Imaging prices at Grand Itasca Clinic and Hospital
Grand Rapids, MN · every code in this section with a posted price and a Medicare benchmark.
238 codes. Prices are the hospital's own posted facility charges.
Compare against other hospitals interactively →
| Procedure | Posted cash | Posted gross | × Medicare |
|---|---|---|---|
| 3-D radiotherapy plan dose-volume histograms (77295) | $1,847.90 | $4,348 | 1.3× |
| Abdomen 1 View (74018) range across 2 matching MRF lines |
$41.65–$106.25 | $98–$250 | varies |
| Abdomen 2 views (74019) range across 2 matching MRF lines |
$50.58–$146.63 | $119–$345 | varies |
| Ankle 2 views (73600) range across 6 matching MRF lines |
$48.03–$226.95 | $113–$534 | varies |
| Basic radiation dosimetry calculation (77300) | $241.32 | $567.80 | 1.7× |
| Bone age studies (77072) range across 2 matching MRF lines |
$33.15–$145.35 | $78–$342 | varies |
| Bone Imaging 3 Phase (78315) | $606.48 | $1,427 | 1.5× |
| Bone Imaging Whole Body (78306) | $675.75 | $1,590 | 1.6× |
| Brain Imaging Pet Metabolic Evaluation (78608) | $2,249.95 | $5,294 | 1.5× |
| Chest 1 view (71045) range across 8 matching MRF lines |
$33.58–$137.30 | $79–$323.04 | varies |
| Chest 2 views (71046) range across 5 matching MRF lines |
$45.46–$151.73 | $106.96–$357 | varies |
| Clavicle complete (73000) range across 4 matching MRF lines |
$47.01–$236.52 | $110.60–$556.50 | varies |
| Computed Tomography Thorax Lw Dose Lng Ca Scr C- (71271) | $294.95 | $694 | 2.7× |
| Continuing medical physics consltj pr wk (77336) range across 3 matching MRF lines |
$290.28–$325.61 | $683–$766.13 | varies |
| Contrast X-Ray Bladder (74430) | $566.53 | $1,333 | 1.6× |
| CT abdomen and pelvis without and with contrast (74178) | $866.15 | $2,038 | 2.4× |
| CT abdomen and pelvis without contrast (74176) range across 2 matching MRF lines |
$541.88–$591.39 | $1,275–$1,391.50 | varies |
| CT abdomen w contrast (74160) | $661.30 | $1,556 | 3.7× |
| CT abdomen w wo contrast (74170) | $762.45 | $1,794 | 4.2× |
| CT abdomen w/o contrast (74150) | $498.95 | $1,174 | 4.6× |
| CT Angio Abdomen and Pelvis (74174) range across 2 matching MRF lines |
$887.55–$888.68 | $2,088.34–$2,091 | varies |
| CT Angio Chest (71275) range across 2 matching MRF lines |
$680.99–$681.28 | $1,602.31–$1,603 | varies |
| CT Angio Head (70496) | $601.80 | $1,416 | 3.3× |
| CT angio hrt w/3d image (75574) | $1,068.45 | $2,514 | 3.0× |
| Ct Angio Lwr Extr W/O&W/Dye (73706) range across 2 matching MRF lines |
$434.78–$652.17 | $1,023–$1,534.50 | varies |
| CT Angio Neck (70498) | $690.20 | $1,624 | 3.8× |
| Ct Angio Upr Extrm W/O&W/Dye (73206) | $557.18 | $1,311 | 3.1× |
| CT cervical spine w/ contrast (72126) | $583.95 | $1,374 | 1.6× |
| CT cervical spine w/o contrast (72125) | $500.65 | $1,178 | 4.6× |
| CT cervical spine w/wo cont (72127) | $370.18 | $871 | 2.0× |
| CT chest w contrast (71260) | $613.70 | $1,444 | 3.4× |
| CT chest w/wo contrast (71270) | $415.23 | $977 | 2.3× |
| CT head/brain without and with contrast (70470) | $509.15 | $1,198 | 2.8× |
| CT heart contrast eval cardiac structure&morph (75572) | $1,190.43 | $2,801 | 3.3× |
| CT heart no contrast quant eval coronry calcium (75571) | $118.15 | $278 | 1.3× |
| CT iac w contrast (70481) | $563.55 | $1,326 | 3.1× |
| CT l-spine w&w/o contrast (72133) | $391.85 | $922 | 2.2× |
| CT lower ext w/o (73700) range across 2 matching MRF lines |
$563.13–$844.69 | $1,325–$1,987.50 | varies |
| CT lower extremity w/contrast material (73701) | $734.40 | $1,728 | 4.1× |
| CT lumbar spine w contrast (72132) | $664.70 | $1,564 | 1.8× |
| CT lumbar spine w/o contrast (72131) range across 2 matching MRF lines |
$498.23–$498.95 | $1,172.29–$1,174 | varies |
| CT maxillofacial w contrast (70487) | $607.33 | $1,429 | 3.4× |
| CT maxillofacial wo contrast (70486) | $595 | $1,400 | 5.5× |
| CT neck tissue combo (70492) | $607.75 | $1,430 | 3.4× |
| Ct Orbit/Ear/Fossa W/O&W/Dye (70482) | $563.55 | $1,326 | 3.1× |
| CT orbits w/o contrast (70480) | $563.55 | $1,326 | 5.2× |
| CT pelvis w&w/o contrast (72194) | $438.60 | $1,032 | 2.4× |
| CT pelvis w/o contrast (72192) | $532.95 | $1,254 | 4.9× |
| CT scan of leg combo (73702) | $439.88 | $1,035 | 2.4× |
| CT soft tissue neck w contrast (70491) range across 3 matching MRF lines |
$558.81–$596.71 | $1,314.83–$1,404 | varies |
| CT soft tissue neck w/o contrast (70490) | $607.75 | $1,430 | 5.6× |
| CT thoracic spine w contrast (72129) | $349.35 | $822 | 1.9× |
| CT thoracic spine w/o contrast (72128) | $493.43 | $1,161 | 4.6× |
| CT thorax w/o contrast (71250) | $498.95 | $1,174 | 4.6× |
| CT upper ext wo (73200) range across 2 matching MRF lines |
$546.98–$820.47 | $1,287–$1,930.50 | varies |
| CT upper extremity with contrast (73201) | $583.95 | $1,374 | 1.6× |
| Cta Abdl Aorta&Bi Iliofem W/Contrast&Postp (75635) | $657.05 | $1,546 | 3.6× |
| Cta Abdomen (74175) | $537.20 | $1,264 | 3.0× |
| CTA pelvis (72191) | $701.68 | $1,651 | 3.9× |
| Doppler Echo Fetal Puls Spectral F/U/Repeat (76828) | $189.98 | $447 | 1.8× |
| Doppler Echo Fetal Spectral Display Complete (76827) | $236.30 | $556 | 2.2× |
| Doppler Fetal Mid Cerebral Artery (76821) | $226.53 | $533 | 2.1× |
| Dxa Bone Density Axial (77080) range across 5 matching MRF lines |
$167.76–$170.52 | $394.72–$401.21 | varies |
| Dxa bone density study (77085) | $185.73 | $437 | 1.7× |
| Dxa bone density study 1/>sites appendiclr skel (77081) range across 3 matching MRF lines |
$211.71–$212.65 | $498.13–$500.34 | varies |
| Echo exam of fetal heart (76825) | $636.65 | $1,498 | 1.1× |
| Echo exam uterus (76831) | $472.18 | $1,111 | 1.9× |
| Esophagram (74220) range across 2 matching MRF lines |
$309.56–$309.83 | $728.37–$729 | varies |
| Fetal Biophys Profile W/Nst (76818) | $599.25 | $1,410 | 5.6× |
| Fetal Biophysical Profile W/O Non-Stress Testing (76819) | $266.90 | $628 | 2.5× |
| Fluoroscopy up to 1 hr (76000) | $351.90 | $828 | 1.4× |
| Foot 2 views (73620) range across 5 matching MRF lines |
$40.80–$231.42 | $96–$544.50 | varies |
| Forearm 2 views (73090) range across 3 matching MRF lines |
$42.08–$226.95 | $99–$534 | varies |
| Gastric emptying imaging study (78264) | $600.10 | $1,412 | 1.5× |
| Gated Heart Planar Single (78472) | $606.90 | $1,428 | 1.5× |
| Hand 2 views (73120) range across 7 matching MRF lines |
$44.49–$239.70 | $104.67–$564 | varies |
| Hepatobil Syst Image W/Drug (78227) | $765.85 | $1,802 | 1.4× |
| Hepatobiliary System Imaging (78226) | $606.90 | $1,428 | 1.5× |
| Ht Muscle Image Spect Sing (78451) | $1,638.80 | $3,856 | 1.2× |
| Hysterosalpingogram (74740) | $473.03 | $1,113 | 1.9× |
| Infant hip ultrasound with hip movement (dynamic) (76885) | $189.13 | $445 | 2.1× |
| Infant hip ultrasound, limited static exam (76886) | $183.60 | $432 | 2.0× |
| K Flow/Funct Image W/Drug (78708) | $689.78 | $1,623 | 1.2× |
| Knee 3 Views (73562) range across 9 matching MRF lines |
$61.23–$246.13 | $144.05–$579.12 | varies |
| Lung Ventilat&Perfus Imaging (78582) | $624.33 | $1,469 | 1.1× |
| Lymph System Imaging (78195) | $624.33 | $1,469 | 1.1× |
| Magnetic Image Jaw Joint (70336) | $519.78 | $1,223 | 2.1× |
| Meckels Divert Exam (78290) | $566.95 | $1,334 | 1.4× |
| Mlc imrt design & construction per imrt plan (77338) range across 2 matching MRF lines |
$511.28–$513.10 | $1,203–$1,207.29 | varies |
| Mra Head W/O & W/Contrast Material (70546) | $818.98 | $1,927 | 2.3× |
| MRA head w/o contrast (70544) range across 5 matching MRF lines |
$583.95–$822.88 | $1,374–$1,936.19 | varies |
| Mra Neck W/O &W/Contrast Material (70549) range across 3 matching MRF lines |
$599.68–$648.72 | $1,411–$1,526.39 | varies |
| MRA neck w/o contrast (70547) | $647.28 | $1,523 | 2.6× |
| MRI abdomen w/o contrast (74181) | $881.88 | $2,075 | 3.6× |
| MRI any jt lower extrem w/contrast material (73722) range across 2 matching MRF lines |
$721.23–$1,081.84 | $1,697–$2,545.50 | varies |
| MRI any jt lower extrem w/o & w/contrast matrl (73723) range across 2 matching MRF lines |
$1,215.08–$1,822.62 | $2,859–$4,288.50 | varies |
| MRI any jt upper extremity w/contrast matrl (73222) range across 2 matching MRF lines |
$1,021.28–$1,531.92 | $2,403–$3,604.50 | varies |
| MRI Breast W/O Contrast Bilateral (77047) | $568.65 | $1,338 | 2.3× |
| MRI cervical spine w contrast (72142) | $613.28 | $1,443 | 1.7× |
| MRI cervical spine w/o cont (72141) | $798.15 | $1,878 | 3.2× |
| MRI chest w/o contrast (71550) | $659.60 | $1,552 | 2.7× |
| MRI chest wo w contrast (71552) | $659.60 | $1,552 | 1.8× |
| MRI lower extrem oth/thn jt w/o & w/contr matr (73720) range across 3 matching MRF lines |
$918–$1,308.15 | $2,160–$3,078 | varies |
| MRI lower extrem oth/thn jt w/o contr matrl (73718) range across 2 matching MRF lines |
$925.65–$1,388.48 | $2,178–$3,267 | varies |
| MRI lumbar spine w contrast (72149) | $594.15 | $1,398 | 1.7× |
| Mri Neck Spine W/O & W/Dye (72156) | $1,231.65 | $2,898 | 3.4× |
| MRI orbit face &/neck w/o contrast (70540) | $601.80 | $1,416 | 2.4× |
| Mri Orbt/Fac/Nck W/O &W/Dye (70543) | $601.80 | $1,416 | 1.7× |
| MRI pelvis w/o & w contrast (72197) range across 2 matching MRF lines |
$1,310.61–$1,314.10 | $3,083.78–$3,092 | varies |
| MRI pelvis w/o contrast (72195) | $852.98 | $2,007 | 3.5× |
| MRI thoracic spine w/o contrast (72146) | $765.43 | $1,801 | 3.1× |
| MRI upper extremity oth than jt w/o contr matrl (73218) | $925.65 | $2,178 | 3.8× |
| Mri Uppr Extremity W/O&W/Dye (73220) | $1,232.50 | $2,900 | 3.4× |
| MRI, abdomen, combo (74183) | $1,328.55 | $3,126 | 3.7× |
| MRI, dorsal spine combo (72157) | $1,228.68 | $2,891 | 3.4× |
| MRI, dorsal spine contrast (72147) | $583.95 | $1,374 | 1.6× |
| MRI, joint upper extrem (73221) range across 3 matching MRF lines |
$574.60–$1,308.79 | $1,352–$3,079.50 | varies |
| MRI, joint upper extrem combo (73223) | $1,178.53 | $2,773 | 3.3× |
| MRI, lumbar spine combo (72158) | $1,231.65 | $2,898 | 3.4× |
| Myocardial Spect Multiple Studies (78452) | $1,485.80 | $3,496 | 1.1× |
| N-invas est c ffr sw aly CTA (75580) | $2,187.05 | $5,146 | 2.5× |
| Neck soft tissue (70360) range across 2 matching MRF lines |
$44.63–$144.93 | $105–$341 | varies |
| Ntsty modul radthx pln dose-vol histos (77301) | $4,353.49 | $10,243.50 | 3.0× |
| Ophthalmic ultrasound dx b-scan w/wo a-scan (76512) range across 2 matching MRF lines |
$209.95–$314.93 | $494–$741 | varies |
| Parathyroid Planar Imaging (78070) | $529.98 | $1,247 | 1.3× |
| Pelvis 1 or 2 views (72170) range across 4 matching MRF lines |
$38.25–$153.85 | $90–$362 | varies |
| PET image w/CT, full body (78816) | $2,111.40 | $4,968 | 1.4× |
| PET imaging CT attenuation skull base mid-thigh (78815) range across 3 matching MRF lines |
$1,919.30–$2,648.60 | $4,516–$6,232 | varies |
| Radex abscess/fistula/sinus tract rs&i (76080) | $608.60 | $1,432 | 1.1× |
| Radex Ankle Complete Minimum 3 Views (73610) range across 6 matching MRF lines |
$55.68–$231.42 | $131–$544.50 | varies |
| Radex Calcaneus Minimum 2 Views (73650) range across 5 matching MRF lines |
$40.80–$227.59 | $96–$535.50 | varies |
| Radex elbow complete minimum 3 views (73080) range across 2 matching MRF lines |
$155.13–$232.69 | $365–$547.50 | varies |
| Radex Facial Bones Complete Minimum 3 Views (70150) range across 2 matching MRF lines |
$67.15–$146.63 | $158–$345 | varies |
| Radex fingr minimum 2 views (73140) range across 3 matching MRF lines |
$60.78–$153.85 | $143–$362 | varies |
| Radex foot complete minimum 3 views (73630) range across 7 matching MRF lines |
$50.99–$233.97 | $119.97–$550.50 | varies |
| Radex Hand Minimum 3 Views (73130) range across 6 matching MRF lines |
$55.68–$227.59 | $131–$535.50 | varies |
| Radex lower extremity infant minimum 2 views (73592) | $151.73 | $357 | 1.7× |
| Radex Nasal Bones Complete Minimum 3 Views (70160) | $119.43 | $281 | 1.3× |
| Radex Ribs Unilateral 2 Views (71100) range across 2 matching MRF lines |
$51–$117.73 | $120–$277 | varies |
| Radex shoulder complete minimum 2 views (73030) range across 7 matching MRF lines |
$49.72–$236.52 | $116.98–$556.50 | varies |
| Radex Sinuses Paransl < 3 Views (70210) range across 2 matching MRF lines |
$46.75–$105.40 | $110–$248 | varies |
| Radex Spine 1 View Specify Level (72020) | $164.48 | $387 | 1.8× |
| Radex Sternum Minimum 2 Views (71120) range across 2 matching MRF lines |
$47.18–$167.88 | $111–$395 | varies |
| Radex Temporomandble Jt Opn & Clsd Mouth Bilat (70330) | $135.58 | $319 | 1.5× |
| Radex Toe Minimum 2 Views (73660) range across 2 matching MRF lines |
$44.63–$152.15 | $105–$358 | varies |
| Radex upper extremity infant minimum 2 views (73092) | $150.88 | $355 | 1.4× |
| Radex Wrist Complete Minimum 3 Views (73110) range across 4 matching MRF lines |
$63.33–$232.05 | $149–$546 | varies |
| Radiation Delivery Stereotactic Cranial Linear (77372) | $8,986.63 | $21,145 | 1.2× |
| Radiation treatment delivery level 3 (77412) | $405.45 | $954 | 0.7× |
| Radiolog exam mandible compl minimum 4 views (70110) | $210.38 | $495 | 1.9× |
| Radiologic exam colon double contrast study (74280) | $361.68 | $851 | 2.0× |
| Radiologic exam colon single contrast study (74270) | $340 | $800 | 1.9× |
| Radiologic Exam Esophagus Double Contrast Study (74221) | $319.18 | $751 | 1.8× |
| Radiologic exam knee complete 4/more views (73564) range across 5 matching MRF lines |
$68.85–$307.28 | $162–$723 | varies |
| Radiologic exam pelvis compl minimum 3 views (72190) | $298.78 | $703 | 2.8× |
| Radiologic exam swallow function contrast study (74230) range across 2 matching MRF lines |
$311.22–$314.93 | $732.28–$741 | varies |
| Radiologic exam upr gi trc double contrast study (74246) | $319.18 | $751 | 1.8× |
| Radiologic examination femur minimum 2 views (73552) range across 3 matching MRF lines |
$52.28–$175.32 | $123–$412.50 | varies |
| Radiologic examination knee 1/2 views (73560) range across 8 matching MRF lines |
$51–$243.59 | $120–$573.14 | varies |
| Radiologic Examination Osseous Survey Limited (77074) | $320.88 | $755 | 3.0× |
| Radiologic examination tibia & fibula 2 views (73590) range across 3 matching MRF lines |
$46.75–$226.95 | $110–$534 | varies |
| Ribs bilateral 3 views (71110) range across 2 matching MRF lines |
$58.65–$146.63 | $138–$345 | varies |
| Rp Loclzj Tum Spect 1 Area Single Day Imaging (78803) | $1,638.80 | $3,856 | 2.9× |
| Rp loclzj tum spect 2 area/sep acquisj img (78831) | $1,638.80 | $3,856 | 1.2× |
| Scapula (73010) | $146.63 | $345 | 1.4× |
| Screening Digital Breast Tomosynthesis Bi (77063) range across 3 matching MRF lines |
$45.48–$46.75 | $107–$110 | varies |
| Shoulder 1 view (73020) range across 2 matching MRF lines |
$28.05–$105.83 | $66–$249 | varies |
| Skull less than 4 views (70250) | $146.63 | $345 | 1.4× |
| Special teletherapy port plan (77321) | $732.28 | $1,723 | 1.9× |
| Special treatment procedure (77470) | $938.40 | $2,208 | 1.6× |
| Stereotactic Body Radiation Delivery (77373) | $3,298.43 | $7,761 | 1.8× |
| Sternoclavicular joints (71130) | $152.15 | $358 | 1.7× |
| Ther Rad Simulaj-Aided Field Setting Complex (77290) | $1,113.89 | $2,620.90 | 2.9× |
| Ther rad simulaj-aided field setting simple (77280) | $1,021.70 | $2,404 | 7.4× |
| Therapeutic Enema Rdctj Intussusception/Obstrcj (74283) | $331.93 | $781 | 1.8× |
| Thoracic spine 2 views (72070) range across 3 matching MRF lines |
$45.41–$160.23 | $106.83–$377 | varies |
| Thoracic spine 3 views (72072) range across 3 matching MRF lines |
$55.68–$193.38 | $131–$455 | varies |
| Thoracolumbar 2 views (72080) | $115.18 | $271 | 1.3× |
| Thyroid Uptake W/Blood Flow Sngle/Mult Quan Meas (78014) | $499.38 | $1,175 | 1.2× |
| Tx Devices Design & Construction Complex (77334) range across 2 matching MRF lines |
$475.73–$476 | $1,119.36–$1,120 | varies |
| Ultrasound Breast Limited (76642) range across 2 matching MRF lines |
$209.95–$314.93 | $494–$741 | varies |
| Ultrasound Elastography Parenchyma (76981) | $171.70 | $404 | 1.6× |
| Ultrasound Exam Aaa Screen (76706) | $170.85 | $402 | 1.6× |
| Ultrasound, abdomen limited (76705) range across 5 matching MRF lines |
$214.42–$230.78 | $504.50–$543 | varies |
| Umbilical-artery Doppler (OB) (76820) | $226.53 | $533 | 2.1× |
| Upper gi w/o kub (74240) | $320.45 | $754 | 1.8× |
| Urethrocystography retrograde (74450) | $472.18 | $1,111 | 1.9× |
| Us breast unilateral complete (76641) range across 2 matching MRF lines |
$154.28–$231.42 | $363–$544.50 | varies |
| Us chest (76604) range across 4 matching MRF lines |
$184.45–$189.13 | $434–$445 | varies |
| Us exam, pelvic, limited (76857) | $240.98 | $567 | 2.2× |
| Us kidney transplant (76776) | $236.73 | $557 | 2.2× |
| Us lmtd joint/oth nonvasc xtr strux r-t w/img (76882) range across 4 matching MRF lines |
$223.77–$401.63 | $526.50–$945 | varies |
| Us ob detailed single fetus (76811) | $375.70 | $884 | 1.5× |
| Us ob limited 1 or more fetuses (76815) range across 2 matching MRF lines |
$97.24–$271.58 | $228.78–$639 | varies |
| Us ob transvaginal (76817) range across 2 matching MRF lines |
$110.93–$244.80 | $261–$576 | varies |
| Us pelvic non ob complete (76856) | $250.75 | $590 | 2.3× |
| Us pg uter img f&mat 14 wk tabdl 1/1st gestation (76801) range across 2 matching MRF lines |
$136.95–$282.20 | $322.22–$664 | varies |
| Us preg uterus real time f/u trnsabdl per fetus (76816) | $415.65 | $978 | 3.9× |
| Us retroperitoneal complete (76770) range across 3 matching MRF lines |
$233.75–$243.79 | $550–$573.62 | varies |
| Us retroperitoneal limited (76775) range across 3 matching MRF lines |
$223.98–$246.94 | $527–$581.03 | varies |
| Us scrotum and contents (76870) | $263.08 | $619 | 2.4× |
| Us spinal canal and contents (76800) | $189.13 | $445 | 1.8× |
| Us thyroid (76536) | $275.40 | $648 | 2.6× |
| Us transrectal (76872) | $257.55 | $606 | 2.4× |
| Wrist 2 views (73100) range across 6 matching MRF lines |
$50.58–$229.50 | $119–$540 | varies |
| X-Ray Ac Jts - Xr Acromioclavicular Joints Bilateral (73050) | $186.15 | $438 | 2.1× |
| X-Ray Bend Only L-S Spine (72120) range across 2 matching MRF lines |
$59.50–$146.63 | $140–$345 | varies |
| X-Ray Elbow 2 Vw - Xr Elbow 1-2 Views Right (73070) range across 5 matching MRF lines |
$41.31–$233.33 | $97.19–$549 | varies |
| X-Ray Exam Breast Specimen (76098) range across 2 matching MRF lines |
$81.60–$608.60 | $192–$1,432 | varies |
| X-Ray Exam Entire Spi 1 Vw (72081) | $115.18 | $271 | 1.3× |
| X-Ray Exam Entire Spi 2/3 Vw (72082) | $162.78 | $383 | 1.5× |
| X-Ray Exam Hip Uni 1 View (73501) | $101.15 | $238 | 1.1× |
| X-Ray Exam Hip Uni 2-3 Views (73502) range across 6 matching MRF lines |
$70.07–$160.65 | $164.87–$378 | varies |
| X-Ray Exam Hips Bi 2 Views (73521) | $155.98 | $367 | 1.4× |
| X-Ray Exam Hips Bi 3-4 Views (73522) range across 3 matching MRF lines |
$76.93–$174.25 | $181–$410 | varies |
| X-Ray Exam L-S Spine Bending (72114) | $158.53 | $373 | 1.5× |
| X-Ray Exam Neck Spine 2-3 Vw (72040) range across 4 matching MRF lines |
$56.53–$159.80 | $133–$376 | varies |
| X-Ray Exam Neck Spine 6/>Vws (72052) range across 2 matching MRF lines |
$93.08–$153.43 | $219–$361 | varies |
| X-Ray Exam Unilat Ribs/Chest (71101) range across 2 matching MRF lines |
$57.38–$195.50 | $135–$460 | varies |
| X-ray eye for foreign body (70030) | $129.20 | $304 | 1.4× |
| X-ray humerus (73060) range across 4 matching MRF lines |
$47.18–$195.08 | $111–$459 | varies |
| X-Ray Jaw <4 Vw - Xr Mandible < 4 Views (70100) | $152.15 | $358 | 1.7× |
| X-Ray Lumbar Spine 2/3 Vw - Xr Lumbar Spine 2-3 Views (72100) range across 5 matching MRF lines |
$56.95–$164.90 | $134–$388 | varies |
| X-ray nose-rectum child f.b. (76010) | $130.05 | $306 | 1.4× |
| X-Ray Ribs, Chest 4+ Vw - Xr Ribs 3 Vws Bil W/ Chest Posteroanterior (71111) | $243.95 | $574 | 2.3× |
| X-Ray Sacroiliac Jts 3+ Vw - Xr Sacroiliac Joints 3+ Views (72202) range across 2 matching MRF lines |
$55.68–$142.38 | $131–$335 | varies |
| X-Ray Sacroiliac Jts <3 Vw - Xr Sacroiliac Joints 1-2 Views (72200) range across 2 matching MRF lines |
$48.45–$227.38 | $114–$535 | varies |
| X-Ray Sacrum/Coccyx 2+ Vw - Xr Sacrum Coccyx 2+ Views (72220) range across 2 matching MRF lines |
$47.18–$103.70 | $111–$244 | varies |
| X-Ray Sinuses 3+ Vw - Xr Paranasal Sinuses 3+ Views (70220) | $164.90 | $388 | 1.8× |
| X-Ray Skull 4+ Vw - Xr Skull Complete 4+ Views (70260) | $269.88 | $635 | 2.5× |
| X-Ray Stress View (77071) | $133.03 | $313 | 1.5× |
| X-ray thoracic spine 4 vw (72074) | $148.75 | $350 | 1.4× |
| X-Ray Urinary Tract Exam With Contrast Material (74420) | $473.03 | $1,113 | 1.3× |
| X-Rays Bone Length Studies (77073) | $189.13 | $445 | 1.8× |
| X-Rays Bone Survey Complete (77075) | $255 | $600 | 2.4× |
| Xr c-spine 4 or 5 views (72050) range across 3 matching MRF lines |
$77.78–$212.93 | $183–$501 | varies |
| Xr facial bones less than 3 views (70140) range across 2 matching MRF lines |
$46.33–$149.18 | $109–$351 | varies |
| Xr orbits complete 4 views (70200) | $145.78 | $343 | 1.4× |
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.