Imaging prices at Witham Health Services
Lebanon, IN · every code in this section with a posted price and a Medicare benchmark.
307 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) | $7,547.72 | $10,782.45 | 5.2× |
| Abdomen 1 View (74018) range across 2 matching MRF lines |
$397.64–$537.60 | $568.05–$768 | varies |
| Abdomen 2 views (74019) | $529.20 | $756 | 4.8× |
| Acute Gastrointestinal Blood Loss Imaging (78278) | $1,048.85 | $1,498.35 | 2.5× |
| Angio internal mammary (75756) | $3,258.99 | $4,655.70 | 1.0× |
| Angio pulmonary bilat (75743) range across 2 matching MRF lines |
$7,386.75–$11,884.22 | $10,552.50–$16,977.45 | varies |
| Angiography extremity bilateral rs&i (75716) | $3,822 | $5,460 | 1.1× |
| Angiography extremity unilateral rs&i (75710) range across 3 matching MRF lines |
$3,258.99–$6,517.98 | $4,655.70–$9,311.40 | varies |
| Angiography pulmonary unilateral slctv rs&i (75741) | $3,258.99 | $4,655.70 | 1.0× |
| Angrph pulmonary nonslctv cath/ven njx rs&i (75746) | $3,258.99 | $4,655.70 | 1.0× |
| Ankle 2 views (73600) | $301.35 | $430.50 | 3.3× |
| Aortography thoracic serialography rs&i (75605) | $3,822 | $5,460 | 0.6× |
| Artery X-Rays Abdomen (75726) | $3,822 | $5,460 | 0.6× |
| Artery X-Rays Pelvis (75736) | $3,822 | $5,460 | 0.6× |
| Arthrogram ankle (73615) | $1,297.28 | $1,853.25 | 3.5× |
| Arthrogram hip (73525) | $1,262.73 | $1,803.90 | 3.4× |
| Arthrogram Wrist (73115) | $1,262.73 | $1,803.90 | 3.4× |
| Basic radiation dosimetry calculation (77300) | $390.29 | $557.55 | 2.7× |
| Bone age studies (77072) | $477.75 | $682.50 | 4.3× |
| Bone Imaging 3 Phase (78315) | $2,387.28 | $3,410.40 | 5.6× |
| Bone Imaging Limited Area (78300) | $999.60 | $1,428 | 2.4× |
| Bone Imaging Whole Body (78306) | $2,040.36 | $2,914.80 | 4.8× |
| Bone marrow imaging limited area (78102) | $1,032.68 | $1,475.25 | 2.4× |
| Bone survey infant (77076) | $244.76 | $349.65 | 2.2× |
| Brain Image W/Flow < 4 Views (78601) | $840.11 | $1,200.15 | 2.0× |
| Brain Imaging Min 4 Static Views W Vascular Flow (78606) | $1,390.62 | $1,986.60 | 2.4× |
| Brain Imaging Pet Metabolic Evaluation (78608) | $3,420.69 | $4,886.70 | 2.3× |
| Chest 1 view (71045) range across 2 matching MRF lines |
$281.51–$432.92 | $402.15–$618.45 | varies |
| Chest 2 views (71046) | $346.92 | $495.60 | 3.8× |
| Chest 4 or more views (71048) | $204.33 | $291.90 | 1.8× |
| Cholecystography Oral Contrast (74290) | $486.57 | $695.10 | 2.6× |
| Clavicle complete (73000) | $484.37 | $691.95 | 5.3× |
| Computed Tomography Thorax Lw Dose Lng Ca Scr C- (71271) | $235.94 | $337.05 | 2.1× |
| Continuing medical physics consltj pr wk (77336) | $811.44 | $1,159.20 | 5.7× |
| Contrast Exam Abdominl Aorta (75625) | $3,822 | $5,460 | 1.1× |
| Contrast X-Ray Bladder (74430) range across 2 matching MRF lines |
$19.85–$425.57 | $28.35–$607.95 | varies |
| Contrast X-Ray Of Elbow (73085) | $1,568.49 | $2,240.70 | 4.2× |
| Contrast X-Ray Of Knee Joint (73580) | $1,262.73 | $1,803.90 | 3.4× |
| CT abdomen and pelvis without and with contrast (74178) | $6,466.53 | $9,237.90 | 17.5× |
| CT abdomen and pelvis without contrast (74176) | $3,527.27 | $5,038.95 | 14.0× |
| CT abdomen w contrast (74160) | $2,404.92 | $3,435.60 | 13.0× |
| CT abdomen w wo contrast (74170) | $3,235.47 | $4,622.10 | 17.4× |
| CT abdomen w/o contrast (74150) | $1,765.47 | $2,522.10 | 16.0× |
| CT Angio Abdomen and Pelvis (74174) | $5,667.59 | $8,096.55 | 15.4× |
| CT Angio Chest (71275) range across 2 matching MRF lines |
$2,287.32–$3,638.25 | $3,267.60–$5,197.50 | varies |
| CT Angio Head (70496) | $3,638.25 | $5,197.50 | 19.6× |
| CT angio hrt w/3d image (75574) | $810.71 | $1,158.15 | 2.2× |
| Ct Angio Lwr Extr W/O&W/Dye (73706) | $510.83 | $729.75 | 2.8× |
| CT Angio Neck (70498) | $3,638.25 | $5,197.50 | 19.6× |
| Ct Angio Upr Extrm W/O&W/Dye (73206) | $1,472.21 | $2,103.15 | 7.9× |
| CT cervical spine w/ contrast (72126) range across 2 matching MRF lines |
$1,238.48–$2,266.74 | $1,769.25–$3,238.20 | varies |
| CT cervical spine w/o contrast (72125) | $1,879.40 | $2,684.85 | 17.0× |
| CT cervical spine w/wo cont (72127) | $2,788.59 | $3,983.70 | 15.0× |
| CT chest w contrast (71260) | $2,286.59 | $3,266.55 | 12.3× |
| CT chest w/wo contrast (71270) | $3,235.47 | $4,622.10 | 17.4× |
| CT head/brain with contrast (70460) | $2,287.32 | $3,267.60 | 12.3× |
| CT head/brain without and with contrast (70470) | $3,400.85 | $4,858.35 | 18.3× |
| CT heart no contrast quant eval coronry calcium (75571) | $179.34 | $256.20 | 1.9× |
| CT iac w contrast (70481) | $1,972.01 | $2,817.15 | 10.6× |
| CT l-spine w&w/o contrast (72133) | $2,788.59 | $3,983.70 | 15.0× |
| CT lower ext w/o (73700) | $1,536.15 | $2,194.50 | 13.9× |
| CT lower extremity w/contrast material (73701) | $2,379.93 | $3,399.90 | 12.8× |
| CT lumbar spine w contrast (72132) range across 2 matching MRF lines |
$1,238.48–$2,266.74 | $1,769.25–$3,238.20 | varies |
| CT lumbar spine w/o contrast (72131) | $1,972.01 | $2,817.15 | 17.8× |
| CT maxillofacial w contrast (70487) range across 2 matching MRF lines |
$1,323–$1,864.70 | $1,890–$2,663.85 | varies |
| CT maxillofacial wo contrast (70486) | $1,536.15 | $2,194.50 | 13.9× |
| CT neck tissue combo (70492) | $3,400.85 | $4,858.35 | 18.3× |
| Ct Orbit/Ear/Fossa W/O&W/Dye (70482) | $3,400.85 | $4,858.35 | 18.3× |
| CT orbits w/o contrast (70480) range across 3 matching MRF lines |
$1,448.69–$1,781.64 | $2,069.55–$2,545.20 | varies |
| CT pelvis w&w/o contrast (72194) | $3,235.47 | $4,622.10 | 17.4× |
| CT pelvis w/o contrast (72192) | $1,765.47 | $2,522.10 | 16.0× |
| CT scan of leg combo (73702) | $2,788.59 | $3,983.70 | 15.0× |
| CT scans face/jaw combo (70488) | $3,400.85 | $4,858.35 | 18.3× |
| CT soft tissue neck w contrast (70491) | $2,287.32 | $3,267.60 | 12.3× |
| CT soft tissue neck w/o contrast (70490) | $1,765.47 | $2,522.10 | 16.0× |
| CT thoracic spine w contrast (72129) range across 2 matching MRF lines |
$1,238.48–$2,379.93 | $1,769.25–$3,399.90 | varies |
| CT thoracic spine w/o contrast (72128) | $1,536.15 | $2,194.50 | 13.9× |
| CT thoracic spine w/wo cont (72130) | $2,788.59 | $3,983.70 | 15.0× |
| CT thorax w/o contrast (71250) | $1,678.01 | $2,397.15 | 15.2× |
| CT unlisted procedure (76497) | $145.53 | $207.90 | 1.6× |
| CT upper ext wo (73200) | $1,972.01 | $2,817.15 | 17.8× |
| CT upper extremity w/o & w/contrast material (73202) range across 2 matching MRF lines |
$2,787.86–$2,788.59 | $3,982.65–$3,983.70 | varies |
| CT upper extremity with contrast (73201) | $2,160.17 | $3,085.95 | 5.9× |
| Cta Abdl Aorta&Bi Iliofem W/Contrast&Postp (75635) | $2,992.92 | $4,275.60 | 16.1× |
| Cta Abdomen (74175) | $3,235.47 | $4,622.10 | 17.4× |
| CTA head&neck c+ w/noncontrast img&post-pxessing (70471) | $7,280 | $10,400 | 19.7× |
| CTA pelvis (72191) | $2,436.53 | $3,480.75 | 13.1× |
| Dacryocystography, nasolacrimal duct, radiological supervision and interpretation Non-Facility (70170) | $784.98 | $1,121.40 | 3.1× |
| Dxa Bone Density Axial (77080) | $897.44 | $1,282.05 | 8.1× |
| Dxa bone density study 1/>sites appendiclr skel (77081) | $477.75 | $682.50 | 5.2× |
| Echo exam uterus (76831) | $616.70 | $881 | 2.4× |
| Echo Guide For Artery Repair (76936) | $602.70 | $861 | 2.6× |
| Esophagram (74220) | $565.95 | $808.50 | 3.0× |
| Fetal Biophys Profile W/Nst (76818) range across 2 matching MRF lines |
$235.20–$740.15 | $336–$1,057.35 | varies |
| Fluoroscopy up to 1 hr (76000) range across 3 matching MRF lines |
$51.45–$826.14 | $73.50–$1,180.20 | varies |
| Follow-Up Angiography (75898) | $887.15 | $1,267.35 | 0.3× |
| Foot 2 views (73620) | $202.86 | $289.80 | 2.2× |
| Forearm 2 views (73090) | $484.37 | $691.95 | 5.3× |
| Gastric emptying imaging study (78264) | $2,121.95 | $3,031.35 | 5.0× |
| Gated Heart Planar Single (78472) | $2,156.49 | $3,080.70 | 5.1× |
| Hand 2 views (73120) | $271.95 | $388.50 | 2.5× |
| Hepatobil Syst Image W/Drug (78227) | $3,774.23 | $5,391.75 | 6.6× |
| Hepatobiliary System Imaging (78226) | $3,674.27 | $5,248.95 | 8.7× |
| Ht Muscle Image Spect Sing (78451) | $2,496.06 | $3,565.80 | 1.8× |
| Hysterosalpingogram (74740) | $1,288.46 | $1,840.65 | 5.1× |
| Infant hip ultrasound with hip movement (dynamic) (76885) | $192.57 | $275.10 | 2.1× |
| K Flow/Funct Image W/Drug (78708) | $2,260.13 | $3,228.75 | 3.9× |
| K Flow/Funct Image W/O Drug (78707) | $1,921.29 | $2,744.70 | 3.3× |
| Knee 3 Views (73562) | $463.05 | $661.50 | 5.0× |
| Liver & Spleen Imaging Static Only (78215) | $1,328.88 | $1,898.40 | 3.1× |
| Liver imaging w/vascular flow (78202) | $2,923.10 | $4,175.85 | 5.1× |
| Lung Perf&Ventilat Diferentl (78598) | $1,090.01 | $1,557.15 | 1.9× |
| Lung perfusion differential (78597) | $840.11 | $1,200.15 | 2.0× |
| Lung Ventilat&Perfus Imaging (78582) | $2,995.86 | $4,279.80 | 5.2× |
| Lung Ventilation Imaging (78579) | $1,420.76 | $2,029.65 | 3.4× |
| Lymph System Imaging (78195) | $1,145.13 | $1,635.90 | 2.0× |
| Magnetic Image Jaw Joint (70336) range across 2 matching MRF lines |
$2,496.06–$3,197.99 | $3,565.80–$4,568.55 | varies |
| Mlc imrt design & construction per imrt plan (77338) | $2,454.17 | $3,505.95 | 6.2× |
| Mr safety implant&/fb assmt clin staf 1st 15 min (76014) | $55.13 | $78.75 | 1.8× |
| Mr safety implt electronics prepj supvj phys/qhp (76018) | $202.86 | $289.80 | 2.0× |
| Mr safety implt pos&/immoblj (76019) | $130.83 | $186.90 | 2.1× |
| Mra Head W/O & W/Contrast Material (70546) | $1,411.20 | $2,016 | 3.8× |
| MRA head w/o contrast (70544) | $2,648.94 | $3,784.20 | 10.5× |
| MRA head with contrast (70545) | $3,295.01 | $4,707.15 | 8.9× |
| MRA neck w contrast (70548) | $2,648.94 | $3,784.20 | 7.2× |
| Mra Neck W/O &W/Contrast Material (70549) | $1,411.20 | $2,016 | 3.8× |
| MRA neck w/o contrast (70547) | $2,496.06 | $3,565.80 | 9.9× |
| MRI abdomen w contrast (74182) | $2,496.06 | $3,565.80 | 6.8× |
| MRI abdomen w/o contrast (74181) | $2,189.57 | $3,127.95 | 8.7× |
| MRI any jt lower extrem w/contrast material (73722) range across 2 matching MRF lines |
$1,541.30–$3,082.59 | $2,201.85–$4,403.70 | varies |
| MRI any jt lower extrem w/o & w/contrast matrl (73723) range across 3 matching MRF lines |
$3,300.15–$4,376.19 | $4,714.50–$6,251.70 | varies |
| MRI any jt upper extremity w/contrast matrl (73222) | $1,541.30 | $2,201.85 | 1.9× |
| MRI Breast W/O Contrast Bilateral (77047) | $902.58 | $1,289.40 | 3.6× |
| MRI Breast Without Contrast Material Unilateral (77046) | $902.58 | $1,289.40 | 3.6× |
| MRI cervical spine w contrast (72142) | $3,386.88 | $4,838.40 | 9.2× |
| MRI cervical spine w/o cont (72141) | $2,617.34 | $3,739.05 | 10.4× |
| MRI chest w/o contrast (71550) | $3,167.12 | $4,524.45 | 12.5× |
| MRI chest wo w contrast (71552) range across 2 matching MRF lines |
$1,947.02–$3,428.78 | $2,781.45–$4,898.25 | varies |
| MRI lower extrem oth/thn jt w/o & w/contr matr (73720) | $3,031.14 | $4,330.20 | 8.2× |
| MRI lower extrem oth/thn jt w/o contr matrl (73718) | $2,617.34 | $3,739.05 | 10.4× |
| MRI lumbar spine w contrast (72149) | $2,648.94 | $3,784.20 | 7.2× |
| Mri Neck Spine W/O & W/Dye (72156) | $3,651.48 | $5,216.40 | 9.9× |
| MRI orbit face &/neck w/o contrast (70540) | $2,617.34 | $3,739.05 | 10.4× |
| Mri Orbt/Fac/Nck W/O &W/Dye (70543) | $3,667.65 | $5,239.50 | 9.9× |
| MRI pelvis w contrast (72196) | $1,764.74 | $2,521.05 | 4.8× |
| MRI pelvis w/o & w contrast (72197) | $1,764.74 | $2,521.05 | 4.8× |
| MRI pelvis w/o contrast (72195) | $2,374.79 | $3,392.55 | 9.4× |
| MRI thoracic spine w/o contrast (72146) | $2,189.57 | $3,127.95 | 8.7× |
| MRI upper extremity oth than jt w/o contr matrl (73218) | $2,799.62 | $3,999.45 | 11.1× |
| Mri Uppr Extremity W/O&W/Dye (73220) | $3,031.14 | $4,330.20 | 8.2× |
| MRI, abdomen, combo (74183) | $3,017.91 | $4,311.30 | 8.2× |
| MRI, dorsal spine combo (72157) | $3,308.24 | $4,726.05 | 9.0× |
| MRI, dorsal spine contrast (72147) | $3,020.12 | $4,314.45 | 8.2× |
| MRI, joint upper extrem (73221) range across 2 matching MRF lines |
$2,617.34–$5,234.67 | $3,739.05–$7,478.10 | varies |
| MRI, joint upper extrem combo (73223) range across 2 matching MRF lines |
$3,667.65–$7,334.57 | $5,239.50–$10,477.95 | varies |
| MRI, lumbar spine combo (72158) | $3,479.49 | $4,970.70 | 9.4× |
| Myelogram cervical (72240) | $1,120.14 | $1,600.20 | 1.4× |
| Myocardial Imaging Pet Metabolic Evaluation (78459) | $3,636.05 | $5,194.35 | 2.7× |
| Myocardial Spect Multiple Studies (78452) | $5,314.05 | $7,591.50 | 3.9× |
| N-invas est c ffr sw aly CTA (75580) | $2,116.07 | $3,022.95 | 2.3× |
| Neck soft tissue (70360) | $330.02 | $471.45 | 3.6× |
| Nonvascular Shunt X-Ray (75809) | $27.20 | $38.85 | 0.2× |
| Ntsty modul radthx pln dose-vol histos (77301) | $7,375.73 | $10,536.75 | 5.0× |
| Nuclear Rx Oral Admin (79005) | $676.94 | $967.05 | 2.7× |
| Parathyroid imaging w/tomographic spect & CT (78072) | $1,253.18 | $1,790.25 | 2.2× |
| Parathyroid Planar Imaging (78070) | $1,003.28 | $1,433.25 | 2.4× |
| Pelvis 1 or 2 views (72170) | $438.80 | $626.85 | 4.0× |
| Peritoneogram Rs&I (74190) | $26.46 | $37.80 | 0.0× |
| Pet Image W/Ct Lmtd (78814) | $3,420.69 | $4,886.70 | 2.3× |
| PET image w/CT, full body (78816) | $3,258.26 | $4,654.65 | 2.2× |
| PET imaging CT attenuation skull base mid-thigh (78815) | $3,258.26 | $4,654.65 | 2.2× |
| Pulmonary Perfusion Imaging Particulate (78580) | $1,841.18 | $2,630.25 | 4.4× |
| Quan&Charac C Atherosclerotc Plaq Asses Sev C Ds (75577) | $2,067.07 | $2,952.96 | 2.1× |
| Radex Abd Compl Aqt Abd W/S/E/D Views 1 View Ch (74022) | $634.31 | $906.15 | 5.7× |
| Radex abscess/fistula/sinus tract rs&i (76080) | $275.63 | $393.75 | 0.5× |
| Radex Ankle Complete Minimum 3 Views (73610) | $484.37 | $691.95 | 5.3× |
| Radex Calcaneus Minimum 2 Views (73650) | $418.95 | $598.50 | 4.6× |
| Radex elbow complete minimum 3 views (73080) | $463.05 | $661.50 | 5.0× |
| Radex Facial Bones Complete Minimum 3 Views (70150) | $463.05 | $661.50 | 4.2× |
| Radex fingr minimum 2 views (73140) | $463.05 | $661.50 | 5.0× |
| Radex foot complete minimum 3 views (73630) | $484.37 | $691.95 | 5.3× |
| Radex Hand Minimum 3 Views (73130) | $500.54 | $715.05 | 5.4× |
| Radex lower extremity infant minimum 2 views (73592) | $202.86 | $289.80 | 2.2× |
| Radex Mastoids Compl Minimum 3 Views PR Side (70130) | $479.22 | $684.60 | 4.3× |
| Radex Nasal Bones Complete Minimum 3 Views (70160) | $463.05 | $661.50 | 5.0× |
| Radex Ribs Unilateral 2 Views (71100) | $463.05 | $661.50 | 5.0× |
| Radex shoulder complete minimum 2 views (73030) range across 2 matching MRF lines |
$463.05–$610.05 | $661.50–$871.50 | varies |
| Radex Sinuses Paransl < 3 Views (70210) | $261.66 | $373.80 | 2.8× |
| Radex Spine 1 View Specify Level (72020) range across 2 matching MRF lines |
$249.90–$377.79 | $357–$539.70 | varies |
| Radex Sternum Minimum 2 Views (71120) | $438.80 | $626.85 | 4.8× |
| Radex Temporomandble Jt Opn & Clsd Mouth Bilat (70330) | $594.62 | $849.45 | 6.5× |
| Radex Toe Minimum 2 Views (73660) range across 2 matching MRF lines |
$202.86–$405.72 | $289.80–$579.60 | varies |
| Radex upper extremity infant minimum 2 views (73092) | $202.86 | $289.80 | 1.8× |
| Radex Wrist Complete Minimum 3 Views (73110) | $463.05 | $661.50 | 5.0× |
| Radiation Delivery Stereotactic Cranial Linear (77372) | $18,646.22 | $26,637.45 | 2.4× |
| Radiation treatment delivery level 1 (77402) | $269.75 | $385.35 | 2.5× |
| Radiation treatment delivery level 2 (77407) | $269.75 | $385.35 | 0.7× |
| Radiation treatment delivery level 3 (77412) | $517.44 | $739.20 | 0.9× |
| Radiolog exam mandible compl minimum 4 views (70110) | $463.05 | $661.50 | 4.2× |
| Radiologic exam colon double contrast study (74280) | $1,093.68 | $1,562.40 | 5.9× |
| Radiologic exam colon single contrast study (74270) | $1,006.95 | $1,438.50 | 5.4× |
| Radiologic exam knee complete 4/more views (73564) | $553.46 | $790.65 | 5.0× |
| Radiologic Exam Small Int Single Contrast Study (74250) | $624.40 | $892 | 3.4× |
| Radiologic exam swallow function contrast study (74230) | $565.95 | $808.50 | 3.0× |
| Radiologic exam upr gi trc double contrast study (74246) | $829.08 | $1,184.40 | 4.5× |
| Radiologic examination femur minimum 2 views (73552) | $563.01 | $804.30 | 6.1× |
| Radiologic examination knee 1/2 views (73560) range across 2 matching MRF lines |
$269.01–$376.32 | $384.30–$537.60 | varies |
| Radiologic Examination Salivary Gland Calculus (70380) | $376.32 | $537.60 | 4.1× |
| Radiologic examination tibia & fibula 2 views (73590) | $463.05 | $661.50 | 5.0× |
| Ribs bilateral 3 views (71110) | $575.51 | $822.15 | 5.2× |
| Rp loclzj tum plnr 1 area single day imaging (78800) | $1,109.12 | $1,584.45 | 2.6× |
| Rp loclzj tum plnr 2+area 1+d img/1 area img>2+d (78801) | $1,109.12 | $1,584.45 | 2.6× |
| Rp Loclzj Tum Plnr Whole Body 2+ Days Imaging (78804) | $3,994.73 | $5,706.75 | 7.0× |
| Rp Loclzj Tum Plnr Whole Body Single Day Imaging (78802) | $2,219.70 | $3,171 | 3.9× |
| Rp Loclzj Tum Spect 1 Area Single Day Imaging (78803) range across 2 matching MRF lines |
$2,435.06–$3,854.34 | $3,478.65–$5,506.20 | varies |
| Scapula (73010) | $463.05 | $661.50 | 4.2× |
| Screening Digital Breast Tomosynthesis Bi (77063) | $108.78 | $155.40 | 4.7× |
| Shoulder 1 view (73020) | $271.95 | $388.50 | 3.0× |
| Shoulder Arthrography (73040) | $1,568.49 | $2,240.70 | 4.2× |
| Sialogram (70390) | $611.52 | $873.60 | 2.4× |
| Skull less than 4 views (70250) | $466.73 | $666.75 | 4.2× |
| Special dosimetry (77331) | $299.15 | $427.35 | 2.1× |
| Special Physics Consult (77370) | $941.54 | $1,345.05 | 6.6× |
| Special teletherapy port plan (77321) | $921.69 | $1,316.70 | 2.3× |
| Special treatment procedure (77470) | $2,340.98 | $3,344.25 | 4.0× |
| Stereotactic Body Radiation Delivery (77373) | $4,272.56 | $6,103.65 | 2.3× |
| Sternoclavicular joints (71130) | $378.53 | $540.75 | 4.1× |
| Telethx isodose pln cplx w/basic dosimetry (77307) | $1,222.31 | $1,746.15 | 3.1× |
| Telethx isodose pln smpl w/dosimetry calculation (77306) | $886.41 | $1,266.30 | 2.2× |
| Ther Rad Simulaj-Aided Field Setting Complex (77290) | $1,453.83 | $2,076.90 | 3.7× |
| Ther Rad Simulaj-Aided Field Setting Intermed (77285) | $1,187.03 | $1,695.75 | 3.0× |
| Ther rad simulaj-aided field setting simple (77280) | $762.20 | $1,088.85 | 5.4× |
| Therapeutic Enema Rdctj Intussusception/Obstrcj (74283) | $471.14 | $673.05 | 2.5× |
| Thoracic spine 2 views (72070) | $288.86 | $412.65 | 2.6× |
| Thoracic spine 3 views (72072) | $662.24 | $946.05 | 6.0× |
| Thoracolumbar 2 views (72080) | $194.04 | $277.20 | 2.1× |
| Thyroid Met Imaging Body (78018) | $1,110.59 | $1,586.55 | 1.9× |
| Thyroid Uptake Measurement (78012) | $1,162.77 | $1,661.10 | 2.7× |
| Thyroid Uptake W/Blood Flow Sngle/Mult Quan Meas (78014) | $1,588.34 | $2,269.05 | 3.8× |
| Tx Devices Design & Construction Complex (77334) | $855.54 | $1,222.20 | 2.2× |
| Tx devices design & construction intermediate (77333) | $521.85 | $745.50 | 3.7× |
| Tx devices design & construction simple (77332) | $366.03 | $522.90 | 2.6× |
| Ultrasound Breast Limited (76642) | $930.51 | $1,329.30 | 10.1× |
| Ultrasound elastography first target lesion (76982) | $263.87 | $376.95 | 2.4× |
| Ultrasound Elastography Parenchyma (76981) | $357.21 | $510.30 | 3.2× |
| Ultrasound Exam Aaa Screen (76706) | $264.60 | $378 | 2.4× |
| Ultrasound, abdomen limited (76705) | $993.72 | $1,419.60 | 9.0× |
| Unlisted fluoroscopic procedure (76496) | $360.89 | $515.55 | 3.9× |
| Unlisted magnetic resonance procedure (76498) | $1,057.67 | $1,510.95 | 11.5× |
| Urethrocystogram voiding (74455) | $985.64 | $1,408.05 | 3.9× |
| Urethrocystography retrograde (74450) range across 3 matching MRF lines |
$18.38–$3,234.74 | $26.25–$4,621.05 | varies |
| Us breast unilateral complete (76641) | $1,972.74 | $2,818.20 | 17.8× |
| Us chest (76604) | $403.52 | $576.45 | 3.6× |
| Us complete joint (76881) range across 3 matching MRF lines |
$253.58–$1,747.10 | $362.25–$2,495.85 | varies |
| Us exam, pelvic, limited (76857) range across 3 matching MRF lines |
$138.92–$1,114.26 | $198.45–$1,591.80 | varies |
| Us lmtd joint/oth nonvasc xtr strux r-t w/img (76882) range across 3 matching MRF lines |
$116.14–$1,312.71 | $165.92–$1,875.30 | varies |
| Us ob detailed single fetus (76811) | $1,368.57 | $1,955.10 | 5.4× |
| Us ob limited 1 or more fetuses (76815) range across 3 matching MRF lines |
$138.92–$366.77 | $198.45–$523.95 | varies |
| Us ob transvaginal (76817) range across 3 matching MRF lines |
$138.92–$376.60 | $198.45–$538 | varies |
| Us pelvic non ob complete (76856) range across 2 matching MRF lines |
$138.92–$1,114.26 | $198.45–$1,591.80 | varies |
| Us pg uter img f&mat 14 wk tabdl 1/1st gestation (76801) | $740.15 | $1,057.35 | 6.7× |
| Us preg uterus real time f/u trnsabdl per fetus (76816) | $382.94 | $547.05 | 3.5× |
| Us retroperitoneal complete (76770) | $905.52 | $1,293.60 | 8.2× |
| Us retroperitoneal limited (76775) range across 3 matching MRF lines |
$671.06–$1,057.67 | $958.65–$1,510.95 | varies |
| Us scrotum and contents (76870) | $1,062.81 | $1,518.30 | 9.6× |
| Us spinal canal and contents (76800) | $294.74 | $421.05 | 2.7× |
| Us thyroid (76536) | $1,164.24 | $1,663.20 | 10.5× |
| Us transrectal (76872) range across 2 matching MRF lines |
$142.10–$258.72 | $203–$369.60 | varies |
| Venography caval inferior serialography rs&i (75825) | $3,256.05 | $4,651.50 | 1.0× |
| Venography extremity bilateral rs&i (75822) | $2,742.29 | $3,917.55 | 1.6× |
| Venography extremity unilateral rs&i (75820) | $2,742.29 | $3,917.55 | 1.6× |
| Wrist 2 views (73100) | $240.35 | $343.35 | 2.6× |
| X-Ray Ac Jts - Xr Acromioclavicular Joints Bilateral (73050) | $378.53 | $540.75 | 4.1× |
| X-ray antegrade pyelogram tube (74425) | $693.11 | $990.15 | 1.9× |
| X-Ray Aorta Leg Arteries (75630) | $3,822 | $5,460 | 1.1× |
| X-Ray Bend Only L-S Spine (72120) | $1,050.32 | $1,500.45 | 9.5× |
| X-Ray Elbow 2 Vw - Xr Elbow 1-2 Views Right (73070) | $463.05 | $661.50 | 5.0× |
| X-Ray Exam Breast Specimen (76098) | $338.84 | $484.05 | 0.6× |
| X-Ray Exam Entire Spi 1 Vw (72081) | $462.32 | $660.45 | 5.0× |
| X-Ray Exam Entire Spi 2/3 Vw (72082) | $905.52 | $1,293.60 | 8.2× |
| X-Ray Exam Hip Uni 1 View (73501) | $438.80 | $626.85 | 4.8× |
| X-Ray Exam Hip Uni 2-3 Views (73502) | $563.01 | $804.30 | 6.1× |
| X-Ray Exam Hips Bi 3-4 Views (73522) | $588 | $840 | 5.3× |
| X-Ray Exam Hips Bi 5/> Views (73523) | $624.75 | $892.50 | 5.6× |
| X-Ray Exam L-S Spine Bending (72114) | $239.61 | $342.30 | 2.2× |
| X-Ray Exam Neck Spine 2-3 Vw (72040) range across 2 matching MRF lines |
$716.63–$747.50 | $1,023.75–$1,067.85 | varies |
| X-Ray Exam Neck Spine 6/>Vws (72052) | $239.61 | $342.30 | 2.2× |
| X-Ray Exam Unilat Ribs/Chest (71101) | $234.47 | $334.95 | 2.1× |
| X-ray eye for foreign body (70030) | $221.97 | $317.10 | 2.4× |
| X-ray humerus (73060) | $438.80 | $626.85 | 4.8× |
| X-ray IV pyelogram (ivp) (74400) | $1,162.77 | $1,661.10 | 6.3× |
| X-ray IV pyelogram+tomography (74415) range across 2 matching MRF lines |
$1,349.46–$1,493.52 | $1,927.80–$2,133.60 | varies |
| X-Ray Jaw <4 Vw - Xr Mandible < 4 Views (70100) | $364.56 | $520.80 | 4.0× |
| X-Ray Knee Bilat Standing - Xr Knees Anteroposterior Standing Bilat (73565) | $383.67 | $548.10 | 4.2× |
| X-Ray Lumbar Spine 2/3 Vw - Xr Lumbar Spine 2-3 Views (72100) | $427.77 | $611.10 | 3.9× |
| X-ray nose-rectum child f.b. (76010) | $244.76 | $349.65 | 2.7× |
| X-Ray Ribs, Chest 4+ Vw - Xr Ribs 3 Vws Bil W/ Chest Posteroanterior (71111) | $234.47 | $334.95 | 2.1× |
| X-Ray Sacroiliac Jts 3+ Vw - Xr Sacroiliac Joints 3+ Views (72202) | $484.37 | $691.95 | 4.4× |
| X-Ray Sacrum/Coccyx 2+ Vw - Xr Sacrum Coccyx 2+ Views (72220) | $529.20 | $756 | 5.7× |
| X-Ray Sinuses 3+ Vw - Xr Paranasal Sinuses 3+ Views (70220) | $378.53 | $540.75 | 4.1× |
| X-Ray Skull 4+ Vw - Xr Skull Complete 4+ Views (70260) | $594.62 | $849.45 | 5.4× |
| X-Ray Urinary Tract Exam With Contrast Material (74420) range across 2 matching MRF lines |
$30.87–$1,349.46 | $44.10–$1,927.80 | varies |
| X-Rays Bone Length Studies (77073) range across 3 matching MRF lines |
$231.53–$571.10 | $330.75–$815.85 | varies |
| X-Rays Bone Survey Complete (77075) | $1,178.21 | $1,683.15 | 10.7× |
| Xr c-spine 4 or 5 views (72050) | $905.52 | $1,293.60 | 8.2× |
| Xr orbits complete 4 views (70200) | $463.05 | $661.50 | 4.2× |
| Xr Tomogram Single Plane (76100) range across 3 matching MRF lines |
$515.24–$1,076.78 | $736.05–$1,538.25 | varies |
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.