Imaging prices at Doctors Memorial Hospital
Perry, FL · every code in this section with a posted price and a Medicare benchmark.
272 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) | $70 | $175 | 0.8× |
| Abdomen 2 views (74019) | $70 | $175 | 0.6× |
| Acute Gastrointestinal Blood Loss Imaging (78278) | $360 | $900 | 0.9× |
| Ankle 2 views (73600) | $70.80 | $177 | 0.8× |
| Arthrogram hip (73525) | $393.60 | $984 | 1.1× |
| Arthrogram Wrist (73115) | $238.40 | $596 | 0.7× |
| Bone age studies (77072) | $52.40 | $131 | 0.5× |
| Bone Imaging 3 Phase (78315) | $360 | $900 | 0.9× |
| Bone Imaging Limited Area (78300) range across 2 matching MRF lines |
$376.80–$384 | $942–$960 | varies |
| Bone Imaging Whole Body (78306) | $288 | $720 | 0.7× |
| Bone survey infant (77076) | $64 | $160 | 0.6× |
| Cat Scan Follow-Up Study (76380) range across 2 matching MRF lines |
$155.20–$224.80 | $388–$562 | varies |
| Chest 1 view (71045) | $53.20 | $133 | 0.6× |
| Chest 2 views (71046) | $85.20 | $213 | 0.9× |
| Chest 3 views (71047) range across 2 matching MRF lines |
$85.20–$126 | $213–$315 | varies |
| Chest 4 or more views (71048) range across 2 matching MRF lines |
$102.80–$166 | $257–$415 | varies |
| Cholecystography Oral Contrast (74290) | $30 | $75 | 0.2× |
| Clavicle complete (73000) | $70.80 | $177 | 0.8× |
| Computed Tomography Thorax Lw Dose Lng Ca Scr C- (71271) | $211.20 | $528 | 1.9× |
| Contrast Exam Abdominl Aorta (75625) range across 3 matching MRF lines |
$472.80–$744.80 | $1,182–$1,862 | varies |
| Contrast X-Ray Bladder (74430) | $181.20 | $453 | 0.5× |
| Contrast X-Ray Of Elbow (73085) | $238.40 | $596 | 0.7× |
| Contrast X-Ray Of Knee Joint (73580) | $238.40 | $596 | 0.7× |
| CT abdomen and pelvis without and with contrast (74178) | $676 | $1,690 | 1.9× |
| CT abdomen and pelvis without contrast (74176) | $472 | $1,180 | 1.9× |
| CT abdomen w contrast (74160) | $350 | $875 | 1.9× |
| CT abdomen w wo contrast (74170) | $408 | $1,020 | 2.2× |
| CT abdomen w/o contrast (74150) | $223.20 | $558 | 2.0× |
| CT Angio Abdomen and Pelvis (74174) | $460 | $1,150 | 1.3× |
| CT Angio Chest (71275) range across 2 matching MRF lines |
$410–$410.40 | $1,025–$1,026 | varies |
| CT Angio Head (70496) | $554 | $1,385 | 3.0× |
| CT angio hrt w/3d image (75574) | $250.80 | $627 | 0.7× |
| Ct Angio Lwr Extr W/O&W/Dye (73706) | $416 | $1,040 | 2.3× |
| CT Angio Neck (70498) | $572 | $1,430 | 3.1× |
| Ct Angio Upr Extrm W/O&W/Dye (73206) | $393.60 | $984 | 2.1× |
| CT bone density (77078) | $88.80 | $222 | 1.0× |
| CT cervical spine w/ contrast (72126) | $350 | $875 | 1.0× |
| CT cervical spine w/o contrast (72125) range across 2 matching MRF lines |
$223.20–$236.80 | $558–$592 | varies |
| CT cervical spine w/wo cont (72127) | $388 | $970 | 2.1× |
| CT chest w contrast (71260) range across 2 matching MRF lines |
$276–$362 | $690–$905 | varies |
| CT chest w/wo contrast (71270) | $388 | $970 | 2.1× |
| CT head/brain with contrast (70460) | $350 | $875 | 1.9× |
| CT head/brain without and with contrast (70470) | $390 | $975 | 2.1× |
| CT heart contrast eval cardiac structure&morph (75572) | $175.20 | $438 | 0.5× |
| CT heart no contrast quant eval coronry calcium (75571) | $100 | $250 | 1.1× |
| CT hrt w/3d image congen (75573) | $175.20 | $438 | 0.5× |
| CT iac w contrast (70481) | $350 | $875 | 1.9× |
| CT l-spine w&w/o contrast (72133) range across 2 matching MRF lines |
$388–$592 | $970–$1,480 | varies |
| CT lower ext w/o (73700) | $223.20 | $558 | 2.0× |
| CT lower extremity w/contrast material (73701) | $350 | $875 | 1.9× |
| CT lumbar spine w contrast (72132) | $350 | $875 | 1.0× |
| CT lumbar spine w/o contrast (72131) | $236.40 | $591 | 2.2× |
| CT maxillofacial w contrast (70487) | $350 | $875 | 1.9× |
| CT maxillofacial wo contrast (70486) range across 3 matching MRF lines |
$189.20–$228 | $473–$570 | varies |
| CT neck tissue combo (70492) | $388 | $970 | 2.1× |
| Ct Orbit/Ear/Fossa W/O&W/Dye (70482) | $388 | $970 | 2.1× |
| CT orbits w/o contrast (70480) | $223.20 | $558 | 2.0× |
| CT pelvis w&w/o contrast (72194) | $388 | $970 | 2.1× |
| CT pelvis w/o contrast (72192) | $236.40 | $591 | 2.2× |
| CT scan of leg combo (73702) | $388 | $970 | 2.1× |
| CT scans face/jaw combo (70488) | $388 | $970 | 2.1× |
| CT soft tissue neck w contrast (70491) | $350 | $875 | 1.9× |
| CT soft tissue neck w/o contrast (70490) | $223.20 | $558 | 2.0× |
| CT thoracic spine w contrast (72129) | $350 | $875 | 1.9× |
| CT thoracic spine w/o contrast (72128) | $236.40 | $591 | 2.2× |
| CT thoracic spine w/wo cont (72130) range across 2 matching MRF lines |
$388–$657.60 | $970–$1,644 | varies |
| CT thorax w/o contrast (71250) | $236.80 | $592 | 2.2× |
| CT unlisted procedure (76497) | $124 | $310 | 1.4× |
| CT upper ext wo (73200) range across 7 matching MRF lines |
$223.20–$470.80 | $558–$1,177 | varies |
| CT upper extremity w/o & w/contrast material (73202) | $388 | $970 | 2.1× |
| CT upper extremity with contrast (73201) | $350 | $875 | 1.0× |
| Cta Abdl Aorta&Bi Iliofem W/Contrast&Postp (75635) | $325.20 | $813 | 1.8× |
| Cta Abdomen (74175) | $460 | $1,150 | 2.5× |
| CTA pelvis (72191) | $432 | $1,080 | 2.4× |
| Dxa Bone Density Axial (77080) | $139.20 | $348 | 1.3× |
| Dxa bone density study 1/>sites appendiclr skel (77081) | $66 | $165 | 0.7× |
| Echo exam uterus (76831) | $180 | $450 | 0.7× |
| Esophagram (74220) | $100 | $250 | 0.5× |
| Fetal Biophys Profile W/Nst (76818) | $112 | $280 | 1.0× |
| Fetal Biophysical Profile W/O Non-Stress Testing (76819) | $64 | $160 | 0.6× |
| Fluoroscopy up to 1 hr (76000) range across 2 matching MRF lines |
$110–$222 | $275–$555 | varies |
| Foot 2 views (73620) range across 5 matching MRF lines |
$20–$52.80 | $50–$132 | varies |
| Forearm 2 views (73090) | $52.80 | $132 | 0.6× |
| Gastric emptying imaging study (78264) | $300 | $750 | 0.7× |
| Gastric Mucosa Imaging (78261) | $284 | $710 | 0.7× |
| Gastroesophageal Reflux Exam (78262) | $284 | $710 | 0.7× |
| Gated Heart Planar Single (78472) range across 2 matching MRF lines |
$313.60–$346.40 | $784–$866 | varies |
| Hepatobil Syst Image W/Drug (78227) | $480 | $1,200 | 0.8× |
| Hepatobiliary System Imaging (78226) | $340.80 | $852 | 0.8× |
| Ht Musc Image Planar Mult (78454) | $188.40 | $471 | 0.1× |
| Ht Muscle Image Spect Sing (78451) | $313.60 | $784 | 0.2× |
| Hysterosalpingogram (74740) | $223.60 | $559 | 0.9× |
| Infant hip ultrasound with hip movement (dynamic) (76885) | $134.40 | $336 | 1.5× |
| K Flow/Funct Image Multiple (78709) | $372 | $930 | 0.7× |
| K Flow/Funct Image W/Drug (78708) range across 2 matching MRF lines |
$193.60–$372 | $484–$930 | varies |
| K Flow/Funct Image W/O Drug (78707) | $372 | $930 | 0.7× |
| Kidney Funcj Study Non-Img Radioisotopic Study (78725) | $180.80 | $452 | 0.4× |
| Kidney Imaging Morphol (78700) | $293.20 | $733 | 0.7× |
| Knee 3 Views (73562) | $52.80 | $132 | 0.6× |
| Liver & Spleen Imaging Static Only (78215) | $384 | $960 | 0.9× |
| Liver imaging static only (78201) | $367.20 | $918 | 0.6× |
| Lung Perf&Ventilat Diferentl (78598) | $370 | $925 | 0.7× |
| Lung Ventilat&Perfus Imaging (78582) | $368 | $920 | 0.6× |
| Lung Ventilation Imaging (78579) | $240 | $600 | 0.6× |
| Magnetic Image Jaw Joint (70336) | $448 | $1,120 | 1.8× |
| Mammary ductogram or galactogram single (77053) range across 2 matching MRF lines |
$223.60–$276 | $559–$690 | varies |
| Meckels Divert Exam (78290) | $354 | $885 | 0.8× |
| Mra Head W/O & W/Contrast Material (70546) | $896 | $2,240 | 2.5× |
| MRA head w/o contrast (70544) | $448 | $1,120 | 1.8× |
| MRA head with contrast (70545) | $506.40 | $1,266 | 1.4× |
| MRA neck w contrast (70548) | $566 | $1,415 | 1.6× |
| Mra Neck W/O &W/Contrast Material (70549) | $896 | $2,240 | 2.5× |
| MRA neck w/o contrast (70547) | $532 | $1,330 | 2.1× |
| MRI abdomen w contrast (74182) | $582 | $1,455 | 1.6× |
| MRI abdomen w/o contrast (74181) | $448 | $1,120 | 1.8× |
| MRI any jt lower extrem w/contrast material (73722) | $506.40 | $1,266 | 0.6× |
| MRI any jt lower extrem w/o & w/contrast matrl (73723) | $896 | $2,240 | 2.5× |
| MRI any jt upper extremity w/contrast matrl (73222) | $506.40 | $1,266 | 0.6× |
| MRI bone marrow blood supply (77084) | $448 | $1,120 | 1.8× |
| MRI cervical spine w contrast (72142) | $530.40 | $1,326 | 1.5× |
| MRI cervical spine w/o cont (72141) | $448 | $1,120 | 1.8× |
| MRI chest w/o contrast (71550) range across 2 matching MRF lines |
$448–$646 | $1,120–$1,615 | varies |
| MRI chest with contrast (71551) | $646 | $1,615 | 0.8× |
| MRI chest wo w contrast (71552) range across 2 matching MRF lines |
$896–$1,523.60 | $2,240–$3,809 | varies |
| MRI lower extrem oth/thn jt w/contrast matrl (73719) | $524 | $1,310 | 1.4× |
| MRI lower extrem oth/thn jt w/o & w/contr matr (73720) | $896 | $2,240 | 2.5× |
| MRI lower extrem oth/thn jt w/o contr matrl (73718) range across 11 matching MRF lines |
$420–$480 | $1,050–$1,200 | varies |
| MRI lumbar spine w contrast (72149) | $537.60 | $1,344 | 1.5× |
| Mri Neck Spine W/O & W/Dye (72156) | $995.20 | $2,488 | 2.7× |
| MRI orbit face &/neck w/o contrast (70540) range across 6 matching MRF lines |
$448–$464 | $1,120–$1,160 | varies |
| MRI orbit face neck w contrast (70542) range across 3 matching MRF lines |
$448–$515.20 | $1,120–$1,288 | varies |
| Mri Orbt/Fac/Nck W/O &W/Dye (70543) | $896 | $2,240 | 2.5× |
| MRI pelvis w contrast (72196) | $524 | $1,310 | 1.4× |
| MRI pelvis w/o & w contrast (72197) | $896 | $2,240 | 2.5× |
| MRI pelvis w/o contrast (72195) | $478 | $1,195 | 1.9× |
| MRI thoracic spine w/o contrast (72146) | $497.20 | $1,243 | 2.0× |
| MRI upper extremity oth than jt w/contr matrl (73219) range across 8 matching MRF lines |
$520–$524 | $1,300–$1,310 | varies |
| MRI upper extremity oth than jt w/o contr matrl (73218) | $480 | $1,200 | 1.9× |
| Mri Uppr Extremity W/O&W/Dye (73220) | $896 | $2,240 | 2.5× |
| MRI, abdomen, combo (74183) | $896 | $2,240 | 2.5× |
| MRI, dorsal spine combo (72157) | $995.20 | $2,488 | 2.7× |
| MRI, dorsal spine contrast (72147) | $537.60 | $1,344 | 1.5× |
| MRI, joint upper extrem (73221) | $448 | $1,120 | 1.8× |
| MRI, joint upper extrem combo (73223) range across 11 matching MRF lines |
$412.40–$896 | $1,031–$2,240 | varies |
| MRI, lumbar spine combo (72158) | $995.20 | $2,488 | 2.7× |
| Myelogram cervical (72240) | $420 | $1,050 | 0.5× |
| Myelogram Lumbar (72265) | $420 | $1,050 | 0.5× |
| Myelography thoracic (72255) | $420 | $1,050 | 0.5× |
| Myelograpy 2/more regions rs&i (72270) | $576 | $1,440 | 0.7× |
| Myocardial Perfusion Planar 1 Study Rest/Stress (78453) | $313.60 | $784 | 0.2× |
| Myocardial Spect Multiple Studies (78452) | $1,274.40 | $3,186 | 0.9× |
| Neck soft tissue (70360) | $40.40 | $101 | 0.4× |
| Ob us nuchal meas 1 gest (76813) | $82 | $205 | 0.8× |
| Oph US Dx B-Scan&Quan a-Scan Sm Pt Enctr (76510) | $92 | $230 | 0.7× |
| Parathyroid Planar Imaging (78070) | $384 | $960 | 0.9× |
| Pelvis 1 or 2 views (72170) range across 2 matching MRF lines |
$52.80–$88 | $132–$220 | varies |
| Pet Myocardial Sngl Study (78491) | $1,714 | $4,285 | 1.1× |
| Pulmonary Perfusion Imaging Particulate (78580) | $240 | $600 | 0.6× |
| Radex Abd Compl Aqt Abd W/S/E/D Views 1 View Ch (74022) range across 2 matching MRF lines |
$30–$116.40 | $75–$291 | varies |
| Radex abscess/fistula/sinus tract rs&i (76080) | $223.60 | $559 | 0.4× |
| Radex Ankle Complete Minimum 3 Views (73610) range across 3 matching MRF lines |
$70.80–$326.40 | $177–$816 | varies |
| Radex Calcaneus Minimum 2 Views (73650) range across 3 matching MRF lines |
$52.80–$75.20 | $132–$188 | varies |
| Radex elbow complete minimum 3 views (73080) | $107.20 | $268 | 1.2× |
| Radex Facial Bones Complete Minimum 3 Views (70150) | $64 | $160 | 0.6× |
| Radex fingr minimum 2 views (73140) | $40.40 | $101 | 0.4× |
| Radex foot complete minimum 3 views (73630) | $88 | $220 | 1.0× |
| Radex Hand Minimum 3 Views (73130) | $52.80 | $132 | 0.6× |
| Radex lower extremity infant minimum 2 views (73592) | $54.80 | $137 | 0.6× |
| Radex Nasal Bones Complete Minimum 3 Views (70160) | $52.80 | $132 | 0.6× |
| Radex Ribs Unilateral 2 Views (71100) | $64 | $160 | 0.7× |
| Radex shoulder complete minimum 2 views (73030) | $52.80 | $132 | 0.6× |
| Radex Sinuses Paransl < 3 Views (70210) | $52.80 | $132 | 0.6× |
| Radex sm int w/mlt srl imges via enteroclss tube (74251) | $354 | $885 | 1.9× |
| Radex Spine 1 View Specify Level (72020) | $40.40 | $101 | 0.4× |
| Radex Sternum Minimum 2 Views (71120) | $52.80 | $132 | 0.6× |
| Radex Temporomandble Jt Opn & Clsd Mouth Bilat (70330) | $139.20 | $348 | 1.5× |
| Radex Toe Minimum 2 Views (73660) | $40.40 | $101 | 0.4× |
| Radex upper extremity infant minimum 2 views (73092) | $64 | $160 | 0.6× |
| Radex Wrist Complete Minimum 3 Views (73110) | $70 | $175 | 0.8× |
| Radiologic Exam Abdomen 3+ Views - Xr Abdomen 3+ Views (74021) | $86.40 | $216 | 0.8× |
| Radiologic exam colon double contrast study (74280) | $200.40 | $501 | 1.1× |
| Radiologic exam colon single contrast study (74270) | $146 | $365 | 0.8× |
| Radiologic exam knee complete 4/more views (73564) | $52.80 | $132 | 0.5× |
| Radiologic Exam Small Int Single Contrast Study (74250) | $102 | $255 | 0.6× |
| Radiologic exam swallow function contrast study (74230) | $100 | $250 | 0.5× |
| Radiologic exam upr gi trc double contrast study (74246) | $114 | $285 | 0.6× |
| Radiologic examination femur minimum 2 views (73552) | $52.80 | $132 | 0.6× |
| Radiologic examination knee 1/2 views (73560) | $66.80 | $167 | 0.7× |
| Radiologic Examination Osseous Survey Limited (77074) | $90 | $225 | 0.8× |
| Radiologic Examination Salivary Gland Calculus (70380) | $54.80 | $137 | 0.6× |
| Radiologic examination tibia & fibula 2 views (73590) | $52.80 | $132 | 0.6× |
| Radiologic examination, internal auditory meati, complete Non-Facility (70134) | $88 | $220 | 0.2× |
| Ribs bilateral 3 views (71110) | $52.80 | $132 | 0.5× |
| Rp loclzj tum plnr 1 area single day imaging (78800) range across 2 matching MRF lines |
$328–$1,420.80 | $820–$3,552 | varies |
| Rp Loclzj Tum Plnr Whole Body 2+ Days Imaging (78804) | $1,340.40 | $3,351 | 2.4× |
| Rp Loclzj Tum Plnr Whole Body Single Day Imaging (78802) | $462 | $1,155 | 0.8× |
| Rp Loclzj Tum Spect 1 Area Single Day Imaging (78803) range across 3 matching MRF lines |
$288–$1,624 | $720–$4,060 | varies |
| Rp loclzj tum spect 2 area/sep acquisj img (78831) | $303.60 | $759 | 0.2× |
| Scapula (73010) | $52.80 | $132 | 0.5× |
| Screening Digital Breast Tomosynthesis Bi (77063) | $28.80 | $72 | 1.2× |
| Shoulder Arthrography (73040) | $238.40 | $596 | 0.7× |
| Skull less than 4 views (70250) | $52.80 | $132 | 0.5× |
| Sternoclavicular joints (71130) | $52.80 | $132 | 0.6× |
| Testicular Imaging W/Flow (78761) | $293.20 | $733 | 0.7× |
| Thoracic spine 3 views (72072) | $64 | $160 | 0.6× |
| Thoracolumbar 2 views (72080) range across 2 matching MRF lines |
$53.20–$70.80 | $133–$177 | varies |
| Thyroid Imaging With Vascular Flow (78013) | $384 | $960 | 0.9× |
| Thyroid Uptake Measurement (78012) | $260 | $650 | 0.6× |
| Thyroid Uptake W/Blood Flow Sngle/Mult Quan Meas (78014) | $526 | $1,315 | 1.3× |
| Ultrasound Breast Limited (76642) | $151.20 | $378 | 1.7× |
| Ultrasound Exam Aaa Screen (76706) | $120 | $300 | 1.1× |
| Ultrasound, abdomen limited (76705) | $180 | $450 | 1.6× |
| Unlisted Dx Radiographic Procedure (76499) range across 4 matching MRF lines |
$52.80–$275.20 | $132–$688 | varies |
| Unlisted magnetic resonance procedure (76498) | $394 | $985 | 4.3× |
| Upper gi w/o kub (74240) | $166 | $415 | 0.9× |
| Urethrocystogram voiding (74455) | $181.20 | $453 | 0.7× |
| Us breast unilateral complete (76641) | $151.20 | $378 | 1.4× |
| Us chest (76604) | $74 | $185 | 0.7× |
| Us complete joint (76881) | $180 | $450 | 1.6× |
| Us exam, pelvic, limited (76857) | $96 | $240 | 0.9× |
| Us head (76506) | $195.60 | $489 | 1.8× |
| Us ob detailed single fetus (76811) | $177.60 | $444 | 0.7× |
| Us ob limited 1 or more fetuses (76815) range across 5 matching MRF lines |
$56.80–$180 | $142–$450 | varies |
| Us ob transvaginal (76817) | $180 | $450 | 1.6× |
| Us pelvic non ob complete (76856) | $180 | $450 | 1.6× |
| Us pg uter img f&mat 14 wk tabdl 1/1st gestation (76801) | $180 | $450 | 1.6× |
| Us preg uterus real time f/u trnsabdl per fetus (76816) | $180 | $450 | 1.6× |
| Us retroperitoneal complete (76770) | $180 | $450 | 1.6× |
| Us retroperitoneal limited (76775) | $180 | $450 | 1.6× |
| Us scrotum and contents (76870) | $180 | $450 | 1.6× |
| Us spinal canal and contents (76800) | $163.20 | $408 | 1.5× |
| Us thyroid (76536) | $180 | $450 | 1.6× |
| Us transrectal (76872) | $180 | $450 | 1.6× |
| Vein X-Ray Chest (75827) | $610.40 | $1,526 | 0.4× |
| Venography caval inferior serialography rs&i (75825) | $610.40 | $1,526 | 0.2× |
| Venography extremity bilateral rs&i (75822) | $458.40 | $1,146 | 0.3× |
| Wrist 2 views (73100) | $70 | $175 | 0.8× |
| X-Ray Ac Jts - Xr Acromioclavicular Joints Bilateral (73050) | $52 | $130 | 0.6× |
| X-Ray Aorta Leg Arteries (75630) | $637.60 | $1,594 | 0.2× |
| X-Ray Bend Only L-S Spine (72120) | $52.80 | $132 | 0.5× |
| X-Ray Elbow 2 Vw - Xr Elbow 1-2 Views Right (73070) | $52.80 | $132 | 0.6× |
| X-Ray Exam Breast Specimen (76098) | $223.60 | $559 | 0.4× |
| X-Ray Exam Entire Spi 2/3 Vw (72082) | $116.40 | $291 | 1.1× |
| X-Ray Exam Entire Spi 4/5 Vw (72083) | $222 | $555 | 2.0× |
| X-Ray Exam Hip Uni 1 View (73501) | $70.80 | $177 | 0.8× |
| X-Ray Exam Hip Uni 2-3 Views (73502) range across 3 matching MRF lines |
$52.80–$70.80 | $132–$177 | varies |
| X-Ray Exam Hip Uni 4/> Views (73503) | $116.40 | $291 | 1.1× |
| X-Ray Exam Hips Bi 2 Views (73521) | $116.40 | $291 | 1.1× |
| X-Ray Exam Hips Bi 3-4 Views (73522) | $116.40 | $291 | 1.1× |
| X-Ray Exam Hips Bi 5/> Views (73523) | $222 | $555 | 2.0× |
| X-Ray Exam L-S Spine Bending (72114) range across 2 matching MRF lines |
$88–$140 | $220–$350 | varies |
| X-Ray Exam Neck Spine 2-3 Vw (72040) range across 2 matching MRF lines |
$52.80–$88 | $132–$220 | varies |
| X-Ray Exam Neck Spine 6/>Vws (72052) | $100 | $250 | 0.9× |
| X-Ray Exam Unilat Ribs/Chest (71101) | $126 | $315 | 1.2× |
| X-ray humerus (73060) | $52.80 | $132 | 0.6× |
| X-ray IV pyelogram (ivp) (74400) range across 2 matching MRF lines |
$67.60–$214 | $169–$535 | varies |
| X-ray IV pyelogram+tomography (74415) | $84.80 | $212 | 0.5× |
| X-Ray Jaw <4 Vw - Xr Mandible < 4 Views (70100) range across 3 matching MRF lines |
$52.80–$54.80 | $132–$137 | varies |
| X-Ray Knee Bilat Standing - Xr Knees Anteroposterior Standing Bilat (73565) range across 2 matching MRF lines |
$40.40–$66.80 | $101–$167 | varies |
| X-Ray Lumbar Spine 2/3 Vw - Xr Lumbar Spine 2-3 Views (72100) range across 2 matching MRF lines |
$52.80–$115.20 | $132–$288 | varies |
| X-ray nose-rectum child f.b. (76010) | $52.40 | $131 | 0.6× |
| X-Ray Ribs, Chest 4+ Vw - Xr Ribs 3 Vws Bil W/ Chest Posteroanterior (71111) | $180 | $450 | 1.6× |
| X-Ray Sacroiliac Jts 3+ Vw - Xr Sacroiliac Joints 3+ Views (72202) | $52.80 | $132 | 0.5× |
| X-Ray Sacrum/Coccyx 2+ Vw - Xr Sacrum Coccyx 2+ Views (72220) | $52.80 | $132 | 0.6× |
| X-Ray Sinuses 3+ Vw - Xr Paranasal Sinuses 3+ Views (70220) | $52.80 | $132 | 0.6× |
| X-Ray Skull 4+ Vw - Xr Skull Complete 4+ Views (70260) | $88 | $220 | 0.8× |
| X-Ray Tmj Unilat (70328) | $69.60 | $174 | 0.8× |
| X-Ray Urinary Tract Exam With Contrast Material (74420) | $214 | $535 | 0.6× |
| X-Rays Bone Length Studies (77073) | $70.80 | $177 | 0.6× |
| Xr c-spine 4 or 5 views (72050) | $88.40 | $221 | 0.8× |
| XR Mastoids < 3 Views Bilateral (70120) | $52.80 | $132 | 0.5× |
| Xr orbits complete 4 views (70200) | $52.80 | $132 | 0.5× |
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.