Imaging prices at Upper Valley Medical Center
Troy, OH · every code in this section with a posted price and a Medicare benchmark.
437 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) | $6,911 | $6,911 | 5.1× |
| Abdomen 1 View (74018) | $537 | $537 | 6.3× |
| Abdomen 2 views (74019) | $1,015 | $1,015 | 9.9× |
| Acute Gastrointestinal Blood Loss Imaging (78278) | $1,860 | $1,860 | 4.7× |
| Angio internal mammary (75756) | $7,615 | $7,615 | 2.5× |
| Angio pulmonary bilat (75743) | $7,615 | $7,615 | 2.5× |
| Angiography Adrenal Bilateral Slctv Rs&I (75733) | $7,615 | $7,615 | 2.5× |
| Angiography extremity bilateral rs&i (75716) | $7,615 | $7,615 | 2.5× |
| Angiography extremity unilateral rs&i (75710) | $7,615 | $7,615 | 2.5× |
| Angiography pulmonary unilateral slctv rs&i (75741) | $7,615 | $7,615 | 2.5× |
| Angrph pulmonary nonslctv cath/ven njx rs&i (75746) | $7,615 | $7,615 | 2.5× |
| Ankle 2 views (73600) range across 3 matching MRF lines |
$640–$1,275 | $640–$1,275 | varies |
| Aortography thoracic serialography rs&i (75605) | $7,615 | $7,615 | 1.4× |
| Artery X-Rays Abdomen (75726) | $7,615 | $7,615 | 1.4× |
| Artery X-Rays Adrenal Gland (75731) | $7,615 | $7,615 | 2.5× |
| Artery X-Rays Pelvis (75736) | $7,615 | $7,615 | 1.4× |
| Artery X-Rays Spine (75705) | $7,615 | $7,615 | 1.4× |
| Arthrogram ankle (73615) range across 3 matching MRF lines |
$3,690–$7,382 | $3,690–$7,382 | varies |
| Arthrogram hip (73525) range across 3 matching MRF lines |
$4,369–$8,735 | $4,369–$8,735 | varies |
| Arthrogram Wrist (73115) range across 3 matching MRF lines |
$2,016–$4,029 | $2,016–$4,029 | varies |
| Basic radiation dosimetry calculation (77300) | $723 | $723 | 5.5× |
| Bone age studies (77072) | $1,057 | $1,057 | 10.3× |
| Bone Imaging 3 Phase (78315) | $1,860 | $1,860 | 4.7× |
| Bone Imaging Limited Area (78300) | $1,860 | $1,860 | 4.7× |
| Bone Imaging Multiple Areas (78305) | $1,696 | $1,696 | 4.3× |
| Bone Imaging Whole Body (78306) | $1,860 | $1,860 | 4.7× |
| Bone marrow imaging limited area (78102) | $1,860 | $1,860 | 4.7× |
| Bone marrow imaging; whole body (78104) | $1,860 | $1,860 | 4.7× |
| Bone survey infant (77076) | $1,057 | $1,057 | 10.3× |
| Brachytx isodose complex (77318) | $1,964 | $1,964 | 5.4× |
| Brachytx isodose intermed (77317) | $1,964 | $1,964 | 5.4× |
| Brachytx Isodose Plan Simple (77316) | $723 | $723 | 2.0× |
| Brain Image W/Flow < 4 Views (78601) | $1,860 | $1,860 | 4.7× |
| Brain Imaging Min 4 Static Views W Vascular Flow (78606) | $2,467 | $2,467 | 4.6× |
| Brain Imaging Pet Metabolic Evaluation (78608) | $7,181 | $7,181 | 5.1× |
| Cardiac MRI w/w/o contrast & further seq (75561) | $3,400 | $3,400 | 9.9× |
| Cardiac MRI w/w/o contrast w/stress (75563) | $8,294 | $8,294 | 10.8× |
| Cat Scan Follow-Up Study (76380) | $691 | $691 | 8.1× |
| Cerebrospinal Fluid Flow W/O Matl Shunt Evaltj (78645) | $1,860 | $1,860 | 3.5× |
| Cerebrospinal Fluid Scan (78630) | $2,467 | $2,467 | 4.6× |
| Chest 1 view (71045) | $765 | $765 | 9.0× |
| Chest 2 views (71046) | $765 | $765 | 9.0× |
| Chest 3 views (71047) | $765 | $765 | 9.0× |
| Chest 4 or more views (71048) | $1,446 | $1,446 | 14.1× |
| Cineradiograpy/vidradiograpy xcpt where spec (76120) | $959 | $959 | 9.4× |
| Cisternography Positive Contrast Rs&I (70015) | $3,350 | $3,350 | 4.4× |
| Clavicle complete (73000) range across 3 matching MRF lines |
$640–$1,275 | $640–$1,275 | varies |
| Computed Tomography Thorax Lw Dose Lng Ca Scr C- (71271) | $452 | $452 | 4.4× |
| Continuing medical physics consltj pr wk (77336) | $723 | $723 | 5.5× |
| Contrast Exam Abdominl Aorta (75625) | $7,615 | $7,615 | 2.5× |
| Contrast X-Ray Bladder (74430) | $1,828 | $1,828 | 5.3× |
| Contrast X-Ray Of Elbow (73085) range across 3 matching MRF lines |
$4,369–$8,735 | $4,369–$8,735 | varies |
| Contrast X-Ray Of Knee Joint (73580) range across 3 matching MRF lines |
$3,690–$7,382 | $3,690–$7,382 | varies |
| CT abdomen and pelvis without and with contrast (74178) | $3,941 | $3,941 | 11.5× |
| CT abdomen and pelvis without contrast (74176) | $2,175 | $2,175 | 9.3× |
| CT abdomen w contrast (74160) | $2,682 | $2,682 | 15.6× |
| CT abdomen w wo contrast (74170) | $2,682 | $2,682 | 15.6× |
| CT abdomen w/o contrast (74150) | $1,274 | $1,274 | 12.4× |
| CT Angio Abdomen and Pelvis (74174) | $3,941 | $3,941 | 11.5× |
| CT Angio Chest (71275) | $2,682 | $2,682 | 15.6× |
| CT Angio Head (70496) | $2,938 | $2,938 | 17.1× |
| CT angio hrt w/3d image (75574) | $2,682 | $2,682 | 7.8× |
| Ct Angio Lwr Extr W/O&W/Dye (73706) range across 3 matching MRF lines |
$2,682–$5,368 | $2,682–$5,368 | varies |
| CT Angio Neck (70498) | $2,938 | $2,938 | 17.1× |
| Ct Angio Upr Extrm W/O&W/Dye (73206) | $2,682 | $2,682 | 15.6× |
| CT Cere Prfuj Alys C+ W/O CT/Cta Same Anatomy (70473) | $2,714 | $2,714 | 15.8× |
| CT cervical spine w/ contrast (72126) | $4,314 | $4,314 | 12.6× |
| CT cervical spine w/o contrast (72125) | $1,396 | $1,396 | 13.6× |
| CT cervical spine w/wo cont (72127) | $4,314 | $4,314 | 25.1× |
| CT chest w contrast (71260) | $2,682 | $2,682 | 15.6× |
| CT chest w/wo contrast (71270) | $3,941 | $3,941 | 22.9× |
| CT head/brain with contrast (70460) | $2,938 | $2,938 | 17.1× |
| CT head/brain without and with contrast (70470) | $2,938 | $2,938 | 17.1× |
| CT heart contrast eval cardiac structure&morph (75572) | $2,682 | $2,682 | 7.8× |
| CT heart no contrast quant eval coronry calcium (75571) | $99 | $99 | 1.2× |
| CT hrt w/3d image congen (75573) | $2,682 | $2,682 | 7.8× |
| CT iac w contrast (70481) | $2,938 | $2,938 | 17.1× |
| CT l-spine w&w/o contrast (72133) | $3,941 | $3,941 | 22.9× |
| CT lower ext w/o (73700) range across 3 matching MRF lines |
$1,274–$2,550 | $1,274–$2,550 | varies |
| CT lower extremity w/contrast material (73701) range across 3 matching MRF lines |
$2,682–$5,368 | $2,682–$5,368 | varies |
| CT lumbar spine w contrast (72132) | $3,941 | $3,941 | 11.5× |
| CT lumbar spine w/o contrast (72131) | $1,274 | $1,274 | 12.4× |
| CT maxillofacial w contrast (70487) | $2,938 | $2,938 | 17.1× |
| CT maxillofacial wo contrast (70486) | $1,396 | $1,396 | 13.6× |
| CT neck tissue combo (70492) | $2,938 | $2,938 | 17.1× |
| Ct Orbit/Ear/Fossa W/O&W/Dye (70482) | $2,938 | $2,938 | 17.1× |
| CT orbits w/o contrast (70480) | $1,396 | $1,396 | 13.6× |
| CT pelvis w&w/o contrast (72194) | $2,682 | $2,682 | 15.6× |
| CT pelvis w/o contrast (72192) | $1,274 | $1,274 | 12.4× |
| CT scan of leg combo (73702) range across 3 matching MRF lines |
$2,682–$5,368 | $2,682–$5,368 | varies |
| CT scans face/jaw combo (70488) | $2,938 | $2,938 | 17.1× |
| CT soft tissue neck w contrast (70491) | $2,938 | $2,938 | 17.1× |
| CT soft tissue neck w/o contrast (70490) | $1,396 | $1,396 | 13.6× |
| CT thoracic spine w contrast (72129) | $2,682 | $2,682 | 15.6× |
| CT thoracic spine w/o contrast (72128) | $1,274 | $1,274 | 12.4× |
| CT thoracic spine w/wo cont (72130) | $2,682 | $2,682 | 15.6× |
| CT thorax w/o contrast (71250) | $1,274 | $1,274 | 12.4× |
| CT unlisted procedure (76497) | $691 | $691 | 8.1× |
| CT upper ext wo (73200) range across 3 matching MRF lines |
$1,274–$2,550 | $1,274–$2,550 | varies |
| CT upper extremity w/o & w/contrast material (73202) range across 3 matching MRF lines |
$2,682–$5,368 | $2,682–$5,368 | varies |
| CT upper extremity with contrast (73201) range across 3 matching MRF lines |
$3,941–$7,877 | $3,941–$7,877 | varies |
| Cta Abdl Aorta&Bi Iliofem W/Contrast&Postp (75635) | $2,682 | $2,682 | 15.6× |
| Cta Abdomen (74175) | $2,682 | $2,682 | 15.6× |
| CTA head&neck c+ w/noncontrast img&post-pxessing (70471) | $2,938 | $2,938 | 8.6× |
| CTA pelvis (72191) | $2,682 | $2,682 | 15.6× |
| Dacryocystography, nasolacrimal duct, radiological supervision and interpretation Non-Facility (70170) | $3,350 | $3,350 | 14.3× |
| Dilation ureters/urethra rs&i (74485) | $14,347 | $14,347 | 7.0× |
| Discography Cerv/Thor Spine (72285) | $6,433 | $6,433 | 3.4× |
| Diskography lumbar (72295) | $6,433 | $6,433 | 3.4× |
| Doppler Echo Fetal Puls Spectral F/U/Repeat (76828) | $1,806 | $1,806 | 17.6× |
| Doppler Echo Fetal Spectral Display Complete (76827) | $1,806 | $1,806 | 17.6× |
| Doppler Fetal Mid Cerebral Artery (76821) | $1,143 | $1,143 | 11.2× |
| Dxa Bone Density Axial (77080) | $1,057 | $1,057 | 10.3× |
| Dxa bone density study (77085) | $1,251 | $1,251 | 12.2× |
| Dxa bone density study 1/>sites appendiclr skel (77081) | $640 | $640 | 7.5× |
| Echo exam of fetal heart (76825) | $4,899 | $4,899 | 9.1× |
| Echo exam uterus (76831) | $1,806 | $1,806 | 7.7× |
| Echo Guide For Artery Repair (76936) | $2,736 | $2,736 | 12.9× |
| Echocardiography, fetal, cardiovascular system, real time with image documentation (2D), with or without M-mode… (76826) | $4,899 | $4,899 | 21.0× |
| Echograp Trans R Pros Study (76873) | $1,306 | $1,306 | 12.7× |
| Esophageal Motility Study (78258) | $1,860 | $1,860 | 4.7× |
| Esophagram (74220) | $959 | $959 | 5.6× |
| Fetal Biophys Profile W/Nst (76818) | $1,806 | $1,806 | 17.6× |
| Fetal Biophysical Profile W/O Non-Stress Testing (76819) | $1,806 | $1,806 | 17.6× |
| Fetal MRI w/placntl matrnl plvc img sing/1st ges (74712) | $2,048 | $2,048 | 8.8× |
| Follow-Up Angiography (75898) range across 2 matching MRF lines |
$5,188–$8,295 | $5,188–$8,295 | varies |
| Foot 2 views (73620) range across 3 matching MRF lines |
$640–$1,275 | $640–$1,275 | varies |
| Forearm 2 views (73090) range across 3 matching MRF lines |
$640–$1,275 | $640–$1,275 | varies |
| Gastric emptying imaging study (78264) | $1,860 | $1,860 | 4.7× |
| Gated Heart Planar Single (78472) | $1,860 | $1,860 | 4.7× |
| Hand 2 views (73120) range across 3 matching MRF lines |
$1,057–$2,113 | $1,057–$2,113 | varies |
| Hepatc Vngrph Wdg/Fr Hemodyn Eval Rs&I (75889) | $7,615 | $7,615 | 2.5× |
| Hepatc Vngrph Wdg/Fr W/O Hemodyn Eval Rs&I (75891) | $7,615 | $7,615 | 2.5× |
| Hepatobil Syst Image W/Drug (78227) | $1,860 | $1,860 | 3.5× |
| Hepatobiliary System Imaging (78226) | $1,860 | $1,860 | 4.7× |
| Ht Musc Image Planar Mult (78454) | $6,194 | $6,194 | 4.9× |
| Ht Muscle Image Spect Sing (78451) | $6,194 | $6,194 | 4.9× |
| Hysterosalpingogram (74740) | $3,350 | $3,350 | 14.3× |
| Image fusion (77399) | $2,178 | $2,178 | 16.5× |
| Interstitial radiation source applic complex (77778) | $4,684 | $4,684 | 6.9× |
| Intracavitary Radiation Source Applic Complex (77763) | $4,684 | $4,684 | 6.9× |
| Intracavitary Radiation Source Applic Intermed (77762) | $3,403 | $3,403 | 6.3× |
| Intracavitary radiation source applic simple (77761) | $3,403 | $3,403 | 6.3× |
| Joint Survey Single View (77077) | $1,057 | $1,057 | 10.3× |
| K Flow/Funct Image Multiple (78709) | $2,467 | $2,467 | 4.6× |
| K Flow/Funct Image W/Drug (78708) | $2,467 | $2,467 | 4.6× |
| K Flow/Funct Image W/O Drug (78707) | $2,467 | $2,467 | 4.6× |
| Kidney Imaging Morphol (78700) | $1,860 | $1,860 | 4.7× |
| Knee 3 Views (73562) range across 3 matching MRF lines |
$640–$1,275 | $640–$1,275 | varies |
| Leveen/Shunt Patency Exam (78291) | $1,860 | $1,860 | 4.7× |
| Liver & Spleen Imaging Static Only (78215) | $1,860 | $1,860 | 4.7× |
| Liver imaging static only (78201) | $1,860 | $1,860 | 3.5× |
| Liver imaging w/vascular flow (78202) | $1,696 | $1,696 | 3.2× |
| Lung Perf&Ventilat Diferentl (78598) | $2,467 | $2,467 | 4.6× |
| Lung perfusion differential (78597) | $1,860 | $1,860 | 4.7× |
| Lung Ventilat&Perfus Imaging (78582) | $2,467 | $2,467 | 4.6× |
| Lung Ventilation Imaging (78579) | $1,860 | $1,860 | 4.7× |
| Lymph System Imaging (78195) | $1,860 | $1,860 | 3.5× |
| Lymphangiography Extremity Only Bilateral Rs&I (75803) | $13,825 | $13,825 | 9.0× |
| Lymphangiography extremity only unilateral rs&i (75801) | $5,325 | $5,325 | 8.7× |
| Lymphangiography Pelvic/Abdominal Bilateral Rs&I (75807) | $38,950 | $38,950 | 12.6× |
| Lymphangiography, pelvic/abdominal, unilateral (75805) | $28,134 | $28,134 | 9.1× |
| Magnetic Image Jaw Joint (70336) | $2,048 | $2,048 | 8.8× |
| Magnetic resonance (eg, proton) imaging, brain (including brain stem andskull base), during open intracranial procedure… (70558) | $3,687 | $3,687 | 21.4× |
| Magnetic resonance (eg, proton) imaging, brain (including brain stem andskull base), during open intracranial procedure… (70557) | $2,220 | $2,220 | 4.1× |
| Magnetic resonance (eg, proton) imaging, brain (including brain stem andskull base), during open intracranial procedure… (70559) | $4,975 | $4,975 | 28.9× |
| Magnetic Resonance Elastography (76391) | $1,704 | $1,704 | 7.3× |
| Mammary ductogram or galactogram multiple (77054) | $2,604 | $2,604 | 11.1× |
| Mammary ductogram or galactogram single (77053) | $2,604 | $2,604 | 11.1× |
| Meckels Divert Exam (78290) | $1,860 | $1,860 | 4.7× |
| Mlc imrt design & construction per imrt plan (77338) | $1,964 | $1,964 | 5.4× |
| Mra Head W/O & W/Contrast Material (70546) | $3,687 | $3,687 | 10.8× |
| MRA head w/o contrast (70544) | $2,220 | $2,220 | 9.5× |
| MRA head with contrast (70545) | $3,687 | $3,687 | 10.8× |
| MRA neck w contrast (70548) | $3,687 | $3,687 | 10.8× |
| Mra Neck W/O &W/Contrast Material (70549) | $3,687 | $3,687 | 10.8× |
| MRA neck w/o contrast (70547) | $2,220 | $2,220 | 9.5× |
| MRI abdomen w contrast (74182) | $3,400 | $3,400 | 9.9× |
| MRI abdomen w/o contrast (74181) | $2,048 | $2,048 | 8.8× |
| MRI any jt lower extrem w/contrast material (73722) range across 3 matching MRF lines |
$3,400–$6,798 | $3,400–$6,798 | varies |
| MRI any jt lower extrem w/o & w/contrast matrl (73723) range across 3 matching MRF lines |
$3,400–$6,798 | $3,400–$6,798 | varies |
| MRI any jt upper extremity w/contrast matrl (73222) range across 3 matching MRF lines |
$3,400–$6,798 | $3,400–$6,798 | varies |
| MRI brain functional w/o physician admnistration (70554) | $2,220 | $2,220 | 9.5× |
| MRI brain functional w/physician admnistration (70555) | $2,220 | $2,220 | 9.5× |
| MRI Breast W/O Contrast Bilateral (77047) | $4,093 | $4,093 | 17.5× |
| MRI Breast Without Contrast Material Unilateral (77046) | $2,293 | $2,293 | 9.8× |
| MRI cardiac w/o cont stress (75559) | $3,303 | $3,303 | 6.2× |
| MRI cardiac w/o contrast (75557) | $2,048 | $2,048 | 8.8× |
| MRI cervical spine w contrast (72142) | $3,687 | $3,687 | 10.8× |
| MRI cervical spine w/o cont (72141) | $2,220 | $2,220 | 9.5× |
| MRI chest w/o contrast (71550) | $2,048 | $2,048 | 8.8× |
| MRI chest with contrast (71551) | $3,400 | $3,400 | 4.4× |
| MRI chest wo w contrast (71552) | $3,400 | $3,400 | 9.9× |
| MRI lower extrem oth/thn jt w/contrast matrl (73719) range across 3 matching MRF lines |
$3,400–$6,798 | $3,400–$6,798 | varies |
| MRI lower extrem oth/thn jt w/o & w/contr matr (73720) range across 3 matching MRF lines |
$3,400–$6,798 | $3,400–$6,798 | varies |
| MRI lower extrem oth/thn jt w/o contr matrl (73718) range across 3 matching MRF lines |
$2,048–$4,093 | $2,048–$4,093 | varies |
| MRI lumbar spine w contrast (72149) | $3,400 | $3,400 | 9.9× |
| Mri Neck Spine W/O & W/Dye (72156) | $3,687 | $3,687 | 10.8× |
| MRI orbit face &/neck w/o contrast (70540) | $2,220 | $2,220 | 9.5× |
| MRI orbit face neck w contrast (70542) | $3,687 | $3,687 | 10.8× |
| Mri Orbt/Fac/Nck W/O &W/Dye (70543) | $3,687 | $3,687 | 10.8× |
| MRI pelvis w contrast (72196) | $3,400 | $3,400 | 9.9× |
| MRI pelvis w/o & w contrast (72197) | $3,400 | $3,400 | 9.9× |
| MRI pelvis w/o contrast (72195) | $2,048 | $2,048 | 8.8× |
| MRI spectroscopy (76390) | $1,823 | $1,823 | 21.4× |
| MRI thoracic spine w/o contrast (72146) | $2,048 | $2,048 | 8.8× |
| MRI upper extremity oth than jt w/contr matrl (73219) range across 3 matching MRF lines |
$3,400–$6,798 | $3,400–$6,798 | varies |
| MRI upper extremity oth than jt w/o contr matrl (73218) range across 3 matching MRF lines |
$2,048–$4,093 | $2,048–$4,093 | varies |
| Mri Uppr Extremity W/O&W/Dye (73220) range across 3 matching MRF lines |
$3,400–$6,798 | $3,400–$6,798 | varies |
| MRI, abdomen, combo (74183) | $3,400 | $3,400 | 9.9× |
| MRI, dorsal spine combo (72157) | $3,400 | $3,400 | 9.9× |
| MRI, dorsal spine contrast (72147) | $3,400 | $3,400 | 9.9× |
| MRI, joint upper extrem (73221) range across 3 matching MRF lines |
$2,048–$4,093 | $2,048–$4,093 | varies |
| MRI, joint upper extrem combo (73223) range across 3 matching MRF lines |
$3,400–$6,798 | $3,400–$6,798 | varies |
| MRI, lumbar spine combo (72158) | $3,400 | $3,400 | 9.9× |
| Musculoskeletal Nuclear Exam (78399) | $1,860 | $1,860 | 4.7× |
| Myelogram cervical (72240) | $8,295 | $8,295 | 10.8× |
| Myelogram Lumbar (72265) | $8,295 | $8,295 | 10.8× |
| Myelography thoracic (72255) | $8,295 | $8,295 | 10.8× |
| Myelograpy 2/more regions rs&i (72270) | $8,295 | $8,295 | 10.8× |
| Myocardial Imaging Infarct Avid Planar Qual/Quan (78466) | $1,860 | $1,860 | 4.7× |
| Myocardial Imaging Pet Metabolic Evaluation (78459) | $7,181 | $7,181 | 5.7× |
| Myocardial Perfusion Planar 1 Study Rest/Stress (78453) | $2,467 | $2,467 | 1.9× |
| Myocardial Spect Multiple Studies (78452) | $6,194 | $6,194 | 4.9× |
| Neck soft tissue (70360) | $579 | $579 | 6.8× |
| Nfs/Instlj Radioelmnt Sln 3 Mo Follow-Up Care (77750) | $1,046 | $1,046 | 2.8× |
| Nm csf leak detection (78650) | $5,652 | $5,652 | 4.5× |
| Nm myocard infarct spect (78469) | $2,467 | $2,467 | 4.6× |
| Nm red cell survival study (78130) | $1,860 | $1,860 | 4.7× |
| Nm unlisted gi procedure (78299) | $1,860 | $1,860 | 4.7× |
| Nonvascular Shunt X-Ray (75809) | $959 | $959 | 9.4× |
| Ntsty modul radthx pln dose-vol histos (77301) | $6,911 | $6,911 | 5.1× |
| Nuclear Rx Intra-Arterial (79445) | $1,476 | $1,476 | 6.5× |
| Nuclear Rx Oral Admin (79005) | $1,476 | $1,476 | 6.5× |
| Ob us nuchal meas 1 gest (76813) | $1,081 | $1,081 | 10.6× |
| Ophthalmic ultrasound dx b-scan w/wo a-scan (76512) | $844 | $844 | 8.2× |
| Optic foramina (70190) range across 3 matching MRF lines |
$640–$1,275 | $640–$1,275 | varies |
| Parathyroid imaging w/tomographic spect & CT (78072) | $2,467 | $2,467 | 4.6× |
| Parathyroid Planar Imaging (78070) | $1,860 | $1,860 | 4.7× |
| Parathyroid planar imaging w/wo subtraction (78071) | $1,860 | $1,860 | 4.7× |
| Pelvis 1 or 2 views (72170) | $1,057 | $1,057 | 10.3× |
| Peritoneogram Rs&I (74190) | $3,350 | $3,350 | 6.3× |
| Pet Image Skull-Thigh (78812) | $8,160 | $8,160 | 5.8× |
| Pet Image W/Ct Lmtd (78814) | $8,160 | $8,160 | 5.8× |
| PET image w/CT, full body (78816) | $8,160 | $8,160 | 5.8× |
| PET imaging CT attenuation skull base mid-thigh (78815) | $8,160 | $8,160 | 5.8× |
| Pet Imaging Limited Area Chest Head/Neck (78811) | $8,160 | $8,160 | 6.4× |
| Pet Myocardial Sngl Study (78491) | $7,181 | $7,181 | 5.1× |
| PET whole body (78813) | $8,160 | $8,160 | 5.8× |
| Prq Transhepatc Portograpy Hemodyn Eval Rs&I (75885) | $7,615 | $7,615 | 2.5× |
| Pulmonary Perfusion Imaging Particulate (78580) | $1,860 | $1,860 | 4.7× |
| Quan&Charac C Atherosclerotc Plaq Asses Sev C Ds (75577) | $2,714 | $2,714 | 3.0× |
| Radex Abd Compl Aqt Abd W/S/E/D Views 1 View Ch (74022) | $1,015 | $1,015 | 9.9× |
| Radex abscess/fistula/sinus tract rs&i (76080) | $3,350 | $3,350 | 6.3× |
| Radex Ankle Complete Minimum 3 Views (73610) range across 3 matching MRF lines |
$640–$1,275 | $640–$1,275 | varies |
| Radex Calcaneus Minimum 2 Views (73650) range across 3 matching MRF lines |
$640–$1,275 | $640–$1,275 | varies |
| Radex elbow complete minimum 3 views (73080) range across 3 matching MRF lines |
$640–$1,275 | $640–$1,275 | varies |
| Radex Facial Bones Complete Minimum 3 Views (70150) | $1,057 | $1,057 | 10.3× |
| Radex fingr minimum 2 views (73140) range across 3 matching MRF lines |
$640–$1,275 | $640–$1,275 | varies |
| Radex foot complete minimum 3 views (73630) range across 3 matching MRF lines |
$640–$1,275 | $640–$1,275 | varies |
| Radex Hand Minimum 3 Views (73130) range across 3 matching MRF lines |
$640–$1,275 | $640–$1,275 | varies |
| Radex lower extremity infant minimum 2 views (73592) range across 3 matching MRF lines |
$640–$1,275 | $640–$1,275 | varies |
| Radex Mastoids Compl Minimum 3 Views PR Side (70130) range across 3 matching MRF lines |
$1,057–$2,113 | $1,057–$2,113 | varies |
| Radex Nasal Bones Complete Minimum 3 Views (70160) | $640 | $640 | 7.5× |
| Radex Ribs Unilateral 2 Views (71100) | $640 | $640 | 7.5× |
| Radex shoulder complete minimum 2 views (73030) range across 3 matching MRF lines |
$640–$1,275 | $640–$1,275 | varies |
| Radex Sinuses Paransl < 3 Views (70210) | $640 | $640 | 7.5× |
| Radex sm int w/mlt srl imges via enteroclss tube (74251) | $1,828 | $1,828 | 10.6× |
| Radex Spine 1 View Specify Level (72020) | $640 | $640 | 7.5× |
| Radex Sternum Minimum 2 Views (71120) | $640 | $640 | 7.5× |
| Radex Temporomandble Jt Opn & Clsd Mouth Bilat (70330) | $640 | $640 | 7.5× |
| Radex Toe Minimum 2 Views (73660) range across 3 matching MRF lines |
$640–$1,275 | $640–$1,275 | varies |
| Radex upper extremity infant minimum 2 views (73092) range across 3 matching MRF lines |
$1,057–$2,113 | $1,057–$2,113 | varies |
| Radex Wrist Complete Minimum 3 Views (73110) range across 3 matching MRF lines |
$640–$1,275 | $640–$1,275 | varies |
| Radex X-Ray Exam Entire Spi 6/> Vw - Xr Entire Spine 6+ Vw (72084) | $2,016 | $2,016 | 19.7× |
| Radiation Delivery Stereotactic Cranial Linear (77372) | $8,025 | $8,025 | 1.1× |
| Radiation treatment delivery level 1 (77402) | $743 | $743 | 7.4× |
| Radiation treatment delivery level 2 (77407) | $743 | $743 | 2.0× |
| Radiation treatment delivery level 3 (77412) | $1,307 | $1,307 | 2.4× |
| Radiolog exam mandible compl minimum 4 views (70110) | $1,057 | $1,057 | 10.3× |
| Radiologic Exam Abdomen 3+ Views - Xr Abdomen 3+ Views (74021) | $1,015 | $1,015 | 9.9× |
| Radiologic exam colon double contrast study (74280) | $1,828 | $1,828 | 10.6× |
| Radiologic exam colon single contrast study (74270) | $959 | $959 | 5.6× |
| Radiologic Exam Esophagus Double Contrast Study (74221) | $959 | $959 | 5.6× |
| Radiologic exam knee complete 4/more views (73564) range across 3 matching MRF lines |
$1,057–$2,113 | $1,057–$2,113 | varies |
| Radiologic exam pelvis compl minimum 3 views (72190) | $1,057 | $1,057 | 10.3× |
| Radiologic Exam Small Int Single Contrast Study (74250) | $959 | $959 | 5.6× |
| Radiologic exam swallow function contrast study (74230) | $959 | $959 | 5.6× |
| Radiologic exam upr gi trc double contrast study (74246) | $959 | $959 | 5.6× |
| Radiologic examination femur 1 view (73551) range across 3 matching MRF lines |
$640–$1,275 | $640–$1,275 | varies |
| Radiologic examination femur minimum 2 views (73552) range across 3 matching MRF lines |
$640–$1,275 | $640–$1,275 | varies |
| Radiologic examination knee 1/2 views (73560) range across 3 matching MRF lines |
$640–$1,275 | $640–$1,275 | varies |
| Radiologic Examination Osseous Survey Limited (77074) | $1,057 | $1,057 | 10.3× |
| Radiologic Examination Salivary Gland Calculus (70380) | $579 | $579 | 6.8× |
| Radiologic examination tibia & fibula 2 views (73590) range across 3 matching MRF lines |
$640–$1,275 | $640–$1,275 | varies |
| Radiopharm Dacryocystography (78660) | $1,860 | $1,860 | 4.7× |
| Radiopharmaceutical therapy, by intracavitary administration Non-Facility (79200) | $1,398 | $1,398 | 6.1× |
| Red Cell Volume Determination Spx 1 Sampling (78120) | $1,860 | $1,860 | 4.7× |
| Renal Cyst Study (74470) | $3,350 | $3,350 | 6.3× |
| Ribs bilateral 3 views (71110) | $1,057 | $1,057 | 10.3× |
| Rp loclzj tum plnr 1 area single day imaging (78800) | $1,860 | $1,860 | 4.7× |
| Rp loclzj tum plnr 2+area 1+d img/1 area img>2+d (78801) | $1,860 | $1,860 | 4.7× |
| Rp Loclzj Tum Plnr Whole Body 2+ Days Imaging (78804) | $6,194 | $6,194 | 11.6× |
| Rp Loclzj Tum Plnr Whole Body Single Day Imaging (78802) | $2,467 | $2,467 | 4.6× |
| Rp Loclzj Tum Spect 1 Area Single Day Imaging (78803) | $7,160 | $7,160 | 13.5× |
| Rp loclzj tum spect 2 area/sep acquisj img (78831) | $7,160 | $7,160 | 5.6× |
| Rp loclzj tum spect CT 2area 1d img/1 ar img>2+d (78832) | $8,122 | $8,122 | 5.8× |
| Rp loclzj tum spect w/CT 1 area/acquisj 1day img (78830) | $7,160 | $7,160 | 5.6× |
| Rp Ther Radiolbld Monoclonal Antibody IV Infus (79403) | $1,818 | $1,818 | 7.9× |
| Rp Therapy Intravenous Administration (79101) | $1,476 | $1,476 | 6.5× |
| Scapula (73010) range across 3 matching MRF lines |
$640–$1,275 | $640–$1,275 | varies |
| Screening Digital Breast Tomosynthesis Bi (77063) | $119 | $119 | 5.1× |
| Sella turcica (70240) | $640 | $640 | 7.5× |
| Shoulder 1 view (73020) range across 3 matching MRF lines |
$640–$1,275 | $640–$1,275 | varies |
| Shoulder Arthrography (73040) range across 3 matching MRF lines |
$4,369–$8,735 | $4,369–$8,735 | varies |
| Sialogram (70390) | $1,828 | $1,828 | 7.8× |
| Skull less than 4 views (70250) | $1,057 | $1,057 | 10.3× |
| Special dosimetry (77331) | $723 | $723 | 5.5× |
| Special Physics Consult (77370) | $1,121 | $1,121 | 8.5× |
| Special teletherapy port plan (77321) | $1,964 | $1,964 | 5.4× |
| Special treatment procedure (77470) | $3,403 | $3,403 | 6.3× |
| Spleen Imaging (78185) | $1,860 | $1,860 | 4.7× |
| Stereotactic Body Radiation Delivery (77373) | $8,841 | $8,841 | 5.0× |
| Sternoclavicular joints (71130) | $640 | $640 | 7.5× |
| Superior sagittal sinus venogram (75870) | $8,295 | $8,295 | 2.7× |
| Tbs technical calculation only (77091) | $623 | $623 | 7.3× |
| Telethx isodose pln cplx w/basic dosimetry (77307) | $1,964 | $1,964 | 5.4× |
| Telethx isodose pln smpl w/dosimetry calculation (77306) | $1,121 | $1,121 | 3.1× |
| Testicular Imaging W/Flow (78761) | $1,860 | $1,860 | 4.7× |
| Ther Rad Simulaj-Aided Field Setting Complex (77290) | $1,964 | $1,964 | 5.4× |
| Ther Rad Simulaj-Aided Field Setting Intermed (77285) | $1,964 | $1,964 | 5.4× |
| Ther rad simulaj-aided field setting simple (77280) | $1,121 | $1,121 | 8.5× |
| Thoracic spine 2 views (72070) | $1,057 | $1,057 | 10.3× |
| Thoracic spine 3 views (72072) | $1,057 | $1,057 | 10.3× |
| Thoracolumbar 2 views (72080) | $640 | $640 | 7.5× |
| Thyroid Imaging With Vascular Flow (78013) | $1,860 | $1,860 | 4.7× |
| Thyroid Met Imaging Body (78018) | $1,860 | $1,860 | 3.5× |
| Thyroid Uptake Measurement (78012) | $1,860 | $1,860 | 4.7× |
| Thyroid Uptake W/Blood Flow Sngle/Mult Quan Meas (78014) | $1,860 | $1,860 | 4.7× |
| Tx Devices Design & Construction Complex (77334) | $1,964 | $1,964 | 5.4× |
| Tx devices design & construction intermediate (77333) | $1,121 | $1,121 | 8.5× |
| Tx devices design & construction simple (77332) | $723 | $723 | 5.5× |
| Ultrasound Breast Limited (76642) range across 4 matching MRF lines |
$876–$2,165 | $876–$2,165 | varies |
| Ultrasound elastography first target lesion (76982) | $1,165 | $1,165 | 11.4× |
| Ultrasound Elastography Parenchyma (76981) | $969 | $969 | 9.5× |
| Ultrasound Exam Aaa Screen (76706) | $1,532 | $1,532 | 15.0× |
| Ultrasound trgt dynamic microbubble 1st lesion (76978) | $2,040 | $2,040 | 6.0× |
| Ultrasound, abdomen limited (76705) range across 6 matching MRF lines |
$1,463–$1,806 | $1,463–$1,806 | varies |
| Umbilical-artery Doppler (OB) (76820) | $1,143 | $1,143 | 11.2× |
| Unlisted Dx Radiographic Procedure (76499) range across 3 matching MRF lines |
$756–$796 | $756–$796 | varies |
| Unlisted fluoroscopic procedure (76496) | $756 | $756 | 8.9× |
| Unlisted magnetic resonance procedure (76498) | $2,048 | $2,048 | 24.0× |
| Unlisted Miscellaneous Px Dx Nuclear Medicine (78999) | $1,860 | $1,860 | 4.7× |
| Unlisted us procedure (76999) range across 2 matching MRF lines |
$876–$1,081 | $876–$1,081 | varies |
| Upper gi w/o kub (74240) | $959 | $959 | 5.6× |
| Urea Breath Test C-14 Isotopic Acquisj Analysis (78267) | $326 | $326 | 29.5× |
| Urea breath test c-14 isotopic analysis (78268) | $326 | $326 | 3.5× |
| Ureteral Reflux Study (78740) | $1,860 | $1,860 | 4.7× |
| Urethrocystogram voiding (74455) | $3,350 | $3,350 | 14.3× |
| Urethrocystography retrograde (74450) | $1,828 | $1,828 | 7.8× |
| Us breast unilateral complete (76641) range across 3 matching MRF lines |
$1,081–$2,165 | $1,081–$2,165 | varies |
| Us chest (76604) range across 4 matching MRF lines |
$876–$1,081 | $876–$1,081 | varies |
| Us complete joint (76881) | $1,670 | $1,670 | 16.3× |
| Us exam, pelvic, limited (76857) range across 3 matching MRF lines |
$876–$1,081 | $876–$1,081 | varies |
| Us head (76506) | $1,081 | $1,081 | 10.6× |
| Us kidney transplant (76776) | $1,806 | $1,806 | 17.6× |
| Us lmtd joint/oth nonvasc xtr strux r-t w/img (76882) range across 7 matching MRF lines |
$1,000–$1,622 | $1,000–$1,622 | varies |
| Us ob detailed single fetus (76811) | $1,806 | $1,806 | 7.7× |
| Us ob limited 1 or more fetuses (76815) range across 2 matching MRF lines |
$1,463–$1,806 | $1,463–$1,806 | varies |
| Us ob transvaginal (76817) range across 2 matching MRF lines |
$1,463–$1,806 | $1,463–$1,806 | varies |
| Us pelvic non ob complete (76856) | $1,806 | $1,806 | 17.6× |
| Us pg uter img f&mat 14 wk tabdl 1/1st gestation (76801) | $1,806 | $1,806 | 17.6× |
| Us preg uterus real time f/u trnsabdl per fetus (76816) | $1,081 | $1,081 | 10.6× |
| Us retroperitoneal complete (76770) range across 2 matching MRF lines |
$1,463–$1,806 | $1,463–$1,806 | varies |
| Us retroperitoneal limited (76775) range across 3 matching MRF lines |
$1,463–$1,806 | $1,463–$1,806 | varies |
| Us scrotum and contents (76870) | $1,806 | $1,806 | 17.6× |
| Us spinal canal and contents (76800) | $1,613 | $1,613 | 15.7× |
| Us thyroid (76536) range across 2 matching MRF lines |
$1,463–$1,806 | $1,463–$1,806 | varies |
| Us transrectal (76872) | $1,806 | $1,806 | 17.6× |
| Vascular Flow Imaging (78445) | $1,860 | $1,860 | 4.7× |
| Vein X-Ray Chest (75827) | $8,295 | $8,295 | 5.4× |
| Vein X-Ray Liver W/O Hemodyn (75887) | $8,295 | $8,295 | 2.7× |
| Vein X-Ray Spleen/Liver (75810) | $7,615 | $7,615 | 2.5× |
| Venogram Sinus/Jugular (75860) | $7,615 | $7,615 | 2.5× |
| Venography Adrenal Unilateral (75840) | $28,134 | $28,134 | 9.1× |
| Venography caval inferior serialography rs&i (75825) | $7,615 | $7,615 | 2.5× |
| Venography extremity bilateral rs&i (75822) | $8,295 | $8,295 | 5.4× |
| Venography extremity unilateral rs&i (75820) | $9,377 | $9,377 | 6.1× |
| Venography Renal Bilateral (75833) | $7,615 | $7,615 | 2.5× |
| Venography Renal Unilateral (75831) | $7,615 | $7,615 | 2.5× |
| Venous sampling by catheter (75893) | $7,615 | $7,615 | 1.4× |
| Venous thrombosis imaging (78457) | $929 | $929 | 1.7× |
| Venous Thrombosis Imaging Venogram Bilateral (78458) | $1,860 | $1,860 | 4.7× |
| Vertebral fracture assessment via dxa (77086) | $756 | $756 | 8.9× |
| Wrist 2 views (73100) range across 3 matching MRF lines |
$640–$1,275 | $640–$1,275 | varies |
| X-Ray Ac Jts - Xr Acromioclavicular Joints Bilateral (73050) | $640 | $640 | 7.5× |
| X-ray antegrade pyelogram tube (74425) | $3,350 | $3,350 | 9.8× |
| X-Ray Aorta Leg Arteries (75630) | $7,615 | $7,615 | 2.5× |
| X-Ray Bend Only L-S Spine (72120) | $640 | $640 | 6.2× |
| X-Ray Elbow 2 Vw - Xr Elbow 1-2 Views Right (73070) range across 3 matching MRF lines |
$640–$1,275 | $640–$1,275 | varies |
| X-Ray Exam Breast Specimen (76098) | $1,376 | $1,376 | 2.6× |
| X-Ray Exam Entire Spi 1 Vw (72081) | $640 | $640 | 7.5× |
| X-Ray Exam Entire Spi 2/3 Vw (72082) | $1,057 | $1,057 | 10.3× |
| X-Ray Exam Entire Spi 4/5 Vw (72083) | $2,016 | $2,016 | 19.7× |
| X-Ray Exam Hip Uni 1 View (73501) | $640 | $640 | 7.5× |
| X-Ray Exam Hip Uni 2-3 Views (73502) | $640 | $640 | 7.5× |
| X-Ray Exam Hip Uni 4/> Views (73503) | $1,057 | $1,057 | 10.3× |
| X-Ray Exam Hips Bi 2 Views (73521) | $1,057 | $1,057 | 10.3× |
| X-Ray Exam Hips Bi 3-4 Views (73522) | $1,057 | $1,057 | 10.3× |
| X-Ray Exam Hips Bi 5/> Views (73523) | $2,016 | $2,016 | 19.7× |
| X-Ray Exam L-S Spine Bending (72114) | $1,057 | $1,057 | 10.3× |
| X-Ray Exam Neck Spine 2-3 Vw (72040) | $1,057 | $1,057 | 12.4× |
| X-Ray Exam Neck Spine 6/>Vws (72052) | $1,057 | $1,057 | 10.3× |
| X-Ray Exam Unilat Ribs/Chest (71101) | $1,057 | $1,057 | 10.3× |
| X-ray eye for foreign body (70030) range across 3 matching MRF lines |
$579–$1,158 | $579–$1,158 | varies |
| X-ray head for orthodontia (70350) | $640 | $640 | 7.5× |
| X-ray humerus (73060) range across 3 matching MRF lines |
$640–$1,275 | $640–$1,275 | varies |
| X-ray IV pyelogram (ivp) (74400) | $1,828 | $1,828 | 10.6× |
| X-ray IV pyelogram+tomography (74415) | $1,828 | $1,828 | 10.6× |
| X-Ray Jaw <4 Vw - Xr Mandible < 4 Views (70100) | $640 | $640 | 7.5× |
| X-Ray Knee Bilat Standing - Xr Knees Anteroposterior Standing Bilat (73565) | $640 | $640 | 7.5× |
| X-Ray Lumbar Spine 2/3 Vw - Xr Lumbar Spine 2-3 Views (72100) | $1,057 | $1,057 | 10.3× |
| X-ray nose-rectum child f.b. (76010) | $1,828 | $1,828 | 21.4× |
| X-Ray Ribs, Chest 4+ Vw - Xr Ribs 3 Vws Bil W/ Chest Posteroanterior (71111) | $1,057 | $1,057 | 10.3× |
| X-Ray Sacroiliac Jts 3+ Vw - Xr Sacroiliac Joints 3+ Views (72202) | $1,057 | $1,057 | 10.3× |
| X-Ray Sacroiliac Jts <3 Vw - Xr Sacroiliac Joints 1-2 Views (72200) | $1,057 | $1,057 | 10.3× |
| X-Ray Sacrum/Coccyx 2+ Vw - Xr Sacrum Coccyx 2+ Views (72220) | $640 | $640 | 7.5× |
| X-Ray Sinuses 3+ Vw - Xr Paranasal Sinuses 3+ Views (70220) | $640 | $640 | 7.5× |
| X-Ray Skull 4+ Vw - Xr Skull Complete 4+ Views (70260) | $1,057 | $1,057 | 10.3× |
| X-ray thoracic spine 4 vw (72074) | $1,057 | $1,057 | 10.3× |
| X-Ray Urinary Tract Exam With Contrast Material (74420) | $3,350 | $3,350 | 9.8× |
| X-Rays Bone Length Studies (77073) | $640 | $640 | 6.2× |
| X-Rays Bone Survey Complete (77075) | $1,057 | $1,057 | 10.3× |
| Xr c-spine 4 or 5 views (72050) | $1,057 | $1,057 | 10.3× |
| Xr facial bones less than 3 views (70140) | $640 | $640 | 7.5× |
| Xr orbits complete 4 views (70200) | $1,057 | $1,057 | 10.3× |
| Xr Tomogram Single Plane (76100) | $959 | $959 | 9.4× |
A range means this hospital published different amounts on matching machine-readable-file lines. We show the lowest–highest posted amount because we cannot tell from the published file which line would apply to a particular visit.