Imaging prices at Wilcox Medical Center
Lihue, HI · every code in this section with a posted price and a Medicare benchmark.
292 codes. Prices are the hospital's own posted facility charges.
Compare against other hospitals interactively →
| Procedure | Posted cash | Posted gross | × Medicare |
|---|---|---|---|
| Abdomen 1 View (74018) | $192 | $320 | 1.9× |
| Abdomen 2 views (74019) | $205.80 | $343 | 1.7× |
| Acute Gastrointestinal Blood Loss Imaging (78278) | $754.80 | $1,258 | 1.6× |
| Angiography extremity bilateral rs&i (75716) | $3,577.20 | $5,962 | 1.0× |
| Angiography extremity unilateral rs&i (75710) | $1,848 | $3,080 | 0.5× |
| Ankle 2 views (73600) range across 4 matching MRF lines |
$171–$235.80 | $285–$393 | varies |
| Arthrogram ankle (73615) | $535.80 | $893 | 1.3× |
| Arthrogram hip (73525) | $535.80 | $893 | 1.3× |
| Arthrogram Wrist (73115) | $535.80 | $893 | 1.3× |
| Bone age studies (77072) | $180.60 | $301 | 1.5× |
| Bone Imaging 3 Phase (78315) | $942.60 | $1,571 | 2.0× |
| Bone Imaging Limited Area (78300) | $743.40 | $1,239 | 1.6× |
| Bone Imaging Multiple Areas (78305) | $841.20 | $1,402 | 1.8× |
| Bone Imaging Whole Body (78306) | $934.20 | $1,557 | 2.0× |
| Bone survey infant (77076) | $298.80 | $498 | 2.4× |
| Brain Imaging Min 4 Static Views W Vascular Flow (78606) | $964.80 | $1,608 | 1.5× |
| Chest 1 view (71045) | $192.60 | $321 | 1.9× |
| Chest 2 views (71046) | $230.40 | $384 | 2.2× |
| Chest 3 views (71047) | $280.80 | $468 | 2.7× |
| Chest 4 or more views (71048) | $307.20 | $512 | 2.5× |
| Clavicle complete (73000) range across 2 matching MRF lines |
$219.60–$244.20 | $366–$407 | varies |
| Computed Tomography Thorax Lw Dose Lng Ca Scr C- (71271) | $488.40 | $814 | 4.0× |
| Contrast X-Ray Bladder (74430) | $494.40 | $824 | 1.2× |
| Contrast X-Ray Of Elbow (73085) | $535.80 | $893 | 1.3× |
| Contrast X-Ray Of Knee Joint (73580) | $535.80 | $893 | 1.3× |
| CT abdomen and pelvis without and with contrast (74178) range across 3 matching MRF lines |
$2,128.20–$2,233.20 | $3,547–$3,722 | varies |
| CT abdomen and pelvis without contrast (74176) range across 4 matching MRF lines |
$1,087.20–$1,698 | $1,812–$2,830 | varies |
| CT abdomen w contrast (74160) range across 2 matching MRF lines |
$540–$1,288.20 | $900–$2,147 | varies |
| CT abdomen w wo contrast (74170) range across 2 matching MRF lines |
$706.20–$1,363.20 | $1,177–$2,272 | varies |
| CT abdomen w/o contrast (74150) range across 2 matching MRF lines |
$514.80–$1,103.40 | $858–$1,839 | varies |
| CT Angio Abdomen and Pelvis (74174) | $1,446 | $2,410 | 3.5× |
| CT Angio Chest (71275) range across 2 matching MRF lines |
$1,405.20–$1,531.80 | $2,342–$2,553 | varies |
| CT Angio Head (70496) range across 3 matching MRF lines |
$1,157.40–$2,014.20 | $1,929–$3,357 | varies |
| CT angio hrt w/3d image (75574) | $1,034.40 | $1,724 | 2.5× |
| Ct Angio Lwr Extr W/O&W/Dye (73706) range across 2 matching MRF lines |
$1,311.60–$1,536.60 | $2,186–$2,561 | varies |
| CT Angio Neck (70498) range across 2 matching MRF lines |
$1,090.80–$1,224.60 | $1,818–$2,041 | varies |
| Ct Angio Upr Extrm W/O&W/Dye (73206) range across 2 matching MRF lines |
$1,341–$1,473 | $2,235–$2,455 | varies |
| CT Cere Prfuj Alys C+ W/O CT/Cta Same Anatomy (70473) | $1,331.40 | $2,219 | 6.4× |
| CT cervical spine w/ contrast (72126) | $1,119 | $1,865 | 2.7× |
| CT cervical spine w/o contrast (72125) | $878.40 | $1,464 | 7.1× |
| CT cervical spine w/wo cont (72127) | $1,113 | $1,855 | 5.4× |
| CT chest w contrast (71260) | $1,269 | $2,115 | 6.1× |
| CT chest w/wo contrast (71270) | $1,527 | $2,545 | 7.4× |
| CT head/brain with contrast (70460) | $1,095 | $1,825 | 5.3× |
| CT head/brain without and with contrast (70470) | $1,254 | $2,090 | 6.1× |
| CT heart contrast eval cardiac structure&morph (75572) | $816.60 | $1,361 | 2.0× |
| CT heart no contrast quant eval coronry calcium (75571) | $125.40 | $209 | 1.2× |
| CT iac w contrast (70481) | $1,290.60 | $2,151 | 6.2× |
| CT l-spine w&w/o contrast (72133) | $904.20 | $1,507 | 4.4× |
| CT lower ext w/o (73700) range across 2 matching MRF lines |
$962.40–$1,347.60 | $1,604–$2,246 | varies |
| CT lower extremity w/contrast material (73701) | $1,288.20 | $2,147 | 6.2× |
| CT lumbar spine w contrast (72132) | $957 | $1,595 | 2.3× |
| CT lumbar spine w/o contrast (72131) | $619.20 | $1,032 | 5.0× |
| CT maxillofacial w contrast (70487) | $1,138.80 | $1,898 | 5.5× |
| CT maxillofacial wo contrast (70486) | $829.80 | $1,383 | 6.7× |
| CT neck tissue combo (70492) | $1,417.80 | $2,363 | 6.8× |
| Ct Orbit/Ear/Fossa W/O&W/Dye (70482) | $1,417.80 | $2,363 | 6.8× |
| CT orbits w/o contrast (70480) | $1,052.40 | $1,754 | 8.5× |
| CT pelvis w&w/o contrast (72194) | $854.40 | $1,424 | 4.1× |
| CT pelvis w/o contrast (72192) | $664.80 | $1,108 | 5.4× |
| CT scan of leg combo (73702) range across 2 matching MRF lines |
$1,537.80–$1,892.40 | $2,563–$3,154 | varies |
| CT scans face/jaw combo (70488) | $1,380 | $2,300 | 6.7× |
| CT soft tissue neck w contrast (70491) | $1,213.80 | $2,023 | 5.9× |
| CT soft tissue neck w/o contrast (70490) | $1,103.40 | $1,839 | 8.9× |
| CT thoracic spine w contrast (72129) | $1,119 | $1,865 | 5.4× |
| CT thoracic spine w/o contrast (72128) | $1,167 | $1,945 | 9.4× |
| CT thoracic spine w/wo cont (72130) | $1,113 | $1,855 | 5.4× |
| CT thorax w/o contrast (71250) range across 4 matching MRF lines |
$791.40–$1,080.60 | $1,319–$1,801 | varies |
| CT unlisted procedure (76497) | $1,083.60 | $1,806 | 10.5× |
| CT upper ext wo (73200) | $1,174.80 | $1,958 | 9.5× |
| CT upper extremity w/o & w/contrast material (73202) | $1,611 | $2,685 | 7.8× |
| CT upper extremity with contrast (73201) | $1,424.40 | $2,374 | 3.5× |
| Cta Abdl Aorta&Bi Iliofem W/Contrast&Postp (75635) | $1,531.80 | $2,553 | 7.4× |
| Cta Abdomen (74175) range across 2 matching MRF lines |
$1,615.80–$1,693.80 | $2,693–$2,823 | varies |
| CTA head&neck c+ w/noncontrast img&post-pxessing (70471) | $1,331.40 | $2,219 | 3.2× |
| CTA pelvis (72191) range across 2 matching MRF lines |
$1,404.60–$1,599 | $2,341–$2,665 | varies |
| Dilation ureters/urethra rs&i (74485) | $1,962.60 | $3,271 | 0.8× |
| Doppler Echo Fetal Puls Spectral F/U/Repeat (76828) range across 3 matching MRF lines |
$378–$522 | $630–$870 | varies |
| Doppler Echo Fetal Spectral Display Complete (76827) range across 3 matching MRF lines |
$378–$522 | $630–$870 | varies |
| Doppler Fetal Mid Cerebral Artery (76821) range across 2 matching MRF lines |
$336–$400.80 | $560–$668 | varies |
| Dxa Bone Density Axial (77080) | $249.60 | $416 | 2.0× |
| Dxa bone density study 1/>sites appendiclr skel (77081) | $146.40 | $244 | 1.4× |
| Echo exam of fetal heart (76825) range across 2 matching MRF lines |
$454.20–$567.60 | $757–$946 | varies |
| Echo exam uterus (76831) | $516 | $860 | 1.8× |
| Echocardiography, fetal, cardiovascular system, real time with image documentation (2D), with or without M-mode… (76826) range across 3 matching MRF lines |
$358.20–$473.40 | $597–$789 | varies |
| Esophagram (74220) | $258 | $430 | 1.2× |
| Fetal Biophysical Profile W/O Non-Stress Testing (76819) range across 2 matching MRF lines |
$296.40–$371.40 | $494–$619 | varies |
| Fetal MRI w/placntl matrnl plvc img sing/1st ges (74712) | $1,285.80 | $2,143 | 4.6× |
| Fluoroscopy up to 1 hr (76000) | $471 | $785 | 1.7× |
| Foot 2 views (73620) range across 5 matching MRF lines |
$132.60–$252.60 | $221–$421 | varies |
| Forearm 2 views (73090) range across 4 matching MRF lines |
$229.20–$319.20 | $382–$532 | varies |
| Gastric emptying imaging study (78264) | $754.80 | $1,258 | 1.6× |
| Gated Heart Planar Single (78472) | $785.40 | $1,309 | 1.7× |
| Hand 2 views (73120) range across 5 matching MRF lines |
$174–$332.40 | $290–$554 | varies |
| Hepatobil Syst Image W/Drug (78227) | $979.80 | $1,633 | 1.5× |
| Hepatobiliary System Imaging (78226) | $754.80 | $1,258 | 1.6× |
| Ht Muscle Image Spect Sing (78451) | $2,575.80 | $4,293 | 1.7× |
| Hysterosalpingogram (74740) | $533.40 | $889 | 1.9× |
| Infant hip ultrasound with hip movement (dynamic) (76885) | $440.40 | $734 | 4.3× |
| Infant hip ultrasound, limited static exam (76886) | $408.60 | $681 | 4.0× |
| K Flow/Funct Image W/Drug (78708) | $1,148.40 | $1,914 | 1.8× |
| K Flow/Funct Image W/O Drug (78707) | $979.80 | $1,633 | 1.5× |
| Kidney Imaging Morphol (78700) | $743.40 | $1,239 | 1.6× |
| Knee 3 Views (73562) range across 5 matching MRF lines |
$289.20–$462.60 | $482–$771 | varies |
| Liver & Spleen Imaging Static Only (78215) | $743.40 | $1,239 | 1.6× |
| Liver & Spleen Imaging W/Vascular Flow (78216) | $857.40 | $1,429 | 1.8× |
| Lung perfusion differential (78597) | $754.80 | $1,258 | 1.6× |
| Lung Ventilat&Perfus Imaging (78582) | $979.80 | $1,633 | 1.5× |
| Lymph System Imaging (78195) range across 2 matching MRF lines |
$964.80–$979.80 | $1,608–$1,633 | varies |
| Magnetic Image Jaw Joint (70336) | $1,242 | $2,070 | 4.4× |
| Mammary ductogram or galactogram multiple (77054) | $423 | $705 | 1.5× |
| Mammary ductogram or galactogram single (77053) | $343.80 | $573 | 1.2× |
| Meckels Divert Exam (78290) | $743.40 | $1,239 | 1.6× |
| Mr safety determination physician/other qhp (76016) | $202.20 | $337 | 2.0× |
| Mr safety implant&/fb assmt clin staf 1st 15 min (76014) | $56.40 | $94 | 1.7× |
| Mr safety implt electronics prepj supvj phys/qhp (76018) | $222.60 | $371 | 2.0× |
| Mr safety implt pos&/immoblj (76019) | $151.20 | $252 | 2.2× |
| Mr safety med physics xm customization plng&mntr (76017) | $555 | $925 | 2.0× |
| Mra Head W/O & W/Contrast Material (70546) | $1,661.40 | $2,769 | 4.0× |
| MRA head w/o contrast (70544) range across 2 matching MRF lines |
$1,093.80–$1,251 | $1,823–$2,085 | varies |
| MRA head with contrast (70545) | $1,763.40 | $2,939 | 4.3× |
| MRA neck w contrast (70548) | $1,641 | $2,735 | 4.0× |
| Mra Neck W/O &W/Contrast Material (70549) | $1,688.40 | $2,814 | 4.1× |
| MRA neck w/o contrast (70547) | $1,459.20 | $2,432 | 5.2× |
| MRI abdomen w contrast (74182) | $1,361.40 | $2,269 | 3.3× |
| MRI abdomen w/o contrast (74181) | $1,300.20 | $2,167 | 4.6× |
| MRI any jt lower extrem w/contrast material (73722) | $1,689 | $2,815 | 1.8× |
| MRI any jt lower extrem w/o & w/contrast matrl (73723) range across 2 matching MRF lines |
$1,609.20–$1,875.60 | $2,682–$3,126 | varies |
| MRI any jt upper extremity w/contrast matrl (73222) | $1,691.40 | $2,819 | 1.8× |
| MRI bone marrow blood supply (77084) | $1,371.60 | $2,286 | 4.9× |
| MRI cervical spine w contrast (72142) | $1,323.60 | $2,206 | 3.2× |
| MRI cervical spine w/o cont (72141) | $1,060.20 | $1,767 | 3.8× |
| MRI chest w/o contrast (71550) | $1,438.20 | $2,397 | 5.1× |
| MRI chest with contrast (71551) | $1,686 | $2,810 | 1.8× |
| MRI chest wo w contrast (71552) | $1,726.20 | $2,877 | 4.2× |
| MRI lower extrem oth/thn jt w/contrast matrl (73719) range across 2 matching MRF lines |
$1,391.40–$1,764.60 | $2,319–$2,941 | varies |
| MRI lower extrem oth/thn jt w/o & w/contr matr (73720) | $1,647.60 | $2,746 | 4.0× |
| MRI lower extrem oth/thn jt w/o contr matrl (73718) range across 2 matching MRF lines |
$1,224.60–$1,809.60 | $2,041–$3,016 | varies |
| MRI lumbar spine w contrast (72149) | $1,369.80 | $2,283 | 3.3× |
| Mri Neck Spine W/O & W/Dye (72156) | $1,546.80 | $2,578 | 3.8× |
| MRI orbit face &/neck w/o contrast (70540) | $1,300.20 | $2,167 | 4.6× |
| MRI orbit face neck w contrast (70542) | $1,323.60 | $2,206 | 3.2× |
| Mri Orbt/Fac/Nck W/O &W/Dye (70543) | $1,543.20 | $2,572 | 3.7× |
| MRI pelvis w contrast (72196) | $1,246.20 | $2,077 | 3.0× |
| MRI pelvis w/o & w contrast (72197) | $1,372.20 | $2,287 | 3.3× |
| MRI pelvis w/o contrast (72195) | $1,239 | $2,065 | 4.4× |
| MRI thoracic spine w/o contrast (72146) | $885 | $1,475 | 3.1× |
| MRI upper extremity oth than jt w/contr matrl (73219) range across 2 matching MRF lines |
$1,347.60–$1,746 | $2,246–$2,910 | varies |
| MRI upper extremity oth than jt w/o contr matrl (73218) | $1,250.40 | $2,084 | 4.4× |
| Mri Uppr Extremity W/O&W/Dye (73220) | $1,647.60 | $2,746 | 4.0× |
| MRI, abdomen, combo (74183) | $1,604.40 | $2,674 | 3.9× |
| MRI, dorsal spine combo (72157) | $999.60 | $1,666 | 2.4× |
| MRI, dorsal spine contrast (72147) | $805.80 | $1,343 | 2.0× |
| MRI, joint upper extrem (73221) | $1,260 | $2,100 | 4.5× |
| MRI, joint upper extrem combo (73223) | $1,623.60 | $2,706 | 3.9× |
| MRI, lumbar spine combo (72158) | $1,447.80 | $2,413 | 3.5× |
| Myocardial Spect Multiple Studies (78452) | $2,785.80 | $4,643 | 1.8× |
| N-invas est c ffr sw aly CTA (75580) | $1,431 | $2,385 | 1.4× |
| Neck soft tissue (70360) | $205.80 | $343 | 2.0× |
| Nuclear Rx Oral Admin (79005) range across 3 matching MRF lines |
$498.60–$506.40 | $831–$844 | varies |
| Ob us nuchal meas 1 gest (76813) | $153.60 | $256 | 1.2× |
| Ophthalmic ultrasound dx b-scan w/wo a-scan (76512) | $160.20 | $267 | 1.3× |
| Parathyroid Planar Imaging (78070) | $754.80 | $1,258 | 1.6× |
| Parathyroid planar imaging w/wo subtraction (78071) | $754.80 | $1,258 | 1.6× |
| Pelvis 1 or 2 views (72170) | $198 | $330 | 1.6× |
| Pulmonary Perfusion Imaging Particulate (78580) | $754.80 | $1,258 | 1.6× |
| Radex Abd Compl Aqt Abd W/S/E/D Views 1 View Ch (74022) | $385.20 | $642 | 3.1× |
| Radex abscess/fistula/sinus tract rs&i (76080) | $474.60 | $791 | 0.7× |
| Radex Ankle Complete Minimum 3 Views (73610) range across 5 matching MRF lines |
$230.40–$375 | $384–$625 | varies |
| Radex Calcaneus Minimum 2 Views (73650) | $173.40 | $289 | 1.7× |
| Radex elbow complete minimum 3 views (73080) range across 5 matching MRF lines |
$231–$376.20 | $385–$627 | varies |
| Radex Facial Bones Complete Minimum 3 Views (70150) | $377.40 | $629 | 3.1× |
| Radex fingr minimum 2 views (73140) | $166.20 | $277 | 1.6× |
| Radex foot complete minimum 3 views (73630) range across 5 matching MRF lines |
$235.20–$376.80 | $392–$628 | varies |
| Radex Hand Minimum 3 Views (73130) range across 5 matching MRF lines |
$275.40–$440.40 | $459–$734 | varies |
| Radex lower extremity infant minimum 2 views (73592) range across 2 matching MRF lines |
$205.20–$271.80 | $342–$453 | varies |
| Radex Mastoids Compl Minimum 3 Views PR Side (70130) | $291.60 | $486 | 2.4× |
| Radex Nasal Bones Complete Minimum 3 Views (70160) | $205.80 | $343 | 2.0× |
| Radex Ribs Unilateral 2 Views (71100) | $221.40 | $369 | 2.2× |
| Radex shoulder complete minimum 2 views (73030) range across 5 matching MRF lines |
$217.80–$358.80 | $363–$598 | varies |
| Radex Sinuses Paransl < 3 Views (70210) | $188.40 | $314 | 1.8× |
| Radex Spine 1 View Specify Level (72020) | $171 | $285 | 1.7× |
| Radex Sternum Minimum 2 Views (71120) | $271.80 | $453 | 2.6× |
| Radex Temporomandble Jt Opn & Clsd Mouth Bilat (70330) | $453.60 | $756 | 4.4× |
| Radex Toe Minimum 2 Views (73660) range across 5 matching MRF lines |
$113.40–$157.80 | $189–$263 | varies |
| Radex upper extremity infant minimum 2 views (73092) range across 2 matching MRF lines |
$208.80–$299.40 | $348–$499 | varies |
| Radex Wrist Complete Minimum 3 Views (73110) range across 4 matching MRF lines |
$223.80–$363.60 | $373–$606 | varies |
| Radex X-Ray Exam Entire Spi 6/> Vw - Xr Entire Spine 6+ Vw (72084) | $497.40 | $829 | 4.0× |
| Radiolog exam mandible compl minimum 4 views (70110) | $327.60 | $546 | 2.7× |
| Radiologic Exam Abdomen 3+ Views - Xr Abdomen 3+ Views (74021) | $221.40 | $369 | 1.8× |
| Radiologic exam colon double contrast study (74280) | $514.20 | $857 | 2.5× |
| Radiologic exam colon single contrast study (74270) range across 2 matching MRF lines |
$504.60–$514.20 | $841–$857 | varies |
| Radiologic Exam Esophagus Double Contrast Study (74221) | $254.40 | $424 | 1.2× |
| Radiologic exam knee complete 4/more views (73564) range across 4 matching MRF lines |
$310.80–$535.80 | $518–$893 | varies |
| Radiologic exam pelvis compl minimum 3 views (72190) | $280.80 | $468 | 2.3× |
| Radiologic Exam Small Int Single Contrast Study (74250) | $470.40 | $784 | 2.3× |
| Radiologic exam swallow function contrast study (74230) | $365.40 | $609 | 1.8× |
| Radiologic exam upr gi trc double contrast study (74246) | $254.40 | $424 | 1.2× |
| Radiologic examination femur 1 view (73551) | $192 | $320 | 1.9× |
| Radiologic examination femur minimum 2 views (73552) | $247.80 | $413 | 2.4× |
| Radiologic examination knee 1/2 views (73560) range across 5 matching MRF lines |
$271.20–$386.40 | $452–$644 | varies |
| Radiologic Examination Osseous Survey Limited (77074) | $276 | $460 | 2.2× |
| Radiologic examination tibia & fibula 2 views (73590) range across 5 matching MRF lines |
$128.40–$244.20 | $214–$407 | varies |
| Ribs bilateral 3 views (71110) | $275.40 | $459 | 2.2× |
| Rp loclzj tum plnr 1 area single day imaging (78800) | $743.40 | $1,239 | 1.6× |
| Rp loclzj tum plnr 2+area 1+d img/1 area img>2+d (78801) | $857.40 | $1,429 | 1.8× |
| Rp Loclzj Tum Plnr Whole Body 2+ Days Imaging (78804) | $2,330.40 | $3,884 | 3.6× |
| Rp Loclzj Tum Plnr Whole Body Single Day Imaging (78802) | $1,981.80 | $3,303 | 3.1× |
| Rp Loclzj Tum Spect 1 Area Single Day Imaging (78803) | $1,610.40 | $2,684 | 2.5× |
| Rp Therapy Intravenous Administration (79101) | $478.20 | $797 | 1.7× |
| Scapula (73010) range across 2 matching MRF lines |
$261.60–$271.80 | $436–$453 | varies |
| Screening Digital Breast Tomosynthesis Bi (77063) range across 2 matching MRF lines |
$45–$72 | $75–$120 | varies |
| Shoulder 1 view (73020) range across 2 matching MRF lines |
$192–$225 | $320–$375 | varies |
| Shoulder Arthrography (73040) | $684 | $1,140 | 1.7× |
| Skull less than 4 views (70250) | $270.60 | $451 | 2.2× |
| Sternoclavicular joints (71130) | $150 | $250 | 1.5× |
| Thoracic spine 2 views (72070) | $265.20 | $442 | 2.1× |
| Thoracic spine 3 views (72072) | $284.40 | $474 | 2.3× |
| Thoracolumbar 2 views (72080) | $268.80 | $448 | 2.6× |
| Thyroid Imaging With Vascular Flow (78013) | $828 | $1,380 | 1.8× |
| Thyroid Met Imaging Body (78018) | $979.80 | $1,633 | 1.5× |
| Thyroid Uptake Measurement (78012) | $754.80 | $1,258 | 1.6× |
| Thyroid Uptake W/Blood Flow Sngle/Mult Quan Meas (78014) | $885 | $1,475 | 1.9× |
| Ultrasound Breast Limited (76642) range across 4 matching MRF lines |
$273.60–$538.80 | $456–$898 | varies |
| Ultrasound Exam Aaa Screen (76706) | $159.60 | $266 | 1.3× |
| Ultrasound, abdomen limited (76705) range across 2 matching MRF lines |
$152.40–$355.80 | $254–$593 | varies |
| Umbilical-artery Doppler (OB) (76820) range across 2 matching MRF lines |
$336–$420 | $560–$700 | varies |
| Unlisted Dx Radiographic Procedure (76499) | $138.60 | $231 | 1.3× |
| Unlisted us procedure (76999) | $207 | $345 | 2.0× |
| Upper gi w/o kub (74240) | $222 | $370 | 1.1× |
| Urethrocystogram voiding (74455) | $615.60 | $1,026 | 2.2× |
| Urethrocystography retrograde (74450) | $504 | $840 | 1.8× |
| Us breast unilateral complete (76641) range across 4 matching MRF lines |
$326.40–$643.20 | $544–$1,072 | varies |
| Us chest (76604) range across 2 matching MRF lines |
$160.20–$352.20 | $267–$587 | varies |
| Us exam, pelvic, limited (76857) | $333.60 | $556 | 2.7× |
| Us head (76506) | $531.60 | $886 | 4.3× |
| Us kidney transplant (76776) | $292.20 | $487 | 2.4× |
| Us lmtd joint/oth nonvasc xtr strux r-t w/img (76882) range across 2 matching MRF lines |
$160.20–$266.40 | $267–$444 | varies |
| Us ob detailed single fetus (76811) | $562.80 | $938 | 2.0× |
| Us ob limited 1 or more fetuses (76815) range across 2 matching MRF lines |
$130.80–$403.80 | $218–$673 | varies |
| Us ob transvaginal (76817) | $403.80 | $673 | 3.3× |
| Us pelvic non ob complete (76856) | $447 | $745 | 3.6× |
| Us pg uter img f&mat 14 wk tabdl 1/1st gestation (76801) | $445.20 | $742 | 3.6× |
| Us preg uterus real time f/u trnsabdl per fetus (76816) range across 2 matching MRF lines |
$264–$403.80 | $440–$673 | varies |
| Us retroperitoneal complete (76770) | $428.40 | $714 | 3.5× |
| Us retroperitoneal limited (76775) | $367.20 | $612 | 3.0× |
| Us scrotum and contents (76870) | $349.20 | $582 | 2.8× |
| Us spinal canal and contents (76800) | $358.20 | $597 | 2.9× |
| Us thyroid (76536) | $319.80 | $533 | 2.6× |
| Vein X-Ray Chest (75827) | $815.40 | $1,359 | 0.4× |
| Venography caval inferior serialography rs&i (75825) | $1,735.20 | $2,892 | 0.5× |
| Wrist 2 views (73100) range across 5 matching MRF lines |
$192.60–$358.80 | $321–$598 | varies |
| X-Ray Ac Jts - Xr Acromioclavicular Joints Bilateral (73050) | $327.60 | $546 | 3.2× |
| X-ray antegrade pyelogram tube (74425) | $515.40 | $859 | 1.3× |
| X-Ray Bend Only L-S Spine (72120) | $204.60 | $341 | 1.7× |
| X-Ray Elbow 2 Vw - Xr Elbow 1-2 Views Right (73070) range across 4 matching MRF lines |
$125.40–$170.40 | $209–$284 | varies |
| X-Ray Exam Breast Specimen (76098) | $600.60 | $1,001 | 0.9× |
| X-Ray Exam Entire Spi 1 Vw (72081) | $201.60 | $336 | 2.0× |
| X-Ray Exam Entire Spi 2/3 Vw (72082) | $310.80 | $518 | 2.5× |
| X-Ray Exam Entire Spi 4/5 Vw (72083) | $305.40 | $509 | 2.5× |
| X-Ray Exam Hip Uni 1 View (73501) | $201.60 | $336 | 2.0× |
| X-Ray Exam Hip Uni 2-3 Views (73502) | $257.40 | $429 | 2.5× |
| X-Ray Exam Hip Uni 4/> Views (73503) | $310.80 | $518 | 2.5× |
| X-Ray Exam Hips Bi 2 Views (73521) | $348.60 | $581 | 2.8× |
| X-Ray Exam Hips Bi 3-4 Views (73522) | $486.60 | $811 | 3.9× |
| X-Ray Exam Hips Bi 5/> Views (73523) | $532.20 | $887 | 4.3× |
| X-Ray Exam L-S Spine Bending (72114) | $363.60 | $606 | 2.9× |
| X-Ray Exam Neck Spine 2-3 Vw (72040) | $261 | $435 | 2.5× |
| X-Ray Exam Neck Spine 6/>Vws (72052) | $402 | $670 | 3.3× |
| X-Ray Exam Unilat Ribs/Chest (71101) | $273.60 | $456 | 2.2× |
| X-ray eye for foreign body (70030) range across 2 matching MRF lines |
$183–$247.20 | $305–$412 | varies |
| X-ray humerus (73060) range across 7 matching MRF lines |
$135–$314.40 | $225–$524 | varies |
| X-ray IV pyelogram (ivp) (74400) | $642 | $1,070 | 3.1× |
| X-Ray Jaw <4 Vw - Xr Mandible < 4 Views (70100) | $265.20 | $442 | 2.6× |
| X-Ray Knee Bilat Standing - Xr Knees Anteroposterior Standing Bilat (73565) | $179.40 | $299 | 1.7× |
| X-Ray Lumbar Spine 2/3 Vw - Xr Lumbar Spine 2-3 Views (72100) | $290.40 | $484 | 2.4× |
| X-ray nose-rectum child f.b. (76010) | $156.60 | $261 | 1.5× |
| X-Ray Ribs, Chest 4+ Vw - Xr Ribs 3 Vws Bil W/ Chest Posteroanterior (71111) | $343.80 | $573 | 2.8× |
| X-Ray Sacroiliac Jts 3+ Vw - Xr Sacroiliac Joints 3+ Views (72202) | $229.80 | $383 | 1.9× |
| X-Ray Sacroiliac Jts <3 Vw - Xr Sacroiliac Joints 1-2 Views (72200) | $177 | $295 | 1.4× |
| X-Ray Sacrum/Coccyx 2+ Vw - Xr Sacrum Coccyx 2+ Views (72220) | $211.20 | $352 | 2.1× |
| X-Ray Sinuses 3+ Vw - Xr Paranasal Sinuses 3+ Views (70220) | $270.60 | $451 | 2.6× |
| X-Ray Skull 4+ Vw - Xr Skull Complete 4+ Views (70260) | $322.20 | $537 | 2.6× |
| X-ray thoracic spine 4 vw (72074) | $408 | $680 | 3.3× |
| X-Ray Tmj Unilat (70328) | $240 | $400 | 2.3× |
| X-Ray Urinary Tract Exam With Contrast Material (74420) | $784.80 | $1,308 | 1.9× |
| X-Rays Bone Length Studies (77073) | $371.40 | $619 | 3.0× |
| X-Rays Bone Survey Complete (77075) | $424.80 | $708 | 3.4× |
| Xr c-spine 4 or 5 views (72050) | $318.60 | $531 | 2.6× |
| Xr facial bones less than 3 views (70140) | $229.20 | $382 | 2.2× |
| XR Mastoids < 3 Views Bilateral (70120) | $169.20 | $282 | 1.4× |
| Xr orbits complete 4 views (70200) | $277.20 | $462 | 2.2× |
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.