Imaging prices at LewisGale Hospital Montgomery
Blacksburg, VA · every code in this section with a posted price and a Medicare benchmark.
262 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) | $1,147 | $1,147 | 13.5× |
| Acute Gastrointestinal Blood Loss Imaging (78278) | $3,072 | $3,072 | 7.9× |
| Angio pulmonary bilat (75743) | $7,111 | $7,111 | 2.3× |
| Angiography extremity bilateral rs&i (75716) | $7,111 | $7,111 | 2.3× |
| Angiography extremity unilateral rs&i (75710) | $6,445 | $6,445 | 2.1× |
| Angiography pulmonary unilateral slctv rs&i (75741) | $7,111 | $7,111 | 2.3× |
| Ankle 2 views (73600) range across 3 matching MRF lines |
$1,076–$1,616 | $1,076–$1,616 | varies |
| Aortography thoracic serialography rs&i (75605) | $17,055 | $17,055 | 3.1× |
| Artery X-Rays Abdomen (75726) | $17,055 | $17,055 | 3.1× |
| Artery X-Rays Pelvis (75736) | $7,700 | $7,700 | 1.4× |
| Arthrogram hip (73525) | $1,548 | $1,548 | 4.5× |
| Arthrogram Wrist (73115) | $1,178 | $1,178 | 3.5× |
| Bone age studies (77072) | $540 | $540 | 5.3× |
| Bone Imaging 3 Phase (78315) | $6,468 | $6,468 | 16.6× |
| Bone Imaging Limited Area (78300) | $3,474 | $3,474 | 8.9× |
| Bone Imaging Whole Body (78306) | $6,091 | $6,091 | 15.6× |
| Bone survey infant (77076) | $1,138 | $1,138 | 11.2× |
| Cat Scan Follow-Up Study (76380) | $855 | $855 | 10.1× |
| Cerebrospinal Fluid Scan (78630) | $5,273 | $5,273 | 10.0× |
| Chest 1 view (71045) | $772 | $772 | 9.1× |
| Chest 2 views (71046) | $1,187 | $1,187 | 14.0× |
| Chest 3 views (71047) | $1,781 | $1,781 | 21.0× |
| Chest 4 or more views (71048) | $2,670 | $2,670 | 26.2× |
| Clavicle complete (73000) range across 3 matching MRF lines |
$1,187–$1,777 | $1,187–$1,777 | varies |
| Computed Tomography Thorax Lw Dose Lng Ca Scr C- (71271) | $183 | $183 | 1.8× |
| Contrast Exam Abdominl Aorta (75625) | $7,111 | $7,111 | 2.3× |
| Contrast X-Ray Bladder (74430) | $1,869 | $1,869 | 5.5× |
| Contrast X-Ray Of Elbow (73085) | $1,548 | $1,548 | 4.5× |
| Contrast X-Ray Of Knee Joint (73580) | $1,928 | $1,928 | 5.7× |
| CT abdomen and pelvis without and with contrast (74178) | $7,729 | $7,729 | 22.7× |
| CT abdomen and pelvis without contrast (74176) | $5,977 | $5,977 | 25.7× |
| CT abdomen w contrast (74160) | $4,394 | $4,394 | 25.7× |
| CT abdomen w wo contrast (74170) | $5,387 | $5,387 | 31.5× |
| CT abdomen w/o contrast (74150) | $3,675 | $3,675 | 36.0× |
| CT Angio Abdomen and Pelvis (74174) | $10,180 | $10,180 | 29.9× |
| CT Angio Chest (71275) | $5,486 | $5,486 | 32.1× |
| CT Angio Head (70496) | $5,360 | $5,360 | 31.3× |
| CT angio hrt w/3d image (75574) | $714 | $714 | 2.1× |
| Ct Angio Lwr Extr W/O&W/Dye (73706) | $3,815 | $3,815 | 22.3× |
| CT Angio Neck (70498) | $4,808 | $4,808 | 28.1× |
| Ct Angio Upr Extrm W/O&W/Dye (73206) | $3,420 | $3,420 | 20.0× |
| CT cervical spine w/ contrast (72126) | $4,085 | $4,085 | 12.0× |
| CT cervical spine w/o contrast (72125) | $4,190 | $4,190 | 41.1× |
| CT cervical spine w/wo cont (72127) | $4,271 | $4,271 | 25.0× |
| CT chest w contrast (71260) | $4,606 | $4,606 | 26.9× |
| CT chest w/wo contrast (71270) | $5,416 | $5,416 | 31.6× |
| CT head/brain with contrast (70460) | $4,362 | $4,362 | 25.5× |
| CT head/brain without and with contrast (70470) | $5,466 | $5,466 | 31.9× |
| CT heart contrast eval cardiac structure&morph (75572) | $714 | $714 | 2.1× |
| CT heart no contrast quant eval coronry calcium (75571) | $176 | $176 | 2.1× |
| CT iac w contrast (70481) | $2,844 | $2,844 | 16.6× |
| CT l-spine w&w/o contrast (72133) | $4,271 | $4,271 | 25.0× |
| CT lower ext w/o (73700) | $2,732 | $2,732 | 26.8× |
| CT lower extremity w/contrast material (73701) | $3,059 | $3,059 | 17.9× |
| CT lumbar spine w contrast (72132) | $3,476 | $3,476 | 10.2× |
| CT lumbar spine w/o contrast (72131) | $3,942 | $3,942 | 38.6× |
| CT maxillofacial w contrast (70487) | $4,269 | $4,269 | 24.9× |
| CT maxillofacial wo contrast (70486) range across 2 matching MRF lines |
$731–$3,846 | $731–$3,846 | varies |
| CT neck tissue combo (70492) | $5,466 | $5,466 | 31.9× |
| Ct Orbit/Ear/Fossa W/O&W/Dye (70482) | $4,380 | $4,380 | 25.6× |
| CT orbits w/o contrast (70480) | $2,481 | $2,481 | 24.3× |
| CT pelvis w&w/o contrast (72194) | $4,918 | $4,918 | 28.7× |
| CT pelvis w/o contrast (72192) | $4,291 | $4,291 | 42.1× |
| CT scan of leg combo (73702) | $3,154 | $3,154 | 18.4× |
| CT scans face/jaw combo (70488) | $4,915 | $4,915 | 28.7× |
| CT soft tissue neck w contrast (70491) | $4,362 | $4,362 | 25.5× |
| CT soft tissue neck w/o contrast (70490) | $4,240 | $4,240 | 41.6× |
| CT thoracic spine w contrast (72129) | $4,190 | $4,190 | 24.5× |
| CT thoracic spine w/o contrast (72128) | $3,942 | $3,942 | 38.6× |
| CT thorax w/o contrast (71250) | $4,506 | $4,506 | 44.2× |
| CT upper ext wo (73200) | $2,374 | $2,374 | 23.3× |
| CT upper extremity w/o & w/contrast material (73202) | $3,101 | $3,101 | 18.1× |
| CT upper extremity with contrast (73201) | $2,603 | $2,603 | 7.6× |
| Cta Abdl Aorta&Bi Iliofem W/Contrast&Postp (75635) | $5,913 | $5,913 | 34.6× |
| Cta Abdomen (74175) | $5,446 | $5,446 | 31.8× |
| CTA head&neck c+ w/noncontrast img&post-pxessing (70471) | $12,186 | $12,186 | 35.8× |
| CTA pelvis (72191) | $4,736 | $4,736 | 27.7× |
| Dxa Bone Density Axial (77080) | $2,163 | $2,163 | 21.2× |
| Esophagram (74220) | $1,869 | $1,869 | 10.9× |
| Fetal Biophys Profile W/Nst (76818) | $1,986 | $1,986 | 19.5× |
| Fetal Biophysical Profile W/O Non-Stress Testing (76819) | $1,986 | $1,986 | 19.5× |
| Fluoroscopy up to 1 hr (76000) range across 2 matching MRF lines |
$915–$3,169 | $915–$3,169 | varies |
| Foot 2 views (73620) range across 3 matching MRF lines |
$1,076–$1,616 | $1,076–$1,616 | varies |
| Forearm 2 views (73090) range across 3 matching MRF lines |
$1,493–$2,233 | $1,493–$2,233 | varies |
| Gastric emptying imaging study (78264) | $5,382 | $5,382 | 13.8× |
| Gated Heart Planar Single (78472) | $3,569 | $3,569 | 9.2× |
| Hand 2 views (73120) range across 3 matching MRF lines |
$1,156–$1,732 | $1,156–$1,732 | varies |
| Hepatobil Syst Image W/Drug (78227) | $5,626 | $5,626 | 10.6× |
| Hepatobiliary System Imaging (78226) | $4,053 | $4,053 | 10.4× |
| Hysterosalpingogram (74740) | $1,483 | $1,483 | 6.4× |
| Infant hip ultrasound with hip movement (dynamic) (76885) | $1,133 | $1,133 | 13.3× |
| Joint Survey Single View (77077) | $557 | $557 | 5.5× |
| K Flow/Funct Image Multiple (78709) | $6,240 | $6,240 | 11.8× |
| Knee 3 Views (73562) range across 3 matching MRF lines |
$1,151–$1,714 | $1,151–$1,714 | varies |
| Lung Ventilat&Perfus Imaging (78582) | $3,749 | $3,749 | 7.1× |
| Lymph System Imaging (78195) | $6,091 | $6,091 | 11.5× |
| Magnetic Image Jaw Joint (70336) | $7,214 | $7,214 | 31.0× |
| Mr safety determination physician/other qhp (76016) | $218 | $218 | 2.6× |
| Mr safety implant&/fb assmt clin staf 1st 15 min (76014) | $25 | $25 | 0.9× |
| Mr safety implt electronics prepj supvj phys/qhp (76018) | $228 | $228 | 2.5× |
| Mr safety implt pos&/immoblj (76019) | $148 | $148 | 2.6× |
| Mra Head W/O & W/Contrast Material (70546) | $7,673 | $7,673 | 22.5× |
| MRA head w/o contrast (70544) | $6,808 | $6,808 | 29.2× |
| MRA neck w contrast (70548) | $7,673 | $7,673 | 22.5× |
| Mra Neck W/O &W/Contrast Material (70549) | $7,673 | $7,673 | 22.5× |
| MRA neck w/o contrast (70547) | $6,808 | $6,808 | 29.2× |
| MRI abdomen w contrast (74182) | $6,808 | $6,808 | 20.0× |
| MRI abdomen w/o contrast (74181) | $6,808 | $6,808 | 29.2× |
| MRI any jt lower extrem w/contrast material (73722) | $7,214 | $7,214 | 9.4× |
| MRI any jt lower extrem w/o & w/contrast matrl (73723) | $7,673 | $7,673 | 22.5× |
| MRI any jt upper extremity w/contrast matrl (73222) | $7,214 | $7,214 | 9.4× |
| MRI Breast W/O Contrast Bilateral (77047) | $6,808 | $6,808 | 29.2× |
| MRI cervical spine w contrast (72142) | $7,214 | $7,214 | 21.2× |
| MRI cervical spine w/o cont (72141) | $6,808 | $6,808 | 29.2× |
| MRI chest w/o contrast (71550) | $6,808 | $6,808 | 29.2× |
| MRI chest with contrast (71551) | $7,214 | $7,214 | 9.4× |
| MRI chest wo w contrast (71552) | $7,673 | $7,673 | 22.5× |
| MRI lower extrem oth/thn jt w/contrast matrl (73719) | $7,214 | $7,214 | 21.2× |
| MRI lower extrem oth/thn jt w/o & w/contr matr (73720) | $8,391 | $8,391 | 24.7× |
| MRI lower extrem oth/thn jt w/o contr matrl (73718) | $7,699 | $7,699 | 33.1× |
| MRI lumbar spine w contrast (72149) | $7,498 | $7,498 | 22.0× |
| Mri Neck Spine W/O & W/Dye (72156) | $7,673 | $7,673 | 22.5× |
| MRI orbit face &/neck w/o contrast (70540) | $7,214 | $7,214 | 31.0× |
| MRI orbit face neck w contrast (70542) | $7,214 | $7,214 | 21.2× |
| Mri Orbt/Fac/Nck W/O &W/Dye (70543) | $7,774 | $7,774 | 22.8× |
| MRI pelvis w contrast (72196) | $7,214 | $7,214 | 21.2× |
| MRI pelvis w/o & w contrast (72197) | $7,781 | $7,781 | 22.9× |
| MRI pelvis w/o contrast (72195) | $6,808 | $6,808 | 29.2× |
| MRI thoracic spine w/o contrast (72146) | $6,808 | $6,808 | 29.2× |
| MRI upper extremity oth than jt w/o contr matrl (73218) | $7,321 | $7,321 | 31.4× |
| Mri Uppr Extremity W/O&W/Dye (73220) | $8,101 | $8,101 | 23.8× |
| MRI, abdomen, combo (74183) | $7,858 | $7,858 | 23.1× |
| MRI, dorsal spine combo (72157) | $7,673 | $7,673 | 22.5× |
| MRI, dorsal spine contrast (72147) | $7,214 | $7,214 | 21.2× |
| MRI, joint upper extrem (73221) | $6,808 | $6,808 | 29.2× |
| MRI, joint upper extrem combo (73223) | $7,781 | $7,781 | 22.9× |
| MRI, lumbar spine combo (72158) | $8,133 | $8,133 | 23.9× |
| Myelogram cervical (72240) | $2,673 | $2,673 | 3.5× |
| Myelogram Lumbar (72265) | $2,171 | $2,171 | 2.8× |
| Myelography thoracic (72255) | $2,077 | $2,077 | 2.7× |
| Myelograpy 2/more regions rs&i (72270) | $4,186 | $4,186 | 5.5× |
| Myocardial Spect Multiple Studies (78452) | $11,893 | $11,893 | 9.4× |
| Neck soft tissue (70360) | $975 | $975 | 11.5× |
| Nuclear Rx Oral Admin (79005) | $1,491 | $1,491 | 6.5× |
| Parathyroid Planar Imaging (78070) | $6,091 | $6,091 | 15.6× |
| Pelvis 1 or 2 views (72170) | $1,483 | $1,483 | 14.5× |
| PET image w/CT, full body (78816) | $24,000 | $24,000 | 17.2× |
| PET imaging CT attenuation skull base mid-thigh (78815) | $23,037 | $23,037 | 16.5× |
| Pulmonary Perfusion Imaging Particulate (78580) | $4,278 | $4,278 | 11.0× |
| Radex Abd Compl Aqt Abd W/S/E/D Views 1 View Ch (74022) | $1,869 | $1,869 | 18.3× |
| Radex Ankle Complete Minimum 3 Views (73610) range across 3 matching MRF lines |
$1,493–$2,233 | $1,493–$2,233 | varies |
| Radex Calcaneus Minimum 2 Views (73650) range across 3 matching MRF lines |
$1,070–$1,591 | $1,070–$1,591 | varies |
| Radex elbow complete minimum 3 views (73080) range across 3 matching MRF lines |
$1,493–$2,233 | $1,493–$2,233 | varies |
| Radex Facial Bones Complete Minimum 3 Views (70150) | $2,394 | $2,394 | 23.5× |
| Radex fingr minimum 2 views (73140) | $1,074 | $1,074 | 12.6× |
| Radex foot complete minimum 3 views (73630) range across 3 matching MRF lines |
$1,493–$2,233 | $1,493–$2,233 | varies |
| Radex Hand Minimum 3 Views (73130) range across 3 matching MRF lines |
$1,493–$2,233 | $1,493–$2,233 | varies |
| Radex lower extremity infant minimum 2 views (73592) range across 3 matching MRF lines |
$1,308–$1,959 | $1,308–$1,959 | varies |
| Radex Nasal Bones Complete Minimum 3 Views (70160) | $1,037 | $1,037 | 12.2× |
| Radex Ribs Unilateral 2 Views (71100) | $1,894 | $1,894 | 22.3× |
| Radex shoulder complete minimum 2 views (73030) range across 3 matching MRF lines |
$1,703–$2,539 | $1,703–$2,539 | varies |
| Radex Sinuses Paransl < 3 Views (70210) | $1,074 | $1,074 | 12.6× |
| Radex Spine 1 View Specify Level (72020) | $1,147 | $1,147 | 13.5× |
| Radex Sternum Minimum 2 Views (71120) | $1,180 | $1,180 | 13.9× |
| Radex Temporomandble Jt Opn & Clsd Mouth Bilat (70330) | $1,375 | $1,375 | 16.2× |
| Radex Toe Minimum 2 Views (73660) range across 3 matching MRF lines |
$1,007–$1,493 | $1,007–$1,493 | varies |
| Radex upper extremity infant minimum 2 views (73092) | $1,248 | $1,248 | 12.2× |
| Radex Wrist Complete Minimum 3 Views (73110) range across 3 matching MRF lines |
$1,493–$2,233 | $1,493–$2,233 | varies |
| Radex X-Ray Exam Entire Spi 6/> Vw - Xr Entire Spine 6+ Vw (72084) | $2,817 | $2,817 | 27.6× |
| Radiolog exam mandible compl minimum 4 views (70110) | $1,725 | $1,725 | 16.9× |
| Radiologic Exam Abdomen 3+ Views - Xr Abdomen 3+ Views (74021) | $2,579 | $2,579 | 25.3× |
| Radiologic exam colon double contrast study (74280) | $3,694 | $3,694 | 21.6× |
| Radiologic exam colon single contrast study (74270) | $2,710 | $2,710 | 15.8× |
| Radiologic exam knee complete 4/more views (73564) range across 3 matching MRF lines |
$1,725–$2,571 | $1,725–$2,571 | varies |
| Radiologic Exam Small Int Single Contrast Study (74250) | $1,997 | $1,997 | 11.7× |
| Radiologic exam swallow function contrast study (74230) | $2,422 | $2,422 | 14.2× |
| Radiologic exam upr gi trc double contrast study (74246) | $2,714 | $2,714 | 15.9× |
| Radiologic examination femur 1 view (73551) | $1,493 | $1,493 | 17.6× |
| Radiologic examination femur minimum 2 views (73552) | $2,233 | $2,233 | 26.3× |
| Radiologic examination knee 1/2 views (73560) range across 3 matching MRF lines |
$1,090–$1,629 | $1,090–$1,629 | varies |
| Radiologic Examination Osseous Survey Limited (77074) | $1,088 | $1,088 | 10.7× |
| Radiologic examination tibia & fibula 2 views (73590) range across 3 matching MRF lines |
$1,493–$2,233 | $1,493–$2,233 | varies |
| Ribs bilateral 3 views (71110) | $2,473 | $2,473 | 24.2× |
| Rp Loclzj Tum Plnr Whole Body Single Day Imaging (78802) | $5,273 | $5,273 | 10.0× |
| Rp Loclzj Tum Spect 1 Area Single Day Imaging (78803) | $4,657 | $4,657 | 8.8× |
| Rp Therapy Intravenous Administration (79101) | $1,134 | $1,134 | 5.0× |
| Scapula (73010) range across 3 matching MRF lines |
$1,180–$1,764 | $1,180–$1,764 | varies |
| Screening Digital Breast Tomosynthesis Bi (77063) | $84 | $84 | 3.6× |
| Shoulder 1 view (73020) range across 3 matching MRF lines |
$1,187–$1,777 | $1,187–$1,777 | varies |
| Shoulder Arthrography (73040) | $1,548 | $1,548 | 4.5× |
| Skull less than 4 views (70250) | $1,124 | $1,124 | 11.0× |
| Sternoclavicular joints (71130) | $1,008 | $1,008 | 11.9× |
| Thoracic spine 3 views (72072) | $1,568 | $1,568 | 15.4× |
| Thoracolumbar 2 views (72080) | $1,525 | $1,525 | 18.0× |
| Thyroid Met Imaging Body (78018) | $4,722 | $4,722 | 8.9× |
| Thyroid Uptake W/Blood Flow Sngle/Mult Quan Meas (78014) | $3,245 | $3,245 | 8.3× |
| Ultrasound Breast Limited (76642) | $821 | $821 | 9.7× |
| Ultrasound Elastography Parenchyma (76981) | $608 | $608 | 6.0× |
| Ultrasound Exam Aaa Screen (76706) | $696 | $696 | 6.8× |
| Ultrasound, abdomen limited (76705) | $2,611 | $2,611 | 25.6× |
| Umbilical-artery Doppler (OB) (76820) | $1,074 | $1,074 | 10.5× |
| Upper gi w/o kub (74240) | $2,235 | $2,235 | 13.1× |
| Urethrocystogram voiding (74455) | $2,847 | $2,847 | 12.2× |
| Urethrocystography retrograde (74450) | $2,539 | $2,539 | 10.9× |
| Us breast unilateral complete (76641) range across 3 matching MRF lines |
$1,173–$1,600 | $1,173–$1,600 | varies |
| Us chest (76604) | $2,038 | $2,038 | 20.0× |
| Us complete joint (76881) | $1,311 | $1,311 | 12.9× |
| Us exam, pelvic, limited (76857) | $873 | $873 | 8.6× |
| Us lmtd joint/oth nonvasc xtr strux r-t w/img (76882) | $307 | $307 | 3.0× |
| Us ob detailed single fetus (76811) | $2,746 | $2,746 | 11.8× |
| Us ob limited 1 or more fetuses (76815) | $1,311 | $1,311 | 12.9× |
| Us ob transvaginal (76817) | $1,354 | $1,354 | 13.3× |
| Us pelvic non ob complete (76856) | $2,728 | $2,728 | 26.7× |
| Us pg uter img f&mat 14 wk tabdl 1/1st gestation (76801) | $996 | $996 | 9.8× |
| Us preg uterus real time f/u trnsabdl per fetus (76816) | $873 | $873 | 8.6× |
| Us retroperitoneal complete (76770) | $2,501 | $2,501 | 24.5× |
| Us retroperitoneal limited (76775) | $2,215 | $2,215 | 21.7× |
| Us scrotum and contents (76870) | $2,340 | $2,340 | 22.9× |
| Us spinal canal and contents (76800) | $813 | $813 | 8.0× |
| Us thyroid (76536) | $2,340 | $2,340 | 22.9× |
| Vein X-Ray Chest (75827) | $7,111 | $7,111 | 4.6× |
| Venogram Sinus/Jugular (75860) | $9,678 | $9,678 | 3.1× |
| Venography caval inferior serialography rs&i (75825) | $7,111 | $7,111 | 2.3× |
| Venography extremity bilateral rs&i (75822) | $3,713 | $3,713 | 2.4× |
| Venography extremity unilateral rs&i (75820) range across 4 matching MRF lines |
$2,649–$3,453 | $2,649–$3,453 | varies |
| Venography Renal Unilateral (75831) | $9,678 | $9,678 | 3.1× |
| Wrist 2 views (73100) range across 3 matching MRF lines |
$1,076–$1,616 | $1,076–$1,616 | varies |
| X-Ray Ac Jts - Xr Acromioclavicular Joints Bilateral (73050) | $1,371 | $1,371 | 16.1× |
| X-ray antegrade pyelogram tube (74425) | $1,751 | $1,751 | 5.1× |
| X-Ray Aorta Leg Arteries (75630) | $7,404 | $7,404 | 2.4× |
| X-Ray Elbow 2 Vw - Xr Elbow 1-2 Views Right (73070) range across 3 matching MRF lines |
$1,090–$1,629 | $1,090–$1,629 | varies |
| X-Ray Exam Breast Specimen (76098) | $1,002 | $1,002 | 1.9× |
| X-Ray Exam Entire Spi 1 Vw (72081) | $1,601 | $1,601 | 18.9× |
| X-Ray Exam Entire Spi 2/3 Vw (72082) | $1,435 | $1,435 | 14.1× |
| X-Ray Exam Hip Uni 1 View (73501) | $1,081 | $1,081 | 12.7× |
| X-Ray Exam Hip Uni 2-3 Views (73502) | $1,648 | $1,648 | 19.4× |
| X-Ray Exam Hip Uni 4/> Views (73503) | $2,061 | $2,061 | 20.2× |
| X-Ray Exam Hips Bi 2 Views (73521) | $1,138 | $1,138 | 11.2× |
| X-Ray Exam Hips Bi 3-4 Views (73522) | $1,483 | $1,483 | 14.5× |
| X-Ray Exam Hips Bi 5/> Views (73523) | $1,493 | $1,493 | 14.6× |
| X-Ray Exam L-S Spine Bending (72114) | $2,235 | $2,235 | 21.9× |
| X-Ray Exam Neck Spine 2-3 Vw (72040) | $1,568 | $1,568 | 18.5× |
| X-Ray Exam Neck Spine 6/>Vws (72052) | $2,817 | $2,817 | 27.6× |
| X-Ray Exam Unilat Ribs/Chest (71101) | $2,300 | $2,300 | 22.5× |
| X-ray humerus (73060) | $1,180 | $1,180 | 13.9× |
| X-ray IV pyelogram (ivp) (74400) | $2,446 | $2,446 | 14.3× |
| X-Ray Jaw <4 Vw - Xr Mandible < 4 Views (70100) | $1,008 | $1,008 | 11.9× |
| X-Ray Lumbar Spine 2/3 Vw - Xr Lumbar Spine 2-3 Views (72100) | $1,877 | $1,877 | 18.4× |
| X-ray nose-rectum child f.b. (76010) | $907 | $907 | 10.7× |
| X-Ray Ribs, Chest 4+ Vw - Xr Ribs 3 Vws Bil W/ Chest Posteroanterior (71111) | $2,884 | $2,884 | 28.3× |
| X-Ray Sacroiliac Jts 3+ Vw - Xr Sacroiliac Joints 3+ Views (72202) | $1,398 | $1,398 | 13.7× |
| X-Ray Sacrum/Coccyx 2+ Vw - Xr Sacrum Coccyx 2+ Views (72220) | $1,525 | $1,525 | 18.0× |
| X-Ray Sinuses 3+ Vw - Xr Paranasal Sinuses 3+ Views (70220) | $1,781 | $1,781 | 21.0× |
| X-Ray Skull 4+ Vw - Xr Skull Complete 4+ Views (70260) | $2,394 | $2,394 | 23.5× |
| X-ray thoracic spine 4 vw (72074) | $2,268 | $2,268 | 22.2× |
| X-Ray Tmj Unilat (70328) | $919 | $919 | 10.8× |
| X-Ray Urinary Tract Exam With Contrast Material (74420) | $3,018 | $3,018 | 8.9× |
| X-Rays Bone Length Studies (77073) | $1,021 | $1,021 | 10.0× |
| X-Rays Bone Survey Complete (77075) | $2,299 | $2,299 | 22.5× |
| Xr c-spine 4 or 5 views (72050) | $2,323 | $2,323 | 22.8× |
| Xr facial bones less than 3 views (70140) | $1,512 | $1,512 | 17.8× |
| Xr orbits complete 4 views (70200) | $1,725 | $1,725 | 16.9× |
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.