33 codes. Prices are the hospital's own posted facility charges.
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| Procedure | Cash price | Gross charge | × Medicare |
|---|
| Cervical spine 2 or 3 views (72040) |
$204 |
$272 |
2.3× |
| Chest 1 view (71045) |
$168.75 |
$225 |
1.9× |
| CT abdomen and pelvis without and with contrast (74178) |
$2,062.50 |
$2,750 |
5.9× |
| CT abdomen and pelvis without contrast (74176) |
$1,181.25 |
$1,575 |
4.9× |
| CT c-spine w/o contrast (72125) |
$1,162.50 |
$1,550 |
11.1× |
| CT chest with contrast (71260) |
$1,387.50 |
$1,850 |
7.9× |
| CT lower ext w/o (73700) |
$1,162.50 |
$1,550 |
11.1× |
| CT lumbar spine w/o contrast (72131) |
$1,200 |
$1,600 |
11.4× |
| CT maxillofacial w/o contrast (70486) |
$1,125 |
$1,500 |
10.7× |
| CT pelvis w/o contrast (72192) |
$1,181.25 |
$1,575 |
11.2× |
| CT scan for measuring calcium and other minerals in bone (77078) |
$166.50 |
$222 |
1.9× |
| CT thorax w/o contrast (71250) |
$1,162.50 |
$1,550 |
11.1× |
| CT upper extremity w/o contrast rt (73200) |
$1,170 |
$1,560 |
11.1× |
| CTA lwr ext w&w/o contrast (73706) |
$1,937.25 |
$2,583 |
11.0× |
| Foot 2 views (73620) |
$165 |
$220 |
1.9× |
| Hand 3 views (73130) |
$225 |
$300 |
2.6× |
| Humerus Min 2 Views Left (73060) |
$204 |
$272 |
2.3× |
| Knee 3 views (73562) |
$243.75 |
$325 |
2.8× |
| Pelvis 1 or 2 views (72170) |
$225 |
$300 |
2.1× |
| Radiologic Exam Chest 2 Views - Xr Chest 2 Views (71046) |
$225 |
$300 |
2.6× |
| Us pelvic non ob complete (76856) |
$512.25 |
$683 |
4.9× |
| X-Ray Ankle 3+ Vw - Xr Ankle 3+ Views Right (73610) |
$243.75 |
$325 |
2.8× |
| X-Ray Elbow 2 Vw - Xr Elbow 1-2 Views Right (73070) |
$170.25 |
$227 |
1.9× |
| X-Ray Elbow 3+ Vw - Xr Elbow 3+ Views Right (73080) |
$191.25 |
$255 |
2.2× |
| X-Ray Foot 3+ Vw - Xr Foot 3+ Views Right (73630) |
$225 |
$300 |
2.6× |
| X-Ray Lumbar Spine 2/3 Vw - Xr Lumbar Spine 2-3 Views (72100) |
$262.50 |
$350 |
2.5× |
| X-Ray Ribs, Chest 3+ Vw - Xr Ribs 2 Vws Lt W/ Chest Anteroposterior (71101) |
$354 |
$472 |
3.4× |
| X-Ray Shoulder 2+ Vw - Xr Shoulder 2+ Views Right (73030) |
$225 |
$300 |
2.6× |
| X-Ray Toe(S) - Xr Toes 2+ Views Right (73660) |
$181.50 |
$242 |
2.1× |
| X-Ray Wrist 3+ Vw - Xr Wrist 3+ Views Right (73110) |
$225 |
$300 |
2.6× |
| Xr finger(s) 2+ views (73140) |
$170.25 |
$227 |
1.9× |
| Xr tibia/fibula 2 views (73590) |
$214.50 |
$286 |
2.5× |
| Xray knee 1 or 2 views rt (73560) |
$165.75 |
$221 |
1.9× |