Imaging prices at Covenant Hospital Plainview
Plainview, TX · every code in this section with a posted price and a Medicare benchmark.
268 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) | $172.62 | $411 | 2.0× |
| Abdomen 2 views (74019) | $232.68 | $554 | 2.2× |
| Acute Gastrointestinal Blood Loss Imaging (78278) | $715.26 | $1,703 | 1.8× |
| Angiography extremity bilateral rs&i (75716) | $6,708.66 | $15,973 | 2.1× |
| Angiography extremity unilateral rs&i (75710) | $6,708.66 | $15,973 | 2.1× |
| Ankle 2 views (73600) range across 2 matching MRF lines |
$134.82–$179.76 | $321–$428 | varies |
| Aortography thoracic serialography rs&i (75605) | $11,183.34 | $26,627 | 2.0× |
| Artery X-Rays Abdomen (75726) | $11,183.34 | $26,627 | 2.0× |
| Artery X-Rays Pelvis (75736) | $11,183.34 | $26,627 | 2.0× |
| Arthrogram hip (73525) | $863.10 | $2,055 | 2.5× |
| Bone age studies (77072) | $241.92 | $576 | 2.3× |
| Bone Imaging 3 Phase (78315) | $715.26 | $1,703 | 1.8× |
| Bone Imaging Whole Body (78306) | $715.26 | $1,703 | 1.8× |
| Bone survey infant (77076) | $241.92 | $576 | 2.3× |
| Brain Imaging Min 4 Static Views W Vascular Flow (78606) | $1,092 | $2,600 | 2.0× |
| Cat Scan Follow-Up Study (76380) | $558.60 | $1,330 | 6.4× |
| Chest 1 view (71045) | $154.98 | $369 | 1.8× |
| Chest 2 views (71046) | $154.98 | $369 | 1.8× |
| Chest 3 views (71047) | $154.98 | $369 | 1.8× |
| Chest 4 or more views (71048) | $208.74 | $497 | 2.0× |
| Clavicle complete (73000) | $179.76 | $428 | 2.1× |
| Computed Tomography Thorax Lw Dose Lng Ca Scr C- (71271) | $558.60 | $1,330 | 5.3× |
| Contrast Exam Abdominl Aorta (75625) | $6,708.66 | $15,973 | 2.1× |
| Contrast X-Ray Bladder (74430) | $784.98 | $1,869 | 2.2× |
| Contrast X-Ray Of Elbow (73085) | $863.10 | $2,055 | 2.5× |
| CT abdomen and pelvis without and with contrast (74178) | $2,596.02 | $6,181 | 7.4× |
| CT abdomen and pelvis without contrast (74176) | $1,588.02 | $3,781 | 6.6× |
| CT abdomen w contrast (74160) | $1,231.86 | $2,933 | 7.0× |
| CT abdomen w wo contrast (74170) | $1,288.56 | $3,068 | 7.3× |
| CT abdomen w/o contrast (74150) | $751.80 | $1,790 | 7.2× |
| CT Angio Abdomen and Pelvis (74174) | $2,539.74 | $6,047 | 7.2× |
| CT Angio Chest (71275) | $1,231.86 | $2,933 | 7.0× |
| CT Angio Head (70496) | $1,572.48 | $3,744 | 8.9× |
| Ct Angio Lwr Extr W/O&W/Dye (73706) | $1,231.86 | $2,933 | 7.0× |
| CT Angio Neck (70498) | $1,572.48 | $3,744 | 8.9× |
| Ct Angio Upr Extrm W/O&W/Dye (73206) | $1,231.86 | $2,933 | 7.0× |
| CT bone density (77078) | $558.60 | $1,330 | 6.4× |
| CT cervical spine w/ contrast (72126) | $3,241.56 | $7,718 | 9.2× |
| CT cervical spine w/o contrast (72125) | $959.28 | $2,284 | 9.1× |
| CT cervical spine w/wo cont (72127) | $3,297 | $7,850 | 18.7× |
| CT chest w contrast (71260) | $1,231.86 | $2,933 | 7.0× |
| CT chest w/wo contrast (71270) | $1,288.56 | $3,068 | 7.3× |
| CT head/brain with contrast (70460) | $1,572.48 | $3,744 | 8.9× |
| CT head/brain without and with contrast (70470) | $1,627.92 | $3,876 | 9.2× |
| CT iac w contrast (70481) | $1,572.48 | $3,744 | 8.9× |
| CT l-spine w&w/o contrast (72133) | $2,596.02 | $6,181 | 14.7× |
| CT lower ext w/o (73700) | $751.80 | $1,790 | 7.2× |
| CT lower extremity w/contrast material (73701) | $1,231.86 | $2,933 | 7.0× |
| CT lumbar spine w contrast (72132) | $2,539.74 | $6,047 | 7.2× |
| CT lumbar spine w/o contrast (72131) | $751.80 | $1,790 | 7.2× |
| CT maxillofacial w contrast (70487) | $1,572.48 | $3,744 | 8.9× |
| CT maxillofacial wo contrast (70486) | $959.28 | $2,284 | 9.1× |
| CT neck tissue combo (70492) | $1,627.92 | $3,876 | 9.2× |
| Ct Orbit/Ear/Fossa W/O&W/Dye (70482) | $1,627.92 | $3,876 | 9.2× |
| CT orbits w/o contrast (70480) | $959.28 | $2,284 | 9.1× |
| CT pelvis w&w/o contrast (72194) | $1,288.56 | $3,068 | 7.3× |
| CT pelvis w/o contrast (72192) | $751.80 | $1,790 | 7.2× |
| CT scan of leg combo (73702) | $1,288.56 | $3,068 | 7.3× |
| CT scans face/jaw combo (70488) | $1,627.92 | $3,876 | 9.2× |
| CT soft tissue neck w contrast (70491) | $1,572.48 | $3,744 | 8.9× |
| CT soft tissue neck w/o contrast (70490) | $959.28 | $2,284 | 9.1× |
| CT thoracic spine w contrast (72129) | $1,231.86 | $2,933 | 7.0× |
| CT thoracic spine w/o contrast (72128) | $751.80 | $1,790 | 7.2× |
| CT thoracic spine w/wo cont (72130) | $1,288.56 | $3,068 | 7.3× |
| CT thorax w/o contrast (71250) | $751.80 | $1,790 | 7.2× |
| CT upper ext wo (73200) | $751.80 | $1,790 | 7.2× |
| CT upper extremity w/o & w/contrast material (73202) | $2,596.02 | $6,181 | 14.7× |
| CT upper extremity with contrast (73201) | $2,539.74 | $6,047 | 7.2× |
| Cta Abdl Aorta&Bi Iliofem W/Contrast&Postp (75635) | $1,231.86 | $2,933 | 7.0× |
| Cta Abdomen (74175) | $1,231.86 | $2,933 | 7.0× |
| CTA pelvis (72191) | $1,231.86 | $2,933 | 7.0× |
| Dilation ureters/urethra rs&i (74485) | $3,823.26 | $9,103 | 1.8× |
| Dxa Bone Density Axial (77080) | $241.92 | $576 | 2.3× |
| Dxa bone density study (77085) | $255.36 | $608 | 2.4× |
| Echo Guide For Artery Repair (76936) | $620.34 | $1,477 | 2.9× |
| Echograp Trans R Pros Study (76873) | $441.42 | $1,051 | 4.2× |
| Esophagram (74220) | $380.94 | $907 | 2.2× |
| Fetal Biophys Profile W/Nst (76818) range across 3 matching MRF lines |
$60.38–$375.06 | $143.75–$893 | varies |
| Fetal Biophysical Profile W/O Non-Stress Testing (76819) range across 3 matching MRF lines |
$44.52–$375.06 | $106–$893 | varies |
| Fluoroscopy up to 1 hr (76000) | $539.70 | $1,285 | 2.3× |
| Follow-Up Angiography (75898) | $6,708.66 | $15,973 | 2.1× |
| Foot 2 views (73620) | $179.76 | $428 | 2.1× |
| Forearm 2 views (73090) range across 2 matching MRF lines |
$134.82–$179.76 | $321–$428 | varies |
| Gastric emptying imaging study (78264) | $715.26 | $1,703 | 1.8× |
| Gated Heart Planar Single (78472) | $841.26 | $2,003 | 2.1× |
| Hand 2 views (73120) | $99.54 | $237 | 0.9× |
| Hepatobil Syst Image W/Drug (78227) | $928.20 | $2,210 | 1.7× |
| Hepatobiliary System Imaging (78226) | $715.26 | $1,703 | 1.8× |
| Infant hip ultrasound with hip movement (dynamic) (76885) | $278.46 | $663 | 3.2× |
| Infant hip ultrasound, limited static exam (76886) | $278.46 | $663 | 3.2× |
| Joint Survey Single View (77077) | $154.56 | $368 | 1.5× |
| K Flow/Funct Image W/Drug (78708) | $1,092 | $2,600 | 2.0× |
| K Flow/Funct Image W/O Drug (78707) | $1,092 | $2,600 | 2.0× |
| Knee 3 Views (73562) | $179.76 | $428 | 2.1× |
| Liver & Spleen Imaging Static Only (78215) | $841.26 | $2,003 | 2.1× |
| Lung Ventilat&Perfus Imaging (78582) | $928.20 | $2,210 | 1.7× |
| Lung Ventilation Imaging (78579) | $841.26 | $2,003 | 2.1× |
| Lymph System Imaging (78195) | $1,092 | $2,600 | 2.0× |
| Meckels Divert Exam (78290) | $841.26 | $2,003 | 2.1× |
| Mra Head W/O & W/Contrast Material (70546) | $2,572.08 | $6,124 | 7.3× |
| MRA head w/o contrast (70544) | $1,608.18 | $3,829 | 6.7× |
| MRA neck w contrast (70548) | $2,572.08 | $6,124 | 7.3× |
| Mra Neck W/O &W/Contrast Material (70549) | $2,622.48 | $6,244 | 7.5× |
| MRA neck w/o contrast (70547) | $1,608.18 | $3,829 | 6.7× |
| MRI abdomen w contrast (74182) | $2,512.86 | $5,983 | 7.2× |
| MRI abdomen w/o contrast (74181) | $1,570.80 | $3,740 | 6.6× |
| MRI any jt lower extrem w/contrast material (73722) | $2,696.40 | $6,420 | 3.4× |
| MRI any jt lower extrem w/o & w/contrast matrl (73723) | $2,743.02 | $6,531 | 7.8× |
| MRI any jt upper extremity w/contrast matrl (73222) | $2,696.40 | $6,420 | 3.4× |
| MRI cervical spine w contrast (72142) | $2,572.08 | $6,124 | 7.3× |
| MRI cervical spine w/o cont (72141) | $1,608.18 | $3,829 | 6.7× |
| MRI chest w/o contrast (71550) | $1,570.80 | $3,740 | 6.6× |
| MRI chest wo w contrast (71552) | $2,512.86 | $5,983 | 7.2× |
| MRI lower extrem oth/thn jt w/contrast matrl (73719) | $2,512.86 | $5,983 | 7.2× |
| MRI lower extrem oth/thn jt w/o & w/contr matr (73720) | $2,559.48 | $6,094 | 7.3× |
| MRI lower extrem oth/thn jt w/o contr matrl (73718) | $1,570.80 | $3,740 | 6.6× |
| MRI lumbar spine w contrast (72149) | $2,168.46 | $5,163 | 6.2× |
| Mri Neck Spine W/O & W/Dye (72156) | $2,622.48 | $6,244 | 7.5× |
| MRI orbit face &/neck w/o contrast (70540) | $1,608.18 | $3,829 | 6.7× |
| MRI orbit face neck w contrast (70542) | $2,281.86 | $5,433 | 6.5× |
| Mri Orbt/Fac/Nck W/O &W/Dye (70543) | $2,572.08 | $6,124 | 7.3× |
| MRI pelvis w contrast (72196) | $2,512.86 | $5,983 | 7.2× |
| MRI pelvis w/o & w contrast (72197) | $2,559.48 | $6,094 | 7.3× |
| MRI pelvis w/o contrast (72195) | $1,570.80 | $3,740 | 6.6× |
| MRI thoracic spine w/o contrast (72146) range across 2 matching MRF lines |
$1,178.10–$1,570.80 | $2,805–$3,740 | varies |
| MRI upper extremity oth than jt w/o contr matrl (73218) | $1,570.80 | $3,740 | 6.6× |
| Mri Uppr Extremity W/O&W/Dye (73220) | $2,512.86 | $5,983 | 7.2× |
| MRI, abdomen, combo (74183) | $2,559.48 | $6,094 | 7.3× |
| MRI, dorsal spine combo (72157) | $2,559.48 | $6,094 | 7.3× |
| MRI, dorsal spine contrast (72147) | $2,512.86 | $5,983 | 7.2× |
| MRI, joint upper extrem (73221) | $1,570.80 | $3,740 | 6.6× |
| MRI, joint upper extrem combo (73223) | $2,743.02 | $6,531 | 7.8× |
| MRI, lumbar spine combo (72158) range across 2 matching MRF lines |
$2,310.84–$2,559.48 | $5,502–$6,094 | varies |
| Myelogram Lumbar (72265) | $1,676.64 | $3,992 | 2.1× |
| Myocardial Imaging Infarct Avid Planar Qual/Quan (78466) | $841.26 | $2,003 | 2.1× |
| Myocardial Spect Multiple Studies (78452) | $2,476.74 | $5,897 | 1.9× |
| Neck soft tissue (70360) | $172.62 | $411 | 2.0× |
| Nonvascular Shunt X-Ray (75809) | $232.68 | $554 | 2.2× |
| Ob us nuchal meas 1 gest (76813) | $441.42 | $1,051 | 4.2× |
| Ophthalmic US Dx Corneal Pachymetry Uni/Bi (76514) | $10.50 | $25 | 0.4× |
| Optic foramina (70190) | $179.76 | $428 | 2.1× |
| Parathyroid Planar Imaging (78070) | $715.26 | $1,703 | 1.8× |
| Pelvis 1 or 2 views (72170) | $241.92 | $576 | 2.3× |
| Pulmonary Perfusion Imaging Particulate (78580) | $715.26 | $1,703 | 1.8× |
| Radex Abd Compl Aqt Abd W/S/E/D Views 1 View Ch (74022) | $232.68 | $554 | 2.2× |
| Radex abscess/fistula/sinus tract rs&i (76080) | $1,029.84 | $2,452 | 1.9× |
| Radex Ankle Complete Minimum 3 Views (73610) | $179.76 | $428 | 2.1× |
| Radex Calcaneus Minimum 2 Views (73650) | $179.76 | $428 | 2.1× |
| Radex elbow complete minimum 3 views (73080) | $179.76 | $428 | 2.1× |
| Radex Facial Bones Complete Minimum 3 Views (70150) | $241.92 | $576 | 2.3× |
| Radex fingr minimum 2 views (73140) | $179.76 | $428 | 2.1× |
| Radex foot complete minimum 3 views (73630) | $179.76 | $428 | 2.1× |
| Radex Hand Minimum 3 Views (73130) | $179.76 | $428 | 2.1× |
| Radex lower extremity infant minimum 2 views (73592) | $179.76 | $428 | 2.1× |
| Radex Mastoids Compl Minimum 3 Views PR Side (70130) | $241.92 | $576 | 2.3× |
| Radex Nasal Bones Complete Minimum 3 Views (70160) | $179.76 | $428 | 2.1× |
| Radex Ribs Unilateral 2 Views (71100) | $179.76 | $428 | 2.1× |
| Radex shoulder complete minimum 2 views (73030) | $179.76 | $428 | 2.1× |
| Radex Sinuses Paransl < 3 Views (70210) | $179.76 | $428 | 2.1× |
| Radex Spine 1 View Specify Level (72020) | $179.76 | $428 | 2.1× |
| Radex Sternum Minimum 2 Views (71120) | $179.76 | $428 | 2.1× |
| Radex Temporomandble Jt Opn & Clsd Mouth Bilat (70330) | $179.76 | $428 | 2.1× |
| Radex Toe Minimum 2 Views (73660) | $179.76 | $428 | 2.1× |
| Radex upper extremity infant minimum 2 views (73092) | $241.92 | $576 | 2.3× |
| Radex Wrist Complete Minimum 3 Views (73110) | $179.76 | $428 | 2.1× |
| Radex X-Ray Exam Entire Spi 6/> Vw - Xr Entire Spine 6+ Vw (72084) | $241.92 | $576 | 2.3× |
| Radiolog exam mandible compl minimum 4 views (70110) | $241.92 | $576 | 2.3× |
| Radiologic Exam Abdomen 3+ Views - Xr Abdomen 3+ Views (74021) | $232.68 | $554 | 2.2× |
| Radiologic exam colon double contrast study (74280) | $380.94 | $907 | 2.2× |
| Radiologic exam colon single contrast study (74270) | $380.94 | $907 | 2.2× |
| Radiologic Exam Esophagus Double Contrast Study (74221) | $380.94 | $907 | 2.2× |
| Radiologic exam knee complete 4/more views (73564) | $241.92 | $576 | 2.3× |
| Radiologic exam pelvis compl minimum 3 views (72190) | $241.92 | $576 | 2.3× |
| Radiologic Exam Small Int Single Contrast Study (74250) | $380.94 | $907 | 2.2× |
| Radiologic exam swallow function contrast study (74230) | $380.94 | $907 | 2.2× |
| Radiologic exam upr gi trc double contrast study (74246) | $380.94 | $907 | 2.2× |
| Radiologic examination femur 1 view (73551) | $179.76 | $428 | 2.1× |
| Radiologic examination femur minimum 2 views (73552) | $179.76 | $428 | 2.1× |
| Radiologic examination knee 1/2 views (73560) | $179.76 | $428 | 2.1× |
| Radiologic Examination Osseous Survey Limited (77074) | $241.92 | $576 | 2.3× |
| Radiologic examination tibia & fibula 2 views (73590) range across 2 matching MRF lines |
$134.82–$179.76 | $321–$428 | varies |
| Ribs bilateral 3 views (71110) | $241.92 | $576 | 2.3× |
| Rp loclzj tum plnr 2+area 1+d img/1 area img>2+d (78801) | $841.26 | $2,003 | 2.1× |
| Rp Loclzj Tum Plnr Whole Body 2+ Days Imaging (78804) | $2,913.96 | $6,938 | 5.3× |
| Scapula (73010) | $241.92 | $576 | 2.3× |
| Screening Digital Breast Tomosynthesis Bi (77063) | $48.30 | $115 | 2.1× |
| Shoulder 1 view (73020) | $179.76 | $428 | 2.1× |
| Shoulder Arthrography (73040) | $863.10 | $2,055 | 2.5× |
| Skull less than 4 views (70250) | $241.92 | $576 | 2.3× |
| Sternoclavicular joints (71130) | $179.76 | $428 | 2.1× |
| Therapeutic Enema Rdctj Intussusception/Obstrcj (74283) | $418.74 | $997 | 2.4× |
| Thoracic spine 2 views (72070) | $241.92 | $576 | 2.3× |
| Thoracic spine 3 views (72072) | $241.92 | $576 | 2.3× |
| Thoracolumbar 2 views (72080) | $179.76 | $428 | 2.1× |
| Thyroid Imaging With Vascular Flow (78013) | $841.26 | $2,003 | 2.1× |
| Thyroid Uptake Measurement (78012) | $715.26 | $1,703 | 1.8× |
| Thyroid Uptake W/Blood Flow Sngle/Mult Quan Meas (78014) | $715.26 | $1,703 | 1.8× |
| Ultrasound Breast Limited (76642) | $328.02 | $781 | 3.8× |
| Ultrasound Exam Aaa Screen (76706) | $375.06 | $893 | 3.6× |
| Ultrasound, abdomen limited (76705) | $375.06 | $893 | 3.6× |
| Umbilical-artery Doppler (OB) (76820) | $152.88 | $364 | 1.5× |
| Unlisted us procedure (76999) | $278.46 | $663 | 3.2× |
| Upper gi w/o kub (74240) | $380.94 | $907 | 2.2× |
| Urethrocystogram voiding (74455) | $490.98 | $1,169 | 2.0× |
| Urethrocystography retrograde (74450) | $490.98 | $1,169 | 2.0× |
| Us breast unilateral complete (76641) | $375.06 | $893 | 3.6× |
| Us chest (76604) | $375.06 | $893 | 3.6× |
| Us complete joint (76881) | $375.06 | $893 | 3.6× |
| Us exam, pelvic, limited (76857) | $375.06 | $893 | 3.6× |
| Us head (76506) | $375.06 | $893 | 3.6× |
| Us kidney transplant (76776) | $375.06 | $893 | 3.6× |
| Us lmtd joint/oth nonvasc xtr strux r-t w/img (76882) | $375.06 | $893 | 3.6× |
| Us ob detailed single fetus (76811) range across 3 matching MRF lines |
$239.40–$901.32 | $570–$2,146 | varies |
| Us ob limited 1 or more fetuses (76815) range across 4 matching MRF lines |
$91.98–$375.06 | $219–$893 | varies |
| Us ob transvaginal (76817) range across 3 matching MRF lines |
$101.64–$375.06 | $242–$893 | varies |
| Us pelvic non ob complete (76856) range across 3 matching MRF lines |
$48.30–$375.06 | $115–$893 | varies |
| Us pg uter img f&mat 14 wk tabdl 1/1st gestation (76801) range across 3 matching MRF lines |
$132.30–$375.06 | $315–$893 | varies |
| Us preg uterus real time f/u trnsabdl per fetus (76816) range across 3 matching MRF lines |
$88.20–$375.06 | $210–$893 | varies |
| Us retroperitoneal complete (76770) | $375.06 | $893 | 3.6× |
| Us retroperitoneal limited (76775) | $375.06 | $893 | 3.6× |
| Us scrotum and contents (76870) | $375.06 | $893 | 3.6× |
| Us spinal canal and contents (76800) | $375.06 | $893 | 3.6× |
| Us thyroid (76536) | $375.06 | $893 | 3.6× |
| Vein X-Ray Chest (75827) | $3,296.58 | $7,849 | 2.1× |
| Venography caval inferior serialography rs&i (75825) | $6,708.66 | $15,973 | 2.1× |
| Venography extremity bilateral rs&i (75822) | $3,296.58 | $7,849 | 2.1× |
| Venography extremity unilateral rs&i (75820) | $3,296.58 | $7,849 | 2.1× |
| Venous sampling by catheter (75893) | $11,183.34 | $26,627 | 2.0× |
| Wrist 2 views (73100) range across 2 matching MRF lines |
$114.66–$179.76 | $273–$428 | varies |
| X-Ray Ac Jts - Xr Acromioclavicular Joints Bilateral (73050) | $179.76 | $428 | 2.1× |
| X-Ray Aorta Leg Arteries (75630) | $6,708.66 | $15,973 | 2.1× |
| X-Ray Bend Only L-S Spine (72120) | $241.92 | $576 | 2.3× |
| X-Ray Elbow 2 Vw - Xr Elbow 1-2 Views Right (73070) range across 2 matching MRF lines |
$145.74–$179.76 | $347–$428 | varies |
| X-Ray Exam Breast Specimen (76098) | $923.58 | $2,199 | 1.7× |
| X-Ray Exam Entire Spi 1 Vw (72081) | $179.76 | $428 | 2.1× |
| X-Ray Exam Entire Spi 2/3 Vw (72082) | $241.92 | $576 | 2.3× |
| X-Ray Exam Entire Spi 4/5 Vw (72083) | $241.92 | $576 | 2.3× |
| X-Ray Exam Hip Uni 1 View (73501) | $179.76 | $428 | 2.1× |
| X-Ray Exam Hip Uni 2-3 Views (73502) | $179.76 | $428 | 2.1× |
| X-Ray Exam Hip Uni 4/> Views (73503) | $241.92 | $576 | 2.3× |
| X-Ray Exam Hips Bi 2 Views (73521) | $241.92 | $576 | 2.3× |
| X-Ray Exam Hips Bi 3-4 Views (73522) | $241.92 | $576 | 2.3× |
| X-Ray Exam Hips Bi 5/> Views (73523) | $241.92 | $576 | 2.3× |
| X-Ray Exam L-S Spine Bending (72114) | $241.92 | $576 | 2.3× |
| X-Ray Exam Neck Spine 2-3 Vw (72040) | $179.76 | $428 | 2.1× |
| X-Ray Exam Neck Spine 6/>Vws (72052) | $241.92 | $576 | 2.3× |
| X-Ray Exam Unilat Ribs/Chest (71101) | $241.92 | $576 | 2.3× |
| X-ray eye for foreign body (70030) | $122.64 | $292 | 1.4× |
| X-ray humerus (73060) | $179.76 | $428 | 2.1× |
| X-ray IV pyelogram (ivp) (74400) | $380.94 | $907 | 2.2× |
| X-Ray Jaw <4 Vw - Xr Mandible < 4 Views (70100) | $179.76 | $428 | 2.1× |
| X-Ray Knee Bilat Standing - Xr Knees Anteroposterior Standing Bilat (73565) | $179.76 | $428 | 2.1× |
| X-Ray Lumbar Spine 2/3 Vw - Xr Lumbar Spine 2-3 Views (72100) | $241.92 | $576 | 2.3× |
| X-ray nose-rectum child f.b. (76010) | $172.62 | $411 | 2.0× |
| X-Ray Ribs, Chest 4+ Vw - Xr Ribs 3 Vws Bil W/ Chest Posteroanterior (71111) | $241.92 | $576 | 2.3× |
| X-Ray Sacroiliac Jts 3+ Vw - Xr Sacroiliac Joints 3+ Views (72202) | $241.92 | $576 | 2.3× |
| X-Ray Sacroiliac Jts <3 Vw - Xr Sacroiliac Joints 1-2 Views (72200) | $241.92 | $576 | 2.3× |
| X-Ray Sacrum/Coccyx 2+ Vw - Xr Sacrum Coccyx 2+ Views (72220) | $179.76 | $428 | 2.1× |
| X-Ray Sinuses 3+ Vw - Xr Paranasal Sinuses 3+ Views (70220) | $179.76 | $428 | 2.1× |
| X-Ray Skull 4+ Vw - Xr Skull Complete 4+ Views (70260) | $241.92 | $576 | 2.3× |
| X-ray thoracic spine 4 vw (72074) | $241.92 | $576 | 2.3× |
| X-Ray Tmj Unilat (70328) | $81.48 | $194 | 0.9× |
| X-Ray Urinary Tract Exam With Contrast Material (74420) | $784.98 | $1,869 | 2.2× |
| X-Rays Bone Length Studies (77073) | $241.92 | $576 | 2.3× |
| X-Rays Bone Survey Complete (77075) | $241.92 | $576 | 2.3× |
| Xr c-spine 4 or 5 views (72050) | $241.92 | $576 | 2.3× |
| Xr facial bones less than 3 views (70140) | $179.76 | $428 | 2.1× |
| Xr orbits complete 4 views (70200) | $241.92 | $576 | 2.3× |
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.