Imaging prices at The Orthopaedic Hospital of Lutheran Health Network
Fort Wayne, IN · every code in this section with a posted price and a Medicare benchmark.
351 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) | $1,860.57 | $6,891 | 1.3× |
| Abdomen 1 View (74018) range across 7 matching MRF lines |
$192.24–$254.61 | $712–$943 | varies |
| Abdomen 2 views (74019) range across 5 matching MRF lines |
$330.48–$367.47 | $1,224–$1,361 | varies |
| Acute Gastrointestinal Blood Loss Imaging (78278) range across 2 matching MRF lines |
$433.88–$487.35 | $1,606.95–$1,805 | varies |
| Acute venous thrombosis imaging, peptide Non-Facility (78456) | $762.75 | $2,825 | 0.6× |
| Adrenal Cortex & Medulla Img (78075) | $862.92 | $3,196 | 0.6× |
| Angiography extremity bilateral rs&i (75716) range across 3 matching MRF lines |
$45.09–$184.14 | $167–$682 | varies |
| Angiography extremity unilateral rs&i (75710) range across 5 matching MRF lines |
$38.07–$515.97 | $141–$1,911 | varies |
| Ankle 2 views (73600) range across 5 matching MRF lines |
$5.94–$196.02 | $22–$726 | varies |
| Aortography thoracic serialography rs&i (75605) range across 2 matching MRF lines |
$39.42–$146.88 | $146–$544 | varies |
| Artery X-Rays Abdomen (75726) likely a partial charge, not the full procedure |
$39.42 | $146 | 0.0× |
| Artery X-Rays Pelvis (75736) likely a partial charge, not the full procedure |
$40.23 | $149 | 0.0× |
| Artery X-Rays Spine (75705) likely a partial charge, not the full procedure |
$75.60 | $280 | 0.0× |
| Arthrogram hip (73525) range across 7 matching MRF lines |
$508.14–$641.79 | $1,882–$2,377 | varies |
| Basic radiation dosimetry calculation (77300) | $224.37 | $831 | 1.6× |
| Bone age studies (77072) range across 2 matching MRF lines |
$106.11–$111.51 | $393–$413 | varies |
| Bone Imaging 3 Phase (78315) | $1,272.51 | $4,713 | 3.0× |
| Bone Imaging Limited Area (78300) | $823.77 | $3,051 | 1.9× |
| Bone Imaging Multiple Areas (78305) | $983.34 | $3,642 | 2.3× |
| Bone Imaging Whole Body (78306) | $1,159.92 | $4,296 | 2.7× |
| Bone marrow imaging limited area (78102) | $897.21 | $3,323 | 2.1× |
| Bone marrow imaging; multiple areas (78103) | $1,020.06 | $3,778 | 2.4× |
| Bone marrow imaging; whole body (78104) | $1,264.14 | $4,682 | 3.0× |
| Bone survey infant (77076) range across 2 matching MRF lines |
$306.99–$322.65 | $1,137–$1,195 | varies |
| Brachytx isodose complex (77318) | $881.01 | $3,263 | 2.2× |
| Brachytx isodose intermed (77317) | $692.55 | $2,565 | 1.7× |
| Brachytx Isodose Plan Simple (77316) | $503.82 | $1,866 | 1.3× |
| Brain Image W/Flow < 4 Views (78601) | $919.89 | $3,407 | 2.2× |
| Card Bl Pool Gated Spect Rest Wal Motn Ejct Frct (78494) | $1,031.94 | $3,822 | 2.4× |
| Cardiac MRI w/w/o contrast & further seq (75561) range across 4 matching MRF lines |
$90.45–$1,098.90 | $335–$4,070 | varies |
| Cardiac MRI w/w/o contrast w/stress (75563) range across 6 matching MRF lines |
$103.95–$1,221.21 | $385–$4,523 | varies |
| Cat Scan Follow-Up Study (76380) | $358.83 | $1,329 | 3.9× |
| Cerebrospinal Fluid Flow W/O Matl Shunt Evaltj (78645) | $700.92 | $2,596 | 1.2× |
| Cerebrospinal Fluid Scan (78630) | $1,359.18 | $5,034 | 2.4× |
| Chest 1 view (71045) range across 9 matching MRF lines |
$5.94–$158.22 | $22–$586 | varies |
| Chest 2 views (71046) range across 8 matching MRF lines |
$10.80–$244.62 | $40–$906 | varies |
| Cineradiograpy/vidradiograpy xcpt where spec (76120) | $14.04 | $52 | 0.1× |
| Clavicle complete (73000) range across 5 matching MRF lines |
$6.21–$244.62 | $23–$906 | varies |
| Computed Tomography Thorax Lw Dose Lng Ca Scr C- (71271) | $38.61 | $143 | 0.3× |
| Continuing medical physics consltj pr wk (77336) | $267.03 | $989 | 1.9× |
| Contrast Exam Abdominl Aorta (75625) range across 3 matching MRF lines |
$39.42–$146.88 | $146–$544 | varies |
| Contrast X-Ray Bladder (74430) range across 5 matching MRF lines |
$37.80–$376.65 | $140–$1,395 | varies |
| CT abdomen and pelvis without and with contrast (74178) | $2,455.65 | $9,095 | 6.7× |
| CT abdomen and pelvis without contrast (74176) range across 5 matching MRF lines |
$2,278.80–$2,415.42 | $8,440–$8,946 | varies |
| CT abdomen w contrast (74160) | $408.78 | $1,514 | 2.2× |
| CT abdomen w wo contrast (74170) | $1,673.19 | $6,197 | 9.0× |
| CT abdomen w/o contrast (74150) | $1,255.77 | $4,651 | 11.4× |
| CT Angio Abdomen and Pelvis (74174) | $2,412.72 | $8,936 | 6.5× |
| CT Angio Chest (71275) range across 4 matching MRF lines |
$1,077.26–$1,210.41 | $3,989.85–$4,483 | varies |
| CT Angio Head (70496) range across 3 matching MRF lines |
$1,201.23–$1,273.32 | $4,449–$4,716 | varies |
| CT angio hrt w/3d image (75574) range across 5 matching MRF lines |
$78.30–$784.89 | $290–$2,907 | varies |
| Ct Angio Lwr Extr W/O&W/Dye (73706) | $1,270.62 | $4,706 | 6.8× |
| CT Angio Neck (70498) | $1,273.32 | $4,716 | 6.9× |
| Ct Angio Upr Extrm W/O&W/Dye (73206) range across 4 matching MRF lines |
$970.72–$1,225.53 | $3,595.25–$4,539 | varies |
| CT cervical spine w/ contrast (72126) | $1,361.61 | $5,043 | 3.7× |
| CT cervical spine w/o contrast (72125) | $1,361.61 | $5,043 | 12.3× |
| CT cervical spine w/wo cont (72127) range across 2 matching MRF lines |
$1,514.86–$1,702.08 | $5,610.60–$6,304 | varies |
| CT chest w contrast (71260) range across 5 matching MRF lines |
$884.64–$993.87 | $3,276.45–$3,681 | varies |
| CT chest w/wo contrast (71270) | $1,412.37 | $5,231 | 7.6× |
| CT colonography screening (74263) | $571.86 | $2,118 | 2.3× |
| CT Colonogrphy Dx Image Postprocess W/Contrast (74262) | $724.95 | $2,685 | 3.9× |
| CT colonogrphy dx image postprocess w/o contrast (74261) | $675.54 | $2,502 | 6.1× |
| CT head/brain with contrast (70460) | $408.78 | $1,514 | 2.2× |
| CT head/brain without and with contrast (70470) | $1,255.77 | $4,651 | 6.8× |
| CT heart contrast eval cardiac structure&morph (75572) range across 3 matching MRF lines |
$61.29–$668.25 | $227–$2,475 | varies |
| CT heart no contrast quant eval coronry calcium (75571) range across 5 matching MRF lines |
$14.31–$20.52 | $53–$76 | varies |
| CT hrt w/3d image congen (75573) range across 3 matching MRF lines |
$88.29–$784.89 | $327–$2,907 | varies |
| CT iac w contrast (70481) | $978.21 | $3,623 | 5.3× |
| CT l-spine w&w/o contrast (72133) range across 2 matching MRF lines |
$1,289.90–$1,449.36 | $4,777.40–$5,368 | varies |
| CT lower ext w/o (73700) range across 17 matching MRF lines |
$758.15–$851.85 | $2,807.95–$3,155 | varies |
| CT lower extremity w/contrast material (73701) range across 15 matching MRF lines |
$742.69–$834.57 | $2,750.70–$3,091 | varies |
| CT lumbar spine w contrast (72132) | $968.76 | $3,588 | 2.6× |
| CT lumbar spine w/o contrast (72131) range across 2 matching MRF lines |
$1,347.03–$1,427.76 | $4,989–$5,288 | varies |
| CT maxillofacial w contrast (70487) | $1,207.44 | $4,472 | 6.5× |
| CT maxillofacial wo contrast (70486) range across 3 matching MRF lines |
$481.68–$510.57 | $1,784–$1,891 | varies |
| CT neck tissue combo (70492) | $1,226.88 | $4,544 | 6.6× |
| Ct Orbit/Ear/Fossa W/O&W/Dye (70482) range across 5 matching MRF lines |
$1,040.34–$1,168.83 | $3,853.10–$4,329 | varies |
| CT orbits w/o contrast (70480) | $613.98 | $2,274 | 5.6× |
| CT pelvis w&w/o contrast (72194) | $1,561.95 | $5,785 | 8.4× |
| CT pelvis w/o contrast (72192) | $1,045.44 | $3,872 | 9.5× |
| CT scan of leg combo (73702) | $1,087.56 | $4,028 | 5.9× |
| CT scans face/jaw combo (70488) | $1,259.55 | $4,665 | 6.8× |
| CT soft tissue neck w contrast (70491) | $1,228.50 | $4,550 | 6.6× |
| CT soft tissue neck w/o contrast (70490) | $1,228.50 | $4,550 | 11.1× |
| CT thoracic spine w contrast (72129) | $1,152.90 | $4,270 | 6.2× |
| CT thoracic spine w/o contrast (72128) range across 2 matching MRF lines |
$1,077.03–$1,141.56 | $3,989–$4,228 | varies |
| CT thoracic spine w/wo cont (72130) range across 2 matching MRF lines |
$1,121.62–$1,260.09 | $4,154.15–$4,667 | varies |
| CT thorax w/o contrast (71250) range across 4 matching MRF lines |
$877.49–$986.04 | $3,249.95–$3,652 | varies |
| CT upper ext wo (73200) range across 18 matching MRF lines |
$887.76–$940.95 | $3,288–$3,485 | varies |
| CT upper extremity w/o & w/contrast material (73202) range across 24 matching MRF lines |
$497.99–$559.44 | $1,844.40–$2,072 | varies |
| CT upper extremity with contrast (73201) range across 20 matching MRF lines |
$645.30–$683.91 | $2,390–$2,533 | varies |
| Cta Abdl Aorta&Bi Iliofem W/Contrast&Postp (75635) | $2,900.07 | $10,741 | 15.6× |
| Cta Abdomen (74175) | $1,439.64 | $5,332 | 7.8× |
| CTA pelvis (72191) range across 2 matching MRF lines |
$1,100.52–$1,166.67 | $4,076–$4,321 | varies |
| Dilation ureters/urethra rs&i (74485) | $26.73 | $99 | 0.0× |
| Doppler Echo Fetal Puls Spectral F/U/Repeat (76828) range across 2 matching MRF lines |
$284.20–$319.41 | $1,052.60–$1,183 | varies |
| Doppler Echo Fetal Spectral Display Complete (76827) range across 2 matching MRF lines |
$512.30–$575.64 | $1,897.40–$2,132 | varies |
| Dxa Bone Density Axial (77080) range across 3 matching MRF lines |
$9.99–$127.17 | $37–$471 | varies |
| Dxa bone density study (77085) range across 2 matching MRF lines |
$151.40–$170.10 | $560.75–$630 | varies |
| Dxa bone density study 1/>sites appendiclr skel (77081) range across 3 matching MRF lines |
$9.99–$70.47 | $37–$261 | varies |
| Echo exam of fetal heart (76825) range across 2 matching MRF lines |
$953.91–$1,071.90 | $3,533–$3,970 | varies |
| Echo exam uterus (76831) range across 3 matching MRF lines |
$56.97–$130.14 | $211–$482 | varies |
| Echocardiography, fetal, cardiovascular system, real time with image documentation (2D), with or without M-mode… (76826) range across 2 matching MRF lines |
$508.29–$571.32 | $1,882.55–$2,116 | varies |
| Esophageal Motility Study (78258) | $762.75 | $2,825 | 1.8× |
| Esophagram (74220) range across 4 matching MRF lines |
$447.66–$470.34 | $1,658–$1,742 | varies |
| Fetal Biophys Profile W/Nst (76818) range across 5 matching MRF lines |
$38.34–$529.74 | $142–$1,962 | varies |
| Fetal Biophysical Profile W/O Non-Stress Testing (76819) range across 3 matching MRF lines |
$33.21–$92.88 | $123–$344 | varies |
| Fluoroscopy up to 1 hr (76000) range across 7 matching MRF lines |
$53.19–$550.53 | $20–$2,039 | varies |
| Follow-Up Angiography (75898) | $59.13 | $219 | 0.0× |
| Foot 2 views (73620) range across 6 matching MRF lines |
$17.55–$271.08 | $65–$1,004 | varies |
| Forearm 2 views (73090) range across 5 matching MRF lines |
$5.94–$193.59 | $22–$717 | varies |
| Gastric emptying imaging study (78264) | $898.02 | $3,326 | 2.1× |
| Gastroesophageal Reflux Exam (78262) | $814.86 | $3,018 | 1.9× |
| Gated Heart Planar Single (78472) range across 3 matching MRF lines |
$31.86–$1,047.87 | $118–$3,881 | varies |
| Gated Heart, Multiple (78473) | $2,276.10 | $8,430 | 5.4× |
| Hand 2 views (73120) range across 4 matching MRF lines |
$197.37–$207.63 | $731–$769 | varies |
| Hdr Rdncl Ntrstl/Icav Brchtx (77772) | $3,383.10 | $12,530 | 4.6× |
| Hdr Rdncl Ntrstl/Icav Brchtx (77771) | $2,087.64 | $7,732 | 2.8× |
| Hdr Rdncl Ntrstl/Icav Brchtx 1 Channel (77770) | $964.98 | $3,574 | 1.3× |
| Heart first pass single,planar (78481) | $613.44 | $2,272 | 1.1× |
| Hepatobil Syst Image W/Drug (78227) | $1,163.16 | $4,308 | 2.0× |
| Hepatobiliary System Imaging (78226) | $1,018.17 | $3,771 | 2.4× |
| Ht Musc Image Planar Mult (78454) | $46.71 | $173 | 0.0× |
| Ht Muscle Image Spect Sing (78451) range across 7 matching MRF lines |
$235.44–$2,653.29 | $164–$9,827 | varies |
| Infant hip ultrasound with hip movement (dynamic) (76885) | $175.23 | $649 | 1.9× |
| Interstitial radiation source applic complex (77778) | $3,429.54 | $12,702 | 4.7× |
| Intracavitary Radiation Source Applic Complex (77763) range across 2 matching MRF lines |
$601.30–$675.81 | $2,227.05–$2,503 | varies |
| Intraop radiaj tx deliver xray single tx session (77424) | $4,054.32 | $15,016 | 0.5× |
| Joint Survey Single View (77077) range across 5 matching MRF lines |
$26.19–$148.77 | $97–$551 | varies |
| K Flow/Funct Image Multiple (78709) | $1,636.74 | $6,062 | 2.8× |
| K Flow/Funct Image W/Drug (78708) | $839.70 | $3,110 | 1.5× |
| K Flow/Funct Image W/O Drug (78707) range across 2 matching MRF lines |
$768.73–$863.73 | $2,847.15–$3,199 | varies |
| Kidney Imaging Morphol (78700) | $557.01 | $2,063 | 1.3× |
| Knee 3 Views (73562) range across 6 matching MRF lines |
$7.02–$239.22 | $26–$886 | varies |
| Leveen/Shunt Patency Exam (78291) range across 2 matching MRF lines |
$428.49–$454.14 | $1,587–$1,682 | varies |
| Liver & Spleen Imaging Static Only (78215) | $890.46 | $3,298 | 2.1× |
| Liver & Spleen Imaging W/Vascular Flow (78216) | $659.88 | $2,444 | 1.6× |
| Liver imaging static only (78201) | $915.03 | $3,389 | 1.6× |
| Lung Perf&Ventilat Diferentl (78598) | $2,215.08 | $8,204 | 3.9× |
| Lung Ventilat&Perfus Imaging (78582) | $1,453.68 | $5,384 | 2.5× |
| Lung Ventilation Imaging (78579) | $751.68 | $2,784 | 1.8× |
| Lymph System Imaging (78195) range across 2 matching MRF lines |
$41.31–$823.77 | $153–$3,051 | varies |
| Magnetic Image Jaw Joint (70336) range across 4 matching MRF lines |
$741.83–$936.36 | $2,747.50–$3,468 | varies |
| Meckels Divert Exam (78290) range across 2 matching MRF lines |
$638.79–$717.66 | $2,365.90–$2,658 | varies |
| Mlc imrt design & construction per imrt plan (77338) | $1,391.58 | $5,154 | 3.5× |
| Mra Head W/O & W/Contrast Material (70546) range across 3 matching MRF lines |
$1,209.33–$1,281.96 | $4,479–$4,748 | varies |
| MRA head w/o contrast (70544) range across 4 matching MRF lines |
$777.60–$824.31 | $2,880–$3,053 | varies |
| MRA head with contrast (70545) range across 3 matching MRF lines |
$733.54–$824.31 | $2,716.80–$3,053 | varies |
| MRA neck w contrast (70548) range across 4 matching MRF lines |
$940.73–$1,057.05 | $3,484.20–$3,915 | varies |
| Mra Neck W/O &W/Contrast Material (70549) range across 3 matching MRF lines |
$1,162.89–$1,232.55 | $4,307–$4,565 | varies |
| MRA neck w/o contrast (70547) range across 3 matching MRF lines |
$747.36–$791.91 | $2,768–$2,933 | varies |
| MRI abdomen w contrast (74182) range across 3 matching MRF lines |
$733.54–$824.31 | $2,716.80–$3,053 | varies |
| MRI abdomen w/o contrast (74181) range across 6 matching MRF lines |
$698.61–$824.31 | $2,587.45–$3,053 | varies |
| MRI any jt lower extrem w/contrast material (73722) range across 20 matching MRF lines |
$878.07–$986.58 | $3,252.10–$3,654 | varies |
| MRI any jt lower extrem w/o & w/contrast matrl (73723) range across 20 matching MRF lines |
$1,300.78–$1,461.51 | $4,817.70–$5,413 | varies |
| MRI any jt upper extremity w/contrast matrl (73222) range across 18 matching MRF lines |
$930.69–$986.58 | $3,447–$3,654 | varies |
| MRI cardiac w/o cont stress (75559) range across 4 matching MRF lines |
$100.98–$1,098.90 | $374–$4,070 | varies |
| MRI cardiac w/o contrast (75557) range across 5 matching MRF lines |
$76.68–$1,098.90 | $284–$4,070 | varies |
| MRI cervical spine w contrast (72142) range across 4 matching MRF lines |
$652.79–$824.31 | $2,417.75–$3,053 | varies |
| MRI cervical spine w/o cont (72141) range across 4 matching MRF lines |
$275.94–$934.74 | $1,022–$3,462 | varies |
| MRI chest w/o contrast (71550) range across 5 matching MRF lines |
$830.55–$933.39 | $3,076.10–$3,457 | varies |
| MRI chest with contrast (71551) range across 5 matching MRF lines |
$733.54–$824.31 | $2,716.80–$3,053 | varies |
| MRI chest wo w contrast (71552) range across 6 matching MRF lines |
$1,140.79–$1,281.96 | $4,225.15–$4,748 | varies |
| MRI lower extrem oth/thn jt w/contrast matrl (73719) range across 34 matching MRF lines |
$882.23–$1,169.64 | $3,267.50–$4,332 | varies |
| MRI lower extrem oth/thn jt w/o & w/contr matr (73720) range across 19 matching MRF lines |
$1,300.21–$1,460.97 | $4,815.60–$5,411 | varies |
| MRI lower extrem oth/thn jt w/o contr matrl (73718) range across 22 matching MRF lines |
$831.13–$933.93 | $3,078.25–$3,459 | varies |
| MRI lumbar spine w contrast (72149) range across 3 matching MRF lines |
$652.79–$824.31 | $2,417.75–$3,053 | varies |
| Mri Neck Spine W/O & W/Dye (72156) range across 3 matching MRF lines |
$1,051.65–$1,463.94 | $3,895–$5,422 | varies |
| MRI orbit face &/neck w/o contrast (70540) range across 17 matching MRF lines |
$698.61–$824.31 | $2,587.45–$3,053 | varies |
| MRI orbit face neck w contrast (70542) range across 3 matching MRF lines |
$733.54–$824.31 | $2,716.80–$3,053 | varies |
| Mri Orbt/Fac/Nck W/O &W/Dye (70543) range across 23 matching MRF lines |
$1,102.28–$1,461.24 | $4,082.50–$5,412 | varies |
| MRI pelvis w contrast (72196) range across 3 matching MRF lines |
$733.54–$824.31 | $2,716.80–$3,053 | varies |
| MRI pelvis w/o & w contrast (72197) range across 3 matching MRF lines |
$1,096.61–$1,384.29 | $4,061.50–$5,127 | varies |
| MRI pelvis w/o contrast (72195) range across 3 matching MRF lines |
$873.99–$926.37 | $3,237–$3,431 | varies |
| MRI spectroscopy (76390) range across 3 matching MRF lines |
$321.17–$405.54 | $1,189.50–$1,502 | varies |
| MRI thoracic spine w/o contrast (72146) range across 7 matching MRF lines |
$260.28–$934.74 | $964–$3,462 | varies |
| MRI upper extremity oth than jt w/contr matrl (73219) range across 14 matching MRF lines |
$1,163.97–$1,307.88 | $4,311–$4,844 | varies |
| MRI upper extremity oth than jt w/o contr matrl (73218) range across 24 matching MRF lines |
$833.41–$1,145.34 | $3,086.70–$4,242 | varies |
| Mri Uppr Extremity W/O&W/Dye (73220) range across 29 matching MRF lines |
$1,185.73–$1,332.18 | $4,391.60–$4,934 | varies |
| MRI, abdomen, combo (74183) range across 5 matching MRF lines |
$777.60–$824.31 | $2,880–$3,053 | varies |
| MRI, dorsal spine combo (72157) range across 3 matching MRF lines |
$1,381.32–$1,464.21 | $5,116–$5,423 | varies |
| MRI, dorsal spine contrast (72147) range across 3 matching MRF lines |
$803.25–$902.61 | $2,975–$3,343 | varies |
| MRI, joint upper extrem (73221) range across 15 matching MRF lines |
$740.34–$934.74 | $2,742–$3,462 | varies |
| MRI, joint upper extrem combo (73223) range across 17 matching MRF lines |
$781.38–$986.58 | $2,894–$3,654 | varies |
| MRI, lumbar spine combo (72158) range across 3 matching MRF lines |
$1,381.05–$1,463.94 | $5,115–$5,422 | varies |
| Myocardial Imaging Infarct Avid Planar Qual/Quan (78466) range across 3 matching MRF lines |
$24.57–$783.81 | $91–$2,903 | varies |
| Myocardial Perfusion Planar 1 Study Rest/Stress (78453) | $34.56 | $128 | 0.0× |
| Myocardial Spect Multiple Studies (78452) range across 10 matching MRF lines |
$325.62–$3,092.31 | $180–$11,453 | varies |
| Neck soft tissue (70360) range across 6 matching MRF lines |
$5.94–$122.04 | $22–$452 | varies |
| Njx Rp Loclzj Non-Img Probe Study Intravenous (78808) | $192.24 | $712 | 0.5× |
| Nm csf leak detection (78650) | $485.46 | $1,798 | 0.4× |
| Ntsty modul radthx pln dose-vol histos (77301) | $8,600.58 | $31,854 | 5.9× |
| Nuclear Rx Oral Admin (79005) range across 2 matching MRF lines |
$61.56–$1,059.75 | $228–$3,925 | varies |
| Ob us nuchal meas 1 gest (76813) range across 2 matching MRF lines |
$82.89–$116.91 | $307–$433 | varies |
| Oph bmtry us echograpy a-scan io lens pwr cal (76519) | $21.87 | $81 | 0.2× |
| Ophthalmic ultrasound dx b-scan w/wo a-scan (76512) | $63.72 | $236 | 0.6× |
| Ophthalmic US Dx Corneal Pachymetry Uni/Bi (76514) | $10.53 | $39 | 0.3× |
| Panoramic X-ray of jaws (70355) range across 3 matching MRF lines |
$206.39–$273.51 | $764.40–$1,013 | varies |
| Parathyroid Planar Imaging (78070) | $661.23 | $2,449 | 1.6× |
| Pelvis 1 or 2 views (72170) range across 5 matching MRF lines |
$6.48–$220.32 | $24–$816 | varies |
| Pet Image Skull-Thigh (78812) | $1,464.48 | $5,424 | 1.0× |
| Pulmonary Perfusion Imaging Particulate (78580) | $487.35 | $1,805 | 1.2× |
| Radex Abd Compl Aqt Abd W/S/E/D Views 1 View Ch (74022) range across 4 matching MRF lines |
$11.34–$516.78 | $42–$1,914 | varies |
| Radex abscess/fistula/sinus tract rs&i (76080) range across 5 matching MRF lines |
$225.23–$252.99 | $834.20–$937 | varies |
| Radex Ankle Complete Minimum 3 Views (73610) range across 5 matching MRF lines |
$6.48–$206.01 | $24–$763 | varies |
| Radex Calcaneus Minimum 2 Views (73650) range across 6 matching MRF lines |
$5.67–$242.73 | $21–$899 | varies |
| Radex elbow complete minimum 3 views (73080) range across 5 matching MRF lines |
$6.48–$209.79 | $24–$777 | varies |
| Radex Facial Bones Complete Minimum 3 Views (70150) range across 10 matching MRF lines |
$9.45–$316.98 | $35–$1,174 | varies |
| Radex fingr minimum 2 views (73140) range across 22 matching MRF lines |
$5.13–$177.66 | $19–$658 | varies |
| Radex foot complete minimum 3 views (73630) range across 5 matching MRF lines |
$5.94–$265.41 | $22–$983 | varies |
| Radex Hand Minimum 3 Views (73130) range across 5 matching MRF lines |
$6.21–$227.34 | $23–$842 | varies |
| Radex lower extremity infant minimum 2 views (73592) range across 7 matching MRF lines |
$19.44–$202.23 | $72–$749 | varies |
| Radex Nasal Bones Complete Minimum 3 Views (70160) range across 5 matching MRF lines |
$6.21–$262.44 | $23–$972 | varies |
| Radex Pharynx/Larx W/Fluor&/Magnification Tq (70370) | $496.53 | $1,839 | 5.4× |
| Radex Ribs Unilateral 2 Views (71100) range across 7 matching MRF lines |
$8.10–$170.91 | $30–$633 | varies |
| Radex shoulder complete minimum 2 views (73030) range across 7 matching MRF lines |
$7.02–$274.05 | $26–$1,015 | varies |
| Radex Sinuses Paransl < 3 Views (70210) range across 6 matching MRF lines |
$6.21–$55.35 | $23–$205 | varies |
| Radex Spine 1 View Specify Level (72020) range across 16 matching MRF lines |
$5.67–$190.89 | $21–$707 | varies |
| Radex Sternum Minimum 2 Views (71120) range across 5 matching MRF lines |
$7.29–$132.30 | $27–$490 | varies |
| Radex Toe Minimum 2 Views (73660) range across 26 matching MRF lines |
$4.86–$184.68 | $18–$684 | varies |
| Radex upper extremity infant minimum 2 views (73092) range across 4 matching MRF lines |
$130.95–$137.97 | $485–$511 | varies |
| Radex Wrist Complete Minimum 3 Views (73110) range across 14 matching MRF lines |
$6.48–$234.36 | $24–$868 | varies |
| Radex X-Ray Exam Entire Spi 6/> Vw - Xr Entire Spine 6+ Vw (72084) | $410.40 | $1,520 | 3.7× |
| Radiation Delivery Stereotactic Cranial Linear (77372) likely a partial charge, not the full procedure |
$977.13 | $3,619 | 0.1× |
| Radiation treatment delivery level 1 (77402) | $668.79 | $2,477 | 6.2× |
| Radiation treatment delivery level 2 (77407) | $36.18 | $134 | 0.1× |
| Radiation treatment delivery level 3 (77412) | $1,339.47 | $4,961 | 2.3× |
| Radiolog exam mandible compl minimum 4 views (70110) range across 4 matching MRF lines |
$8.91–$313.20 | $33–$1,160 | varies |
| Radiologic Exam Abdomen 3+ Views - Xr Abdomen 3+ Views (74021) range across 4 matching MRF lines |
$357.75–$474.12 | $1,325–$1,756 | varies |
| Radiologic exam colon double contrast study (74280) range across 2 matching MRF lines |
$620.73–$651.51 | $2,299–$2,413 | varies |
| Radiologic exam colon single contrast study (74270) range across 4 matching MRF lines |
$491.40–$515.97 | $1,820–$1,911 | varies |
| Radiologic exam knee complete 4/more views (73564) range across 19 matching MRF lines |
$8.37–$242.46 | $31–$898 | varies |
| Radiologic exam pelvis compl minimum 3 views (72190) range across 7 matching MRF lines |
$7.83–$174.96 | $29–$648 | varies |
| Radiologic Exam Small Int Single Contrast Study (74250) range across 6 matching MRF lines |
$69.66–$585.90 | $258–$2,170 | varies |
| Radiologic exam swallow function contrast study (74230) range across 2 matching MRF lines |
$205.67–$259.47 | $761.75–$961 | varies |
| Radiologic exam upr gi trc double contrast study (74246) range across 3 matching MRF lines |
$595.62–$631.26 | $2,206–$2,338 | varies |
| Radiologic examination femur 1 view (73551) range across 5 matching MRF lines |
$91.40–$115.29 | $338.50–$427 | varies |
| Radiologic examination femur minimum 2 views (73552) range across 4 matching MRF lines |
$226.80–$237.87 | $840–$881 | varies |
| Radiologic examination knee 1/2 views (73560) range across 6 matching MRF lines |
$6.75–$194.13 | $25–$719 | varies |
| Radiologic Examination Osseous Survey Limited (77074) range across 3 matching MRF lines |
$102.33–$135.54 | $379–$502 | varies |
| Radiologic examination tibia & fibula 2 views (73590) range across 5 matching MRF lines |
$6.21–$240.30 | $23–$890 | varies |
| Radiopharmaceutical therapy, by intracavitary administration Non-Facility (79200) range across 2 matching MRF lines |
$1,770.12–$1,876.23 | $6,556–$6,949 | varies |
| Ribs bilateral 3 views (71110) range across 6 matching MRF lines |
$9.72–$176.04 | $36–$652 | varies |
| Rp loclzj tum plnr 1 area single day imaging (78800) range across 4 matching MRF lines |
$23.22–$912.33 | $86–$3,379 | varies |
| Rp Loclzj Tum Plnr Whole Body 2+ Days Imaging (78804) | $2,539.62 | $9,406 | 4.4× |
| Rp Loclzj Tum Plnr Whole Body Single Day Imaging (78802) | $827.01 | $3,063 | 1.4× |
| Rp Loclzj Tum Spect 1 Area Single Day Imaging (78803) range across 11 matching MRF lines |
$34.83–$1,365.66 | $129–$5,058 | varies |
| Rp Ther Radiolbld Monoclonal Antibody IV Infus (79403) | $1,179.36 | $4,368 | 4.8× |
| Rp Therapy Intravenous Administration (79101) | $328.05 | $1,215 | 1.3× |
| Scapula (73010) range across 8 matching MRF lines |
$20.25–$288.90 | $75–$1,070 | varies |
| Shoulder 1 view (73020) range across 4 matching MRF lines |
$241.38–$253.26 | $894–$938 | varies |
| Shoulder Arthrography (73040) range across 6 matching MRF lines |
$544.35–$611.55 | $2,016.10–$2,265 | varies |
| Skull less than 4 views (70250) range across 8 matching MRF lines |
$8.91–$55.35 | $33–$205 | varies |
| Special dosimetry (77331) | $223.83 | $829 | 1.6× |
| Special Physics Consult (77370) | $592.65 | $2,195 | 4.2× |
| Special teletherapy port plan (77321) | $566.46 | $2,098 | 1.4× |
| Special treatment procedure (77470) | $673.38 | $2,494 | 1.2× |
| Stereotactic Body Radiation Delivery (77373) | $1,250.64 | $4,632 | 0.7× |
| Sternoclavicular joints (71130) range across 5 matching MRF lines |
$8.10–$114.21 | $30–$423 | varies |
| Superior sagittal sinus venogram (75870) | $39.96 | $148 | 0.0× |
| Telethx isodose pln cplx w/basic dosimetry (77307) | $566.46 | $2,098 | 1.4× |
| Telethx isodose pln smpl w/dosimetry calculation (77306) | $224.37 | $831 | 0.6× |
| Testicular Imaging W/Flow (78761) | $533.25 | $1,975 | 1.3× |
| Ther Rad Simulaj-Aided Field Setting Complex (77290) | $2,306.07 | $8,541 | 5.8× |
| Ther Rad Simulaj-Aided Field Setting Intermed (77285) | $1,423.17 | $5,271 | 3.6× |
| Ther rad simulaj-aided field setting simple (77280) | $785.70 | $2,910 | 5.5× |
| Therapeutic Enema Rdctj Intussusception/Obstrcj (74283) | $543.51 | $2,013 | 2.9× |
| Thoracic spine 2 views (72070) range across 5 matching MRF lines |
$8.10–$289.44 | $30–$1,072 | varies |
| Thoracic spine 3 views (72072) range across 6 matching MRF lines |
$7.83–$322.65 | $29–$1,195 | varies |
| Thoracolumbar 2 views (72080) range across 8 matching MRF lines |
$8.37–$279.18 | $31–$1,034 | varies |
| Thyroid Imaging With Vascular Flow (78013) | $468.45 | $1,735 | 1.1× |
| Thyroid Met Imaging Body (78018) | $864.54 | $3,202 | 1.5× |
| Thyroid Uptake Measurement (78012) range across 6 matching MRF lines |
$242.12–$272.16 | $896.75–$1,008 | varies |
| Thyroid Uptake W/Blood Flow Sngle/Mult Quan Meas (78014) range across 3 matching MRF lines |
$725.23–$814.86 | $2,686.05–$3,018 | varies |
| Tx Devices Design & Construction Complex (77334) | $468.45 | $1,735 | 1.2× |
| Tx devices design & construction intermediate (77333) | $419.04 | $1,552 | 2.9× |
| Tx devices design & construction simple (77332) | $419.04 | $1,552 | 2.9× |
| Ultrasound Breast Limited (76642) | $22.41 | $83 | 0.2× |
| Ultrasound Exam Aaa Screen (76706) | $138.78 | $514 | 1.3× |
| Ultrasound, abdomen limited (76705) range across 11 matching MRF lines |
$20.79–$559.98 | $77–$2,074 | varies |
| Unlisted us procedure (76999) range across 2 matching MRF lines |
$168.41–$212.76 | $623.75–$788 | varies |
| Upper gi w/o kub (74240) range across 13 matching MRF lines |
$566.60–$715.23 | $2,098.50–$2,649 | varies |
| Ureteral Reflux Study (78740) | $709.29 | $2,627 | 1.7× |
| Urethrocystogram voiding (74455) range across 3 matching MRF lines |
$456.49–$513 | $1,690.70–$1,900 | varies |
| Urethrocystography retrograde (74450) | $444.15 | $1,645 | 1.8× |
| Us chest (76604) range across 2 matching MRF lines |
$19.44–$142.56 | $72–$528 | varies |
| Us complete joint (76881) range across 6 matching MRF lines |
$22.41–$479.52 | $83–$1,776 | varies |
| Us exam, pelvic, limited (76857) range across 7 matching MRF lines |
$59.67–$481.41 | $221–$1,783 | varies |
| Us head (76506) | $515.70 | $1,910 | 4.7× |
| Us kidney transplant (76776) range across 5 matching MRF lines |
$26.73–$944.73 | $99–$3,499 | varies |
| Us lmtd joint/oth nonvasc xtr strux r-t w/img (76882) range across 7 matching MRF lines |
$17.28–$354.24 | $64–$1,312 | varies |
| Us ob detailed single fetus (76811) range across 3 matching MRF lines |
$124.20–$571.32 | $460–$2,116 | varies |
| Us ob limited 1 or more fetuses (76815) range across 11 matching MRF lines |
$57.51–$98.01 | $213–$363 | varies |
| Us ob transvaginal (76817) range across 5 matching MRF lines |
$66.15–$349.11 | $245–$1,293 | varies |
| Us pelvic non ob complete (76856) range across 3 matching MRF lines |
$78.30–$493.29 | $290–$1,827 | varies |
| Us pg uter img f&mat 14 wk tabdl 1/1st gestation (76801) range across 6 matching MRF lines |
$84.24–$554.58 | $312–$2,054 | varies |
| Us preg uterus real time f/u trnsabdl per fetus (76816) range across 4 matching MRF lines |
$78.03–$89.37 | $289–$331 | varies |
| Us retroperitoneal complete (76770) | $415.26 | $1,538 | 3.8× |
| Us retroperitoneal limited (76775) range across 10 matching MRF lines |
$18.36–$391.77 | $68–$1,451 | varies |
| Us scrotum and contents (76870) | $487.35 | $1,805 | 4.4× |
| Us spinal canal and contents (76800) | $238.95 | $885 | 2.2× |
| Us thyroid (76536) range across 5 matching MRF lines |
$19.71–$460.08 | $73–$1,704 | varies |
| Us transrectal (76872) range across 4 matching MRF lines |
$23.76–$478.44 | $88–$1,772 | varies |
| Vein X-Ray Chest (75827) range across 4 matching MRF lines |
$38.88–$142.83 | $144–$529 | varies |
| Venogram Sinus/Jugular (75860) | $39.42 | $146 | 0.0× |
| Venography caval inferior serialography rs&i (75825) | $39.42 | $146 | 0.0× |
| Venography extremity bilateral rs&i (75822) range across 4 matching MRF lines |
$36.72–$194.40 | $136–$720 | varies |
| Venography extremity unilateral rs&i (75820) range across 9 matching MRF lines |
$24.57–$86.67 | $91–$321 | varies |
| Venography Renal Bilateral (75833) | $52.38 | $194 | 0.0× |
| Venography Renal Unilateral (75831) | $38.34 | $142 | 0.0× |
| Venous sampling by catheter (75893) likely a partial charge, not the full procedure |
$19.17 | $71 | 0.0× |
| Venous thrombosis imaging (78457) | $225.18 | $834 | 0.4× |
| Venous Thrombosis Imaging Venogram Bilateral (78458) | $606.15 | $2,245 | 1.4× |
| Vertebral fracture assessment via dxa (77086) | $78.30 | $290 | 0.9× |
| Wrist 2 views (73100) range across 6 matching MRF lines |
$20.25–$197.10 | $75–$730 | varies |
| X-Ray Ac Jts - Xr Acromioclavicular Joints Bilateral (73050) range across 7 matching MRF lines |
$7.56–$340.20 | $28–$1,260 | varies |
| X-ray antegrade pyelogram tube (74425) range across 7 matching MRF lines |
$614.52–$645.30 | $2,276–$2,390 | varies |
| X-Ray Aorta Leg Arteries (75630) range across 3 matching MRF lines |
$62.10–$171.99 | $230–$637 | varies |
| X-Ray Bend Only L-S Spine (72120) range across 4 matching MRF lines |
$8.37–$329.40 | $31–$1,220 | varies |
| X-Ray Elbow 2 Vw - Xr Elbow 1-2 Views Right (73070) range across 5 matching MRF lines |
$5.94–$193.59 | $22–$717 | varies |
| X-Ray Exam Entire Spi 1 Vw (72081) | $173.07 | $641 | 1.9× |
| X-Ray Exam Entire Spi 2/3 Vw (72082) range across 3 matching MRF lines |
$270.61–$341.55 | $1,002.25–$1,265 | varies |
| X-Ray Exam Entire Spi 4/5 Vw (72083) range across 3 matching MRF lines |
$309.02–$390.15 | $1,144.50–$1,445 | varies |
| X-Ray Exam Hip Uni 1 View (73501) range across 9 matching MRF lines |
$7.02–$111.51 | $26–$413 | varies |
| X-Ray Exam Hip Uni 2-3 Views (73502) range across 10 matching MRF lines |
$8.10–$252.99 | $30–$937 | varies |
| X-Ray Exam Hips Bi 2 Views (73521) range across 12 matching MRF lines |
$8.37–$264.33 | $31–$979 | varies |
| X-Ray Exam Hips Bi 3-4 Views (73522) range across 4 matching MRF lines |
$11.07–$22.14 | $41–$82 | varies |
| X-Ray Exam L-S Spine Bending (72114) range across 4 matching MRF lines |
$12.15–$348.30 | $45–$1,290 | varies |
| X-Ray Exam Neck Spine 2-3 Vw (72040) range across 8 matching MRF lines |
$8.10–$307.26 | $30–$1,138 | varies |
| X-Ray Exam Neck Spine 6/>Vws (72052) range across 5 matching MRF lines |
$13.23–$264.87 | $49–$981 | varies |
| X-Ray Exam Unilat Ribs/Chest (71101) range across 6 matching MRF lines |
$9.45–$335.88 | $35–$1,244 | varies |
| X-ray eye for foreign body (70030) range across 6 matching MRF lines |
$41.65–$55.35 | $154.25–$205 | varies |
| X-ray humerus (73060) range across 6 matching MRF lines |
$18.36–$194.67 | $68–$721 | varies |
| X-ray IV pyelogram (ivp) (74400) range across 3 matching MRF lines |
$119.88–$127.17 | $444–$471 | varies |
| X-Ray Jaw <4 Vw - Xr Mandible < 4 Views (70100) range across 4 matching MRF lines |
$6.48–$244.62 | $24–$906 | varies |
| X-Ray Knee Bilat Standing - Xr Knees Anteroposterior Standing Bilat (73565) range across 7 matching MRF lines |
$6.75–$97.20 | $25–$360 | varies |
| X-Ray Lumbar Spine 2/3 Vw - Xr Lumbar Spine 2-3 Views (72100) range across 6 matching MRF lines |
$8.10–$365.04 | $30–$1,352 | varies |
| X-ray nose-rectum child f.b. (76010) range across 4 matching MRF lines |
$6.48–$225.18 | $24–$834 | varies |
| X-Ray Ribs, Chest 4+ Vw - Xr Ribs 3 Vws Bil W/ Chest Posteroanterior (71111) range across 5 matching MRF lines |
$11.61–$220.05 | $43–$815 | varies |
| X-Ray Sacroiliac Jts 3+ Vw - Xr Sacroiliac Joints 3+ Views (72202) range across 5 matching MRF lines |
$6.75–$162.81 | $25–$603 | varies |
| X-Ray Sacrum/Coccyx 2+ Vw - Xr Sacrum Coccyx 2+ Views (72220) range across 6 matching MRF lines |
$6.21–$293.49 | $23–$1,087 | varies |
| X-Ray Sinuses 3+ Vw - Xr Paranasal Sinuses 3+ Views (70220) range across 7 matching MRF lines |
$8.91–$185.49 | $33–$687 | varies |
| X-Ray Skull 4+ Vw - Xr Skull Complete 4+ Views (70260) range across 8 matching MRF lines |
$12.42–$392.85 | $46–$1,455 | varies |
| X-Ray Stress View (77071) range across 2 matching MRF lines |
$468.99–$497.07 | $1,737–$1,841 | varies |
| X-Ray Tmj Unilat (70328) range across 6 matching MRF lines |
$133.04–$167.94 | $492.75–$622 | varies |
| X-Ray Urinary Tract Exam With Contrast Material (74420) range across 6 matching MRF lines |
$81.54–$595.89 | $47–$2,207 | varies |
| X-Rays Bone Length Studies (77073) range across 3 matching MRF lines |
$24.30–$343.71 | $90–$1,273 | varies |
| X-Rays Bone Survey Complete (77075) range across 2 matching MRF lines |
$361.26–$379.35 | $1,338–$1,405 | varies |
| Xr c-spine 4 or 5 views (72050) range across 6 matching MRF lines |
$11.34–$407.97 | $42–$1,511 | varies |
| Xr facial bones less than 3 views (70140) range across 5 matching MRF lines |
$7.56–$272.43 | $28–$1,009 | varies |
| Xr orbits complete 4 views (70200) range across 5 matching MRF lines |
$240.10–$318.33 | $889.25–$1,179 | 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.