Imaging prices at Dahl Memorial Healthcare Association Inc
Ekalaka, MT · every code in this section with a posted price and a Medicare benchmark.
116 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) | $243.60 | $243.60 | 2.7× |
| Abdomen 2 views (74019) | $399 | $399 | 3.7× |
| Ankle 2 views (73600) | $227.85 | $227.85 | 2.6× |
| Bone age studies (77072) | $275.10 | $275.10 | 2.6× |
| Bone survey infant (77076) | $417.90 | $417.90 | 3.9× |
| Cat Scan Follow-Up Study (76380) | $816.20 | $816.20 | 9.2× |
| Chest 1 view (71045) range across 2 matching MRF lines |
$257.25–$546 | $257.25–$546 | varies |
| Chest 2 views (71046) | $270.90 | $270.90 | 3.0× |
| Chest 3 views (71047) | $252.47 | $252.47 | 2.8× |
| Chest 4 or more views (71048) | $304.29 | $304.29 | 2.8× |
| Clavicle complete (73000) | $208.95 | $208.95 | 2.4× |
| CT abdomen and pelvis without and with contrast (74178) range across 2 matching MRF lines |
$3,528–$6,465.90 | $3,528–$6,465.90 | varies |
| CT abdomen and pelvis without contrast (74176) | $2,369.85 | $2,369.85 | 9.7× |
| CT abdomen w contrast (74160) | $1,740.20 | $1,740.20 | 9.7× |
| CT abdomen w wo contrast (74170) | $1,905.75 | $1,905.75 | 10.6× |
| CT abdomen w/o contrast (74150) | $1,395.45 | $1,395.45 | 13.1× |
| CT Angio Abdomen and Pelvis (74174) | $2,906.20 | $2,906.20 | 8.2× |
| CT Angio Chest (71275) range across 2 matching MRF lines |
$2,378.20–$3,087 | $2,378.20–$3,087 | varies |
| CT Angio Head (70496) range across 2 matching MRF lines |
$2,430.75–$3,754.01 | $2,430.75–$3,754.01 | varies |
| Ct Angio Lwr Extr W/O&W/Dye (73706) | $1,620.68 | $1,620.68 | 9.0× |
| CT Angio Neck (70498) | $2,304.75 | $2,304.75 | 12.9× |
| Ct Angio Upr Extrm W/O&W/Dye (73206) | $1,620.68 | $1,620.68 | 9.0× |
| CT bone density (77078) | $1,323 | $1,323 | 14.9× |
| CT cervical spine w/ contrast (72126) | $2,521.20 | $2,521.20 | 7.1× |
| CT cervical spine w/o contrast (72125) | $2,100 | $2,100 | 19.7× |
| CT cervical spine w/wo cont (72127) | $2,535.75 | $2,535.75 | 14.2× |
| CT chest w contrast (71260) range across 2 matching MRF lines |
$2,024.40–$3,685.50 | $2,024.40–$3,685.50 | varies |
| CT chest w/wo contrast (71270) range across 2 matching MRF lines |
$2,521.20–$2,937.90 | $2,521.20–$2,937.90 | varies |
| CT head/brain with contrast (70460) | $1,653.75 | $1,653.75 | 9.2× |
| CT head/brain without and with contrast (70470) | $2,205 | $2,205 | 12.3× |
| CT l-spine w&w/o contrast (72133) | $2,535.75 | $2,535.75 | 14.2× |
| CT lower ext w/o (73700) | $1,543.50 | $1,543.50 | 14.5× |
| CT lower extremity w/contrast material (73701) | $1,764 | $1,764 | 9.8× |
| CT lumbar spine w contrast (72132) | $1,874.25 | $1,874.25 | 5.3× |
| CT lumbar spine w/o contrast (72131) | $1,764 | $1,764 | 16.5× |
| CT maxillofacial w contrast (70487) | $1,603.80 | $1,603.80 | 8.9× |
| CT maxillofacial wo contrast (70486) | $1,403.85 | $1,403.85 | 13.1× |
| CT neck tissue combo (70492) | $2,908.40 | $2,908.40 | 16.2× |
| CT orbits w/o contrast (70480) | $2,574.60 | $2,574.60 | 24.1× |
| CT pelvis w&w/o contrast (72194) | $1,764 | $1,764 | 9.8× |
| CT pelvis w/o contrast (72192) | $1,580.25 | $1,580.25 | 14.8× |
| CT scan of leg combo (73702) | $2,535.75 | $2,535.75 | 14.2× |
| CT scans face/jaw combo (70488) | $2,535.75 | $2,535.75 | 14.2× |
| CT soft tissue neck w contrast (70491) | $1,874.25 | $1,874.25 | 10.5× |
| CT soft tissue neck w/o contrast (70490) | $1,653.75 | $1,653.75 | 15.5× |
| CT thoracic spine w contrast (72129) | $1,874.25 | $1,874.25 | 10.5× |
| CT thoracic spine w/o contrast (72128) | $1,792.35 | $1,792.35 | 16.8× |
| CT thoracic spine w/wo cont (72130) | $2,535.75 | $2,535.75 | 14.2× |
| CT thorax w/o contrast (71250) range across 3 matching MRF lines |
$1,375–$4,133.85 | $1,375–$4,133.85 | varies |
| CT upper ext wo (73200) | $1,487.20 | $1,487.20 | 13.9× |
| CT upper extremity w/o & w/contrast material (73202) | $2,205 | $2,205 | 12.3× |
| CT upper extremity with contrast (73201) | $1,764 | $1,764 | 4.9× |
| Cta Abdl Aorta&Bi Iliofem W/Contrast&Postp (75635) | $3,307.50 | $3,307.50 | 18.5× |
| Cta Abdomen (74175) | $2,156.70 | $2,156.70 | 12.0× |
| CTA pelvis (72191) | $3,087 | $3,087 | 17.2× |
| Foot 2 views (73620) | $239.80 | $239.80 | 2.7× |
| Forearm 2 views (73090) | $249.90 | $249.90 | 2.8× |
| Hand 2 views (73120) | $305.55 | $305.55 | 2.9× |
| Knee 3 Views (73562) | $316.05 | $316.05 | 3.6× |
| Neck soft tissue (70360) | $296.10 | $296.10 | 3.3× |
| Pelvis 1 or 2 views (72170) | $278.25 | $278.25 | 2.6× |
| Radex Abd Compl Aqt Abd W/S/E/D Views 1 View Ch (74022) | $434.70 | $434.70 | 4.1× |
| Radex Ankle Complete Minimum 3 Views (73610) | $278.25 | $278.25 | 3.1× |
| Radex Calcaneus Minimum 2 Views (73650) | $179.30 | $179.30 | 2.0× |
| Radex elbow complete minimum 3 views (73080) | $290.85 | $290.85 | 3.3× |
| Radex Facial Bones Complete Minimum 3 Views (70150) | $278.93 | $278.93 | 2.6× |
| Radex fingr minimum 2 views (73140) | $210 | $210 | 2.4× |
| Radex foot complete minimum 3 views (73630) | $271.95 | $271.95 | 3.1× |
| Radex Hand Minimum 3 Views (73130) | $249.90 | $249.90 | 2.8× |
| Radex Nasal Bones Complete Minimum 3 Views (70160) | $210.03 | $210.03 | 2.4× |
| Radex Ribs Unilateral 2 Views (71100) | $355.95 | $355.95 | 4.0× |
| Radex shoulder complete minimum 2 views (73030) | $285.60 | $285.60 | 3.2× |
| Radex Sinuses Paransl < 3 Views (70210) | $200.66 | $200.66 | 2.3× |
| Radex Spine 1 View Specify Level (72020) | $220 | $220 | 2.5× |
| Radex Sternum Minimum 2 Views (71120) | $255.23 | $255.23 | 2.9× |
| Radex Toe Minimum 2 Views (73660) | $207.90 | $207.90 | 2.3× |
| Radex Wrist Complete Minimum 3 Views (73110) | $253.58 | $253.58 | 2.9× |
| Radiologic exam knee complete 4/more views (73564) | $458.09 | $458.09 | 4.3× |
| Radiologic exam pelvis compl minimum 3 views (72190) | $262.40 | $262.40 | 2.5× |
| Radiologic examination femur 1 view (73551) | $200.20 | $200.20 | 2.3× |
| Radiologic examination femur minimum 2 views (73552) | $278.25 | $278.25 | 3.1× |
| Radiologic examination knee 1/2 views (73560) | $238.35 | $238.35 | 2.7× |
| Radiologic Examination Osseous Survey Limited (77074) | $829.50 | $829.50 | 7.8× |
| Radiologic examination tibia & fibula 2 views (73590) | $262.50 | $262.50 | 3.0× |
| Ribs bilateral 3 views (71110) | $319.73 | $319.73 | 3.0× |
| Scapula (73010) | $195.70 | $195.70 | 1.8× |
| Shoulder 1 view (73020) | $228.90 | $228.90 | 2.6× |
| Skull less than 4 views (70250) | $260.40 | $260.40 | 2.4× |
| Thoracic spine 2 views (72070) | $282.45 | $282.45 | 2.6× |
| Thoracolumbar 2 views (72080) | $270.67 | $270.67 | 3.0× |
| Wrist 2 views (73100) | $185.85 | $185.85 | 2.1× |
| X-Ray Ac Jts - Xr Acromioclavicular Joints Bilateral (73050) | $206.72 | $206.72 | 2.3× |
| X-Ray Elbow 2 Vw - Xr Elbow 1-2 Views Right (73070) | $228.90 | $228.90 | 2.6× |
| X-Ray Exam Entire Spi 1 Vw (72081) | $336 | $336 | 3.8× |
| X-Ray Exam Entire Spi 2/3 Vw (72082) | $567 | $567 | 5.3× |
| X-Ray Exam Hip Uni 1 View (73501) | $220 | $220 | 2.5× |
| X-Ray Exam Hip Uni 2-3 Views (73502) | $313.67 | $313.67 | 3.5× |
| X-Ray Exam Hips Bi 2 Views (73521) | $402.15 | $402.15 | 3.8× |
| X-Ray Exam Hips Bi 3-4 Views (73522) | $397.95 | $397.95 | 3.7× |
| X-Ray Exam L-S Spine Bending (72114) | $518.10 | $518.10 | 4.9× |
| X-Ray Exam Neck Spine 2-3 Vw (72040) | $269.85 | $269.85 | 3.0× |
| X-Ray Exam Neck Spine 6/>Vws (72052) | $529.20 | $529.20 | 5.0× |
| X-Ray Exam Unilat Ribs/Chest (71101) | $385.88 | $385.88 | 3.6× |
| X-ray humerus (73060) | $257.25 | $257.25 | 2.9× |
| X-Ray Jaw <4 Vw - Xr Mandible < 4 Views (70100) | $200.66 | $200.66 | 2.3× |
| X-Ray Lumbar Spine 2/3 Vw - Xr Lumbar Spine 2-3 Views (72100) | $295.05 | $295.05 | 2.8× |
| X-Ray Ribs, Chest 4+ Vw - Xr Ribs 3 Vws Bil W/ Chest Posteroanterior (71111) | $413.44 | $413.44 | 3.9× |
| X-Ray Sacroiliac Jts <3 Vw - Xr Sacroiliac Joints 1-2 Views (72200) | $234.30 | $234.30 | 2.2× |
| X-Ray Sacrum/Coccyx 2+ Vw - Xr Sacrum Coccyx 2+ Views (72220) | $283.50 | $283.50 | 3.2× |
| X-Ray Sinuses 3+ Vw - Xr Paranasal Sinuses 3+ Views (70220) | $271.77 | $271.77 | 3.1× |
| X-Ray Skull 4+ Vw - Xr Skull Complete 4+ Views (70260) | $385.88 | $385.88 | 3.6× |
| X-ray thoracic spine 4 vw (72074) | $418.95 | $418.95 | 3.9× |
| X-Rays Bone Length Studies (77073) | $233.20 | $233.20 | 2.2× |
| X-Rays Bone Survey Complete (77075) | $833.23 | $833.23 | 7.8× |
| Xr c-spine 4 or 5 views (72050) range across 2 matching MRF lines |
$358.60–$376.95 | $358.60–$376.95 | varies |
| Xr orbits complete 4 views (70200) | $278.93 | $278.93 | 2.6× |
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.