Imaging prices at Benefis Teton Medical Center
Choteau, MT · every code in this section with a posted price and a Medicare benchmark.
123 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) | $174.60 | $291 | 2.0× |
| Abdomen 2 views (74019) | $247.80 | $413 | 2.3× |
| Ankle 2 views (73600) | $171.60 | $286 | 1.9× |
| Bone age studies (77072) | $135.60 | $226 | 1.3× |
| Bone survey infant (77076) | $296.40 | $494 | 2.8× |
| Chest 1 view (71045) | $180 | $300 | 2.0× |
| Chest 2 views (71046) | $190.80 | $318 | 2.1× |
| Chest 3 views (71047) | $241.20 | $402 | 2.7× |
| Chest 4 or more views (71048) | $241.20 | $402 | 2.3× |
| Clavicle complete (73000) | $172.20 | $287 | 1.9× |
| Computed Tomography Thorax Lw Dose Lng Ca Scr C- (71271) | $247.20 | $412 | 2.3× |
| CT abdomen and pelvis without and with contrast (74178) | $2,508 | $4,180 | 7.0× |
| CT abdomen and pelvis without contrast (74176) | $1,774.20 | $2,957 | 7.3× |
| CT abdomen w contrast (74160) | $1,399.20 | $2,332 | 7.8× |
| CT abdomen w wo contrast (74170) | $1,693.80 | $2,823 | 9.5× |
| CT abdomen w/o contrast (74150) | $892.20 | $1,487 | 8.4× |
| CT Angio Abdomen and Pelvis (74174) | $1,699.80 | $2,833 | 4.8× |
| CT Angio Chest (71275) | $1,544.40 | $2,574 | 8.6× |
| CT cervical spine w/ contrast (72126) | $1,141.20 | $1,902 | 3.2× |
| CT cervical spine w/o contrast (72125) | $1,102.20 | $1,837 | 10.3× |
| CT cervical spine w/wo cont (72127) | $1,339.80 | $2,233 | 7.5× |
| CT chest w contrast (71260) | $1,373.40 | $2,289 | 7.7× |
| CT chest w/wo contrast (71270) | $1,221 | $2,035 | 6.8× |
| CT head/brain with contrast (70460) | $937.80 | $1,563 | 5.2× |
| CT head/brain without and with contrast (70470) | $1,129.80 | $1,883 | 6.3× |
| CT iac w contrast (70481) | $943.20 | $1,572 | 5.3× |
| CT l-spine w&w/o contrast (72133) | $1,332.60 | $2,221 | 7.4× |
| CT lower ext w/o (73700) range across 6 matching MRF lines |
$896.40–$1,033.80 | $1,494–$1,723 | varies |
| CT lower extremity w/contrast material (73701) | $1,116.60 | $1,861 | 6.2× |
| CT lumbar spine w contrast (72132) | $1,117.20 | $1,862 | 3.1× |
| CT lumbar spine w/o contrast (72131) | $1,161 | $1,935 | 10.9× |
| CT maxillofacial w contrast (70487) | $963.60 | $1,606 | 5.4× |
| CT maxillofacial wo contrast (70486) | $900 | $1,500 | 8.4× |
| CT neck tissue combo (70492) | $1,132.20 | $1,887 | 6.3× |
| Ct Orbit/Ear/Fossa W/O&W/Dye (70482) | $1,063.80 | $1,773 | 5.9× |
| CT orbits w/o contrast (70480) | $809.40 | $1,349 | 7.6× |
| CT pelvis w&w/o contrast (72194) | $1,197 | $1,995 | 6.7× |
| CT pelvis w/o contrast (72192) | $1,181.40 | $1,969 | 11.1× |
| CT scan of leg combo (73702) | $1,293.60 | $2,156 | 7.2× |
| CT scans face/jaw combo (70488) | $1,420.20 | $2,367 | 7.9× |
| CT soft tissue neck w contrast (70491) | $1,272 | $2,120 | 7.1× |
| CT soft tissue neck w/o contrast (70490) | $1,048.80 | $1,748 | 9.8× |
| CT thoracic spine w contrast (72129) | $1,350.60 | $2,251 | 7.5× |
| CT thoracic spine w/o contrast (72128) | $958.20 | $1,597 | 9.0× |
| CT thoracic spine w/wo cont (72130) | $1,332.60 | $2,221 | 7.4× |
| CT thorax w/o contrast (71250) | $1,174.20 | $1,957 | 11.0× |
| CT upper ext wo (73200) range across 6 matching MRF lines |
$896.40–$934.20 | $1,494–$1,557 | varies |
| CT upper extremity w/o & w/contrast material (73202) | $1,189.20 | $1,982 | 6.6× |
| CT upper extremity with contrast (73201) | $963 | $1,605 | 2.7× |
| CTA head&neck c+ w/noncontrast img&post-pxessing (70471) | $2,496.60 | $4,161 | 7.0× |
| Dxa Bone Density Axial (77080) | $295.20 | $492 | 2.8× |
| Foot 2 views (73620) range across 2 matching MRF lines |
$156.60–$234.90 | $261–$391.50 | varies |
| Forearm 2 views (73090) | $171.60 | $286 | 1.9× |
| Hand 2 views (73120) range across 2 matching MRF lines |
$180.60–$270.90 | $301–$451.50 | varies |
| Knee 3 Views (73562) range across 2 matching MRF lines |
$223.20–$334.80 | $372–$558 | varies |
| Neck soft tissue (70360) | $137.40 | $229 | 1.5× |
| Optic foramina (70190) | $190.20 | $317 | 2.1× |
| Pelvis 1 or 2 views (72170) | $196.80 | $328 | 1.8× |
| Radex Abd Compl Aqt Abd W/S/E/D Views 1 View Ch (74022) | $291.60 | $486 | 2.7× |
| Radex Ankle Complete Minimum 3 Views (73610) range across 2 matching MRF lines |
$207.60–$311.40 | $346–$519 | varies |
| Radex Calcaneus Minimum 2 Views (73650) | $168 | $280 | 1.9× |
| Radex elbow complete minimum 3 views (73080) | $209.40 | $349 | 2.4× |
| Radex Facial Bones Complete Minimum 3 Views (70150) | $224.40 | $374 | 2.1× |
| Radex fingr minimum 2 views (73140) | $150.60 | $251 | 1.7× |
| Radex foot complete minimum 3 views (73630) range across 2 matching MRF lines |
$210–$315 | $350–$525 | varies |
| Radex Hand Minimum 3 Views (73130) range across 2 matching MRF lines |
$204–$306 | $340–$510 | varies |
| Radex Mastoids Compl Minimum 3 Views PR Side (70130) | $336 | $560 | 3.1× |
| Radex Nasal Bones Complete Minimum 3 Views (70160) | $186.60 | $311 | 2.1× |
| Radex Ribs Unilateral 2 Views (71100) | $224.40 | $374 | 2.5× |
| Radex shoulder complete minimum 2 views (73030) range across 2 matching MRF lines |
$189.60–$284.40 | $316–$474 | varies |
| Radex Sinuses Paransl < 3 Views (70210) | $121.20 | $202 | 1.4× |
| Radex Spine 1 View Specify Level (72020) | $187.80 | $313 | 2.1× |
| Radex Sternum Minimum 2 Views (71120) | $137.40 | $229 | 1.5× |
| Radex Temporomandble Jt Opn & Clsd Mouth Bilat (70330) | $143.40 | $239 | 1.6× |
| Radex Toe Minimum 2 Views (73660) | $147 | $245 | 1.7× |
| Radex Wrist Complete Minimum 3 Views (73110) range across 2 matching MRF lines |
$193.20–$289.80 | $322–$483 | varies |
| Radiolog exam mandible compl minimum 4 views (70110) | $286.80 | $478 | 2.7× |
| Radiologic Exam Abdomen 3+ Views - Xr Abdomen 3+ Views (74021) | $258.60 | $431 | 2.4× |
| Radiologic exam knee complete 4/more views (73564) range across 2 matching MRF lines |
$231.60–$347.40 | $386–$579 | varies |
| Radiologic exam pelvis compl minimum 3 views (72190) | $159.60 | $266 | 1.5× |
| Radiologic examination femur 1 view (73551) | $99 | $165 | 1.1× |
| Radiologic examination femur minimum 2 views (73552) | $189 | $315 | 2.1× |
| Radiologic examination knee 1/2 views (73560) range across 2 matching MRF lines |
$173.40–$260.10 | $289–$433.50 | varies |
| Radiologic examination tibia & fibula 2 views (73590) | $188.40 | $314 | 2.1× |
| Ribs bilateral 3 views (71110) | $208.20 | $347 | 1.9× |
| Scapula (73010) | $155.40 | $259 | 1.5× |
| Screening Digital Breast Tomosynthesis Bi (77063) range across 2 matching MRF lines |
$50.40–$73.80 | $84–$123 | varies |
| Shoulder 1 view (73020) | $156 | $260 | 1.8× |
| Skull less than 4 views (70250) | $173.40 | $289 | 1.6× |
| Sternoclavicular joints (71130) | $137.40 | $229 | 1.5× |
| Thoracic spine 2 views (72070) | $212.40 | $354 | 2.0× |
| Thoracic spine 3 views (72072) | $264 | $440 | 2.5× |
| Thoracolumbar 2 views (72080) | $203.40 | $339 | 2.3× |
| Wrist 2 views (73100) range across 2 matching MRF lines |
$166.20–$249.30 | $277–$415.50 | varies |
| X-Ray Ac Jts - Xr Acromioclavicular Joints Bilateral (73050) | $141 | $235 | 1.6× |
| X-Ray Bend Only L-S Spine (72120) | $216.60 | $361 | 2.0× |
| X-Ray Elbow 2 Vw - Xr Elbow 1-2 Views Right (73070) | $175.80 | $293 | 2.0× |
| X-Ray Exam Entire Spi 2/3 Vw (72082) | $187.80 | $313 | 1.8× |
| X-Ray Exam Entire Spi 4/5 Vw (72083) | $316.80 | $528 | 3.0× |
| X-Ray Exam Hip Uni 1 View (73501) | $120.60 | $201 | 1.4× |
| X-Ray Exam Hip Uni 2-3 Views (73502) | $208.20 | $347 | 2.3× |
| X-Ray Exam Hips Bi 2 Views (73521) | $265.20 | $442 | 2.5× |
| X-Ray Exam Hips Bi 3-4 Views (73522) | $181.80 | $303 | 1.7× |
| X-Ray Exam L-S Spine Bending (72114) | $272.40 | $454 | 2.6× |
| X-Ray Exam Neck Spine 2-3 Vw (72040) | $217.80 | $363 | 2.4× |
| X-Ray Exam Neck Spine 6/>Vws (72052) | $346.80 | $578 | 3.2× |
| X-Ray Exam Unilat Ribs/Chest (71101) | $261.60 | $436 | 2.4× |
| X-ray eye for foreign body (70030) | $144 | $240 | 1.6× |
| X-ray humerus (73060) | $168.60 | $281 | 1.9× |
| X-Ray Jaw <4 Vw - Xr Mandible < 4 Views (70100) | $132 | $220 | 1.5× |
| X-Ray Knee Bilat Standing - Xr Knees Anteroposterior Standing Bilat (73565) | $229.80 | $383 | 2.6× |
| X-Ray Lumbar Spine 2/3 Vw - Xr Lumbar Spine 2-3 Views (72100) | $215.40 | $359 | 2.0× |
| X-Ray Ribs, Chest 4+ Vw - Xr Ribs 3 Vws Bil W/ Chest Posteroanterior (71111) | $324.60 | $541 | 3.0× |
| X-Ray Sacroiliac Jts 3+ Vw - Xr Sacroiliac Joints 3+ Views (72202) | $214.80 | $358 | 2.0× |
| X-Ray Sacroiliac Jts <3 Vw - Xr Sacroiliac Joints 1-2 Views (72200) | $132 | $220 | 1.2× |
| X-Ray Sacrum/Coccyx 2+ Vw - Xr Sacrum Coccyx 2+ Views (72220) | $207 | $345 | 2.3× |
| X-Ray Sinuses 3+ Vw - Xr Paranasal Sinuses 3+ Views (70220) | $141 | $235 | 1.6× |
| X-Ray Skull 4+ Vw - Xr Skull Complete 4+ Views (70260) | $216.60 | $361 | 2.0× |
| X-Ray Tmj Unilat (70328) | $190.20 | $317 | 2.1× |
| X-Rays Bone Survey Complete (77075) | $307.80 | $513 | 2.9× |
| Xr c-spine 4 or 5 views (72050) | $308.40 | $514 | 2.9× |
| Xr facial bones less than 3 views (70140) | $162 | $270 | 1.8× |
| XR Mastoids < 3 Views Bilateral (70120) | $111 | $185 | 1.0× |
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.