Imaging prices at MercyOne Genesis Dewitt Medical Center
Dewitt, IA · every code in this section with a posted price and a Medicare benchmark.
237 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) | $154.80 | $258 | 1.9× |
| Abdomen 2 views (74019) | $183.60 | $306 | 1.8× |
| Angiography extremity bilateral rs&i (75716) | $133.20 | $222 | 0.0× |
| Angiography extremity unilateral rs&i (75710) | $118.20 | $197 | 0.0× |
| Ankle 2 views (73600) range across 6 matching MRF lines |
$133.80–$200.40 | $223–$334 | varies |
| Aortography thoracic serialography rs&i (75605) likely a partial charge, not the full procedure |
$114 | $190 | 0.0× |
| Aortography thoracic w/o serialography rs&i (75600) | $47.40 | $79 | 0.0× |
| Artery X-Rays Abdomen (75726) likely a partial charge, not the full procedure |
$299.40 | $499 | 0.1× |
| Artery X-Rays Pelvis (75736) likely a partial charge, not the full procedure |
$94.80 | $158 | 0.0× |
| Bone age studies (77072) | $130.20 | $217 | 1.3× |
| Bone survey infant (77076) | $469.20 | $782 | 4.7× |
| Cardiac MRI w/w/o contrast & further seq (75561) | $1,499.40 | $2,499 | 4.5× |
| Cardiac MRI w/w/o contrast w/stress (75563) | $2,499.60 | $4,166 | 3.3× |
| Cat Scan Follow-Up Study (76380) range across 3 matching MRF lines |
$417–$447.60 | $695–$746 | varies |
| Chest 1 view (71045) | $129 | $215 | 1.5× |
| Chest 2 views (71046) range across 5 matching MRF lines |
$160.80–$201.60 | $268–$336 | varies |
| Chest 3 views (71047) | $219.60 | $366 | 2.6× |
| Chest 4 or more views (71048) | $247.80 | $413 | 2.5× |
| Clavicle complete (73000) range across 3 matching MRF lines |
$196.80–$295.20 | $328–$492 | varies |
| Computed Tomography Thorax Lw Dose Lng Ca Scr C- (71271) | $420.60 | $701 | 4.2× |
| Contrast Exam Abdominl Aorta (75625) | $120.60 | $201 | 0.0× |
| Contrast X-Ray Bladder (74430) | $318.60 | $531 | 0.9× |
| CT abdomen and pelvis without and with contrast (74178) | $3,022.80 | $5,038 | 9.0× |
| CT abdomen and pelvis without contrast (74176) | $2,240.40 | $3,734 | 9.8× |
| CT abdomen w contrast (74160) | $1,473.60 | $2,456 | 8.7× |
| CT abdomen w wo contrast (74170) range across 2 matching MRF lines |
$1,077.60–$1,659.60 | $1,796–$2,766 | varies |
| CT abdomen w/o contrast (74150) | $1,077.60 | $1,796 | 10.7× |
| CT Angio Abdomen and Pelvis (74174) | $1,978.20 | $3,297 | 5.9× |
| CT Angio Chest (71275) | $1,627.20 | $2,712 | 9.7× |
| CT Angio Head (70496) | $1,656.60 | $2,761 | 9.8× |
| Ct Angio Lwr Extr W/O&W/Dye (73706) range across 4 matching MRF lines |
$1,912.20–$2,868 | $3,187–$4,780 | varies |
| CT Angio Neck (70498) | $1,656.60 | $2,761 | 9.8× |
| Ct Angio Upr Extrm W/O&W/Dye (73206) range across 4 matching MRF lines |
$1,431.60–$2,147.40 | $2,386–$3,579 | varies |
| CT cervical spine w/ contrast (72126) | $1,708.20 | $2,847 | 5.1× |
| CT cervical spine w/o contrast (72125) | $1,435.80 | $2,393 | 14.3× |
| CT cervical spine w/wo cont (72127) | $1,952.40 | $3,254 | 11.6× |
| CT chest w contrast (71260) | $1,554.60 | $2,591 | 9.2× |
| CT chest w/wo contrast (71270) | $1,603.20 | $2,672 | 9.5× |
| CT head/brain with contrast (70460) | $1,263.60 | $2,106 | 7.5× |
| CT head/brain without and with contrast (70470) | $1,509 | $2,515 | 8.9× |
| CT iac w contrast (70481) | $1,222.20 | $2,037 | 7.2× |
| CT l-spine w&w/o contrast (72133) | $1,909.80 | $3,183 | 11.3× |
| CT lower ext w/o (73700) range across 3 matching MRF lines |
$1,116–$1,674 | $1,860–$2,790 | varies |
| CT lower extremity w/contrast material (73701) range across 6 matching MRF lines |
$1,128.60–$1,693.20 | $1,881–$2,822 | varies |
| CT lumbar spine w contrast (72132) | $1,486.20 | $2,477 | 4.4× |
| CT lumbar spine w/o contrast (72131) | $1,414.80 | $2,358 | 14.1× |
| CT maxillofacial w contrast (70487) | $1,342.80 | $2,238 | 8.0× |
| CT maxillofacial wo contrast (70486) | $1,021.80 | $1,703 | 10.2× |
| CT neck tissue combo (70492) | $1,374.60 | $2,291 | 8.2× |
| Ct Orbit/Ear/Fossa W/O&W/Dye (70482) | $1,249.80 | $2,083 | 7.4× |
| CT orbits w/o contrast (70480) | $988.80 | $1,648 | 9.8× |
| CT pelvis w&w/o contrast (72194) | $1,521.60 | $2,536 | 9.0× |
| CT pelvis w/o contrast (72192) | $1,170.60 | $1,951 | 11.6× |
| CT scan of leg combo (73702) range across 3 matching MRF lines |
$1,308.60–$1,963.20 | $2,181–$3,272 | varies |
| CT scans face/jaw combo (70488) | $1,351.80 | $2,253 | 8.0× |
| CT soft tissue neck w contrast (70491) | $1,365.60 | $2,276 | 8.1× |
| CT soft tissue neck w/o contrast (70490) | $1,053 | $1,755 | 10.5× |
| CT thoracic spine w contrast (72129) | $1,443 | $2,405 | 8.6× |
| CT thoracic spine w/o contrast (72128) | $1,381.20 | $2,302 | 13.7× |
| CT thoracic spine w/wo cont (72130) | $1,612.20 | $2,687 | 9.6× |
| CT thorax w/o contrast (71250) | $1,145.40 | $1,909 | 11.4× |
| CT upper ext wo (73200) range across 3 matching MRF lines |
$1,163.40–$1,744.80 | $1,939–$2,908 | varies |
| CT upper extremity w/o & w/contrast material (73202) range across 3 matching MRF lines |
$1,114.80–$1,672.20 | $1,858–$2,787 | varies |
| CT upper extremity with contrast (73201) range across 12 matching MRF lines |
$1,168.80–$1,753.80 | $1,948–$2,923 | varies |
| Cta Abdl Aorta&Bi Iliofem W/Contrast&Postp (75635) | $1,914 | $3,190 | 11.4× |
| Cta Abdomen (74175) | $1,745.40 | $2,909 | 10.4× |
| Dxa Bone Density Axial (77080) | $246 | $410 | 2.4× |
| Dxa bone density study 1/>sites appendiclr skel (77081) | $229.20 | $382 | 2.7× |
| Echo exam uterus (76831) | $309.60 | $516 | 1.3× |
| Esophagram (74220) | $321.60 | $536 | 1.9× |
| Fetal Biophys Profile W/Nst (76818) | $396.60 | $661 | 3.9× |
| Fetal Biophysical Profile W/O Non-Stress Testing (76819) | $324 | $540 | 3.2× |
| Fluoroscopy up to 1 hr (76000) range across 4 matching MRF lines |
$282.60–$291 | $471–$485 | varies |
| Foot 2 views (73620) range across 5 matching MRF lines |
$121.80–$183 | $203–$305 | varies |
| Forearm 2 views (73090) range across 3 matching MRF lines |
$193.20–$289.20 | $322–$482 | varies |
| Hand 2 views (73120) range across 6 matching MRF lines |
$141–$210.60 | $235–$351 | varies |
| Hysterosalpingogram (74740) | $519.60 | $866 | 2.3× |
| Infant hip ultrasound with hip movement (dynamic) (76885) | $245.40 | $409 | 2.9× |
| Joint Survey Single View (77077) | $121.20 | $202 | 1.2× |
| Knee 3 Views (73562) range across 3 matching MRF lines |
$192.60–$288.60 | $321–$481 | varies |
| Magnetic Image Jaw Joint (70336) | $1,246.80 | $2,078 | 5.4× |
| Mammary ductogram or galactogram multiple (77054) | $231.60 | $386 | 1.0× |
| Mra Head W/O & W/Contrast Material (70546) | $2,329.20 | $3,882 | 6.9× |
| MRA head w/o contrast (70544) | $1,755.60 | $2,926 | 7.7× |
| MRA head with contrast (70545) | $1,891.80 | $3,153 | 5.6× |
| MRA neck w contrast (70548) | $1,764 | $2,940 | 5.3× |
| Mra Neck W/O &W/Contrast Material (70549) | $2,544.60 | $4,241 | 7.6× |
| MRI abdomen w contrast (74182) | $1,061.40 | $1,769 | 3.2× |
| MRI abdomen w/o contrast (74181) | $1,544.40 | $2,574 | 6.7× |
| MRI any jt lower extrem w/contrast material (73722) range across 8 matching MRF lines |
$1,779–$2,693.40 | $2,965–$4,489 | varies |
| MRI any jt lower extrem w/o & w/contrast matrl (73723) range across 12 matching MRF lines |
$2,454.60–$3,717 | $4,091–$6,195 | varies |
| MRI any jt upper extremity w/contrast matrl (73222) range across 6 matching MRF lines |
$1,605.60–$2,408.40 | $2,676–$4,014 | varies |
| MRI Breast W/O Contrast Bilateral (77047) | $1,151.40 | $1,919 | 5.0× |
| MRI cardiac w/o contrast (75557) | $1,232.40 | $2,054 | 5.4× |
| MRI cervical spine w contrast (72142) | $1,275.60 | $2,126 | 3.8× |
| MRI cervical spine w/o cont (72141) | $1,741.80 | $2,903 | 7.6× |
| MRI chest w/o contrast (71550) | $1,432.20 | $2,387 | 6.2× |
| MRI chest with contrast (71551) | $1,556.40 | $2,594 | 2.1× |
| MRI chest wo w contrast (71552) | $2,305.20 | $3,842 | 6.9× |
| MRI lower extrem oth/thn jt w/contrast matrl (73719) range across 13 matching MRF lines |
$1,560–$2,340.60 | $2,600–$3,901 | varies |
| MRI lower extrem oth/thn jt w/o & w/contr matr (73720) range across 10 matching MRF lines |
$2,527.80–$3,791.40 | $4,213–$6,319 | varies |
| MRI lower extrem oth/thn jt w/o contr matrl (73718) range across 11 matching MRF lines |
$1,608–$2,412 | $2,680–$4,020 | varies |
| MRI lumbar spine w contrast (72149) | $1,275.60 | $2,126 | 3.8× |
| Mri Neck Spine W/O & W/Dye (72156) | $2,361.60 | $3,936 | 7.0× |
| MRI orbit face &/neck w/o contrast (70540) | $1,522.20 | $2,537 | 6.6× |
| MRI orbit face neck w contrast (70542) | $1,662 | $2,770 | 5.0× |
| Mri Orbt/Fac/Nck W/O &W/Dye (70543) | $2,674.20 | $4,457 | 8.0× |
| MRI pelvis w contrast (72196) | $1,741.20 | $2,902 | 5.2× |
| MRI pelvis w/o & w contrast (72197) range across 4 matching MRF lines |
$2,391–$2,616 | $3,985–$4,360 | varies |
| MRI pelvis w/o contrast (72195) | $1,576.80 | $2,628 | 6.9× |
| MRI spectroscopy (76390) | $1,117.20 | $1,862 | 13.4× |
| MRI thoracic spine w/o contrast (72146) | $1,741.80 | $2,903 | 7.6× |
| MRI upper extremity oth than jt w/contr matrl (73219) range across 9 matching MRF lines |
$1,061.40–$1,591.80 | $1,769–$2,653 | varies |
| MRI upper extremity oth than jt w/o contr matrl (73218) range across 9 matching MRF lines |
$1,347–$2,020.80 | $2,245–$3,368 | varies |
| Mri Uppr Extremity W/O&W/Dye (73220) range across 9 matching MRF lines |
$2,499.60–$3,748.80 | $4,166–$6,248 | varies |
| MRI, abdomen, combo (74183) | $3,073.80 | $5,123 | 9.2× |
| MRI, dorsal spine combo (72157) | $2,361.60 | $3,936 | 7.0× |
| MRI, dorsal spine contrast (72147) | $1,275.60 | $2,126 | 3.8× |
| MRI, joint upper extrem (73221) range across 10 matching MRF lines |
$1,461.60–$2,193.60 | $2,436–$3,656 | varies |
| MRI, joint upper extrem combo (73223) range across 13 matching MRF lines |
$2,086.80–$3,769.80 | $3,478–$6,283 | varies |
| MRI, lumbar spine combo (72158) | $2,361.60 | $3,936 | 7.0× |
| Neck soft tissue (70360) | $144.60 | $241 | 1.7× |
| Ob us nuchal meas 1 gest (76813) | $220.80 | $368 | 2.2× |
| Panoramic X-ray of jaws (70355) | $127.80 | $213 | 1.5× |
| Pelvis 1 or 2 views (72170) | $172.80 | $288 | 1.7× |
| Radex Abd Compl Aqt Abd W/S/E/D Views 1 View Ch (74022) | $252 | $420 | 2.5× |
| Radex abscess/fistula/sinus tract rs&i (76080) | $383.40 | $639 | 0.7× |
| Radex Ankle Complete Minimum 3 Views (73610) range across 3 matching MRF lines |
$186.60–$280.80 | $311–$468 | varies |
| Radex Calcaneus Minimum 2 Views (73650) range across 6 matching MRF lines |
$172.80–$259.20 | $288–$432 | varies |
| Radex elbow complete minimum 3 views (73080) range across 3 matching MRF lines |
$195.60–$293.40 | $326–$489 | varies |
| Radex Facial Bones Complete Minimum 3 Views (70150) | $294.60 | $491 | 2.9× |
| Radex fingr minimum 2 views (73140) range across 6 matching MRF lines |
$141.60–$211.80 | $236–$353 | varies |
| Radex foot complete minimum 3 views (73630) range across 3 matching MRF lines |
$186.60–$280.80 | $311–$468 | varies |
| Radex Hand Minimum 3 Views (73130) range across 3 matching MRF lines |
$176.40–$264.60 | $294–$441 | varies |
| Radex lower extremity infant minimum 2 views (73592) range across 3 matching MRF lines |
$154.80–$232.20 | $258–$387 | varies |
| Radex Mastoids Compl Minimum 3 Views PR Side (70130) | $235.20 | $392 | 2.3× |
| Radex Nasal Bones Complete Minimum 3 Views (70160) | $197.40 | $329 | 2.4× |
| Radex Ribs Unilateral 2 Views (71100) | $243.60 | $406 | 2.9× |
| Radex shoulder complete minimum 2 views (73030) range across 3 matching MRF lines |
$200.40–$300.60 | $334–$501 | varies |
| Radex Sinuses Paransl < 3 Views (70210) | $207.60 | $346 | 2.5× |
| Radex Spine 1 View Specify Level (72020) | $148.20 | $247 | 1.8× |
| Radex Sternum Minimum 2 Views (71120) | $176.40 | $294 | 2.1× |
| Radex Temporomandble Jt Opn & Clsd Mouth Bilat (70330) | $232.20 | $387 | 2.8× |
| Radex Toe Minimum 2 Views (73660) range across 6 matching MRF lines |
$150.60–$226.20 | $251–$377 | varies |
| Radex upper extremity infant minimum 2 views (73092) range across 3 matching MRF lines |
$130.20–$195 | $217–$325 | varies |
| Radex Wrist Complete Minimum 3 Views (73110) range across 3 matching MRF lines |
$176.40–$264.60 | $294–$441 | varies |
| Radex X-Ray Exam Entire Spi 6/> Vw - Xr Entire Spine 6+ Vw (72084) | $115.20 | $192 | 1.1× |
| Radiolog exam mandible compl minimum 4 views (70110) | $232.80 | $388 | 2.3× |
| Radiologic Exam Abdomen 3+ Views - Xr Abdomen 3+ Views (74021) range across 2 matching MRF lines |
$183.60–$186 | $306–$310 | varies |
| Radiologic exam colon single contrast study (74270) | $327.60 | $546 | 1.9× |
| Radiologic exam knee complete 4/more views (73564) range across 6 matching MRF lines |
$195.60–$293.40 | $326–$489 | varies |
| Radiologic exam pelvis compl minimum 3 views (72190) | $243 | $405 | 2.4× |
| Radiologic Exam Small Int Single Contrast Study (74250) | $352.80 | $588 | 2.1× |
| Radiologic exam swallow function contrast study (74230) | $295.20 | $492 | 1.8× |
| Radiologic exam upr gi trc double contrast study (74246) | $363.60 | $606 | 2.2× |
| Radiologic examination femur 1 view (73551) range across 3 matching MRF lines |
$127.80–$191.40 | $213–$319 | varies |
| Radiologic examination femur minimum 2 views (73552) range across 3 matching MRF lines |
$154.20–$231.60 | $257–$386 | varies |
| Radiologic examination knee 1/2 views (73560) range across 9 matching MRF lines |
$159–$238.20 | $265–$397 | varies |
| Radiologic Examination Osseous Survey Limited (77074) | $244.20 | $407 | 2.4× |
| Radiologic examination tibia & fibula 2 views (73590) range across 6 matching MRF lines |
$166.20–$249 | $277–$415 | varies |
| Ribs bilateral 3 views (71110) | $280.80 | $468 | 2.8× |
| Scapula (73010) range across 3 matching MRF lines |
$159–$238.20 | $265–$397 | varies |
| Screening Digital Breast Tomosynthesis Bi (77063) | $26.40 | $44 | 1.1× |
| Shoulder 1 view (73020) range across 3 matching MRF lines |
$110.40–$165.60 | $184–$276 | varies |
| Shoulder Arthrography (73040) range across 3 matching MRF lines |
$274.80–$412.20 | $458–$687 | varies |
| Skull less than 4 views (70250) | $165 | $275 | 1.6× |
| Sternoclavicular joints (71130) | $192 | $320 | 2.3× |
| Thoracic spine 2 views (72070) | $223.20 | $372 | 2.2× |
| Thoracic spine 3 views (72072) | $246 | $410 | 2.4× |
| Thoracolumbar 2 views (72080) | $165 | $275 | 2.0× |
| Ultrasound Breast Limited (76642) range across 14 matching MRF lines |
$327.60–$516.60 | $546–$861 | varies |
| Ultrasound Exam Aaa Screen (76706) | $193.20 | $322 | 1.9× |
| Ultrasound, abdomen limited (76705) | $438 | $730 | 4.4× |
| Umbilical-artery Doppler (OB) (76820) range across 2 matching MRF lines |
$33–$272.40 | $55–$454 | varies |
| Unlisted us procedure (76999) range across 2 matching MRF lines |
$94.80–$157.80 | $158–$263 | varies |
| Upper gi w/o kub (74240) | $346.80 | $578 | 2.1× |
| Urethrocystogram voiding (74455) | $480.60 | $801 | 2.1× |
| Us chest (76604) | $310.20 | $517 | 3.1× |
| Us complete joint (76881) | $238.80 | $398 | 2.4× |
| Us exam, pelvic, limited (76857) | $213.60 | $356 | 2.1× |
| Us lmtd joint/oth nonvasc xtr strux r-t w/img (76882) | $154.20 | $257 | 1.5× |
| Us ob detailed single fetus (76811) | $361.80 | $603 | 1.6× |
| Us ob limited 1 or more fetuses (76815) | $322.20 | $537 | 3.2× |
| Us ob transvaginal (76817) | $384 | $640 | 3.8× |
| Us pelvic non ob complete (76856) | $373.80 | $623 | 3.7× |
| Us pg uter img f&mat 14 wk tabdl 1/1st gestation (76801) | $379.20 | $632 | 3.8× |
| Us preg uterus real time f/u trnsabdl per fetus (76816) range across 6 matching MRF lines |
$251.40–$275.40 | $419–$459 | varies |
| Us retroperitoneal complete (76770) | $486 | $810 | 4.8× |
| Us retroperitoneal limited (76775) | $372 | $620 | 3.7× |
| Us scrotum and contents (76870) | $472.80 | $788 | 4.7× |
| Us spinal canal and contents (76800) | $398.40 | $664 | 4.0× |
| Us thyroid (76536) | $351 | $585 | 3.5× |
| Us transrectal (76872) | $318.60 | $531 | 3.2× |
| Vein X-Ray Chest (75827) | $117.60 | $196 | 0.1× |
| Venogram Sinus/Jugular (75860) | $919.80 | $1,533 | 0.3× |
| Venography caval inferior serialography rs&i (75825) | $141 | $235 | 0.0× |
| Venography extremity bilateral rs&i (75822) | $1,332.60 | $2,221 | 0.9× |
| Venography extremity unilateral rs&i (75820) | $73.80 | $123 | 0.0× |
| Wrist 2 views (73100) range across 6 matching MRF lines |
$122.40–$184.20 | $204–$307 | varies |
| X-Ray Ac Jts - Xr Acromioclavicular Joints Bilateral (73050) | $175.20 | $292 | 2.1× |
| X-Ray Aorta Leg Arteries (75630) | $188.40 | $314 | 0.1× |
| X-Ray Bend Only L-S Spine (72120) | $144.60 | $241 | 1.4× |
| X-Ray Elbow 2 Vw - Xr Elbow 1-2 Views Right (73070) range across 6 matching MRF lines |
$129–$193.20 | $215–$322 | varies |
| X-Ray Exam Entire Spi 1 Vw (72081) | $158.40 | $264 | 1.9× |
| X-Ray Exam Entire Spi 2/3 Vw (72082) | $268.80 | $448 | 2.7× |
| X-Ray Exam Entire Spi 4/5 Vw (72083) | $91.80 | $153 | 0.9× |
| X-Ray Exam Hip Uni 1 View (73501) range across 8 matching MRF lines |
$171.60–$264.60 | $286–$441 | varies |
| X-Ray Exam Hip Uni 2-3 Views (73502) | $309.60 | $516 | 3.7× |
| X-Ray Exam Hip Uni 4/> Views (73503) range across 2 matching MRF lines |
$66–$83.40 | $110–$139 | varies |
| X-Ray Exam Hips Bi 2 Views (73521) | $232.80 | $388 | 2.3× |
| X-Ray Exam Hips Bi 3-4 Views (73522) range across 4 matching MRF lines |
$304.80–$393.60 | $508–$656 | varies |
| X-Ray Exam Hips Bi 5/> Views (73523) | $376.20 | $627 | 3.7× |
| X-Ray Exam L-S Spine Bending (72114) | $438.60 | $731 | 4.4× |
| X-Ray Exam Neck Spine 2-3 Vw (72040) | $223.20 | $372 | 2.7× |
| X-Ray Exam Neck Spine 6/>Vws (72052) | $309 | $515 | 3.1× |
| X-Ray Exam Unilat Ribs/Chest (71101) | $323.40 | $539 | 3.2× |
| X-ray eye for foreign body (70030) | $161.40 | $269 | 1.9× |
| X-ray humerus (73060) range across 6 matching MRF lines |
$187.20–$281.40 | $312–$469 | varies |
| X-ray IV pyelogram (ivp) (74400) | $426 | $710 | 2.5× |
| X-ray IV pyelogram+tomography (74415) | $481.20 | $802 | 2.9× |
| X-Ray Jaw <4 Vw - Xr Mandible < 4 Views (70100) range across 6 matching MRF lines |
$111–$181.20 | $185–$302 | varies |
| X-Ray Knee Bilat Standing - Xr Knees Anteroposterior Standing Bilat (73565) | $128.40 | $214 | 1.5× |
| X-Ray Lumbar Spine 2/3 Vw - Xr Lumbar Spine 2-3 Views (72100) | $257.40 | $429 | 2.6× |
| X-ray nose-rectum child f.b. (76010) | $166.80 | $278 | 2.0× |
| X-Ray Ribs, Chest 4+ Vw - Xr Ribs 3 Vws Bil W/ Chest Posteroanterior (71111) | $345.60 | $576 | 3.4× |
| X-Ray Sacroiliac Jts 3+ Vw - Xr Sacroiliac Joints 3+ Views (72202) | $184.80 | $308 | 1.8× |
| X-Ray Sacroiliac Jts <3 Vw - Xr Sacroiliac Joints 1-2 Views (72200) | $170.40 | $284 | 1.7× |
| X-Ray Sacrum/Coccyx 2+ Vw - Xr Sacrum Coccyx 2+ Views (72220) | $186.60 | $311 | 2.2× |
| X-Ray Sinuses 3+ Vw - Xr Paranasal Sinuses 3+ Views (70220) | $250.20 | $417 | 3.0× |
| X-Ray Skull 4+ Vw - Xr Skull Complete 4+ Views (70260) | $273 | $455 | 2.7× |
| X-Ray Tmj Unilat (70328) | $169.80 | $283 | 2.0× |
| X-Rays Bone Length Studies (77073) | $186 | $310 | 1.9× |
| X-Rays Bone Survey Complete (77075) | $464.40 | $774 | 4.6× |
| Xr c-spine 4 or 5 views (72050) | $263.40 | $439 | 2.6× |
| Xr facial bones less than 3 views (70140) | $175.80 | $293 | 2.1× |
| Xr orbits complete 4 views (70200) | $161.40 | $269 | 1.6× |
| Xr Tomogram Single Plane (76100) | $250.80 | $418 | 2.5× |
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.