Imaging prices at Stanford Health Care Tri-valley
Pleasanton, CA · every code in this section with a posted price and a Medicare benchmark.
262 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) | $324.40 | $811 | 2.5× |
| Abdomen 2 views (74019) | $449.60 | $1,124 | 2.9× |
| Acute Gastrointestinal Blood Loss Imaging (78278) | $1,484.40 | $3,711 | 2.5× |
| Angio internal mammary (75756) | $4,047.20 | $10,118 | 0.9× |
| Angio pulmonary bilat (75743) | $4,542.40 | $11,356 | 1.0× |
| Angiography extremity bilateral rs&i (75716) | $7,844 | $19,610 | 1.7× |
| Angiography extremity unilateral rs&i (75710) | $6,606.80 | $16,517 | 1.4× |
| Angiography pulmonary unilateral slctv rs&i (75741) | $3,419.60 | $8,549 | 0.7× |
| Angrph pulmonary nonslctv cath/ven njx rs&i (75746) | $1,952.40 | $4,881 | 0.4× |
| Ankle 2 views (73600) | $234.40 | $586 | 1.8× |
| Aortography thoracic serialography rs&i (75605) unusually low: confirm this is the full procedure |
$3,784 | $9,460 | 0.5× |
| Artery X-Rays Abdomen (75726) | $7,612 | $19,030 | 0.9× |
| Artery X-Rays Pelvis (75736) unusually low: confirm this is the full procedure |
$3,560.80 | $8,902 | 0.4× |
| Arthrogram hip (73525) | $1,511.20 | $3,778 | 3.0× |
| Bone age studies (77072) | $248.80 | $622 | 1.6× |
| Bone Imaging 3 Phase (78315) | $1,368.80 | $3,422 | 2.3× |
| Bone Imaging Limited Area (78300) | $820.48 | $2,051.19 | 1.4× |
| Bone Imaging Whole Body (78306) | $1,115.20 | $2,788 | 1.9× |
| Bone survey infant (77076) | $583.20 | $1,458 | 3.8× |
| Brain imaging < 4 static views (78600) | $842.80 | $2,107 | 1.4× |
| Brain Imaging Min 4 Static Views W Vascular Flow (78606) | $623.20 | $1,558 | 0.8× |
| Brain Imaging Pet Metabolic Evaluation (78608) | $2,677.20 | $6,693 | 1.3× |
| Cat Scan Follow-Up Study (76380) | $179.20 | $448 | 1.4× |
| Chest 1 view (71045) | $292.80 | $732 | 2.3× |
| Chest 2 views (71046) | $362.80 | $907 | 2.8× |
| Chest 3 views (71047) | $386 | $965 | 3.0× |
| Chest 4 or more views (71048) | $702.40 | $1,756 | 4.6× |
| Chg us nrv&acc strux 1 xtr compre w/img pr extremity (76883) | $404.40 | $1,011 | 2.6× |
| Clavicle complete (73000) | $279.60 | $699 | 2.2× |
| Computed Tomography Thorax Lw Dose Lng Ca Scr C- (71271) | $396 | $827 | 2.6× |
| Contrast Exam Abdominl Aorta (75625) | $5,240.80 | $13,102 | 1.1× |
| Contrast X-Ray Bladder (74430) | $536.40 | $1,341 | 1.1× |
| Contrast X-Ray Of Knee Joint (73580) | $904.80 | $2,262 | 1.8× |
| CT abdomen and pelvis without and with contrast (74178) | $4,391.60 | $10,979 | 8.6× |
| CT abdomen and pelvis without contrast (74176) | $3,722.80 | $9,307 | 10.7× |
| CT abdomen w contrast (74160) | $1,784.80 | $4,462 | 7.0× |
| CT abdomen w wo contrast (74170) | $2,400.80 | $6,002 | 9.4× |
| CT abdomen w/o contrast (74150) | $1,696.40 | $4,241 | 11.1× |
| CT Angio Abdomen and Pelvis (74174) | $4,732 | $11,830 | 9.3× |
| CT Angio Chest (71275) | $2,252.80 | $5,632 | 8.8× |
| CT Angio Head (70496) | $2,387.20 | $5,968 | 9.3× |
| CT angio hrt w/3d image (75574) | $2,558 | $6,395 | 5.0× |
| Ct Angio Lwr Extr W/O&W/Dye (73706) | $4,108 | $10,270 | 16.0× |
| CT Angio Neck (70498) | $2,392.40 | $5,981 | 9.3× |
| Ct Angio Upr Extrm W/O&W/Dye (73206) | $4,072.40 | $10,181 | 15.9× |
| CT cervical spine w/ contrast (72126) | $1,942.40 | $4,856 | 3.8× |
| CT cervical spine w/o contrast (72125) | $1,585.20 | $3,963 | 10.4× |
| CT cervical spine w/wo cont (72127) | $4,370 | $10,925 | 17.0× |
| CT chest w contrast (71260) | $1,883.60 | $4,709 | 7.3× |
| CT chest w/wo contrast (71270) | $1,972.80 | $4,932 | 7.7× |
| CT colonogrphy dx image postprocess w/o contrast (74261) | $200.80 | $502 | 1.3× |
| CT head/brain with contrast (70460) | $1,966.40 | $4,916 | 7.7× |
| CT head/brain without and with contrast (70470) | $2,278.80 | $5,697 | 8.9× |
| CT heart no contrast quant eval coronry calcium (75571) | $234 | $1,162 | 1.8× |
| CT iac w contrast (70481) | $1,577.60 | $3,944 | 6.1× |
| CT l-spine w&w/o contrast (72133) | $4,048.40 | $10,121 | 15.8× |
| CT lower ext w/o (73700) | $1,664 | $4,160 | 10.9× |
| CT lower extremity w/contrast material (73701) | $2,055.60 | $5,139 | 8.0× |
| CT lumbar spine w contrast (72132) | $1,982 | $4,955 | 3.9× |
| CT lumbar spine w/o contrast (72131) | $1,854 | $4,635 | 12.1× |
| CT maxillofacial w contrast (70487) | $2,875.60 | $7,189 | 11.2× |
| CT maxillofacial wo contrast (70486) | $1,587.20 | $3,968 | 10.4× |
| CT neck tissue combo (70492) | $3,904.80 | $9,762 | 15.2× |
| Ct Orbit/Ear/Fossa W/O&W/Dye (70482) | $3,467.20 | $8,668 | 13.5× |
| CT orbits w/o contrast (70480) | $1,401.60 | $3,504 | 9.2× |
| CT pelvis w&w/o contrast (72194) | $2,191.20 | $5,478 | 8.5× |
| CT pelvis w/o contrast (72192) | $2,019.60 | $5,049 | 13.2× |
| CT scan of leg combo (73702) | $3,526 | $8,815 | 13.7× |
| CT scans face/jaw combo (70488) | $3,722.80 | $9,307 | 14.5× |
| CT soft tissue neck w contrast (70491) | $2,793.60 | $6,984 | 10.9× |
| CT soft tissue neck w/o contrast (70490) | $2,514 | $6,285 | 16.4× |
| CT thoracic spine w contrast (72129) | $1,813.60 | $4,534 | 7.1× |
| CT thoracic spine w/o contrast (72128) | $1,637.60 | $4,094 | 10.7× |
| CT thoracic spine w/wo cont (72130) | $2,763.60 | $6,909 | 10.8× |
| CT thorax w/o contrast (71250) | $1,456.40 | $3,641 | 9.5× |
| CT upper ext wo (73200) | $1,532 | $3,830 | 10.0× |
| CT upper extremity w/o & w/contrast material (73202) | $2,279.60 | $5,699 | 8.9× |
| CT upper extremity with contrast (73201) | $2,754.80 | $6,887 | 5.4× |
| Cta Abdl Aorta&Bi Iliofem W/Contrast&Postp (75635) | $5,128.40 | $12,821 | 20.0× |
| Cta Abdomen (74175) | $3,142 | $7,855 | 12.2× |
| CTA pelvis (72191) | $2,672 | $6,680 | 10.4× |
| Dxa Bone Density Axial (77080) | $448.80 | $1,122 | 2.9× |
| Dxa bone density study (77085) | $721.60 | $1,804 | 4.7× |
| Dxa bone density study 1/>sites appendiclr skel (77081) | $309.60 | $774 | 2.4× |
| Esophagram (74220) | $540.40 | $1,351 | 2.1× |
| Fetal Biophysical Profile W/O Non-Stress Testing (76819) | $608.80 | $1,522 | 4.0× |
| Fluoroscopy up to 1 hr (76000) | $1,565.60 | $3,914 | 4.5× |
| Follow-Up Angiography (75898) | $2,223.60 | $5,559 | 0.5× |
| Foot 2 views (73620) | $248.80 | $622 | 2.0× |
| Forearm 2 views (73090) | $312.40 | $781 | 2.5× |
| Gastric emptying imaging study (78264) | $1,141.60 | $2,854 | 2.0× |
| Gated Heart Planar Single (78472) | $2,008 | $5,020 | 3.4× |
| Hand 2 views (73120) | $236.80 | $592 | 1.5× |
| Hepatc Vngrph Wdg/Fr Hemodyn Eval Rs&I (75889) | $3,240 | $8,100 | 0.7× |
| Hepatobil Syst Image W/Drug (78227) | $2,870 | $7,175 | 3.6× |
| Hepatobiliary System Imaging (78226) | $2,160.80 | $5,402 | 3.7× |
| Ht Muscle Image Spect Sing (78451) | $2,542.40 | $6,356 | 1.3× |
| Hysterosalpingogram (74740) | $453.20 | $1,133 | 1.3× |
| Infant hip ultrasound with hip movement (dynamic) (76885) | $209.20 | $523 | 1.6× |
| K Flow/Funct Image W/Drug (78708) | $2,289.20 | $5,723 | 2.9× |
| K Flow/Funct Image W/O Drug (78707) | $1,356.40 | $3,391 | 1.7× |
| Knee 3 Views (73562) | $323.60 | $809 | 2.5× |
| Lung Ventilat&Perfus Imaging (78582) | $4,284.80 | $10,712 | 5.4× |
| Lung Ventilation Imaging (78579) | $660.80 | $1,652 | 1.1× |
| Lymph System Imaging (78195) | $938 | $2,345 | 1.2× |
| Magnetic Image Jaw Joint (70336) | $3,028 | $7,570 | 8.7× |
| Meckels Divert Exam (78290) | $1,163.20 | $2,908 | 2.0× |
| Mra Head W/O & W/Contrast Material (70546) | $3,699.60 | $9,249 | 7.2× |
| MRA head w/o contrast (70544) | $3,338 | $8,345 | 9.6× |
| MRA neck w contrast (70548) | $2,986.40 | $7,466 | 5.9× |
| Mra Neck W/O &W/Contrast Material (70549) | $3,521.20 | $8,803 | 6.9× |
| MRA neck w/o contrast (70547) | $2,422 | $6,055 | 6.9× |
| MRI abdomen w contrast (74182) | $4,664 | $11,660 | 9.1× |
| MRI abdomen w/o contrast (74181) | $3,724.80 | $9,312 | 10.7× |
| MRI any jt lower extrem w/contrast material (73722) | $4,333.60 | $10,834 | 3.8× |
| MRI any jt lower extrem w/o & w/contrast matrl (73723) | $3,880 | $9,700 | 7.6× |
| MRI Breast W/O Contrast Bilateral (77047) | $2,582 | $6,455 | 7.4× |
| MRI cervical spine w contrast (72142) | $3,884.10 | $9,710.25 | 7.6× |
| MRI cervical spine w/o cont (72141) | $2,815.20 | $7,038 | 8.1× |
| MRI chest w/o contrast (71550) | $2,578.80 | $6,447 | 7.4× |
| MRI chest wo w contrast (71552) | $4,803.20 | $12,008 | 9.4× |
| MRI lower extrem oth/thn jt w/contrast matrl (73719) | $3,748 | $9,370 | 7.3× |
| MRI lower extrem oth/thn jt w/o & w/contr matr (73720) | $3,880 | $9,700 | 7.6× |
| MRI lower extrem oth/thn jt w/o contr matrl (73718) | $2,206.40 | $5,516 | 6.3× |
| MRI lumbar spine w contrast (72149) | $4,539.60 | $11,349 | 8.9× |
| Mri Neck Spine W/O & W/Dye (72156) | $4,962 | $12,405 | 9.7× |
| MRI orbit face &/neck w/o contrast (70540) | $1,170 | $2,925 | 3.4× |
| Mri Orbt/Fac/Nck W/O &W/Dye (70543) | $2,821.20 | $7,053 | 5.5× |
| MRI pelvis w contrast (72196) | $4,539.60 | $11,349 | 8.9× |
| MRI pelvis w/o & w contrast (72197) | $4,522 | $11,305 | 8.9× |
| MRI pelvis w/o contrast (72195) | $3,892.80 | $9,732 | 11.2× |
| MRI thoracic spine w/o contrast (72146) | $4,500.40 | $11,251 | 12.9× |
| MRI upper extremity oth than jt w/contr matrl (73219) | $3,494.40 | $8,736 | 6.8× |
| MRI upper extremity oth than jt w/o contr matrl (73218) | $3,392.80 | $8,482 | 9.7× |
| Mri Uppr Extremity W/O&W/Dye (73220) | $3,587.20 | $8,968 | 7.0× |
| MRI, abdomen, combo (74183) | $6,458.80 | $16,147 | 12.7× |
| MRI, dorsal spine combo (72157) | $6,016.40 | $15,041 | 11.8× |
| MRI, dorsal spine contrast (72147) | $4,635.20 | $11,588 | 9.1× |
| MRI, joint upper extrem (73221) | $3,862.80 | $9,657 | 11.1× |
| MRI, joint upper extrem combo (73223) | $4,212 | $10,530 | 8.3× |
| MRI, lumbar spine combo (72158) | $6,292.40 | $15,731 | 12.3× |
| Myocardial Spect Multiple Studies (78452) | $4,058.80 | $10,147 | 2.1× |
| N-invas est c ffr sw aly CTA (75580) | $5,246.80 | $13,117 | 4.2× |
| Neck soft tissue (70360) | $294.80 | $737 | 2.3× |
| Ophthalmic ultrasound dx b-scan w/wo a-scan (76512) | $200.80 | $502 | 1.3× |
| Parathyroid imaging w/tomographic spect & CT (78072) | $597.20 | $1,493 | 0.8× |
| Pelvis 1 or 2 views (72170) | $309.60 | $774 | 2.0× |
| Peritoneogram Rs&I (74190) | $371.20 | $928 | 0.5× |
| PET image w/CT, full body (78816) | $5,995.60 | $14,989 | 2.9× |
| PET imaging CT attenuation skull base mid-thigh (78815) | $5,643.20 | $14,108 | 2.7× |
| Pulmonary Perfusion Imaging Particulate (78580) | $2,322.80 | $5,807 | 4.0× |
| Radex Abd Compl Aqt Abd W/S/E/D Views 1 View Ch (74022) | $652.80 | $1,632 | 4.3× |
| Radex abscess/fistula/sinus tract rs&i (76080) | $1,608.40 | $4,021 | 2.0× |
| Radex Ankle Complete Minimum 3 Views (73610) | $298.40 | $746 | 2.3× |
| Radex Calcaneus Minimum 2 Views (73650) | $240.80 | $602 | 1.9× |
| Radex elbow complete minimum 3 views (73080) | $351.20 | $878 | 2.8× |
| Radex Facial Bones Complete Minimum 3 Views (70150) | $372.80 | $932 | 2.4× |
| Radex fingr minimum 2 views (73140) | $255.20 | $638 | 2.0× |
| Radex foot complete minimum 3 views (73630) | $297.20 | $743 | 2.3× |
| Radex Hand Minimum 3 Views (73130) | $315.20 | $788 | 2.5× |
| Radex lower extremity infant minimum 2 views (73592) | $290.40 | $726 | 2.3× |
| Radex Nasal Bones Complete Minimum 3 Views (70160) | $363.60 | $909 | 2.9× |
| Radex Ribs Unilateral 2 Views (71100) | $280 | $700 | 2.2× |
| Radex shoulder complete minimum 2 views (73030) | $292 | $730 | 2.3× |
| Radex Spine 1 View Specify Level (72020) | $412 | $1,030 | 3.2× |
| Radex Sternum Minimum 2 Views (71120) | $346.80 | $867 | 2.7× |
| Radex Temporomandble Jt Opn & Clsd Mouth Bilat (70330) | $423.20 | $1,058 | 3.3× |
| Radex Toe Minimum 2 Views (73660) | $278 | $695 | 2.2× |
| Radex upper extremity infant minimum 2 views (73092) | $289.20 | $723 | 1.9× |
| Radex Wrist Complete Minimum 3 Views (73110) | $328 | $820 | 2.6× |
| Radiolog exam mandible compl minimum 4 views (70110) | $415.20 | $1,038 | 2.7× |
| Radiologic Exam Abdomen 3+ Views - Xr Abdomen 3+ Views (74021) | $640 | $1,600 | 4.2× |
| Radiologic exam colon single contrast study (74270) | $1,508 | $3,770 | 5.9× |
| Radiologic exam knee complete 4/more views (73564) | $348.40 | $871 | 2.3× |
| Radiologic exam pelvis compl minimum 3 views (72190) | $353.60 | $884 | 2.3× |
| Radiologic Exam Small Int Single Contrast Study (74250) | $695.20 | $1,738 | 2.7× |
| Radiologic exam swallow function contrast study (74230) | $652 | $1,630 | 2.5× |
| Radiologic exam upr gi trc double contrast study (74246) | $1,536 | $3,840 | 6.0× |
| Radiologic examination femur 1 view (73551) | $207.20 | $518 | 1.6× |
| Radiologic examination femur minimum 2 views (73552) | $207.20 | $518 | 1.6× |
| Radiologic examination knee 1/2 views (73560) | $275.60 | $689 | 2.2× |
| Radiologic examination tibia & fibula 2 views (73590) | $384.40 | $961 | 3.0× |
| Ribs bilateral 3 views (71110) | $670 | $1,675 | 4.4× |
| Rp loclzj tum plnr 1 area single day imaging (78800) | $746.40 | $1,866 | 1.3× |
| Rp Loclzj Tum Plnr Whole Body Single Day Imaging (78802) | $1,522 | $3,805 | 1.9× |
| Rp Loclzj Tum Spect 1 Area Single Day Imaging (78803) | $3,316.40 | $8,291 | 4.2× |
| Rp loclzj tum spect w/CT 1 area/acquisj 1day img (78830) | $3,542.40 | $8,856 | 1.9× |
| Scapula (73010) | $294 | $735 | 1.9× |
| Screening Digital Breast Tomosynthesis Bi (77063) | $69.60 | $174 | 3.0× |
| Shoulder 1 view (73020) | $380 | $950 | 3.0× |
| Shoulder Arthrography (73040) | $548 | $1,370 | 1.1× |
| Skull less than 4 views (70250) | $327.20 | $818 | 2.1× |
| Sternoclavicular joints (71130) | $134.40 | $336 | 1.1× |
| Thoracic spine 2 views (72070) | $547.60 | $1,369 | 3.6× |
| Thoracic spine 3 views (72072) | $302.40 | $756 | 2.0× |
| Thoracolumbar 2 views (72080) | $400.40 | $1,001 | 3.1× |
| Thyroid Met Imaging Body (78018) | $1,402 | $3,505 | 1.8× |
| Thyroid Uptake Measurement (78012) | $1,001.60 | $2,504 | 1.7× |
| Thyroid Uptake W/Blood Flow Sngle/Mult Quan Meas (78014) | $1,029.60 | $2,574 | 1.8× |
| Ultrasound Breast Limited (76642) | $321.20 | $803 | 2.5× |
| Ultrasound Elastography Parenchyma (76981) | $574 | $1,435 | 3.8× |
| Ultrasound Exam Aaa Screen (76706) | $1,001.20 | $2,503 | 6.5× |
| Ultrasound, abdomen limited (76705) | $922.40 | $2,306 | 6.0× |
| Unlisted fluoroscopic procedure (76496) | $307.60 | $769 | 2.4× |
| Upper gi w/o kub (74240) | $1,295.20 | $3,238 | 5.0× |
| Urethrocystogram voiding (74455) | $812.80 | $2,032 | 2.3× |
| Us breast unilateral complete (76641) | $103 | $354 | 0.7× |
| Us chest (76604) | $618 | $1,545 | 4.0× |
| Us complete joint (76881) | $976.80 | $2,442 | 6.4× |
| Us exam, pelvic, limited (76857) | $604.40 | $1,511 | 4.0× |
| Us head (76506) | $592.80 | $1,482 | 3.9× |
| Us kidney transplant (76776) | $925.60 | $2,314 | 6.1× |
| Us lmtd joint/oth nonvasc xtr strux r-t w/img (76882) | $454 | $1,135 | 3.0× |
| Us ob limited 1 or more fetuses (76815) | $534.40 | $1,336 | 3.5× |
| Us ob transvaginal (76817) | $276.40 | $691 | 1.8× |
| Us pelvic non ob complete (76856) | $676 | $1,690 | 4.4× |
| Us pg uter img f&mat 14 wk tabdl 1/1st gestation (76801) | $599.20 | $1,498 | 3.9× |
| Us retroperitoneal complete (76770) | $833.20 | $2,083 | 5.4× |
| Us retroperitoneal limited (76775) | $630.40 | $1,576 | 4.1× |
| Us scrotum and contents (76870) | $687.60 | $1,719 | 4.5× |
| Us spinal canal and contents (76800) | $148.80 | $372 | 1.0× |
| Us thyroid (76536) | $721.20 | $1,803 | 4.7× |
| Vein X-Ray Chest (75827) | $4,108.40 | $10,271 | 1.8× |
| Vein X-Ray Liver W/O Hemodyn (75887) | $2,299.20 | $5,748 | 0.5× |
| Venogram Sinus/Jugular (75860) | $4,613.20 | $11,533 | 1.0× |
| Venography caval inferior serialography rs&i (75825) | $4,785.60 | $11,964 | 1.0× |
| Venography extremity bilateral rs&i (75822) | $2,402 | $6,005 | 1.0× |
| Venography extremity unilateral rs&i (75820) | $2,283.20 | $5,708 | 1.0× |
| Venography Renal Bilateral (75833) | $4,838 | $12,095 | 1.0× |
| Venography Renal Unilateral (75831) | $4,391.20 | $10,978 | 1.0× |
| Vertebral fracture assessment via dxa (77086) | $262.40 | $656 | 2.1× |
| Wrist 2 views (73100) | $260 | $650 | 2.0× |
| X-Ray Ac Jts - Xr Acromioclavicular Joints Bilateral (73050) | $407.20 | $1,018 | 3.2× |
| X-ray antegrade pyelogram tube (74425) | $884.80 | $2,212 | 1.7× |
| X-Ray Aorta Leg Arteries (75630) | $5,494.80 | $13,737 | 1.2× |
| X-Ray Bend Only L-S Spine (72120) | $382.40 | $956 | 2.5× |
| X-Ray Elbow 2 Vw - Xr Elbow 1-2 Views Right (73070) | $277.20 | $693 | 2.2× |
| X-Ray Exam Breast Specimen (76098) | $623.20 | $1,558 | 0.8× |
| X-Ray Exam Entire Spi 1 Vw (72081) | $233.20 | $583 | 1.8× |
| X-Ray Exam Entire Spi 2/3 Vw (72082) | $182 | $455 | 1.2× |
| X-Ray Exam Hip Uni 1 View (73501) | $207.20 | $518 | 1.6× |
| X-Ray Exam Hip Uni 2-3 Views (73502) | $238.40 | $596 | 1.9× |
| X-Ray Exam Hips Bi 2 Views (73521) | $342.80 | $857 | 2.2× |
| X-Ray Exam L-S Spine Bending (72114) | $510 | $1,275 | 3.3× |
| X-Ray Exam Neck Spine 2-3 Vw (72040) | $556.80 | $1,392 | 4.4× |
| X-Ray Exam Neck Spine 6/>Vws (72052) | $556.40 | $1,391 | 3.6× |
| X-Ray Exam Unilat Ribs/Chest (71101) | $389.60 | $974 | 2.5× |
| X-ray eye for foreign body (70030) | $478.80 | $1,197 | 3.8× |
| X-ray humerus (73060) | $302.80 | $757 | 2.4× |
| X-Ray Knee Bilat Standing - Xr Knees Anteroposterior Standing Bilat (73565) | $347.20 | $868 | 2.7× |
| X-Ray Lumbar Spine 2/3 Vw - Xr Lumbar Spine 2-3 Views (72100) | $374.40 | $936 | 2.4× |
| X-ray nose-rectum child f.b. (76010) | $473.20 | $1,183 | 3.7× |
| X-Ray Ribs, Chest 4+ Vw - Xr Ribs 3 Vws Bil W/ Chest Posteroanterior (71111) | $540.40 | $1,351 | 3.5× |
| X-Ray Sacroiliac Jts 3+ Vw - Xr Sacroiliac Joints 3+ Views (72202) | $364.80 | $912 | 2.4× |
| X-Ray Sacrum/Coccyx 2+ Vw - Xr Sacrum Coccyx 2+ Views (72220) | $292.80 | $732 | 2.3× |
| X-Ray Sinuses 3+ Vw - Xr Paranasal Sinuses 3+ Views (70220) | $376 | $940 | 3.0× |
| X-Ray Skull 4+ Vw - Xr Skull Complete 4+ Views (70260) | $381.20 | $953 | 2.5× |
| X-Rays Bone Length Studies (77073) | $557.60 | $1,394 | 3.6× |
| X-Rays Bone Survey Complete (77075) | $1,143.60 | $2,859 | 7.5× |
| Xr c-spine 4 or 5 views (72050) | $538.40 | $1,346 | 3.5× |
| Xr facial bones less than 3 views (70140) | $251.60 | $629 | 2.0× |
| Xr orbits complete 4 views (70200) | $363.20 | $908 | 2.4× |