Imaging prices at Daviess Community Hospital
Washington, IN · every code in this section with a posted price and a Medicare benchmark.
259 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) range across 2 matching MRF lines |
$15.05–$214.20 | $21.50–$306 | varies |
| Abdomen 2 views (74019) range across 2 matching MRF lines |
$18.90–$354.90 | $27–$507 | varies |
| Acute Gastrointestinal Blood Loss Imaging (78278) | $1,249.15 | $1,784.50 | 3.0× |
| Ankle 2 views (73600) | $247.45 | $353.50 | 2.7× |
| Arthrogram ankle (73615) range across 2 matching MRF lines |
$484.75–$969.50 | $692.50–$1,385 | varies |
| Arthrogram hip (73525) | $1,331.05 | $1,901.50 | 3.6× |
| Arthrogram Wrist (73115) range across 2 matching MRF lines |
$806.40–$1,612.45 | $1,152–$2,303.50 | varies |
| Bone age studies (77072) | $431.55 | $616.50 | 3.9× |
| Bone Imaging 3 Phase (78315) | $1,983.10 | $2,833 | 4.7× |
| Bone Imaging Limited Area (78300) | $1,301.30 | $1,859 | 3.1× |
| Bone Imaging Multiple Areas (78305) | $810.25 | $1,157.50 | 1.9× |
| Bone Imaging Whole Body (78306) | $1,388.80 | $1,984 | 3.3× |
| Bone survey infant (77076) range across 2 matching MRF lines |
$136.15–$185.85 | $194.50–$265.50 | varies |
| Brain Imaging Pet Metabolic Evaluation (78608) | $3,561.25 | $5,087.50 | 2.4× |
| Chest 1 view (71045) range across 3 matching MRF lines |
$36.40–$193.90 | $52–$277 | varies |
| Chest 2 views (71046) range across 3 matching MRF lines |
$18.20–$231 | $26–$330 | varies |
| Chest 3 views (71047) range across 2 matching MRF lines |
$213.85–$288.40 | $305.50–$412 | varies |
| Chest 4 or more views (71048) range across 2 matching MRF lines |
$220.15–$354.55 | $314.50–$506.50 | varies |
| Clavicle complete (73000) range across 2 matching MRF lines |
$11.55–$278.60 | $16.50–$398 | varies |
| Computed Tomography Thorax Lw Dose Lng Ca Scr C- (71271) range across 4 matching MRF lines |
$34.30–$371.35 | $49–$530.50 | varies |
| Contrast X-Ray Bladder (74430) | $982.80 | $1,404 | 2.7× |
| Contrast X-Ray Of Elbow (73085) range across 2 matching MRF lines |
$468.30–$506.80 | $669–$724 | varies |
| Contrast X-Ray Of Knee Joint (73580) range across 2 matching MRF lines |
$484.75–$969.50 | $692.50–$1,385 | varies |
| CT abdomen and pelvis without and with contrast (74178) range across 2 matching MRF lines |
$162.40–$3,032.75 | $232–$4,332.50 | varies |
| CT abdomen and pelvis without contrast (74176) range across 2 matching MRF lines |
$141.05–$2,058.70 | $201.50–$2,941 | varies |
| CT abdomen w contrast (74160) | $1,402.10 | $2,003 | 7.6× |
| CT abdomen w wo contrast (74170) range across 2 matching MRF lines |
$107.10–$1,674.75 | $153–$2,392.50 | varies |
| CT abdomen w/o contrast (74150) | $1,152.20 | $1,646 | 10.4× |
| CT Angio Abdomen and Pelvis (74174) range across 2 matching MRF lines |
$177.10–$1,543.50 | $253–$2,205 | varies |
| CT Angio Chest (71275) range across 2 matching MRF lines |
$123.90–$1,586.55 | $177–$2,266.50 | varies |
| CT Angio Head (70496) range across 2 matching MRF lines |
$134.23–$1,380.40 | $191.75–$1,972 | varies |
| Ct Angio Lwr Extr W/O&W/Dye (73706) | $1,754.55 | $2,506.50 | 9.5× |
| CT Angio Neck (70498) range across 2 matching MRF lines |
$134.23–$1,389.15 | $191.75–$1,984.50 | varies |
| Ct Angio Upr Extrm W/O&W/Dye (73206) range across 2 matching MRF lines |
$379.40–$758.45 | $542–$1,083.50 | varies |
| CT cervical spine w/ contrast (72126) | $1,179.85 | $1,685.50 | 3.2× |
| CT cervical spine w/o contrast (72125) | $1,030.40 | $1,472 | 9.3× |
| CT cervical spine w/wo cont (72127) | $1,864.80 | $2,664 | 10.0× |
| CT chest w contrast (71260) range across 2 matching MRF lines |
$89.60–$1,438.85 | $128–$2,055.50 | varies |
| CT chest w/wo contrast (71270) range across 2 matching MRF lines |
$101.15–$1,632.05 | $144.50–$2,331.50 | varies |
| CT head/brain with contrast (70460) | $928.90 | $1,327 | 5.0× |
| CT head/brain without and with contrast (70470) | $1,540 | $2,200 | 8.3× |
| CT heart no contrast quant eval coronry calcium (75571) range across 2 matching MRF lines |
$34.30–$950.60 | $49–$1,358 | varies |
| CT iac w contrast (70481) | $647.85 | $925.50 | 3.5× |
| CT l-spine w&w/o contrast (72133) range across 2 matching MRF lines |
$102.90–$1,463 | $147–$2,090 | varies |
| CT lower ext w/o (73700) | $1,041.60 | $1,488 | 9.4× |
| CT lower extremity w/contrast material (73701) | $1,047.55 | $1,496.50 | 5.6× |
| CT lumbar spine w contrast (72132) | $1,631 | $2,330 | 4.4× |
| CT lumbar spine w/o contrast (72131) | $1,293.25 | $1,847.50 | 11.7× |
| CT maxillofacial w contrast (70487) | $1,114.40 | $1,592 | 6.0× |
| CT maxillofacial wo contrast (70486) range across 2 matching MRF lines |
$69.30–$1,177.40 | $99–$1,682 | varies |
| CT neck tissue combo (70492) | $1,103.20 | $1,576 | 5.9× |
| Ct Orbit/Ear/Fossa W/O&W/Dye (70482) | $1,534.40 | $2,192 | 8.3× |
| CT orbits w/o contrast (70480) | $1,133.65 | $1,619.50 | 10.2× |
| CT pelvis w&w/o contrast (72194) | $1,457.05 | $2,081.50 | 7.9× |
| CT pelvis w/o contrast (72192) | $1,047.55 | $1,496.50 | 9.5× |
| CT scan of leg combo (73702) range across 2 matching MRF lines |
$1,384.60–$1,786.05 | $1,978–$2,551.50 | varies |
| CT scans face/jaw combo (70488) | $1,301.30 | $1,859 | 7.0× |
| CT soft tissue neck w contrast (70491) range across 2 matching MRF lines |
$105.88–$1,183.35 | $151.25–$1,690.50 | varies |
| CT soft tissue neck w/o contrast (70490) | $1,047.20 | $1,496 | 9.5× |
| CT thoracic spine w contrast (72129) | $631.40 | $902 | 3.4× |
| CT thoracic spine w/o contrast (72128) | $1,252.65 | $1,789.50 | 11.3× |
| CT thoracic spine w/wo cont (72130) | $1,572.90 | $2,247 | 8.5× |
| CT thorax w/o contrast (71250) range across 2 matching MRF lines |
$73.85–$1,110.20 | $105.50–$1,586 | varies |
| CT upper ext wo (73200) | $1,050 | $1,500 | 9.5× |
| CT upper extremity w/o & w/contrast material (73202) range across 2 matching MRF lines |
$1,522.85–$1,786.05 | $2,175.50–$2,551.50 | varies |
| CT upper extremity with contrast (73201) | $1,241.45 | $1,773.50 | 3.4× |
| Cta Abdl Aorta&Bi Iliofem W/Contrast&Postp (75635) | $2,258.55 | $3,226.50 | 12.2× |
| Cta Abdomen (74175) | $1,499.75 | $2,142.50 | 8.1× |
| CTA pelvis (72191) | $1,362.20 | $1,946 | 7.3× |
| Dxa Bone Density Axial (77080) range across 2 matching MRF lines |
$16.45–$435.75 | $23.50–$622.50 | varies |
| Dxa bone density study 1/>sites appendiclr skel (77081) | $105 | $150 | 1.1× |
| Esophagram (74220) range across 2 matching MRF lines |
$41.65–$447.30 | $59.50–$639 | varies |
| Fetal Biophys Profile W/Nst (76818) | $161.35 | $230.50 | 1.5× |
| Fluoroscopy up to 1 hr (76000) range across 2 matching MRF lines |
$21.70–$700 | $31–$1,000 | varies |
| Foot 2 views (73620) range across 2 matching MRF lines |
$12.95–$205.80 | $18.50–$294 | varies |
| Forearm 2 views (73090) range across 2 matching MRF lines |
$13.65–$239.05 | $19.50–$341.50 | varies |
| Gastric emptying imaging study (78264) | $1,776.95 | $2,538.50 | 4.2× |
| Gastroesophageal Reflux Exam (78262) | $687.75 | $982.50 | 1.6× |
| Gated Heart Planar Single (78472) | $1,466.15 | $2,094.50 | 3.5× |
| Hand 2 views (73120) range across 2 matching MRF lines |
$14–$226.10 | $20–$323 | varies |
| Hepatobil Syst Image W/Drug (78227) range across 2 matching MRF lines |
$71.75–$1,653.05 | $102.50–$2,361.50 | varies |
| Hepatobiliary System Imaging (78226) | $1,576.05 | $2,251.50 | 3.7× |
| Ht Muscle Image Spect Sing (78451) | $3,199.70 | $4,571 | 2.3× |
| Hysterosalpingogram (74740) range across 2 matching MRF lines |
$156.80–$346.85 | $224–$495.50 | varies |
| K Flow/Funct Image Multiple (78709) | $4,049.15 | $5,784.50 | 7.0× |
| K Flow/Funct Image W/Drug (78708) range across 2 matching MRF lines |
$95.90–$1,387.75 | $137–$1,982.50 | varies |
| K Flow/Funct Image W/O Drug (78707) | $1,536.85 | $2,195.50 | 2.7× |
| Knee 3 Views (73562) range across 2 matching MRF lines |
$15.75–$321.65 | $22.50–$459.50 | varies |
| Liver & Spleen Imaging Static Only (78215) | $1,051.75 | $1,502.50 | 2.5× |
| Lung Ventilat&Perfus Imaging (78582) | $2,497.25 | $3,567.50 | 4.3× |
| Lymph System Imaging (78195) | $753.55 | $1,076.50 | 1.3× |
| Magnetic Image Jaw Joint (70336) range across 2 matching MRF lines |
$112.88–$1,485.40 | $161.25–$2,122 | varies |
| Mammary ductogram or galactogram multiple (77054) | $737.45 | $1,053.50 | 2.9× |
| Mammary ductogram or galactogram single (77053) | $532 | $760 | 2.1× |
| Meckels Divert Exam (78290) | $970.90 | $1,387 | 2.3× |
| Mra Head W/O & W/Contrast Material (70546) | $1,485.40 | $2,122 | 4.0× |
| MRA head w/o contrast (70544) | $1,645 | $2,350 | 6.5× |
| MRA head with contrast (70545) | $1,485.40 | $2,122 | 4.0× |
| MRA neck w contrast (70548) | $1,678.25 | $2,397.50 | 4.5× |
| Mra Neck W/O &W/Contrast Material (70549) | $1,787.45 | $2,553.50 | 4.8× |
| MRA neck w/o contrast (70547) | $1,858.15 | $2,654.50 | 7.4× |
| MRI abdomen w contrast (74182) | $1,485.40 | $2,122 | 4.0× |
| MRI abdomen w/o contrast (74181) | $1,551.90 | $2,217 | 6.1× |
| MRI any jt lower extrem w/contrast material (73722) | $1,485.40 | $2,122 | 1.8× |
| MRI any jt lower extrem w/o & w/contrast matrl (73723) | $2,092.65 | $2,989.50 | 5.7× |
| MRI any jt upper extremity w/contrast matrl (73222) | $3,164.70 | $4,521 | 3.8× |
| MRI cervical spine w contrast (72142) | $1,485.40 | $2,122 | 4.0× |
| MRI cervical spine w/o cont (72141) range across 2 matching MRF lines |
$120.05–$1,794.45 | $171.50–$2,563.50 | varies |
| MRI chest w/o contrast (71550) | $1,485.40 | $2,122 | 5.9× |
| MRI chest with contrast (71551) | $1,485.40 | $2,122 | 1.8× |
| MRI chest wo w contrast (71552) | $1,485.40 | $2,122 | 4.0× |
| MRI lower extrem oth/thn jt w/contrast matrl (73719) | $1,485.40 | $2,122 | 4.0× |
| MRI lower extrem oth/thn jt w/o & w/contr matr (73720) | $2,255.40 | $3,222 | 6.1× |
| MRI lower extrem oth/thn jt w/o contr matrl (73718) | $1,843.10 | $2,633 | 7.3× |
| MRI lumbar spine w contrast (72149) | $1,485.40 | $2,122 | 4.0× |
| Mri Neck Spine W/O & W/Dye (72156) | $2,282.35 | $3,260.50 | 6.2× |
| MRI orbit face &/neck w/o contrast (70540) | $1,485.40 | $2,122 | 5.9× |
| MRI orbit face neck w contrast (70542) | $1,485.40 | $2,122 | 4.0× |
| Mri Orbt/Fac/Nck W/O &W/Dye (70543) | $2,417.10 | $3,453 | 6.5× |
| MRI pelvis w contrast (72196) | $1,899.80 | $2,714 | 5.1× |
| MRI pelvis w/o & w contrast (72197) | $2,489.20 | $3,556 | 6.7× |
| MRI pelvis w/o contrast (72195) | $1,731.45 | $2,473.50 | 6.9× |
| MRI thoracic spine w/o contrast (72146) range across 2 matching MRF lines |
$113.93–$1,713.60 | $162.75–$2,448 | varies |
| MRI upper extremity oth than jt w/contr matrl (73219) | $1,485.40 | $2,122 | 4.0× |
| MRI upper extremity oth than jt w/o contr matrl (73218) | $1,485.40 | $2,122 | 5.9× |
| Mri Uppr Extremity W/O&W/Dye (73220) | $1,485.40 | $2,122 | 4.0× |
| MRI, abdomen, combo (74183) range across 2 matching MRF lines |
$165.73–$2,382.45 | $236.75–$3,403.50 | varies |
| MRI, dorsal spine combo (72157) | $2,427.60 | $3,468 | 6.6× |
| MRI, dorsal spine contrast (72147) | $1,485.40 | $2,122 | 4.0× |
| MRI, joint upper extrem (73221) range across 2 matching MRF lines |
$104.30–$1,766.80 | $149–$2,524 | varies |
| MRI, joint upper extrem combo (73223) | $2,533.30 | $3,619 | 6.9× |
| MRI, lumbar spine combo (72158) | $2,369.15 | $3,384.50 | 6.4× |
| Myocardial Spect Multiple Studies (78452) | $3,964.80 | $5,664 | 2.9× |
| Neck soft tissue (70360) | $254.45 | $363.50 | 2.8× |
| Nuclear Rx Oral Admin (79005) | $370.65 | $529.50 | 1.5× |
| Parathyroid Planar Imaging (78070) | $1,423.10 | $2,033 | 3.4× |
| Pelvis 1 or 2 views (72170) range across 2 matching MRF lines |
$14.70–$289.10 | $21–$413 | varies |
| Pet Image Skull-Thigh (78812) | $2,212.35 | $3,160.50 | 1.5× |
| Pet Image W/Ct Lmtd (78814) | $2,275 | $3,250 | 1.5× |
| PET image w/CT, full body (78816) | $4,697.35 | $6,710.50 | 3.1× |
| PET imaging CT attenuation skull base mid-thigh (78815) | $4,876.20 | $6,966 | 3.2× |
| Pulmonary Perfusion Imaging Particulate (78580) range across 2 matching MRF lines |
$50.05–$990.50 | $71.50–$1,415 | varies |
| Radex Abd Compl Aqt Abd W/S/E/D Views 1 View Ch (74022) range across 2 matching MRF lines |
$26.25–$378 | $37.50–$540 | varies |
| Radex abscess/fistula/sinus tract rs&i (76080) | $821.80 | $1,174 | 1.4× |
| Radex Ankle Complete Minimum 3 Views (73610) range across 2 matching MRF lines |
$29.05–$268.10 | $41.50–$383 | varies |
| Radex Calcaneus Minimum 2 Views (73650) | $287.70 | $411 | 3.1× |
| Radex elbow complete minimum 3 views (73080) range across 2 matching MRF lines |
$14.70–$301.70 | $21–$431 | varies |
| Radex Facial Bones Complete Minimum 3 Views (70150) | $441.35 | $630.50 | 4.0× |
| Radex fingr minimum 2 views (73140) | $246.05 | $351.50 | 2.7× |
| Radex foot complete minimum 3 views (73630) range across 3 matching MRF lines |
$13.13–$273.35 | $18.75–$390.50 | varies |
| Radex Hand Minimum 3 Views (73130) range across 2 matching MRF lines |
$14.70–$295.75 | $21–$422.50 | varies |
| Radex lower extremity infant minimum 2 views (73592) range across 4 matching MRF lines |
$215.60–$453.25 | $308–$647.50 | varies |
| Radex Mastoids Compl Minimum 3 Views PR Side (70130) range across 2 matching MRF lines |
$151.20–$376.25 | $216–$537.50 | varies |
| Radex Nasal Bones Complete Minimum 3 Views (70160) range across 3 matching MRF lines |
$120.40–$284.90 | $172–$407 | varies |
| Radex Ribs Unilateral 2 Views (71100) range across 2 matching MRF lines |
$17.50–$270.20 | $25–$386 | varies |
| Radex shoulder complete minimum 2 views (73030) range across 2 matching MRF lines |
$15.75–$295.75 | $22.50–$422.50 | varies |
| Radex Sinuses Paransl < 3 Views (70210) | $13.65 | $19.50 | 0.1× |
| Radex sm int w/mlt srl imges via enteroclss tube (74251) range across 2 matching MRF lines |
$80.15–$191.10 | $114.50–$273 | varies |
| Radex Spine 1 View Specify Level (72020) | $257.25 | $367.50 | 2.8× |
| Radex Sternum Minimum 2 Views (71120) range across 3 matching MRF lines |
$217–$311.15 | $310–$444.50 | varies |
| Radex Temporomandble Jt Opn & Clsd Mouth Bilat (70330) range across 2 matching MRF lines |
$217–$357.70 | $310–$511 | varies |
| Radex Toe Minimum 2 Views (73660) | $257.95 | $368.50 | 2.8× |
| Radex upper extremity infant minimum 2 views (73092) range across 5 matching MRF lines |
$226.80–$453.25 | $324–$647.50 | varies |
| Radex Wrist Complete Minimum 3 Views (73110) range across 2 matching MRF lines |
$14.70–$279.65 | $21–$399.50 | varies |
| Radex X-Ray Exam Entire Spi 6/> Vw - Xr Entire Spine 6+ Vw (72084) | $851.90 | $1,217 | 7.7× |
| Radiolog exam mandible compl minimum 4 views (70110) range across 3 matching MRF lines |
$284.55–$568.40 | $406.50–$812 | varies |
| Radiologic Exam Abdomen 3+ Views - Xr Abdomen 3+ Views (74021) | $393.05 | $561.50 | 3.6× |
| Radiologic exam colon double contrast study (74280) range across 3 matching MRF lines |
$87.50–$1,622.95 | $125–$2,318.50 | varies |
| Radiologic exam colon single contrast study (74270) range across 2 matching MRF lines |
$84–$813.75 | $120–$1,162.50 | varies |
| Radiologic Exam Esophagus Double Contrast Study (74221) range across 2 matching MRF lines |
$49.35–$547.40 | $70.50–$782 | varies |
| Radiologic exam knee complete 4/more views (73564) range across 2 matching MRF lines |
$19.25–$330.75 | $27.50–$472.50 | varies |
| Radiologic exam pelvis compl minimum 3 views (72190) | $320.25 | $457.50 | 2.9× |
| Radiologic Exam Small Int Single Contrast Study (74250) range across 2 matching MRF lines |
$56.70–$513.10 | $81–$733 | varies |
| Radiologic exam swallow function contrast study (74230) range across 2 matching MRF lines |
$37.45–$362.95 | $53.50–$518.50 | varies |
| Radiologic exam upr gi trc double contrast study (74246) range across 2 matching MRF lines |
$62.65–$234.85 | $89.50–$335.50 | varies |
| Radiologic examination femur 1 view (73551) range across 2 matching MRF lines |
$97.30–$239.05 | $139–$341.50 | varies |
| Radiologic examination femur minimum 2 views (73552) | $246.75 | $352.50 | 2.7× |
| Radiologic examination knee 1/2 views (73560) range across 2 matching MRF lines |
$14–$261.45 | $20–$373.50 | varies |
| Radiologic Examination Osseous Survey Limited (77074) | $650.30 | $929 | 5.9× |
| Radiologic Examination Salivary Gland Calculus (70380) | $81.90 | $117 | 0.9× |
| Radiologic examination tibia & fibula 2 views (73590) range across 2 matching MRF lines |
$13.65–$256.55 | $19.50–$366.50 | varies |
| Ribs bilateral 3 views (71110) | $598.15 | $854.50 | 5.4× |
| Rp loclzj tum plnr 1 area single day imaging (78800) | $1,059.10 | $1,513 | 2.5× |
| Rp loclzj tum plnr 2+area 1+d img/1 area img>2+d (78801) | $1,401.40 | $2,002 | 3.3× |
| Rp Loclzj Tum Plnr Whole Body 2+ Days Imaging (78804) | $3,362.10 | $4,803 | 5.9× |
| Rp Loclzj Tum Plnr Whole Body Single Day Imaging (78802) | $1,940.75 | $2,772.50 | 3.4× |
| Rp Loclzj Tum Spect 1 Area Single Day Imaging (78803) range across 2 matching MRF lines |
$1,049.30–$2,427.95 | $1,499–$3,468.50 | varies |
| Rp loclzj tum spect 2 area/sep acquisj img (78831) | $1,951.25 | $2,787.50 | 1.4× |
| Scapula (73010) | $424.90 | $607 | 3.8× |
| Screening Digital Breast Tomosynthesis Bi (77063) range across 3 matching MRF lines |
$15.47–$46.20 | $22.10–$66 | varies |
| Shoulder 1 view (73020) range across 2 matching MRF lines |
$11.90–$189.70 | $17–$271 | varies |
| Shoulder Arthrography (73040) range across 2 matching MRF lines |
$43.40–$1,004.85 | $62–$1,435.50 | varies |
| Sialogram (70390) | $331.10 | $473 | 1.3× |
| Skull less than 4 views (70250) range across 2 matching MRF lines |
$331.80–$346.50 | $474–$495 | varies |
| Sternoclavicular joints (71130) range across 2 matching MRF lines |
$217–$246.05 | $310–$351.50 | varies |
| Testicular Imaging W/Flow (78761) | $876.40 | $1,252 | 2.1× |
| Thoracic spine 2 views (72070) | $317.45 | $453.50 | 2.9× |
| Thoracic spine 3 views (72072) range across 3 matching MRF lines |
$18.90–$356.65 | $27–$509.50 | varies |
| Thoracolumbar 2 views (72080) | $235.20 | $336 | 2.6× |
| Thyroid Uptake W/Blood Flow Sngle/Mult Quan Meas (78014) range across 2 matching MRF lines |
$39.55–$1,629.25 | $56.50–$2,327.50 | varies |
| Ultrasound Breast Limited (76642) range across 2 matching MRF lines |
$52.68–$354.20 | $75.25–$506 | varies |
| Ultrasound Exam Aaa Screen (76706) | $451.15 | $644.50 | 4.1× |
| Ultrasound, abdomen limited (76705) range across 2 matching MRF lines |
$41.30–$633.50 | $59–$905 | varies |
| Upper gi w/o kub (74240) range across 2 matching MRF lines |
$56–$711.55 | $80–$1,016.50 | varies |
| Urea Breath Test C-14 Isotopic Acquisj Analysis (78267) | $16.45 | $23.50 | 1.5× |
| Urea breath test c-14 isotopic analysis (78268) | $140.70 | $201 | 1.5× |
| Urethrocystogram voiding (74455) range across 2 matching MRF lines |
$22.40–$870.45 | $32–$1,243.50 | varies |
| Urethrocystography retrograde (74450) | $1,050.70 | $1,501 | 4.2× |
| Us breast unilateral complete (76641) | $522.20 | $746 | 4.7× |
| Us chest (76604) | $408.80 | $584 | 3.7× |
| Us exam, pelvic, limited (76857) | $491.05 | $701.50 | 4.4× |
| Us head (76506) | $162.05 | $231.50 | 1.5× |
| Us kidney transplant (76776) | $371.35 | $530.50 | 3.4× |
| Us lmtd joint/oth nonvasc xtr strux r-t w/img (76882) range across 2 matching MRF lines |
$45.15–$441 | $64.50–$630 | varies |
| Us ob limited 1 or more fetuses (76815) | $234.15 | $334.50 | 2.1× |
| Us ob transvaginal (76817) | $394.45 | $563.50 | 3.6× |
| Us pelvic non ob complete (76856) range across 2 matching MRF lines |
$53.03–$636.30 | $75.75–$909 | varies |
| Us pg uter img f&mat 14 wk tabdl 1/1st gestation (76801) range across 2 matching MRF lines |
$211.40–$567 | $302–$810 | varies |
| Us retroperitoneal complete (76770) | $584.85 | $835.50 | 5.3× |
| Us retroperitoneal limited (76775) | $484.75 | $692.50 | 4.4× |
| Us scrotum and contents (76870) range across 2 matching MRF lines |
$49–$573.65 | $70–$819.50 | varies |
| Us spinal canal and contents (76800) | $161.35 | $230.50 | 1.5× |
| Us thyroid (76536) range across 2 matching MRF lines |
$38.15–$556.85 | $54.50–$795.50 | varies |
| Us transrectal (76872) | $285.60 | $408 | 2.6× |
| Wrist 2 views (73100) | $267.05 | $381.50 | 2.9× |
| X-Ray Ac Jts - Xr Acromioclavicular Joints Bilateral (73050) range across 4 matching MRF lines |
$214.55–$450.10 | $306.50–$643 | varies |
| X-Ray Bend Only L-S Spine (72120) | $372.05 | $531.50 | 3.4× |
| X-Ray Elbow 2 Vw - Xr Elbow 1-2 Views Right (73070) range across 2 matching MRF lines |
$12.95–$238.70 | $18.50–$341 | varies |
| X-Ray Exam Breast Specimen (76098) range across 2 matching MRF lines |
$71.75–$658.35 | $102.50–$940.50 | varies |
| X-Ray Exam Entire Spi 1 Vw (72081) range across 2 matching MRF lines |
$177.80–$545.30 | $254–$779 | varies |
| X-Ray Exam Entire Spi 2/3 Vw (72082) | $498.75 | $712.50 | 4.5× |
| X-Ray Exam Entire Spi 4/5 Vw (72083) | $495.95 | $708.50 | 4.5× |
| X-Ray Exam Hip Uni 1 View (73501) | $234.15 | $334.50 | 2.5× |
| X-Ray Exam Hip Uni 2-3 Views (73502) range across 2 matching MRF lines |
$17.50–$338.45 | $25–$483.50 | varies |
| X-Ray Exam Hip Uni 4/> Views (73503) | $159.95 | $228.50 | 1.4× |
| X-Ray Exam Hips Bi 2 Views (73521) | $301 | $430 | 2.7× |
| X-Ray Exam Hips Bi 3-4 Views (73522) range across 2 matching MRF lines |
$24.50–$521.50 | $35–$745 | varies |
| X-Ray Exam Hips Bi 5/> Views (73523) | $291.20 | $416 | 2.6× |
| X-Ray Exam L-S Spine Bending (72114) | $604.45 | $863.50 | 5.5× |
| X-Ray Exam Neck Spine 2-3 Vw (72040) range across 2 matching MRF lines |
$18.90–$333.20 | $27–$476 | varies |
| X-Ray Exam Neck Spine 6/>Vws (72052) range across 2 matching MRF lines |
$23.28–$454.65 | $33.25–$649.50 | varies |
| X-Ray Exam Unilat Ribs/Chest (71101) | $384.65 | $549.50 | 3.5× |
| X-ray eye for foreign body (70030) range across 2 matching MRF lines |
$45.50–$130.55 | $65–$186.50 | varies |
| X-ray humerus (73060) range across 2 matching MRF lines |
$13.65–$237.30 | $19.50–$339 | varies |
| X-ray IV pyelogram (ivp) (74400) | $901.60 | $1,288 | 4.9× |
| X-Ray Knee Bilat Standing - Xr Knees Anteroposterior Standing Bilat (73565) | $249.90 | $357 | 2.7× |
| X-Ray Lumbar Spine 2/3 Vw - Xr Lumbar Spine 2-3 Views (72100) range across 3 matching MRF lines |
$18.90–$333.20 | $27–$476 | varies |
| X-ray nose-rectum child f.b. (76010) | $191.80 | $274 | 2.1× |
| X-Ray Ribs, Chest 4+ Vw - Xr Ribs 3 Vws Bil W/ Chest Posteroanterior (71111) | $354.90 | $507 | 3.2× |
| X-Ray Sacroiliac Jts 3+ Vw - Xr Sacroiliac Joints 3+ Views (72202) | $303.10 | $433 | 2.7× |
| X-Ray Sacrum/Coccyx 2+ Vw - Xr Sacrum Coccyx 2+ Views (72220) range across 2 matching MRF lines |
$14.70–$268.80 | $21–$384 | varies |
| X-Ray Sinuses 3+ Vw - Xr Paranasal Sinuses 3+ Views (70220) | $397.95 | $568.50 | 4.3× |
| X-Ray Skull 4+ Vw - Xr Skull Complete 4+ Views (70260) range across 2 matching MRF lines |
$151.20–$380.80 | $216–$544 | varies |
| X-Ray Urinary Tract Exam With Contrast Material (74420) | $1,106.70 | $1,581 | 3.0× |
| X-Rays Bone Length Studies (77073) range across 2 matching MRF lines |
$22.40–$416.15 | $32–$594.50 | varies |
| X-Rays Bone Survey Complete (77075) range across 2 matching MRF lines |
$45.15–$746.20 | $64.50–$1,066 | varies |
| Xr c-spine 4 or 5 views (72050) range across 2 matching MRF lines |
$22.05–$390.95 | $31.50–$558.50 | varies |
| XR Mastoids < 3 Views Bilateral (70120) | $376.25 | $537.50 | 3.4× |
| Xr orbits complete 4 views (70200) range across 4 matching MRF lines |
$305.20–$640.15 | $436–$914.50 | 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.