Imaging prices at Soldiers & Sailors Memorial Hospital
Penn Yan, NY · every code in this section with a posted price and a Medicare benchmark.
244 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) | $125.04 | $312.58 | 1.2× |
| Abdomen 2 views (74019) | $151.01 | $377.52 | 1.2× |
| Acute Gastrointestinal Blood Loss Imaging (78278) | $442.32 | $1,105.80 | 0.9× |
| Angiography extremity bilateral rs&i (75716) | $3,508.36 | $8,770.89 | 0.9× |
| Angiography extremity unilateral rs&i (75710) | $3,508.36 | $8,770.89 | 0.9× |
| Ankle 2 views (73600) | $125.04 | $312.58 | 1.2× |
| Artery X-Rays Abdomen (75726) | $5,849.09 | $14,622.72 | 0.8× |
| Arthrogram hip (73525) | $447.24 | $1,118.08 | 1.0× |
| Arthrogram Wrist (73115) | $447.24 | $1,118.08 | 1.0× |
| Bone age studies (77072) | $151.01 | $377.52 | 1.2× |
| Bone Imaging 3 Phase (78315) | $442.32 | $1,105.80 | 0.9× |
| Bone Imaging Limited Area (78300) | $442.32 | $1,105.80 | 0.9× |
| Bone Imaging Whole Body (78306) | $570.62 | $1,426.53 | 1.1× |
| Bone survey infant (77076) | $133.43 | $333.57 | 1.0× |
| Brain Image W/Flow < 4 Views (78601) | $442.32 | $1,105.80 | 0.9× |
| Brain Imaging Min 4 Static Views W Vascular Flow (78606) | $593.27 | $1,483.16 | 0.9× |
| Cat Scan Follow-Up Study (76380) | $99.14 | $247.83 | 0.9× |
| Cerebrospinal Fluid Scan (78630) | $593.27 | $1,483.16 | 0.9× |
| Chest 1 view (71045) | $125.04 | $312.58 | 1.2× |
| Chest 2 views (71046) | $103.90 | $259.74 | 1.0× |
| Chest 3 views (71047) | $99.14 | $247.83 | 0.9× |
| Chest 4 or more views (71048) | $133.43 | $333.57 | 1.0× |
| Cholecystography Oral Contrast (74290) | $212.07 | $530.16 | 1.0× |
| Clavicle complete (73000) | $125.04 | $312.58 | 1.2× |
| Computed Tomography Thorax Lw Dose Lng Ca Scr C- (71271) | $151.01 | $377.52 | 1.2× |
| Contrast Exam Abdominl Aorta (75625) | $3,508.36 | $8,770.89 | 0.9× |
| Contrast X-Ray Bladder (74430) | $447.24 | $1,118.08 | 1.0× |
| Contrast Xray Throat/Cerv Esopha (74210) | $212.07 | $530.16 | 1.0× |
| CT abdomen and pelvis without and with contrast (74178) | $507.14 | $1,267.84 | 1.2× |
| CT abdomen and pelvis without contrast (74176) | $343.26 | $858.13 | 1.2× |
| CT abdomen w contrast (74160) | $252.80 | $631.99 | 1.2× |
| CT abdomen w wo contrast (74170) | $252.80 | $631.99 | 1.2× |
| CT abdomen w/o contrast (74150) | $151.01 | $377.52 | 1.2× |
| CT Angio Abdomen and Pelvis (74174) | $507.14 | $1,267.84 | 1.2× |
| CT Angio Chest (71275) | $252.80 | $631.99 | 1.2× |
| CT Angio Head (70496) | $252.80 | $631.99 | 1.2× |
| Ct Angio Lwr Extr W/O&W/Dye (73706) | $212.07 | $530.16 | 1.0× |
| CT Angio Neck (70498) | $252.80 | $631.99 | 1.2× |
| Ct Angio Upr Extrm W/O&W/Dye (73206) | $212.07 | $530.16 | 1.0× |
| CT cervical spine w/ contrast (72126) | $447.24 | $1,118.08 | 1.0× |
| CT cervical spine w/o contrast (72125) | $151.01 | $377.52 | 1.2× |
| CT cervical spine w/wo cont (72127) | $212.07 | $530.16 | 1.0× |
| CT chest w contrast (71260) | $252.80 | $631.99 | 1.2× |
| CT chest w/wo contrast (71270) | $252.80 | $631.99 | 1.2× |
| CT head/brain with contrast (70460) | $252.80 | $631.99 | 1.2× |
| CT head/brain without and with contrast (70470) | $212.07 | $530.16 | 1.0× |
| CT heart no contrast quant eval coronry calcium (75571) | $117.50 | $293.73 | 1.1× |
| CT iac w contrast (70481) | $212.07 | $530.16 | 1.0× |
| CT l-spine w&w/o contrast (72133) | $212.07 | $530.16 | 1.0× |
| CT lower ext w/o (73700) | $133.43 | $333.57 | 1.0× |
| CT lower extremity w/contrast material (73701) | $252.80 | $631.99 | 1.2× |
| CT lumbar spine w contrast (72132) | $507.14 | $1,267.84 | 1.2× |
| CT lumbar spine w/o contrast (72131) | $151.01 | $377.52 | 1.2× |
| CT maxillofacial w contrast (70487) | $252.80 | $631.99 | 1.2× |
| CT maxillofacial wo contrast (70486) | $151.01 | $377.52 | 1.2× |
| CT neck tissue combo (70492) | $252.80 | $631.99 | 1.2× |
| Ct Orbit/Ear/Fossa W/O&W/Dye (70482) range across 2 matching MRF lines |
$212.07–$477.41 | $530.16–$1,193.52 | varies |
| CT orbits w/o contrast (70480) range across 2 matching MRF lines |
$133.43–$151.01 | $333.57–$377.52 | varies |
| CT pelvis w&w/o contrast (72194) | $212.07 | $530.16 | 1.0× |
| CT pelvis w/o contrast (72192) | $151.01 | $377.52 | 1.2× |
| CT scan of leg combo (73702) | $212.07 | $530.16 | 1.0× |
| CT scans face/jaw combo (70488) | $212.07 | $530.16 | 1.0× |
| CT soft tissue neck w contrast (70491) | $252.80 | $631.99 | 1.2× |
| CT soft tissue neck w/o contrast (70490) | $151.01 | $377.52 | 1.2× |
| CT thoracic spine w contrast (72129) | $252.80 | $631.99 | 1.2× |
| CT thoracic spine w/o contrast (72128) | $151.01 | $377.52 | 1.2× |
| CT thoracic spine w/wo cont (72130) | $212.07 | $530.16 | 1.0× |
| CT thorax w/o contrast (71250) | $151.01 | $377.52 | 1.2× |
| CT upper ext wo (73200) | $151.01 | $377.52 | 1.2× |
| CT upper extremity w/o & w/contrast material (73202) | $212.07 | $530.16 | 1.0× |
| CT upper extremity with contrast (73201) | $507.14 | $1,267.84 | 1.2× |
| Cta Abdl Aorta&Bi Iliofem W/Contrast&Postp (75635) | $252.80 | $631.99 | 1.2× |
| Cta Abdomen (74175) | $212.07 | $530.16 | 1.0× |
| CTA pelvis (72191) | $212.07 | $530.16 | 1.0× |
| Dacryocystography, nasolacrimal duct, radiological supervision and interpretation Non-Facility (70170) | $274.62 | $686.53 | 0.9× |
| Dxa Bone Density Axial (77080) | $151.01 | $377.52 | 1.2× |
| Dxa bone density study 1/>sites appendiclr skel (77081) | $99.14 | $247.83 | 0.9× |
| Echo exam uterus (76831) range across 2 matching MRF lines |
$274.62–$280.06 | $686.53–$700.14 | varies |
| Esophagram (74220) | $252.80 | $631.99 | 1.2× |
| Fetal Biophysical Profile W/O Non-Stress Testing (76819) | $133.43 | $333.57 | 1.0× |
| Fluoroscopy up to 1 hr (76000) | $343.26 | $858.13 | 1.2× |
| Foot 2 views (73620) | $125.04 | $312.58 | 1.2× |
| Forearm 2 views (73090) | $125.04 | $312.58 | 1.2× |
| Gastric emptying imaging study (78264) | $570.62 | $1,426.53 | 1.1× |
| Gated Heart Planar Single (78472) | $442.32 | $1,105.80 | 0.9× |
| Hand 2 views (73120) | $151.01 | $377.52 | 1.2× |
| Hepatc Vngrph Wdg/Fr W/O Hemodyn Eval Rs&I (75891) | $3,508.36 | $8,770.89 | 0.9× |
| Hepatobiliary System Imaging (78226) | $570.62 | $1,426.53 | 1.1× |
| Ht Musc Image Planar Mult (78454) | $1,585.97 | $3,964.91 | 1.0× |
| Ht Muscle Image Spect Sing (78451) | $1,585.97 | $3,964.91 | 1.0× |
| Hysterosalpingogram (74740) | $343.26 | $858.13 | 1.2× |
| Infant hip ultrasound with hip movement (dynamic) (76885) range across 2 matching MRF lines |
$99.14–$125.04 | $247.83–$312.58 | varies |
| Joint Survey Single View (77077) | $133.43 | $333.57 | 1.0× |
| K Flow/Funct Image W/Drug (78708) | $764.36 | $1,910.90 | 1.1× |
| Kidney Imaging Morphoogy W/Vascular Flow (78701) | $442.32 | $1,105.80 | 0.9× |
| Knee 3 Views (73562) | $125.04 | $312.58 | 1.2× |
| Liver & Spleen Imaging Static Only (78215) | $442.32 | $1,105.80 | 0.9× |
| Mammary ductogram or galactogram single (77053) | $274.62 | $686.53 | 0.9× |
| Meckels Divert Exam (78290) | $442.32 | $1,105.80 | 0.9× |
| MRA head w/o contrast (70544) | $280.17 | $700.41 | 0.9× |
| Mra Neck W/O &W/Contrast Material (70549) | $447.24 | $1,118.08 | 1.0× |
| MRA neck w/o contrast (70547) | $280.17 | $700.41 | 0.9× |
| MRI abdomen w contrast (74182) | $447.24 | $1,118.08 | 1.0× |
| MRI abdomen w/o contrast (74181) | $280.17 | $700.41 | 0.9× |
| MRI any jt lower extrem w/o & w/contrast matrl (73723) | $447.24 | $1,118.08 | 1.0× |
| MRI any jt upper extremity w/contrast matrl (73222) | $842.98 | $2,107.44 | 0.9× |
| MRI cervical spine w contrast (72142) | $447.24 | $1,118.08 | 1.0× |
| MRI cervical spine w/o cont (72141) | $343.26 | $858.13 | 1.2× |
| MRI chest wo w contrast (71552) | $447.24 | $1,118.08 | 1.0× |
| MRI lower extrem oth/thn jt w/contrast matrl (73719) | $419.28 | $1,048.20 | 1.0× |
| MRI lower extrem oth/thn jt w/o & w/contr matr (73720) | $447.24 | $1,118.08 | 1.0× |
| MRI lower extrem oth/thn jt w/o contr matrl (73718) | $343.26 | $858.13 | 1.2× |
| MRI lumbar spine w contrast (72149) | $447.24 | $1,118.08 | 1.0× |
| Mri Neck Spine W/O & W/Dye (72156) | $507.14 | $1,267.84 | 1.2× |
| MRI orbit face &/neck w/o contrast (70540) | $274.62 | $686.53 | 0.9× |
| Mri Orbt/Fac/Nck W/O &W/Dye (70543) | $447.24 | $1,118.08 | 1.0× |
| MRI pelvis w/o & w contrast (72197) | $447.24 | $1,118.08 | 1.0× |
| MRI pelvis w/o contrast (72195) | $274.62 | $686.53 | 0.9× |
| MRI thoracic spine w/o contrast (72146) | $280.17 | $700.41 | 0.9× |
| MRI upper extremity oth than jt w/o contr matrl (73218) | $274.62 | $686.53 | 0.9× |
| Mri Uppr Extremity W/O&W/Dye (73220) | $447.24 | $1,118.08 | 1.0× |
| MRI, abdomen, combo (74183) | $507.14 | $1,267.84 | 1.2× |
| MRI, dorsal spine combo (72157) | $507.14 | $1,267.84 | 1.2× |
| MRI, joint upper extrem (73221) | $274.62 | $686.53 | 0.9× |
| MRI, joint upper extrem combo (73223) | $447.24 | $1,118.08 | 1.0× |
| MRI, lumbar spine combo (72158) | $507.14 | $1,267.84 | 1.2× |
| Myocardial Perfusion Planar 1 Study Rest/Stress (78453) | $1,585.97 | $3,964.91 | 1.0× |
| Myocardial Spect Multiple Studies (78452) | $1,623.52 | $4,058.79 | 1.0× |
| Neck soft tissue (70360) | $125.04 | $312.58 | 1.2× |
| Ophthalmic ultrasound dx b-scan w/wo a-scan (76512) | $142.16 | $355.38 | 1.1× |
| Parathyroid Planar Imaging (78070) | $442.32 | $1,105.80 | 0.9× |
| Pelvis 1 or 2 views (72170) | $151.01 | $377.52 | 1.2× |
| Perineogram (74775) | $274.62 | $686.53 | 0.9× |
| Pulmonary Perfusion Imaging Particulate (78580) | $570.62 | $1,426.53 | 1.1× |
| Radex Abd Compl Aqt Abd W/S/E/D Views 1 View Ch (74022) | $133.43 | $333.57 | 1.0× |
| Radex abscess/fistula/sinus tract rs&i (76080) | $591.66 | $1,479.13 | 0.9× |
| Radex Ankle Complete Minimum 3 Views (73610) | $125.04 | $312.58 | 1.2× |
| Radex Calcaneus Minimum 2 Views (73650) | $125.04 | $312.58 | 1.2× |
| Radex elbow complete minimum 3 views (73080) | $125.04 | $312.58 | 1.2× |
| Radex Facial Bones Complete Minimum 3 Views (70150) | $133.43 | $333.57 | 1.0× |
| Radex fingr minimum 2 views (73140) | $125.04 | $312.58 | 1.2× |
| Radex foot complete minimum 3 views (73630) | $125.04 | $312.58 | 1.2× |
| Radex Hand Minimum 3 Views (73130) | $125.04 | $312.58 | 1.2× |
| Radex lower extremity infant minimum 2 views (73592) | $99.14 | $247.83 | 0.9× |
| Radex Nasal Bones Complete Minimum 3 Views (70160) | $125.04 | $312.58 | 1.2× |
| Radex Ribs Unilateral 2 Views (71100) | $103.90 | $259.74 | 1.0× |
| Radex shoulder complete minimum 2 views (73030) | $125.04 | $312.58 | 1.2× |
| Radex Sinuses Paransl < 3 Views (70210) | $99.14 | $247.83 | 0.9× |
| Radex Spine 1 View Specify Level (72020) | $99.14 | $247.83 | 0.9× |
| Radex Sternum Minimum 2 Views (71120) | $103.90 | $259.74 | 1.0× |
| Radex Temporomandble Jt Opn & Clsd Mouth Bilat (70330) | $99.14 | $247.83 | 0.9× |
| Radex Toe Minimum 2 Views (73660) | $125.04 | $312.58 | 1.2× |
| Radex upper extremity infant minimum 2 views (73092) | $133.43 | $333.57 | 1.0× |
| Radex Wrist Complete Minimum 3 Views (73110) | $125.04 | $312.58 | 1.2× |
| Radiolog exam mandible compl minimum 4 views (70110) | $133.43 | $333.57 | 1.0× |
| Radiologic Exam Abdomen 3+ Views - Xr Abdomen 3+ Views (74021) | $133.43 | $333.57 | 1.0× |
| Radiologic exam colon double contrast study (74280) | $212.07 | $530.16 | 1.0× |
| Radiologic exam colon single contrast study (74270) | $212.07 | $530.16 | 1.0× |
| Radiologic Exam Esophagus Double Contrast Study (74221) | $212.07 | $530.16 | 1.0× |
| Radiologic exam knee complete 4/more views (73564) | $151.01 | $377.52 | 1.2× |
| Radiologic exam pelvis compl minimum 3 views (72190) | $133.43 | $333.57 | 1.0× |
| Radiologic Exam Small Int Single Contrast Study (74250) | $252.80 | $631.99 | 1.2× |
| Radiologic exam swallow function contrast study (74230) | $252.80 | $631.99 | 1.2× |
| Radiologic exam upr gi trc double contrast study (74246) | $252.80 | $631.99 | 1.2× |
| Radiologic examination femur 1 view (73551) | $103.90 | $259.74 | 1.0× |
| Radiologic examination femur minimum 2 views (73552) | $125.04 | $312.58 | 1.2× |
| Radiologic examination knee 1/2 views (73560) | $125.04 | $312.58 | 1.2× |
| Radiologic Examination Osseous Survey Limited (77074) | $133.43 | $333.57 | 1.0× |
| Radiologic examination tibia & fibula 2 views (73590) | $125.04 | $312.58 | 1.2× |
| Ribs bilateral 3 views (71110) | $133.43 | $333.57 | 1.0× |
| Rp Loclzj Tum Spect 1 Area Single Day Imaging (78803) | $1,510.44 | $3,776.10 | 2.2× |
| Scapula (73010) | $151.01 | $377.52 | 1.2× |
| Screening Digital Breast Tomosynthesis Bi (77063) range across 2 matching MRF lines |
$26.52–$28.88 | $66.30–$72.18 | varies |
| Shoulder 1 view (73020) | $125.04 | $312.58 | 1.2× |
| Shoulder Arthrography (73040) range across 2 matching MRF lines |
$365.75–$447.24 | $914.36–$1,118.08 | varies |
| Skull less than 4 views (70250) | $151.01 | $377.52 | 1.2× |
| Sternoclavicular joints (71130) | $99.14 | $247.83 | 0.9× |
| Thoracic spine 2 views (72070) | $151.01 | $377.52 | 1.2× |
| Thoracic spine 3 views (72072) | $151.01 | $377.52 | 1.2× |
| Thoracolumbar 2 views (72080) | $125.04 | $312.58 | 1.2× |
| Thyroid Uptake W/Blood Flow Sngle/Mult Quan Meas (78014) | $442.32 | $1,105.80 | 0.9× |
| Ultrasound Breast Limited (76642) range across 2 matching MRF lines |
$117.50–$125.04 | $293.73–$312.58 | varies |
| Ultrasound Elastography Parenchyma (76981) | $151.01 | $377.52 | 1.2× |
| Ultrasound Exam Aaa Screen (76706) range across 2 matching MRF lines |
$125.04–$151.01 | $312.60–$377.52 | varies |
| Ultrasound, abdomen limited (76705) range across 3 matching MRF lines |
$133.43–$151.01 | $333.57–$377.52 | varies |
| Unlisted us procedure (76999) | $99.14 | $247.83 | 0.9× |
| Upper gi w/o kub (74240) | $252.80 | $631.99 | 1.2× |
| Urethrocystogram voiding (74455) | $274.62 | $686.53 | 0.9× |
| Urethrocystography retrograde (74450) | $274.62 | $686.53 | 0.9× |
| Us breast unilateral complete (76641) | $151.01 | $377.52 | 1.2× |
| Us chest (76604) | $133.43 | $333.57 | 1.0× |
| Us complete joint (76881) | $151.01 | $377.52 | 1.2× |
| Us exam, pelvic, limited (76857) range across 3 matching MRF lines |
$142.16–$151.01 | $355.38–$377.52 | varies |
| Us head (76506) | $133.43 | $333.57 | 1.0× |
| Us lmtd joint/oth nonvasc xtr strux r-t w/img (76882) range across 3 matching MRF lines |
$142.16–$151.01 | $355.38–$377.52 | varies |
| Us ob limited 1 or more fetuses (76815) range across 3 matching MRF lines |
$133.43–$151.01 | $333.57–$377.52 | varies |
| Us ob transvaginal (76817) range across 2 matching MRF lines |
$133.43–$151.01 | $333.57–$377.52 | varies |
| Us pelvic non ob complete (76856) | $151.01 | $377.52 | 1.2× |
| Us pg uter img f&mat 14 wk tabdl 1/1st gestation (76801) | $151.01 | $377.52 | 1.2× |
| Us preg uterus real time f/u trnsabdl per fetus (76816) | $133.43 | $333.57 | 1.0× |
| Us retroperitoneal complete (76770) range across 2 matching MRF lines |
$133.43–$151.01 | $333.57–$377.52 | varies |
| Us retroperitoneal limited (76775) range across 3 matching MRF lines |
$133.43–$151.01 | $333.57–$377.52 | varies |
| Us scrotum and contents (76870) range across 2 matching MRF lines |
$133.43–$151.01 | $333.57–$377.52 | varies |
| Us spinal canal and contents (76800) | $133.43 | $333.57 | 1.0× |
| Us thyroid (76536) range across 3 matching MRF lines |
$133.43–$151.01 | $333.57–$377.52 | varies |
| Us transrectal (76872) | $133.43 | $333.57 | 1.0× |
| Vein X-Ray Chest (75827) | $1,723.40 | $4,308.48 | 0.9× |
| Venography extremity unilateral rs&i (75820) | $1,723.40 | $4,308.48 | 0.9× |
| Vertebral fracture assessment via dxa (77086) | $99.14 | $247.83 | 0.9× |
| Wrist 2 views (73100) | $125.04 | $312.58 | 1.2× |
| X-Ray Ac Jts - Xr Acromioclavicular Joints Bilateral (73050) | $99.14 | $247.83 | 0.9× |
| X-ray antegrade pyelogram tube (74425) | $447.24 | $1,118.08 | 1.0× |
| X-Ray Aorta Leg Arteries (75630) | $3,508.36 | $8,770.89 | 0.9× |
| X-Ray Elbow 2 Vw - Xr Elbow 1-2 Views Right (73070) | $125.04 | $312.58 | 1.2× |
| X-Ray Exam Breast Specimen (76098) | $630.76 | $1,576.89 | 0.9× |
| X-Ray Exam Entire Spi 1 Vw (72081) | $125.04 | $312.58 | 1.2× |
| X-Ray Exam Entire Spi 2/3 Vw (72082) range across 3 matching MRF lines |
$133.43–$151.01 | $333.57–$377.52 | varies |
| X-Ray Exam Hip Uni 1 View (73501) range across 2 matching MRF lines |
$103.90–$125.04 | $259.74–$312.58 | varies |
| X-Ray Exam Hip Uni 2-3 Views (73502) | $125.04 | $312.58 | 1.2× |
| X-Ray Exam Hips Bi 2 Views (73521) | $133.43 | $333.57 | 1.0× |
| X-Ray Exam Hips Bi 5/> Views (73523) | $151.01 | $377.52 | 1.2× |
| X-Ray Exam L-S Spine Bending (72114) | $151.01 | $377.52 | 1.2× |
| X-Ray Exam Neck Spine 2-3 Vw (72040) | $125.04 | $312.58 | 1.2× |
| X-Ray Exam Neck Spine 6/>Vws (72052) | $151.01 | $377.52 | 1.2× |
| X-Ray Exam Unilat Ribs/Chest (71101) | $151.01 | $377.52 | 1.2× |
| X-ray eye for foreign body (70030) | $125.04 | $312.58 | 1.2× |
| X-ray humerus (73060) | $125.04 | $312.58 | 1.2× |
| X-Ray Knee Bilat Standing - Xr Knees Anteroposterior Standing Bilat (73565) | $103.90 | $259.74 | 1.0× |
| X-Ray Lumbar Spine 2/3 Vw - Xr Lumbar Spine 2-3 Views (72100) | $151.01 | $377.52 | 1.2× |
| X-ray nose-rectum child f.b. (76010) | $125.04 | $312.58 | 1.2× |
| X-Ray Ribs, Chest 4+ Vw - Xr Ribs 3 Vws Bil W/ Chest Posteroanterior (71111) | $133.43 | $333.57 | 1.0× |
| X-Ray Sacroiliac Jts 3+ Vw - Xr Sacroiliac Joints 3+ Views (72202) | $151.01 | $377.52 | 1.2× |
| X-Ray Sacroiliac Jts <3 Vw - Xr Sacroiliac Joints 1-2 Views (72200) | $133.43 | $333.57 | 1.0× |
| X-Ray Sacrum/Coccyx 2+ Vw - Xr Sacrum Coccyx 2+ Views (72220) | $125.04 | $312.58 | 1.2× |
| X-Ray Sinuses 3+ Vw - Xr Paranasal Sinuses 3+ Views (70220) | $99.14 | $247.83 | 0.9× |
| X-Ray Skull 4+ Vw - Xr Skull Complete 4+ Views (70260) | $133.43 | $333.57 | 1.0× |
| X-ray thoracic spine 4 vw (72074) | $133.43 | $333.57 | 1.0× |
| X-Ray Urinary Tract Exam With Contrast Material (74420) | $447.24 | $1,118.08 | 1.0× |
| X-Rays Bone Length Studies (77073) | $133.43 | $333.57 | 1.0× |
| X-Rays Bone Survey Complete (77075) | $133.43 | $333.57 | 1.0× |
| Xr c-spine 4 or 5 views (72050) | $151.01 | $377.52 | 1.2× |
| Xr facial bones less than 3 views (70140) | $99.14 | $247.83 | 0.9× |
| Xr orbits complete 4 views (70200) | $133.43 | $333.57 | 1.0× |
| Xr Tomogram Single Plane (76100) | $133.43 | $333.57 | 1.0× |
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.