Imaging prices at CHI Health St. Mary's
Nebraska City, NE · every code in this section with a posted price and a Medicare benchmark.
255 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) | $8,684.29 | $10,463 | 6.0× |
| Abdomen 1 View (74018) range across 2 matching MRF lines |
$59.76–$172.64 | $72–$208 | varies |
| Abdomen 2 views (74019) range across 2 matching MRF lines |
$57.27–$253.15 | $69–$305 | varies |
| Acute Gastrointestinal Blood Loss Imaging (78278) | $1,474.91 | $1,777 | 3.6× |
| Ankle 2 views (73600) range across 2 matching MRF lines |
$61.42–$161.85 | $74–$195 | varies |
| Arthrogram hip (73525) | $626.65 | $755 | 1.7× |
| Arthrogram Wrist (73115) | $516.26 | $622 | 1.4× |
| Bone age studies (77072) | $195.05 | $235 | 1.8× |
| Bone Imaging 3 Phase (78315) | $2,153.02 | $2,594 | 5.2× |
| Bone Imaging Limited Area (78300) | $932.92 | $1,124 | 2.2× |
| Bone Imaging Whole Body (78306) | $1,794.46 | $2,162 | 4.3× |
| Bone survey infant (77076) | $590.13 | $711 | 5.4× |
| Brain Imaging Pet Metabolic Evaluation (78608) | $4,520.18 | $5,446 | 3.0× |
| Cat Scan Follow-Up Study (76380) | $880.63 | $1,061 | 9.7× |
| Chest 1 view (71045) range across 2 matching MRF lines |
$46.48–$239.04 | $56–$288 | varies |
| Chest 2 views (71046) range across 2 matching MRF lines |
$57.27–$262.28 | $69–$316 | varies |
| Chest 3 views (71047) | $291.33 | $351 | 3.2× |
| Clavicle complete (73000) range across 2 matching MRF lines |
$67.23–$244.02 | $81–$294 | varies |
| Computed Tomography Thorax Lw Dose Lng Ca Scr C- (71271) | $345.28 | $416 | 3.2× |
| Contrast X-Ray Bladder (74430) | $502.15 | $605 | 1.4× |
| Contrast X-Ray Of Knee Joint (73580) | $960.31 | $1,157 | 2.7× |
| CT abdomen and pelvis without and with contrast (74178) | $6,073.11 | $7,317 | 16.8× |
| CT abdomen and pelvis without contrast (74176) | $3,980.68 | $4,796 | 16.1× |
| CT abdomen w contrast (74160) | $2,591.26 | $3,122 | 14.2× |
| CT abdomen w wo contrast (74170) | $3,316.68 | $3,996 | 18.2× |
| CT abdomen w/o contrast (74150) | $2,151.36 | $2,592 | 19.8× |
| CT Angio Abdomen and Pelvis (74174) | $7,183.65 | $8,655 | 19.8× |
| CT Angio Chest (71275) | $3,665.28 | $4,416 | 20.1× |
| CT Angio Head (70496) | $3,422.09 | $4,123 | 18.8× |
| CT Angio Neck (70498) | $3,473.55 | $4,185 | 19.1× |
| CT cervical spine w/ contrast (72126) | $2,601.22 | $3,134 | 7.2× |
| CT cervical spine w/o contrast (72125) | $2,454.31 | $2,957 | 22.6× |
| CT chest w contrast (71260) | $2,543.95 | $3,065 | 14.0× |
| CT chest w/wo contrast (71270) | $3,406.32 | $4,104 | 18.7× |
| CT head/brain with contrast (70460) | $1,965.44 | $2,368 | 10.8× |
| CT head/brain without and with contrast (70470) | $2,499.13 | $3,011 | 13.7× |
| CT heart no contrast quant eval coronry calcium (75571) | $105.41 | $127 | 1.2× |
| CT iac w contrast (70481) | $2,402.02 | $2,894 | 13.2× |
| CT lower ext w/o (73700) | $2,332.30 | $2,810 | 21.5× |
| CT lower extremity w/contrast material (73701) | $2,775.52 | $3,344 | 15.2× |
| CT lumbar spine w contrast (72132) | $2,431.07 | $2,929 | 6.7× |
| CT lumbar spine w/o contrast (72131) | $2,133.10 | $2,570 | 19.6× |
| CT maxillofacial w contrast (70487) | $2,255.94 | $2,718 | 12.4× |
| CT maxillofacial wo contrast (70486) | $1,834.30 | $2,210 | 16.9× |
| CT neck tissue combo (70492) | $2,936.54 | $3,538 | 16.1× |
| Ct Orbit/Ear/Fossa W/O&W/Dye (70482) | $2,579.64 | $3,108 | 14.2× |
| CT orbits w/o contrast (70480) | $2,333.13 | $2,811 | 21.5× |
| CT pelvis w&w/o contrast (72194) | $3,040.29 | $3,663 | 16.7× |
| CT pelvis w/o contrast (72192) | $1,985.36 | $2,392 | 18.3× |
| CT scan of leg combo (73702) | $2,915.79 | $3,513 | 16.0× |
| CT scans face/jaw combo (70488) | $2,806.23 | $3,381 | 15.4× |
| CT soft tissue neck w contrast (70491) | $2,621.97 | $3,159 | 14.4× |
| CT soft tissue neck w/o contrast (70490) | $1,940.54 | $2,338 | 17.9× |
| CT thoracic spine w contrast (72129) | $2,330.64 | $2,808 | 12.8× |
| CT thoracic spine w/o contrast (72128) | $2,177.92 | $2,624 | 20.1× |
| CT thorax w/o contrast (71250) | $2,155.51 | $2,597 | 19.9× |
| CT upper ext wo (73200) | $2,109.86 | $2,542 | 19.4× |
| CT upper extremity with contrast (73201) | $2,468.42 | $2,974 | 6.8× |
| Cta Abdl Aorta&Bi Iliofem W/Contrast&Postp (75635) | $2,138.91 | $2,577 | 11.7× |
| Cta Abdomen (74175) | $3,376.44 | $4,068 | 18.5× |
| CTA pelvis (72191) | $3,228.70 | $3,890 | 17.7× |
| Doppler Fetal Mid Cerebral Artery (76821) | $288.84 | $348 | 2.7× |
| Dxa Bone Density Axial (77080) range across 3 matching MRF lines |
$86.32–$1,132.12 | $104–$1,364 | varies |
| Dxa bone density study (77085) | $441.56 | $532 | 4.1× |
| Dxa bone density study 1/>sites appendiclr skel (77081) | $238.21 | $287 | 2.6× |
| Esophagram (74220) | $776.05 | $935 | 4.3× |
| Fetal Biophys Profile W/Nst (76818) | $576.85 | $695 | 5.3× |
| Fetal Biophysical Profile W/O Non-Stress Testing (76819) range across 2 matching MRF lines |
$483.89–$582.66 | $583–$702 | varies |
| Fluoroscopy up to 1 hr (76000) range across 3 matching MRF lines |
$99.60–$524.56 | $120–$632 | varies |
| Foot 2 views (73620) range across 2 matching MRF lines |
$64.74–$117.86 | $78–$142 | varies |
| Forearm 2 views (73090) range across 2 matching MRF lines |
$61.42–$240.70 | $74–$290 | varies |
| Gastric emptying imaging study (78264) | $1,787.82 | $2,154 | 4.3× |
| Gated Heart Planar Single (78472) | $1,758.77 | $2,119 | 4.2× |
| Hand 2 views (73120) range across 2 matching MRF lines |
$64.74–$144.42 | $78–$174 | varies |
| Hepatobil Syst Image W/Drug (78227) | $1,777.86 | $2,142 | 3.2× |
| Hepatobiliary System Imaging (78226) | $2,026.86 | $2,442 | 4.9× |
| Ht Muscle Image Spect Sing (78451) | $2,300.76 | $2,772 | 1.7× |
| Infant hip ultrasound with hip movement (dynamic) (76885) | $413.34 | $498 | 4.6× |
| K Flow/Funct Image W/Drug (78708) | $1,791.14 | $2,158 | 3.2× |
| K Flow/Funct Image W/O Drug (78707) | $1,296.46 | $1,562 | 2.3× |
| Kidney Imaging Morphoogy W/Vascular Flow (78701) | $824.19 | $993 | 2.0× |
| Knee 3 Views (73562) range across 2 matching MRF lines |
$88.81–$327.02 | $107–$394 | varies |
| Liver & Spleen Imaging Static Only (78215) | $1,689.88 | $2,036 | 4.1× |
| Lung perfusion differential (78597) | $2,199.50 | $2,650 | 5.3× |
| Lung Ventilat&Perfus Imaging (78582) | $2,131.44 | $2,568 | 3.8× |
| Lung Ventilation Imaging (78579) | $993.51 | $1,197 | 2.4× |
| Magnetic resonance (eg, proton) imaging, brain (including brain stem andskull base), during open intracranial procedure… (70557) | $676.45 | $815 | 1.2× |
| Meckels Divert Exam (78290) | $1,050.78 | $1,266 | 2.5× |
| MRA head w/o contrast (70544) | $2,882.59 | $3,473 | 11.6× |
| MRA neck w contrast (70548) | $2,683.39 | $3,233 | 7.4× |
| Mra Neck W/O &W/Contrast Material (70549) | $2,848.56 | $3,432 | 7.9× |
| MRA neck w/o contrast (70547) | $2,503.28 | $3,016 | 10.1× |
| MRI abdomen w contrast (74182) | $2,751.45 | $3,315 | 7.6× |
| MRI abdomen w/o contrast (74181) | $3,393.04 | $4,088 | 13.7× |
| MRI any jt lower extrem w/contrast material (73722) | $3,338.26 | $4,022 | 4.1× |
| MRI any jt lower extrem w/o & w/contrast matrl (73723) | $3,910.96 | $4,712 | 10.8× |
| MRI any jt upper extremity w/contrast matrl (73222) | $3,403.83 | $4,101 | 4.2× |
| MRI cervical spine w contrast (72142) | $3,014.56 | $3,632 | 8.3× |
| MRI cervical spine w/o cont (72141) | $3,349.05 | $4,035 | 13.5× |
| MRI chest w/o contrast (71550) | $2,724.89 | $3,283 | 11.0× |
| MRI chest with contrast (71551) | $1,845.09 | $2,223 | 2.3× |
| MRI chest wo w contrast (71552) | $3,715.91 | $4,477 | 10.3× |
| MRI lower extrem oth/thn jt w/contrast matrl (73719) | $2,675.92 | $3,224 | 7.4× |
| MRI lower extrem oth/thn jt w/o & w/contr matr (73720) | $3,629.59 | $4,373 | 10.0× |
| MRI lower extrem oth/thn jt w/o contr matrl (73718) | $2,649.36 | $3,192 | 10.7× |
| MRI lumbar spine w contrast (72149) | $2,992.15 | $3,605 | 8.3× |
| Mri Neck Spine W/O & W/Dye (72156) | $4,186.52 | $5,044 | 11.6× |
| MRI orbit face &/neck w/o contrast (70540) | $2,499.13 | $3,011 | 10.1× |
| MRI orbit face neck w contrast (70542) | $1,753.79 | $2,113 | 4.8× |
| Mri Orbt/Fac/Nck W/O &W/Dye (70543) | $2,811.21 | $3,387 | 7.8× |
| MRI pelvis w contrast (72196) | $2,771.37 | $3,339 | 7.7× |
| MRI pelvis w/o & w contrast (72197) | $2,947.33 | $3,551 | 8.1× |
| MRI pelvis w/o contrast (72195) | $2,363.01 | $2,847 | 9.5× |
| MRI thoracic spine w/o contrast (72146) | $3,211.27 | $3,869 | 13.0× |
| MRI upper extremity oth than jt w/contr matrl (73219) | $2,065.04 | $2,488 | 5.7× |
| MRI upper extremity oth than jt w/o contr matrl (73218) | $2,387.91 | $2,877 | 9.6× |
| Mri Uppr Extremity W/O&W/Dye (73220) | $3,130.76 | $3,772 | 8.6× |
| MRI, abdomen, combo (74183) | $4,584.92 | $5,524 | 12.7× |
| MRI, dorsal spine combo (72157) | $4,142.53 | $4,991 | 11.4× |
| MRI, dorsal spine contrast (72147) | $2,697.50 | $3,250 | 7.4× |
| MRI, joint upper extrem (73221) | $2,413.64 | $2,908 | 9.7× |
| MRI, joint upper extrem combo (73223) | $3,861.99 | $4,653 | 10.7× |
| MRI, lumbar spine combo (72158) | $3,927.56 | $4,732 | 10.8× |
| Myocardial Imaging Infarct Avid Planar Qual/Quan (78466) | $705.50 | $850 | 1.7× |
| Myocardial Imaging Pet Metabolic Evaluation (78459) | $4,520.18 | $5,446 | 3.4× |
| Myocardial imaging, infarct avid, planar; with ejection fraction by first pass technique Non-Facility (78468) | $935.41 | $1,127 | 1.7× |
| Myocardial Spect Multiple Studies (78452) range across 2 matching MRF lines |
$180.94–$4,260.39 | $218–$5,133 | varies |
| Myocrd Img Pet Metab Eval Single Study Cncrnt CT (78429) | $2,018.56 | $2,432 | 1.4× |
| Neck soft tissue (70360) | $257.30 | $310 | 2.8× |
| Nm myocard infarct spect (78469) | $1,266.58 | $1,526 | 2.2× |
| Nuclear Rx Oral Admin (79005) | $1,579.49 | $1,903 | 6.5× |
| Optic foramina (70190) | $195.88 | $236 | 2.2× |
| Parathyroid Planar Imaging (78070) | $1,318.87 | $1,589 | 3.2× |
| Parathyroid planar imaging w/wo subtraction (78071) | $1,346.26 | $1,622 | 3.2× |
| Pelvis 1 or 2 views (72170) range across 2 matching MRF lines |
$64.74–$265.60 | $78–$320 | varies |
| Pet Image W/Ct Lmtd (78814) | $5,379.23 | $6,481 | 3.6× |
| PET image w/CT, full body (78816) | $7,356.29 | $8,863 | 5.0× |
| PET imaging CT attenuation skull base mid-thigh (78815) range across 2 matching MRF lines |
$5,536.93–$7,909.90 | $6,671–$9,530 | varies |
| Pulmonary Perfusion Imaging Particulate (78580) | $1,208.48 | $1,456 | 2.9× |
| Radex Abd Compl Aqt Abd W/S/E/D Views 1 View Ch (74022) | $445.71 | $537 | 4.1× |
| Radex abscess/fistula/sinus tract rs&i (76080) | $1,591.94 | $1,918 | 2.8× |
| Radex Ankle Complete Minimum 3 Views (73610) range across 2 matching MRF lines |
$63.08–$234.89 | $76–$283 | varies |
| Radex Calcaneus Minimum 2 Views (73650) range across 2 matching MRF lines |
$47.31–$83.83 | $57–$101 | varies |
| Radex elbow complete minimum 3 views (73080) range across 2 matching MRF lines |
$75.53–$250.66 | $91–$302 | varies |
| Radex Facial Bones Complete Minimum 3 Views (70150) | $394.25 | $475 | 3.6× |
| Radex fingr minimum 2 views (73140) range across 2 matching MRF lines |
$63.91–$146.91 | $77–$177 | varies |
| Radex foot complete minimum 3 views (73630) range across 2 matching MRF lines |
$71.38–$273.07 | $86–$329 | varies |
| Radex Hand Minimum 3 Views (73130) range across 2 matching MRF lines |
$73.87–$283.03 | $89–$341 | varies |
| Radex lower extremity infant minimum 2 views (73592) range across 2 matching MRF lines |
$48.97–$57.27 | $59–$69 | varies |
| Radex Mastoids Compl Minimum 3 Views PR Side (70130) | $205.84 | $248 | 1.9× |
| Radex Nasal Bones Complete Minimum 3 Views (70160) | $263.11 | $317 | 2.9× |
| Radex Ribs Unilateral 2 Views (71100) range across 2 matching MRF lines |
$73.04–$405.87 | $88–$489 | varies |
| Radex shoulder complete minimum 2 views (73030) range across 3 matching MRF lines |
$21.58–$292.99 | $26–$353 | varies |
| Radex Sinuses Paransl < 3 Views (70210) | $177.62 | $214 | 2.0× |
| Radex Spine 1 View Specify Level (72020) range across 2 matching MRF lines |
$33.20–$217.46 | $40–$262 | varies |
| Radex Sternum Minimum 2 Views (71120) range across 2 matching MRF lines |
$52.29–$57.27 | $63–$69 | varies |
| Radex Temporomandble Jt Opn & Clsd Mouth Bilat (70330) | $73.87 | $89 | 0.8× |
| Radex Toe Minimum 2 Views (73660) range across 2 matching MRF lines |
$68.06–$139.44 | $82–$168 | varies |
| Radex upper extremity infant minimum 2 views (73092) | $192.56 | $232 | 1.8× |
| Radex Wrist Complete Minimum 3 Views (73110) range across 2 matching MRF lines |
$85.49–$245.68 | $103–$296 | varies |
| Radex X-Ray Exam Entire Spi 6/> Vw - Xr Entire Spine 6+ Vw (72084) | $149.40 | $180 | 1.4× |
| Radiolog exam mandible compl minimum 4 views (70110) | $192.56 | $232 | 1.8× |
| Radiologic Exam Abdomen 3+ Views - Xr Abdomen 3+ Views (74021) | $330.34 | $398 | 3.0× |
| Radiologic exam colon double contrast study (74280) | $1,274.88 | $1,536 | 7.0× |
| Radiologic exam colon single contrast study (74270) | $1,004.30 | $1,210 | 5.5× |
| Radiologic Exam Esophagus Double Contrast Study (74221) | $255.64 | $308 | 1.4× |
| Radiologic exam knee complete 4/more views (73564) range across 2 matching MRF lines |
$96.28–$401.72 | $116–$484 | varies |
| Radiologic exam pelvis compl minimum 3 views (72190) | $350.26 | $422 | 3.2× |
| Radiologic Exam Small Int Single Contrast Study (74250) | $869.84 | $1,048 | 4.8× |
| Radiologic exam swallow function contrast study (74230) | $795.14 | $958 | 4.4× |
| Radiologic exam upr gi trc double contrast study (74246) | $1,098.92 | $1,324 | 6.0× |
| Radiologic examination femur 1 view (73551) | $291.33 | $351 | 3.2× |
| Radiologic examination femur minimum 2 views (73552) | $291.33 | $351 | 3.2× |
| Radiologic examination knee 1/2 views (73560) range across 2 matching MRF lines |
$75.53–$209.16 | $91–$252 | varies |
| Radiologic examination tibia & fibula 2 views (73590) range across 2 matching MRF lines |
$64.74–$260.62 | $78–$314 | varies |
| Rp loclzj tum plnr 1 area single day imaging (78800) | $795.97 | $959 | 1.9× |
| Rp Loclzj Tum Spect 1 Area Single Day Imaging (78803) range across 2 matching MRF lines |
$1,615.18–$2,519.88 | $1,946–$3,036 | varies |
| Scapula (73010) | $239.87 | $289 | 2.2× |
| Screening Digital Breast Tomosynthesis Bi (77063) | $54.78 | $66 | 2.3× |
| Shoulder 1 view (73020) range across 2 matching MRF lines |
$55.61–$290.50 | $67–$350 | varies |
| Shoulder Arthrography (73040) | $716.29 | $863 | 2.0× |
| Skull less than 4 views (70250) range across 2 matching MRF lines |
$63.91–$242.36 | $77–$292 | varies |
| Special Physics Consult (77370) | $1,088.96 | $1,312 | 7.8× |
| Speech evaluation, complex (70371) | $489.70 | $590 | 2.0× |
| Telethx isodose pln cplx w/basic dosimetry (77307) | $2,983.85 | $3,595 | 7.7× |
| Thoracic spine 2 views (72070) range across 2 matching MRF lines |
$83–$223.27 | $100–$269 | varies |
| Thoracic spine 3 views (72072) range across 2 matching MRF lines |
$85.49–$531.20 | $103–$640 | varies |
| Thoracolumbar 2 views (72080) | $148.57 | $179 | 1.6× |
| Thyroid Carcinoma Metastases Img Lmtd Area (78015) | $689.73 | $831 | 1.7× |
| Thyroid Met Imaging Body (78018) | $1,727.23 | $2,081 | 3.1× |
| Thyroid Uptake Measurement (78012) | $474.76 | $572 | 1.1× |
| Thyroid Uptake W/Blood Flow Sngle/Mult Quan Meas (78014) | $1,140.42 | $1,374 | 2.7× |
| Ultrasound Breast Limited (76642) | $425.79 | $513 | 4.7× |
| Ultrasound Exam Aaa Screen (76706) | $448.20 | $540 | 4.1× |
| Ultrasound, abdomen limited (76705) | $470.61 | $567 | 4.3× |
| Umbilical-artery Doppler (OB) (76820) | $332 | $400 | 3.1× |
| Upper gi w/o kub (74240) range across 2 matching MRF lines |
$463.97–$1,034.18 | $559–$1,246 | varies |
| Urethrocystogram voiding (74455) | $590.13 | $711 | 2.4× |
| Us breast unilateral complete (76641) | $485.55 | $585 | 4.5× |
| Us chest (76604) | $451.52 | $544 | 4.2× |
| Us complete joint (76881) | $665.66 | $802 | 6.1× |
| Us exam, pelvic, limited (76857) | $472.27 | $569 | 4.4× |
| Us head (76506) | $472.27 | $569 | 4.4× |
| Us kidney transplant (76776) | $585.15 | $705 | 5.4× |
| Us lmtd joint/oth nonvasc xtr strux r-t w/img (76882) | $524.56 | $632 | 4.8× |
| Us ob detailed single fetus (76811) | $1,339.62 | $1,614 | 5.4× |
| Us ob limited 1 or more fetuses (76815) | $483.06 | $582 | 4.4× |
| Us ob transvaginal (76817) | $742.02 | $894 | 6.8× |
| Us pelvic non ob complete (76856) | $761.94 | $918 | 7.0× |
| Us pg uter img f&mat 14 wk tabdl 1/1st gestation (76801) | $1,008.45 | $1,215 | 9.3× |
| Us preg uterus real time f/u trnsabdl per fetus (76816) range across 2 matching MRF lines |
$334.49–$512.11 | $403–$617 | varies |
| Us retroperitoneal complete (76770) | $760.28 | $916 | 7.0× |
| Us retroperitoneal limited (76775) | $532.03 | $641 | 4.9× |
| Us scrotum and contents (76870) | $707.99 | $853 | 6.5× |
| Us spinal canal and contents (76800) | $508.79 | $613 | 4.7× |
| Us thyroid (76536) | $563.57 | $679 | 5.2× |
| Us transrectal (76872) | $77.19 | $93 | 0.7× |
| Vertebral fracture assessment via dxa (77086) | $22.41 | $27 | 0.2× |
| Wrist 2 views (73100) range across 2 matching MRF lines |
$69.72–$176.79 | $84–$213 | varies |
| X-Ray Ac Jts - Xr Acromioclavicular Joints Bilateral (73050) range across 2 matching MRF lines |
$63.08–$175.96 | $76–$212 | varies |
| X-ray antegrade pyelogram tube (74425) | $535.35 | $645 | 1.5× |
| X-Ray Bend Only L-S Spine (72120) | $611.71 | $737 | 5.6× |
| X-Ray Elbow 2 Vw - Xr Elbow 1-2 Views Right (73070) range across 2 matching MRF lines |
$65.57–$224.10 | $79–$270 | varies |
| X-Ray Exam Breast Specimen (76098) | $163.51 | $197 | 0.3× |
| X-Ray Exam Entire Spi 1 Vw (72081) | $133.63 | $161 | 1.5× |
| X-Ray Exam Entire Spi 2/3 Vw (72082) | $133.63 | $161 | 1.2× |
| X-Ray Exam Entire Spi 4/5 Vw (72083) | $149.40 | $180 | 1.4× |
| X-Ray Exam Hip Uni 1 View (73501) | $197.54 | $238 | 2.2× |
| X-Ray Exam Hip Uni 2-3 Views (73502) range across 2 matching MRF lines |
$127.82–$197.54 | $154–$238 | varies |
| X-Ray Exam Hip Uni 4/> Views (73503) | $319.55 | $385 | 2.9× |
| X-Ray Exam Hips Bi 2 Views (73521) | $380.97 | $459 | 3.5× |
| X-Ray Exam Hips Bi 3-4 Views (73522) | $380.97 | $459 | 3.5× |
| X-Ray Exam Hips Bi 5/> Views (73523) | $380.97 | $459 | 3.5× |
| X-Ray Exam L-S Spine Bending (72114) range across 2 matching MRF lines |
$83–$638.27 | $100–$769 | varies |
| X-Ray Exam Neck Spine 2-3 Vw (72040) range across 2 matching MRF lines |
$84.66–$187.58 | $102–$226 | varies |
| X-Ray Exam Neck Spine 6/>Vws (72052) | $139.44 | $168 | 1.3× |
| X-Ray Exam Unilat Ribs/Chest (71101) range across 2 matching MRF lines |
$99.60–$126.16 | $120–$152 | varies |
| X-ray eye for foreign body (70030) | $192.56 | $232 | 2.1× |
| X-ray humerus (73060) range across 2 matching MRF lines |
$66.40–$276.39 | $80–$333 | varies |
| X-ray IV pyelogram (ivp) (74400) | $798.46 | $962 | 4.4× |
| X-Ray Jaw <4 Vw - Xr Mandible < 4 Views (70100) | $221.61 | $267 | 2.5× |
| X-Ray Knee Bilat Standing - Xr Knees Anteroposterior Standing Bilat (73565) | $111.22 | $134 | 1.2× |
| X-Ray Lumbar Spine 2/3 Vw - Xr Lumbar Spine 2-3 Views (72100) range across 2 matching MRF lines |
$87.15–$244.85 | $105–$295 | varies |
| X-ray nose-rectum child f.b. (76010) | $194.22 | $234 | 2.1× |
| X-Ray Ribs, Chest 4+ Vw - Xr Ribs 3 Vws Bil W/ Chest Posteroanterior (71111) | $494.68 | $596 | 4.6× |
| X-Ray Sacroiliac Jts 3+ Vw - Xr Sacroiliac Joints 3+ Views (72202) | $296.31 | $357 | 2.7× |
| X-Ray Sacroiliac Jts <3 Vw - Xr Sacroiliac Joints 1-2 Views (72200) | $49.80 | $60 | 0.5× |
| X-Ray Sacrum/Coccyx 2+ Vw - Xr Sacrum Coccyx 2+ Views (72220) range across 2 matching MRF lines |
$37.35–$180.11 | $45–$217 | varies |
| X-Ray Sinuses 3+ Vw - Xr Paranasal Sinuses 3+ Views (70220) range across 2 matching MRF lines |
$66.40–$390.93 | $80–$471 | varies |
| X-Ray Skull 4+ Vw - Xr Skull Complete 4+ Views (70260) | $407.53 | $491 | 3.8× |
| X-Rays Bone Length Studies (77073) | $216.63 | $261 | 2.0× |
| X-Rays Bone Survey Complete (77075) | $639.93 | $771 | 5.9× |
| Xr c-spine 4 or 5 views (72050) range across 2 matching MRF lines |
$109.56–$583.49 | $132–$703 | varies |
| Xr facial bones less than 3 views (70140) | $260.62 | $314 | 2.9× |
| Xr orbits complete 4 views (70200) | $351.92 | $424 | 3.2× |
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.