Imaging prices at SSM Health St. Clare Hospital - Baraboo
Baraboo, WI · every code in this section with a posted price and a Medicare benchmark.
268 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) | $5,025.35 | $9,137 | 3.7× |
| Abdomen 1 View (74018) | $334.95 | $609 | 4.0× |
| Abdomen 2 views (74019) | $346.50 | $630 | 3.4× |
| Acute Gastrointestinal Blood Loss Imaging (78278) | $1,172.05 | $2,131 | 3.0× |
| Ankle 2 views (73600) range across 2 matching MRF lines |
$147.95–$244.75 | $269–$445 | varies |
| Arthrogram ankle (73615) | $426.80 | $776 | 1.3× |
| Arthrogram hip (73525) | $591.25 | $1,075 | 1.7× |
| Arthrogram Wrist (73115) | $439.45 | $799 | 1.3× |
| Basic radiation dosimetry calculation (77300) | $475.20 | $864 | 3.6× |
| Bone age studies (77072) | $1,195.15 | $2,173 | 11.8× |
| Bone Imaging 3 Phase (78315) | $1,451.45 | $2,639 | 3.7× |
| Bone Imaging Limited Area (78300) | $1,040.05 | $1,891 | 2.7× |
| Bone Imaging Whole Body (78306) | $1,225.95 | $2,229 | 3.2× |
| Bone survey infant (77076) | $470.25 | $855 | 4.6× |
| Brain Imaging Pet Metabolic Evaluation (78608) | $3,353.35 | $6,097 | 2.4× |
| Chest 1 view (71045) | $317.35 | $577 | 3.8× |
| Chest 2 views (71046) | $345.95 | $629 | 4.1× |
| Chest 3 views (71047) | $392.15 | $713 | 4.6× |
| Chest 4 or more views (71048) | $438.35 | $797 | 4.3× |
| Clavicle complete (73000) | $209.55 | $381 | 2.5× |
| Computed Tomography Thorax Lw Dose Lng Ca Scr C- (71271) | $1,117.05 | $2,031 | 11.0× |
| Continuing medical physics consltj pr wk (77336) | $538.45 | $979 | 4.1× |
| Contrast X-Ray Bladder (74430) | $589.60 | $1,072 | 1.7× |
| Contrast X-Ray Of Elbow (73085) | $609.40 | $1,108 | 1.8× |
| Contrast X-Ray Of Knee Joint (73580) | $452.65 | $823 | 1.3× |
| CT abdomen and pelvis without and with contrast (74178) | $2,952.40 | $5,368 | 8.7× |
| CT abdomen and pelvis without contrast (74176) | $2,552.55 | $4,641 | 11.0× |
| CT abdomen w contrast (74160) | $1,655.50 | $3,010 | 9.7× |
| CT abdomen w wo contrast (74170) | $1,831.50 | $3,330 | 10.8× |
| CT abdomen w/o contrast (74150) | $1,403.60 | $2,552 | 13.8× |
| CT Angio Abdomen and Pelvis (74174) | $3,509.55 | $6,381 | 10.4× |
| CT Angio Chest (71275) | $2,698.85 | $4,907 | 15.8× |
| CT Angio Head (70496) | $2,830.85 | $5,147 | 16.6× |
| Ct Angio Lwr Extr W/O&W/Dye (73706) | $1,698.95 | $3,089 | 10.0× |
| CT Angio Neck (70498) | $2,576.20 | $4,684 | 15.1× |
| Ct Angio Upr Extrm W/O&W/Dye (73206) | $1,608.75 | $2,925 | 9.4× |
| CT cervical spine w/ contrast (72126) | $1,822.70 | $3,314 | 5.4× |
| CT cervical spine w/o contrast (72125) | $1,696.75 | $3,085 | 16.7× |
| CT cervical spine w/wo cont (72127) | $2,011.35 | $3,657 | 11.8× |
| CT chest w contrast (71260) | $1,477.85 | $2,687 | 8.7× |
| CT chest w/wo contrast (71270) | $1,616.45 | $2,939 | 9.5× |
| CT colonography screening (74263) | $964.15 | $1,753 | 4.2× |
| CT head/brain with contrast (70460) | $1,797.95 | $3,269 | 10.6× |
| CT head/brain without and with contrast (70470) | $1,923.90 | $3,498 | 11.3× |
| CT iac w contrast (70481) | $1,612.05 | $2,931 | 9.5× |
| CT l-spine w&w/o contrast (72133) | $2,394.70 | $4,354 | 14.1× |
| CT lower ext w/o (73700) | $1,045.55 | $1,901 | 10.3× |
| CT lower extremity w/contrast material (73701) | $1,390.40 | $2,528 | 8.2× |
| CT lumbar spine w contrast (72132) | $1,778.70 | $3,234 | 5.2× |
| CT lumbar spine w/o contrast (72131) | $1,497.10 | $2,722 | 14.7× |
| CT maxillofacial w contrast (70487) | $1,701.15 | $3,093 | 10.0× |
| CT maxillofacial wo contrast (70486) | $1,187.45 | $2,159 | 11.7× |
| CT neck tissue combo (70492) | $1,595 | $2,900 | 9.4× |
| Ct Orbit/Ear/Fossa W/O&W/Dye (70482) | $2,459.60 | $4,472 | 14.4× |
| CT orbits w/o contrast (70480) | $1,603.80 | $2,916 | 15.8× |
| CT pelvis w&w/o contrast (72194) | $1,655.50 | $3,010 | 9.7× |
| CT pelvis w/o contrast (72192) | $1,350.25 | $2,455 | 13.3× |
| CT scan of leg combo (73702) | $1,422.85 | $2,587 | 8.4× |
| CT scans face/jaw combo (70488) | $2,038.85 | $3,707 | 12.0× |
| CT soft tissue neck w contrast (70491) | $1,496 | $2,720 | 8.8× |
| CT soft tissue neck w/o contrast (70490) | $1,108.25 | $2,015 | 10.9× |
| CT thoracic spine w contrast (72129) | $1,667.05 | $3,031 | 9.8× |
| CT thoracic spine w/o contrast (72128) | $1,643.40 | $2,988 | 16.2× |
| CT thoracic spine w/wo cont (72130) | $1,778.70 | $3,234 | 10.4× |
| CT thorax w/o contrast (71250) | $1,260.05 | $2,291 | 12.4× |
| CT upper ext wo (73200) | $1,075.25 | $1,955 | 10.6× |
| CT upper extremity w/o & w/contrast material (73202) | $1,523.50 | $2,770 | 8.9× |
| CT upper extremity with contrast (73201) | $1,422.85 | $2,587 | 4.2× |
| Cta Abdl Aorta&Bi Iliofem W/Contrast&Postp (75635) | $2,698.85 | $4,907 | 15.8× |
| Cta Abdomen (74175) | $2,544.85 | $4,627 | 14.9× |
| CTA pelvis (72191) | $2,544.85 | $4,627 | 14.9× |
| Diskography lumbar (72295) | $1,877.70 | $3,414 | 1.0× |
| Dxa Bone Density Axial (77080) | $335.50 | $610 | 3.3× |
| Dxa bone density study 1/>sites appendiclr skel (77081) | $102.30 | $186 | 1.2× |
| Echo exam uterus (76831) | $449.35 | $817 | 1.9× |
| Esophagram (74220) | $369.05 | $671 | 2.2× |
| Fetal Biophysical Profile W/O Non-Stress Testing (76819) | $939.40 | $1,708 | 9.3× |
| Fetal MRI w/placntl matrnl plvc img sing/1st ges (74712) | $2,251.70 | $4,094 | 9.7× |
| Fluoroscopy up to 1 hr (76000) | $378.40 | $688 | 1.6× |
| Foot 2 views (73620) range across 2 matching MRF lines |
$144.10–$257.95 | $262–$469 | varies |
| Forearm 2 views (73090) | $248.60 | $452 | 2.9× |
| Gastric emptying imaging study (78264) | $789.80 | $1,436 | 2.0× |
| Gated Heart Planar Single (78472) | $1,727.55 | $3,141 | 4.4× |
| Hand 2 views (73120) range across 2 matching MRF lines |
$125.95–$244.75 | $229–$445 | varies |
| Hepatobil Syst Image W/Drug (78227) | $1,238.05 | $2,251 | 2.3× |
| Hepatobiliary System Imaging (78226) | $1,127.50 | $2,050 | 2.9× |
| Ht Muscle Image Spect Sing (78451) | $1,579.05 | $2,871 | 1.3× |
| Hysterosalpingogram (74740) | $526.90 | $958 | 2.3× |
| Image fusion (77399) | $507.65 | $923 | 3.9× |
| Infant hip ultrasound with hip movement (dynamic) (76885) | $1,010.90 | $1,838 | 12.0× |
| Joint Survey Single View (77077) | $259.05 | $471 | 2.6× |
| K Flow/Funct Image Multiple (78709) | $1,296.35 | $2,357 | 2.5× |
| K Flow/Funct Image W/Drug (78708) | $768.90 | $1,398 | 1.5× |
| K Flow/Funct Image W/O Drug (78707) | $711.15 | $1,293 | 1.3× |
| Knee 3 Views (73562) | $242.55 | $441 | 2.9× |
| Liver & Spleen Imaging Static Only (78215) | $1,026.30 | $1,866 | 2.6× |
| Lung Perf&Ventilat Diferentl (78598) | $2,332.55 | $4,241 | 4.4× |
| Lung perfusion differential (78597) | $1,251.80 | $2,276 | 3.2× |
| Lung Ventilat&Perfus Imaging (78582) | $2,332.55 | $4,241 | 4.4× |
| Lung Ventilation Imaging (78579) | $1,080.75 | $1,965 | 2.8× |
| Lymph System Imaging (78195) | $594.55 | $1,081 | 1.1× |
| Magnetic Image Jaw Joint (70336) | $2,318.25 | $4,215 | 10.0× |
| Mammary ductogram or galactogram multiple (77054) | $634.15 | $1,153 | 2.7× |
| Mammary ductogram or galactogram single (77053) | $453.75 | $825 | 2.0× |
| Meckels Divert Exam (78290) | $937.75 | $1,705 | 2.4× |
| Medical physics dose eval radiation expos w/rprt (76145) | $176.55 | $321 | 0.5× |
| Mlc imrt design & construction per imrt plan (77338) | $2,511.85 | $4,567 | 6.9× |
| Mra Head W/O & W/Contrast Material (70546) | $2,415.05 | $4,391 | 7.1× |
| MRA head w/o contrast (70544) | $2,356.20 | $4,284 | 10.2× |
| MRA head with contrast (70545) | $2,384.25 | $4,335 | 7.0× |
| MRA neck w contrast (70548) | $2,392.50 | $4,350 | 7.1× |
| Mra Neck W/O &W/Contrast Material (70549) | $2,415.05 | $4,391 | 7.1× |
| MRA neck w/o contrast (70547) | $2,288 | $4,160 | 9.9× |
| MRI abdomen w contrast (74182) | $2,384.25 | $4,335 | 7.0× |
| MRI abdomen w/o contrast (74181) | $2,318.25 | $4,215 | 10.0× |
| MRI any jt lower extrem w/contrast material (73722) | $2,384.25 | $4,335 | 3.1× |
| MRI any jt lower extrem w/o & w/contrast matrl (73723) | $2,448.60 | $4,452 | 7.2× |
| MRI any jt upper extremity w/contrast matrl (73222) | $2,448.60 | $4,452 | 3.2× |
| MRI Breast W/O Contrast Bilateral (77047) | $1,567.50 | $2,850 | 6.8× |
| MRI Breast Without Contrast Material Unilateral (77046) | $783.75 | $1,425 | 3.4× |
| MRI cervical spine w contrast (72142) | $2,384.25 | $4,335 | 7.0× |
| MRI cervical spine w/o cont (72141) | $2,318.25 | $4,215 | 10.0× |
| MRI chest w/o contrast (71550) | $2,318.25 | $4,215 | 10.0× |
| MRI chest with contrast (71551) | $2,384.25 | $4,335 | 3.1× |
| MRI chest wo w contrast (71552) | $2,448.60 | $4,452 | 7.2× |
| MRI lower extrem oth/thn jt w/contrast matrl (73719) | $2,384.25 | $4,335 | 7.0× |
| MRI lower extrem oth/thn jt w/o & w/contr matr (73720) | $2,448.60 | $4,452 | 7.2× |
| MRI lower extrem oth/thn jt w/o contr matrl (73718) | $2,318.25 | $4,215 | 10.0× |
| MRI lumbar spine w contrast (72149) | $2,384.25 | $4,335 | 7.0× |
| Mri Neck Spine W/O & W/Dye (72156) | $2,481.60 | $4,512 | 7.3× |
| MRI orbit face &/neck w/o contrast (70540) | $2,288 | $4,160 | 9.9× |
| Mri Orbt/Fac/Nck W/O &W/Dye (70543) | $2,488.20 | $4,524 | 7.3× |
| MRI pelvis w/o & w contrast (72197) | $2,521.20 | $4,584 | 7.4× |
| MRI pelvis w/o contrast (72195) | $2,318.25 | $4,215 | 10.0× |
| MRI thoracic spine w/o contrast (72146) | $2,318.25 | $4,215 | 10.0× |
| MRI upper extremity oth than jt w/contr matrl (73219) | $2,376.55 | $4,321 | 7.0× |
| MRI upper extremity oth than jt w/o contr matrl (73218) | $2,318.25 | $4,215 | 10.0× |
| Mri Uppr Extremity W/O&W/Dye (73220) | $2,448.60 | $4,452 | 7.2× |
| MRI, abdomen, combo (74183) | $2,448.60 | $4,452 | 7.2× |
| MRI, dorsal spine combo (72157) | $2,448.60 | $4,452 | 7.2× |
| MRI, dorsal spine contrast (72147) | $2,384.25 | $4,335 | 7.0× |
| MRI, joint upper extrem (73221) | $2,318.25 | $4,215 | 10.0× |
| MRI, joint upper extrem combo (73223) | $2,521.20 | $4,584 | 7.4× |
| MRI, lumbar spine combo (72158) | $2,448.60 | $4,452 | 7.2× |
| Myocardial Spect Multiple Studies (78452) | $2,438.70 | $4,434 | 1.9× |
| Neck soft tissue (70360) | $239.80 | $436 | 2.8× |
| Ntsty modul radthx pln dose-vol histos (77301) | $5,626.50 | $10,230 | 4.2× |
| Parathyroid Planar Imaging (78070) | $908.60 | $1,652 | 2.3× |
| Pelvis 1 or 2 views (72170) | $294.25 | $535 | 2.9× |
| PET image w/CT, full body (78816) | $3,353.35 | $6,097 | 2.4× |
| PET imaging CT attenuation skull base mid-thigh (78815) | $3,320.90 | $6,038 | 2.4× |
| Pulmonary Perfusion Imaging Particulate (78580) | $1,251.80 | $2,276 | 3.2× |
| Radex Abd Compl Aqt Abd W/S/E/D Views 1 View Ch (74022) | $424.05 | $771 | 4.2× |
| Radex abscess/fistula/sinus tract rs&i (76080) | $430.65 | $783 | 0.8× |
| Radex Ankle Complete Minimum 3 Views (73610) | $291.50 | $530 | 3.4× |
| Radex Calcaneus Minimum 2 Views (73650) | $196.90 | $358 | 2.3× |
| Radex elbow complete minimum 3 views (73080) | $282.15 | $513 | 3.3× |
| Radex Facial Bones Complete Minimum 3 Views (70150) | $352 | $640 | 3.5× |
| Radex fingr minimum 2 views (73140) | $264 | $480 | 3.1× |
| Radex foot complete minimum 3 views (73630) | $297.55 | $541 | 3.5× |
| Radex Hand Minimum 3 Views (73130) | $291.50 | $530 | 3.4× |
| Radex lower extremity infant minimum 2 views (73592) | $128.70 | $234 | 1.5× |
| Radex Nasal Bones Complete Minimum 3 Views (70160) | $278.30 | $506 | 3.3× |
| Radex Ribs Unilateral 2 Views (71100) | $338.25 | $615 | 4.0× |
| Radex shoulder complete minimum 2 views (73030) | $282.15 | $513 | 3.3× |
| Radex Sinuses Paransl < 3 Views (70210) | $106.70 | $194 | 1.3× |
| Radex Spine 1 View Specify Level (72020) | $295.90 | $538 | 3.5× |
| Radex Sternum Minimum 2 Views (71120) | $268.40 | $488 | 3.2× |
| Radex Temporomandble Jt Opn & Clsd Mouth Bilat (70330) | $546.70 | $994 | 6.5× |
| Radex Toe Minimum 2 Views (73660) | $167.75 | $305 | 2.0× |
| Radex upper extremity infant minimum 2 views (73092) | $264 | $480 | 2.6× |
| Radex Wrist Complete Minimum 3 Views (73110) | $298.10 | $542 | 3.5× |
| Radiation treatment delivery level 1 (77402) | $452.10 | $822 | 4.6× |
| Radiation treatment delivery level 2 (77407) | $613.25 | $1,115 | 1.6× |
| Radiation treatment delivery level 3 (77412) | $825.55 | $1,501 | 1.5× |
| Radiolog exam mandible compl minimum 4 views (70110) | $347.05 | $631 | 3.4× |
| Radiologic exam colon double contrast study (74280) | $874.50 | $1,590 | 5.1× |
| Radiologic exam colon single contrast study (74270) | $561.55 | $1,021 | 3.3× |
| Radiologic Exam Esophagus Double Contrast Study (74221) | $716.10 | $1,302 | 4.2× |
| Radiologic exam knee complete 4/more views (73564) | $328.35 | $597 | 3.2× |
| Radiologic exam pelvis compl minimum 3 views (72190) | $311.85 | $567 | 3.1× |
| Radiologic Exam Small Int Single Contrast Study (74250) | $584.10 | $1,062 | 3.4× |
| Radiologic exam swallow function contrast study (74230) | $385.55 | $701 | 2.3× |
| Radiologic exam upr gi trc double contrast study (74246) | $716.65 | $1,303 | 4.2× |
| Radiologic examination femur 1 view (73551) | $149.05 | $271 | 1.8× |
| Radiologic examination femur minimum 2 views (73552) | $289.85 | $527 | 3.4× |
| Radiologic examination knee 1/2 views (73560) | $234.85 | $427 | 2.8× |
| Radiologic examination tibia & fibula 2 views (73590) | $287.10 | $522 | 3.4× |
| Ribs bilateral 3 views (71110) | $441.10 | $802 | 4.3× |
| Rp Loclzj Tum Spect 1 Area Single Day Imaging (78803) | $1,461.90 | $2,658 | 2.8× |
| Rp loclzj tum spect w/CT 1 area/acquisj 1day img (78830) | $1,702.25 | $3,095 | 1.4× |
| Salivary Gland Imaging Serial Images (78231) | $955.90 | $1,738 | 2.5× |
| Scapula (73010) | $301.40 | $548 | 3.0× |
| Screening Digital Breast Tomosynthesis Bi (77063) | $26.40 | $48 | 1.1× |
| Shoulder 1 view (73020) | $135.30 | $246 | 1.6× |
| Shoulder Arthrography (73040) | $609.40 | $1,108 | 1.8× |
| Skull less than 4 views (70250) | $272.25 | $495 | 2.7× |
| Special dosimetry (77331) | $476.30 | $866 | 3.6× |
| Special Physics Consult (77370) | $908.05 | $1,651 | 7.0× |
| Special teletherapy port plan (77321) | $1,074.70 | $1,954 | 3.0× |
| Special treatment procedure (77470) | $2,085.60 | $3,792 | 3.9× |
| Stereotactic Body Radiation Delivery (77373) | $8,078.95 | $14,689 | 4.7× |
| Sternoclavicular joints (71130) | $237.60 | $432 | 2.8× |
| Telethx isodose pln cplx w/basic dosimetry (77307) | $651.20 | $1,184 | 1.8× |
| Telethx isodose pln smpl w/dosimetry calculation (77306) | $355.85 | $647 | 1.0× |
| Testicular Imaging W/Flow (78761) | $762.30 | $1,386 | 2.0× |
| Ther Rad Simulaj-Aided Field Setting Complex (77290) | $1,711.60 | $3,112 | 4.7× |
| Ther Rad Simulaj-Aided Field Setting Intermed (77285) | $1,386 | $2,520 | 3.8× |
| Ther rad simulaj-aided field setting simple (77280) | $839.30 | $1,526 | 6.4× |
| Thoracic spine 2 views (72070) | $288.20 | $524 | 2.8× |
| Thoracolumbar 2 views (72080) | $271.70 | $494 | 3.2× |
| Thyroid Uptake W/Blood Flow Sngle/Mult Quan Meas (78014) | $1,168.75 | $2,125 | 3.0× |
| Tx Devices Design & Construction Complex (77334) | $1,072.50 | $1,950 | 2.9× |
| Tx devices design & construction intermediate (77333) | $728.20 | $1,324 | 5.6× |
| Tx devices design & construction simple (77332) | $546.15 | $993 | 4.2× |
| Ultrasound Breast Limited (76642) range across 2 matching MRF lines |
$590.70–$1,097.25 | $1,074–$1,995 | varies |
| Ultrasound Exam Aaa Screen (76706) range across 2 matching MRF lines |
$479.60–$551.65 | $872–$1,003 | varies |
| Ultrasound, abdomen limited (76705) range across 2 matching MRF lines |
$751.85–$864.60 | $1,367–$1,572 | varies |
| Umbilical-artery Doppler (OB) (76820) | $836 | $1,520 | 8.2× |
| Upper gi w/o kub (74240) | $572.55 | $1,041 | 3.4× |
| Urethrocystogram voiding (74455) | $887.70 | $1,614 | 3.8× |
| Us breast unilateral complete (76641) | $588.50 | $1,070 | 5.8× |
| Us chest (76604) range across 2 matching MRF lines |
$614.90–$707.30 | $1,118–$1,286 | varies |
| Us complete joint (76881) | $710.05 | $1,291 | 7.0× |
| Us exam, pelvic, limited (76857) | $257.40 | $468 | 2.5× |
| Us head (76506) | $454.85 | $827 | 4.5× |
| Us lmtd joint/oth nonvasc xtr strux r-t w/img (76882) range across 2 matching MRF lines |
$439.45–$505.45 | $799–$919 | varies |
| Us ob limited 1 or more fetuses (76815) range across 2 matching MRF lines |
$572–$657.80 | $1,040–$1,196 | varies |
| Us ob transvaginal (76817) | $750.20 | $1,364 | 7.4× |
| Us pelvic non ob complete (76856) | $849.20 | $1,544 | 8.4× |
| Us pg uter img f&mat 14 wk tabdl 1/1st gestation (76801) | $625.35 | $1,137 | 6.2× |
| Us preg uterus real time f/u trnsabdl per fetus (76816) | $592.35 | $1,077 | 5.8× |
| Us retroperitoneal complete (76770) | $921.25 | $1,675 | 9.1× |
| Us retroperitoneal limited (76775) | $746.90 | $1,358 | 7.4× |
| Us scrotum and contents (76870) | $644.60 | $1,172 | 6.3× |
| Us spinal canal and contents (76800) | $304.15 | $553 | 3.0× |
| Us thyroid (76536) | $917.40 | $1,668 | 9.0× |
| Venography extremity bilateral rs&i (75822) | $1,346.40 | $2,448 | 0.9× |
| Wrist 2 views (73100) | $244.75 | $445 | 2.9× |
| X-Ray Ac Jts - Xr Acromioclavicular Joints Bilateral (73050) | $355.85 | $647 | 4.2× |
| X-ray antegrade pyelogram tube (74425) | $521.40 | $948 | 1.5× |
| X-Ray Bend Only L-S Spine (72120) | $335.50 | $610 | 3.3× |
| X-Ray Elbow 2 Vw - Xr Elbow 1-2 Views Right (73070) | $207.35 | $377 | 2.5× |
| X-Ray Exam Entire Spi 2/3 Vw (72082) | $955.35 | $1,737 | 9.4× |
| X-Ray Exam Hip Uni 1 View (73501) | $283.80 | $516 | 3.4× |
| X-Ray Exam Hip Uni 2-3 Views (73502) | $283.80 | $516 | 3.4× |
| X-Ray Exam Hips Bi 2 Views (73521) | $283.80 | $516 | 2.8× |
| X-Ray Exam Hips Bi 3-4 Views (73522) | $300.85 | $547 | 3.0× |
| X-Ray Exam Hips Bi 5/> Views (73523) | $357.50 | $650 | 3.5× |
| X-Ray Exam Neck Spine 2-3 Vw (72040) | $326.70 | $594 | 3.9× |
| X-Ray Exam Neck Spine 6/>Vws (72052) | $668.80 | $1,216 | 6.6× |
| X-Ray Exam Unilat Ribs/Chest (71101) | $406.45 | $739 | 4.0× |
| X-ray eye for foreign body (70030) | $128.70 | $234 | 1.5× |
| X-ray humerus (73060) | $190.85 | $347 | 2.3× |
| X-ray IV pyelogram (ivp) (74400) | $800.25 | $1,455 | 4.7× |
| X-Ray Knee Bilat Standing - Xr Knees Anteroposterior Standing Bilat (73565) | $262.35 | $477 | 3.1× |
| X-Ray Lumbar Spine 2/3 Vw - Xr Lumbar Spine 2-3 Views (72100) | $344.85 | $627 | 3.4× |
| X-ray nose-rectum child f.b. (76010) | $316.25 | $575 | 3.7× |
| X-Ray Ribs, Chest 4+ Vw - Xr Ribs 3 Vws Bil W/ Chest Posteroanterior (71111) | $627 | $1,140 | 6.2× |
| X-Ray Sacroiliac Jts 3+ Vw - Xr Sacroiliac Joints 3+ Views (72202) | $272.25 | $495 | 2.7× |
| X-Ray Sacrum/Coccyx 2+ Vw - Xr Sacrum Coccyx 2+ Views (72220) | $284.35 | $517 | 3.4× |
| X-Ray Sinuses 3+ Vw - Xr Paranasal Sinuses 3+ Views (70220) | $411.95 | $749 | 4.9× |
| X-Ray Skull 4+ Vw - Xr Skull Complete 4+ Views (70260) | $474.10 | $862 | 4.7× |
| X-Ray Urinary Tract Exam With Contrast Material (74420) | $467.50 | $850 | 1.4× |
| X-Rays Bone Length Studies (77073) | $1,793 | $3,260 | 17.7× |
| X-Rays Bone Survey Complete (77075) | $641.30 | $1,166 | 6.3× |
| Xr c-spine 4 or 5 views (72050) | $360.25 | $655 | 3.5× |
| Xr facial bones less than 3 views (70140) | $146.30 | $266 | 1.7× |
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.