Imaging prices at Southwest Health Center
Platteville, WI · every code in this section with a posted price and a Medicare benchmark.
272 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) | $219.75 | $293 | 2.6× |
| Abdomen 2 views (74019) | $289.50 | $386 | 2.9× |
| Acute Gastrointestinal Blood Loss Imaging (78278) | $1,778.25 | $2,371 | 4.6× |
| Ankle 2 views (73600) range across 2 matching MRF lines |
$237.75–$329.25 | $317–$439 | varies |
| Arthrogram ankle (73615) | $1,029 | $1,372 | 3.0× |
| Arthrogram hip (73525) | $816.75 | $1,089 | 2.4× |
| Arthrogram Wrist (73115) | $556.50 | $742 | 1.6× |
| Bone age studies (77072) | $226.50 | $302 | 2.2× |
| Bone Imaging 3 Phase (78315) | $1,757.25 | $2,343 | 4.5× |
| Bone Imaging Limited Area (78300) | $1,116 | $1,488 | 2.9× |
| Bone Imaging Multiple Areas (78305) | $1,299 | $1,732 | 3.3× |
| Bone Imaging Whole Body (78306) | $1,434.75 | $1,913 | 3.7× |
| Bone survey infant (77076) | $515.25 | $687 | 5.1× |
| Brain Flow Imaging Only (78610) | $1,335 | $1,780 | 2.5× |
| Brain Imaging Pet Metabolic Evaluation (78608) | $3,716.25 | $4,955 | 2.7× |
| Cat Scan Follow-Up Study (76380) | $1,135.50 | $1,514 | 13.4× |
| Chest 1 view (71045) | $236.25 | $315 | 2.8× |
| Chest 2 views (71046) | $277.50 | $370 | 3.3× |
| Cholecystography Oral Contrast (74290) | $340.50 | $454 | 2.0× |
| Clavicle complete (73000) | $255 | $340 | 3.0× |
| Computed Tomography Thorax Lw Dose Lng Ca Scr C- (71271) | $228 | $304 | 2.2× |
| Contrast X-Ray Bladder (74430) | $429.75 | $573 | 1.3× |
| Contrast X-Ray Of Elbow (73085) | $789.75 | $1,053 | 2.3× |
| Contrast X-Ray Of Knee Joint (73580) | $963.75 | $1,285 | 2.8× |
| CT abdomen and pelvis without and with contrast (74178) | $3,192.75 | $4,257 | 9.4× |
| CT abdomen and pelvis without contrast (74176) | $3,164.25 | $4,219 | 13.7× |
| CT abdomen w contrast (74160) | $2,350.50 | $3,134 | 13.8× |
| CT abdomen w wo contrast (74170) | $2,469.75 | $3,293 | 14.5× |
| CT abdomen w/o contrast (74150) | $1,453.50 | $1,938 | 14.3× |
| CT Angio Abdomen and Pelvis (74174) | $3,175.50 | $4,234 | 9.4× |
| CT Angio Chest (71275) | $2,739 | $3,652 | 16.1× |
| CT Angio Head (70496) | $3,030.75 | $4,041 | 17.8× |
| CT Angio Neck (70498) | $2,514.75 | $3,353 | 14.8× |
| Ct Angio Upr Extrm W/O&W/Dye (73206) | $2,350.50 | $3,134 | 13.8× |
| CT cervical spine w/ contrast (72126) | $2,350.50 | $3,134 | 6.9× |
| CT cervical spine w/o contrast (72125) range across 2 matching MRF lines |
$1,752–$1,851 | $2,336–$2,468 | varies |
| CT cervical spine w/wo cont (72127) | $1,486.50 | $1,982 | 8.7× |
| CT chest w contrast (71260) | $2,049 | $2,732 | 12.0× |
| CT chest w/wo contrast (71270) | $2,504.25 | $3,339 | 14.7× |
| CT head/brain with contrast (70460) | $1,624.50 | $2,166 | 9.5× |
| CT head/brain without and with contrast (70470) | $2,125.50 | $2,834 | 12.5× |
| CT iac w contrast (70481) | $919.50 | $1,226 | 5.4× |
| CT l-spine w&w/o contrast (72133) | $1,486.50 | $1,982 | 8.7× |
| CT lower ext w/o (73700) | $1,713 | $2,284 | 16.9× |
| CT lower extremity w/contrast material (73701) | $2,350.50 | $3,134 | 13.8× |
| CT lumbar spine w contrast (72132) | $2,040.75 | $2,721 | 6.0× |
| CT lumbar spine w/o contrast (72131) range across 2 matching MRF lines |
$1,716–$2,350.50 | $2,288–$3,134 | varies |
| CT maxillofacial w contrast (70487) | $2,350.50 | $3,134 | 13.8× |
| CT maxillofacial wo contrast (70486) | $1,698.75 | $2,265 | 16.7× |
| CT neck tissue combo (70492) | $2,115.75 | $2,821 | 12.4× |
| Ct Orbit/Ear/Fossa W/O&W/Dye (70482) | $2,282.25 | $3,043 | 13.4× |
| CT orbits w/o contrast (70480) | $1,518 | $2,024 | 14.9× |
| CT pelvis w&w/o contrast (72194) | $2,040.75 | $2,721 | 12.0× |
| CT pelvis w/o contrast (72192) | $1,716 | $2,288 | 16.9× |
| CT scan of leg combo (73702) | $2,123.25 | $2,831 | 12.5× |
| CT scans face/jaw combo (70488) | $2,350.50 | $3,134 | 13.8× |
| CT soft tissue neck w contrast (70491) | $1,760.25 | $2,347 | 10.3× |
| CT soft tissue neck w/o contrast (70490) | $1,586.25 | $2,115 | 15.6× |
| CT thoracic spine w contrast (72129) | $2,350.50 | $3,134 | 13.8× |
| CT thoracic spine w/o contrast (72128) | $1,826.25 | $2,435 | 18.0× |
| CT thoracic spine w/wo cont (72130) | $1,486.50 | $1,982 | 8.7× |
| CT thorax w/o contrast (71250) range across 2 matching MRF lines |
$1,751.25–$1,853.25 | $2,335–$2,471 | varies |
| CT upper ext wo (73200) | $1,507.50 | $2,010 | 14.8× |
| CT upper extremity w/o & w/contrast material (73202) | $2,350.50 | $3,134 | 13.8× |
| CT upper extremity with contrast (73201) | $2,350.50 | $3,134 | 6.9× |
| Cta Abdl Aorta&Bi Iliofem W/Contrast&Postp (75635) | $2,833.50 | $3,778 | 16.6× |
| Cta Abdomen (74175) | $1,617 | $2,156 | 9.5× |
| CTA head&neck c+ w/noncontrast img&post-pxessing (70471) | $822.75 | $1,097 | 2.4× |
| CTA pelvis (72191) | $1,250.25 | $1,667 | 7.3× |
| Dxa Bone Density Axial (77080) | $626.25 | $835 | 6.2× |
| Dxa bone density study 1/>sites appendiclr skel (77081) | $207.75 | $277 | 2.5× |
| Echo exam uterus (76831) | $679.50 | $906 | 2.9× |
| Esophagram (74220) | $522 | $696 | 3.1× |
| Fetal Biophys Profile W/Nst (76818) | $301.50 | $402 | 3.0× |
| Fetal Biophysical Profile W/O Non-Stress Testing (76819) range across 2 matching MRF lines |
$234.75–$643.50 | $313–$858 | varies |
| Fluoroscopy up to 1 hr (76000) | $433.50 | $578 | 1.9× |
| Foot 2 views (73620) range across 2 matching MRF lines |
$178.50–$231.75 | $238–$309 | varies |
| Forearm 2 views (73090) | $313.50 | $418 | 3.7× |
| Gastric emptying imaging study (78264) | $1,933.50 | $2,578 | 5.0× |
| Gated Heart Planar Single (78472) | $946.50 | $1,262 | 2.4× |
| Hand 2 views (73120) | $203.25 | $271 | 2.0× |
| Hepatobil Syst Image W/Drug (78227) | $1,713.75 | $2,285 | 3.2× |
| Hepatobiliary System Imaging (78226) | $1,888.50 | $2,518 | 4.9× |
| Ht Muscle Image Spect Sing (78451) range across 3 matching MRF lines |
$130.50–$3,186 | $174–$4,248 | varies |
| Hysterosalpingogram (74740) | $546.75 | $729 | 2.4× |
| Infant hip ultrasound with hip movement (dynamic) (76885) | $411.75 | $549 | 4.9× |
| Joint Survey Single View (77077) range across 3 matching MRF lines |
$159–$422.25 | $212–$563 | varies |
| K Flow/Funct Image W/Drug (78708) | $2,054.25 | $2,739 | 3.9× |
| K Flow/Funct Image W/O Drug (78707) | $1,640.25 | $2,187 | 3.1× |
| Knee 3 Views (73562) | $300 | $400 | 3.5× |
| Labeled RBC Sequestration Differntl Organ/Tissue (78140) | $1,802.25 | $2,403 | 4.6× |
| Liver & Spleen Imaging Static Only (78215) | $1,326.75 | $1,769 | 3.4× |
| Lung Ventilat&Perfus Imaging (78582) | $2,224.50 | $2,966 | 4.2× |
| Lung Ventilation Imaging (78579) | $1,089 | $1,452 | 2.8× |
| Lymph System Imaging (78195) | $873 | $1,164 | 1.7× |
| Magnetic Image Jaw Joint (70336) | $3,211.50 | $4,282 | 13.9× |
| Mammary ductogram or galactogram multiple (77054) | $879 | $1,172 | 3.8× |
| Mammary ductogram or galactogram single (77053) | $897.75 | $1,197 | 3.9× |
| Meckels Divert Exam (78290) | $1,152.75 | $1,537 | 3.0× |
| Mra Head W/O & W/Contrast Material (70546) | $3,579.75 | $4,773 | 10.6× |
| MRA head w/o contrast (70544) range across 2 matching MRF lines |
$2,458.50–$2,641.50 | $3,278–$3,522 | varies |
| MRA head with contrast (70545) | $1,485 | $1,980 | 4.4× |
| MRA neck w contrast (70548) | $2,840.25 | $3,787 | 8.4× |
| Mra Neck W/O &W/Contrast Material (70549) | $2,946 | $3,928 | 8.7× |
| MRA neck w/o contrast (70547) range across 2 matching MRF lines |
$3,180.75–$3,211.50 | $4,241–$4,282 | varies |
| MRI abdomen w contrast (74182) | $1,577.25 | $2,103 | 4.7× |
| MRI abdomen w/o contrast (74181) range across 2 matching MRF lines |
$3,180.75–$3,211.50 | $4,241–$4,282 | varies |
| MRI any jt lower extrem w/contrast material (73722) range across 4 matching MRF lines |
$2,220.75–$3,184.50 | $2,961–$4,246 | varies |
| MRI any jt lower extrem w/o & w/contrast matrl (73723) range across 7 matching MRF lines |
$3,579.75–$3,613.50 | $4,773–$4,818 | varies |
| MRI any jt upper extremity w/contrast matrl (73222) range across 4 matching MRF lines |
$3,196.50–$3,616.50 | $4,262–$4,822 | varies |
| MRI cervical spine w contrast (72142) | $3,211.50 | $4,282 | 9.5× |
| MRI cervical spine w/o cont (72141) | $3,082.50 | $4,110 | 13.3× |
| MRI chest w/o contrast (71550) | $3,177.75 | $4,237 | 13.7× |
| MRI chest with contrast (71551) | $1,577.25 | $2,103 | 2.1× |
| MRI chest wo w contrast (71552) | $2,228.25 | $2,971 | 6.6× |
| MRI lower extrem oth/thn jt w/contrast matrl (73719) | $3,579.75 | $4,773 | 10.6× |
| MRI lower extrem oth/thn jt w/o & w/contr matr (73720) | $3,613.50 | $4,818 | 10.7× |
| MRI lower extrem oth/thn jt w/o contr matrl (73718) | $2,530.50 | $3,374 | 10.9× |
| MRI lumbar spine w contrast (72149) | $3,211.50 | $4,282 | 9.5× |
| Mri Neck Spine W/O & W/Dye (72156) | $3,410.25 | $4,547 | 10.1× |
| MRI orbit face &/neck w/o contrast (70540) | $1,009.50 | $1,346 | 4.4× |
| MRI orbit face neck w contrast (70542) | $3,582.75 | $4,777 | 10.6× |
| Mri Orbt/Fac/Nck W/O &W/Dye (70543) | $2,858.25 | $3,811 | 8.4× |
| MRI pelvis w contrast (72196) | $3,180.75 | $4,241 | 9.4× |
| MRI pelvis w/o & w contrast (72197) range across 3 matching MRF lines |
$3,313.50–$3,616.50 | $4,418–$4,822 | varies |
| MRI pelvis w/o contrast (72195) | $2,166 | $2,888 | 9.3× |
| MRI thoracic spine w/o contrast (72146) | $2,994 | $3,992 | 12.9× |
| MRI upper extremity oth than jt w/contr matrl (73219) | $1,577.25 | $2,103 | 4.7× |
| MRI upper extremity oth than jt w/o contr matrl (73218) | $2,457.75 | $3,277 | 10.6× |
| Mri Uppr Extremity W/O&W/Dye (73220) | $3,287.25 | $4,383 | 9.7× |
| MRI, abdomen, combo (74183) | $2,458.50 | $3,278 | 7.3× |
| MRI, dorsal spine combo (72157) | $3,898.50 | $5,198 | 11.5× |
| MRI, dorsal spine contrast (72147) | $3,613.50 | $4,818 | 10.7× |
| MRI, joint upper extrem (73221) | $2,568 | $3,424 | 11.1× |
| MRI, joint upper extrem combo (73223) | $3,579.75 | $4,773 | 10.6× |
| MRI, lumbar spine combo (72158) | $3,606 | $4,808 | 10.6× |
| Myelogram cervical (72240) | $1,704.75 | $2,273 | 2.2× |
| Myelogram Lumbar (72265) | $1,486.50 | $1,982 | 2.0× |
| Myelography thoracic (72255) | $1,588.50 | $2,118 | 2.1× |
| Myelograpy 2/more regions rs&i (72270) | $2,256 | $3,008 | 3.0× |
| Myocardial Spect Multiple Studies (78452) range across 2 matching MRF lines |
$896.25–$3,948.75 | $1,195–$5,265 | varies |
| Neck soft tissue (70360) | $189.75 | $253 | 2.2× |
| Njx Rp Loclzj Non-Img Probe Study Intravenous (78808) | $814.50 | $1,086 | 2.1× |
| Ob us nuchal meas 1 gest (76813) | $267 | $356 | 2.6× |
| Oph bmtry us echograpy a-scan io lens pwr cal (76519) | $212.25 | $283 | 2.1× |
| Ophthalmic Biometry US Echograpy a-Scan (76516) | $212.25 | $283 | 2.1× |
| Ophthalmic ultrasound dx b-scan w/wo a-scan (76512) | $229.50 | $306 | 2.3× |
| Ophthalmic US Dx Corneal Pachymetry Uni/Bi (76514) | $56.25 | $75 | 2.0× |
| Parathyroid Planar Imaging (78070) | $1,887.75 | $2,517 | 4.9× |
| Parathyroid planar imaging w/wo subtraction (78071) | $2,247.75 | $2,997 | 5.8× |
| Pelvis 1 or 2 views (72170) | $301.50 | $402 | 3.0× |
| Pet Image W/Ct Lmtd (78814) | $3,096.75 | $4,129 | 2.2× |
| PET image w/CT, full body (78816) | $3,096.75 | $4,129 | 2.2× |
| PET imaging CT attenuation skull base mid-thigh (78815) | $3,096.75 | $4,129 | 2.2× |
| Pulmonary Perfusion Imaging Particulate (78580) | $1,270.50 | $1,694 | 3.3× |
| Radex Abd Compl Aqt Abd W/S/E/D Views 1 View Ch (74022) | $340.50 | $454 | 3.4× |
| Radex abscess/fistula/sinus tract rs&i (76080) range across 2 matching MRF lines |
$522–$772.50 | $696–$1,030 | varies |
| Radex Ankle Complete Minimum 3 Views (73610) | $300 | $400 | 3.5× |
| Radex Calcaneus Minimum 2 Views (73650) | $199.50 | $266 | 2.4× |
| Radex elbow complete minimum 3 views (73080) | $316.50 | $422 | 3.7× |
| Radex Facial Bones Complete Minimum 3 Views (70150) | $311.25 | $415 | 3.1× |
| Radex fingr minimum 2 views (73140) | $210 | $280 | 2.5× |
| Radex foot complete minimum 3 views (73630) | $219.75 | $293 | 2.6× |
| Radex Hand Minimum 3 Views (73130) | $291.75 | $389 | 3.5× |
| Radex lower extremity infant minimum 2 views (73592) | $192 | $256 | 2.3× |
| Radex Mastoids Compl Minimum 3 Views PR Side (70130) | $363.75 | $485 | 3.6× |
| Radex Nasal Bones Complete Minimum 3 Views (70160) | $330.75 | $441 | 3.9× |
| Radex Ribs Unilateral 2 Views (71100) | $166.50 | $222 | 2.0× |
| Radex shoulder complete minimum 2 views (73030) | $329.25 | $439 | 3.9× |
| Radex Sinuses Paransl < 3 Views (70210) | $169.50 | $226 | 2.0× |
| Radex Spine 1 View Specify Level (72020) | $209.25 | $279 | 2.5× |
| Radex Sternum Minimum 2 Views (71120) | $264.75 | $353 | 3.1× |
| Radex Temporomandble Jt Opn & Clsd Mouth Bilat (70330) | $240 | $320 | 2.8× |
| Radex Toe Minimum 2 Views (73660) | $126 | $168 | 1.5× |
| Radex upper extremity infant minimum 2 views (73092) | $192 | $256 | 1.9× |
| Radex Wrist Complete Minimum 3 Views (73110) | $281.25 | $375 | 3.3× |
| Radex X-Ray Exam Entire Spi 6/> Vw - Xr Entire Spine 6+ Vw (72084) | $202.50 | $270 | 2.0× |
| Radiolog exam mandible compl minimum 4 views (70110) | $446.25 | $595 | 4.4× |
| Radiologic exam colon double contrast study (74280) | $1,038 | $1,384 | 6.1× |
| Radiologic exam colon single contrast study (74270) | $767.25 | $1,023 | 4.5× |
| Radiologic Exam Esophagus Double Contrast Study (74221) | $571.50 | $762 | 3.4× |
| Radiologic exam knee complete 4/more views (73564) | $404.25 | $539 | 4.0× |
| Radiologic exam pelvis compl minimum 3 views (72190) | $273.75 | $365 | 2.7× |
| Radiologic Exam Small Int Single Contrast Study (74250) | $273 | $364 | 1.6× |
| Radiologic exam swallow function contrast study (74230) | $588.75 | $785 | 3.5× |
| Radiologic exam upr gi trc double contrast study (74246) | $749.25 | $999 | 4.4× |
| Radiologic examination femur minimum 2 views (73552) | $247.50 | $330 | 2.9× |
| Radiologic examination knee 1/2 views (73560) range across 2 matching MRF lines |
$213.75–$285 | $285–$380 | varies |
| Radiologic Examination Salivary Gland Calculus (70380) | $159 | $212 | 1.9× |
| Radiologic examination tibia & fibula 2 views (73590) | $282 | $376 | 3.3× |
| Ribs bilateral 3 views (71110) | $202.50 | $270 | 2.0× |
| Rp Loclzj Tum Spect 1 Area Single Day Imaging (78803) | $3,075.75 | $4,101 | 5.8× |
| Scapula (73010) | $216 | $288 | 2.1× |
| Screening Digital Breast Tomosynthesis Bi (77063) | $22.50 | $30 | 1.0× |
| Shoulder 1 view (73020) | $196.50 | $262 | 2.3× |
| Shoulder Arthrography (73040) | $814.50 | $1,086 | 2.4× |
| Sialogram (70390) | $879 | $1,172 | 3.8× |
| Skull less than 4 views (70250) | $276 | $368 | 2.7× |
| Sternoclavicular joints (71130) | $285 | $380 | 3.4× |
| Tbs technical calculation only (77091) | $148.50 | $198 | 1.8× |
| Testicular Imaging W/Flow (78761) | $1,389.75 | $1,853 | 3.6× |
| Therapeutic Enema Rdctj Intussusception/Obstrcj (74283) | $423.75 | $565 | 2.5× |
| Thoracic spine 2 views (72070) | $243 | $324 | 2.4× |
| Thoracolumbar 2 views (72080) | $378 | $504 | 4.5× |
| Thyroid Imaging With Vascular Flow (78013) | $621 | $828 | 1.6× |
| Thyroid Uptake Measurement (78012) | $472.50 | $630 | 1.2× |
| Thyroid Uptake W/Blood Flow Sngle/Mult Quan Meas (78014) | $758.25 | $1,011 | 2.0× |
| Ultrasound Breast Limited (76642) | $321 | $428 | 3.8× |
| Ultrasound Exam Aaa Screen (76706) | $542.25 | $723 | 5.3× |
| Ultrasound, abdomen limited (76705) range across 5 matching MRF lines |
$472.50–$1,002.75 | $630–$1,337 | varies |
| Umbilical-artery Doppler (OB) (76820) | $172.50 | $230 | 1.7× |
| Upper gi w/o kub (74240) | $684.75 | $913 | 4.0× |
| Urethrocystogram voiding (74455) | $580.50 | $774 | 2.5× |
| Urethrocystography retrograde (74450) | $546 | $728 | 2.4× |
| Us breast unilateral complete (76641) | $403.50 | $538 | 4.0× |
| Us chest (76604) | $420.75 | $561 | 4.1× |
| Us complete joint (76881) | $560.25 | $747 | 5.5× |
| Us exam, pelvic, limited (76857) | $610.50 | $814 | 6.0× |
| Us head (76506) | $547.50 | $730 | 5.4× |
| Us kidney transplant (76776) | $678 | $904 | 6.7× |
| Us lmtd joint/oth nonvasc xtr strux r-t w/img (76882) | $594.75 | $793 | 5.9× |
| Us ob detailed single fetus (76811) | $585 | $780 | 2.5× |
| Us ob limited 1 or more fetuses (76815) | $557.25 | $743 | 5.5× |
| Us ob transvaginal (76817) | $378 | $504 | 3.7× |
| Us pelvic non ob complete (76856) | $524.25 | $699 | 5.2× |
| Us pg uter img f&mat 14 wk tabdl 1/1st gestation (76801) | $554.25 | $739 | 5.5× |
| Us preg uterus real time f/u trnsabdl per fetus (76816) | $383.25 | $511 | 3.8× |
| Us retroperitoneal complete (76770) | $765 | $1,020 | 7.5× |
| Us retroperitoneal limited (76775) | $681 | $908 | 6.7× |
| Us scrotum and contents (76870) range across 2 matching MRF lines |
$559.50–$671.25 | $746–$895 | varies |
| Us spinal canal and contents (76800) | $249.75 | $333 | 2.5× |
| Us thyroid (76536) range across 2 matching MRF lines |
$461.25–$615 | $615–$820 | varies |
| Us transrectal (76872) | $479.25 | $639 | 4.7× |
| Venography extremity unilateral rs&i (75820) | $1,575 | $2,100 | 1.0× |
| Wrist 2 views (73100) | $226.50 | $302 | 2.7× |
| X-Ray Ac Jts - Xr Acromioclavicular Joints Bilateral (73050) | $169.50 | $226 | 2.0× |
| X-ray antegrade pyelogram tube (74425) | $721.50 | $962 | 2.1× |
| X-Ray Bend Only L-S Spine (72120) | $504 | $672 | 5.0× |
| X-Ray Elbow 2 Vw - Xr Elbow 1-2 Views Right (73070) | $222.75 | $297 | 2.6× |
| X-Ray Exam Breast Specimen (76098) | $184.50 | $246 | 0.3× |
| X-Ray Exam Entire Spi 1 Vw (72081) | $166.50 | $222 | 2.0× |
| X-Ray Exam Entire Spi 2/3 Vw (72082) | $202.50 | $270 | 2.0× |
| X-Ray Exam Hip Uni 1 View (73501) | $187.50 | $250 | 2.2× |
| X-Ray Exam Hip Uni 2-3 Views (73502) | $204 | $272 | 2.4× |
| X-Ray Exam Hip Uni 4/> Views (73503) | $229.50 | $306 | 2.3× |
| X-Ray Exam Hips Bi 2 Views (73521) | $228 | $304 | 2.2× |
| X-Ray Exam Hips Bi 3-4 Views (73522) | $380.25 | $507 | 3.7× |
| X-Ray Exam Hips Bi 5/> Views (73523) | $781.50 | $1,042 | 7.7× |
| X-Ray Exam L-S Spine Bending (72114) | $643.50 | $858 | 6.3× |
| X-Ray Exam Neck Spine 2-3 Vw (72040) | $336.75 | $449 | 4.0× |
| X-Ray Exam Neck Spine 6/>Vws (72052) | $468.75 | $625 | 4.6× |
| X-Ray Exam Unilat Ribs/Chest (71101) | $302.25 | $403 | 3.0× |
| X-ray eye for foreign body (70030) | $175.50 | $234 | 2.1× |
| X-ray humerus (73060) | $233.25 | $311 | 2.8× |
| X-ray IV pyelogram (ivp) (74400) | $724.50 | $966 | 4.3× |
| X-ray IV pyelogram+tomography (74415) | $674.25 | $899 | 4.0× |
| X-Ray Knee Bilat Standing - Xr Knees Anteroposterior Standing Bilat (73565) | $173.25 | $231 | 2.0× |
| X-Ray Lumbar Spine 2/3 Vw - Xr Lumbar Spine 2-3 Views (72100) | $378 | $504 | 3.7× |
| X-ray nose-rectum child f.b. (76010) | $192 | $256 | 2.3× |
| X-Ray Ribs, Chest 4+ Vw - Xr Ribs 3 Vws Bil W/ Chest Posteroanterior (71111) | $228 | $304 | 2.2× |
| X-Ray Sacroiliac Jts 3+ Vw - Xr Sacroiliac Joints 3+ Views (72202) | $252.75 | $337 | 2.5× |
| X-Ray Sacrum/Coccyx 2+ Vw - Xr Sacrum Coccyx 2+ Views (72220) | $329.25 | $439 | 3.9× |
| X-Ray Sinuses 3+ Vw - Xr Paranasal Sinuses 3+ Views (70220) | $234.75 | $313 | 2.8× |
| X-Ray Skull 4+ Vw - Xr Skull Complete 4+ Views (70260) | $393 | $524 | 3.9× |
| X-Ray Stress View (77071) | $159 | $212 | 1.9× |
| X-Ray Urinary Tract Exam With Contrast Material (74420) | $1,368 | $1,824 | 4.0× |
| X-Rays Bone Length Studies (77073) | $429 | $572 | 4.2× |
| X-Rays Bone Survey Complete (77075) | $628.50 | $838 | 6.2× |
| Xr c-spine 4 or 5 views (72050) | $413.25 | $551 | 4.1× |
| Xr facial bones less than 3 views (70140) | $154.50 | $206 | 1.8× |
| Xr orbits complete 4 views (70200) | $329.25 | $439 | 3.2× |
| Xr Tomogram Single Plane (76100) | $592.50 | $790 | 5.8× |
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.