Imaging prices at Memorial Hospital of Converse County

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

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

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ProcedureCash priceGross charge× Medicare
Abdomen 2 views (74019) $277.59 $487 2.6×
Acute gastrointestinal blood loss imaging (78278) $943.35 $1,655 2.3×
Ankle 2 views (73600) $223.72 $392.50 2.5×
Arthrogram hip (73525) $664.05 $1,165 1.9×
Arthrogram shoulder (73040) $764.08 $1,340.50 2.1×
Arthrogram wrist (73115) $484.50 $850 1.4×
Arthrography knee lt (73580) $524.97 $921 1.5×
Bone &/Joint Imaging Limited Area (78300) $1,557.81 $2,733 3.8×
Bone &/Joint Imaging Multiple Areas (78305) $1,700.88 $2,984 4.2×
Bone &/joint imaging whole body (78306) $1,610.25 $2,825 3.9×
Bone age studies (77072) $234.84 $412 2.2×
Bone Imaging 3 Phase (78315) $1,760.73 $3,089 4.3×
Bone survey complete (77075) $581.40 $1,020 5.4×
Card Bl Pool Gated Spect Rest Wal Motn Ejct Frct (78494) $978.12 $1,716 2.4×
Cervical spine 2 or 3 views (72040) $296.40 $520 3.3×
Chest 1 view (71045) $192.94 $338.50 2.2×
Clavicle complete (73000) $251.37 $441 2.8×
Computed Tomography Thorax Lw Dose Lng Ca Scr C- (71271) $172.71 $303 1.6×
CT abdomen and pelvis without and with contrast (74178) $3,034.96 $5,324.50 8.5×
CT abdomen and pelvis without contrast (74176) $2,931.51 $5,143 12.0×
CT abdomen w contrast (74160) $1,784.67 $3,131 10.0×
CT abdomen w wo contrast (74170) $2,142.34 $3,758.50 12.0×
CT abdomen w/o contrast (74150) $1,583.46 $2,778 14.8×
CT angio hrt w/3d image (75574) $1,224.93 $2,149 3.4×
CT angiography upper extremity lt (73206) $1,962.51 $3,443 11.0×
CT c-spine w/o contrast (72125) $1,723.96 $3,024.50 16.1×
CT cervical spine w&w/o contrast (72127) $2,803.26 $4,918 15.6×
CT cervical spine with contrast (72126) $2,040.32 $3,579.50 5.7×
CT chest w/wo contrast (71270) $2,109.86 $3,701.50 11.8×
CT chest with contrast (71260) $1,708.58 $2,997.50 9.5×
CT head/brain with contrast (70460) $1,421.86 $2,494.50 7.9×
CT head/brain without and with contrast (70470) $1,959.94 $3,438.50 10.9×
CT heart no contrast quant eval coronry calcium (75571) $107.73 $189 1.2×
CT iac w contrast (70481) $1,781.82 $3,126 9.9×
CT lower ext w/o (73700) $1,444.95 $2,535 13.5×
CT lower extremity w wo contrast (73702) $3,559.08 $6,244 19.9×
CT lower extremity with contrast (73701) $1,543.56 $2,708 8.6×
CT lumbar spine w & w/o contrast (72133) $2,972.55 $5,215 16.6×
CT lumbar spine w/o contrast (72131) $1,728.81 $3,033 16.2×
CT lumbar spine with contrast (72132) $1,942.84 $3,408.50 5.5×
CT maxillofacial w contrast (70487) $1,737.08 $3,047.50 9.7×
CT maxillofacial w/o contrast (70486) $1,266.82 $2,222.50 11.9×
CT maxillofacial w/wo contrast (70488) $2,361.80 $4,143.50 13.2×
CT neck soft tissue w contrast (70491) $1,687.48 $2,960.50 9.4×
CT orbit sella/post fossa/ear w/o & w/contr matr (70482) $2,020.94 $3,545.50 11.3×
CT orbits w/o contrast (70480) $1,352.04 $2,372 12.7×
CT pelvis w & w/o contrast (72194) $2,251.50 $3,950 12.6×
CT pelvis w/o contrast (72192) $1,490.26 $2,614.50 14.0×
CT scan for measuring calcium and other minerals in bone (77078) $482.22 $846 5.4×
CT soft tissue neck w/o & w/contrast material (70492) $2,003.55 $3,515 11.2×
CT soft tissue neck w/o contrast (70490) $1,534.44 $2,692 14.4×
CT thoracic spine w/contrast (72129) $2,156.31 $3,783 12.0×
CT thoracic spine w/o contrast (72128) $2,106.72 $3,696 19.7×
CT thoracic spine w/wo contrast (72130) $2,595.21 $4,553 14.5×
CT thorax w/o contrast (71250) $1,410.18 $2,474 13.2×
CT upper extremity w/o & w/contrast material (73202) $2,754.81 $4,833 15.4×
CT upper extremity w/o contrast rt (73200) $1,385.38 $2,430.50 13.0×
CT upper extremity with contrast (73201) $1,809.46 $3,174.50 5.1×
Cta Abdl Aorta&Bi Iliofem W/Contrast&Postp (75635) $2,262.62 $3,969.50 12.6×
Cta Abdomen (74175) $2,255.49 $3,957 12.6×
CTA abdomen pelvis (74174) $4,008.24 $7,032 11.2×
CTA chest (71275) $1,887.84 $3,312 10.5×
Cta Head (70496) $1,767 $3,100 9.9×
CTA lwr ext w&w/o contrast (73706) $2,273.16 $3,988 12.7×
Cta Neck (70498) $1,897.53 $3,329 10.6×
Cta Pelvis (72191) $2,876.79 $5,047 16.1×
Cystography minimum 3 views rs&i (74430) $385.89 $677 1.1×
Diskogram cervical (72285) $110.58 $194 0.1×
Diskography lumbar (72295) $78.09 $137 0.0×
Dxa bone density study 1/> sites axial skel (77080) $309.80 $543.50 2.9×
Esophagus (74220) $472.82 $829.50 2.6×
Fetal biophysical profile non-stress testing (76818) $369.36 $648 3.5×
Fetal Biophysical Profile W/O Non-Stress Testing (76819) $545.49 $957 5.1×
Foot 2 views (73620) $205.48 $360.50 2.3×
Forearm 2 views (73090) $239.68 $420.50 2.7×
Gastric mucosa imaging (78261) $719.34 $1,262 1.8×
Gated Heart Planar Single (78472) $1,654.14 $2,902 4.0×
Hand 2 views (73120) $243.68 $427.50 2.3×
Hand 3 views (73130) $263.91 $463 3.0×
Hepatobil Syst Imag Inc Gb W/Pharma Intervenj (78227) $895.18 $1,570.50 1.6×
Hepatobiliary syst imaging including gallbladder (78226) $788.88 $1,384 1.9×
Ht muscle image spect sing (78451) $5,527.86 $9,698 4.2×
Humerus Min 2 Views Left (73060) $206.06 $361.50 2.3×
Hysterosalpingogram (74740) $817.10 $1,433.50 3.4×
Joint Survey, Single View - Xr Joint Anteroposterior 2+ Joints (77077) $242.82 $426 2.3×
Kidney Img Morphology Vascular Flow 1 W/O Rx (78707) $939.93 $1,649 1.7×
Knee 3 views (73562) $336.87 $591 3.8×
Liver & Spleen Imaging W/Vascular Flow (78216) $1,106.37 $1,941 2.7×
Lymphoscintigraphy (78195) $1,099.82 $1,929.50 2.0×
Mammary ductogram or galactogram multiple (77054) $718.20 $1,260 2.9×
Mammary ductogram or galactogram single (77053) $538.65 $945 2.2×
Meckels Diverticulum (78290) $691.41 $1,213 1.7×
MRA head w & w/o contrast (70546) $2,743.41 $4,813 7.7×
MRA head w/o contrast (70544) $1,663.26 $2,918 6.8×
MRA head with contrast (70545) $2,447.58 $4,294 6.9×
MRA neck w contrast (70548) $2,458.41 $4,313 6.9×
Mra Neck W/O &W/Contrast Material (70549) $2,666.74 $4,678.50 7.5×
MRA neck w/o contrast (70547) $1,858.77 $3,261 7.6×
MRI abdomen w contrast (74182) $2,976.54 $5,222 8.4×
MRI abdomen w/o & w/contrast material (74183) $2,922.10 $5,126.50 8.2×
MRI abdomen w/o contrast (74181) $2,232.98 $3,917.50 9.2×
MRI any jnt lwr ext with con lt (73722) $2,355.24 $4,132 2.9×
MRI any jt upper extremity w/contrast matrl (73222) $1,698.03 $2,979 2.1×
MRI c-spine with contrast (72142) $2,536.50 $4,450 7.1×
MRI cervical spine w/o contrast (72141) $1,863.33 $3,269 7.6×
MRI chest w/o & w/contrast material (71552) $2,197.64 $3,855.50 6.2×
MRI chest w/o contrast (71550) $1,742.49 $3,057 7.1×
MRI lower extrem oth/thn jt w/contrast matrl (73719) $2,218.44 $3,892 6.2×
MRI lower extrem oth/thn jt w/o contr matrl (73718) $1,595.43 $2,799 6.5×
MRI orbit face &/neck w/o contrast (70540) $1,541.28 $2,704 6.3×
MRI orbit/face/neck w&w/o cont (70543) $2,300.24 $4,035.50 6.5×
MRI orbit/face/neck w/contrast (70542) $1,863.33 $3,269 5.2×
MRI pelvis w contrast (72196) $2,534.79 $4,447 7.1×
MRI pelvis w/o & w/contrast material (72197) $2,497.46 $4,381.50 7.0×
MRI pelvis w/o contrast (72195) $1,861.90 $3,266.50 7.6×
MRI scan of arm joint before and after contrast (73223) $2,118.12 $3,716 5.9×
MRI scan of leg joint before and after contrast (73723) $2,346.69 $4,117 6.6×
MRI spinal canal cervical w/o & w/contr matrl (72156) $2,467.82 $4,329.50 6.9×
MRI spinal canal lumbar w/contrast material (72149) $2,661.90 $4,670 7.5×
MRI spinal canal lumbar w/o & w/contr matrl (72158) $2,611.17 $4,581 7.3×
MRI spinal canal thoracic w/contrast matrl (72147) $2,716.62 $4,766 7.6×
MRI spinal canal thoracic w/o & w/contr matrl (72157) $2,956.30 $5,186.50 8.3×
MRI thoracic spine w/o contrast (72146) $1,813.17 $3,181 7.4×
MRI tmj (70336) $1,452.36 $2,548 6.0×
MRI upper ext joint w/o contrast (73221) $1,716.27 $3,011 7.0×
MRI upper extrem other than jt w/o & w/contras (73220) $2,340.42 $4,106 6.6×
MRI upper extremity oth than jt w/o contr matrl (73218) $1,540.42 $2,702.50 6.3×
Myocardial Spect Multiple Studies (78452) $3,336.78 $5,854 2.5×
Neck soft tissue (70360) $260.49 $457 2.9×
Nm gastric emptying study (78264) $1,121.76 $1,968 2.7×
Nuclear medicine study to assess blood clot in vein of side (78457) $1,085.28 $1,904 2.0×
Ob Us Follow-Up Per Fetus - Us Ob Follow Up Transabdominal Approach (76816) $398.14 $698.50 3.7×
Osseous survey infant (77076) $229.71 $403 2.2×
Osseous survey limited (77074) $372.21 $653 3.5×
Parathyrd planar w/spect&CT (78072) $743 $1,303.50 1.3×
Parathyroid imaging (78070) $1,165.94 $2,045.50 2.9×
Pelvis 1 or 2 views (72170) $249.09 $437 2.3×
Pr MRI, lower extr, w/o contrast f/u by contrast (73720) $2,475.51 $4,343 6.9×
Pulmonary Perfusion Imaging Particulate (78580) $833.06 $1,461.50 2.0×
Pulmonary Ventilation & Perfusion Imaging (78582) $1,387.95 $2,435 2.5×
Radex abscess/fistula/sinus tract rs&i (76080) $410.40 $720 0.7×
Radex Entir Thrc Lmbr Crv Sac Spi W/Skull 1 Vw - Xr Scoliosis 1 Vw (72081) $148.77 $261 1.7×
Radex entir thrc lmbr crv sac spi w/skull 2/3 vw (72082) $324.04 $568.50 3.0×
Radex hips bilateral with pelvis 2 views (73521) $375.92 $659.50 3.5×
Radiolog exam mandible compl minimum 4 views (70110) $255.93 $449 2.4×
Radiologic Exam Abdomen 1 View - Xr Abdomen 1 View (74018) $351.12 $616 3.9×
Radiologic Exam Abdomen 3+ Views - Xr Abdomen 3+ Views (74021) $282.15 $495 2.6×
Radiologic Exam Chest 2 Views - Xr Chest 2 Views (71046) $262.20 $460 2.9×
Radiologic exam colon single contrast study (74270) $529.53 $929 3.0×
Radiologic exam upr gi trc double contrast study (74246) $731.02 $1,282.50 4.1×
Radiologic exam upr gi trc single contrast study (74240) $549.48 $964 3.1×
Radiologic Examination Femur Minimum 2 Views - Xr Femur 2+ Vw Lt (73552) $265.62 $466 3.0×
Radiological examination surgical specimen (76098) $416.67 $731 0.7×
Ribs bilateral 3 views (71110) $360.24 $632 3.4×
Rp loclzj tum plnr whole body single day imaging (78802) $808.26 $1,418 1.5×
Rp loclzj tum spect 1 area single day imaging (78803) $1,342.92 $2,356 2.4×
Rp loclzj tum spect 2 area/sep acquisj img (78831) $1,764.72 $3,096 1.3×
Rp loclzj tum spect CT 2area 1d img/1 ar img>2+d (78832) $2,287.98 $4,014 1.6×
Rp loclzj tum spect w/CT 1 area 1 day imaging (78830) $2,180.25 $3,825 1.6×
Saline Infus Sonohysterography W/Color Doppler (76831) $454.58 $797.50 1.9×
Scanogram (77073) $246.81 $433 2.3×
Scapula complete (73010) $307.23 $539 2.9×
Shuntogram indwelling nonvascular shunt rs&i (75809) $35.91 $63 0.3×
Small bowel series (74250) $473.10 $830 2.6×
Spine thoracic 3 views (72072) $368.22 $646 3.4×
Thoracolumbar 2 views (72080) $260.20 $456.50 2.9×
Thyroid Uptake W/Blood Flow Sngle/Mult Quan Meas (78014) $621.87 $1,091 1.5×
Tmj unilateral (70328) $171.57 $301 1.9×
Tumor Imaging, Limited Area - Nm Tumor Localization Limited (78800) $573.42 $1,006 1.4×
Ultrasound, abdomen limited (76705) $572.28 $1,004 5.4×
Upper Extremity Infant (73092) $242.82 $426 2.3×
Urethrocystography retrograde rs&i (74450) $315.21 $553 1.3×
Urethrocystography voiding (74455) $607.05 $1,065 2.5×
Urography (pyelography), intravenous, with or without KUB, with or without tomography (74400) $830.49 $1,457 4.6×
Us breast unilateral complete (76641) $358.82 $629.50 3.4×
Us chest (76604) $456 $800 4.3×
Us compl joint r-t w/image documentation (76881) $343.14 $602 3.2×
Us fetal nuchal translucency 1st gestation (76813) $538.08 $944 5.0×
Us ob detailed single fetus (76811) $912.57 $1,601 3.7×
Us ob transvaginal (76817) $488.49 $857 4.6×
Us pelvic non ob complete (76856) $555.18 $974 5.2×
Us pelvic nonobstetric image dcmtn limited/f/u (76857) $342.57 $601 3.2×
Us pregnancy ltd (76815) $438.90 $770 4.1×
Us pregnant uterus 14 wk transabdl 1/1st gestat (76801) $540.93 $949 5.1×
Us retroperitoneal complete (76770) $630.70 $1,106.50 5.9×
Us retroperitoneal limited (76775) $406.12 $712.50 3.8×
Us scrotum and contents (76870) $497.61 $873 4.7×
Us soft tissue head/neck (76536) $534.09 $937 5.0×
Us spinal canal and contents (76800) $319.77 $561 3.0×
Us transrectal (76872) $62.70 $110 0.6×
Us transrectal prostate volume (76873) $124.26 $218 1.2×
Us xtr non-vasc lmtd (76882) $211.47 $371 2.0×
Wrist 2 views (73100) $210.90 $370 2.4×
X-Ray Abdomen,Comp Acute Series - Xr Abdomen 2 Vws With Chest 1 View (74022) $412.40 $723.50 3.9×
X-Ray Ac Jts - Xr Acromioclavicular Joints Bilateral (73050) $288.42 $506 3.2×
X-Ray Ankle 3+ Vw - Xr Ankle 3+ Views Right (73610) $300.96 $528 3.4×
X-Ray Colon Air Contrast - Fl Barium Enema Air Contrast (74280) $732.16 $1,284.50 4.1×
X-Ray Elbow 2 Vw - Xr Elbow 1-2 Views Right (73070) $213.18 $374 2.4×
X-Ray Elbow 3+ Vw - Xr Elbow 3+ Views Right (73080) $281.01 $493 3.2×
X-ray exam hip uni 1 view (73501) $230.28 $404 2.6×
X-Ray Exam Hip Uni 2-3 Views (73502) $249.09 $437 2.8×
X-ray eye for foreign body (70030) $252.51 $443 2.8×
X-Ray Facial Bones 3+ Vw - Xr Facial Bones 3+ Views (70150) $423.51 $743 4.0×
X-Ray Facial Bones <3 Vw - Xr Facial Bones 1-2 Views (70140) $277.02 $486 3.1×
X-Ray Foot 3+ Vw - Xr Foot 3+ Views Right (73630) $251.94 $442 2.8×
X-Ray Heel - Xr Calcaneus 2 Views Right (73650) $214.89 $377 2.4×
X-Ray Jaw <4 Vw - Xr Mandible < 4 Views (70100) $219.45 $385 2.5×
X-Ray Knee 4+ View - Xr Knee 4+ Views Right (73564) $339.44 $595.50 3.2×
X-Ray Knee Bilat Standing - Xr Knees Anteroposterior Standing Bilat (73565) $344.85 $605 3.9×
X-Ray Leg, Infant - Xr Lower Extremity 2+ Views Infant Left (73592) $176.13 $309 2.0×
X-Ray Lumbar Spine 2/3 Vw - Xr Lumbar Spine 2-3 Views (72100) $338.86 $594.50 3.2×
X-Ray Lumbar Spine 6+ Vw - Xr Lumbar Spine 6+ Vws Including Bending (72114) $427.22 $749.50 4.0×
X-Ray Lumbar Spine Flex/Exten - Xr Lumbar Spine 4+ Views W/ Flex Ext (72120) $328.89 $577 3.1×
X-Ray Nasal Bones - Xr Nasal Bones (70160) $310.65 $545 3.5×
X-Ray Nose-Rectum Child F.B. - Xr Nose to Rectum Foreign Body Peds (76010) $446.60 $783.50 5.0×
X-Ray Orbits - Xr Orbits Complete 4+ Views (70200) $410.40 $720 3.8×
X-Ray Pelvis 3+ Vw - Xr Pelvis 3+ Views (72190) $320.34 $562 3.0×
X-Ray Ribs 2 Vw Unilat - Xr Ribs 2 Views Right (71100) $241.40 $423.50 2.7×
X-Ray Ribs, Chest 3+ Vw - Xr Ribs 2 Vws Lt W/ Chest Anteroposterior (71101) $344.28 $604 3.2×
X-Ray Ribs, Chest 4+ Vw - Xr Ribs 3 Vws Bil W/ Chest Posteroanterior (71111) $440.32 $772.50 4.1×
X-Ray Sacroiliac Jts 3+ Vw - Xr Sacroiliac Joints 3+ Views (72202) $275.60 $483.50 2.6×
X-Ray Sacrum/Coccyx 2+ Vw - Xr Sacrum Coccyx 2+ Views (72220) $268.47 $471 3.0×
X-Ray Shoulder 2+ Vw - Xr Shoulder 2+ Views Right (73030) $285 $500 3.2×
X-Ray Sinuses 3+ Vw - Xr Paranasal Sinuses 3+ Views (70220) $372.78 $654 4.2×
X-Ray Sinuses <3 Vw - Xr Paranasal Sinuses 1-2 Views (70210) $216.03 $379 2.4×
X-Ray Skull 4+ Vw - Xr Skull Complete 4+ Views (70260) $518.13 $909 4.9×
X-Ray Skull <4 Vw - Xr Skull 1-3 Views (70250) $283.86 $498 2.7×
X-Ray Spine One View - Xr Spine (72020) $167.01 $293 1.9×
X-Ray Sterno-Clavicluar Jt - Xr Sternoclavicular Joints 3+ Views (71130) $203.49 $357 2.3×
X-Ray Sternum 2+ Vw - Xr Sternum 2+ Views (71120) $354.82 $622.50 4.0×
X-Ray Thoracic Spine 2 Vw - Xr Thoracic Spine 2 Views (72070) $285 $500 2.7×
X-Ray Toe(S) - Xr Toes 2+ Views Right (73660) $186.39 $327 2.1×
X-Ray Wrist 3+ Vw - Xr Wrist 3+ Views Right (73110) $271.04 $475.50 3.0×
Xr arthrogram ankle (73615) $438.90 $770 1.2×
Xr c-spine 6 or more views (72052) $513.28 $900.50 4.8×
Xr chest 4+ views (71048) $346.56 $608 3.2×
Xr finger(s) 2+ views (73140) $186.96 $328 2.1×
Xr optic foramina (70190) $127.11 $223 1.4×
Xr shoulder 1 view (73020) $190.10 $333.50 2.1×
Xr spine cervical 4 or 5 views (72050) $381.33 $669 3.6×
Xr tibia/fibula 2 views (73590) $267.33 $469 3.0×
Xray knee 1 or 2 views rt (73560) $241.96 $424.50 2.7×