Imaging prices at Novant Health Ballantyne Medical Center

Charlotte, NC · every code in this section with a posted price and a Medicare benchmark.

344 codes. Prices are the hospital's own posted facility charges.

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ProcedurePosted cashPosted gross× Medicare
Abdomen 1 View (74018) $196 $392 2.3×
Abdomen 2 views (74019) $232.50 $465 2.3×
Acute Gastrointestinal Blood Loss Imaging (78278) $910 $1,820 2.3×
Acute venous thrombosis imaging, peptide Non-Facility (78456) $1,301.52 $2,603.04 1.0×
Angiography extremity bilateral rs&i (75716) $3,093.50 $6,187 1.0×
Angiography extremity unilateral rs&i (75710) $2,811 $5,622 0.9×
Ankle 2 views (73600)
range across 2 matching MRF lines		 $143–$232.50 $286–$465 varies
Artery X-Rays Pelvis (75736) $2,811 $5,622 0.5×
Arthrogram ankle (73615) $537.50 $1,075 1.6×
Arthrogram hip (73525) $625 $1,250 1.8×
Arthrogram Wrist (73115) $625 $1,250 1.8×
Bone age studies (77072) $129.50 $259 1.3×
Bone Imaging 3 Phase (78315) $1,242.50 $2,485 3.2×
Bone Imaging Limited Area (78300) $431 $862 1.1×
Bone Imaging Whole Body (78306) $1,102 $2,204 2.8×
Bone marrow imaging limited area (78102) $823 $1,646 2.1×
Bone marrow imaging; multiple areas (78103) $823 $1,646 2.1×
Bone marrow imaging; whole body (78104) $435 $870 1.1×
Bone survey infant (77076) $232.50 $465 2.3×
Brain Flow Imaging Only (78610) $1,091.50 $2,183 2.1×
Brain Image W/Flow < 4 Views (78601) $946.50 $1,893 2.4×
Brain imaging < 4 static views (78600) $450 $900 1.2×
Brain Imaging Min 4 Static Views W Vascular Flow (78606) $1,014.50 $2,029 1.9×
Brain Imaging Minimum 4 Static Views (78605) $728 $1,456 1.4×
Card Bl Pool Gated Spect Rest Wal Motn Ejct Frct (78494) $770 $1,540 2.0×
Cardiac Shunt Detection (78428) $816.50 $1,633 2.1×
Cat Scan Follow-Up Study (76380) $495 $990 5.9×
Cerebrospinal Fluid Flow W/O Matl Shunt Evaltj (78645) $1,014.50 $2,029 1.9×
Cerebrospinal Fluid Scan (78630) $1,014.50 $2,029 1.9×
Chest 1 view (71045) $196 $392 2.3×
Chest 2 views (71046) $232.50 $465 2.7×
Chest 3 views (71047) $280 $560 3.3×
Chest 4 or more views (71048) $297.50 $595 2.9×
Cholecystography Oral Contrast (74290) $222 $444 1.3×
Clavicle complete (73000) $196 $392 2.3×
Computed Tomography Thorax Lw Dose Lng Ca Scr C- (71271) $183 $366 1.8×
Contrast Exam Abdominl Aorta (75625) $1,932 $3,864 0.6×
Contrast X-Ray Bladder (74430) $280 $560 0.8×
Contrast X-Ray Of Elbow (73085) $625 $1,250 1.8×
Contrast X-Ray Of Knee Joint (73580) $625 $1,250 1.8×
CT abdomen and pelvis without and with contrast (74178) $3,248.50 $6,497 9.6×
CT abdomen and pelvis without contrast (74176) $2,292.50 $4,585 9.9×
CT abdomen w contrast (74160) $1,608 $3,216 9.4×
CT abdomen w wo contrast (74170)
range across 2 matching MRF lines		 $1,845.50–$1,851.50 $3,691–$3,703 varies
CT abdomen w/o contrast (74150) $1,244 $2,488 12.2×
CT Angio Abdomen and Pelvis (74174) $2,665 $5,330 7.9×
CT Angio Chest (71275) $1,731.50 $3,463 10.2×
CT Angio Head (70496) $1,724 $3,448 10.1×
CT angio hrt w/3d image (75574) $985.50 $1,971 2.9×
Ct Angio Lwr Extr W/O&W/Dye (73706) $1,514 $3,028 8.9×
CT Angio Neck (70498) $1,823 $3,646 10.7×
Ct Angio Upr Extrm W/O&W/Dye (73206) $1,499 $2,998 8.8×
CT bone density (77078) $245.50 $491 2.9×
CT cervical spine w/ contrast (72126) $1,608 $3,216 4.7×
CT cervical spine w/o contrast (72125) $1,300 $2,600 12.8×
CT cervical spine w/wo cont (72127) $1,913.50 $3,827 11.2×
CT chest w contrast (71260) $1,432.50 $2,865 8.4×
CT chest w/wo contrast (71270) $1,752 $3,504 10.3×
CT colonography screening (74263) $1,191.50 $2,383 5.1×
CT colonogrphy dx image postprocess w/o contrast (74261) $1,178.50 $2,357 11.6×
CT head/brain with contrast (70460) $1,275.50 $2,551 7.5×
CT head/brain without and with contrast (70470) $1,464.50 $2,929 8.6×
CT heart contrast eval cardiac structure&morph (75572) $494.50 $989 1.5×
CT heart no contrast quant eval coronry calcium (75571) $125 $250 1.5×
CT hrt w/3d image congen (75573) $535 $1,070 1.6×
CT iac w contrast (70481) $1,432.50 $2,865 8.4×
CT l-spine w&w/o contrast (72133) $2,138 $4,276 12.5×
CT lower ext w/o (73700) $1,164 $2,328 11.5×
CT lower extremity w/contrast material (73701) $1,523 $3,046 8.9×
CT lumbar spine w contrast (72132) $1,715 $3,430 5.1×
CT lumbar spine w/o contrast (72131) $1,384 $2,768 13.6×
CT maxillofacial w contrast (70487) $1,094 $2,188 6.4×
CT maxillofacial wo contrast (70486)
range across 2 matching MRF lines		 $941.50–$1,107.50 $1,883–$2,215 varies
CT neck tissue combo (70492) $1,644 $3,288 9.6×
Ct Orbit/Ear/Fossa W/O&W/Dye (70482) $1,555 $3,110 9.1×
CT orbits w/o contrast (70480) $1,268.50 $2,537 12.5×
CT pelvis w&w/o contrast (72194)
range across 2 matching MRF lines		 $1,426–$1,593 $2,852–$3,186 varies
CT pelvis w/o contrast (72192)
range across 2 matching MRF lines		 $1,136.50–$1,188.50 $2,273–$2,377 varies
CT scan of leg combo (73702) $1,685 $3,370 9.9×
CT scans face/jaw combo (70488) $1,723 $3,446 10.1×
CT soft tissue neck w contrast (70491) $1,489 $2,978 8.7×
CT soft tissue neck w/o contrast (70490) $1,210 $2,420 11.9×
CT thoracic spine w contrast (72129) $1,437 $2,874 8.4×
CT thoracic spine w/o contrast (72128) $1,117 $2,234 11.0×
CT thoracic spine w/wo cont (72130) $1,600 $3,200 9.4×
CT thorax w/o contrast (71250)
range across 2 matching MRF lines		 $902–$1,061.50 $1,804–$2,123 varies
CT unlisted procedure (76497) $405.50 $811 4.8×
CT upper ext wo (73200) $1,334.50 $2,669 13.1×
CT upper extremity w/o & w/contrast material (73202) $1,632.50 $3,265 9.6×
CT upper extremity with contrast (73201) $1,499 $2,998 4.4×
Cta Abdl Aorta&Bi Iliofem W/Contrast&Postp (75635) $1,808 $3,616 10.6×
Cta Abdomen (74175) $1,377 $2,754 8.1×
CTA pelvis (72191) $1,784 $3,568 10.5×
Dacryocystography, nasolacrimal duct, radiological supervision and interpretation Non-Facility (70170) $355.50 $711 1.5×
Dilation ureters/urethra rs&i (74485) $1,286.50 $2,573 0.6×
Discography Cerv/Thor Spine (72285) $1,887 $3,774 1.0×
Diskography lumbar (72295) $2,519 $5,038 1.3×
Doppler Echo Fetal Puls Spectral F/U/Repeat (76828) $201 $402 2.0×
Doppler Fetal Mid Cerebral Artery (76821) $206 $412 2.0×
Dxa Bone Density Axial (77080) $205 $410 2.0×
Dxa bone density study (77085) $147.50 $295 1.5×
Dxa bone density study 1/>sites appendiclr skel (77081) $210.50 $421 2.5×
Echo exam uterus (76831) $401 $802 1.7×
Echo Guide For Artery Repair (76936) $360.50 $721 1.7×
Esophagram (74220) $287.50 $575 1.7×
Fetal Biophys Profile W/Nst (76818)
range across 2 matching MRF lines		 $387.50–$467.50 $775–$935 varies
Fetal Biophysical Profile W/O Non-Stress Testing (76819)
range across 2 matching MRF lines		 $354–$360.50 $708–$721 varies
Fluoroscopy up to 1 hr (76000) $476.50 $953 2.1×
Follow-Up Angiography (75898) $2,045.50 $4,091 0.7×
Foot 2 views (73620)
range across 2 matching MRF lines		 $143–$232.50 $286–$465 varies
Forearm 2 views (73090)
range across 2 matching MRF lines		 $89.50–$232.50 $179–$465 varies
Gastric emptying imaging study (78264) $1,321.50 $2,643 3.4×
Gastric Emptyng Imag Std W/Sm Bwl Transit (78265) $928 $1,856 2.4×
Gastroesophageal Reflux Exam (78262) $483.50 $967 1.2×
Gated Heart Planar Single (78472) $1,276.50 $2,553 3.3×
Gated Heart, Multiple (78473) $770 $1,540 2.0×
Gstrc Emptng Imag Std W/Sm Bwl Col Trnst Mlt Day (78266) $3,016.50 $6,033 5.7×
Hand 2 views (73120)
range across 2 matching MRF lines		 $89.50–$232.50 $179–$465 varies
Hepatobil Syst Image W/Drug (78227) $1,620 $3,240 3.1×
Hepatobiliary System Imaging (78226) $1,591 $3,182 4.1×
Ht Muscle Image Spect Sing (78451) $1,906 $3,812 1.5×
Hysterosalpingogram (74740) $596 $1,192 2.6×
Infant hip ultrasound with hip movement (dynamic) (76885) $277 $554 3.3×
Infusion Ivp (74410) $396 $792 2.3×
Joint Survey Single View (77077) $196 $392 1.9×
K Flow/Funct Image Multiple (78709) $1,697 $3,394 3.2×
K Flow/Funct Image W/Drug (78708) $1,172 $2,344 2.2×
K Flow/Funct Image W/O Drug (78707) $1,049.50 $2,099 2.0×
Kidney Imaging Morphol (78700) $612 $1,224 1.6×
Kidney Imaging Morphoogy W/Vascular Flow (78701) $1,453 $2,906 3.7×
Knee 3 Views (73562) $280 $560 3.3×
Leveen/Shunt Patency Exam (78291) $629.50 $1,259 1.6×
Liver & Spleen Imaging Static Only (78215) $699.50 $1,399 1.8×
Liver imaging w/vascular flow (78202) $783 $1,566 1.5×
Lung Perf&Ventilat Diferentl (78598) $1,294 $2,588 2.5×
Lung perfusion differential (78597) $987 $1,974 2.5×
Lung Ventilat&Perfus Imaging (78582) $1,276.50 $2,553 2.4×
Lung Ventilation Imaging (78579) $1,112.50 $2,225 2.9×
Lymph System Imaging (78195) $1,248.50 $2,497 2.4×
Lymphangiography Extremity Only Bilateral Rs&I (75803) $808 $1,616 0.5×
Lymphangiography, pelvic/abdominal, unilateral (75805) $1,637 $3,274 0.5×
Magnetic Image Jaw Joint (70336)
range across 2 matching MRF lines		 $1,461.50–$1,951 $2,923–$3,902 varies
Mammary ductogram or galactogram multiple (77054) $543 $1,086 2.3×
Mammary ductogram or galactogram single (77053) $338.50 $677 1.5×
Meckels Divert Exam (78290) $699.50 $1,399 1.8×
Mra Head W/O & W/Contrast Material (70546) $2,387 $4,774 7.0×
MRA head w/o contrast (70544) $1,775 $3,550 7.7×
MRA head with contrast (70545) $2,143.50 $4,287 6.3×
MRA neck w contrast (70548) $2,068.50 $4,137 6.1×
Mra Neck W/O &W/Contrast Material (70549) $2,306 $4,612 6.8×
MRA neck w/o contrast (70547) $1,580 $3,160 6.8×
MRI brain functional w/o physician admnistration (70554) $761 $1,522 3.3×
MRI brain functional w/physician admnistration (70555) $761 $1,522 3.3×
MRI cervical spine w contrast (72142) $2,136.50 $4,273 6.3×
MRI cervical spine w/o cont (72141) $1,961 $3,922 8.5×
MRI chest w/o contrast (71550) $1,606.50 $3,213 6.9×
MRI chest with contrast (71551) $1,684.50 $3,369 2.2×
MRI chest wo w contrast (71552) $2,270 $4,540 6.7×
MRI orbit face &/neck w/o contrast (70540) $1,635.50 $3,271 7.1×
MRI orbit face neck w contrast (70542) $1,781.50 $3,563 5.3×
Mri Orbt/Fac/Nck W/O &W/Dye (70543) $2,254.50 $4,509 6.7×
Myelogram cervical (72240) $788 $1,576 1.0×
Myelogram Lumbar (72265)
range across 2 matching MRF lines		 $979.50–$1,027 $1,959–$2,054 varies
Myelography thoracic (72255) $2,598.50 $5,197 3.4×
Myelograpy 2/more regions rs&i (72270) $1,124 $2,248 1.5×
Myocardial Imaging Infarct Avid Planar Qual/Quan (78466) $615.50 $1,231 1.6×
Myocardial Spect Multiple Studies (78452) $3,165 $6,330 2.5×
Myocrd img PET prfuj 1std rest/stress cncrnt CT (78430) $1,896.50 $3,793 1.4×
Myocrd Img Pet Prfuj Mlt Std Rst&Strs Cncrnt CT (78431) $2,925.50 $5,851 1.4×
N-invas est c ffr sw aly CTA (75580) $2,608 $5,216 3.1×
Neck soft tissue (70360) $196 $392 2.3×
Nfs/Instlj Radioelmnt Sln 3 Mo Follow-Up Care (77750) $266.30 $532.60 0.7×
Nm csf leak detection (78650) $1,301.52 $2,603.04 1.0×
Nm whole blood volume (78122) $1,102 $2,204 2.1×
Nonvascular Shunt X-Ray (75809) $188 $376 1.9×
Nuclear Rx Oral Admin (79005) $764.50 $1,529 3.4×
Ophthalmic Biometry US Echograpy a-Scan (76516) $283.50 $567 2.8×
Optic foramina (70190) $122.50 $245 1.4×
Panoramic X-ray of jaws (70355) $256.50 $513 3.0×
Parathyroid imaging w/tomographic spect & CT (78072) $2,773.50 $5,547 5.3×
Parathyroid Planar Imaging (78070) $804.50 $1,609 2.1×
Parathyroid planar imaging w/wo subtraction (78071) $1,012 $2,024 2.6×
Pelvis 1 or 2 views (72170) $232.50 $465 2.3×
Pulmonary Perfusion Imaging Particulate (78580) $629.50 $1,259 1.6×
Radex Abd Compl Aqt Abd W/S/E/D Views 1 View Ch (74022) $324.50 $649 3.2×
Radex abscess/fistula/sinus tract rs&i (76080) $366 $732 0.7×
Radex Ankle Complete Minimum 3 Views (73610) $280 $560 3.3×
Radex Calcaneus Minimum 2 Views (73650) $232.50 $465 2.7×
Radex elbow complete minimum 3 views (73080) $280 $560 3.3×
Radex Facial Bones Complete Minimum 3 Views (70150) $280 $560 2.8×
Radex fingr minimum 2 views (73140)
range across 11 matching MRF lines		 $196–$232.50 $392–$465 varies
Radex foot complete minimum 3 views (73630) $280 $560 3.3×
Radex Hand Minimum 3 Views (73130) $280 $560 3.3×
Radex lower extremity infant minimum 2 views (73592) $232.50 $465 2.7×
Radex Mastoids Compl Minimum 3 Views PR Side (70130) $280 $560 2.8×
Radex Nasal Bones Complete Minimum 3 Views (70160) $280 $560 3.3×
Radex Ribs Unilateral 2 Views (71100) $196 $392 2.3×
Radex shoulder complete minimum 2 views (73030) $232.50 $465 2.7×
Radex Sinuses Paransl < 3 Views (70210) $158 $316 1.9×
Radex sm int w/mlt srl imges via enteroclss tube (74251) $321.50 $643 1.9×
Radex Spine 1 View Specify Level (72020) $196 $392 2.3×
Radex Sternum Minimum 2 Views (71120) $232.50 $465 2.7×
Radex Temporomandble Jt Opn & Clsd Mouth Bilat (70330) $215.50 $431 2.5×
Radex Toe Minimum 2 Views (73660)
range across 11 matching MRF lines		 $170.50–$196 $341–$392 varies
Radex upper extremity infant minimum 2 views (73092) $232.50 $465 2.3×
Radex Wrist Complete Minimum 3 Views (73110) $280 $560 3.3×
Radex X-Ray Exam Entire Spi 6/> Vw - Xr Entire Spine 6+ Vw (72084) $295 $590 2.9×
Radiolog exam mandible compl minimum 4 views (70110) $297.50 $595 2.9×
Radiologic Exam Abdomen 3+ Views - Xr Abdomen 3+ Views (74021) $280 $560 2.8×
Radiologic exam colon double contrast study (74280) $614.50 $1,229 3.6×
Radiologic exam colon single contrast study (74270) $614.50 $1,229 3.6×
Radiologic Exam Esophagus Double Contrast Study (74221) $287.50 $575 1.7×
Radiologic exam knee complete 4/more views (73564) $297.50 $595 2.9×
Radiologic exam pelvis compl minimum 3 views (72190) $280 $560 2.8×
Radiologic Exam Small Int Single Contrast Study (74250) $350 $700 2.1×
Radiologic exam swallow function contrast study (74230) $383 $766 2.2×
Radiologic Exam Teeth Prtl Exam < Full Mouth (70310) $152 $304 0.7×
Radiologic exam upr gi trc double contrast study (74246) $350 $700 2.1×
Radiologic examination femur 1 view (73551) $196 $392 2.3×
Radiologic examination femur minimum 2 views (73552) $232.50 $465 2.7×
Radiologic examination knee 1/2 views (73560)
range across 2 matching MRF lines		 $170.50–$232.50 $341–$465 varies
Radiologic Examination Osseous Survey Limited (77074) $181 $362 1.8×
Radiologic Examination Salivary Gland Calculus (70380) $57.50 $115 0.7×
Radiologic examination tibia & fibula 2 views (73590)
range across 2 matching MRF lines		 $89.50–$232.50 $179–$465 varies
Radiologic examination, internal auditory meati, complete Non-Facility (70134) $341.50 $683 0.6×
Radiologic examination, teeth; single view Non-Facility (70300) $47 $94 0.6×
Radiopharm Dacryocystography (78660) $378.04 $756.07 1.0×
Radiopharmaceutical therapy, by interstitial radioactive colloid administration Facility (79300) $463.50 $927 2.0×
Radiopharmaceutical therapy, by intracavitary administration Non-Facility (79200) $571.50 $1,143 2.5×
Ribs bilateral 3 views (71110) $280 $560 2.8×
Rp loclzj tum plnr 1 area single day imaging (78800) $768.50 $1,537 2.0×
Rp loclzj tum plnr 2+area 1+d img/1 area img>2+d (78801) $768.50 $1,537 2.0×
Rp Loclzj Tum Plnr Whole Body 2+ Days Imaging (78804) $1,767 $3,534 3.3×
Rp Loclzj Tum Plnr Whole Body Single Day Imaging (78802) $1,407 $2,814 2.7×
Rp Loclzj Tum Spect 1 Area Single Day Imaging (78803) $1,301.52 $2,603.04 2.5×
Rp loclzj tum spect 2 area/sep acquisj img (78831) $1,231.17 $2,462.33 1.0×
Rp loclzj tum spect CT 2area 1d img/1 ar img>2+d (78832) $1,356.45 $2,712.89 1.0×
Rp loclzj tum spect w/CT 1 area/acquisj 1day img (78830) $1,231.17 $2,462.33 1.0×
Rp Ther Radiolbld Monoclonal Antibody IV Infus (79403) $831 $1,662 3.7×
Rp Therapy Intravenous Administration (79101) $764.50 $1,529 3.4×
Salivary Gland Imaging (78230) $408.69 $817.38 1.1×
Salivary Gland Imaging Serial Images (78231) $423.50 $847 1.1×
Scapula (73010) $280 $560 2.8×
Screening Digital Breast Tomosynthesis Bi (77063) $86.50 $173 3.7×
Sella turcica (70240) $131.50 $263 1.6×
Shoulder 1 view (73020) $196 $392 2.3×
Shoulder Arthrography (73040) $625 $1,250 1.8×
Sialogram (70390) $291 $582 1.3×
Skull less than 4 views (70250) $280 $560 2.8×
Spleen Imaging (78185) $746 $1,492 1.9×
Sternoclavicular joints (71130) $280 $560 3.3×
Temporomandble Jt Arthrography Rs&I (70332)
range across 2 matching MRF lines		 $528.50–$724 $1,057–$1,448 varies
Testicular Imaging W/Flow (78761) $837 $1,674 2.2×
Therapeutic Enema Rdctj Intussusception/Obstrcj (74283) $614.50 $1,229 3.6×
Thoracic spine 2 views (72070) $232.50 $465 2.3×
Thoracic spine 3 views (72072) $280 $560 2.8×
Thoracolumbar 2 views (72080) $232.50 $465 2.7×
Thyroid Carcinoma Metastases Img Lmtd Area (78015) $787.50 $1,575 2.0×
Thyroid Imaging With Vascular Flow (78013) $595.50 $1,191 1.5×
Thyroid Met Imaging Body (78018) $1,364 $2,728 2.6×
Thyroid Uptake Measurement (78012) $420 $840 1.1×
Thyroid Uptake W/Blood Flow Sngle/Mult Quan Meas (78014) $643 $1,286 1.7×
Ultrasound Breast Limited (76642)
range across 2 matching MRF lines		 $304.50–$328.50 $609–$657 varies
Ultrasound Exam Aaa Screen (76706) $298 $596 2.9×
Ultrasound trgt dynamic microbubble 1st lesion (76978) $679.50 $1,359 2.0×
Ultrasound, abdomen limited (76705) $479.50 $959 4.7×
Umbilical-artery Doppler (OB) (76820) $206 $412 2.0×
Unlisted Dx Radiographic Procedure (76499) $785.50 $1,571 9.3×
Unlisted us procedure (76999) $150.50 $301 1.8×
Upper gi w/o kub (74240) $324.50 $649 1.9×
Urea Breath Test C-14 Isotopic Acquisj Analysis (78267) $20.50 $41 1.9×
Ureteral Reflux Study (78740) $837 $1,674 2.2×
Urethrocystogram voiding (74455) $573 $1,146 2.5×
Urethrocystography retrograde (74450) $371 $742 1.6×
Us breast unilateral complete (76641)
range across 2 matching MRF lines		 $304.50–$328.50 $609–$657 varies
Us chest (76604) $256 $512 2.5×
Us complete joint (76881) $378 $756 3.7×
Us exam, pelvic, limited (76857) $242 $484 2.4×
Us head (76506) $290.50 $581 2.9×
Us kidney transplant (76776) $416.50 $833 4.1×
Us lmtd joint/oth nonvasc xtr strux r-t w/img (76882) $179.50 $359 1.8×
Us ob detailed single fetus (76811) $561 $1,122 2.4×
Us ob limited 1 or more fetuses (76815) $311.50 $623 3.1×
Us ob transvaginal (76817) $388 $776 3.8×
Us pelvic non ob complete (76856) $647 $1,294 6.4×
Us pg uter img f&mat 14 wk tabdl 1/1st gestation (76801) $395.50 $791 3.9×
Us preg uterus real time f/u trnsabdl per fetus (76816) $256 $512 2.5×
Us retroperitoneal complete (76770) $564 $1,128 5.6×
Us retroperitoneal limited (76775) $346.50 $693 3.4×
Us scrotum and contents (76870) $517.50 $1,035 5.1×
Us spinal canal and contents (76800) $398.50 $797 3.9×
Us thyroid (76536) $458 $916 4.5×
Us transrectal (76872) $574 $1,148 5.7×
Venography extremity bilateral rs&i (75822) $1,024 $2,048 0.7×
Venography extremity unilateral rs&i (75820) $941.50 $1,883 0.6×
Venous Thrombosis Imaging Venogram Bilateral (78458) $450 $900 1.2×
Vertebral fracture assessment via dxa (77086) $167.50 $335 2.0×
Wrist 2 views (73100)
range across 2 matching MRF lines		 $89.50–$232.50 $179–$465 varies
X-Ray Ac Jts - Xr Acromioclavicular Joints Bilateral (73050) $280 $560 3.3×
X-ray antegrade pyelogram tube (74425) $307 $614 0.9×
X-Ray Aorta Leg Arteries (75630) $2,045 $4,090 0.7×
X-Ray Bend Only L-S Spine (72120) $297.50 $595 2.9×
X-Ray Elbow 2 Vw - Xr Elbow 1-2 Views Right (73070)
range across 2 matching MRF lines		 $89.50–$232.50 $179–$465 varies
X-Ray Exam Breast Specimen (76098) $451.50 $903 0.9×
X-Ray Exam Entire Spi 1 Vw (72081) $174 $348 2.1×
X-Ray Exam Entire Spi 2/3 Vw (72082) $195 $390 1.9×
X-Ray Exam Entire Spi 4/5 Vw (72083) $215 $430 2.1×
X-Ray Exam Hip Uni 1 View (73501) $196 $392 2.3×
X-Ray Exam Hip Uni 2-3 Views (73502) $249 $498 2.9×
X-Ray Exam Hip Uni 4/> Views (73503) $297.50 $595 2.9×
X-Ray Exam Hips Bi 2 Views (73521) $232.50 $465 2.3×
X-Ray Exam Hips Bi 3-4 Views (73522) $297.50 $595 2.9×
X-Ray Exam Hips Bi 5/> Views (73523) $321.50 $643 3.2×
X-Ray Exam L-S Spine Bending (72114) $389 $778 3.8×
X-Ray Exam Neck Spine 2-3 Vw (72040) $280 $560 3.3×
X-Ray Exam Neck Spine 6/>Vws (72052) $372 $744 3.7×
X-Ray Exam Unilat Ribs/Chest (71101) $232.50 $465 2.3×
X-ray eye for foreign body (70030) $196 $392 2.3×
X-ray head for orthodontia (70350) $138 $276 1.6×
X-ray humerus (73060)
range across 2 matching MRF lines		 $89.50–$232.50 $179–$465 varies
X-ray IV pyelogram (ivp) (74400) $364 $728 2.1×
X-ray IV pyelogram+tomography (74415) $445 $890 2.6×
X-Ray Jaw <4 Vw - Xr Mandible < 4 Views (70100) $297.50 $595 3.5×
X-Ray Knee Bilat Standing - Xr Knees Anteroposterior Standing Bilat (73565) $297.50 $595 3.5×
X-Ray Lumbar Spine 2/3 Vw - Xr Lumbar Spine 2-3 Views (72100) $280 $560 2.8×
X-ray nose-rectum child f.b. (76010) $196 $392 2.3×
X-Ray Ribs, Chest 4+ Vw - Xr Ribs 3 Vws Bil W/ Chest Posteroanterior (71111) $280 $560 2.8×
X-Ray Sacroiliac Jts 3+ Vw - Xr Sacroiliac Joints 3+ Views (72202) $280 $560 2.8×
X-Ray Sacroiliac Jts <3 Vw - Xr Sacroiliac Joints 1-2 Views (72200) $280 $560 2.8×
X-Ray Sacrum/Coccyx 2+ Vw - Xr Sacrum Coccyx 2+ Views (72220) $232.50 $465 2.7×
X-Ray Sinuses 3+ Vw - Xr Paranasal Sinuses 3+ Views (70220) $280 $560 3.3×
X-Ray Skull 4+ Vw - Xr Skull Complete 4+ Views (70260) $297.50 $595 2.9×
X-Ray Stress View (77071) $129.50 $259 1.5×
X-ray thoracic spine 4 vw (72074) $297.50 $595 2.9×
X-Ray Tmj Unilat (70328) $196 $392 2.3×
X-Ray Urinary Tract Exam With Contrast Material (74420) $444 $888 1.3×
X-Rays Bone Length Studies (77073) $188 $376 1.9×
X-Rays Bone Survey Complete (77075) $335 $670 3.3×
Xr c-spine 4 or 5 views (72050) $297.50 $595 2.9×
Xr facial bones less than 3 views (70140) $232.50 $465 2.7×
XR Mastoids < 3 Views Bilateral (70120) $232.50 $465 2.3×
Xr myelogram posterior fossa (70010) $637.50 $1,275 1.9×
Xr orbits complete 4 views (70200) $297.50 $595 2.9×
Xr Tomogram Single Plane (76100) $219.50 $439 2.2×

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.