Imaging prices at White Rock Medical Center
Dallas, TX · every code in this section with a posted price and a Medicare benchmark.
274 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) | $502.52 | $739 | 5.7× |
| Abdomen 2 views (74019) | $549.44 | $808 | 5.2× |
| Acute Gastrointestinal Blood Loss Imaging (78278) | $731 | $1,075 | 1.8× |
| Angio internal mammary (75756) | $1,979.48 | $2,911 | 0.6× |
| Angio pulmonary bilat (75743) | $3,158.60 | $4,645 | 1.0× |
| Angiography extremity bilateral rs&i (75716) | $3,952.84 | $5,813 | 1.2× |
| Angiography extremity unilateral rs&i (75710) | $3,242.24 | $4,768 | 1.0× |
| Angrph pulmonary nonslctv cath/ven njx rs&i (75746) | $3,158.60 | $4,645 | 1.0× |
| Ankle 2 views (73600) | $365.16 | $537 | 4.2× |
| Aortography thoracic serialography rs&i (75605) | $2,979.76 | $4,382 | 0.5× |
| Artery X-Rays Abdomen (75726) | $2,990.64 | $4,398 | 0.5× |
| Artery X-Rays Pelvis (75736) | $5,406.68 | $7,951 | 1.0× |
| Arthrogram hip (73525) | $379.44 | $558 | 1.1× |
| Arthrogram Wrist (73115) | $609.28 | $896 | 1.7× |
| Bone age studies (77072) | $410.72 | $604 | 3.9× |
| Bone Imaging 3 Phase (78315) | $1,939.36 | $2,852 | 4.8× |
| Bone Imaging Limited Area (78300) | $771.12 | $1,134 | 1.9× |
| Bone Imaging Whole Body (78306) | $1,504.16 | $2,212 | 3.7× |
| Bone marrow imaging limited area (78102) | $1,199.52 | $1,764 | 3.0× |
| Bone marrow imaging; whole body (78104) | $1,345.04 | $1,978 | 3.3× |
| Bone survey infant (77076) | $339.32 | $499 | 3.2× |
| Brain imaging < 4 static views (78600) | $760.24 | $1,118 | 1.9× |
| Cat Scan Follow-Up Study (76380) | $756.84 | $1,113 | 8.7× |
| Cerebrospinal Fluid Scan (78630) | $852.72 | $1,254 | 1.6× |
| Chest 1 view (71045) | $451.52 | $664 | 5.2× |
| Chest 2 views (71046) | $472.60 | $695 | 5.4× |
| Chest 3 views (71047) | $488.24 | $718 | 5.6× |
| Chest 4 or more views (71048) | $521.56 | $767 | 5.0× |
| Clavicle complete (73000) | $314.84 | $463 | 3.6× |
| Computed Tomography Thorax Lw Dose Lng Ca Scr C- (71271) | $289.24 | $425.36 | 2.8× |
| Contrast Exam Abdominl Aorta (75625) | $16,205.60 | $23,831.76 | 5.1× |
| Contrast X-Ray Bladder (74430) | $497.76 | $732 | 1.4× |
| Contrast X-Ray Of Knee Joint (73580) | $617.44 | $908 | 1.8× |
| Contrast Xray Throat/Cerv Esopha (74210) | $578.68 | $851 | 3.3× |
| CT abdomen and pelvis without and with contrast (74178) | $6,404.92 | $9,419 | 18.3× |
| CT abdomen and pelvis without contrast (74176) | $5,303.32 | $7,799 | 22.1× |
| CT abdomen w contrast (74160) | $3,509.48 | $5,161 | 19.9× |
| CT abdomen w wo contrast (74170) | $4,329.56 | $6,367 | 24.6× |
| CT abdomen w/o contrast (74150) | $2,822 | $4,150 | 26.9× |
| CT Angio Abdomen and Pelvis (74174) | $8,774.04 | $12,903 | 25.0× |
| CT Angio Chest (71275) | $4,998.68 | $7,351 | 28.4× |
| CT Angio Head (70496) | $4,727.36 | $6,952 | 26.8× |
| CT angio hrt w/3d image (75574) | $941.80 | $1,385 | 2.7× |
| Ct Angio Lwr Extr W/O&W/Dye (73706) | $4,156.16 | $6,112 | 23.6× |
| CT Angio Neck (70498) | $5,971.76 | $8,782 | 33.9× |
| Ct Angio Upr Extrm W/O&W/Dye (73206) | $3,980.72 | $5,854 | 22.6× |
| CT cervical spine w/ contrast (72126) | $4,380.56 | $6,442 | 12.5× |
| CT cervical spine w/o contrast (72125) | $4,022.88 | $5,916 | 38.3× |
| CT cervical spine w/wo cont (72127) | $484.21 | $712.08 | 2.7× |
| CT chest w contrast (71260) | $3,493.84 | $5,138 | 19.8× |
| CT chest w/wo contrast (71270) | $4,192.20 | $6,165 | 23.8× |
| CT head/brain with contrast (70460) | $4,135.76 | $6,082 | 23.5× |
| CT head/brain without and with contrast (70470) | $5,917.36 | $8,702 | 33.6× |
| CT heart contrast eval cardiac structure&morph (75572) | $1,186 | $1,744.12 | 3.4× |
| CT heart no contrast quant eval coronry calcium (75571) | $102.68 | $151 | 1.2× |
| CT iac w contrast (70481) | $2,945.76 | $4,332 | 16.7× |
| CT l-spine w&w/o contrast (72133) | $4,711.04 | $6,928 | 26.7× |
| CT lower ext w/o (73700) | $2,220.88 | $3,266 | 21.1× |
| CT lower extremity w/contrast material (73701) | $2,581.96 | $3,797 | 14.7× |
| CT lumbar spine w contrast (72132) | $4,486.64 | $6,598 | 12.8× |
| CT lumbar spine w/o contrast (72131) | $3,481.60 | $5,120 | 33.2× |
| CT maxillofacial w contrast (70487) | $2,774.40 | $4,080 | 15.7× |
| CT maxillofacial wo contrast (70486) | $2,438.48 | $3,586 | 23.2× |
| CT neck tissue combo (70492) | $5,687.52 | $8,364 | 32.3× |
| Ct Orbit/Ear/Fossa W/O&W/Dye (70482) | $3,695.80 | $5,435 | 21.0× |
| CT orbits w/o contrast (70480) | $2,225.64 | $3,273 | 21.2× |
| CT pelvis w&w/o contrast (72194) | $3,240.20 | $4,765 | 18.4× |
| CT pelvis w/o contrast (72192) | $2,569.04 | $3,778 | 24.5× |
| CT scans face/jaw combo (70488) | $3,516.28 | $5,171 | 20.0× |
| CT soft tissue neck w contrast (70491) | $4,811.68 | $7,076 | 27.3× |
| CT soft tissue neck w/o contrast (70490) | $4,051.44 | $5,958 | 38.6× |
| CT thoracic spine w contrast (72129) | $2,278 | $3,350 | 12.9× |
| CT thoracic spine w/o contrast (72128) | $1,633.36 | $2,402 | 15.6× |
| CT thoracic spine w/wo cont (72130) | $484.21 | $712.08 | 2.7× |
| CT thorax w/o contrast (71250) | $2,771 | $4,075 | 26.4× |
| CT upper ext wo (73200) | $1,215.84 | $1,788 | 11.6× |
| CT upper extremity w/o & w/contrast material (73202) | $2,276.64 | $3,348 | 12.9× |
| CT upper extremity with contrast (73201) | $2,252.16 | $3,312 | 6.4× |
| Cta Abdl Aorta&Bi Iliofem W/Contrast&Postp (75635) | $3,704.64 | $5,448 | 21.0× |
| Cta Abdomen (74175) | $4,459.44 | $6,558 | 25.3× |
| CTA pelvis (72191) | $3,402.04 | $5,003 | 19.3× |
| Diskography lumbar (72295) | $6,097.25 | $8,966.55 | 3.1× |
| Dxa Bone Density Axial (77080) | $346.80 | $510 | 3.3× |
| Dxa bone density study (77085) | $365.84 | $538 | 3.5× |
| Dxa bone density study 1/>sites appendiclr skel (77081) | $186.32 | $274 | 2.1× |
| Echo exam of fetal heart (76825) | $764.32 | $1,124 | 1.4× |
| Echo exam uterus (76831) | $1,163.48 | $1,711 | 4.9× |
| Echo Guide For Artery Repair (76936) | $743.92 | $1,094 | 3.4× |
| Esophagram (74220) | $429.08 | $631 | 2.4× |
| Fetal Biophys Profile W/Nst (76818) | $688.16 | $1,012 | 6.6× |
| Fetal Biophysical Profile W/O Non-Stress Testing (76819) | $369.24 | $543 | 3.5× |
| Fluoroscopy up to 1 hr (76000) range across 3 matching MRF lines |
$326.40–$703.12 | $480–$1,034 | varies |
| Follow-Up Angiography (75898) | $1,623.16 | $2,387 | 0.5× |
| Foot 2 views (73620) | $365.16 | $537 | 4.2× |
| Forearm 2 views (73090) | $363.80 | $535 | 4.2× |
| Gastric emptying imaging study (78264) | $1,521.16 | $2,237 | 3.8× |
| Gated Heart Planar Single (78472) | $1,190.68 | $1,751 | 3.0× |
| Hand 2 views (73120) | $522.24 | $768 | 5.0× |
| Hepatobil Syst Image W/Drug (78227) | $2,338.52 | $3,439 | 4.3× |
| Hepatobiliary System Imaging (78226) | $1,838.72 | $2,704 | 4.6× |
| Ht Muscle Image Spect Sing (78451) | $2,924.68 | $4,301 | 2.2× |
| Hysterosalpingogram (74740) | $558.28 | $821 | 2.3× |
| K Flow/Funct Image Multiple (78709) | $1,206.32 | $1,774 | 2.2× |
| K Flow/Funct Image W/O Drug (78707) | $815.32 | $1,199 | 1.5× |
| Knee 3 Views (73562) | $497.76 | $732 | 5.7× |
| Liver & Spleen Imaging Static Only (78215) | $1,559.24 | $2,293 | 3.9× |
| Liver imaging static only (78201) | $1,533.40 | $2,255 | 2.8× |
| Liver imaging w/vascular flow (78202) | $1,689.80 | $2,485 | 3.1× |
| Lung Ventilat&Perfus Imaging (78582) | $1,595.28 | $2,346 | 2.9× |
| Lung Ventilation Imaging (78579) | $1,429.36 | $2,102 | 3.6× |
| Lymph System Imaging (78195) | $1,437.52 | $2,114 | 2.6× |
| Magnetic Image Jaw Joint (70336) | $1,948.88 | $2,866 | 8.1× |
| Meckels Divert Exam (78290) | $510 | $750 | 1.3× |
| MRA head w/o contrast (70544) | $3,901.16 | $5,737 | 16.3× |
| MRA head with contrast (70545) | $4,291.48 | $6,311 | 12.2× |
| MRA neck w contrast (70548) | $4,291.48 | $6,311 | 12.2× |
| Mra Neck W/O &W/Contrast Material (70549) | $4,506.36 | $6,627 | 12.9× |
| MRA neck w/o contrast (70547) | $3,901.16 | $5,737 | 16.3× |
| MRI abdomen w/o contrast (74181) | $4,464.88 | $6,566 | 18.6× |
| MRI any jt lower extrem w/contrast material (73722) | $3,009 | $4,425 | 3.8× |
| MRI any jt lower extrem w/o & w/contrast matrl (73723) | $3,635.96 | $5,347 | 10.4× |
| MRI any jt upper extremity w/contrast matrl (73222) | $2,530.96 | $3,722 | 3.2× |
| MRI cervical spine w/o cont (72141) | $4,451.28 | $6,546 | 18.6× |
| MRI chest w/o contrast (71550) | $2,936.92 | $4,319 | 12.3× |
| MRI chest wo w contrast (71552) | $4,001.12 | $5,884 | 11.4× |
| MRI lower extrem oth/thn jt w/o & w/contr matr (73720) | $3,106.24 | $4,568 | 8.9× |
| MRI lower extrem oth/thn jt w/o contr matrl (73718) | $2,471.80 | $3,635 | 10.3× |
| MRI lumbar spine w contrast (72149) | $1,201.07 | $1,766.28 | 3.4× |
| Mri Neck Spine W/O & W/Dye (72156) | $7,215.48 | $10,611 | 20.6× |
| MRI orbit face &/neck w/o contrast (70540) | $2,465 | $3,625 | 10.3× |
| Mri Orbt/Fac/Nck W/O &W/Dye (70543) | $5,141.48 | $7,561 | 14.7× |
| MRI pelvis w contrast (72196) | $3,923.60 | $5,770 | 11.2× |
| MRI pelvis w/o & w contrast (72197) | $4,914.36 | $7,227 | 14.0× |
| MRI pelvis w/o contrast (72195) | $3,725.04 | $5,478 | 15.5× |
| MRI thoracic spine w/o contrast (72146) | $4,242.52 | $6,239 | 17.7× |
| MRI upper extremity oth than jt w/contr matrl (73219) | $2,691.44 | $3,958 | 7.7× |
| MRI upper extremity oth than jt w/o contr matrl (73218) | $2,530.96 | $3,722 | 10.6× |
| Mri Uppr Extremity W/O&W/Dye (73220) | $3,133.44 | $4,608 | 8.9× |
| MRI, abdomen, combo (74183) | $4,862.68 | $7,151 | 13.9× |
| MRI, dorsal spine combo (72157) | $6,876.84 | $10,113 | 19.6× |
| MRI, joint upper extrem (73221) | $2,278 | $3,350 | 9.5× |
| MRI, joint upper extrem combo (73223) | $2,657.44 | $3,908 | 7.6× |
| MRI, lumbar spine combo (72158) | $6,876.84 | $10,113 | 19.6× |
| Myelogram cervical (72240) | $1,541.56 | $2,267 | 2.0× |
| Myelogram Lumbar (72265) | $1,505.52 | $2,214 | 1.9× |
| Myelography thoracic (72255) | $1,570.12 | $2,309 | 2.0× |
| Myelograpy 2/more regions rs&i (72270) | $2,169.20 | $3,190 | 2.8× |
| Myocardial Spect Multiple Studies (78452) | $5,013.64 | $7,373 | 3.9× |
| Neck soft tissue (70360) | $453.56 | $667 | 5.2× |
| Nonvascular Shunt X-Ray (75809) | $436.07 | $641.28 | 4.2× |
| Nuclear Rx Oral Admin (79005) | $1,196.80 | $1,760 | 5.1× |
| Parathyroid Planar Imaging (78070) | $1,238.96 | $1,822 | 3.1× |
| Parathyroid planar imaging w/wo subtraction (78071) | $1,392.64 | $2,048 | 3.5× |
| Pelvis 1 or 2 views (72170) | $371.28 | $546 | 3.5× |
| Prq Transhepatc Portograpy Hemodyn Eval Rs&I (75885) | $2,948.48 | $4,336 | 0.9× |
| Pulmonary Perfusion Imaging Particulate (78580) | $1,531.36 | $2,252 | 3.8× |
| Radex Abd Compl Aqt Abd W/S/E/D Views 1 View Ch (74022) | $562.36 | $827 | 5.4× |
| Radex abscess/fistula/sinus tract rs&i (76080) | $477.36 | $702 | 0.9× |
| Radex Ankle Complete Minimum 3 Views (73610) | $413.44 | $608 | 4.7× |
| Radex Calcaneus Minimum 2 Views (73650) | $208.76 | $307 | 2.4× |
| Radex elbow complete minimum 3 views (73080) | $451.52 | $664 | 5.2× |
| Radex Facial Bones Complete Minimum 3 Views (70150) | $259.08 | $381 | 2.5× |
| Radex fingr minimum 2 views (73140) | $330.48 | $486 | 3.8× |
| Radex foot complete minimum 3 views (73630) | $413.44 | $608 | 4.7× |
| Radex Hand Minimum 3 Views (73130) | $552.84 | $813 | 6.3× |
| Radex lower extremity infant minimum 2 views (73592) | $376.04 | $553 | 4.3× |
| Radex Nasal Bones Complete Minimum 3 Views (70160) | $263.16 | $387 | 3.0× |
| Radex Ribs Unilateral 2 Views (71100) | $494.36 | $727 | 5.7× |
| Radex shoulder complete minimum 2 views (73030) | $424.32 | $624 | 4.9× |
| Radex Sinuses Paransl < 3 Views (70210) | $131.24 | $193 | 1.5× |
| Radex sm int w/mlt srl imges via enteroclss tube (74251) | $606.56 | $892 | 3.4× |
| Radex Spine 1 View Specify Level (72020) | $247.52 | $364 | 2.8× |
| Radex Sternum Minimum 2 Views (71120) | $192.44 | $283 | 2.2× |
| Radex Temporomandble Jt Opn & Clsd Mouth Bilat (70330) | $413.44 | $608 | 4.7× |
| Radex Toe Minimum 2 Views (73660) | $344.08 | $506 | 3.9× |
| Radex upper extremity infant minimum 2 views (73092) | $376.04 | $553 | 3.6× |
| Radex Wrist Complete Minimum 3 Views (73110) | $363.80 | $535 | 4.2× |
| Radex X-Ray Exam Entire Spi 6/> Vw - Xr Entire Spine 6+ Vw (72084) | $641.92 | $944 | 6.1× |
| Radiolog exam mandible compl minimum 4 views (70110) | $231.88 | $341 | 2.2× |
| Radiologic Exam Abdomen 3+ Views - Xr Abdomen 3+ Views (74021) | $556.92 | $819 | 5.3× |
| Radiologic exam colon double contrast study (74280) | $606.56 | $892 | 3.4× |
| Radiologic exam colon single contrast study (74270) | $529.72 | $779 | 3.0× |
| Radiologic exam knee complete 4/more views (73564) | $555.56 | $817 | 5.3× |
| Radiologic exam pelvis compl minimum 3 views (72190) | $410.04 | $603 | 3.9× |
| Radiologic Exam Small Int Single Contrast Study (74250) | $465.80 | $685 | 2.6× |
| Radiologic exam swallow function contrast study (74230) | $535.84 | $788 | 3.0× |
| Radiologic exam upr gi trc double contrast study (74246) | $924.12 | $1,359 | 5.2× |
| Radiologic examination femur 1 view (73551) | $223.72 | $329 | 2.6× |
| Radiologic examination femur minimum 2 views (73552) | $426.36 | $627 | 4.9× |
| Radiologic examination knee 1/2 views (73560) | $484.16 | $712 | 5.5× |
| Radiologic Examination Osseous Survey Limited (77074) | $307.36 | $452 | 2.9× |
| Radiologic examination tibia & fibula 2 views (73590) | $363.80 | $535 | 4.2× |
| Renal Cyst Study (74470) | $778.60 | $1,145 | 1.4× |
| Ribs bilateral 3 views (71110) | $612 | $900 | 5.8× |
| Rp loclzj tum plnr 1 area single day imaging (78800) | $1,288.60 | $1,895 | 3.2× |
| Rp loclzj tum plnr 2+area 1+d img/1 area img>2+d (78801) | $1,395.36 | $2,052 | 3.5× |
| Rp Loclzj Tum Plnr Whole Body 2+ Days Imaging (78804) | $2,746.52 | $4,039 | 5.0× |
| Rp Loclzj Tum Plnr Whole Body Single Day Imaging (78802) | $1,578.28 | $2,321 | 2.9× |
| Scapula (73010) | $259.76 | $382 | 2.5× |
| Screening Digital Breast Tomosynthesis Bi (77063) | $44.88 | $66 | 1.9× |
| Shoulder 1 view (73020) | $344.76 | $507 | 3.9× |
| Shoulder Arthrography (73040) | $463.08 | $681 | 1.3× |
| Skull less than 4 views (70250) | $301.24 | $443 | 2.9× |
| Speech evaluation, complex (70371) | $488.92 | $719 | 2.0× |
| Thoracic spine 2 views (72070) | $574.60 | $845 | 5.5× |
| Thoracic spine 3 views (72072) | $574.60 | $845 | 5.5× |
| Thoracolumbar 2 views (72080) | $228.48 | $336 | 2.6× |
| Thyroid Carcinoma Metastases Img Lmtd Area (78015) | $1,367.48 | $2,011 | 3.4× |
| Thyroid Imaging With Vascular Flow (78013) | $697.68 | $1,026 | 1.7× |
| Thyroid Met Imaging Body (78018) | $1,504.16 | $2,212 | 2.8× |
| Thyroid Uptake Measurement (78012) | $775.20 | $1,140 | 1.9× |
| Ultrasound Breast Limited (76642) | $352.92 | $519 | 4.0× |
| Ultrasound, abdomen limited (76705) | $840.48 | $1,236 | 8.0× |
| Upper gi w/o kub (74240) | $667.08 | $981 | 3.8× |
| Ureteral Reflux Study (78740) | $1,215.16 | $1,787 | 3.0× |
| Urethrocystogram voiding (74455) | $466.48 | $686 | 1.9× |
| Urethrocystography retrograde (74450) | $718.76 | $1,057 | 3.0× |
| Us breast unilateral complete (76641) | $400.52 | $589 | 3.8× |
| Us chest (76604) | $320.28 | $471 | 3.0× |
| Us complete joint (76881) | $662.32 | $974 | 6.3× |
| Us exam, pelvic, limited (76857) | $416.84 | $613 | 4.0× |
| Us head (76506) | $422.96 | $622 | 4.0× |
| Us lmtd joint/oth nonvasc xtr strux r-t w/img (76882) | $573.92 | $844 | 5.5× |
| Us ob detailed single fetus (76811) | $938.40 | $1,380 | 3.9× |
| Us ob limited 1 or more fetuses (76815) | $405.28 | $596 | 3.9× |
| Us ob transvaginal (76817) | $206.04 | $303 | 2.0× |
| Us pelvic non ob complete (76856) | $1,008.44 | $1,483 | 9.6× |
| Us pg uter img f&mat 14 wk tabdl 1/1st gestation (76801) | $1,092.08 | $1,606 | 10.4× |
| Us preg uterus real time f/u trnsabdl per fetus (76816) | $517.48 | $761 | 4.9× |
| Us retroperitoneal complete (76770) | $1,054.68 | $1,551 | 10.0× |
| Us retroperitoneal limited (76775) | $289.24 | $425.36 | 2.8× |
| Us scrotum and contents (76870) | $843.88 | $1,241 | 8.0× |
| Us spinal canal and contents (76800) | $478.72 | $704 | 4.6× |
| Us thyroid (76536) | $768.40 | $1,130 | 7.3× |
| Us transrectal (76872) | $318.92 | $469 | 3.0× |
| Vein X-Ray Chest (75827) | $1,719.72 | $2,529 | 1.1× |
| Venography caval inferior serialography rs&i (75825) | $2,283.44 | $3,358 | 0.7× |
| Venography extremity bilateral rs&i (75822) | $1,224 | $1,800 | 0.8× |
| Venography extremity unilateral rs&i (75820) | $984.64 | $1,448 | 0.6× |
| Wrist 2 views (73100) | $316.20 | $465 | 3.6× |
| X-Ray Ac Jts - Xr Acromioclavicular Joints Bilateral (73050) | $476.68 | $701 | 5.5× |
| X-ray antegrade pyelogram tube (74425) | $294.44 | $433 | 0.8× |
| X-Ray Aorta Leg Arteries (75630) | $3,384.36 | $4,977 | 1.1× |
| X-Ray Bend Only L-S Spine (72120) | $461.04 | $678 | 4.4× |
| X-Ray Elbow 2 Vw - Xr Elbow 1-2 Views Right (73070) | $403.92 | $594 | 4.6× |
| X-Ray Exam Breast Specimen (76098) | $226.44 | $333 | 0.4× |
| X-Ray Exam Entire Spi 1 Vw (72081) | $207.40 | $305 | 2.4× |
| X-Ray Exam Entire Spi 2/3 Vw (72082) | $363.80 | $535 | 3.5× |
| X-Ray Exam Entire Spi 4/5 Vw (72083) | $458.32 | $674 | 4.4× |
| X-Ray Exam Hip Uni 1 View (73501) | $360.40 | $530 | 4.1× |
| X-Ray Exam Hip Uni 2-3 Views (73502) | $420.24 | $618 | 4.8× |
| X-Ray Exam Hip Uni 4/> Views (73503) | $289.24 | $425.36 | 2.8× |
| X-Ray Exam Hips Bi 2 Views (73521) | $504.56 | $742 | 4.8× |
| X-Ray Exam Hips Bi 3-4 Views (73522) | $539.92 | $794 | 5.1× |
| X-Ray Exam L-S Spine Bending (72114) | $769.08 | $1,131 | 7.3× |
| X-Ray Exam Neck Spine 2-3 Vw (72040) | $387.60 | $570 | 4.4× |
| X-Ray Exam Neck Spine 6/>Vws (72052) | $526.32 | $774 | 5.0× |
| X-Ray Exam Unilat Ribs/Chest (71101) | $284.92 | $419 | 2.7× |
| X-ray humerus (73060) | $361.76 | $532 | 4.1× |
| X-ray IV pyelogram (ivp) (74400) | $707.88 | $1,041 | 4.0× |
| X-Ray Jaw <4 Vw - Xr Mandible < 4 Views (70100) | $137.36 | $202 | 1.6× |
| X-Ray Lumbar Spine 2/3 Vw - Xr Lumbar Spine 2-3 Views (72100) | $605.20 | $890 | 5.8× |
| X-ray nose-rectum child f.b. (76010) | $272.68 | $401 | 3.1× |
| X-Ray Sacroiliac Jts 3+ Vw - Xr Sacroiliac Joints 3+ Views (72202) | $163.88 | $241 | 1.6× |
| X-Ray Sacrum/Coccyx 2+ Vw - Xr Sacrum Coccyx 2+ Views (72220) | $233.92 | $344 | 2.7× |
| X-Ray Sinuses 3+ Vw - Xr Paranasal Sinuses 3+ Views (70220) | $294.44 | $433 | 3.4× |
| X-Ray Skull 4+ Vw - Xr Skull Complete 4+ Views (70260) | $433.16 | $637 | 4.1× |
| X-ray thoracic spine 4 vw (72074) | $284.92 | $419 | 2.7× |
| X-Ray Urinary Tract Exam With Contrast Material (74420) | $553.52 | $814 | 1.6× |
| X-Rays Bone Survey Complete (77075) | $323 | $475 | 3.1× |
| Xr c-spine 4 or 5 views (72050) | $465.80 | $685 | 4.4× |
| Xr facial bones less than 3 views (70140) | $214.20 | $315 | 2.5× |
| XR Mastoids < 3 Views Bilateral (70120) | $325.04 | $478 | 3.1× |
| Xr orbits complete 4 views (70200) | $237.32 | $349 | 2.3× |
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.