Imaging prices at MaineHealth Memorial Hospital
North Conway, NH · every code in this section with a posted price and a Medicare benchmark.
245 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) | $269.50 | $269.50 | 2.9× |
| Abdomen 2 views (74019) | $331 | $331 | 3.0× |
| Ankle 2 views (73600) | $256.45 | $256.45 | 2.8× |
| Arthrogram ankle (73615) | $775.80 | $775.80 | 2.1× |
| Arthrogram hip (73525) | $1,108.15 | $1,108.15 | 3.0× |
| Arthrogram Wrist (73115) | $839.95 | $839.95 | 2.3× |
| Bone age studies (77072) | $298.25 | $298.25 | 2.7× |
| Bone Imaging 3 Phase (78315) | $3,137.35 | $3,137.35 | 7.3× |
| Bone Imaging Limited Area (78300) | $1,961.20 | $1,961.20 | 4.6× |
| Bone Imaging Multiple Areas (78305) | $2,400.80 | $2,400.80 | 5.6× |
| Bone Imaging Whole Body (78306) | $2,799.85 | $2,799.85 | 6.6× |
| Bone survey infant (77076) | $514.10 | $514.10 | 4.6× |
| Cat Scan Follow-Up Study (76380) | $1,279.55 | $1,279.55 | 13.8× |
| Chest 1 view (71045) | $246 | $246 | 2.6× |
| Chest 2 views (71046) | $331 | $331 | 3.6× |
| Chest 3 views (71047) | $392.45 | $392.45 | 4.2× |
| Chest 4 or more views (71048) | $413.50 | $413.50 | 3.7× |
| Clavicle complete (73000) | $269.50 | $269.50 | 2.9× |
| Computed Tomography Thorax Lw Dose Lng Ca Scr C- (71271) | $2,107.70 | $2,107.70 | 18.9× |
| Contrast X-Ray Bladder (74430) | $554.80 | $554.80 | 1.5× |
| Contrast X-Ray Of Elbow (73085) | $1,108.15 | $1,108.15 | 3.0× |
| Contrast X-Ray Of Knee Joint (73580) | $1,377.70 | $1,377.70 | 3.7× |
| CT abdomen and pelvis without and with contrast (74178) | $2,925.40 | $2,925.40 | 7.9× |
| CT abdomen and pelvis without contrast (74176) | $1,208.90 | $1,208.90 | 4.7× |
| CT abdomen w contrast (74160) | $2,400.80 | $2,400.80 | 12.8× |
| CT abdomen w wo contrast (74170) | $2,973.85 | $2,973.85 | 15.9× |
| CT abdomen w/o contrast (74150) | $1,987.35 | $1,987.35 | 17.8× |
| CT Angio Abdomen and Pelvis (74174) | $4,017.95 | $4,017.95 | 10.8× |
| CT Angio Chest (71275) | $4,260 | $4,260 | 22.7× |
| CT Angio Head (70496) | $3,727.40 | $3,727.40 | 19.9× |
| Ct Angio Lwr Extr W/O&W/Dye (73706) | $3,783.70 | $3,783.70 | 20.2× |
| CT Angio Neck (70498) | $3,727.40 | $3,727.40 | 19.9× |
| Ct Angio Upr Extrm W/O&W/Dye (73206) | $3,783.70 | $3,783.70 | 20.2× |
| CT cervical spine w/o contrast (72125) | $2,107.70 | $2,107.70 | 18.9× |
| CT chest w contrast (71260) | $2,481.90 | $2,481.90 | 13.3× |
| CT chest w/wo contrast (71270) | $3,104.70 | $3,104.70 | 16.6× |
| CT head/brain with contrast (70460) | $1,987.35 | $1,987.35 | 10.6× |
| CT head/brain without and with contrast (70470) | $2,481.90 | $2,481.90 | 13.3× |
| CT heart no contrast quant eval coronry calcium (75571) | $225.10 | $225.10 | 2.4× |
| CT iac w contrast (70481) | $1,987.35 | $1,987.35 | 10.6× |
| CT l-spine w&w/o contrast (72133) | $3,104.70 | $3,104.70 | 16.6× |
| CT lower ext w/o (73700) | $2,599.70 | $2,599.70 | 23.3× |
| CT lower extremity w/contrast material (73701) | $2,716.15 | $2,716.15 | 14.5× |
| CT lumbar spine w contrast (72132) | $2,481.90 | $2,481.90 | 6.7× |
| CT lumbar spine w/o contrast (72131) | $2,107.70 | $2,107.70 | 18.9× |
| CT maxillofacial w contrast (70487) | $1,987.35 | $1,987.35 | 10.6× |
| CT maxillofacial wo contrast (70486) | $1,728.30 | $1,728.30 | 15.5× |
| CT neck tissue combo (70492) | $2,481.90 | $2,481.90 | 13.3× |
| Ct Orbit/Ear/Fossa W/O&W/Dye (70482) | $2,481.90 | $2,481.90 | 13.3× |
| CT orbits w/o contrast (70480) | $1,728.30 | $1,728.30 | 15.5× |
| CT pelvis w&w/o contrast (72194) | $2,973.85 | $2,973.85 | 15.9× |
| CT pelvis w/o contrast (72192) | $2,107.70 | $2,107.70 | 18.9× |
| CT scan of leg combo (73702) | $3,410.90 | $3,410.90 | 18.2× |
| CT scans face/jaw combo (70488) | $2,481.90 | $2,481.90 | 13.3× |
| CT soft tissue neck w contrast (70491) | $1,987.35 | $1,987.35 | 10.6× |
| CT soft tissue neck w/o contrast (70490) | $1,728.30 | $1,728.30 | 15.5× |
| CT thoracic spine w contrast (72129) | $2,481.90 | $2,481.90 | 13.3× |
| CT thoracic spine w/o contrast (72128) | $2,107.70 | $2,107.70 | 18.9× |
| CT thorax w/o contrast (71250) | $2,107.70 | $2,107.70 | 18.9× |
| CT upper ext wo (73200) | $2,599.70 | $2,599.70 | 23.3× |
| CT upper extremity w/o & w/contrast material (73202) | $3,410.90 | $3,410.90 | 18.2× |
| CT upper extremity with contrast (73201) | $2,716.15 | $2,716.15 | 7.3× |
| Cta Abdl Aorta&Bi Iliofem W/Contrast&Postp (75635) | $5,433.55 | $5,433.55 | 29.0× |
| Cta Abdomen (74175) | $4,139.55 | $4,139.55 | 22.1× |
| CTA pelvis (72191) | $2,105.20 | $2,105.20 | 11.2× |
| Doppler Fetal Mid Cerebral Artery (76821) | $654.20 | $654.20 | 5.9× |
| Dxa Bone Density Axial (77080) | $1,000.90 | $1,000.90 | 9.0× |
| Dxa bone density study (77085) | $529.90 | $529.90 | 4.7× |
| Echo exam uterus (76831) | $809.85 | $809.85 | 3.2× |
| Esophagram (74220) | $625.40 | $625.40 | 3.3× |
| Fetal Biophys Profile W/Nst (76818) | $855.65 | $855.65 | 7.7× |
| Fetal Biophysical Profile W/O Non-Stress Testing (76819) | $855.65 | $855.65 | 7.7× |
| Fluoroscopy up to 1 hr (76000) | $696.05 | $696.05 | 2.7× |
| Foot 2 views (73620) | $277.35 | $277.35 | 3.0× |
| Forearm 2 views (73090) | $269.50 | $269.50 | 2.9× |
| Gastric emptying imaging study (78264) | $2,713.45 | $2,713.45 | 6.4× |
| Gated Heart Planar Single (78472) | $3,624.15 | $3,624.15 | 8.5× |
| Hand 2 views (73120) | $256.45 | $256.45 | 2.3× |
| Hepatobil Syst Image W/Drug (78227) | $3,863.55 | $3,863.55 | 6.7× |
| Hepatobiliary System Imaging (78226) | $1,894 | $1,894 | 4.4× |
| Ht Muscle Image Spect Sing (78451) | $2,560.40 | $2,560.40 | 1.9× |
| Hysterosalpingogram (74740) | $689.50 | $689.50 | 2.7× |
| K Flow/Funct Image Multiple (78709) | $2,931.95 | $2,931.95 | 5.1× |
| K Flow/Funct Image W/Drug (78708) | $2,931.95 | $2,931.95 | 5.1× |
| K Flow/Funct Image W/O Drug (78707) | $2,093.35 | $2,093.35 | 3.6× |
| Knee 3 Views (73562) | $304.90 | $304.90 | 3.3× |
| Lung Perf&Ventilat Diferentl (78598) | $2,385.10 | $2,385.10 | 4.1× |
| Lung perfusion differential (78597) | $1,589.65 | $1,589.65 | 3.7× |
| Lung Ventilat&Perfus Imaging (78582) | $3,579.65 | $3,579.65 | 6.2× |
| Lung Ventilation Imaging (78579) | $2,493.70 | $2,493.70 | 5.8× |
| Lymph System Imaging (78195) | $2,676.85 | $2,676.85 | 4.6× |
| Magnetic Image Jaw Joint (70336) | $3,932.90 | $3,932.90 | 15.4× |
| Meckels Divert Exam (78290) | $2,000.45 | $2,000.45 | 4.7× |
| Mr safety determination physician/other qhp (76016) | $176.10 | $176.10 | 1.9× |
| Mr safety implant&/fb assmt clin staf 1st 15 min (76014) | $49 | $49 | 1.6× |
| Mr safety implt electronics prepj supvj phys/qhp (76018) | $183.60 | $183.60 | 1.8× |
| Mr safety implt pos&/immoblj (76019) | $118.80 | $118.80 | 1.9× |
| Mr safety med physics xm customization plng&mntr (76017) | $483.45 | $483.45 | 1.9× |
| MRA head w/o contrast (70544) | $3,932.90 | $3,932.90 | 15.4× |
| Mra Neck W/O &W/Contrast Material (70549) | $7,666.90 | $7,666.90 | 20.6× |
| MRA neck w/o contrast (70547) | $3,932.90 | $3,932.90 | 15.4× |
| MRI abdomen w contrast (74182) | $4,655.10 | $4,655.10 | 12.5× |
| MRI abdomen w/o contrast (74181) | $3,883.20 | $3,883.20 | 15.2× |
| MRI any jt lower extrem w/contrast material (73722) | $3,945.95 | $3,945.95 | 4.7× |
| MRI any jt lower extrem w/o & w/contrast matrl (73723) | $6,736.70 | $6,736.70 | 18.1× |
| MRI any jt upper extremity w/contrast matrl (73222) | $3,989.15 | $3,989.15 | 4.8× |
| MRI cervical spine w contrast (72142) | $4,713.95 | $4,713.95 | 12.7× |
| MRI cervical spine w/o cont (72141) | $3,932.90 | $3,932.90 | 15.4× |
| MRI chest w/o contrast (71550) | $3,883.20 | $3,883.20 | 15.2× |
| MRI chest with contrast (71551) | $4,655.10 | $4,655.10 | 5.6× |
| MRI chest wo w contrast (71552) | $8,522.55 | $8,522.55 | 22.9× |
| MRI lower extrem oth/thn jt w/contrast matrl (73719) | $3,989.15 | $3,989.15 | 10.7× |
| MRI lower extrem oth/thn jt w/o & w/contr matr (73720) | $6,736.70 | $6,736.70 | 18.1× |
| MRI lower extrem oth/thn jt w/o contr matrl (73718) | $3,614.95 | $3,614.95 | 14.2× |
| MRI lumbar spine w contrast (72149) | $4,713.95 | $4,713.95 | 12.7× |
| Mri Neck Spine W/O & W/Dye (72156) | $8,730.55 | $8,730.55 | 23.4× |
| MRI orbit face &/neck w/o contrast (70540) | $3,864.90 | $3,864.90 | 15.2× |
| Mri Orbt/Fac/Nck W/O &W/Dye (70543) | $8,574.90 | $8,574.90 | 23.0× |
| MRI pelvis w contrast (72196) | $4,655.10 | $4,655.10 | 12.5× |
| MRI pelvis w/o & w contrast (72197) | $8,602.30 | $8,602.30 | 23.1× |
| MRI pelvis w/o contrast (72195) | $3,883.20 | $3,883.20 | 15.2× |
| MRI thoracic spine w/o contrast (72146) | $4,362 | $4,362 | 17.1× |
| MRI upper extremity oth than jt w/contr matrl (73219) | $3,989.15 | $3,989.15 | 10.7× |
| MRI upper extremity oth than jt w/o contr matrl (73218) | $3,614.95 | $3,614.95 | 14.2× |
| Mri Uppr Extremity W/O&W/Dye (73220) | $6,736.70 | $6,736.70 | 18.1× |
| MRI, abdomen, combo (74183) | $8,602.30 | $8,602.30 | 23.1× |
| MRI, dorsal spine combo (72157) | $8,730.55 | $8,730.55 | 23.4× |
| MRI, dorsal spine contrast (72147) | $4,713.95 | $4,713.95 | 12.7× |
| MRI, joint upper extrem (73221) | $3,614.95 | $3,614.95 | 14.2× |
| MRI, joint upper extrem combo (73223) | $6,736.70 | $6,736.70 | 18.1× |
| MRI, lumbar spine combo (72158) | $8,730.55 | $8,730.55 | 23.4× |
| Myocardial Spect Multiple Studies (78452) | $2,642.90 | $2,642.90 | 1.9× |
| Neck soft tissue (70360) | $221.15 | $221.15 | 2.4× |
| Nonvascular Shunt X-Ray (75809) | $413.50 | $413.50 | 3.7× |
| Ophthalmic ultrasound dx b-scan w/wo a-scan (76512) | $265.85 | $265.85 | 2.4× |
| Optic foramina (70190) | $331 | $331 | 3.6× |
| Pelvis 1 or 2 views (72170) | $269.50 | $269.50 | 2.4× |
| Pulmonary Perfusion Imaging Particulate (78580) | $2,251.60 | $2,251.60 | 5.3× |
| Radex Abd Compl Aqt Abd W/S/E/D Views 1 View Ch (74022) | $392.45 | $392.45 | 3.5× |
| Radex Ankle Complete Minimum 3 Views (73610) | $277.35 | $277.35 | 3.0× |
| Radex Calcaneus Minimum 2 Views (73650) | $268.20 | $268.20 | 2.9× |
| Radex elbow complete minimum 3 views (73080) | $304.90 | $304.90 | 3.3× |
| Radex Facial Bones Complete Minimum 3 Views (70150) | $413.50 | $413.50 | 3.7× |
| Radex fingr minimum 2 views (73140) | $221.15 | $221.15 | 2.4× |
| Radex foot complete minimum 3 views (73630) | $337.55 | $337.55 | 3.6× |
| Radex Hand Minimum 3 Views (73130) | $277.35 | $277.35 | 3.0× |
| Radex lower extremity infant minimum 2 views (73592) | $256.45 | $256.45 | 2.8× |
| Radex Nasal Bones Complete Minimum 3 Views (70160) | $269.50 | $269.50 | 2.9× |
| Radex Ribs Unilateral 2 Views (71100) | $304.90 | $304.90 | 3.3× |
| Radex shoulder complete minimum 2 views (73030) | $304.90 | $304.90 | 3.3× |
| Radex Sinuses Paransl < 3 Views (70210) | $331 | $331 | 3.6× |
| Radex Spine 1 View Specify Level (72020) | $221.15 | $221.15 | 2.4× |
| Radex Sternum Minimum 2 Views (71120) | $346.75 | $346.75 | 3.7× |
| Radex Temporomandble Jt Opn & Clsd Mouth Bilat (70330) | $444.80 | $444.80 | 4.8× |
| Radex Toe Minimum 2 Views (73660) | $221.15 | $221.15 | 2.4× |
| Radex upper extremity infant minimum 2 views (73092) | $256.45 | $256.45 | 2.3× |
| Radex Wrist Complete Minimum 3 Views (73110) | $312.70 | $312.70 | 3.4× |
| Radiolog exam mandible compl minimum 4 views (70110) | $417.30 | $417.30 | 3.7× |
| Radiologic exam colon double contrast study (74280) | $1,180.10 | $1,180.10 | 6.3× |
| Radiologic exam colon single contrast study (74270) | $904.05 | $904.05 | 4.8× |
| Radiologic Exam Esophagus Double Contrast Study (74221) | $625.40 | $625.40 | 3.3× |
| Radiologic exam knee complete 4/more views (73564) | $331 | $331 | 3.0× |
| Radiologic exam pelvis compl minimum 3 views (72190) | $355.90 | $355.90 | 3.2× |
| Radiologic Exam Small Int Single Contrast Study (74250) | $689.50 | $689.50 | 3.7× |
| Radiologic exam swallow function contrast study (74230) | $689.50 | $689.50 | 3.7× |
| Radiologic exam upr gi trc double contrast study (74246) | $870 | $870 | 4.6× |
| Radiologic examination femur 1 view (73551) | $209.35 | $209.35 | 2.3× |
| Radiologic examination femur minimum 2 views (73552) | $304.90 | $304.90 | 3.3× |
| Radiologic examination knee 1/2 views (73560) | $269.50 | $269.50 | 2.9× |
| Radiologic Examination Osseous Survey Limited (77074) | $554.80 | $554.80 | 5.0× |
| Radiologic examination tibia & fibula 2 views (73590) | $268.20 | $268.20 | 2.9× |
| Ribs bilateral 3 views (71110) | $413.50 | $413.50 | 3.7× |
| Rp Loclzj Tum Spect 1 Area Single Day Imaging (78803) | $2,451.80 | $2,451.80 | 4.2× |
| Scapula (73010) | $269.50 | $269.50 | 2.4× |
| Screening Digital Breast Tomosynthesis Bi (77063) | $261.65 | $261.65 | 11.2× |
| Shoulder 1 view (73020) | $246 | $246 | 2.6× |
| Shoulder Arthrography (73040) | $1,108.15 | $1,108.15 | 3.0× |
| Skull less than 4 views (70250) | $331 | $331 | 3.0× |
| Sternoclavicular joints (71130) | $376.80 | $376.80 | 4.1× |
| Thoracic spine 2 views (72070) | $346.75 | $346.75 | 3.1× |
| Thoracic spine 3 views (72072) | $392.45 | $392.45 | 3.5× |
| Thoracolumbar 2 views (72080) | $355.90 | $355.90 | 3.8× |
| Thyroid Uptake W/Blood Flow Sngle/Mult Quan Meas (78014) | $1,957.30 | $1,957.30 | 4.6× |
| Ultrasound Breast Limited (76642) | $485.40 | $485.40 | 5.2× |
| Ultrasound Exam Aaa Screen (76706) | $761.45 | $761.45 | 6.8× |
| Ultrasound, abdomen limited (76705) | $747.15 | $747.15 | 6.7× |
| Umbilical-artery Doppler (OB) (76820) | $397.70 | $397.70 | 3.6× |
| Upper gi w/o kub (74240) | $769.35 | $769.35 | 4.1× |
| Urethrocystogram voiding (74455) | $839.95 | $839.95 | 3.3× |
| Urethrocystography retrograde (74450) | $927.65 | $927.65 | 3.6× |
| Us breast unilateral complete (76641) | $554.80 | $554.80 | 5.0× |
| Us chest (76604) | $689.50 | $689.50 | 6.2× |
| Us complete joint (76881) | $696.05 | $696.05 | 6.2× |
| Us exam, pelvic, limited (76857) range across 2 matching MRF lines |
$51–$673.85 | $51–$673.85 | varies |
| Us lmtd joint/oth nonvasc xtr strux r-t w/img (76882) range across 2 matching MRF lines |
$72–$226.30 | $72–$226.30 | varies |
| Us ob detailed single fetus (76811) | $1,183.80 | $1,183.80 | 4.6× |
| Us ob limited 1 or more fetuses (76815) range across 2 matching MRF lines |
$111.20–$747.15 | $111.20–$747.15 | varies |
| Us ob transvaginal (76817) range across 2 matching MRF lines |
$130.85–$809.85 | $130.85–$809.85 | varies |
| Us pelvic non ob complete (76856) | $809.85 | $809.85 | 7.3× |
| Us pg uter img f&mat 14 wk tabdl 1/1st gestation (76801) | $1,108.15 | $1,108.15 | 9.9× |
| Us preg uterus real time f/u trnsabdl per fetus (76816) range across 2 matching MRF lines |
$150.50–$785 | $150.50–$785 | varies |
| Us retroperitoneal complete (76770) | $1,040.15 | $1,040.15 | 9.3× |
| Us retroperitoneal limited (76775) range across 2 matching MRF lines |
$60–$522 | $60–$522 | varies |
| Us scrotum and contents (76870) | $821.60 | $821.60 | 7.4× |
| Us spinal canal and contents (76800) | $751 | $751 | 6.7× |
| Us thyroid (76536) | $822.90 | $822.90 | 7.4× |
| Vertebral fracture assessment via dxa (77086) | $133.45 | $133.45 | 1.4× |
| Wrist 2 views (73100) | $256.45 | $256.45 | 2.8× |
| X-Ray Ac Jts - Xr Acromioclavicular Joints Bilateral (73050) | $444.80 | $444.80 | 4.8× |
| X-ray antegrade pyelogram tube (74425) | $689.50 | $689.50 | 1.9× |
| X-Ray Bend Only L-S Spine (72120) | $476.20 | $476.20 | 4.3× |
| X-Ray Elbow 2 Vw - Xr Elbow 1-2 Views Right (73070) | $269.50 | $269.50 | 2.9× |
| X-Ray Exam Breast Specimen (76098) | $268.20 | $268.20 | 0.5× |
| X-Ray Exam Entire Spi 1 Vw (72081) | $226.30 | $226.30 | 2.4× |
| X-Ray Exam Entire Spi 2/3 Vw (72082) | $268.20 | $268.20 | 2.4× |
| X-Ray Exam Entire Spi 4/5 Vw (72083) | $272.40 | $272.40 | 2.4× |
| X-Ray Exam Hip Uni 1 View (73501) | $247.30 | $247.30 | 2.7× |
| X-Ray Exam Hip Uni 2-3 Views (73502) | $304.90 | $304.90 | 3.3× |
| X-Ray Exam Hip Uni 4/> Views (73503) | $378.10 | $378.10 | 3.4× |
| X-Ray Exam Hips Bi 2 Views (73521) | $490.60 | $490.60 | 4.4× |
| X-Ray Exam Hips Bi 3-4 Views (73522) | $371.60 | $371.60 | 3.3× |
| X-Ray Exam Hips Bi 5/> Views (73523) | $626.70 | $626.70 | 5.6× |
| X-Ray Exam L-S Spine Bending (72114) | $625.40 | $625.40 | 5.6× |
| X-Ray Exam Neck Spine 2-3 Vw (72040) | $321.85 | $321.85 | 3.5× |
| X-Ray Exam Neck Spine 6/>Vws (72052) | $595.30 | $595.30 | 5.3× |
| X-Ray Exam Unilat Ribs/Chest (71101) | $355.90 | $355.90 | 3.2× |
| X-ray eye for foreign body (70030) | $221.15 | $221.15 | 2.4× |
| X-ray humerus (73060) | $304.90 | $304.90 | 3.3× |
| X-Ray Jaw <4 Vw - Xr Mandible < 4 Views (70100) | $269.50 | $269.50 | 2.9× |
| X-Ray Knee Bilat Standing - Xr Knees Anteroposterior Standing Bilat (73565) | $298.25 | $298.25 | 3.2× |
| X-Ray Lumbar Spine 2/3 Vw - Xr Lumbar Spine 2-3 Views (72100) | $355.90 | $355.90 | 3.2× |
| X-ray nose-rectum child f.b. (76010) | $269.50 | $269.50 | 2.9× |
| X-Ray Ribs, Chest 4+ Vw - Xr Ribs 3 Vws Bil W/ Chest Posteroanterior (71111) | $476.20 | $476.20 | 4.3× |
| X-Ray Sacroiliac Jts 3+ Vw - Xr Sacroiliac Joints 3+ Views (72202) | $331 | $331 | 3.0× |
| X-Ray Sacroiliac Jts <3 Vw - Xr Sacroiliac Joints 1-2 Views (72200) | $269.50 | $269.50 | 2.4× |
| X-Ray Sacrum/Coccyx 2+ Vw - Xr Sacrum Coccyx 2+ Views (72220) | $304.90 | $304.90 | 3.3× |
| X-Ray Sinuses 3+ Vw - Xr Paranasal Sinuses 3+ Views (70220) | $413.50 | $413.50 | 4.5× |
| X-Ray Skull 4+ Vw - Xr Skull Complete 4+ Views (70260) | $476.20 | $476.20 | 4.3× |
| X-ray thoracic spine 4 vw (72074) | $485.40 | $485.40 | 4.3× |
| X-Ray Urinary Tract Exam With Contrast Material (74420) | $1,231.15 | $1,231.15 | 3.3× |
| X-Rays Bone Length Studies (77073) | $386 | $386 | 3.5× |
| X-Rays Bone Survey Complete (77075) | $829.50 | $829.50 | 7.4× |
| Xr c-spine 4 or 5 views (72050) | $476.20 | $476.20 | 4.3× |
| Xr facial bones less than 3 views (70140) | $331 | $331 | 3.6× |
| Xr orbits complete 4 views (70200) | $413.50 | $413.50 | 3.7× |
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.