Imaging prices at St. Mary Medical Center
Galesburg, IL · every code in this section with a posted price and a Medicare benchmark.
313 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) | $5,204.40 | $8,674 | 3.5× |
| Abdomen 1 View (74018) | $277.20 | $462 | 3.0× |
| Abdomen 2 views (74019) | $337.80 | $563 | 3.0× |
| Acute Gastrointestinal Blood Loss Imaging (78278) | $1,871.40 | $3,119 | 4.4× |
| Angio pulmonary bilat (75743) | $1,959.60 | $3,266 | 0.6× |
| Angiography extremity bilateral rs&i (75716) | $5,385.60 | $8,976 | 1.6× |
| Angiography extremity unilateral rs&i (75710) | $4,831.20 | $8,052 | 1.4× |
| Ankle 2 views (73600) range across 3 matching MRF lines |
$430.80–$645 | $718–$1,075 | varies |
| Artery X-Rays Pelvis (75736) | $4,831.20 | $8,052 | 0.8× |
| Basic radiation dosimetry calculation (77300) | $622.80 | $1,038 | 4.3× |
| Bone age studies (77072) | $430.80 | $718 | 3.8× |
| Bone Imaging 3 Phase (78315) | $2,011.20 | $3,352 | 4.7× |
| Bone Imaging Limited Area (78300) | $2,011.20 | $3,352 | 4.7× |
| Bone Imaging Multiple Areas (78305) | $1,970.40 | $3,284 | 4.6× |
| Bone Imaging Whole Body (78306) | $1,755 | $2,925 | 4.1× |
| Bone marrow imaging; whole body (78104) | $1,572 | $2,620 | 3.7× |
| Bone survey infant (77076) | $411.60 | $686 | 3.7× |
| Brachytx isodose complex (77318) | $1,411.80 | $2,353 | 3.5× |
| Brachytx isodose intermed (77317) | $1,064.40 | $1,774 | 2.7× |
| Brachytx Isodose Plan Simple (77316) | $876 | $1,460 | 2.2× |
| Brain Imaging Pet Metabolic Evaluation (78608) | $6,678.60 | $11,131 | 4.4× |
| Cat Scan Follow-Up Study (76380) | $2,446.80 | $4,078 | 26.2× |
| Chest 1 view (71045) | $236.40 | $394 | 2.5× |
| Chest 2 views (71046) range across 2 matching MRF lines |
$279.60–$333.60 | $466–$556 | varies |
| Chest 3 views (71047) | $332.40 | $554 | 3.6× |
| Chest 4 or more views (71048) | $375.60 | $626 | 3.4× |
| Clavicle complete (73000) range across 3 matching MRF lines |
$430.80–$645.60 | $718–$1,076 | varies |
| Computed Tomography Thorax Lw Dose Lng Ca Scr C- (71271) | $176.40 | $294 | 1.6× |
| Continuing medical physics consltj pr wk (77336) | $828 | $1,380 | 5.7× |
| Contrast Exam Abdominl Aorta (75625) | $4,831.20 | $8,052 | 1.4× |
| Contrast X-Ray Bladder (74430) | $1,233 | $2,055 | 3.3× |
| CT abdomen and pelvis without and with contrast (74178) | $4,243.20 | $7,072 | 11.3× |
| CT abdomen and pelvis without contrast (74176) | $3,307.20 | $5,512 | 12.9× |
| CT abdomen w contrast (74160) | $2,446.80 | $4,078 | 13.0× |
| CT abdomen w wo contrast (74170) | $2,597.40 | $4,329 | 13.8× |
| CT abdomen w/o contrast (74150) | $2,446.80 | $4,078 | 21.8× |
| CT Angio Abdomen and Pelvis (74174) | $3,609.60 | $6,016 | 9.7× |
| CT Angio Chest (71275) | $2,478.60 | $4,131 | 13.2× |
| CT Angio Head (70496) | $2,508 | $4,180 | 13.3× |
| Ct Angio Lwr Extr W/O&W/Dye (73706) range across 3 matching MRF lines |
$2,607.60–$3,912 | $4,346–$6,520 | varies |
| CT Angio Neck (70498) | $2,446.80 | $4,078 | 13.0× |
| Ct Angio Upr Extrm W/O&W/Dye (73206) range across 3 matching MRF lines |
$2,446.80–$3,670.80 | $4,078–$6,118 | varies |
| CT Cere Prfuj Alys C+ W/O CT/Cta Same Anatomy (70473) | $2,362.80 | $3,938 | 12.6× |
| CT cervical spine w/ contrast (72126) | $2,446.80 | $4,078 | 6.5× |
| CT cervical spine w/o contrast (72125) | $2,446.80 | $4,078 | 21.8× |
| CT cervical spine w/wo cont (72127) | $2,700 | $4,500 | 14.4× |
| CT chest w contrast (71260) | $2,446.80 | $4,078 | 13.0× |
| CT chest w/wo contrast (71270) | $2,723.40 | $4,539 | 14.5× |
| CT head/brain with contrast (70460) | $2,446.80 | $4,078 | 13.0× |
| CT head/brain without and with contrast (70470) | $2,446.80 | $4,078 | 13.0× |
| CT heart no contrast quant eval coronry calcium (75571) | $117 | $195 | 1.3× |
| CT iac w contrast (70481) | $2,446.80 | $4,078 | 13.0× |
| CT l-spine w&w/o contrast (72133) | $2,446.80 | $4,078 | 13.0× |
| CT lower ext w/o (73700) range across 3 matching MRF lines |
$2,446.80–$3,670.80 | $4,078–$6,118 | varies |
| CT lower extremity w/contrast material (73701) range across 3 matching MRF lines |
$2,446.80–$3,736.20 | $4,078–$6,227 | varies |
| CT lumbar spine w contrast (72132) | $2,446.80 | $4,078 | 6.5× |
| CT lumbar spine w/o contrast (72131) | $2,446.80 | $4,078 | 21.8× |
| CT maxillofacial w contrast (70487) | $2,446.80 | $4,078 | 13.0× |
| CT maxillofacial wo contrast (70486) | $2,446.80 | $4,078 | 21.8× |
| CT neck tissue combo (70492) | $2,550.60 | $4,251 | 13.6× |
| Ct Orbit/Ear/Fossa W/O&W/Dye (70482) | $2,446.80 | $4,078 | 13.0× |
| CT orbits w/o contrast (70480) | $2,446.80 | $4,078 | 21.8× |
| CT pelvis w&w/o contrast (72194) | $2,546.40 | $4,244 | 13.5× |
| CT pelvis w/o contrast (72192) | $2,446.80 | $4,078 | 21.8× |
| CT scan of leg combo (73702) range across 3 matching MRF lines |
$2,446.80–$3,670.80 | $4,078–$6,118 | varies |
| CT scans face/jaw combo (70488) | $2,446.80 | $4,078 | 13.0× |
| CT soft tissue neck w contrast (70491) | $2,446.80 | $4,078 | 13.0× |
| CT soft tissue neck w/o contrast (70490) | $2,446.80 | $4,078 | 21.8× |
| CT thoracic spine w contrast (72129) | $2,606.40 | $4,344 | 13.9× |
| CT thoracic spine w/o contrast (72128) | $2,446.80 | $4,078 | 21.8× |
| CT thoracic spine w/wo cont (72130) | $2,610.60 | $4,351 | 13.9× |
| CT thorax w/o contrast (71250) | $2,446.80 | $4,078 | 21.8× |
| CT unlisted procedure (76497) | $2,446.80 | $4,078 | 26.2× |
| CT upper ext wo (73200) range across 3 matching MRF lines |
$2,446.80–$3,670.80 | $4,078–$6,118 | varies |
| CT upper extremity w/o & w/contrast material (73202) range across 3 matching MRF lines |
$2,446.80–$3,670.80 | $4,078–$6,118 | varies |
| CT upper extremity with contrast (73201) range across 3 matching MRF lines |
$2,469.60–$3,670.80 | $4,116–$6,118 | varies |
| Cta Abdl Aorta&Bi Iliofem W/Contrast&Postp (75635) | $2,901 | $4,835 | 15.4× |
| Cta Abdomen (74175) | $2,650.80 | $4,418 | 14.1× |
| CTA head&neck c+ w/noncontrast img&post-pxessing (70471) | $2,362.80 | $3,938 | 6.3× |
| CTA pelvis (72191) | $2,785.20 | $4,642 | 14.8× |
| Dxa Bone Density Axial (77080) | $409.80 | $683 | 3.7× |
| Dxa bone density study (77085) | $368.40 | $614 | 3.3× |
| Dxa bone density study 1/>sites appendiclr skel (77081) | $426.60 | $711 | 4.6× |
| Esophagram (74220) | $732 | $1,220 | 3.9× |
| Fetal Biophysical Profile W/O Non-Stress Testing (76819) range across 2 matching MRF lines |
$395.40–$742.80 | $659–$1,238 | varies |
| Fluoroscopy up to 1 hr (76000) | $561.60 | $936 | 2.2× |
| Follow-Up Angiography (75898) | $1,959.60 | $3,266 | 0.6× |
| Foot 2 views (73620) range across 3 matching MRF lines |
$430.80–$604.20 | $718–$1,007 | varies |
| Forearm 2 views (73090) range across 3 matching MRF lines |
$430.80–$604.20 | $718–$1,007 | varies |
| Gated Heart, Multiple (78473) | $2,557.80 | $4,263 | 6.0× |
| Hand 2 views (73120) range across 3 matching MRF lines |
$430.80–$742.80 | $718–$1,238 | varies |
| Hdr Rdncl Ntrstl/Icav Brchtx (77772) | $3,151.80 | $5,253 | 4.2× |
| Hdr Rdncl Ntrstl/Icav Brchtx (77771) | $2,739.60 | $4,566 | 3.7× |
| Hdr Rdncl Ntrstl/Icav Brchtx 1 Channel (77770) | $2,383.20 | $3,972 | 3.2× |
| Hepatc Vngrph Wdg/Fr Hemodyn Eval Rs&I (75889) | $2,712 | $4,520 | 0.8× |
| Hepatobil Syst Image W/Drug (78227) | $1,955.40 | $3,259 | 3.4× |
| Hepatobiliary System Imaging (78226) | $1,515 | $2,525 | 3.5× |
| Ht Muscle Image Spect Sing (78451) | $3,654 | $6,090 | 2.6× |
| Hysterosalpingogram (74740) | $1,512 | $2,520 | 5.9× |
| Interstitial radiation source applic complex (77778) | $3,073.20 | $5,122 | 4.1× |
| Intracavitary Radiation Source Applic Complex (77763) | $3,031.80 | $5,053 | 4.1× |
| Intracavitary Radiation Source Applic Intermed (77762) | $2,107.80 | $3,513 | 3.6× |
| Intracavitary radiation source applic simple (77761) | $1,410 | $2,350 | 2.4× |
| Joint Survey Single View (77077) | $463.20 | $772 | 4.1× |
| K Flow/Funct Image W/Drug (78708) | $1,808.40 | $3,014 | 3.1× |
| K Flow/Funct Image W/O Drug (78707) | $1,757.40 | $2,929 | 3.0× |
| Knee 3 Views (73562) range across 3 matching MRF lines |
$430.80–$604.20 | $718–$1,007 | varies |
| Liver & Spleen Imaging Static Only (78215) | $2,241 | $3,735 | 5.2× |
| Lung Perf&Ventilat Diferentl (78598) | $1,701 | $2,835 | 2.9× |
| Lung perfusion differential (78597) | $1,488.60 | $2,481 | 3.5× |
| Lung Ventilat&Perfus Imaging (78582) | $2,278.20 | $3,797 | 3.9× |
| Lymph System Imaging (78195) | $339 | $565 | 0.6× |
| Mammary ductogram or galactogram multiple (77054) | $857.40 | $1,429 | 3.4× |
| Mammary ductogram or galactogram single (77053) | $771 | $1,285 | 3.0× |
| Meckels Divert Exam (78290) | $2,892 | $4,820 | 6.8× |
| Mlc imrt design & construction per imrt plan (77338) | $1,544.40 | $2,574 | 3.8× |
| Mr safety determination physician/other qhp (76016) | $134.40 | $224 | 1.4× |
| Mr safety implant&/fb assmt clin staf 1st 15 min (76014) | $37.80 | $63 | 1.2× |
| Mr safety implt electronics prepj supvj phys/qhp (76018) | $140.40 | $234 | 1.4× |
| Mr safety implt pos&/immoblj (76019) | $90.60 | $151 | 1.4× |
| Mr safety med physics xm customization plng&mntr (76017) | $369.60 | $616 | 1.4× |
| Mra Head W/O & W/Contrast Material (70546) | $4,119.60 | $6,866 | 11.0× |
| MRA head w/o contrast (70544) | $4,119.60 | $6,866 | 16.1× |
| MRA head with contrast (70545) | $4,119.60 | $6,866 | 11.0× |
| MRA neck w contrast (70548) | $4,119.60 | $6,866 | 11.0× |
| Mra Neck W/O &W/Contrast Material (70549) | $4,250.40 | $7,084 | 11.4× |
| MRA neck w/o contrast (70547) | $4,119.60 | $6,866 | 16.1× |
| MRI abdomen w/o contrast (74181) | $4,119.60 | $6,866 | 16.1× |
| MRI any jt lower extrem w/o & w/contrast matrl (73723) range across 3 matching MRF lines |
$4,202.40–$6,179.40 | $7,004–$10,299 | varies |
| MRI Breast W/O Contrast Bilateral (77047) | $6,179.40 | $10,299 | 24.2× |
| MRI cervical spine w/o cont (72141) | $4,119.60 | $6,866 | 16.1× |
| MRI chest w/o contrast (71550) | $4,141.20 | $6,902 | 16.2× |
| MRI chest wo w contrast (71552) | $4,446.60 | $7,411 | 11.9× |
| MRI lower extrem oth/thn jt w/o & w/contr matr (73720) range across 3 matching MRF lines |
$4,119.60–$6,179.40 | $6,866–$10,299 | varies |
| MRI lower extrem oth/thn jt w/o contr matrl (73718) range across 3 matching MRF lines |
$4,119.60–$6,179.40 | $6,866–$10,299 | varies |
| MRI lumbar spine w contrast (72149) | $4,119.60 | $6,866 | 11.0× |
| Mri Neck Spine W/O & W/Dye (72156) | $4,119.60 | $6,866 | 11.0× |
| MRI orbit face &/neck w/o contrast (70540) | $4,119.60 | $6,866 | 16.1× |
| Mri Orbt/Fac/Nck W/O &W/Dye (70543) | $4,119.60 | $6,866 | 11.0× |
| MRI pelvis w/o & w contrast (72197) | $4,119.60 | $6,866 | 11.0× |
| MRI pelvis w/o contrast (72195) | $4,119.60 | $6,866 | 16.1× |
| MRI thoracic spine w/o contrast (72146) | $4,119.60 | $6,866 | 16.1× |
| MRI upper extremity oth than jt w/o contr matrl (73218) | $4,119.60 | $6,866 | 16.1× |
| Mri Uppr Extremity W/O&W/Dye (73220) | $4,119.60 | $6,866 | 11.0× |
| MRI, abdomen, combo (74183) | $4,119.60 | $6,866 | 11.0× |
| MRI, dorsal spine combo (72157) | $4,119.60 | $6,866 | 11.0× |
| MRI, joint upper extrem (73221) range across 3 matching MRF lines |
$4,119.60–$6,179.40 | $6,866–$10,299 | varies |
| MRI, joint upper extrem combo (73223) | $4,199.40 | $6,999 | 11.2× |
| MRI, lumbar spine combo (72158) | $4,119.60 | $6,866 | 11.0× |
| Myelogram Lumbar (72265) | $1,102.80 | $1,838 | 1.3× |
| Myocardial Spect Multiple Studies (78452) | $4,045.20 | $6,742 | 2.9× |
| Neck soft tissue (70360) | $373.80 | $623 | 4.0× |
| Nfs/Instlj Radioelmnt Sln 3 Mo Follow-Up Care (77750) | $946.20 | $1,577 | 2.3× |
| Njx Rp Loclzj Non-Img Probe Study Intravenous (78808) | $613.80 | $1,023 | 1.4× |
| Ntsty modul radthx pln dose-vol histos (77301) | $5,911.80 | $9,853 | 4.0× |
| Panoramic X-ray of jaws (70355) | $2,548.20 | $4,247 | 27.3× |
| Parathyroid Planar Imaging (78070) | $1,396.20 | $2,327 | 3.3× |
| Pelvis 1 or 2 views (72170) | $430.80 | $718 | 3.8× |
| Pet Image W/Ct Lmtd (78814) | $9,572.40 | $15,954 | 6.2× |
| PET image w/CT, full body (78816) | $7,707.60 | $12,846 | 5.0× |
| PET imaging CT attenuation skull base mid-thigh (78815) | $6,967.20 | $11,612 | 4.5× |
| Prq Transhepatc Portograpy Hemodyn Eval Rs&I (75885) | $1,959.60 | $3,266 | 0.6× |
| Pulmonary Perfusion Imaging Particulate (78580) | $1,520.40 | $2,534 | 3.5× |
| Radex Abd Compl Aqt Abd W/S/E/D Views 1 View Ch (74022) | $626.40 | $1,044 | 5.6× |
| Radex abscess/fistula/sinus tract rs&i (76080) | $864 | $1,440 | 1.5× |
| Radex Ankle Complete Minimum 3 Views (73610) range across 3 matching MRF lines |
$430.80–$604.20 | $718–$1,007 | varies |
| Radex Calcaneus Minimum 2 Views (73650) range across 3 matching MRF lines |
$430.80–$604.20 | $718–$1,007 | varies |
| Radex elbow complete minimum 3 views (73080) range across 3 matching MRF lines |
$430.80–$604.20 | $718–$1,007 | varies |
| Radex Facial Bones Complete Minimum 3 Views (70150) | $463.20 | $772 | 4.1× |
| Radex fingr minimum 2 views (73140) range across 4 matching MRF lines |
$312–$468.60 | $520–$781 | varies |
| Radex foot complete minimum 3 views (73630) range across 3 matching MRF lines |
$430.80–$604.20 | $718–$1,007 | varies |
| Radex Hand Minimum 3 Views (73130) range across 3 matching MRF lines |
$430.80–$604.20 | $718–$1,007 | varies |
| Radex lower extremity infant minimum 2 views (73592) range across 3 matching MRF lines |
$463.20–$606 | $772–$1,010 | varies |
| Radex Mastoids Compl Minimum 3 Views PR Side (70130) | $664.80 | $1,108 | 5.9× |
| Radex Nasal Bones Complete Minimum 3 Views (70160) | $430.80 | $718 | 4.6× |
| Radex Ribs Unilateral 2 Views (71100) | $430.80 | $718 | 4.6× |
| Radex shoulder complete minimum 2 views (73030) range across 3 matching MRF lines |
$430.80–$604.20 | $718–$1,007 | varies |
| Radex Spine 1 View Specify Level (72020) range across 6 matching MRF lines |
$301.80–$324 | $503–$540 | varies |
| Radex Sternum Minimum 2 Views (71120) | $463.20 | $772 | 5.0× |
| Radex Temporomandble Jt Opn & Clsd Mouth Bilat (70330) | $463.20 | $772 | 5.0× |
| Radex Toe Minimum 2 Views (73660) range across 4 matching MRF lines |
$312–$468.60 | $520–$781 | varies |
| Radex upper extremity infant minimum 2 views (73092) range across 3 matching MRF lines |
$463.20–$659.40 | $772–$1,099 | varies |
| Radex Wrist Complete Minimum 3 Views (73110) range across 3 matching MRF lines |
$430.80–$604.20 | $718–$1,007 | varies |
| Radex X-Ray Exam Entire Spi 6/> Vw - Xr Entire Spine 6+ Vw (72084) | $385.20 | $642 | 3.4× |
| Radiation Delivery Stereotactic Cranial Linear (77372) | $17,736 | $29,560 | 2.2× |
| Radiation treatment delivery level 1 (77402) | $648 | $1,080 | 5.9× |
| Radiation treatment delivery level 2 (77407) | $2,449.20 | $4,082 | 5.9× |
| Radiation treatment delivery level 3 (77412) | $3,058.20 | $5,097 | 5.2× |
| Radiolog exam mandible compl minimum 4 views (70110) | $463.20 | $772 | 4.1× |
| Radiologic Exam Abdomen 3+ Views - Xr Abdomen 3+ Views (74021) | $389.40 | $649 | 3.5× |
| Radiologic exam colon double contrast study (74280) | $1,136.40 | $1,894 | 6.0× |
| Radiologic exam colon single contrast study (74270) | $732 | $1,220 | 3.9× |
| Radiologic Exam Esophagus Double Contrast Study (74221) | $1,099.20 | $1,832 | 5.8× |
| Radiologic exam knee complete 4/more views (73564) range across 3 matching MRF lines |
$430.80–$742.80 | $718–$1,238 | varies |
| Radiologic exam pelvis compl minimum 3 views (72190) | $463.20 | $772 | 4.1× |
| Radiologic Exam Small Int Single Contrast Study (74250) | $732 | $1,220 | 3.9× |
| Radiologic exam swallow function contrast study (74230) | $732 | $1,220 | 3.9× |
| Radiologic exam upr gi trc double contrast study (74246) | $867 | $1,445 | 4.6× |
| Radiologic examination femur 1 view (73551) range across 3 matching MRF lines |
$342.60–$516 | $571–$860 | varies |
| Radiologic examination femur minimum 2 views (73552) range across 3 matching MRF lines |
$479.40–$604.20 | $799–$1,007 | varies |
| Radiologic examination knee 1/2 views (73560) range across 3 matching MRF lines |
$430.80–$604.20 | $718–$1,007 | varies |
| Radiologic examination tibia & fibula 2 views (73590) range across 3 matching MRF lines |
$430.80–$604.20 | $718–$1,007 | varies |
| Ribs bilateral 3 views (71110) | $463.20 | $772 | 4.1× |
| Rp loclzj tum plnr 1 area single day imaging (78800) | $1,798.80 | $2,998 | 4.2× |
| Rp loclzj tum plnr 2+area 1+d img/1 area img>2+d (78801) | $3,597 | $5,995 | 8.4× |
| Rp Loclzj Tum Plnr Whole Body Single Day Imaging (78802) | $1,798.80 | $2,998 | 3.1× |
| Rp Loclzj Tum Spect 1 Area Single Day Imaging (78803) | $2,091 | $3,485 | 3.6× |
| Rp loclzj tum spect 2 area/sep acquisj img (78831) | $3,138 | $5,230 | 2.3× |
| Rp loclzj tum spect CT 2area 1d img/1 ar img>2+d (78832) | $4,182.60 | $6,971 | 2.7× |
| Rp Therapy Intravenous Administration (79101) | $642 | $1,070 | 2.6× |
| Scapula (73010) range across 3 matching MRF lines |
$463.20–$923.40 | $772–$1,539 | varies |
| Screening Digital Breast Tomosynthesis Bi (77063) | $85.20 | $142 | 3.6× |
| Shoulder 1 view (73020) | $430.80 | $718 | 4.6× |
| Shoulder Arthrography (73040) | $1,602 | $2,670 | 4.3× |
| Skull less than 4 views (70250) | $430.80 | $718 | 3.8× |
| Special dosimetry (77331) | $536.40 | $894 | 3.7× |
| Special Physics Consult (77370) | $927 | $1,545 | 6.4× |
| Special teletherapy port plan (77321) | $1,158 | $1,930 | 2.9× |
| Special treatment procedure (77470) | $2,347.20 | $3,912 | 4.0× |
| Srs Multisource (77371) | $36,840 | $61,400 | 4.7× |
| Stereotactic Body Radiation Delivery (77373) range across 2 matching MRF lines |
$9,210–$11,970 | $15,350–$19,950 | varies |
| Sternoclavicular joints (71130) | $463.20 | $772 | 5.0× |
| Surface Applic Low Dose Rate Radionuclide Source (77789) | $212.40 | $354 | 1.9× |
| Telethx isodose pln cplx w/basic dosimetry (77307) | $1,371.60 | $2,286 | 3.4× |
| Telethx isodose pln smpl w/dosimetry calculation (77306) | $876 | $1,460 | 2.2× |
| Ther Rad Simulaj-Aided Field Setting Complex (77290) | $2,107.80 | $3,513 | 5.3× |
| Ther Rad Simulaj-Aided Field Setting Intermed (77285) | $1,417.80 | $2,363 | 3.5× |
| Ther rad simulaj-aided field setting simple (77280) | $905.40 | $1,509 | 6.3× |
| Thoracic spine 2 views (72070) | $405 | $675 | 3.6× |
| Thoracic spine 3 views (72072) | $465.60 | $776 | 4.2× |
| Thoracolumbar 2 views (72080) | $198 | $330 | 2.1× |
| Thyroid Imaging With Vascular Flow (78013) | $765 | $1,275 | 1.8× |
| Thyroid Met Imaging Body (78018) | $1,904.40 | $3,174 | 3.3× |
| Thyroid Uptake Measurement (78012) | $526.20 | $877 | 1.2× |
| Thyroid Uptake W/Blood Flow Sngle/Mult Quan Meas (78014) | $1,368 | $2,280 | 3.2× |
| Tx Devices Design & Construction Complex (77334) | $1,655.40 | $2,759 | 4.1× |
| Tx devices design & construction intermediate (77333) | $734.40 | $1,224 | 5.1× |
| Tx devices design & construction simple (77332) | $464.40 | $774 | 3.2× |
| Ultrasound Breast Limited (76642) range across 3 matching MRF lines |
$574.80–$604.20 | $958–$1,007 | varies |
| Ultrasound Exam Aaa Screen (76706) | $852 | $1,420 | 7.6× |
| Ultrasound, abdomen limited (76705) | $742.80 | $1,238 | 6.6× |
| Umbilical-artery Doppler (OB) (76820) | $488.40 | $814 | 4.4× |
| Unlisted fluoroscopic procedure (76496) | $561.60 | $936 | 6.0× |
| Unlisted us procedure (76999) | $543.60 | $906 | 5.8× |
| Upper gi w/o kub (74240) | $867 | $1,445 | 4.6× |
| Ureteral Reflux Study (78740) | $1,757.40 | $2,929 | 4.1× |
| Urethrocystogram voiding (74455) | $1,233 | $2,055 | 4.8× |
| Urethrocystography retrograde (74450) | $1,233 | $2,055 | 4.8× |
| Us breast unilateral complete (76641) | $742.80 | $1,238 | 6.6× |
| Us chest (76604) | $543.60 | $906 | 4.9× |
| Us complete joint (76881) range across 3 matching MRF lines |
$742.80–$1,204.80 | $1,238–$2,008 | varies |
| Us exam, pelvic, limited (76857) | $543.60 | $906 | 4.9× |
| Us head (76506) | $543.60 | $906 | 4.9× |
| Us kidney transplant (76776) | $742.80 | $1,238 | 6.6× |
| Us lmtd joint/oth nonvasc xtr strux r-t w/img (76882) range across 3 matching MRF lines |
$742.80–$745.20 | $1,238–$1,242 | varies |
| Us ob detailed single fetus (76811) | $1,352.40 | $2,254 | 5.3× |
| Us ob limited 1 or more fetuses (76815) | $742.80 | $1,238 | 6.6× |
| Us ob transvaginal (76817) | $543.60 | $906 | 4.9× |
| Us pelvic non ob complete (76856) | $742.80 | $1,238 | 6.6× |
| Us pg uter img f&mat 14 wk tabdl 1/1st gestation (76801) | $742.80 | $1,238 | 6.6× |
| Us preg uterus real time f/u trnsabdl per fetus (76816) range across 2 matching MRF lines |
$391.20–$408.60 | $652–$681 | varies |
| Us retroperitoneal complete (76770) | $742.80 | $1,238 | 6.6× |
| Us retroperitoneal limited (76775) | $742.80 | $1,238 | 6.6× |
| Us scrotum and contents (76870) | $742.80 | $1,238 | 6.6× |
| Us spinal canal and contents (76800) | $947.40 | $1,579 | 8.5× |
| Us thyroid (76536) | $742.80 | $1,238 | 6.6× |
| Vein X-Ray Liver W/O Hemodyn (75887) | $1,959.60 | $3,266 | 0.6× |
| Venogram Sinus/Jugular (75860) | $1,959.60 | $3,266 | 0.6× |
| Venography caval inferior serialography rs&i (75825) | $3,873 | $6,455 | 1.1× |
| Venography extremity bilateral rs&i (75822) | $1,710 | $2,850 | 1.0× |
| Venography extremity unilateral rs&i (75820) | $1,297.80 | $2,163 | 0.8× |
| Wrist 2 views (73100) range across 3 matching MRF lines |
$430.80–$604.20 | $718–$1,007 | varies |
| X-Ray Ac Jts - Xr Acromioclavicular Joints Bilateral (73050) | $463.20 | $772 | 5.0× |
| X-ray antegrade pyelogram tube (74425) | $1,233 | $2,055 | 3.3× |
| X-Ray Aorta Leg Arteries (75630) | $5,385.60 | $8,976 | 1.6× |
| X-Ray Bend Only L-S Spine (72120) | $415.80 | $693 | 3.7× |
| X-Ray Elbow 2 Vw - Xr Elbow 1-2 Views Right (73070) range across 3 matching MRF lines |
$430.80–$606.60 | $718–$1,011 | varies |
| X-Ray Exam Breast Specimen (76098) | $477 | $795 | 0.8× |
| X-Ray Exam Entire Spi 1 Vw (72081) | $260.40 | $434 | 2.8× |
| X-Ray Exam Entire Spi 2/3 Vw (72082) | $301.80 | $503 | 2.7× |
| X-Ray Exam Entire Spi 4/5 Vw (72083) | $334.20 | $557 | 3.0× |
| X-Ray Exam Hip Uni 1 View (73501) | $411 | $685 | 4.4× |
| X-Ray Exam Hip Uni 2-3 Views (73502) | $502.20 | $837 | 5.4× |
| X-Ray Exam Hip Uni 4/> Views (73503) | $547.80 | $913 | 4.9× |
| X-Ray Exam Hips Bi 2 Views (73521) | $583.20 | $972 | 5.2× |
| X-Ray Exam Hips Bi 3-4 Views (73522) | $534.60 | $891 | 4.8× |
| X-Ray Exam Hips Bi 5/> Views (73523) | $615.60 | $1,026 | 5.5× |
| X-Ray Exam L-S Spine Bending (72114) | $540.60 | $901 | 4.8× |
| X-Ray Exam Neck Spine 2-3 Vw (72040) | $412.80 | $688 | 4.4× |
| X-Ray Exam Neck Spine 6/>Vws (72052) | $560.40 | $934 | 5.0× |
| X-Ray Exam Unilat Ribs/Chest (71101) | $430.80 | $718 | 3.8× |
| X-ray eye for foreign body (70030) | $330.60 | $551 | 3.5× |
| X-ray humerus (73060) range across 3 matching MRF lines |
$430.80–$604.20 | $718–$1,007 | varies |
| X-ray IV pyelogram (ivp) (74400) | $1,233 | $2,055 | 6.6× |
| X-Ray Jaw <4 Vw - Xr Mandible < 4 Views (70100) | $463.20 | $772 | 5.0× |
| X-Ray Knee Bilat Standing - Xr Knees Anteroposterior Standing Bilat (73565) | $463.20 | $772 | 5.0× |
| X-Ray Lumbar Spine 2/3 Vw - Xr Lumbar Spine 2-3 Views (72100) | $415.80 | $693 | 3.7× |
| X-ray nose-rectum child f.b. (76010) | $373.80 | $623 | 4.0× |
| X-Ray Ribs, Chest 4+ Vw - Xr Ribs 3 Vws Bil W/ Chest Posteroanterior (71111) | $819 | $1,365 | 7.3× |
| X-Ray Sacroiliac Jts 3+ Vw - Xr Sacroiliac Joints 3+ Views (72202) | $430.80 | $718 | 3.8× |
| X-Ray Sacroiliac Jts <3 Vw - Xr Sacroiliac Joints 1-2 Views (72200) | $428.40 | $714 | 3.8× |
| X-Ray Sacrum/Coccyx 2+ Vw - Xr Sacrum Coccyx 2+ Views (72220) | $430.80 | $718 | 4.6× |
| X-Ray Sinuses 3+ Vw - Xr Paranasal Sinuses 3+ Views (70220) | $463.20 | $772 | 5.0× |
| X-Ray Skull 4+ Vw - Xr Skull Complete 4+ Views (70260) | $819 | $1,365 | 7.3× |
| X-ray thoracic spine 4 vw (72074) | $502.20 | $837 | 4.5× |
| X-Ray Tmj Unilat (70328) | $339.60 | $566 | 3.6× |
| X-Ray Urinary Tract Exam With Contrast Material (74420) | $1,233 | $2,055 | 3.3× |
| X-Rays Bone Length Studies (77073) | $430.80 | $718 | 3.8× |
| X-Rays Bone Survey Complete (77075) | $785.40 | $1,309 | 7.0× |
| Xr c-spine 4 or 5 views (72050) | $510 | $850 | 4.6× |
| Xr facial bones less than 3 views (70140) | $463.20 | $772 | 5.0× |
| Xr orbits complete 4 views (70200) | $463.20 | $772 | 4.1× |
| Xr Tomogram Single Plane (76100) range across 4 matching MRF lines |
$626.40–$1,165.20 | $1,044–$1,942 | varies |
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.