Chest X-Ray, 2 Views (PA and Lateral)
CPT 71046 is one of the cheapest and most common imaging studies in medicine, used for pneumonia, heart failure evaluation, and pre-surgical clearance. Medicare pays $33.07, and providers charge an average of $86.59 (a 2.6x markup). The low absolute cost means the markup matters less in dollar terms ($53 over Medicare). However, hospital facility fees can triple the cost of this $33 test.
CPT 71046 at a Glance
- Average provider charge: $86.59
- Medicare rate: $33.07
- Typical markup: 2.6x over Medicare
- Dollar spread: $53 over Medicare
- Setting: Same rate office and facility
- Common uses: Pneumonia, heart failure, pre-op
- Outpatient beneficiaries: 2.2 million
- Views: PA (front) and lateral (side)
On this page
How the Medicare Rate Is Calculated
Medicare prices every procedure using Relative Value Units (RVUs) across three components, then multiplies by a national conversion factor of $33.4009 (2026). For imaging codes like 71046, the non-facility and facility Practice Expense RVUs are identical, so Medicare pays the same rate regardless of setting. Hospitals add their own facility fee on top.
| Component | What It Covers | RVU |
|---|---|---|
| Work RVU | Radiologist time and interpretation | 0.21 |
| Practice Expense RVU | X-ray equipment, technologist, film/digital | 0.76 |
| Malpractice RVU | Professional liability insurance | 0.02 |
| Total RVU | 0.99 | |
| x $33.4009 | 2026 conversion factor | $33.07 |
Medicare Rate by State
Medicare adjusts the national rate using Geographic Practice Cost Indices (GPCIs). Because the chest X-ray rate is so low, the state variation is small in dollar terms.
Medicare Rate by State (2026)
Medicare adjusts payments by location using Geographic Practice Cost Indices (GPCIs). Select your state to see the adjusted rate.
Sample State Rates
| State | Medicare Pays | Avg. Charge | Markup |
|---|---|---|---|
| Texas (Austin) | $34.41 | $86.59 | 2.5x |
| California (Los Angeles) | $37.54 | $86.59 | 2.3x |
| New York (Manhattan) | $38.23 | $86.59 | 2.3x |
| Florida (Fort Lauderdale) | $34.51 | $86.59 | 2.5x |
| Ohio | $30.97 | $86.59 | 2.8x |
| Mississippi | $29.56 | $86.59 | 2.9x |
| Arkansas | $29.36 | $86.59 | 2.9x |
| Alaska | $38.30 | $86.59 | 2.3x |
Rates shown use 2026 GPCIs and the $33.4009 conversion factor. For imaging codes, the Medicare physician fee is the same in office and facility settings. The average provider charge of $86.59 is the 2023 national average from CMS utilization data.
What Insured Patients Actually Pay for a Chest X-Ray
Your insurer has a negotiated rate with the facility, typically 150% to 250% of the Medicare rate. For a 2-view chest X-ray, that negotiated rate is usually $50 to $85. Because the amounts are small, the plan design matters less for this particular test:
| Your Situation | What You Likely Pay | How It Works |
|---|---|---|
| Copay plan (deductible met) | $0 to $30 | Some plans cover basic X-rays at no cost or minimal copay |
| Coinsurance plan (deductible met) | $10 to $17 | 20% of the negotiated rate ($50 to $85) |
| High-deductible plan (deductible NOT met) | $50 to $85 | Full negotiated rate until deductible is met |
| Medicare Part B | $6.61 | 20% of $33.07 after annual deductible |
Should You Use Insurance or Pay Cash?
For a test this inexpensive, cash-pay pricing is often comparable to or cheaper than the insurer's negotiated rate. Many urgent care centers charge $30 to $75 for a chest X-ray with cash payment.
When Cash-Pay Wins
- You have a high deductible and have not met it
- The cash price at an urgent care or freestanding clinic is $30 to $50
- You want to avoid the hassle of insurance billing for a small amount
- You are unlikely to meet your deductible this year
When Using Insurance Wins
- You are close to meeting your annual deductible
- Your plan covers X-rays with no copay or a minimal copay
- You need the X-ray documented in your insurance records for follow-up care
- You expect significant medical expenses later this year
Common Billing Problems with Chest X-Rays
Wrong number of views billed
CPT 71045 is a single-view chest X-ray. CPT 71046 is 2 views. CPT 71048 is 4 or more views. Each has a different price. Check your bill to confirm the number of views matches what was actually taken. Being billed for 2 views (71046) when only 1 view was done, or for 4+ views (71048) when only 2 were done, is a billing error.
Facility fee that triples the cost
A $33 chest X-ray done at a hospital outpatient department can become a $150 to $350 total bill once the hospital's facility fee is added. This is the single biggest billing issue for low-cost imaging studies. If your doctor's office is owned by a hospital system, you may be paying hospital outpatient rates without realizing it. Ask if there is a facility fee before scheduling.
Duplicate billing for pre-op X-rays
Chest X-rays ordered for pre-surgical clearance are sometimes billed separately even when the surgeon's office or hospital already includes them in the surgical facility fee. If you had a chest X-ray as part of pre-operative testing and see a separate charge, verify it is not a duplicate.
Separate technical and professional charges
Like all imaging, chest X-rays can be billed as two separate components: the technical component (equipment and technologist) and the professional component (radiologist reading). At a hospital, these may come as two separate bills from two different entities. Together they should not exceed the global rate significantly.
Related Imaging Codes
| Code | Description | Medicare Rate |
|---|---|---|
| 71045 | Chest X-ray, 1 view | ~$23 |
| 71046 | Chest X-ray, 2 views | $33.07 |
| 71048 | Chest X-ray, 4+ views | ~$40 |
Frequently Asked Questions
How much does a chest X-ray cost without insurance?
Without insurance, a 2-view chest X-ray (CPT 71046) costs $30 to $150 depending on the facility. The national average provider charge is $86.59. Urgent care centers and freestanding imaging centers offer the lowest prices. Medicare pays $33.07 for this X-ray. Watch for separate facility fees at hospital outpatient departments that can triple the cost.
What is the difference between CPT 71045 and 71046?
CPT 71045 is a single-view chest X-ray (typically just the PA or frontal view). CPT 71046 is a 2-view chest X-ray that includes both the PA (front-to-back) and lateral (side) views. The 2-view study provides more information and is the standard for most diagnostic purposes. Check your bill to make sure you are being charged for the correct number of views.
Why is my chest X-ray bill so high when the Medicare rate is only $33?
While the chest X-ray itself is inexpensive, hospital outpatient departments add a separate facility fee that can be $100 to $300 on top of the scan cost. This means a $33 X-ray can become a $150 to $350 total bill. Freestanding imaging centers and urgent care clinics do not charge separate facility fees, making them significantly cheaper for basic X-rays.
Does insurance cover a chest X-ray?
Most insurance plans cover chest X-rays when medically necessary. Prior authorization is usually not required for basic X-rays. If you have a high-deductible plan and have not met your deductible, you pay the full negotiated rate. Medicare Part B covers 80% after your deductible, leaving approximately $7 in coinsurance. For a test this inexpensive, cash-pay may be cheaper than using insurance at some facilities.
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