Imaging prices at Tomah Memorial Hospital
Tomah, WI · every code in this section with a posted price and a Medicare benchmark.
228 codes. Prices are the hospital's own posted facility charges.
Compare against other hospitals interactively →
| Procedure | Posted cash | Posted gross | × Medicare |
|---|---|---|---|
| Abdomen 1 View (74018) range across 2 matching MRF lines |
$83.95–$144.04 | $146–$250.50 | varies |
| Abdomen 2 views (74019) range across 2 matching MRF lines |
$152.23–$259.18 | $264.75–$450.75 | varies |
| Acute Gastrointestinal Blood Loss Imaging (78278) range across 2 matching MRF lines |
$665.85–$947.74 | $1,158–$1,648.25 | varies |
| Ankle 2 views (73600) range across 2 matching MRF lines |
$83.95–$153.38 | $146–$266.75 | varies |
| Arthrogram hip (73525) range across 2 matching MRF lines |
$117.73–$233.74 | $204.75–$406.50 | varies |
| Arthrogram Wrist (73115) range across 2 matching MRF lines |
$101.49–$228.85 | $176.50–$398 | varies |
| Bone Imaging 3 Phase (78315) range across 2 matching MRF lines |
$475.09–$1,083.59 | $826.25–$1,884.50 | varies |
| Bone Imaging Limited Area (78300) range across 2 matching MRF lines |
$364.41–$884.21 | $633.75–$1,537.75 | varies |
| Bone Imaging Multiple Areas (78305) range across 2 matching MRF lines |
$385.97–$1,003.95 | $671.25–$1,746 | varies |
| Bone Imaging Whole Body (78306) range across 2 matching MRF lines |
$602.17–$1,003.95 | $1,047.25–$1,746 | varies |
| Bone survey infant (77076) range across 2 matching MRF lines |
$98.47–$237.33 | $171.25–$412.75 | varies |
| Cat Scan Follow-Up Study (76380) range across 2 matching MRF lines |
$284.05–$407.53 | $494–$708.75 | varies |
| Chest 1 view (71045) range across 2 matching MRF lines |
$65.41–$120.61 | $113.75–$209.75 | varies |
| Chest 2 views (71046) range across 2 matching MRF lines |
$113.42–$178.97 | $197.25–$311.25 | varies |
| Chest 3 views (71047) range across 2 matching MRF lines |
$128.23–$187.88 | $223–$326.75 | varies |
| Chest 4 or more views (71048) range across 2 matching MRF lines |
$149.79–$212.32 | $260.50–$369.25 | varies |
| Clavicle complete (73000) range across 2 matching MRF lines |
$98.18–$165.31 | $170.75–$287.50 | varies |
| Computed Tomography Thorax Lw Dose Lng Ca Scr C- (71271) range across 2 matching MRF lines |
$107.24–$276.43 | $186.50–$480.75 | varies |
| Contrast X-Ray Bladder (74430) range across 2 matching MRF lines |
$152.81–$237.04 | $265.75–$412.25 | varies |
| Contrast X-Ray Of Knee Joint (73580) range across 2 matching MRF lines |
$133.40–$228.85 | $232–$398 | varies |
| CT abdomen and pelvis without and with contrast (74178) range across 2 matching MRF lines |
$1,176.02–$3,640.33 | $2,045.25–$6,331 | varies |
| CT abdomen and pelvis without contrast (74176) range across 2 matching MRF lines |
$917.56–$2,509.01 | $1,595.75–$4,363.50 | varies |
| CT abdomen w contrast (74160) range across 2 matching MRF lines |
$607.34–$1,538.27 | $1,056.25–$2,675.25 | varies |
| CT abdomen w wo contrast (74170) range across 2 matching MRF lines |
$660.24–$1,603.10 | $1,148.25–$2,788 | varies |
| CT abdomen w/o contrast (74150) range across 2 matching MRF lines |
$443.90–$1,186.23 | $772–$2,063 | varies |
| CT Angio Abdomen and Pelvis (74174) range across 2 matching MRF lines |
$502.84–$2,003.88 | $874.50–$3,485 | varies |
| CT Angio Chest (71275) range across 2 matching MRF lines |
$881.33–$1,844.89 | $1,532.75–$3,208.50 | varies |
| CT Angio Head (70496) range across 2 matching MRF lines |
$704.38–$1,639.76 | $1,225–$2,851.75 | varies |
| Ct Angio Lwr Extr W/O&W/Dye (73706) range across 2 matching MRF lines |
$253.29–$1,584.13 | $440.50–$2,755 | varies |
| CT Angio Neck (70498) range across 2 matching MRF lines |
$695.75–$2,056.20 | $1,210–$3,576 | varies |
| Ct Angio Upr Extrm W/O&W/Dye (73206) range across 2 matching MRF lines |
$192.34–$1,459.06 | $334.50–$2,537.50 | varies |
| CT cervical spine w/ contrast (72126) range across 2 matching MRF lines |
$911.23–$1,547.33 | $1,584.75–$2,691 | varies |
| CT cervical spine w/o contrast (72125) range across 2 matching MRF lines |
$844.68–$1,122.98 | $1,469–$1,953 | varies |
| CT chest w contrast (71260) range across 2 matching MRF lines |
$546.25–$1,833.10 | $950–$3,188 | varies |
| CT chest w/wo contrast (71270) range across 2 matching MRF lines |
$811.90–$1,819.01 | $1,412–$3,163.50 | varies |
| CT head/brain with contrast (70460) range across 2 matching MRF lines |
$519.94–$1,343.34 | $904.25–$2,336.25 | varies |
| CT head/brain without and with contrast (70470) range across 2 matching MRF lines |
$918.85–$1,363.47 | $1,598–$2,371.25 | varies |
| CT iac w contrast (70481) range across 2 matching MRF lines |
$577.16–$1,343.34 | $1,003.75–$2,336.25 | varies |
| CT l-spine w&w/o contrast (72133) range across 2 matching MRF lines |
$239.78–$737.44 | $417–$1,282.50 | varies |
| CT lower ext w/o (73700) range across 2 matching MRF lines |
$631.49–$1,041.61 | $1,098.25–$1,811.50 | varies |
| CT lower extremity w/contrast material (73701) range across 2 matching MRF lines |
$721.77–$1,509.81 | $1,255.25–$2,625.75 | varies |
| CT lumbar spine w contrast (72132) range across 2 matching MRF lines |
$688.56–$1,411.77 | $1,197.50–$2,455.25 | varies |
| CT lumbar spine w/o contrast (72131) range across 2 matching MRF lines |
$844.68–$1,178.32 | $1,469–$2,049.25 | varies |
| CT maxillofacial w contrast (70487) range across 2 matching MRF lines |
$212.32–$1,541.86 | $369.25–$2,681.50 | varies |
| CT maxillofacial wo contrast (70486) range across 2 matching MRF lines |
$454.54–$1,076.26 | $790.50–$1,871.75 | varies |
| CT neck tissue combo (70492) range across 2 matching MRF lines |
$1,111.19–$1,530.79 | $1,932.50–$2,662.25 | varies |
| Ct Orbit/Ear/Fossa W/O&W/Dye (70482) range across 2 matching MRF lines |
$74.89–$1,411.77 | $130.25–$2,455.25 | varies |
| CT orbits w/o contrast (70480) range across 2 matching MRF lines |
$537.91–$962.69 | $935.50–$1,674.25 | varies |
| CT pelvis w&w/o contrast (72194) range across 2 matching MRF lines |
$392.73–$1,699.41 | $683–$2,955.50 | varies |
| CT pelvis w/o contrast (72192) range across 2 matching MRF lines |
$660.24–$1,107.74 | $1,148.25–$1,926.50 | varies |
| CT scans face/jaw combo (70488) range across 2 matching MRF lines |
$373.89–$881.04 | $650.25–$1,532.25 | varies |
| CT soft tissue neck w contrast (70491) range across 2 matching MRF lines |
$682.81–$1,575.50 | $1,187.50–$2,740 | varies |
| CT soft tissue neck w/o contrast (70490) range across 2 matching MRF lines |
$618.13–$985.26 | $1,075–$1,713.50 | varies |
| CT thoracic spine w contrast (72129) range across 2 matching MRF lines |
$185.29–$524.54 | $322.25–$912.25 | varies |
| CT thoracic spine w/o contrast (72128) range across 2 matching MRF lines |
$846.69–$1,122.98 | $1,472.50–$1,953 | varies |
| CT thoracic spine w/wo cont (72130) range across 2 matching MRF lines |
$264.07–$452.24 | $459.25–$786.50 | varies |
| CT thorax w/o contrast (71250) range across 2 matching MRF lines |
$538.78–$1,122.98 | $937–$1,953 | varies |
| CT upper ext wo (73200) range across 2 matching MRF lines |
$631.49–$1,062.60 | $1,098.25–$1,848 | varies |
| CT upper extremity w/o & w/contrast material (73202) range across 2 matching MRF lines |
$840.51–$1,601.38 | $1,461.75–$2,785 | varies |
| CT upper extremity with contrast (73201) range across 2 matching MRF lines |
$721.77–$1,370.66 | $1,255.25–$2,383.75 | varies |
| Cta Abdl Aorta&Bi Iliofem W/Contrast&Postp (75635) range across 2 matching MRF lines |
$443.90–$1,410.19 | $772–$2,452.50 | varies |
| Cta Abdomen (74175) range across 2 matching MRF lines |
$881.04–$1,678.43 | $1,532.25–$2,919 | varies |
| CTA head&neck c+ w/noncontrast img&post-pxessing (70471) range across 2 matching MRF lines |
$307.63–$661.25 | $535–$1,150 | varies |
| Esophagram (74220) range across 2 matching MRF lines |
$151.51–$323.87 | $263.50–$563.25 | varies |
| Fetal Biophysical Profile W/O Non-Stress Testing (76819) range across 2 matching MRF lines |
$164.31–$543.09 | $285.75–$944.50 | varies |
| Fluoroscopy up to 1 hr (76000) range across 2 matching MRF lines |
$245.81–$403.51 | $427.50–$701.75 | varies |
| Foot 2 views (73620) range across 2 matching MRF lines |
$83.95–$167.61 | $146–$291.50 | varies |
| Forearm 2 views (73090) range across 2 matching MRF lines |
$83.95–$165.31 | $146–$287.50 | varies |
| Gastric emptying imaging study (78264) range across 2 matching MRF lines |
$490.62–$618.99 | $853.25–$1,076.50 | varies |
| Hand 2 views (73120) range across 2 matching MRF lines |
$77.05–$131.24 | $134–$228.25 | varies |
| Hepatobil Syst Image W/Drug (78227) range across 2 matching MRF lines |
$560.34–$1,501.04 | $974.50–$2,610.50 | varies |
| Hepatobiliary System Imaging (78226) range across 2 matching MRF lines |
$103.64–$461.87 | $180.25–$803.25 | varies |
| Ht Muscle Image Spect Sing (78451) | $761.88 | $1,325 | 0.6× |
| Hysterosalpingogram (74740) range across 2 matching MRF lines |
$216.34–$363.83 | $376.25–$632.75 | varies |
| Infant hip ultrasound with hip movement (dynamic) (76885) range across 2 matching MRF lines |
$138.29–$375.91 | $240.50–$653.75 | varies |
| Joint Survey Single View (77077) range across 2 matching MRF lines |
$107.24–$152.81 | $186.50–$265.75 | varies |
| K Flow/Funct Image W/Drug (78708) range across 2 matching MRF lines |
$250.41–$481.13 | $435.50–$836.75 | varies |
| K Flow/Funct Image W/O Drug (78707) range across 2 matching MRF lines |
$208.01–$1,203.62 | $361.75–$2,093.25 | varies |
| Kidney Imaging Morphol (78700) range across 2 matching MRF lines |
$402.36–$794.65 | $699.75–$1,382 | varies |
| Knee 3 Views (73562) range across 2 matching MRF lines |
$98.18–$180.12 | $170.75–$313.25 | varies |
| Liver & Spleen Imaging Static Only (78215) range across 2 matching MRF lines |
$402.36–$912.24 | $699.75–$1,586.50 | varies |
| Liver & Spleen Imaging W/Vascular Flow (78216) range across 2 matching MRF lines |
$444.91–$912.24 | $773.75–$1,586.50 | varies |
| Lung Ventilat&Perfus Imaging (78582) range across 2 matching MRF lines |
$663.98–$999.21 | $1,154.75–$1,737.75 | varies |
| Magnetic Image Jaw Joint (70336) range across 2 matching MRF lines |
$804.28–$2,035.93 | $1,398.75–$3,540.75 | varies |
| Meckels Divert Exam (78290) range across 2 matching MRF lines |
$364.12–$810.75 | $633.25–$1,410 | varies |
| Mr safety implant&/fb assmt clin staf 1st 15 min (76014) | $106.38 | $185 | 3.8× |
| Mra Head W/O & W/Contrast Material (70546) range across 2 matching MRF lines |
$743.91–$1,899.08 | $1,293.75–$3,302.75 | varies |
| MRA head w/o contrast (70544) range across 2 matching MRF lines |
$794.36–$2,035.93 | $1,381.50–$3,540.75 | varies |
| MRA head with contrast (70545) range across 2 matching MRF lines |
$310.21–$1,398.11 | $539.50–$2,431.50 | varies |
| MRA neck w contrast (70548) range across 2 matching MRF lines |
$286.21–$1,894.63 | $497.75–$3,295 | varies |
| Mra Neck W/O &W/Contrast Material (70549) range across 2 matching MRF lines |
$379.07–$2,261.33 | $659.25–$3,932.75 | varies |
| MRI abdomen w/o contrast (74181) range across 2 matching MRF lines |
$843.09–$2,035.93 | $1,466.25–$3,540.75 | varies |
| MRI any jt lower extrem w/contrast material (73722) range across 2 matching MRF lines |
$946.31–$2,506.57 | $1,645.75–$4,359.25 | varies |
| MRI any jt lower extrem w/o & w/contrast matrl (73723) range across 2 matching MRF lines |
$1,143.24–$2,422.91 | $1,988.25–$4,213.75 | varies |
| MRI any jt upper extremity w/contrast matrl (73222) range across 2 matching MRF lines |
$946.31–$2,457.12 | $1,645.75–$4,273.25 | varies |
| MRI cervical spine w contrast (72142) range across 2 matching MRF lines |
$872.28–$2,443.75 | $1,517–$4,250 | varies |
| MRI cervical spine w/o cont (72141) range across 2 matching MRF lines |
$766.33–$2,076.76 | $1,332.75–$3,611.75 | varies |
| MRI chest w/o contrast (71550) range across 2 matching MRF lines |
$869.54–$2,035.93 | $1,512.25–$3,540.75 | varies |
| MRI chest wo w contrast (71552) range across 2 matching MRF lines |
$339.25–$1,925.10 | $590–$3,348 | varies |
| MRI lower extrem oth/thn jt w/contrast matrl (73719) range across 2 matching MRF lines |
$267.09–$1,168.54 | $464.50–$2,032.25 | varies |
| MRI lower extrem oth/thn jt w/o & w/contr matr (73720) range across 2 matching MRF lines |
$1,143.24–$2,971.46 | $1,988.25–$5,167.75 | varies |
| MRI lower extrem oth/thn jt w/o contr matrl (73718) range across 2 matching MRF lines |
$840.51–$2,971.46 | $1,461.75–$5,167.75 | varies |
| MRI lumbar spine w contrast (72149) range across 2 matching MRF lines |
$872.28–$2,076.76 | $1,517–$3,611.75 | varies |
| Mri Neck Spine W/O & W/Dye (72156) range across 2 matching MRF lines |
$1,068.93–$3,233.80 | $1,859–$5,624 | varies |
| MRI orbit face &/neck w/o contrast (70540) range across 2 matching MRF lines |
$752.10–$1,973.54 | $1,308–$3,432.25 | varies |
| Mri Orbt/Fac/Nck W/O &W/Dye (70543) range across 2 matching MRF lines |
$946.88–$2,744.19 | $1,646.75–$4,772.50 | varies |
| MRI pelvis w contrast (72196) range across 2 matching MRF lines |
$620.71–$2,312.36 | $1,079.50–$4,021.50 | varies |
| MRI pelvis w/o & w contrast (72197) range across 2 matching MRF lines |
$1,387.33–$3,075.68 | $2,412.75–$5,349 | varies |
| MRI pelvis w/o contrast (72195) range across 2 matching MRF lines |
$766.33–$2,036.08 | $1,332.75–$3,541 | varies |
| MRI thoracic spine w/o contrast (72146) range across 2 matching MRF lines |
$766.33–$1,990.51 | $1,332.75–$3,461.75 | varies |
| MRI upper extremity oth than jt w/o contr matrl (73218) range across 2 matching MRF lines |
$840.51–$2,422.91 | $1,461.75–$4,213.75 | varies |
| Mri Uppr Extremity W/O&W/Dye (73220) range across 2 matching MRF lines |
$1,143.24–$2,746.34 | $1,988.25–$4,776.25 | varies |
| MRI, abdomen, combo (74183) range across 2 matching MRF lines |
$809.89–$2,882.91 | $1,408.50–$5,013.75 | varies |
| MRI, dorsal spine combo (72157) range across 2 matching MRF lines |
$1,068.93–$3,233.80 | $1,859–$5,624 | varies |
| MRI, dorsal spine contrast (72147) range across 2 matching MRF lines |
$872.28–$2,341.98 | $1,517–$4,073 | varies |
| MRI, joint upper extrem (73221) range across 2 matching MRF lines |
$840.51–$2,443.75 | $1,461.75–$4,250 | varies |
| MRI, joint upper extrem combo (73223) range across 2 matching MRF lines |
$768.49–$2,678.21 | $1,336.50–$4,657.75 | varies |
| MRI, lumbar spine combo (72158) range across 2 matching MRF lines |
$1,068.93–$3,233.80 | $1,859–$5,624 | varies |
| Myocardial Spect Multiple Studies (78452) range across 2 matching MRF lines |
$962.69–$2,233.30 | $1,674.25–$3,884 | varies |
| Neck soft tissue (70360) range across 2 matching MRF lines |
$60.38–$142.60 | $105–$248 | varies |
| Ophthalmic ultrasound dx b-scan w/wo a-scan (76512) range across 2 matching MRF lines |
$95.31–$170.78 | $165.75–$297 | varies |
| Parathyroid Planar Imaging (78070) range across 2 matching MRF lines |
$569.68–$893.12 | $990.75–$1,553.25 | varies |
| Parathyroid planar imaging w/wo subtraction (78071) range across 2 matching MRF lines |
$569.68–$887.66 | $990.75–$1,543.75 | varies |
| Pelvis 1 or 2 views (72170) range across 2 matching MRF lines |
$98.18–$142.89 | $170.75–$248.50 | varies |
| Pulmonary Perfusion Imaging Particulate (78580) range across 2 matching MRF lines |
$447.35–$898.44 | $778–$1,562.50 | varies |
| Radex Abd Compl Aqt Abd W/S/E/D Views 1 View Ch (74022) range across 2 matching MRF lines |
$152.81–$357.08 | $265.75–$621 | varies |
| Radex abscess/fistula/sinus tract rs&i (76080) range across 2 matching MRF lines |
$164.31–$328.33 | $285.75–$571 | varies |
| Radex Ankle Complete Minimum 3 Views (73610) range across 2 matching MRF lines |
$98.18–$167.61 | $170.75–$291.50 | varies |
| Radex Calcaneus Minimum 2 Views (73650) range across 2 matching MRF lines |
$92.72–$159.71 | $161.25–$277.75 | varies |
| Radex elbow complete minimum 3 views (73080) range across 2 matching MRF lines |
$98.18–$204.27 | $170.75–$355.25 | varies |
| Radex Facial Bones Complete Minimum 3 Views (70150) range across 2 matching MRF lines |
$150.51–$200.82 | $261.75–$349.25 | varies |
| Radex fingr minimum 2 views (73140) range across 2 matching MRF lines |
$76.76–$147.06 | $133.50–$255.75 | varies |
| Radex foot complete minimum 3 views (73630) range across 2 matching MRF lines |
$98.18–$167.61 | $170.75–$291.50 | varies |
| Radex Hand Minimum 3 Views (73130) range across 2 matching MRF lines |
$98.18–$186.01 | $170.75–$323.50 | varies |
| Radex lower extremity infant minimum 2 views (73592) range across 2 matching MRF lines |
$90.99–$175.52 | $158.25–$305.25 | varies |
| Radex Nasal Bones Complete Minimum 3 Views (70160) range across 2 matching MRF lines |
$90.99–$165.31 | $158.25–$287.50 | varies |
| Radex Ribs Unilateral 2 Views (71100) range across 2 matching MRF lines |
$90.99–$164.31 | $158.25–$285.75 | varies |
| Radex shoulder complete minimum 2 views (73030) range across 2 matching MRF lines |
$98.18–$205.42 | $170.75–$357.25 | varies |
| Radex Sinuses Paransl < 3 Views (70210) range across 2 matching MRF lines |
$86.97–$125.93 | $151.25–$219 | varies |
| Radex Spine 1 View Specify Level (72020) range across 2 matching MRF lines |
$60.38–$182.42 | $105–$317.25 | varies |
| Radex Sternum Minimum 2 Views (71120) range across 2 matching MRF lines |
$92.72–$181.13 | $161.25–$315 | varies |
| Radex Temporomandble Jt Opn & Clsd Mouth Bilat (70330) range across 2 matching MRF lines |
$121.61–$188.60 | $211.50–$328 | varies |
| Radex Toe Minimum 2 Views (73660) range across 2 matching MRF lines |
$77.05–$147.06 | $134–$255.75 | varies |
| Radex upper extremity infant minimum 2 views (73092) range across 2 matching MRF lines |
$90.99–$165.31 | $158.25–$287.50 | varies |
| Radex Wrist Complete Minimum 3 Views (73110) range across 2 matching MRF lines |
$101.20–$186.44 | $176–$324.25 | varies |
| Radiolog exam mandible compl minimum 4 views (70110) range across 2 matching MRF lines |
$151.66–$218.21 | $263.75–$379.50 | varies |
| Radiologic Exam Abdomen 3+ Views - Xr Abdomen 3+ Views (74021) range across 2 matching MRF lines |
$153.38–$281.61 | $266.75–$489.75 | varies |
| Radiologic exam colon double contrast study (74280) range across 2 matching MRF lines |
$241.64–$545.96 | $420.25–$949.50 | varies |
| Radiologic exam colon single contrast study (74270) range across 2 matching MRF lines |
$181.13–$553.29 | $315–$962.25 | varies |
| Radiologic exam knee complete 4/more views (73564) range across 2 matching MRF lines |
$152.81–$204.27 | $265.75–$355.25 | varies |
| Radiologic exam pelvis compl minimum 3 views (72190) range across 2 matching MRF lines |
$58.65–$248.83 | $102–$432.75 | varies |
| Radiologic Exam Small Int Single Contrast Study (74250) range across 2 matching MRF lines |
$181.13–$314.09 | $315–$546.25 | varies |
| Radiologic exam swallow function contrast study (74230) range across 2 matching MRF lines |
$279.59–$323.87 | $486.25–$563.25 | varies |
| Radiologic exam upr gi trc double contrast study (74246) range across 2 matching MRF lines |
$245.24–$462.73 | $426.50–$804.75 | varies |
| Radiologic examination femur 1 view (73551) range across 2 matching MRF lines |
$40.68–$110.11 | $70.75–$191.50 | varies |
| Radiologic examination femur minimum 2 views (73552) range across 2 matching MRF lines |
$98.47–$162.73 | $171.25–$283 | varies |
| Radiologic examination knee 1/2 views (73560) range across 2 matching MRF lines |
$83.95–$156.26 | $146–$271.75 | varies |
| Radiologic examination tibia & fibula 2 views (73590) range across 2 matching MRF lines |
$83.95–$165.31 | $146–$287.50 | varies |
| Ribs bilateral 3 views (71110) range across 2 matching MRF lines |
$131.24–$269.82 | $228.25–$469.25 | varies |
| Rp Loclzj Tum Spect 1 Area Single Day Imaging (78803) range across 2 matching MRF lines |
$237.33–$900.74 | $412.75–$1,566.50 | varies |
| Rp loclzj tum spect w/CT 1 area/acquisj 1day img (78830) | $289.23 | $503 | 0.2× |
| Scapula (73010) range across 2 matching MRF lines |
$105.08–$142.89 | $182.75–$248.50 | varies |
| Shoulder 1 view (73020) range across 2 matching MRF lines |
$90.99–$148.64 | $158.25–$258.50 | varies |
| Shoulder Arthrography (73040) range across 2 matching MRF lines |
$279.59–$447.64 | $486.25–$778.50 | varies |
| Skull less than 4 views (70250) range across 2 matching MRF lines |
$105.08–$182.42 | $182.75–$317.25 | varies |
| Sternoclavicular joints (71130) range across 2 matching MRF lines |
$58.65–$214.91 | $102–$373.75 | varies |
| Thoracic spine 2 views (72070) range across 2 matching MRF lines |
$90.99–$179.83 | $158.25–$312.75 | varies |
| Thoracic spine 3 views (72072) range across 2 matching MRF lines |
$119.17–$213.61 | $207.25–$371.50 | varies |
| Thoracolumbar 2 views (72080) range across 2 matching MRF lines |
$90.99–$174.66 | $158.25–$303.75 | varies |
| Thyroid Imaging With Vascular Flow (78013) range across 2 matching MRF lines |
$279.02–$1,057.43 | $485.25–$1,839 | varies |
| Ultrasound Breast Limited (76642) range across 2 matching MRF lines |
$110.11–$258.61 | $191.50–$449.75 | varies |
| Ultrasound Elastography Parenchyma (76981) range across 2 matching MRF lines |
$112.27–$267.09 | $195.25–$464.50 | varies |
| Ultrasound Exam Aaa Screen (76706) range across 2 matching MRF lines |
$135.27–$295.69 | $235.25–$514.25 | varies |
| Ultrasound, abdomen limited (76705) range across 2 matching MRF lines |
$124.49–$185.01 | $216.50–$321.75 | varies |
| Umbilical-artery Doppler (OB) (76820) range across 2 matching MRF lines |
$221.66–$238.48 | $385.50–$414.75 | varies |
| Upper gi w/o kub (74240) range across 2 matching MRF lines |
$226.69–$415.58 | $394.25–$722.75 | varies |
| Urethrocystogram voiding (74455) range across 2 matching MRF lines |
$46.43–$328.61 | $80.75–$571.50 | varies |
| Us breast unilateral complete (76641) range across 2 matching MRF lines |
$153.09–$475.38 | $266.25–$826.75 | varies |
| Us chest (76604) range across 2 matching MRF lines |
$130.96–$372.03 | $227.75–$647 | varies |
| Us complete joint (76881) range across 2 matching MRF lines |
$164.02–$429.53 | $285.25–$747 | varies |
| Us exam, pelvic, limited (76857) range across 2 matching MRF lines |
$76.76–$173.65 | $133.50–$302 | varies |
| Us head (76506) range across 2 matching MRF lines |
$338.24–$343.42 | $588.25–$597.25 | varies |
| Us kidney transplant (76776) range across 2 matching MRF lines |
$139.73–$309.06 | $243–$537.50 | varies |
| Us lmtd joint/oth nonvasc xtr strux r-t w/img (76882) range across 2 matching MRF lines |
$48.73–$148.64 | $84.75–$258.50 | varies |
| Us ob detailed single fetus (76811) range across 2 matching MRF lines |
$323.58–$329.91 | $562.75–$573.75 | varies |
| Us ob limited 1 or more fetuses (76815) range across 2 matching MRF lines |
$176.09–$297.13 | $306.25–$516.75 | varies |
| Us ob transvaginal (76817) range across 2 matching MRF lines |
$268.24–$382.81 | $466.50–$665.75 | varies |
| Us pelvic non ob complete (76856) range across 2 matching MRF lines |
$227.99–$532.59 | $396.50–$926.25 | varies |
| Us pg uter img f&mat 14 wk tabdl 1/1st gestation (76801) range across 2 matching MRF lines |
$268.24–$638.11 | $466.50–$1,109.75 | varies |
| Us preg uterus real time f/u trnsabdl per fetus (76816) range across 2 matching MRF lines |
$114.86–$303.03 | $199.75–$527 | varies |
| Us retroperitoneal complete (76770) range across 2 matching MRF lines |
$418.03–$654.78 | $727–$1,138.75 | varies |
| Us retroperitoneal limited (76775) range across 2 matching MRF lines |
$98.47–$317.69 | $171.25–$552.50 | varies |
| Us scrotum and contents (76870) range across 2 matching MRF lines |
$239.92–$506.58 | $417.25–$881 | varies |
| Us spinal canal and contents (76800) range across 2 matching MRF lines |
$211.03–$637.82 | $367–$1,109.25 | varies |
| Us thyroid (76536) range across 2 matching MRF lines |
$193.92–$555.02 | $337.25–$965.25 | varies |
| Us transrectal (76872) range across 2 matching MRF lines |
$227.99–$453.10 | $396.50–$788 | varies |
| Wrist 2 views (73100) range across 2 matching MRF lines |
$77.05–$186.01 | $134–$323.50 | varies |
| X-Ray Ac Jts - Xr Acromioclavicular Joints Bilateral (73050) range across 2 matching MRF lines |
$105.08–$188.89 | $182.75–$328.50 | varies |
| X-Ray Bend Only L-S Spine (72120) range across 2 matching MRF lines |
$117.01–$152.52 | $203.50–$265.25 | varies |
| X-Ray Elbow 2 Vw - Xr Elbow 1-2 Views Right (73070) range across 2 matching MRF lines |
$83.95–$165.31 | $146–$287.50 | varies |
| X-Ray Exam Entire Spi 1 Vw (72081) range across 2 matching MRF lines |
$113.85–$172.36 | $198–$299.75 | varies |
| X-Ray Exam Entire Spi 2/3 Vw (72082) range across 2 matching MRF lines |
$139.73–$208.01 | $243–$361.75 | varies |
| X-Ray Exam Hip Uni 1 View (73501) range across 2 matching MRF lines |
$77.05–$755.98 | $134–$1,314.75 | varies |
| X-Ray Exam Hip Uni 2-3 Views (73502) range across 2 matching MRF lines |
$98.18–$216.63 | $170.75–$376.75 | varies |
| X-Ray Exam Hips Bi 2 Views (73521) range across 2 matching MRF lines |
$169.05–$191.19 | $294–$332.50 | varies |
| X-Ray Exam Hips Bi 3-4 Views (73522) range across 2 matching MRF lines |
$192.34–$332.64 | $334.50–$578.50 | varies |
| X-Ray Exam L-S Spine Bending (72114) range across 2 matching MRF lines |
$187.59–$269.82 | $326.25–$469.25 | varies |
| X-Ray Exam Neck Spine 2-3 Vw (72040) range across 2 matching MRF lines |
$119.17–$241.93 | $207.25–$420.75 | varies |
| X-Ray Exam Neck Spine 6/>Vws (72052) range across 2 matching MRF lines |
$275.86–$511.89 | $479.75–$890.25 | varies |
| X-Ray Exam Unilat Ribs/Chest (71101) range across 2 matching MRF lines |
$152.52–$254.44 | $265.25–$442.50 | varies |
| X-ray eye for foreign body (70030) range across 2 matching MRF lines |
$121.61–$152.23 | $211.50–$264.75 | varies |
| X-ray humerus (73060) range across 2 matching MRF lines |
$83.95–$173.65 | $146–$302 | varies |
| X-ray IV pyelogram (ivp) (74400) range across 2 matching MRF lines |
$186.44–$354.06 | $324.25–$615.75 | varies |
| X-Ray Jaw <4 Vw - Xr Mandible < 4 Views (70100) range across 2 matching MRF lines |
$88.84–$168.04 | $154.50–$292.25 | varies |
| X-Ray Knee Bilat Standing - Xr Knees Anteroposterior Standing Bilat (73565) range across 2 matching MRF lines |
$62.39–$135.84 | $108.50–$236.25 | varies |
| X-Ray Lumbar Spine 2/3 Vw - Xr Lumbar Spine 2-3 Views (72100) range across 2 matching MRF lines |
$119.17–$222.67 | $207.25–$387.25 | varies |
| X-ray nose-rectum child f.b. (76010) range across 2 matching MRF lines |
$58.36–$127.79 | $101.50–$222.25 | varies |
| X-Ray Ribs, Chest 4+ Vw - Xr Ribs 3 Vws Bil W/ Chest Posteroanterior (71111) range across 2 matching MRF lines |
$176.53–$233.16 | $307–$405.50 | varies |
| X-Ray Sacroiliac Jts 3+ Vw - Xr Sacroiliac Joints 3+ Views (72202) range across 2 matching MRF lines |
$105.08–$174.66 | $182.75–$303.75 | varies |
| X-Ray Sacrum/Coccyx 2+ Vw - Xr Sacrum Coccyx 2+ Views (72220) range across 2 matching MRF lines |
$105.08–$174.66 | $182.75–$303.75 | varies |
| X-Ray Sinuses 3+ Vw - Xr Paranasal Sinuses 3+ Views (70220) range across 2 matching MRF lines |
$151.66–$187.02 | $263.75–$325.25 | varies |
| X-Ray Skull 4+ Vw - Xr Skull Complete 4+ Views (70260) range across 2 matching MRF lines |
$136.13–$251.85 | $236.75–$438 | varies |
| X-Ray Stress View (77071) | $84.24 | $146.50 | 1.0× |
| X-Rays Bone Length Studies (77073) range across 2 matching MRF lines |
$72.31–$97.46 | $125.75–$169.50 | varies |
| X-Rays Bone Survey Complete (77075) range across 2 matching MRF lines |
$160.43–$323.01 | $279–$561.75 | varies |
| Xr c-spine 4 or 5 views (72050) range across 2 matching MRF lines |
$275.86–$300.01 | $479.75–$521.75 | varies |
| Xr facial bones less than 3 views (70140) range across 2 matching MRF lines |
$110.11–$166.46 | $191.50–$289.50 | varies |
| Xr orbits complete 4 views (70200) range across 2 matching MRF lines |
$117.01–$188.60 | $203.50–$328 | 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.