Imaging prices at Liberty Dayton Regional Medical Center

Liberty, TX · every code in this section with a posted price and a Medicare benchmark.

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

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ProcedurePosted cashPosted gross× Medicare
Abdomen 1 View (74018) $186 $266 2.1×
Abdomen 2 views (74019) $239 $341 2.3×
Ankle 2 views (73600) $186 $266 2.1×
Bone age studies (77072) $239 $341 2.3×
Chest 1 view (71045) $195 $279 2.2×
Chest 2 views (71046) $195 $279 2.2×
Clavicle complete (73000) $195 $279 2.2×
Computed Tomography Thorax Lw Dose Lng Ca Scr C- (71271) $228 $326 2.2×
CT abdomen and pelvis without and with contrast (74178) $1,336 $1,908 3.8×
CT abdomen and pelvis without contrast (74176) $904 $1,292 3.8×
CT abdomen w contrast (74160) $904 $1,292 5.1×
CT abdomen w wo contrast (74170) $1,033 $1,476 5.9×
CT abdomen w/o contrast (74150) $664 $948 6.3×
CT Angio Abdomen and Pelvis (74174) $1,217 $1,739 3.5×
CT Angio Chest (71275) $1,217 $1,739 6.9×
CT Angio Head (70496) $1,217 $1,739 6.9×
CT angio hrt w/3d image (75574) $1,652 $2,360 4.7×
Ct Angio Lwr Extr W/O&W/Dye (73706) $1,217 $1,739 6.9×
CT Angio Neck (70498) $1,217 $1,739 6.9×
Ct Angio Upr Extrm W/O&W/Dye (73206) $1,217 $1,739 6.9×
CT bone density (77078) $234 $335 2.7×
CT cervical spine w/ contrast (72126) $904 $1,292 2.6×
CT cervical spine w/o contrast (72125) $664 $948 6.3×
CT cervical spine w/wo cont (72127) $1,033 $1,476 5.9×
CT chest w contrast (71260)
range across 4 matching MRF lines		 $904–$906 $1,292–$1,295 varies
CT chest w/wo contrast (71270) $1,033 $1,476 5.9×
CT head/brain with contrast (70460) $904 $1,292 5.1×
CT head/brain without and with contrast (70470) $1,033 $1,476 5.9×
CT heart no contrast quant eval coronry calcium (75571) $216 $308 2.5×
CT iac w contrast (70481) $904 $1,292 5.1×
CT l-spine w&w/o contrast (72133) $1,033 $1,476 5.9×
CT lower ext w/o (73700) $664 $948 6.3×
CT lower extremity w/contrast material (73701) $904 $1,292 5.1×
CT lumbar spine w contrast (72132) $904 $1,292 2.6×
CT lumbar spine w/o contrast (72131) $664 $948 6.3×
CT maxillofacial w contrast (70487) $904 $1,292 5.1×
CT maxillofacial wo contrast (70486) $664 $948 6.3×
CT neck tissue combo (70492) $1,033 $1,476 5.9×
Ct Orbit/Ear/Fossa W/O&W/Dye (70482) $1,033 $1,476 5.9×
CT orbits w/o contrast (70480) $664 $948 6.3×
CT pelvis w&w/o contrast (72194) $1,033 $1,476 5.9×
CT pelvis w/o contrast (72192) $664 $948 6.3×
CT scan of leg combo (73702) $1,033 $1,476 5.9×
CT scans face/jaw combo (70488) $1,033 $1,476 5.9×
CT soft tissue neck w contrast (70491) $904 $1,292 5.1×
CT soft tissue neck w/o contrast (70490) $664 $948 6.3×
CT thoracic spine w contrast (72129) $904 $1,292 5.1×
CT thoracic spine w/o contrast (72128) $664 $948 6.3×
CT thoracic spine w/wo cont (72130) $1,033 $1,476 5.9×
CT thorax w/o contrast (71250)
range across 3 matching MRF lines		 $657–$659 $938–$941 varies
CT upper ext wo (73200) $664 $948 6.3×
CT upper extremity w/o & w/contrast material (73202) $1,033 $1,476 5.9×
CT upper extremity with contrast (73201) $904 $1,292 2.6×
Cta Abdl Aorta&Bi Iliofem W/Contrast&Postp (75635) $1,217 $1,739 6.9×
Cta Abdomen (74175) $1,217 $1,739 6.9×
CTA head&neck c+ w/noncontrast img&post-pxessing (70471) $2,435 $3,478 6.9×
CTA pelvis (72191) $1,217 $1,739 6.9×
Fetal Biophysical Profile W/O Non-Stress Testing (76819) $620 $886 5.9×
Foot 2 views (73620) $186 $266 2.1×
Forearm 2 views (73090) $195 $279 2.2×
Hand 2 views (73120) $186 $266 1.8×
Knee 3 Views (73562) $195 $279 2.2×
Magnetic Image Jaw Joint (70336) $1,269 $1,813 5.3×
Mra Head W/O & W/Contrast Material (70546) $1,537 $2,195 4.4×
MRA head w/o contrast (70544) $1,341 $1,916 5.6×
MRA head with contrast (70545) $1,392 $1,989 4.0×
MRA neck w contrast (70548) $1,392 $1,989 4.0×
Mra Neck W/O &W/Contrast Material (70549) $1,537 $2,195 4.4×
MRA neck w/o contrast (70547) $1,341 $1,916 5.6×
MRI abdomen w/o contrast (74181) $1,269 $1,813 5.3×
MRI any jt lower extrem w/contrast material (73722) $1,659 $2,370 2.1×
MRI any jt lower extrem w/o & w/contrast matrl (73723) $1,775 $2,535 5.1×
MRI any jt upper extremity w/contrast matrl (73222) $1,659 $2,370 2.1×
MRI cervical spine w/o cont (72141) $1,248 $1,783 5.2×
MRI chest w/o contrast (71550) $1,248 $1,783 5.2×
MRI lower extrem oth/thn jt w/o & w/contr matr (73720) $1,775 $2,535 5.1×
MRI lower extrem oth/thn jt w/o contr matrl (73718) $1,269 $1,813 5.3×
Mri Neck Spine W/O & W/Dye (72156) $1,775 $2,535 5.1×
MRI orbit face &/neck w/o contrast (70540) $1,248 $1,783 5.2×
MRI orbit face neck w contrast (70542) $1,341 $1,916 3.8×
Mri Orbt/Fac/Nck W/O &W/Dye (70543) $1,775 $2,535 5.1×
MRI pelvis w/o & w contrast (72197) $1,775 $2,535 5.1×
MRI pelvis w/o contrast (72195) $1,269 $1,813 5.3×
MRI thoracic spine w/o contrast (72146) $1,248 $1,783 5.2×
MRI upper extremity oth than jt w/o contr matrl (73218) $1,269 $1,813 5.3×
Mri Uppr Extremity W/O&W/Dye (73220) $1,775 $2,535 5.1×
MRI, abdomen, combo (74183) $1,775 $2,535 5.1×
MRI, dorsal spine combo (72157) $1,775 $2,535 5.1×
MRI, joint upper extrem (73221) $1,269 $1,813 5.3×
MRI, joint upper extrem combo (73223) $1,775 $2,535 5.1×
MRI, lumbar spine combo (72158) $1,775 $2,535 5.1×
Neck soft tissue (70360) $195 $279 2.2×
Pelvis 1 or 2 views (72170) $239 $341 2.3×
Radex Abd Compl Aqt Abd W/S/E/D Views 1 View Ch (74022) $239 $341 2.3×
Radex Ankle Complete Minimum 3 Views (73610) $195 $279 2.2×
Radex Calcaneus Minimum 2 Views (73650) $195 $279 2.2×
Radex elbow complete minimum 3 views (73080) $195 $279 2.2×
Radex Facial Bones Complete Minimum 3 Views (70150) $239 $341 2.3×
Radex fingr minimum 2 views (73140) $195 $279 2.2×
Radex foot complete minimum 3 views (73630) $195 $279 2.2×
Radex Hand Minimum 3 Views (73130) $195 $279 2.2×
Radex lower extremity infant minimum 2 views (73592) $186 $266 2.1×
Radex Nasal Bones Complete Minimum 3 Views (70160) $195 $279 2.2×
Radex Ribs Unilateral 2 Views (71100) $195 $279 2.2×
Radex shoulder complete minimum 2 views (73030) $195 $279 2.2×
Radex Spine 1 View Specify Level (72020) $186 $266 2.1×
Radex Sternum Minimum 2 Views (71120) $195 $279 2.2×
Radex Temporomandble Jt Opn & Clsd Mouth Bilat (70330) $659 $941 7.5×
Radex Toe Minimum 2 Views (73660) $195 $279 2.2×
Radex upper extremity infant minimum 2 views (73092) $239 $341 2.3×
Radex Wrist Complete Minimum 3 Views (73110) $195 $279 2.2×
Radiolog exam mandible compl minimum 4 views (70110) $239 $341 2.3×
Radiologic exam knee complete 4/more views (73564)
range across 3 matching MRF lines		 $237–$239 $338–$341 varies
Radiologic exam pelvis compl minimum 3 views (72190) $239 $341 2.3×
Radiologic examination femur minimum 2 views (73552) $195 $279 2.2×
Radiologic examination knee 1/2 views (73560) $186 $266 2.1×
Radiologic examination tibia & fibula 2 views (73590) $195 $279 2.2×
Scapula (73010) $239 $341 2.3×
Shoulder 1 view (73020) $186 $266 2.1×
Skull less than 4 views (70250) $239 $341 2.3×
Sternoclavicular joints (71130) $195 $279 2.2×
Thoracic spine 3 views (72072) $239 $341 2.3×
Ultrasound, abdomen limited (76705) $359 $513 3.4×
Unlisted us procedure (76999) $295 $422 3.4×
Us breast unilateral complete (76641) $620 $886 5.9×
Us chest (76604) $326 $466 3.1×
Us complete joint (76881) $304 $434 2.9×
Us exam, pelvic, limited (76857) $359 $513 3.4×
Us lmtd joint/oth nonvasc xtr strux r-t w/img (76882) $359 $513 3.4×
Us ob limited 1 or more fetuses (76815)
range across 2 matching MRF lines		 $358–$359 $512–$513 varies
Us ob transvaginal (76817) $466 $666 4.4×
Us pelvic non ob complete (76856) $466 $666 4.4×
Us pg uter img f&mat 14 wk tabdl 1/1st gestation (76801) $466 $666 4.4×
Us retroperitoneal limited (76775) $382 $545 3.6×
Us scrotum and contents (76870) $466 $666 4.4×
Us thyroid (76536) $359 $513 3.4×
Wrist 2 views (73100) $186 $266 2.1×
X-Ray Ac Jts - Xr Acromioclavicular Joints Bilateral (73050) $195 $279 2.2×
X-Ray Elbow 2 Vw - Xr Elbow 1-2 Views Right (73070) $186 $266 2.1×
X-Ray Exam Entire Spi 4/5 Vw (72083) $239 $341 2.3×
X-Ray Exam Hip Uni 1 View (73501) $186 $266 2.1×
X-Ray Exam Hip Uni 2-3 Views (73502) $195 $279 2.2×
X-Ray Exam Hips Bi 3-4 Views (73522) $239 $341 2.3×
X-Ray Exam L-S Spine Bending (72114) $239 $341 2.3×
X-Ray Exam Neck Spine 2-3 Vw (72040) $186 $266 2.1×
X-Ray Exam Neck Spine 6/>Vws (72052) $239 $341 2.3×
X-ray humerus (73060) $195 $279 2.2×
X-Ray Lumbar Spine 2/3 Vw - Xr Lumbar Spine 2-3 Views (72100) $239 $341 2.3×
X-ray nose-rectum child f.b. (76010) $195 $279 2.2×
X-Ray Ribs, Chest 4+ Vw - Xr Ribs 3 Vws Bil W/ Chest Posteroanterior (71111) $239 $341 2.3×
X-Ray Sacroiliac Jts <3 Vw - Xr Sacroiliac Joints 1-2 Views (72200) $239 $341 2.3×
X-Ray Sacrum/Coccyx 2+ Vw - Xr Sacrum Coccyx 2+ Views (72220) $186 $266 2.1×
X-Ray Sinuses 3+ Vw - Xr Paranasal Sinuses 3+ Views (70220) $239 $341 2.7×
X-Ray Skull 4+ Vw - Xr Skull Complete 4+ Views (70260) $239 $341 2.3×
X-Ray Tmj Unilat (70328) $186 $266 2.1×
X-Rays Bone Survey Complete (77075) $239 $341 2.3×
Xr orbits complete 4 views (70200) $239 $341 2.3×

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.