Imaging prices at St. Lukes Regional Medical Center
Sioux City, IA · every code in this section with a posted price and a Medicare benchmark.
365 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) | $3,311.39 | $4,139.23 | 2.4× |
| Abdomen 1 View (74018) | $190.96 | $238.70 | 2.2× |
| Abdomen 2 views (74019) | $254.62 | $318.27 | 2.4× |
| Acute Gastrointestinal Blood Loss Imaging (78278) | $1,108.44 | $1,385.54 | 2.7× |
| Adrenal Cortex & Medulla Img (78075) | $2,970.52 | $3,713.15 | 2.3× |
| Angio internal mammary (75756) | $3,441.49 | $4,301.86 | 1.1× |
| Angio pulmonary bilat (75743) | $5,798.05 | $7,247.56 | 1.8× |
| Angiography extremity bilateral rs&i (75716) | $5,120.76 | $6,400.94 | 1.6× |
| Angiography extremity unilateral rs&i (75710) | $5,120.76 | $6,400.94 | 1.6× |
| Angiography pulmonary unilateral slctv rs&i (75741) | $5,798.05 | $7,247.56 | 1.8× |
| Angrph pulmonary nonslctv cath/ven njx rs&i (75746) | $2,277.81 | $2,847.26 | 0.7× |
| Ankle 2 views (73600) | $190.96 | $238.70 | 2.2× |
| Aortography thoracic serialography rs&i (75605) | $4,882.44 | $6,103.05 | 0.9× |
| Artery X-Rays Abdomen (75726) | $6,520.51 | $8,150.63 | 1.2× |
| Artery X-Rays Pelvis (75736) | $5,790.92 | $7,238.64 | 1.0× |
| Artery X-Rays Spine (75705) | $11,348.20 | $14,185.25 | 2.0× |
| Arthrogram ankle (73615) | $859.96 | $1,074.94 | 2.4× |
| Arthrogram hip (73525) | $859.96 | $1,074.94 | 2.4× |
| Arthrogram Wrist (73115) | $859.96 | $1,074.94 | 2.4× |
| Basic radiation dosimetry calculation (77300) | $636.55 | $795.68 | 4.7× |
| Bone age studies (77072) | $254.62 | $318.27 | 2.4× |
| Bone Imaging 3 Phase (78315) | $1,272.03 | $1,590.03 | 3.1× |
| Bone Imaging Limited Area (78300) | $1,272.03 | $1,590.03 | 3.1× |
| Bone Imaging Multiple Areas (78305) | $1,272.03 | $1,590.03 | 3.1× |
| Bone Imaging Whole Body (78306) | $1,272.03 | $1,590.03 | 3.1× |
| Bone marrow imaging; multiple areas (78103) | $891.16 | $1,113.95 | 2.2× |
| Bone survey infant (77076) | $254.62 | $318.27 | 2.4× |
| Brain Image W/Flow < 4 Views (78601) | $1,497.39 | $1,871.73 | 3.7× |
| Brain Imaging Min 4 Static Views W Vascular Flow (78606) | $1,962.32 | $2,452.89 | 3.6× |
| Card Bl Pool Gated Spect Rest Wal Motn Ejct Frct (78494) | $1,977.49 | $2,471.86 | 4.9× |
| Cat Scan Follow-Up Study (76380) | $332.63 | $415.78 | 3.8× |
| Cerebrospinal Fluid Flow W/O Matl Shunt Evaltj (78645) | $872.52 | $1,090.65 | 1.6× |
| Cerebrospinal Fluid Scan (78630) | $1,971.59 | $2,464.48 | 3.6× |
| Chest 1 view (71045) | $195.21 | $244.01 | 2.2× |
| Chest 2 views (71046) | $195.21 | $244.01 | 2.2× |
| Chest 3 views (71047) | $190.96 | $238.70 | 2.2× |
| Chest 4 or more views (71048) | $254.62 | $318.27 | 2.4× |
| Cholecystography Oral Contrast (74290) | $287.54 | $359.42 | 1.6× |
| Cineradiograpy/vidradiograpy xcpt where spec (76120) | $242.24 | $302.79 | 2.3× |
| Clavicle complete (73000) | $190.96 | $238.70 | 2.2× |
| Computed Tomography Thorax Lw Dose Lng Ca Scr C- (71271) | $564.62 | $705.77 | 5.3× |
| Continuing medical physics consltj pr wk (77336) | $297.06 | $371.32 | 2.2× |
| Contrast Exam Abdominl Aorta (75625) | $3,797.18 | $4,746.47 | 1.2× |
| Contrast X-Ray Bladder (74430) | $734.36 | $917.94 | 2.1× |
| Contrast X-Ray Of Elbow (73085) | $859.96 | $1,074.94 | 2.4× |
| Contrast X-Ray Of Knee Joint (73580) | $859.96 | $1,074.94 | 2.4× |
| CT abdomen and pelvis without and with contrast (74178) | $2,392.28 | $2,990.35 | 6.8× |
| CT abdomen and pelvis without contrast (74176) | $1,193.39 | $1,491.73 | 4.9× |
| CT abdomen w contrast (74160) | $1,193.39 | $1,491.73 | 6.7× |
| CT abdomen w wo contrast (74170) | $1,193.39 | $1,491.73 | 6.7× |
| CT abdomen w/o contrast (74150) | $1,193.39 | $1,491.73 | 11.2× |
| CT Angio Abdomen and Pelvis (74174) | $1,464.72 | $1,830.89 | 4.1× |
| CT Angio Chest (71275) | $1,143.98 | $1,429.97 | 6.4× |
| CT Angio Head (70496) | $1,143.98 | $1,429.97 | 6.4× |
| CT angio hrt w/3d image (75574) | $1,572.87 | $1,966.08 | 4.4× |
| Ct Angio Lwr Extr W/O&W/Dye (73706) | $942.68 | $1,178.35 | 5.3× |
| CT Angio Neck (70498) | $1,143.98 | $1,429.97 | 6.4× |
| Ct Angio Upr Extrm W/O&W/Dye (73206) | $917.32 | $1,146.64 | 5.2× |
| CT cervical spine w/ contrast (72126) | $848.72 | $1,060.90 | 2.4× |
| CT cervical spine w/o contrast (72125) | $685.79 | $857.23 | 6.5× |
| CT cervical spine w/wo cont (72127) | $842.90 | $1,053.62 | 4.7× |
| CT chest w contrast (71260) | $758.16 | $947.69 | 4.3× |
| CT chest w/wo contrast (71270) | $842.90 | $1,053.62 | 4.7× |
| CT colonography screening (74263) | $297.06 | $371.32 | 1.2× |
| CT Colonogrphy Dx Image Postprocess W/Contrast (74262) | $758.16 | $947.69 | 4.3× |
| CT colonogrphy dx image postprocess w/o contrast (74261) | $484.14 | $605.17 | 4.6× |
| CT head/brain with contrast (70460) | $758.16 | $947.69 | 4.3× |
| CT head/brain without and with contrast (70470) | $842.90 | $1,053.62 | 4.7× |
| CT heart no contrast quant eval coronry calcium (75571) | $100 | $125 | 1.1× |
| CT iac w contrast (70481) | $758.16 | $947.69 | 4.3× |
| CT l-spine w&w/o contrast (72133) | $842.90 | $1,053.62 | 4.7× |
| CT lower ext w/o (73700) | $683.83 | $854.78 | 6.4× |
| CT lower extremity w/contrast material (73701) | $758.16 | $947.69 | 4.3× |
| CT lumbar spine w contrast (72132) | $827.51 | $1,034.38 | 2.3× |
| CT lumbar spine w/o contrast (72131) | $685.79 | $857.23 | 6.5× |
| CT maxillofacial w contrast (70487) | $758.16 | $947.69 | 4.3× |
| CT maxillofacial wo contrast (70486) | $683.83 | $854.78 | 6.4× |
| CT neck tissue combo (70492) | $842.90 | $1,053.62 | 4.7× |
| Ct Orbit/Ear/Fossa W/O&W/Dye (70482) | $842.90 | $1,053.62 | 4.7× |
| CT orbits w/o contrast (70480) | $683.83 | $854.78 | 6.4× |
| CT pelvis w&w/o contrast (72194) | $842.90 | $1,053.62 | 4.7× |
| CT pelvis w/o contrast (72192) | $683.83 | $854.78 | 6.4× |
| CT scan of leg combo (73702) | $842.90 | $1,053.62 | 4.7× |
| CT scans face/jaw combo (70488) | $842.90 | $1,053.62 | 4.7× |
| CT soft tissue neck w contrast (70491) | $758.16 | $947.69 | 4.3× |
| CT soft tissue neck w/o contrast (70490) | $683.83 | $854.78 | 6.4× |
| CT thoracic spine w contrast (72129) | $758.16 | $947.69 | 4.3× |
| CT thoracic spine w/o contrast (72128) | $685.79 | $857.23 | 6.5× |
| CT thoracic spine w/wo cont (72130) | $842.90 | $1,053.62 | 4.7× |
| CT thorax w/o contrast (71250) | $683.83 | $854.78 | 6.4× |
| CT upper ext wo (73200) | $683.83 | $854.78 | 6.4× |
| CT upper extremity w/o & w/contrast material (73202) | $842.90 | $1,053.62 | 4.7× |
| CT upper extremity with contrast (73201) | $848.72 | $1,060.90 | 2.4× |
| Cta Abdl Aorta&Bi Iliofem W/Contrast&Postp (75635) | $1,157.48 | $1,446.84 | 6.5× |
| Cta Abdomen (74175) | $983.20 | $1,229 | 5.5× |
| CTA pelvis (72191) | $947.61 | $1,184.51 | 5.3× |
| Dilation ureters/urethra rs&i (74485) | $2,277.23 | $2,846.53 | 1.1× |
| Doppler Echo Fetal Puls Spectral F/U/Repeat (76828) | $279.84 | $349.79 | 2.6× |
| Doppler Echo Fetal Spectral Display Complete (76827) | $279.84 | $349.79 | 2.6× |
| Doppler Fetal Mid Cerebral Artery (76821) | $319.80 | $399.75 | 3.0× |
| Dxa Bone Density Axial (77080) | $254.62 | $318.27 | 2.4× |
| Dxa bone density study (77085) | $237.36 | $296.70 | 2.2× |
| Dxa bone density study 1/>sites appendiclr skel (77081) | $210.98 | $263.72 | 2.4× |
| Echo exam of fetal heart (76825) | $1,145.78 | $1,432.22 | 2.1× |
| Echo Guide For Artery Repair (76936) | $1,031.25 | $1,289.06 | 4.7× |
| Echocardiography, fetal, cardiovascular system, real time with image documentation (2D), with or without M-mode… (76826) | $539.56 | $674.44 | 2.2× |
| Esophagram (74220) | $403.15 | $503.93 | 2.3× |
| Fetal Biophys Profile W/Nst (76818) | $242.99 | $303.73 | 2.3× |
| Fetal Biophysical Profile W/O Non-Stress Testing (76819) | $242.99 | $303.73 | 2.3× |
| Fluoroscopy up to 1 hr (76000) | $530.45 | $663.06 | 2.2× |
| Follow-Up Angiography (75898) | $858 | $1,072.49 | 0.3× |
| Foot 2 views (73620) | $190.96 | $238.70 | 2.2× |
| Forearm 2 views (73090) | $190.96 | $238.70 | 2.2× |
| Gastric emptying imaging study (78264) | $1,270 | $1,587.49 | 3.1× |
| Gastric Emptyng Imag Std W/Sm Bwl Transit (78265) | $1,270 | $1,587.49 | 3.1× |
| Gastroesophageal Reflux Exam (78262) | $891.56 | $1,114.44 | 2.2× |
| Gated Heart Planar Single (78472) | $1,084.88 | $1,356.09 | 2.7× |
| Gated Heart, Multiple (78473) | $1,276.51 | $1,595.63 | 3.1× |
| Gstrc Emptng Imag Std W/Sm Bwl Col Trnst Mlt Day (78266) | $1,664.33 | $2,080.41 | 3.0× |
| Hand 2 views (73120) | $254.62 | $318.27 | 2.4× |
| Heart first pass single,planar (78481) | $1,188.21 | $1,485.26 | 2.2× |
| Hepatc Vngrph Wdg/Fr Hemodyn Eval Rs&I (75889) | $7,050.36 | $8,812.95 | 2.2× |
| Hepatobil Syst Image W/Drug (78227) | $1,193.36 | $1,491.70 | 2.2× |
| Hepatobiliary System Imaging (78226) | $1,084.88 | $1,356.09 | 2.7× |
| Ht Musc Image Planar Mult (78454) | $2,068.33 | $2,585.41 | 1.6× |
| Ht Muscle Image Spect Sing (78451) | $2,143.02 | $2,678.77 | 1.6× |
| Hysterosalpingogram (74740) | $667.60 | $834.49 | 2.8× |
| Infant hip ultrasound with hip movement (dynamic) (76885) | $247.20 | $308.99 | 2.8× |
| Infant hip ultrasound, limited static exam (76886) | $247.20 | $308.99 | 2.8× |
| Infusion Ivp (74410) | $476.28 | $595.35 | 2.7× |
| Joint Survey Single View (77077) | $254.62 | $318.27 | 2.4× |
| K Flow/Funct Image Multiple (78709) | $1,749.08 | $2,186.35 | 3.2× |
| K Flow/Funct Image W/Drug (78708) | $1,422.67 | $1,778.33 | 2.6× |
| K Flow/Funct Image W/O Drug (78707) | $1,145.78 | $1,432.22 | 2.1× |
| Kidney Imaging Morphoogy W/Vascular Flow (78701) | $971.71 | $1,214.63 | 2.4× |
| Knee 3 Views (73562) | $191.09 | $238.86 | 2.2× |
| Liver & Spleen Imaging Static Only (78215) | $869.28 | $1,086.60 | 2.1× |
| Liver & Spleen Imaging W/Vascular Flow (78216) | $1,081.28 | $1,351.59 | 2.7× |
| Lung Perf&Ventilat Diferentl (78598) | $2,046.31 | $2,557.88 | 3.7× |
| Lung perfusion differential (78597) | $1,697.44 | $2,121.80 | 4.2× |
| Lung Ventilat&Perfus Imaging (78582) | $1,557.40 | $1,946.75 | 2.8× |
| Lung Ventilation Imaging (78579) | $1,178.88 | $1,473.59 | 2.9× |
| Lymph System Imaging (78195) | $1,697.44 | $2,121.80 | 3.1× |
| Magnetic Image Jaw Joint (70336) | $1,007.87 | $1,259.83 | 4.2× |
| Mammary ductogram or galactogram multiple (77054) | $688.71 | $860.88 | 2.8× |
| Mammary ductogram or galactogram single (77053) | $688.71 | $860.88 | 2.8× |
| Meckels Divert Exam (78290) | $891.16 | $1,113.95 | 2.2× |
| Mlc imrt design & construction per imrt plan (77338) | $848.72 | $1,060.90 | 2.2× |
| Mra Head W/O & W/Contrast Material (70546) | $1,788.48 | $2,235.60 | 5.1× |
| MRA head w/o contrast (70544) | $1,139.58 | $1,424.47 | 4.7× |
| MRA head with contrast (70545) | $1,788.48 | $2,235.60 | 5.1× |
| MRA neck w contrast (70548) | $1,153.80 | $1,442.25 | 3.3× |
| Mra Neck W/O &W/Contrast Material (70549) | $1,896.42 | $2,370.52 | 5.4× |
| MRA neck w/o contrast (70547) | $1,119.44 | $1,399.30 | 4.6× |
| MRI abdomen w contrast (74182) range across 2 matching MRF lines |
$1,263.08–$1,404.53 | $1,578.84–$1,755.66 | varies |
| MRI abdomen w/o contrast (74181) | $1,185.59 | $1,481.98 | 4.9× |
| MRI any jt lower extrem w/contrast material (73722) | $1,697.44 | $2,121.80 | 2.1× |
| MRI any jt lower extrem w/o & w/contrast matrl (73723) | $1,750.36 | $2,187.94 | 4.9× |
| MRI any jt upper extremity w/contrast matrl (73222) | $1,697.44 | $2,121.80 | 2.1× |
| MRI Breast W/O Contrast Bilateral (77047) | $1,912.38 | $2,390.47 | 7.9× |
| MRI Breast Without Contrast Material Unilateral (77046) | $1,634.96 | $2,043.70 | 6.8× |
| MRI cervical spine w contrast (72142) | $1,201.69 | $1,502.11 | 3.4× |
| MRI cervical spine w/o cont (72141) | $1,084.23 | $1,355.28 | 4.5× |
| MRI chest w/o contrast (71550) | $1,128.03 | $1,410.03 | 4.7× |
| MRI chest with contrast (71551) | $1,697.44 | $2,121.80 | 2.1× |
| MRI chest wo w contrast (71552) | $1,935.68 | $2,419.60 | 5.5× |
| MRI lower extrem oth/thn jt w/contrast matrl (73719) | $1,178.36 | $1,472.94 | 3.3× |
| MRI lower extrem oth/thn jt w/o & w/contr matr (73720) | $1,806.81 | $2,258.51 | 5.1× |
| MRI lower extrem oth/thn jt w/o contr matrl (73718) | $1,101.36 | $1,376.70 | 4.5× |
| MRI lumbar spine w contrast (72149) | $1,200.46 | $1,500.57 | 3.4× |
| Mri Neck Spine W/O & W/Dye (72156) | $1,790.85 | $2,238.56 | 5.1× |
| MRI orbit face &/neck w/o contrast (70540) | $1,101.36 | $1,376.70 | 4.5× |
| MRI orbit face neck w contrast (70542) | $1,174.68 | $1,468.34 | 3.3× |
| Mri Orbt/Fac/Nck W/O &W/Dye (70543) | $1,798.22 | $2,247.77 | 5.1× |
| MRI pelvis w contrast (72196) | $1,185.72 | $1,482.14 | 3.3× |
| MRI pelvis w/o & w contrast (72197) | $1,811.72 | $2,264.65 | 5.1× |
| MRI pelvis w/o contrast (72195) | $1,101.36 | $1,376.70 | 4.5× |
| MRI thoracic spine w/o contrast (72146) | $1,084.23 | $1,355.28 | 4.5× |
| MRI upper extremity oth than jt w/o contr matrl (73218) | $1,101.36 | $1,376.70 | 4.5× |
| Mri Uppr Extremity W/O&W/Dye (73220) | $1,809.25 | $2,261.56 | 5.1× |
| MRI, abdomen, combo (74183) range across 2 matching MRF lines |
$1,811.72–$2,014.64 | $2,264.65–$2,518.29 | varies |
| MRI, dorsal spine combo (72157) | $1,727.03 | $2,158.78 | 4.9× |
| MRI, dorsal spine contrast (72147) | $1,119.44 | $1,399.30 | 3.2× |
| MRI, joint upper extrem (73221) | $1,011.42 | $1,264.27 | 4.2× |
| MRI, joint upper extrem combo (73223) | $1,750.36 | $2,187.94 | 4.9× |
| MRI, lumbar spine combo (72158) | $1,789.64 | $2,237.04 | 5.1× |
| Myelogram cervical (72240) | $1,636.15 | $2,045.18 | 2.1× |
| Myelogram Lumbar (72265) | $1,636.15 | $2,045.18 | 2.1× |
| Myelography thoracic (72255) | $1,636.15 | $2,045.18 | 2.1× |
| Myelograpy 2/more regions rs&i (72270) | $1,940.97 | $2,426.21 | 2.4× |
| Myocardial Perfusion Planar 1 Study Rest/Stress (78453) | $1,911.62 | $2,389.52 | 1.5× |
| Myocardial Spect Multiple Studies (78452) | $2,928.09 | $3,660.11 | 2.2× |
| Neck soft tissue (70360) | $190.96 | $238.70 | 2.2× |
| Njx Rp Loclzj Non-Img Probe Study Intravenous (78808) | $731.22 | $914.02 | 1.8× |
| Nm myocard infarct spect (78469) | $1,438.59 | $1,798.23 | 2.6× |
| Nonvascular Shunt X-Ray (75809) | $667.60 | $834.49 | 6.3× |
| Ntsty modul radthx pln dose-vol histos (77301) | $5,327.20 | $6,659 | 3.8× |
| Nuclear Rx Intra-Arterial (79445) | $1,130.73 | $1,413.41 | 4.8× |
| Nuclear Rx Oral Admin (79005) | $2,987.80 | $3,734.75 | 12.6× |
| Ob us nuchal meas 1 gest (76813) | $254.62 | $318.27 | 2.4× |
| Ophthalmic ultrasound dx b-scan w/wo a-scan (76512) | $254.62 | $318.27 | 2.4× |
| Optic foramina (70190) | $266.36 | $332.94 | 3.0× |
| Parathyroid Planar Imaging (78070) | $1,019.32 | $1,274.14 | 2.5× |
| Parathyroid planar imaging w/wo subtraction (78071) | $970.12 | $1,212.65 | 2.4× |
| Pelvis 1 or 2 views (72170) | $254.62 | $318.27 | 2.4× |
| Peritoneogram Rs&I (74190) | $1,080.95 | $1,351.18 | 1.9× |
| Pulmonary Perfusion Imaging Particulate (78580) | $1,018.47 | $1,273.08 | 2.5× |
| Radex Abd Compl Aqt Abd W/S/E/D Views 1 View Ch (74022) | $254.62 | $318.27 | 2.4× |
| Radex abscess/fistula/sinus tract rs&i (76080) | $594.11 | $742.63 | 1.1× |
| Radex Ankle Complete Minimum 3 Views (73610) | $190.96 | $238.70 | 2.2× |
| Radex Calcaneus Minimum 2 Views (73650) | $190.96 | $238.70 | 2.2× |
| Radex elbow complete minimum 3 views (73080) | $190.96 | $238.70 | 2.2× |
| Radex Facial Bones Complete Minimum 3 Views (70150) | $254.62 | $318.27 | 2.4× |
| Radex fingr minimum 2 views (73140) | $190.96 | $238.70 | 2.2× |
| Radex foot complete minimum 3 views (73630) | $212.19 | $265.23 | 2.4× |
| Radex Hand Minimum 3 Views (73130) | $190.96 | $238.70 | 2.2× |
| Radex lower extremity infant minimum 2 views (73592) | $124.35 | $155.43 | 1.4× |
| Radex Mastoids Compl Minimum 3 Views PR Side (70130) | $272.83 | $341.03 | 2.6× |
| Radex Nasal Bones Complete Minimum 3 Views (70160) | $190.96 | $238.70 | 2.2× |
| Radex Ribs Unilateral 2 Views (71100) | $190.96 | $238.70 | 2.2× |
| Radex shoulder complete minimum 2 views (73030) | $212.19 | $265.23 | 2.4× |
| Radex Sinuses Paransl < 3 Views (70210) | $190.96 | $238.70 | 2.2× |
| Radex Spine 1 View Specify Level (72020) | $190.96 | $238.70 | 2.2× |
| Radex Sternum Minimum 2 Views (71120) | $190.96 | $238.70 | 2.2× |
| Radex Temporomandble Jt Opn & Clsd Mouth Bilat (70330) | $216.54 | $270.67 | 2.5× |
| Radex Toe Minimum 2 Views (73660) | $190.96 | $238.70 | 2.2× |
| Radex upper extremity infant minimum 2 views (73092) | $254.62 | $318.27 | 2.4× |
| Radex Wrist Complete Minimum 3 Views (73110) | $190.96 | $238.70 | 2.2× |
| Radex X-Ray Exam Entire Spi 6/> Vw - Xr Entire Spine 6+ Vw (72084) | $254.62 | $318.27 | 2.4× |
| Radiation treatment delivery level 1 (77402) | $318.28 | $397.84 | 3.1× |
| Radiation treatment delivery level 2 (77407) | $594.11 | $742.63 | 1.5× |
| Radiation treatment delivery level 3 (77412) | $594.11 | $742.63 | 1.1× |
| Radiolog exam mandible compl minimum 4 views (70110) | $254.62 | $318.27 | 2.4× |
| Radiologic Exam Abdomen 3+ Views - Xr Abdomen 3+ Views (74021) | $254.62 | $318.27 | 2.4× |
| Radiologic exam colon double contrast study (74280) | $669.11 | $836.38 | 3.8× |
| Radiologic exam colon single contrast study (74270) | $570.02 | $712.52 | 3.2× |
| Radiologic Exam Esophagus Double Contrast Study (74221) | $403.15 | $503.93 | 2.3× |
| Radiologic exam knee complete 4/more views (73564) | $231.20 | $289 | 2.2× |
| Radiologic exam pelvis compl minimum 3 views (72190) | $254.62 | $318.27 | 2.4× |
| Radiologic Exam Small Int Single Contrast Study (74250) | $403.15 | $503.93 | 2.3× |
| Radiologic exam swallow function contrast study (74230) | $540.79 | $675.98 | 3.0× |
| Radiologic exam teeth complete full mouth (70320) | $242.99 | $303.73 | 1.0× |
| Radiologic exam upr gi trc double contrast study (74246) | $468.18 | $585.22 | 2.6× |
| Radiologic examination femur 1 view (73551) | $190.96 | $238.70 | 2.2× |
| Radiologic examination femur minimum 2 views (73552) | $190.96 | $238.70 | 2.2× |
| Radiologic examination knee 1/2 views (73560) | $191.09 | $238.86 | 2.2× |
| Radiologic Examination Osseous Survey Limited (77074) | $527.80 | $659.75 | 5.0× |
| Radiologic examination tibia & fibula 2 views (73590) | $190.96 | $238.70 | 2.2× |
| Ribs bilateral 3 views (71110) | $254.62 | $318.27 | 2.4× |
| Rp loclzj tum plnr 1 area single day imaging (78800) | $443.21 | $554.01 | 1.1× |
| Rp loclzj tum plnr 2+area 1+d img/1 area img>2+d (78801) | $443.21 | $554.01 | 1.1× |
| Rp Loclzj Tum Plnr Whole Body 2+ Days Imaging (78804) | $1,525.88 | $1,907.34 | 2.8× |
| Rp Loclzj Tum Plnr Whole Body Single Day Imaging (78802) | $1,525.88 | $1,907.34 | 2.8× |
| Rp Loclzj Tum Spect 1 Area Single Day Imaging (78803) | $1,525.88 | $1,907.34 | 2.8× |
| Rp loclzj tum spect 2 area/sep acquisj img (78831) | $2,595.64 | $3,244.54 | 2.0× |
| Rp loclzj tum spect CT 2area 1d img/1 ar img>2+d (78832) | $2,944.06 | $3,680.07 | 2.0× |
| Rp loclzj tum spect w/CT 1 area/acquisj 1day img (78830) | $2,595.64 | $3,244.54 | 2.0× |
| Rp Therapy Intravenous Administration (79101) | $652 | $815 | 2.8× |
| Scapula (73010) | $254.62 | $318.27 | 2.4× |
| Screening Digital Breast Tomosynthesis Bi (77063) | $23.41 | $29.26 | 1.0× |
| Sella turcica (70240) | $190.96 | $238.70 | 2.2× |
| Shoulder 1 view (73020) | $190.96 | $238.70 | 2.2× |
| Shoulder Arthrography (73040) | $859.96 | $1,074.94 | 2.4× |
| Skull less than 4 views (70250) | $254.62 | $318.27 | 2.4× |
| Special dosimetry (77331) | $318.28 | $397.84 | 2.3× |
| Special Physics Consult (77370) | $318.28 | $397.84 | 2.3× |
| Special teletherapy port plan (77321) | $848.72 | $1,060.90 | 2.2× |
| Special treatment procedure (77470) | $933.60 | $1,166.99 | 1.7× |
| Spleen Imaging (78185) | $1,170.93 | $1,463.66 | 2.9× |
| Stereotactic Body Radiation Delivery (77373) | $9,826.76 | $12,283.44 | 5.4× |
| Sternoclavicular joints (71130) | $190.96 | $238.70 | 2.2× |
| Telethx isodose pln cplx w/basic dosimetry (77307) | $848.72 | $1,060.90 | 2.2× |
| Telethx isodose pln smpl w/dosimetry calculation (77306) | $848.72 | $1,060.90 | 2.2× |
| Ther Rad Simulaj-Aided Field Setting Complex (77290) | $848.72 | $1,060.90 | 2.2× |
| Ther rad simulaj-aided field setting simple (77280) | $318.28 | $397.84 | 2.3× |
| Therapeutic Enema Rdctj Intussusception/Obstrcj (74283) | $685.52 | $856.90 | 3.9× |
| Thoracic spine 2 views (72070) | $254.62 | $318.27 | 2.4× |
| Thoracic spine 3 views (72072) | $254.62 | $318.27 | 2.4× |
| Thoracolumbar 2 views (72080) | $190.96 | $238.70 | 2.2× |
| Thyroid Imaging With Vascular Flow (78013) | $848.72 | $1,060.90 | 2.1× |
| Thyroid Met Imaging Body (78018) | $1,145.78 | $1,432.22 | 2.1× |
| Thyroid Uptake Measurement (78012) | $848.72 | $1,060.90 | 2.1× |
| Thyroid Uptake W/Blood Flow Sngle/Mult Quan Meas (78014) | $848.72 | $1,060.90 | 2.1× |
| Tx Devices Design & Construction Complex (77334) | $848.72 | $1,060.90 | 2.2× |
| Tx devices design & construction simple (77332) | $318.28 | $397.84 | 2.3× |
| Ultrasound Breast Limited (76642) range across 2 matching MRF lines |
$226–$452 | $282.50–$565 | varies |
| Ultrasound Exam Aaa Screen (76706) | $254.62 | $318.27 | 2.4× |
| Ultrasound, abdomen limited (76705) | $247.20 | $308.99 | 2.3× |
| Umbilical-artery Doppler (OB) (76820) | $319.80 | $399.75 | 3.0× |
| Unlisted fluoroscopic procedure (76496) | $200.75 | $250.93 | 2.3× |
| Unlisted us procedure (76999) | $239.86 | $299.82 | 2.7× |
| Upper gi w/o kub (74240) | $403.15 | $503.93 | 2.3× |
| Ureteral Reflux Study (78740) | $1,422.67 | $1,778.33 | 3.5× |
| Urethrocystogram voiding (74455) | $667.60 | $834.49 | 2.8× |
| Urethrocystography retrograde (74450) | $989.31 | $1,236.63 | 4.1× |
| Us breast unilateral complete (76641) range across 2 matching MRF lines |
$256.83–$513.65 | $321.03–$642.06 | varies |
| Us chest (76604) | $341.39 | $426.73 | 3.2× |
| Us complete joint (76881) | $247.20 | $308.99 | 2.3× |
| Us exam, pelvic, limited (76857) | $247.20 | $308.99 | 2.3× |
| Us head (76506) | $247.20 | $308.99 | 2.3× |
| Us kidney transplant (76776) | $247.20 | $308.99 | 2.3× |
| Us lmtd joint/oth nonvasc xtr strux r-t w/img (76882) | $247.20 | $308.99 | 2.3× |
| Us ob detailed single fetus (76811) | $297.06 | $371.32 | 1.2× |
| Us ob limited 1 or more fetuses (76815) | $254.62 | $318.27 | 2.4× |
| Us ob transvaginal (76817) | $254.62 | $318.27 | 2.4× |
| Us pelvic non ob complete (76856) | $306.26 | $382.82 | 2.9× |
| Us pg uter img f&mat 14 wk tabdl 1/1st gestation (76801) | $242.99 | $303.73 | 2.3× |
| Us preg uterus real time f/u trnsabdl per fetus (76816) | $254.62 | $318.27 | 2.4× |
| Us retroperitoneal complete (76770) | $339.49 | $424.36 | 3.2× |
| Us retroperitoneal limited (76775) | $247.20 | $308.99 | 2.3× |
| Us scrotum and contents (76870) | $247.20 | $308.99 | 2.3× |
| Us spinal canal and contents (76800) | $247.20 | $308.99 | 2.3× |
| Us thyroid (76536) | $247.20 | $308.99 | 2.3× |
| Vascular Flow Imaging (78445) | $891.16 | $1,113.95 | 2.2× |
| Vein X-Ray Chest (75827) | $1,711.96 | $2,139.94 | 1.1× |
| Vein X-Ray Liver W/O Hemodyn (75887) | $2,276.83 | $2,846.03 | 0.7× |
| Venogram Sinus/Jugular (75860) | $4,738.85 | $5,923.56 | 1.5× |
| Venography caval inferior serialography rs&i (75825) | $4,880.91 | $6,101.13 | 1.5× |
| Venography extremity bilateral rs&i (75822) | $1,711.96 | $2,139.94 | 1.1× |
| Venography extremity unilateral rs&i (75820) | $1,711.96 | $2,139.94 | 1.1× |
| Venography Renal Unilateral (75831) | $4,750.74 | $5,938.42 | 1.5× |
| Wrist 2 views (73100) | $190.96 | $238.70 | 2.2× |
| X-Ray Ac Jts - Xr Acromioclavicular Joints Bilateral (73050) | $190.96 | $238.70 | 2.2× |
| X-ray antegrade pyelogram tube (74425) | $734.36 | $917.94 | 2.1× |
| X-Ray Aorta Leg Arteries (75630) | $3,797 | $4,746.24 | 1.2× |
| X-Ray Bend Only L-S Spine (72120) | $254.62 | $318.27 | 2.4× |
| X-Ray Elbow 2 Vw - Xr Elbow 1-2 Views Right (73070) | $190.96 | $238.70 | 2.2× |
| X-Ray Exam Breast Specimen (76098) | $1,103.34 | $1,379.17 | 2.0× |
| X-Ray Exam Entire Spi 1 Vw (72081) | $190.96 | $238.70 | 2.2× |
| X-Ray Exam Entire Spi 2/3 Vw (72082) | $254.62 | $318.27 | 2.4× |
| X-Ray Exam Entire Spi 4/5 Vw (72083) | $254.62 | $318.27 | 2.4× |
| X-Ray Exam Hip Uni 1 View (73501) | $190.96 | $238.70 | 2.2× |
| X-Ray Exam Hip Uni 2-3 Views (73502) | $190.96 | $238.70 | 2.2× |
| X-Ray Exam Hip Uni 4/> Views (73503) | $254.62 | $318.27 | 2.4× |
| X-Ray Exam Hips Bi 2 Views (73521) | $254.62 | $318.27 | 2.4× |
| X-Ray Exam Hips Bi 3-4 Views (73522) | $254.62 | $318.27 | 2.4× |
| X-Ray Exam Hips Bi 5/> Views (73523) | $243.59 | $304.48 | 2.3× |
| X-Ray Exam L-S Spine Bending (72114) | $254.62 | $318.27 | 2.4× |
| X-Ray Exam Neck Spine 2-3 Vw (72040) | $190.96 | $238.70 | 2.2× |
| X-Ray Exam Neck Spine 6/>Vws (72052) | $254.62 | $318.27 | 2.4× |
| X-Ray Exam Unilat Ribs/Chest (71101) | $254.62 | $318.27 | 2.4× |
| X-ray eye for foreign body (70030) | $190.96 | $238.70 | 2.2× |
| X-ray humerus (73060) | $190.96 | $238.70 | 2.2× |
| X-ray IV pyelogram (ivp) (74400) | $476.28 | $595.35 | 2.7× |
| X-ray IV pyelogram+tomography (74415) | $476.28 | $595.35 | 2.7× |
| X-Ray Jaw <4 Vw - Xr Mandible < 4 Views (70100) | $190.96 | $238.70 | 2.2× |
| X-Ray Knee Bilat Standing - Xr Knees Anteroposterior Standing Bilat (73565) | $191.09 | $238.86 | 2.2× |
| X-Ray Lumbar Spine 2/3 Vw - Xr Lumbar Spine 2-3 Views (72100) | $254.62 | $318.27 | 2.4× |
| X-ray nose-rectum child f.b. (76010) | $190.96 | $238.70 | 2.2× |
| X-Ray Ribs, Chest 4+ Vw - Xr Ribs 3 Vws Bil W/ Chest Posteroanterior (71111) | $254.62 | $318.27 | 2.4× |
| X-Ray Sacroiliac Jts 3+ Vw - Xr Sacroiliac Joints 3+ Views (72202) | $254.62 | $318.27 | 2.4× |
| X-Ray Sacroiliac Jts <3 Vw - Xr Sacroiliac Joints 1-2 Views (72200) | $254.62 | $318.27 | 2.4× |
| X-Ray Sacrum/Coccyx 2+ Vw - Xr Sacrum Coccyx 2+ Views (72220) | $190.96 | $238.70 | 2.2× |
| X-Ray Sinuses 3+ Vw - Xr Paranasal Sinuses 3+ Views (70220) | $190.96 | $238.70 | 2.2× |
| X-Ray Skull 4+ Vw - Xr Skull Complete 4+ Views (70260) | $254.62 | $318.27 | 2.4× |
| X-ray thoracic spine 4 vw (72074) | $254.62 | $318.27 | 2.4× |
| X-Ray Tmj Unilat (70328) | $216.54 | $270.67 | 2.5× |
| X-Ray Urinary Tract Exam With Contrast Material (74420) | $848.72 | $1,060.90 | 2.4× |
| X-Rays Bone Length Studies (77073) | $254.62 | $318.27 | 2.4× |
| X-Rays Bone Survey Complete (77075) | $581.92 | $727.39 | 5.5× |
| Xr c-spine 4 or 5 views (72050) | $254.62 | $318.27 | 2.4× |
| Xr facial bones less than 3 views (70140) | $190.96 | $238.70 | 2.2× |
| XR Mastoids < 3 Views Bilateral (70120) | $254.62 | $318.27 | 2.4× |
| Xr orbits complete 4 views (70200) | $254.62 | $318.27 | 2.4× |
| Xr Tomogram Single Plane (76100) | $254.62 | $318.27 | 2.4× |
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.