Imaging prices at Grand Lake Health System
Saint Marys, OH · every code in this section with a posted price and a Medicare benchmark.
271 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) | $335.70 | $373 | 3.9× |
| Abdomen 2 views (74019) | $371.70 | $413 | 3.6× |
| Acute Gastrointestinal Blood Loss Imaging (78278) | $1,921.50 | $2,135 | 4.8× |
| Ankle 2 views (73600) | $317.70 | $353 | 3.7× |
| Arthrogram ankle (73615) | $882 | $980 | 2.5× |
| Arthrogram hip (73525) | $833.40 | $926 | 2.4× |
| Arthrogram Wrist (73115) | $760.50 | $845 | 2.2× |
| Bone age studies (77072) | $290.70 | $323 | 2.8× |
| Bone Imaging 3 Phase (78315) | $1,957.50 | $2,175 | 4.9× |
| Bone Imaging Limited Area (78300) | $1,062.90 | $1,181 | 2.7× |
| Bone Imaging Whole Body (78306) | $1,738.80 | $1,932 | 4.4× |
| Bone survey infant (77076) | $607.50 | $675 | 5.9× |
| Card Bl Pool Gated Spect Rest Wal Motn Ejct Frct (78494) | $3,684.60 | $4,094 | 9.3× |
| Cat Scan Follow-Up Study (76380) | $1,269.90 | $1,411 | 14.7× |
| Cerebrospinal Fluid Scan (78630) | $2,033.10 | $2,259 | 3.8× |
| Chest 1 view (71045) range across 2 matching MRF lines |
$339.30–$369.90 | $377–$411 | varies |
| Chest 2 views (71046) range across 5 matching MRF lines |
$350.10–$491.40 | $389–$546 | varies |
| Chest 3 views (71047) | $493.20 | $548 | 5.7× |
| Chest 4 or more views (71048) | $502.20 | $558 | 4.8× |
| Cholecystography Oral Contrast (74290) | $459 | $510 | 2.6× |
| Clavicle complete (73000) | $274.50 | $305 | 3.2× |
| Computed Tomography Thorax Lw Dose Lng Ca Scr C- (71271) | $397.80 | $442 | 3.8× |
| Contrast X-Ray Bladder (74430) | $662.40 | $736 | 1.9× |
| Contrast X-Ray Of Elbow (73085) | $833.40 | $926 | 2.4× |
| Contrast X-Ray Of Knee Joint (73580) | $1,221.30 | $1,357 | 3.5× |
| CT abdomen and pelvis without and with contrast (74178) | $4,146.30 | $4,607 | 12.0× |
| CT abdomen and pelvis without contrast (74176) | $3,282.30 | $3,647 | 13.9× |
| CT abdomen w contrast (74160) | $2,202.30 | $2,447 | 12.7× |
| CT abdomen w wo contrast (74170) | $2,994.30 | $3,327 | 17.2× |
| CT abdomen w/o contrast (74150) | $2,186.10 | $2,429 | 21.1× |
| CT Angio Abdomen and Pelvis (74174) | $4,364.10 | $4,849 | 12.6× |
| CT Angio Chest (71275) | $3,093.30 | $3,437 | 17.8× |
| CT Angio Head (70496) | $2,544.30 | $2,827 | 14.6× |
| Ct Angio Lwr Extr W/O&W/Dye (73706) range across 2 matching MRF lines |
$3,195.90–$3,356.10 | $3,551–$3,729 | varies |
| CT Angio Neck (70498) | $3,249 | $3,610 | 18.7× |
| Ct Angio Upr Extrm W/O&W/Dye (73206) range across 2 matching MRF lines |
$3,195.90–$3,356.10 | $3,551–$3,729 | varies |
| CT cervical spine w/ contrast (72126) | $2,223 | $2,470 | 6.4× |
| CT cervical spine w/o contrast (72125) | $2,205.90 | $2,451 | 21.3× |
| CT cervical spine w/wo cont (72127) | $2,880.90 | $3,201 | 16.6× |
| CT chest w contrast (71260) | $2,389.50 | $2,655 | 13.7× |
| CT chest w/wo contrast (71270) | $2,562.30 | $2,847 | 14.7× |
| CT head/brain with contrast (70460) | $1,756.80 | $1,952 | 10.1× |
| CT head/brain without and with contrast (70470) | $2,244.60 | $2,494 | 12.9× |
| CT iac w contrast (70481) | $1,883.70 | $2,093 | 10.8× |
| CT l-spine w&w/o contrast (72133) | $2,892.60 | $3,214 | 16.6× |
| CT lower ext w/o (73700) | $1,847.70 | $2,053 | 17.8× |
| CT lower extremity w/contrast material (73701) | $1,873.80 | $2,082 | 10.8× |
| CT lumbar spine w contrast (72132) | $2,435.40 | $2,706 | 7.0× |
| CT lumbar spine w/o contrast (72131) | $2,420.10 | $2,689 | 23.3× |
| CT maxillofacial w contrast (70487) | $2,007 | $2,230 | 11.5× |
| CT maxillofacial wo contrast (70486) range across 3 matching MRF lines |
$993.60–$1,990.80 | $1,104–$2,212 | varies |
| CT neck tissue combo (70492) | $2,469.60 | $2,744 | 14.2× |
| Ct Orbit/Ear/Fossa W/O&W/Dye (70482) | $2,530.80 | $2,812 | 14.6× |
| CT orbits w/o contrast (70480) | $1,865.70 | $2,073 | 18.0× |
| CT pelvis w&w/o contrast (72194) | $2,809.80 | $3,122 | 16.2× |
| CT pelvis w/o contrast (72192) | $2,186.10 | $2,429 | 21.1× |
| CT scan of leg combo (73702) | $2,524.50 | $2,805 | 14.5× |
| CT scans face/jaw combo (70488) | $2,707.20 | $3,008 | 15.6× |
| CT soft tissue neck w contrast (70491) | $2,042.10 | $2,269 | 11.7× |
| CT soft tissue neck w/o contrast (70490) | $1,976.40 | $2,196 | 19.1× |
| CT thoracic spine w contrast (72129) | $2,421.90 | $2,691 | 13.9× |
| CT thoracic spine w/o contrast (72128) | $2,406.60 | $2,674 | 23.2× |
| CT thoracic spine w/wo cont (72130) | $3,107.70 | $3,453 | 17.9× |
| CT thorax w/o contrast (71250) | $2,375.10 | $2,639 | 22.9× |
| CT upper ext wo (73200) | $1,847.70 | $2,053 | 17.8× |
| CT upper extremity w/o & w/contrast material (73202) | $2,524.50 | $2,805 | 14.5× |
| CT upper extremity with contrast (73201) | $1,873.80 | $2,082 | 5.4× |
| Cta Abdl Aorta&Bi Iliofem W/Contrast&Postp (75635) | $4,383.90 | $4,871 | 25.2× |
| Cta Abdomen (74175) | $3,492.90 | $3,881 | 20.1× |
| CTA head&neck c+ w/noncontrast img&post-pxessing (70471) | $5,793.30 | $6,437 | 16.7× |
| CTA pelvis (72191) | $3,492.90 | $3,881 | 20.1× |
| Dxa Bone Density Axial (77080) | $738 | $820 | 7.1× |
| Dxa bone density study 1/>sites appendiclr skel (77081) | $315.90 | $351 | 3.7× |
| Echo Guide For Artery Repair (76936) | $1,022.40 | $1,136 | 4.8× |
| Esophagram (74220) | $667.80 | $742 | 3.8× |
| Fetal Biophysical Profile W/O Non-Stress Testing (76819) | $959.40 | $1,066 | 9.3× |
| Fluoroscopy up to 1 hr (76000) | $691.20 | $768 | 2.9× |
| Foot 2 views (73620) | $317.70 | $353 | 3.7× |
| Forearm 2 views (73090) | $347.40 | $386 | 4.0× |
| Gastric emptying imaging study (78264) | $1,544.40 | $1,716 | 3.9× |
| Hand 2 views (73120) | $317.70 | $353 | 3.1× |
| Hepatc Vngrph Wdg/Fr W/O Hemodyn Eval Rs&I (75891) | $5,535 | $6,150 | 1.8× |
| Hepatobil Syst Image W/Drug (78227) | $2,214.90 | $2,461 | 4.1× |
| Hepatobiliary System Imaging (78226) | $1,638.90 | $1,821 | 4.1× |
| Ht Muscle Image Spect Sing (78451) | $3,753.90 | $4,171 | 2.9× |
| Hysterosalpingogram (74740) | $828 | $920 | 3.5× |
| Infant hip ultrasound with hip movement (dynamic) (76885) | $838.80 | $932 | 9.7× |
| K Flow/Funct Image Multiple (78709) | $2,299.50 | $2,555 | 4.3× |
| K Flow/Funct Image W/O Drug (78707) | $1,856.70 | $2,063 | 3.4× |
| Knee 3 Views (73562) | $361.80 | $402 | 4.2× |
| Liver & Spleen Imaging Static Only (78215) | $1,098 | $1,220 | 2.8× |
| Lung perfusion differential (78597) | $1,391.40 | $1,546 | 3.5× |
| Lung Ventilat&Perfus Imaging (78582) | $2,277.90 | $2,531 | 4.2× |
| Lung Ventilation Imaging (78579) | $1,062.90 | $1,181 | 2.7× |
| Magnetic Image Jaw Joint (70336) | $3,036.60 | $3,374 | 12.8× |
| Mammary ductogram or galactogram single (77053) | $1,314.90 | $1,461 | 5.6× |
| Meckels Divert Exam (78290) | $1,245.60 | $1,384 | 3.1× |
| Mr safety implant&/fb assmt clin staf 1st 15 min (76014) | $47.70 | $53 | 1.7× |
| Mra Head W/O & W/Contrast Material (70546) | $3,737.70 | $4,153 | 10.8× |
| MRA head w/o contrast (70544) | $2,622.60 | $2,914 | 11.1× |
| MRA head with contrast (70545) | $3,272.40 | $3,636 | 9.5× |
| MRA neck w contrast (70548) | $2,934 | $3,260 | 8.5× |
| Mra Neck W/O &W/Contrast Material (70549) | $3,393.90 | $3,771 | 9.8× |
| MRA neck w/o contrast (70547) | $2,483.10 | $2,759 | 10.5× |
| MRI abdomen w contrast (74182) | $3,162.60 | $3,514 | 9.1× |
| MRI abdomen w/o contrast (74181) | $3,141.90 | $3,491 | 13.3× |
| MRI any jt lower extrem w/contrast material (73722) | $2,952 | $3,280 | 3.8× |
| MRI any jt lower extrem w/o & w/contrast matrl (73723) | $3,434.40 | $3,816 | 9.9× |
| MRI any jt upper extremity w/contrast matrl (73222) | $2,952 | $3,280 | 3.8× |
| MRI bone marrow blood supply (77084) | $3,141.90 | $3,491 | 13.3× |
| MRI Breast W/O Contrast Bilateral (77047) | $3,159.90 | $3,511 | 13.4× |
| MRI Breast Without Contrast Material Unilateral (77046) | $2,109.60 | $2,344 | 8.9× |
| MRI cervical spine w contrast (72142) | $3,367.80 | $3,742 | 9.7× |
| MRI cervical spine w/o cont (72141) | $3,191.40 | $3,546 | 13.5× |
| MRI chest w/o contrast (71550) | $3,021.30 | $3,357 | 12.8× |
| MRI chest with contrast (71551) | $3,048.30 | $3,387 | 3.9× |
| MRI chest wo w contrast (71552) | $3,528.90 | $3,921 | 10.2× |
| MRI lower extrem oth/thn jt w/contrast matrl (73719) | $2,952 | $3,280 | 8.5× |
| MRI lower extrem oth/thn jt w/o & w/contr matr (73720) | $3,434.40 | $3,816 | 9.9× |
| MRI lower extrem oth/thn jt w/o contr matrl (73718) | $2,931.30 | $3,257 | 12.4× |
| MRI lumbar spine w contrast (72149) | $3,455.10 | $3,839 | 10.0× |
| Mri Neck Spine W/O & W/Dye (72156) | $4,128.30 | $4,587 | 11.9× |
| MRI orbit face &/neck w/o contrast (70540) | $3,021.30 | $3,357 | 12.8× |
| MRI orbit face neck w contrast (70542) | $3,048.30 | $3,387 | 8.8× |
| Mri Orbt/Fac/Nck W/O &W/Dye (70543) range across 2 matching MRF lines |
$3,788.10–$3,977.10 | $4,209–$4,419 | varies |
| MRI pelvis w contrast (72196) | $3,162.60 | $3,514 | 9.1× |
| MRI pelvis w/o & w contrast (72197) | $3,630.60 | $4,034 | 10.5× |
| MRI pelvis w/o contrast (72195) | $2,992.50 | $3,325 | 12.7× |
| MRI thoracic spine w/o contrast (72146) | $3,191.40 | $3,546 | 13.5× |
| MRI upper extremity oth than jt w/contr matrl (73219) | $2,952 | $3,280 | 8.5× |
| MRI upper extremity oth than jt w/o contr matrl (73218) | $2,931.30 | $3,257 | 12.4× |
| Mri Uppr Extremity W/O&W/Dye (73220) | $3,434.40 | $3,816 | 9.9× |
| MRI, abdomen, combo (74183) | $3,630.60 | $4,034 | 10.5× |
| MRI, dorsal spine combo (72157) | $4,128.30 | $4,587 | 11.9× |
| MRI, dorsal spine contrast (72147) | $3,389.40 | $3,766 | 9.8× |
| MRI, joint upper extrem (73221) range across 6 matching MRF lines |
$2,791.80–$2,931.30 | $3,102–$3,257 | varies |
| MRI, joint upper extrem combo (73223) | $3,434.40 | $3,816 | 9.9× |
| MRI, lumbar spine combo (72158) | $4,128.30 | $4,587 | 11.9× |
| Myocardial Imaging Infarct Avid Planar Qual/Quan (78466) | $1,134 | $1,260 | 2.9× |
| Myocardial Spect Multiple Studies (78452) range across 2 matching MRF lines |
$4,482–$4,655.70 | $4,980–$5,173 | varies |
| Neck soft tissue (70360) | $291.60 | $324 | 3.4× |
| Ophthalmic Ultrasonic Foreign Body Localization (76529) range across 2 matching MRF lines |
$59.40–$126.90 | $66–$141 | varies |
| Ophthalmic ultrasound dx b-scan w/wo a-scan (76512) range across 2 matching MRF lines |
$83.70–$187.20 | $93–$208 | varies |
| Parathyroid planar imaging w/wo subtraction (78071) | $926.10 | $1,029 | 2.3× |
| Pelvis 1 or 2 views (72170) | $347.40 | $386 | 3.4× |
| Pet Image W/Ct Lmtd (78814) | $7,322.40 | $8,136 | 5.2× |
| PET image w/CT, full body (78816) | $7,322.40 | $8,136 | 5.2× |
| PET imaging CT attenuation skull base mid-thigh (78815) | $7,322.40 | $8,136 | 5.2× |
| Pulmonary Perfusion Imaging Particulate (78580) | $1,370.70 | $1,523 | 3.5× |
| Radex Abd Compl Aqt Abd W/S/E/D Views 1 View Ch (74022) | $649.80 | $722 | 6.3× |
| Radex abscess/fistula/sinus tract rs&i (76080) | $585.90 | $651 | 1.1× |
| Radex Ankle Complete Minimum 3 Views (73610) range across 4 matching MRF lines |
$347.40–$415.80 | $386–$462 | varies |
| Radex Calcaneus Minimum 2 Views (73650) | $317.70 | $353 | 3.7× |
| Radex elbow complete minimum 3 views (73080) | $375.30 | $417 | 4.3× |
| Radex Facial Bones Complete Minimum 3 Views (70150) | $377.10 | $419 | 3.6× |
| Radex fingr minimum 2 views (73140) | $286.20 | $318 | 3.3× |
| Radex foot complete minimum 3 views (73630) | $347.40 | $386 | 4.0× |
| Radex Hand Minimum 3 Views (73130) | $347.40 | $386 | 4.0× |
| Radex lower extremity infant minimum 2 views (73592) | $282.60 | $314 | 3.3× |
| Radex Mastoids Compl Minimum 3 Views PR Side (70130) | $450 | $500 | 4.3× |
| Radex Nasal Bones Complete Minimum 3 Views (70160) | $291.60 | $324 | 3.4× |
| Radex Ribs Unilateral 2 Views (71100) | $522 | $580 | 6.1× |
| Radex shoulder complete minimum 2 views (73030) | $450.90 | $501 | 5.2× |
| Radex Sinuses Paransl < 3 Views (70210) | $333.90 | $371 | 3.9× |
| Radex sm int w/mlt srl imges via enteroclss tube (74251) | $649.80 | $722 | 3.7× |
| Radex Spine 1 View Specify Level (72020) | $241.20 | $268 | 2.8× |
| Radex Sternum Minimum 2 Views (71120) | $360.90 | $401 | 4.2× |
| Radex Temporomandble Jt Opn & Clsd Mouth Bilat (70330) | $415.80 | $462 | 4.8× |
| Radex Toe Minimum 2 Views (73660) | $286.20 | $318 | 3.3× |
| Radex upper extremity infant minimum 2 views (73092) | $303.30 | $337 | 2.9× |
| Radex Wrist Complete Minimum 3 Views (73110) | $347.40 | $386 | 4.0× |
| Radiolog exam mandible compl minimum 4 views (70110) | $361.80 | $402 | 3.5× |
| Radiologic Exam Abdomen 3+ Views - Xr Abdomen 3+ Views (74021) | $439.20 | $488 | 4.2× |
| Radiologic exam colon double contrast study (74280) | $1,421.10 | $1,579 | 8.2× |
| Radiologic exam colon single contrast study (74270) | $946.80 | $1,052 | 5.4× |
| Radiologic exam knee complete 4/more views (73564) | $409.50 | $455 | 4.0× |
| Radiologic exam pelvis compl minimum 3 views (72190) | $423.90 | $471 | 4.1× |
| Radiologic Exam Small Int Single Contrast Study (74250) | $702 | $780 | 4.0× |
| Radiologic exam swallow function contrast study (74230) | $828 | $920 | 4.8× |
| Radiologic exam upr gi trc double contrast study (74246) | $1,177.20 | $1,308 | 6.8× |
| Radiologic examination femur 1 view (73551) | $315 | $350 | 3.7× |
| Radiologic examination femur minimum 2 views (73552) | $372.60 | $414 | 4.3× |
| Radiologic examination knee 1/2 views (73560) range across 6 matching MRF lines |
$320.40–$361.80 | $356–$402 | varies |
| Radiologic Examination Osseous Survey Limited (77074) | $630.90 | $701 | 6.1× |
| Radiologic Examination Salivary Gland Calculus (70380) | $324 | $360 | 3.8× |
| Radiologic examination tibia & fibula 2 views (73590) | $347.40 | $386 | 4.0× |
| Renal Cyst Study (74470) | $1,873.80 | $2,082 | 3.5× |
| Ribs bilateral 3 views (71110) | $592.20 | $658 | 5.7× |
| Rp loclzj tum plnr 1 area single day imaging (78800) | $2,029.50 | $2,255 | 5.1× |
| Rp loclzj tum plnr 2+area 1+d img/1 area img>2+d (78801) | $1,786.50 | $1,985 | 4.5× |
| Rp Loclzj Tum Plnr Whole Body 2+ Days Imaging (78804) | $3,236.40 | $3,596 | 6.0× |
| Rp Loclzj Tum Plnr Whole Body Single Day Imaging (78802) | $2,029.50 | $2,255 | 3.8× |
| Rp Loclzj Tum Spect 1 Area Single Day Imaging (78803) range across 4 matching MRF lines |
$2,064.60–$3,251.70 | $2,294–$3,613 | varies |
| Salivary Gland Imaging Serial Images (78231) | $1,228.50 | $1,365 | 3.1× |
| Scapula (73010) | $291.60 | $324 | 2.8× |
| Screening Digital Breast Tomosynthesis Bi (77063) | $63.90 | $71 | 2.7× |
| Shoulder 1 view (73020) | $303.30 | $337 | 3.5× |
| Shoulder Arthrography (73040) | $903.60 | $1,004 | 2.6× |
| Sialogram (70390) | $590.40 | $656 | 2.5× |
| Skull less than 4 views (70250) | $347.40 | $386 | 3.4× |
| Sternoclavicular joints (71130) | $361.80 | $402 | 4.2× |
| Testicular Imaging W/Flow (78761) | $1,134 | $1,260 | 2.9× |
| Thoracic spine 3 views (72072) | $409.50 | $455 | 4.0× |
| Thyroid Imaging With Vascular Flow (78013) | $734.40 | $816 | 1.9× |
| Thyroid Uptake W/Blood Flow Sngle/Mult Quan Meas (78014) | $990.90 | $1,101 | 2.5× |
| Ultrasound Breast Limited (76642) | $574.20 | $638 | 6.7× |
| Ultrasound Exam Aaa Screen (76706) | $397.80 | $442 | 3.8× |
| Ultrasound, abdomen limited (76705) range across 7 matching MRF lines |
$53.10–$856.80 | $59–$952 | varies |
| Unlisted Dx Radiographic Procedure (76499) | $625.50 | $695 | 7.2× |
| Unlisted us procedure (76999) | $959.40 | $1,066 | 11.1× |
| Upper gi w/o kub (74240) | $1,147.50 | $1,275 | 6.6× |
| Ureteral Reflux Study (78740) | $1,000.80 | $1,112 | 2.5× |
| Urethrocystogram voiding (74455) | $532.80 | $592 | 2.3× |
| Urethrocystography retrograde (74450) | $745.20 | $828 | 3.2× |
| Us breast unilateral complete (76641) | $1,069.20 | $1,188 | 10.3× |
| Us chest (76604) range across 5 matching MRF lines |
$50.40–$649.80 | $56–$722 | varies |
| Us complete joint (76881) | $1,028.70 | $1,143 | 9.9× |
| Us exam, pelvic, limited (76857) range across 4 matching MRF lines |
$43.20–$600.30 | $48–$667 | varies |
| Us kidney transplant (76776) | $959.40 | $1,066 | 9.3× |
| Us lmtd joint/oth nonvasc xtr strux r-t w/img (76882) range across 6 matching MRF lines |
$32.40–$757.80 | $36–$842 | varies |
| Us ob limited 1 or more fetuses (76815) range across 6 matching MRF lines |
$59.40–$856.80 | $66–$952 | varies |
| Us ob transvaginal (76817) | $675 | $750 | 6.5× |
| Us pelvic non ob complete (76856) | $1,026 | $1,140 | 9.9× |
| Us pg uter img f&mat 14 wk tabdl 1/1st gestation (76801) | $999 | $1,110 | 9.6× |
| Us preg uterus real time f/u trnsabdl per fetus (76816) | $787.50 | $875 | 7.6× |
| Us retroperitoneal complete (76770) | $959.40 | $1,066 | 9.3× |
| Us retroperitoneal limited (76775) range across 6 matching MRF lines |
$53.10–$694.80 | $59–$772 | varies |
| Us scrotum and contents (76870) range across 3 matching MRF lines |
$47.70–$959.40 | $53–$1,066 | varies |
| Us spinal canal and contents (76800) | $811.80 | $902 | 7.8× |
| Us thyroid (76536) range across 5 matching MRF lines |
$51.30–$959.40 | $57–$1,066 | varies |
| Vein X-Ray Chest (75827) | $3,060 | $3,400 | 2.0× |
| Venography caval inferior serialography rs&i (75825) | $5,812.20 | $6,458 | 1.9× |
| Venography extremity bilateral rs&i (75822) | $2,007.90 | $2,231 | 1.3× |
| Venography extremity unilateral rs&i (75820) | $1,896.30 | $2,107 | 1.2× |
| Venography Renal Bilateral (75833) | $5,548.50 | $6,165 | 1.8× |
| Venography Renal Unilateral (75831) | $5,535 | $6,150 | 1.8× |
| Venous thrombosis imaging (78457) | $1,162.80 | $1,292 | 2.2× |
| Venous Thrombosis Imaging Venogram Bilateral (78458) | $1,622.70 | $1,803 | 4.1× |
| Wrist 2 views (73100) | $317.70 | $353 | 3.7× |
| X-Ray Ac Jts - Xr Acromioclavicular Joints Bilateral (73050) | $335.70 | $373 | 3.9× |
| X-ray antegrade pyelogram tube (74425) | $662.40 | $736 | 1.9× |
| X-Ray Bend Only L-S Spine (72120) | $347.40 | $386 | 3.4× |
| X-Ray Elbow 2 Vw - Xr Elbow 1-2 Views Right (73070) | $317.70 | $353 | 3.7× |
| X-Ray Exam Breast Specimen (76098) | $476.10 | $529 | 0.9× |
| X-Ray Exam Entire Spi 2/3 Vw (72082) | $605.70 | $673 | 5.8× |
| X-Ray Exam Hip Uni 1 View (73501) | $315 | $350 | 3.7× |
| X-Ray Exam Hip Uni 2-3 Views (73502) | $387.90 | $431 | 4.5× |
| X-Ray Exam Hips Bi 2 Views (73521) | $453.60 | $504 | 4.4× |
| X-Ray Exam Hips Bi 3-4 Views (73522) | $539.10 | $599 | 5.2× |
| X-Ray Exam L-S Spine Bending (72114) | $766.80 | $852 | 7.4× |
| X-Ray Exam Neck Spine 2-3 Vw (72040) | $320.40 | $356 | 3.7× |
| X-Ray Exam Neck Spine 6/>Vws (72052) | $774.90 | $861 | 7.5× |
| X-Ray Exam Unilat Ribs/Chest (71101) | $592.20 | $658 | 5.7× |
| X-ray humerus (73060) | $347.40 | $386 | 4.0× |
| X-ray IV pyelogram (ivp) (74400) range across 2 matching MRF lines |
$846.90–$889.20 | $941–$988 | varies |
| X-Ray Jaw <4 Vw - Xr Mandible < 4 Views (70100) | $291.60 | $324 | 3.4× |
| X-Ray Knee Bilat Standing - Xr Knees Anteroposterior Standing Bilat (73565) range across 3 matching MRF lines |
$335.70–$347.40 | $373–$386 | varies |
| X-Ray Lumbar Spine 2/3 Vw - Xr Lumbar Spine 2-3 Views (72100) | $347.40 | $386 | 3.4× |
| X-ray nose-rectum child f.b. (76010) | $333.90 | $371 | 3.9× |
| X-Ray Ribs, Chest 4+ Vw - Xr Ribs 3 Vws Bil W/ Chest Posteroanterior (71111) | $730.80 | $812 | 7.1× |
| X-Ray Sacroiliac Jts 3+ Vw - Xr Sacroiliac Joints 3+ Views (72202) | $337.50 | $375 | 3.3× |
| X-Ray Sacrum/Coccyx 2+ Vw - Xr Sacrum Coccyx 2+ Views (72220) range across 3 matching MRF lines |
$333.90–$389.70 | $371–$433 | varies |
| X-Ray Sinuses 3+ Vw - Xr Paranasal Sinuses 3+ Views (70220) | $415.80 | $462 | 4.8× |
| X-Ray Skull 4+ Vw - Xr Skull Complete 4+ Views (70260) | $465.30 | $517 | 4.5× |
| X-ray thoracic spine 4 vw (72074) | $522 | $580 | 5.0× |
| X-Ray Urinary Tract Exam With Contrast Material (74420) range across 3 matching MRF lines |
$1,057.50–$1,117.80 | $1,175–$1,242 | varies |
| X-Rays Bone Length Studies (77073) | $414.90 | $461 | 4.0× |
| X-Rays Bone Survey Complete (77075) | $792 | $880 | 7.6× |
| Xr c-spine 4 or 5 views (72050) | $564.30 | $627 | 5.4× |
| Xr facial bones less than 3 views (70140) | $333.90 | $371 | 3.9× |
| Xr orbits complete 4 views (70200) | $415.80 | $462 | 4.0× |
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.