Imaging prices at Hot Springs County Memorial Hospital

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

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

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ProcedureCash priceGross charge× Medicare
Abdomen 2 views (74019) $279.50 $279.50 2.6×
Acute gastrointestinal blood loss imaging (78278) $1,679 $1,679 4.1×
Ankle 2 views (73600) $201.50 $201.50 2.3×
Antegrade urography radiological supvj & interpj (74425) $461 $461 1.3×
Arthrogram shoulder (73040) $698.50 $698.50 2.0×
Arthrogram wrist (73115) $470 $470 1.3×
Arthrography knee lt (73580) $543 $543 1.5×
Bone &/Joint Imaging Limited Area (78300) $942.50 $942.50 2.3×
Bone &/joint imaging whole body (78306) $1,207 $1,207 3.0×
Bone age studies (77072) $202 $202 1.9×
Bone Imaging 3 Phase (78315) $1,335.50 $1,335.50 3.3×
Bone survey complete (77075) $736.50 $736.50 6.9×
Brain image w/flow 4 + views (78606) $193 $193 0.3×
Cervical spine 2 or 3 views (72040) $241 $241 2.7×
Chest 1 view (71045) $169 $169 1.9×
Chest 3 views (71047) $248.50 $248.50 2.8×
Cine/Vid X-Ray Throat/Esoph - Fl Esoph Barium Swlw W/ Video & Speech (74230) $412 $412 2.3×
Clavicle complete (73000) $198 $198 2.2×
Computed Tomography Thorax Lw Dose Lng Ca Scr C- (71271) $171 $171 1.6×
CT abdomen and pelvis without and with contrast (74178) $393 $393 1.1×
CT abdomen and pelvis without contrast (74176) $346 $346 1.4×
CT abdomen w contrast (74160) $345 $345 1.9×
CT abdomen w wo contrast (74170) $1,781.50 $1,781.50 9.9×
CT abdomen w/o contrast (74150) $345 $345 3.2×
CT angio hrt w/3d image (75574) $380 $380 1.1×
CT angiography upper extremity lt (73206) $1,530 $1,530 8.5×
CT c-spine w/o contrast (72125) $1,325.50 $1,325.50 12.4×
CT cervical spine w&w/o contrast (72127) $1,868.50 $1,868.50 10.4×
CT cervical spine with contrast (72126) $1,459.50 $1,459.50 4.1×
CT chest w/wo contrast (71270) $1,605.50 $1,605.50 9.0×
CT chest with contrast (71260) $1,400.50 $1,400.50 7.8×
CT colonography screening (74263) $849.50 $849.50 3.5×
CT colonography w/o cntrst (74261) $1,119 $1,119 10.5×
CT head/brain with contrast (70460) $1,258.50 $1,258.50 7.0×
CT head/brain without and with contrast (70470) $1,557 $1,557 8.7×
CT heart contrast eval cardiac structure&morph (75572) $1,467.50 $1,467.50 4.1×
CT heart no contrast quant eval coronry calcium (75571) $219 $219 2.5×
CT hrt w/3d image congen (75573) $1,453 $1,453 4.1×
CT iac w contrast (70481) $1,333.50 $1,333.50 7.4×
CT limited/localized follow up study (76380) $654.50 $654.50 7.4×
CT lower ext w/o (73700) $1,107 $1,107 10.4×
CT lower extremity w wo contrast (73702) $1,452 $1,452 8.1×
CT lower extremity with contrast (73701) $1,312.50 $1,312.50 7.3×
CT lumbar spine w & w/o contrast (72133) $1,676 $1,676 9.4×
CT lumbar spine w/o contrast (72131) $1,315 $1,315 12.3×
CT lumbar spine with contrast (72132) $1,513.50 $1,513.50 4.2×
CT maxillofacial w contrast (70487) $1,440.50 $1,440.50 8.0×
CT maxillofacial w/o contrast (70486) $1,316.50 $1,316.50 12.3×
CT maxillofacial w/wo contrast (70488) $1,575.50 $1,575.50 8.8×
CT neck soft tissue w contrast (70491) $1,340 $1,340 7.5×
CT orbit sella/post fossa/ear w/o & w/contr matr (70482) $1,814 $1,814 10.1×
CT orbits w/o contrast (70480) $1,178 $1,178 11.0×
CT pelvis w & w/o contrast (72194) $345 $345 1.9×
CT pelvis w/o contrast (72192) $393 $393 3.7×
CT scan for measuring calcium and other minerals in bone (77078) $275.50 $275.50 3.1×
CT soft tissue neck w/o & w/contrast material (70492) $1,552 $1,552 8.7×
CT soft tissue neck w/o contrast (70490) $1,161.50 $1,161.50 10.9×
CT thoracic spine w/contrast (72129) $1,518.50 $1,518.50 8.5×
CT thoracic spine w/o contrast (72128) $1,329 $1,329 12.4×
CT thoracic spine w/wo contrast (72130) $1,629.50 $1,629.50 9.1×
CT thorax w/o contrast (71250) $1,224.50 $1,224.50 11.5×
CT unlisted procedure (76497) $211 $211 2.4×
CT upper extremity w/o & w/contrast material (73202) $1,676 $1,676 9.4×
CT upper extremity w/o contrast rt (73200) $1,107 $1,107 10.4×
CT upper extremity with contrast (73201) $1,262.50 $1,262.50 3.5×
Cta Abdl Aorta&Bi Iliofem W/Contrast&Postp (75635) $2,118.50 $2,118.50 11.8×
Cta Abdomen (74175) $1,739 $1,739 9.7×
CTA abdomen pelvis (74174) $2,567 $2,567 7.2×
CTA chest (71275) $1,725 $1,725 9.6×
Cta Head (70496) $1,471.50 $1,471.50 8.2×
CTA head&neck c+ w/noncontrast img&post-pxessing (70471) $1,471.50 $1,471.50 4.1×
CTA lwr ext w&w/o contrast (73706) $1,743.50 $1,743.50 9.7×
Cta Neck (70498) $1,527.50 $1,527.50 8.5×
Cta Pelvis (72191) $1,649 $1,649 9.2×
Cystography minimum 3 views rs&i (74430) $447 $447 1.3×
Doppler Fetal Mid Cerebral Artery (76821) $378 $378 3.5×
Echoencephalography real time imaging (76506) $439 $439 4.1×
Esophagus (74220) $355.50 $355.50 2.0×
Fetal biophysical profile non-stress testing (76818) $700.50 $700.50 6.6×
Fetal Biophysical Profile W/O Non-Stress Testing (76819) $456 $456 4.3×
Fluoroscopy up to 1 hr (76000) $376.50 $376.50 1.5×
Foot 2 views (73620) $175 $175 2.0×
Forearm 2 views (73090) $182.50 $182.50 2.1×
Gated Heart Planar Single (78472) $1,241 $1,241 3.0×
Hand 2 views (73120) $177.50 $177.50 1.7×
Hand 3 views (73130) $206 $206 2.3×
Hepatobil Syst Imag Inc Gb W/Pharma Intervenj (78227) $1,401.50 $1,401.50 2.5×
Hepatobiliary syst imaging including gallbladder (78226) $1,251.50 $1,251.50 3.1×
Ht muscle image spect sing (78451) $2,302 $2,302 1.7×
Humerus Min 2 Views Left (73060) $198 $198 2.2×
Hysterosalpingogram (74740) $473 $473 1.9×
Kidney Img Morphology Vascular Flow 1 W/O Rx (78707) $1,039 $1,039 1.9×
Kidney img morphology vascular flow 1 w/rx (78708) $1,001.50 $1,001.50 1.8×
Kidney Img Morphology Vascular Flow Multiple (78709) $1,285.50 $1,285.50 2.3×
Knee 3 views (73562) $223.50 $223.50 2.5×
Liver & spleen imaging static only (78215) $1,057 $1,057 2.6×
Lung Ventilation Imaging (78579) $1,109 $1,109 2.7×
Lymphoscintigraphy (78195) $1,465.50 $1,465.50 2.6×
Mammary ductogram or galactogram multiple (77054) $324.50 $324.50 1.3×
Mammary ductogram or galactogram single (77053) $253 $253 1.0×
Meckels Diverticulum (78290) $855.50 $855.50 2.1×
MRA head w & w/o contrast (70546) $2,204.50 $2,204.50 6.2×
MRA head w/o contrast (70544) $1,250.50 $1,250.50 5.1×
MRA head with contrast (70545) $1,428.50 $1,428.50 4.0×
MRA neck w contrast (70548) $1,590 $1,590 4.5×
Mra Neck W/O &W/Contrast Material (70549) $2,307.50 $2,307.50 6.5×
MRA neck w/o contrast (70547) $1,526 $1,526 6.3×
MRI abdomen w contrast (74182) $2,069.50 $2,069.50 5.8×
MRI abdomen w/o & w/contrast material (74183) $2,291.50 $2,291.50 6.4×
MRI abdomen w/o contrast (74181) $1,950 $1,950 8.0×
MRI any jnt lwr ext with con lt (73722) $1,880 $1,880 2.3×
MRI any jt upper extremity w/contrast matrl (73222) $1,837 $1,837 2.3×
MRI breast w/o contrast bilateral (77047) $570.50 $570.50 2.3×
MRI breast w/o contrast unilat (77046) $466.50 $466.50 1.9×
MRI c-spine with contrast (72142) $2,163.50 $2,163.50 6.1×
MRI cervical spine w/o contrast (72141) $1,734 $1,734 7.1×
MRI chest w/o & w/contrast material (71552) $2,413 $2,413 6.8×
MRI chest w/o contrast (71550) $1,390 $1,390 5.7×
MRI chest with contrast (71551) $1,509.50 $1,509.50 1.9×
MRI Forearm w/ Contrast Bilateral 73219 (73219) $2,820 $2,820 7.9×
MRI lower extrem oth/thn jt w/contrast matrl (73719) $1,764.50 $1,764.50 5.0×
MRI lower extrem oth/thn jt w/o contr matrl (73718) $1,500 $1,500 6.2×
MRI orbit face &/neck w/o contrast (70540) $1,327 $1,327 5.4×
MRI orbit/face/neck w&w/o cont (70543) $2,737 $2,737 7.7×
MRI orbit/face/neck w/contrast (70542) $1,626.50 $1,626.50 4.6×
MRI pelvis w contrast (72196) $1,583.50 $1,583.50 4.4×
MRI pelvis w/o & w/contrast material (72197) $2,404.50 $2,404.50 6.7×
MRI pelvis w/o contrast (72195) $2,129 $2,129 8.7×
MRI scan of arm joint before and after contrast (73223) $2,319 $2,319 6.5×
MRI scan of leg joint before and after contrast (73723) $2,112.50 $2,112.50 5.9×
MRI spinal canal cervical w/o & w/contr matrl (72156) $2,423.50 $2,423.50 6.8×
MRI spinal canal lumbar w/contrast material (72149) $2,113.50 $2,113.50 5.9×
MRI spinal canal lumbar w/o & w/contr matrl (72158) $2,418 $2,418 6.8×
MRI spinal canal thoracic w/contrast matrl (72147) $2,126.50 $2,126.50 6.0×
MRI spinal canal thoracic w/o & w/contr matrl (72157) $2,557.50 $2,557.50 7.2×
MRI thoracic spine w/o contrast (72146) $1,711.50 $1,711.50 7.0×
MRI tmj (70336) $1,391 $1,391 5.7×
MRI upper ext joint w/o contrast (73221) $1,660 $1,660 6.8×
MRI upper extrem other than jt w/o & w/contras (73220) $3,314 $3,314 9.3×
MRI upper extremity oth than jt w/o contr matrl (73218) $2,418 $2,418 9.9×
Myocardial Spect Multiple Studies (78452) $2,516.50 $2,516.50 1.9×
Neck soft tissue (70360) $163.50 $163.50 1.8×
Nm gastric emptying study (78264) $929 $929 2.3×
Nuclear Rx Oral Admin (79005) $1,242 $1,242 5.2×
Ob Us Follow-Up Per Fetus - Us Ob Follow Up Transabdominal Approach (76816) $254 $254 2.4×
Osseous survey infant (77076) $105 $105 1.0×
Osseous survey limited (77074) $403.50 $403.50 3.8×
Parathyroid imaging (78070) $1,363.50 $1,363.50 3.3×
Pelvis 1 or 2 views (72170) $56 $56 0.5×
Peritoneogram rs&i (74190) $92 $92 0.2×
Pr MRI, lower extr, w/o contrast f/u by contrast (73720) $2,169 $2,169 6.1×
Pulmonary Perfusion Imaging Particulate (78580) $1,350.50 $1,350.50 3.3×
Pulmonary Ventilation & Perfusion Imaging (78582) $1,536 $1,536 2.8×
Radex abscess/fistula/sinus tract rs&i (76080) $553.50 $553.50 1.0×
Radex Entir Thrc Lmbr Crv Sac Spi W/Skull 1 Vw - Xr Scoliosis 1 Vw (72081) $353.50 $353.50 4.0×
Radex entir thrc lmbr crv sac spi w/skull 2/3 vw (72082) $478.50 $478.50 4.5×
Radex mastoids compl minimum 3 views pr side (70130) $329 $329 3.1×
Radiolog exam mandible compl minimum 4 views (70110) $265 $265 2.5×
Radiologic Exam Abdomen 1 View - Xr Abdomen 1 View (74018) $197.50 $197.50 2.2×
Radiologic Exam Chest 2 Views - Xr Chest 2 Views (71046) $220 $220 2.5×
Radiologic exam colon single contrast study (74270) $546 $546 3.0×
Radiologic exam upr gi trc double contrast study (74246) $213.50 $213.50 1.2×
Radiologic exam upr gi trc single contrast study (74240) $606.50 $606.50 3.4×
Radiologic Examination Femur Minimum 2 Views - Xr Femur 2+ Vw Lt (73552) $605 $605 6.8×
Radiological examination surgical specimen (76098) $304.50 $304.50 0.5×
Ribs bilateral 3 views (71110) $517.50 $517.50 4.8×
Rp loclzj tum plnr 2+area 1+d img/1 area img>2+d (78801) $1,014 $1,014 2.5×
Rp loclzj tum plnr whole body single day imaging (78802) $170 $170 0.3×
Rp loclzj tum spect 1 area single day imaging (78803) $272.50 $272.50 0.5×
Sacroiliac Joints < 3 Views (72200) $184.50 $184.50 1.7×
Salivary gland imaging serial images (78231) $571.50 $571.50 1.4×
Scanogram (77073) $213.50 $213.50 2.0×
Scapula complete (73010) $208 $208 1.9×
Screening digital breast tomosynthesis (77063) $93 $93 4.0×
Sella turcica (70240) $138.50 $138.50 1.6×
Sialogram (70390) $405.50 $405.50 1.7×
Small bowel series (74250) $425 $425 2.4×
Spine thoracic 3 views (72072) $276 $276 2.6×
Testicular Imaging With Vascular Flow (78761) $188 $188 0.5×
Therapeutic Enema (74283) $512 $512 2.9×
Thoracolumbar 2 views (72080) $230.50 $230.50 2.6×
Thyroid uptake measurement (78012) $803.50 $803.50 2.0×
Thyroid Uptake W/Blood Flow Sngle/Mult Quan Meas (78014) $863 $863 2.1×
Tmj unilateral (70328) $182.50 $182.50 2.1×
Tomogram (76100) $428 $428 4.0×
Tumor Imaging, Limited Area - Nm Tumor Localization Limited (78800) $824 $824 2.0×
Ultrasound elastography first target lesion (76982) $192.50 $192.50 1.8×
Ultrasound, abdomen limited (76705) $468 $468 4.4×
Umbilical-artery Doppler (OB) (76820) $374 $374 3.5×
Unlisted magnetic resonance procedure (76498) $579 $579 6.5×
Upper Extremity Infant (73092) $117 $117 1.1×
Ureteral Reflux Study Rp Voiding Cystogram (78740) $187 $187 0.5×
Urethrocystography retrograde rs&i (74450) $481 $481 2.0×
Urethrocystography voiding (74455) $445 $445 1.8×
Urography (pyelography), intravenous, with or without KUB, with or without tomography (74400) $571.50 $571.50 3.2×
Us abdl aorta screen aaa (76706) $390 $390 3.7×
Us breast unilateral limited (76642) $606 $606 6.8×
Us chest (76604) $406 $406 3.8×
Us compl joint r-t w/image documentation (76881) $470 $470 4.4×
Us elastography parenchyma (76981) $286 $286 2.7×
Us guided compression repair (76936) $688 $688 3.1×
Us infant hips dynamic (76885) $383 $383 4.3×
Us ob detailed single fetus (76811) $528 $528 2.2×
Us ob transvaginal (76817) $469 $469 4.4×
Us pelvic non ob complete (76856) $489 $489 4.6×
Us pelvic nonobstetric image dcmtn limited/f/u (76857) $395 $395 3.7×
Us pregnancy ltd (76815) $325.50 $325.50 3.0×
Us pregnant uterus 14 wk transabdl 1/1st gestat (76801) $379 $379 3.5×
Us retroperitoneal complete (76770) $518 $518 4.8×
Us retroperitoneal limited (76775) $532.50 $532.50 5.0×
Us scrotum and contents (76870) $480 $480 4.5×
Us soft tissue head/neck (76536) $456.50 $456.50 4.3×
Us spinal canal and contents (76800) $436.50 $436.50 4.1×
Us xtr non-vasc lmtd (76882) $348 $348 3.3×
Wrist 2 views (73100) $177.50 $177.50 2.0×
X-Ray Abdomen,Comp Acute Series - Xr Abdomen 2 Vws With Chest 1 View (74022) $340 $340 3.2×
X-Ray Ac Jts - Xr Acromioclavicular Joints Bilateral (73050) $229.50 $229.50 2.6×
X-Ray Ankle 3+ Vw - Xr Ankle 3+ Views Right (73610) $214 $214 2.4×
X-Ray Colon Air Contrast - Fl Barium Enema Air Contrast (74280) $711.50 $711.50 4.0×
X-Ray Elbow 2 Vw - Xr Elbow 1-2 Views Right (73070) $184.50 $184.50 2.1×
X-Ray Elbow 3+ Vw - Xr Elbow 3+ Views Right (73080) $203 $203 2.3×
X-ray exam hip uni 1 view (73501) $539 $539 6.1×
X-Ray Exam Hip Uni 2-3 Views (73502) $385.50 $385.50 4.3×
X-Ray Exam Hips Bi 3-4 Views (73522) $385.50 $385.50 3.6×
X-ray exam of femur 1 (73551) $277 $277 3.1×
X-ray eye for foreign body (70030) $224.50 $224.50 2.5×
X-Ray Facial Bones 3+ Vw - Xr Facial Bones 3+ Views (70150) $353 $353 3.3×
X-Ray Facial Bones <3 Vw - Xr Facial Bones 1-2 Views (70140) $257 $257 2.9×
X-Ray Foot 3+ Vw - Xr Foot 3+ Views Right (73630) $203 $203 2.3×
X-Ray Heel - Xr Calcaneus 2 Views Right (73650) $169.50 $169.50 1.9×
X-Ray Jaw <4 Vw - Xr Mandible < 4 Views (70100) $210.50 $210.50 2.4×
X-Ray Knee 4+ View - Xr Knee 4+ Views Right (73564) $254 $254 2.4×
X-Ray Knee Bilat Standing - Xr Knees Anteroposterior Standing Bilat (73565) $206 $206 2.3×
X-Ray Leg, Infant - Xr Lower Extremity 2+ Views Infant Left (73592) $156 $156 1.8×
X-Ray Lumbar Spine 2/3 Vw - Xr Lumbar Spine 2-3 Views (72100) $246.50 $246.50 2.3×
X-Ray Lumbar Spine 6+ Vw - Xr Lumbar Spine 6+ Vws Including Bending (72114) $468 $468 4.4×
X-Ray Lumbar Spine Flex/Exten - Xr Lumbar Spine 4+ Views W/ Flex Ext (72120) $267 $267 2.5×
X-Ray Nasal Bones - Xr Nasal Bones (70160) $202 $202 2.3×
X-Ray Nose-Rectum Child F.B. - Xr Nose to Rectum Foreign Body Peds (76010) $184.50 $184.50 2.1×
X-Ray Orbits - Xr Orbits Complete 4+ Views (70200) $276 $276 2.6×
X-Ray Pelvis 3+ Vw - Xr Pelvis 3+ Views (72190) $244 $244 2.3×
X-Ray Retrograde Pyelogram - Fl Pyelogram Retrograde (74420) $865 $865 2.4×
X-Ray Ribs, Chest 3+ Vw - Xr Ribs 2 Vws Lt W/ Chest Anteroposterior (71101) $264 $264 2.5×
X-Ray Ribs, Chest 4+ Vw - Xr Ribs 3 Vws Bil W/ Chest Posteroanterior (71111) $343 $343 3.2×
X-Ray Sacroiliac Jts 3+ Vw - Xr Sacroiliac Joints 3+ Views (72202) $255 $255 2.4×
X-Ray Sacrum/Coccyx 2+ Vw - Xr Sacrum Coccyx 2+ Views (72220) $216 $216 2.4×
X-Ray Shoulder 2+ Vw - Xr Shoulder 2+ Views Right (73030) $235.50 $235.50 2.6×
X-Ray Sinuses 3+ Vw - Xr Paranasal Sinuses 3+ Views (70220) $359.50 $359.50 4.0×
X-Ray Sinuses <3 Vw - Xr Paranasal Sinuses 1-2 Views (70210) $195.50 $195.50 2.2×
X-Ray Skull 4+ Vw - Xr Skull Complete 4+ Views (70260) $413.50 $413.50 3.9×
X-Ray Skull <4 Vw - Xr Skull 1-3 Views (70250) $290 $290 2.7×
X-Ray Spine One View - Xr Spine (72020) $155 $155 1.7×
X-Ray Sterno-Clavicluar Jt - Xr Sternoclavicular Joints 3+ Views (71130) $225.50 $225.50 2.5×
X-Ray Sternum 2+ Vw - Xr Sternum 2+ Views (71120) $264 $264 3.0×
X-Ray Thoracic Spine 2 Vw - Xr Thoracic Spine 2 Views (72070) $227.50 $227.50 2.1×
X-Ray Toe(S) - Xr Toes 2+ Views Right (73660) $161.50 $161.50 1.8×
X-Ray Wrist 3+ Vw - Xr Wrist 3+ Views Right (73110) $210 $210 2.4×
Xr c-spine 6 or more views (72052) $434 $434 4.1×
Xr chest 4+ views (71048) $214 $214 2.0×
Xr finger(s) 2+ views (73140) $160.50 $160.50 1.8×
Xr internal auditory meati complete (70134) $321.50 $321.50 0.6×
XR Mastoids < 3 Views Bilateral (70120) $177 $177 1.7×
Xr optic foramina (70190) $177 $177 2.0×
Xr shoulder 1 view (73020) $177 $177 2.0×
Xr spine cervical 4 or 5 views (72050) $326.50 $326.50 3.1×
Xr tibia/fibula 2 views (73590) $210 $210 2.4×
Xr tmj bilateral (70330) $342 $342 3.8×
Xray knee 1 or 2 views rt (73560) $206.50 $206.50 2.3×