Imaging prices at Pawnee Valley Community Hospital
Larned, KS · every code in this section with a posted price and a Medicare benchmark.
290 codes. Prices are the hospital's own posted facility charges.
Compare against other hospitals interactively →
| Procedure | Posted cash | Posted gross | × Medicare |
|---|---|---|---|
| 3-D radiotherapy plan dose-volume histograms (77295) | $3,500 | $8,750 | 2.7× |
| Abdomen 1 View (74018) range across 2 matching MRF lines |
$16.80–$116 | $42–$290 | varies |
| Abdomen 2 views (74019) | $140 | $350 | 1.5× |
| Acute Gastrointestinal Blood Loss Imaging (78278) | $836 | $2,090 | 2.3× |
| Angiography extremity bilateral rs&i (75716) | $2,308 | $5,770 | 0.8× |
| Angiography extremity unilateral rs&i (75710) | $2,544 | $6,360 | 0.9× |
| Ankle 2 views (73600) range across 3 matching MRF lines |
$18–$120 | $45–$300 | varies |
| Aortography thoracic serialography rs&i (75605) unusually low: confirm this is the full procedure |
$1,584 | $3,960 | 0.3× |
| Arthrogram hip (73525) | $544 | $1,360 | 1.7× |
| Arthrogram Wrist (73115) | $492 | $1,230 | 1.5× |
| Basic radiation dosimetry calculation (77300) | $316 | $790 | 2.6× |
| Bone age studies (77072) range across 3 matching MRF lines |
$22.40–$156 | $56–$390 | varies |
| Bone Imaging 3 Phase (78315) | $848 | $2,120 | 2.3× |
| Bone Imaging Limited Area (78300) | $512 | $1,280 | 1.4× |
| Bone Imaging Multiple Areas (78305) | $612 | $1,530 | 1.7× |
| Bone Imaging Whole Body (78306) | $724 | $1,810 | 2.0× |
| Bone marrow imaging limited area (78102) | $760 | $1,900 | 2.1× |
| Bone survey infant (77076) | $176 | $440 | 1.8× |
| Brain Imaging Min 4 Static Views W Vascular Flow (78606) | $804 | $2,010 | 1.6× |
| Brain Imaging Pet Metabolic Evaluation (78608) | $2,632 | $6,580 | 2.0× |
| Cat Scan Follow-Up Study (76380) | $340 | $850 | 4.2× |
| Cerebrospinal Fluid Scan (78630) | $860 | $2,150 | 1.7× |
| Chest 1 view (71045) range across 2 matching MRF lines |
$16.80–$108 | $42–$270 | varies |
| Chest 2 views (71046) range across 2 matching MRF lines |
$20.40–$144 | $51–$360 | varies |
| Clavicle complete (73000) range across 3 matching MRF lines |
$18.80–$132 | $47–$330 | varies |
| Continuing medical physics consltj pr wk (77336) | $404 | $1,010 | 3.3× |
| Contrast Exam Abdominl Aorta (75625) | $1,524 | $3,810 | 0.5× |
| Contrast X-Ray Bladder (74430) | $348 | $870 | 1.1× |
| CT abdomen and pelvis without and with contrast (74178) | $1,744 | $4,360 | 5.4× |
| CT abdomen and pelvis without contrast (74176) | $1,232 | $3,080 | 5.6× |
| CT abdomen w contrast (74160) | $804 | $2,010 | 5.0× |
| CT abdomen w wo contrast (74170) | $1,008 | $2,520 | 6.2× |
| CT abdomen w/o contrast (74150) | $760 | $1,900 | 7.9× |
| CT Angio Abdomen and Pelvis (74174) | $1,476 | $3,690 | 4.6× |
| CT Angio Chest (71275) | $1,056 | $2,640 | 6.5× |
| CT Angio Head (70496) | $1,032 | $2,580 | 6.4× |
| CT angio hrt w/3d image (75574) | $912 | $2,280 | 2.8× |
| Ct Angio Lwr Extr W/O&W/Dye (73706) | $844 | $2,110 | 5.2× |
| CT Angio Neck (70498) | $956 | $2,390 | 5.9× |
| Ct Angio Upr Extrm W/O&W/Dye (73206) | $824 | $2,060 | 5.1× |
| CT cervical spine w/ contrast (72126) | $876 | $2,190 | 2.7× |
| CT cervical spine w/o contrast (72125) range across 2 matching MRF lines |
$720–$728 | $1,800–$1,820 | varies |
| CT chest w contrast (71260) | $804 | $2,010 | 5.0× |
| CT chest w/wo contrast (71270) | $872 | $2,180 | 5.4× |
| CT head/brain with contrast (70460) | $696 | $1,740 | 4.3× |
| CT head/brain without and with contrast (70470) range across 2 matching MRF lines |
$932–$940 | $2,330–$2,350 | varies |
| CT heart contrast eval cardiac structure&morph (75572) | $868 | $2,170 | 2.7× |
| CT heart no contrast quant eval coronry calcium (75571) | $264 | $660 | 3.3× |
| CT iac w contrast (70481) | $700 | $1,750 | 4.3× |
| CT l-spine w&w/o contrast (72133) | $932 | $2,330 | 5.8× |
| CT lower ext w/o (73700) | $560 | $1,400 | 5.8× |
| CT lower extremity w/contrast material (73701) | $632 | $1,580 | 3.9× |
| CT lumbar spine w contrast (72132) | $812 | $2,030 | 2.5× |
| CT lumbar spine w/o contrast (72131) range across 2 matching MRF lines |
$752–$784 | $1,880–$1,960 | varies |
| CT maxillofacial w contrast (70487) | $772 | $1,930 | 4.8× |
| CT maxillofacial wo contrast (70486) | $636 | $1,590 | 6.6× |
| CT neck tissue combo (70492) | $804 | $2,010 | 5.0× |
| Ct Orbit/Ear/Fossa W/O&W/Dye (70482) | $824 | $2,060 | 5.1× |
| CT orbits w/o contrast (70480) | $604 | $1,510 | 6.3× |
| CT pelvis w&w/o contrast (72194) | $948 | $2,370 | 5.9× |
| CT pelvis w/o contrast (72192) | $652 | $1,630 | 6.8× |
| CT scan of leg combo (73702) | $736 | $1,840 | 4.6× |
| CT scans face/jaw combo (70488) | $816 | $2,040 | 5.1× |
| CT soft tissue neck w contrast (70491) | $772 | $1,930 | 4.8× |
| CT soft tissue neck w/o contrast (70490) | $628 | $1,570 | 6.5× |
| CT thoracic spine w contrast (72129) | $724 | $1,810 | 4.5× |
| CT thoracic spine w/o contrast (72128) | $708 | $1,770 | 7.4× |
| CT thoracic spine w/wo cont (72130) | $932 | $2,330 | 5.8× |
| CT thorax w/o contrast (71250) range across 2 matching MRF lines |
$680–$684 | $1,700–$1,710 | varies |
| CT upper ext wo (73200) | $560 | $1,400 | 5.8× |
| CT upper extremity w/o & w/contrast material (73202) | $820 | $2,050 | 5.1× |
| CT upper extremity with contrast (73201) | $612 | $1,530 | 1.9× |
| Cta Abdl Aorta&Bi Iliofem W/Contrast&Postp (75635) | $1,108 | $2,770 | 6.9× |
| Cta Abdomen (74175) | $1,072 | $2,680 | 6.6× |
| CTA head&neck c+ w/noncontrast img&post-pxessing (70471) range across 2 matching MRF lines |
$1,476–$1,916 | $3,690–$4,790 | varies |
| CTA pelvis (72191) | $1,028 | $2,570 | 6.4× |
| Doppler Fetal Mid Cerebral Artery (76821) | $200 | $500 | 2.1× |
| Dxa Bone Density Axial (77080) range across 2 matching MRF lines |
$208–$224 | $520–$560 | varies |
| Dxa bone density study 1/>sites appendiclr skel (77081) | $112 | $280 | 1.4× |
| Echo Guide For Artery Repair (76936) | $272 | $680 | 1.4× |
| Esophagram (74220) | $292 | $730 | 1.8× |
| Fetal Biophysical Profile W/O Non-Stress Testing (76819) | $240 | $600 | 2.5× |
| Fluoroscopy up to 1 hr (76000) range across 2 matching MRF lines |
$19.20–$192 | $48–$480 | varies |
| Foot 2 views (73620) range across 3 matching MRF lines |
$16.40–$132 | $41–$330 | varies |
| Forearm 2 views (73090) range across 3 matching MRF lines |
$16.40–$128 | $41–$320 | varies |
| Gastric emptying imaging study (78264) | $748 | $1,870 | 2.0× |
| Gated Heart Planar Single (78472) | $888 | $2,220 | 2.4× |
| Hand 2 views (73120) range across 3 matching MRF lines |
$14–$152 | $35–$380 | varies |
| Hepatobil Syst Image W/Drug (78227) | $640 | $1,600 | 1.3× |
| Hepatobiliary System Imaging (78226) | $824 | $2,060 | 2.2× |
| Ht Musc Image Planar Mult (78454) | $2,112 | $5,280 | 1.8× |
| Ht Muscle Image Spect Sing (78451) | $1,360 | $3,400 | 1.1× |
| Hysterosalpingogram (74740) | $392 | $980 | 1.8× |
| Infant hip ultrasound with hip movement (dynamic) (76885) | $264 | $660 | 3.3× |
| Joint Survey Single View (77077) | $112 | $280 | 1.2× |
| K Flow/Funct Image W/Drug (78708) | $864 | $2,160 | 1.7× |
| K Flow/Funct Image W/O Drug (78707) | $828 | $2,070 | 1.7× |
| Kidney Imaging Morphol (78700) | $600 | $1,500 | 1.6× |
| Knee 3 Views (73562) range across 3 matching MRF lines |
$21.20–$160 | $53–$400 | varies |
| Leveen/Shunt Patency Exam (78291) | $580 | $1,450 | 1.6× |
| Lung Perf&Ventilat Diferentl (78598) | $848 | $2,120 | 1.7× |
| Lung Ventilat&Perfus Imaging (78582) | $732 | $1,830 | 1.5× |
| Lymph System Imaging (78195) | $792 | $1,980 | 1.6× |
| Magnetic Image Jaw Joint (70336) | $904 | $2,260 | 4.1× |
| Mammary ductogram or galactogram multiple (77054) | $288 | $720 | 1.3× |
| Mammary ductogram or galactogram single (77053) | $220 | $550 | 1.0× |
| Meckels Divert Exam (78290) | $652 | $1,630 | 1.8× |
| Mlc imrt design & construction per imrt plan (77338) | $1,320 | $3,300 | 3.8× |
| Mr safety determination physician/other qhp (76016) | $108 | $270 | 1.3× |
| Mr safety implant&/fb assmt clin staf 1st 15 min (76014) | $32 | $80 | 1.2× |
| Mr safety implt electronics prepj supvj phys/qhp (76018) | $104 | $260 | 1.2× |
| Mr safety med physics xm customization plng&mntr (76017) | $290 | $725 | 1.3× |
| Mra Head W/O & W/Contrast Material (70546) | $1,264 | $3,160 | 3.9× |
| MRA head w/o contrast (70544) range across 2 matching MRF lines |
$1,048–$1,156 | $2,620–$2,890 | varies |
| MRA head with contrast (70545) | $1,132 | $2,830 | 3.5× |
| MRA neck w contrast (70548) | $976 | $2,440 | 3.0× |
| Mra Neck W/O &W/Contrast Material (70549) range across 2 matching MRF lines |
$1,396–$1,536 | $3,490–$3,840 | varies |
| MRA neck w/o contrast (70547) | $1,020 | $2,550 | 4.6× |
| MRI abdomen w/o contrast (74181) | $928 | $2,320 | 4.2× |
| MRI any jt lower extrem w/contrast material (73722) | $1,524 | $3,810 | 2.1× |
| MRI any jt lower extrem w/o & w/contrast matrl (73723) range across 3 matching MRF lines |
$1,264–$1,656 | $3,160–$4,140 | varies |
| MRI any jt upper extremity w/contrast matrl (73222) | $1,476 | $3,690 | 2.0× |
| MRI Breast W/O Contrast Bilateral (77047) | $976 | $2,440 | 4.4× |
| MRI Breast Without Contrast Material Unilateral (77046) | $692 | $1,730 | 3.2× |
| MRI cervical spine w/o cont (72141) range across 2 matching MRF lines |
$956–$1,028 | $2,390–$2,570 | varies |
| MRI chest w/o contrast (71550) | $1,100 | $2,750 | 5.0× |
| MRI chest wo w contrast (71552) | $1,496 | $3,740 | 4.7× |
| MRI lower extrem oth/thn jt w/o & w/contr matr (73720) | $1,348 | $3,370 | 4.2× |
| MRI lower extrem oth/thn jt w/o contr matrl (73718) | $892 | $2,230 | 4.1× |
| Mri Neck Spine W/O & W/Dye (72156) | $1,356 | $3,390 | 4.2× |
| MRI orbit face &/neck w/o contrast (70540) | $1,224 | $3,060 | 5.6× |
| Mri Orbt/Fac/Nck W/O &W/Dye (70543) | $1,528 | $3,820 | 4.8× |
| MRI pelvis w/o & w contrast (72197) | $1,304 | $3,260 | 4.1× |
| MRI pelvis w/o contrast (72195) | $908 | $2,270 | 4.1× |
| MRI thoracic spine w/o contrast (72146) | $952 | $2,380 | 4.3× |
| MRI upper extremity oth than jt w/o contr matrl (73218) | $872 | $2,180 | 4.0× |
| Mri Uppr Extremity W/O&W/Dye (73220) | $1,460 | $3,650 | 4.6× |
| MRI, abdomen, combo (74183) | $1,484 | $3,710 | 4.6× |
| MRI, dorsal spine combo (72157) | $1,492 | $3,730 | 4.7× |
| MRI, joint upper extrem (73221) range across 2 matching MRF lines |
$940–$1,012 | $2,350–$2,530 | varies |
| MRI, joint upper extrem combo (73223) | $1,256 | $3,140 | 3.9× |
| MRI, lumbar spine combo (72158) | $1,344 | $3,360 | 4.2× |
| Myocardial Spect Multiple Studies (78452) range across 2 matching MRF lines |
$1,920–$1,996 | $4,800–$4,990 | varies |
| Neck soft tissue (70360) | $108 | $270 | 1.3× |
| Ntsty modul radthx pln dose-vol histos (77301) | $4,044 | $10,110 | 3.2× |
| Nuclear Rx Oral Admin (79005) | $564 | $1,410 | 2.6× |
| Panoramic X-ray of jaws (70355) | $144 | $360 | 1.8× |
| Parathyroid Planar Imaging (78070) | $696 | $1,740 | 1.9× |
| Parathyroid planar imaging w/wo subtraction (78071) | $684 | $1,710 | 1.9× |
| Pelvis 1 or 2 views (72170) range across 2 matching MRF lines |
$21.60–$148 | $54–$370 | varies |
| Pet Image W/Ct Lmtd (78814) | $2,304 | $5,760 | 1.8× |
| PET image w/CT, full body (78816) | $2,668 | $6,670 | 2.0× |
| PET imaging CT attenuation skull base mid-thigh (78815) | $2,632 | $6,580 | 2.0× |
| Pulmonary Perfusion Imaging Particulate (78580) | $524 | $1,310 | 1.4× |
| Radex Abd Compl Aqt Abd W/S/E/D Views 1 View Ch (74022) | $176 | $440 | 1.8× |
| Radex abscess/fistula/sinus tract rs&i (76080) | $492 | $1,230 | 1.0× |
| Radex Ankle Complete Minimum 3 Views (73610) range across 3 matching MRF lines |
$20–$140 | $50–$350 | varies |
| Radex Calcaneus Minimum 2 Views (73650) range across 3 matching MRF lines |
$17.60–$112 | $44–$280 | varies |
| Radex elbow complete minimum 3 views (73080) range across 3 matching MRF lines |
$28.80–$144 | $72–$360 | varies |
| Radex Facial Bones Complete Minimum 3 Views (70150) | $168 | $420 | 1.7× |
| Radex fingr minimum 2 views (73140) range across 3 matching MRF lines |
$21.20–$104 | $53–$260 | varies |
| Radex foot complete minimum 3 views (73630) range across 3 matching MRF lines |
$18.40–$140 | $46–$350 | varies |
| Radex Hand Minimum 3 Views (73130) range across 3 matching MRF lines |
$19.60–$140 | $49–$350 | varies |
| Radex lower extremity infant minimum 2 views (73592) | $124 | $310 | 1.5× |
| Radex Nasal Bones Complete Minimum 3 Views (70160) range across 2 matching MRF lines |
$112–$124 | $280–$310 | varies |
| Radex Ribs Unilateral 2 Views (71100) range across 3 matching MRF lines |
$24–$136 | $60–$340 | varies |
| Radex shoulder complete minimum 2 views (73030) range across 4 matching MRF lines |
$17.20–$160 | $43–$400 | varies |
| Radex Sinuses Paransl < 3 Views (70210) | $124 | $310 | 1.5× |
| Radex Spine 1 View Specify Level (72020) | $124 | $310 | 1.5× |
| Radex Sternum Minimum 2 Views (71120) range across 2 matching MRF lines |
$24–$140 | $60–$350 | varies |
| Radex Temporomandble Jt Opn & Clsd Mouth Bilat (70330) range across 2 matching MRF lines |
$208–$232 | $520–$580 | varies |
| Radex Toe Minimum 2 Views (73660) range across 3 matching MRF lines |
$14–$108 | $35–$270 | varies |
| Radex upper extremity infant minimum 2 views (73092) | $124 | $310 | 1.3× |
| Radex Wrist Complete Minimum 3 Views (73110) range across 3 matching MRF lines |
$26.40–$144 | $66–$360 | varies |
| Radiation Delivery Stereotactic Cranial Linear (77372) | $9,680 | $24,200 | 1.4× |
| Radiation treatment delivery level 1 (77402) | $320 | $800 | 3.4× |
| Radiation treatment delivery level 2 (77407) | $348 | $870 | 1.0× |
| Radiation treatment delivery level 3 (77412) | $564 | $1,410 | 1.1× |
| Radiolog exam mandible compl minimum 4 views (70110) | $200 | $500 | 2.1× |
| Radiologic Exam Abdomen 3+ Views - Xr Abdomen 3+ Views (74021) | $264 | $660 | 2.7× |
| Radiologic exam colon double contrast study (74280) | $536 | $1,340 | 3.3× |
| Radiologic exam colon single contrast study (74270) | $456 | $1,140 | 2.8× |
| Radiologic Exam Esophagus Double Contrast Study (74221) | $360 | $900 | 2.2× |
| Radiologic exam knee complete 4/more views (73564) range across 3 matching MRF lines |
$37.20–$180 | $93–$450 | varies |
| Radiologic exam pelvis compl minimum 3 views (72190) range across 3 matching MRF lines |
$25.20–$228 | $63–$570 | varies |
| Radiologic Exam Small Int Single Contrast Study (74250) | $332 | $830 | 2.1× |
| Radiologic exam swallow function contrast study (74230) | $328 | $820 | 2.0× |
| Radiologic exam upr gi trc double contrast study (74246) | $420 | $1,050 | 2.6× |
| Radiologic examination femur minimum 2 views (73552) range across 3 matching MRF lines |
$20–$128 | $50–$320 | varies |
| Radiologic examination knee 1/2 views (73560) range across 3 matching MRF lines |
$17.60–$136 | $44–$340 | varies |
| Radiologic Examination Osseous Survey Limited (77074) | $232 | $580 | 2.4× |
| Radiologic examination tibia & fibula 2 views (73590) range across 3 matching MRF lines |
$18.80–$128 | $47–$320 | varies |
| Ribs bilateral 3 views (71110) range across 2 matching MRF lines |
$208.80–$228 | $522–$570 | varies |
| Rp loclzj tum plnr 1 area single day imaging (78800) | $648 | $1,620 | 1.8× |
| Rp Loclzj Tum Plnr Whole Body 2+ Days Imaging (78804) | $1,552 | $3,880 | 3.1× |
| Rp Loclzj Tum Plnr Whole Body Single Day Imaging (78802) | $1,096 | $2,740 | 2.2× |
| Rp Loclzj Tum Spect 1 Area Single Day Imaging (78803) | $1,364 | $3,410 | 2.7× |
| Rp Therapy Intravenous Administration (79101) | $548 | $1,370 | 2.6× |
| Scapula (73010) range across 3 matching MRF lines |
$22.40–$140 | $56–$350 | varies |
| Screening Digital Breast Tomosynthesis Bi (77063) | $36 | $90 | 1.5× |
| Shoulder 1 view (73020) range across 3 matching MRF lines |
$16.80–$112 | $42–$280 | varies |
| Shoulder Arthrography (73040) | $428 | $1,070 | 1.3× |
| Skull less than 4 views (70250) range across 2 matching MRF lines |
$21.20–$152 | $53–$380 | varies |
| Special Physics Consult (77370) | $528 | $1,320 | 4.3× |
| Special teletherapy port plan (77321) | $744 | $1,860 | 2.2× |
| Special treatment procedure (77470) | $1,380 | $3,450 | 2.7× |
| Stereotactic Body Radiation Delivery (77373) | $5,232 | $13,080 | 3.2× |
| Sternoclavicular joints (71130) | $152 | $380 | 1.9× |
| Telethx isodose pln cplx w/basic dosimetry (77307) | $848 | $2,120 | 2.5× |
| Telethx isodose pln smpl w/dosimetry calculation (77306) | $440 | $1,100 | 1.3× |
| Ther Rad Simulaj-Aided Field Setting Complex (77290) | $1,116 | $2,790 | 3.2× |
| Ther rad simulaj-aided field setting simple (77280) | $584 | $1,460 | 4.7× |
| Thoracic spine 2 views (72070) range across 3 matching MRF lines |
$21.20–$160 | $53–$400 | varies |
| Thoracic spine 3 views (72072) | $188 | $470 | 2.0× |
| Thoracolumbar 2 views (72080) | $21.20 | $53 | 0.3× |
| Thyroid Imaging With Vascular Flow (78013) | $424 | $1,060 | 1.2× |
| Thyroid Met Imaging Body (78018) | $924 | $2,310 | 1.9× |
| Thyroid Uptake Measurement (78012) | $288 | $720 | 0.8× |
| Thyroid Uptake W/Blood Flow Sngle/Mult Quan Meas (78014) | $472 | $1,180 | 1.3× |
| Tx Devices Design & Construction Complex (77334) | $724 | $1,810 | 2.1× |
| Tx devices design & construction intermediate (77333) | $472 | $1,180 | 3.8× |
| Tx devices design & construction simple (77332) | $388 | $970 | 3.1× |
| Ultrasound Breast Limited (76642) range across 3 matching MRF lines |
$184–$400 | $460–$1,000 | varies |
| Ultrasound Elastography Parenchyma (76981) | $204 | $510 | 2.1× |
| Ultrasound Exam Aaa Screen (76706) range across 2 matching MRF lines |
$196–$212 | $490–$530 | varies |
| Ultrasound, abdomen limited (76705) range across 2 matching MRF lines |
$240–$260 | $600–$650 | varies |
| Umbilical-artery Doppler (OB) (76820) | $192 | $480 | 2.0× |
| Unlisted Dx Radiographic Procedure (76499) | $256 | $640 | 3.2× |
| Upper gi w/o kub (74240) | $372 | $930 | 2.3× |
| Urethrocystogram voiding (74455) | $436 | $1,090 | 2.0× |
| Urethrocystography retrograde (74450) | $408 | $1,020 | 1.9× |
| Us breast unilateral complete (76641) range across 2 matching MRF lines |
$204–$408 | $510–$1,020 | varies |
| Us chest (76604) | $148 | $370 | 1.5× |
| Us complete joint (76881) | $268 | $670 | 2.8× |
| Us exam, pelvic, limited (76857) range across 2 matching MRF lines |
$45.60–$240 | $114–$600 | varies |
| Us head (76506) | $280 | $700 | 2.9× |
| Us kidney transplant (76776) | $236 | $590 | 2.5× |
| Us lmtd joint/oth nonvasc xtr strux r-t w/img (76882) range across 3 matching MRF lines |
$200–$212 | $500–$530 | varies |
| Us ob limited 1 or more fetuses (76815) range across 2 matching MRF lines |
$192–$212 | $480–$530 | varies |
| Us ob transvaginal (76817) | $212 | $530 | 2.2× |
| Us pelvic non ob complete (76856) range across 2 matching MRF lines |
$288–$312 | $720–$780 | varies |
| Us pg uter img f&mat 14 wk tabdl 1/1st gestation (76801) | $228 | $570 | 2.4× |
| Us preg uterus real time f/u trnsabdl per fetus (76816) | $156 | $390 | 1.6× |
| Us retroperitoneal complete (76770) | $276 | $690 | 2.9× |
| Us retroperitoneal limited (76775) | $236 | $590 | 2.5× |
| Us scrotum and contents (76870) | $240 | $600 | 2.5× |
| Us spinal canal and contents (76800) | $232 | $580 | 2.4× |
| Us thyroid (76536) range across 2 matching MRF lines |
$308–$332 | $770–$830 | varies |
| Us transrectal (76872) range across 2 matching MRF lines |
$54.40–$336 | $136–$840 | varies |
| Venography caval inferior serialography rs&i (75825) | $1,216 | $3,040 | 0.4× |
| Venography extremity unilateral rs&i (75820) | $756 | $1,890 | 0.5× |
| Venography Renal Bilateral (75833) | $1,504 | $3,760 | 0.5× |
| Wrist 2 views (73100) range across 2 matching MRF lines |
$16.40–$120 | $41–$300 | varies |
| X-Ray Ac Jts - Xr Acromioclavicular Joints Bilateral (73050) | $164 | $410 | 2.0× |
| X-ray antegrade pyelogram tube (74425) | $504 | $1,260 | 1.6× |
| X-Ray Aorta Leg Arteries (75630) | $1,828 | $4,570 | 0.6× |
| X-Ray Bend Only L-S Spine (72120) | $24.80 | $62 | 0.3× |
| X-Ray Elbow 2 Vw - Xr Elbow 1-2 Views Right (73070) range across 3 matching MRF lines |
$17.60–$124 | $44–$310 | varies |
| X-Ray Exam Breast Specimen (76098) | $280 | $700 | 0.6× |
| X-Ray Exam Entire Spi 1 Vw (72081) range across 3 matching MRF lines |
$24–$128 | $60–$320 | varies |
| X-Ray Exam Entire Spi 2/3 Vw (72082) range across 2 matching MRF lines |
$42–$236 | $105–$590 | varies |
| X-Ray Exam Hip Uni 1 View (73501) range across 2 matching MRF lines |
$20–$120 | $50–$300 | varies |
| X-Ray Exam Hip Uni 2-3 Views (73502) range across 3 matching MRF lines |
$38–$156 | $95–$390 | varies |
| X-Ray Exam Hips Bi 2 Views (73521) range across 2 matching MRF lines |
$26–$168 | $65–$420 | varies |
| X-Ray Exam Hips Bi 3-4 Views (73522) range across 3 matching MRF lines |
$30–$220 | $75–$550 | varies |
| X-Ray Exam Hips Bi 5/> Views (73523) range across 3 matching MRF lines |
$32.80–$304 | $82–$760 | varies |
| X-Ray Exam L-S Spine Bending (72114) range across 2 matching MRF lines |
$35.20–$288 | $88–$720 | varies |
| X-Ray Exam Neck Spine 2-3 Vw (72040) range across 2 matching MRF lines |
$21.20–$160 | $53–$400 | varies |
| X-Ray Exam Neck Spine 6/>Vws (72052) range across 2 matching MRF lines |
$42.40–$264 | $106–$660 | varies |
| X-Ray Exam Unilat Ribs/Chest (71101) range across 3 matching MRF lines |
$25.20–$160 | $63–$400 | varies |
| X-ray eye for foreign body (70030) | $128 | $320 | 1.6× |
| X-ray humerus (73060) range across 3 matching MRF lines |
$19.60–$140 | $49–$350 | varies |
| X-ray IV pyelogram (ivp) (74400) | $492 | $1,230 | 3.1× |
| X-Ray Jaw <4 Vw - Xr Mandible < 4 Views (70100) | $116 | $290 | 1.4× |
| X-Ray Knee Bilat Standing - Xr Knees Anteroposterior Standing Bilat (73565) range across 2 matching MRF lines |
$17.60–$140 | $44–$350 | varies |
| X-Ray Lumbar Spine 2/3 Vw - Xr Lumbar Spine 2-3 Views (72100) range across 2 matching MRF lines |
$21.20–$168 | $53–$420 | varies |
| X-ray nose-rectum child f.b. (76010) range across 2 matching MRF lines |
$172–$192 | $430–$480 | varies |
| X-Ray Ribs, Chest 4+ Vw - Xr Ribs 3 Vws Bil W/ Chest Posteroanterior (71111) range across 3 matching MRF lines |
$220–$312 | $550–$780 | varies |
| X-Ray Sacroiliac Jts 3+ Vw - Xr Sacroiliac Joints 3+ Views (72202) | $156 | $390 | 1.6× |
| X-Ray Sacroiliac Jts <3 Vw - Xr Sacroiliac Joints 1-2 Views (72200) | $18.40 | $46 | 0.2× |
| X-Ray Sacrum/Coccyx 2+ Vw - Xr Sacrum Coccyx 2+ Views (72220) range across 2 matching MRF lines |
$18–$116 | $45–$290 | varies |
| X-Ray Sinuses 3+ Vw - Xr Paranasal Sinuses 3+ Views (70220) | $172 | $430 | 2.1× |
| X-Ray Skull 4+ Vw - Xr Skull Complete 4+ Views (70260) | $212 | $530 | 2.2× |
| X-Ray Urinary Tract Exam With Contrast Material (74420) range across 2 matching MRF lines |
$508–$636 | $1,270–$1,590 | varies |
| X-Rays Bone Length Studies (77073) range across 2 matching MRF lines |
$31.20–$172 | $78–$430 | varies |
| X-Rays Bone Survey Complete (77075) | $320 | $800 | 3.3× |
| Xr c-spine 4 or 5 views (72050) range across 2 matching MRF lines |
$33.20–$232 | $83–$580 | varies |
| Xr facial bones less than 3 views (70140) | $148 | $370 | 1.8× |
| Xr orbits complete 4 views (70200) | $164 | $410 | 1.7× |
| Xr Tomogram Single Plane (76100) | $320 | $800 | 3.3× |
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.