Imaging prices at Uw Health
Rockford, IL · every code in this section with a posted price and a Medicare benchmark.
294 codes. Prices are the hospital's own posted facility charges.
Compare against other hospitals interactively →
| Procedure | Posted cash | Posted gross | × Medicare |
|---|---|---|---|
| 3-D radiotherapy plan dose-volume histograms (77295) | $1,831.84 | $11,449 | 1.2× |
| Abdomen 1 View (74018) | $126.56 | $791 | 1.4× |
| Abdomen 2 views (74019) | $149.12 | $932 | 1.3× |
| Acute Gastrointestinal Blood Loss Imaging (78278) | $438.88 | $2,743 | 1.0× |
| Angio pulmonary bilat (75743) | $690.40 | $4,315 | 0.2× |
| Angiography extremity bilateral rs&i (75716) | $1,279.04 | $7,994 | 0.4× |
| Angiography extremity unilateral rs&i (75710) | $895.04 | $5,594 | 0.3× |
| Angiography pulmonary unilateral slctv rs&i (75741) | $637.76 | $3,986 | 0.2× |
| Ankle 2 views (73600) | $135.68 | $848 | 1.5× |
| Artery X-Rays Abdomen (75726) likely a partial charge, not the full procedure |
$864.96 | $5,406 | 0.1× |
| Artery X-Rays Pelvis (75736) range across 3 matching MRF lines |
$864.96–$1,729.92 | $5,406–$10,812 | varies |
| Basic radiation dosimetry calculation (77300) | $212.32 | $1,327 | 1.5× |
| Bone age studies (77072) | $175.20 | $1,095 | 1.6× |
| Bone Imaging 3 Phase (78315) | $771.36 | $4,821 | 1.8× |
| Bone Imaging Limited Area (78300) | $418.24 | $2,614 | 1.0× |
| Bone Imaging Whole Body (78306) | $552.48 | $3,453 | 1.3× |
| Bone survey infant (77076) | $324.48 | $2,028 | 2.9× |
| Brain Imaging Min 4 Static Views W Vascular Flow (78606) | $1,132.48 | $7,078 | 1.9× |
| Brain Imaging Pet Metabolic Evaluation (78608) | $1,581.44 | $9,884 | 1.0× |
| Cardiac MRI w/w/o contrast & further seq (75561) | $880.96 | $5,506 | 2.4× |
| Cat Scan Follow-Up Study (76380) | $225.44 | $1,409 | 2.4× |
| Chest 1 view (71045) | $119.36 | $746 | 1.3× |
| Chest 2 views (71046) | $148.96 | $931 | 1.6× |
| Clavicle complete (73000) | $146.88 | $918 | 1.6× |
| Computed Tomography Thorax Lw Dose Lng Ca Scr C- (71271) | $641.60 | $4,010 | 5.7× |
| Continuing medical physics consltj pr wk (77336) | $227.84 | $1,424 | 1.6× |
| Contrast Exam Abdominl Aorta (75625) | $797.76 | $4,986 | 0.2× |
| Contrast X-Ray Bladder (74430) | $283.52 | $1,772 | 0.8× |
| CT abdomen and pelvis without and with contrast (74178) | $1,516.64 | $9,479 | 4.1× |
| CT abdomen and pelvis without contrast (74176) | $996 | $6,225 | 3.9× |
| CT abdomen w contrast (74160) | $595.36 | $3,721 | 3.2× |
| CT abdomen w wo contrast (74170) | $698.08 | $4,363 | 3.7× |
| CT abdomen w/o contrast (74150) | $468 | $2,925 | 4.2× |
| CT Angio Abdomen and Pelvis (74174) | $1,216.16 | $7,601 | 3.3× |
| CT Angio Chest (71275) | $706.08 | $4,413 | 3.8× |
| CT Angio Head (70496) | $705.12 | $4,407 | 3.8× |
| CT angio hrt w/3d image (75574) | $1,226.88 | $7,668 | 3.3× |
| Ct Angio Lwr Extr W/O&W/Dye (73706) range across 2 matching MRF lines |
$701.60–$1,403.20 | $4,385–$8,770 | varies |
| CT Angio Neck (70498) | $773.92 | $4,837 | 4.1× |
| Ct Angio Upr Extrm W/O&W/Dye (73206) | $776.48 | $4,853 | 4.1× |
| CT cervical spine w/ contrast (72126) | $774.88 | $4,843 | 2.1× |
| CT cervical spine w/o contrast (72125) | $584.80 | $3,655 | 5.2× |
| CT chest w contrast (71260) | $591.68 | $3,698 | 3.1× |
| CT head/brain with contrast (70460) | $644.80 | $4,030 | 3.4× |
| CT head/brain without and with contrast (70470) | $617.44 | $3,859 | 3.3× |
| CT heart contrast eval cardiac structure&morph (75572) | $807.04 | $5,044 | 2.2× |
| CT heart no contrast quant eval coronry calcium (75571) | $173.76 | $1,086 | 1.9× |
| CT hrt w/3d image congen (75573) | $1,016.96 | $6,356 | 2.7× |
| CT iac w contrast (70481) | $636.64 | $3,979 | 3.4× |
| CT l-spine w&w/o contrast (72133) | $801.92 | $5,012 | 4.3× |
| CT lower ext w/o (73700) | $488.16 | $3,051 | 4.4× |
| CT lower extremity w/contrast material (73701) | $636.80 | $3,980 | 3.4× |
| CT lumbar spine w contrast (72132) | $748.80 | $4,680 | 2.0× |
| CT lumbar spine w/o contrast (72131) | $519.36 | $3,246 | 4.6× |
| CT maxillofacial w contrast (70487) | $648.32 | $4,052 | 3.4× |
| CT maxillofacial wo contrast (70486) | $464.16 | $2,901 | 4.1× |
| CT neck tissue combo (70492) | $809.92 | $5,062 | 4.3× |
| Ct Orbit/Ear/Fossa W/O&W/Dye (70482) | $711.20 | $4,445 | 3.8× |
| CT orbits w/o contrast (70480) | $575.68 | $3,598 | 5.1× |
| CT pelvis w&w/o contrast (72194) | $724.48 | $4,528 | 3.9× |
| CT pelvis w/o contrast (72192) | $456 | $2,850 | 4.1× |
| CT scans face/jaw combo (70488) | $703.68 | $4,398 | 3.7× |
| CT soft tissue neck w contrast (70491) | $554.24 | $3,464 | 2.9× |
| CT soft tissue neck w/o contrast (70490) | $403.36 | $2,521 | 3.6× |
| CT thoracic spine w contrast (72129) | $612.64 | $3,829 | 3.3× |
| CT thoracic spine w/o contrast (72128) | $481.60 | $3,010 | 4.3× |
| CT thoracic spine w/wo cont (72130) | $696.16 | $4,351 | 3.7× |
| CT thorax w/o contrast (71250) | $502.88 | $3,143 | 4.5× |
| CT unlisted procedure (76497) range across 2 matching MRF lines |
$61.76–$192 | $386–$1,200 | varies |
| CT upper ext wo (73200) | $530.40 | $3,315 | 4.7× |
| CT upper extremity with contrast (73201) | $601.12 | $3,757 | 1.6× |
| Cta Abdl Aorta&Bi Iliofem W/Contrast&Postp (75635) | $1,688.48 | $10,553 | 9.0× |
| Cta Abdomen (74175) | $857.92 | $5,362 | 4.6× |
| CTA pelvis (72191) | $633.12 | $3,957 | 3.4× |
| Doppler Echo Fetal Puls Spectral F/U/Repeat (76828) | $200.80 | $1,255 | 1.8× |
| Doppler Echo Fetal Spectral Display Complete (76827) | $218.56 | $1,366 | 2.0× |
| Doppler Fetal Mid Cerebral Artery (76821) | $574.72 | $3,592 | 5.1× |
| Dxa Bone Density Axial (77080) | $144.48 | $903 | 1.3× |
| Dxa bone density study 1/>sites appendiclr skel (77081) | $105.44 | $659 | 1.1× |
| Echo exam of fetal heart (76825) | $212.32 | $1,327 | 0.4× |
| Echo exam uterus (76831) | $158.08 | $988 | 0.6× |
| Echocardiography, fetal, cardiovascular system, real time with image documentation (2D), with or without M-mode… (76826) | $98.56 | $616 | 0.4× |
| Esophagram (74220) | $297.12 | $1,857 | 1.6× |
| Fetal Biophys Profile W/Nst (76818) | $379.84 | $2,374 | 3.4× |
| Fetal Biophysical Profile W/O Non-Stress Testing (76819) | $304 | $1,900 | 2.7× |
| Fluoroscopy up to 1 hr (76000) | $281.60 | $1,760 | 1.1× |
| Follow-Up Angiography (75898) | $503.68 | $3,148 | 0.1× |
| Foot 2 views (73620) range across 3 matching MRF lines |
$134.24–$268.48 | $839–$1,678 | varies |
| Forearm 2 views (73090) | $130.72 | $817 | 1.4× |
| Gastric emptying imaging study (78264) | $498.56 | $3,116 | 1.2× |
| Gated Heart Planar Single (78472) | $536.16 | $3,351 | 1.3× |
| Hand 2 views (73120) range across 2 matching MRF lines |
$123.04–$246.08 | $769–$1,538 | varies |
| Hepatc Vngrph Wdg/Fr Hemodyn Eval Rs&I (75889) | $881.76 | $5,511 | 0.3× |
| Hepatc Vngrph Wdg/Fr W/O Hemodyn Eval Rs&I (75891) | $657.28 | $4,108 | 0.2× |
| Hepatobil Syst Image W/Drug (78227) | $1,079.04 | $6,744 | 1.9× |
| Hepatobiliary System Imaging (78226) | $529.12 | $3,307 | 1.2× |
| Ht Muscle Image Spect Sing (78451) | $1,001.28 | $6,258 | 0.7× |
| Hysterosalpingogram (74740) | $372.64 | $2,329 | 1.5× |
| Infant hip ultrasound with hip movement (dynamic) (76885) | $123.52 | $772 | 1.3× |
| K Flow/Funct Image W/Drug (78708) | $531.04 | $3,319 | 0.9× |
| K Flow/Funct Image W/O Drug (78707) | $525.76 | $3,286 | 0.9× |
| Knee 3 Views (73562) range across 5 matching MRF lines |
$147.68–$295.36 | $923–$1,846 | varies |
| Liver & Spleen Imaging Static Only (78215) | $469.92 | $2,937 | 1.1× |
| Lung perfusion differential (78597) | $282.72 | $1,767 | 0.7× |
| Lung Ventilat&Perfus Imaging (78582) | $571.84 | $3,574 | 1.0× |
| Lymph System Imaging (78195) | $448.64 | $2,804 | 0.8× |
| Magnetic Image Jaw Joint (70336) | $674.40 | $4,215 | 2.6× |
| Meckels Divert Exam (78290) | $678.08 | $4,238 | 1.6× |
| Mlc imrt design & construction per imrt plan (77338) | $837.28 | $5,233 | 2.1× |
| MRA head w/o contrast (70544) | $657.60 | $4,110 | 2.6× |
| Mra Neck W/O &W/Contrast Material (70549) | $952 | $5,950 | 2.5× |
| MRA neck w/o contrast (70547) | $724.48 | $4,528 | 2.8× |
| MRI abdomen w/o contrast (74181) | $719.84 | $4,499 | 2.8× |
| MRI any jt lower extrem w/contrast material (73722) | $1,101.76 | $6,886 | 1.3× |
| MRI any jt lower extrem w/o & w/contrast matrl (73723) | $1,085.76 | $6,786 | 2.9× |
| MRI any jt upper extremity w/contrast matrl (73222) | $1,069.12 | $6,682 | 1.3× |
| MRI Breast W/O Contrast Bilateral (77047) | $2,108.96 | $13,181 | 8.2× |
| MRI cardiac w/o contrast (75557) | $642.56 | $4,016 | 2.5× |
| MRI cervical spine w contrast (72142) | $1,115.20 | $6,970 | 3.0× |
| MRI cervical spine w/o cont (72141) range across 2 matching MRF lines |
$727.36–$864.16 | $4,546–$5,401 | varies |
| MRI chest w/o contrast (71550) | $928 | $5,800 | 3.6× |
| MRI chest wo w contrast (71552) | $968.96 | $6,056 | 2.6× |
| MRI lower extrem oth/thn jt w/contrast matrl (73719) | $768 | $4,800 | 2.1× |
| MRI lower extrem oth/thn jt w/o & w/contr matr (73720) | $1,085.76 | $6,786 | 2.9× |
| MRI lower extrem oth/thn jt w/o contr matrl (73718) | $755.36 | $4,721 | 3.0× |
| MRI lumbar spine w contrast (72149) | $1,124.96 | $7,031 | 3.0× |
| Mri Neck Spine W/O & W/Dye (72156) | $975.36 | $6,096 | 2.6× |
| MRI orbit face &/neck w/o contrast (70540) | $1,051.68 | $6,573 | 4.1× |
| MRI orbit face neck w contrast (70542) | $1,002.24 | $6,264 | 2.7× |
| Mri Orbt/Fac/Nck W/O &W/Dye (70543) | $1,055.36 | $6,596 | 2.8× |
| MRI pelvis w/o & w contrast (72197) | $993.12 | $6,207 | 2.7× |
| MRI pelvis w/o contrast (72195) | $734.72 | $4,592 | 2.9× |
| MRI thoracic spine w/o contrast (72146) range across 4 matching MRF lines |
$652.96–$775.68 | $4,081–$4,848 | varies |
| MRI upper extremity oth than jt w/o contr matrl (73218) | $771.84 | $4,824 | 3.0× |
| Mri Uppr Extremity W/O&W/Dye (73220) | $1,315.36 | $8,221 | 3.5× |
| MRI, abdomen, combo (74183) | $1,154.08 | $7,213 | 3.1× |
| MRI, dorsal spine combo (72157) | $1,020 | $6,375 | 2.7× |
| MRI, dorsal spine contrast (72147) | $1,137.92 | $7,112 | 3.0× |
| MRI, joint upper extrem (73221) | $787.04 | $4,919 | 3.1× |
| MRI, joint upper extrem combo (73223) | $1,359.52 | $8,497 | 3.6× |
| MRI, lumbar spine combo (72158) | $1,063.52 | $6,647 | 2.8× |
| Myelogram Lumbar (72265) | $1,785.28 | $11,158 | 2.1× |
| Myelography thoracic (72255) | $452 | $2,825 | 0.5× |
| Myelograpy 2/more regions rs&i (72270) | $1,775.84 | $11,099 | 2.1× |
| Myocardial Spect Multiple Studies (78452) | $1,457.28 | $9,108 | 1.1× |
| Neck soft tissue (70360) | $119.52 | $747 | 1.3× |
| Nfs/Instlj Radioelmnt Sln 3 Mo Follow-Up Care (77750) | $208 | $1,300 | 0.5× |
| Ntsty modul radthx pln dose-vol histos (77301) | $2,585.44 | $16,159 | 1.7× |
| Nuclear Rx Intra-Arterial (79445) | $98.40 | $615 | 0.4× |
| Nuclear Rx Oral Admin (79005) | $197.12 | $1,232 | 0.8× |
| Ob us nuchal meas 1 gest (76813) | $660.48 | $4,128 | 5.9× |
| Ophthalmic ultrasound dx b-scan w/wo a-scan (76512) range across 2 matching MRF lines |
$97.60–$195.20 | $610–$1,220 | varies |
| Parathyroid imaging w/tomographic spect & CT (78072) | $1,050.72 | $6,567 | 1.8× |
| Parathyroid planar imaging w/wo subtraction (78071) | $536.96 | $3,356 | 1.3× |
| Pelvis 1 or 2 views (72170) | $126.56 | $791 | 1.1× |
| Peritoneogram Rs&I (74190) | $277.92 | $1,737 | 0.5× |
| Pet Image Skull-Thigh (78812) | $1,382.08 | $8,638 | 0.9× |
| Pet Image W/Ct Lmtd (78814) | $1,285.60 | $8,035 | 0.8× |
| PET image w/CT, full body (78816) | $1,560.96 | $9,756 | 1.0× |
| PET imaging CT attenuation skull base mid-thigh (78815) | $1,666.40 | $10,415 | 1.1× |
| Pulmonary Perfusion Imaging Particulate (78580) | $426.88 | $2,668 | 1.0× |
| Radex Abd Compl Aqt Abd W/S/E/D Views 1 View Ch (74022) | $194.72 | $1,217 | 1.7× |
| Radex abscess/fistula/sinus tract rs&i (76080) | $189.28 | $1,183 | 0.3× |
| Radex Ankle Complete Minimum 3 Views (73610) range across 3 matching MRF lines |
$141.92–$283.84 | $887–$1,774 | varies |
| Radex Calcaneus Minimum 2 Views (73650) | $143.04 | $894 | 1.5× |
| Radex elbow complete minimum 3 views (73080) | $130.72 | $817 | 1.4× |
| Radex Facial Bones Complete Minimum 3 Views (70150) | $257.44 | $1,609 | 2.3× |
| Radex fingr minimum 2 views (73140) | $119.52 | $747 | 1.3× |
| Radex foot complete minimum 3 views (73630) range across 5 matching MRF lines |
$139.20–$278.40 | $870–$1,740 | varies |
| Radex Hand Minimum 3 Views (73130) range across 4 matching MRF lines |
$127.84–$255.68 | $799–$1,598 | varies |
| Radex lower extremity infant minimum 2 views (73592) | $224.32 | $1,402 | 2.4× |
| Radex Mastoids Compl Minimum 3 Views PR Side (70130) | $220.96 | $1,381 | 2.0× |
| Radex Nasal Bones Complete Minimum 3 Views (70160) | $166.56 | $1,041 | 1.8× |
| Radex shoulder complete minimum 2 views (73030) range across 5 matching MRF lines |
$139.20–$278.40 | $870–$1,740 | varies |
| Radex Sinuses Paransl < 3 Views (70210) | $161.44 | $1,009 | 1.7× |
| Radex Spine 1 View Specify Level (72020) | $135.52 | $847 | 1.5× |
| Radex Sternum Minimum 2 Views (71120) | $166.72 | $1,042 | 1.8× |
| Radex Temporomandble Jt Opn & Clsd Mouth Bilat (70330) | $270.40 | $1,690 | 2.9× |
| Radex Toe Minimum 2 Views (73660) | $90.72 | $567 | 1.0× |
| Radex upper extremity infant minimum 2 views (73092) | $203.52 | $1,272 | 1.8× |
| Radex Wrist Complete Minimum 3 Views (73110) range across 4 matching MRF lines |
$124.32–$248.64 | $777–$1,554 | varies |
| Radiation Delivery Stereotactic Cranial Linear (77372) | $6,730.88 | $42,068 | 0.9× |
| Radiation treatment delivery level 1 (77402) | $272.32 | $1,702 | 2.5× |
| Radiation treatment delivery level 2 (77407) | $1,029.28 | $6,433 | 2.5× |
| Radiation treatment delivery level 3 (77412) | $1,474.56 | $9,216 | 2.5× |
| Radiolog exam mandible compl minimum 4 views (70110) | $249.44 | $1,559 | 2.2× |
| Radiologic Exam Abdomen 3+ Views - Xr Abdomen 3+ Views (74021) | $223.36 | $1,396 | 2.0× |
| Radiologic exam colon single contrast study (74270) | $391.68 | $2,448 | 2.1× |
| Radiologic Exam Esophagus Double Contrast Study (74221) | $170.24 | $1,064 | 0.9× |
| Radiologic exam knee complete 4/more views (73564) range across 6 matching MRF lines |
$154.56–$309.12 | $966–$1,932 | varies |
| Radiologic exam pelvis compl minimum 3 views (72190) | $363.20 | $2,270 | 3.2× |
| Radiologic Exam Small Int Single Contrast Study (74250) | $320.32 | $2,002 | 1.7× |
| Radiologic exam swallow function contrast study (74230) | $283.04 | $1,769 | 1.5× |
| Radiologic exam upr gi trc double contrast study (74246) | $266.08 | $1,663 | 1.4× |
| Radiologic examination femur 1 view (73551) | $158.88 | $993 | 1.7× |
| Radiologic examination femur minimum 2 views (73552) | $153.12 | $957 | 1.6× |
| Radiologic examination knee 1/2 views (73560) range across 4 matching MRF lines |
$141.92–$283.84 | $887–$1,774 | varies |
| Radiologic Examination Osseous Survey Limited (77074) | $222.56 | $1,391 | 2.0× |
| Radiologic examination tibia & fibula 2 views (73590) range across 3 matching MRF lines |
$142.08–$284.16 | $888–$1,776 | varies |
| Ribs bilateral 3 views (71110) | $171.52 | $1,072 | 1.5× |
| Rp Loclzj Tum Plnr Whole Body Single Day Imaging (78802) | $652.48 | $4,078 | 1.1× |
| Rp Loclzj Tum Spect 1 Area Single Day Imaging (78803) | $1,181.60 | $7,385 | 2.0× |
| Rp loclzj tum spect 2 area/sep acquisj img (78831) | $812 | $5,075 | 0.6× |
| Rp loclzj tum spect CT 2area 1d img/1 ar img>2+d (78832) | $1,060 | $6,625 | 0.7× |
| Rp loclzj tum spect w/CT 1 area/acquisj 1day img (78830) | $739.36 | $4,621 | 0.5× |
| Scapula (73010) | $176.64 | $1,104 | 1.6× |
| Screening Digital Breast Tomosynthesis Bi (77063) | $45.76 | $286 | 2.0× |
| Shoulder 1 view (73020) range across 2 matching MRF lines |
$127.84–$255.68 | $799–$1,598 | varies |
| Shoulder Arthrography (73040) | $180.32 | $1,127 | 0.5× |
| Skull less than 4 views (70250) | $181.44 | $1,134 | 1.6× |
| Special dosimetry (77331) | $207.36 | $1,296 | 1.4× |
| Special Physics Consult (77370) | $325.76 | $2,036 | 2.3× |
| Special teletherapy port plan (77321) | $304.16 | $1,901 | 0.8× |
| Special treatment procedure (77470) | $826.24 | $5,164 | 1.4× |
| Stereotactic Body Radiation Delivery (77373) | $2,060.96 | $12,881 | 1.1× |
| Sternoclavicular joints (71130) | $197.44 | $1,234 | 2.1× |
| Telethx isodose pln cplx w/basic dosimetry (77307) | $623.68 | $3,898 | 1.6× |
| Ther Rad Simulaj-Aided Field Setting Complex (77290) | $1,045.60 | $6,535 | 2.6× |
| Ther rad simulaj-aided field setting simple (77280) | $414.40 | $2,590 | 2.9× |
| Thoracic spine 2 views (72070) | $154.56 | $966 | 1.4× |
| Thoracic spine 3 views (72072) | $173.92 | $1,087 | 1.6× |
| Thoracolumbar 2 views (72080) | $102.56 | $641 | 1.1× |
| Thyroid Met Imaging Body (78018) | $389.44 | $2,434 | 0.7× |
| Thyroid Uptake W/Blood Flow Sngle/Mult Quan Meas (78014) | $559.68 | $3,498 | 1.3× |
| Tx Devices Design & Construction Complex (77334) | $394.88 | $2,468 | 1.0× |
| Tx devices design & construction intermediate (77333) | $228.32 | $1,427 | 1.6× |
| Tx devices design & construction simple (77332) | $177.60 | $1,110 | 1.2× |
| Ultrasound Breast Limited (76642) range across 5 matching MRF lines |
$184.64–$369.28 | $1,154–$2,308 | varies |
| Ultrasound Exam Aaa Screen (76706) | $139.84 | $874 | 1.2× |
| Ultrasound, abdomen limited (76705) | $365.28 | $2,283 | 3.3× |
| Umbilical-artery Doppler (OB) (76820) | $432.64 | $2,704 | 3.9× |
| Unlisted fluoroscopic procedure (76496) | $133.60 | $835 | 1.4× |
| Unlisted us procedure (76999) | $182.08 | $1,138 | 2.0× |
| Upper gi w/o kub (74240) | $219.36 | $1,371 | 1.2× |
| Urethrocystogram voiding (74455) | $399.68 | $2,498 | 1.6× |
| Urethrocystography retrograde (74450) | $234.56 | $1,466 | 0.9× |
| Us breast unilateral complete (76641) range across 5 matching MRF lines |
$203.52–$407.04 | $1,272–$2,544 | varies |
| Us chest (76604) | $223.20 | $1,395 | 2.0× |
| Us complete joint (76881) | $266.72 | $1,667 | 2.4× |
| Us exam, pelvic, limited (76857) | $178.24 | $1,114 | 1.6× |
| Us head (76506) | $202.24 | $1,264 | 1.8× |
| Us kidney transplant (76776) | $195.20 | $1,220 | 1.7× |
| Us lmtd joint/oth nonvasc xtr strux r-t w/img (76882) range across 4 matching MRF lines |
$186.40–$372.80 | $1,165–$2,330 | varies |
| Us ob detailed single fetus (76811) | $679.04 | $4,244 | 2.7× |
| Us ob limited 1 or more fetuses (76815) | $202.88 | $1,268 | 1.8× |
| Us ob transvaginal (76817) | $198.72 | $1,242 | 1.8× |
| Us pelvic non ob complete (76856) | $317.12 | $1,982 | 2.8× |
| Us pg uter img f&mat 14 wk tabdl 1/1st gestation (76801) | $405.28 | $2,533 | 3.6× |
| Us preg uterus real time f/u trnsabdl per fetus (76816) range across 2 matching MRF lines |
$426.40–$459.20 | $2,665–$2,870 | varies |
| Us retroperitoneal complete (76770) | $463.36 | $2,896 | 4.1× |
| Us retroperitoneal limited (76775) | $338.24 | $2,114 | 3.0× |
| Us scrotum and contents (76870) | $260 | $1,625 | 2.3× |
| Us spinal canal and contents (76800) | $206.88 | $1,293 | 1.8× |
| Us thyroid (76536) | $302.88 | $1,893 | 2.7× |
| Vein X-Ray Chest (75827) | $627.36 | $3,921 | 0.4× |
| Venography caval inferior serialography rs&i (75825) | $778.88 | $4,868 | 0.2× |
| Venography extremity bilateral rs&i (75822) | $648.96 | $4,056 | 0.4× |
| Venography extremity unilateral rs&i (75820) | $453.92 | $2,837 | 0.3× |
| Venography Renal Bilateral (75833) | $617.92 | $3,862 | 0.2× |
| Wrist 2 views (73100) | $118.72 | $742 | 1.3× |
| X-Ray Ac Jts - Xr Acromioclavicular Joints Bilateral (73050) | $194.40 | $1,215 | 2.1× |
| X-ray antegrade pyelogram tube (74425) | $259.20 | $1,620 | 0.7× |
| X-Ray Aorta Leg Arteries (75630) | $682.08 | $4,263 | 0.2× |
| X-Ray Bend Only L-S Spine (72120) | $118.40 | $740 | 1.1× |
| X-Ray Elbow 2 Vw - Xr Elbow 1-2 Views Right (73070) | $125.12 | $782 | 1.3× |
| X-Ray Exam Breast Specimen (76098) | $178.08 | $1,113 | 0.3× |
| X-Ray Exam Entire Spi 1 Vw (72081) | $216 | $1,350 | 2.3× |
| X-Ray Exam Entire Spi 2/3 Vw (72082) | $232 | $1,450 | 2.1× |
| X-Ray Exam Hip Uni 1 View (73501) | $107.68 | $673 | 1.2× |
| X-Ray Exam Hip Uni 2-3 Views (73502) | $229.12 | $1,432 | 2.5× |
| X-Ray Exam Hips Bi 2 Views (73521) | $176.48 | $1,103 | 1.6× |
| X-Ray Exam Hips Bi 3-4 Views (73522) | $244.48 | $1,528 | 2.2× |
| X-Ray Exam L-S Spine Bending (72114) | $290.56 | $1,816 | 2.6× |
| X-Ray Exam Neck Spine 2-3 Vw (72040) | $172 | $1,075 | 1.8× |
| X-Ray Exam Neck Spine 6/>Vws (72052) | $236.64 | $1,479 | 2.1× |
| X-Ray Exam Unilat Ribs/Chest (71101) | $167.52 | $1,047 | 1.5× |
| X-ray eye for foreign body (70030) range across 3 matching MRF lines |
$182.24–$364.48 | $1,139–$2,278 | varies |
| X-ray humerus (73060) | $139.20 | $870 | 1.5× |
| X-Ray Jaw <4 Vw - Xr Mandible < 4 Views (70100) | $230.08 | $1,438 | 2.5× |
| X-Ray Knee Bilat Standing - Xr Knees Anteroposterior Standing Bilat (73565) | $197.44 | $1,234 | 2.1× |
| X-Ray Lumbar Spine 2/3 Vw - Xr Lumbar Spine 2-3 Views (72100) | $172.80 | $1,080 | 1.5× |
| X-ray nose-rectum child f.b. (76010) | $174.88 | $1,093 | 1.9× |
| X-Ray Ribs, Chest 4+ Vw - Xr Ribs 3 Vws Bil W/ Chest Posteroanterior (71111) | $190.24 | $1,189 | 1.7× |
| X-Ray Sacroiliac Jts 3+ Vw - Xr Sacroiliac Joints 3+ Views (72202) | $145.28 | $908 | 1.3× |
| X-Ray Sacroiliac Jts <3 Vw - Xr Sacroiliac Joints 1-2 Views (72200) | $146.24 | $914 | 1.3× |
| X-Ray Sacrum/Coccyx 2+ Vw - Xr Sacrum Coccyx 2+ Views (72220) | $139.20 | $870 | 1.5× |
| X-Ray Sinuses 3+ Vw - Xr Paranasal Sinuses 3+ Views (70220) | $184.32 | $1,152 | 2.0× |
| X-Ray Skull 4+ Vw - Xr Skull Complete 4+ Views (70260) | $240.16 | $1,501 | 2.1× |
| X-Ray Urinary Tract Exam With Contrast Material (74420) range across 2 matching MRF lines |
$259.20–$518.40 | $1,620–$3,240 | varies |
| X-Rays Bone Length Studies (77073) | $155.68 | $973 | 1.4× |
| X-Rays Bone Survey Complete (77075) | $256.48 | $1,603 | 2.3× |
| Xr c-spine 4 or 5 views (72050) | $236.64 | $1,479 | 2.1× |
| Xr facial bones less than 3 views (70140) | $161.44 | $1,009 | 1.7× |
| Xr orbits complete 4 views (70200) | $225.28 | $1,408 | 2.0× |
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.