Imaging prices at Ivinson Memorial Hospital

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

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

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ProcedureCash priceGross charge× Medicare
3-D radiotherapy plan dose-volume histograms (77295) $6,579 $6,579 4.7×
Abdomen 2 views (74019) $412 $412 3.9×
Acute gastrointestinal blood loss imaging (78278) $2,505 $2,505 6.1×
Ankle 2 views (73600) $377 $377 4.2×
Antegrade urography radiological supvj & interpj (74425) $1,038 $1,038 2.9×
Arthrogram hip (73525) $793 $793 2.2×
Arthrogram shoulder (73040) $1,307 $1,307 3.7×
Arthrogram wrist (73115) $969 $969 2.7×
Arthrography knee lt (73580) $1,140 $1,140 3.2×
Basic radiation dosimetry calculation (77300) $546 $546 4.0×
Bone &/Joint Imaging Limited Area (78300) $1,257 $1,257 3.1×
Bone &/joint imaging whole body (78306) $1,936 $1,936 4.7×
Bone age studies (77072) $289 $289 2.7×
Bone Imaging 3 Phase (78315) $1,999 $1,999 4.9×
Bone survey complete (77075) $798 $798 7.5×
Brachytx isodose complex (77318) $2,358 $2,358 6.2×
Cervical spine 2 or 3 views (72040) $439 $439 4.9×
Chest 1 view (71045) $251 $251 2.8×
Chest 3 views (71047) $456 $456 5.1×
Cine/Vid X-Ray Throat/Esoph - Fl Esoph Barium Swlw W/ Video & Speech (74230) $500 $500 2.8×
Clavicle complete (73000) $454 $454 5.1×
Computed Tomography Thorax Lw Dose Lng Ca Scr C- (71271) $522 $522 4.9×
Continuing medical physics consltj pr wk (77336) $769 $769 5.6×
CT abdomen and pelvis without and with contrast (74178) $4,996 $4,996 14.0×
CT abdomen and pelvis without contrast (74176) $4,441 $4,441 18.2×
CT abdomen w contrast (74160) $2,564 $2,564 14.3×
CT abdomen w wo contrast (74170) $3,009 $3,009 16.8×
CT abdomen w/o contrast (74150) $2,176 $2,176 20.4×
CT angiography upper extremity lt (73206) $2,827 $2,827 15.8×
CT c-spine w/o contrast (72125) $2,822 $2,822 26.4×
CT cervical spine w&w/o contrast (72127) $4,310 $4,310 24.1×
CT cervical spine with contrast (72126) $3,770 $3,770 10.6×
CT chest w/wo contrast (71270) $2,330 $2,330 13.0×
CT chest with contrast (71260) $2,052 $2,052 11.5×
CT head/brain with contrast (70460) $1,941 $1,941 10.8×
CT head/brain without and with contrast (70470) $2,829 $2,829 15.8×
CT iac w contrast (70481) $3,918 $3,918 21.9×
CT lower ext w/o (73700) $2,289 $2,289 21.4×
CT lower extremity w wo contrast (73702) $4,707 $4,707 26.3×
CT lower extremity with contrast (73701) $3,368 $3,368 18.8×
CT lumbar spine w & w/o contrast (72133) $2,582 $2,582 14.4×
CT lumbar spine w/o contrast (72131) $2,352 $2,352 22.0×
CT lumbar spine with contrast (72132) $2,375 $2,375 6.7×
CT maxillofacial w contrast (70487) $3,046 $3,046 17.0×
CT maxillofacial w/o contrast (70486) $2,371 $2,371 22.2×
CT maxillofacial w/wo contrast (70488) $3,629 $3,629 20.3×
CT neck soft tissue w contrast (70491) $3,010 $3,010 16.8×
CT orbit sella/post fossa/ear w/o & w/contr matr (70482) $5,692 $5,692 31.8×
CT orbits w/o contrast (70480) $3,803 $3,803 35.6×
CT pelvis w & w/o contrast (72194) $2,374 $2,374 13.2×
CT pelvis w/o contrast (72192) $1,872 $1,872 17.5×
CT soft tissue neck w/o & w/contrast material (70492) $3,605 $3,605 20.1×
CT soft tissue neck w/o contrast (70490) $3,078 $3,078 28.8×
CT thoracic spine w/contrast (72129) $3,036 $3,036 16.9×
CT thoracic spine w/o contrast (72128) $2,730 $2,730 25.6×
CT thoracic spine w/wo contrast (72130) $3,471 $3,471 19.4×
CT thorax w/o contrast (71250) $1,693 $1,693 15.9×
CT upper extremity w/o & w/contrast material (73202) $2,394 $2,394 13.4×
CT upper extremity w/o contrast rt (73200) $1,935 $1,935 18.1×
CT upper extremity with contrast (73201) $2,192 $2,192 6.1×
Cta Abdl Aorta&Bi Iliofem W/Contrast&Postp (75635) $3,769 $3,769 21.0×
Cta Abdomen (74175) $2,525 $2,525 14.1×
CTA abdomen pelvis (74174) $5,009 $5,009 14.1×
CTA chest (71275) $3,011 $3,011 16.8×
Cta Head (70496) $1,639 $1,639 9.1×
CTA lwr ext w&w/o contrast (73706) $5,508 $5,508 30.7×
Cta Neck (70498) $2,775 $2,775 15.5×
Cta Pelvis (72191) $3,582 $3,582 20.0×
Cystography minimum 3 views rs&i (74430) $554 $554 1.6×
Diskography lumbar (72295) $1,543 $1,543 0.8×
Doppler Fetal Mid Cerebral Artery (76821) $421 $421 3.9×
Dxa bone density study 1/> sites axial skel (77080) $547 $547 5.1×
Dxa bone density study 1/>sites appendiclr skel (77081) $314 $314 3.5×
Esophagus (74220) $642 $642 3.6×
Fetal biophysical profile non-stress testing (76818) $987 $987 9.2×
Fetal Biophysical Profile W/O Non-Stress Testing (76819) $731 $731 6.8×
Fluoroscopy up to 1 hr (76000) $692 $692 2.8×
Foot 2 views (73620) $390 $390 4.4×
Forearm 2 views (73090) $346 $346 3.9×
Gated Heart Planar Single (78472) $2,260 $2,260 5.5×
Hand 2 views (73120) $329 $329 3.1×
Hand 3 views (73130) $313 $313 3.5×
Hepatobil Syst Imag Inc Gb W/Pharma Intervenj (78227) $2,168 $2,168 3.9×
Hepatobiliary syst imaging including gallbladder (78226) $1,730 $1,730 4.2×
Ht muscle image spect sing (78451) $1,900 $1,900 1.4×
Humerus Min 2 Views Left (73060) $346 $346 3.9×
Hysterosalpingogram (74740) $1,028 $1,028 4.2×
Interstitial radiation source applic complex (77778) $4,874 $4,874 6.8×
Kidney Img Morphology Vascular Flow 1 W/O Rx (78707) $1,135 $1,135 2.0×
Kidney img morphology vascular flow 1 w/rx (78708) $1,011 $1,011 1.8×
Knee 3 views (73562) $407 $407 4.6×
Lung perf&ventilat diferentl (78598) $2,268 $2,268 4.1×
Lymphoscintigraphy (78195) $1,875 $1,875 3.4×
Meckels Diverticulum (78290) $1,951 $1,951 4.8×
Mlc imrt design & construction per imrt plan (77338) $275 $275 0.7×
MRA head w & w/o contrast (70546) $4,485 $4,485 12.6×
MRA head w/o contrast (70544) $3,582 $3,582 14.7×
MRA head with contrast (70545) $4,236 $4,236 11.9×
Mra Neck W/O &W/Contrast Material (70549) $3,747 $3,747 10.5×
MRA neck w/o contrast (70547) $3,582 $3,582 14.7×
MRI abdomen w/o & w/contrast material (74183) $3,407 $3,407 9.6×
MRI abdomen w/o contrast (74181) $2,518 $2,518 10.3×
MRI any jnt lwr ext with con lt (73722) $2,892 $2,892 3.6×
MRI any jt upper extremity w/contrast matrl (73222) $2,934 $2,934 3.7×
MRI breast w/o contrast bilateral (77047) $3,666 $3,666 15.0×
MRI breast w/o contrast unilat (77046) $2,107 $2,107 8.6×
MRI c-spine with contrast (72142) $3,626 $3,626 10.2×
MRI cervical spine w/o contrast (72141) $3,116 $3,116 12.8×
MRI chest w/o & w/contrast material (71552) $5,227 $5,227 14.7×
MRI chest w/o contrast (71550) $3,886 $3,886 15.9×
MRI lower extrem oth/thn jt w/contrast matrl (73719) $2,686 $2,686 7.5×
MRI lower extrem oth/thn jt w/o contr matrl (73718) $2,195 $2,195 9.0×
MRI orbit face &/neck w/o contrast (70540) $3,582 $3,582 14.7×
MRI orbit/face/neck w&w/o cont (70543) $3,998 $3,998 11.2×
MRI pelvis w/o & w/contrast material (72197) $4,839 $4,839 13.6×
MRI pelvis w/o contrast (72195) $3,527 $3,527 14.5×
MRI scan of arm joint before and after contrast (73223) $3,656 $3,656 10.3×
MRI scan of leg joint before and after contrast (73723) $3,270 $3,270 9.2×
MRI spinal canal cervical w/o & w/contr matrl (72156) $3,577 $3,577 10.0×
MRI spinal canal lumbar w/contrast material (72149) $3,250 $3,250 9.1×
MRI spinal canal lumbar w/o & w/contr matrl (72158) $3,547 $3,547 10.0×
MRI spinal canal thoracic w/contrast matrl (72147) $3,729 $3,729 10.5×
MRI spinal canal thoracic w/o & w/contr matrl (72157) $3,487 $3,487 9.8×
MRI thoracic spine w/o contrast (72146) $3,036 $3,036 12.5×
MRI upper ext joint w/o contrast (73221) $2,540 $2,540 10.4×
MRI upper extrem other than jt w/o & w/contras (73220) $3,770 $3,770 10.6×
MRI upper extremity oth than jt w/o contr matrl (73218) $2,694 $2,694 11.1×
Myelogram Lumbar (72265) $2,101 $2,101 2.6×
Myelogram thoracic (72255) $611 $611 0.8×
Myocardial Spect Multiple Studies (78452) $3,306 $3,306 2.5×
Neck soft tissue (70360) $348 $348 3.9×
Nm gastric emptying study (78264) $1,693 $1,693 4.1×
Ntsty modul radthx pln dose-vol histos (77301) $8,554 $8,554 6.0×
Nuclear Rx Oral Admin (79005) $1,634 $1,634 6.9×
Ob Us Follow-Up Per Fetus - Us Ob Follow Up Transabdominal Approach (76816) $611 $611 5.7×
Orthopantogram (70355) $406 $406 4.6×
Osseous survey infant (77076) $432 $432 4.0×
Parathyrd planar w/wo subtrj (78071) $1,900 $1,900 4.7×
Parathyroid imaging (78070) $1,609 $1,609 3.9×
Pelvis 1 or 2 views (72170) $432 $432 4.0×
PET image w/CT, skull-thigh (78815) $7,654 $7,654 5.2×
PET imaging for CT attenuation whole body (78816) $7,825 $7,825 5.4×
Pr MRI, lower extr, w/o contrast f/u by contrast (73720) $3,096 $3,096 8.7×
Pulmonary Perfusion Imaging Particulate (78580) $989 $989 2.4×
Pulmonary Ventilation & Perfusion Imaging (78582) $1,412 $1,412 2.5×
Radex Entir Thrc Lmbr Crv Sac Spi W/Skull 1 Vw - Xr Scoliosis 1 Vw (72081) $564 $564 6.3×
Radex entir thrc lmbr crv sac spi w/skull 2/3 vw (72082) $559 $559 5.2×
Radex hips bilateral with pelvis 2 views (73521) $439 $439 4.1×
Radiation Delivery Stereotactic Cranial Linear (77372) $23,569 $23,569 3.1×
Radiation treatment delivery 1 mev >= complex (77412) $624 $624 1.1×
Radiolog exam mandible compl minimum 4 views (70110) $626 $626 5.9×
Radiologic Exam Abdomen 1 View - Xr Abdomen 1 View (74018) $317 $317 3.6×
Radiologic Exam Abdomen 3+ Views - Xr Abdomen 3+ Views (74021) $387 $387 3.6×
Radiologic Exam Chest 2 Views - Xr Chest 2 Views (71046) $345 $345 3.9×
Radiologic exam colon single contrast study (74270) $751 $751 4.2×
Radiologic Exam Esophagus Double Contrast Study (74221) $642 $642 3.6×
Radiologic exam upr gi trc double contrast study (74246) $1,347 $1,347 7.5×
Radiologic exam upr gi trc single contrast study (74240) $1,135 $1,135 6.3×
Radiologic Examination Femur Minimum 2 Views - Xr Femur 2+ Vw Lt (73552) $365 $365 4.1×
Radiological examination surgical specimen (76098) $620 $620 1.1×
Ribs bilateral 3 views (71110) $590 $590 5.5×
Rp loclzj tum plnr 2+area 1+d img/1 area img>2+d (78801) $2,033 $2,033 5.0×
Rp loclzj tum plnr whole body single day imaging (78802) $2,397 $2,397 4.3×
Rp loclzj tum spect 1 area single day imaging (78803) $2,838 $2,838 5.1×
Rp loclzj tum spect 2 area/sep acquisj img (78831) $3,163 $3,163 2.4×
Sacroiliac Joints < 3 Views (72200) $383 $383 3.6×
Scanogram (77073) $442 $442 4.1×
Scapula complete (73010) $433 $433 4.1×
Screening digital breast tomosynthesis (77063) $27 $27 1.2×
Simulation intermediate (77285) $1,830 $1,830 4.8×
Small bowel series (74250) $756 $756 4.2×
Spec medical radj physics consltj (77370) $864 $864 6.3×
Special dosimetry (77331) $334 $334 2.4×
Special treatment procedure (77470) $3,100 $3,100 5.5×
Spine thoracic 3 views (72072) $617 $617 5.8×
Stereotactic body radiation delivery (77373) $7,117 $7,117 3.9×
Telethx isodose pln cplx w/basic dosimetry (77307) $1,078 $1,078 2.8×
Ther rad simulaj-aided field setting complex (77290) $2,558 $2,558 6.7×
Ther rad simulaj-aided field setting simple (77280) $1,289 $1,289 9.4×
Therapeutic Enema (74283) $764 $764 4.3×
Thoracolumbar 2 views (72080) $587 $587 6.6×
Thyroid carcinoma metastases img whole body (78018) $2,246 $2,246 4.0×
Thyroid Imaging With Vascular Flow (78013) $1,069 $1,069 2.6×
Thyroid uptake measurement (78012) $1,343 $1,343 3.3×
Thyroid Uptake W/Blood Flow Sngle/Mult Quan Meas (78014) $1,343 $1,343 3.3×
Tomogram (76100) $970 $970 9.1×
Treatment devices simple (77332) $447 $447 3.3×
Tumor Imaging Whole Body - Nm Tumor Local Whole Body Mult Days (78804) $3,773 $3,773 6.8×
Tx devices design & construction complex (77334) $1,335 $1,335 3.5×
Ultrasound elastography first target lesion (76982) $358 $358 3.4×
Ultrasound, abdomen limited (76705) $689 $689 6.5×
Umbilical-artery Doppler (OB) (76820) $504 $504 4.7×
Unlisted Ultrasound Procedure (76999) $471 $471 5.3×
Upper Extremity Infant (73092) $341 $341 3.2×
Urethrocystography retrograde rs&i (74450) $952 $952 3.9×
Urethrocystography voiding (74455) $916 $916 3.8×
Urography (pyelography), intravenous, with or without KUB, with or without tomography (74400) $1,025 $1,025 5.7×
Us abdl aorta screen aaa (76706) $876 $876 8.2×
Us breast unilateral complete (76641) $540 $540 5.1×
Us breast unilateral limited (76642) $490 $490 5.5×
Us chest (76604) $522 $522 4.9×
Us compl joint r-t w/image documentation (76881) $733 $733 6.9×
Us elastography parenchyma (76981) $689 $689 6.5×
Us infant hips dynamic (76885) $742 $742 8.3×
Us kidney transplant (76776) $819 $819 7.7×
Us ob detailed single fetus (76811) $1,124 $1,124 4.6×
Us ob transvaginal (76817) $844 $844 7.9×
Us pelvic non ob complete (76856) $1,053 $1,053 9.9×
Us pelvic nonobstetric image dcmtn limited/f/u (76857) $654 $654 6.1×
Us pregnancy ltd (76815) $530 $530 5.0×
Us pregnant uterus 14 wk transabdl 1/1st gestat (76801) $854 $854 8.0×
Us retroperitoneal complete (76770) $946 $946 8.9×
Us retroperitoneal limited (76775) $622 $622 5.8×
Us scrotum and contents (76870) $697 $697 6.5×
Us soft tissue head/neck (76536) $802 $802 7.5×
Us spinal canal and contents (76800) $720 $720 6.7×
Us transrectal (76872) $713 $713 6.7×
Us transrectal prostate volume (76873) $856 $856 8.0×
Us xtr non-vasc lmtd (76882) $545 $545 5.1×
Us, eye b-scan (76512) $469 $469 4.4×
Venography venous sinus/jugular cath rs&i (75860) $3,554 $3,554 1.1×
Wrist 2 views (73100) $313 $313 3.5×
X-Ray Abdomen,Comp Acute Series - Xr Abdomen 2 Vws With Chest 1 View (74022) $520 $520 4.9×
X-Ray Ac Jts - Xr Acromioclavicular Joints Bilateral (73050) $441 $441 5.0×
X-Ray Ankle 3+ Vw - Xr Ankle 3+ Views Right (73610) $346 $346 3.9×
X-Ray Colon Air Contrast - Fl Barium Enema Air Contrast (74280) $1,034 $1,034 5.8×
X-Ray Elbow 2 Vw - Xr Elbow 1-2 Views Right (73070) $314 $314 3.5×
X-Ray Elbow 3+ Vw - Xr Elbow 3+ Views Right (73080) $405 $405 4.6×
X-ray exam entire spi 4/5 vw (72083) $645 $645 6.0×
X-ray exam hip uni 1 view (73501) $266 $266 3.0×
X-Ray Exam Hip Uni 2-3 Views (73502) $289 $289 3.3×
X-ray exam hip uni 4/> views (73503) $553 $553 5.2×
X-Ray Exam Hips Bi 3-4 Views (73522) $355 $355 3.3×
X-Ray Exam Hips Bi 5/> Views (73523) $718 $718 6.7×
X-ray exam of femur 1 (73551) $334 $334 3.8×
X-ray eye for foreign body (70030) $314 $314 3.5×
X-Ray Facial Bones 3+ Vw - Xr Facial Bones 3+ Views (70150) $550 $550 5.1×
X-Ray Facial Bones <3 Vw - Xr Facial Bones 1-2 Views (70140) $547 $547 6.2×
X-Ray Foot 3+ Vw - Xr Foot 3+ Views Right (73630) $346 $346 3.9×
X-Ray Heel - Xr Calcaneus 2 Views Right (73650) $302 $302 3.4×
X-ray IV pyelogram+drip infusn (74410) $1,148 $1,148 6.4×
X-Ray Jaw <4 Vw - Xr Mandible < 4 Views (70100) $508 $508 5.7×
X-Ray Knee 4+ View - Xr Knee 4+ Views Right (73564) $426 $426 4.0×
X-Ray Knee Bilat Standing - Xr Knees Anteroposterior Standing Bilat (73565) $375 $375 4.2×
X-Ray Leg, Infant - Xr Lower Extremity 2+ Views Infant Left (73592) $341 $341 3.8×
X-Ray Lumbar Spine 2/3 Vw - Xr Lumbar Spine 2-3 Views (72100) $476 $476 4.5×
X-Ray Lumbar Spine 6+ Vw - Xr Lumbar Spine 6+ Vws Including Bending (72114) $679 $679 6.4×
X-Ray Lumbar Spine Flex/Exten - Xr Lumbar Spine 4+ Views W/ Flex Ext (72120) $471 $471 4.4×
X-Ray Nasal Bones - Xr Nasal Bones (70160) $427 $427 4.8×
X-Ray Nose-Rectum Child F.B. - Xr Nose to Rectum Foreign Body Peds (76010) $245 $245 2.8×
X-Ray Orbits - Xr Orbits Complete 4+ Views (70200) $489 $489 4.6×
X-Ray Pelvis 3+ Vw - Xr Pelvis 3+ Views (72190) $545 $545 5.1×
X-Ray Retrograde Pyelogram - Fl Pyelogram Retrograde (74420) $1,010 $1,010 2.8×
X-Ray Ribs 2 Vw Unilat - Xr Ribs 2 Views Right (71100) $337 $337 3.8×
X-Ray Ribs, Chest 3+ Vw - Xr Ribs 2 Vws Lt W/ Chest Anteroposterior (71101) $399 $399 3.7×
X-Ray Ribs, Chest 4+ Vw - Xr Ribs 3 Vws Bil W/ Chest Posteroanterior (71111) $614 $614 5.7×
X-Ray Sacroiliac Jts 3+ Vw - Xr Sacroiliac Joints 3+ Views (72202) $416 $416 3.9×
X-Ray Sacrum/Coccyx 2+ Vw - Xr Sacrum Coccyx 2+ Views (72220) $353 $353 4.0×
X-Ray Shoulder 2+ Vw - Xr Shoulder 2+ Views Right (73030) $402 $402 4.5×
X-Ray Sinuses 3+ Vw - Xr Paranasal Sinuses 3+ Views (70220) $538 $538 6.1×
X-Ray Sinuses <3 Vw - Xr Paranasal Sinuses 1-2 Views (70210) $474 $474 5.3×
X-Ray Skull 4+ Vw - Xr Skull Complete 4+ Views (70260) $791 $791 7.4×
X-Ray Skull <4 Vw - Xr Skull 1-3 Views (70250) $470 $470 4.4×
X-Ray Spine One View - Xr Spine (72020) $351 $351 3.9×
X-Ray Sterno-Clavicluar Jt - Xr Sternoclavicular Joints 3+ Views (71130) $257 $257 2.9×
X-Ray Sternum 2+ Vw - Xr Sternum 2+ Views (71120) $617 $617 6.9×
X-Ray Thoracic Spine 2 Vw - Xr Thoracic Spine 2 Views (72070) $496 $496 4.6×
X-Ray Thoracic Spine 4 Vw - Xr Thoracic Spine Complete 4+ Views (72074) $549 $549 5.1×
X-Ray Toe(S) - Xr Toes 2+ Views Right (73660) $304 $304 3.4×
X-Ray Wrist 3+ Vw - Xr Wrist 3+ Views Right (73110) $353 $353 4.0×
Xr c-spine 6 or more views (72052) $1,041 $1,041 9.7×
Xr chest 4+ views (71048) $447 $447 4.2×
Xr finger(s) 2+ views (73140) $303 $303 3.4×
Xr shoulder 1 view (73020) $267 $267 3.0×
Xr spine cervical 4 or 5 views (72050) $780 $780 7.3×
Xr tibia/fibula 2 views (73590) $374 $374 4.2×
Xr tmj bilateral (70330) $394 $394 4.4×
Xray knee 1 or 2 views rt (73560) $325 $325 3.7×