Imaging prices at UVA Health Prince William Medical Center

Manassas, VA · every code in this section with a posted price and a Medicare benchmark.

458 codes. Prices are the hospital's own posted facility charges.

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ProcedurePosted cashPosted gross× Medicare
3-D radiotherapy plan dose-volume histograms (77295) $6,036 $12,072 4.2×
Abdomen 1 View (74018) $205 $410 2.3×
Abdomen 2 views (74019) $207.50 $415 1.9×
Acute Gastrointestinal Blood Loss Imaging (78278) $529 $1,058 1.3×
Angio internal mammary (75756) $1,728 $3,456 0.5×
Angio pulmonary bilat (75743) $7,500 $15,000 2.3×
Angiography extremity bilateral rs&i (75716) $2,115 $4,230 0.6×
Angiography extremity unilateral rs&i (75710) $14,170.43 $28,340.87 4.3×
Angiography pulmonary unilateral slctv rs&i (75741) $1,593 $3,186 0.5×
Angrph pulmonary nonslctv cath/ven njx rs&i (75746) $1,663.50 $3,327 0.5×
Ankle 2 views (73600)
range across 2 matching MRF lines		 $261.50–$392.50 $523–$785 varies
Aortography thoracic serialography rs&i (75605) $3,460.50 $6,921 0.6×
Aortography thoracic w/o serialography rs&i (75600) $1,282 $2,564 0.4×
Artery X-Rays Abdomen (75726) $23,411.92 $46,823.84 4.1×
Artery X-Rays Pelvis (75736)
range across 2 matching MRF lines		 $19,004.49–$19,702.09 $38,008.98–$39,404.18 varies
Artery X-Rays Spine (75705)
unusually low: confirm this is the full procedure		 $2,748.50 $5,497 0.5×
Arthrogram ankle (73615) $664.50 $1,329 1.8×
Arthrogram hip (73525) $2,406.25 $4,812.50 6.7×
Arthrogram Wrist (73115) $586 $1,172 1.6×
Basic radiation dosimetry calculation (77300) $633.50 $1,267 4.6×
Bone age studies (77072) $113 $226 1.0×
Bone Imaging 3 Phase (78315) $1,691.50 $3,383 4.1×
Bone Imaging Limited Area (78300) $2,499.50 $4,999 6.0×
Bone Imaging Whole Body (78306) $1,588 $3,176 3.8×
Bone marrow imaging limited area (78102) $548 $1,096 1.3×
Bone marrow imaging; multiple areas (78103) $798 $1,596 1.9×
Bone marrow imaging; whole body (78104) $547 $1,094 1.3×
Bone survey infant (77076) $692 $1,384 6.4×
Brachytx isodose complex (77318) $682.50 $1,365 1.8×
Brachytx isodose intermed (77317) $682 $1,364 1.8×
Brachytx Isodose Plan Simple (77316) $290 $580 0.7×
Brain Imaging Min 4 Static Views W Vascular Flow (78606) $1,050 $2,100 1.9×
Brain Imaging Pet Metabolic Evaluation (78608) $8,492.50 $16,985 5.7×
Cardiac MRI w/w/o contrast & further seq (75561) $1,090.50 $2,181 3.0×
Cardiac MRI w/w/o contrast w/stress (75563) $1,148.50 $2,297 1.4×
Cat Scan Follow-Up Study (76380) $486 $972 5.4×
Cerebrospinal Fluid Flow W/O Matl Shunt Evaltj (78645) $1,217.50 $2,435 2.2×
Cerebrospinal Fluid Scan (78630) $418.50 $837 0.7×
Chest 1 view (71045) $186.50 $373 2.1×
Chest 2 views (71046) $249.50 $499 2.8×
Chest 3 views (71047) $186.50 $373 2.1×
Chest 4 or more views (71048) $250 $500 2.3×
Chg us nrv&acc strux 1 xtr compre w/img pr extremity (76883) $131.50 $263 1.2×
Cineradiograpy/vidradiograpy xcpt where spec (76120) $329.50 $659 3.0×
Cisternography Positive Contrast Rs&I (70015) $491 $982 0.6×
Clavicle complete (73000)
range across 2 matching MRF lines		 $202–$303 $404–$606 varies
Computed Tomography Thorax Lw Dose Lng Ca Scr C- (71271) $226.50 $453 2.1×
Continuing medical physics consltj pr wk (77336) $957 $1,914 6.9×
Contrast Exam Abdominl Aorta (75625) $2,128.50 $4,257 0.7×
Contrast X-Ray Bladder (74430) $967.50 $1,935 2.7×
Contrast X-Ray Of Elbow (73085) $1,646.33 $3,292.67 4.6×
Contrast X-Ray Of Knee Joint (73580) $640 $1,280 1.8×
Contrast Xray Throat/Cerv Esopha (74210) $744 $1,488 4.1×
CT abdomen and pelvis without and with contrast (74178) $2,292.16 $4,584.32 6.4×
CT abdomen and pelvis without contrast (74176) $1,470 $2,940 6.0×
CT abdomen w contrast (74160) $1,197 $2,394 6.6×
CT abdomen w wo contrast (74170) $2,117.66 $4,235.32 11.7×
CT abdomen w/o contrast (74150) $997.50 $1,995 9.2×
CT Angio Abdomen and Pelvis (74174) $2,525.50 $5,051 7.0×
CT Angio Chest (71275) $1,601.50 $3,203 8.8×
CT Angio Head (70496) $1,389 $2,778 7.7×
CT angio hrt w/3d image (75574)
range across 2 matching MRF lines		 $1,283.73–$1,317.65 $2,567.47–$2,635.31 varies
Ct Angio Lwr Extr W/O&W/Dye (73706)
range across 2 matching MRF lines		 $895–$1,342.50 $1,790–$2,685 varies
CT Angio Neck (70498) $1,389 $2,778 7.7×
Ct Angio Upr Extrm W/O&W/Dye (73206) $804.50 $1,609 4.4×
CT bone density (77078) $470.50 $941 5.2×
CT Cere Prfuj Alys C+ W/O CT/Cta Same Anatomy (70473) $1,392.50 $2,785 7.7×
CT cervical spine w/ contrast (72126) $1,304.50 $2,609 3.6×
CT cervical spine w/o contrast (72125) $1,087.50 $2,175 10.1×
CT cervical spine w/wo cont (72127) $2,044 $4,088 11.3×
CT chest w contrast (71260) $1,150 $2,300 6.3×
CT chest w/wo contrast (71270) $1,801.50 $3,603 9.9×
CT colonography screening (74263) $277 $554 1.1×
CT Colonogrphy Dx Image Postprocess W/Contrast (74262) $264 $528 1.5×
CT colonogrphy dx image postprocess w/o contrast (74261) $247.50 $495 2.3×
CT head/brain with contrast (70460) $1,219.50 $2,439 6.7×
CT head/brain without and with contrast (70470) $1,911 $3,822 10.5×
CT heart contrast eval cardiac structure&morph (75572) $1,090 $2,180 3.0×
CT heart no contrast quant eval coronry calcium (75571) $120 $240 1.3×
CT hrt w/3d image congen (75573) $3,110 $6,220 8.6×
CT iac w contrast (70481) $1,218.50 $2,437 6.7×
CT l-spine w&w/o contrast (72133) $1,678 $3,356 9.2×
CT lower ext w/o (73700)
range across 2 matching MRF lines		 $591.50–$887.50 $1,183–$1,775 varies
CT lower extremity w/contrast material (73701)
range across 2 matching MRF lines		 $710–$1,065 $1,420–$2,130 varies
CT lumbar spine w contrast (72132) $1,071 $2,142 3.0×
CT lumbar spine w/o contrast (72131) $892.50 $1,785 8.3×
CT maxillofacial w contrast (70487) $1,260 $2,520 6.9×
CT maxillofacial wo contrast (70486) $1,050 $2,100 9.7×
CT neck tissue combo (70492) $2,151.50 $4,303 11.9×
Ct Orbit/Ear/Fossa W/O&W/Dye (70482) $1,909 $3,818 10.5×
CT orbits w/o contrast (70480) $1,015.50 $2,031 9.4×
CT pelvis w&w/o contrast (72194) $1,260 $2,520 6.9×
CT pelvis w/o contrast (72192) $892.50 $1,785 8.3×
CT scan of leg combo (73702) $1,112.50 $2,225 6.1×
CT scans face/jaw combo (70488) $1,974 $3,948 10.9×
CT soft tissue neck w contrast (70491) $1,373.50 $2,747 7.6×
CT soft tissue neck w/o contrast (70490) $1,144.50 $2,289 10.6×
CT thoracic spine w contrast (72129) $1,304.50 $2,609 7.2×
CT thoracic spine w/o contrast (72128) $1,087.50 $2,175 10.1×
CT thoracic spine w/wo cont (72130) $2,044 $4,088 11.3×
CT thorax w/o contrast (71250) $958 $1,916 8.9×
CT upper ext wo (73200)
range across 2 matching MRF lines		 $576–$864 $1,152–$1,728 varies
CT upper extremity w/o & w/contrast material (73202) $1,082.50 $2,165 6.0×
CT upper extremity with contrast (73201)
range across 2 matching MRF lines		 $691–$1,036.50 $1,382–$2,073 varies
Cta Abdl Aorta&Bi Iliofem W/Contrast&Postp (75635) $1,421 $2,842 7.8×
Cta Abdomen (74175) $1,568 $3,136 8.6×
CTA head&neck c+ w/noncontrast img&post-pxessing (70471) $1,392.50 $2,785 3.9×
CTA pelvis (72191) $997.50 $1,995 5.5×
Dilation ureters/urethra rs&i (74485) $1,505.50 $3,011 0.7×
Discography Cerv/Thor Spine (72285) $1,953.50 $3,907 1.0×
Diskography lumbar (72295) $1,848 $3,696 0.9×
Doppler Echo Fetal Puls Spectral F/U/Repeat (76828) $479.50 $959 4.4×
Doppler Echo Fetal Spectral Display Complete (76827) $1,164.50 $2,329 10.8×
Doppler Fetal Mid Cerebral Artery (76821) $488.50 $977 4.5×
Dxa Bone Density Axial (77080) $585.50 $1,171 5.4×
Dxa bone density study (77085) $453.50 $907 4.2×
Dxa bone density study 1/>sites appendiclr skel (77081) $269 $538 3.0×
Echo exam of fetal heart (76825) $1,361 $2,722 2.4×
Echo exam uterus (76831) $612.50 $1,225 2.5×
Echo Guide For Artery Repair (76936) $1,054.50 $2,109 4.7×
Echocardiography, fetal, cardiovascular system, real time with image documentation (2D), with or without M-mode… (76826) $1,201 $2,402 4.9×
Echograp Trans R Pros Study (76873) $1,060 $2,120 9.8×
Esophageal Motility Study (78258) $524.50 $1,049 1.3×
Esophagram (74220) $379.50 $759 2.1×
Fetal Biophys Profile W/Nst (76818) $276 $552 2.6×
Fetal Biophysical Profile W/O Non-Stress Testing (76819) $353.50 $707 3.3×
Fetal MRI w/placntl matrnl plvc img sing/1st ges (74712) $746.50 $1,493 3.0×
Fluoroscopy up to 1 hr (76000)
range across 2 matching MRF lines		 $13,834.52–$14,167.38 $27,669.04–$28,334.76 varies
Follow-Up Angiography (75898) $895.50 $1,791 0.3×
Foot 2 views (73620)
range across 2 matching MRF lines		 $260–$390 $520–$780 varies
Forearm 2 views (73090)
range across 2 matching MRF lines		 $263–$394.50 $526–$789 varies
Gastric emptying imaging study (78264) $1,386 $2,772 3.4×
Gastric Emptyng Imag Std W/Sm Bwl Transit (78265) $2,448 $4,896 5.9×
Gastric Mucosa Imaging (78261) $749.50 $1,499 1.8×
Gastroesophageal Reflux Exam (78262) $885.50 $1,771 2.1×
Gated Heart Planar Single (78472) $1,719.50 $3,439 4.2×
Gstrc Emptng Imag Std W/Sm Bwl Col Trnst Mlt Day (78266) $2,284.50 $4,569 4.1×
Hand 2 views (73120)
range across 2 matching MRF lines		 $250–$375 $500–$750 varies
Hdr Rdncl Ntrstl/Icav Brchtx (77772) $551.50 $1,103 0.8×
Hdr Rdncl Ntrstl/Icav Brchtx (77771) $551.50 $1,103 0.8×
Hdr Rdncl Ntrstl/Icav Brchtx 1 Channel (77770) $551.50 $1,103 0.8×
Heart Image (Pet) Multiple (78492) $3,519 $7,038 2.4×
Hepatc Vngrph Wdg/Fr Hemodyn Eval Rs&I (75889) $1,794.50 $3,589 0.5×
Hepatc Vngrph Wdg/Fr W/O Hemodyn Eval Rs&I (75891) $1,185 $2,370 0.4×
Hepatobil Syst Image W/Drug (78227) $1,583 $3,166 2.8×
Hepatobiliary System Imaging (78226) $489 $978 1.2×
Ht Muscle Image Spect Sing (78451) $1,567 $3,134 1.2×
Hysterosalpingogram (74740) $1,076.20 $2,152.40 4.4×
Infant hip ultrasound with hip movement (dynamic) (76885) $304 $608 3.4×
Infant hip ultrasound, limited static exam (76886) $1,146 $2,292 12.7×
Infusion Ivp (74410) $732 $1,464 4.0×
Interstitial radiation source applic complex (77778) $2,165 $4,330 3.0×
Intracavitary Radiation Source Applic Complex (77763) $2,407.50 $4,815 3.3×
Intracavitary Radiation Source Applic Intermed (77762) $2,008.50 $4,017 3.5×
Intracavitary radiation source applic simple (77761) $1,235 $2,470 2.2×
Joint Survey Single View (77077) $105.50 $211 1.0×
K Flow/Funct Image Multiple (78709) $908.50 $1,817 1.6×
K Flow/Funct Image W/Drug (78708) $1,119.50 $2,239 2.0×
K Flow/Funct Image W/O Drug (78707) $539 $1,078 1.0×
Knee 3 Views (73562)
range across 2 matching MRF lines		 $293.50–$440.50 $587–$881 varies
Leveen/Shunt Patency Exam (78291) $1,176 $2,352 2.8×
Liver & Spleen Imaging Static Only (78215) $760.50 $1,521 1.8×
Liver imaging w/vascular flow (78202) $482 $964 0.9×
Lung Perf&Ventilat Diferentl (78598) $405 $810 0.7×
Lung perfusion differential (78597) $1,470 $2,940 3.6×
Lung Ventilat&Perfus Imaging (78582) $912 $1,824 1.6×
Lung Ventilation Imaging (78579) $355 $710 0.9×
Lymph System Imaging (78195)
range across 2 matching MRF lines		 $3,008.15–$3,614.80 $6,016.31–$7,229.60 varies
Lymphangiography Extremity Only Bilateral Rs&I (75803) $752 $1,504 0.5×
Lymphangiography Pelvic/Abdominal Bilateral Rs&I (75807) $408.50 $817 0.1×
Lymphangiography, pelvic/abdominal, unilateral (75805) $378.50 $757 0.1×
Magnetic Image Jaw Joint (70336) $717.50 $1,435 2.9×
Magnetic resonance (eg, proton) imaging, brain (including brain stem andskull base), during open intracranial procedure… (70558) $2,173 $4,346 12.0×
Magnetic resonance (eg, proton) imaging, brain (including brain stem andskull base), during open intracranial procedure… (70557) $1,810.50 $3,621 3.2×
Magnetic resonance (eg, proton) imaging, brain (including brain stem andskull base), during open intracranial procedure… (70559) $3,404 $6,808 18.8×
Magnetic Resonance Elastography (76391) $455.50 $911 1.8×
Mammary ductogram or galactogram multiple (77054) $505 $1,010 2.0×
Mammary ductogram or galactogram single (77053) $201.50 $403 0.8×
Meckels Divert Exam (78290) $521.50 $1,043 1.3×
Medical physics dose eval radiation expos w/rprt (76145) $157 $314 0.4×
Mlc imrt design & construction per imrt plan (77338) $2,000.50 $4,001 5.2×
Mr safety determination physician/other qhp (76016) $115.50 $231 1.3×
Mr safety implant&/fb assmt clin staf 1st 15 min (76014) $65.50 $131 2.2×
Mr safety implt electronics prepj supvj phys/qhp (76018) $121 $242 1.2×
Mr safety implt pos&/immoblj (76019) $78 $156 1.3×
Mr safety med physics xm customization plng&mntr (76017) $317 $634 1.3×
Mra Head W/O & W/Contrast Material (70546) $1,830.50 $3,661 5.1×
MRA head w/o contrast (70544) $974 $1,948 3.9×
MRA head with contrast (70545) $1,168.50 $2,337 3.2×
MRA neck w contrast (70548) $1,764 $3,528 4.9×
Mra Neck W/O &W/Contrast Material (70549) $2,763.50 $5,527 7.7×
MRA neck w/o contrast (70547) $1,470 $2,940 6.0×
MRI abdomen w contrast (74182) $1,178 $2,356 3.3×
MRI abdomen w/o contrast (74181)
range across 2 matching MRF lines		 $982–$1,216 $1,964–$2,432 varies
MRI any jt lower extrem w/contrast material (73722) $1,005 $2,010 1.2×
MRI any jt lower extrem w/o & w/contrast matrl (73723) $1,574.50 $3,149 4.4×
MRI any jt upper extremity w/contrast matrl (73222)
range across 2 matching MRF lines		 $2,337.25–$2,373.25 $4,674.51–$4,746.50 varies
MRI bone marrow blood supply (77084) $992.50 $1,985 4.0×
MRI brain functional w/o physician admnistration (70554) $756.50 $1,513 3.1×
MRI brain functional w/physician admnistration (70555) $439.50 $879 1.8×
MRI Breast W/O Contrast Bilateral (77047) $1,421.50 $2,843 5.8×
MRI Breast Without Contrast Material Unilateral (77046) $2,612.50 $5,225 10.6×
MRI cardiac w/o cont stress (75559) $548 $1,096 1.0×
MRI cardiac w/o contrast (75557) $924.50 $1,849 3.7×
MRI cervical spine w contrast (72142) $1,342 $2,684 3.7×
MRI cervical spine w/o cont (72141) $1,118.50 $2,237 4.5×
MRI chest w/o contrast (71550) $1,050 $2,100 4.3×
MRI chest with contrast (71551) $1,260 $2,520 1.6×
MRI chest wo w contrast (71552) $1,974 $3,948 5.5×
MRI lower extrem oth/thn jt w/contrast matrl (73719) $674 $1,348 1.9×
MRI lower extrem oth/thn jt w/o & w/contr matr (73720) $1,056.50 $2,113 2.9×
MRI lower extrem oth/thn jt w/o contr matrl (73718) $562 $1,124 2.3×
MRI lumbar spine w contrast (72149) $1,342 $2,684 3.7×
Mri Neck Spine W/O & W/Dye (72156) $2,102 $4,204 5.8×
MRI orbit face &/neck w/o contrast (70540) $840 $1,680 3.4×
MRI orbit face neck w contrast (70542) $1,008 $2,016 2.8×
Mri Orbt/Fac/Nck W/O &W/Dye (70543) $1,579 $3,158 4.4×
MRI pelvis w contrast (72196) $1,304 $2,608 3.6×
MRI pelvis w/o & w contrast (72197) $2,043.50 $4,087 5.7×
MRI pelvis w/o contrast (72195) $1,087 $2,174 4.4×
MRI spectroscopy (76390)
range across 2 matching MRF lines		 $463.50–$1,722 $927–$3,444 varies
MRI thoracic spine w/o contrast (72146) $1,118.50 $2,237 4.5×
MRI upper extremity oth than jt w/contr matrl (73219) $861 $1,722 2.4×
MRI upper extremity oth than jt w/o contr matrl (73218) $717.50 $1,435 2.9×
Mri Uppr Extremity W/O&W/Dye (73220) $1,349.50 $2,699 3.7×
MRI, abdomen, combo (74183)
range across 2 matching MRF lines		 $1,755.50–$1,846 $3,511–$3,692 varies
MRI, dorsal spine combo (72157) $2,102 $4,204 5.8×
MRI, dorsal spine contrast (72147) $1,342 $2,684 3.7×
MRI, joint upper extrem (73221)
range across 2 matching MRF lines		 $984.50–$1,477 $1,969–$2,954 varies
MRI, joint upper extrem combo (73223) $1,850.50 $3,701 5.1×
MRI, lumbar spine combo (72158) $2,102 $4,204 5.8×
Myelogram cervical (72240) $1,283.50 $2,567 1.6×
Myelogram Lumbar (72265) $820 $1,640 1.0×
Myelograpy 2/more regions rs&i (72270) $1,536.50 $3,073 1.9×
Myocardial Imaging Infarct Avid Planar Qual/Quan (78466) $736.50 $1,473 1.8×
Myocardial Imaging Pet Metabolic Evaluation (78459) $4,829 $9,658 3.6×
Myocardial Spect Multiple Studies (78452) $3,257 $6,514 2.4×
Myocrd Img Pet Metab Eval Single Study Cncrnt CT (78429) $3,341 $6,682 2.3×
Myocrd img PET prfuj 1std rest/stress cncrnt CT (78430) $6,515.50 $13,031 4.4×
Myocrd Img Pet Prfuj Mlt Std Rst&Strs Cncrnt CT (78431) $9,377.50 $18,755 4.1×
Myocrd Img Pet Prfuj W/Metab 2rtracer Cncrnt CT (78433) $8,752 $17,504 3.8×
Myocrd Img Pet Prfuj W/Metab Dual Radiotracer (78432) $5,209.50 $10,419 3.3×
N-invas est c ffr sw aly CTA (75580) $1,309 $2,618 1.5×
Neck soft tissue (70360) $292.50 $585 3.2×
Nfs/Instlj Radioelmnt Sln 3 Mo Follow-Up Care (77750) $637 $1,274 1.6×
Njx Rp Loclzj Non-Img Probe Study Intravenous (78808) $536.50 $1,073 1.3×
Nm csf leak detection (78650) $1,183.50 $2,367 0.9×
Nm myocard infarct spect (78469) $1,019 $2,038 1.8×
Nonvascular Shunt X-Ray (75809) $156.50 $313 1.4×
Ntsty modul radthx pln dose-vol histos (77301) $7,621 $15,242 5.3×
Nuclear Rx Oral Admin (79005) $1,869.50 $3,739 7.7×
Ob us nuchal meas 1 gest (76813) $868.50 $1,737 8.0×
Oph bmtry us echograpy a-scan io lens pwr cal (76519) $143 $286 1.3×
Oph us dx ant sgm us immersion b-scan/hr biom (76513) $240.50 $481 2.2×
Ophthalmic ultrasound dx b-scan w/wo a-scan (76512) $519 $1,038 4.8×
Ophthalmic US Dx Corneal Pachymetry Uni/Bi (76514) $302.50 $605 10.1×
Ophthalmic us dx quantitative a-scan only (76511) $134 $268 1.2×
Optic foramina (70190) $55.50 $111 0.6×
Panoramic X-ray of jaws (70355) $619.50 $1,239 6.9×
Parathyroid imaging w/tomographic spect & CT (78072) $1,996.50 $3,993 3.6×
Parathyroid Planar Imaging (78070) $712.50 $1,425 1.7×
Parathyroid planar imaging w/wo subtraction (78071) $939 $1,878 2.3×
Pelvis 1 or 2 views (72170) $270 $540 2.5×
Perineogram (74775) $305.50 $611 1.2×
Peritoneogram Rs&I (74190) $266.50 $533 0.5×
Pet Image W/Ct Lmtd (78814)
range across 2 matching MRF lines		 $2,650–$4,250 $5,300–$8,500 varies
PET image w/CT, full body (78816)
range across 3 matching MRF lines		 $1,150–$4,717.50 $2,300–$9,435 varies
PET imaging CT attenuation skull base mid-thigh (78815)
range across 2 matching MRF lines		 $1,150–$4,717.50 $2,300–$9,435 varies
Pet Myocardial Sngl Study (78491) $4,740 $9,480 3.2×
Prq Transhepatc Portograpy Hemodyn Eval Rs&I (75885) $1,167.50 $2,335 0.4×
Pulmonary Perfusion Imaging Particulate (78580) $678.50 $1,357 1.6×
Quan&Charac C Atherosclerotc Plaq Asses Sev C Ds (75577) $1,188 $2,376 1.2×
Radex Abd Compl Aqt Abd W/S/E/D Views 1 View Ch (74022) $241.50 $483 2.2×
Radex abscess/fistula/sinus tract rs&i (76080) $1,137.28 $2,274.56 2.0×
Radex Ankle Complete Minimum 3 Views (73610)
range across 2 matching MRF lines		 $301–$451.50 $602–$903 varies
Radex Calcaneus Minimum 2 Views (73650)
range across 2 matching MRF lines		 $218–$327 $436–$654 varies
Radex elbow complete minimum 3 views (73080)
range across 2 matching MRF lines		 $297.50–$446.50 $595–$893 varies
Radex Facial Bones Complete Minimum 3 Views (70150) $492 $984 4.5×
Radex fingr minimum 2 views (73140)
range across 2 matching MRF lines		 $256.50–$385 $513–$770 varies
Radex foot complete minimum 3 views (73630)
range across 2 matching MRF lines		 $299.50–$449.50 $599–$899 varies
Radex Hand Minimum 3 Views (73130)
range across 2 matching MRF lines		 $298–$447 $596–$894 varies
Radex lower extremity infant minimum 2 views (73592)
range across 2 matching MRF lines		 $335–$502.50 $670–$1,005 varies
Radex Mastoids Compl Minimum 3 Views PR Side (70130) $380.50 $761 3.5×
Radex Nasal Bones Complete Minimum 3 Views (70160) $275 $550 3.1×
Radex Ribs Unilateral 2 Views (71100) $279.50 $559 3.1×
Radex shoulder complete minimum 2 views (73030)
range across 2 matching MRF lines		 $261.50–$392.50 $523–$785 varies
Radex Sinuses Paransl < 3 Views (70210) $170 $340 1.9×
Radex sm int w/mlt srl imges via enteroclss tube (74251) $765 $1,530 4.2×
Radex Spine 1 View Specify Level (72020) $223.50 $447 2.5×
Radex Sternum Minimum 2 Views (71120) $144 $288 1.6×
Radex Temporomandble Jt Opn & Clsd Mouth Bilat (70330) $366 $732 4.1×
Radex Toe Minimum 2 Views (73660)
range across 2 matching MRF lines		 $259–$388.50 $518–$777 varies
Radex upper extremity infant minimum 2 views (73092)
range across 2 matching MRF lines		 $164–$246 $328–$492 varies
Radex Wrist Complete Minimum 3 Views (73110)
range across 2 matching MRF lines		 $301–$451.50 $602–$903 varies
Radex X-Ray Exam Entire Spi 6/> Vw - Xr Entire Spine 6+ Vw (72084) $551.50 $1,103 5.1×
Radiation Delivery Stereotactic Cranial Linear (77372) $13,762.50 $27,525 1.8×
Radiation treatment delivery level 1 (77402) $580 $1,160 5.5×
Radiation treatment delivery level 2 (77407) $511.50 $1,023 1.3×
Radiation treatment delivery level 3 (77412) $1,090 $2,180 1.9×
Radiolog exam mandible compl minimum 4 views (70110) $340.50 $681 3.1×
Radiologic Exam Abdomen 3+ Views - Xr Abdomen 3+ Views (74021) $210 $420 1.9×
Radiologic exam colon double contrast study (74280) $578.50 $1,157 3.2×
Radiologic exam colon single contrast study (74270) $506.50 $1,013 2.8×
Radiologic Exam Esophagus Double Contrast Study (74221) $392.50 $785 2.2×
Radiologic exam knee complete 4/more views (73564)
range across 2 matching MRF lines		 $334.50–$502 $669–$1,004 varies
Radiologic exam pelvis compl minimum 3 views (72190) $329.50 $659 3.0×
Radiologic Exam Small Int Single Contrast Study (74250) $369 $738 2.0×
Radiologic exam swallow function contrast study (74230) $379 $758 2.1×
Radiologic exam upr gi trc double contrast study (74246) $985 $1,970 5.4×
Radiologic examination femur 1 view (73551)
range across 2 matching MRF lines		 $45.50–$68.50 $91–$137 varies
Radiologic examination femur minimum 2 views (73552)
range across 2 matching MRF lines		 $238–$357 $476–$714 varies
Radiologic examination knee 1/2 views (73560)
range across 2 matching MRF lines		 $254–$381 $508–$762 varies
Radiologic Examination Osseous Survey Limited (77074) $224 $448 2.1×
Radiologic examination tibia & fibula 2 views (73590)
range across 2 matching MRF lines		 $262–$393 $524–$786 varies
Radiologic examination, internal auditory meati, complete Non-Facility (70134) $168.50 $337 0.3×
Radiologic examination, teeth; single view Non-Facility (70300) $86 $172 1.0×
Radiopharmaceutical therapy, by intra-articular administration Non-Facility (79440) $3,282.50 $6,565 13.6×
Remote afterloading high dose rate radionuclide skin surface brachytherapy, includes basic dosimetry, when performed;… (77768) $340.50 $681 0.9×
Remote afterloading high dose rate radionuclide skin surface brachytherapy, includes basic dosimetry, when performed;… (77767) $340.50 $681 0.9×
Renal Cyst Study (74470) $239.50 $479 0.4×
Ribs bilateral 3 views (71110) $282 $564 2.6×
Rp loclzj tum plnr 1 area single day imaging (78800) $265 $530 0.6×
Rp loclzj tum plnr 2+area 1+d img/1 area img>2+d (78801) $303.50 $607 0.7×
Rp Loclzj Tum Plnr Whole Body 2+ Days Imaging (78804) $1,236 $2,472 2.2×
Rp Loclzj Tum Plnr Whole Body Single Day Imaging (78802) $1,260.50 $2,521 2.2×
Rp Loclzj Tum Spect 1 Area Single Day Imaging (78803) $1,366 $2,732 2.4×
Rp loclzj tum spect 2 area/sep acquisj img (78831) $1,739.50 $3,479 1.3×
Rp loclzj tum spect CT 2area 1d img/1 ar img>2+d (78832) $3,664.50 $7,329 2.5×
Rp loclzj tum spect w/CT 1 area/acquisj 1day img (78830) $3,230.50 $6,461 2.4×
Rp Ther Radiolbld Monoclonal Antibody IV Infus (79403) $2,093 $4,186 8.7×
Rp Therapy Intravenous Administration (79101) $589.50 $1,179 2.4×
Salivary Gland Imaging (78230) $829 $1,658 2.0×
Scapula (73010)
range across 2 matching MRF lines		 $266–$399 $532–$798 varies
Screening Digital Breast Tomosynthesis Bi (77063) $460 $920 19.7×
Shoulder 1 view (73020) $224.50 $449 2.5×
Shoulder Arthrography (73040) $2,337.25 $4,674.51 6.5×
Skull less than 4 views (70250) $223 $446 2.1×
Special dosimetry (77331) $135 $270 1.0×
Special Physics Consult (77370) $640 $1,280 4.6×
Special teletherapy port plan (77321) $1,013.50 $2,027 2.6×
Special treatment procedure (77470) $1,994 $3,988 3.5×
Speech evaluation, complex (70371) $459.50 $919 1.9×
Srs Multisource (77371) $64,303.50 $128,607 8.4×
Stereotactic Body Radiation Delivery (77373) $36,582.50 $73,165 19.8×
Sternoclavicular joints (71130) $66 $132 0.7×
Superior sagittal sinus venogram (75870) $2,286.50 $4,573 0.7×
Surface Applic Low Dose Rate Radionuclide Source (77789) $411.50 $823 3.9×
Telethx isodose pln cplx w/basic dosimetry (77307) $3,786 $7,572 9.8×
Telethx isodose pln smpl w/dosimetry calculation (77306) $1,057 $2,114 2.7×
Ther Rad Simulaj-Aided Field Setting Complex (77290) $1,563.50 $3,127 4.0×
Ther Rad Simulaj-Aided Field Setting Intermed (77285) $1,154 $2,308 3.0×
Ther rad simulaj-aided field setting simple (77280) $753.50 $1,507 5.4×
Therapeutic Enema Rdctj Intussusception/Obstrcj (74283) $302.50 $605 1.7×
Thoracic spine 2 views (72070) $315 $630 2.9×
Thoracic spine 3 views (72072) $325.50 $651 3.0×
Thoracolumbar 2 views (72080) $354.50 $709 3.9×
Thyroid Carcinoma Metastases Img Lmtd Area (78015) $682 $1,364 1.6×
Thyroid Imaging With Vascular Flow (78013) $777 $1,554 1.9×
Thyroid Met Imaging Body (78018) $1,913.50 $3,827 3.4×
Thyroid Uptake Measurement (78012) $931 $1,862 2.3×
Thyroid Uptake W/Blood Flow Sngle/Mult Quan Meas (78014) $1,141 $2,282 2.8×
Tx Devices Design & Construction Complex (77334) $1,312.50 $2,625 3.4×
Tx devices design & construction intermediate (77333) $910 $1,820 6.5×
Tx devices design & construction simple (77332) $340 $680 2.4×
Ultrasound Breast Limited (76642)
range across 2 matching MRF lines		 $755–$898.50 $1,510–$1,797 varies
Ultrasound elastography first target lesion (76982) $879.50 $1,759 8.1×
Ultrasound Elastography Parenchyma (76981) $228 $456 2.1×
Ultrasound Exam Aaa Screen (76706) $734.50 $1,469 6.8×
Ultrasound trgt dynamic microbubble 1st lesion (76978) $1,155 $2,310 3.2×
Ultrasound, abdomen limited (76705) $647.50 $1,295 6.0×
Umbilical-artery Doppler (OB) (76820) $903.50 $1,807 8.4×
Unlisted Dx Radiographic Procedure (76499) $514.50 $1,029 5.7×
Unlisted fluoroscopic procedure (76496) $155 $310 1.7×
Unlisted hematopoietic, reticuloendothelial and lymphatic procedure, diagnostic nuclear medicine (78199) $281.50 $563 0.7×
Unlisted magnetic resonance procedure (76498) $2,801.50 $5,603 31.1×
Unlisted Procedure Clinical Brachytherapy (77799) $1,634 $3,268 15.5×
Unlisted respiratory px dx nuclear medicine (78599) $1,173.50 $2,347 2.8×
Unlisted us procedure (76999) $1,542.50 $3,085 17.1×
Upper gi w/o kub (74240) $607 $1,214 3.3×
Ureteral Reflux Study (78740) $957 $1,914 2.3×
Urethrocystogram voiding (74455) $307 $614 1.2×
Urethrocystography retrograde (74450) $623.50 $1,247 2.5×
Us breast unilateral complete (76641) $678 $1,356 6.3×
Us chest (76604) $377.50 $755 3.5×
Us complete joint (76881) $628 $1,256 5.8×
Us exam, pelvic, limited (76857) $423.50 $847 3.9×
Us head (76506) $699 $1,398 6.5×
Us kidney transplant (76776) $256 $512 2.4×
Us lmtd joint/oth nonvasc xtr strux r-t w/img (76882) $405 $810 3.7×
Us ob detailed single fetus (76811) $420 $840 1.7×
Us ob limited 1 or more fetuses (76815) $536 $1,072 5.0×
Us ob transvaginal (76817) $942 $1,884 8.7×
Us pelvic non ob complete (76856) $1,483 $2,966 13.7×
Us pg uter img f&mat 14 wk tabdl 1/1st gestation (76801) $525 $1,050 4.9×
Us preg uterus real time f/u trnsabdl per fetus (76816) $234.50 $469 2.2×
Us retroperitoneal complete (76770) $670 $1,340 6.2×
Us retroperitoneal limited (76775) $524 $1,048 4.8×
Us scrotum and contents (76870) $752 $1,504 7.0×
Us spinal canal and contents (76800) $605 $1,210 5.6×
Us thyroid (76536) $662 $1,324 6.1×
Us transrectal (76872) $1,234 $2,468 11.4×
Vascular Flow Imaging (78445) $962.50 $1,925 2.3×
Vein X-Ray Chest (75827) $969 $1,938 0.6×
Vein X-Ray Liver W/O Hemodyn (75887) $1,483 $2,966 0.5×
Vein X-Ray Spleen/Liver (75810) $1,200.50 $2,401 0.4×
Venogram Sinus/Jugular (75860) $2,118.50 $4,237 0.6×
Venography Adrenal Unilateral (75840) $1,200.50 $2,401 0.4×
Venography caval inferior serialography rs&i (75825) $3,726.50 $7,453 1.1×
Venography extremity bilateral rs&i (75822) $1,761.50 $3,523 1.1×
Venography extremity unilateral rs&i (75820)
range across 2 matching MRF lines		 $2,593.69–$6,885.69 $5,187.38–$13,771.39 varies
Venography Orbital Rs&I (75880) $371 $742 0.6×
Venography Renal Bilateral (75833) $13,153.08 $26,306.17 4.0×
Venography Renal Unilateral (75831) $6,728.69 $13,457.38 2.1×
Venous sampling by catheter (75893)
likely a partial charge, not the full procedure		 $1,004 $2,008 0.2×
Vertebral fracture assessment via dxa (77086) $369.50 $739 4.1×
Wrist 2 views (73100)
range across 2 matching MRF lines		 $259–$388.50 $518–$777 varies
X-Ray Ac Jts - Xr Acromioclavicular Joints Bilateral (73050) $294 $588 3.3×
X-ray antegrade pyelogram tube (74425) $511 $1,022 1.4×
X-Ray Aorta Leg Arteries (75630) $2,460.50 $4,921 0.8×
X-Ray Bend Only L-S Spine (72120) $360 $720 3.3×
X-Ray Elbow 2 Vw - Xr Elbow 1-2 Views Right (73070)
range across 2 matching MRF lines		 $262–$393 $524–$786 varies
X-Ray Exam Breast Specimen (76098) $412 $824 0.7×
X-Ray Exam Entire Spi 1 Vw (72081) $232.50 $465 2.6×
X-Ray Exam Entire Spi 2/3 Vw (72082) $379 $758 3.5×
X-Ray Exam Entire Spi 4/5 Vw (72083) $538 $1,076 5.0×
X-Ray Exam Hip Uni 1 View (73501) $151.50 $303 1.7×
X-Ray Exam Hip Uni 2-3 Views (73502) $300 $600 3.3×
X-Ray Exam Hip Uni 4/> Views (73503) $682 $1,364 6.3×
X-Ray Exam Hips Bi 2 Views (73521) $403 $806 3.7×
X-Ray Exam Hips Bi 3-4 Views (73522) $434.50 $869 4.0×
X-Ray Exam Hips Bi 5/> Views (73523)
range across 2 matching MRF lines		 $466.50–$534 $933–$1,068 varies
X-Ray Exam L-S Spine Bending (72114) $398.50 $797 3.7×
X-Ray Exam Neck Spine 2-3 Vw (72040) $318.50 $637 3.5×
X-Ray Exam Neck Spine 6/>Vws (72052) $527 $1,054 4.9×
X-Ray Exam Unilat Ribs/Chest (71101) $236.50 $473 2.2×
X-ray eye for foreign body (70030) $130.50 $261 1.4×
X-ray humerus (73060) $279.50 $559 3.1×
X-ray IV pyelogram+tomography (74415) $974.50 $1,949 5.4×
X-Ray Jaw <4 Vw - Xr Mandible < 4 Views (70100) $105 $210 1.2×
X-Ray Knee Bilat Standing - Xr Knees Anteroposterior Standing Bilat (73565) $264 $528 2.9×
X-Ray Lumbar Spine 2/3 Vw - Xr Lumbar Spine 2-3 Views (72100) $338.50 $677 3.1×
X-ray nose-rectum child f.b. (76010) $339 $678 3.8×
X-Ray Ribs, Chest 4+ Vw - Xr Ribs 3 Vws Bil W/ Chest Posteroanterior (71111) $262.50 $525 2.4×
X-Ray Sacroiliac Jts 3+ Vw - Xr Sacroiliac Joints 3+ Views (72202) $356.50 $713 3.3×
X-Ray Sacroiliac Jts <3 Vw - Xr Sacroiliac Joints 1-2 Views (72200) $198 $396 1.8×
X-Ray Sacrum/Coccyx 2+ Vw - Xr Sacrum Coccyx 2+ Views (72220) $314 $628 3.5×
X-Ray Sinuses 3+ Vw - Xr Paranasal Sinuses 3+ Views (70220) $731.50 $1,463 8.1×
X-Ray Skull 4+ Vw - Xr Skull Complete 4+ Views (70260) $226 $452 2.1×
X-ray thoracic spine 4 vw (72074) $339.50 $679 3.1×
X-Ray Tmj Unilat (70328) $104.50 $209 1.2×
X-Ray Urinary Tract Exam With Contrast Material (74420) $624 $1,248 1.7×
X-Rays Bone Length Studies (77073) $274.50 $549 2.5×
X-Rays Bone Survey Complete (77075) $622 $1,244 5.8×
Xr c-spine 4 or 5 views (72050) $428 $856 4.0×
Xr facial bones less than 3 views (70140) $170 $340 1.9×
XR Mastoids < 3 Views Bilateral (70120) $245.50 $491 2.3×
Xr orbits complete 4 views (70200) $310 $620 2.9×
Xr Tomogram Single Plane (76100) $340.50 $681 3.1×

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.