Imaging prices at Memorial Hospital

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

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

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ProcedureCash priceGross charge× Medicare
Abdomen 2 views (74019) $372.80 $466 3.5×
Acute gastrointestinal blood loss imaging (78278) $1,056 $1,320 2.6×
Ankle 2 views (73600) $157.60 $197 1.8×
Arthrogram elbow (73085) $874.40 $1,093 2.5×
Arthrogram hip (73525) $874.40 $1,093 2.5×
Arthrogram shoulder (73040) $874.40 $1,093 2.5×
Arthrogram wrist (73115) $848.80 $1,061 2.4×
Arthrography knee lt (73580) $874.40 $1,093 2.5×
Bone &/Joint Imaging Limited Area (78300) $1,140.80 $1,426 2.8×
Bone &/Joint Imaging Multiple Areas (78305) $1,100 $1,375 2.7×
Bone &/joint imaging whole body (78306) $152.80 $191 0.4×
Bone age studies (77072) $278.40 $348 2.7×
Bone Imaging 3 Phase (78315) $944 $1,180 2.4×
Bone survey complete (77075) $737.60 $922 7.0×
Cervical spine 2 or 3 views (72040) $54.40 $68 0.6×
Chest 1 view (71045) $266.40 $333 3.0×
Chest 3 views (71047) $355.20 $444 4.1×
Cine/Vid X-Ray Throat/Esoph - Fl Esoph Barium Swlw W/ Video & Speech (74230) $358.80 $448.50 2.0×
Clavicle complete (73000) $158 $197.50 1.8×
CT abdomen and pelvis without and with contrast (74178) $4,064 $5,080 11.6×
CT abdomen and pelvis without contrast (74176) $2,651.20 $3,314 11.1×
CT abdomen w contrast (74160) $279.20 $349 1.6×
CT abdomen w wo contrast (74170) $372 $465 2.1×
CT abdomen w/o contrast (74150) $269.60 $337 2.6×
CT angiography upper extremity lt (73206) $2,840 $3,550 16.1×
CT c-spine w/o contrast (72125) $262.40 $328 2.5×
CT cervical spine w&w/o contrast (72127) $2,496.80 $3,121 14.2×
CT cervical spine with contrast (72126) $2,277.60 $2,847 6.5×
CT chest w/wo contrast (71270) $372 $465 2.1×
CT chest with contrast (71260) $279.20 $349 1.6×
CT colonography w/dye (74262) $1,848.80 $2,311 10.5×
CT colonography w/o cntrst (74261) $1,848.80 $2,311 17.6×
CT head/brain with contrast (70460) $264.80 $331 1.5×
CT head/brain without and with contrast (70470) $372 $465 2.1×
CT heart no contrast quant eval coronry calcium (75571) $178.40 $223 2.0×
CT iac w contrast (70481) $1,828.80 $2,286 10.4×
CT limited/localized follow up study (76380) $640.80 $801 7.3×
CT lower ext w/o (73700) $1,434.40 $1,793 13.7×
CT lower extremity w wo contrast (73702) $2,194.40 $2,743 12.5×
CT lower extremity with contrast (73701) $1,568.80 $1,961 8.9×
CT lumbar spine w & w/o contrast (72133) $1,400 $1,750 7.9×
CT lumbar spine w/o contrast (72131) $262.40 $328 2.5×
CT lumbar spine with contrast (72132) $2,277.60 $2,847 6.5×
CT maxillofacial w contrast (70487) $1,793.20 $2,241.50 10.2×
CT maxillofacial w/o contrast (70486) $245.60 $307 2.3×
CT maxillofacial w/wo contrast (70488) $2,496.80 $3,121 14.2×
CT neck soft tissue w contrast (70491) $1,061.60 $1,327 6.0×
CT orbit sella/post fossa/ear w/o & w/contr matr (70482) $2,496.80 $3,121 14.2×
CT orbits w/o contrast (70480) $1,847.20 $2,309 17.6×
CT pelvis w & w/o contrast (72194) $1,579.20 $1,974 9.0×
CT pelvis w/o contrast (72192) $234.40 $293 2.2×
CT soft tissue neck w/o & w/contrast material (70492) $1,466 $1,832.50 8.3×
CT soft tissue neck w/o contrast (70490) $985.20 $1,231.50 9.4×
CT thoracic spine w/contrast (72129) $2,277.60 $2,847 12.9×
CT thoracic spine w/o contrast (72128) $1,115.60 $1,394.50 10.6×
CT thoracic spine w/wo contrast (72130) $2,496.80 $3,121 14.2×
CT thorax w/o contrast (71250) $269.60 $337 2.6×
CT upper extremity w/o & w/contrast material (73202) $2,194.40 $2,743 12.5×
CT upper extremity w/o contrast rt (73200) $1,434.40 $1,793 13.7×
CT upper extremity with contrast (73201) $1,568.80 $1,961 4.5×
Cta Abdl Aorta&Bi Iliofem W/Contrast&Postp (75635) $4,652 $5,815 26.4×
Cta Abdomen (74175) $2,897.60 $3,622 16.4×
CTA chest (71275) $1,635.60 $2,044.50 9.3×
Cta Head (70496) $2,755.20 $3,444 15.6×
CTA lwr ext w&w/o contrast (73706) $2,139.20 $2,674 12.1×
Cta Neck (70498) $3,192 $3,990 18.1×
Cystography minimum 3 views rs&i (74430) $685.60 $857 2.0×
Dxa bone density study 1/> sites axial skel (77080) $107.20 $134 1.0×
Dxa bone density study 1/>sites appendiclr skel (77081) $266.40 $333 3.0×
Echoencephalography real time imaging (76506) $695.20 $869 6.6×
Esophageal motility (78258) $1,056 $1,320 2.6×
Esophagus (74220) $472.80 $591 2.7×
Fetal biophysical profile non-stress testing (76818) $115.60 $144.50 1.1×
Fetal Biophysical Profile W/O Non-Stress Testing (76819) $550.40 $688 5.2×
Fluoroscopy up to 1 hr (76000) $430.40 $538 1.8×
Foot 2 views (73620) $48 $60 0.5×
Forearm 2 views (73090) $45.60 $57 0.5×
Gated Heart Planar Single (78472) $1,521.60 $1,902 3.8×
Hand 2 views (73120) $156.40 $195.50 1.5×
Hand 3 views (73130) $163.20 $204 1.9×
Heart infarct image w ef (78468) $1,174.40 $1,468 2.2×
Hepatobil Syst Imag Inc Gb W/Pharma Intervenj (78227) $1,509.60 $1,887 2.8×
Humerus Min 2 Views Left (73060) $52 $65 0.6×
Hysterosalpingogram (74740) $860.80 $1,076 3.6×
Kidney funcj study non-img radioisotopic study (78725) $1,067.20 $1,334 2.7×
Kidney imaging morphology (78700) $1,044.80 $1,306 2.6×
Kidney Img Morphology Vascular Flow 1 W/O Rx (78707) $1,044.80 $1,306 1.9×
Kidney img morphology vascular flow 1 w/rx (78708) $1,831.20 $2,289 3.4×
Knee 3 views (73562) $211.60 $264.50 2.4×
Liver & spleen imaging static only (78215) $1,184 $1,480 2.9×
Liver imaging w/vascular flow (78202) $1,184 $1,480 2.2×
Lung Ventilation Imaging (78579) $440.80 $551 1.1×
Mammary ductogram or galactogram multiple (77054) $625.60 $782 2.6×
Mammary ductogram or galactogram single (77053) $500.80 $626 2.1×
Manual appl stress pfrmd phys/qhp joint films (77071) $288 $360 3.3×
Meckels Diverticulum (78290) $1,056 $1,320 2.6×
MRA head w & w/o contrast (70546) $3,227.20 $4,034 9.2×
MRA head w/o contrast (70544) $1,168.40 $1,460.50 4.9×
MRA head with contrast (70545) $2,352.80 $2,941 6.7×
MRA neck w contrast (70548) $2,352.80 $2,941 6.7×
Mra Neck W/O &W/Contrast Material (70549) $3,227.20 $4,034 9.2×
MRA neck w/o contrast (70547) $2,139.20 $2,674 8.9×
MRI abdomen w contrast (74182) $2,352.80 $2,941 6.7×
MRI abdomen w/o & w/contrast material (74183) $3,071.20 $3,839 8.8×
MRI abdomen w/o contrast (74181) $2,139.20 $2,674 8.9×
MRI any jnt lwr ext with con lt (73722) $2,071.20 $2,589 2.6×
MRI any jt upper extremity w/contrast matrl (73222) $2,071.20 $2,589 2.6×
MRI c-spine with contrast (72142) $2,352.80 $2,941 6.7×
MRI cervical spine w/o contrast (72141) $197.60 $247 0.8×
MRI chest w/o & w/contrast material (71552) $3,227.20 $4,034 9.2×
MRI chest w/o contrast (71550) $2,139.20 $2,674 8.9×
MRI chest with contrast (71551) $2,499.20 $3,124 3.2×
MRI Forearm w/ Contrast Bilateral 73219 (73219) $2,071.20 $2,589 5.9×
MRI lower extrem oth/thn jt w/contrast matrl (73719) $2,071.20 $2,589 5.9×
MRI lower extrem oth/thn jt w/o contr matrl (73718) $2,212.80 $2,766 9.2×
MRI orbit face &/neck w/o contrast (70540) $2,139.20 $2,674 8.9×
MRI orbit/face/neck w&w/o cont (70543) $3,071.20 $3,839 8.8×
MRI orbit/face/neck w/contrast (70542) $2,352.80 $2,941 6.7×
MRI pelvis w contrast (72196) $2,352.80 $2,941 6.7×
MRI pelvis w/o & w/contrast material (72197) $3,071.20 $3,839 8.8×
MRI pelvis w/o contrast (72195) $2,139.20 $2,674 8.9×
MRI scan of arm joint before and after contrast (73223) $2,854.40 $3,568 8.1×
MRI scan of leg joint before and after contrast (73723) $2,854.40 $3,568 8.1×
MRI spinal canal cervical w/o & w/contr matrl (72156) $3,242.40 $4,053 9.3×
MRI spinal canal lumbar w/contrast material (72149) $2,226.40 $2,783 6.4×
MRI spinal canal lumbar w/o & w/contr matrl (72158) $1,707.20 $2,134 4.9×
MRI spinal canal thoracic w/contrast matrl (72147) $2,352.80 $2,941 6.7×
MRI spinal canal thoracic w/o & w/contr matrl (72157) $3,242.40 $4,053 9.3×
MRI thoracic spine w/o contrast (72146) $1,444.80 $1,806 6.0×
MRI tmj (70336) $2,083.20 $2,604 8.7×
MRI upper ext joint w/o contrast (73221) $2,212.80 $2,766 9.2×
MRI upper extrem other than jt w/o & w/contras (73220) $2,854.40 $3,568 8.1×
MRI upper extremity oth than jt w/o contr matrl (73218) $1,872.80 $2,341 7.8×
Myelogram Cervical (72240) $1,893.60 $2,367 2.4×
Myelogram Lumbar (72265) $1,893.60 $2,367 2.4×
Myelogram thoracic (72255) $1,690.40 $2,113 2.1×
Myelography 2 or more regions (72270) $1,732.80 $2,166 2.2×
Myocardial Spect Multiple Studies (78452) $2,778.40 $3,473 2.1×
Neck soft tissue (70360) $78.80 $98.50 0.9×
Nm gastric emptying study (78264) $1,057.20 $1,321.50 2.6×
Nuclear medicine of heart pumping function (78473) $1,560 $1,950 3.9×
Nuclear medicine study of digestive tracts (78299) $667.20 $834 1.7×
Ob Us Follow-Up Per Fetus - Us Ob Follow Up Transabdominal Approach (76816) $363.20 $454 3.5×
Osseous survey infant (77076) $264.40 $330.50 2.5×
Parathyrd planar w/wo subtrj (78071) $1,132 $1,415 2.8×
Parathyroid imaging (78070) $1,074 $1,342.50 2.7×
Pelvis 1 or 2 views (72170) $51.60 $64.50 0.5×
Pr MRI, lower extr, w/o contrast f/u by contrast (73720) $2,854.40 $3,568 8.1×
Pulmonary Perfusion Imaging Particulate (78580) $545.20 $681.50 1.4×
Pulmonary Ventilation & Perfusion Imaging (78582) $1,869.60 $2,337 3.4×
Radex abscess/fistula/sinus tract rs&i (76080) $530.40 $663 1.0×
Radex entir thrc lmbr crv sac spi w/skull 2/3 vw (72082) $337.60 $422 3.2×
Radex mastoids compl minimum 3 views pr side (70130) $266.40 $333 2.5×
Radex X-Ray Exam Entire Spi 6/> Vw - Xr Entire Spine 6+ Vw (72084) $527.20 $659 5.0×
Radiolog exam mandible compl minimum 4 views (70110) $337.60 $422 3.2×
Radiologic Exam Abdomen 1 View - Xr Abdomen 1 View (74018) $260.80 $326 3.0×
Radiologic Exam Chest 2 Views - Xr Chest 2 Views (71046) $310.40 $388 3.6×
Radiologic exam colon single contrast study (74270) $527.20 $659 3.0×
Radiologic exam upr gi trc double contrast study (74246) $502.40 $628 2.9×
Radiologic exam upr gi trc single contrast study (74240) $585.60 $732 3.3×
Radiologic Examination Femur Minimum 2 Views - Xr Femur 2+ Vw Lt (73552) $300.80 $376 3.4×
Radiological examination surgical specimen (76098) $291.20 $364 0.5×
Ribs bilateral 3 views (71110) $59.20 $74 0.6×
Rp loclzj tum plnr whole body single day imaging (78802) $1,841.60 $2,302 3.4×
Rp loclzj tum spect 1 area single day imaging (78803) $1,728.80 $2,161 3.2×
Saline Infus Sonohysterography W/Color Doppler (76831) $444.80 $556 1.9×
Scanogram (77073) $317.60 $397 3.0×
Scapula complete (73010) $159.60 $199.50 1.5×
Screening digital breast tomosynthesis (77063) $154.40 $193 6.6×
Sella turcica (70240) $266.40 $333 3.0×
Small bowel series (74250) $414.40 $518 2.4×
Spine thoracic 3 views (72072) $44.80 $56 0.4×
Thoracolumbar 2 views (72080) $180.40 $225.50 2.1×
Thyroid Imaging With Vascular Flow (78013) $820 $1,025 2.0×
Thyroid uptake measurement (78012) $580 $725 1.4×
Thyroid Uptake W/Blood Flow Sngle/Mult Quan Meas (78014) $820 $1,025 2.0×
Tmj unilateral (70328) $53.60 $67 0.6×
Tomogram (76100) $460.80 $576 4.4×
Ultrasound, abdomen limited (76705) $592 $740 5.6×
Umbilical-artery Doppler (OB) (76820) $105.60 $132 1.0×
Unlisted Ultrasound Procedure (76999) $250.80 $313.50 2.9×
Ureteral Reflux Study Rp Voiding Cystogram (78740) $945.60 $1,182 2.4×
Urethrocystography retrograde rs&i (74450) $685.60 $857 2.9×
Urethrocystography voiding (74455) $685.60 $857 2.9×
Urography (pyelography), intravenous, with or without KUB, with or without tomography (74400) $209.60 $262 1.2×
Us abdl aorta screen aaa (76706) $504 $630 4.8×
Us breast unilateral complete (76641) $452.80 $566 4.3×
Us breast unilateral limited (76642) $276.80 $346 3.2×
Us chest (76604) $506.40 $633 4.8×
Us compl joint r-t w/image documentation (76881) $540 $675 5.1×
Us infant hips dynamic (76885) $568.80 $711 6.5×
Us ob transvaginal (76817) $289.20 $361.50 2.8×
Us pelvic non ob complete (76856) $369.20 $461.50 3.5×
Us pelvic nonobstetric image dcmtn limited/f/u (76857) $250.80 $313.50 2.4×
Us pregnancy ltd (76815) $263.60 $329.50 2.5×
Us pregnant uterus 14 wk transabdl 1/1st gestat (76801) $124 $155 1.2×
Us retroperitoneal complete (76770) $305.60 $382 2.9×
Us scrotum and contents (76870) $107.20 $134 1.0×
Us soft tissue head/neck (76536) $369.60 $462 3.5×
Us spinal canal and contents (76800) $570.40 $713 5.4×
Us xtr non-vasc lmtd (76882) $341.60 $427 3.3×
Venogram extremity bilateral (75822) $3,450.40 $4,313 2.2×
Venography extremity unilateral rs&i (75820) $1,728.80 $2,161 1.1×
Vertebral fracture assessment via dxa (77086) $197.60 $247 2.3×
Wrist 2 views (73100) $52 $65 0.6×
X-Ray Abdomen,Comp Acute Series - Xr Abdomen 2 Vws With Chest 1 View (74022) $107.20 $134 1.0×
X-Ray Ac Jts - Xr Acromioclavicular Joints Bilateral (73050) $164.80 $206 1.9×
X-Ray Ankle 3+ Vw - Xr Ankle 3+ Views Right (73610) $288 $360 3.3×
X-Ray Colon Air Contrast - Fl Barium Enema Air Contrast (74280) $644.80 $806 3.7×
X-Ray Elbow 2 Vw - Xr Elbow 1-2 Views Right (73070) $158 $197.50 1.8×
X-Ray Elbow 3+ Vw - Xr Elbow 3+ Views Right (73080) $155.60 $194.50 1.8×
X-ray exam hip uni 1 view (73501) $266.40 $333 3.0×
X-Ray Exam Hip Uni 2-3 Views (73502) $308.80 $386 3.5×
X-Ray Exam Hips Bi 3-4 Views (73522) $418.40 $523 4.0×
X-Ray Exam Hips Bi 5/> Views (73523) $532.80 $666 5.1×
X-ray eye for foreign body (70030) $49.60 $62 0.6×
X-Ray Facial Bones 3+ Vw - Xr Facial Bones 3+ Views (70150) $69.60 $87 0.7×
X-Ray Facial Bones <3 Vw - Xr Facial Bones 1-2 Views (70140) $266.40 $333 3.0×
X-Ray Foot 3+ Vw - Xr Foot 3+ Views Right (73630) $189.60 $237 2.2×
X-Ray Heel - Xr Calcaneus 2 Views Right (73650) $266.40 $333 3.0×
X-Ray Jaw <4 Vw - Xr Mandible < 4 Views (70100) $266.40 $333 3.0×
X-Ray Knee 4+ View - Xr Knee 4+ Views Right (73564) $388 $485 3.7×
X-Ray Knee Bilat Standing - Xr Knees Anteroposterior Standing Bilat (73565) $266.40 $333 3.0×
X-Ray Leg, Infant - Xr Lower Extremity 2+ Views Infant Left (73592) $266.40 $333 3.0×
X-Ray Lumbar Spine 2/3 Vw - Xr Lumbar Spine 2-3 Views (72100) $52 $65 0.5×
X-Ray Lumbar Spine 6+ Vw - Xr Lumbar Spine 6+ Vws Including Bending (72114) $527.20 $659 5.0×
X-Ray Lumbar Spine Flex/Exten - Xr Lumbar Spine 4+ Views W/ Flex Ext (72120) $192.80 $241 1.8×
X-Ray Nasal Bones - Xr Nasal Bones (70160) $55.20 $69 0.6×
X-Ray Nose-Rectum Child F.B. - Xr Nose to Rectum Foreign Body Peds (76010) $266.40 $333 3.0×
X-Ray Orbits - Xr Orbits Complete 4+ Views (70200) $184 $230 1.8×
X-Ray Pelvis 3+ Vw - Xr Pelvis 3+ Views (72190) $296.80 $371 2.8×
X-Ray Retrograde Pyelogram - Fl Pyelogram Retrograde (74420) $685.60 $857 2.0×
X-Ray Ribs 2 Vw Unilat - Xr Ribs 2 Views Right (71100) $53.60 $67 0.6×
X-Ray Ribs, Chest 3+ Vw - Xr Ribs 2 Vws Lt W/ Chest Anteroposterior (71101) $44.80 $56 0.4×
X-Ray Ribs, Chest 4+ Vw - Xr Ribs 3 Vws Bil W/ Chest Posteroanterior (71111) $496 $620 4.7×
X-Ray Sacroiliac Jts 3+ Vw - Xr Sacroiliac Joints 3+ Views (72202) $170.80 $213.50 1.6×
X-Ray Sacrum/Coccyx 2+ Vw - Xr Sacrum Coccyx 2+ Views (72220) $49.60 $62 0.6×
X-Ray Shoulder 2+ Vw - Xr Shoulder 2+ Views Right (73030) $49.60 $62 0.6×
X-Ray Sinuses 3+ Vw - Xr Paranasal Sinuses 3+ Views (70220) $51.20 $64 0.6×
X-Ray Sinuses <3 Vw - Xr Paranasal Sinuses 1-2 Views (70210) $174.80 $218.50 2.0×
X-Ray Skull 4+ Vw - Xr Skull Complete 4+ Views (70260) $184.80 $231 1.8×
X-Ray Skull <4 Vw - Xr Skull 1-3 Views (70250) $44.80 $56 0.4×
X-Ray Spine One View - Xr Spine (72020) $32.80 $41 0.4×
X-Ray Sterno-Clavicluar Jt - Xr Sternoclavicular Joints 3+ Views (71130) $180 $225 2.1×
X-Ray Sternum 2+ Vw - Xr Sternum 2+ Views (71120) $173.20 $216.50 2.0×
X-Ray Thoracic Spine 2 Vw - Xr Thoracic Spine 2 Views (72070) $170.80 $213.50 1.6×
X-Ray Toe(S) - Xr Toes 2+ Views Right (73660) $266.40 $333 3.0×
X-Ray Wrist 3+ Vw - Xr Wrist 3+ Views Right (73110) $274.40 $343 3.1×
Xr arthrogram ankle (73615) $874.40 $1,093 2.5×
Xr c-spine 6 or more views (72052) $269.20 $336.50 2.6×
Xr chest 4+ views (71048) $400 $500 3.8×
Xr Cholecystography Oral Contrast (74290) $381.60 $477 2.2×
Xr finger(s) 2+ views (73140) $266.40 $333 3.0×
XR Mastoids < 3 Views Bilateral (70120) $63.20 $79 0.6×
Xr shoulder 1 view (73020) $266.40 $333 3.0×
Xr spine cervical 4 or 5 views (72050) $91.20 $114 0.9×
Xr tibia/fibula 2 views (73590) $51.20 $64 0.6×
Xr tmj bilateral (70330) $310.40 $388 3.6×
Xray knee 1 or 2 views rt (73560) $334.40 $418 3.8×