Imaging prices at Coteau Des Prairies Health Care System

Sisseton, SD · every code in this section with a posted price and a Medicare benchmark.

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

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ProcedurePosted cashPosted gross× Medicare
Abdomen 1 View (74018) $285 $285 3.2×
Abdomen 2 views (74019)
range across 2 matching MRF lines		 $563–$565 $563–$565 varies
Acute Gastrointestinal Blood Loss Imaging (78278) $3,940 $3,940 9.6×
Ankle 2 views (73600) $298 $298 3.4×
Bone Imaging 3 Phase (78315) $3,586 $3,586 8.8×
Bone Imaging Limited Area (78300) $1,726 $1,726 4.2×
Bone Imaging Whole Body (78306) $3,284 $3,284 8.0×
Bone survey infant (77076) $357 $357 3.3×
Chest 1 view (71045) $312 $312 3.5×
Chest 2 views (71046) $479 $479 5.4×
Chest 3 views (71047) $330 $330 3.7×
Chest 4 or more views (71048) $594 $594 5.6×
Clavicle complete (73000)
range across 2 matching MRF lines		 $312–$322 $312–$322 varies
CT abdomen and pelvis without and with contrast (74178) $4,390 $4,390 12.3×
CT abdomen and pelvis without contrast (74176) $3,543 $3,543 14.5×
CT abdomen w contrast (74160) $2,318 $2,318 12.9×
CT abdomen w wo contrast (74170) $3,006 $3,006 16.8×
CT abdomen w/o contrast (74150) $2,199 $2,199 20.6×
CT Angio Abdomen and Pelvis (74174) $4,176 $4,176 11.7×
CT Angio Chest (71275) $3,631 $3,631 20.3×
CT Angio Head (70496) $3,773 $3,773 21.1×
Ct Angio Lwr Extr W/O&W/Dye (73706) $3,730 $3,730 20.8×
CT Angio Neck (70498) $3,568 $3,568 19.9×
Ct Angio Upr Extrm W/O&W/Dye (73206) $3,813 $3,813 21.3×
CT cervical spine w/ contrast (72126) $2,469 $2,469 6.9×
CT cervical spine w/o contrast (72125) $2,427 $2,427 22.7×
CT cervical spine w/wo cont (72127) $2,642 $2,642 14.7×
CT chest w contrast (71260) $2,437 $2,437 13.6×
CT chest w/wo contrast (71270) $2,566 $2,566 14.3×
CT head/brain with contrast (70460) $2,292 $2,292 12.8×
CT head/brain without and with contrast (70470) $2,566 $2,566 14.3×
CT iac w contrast (70481) $2,598 $2,598 14.5×
CT l-spine w&w/o contrast (72133) $2,642 $2,642 14.7×
CT lower ext w/o (73700) $2,199 $2,199 20.6×
CT lower extremity w/contrast material (73701) $2,199 $2,199 12.3×
CT lumbar spine w contrast (72132) $1,808 $1,808 5.1×
CT lumbar spine w/o contrast (72131) $2,199 $2,199 20.6×
CT maxillofacial w contrast (70487) $2,222 $2,222 12.4×
CT maxillofacial wo contrast (70486) $2,196 $2,196 20.6×
CT neck tissue combo (70492) $2,770 $2,770 15.5×
Ct Orbit/Ear/Fossa W/O&W/Dye (70482) $3,052 $3,052 17.0×
CT orbits w/o contrast (70480) $2,199 $2,199 20.6×
CT pelvis w&w/o contrast (72194) $2,533 $2,533 14.1×
CT pelvis w/o contrast (72192) $2,199 $2,199 20.6×
CT scan of leg combo (73702) $2,377 $2,377 13.3×
CT scans face/jaw combo (70488) $2,377 $2,377 13.3×
CT soft tissue neck w contrast (70491) $2,614 $2,614 14.6×
CT soft tissue neck w/o contrast (70490) $2,323 $2,323 21.7×
CT thoracic spine w contrast (72129) $2,469 $2,469 13.8×
CT thoracic spine w/o contrast (72128) $2,053 $2,053 19.2×
CT thoracic spine w/wo cont (72130) $2,642 $2,642 14.7×
CT thorax w/o contrast (71250) $2,368 $2,368 22.2×
CT upper ext wo (73200) $2,199 $2,199 20.6×
CT upper extremity w/o & w/contrast material (73202) $2,377 $2,377 13.3×
CT upper extremity with contrast (73201) $2,293 $2,293 6.4×
Cta Abdl Aorta&Bi Iliofem W/Contrast&Postp (75635) $3,919 $3,919 21.9×
Cta Abdomen (74175) $3,690 $3,690 20.6×
CTA head&neck c+ w/noncontrast img&post-pxessing (70471) $3,568 $3,568 10.0×
CTA pelvis (72191) $3,552 $3,552 19.8×
Dxa Bone Density Axial (77080)
range across 2 matching MRF lines		 $692–$696 $692–$696 varies
Dxa bone density study 1/>sites appendiclr skel (77081) $507 $507 5.7×
Esophagram (74220) $240 $240 1.3×
Fetal Biophys Profile W/Nst (76818) $837 $837 7.8×
Fetal Biophysical Profile W/O Non-Stress Testing (76819)
range across 2 matching MRF lines		 $810–$835 $810–$835 varies
Fluoroscopy up to 1 hr (76000) $621 $621 2.5×
Foot 2 views (73620)
range across 2 matching MRF lines		 $211–$218 $211–$218 varies
Forearm 2 views (73090) $426 $426 4.8×
Gastric emptying imaging study (78264) $4,776 $4,776 11.7×
Gastroesophageal Reflux Exam (78262) $1,713 $1,713 4.2×
Hand 2 views (73120) $153 $153 1.4×
Hepatobil Syst Image W/Drug (78227) $4,171 $4,171 7.5×
Hysterosalpingogram (74740) $533 $533 2.2×
Infant hip ultrasound with hip movement (dynamic) (76885) $257 $257 2.9×
Joint Survey Single View (77077) $389 $389 3.6×
Knee 3 Views (73562) $366 $366 4.1×
Lymph System Imaging (78195) $3,213 $3,213 5.8×
Magnetic Image Jaw Joint (70336) $4,384 $4,384 18.0×
Mra Head W/O & W/Contrast Material (70546) $4,858 $4,858 13.6×
MRA head w/o contrast (70544) $4,094 $4,094 16.8×
MRA head with contrast (70545) $4,290 $4,290 12.0×
MRA neck w contrast (70548) $4,290 $4,290 12.0×
Mra Neck W/O &W/Contrast Material (70549) $4,858 $4,858 13.6×
MRA neck w/o contrast (70547) $4,038 $4,038 16.6×
MRI abdomen w contrast (74182) $4,517 $4,517 12.7×
MRI abdomen w/o contrast (74181) $4,232 $4,232 17.4×
MRI any jt lower extrem w/contrast material (73722) $4,479 $4,479 5.6×
MRI any jt lower extrem w/o & w/contrast matrl (73723) $4,728 $4,728 13.3×
MRI any jt upper extremity w/contrast matrl (73222) $4,479 $4,479 5.6×
MRI cervical spine w contrast (72142) $4,662 $4,662 13.1×
MRI cervical spine w/o cont (72141) $4,219 $4,219 17.3×
MRI chest w/o contrast (71550) $4,228 $4,228 17.3×
MRI chest wo w contrast (71552) $5,006 $5,006 14.0×
MRI lower extrem oth/thn jt w/contrast matrl (73719) $4,479 $4,479 12.6×
MRI lower extrem oth/thn jt w/o & w/contr matr (73720) $4,728 $4,728 13.3×
MRI lower extrem oth/thn jt w/o contr matrl (73718) $3,931 $3,931 16.1×
MRI lumbar spine w contrast (72149) $4,346 $4,346 12.2×
Mri Neck Spine W/O & W/Dye (72156) $5,096 $5,096 14.3×
MRI orbit face &/neck w/o contrast (70540) $4,153 $4,153 17.0×
Mri Orbt/Fac/Nck W/O &W/Dye (70543) $5,060 $5,060 14.2×
MRI pelvis w contrast (72196) $4,517 $4,517 12.7×
MRI pelvis w/o & w contrast (72197) $5,581 $5,581 15.7×
MRI pelvis w/o contrast (72195) $4,217 $4,217 17.3×
MRI thoracic spine w/o contrast (72146) $4,044 $4,044 16.6×
MRI upper extremity oth than jt w/contr matrl (73219) $4,479 $4,479 12.6×
MRI upper extremity oth than jt w/o contr matrl (73218) $4,009 $4,009 16.4×
Mri Uppr Extremity W/O&W/Dye (73220) $5,111 $5,111 14.3×
MRI, abdomen, combo (74183) $5,432 $5,432 15.2×
MRI, dorsal spine combo (72157) $5,195 $5,195 14.6×
MRI, dorsal spine contrast (72147) $4,226 $4,226 11.9×
MRI, joint upper extrem (73221) $4,022 $4,022 16.5×
MRI, joint upper extrem combo (73223) $4,728 $4,728 13.3×
MRI, lumbar spine combo (72158) $5,269 $5,269 14.8×
Myocardial Spect Multiple Studies (78452) $7,640 $7,640 5.8×
Neck soft tissue (70360) $196 $196 2.2×
Optic foramina (70190) $313 $313 3.5×
Parathyroid planar imaging w/wo subtraction (78071) $3,053 $3,053 7.5×
Pelvis 1 or 2 views (72170) $325 $325 3.0×
Radex Abd Compl Aqt Abd W/S/E/D Views 1 View Ch (74022) $523 $523 4.9×
Radex Ankle Complete Minimum 3 Views (73610) $339 $339 3.8×
Radex Calcaneus Minimum 2 Views (73650) $235 $235 2.6×
Radex elbow complete minimum 3 views (73080) $461 $461 5.2×
Radex Facial Bones Complete Minimum 3 Views (70150) $473 $473 4.4×
Radex fingr minimum 2 views (73140) $270 $270 3.0×
Radex foot complete minimum 3 views (73630) $343 $343 3.9×
Radex Hand Minimum 3 Views (73130) $315 $315 3.5×
Radex lower extremity infant minimum 2 views (73592) $217 $217 2.4×
Radex Mastoids Compl Minimum 3 Views PR Side (70130) $405 $405 3.8×
Radex Nasal Bones Complete Minimum 3 Views (70160) $377 $377 4.2×
Radex Ribs Unilateral 2 Views (71100) $405 $405 4.6×
Radex shoulder complete minimum 2 views (73030) $367 $367 4.1×
Radex Sinuses Paransl < 3 Views (70210)
range across 2 matching MRF lines		 $312–$322 $312–$322 varies
Radex Spine 1 View Specify Level (72020) $493 $493 5.5×
Radex Sternum Minimum 2 Views (71120) $357 $357 4.0×
Radex Temporomandble Jt Opn & Clsd Mouth Bilat (70330) $482 $482 5.4×
Radex Toe Minimum 2 Views (73660) $191 $191 2.1×
Radex upper extremity infant minimum 2 views (73092) $232 $232 2.2×
Radex Wrist Complete Minimum 3 Views (73110) $374 $374 4.2×
Radiolog exam mandible compl minimum 4 views (70110) $405 $405 3.8×
Radiologic Exam Abdomen 3+ Views - Xr Abdomen 3+ Views (74021) $569 $569 5.3×
Radiologic exam colon single contrast study (74270) $634 $634 3.5×
Radiologic exam knee complete 4/more views (73564) $461 $461 4.3×
Radiologic exam pelvis compl minimum 3 views (72190) $385 $385 3.6×
Radiologic Exam Small Int Single Contrast Study (74250) $372 $372 2.1×
Radiologic examination femur 1 view (73551) $132 $132 1.5×
Radiologic examination femur minimum 2 views (73552) $156 $156 1.8×
Radiologic examination knee 1/2 views (73560) $295 $295 3.3×
Radiologic Examination Salivary Gland Calculus (70380) $242 $242 2.7×
Radiologic examination tibia & fibula 2 views (73590) $442 $442 5.0×
Ribs bilateral 3 views (71110) $472 $472 4.4×
Rp Loclzj Tum Spect 1 Area Single Day Imaging (78803) $1,427 $1,427 2.6×
Scapula (73010)
range across 2 matching MRF lines		 $225–$232 $225–$232 varies
Screening Digital Breast Tomosynthesis Bi (77063) $155 $155 6.6×
Sella turcica (70240) $351 $351 3.9×
Shoulder 1 view (73020)
range across 2 matching MRF lines		 $147–$152 $147–$152 varies
Skull less than 4 views (70250)
range across 2 matching MRF lines		 $318–$328 $318–$328 varies
Sternoclavicular joints (71130) $239 $239 2.7×
Thoracic spine 2 views (72070) $461 $461 4.3×
Thoracic spine 3 views (72072) $377 $377 3.5×
Thoracolumbar 2 views (72080) $183 $183 2.1×
Thyroid Imaging With Vascular Flow (78013) $1,309 $1,309 3.2×
Thyroid Uptake Measurement (78012) $1,597 $1,597 3.9×
Ultrasound Breast Limited (76642) $1,074 $1,074 12.1×
Ultrasound Exam Aaa Screen (76706) $1,169 $1,169 10.9×
Ultrasound, abdomen limited (76705) $1,308 $1,308 12.2×
Umbilical-artery Doppler (OB) (76820) $632 $632 5.9×
Unlisted us procedure (76999) $904 $904 10.2×
Us breast unilateral complete (76641) $1,187 $1,187 11.1×
Us chest (76604) $919 $919 8.6×
Us complete joint (76881) $986 $986 9.2×
Us exam, pelvic, limited (76857) $972 $972 9.1×
Us kidney transplant (76776) $595 $595 5.6×
Us lmtd joint/oth nonvasc xtr strux r-t w/img (76882) $919 $919 8.6×
Us ob limited 1 or more fetuses (76815) $1,030 $1,030 9.6×
Us ob transvaginal (76817) $1,161 $1,161 10.9×
Us pelvic non ob complete (76856)
range across 2 matching MRF lines		 $1,127–$1,161 $1,127–$1,161 varies
Us pg uter img f&mat 14 wk tabdl 1/1st gestation (76801)
range across 2 matching MRF lines		 $1,219–$1,256 $1,219–$1,256 varies
Us preg uterus real time f/u trnsabdl per fetus (76816) $1,070 $1,070 10.0×
Us retroperitoneal complete (76770) $1,308 $1,308 12.2×
Us retroperitoneal limited (76775) $1,169 $1,169 10.9×
Us scrotum and contents (76870) $1,123 $1,123 10.5×
Us thyroid (76536) $1,211 $1,211 11.3×
Wrist 2 views (73100) $299 $299 3.4×
X-Ray Ac Jts - Xr Acromioclavicular Joints Bilateral (73050) $298 $298 3.4×
X-Ray Bend Only L-S Spine (72120) $606 $606 5.7×
X-Ray Elbow 2 Vw - Xr Elbow 1-2 Views Right (73070) $219 $219 2.5×
X-Ray Exam Entire Spi 2/3 Vw (72082) $661 $661 6.2×
X-Ray Exam Hip Uni 1 View (73501) $127 $127 1.4×
X-Ray Exam Hip Uni 2-3 Views (73502) $196 $196 2.2×
X-Ray Exam Hip Uni 4/> Views (73503) $246 $246 2.3×
X-Ray Exam Hips Bi 2 Views (73521) $191 $191 1.8×
X-Ray Exam Hips Bi 3-4 Views (73522) $232 $232 2.2×
X-Ray Exam Hips Bi 5/> Views (73523) $270 $270 2.5×
X-Ray Exam L-S Spine Bending (72114) $715 $715 6.7×
X-Ray Exam Neck Spine 2-3 Vw (72040) $186 $186 2.1×
X-Ray Exam Neck Spine 6/>Vws (72052) $625 $625 5.9×
X-Ray Exam Unilat Ribs/Chest (71101) $476 $476 4.5×
X-ray eye for foreign body (70030) $250 $250 2.8×
X-ray humerus (73060) $206 $206 2.3×
X-ray IV pyelogram (ivp) (74400) $1,072 $1,072 6.0×
X-Ray Jaw <4 Vw - Xr Mandible < 4 Views (70100) $257 $257 2.9×
X-Ray Knee Bilat Standing - Xr Knees Anteroposterior Standing Bilat (73565) $352 $352 4.0×
X-Ray Lumbar Spine 2/3 Vw - Xr Lumbar Spine 2-3 Views (72100) $568 $568 5.3×
X-ray nose-rectum child f.b. (76010) $210 $210 2.4×
X-Ray Ribs, Chest 4+ Vw - Xr Ribs 3 Vws Bil W/ Chest Posteroanterior (71111) $733 $733 6.9×
X-Ray Sacroiliac Jts 3+ Vw - Xr Sacroiliac Joints 3+ Views (72202) $357 $357 3.3×
X-Ray Sacroiliac Jts <3 Vw - Xr Sacroiliac Joints 1-2 Views (72200) $356 $356 3.3×
X-Ray Sacrum/Coccyx 2+ Vw - Xr Sacrum Coccyx 2+ Views (72220) $399 $399 4.5×
X-Ray Sinuses 3+ Vw - Xr Paranasal Sinuses 3+ Views (70220) $438 $438 4.9×
X-Ray Skull 4+ Vw - Xr Skull Complete 4+ Views (70260) $770 $770 7.2×
X-ray thoracic spine 4 vw (72074) $462 $462 4.3×
X-Ray Tmj Unilat (70328) $244 $244 2.7×
X-Rays Bone Survey Complete (77075) $763 $763 7.1×
Xr c-spine 4 or 5 views (72050) $290 $290 2.7×
Xr facial bones less than 3 views (70140) $337 $337 3.8×
XR Mastoids < 3 Views Bilateral (70120) $257 $257 2.4×
Xr orbits complete 4 views (70200) $312 $312 2.9×

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.