Imaging prices at Jefferson County Health Center
Fairfield, IA · 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) range across 3 matching MRF lines |
$40.20–$133.80 | $67–$223 | varies |
| Abdomen 2 views (74019) | $176.40 | $294 | 1.8× |
| Acute Gastrointestinal Blood Loss Imaging (78278) | $604.80 | $1,008 | 1.6× |
| Ankle 2 views (73600) range across 2 matching MRF lines |
$39–$127.80 | $65–$213 | varies |
| Arthrogram ankle (73615) | $318 | $530 | 0.9× |
| Arthrogram hip (73525) | $318 | $530 | 0.9× |
| Arthrogram Wrist (73115) | $334.20 | $557 | 1.0× |
| Bone age studies (77072) | $90 | $150 | 0.9× |
| Bone Imaging 3 Phase (78315) | $744.60 | $1,241 | 1.9× |
| Bone Imaging Limited Area (78300) | $359.40 | $599 | 0.9× |
| Bone Imaging Whole Body (78306) | $896.40 | $1,494 | 2.3× |
| Bone survey infant (77076) | $159 | $265 | 1.6× |
| Brain Flow Imaging Only (78610) | $231.60 | $386 | 0.4× |
| Brain Imaging Min 4 Static Views W Vascular Flow (78606) | $627 | $1,045 | 1.2× |
| Brain Imaging Minimum 4 Static Views (78605) | $385.20 | $642 | 0.7× |
| Cat Scan Follow-Up Study (76380) | $387.60 | $646 | 4.6× |
| Chest 1 view (71045) range across 3 matching MRF lines |
$36–$121.20 | $60–$202 | varies |
| Chest 2 views (71046) range across 5 matching MRF lines |
$48.60–$160.20 | $81–$267 | varies |
| Chest 3 views (71047) range across 2 matching MRF lines |
$140.40–$195 | $234–$325 | varies |
| Chest 4 or more views (71048) range across 2 matching MRF lines |
$140.40–$252 | $234–$420 | varies |
| Clavicle complete (73000) range across 2 matching MRF lines |
$40.20–$129 | $67–$215 | varies |
| Computed Tomography Thorax Lw Dose Lng Ca Scr C- (71271) | $444 | $740 | 4.4× |
| Contrast X-Ray Bladder (74430) | $140.40 | $234 | 0.4× |
| Contrast X-Ray Of Elbow (73085) | $318 | $530 | 0.9× |
| Contrast X-Ray Of Knee Joint (73580) | $318 | $530 | 0.9× |
| Contrast Xray Throat/Cerv Esopha (74210) | $141 | $235 | 0.8× |
| CT abdomen and pelvis without and with contrast (74178) | $2,041.80 | $3,403 | 6.1× |
| CT abdomen and pelvis without contrast (74176) | $1,928.40 | $3,214 | 8.4× |
| CT abdomen w contrast (74160) | $985.80 | $1,643 | 5.8× |
| CT abdomen w wo contrast (74170) | $1,038.60 | $1,731 | 6.2× |
| CT abdomen w/o contrast (74150) | $929.40 | $1,549 | 9.2× |
| CT Angio Abdomen and Pelvis (74174) | $1,524 | $2,540 | 4.5× |
| CT Angio Chest (71275) | $1,606.80 | $2,678 | 9.5× |
| CT Angio Head (70496) | $1,503.60 | $2,506 | 8.9× |
| Ct Angio Lwr Extr W/O&W/Dye (73706) | $1,524 | $2,540 | 9.0× |
| CT Angio Neck (70498) | $1,500 | $2,500 | 8.9× |
| Ct Angio Upr Extrm W/O&W/Dye (73206) | $894 | $1,490 | 5.3× |
| CT cervical spine w/ contrast (72126) | $1,204.20 | $2,007 | 3.6× |
| CT cervical spine w/o contrast (72125) | $1,147.20 | $1,912 | 11.4× |
| CT cervical spine w/wo cont (72127) | $1,260 | $2,100 | 7.5× |
| CT chest w contrast (71260) | $1,125.60 | $1,876 | 6.7× |
| CT chest w/wo contrast (71270) | $1,239 | $2,065 | 7.3× |
| CT head/brain with contrast (70460) | $1,234.80 | $2,058 | 7.3× |
| CT head/brain without and with contrast (70470) | $1,291.80 | $2,153 | 7.7× |
| CT iac w contrast (70481) | $1,054.80 | $1,758 | 6.3× |
| CT l-spine w&w/o contrast (72133) | $1,267.20 | $2,112 | 7.5× |
| CT lower ext w/o (73700) | $1,066.20 | $1,777 | 10.6× |
| CT lower extremity w/contrast material (73701) | $1,066.20 | $1,777 | 6.3× |
| CT lumbar spine w contrast (72132) | $1,210.20 | $2,017 | 3.6× |
| CT lumbar spine w/o contrast (72131) | $1,153.80 | $1,923 | 11.5× |
| CT maxillofacial w contrast (70487) | $1,129.80 | $1,883 | 6.7× |
| CT maxillofacial wo contrast (70486) | $1,033.80 | $1,723 | 10.3× |
| CT neck tissue combo (70492) | $1,274.40 | $2,124 | 7.6× |
| Ct Orbit/Ear/Fossa W/O&W/Dye (70482) | $1,234.80 | $2,058 | 7.3× |
| CT orbits w/o contrast (70480) | $874.80 | $1,458 | 8.7× |
| CT pelvis w&w/o contrast (72194) | $1,159.20 | $1,932 | 6.9× |
| CT pelvis w/o contrast (72192) | $730.80 | $1,218 | 7.3× |
| CT scan of leg combo (73702) | $1,251.60 | $2,086 | 7.4× |
| CT scans face/jaw combo (70488) | $1,186.20 | $1,977 | 7.0× |
| CT soft tissue neck w contrast (70491) | $1,218 | $2,030 | 7.2× |
| CT soft tissue neck w/o contrast (70490) | $1,161 | $1,935 | 11.6× |
| CT thoracic spine w contrast (72129) | $1,194 | $1,990 | 7.1× |
| CT thoracic spine w/o contrast (72128) | $1,137 | $1,895 | 11.3× |
| CT thoracic spine w/wo cont (72130) | $1,250.40 | $2,084 | 7.4× |
| CT thorax w/o contrast (71250) | $1,069.20 | $1,782 | 10.6× |
| CT upper ext wo (73200) | $979.80 | $1,633 | 9.7× |
| CT upper extremity w/o & w/contrast material (73202) | $1,093.20 | $1,822 | 6.5× |
| CT upper extremity with contrast (73201) | $1,036.20 | $1,727 | 3.1× |
| Cta Abdl Aorta&Bi Iliofem W/Contrast&Postp (75635) | $1,905.60 | $3,176 | 11.3× |
| Cta Abdomen (74175) | $1,524 | $2,540 | 9.0× |
| CTA pelvis (72191) | $1,038.60 | $1,731 | 6.2× |
| Dxa Bone Density Axial (77080) | $282.60 | $471 | 2.8× |
| Esophagram (74220) | $249.60 | $416 | 1.5× |
| Fetal Biophys Profile W/Nst (76818) | $300 | $500 | 3.0× |
| Fluoroscopy up to 1 hr (76000) | $283.20 | $472 | 1.2× |
| Foot 2 views (73620) range across 2 matching MRF lines |
$37.80–$123.60 | $63–$206 | varies |
| Forearm 2 views (73090) range across 2 matching MRF lines |
$40.20–$128.40 | $67–$214 | varies |
| Gastric emptying imaging study (78264) range across 2 matching MRF lines |
$979.80–$1,066.20 | $1,633–$1,777 | varies |
| Gated Heart Planar Single (78472) | $701.40 | $1,169 | 1.8× |
| Hand 2 views (73120) range across 2 matching MRF lines |
$39–$81 | $65–$135 | varies |
| Hepatobil Syst Image W/Drug (78227) | $1,146.60 | $1,911 | 2.2× |
| Hepatobiliary System Imaging (78226) | $436.20 | $727 | 1.1× |
| Infusion Ivp (74410) | $301.20 | $502 | 1.8× |
| Joint Survey Single View (77077) | $140.40 | $234 | 1.4× |
| K Flow/Funct Image Multiple (78709) | $520.20 | $867 | 1.0× |
| K Flow/Funct Image W/Drug (78708) | $1,156.80 | $1,928 | 2.2× |
| K Flow/Funct Image W/O Drug (78707) range across 2 matching MRF lines |
$520.20–$542.40 | $867–$904 | varies |
| Knee 3 Views (73562) range across 2 matching MRF lines |
$46.80–$168.60 | $78–$281 | varies |
| Liver & Spleen Imaging Static Only (78215) | $377.40 | $629 | 1.0× |
| Magnetic Image Jaw Joint (70336) | $1,194 | $1,990 | 5.2× |
| Mammary ductogram or galactogram multiple (77054) | $421.20 | $702 | 1.8× |
| Mammary ductogram or galactogram single (77053) | $312 | $520 | 1.4× |
| Meckels Divert Exam (78290) | $453 | $755 | 1.2× |
| Mra Head W/O & W/Contrast Material (70546) | $1,881.60 | $3,136 | 5.6× |
| MRA head w/o contrast (70544) | $1,768.20 | $2,947 | 7.7× |
| MRA head with contrast (70545) | $1,825.20 | $3,042 | 5.4× |
| MRA neck w contrast (70548) | $1,250.40 | $2,084 | 3.7× |
| Mra Neck W/O &W/Contrast Material (70549) | $1,307.40 | $2,179 | 3.9× |
| MRA neck w/o contrast (70547) | $1,194 | $1,990 | 5.2× |
| MRI abdomen w contrast (74182) | $1,635 | $2,725 | 4.9× |
| MRI abdomen w/o contrast (74181) | $1,578 | $2,630 | 6.9× |
| MRI any jt lower extrem w/contrast material (73722) | $1,672.80 | $2,788 | 2.2× |
| MRI any jt lower extrem w/o & w/contrast matrl (73723) | $1,729.20 | $2,882 | 5.2× |
| MRI any jt upper extremity w/contrast matrl (73222) | $1,636.20 | $2,727 | 2.2× |
| MRI bone marrow blood supply (77084) | $1,194 | $1,990 | 5.2× |
| MRI cervical spine w contrast (72142) | $1,774.80 | $2,958 | 5.3× |
| MRI cervical spine w/o cont (72141) | $1,698.60 | $2,831 | 7.4× |
| MRI chest w/o contrast (71550) | $1,703.40 | $2,839 | 7.4× |
| MRI chest with contrast (71551) | $1,760.40 | $2,934 | 2.3× |
| MRI chest wo w contrast (71552) | $2,075.40 | $3,459 | 6.2× |
| MRI lower extrem oth/thn jt w/contrast matrl (73719) | $1,668 | $2,780 | 5.0× |
| MRI lower extrem oth/thn jt w/o & w/contr matr (73720) | $1,725 | $2,875 | 5.1× |
| MRI lower extrem oth/thn jt w/o contr matrl (73718) | $1,611.60 | $2,686 | 7.0× |
| MRI lumbar spine w contrast (72149) | $1,367.40 | $2,279 | 4.1× |
| Mri Neck Spine W/O & W/Dye (72156) | $2,470.80 | $4,118 | 7.4× |
| MRI orbit face &/neck w/o contrast (70540) | $2,296.80 | $3,828 | 10.0× |
| MRI orbit face neck w contrast (70542) | $2,353.80 | $3,923 | 7.0× |
| Mri Orbt/Fac/Nck W/O &W/Dye (70543) | $2,410.20 | $4,017 | 7.2× |
| MRI pelvis w contrast (72196) | $1,624.80 | $2,708 | 4.8× |
| MRI pelvis w/o & w contrast (72197) | $1,681.20 | $2,802 | 5.0× |
| MRI pelvis w/o contrast (72195) | $1,567.80 | $2,613 | 6.8× |
| MRI thoracic spine w/o contrast (72146) | $1,642.80 | $2,738 | 7.2× |
| MRI upper extremity oth than jt w/contr matrl (73219) | $2,231.40 | $3,719 | 6.7× |
| MRI upper extremity oth than jt w/o contr matrl (73218) | $2,175 | $3,625 | 9.5× |
| Mri Uppr Extremity W/O&W/Dye (73220) | $2,288.40 | $3,814 | 6.8× |
| MRI, abdomen, combo (74183) | $1,691.40 | $2,819 | 5.0× |
| MRI, dorsal spine combo (72157) | $2,435.40 | $4,059 | 7.3× |
| MRI, dorsal spine contrast (72147) | $1,699.80 | $2,833 | 5.1× |
| MRI, joint upper extrem (73221) | $1,579.20 | $2,632 | 6.9× |
| MRI, joint upper extrem combo (73223) | $1,692.60 | $2,821 | 5.0× |
| MRI, lumbar spine combo (72158) | $2,573.40 | $4,289 | 7.7× |
| Myelogram cervical (72240) | $774 | $1,290 | 1.0× |
| Myelogram Lumbar (72265) | $774 | $1,290 | 1.0× |
| Myelography thoracic (72255) | $774 | $1,290 | 1.0× |
| Myocardial Imaging Infarct Avid Planar Qual/Quan (78466) | $520.20 | $867 | 1.4× |
| Myocardial Perfusion Planar 1 Study Rest/Stress (78453) | $1,446 | $2,410 | 1.2× |
| Neck soft tissue (70360) | $120.60 | $201 | 1.4× |
| Nuclear Rx Oral Admin (79005) | $982.20 | $1,637 | 4.4× |
| Oph bmtry us echograpy a-scan io lens pwr cal (76519) range across 2 matching MRF lines |
$54–$88.80 | $90–$148 | varies |
| Ophthalmic US Dx Corneal Pachymetry Uni/Bi (76514) | $27.60 | $46 | 1.0× |
| Optic foramina (70190) | $99 | $165 | 1.2× |
| Parathyroid Planar Imaging (78070) | $582.60 | $971 | 1.5× |
| Pelvis 1 or 2 views (72170) range across 2 matching MRF lines |
$41.40–$142.20 | $69–$237 | varies |
| PET image w/CT, full body (78816) | $3,150.60 | $5,251 | 2.3× |
| PET imaging CT attenuation skull base mid-thigh (78815) | $3,421.80 | $5,703 | 2.5× |
| Pulmonary Perfusion Imaging Particulate (78580) | $405.60 | $676 | 1.1× |
| Radex Abd Compl Aqt Abd W/S/E/D Views 1 View Ch (74022) | $234 | $390 | 2.3× |
| Radex abscess/fistula/sinus tract rs&i (76080) | $183.60 | $306 | 0.3× |
| Radex Ankle Complete Minimum 3 Views (73610) range across 2 matching MRF lines |
$43.80–$156 | $73–$260 | varies |
| Radex Calcaneus Minimum 2 Views (73650) range across 2 matching MRF lines |
$37.20–$81 | $62–$135 | varies |
| Radex elbow complete minimum 3 views (73080) range across 2 matching MRF lines |
$46.80–$144.60 | $78–$241 | varies |
| Radex Facial Bones Complete Minimum 3 Views (70150) | $217.80 | $363 | 2.2× |
| Radex fingr minimum 2 views (73140) range across 2 matching MRF lines |
$37.80–$120.60 | $63–$201 | varies |
| Radex foot complete minimum 3 views (73630) range across 2 matching MRF lines |
$43.80–$151.80 | $73–$253 | varies |
| Radex Hand Minimum 3 Views (73130) range across 2 matching MRF lines |
$43.80–$153.60 | $73–$256 | varies |
| Radex lower extremity infant minimum 2 views (73592) | $108 | $180 | 1.3× |
| Radex Mastoids Compl Minimum 3 Views PR Side (70130) | $159 | $265 | 1.6× |
| Radex Nasal Bones Complete Minimum 3 Views (70160) range across 2 matching MRF lines |
$44.40–$207.60 | $74–$346 | varies |
| Radex Ribs Unilateral 2 Views (71100) range across 2 matching MRF lines |
$46.80–$150 | $78–$250 | varies |
| Radex shoulder complete minimum 2 views (73030) range across 2 matching MRF lines |
$44.40–$157.20 | $74–$262 | varies |
| Radex Sinuses Paransl < 3 Views (70210) | $87.60 | $146 | 1.0× |
| Radex Spine 1 View Specify Level (72020) | $119.40 | $199 | 1.4× |
| Radex Sternum Minimum 2 Views (71120) range across 2 matching MRF lines |
$48–$135 | $80–$225 | varies |
| Radex Temporomandble Jt Opn & Clsd Mouth Bilat (70330) | $166.20 | $277 | 2.0× |
| Radex Toe Minimum 2 Views (73660) range across 2 matching MRF lines |
$37.20–$118.20 | $62–$197 | varies |
| Radex upper extremity infant minimum 2 views (73092) | $102.60 | $171 | 1.0× |
| Radex Wrist Complete Minimum 3 Views (73110) range across 2 matching MRF lines |
$45.60–$151.80 | $76–$253 | varies |
| Radiolog exam mandible compl minimum 4 views (70110) | $147.60 | $246 | 1.5× |
| Radiologic Exam Abdomen 3+ Views - Xr Abdomen 3+ Views (74021) | $216 | $360 | 2.1× |
| Radiologic exam colon double contrast study (74280) | $306 | $510 | 1.8× |
| Radiologic exam colon single contrast study (74270) | $207.60 | $346 | 1.2× |
| Radiologic exam knee complete 4/more views (73564) range across 2 matching MRF lines |
$53.40–$187.20 | $89–$312 | varies |
| Radiologic exam pelvis compl minimum 3 views (72190) | $112.80 | $188 | 1.1× |
| Radiologic Exam Small Int Single Contrast Study (74250) | $200.40 | $334 | 1.2× |
| Radiologic exam swallow function contrast study (74230) | $305.40 | $509 | 1.8× |
| Radiologic exam upr gi trc double contrast study (74246) range across 2 matching MRF lines |
$331.80–$349.80 | $553–$583 | varies |
| Radiologic examination femur minimum 2 views (73552) | $142.80 | $238 | 1.7× |
| Radiologic examination knee 1/2 views (73560) range across 2 matching MRF lines |
$41.40–$136.80 | $69–$228 | varies |
| Radiologic Examination Osseous Survey Limited (77074) | $140.40 | $234 | 1.4× |
| Radiologic Examination Salivary Gland Calculus (70380) | $112.80 | $188 | 1.3× |
| Radiologic examination tibia & fibula 2 views (73590) range across 2 matching MRF lines |
$41.40–$138 | $69–$230 | varies |
| Radiologic examination, internal auditory meati, complete Non-Facility (70134) | $198.60 | $331 | 0.4× |
| Renal Cyst Study (74470) | $406.20 | $677 | 0.8× |
| Ribs bilateral 3 views (71110) | $151.20 | $252 | 1.5× |
| Rp loclzj tum plnr 2+area 1+d img/1 area img>2+d (78801) | $584.40 | $974 | 1.5× |
| Rp Loclzj Tum Plnr Whole Body Single Day Imaging (78802) | $663.60 | $1,106 | 1.3× |
| Rp Loclzj Tum Spect 1 Area Single Day Imaging (78803) range across 2 matching MRF lines |
$752.40–$1,029.60 | $1,254–$1,716 | varies |
| Scapula (73010) | $139.80 | $233 | 1.4× |
| Screening Digital Breast Tomosynthesis Bi (77063) | $43.20 | $72 | 1.8× |
| Shoulder 1 view (73020) range across 2 matching MRF lines |
$35.40–$108.60 | $59–$181 | varies |
| Shoulder Arthrography (73040) | $334.20 | $557 | 1.0× |
| Skull less than 4 views (70250) | $103.80 | $173 | 1.0× |
| Sternoclavicular joints (71130) | $90 | $150 | 1.1× |
| Tbs techl prep&transmis data alys pfrmd elsewhr (77090) | $115.80 | $193 | 1.4× |
| Tbs technical calculation only (77091) | $115.80 | $193 | 1.4× |
| Testicular Imaging W/Flow (78761) | $635.40 | $1,059 | 1.7× |
| Thoracic spine 2 views (72070) range across 2 matching MRF lines |
$48.60–$165 | $81–$275 | varies |
| Thoracic spine 3 views (72072) | $180 | $300 | 1.8× |
| Thoracolumbar 2 views (72080) | $110.40 | $184 | 1.3× |
| Thyroid Uptake Measurement (78012) | $339.60 | $566 | 0.9× |
| Thyroid Uptake W/Blood Flow Sngle/Mult Quan Meas (78014) | $730.80 | $1,218 | 1.9× |
| Ultrasound Breast Limited (76642) | $244.80 | $408 | 2.9× |
| Ultrasound, abdomen limited (76705) | $396 | $660 | 3.9× |
| Upper gi w/o kub (74240) range across 2 matching MRF lines |
$297–$351 | $495–$585 | varies |
| Ureteral Reflux Study (78740) | $442.20 | $737 | 1.2× |
| Urethrocystogram voiding (74455) | $280.80 | $468 | 1.2× |
| Urethrocystography retrograde (74450) | $199.80 | $333 | 0.9× |
| Us breast unilateral complete (76641) | $342 | $570 | 3.4× |
| Us chest (76604) | $300 | $500 | 3.0× |
| Us complete joint (76881) | $342 | $570 | 3.4× |
| Us exam, pelvic, limited (76857) | $256.80 | $428 | 2.6× |
| Us kidney transplant (76776) | $342 | $570 | 3.4× |
| Us lmtd joint/oth nonvasc xtr strux r-t w/img (76882) | $267.60 | $446 | 2.7× |
| Us ob limited 1 or more fetuses (76815) range across 3 matching MRF lines |
$64.80–$160.80 | $108–$268 | varies |
| Us ob transvaginal (76817) | $184.20 | $307 | 1.8× |
| Us pelvic non ob complete (76856) | $396.60 | $661 | 3.9× |
| Us pg uter img f&mat 14 wk tabdl 1/1st gestation (76801) | $294 | $490 | 2.9× |
| Us preg uterus real time f/u trnsabdl per fetus (76816) | $154.20 | $257 | 1.5× |
| Us retroperitoneal complete (76770) | $424.80 | $708 | 4.2× |
| Us retroperitoneal limited (76775) | $309.60 | $516 | 3.1× |
| Us scrotum and contents (76870) | $374.40 | $624 | 3.7× |
| Us thyroid (76536) | $332.40 | $554 | 3.3× |
| Us transrectal (76872) | $294 | $490 | 2.9× |
| Vascular Flow Imaging (78445) | $259.20 | $432 | 0.7× |
| Wrist 2 views (73100) range across 2 matching MRF lines |
$40.20–$127.80 | $67–$213 | varies |
| X-Ray Ac Jts - Xr Acromioclavicular Joints Bilateral (73050) range across 2 matching MRF lines |
$49.80–$100.80 | $83–$168 | varies |
| X-ray antegrade pyelogram tube (74425) | $151.20 | $252 | 0.5× |
| X-Ray Bend Only L-S Spine (72120) | $157.20 | $262 | 1.6× |
| X-Ray Elbow 2 Vw - Xr Elbow 1-2 Views Right (73070) range across 2 matching MRF lines |
$39–$127.80 | $65–$213 | varies |
| X-Ray Exam Breast Specimen (76098) | $691.20 | $1,152 | 1.3× |
| X-Ray Exam Entire Spi 1 Vw (72081) | $126.60 | $211 | 1.5× |
| X-Ray Exam Entire Spi 2/3 Vw (72082) | $252.60 | $421 | 2.5× |
| X-Ray Exam Hip Uni 1 View (73501) range across 2 matching MRF lines |
$37.20–$124.20 | $62–$207 | varies |
| X-Ray Exam Hip Uni 2-3 Views (73502) | $153 | $255 | 1.8× |
| X-Ray Exam Hips Bi 2 Views (73521) | $184.20 | $307 | 1.8× |
| X-Ray Exam L-S Spine Bending (72114) | $287.40 | $479 | 2.9× |
| X-Ray Exam Neck Spine 2-3 Vw (72040) | $166.80 | $278 | 2.0× |
| X-Ray Exam Neck Spine 6/>Vws (72052) | $246.60 | $411 | 2.5× |
| X-Ray Exam Unilat Ribs/Chest (71101) range across 2 matching MRF lines |
$56.40–$194.40 | $94–$324 | varies |
| X-ray eye for foreign body (70030) | $131.40 | $219 | 1.6× |
| X-ray humerus (73060) range across 2 matching MRF lines |
$43.80–$138 | $73–$230 | varies |
| X-ray IV pyelogram (ivp) (74400) | $255 | $425 | 1.5× |
| X-Ray Jaw <4 Vw - Xr Mandible < 4 Views (70100) | $99 | $165 | 1.2× |
| X-Ray Knee Bilat Standing - Xr Knees Anteroposterior Standing Bilat (73565) | $77.40 | $129 | 0.9× |
| X-Ray Lumbar Spine 2/3 Vw - Xr Lumbar Spine 2-3 Views (72100) range across 2 matching MRF lines |
$53.40–$193.20 | $89–$322 | varies |
| X-ray nose-rectum child f.b. (76010) | $69.60 | $116 | 0.8× |
| X-Ray Ribs, Chest 4+ Vw - Xr Ribs 3 Vws Bil W/ Chest Posteroanterior (71111) | $250.20 | $417 | 2.5× |
| X-Ray Sacroiliac Jts 3+ Vw - Xr Sacroiliac Joints 3+ Views (72202) | $156 | $260 | 1.6× |
| X-Ray Sacrum/Coccyx 2+ Vw - Xr Sacrum Coccyx 2+ Views (72220) | $142.20 | $237 | 1.7× |
| X-Ray Sinuses 3+ Vw - Xr Paranasal Sinuses 3+ Views (70220) | $151.20 | $252 | 1.8× |
| X-Ray Skull 4+ Vw - Xr Skull Complete 4+ Views (70260) | $176.40 | $294 | 1.8× |
| X-Ray Stress View (77071) | $69.60 | $116 | 0.8× |
| X-Ray Tmj Unilat (70328) | $80.40 | $134 | 1.0× |
| X-Ray Urinary Tract Exam With Contrast Material (74420) | $312 | $520 | 0.9× |
| X-Rays Bone Length Studies (77073) | $127.80 | $213 | 1.3× |
| X-Rays Bone Survey Complete (77075) | $387.60 | $646 | 3.9× |
| Xr c-spine 4 or 5 views (72050) | $236.40 | $394 | 2.4× |
| Xr facial bones less than 3 views (70140) | $123 | $205 | 1.5× |
| XR Mastoids < 3 Views Bilateral (70120) | $80.40 | $134 | 0.8× |
| Xr orbits complete 4 views (70200) | $198.60 | $331 | 2.0× |
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.