Imaging prices at Fort Memorial Hospital
Fort Atkinson, WI · every code in this section with a posted price and a Medicare benchmark.
260 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) | $129.92 | $406 | 1.5× |
| Abdomen 2 views (74019) range across 3 matching MRF lines |
$224–$227.52 | $700–$711 | varies |
| Acute Gastrointestinal Blood Loss Imaging (78278) | $690.56 | $2,158 | 1.7× |
| Ankle 2 views (73600) | $124.80 | $390 | 1.4× |
| Arthrogram ankle (73615) | $340.48 | $1,064 | 1.0× |
| Arthrogram hip (73525) | $487.36 | $1,523 | 1.4× |
| Arthrogram Wrist (73115) | $287.04 | $897 | 0.8× |
| Bone age studies (77072) | $123.52 | $386 | 1.2× |
| Bone Imaging 3 Phase (78315) | $1,005.44 | $3,142 | 2.5× |
| Bone Imaging Limited Area (78300) | $355.20 | $1,110 | 0.9× |
| Bone Imaging Multiple Areas (78305) | $355.20 | $1,110 | 0.9× |
| Bone Imaging Whole Body (78306) | $649.60 | $2,030 | 1.6× |
| Bone marrow imaging limited area (78102) | $292.16 | $913 | 0.7× |
| Bone survey infant (77076) | $152.64 | $477 | 1.5× |
| Brain Imaging Pet Metabolic Evaluation (78608) | $127.36 | $398 | 0.1× |
| Chest 1 view (71045) | $122.88 | $384 | 1.4× |
| Chest 2 views (71046) | $159.04 | $497 | 1.8× |
| Chest 3 views (71047) | $186.88 | $584 | 2.2× |
| Chest 4 or more views (71048) | $111.36 | $348 | 1.1× |
| Clavicle complete (73000) | $124.80 | $390 | 1.4× |
| Computed Tomography Thorax Lw Dose Lng Ca Scr C- (71271) | $487.36 | $1,523 | 4.7× |
| Contrast X-Ray Bladder (74430) | $214.08 | $669 | 0.6× |
| Contrast X-Ray Of Elbow (73085) | $340.48 | $1,064 | 1.0× |
| Contrast X-Ray Of Knee Joint (73580) | $487.36 | $1,523 | 1.4× |
| CT abdomen and pelvis without and with contrast (74178) | $1,688.96 | $5,278 | 4.9× |
| CT abdomen and pelvis without contrast (74176) range across 3 matching MRF lines |
$1,461.76–$1,747.52 | $4,568–$5,461 | varies |
| CT abdomen w contrast (74160) | $1,248.64 | $3,902 | 7.2× |
| CT abdomen w wo contrast (74170) range across 3 matching MRF lines |
$1,179.84–$1,299.20 | $3,687–$4,060 | varies |
| CT abdomen w/o contrast (74150) range across 2 matching MRF lines |
$844.48–$970.24 | $2,639–$3,032 | varies |
| CT Angio Abdomen and Pelvis (74174) range across 3 matching MRF lines |
$2,052.16–$2,069.12 | $6,413–$6,466 | varies |
| CT Angio Chest (71275) range across 5 matching MRF lines |
$1,472–$1,494.08 | $4,600–$4,669 | varies |
| CT Angio Head (70496) | $1,362.88 | $4,259 | 7.9× |
| CT angio hrt w/3d image (75574) | $438.72 | $1,371 | 1.3× |
| Ct Angio Lwr Extr W/O&W/Dye (73706) range across 3 matching MRF lines |
$844.48–$1,688.96 | $2,639–$5,278 | varies |
| CT Angio Neck (70498) | $1,454.72 | $4,546 | 8.4× |
| Ct Angio Upr Extrm W/O&W/Dye (73206) | $1,045.12 | $3,266 | 6.0× |
| CT cervical spine w/ contrast (72126) | $685.12 | $2,141 | 2.0× |
| CT cervical spine w/o contrast (72125) | $974.40 | $3,045 | 9.4× |
| CT cervical spine w/wo cont (72127) | $1,287.04 | $4,022 | 7.4× |
| CT chest w contrast (71260) range across 2 matching MRF lines |
$925.76–$1,169.28 | $2,893–$3,654 | varies |
| CT chest w/wo contrast (71270) | $1,354.24 | $4,232 | 7.8× |
| CT colonography screening (74263) | $1,192.96 | $3,728 | 5.1× |
| CT colonogrphy dx image postprocess w/o contrast (74261) | $1,192.96 | $3,728 | 11.5× |
| CT head/brain with contrast (70460) | $882.88 | $2,759 | 5.1× |
| CT head/brain without and with contrast (70470) | $1,058.56 | $3,308 | 6.1× |
| CT heart no contrast quant eval coronry calcium (75571) | $70.40 | $220 | 0.8× |
| CT iac w contrast (70481) | $1,038.08 | $3,244 | 6.0× |
| CT l-spine w&w/o contrast (72133) | $1,344.64 | $4,202 | 7.8× |
| CT lower ext w/o (73700) range across 6 matching MRF lines |
$465.28–$550.72 | $1,454–$1,721 | varies |
| CT lower extremity w/contrast material (73701) | $654.40 | $2,045 | 3.8× |
| CT lumbar spine w contrast (72132) | $974.40 | $3,045 | 2.8× |
| CT lumbar spine w/o contrast (72131) | $893.44 | $2,792 | 8.6× |
| CT maxillofacial w contrast (70487) | $873.28 | $2,729 | 5.0× |
| CT maxillofacial wo contrast (70486) | $760.32 | $2,376 | 7.4× |
| CT neck tissue combo (70492) | $1,077.12 | $3,366 | 6.2× |
| Ct Orbit/Ear/Fossa W/O&W/Dye (70482) range across 3 matching MRF lines |
$936.96–$1,136.32 | $2,928–$3,551 | varies |
| CT orbits w/o contrast (70480) range across 2 matching MRF lines |
$664.64–$780.48 | $2,077–$2,439 | varies |
| CT pelvis w&w/o contrast (72194) | $1,024.32 | $3,201 | 5.9× |
| CT pelvis w/o contrast (72192) | $837.44 | $2,617 | 8.1× |
| CT scan of leg combo (73702) | $785.60 | $2,455 | 4.5× |
| CT scans face/jaw combo (70488) | $1,047.68 | $3,274 | 6.0× |
| CT soft tissue neck w contrast (70491) | $897.28 | $2,804 | 5.2× |
| CT soft tissue neck w/o contrast (70490) | $758.72 | $2,371 | 7.3× |
| CT thoracic spine w contrast (72129) | $1,055.04 | $3,297 | 6.1× |
| CT thoracic spine w/o contrast (72128) | $980.80 | $3,065 | 9.5× |
| CT thoracic spine w/wo cont (72130) | $1,169.28 | $3,654 | 6.7× |
| CT thorax w/o contrast (71250) range across 4 matching MRF lines |
$779.52–$860.80 | $2,436–$2,690 | varies |
| CT unlisted procedure (76497) | $393.60 | $1,230 | 4.6× |
| CT upper ext wo (73200) | $636.80 | $1,990 | 6.2× |
| CT upper extremity w/o & w/contrast material (73202) | $824.32 | $2,576 | 4.8× |
| CT upper extremity with contrast (73201) | $685.12 | $2,141 | 2.0× |
| Cta Abdl Aorta&Bi Iliofem W/Contrast&Postp (75635) | $1,486.40 | $4,645 | 8.6× |
| Cta Abdomen (74175) | $1,464 | $4,575 | 8.4× |
| CTA head&neck c+ w/noncontrast img&post-pxessing (70471) | $2,109.44 | $6,592 | 6.1× |
| CTA pelvis (72191) | $1,379.84 | $4,312 | 8.0× |
| Dacryocystography, nasolacrimal duct, radiological supervision and interpretation Non-Facility (70170) | $171.52 | $536 | 0.7× |
| Dxa Bone Density Axial (77080) | $292.48 | $914 | 2.8× |
| Dxa bone density study 1/>sites appendiclr skel (77081) | $178.88 | $559 | 2.1× |
| Echo exam uterus (76831) | $192 | $600 | 0.8× |
| Echograp Trans R Pros Study (76873) | $352.96 | $1,103 | 3.4× |
| Esophagram (74220) | $211.20 | $660 | 1.2× |
| Fetal Biophys Profile W/Nst (76818) range across 2 matching MRF lines |
$333.44–$354.88 | $1,042–$1,109 | varies |
| Fluoroscopy up to 1 hr (76000) range across 3 matching MRF lines |
$200.96–$312.96 | $628–$978 | varies |
| Foot 2 views (73620) | $124.80 | $390 | 1.4× |
| Forearm 2 views (73090) | $124.80 | $390 | 1.4× |
| Gastric emptying imaging study (78264) | $639.36 | $1,998 | 1.6× |
| Gated Heart Planar Single (78472) | $851.20 | $2,660 | 2.2× |
| Gated Heart, Multiple (78473) | $2,437.12 | $7,616 | 6.2× |
| Hand 2 views (73120) | $124.80 | $390 | 1.2× |
| Heart first pass single,planar (78481) | $1,676.16 | $5,238 | 3.1× |
| Hepatobil Syst Image W/Drug (78227) | $974.40 | $3,045 | 1.8× |
| Hepatobiliary System Imaging (78226) | $747.20 | $2,335 | 1.9× |
| Ht Musc Image Planar Mult (78454) | $625.92 | $1,956 | 0.5× |
| Ht Muscle Image Spect Sing (78451) | $1,299.20 | $4,060 | 1.0× |
| Hysterosalpingogram (74740) | $280.64 | $877 | 1.2× |
| Joint Survey Single View (77077) | $113.92 | $356 | 1.1× |
| K Flow/Funct Image Multiple (78709) | $1,350.72 | $4,221 | 2.5× |
| K Flow/Funct Image W/Drug (78708) | $893.44 | $2,792 | 1.7× |
| K Flow/Funct Image W/O Drug (78707) | $901.12 | $2,816 | 1.7× |
| Knee 3 Views (73562) | $146.24 | $457 | 1.7× |
| Lung Ventilat&Perfus Imaging (78582) | $1,074.24 | $3,357 | 2.0× |
| Lung Ventilation Imaging (78579) | $513.60 | $1,605 | 1.3× |
| Lymph System Imaging (78195) | $649.60 | $2,030 | 1.2× |
| Magnetic Image Jaw Joint (70336) | $1,285.76 | $4,018 | 5.4× |
| Meckels Divert Exam (78290) | $524.80 | $1,640 | 1.3× |
| MRA head w/o contrast (70544) range across 2 matching MRF lines |
$1,234.24–$1,570.56 | $3,857–$4,908 | varies |
| MRA neck w contrast (70548) range across 2 matching MRF lines |
$1,624–$1,765.76 | $5,075–$5,518 | varies |
| MRA neck w/o contrast (70547) | $1,545.60 | $4,830 | 6.5× |
| MRI abdomen w contrast (74182) | $1,723.20 | $5,385 | 5.0× |
| MRI abdomen w/o contrast (74181) | $1,449.60 | $4,530 | 6.1× |
| MRI any jt lower extrem w/contrast material (73722) | $1,494.72 | $4,671 | 1.9× |
| MRI any jt lower extrem w/o & w/contrast matrl (73723) | $1,758.40 | $5,495 | 5.1× |
| MRI any jt upper extremity w/contrast matrl (73222) | $1,494.72 | $4,671 | 1.9× |
| MRI bone marrow blood supply (77084) | $1,520.32 | $4,751 | 6.4× |
| MRI Breast W/O Contrast Bilateral (77047) | $341.12 | $1,066 | 1.4× |
| MRI Breast Without Contrast Material Unilateral (77046) | $221.12 | $691 | 0.9× |
| MRI cervical spine w contrast (72142) | $1,880 | $5,875 | 5.4× |
| MRI cervical spine w/o cont (72141) range across 3 matching MRF lines |
$1,146.24–$1,250.56 | $3,582–$3,908 | varies |
| MRI chest w/o contrast (71550) | $2,107.52 | $6,586 | 8.9× |
| MRI chest wo w contrast (71552) | $1,818.88 | $5,684 | 5.3× |
| MRI lower extrem oth/thn jt w/contrast matrl (73719) | $1,494.72 | $4,671 | 4.3× |
| MRI lower extrem oth/thn jt w/o & w/contr matr (73720) | $1,758.40 | $5,495 | 5.1× |
| MRI lower extrem oth/thn jt w/o contr matrl (73718) range across 4 matching MRF lines |
$1,299.20–$1,758.40 | $4,060–$5,495 | varies |
| MRI lumbar spine w contrast (72149) range across 2 matching MRF lines |
$1,457.60–$1,551.36 | $4,555–$4,848 | varies |
| Mri Neck Spine W/O & W/Dye (72156) | $1,751.36 | $5,473 | 5.1× |
| MRI orbit face &/neck w/o contrast (70540) | $2,099.52 | $6,561 | 8.9× |
| MRI orbit face neck w contrast (70542) | $1,461.76 | $4,568 | 4.2× |
| Mri Orbt/Fac/Nck W/O &W/Dye (70543) range across 2 matching MRF lines |
$1,867.84–$2,831.68 | $5,837–$8,849 | varies |
| MRI pelvis w contrast (72196) | $1,748.80 | $5,465 | 5.1× |
| MRI pelvis w/o & w contrast (72197) | $2,095.04 | $6,547 | 6.1× |
| MRI pelvis w/o contrast (72195) | $1,499.52 | $4,686 | 6.4× |
| MRI thoracic spine w/o contrast (72146) range across 3 matching MRF lines |
$1,408–$1,521.60 | $4,400–$4,755 | varies |
| MRI upper extremity oth than jt w/contr matrl (73219) | $1,494.72 | $4,671 | 4.3× |
| MRI upper extremity oth than jt w/o contr matrl (73218) | $1,135.36 | $3,548 | 4.8× |
| Mri Uppr Extremity W/O&W/Dye (73220) | $1,758.40 | $5,495 | 5.1× |
| MRI, abdomen, combo (74183) range across 3 matching MRF lines |
$1,461.76–$2,095.04 | $4,568–$6,547 | varies |
| MRI, dorsal spine combo (72157) range across 3 matching MRF lines |
$1,645.76–$1,751.36 | $5,143–$5,473 | varies |
| MRI, dorsal spine contrast (72147) range across 2 matching MRF lines |
$1,766.40–$1,880 | $5,520–$5,875 | varies |
| MRI, joint upper extrem (73221) range across 4 matching MRF lines |
$1,201.92–$1,494.72 | $3,756–$4,671 | varies |
| MRI, joint upper extrem combo (73223) | $1,758.40 | $5,495 | 5.1× |
| MRI, lumbar spine combo (72158) range across 3 matching MRF lines |
$1,600–$1,702.72 | $5,000–$5,321 | varies |
| Myocardial Imaging Infarct Avid Planar Qual/Quan (78466) | $580.48 | $1,814 | 1.5× |
| Myocardial imaging, infarct avid, planar; with ejection fraction by first pass technique Non-Facility (78468) | $621.44 | $1,942 | 1.2× |
| Myocardial Perfusion Planar 1 Study Rest/Stress (78453) | $722.88 | $2,259 | 0.6× |
| Myocardial Spect Multiple Studies (78452) | $2,127.68 | $6,649 | 1.7× |
| N-invas est c ffr sw aly CTA (75580) | $1,299.20 | $4,060 | 1.5× |
| Neck soft tissue (70360) | $139.84 | $437 | 1.6× |
| Njx Rp Loclzj Non-Img Probe Study Intravenous (78808) | $145.92 | $456 | 0.4× |
| Nm myocard infarct spect (78469) | $752.96 | $2,353 | 1.4× |
| Parathyroid imaging w/tomographic spect & CT (78072) | $559.68 | $1,749 | 1.0× |
| Parathyroid Planar Imaging (78070) | $632.64 | $1,977 | 1.6× |
| Pelvis 1 or 2 views (72170) | $113.92 | $356 | 1.1× |
| Pet Image W/Ct Lmtd (78814) | $2,668.80 | $8,340 | 1.9× |
| PET image w/CT, full body (78816) | $3,017.60 | $9,430 | 2.1× |
| PET imaging CT attenuation skull base mid-thigh (78815) | $2,937.60 | $9,180 | 2.1× |
| Pulmonary Perfusion Imaging Particulate (78580) | $595.84 | $1,862 | 1.5× |
| Radex Abd Compl Aqt Abd W/S/E/D Views 1 View Ch (74022) range across 2 matching MRF lines |
$242.56–$246.40 | $758–$770 | varies |
| Radex abscess/fistula/sinus tract rs&i (76080) | $273.28 | $854 | 0.5× |
| Radex Ankle Complete Minimum 3 Views (73610) | $124.80 | $390 | 1.4× |
| Radex Calcaneus Minimum 2 Views (73650) | $124.80 | $390 | 1.4× |
| Radex elbow complete minimum 3 views (73080) | $146.56 | $458 | 1.7× |
| Radex Facial Bones Complete Minimum 3 Views (70150) | $187.20 | $585 | 1.8× |
| Radex fingr minimum 2 views (73140) | $124.80 | $390 | 1.4× |
| Radex foot complete minimum 3 views (73630) | $124.80 | $390 | 1.4× |
| Radex Hand Minimum 3 Views (73130) | $138.24 | $432 | 1.6× |
| Radex lower extremity infant minimum 2 views (73592) | $124.80 | $390 | 1.4× |
| Radex Mastoids Compl Minimum 3 Views PR Side (70130) | $187.20 | $585 | 1.8× |
| Radex Nasal Bones Complete Minimum 3 Views (70160) | $150.08 | $469 | 1.7× |
| Radex Ribs Unilateral 2 Views (71100) | $139.84 | $437 | 1.6× |
| Radex shoulder complete minimum 2 views (73030) range across 4 matching MRF lines |
$129.92–$146.24 | $406–$457 | varies |
| Radex Sinuses Paransl < 3 Views (70210) | $113.92 | $356 | 1.3× |
| Radex Sternum Minimum 2 Views (71120) | $143.04 | $447 | 1.7× |
| Radex Temporomandble Jt Opn & Clsd Mouth Bilat (70330) | $340.48 | $1,064 | 4.0× |
| Radex Toe Minimum 2 Views (73660) | $124.80 | $390 | 1.4× |
| Radex upper extremity infant minimum 2 views (73092) | $124.80 | $390 | 1.2× |
| Radex Wrist Complete Minimum 3 Views (73110) | $146.24 | $457 | 1.7× |
| Radex X-Ray Exam Entire Spi 6/> Vw - Xr Entire Spine 6+ Vw (72084) | $365.44 | $1,142 | 3.5× |
| Radiolog exam mandible compl minimum 4 views (70110) | $187.20 | $585 | 1.8× |
| Radiologic Exam Abdomen 3+ Views - Xr Abdomen 3+ Views (74021) | $95.04 | $297 | 0.9× |
| Radiologic exam colon double contrast study (74280) | $610.24 | $1,907 | 3.5× |
| Radiologic exam colon single contrast study (74270) | $292.48 | $914 | 1.7× |
| Radiologic exam knee complete 4/more views (73564) | $162.56 | $508 | 1.6× |
| Radiologic exam pelvis compl minimum 3 views (72190) | $124.80 | $390 | 1.2× |
| Radiologic Exam Small Int Single Contrast Study (74250) | $257.92 | $806 | 1.5× |
| Radiologic exam swallow function contrast study (74230) | $322.56 | $1,008 | 1.9× |
| Radiologic exam upr gi trc double contrast study (74246) | $296.32 | $926 | 1.7× |
| Radiologic examination femur 1 view (73551) | $121.92 | $381 | 1.4× |
| Radiologic examination femur minimum 2 views (73552) | $124.80 | $390 | 1.4× |
| Radiologic examination knee 1/2 views (73560) | $124.80 | $390 | 1.4× |
| Radiologic Examination Osseous Survey Limited (77074) | $223.68 | $699 | 2.2× |
| Radiologic Examination Salivary Gland Calculus (70380) | $187.20 | $585 | 2.2× |
| Radiologic examination tibia & fibula 2 views (73590) | $124.80 | $390 | 1.4× |
| Radiopharmaceutical therapy, by interstitial radioactive colloid administration Facility (79300) | $26.24 | $82 | 0.1× |
| Ribs bilateral 3 views (71110) | $178.88 | $559 | 1.7× |
| Rp loclzj tum plnr 1 area single day imaging (78800) range across 4 matching MRF lines |
$488–$694.08 | $1,525–$2,169 | varies |
| Rp loclzj tum plnr 2+area 1+d img/1 area img>2+d (78801) range across 2 matching MRF lines |
$617.60–$1,385.92 | $1,930–$4,331 | varies |
| Rp Loclzj Tum Plnr Whole Body Single Day Imaging (78802) | $1,081.92 | $3,381 | 2.0× |
| Rp Loclzj Tum Spect 1 Area Single Day Imaging (78803) range across 3 matching MRF lines |
$694.08–$765.12 | $2,169–$2,391 | varies |
| Scapula (73010) | $124.80 | $390 | 1.2× |
| Screening Digital Breast Tomosynthesis Bi (77063) | $21.44 | $67 | 0.9× |
| Shoulder 1 view (73020) | $124.80 | $390 | 1.4× |
| Shoulder Arthrography (73040) | $625.28 | $1,954 | 1.8× |
| Sialogram (70390) range across 3 matching MRF lines |
$254.40–$508.80 | $795–$1,590 | varies |
| Skull less than 4 views (70250) range across 2 matching MRF lines |
$120–$121.92 | $375–$381 | varies |
| Sternoclavicular joints (71130) | $129.92 | $406 | 1.5× |
| Tbs techl prep&transmis data alys pfrmd elsewhr (77090) | $73.60 | $230 | 0.9× |
| Thoracic spine 2 views (72070) | $130.88 | $409 | 1.3× |
| Thyroid Imaging With Vascular Flow (78013) | $429.76 | $1,343 | 1.1× |
| Thyroid Uptake Measurement (78012) | $200 | $625 | 0.5× |
| Thyroid Uptake W/Blood Flow Sngle/Mult Quan Meas (78014) | $552.32 | $1,726 | 1.4× |
| Ultrasound Breast Limited (76642) range across 6 matching MRF lines |
$200–$399.68 | $625–$1,249 | varies |
| Ultrasound Exam Aaa Screen (76706) | $333.44 | $1,042 | 3.2× |
| Ultrasound, abdomen limited (76705) range across 4 matching MRF lines |
$268.16–$274.56 | $838–$858 | varies |
| Umbilical-artery Doppler (OB) (76820) | $170.56 | $533 | 1.6× |
| Unlisted fluoroscopic procedure (76496) | $305.60 | $955 | 3.6× |
| Upper gi w/o kub (74240) | $284.48 | $889 | 1.6× |
| Us breast unilateral complete (76641) | $258.56 | $808 | 2.5× |
| Us chest (76604) range across 2 matching MRF lines |
$319.36–$333.44 | $998–$1,042 | varies |
| Us exam, pelvic, limited (76857) range across 5 matching MRF lines |
$269.44–$282.24 | $842–$882 | varies |
| Us lmtd joint/oth nonvasc xtr strux r-t w/img (76882) range across 4 matching MRF lines |
$134.72–$178.88 | $421–$559 | varies |
| Us ob limited 1 or more fetuses (76815) range across 5 matching MRF lines |
$47.04–$266.24 | $147–$832 | varies |
| Us ob transvaginal (76817) range across 2 matching MRF lines |
$339.84–$361.60 | $1,062–$1,130 | varies |
| Us pelvic non ob complete (76856) | $352.96 | $1,103 | 3.4× |
| Us pg uter img f&mat 14 wk tabdl 1/1st gestation (76801) | $284.48 | $889 | 2.8× |
| Us preg uterus real time f/u trnsabdl per fetus (76816) range across 5 matching MRF lines |
$336.32–$396.48 | $1,051–$1,239 | varies |
| Us retroperitoneal complete (76770) | $333.44 | $1,042 | 3.2× |
| Us retroperitoneal limited (76775) range across 2 matching MRF lines |
$106.88–$276.16 | $334–$863 | varies |
| Us scrotum and contents (76870) | $303.68 | $949 | 2.9× |
| Us thyroid (76536) range across 4 matching MRF lines |
$203.84–$250.24 | $637–$782 | varies |
| Vascular Flow Imaging (78445) | $484.48 | $1,514 | 1.2× |
| Venography extremity bilateral rs&i (75822) | $712 | $2,225 | 0.5× |
| Venography extremity unilateral rs&i (75820) | $356.16 | $1,113 | 0.2× |
| Wrist 2 views (73100) | $124.80 | $390 | 1.4× |
| X-Ray Ac Jts - Xr Acromioclavicular Joints Bilateral (73050) | $191.36 | $598 | 2.2× |
| X-Ray Elbow 2 Vw - Xr Elbow 1-2 Views Right (73070) | $124.80 | $390 | 1.4× |
| X-Ray Exam Breast Specimen (76098) | $584.64 | $1,827 | 1.1× |
| X-Ray Exam Entire Spi 2/3 Vw (72082) | $186.88 | $584 | 1.8× |
| X-Ray Exam Hip Uni 1 View (73501) | $124.80 | $390 | 1.4× |
| X-Ray Exam Hip Uni 2-3 Views (73502) | $134.40 | $420 | 1.6× |
| X-Ray Exam Hips Bi 2 Views (73521) | $186.88 | $584 | 1.8× |
| X-Ray Exam Hips Bi 3-4 Views (73522) | $211.20 | $660 | 2.0× |
| X-Ray Exam Neck Spine 2-3 Vw (72040) | $146.24 | $457 | 1.7× |
| X-Ray Exam Neck Spine 6/>Vws (72052) | $243.84 | $762 | 2.4× |
| X-Ray Exam Unilat Ribs/Chest (71101) | $223.36 | $698 | 2.2× |
| X-ray eye for foreign body (70030) | $113.92 | $356 | 1.3× |
| X-ray humerus (73060) | $124.80 | $390 | 1.4× |
| X-ray IV pyelogram (ivp) (74400) | $261.76 | $818 | 1.5× |
| X-Ray Knee Bilat Standing - Xr Knees Anteroposterior Standing Bilat (73565) | $113.60 | $355 | 1.3× |
| X-Ray Lumbar Spine 2/3 Vw - Xr Lumbar Spine 2-3 Views (72100) | $162.88 | $509 | 1.6× |
| X-ray nose-rectum child f.b. (76010) | $113.92 | $356 | 1.3× |
| X-Ray Ribs, Chest 4+ Vw - Xr Ribs 3 Vws Bil W/ Chest Posteroanterior (71111) | $219.52 | $686 | 2.1× |
| X-Ray Sacroiliac Jts 3+ Vw - Xr Sacroiliac Joints 3+ Views (72202) | $159.04 | $497 | 1.5× |
| X-Ray Sacrum/Coccyx 2+ Vw - Xr Sacrum Coccyx 2+ Views (72220) | $123.52 | $386 | 1.4× |
| X-Ray Sinuses 3+ Vw - Xr Paranasal Sinuses 3+ Views (70220) | $150.40 | $470 | 1.7× |
| X-Ray Skull 4+ Vw - Xr Skull Complete 4+ Views (70260) | $196.16 | $613 | 1.9× |
| X-Ray Urinary Tract Exam With Contrast Material (74420) | $487.36 | $1,523 | 1.4× |
| X-Rays Bone Length Studies (77073) range across 2 matching MRF lines |
$97.60–$127.36 | $305–$398 | varies |
| X-Rays Bone Survey Complete (77075) | $297.60 | $930 | 2.9× |
| Xr c-spine 4 or 5 views (72050) | $204.80 | $640 | 2.0× |
| Xr orbits complete 4 views (70200) | $187.20 | $585 | 1.8× |
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.