Imaging prices at Wyoming County Community Health System
Warsaw, NY · every code in this section with a posted price and a Medicare benchmark.
262 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) | $183.51 | $262.15 | 1.7× |
| Abdomen 2 views (74019) | $222.02 | $317.17 | 1.7× |
| Acute Gastrointestinal Blood Loss Imaging (78278) | $832.90 | $1,189.85 | 1.7× |
| Ankle 2 views (73600) | $183.51 | $262.15 | 1.7× |
| Arthrogram hip (73525) | $776.63 | $1,109.47 | 1.8× |
| Bone age studies (77072) | $222.02 | $317.17 | 1.7× |
| Bone Imaging 3 Phase (78315) | $832.90 | $1,189.85 | 1.7× |
| Bone Imaging Limited Area (78300) | $832.90 | $1,189.85 | 1.7× |
| Bone Imaging Whole Body (78306) | $832.90 | $1,189.85 | 1.7× |
| Bone survey infant (77076) | $222.02 | $317.17 | 1.7× |
| Cat Scan Follow-Up Study (76380) | $602.10 | $860.14 | 5.5× |
| Chest 1 view (71045) | $183.51 | $262.15 | 1.7× |
| Chest 2 views (71046) | $183.51 | $262.15 | 1.7× |
| Chest 3 views (71047) | $183.51 | $262.15 | 1.7× |
| Chest 4 or more views (71048) | $222.02 | $317.17 | 1.7× |
| Clavicle complete (73000) | $183.51 | $262.15 | 1.7× |
| Computed Tomography Thorax Lw Dose Lng Ca Scr C- (71271) | $222.02 | $317.17 | 1.7× |
| Contrast X-Ray Bladder (74430) | $776.63 | $1,109.47 | 1.8× |
| Contrast X-Ray Of Knee Joint (73580) | $776.63 | $1,109.47 | 1.8× |
| CT abdomen and pelvis without and with contrast (74178) | $1,083.60 | $1,548 | 2.5× |
| CT abdomen and pelvis without contrast (74176) range across 2 matching MRF lines |
$423.01–$662.30 | $604.30–$946.14 | varies |
| CT abdomen w contrast (74160) | $782.60 | $1,118 | 3.6× |
| CT abdomen w wo contrast (74170) | $812.70 | $1,161 | 3.7× |
| CT abdomen w/o contrast (74150) range across 2 matching MRF lines |
$186.10–$722.40 | $265.85–$1,032 | varies |
| CT Angio Abdomen and Pelvis (74174) | $776.63 | $1,109.47 | 1.8× |
| CT Angio Chest (71275) | $371.05 | $530.07 | 1.7× |
| CT Angio Head (70496) | $371.05 | $530.07 | 1.7× |
| Ct Angio Lwr Extr W/O&W/Dye (73706) range across 2 matching MRF lines |
$369.60–$903 | $528–$1,290 | varies |
| CT Angio Neck (70498) | $371.05 | $530.07 | 1.7× |
| Ct Angio Upr Extrm W/O&W/Dye (73206) | $403 | $575.71 | 1.8× |
| CT cervical spine w/ contrast (72126) | $776.63 | $1,109.47 | 1.8× |
| CT cervical spine w/o contrast (72125) | $312 | $445.71 | 2.4× |
| CT cervical spine w/wo cont (72127) | $371.05 | $530.07 | 1.7× |
| CT chest w contrast (71260) | $371.05 | $530.07 | 1.7× |
| CT chest w/wo contrast (71270) | $371.05 | $530.07 | 1.7× |
| CT head/brain with contrast (70460) | $782.60 | $1,118 | 3.6× |
| CT head/brain without and with contrast (70470) | $812.70 | $1,161 | 3.7× |
| CT iac w contrast (70481) | $371.05 | $530.07 | 1.7× |
| CT l-spine w&w/o contrast (72133) | $371.05 | $530.07 | 1.7× |
| CT lower ext w/o (73700) | $222.02 | $317.17 | 1.7× |
| CT lower extremity w/contrast material (73701) range across 3 matching MRF lines |
$371.05–$782.60 | $530.07–$1,118 | varies |
| CT lumbar spine w contrast (72132) | $782.60 | $1,118 | 1.8× |
| CT lumbar spine w/o contrast (72131) | $225.80 | $322.57 | 1.7× |
| CT maxillofacial w contrast (70487) range across 2 matching MRF lines |
$257.33–$782.60 | $367.62–$1,118 | varies |
| CT maxillofacial wo contrast (70486) range across 2 matching MRF lines |
$236–$722.40 | $337.14–$1,032 | varies |
| CT neck tissue combo (70492) | $812.70 | $1,161 | 3.7× |
| Ct Orbit/Ear/Fossa W/O&W/Dye (70482) | $383 | $547.14 | 1.7× |
| CT orbits w/o contrast (70480) | $722.40 | $1,032 | 5.5× |
| CT pelvis w&w/o contrast (72194) | $812.70 | $1,161 | 3.7× |
| CT pelvis w/o contrast (72192) | $722.40 | $1,032 | 5.5× |
| CT scan of leg combo (73702) | $464 | $662.86 | 2.1× |
| CT scans face/jaw combo (70488) | $812.70 | $1,161 | 3.7× |
| CT soft tissue neck w contrast (70491) | $782.60 | $1,118 | 3.6× |
| CT soft tissue neck w/o contrast (70490) | $722.40 | $1,032 | 5.5× |
| CT thoracic spine w contrast (72129) | $371.05 | $530.07 | 1.7× |
| CT thoracic spine w/o contrast (72128) | $226.80 | $324 | 1.7× |
| CT thoracic spine w/wo cont (72130) | $471 | $672.86 | 2.2× |
| CT thorax w/o contrast (71250) | $222.02 | $317.17 | 1.7× |
| CT upper ext wo (73200) | $222.02 | $317.17 | 1.7× |
| CT upper extremity w/o & w/contrast material (73202) | $471 | $672.86 | 2.2× |
| CT upper extremity with contrast (73201) | $776.63 | $1,109.47 | 1.8× |
| Cta Abdl Aorta&Bi Iliofem W/Contrast&Postp (75635) | $543 | $775.71 | 2.5× |
| Cta Abdomen (74175) range across 3 matching MRF lines |
$371.05–$392 | $530.07–$560 | varies |
| CTA pelvis (72191) | $394 | $562.86 | 1.8× |
| Dxa Bone Density Axial (77080) | $222.02 | $317.17 | 1.7× |
| Echo exam uterus (76831) | $494.84 | $706.92 | 1.7× |
| Esophageal Motility Study (78258) | $832.90 | $1,189.85 | 1.7× |
| Esophagram (74220) | $371.05 | $530.07 | 1.7× |
| Fetal Biophys Profile W/Nst (76818) | $240.90 | $344.14 | 1.8× |
| Fetal Biophysical Profile W/O Non-Stress Testing (76819) | $222.02 | $317.17 | 1.7× |
| Fluoroscopy up to 1 hr (76000) | $494.84 | $706.92 | 1.7× |
| Foot 2 views (73620) | $183.51 | $262.15 | 1.7× |
| Forearm 2 views (73090) | $183.51 | $262.15 | 1.7× |
| Gastric emptying imaging study (78264) | $832.90 | $1,189.85 | 1.7× |
| Gastroesophageal Reflux Exam (78262) | $832.90 | $1,189.85 | 1.7× |
| Gated Heart Planar Single (78472) | $832.90 | $1,189.85 | 1.7× |
| Hand 2 views (73120) | $222.02 | $317.17 | 1.7× |
| Heart first pass single,planar (78481) | $1,091.52 | $1,559.32 | 1.6× |
| Hepatobil Syst Image W/Drug (78227) | $1,091.52 | $1,559.32 | 1.6× |
| Hepatobiliary System Imaging (78226) | $832.90 | $1,189.85 | 1.7× |
| Ht Musc Image Planar Mult (78454) | $2,867.55 | $4,096.50 | 1.8× |
| Ht Muscle Image Spect Sing (78451) | $2,867.55 | $4,096.50 | 1.8× |
| Hysterosalpingogram (74740) | $494.84 | $706.92 | 1.7× |
| Infant hip ultrasound with hip movement (dynamic) (76885) | $240.90 | $344.14 | 2.2× |
| Infant hip ultrasound, limited static exam (76886) | $183.51 | $262.15 | 1.7× |
| K Flow/Funct Image Multiple (78709) | $1,091.52 | $1,559.32 | 1.6× |
| K Flow/Funct Image W/Drug (78708) | $1,091.52 | $1,559.32 | 1.6× |
| K Flow/Funct Image W/O Drug (78707) | $1,091.52 | $1,559.32 | 1.6× |
| Knee 3 Views (73562) | $183.51 | $262.15 | 1.7× |
| Liver & Spleen Imaging Static Only (78215) | $832.90 | $1,189.85 | 1.7× |
| Lung Ventilat&Perfus Imaging (78582) | $1,091.52 | $1,559.32 | 1.6× |
| Lung Ventilation Imaging (78579) | $832.90 | $1,189.85 | 1.7× |
| Magnetic Image Jaw Joint (70336) | $1,321.30 | $1,887.57 | 4.4× |
| Meckels Divert Exam (78290) | $832.90 | $1,189.85 | 1.7× |
| Mra Head W/O & W/Contrast Material (70546) range across 2 matching MRF lines |
$740.60–$2,160.50 | $1,058–$3,086.43 | varies |
| MRA head w/o contrast (70544) range across 3 matching MRF lines |
$500.50–$1,563.30 | $715–$2,233.29 | varies |
| MRA head with contrast (70545) | $740.60 | $1,058 | 1.7× |
| MRA neck w contrast (70548) | $776.63 | $1,109.47 | 1.8× |
| Mra Neck W/O &W/Contrast Material (70549) | $2,160.50 | $3,086.43 | 5.0× |
| MRA neck w/o contrast (70547) | $1,563.30 | $2,233.29 | 5.2× |
| MRI abdomen w contrast (74182) | $1,857.20 | $2,653.14 | 4.3× |
| MRI abdomen w/o contrast (74181) range across 2 matching MRF lines |
$423.01–$494.84 | $604.30–$706.92 | varies |
| MRI any jt lower extrem w/contrast material (73722) | $1,616.93 | $2,309.90 | 1.7× |
| MRI any jt lower extrem w/o & w/contrast matrl (73723) | $2,160.50 | $3,086.43 | 5.0× |
| MRI any jt upper extremity w/contrast matrl (73222) | $1,616.93 | $2,309.90 | 1.7× |
| MRI bone marrow blood supply (77084) | $1,563.30 | $2,233.29 | 5.2× |
| MRI cervical spine w contrast (72142) | $776.63 | $1,109.47 | 1.8× |
| MRI cervical spine w/o cont (72141) | $1,562.20 | $2,231.71 | 5.2× |
| MRI chest w/o contrast (71550) | $1,563.30 | $2,233.29 | 5.2× |
| MRI chest with contrast (71551) | $1,857.20 | $2,653.14 | 1.9× |
| MRI chest wo w contrast (71552) | $2,160.50 | $3,086.43 | 5.0× |
| MRI lower extrem oth/thn jt w/contrast matrl (73719) range across 2 matching MRF lines |
$1,300.04–$1,857.20 | $1,857.20–$2,653.14 | varies |
| MRI lower extrem oth/thn jt w/o & w/contr matr (73720) | $2,160.50 | $3,086.43 | 5.0× |
| MRI lower extrem oth/thn jt w/o contr matrl (73718) | $1,563.30 | $2,233.29 | 5.2× |
| MRI lumbar spine w contrast (72149) | $776.63 | $1,109.47 | 1.8× |
| Mri Neck Spine W/O & W/Dye (72156) | $776.63 | $1,109.47 | 1.8× |
| MRI orbit face &/neck w/o contrast (70540) | $1,563.30 | $2,233.29 | 5.2× |
| MRI orbit face neck w contrast (70542) | $1,857.20 | $2,653.14 | 4.3× |
| Mri Orbt/Fac/Nck W/O &W/Dye (70543) | $2,160.50 | $3,086.43 | 5.0× |
| MRI pelvis w contrast (72196) | $776.63 | $1,109.47 | 1.8× |
| MRI pelvis w/o & w contrast (72197) | $776.63 | $1,109.47 | 1.8× |
| MRI pelvis w/o contrast (72195) range across 2 matching MRF lines |
$494.84–$1,563.30 | $706.92–$2,233.29 | varies |
| MRI thoracic spine w/o contrast (72146) | $494.84 | $706.92 | 1.7× |
| MRI upper extremity oth than jt w/contr matrl (73219) | $776.63 | $1,109.47 | 1.8× |
| MRI upper extremity oth than jt w/o contr matrl (73218) | $609 | $870 | 2.0× |
| Mri Uppr Extremity W/O&W/Dye (73220) range across 2 matching MRF lines |
$828–$1,280.20 | $1,182.86–$1,828.86 | varies |
| MRI, abdomen, combo (74183) | $776.63 | $1,109.47 | 1.8× |
| MRI, dorsal spine combo (72157) | $776.63 | $1,109.47 | 1.8× |
| MRI, dorsal spine contrast (72147) | $776.63 | $1,109.47 | 1.8× |
| MRI, joint upper extrem (73221) | $494.84 | $706.92 | 1.7× |
| MRI, joint upper extrem combo (73223) | $2,160.50 | $3,086.43 | 5.0× |
| MRI, lumbar spine combo (72158) range across 2 matching MRF lines |
$624.98–$776.63 | $892.83–$1,109.47 | varies |
| Myocardial Perfusion Planar 1 Study Rest/Stress (78453) | $2,867.55 | $4,096.50 | 1.8× |
| Myocardial Spect Multiple Studies (78452) range across 2 matching MRF lines |
$2,283.62–$2,867.55 | $3,262.32–$4,096.50 | varies |
| Neck soft tissue (70360) | $183.51 | $262.15 | 1.7× |
| Ob us nuchal meas 1 gest (76813) | $222.02 | $317.17 | 1.7× |
| Optic foramina (70190) | $183.51 | $262.15 | 1.7× |
| Parathyroid Planar Imaging (78070) | $832.90 | $1,189.85 | 1.7× |
| Parathyroid planar imaging w/wo subtraction (78071) | $832.90 | $1,189.85 | 1.7× |
| Pelvis 1 or 2 views (72170) | $222.02 | $317.17 | 1.7× |
| Pulmonary Perfusion Imaging Particulate (78580) | $832.90 | $1,189.85 | 1.7× |
| Radex Abd Compl Aqt Abd W/S/E/D Views 1 View Ch (74022) | $222.02 | $317.17 | 1.7× |
| Radex abscess/fistula/sinus tract rs&i (76080) range across 2 matching MRF lines |
$1,114.06–$1,517 | $1,591.52–$2,167.14 | varies |
| Radex Ankle Complete Minimum 3 Views (73610) | $183.51 | $262.15 | 1.7× |
| Radex Calcaneus Minimum 2 Views (73650) | $183.51 | $262.15 | 1.7× |
| Radex elbow complete minimum 3 views (73080) | $183.51 | $262.15 | 1.7× |
| Radex Facial Bones Complete Minimum 3 Views (70150) | $222.02 | $317.17 | 1.7× |
| Radex fingr minimum 2 views (73140) | $183.51 | $262.15 | 1.7× |
| Radex foot complete minimum 3 views (73630) | $183.51 | $262.15 | 1.7× |
| Radex Hand Minimum 3 Views (73130) | $183.51 | $262.15 | 1.7× |
| Radex lower extremity infant minimum 2 views (73592) | $183.51 | $262.15 | 1.7× |
| Radex Mastoids Compl Minimum 3 Views PR Side (70130) | $222.02 | $317.17 | 1.7× |
| Radex Nasal Bones Complete Minimum 3 Views (70160) | $183.51 | $262.15 | 1.7× |
| Radex Ribs Unilateral 2 Views (71100) | $183.51 | $262.15 | 1.7× |
| Radex shoulder complete minimum 2 views (73030) | $183.51 | $262.15 | 1.7× |
| Radex Sinuses Paransl < 3 Views (70210) | $183.51 | $262.15 | 1.7× |
| Radex Spine 1 View Specify Level (72020) | $183.51 | $262.15 | 1.7× |
| Radex Sternum Minimum 2 Views (71120) | $183.51 | $262.15 | 1.7× |
| Radex Temporomandble Jt Opn & Clsd Mouth Bilat (70330) | $183.51 | $262.15 | 1.7× |
| Radex Toe Minimum 2 Views (73660) | $183.51 | $262.15 | 1.7× |
| Radex upper extremity infant minimum 2 views (73092) | $222.02 | $317.17 | 1.7× |
| Radex Wrist Complete Minimum 3 Views (73110) | $183.51 | $262.15 | 1.7× |
| Radiolog exam mandible compl minimum 4 views (70110) | $490 | $700 | 3.8× |
| Radiologic Exam Abdomen 3+ Views - Xr Abdomen 3+ Views (74021) | $222.02 | $317.17 | 1.7× |
| Radiologic exam colon double contrast study (74280) | $371.05 | $530.07 | 1.7× |
| Radiologic exam colon single contrast study (74270) | $371.05 | $530.07 | 1.7× |
| Radiologic Exam Esophagus Double Contrast Study (74221) | $371.05 | $530.07 | 1.7× |
| Radiologic exam knee complete 4/more views (73564) | $222.02 | $317.17 | 1.7× |
| Radiologic exam pelvis compl minimum 3 views (72190) | $222.02 | $317.17 | 1.7× |
| Radiologic Exam Small Int Single Contrast Study (74250) | $371.05 | $530.07 | 1.7× |
| Radiologic exam swallow function contrast study (74230) | $371.05 | $530.07 | 1.7× |
| Radiologic exam upr gi trc double contrast study (74246) | $371.05 | $530.07 | 1.7× |
| Radiologic examination femur 1 view (73551) | $183.51 | $262.15 | 1.7× |
| Radiologic examination femur minimum 2 views (73552) | $183.51 | $262.15 | 1.7× |
| Radiologic examination knee 1/2 views (73560) | $183.51 | $262.15 | 1.7× |
| Radiologic Examination Osseous Survey Limited (77074) | $222.02 | $317.17 | 1.7× |
| Radiologic Examination Salivary Gland Calculus (70380) | $183.51 | $262.15 | 1.7× |
| Radiologic examination tibia & fibula 2 views (73590) | $183.51 | $262.15 | 1.7× |
| Radiologic examination, internal auditory meati, complete Non-Facility (70134) | $1,114.06 | $1,591.52 | 1.6× |
| Ribs bilateral 3 views (71110) | $222.02 | $317.17 | 1.7× |
| Rp Loclzj Tum Spect 1 Area Single Day Imaging (78803) | $511.80 | $731.14 | 0.8× |
| Salivary Gland Imaging Serial Images (78231) | $832.90 | $1,189.85 | 1.7× |
| Scapula (73010) | $222.02 | $317.17 | 1.7× |
| Screening Digital Breast Tomosynthesis Bi (77063) | $190.40 | $272 | 8.1× |
| Sella turcica (70240) | $183.51 | $262.15 | 1.7× |
| Shoulder 1 view (73020) | $183.51 | $262.15 | 1.7× |
| Shoulder Arthrography (73040) | $776.63 | $1,109.47 | 1.8× |
| Skull less than 4 views (70250) | $222.02 | $317.17 | 1.7× |
| Spleen Imaging (78185) | $832.90 | $1,189.85 | 1.7× |
| Sternoclavicular joints (71130) | $183.51 | $262.15 | 1.7× |
| Thoracic spine 2 views (72070) | $222.02 | $317.17 | 1.7× |
| Thoracic spine 3 views (72072) | $222.02 | $317.17 | 1.7× |
| Thoracolumbar 2 views (72080) | $183.51 | $262.15 | 1.7× |
| Thyroid Uptake Measurement (78012) | $832.90 | $1,189.85 | 1.7× |
| Thyroid Uptake W/Blood Flow Sngle/Mult Quan Meas (78014) | $832.90 | $1,189.85 | 1.7× |
| Ultrasound Breast Limited (76642) | $183.51 | $262.15 | 1.7× |
| Ultrasound elastography first target lesion (76982) | $222.02 | $317.17 | 1.7× |
| Ultrasound Elastography Parenchyma (76981) | $222.02 | $317.17 | 1.7× |
| Ultrasound Exam Aaa Screen (76706) | $222.02 | $317.17 | 1.7× |
| Ultrasound, abdomen limited (76705) | $222.02 | $317.17 | 1.7× |
| Umbilical-artery Doppler (OB) (76820) | $222.02 | $317.17 | 1.7× |
| Upper gi w/o kub (74240) | $371.05 | $530.07 | 1.7× |
| Urethrocystogram voiding (74455) | $494.84 | $706.92 | 1.7× |
| Us breast unilateral complete (76641) range across 3 matching MRF lines |
$222.02–$444.04 | $317.17–$634.34 | varies |
| Us chest (76604) | $222.02 | $317.17 | 1.7× |
| Us complete joint (76881) | $222.02 | $317.17 | 1.7× |
| Us exam, pelvic, limited (76857) | $222.02 | $317.17 | 1.7× |
| Us kidney transplant (76776) | $331.20 | $473.14 | 2.5× |
| Us lmtd joint/oth nonvasc xtr strux r-t w/img (76882) range across 3 matching MRF lines |
$220.50–$222.02 | $315–$317.17 | varies |
| Us ob detailed single fetus (76811) | $494.84 | $706.92 | 1.7× |
| Us ob limited 1 or more fetuses (76815) | $222.02 | $317.17 | 1.7× |
| Us ob transvaginal (76817) | $240.90 | $344.14 | 1.8× |
| Us pelvic non ob complete (76856) | $301.10 | $430.14 | 2.3× |
| Us pg uter img f&mat 14 wk tabdl 1/1st gestation (76801) | $271.10 | $387.29 | 2.1× |
| Us preg uterus real time f/u trnsabdl per fetus (76816) | $222.02 | $317.17 | 1.7× |
| Us retroperitoneal complete (76770) | $222.02 | $317.17 | 1.7× |
| Us retroperitoneal limited (76775) | $271.10 | $387.29 | 2.1× |
| Us scrotum and contents (76870) range across 3 matching MRF lines |
$301.07–$301.10 | $430.10–$430.14 | varies |
| Us spinal canal and contents (76800) | $271.10 | $387.29 | 2.1× |
| Us thyroid (76536) | $301.10 | $430.14 | 2.3× |
| Us transrectal (76872) | $301.10 | $430.14 | 2.3× |
| Vein X-Ray Chest (75827) | $3,234.22 | $4,620.32 | 1.6× |
| Venography extremity bilateral rs&i (75822) | $3,234.22 | $4,620.32 | 1.6× |
| Venography extremity unilateral rs&i (75820) | $3,234.22 | $4,620.32 | 1.6× |
| Wrist 2 views (73100) | $183.51 | $262.15 | 1.7× |
| X-Ray Ac Jts - Xr Acromioclavicular Joints Bilateral (73050) | $183.51 | $262.15 | 1.7× |
| X-ray antegrade pyelogram tube (74425) | $776.63 | $1,109.47 | 1.8× |
| X-Ray Bend Only L-S Spine (72120) | $222.02 | $317.17 | 1.7× |
| X-Ray Elbow 2 Vw - Xr Elbow 1-2 Views Right (73070) | $183.51 | $262.15 | 1.7× |
| X-Ray Exam Breast Specimen (76098) | $1,114.06 | $1,591.52 | 1.6× |
| X-Ray Exam Entire Spi 1 Vw (72081) | $183.51 | $262.15 | 1.7× |
| X-Ray Exam Entire Spi 2/3 Vw (72082) | $222.02 | $317.17 | 1.7× |
| X-Ray Exam Hip Uni 1 View (73501) | $183.51 | $262.15 | 1.7× |
| X-Ray Exam Hip Uni 2-3 Views (73502) | $183.51 | $262.15 | 1.7× |
| X-Ray Exam Hip Uni 4/> Views (73503) | $222.02 | $317.17 | 1.7× |
| X-Ray Exam Hips Bi 2 Views (73521) | $222.02 | $317.17 | 1.7× |
| X-Ray Exam Hips Bi 3-4 Views (73522) | $222.02 | $317.17 | 1.7× |
| X-Ray Exam L-S Spine Bending (72114) | $222.02 | $317.17 | 1.7× |
| X-Ray Exam Neck Spine 2-3 Vw (72040) | $183.51 | $262.15 | 1.7× |
| X-Ray Exam Neck Spine 6/>Vws (72052) | $222.02 | $317.17 | 1.7× |
| X-Ray Exam Unilat Ribs/Chest (71101) | $222.02 | $317.17 | 1.7× |
| X-ray eye for foreign body (70030) | $183.51 | $262.15 | 1.7× |
| X-ray humerus (73060) | $183.51 | $262.15 | 1.7× |
| X-ray IV pyelogram (ivp) (74400) | $371.05 | $530.07 | 1.7× |
| X-Ray Jaw <4 Vw - Xr Mandible < 4 Views (70100) | $183.51 | $262.15 | 1.7× |
| X-Ray Knee Bilat Standing - Xr Knees Anteroposterior Standing Bilat (73565) | $183.51 | $262.15 | 1.7× |
| X-Ray Lumbar Spine 2/3 Vw - Xr Lumbar Spine 2-3 Views (72100) | $222.02 | $317.17 | 1.7× |
| X-ray nose-rectum child f.b. (76010) | $183.51 | $262.15 | 1.7× |
| X-Ray Ribs, Chest 4+ Vw - Xr Ribs 3 Vws Bil W/ Chest Posteroanterior (71111) | $222.02 | $317.17 | 1.7× |
| X-Ray Sacroiliac Jts 3+ Vw - Xr Sacroiliac Joints 3+ Views (72202) | $222.02 | $317.17 | 1.7× |
| X-Ray Sacroiliac Jts <3 Vw - Xr Sacroiliac Joints 1-2 Views (72200) | $222.02 | $317.17 | 1.7× |
| X-Ray Sacrum/Coccyx 2+ Vw - Xr Sacrum Coccyx 2+ Views (72220) | $183.51 | $262.15 | 1.7× |
| X-Ray Sinuses 3+ Vw - Xr Paranasal Sinuses 3+ Views (70220) | $183.51 | $262.15 | 1.7× |
| X-Ray Skull 4+ Vw - Xr Skull Complete 4+ Views (70260) | $222.02 | $317.17 | 1.7× |
| X-ray thoracic spine 4 vw (72074) | $222.02 | $317.17 | 1.7× |
| X-Ray Urinary Tract Exam With Contrast Material (74420) | $776.63 | $1,109.47 | 1.8× |
| X-Rays Bone Length Studies (77073) range across 2 matching MRF lines |
$51.95–$222.02 | $74.22–$317.17 | varies |
| X-Rays Bone Survey Complete (77075) | $222.02 | $317.17 | 1.7× |
| Xr c-spine 4 or 5 views (72050) | $222.02 | $317.17 | 1.7× |
| Xr facial bones less than 3 views (70140) | $183.51 | $262.15 | 1.7× |
| XR Mastoids < 3 Views Bilateral (70120) | $222.02 | $317.17 | 1.7× |
| Xr orbits complete 4 views (70200) | $222.02 | $317.17 | 1.7× |
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.