Imaging prices at Gritman Medical Center

Moscow, ID · every code in this section with a posted price and a Medicare benchmark.

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

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ProcedureCash priceGross charge× Medicare
Abdomen 2 views (74019) $429 $429 4.2×
Ankle 2 views (73600) $319 $319 3.7×
Arthrogram hip (73525) $1,448 $1,448 4.2×
Arthrogram shoulder (73040) $1,448 $1,448 4.2×
Arthrogram wrist (73115) $1,448 $1,448 4.2×
Bone &/Joint Imaging Limited Area (78300) $1,483 $1,483 3.8×
Bone &/joint imaging whole body (78306) $1,483 $1,483 3.8×
Bone age studies (77072) $429 $429 4.2×
Bone Imaging 3 Phase (78315) $1,483 $1,483 3.8×
Bone survey complete (77075) $429 $429 4.2×
Bone survey infant (77076) $429 $429 4.2×
Cervical spine 2 or 3 views (72040) $319 $319 3.7×
Chest 1 view (71045) $319 $319 3.7×
Cine/Vid X-Ray Throat/Esoph - Fl Esoph Barium Swlw W/ Video & Speech (74230) $703 $703 4.1×
Cisternography Positive Contrast Rs&I (70015) $2,814 $2,814 3.6×
Clavicle complete (73000) $319 $319 3.7×
Computed Tomography Thorax Lw Dose Lng Ca Scr C- (71271) $429 $429 4.2×
CT abdomen and pelvis without and with contrast (74178) $2,802 $2,802 8.1×
CT abdomen and pelvis without contrast (74176) $1,777 $1,777 7.5×
CT abdomen w contrast (74160) $1,064 $1,064 6.1×
CT abdomen w wo contrast (74170) $1,200 $1,200 6.9×
CT abdomen w/o contrast (74150) $784 $784 7.6×
CT angio hrt w/3d image (75574) $888 $888 2.6×
CT angio lwr extr w/o&w/dye (73706) $1,210 $1,210 7.0×
CT angiography upper extremity lt (73206) $1,210 $1,210 7.0×
CT c-spine w/contrast (72126) $1,448 $1,448 4.2×
CT c-spine w/o contrast (72125) $1,250 $1,250 12.1×
CT chest w contrast (71260) $1,725 $1,725 10.0×
CT chest w/wo contrast (71270) $1,200 $1,200 6.9×
CT head/brain with contrast (70460) $1,064 $1,064 6.1×
CT head/brain without and with contrast (70470) $1,200 $1,200 6.9×
CT heart w/o contrast quant eval coronary calcium (75571) $319 $319 3.7×
CT iac w contrast (70481) $1,064 $1,064 6.1×
CT lower ext w/o (73700) $784 $784 7.6×
CT lower extremity w wo contrast (73702) $1,200 $1,200 6.9×
CT lower extremity w/contrast material (73701) $1,064 $1,064 6.1×
CT lumbar spine w & w/o contrast (72133) $1,200 $1,200 6.9×
CT lumbar spine w/contrast (72132) $1,448 $1,448 4.2×
CT lumbar spine w/o contrast (72131) $784 $784 7.6×
CT maxillofacial w contrast (70487) $1,064 $1,064 6.1×
CT maxillofacial wo contrast (70486) $784 $784 7.6×
CT orbit sella/post fossa/ear w/o & w/contr matr (70482) $1,200 $1,200 6.9×
CT orbits w/o contrast (70480) $784 $784 7.6×
CT pelvis w/o contrast (72192) $784 $784 7.6×
CT pelvis w/wo contrast (72194) $1,200 $1,200 6.9×
CT soft tissue neck w contrast (70491) $1,064 $1,064 6.1×
CT soft tissue neck w/o & w/contrast material (70492) $1,200 $1,200 6.9×
CT soft tissue neck w/o contrast (70490) $784 $784 7.6×
CT thoracic spine w/contrast (72129) $1,064 $1,064 6.1×
CT thoracic spine w/o contrast (72128) $784 $784 7.6×
CT thorax w/o contrast (71250) $784 $784 7.6×
CT upper ext wo (73200) $784 $784 7.6×
CT upper extremity with contrast (73201) $1,448 $1,448 4.2×
Cta Aa&Bi Iliofem Lxtr Rs&I C-/C+ Post-Pxessing (75635) $1,210 $1,210 7.0×
Cta Abdomen (74175) $1,210 $1,210 7.0×
CTA abdomen pelvis (74174) $1,848 $1,848 5.4×
CTA chest (71275) $2,330 $2,330 13.4×
Cta Head (70496) $1,210 $1,210 7.0×
CTA head&neck c+ w/noncontrast img&post-pxessing (70471) $1,008 $1,008 2.9×
Cta Neck (70498) $1,210 $1,210 7.0×
Cystography minimum 3 views rs&i (74430) $1,448 $1,448 4.2×
Doppler Echo Fetal Spectral Display Complete (76827) $429 $429 4.2×
Dxa bone density study 1/> sites axial skel (77080) $429 $429 4.2×
Esophagus (74220) $703 $703 4.1×
Facial bones min 3 views (70150) $429 $429 4.2×
Fetal biophysical profile non-stress testing (76818) $449 $449 4.3×
Fetal Biophysical Profile W/O Non-Stress Testing (76819) $449 $449 4.3×
Fluoroscopy up to 1 hr (76000) $905 $905 3.8×
Foot 2 views (73620) $319 $319 3.7×
Forearm 2 views (73090) $319 $319 3.7×
Hand 2 views (73120) $429 $429 4.2×
Hepatobil Syst Imag Inc Gb W/Pharma Intervenj (78227) $1,925 $1,925 3.6×
Hysterosalpingogram (74740) $905 $905 3.8×
Kidney img morphology vascular flow 1 w/rx (78708) $1,925 $1,925 3.6×
Knee 3 views (73562) $319 $319 3.7×
Lung ventilation imaging (78579) $1,483 $1,483 3.8×
Lymphoscintigraphy (78195) $1,925 $1,925 3.6×
Magnetic resonance (eg, proton) imaging, any joint of upper extremity; with contrast material(s) Non-Facility (73222) $2,814 $2,814 3.6×
Magnetic resonance (eg, proton) imaging, upper extremity, other than joint; without contrast material(s), followed by… (73220) $2,137 $2,137 6.2×
Manual Appl Stress Pfrmd Phys/Qhp Joint Films (77071) $319 $319 3.7×
MRA head w & w/o contrast (70546) $2,210 $2,210 6.4×
MRA head w/o contrast (70544) $1,527 $1,527 6.5×
MRA neck w contrast (70548) $1,799 $1,799 5.2×
MRA neck w/o contrast (70547) $1,527 $1,527 6.5×
MRI abdomen w/o & w/contrast material (74183) $2,210 $2,210 6.4×
MRI abdomen w/o contrast (74181) $1,527 $1,527 6.5×
MRI any jt lower extrem w/contrast material (73722) $2,814 $2,814 3.6×
MRI any jt lower extrem w/o & w/contrast matrl (73723) $2,210 $2,210 6.4×
MRI cervical spine w/o contrast (72141) $1,965 $1,965 8.3×
MRI chest w/o & w/contrast material (71552) $2,210 $2,210 6.4×
MRI chest w/o contrast (71550) $1,527 $1,527 6.5×
MRI lower extrem oth/thn jt w/o & w/contr matr (73720) $2,210 $2,210 6.4×
MRI lower extrem oth/thn jt w/o contr matrl (73718) $1,527 $1,527 6.5×
MRI orbit/face/neck w&w/o cont (70543) $2,210 $2,210 6.4×
MRI pelvis w/o & w/contrast material (72197) $1,212.50 $1,212.50 3.5×
MRI pelvis w/o contrast (72195) $1,527 $1,527 6.5×
MRI spinal canal cervical w/o & w/contr matrl (72156) $2,210 $2,210 6.4×
MRI spinal canal lumbar w/contrast material (72149) $1,448 $1,448 4.2×
MRI spinal canal lumbar w/o & w/contr matrl (72158) $2,210 $2,210 6.4×
MRI spinal canal thoracic w/o & w/contr matrl (72157) $2,210 $2,210 6.4×
MRI temporomandibular joint (70336) $1,527 $1,527 6.5×
MRI thoracic spine w/o contrast (72146) $1,527 $1,527 6.5×
MRI up ext w/o contrast (73218) $1,527 $1,527 6.5×
MRI upper ext joint w/o contrast (73221) $1,527 $1,527 6.5×
MRI, joint upper extrem combo (73223) $2,210 $2,210 6.4×
Myelogram Cervical (72240) $2,814 $2,814 3.6×
Myelogram Lumbar (72265) $2,814 $2,814 3.6×
Myelogram thoracic (72255) $2,814 $2,814 3.6×
Myocardial Spect Multiple Studies (78452) $5,139 $5,139 4.0×
Myocardial spect single study at rest or stress (78451) $5,139 $5,139 4.0×
Neck soft tissue (70360) $319 $319 3.7×
Nm cisternogram (78630) $1,925 $1,925 3.6×
Nm gastric emptying study (78264) $1,042 $1,042 2.6×
Ob us nuchal meas 1 gest (76813) $236 $236 2.3×
Osseous survey limited (77074) $429 $429 4.2×
Parathyroid Planar Imaging (78070) $1,483 $1,483 3.8×
Pelvis 1 or 2 views (72170) $242.50 $242.50 2.3×
Pulmonary Perfusion Imaging Particulate (78580) $1,483 $1,483 3.8×
Pulmonary Ventilation & Perfusion Imaging (78582) $1,925 $1,925 3.6×
Radex abscess/fistula/sinus tract rs&i (76080) $1,900 $1,900 3.5×
Radex Ankle Compl Minimum 3 Views (73610) $319 $319 3.7×
Radex Calcaneus Minimum 2 Views (73650) $319 $319 3.7×
Radex Elbw Compl Minimum 3 Views (73080) $319 $319 3.7×
Radex Entir Thrc Lmbr Crv Sac Spi W/Skull 1 Vw - Xr Scoliosis 1 Vw (72081) $319 $319 3.7×
Radex entir thrc lmbr crv sac spi w/skull 2/3 vw (72082) $429 $429 4.2×
Radex fingr minimum 2 views (73140) $319 $319 3.7×
Radex Foot Compl Minimum 3 Views (73630) $319 $319 3.7×
Radex Hand Minimum 3 Views (73130) $319 $319 3.7×
Radex Hip Unilateral With Pelvis 1 View (73501) $319 $319 3.7×
Radex Hips Bilateral With Pelvis 2 Views (73521) $429 $429 4.2×
Radex Humerus Minimum 2 Views (73060) $319 $319 3.7×
Radex Kne 1/2 Views (73560) $319 $319 3.7×
Radex Kne Compl 4/More Views (73564) $429 $429 4.2×
Radex Mndbl Compl Minimum 4 Views (70110) $429 $429 4.2×
Radex Nasal Bones Complete Minimum 3 Views (70160) $319 $319 3.7×
Radex Pelvis Compl Minimum 3 Views (72190) $428 $428 4.1×
Radex Sho Compl Minimum 2 Views (73030) $319 $319 3.7×
Radex Sinuses Paransl < 3 Views (70210) $319 $319 3.7×
Radex Spine Lumbosacral Only Bending 2/3 Views (72120) $429 $429 4.2×
Radex Temporomandble Jt Opn & Clsd Mouth Bilat (70330) $319 $319 3.7×
Radex Toe Minimum 2 Views (73660) $319 $319 3.7×
Radex Wrst Compl Minimum 3 Views (73110) $319 $319 3.7×
Radiologic Exam Abdomen 1 View - Xr Abdomen 1 View (74018) $319 $319 3.7×
Radiologic exam chest 2 views (71046) $319 $319 3.7×
Radiologic exam colon single contrast study (74270) $703 $703 4.1×
Radiologic Exam Esophagus Double Contrast Study (74221) $703 $703 4.1×
Radiologic exam upr gi trc double contrast study (74246) $703 $703 4.1×
Radiologic exam upr gi trc single contrast study (74240) $703 $703 4.1×
Radiologic examination femur 1 view (73551) $319 $319 3.7×
Radiologic examination tibia & fibula 2 views (73590) $319 $319 3.7×
Radiological examination surgical specimen (76098) $1,900 $1,900 3.5×
Ribs bilateral 3 views (71110) $429 $429 4.2×
Sacroiliac Joints < 3 Views (72200) $429 $429 4.2×
Scapula (73010) $429 $429 4.2×
Screening Digital Breast Tomosynthesis Bi (77063) $47 $47 2.0×
Shoulder 1 view (73020) $319 $319 3.7×
Small bowel series (74250) $703 $703 4.1×
Spine thoracic 3 views (72072) $429 $429 4.2×
Thyroid Uptake W/Blood Flow Sngle/Mult Quan Meas (78014) $1,483 $1,483 3.8×
Ultrasound breast complete (76641) $429 $429 4.2×
Ultrasound Exam Aaa Screen (76706) $599 $599 5.8×
Ultrasound, abdomen limited (76705) $449 $449 4.3×
Umbilical-artery Doppler (OB) (76820) $429 $429 4.2×
Unlisted miscellaneous px dx nuclear medicine (78999) $125 $125 0.3×
Urethrocystography retrograde rs&i (74450) $905 $905 3.8×
Us breast unilateral limited (76642) $319 $319 3.7×
Us chest (76604) $429 $429 4.2×
Us compl joint r-t w/image documentation (76881) $449 $449 4.3×
Us lmtd joint/oth nonvasc xtr strux r-t w/img (76882) $429 $429 4.2×
Us ob detailed single fetus (76811) $633.50 $633.50 2.7×
Us ob limited (76815) $164 $164 1.6×
Us ob transvaginal (76817) $308 $308 3.0×
Us pelvic non ob complete (76856) $330.50 $330.50 3.2×
Us pelvic nonobstetric image dcmtn limited/f/u (76857) $429 $429 4.2×
Us pg uter img f&mat 14 wk tabdl 1/1st gestation (76801) $449 $449 4.3×
Us pg uter r-t img f-up tabdl appr pr fetus (76816) $326 $326 3.2×
Us retroperitoneal complete (76770) $449 $449 4.3×
Us retroperitoneal limited (76775) $449 $449 4.3×
Us scrotum and contents (76870) $449 $449 4.3×
Us soft tissue head/neck (76536) $449 $449 4.3×
Us transrectal (76872) $353 $353 3.4×
Wrist 2 views (73100) $319 $319 3.7×
X-Ray Abdomen,Comp Acute Series - Xr Abdomen 2 Vws With Chest 1 View (74022) $429 $429 4.2×
X-Ray Ac Jts - Xr Acromioclavicular Joints Bilateral (73050) $319 $319 3.7×
X-Ray Colon Air Contrast - Fl Barium Enema Air Contrast (74280) $703 $703 4.1×
X-Ray Elbow 2 Vw - Xr Elbow 1-2 Views Right (73070) $319 $319 3.7×
X-Ray Exam Hip Uni 2-3 Views (73502) $319 $319 3.7×
X-ray exam of femur 2/> (73552) $319 $319 3.7×
X-ray eye for foreign body (70030) $319 $319 3.7×
X-Ray Facial Bones <3 Vw - Xr Facial Bones 1-2 Views (70140) $319 $319 3.7×
X-Ray Jaw <4 Vw - Xr Mandible < 4 Views (70100) $319 $319 3.7×
X-Ray Knee Bilat Standing - Xr Knees Anteroposterior Standing Bilat (73565) $199.50 $199.50 2.3×
X-ray leg, infant (73592) $319 $319 3.7×
X-Ray Lumbar Spine 2/3 Vw - Xr Lumbar Spine 2-3 Views (72100) $429 $429 4.2×
X-Ray Lumbar Spine 6+ Vw - Xr Lumbar Spine 6+ Vws Including Bending (72114) $429 $429 4.2×
X-Ray Orbits - Xr Orbits Complete 4+ Views (70200) $429 $429 4.2×
X-ray retrograde pyelogram (74420) $157 $157 0.5×
X-Ray Ribs 2 Vw Unilat - Xr Ribs 2 Views Right (71100) $319 $319 3.7×
X-Ray Ribs, Chest 3+ Vw - Xr Ribs 2 Vws Lt W/ Chest Anteroposterior (71101) $429 $429 4.2×
X-Ray Ribs, Chest 4+ Vw - Xr Ribs 3 Vws Bil W/ Chest Posteroanterior (71111) $429 $429 4.2×
X-Ray Sacroiliac Jts 3+ Vw - Xr Sacroiliac Joints 3+ Views (72202) $429 $429 4.2×
X-Ray Sacrum/Coccyx 2+ Vw - Xr Sacrum Coccyx 2+ Views (72220) $319 $319 3.7×
X-Ray Sinuses 3+ Vw - Xr Paranasal Sinuses 3+ Views (70220) $320 $320 3.7×
X-Ray Skull 4+ Vw - Xr Skull Complete 4+ Views (70260) $429 $429 4.2×
X-Ray Skull <4 Vw - Xr Skull 1-3 Views (70250) $429 $429 4.2×
X-Ray Sterno-Clavicluar Jt - Xr Sternoclavicular Joints 3+ Views (71130) $319 $319 3.7×
X-Ray Sternum 2+ Vw - Xr Sternum 2+ Views (71120) $319 $319 3.7×
X-Ray Thoracic Spine 2 Vw - Xr Thoracic Spine 2 Views (72070) $429 $429 4.2×
Xr bone length studies (77073) $429 $429 4.2×
Xr c-spine 4 or 5 views (72050) $429 $429 4.2×
Xr c-spine 6 or more views (72052) $429 $429 4.2×