Imaging prices at Summit Medical Center
Casper, WY · every code in this section with a posted price and a Medicare benchmark.
220 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) | $175.64 | $428.40 | 2.0× |
| Abdomen 2 views (74019) | $199.38 | $486.30 | 1.9× |
| Ankle 2 views (73600) range across 6 matching MRF lines |
$105.86–$211.68 | $258.20–$516.30 | varies |
| Arthrogram ankle (73615) range across 6 matching MRF lines |
$593.12–$1,186.25 | $1,446.65–$2,893.30 | varies |
| Arthrogram hip (73525) range across 8 matching MRF lines |
$406.06–$1,186.25 | $990.40–$2,893.30 | varies |
| Arthrogram Wrist (73115) range across 6 matching MRF lines |
$593.12–$1,186.25 | $1,446.65–$2,893.30 | varies |
| Bone age studies (77072) | $151.92 | $370.55 | 1.4× |
| Bone survey infant (77076) | $207.58 | $506.30 | 1.9× |
| Cat Scan Follow-Up Study (76380) | $469.51 | $1,145.15 | 5.3× |
| Chest 1 view (71045) | $143.25 | $349.40 | 1.6× |
| Chest 2 views (71046) | $175.64 | $428.40 | 2.0× |
| Chest 3 views (71047) | $249.11 | $607.60 | 2.8× |
| Chest 4 or more views (71048) | $140.30 | $342.20 | 1.3× |
| Cholecystography Oral Contrast (74290) | $187.98 | $458.50 | 1.0× |
| Clavicle complete (73000) range across 6 matching MRF lines |
$105.86–$211.68 | $258.20–$516.30 | varies |
| Computed Tomography Thorax Lw Dose Lng Ca Scr C- (71271) | $124.10 | $302.70 | 1.2× |
| Contrast X-Ray Bladder (74430) | $475.84 | $1,160.60 | 1.3× |
| Contrast X-Ray Of Elbow (73085) range across 6 matching MRF lines |
$593.12–$1,186.25 | $1,446.65–$2,893.30 | varies |
| Contrast X-Ray Of Knee Joint (73580) range across 6 matching MRF lines |
$593.12–$1,186.25 | $1,446.65–$2,893.30 | varies |
| CT abdomen and pelvis without and with contrast (74178) | $2,256.59 | $5,503.90 | 6.3× |
| CT abdomen and pelvis without contrast (74176) | $2,179.49 | $5,315.85 | 8.9× |
| CT abdomen w contrast (74160) | $1,283.42 | $3,130.30 | 7.2× |
| CT abdomen w wo contrast (74170) | $1,592.76 | $3,884.80 | 8.9× |
| CT abdomen w/o contrast (74150) | $1,177.11 | $2,871 | 11.0× |
| CT Angio Abdomen and Pelvis (74174) | $2,980.22 | $7,268.85 | 8.4× |
| CT Angio Chest (71275) | $1,403.43 | $3,423 | 7.8× |
| CT Angio Head (70496) | $1,313.53 | $3,203.75 | 7.3× |
| Ct Angio Lwr Extr W/O&W/Dye (73706) range across 6 matching MRF lines |
$739.23–$1,478.23 | $1,803–$3,605.45 | varies |
| CT Angio Neck (70498) | $1,410.72 | $3,440.80 | 7.9× |
| Ct Angio Upr Extrm W/O&W/Dye (73206) range across 6 matching MRF lines |
$753.84–$1,411.15 | $1,838.65–$3,441.85 | varies |
| CT cervical spine w/ contrast (72126) | $1,517.02 | $3,700.05 | 4.3× |
| CT cervical spine w/o contrast (72125) | $1,281.59 | $3,125.85 | 12.0× |
| CT cervical spine w/wo cont (72127) | $1,102.32 | $2,688.60 | 6.2× |
| CT chest w contrast (71260) | $1,270.18 | $3,098 | 7.1× |
| CT chest w/wo contrast (71270) | $1,568.57 | $3,825.80 | 8.8× |
| CT head/brain with contrast (70460) | $1,174.83 | $2,865.45 | 6.6× |
| CT head/brain without and with contrast (70470) | $1,457.24 | $3,554.25 | 8.1× |
| CT heart no contrast quant eval coronry calcium (75571) | $77.10 | $188.05 | 0.9× |
| CT iac w contrast (70481) | $673.65 | $1,643.05 | 3.8× |
| CT l-spine w&w/o contrast (72133) | $1,051.42 | $2,564.45 | 5.9× |
| CT lower ext w/o (73700) range across 6 matching MRF lines |
$804.80–$1,073.99 | $1,962.95–$2,619.50 | varies |
| CT lower extremity w/contrast material (73701) range across 6 matching MRF lines |
$459.89–$1,275.20 | $1,121.70–$3,110.25 | varies |
| CT lumbar spine w contrast (72132) | $1,444.49 | $3,523.15 | 4.1× |
| CT lumbar spine w/o contrast (72131) | $1,243.28 | $3,032.40 | 11.6× |
| CT maxillofacial w contrast (70487) range across 4 matching MRF lines |
$666.61–$1,434.89 | $1,625.90–$3,499.75 | varies |
| CT maxillofacial wo contrast (70486) range across 4 matching MRF lines |
$579.63–$941.68 | $1,413.75–$2,296.80 | varies |
| CT neck tissue combo (70492) | $1,489.65 | $3,633.30 | 8.3× |
| Ct Orbit/Ear/Fossa W/O&W/Dye (70482) | $838.63 | $2,045.45 | 4.7× |
| CT orbits w/o contrast (70480) range across 8 matching MRF lines |
$594.88–$971.80 | $1,450.95–$2,370.25 | varies |
| CT pelvis w&w/o contrast (72194) | $932.70 | $2,274.90 | 5.2× |
| CT pelvis w/o contrast (72192) | $1,107.75 | $2,701.85 | 10.4× |
| CT scan of leg combo (73702) range across 8 matching MRF lines |
$591.09–$1,181.68 | $1,441.70–$2,882.15 | varies |
| CT scans face/jaw combo (70488) range across 4 matching MRF lines |
$825.61–$1,756.09 | $2,013.70–$4,283.15 | varies |
| CT soft tissue neck w contrast (70491) | $1,254.68 | $3,060.20 | 7.0× |
| CT soft tissue neck w/o contrast (70490) | $587.26 | $1,432.35 | 5.5× |
| CT thoracic spine w contrast (72129) | $1,603.24 | $3,910.35 | 8.9× |
| CT thoracic spine w/o contrast (72128) | $1,566.28 | $3,820.20 | 14.7× |
| CT thoracic spine w/wo cont (72130) | $1,085.37 | $2,647.25 | 6.1× |
| CT thorax w/o contrast (71250) | $1,014.23 | $2,473.75 | 9.5× |
| CT upper ext wo (73200) range across 6 matching MRF lines |
$1,029.75–$2,058.38 | $2,511.60–$5,020.45 | varies |
| CT upper extremity w/o & w/contrast material (73202) | $557.43 | $1,359.60 | 3.1× |
| CT upper extremity with contrast (73201) range across 6 matching MRF lines |
$466.12–$932.56 | $1,136.90–$2,274.55 | varies |
| Cta Abdl Aorta&Bi Iliofem W/Contrast&Postp (75635) range across 6 matching MRF lines |
$374.12–$1,682.18 | $912.50–$4,102.90 | varies |
| Cta Abdomen (74175) | $1,621.96 | $3,956 | 9.1× |
| CTA pelvis (72191) | $374.12 | $912.50 | 2.1× |
| Discography Cerv/Thor Spine (72285) range across 4 matching MRF lines |
$1,469.58–$5,099.49 | $3,584.35–$12,437.80 | varies |
| Diskography lumbar (72295) | $258.68 | $630.95 | 0.1× |
| Esophagram (74220) | $194.38 | $474.10 | 1.1× |
| Fetal Biophys Profile W/Nst (76818) | $248.52 | $606.15 | 2.3× |
| Fetal Biophysical Profile W/O Non-Stress Testing (76819) | $248.52 | $606.15 | 2.3× |
| Fluoroscopy up to 1 hr (76000) | $289.25 | $705.50 | 1.2× |
| Foot 2 views (73620) range across 6 matching MRF lines |
$105.86–$211.68 | $258.20–$516.30 | varies |
| Forearm 2 views (73090) range across 6 matching MRF lines |
$105.86–$211.68 | $258.20–$516.30 | varies |
| Hand 2 views (73120) range across 6 matching MRF lines |
$105.86–$158.79 | $258.20–$387.30 | varies |
| Hysterosalpingogram (74740) | $587.20 | $1,432.20 | 2.4× |
| Knee 3 Views (73562) range across 6 matching MRF lines |
$241.81–$362.70 | $589.80–$884.65 | varies |
| Mra Head W/O & W/Contrast Material (70546) | $1,860.76 | $4,538.45 | 5.2× |
| MRA head w/o contrast (70544) | $1,196.29 | $2,917.80 | 4.9× |
| MRA head with contrast (70545) | $1,433.03 | $3,495.20 | 4.0× |
| MRA neck w contrast (70548) | $1,451.17 | $3,539.45 | 4.1× |
| Mra Neck W/O &W/Contrast Material (70549) | $1,982.86 | $4,836.25 | 5.6× |
| MRA neck w/o contrast (70547) | $1,269.77 | $3,097 | 5.2× |
| MRI abdomen w contrast (74182) | $2,027.10 | $4,944.15 | 5.7× |
| MRI abdomen w/o contrast (74181) | $1,660.27 | $4,049.45 | 6.8× |
| MRI any jt lower extrem w/contrast material (73722) range across 6 matching MRF lines |
$1,693.60–$2,137.98 | $4,130.75–$5,214.60 | varies |
| MRI any jt lower extrem w/o & w/contrast matrl (73723) range across 6 matching MRF lines |
$1,687.66–$2,690.03 | $4,116.25–$6,561.05 | varies |
| MRI any jt upper extremity w/contrast matrl (73222) range across 6 matching MRF lines |
$1,220.91–$2,060.41 | $2,977.85–$5,025.40 | varies |
| MRI Breast W/O Contrast Bilateral (77047) | $820.77 | $2,001.90 | 3.4× |
| MRI cervical spine w contrast (72142) | $1,560.19 | $3,805.35 | 4.4× |
| MRI cervical spine w/o cont (72141) | $1,385.16 | $3,378.45 | 5.7× |
| MRI chest w/o contrast (71550) | $1,089.96 | $2,658.45 | 4.5× |
| MRI chest with contrast (71551) | $1,607.63 | $3,921.05 | 2.0× |
| MRI chest wo w contrast (71552) | $1,633.82 | $3,984.95 | 4.6× |
| MRI lower extrem oth/thn jt w/contrast matrl (73719) range across 6 matching MRF lines |
$1,080.59–$2,160.80 | $2,635.60–$5,270.25 | varies |
| MRI lower extrem oth/thn jt w/o & w/contr matr (73720) range across 6 matching MRF lines |
$1,779.83–$2,737.48 | $4,341.05–$6,676.80 | varies |
| MRI lower extrem oth/thn jt w/o contr matrl (73718) range across 6 matching MRF lines |
$1,186.25–$1,898.91 | $2,893.30–$4,631.50 | varies |
| MRI lumbar spine w contrast (72149) | $1,721.40 | $4,198.55 | 4.8× |
| Mri Neck Spine W/O & W/Dye (72156) | $1,835.03 | $4,475.70 | 5.1× |
| MRI orbit face &/neck w/o contrast (70540) | $1,108.23 | $2,703 | 4.5× |
| MRI orbit face neck w contrast (70542) | $1,666.38 | $4,064.35 | 4.7× |
| Mri Orbt/Fac/Nck W/O &W/Dye (70543) | $1,710.45 | $4,171.85 | 4.8× |
| MRI pelvis w contrast (72196) | $1,621.67 | $3,955.30 | 4.5× |
| MRI pelvis w/o & w contrast (72197) | $1,856.93 | $4,529.10 | 5.2× |
| MRI pelvis w/o contrast (72195) | $1,384.24 | $3,376.20 | 5.7× |
| MRI thoracic spine w/o contrast (72146) | $1,347.75 | $3,287.20 | 5.5× |
| MRI upper extremity oth than jt w/contr matrl (73219) range across 6 matching MRF lines |
$935.37–$1,870.62 | $2,281.40–$4,562.50 | varies |
| MRI upper extremity oth than jt w/o contr matrl (73218) range across 6 matching MRF lines |
$1,145.17–$1,570.40 | $2,793.10–$3,830.25 | varies |
| Mri Uppr Extremity W/O&W/Dye (73220) range across 6 matching MRF lines |
$1,740.12–$2,363.36 | $4,244.20–$5,764.30 | varies |
| MRI, abdomen, combo (74183) range across 4 matching MRF lines |
$2,172.65–$2,765.75 | $5,299.15–$6,745.75 | varies |
| MRI, dorsal spine combo (72157) | $2,198.19 | $5,361.45 | 6.2× |
| MRI, dorsal spine contrast (72147) | $1,653.48 | $4,032.90 | 4.6× |
| MRI, joint upper extrem (73221) range across 6 matching MRF lines |
$1,276.12–$1,782.10 | $3,112.50–$4,346.60 | varies |
| MRI, joint upper extrem combo (73223) range across 6 matching MRF lines |
$1,522.94–$2,651.71 | $3,714.50–$6,467.60 | varies |
| MRI, lumbar spine combo (72158) | $1,941.32 | $4,734.95 | 5.4× |
| Myelogram cervical (72240) | $1,103.18 | $2,690.70 | 1.4× |
| Myelogram Lumbar (72265) | $1,103.18 | $2,690.70 | 1.4× |
| Myelography thoracic (72255) | $1,103.18 | $2,690.70 | 1.4× |
| Myelograpy 2/more regions rs&i (72270) | $1,103.18 | $2,690.70 | 1.4× |
| Neck soft tissue (70360) | $105.92 | $258.35 | 1.2× |
| Optic foramina (70190) | $110.86 | $270.40 | 1.2× |
| Pelvis 1 or 2 views (72170) | $178.86 | $436.25 | 1.7× |
| Radex Abd Compl Aqt Abd W/S/E/D Views 1 View Ch (74022) | $257.07 | $627 | 2.4× |
| Radex abscess/fistula/sinus tract rs&i (76080) | $587.14 | $1,432.05 | 1.1× |
| Radex Ankle Complete Minimum 3 Views (73610) range across 6 matching MRF lines |
$98.09–$223.55 | $239.25–$545.25 | varies |
| Radex Calcaneus Minimum 2 Views (73650) range across 6 matching MRF lines |
$105.86–$211.68 | $258.20–$516.30 | varies |
| Radex elbow complete minimum 3 views (73080) range across 6 matching MRF lines |
$208.50–$217.17 | $508.55–$529.70 | varies |
| Radex Facial Bones Complete Minimum 3 Views (70150) | $167.87 | $409.45 | 1.6× |
| Radex fingr minimum 2 views (73140) range across 20 matching MRF lines |
$105.86–$134.13 | $258.20–$327.15 | varies |
| Radex foot complete minimum 3 views (73630) range across 6 matching MRF lines |
$193.90–$290.85 | $472.95–$709.40 | varies |
| Radex Hand Minimum 3 Views (73130) range across 6 matching MRF lines |
$195.73–$293.58 | $477.40–$716.05 | varies |
| Radex Mastoids Compl Minimum 3 Views PR Side (70130) | $143.25 | $349.40 | 1.3× |
| Radex Nasal Bones Complete Minimum 3 Views (70160) | $105.92 | $258.35 | 1.2× |
| Radex Ribs Unilateral 2 Views (71100) range across 4 matching MRF lines |
$109.53–$199.38 | $267.15–$486.30 | varies |
| Radex shoulder complete minimum 2 views (73030) range across 6 matching MRF lines |
$204.85–$307.27 | $499.65–$749.45 | varies |
| Radex Sinuses Paransl < 3 Views (70210) | $105.92 | $258.35 | 1.2× |
| Radex Spine 1 View Specify Level (72020) | $105.86 | $258.20 | 1.2× |
| Radex Sternum Minimum 2 Views (71120) | $263.26 | $642.10 | 3.0× |
| Radex Temporomandble Jt Opn & Clsd Mouth Bilat (70330) | $226.29 | $551.95 | 2.5× |
| Radex Toe Minimum 2 Views (73660) range across 20 matching MRF lines |
$105.86–$143.25 | $258.20–$349.40 | varies |
| Radex Wrist Complete Minimum 3 Views (73110) | $201.20 | $490.75 | 2.3× |
| Radiolog exam mandible compl minimum 4 views (70110) | $151.92 | $370.55 | 1.4× |
| Radiologic exam colon double contrast study (74280) | $427.95 | $1,043.80 | 2.4× |
| Radiologic exam colon single contrast study (74270) | $308.97 | $753.60 | 1.7× |
| Radiologic exam knee complete 4/more views (73564) | $251.86 | $614.30 | 2.4× |
| Radiologic exam pelvis compl minimum 3 views (72190) | $229.94 | $560.85 | 2.2× |
| Radiologic Exam Small Int Single Contrast Study (74250) | $226.73 | $553 | 1.3× |
| Radiologic exam swallow function contrast study (74230) | $217.27 | $529.95 | 1.2× |
| Radiologic exam upr gi trc double contrast study (74246) | $279.23 | $681.05 | 1.6× |
| Radiologic examination femur minimum 2 views (73552) | $219 | $534.15 | 2.5× |
| Radiologic examination knee 1/2 views (73560) range across 6 matching MRF lines |
$179.76–$269.64 | $438.45–$657.68 | varies |
| Radiologic Examination Osseous Survey Limited (77074) | $167.87 | $409.45 | 1.6× |
| Radiologic examination tibia & fibula 2 views (73590) range across 6 matching MRF lines |
$198.46–$211.68 | $484.05–$516.30 | varies |
| Ribs bilateral 3 views (71110) | $258.68 | $630.95 | 2.4× |
| Scapula (73010) range across 6 matching MRF lines |
$109.96–$220.35 | $268.20–$537.45 | varies |
| Sella turcica (70240) | $105.92 | $258.35 | 1.2× |
| Shoulder 1 view (73020) range across 6 matching MRF lines |
$140.97–$211.68 | $343.85–$516.30 | varies |
| Shoulder Arthrography (73040) range across 6 matching MRF lines |
$593.12–$1,186.25 | $1,446.65–$2,893.30 | varies |
| Skull less than 4 views (70250) | $109.49 | $267.05 | 1.0× |
| Sternoclavicular joints (71130) | $132.36 | $322.85 | 1.5× |
| Thoracic spine 2 views (72070) | $211.68 | $516.30 | 2.0× |
| Thoracic spine 3 views (72072) | $273.75 | $667.70 | 2.6× |
| Ultrasound Breast Limited (76642) | $88.49 | $215.85 | 1.0× |
| Ultrasound Exam Aaa Screen (76706) | $205.71 | $501.75 | 1.9× |
| Ultrasound, abdomen limited (76705) range across 14 matching MRF lines |
$204.38–$425.23 | $498.50–$1,037.15 | varies |
| Umbilical-artery Doppler (OB) (76820) | $202.10 | $492.95 | 1.9× |
| Upper gi w/o kub (74240) | $279.23 | $681.05 | 1.6× |
| Urethrocystogram voiding (74455) | $475.84 | $1,160.60 | 2.0× |
| Urethrocystography retrograde (74450) | $475.84 | $1,160.60 | 2.0× |
| Us breast unilateral complete (76641) range across 6 matching MRF lines |
$166.31–$266.43 | $405.65–$649.85 | varies |
| Us chest (76604) | $327.56 | $798.95 | 3.1× |
| Us complete joint (76881) range across 16 matching MRF lines |
$204.38–$497.30 | $498.50–$1,212.95 | varies |
| Us exam, pelvic, limited (76857) | $245.91 | $599.80 | 2.3× |
| Us lmtd joint/oth nonvasc xtr strux r-t w/img (76882) | $204.38 | $498.50 | 1.9× |
| Us ob detailed single fetus (76811) | $570.76 | $1,392.10 | 2.3× |
| Us ob limited 1 or more fetuses (76815) | $337.61 | $823.45 | 3.2× |
| Us ob transvaginal (76817) | $375.94 | $916.95 | 3.5× |
| Us pelvic non ob complete (76856) | $427.05 | $1,041.60 | 4.0× |
| Us pg uter img f&mat 14 wk tabdl 1/1st gestation (76801) | $182.49 | $445.10 | 1.7× |
| Us preg uterus real time f/u trnsabdl per fetus (76816) | $318.91 | $777.85 | 3.0× |
| Us retroperitoneal complete (76770) range across 4 matching MRF lines |
$248.64–$468.56 | $606.45–$1,142.85 | varies |
| Us retroperitoneal limited (76775) | $301.57 | $735.55 | 2.8× |
| Us scrotum and contents (76870) | $369.55 | $901.35 | 3.5× |
| Us thyroid (76536) | $396.94 | $968.15 | 3.7× |
| Us transrectal (76872) | $248.52 | $606.15 | 2.3× |
| Venography extremity bilateral rs&i (75822) | $1,364.27 | $3,327.50 | 0.8× |
| Venography extremity unilateral rs&i (75820) | $1,527.29 | $3,725.10 | 0.9× |
| Wrist 2 views (73100) | $151.02 | $368.35 | 1.7× |
| X-Ray Ac Jts - Xr Acromioclavicular Joints Bilateral (73050) | $126.83 | $309.35 | 1.4× |
| X-Ray Bend Only L-S Spine (72120) | $236.32 | $576.40 | 2.2× |
| X-Ray Elbow 2 Vw - Xr Elbow 1-2 Views Right (73070) range across 6 matching MRF lines |
$158.32–$211.68 | $386.15–$516.30 | varies |
| X-Ray Exam Hip Uni 1 View (73501) | $211.68 | $516.30 | 2.4× |
| X-Ray Exam Hip Uni 2-3 Views (73502) | $184.78 | $450.70 | 2.1× |
| X-Ray Exam Hip Uni 4/> Views (73503) | $294.72 | $718.85 | 2.8× |
| X-Ray Exam Hips Bi 2 Views (73521) | $249.78 | $609.23 | 2.3× |
| X-Ray Exam Hips Bi 3-4 Views (73522) | $182.49 | $445.10 | 1.7× |
| X-Ray Exam Hips Bi 5/> Views (73523) | $461.72 | $1,126.15 | 4.3× |
| X-Ray Exam Neck Spine 2-3 Vw (72040) | $219.92 | $536.40 | 2.5× |
| X-Ray Exam Neck Spine 6/>Vws (72052) | $331.69 | $809 | 3.1× |
| X-Ray Exam Unilat Ribs/Chest (71101) range across 4 matching MRF lines |
$167.89–$247.29 | $409.50–$603.15 | varies |
| X-ray eye for foreign body (70030) | $187.51 | $457.35 | 2.1× |
| X-ray humerus (73060) range across 6 matching MRF lines |
$112.70–$225.37 | $274.90–$549.70 | varies |
| X-ray IV pyelogram (ivp) (74400) | $475.84 | $1,160.60 | 2.7× |
| X-Ray Jaw <4 Vw - Xr Mandible < 4 Views (70100) | $105.92 | $258.35 | 1.2× |
| X-Ray Knee Bilat Standing - Xr Knees Anteroposterior Standing Bilat (73565) | $247.72 | $604.20 | 2.8× |
| X-Ray Lumbar Spine 2/3 Vw - Xr Lumbar Spine 2-3 Views (72100) | $251.39 | $613.15 | 2.4× |
| X-ray nose-rectum child f.b. (76010) | $105.92 | $258.35 | 1.2× |
| X-Ray Ribs, Chest 4+ Vw - Xr Ribs 3 Vws Bil W/ Chest Posteroanterior (71111) | $327.13 | $797.90 | 3.1× |
| X-Ray Sacroiliac Jts 3+ Vw - Xr Sacroiliac Joints 3+ Views (72202) | $105.86 | $258.20 | 1.0× |
| X-Ray Sacroiliac Jts <3 Vw - Xr Sacroiliac Joints 1-2 Views (72200) | $27.83 | $67.90 | 0.3× |
| X-Ray Sacrum/Coccyx 2+ Vw - Xr Sacrum Coccyx 2+ Views (72220) | $199.38 | $486.30 | 2.2× |
| X-Ray Sinuses 3+ Vw - Xr Paranasal Sinuses 3+ Views (70220) | $267.83 | $653.25 | 3.0× |
| X-Ray Skull 4+ Vw - Xr Skull Complete 4+ Views (70260) | $372.30 | $908.05 | 3.5× |
| X-Ray Stress View (77071) | $105.86 | $258.20 | 1.2× |
| X-ray thoracic spine 4 vw (72074) | $185.64 | $452.80 | 1.7× |
| X-Ray Tmj Unilat (70328) | $113.13 | $275.95 | 1.3× |
| X-Ray Urinary Tract Exam With Contrast Material (74420) | $475.84 | $1,160.60 | 1.3× |
| X-Rays Bone Survey Complete (77075) | $417.93 | $1,019.35 | 3.9× |
| Xr c-spine 4 or 5 views (72050) | $283.33 | $691.05 | 2.7× |
| Xr facial bones less than 3 views (70140) | $117.71 | $287.10 | 1.3× |
| Xr orbits complete 4 views (70200) | $141.42 | $344.95 | 1.3× |
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.