,333 | $2,333 | 21.8× |
| CT maxillofacial w contrast (70487) | $2,235 | $2,235 | 12.5× |
| CT maxillofacial wo contrast (70486) | $2,089 | $2,089 | 19.6× |
| CT neck tissue combo (70492) | $2,500 | $2,500 | 14.0× |
| Ct Orbit/Ear/Fossa W/O&W/Dye (70482) | $904 | $904 | 5.0× |
| CT orbits w/o contrast (70480) | $1,778 | $1,778 | 16.6× |
| CT pelvis w&w/o contrast (72194) | $2,773 | $2,773 | 15.5× |
| CT pelvis w/o contrast (72192) | $2,069 | $2,069 | 19.4× |
| CT scan of leg combo (73702) | $2,490 | $2,490 | 13.9× |
| CT scans face/jaw combo (70488) | $3,395 | $3,395 | 18.9× |
| CT soft tissue neck w contrast (70491) | $2,267 | $2,267 | 12.7× |
| CT soft tissue neck w/o contrast (70490) | $1,790 | $1,790 | 16.8× |
| CT thoracic spine w contrast (72129) | $2,377 | $2,377 | 13.3× |
| CT thoracic spine w/o contrast (72128) | $2,187 | $2,187 | 20.5× |
| CT thoracic spine w/wo cont (72130) | $802 | $802 | 4.5× |
| CT thorax w/o contrast (71250) | $1,990 | $1,990 | 18.6× |
| CT upper ext wo (73200) range across 2 matching MRF lines |
$1,743–$2,615 | $1,743–$2,615 | varies |
| CT upper extremity w/o & w/contrast material (73202) range across 2 matching MRF lines |
$2,335–$3,503 | $2,335–$3,503 | varies |
| CT upper extremity with contrast (73201) range across 2 matching MRF lines |
$2,009–$3,014 | $2,009–$3,014 | varies |
| Cta Abdl Aorta&Bi Iliofem W/Contrast&Postp (75635) | $3,478 | $3,478 | 19.4× |
| Cta Abdomen (74175) | $2,392 | $2,392 | 13.3× |
| CTA pelvis (72191) | $2,322 | $2,322 | 13.0× |
| Dacryocystography, nasolacrimal duct, radiological supervision and interpretation Non-Facility (70170) | $38 | $38 | 0.2× |
| Determination of central c-v hemodynamics (non-imaging) (eg, ejection fraction with probe technique) with or without… (78414) | $57 | $57 | 0.1× |
| Dilation ureters/urethra rs&i (74485) | $250 | $250 | 0.1× |
| Discography Cerv/Thor Spine (72285) | $299 | $299 | 0.1× |
| Diskography lumbar (72295) range across 2 matching MRF lines |
$262–$3,831 | $262–$3,831 | varies |
| Doppler Echo Fetal Spectral Display Complete (76827) range across 2 matching MRF lines |
$384–$705 | $384–$705 | varies |
| Doppler Fetal Mid Cerebral Artery (76821) range across 2 matching MRF lines |
$108–$475 | $108–$475 | varies |
| Dxa Bone Density Axial (77080) | $586 | $586 | 5.5× |
| Dxa bone density study 1/>sites appendiclr skel (77081) | $355 | $355 | 4.0× |
| Echo exam of fetal heart (76825) range across 2 matching MRF lines |
$770–$1,110 | $770–$1,110 | varies |
| Echo exam uterus (76831) range across 2 matching MRF lines |
$323–$450 | $323–$450 | varies |
| Echo Guide For Artery Repair (76936) | $722 | $722 | 3.3× |
| Echograp Trans R Pros Study (76873) | $435 | $435 | 4.1× |
| Esophageal Motility Study (78258) | $579 | $579 | 1.4× |
| Esophagram (74220) | $837 | $837 | 4.7× |
| Fetal Biophys Profile W/Nst (76818) range across 2 matching MRF lines |
$460–$684 | $460–$684 | varies |
| Fetal Biophysical Profile W/O Non-Stress Testing (76819) range across 3 matching MRF lines |
$230–$350 | $230–$350 | varies |
| Fluoroscopy up to 1 hr (76000) range across 3 matching MRF lines |
$38–$814 | $38–$814 | varies |
| Follow-Up Angiography (75898) | $212 | $212 | 0.1× |
| Foot 2 views (73620) range across 2 matching MRF lines |
$72–$321 | $72–$321 | varies |
| Forearm 2 views (73090) range across 2 matching MRF lines |
$73–$409 | $73–$409 | varies |
| Gastric emptying imaging study (78264) | $2,159 | $2,159 | 5.3× |
| Gastric Mucosa Imaging (78261) | $652 | $652 | 1.6× |
| Gastroesophageal Reflux Exam (78262) | $646 | $646 | 1.6× |
| Gastrointestinal Protein Loss (78282) | $47 | $47 | 0.1× |
| Gated Heart Planar Single (78472) | $4,171 | $4,171 | 10.2× |
| Gated Heart, Multiple (78473) | $758 | $758 | 1.9× |
| GI Endoscopic US S&I (76975) | $110 | $110 | 0.5× |
| Hand 2 views (73120) range across 2 matching MRF lines |
$72–$359 | $72–$359 | varies |
| Hdr Rdncl Ntrstl/Icav Brchtx (77772) | $6,121 | $6,121 | 8.6× |
| Hdr Rdncl Ntrstl/Icav Brchtx (77771) | $8,080 | $8,080 | 11.4× |
| Hdr Rdncl Ntrstl/Icav Brchtx 1 Channel (77770) | $6,631 | $6,631 | 9.3× |
| Heart first pass single,planar (78481) | $470 | $470 | 0.8× |
| Heart Image (Pet) Multiple (78492) | $224 | $224 | 0.2× |
| Hepatobil Syst Image W/Drug (78227) | $2,666 | $2,666 | 4.8× |
| Hepatobiliary System Imaging (78226) | $2,363 | $2,363 | 5.8× |
| High energy neutron radj tx dlvr 1/> isocenter (77423) | $721 | $721 | 1.3× |
| Ht Musc Image Planar Mult (78454) | $1,127 | $1,127 | 0.9× |
| Ht Muscle Image Spect Sing (78451) range across 2 matching MRF lines |
$902–$5,254 | $902–$5,254 | varies |
| Hysterosalpingogram (74740) | $649 | $649 | 2.7× |
| Infant hip ultrasound with hip movement (dynamic) (76885) | $385 | $385 | 4.3× |
| Infant hip ultrasound, limited static exam (76886) range across 2 matching MRF lines |
$269–$306 | $269–$306 | varies |
| Infusion Ivp (74410) | $395 | $395 | 2.2× |
| Interstitial radiation source applic complex (77778) | $5,700 | $5,700 | 8.0× |
| Intracavitary Radiation Source Applic Complex (77763) | $3,040 | $3,040 | 4.3× |
| Intracavitary Radiation Source Applic Intermed (77762) | $2,130 | $2,130 | 3.8× |
| Intracavitary radiation source applic simple (77761) | $1,610 | $1,610 | 2.9× |
| Joint Survey Single View (77077) | $619 | $619 | 5.8× |
| K Flow/Funct Image W/O Drug (78707) | $2,090 | $2,090 | 3.8× |
| Kidney Funcj Study Non-Img Radioisotopic Study (78725) | $286 | $286 | 0.7× |
| Kidney Imaging Morphol (78700) | $457 | $457 | 1.1× |
| Kidney Imaging Morphoogy W/Vascular Flow (78701) | $551 | $551 | 1.3× |
| Knee 3 Views (73562) range across 2 matching MRF lines |
$99–$497 | $99–$497 | varies |
| Labeled RBC Sequestration Differntl Organ/Tissue (78140) | $348 | $348 | 0.9× |
| Leveen/Shunt Patency Exam (78291) | $660 | $660 | 1.6× |
| Liver & Spleen Imaging Static Only (78215) | $1,355 | $1,355 | 3.3× |
| Liver & Spleen Imaging W/Vascular Flow (78216) | $318 | $318 | 0.8× |
| Liver imaging static only (78201) | $481 | $481 | 0.9× |
| Liver imaging w/vascular flow (78202) | $624 | $624 | 1.1× |
| Lung Perf&Ventilat Diferentl (78598) | $911 | $911 | 1.6× |
| Lung perfusion differential (78597) | $611 | $611 | 1.5× |
| Lung Ventilat&Perfus Imaging (78582) range across 2 matching MRF lines |
$981–$2,866 | $981–$2,866 | varies |
| Lung Ventilation Imaging (78579) | $785 | $785 | 1.9× |
| Lymph System Imaging (78195) | $1,988 | $1,988 | 3.6× |
| Lymphangiography Extremity Only Bilateral Rs&I (75803) | $147 | $147 | 0.1× |
| Lymphangiography extremity only unilateral rs&i (75801) | $115 | $115 | 0.2× |
| Magnetic Image Jaw Joint (70336) | $2,254 | $2,254 | 9.2× |
| Magnetic resonance (eg, proton) imaging, brain (including brain stem andskull base), during open intracranial procedure… (70558) | $403 | $403 | 2.2× |
| Magnetic resonance (eg, proton) imaging, brain (including brain stem andskull base), during open intracranial procedure… (70559) | $404 | $404 | 2.3× |
| Mammary ductogram or galactogram multiple (77054) | $630 | $630 | 2.6× |
| Mammary ductogram or galactogram single (77053) | $477 | $477 | 2.0× |
| Meckels Divert Exam (78290) | $981 | $981 | 2.4× |
| Mlc imrt design & construction per imrt plan (77338) | $1,258 | $1,258 | 3.3× |
| Mr safety determination physician/other qhp (76016) | $236 | $236 | 2.7× |
| Mr safety implant&/fb assmt clin staf 1st 15 min (76014) | $65 | $65 | 2.2× |
| Mr safety implt electronics prepj supvj phys/qhp (76018) | $246 | $246 | 2.5× |
| Mr safety med physics xm customization plng&mntr (76017) | $647 | $647 | 2.7× |
| Mra Head W/O & W/Contrast Material (70546) | $3,863 | $3,863 | 10.8× |
| MRA head w/o contrast (70544) | $2,594 | $2,594 | 10.6× |
| MRA head with contrast (70545) | $2,800 | $2,800 | 7.9× |
| MRA neck w contrast (70548) | $3,368 | $3,368 | 9.4× |
| Mra Neck W/O &W/Contrast Material (70549) | $3,713 | $3,713 | 10.4× |
| MRA neck w/o contrast (70547) | $2,700 | $2,700 | 11.1× |
| MRI abdomen w contrast (74182) | $3,156 | $3,156 | 8.9× |
| MRI abdomen w/o contrast (74181) | $3,305 | $3,305 | 13.6× |
| MRI any jt lower extrem w/contrast material (73722) range across 2 matching MRF lines |
$775–$2,725 | $775–$2,725 | varies |
| MRI any jt lower extrem w/o & w/contrast matrl (73723) | $3,400 | $3,400 | 9.5× |
| MRI any jt upper extremity w/contrast matrl (73222) | $2,750 | $2,750 | 3.4× |
| MRI bone marrow blood supply (77084) range across 2 matching MRF lines |
$1,119–$1,728 | $1,119–$1,728 | varies |
| MRI brain functional w/o physician admnistration (70554) | $1,246 | $1,246 | 5.1× |
| MRI brain functional w/physician admnistration (70555) | $320 | $320 | 1.3× |
| MRI Breast W/O Contrast Bilateral (77047) | $2,743 | $2,743 | 11.3× |
| MRI cardiac w/o cont stress (75559) range across 2 matching MRF lines |
$1,258–$3,362 | $1,258–$3,362 | varies |
| MRI cardiac w/o contrast (75557) | $2,495 | $2,495 | 10.2× |
| MRI cervical spine w contrast (72142) | $3,204 | $3,204 | 9.0× |
| MRI cervical spine w/o cont (72141) | $2,950 | $2,950 | 12.1× |
| MRI chest w/o contrast (71550) | $3,104 | $3,104 | 12.7× |
| MRI chest with contrast (71551) | $3,375 | $3,375 | 4.2× |
| MRI chest wo w contrast (71552) | $3,920 | $3,920 | 11.0× |
| MRI lower extrem oth/thn jt w/contrast matrl (73719) | $2,700 | $2,700 | 7.6× |
| MRI lower extrem oth/thn jt w/o & w/contr matr (73720) | $3,690 | $3,690 | 10.4× |
| MRI lower extrem oth/thn jt w/o contr matrl (73718) | $2,541 | $2,541 | 10.4× |
| MRI lumbar spine w contrast (72149) | $3,300 | $3,300 | 9.3× |
| Mri Neck Spine W/O & W/Dye (72156) | $4,059 | $4,059 | 11.4× |
| MRI orbit face &/neck w/o contrast (70540) | $2,025 | $2,025 | 8.3× |
| MRI orbit face neck w contrast (70542) | $2,300 | $2,300 | 6.5× |
| Mri Orbt/Fac/Nck W/O &W/Dye (70543) | $2,922 | $2,922 | 8.2× |
| MRI pelvis w contrast (72196) | $3,300 | $3,300 | 9.3× |
| MRI pelvis w/o & w contrast (72197) | $3,737 | $3,737 | 10.5× |
| MRI pelvis w/o contrast (72195) | $2,802 | $2,802 | 11.5× |
| MRI thoracic spine w/o contrast (72146) | $2,831 | $2,831 | 11.6× |
| MRI upper extremity oth than jt w/contr matrl (73219) | $2,725 | $2,725 | 7.6× |
| MRI upper extremity oth than jt w/o contr matrl (73218) range across 2 matching MRF lines |
$760–$2,482 | $760–$2,482 | varies |
| Mri Uppr Extremity W/O&W/Dye (73220) | $3,693 | $3,693 | 10.4× |
| MRI, abdomen, combo (74183) range across 2 matching MRF lines |
$2,877–$3,836 | $2,877–$3,836 | varies |
| MRI, dorsal spine combo (72157) | $4,139 | $4,139 | 11.6× |
| MRI, dorsal spine contrast (72147) | $3,271 | $3,271 | 9.2× |
| MRI, joint upper extrem (73221) range across 3 matching MRF lines |
$500–$2,526 | $500–$2,526 | varies |
| MRI, joint upper extrem combo (73223) | $3,551 | $3,551 | 10.0× |
| MRI, lumbar spine combo (72158) | $4,349 | $4,349 | 12.2× |
| Myelogram Lumbar (72265) | $323 | $323 | 0.4× |
| Myelography thoracic (72255) | $314 | $314 | 0.4× |
| Myelograpy 2/more regions rs&i (72270) | $503 | $503 | 0.6× |
| Myocardial Imaging Infarct Avid Planar Qual/Quan (78466) | $507 | $507 | 1.2× |
| Myocardial Imaging Pet Metabolic Evaluation (78459) | $177 | $177 | 0.1× |
| Myocardial imaging, infarct avid, planar; with ejection fraction by first pass technique Non-Facility (78468) | $516 | $516 | 0.9× |
| Myocardial Perfusion Planar 1 Study Rest/Stress (78453) | $784 | $784 | 0.6× |
| Myocardial Spect Multiple Studies (78452) range across 2 matching MRF lines |
$1,257–$5,881 | $1,257–$5,881 | varies |
| Neck soft tissue (70360) range across 2 matching MRF lines |
$72–$362 | $72–$362 | varies |
| Nfs/Instlj Radioelmnt Sln 3 Mo Follow-Up Care (77750) | $907 | $907 | 2.3× |
| Njx Rp Loclzj Non-Img Probe Study Intravenous (78808) | $115 | $115 | 0.3× |
| Nm csf leak detection (78650) | $861 | $861 | 0.7× |
| Nm myocard infarct spect (78469) | $586 | $586 | 1.1× |
| Nm red cell survival study (78130) | $414 | $414 | 1.0× |
| Nm whole blood volume (78122) | $253 | $253 | 0.5× |
| Nonvascular Shunt X-Ray (75809) | $266 | $266 | 2.5× |
| Ntsty modul radthx pln dose-vol histos (77301) | $4,988 | $4,988 | 3.5× |
| Nuclear Rx Intra-Arterial (79445) | $286 | $286 | 1.2× |
| Nuclear Rx Oral Admin (79005) | $2,102 | $2,102 | 8.8× |
| Ob us nuchal meas 1 gest (76813) range across 2 matching MRF lines |
$375–$390 | $375–$390 | varies |
| Oph bmtry us echograpy a-scan io lens pwr cal (76519) | $220 | $220 | 2.1× |
| Oph us dx ant sgm us immersion b-scan/hr biom (76513) | $250 | $250 | 2.3× |
| Oph US Dx B-Scan&Quan a-Scan Sm Pt Enctr (76510) | $461 | $461 | 3.4× |
| Ophthalmic ultrasound dx b-scan w/wo a-scan (76512) | $241 | $241 | 2.3× |
| Ophthalmic US Dx Corneal Pachymetry Uni/Bi (76514) | $39 | $39 | 1.3× |
| Panoramic X-ray of jaws (70355) | $54 | $54 | 0.6× |
| Parathyroid imaging w/tomographic spect & CT (78072) range across 2 matching MRF lines |
$197–$3,313 | $197–$3,313 | varies |
| Parathyroid Planar Imaging (78070) | $2,223 | $2,223 | 5.4× |
| Parathyroid planar imaging w/wo subtraction (78071) | $1,961 | $1,961 | 4.8× |
| Pelvis 1 or 2 views (72170) range across 2 matching MRF lines |
$76–$424 | $76–$424 | varies |
| Perineogram (74775) | $78 | $78 | 0.3× |
| Peritoneogram Rs&I (74190) | $756 | $756 | 1.4× |
| Pet Image Skull-Thigh (78812) | $235 | $235 | 0.2× |
| Pet Image W/Ct Lmtd (78814) range across 2 matching MRF lines |
$271–$3,912 | $271–$3,912 | varies |
| PET image w/CT, full body (78816) range across 2 matching MRF lines |
$302–$8,401 | $302–$8,401 | varies |
| PET imaging CT attenuation skull base mid-thigh (78815) range across 2 matching MRF lines |
$300–$7,902 | $300–$7,902 | varies |
| Pet Imaging Limited Area Chest Head/Neck (78811) | $195 | $195 | 0.1× |
| Pet Myocardial Sngl Study (78491) | $181 | $181 | 0.1× |
| PET whole body (78813) | $245 | $245 | 0.2× |
| Plasma Vol Radiopharm Vol Dilute Spx Mult Smples (78111) | $218 | $218 | 0.2× |
| Plasma volume, radiopharmaceutical volume-dilution technique (separate procedure); single sampling Non-Facility (78110) | $238 | $238 | 0.2× |
| Platelet survival study Non-Facility (78191) | $415 | $415 | 1.0× |
| Pulmonary Perfusion Imaging Particulate (78580) | $2,244 | $2,244 | 5.5× |
| Radex Abd Compl Aqt Abd W/S/E/D Views 1 View Ch (74022) range across 2 matching MRF lines |
$125–$510 | $125–$510 | varies |
| Radex abscess/fistula/sinus tract rs&i (76080) range across 2 matching MRF lines |
$60–$1,146 | $60–$1,146 | varies |
| Radex Ankle Complete Minimum 3 Views (73610) range across 2 matching MRF lines |
$87–$493 | $87–$493 | varies |
| Radex Calcaneus Minimum 2 Views (73650) range across 2 matching MRF lines |
$74–$319 | $74–$319 | varies |
| Radex elbow complete minimum 3 views (73080) range across 2 matching MRF lines |
$87–$492 | $87–$492 | varies |
| Radex Facial Bones Complete Minimum 3 Views (70150) range across 2 matching MRF lines |
$110–$525 | $110–$525 | varies |
| Radex fingr minimum 2 views (73140) range across 2 matching MRF lines |
$88–$319 | $88–$319 | varies |
| Radex foot complete minimum 3 views (73630) range across 3 matching MRF lines |
$82–$647 | $82–$647 | varies |
| Radex Hand Minimum 3 Views (73130) range across 3 matching MRF lines |
$85–$722 | $85–$722 | varies |
| Radex lower extremity infant minimum 2 views (73592) range across 2 matching MRF lines |
$73–$110 | $73–$110 | varies |
| Radex Mastoids Compl Minimum 3 Views PR Side (70130) range across 2 matching MRF lines |
$152–$190 | $152–$190 | varies |
| Radex Nasal Bones Complete Minimum 3 Views (70160) range across 2 matching MRF lines |
$87–$319 | $87–$319 | varies |
| Radex Pharynx/Larx W/Fluor&/Magnification Tq (70370) | $210 | $210 | 2.4× |
| Radex Ribs Unilateral 2 Views (71100) range across 3 matching MRF lines |
$84–$459 | $84–$459 | varies |
| Radex shoulder complete minimum 2 views (73030) range across 2 matching MRF lines |
$81–$499 | $81–$499 | varies |
| Radex Sinuses Paransl < 3 Views (70210) range across 2 matching MRF lines |
$80–$346 | $80–$346 | varies |
| Radex sm int w/mlt srl imges via enteroclss tube (74251) | $900 | $900 | 5.0× |
| Radex Spine 1 View Specify Level (72020) range across 2 matching MRF lines |
$61–$320 | $61–$320 | varies |
| Radex Sternum Minimum 2 Views (71120) range across 2 matching MRF lines |
$81–$397 | $81–$397 | varies |
| Radex Temporomandble Jt Opn & Clsd Mouth Bilat (70330) range across 2 matching MRF lines |
$125–$445 | $125–$445 | varies |
| Radex Toe Minimum 2 Views (73660) range across 2 matching MRF lines |
$80–$304 | $80–$304 | varies |
| Radex upper extremity infant minimum 2 views (73092) | $116 | $116 | 1.1× |
| Radex Wrist Complete Minimum 3 Views (73110) range across 4 matching MRF lines |
$98–$741 | $98–$741 | varies |
| Radiation Delivery Stereotactic Cranial Linear (77372) likely a partial charge, not the full procedure |
$1,963 | $1,963 | 0.3× |
| Radiolog exam mandible compl minimum 4 views (70110) range across 2 matching MRF lines |
$102–$481 | $102–$481 | varies |
| Radiologic Exam Abdomen 3+ Views - Xr Abdomen 3+ Views (74021) range across 2 matching MRF lines |
$122–$488 | $122–$488 | varies |
| Radiologic exam colon double contrast study (74280) | $1,013 | $1,013 | 5.7× |
| Radiologic exam colon single contrast study (74270) | $951 | $951 | 5.3× |
| Radiologic Exam Esophagus Double Contrast Study (74221) | $798 | $798 | 4.5× |
| Radiologic exam knee complete 4/more views (73564) range across 4 matching MRF lines |
$115–$812 | $115–$812 | varies |
| Radiologic exam pelvis compl minimum 3 views (72190) range across 2 matching MRF lines |
$113–$567 | $113–$567 | varies |
| Radiologic Exam Small Int Single Contrast Study (74250) | $922 | $922 | 5.1× |
| Radiologic exam swallow function contrast study (74230) | $948 | $948 | 5.3× |
| Radiologic exam teeth complete full mouth (70320) | $140 | $140 | 0.6× |
| Radiologic exam upr gi trc double contrast study (74246) | $1,379 | $1,379 | 7.7× |
| Radiologic examination femur minimum 2 views (73552) range across 2 matching MRF lines |
$75–$343 | $75–$343 | varies |
| Radiologic examination knee 1/2 views (73560) range across 3 matching MRF lines |
$82–$381 | $82–$381 | varies |
| Radiologic Examination Osseous Survey Limited (77074) | $450 | $450 | 4.2× |
| Radiologic Examination Salivary Gland Calculus (70380) | $102 | $102 | 1.1× |
| Radiologic examination tibia & fibula 2 views (73590) range across 2 matching MRF lines |
$72–$422 | $72–$422 | varies |
| Radiologic examination, internal auditory meati, complete Non-Facility (70134) | $119 | $119 | 0.2× |
| Radiopharm Dacryocystography (78660) | $488 | $488 | 1.2× |
| Radiopharmaceutical therapy, by interstitial radioactive colloid administration Facility (79300) | $201 | $201 | 0.8× |
| Radiopharmaceutical therapy, by intra-articular administration Non-Facility (79440) | $358 | $358 | 1.5× |
| Radiopharmaceutical therapy, by intracavitary administration Non-Facility (79200) | $392 | $392 | 1.6× |
| Red Cell Volume Determination Spx 1 Sampling (78120) | $235 | $235 | 0.6× |
| Red Cell Volume Determination Spx Mult Samplings (78121) | $199 | $199 | 0.4× |
| Remote afterloading high dose rate radionuclide skin surface brachytherapy, includes basic dosimetry, when performed;… (77768) | $2,406 | $2,406 | 6.1× |
| Remote afterloading high dose rate radionuclide skin surface brachytherapy, includes basic dosimetry, when performed;… (77767) | $1,632 | $1,632 | 4.1× |
| Renal Cyst Study (74470) | $66 | $66 | 0.1× |
| Ribs bilateral 3 views (71110) range across 2 matching MRF lines |
$105–$653 | $105–$653 | varies |
| Rp loclzj tum plnr 1 area single day imaging (78800) | $490 | $490 | 1.2× |
| Rp loclzj tum plnr 2+area 1+d img/1 area img>2+d (78801) | $1,835 | $1,835 | 4.5× |
| Rp Loclzj Tum Plnr Whole Body 2+ Days Imaging (78804) | $4,711 | $4,711 | 8.5× |
| Rp Loclzj Tum Spect 1 Area Single Day Imaging (78803) range across 2 matching MRF lines |
$1,000–$3,377 | $1,000–$3,377 | varies |
| Rp loclzj tum spect w/CT 1 area/acquisj 1day img (78830) | $3,542 | $3,542 | 2.7× |
| Rp Ther Radiolbld Monoclonal Antibody IV Infus (79403) | $477 | $477 | 2.0× |
| Rp Therapy Intravenous Administration (79101) | $1,150 | $1,150 | 4.8× |
| Salivary Gland Function Study (78232) | $250 | $250 | 0.6× |
| Salivary Gland Imaging (78230) | $447 | $447 | 1.1× |
| Salivary Gland Imaging Serial Images (78231) | $332 | $332 | 0.8× |
| Scapula (73010) range across 2 matching MRF lines |
$84–$499 | $84–$499 | varies |
| Screening Digital Breast Tomosynthesis Bi (77063) | $95 | $95 | 4.1× |
| Sella turcica (70240) range across 2 matching MRF lines |
$78–$122 | $78–$122 | varies |
| Shoulder 1 view (73020) range across 2 matching MRF lines |
$62–$317 | $62–$317 | varies |
| Shoulder Arthrography (73040) | $1,335 | $1,335 | 3.7× |
| Sialogram (70390) | $480 | $480 | 2.0× |
| Skull less than 4 views (70250) | $475 | $475 | 4.4× |
| Special dosimetry (77331) range across 2 matching MRF lines |
$156–$705 | $156–$705 | varies |
| Special Physics Consult (77370) | $1,531 | $1,531 | 11.1× |
| Special teletherapy port plan (77321) | $228 | $228 | 0.6× |
| Special treatment procedure (77470) | $2,860 | $2,860 | 5.1× |
| Speech evaluation, complex (70371) | $235 | $235 | 1.0× |
| Spleen Imaging (78185) | $547 | $547 | 1.3× |
| Stereotactic Body Radiation Delivery (77373) | $3,173 | $3,173 | 1.7× |
| Sternoclavicular joints (71130) range across 2 matching MRF lines |
$97–$438 | $97–$438 | varies |
| Surface Applic Low Dose Rate Radionuclide Source (77789) | $296 | $296 | 2.8× |
| Testicular Imaging W/Flow (78761) | $557 | $557 | 1.4× |
| Ther Rad Simulaj-Aided Field Setting Complex (77290) | $2,974 | $2,974 | 7.8× |
| Ther rad simulaj-aided field setting simple (77280) | $1,589 | $1,589 | 11.6× |
| Therapeutic Enema Rdctj Intussusception/Obstrcj (74283) | $880 | $880 | 4.9× |
| Thoracic spine 2 views (72070) range across 2 matching MRF lines |
$87–$550 | $87–$550 | varies |
| Thoracic spine 3 views (72072) range across 2 matching MRF lines |
$96–$585 | $96–$585 | varies |
| Thoracolumbar 2 views (72080) range across 2 matching MRF lines |
$95–$470 | $95–$470 | varies |
| Thyroid Imaging With Vascular Flow (78013) | $668 | $668 | 1.6× |
| Thyroid Met Imaging Body (78018) | $2,368 | $2,368 | 4.3× |
| Thyroid Uptake Measurement (78012) | $715 | $715 | 1.8× |
| Thyroid Uptake W/Blood Flow Sngle/Mult Quan Meas (78014) | $1,960 | $1,960 | 4.8× |
| Tx Devices Design & Construction Complex (77334) | $1,863 | $1,863 | 4.9× |
| Tx devices design & construction simple (77332) | $724 | $724 | 5.3× |
| Ultrasound Breast Limited (76642) | $561 | $561 | 6.3× |
| Ultrasound Exam Aaa Screen (76706) | $621 | $621 | 5.8× |
| Ultrasound, abdomen limited (76705) range across 2 matching MRF lines |
$220–$730 | $220–$730 | varies |
| Umbilical-artery Doppler (OB) (76820) range across 2 matching MRF lines |
$78–$456 | $78–$456 | varies |
| Unlisted magnetic resonance procedure (76498) | $7,000 | $7,000 | 78.7× |
| Upper gi w/o kub (74240) | $1,021 | $1,021 | 5.7× |
| Ureteral Reflux Study (78740) | $520 | $520 | 1.3× |
| Urethrocystogram voiding (74455) | $906 | $906 | 3.7× |
| Urethrocystography retrograde (74450) | $924 | $924 | 3.8× |
| Us breast unilateral complete (76641) | $692 | $692 | 6.5× |
| Us chest (76604) | $685 | $685 | 6.4× |
| Us complete joint (76881) | $688 | $688 | 6.4× |
| Us exam, pelvic, limited (76857) range across 3 matching MRF lines |
$130–$613 | $130–$613 | varies |
| Us head (76506) range across 2 matching MRF lines |
$280–$322 | $280–$322 | varies |
| Us kidney transplant (76776) | $933 | $933 | 8.7× |
| Us lmtd joint/oth nonvasc xtr strux r-t w/img (76882) | $445 | $445 | 4.2× |
| Us ob detailed single fetus (76811) | $1,130 | $1,130 | 4.6× |
| Us ob limited 1 or more fetuses (76815) range across 4 matching MRF lines |
$210–$513 | $210–$513 | varies |
| Us ob transvaginal (76817) range across 5 matching MRF lines |
$88–$637 | $88–$637 | varies |
| Us pelvic non ob complete (76856) range across 2 matching MRF lines |
$420–$934 | $420–$934 | varies |
| Us pg uter img f&mat 14 wk tabdl 1/1st gestation (76801) range across 3 matching MRF lines |
$380–$650 | $380–$650 | varies |
| Us preg uterus real time f/u trnsabdl per fetus (76816) range across 4 matching MRF lines |
$280–$523 | $280–$523 | varies |
| Us retroperitoneal complete (76770) | $1,014 | $1,014 | 9.5× |
| Us retroperitoneal limited (76775) | $551 | $551 | 5.2× |
| Us scrotum and contents (76870) | $742 | $742 | 6.9× |
| Us spinal canal and contents (76800) | $385 | $385 | 3.6× |
| Us thyroid (76536) | $797 | $797 | 7.5× |
| Us transrectal (76872) | $595 | $595 | 5.6× |
| Vascular Flow Imaging (78445) | $505 | $505 | 1.2× |
| Vasogram (74440) | $216 | $216 | 0.9× |
| Vein X-Ray Chest (75827) | $389 | $389 | 0.2× |
| Vein X-Ray Spleen/Liver (75810) | $142 | $142 | 0.0× |
| Venogram Sinus/Jugular (75860) | $395 | $395 | 0.1× |
| Venography Adrenal Unilateral (75840) | $413 | $413 | 0.1× |
| Venography caval inferior serialography rs&i (75825) range across 2 matching MRF lines |
$380–$8,427 | $380–$8,427 | varies |
| Venography extremity bilateral rs&i (75822) range across 2 matching MRF lines |
$401–$2,569 | $401–$2,569 | varies |
| Venography extremity unilateral rs&i (75820) | $1,809 | $1,809 | 1.1× |
| Venography Orbital Rs&I (75880) | $605 | $605 | 0.9× |
| Venography Renal Bilateral (75833) range across 3 matching MRF lines |
$163–$8,427 | $163–$8,427 | varies |
| Venography Renal Unilateral (75831) range across 2 matching MRF lines |
$412–$8,427 | $412–$8,427 | varies |
| Venous sampling by catheter (75893) likely a partial charge, not the full procedure |
$322 | $322 | 0.1× |
| Venous thrombosis imaging (78457) | $526 | $526 | 0.9× |
| Venous Thrombosis Imaging Venogram Bilateral (78458) | $483 | $483 | 1.2× |
| Wrist 2 views (73100) range across 3 matching MRF lines |
$84–$525 | $84–$525 | varies |
| X-Ray Ac Jts - Xr Acromioclavicular Joints Bilateral (73050) range across 2 matching MRF lines |
$75–$524 | $75–$524 | varies |
| X-ray antegrade pyelogram tube (74425) | $989 | $989 | 2.8× |
| X-Ray Aorta Leg Arteries (75630) | $468 | $468 | 0.1× |
| X-Ray Elbow 2 Vw - Xr Elbow 1-2 Views Right (73070) range across 2 matching MRF lines |
$74–$343 | $74–$343 | varies |
| X-Ray Exam Breast Specimen (76098) | $756 | $756 | 1.4× |
| X-Ray Exam Entire Spi 1 Vw (72081) | $355 | $355 | 4.0× |
| X-Ray Exam Entire Spi 2/3 Vw (72082) | $572 | $572 | 5.4× |
| X-Ray Exam Hip Uni 1 View (73501) range across 2 matching MRF lines |
$75–$363 | $75–$363 | varies |
| X-Ray Exam Hip Uni 2-3 Views (73502) range across 2 matching MRF lines |
$105–$573 | $105–$573 | varies |
| X-Ray Exam Hips Bi 2 Views (73521) range across 2 matching MRF lines |
$100–$626 | $100–$626 | varies |
| X-Ray Exam Hips Bi 3-4 Views (73522) range across 2 matching MRF lines |
$125–$809 | $125–$809 | varies |
| X-Ray Exam L-S Spine Bending (72114) range across 2 matching MRF lines |
$166–$765 | $166–$765 | varies |
| X-Ray Exam Neck Spine 2-3 Vw (72040) range across 2 matching MRF lines |
$93–$421 | $93–$421 | varies |
| X-Ray Exam Neck Spine 6/>Vws (72052) range across 2 matching MRF lines |
$161–$752 | $161–$752 | varies |
| X-Ray Exam Unilat Ribs/Chest (71101) range across 2 matching MRF lines |
$102–$564 | $102–$564 | varies |
| X-ray eye for foreign body (70030) range across 2 matching MRF lines |
$85–$271 | $85–$271 | varies |
| X-ray head for orthodontia (70350) | $56 | $56 | 0.6× |
| X-ray humerus (73060) range across 2 matching MRF lines |
$75–$427 | $75–$427 | varies |
| X-ray IV pyelogram+tomography (74415) | $605 | $605 | 3.4× |
| X-Ray Jaw <4 Vw - Xr Mandible < 4 Views (70100) range across 2 matching MRF lines |
$90–$411 | $90–$411 | varies |
| X-Ray Knee Bilat Standing - Xr Knees Anteroposterior Standing Bilat (73565) range across 2 matching MRF lines |
$94–$296 | $94–$296 | varies |
| X-Ray Lumbar Spine 2/3 Vw - Xr Lumbar Spine 2-3 Views (72100) range across 2 matching MRF lines |
$94–$541 | $94–$541 | varies |
| X-ray nose-rectum child f.b. (76010) | $120 | $120 | 1.3× |
| X-Ray Ribs, Chest 4+ Vw - Xr Ribs 3 Vws Bil W/ Chest Posteroanterior (71111) range across 2 matching MRF lines |
$137–$664 | $137–$664 | varies |
| X-Ray Sacroiliac Jts 3+ Vw - Xr Sacroiliac Joints 3+ Views (72202) range across 2 matching MRF lines |
$90–$497 | $90–$497 | varies |
| X-Ray Sacrum/Coccyx 2+ Vw - Xr Sacrum Coccyx 2+ Views (72220) range across 2 matching MRF lines |
$75–$452 | $75–$452 | varies |
| X-Ray Sinuses 3+ Vw - Xr Paranasal Sinuses 3+ Views (70220) range across 2 matching MRF lines |
$101–$506 | $101–$506 | varies |
| X-Ray Skull 4+ Vw - Xr Skull Complete 4+ Views (70260) range across 2 matching MRF lines |
$121–$619 | $121–$619 | varies |
| X-Ray Stress View (77071) | $132 | $132 | 1.5× |
| X-Ray Urinary Tract Exam With Contrast Material (74420) | $1,273 | $1,273 | 3.6× |
| X-Rays Bone Length Studies (77073) | $682 | $682 | 6.4× |
| X-Rays Bone Survey Complete (77075) | $1,020 | $1,020 | 9.5× |
| Xr c-spine 4 or 5 views (72050) range across 2 matching MRF lines |
$125–$596 | $125–$596 | varies |
| Xr facial bones less than 3 views (70140) range across 2 matching MRF lines |
$78–$327 | $78–$327 | varies |
| Xr orbits complete 4 views (70200) range across 2 matching MRF lines |
$113–$595 | $113–$595 | varies |
| Xr Tomogram Single Plane (76100) | $310 | $310 | 2.9× |
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.