Imaging prices at Banner Lassen Medical Center

Susanville, CA · every code in this section with a posted price and a Medicare benchmark.

286 codes. Prices are the hospital's own posted facility charges.

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ProcedurePosted cashPosted gross× Medicare
Abdomen 1 View (74018) $135.14 $206 1.2×
Abdomen 2 views (74019) $198.77 $303 1.5×
Acute Gastrointestinal Blood Loss Imaging (78278) $1,264.84 $1,885 2.5×
Ankle 2 views (73600) $158.10 $241 1.4×
Arthrogram ankle (73615) $832.37 $786 1.9×
Arthrogram hip (73525) $944.63 $892 2.1×
Arthrogram Wrist (73115) $434.19 $410 1.0×
Bone age studies (77072) $247.31 $377 1.8×
Bone Imaging 3 Phase (78315) $2,282.74 $3,402 4.4×
Bone Imaging Limited Area (78300) $1,284.97 $1,915 2.5×
Bone Imaging Multiple Areas (78305) $1,541.96 $2,298 3.0×
Bone Imaging Whole Body (78306) $1,984.82 $2,958 3.9×
Bone marrow imaging limited area (78102) $997.11 $1,486 1.9×
Bone marrow imaging; multiple areas (78103) $1,256.78 $1,873 2.4×
Bone marrow imaging; whole body (78104) $1,444.66 $2,153 2.8×
Bone survey infant (77076) $422.46 $644 3.1×
Cat Scan Follow-Up Study (76380) $537.88 $1,063 4.8×
Cerebrospinal Fluid Flow W/O Matl Shunt Evaltj (78645) $917.93 $1,368 1.3×
Cerebrospinal Fluid Scan (78630) $580.42 $865 0.8×
Chest 1 view (71045) $286.08 $457 2.6×
Chest 2 views (71046) $314.25 $502 2.8×
Chest 3 views (71047) $329.90 $527 2.9×
Chest 4 or more views (71048) $418.79 $669 3.1×
Clavicle complete (73000) $303.73 $463 2.7×
Computed Tomography Thorax Lw Dose Lng Ca Scr C- (71271) $361.31 $635 2.7×
Contrast X-Ray Bladder (74430) $272.24 $415 0.6×
Contrast X-Ray Of Elbow (73085) $844.02 $797 1.9×
Contrast X-Ray Of Knee Joint (73580) $747.65 $706 1.7×
CT abdomen and pelvis without and with contrast (74178) $3,575.60 $6,284 8.0×
CT abdomen and pelvis without contrast (74176) $2,383.54 $4,189 7.8×
CT abdomen w contrast (74160) $1,889.08 $3,320 8.4×
CT abdomen w wo contrast (74170) $2,266.90 $3,984 10.0×
CT abdomen w/o contrast (74150) $1,511.26 $2,656 11.2×
CT Angio Abdomen and Pelvis (74174) $3,754.83 $6,599 8.4×
CT Angio Chest (71275) $2,446.13 $4,299 10.8×
CT Angio Head (70496) $1,122.31 $1,997 5.0×
Ct Angio Lwr Extr W/O&W/Dye (73706) $1,281.96 $2,253 5.7×
CT Angio Neck (70498) $1,161.09 $2,066 5.1×
Ct Angio Upr Extrm W/O&W/Dye (73206) $1,169.86 $2,056 5.2×
CT cervical spine w/ contrast (72126) $1,427.05 $2,508 3.2×
CT cervical spine w/o contrast (72125) $1,141.41 $2,006 8.5×
CT cervical spine w/wo cont (72127) $1,712.12 $3,009 7.6×
CT chest w contrast (71260) $1,941.43 $3,412 8.6×
CT chest w/wo contrast (71270) $2,329.49 $4,094 10.3×
CT head/brain with contrast (70460) $890.21 $1,584 3.9×
CT head/brain without and with contrast (70470) $1,068.36 $1,901 4.7×
CT iac w contrast (70481) $1,040.82 $1,852 4.6×
CT l-spine w&w/o contrast (72133) $2,095.63 $3,683 9.3×
CT lower ext w/o (73700) $813.67 $1,430 6.1×
CT lower extremity w/contrast material (73701) $1,017.37 $1,788 4.5×
CT lumbar spine w contrast (72132) $1,746.26 $3,069 3.9×
CT lumbar spine w/o contrast (72131) $1,396.89 $2,455 10.4×
CT maxillofacial w contrast (70487) $1,016.66 $1,809 4.5×
CT maxillofacial wo contrast (70486) $813.21 $1,447 6.0×
CT neck tissue combo (70492) $1,105.45 $1,967 4.9×
Ct Orbit/Ear/Fossa W/O&W/Dye (70482) $1,248.76 $2,222 5.5×
CT orbits w/o contrast (70480) $832.32 $1,481 6.2×
CT pelvis w&w/o contrast (72194) $2,314.69 $4,068 10.3×
CT pelvis w/o contrast (72192) $1,543.13 $2,712 11.5×
CT scan of leg combo (73702) $1,220.50 $2,145 5.4×
CT scans face/jaw combo (70488) $1,220.10 $2,171 5.4×
CT soft tissue neck w contrast (70491) $921.12 $1,639 4.1×
CT soft tissue neck w/o contrast (70490) $736.78 $1,311 5.5×
CT thoracic spine w contrast (72129) $1,495.90 $2,629 6.6×
CT thoracic spine w/o contrast (72128) $1,196.61 $2,103 8.9×
CT thoracic spine w/wo cont (72130) $1,795.19 $3,155 8.0×
CT thorax w/o contrast (71250) $1,552.80 $2,729 11.5×
CT upper ext wo (73200) $742.54 $1,305 5.5×
CT upper extremity w/o & w/contrast material (73202) $1,114.10 $1,958 4.9×
CT upper extremity with contrast (73201) $928.61 $1,632 2.1×
Cta Abdl Aorta&Bi Iliofem W/Contrast&Postp (75635) $2,111.03 $4,172 9.4×
Cta Abdomen (74175) $2,380.70 $4,184 10.6×
CTA pelvis (72191) $2,430.77 $4,272 10.8×
Doppler Fetal Mid Cerebral Artery (76821) $633.50 $807 4.7×
Dxa Bone Density Axial (77080) $491.34 $749 3.7×
Dxa bone density study (77085) $503.81 $768 3.7×
Dxa bone density study 1/>sites appendiclr skel (77081) $271.58 $414 2.4×
Esophageal Motility Study (78258) $650.87 $970 1.3×
Esophagram (74220) $438.86 $669 1.9×
Fetal Biophys Profile W/Nst (76818) $489.84 $624 3.6×
Fetal Biophysical Profile W/O Non-Stress Testing (76819) $423.90 $540 3.2×
Fluoroscopy up to 1 hr (76000) $556.29 $848 1.8×
Foot 2 views (73620) $148.91 $227 1.3×
Forearm 2 views (73090) $155.47 $237 1.4×
Gastric emptying imaging study (78264) $1,769.43 $2,637 3.4×
Gastroesophageal Reflux Exam (78262) $890.42 $1,327 1.7×
Gated Heart Planar Single (78472) $1,867.39 $2,783 3.6×
Hand 2 views (73120) $248.62 $379 1.8×
Hepatobil Syst Image W/Drug (78227) $1,966.03 $2,930 2.8×
Hepatobiliary System Imaging (78226) $748.17 $1,115 1.5×
Ht Muscle Image Spect Sing (78451)
range across 2 matching MRF lines		 $80.04–$2,300.86 $138–$3,429 varies
Hysterosalpingogram (74740) $681.58 $1,039 2.2×
Infant hip ultrasound with hip movement (dynamic) (76885) $304.58 $388 2.7×
Joint Survey Single View (77077) $238.13 $363 1.8×
K Flow/Funct Image Multiple (78709) $1,328.58 $1,980 1.9×
K Flow/Funct Image W/Drug (78708) $623.36 $929 0.9×
K Flow/Funct Image W/O Drug (78707) $860.89 $1,283 1.2×
Kidney Imaging Morphol (78700) $403.27 $601 0.8×
Kidney Imaging Morphoogy W/Vascular Flow (78701) $516.67 $770 1.0×
Knee 3 Views (73562) $389.66 $594 3.5×
Leveen/Shunt Patency Exam (78291) $556.93 $830 1.1×
Liver & Spleen Imaging Static Only (78215) $702.54 $1,047 1.4×
Liver & Spleen Imaging W/Vascular Flow (78216) $609.27 $908 1.2×
Liver imaging static only (78201) $514.66 $767 0.7×
Liver imaging w/vascular flow (78202) $754.20 $1,124 1.1×
Lung Perf&Ventilat Diferentl (78598) $829.36 $1,236 1.2×
Lung Ventilat&Perfus Imaging (78582) $728.71 $1,086 1.0×
Lymph System Imaging (78195) $1,454.73 $2,168 2.1×
Meckels Divert Exam (78290) $1,136.67 $1,694 2.2×
Mr safety determination physician/other qhp (76016) $70.85 $108 0.6×
Mr safety implant&/fb assmt clin staf 1st 15 min (76014) $24.93 $38 0.7×
Mr safety implt electronics prepj supvj phys/qhp (76018) $124.64 $190 1.0×
Mr safety implt pos&/immoblj (76019) $190.24 $290 2.5×
Mr safety med physics xm customization plng&mntr (76017) $295.86 $451 1.0×
Mra Head W/O & W/Contrast Material (70546) $838.35 $3,105 1.9×
MRA head w/o contrast (70544) $558.90 $2,070 1.8×
MRA head with contrast (70545) $698.76 $2,588 1.6×
MRA neck w contrast (70548) $1,172.88 $4,344 2.6×
Mra Neck W/O &W/Contrast Material (70549) $1,407.51 $5,213 3.1×
MRA neck w/o contrast (70547) $938.25 $3,475 3.1×
MRI abdomen w contrast (74182) $2,835.60 $4,080 6.3×
MRI abdomen w/o contrast (74181) $2,268.48 $3,264 7.4×
MRI any jt lower extrem w/contrast material (73722) $2,932.20 $4,219 2.9×
MRI any jt lower extrem w/o & w/contrast matrl (73723) $3,518.78 $5,063 7.8×
MRI any jt upper extremity w/contrast matrl (73222) $1,794.49 $2,582 1.8×
MRI Breast W/O Contrast Bilateral (77047) $1,241.96 $1,787 4.0×
MRI Breast Without Contrast Material Unilateral (77046) $1,050.84 $1,512 3.4×
MRI cervical spine w contrast (72142) $1,725.58 $3,038 3.8×
MRI cervical spine w/o cont (72141) $1,380.24 $2,430 4.5×
MRI chest w/o contrast (71550) $1,495.64 $2,152 4.9×
MRI chest with contrast (71551) $1,869.55 $2,690 1.9×
MRI chest wo w contrast (71552) $2,243.46 $3,228 5.0×
MRI lower extrem oth/thn jt w/contrast matrl (73719) $1,336.48 $1,923 3.0×
MRI lower extrem oth/thn jt w/o & w/contr matr (73720) $1,603.36 $2,307 3.6×
MRI lower extrem oth/thn jt w/o contr matrl (73718) $1,068.91 $1,538 3.5×
MRI lumbar spine w contrast (72149) $3,060.38 $5,388 6.8×
Mri Neck Spine W/O & W/Dye (72156) $2,070.36 $3,645 4.6×
MRI orbit face &/neck w/o contrast (70540) $2,237.84 $3,865 7.3×
MRI orbit face neck w contrast (70542) $2,797.73 $4,832 6.2×
Mri Orbt/Fac/Nck W/O &W/Dye (70543) $3,357.04 $5,798 7.5×
MRI pelvis w contrast (72196) $2,059.28 $2,963 4.6×
MRI pelvis w/o & w contrast (72197) $2,470.72 $3,555 5.5×
MRI pelvis w/o contrast (72195) $1,647.15 $2,370 5.4×
MRI thoracic spine w/o contrast (72146) $1,278 $2,250 4.2×
MRI upper extremity oth than jt w/contr matrl (73219) $1,639.50 $2,359 3.7×
MRI upper extremity oth than jt w/o contr matrl (73218) $1,311.46 $1,887 4.3×
Mri Uppr Extremity W/O&W/Dye (73220) $1,967.54 $2,831 4.4×
MRI, abdomen, combo (74183) $3,402.72 $4,896 7.6×
MRI, dorsal spine combo (72157) $1,917 $3,375 4.3×
MRI, dorsal spine contrast (72147) $1,597.78 $2,813 3.6×
MRI, joint upper extrem (73221) $1,435.17 $2,065 4.7×
MRI, joint upper extrem combo (73223) $2,153.11 $3,098 4.8×
MRI, lumbar spine combo (72158) $3,672.12 $6,465 8.2×
Myelogram cervical (72240) $1,375.63 $2,097 1.4×
Myelogram Lumbar (72265) $1,433.36 $2,185 1.4×
Myelograpy 2/more regions rs&i (72270) $1,491.09 $2,273 1.5×
Myocardial Spect Multiple Studies (78452)
range across 2 matching MRF lines		 $93.96–$4,154.83 $162–$6,192 varies
Neck soft tissue (70360) $311.60 $475 2.8×
Nuclear Rx Oral Admin (79005) $726.40 $1,042 2.4×
Ob us nuchal meas 1 gest (76813) $514.96 $656 3.8×
Parathyroid Planar Imaging (78070) $724.68 $1,080 1.4×
Pelvis 1 or 2 views (72170) $336.53 $513 2.5×
Peritoneogram Rs&I (74190) $409.34 $624 0.6×
Pulmonary Perfusion Imaging Particulate (78580) $756.89 $1,128 1.5×
Radex Abd Compl Aqt Abd W/S/E/D Views 1 View Ch (74022) $275.52 $420 2.0×
Radex abscess/fistula/sinus tract rs&i (76080) $287.98 $439 0.4×
Radex Ankle Complete Minimum 3 Views (73610) $182.37 $278 1.6×
Radex Calcaneus Minimum 2 Views (73650) $167.28 $255 1.5×
Radex elbow complete minimum 3 views (73080) $186.30 $284 1.7×
Radex Facial Bones Complete Minimum 3 Views (70150) $320.78 $489 2.4×
Radex fingr minimum 2 views (73140) $262.40 $400 2.3×
Radex foot complete minimum 3 views (73630) $343.09 $523 3.1×
Radex Hand Minimum 3 Views (73130) $259.12 $395 2.3×
Radex lower extremity infant minimum 2 views (73592) $164.66 $251 1.5×
Radex Mastoids Compl Minimum 3 Views PR Side (70130) $356.21 $543 2.6×
Radex Nasal Bones Complete Minimum 3 Views (70160) $213.20 $325 1.9×
Radex Ribs Unilateral 2 Views (71100) $342.43 $522 3.1×
Radex shoulder complete minimum 2 views (73030) $388.35 $592 3.5×
Radex Sinuses Paransl < 3 Views (70210) $290.61 $443 2.6×
Radex Spine 1 View Specify Level (72020) $265.68 $405 2.4×
Radex Sternum Minimum 2 Views (71120) $203.36 $310 1.8×
Radex Temporomandble Jt Opn & Clsd Mouth Bilat (70330) $375.89 $573 3.4×
Radex Toe Minimum 2 Views (73660) $183.02 $279 1.6×
Radex upper extremity infant minimum 2 views (73092) $172.53 $263 1.3×
Radex Wrist Complete Minimum 3 Views (73110) $357.52 $545 3.2×
Radiolog exam mandible compl minimum 4 views (70110) $284.05 $433 2.1×
Radiologic Exam Abdomen 3+ Views - Xr Abdomen 3+ Views (74021) $232.22 $354 1.7×
Radiologic exam colon double contrast study (74280) $585.15 $892 2.6×
Radiologic exam colon single contrast study (74270) $352.93 $538 1.6×
Radiologic exam knee complete 4/more views (73564) $445.42 $679 3.3×
Radiologic exam pelvis compl minimum 3 views (72190) $402.78 $614 3.0×
Radiologic Exam Small Int Single Contrast Study (74250) $314.22 $479 1.4×
Radiologic exam swallow function contrast study (74230) $237.47 $362 1.1×
Radiologic exam upr gi trc double contrast study (74246) $787.20 $1,200 3.5×
Radiologic examination femur minimum 2 views (73552) $251.90 $384 2.3×
Radiologic examination knee 1/2 views (73560) $319.47 $487 2.9×
Radiologic Examination Osseous Survey Limited (77074) $266.99 $407 2.0×
Radiologic examination tibia & fibula 2 views (73590) $173.84 $265 1.6×
Rp loclzj tum plnr 1 area single day imaging (78800) $550.89 $821 1.1×
Rp loclzj tum plnr 2+area 1+d img/1 area img>2+d (78801) $587.12 $875 1.1×
Rp Loclzj Tum Plnr Whole Body 2+ Days Imaging (78804) $1,683.54 $2,509 2.4×
Rp Loclzj Tum Spect 1 Area Single Day Imaging (78803) $803.86 $1,198 1.2×
Rp loclzj tum spect 2 area/sep acquisj img (78831) $1,158.82 $1,727 0.7×
Rp loclzj tum spect CT 2area 1d img/1 ar img>2+d (78832) $1,482.91 $2,210 0.8×
Rp loclzj tum spect w/CT 1 area/acquisj 1day img (78830) $1,482.91 $2,210 0.9×
Scapula (73010) $218.45 $333 1.6×
Screening Digital Breast Tomosynthesis Bi (77063) $41.01 $58 1.8×
Shoulder 1 view (73020) $156.13 $238 1.4×
Shoulder Arthrography (73040) $984.87 $930 2.2×
Sialogram (70390) $528.74 $806 1.7×
Skull less than 4 views (70250) $198.77 $303 1.5×
Sternoclavicular joints (71130) $259.12 $395 2.3×
Thoracic spine 2 views (72070) $385.07 $587 2.9×
Thoracic spine 3 views (72072) $487.41 $743 3.6×
Thoracolumbar 2 views (72080) $221.07 $337 2.0×
Thyroid Imaging With Vascular Flow (78013) $522.71 $779 1.0×
Thyroid Met Imaging Body (78018) $879.01 $1,310 1.3×
Thyroid Uptake Measurement (78012) $330.13 $492 0.6×
Thyroid Uptake W/Blood Flow Sngle/Mult Quan Meas (78014) $817.28 $1,218 1.6×
Ultrasound Breast Limited (76642)
range across 3 matching MRF lines		 $506.33–$759.88 $645–$968 varies
Ultrasound elastography first target lesion (76982) $388.58 $495 2.9×
Ultrasound Elastography Parenchyma (76981) $418.41 $533 3.1×
Ultrasound Exam Aaa Screen (76706) $349.32 $445 2.6×
Ultrasound, abdomen limited (76705) $814.83 $1,038 6.1×
Umbilical-artery Doppler (OB) (76820) $255.12 $325 1.9×
Upper gi w/o kub (74240) $737.34 $1,124 3.3×
Ureteral Reflux Study (78740) $555.59 $828 1.1×
Urethrocystogram voiding (74455) $733.41 $1,118 2.4×
Urethrocystography retrograde (74450) $495.28 $755 1.6×
Us breast unilateral complete (76641)
range across 3 matching MRF lines		 $571.48–$857.22 $728–$1,092 varies
Us chest (76604) $458.44 $584 3.4×
Us complete joint (76881) $483.56 $616 3.6×
Us exam, pelvic, limited (76857) $655.48 $835 4.9×
Us head (76506) $506.33 $645 3.8×
Us lmtd joint/oth nonvasc xtr strux r-t w/img (76882) $563.63 $718 4.2×
Us ob detailed single fetus (76811) $649.98 $828 2.1×
Us ob limited 1 or more fetuses (76815) $578.55 $737 4.3×
Us ob transvaginal (76817) $663.32 $845 4.9×
Us pelvic non ob complete (76856) $826.60 $1,053 6.1×
Us pg uter img f&mat 14 wk tabdl 1/1st gestation (76801) $806.98 $1,028 6.0×
Us preg uterus real time f/u trnsabdl per fetus (76816) $569.12 $725 4.2×
Us retroperitoneal complete (76770) $826.60 $1,053 6.1×
Us retroperitoneal limited (76775) $520.46 $663 3.9×
Us scrotum and contents (76870) $762.24 $971 5.7×
Us spinal canal and contents (76800) $313.22 $399 2.3×
Us thyroid (76536) $826.60 $1,053 6.1×
Venography extremity bilateral rs&i (75822) $635.66 $969 0.3×
Venography extremity unilateral rs&i (75820) $514.96 $785 0.3×
Vertebral fracture assessment via dxa (77086) $173.18 $264 1.5×
Wrist 2 views (73100) $148.91 $227 1.3×
X-Ray Ac Jts - Xr Acromioclavicular Joints Bilateral (73050) $211.89 $323 1.9×
X-ray antegrade pyelogram tube (74425) $579.25 $883 1.3×
X-Ray Bend Only L-S Spine (72120) $407.38 $621 3.0×
X-Ray Elbow 2 Vw - Xr Elbow 1-2 Views Right (73070) $149.57 $228 1.3×
X-Ray Exam Breast Specimen (76098) $113.49 $173 0.2×
X-Ray Exam Entire Spi 1 Vw (72081) $202.05 $308 1.8×
X-Ray Exam Entire Spi 4/5 Vw (72083) $461.82 $704 3.4×
X-Ray Exam Hip Uni 1 View (73501) $144.32 $220 1.3×
X-Ray Exam Hip Uni 2-3 Views (73502) $410 $625 3.7×
X-Ray Exam Hips Bi 2 Views (73521) $371.95 $567 2.8×
X-Ray Exam Hips Bi 3-4 Views (73522) $484.13 $738 3.6×
X-Ray Exam L-S Spine Bending (72114) $746.53 $1,138 5.6×
X-Ray Exam Neck Spine 2-3 Vw (72040) $378.51 $577 3.4×
X-Ray Exam Neck Spine 6/>Vws (72052) $619.26 $944 4.6×
X-Ray Exam Unilat Ribs/Chest (71101) $434.93 $663 3.2×
X-ray eye for foreign body (70030) $172.53 $263 1.5×
X-ray humerus (73060) $222.38 $339 2.0×
X-ray IV pyelogram (ivp) (74400) $617.30 $941 2.7×
X-ray IV pyelogram+tomography (74415) $1,210.32 $1,845 5.4×
X-Ray Jaw <4 Vw - Xr Mandible < 4 Views (70100) $154.82 $236 1.4×
X-Ray Knee Bilat Standing - Xr Knees Anteroposterior Standing Bilat (73565) $303.73 $463 2.7×
X-Ray Lumbar Spine 2/3 Vw - Xr Lumbar Spine 2-3 Views (72100) $465.76 $710 3.5×
X-ray nose-rectum child f.b. (76010) $118.74 $181 1.1×
X-Ray Ribs, Chest 4+ Vw - Xr Ribs 3 Vws Bil W/ Chest Posteroanterior (71111) $547.10 $834 4.1×
X-Ray Sacroiliac Jts 3+ Vw - Xr Sacroiliac Joints 3+ Views (72202) $404.75 $617 3.0×
X-Ray Sacroiliac Jts <3 Vw - Xr Sacroiliac Joints 1-2 Views (72200) $240.10 $366 1.8×
X-Ray Sacrum/Coccyx 2+ Vw - Xr Sacrum Coccyx 2+ Views (72220) $223.04 $340 2.0×
X-Ray Sinuses 3+ Vw - Xr Paranasal Sinuses 3+ Views (70220) $331.28 $505 3.0×
X-Ray Skull 4+ Vw - Xr Skull Complete 4+ Views (70260) $297.17 $453 2.2×
X-Ray Stress View (77071) $212.54 $324 1.9×
X-Rays Bone Length Studies (77073) $409.34 $624 3.0×
X-Rays Bone Survey Complete (77075) $289.30 $441 2.2×
Xr c-spine 4 or 5 views (72050) $490.69 $748 3.6×
Xr facial bones less than 3 views (70140) $174.50 $266 1.6×
Xr orbits complete 4 views (70200) $275.52 $420 2.0×
Xr Tomogram Single Plane (76100) $429.02 $654 3.2×

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.