Imaging prices at CommonSpirit Saint Joseph Hospital - Berea
Berea, KY · every code in this section with a posted price and a Medicare benchmark.
288 codes. Prices are the hospital's own posted facility charges.
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| Procedure | Posted cash | Posted gross | × Medicare |
|---|---|---|---|
| 3-D radiotherapy plan dose-volume histograms (77295) | $2,157.68 | $4,476 | 1.7× |
| Abdomen 1 View (74018) | $183.67 | $381 | 2.2× |
| Abdomen 2 views (74019) | $170.65 | $354 | 1.7× |
| Acute Gastrointestinal Blood Loss Imaging (78278) | $461.33 | $957 | 1.2× |
| Ankle 2 views (73600) | $140.76 | $292 | 1.7× |
| Arthrogram ankle (73615) | $224.16 | $465 | 0.7× |
| Arthrogram hip (73525) | $246.33 | $511 | 0.8× |
| Arthrogram Wrist (73115) | $558.71 | $1,159 | 1.7× |
| Bone age studies (77072) | $175.47 | $364 | 1.8× |
| Bone Imaging 3 Phase (78315) | $955.92 | $1,983 | 2.5× |
| Bone Imaging Limited Area (78300) | $637.28 | $1,322 | 1.7× |
| Bone Imaging Multiple Areas (78305) | $704.29 | $1,461 | 1.9× |
| Bone Imaging Whole Body (78306) | $838.30 | $1,739 | 2.2× |
| Bone survey infant (77076) | $165.35 | $343 | 1.7× |
| Brain Image W/Flow < 4 Views (78601) | $214.04 | $444 | 0.6× |
| Brain imaging < 4 static views (78600) | $400.59 | $831 | 1.1× |
| Brain Imaging Min 4 Static Views W Vascular Flow (78606) | $655.12 | $1,359 | 1.3× |
| Brain Imaging Minimum 4 Static Views (78605) | $556.78 | $1,155 | 1.1× |
| Cat Scan Follow-Up Study (76380) | $297.91 | $618 | 3.6× |
| Cerebrospinal Fluid Scan (78630) | $959.29 | $1,990 | 1.9× |
| Chest 1 view (71045) range across 2 matching MRF lines |
$143.66–$202.47 | $298–$420 | varies |
| Chest 2 views (71046) | $265.62 | $551 | 3.3× |
| Chest 3 views (71047) | $165.35 | $343 | 2.0× |
| Chest 4 or more views (71048) | $189.45 | $393 | 1.9× |
| Clavicle complete (73000) range across 2 matching MRF lines |
$170.65–$213.56 | $354–$443 | varies |
| Computed Tomography Thorax Lw Dose Lng Ca Scr C- (71271) | $439.64 | $912 | 4.5× |
| Contrast X-Ray Bladder (74430) | $289.24 | $600 | 0.9× |
| Contrast X-Ray Of Elbow (73085) | $558.71 | $1,159 | 1.7× |
| Contrast X-Ray Of Knee Joint (73580) | $224.16 | $465 | 0.7× |
| CT abdomen and pelvis without and with contrast (74178) | $973.27 | $2,019 | 3.0× |
| CT abdomen and pelvis without contrast (74176) | $935.67 | $1,941 | 4.2× |
| CT abdomen w contrast (74160) | $595.34 | $1,235 | 3.6× |
| CT abdomen w wo contrast (74170) | $654.15 | $1,357 | 4.0× |
| CT abdomen w/o contrast (74150) | $386.13 | $801 | 3.9× |
| CT Angio Abdomen and Pelvis (74174) | $885.54 | $1,837 | 2.7× |
| CT Angio Chest (71275) | $676.81 | $1,404 | 4.1× |
| CT Angio Head (70496) | $865.77 | $1,796 | 5.3× |
| Ct Angio Lwr Extr W/O&W/Dye (73706) | $674.88 | $1,400 | 4.1× |
| CT Angio Neck (70498) | $738.99 | $1,533 | 4.5× |
| Ct Angio Upr Extrm W/O&W/Dye (73206) range across 2 matching MRF lines |
$618.96–$901.45 | $1,284–$1,870 | varies |
| CT cervical spine w/ contrast (72126) | $681.63 | $1,414 | 2.1× |
| CT cervical spine w/o contrast (72125) | $528.34 | $1,096 | 5.4× |
| CT cervical spine w/wo cont (72127) | $860.95 | $1,786 | 5.2× |
| CT chest w contrast (71260) | $755.87 | $1,568 | 4.6× |
| CT chest w/wo contrast (71270) | $870.59 | $1,806 | 5.3× |
| CT head/brain with contrast (70460) | $742.85 | $1,541 | 4.5× |
| CT head/brain without and with contrast (70470) | $835.40 | $1,733 | 5.1× |
| CT iac w contrast (70481) | $701.39 | $1,455 | 4.3× |
| CT l-spine w&w/o contrast (72133) | $1,494.37 | $3,100 | 9.1× |
| CT lower ext w/o (73700) | $423.25 | $878 | 4.3× |
| CT lower extremity w/contrast material (73701) range across 2 matching MRF lines |
$672.95–$977.61 | $1,396–$2,028 | varies |
| CT lumbar spine w contrast (72132) | $940.01 | $1,950 | 2.9× |
| CT lumbar spine w/o contrast (72131) | $583.77 | $1,211 | 6.0× |
| CT maxillofacial w contrast (70487) | $905.78 | $1,879 | 5.5× |
| CT maxillofacial wo contrast (70486) | $823.35 | $1,708 | 8.4× |
| CT neck tissue combo (70492) | $494.11 | $1,025 | 3.0× |
| Ct Orbit/Ear/Fossa W/O&W/Dye (70482) | $562.08 | $1,166 | 3.4× |
| CT orbits w/o contrast (70480) | $515.80 | $1,070 | 5.3× |
| CT pelvis w&w/o contrast (72194) | $714.89 | $1,483 | 4.3× |
| CT pelvis w/o contrast (72192) | $591 | $1,226 | 6.0× |
| CT scan of leg combo (73702) | $714.89 | $1,483 | 4.3× |
| CT scans face/jaw combo (70488) | $740.92 | $1,537 | 4.5× |
| CT soft tissue neck w contrast (70491) | $658.49 | $1,366 | 4.0× |
| CT soft tissue neck w/o contrast (70490) | $421.32 | $874 | 4.3× |
| CT thoracic spine w contrast (72129) | $680.18 | $1,411 | 4.1× |
| CT thoracic spine w/o contrast (72128) | $586.18 | $1,216 | 6.0× |
| CT thoracic spine w/wo cont (72130) | $1,805.30 | $3,745 | 11.0× |
| CT thorax w/o contrast (71250) | $439.64 | $912 | 4.5× |
| CT upper ext wo (73200) | $417.95 | $867 | 4.3× |
| CT upper extremity w/o & w/contrast material (73202) | $610.29 | $1,266 | 3.7× |
| CT upper extremity with contrast (73201) | $463.74 | $962 | 1.4× |
| Cta Abdl Aorta&Bi Iliofem W/Contrast&Postp (75635) | $612.21 | $1,270 | 3.7× |
| Cta Abdomen (74175) | $611.25 | $1,268 | 3.7× |
| CTA pelvis (72191) | $508.57 | $1,055 | 3.1× |
| Diskography lumbar (72295) | $1,764.32 | $3,660 | 1.0× |
| Dxa Bone Density Axial (77080) range across 2 matching MRF lines |
$290.20–$337.44 | $602–$700 | varies |
| Dxa bone density study 1/>sites appendiclr skel (77081) | $209.22 | $434 | 2.6× |
| Echograp Trans R Pros Study (76873) | $150.41 | $312 | 1.5× |
| Esophagram (74220) | $334.55 | $694 | 2.0× |
| Fetal Biophysical Profile W/O Non-Stress Testing (76819) | $140.76 | $292 | 1.4× |
| Fluoroscopy up to 1 hr (76000) | $218.86 | $454 | 1.0× |
| Foot 2 views (73620) range across 2 matching MRF lines |
$179.33–$391.43 | $372–$812 | varies |
| Forearm 2 views (73090) | $220.79 | $458 | 2.7× |
| Gastric emptying imaging study (78264) | $991.11 | $2,056 | 2.6× |
| Gastroesophageal Reflux Exam (78262) | $537.98 | $1,116 | 1.4× |
| Gated Heart Planar Single (78472) | $755.87 | $1,568 | 2.0× |
| Hand 2 views (73120) range across 2 matching MRF lines |
$114.73–$273.81 | $238–$568 | varies |
| Hepatobil Syst Image W/Drug (78227) | $1,076.91 | $2,234 | 2.1× |
| Hepatobiliary System Imaging (78226) | $689.34 | $1,430 | 1.8× |
| Ht Musc Image Planar Mult (78454) | $1,195.50 | $2,480 | 1.0× |
| Ht Muscle Image Spect Sing (78451) | $1,105.36 | $2,293 | 0.9× |
| Hysterosalpingogram (74740) | $245.85 | $510 | 1.1× |
| Infusion Ivp (74410) | $627.64 | $1,302 | 3.8× |
| Interstitial radiation source applic complex (77778) | $422.77 | $877 | 0.6× |
| Joint Survey Single View (77077) | $328.28 | $681 | 3.3× |
| K Flow/Funct Image Multiple (78709) | $714.89 | $1,483 | 1.4× |
| K Flow/Funct Image W/Drug (78708) | $964.11 | $2,000 | 1.9× |
| K Flow/Funct Image W/O Drug (78707) | $605.47 | $1,256 | 1.2× |
| Kidney Imaging Morphol (78700) | $526.41 | $1,092 | 1.4× |
| Kidney Imaging Morphoogy W/Vascular Flow (78701) | $459.40 | $953 | 1.2× |
| Knee 3 Views (73562) | $187.52 | $389 | 2.3× |
| Liver & Spleen Imaging Static Only (78215) | $522.07 | $1,083 | 1.4× |
| Liver imaging static only (78201) | $438.19 | $909 | 0.9× |
| Liver imaging w/vascular flow (78202) | $522.07 | $1,083 | 1.0× |
| Lung Perf&Ventilat Diferentl (78598) | $542.32 | $1,125 | 1.1× |
| Lung perfusion differential (78597) | $604.98 | $1,255 | 1.6× |
| Lung Ventilat&Perfus Imaging (78582) | $795.39 | $1,650 | 1.6× |
| Magnetic Image Jaw Joint (70336) | $711.52 | $1,476 | 3.2× |
| Meckels Divert Exam (78290) | $558.22 | $1,158 | 1.5× |
| Mr safety determination physician/other qhp (76016) | $107.50 | $223 | 1.3× |
| Mr safety implant&/fb assmt clin staf 1st 15 min (76014) | $29.89 | $62 | 1.1× |
| Mr safety implt electronics prepj supvj phys/qhp (76018) | $112.32 | $233 | 1.3× |
| Mr safety med physics xm customization plng&mntr (76017) | $295.02 | $612 | 1.3× |
| Mra Head W/O & W/Contrast Material (70546) | $1,494.86 | $3,101 | 4.6× |
| MRA head w/o contrast (70544) | $1,037.87 | $2,153 | 4.6× |
| MRA head with contrast (70545) | $1,048.47 | $2,175 | 3.2× |
| MRA neck w contrast (70548) | $754.90 | $1,566 | 2.3× |
| Mra Neck W/O &W/Contrast Material (70549) | $1,078.36 | $2,237 | 3.3× |
| MRA neck w/o contrast (70547) | $750.56 | $1,557 | 3.4× |
| MRI abdomen w contrast (74182) | $1,527.63 | $3,169 | 4.7× |
| MRI abdomen w/o contrast (74181) | $1,045.10 | $2,168 | 4.7× |
| MRI any jt lower extrem w/contrast material (73722) | $1,241.29 | $2,575 | 1.7× |
| MRI any jt lower extrem w/o & w/contrast matrl (73723) | $1,644.77 | $3,412 | 5.0× |
| MRI any jt upper extremity w/contrast matrl (73222) | $1,372.90 | $2,848 | 1.9× |
| MRI cervical spine w contrast (72142) | $1,292.39 | $2,681 | 3.9× |
| MRI cervical spine w/o cont (72141) | $929.89 | $1,929 | 4.2× |
| MRI chest w/o contrast (71550) | $711.52 | $1,476 | 3.2× |
| MRI chest with contrast (71551) | $798.29 | $1,656 | 1.1× |
| MRI chest wo w contrast (71552) | $848.90 | $1,761 | 2.6× |
| MRI lower extrem oth/thn jt w/contrast matrl (73719) | $1,301.07 | $2,699 | 4.0× |
| MRI lower extrem oth/thn jt w/o & w/contr matr (73720) | $1,633.20 | $3,388 | 5.0× |
| MRI lower extrem oth/thn jt w/o contr matrl (73718) | $922.66 | $1,914 | 4.1× |
| MRI lumbar spine w contrast (72149) | $998.82 | $2,072 | 3.1× |
| Mri Neck Spine W/O & W/Dye (72156) | $1,589.82 | $3,298 | 4.9× |
| MRI orbit face &/neck w/o contrast (70540) | $747.19 | $1,550 | 3.3× |
| MRI orbit face neck w contrast (70542) | $990.63 | $2,055 | 3.0× |
| Mri Orbt/Fac/Nck W/O &W/Dye (70543) | $1,193.57 | $2,476 | 3.6× |
| MRI pelvis w contrast (72196) | $718.75 | $1,491 | 2.2× |
| MRI pelvis w/o & w contrast (72197) | $1,183.93 | $2,456 | 3.6× |
| MRI pelvis w/o contrast (72195) | $738.51 | $1,532 | 3.3× |
| MRI thoracic spine w/o contrast (72146) | $928.44 | $1,926 | 4.1× |
| MRI upper extremity oth than jt w/contr matrl (73219) | $1,040.28 | $2,158 | 3.2× |
| MRI upper extremity oth than jt w/o contr matrl (73218) | $812.27 | $1,685 | 3.6× |
| Mri Uppr Extremity W/O&W/Dye (73220) | $1,267.33 | $2,629 | 3.9× |
| MRI, abdomen, combo (74183) | $1,607.66 | $3,335 | 4.9× |
| MRI, dorsal spine combo (72157) | $1,615.85 | $3,352 | 4.9× |
| MRI, dorsal spine contrast (72147) | $1,169.95 | $2,427 | 3.6× |
| MRI, joint upper extrem (73221) range across 2 matching MRF lines |
$1,017.14–$2,115.26 | $2,110–$4,388 | varies |
| MRI, joint upper extrem combo (73223) | $1,312.16 | $2,722 | 4.0× |
| MRI, lumbar spine combo (72158) | $1,614.40 | $3,349 | 4.9× |
| Myelogram Lumbar (72265) | $925.07 | $1,919 | 1.3× |
| Myelography thoracic (72255) | $692.72 | $1,437 | 0.9× |
| Myelograpy 2/more regions rs&i (72270) | $810.82 | $1,682 | 1.1× |
| Myocardial imaging, infarct avid, planar; with ejection fraction by first pass technique Non-Facility (78468) | $662.35 | $1,374 | 1.3× |
| Myocardial Spect Multiple Studies (78452) | $2,255.54 | $4,679 | 1.9× |
| N-invas est c ffr sw aly CTA (75580) | $1,200.32 | $2,490 | 1.5× |
| Neck soft tissue (70360) | $197.65 | $410 | 2.4× |
| Nonvascular Shunt X-Ray (75809) | $271.40 | $563 | 2.8× |
| Ob us nuchal meas 1 gest (76813) | $140.76 | $292 | 1.4× |
| Optic foramina (70190) | $84.85 | $176 | 1.0× |
| Parathyroid Planar Imaging (78070) | $676.33 | $1,403 | 1.8× |
| Parathyroid planar imaging w/wo subtraction (78071) | $209.70 | $435 | 0.6× |
| Pelvis 1 or 2 views (72170) | $180.29 | $374 | 1.8× |
| Perineogram (74775) | $262.72 | $545 | 1.2× |
| Pulmonary Perfusion Imaging Particulate (78580) | $427.59 | $887 | 1.1× |
| Radex Abd Compl Aqt Abd W/S/E/D Views 1 View Ch (74022) | $308.52 | $640 | 3.1× |
| Radex abscess/fistula/sinus tract rs&i (76080) | $284.42 | $590 | 0.6× |
| Radex Ankle Complete Minimum 3 Views (73610) | $242.48 | $503 | 3.0× |
| Radex Calcaneus Minimum 2 Views (73650) | $170.65 | $354 | 2.1× |
| Radex elbow complete minimum 3 views (73080) | $128.23 | $266 | 1.6× |
| Radex Facial Bones Complete Minimum 3 Views (70150) range across 2 matching MRF lines |
$164.87–$317.20 | $342–$658 | varies |
| Radex fingr minimum 2 views (73140) | $150.89 | $313 | 1.8× |
| Radex foot complete minimum 3 views (73630) | $221.27 | $459 | 2.7× |
| Radex Hand Minimum 3 Views (73130) | $248.74 | $516 | 3.0× |
| Radex lower extremity infant minimum 2 views (73592) range across 2 matching MRF lines |
$92.08–$259.35 | $191–$538 | varies |
| Radex Mastoids Compl Minimum 3 Views PR Side (70130) | $172.10 | $357 | 1.8× |
| Radex Nasal Bones Complete Minimum 3 Views (70160) | $172.58 | $358 | 2.1× |
| Radex Ribs Unilateral 2 Views (71100) | $182.22 | $378 | 2.2× |
| Radex shoulder complete minimum 2 views (73030) range across 4 matching MRF lines |
$235.73–$491.70 | $489–$1,020 | varies |
| Radex Sinuses Paransl < 3 Views (70210) | $78.58 | $163 | 1.0× |
| Radex sm int w/mlt srl imges via enteroclss tube (74251) | $348.05 | $722 | 2.1× |
| Radex Spine 1 View Specify Level (72020) | $106.54 | $221 | 1.3× |
| Radex Sternum Minimum 2 Views (71120) range across 2 matching MRF lines |
$156.19–$316.23 | $324–$656 | varies |
| Radex Temporomandble Jt Opn & Clsd Mouth Bilat (70330) | $158.12 | $328 | 1.9× |
| Radex Toe Minimum 2 Views (73660) | $127.27 | $264 | 1.6× |
| Radex upper extremity infant minimum 2 views (73092) | $175.47 | $364 | 1.8× |
| Radex Wrist Complete Minimum 3 Views (73110) | $240.07 | $498 | 2.9× |
| Radex X-Ray Exam Entire Spi 6/> Vw - Xr Entire Spine 6+ Vw (72084) | $184.63 | $383 | 1.9× |
| Radiolog exam mandible compl minimum 4 views (70110) | $137.39 | $285 | 1.4× |
| Radiologic Exam Abdomen 3+ Views - Xr Abdomen 3+ Views (74021) | $192.83 | $400 | 2.0× |
| Radiologic exam colon double contrast study (74280) | $388.54 | $806 | 2.4× |
| Radiologic exam colon single contrast study (74270) | $381.79 | $792 | 2.3× |
| Radiologic Exam Esophagus Double Contrast Study (74221) | $309.97 | $643 | 1.9× |
| Radiologic exam knee complete 4/more views (73564) range across 2 matching MRF lines |
$276.22–$328.77 | $573–$682 | varies |
| Radiologic exam pelvis compl minimum 3 views (72190) | $173.06 | $359 | 1.8× |
| Radiologic Exam Small Int Single Contrast Study (74250) range across 2 matching MRF lines |
$298.40–$497.48 | $619–$1,032 | varies |
| Radiologic exam swallow function contrast study (74230) | $355.76 | $738 | 2.2× |
| Radiologic exam upr gi trc double contrast study (74246) range across 2 matching MRF lines |
$348.05–$382.76 | $722–$794 | varies |
| Radiologic examination femur minimum 2 views (73552) range across 3 matching MRF lines |
$192.34–$407.34 | $399–$845 | varies |
| Radiologic examination knee 1/2 views (73560) | $203.91 | $423 | 2.5× |
| Radiologic Examination Osseous Survey Limited (77074) | $370.22 | $768 | 3.8× |
| Radiologic Examination Salivary Gland Calculus (70380) | $80.03 | $166 | 1.0× |
| Radiologic examination tibia & fibula 2 views (73590) | $205.36 | $426 | 2.5× |
| Ribs bilateral 3 views (71110) range across 2 matching MRF lines |
$208.25–$375.53 | $432–$779 | varies |
| Rp loclzj tum plnr 1 area single day imaging (78800) | $1,289.50 | $2,675 | 3.4× |
| Rp loclzj tum plnr 2+area 1+d img/1 area img>2+d (78801) | $1,392.18 | $2,888 | 3.7× |
| Rp Loclzj Tum Plnr Whole Body Single Day Imaging (78802) | $1,002.68 | $2,080 | 2.0× |
| Rp Loclzj Tum Spect 1 Area Single Day Imaging (78803) range across 2 matching MRF lines |
$1,078.84–$1,652.49 | $2,238–$3,428 | varies |
| Rp loclzj tum spect 2 area/sep acquisj img (78831) | $654.15 | $1,357 | 0.5× |
| Scapula (73010) | $165.35 | $343 | 1.7× |
| Screening Digital Breast Tomosynthesis Bi (77063) | $44.35 | $92 | 1.9× |
| Shoulder 1 view (73020) range across 2 matching MRF lines |
$129.68–$296.95 | $269–$616 | varies |
| Shoulder Arthrography (73040) | $246.33 | $511 | 0.8× |
| Skull less than 4 views (70250) range across 2 matching MRF lines |
$130.16–$227.05 | $270–$471 | varies |
| Sternoclavicular joints (71130) | $143.66 | $298 | 1.8× |
| Testicular Imaging W/Flow (78761) | $441.57 | $916 | 1.2× |
| Thoracic spine 2 views (72070) | $170.17 | $353 | 1.7× |
| Thoracic spine 3 views (72072) range across 2 matching MRF lines |
$196.68–$293.58 | $408–$609 | varies |
| Thoracolumbar 2 views (72080) | $138.35 | $287 | 1.7× |
| Thyroid Uptake Measurement (78012) | $606.43 | $1,258 | 1.6× |
| Thyroid Uptake W/Blood Flow Sngle/Mult Quan Meas (78014) | $416.02 | $863 | 1.1× |
| Tx Devices Design & Construction Complex (77334) | $476.27 | $988 | 1.4× |
| Ultrasound Breast Limited (76642) range across 2 matching MRF lines |
$93.04–$245.37 | $193–$509 | varies |
| Ultrasound Exam Aaa Screen (76706) | $248.74 | $516 | 2.5× |
| Ultrasound, abdomen limited (76705) | $554.37 | $1,150 | 5.7× |
| Unlisted Dx Radiographic Procedure (76499) | $546.65 | $1,134 | 6.7× |
| Upper gi w/o kub (74240) | $263.69 | $547 | 1.6× |
| Urea Breath Test C-14 Isotopic Acquisj Analysis (78267) | $185.60 | $385 | 16.8× |
| Urea breath test c-14 isotopic analysis (78268) | $276.22 | $573 | 2.9× |
| Ureteral Reflux Study (78740) | $449.76 | $933 | 1.2× |
| Urethrocystogram voiding (74455) | $255.01 | $529 | 1.1× |
| Urethrocystography retrograde (74450) | $255.01 | $529 | 1.1× |
| Us breast unilateral complete (76641) range across 2 matching MRF lines |
$245.37–$467.60 | $509–$970 | varies |
| Us chest (76604) | $255.98 | $531 | 2.6× |
| Us complete joint (76881) | $469.04 | $973 | 4.8× |
| Us exam, pelvic, limited (76857) | $537.50 | $1,115 | 5.5× |
| Us head (76506) | $479.17 | $994 | 4.9× |
| Us lmtd joint/oth nonvasc xtr strux r-t w/img (76882) range across 2 matching MRF lines |
$214.04–$336.48 | $444–$698 | varies |
| Us ob limited 1 or more fetuses (76815) | $429.52 | $891 | 4.4× |
| Us ob transvaginal (76817) | $245.37 | $509 | 2.5× |
| Us pelvic non ob complete (76856) | $479.65 | $995 | 4.9× |
| Us pg uter img f&mat 14 wk tabdl 1/1st gestation (76801) | $177.40 | $368 | 1.8× |
| Us retroperitoneal complete (76770) | $418.91 | $869 | 4.3× |
| Us retroperitoneal limited (76775) | $343.71 | $713 | 3.5× |
| Us scrotum and contents (76870) | $501.34 | $1,040 | 5.1× |
| Us spinal canal and contents (76800) | $317.68 | $659 | 3.2× |
| Us thyroid (76536) | $524.48 | $1,088 | 5.3× |
| Us transrectal (76872) | $2,043.91 | $4,240 | 20.8× |
| Vascular Flow Imaging (78445) | $606.91 | $1,259 | 1.6× |
| Venous thrombosis imaging (78457) | $445.91 | $925 | 0.9× |
| Venous Thrombosis Imaging Venogram Bilateral (78458) | $708.62 | $1,470 | 1.9× |
| Wrist 2 views (73100) | $110.88 | $230 | 1.4× |
| X-Ray Ac Jts - Xr Acromioclavicular Joints Bilateral (73050) | $151.85 | $315 | 1.9× |
| X-Ray Bend Only L-S Spine (72120) | $95.45 | $198 | 1.0× |
| X-Ray Elbow 2 Vw - Xr Elbow 1-2 Views Right (73070) | $230.43 | $478 | 2.8× |
| X-Ray Exam Entire Spi 1 Vw (72081) | $207.29 | $430 | 2.5× |
| X-Ray Exam Entire Spi 2/3 Vw (72082) | $420.84 | $873 | 4.3× |
| X-Ray Exam Entire Spi 4/5 Vw (72083) | $403.97 | $838 | 4.1× |
| X-Ray Exam Hip Uni 1 View (73501) | $188.97 | $392 | 2.3× |
| X-Ray Exam Hip Uni 2-3 Views (73502) | $236.21 | $490 | 2.9× |
| X-Ray Exam Hips Bi 2 Views (73521) | $191.38 | $397 | 2.0× |
| X-Ray Exam Hips Bi 3-4 Views (73522) range across 2 matching MRF lines |
$283.45–$311.89 | $588–$647 | varies |
| X-Ray Exam Hips Bi 5/> Views (73523) | $396.74 | $823 | 4.0× |
| X-Ray Exam L-S Spine Bending (72114) | $224.16 | $465 | 2.3× |
| X-Ray Exam Neck Spine 2-3 Vw (72040) | $240.07 | $498 | 2.9× |
| X-Ray Exam Neck Spine 6/>Vws (72052) range across 2 matching MRF lines |
$329.25–$518.70 | $683–$1,076 | varies |
| X-Ray Exam Unilat Ribs/Chest (71101) | $293.58 | $609 | 3.0× |
| X-ray humerus (73060) range across 2 matching MRF lines |
$183.67–$491.70 | $381–$1,020 | varies |
| X-ray IV pyelogram (ivp) (74400) | $294.54 | $611 | 1.8× |
| X-Ray Jaw <4 Vw - Xr Mandible < 4 Views (70100) | $265.13 | $550 | 3.2× |
| X-Ray Knee Bilat Standing - Xr Knees Anteroposterior Standing Bilat (73565) range across 2 matching MRF lines |
$180.78–$269.47 | $375–$559 | varies |
| X-Ray Lumbar Spine 2/3 Vw - Xr Lumbar Spine 2-3 Views (72100) range across 2 matching MRF lines |
$161.49–$298.40 | $335–$619 | varies |
| X-ray nose-rectum child f.b. (76010) | $116.66 | $242 | 1.4× |
| X-Ray Ribs, Chest 4+ Vw - Xr Ribs 3 Vws Bil W/ Chest Posteroanterior (71111) range across 2 matching MRF lines |
$287.79–$466.63 | $597–$968 | varies |
| X-Ray Sacroiliac Jts 3+ Vw - Xr Sacroiliac Joints 3+ Views (72202) | $222.23 | $461 | 2.3× |
| X-Ray Sacroiliac Jts <3 Vw - Xr Sacroiliac Joints 1-2 Views (72200) | $211.14 | $438 | 2.2× |
| X-Ray Sacrum/Coccyx 2+ Vw - Xr Sacrum Coccyx 2+ Views (72220) | $185.11 | $384 | 2.3× |
| X-Ray Sinuses 3+ Vw - Xr Paranasal Sinuses 3+ Views (70220) range across 2 matching MRF lines |
$146.07–$325.39 | $303–$675 | varies |
| X-Ray Skull 4+ Vw - Xr Skull Complete 4+ Views (70260) range across 2 matching MRF lines |
$156.19–$372.15 | $324–$772 | varies |
| X-Ray Stress View (77071) | $94.97 | $197 | 1.2× |
| X-ray thoracic spine 4 vw (72074) | $190.90 | $396 | 1.9× |
| X-Ray Tmj Unilat (70328) | $92.08 | $191 | 1.1× |
| X-Rays Bone Survey Complete (77075) | $370.22 | $768 | 3.8× |
| Xr c-spine 4 or 5 views (72050) | $309.97 | $643 | 3.2× |
| Xr facial bones less than 3 views (70140) | $111.36 | $231 | 1.4× |
| XR Mastoids < 3 Views Bilateral (70120) | $118.59 | $246 | 1.2× |
| Xr orbits complete 4 views (70200) range across 2 matching MRF lines |
$161.01–$203.43 | $334–$422 | varies |
| Xr Tomogram Single Plane (76100) range across 2 matching MRF lines |
$402.04–$765.51 | $834–$1,588 | 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.