Imaging prices at Memorial Hospital of Sweetwater County
Rock Springs, WY · every code in this section with a posted price and a Medicare benchmark.
310 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) | $333 | $333 | 3.7× |
| Abdomen 2 views (74019) | $509 | $509 | 4.8× |
| Acute Gastrointestinal Blood Loss Imaging (78278) | $1,805 | $1,805 | 4.4× |
| Ankle 2 views (73600) | $325 | $325 | 3.7× |
| Arthrogram ankle (73615) | $1,246 | $1,246 | 3.5× |
| Arthrogram hip (73525) | $1,638 | $1,638 | 4.6× |
| Arthrogram Wrist (73115) | $1,638 | $1,638 | 4.6× |
| Basic radiation dosimetry calculation (77300) | $903 | $903 | 6.6× |
| Bone age studies (77072) | $472 | $472 | 4.4× |
| Bone Imaging 3 Phase (78315) | $2,310 | $2,310 | 5.7× |
| Bone Imaging Limited Area (78300) | $1,343 | $1,343 | 3.3× |
| Bone Imaging Multiple Areas (78305) | $1,534 | $1,534 | 3.8× |
| Bone Imaging Whole Body (78306) | $1,576 | $1,576 | 3.9× |
| Bone marrow imaging limited area (78102) | $1,040 | $1,040 | 2.5× |
| Bone marrow imaging; whole body (78104) | $1,613 | $1,613 | 3.9× |
| Bone survey infant (77076) | $548 | $548 | 5.1× |
| Brain Imaging Min 4 Static Views W Vascular Flow (78606) | $2,292 | $2,292 | 4.1× |
| Cerebrospinal Fluid Flow W/O Matl Shunt Evaltj (78645) | $1,370 | $1,370 | 2.5× |
| Cerebrospinal Fluid Scan (78630) | $2,190 | $2,190 | 3.9× |
| Chest 1 view (71045) | $302 | $302 | 3.4× |
| Chest 2 views (71046) | $376 | $376 | 4.2× |
| Chest 3 views (71047) | $532 | $532 | 6.0× |
| Chest 4 or more views (71048) | $708 | $708 | 6.6× |
| Clavicle complete (73000) | $325 | $325 | 3.7× |
| Computed Tomography Thorax Lw Dose Lng Ca Scr C- (71271) | $935 | $935 | 8.8× |
| Continuing medical physics consltj pr wk (77336) | $1,435 | $1,435 | 10.5× |
| Contrast X-Ray Bladder (74430) | $1,191 | $1,191 | 3.3× |
| Contrast X-Ray Of Elbow (73085) | $1,246 | $1,246 | 3.5× |
| Contrast X-Ray Of Knee Joint (73580) | $1,428 | $1,428 | 4.0× |
| CT abdomen and pelvis without and with contrast (74178) range across 3 matching MRF lines |
$6,531–$6,734 | $6,531–$6,734 | varies |
| CT abdomen and pelvis without contrast (74176) | $4,989 | $4,989 | 20.5× |
| CT abdomen w contrast (74160) | $2,766 | $2,766 | 15.4× |
| CT abdomen w wo contrast (74170) | $3,336 | $3,336 | 18.6× |
| CT abdomen w/o contrast (74150) | $2,114 | $2,114 | 19.8× |
| CT Angio Abdomen and Pelvis (74174) | $5,646 | $5,646 | 15.8× |
| CT Angio Chest (71275) | $3,150 | $3,150 | 17.6× |
| CT Angio Head (70496) | $2,514 | $2,514 | 14.0× |
| Ct Angio Lwr Extr W/O&W/Dye (73706) | $2,546 | $2,546 | 14.2× |
| CT Angio Neck (70498) | $2,414 | $2,414 | 13.5× |
| Ct Angio Upr Extrm W/O&W/Dye (73206) | $2,546 | $2,546 | 14.2× |
| CT cervical spine w/ contrast (72126) | $2,456 | $2,456 | 6.9× |
| CT cervical spine w/o contrast (72125) | $2,037 | $2,037 | 19.1× |
| CT cervical spine w/wo cont (72127) | $3,445 | $3,445 | 19.2× |
| CT chest w contrast (71260) range across 3 matching MRF lines |
$2,663–$2,864 | $2,663–$2,864 | varies |
| CT chest w/wo contrast (71270) | $3,392 | $3,392 | 18.9× |
| CT head/brain with contrast (70460) | $2,119 | $2,119 | 11.8× |
| CT head/brain without and with contrast (70470) | $2,928 | $2,928 | 16.3× |
| CT iac w contrast (70481) range across 3 matching MRF lines |
$1,888–$2,090 | $1,888–$2,090 | varies |
| CT l-spine w&w/o contrast (72133) | $3,067 | $3,067 | 17.1× |
| CT lower ext w/o (73700) | $1,858 | $1,858 | 17.4× |
| CT lower extremity w/contrast material (73701) | $2,202 | $2,202 | 12.3× |
| CT lumbar spine w contrast (72132) | $2,928 | $2,928 | 8.2× |
| CT lumbar spine w/o contrast (72131) | $2,161 | $2,161 | 20.2× |
| CT maxillofacial w contrast (70487) | $2,422 | $2,422 | 13.5× |
| CT maxillofacial wo contrast (70486) | $2,119 | $2,119 | 19.8× |
| CT neck tissue combo (70492) | $2,725 | $2,725 | 15.2× |
| Ct Orbit/Ear/Fossa W/O&W/Dye (70482) range across 3 matching MRF lines |
$2,414–$2,616 | $2,414–$2,616 | varies |
| CT orbits w/o contrast (70480) | $1,701 | $1,701 | 15.9× |
| CT pelvis w&w/o contrast (72194) | $3,300 | $3,300 | 18.4× |
| CT pelvis w/o contrast (72192) | $2,198 | $2,198 | 20.6× |
| CT scan of leg combo (73702) range across 3 matching MRF lines |
$2,072–$2,275 | $2,072–$2,275 | varies |
| CT scans face/jaw combo (70488) | $2,928 | $2,928 | 16.3× |
| CT soft tissue neck w contrast (70491) | $2,130 | $2,130 | 11.9× |
| CT soft tissue neck w/o contrast (70490) | $1,916 | $1,916 | 17.9× |
| CT thoracic spine w contrast (72129) | $2,463 | $2,463 | 13.7× |
| CT thoracic spine w/o contrast (72128) | $1,955 | $1,955 | 18.3× |
| CT thoracic spine w/wo cont (72130) | $3,067 | $3,067 | 17.1× |
| CT thorax w/o contrast (71250) | $1,557 | $1,557 | 14.6× |
| CT upper ext wo (73200) | $1,999 | $1,999 | 18.7× |
| CT upper extremity w/o & w/contrast material (73202) | $2,758 | $2,758 | 15.4× |
| CT upper extremity with contrast (73201) | $2,028 | $2,028 | 5.7× |
| Cta Abdl Aorta&Bi Iliofem W/Contrast&Postp (75635) | $2,396 | $2,396 | 13.4× |
| Cta Abdomen (74175) | $2,373 | $2,373 | 13.2× |
| CTA pelvis (72191) | $2,472 | $2,472 | 13.8× |
| Dilation ureters/urethra rs&i (74485) | $1,578 | $1,578 | 0.7× |
| Doppler Fetal Mid Cerebral Artery (76821) | $299 | $299 | 2.8× |
| Dxa Bone Density Axial (77080) | $677 | $677 | 6.3× |
| Dxa bone density study 1/>sites appendiclr skel (77081) | $593 | $593 | 6.7× |
| Echo exam uterus (76831) | $935 | $935 | 3.8× |
| Esophagram (74220) | $720 | $720 | 4.0× |
| Fetal Biophys Profile W/Nst (76818) range across 2 matching MRF lines |
$416–$658 | $416–$658 | varies |
| Fetal Biophysical Profile W/O Non-Stress Testing (76819) range across 2 matching MRF lines |
$306–$658 | $306–$658 | varies |
| Fluoroscopy up to 1 hr (76000) range across 5 matching MRF lines |
$936–$1,047 | $936–$1,047 | varies |
| Foot 2 views (73620) | $284 | $284 | 3.2× |
| Forearm 2 views (73090) | $304 | $304 | 3.4× |
| Gastric emptying imaging study (78264) | $1,991 | $1,991 | 4.9× |
| Gastroesophageal Reflux Exam (78262) | $1,707 | $1,707 | 4.2× |
| Gated Heart Planar Single (78472) | $2,657 | $2,657 | 6.5× |
| Gstrc Emptng Imag Std W/Sm Bwl Col Trnst Mlt Day (78266) | $2,928 | $2,928 | 5.3× |
| Hand 2 views (73120) | $304 | $304 | 2.8× |
| Hepatobil Syst Image W/Drug (78227) | $2,127 | $2,127 | 3.8× |
| Hepatobiliary System Imaging (78226) | $1,744 | $1,744 | 4.3× |
| Ht Muscle Image Spect Sing (78451) | $4,842 | $4,842 | 3.7× |
| Hysterosalpingogram (74740) | $1,532 | $1,532 | 6.3× |
| Infant hip ultrasound with hip movement (dynamic) (76885) | $950 | $950 | 10.7× |
| K Flow/Funct Image W/Drug (78708) | $2,213 | $2,213 | 4.0× |
| K Flow/Funct Image W/O Drug (78707) | $2,213 | $2,213 | 4.0× |
| Knee 3 Views (73562) | $391 | $391 | 4.4× |
| Labeled RBC Sequestration Differntl Organ/Tissue (78140) | $2,439 | $2,439 | 6.0× |
| Liver & Spleen Imaging Static Only (78215) | $1,347 | $1,347 | 3.3× |
| Lung Ventilat&Perfus Imaging (78582) | $1,679 | $1,679 | 3.0× |
| Lung Ventilation Imaging (78579) | $1,154 | $1,154 | 2.8× |
| Lymph System Imaging (78195) | $1,693 | $1,693 | 3.1× |
| Magnetic Image Jaw Joint (70336) | $3,985 | $3,985 | 16.3× |
| Mammary ductogram or galactogram multiple (77054) | $1,454 | $1,454 | 6.0× |
| Mammary ductogram or galactogram single (77053) | $1,454 | $1,454 | 6.0× |
| Meckels Divert Exam (78290) | $1,423 | $1,423 | 3.5× |
| Mra Head W/O & W/Contrast Material (70546) range across 2 matching MRF lines |
$5,072–$5,393 | $5,072–$5,393 | varies |
| MRA head w/o contrast (70544) | $3,470 | $3,470 | 14.2× |
| MRA head with contrast (70545) range across 2 matching MRF lines |
$3,985–$4,306 | $3,985–$4,306 | varies |
| MRA neck w contrast (70548) range across 2 matching MRF lines |
$4,613–$4,934 | $4,613–$4,934 | varies |
| Mra Neck W/O &W/Contrast Material (70549) range across 2 matching MRF lines |
$5,193–$5,514 | $5,193–$5,514 | varies |
| MRA neck w/o contrast (70547) | $3,002 | $3,002 | 12.3× |
| MRI abdomen w contrast (74182) | $4,242 | $4,242 | 11.9× |
| MRI abdomen w/o contrast (74181) | $3,530 | $3,530 | 14.5× |
| MRI any jt lower extrem w/contrast material (73722) range across 6 matching MRF lines |
$4,432–$4,753 | $4,432–$4,753 | varies |
| MRI any jt lower extrem w/o & w/contrast matrl (73723) range across 7 matching MRF lines |
$4,872–$5,393 | $4,872–$5,393 | varies |
| MRI any jt upper extremity w/contrast matrl (73222) range across 6 matching MRF lines |
$4,432–$4,934 | $4,432–$4,934 | varies |
| MRI Breast W/O Contrast Bilateral (77047) | $5,072 | $5,072 | 20.8× |
| MRI Breast Without Contrast Material Unilateral (77046) | $3,725 | $3,725 | 15.3× |
| MRI cervical spine w contrast (72142) | $4,240 | $4,240 | 11.9× |
| MRI cervical spine w/o cont (72141) | $3,678 | $3,678 | 15.1× |
| MRI chest w/o contrast (71550) | $3,530 | $3,530 | 14.5× |
| MRI chest with contrast (71551) | $3,662 | $3,662 | 4.6× |
| MRI chest wo w contrast (71552) | $5,393 | $5,393 | 15.1× |
| MRI lower extrem oth/thn jt w/contrast matrl (73719) | $3,662 | $3,662 | 10.3× |
| MRI lower extrem oth/thn jt w/o & w/contr matr (73720) | $5,393 | $5,393 | 15.1× |
| MRI lower extrem oth/thn jt w/o contr matrl (73718) | $3,678 | $3,678 | 15.1× |
| MRI lumbar spine w contrast (72149) | $4,753 | $4,753 | 13.3× |
| Mri Neck Spine W/O & W/Dye (72156) | $5,393 | $5,393 | 15.1× |
| MRI orbit face &/neck w/o contrast (70540) | $3,530 | $3,530 | 14.5× |
| MRI orbit face neck w contrast (70542) | $3,662 | $3,662 | 10.3× |
| Mri Orbt/Fac/Nck W/O &W/Dye (70543) | $5,393 | $5,393 | 15.1× |
| MRI pelvis w contrast (72196) | $3,662 | $3,662 | 10.3× |
| MRI pelvis w/o & w contrast (72197) | $5,393 | $5,393 | 15.1× |
| MRI pelvis w/o contrast (72195) | $3,530 | $3,530 | 14.5× |
| MRI thoracic spine w/o contrast (72146) | $3,822 | $3,822 | 15.7× |
| MRI upper extremity oth than jt w/contr matrl (73219) range across 6 matching MRF lines |
$3,662–$4,141 | $3,662–$4,141 | varies |
| MRI upper extremity oth than jt w/o contr matrl (73218) | $3,985 | $3,985 | 16.3× |
| Mri Uppr Extremity W/O&W/Dye (73220) range across 6 matching MRF lines |
$5,193–$5,229 | $5,193–$5,229 | varies |
| MRI, abdomen, combo (74183) | $5,393 | $5,393 | 15.1× |
| MRI, dorsal spine combo (72157) | $4,753 | $4,753 | 13.3× |
| MRI, dorsal spine contrast (72147) | $4,306 | $4,306 | 12.1× |
| MRI, joint upper extrem (73221) | $4,152 | $4,152 | 17.0× |
| MRI, joint upper extrem combo (73223) | $5,193 | $5,193 | 14.6× |
| MRI, lumbar spine combo (72158) | $5,393 | $5,393 | 15.1× |
| Myelogram cervical (72240) | $2,869 | $2,869 | 3.6× |
| Myelogram Lumbar (72265) | $2,869 | $2,869 | 3.6× |
| Myelography thoracic (72255) | $2,753 | $2,753 | 3.4× |
| Myelograpy 2/more regions rs&i (72270) | $2,597 | $2,597 | 3.2× |
| Myocardial Spect Multiple Studies (78452) | $7,409 | $7,409 | 5.6× |
| Neck soft tissue (70360) | $304 | $304 | 3.4× |
| Nm csf leak detection (78650) | $2,292 | $2,292 | 1.7× |
| Nonvascular Shunt X-Ray (75809) | $894 | $894 | 8.4× |
| Ntsty modul radthx pln dose-vol histos (77301) | $11,719 | $11,719 | 8.3× |
| Nuclear Rx Oral Admin (79005) | $1,264 | $1,264 | 5.3× |
| Optic foramina (70190) | $336 | $336 | 3.8× |
| Panoramic X-ray of jaws (70355) | $491 | $491 | 5.5× |
| Parathyroid imaging w/tomographic spect & CT (78072) | $3,181 | $3,181 | 5.7× |
| Parathyroid Planar Imaging (78070) | $2,000 | $2,000 | 4.9× |
| Parathyroid planar imaging w/wo subtraction (78071) | $3,181 | $3,181 | 7.8× |
| Pelvis 1 or 2 views (72170) | $411 | $411 | 3.8× |
| Pet Image W/Ct Lmtd (78814) | $7,737 | $7,737 | 5.3× |
| PET image w/CT, full body (78816) | $8,936 | $8,936 | 6.1× |
| PET imaging CT attenuation skull base mid-thigh (78815) | $8,162 | $8,162 | 5.6× |
| Pulmonary Perfusion Imaging Particulate (78580) | $1,486 | $1,486 | 3.6× |
| Radex Abd Compl Aqt Abd W/S/E/D Views 1 View Ch (74022) | $533 | $533 | 5.0× |
| Radex abscess/fistula/sinus tract rs&i (76080) range across 2 matching MRF lines |
$1,516–$1,532 | $1,516–$1,532 | varies |
| Radex Ankle Complete Minimum 3 Views (73610) | $391 | $391 | 4.4× |
| Radex Calcaneus Minimum 2 Views (73650) | $304 | $304 | 3.4× |
| Radex elbow complete minimum 3 views (73080) | $391 | $391 | 4.4× |
| Radex Facial Bones Complete Minimum 3 Views (70150) | $560 | $560 | 5.2× |
| Radex fingr minimum 2 views (73140) | $422 | $422 | 4.7× |
| Radex foot complete minimum 3 views (73630) | $351 | $351 | 3.9× |
| Radex Hand Minimum 3 Views (73130) | $391 | $391 | 4.4× |
| Radex lower extremity infant minimum 2 views (73592) | $310 | $310 | 3.5× |
| Radex Mastoids Compl Minimum 3 Views PR Side (70130) | $421 | $421 | 3.9× |
| Radex Nasal Bones Complete Minimum 3 Views (70160) | $470 | $470 | 5.3× |
| Radex Pharynx/Larx W/Fluor&/Magnification Tq (70370) | $714 | $714 | 8.0× |
| Radex Ribs Unilateral 2 Views (71100) | $411 | $411 | 4.6× |
| Radex shoulder complete minimum 2 views (73030) | $333 | $333 | 3.7× |
| Radex Sinuses Paransl < 3 Views (70210) | $411 | $411 | 4.6× |
| Radex sm int w/mlt srl imges via enteroclss tube (74251) | $1,273 | $1,273 | 7.1× |
| Radex Spine 1 View Specify Level (72020) | $252 | $252 | 2.8× |
| Radex Sternum Minimum 2 Views (71120) | $411 | $411 | 4.6× |
| Radex Temporomandble Jt Opn & Clsd Mouth Bilat (70330) | $403 | $403 | 4.5× |
| Radex Toe Minimum 2 Views (73660) range across 9 matching MRF lines |
$130–$271 | $130–$271 | varies |
| Radex upper extremity infant minimum 2 views (73092) | $325 | $325 | 3.0× |
| Radex Wrist Complete Minimum 3 Views (73110) | $351 | $351 | 3.9× |
| Radex X-Ray Exam Entire Spi 6/> Vw - Xr Entire Spine 6+ Vw (72084) | $803 | $803 | 7.5× |
| Radiation Delivery Stereotactic Cranial Linear (77372) | $33,845 | $33,845 | 4.5× |
| Radiation treatment delivery level 3 (77412) | $1,453 | $1,453 | 2.6× |
| Radiolog exam mandible compl minimum 4 views (70110) | $437 | $437 | 4.1× |
| Radiologic Exam Abdomen 3+ Views - Xr Abdomen 3+ Views (74021) | $391 | $391 | 3.7× |
| Radiologic exam colon double contrast study (74280) | $1,304 | $1,304 | 7.3× |
| Radiologic exam colon single contrast study (74270) | $1,007 | $1,007 | 5.6× |
| Radiologic exam knee complete 4/more views (73564) | $409 | $409 | 3.8× |
| Radiologic exam pelvis compl minimum 3 views (72190) | $467 | $467 | 4.4× |
| Radiologic Exam Small Int Single Contrast Study (74250) | $805 | $805 | 4.5× |
| Radiologic exam swallow function contrast study (74230) | $596 | $596 | 3.3× |
| Radiologic exam upr gi trc double contrast study (74246) | $1,514 | $1,514 | 8.4× |
| Radiologic examination femur 1 view (73551) | $346 | $346 | 3.9× |
| Radiologic examination femur minimum 2 views (73552) | $411 | $411 | 4.6× |
| Radiologic examination knee 1/2 views (73560) | $351 | $351 | 3.9× |
| Radiologic Examination Osseous Survey Limited (77074) | $492 | $492 | 4.6× |
| Radiologic examination tibia & fibula 2 views (73590) | $347 | $347 | 3.9× |
| Ribs bilateral 3 views (71110) | $467 | $467 | 4.4× |
| Rp Loclzj Tum Plnr Whole Body Single Day Imaging (78802) | $2,228 | $2,228 | 4.0× |
| Rp Loclzj Tum Spect 1 Area Single Day Imaging (78803) | $2,829 | $2,829 | 5.1× |
| Rp loclzj tum spect CT 2area 1d img/1 ar img>2+d (78832) | $3,222 | $3,222 | 2.2× |
| Scapula (73010) | $372 | $372 | 3.5× |
| Screening Digital Breast Tomosynthesis Bi (77063) | $156 | $156 | 6.7× |
| Shoulder 1 view (73020) | $289 | $289 | 3.3× |
| Shoulder Arthrography (73040) | $1,571 | $1,571 | 4.4× |
| Skull less than 4 views (70250) | $391 | $391 | 3.7× |
| Special dosimetry (77331) | $558 | $558 | 4.1× |
| Special Physics Consult (77370) | $979 | $979 | 7.1× |
| Special treatment procedure (77470) | $3,205 | $3,205 | 5.7× |
| Stereotactic Body Radiation Delivery (77373) | $15,677 | $15,677 | 8.6× |
| Sternoclavicular joints (71130) | $361 | $361 | 4.1× |
| Telethx isodose pln cplx w/basic dosimetry (77307) | $4,464 | $4,464 | 11.7× |
| Testicular Imaging W/Flow (78761) | $1,299 | $1,299 | 3.2× |
| Ther Rad Simulaj-Aided Field Setting Complex (77290) | $4,557 | $4,557 | 11.9× |
| Ther Rad Simulaj-Aided Field Setting Intermed (77285) | $1,693 | $1,693 | 4.4× |
| Ther rad simulaj-aided field setting simple (77280) | $1,718 | $1,718 | 12.5× |
| Therapeutic Enema Rdctj Intussusception/Obstrcj (74283) | $1,038 | $1,038 | 5.8× |
| Thoracic spine 2 views (72070) | $411 | $411 | 3.8× |
| Thoracic spine 3 views (72072) | $509 | $509 | 4.8× |
| Thoracolumbar 2 views (72080) | $310 | $310 | 3.5× |
| Thyroid Imaging With Vascular Flow (78013) | $700 | $700 | 1.7× |
| Thyroid Met Imaging Body (78018) | $2,194 | $2,194 | 4.0× |
| Thyroid Uptake W/Blood Flow Sngle/Mult Quan Meas (78014) | $1,810 | $1,810 | 4.4× |
| Tx Devices Design & Construction Complex (77334) | $2,142 | $2,142 | 5.6× |
| Tx devices design & construction intermediate (77333) | $1,037 | $1,037 | 7.6× |
| Tx devices design & construction simple (77332) range across 2 matching MRF lines |
$266–$730 | $266–$730 | varies |
| Ultrasound Breast Limited (76642) | $584 | $584 | 6.6× |
| Ultrasound Elastography Parenchyma (76981) | $294 | $294 | 2.8× |
| Ultrasound Exam Aaa Screen (76706) | $729 | $729 | 6.8× |
| Ultrasound, abdomen limited (76705) | $1,060 | $1,060 | 9.9× |
| Umbilical-artery Doppler (OB) (76820) | $158 | $158 | 1.5× |
| Unlisted Dx Radiographic Procedure (76499) range across 2 matching MRF lines |
$284–$302 | $284–$302 | varies |
| Unlisted magnetic resonance procedure (76498) | $10,228 | $10,228 | 115.0× |
| Unlisted us procedure (76999) | $629 | $629 | 7.1× |
| Upper gi w/o kub (74240) range across 3 matching MRF lines |
$805–$1,060 | $805–$1,060 | varies |
| Ureteral Reflux Study (78740) | $1,299 | $1,299 | 3.2× |
| Urethrocystogram voiding (74455) | $932 | $932 | 3.8× |
| Urethrocystography retrograde (74450) | $1,191 | $1,191 | 4.9× |
| Us breast unilateral complete (76641) | $584 | $584 | 5.5× |
| Us chest (76604) | $660 | $660 | 6.2× |
| Us complete joint (76881) range across 3 matching MRF lines |
$565–$668 | $565–$668 | varies |
| Us exam, pelvic, limited (76857) | $684 | $684 | 6.4× |
| Us head (76506) | $660 | $660 | 6.2× |
| Us kidney transplant (76776) | $654 | $654 | 6.1× |
| Us lmtd joint/oth nonvasc xtr strux r-t w/img (76882) | $480 | $480 | 4.5× |
| Us ob detailed single fetus (76811) range across 3 matching MRF lines |
$623–$1,445 | $623–$1,445 | varies |
| Us ob limited 1 or more fetuses (76815) | $703 | $703 | 6.6× |
| Us ob transvaginal (76817) | $935 | $935 | 8.8× |
| Us pelvic non ob complete (76856) range across 3 matching MRF lines |
$479–$841 | $479–$841 | varies |
| Us pg uter img f&mat 14 wk tabdl 1/1st gestation (76801) range across 6 matching MRF lines |
$430–$841 | $430–$841 | varies |
| Us preg uterus real time f/u trnsabdl per fetus (76816) range across 3 matching MRF lines |
$398–$531 | $398–$531 | varies |
| Us retroperitoneal complete (76770) | $921 | $921 | 8.6× |
| Us retroperitoneal limited (76775) | $697 | $697 | 6.5× |
| Us scrotum and contents (76870) | $741 | $741 | 6.9× |
| Us spinal canal and contents (76800) | $872 | $872 | 8.2× |
| Us thyroid (76536) | $660 | $660 | 6.2× |
| Us transrectal (76872) range across 2 matching MRF lines |
$423–$1,097 | $423–$1,097 | varies |
| Venography caval inferior serialography rs&i (75825) | $6,353 | $6,353 | 2.0× |
| Venography extremity bilateral rs&i (75822) | $2,232 | $2,232 | 1.4× |
| Venography extremity unilateral rs&i (75820) | $2,141 | $2,141 | 1.3× |
| Wrist 2 views (73100) | $325 | $325 | 3.7× |
| X-Ray Ac Jts - Xr Acromioclavicular Joints Bilateral (73050) | $411 | $411 | 4.6× |
| X-ray antegrade pyelogram tube (74425) | $810 | $810 | 2.3× |
| X-Ray Bend Only L-S Spine (72120) | $509 | $509 | 4.8× |
| X-Ray Elbow 2 Vw - Xr Elbow 1-2 Views Right (73070) | $347 | $347 | 3.9× |
| X-Ray Exam Breast Specimen (76098) | $1,564 | $1,564 | 2.8× |
| X-Ray Exam Entire Spi 1 Vw (72081) | $668 | $668 | 7.5× |
| X-Ray Exam Entire Spi 2/3 Vw (72082) | $531 | $531 | 5.0× |
| X-Ray Exam Entire Spi 4/5 Vw (72083) | $668 | $668 | 6.3× |
| X-Ray Exam Hip Uni 1 View (73501) range across 4 matching MRF lines |
$241–$411 | $241–$411 | varies |
| X-Ray Exam Hip Uni 2-3 Views (73502) | $411 | $411 | 4.6× |
| X-Ray Exam Hip Uni 4/> Views (73503) | $540 | $540 | 5.1× |
| X-Ray Exam Hips Bi 2 Views (73521) | $459 | $459 | 4.3× |
| X-Ray Exam Hips Bi 3-4 Views (73522) | $547 | $547 | 5.1× |
| X-Ray Exam Hips Bi 5/> Views (73523) | $663 | $663 | 6.2× |
| X-Ray Exam L-S Spine Bending (72114) | $720 | $720 | 6.7× |
| X-Ray Exam Neck Spine 2-3 Vw (72040) | $430 | $430 | 4.8× |
| X-Ray Exam Neck Spine 6/>Vws (72052) | $341 | $341 | 3.2× |
| X-Ray Exam Unilat Ribs/Chest (71101) | $467 | $467 | 4.4× |
| X-ray eye for foreign body (70030) | $381 | $381 | 4.3× |
| X-ray humerus (73060) | $346 | $346 | 3.9× |
| X-ray IV pyelogram (ivp) (74400) | $1,197 | $1,197 | 6.7× |
| X-Ray Jaw <4 Vw - Xr Mandible < 4 Views (70100) | $411 | $411 | 4.6× |
| X-Ray Knee Bilat Standing - Xr Knees Anteroposterior Standing Bilat (73565) | $333 | $333 | 3.7× |
| X-Ray Lumbar Spine 2/3 Vw - Xr Lumbar Spine 2-3 Views (72100) | $472 | $472 | 4.4× |
| X-ray nose-rectum child f.b. (76010) | $325 | $325 | 3.7× |
| X-Ray Ribs, Chest 4+ Vw - Xr Ribs 3 Vws Bil W/ Chest Posteroanterior (71111) | $591 | $591 | 5.5× |
| X-Ray Sacroiliac Jts 3+ Vw - Xr Sacroiliac Joints 3+ Views (72202) | $391 | $391 | 3.7× |
| X-Ray Sacroiliac Jts <3 Vw - Xr Sacroiliac Joints 1-2 Views (72200) | $372 | $372 | 3.5× |
| X-Ray Sacrum/Coccyx 2+ Vw - Xr Sacrum Coccyx 2+ Views (72220) | $353 | $353 | 4.0× |
| X-Ray Sinuses 3+ Vw - Xr Paranasal Sinuses 3+ Views (70220) | $491 | $491 | 5.5× |
| X-Ray Skull 4+ Vw - Xr Skull Complete 4+ Views (70260) | $459 | $459 | 4.3× |
| X-ray thoracic spine 4 vw (72074) | $607 | $607 | 5.7× |
| X-Ray Urinary Tract Exam With Contrast Material (74420) | $1,578 | $1,578 | 4.4× |
| X-Rays Bone Length Studies (77073) | $420 | $420 | 3.9× |
| X-Rays Bone Survey Complete (77075) | $687 | $687 | 6.4× |
| Xr c-spine 4 or 5 views (72050) | $661 | $661 | 6.2× |
| Xr facial bones less than 3 views (70140) | $371 | $371 | 4.2× |
| XR Mastoids < 3 Views Bilateral (70120) | $326 | $326 | 3.1× |
| Xr orbits complete 4 views (70200) | $560 | $560 | 5.2× |
| Xr Tomogram Single Plane (76100) | $737 | $737 | 6.9× |
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.