Imaging prices at Mountain West Medical Center
Tooele, UT · every code in this section with a posted price and a Medicare benchmark.
286 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) | $276.95 | $461.58 | 3.1× |
| Abdomen 2 views (74019) | $511.03 | $851.71 | 4.8× |
| Acute Gastrointestinal Blood Loss Imaging (78278) | $855.88 | $1,426.46 | 2.1× |
| Adrenal Cortex & Medulla Img (78075) | $941.81 | $1,569.69 | 0.7× |
| Angiography extremity bilateral rs&i (75716) | $1,441.07 | $2,401.78 | 0.5× |
| Angiography extremity unilateral rs&i (75710) | $1,494.25 | $2,490.42 | 0.5× |
| Ankle 2 views (73600) | $119.60 | $199.34 | 1.4× |
| Aortography thoracic serialography rs&i (75605) | $4,130.08 | $6,883.46 | 0.7× |
| Arthrogram ankle (73615) | $701.48 | $1,169.14 | 2.0× |
| Arthrogram hip (73525) | $837.30 | $1,395.50 | 2.4× |
| Arthrogram Wrist (73115) | $575.06 | $958.44 | 1.6× |
| Bone age studies (77072) | $325.36 | $542.26 | 3.1× |
| Bone Imaging 3 Phase (78315) | $1,839.10 | $3,065.17 | 4.5× |
| Bone Imaging Whole Body (78306) | $1,661.89 | $2,769.82 | 4.1× |
| Bone marrow imaging; whole body (78104) | $1,256.12 | $2,093.54 | 3.1× |
| Bone survey infant (77076) | $266.10 | $443.50 | 2.5× |
| Brain Flow Imaging Only (78610) | $874.49 | $1,457.48 | 1.6× |
| Chest 1 view (71045) | $267.57 | $445.95 | 3.0× |
| Chest 2 views (71046) | $399.51 | $665.85 | 4.5× |
| Chest 3 views (71047) | $412.76 | $687.93 | 4.7× |
| Cholecystography Oral Contrast (74290) | $500.91 | $834.85 | 2.8× |
| Clavicle complete (73000) | $342.46 | $570.77 | 3.9× |
| Computed Tomography Thorax Lw Dose Lng Ca Scr C- (71271) | $137.42 | $229.04 | 1.3× |
| Contrast Exam Abdominl Aorta (75625) | $1,494.25 | $2,490.42 | 0.5× |
| Contrast X-Ray Bladder (74430) | $546.17 | $910.29 | 1.5× |
| Contrast X-Ray Of Elbow (73085) | $701.48 | $1,169.14 | 2.0× |
| Contrast X-Ray Of Knee Joint (73580) | $824.79 | $1,374.65 | 2.3× |
| CT abdomen and pelvis without and with contrast (74178) | $3,235.65 | $5,392.75 | 9.2× |
| CT abdomen and pelvis without contrast (74176) | $2,917.96 | $4,863.27 | 12.1× |
| CT abdomen w contrast (74160) | $1,528.49 | $2,547.49 | 8.6× |
| CT abdomen w wo contrast (74170) | $1,633.66 | $2,722.76 | 9.2× |
| CT abdomen w/o contrast (74150) | $1,423.19 | $2,371.98 | 13.4× |
| CT Angio Abdomen and Pelvis (74174) | $1,568.27 | $2,613.79 | 4.4× |
| CT Angio Chest (71275) | $2,203.66 | $3,672.76 | 12.4× |
| CT Angio Head (70496) | $784.45 | $1,307.42 | 4.4× |
| CT angio hrt w/3d image (75574) | $1,530 | $2,550 | 4.3× |
| Ct Angio Lwr Extr W/O&W/Dye (73706) range across 2 matching MRF lines |
$492.11–$656.15 | $820.19–$1,093.59 | varies |
| CT Angio Neck (70498) | $863.99 | $1,439.99 | 4.9× |
| Ct Angio Upr Extrm W/O&W/Dye (73206) range across 2 matching MRF lines |
$558.55–$638.09 | $930.92–$1,063.49 | varies |
| CT bone density (77078) | $217.20 | $362 | 2.5× |
| CT cervical spine w/ contrast (72126) | $1,447.52 | $2,412.53 | 4.1× |
| CT cervical spine w/o contrast (72125) | $1,980.45 | $3,300.75 | 18.7× |
| CT cervical spine w/wo cont (72127) | $2,325.83 | $3,876.39 | 13.1× |
| CT chest w contrast (71260) | $1,784.78 | $2,974.64 | 10.0× |
| CT chest w/wo contrast (71270) | $1,899.48 | $3,165.80 | 10.7× |
| CT head/brain with contrast (70460) | $1,868.46 | $3,114.10 | 10.5× |
| CT head/brain without and with contrast (70470) | $2,064.77 | $3,441.29 | 11.6× |
| CT heart contrast eval cardiac structure&morph (75572) | $660 | $1,100 | 1.9× |
| CT heart no contrast quant eval coronry calcium (75571) | $150 | $250 | 1.7× |
| CT hrt w/3d image congen (75573) | $900 | $1,500 | 2.5× |
| CT iac w contrast (70481) | $2,222.59 | $3,704.31 | 12.5× |
| CT l-spine w&w/o contrast (72133) | $2,410.79 | $4,017.98 | 13.6× |
| CT lower ext w/o (73700) range across 2 matching MRF lines |
$2,035.66–$2,037.09 | $3,392.77–$3,395.15 | varies |
| CT lower extremity w/contrast material (73701) range across 2 matching MRF lines |
$822.31–$2,086.25 | $1,370.51–$3,477.09 | varies |
| CT lumbar spine w contrast (72132) | $2,325.83 | $3,876.39 | 6.6× |
| CT lumbar spine w/o contrast (72131) | $2,246.77 | $3,744.61 | 21.2× |
| CT maxillofacial w contrast (70487) | $1,969.64 | $3,282.73 | 11.1× |
| CT maxillofacial wo contrast (70486) | $1,827.26 | $3,045.43 | 17.3× |
| CT neck tissue combo (70492) | $2,401.24 | $4,002.07 | 13.5× |
| Ct Orbit/Ear/Fossa W/O&W/Dye (70482) | $2,252.18 | $3,753.63 | 12.7× |
| CT orbits w/o contrast (70480) | $1,846.19 | $3,076.98 | 17.4× |
| CT pelvis w&w/o contrast (72194) | $1,601.99 | $2,669.99 | 9.0× |
| CT pelvis w/o contrast (72192) | $1,494.77 | $2,491.29 | 14.1× |
| CT scan of leg combo (73702) range across 2 matching MRF lines |
$2,411.43–$2,531.53 | $4,019.05–$4,219.21 | varies |
| CT scans face/jaw combo (70488) | $2,521.98 | $4,203.30 | 14.2× |
| CT soft tissue neck w contrast (70491) | $2,111.23 | $3,518.71 | 11.9× |
| CT soft tissue neck w/o contrast (70490) | $1,716.69 | $2,861.15 | 16.2× |
| CT thoracic spine w contrast (72129) | $1,351.10 | $2,251.84 | 7.6× |
| CT thoracic spine w/o contrast (72128) | $1,598.65 | $2,664.42 | 15.1× |
| CT thoracic spine w/wo cont (72130) | $2,103.11 | $3,505.19 | 11.8× |
| CT thorax w/o contrast (71250) | $1,899.48 | $3,165.80 | 17.9× |
| CT upper ext wo (73200) | $1,848.91 | $3,081.51 | 17.5× |
| CT upper extremity with contrast (73201) | $2,030.25 | $3,383.75 | 5.7× |
| Cta Abdl Aorta&Bi Iliofem W/Contrast&Postp (75635) | $862.72 | $1,437.87 | 4.9× |
| Cta Abdomen (74175) | $784.45 | $1,307.42 | 4.4× |
| CTA pelvis (72191) | $784.45 | $1,307.42 | 4.4× |
| Dilation ureters/urethra rs&i (74485) | $1,140.74 | $1,901.24 | 0.5× |
| Doppler Fetal Mid Cerebral Artery (76821) | $602.08 | $1,003.46 | 5.7× |
| Echo exam uterus (76831) | $1,505.35 | $2,508.91 | 6.2× |
| Esophagram (74220) | $502.57 | $837.61 | 2.8× |
| Fetal Biophys Profile W/Nst (76818) | $937.62 | $1,562.70 | 8.9× |
| Fetal Biophysical Profile W/O Non-Stress Testing (76819) | $667.55 | $1,112.58 | 6.3× |
| Fluoroscopy up to 1 hr (76000) range across 2 matching MRF lines |
$296.38–$308.23 | $493.96–$513.72 | varies |
| Foot 2 views (73620) | $334 | $556.66 | 3.8× |
| Forearm 2 views (73090) | $356.64 | $594.40 | 4.0× |
| Gastric emptying imaging study (78264) | $728.72 | $1,214.53 | 1.8× |
| Gated Heart Planar Single (78472) | $1,391.20 | $2,318.67 | 3.4× |
| Gated Heart, Multiple (78473) | $2,153.42 | $3,589.03 | 5.3× |
| Hand 2 views (73120) | $338.60 | $564.34 | 3.2× |
| Hepatobil Syst Image W/Drug (78227) | $1,259.26 | $2,098.76 | 2.3× |
| Hepatobiliary System Imaging (78226) | $1,259.26 | $2,098.76 | 3.1× |
| Ht Muscle Image Spect Sing (78451) | $1,111.85 | $1,853.09 | 0.8× |
| Hysterosalpingogram (74740) range across 2 matching MRF lines |
$859.06–$893.42 | $1,431.77–$1,489.04 | varies |
| Infant hip ultrasound with hip movement (dynamic) (76885) | $713.25 | $1,188.75 | 8.1× |
| Infusion Ivp (74410) | $763.88 | $1,273.13 | 4.3× |
| Joint Survey Single View (77077) | $294.98 | $491.64 | 2.8× |
| K Flow/Funct Image Multiple (78709) | $991.20 | $1,652 | 1.8× |
| K Flow/Funct Image W/Drug (78708) | $941.81 | $1,569.69 | 1.7× |
| K Flow/Funct Image W/O Drug (78707) | $1,057.19 | $1,761.99 | 1.9× |
| Knee 3 Views (73562) range across 2 matching MRF lines |
$101.39–$124.77 | $168.99–$207.95 | varies |
| Liver & Spleen Imaging Static Only (78215) | $512.69 | $854.48 | 1.3× |
| Lung Ventilat&Perfus Imaging (78582) | $942.56 | $1,570.93 | 1.7× |
| Lymph System Imaging (78195) | $753.75 | $1,256.25 | 1.4× |
| Magnetic Image Jaw Joint (70336) | $1,589.98 | $2,649.97 | 6.6× |
| Meckels Divert Exam (78290) | $546.17 | $910.29 | 1.3× |
| Mra Head W/O & W/Contrast Material (70546) | $1,409.05 | $2,348.41 | 4.0× |
| MRA head w/o contrast (70544) | $2,629.98 | $4,383.30 | 10.9× |
| MRA head with contrast (70545) | $2,930.15 | $4,883.58 | 8.3× |
| MRA neck w contrast (70548) | $1,023.58 | $1,705.96 | 2.9× |
| Mra Neck W/O &W/Contrast Material (70549) | $1,409.05 | $2,348.41 | 4.0× |
| MRA neck w/o contrast (70547) | $2,629.98 | $4,383.30 | 10.9× |
| MRI abdomen w contrast (74182) | $2,434.90 | $4,058.16 | 6.9× |
| MRI abdomen w/o contrast (74181) | $2,508.31 | $4,180.52 | 10.4× |
| MRI any jt lower extrem w/contrast material (73722) | $2,174.05 | $3,623.42 | 2.7× |
| MRI any jt lower extrem w/o & w/contrast matrl (73723) | $2,277.02 | $3,795.04 | 6.4× |
| MRI any jt upper extremity w/contrast matrl (73222) | $2,355.70 | $3,926.16 | 3.0× |
| MRI cervical spine w contrast (72142) | $2,913.02 | $4,855.04 | 8.2× |
| MRI cervical spine w/o cont (72141) | $2,913.02 | $4,855.04 | 12.1× |
| MRI chest w/o contrast (71550) | $744.90 | $1,241.50 | 3.1× |
| MRI chest with contrast (71551) | $919.90 | $1,533.16 | 1.2× |
| MRI chest wo w contrast (71552) | $1,095.59 | $1,825.99 | 3.1× |
| MRI lower extrem oth/thn jt w/contrast matrl (73719) | $2,088.04 | $3,480.07 | 5.9× |
| MRI lower extrem oth/thn jt w/o & w/contr matr (73720) | $2,168.81 | $3,614.69 | 6.1× |
| MRI lower extrem oth/thn jt w/o contr matrl (73718) | $2,277.02 | $3,795.04 | 9.4× |
| MRI lumbar spine w contrast (72149) | $3,021.93 | $5,036.55 | 8.6× |
| Mri Neck Spine W/O & W/Dye (72156) | $3,262.83 | $5,438.05 | 9.2× |
| MRI orbit face &/neck w/o contrast (70540) | $2,121.44 | $3,535.73 | 8.8× |
| MRI orbit face neck w contrast (70542) | $2,211.82 | $3,686.37 | 6.3× |
| Mri Orbt/Fac/Nck W/O &W/Dye (70543) | $2,318.63 | $3,864.39 | 6.6× |
| MRI pelvis w contrast (72196) | $2,386.11 | $3,976.85 | 6.8× |
| MRI pelvis w/o & w contrast (72197) | $2,498.69 | $4,164.49 | 7.1× |
| MRI pelvis w/o contrast (72195) | $1,764.11 | $2,940.18 | 7.3× |
| MRI thoracic spine w/o contrast (72146) | $2,223 | $3,705 | 9.2× |
| MRI upper extremity oth than jt w/contr matrl (73219) | $1,486.84 | $2,478.07 | 4.2× |
| MRI upper extremity oth than jt w/o contr matrl (73218) | $1,360.97 | $2,268.28 | 5.6× |
| Mri Uppr Extremity W/O&W/Dye (73220) | $1,609.91 | $2,683.18 | 4.6× |
| MRI, abdomen, combo (74183) | $2,508.31 | $4,180.52 | 7.1× |
| MRI, dorsal spine combo (72157) | $3,163.53 | $5,272.55 | 9.0× |
| MRI, dorsal spine contrast (72147) | $2,770.01 | $4,616.69 | 7.8× |
| MRI, joint upper extrem (73221) | $2,277.02 | $3,795.04 | 9.4× |
| MRI, joint upper extrem combo (73223) | $2,168.81 | $3,614.69 | 6.1× |
| MRI, lumbar spine combo (72158) | $3,207.24 | $5,345.40 | 9.1× |
| Myocardial Spect Multiple Studies (78452) | $2,637.94 | $4,396.56 | 2.0× |
| N-invas est c ffr sw aly CTA (75580) | $2,803.20 | $4,672 | 3.2× |
| Neck soft tissue (70360) | $383.87 | $639.79 | 4.4× |
| Nm csf leak detection (78650) | $855.14 | $1,425.24 | 0.7× |
| Nm whole blood volume (78122) | $941.81 | $1,569.69 | 1.7× |
| Nuclear Rx Oral Admin (79005) | $489.13 | $815.22 | 2.1× |
| Ob us nuchal meas 1 gest (76813) | $591.03 | $985.05 | 5.6× |
| Optic foramina (70190) | $500.91 | $834.85 | 5.7× |
| Parathyroid imaging w/tomographic spect & CT (78072) | $1,299.92 | $2,166.54 | 2.4× |
| Parathyroid Planar Imaging (78070) | $941.81 | $1,569.69 | 2.3× |
| Parathyroid planar imaging w/wo subtraction (78071) | $1,299.92 | $2,166.54 | 3.2× |
| Pelvis 1 or 2 views (72170) | $370.62 | $617.70 | 3.5× |
| Peritoneogram Rs&I (74190) | $425.27 | $708.79 | 0.8× |
| Plasma Vol Radiopharm Vol Dilute Spx Mult Smples (78111) | $941.81 | $1,569.69 | 0.7× |
| Pulmonary Perfusion Imaging Particulate (78580) | $1,196.87 | $1,994.78 | 3.0× |
| Radex Abd Compl Aqt Abd W/S/E/D Views 1 View Ch (74022) | $575.80 | $959.67 | 5.4× |
| Radex abscess/fistula/sinus tract rs&i (76080) | $635.98 | $1,059.96 | 1.1× |
| Radex Ankle Complete Minimum 3 Views (73610) | $400.98 | $668.30 | 4.6× |
| Radex Calcaneus Minimum 2 Views (73650) | $334 | $556.66 | 3.8× |
| Radex elbow complete minimum 3 views (73080) | $415.15 | $691.92 | 4.7× |
| Radex Facial Bones Complete Minimum 3 Views (70150) | $546.17 | $910.29 | 5.2× |
| Radex fingr minimum 2 views (73140) | $338.60 | $564.34 | 3.8× |
| Radex foot complete minimum 3 views (73630) | $393.25 | $655.42 | 4.5× |
| Radex Hand Minimum 3 Views (73130) | $371.36 | $618.94 | 4.2× |
| Radex lower extremity infant minimum 2 views (73592) | $363.63 | $606.05 | 4.1× |
| Radex Mastoids Compl Minimum 3 Views PR Side (70130) | $383.87 | $639.79 | 3.6× |
| Radex Nasal Bones Complete Minimum 3 Views (70160) | $432.26 | $720.44 | 4.9× |
| Radex Ribs Unilateral 2 Views (71100) | $436.87 | $728.11 | 5.0× |
| Radex shoulder complete minimum 2 views (73030) | $500.91 | $834.85 | 5.7× |
| Radex Sinuses Paransl < 3 Views (70210) | $429.87 | $716.45 | 4.9× |
| Radex sm int w/mlt srl imges via enteroclss tube (74251) | $715.47 | $1,192.45 | 4.0× |
| Radex Spine 1 View Specify Level (72020) | $216.96 | $361.60 | 2.5× |
| Radex Sternum Minimum 2 Views (71120) | $412.03 | $686.71 | 4.7× |
| Radex Temporomandble Jt Opn & Clsd Mouth Bilat (70330) | $479.92 | $799.87 | 5.4× |
| Radex Toe Minimum 2 Views (73660) | $325.36 | $542.26 | 3.7× |
| Radex upper extremity infant minimum 2 views (73092) | $315.96 | $526.60 | 3.0× |
| Radex Wrist Complete Minimum 3 Views (73110) | $370.62 | $617.70 | 4.2× |
| Radex X-Ray Exam Entire Spi 6/> Vw - Xr Entire Spine 6+ Vw (72084) | $755.23 | $1,258.71 | 7.1× |
| Radiolog exam mandible compl minimum 4 views (70110) | $544.70 | $907.84 | 5.1× |
| Radiologic exam colon double contrast study (74280) | $1,140.74 | $1,901.24 | 6.4× |
| Radiologic exam colon single contrast study (74270) | $887.17 | $1,478.61 | 5.0× |
| Radiologic exam knee complete 4/more views (73564) | $433.73 | $722.89 | 4.1× |
| Radiologic exam pelvis compl minimum 3 views (72190) | $454.16 | $756.93 | 4.3× |
| Radiologic Exam Small Int Single Contrast Study (74250) | $648.31 | $1,080.51 | 3.7× |
| Radiologic exam swallow function contrast study (74230) | $212.09 | $353.48 | 1.2× |
| Radiologic exam upr gi trc double contrast study (74246) range across 2 matching MRF lines |
$787.04–$818.53 | $1,311.74–$1,364.21 | varies |
| Radiologic examination femur minimum 2 views (73552) | $415.15 | $691.92 | 4.7× |
| Radiologic examination knee 1/2 views (73560) | $371.36 | $618.94 | 4.2× |
| Radiologic examination tibia & fibula 2 views (73590) | $378.35 | $630.58 | 4.3× |
| Red Cell Volume Determination Spx 1 Sampling (78120) | $941.81 | $1,569.69 | 2.3× |
| Ribs bilateral 3 views (71110) | $500.91 | $834.85 | 4.7× |
| Rp loclzj tum plnr 1 area single day imaging (78800) range across 2 matching MRF lines |
$905.59–$941.81 | $1,509.32–$1,569.69 | varies |
| Rp loclzj tum plnr 2+area 1+d img/1 area img>2+d (78801) | $1,013.69 | $1,689.48 | 2.5× |
| Rp Loclzj Tum Plnr Whole Body 2+ Days Imaging (78804) | $2,567.83 | $4,279.71 | 4.7× |
| Rp Loclzj Tum Plnr Whole Body Single Day Imaging (78802) range across 2 matching MRF lines |
$1,207.81–$1,350.53 | $2,013.02–$2,250.88 | varies |
| Rp Loclzj Tum Spect 1 Area Single Day Imaging (78803) | $2,337.68 | $3,896.13 | 4.3× |
| Rp loclzj tum spect 2 area/sep acquisj img (78831) | $1,279.28 | $2,132.14 | 1.0× |
| Rp Therapy Intravenous Administration (79101) | $792.76 | $1,321.27 | 3.4× |
| Scapula (73010) | $380.74 | $634.57 | 3.6× |
| Screening Digital Breast Tomosynthesis Bi (77063) range across 3 matching MRF lines |
$31.83–$63.65 | $53.05–$106.09 | varies |
| Sella turcica (70240) | $230.21 | $383.69 | 2.6× |
| Shoulder 1 view (73020) | $272.36 | $453.93 | 3.1× |
| Shoulder Arthrography (73040) | $775.65 | $1,292.75 | 2.2× |
| Skull less than 4 views (70250) | $402.64 | $671.06 | 3.8× |
| Speech evaluation, complex (70371) | $430.46 | $717.43 | 1.8× |
| Spleen Imaging (78185) | $616.69 | $1,027.82 | 1.5× |
| Sternoclavicular joints (71130) | $366.76 | $611.26 | 4.2× |
| Thoracic spine 2 views (72070) | $377.61 | $629.35 | 3.6× |
| Thoracic spine 3 views (72072) | $377.61 | $629.35 | 3.6× |
| Thoracolumbar 2 views (72080) | $144.27 | $240.45 | 1.6× |
| Thyroid Imaging With Vascular Flow (78013) | $332.34 | $553.90 | 0.8× |
| Thyroid Met Imaging Body (78018) | $1,256.12 | $2,093.54 | 2.3× |
| Thyroid Uptake Measurement (78012) | $337.13 | $561.88 | 0.8× |
| Thyroid Uptake W/Blood Flow Sngle/Mult Quan Meas (78014) | $1,072.85 | $1,788.08 | 2.7× |
| Ultrasound Breast Limited (76642) range across 2 matching MRF lines |
$982.43–$1,473.65 | $1,637.38–$2,456.09 | varies |
| Ultrasound Exam Aaa Screen (76706) | $591.03 | $985.05 | 5.6× |
| Ultrasound, abdomen limited (76705) range across 2 matching MRF lines |
$409.11–$1,053.71 | $681.85–$1,756.19 | varies |
| Umbilical-artery Doppler (OB) (76820) | $500.81 | $834.69 | 4.7× |
| Upper gi w/o kub (74240) range across 2 matching MRF lines |
$657.17–$683.45 | $1,095.28–$1,139.09 | varies |
| Urethrocystogram voiding (74455) range across 2 matching MRF lines |
$859.06–$893.42 | $1,431.77–$1,489.04 | varies |
| Urethrocystography retrograde (74450) | $833.24 | $1,388.74 | 3.4× |
| Us breast unilateral complete (76641) range across 2 matching MRF lines |
$982.43–$1,473.65 | $1,637.38–$2,456.09 | varies |
| Us chest (76604) range across 2 matching MRF lines |
$405.31–$423.12 | $675.51–$705.20 | varies |
| Us complete joint (76881) | $1,077.31 | $1,795.51 | 10.2× |
| Us exam, pelvic, limited (76857) range across 2 matching MRF lines |
$346.31–$528.16 | $577.19–$880.27 | varies |
| Us kidney transplant (76776) | $892.21 | $1,487.02 | 8.4× |
| Us lmtd joint/oth nonvasc xtr strux r-t w/img (76882) range across 2 matching MRF lines |
$340.61–$538.06 | $567.68–$896.76 | varies |
| Us ob detailed single fetus (76811) | $676.28 | $1,127.13 | 2.8× |
| Us ob limited 1 or more fetuses (76815) range across 2 matching MRF lines |
$454.78–$556.40 | $757.97–$927.34 | varies |
| Us ob transvaginal (76817) | $650.10 | $1,083.50 | 6.1× |
| Us pelvic non ob complete (76856) | $556.40 | $927.34 | 5.3× |
| Us pg uter img f&mat 14 wk tabdl 1/1st gestation (76801) | $707.13 | $1,178.55 | 6.7× |
| Us preg uterus real time f/u trnsabdl per fetus (76816) | $1,081.96 | $1,803.26 | 10.2× |
| Us retroperitoneal complete (76770) | $1,331.34 | $2,218.90 | 12.6× |
| Us retroperitoneal limited (76775) range across 2 matching MRF lines |
$405.31–$665.45 | $675.51–$1,109.08 | varies |
| Us scrotum and contents (76870) | $1,191.95 | $1,986.59 | 11.3× |
| Us spinal canal and contents (76800) | $285.50 | $475.84 | 2.7× |
| Us thyroid (76536) | $1,081.96 | $1,803.26 | 10.2× |
| Us transrectal (76872) | $650.10 | $1,083.50 | 6.1× |
| Vein X-Ray Chest (75827) | $1,339.67 | $2,232.79 | 0.8× |
| Venography caval inferior serialography rs&i (75825) | $1,814.09 | $3,023.48 | 0.6× |
| Venography extremity bilateral rs&i (75822) | $753.56 | $1,255.93 | 0.5× |
| Venography extremity unilateral rs&i (75820) | $778.78 | $1,297.96 | 0.5× |
| Venography Renal Bilateral (75833) | $2,001.41 | $3,335.69 | 0.6× |
| Wrist 2 views (73100) | $338.60 | $564.34 | 3.8× |
| X-Ray Ac Jts - Xr Acromioclavicular Joints Bilateral (73050) | $450.11 | $750.19 | 5.1× |
| X-ray antegrade pyelogram tube (74425) | $343.39 | $572.31 | 1.0× |
| X-Ray Aorta Leg Arteries (75630) | $1,045.61 | $1,742.69 | 0.3× |
| X-Ray Bend Only L-S Spine (72120) | $189.55 | $315.91 | 1.8× |
| X-Ray Elbow 2 Vw - Xr Elbow 1-2 Views Right (73070) | $367.49 | $612.48 | 4.2× |
| X-Ray Exam Breast Specimen (76098) | $272.36 | $453.93 | 0.5× |
| X-Ray Exam Entire Spi 1 Vw (72081) | $377.61 | $629.35 | 4.3× |
| X-Ray Exam Entire Spi 2/3 Vw (72082) | $377.61 | $629.35 | 3.6× |
| X-Ray Exam Entire Spi 4/5 Vw (72083) | $755.23 | $1,258.71 | 7.1× |
| X-Ray Exam Hip Uni 1 View (73501) | $313.57 | $522.62 | 3.6× |
| X-Ray Exam Hip Uni 2-3 Views (73502) | $367.31 | $612.19 | 4.2× |
| X-Ray Exam Hip Uni 4/> Views (73503) | $551.32 | $918.87 | 5.2× |
| X-Ray Exam Hips Bi 2 Views (73521) | $468.15 | $780.25 | 4.4× |
| X-Ray Exam Hips Bi 3-4 Views (73522) | $468.15 | $780.25 | 4.4× |
| X-Ray Exam Hips Bi 5/> Views (73523) | $936.30 | $1,560.50 | 8.8× |
| X-Ray Exam L-S Spine Bending (72114) | $248.98 | $414.97 | 2.4× |
| X-Ray Exam Neck Spine 2-3 Vw (72040) | $367.49 | $612.48 | 4.2× |
| X-Ray Exam Neck Spine 6/>Vws (72052) | $631.93 | $1,053.22 | 6.0× |
| X-Ray Exam Unilat Ribs/Chest (71101) | $706.82 | $1,178.03 | 6.7× |
| X-ray eye for foreign body (70030) | $273.09 | $455.15 | 3.1× |
| X-ray humerus (73060) | $381.47 | $635.79 | 4.3× |
| X-ray IV pyelogram (ivp) (74400) | $818.53 | $1,364.21 | 4.6× |
| X-Ray Knee Bilat Standing - Xr Knees Anteroposterior Standing Bilat (73565) | $188.81 | $314.68 | 2.1× |
| X-Ray Lumbar Spine 2/3 Vw - Xr Lumbar Spine 2-3 Views (72100) | $481.40 | $802.33 | 4.5× |
| X-ray nose-rectum child f.b. (76010) | $266.83 | $444.71 | 3.0× |
| X-Ray Ribs, Chest 4+ Vw - Xr Ribs 3 Vws Bil W/ Chest Posteroanterior (71111) | $834.91 | $1,391.51 | 7.9× |
| X-Ray Sacroiliac Jts 3+ Vw - Xr Sacroiliac Joints 3+ Views (72202) | $272.36 | $453.93 | 2.6× |
| X-Ray Sacrum/Coccyx 2+ Vw - Xr Sacrum Coccyx 2+ Views (72220) | $415.15 | $691.92 | 4.7× |
| X-Ray Sinuses 3+ Vw - Xr Paranasal Sinuses 3+ Views (70220) | $544.70 | $907.84 | 6.2× |
| X-Ray Skull 4+ Vw - Xr Skull Complete 4+ Views (70260) | $635.98 | $1,059.96 | 6.0× |
| X-Ray Stress View (77071) | $530.53 | $884.22 | 6.0× |
| X-Ray Urinary Tract Exam With Contrast Material (74420) | $1,270.30 | $2,117.16 | 3.6× |
| X-Rays Bone Length Studies (77073) range across 2 matching MRF lines |
$300.20–$347.26 | $500.33–$578.76 | varies |
| X-Rays Bone Survey Complete (77075) | $530.53 | $884.22 | 5.0× |
| Xr c-spine 4 or 5 views (72050) | $454.90 | $758.17 | 4.3× |
| Xr facial bones less than 3 views (70140) | $168.56 | $280.94 | 1.9× |
| XR Mastoids < 3 Views Bilateral (70120) | $321.49 | $535.82 | 3.0× |
| Xr orbits complete 4 views (70200) | $601.57 | $1,002.61 | 5.7× |
| Xr Tomogram Single Plane (76100) | $412.03 | $686.71 | 3.9× |
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.