Imaging prices at West Tennessee Healthcare Bolivar Hospital
Bolivar, TN · every code in this section with a posted price and a Medicare benchmark.
320 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) | $1,856.40 | $6,188 | 1.5× |
| Abdomen 1 View (74018) | $137.40 | $458 | 1.7× |
| Abdomen 2 views (74019) | $173.10 | $577 | 1.8× |
| Acute Gastrointestinal Blood Loss Imaging (78278) | $336.30 | $1,121 | 0.9× |
| Angio internal mammary (75756) | $1,069.80 | $3,566 | 0.4× |
| Angio pulmonary bilat (75743) | $2,151.60 | $7,172 | 0.8× |
| Angiography extremity bilateral rs&i (75716) | $2,085.60 | $6,952 | 0.7× |
| Angiography extremity unilateral rs&i (75710) | $1,750.50 | $5,835 | 0.6× |
| Angiography pulmonary unilateral slctv rs&i (75741) | $1,378.80 | $4,596 | 0.5× |
| Angrph pulmonary nonslctv cath/ven njx rs&i (75746) | $958.80 | $3,196 | 0.3× |
| Ankle 2 views (73600) range across 2 matching MRF lines |
$136.50–$273 | $455–$910 | varies |
| Aortography thoracic serialography rs&i (75605) unusually low: confirm this is the full procedure |
$1,869.60 | $6,232 | 0.4× |
| Artery X-Rays Abdomen (75726) unusually low: confirm this is the full procedure |
$2,506.80 | $8,356 | 0.5× |
| Artery X-Rays Pelvis (75736) unusually low: confirm this is the full procedure |
$1,879.50 | $6,265 | 0.4× |
| Arthrogram hip (73525) | $270.60 | $902 | 0.9× |
| Basic radiation dosimetry calculation (77300) | $374.40 | $1,248 | 3.1× |
| Bone age studies (77072) | $138.30 | $461 | 1.5× |
| Bone Imaging 3 Phase (78315) | $849.90 | $2,833 | 2.3× |
| Bone Imaging Limited Area (78300) | $530.10 | $1,767 | 1.5× |
| Bone Imaging Whole Body (78306) | $806.70 | $2,689 | 2.2× |
| Bone marrow imaging limited area (78102) | $400.50 | $1,335 | 1.1× |
| Brachytx isodose intermed (77317) | $418.20 | $1,394 | 1.2× |
| Brachytx Isodose Plan Simple (77316) | $389.10 | $1,297 | 1.1× |
| Brain Flow Imaging Only (78610) | $242.40 | $808 | 0.5× |
| Brain Image W/Flow < 4 Views (78601) | $315.30 | $1,051 | 0.9× |
| Brain Imaging Pet Metabolic Evaluation (78608) | $1,209.60 | $4,032 | 0.9× |
| Cardiac MRI w/w/o contrast & further seq (75561) | $279.60 | $932 | 0.9× |
| Cardiac Shunt Detection (78428) | $588.60 | $1,962 | 1.6× |
| Cat Scan Follow-Up Study (76380) | $117 | $390 | 1.5× |
| Cerebrospinal Fluid Scan (78630) | $383.10 | $1,277 | 0.8× |
| Chest 1 view (71045) | $144 | $480 | 1.8× |
| Chest 2 views (71046) | $150.30 | $501 | 1.9× |
| Chest 3 views (71047) | $157.20 | $524 | 2.0× |
| Chest 4 or more views (71048) | $169.50 | $565 | 1.8× |
| Clavicle complete (73000) range across 2 matching MRF lines |
$52.80–$105.60 | $176–$352 | varies |
| Computed Tomography Thorax Lw Dose Lng Ca Scr C- (71271) | $113.10 | $377 | 1.2× |
| Continuing medical physics consltj pr wk (77336) | $384.90 | $1,283 | 3.2× |
| Contrast Exam Abdominl Aorta (75625) | $1,137.60 | $3,792 | 0.4× |
| Contrast X-Ray Bladder (74430) | $218.40 | $728 | 0.7× |
| CT abdomen and pelvis without and with contrast (74178) | $230.40 | $768 | 0.7× |
| CT abdomen and pelvis without contrast (74176) | $149.10 | $497 | 0.7× |
| CT abdomen w contrast (74160) | $152.70 | $509 | 1.0× |
| CT abdomen w wo contrast (74170) | $175.50 | $585 | 1.1× |
| CT abdomen w/o contrast (74150) | $118.50 | $395 | 1.2× |
| CT Angio Abdomen and Pelvis (74174) | $805.50 | $2,685 | 2.5× |
| CT Angio Chest (71275) | $231.30 | $771 | 1.5× |
| CT Angio Head (70496) | $288.90 | $963 | 1.8× |
| CT angio hrt w/3d image (75574) | $237.30 | $791 | 0.7× |
| Ct Angio Lwr Extr W/O&W/Dye (73706) | $225 | $750 | 1.4× |
| CT Angio Neck (70498) | $288.90 | $963 | 1.8× |
| Ct Angio Upr Extrm W/O&W/Dye (73206) | $217.50 | $725 | 1.4× |
| CT bone density (77078) | $117 | $390 | 1.5× |
| CT cervical spine w/ contrast (72126) | $152.40 | $508 | 0.5× |
| CT cervical spine w/o contrast (72125) | $118.50 | $395 | 1.2× |
| CT cervical spine w/wo cont (72127) | $189 | $630 | 1.2× |
| CT chest w contrast (71260) | $173.40 | $578 | 1.1× |
| CT chest w/wo contrast (71270) | $231.30 | $771 | 1.5× |
| CT head/brain with contrast (70460) | $123.90 | $413 | 0.8× |
| CT head/brain without and with contrast (70470) | $123.90 | $413 | 0.8× |
| CT heart no contrast quant eval coronry calcium (75571) | $117 | $390 | 1.5× |
| CT iac w contrast (70481) | $188.70 | $629 | 1.2× |
| CT l-spine w&w/o contrast (72133) | $187.80 | $626 | 1.2× |
| CT lower ext w/o (73700) range across 2 matching MRF lines |
$118.50–$237.30 | $395–$791 | varies |
| CT lower extremity w/contrast material (73701) range across 2 matching MRF lines |
$153–$306 | $510–$1,020 | varies |
| CT lumbar spine w contrast (72132) | $152.40 | $508 | 0.5× |
| CT lumbar spine w/o contrast (72131) | $118.50 | $395 | 1.2× |
| CT maxillofacial w contrast (70487) | $173.40 | $578 | 1.1× |
| CT maxillofacial wo contrast (70486) | $118.50 | $395 | 1.2× |
| CT neck tissue combo (70492) | $231.30 | $771 | 1.5× |
| Ct Orbit/Ear/Fossa W/O&W/Dye (70482) | $207.90 | $693 | 1.3× |
| CT orbits w/o contrast (70480) | $149.10 | $497 | 1.6× |
| CT pelvis w&w/o contrast (72194) | $181.50 | $605 | 1.1× |
| CT pelvis w/o contrast (72192) | $118.50 | $395 | 1.2× |
| CT scan of leg combo (73702) | $194.70 | $649 | 1.2× |
| CT scans face/jaw combo (70488) | $202.20 | $674 | 1.3× |
| CT soft tissue neck w contrast (70491) | $173.40 | $578 | 1.1× |
| CT soft tissue neck w/o contrast (70490) | $118.50 | $395 | 1.2× |
| CT thoracic spine w contrast (72129) | $153 | $510 | 1.0× |
| CT thoracic spine w/o contrast (72128) | $118.50 | $395 | 1.2× |
| CT thoracic spine w/wo cont (72130) | $183.30 | $611 | 1.2× |
| CT thorax w/o contrast (71250) | $118.50 | $395 | 1.2× |
| CT unlisted procedure (76497) | $357.90 | $1,193 | 4.5× |
| CT upper ext wo (73200) range across 2 matching MRF lines |
$149.10–$298.20 | $497–$994 | varies |
| CT upper extremity w/o & w/contrast material (73202) | $197.70 | $659 | 1.2× |
| CT upper extremity with contrast (73201) range across 2 matching MRF lines |
$150–$300 | $500–$1,000 | varies |
| Cta Abdl Aorta&Bi Iliofem W/Contrast&Postp (75635) | $231.30 | $771 | 1.5× |
| Cta Abdomen (74175) | $210 | $700 | 1.3× |
| CTA pelvis (72191) | $196.20 | $654 | 1.2× |
| Dxa Bone Density Axial (77080) | $175.80 | $586 | 1.9× |
| Dxa bone density study 1/>sites appendiclr skel (77081) | $93.60 | $312 | 1.2× |
| Echo Guide For Artery Repair (76936) | $340.80 | $1,136 | 1.7× |
| Esophagram (74220) | $208.80 | $696 | 1.3× |
| Fetal Biophys Profile W/Nst (76818) | $130.20 | $434 | 1.4× |
| Fetal Biophysical Profile W/O Non-Stress Testing (76819) | $85.50 | $285 | 0.9× |
| Fluoroscopy up to 1 hr (76000) | $192.60 | $642 | 0.9× |
| Foot 2 views (73620) range across 2 matching MRF lines |
$140.10–$280.20 | $467–$934 | varies |
| Forearm 2 views (73090) range across 2 matching MRF lines |
$149.70–$222.30 | $499–$741 | varies |
| Gastric emptying imaging study (78264) | $579.30 | $1,931 | 1.6× |
| Gastroesophageal Reflux Exam (78262) | $815.40 | $2,718 | 2.2× |
| Gated Heart Planar Single (78472) | $437.10 | $1,457 | 1.2× |
| Hand 2 views (73120) range across 2 matching MRF lines |
$142.50–$285 | $475–$950 | varies |
| Hdr Rdncl Ntrstl/Icav Brchtx (77771) | $1,724.70 | $5,749 | 2.7× |
| Hdr Rdncl Ntrstl/Icav Brchtx 1 Channel (77770) | $1,436.40 | $4,788 | 2.3× |
| Hepatc Vngrph Wdg/Fr W/O Hemodyn Eval Rs&I (75891) | $1,299.90 | $4,333 | 0.5× |
| Hepatobil Syst Image W/Drug (78227) | $652.80 | $2,176 | 1.3× |
| Hepatobiliary System Imaging (78226) | $611.40 | $2,038 | 1.7× |
| Ht Muscle Image Spect Sing (78451) | $1,379.70 | $4,599 | 1.2× |
| Hysterosalpingogram (74740) | $269.10 | $897 | 1.2× |
| Infant hip ultrasound with hip movement (dynamic) (76885) | $234.60 | $782 | 3.0× |
| Infusion Ivp (74410) | $231.60 | $772 | 1.5× |
| Joint Survey Single View (77077) | $113.70 | $379 | 1.2× |
| K Flow/Funct Image Multiple (78709) | $930 | $3,100 | 1.9× |
| K Flow/Funct Image W/Drug (78708) | $438.60 | $1,462 | 0.9× |
| K Flow/Funct Image W/O Drug (78707) | $423.90 | $1,413 | 0.9× |
| Knee 3 Views (73562) range across 2 matching MRF lines |
$160.80–$321.60 | $536–$1,072 | varies |
| Liver & Spleen Imaging Static Only (78215) | $548.40 | $1,828 | 1.5× |
| Liver imaging w/vascular flow (78202) | $729.90 | $2,433 | 1.5× |
| Lung Perf&Ventilat Diferentl (78598) | $878.10 | $2,927 | 1.8× |
| Lung perfusion differential (78597) | $600.90 | $2,003 | 1.7× |
| Lung Ventilat&Perfus Imaging (78582) | $744.90 | $2,483 | 1.5× |
| Lymph System Imaging (78195) | $400.80 | $1,336 | 0.8× |
| Magnetic Image Jaw Joint (70336) | $226.80 | $756 | 1.0× |
| Mammary ductogram or galactogram single (77053) | $80.40 | $268 | 0.4× |
| Meckels Divert Exam (78290) | $304.50 | $1,015 | 0.8× |
| Mlc imrt design & construction per imrt plan (77338) | $475.20 | $1,584 | 1.4× |
| Mr safety implant&/fb assmt clin staf 1st 15 min (76014) | $23.10 | $77 | 0.9× |
| MRA head w/o contrast (70544) | $287.10 | $957 | 1.3× |
| MRA head with contrast (70545) | $340.80 | $1,136 | 1.1× |
| MRA neck w contrast (70548) | $340.80 | $1,136 | 1.1× |
| Mra Neck W/O &W/Contrast Material (70549) | $377.10 | $1,257 | 1.2× |
| MRA neck w/o contrast (70547) | $287.10 | $957 | 1.3× |
| MRI abdomen w contrast (74182) | $270.60 | $902 | 0.9× |
| MRI abdomen w/o contrast (74181) | $215.40 | $718 | 1.0× |
| MRI any jt lower extrem w/contrast material (73722) | $274.20 | $914 | 0.4× |
| MRI any jt lower extrem w/o & w/contrast matrl (73723) range across 2 matching MRF lines |
$340.80–$681.60 | $1,136–$2,272 | varies |
| MRI any jt upper extremity w/contrast matrl (73222) | $272.10 | $907 | 0.4× |
| MRI bone marrow blood supply (77084) | $202.80 | $676 | 0.9× |
| MRI Breast W/O Contrast Bilateral (77047) | $243 | $810 | 1.1× |
| MRI Breast Without Contrast Material Unilateral (77046) | $243 | $810 | 1.1× |
| MRI cardiac w/o contrast (75557) | $195 | $650 | 0.9× |
| MRI cervical spine w contrast (72142) | $249.90 | $833 | 0.8× |
| MRI cervical spine w/o cont (72141) | $215.40 | $718 | 1.0× |
| MRI chest w/o contrast (71550) | $243 | $810 | 1.1× |
| MRI chest wo w contrast (71552) | $406.50 | $1,355 | 1.3× |
| MRI lower extrem oth/thn jt w/contrast matrl (73719) | $238.50 | $795 | 0.8× |
| MRI lower extrem oth/thn jt w/o & w/contr matr (73720) range across 2 matching MRF lines |
$340.80–$681.60 | $1,136–$2,272 | varies |
| MRI lower extrem oth/thn jt w/o contr matrl (73718) range across 2 matching MRF lines |
$215.40–$430.80 | $718–$1,436 | varies |
| MRI lumbar spine w contrast (72149) | $249.90 | $833 | 0.8× |
| Mri Neck Spine W/O & W/Dye (72156) | $340.80 | $1,136 | 1.1× |
| MRI orbit face &/neck w/o contrast (70540) | $185.70 | $619 | 0.9× |
| Mri Orbt/Fac/Nck W/O &W/Dye (70543) | $340.80 | $1,136 | 1.1× |
| MRI pelvis w contrast (72196) | $272.70 | $909 | 0.9× |
| MRI pelvis w/o & w contrast (72197) | $340.80 | $1,136 | 1.1× |
| MRI pelvis w/o contrast (72195) | $258.30 | $861 | 1.2× |
| MRI spectroscopy (76390) | $75.90 | $253 | 1.0× |
| MRI thoracic spine w/o contrast (72146) | $215.40 | $718 | 1.0× |
| MRI upper extremity oth than jt w/contr matrl (73219) | $294 | $980 | 0.9× |
| MRI upper extremity oth than jt w/o contr matrl (73218) | $243 | $810 | 1.1× |
| Mri Uppr Extremity W/O&W/Dye (73220) | $358.80 | $1,196 | 1.1× |
| MRI, abdomen, combo (74183) | $340.80 | $1,136 | 1.1× |
| MRI, dorsal spine combo (72157) | $340.80 | $1,136 | 1.1× |
| MRI, dorsal spine contrast (72147) | $249.90 | $833 | 0.8× |
| MRI, joint upper extrem (73221) range across 2 matching MRF lines |
$215.40–$430.80 | $718–$1,436 | varies |
| MRI, joint upper extrem combo (73223) | $331.20 | $1,104 | 1.0× |
| MRI, lumbar spine combo (72158) | $340.80 | $1,136 | 1.1× |
| Myocardial Spect Multiple Studies (78452) | $1,878.60 | $6,262 | 1.6× |
| N-invas est c ffr sw aly CTA (75580) | $865.80 | $2,886 | 1.1× |
| Neck soft tissue (70360) | $108.90 | $363 | 1.4× |
| Njx Rp Loclzj Non-Img Probe Study Intravenous (78808) | $196.80 | $656 | 0.5× |
| Nonvascular Shunt X-Ray (75809) | $207.90 | $693 | 2.2× |
| Ntsty modul radthx pln dose-vol histos (77301) | $1,948.80 | $6,496 | 1.6× |
| Nuclear Rx Intra-Arterial (79445) | $442.50 | $1,475 | 2.1× |
| Nuclear Rx Oral Admin (79005) | $518.70 | $1,729 | 2.5× |
| Panoramic X-ray of jaws (70355) | $143.40 | $478 | 1.8× |
| Parathyroid imaging w/tomographic spect & CT (78072) | $507.30 | $1,691 | 1.0× |
| Parathyroid Planar Imaging (78070) | $475.20 | $1,584 | 1.3× |
| Parathyroid planar imaging w/wo subtraction (78071) | $507.30 | $1,691 | 1.4× |
| Pelvis 1 or 2 views (72170) | $148.20 | $494 | 1.6× |
| Peritoneogram Rs&I (74190) | $266.70 | $889 | 0.5× |
| Pet Image W/Ct Lmtd (78814) | $1,743.90 | $5,813 | 1.3× |
| PET image w/CT, full body (78816) | $1,937.70 | $6,459 | 1.5× |
| PET imaging CT attenuation skull base mid-thigh (78815) | $1,937.70 | $6,459 | 1.5× |
| Prq Transhepatc Portograpy Hemodyn Eval Rs&I (75885) | $1,422.60 | $4,742 | 0.5× |
| Pulmonary Perfusion Imaging Particulate (78580) | $561.90 | $1,873 | 1.5× |
| Radex Abd Compl Aqt Abd W/S/E/D Views 1 View Ch (74022) | $233.70 | $779 | 2.5× |
| Radex abscess/fistula/sinus tract rs&i (76080) | $251.10 | $837 | 0.5× |
| Radex Ankle Complete Minimum 3 Views (73610) range across 2 matching MRF lines |
$154.20–$308.40 | $514–$1,028 | varies |
| Radex Calcaneus Minimum 2 Views (73650) range across 2 matching MRF lines |
$138.30–$276.60 | $461–$922 | varies |
| Radex Facial Bones Complete Minimum 3 Views (70150) | $76.20 | $254 | 0.8× |
| Radex fingr minimum 2 views (73140) | $128.40 | $428 | 1.6× |
| Radex foot complete minimum 3 views (73630) range across 2 matching MRF lines |
$157.20–$314.40 | $524–$1,048 | varies |
| Radex Hand Minimum 3 Views (73130) range across 2 matching MRF lines |
$156.30–$312.60 | $521–$1,042 | varies |
| Radex lower extremity infant minimum 2 views (73592) range across 2 matching MRF lines |
$64.50–$129 | $215–$430 | varies |
| Radex Nasal Bones Complete Minimum 3 Views (70160) | $57.30 | $191 | 0.7× |
| Radex Ribs Unilateral 2 Views (71100) | $140.40 | $468 | 1.8× |
| Radex shoulder complete minimum 2 views (73030) range across 2 matching MRF lines |
$165.90–$248.10 | $553–$827 | varies |
| Radex Sinuses Paransl < 3 Views (70210) | $98.40 | $328 | 1.2× |
| Radex Spine 1 View Specify Level (72020) | $135.30 | $451 | 1.7× |
| Radex Sternum Minimum 2 Views (71120) | $55.50 | $185 | 0.7× |
| Radex Temporomandble Jt Opn & Clsd Mouth Bilat (70330) | $149.10 | $497 | 1.9× |
| Radex Toe Minimum 2 Views (73660) | $128.10 | $427 | 1.6× |
| Radex upper extremity infant minimum 2 views (73092) | $39.60 | $132 | 0.4× |
| Radex Wrist Complete Minimum 3 Views (73110) range across 2 matching MRF lines |
$152.10–$304.20 | $507–$1,014 | varies |
| Radex X-Ray Exam Entire Spi 6/> Vw - Xr Entire Spine 6+ Vw (72084) | $211.80 | $706 | 2.2× |
| Radiation Delivery Stereotactic Cranial Linear (77372) | $3,575.10 | $11,917 | 0.5× |
| Radiation treatment delivery level 3 (77412) | $384.30 | $1,281 | 0.8× |
| Radiolog exam mandible compl minimum 4 views (70110) | $194.10 | $647 | 2.0× |
| Radiologic Exam Abdomen 3+ Views - Xr Abdomen 3+ Views (74021) | $175.50 | $585 | 1.9× |
| Radiologic exam colon double contrast study (74280) | $389.40 | $1,298 | 2.4× |
| Radiologic exam colon single contrast study (74270) | $299.40 | $998 | 1.9× |
| Radiologic exam knee complete 4/more views (73564) range across 2 matching MRF lines |
$169.50–$339 | $565–$1,130 | varies |
| Radiologic exam pelvis compl minimum 3 views (72190) | $155.40 | $518 | 1.6× |
| Radiologic Exam Small Int Single Contrast Study (74250) | $238.20 | $794 | 1.5× |
| Radiologic exam swallow function contrast study (74230) | $207 | $690 | 1.3× |
| Radiologic exam upr gi trc double contrast study (74246) | $273 | $910 | 1.7× |
| Radiologic examination femur 1 view (73551) | $50.10 | $167 | 0.6× |
| Radiologic examination femur minimum 2 views (73552) range across 2 matching MRF lines |
$51.30–$102.30 | $171–$341 | varies |
| Radiologic examination knee 1/2 views (73560) range across 2 matching MRF lines |
$140.70–$281.40 | $469–$938 | varies |
| Radiologic Examination Osseous Survey Limited (77074) | $89.70 | $299 | 0.9× |
| Radiologic examination tibia & fibula 2 views (73590) range across 2 matching MRF lines |
$157.50–$315 | $525–$1,050 | varies |
| Ribs bilateral 3 views (71110) | $169.50 | $565 | 1.8× |
| Rp loclzj tum plnr 1 area single day imaging (78800) | $425.70 | $1,419 | 1.2× |
| Rp loclzj tum plnr 2+area 1+d img/1 area img>2+d (78801) | $657.30 | $2,191 | 1.8× |
| Rp Loclzj Tum Plnr Whole Body 2+ Days Imaging (78804) | $1,414.50 | $4,715 | 2.9× |
| Rp Loclzj Tum Plnr Whole Body Single Day Imaging (78802) | $1,228.50 | $4,095 | 2.5× |
| Rp loclzj tum spect CT 2area 1d img/1 ar img>2+d (78832) | $1,622.40 | $5,408 | 1.3× |
| Rp loclzj tum spect w/CT 1 area/acquisj 1day img (78830) | $1,429.80 | $4,766 | 1.2× |
| Rp Therapy Intravenous Administration (79101) | $253.80 | $846 | 1.2× |
| Scapula (73010) | $48.60 | $162 | 0.5× |
| Screening Digital Breast Tomosynthesis Bi (77063) | $82.20 | $274 | 3.5× |
| Shoulder 1 view (73020) | $91.50 | $305 | 1.2× |
| Shoulder Arthrography (73040) | $284.70 | $949 | 0.9× |
| Skull less than 4 views (70250) | $51.60 | $172 | 0.5× |
| Special dosimetry (77331) | $174.90 | $583 | 1.4× |
| Special Physics Consult (77370) | $415.50 | $1,385 | 3.4× |
| Special teletherapy port plan (77321) | $394.20 | $1,314 | 1.2× |
| Special treatment procedure (77470) | $813.90 | $2,713 | 1.6× |
| Stereotactic Body Radiation Delivery (77373) | $4,109.10 | $13,697 | 2.5× |
| Sternoclavicular joints (71130) | $33 | $110 | 0.4× |
| Telethx isodose pln cplx w/basic dosimetry (77307) | $447 | $1,490 | 1.3× |
| Ther Rad Simulaj-Aided Field Setting Complex (77290) | $534.60 | $1,782 | 1.6× |
| Ther rad simulaj-aided field setting simple (77280) | $450 | $1,500 | 3.7× |
| Thoracic spine 2 views (72070) | $141.30 | $471 | 1.5× |
| Thoracic spine 3 views (72072) | $169.50 | $565 | 1.8× |
| Thoracolumbar 2 views (72080) | $104.10 | $347 | 1.3× |
| Thyroid Imaging With Vascular Flow (78013) | $198.30 | $661 | 0.5× |
| Thyroid Met Imaging Body (78018) | $718.20 | $2,394 | 1.5× |
| Thyroid Uptake W/Blood Flow Sngle/Mult Quan Meas (78014) | $299.70 | $999 | 0.8× |
| Tx Devices Design & Construction Complex (77334) | $417 | $1,390 | 1.2× |
| Ultrasound Breast Limited (76642) range across 2 matching MRF lines |
$233.10–$465.90 | $777–$1,553 | varies |
| Ultrasound Exam Aaa Screen (76706) | $204 | $680 | 2.2× |
| Ultrasound, abdomen limited (76705) | $314.40 | $1,048 | 3.3× |
| Unlisted magnetic resonance procedure (76498) | $65.40 | $218 | 0.8× |
| Upper gi w/o kub (74240) | $241.50 | $805 | 1.5× |
| Urethrocystogram voiding (74455) | $261.60 | $872 | 1.2× |
| Urethrocystography retrograde (74450) | $206.10 | $687 | 1.0× |
| Us breast unilateral complete (76641) range across 2 matching MRF lines |
$266.40–$532.80 | $888–$1,776 | varies |
| Us chest (76604) | $213.60 | $712 | 2.3× |
| Us exam, pelvic, limited (76857) | $217.20 | $724 | 2.3× |
| Us head (76506) | $71.70 | $239 | 0.8× |
| Us kidney transplant (76776) | $81 | $270 | 0.9× |
| Us lmtd joint/oth nonvasc xtr strux r-t w/img (76882) | $209.10 | $697 | 2.2× |
| Us ob limited 1 or more fetuses (76815) | $67.80 | $226 | 0.7× |
| Us ob transvaginal (76817) | $74.40 | $248 | 0.8× |
| Us pelvic non ob complete (76856) | $272.40 | $908 | 2.9× |
| Us pg uter img f&mat 14 wk tabdl 1/1st gestation (76801) | $226.20 | $754 | 2.4× |
| Us retroperitoneal complete (76770) | $348.30 | $1,161 | 3.7× |
| Us retroperitoneal limited (76775) | $286.80 | $956 | 3.0× |
| Us scrotum and contents (76870) | $226.20 | $754 | 2.4× |
| Us spinal canal and contents (76800) | $63 | $210 | 0.7× |
| Us thyroid (76536) | $240 | $800 | 2.5× |
| Vein X-Ray Chest (75827) | $897.30 | $2,991 | 0.6× |
| Vein X-Ray Liver W/O Hemodyn (75887) | $622.50 | $2,075 | 0.2× |
| Venogram Sinus/Jugular (75860) | $1,033.50 | $3,445 | 0.4× |
| Venography caval inferior serialography rs&i (75825) | $1,014.90 | $3,383 | 0.4× |
| Venography extremity bilateral rs&i (75822) | $769.50 | $2,565 | 0.5× |
| Venography extremity unilateral rs&i (75820) | $402.30 | $1,341 | 0.3× |
| Venography Renal Bilateral (75833) | $1,487.40 | $4,958 | 0.5× |
| Venography Renal Unilateral (75831) | $1,266.60 | $4,222 | 0.4× |
| Venous sampling by catheter (75893) unusually low: confirm this is the full procedure |
$1,961.10 | $6,537 | 0.4× |
| Wrist 2 views (73100) range across 2 matching MRF lines |
$149.70–$299.40 | $499–$998 | varies |
| X-Ray Ac Jts - Xr Acromioclavicular Joints Bilateral (73050) | $50.10 | $167 | 0.6× |
| X-Ray Aorta Leg Arteries (75630) | $1,922.40 | $6,408 | 0.7× |
| X-Ray Bend Only L-S Spine (72120) | $210.30 | $701 | 2.2× |
| X-Ray Elbow 2 Vw - Xr Elbow 1-2 Views Right (73070) range across 2 matching MRF lines |
$74.40–$141.30 | $248–$471 | varies |
| X-Ray Exam Breast Specimen (76098) | $258.60 | $862 | 0.5× |
| X-Ray Exam Entire Spi 1 Vw (72081) | $75.30 | $251 | 1.0× |
| X-Ray Exam Entire Spi 2/3 Vw (72082) | $192 | $640 | 2.0× |
| X-Ray Exam Entire Spi 4/5 Vw (72083) | $197.70 | $659 | 2.1× |
| X-Ray Exam Hip Uni 1 View (73501) | $65.70 | $219 | 0.8× |
| X-Ray Exam Hip Uni 2-3 Views (73502) | $154.20 | $514 | 2.0× |
| X-Ray Exam Hip Uni 4/> Views (73503) | $161.10 | $537 | 1.7× |
| X-Ray Exam Hips Bi 2 Views (73521) | $189 | $630 | 2.0× |
| X-Ray Exam Hips Bi 3-4 Views (73522) | $189.90 | $633 | 2.0× |
| X-Ray Exam L-S Spine Bending (72114) | $300 | $1,000 | 3.2× |
| X-Ray Exam Neck Spine 2-3 Vw (72040) | $168.30 | $561 | 2.1× |
| X-Ray Exam Neck Spine 6/>Vws (72052) | $272.10 | $907 | 2.9× |
| X-Ray Exam Unilat Ribs/Chest (71101) | $141.30 | $471 | 1.5× |
| X-ray eye for foreign body (70030) | $40.50 | $135 | 0.5× |
| X-ray humerus (73060) range across 2 matching MRF lines |
$51.30–$102.30 | $171–$341 | varies |
| X-ray IV pyelogram (ivp) (74400) | $153.60 | $512 | 1.0× |
| X-ray IV pyelogram+tomography (74415) | $230.40 | $768 | 1.4× |
| X-Ray Jaw <4 Vw - Xr Mandible < 4 Views (70100) | $145.20 | $484 | 1.8× |
| X-Ray Lumbar Spine 2/3 Vw - Xr Lumbar Spine 2-3 Views (72100) | $190.20 | $634 | 2.0× |
| X-ray nose-rectum child f.b. (76010) | $130.80 | $436 | 1.7× |
| X-Ray Ribs, Chest 4+ Vw - Xr Ribs 3 Vws Bil W/ Chest Posteroanterior (71111) | $197.70 | $659 | 2.1× |
| X-Ray Sacroiliac Jts 3+ Vw - Xr Sacroiliac Joints 3+ Views (72202) | $160.80 | $536 | 1.7× |
| X-Ray Sacroiliac Jts <3 Vw - Xr Sacroiliac Joints 1-2 Views (72200) | $125.40 | $418 | 1.3× |
| X-Ray Sacrum/Coccyx 2+ Vw - Xr Sacrum Coccyx 2+ Views (72220) | $151.80 | $506 | 1.9× |
| X-Ray Sinuses 3+ Vw - Xr Paranasal Sinuses 3+ Views (70220) | $172.80 | $576 | 2.2× |
| X-Ray Skull 4+ Vw - Xr Skull Complete 4+ Views (70260) | $108.90 | $363 | 1.1× |
| X-Ray Tmj Unilat (70328) | $94.80 | $316 | 1.2× |
| X-Ray Urinary Tract Exam With Contrast Material (74420) | $194.10 | $647 | 0.6× |
| X-Rays Bone Length Studies (77073) | $130.20 | $434 | 1.4× |
| X-Rays Bone Survey Complete (77075) | $128.40 | $428 | 1.4× |
| Xr c-spine 4 or 5 views (72050) | $252.30 | $841 | 2.7× |
| Xr facial bones less than 3 views (70140) | $39.60 | $132 | 0.5× |
| XR Mastoids < 3 Views Bilateral (70120) range across 2 matching MRF lines |
$34.20–$68.70 | $114–$229 | varies |
| Xr orbits complete 4 views (70200) | $63.60 | $212 | 0.7× |
| Xr Tomogram Single Plane (76100) | $125.10 | $417 | 1.3× |
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.