Imaging prices at Western Missouri Medical Center
Warrensburg, MO · every code in this section with a posted price and a Medicare benchmark.
240 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) range across 6 matching MRF lines |
$105 | $34–$344 | 1.2× |
| Abdomen 2 views (74019) range across 3 matching MRF lines |
— | $48.40–$496.50 | — |
| Acute Gastrointestinal Blood Loss Imaging (78278) | — | $602.60 | — |
| Angiography Adrenal Bilateral Slctv Rs&I (75733) | — | $720 | — |
| Angiography extremity bilateral rs&i (75716) | — | $732.30 | — |
| Ankle 2 views (73600) range across 12 matching MRF lines |
— | $20.60–$331.70 | — |
| Arthrogram hip (73525) | — | $2,483.30 | — |
| Arthrogram Wrist (73115) | — | $579.90 | — |
| Bone age studies (77072) | — | $255.40 | — |
| Bone Imaging 3 Phase (78315) | — | $1,917.90 | — |
| Bone Imaging Limited Area (78300) | — | $879.60 | — |
| Bone Imaging Whole Body (78306) range across 2 matching MRF lines |
— | $804.40–$1,937.40 | — |
| Bone survey infant (77076) | — | $372.90 | — |
| Cat Scan Follow-Up Study (76380) range across 2 matching MRF lines |
— | $496.50–$1,117.60 | — |
| Chest 1 view (71045) range across 13 matching MRF lines |
— | $20.08–$315.20 | — |
| Chest 2 views (71046) range across 5 matching MRF lines |
$115 | $27.80–$457.30 | 1.3× |
| Chest 3 views (71047) | — | $277.10 | — |
| Chest 4 or more views (71048) | — | $405.80 | — |
| Clavicle complete (73000) range across 12 matching MRF lines |
— | $29.90–$308 | — |
| Computed Tomography Thorax Lw Dose Lng Ca Scr C- (71271) | — | $372.90 | — |
| Contrast Exam Abdominl Aorta (75625) | — | $545.90 | — |
| Contrast X-Ray Bladder (74430) | — | $360.50 | — |
| Contrast X-Ray Of Elbow (73085) | — | $496.50 | — |
| Contrast X-Ray Of Knee Joint (73580) | — | $979.50 | — |
| CT abdomen and pelvis without and with contrast (74178) | $690 | $5,147.90 | 2.0× |
| CT abdomen and pelvis without contrast (74176) | $645 | $4,142.70 | 2.7× |
| CT abdomen w contrast (74160) | $662.50 | $2,439 | 3.8× |
| CT abdomen w wo contrast (74170) | $632.50 | $2,608 | 3.6× |
| CT abdomen w/o contrast (74150) range across 2 matching MRF lines |
$695 | $2,135.20–$5,147.90 | 6.6× |
| CT Angio Abdomen and Pelvis (74174) range across 2 matching MRF lines |
$522.50 | $1,108.30–$1,238.10 | 1.5× |
| CT Angio Chest (71275) range across 3 matching MRF lines |
— | $869.30–$2,344.30 | — |
| CT Angio Head (70496) | $667.50 | $1,737.60 | 3.8× |
| CT angio hrt w/3d image (75574) | $612.50 | $707.60 | 1.8× |
| Ct Angio Lwr Extr W/O&W/Dye (73706) | $582.50 | $1,084.60 | 3.3× |
| CT Angio Neck (70498) | $632.50 | $1,862.20 | 3.6× |
| Ct Angio Upr Extrm W/O&W/Dye (73206) | $607.50 | $869.30 | 3.5× |
| CT cervical spine w/ contrast (72126) | $865 | $2,419.50 | 2.5× |
| CT cervical spine w/o contrast (72125) | $695 | $2,356.60 | 6.6× |
| CT cervical spine w/wo cont (72127) | $707.50 | $2,545.10 | 4.0× |
| CT chest w contrast (71260) range across 7 matching MRF lines |
— | $228.70–$2,344.30 | — |
| CT chest w/wo contrast (71270) | — | $3,173.40 | — |
| CT head/brain with contrast (70460) | $762.50 | $2,234.10 | 4.3× |
| CT head/brain without and with contrast (70470) | $737.50 | $2,582.20 | 4.2× |
| CT heart contrast eval cardiac structure&morph (75572) | — | $474.80 | — |
| CT heart no contrast quant eval coronry calcium (75571) | — | $51.50 | — |
| CT iac w contrast (70481) | $722.50 | $2,234.10 | 4.1× |
| CT l-spine w&w/o contrast (72133) | $707.50 | $2,730.50 | 4.0× |
| CT lower ext w/o (73700) | $695 | $1,798.40 | 6.6× |
| CT lower extremity w/contrast material (73701) | $742.50 | $1,963.20 | 4.2× |
| CT lumbar spine w contrast (72132) | $865 | $2,606.90 | 2.5× |
| CT lumbar spine w/o contrast (72131) | $695 | $2,391.70 | 6.6× |
| CT maxillofacial w contrast (70487) | $757.50 | $2,234.10 | 4.3× |
| CT maxillofacial wo contrast (70486) range across 4 matching MRF lines |
$685 | $1,862.20–$2,019.80 | 6.5× |
| CT neck tissue combo (70492) | $692.50 | $2,243.30 | 3.9× |
| Ct Orbit/Ear/Fossa W/O&W/Dye (70482) | $692.50 | $2,582.20 | 3.9× |
| CT orbits w/o contrast (70480) | $670 | $2,047.60 | 6.4× |
| CT pelvis w&w/o contrast (72194) | $632.50 | $2,541 | 3.6× |
| CT pelvis w/o contrast (72192) | $695 | $2,007.50 | 6.6× |
| CT scan of leg combo (73702) | $707.50 | $2,133.10 | 4.0× |
| CT scans face/jaw combo (70488) | $722.50 | $2,582.20 | 4.1× |
| CT soft tissue neck w contrast (70491) | $732.50 | $2,158.90 | 4.2× |
| CT soft tissue neck w/o contrast (70490) | $685 | $2,116.70 | 6.5× |
| CT thoracic spine w contrast (72129) | $742.50 | $1,991 | 4.2× |
| CT thoracic spine w/o contrast (72128) | $695 | $1,651.10 | 6.6× |
| CT thoracic spine w/wo cont (72130) | $707.50 | $2,141.40 | 4.0× |
| CT thorax w/o contrast (71250) | $695 | $2,150.60 | 6.6× |
| CT upper ext wo (73200) | — | $2,358.70 | — |
| CT upper extremity with contrast (73201) | $697.50 | $2,482.30 | 2.0× |
| Cta Abdl Aorta&Bi Iliofem W/Contrast&Postp (75635) | — | $1,223.60 | — |
| Cta Abdomen (74175) range across 2 matching MRF lines |
$597.50 | $1,106.20–$2,688.30 | 3.4× |
| Dxa Bone Density Axial (77080) range across 3 matching MRF lines |
$90 | $33–$247.20 | 0.9× |
| Echo exam uterus (76831) | — | $558.30 | — |
| Esophagram (74220) | $210 | $447 | 1.2× |
| Fetal Biophys Profile W/Nst (76818) | — | $1,723.20 | — |
| Fetal Biophysical Profile W/O Non-Stress Testing (76819) range across 8 matching MRF lines |
$160 | $116.40–$869.30 | 1.5× |
| Fluoroscopy up to 1 hr (76000) range across 4 matching MRF lines |
— | $148.30–$621.10 | — |
| Foot 2 views (73620) range across 12 matching MRF lines |
— | $20.60–$408.90 | — |
| Forearm 2 views (73090) range across 12 matching MRF lines |
— | $29.90–$297.70 | — |
| Gastric emptying imaging study (78264) | — | $1,605.80 | — |
| Gated Heart Planar Single (78472) | — | $1,811.80 | — |
| Hand 2 views (73120) range across 10 matching MRF lines |
— | $25.80–$246.20 | — |
| Hepatobil Syst Image W/Drug (78227) | $460 | $1,443 | 0.8× |
| Hepatobiliary System Imaging (78226) | — | $1,799.40 | — |
| Ht Muscle Image Spect Sing (78451) range across 5 matching MRF lines |
— | $90.60–$1,129.90 | — |
| Hysterosalpingogram (74740) | — | $558.30 | — |
| Joint Survey Single View (77077) range across 2 matching MRF lines |
— | $40.20–$59.70 | — |
| K Flow/Funct Image W/Drug (78708) | — | $2,904.60 | — |
| K Flow/Funct Image W/O Drug (78707) | — | $1,691.30 | — |
| Knee 3 Views (73562) range across 15 matching MRF lines |
$130 | $25.80–$428.50 | 1.5× |
| Liver & Spleen Imaging W/Vascular Flow (78216) range across 2 matching MRF lines |
— | $104–$844.60 | — |
| Liver imaging w/vascular flow (78202) | — | $779.70 | — |
| Lung Ventilat&Perfus Imaging (78582) | — | $2,297.90 | — |
| Lung Ventilation Imaging (78579) | — | $726.20 | — |
| Lymph System Imaging (78195) | — | $1,862.20 | — |
| Magnetic Image Jaw Joint (70336) | — | $1,562.50 | — |
| Mammary ductogram or galactogram single (77053) | — | $1,366.80 | — |
| Meckels Divert Exam (78290) | — | $726.20 | — |
| MRA head w/o contrast (70544) | — | $2,165.10 | — |
| MRA neck w contrast (70548) | — | $2,331.90 | — |
| Mra Neck W/O &W/Contrast Material (70549) range across 2 matching MRF lines |
— | $1,081.50–$2,382.40 | — |
| MRA neck w/o contrast (70547) | — | $2,217.60 | — |
| MRI abdomen w/o contrast (74181) range across 2 matching MRF lines |
$705 | $2,290–$2,358.70 | 2.9× |
| MRI any jt lower extrem w/contrast material (73722) | $875 | $2,545.10 | 1.1× |
| MRI any jt lower extrem w/o & w/contrast matrl (73723) | $635 | $2,606.90 | 1.8× |
| MRI any jt upper extremity w/contrast matrl (73222) range across 6 matching MRF lines |
$875 | $1,985.80–$2,485.40 | 1.1× |
| MRI Breast W/O Contrast Bilateral (77047) | — | $2,234.10 | — |
| MRI Breast Without Contrast Material Unilateral (77046) | — | $1,737.60 | — |
| MRI cervical spine w contrast (72142) | $760 | $2,606.90 | 2.2× |
| MRI cervical spine w/o cont (72141) | $710 | $2,606.90 | 3.0× |
| MRI chest w/o contrast (71550) | $520 | $2,390.60 | 2.2× |
| MRI chest with contrast (71551) | $800 | $2,482.30 | 1.0× |
| MRI chest wo w contrast (71552) | $530 | $2,730.50 | 1.5× |
| MRI lower extrem oth/thn jt w/o & w/contr matr (73720) | $700 | $2,698.60 | 2.0× |
| MRI lower extrem oth/thn jt w/o contr matrl (73718) | $660 | $2,500.80 | 2.8× |
| MRI lumbar spine w contrast (72149) | $765 | $2,855.20 | 2.2× |
| Mri Neck Spine W/O & W/Dye (72156) | $730 | $2,855.20 | 2.1× |
| MRI orbit face &/neck w/o contrast (70540) | $655 | $2,250.60 | 2.7× |
| Mri Orbt/Fac/Nck W/O &W/Dye (70543) | $695 | $2,858.30 | 2.0× |
| MRI pelvis w contrast (72196) | $765 | $2,234.10 | 2.2× |
| MRI pelvis w/o & w contrast (72197) | $705 | $2,381.40 | 2.0× |
| MRI pelvis w/o contrast (72195) range across 3 matching MRF lines |
$660 | $1,862.20–$2,300 | 2.8× |
| MRI thoracic spine w/o contrast (72146) | $710 | $2,482.30 | 3.0× |
| MRI upper extremity oth than jt w/o contr matrl (73218) | $555 | $2,358.70 | 2.3× |
| Mri Uppr Extremity W/O&W/Dye (73220) | $605 | $2,606.90 | 1.7× |
| MRI, abdomen, combo (74183) | $700 | $3,227 | 2.0× |
| MRI, dorsal spine combo (72157) | $730 | $2,855.20 | 2.1× |
| MRI, dorsal spine contrast (72147) | $760 | $2,667.70 | 2.2× |
| MRI, joint upper extrem (73221) | $690 | $2,423.60 | 2.9× |
| MRI, joint upper extrem combo (73223) | $635 | $2,698.60 | 1.8× |
| MRI, lumbar spine combo (72158) | $730 | $3,103.40 | 2.1× |
| Myelogram cervical (72240) | — | $151.40 | — |
| Myocardial Spect Multiple Studies (78452) range across 5 matching MRF lines |
— | $107.10–$4,028.30 | — |
| Neck soft tissue (70360) | — | $248.20 | — |
| Parathyroid Planar Imaging (78070) | — | $1,284.40 | — |
| Pelvis 1 or 2 views (72170) range across 5 matching MRF lines |
$210 | $33–$342 | 2.0× |
| PET image w/CT, full body (78816) range across 2 matching MRF lines |
— | $496.50–$5,647.50 | — |
| PET imaging CT attenuation skull base mid-thigh (78815) range across 2 matching MRF lines |
— | $496.50–$6,206.80 | — |
| Pulmonary Perfusion Imaging Particulate (78580) | — | $726.20 | — |
| Radex Abd Compl Aqt Abd W/S/E/D Views 1 View Ch (74022) range across 3 matching MRF lines |
— | $58.70–$694.20 | — |
| Radex abscess/fistula/sinus tract rs&i (76080) | — | $1,060.90 | — |
| Radex Ankle Complete Minimum 3 Views (73610) range across 12 matching MRF lines |
$110 | $21.60–$359.50 | 1.3× |
| Radex Calcaneus Minimum 2 Views (73650) range across 12 matching MRF lines |
— | $20.60–$256.50 | — |
| Radex elbow complete minimum 3 views (73080) range across 12 matching MRF lines |
— | $25.80–$384.20 | — |
| Radex Facial Bones Complete Minimum 3 Views (70150) | $100 | $434.70 | 1.0× |
| Radex fingr minimum 2 views (73140) range across 12 matching MRF lines |
— | $25.80–$248.20 | — |
| Radex foot complete minimum 3 views (73630) range across 12 matching MRF lines |
$115 | $21.60–$348.10 | 1.3× |
| Radex Hand Minimum 3 Views (73130) range across 14 matching MRF lines |
$110 | $33–$350.20 | 1.3× |
| Radex lower extremity infant minimum 2 views (73592) | — | $167.90 | — |
| Radex Mastoids Compl Minimum 3 Views PR Side (70130) | — | $311.10 | — |
| Radex Nasal Bones Complete Minimum 3 Views (70160) range across 3 matching MRF lines |
— | $33–$334.80 | — |
| Radex Ribs Unilateral 2 Views (71100) range across 13 matching MRF lines |
$115 | $33–$620.10 | 1.3× |
| Radex shoulder complete minimum 2 views (73030) range across 14 matching MRF lines |
$115 | $25.80–$427.50 | 1.3× |
| Radex Sinuses Paransl < 3 Views (70210) | — | $191.60 | — |
| Radex Spine 1 View Specify Level (72020) range across 3 matching MRF lines |
— | $39.10–$297.70 | — |
| Radex Sternum Minimum 2 Views (71120) range across 5 matching MRF lines |
$115 | $33–$322.40 | 1.3× |
| Radex Temporomandble Jt Opn & Clsd Mouth Bilat (70330) | — | $328.60 | — |
| Radex Toe Minimum 2 Views (73660) range across 10 matching MRF lines |
— | $15.50–$208.10 | — |
| Radex upper extremity infant minimum 2 views (73092) range across 9 matching MRF lines |
— | $25.80–$167.90 | — |
| Radex Wrist Complete Minimum 3 Views (73110) range across 12 matching MRF lines |
$105 | $33–$334.80 | 1.2× |
| Radiolog exam mandible compl minimum 4 views (70110) range across 3 matching MRF lines |
— | $62.80–$340.90 | — |
| Radiologic exam colon double contrast study (74280) | — | $762.20 | — |
| Radiologic exam colon single contrast study (74270) | — | $621.10 | — |
| Radiologic exam knee complete 4/more views (73564) range across 12 matching MRF lines |
$205 | $39.10–$434.70 | 2.0× |
| Radiologic Exam Small Int Single Contrast Study (74250) | — | $682.90 | — |
| Radiologic exam swallow function contrast study (74230) | — | $402.70 | — |
| Radiologic exam upr gi trc double contrast study (74246) range across 2 matching MRF lines |
— | $560.30–$1,009.40 | — |
| Radiologic examination femur minimum 2 views (73552) range across 12 matching MRF lines |
— | $22.70–$1,340 | — |
| Radiologic examination knee 1/2 views (73560) range across 12 matching MRF lines |
$115 | $33–$322.40 | 1.3× |
| Radiologic Examination Osseous Survey Limited (77074) | — | $473.80 | — |
| Radiologic examination tibia & fibula 2 views (73590) range across 12 matching MRF lines |
— | $33–$340.90 | — |
| Rp Loclzj Tum Spect 1 Area Single Day Imaging (78803) | — | $1,647 | — |
| Scapula (73010) range across 8 matching MRF lines |
— | $25.80–$324.50 | — |
| Screening Digital Breast Tomosynthesis Bi (77063) range across 6 matching MRF lines |
— | $96.80–$99.90 | — |
| Shoulder 1 view (73020) range across 12 matching MRF lines |
— | $25.80–$479 | — |
| Shoulder Arthrography (73040) | — | $772.50 | — |
| Sialogram (70390) range across 2 matching MRF lines |
— | $185.40–$440.80 | — |
| Skull less than 4 views (70250) | — | $311.10 | — |
| Spleen Imaging (78185) | — | $713.80 | — |
| Sternoclavicular joints (71130) range across 5 matching MRF lines |
— | $33–$248.20 | — |
| Thoracic spine 2 views (72070) range across 5 matching MRF lines |
$145 | $33–$384.20 | 1.4× |
| Thoracic spine 3 views (72072) range across 3 matching MRF lines |
— | $39.10–$542.80 | — |
| Thyroid Imaging With Vascular Flow (78013) | — | $899.20 | — |
| Thyroid Uptake Measurement (78012) | — | $728.20 | — |
| Thyroid Uptake W/Blood Flow Sngle/Mult Quan Meas (78014) | — | $2,242.30 | — |
| Ultrasound Breast Limited (76642) range across 8 matching MRF lines |
$100 | $69–$916.70 | 1.1× |
| Ultrasound Exam Aaa Screen (76706) | — | $918.80 | — |
| Ultrasound, abdomen limited (76705) range across 7 matching MRF lines |
$225 | $185–$1,241.20 | 2.1× |
| Unlisted us procedure (76999) | — | $500.60 | — |
| Upper gi w/o kub (74240) range across 2 matching MRF lines |
— | $628.30–$869.30 | — |
| Ureteral Reflux Study (78740) range across 2 matching MRF lines |
— | $99.90–$849.80 | — |
| Urethrocystogram voiding (74455) | — | $558.30 | — |
| Urethrocystography retrograde (74450) | — | $466.60 | — |
| Us breast unilateral complete (76641) range across 8 matching MRF lines |
$220 | $69–$990.90 | 2.1× |
| Us chest (76604) | — | $430.50 | — |
| Us complete joint (76881) range across 8 matching MRF lines |
— | $106.10–$714.80 | — |
| Us exam, pelvic, limited (76857) range across 4 matching MRF lines |
— | $271–$402.70 | — |
| Us lmtd joint/oth nonvasc xtr strux r-t w/img (76882) range across 2 matching MRF lines |
— | $25.80–$62.80 | — |
| Us ob limited 1 or more fetuses (76815) range across 15 matching MRF lines |
$160 | $93.70–$496.50 | 1.5× |
| Us ob transvaginal (76817) range across 8 matching MRF lines |
— | $113.30–$621.10 | — |
| Us pelvic non ob complete (76856) range across 7 matching MRF lines |
$100 | $215–$869.30 | 1.0× |
| Us pg uter img f&mat 14 wk tabdl 1/1st gestation (76801) range across 8 matching MRF lines |
$160 | $146.30–$869.30 | 1.5× |
| Us preg uterus real time f/u trnsabdl per fetus (76816) range across 3 matching MRF lines |
— | $127.70–$434.70 | — |
| Us retroperitoneal complete (76770) range across 2 matching MRF lines |
$255 | $919.80–$1,862.20 | 2.4× |
| Us retroperitoneal limited (76775) range across 2 matching MRF lines |
$300 | $918.80–$1,241.20 | 2.9× |
| Us scrotum and contents (76870) | — | $731.30 | — |
| Us spinal canal and contents (76800) | — | $434.70 | — |
| Us thyroid (76536) | $240 | $682.90 | 2.3× |
| Us transrectal (76872) range across 2 matching MRF lines |
— | $111.20–$281.20 | — |
| Wrist 2 views (73100) range across 10 matching MRF lines |
— | $25.80–$248.20 | — |
| X-Ray Ac Jts - Xr Acromioclavicular Joints Bilateral (73050) range across 5 matching MRF lines |
— | $37.10–$447 | — |
| X-ray antegrade pyelogram tube (74425) | — | $590.20 | — |
| X-Ray Aorta Leg Arteries (75630) | — | $489.30 | — |
| X-Ray Elbow 2 Vw - Xr Elbow 1-2 Views Right (73070) range across 10 matching MRF lines |
— | $25.80–$343 | — |
| X-Ray Exam Breast Specimen (76098) | — | $226.60 | — |
| X-Ray Exam Entire Spi 2/3 Vw (72082) | $110 | $320.30 | 1.1× |
| X-Ray Exam Hip Uni 1 View (73501) range across 6 matching MRF lines |
— | $48.40–$280.20 | — |
| X-Ray Exam Hip Uni 2-3 Views (73502) range across 16 matching MRF lines |
$100 | $30.90–$457.30 | 1.1× |
| X-Ray Exam Hip Uni 4/> Views (73503) range across 4 matching MRF lines |
— | $30.90–$86.50 | — |
| X-Ray Exam Hips Bi 2 Views (73521) range across 3 matching MRF lines |
$200 | $34–$402.70 | 1.9× |
| X-Ray Exam L-S Spine Bending (72114) | — | $775.60 | — |
| X-Ray Exam Neck Spine 2-3 Vw (72040) range across 5 matching MRF lines |
$90 | $29.90–$372.90 | 1.0× |
| X-Ray Exam Neck Spine 6/>Vws (72052) range across 3 matching MRF lines |
— | $67–$752.90 | — |
| X-Ray Exam Unilat Ribs/Chest (71101) range across 6 matching MRF lines |
— | $48.40–$545.90 | — |
| X-ray humerus (73060) range across 10 matching MRF lines |
— | $25.80–$322.40 | — |
| X-ray IV pyelogram (ivp) (74400) | — | $682.90 | — |
| X-ray IV pyelogram+tomography (74415) | — | $881.70 | — |
| X-Ray Knee Bilat Standing - Xr Knees Anteroposterior Standing Bilat (73565) range across 3 matching MRF lines |
— | $29.90–$116.40 | — |
| X-Ray Lumbar Spine 2/3 Vw - Xr Lumbar Spine 2-3 Views (72100) range across 5 matching MRF lines |
$160 | $33–$469.70 | 1.5× |
| X-Ray Ribs, Chest 4+ Vw - Xr Ribs 3 Vws Bil W/ Chest Posteroanterior (71111) range across 3 matching MRF lines |
— | $73.10–$726.20 | — |
| X-Ray Sacroiliac Jts <3 Vw - Xr Sacroiliac Joints 1-2 Views (72200) | — | $322.40 | — |
| X-Ray Sacrum/Coccyx 2+ Vw - Xr Sacrum Coccyx 2+ Views (72220) range across 5 matching MRF lines |
— | $33–$347.10 | — |
| X-Ray Sinuses 3+ Vw - Xr Paranasal Sinuses 3+ Views (70220) range across 3 matching MRF lines |
— | $38.10–$385.20 | — |
| X-Ray Skull 4+ Vw - Xr Skull Complete 4+ Views (70260) | — | $447 | — |
| X-ray thoracic spine 4 vw (72074) | — | $639.60 | — |
| X-Ray Urinary Tract Exam With Contrast Material (74420) | — | $527.40 | — |
| X-Rays Bone Length Studies (77073) | — | $167.90 | — |
| Xr c-spine 4 or 5 views (72050) range across 6 matching MRF lines |
$135 | $39.10–$597.40 | 1.3× |
| Xr facial bones less than 3 views (70140) | — | $280.20 | — |
| Xr orbits complete 4 views (70200) range across 3 matching MRF lines |
— | $50.50–$434.70 | — |
| Xr Tomogram Single Plane (76100) | — | $217.30 | — |
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.