Imaging prices at Summit Healthcare Regional Medical Center
Show Low, AZ · every code in this section with a posted price and a Medicare benchmark.
288 codes. Prices are the hospital's own posted facility charges.
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| Procedure | Posted cash | Posted gross | × Medicare |
|---|---|---|---|
| 3-D radiotherapy plan dose-volume histograms (77295) range across 2 matching MRF lines |
— | $607.52–$8,113.03 | — |
| Abdomen 1 View (74018) range across 2 matching MRF lines |
— | $192.08–$324.28 | — |
| Abdomen 2 views (74019) range across 3 matching MRF lines |
— | $243.18–$385.11 | — |
| Acute Gastrointestinal Blood Loss Imaging (78278) | — | $2,621.53 | — |
| Angio pulmonary bilat (75743) | — | $5,693.34 | — |
| Angiography extremity bilateral rs&i (75716) | — | $5,681.34 | — |
| Angiography extremity unilateral rs&i (75710) range across 3 matching MRF lines |
— | $10,605.18–$10,668.66 | — |
| Angrph pulmonary nonslctv cath/ven njx rs&i (75746) | — | $10,833.11 | — |
| Ankle 2 views (73600) range across 4 matching MRF lines |
— | $523.74–$595 | — |
| Aortography thoracic serialography rs&i (75605) | — | $12,780.68 | — |
| Aortography thoracic w/o serialography rs&i (75600) | — | $4,073.42 | — |
| Artery X-Rays Abdomen (75726) | — | $18,058.73 | — |
| Artery X-Rays Pelvis (75736) | — | $5,693.34 | — |
| Arthrogram ankle (73615) | — | $1,238.24 | — |
| Arthrogram hip (73525) range across 3 matching MRF lines |
— | $936.58–$1,461.10 | — |
| Arthrogram Wrist (73115) | — | $1,318.79 | — |
| Basic radiation dosimetry calculation (77300) range across 2 matching MRF lines |
— | $87.52–$629.42 | — |
| Bone age studies (77072) | — | $304.16 | — |
| Bone Imaging 3 Phase (78315) | — | $5,968.35 | — |
| Bone Imaging Limited Area (78300) | — | $2,127.77 | — |
| Bone Imaging Whole Body (78306) | — | $4,152.70 | — |
| Bone survey infant (77076) | — | $525.22 | — |
| Card Bl Pool Gated Spect Rest Wal Motn Ejct Frct (78494) | — | $3,731.09 | — |
| Cerebrospinal Fluid Scan (78630) | — | $2,809.04 | — |
| Chest 1 view (71045) range across 2 matching MRF lines |
— | $192.08–$324.28 | — |
| Chest 2 views (71046) range across 3 matching MRF lines |
— | $233.83–$370.30 | — |
| Chest 4 or more views (71048) range across 2 matching MRF lines |
— | $374.58–$506.78 | — |
| Clavicle complete (73000) range across 4 matching MRF lines |
— | $416.14–$435.03 | — |
| Computed Tomography Thorax Lw Dose Lng Ca Scr C- (71271) | — | $542.11 | — |
| Continuing medical physics consltj pr wk (77336) | — | $1,121.78 | — |
| Contrast Exam Abdominl Aorta (75625) | — | $5,235.37 | — |
| Contrast X-Ray Bladder (74430) | — | $1,007.27 | — |
| Contrast X-Ray Of Elbow (73085) | — | $972.40 | — |
| Contrast X-Ray Of Knee Joint (73580) range across 3 matching MRF lines |
— | $1,505.85–$2,349.11 | — |
| CT abdomen and pelvis without and with contrast (74178) range across 2 matching MRF lines |
— | $8,834.81–$9,363.19 | — |
| CT abdomen and pelvis without contrast (74176) | — | $6,309.96 | — |
| CT abdomen w contrast (74160) | — | $5,674.36 | — |
| CT abdomen w wo contrast (74170) range across 2 matching MRF lines |
— | $6,034.60–$6,393.25 | — |
| CT abdomen w/o contrast (74150) range across 2 matching MRF lines |
— | $5,315.71–$5,616 | — |
| CT Angio Abdomen and Pelvis (74174) | — | $8,316.10 | — |
| CT Angio Chest (71275) range across 2 matching MRF lines |
— | $4,484.77–$4,709.74 | — |
| CT Angio Head (70496) range across 2 matching MRF lines |
— | $2,723.62–$2,932.02 | — |
| CT angio hrt w/3d image (75574) | — | $3,664.32 | — |
| Ct Angio Lwr Extr W/O&W/Dye (73706) range across 3 matching MRF lines |
— | $5,648.24–$5,911.29 | — |
| CT Angio Neck (70498) | — | $3,543.03 | — |
| Ct Angio Upr Extrm W/O&W/Dye (73206) range across 3 matching MRF lines |
— | $5,497.19–$7,418.32 | — |
| CT cervical spine w/ contrast (72126) | — | $5,079.70 | — |
| CT cervical spine w/o contrast (72125) | — | $4,295.87 | — |
| CT cervical spine w/wo cont (72127) | — | $5,605.80 | — |
| CT chest w contrast (71260) range across 2 matching MRF lines |
— | $4,803.39–$4,842.10 | — |
| CT chest w/wo contrast (71270) | — | $5,602.30 | — |
| CT head/brain with contrast (70460) range across 2 matching MRF lines |
— | $2,435.43–$2,770.54 | — |
| CT head/brain without and with contrast (70470) range across 2 matching MRF lines |
— | $5,094.43–$5,129.99 | — |
| CT heart contrast eval cardiac structure&morph (75572) | — | $3,664.32 | — |
| CT heart no contrast quant eval coronry calcium (75571) | — | $901.42 | — |
| CT iac w contrast (70481) | — | $3,973.64 | — |
| CT l-spine w&w/o contrast (72133) | — | $6,535.82 | — |
| CT lower ext w/o (73700) range across 5 matching MRF lines |
— | $3,139.88–$6,491.82 | — |
| CT lower extremity w/contrast material (73701) range across 3 matching MRF lines |
— | $3,594.59–$4,226.06 | — |
| CT lumbar spine w contrast (72132) | — | $5,902.79 | — |
| CT lumbar spine w/o contrast (72131) | — | $5,271.47 | — |
| CT maxillofacial w contrast (70487) | — | $3,671.28 | — |
| CT maxillofacial wo contrast (70486) | — | $3,839.54 | — |
| CT neck tissue combo (70492) | — | $4,203.18 | — |
| Ct Orbit/Ear/Fossa W/O&W/Dye (70482) | — | $4,505.53 | — |
| CT orbits w/o contrast (70480) | — | $3,443.33 | — |
| CT pelvis w&w/o contrast (72194) | — | $6,403.47 | — |
| CT pelvis w/o contrast (72192) range across 2 matching MRF lines |
— | $5,147.60–$5,524.33 | — |
| CT scan of leg combo (73702) | — | $3,553.99 | — |
| CT scans face/jaw combo (70488) | — | $4,217.43 | — |
| CT soft tissue neck w contrast (70491) range across 2 matching MRF lines |
— | $4,118.13–$4,331.39 | — |
| CT soft tissue neck w/o contrast (70490) | — | $3,940.41 | — |
| CT thoracic spine w contrast (72129) | — | $3,988.47 | — |
| CT thoracic spine w/o contrast (72128) | — | $2,739.39 | — |
| CT thoracic spine w/wo cont (72130) | — | $4,327.89 | — |
| CT thorax w/o contrast (71250) range across 2 matching MRF lines |
— | $4,006.06–$4,039.37 | — |
| CT upper ext wo (73200) range across 3 matching MRF lines |
— | $3,605.80–$4,063.12 | — |
| CT upper extremity w/o & w/contrast material (73202) | — | $4,210.78 | — |
| CT upper extremity with contrast (73201) | — | $4,008.83 | — |
| Cta Abdl Aorta&Bi Iliofem W/Contrast&Postp (75635) | — | $4,142.90 | — |
| Cta Abdomen (74175) range across 2 matching MRF lines |
— | $3,895.60–$4,835.32 | — |
| CTA pelvis (72191) | — | $1,622.21 | — |
| Dxa Bone Density Axial (77080) | — | $854.59 | — |
| Dxa bone density study (77085) range across 2 matching MRF lines |
— | $491.64–$531.76 | — |
| Dxa bone density study 1/>sites appendiclr skel (77081) range across 2 matching MRF lines |
— | $261.06–$271.50 | — |
| Echo exam uterus (76831) | — | $1,203.10 | — |
| Echo Guide For Artery Repair (76936) | — | $2,013.99 | — |
| Esophagram (74220) range across 2 matching MRF lines |
— | $728.59–$1,415.26 | — |
| Fetal Biophys Profile W/Nst (76818) range across 2 matching MRF lines |
— | $751.91–$1,342.61 | — |
| Fetal Biophysical Profile W/O Non-Stress Testing (76819) range across 3 matching MRF lines |
— | $546.09–$791.28 | — |
| Fluoroscopy up to 1 hr (76000) range across 2 matching MRF lines |
— | $928.82–$937.75 | — |
| Follow-Up Angiography (75898) | — | $10,833.11 | — |
| Foot 2 views (73620) range across 6 matching MRF lines |
— | $500.47–$881.58 | — |
| Forearm 2 views (73090) range across 4 matching MRF lines |
— | $455.38–$567.37 | — |
| Gastric emptying imaging study (78264) | — | $2,908.62 | — |
| Hand 2 views (73120) range across 6 matching MRF lines |
— | $392.87–$674.40 | — |
| Hepatobil Syst Image W/Drug (78227) | — | $3,762.14 | — |
| Hepatobiliary System Imaging (78226) | — | $3,454.36 | — |
| Ht Musc Image Planar Mult (78454) | — | $4,938.72 | — |
| Hysterosalpingogram (74740) | — | $1,514.92 | — |
| Infant hip ultrasound with hip movement (dynamic) (76885) range across 2 matching MRF lines |
— | $268.28–$745.82 | — |
| K Flow/Funct Image W/Drug (78708) | — | $3,034.07 | — |
| K Flow/Funct Image W/O Drug (78707) | — | $3,137.52 | — |
| Knee 3 Views (73562) range across 5 matching MRF lines |
— | $573.18–$721.52 | — |
| Lung Ventilat&Perfus Imaging (78582) | — | $2,165.04 | — |
| Lymph System Imaging (78195) | — | $1,376.28 | — |
| Mammary ductogram or galactogram multiple (77054) range across 2 matching MRF lines |
— | $1,044.35–$1,086.12 | — |
| Mammary ductogram or galactogram single (77053) range across 2 matching MRF lines |
— | $1,173.58–$1,220.52 | — |
| Meckels Divert Exam (78290) | — | $1,381.35 | — |
| Mlc imrt design & construction per imrt plan (77338) range across 2 matching MRF lines |
— | $607.52–$3,393.75 | — |
| MRA head w/o contrast (70544) | — | $2,871.68 | — |
| MRA neck w contrast (70548) | — | $3,521.54 | — |
| Mra Neck W/O &W/Contrast Material (70549) | — | $3,580.61 | — |
| MRA neck w/o contrast (70547) | — | $3,463.70 | — |
| MRI abdomen w contrast (74182) | — | $4,151.78 | — |
| MRI abdomen w/o contrast (74181) | — | $3,462.91 | — |
| MRI any jt lower extrem w/contrast material (73722) | — | $4,526.33 | — |
| MRI any jt lower extrem w/o & w/contrast matrl (73723) | — | $4,867.42 | — |
| MRI any jt upper extremity w/contrast matrl (73222) range across 3 matching MRF lines |
— | $5,234.05–$7,055.74 | — |
| MRI Breast W/O Contrast Bilateral (77047) | — | $2,775.03 | — |
| MRI Breast Without Contrast Material Unilateral (77046) | — | $1,890.62 | — |
| MRI cervical spine w contrast (72142) | — | $5,927.74 | — |
| MRI cervical spine w/o cont (72141) | — | $5,673.51 | — |
| MRI chest w/o contrast (71550) | — | $4,256.78 | — |
| MRI chest with contrast (71551) | — | $4,168.31 | — |
| MRI chest wo w contrast (71552) | — | $4,779.27 | — |
| MRI lower extrem oth/thn jt w/contrast matrl (73719) | — | $4,223.82 | — |
| MRI lower extrem oth/thn jt w/o & w/contr matr (73720) | — | $4,627.25 | — |
| MRI lower extrem oth/thn jt w/o contr matrl (73718) | — | $3,786.65 | — |
| MRI lumbar spine w contrast (72149) | — | $5,655.62 | — |
| Mri Neck Spine W/O & W/Dye (72156) | — | $6,173.01 | — |
| MRI orbit face &/neck w/o contrast (70540) | — | $3,437.83 | — |
| MRI orbit face neck w contrast (70542) | — | $3,178.47 | — |
| Mri Orbt/Fac/Nck W/O &W/Dye (70543) | — | $4,609.58 | — |
| MRI pelvis w contrast (72196) | — | $4,333.43 | — |
| MRI pelvis w/o & w contrast (72197) | — | $4,984.95 | — |
| MRI pelvis w/o contrast (72195) | — | $3,750.90 | — |
| MRI thoracic spine w/o contrast (72146) | — | $4,878.91 | — |
| MRI upper extremity oth than jt w/contr matrl (73219) | — | $3,442.04 | — |
| MRI upper extremity oth than jt w/o contr matrl (73218) | — | $3,347.22 | — |
| Mri Uppr Extremity W/O&W/Dye (73220) | — | $4,521.21 | — |
| MRI, abdomen, combo (74183) | — | $5,174.01 | — |
| MRI, dorsal spine combo (72157) | — | $5,650.51 | — |
| MRI, dorsal spine contrast (72147) | — | $5,241.72 | — |
| MRI, joint upper extrem (73221) range across 3 matching MRF lines |
— | $5,029.65–$6,026.43 | — |
| MRI, joint upper extrem combo (73223) | — | $5,898.35 | — |
| MRI, lumbar spine combo (72158) | — | $6,096.37 | — |
| Myelogram cervical (72240) | — | $2,771.71 | — |
| Myocardial Spect Multiple Studies (78452) | — | $6,598.14 | — |
| Neck soft tissue (70360) range across 2 matching MRF lines |
— | $598.30–$631.19 | — |
| Ntsty modul radthx pln dose-vol histos (77301) range across 2 matching MRF lines |
— | $1,128.56–$6,734.48 | — |
| Nuclear Rx Oral Admin (79005) | — | $3,157.54 | — |
| Parathyroid Planar Imaging (78070) | — | $2,346.09 | — |
| Pelvis 1 or 2 views (72170) | — | $503.38 | — |
| Pulmonary Perfusion Imaging Particulate (78580) | — | $2,129.34 | — |
| Radex Abd Compl Aqt Abd W/S/E/D Views 1 View Ch (74022) range across 2 matching MRF lines |
— | $925.94–$1,003.18 | — |
| Radex abscess/fistula/sinus tract rs&i (76080) | — | $1,925.57 | — |
| Radex Ankle Complete Minimum 3 Views (73610) range across 5 matching MRF lines |
— | $557.19–$868.40 | — |
| Radex Calcaneus Minimum 2 Views (73650) range across 4 matching MRF lines |
— | $437.94–$490.30 | — |
| Radex elbow complete minimum 3 views (73080) range across 5 matching MRF lines |
— | $519.39–$808.79 | — |
| Radex Facial Bones Complete Minimum 3 Views (70150) range across 2 matching MRF lines |
— | $622.64–$640.08 | — |
| Radex fingr minimum 2 views (73140) range across 5 matching MRF lines |
— | $328.87–$481.57 | — |
| Radex foot complete minimum 3 views (73630) range across 5 matching MRF lines |
— | $481.57–$749.14 | — |
| Radex Hand Minimum 3 Views (73130) range across 5 matching MRF lines |
— | $481.57–$727.33 | — |
| Radex lower extremity infant minimum 2 views (73592) range across 3 matching MRF lines |
— | $276.52–$439.39 | — |
| Radex Nasal Bones Complete Minimum 3 Views (70160) range across 2 matching MRF lines |
— | $583.38–$653.16 | — |
| Radex Ribs Unilateral 2 Views (71100) | — | $709.88 | — |
| Radex shoulder complete minimum 2 views (73030) range across 5 matching MRF lines |
— | $574.65–$887.31 | — |
| Radex Sinuses Paransl < 3 Views (70210) range across 2 matching MRF lines |
— | $401.60–$426.32 | — |
| Radex Sternum Minimum 2 Views (71120) range across 2 matching MRF lines |
— | $599.37–$611 | — |
| Radex Temporomandble Jt Opn & Clsd Mouth Bilat (70330) range across 2 matching MRF lines |
— | $478.66–$487.39 | — |
| Radex Toe Minimum 2 Views (73660) range across 2 matching MRF lines |
— | $410.31–$512.11 | — |
| Radex upper extremity infant minimum 2 views (73092) range across 3 matching MRF lines |
— | $304.16–$448.12 | — |
| Radex Wrist Complete Minimum 3 Views (73110) range across 5 matching MRF lines |
— | $522.29–$804.41 | — |
| Radex X-Ray Exam Entire Spi 6/> Vw - Xr Entire Spine 6+ Vw (72084) | — | $1,006.83 | — |
| Radiation treatment delivery level 1 (77402) | — | $487.72 | — |
| Radiation treatment delivery level 2 (77407) | — | $546.57 | — |
| Radiation treatment delivery level 3 (77412) | — | $695.46 | — |
| Radiolog exam mandible compl minimum 4 views (70110) range across 2 matching MRF lines |
— | $718.62–$746.25 | — |
| Radiologic Exam Abdomen 3+ Views - Xr Abdomen 3+ Views (74021) range across 2 matching MRF lines |
— | $313.75–$445.95 | — |
| Radiologic exam colon double contrast study (74280) | — | $1,916.02 | — |
| Radiologic exam colon single contrast study (74270) | — | $1,536.88 | — |
| Radiologic Exam Esophagus Double Contrast Study (74221) | — | $728.59 | — |
| Radiologic exam knee complete 4/more views (73564) range across 5 matching MRF lines |
— | $544.11–$788.42 | — |
| Radiologic exam pelvis compl minimum 3 views (72190) | — | $552.84 | — |
| Radiologic Exam Small Int Single Contrast Study (74250) | — | $1,410.97 | — |
| Radiologic exam swallow function contrast study (74230) | — | $1,090.48 | — |
| Radiologic exam upr gi trc double contrast study (74246) range across 3 matching MRF lines |
— | $700.57–$1,241.03 | — |
| Radiologic examination femur 1 view (73551) range across 2 matching MRF lines |
— | $557.19–$622.64 | — |
| Radiologic examination femur minimum 2 views (73552) range across 2 matching MRF lines |
— | $643.05–$708.48 | — |
| Radiologic examination knee 1/2 views (73560) range across 4 matching MRF lines |
— | $356.51–$360.87 | — |
| Radiologic Examination Osseous Survey Limited (77074) | — | $983.30 | — |
| Radiologic examination tibia & fibula 2 views (73590) range across 4 matching MRF lines |
— | $490.30–$555.73 | — |
| Rp Loclzj Tum Plnr Whole Body 2+ Days Imaging (78804) | — | $4,312.12 | — |
| Rp Loclzj Tum Spect 1 Area Single Day Imaging (78803) | — | $4,703.03 | — |
| Scapula (73010) range across 4 matching MRF lines |
— | $472.86–$490.30 | — |
| Screening Digital Breast Tomosynthesis Bi (77063) | — | $79.04 | — |
| Shoulder 1 view (73020) | — | $295.43 | — |
| Shoulder Arthrography (73040) range across 3 matching MRF lines |
— | $1,510.45–$2,356.32 | — |
| Skull less than 4 views (70250) range across 3 matching MRF lines |
— | $590.30–$622.64 | — |
| Special dosimetry (77331) range across 2 matching MRF lines |
— | $122.88–$713.49 | — |
| Special Physics Consult (77370) | — | $1,425.58 | — |
| Special teletherapy port plan (77321) range across 2 matching MRF lines |
— | $134.32–$1,623.71 | — |
| Special treatment procedure (77470) range across 2 matching MRF lines |
— | $296.56–$4,839.55 | — |
| Stereotactic Body Radiation Delivery (77373) | — | $7,242.80 | — |
| Sternoclavicular joints (71130) | — | $472.86 | — |
| Telethx isodose pln cplx w/basic dosimetry (77307) range across 2 matching MRF lines |
— | $390.16–$2,350.22 | — |
| Telethx isodose pln smpl w/dosimetry calculation (77306) range across 2 matching MRF lines |
— | $187.36–$1,373.95 | — |
| Ther Rad Simulaj-Aided Field Setting Complex (77290) range across 2 matching MRF lines |
— | $220.64–$2,663.64 | — |
| Ther Rad Simulaj-Aided Field Setting Intermed (77285) range across 2 matching MRF lines |
— | $159.28–$1,651.32 | — |
| Ther rad simulaj-aided field setting simple (77280) range across 2 matching MRF lines |
— | $98.96–$1,292.29 | — |
| Thoracic spine 2 views (72070) | — | $657.54 | — |
| Thoracic spine 3 views (72072) range across 2 matching MRF lines |
— | $669.17–$698.26 | — |
| Thyroid Met Imaging Body (78018) | — | $2,858.19 | — |
| Thyroid Uptake W/Blood Flow Sngle/Mult Quan Meas (78014) | — | $1,226.15 | — |
| Tx Devices Design & Construction Complex (77334) range across 2 matching MRF lines |
— | $1,055.76–$1,700.58 | — |
| Tx devices design & construction intermediate (77333) range across 2 matching MRF lines |
— | $743.76–$1,050.91 | — |
| Tx devices design & construction simple (77332) range across 2 matching MRF lines |
— | $535.76–$876.80 | — |
| Ultrasound Breast Limited (76642) range across 2 matching MRF lines |
— | $515.21–$581.90 | — |
| Ultrasound Exam Aaa Screen (76706) range across 2 matching MRF lines |
— | $309.46–$433.26 | — |
| Ultrasound, abdomen limited (76705) | — | $1,811.37 | — |
| Umbilical-artery Doppler (OB) (76820) | — | $406.28 | — |
| Unlisted Dx Radiographic Procedure (76499) | — | $268.28 | — |
| Unlisted genitourinary px dx nuclear medicine (78799) | — | $1,394.28 | — |
| Unlisted magnetic resonance procedure (76498) | — | $319.14 | — |
| Upper gi w/o kub (74240) range across 2 matching MRF lines |
— | $728.59–$1,116.24 | — |
| Urethrocystogram voiding (74455) | — | $1,276.92 | — |
| Urethrocystography retrograde (74450) | — | $889.55 | — |
| Us breast unilateral complete (76641) range across 4 matching MRF lines |
— | $547.27–$738.29 | — |
| Us chest (76604) | — | $660.65 | — |
| Us complete joint (76881) | — | $676.76 | — |
| Us exam, pelvic, limited (76857) | — | $957.73 | — |
| Us head (76506) | — | $1,023.94 | — |
| Us kidney transplant (76776) | — | $1,480.29 | — |
| Us lmtd joint/oth nonvasc xtr strux r-t w/img (76882) | — | $438.72 | — |
| Us ob detailed single fetus (76811) | — | $857.97 | — |
| Us ob limited 1 or more fetuses (76815) | — | $553.27 | — |
| Us ob transvaginal (76817) range across 2 matching MRF lines |
— | $783.64–$884.34 | — |
| Us pelvic non ob complete (76856) | — | $2,191.72 | — |
| Us pg uter img f&mat 14 wk tabdl 1/1st gestation (76801) range across 2 matching MRF lines |
— | $783.64–$870.03 | — |
| Us preg uterus real time f/u trnsabdl per fetus (76816) | — | $546.09 | — |
| Us retroperitoneal complete (76770) | — | $1,532.18 | — |
| Us retroperitoneal limited (76775) range across 2 matching MRF lines |
— | $2,179.90–$2,409.11 | — |
| Us scrotum and contents (76870) range across 2 matching MRF lines |
— | $1,188.86–$1,363.98 | — |
| Us spinal canal and contents (76800) | — | $839.61 | — |
| Us thyroid (76536) | — | $1,215.43 | — |
| Vein X-Ray Chest (75827) | — | $2,487.11 | — |
| Venogram Sinus/Jugular (75860) | — | $10,833.11 | — |
| Venography caval inferior serialography rs&i (75825) | — | $6,567.83 | — |
| Venography extremity bilateral rs&i (75822) | — | $4,139.47 | — |
| Venography extremity unilateral rs&i (75820) | — | $5,242.28 | — |
| Vertebral fracture assessment via dxa (77086) | — | $282.36 | — |
| Wrist 2 views (73100) range across 4 matching MRF lines |
— | $471.40–$707.10 | — |
| X-Ray Ac Jts - Xr Acromioclavicular Joints Bilateral (73050) | — | $445.22 | — |
| X-ray antegrade pyelogram tube (74425) | — | $1,325.07 | — |
| X-Ray Aorta Leg Arteries (75630) range across 3 matching MRF lines |
— | $6,401.83–$10,668.66 | — |
| X-Ray Bend Only L-S Spine (72120) | — | $490.30 | — |
| X-Ray Elbow 2 Vw - Xr Elbow 1-2 Views Right (73070) range across 4 matching MRF lines |
— | $291.06–$353.61 | — |
| X-Ray Exam Breast Specimen (76098) | — | $788.59 | — |
| X-Ray Exam Entire Spi 1 Vw (72081) | — | $863.75 | — |
| X-Ray Exam Entire Spi 2/3 Vw (72082) | — | $277.89 | — |
| X-Ray Exam Entire Spi 4/5 Vw (72083) | — | $971.07 | — |
| X-Ray Exam Hip Uni 1 View (73501) range across 2 matching MRF lines |
— | $323.06–$373.95 | — |
| X-Ray Exam Hip Uni 2-3 Views (73502) range across 2 matching MRF lines |
— | $574.65–$670.64 | — |
| X-Ray Exam Hips Bi 2 Views (73521) range across 2 matching MRF lines |
— | $721.52–$752.09 | — |
| X-Ray Exam Hips Bi 3-4 Views (73522) range across 2 matching MRF lines |
— | $793.05–$823.62 | — |
| X-Ray Exam Hips Bi 5/> Views (73523) range across 2 matching MRF lines |
— | $864.59–$895.16 | — |
| X-Ray Exam L-S Spine Bending (72114) | — | $1,330.84 | — |
| X-Ray Exam Neck Spine 2-3 Vw (72040) range across 2 matching MRF lines |
— | $532.96–$554.28 | — |
| X-Ray Exam Neck Spine 6/>Vws (72052) | — | $1,185.41 | — |
| X-Ray Exam Unilat Ribs/Chest (71101) range across 4 matching MRF lines |
— | $647.36–$667.71 | — |
| X-ray eye for foreign body (70030) | — | $333.60 | — |
| X-ray humerus (73060) range across 4 matching MRF lines |
— | $568.83–$699.70 | — |
| X-Ray Knee Bilat Standing - Xr Knees Anteroposterior Standing Bilat (73565) | — | $397.25 | — |
| X-Ray Lumbar Spine 2/3 Vw - Xr Lumbar Spine 2-3 Views (72100) range across 2 matching MRF lines |
— | $772.42–$804.41 | — |
| X-Ray Ribs, Chest 4+ Vw - Xr Ribs 3 Vws Bil W/ Chest Posteroanterior (71111) | — | $798.62 | — |
| X-Ray Sacroiliac Jts 3+ Vw - Xr Sacroiliac Joints 3+ Views (72202) | — | $603.72 | — |
| X-Ray Sacrum/Coccyx 2+ Vw - Xr Sacrum Coccyx 2+ Views (72220) range across 2 matching MRF lines |
— | $672.08–$734.60 | — |
| X-Ray Sinuses 3+ Vw - Xr Paranasal Sinuses 3+ Views (70220) | — | $512.11 | — |
| X-Ray Skull 4+ Vw - Xr Skull Complete 4+ Views (70260) | — | $797.16 | — |
| X-ray thoracic spine 4 vw (72074) | — | $1,455.92 | — |
| X-Ray Urinary Tract Exam With Contrast Material (74420) | — | $1,121.96 | — |
| X-Rays Bone Length Studies (77073) | — | $275.08 | — |
| X-Rays Bone Survey Complete (77075) | — | $1,207.24 | — |
| Xr c-spine 4 or 5 views (72050) range across 2 matching MRF lines |
— | $1,185.41–$1,208.69 | — |
| Xr facial bones less than 3 views (70140) | — | $497.57 | — |
| XR Mastoids < 3 Views Bilateral (70120) | — | $245.99 | — |
| Xr orbits complete 4 views (70200) | — | $885.85 | — |
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.