Imaging prices at Ascension St. Vincent Salem
Salem, IN · every code in this section with a posted price and a Medicare benchmark.
233 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) | $266.40 | $444 | 2.9× |
| Abdomen 2 views (74019) | $300 | $500 | 2.7× |
| Acute Gastrointestinal Blood Loss Imaging (78278) | $1,215.60 | $2,026 | 2.9× |
| Ankle 2 views (73600) range across 2 matching MRF lines |
$224.40–$448.80 | $374–$748 | varies |
| Bone age studies (77072) | $239.40 | $399 | 2.2× |
| Bone Imaging 3 Phase (78315) | $1,639.20 | $2,732 | 3.9× |
| Bone Imaging Limited Area (78300) | $1,422.60 | $2,371 | 3.4× |
| Bone Imaging Whole Body (78306) | $1,736.40 | $2,894 | 4.1× |
| Bone survey infant (77076) | $792 | $1,320 | 7.2× |
| Chest 1 view (71045) | $130.80 | $218 | 1.4× |
| Chest 2 views (71046) | $246 | $410 | 2.7× |
| Chest 3 views (71047) | $249.60 | $416 | 2.7× |
| Chest 4 or more views (71048) | $271.20 | $452 | 2.5× |
| Clavicle complete (73000) range across 2 matching MRF lines |
$235.20–$470.40 | $392–$784 | varies |
| Computed Tomography Thorax Lw Dose Lng Ca Scr C- (71271) | $562.80 | $938 | 5.1× |
| CT abdomen and pelvis without and with contrast (74178) | $3,805.80 | $6,343 | 10.3× |
| CT abdomen and pelvis without contrast (74176) | $2,405.40 | $4,009 | 9.5× |
| CT abdomen w contrast (74160) | $1,634.40 | $2,724 | 8.8× |
| CT abdomen w wo contrast (74170) | $1,908.60 | $3,181 | 10.3× |
| CT abdomen w/o contrast (74150) | $1,143.60 | $1,906 | 10.3× |
| CT Angio Abdomen and Pelvis (74174) | $3,405 | $5,675 | 9.2× |
| CT Angio Chest (71275) | $1,574.40 | $2,624 | 8.5× |
| CT Angio Head (70496) | $2,021.40 | $3,369 | 10.9× |
| Ct Angio Lwr Extr W/O&W/Dye (73706) range across 2 matching MRF lines |
$2,253–$4,506 | $3,755–$7,510 | varies |
| CT Angio Neck (70498) | $1,772.40 | $2,954 | 9.6× |
| Ct Angio Upr Extrm W/O&W/Dye (73206) | $2,622.60 | $4,371 | 14.1× |
| CT cervical spine w/ contrast (72126) | $1,333.20 | $2,222 | 3.6× |
| CT cervical spine w/o contrast (72125) | $1,329.60 | $2,216 | 12.0× |
| CT cervical spine w/wo cont (72127) | $1,777.80 | $2,963 | 9.6× |
| CT chest w contrast (71260) | $1,460.40 | $2,434 | 7.9× |
| CT chest w/wo contrast (71270) | $1,617 | $2,695 | 8.7× |
| CT head/brain with contrast (70460) | $1,279.80 | $2,133 | 6.9× |
| CT head/brain without and with contrast (70470) | $1,749.60 | $2,916 | 9.4× |
| CT heart no contrast quant eval coronry calcium (75571) | $255.60 | $426 | 2.8× |
| CT iac w contrast (70481) | $1,608 | $2,680 | 8.7× |
| CT l-spine w&w/o contrast (72133) | $1,731 | $2,885 | 9.3× |
| CT lower ext w/o (73700) range across 2 matching MRF lines |
$1,179.60–$2,359.20 | $1,966–$3,932 | varies |
| CT lower extremity w/contrast material (73701) range across 2 matching MRF lines |
$1,116–$2,232 | $1,860–$3,720 | varies |
| CT lumbar spine w contrast (72132) | $939.60 | $1,566 | 2.5× |
| CT lumbar spine w/o contrast (72131) | $1,245 | $2,075 | 11.3× |
| CT maxillofacial w contrast (70487) | $1,237.80 | $2,063 | 6.7× |
| CT maxillofacial wo contrast (70486) | $1,186.80 | $1,978 | 10.7× |
| CT neck tissue combo (70492) | $1,963.20 | $3,272 | 10.6× |
| Ct Orbit/Ear/Fossa W/O&W/Dye (70482) | $1,939.20 | $3,232 | 10.4× |
| CT orbits w/o contrast (70480) | $1,241.40 | $2,069 | 11.2× |
| CT pelvis w&w/o contrast (72194) | $1,651.80 | $2,753 | 8.9× |
| CT pelvis w/o contrast (72192) | $1,160.40 | $1,934 | 10.5× |
| CT scan of leg combo (73702) range across 2 matching MRF lines |
$1,178.40–$2,356.80 | $1,964–$3,928 | varies |
| CT scans face/jaw combo (70488) | $1,844.40 | $3,074 | 9.9× |
| CT soft tissue neck w contrast (70491) | $1,356.60 | $2,261 | 7.3× |
| CT soft tissue neck w/o contrast (70490) | $1,344.60 | $2,241 | 12.2× |
| CT thoracic spine w contrast (72129) | $1,285.80 | $2,143 | 6.9× |
| CT thoracic spine w/o contrast (72128) | $1,258.80 | $2,098 | 11.4× |
| CT thoracic spine w/wo cont (72130) | $1,510.20 | $2,517 | 8.1× |
| CT thorax w/o contrast (71250) | $1,186.80 | $1,978 | 10.7× |
| CT upper ext wo (73200) range across 2 matching MRF lines |
$1,177.20–$2,354.40 | $1,962–$3,924 | varies |
| CT upper extremity w/o & w/contrast material (73202) range across 2 matching MRF lines |
$1,225.20–$2,450.40 | $2,042–$4,084 | varies |
| CT upper extremity with contrast (73201) range across 2 matching MRF lines |
$1,036.80–$2,073.60 | $1,728–$3,456 | varies |
| Cta Abdl Aorta&Bi Iliofem W/Contrast&Postp (75635) | $2,750.40 | $4,584 | 14.8× |
| Cta Abdomen (74175) | $2,289.60 | $3,816 | 12.3× |
| CTA pelvis (72191) | $2,102.40 | $3,504 | 11.3× |
| Dxa Bone Density Axial (77080) | $463.20 | $772 | 4.2× |
| Dxa bone density study 1/>sites appendiclr skel (77081) | $225.60 | $376 | 2.5× |
| Fetal Biophysical Profile W/O Non-Stress Testing (76819) | $517.20 | $862 | 4.7× |
| Fetal MRI w/placntl matrnl plvc img sing/1st ges (74712) | $1,878 | $3,130 | 7.4× |
| Fluoroscopy up to 1 hr (76000) | $464.40 | $774 | 1.8× |
| Foot 2 views (73620) range across 2 matching MRF lines |
$201.60–$403.20 | $336–$672 | varies |
| Forearm 2 views (73090) range across 2 matching MRF lines |
$268.80–$537.60 | $448–$896 | varies |
| Gastric emptying imaging study (78264) | $1,501.20 | $2,502 | 3.5× |
| Gastric Emptyng Imag Std W/Sm Bwl Transit (78265) | $1,509.60 | $2,516 | 3.6× |
| Gated Heart Planar Single (78472) | $1,489.80 | $2,483 | 3.5× |
| Gstrc Emptng Imag Std W/Sm Bwl Col Trnst Mlt Day (78266) | $1,509.60 | $2,516 | 2.6× |
| Hand 2 views (73120) range across 2 matching MRF lines |
$193.80–$387.60 | $323–$646 | varies |
| Hepatobil Syst Image W/Drug (78227) | $2,062.20 | $3,437 | 3.6× |
| Hepatobiliary System Imaging (78226) | $1,856.40 | $3,094 | 4.4× |
| Ht Musc Image Planar Mult (78454) | $4,064.40 | $6,774 | 3.0× |
| Ht Muscle Image Spect Sing (78451) | $4,173 | $6,955 | 3.0× |
| Infant hip ultrasound with hip movement (dynamic) (76885) | $228 | $380 | 2.5× |
| K Flow/Funct Image W/Drug (78708) | $1,912.20 | $3,187 | 3.3× |
| K Flow/Funct Image W/O Drug (78707) | $1,961.40 | $3,269 | 3.4× |
| Knee 3 Views (73562) range across 2 matching MRF lines |
$333.60–$667.20 | $556–$1,112 | varies |
| Liver & Spleen Imaging Static Only (78215) | $1,250.40 | $2,084 | 3.0× |
| Lung Perf&Ventilat Diferentl (78598) | $2,852.40 | $4,754 | 5.0× |
| Lung perfusion differential (78597) | $1,842.60 | $3,071 | 4.4× |
| Lung Ventilat&Perfus Imaging (78582) | $2,542.20 | $4,237 | 4.4× |
| Lung Ventilation Imaging (78579) | $1,426.20 | $2,377 | 3.4× |
| Magnetic Image Jaw Joint (70336) | $1,847.40 | $3,079 | 7.3× |
| Mammary ductogram or galactogram multiple (77054) | $621 | $1,035 | 2.5× |
| Mammary ductogram or galactogram single (77053) | $514.20 | $857 | 2.0× |
| Meckels Divert Exam (78290) | $1,324.20 | $2,207 | 3.1× |
| Mra Head W/O & W/Contrast Material (70546) | $1,886.40 | $3,144 | 5.1× |
| MRA head w/o contrast (70544) | $1,902 | $3,170 | 7.5× |
| MRA head with contrast (70545) | $1,782 | $2,970 | 4.8× |
| MRA neck w contrast (70548) | $1,512.60 | $2,521 | 4.1× |
| Mra Neck W/O &W/Contrast Material (70549) | $2,679.60 | $4,466 | 7.3× |
| MRA neck w/o contrast (70547) | $946.80 | $1,578 | 3.8× |
| MRI abdomen w contrast (74182) | $2,222.40 | $3,704 | 6.0× |
| MRI abdomen w/o contrast (74181) | $2,123.40 | $3,539 | 8.4× |
| MRI any jt lower extrem w/contrast material (73722) range across 2 matching MRF lines |
$2,205.60–$4,411.20 | $3,676–$7,352 | varies |
| MRI any jt lower extrem w/o & w/contrast matrl (73723) range across 2 matching MRF lines |
$2,302.20–$4,604.40 | $3,837–$7,674 | varies |
| MRI any jt upper extremity w/contrast matrl (73222) range across 2 matching MRF lines |
$1,642.80–$3,285.60 | $2,738–$5,476 | varies |
| MRI cervical spine w contrast (72142) | $2,428.80 | $4,048 | 6.6× |
| MRI cervical spine w/o cont (72141) | $1,850.40 | $3,084 | 7.3× |
| MRI chest w/o contrast (71550) | $2,219.40 | $3,699 | 8.8× |
| MRI chest with contrast (71551) | $2,799 | $4,665 | 3.4× |
| MRI chest wo w contrast (71552) | $3,360.60 | $5,601 | 9.1× |
| MRI lower extrem oth/thn jt w/contrast matrl (73719) range across 2 matching MRF lines |
$2,093.40–$4,186.80 | $3,489–$6,978 | varies |
| MRI lower extrem oth/thn jt w/o & w/contr matr (73720) range across 2 matching MRF lines |
$2,538–$5,076 | $4,230–$8,460 | varies |
| MRI lower extrem oth/thn jt w/o contr matrl (73718) range across 2 matching MRF lines |
$1,870.80–$3,741.60 | $3,118–$6,236 | varies |
| MRI lumbar spine w contrast (72149) | $2,767.20 | $4,612 | 7.5× |
| Mri Neck Spine W/O & W/Dye (72156) | $2,529 | $4,215 | 6.9× |
| MRI orbit face &/neck w/o contrast (70540) | $2,593.80 | $4,323 | 10.3× |
| MRI orbit face neck w contrast (70542) | $2,665.80 | $4,443 | 7.2× |
| Mri Orbt/Fac/Nck W/O &W/Dye (70543) | $2,630.40 | $4,384 | 7.1× |
| MRI pelvis w contrast (72196) | $2,311.80 | $3,853 | 6.3× |
| MRI pelvis w/o & w contrast (72197) | $2,596.20 | $4,327 | 7.0× |
| MRI pelvis w/o contrast (72195) | $1,878 | $3,130 | 7.4× |
| MRI thoracic spine w/o contrast (72146) | $1,845.60 | $3,076 | 7.3× |
| MRI upper extremity oth than jt w/contr matrl (73219) range across 2 matching MRF lines |
$2,019–$4,038 | $3,365–$6,730 | varies |
| MRI upper extremity oth than jt w/o contr matrl (73218) range across 2 matching MRF lines |
$2,175.60–$4,351.20 | $3,626–$7,252 | varies |
| Mri Uppr Extremity W/O&W/Dye (73220) range across 2 matching MRF lines |
$2,184.60–$4,369.20 | $3,641–$7,282 | varies |
| MRI, abdomen, combo (74183) | $2,485.20 | $4,142 | 6.7× |
| MRI, dorsal spine combo (72157) | $2,187 | $3,645 | 5.9× |
| MRI, dorsal spine contrast (72147) | $2,456.40 | $4,094 | 6.7× |
| MRI, joint upper extrem (73221) range across 2 matching MRF lines |
$2,109.60–$4,219.20 | $3,516–$7,032 | varies |
| MRI, joint upper extrem combo (73223) range across 2 matching MRF lines |
$2,438.40–$4,876.80 | $4,064–$8,128 | varies |
| MRI, lumbar spine combo (72158) | $2,501.40 | $4,169 | 6.8× |
| Myocardial Perfusion Planar 1 Study Rest/Stress (78453) | $3,372 | $5,620 | 2.5× |
| Myocardial Spect Multiple Studies (78452) | $5,283 | $8,805 | 3.9× |
| Neck soft tissue (70360) | $195.60 | $326 | 2.1× |
| Parathyroid Planar Imaging (78070) | $1,156.80 | $1,928 | 2.7× |
| Parathyroid planar imaging w/wo subtraction (78071) | $1,531.80 | $2,553 | 3.6× |
| Pelvis 1 or 2 views (72170) | $146.40 | $244 | 1.3× |
| Pulmonary Perfusion Imaging Particulate (78580) | $1,153.80 | $1,923 | 2.7× |
| Radex Abd Compl Aqt Abd W/S/E/D Views 1 View Ch (74022) | $328.80 | $548 | 3.0× |
| Radex Ankle Complete Minimum 3 Views (73610) range across 2 matching MRF lines |
$301.20–$602.40 | $502–$1,004 | varies |
| Radex Calcaneus Minimum 2 Views (73650) range across 2 matching MRF lines |
$221.40–$442.80 | $369–$738 | varies |
| Radex elbow complete minimum 3 views (73080) range across 2 matching MRF lines |
$278.40–$556.80 | $464–$928 | varies |
| Radex Facial Bones Complete Minimum 3 Views (70150) | $357.60 | $596 | 3.2× |
| Radex fingr minimum 2 views (73140) range across 2 matching MRF lines |
$187.20–$374.40 | $312–$624 | varies |
| Radex foot complete minimum 3 views (73630) range across 2 matching MRF lines |
$301.20–$602.40 | $502–$1,004 | varies |
| Radex Hand Minimum 3 Views (73130) range across 2 matching MRF lines |
$304.80–$609.60 | $508–$1,016 | varies |
| Radex lower extremity infant minimum 2 views (73592) range across 2 matching MRF lines |
$105.60–$211.20 | $176–$352 | varies |
| Radex Mastoids Compl Minimum 3 Views PR Side (70130) range across 2 matching MRF lines |
$318.60–$637.20 | $531–$1,062 | varies |
| Radex Nasal Bones Complete Minimum 3 Views (70160) | $244.80 | $408 | 2.7× |
| Radex Ribs Unilateral 2 Views (71100) | $313.20 | $522 | 3.4× |
| Radex shoulder complete minimum 2 views (73030) range across 2 matching MRF lines |
$260.40–$520.80 | $434–$868 | varies |
| Radex Sinuses Paransl < 3 Views (70210) | $235.20 | $392 | 2.6× |
| Radex Spine 1 View Specify Level (72020) | $215.40 | $359 | 2.3× |
| Radex Sternum Minimum 2 Views (71120) | $229.20 | $382 | 2.5× |
| Radex Temporomandble Jt Opn & Clsd Mouth Bilat (70330) | $384 | $640 | 4.2× |
| Radex Toe Minimum 2 Views (73660) range across 2 matching MRF lines |
$175.20–$350.40 | $292–$584 | varies |
| Radex upper extremity infant minimum 2 views (73092) range across 2 matching MRF lines |
$127.20–$254.40 | $212–$424 | varies |
| Radex Wrist Complete Minimum 3 Views (73110) range across 2 matching MRF lines |
$300–$600 | $500–$1,000 | varies |
| Radex X-Ray Exam Entire Spi 6/> Vw - Xr Entire Spine 6+ Vw (72084) | $524.40 | $874 | 4.7× |
| Radiolog exam mandible compl minimum 4 views (70110) | $331.80 | $553 | 3.0× |
| Radiologic Exam Abdomen 3+ Views - Xr Abdomen 3+ Views (74021) | $348.60 | $581 | 3.2× |
| Radiologic exam knee complete 4/more views (73564) range across 2 matching MRF lines |
$382.80–$765.60 | $638–$1,276 | varies |
| Radiologic exam pelvis compl minimum 3 views (72190) | $178.20 | $297 | 1.6× |
| Radiologic examination femur 1 view (73551) range across 2 matching MRF lines |
$123–$246 | $205–$410 | varies |
| Radiologic examination femur minimum 2 views (73552) range across 2 matching MRF lines |
$244.80–$489.60 | $408–$816 | varies |
| Radiologic examination knee 1/2 views (73560) range across 2 matching MRF lines |
$260.40–$520.80 | $434–$868 | varies |
| Radiologic Examination Osseous Survey Limited (77074) | $501 | $835 | 4.5× |
| Radiologic examination tibia & fibula 2 views (73590) range across 2 matching MRF lines |
$277.20–$554.40 | $462–$924 | varies |
| Ribs bilateral 3 views (71110) | $402 | $670 | 3.6× |
| Rp Loclzj Tum Spect 1 Area Single Day Imaging (78803) | $2,494.80 | $4,158 | 4.3× |
| Rp loclzj tum spect 2 area/sep acquisj img (78831) | $2,893.20 | $4,822 | 2.1× |
| Scapula (73010) range across 2 matching MRF lines |
$248.40–$496.80 | $414–$828 | varies |
| Screening Digital Breast Tomosynthesis Bi (77063) | $53.40 | $89 | 2.3× |
| Shoulder 1 view (73020) range across 2 matching MRF lines |
$168–$336 | $280–$560 | varies |
| Skull less than 4 views (70250) | $255.60 | $426 | 2.3× |
| Sternoclavicular joints (71130) | $281.40 | $469 | 3.1× |
| Thoracic spine 2 views (72070) | $307.20 | $512 | 2.8× |
| Thoracic spine 3 views (72072) | $387.60 | $646 | 3.5× |
| Thoracolumbar 2 views (72080) | $327.60 | $546 | 3.6× |
| Thyroid Imaging With Vascular Flow (78013) | $900 | $1,500 | 2.1× |
| Thyroid Uptake Measurement (78012) | $583.80 | $973 | 1.4× |
| Thyroid Uptake W/Blood Flow Sngle/Mult Quan Meas (78014) | $1,379.40 | $2,299 | 3.3× |
| Ultrasound Breast Limited (76642) range across 2 matching MRF lines |
$296.40–$592.80 | $494–$988 | varies |
| Ultrasound Exam Aaa Screen (76706) | $381.60 | $636 | 3.4× |
| Ultrasound, abdomen limited (76705) | $516 | $860 | 4.7× |
| Us breast unilateral complete (76641) range across 3 matching MRF lines |
$588–$1,176 | $980–$1,960 | varies |
| Us chest (76604) range across 2 matching MRF lines |
$193.20–$386.40 | $322–$644 | varies |
| Us complete joint (76881) | $477.60 | $796 | 4.3× |
| Us exam, pelvic, limited (76857) | $242.40 | $404 | 2.2× |
| Us lmtd joint/oth nonvasc xtr strux r-t w/img (76882) | $286.80 | $478 | 2.6× |
| Us ob limited 1 or more fetuses (76815) | $506.40 | $844 | 4.6× |
| Us ob transvaginal (76817) | $369.60 | $616 | 3.3× |
| Us pelvic non ob complete (76856) | $608.40 | $1,014 | 5.5× |
| Us pg uter img f&mat 14 wk tabdl 1/1st gestation (76801) | $382.80 | $638 | 3.5× |
| Us preg uterus real time f/u trnsabdl per fetus (76816) | $476.40 | $794 | 4.3× |
| Us retroperitoneal complete (76770) | $614.40 | $1,024 | 5.6× |
| Us retroperitoneal limited (76775) | $434.40 | $724 | 3.9× |
| Us scrotum and contents (76870) | $554.40 | $924 | 5.0× |
| Us thyroid (76536) | $505.20 | $842 | 4.6× |
| Us transrectal (76872) | $670.20 | $1,117 | 6.1× |
| Wrist 2 views (73100) range across 2 matching MRF lines |
$198–$396 | $330–$660 | varies |
| X-Ray Ac Jts - Xr Acromioclavicular Joints Bilateral (73050) | $272.40 | $454 | 3.0× |
| X-Ray Bend Only L-S Spine (72120) | $400.80 | $668 | 3.6× |
| X-Ray Elbow 2 Vw - Xr Elbow 1-2 Views Right (73070) range across 2 matching MRF lines |
$165.60–$331.20 | $276–$552 | varies |
| X-Ray Exam Breast Specimen (76098) | $682.80 | $1,138 | 1.2× |
| X-Ray Exam Entire Spi 1 Vw (72081) | $235.20 | $392 | 2.6× |
| X-Ray Exam Entire Spi 2/3 Vw (72082) | $391.20 | $652 | 3.5× |
| X-Ray Exam Entire Spi 4/5 Vw (72083) | $403.20 | $672 | 3.6× |
| X-Ray Exam Hip Uni 1 View (73501) | $166.80 | $278 | 1.8× |
| X-Ray Exam Hip Uni 2-3 Views (73502) | $265.20 | $442 | 2.9× |
| X-Ray Exam Hip Uni 4/> Views (73503) | $362.40 | $604 | 3.3× |
| X-Ray Exam Hips Bi 2 Views (73521) | $264.60 | $441 | 2.4× |
| X-Ray Exam Hips Bi 3-4 Views (73522) | $362.40 | $604 | 3.3× |
| X-Ray Exam Hips Bi 5/> Views (73523) | $462 | $770 | 4.2× |
| X-Ray Exam L-S Spine Bending (72114) | $388.20 | $647 | 3.5× |
| X-Ray Exam Neck Spine 2-3 Vw (72040) | $277.20 | $462 | 3.0× |
| X-Ray Exam Neck Spine 6/>Vws (72052) | $451.20 | $752 | 4.1× |
| X-Ray Exam Unilat Ribs/Chest (71101) | $255.60 | $426 | 2.3× |
| X-ray eye for foreign body (70030) range across 2 matching MRF lines |
$246.60–$493.20 | $411–$822 | varies |
| X-ray humerus (73060) range across 2 matching MRF lines |
$266.40–$532.80 | $444–$888 | varies |
| X-ray IV pyelogram (ivp) (74400) | $673.20 | $1,122 | 3.6× |
| X-Ray Jaw <4 Vw - Xr Mandible < 4 Views (70100) | $232.80 | $388 | 2.5× |
| X-Ray Knee Bilat Standing - Xr Knees Anteroposterior Standing Bilat (73565) | $262.80 | $438 | 2.9× |
| X-Ray Lumbar Spine 2/3 Vw - Xr Lumbar Spine 2-3 Views (72100) | $302.40 | $504 | 2.7× |
| X-ray nose-rectum child f.b. (76010) | $266.40 | $444 | 2.9× |
| X-Ray Ribs, Chest 4+ Vw - Xr Ribs 3 Vws Bil W/ Chest Posteroanterior (71111) | $396 | $660 | 3.6× |
| X-Ray Sacroiliac Jts 3+ Vw - Xr Sacroiliac Joints 3+ Views (72202) | $230.40 | $384 | 2.1× |
| X-Ray Sacroiliac Jts <3 Vw - Xr Sacroiliac Joints 1-2 Views (72200) | $124.80 | $208 | 1.1× |
| X-Ray Sacrum/Coccyx 2+ Vw - Xr Sacrum Coccyx 2+ Views (72220) | $285.60 | $476 | 3.1× |
| X-Ray Sinuses 3+ Vw - Xr Paranasal Sinuses 3+ Views (70220) | $309 | $515 | 3.4× |
| X-Ray Skull 4+ Vw - Xr Skull Complete 4+ Views (70260) | $384 | $640 | 3.5× |
| X-ray thoracic spine 4 vw (72074) | $367.20 | $612 | 3.3× |
| X-Rays Bone Length Studies (77073) | $380.40 | $634 | 3.4× |
| X-Rays Bone Survey Complete (77075) | $730.80 | $1,218 | 6.6× |
| Xr c-spine 4 or 5 views (72050) | $474 | $790 | 4.3× |
| Xr facial bones less than 3 views (70140) | $120 | $200 | 1.3× |
| Xr orbits complete 4 views (70200) | $320.40 | $534 | 2.9× |
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.