Imaging prices at Pacifica Hospital of the Valley

Sun Valley, CA · every code in this section with a posted price and a Medicare benchmark.

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

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ProcedurePosted cashPosted gross× Medicare
Abdomen 1 View (74018) $236 $236 2.1×
Abdomen 2 views (74019) $347 $347 2.6×
Acute Gastrointestinal Blood Loss Imaging (78278) $1,148 $1,148 2.2×
Angio pulmonary bilat (75743) $3,238 $3,238 0.8×
Angiography extremity bilateral rs&i (75716) $3,969 $3,969 1.0×
Ankle 2 views (73600) $236 $236 2.1×
Bone Imaging 3 Phase (78315) $1,396 $1,396 2.7×
Bone Imaging Limited Area (78300) $277 $277 0.5×
Bone Imaging Multiple Areas (78305) $833 $833 1.6×
Bone Imaging Whole Body (78306) $1,024 $1,024 2.0×
Cardiac blood pool imaging, first pass technique; multiple studies, resting and with stress (exercise and/or… (78483) $910 $910 1.3×
Chest 1 view (71045) $260 $260 2.3×
Chest 2 views (71046)
range across 2 matching MRF lines		 $239–$336 $239–$336 varies
Chest 3 views (71047) $395 $395 3.5×
Chest 4 or more views (71048) $467 $467 3.5×
Cholecystography Oral Contrast (74290) $333 $333 1.5×
Clavicle complete (73000) $299 $299 2.7×
Contrast X-Ray Bladder (74430) $504 $504 1.1×
Corpora cavernosography (74445) $270 $270 2.0×
CT abdomen and pelvis without and with contrast (74178) $4,233 $4,233 9.4×
CT abdomen and pelvis without contrast (74176) $6,378 $6,378 20.8×
CT abdomen w contrast (74160) $2,441 $2,441 10.8×
CT abdomen w wo contrast (74170) $3,196 $3,196 14.2×
CT abdomen w/o contrast (74150) $1,431 $1,431 10.6×
CT Angio Chest (71275) $2,723 $2,723 12.1×
CT Angio Head (70496) $2,441 $2,441 10.8×
CT Angio Neck (70498) $2,941 $2,941 13.0×
CT cervical spine w/ contrast (72126) $3,957 $3,957 8.8×
CT cervical spine w/o contrast (72125) $1,635 $1,635 12.2×
CT cervical spine w/wo cont (72127) $3,942 $3,942 17.5×
CT chest w contrast (71260) $1,750 $1,750 7.8×
CT chest w/wo contrast (71270) $2,211 $2,211 9.8×
CT head/brain with contrast (70460) $1,375 $1,375 6.1×
CT head/brain without and with contrast (70470) $1,979 $1,979 8.8×
CT lower ext w/o (73700) $2,069 $2,069 15.4×
CT lumbar spine w/o contrast (72131) $3,010 $3,010 22.4×
CT maxillofacial wo contrast (70486) $1,854 $1,854 13.8×
Ct Orbit/Ear/Fossa W/O&W/Dye (70482) $2,194 $2,194 9.7×
CT orbits w/o contrast (70480) $1,506 $1,506 11.2×
CT pelvis w&w/o contrast (72194) $2,121 $2,121 9.4×
CT pelvis w/o contrast (72192) $1,413 $1,413 10.5×
CT scans face/jaw combo (70488) $2,009 $2,009 8.9×
CT soft tissue neck w contrast (70491) $1,590 $1,590 7.0×
CT soft tissue neck w/o contrast (70490) $2,211 $2,211 16.4×
CT thoracic spine w/o contrast (72128) $2,948 $2,948 21.9×
CT thorax w/o contrast (71250) $1,590 $1,590 11.8×
CT upper ext wo (73200) $1,679 $1,679 12.5×
Cta Abdl Aorta&Bi Iliofem W/Contrast&Postp (75635) $2,441 $2,441 10.8×
Cta Abdomen (74175) $3,881 $3,881 17.2×
Echo exam of fetal heart (76825) $179 $179 0.3×
Esophagram (74220) $483 $483 2.1×
Fetal MRI w/placntl matrnl plvc img sing/1st ges (74712) $6 $6 0.0×
Fluoroscopy up to 1 hr (76000) $988 $988 3.2×
Foot 2 views (73620) $185 $185 1.7×
Forearm 2 views (73090) $236 $236 2.1×
Gastric emptying imaging study (78264) $2,151 $2,151 4.2×
Gated Heart, Multiple (78473) $1,300 $1,300 2.5×
Hand 2 views (73120) $223 $223 1.7×
Hepatobiliary System Imaging (78226) $1,739 $1,739 3.4×
Hysterosalpingogram (74740) $890 $890 2.9×
Infant hip ultrasound with hip movement (dynamic) (76885) $593 $593 5.3×
K Flow/Funct Image Multiple (78709) $1,502 $1,502 2.2×
Knee 3 Views (73562) $227 $227 2.0×
Liver & Spleen Imaging Static Only (78215) $1,790 $1,790 3.5×
Lung Perf&Ventilat Diferentl (78598) $816 $816 1.2×
Lung Ventilat&Perfus Imaging (78582) $1,960 $1,960 2.8×
Lung Ventilation Imaging (78579) $1,274 $1,274 2.5×
Magnetic Image Jaw Joint (70336) $1,440 $1,440 4.7×
Meckels Divert Exam (78290) $898 $898 1.7×
MRA head w/o contrast (70544) $3,503 $3,503 11.4×
MRA neck w/o contrast (70547) $2,731 $2,731 8.9×
MRI abdomen w contrast (74182) $3,318 $3,318 7.4×
MRI abdomen w/o contrast (74181) $3,356 $3,356 10.9×
MRI cervical spine w contrast (72142) $2,699 $2,699 6.0×
MRI cervical spine w/o cont (72141) $2,714 $2,714 8.8×
MRI chest w/o contrast (71550) $2,511 $2,511 8.2×
MRI lower extrem oth/thn jt w/o & w/contr matr (73720) $1,314 $1,314 2.9×
MRI lumbar spine w contrast (72149) $2,969 $2,969 6.6×
Mri Neck Spine W/O & W/Dye (72156) $3,446 $3,446 7.7×
MRI orbit face &/neck w/o contrast (70540) $2,714 $2,714 8.8×
MRI pelvis w contrast (72196) $2,039 $2,039 4.5×
MRI thoracic spine w/o contrast (72146) $3,390 $3,390 11.0×
Mri Uppr Extremity W/O&W/Dye (73220) $1,314 $1,314 2.9×
MRI, abdomen, combo (74183) $3,356 $3,356 7.5×
MRI, dorsal spine combo (72157) $4,102 $4,102 9.1×
MRI, dorsal spine contrast (72147) $3,381 $3,381 7.5×
MRI, joint upper extrem (73221) $1,764 $1,764 5.7×
MRI, lumbar spine combo (72158) $3,390 $3,390 7.6×
Myocardial Perfusion Planar 1 Study Rest/Stress (78453) $2,108 $2,108 1.3×
Myocardial Spect Multiple Studies (78452) $2,275 $2,275 1.4×
Neck soft tissue (70360) $377 $377 3.4×
Nm myocard infarct spect (78469) $1,138 $1,138 1.6×
Nm red cell survival study (78130) $30 $30 0.1×
Parathyroid Planar Imaging (78070) $1,673 $1,673 3.3×
Pelvis 1 or 2 views (72170) $433 $433 3.2×
Plasma volume, radiopharmaceutical volume-dilution technique (separate procedure); single sampling Non-Facility (78110)
range across 2 matching MRF lines		 $2–$10 $2–$10 varies
Pulmonary Perfusion Imaging Particulate (78580) $1,697 $1,697 3.3×
Radex abscess/fistula/sinus tract rs&i (76080) $381 $381 0.5×
Radex Ankle Complete Minimum 3 Views (73610)
range across 2 matching MRF lines		 $195–$273 $195–$273 varies
Radex Calcaneus Minimum 2 Views (73650) $451 $451 4.0×
Radex elbow complete minimum 3 views (73080) $299 $299 2.7×
Radex Facial Bones Complete Minimum 3 Views (70150) $569 $569 4.2×
Radex fingr minimum 2 views (73140) $222 $222 2.0×
Radex foot complete minimum 3 views (73630) $273 $273 2.4×
Radex Hand Minimum 3 Views (73130)
range across 2 matching MRF lines		 $21–$273 $21–$273 varies
Radex Nasal Bones Complete Minimum 3 Views (70160) $574 $574 5.1×
Radex shoulder complete minimum 2 views (73030) $487 $487 4.4×
Radex Sternum Minimum 2 Views (71120) $452 $452 4.0×
Radex Temporomandble Jt Opn & Clsd Mouth Bilat (70330) $483 $483 4.3×
Radex Toe Minimum 2 Views (73660) $189 $189 1.7×
Radex Wrist Complete Minimum 3 Views (73110) $470 $470 4.2×
Radiolog exam mandible compl minimum 4 views (70110) $813 $813 6.0×
Radiologic Exam Abdomen 3+ Views - Xr Abdomen 3+ Views (74021) $433 $433 3.2×
Radiologic exam colon double contrast study (74280) $1,132 $1,132 5.0×
Radiologic exam colon single contrast study (74270) $1,112 $1,112 4.9×
Radiologic exam knee complete 4/more views (73564)
range across 2 matching MRF lines		 $230–$322 $230–$322 varies
Radiologic Exam Small Int Single Contrast Study (74250) $483 $483 2.1×
Radiologic examination femur 1 view (73551) $254 $254 2.3×
Radiologic examination femur minimum 2 views (73552) $383 $383 3.4×
Radiologic examination knee 1/2 views (73560) $247 $247 2.2×
Radiologic examination tibia & fibula 2 views (73590) $236 $236 2.1×
Red Cell Volume Determination Spx Mult Samplings (78121)
range across 2 matching MRF lines		 $6–$8 $6–$8 varies
Ribs bilateral 3 views (71110) $667 $667 5.0×
Rp loclzj tum plnr 1 area single day imaging (78800) $2,038 $2,038 4.0×
Scapula (73010) $400 $400 3.0×
Sella turcica (70240) $273 $273 2.4×
Shoulder 1 view (73020) $400 $400 3.6×
Skull less than 4 views (70250) $514 $514 3.8×
Speech evaluation, complex (70371) $737 $737 2.4×
Sternoclavicular joints (71130) $335 $335 3.0×
Thoracic spine 3 views (72072) $713 $713 5.3×
Thyroid Met Imaging Body (78018)
range across 2 matching MRF lines		 $134–$2,589 $134–$2,589 varies
Thyroid Uptake W/Blood Flow Sngle/Mult Quan Meas (78014) $42 $42 0.1×
Ultrasound, abdomen limited (76705)
range across 4 matching MRF lines		 $602–$1,033 $602–$1,033 varies
Unlisted Dx Radiographic Procedure (76499) $42 $42 0.4×
Upper gi w/o kub (74240) $984 $984 4.4×
Urethrocystogram voiding (74455) $770 $770 2.5×
Us breast unilateral complete (76641) $675 $675 5.0×
Us chest (76604) $491 $491 3.7×
Us complete joint (76881) $338 $338 2.5×
Us lmtd joint/oth nonvasc xtr strux r-t w/img (76882)
range across 2 matching MRF lines		 $176–$455 $176–$455 varies
Us ob detailed single fetus (76811) $1,099 $1,099 3.6×
Us ob limited 1 or more fetuses (76815) $624 $624 4.6×
Us ob transvaginal (76817) $953 $953 7.1×
Us pelvic non ob complete (76856) $944 $944 7.0×
Us pg uter img f&mat 14 wk tabdl 1/1st gestation (76801) $918 $918 6.8×
Us preg uterus real time f/u trnsabdl per fetus (76816) $853 $853 6.3×
Us retroperitoneal complete (76770) $964 $964 7.2×
Us retroperitoneal limited (76775) $894 $894 6.6×
Us scrotum and contents (76870) $716 $716 5.3×
Us thyroid (76536) $801 $801 6.0×
Us transrectal (76872) $1,123 $1,123 8.4×
Vascular Flow Imaging (78445) $1,014 $1,014 2.0×
Venography extremity bilateral rs&i (75822) $1,479 $1,479 0.7×
Wrist 2 views (73100) $300 $300 2.7×
X-Ray Ac Jts - Xr Acromioclavicular Joints Bilateral (73050) $258 $258 2.3×
X-ray antegrade pyelogram tube (74425) $2,548 $2,548 5.7×
X-Ray Elbow 2 Vw - Xr Elbow 1-2 Views Right (73070) $236 $236 2.1×
X-Ray Exam Hip Uni 1 View (73501) $307 $307 2.7×
X-Ray Exam Hip Uni 2-3 Views (73502) $433 $433 3.9×
X-Ray Exam Hip Uni 4/> Views (73503) $502 $502 3.7×
X-Ray Exam Hips Bi 2 Views (73521) $420 $420 3.1×
X-Ray Exam Hips Bi 3-4 Views (73522) $525 $525 3.9×
X-Ray Exam Hips Bi 5/> Views (73523) $560 $560 4.2×
X-Ray Exam L-S Spine Bending (72114) $876 $876 6.5×
X-Ray Exam Neck Spine 2-3 Vw (72040) $680 $680 6.1×
X-Ray Exam Neck Spine 6/>Vws (72052) $825 $825 6.1×
X-Ray Exam Unilat Ribs/Chest (71101)
range across 3 matching MRF lines		 $7–$515 $7–$515 varies
X-ray humerus (73060) $299 $299 2.7×
X-ray IV pyelogram+tomography (74415) $722 $722 3.2×
X-Ray Lumbar Spine 2/3 Vw - Xr Lumbar Spine 2-3 Views (72100) $458 $458 3.4×
X-Ray Sacrum/Coccyx 2+ Vw - Xr Sacrum Coccyx 2+ Views (72220) $319 $319 2.8×
X-Ray Sinuses 3+ Vw - Xr Paranasal Sinuses 3+ Views (70220) $700 $700 6.3×
X-Ray Skull 4+ Vw - Xr Skull Complete 4+ Views (70260) $888 $888 6.6×
X-Ray Urinary Tract Exam With Contrast Material (74420) $1,077 $1,077 2.4×
Xr facial bones less than 3 views (70140) $310 $310 2.8×
Xr orbits complete 4 views (70200) $555 $555 4.1×
Xr Tomogram Single Plane (76100) $492 $492 3.7×

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.