Imaging prices at University of Michigan Health - Sparrow Clinton
Saint Johns, MI · every code in this section with a posted price and a Medicare benchmark.
356 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) | $214 | $428 | 0.2× |
| Abdomen 1 View (74018) | $61 | $244 | 0.7× |
| Abdomen 2 views (74019) | $61 | $244 | 0.6× |
| Acute Gastrointestinal Blood Loss Imaging (78278) | $511.75 | $2,047 | 1.3× |
| Angio internal mammary (75756) range across 3 matching MRF lines |
$54.50–$162 | $109–$324 | varies |
| Angio pulmonary bilat (75743) range across 3 matching MRF lines |
$71–$147.50 | $142–$295 | varies |
| Angiography extremity bilateral rs&i (75716) range across 3 matching MRF lines |
$71–$162 | $142–$324 | varies |
| Angiography extremity unilateral rs&i (75710) range across 3 matching MRF lines |
$67–$148 | $134–$296 | varies |
| Angiography pulmonary unilateral slctv rs&i (75741) | $59 | $118 | 0.0× |
| Ankle 2 views (73600) | $61 | $244 | 0.7× |
| Aortography thoracic serialography rs&i (75605) range across 3 matching MRF lines |
$52.50–$120 | $105–$240 | varies |
| Aortography thoracic w/o serialography rs&i (75600) range across 3 matching MRF lines |
$23–$173 | $46–$346 | varies |
| Artery X-Rays Abdomen (75726) range across 3 matching MRF lines |
$77–$170.50 | $154–$341 | varies |
| Artery X-Rays Pelvis (75736) range across 3 matching MRF lines |
$51–$144 | $102–$288 | varies |
| Artery X-Rays Spine (75705) range across 3 matching MRF lines |
$117–$256.50 | $234–$513 | varies |
| Arthrogram ankle (73615) | $56.75 | $227 | 0.2× |
| Arthrogram hip (73525) | $74.50 | $298 | 0.2× |
| Arthrogram Wrist (73115) | $56.75 | $227 | 0.2× |
| Basic radiation dosimetry calculation (77300) | $259.25 | $1,037 | 1.9× |
| Bone age studies (77072) | $46.50 | $186 | 0.4× |
| Bone Imaging 3 Phase (78315) | $447.75 | $1,791 | 1.1× |
| Bone Imaging Multiple Areas (78305) | $281 | $1,124 | 0.7× |
| Bone Imaging Whole Body (78306) | $447.75 | $1,791 | 1.1× |
| Bone survey infant (77076) | $50 | $200 | 0.5× |
| Brachytx isodose intermed (77317) | $97 | $194 | 0.3× |
| Brachytx Isodose Plan Simple (77316) | $74 | $148 | 0.2× |
| Brain Image W/Flow < 4 Views (78601) | $23.50 | $47 | 0.1× |
| Brain Imaging Pet Metabolic Evaluation (78608) | $743 | $2,972 | 0.5× |
| Cardiac MRI w/w/o contrast & further seq (75561) range across 3 matching MRF lines |
$121–$365 | $242–$730 | varies |
| Cardiac MRI w/w/o contrast w/stress (75563) range across 3 matching MRF lines |
$138.50–$425 | $277–$850 | varies |
| Cat Scan Follow-Up Study (76380) | $190.75 | $763 | 2.2× |
| Cerebrospinal Fluid Flow W/O Matl Shunt Evaltj (78645) | $26 | $52 | 0.0× |
| Chest 1 view (71045) | $47 | $188 | 0.5× |
| Chest 2 views (71046) range across 2 matching MRF lines |
$16.75–$47 | $67–$188 | varies |
| Chest 3 views (71047) | $49.75 | $199 | 0.6× |
| Chest 4 or more views (71048) | $78.50 | $314 | 0.8× |
| Clavicle complete (73000) | $61 | $244 | 0.7× |
| Computed Tomography Thorax Lw Dose Lng Ca Scr C- (71271) | $55 | $220 | 0.5× |
| Continuing medical physics consltj pr wk (77336) | $91 | $182 | 0.7× |
| Contrast Exam Abdominl Aorta (75625) range across 3 matching MRF lines |
$58.50–$125 | $117–$250 | varies |
| Contrast X-Ray Bladder (74430) | $149.50 | $598 | 0.4× |
| Contrast X-Ray Of Elbow (73085) | $56.75 | $227 | 0.2× |
| Contrast X-Ray Of Knee Joint (73580) | $74.50 | $298 | 0.2× |
| CT abdomen and pelvis without and with contrast (74178) | $739 | $2,956 | 2.1× |
| CT abdomen and pelvis without contrast (74176) | $985.25 | $3,941 | 4.1× |
| CT abdomen w contrast (74160) | $739 | $2,956 | 4.2× |
| CT abdomen w wo contrast (74170) | $739 | $2,956 | 4.2× |
| CT abdomen w/o contrast (74150) | $487 | $1,948 | 4.7× |
| CT Angio Abdomen and Pelvis (74174) | $1,234.75 | $4,939 | 3.6× |
| CT Angio Chest (71275) | $739 | $2,956 | 4.2× |
| CT Angio Head (70496) | $739 | $2,956 | 4.2× |
| CT angio hrt w/3d image (75574) | $789.50 | $3,158 | 2.3× |
| Ct Angio Lwr Extr W/O&W/Dye (73706) | $781 | $3,124 | 4.5× |
| CT Angio Neck (70498) | $739 | $2,956 | 4.2× |
| Ct Angio Upr Extrm W/O&W/Dye (73206) | $769 | $3,076 | 4.4× |
| CT cervical spine w/ contrast (72126) | $502.75 | $2,011 | 1.4× |
| CT cervical spine w/o contrast (72125) range across 2 matching MRF lines |
$66–$487 | $264–$1,948 | varies |
| CT cervical spine w/wo cont (72127) | $538.25 | $2,153 | 3.1× |
| CT chest w contrast (71260) | $739 | $2,956 | 4.2× |
| CT chest w/wo contrast (71270) | $553.50 | $2,214 | 3.2× |
| CT head/brain with contrast (70460) | $461.75 | $1,847 | 2.6× |
| CT head/brain without and with contrast (70470) | $739 | $2,956 | 4.2× |
| CT heart contrast eval cardiac structure&morph (75572) range across 3 matching MRF lines |
$81–$231 | $162–$462 | varies |
| CT heart no contrast quant eval coronry calcium (75571) | $39.50 | $158 | 0.5× |
| CT iac w contrast (70481) | $739 | $2,956 | 4.2× |
| CT l-spine w&w/o contrast (72133) | $464.50 | $1,858 | 2.7× |
| CT lower ext w/o (73700) | $487 | $1,948 | 4.7× |
| CT lower extremity w/contrast material (73701) | $449.25 | $1,797 | 2.6× |
| CT lumbar spine w contrast (72132) | $739 | $2,956 | 2.1× |
| CT lumbar spine w/o contrast (72131) | $487 | $1,948 | 4.7× |
| CT maxillofacial w contrast (70487) | $739 | $2,956 | 4.2× |
| CT maxillofacial wo contrast (70486) | $487 | $1,948 | 4.7× |
| CT neck tissue combo (70492) | $463.50 | $1,854 | 2.7× |
| Ct Orbit/Ear/Fossa W/O&W/Dye (70482) | $662 | $2,648 | 3.8× |
| CT orbits w/o contrast (70480) | $487 | $1,948 | 4.7× |
| CT pelvis w&w/o contrast (72194) | $553.50 | $2,214 | 3.2× |
| CT pelvis w/o contrast (72192) | $487 | $1,948 | 4.7× |
| CT scan of leg combo (73702) | $558.25 | $2,233 | 3.2× |
| CT scans face/jaw combo (70488) | $421.50 | $1,686 | 2.4× |
| CT soft tissue neck w contrast (70491) | $739 | $2,956 | 4.2× |
| CT soft tissue neck w/o contrast (70490) | $487 | $1,948 | 4.7× |
| CT thoracic spine w contrast (72129) | $441 | $1,764 | 2.5× |
| CT thoracic spine w/o contrast (72128) | $487 | $1,948 | 4.7× |
| CT thoracic spine w/wo cont (72130) | $464.50 | $1,858 | 2.7× |
| CT thorax w/o contrast (71250) | $487 | $1,948 | 4.7× |
| CT unlisted procedure (76497) | $45 | $180 | 0.5× |
| CT upper ext wo (73200) | $487 | $1,948 | 4.7× |
| CT upper extremity w/o & w/contrast material (73202) | $390 | $1,560 | 2.2× |
| CT upper extremity with contrast (73201) | $460.25 | $1,841 | 1.3× |
| Cta Abdl Aorta&Bi Iliofem W/Contrast&Postp (75635) | $739 | $2,956 | 4.2× |
| Cta Abdomen (74175) | $739 | $2,956 | 4.2× |
| CTA pelvis (72191) | $1,088 | $4,352 | 6.2× |
| Dilation ureters/urethra rs&i (74485) | $38.50 | $77 | 0.0× |
| Doppler Echo Fetal Puls Spectral F/U/Repeat (76828) range across 3 matching MRF lines |
$22–$48 | $44–$96 | varies |
| Doppler Echo Fetal Spectral Display Complete (76827) | $54 | $216 | 0.5× |
| Doppler Fetal Mid Cerebral Artery (76821) | $58.25 | $233 | 0.6× |
| Dxa Bone Density Axial (77080) | $64 | $256 | 0.6× |
| Dxa bone density study (77085) | $60.75 | $243 | 0.6× |
| Dxa bone density study 1/>sites appendiclr skel (77081) | $27.50 | $110 | 0.3× |
| Echo exam of fetal heart (76825) range across 3 matching MRF lines |
$77.50–$255.50 | $155–$511 | varies |
| Echo exam uterus (76831) | $105.25 | $421 | 0.4× |
| Echo Guide For Artery Repair (76936) | $54 | $216 | 0.3× |
| Echocardiography, fetal, cardiovascular system, real time with image documentation (2D), with or without M-mode… (76826) range across 3 matching MRF lines |
$38.50–$153.50 | $77–$307 | varies |
| Esophagram (74220) | $134.75 | $539 | 0.8× |
| Fetal Biophys Profile W/Nst (76818) range across 2 matching MRF lines |
$59.25–$71.25 | $237–$285 | varies |
| Fetal Biophysical Profile W/O Non-Stress Testing (76819) | $88.75 | $355 | 0.9× |
| Fluoroscopy up to 1 hr (76000) | $130.25 | $521 | 0.5× |
| Follow-Up Angiography (75898) range across 2 matching MRF lines |
$1,898 | $180–$3,796 | 0.6× |
| Foot 2 views (73620) | $61 | $244 | 0.7× |
| Forearm 2 views (73090) | $61 | $244 | 0.7× |
| Gastric emptying imaging study (78264) | $809 | $3,236 | 2.0× |
| Gated Heart Planar Single (78472) | $382.75 | $1,531 | 1.0× |
| Gated Heart, Multiple (78473) | $779.75 | $3,119 | 2.0× |
| Hand 2 views (73120) | $46.50 | $186 | 0.4× |
| Hdr Rdncl Ntrstl/Icav Brchtx (77771) | $201.50 | $403 | 0.3× |
| Hdr Rdncl Ntrstl/Icav Brchtx 1 Channel (77770) | $103 | $206 | 0.1× |
| Hepatc Vngrph Wdg/Fr Hemodyn Eval Rs&I (75889) | $51 | $102 | 0.0× |
| Hepatc Vngrph Wdg/Fr W/O Hemodyn Eval Rs&I (75891) | $51.50 | $103 | 0.0× |
| Hepatobil Syst Image W/Drug (78227) | $364 | $1,456 | 0.7× |
| Hepatobiliary System Imaging (78226) | $393.75 | $1,575 | 1.0× |
| Ht Muscle Image Spect Sing (78451) | $687.50 | $2,750 | 0.5× |
| Hysterosalpingogram (74740) | $98.25 | $393 | 0.4× |
| Infant hip ultrasound with hip movement (dynamic) (76885) | $154.50 | $618 | 1.8× |
| Infant hip ultrasound, limited static exam (76886) | $137.25 | $549 | 1.6× |
| Interstitial radiation source applic complex (77778) range across 3 matching MRF lines |
$464.50–$934 | $929–$1,868 | varies |
| Intracavitary Radiation Source Applic Intermed (77762) range across 3 matching MRF lines |
$256–$561 | $512–$1,122 | varies |
| Joint Survey Single View (77077) | $48 | $192 | 0.5× |
| K Flow/Funct Image W/Drug (78708) | $216 | $864 | 0.4× |
| K Flow/Funct Image W/O Drug (78707) | $363.50 | $1,454 | 0.7× |
| Knee 3 Views (73562) | $61 | $244 | 0.7× |
| Liver imaging static only (78201) range across 3 matching MRF lines |
$20–$175 | $40–$350 | varies |
| Lung Ventilat&Perfus Imaging (78582) | $184 | $736 | 0.3× |
| Lymph System Imaging (78195) | $352.25 | $1,409 | 0.7× |
| Lymphangiography Pelvic/Abdominal Bilateral Rs&I (75807) | $51.50 | $103 | 0.0× |
| Lymphangiography, pelvic/abdominal, unilateral (75805) | $38.50 | $77 | 0.0× |
| Magnetic Image Jaw Joint (70336) | $571 | $2,284 | 2.4× |
| Mammary ductogram or galactogram single (77053) | $17 | $34 | 0.1× |
| Meckels Divert Exam (78290) | $31.50 | $63 | 0.1× |
| Mlc imrt design & construction per imrt plan (77338) | $260 | $1,040 | 0.7× |
| Mr safety determination physician/other qhp (76016) | $43.25 | $173 | 0.5× |
| Mr safety implt electronics prepj supvj phys/qhp (76018) | $45 | $180 | 0.5× |
| Mr safety implt pos&/immoblj (76019) | $29.25 | $117 | 0.5× |
| Mr safety med physics xm customization plng&mntr (76017) | $118.50 | $474 | 0.5× |
| Mra Head W/O & W/Contrast Material (70546) | $949.50 | $3,798 | 2.7× |
| MRA head w/o contrast (70544) | $606 | $2,424 | 2.5× |
| MRA head with contrast (70545) | $640 | $2,560 | 1.8× |
| MRA neck w contrast (70548) | $546.50 | $2,186 | 1.6× |
| Mra Neck W/O &W/Contrast Material (70549) | $959 | $3,836 | 2.8× |
| MRA neck w/o contrast (70547) | $606 | $2,424 | 2.5× |
| MRI abdomen w contrast (74182) | $628 | $2,512 | 1.8× |
| MRI abdomen w/o contrast (74181) | $571 | $2,284 | 2.4× |
| MRI any jt lower extrem w/contrast material (73722) | $634.25 | $2,537 | 0.8× |
| MRI any jt lower extrem w/o & w/contrast matrl (73723) | $634.25 | $2,537 | 1.8× |
| MRI any jt upper extremity w/contrast matrl (73222) | $546.50 | $2,186 | 0.7× |
| MRI Breast W/O Contrast Bilateral (77047) | $75 | $150 | 0.3× |
| MRI Breast Without Contrast Material Unilateral (77046) | $146 | $584 | 0.6× |
| MRI cardiac w/o cont stress (75559) range across 3 matching MRF lines |
$135–$374.50 | $270–$749 | varies |
| MRI cardiac w/o contrast (75557) | $513 | $2,052 | 2.2× |
| MRI cervical spine w contrast (72142) | $687.25 | $2,749 | 2.0× |
| MRI cervical spine w/o cont (72141) | $628 | $2,512 | 2.6× |
| MRI chest w/o contrast (71550) | $571 | $2,284 | 2.4× |
| MRI chest wo w contrast (71552) | $571 | $2,284 | 1.6× |
| MRI lower extrem oth/thn jt w/contrast matrl (73719) | $546.50 | $2,186 | 1.6× |
| MRI lower extrem oth/thn jt w/o & w/contr matr (73720) | $659.25 | $2,637 | 1.9× |
| MRI lower extrem oth/thn jt w/o contr matrl (73718) | $428.50 | $1,714 | 1.8× |
| MRI lumbar spine w contrast (72149) | $628 | $2,512 | 1.8× |
| Mri Neck Spine W/O & W/Dye (72156) | $812.75 | $3,251 | 2.3× |
| MRI orbit face &/neck w/o contrast (70540) | $941.25 | $3,765 | 4.0× |
| MRI orbit face neck w contrast (70542) | $546.50 | $2,186 | 1.6× |
| Mri Orbt/Fac/Nck W/O &W/Dye (70543) | $941.25 | $3,765 | 2.7× |
| MRI pelvis w contrast (72196) | $628 | $2,512 | 1.8× |
| MRI pelvis w/o & w contrast (72197) | $667 | $2,668 | 1.9× |
| MRI pelvis w/o contrast (72195) | $628 | $2,512 | 2.6× |
| MRI thoracic spine w/o contrast (72146) | $571 | $2,284 | 2.4× |
| MRI upper extremity oth than jt w/contr matrl (73219) | $546.50 | $2,186 | 1.6× |
| MRI upper extremity oth than jt w/o contr matrl (73218) | $428.50 | $1,714 | 1.8× |
| Mri Uppr Extremity W/O&W/Dye (73220) | $628 | $2,512 | 1.8× |
| MRI, abdomen, combo (74183) | $667 | $2,668 | 1.9× |
| MRI, dorsal spine combo (72157) | $687.25 | $2,749 | 2.0× |
| MRI, dorsal spine contrast (72147) | $463.25 | $1,853 | 1.3× |
| MRI, joint upper extrem (73221) | $856.50 | $3,426 | 3.6× |
| MRI, joint upper extrem combo (73223) | $667 | $2,668 | 1.9× |
| MRI, lumbar spine combo (72158) | $756.25 | $3,025 | 2.2× |
| Myocardial Spect Multiple Studies (78452) | $590 | $2,360 | 0.5× |
| N-invas est c ffr sw aly CTA (75580) | $34.50 | $69 | 0.0× |
| Neck soft tissue (70360) | $61 | $244 | 0.7× |
| Njx Rp Loclzj Non-Img Probe Study Intravenous (78808) range across 2 matching MRF lines |
$20–$209.50 | $80–$838 | varies |
| Ntsty modul radthx pln dose-vol histos (77301) | $717.25 | $2,869 | 0.5× |
| Nuclear Rx Intra-Arterial (79445) range across 2 matching MRF lines |
$108.50–$148 | $217–$296 | varies |
| Nuclear Rx Oral Admin (79005) range across 3 matching MRF lines |
$51.50–$134.50 | $103–$269 | varies |
| Ob us nuchal meas 1 gest (76813) range across 3 matching MRF lines |
$55.50–$113 | $111–$226 | varies |
| Oph bmtry us echograpy a-scan io lens pwr cal (76519) range across 3 matching MRF lines |
$30–$68 | $60–$136 | varies |
| Oph US Dx B-Scan&Quan a-Scan Sm Pt Enctr (76510) range across 3 matching MRF lines |
$29.50–$67.50 | $59–$135 | varies |
| Ophthalmic US Dx Corneal Pachymetry Uni/Bi (76514) range across 3 matching MRF lines |
$3.50–$11.50 | $7–$23 | varies |
| Panoramic X-ray of jaws (70355) range across 2 matching MRF lines |
$10–$19 | $20–$38 | varies |
| Parathyroid imaging w/tomographic spect & CT (78072) | $72 | $144 | 0.1× |
| Parathyroid Planar Imaging (78070) | $221.25 | $885 | 0.6× |
| Parathyroid planar imaging w/wo subtraction (78071) | $232.50 | $930 | 0.6× |
| Pelvis 1 or 2 views (72170) | $61 | $244 | 0.6× |
| Pet Image W/Ct Lmtd (78814) | $100 | $200 | 0.1× |
| PET image w/CT, full body (78816) | $113 | $226 | 0.1× |
| PET imaging CT attenuation skull base mid-thigh (78815) | $112 | $224 | 0.1× |
| Prq Transhepatc Portograpy Hemodyn Eval Rs&I (75885) range across 3 matching MRF lines |
$64.50–$137 | $129–$274 | varies |
| Pulmonary Perfusion Imaging Particulate (78580) | $166.75 | $667 | 0.4× |
| Radex Abd Compl Aqt Abd W/S/E/D Views 1 View Ch (74022) | $90.50 | $362 | 0.9× |
| Radex abscess/fistula/sinus tract rs&i (76080) | $65.25 | $261 | 0.1× |
| Radex Ankle Complete Minimum 3 Views (73610) | $61 | $244 | 0.7× |
| Radex Calcaneus Minimum 2 Views (73650) | $56.75 | $227 | 0.7× |
| Radex elbow complete minimum 3 views (73080) | $66.25 | $265 | 0.8× |
| Radex Facial Bones Complete Minimum 3 Views (70150) | $90.25 | $361 | 0.9× |
| Radex fingr minimum 2 views (73140) | $61 | $244 | 0.7× |
| Radex foot complete minimum 3 views (73630) | $61 | $244 | 0.7× |
| Radex Hand Minimum 3 Views (73130) | $61 | $244 | 0.7× |
| Radex lower extremity infant minimum 2 views (73592) | $7.50 | $15 | 0.1× |
| Radex Mastoids Compl Minimum 3 Views PR Side (70130) | $98.25 | $393 | 0.9× |
| Radex Nasal Bones Complete Minimum 3 Views (70160) | $60.75 | $243 | 0.7× |
| Radex Ribs Unilateral 2 Views (71100) | $39.50 | $158 | 0.5× |
| Radex shoulder complete minimum 2 views (73030) | $61 | $244 | 0.7× |
| Radex Sinuses Paransl < 3 Views (70210) | $52.25 | $209 | 0.6× |
| Radex Spine 1 View Specify Level (72020) | $50 | $200 | 0.6× |
| Radex Sternum Minimum 2 Views (71120) | $76.50 | $306 | 0.9× |
| Radex Temporomandble Jt Opn & Clsd Mouth Bilat (70330) | $84.75 | $339 | 1.0× |
| Radex Toe Minimum 2 Views (73660) | $61 | $244 | 0.7× |
| Radex upper extremity infant minimum 2 views (73092) | $7.50 | $15 | 0.1× |
| Radex Wrist Complete Minimum 3 Views (73110) | $61 | $244 | 0.7× |
| Radex X-Ray Exam Entire Spi 6/> Vw - Xr Entire Spine 6+ Vw (72084) | $20 | $40 | 0.2× |
| Radiation Delivery Stereotactic Cranial Linear (77372) likely a partial charge, not the full procedure |
$465.25 | $1,861 | 0.1× |
| Radiation treatment delivery level 3 (77412) | $127 | $254 | 0.2× |
| Radiolog exam mandible compl minimum 4 views (70110) | $84.75 | $339 | 0.8× |
| Radiologic Exam Abdomen 3+ Views - Xr Abdomen 3+ Views (74021) range across 3 matching MRF lines |
$12.50–$42.50 | $25–$85 | varies |
| Radiologic exam colon double contrast study (74280) | $203.75 | $815 | 1.2× |
| Radiologic exam colon single contrast study (74270) | $194.75 | $779 | 1.1× |
| Radiologic exam knee complete 4/more views (73564) | $61 | $244 | 0.6× |
| Radiologic exam pelvis compl minimum 3 views (72190) | $77 | $308 | 0.7× |
| Radiologic Exam Small Int Single Contrast Study (74250) | $134.75 | $539 | 0.8× |
| Radiologic exam swallow function contrast study (74230) | $134.75 | $539 | 0.8× |
| Radiologic exam upr gi trc double contrast study (74246) | $110 | $440 | 0.6× |
| Radiologic examination femur 1 view (73551) | $8 | $16 | 0.1× |
| Radiologic examination femur minimum 2 views (73552) | $42.50 | $170 | 0.5× |
| Radiologic examination knee 1/2 views (73560) | $61 | $244 | 0.7× |
| Radiologic Examination Osseous Survey Limited (77074) | $199.25 | $797 | 1.9× |
| Radiologic examination tibia & fibula 2 views (73590) | $61 | $244 | 0.7× |
| Renal Cyst Study (74470) range across 2 matching MRF lines |
$25–$328.50 | $50–$657 | varies |
| Ribs bilateral 3 views (71110) | $90.50 | $362 | 0.9× |
| Rp loclzj tum plnr 1 area single day imaging (78800) | $518.50 | $2,074 | 1.3× |
| Rp Loclzj Tum Spect 1 Area Single Day Imaging (78803) | $475.50 | $1,902 | 0.9× |
| Scapula (73010) | $61 | $244 | 0.6× |
| Screening Digital Breast Tomosynthesis Bi (77063) | $27 | $108 | 1.2× |
| Shoulder 1 view (73020) | $49.25 | $197 | 0.6× |
| Shoulder Arthrography (73040) | $97 | $388 | 0.3× |
| Sialogram (70390) | $32.50 | $130 | 0.1× |
| Skull less than 4 views (70250) | $61 | $244 | 0.6× |
| Special dosimetry (77331) | $46.50 | $93 | 0.3× |
| Special teletherapy port plan (77321) | $50.50 | $101 | 0.1× |
| Special treatment procedure (77470) | $107.50 | $215 | 0.2× |
| Stereotactic Body Radiation Delivery (77373) | $977 | $1,954 | 0.5× |
| Sternoclavicular joints (71130) | $75.75 | $303 | 0.9× |
| Superior sagittal sinus venogram (75870) range across 3 matching MRF lines |
$59.50–$164 | $119–$328 | varies |
| Tbs techl prep&transmis data alys pfrmd elsewhr (77090) | $3 | $6 | 0.0× |
| Tbs technical calculation only (77091) | $27.50 | $55 | 0.3× |
| Telethx isodose pln cplx w/basic dosimetry (77307) | $154 | $308 | 0.4× |
| Telethx isodose pln smpl w/dosimetry calculation (77306) | $74 | $148 | 0.2× |
| Ther Rad Simulaj-Aided Field Setting Complex (77290) | $82.50 | $165 | 0.2× |
| Ther Rad Simulaj-Aided Field Setting Intermed (77285) | $56.50 | $113 | 0.2× |
| Ther rad simulaj-aided field setting simple (77280) | $37.50 | $75 | 0.3× |
| Therapeutic Enema Rdctj Intussusception/Obstrcj (74283) | $100 | $200 | 0.6× |
| Thoracic spine 2 views (72070) | $34.75 | $139 | 0.3× |
| Thoracic spine 3 views (72072) | $90.50 | $362 | 0.9× |
| Thyroid Met Imaging Body (78018) | $38.50 | $77 | 0.1× |
| Thyroid Uptake W/Blood Flow Sngle/Mult Quan Meas (78014) | $23 | $46 | 0.1× |
| Tx Devices Design & Construction Complex (77334) | $270.50 | $1,082 | 0.7× |
| Tx devices design & construction intermediate (77333) | $42 | $84 | 0.3× |
| Tx devices design & construction simple (77332) | $27.50 | $55 | 0.2× |
| Ultrasound Breast Limited (76642) | $59.50 | $238 | 0.7× |
| Ultrasound Elastography Parenchyma (76981) range across 3 matching MRF lines |
$28.50–$105.50 | $57–$211 | varies |
| Ultrasound Exam Aaa Screen (76706) | $101.75 | $407 | 1.0× |
| Ultrasound, abdomen limited (76705) | $184.25 | $737 | 1.8× |
| Umbilical-artery Doppler (OB) (76820) | $67 | $268 | 0.6× |
| Unlisted Dx Radiographic Procedure (76499) | $56.25 | $225 | 0.6× |
| Unlisted us procedure (76999) | $94.75 | $379 | 1.1× |
| Upper gi w/o kub (74240) | $191 | $764 | 1.1× |
| Urethrocystogram voiding (74455) | $284 | $1,136 | 1.2× |
| Urethrocystography retrograde (74450) | $284 | $1,136 | 1.2× |
| Us breast unilateral complete (76641) | $139 | $556 | 1.3× |
| Us chest (76604) | $66.25 | $265 | 0.6× |
| Us complete joint (76881) | $66.25 | $265 | 0.6× |
| Us exam, pelvic, limited (76857) | $109.75 | $439 | 1.1× |
| Us head (76506) | $30 | $60 | 0.3× |
| Us kidney transplant (76776) | $213.75 | $855 | 2.1× |
| Us lmtd joint/oth nonvasc xtr strux r-t w/img (76882) range across 2 matching MRF lines |
$32–$139 | $128–$556 | varies |
| Us ob detailed single fetus (76811) | $195.25 | $781 | 0.8× |
| Us ob limited 1 or more fetuses (76815) | $85 | $340 | 0.8× |
| Us ob transvaginal (76817) | $130.25 | $521 | 1.3× |
| Us pelvic non ob complete (76856) | $242.25 | $969 | 2.3× |
| Us pg uter img f&mat 14 wk tabdl 1/1st gestation (76801) | $130.25 | $521 | 1.3× |
| Us preg uterus real time f/u trnsabdl per fetus (76816) | $49 | $196 | 0.5× |
| Us retroperitoneal complete (76770) | $215.25 | $861 | 2.1× |
| Us retroperitoneal limited (76775) | $242.25 | $969 | 2.3× |
| Us scrotum and contents (76870) | $242.25 | $969 | 2.3× |
| Us spinal canal and contents (76800) | $170.50 | $682 | 1.6× |
| Us thyroid (76536) | $130.25 | $521 | 1.3× |
| Us transrectal (76872) | $253.25 | $1,013 | 2.4× |
| Vein X-Ray Chest (75827) range across 3 matching MRF lines |
$52.50–$117 | $105–$234 | varies |
| Vein X-Ray Skull Epidural (75872) range across 3 matching MRF lines |
$53.50–$128 | $107–$256 | varies |
| Venogram Sinus/Jugular (75860) range across 3 matching MRF lines |
$53.50–$126 | $107–$252 | varies |
| Venography Adrenal Unilateral (75840) range across 3 matching MRF lines |
$53.50–$128 | $107–$256 | varies |
| Venography caval inferior serialography rs&i (75825) range across 3 matching MRF lines |
$53–$114 | $106–$228 | varies |
| Venography extremity bilateral rs&i (75822) range across 3 matching MRF lines |
$64.50–$132.50 | $129–$265 | varies |
| Venography extremity unilateral rs&i (75820) range across 3 matching MRF lines |
$48–$106 | $96–$212 | varies |
| Venography Orbital Rs&I (75880) range across 3 matching MRF lines |
$33.50–$107.50 | $67–$215 | varies |
| Venography Renal Bilateral (75833) | $68.50 | $137 | 0.0× |
| Venography Renal Unilateral (75831) range across 3 matching MRF lines |
$50.50–$119.50 | $101–$239 | varies |
| Venous sampling by catheter (75893) range across 3 matching MRF lines |
$25–$105 | $50–$210 | varies |
| Venous thrombosis imaging (78457) range across 3 matching MRF lines |
$35.50–$156 | $71–$312 | varies |
| Vertebral fracture assessment via dxa (77086) | $46 | $184 | 0.5× |
| Wrist 2 views (73100) | $61 | $244 | 0.7× |
| X-Ray Ac Jts - Xr Acromioclavicular Joints Bilateral (73050) | $66.25 | $265 | 0.8× |
| X-ray antegrade pyelogram tube (74425) | $90 | $360 | 0.3× |
| X-Ray Aorta Leg Arteries (75630) range across 3 matching MRF lines |
$63.50–$156 | $127–$312 | varies |
| X-Ray Bend Only L-S Spine (72120) | $43.75 | $175 | 0.4× |
| X-Ray Elbow 2 Vw - Xr Elbow 1-2 Views Right (73070) | $62.75 | $251 | 0.7× |
| X-Ray Exam Breast Specimen (76098) | $291 | $1,164 | 0.5× |
| X-Ray Exam Entire Spi 1 Vw (72081) | $42.50 | $170 | 0.5× |
| X-Ray Exam Entire Spi 2/3 Vw (72082) | $69 | $276 | 0.7× |
| X-Ray Exam Entire Spi 4/5 Vw (72083) | $17 | $34 | 0.2× |
| X-Ray Exam Hip Uni 1 View (73501) | $42.50 | $170 | 0.5× |
| X-Ray Exam Hip Uni 2-3 Views (73502) | $42.50 | $170 | 0.5× |
| X-Ray Exam Hip Uni 4/> Views (73503) range across 3 matching MRF lines |
$13.50–$60.50 | $27–$121 | varies |
| X-Ray Exam Hips Bi 2 Views (73521) | $69 | $276 | 0.7× |
| X-Ray Exam Hips Bi 3-4 Views (73522) | $69 | $276 | 0.7× |
| X-Ray Exam Hips Bi 5/> Views (73523) range across 3 matching MRF lines |
$15–$62 | $30–$124 | varies |
| X-Ray Exam L-S Spine Bending (72114) | $114 | $456 | 1.1× |
| X-Ray Exam Neck Spine 2-3 Vw (72040) | $61 | $244 | 0.7× |
| X-Ray Exam Neck Spine 6/>Vws (72052) | $90.50 | $362 | 0.9× |
| X-Ray Exam Unilat Ribs/Chest (71101) | $60.50 | $242 | 0.6× |
| X-ray humerus (73060) | $61 | $244 | 0.7× |
| X-ray IV pyelogram (ivp) (74400) | $172.75 | $691 | 1.0× |
| X-ray IV pyelogram+tomography (74415) | $192.50 | $770 | 1.1× |
| X-Ray Jaw <4 Vw - Xr Mandible < 4 Views (70100) | $56.75 | $227 | 0.7× |
| X-Ray Knee Bilat Standing - Xr Knees Anteroposterior Standing Bilat (73565) | $61 | $244 | 0.7× |
| X-Ray Lumbar Spine 2/3 Vw - Xr Lumbar Spine 2-3 Views (72100) | $61 | $244 | 0.6× |
| X-ray nose-rectum child f.b. (76010) | $47.25 | $189 | 0.5× |
| X-Ray Ribs, Chest 4+ Vw - Xr Ribs 3 Vws Bil W/ Chest Posteroanterior (71111) | $90.50 | $362 | 0.9× |
| X-Ray Sacroiliac Jts 3+ Vw - Xr Sacroiliac Joints 3+ Views (72202) | $61 | $244 | 0.6× |
| X-Ray Sacrum/Coccyx 2+ Vw - Xr Sacrum Coccyx 2+ Views (72220) | $61 | $244 | 0.7× |
| X-Ray Sinuses 3+ Vw - Xr Paranasal Sinuses 3+ Views (70220) | $61 | $244 | 0.7× |
| X-Ray Skull 4+ Vw - Xr Skull Complete 4+ Views (70260) | $99.50 | $398 | 1.0× |
| X-Ray Stress View (77071) | $54.50 | $109 | 0.6× |
| X-ray thoracic spine 4 vw (72074) | $92.25 | $369 | 0.9× |
| X-Ray Urinary Tract Exam With Contrast Material (74420) | $260 | $1,040 | 0.7× |
| X-Rays Bone Length Studies (77073) | $74.50 | $298 | 0.7× |
| X-Rays Bone Survey Complete (77075) | $55 | $220 | 0.5× |
| Xr c-spine 4 or 5 views (72050) | $90.50 | $362 | 0.9× |
| Xr facial bones less than 3 views (70140) | $61 | $244 | 0.7× |
| Xr orbits complete 4 views (70200) | $89.50 | $358 | 0.9× |
| Xr Tomogram Single Plane (76100) | $161.75 | $647 | 1.6× |
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.