Imaging prices at HealthAlliance-Clinton Hospital (Leominster and Clinton campuses)
Leominster, MA · every code in this section with a posted price and a Medicare benchmark.
295 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) | $369 | $369 | 3.5× |
| Abdomen 2 views (74019) | $390 | $390 | 3.1× |
| Acute Gastrointestinal Blood Loss Imaging (78278) | $1,560 | $1,560 | 3.3× |
| Angiography extremity unilateral rs&i (75710) | $8,715 | $8,715 | 2.3× |
| Ankle 2 views (73600) | $284 | $284 | 2.7× |
| Arthrogram ankle (73615) | $1,067 | $1,067 | 2.6× |
| Arthrogram hip (73525) range across 2 matching MRF lines |
$1,067–$1,174 | $1,067–$1,174 | varies |
| Arthrogram Wrist (73115) | $1,067 | $1,067 | 2.6× |
| Bone age studies (77072) | $288 | $288 | 2.3× |
| Bone Imaging 3 Phase (78315) range across 2 matching MRF lines |
$1,418–$1,560 | $1,418–$1,560 | varies |
| Bone Imaging Limited Area (78300) | $1,323 | $1,323 | 2.8× |
| Bone Imaging Multiple Areas (78305) | $1,323 | $1,323 | 2.8× |
| Bone Imaging Whole Body (78306) | $1,560 | $1,560 | 3.3× |
| Bone survey infant (77076) | $441 | $441 | 3.5× |
| Brain Flow Imaging Only (78610) | $1,595 | $1,595 | 2.5× |
| Cat Scan Follow-Up Study (76380) | $1,077 | $1,077 | 10.3× |
| Cerebrospinal Fluid Scan (78630) | $2,138 | $2,138 | 3.3× |
| Chest 1 view (71045) range across 2 matching MRF lines |
$16,365.73–$18,569.52 | $16,365.73–$18,569.52 | varies |
| Chest 2 views (71046) range across 2 matching MRF lines |
$428–$3,415 | $428–$3,415 | varies |
| Chest 3 views (71047) | $432 | $432 | 4.1× |
| Chest 4 or more views (71048) | $462 | $462 | 3.7× |
| Clavicle complete (73000) | $284 | $284 | 2.7× |
| Computed Tomography Thorax Lw Dose Lng Ca Scr C- (71271) | $447 | $447 | 3.6× |
| Contrast X-Ray Bladder (74430) | $879 | $879 | 2.1× |
| Contrast X-Ray Of Elbow (73085) | $1,067 | $1,067 | 2.6× |
| Contrast X-Ray Of Knee Joint (73580) | $1,067 | $1,067 | 2.6× |
| CT abdomen and pelvis without and with contrast (74178) | $5,021 | $5,021 | 12.0× |
| CT abdomen and pelvis without contrast (74176) | $4,692 | $4,692 | 16.4× |
| CT abdomen w contrast (74160) | $2,805 | $2,805 | 13.3× |
| CT abdomen w wo contrast (74170) | $2,843 | $2,843 | 13.5× |
| CT abdomen w/o contrast (74150) | $2,386 | $2,386 | 19.0× |
| CT Angio Abdomen and Pelvis (74174) | $6,045.56 | $6,045.56 | 14.5× |
| CT Angio Chest (71275) | $3,128.38 | $3,128.38 | 14.9× |
| CT Angio Head (70496) | $2,247 | $2,247 | 10.7× |
| CT angio hrt w/3d image (75574) | $1,573 | $1,573 | 3.8× |
| Ct Angio Lwr Extr W/O&W/Dye (73706) range across 8 matching MRF lines |
$2,191–$2,411 | $2,191–$2,411 | varies |
| CT Angio Neck (70498) | $2,091 | $2,091 | 9.9× |
| Ct Angio Upr Extrm W/O&W/Dye (73206) | $1,824 | $1,824 | 8.7× |
| CT Cere Prfuj Alys C+ W/O CT/Cta Same Anatomy (70473) | $2,091 | $2,091 | 9.9× |
| CT cervical spine w/ contrast (72126) | $2,351 | $2,351 | 5.6× |
| CT cervical spine w/o contrast (72125) | $2,351 | $2,351 | 18.8× |
| CT cervical spine w/wo cont (72127) | $2,711 | $2,711 | 12.9× |
| CT chest w contrast (71260) range across 2 matching MRF lines |
$6,013.26–$7,842.56 | $6,013.26–$7,842.56 | varies |
| CT chest w/wo contrast (71270) range across 2 matching MRF lines |
$2,611–$2,873 | $2,611–$2,873 | varies |
| CT colonography screening (74263) | $4,005 | $4,005 | 14.0× |
| CT colonogrphy dx image postprocess w/o contrast (74261) | $1,325 | $1,325 | 10.6× |
| CT head/brain with contrast (70460) | $2,763 | $2,763 | 13.1× |
| CT head/brain without and with contrast (70470) | $2,932 | $2,932 | 13.9× |
| CT heart contrast eval cardiac structure&morph (75572) | $1,207 | $1,207 | 2.9× |
| CT heart no contrast quant eval coronry calcium (75571) | $61 | $61 | 0.6× |
| CT iac w contrast (70481) | $1,973 | $1,973 | 9.4× |
| CT l-spine w&w/o contrast (72133) range across 2 matching MRF lines |
$2,549–$2,804 | $2,549–$2,804 | varies |
| CT lower ext w/o (73700) | $1,973 | $1,973 | 15.7× |
| CT lower extremity w/contrast material (73701) | $1,982 | $1,982 | 9.4× |
| CT lumbar spine w contrast (72132) | $2,658 | $2,658 | 6.4× |
| CT lumbar spine w/o contrast (72131) | $2,386 | $2,386 | 19.0× |
| CT maxillofacial w contrast (70487) | $2,055 | $2,055 | 9.8× |
| CT maxillofacial wo contrast (70486) | $1,971 | $1,971 | 15.7× |
| CT neck tissue combo (70492) | $2,264 | $2,264 | 10.8× |
| Ct Orbit/Ear/Fossa W/O&W/Dye (70482) | $2,218 | $2,218 | 10.6× |
| CT orbits w/o contrast (70480) | $1,699 | $1,699 | 13.6× |
| CT pelvis w&w/o contrast (72194) | $2,770 | $2,770 | 13.2× |
| CT pelvis w/o contrast (72192) | $2,371 | $2,371 | 18.9× |
| CT scan of leg combo (73702) | $2,254 | $2,254 | 10.7× |
| CT scans face/jaw combo (70488) | $3,135 | $3,135 | 14.9× |
| CT soft tissue neck w contrast (70491) | $2,799 | $2,799 | 13.3× |
| CT soft tissue neck w/o contrast (70490) range across 2 matching MRF lines |
$2,595–$2,854 | $2,595–$2,854 | varies |
| CT thoracic spine w contrast (72129) | $2,351 | $2,351 | 11.2× |
| CT thoracic spine w/o contrast (72128) | $2,297 | $2,297 | 18.3× |
| CT thoracic spine w/wo cont (72130) range across 2 matching MRF lines |
$2,439–$2,683 | $2,439–$2,683 | varies |
| CT thorax w/o contrast (71250) | $2,211 | $2,211 | 17.6× |
| CT upper ext wo (73200) | $1,967 | $1,967 | 15.7× |
| CT upper extremity w/o & w/contrast material (73202) range across 2 matching MRF lines |
$2,049–$2,254 | $2,049–$2,254 | varies |
| CT upper extremity with contrast (73201) | $1,976 | $1,976 | 4.7× |
| Cta Abdl Aorta&Bi Iliofem W/Contrast&Postp (75635) | $2,718 | $2,718 | 12.9× |
| Cta Abdomen (74175) range across 2 matching MRF lines |
$1,990–$2,189 | $1,990–$2,189 | varies |
| CTA head&neck c+ w/noncontrast img&post-pxessing (70471) | $2,091 | $2,091 | 5.0× |
| CTA pelvis (72191) range across 2 matching MRF lines |
$1,907–$2,098 | $1,907–$2,098 | varies |
| Dilation ureters/urethra rs&i (74485) | $4,290 | $4,290 | 1.7× |
| Diskography lumbar (72295) | $9,041 | $9,041 | 3.9× |
| Doppler Echo Fetal Puls Spectral F/U/Repeat (76828) | $537 | $537 | 4.3× |
| Doppler Echo Fetal Spectral Display Complete (76827) | $537 | $537 | 4.3× |
| Dxa Bone Density Axial (77080) | $1,085 | $1,085 | 8.7× |
| Dxa bone density study 1/>sites appendiclr skel (77081) | $462 | $462 | 4.4× |
| Echo exam of fetal heart (76825) | $1,177 | $1,177 | 1.8× |
| Echo exam uterus (76831) | $626 | $626 | 2.2× |
| Echocardiography, fetal, cardiovascular system, real time with image documentation (2D), with or without M-mode… (76826) | $1,177 | $1,177 | 4.1× |
| Esophagram (74220) | $642 | $642 | 3.1× |
| Fetal Biophys Profile W/Nst (76818) | $580 | $580 | 4.6× |
| Fetal Biophysical Profile W/O Non-Stress Testing (76819) | $460 | $460 | 3.7× |
| Fluoroscopy up to 1 hr (76000) | $632 | $632 | 2.2× |
| Foot 2 views (73620) | $353 | $353 | 3.4× |
| Forearm 2 views (73090) range across 2 matching MRF lines |
$572–$707 | $572–$707 | varies |
| Gastric emptying imaging study (78264) | $1,320 | $1,320 | 2.8× |
| Gastric Emptyng Imag Std W/Sm Bwl Transit (78265) | $1,230 | $1,230 | 2.6× |
| Gated Heart Planar Single (78472) | $2,220 | $2,220 | 4.6× |
| Gated Heart, Multiple (78473) | $1,819 | $1,819 | 3.8× |
| Gstrc Emptng Imag Std W/Sm Bwl Col Trnst Mlt Day (78266) | $1,595 | $1,595 | 2.5× |
| Hand 2 views (73120) | $365 | $365 | 2.9× |
| Hepatobil Syst Image W/Drug (78227) | $1,936 | $1,936 | 3.0× |
| Hepatobiliary System Imaging (78226) | $1,936 | $1,936 | 4.0× |
| Ht Muscle Image Spect Sing (78451) | $3,182 | $3,182 | 2.1× |
| Hysterosalpingogram (74740) | $1,043 | $1,043 | 3.6× |
| Infant hip ultrasound with hip movement (dynamic) (76885) | $488 | $488 | 4.7× |
| Infant hip ultrasound, limited static exam (76886) | $475 | $475 | 4.6× |
| Joint Survey Single View (77077) | $356 | $356 | 2.8× |
| K Flow/Funct Image Multiple (78709) | $1,622 | $1,622 | 2.5× |
| K Flow/Funct Image W/Drug (78708) | $1,622 | $1,622 | 2.5× |
| K Flow/Funct Image W/O Drug (78707) range across 2 matching MRF lines |
$1,887–$2,076 | $1,887–$2,076 | varies |
| Kidney Imaging Morphol (78700) | $2,908 | $2,908 | 6.1× |
| Knee 3 Views (73562) range across 4 matching MRF lines |
$688–$1,497 | $688–$1,497 | varies |
| Liver & Spleen Imaging Static Only (78215) | $1,237 | $1,237 | 2.6× |
| Lung Perf&Ventilat Diferentl (78598) | $2,352 | $2,352 | 3.6× |
| Lung perfusion differential (78597) | $1,456 | $1,456 | 3.0× |
| Lung Ventilat&Perfus Imaging (78582) range across 2 matching MRF lines |
$1,720–$1,892 | $1,720–$1,892 | varies |
| Lung Ventilation Imaging (78579) | $1,474 | $1,474 | 3.1× |
| Lymph System Imaging (78195) range across 3 matching MRF lines |
$24,447.67–$28,859.80 | $24,447.67–$28,859.80 | varies |
| Magnetic Resonance Elastography (76391) | $924 | $924 | 3.2× |
| Mammary ductogram or galactogram single (77053) | $1,069 | $1,069 | 3.7× |
| Meckels Divert Exam (78290) | $1,074 | $1,074 | 2.2× |
| Mr safety determination physician/other qhp (76016) | $266 | $266 | 2.6× |
| Mr safety implant&/fb assmt clin staf 1st 15 min (76014) | $300 | $300 | 8.7× |
| Mr safety implt electronics prepj supvj phys/qhp (76018) range across 2 matching MRF lines |
$432–$1,013 | $432–$1,013 | varies |
| Mr safety implt pos&/immoblj (76019) | $249 | $249 | 3.5× |
| Mra Head W/O & W/Contrast Material (70546) | $5,424 | $5,424 | 13.0× |
| MRA head w/o contrast (70544) | $2,754 | $2,754 | 9.6× |
| Mra Neck W/O &W/Contrast Material (70549) | $5,424 | $5,424 | 13.0× |
| MRA neck w/o contrast (70547) | $2,754 | $2,754 | 9.6× |
| MRI abdomen w/o contrast (74181) | $3,400 | $3,400 | 11.9× |
| MRI any jt lower extrem w/o & w/contrast matrl (73723) | $6,051 | $6,051 | 14.5× |
| MRI Breast W/O Contrast Bilateral (77047) | $4,494 | $4,494 | 15.7× |
| MRI cervical spine w/o cont (72141) | $3,774 | $3,774 | 13.2× |
| MRI chest w/o contrast (71550) | $3,400 | $3,400 | 11.9× |
| MRI lower extrem oth/thn jt w/o & w/contr matr (73720) | $3,400 | $3,400 | 8.1× |
| MRI lower extrem oth/thn jt w/o contr matrl (73718) | $2,724 | $2,724 | 9.5× |
| Mri Neck Spine W/O & W/Dye (72156) | $4,079 | $4,079 | 9.8× |
| MRI orbit face &/neck w/o contrast (70540) | $3,400 | $3,400 | 11.9× |
| Mri Orbt/Fac/Nck W/O &W/Dye (70543) | $3,400 | $3,400 | 8.1× |
| MRI pelvis w/o & w contrast (72197) | $6,094 | $6,094 | 14.6× |
| MRI pelvis w/o contrast (72195) | $2,732 | $2,732 | 9.6× |
| MRI thoracic spine w/o contrast (72146) | $3,774 | $3,774 | 13.2× |
| MRI upper extremity oth than jt w/o contr matrl (73218) | $2,724 | $2,724 | 9.5× |
| Mri Uppr Extremity W/O&W/Dye (73220) | $3,400 | $3,400 | 8.1× |
| MRI, abdomen, combo (74183) | $4,506 | $4,506 | 10.8× |
| MRI, dorsal spine combo (72157) | $4,079 | $4,079 | 9.8× |
| MRI, dorsal spine contrast (72147) | $3,608 | $3,608 | 8.6× |
| MRI, joint upper extrem (73221) | $3,400 | $3,400 | 11.9× |
| MRI, joint upper extrem combo (73223) | $6,051 | $6,051 | 14.5× |
| MRI, lumbar spine combo (72158) | $4,079 | $4,079 | 9.8× |
| Musculoskeletal Nuclear Exam (78399) | $1,355 | $1,355 | 2.8× |
| Myocardial Spect Multiple Studies (78452) | $4,222 | $4,222 | 2.7× |
| N-invas est c ffr sw aly CTA (75580) | $3,021 | $3,021 | 2.9× |
| Neck soft tissue (70360) | $292 | $292 | 2.8× |
| Nuclear Rx Oral Admin (79005) | $1,391 | $1,391 | 5.0× |
| Ob us nuchal meas 1 gest (76813) | $477 | $477 | 3.8× |
| Ophthalmic ultrasound dx b-scan w/wo a-scan (76512) | $802 | $802 | 6.4× |
| Parathyroid imaging w/tomographic spect & CT (78072) | $1,934 | $1,934 | 3.0× |
| Parathyroid Planar Imaging (78070) | $1,096 | $1,096 | 2.3× |
| Parathyroid planar imaging w/wo subtraction (78071) | $3,232 | $3,232 | 6.7× |
| Pelvis 1 or 2 views (72170) | $426 | $426 | 3.4× |
| Pulmonary Perfusion Imaging Particulate (78580) | $1,622 | $1,622 | 3.4× |
| Quan&Charac C Atherosclerotc Plaq Asses Sev C Ds (75577) | $1,561 | $1,561 | 1.4× |
| Radex Abd Compl Aqt Abd W/S/E/D Views 1 View Ch (74022) range across 2 matching MRF lines |
$401–$441 | $401–$441 | varies |
| Radex abscess/fistula/sinus tract rs&i (76080) | $1,197 | $1,197 | 1.8× |
| Radex Ankle Complete Minimum 3 Views (73610) | $319 | $319 | 3.1× |
| Radex Calcaneus Minimum 2 Views (73650) | $423 | $423 | 4.1× |
| Radex elbow complete minimum 3 views (73080) | $288 | $288 | 2.8× |
| Radex Facial Bones Complete Minimum 3 Views (70150) | $514 | $514 | 4.1× |
| Radex fingr minimum 2 views (73140) | $284 | $284 | 2.7× |
| Radex foot complete minimum 3 views (73630) | $357 | $357 | 3.4× |
| Radex Hand Minimum 3 Views (73130) | $319 | $319 | 3.1× |
| Radex lower extremity infant minimum 2 views (73592) | $293 | $293 | 2.8× |
| Radex Mastoids Compl Minimum 3 Views PR Side (70130) | $441 | $441 | 3.5× |
| Radex Nasal Bones Complete Minimum 3 Views (70160) | $333 | $333 | 3.2× |
| Radex Ribs Unilateral 2 Views (71100) | $365 | $365 | 3.5× |
| Radex shoulder complete minimum 2 views (73030) range across 4 matching MRF lines |
$846–$1,306 | $846–$1,306 | varies |
| Radex Sinuses Paransl < 3 Views (70210) | $406 | $406 | 3.9× |
| Radex Spine 1 View Specify Level (72020) | $296 | $296 | 2.8× |
| Radex Sternum Minimum 2 Views (71120) | $284 | $284 | 2.7× |
| Radex Temporomandble Jt Opn & Clsd Mouth Bilat (70330) | $403 | $403 | 3.9× |
| Radex Toe Minimum 2 Views (73660) | $284 | $284 | 2.7× |
| Radex upper extremity infant minimum 2 views (73092) | $365 | $365 | 2.9× |
| Radex Wrist Complete Minimum 3 Views (73110) range across 2 matching MRF lines |
$707–$714 | $707–$714 | varies |
| Radex X-Ray Exam Entire Spi 6/> Vw - Xr Entire Spine 6+ Vw (72084) | $841 | $841 | 6.7× |
| Radiation treatment delivery level 1 (77402) | $5,470 | $5,470 | 44.7× |
| Radiation treatment delivery level 2 (77407) | $6,860 | $6,860 | 14.8× |
| Radiation treatment delivery level 3 (77412) | $6,927 | $6,927 | 10.5× |
| Radiolog exam mandible compl minimum 4 views (70110) | $514 | $514 | 4.1× |
| Radiologic Exam Abdomen 3+ Views - Xr Abdomen 3+ Views (74021) | $406 | $406 | 3.2× |
| Radiologic exam colon double contrast study (74280) range across 2 matching MRF lines |
$973–$1,070 | $973–$1,070 | varies |
| Radiologic exam colon single contrast study (74270) range across 2 matching MRF lines |
$903–$994 | $903–$994 | varies |
| Radiologic Exam Esophagus Double Contrast Study (74221) | $642 | $642 | 3.1× |
| Radiologic exam knee complete 4/more views (73564) | $470 | $470 | 3.8× |
| Radiologic exam pelvis compl minimum 3 views (72190) | $426 | $426 | 3.4× |
| Radiologic Exam Small Int Single Contrast Study (74250) range across 2 matching MRF lines |
$562–$618 | $562–$618 | varies |
| Radiologic exam swallow function contrast study (74230) range across 2 matching MRF lines |
$629–$691 | $629–$691 | varies |
| Radiologic exam upr gi trc double contrast study (74246) range across 4 matching MRF lines |
$593–$652 | $593–$652 | varies |
| Radiologic examination femur 1 view (73551) | $200 | $200 | 1.9× |
| Radiologic examination femur minimum 2 views (73552) | $299 | $299 | 2.9× |
| Radiologic examination knee 1/2 views (73560) range across 2 matching MRF lines |
$1,852–$58,666.40 | $1,852–$58,666.40 | varies |
| Radiologic Examination Osseous Survey Limited (77074) | $403 | $403 | 3.2× |
| Radiologic examination tibia & fibula 2 views (73590) range across 3 matching MRF lines |
$615–$653 | $615–$653 | varies |
| Ribs bilateral 3 views (71110) | $510 | $510 | 4.1× |
| Rp loclzj tum plnr 1 area single day imaging (78800) | $1,463 | $1,463 | 3.1× |
| Rp loclzj tum plnr 2+area 1+d img/1 area img>2+d (78801) | $1,806 | $1,806 | 3.8× |
| Rp Loclzj Tum Plnr Whole Body 2+ Days Imaging (78804) range across 2 matching MRF lines |
$3,723–$4,095 | $3,723–$4,095 | varies |
| Rp Loclzj Tum Plnr Whole Body Single Day Imaging (78802) range across 2 matching MRF lines |
$1,965–$2,161 | $1,965–$2,161 | varies |
| Rp Loclzj Tum Spect 1 Area Single Day Imaging (78803) range across 2 matching MRF lines |
$2,615–$2,876 | $2,615–$2,876 | varies |
| Rp loclzj tum spect 2 area/sep acquisj img (78831) | $3,219 | $3,219 | 2.1× |
| Rp loclzj tum spect CT 2area 1d img/1 ar img>2+d (78832) | $7,345 | $7,345 | 4.3× |
| Rp loclzj tum spect w/CT 1 area/acquisj 1day img (78830) | $3,219 | $3,219 | 2.1× |
| Scapula (73010) | $284 | $284 | 2.3× |
| Screening Digital Breast Tomosynthesis Bi (77063) | $102 | $102 | 4.4× |
| Shoulder 1 view (73020) | $274 | $274 | 2.6× |
| Shoulder Arthrography (73040) | $1,067 | $1,067 | 2.6× |
| Sialogram (70390) | $948 | $948 | 3.3× |
| Skull less than 4 views (70250) | $426 | $426 | 3.4× |
| Sternoclavicular joints (71130) | $284 | $284 | 2.7× |
| Tbs techl prep&transmis data alys pfrmd elsewhr (77090) | $281 | $281 | 2.7× |
| Tbs technical calculation only (77091) | $309 | $309 | 3.0× |
| Thoracic spine 2 views (72070) | $467 | $467 | 3.7× |
| Thoracic spine 3 views (72072) | $483 | $483 | 3.9× |
| Thoracolumbar 2 views (72080) | $328 | $328 | 3.1× |
| Thyroid Imaging With Vascular Flow (78013) | $765 | $765 | 1.6× |
| Thyroid Met Imaging Body (78018) | $1,402 | $1,402 | 2.2× |
| Thyroid Uptake Measurement (78012) | $1,491 | $1,491 | 3.1× |
| Thyroid Uptake W/Blood Flow Sngle/Mult Quan Meas (78014) | $1,029 | $1,029 | 2.1× |
| Ultrasound Breast Limited (76642) range across 6 matching MRF lines |
$1,139–$1,150 | $1,139–$1,150 | varies |
| Ultrasound Elastography Parenchyma (76981) | $375 | $375 | 3.0× |
| Ultrasound Exam Aaa Screen (76706) | $420 | $420 | 3.4× |
| Ultrasound, abdomen limited (76705) range across 2 matching MRF lines |
$621–$2,271 | $621–$2,271 | varies |
| Unlisted Miscellaneous Px Dx Nuclear Medicine (78999) | $568 | $568 | 1.2× |
| Upper gi w/o kub (74240) range across 2 matching MRF lines |
$621–$684 | $621–$684 | varies |
| Urethrocystogram voiding (74455) | $853 | $853 | 3.0× |
| Urethrocystography retrograde (74450) | $1,093 | $1,093 | 3.8× |
| Us breast unilateral complete (76641) | $690 | $690 | 5.5× |
| Us chest (76604) | $621 | $621 | 5.0× |
| Us complete joint (76881) | $592 | $592 | 4.7× |
| Us exam, pelvic, limited (76857) | $578 | $578 | 4.6× |
| Us lmtd joint/oth nonvasc xtr strux r-t w/img (76882) range across 6 matching MRF lines |
$592–$2,717 | $592–$2,717 | varies |
| Us ob detailed single fetus (76811) | $1,237 | $1,237 | 4.3× |
| Us ob limited 1 or more fetuses (76815) | $1,053 | $1,053 | 8.4× |
| Us ob transvaginal (76817) | $597 | $597 | 4.8× |
| Us pelvic non ob complete (76856) range across 2 matching MRF lines |
$1,254–$3,005 | $1,254–$3,005 | varies |
| Us pg uter img f&mat 14 wk tabdl 1/1st gestation (76801) | $633 | $633 | 5.1× |
| Us preg uterus real time f/u trnsabdl per fetus (76816) | $355 | $355 | 2.8× |
| Us retroperitoneal complete (76770) | $1,233 | $1,233 | 9.8× |
| Us retroperitoneal limited (76775) | $643 | $643 | 5.1× |
| Us scrotum and contents (76870) | $1,237 | $1,237 | 9.9× |
| Us spinal canal and contents (76800) | $483 | $483 | 3.9× |
| Us thyroid (76536) | $566 | $566 | 4.5× |
| Us transrectal (76872) | $537 | $537 | 4.3× |
| Venography extremity bilateral rs&i (75822) | $2,712 | $2,712 | 1.4× |
| Venography extremity unilateral rs&i (75820) | $2,878 | $2,878 | 1.5× |
| Wrist 2 views (73100) | $315 | $315 | 3.0× |
| X-Ray Ac Jts - Xr Acromioclavicular Joints Bilateral (73050) | $284 | $284 | 2.7× |
| X-ray antegrade pyelogram tube (74425) | $977 | $977 | 2.3× |
| X-Ray Bend Only L-S Spine (72120) | $512 | $512 | 4.1× |
| X-Ray Elbow 2 Vw - Xr Elbow 1-2 Views Right (73070) | $284 | $284 | 2.7× |
| X-Ray Exam Breast Specimen (76098) range across 3 matching MRF lines |
$21,683.60–$38,836.52 | $21,683.60–$38,836.52 | varies |
| X-Ray Exam Entire Spi 1 Vw (72081) | $423 | $423 | 4.1× |
| X-Ray Exam Entire Spi 2/3 Vw (72082) | $470 | $470 | 3.8× |
| X-Ray Exam Entire Spi 4/5 Vw (72083) | $841 | $841 | 6.7× |
| X-Ray Exam Hip Uni 1 View (73501) | $64,167.71 | $64,167.71 | 615.3× |
| X-Ray Exam Hip Uni 2-3 Views (73502) range across 2 matching MRF lines |
$683–$714 | $683–$714 | varies |
| X-Ray Exam Hip Uni 4/> Views (73503) | $441 | $441 | 3.5× |
| X-Ray Exam Hips Bi 2 Views (73521) | $441 | $441 | 3.5× |
| X-Ray Exam Hips Bi 3-4 Views (73522) | $453 | $453 | 3.6× |
| X-Ray Exam Hips Bi 5/> Views (73523) | $728 | $728 | 5.8× |
| X-Ray Exam L-S Spine Bending (72114) | $724 | $724 | 5.8× |
| X-Ray Exam Neck Spine 2-3 Vw (72040) | $441 | $441 | 4.2× |
| X-Ray Exam Neck Spine 6/>Vws (72052) | $780 | $780 | 6.2× |
| X-Ray Exam Unilat Ribs/Chest (71101) | $438 | $438 | 3.5× |
| X-ray eye for foreign body (70030) | $256 | $256 | 2.5× |
| X-ray humerus (73060) | $284 | $284 | 2.7× |
| X-Ray Jaw <4 Vw - Xr Mandible < 4 Views (70100) | $423 | $423 | 4.1× |
| X-Ray Knee Bilat Standing - Xr Knees Anteroposterior Standing Bilat (73565) | $284 | $284 | 2.7× |
| X-Ray Lumbar Spine 2/3 Vw - Xr Lumbar Spine 2-3 Views (72100) | $512 | $512 | 4.1× |
| X-ray nose-rectum child f.b. (76010) | $354 | $354 | 3.4× |
| X-Ray Ribs, Chest 4+ Vw - Xr Ribs 3 Vws Bil W/ Chest Posteroanterior (71111) | $527 | $527 | 4.2× |
| X-Ray Sacroiliac Jts 3+ Vw - Xr Sacroiliac Joints 3+ Views (72202) | $487 | $487 | 3.9× |
| X-Ray Sacroiliac Jts <3 Vw - Xr Sacroiliac Joints 1-2 Views (72200) | $365 | $365 | 2.9× |
| X-Ray Sacrum/Coccyx 2+ Vw - Xr Sacrum Coccyx 2+ Views (72220) | $319 | $319 | 3.1× |
| X-Ray Sinuses 3+ Vw - Xr Paranasal Sinuses 3+ Views (70220) | $581 | $581 | 5.6× |
| X-Ray Skull 4+ Vw - Xr Skull Complete 4+ Views (70260) | $530 | $530 | 4.2× |
| X-Ray Stress View (77071) | $199 | $199 | 1.9× |
| X-ray thoracic spine 4 vw (72074) | $483 | $483 | 3.9× |
| X-Ray Tmj Unilat (70328) | $270 | $270 | 2.6× |
| X-Ray Urinary Tract Exam With Contrast Material (74420) | $1,013 | $1,013 | 2.4× |
| X-Rays Bone Length Studies (77073) | $582 | $582 | 4.6× |
| X-Rays Bone Survey Complete (77075) | $713 | $713 | 5.7× |
| Xr c-spine 4 or 5 views (72050) | $483 | $483 | 3.9× |
| Xr facial bones less than 3 views (70140) | $284 | $284 | 2.7× |
| XR Mastoids < 3 Views Bilateral (70120) | $348 | $348 | 2.8× |
| Xr orbits complete 4 views (70200) | $510 | $510 | 4.1× |
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.