Imaging prices at Campbell County Health

Gillette, WY · every code in this section with a posted price and a Medicare benchmark.

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

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ProcedureCash priceGross charge× Medicare
3-D radiotherapy plan dose-volume histograms (77295) $6,124.05 $6,804.50 4.3×
Abdomen 2 views (74019) $292.50 $325 2.7×
Acute gastrointestinal blood loss imaging (78278) $1,285.20 $1,428 3.1×
Angiography extremity unilateral rs&i (75710) $3,465 $3,850 1.1×
Ankle 2 views (73600) $175.50 $195 2.0×
Antegrade urography radiological supvj & interpj (74425) $404.10 $449 1.1×
Aortogram thoracic (75605) $7,774.20 $8,638 1.4×
Arthrogram elbow (73085) $675 $750 1.9×
Arthrogram hip (73525) $675 $750 1.9×
Arthrogram shoulder (73040) $675 $750 1.9×
Arthrogram wrist (73115) $444.60 $494 1.2×
Arthrography knee lt (73580) $565.65 $628.50 1.6×
Basic radiation dosimetry calculation (77300) $405 $450 2.9×
Bone &/Joint Imaging Limited Area (78300) $997.20 $1,108 2.4×
Bone &/Joint Imaging Multiple Areas (78305) $1,340.10 $1,489 3.3×
Bone &/joint imaging whole body (78306) $1,170 $1,300 2.9×
Bone age studies (77072) $117 $130 1.1×
Bone Imaging 3 Phase (78315) $1,393.20 $1,548 3.4×
Bone survey complete (77075) $495 $550 4.6×
Brain Imaging Pet Metabolic Evaluation (78608) $4,464 $4,960 3.1×
Cervical spine 2 or 3 views (72040) $292.50 $325 3.3×
Chest 1 view (71045) $182.70 $203 2.1×
Chest 3 views (71047) $261.90 $291 2.9×
Cine/Vid X-Ray Throat/Esoph - Fl Esoph Barium Swlw W/ Video & Speech (74230) $400.50 $445 2.2×
Clavicle complete (73000) $182.70 $203 2.1×
Computed Tomography Thorax Lw Dose Lng Ca Scr C- (71271) $315 $350 2.9×
Continuing medical physics consltj pr wk (77336) $615.60 $684 4.5×
CT abdomen and pelvis without and with contrast (74178) $4,041.90 $4,491 11.3×
CT abdomen and pelvis without contrast (74176) $3,150.90 $3,501 12.9×
CT abdomen w contrast (74160) $1,926 $2,140 10.7×
CT abdomen w wo contrast (74170) $2,205 $2,450 12.3×
CT abdomen w/o contrast (74150) $1,665 $1,850 15.6×
CT angiography upper extremity lt (73206) $450 $500 2.5×
CT c-spine w/o contrast (72125) $1,639.80 $1,822 15.4×
CT cervical spine with contrast (72126) $1,777.50 $1,975 5.0×
CT chest w/wo contrast (71270) $2,051.10 $2,279 11.4×
CT chest with contrast (71260) $1,771.20 $1,968 9.9×
CT head/brain with contrast (70460) $1,689.30 $1,877 9.4×
CT head/brain without and with contrast (70470) $1,967.40 $2,186 11.0×
CT heart no contrast quant eval coronry calcium (75571) $180 $200 2.0×
CT iac w contrast (70481) $1,332.90 $1,481 7.4×
CT lower ext w/o (73700) $1,800 $2,000 16.9×
CT lower extremity w wo contrast (73702) $1,646.10 $1,829 9.2×
CT lower extremity with contrast (73701) $1,464.30 $1,627 8.2×
CT lumbar spine w & w/o contrast (72133) $450 $500 2.5×
CT lumbar spine w/o contrast (72131) $1,728 $1,920 16.2×
CT lumbar spine with contrast (72132) $1,867.50 $2,075 5.2×
CT maxillofacial w contrast (70487) $1,755 $1,950 9.8×
CT maxillofacial w/o contrast (70486) $1,471.50 $1,635 13.8×
CT maxillofacial w/wo contrast (70488) $1,723.95 $1,915.50 9.6×
CT neck soft tissue w contrast (70491) $1,651.50 $1,835 9.2×
CT orbit sella/post fossa/ear w/o & w/contr matr (70482) $1,963.80 $2,182 11.0×
CT orbits w/o contrast (70480) $1,210.50 $1,345 11.3×
CT pelvis w & w/o contrast (72194) $1,935.90 $2,151 10.8×
CT pelvis w/o contrast (72192) $1,633.50 $1,815 15.3×
CT soft tissue neck w/o & w/contrast material (70492) $1,883.25 $2,092.50 10.5×
CT soft tissue neck w/o contrast (70490) $1,271.70 $1,413 11.9×
CT thoracic spine w/contrast (72129) $1,866.60 $2,074 10.4×
CT thoracic spine w/o contrast (72128) $1,395 $1,550 13.1×
CT thorax w/o contrast (71250) $1,516.50 $1,685 14.2×
CT upper extremity w/o & w/contrast material (73202) $1,646.10 $1,829 9.2×
CT upper extremity w/o contrast rt (73200) $1,710 $1,900 16.0×
CT upper extremity with contrast (73201) $967.50 $1,075 2.7×
Cta Abdl Aorta&Bi Iliofem W/Contrast&Postp (75635) $2,380.50 $2,645 13.3×
Cta Abdomen (74175) $2,110.50 $2,345 11.8×
CTA abdomen pelvis (74174) $2,651.40 $2,946 7.4×
CTA chest (71275) $1,855.80 $2,062 10.4×
Cta Head (70496) $1,715.40 $1,906 9.6×
CTA lwr ext w&w/o contrast (73706) $1,645.20 $1,828 9.2×
Cta Neck (70498) $1,730.70 $1,923 9.7×
Cta Pelvis (72191) $2,110.50 $2,345 11.8×
Cystography minimum 3 views rs&i (74430) $427.50 $475 1.2×
Dxa bone density study 1/> sites axial skel (77080) $461.25 $512.50 4.3×
Dxa bone density study 1/>sites appendiclr skel (77081) $290.70 $323 3.3×
Echoencephalography real time imaging (76506) $417.15 $463.50 3.9×
Esophagus (74220) $574.20 $638 3.2×
Fetal biophysical profile non-stress testing (76818) $393.30 $437 3.7×
Fluoroscopy up to 1 hr (76000) $489.60 $544 2.0×
Foot 2 views (73620) $226.80 $252 2.6×
Forearm 2 views (73090) $220.50 $245 2.5×
Hand 2 views (73120) $211.50 $235 2.0×
Hand 3 views (73130) $231.30 $257 2.6×
Hepatobil Syst Imag Inc Gb W/Pharma Intervenj (78227) $1,305 $1,450 2.4×
Hepatobiliary syst imaging including gallbladder (78226) $1,175.85 $1,306.50 2.9×
Ht muscle image spect sing (78451) $3,006 $3,340 2.3×
Humerus Min 2 Views Left (73060) $198 $220 2.2×
Hysterosalpingogram (74740) $509.40 $566 2.1×
Kidney Img Morphology Vascular Flow 1 W/O Rx (78707) $1,486.80 $1,652 2.7×
Kidney img morphology vascular flow 1 w/rx (78708) $1,486.80 $1,652 2.7×
Kidney Img Morphology Vascular Flow Multiple (78709) $1,486.80 $1,652 2.7×
Knee 3 views (73562) $220.50 $245 2.5×
Lymphoscintigraphy (78195) $1,305 $1,450 2.4×
Meckels Diverticulum (78290) $778.95 $865.50 1.9×
Mlc imrt design & construction per imrt plan (77338) $4,010.40 $4,456 10.5×
MRA head w/o contrast (70544) $1,215 $1,350 5.0×
MRA neck w contrast (70548) $1,080 $1,200 3.0×
Mra Neck W/O &W/Contrast Material (70549) $1,719 $1,910 4.8×
MRA neck w/o contrast (70547) $1,035 $1,150 4.2×
MRI abdomen w/o & w/contrast material (74183) $1,942.20 $2,158 5.4×
MRI abdomen w/o contrast (74181) $1,668.60 $1,854 6.8×
MRI any jnt lwr ext with con lt (73722) $2,155.50 $2,395 2.7×
MRI any jt upper extremity w/contrast matrl (73222) $2,155.50 $2,395 2.7×
MRI breast w/o contrast bilateral (77047) $1,832.40 $2,036 7.5×
MRI c-spine with contrast (72142) $2,062.80 $2,292 5.8×
MRI cervical spine w/o contrast (72141) $1,941.75 $2,157.50 8.0×
MRI chest w/o & w/contrast material (71552) $2,246.40 $2,496 6.3×
MRI chest w/o contrast (71550) $1,602 $1,780 6.6×
MRI Forearm w/ Contrast Bilateral 73219 (73219) $652.50 $725 1.8×
MRI lower extrem oth/thn jt w/contrast matrl (73719) $652.50 $725 1.8×
MRI lower extrem oth/thn jt w/o contr matrl (73718) $1,786.50 $1,985 7.3×
MRI orbit face &/neck w/o contrast (70540) $1,337.85 $1,486.50 5.5×
MRI orbit/face/neck w&w/o cont (70543) $2,465.10 $2,739 6.9×
MRI orbit/face/neck w/contrast (70542) $1,080 $1,200 3.0×
MRI pelvis w contrast (72196) $2,726.10 $3,029 7.6×
MRI pelvis w/o & w/contrast material (72197) $2,726.10 $3,029 7.6×
MRI pelvis w/o contrast (72195) $1,687.50 $1,875 6.9×
MRI scan of arm joint before and after contrast (73223) $2,313 $2,570 6.5×
MRI scan of leg joint before and after contrast (73723) $2,313 $2,570 6.5×
MRI spinal canal cervical w/o & w/contr matrl (72156) $2,811.60 $3,124 7.9×
MRI spinal canal lumbar w/contrast material (72149) $2,255.40 $2,506 6.3×
MRI spinal canal lumbar w/o & w/contr matrl (72158) $2,848.50 $3,165 8.0×
MRI spinal canal thoracic w/contrast matrl (72147) $2,061.90 $2,291 5.8×
MRI spinal canal thoracic w/o & w/contr matrl (72157) $2,811.60 $3,124 7.9×
MRI thoracic spine w/o contrast (72146) $1,827 $2,030 7.5×
MRI upper ext joint w/o contrast (73221) $1,957.50 $2,175 8.0×
MRI upper extrem other than jt w/o & w/contras (73220) $2,009.70 $2,233 5.6×
MRI upper extremity oth than jt w/o contr matrl (73218) $1,310.40 $1,456 5.4×
Myocardial Spect Multiple Studies (78452) $3,433.50 $3,815 2.6×
N-Invas Est C Ffr Augmnt Sw Alys Cta I&R Phy/Qhp (75580) $2,893.05 $3,214.50 3.3×
Neck soft tissue (70360) $103.50 $115 1.2×
Nm gastric emptying study (78264) $1,170 $1,300 2.9×
Ntsty modul radthx pln dose-vol histos (77301) $6,581.70 $7,313 4.7×
Nuclear Rx Oral Admin (79005) $747 $830 3.1×
Osseous survey infant (77076) $191.25 $212.50 1.8×
Osseous survey limited (77074) $238.50 $265 2.2×
Parathyrd planar w/spect&CT (78072) $1,484.10 $1,649 2.7×
Parathyrd planar w/wo subtrj (78071) $1,945.80 $2,162 4.8×
Pelvis 1 or 2 views (72170) $211.50 $235 2.0×
PET image w/CT, skull-thigh (78815) $5,978.70 $6,643 4.1×
PET imaging for CT attenuation whole body (78816) $6,632.10 $7,369 4.5×
Pr MRI, lower extr, w/o contrast f/u by contrast (73720) $2,312.55 $2,569.50 6.5×
Pulmonary Perfusion Imaging Particulate (78580) $1,159.20 $1,288 2.8×
Pulmonary Ventilation & Perfusion Imaging (78582) $1,486.80 $1,652 2.7×
Radex abscess/fistula/sinus tract rs&i (76080) $549.45 $610.50 1.0×
Radex Entir Thrc Lmbr Crv Sac Spi W/Skull 1 Vw - Xr Scoliosis 1 Vw (72081) $130.50 $145 1.5×
Radex entir thrc lmbr crv sac spi w/skull 2/3 vw (72082) $355.50 $395 3.3×
Radex hips bilateral with pelvis 2 views (73521) $238.50 $265 2.2×
Radiation treatment delivery 1 mev >= complex (77412) $646.20 $718 1.1×
Radiation treatment delivery 1 mev >= simple (77402) $294.30 $327 2.8×
Radiologic Exam Abdomen 1 View - Xr Abdomen 1 View (74018) $212.40 $236 2.4×
Radiologic Exam Chest 2 Views - Xr Chest 2 Views (71046) $225 $250 2.5×
Radiologic exam colon single contrast study (74270) $437.40 $486 2.4×
Radiologic Exam Esophagus Double Contrast Study (74221) $574.20 $638 3.2×
Radiologic exam upr gi trc double contrast study (74246) $574.20 $638 3.2×
Radiologic exam upr gi trc single contrast study (74240) $544.50 $605 3.0×
Radiologic Examination Femur Minimum 2 Views - Xr Femur 2+ Vw Lt (73552) $202.50 $225 2.3×
Radiological examination surgical specimen (76098) $553.50 $615 1.0×
Ribs bilateral 3 views (71110) $301.50 $335 2.8×
Rp loclzj tum spect 1 area single day imaging (78803) $1,800 $2,000 3.2×
Rp loclzj tum spect CT 2area 1d img/1 ar img>2+d (78832) $2,745.90 $3,051 1.9×
Rp loclzj tum spect w/CT 1 area 1 day imaging (78830) $2,448 $2,720 1.9×
Sacroiliac Joints < 3 Views (72200) $202.50 $225 1.9×
Scanogram (77073) $261 $290 2.4×
Scapula complete (73010) $225 $250 2.1×
Screening digital breast tomosynthesis (77063) $77.40 $86 3.3×
Small bowel series (74250) $437.40 $486 2.4×
Spec medical radj physics consltj (77370) $600.75 $667.50 4.4×
Special dosimetry (77331) $397.80 $442 2.9×
Special treatment procedure (77470) $1,800 $2,000 3.2×
Spine thoracic 3 views (72072) $2,285.10 $2,539 21.4×
Telethx isodose pln cplx w/basic dosimetry (77307) $2,536.20 $2,818 6.6×
Telethx isodose pln smpl w/dosimetry calculation (77306) $2,077.65 $2,308.50 5.4×
Ther rad simulaj-aided field setting complex (77290) $1,190.70 $1,323 3.1×
Ther rad simulaj-aided field setting simple (77280) $1,642.50 $1,825 12.0×
Therapeutic Enema (74283) $735.75 $817.50 4.1×
Thoracolumbar 2 views (72080) $229.50 $255 2.6×
Thyroid carcinoma metastases img whole body (78018) $913.05 $1,014.50 1.6×
Thyroid Uptake W/Blood Flow Sngle/Mult Quan Meas (78014) $1,170 $1,300 2.9×
Treatment device intermediate (77333) $1,030.50 $1,145 7.5×
Treatment devices simple (77332) $495 $550 3.6×
Tx devices design & construction complex (77334) $1,190.70 $1,323 3.1×
Ultrasound, abdomen limited (76705) $509.85 $566.50 4.8×
Unlisted fluoroscopic procedure (76496) $278.10 $309 3.1×
Unlisted Ultrasound Procedure (76999) $252 $280 2.8×
Upper Extremity Infant (73092) $140.85 $156.50 1.3×
Urethrocystography retrograde rs&i (74450) $436.50 $485 1.8×
Urethrocystography voiding (74455) $436.50 $485 1.8×
Urography (pyelography), intravenous, with or without KUB, with or without tomography (74400) $552.60 $614 3.1×
Us abdl aorta screen aaa (76706) $364.50 $405 3.4×
Us breast unilateral complete (76641) $270 $300 2.5×
Us breast unilateral limited (76642) $337.50 $375 3.8×
Us chest (76604) $270 $300 2.5×
Us infant hips dynamic (76885) $256.95 $285.50 2.9×
Us kidney transplant (76776) $1,149.30 $1,277 10.8×
Us ob transvaginal (76817) $558 $620 5.2×
Us pelvic non ob complete (76856) $560.70 $623 5.2×
Us pelvic nonobstetric image dcmtn limited/f/u (76857) $472.50 $525 4.4×
Us pregnancy ltd (76815) $253.80 $282 2.4×
Us pregnant uterus 14 wk transabdl 1/1st gestat (76801) $536.85 $596.50 5.0×
Us retroperitoneal complete (76770) $972.90 $1,081 9.1×
Us retroperitoneal limited (76775) $441.90 $491 4.1×
Us scrotum and contents (76870) $541.80 $602 5.1×
Us soft tissue head/neck (76536) $486 $540 4.6×
Us xtr non-vasc lmtd (76882) $355.50 $395 3.3×
Venogram extremity bilateral (75822) $2,547.45 $2,830.50 1.6×
Venography caval inferior serialography rs&i (75825) $3,589.29 $3,988.10 1.1×
Venography caval superior serialography rs&i (75827) $2,011.95 $2,235.50 1.3×
Venography extremity unilateral rs&i (75820) $1,987.65 $2,208.50 1.2×
Wrist 2 views (73100) $198 $220 2.2×
X-Ray Abdomen,Comp Acute Series - Xr Abdomen 2 Vws With Chest 1 View (74022) $349.20 $388 3.3×
X-Ray Ac Jts - Xr Acromioclavicular Joints Bilateral (73050) $179.55 $199.50 2.0×
X-Ray Ankle 3+ Vw - Xr Ankle 3+ Views Right (73610) $226.80 $252 2.6×
X-Ray Colon Air Contrast - Fl Barium Enema Air Contrast (74280) $713.70 $793 4.0×
X-Ray Elbow 2 Vw - Xr Elbow 1-2 Views Right (73070) $193.50 $215 2.2×
X-Ray Elbow 3+ Vw - Xr Elbow 3+ Views Right (73080) $247.50 $275 2.8×
X-ray exam hip uni 1 view (73501) $180 $200 2.0×
X-Ray Exam Hip Uni 2-3 Views (73502) $198 $220 2.2×
X-ray exam hip uni 4/> views (73503) $215.10 $239 2.0×
X-Ray Exam Hips Bi 3-4 Views (73522) $301.50 $335 2.8×
X-Ray Exam Hips Bi 5/> Views (73523) $522 $580 4.9×
X-ray exam of femur 1 (73551) $238.50 $265 2.7×
X-ray eye for foreign body (70030) $306 $340 3.4×
X-Ray Facial Bones 3+ Vw - Xr Facial Bones 3+ Views (70150) $249.30 $277 2.3×
X-Ray Facial Bones <3 Vw - Xr Facial Bones 1-2 Views (70140) $133.20 $148 1.5×
X-Ray Foot 3+ Vw - Xr Foot 3+ Views Right (73630) $226.80 $252 2.6×
X-Ray Heel - Xr Calcaneus 2 Views Right (73650) $171 $190 1.9×
X-Ray Knee 4+ View - Xr Knee 4+ Views Right (73564) $229.50 $255 2.1×
X-Ray Leg, Infant - Xr Lower Extremity 2+ Views Infant Left (73592) $145.35 $161.50 1.6×
X-Ray Lumbar Spine 2/3 Vw - Xr Lumbar Spine 2-3 Views (72100) $274.50 $305 2.6×
X-Ray Lumbar Spine 6+ Vw - Xr Lumbar Spine 6+ Vws Including Bending (72114) $387.90 $431 3.6×
X-Ray Lumbar Spine Flex/Exten - Xr Lumbar Spine 4+ Views W/ Flex Ext (72120) $256.50 $285 2.4×
X-Ray Nasal Bones - Xr Nasal Bones (70160) $168.75 $187.50 1.9×
X-Ray Nose-Rectum Child F.B. - Xr Nose to Rectum Foreign Body Peds (76010) $152.55 $169.50 1.7×
X-Ray Orbits - Xr Orbits Complete 4+ Views (70200) $225.45 $250.50 2.1×
X-Ray Pelvis 3+ Vw - Xr Pelvis 3+ Views (72190) $193.50 $215 1.8×
X-Ray Retrograde Pyelogram - Fl Pyelogram Retrograde (74420) $659.70 $733 1.9×
X-Ray Ribs 2 Vw Unilat - Xr Ribs 2 Views Right (71100) $193.50 $215 2.2×
X-Ray Ribs, Chest 3+ Vw - Xr Ribs 2 Vws Lt W/ Chest Anteroposterior (71101) $274.50 $305 2.6×
X-Ray Ribs, Chest 4+ Vw - Xr Ribs 3 Vws Bil W/ Chest Posteroanterior (71111) $301.50 $335 2.8×
X-Ray Sacroiliac Jts 3+ Vw - Xr Sacroiliac Joints 3+ Views (72202) $292.50 $325 2.7×
X-Ray Sacrum/Coccyx 2+ Vw - Xr Sacrum Coccyx 2+ Views (72220) $180 $200 2.0×
X-Ray Shoulder 2+ Vw - Xr Shoulder 2+ Views Right (73030) $230.40 $256 2.6×
X-Ray Sinuses 3+ Vw - Xr Paranasal Sinuses 3+ Views (70220) $267.30 $297 3.0×
X-Ray Sinuses <3 Vw - Xr Paranasal Sinuses 1-2 Views (70210) $172.35 $191.50 1.9×
X-Ray Skull 4+ Vw - Xr Skull Complete 4+ Views (70260) $346.95 $385.50 3.2×
X-Ray Skull <4 Vw - Xr Skull 1-3 Views (70250) $148.50 $165 1.4×
X-Ray Spine One View - Xr Spine (72020) $139.50 $155 1.6×
X-Ray Sterno-Clavicluar Jt - Xr Sternoclavicular Joints 3+ Views (71130) $181.35 $201.50 2.0×
X-Ray Sternum 2+ Vw - Xr Sternum 2+ Views (71120) $207 $230 2.3×
X-Ray Thoracic Spine 2 Vw - Xr Thoracic Spine 2 Views (72070) $352.80 $392 3.3×
X-Ray Toe(S) - Xr Toes 2+ Views Right (73660) $177.30 $197 2.0×
X-Ray Wrist 3+ Vw - Xr Wrist 3+ Views Right (73110) $220.50 $245 2.5×
Xr c-spine 6 or more views (72052) $553.50 $615 5.2×
Xr chest 4+ views (71048) $352.80 $392 3.3×
Xr finger(s) 2+ views (73140) $198 $220 2.2×
Xr shoulder 1 view (73020) $148.50 $165 1.7×
Xr spine cervical 4 or 5 views (72050) $367.20 $408 3.4×
Xr tibia/fibula 2 views (73590) $175.50 $195 2.0×
Xr tmj bilateral (70330) $208.80 $232 2.3×
Xray knee 1 or 2 views rt (73560) $202.50 $225 2.3×