Imaging prices at Nemaha Valley Community Hospital
Seneca, KS · every code in this section with a posted price and a Medicare benchmark.
242 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 2 matching MRF lines |
$286.20–$472.50 | $318–$525 | varies |
| Abdomen 2 views (74019) | $399.60 | $444 | 4.2× |
| Acute Gastrointestinal Blood Loss Imaging (78278) | $1,068.30 | $1,187 | 2.9× |
| Ankle 2 views (73600) | $208.80 | $232 | 2.6× |
| Bone age studies (77072) | $222.30 | $247 | 2.3× |
| Bone Imaging 3 Phase (78315) | $1,544.40 | $1,716 | 4.2× |
| Bone Imaging Limited Area (78300) | $918 | $1,020 | 2.5× |
| Bone Imaging Multiple Areas (78305) | $1,058.40 | $1,176 | 2.9× |
| Bone Imaging Whole Body (78306) | $1,328.40 | $1,476 | 3.6× |
| Bone survey infant (77076) | $803.70 | $893 | 8.4× |
| Brain Imaging Min 4 Static Views W Vascular Flow (78606) | $969.30 | $1,077 | 1.9× |
| Brain Imaging Minimum 4 Static Views (78605) | $908.10 | $1,009 | 1.8× |
| Cardiac MRI w/w/o contrast & further seq (75561) | $1,789.92 | $1,988.80 | 5.6× |
| Cat Scan Follow-Up Study (76380) | $809.10 | $899 | 10.1× |
| Chest 1 view (71045) | $218.70 | $243 | 2.7× |
| Chest 2 views (71046) | $250.20 | $278 | 3.1× |
| Chest 3 views (71047) range across 2 matching MRF lines |
$288.90–$415.80 | $321–$462 | varies |
| Chest 4 or more views (71048) | $415.80 | $462 | 4.3× |
| Clavicle complete (73000) | $250.20 | $278 | 3.1× |
| Computed Tomography Thorax Lw Dose Lng Ca Scr C- (71271) | $1,557.90 | $1,731 | 16.2× |
| Contrast X-Ray Bladder (74430) | $512.10 | $569 | 1.6× |
| CT abdomen and pelvis without and with contrast (74178) range across 2 matching MRF lines |
$2,475–$2,524.50 | $2,750–$2,805 | varies |
| CT abdomen and pelvis without contrast (74176) range across 2 matching MRF lines |
$2,079.90–$2,120.40 | $2,311–$2,356 | varies |
| CT abdomen w contrast (74160) | $1,655.10 | $1,839 | 10.3× |
| CT abdomen w wo contrast (74170) | $1,764 | $1,960 | 10.9× |
| CT abdomen w/o contrast (74150) | $1,557.90 | $1,731 | 16.2× |
| CT Angio Abdomen and Pelvis (74174) | $2,124.90 | $2,361 | 6.6× |
| CT Angio Chest (71275) | $2,025 | $2,250 | 12.6× |
| CT Angio Head (70496) | $1,380.60 | $1,534 | 8.6× |
| Ct Angio Lwr Extr W/O&W/Dye (73706) | $2,025 | $2,250 | 12.6× |
| CT Angio Neck (70498) | $1,640.70 | $1,823 | 10.2× |
| CT cervical spine w/ contrast (72126) | $1,655.10 | $1,839 | 5.2× |
| CT cervical spine w/o contrast (72125) | $1,557.90 | $1,731 | 16.2× |
| CT cervical spine w/wo cont (72127) | $1,764 | $1,960 | 10.9× |
| CT chest w contrast (71260) range across 2 matching MRF lines |
$1,622.70–$1,655.10 | $1,803–$1,839 | varies |
| CT chest w/wo contrast (71270) range across 2 matching MRF lines |
$1,729.80–$1,764 | $1,922–$1,960 | varies |
| CT head/brain with contrast (70460) | $1,655.10 | $1,839 | 10.3× |
| CT head/brain without and with contrast (70470) | $1,764 | $1,960 | 10.9× |
| CT heart no contrast quant eval coronry calcium (75571) | $90 | $100 | 1.1× |
| CT iac w contrast (70481) | $1,655.10 | $1,839 | 10.3× |
| CT l-spine w&w/o contrast (72133) | $1,764 | $1,960 | 10.9× |
| CT lower ext w/o (73700) | $1,557.90 | $1,731 | 16.2× |
| CT lower extremity w/contrast material (73701) range across 2 matching MRF lines |
$1,655.10–$3,054.60 | $1,839–$3,394 | varies |
| CT lumbar spine w contrast (72132) | $1,655.10 | $1,839 | 5.2× |
| CT lumbar spine w/o contrast (72131) | $1,557.90 | $1,731 | 16.2× |
| CT maxillofacial w contrast (70487) | $1,655.10 | $1,839 | 10.3× |
| CT maxillofacial wo contrast (70486) | $1,557.90 | $1,731 | 16.2× |
| CT neck tissue combo (70492) | $1,764 | $1,960 | 10.9× |
| Ct Orbit/Ear/Fossa W/O&W/Dye (70482) | $1,764 | $1,960 | 10.9× |
| CT orbits w/o contrast (70480) | $1,557.90 | $1,731 | 16.2× |
| CT pelvis w&w/o contrast (72194) | $1,764 | $1,960 | 10.9× |
| CT pelvis w/o contrast (72192) | $1,557.90 | $1,731 | 16.2× |
| CT scan of leg combo (73702) range across 2 matching MRF lines |
$1,764–$3,245.40 | $1,960–$3,606 | varies |
| CT scans face/jaw combo (70488) | $1,764 | $1,960 | 10.9× |
| CT soft tissue neck w contrast (70491) | $1,655.10 | $1,839 | 10.3× |
| CT soft tissue neck w/o contrast (70490) | $1,557.90 | $1,731 | 16.2× |
| CT thoracic spine w contrast (72129) | $1,655.10 | $1,839 | 10.3× |
| CT thoracic spine w/o contrast (72128) | $1,557.90 | $1,731 | 16.2× |
| CT thoracic spine w/wo cont (72130) | $1,764 | $1,960 | 10.9× |
| CT thorax w/o contrast (71250) range across 2 matching MRF lines |
$1,527.30–$1,557.90 | $1,697–$1,731 | varies |
| CT upper ext wo (73200) range across 2 matching MRF lines |
$1,557.90–$2,874.60 | $1,731–$3,194 | varies |
| CT upper extremity w/o & w/contrast material (73202) range across 2 matching MRF lines |
$1,764–$3,245.40 | $1,960–$3,606 | varies |
| CT upper extremity with contrast (73201) range across 2 matching MRF lines |
$1,655.10–$3,054.60 | $1,839–$3,394 | varies |
| Dxa Bone Density Axial (77080) | $355.50 | $395 | 3.7× |
| Echograp Trans R Pros Study (76873) | $763.20 | $848 | 7.9× |
| Esophagram (74220) | $262.80 | $292 | 1.6× |
| Fetal Biophysical Profile W/O Non-Stress Testing (76819) | $770.40 | $856 | 8.0× |
| Fluoroscopy up to 1 hr (76000) range across 3 matching MRF lines |
$279.90–$324 | $311–$360 | varies |
| Foot 2 views (73620) | $208.80 | $232 | 2.6× |
| Forearm 2 views (73090) | $241.20 | $268 | 3.0× |
| Gastric emptying imaging study (78264) | $1,301.40 | $1,446 | 3.5× |
| Gated Heart Planar Single (78472) | $1,828.80 | $2,032 | 5.0× |
| Hand 2 views (73120) | $222.30 | $247 | 2.3× |
| Hepatobil Syst Image W/Drug (78227) | $1,058.40 | $1,176 | 2.1× |
| Hepatobiliary System Imaging (78226) | $969.30 | $1,077 | 2.6× |
| Ht Muscle Image Spect Sing (78451) | $2,848.50 | $3,165 | 2.4× |
| Hysterosalpingogram (74740) | $632.70 | $703 | 2.9× |
| Infant hip ultrasound with hip movement (dynamic) (76885) | $541.80 | $602 | 6.8× |
| Joint Survey Single View (77077) | $237.60 | $264 | 2.5× |
| K Flow/Funct Image W/Drug (78708) range across 2 matching MRF lines |
$1,577.70–$1,777.50 | $1,753–$1,975 | varies |
| K Flow/Funct Image W/O Drug (78707) | $1,318.50 | $1,465 | 2.6× |
| Kidney Funcj Study Non-Img Radioisotopic Study (78725) | $1,129.50 | $1,255 | 3.1× |
| Kidney Imaging Morphol (78700) | $939.60 | $1,044 | 2.6× |
| Kidney Imaging Morphoogy W/Vascular Flow (78701) | $1,129.50 | $1,255 | 3.1× |
| Knee 3 Views (73562) range across 2 matching MRF lines |
$283.50–$288.90 | $315–$321 | varies |
| Liver & Spleen Imaging Static Only (78215) | $908.10 | $1,009 | 2.5× |
| Liver & Spleen Imaging W/Vascular Flow (78216) | $969.30 | $1,077 | 2.6× |
| Liver imaging w/vascular flow (78202) | $364.50 | $405 | 0.7× |
| Lung Perf&Ventilat Diferentl (78598) | $2,080.80 | $2,312 | 4.2× |
| Lung Ventilat&Perfus Imaging (78582) | $1,598.40 | $1,776 | 3.2× |
| Lung Ventilation Imaging (78579) | $939.60 | $1,044 | 2.6× |
| Lymph System Imaging (78195) | $1,049.40 | $1,166 | 2.1× |
| Magnetic Image Jaw Joint (70336) | $1,789.92 | $1,988.80 | 8.2× |
| Meckels Divert Exam (78290) | $939.60 | $1,044 | 2.6× |
| Mra Head W/O & W/Contrast Material (70546) | $1,535.04 | $1,705.60 | 4.8× |
| MRA head w/o contrast (70544) | $1,535.04 | $1,705.60 | 7.0× |
| Mra Neck W/O &W/Contrast Material (70549) | $1,918.80 | $2,132 | 6.0× |
| MRA neck w/o contrast (70547) | $1,504.80 | $1,672 | 6.9× |
| MRI abdomen w contrast (74182) | $1,789.92 | $1,988.80 | 5.6× |
| MRI abdomen w/o contrast (74181) | $1,789.92 | $1,988.80 | 8.2× |
| MRI any jt lower extrem w/o & w/contrast matrl (73723) | $1,869.12 | $2,076.80 | 5.8× |
| MRI bone marrow blood supply (77084) | $1,789.92 | $1,988.80 | 8.2× |
| MRI cardiac w/o contrast (75557) | $1,789.92 | $1,988.80 | 8.2× |
| MRI cervical spine w contrast (72142) | $1,789.92 | $1,988.80 | 5.6× |
| MRI cervical spine w/o cont (72141) | $1,789.92 | $1,988.80 | 8.2× |
| MRI chest w/o contrast (71550) | $1,789.92 | $1,988.80 | 8.2× |
| MRI chest wo w contrast (71552) | $2,305.44 | $2,561.60 | 7.2× |
| MRI lower extrem oth/thn jt w/contrast matrl (73719) | $1,789.92 | $1,988.80 | 5.6× |
| MRI lower extrem oth/thn jt w/o & w/contr matr (73720) | $1,869.12 | $2,076.80 | 5.8× |
| MRI lower extrem oth/thn jt w/o contr matrl (73718) | $1,754.64 | $1,949.60 | 8.0× |
| MRI lumbar spine w contrast (72149) | $1,789.92 | $1,988.80 | 5.6× |
| Mri Neck Spine W/O & W/Dye (72156) | $1,869.12 | $2,076.80 | 5.8× |
| MRI orbit face &/neck w/o contrast (70540) | $1,789.92 | $1,988.80 | 8.2× |
| Mri Orbt/Fac/Nck W/O &W/Dye (70543) | $2,305.44 | $2,561.60 | 7.2× |
| MRI pelvis w contrast (72196) | $1,981.44 | $2,201.60 | 6.2× |
| MRI pelvis w/o & w contrast (72197) | $2,305.44 | $2,561.60 | 7.2× |
| MRI pelvis w/o contrast (72195) | $1,789.92 | $1,988.80 | 8.2× |
| MRI thoracic spine w/o contrast (72146) | $1,789.92 | $1,988.80 | 8.2× |
| MRI upper extremity oth than jt w/o contr matrl (73218) | $1,789.92 | $1,988.80 | 8.2× |
| Mri Uppr Extremity W/O&W/Dye (73220) | $1,869.12 | $2,076.80 | 5.8× |
| MRI, abdomen, combo (74183) | $2,305.44 | $2,561.60 | 7.2× |
| MRI, dorsal spine combo (72157) | $1,869.12 | $2,076.80 | 5.8× |
| MRI, dorsal spine contrast (72147) | $1,789.92 | $1,988.80 | 5.6× |
| MRI, joint upper extrem (73221) | $1,789.92 | $1,988.80 | 8.2× |
| MRI, joint upper extrem combo (73223) | $2,260.08 | $2,511.20 | 7.0× |
| MRI, lumbar spine combo (72158) | $1,869.12 | $2,076.80 | 5.8× |
| Myelogram Lumbar (72265) | $4,512.60 | $5,014 | 6.3× |
| Myocardial Imaging Infarct Avid Planar Qual/Quan (78466) | $921.60 | $1,024 | 2.5× |
| Myocardial Spect Multiple Studies (78452) | $3,045.60 | $3,384 | 2.6× |
| Neck soft tissue (70360) | $263.70 | $293 | 3.3× |
| Nonvascular Shunt X-Ray (75809) | $515.70 | $573 | 5.4× |
| Optic foramina (70190) | $298.80 | $332 | 3.7× |
| Parathyroid Planar Imaging (78070) | $1,162.80 | $1,292 | 3.2× |
| Pelvis 1 or 2 views (72170) | $286.20 | $318 | 3.0× |
| Radex Abd Compl Aqt Abd W/S/E/D Views 1 View Ch (74022) | $396 | $440 | 4.1× |
| Radex Ankle Complete Minimum 3 Views (73610) | $236.70 | $263 | 3.0× |
| Radex Calcaneus Minimum 2 Views (73650) | $250.20 | $278 | 3.1× |
| Radex elbow complete minimum 3 views (73080) | $241.20 | $268 | 3.0× |
| Radex Facial Bones Complete Minimum 3 Views (70150) | $311.40 | $346 | 3.2× |
| Radex fingr minimum 2 views (73140) | $241.20 | $268 | 3.0× |
| Radex foot complete minimum 3 views (73630) | $241.20 | $268 | 3.0× |
| Radex Hand Minimum 3 Views (73130) | $241.20 | $268 | 3.0× |
| Radex lower extremity infant minimum 2 views (73592) | $191.70 | $213 | 2.4× |
| Radex Mastoids Compl Minimum 3 Views PR Side (70130) | $311.40 | $346 | 3.2× |
| Radex Nasal Bones Complete Minimum 3 Views (70160) | $247.50 | $275 | 3.1× |
| Radex Ribs Unilateral 2 Views (71100) | $250.20 | $278 | 3.1× |
| Radex shoulder complete minimum 2 views (73030) | $243.90 | $271 | 3.0× |
| Radex Sinuses Paransl < 3 Views (70210) | $279.90 | $311 | 3.5× |
| Radex Spine 1 View Specify Level (72020) range across 2 matching MRF lines |
$250.20–$565.20 | $278–$628 | varies |
| Radex Sternum Minimum 2 Views (71120) | $250.20 | $278 | 3.1× |
| Radex Toe Minimum 2 Views (73660) | $250.20 | $278 | 3.1× |
| Radex upper extremity infant minimum 2 views (73092) | $203.40 | $226 | 2.1× |
| Radex Wrist Complete Minimum 3 Views (73110) | $241.20 | $268 | 3.0× |
| Radiolog exam mandible compl minimum 4 views (70110) | $279.90 | $311 | 2.9× |
| Radiologic Exam Abdomen 3+ Views - Xr Abdomen 3+ Views (74021) | $399.60 | $444 | 4.2× |
| Radiologic exam colon double contrast study (74280) | $1,313.10 | $1,459 | 8.1× |
| Radiologic exam colon single contrast study (74270) | $1,313.10 | $1,459 | 8.1× |
| Radiologic Exam Esophagus Double Contrast Study (74221) | $262.80 | $292 | 1.6× |
| Radiologic exam knee complete 4/more views (73564) range across 2 matching MRF lines |
$357.30–$364.50 | $397–$405 | varies |
| Radiologic exam pelvis compl minimum 3 views (72190) | $311.40 | $346 | 3.2× |
| Radiologic Exam Small Int Single Contrast Study (74250) | $565.20 | $628 | 3.5× |
| Radiologic exam swallow function contrast study (74230) | $330.30 | $367 | 2.0× |
| Radiologic exam upr gi trc double contrast study (74246) range across 2 matching MRF lines |
$617.40–$805.50 | $686–$895 | varies |
| Radiologic examination femur 1 view (73551) | $326.70 | $363 | 4.1× |
| Radiologic examination femur minimum 2 views (73552) | $353.70 | $393 | 4.4× |
| Radiologic examination knee 1/2 views (73560) | $250.20 | $278 | 3.1× |
| Radiologic Examination Osseous Survey Limited (77074) range across 3 matching MRF lines |
$1,080–$1,170 | $1,200–$1,300 | varies |
| Radiologic examination tibia & fibula 2 views (73590) | $241.20 | $268 | 3.0× |
| Rp Loclzj Tum Plnr Whole Body Single Day Imaging (78802) | $1,612.80 | $1,792 | 3.2× |
| Rp Loclzj Tum Spect 1 Area Single Day Imaging (78803) | $1,724.40 | $1,916 | 3.5× |
| Salivary Gland Imaging (78230) | $860.40 | $956 | 2.3× |
| Scapula (73010) | $245.70 | $273 | 2.6× |
| Screening Digital Breast Tomosynthesis Bi (77063) | $90 | $100 | 3.8× |
| Sella turcica (70240) | $298.80 | $332 | 3.7× |
| Shoulder 1 view (73020) | $205.20 | $228 | 2.6× |
| Shoulder Arthrography (73040) | $476.10 | $529 | 1.5× |
| Sialogram (70390) | $412.20 | $458 | 1.9× |
| Skull less than 4 views (70250) | $279.90 | $311 | 2.9× |
| Spleen Imaging (78185) | $908.10 | $1,009 | 2.5× |
| Sternoclavicular joints (71130) | $415.80 | $462 | 5.2× |
| Testicular Imaging W/Flow (78761) | $849.60 | $944 | 2.3× |
| Thoracic spine 3 views (72072) | $257.40 | $286 | 2.7× |
| Thoracolumbar 2 views (72080) | $247.50 | $275 | 3.1× |
| Thyroid Imaging With Vascular Flow (78013) | $990.90 | $1,101 | 2.7× |
| Thyroid Uptake Measurement (78012) | $990.90 | $1,101 | 2.7× |
| Thyroid Uptake W/Blood Flow Sngle/Mult Quan Meas (78014) | $734.40 | $816 | 2.0× |
| Ultrasound Breast Limited (76642) range across 3 matching MRF lines |
$91.80–$547.20 | $102–$608 | varies |
| Ultrasound Exam Aaa Screen (76706) | $706.50 | $785 | 7.3× |
| Ultrasound, abdomen limited (76705) range across 4 matching MRF lines |
$78.30–$706.50 | $87–$785 | varies |
| Unlisted Dx Radiographic Procedure (76499) | $286.20 | $318 | 3.6× |
| Upper gi w/o kub (74240) range across 2 matching MRF lines |
$581.40–$805.50 | $646–$895 | varies |
| Urethrocystogram voiding (74455) | $641.70 | $713 | 2.9× |
| Urethrocystography retrograde (74450) | $325.80 | $362 | 1.5× |
| Us breast unilateral complete (76641) | $639 | $710 | 6.6× |
| Us chest (76604) range across 3 matching MRF lines |
$75.60–$552.60 | $84–$614 | varies |
| Us complete joint (76881) | $541.80 | $602 | 5.6× |
| Us exam, pelvic, limited (76857) range across 3 matching MRF lines |
$67.50–$563.40 | $75–$626 | varies |
| Us lmtd joint/oth nonvasc xtr strux r-t w/img (76882) range across 4 matching MRF lines |
$91.80–$541.80 | $102–$602 | varies |
| Us ob limited 1 or more fetuses (76815) range across 5 matching MRF lines |
$82.80–$508.50 | $92–$565 | varies |
| Us ob transvaginal (76817) | $557.10 | $619 | 5.8× |
| Us pelvic non ob complete (76856) | $763.20 | $848 | 7.9× |
| Us pg uter img f&mat 14 wk tabdl 1/1st gestation (76801) | $586.80 | $652 | 6.1× |
| Us preg uterus real time f/u trnsabdl per fetus (76816) | $706.50 | $785 | 7.3× |
| Us retroperitoneal complete (76770) | $810.90 | $901 | 8.4× |
| Us retroperitoneal limited (76775) | $706.50 | $785 | 7.3× |
| Us scrotum and contents (76870) | $763.20 | $848 | 7.9× |
| Us spinal canal and contents (76800) | $541.80 | $602 | 5.6× |
| Us thyroid (76536) range across 3 matching MRF lines |
$75.60–$774 | $84–$860 | varies |
| Us transrectal (76872) | $685.80 | $762 | 7.1× |
| Vascular Flow Imaging (78445) | $747 | $830 | 2.0× |
| Venogram Sinus/Jugular (75860) | $675 | $750 | 0.2× |
| Venography extremity unilateral rs&i (75820) | $517.50 | $575 | 0.4× |
| Wrist 2 views (73100) | $208.80 | $232 | 2.6× |
| X-Ray Ac Jts - Xr Acromioclavicular Joints Bilateral (73050) | $290.70 | $323 | 3.6× |
| X-Ray Bend Only L-S Spine (72120) | $264.60 | $294 | 2.8× |
| X-Ray Elbow 2 Vw - Xr Elbow 1-2 Views Right (73070) | $208.80 | $232 | 2.6× |
| X-Ray Exam Breast Specimen (76098) | $100.80 | $112 | 0.2× |
| X-Ray Exam Entire Spi 1 Vw (72081) | $407.70 | $453 | 5.1× |
| X-Ray Exam Entire Spi 2/3 Vw (72082) | $426.60 | $474 | 4.4× |
| X-Ray Exam Entire Spi 4/5 Vw (72083) | $450 | $500 | 4.7× |
| X-Ray Exam Hip Uni 1 View (73501) | $286.20 | $318 | 3.6× |
| X-Ray Exam Hip Uni 2-3 Views (73502) | $326.70 | $363 | 4.1× |
| X-Ray Exam Hips Bi 3-4 Views (73522) range across 2 matching MRF lines |
$361.80–$369 | $402–$410 | varies |
| X-Ray Exam L-S Spine Bending (72114) | $420.30 | $467 | 4.4× |
| X-Ray Exam Neck Spine 2-3 Vw (72040) | $263.70 | $293 | 3.3× |
| X-Ray Exam Neck Spine 6/>Vws (72052) | $378.90 | $421 | 3.9× |
| X-Ray Exam Unilat Ribs/Chest (71101) | $415.80 | $462 | 4.3× |
| X-ray humerus (73060) | $241.20 | $268 | 3.0× |
| X-ray IV pyelogram (ivp) (74400) range across 2 matching MRF lines |
$333–$339.30 | $370–$377 | varies |
| X-ray IV pyelogram+tomography (74415) | $581.40 | $646 | 3.6× |
| X-Ray Knee Bilat Standing - Xr Knees Anteroposterior Standing Bilat (73565) | $250.20 | $278 | 3.1× |
| X-Ray Lumbar Spine 2/3 Vw - Xr Lumbar Spine 2-3 Views (72100) | $239.40 | $266 | 2.5× |
| X-Ray Sacroiliac Jts 3+ Vw - Xr Sacroiliac Joints 3+ Views (72202) | $223.20 | $248 | 2.3× |
| X-Ray Sacrum/Coccyx 2+ Vw - Xr Sacrum Coccyx 2+ Views (72220) | $250.20 | $278 | 3.1× |
| X-Ray Sinuses 3+ Vw - Xr Paranasal Sinuses 3+ Views (70220) | $311.40 | $346 | 3.9× |
| X-Ray Skull 4+ Vw - Xr Skull Complete 4+ Views (70260) | $311.40 | $346 | 3.2× |
| X-ray thoracic spine 4 vw (72074) | $262.80 | $292 | 2.7× |
| X-Rays Bone Length Studies (77073) | $361.80 | $402 | 3.8× |
| Xr c-spine 4 or 5 views (72050) | $360 | $400 | 3.7× |
| Xr facial bones less than 3 views (70140) | $279.90 | $311 | 3.5× |
| XR Mastoids < 3 Views Bilateral (70120) | $279.90 | $311 | 2.9× |
| Xr orbits complete 4 views (70200) | $311.40 | $346 | 3.2× |
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.