Imaging prices at Nelson County Health System (Mcville, ND)

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

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Procedure	Posted cash	Posted gross	× Medicare
Abdomen 1 View (74018) range across 2 matching MRF lines	$25–$107	$25–$107	varies
Abdomen 2 views (74019) range across 2 matching MRF lines	$31–$170	$31–$170	varies
Ankle 2 views (73600) range across 2 matching MRF lines	$23–$100	$23–$100	varies
Bone survey infant (77076)	$93	$93	0.9×
Cat Scan Follow-Up Study (76380)	$540	$540	6.1×
Chest 1 view (71045) range across 2 matching MRF lines	$25–$121	$25–$121	varies
Chest 2 views (71046) range across 2 matching MRF lines	$29–$159	$29–$159	varies
Chest 3 views (71047) range across 2 matching MRF lines	$37–$191	$37–$191	varies
Chest 4 or more views (71048)	$43	$43	0.4×
Cisternography Positive Contrast Rs&I (70015)	$159	$159	0.2×
Clavicle complete (73000) range across 2 matching MRF lines	$23–$107	$23–$107	varies
Computed Tomography Thorax Lw Dose Lng Ca Scr C- (71271) range across 2 matching MRF lines	$131–$649	$131–$649	varies
Contrast X-Ray Bladder (74430)	$43	$43	0.1×
CT abdomen and pelvis without and with contrast (74178) range across 2 matching MRF lines	$252–$1,854	$252–$1,854	varies
CT abdomen and pelvis without contrast (74176) range across 3 matching MRF lines	$25–$927	$25–$927	varies
CT abdomen w contrast (74160) range across 2 matching MRF lines	$169–$1,193	$169–$1,193	varies
CT abdomen w wo contrast (74170) range across 2 matching MRF lines	$185–$1,478	$185–$1,478	varies
CT abdomen w/o contrast (74150) range across 2 matching MRF lines	$159–$863	$159–$863	varies
CT Angio Chest (71275) range across 2 matching MRF lines	$237–$1,797	$237–$1,797	varies
CT Angio Head (70496)	$232	$232	1.3×
CT Angio Neck (70498)	$232	$232	1.3×
CT cervical spine w/ contrast (72126) range across 2 matching MRF lines	$162–$1,339	$162–$1,339	varies
CT cervical spine w/o contrast (72125) range across 2 matching MRF lines	$141–$927	$141–$927	varies
CT cervical spine w/wo cont (72127) range across 2 matching MRF lines	$168–$1,545	$168–$1,545	varies
CT chest w contrast (71260) range across 2 matching MRF lines	$165–$1,130	$165–$1,130	varies
CT chest w/wo contrast (71270) range across 2 matching MRF lines	$183–$1,249	$183–$1,249	varies
CT head/brain with contrast (70460) range across 2 matching MRF lines	$151–$846	$151–$846	varies
CT head/brain without and with contrast (70470) range across 2 matching MRF lines	$169–$988	$169–$988	varies
CT iac w contrast (70481)	$1,545	$1,545	8.6×
CT l-spine w&w/o contrast (72133)	$169	$169	0.9×
CT lower ext w/o (73700) range across 2 matching MRF lines	$133–$748	$133–$748	varies
CT lower extremity w/contrast material (73701) range across 2 matching MRF lines	$155–$928	$155–$928	varies
CT lumbar spine w contrast (72132) range across 2 matching MRF lines	$162–$1,236	$162–$1,236	varies
CT lumbar spine w/o contrast (72131) range across 2 matching MRF lines	$133–$911	$133–$911	varies
CT maxillofacial w contrast (70487) range across 2 matching MRF lines	$149–$950	$149–$950	varies
CT maxillofacial wo contrast (70486) range across 2 matching MRF lines	$113–$775	$113–$775	varies
CT neck tissue combo (70492) range across 2 matching MRF lines	$214–$1,104	$214–$1,104	varies
Ct Orbit/Ear/Fossa W/O&W/Dye (70482) range across 2 matching MRF lines	$192–$1,751	$192–$1,751	varies
CT orbits w/o contrast (70480) range across 2 matching MRF lines	$170–$1,313	$170–$1,313	varies
CT pelvis w&w/o contrast (72194) range across 2 matching MRF lines	$162–$1,251	$162–$1,251	varies
CT pelvis w/o contrast (72192) range across 2 matching MRF lines	$144–$901	$144–$901	varies
CT scan of leg combo (73702) range across 2 matching MRF lines	$161–$1,229	$161–$1,229	varies
CT scans face/jaw combo (70488) range across 2 matching MRF lines	$169–$1,187	$169–$1,187	varies
CT soft tissue neck w contrast (70491) range across 2 matching MRF lines	$183–$986	$183–$986	varies
CT soft tissue neck w/o contrast (70490) range across 2 matching MRF lines	$170–$740	$170–$740	varies
CT thoracic spine w contrast (72129) range across 2 matching MRF lines	$162–$992	$162–$992	varies
CT thoracic spine w/o contrast (72128) range across 2 matching MRF lines	$133–$820	$133–$820	varies
CT thoracic spine w/wo cont (72130)	$168	$168	0.9×
CT thorax w/o contrast (71250) range across 2 matching MRF lines	$155–$911	$155–$911	varies
CT upper ext wo (73200) range across 2 matching MRF lines	$133–$745	$133–$745	varies
CT upper extremity w/o & w/contrast material (73202) range across 2 matching MRF lines	$162–$1,227	$162–$1,227	varies
CT upper extremity with contrast (73201) range across 2 matching MRF lines	$155–$922	$155–$922	varies
CTA pelvis (72191)	$239	$239	1.3×
Dacryocystography, nasolacrimal duct, radiological supervision and interpretation Non-Facility (70170)	$40	$40	0.2×
Dxa Bone Density Axial (77080) range across 3 matching MRF lines	$26–$437	$26–$437	varies
Dxa bone density study 1/>sites appendiclr skel (77081)	$27	$27	0.3×
Fetal Biophys Profile W/Nst (76818)	$335	$335	3.1×
Foot 2 views (73620) range across 2 matching MRF lines	$23–$100	$23–$100	varies
Forearm 2 views (73090) range across 2 matching MRF lines	$23–$122	$23–$122	varies
Hand 2 views (73120) range across 2 matching MRF lines	$23–$100	$23–$100	varies
Hysterosalpingogram (74740)	$50	$50	0.2×
Infusion Ivp (74410)	$64	$64	0.4×
Joint Survey Single View (77077)	$101	$101	0.9×
Knee 3 Views (73562) range across 2 matching MRF lines	$25–$134	$25–$134	varies
Magnetic Image Jaw Joint (70336) range across 2 matching MRF lines	$195–$1,854	$195–$1,854	varies
Magnetic resonance (eg, proton) imaging, brain (including brain stem andskull base), during open intracranial procedure… (70558)	$456	$456	2.5×
Magnetic resonance (eg, proton) imaging, brain (including brain stem andskull base), during open intracranial procedure… (70557)	$414	$414	0.7×
Magnetic resonance (eg, proton) imaging, brain (including brain stem andskull base), during open intracranial procedure… (70559)	$436	$436	2.4×
Mra Head W/O & W/Contrast Material (70546)	$196	$196	0.5×
MRA head w/o contrast (70544) range across 2 matching MRF lines	$160–$2,472	$160–$2,472	varies
MRA head with contrast (70545) range across 2 matching MRF lines	$160–$2,451	$160–$2,451	varies
MRI abdomen w contrast (74182) range across 2 matching MRF lines	$230–$2,742	$230–$2,742	varies
MRI abdomen w/o contrast (74181) range across 2 matching MRF lines	$194–$1,936	$194–$1,936	varies
MRI any jt lower extrem w/contrast material (73722)	$2,236	$2,236	2.8×
MRI any jt lower extrem w/o & w/contrast matrl (73723)	$2,705	$2,705	7.6×
MRI any jt upper extremity w/contrast matrl (73222) range across 2 matching MRF lines	$216–$2,212	$216–$2,212	varies
MRI Breast W/O Contrast Bilateral (77047) range across 2 matching MRF lines	$212–$1,305	$212–$1,305	varies
MRI Breast Without Contrast Material Unilateral (77046) range across 2 matching MRF lines	$192–$3,435	$192–$3,435	varies
MRI cervical spine w contrast (72142) range across 2 matching MRF lines	$237–$1,756	$237–$1,756	varies
MRI cervical spine w/o cont (72141) range across 2 matching MRF lines	$198–$1,118	$198–$1,118	varies
MRI chest w/o contrast (71550) range across 2 matching MRF lines	$192–$2,554	$192–$2,554	varies
MRI chest with contrast (71551) range across 2 matching MRF lines	$230–$2,797	$230–$2,797	varies
MRI chest wo w contrast (71552) range across 2 matching MRF lines	$286–$3,478	$286–$3,478	varies
MRI lower extrem oth/thn jt w/contrast matrl (73719) range across 2 matching MRF lines	$215–$2,413	$215–$2,413	varies
MRI lower extrem oth/thn jt w/o & w/contr matr (73720) range across 2 matching MRF lines	$284–$2,944	$284–$2,944	varies
MRI lower extrem oth/thn jt w/o contr matrl (73718) range across 2 matching MRF lines	$179–$2,215	$179–$2,215	varies
MRI lumbar spine w contrast (72149) range across 2 matching MRF lines	$238–$1,727	$238–$1,727	varies
Mri Neck Spine W/O & W/Dye (72156) range across 2 matching MRF lines	$303–$1,978	$303–$1,978	varies
MRI orbit face &/neck w/o contrast (70540) range across 2 matching MRF lines	$179–$1,751	$179–$1,751	varies
MRI orbit face neck w contrast (70542) range across 2 matching MRF lines	$215–$1,926	$215–$1,926	varies
Mri Orbt/Fac/Nck W/O &W/Dye (70543) range across 2 matching MRF lines	$283–$2,307	$283–$2,307	varies
MRI pelvis w contrast (72196) range across 2 matching MRF lines	$230–$2,415	$230–$2,415	varies
MRI pelvis w/o & w contrast (72197) range across 2 matching MRF lines	$291–$2,925	$291–$2,925	varies
MRI pelvis w/o contrast (72195) range across 2 matching MRF lines	$194–$2,252	$194–$2,252	varies
MRI thoracic spine w/o contrast (72146) range across 2 matching MRF lines	$198–$1,121	$198–$1,121	varies
MRI upper extremity oth than jt w/contr matrl (73219) range across 2 matching MRF lines	$215–$2,390	$215–$2,390	varies
MRI upper extremity oth than jt w/o contr matrl (73218) range across 2 matching MRF lines	$180–$2,220	$180–$2,220	varies
Mri Uppr Extremity W/O&W/Dye (73220) range across 2 matching MRF lines	$284–$2,925	$284–$2,925	varies
MRI, abdomen, combo (74183) range across 2 matching MRF lines	$291–$2,932	$291–$2,932	varies
MRI, dorsal spine combo (72157) range across 2 matching MRF lines	$303–$1,982	$303–$1,982	varies
MRI, dorsal spine contrast (72147) range across 2 matching MRF lines	$237–$1,741	$237–$1,741	varies
MRI, joint upper extrem (73221) range across 2 matching MRF lines	$181–$1,259	$181–$1,259	varies
MRI, joint upper extrem combo (73223) range across 2 matching MRF lines	$285–$2,701	$285–$2,701	varies
MRI, lumbar spine combo (72158) range across 2 matching MRF lines	$303–$1,962	$303–$1,962	varies
Neck soft tissue (70360) range across 2 matching MRF lines	$23–$111	$23–$111	varies
Optic foramina (70190)	$29	$29	0.3×
Pelvis 1 or 2 views (72170) range across 2 matching MRF lines	$24–$136	$24–$136	varies
Radex Abd Compl Aqt Abd W/S/E/D Views 1 View Ch (74022) range across 2 matching MRF lines	$43–$190	$43–$190	varies
Radex Ankle Complete Minimum 3 Views (73610) range across 2 matching MRF lines	$24–$113	$24–$113	varies
Radex Calcaneus Minimum 2 Views (73650) range across 2 matching MRF lines	$22–$96	$22–$96	varies
Radex elbow complete minimum 3 views (73080) range across 2 matching MRF lines	$24–$135	$24–$135	varies
Radex Facial Bones Complete Minimum 3 Views (70150) range across 2 matching MRF lines	$35–$161	$35–$161	varies
Radex fingr minimum 2 views (73140) range across 2 matching MRF lines	$19–$149	$19–$149	varies
Radex foot complete minimum 3 views (73630) range across 2 matching MRF lines	$23–$110	$23–$110	varies
Radex Hand Minimum 3 Views (73130) range across 2 matching MRF lines	$24–$121	$24–$121	varies
Radex lower extremity infant minimum 2 views (73592)	$22	$22	0.2×
Radex Mastoids Compl Minimum 3 Views PR Side (70130)	$46	$46	0.4×
Radex Nasal Bones Complete Minimum 3 Views (70160) range across 2 matching MRF lines	$24–$122	$24–$122	varies
Radex Ribs Unilateral 2 Views (71100) range across 2 matching MRF lines	$30–$171	$30–$171	varies
Radex shoulder complete minimum 2 views (73030) range across 2 matching MRF lines	$25–$167	$25–$167	varies
Radex Sinuses Paransl < 3 Views (70210) range across 2 matching MRF lines	$24–$126	$24–$126	varies
Radex Spine 1 View Specify Level (72020) range across 2 matching MRF lines	$21–$61	$21–$61	varies
Radex Sternum Minimum 2 Views (71120) range across 2 matching MRF lines	$27–$131	$27–$131	varies
Radex Temporomandble Jt Opn & Clsd Mouth Bilat (70330)	$33	$33	0.4×
Radex Toe Minimum 2 Views (73660) range across 2 matching MRF lines	$18–$103	$18–$103	varies
Radex upper extremity infant minimum 2 views (73092)	$22	$22	0.2×
Radex Wrist Complete Minimum 3 Views (73110) range across 2 matching MRF lines	$24–$149	$24–$149	varies
Radex X-Ray Exam Entire Spi 6/> Vw - Xr Entire Spine 6+ Vw (72084)	$56	$56	0.5×
Radiolog exam mandible compl minimum 4 views (70110) range across 2 matching MRF lines	$34–$144	$34–$144	varies
Radiologic Exam Abdomen 3+ Views - Xr Abdomen 3+ Views (74021) range across 2 matching MRF lines	$36–$211	$36–$211	varies
Radiologic exam knee complete 4/more views (73564) range across 2 matching MRF lines	$30–$126	$30–$126	varies
Radiologic exam pelvis compl minimum 3 views (72190) range across 2 matching MRF lines	$29–$151	$29–$151	varies
Radiologic exam teeth complete full mouth (70320)	$33	$33	0.1×
Radiologic Exam Teeth Prtl Exam < Full Mouth (70310)	$21	$21	0.1×
Radiologic examination femur 1 view (73551) range across 2 matching MRF lines	$23–$98	$23–$98	varies
Radiologic examination femur minimum 2 views (73552) range across 2 matching MRF lines	$24–$98	$24–$98	varies
Radiologic examination knee 1/2 views (73560) range across 2 matching MRF lines	$23–$107	$23–$107	varies
Radiologic Examination Osseous Survey Limited (77074)	$61	$61	0.6×
Radiologic examination tibia & fibula 2 views (73590) range across 2 matching MRF lines	$22–$117	$22–$117	varies
Radiologic examination, internal auditory meati, complete Non-Facility (70134)	$46	$46	0.1×
Radiologic examination, teeth; single view Non-Facility (70300)	$15	$15	0.2×
Renal Cyst Study (74470)	$70	$70	0.1×
Ribs bilateral 3 views (71110) range across 2 matching MRF lines	$39–$183	$39–$183	varies
Scapula (73010) range across 2 matching MRF lines	$25–$107	$25–$107	varies
Screening Digital Breast Tomosynthesis Bi (77063) range across 3 matching MRF lines	$78–$118	$78–$118	varies
Sella turcica (70240)	$26	$26	0.3×
Shoulder 1 view (73020) range across 2 matching MRF lines	$22–$106	$22–$106	varies
Skull less than 4 views (70250) range across 2 matching MRF lines	$34–$126	$34–$126	varies
Sternoclavicular joints (71130)	$29	$29	0.3×
Temporomandble Jt Arthrography Rs&I (70332)	$72	$72	0.3×
Thoracic spine 2 views (72070) range across 3 matching MRF lines	$30–$131	$30–$131	varies
Thoracic spine 3 views (72072) range across 2 matching MRF lines	$29–$119	$29–$119	varies
Thoracolumbar 2 views (72080) range across 2 matching MRF lines	$30–$149	$30–$149	varies
Ultrasound Breast Limited (76642) range across 2 matching MRF lines	$91–$227	$91–$227	varies
Ultrasound Exam Aaa Screen (76706) range across 2 matching MRF lines	$72–$412	$72–$412	varies
Ultrasound, abdomen limited (76705) range across 2 matching MRF lines	$62–$281	$62–$281	varies
Unlisted us procedure (76999)	$226	$226	2.5×
Us breast unilateral complete (76641)	$309	$309	2.9×
Us chest (76604)	$162	$162	1.5×
Us complete joint (76881)	$321	$321	3.0×
Us exam, pelvic, limited (76857)	$113	$113	1.1×
Us head (76506)	$324	$324	3.0×
Us lmtd joint/oth nonvasc xtr strux r-t w/img (76882) range across 2 matching MRF lines	$65–$155	$65–$155	varies
Us ob limited 1 or more fetuses (76815)	$251	$251	2.3×
Us ob transvaginal (76817)	$283	$283	2.6×
Us pelvic non ob complete (76856) range across 2 matching MRF lines	$103–$361	$103–$361	varies
Us pg uter img f&mat 14 wk tabdl 1/1st gestation (76801)	$355	$355	3.3×
Us retroperitoneal complete (76770)	$357	$357	3.3×
Us retroperitoneal limited (76775) range across 2 matching MRF lines	$76–$311	$76–$311	varies
Us scrotum and contents (76870)	$333	$333	3.1×
Us thyroid (76536) range across 2 matching MRF lines	$74–$412	$74–$412	varies
Us transrectal (76872)	$406	$406	3.8×
Wrist 2 views (73100) range across 2 matching MRF lines	$23–$100	$23–$100	varies
X-Ray Ac Jts - Xr Acromioclavicular Joints Bilateral (73050) range across 2 matching MRF lines	$28–$135	$28–$135	varies
X-ray antegrade pyelogram tube (74425)	$46	$46	0.1×
X-Ray Bend Only L-S Spine (72120)	$30	$30	0.3×
X-Ray Elbow 2 Vw - Xr Elbow 1-2 Views Right (73070) range across 2 matching MRF lines	$22–$107	$22–$107	varies
X-Ray Exam Entire Spi 1 Vw (72081)	$36	$36	0.4×
X-Ray Exam Entire Spi 2/3 Vw (72082) range across 2 matching MRF lines	$43–$275	$43–$275	varies
X-Ray Exam Entire Spi 4/5 Vw (72083)	$48	$48	0.4×
X-Ray Exam Hip Uni 1 View (73501) range across 2 matching MRF lines	$25–$98	$25–$98	varies
X-Ray Exam Hip Uni 2-3 Views (73502) range across 2 matching MRF lines	$30–$139	$30–$139	varies
X-Ray Exam Hip Uni 4/> Views (73503)	$37	$37	0.3×
X-Ray Exam Hips Bi 2 Views (73521) range across 2 matching MRF lines	$30–$163	$30–$163	varies
X-Ray Exam Hips Bi 3-4 Views (73522) range across 2 matching MRF lines	$40–$163	$40–$163	varies
X-Ray Exam Hips Bi 5/> Views (73523)	$43	$43	0.4×
X-Ray Exam L-S Spine Bending (72114)	$43	$43	0.4×
X-Ray Exam Neck Spine 2-3 Vw (72040) range across 2 matching MRF lines	$30–$124	$30–$124	varies
X-Ray Exam Neck Spine 6/>Vws (72052) range across 2 matching MRF lines	$48–$239	$48–$239	varies
X-Ray Exam Unilat Ribs/Chest (71101) range across 2 matching MRF lines	$36–$93	$36–$93	varies
X-ray eye for foreign body (70030) range across 2 matching MRF lines	$23–$85	$23–$85	varies
X-ray humerus (73060) range across 2 matching MRF lines	$23–$118	$23–$118	varies
X-ray IV pyelogram (ivp) (74400) range across 2 matching MRF lines	$65–$344	$65–$344	varies
X-ray IV pyelogram+tomography (74415)	$65	$65	0.4×
X-Ray Jaw <4 Vw - Xr Mandible < 4 Views (70100) range across 2 matching MRF lines	$25–$107	$25–$107	varies
X-Ray Knee Bilat Standing - Xr Knees Anteroposterior Standing Bilat (73565) range across 2 matching MRF lines	$24–$129	$24–$129	varies
X-Ray Lumbar Spine 2/3 Vw - Xr Lumbar Spine 2-3 Views (72100) range across 2 matching MRF lines	$30–$155	$30–$155	varies
X-Ray Ribs, Chest 4+ Vw - Xr Ribs 3 Vws Bil W/ Chest Posteroanterior (71111) range across 2 matching MRF lines	$43–$475	$43–$475	varies
X-Ray Sacroiliac Jts 3+ Vw - Xr Sacroiliac Joints 3+ Views (72202) range across 2 matching MRF lines	$25–$139	$25–$139	varies
X-Ray Sacroiliac Jts <3 Vw - Xr Sacroiliac Joints 1-2 Views (72200) range across 2 matching MRF lines	$24–$107	$24–$107	varies
X-Ray Sacrum/Coccyx 2+ Vw - Xr Sacrum Coccyx 2+ Views (72220) range across 2 matching MRF lines	$24–$118	$24–$118	varies
X-Ray Sinuses 3+ Vw - Xr Paranasal Sinuses 3+ Views (70220) range across 2 matching MRF lines	$34–$171	$34–$171	varies
X-Ray Skull 4+ Vw - Xr Skull Complete 4+ Views (70260) range across 2 matching MRF lines	$46–$182	$46–$182	varies
X-ray thoracic spine 4 vw (72074)	$29	$29	0.3×
X-Ray Tmj Unilat (70328)	$25	$25	0.3×
X-Ray Urinary Tract Exam With Contrast Material (74420)	$68	$68	0.2×
X-Rays Bone Length Studies (77073)	$38	$38	0.4×
X-Rays Bone Survey Complete (77075) range across 2 matching MRF lines	$72–$270	$72–$270	varies
Xr c-spine 4 or 5 views (72050) range across 2 matching MRF lines	$42–$208	$42–$208	varies
Xr facial bones less than 3 views (70140) range across 2 matching MRF lines	$27–$126	$27–$126	varies
XR Mastoids < 3 Views Bilateral (70120)	$25	$25	0.2×
Xr orbits complete 4 views (70200) range across 2 matching MRF lines	$37–$161	$37–$161	varies

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.