Imaging prices at Palo Pinto General Hospital

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

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

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ProcedureCash priceGross charge× Medicare
Abdomen 2 views (74019) $171.45 $342.90 1.6×
Acute gastrointestinal blood loss imaging (78278) $565.50 $1,131 1.4×
Angiography extremity bilateral rs&i (75716) $1,509.35 $3,018.70 0.5×
Angiography extremity unilateral rs&i (75710) $1,388.05 $2,776.10 0.4×
Angiography pelvic slctv/supraslctv rs&i (75736)
likely a partial charge, not the full procedure
$1,440.45 $2,880.90 0.3×
Ankle 2 views (73600) $125.15 $250.30 1.4×
Aortography abdl bi iliofem low extrem cath rs&i (75630) $1,614.65 $3,229.30 0.5×
Aortography abdominal serialography rs&i (75625) $1,438.25 $2,876.50 0.5×
Arthrogram elbow (73085) $401.30 $802.60 1.1×
Arthrogram hip (73525) $401.30 $802.60 1.1×
Arthrogram shoulder (73040) $401.30 $802.60 1.1×
Arthrogram wrist (73115) $401.30 $802.60 1.1×
Arthrography knee lt (73580) $401.30 $802.60 1.1×
Bone &/Joint Imaging Limited Area (78300) $727 $1,454 1.8×
Bone &/joint imaging whole body (78306) $331 $662 0.8×
Bone age studies (77072) $147.75 $295.50 1.4×
Bone Imaging 3 Phase (78315) $331 $662 0.8×
Bone survey complete (77075) $353.40 $706.80 3.4×
Cervical spine 2 or 3 views (72040) $173.10 $346.20 2.0×
Chest 1 view (71045) $130.10 $260.20 1.5×
Chest 3 views (71047) $157.15 $314.30 1.8×
Cine/Vid X-Ray Throat/Esoph - Fl Esoph Barium Swlw W/ Video & Speech (74230) $243.15 $486.30 1.4×
Clavicle complete (73000) $136.70 $273.40 1.6×
CT abdomen and pelvis without and with contrast (74178) $917.30 $1,834.60 2.6×
CT abdomen and pelvis without contrast (74176) $687.95 $1,375.90 2.9×
CT abdomen w contrast (74160) $573.30 $1,146.60 3.3×
CT abdomen w wo contrast (74170) $687.95 $1,375.90 3.9×
CT abdomen w/o contrast (74150) $544.65 $1,089.30 5.2×
CT angiography upper extremity lt (73206) $917.30 $1,834.60 5.2×
CT c-spine w/o contrast (72125) $544.65 $1,089.30 5.2×
CT cervical spine w&w/o contrast (72127) $687.95 $1,375.90 3.9×
CT cervical spine with contrast (72126) $573.30 $1,146.60 1.6×
CT chest w/wo contrast (71270) $687.95 $1,375.90 3.9×
CT chest with contrast (71260) $573.30 $1,146.60 3.3×
CT head/brain with contrast (70460) $573.30 $1,146.60 3.3×
CT head/brain without and with contrast (70470) $687.95 $1,375.90 3.9×
CT iac w contrast (70481) $573.30 $1,146.60 3.3×
CT lower ext w/o (73700) $544.65 $1,089.30 5.2×
CT lower extremity w wo contrast (73702) $687.95 $1,375.90 3.9×
CT lower extremity with contrast (73701) $573.30 $1,146.60 3.3×
CT lumbar spine w & w/o contrast (72133) $687.95 $1,375.90 3.9×
CT lumbar spine w/o contrast (72131) $544.65 $1,089.30 5.2×
CT lumbar spine with contrast (72132) $573.30 $1,146.60 1.6×
CT maxillofacial w contrast (70487) $573.30 $1,146.60 3.3×
CT maxillofacial w/o contrast (70486) $544.65 $1,089.30 5.2×
CT maxillofacial w/wo contrast (70488) $687.95 $1,375.90 3.9×
CT neck soft tissue w contrast (70491) $573.30 $1,146.60 3.3×
CT orbit sella/post fossa/ear w/o & w/contr matr (70482) $687.95 $1,375.90 3.9×
CT orbits w/o contrast (70480) $544.65 $1,089.30 5.2×
CT pelvis w & w/o contrast (72194) $687.95 $1,375.90 3.9×
CT pelvis w/o contrast (72192) $544.65 $1,089.30 5.2×
CT soft tissue neck w/o & w/contrast material (70492) $687.95 $1,375.90 3.9×
CT soft tissue neck w/o contrast (70490) $544.65 $1,089.30 5.2×
CT thoracic spine w/contrast (72129) $573.30 $1,146.60 3.3×
CT thoracic spine w/o contrast (72128) $544.65 $1,089.30 5.2×
CT thoracic spine w/wo contrast (72130) $687.95 $1,375.90 3.9×
CT thorax w/o contrast (71250) $544.65 $1,089.30 5.2×
CT upper extremity w/o & w/contrast material (73202) $687.95 $1,375.90 3.9×
CT upper extremity w/o contrast rt (73200) $544.65 $1,089.30 5.2×
CT upper extremity with contrast (73201) $551.85 $1,103.70 1.6×
Cta Abdl Aorta&Bi Iliofem W/Contrast&Postp (75635) $1,146.60 $2,293.20 6.5×
Cta Abdomen (74175) $1,031.95 $2,063.90 5.9×
CTA abdomen pelvis (74174) $1,031.95 $2,063.90 2.9×
CTA chest (71275) $1,031.95 $2,063.90 5.9×
Cta Head (70496) $917.30 $1,834.60 5.2×
CTA lwr ext w&w/o contrast (73706) $1,031.95 $2,063.90 5.9×
Cta Neck (70498) $917.30 $1,834.60 5.2×
Cta Pelvis (72191) $1,031.95 $2,063.90 5.9×
Cystography minimum 3 views rs&i (74430) $280.05 $560.10 0.8×
Dxa bone density study 1/> sites axial skel (77080) $125 $250 1.2×
Esophagus (74220) $243.15 $486.30 1.4×
Fetal biophysical profile non-stress testing (76818) $296.60 $593.20 2.8×
Fluoroscopy up to 1 hr (76000) $62.30 $124.60 0.3×
Foot 2 views (73620) $125.70 $251.40 1.4×
Forearm 2 views (73090) $139.50 $279 1.6×
Gated Heart Planar Single (78472) $423 $846 1.1×
Hand 2 views (73120) $125.15 $250.30 1.2×
Hand 3 views (73130) $149.95 $299.90 1.7×
Hepatobil Syst Imag Inc Gb W/Pharma Intervenj (78227) $390.50 $781 0.7×
Hepatobiliary syst imaging including gallbladder (78226) $748.50 $1,497 1.9×
Ht muscle image spect sing (78451) $1,142.50 $2,285 0.9×
Humerus Min 2 Views Left (73060) $142.80 $285.60 1.6×
Hysterosalpingogram (74740) $320.85 $641.70 1.3×
Kidney img morphology vascular flow 1 w/rx (78708) $442.50 $885 0.8×
Knee 3 views (73562) $163.15 $326.30 1.9×
Lymphoscintigraphy (78195) $532.50 $1,065 1.0×
Meckels Diverticulum (78290) $565.50 $1,131 1.4×
MRA head w & w/o contrast (70546) $917.30 $1,834.60 2.6×
MRA head w/o contrast (70544) $917.30 $1,834.60 3.8×
MRA head with contrast (70545) $917.30 $1,834.60 2.6×
MRA neck w contrast (70548) $917.30 $1,834.60 2.6×
Mra Neck W/O &W/Contrast Material (70549) $917.30 $1,834.60 2.6×
MRA neck w/o contrast (70547) $917.30 $1,834.60 3.8×
MRI abdomen w contrast (74182) $802.60 $1,605.20 2.3×
MRI abdomen w/o & w/contrast material (74183) $917.30 $1,834.60 2.6×
MRI abdomen w/o contrast (74181) $802.60 $1,605.20 3.3×
MRI any jnt lwr ext with con lt (73722) $802.60 $1,605.20 1.0×
MRI any jt upper extremity w/contrast matrl (73222) $687.95 $1,375.90 0.9×
MRI c-spine with contrast (72142) $802.60 $1,605.20 2.3×
MRI cervical spine w/o contrast (72141) $687.95 $1,375.90 2.9×
MRI chest w/o & w/contrast material (71552) $917.30 $1,834.60 2.6×
MRI chest w/o contrast (71550) $687.95 $1,375.90 2.9×
MRI chest with contrast (71551) $802.60 $1,605.20 1.0×
MRI Forearm w/ Contrast Bilateral 73219 (73219) $687.95 $1,375.90 2.0×
MRI lower extrem oth/thn jt w/contrast matrl (73719) $687.95 $1,375.90 2.0×
MRI lower extrem oth/thn jt w/o contr matrl (73718) $687.95 $1,375.90 2.9×
MRI orbit face &/neck w/o contrast (70540) $687.95 $1,375.90 2.9×
MRI orbit/face/neck w&w/o cont (70543) $917.30 $1,834.60 2.6×
MRI orbit/face/neck w/contrast (70542) $802.60 $1,605.20 2.3×
MRI pelvis w contrast (72196) $802.60 $1,605.20 2.3×
MRI pelvis w/o & w/contrast material (72197) $917.30 $1,834.60 2.6×
MRI pelvis w/o contrast (72195) $802.60 $1,605.20 3.3×
MRI scan of arm joint before and after contrast (73223) $917.30 $1,834.60 2.6×
MRI scan of leg joint before and after contrast (73723) $917.30 $1,834.60 2.6×
MRI spinal canal cervical w/o & w/contr matrl (72156) $917.30 $1,834.60 2.6×
MRI spinal canal lumbar w/contrast material (72149) $802.60 $1,605.20 2.3×
MRI spinal canal lumbar w/o & w/contr matrl (72158) $917.30 $1,834.60 2.6×
MRI spinal canal thoracic w/contrast matrl (72147) $802.60 $1,605.20 2.3×
MRI spinal canal thoracic w/o & w/contr matrl (72157) $917.30 $1,834.60 2.6×
MRI thoracic spine w/o contrast (72146) $687.95 $1,375.90 2.9×
MRI tmj (70336) $687.95 $1,375.90 2.9×
MRI upper ext joint w/o contrast (73221) $687.95 $1,375.90 2.9×
MRI upper extrem other than jt w/o & w/contras (73220) $917.30 $1,834.60 2.6×
MRI upper extremity oth than jt w/o contr matrl (73218) $687.95 $1,375.90 2.9×
Myelogram Cervical (72240) $745.30 $1,490.60 0.9×
Myelogram Lumbar (72265) $745.30 $1,490.60 0.9×
Myelogram thoracic (72255) $745.30 $1,490.60 0.9×
Myelography 2 or more regions (72270) $745.30 $1,490.60 0.9×
Myocardial Spect Multiple Studies (78452) $1,509.50 $3,019 1.2×
Neck soft tissue (70360) $132.30 $264.60 1.5×
Nm gastric emptying study (78264) $331 $662 0.8×
Ob Us Follow-Up Per Fetus - Us Ob Follow Up Transabdominal Approach (76816) $180.80 $361.60 1.7×
Osseous survey infant (77076) $173.10 $346.20 1.6×
Osseous survey limited (77074) $231.55 $463.10 2.2×
Parathyrd planar w/wo subtrj (78071) $497.50 $995 1.2×
Parathyroid imaging (78070) $300.50 $601 0.7×
Pelvis 1 or 2 views (72170) $126.25 $252.50 1.2×
Pr MRI, lower extr, w/o contrast f/u by contrast (73720) $917.30 $1,834.60 2.6×
Pulmonary Perfusion Imaging Particulate (78580) $748.65 $1,497.30 1.9×
Pulmonary Ventilation & Perfusion Imaging (78582) $655 $1,310 1.2×
Radex abscess/fistula/sinus tract rs&i (76080) $232.65 $465.30 0.4×
Radex Entir Thrc Lmbr Crv Sac Spi W/Skull 1 Vw - Xr Scoliosis 1 Vw (72081) $159.85 $319.70 1.8×
Radex mastoids compl minimum 3 views pr side (70130) $162.65 $325.30 1.5×
Radiolog exam mandible compl minimum 4 views (70110) $196.25 $392.50 1.9×
Radiologic Exam Abdomen 1 View - Xr Abdomen 1 View (74018) $134 $268 1.5×
Radiologic Exam Abdomen 3+ Views - Xr Abdomen 3+ Views (74021) $171.45 $342.90 1.6×
Radiologic Exam Chest 2 Views - Xr Chest 2 Views (71046) $135.90 $271.80 1.6×
Radiologic exam colon single contrast study (74270) $346.75 $693.50 2.0×
Radiologic exam upr gi trc double contrast study (74246) $300.45 $600.90 1.7×
Radiologic Examination Femur Minimum 2 Views - Xr Femur 2+ Vw Lt (73552) $151.60 $303.20 1.7×
Radiological examination surgical specimen (76098) $105.30 $210.60 0.2×
Scanogram (77073) $177 $354 1.7×
Scapula complete (73010) $141.10 $282.20 1.3×
Screening digital breast tomosynthesis (77063) $39.40 $78.80 1.7×
Shuntogram indwelling nonvascular shunt rs&i (75809) $143.35 $286.70 1.4×
Small bowel series (74250) $296.05 $592.10 1.7×
Spine thoracic 3 views (72072) $191.85 $383.70 1.8×
Thoracolumbar 2 views (72080) $167.05 $334.10 1.9×
Thyroid Uptake W/Blood Flow Sngle/Mult Quan Meas (78014) $300.50 $601 0.7×
Ultrasound, abdomen limited (76705) $325.25 $650.50 3.1×
Upper Extremity Infant (73092) $59.55 $119.10 0.6×
Urethrocystography voiding (74455) $315.30 $630.60 1.3×
Urography (pyelography), intravenous, with or without KUB, with or without tomography (74400) $408.50 $817 2.3×
Us breast unilateral complete (76641) $131.08 $262.15 1.2×
Us breast unilateral limited (76642) $120 $240 1.4×
Us chest (76604) $255.80 $511.60 2.4×
Us compl joint r-t w/image documentation (76881) $200.65 $401.30 1.9×
Us ob transvaginal (76817) $296.60 $593.20 2.8×
Us pelvic non ob complete (76856) $118 $236 1.1×
Us pelvic nonobstetric image dcmtn limited/f/u (76857) $172 $344 1.6×
Us pregnancy ltd (76815) $203.95 $407.90 1.9×
Us pregnant uterus 14 wk transabdl 1/1st gestat (76801) $276.75 $553.50 2.6×
Us retroperitoneal complete (76770) $350.60 $701.20 3.3×
Us scrotum and contents (76870) $322.50 $645 3.1×
Us soft tissue head/neck (76536) $302.10 $604.20 2.9×
Us transrectal (76872) $228.58 $457.15 2.2×
Us xtr non-vasc lmtd (76882) $143.35 $286.70 1.4×
Venography caval inferior serialography rs&i (75825) $1,147.70 $2,295.40 0.4×
Venography extremity unilateral rs&i (75820) $522.05 $1,044.10 0.3×
Wrist 2 views (73100) $121.85 $243.70 1.4×
X-Ray Abdomen,Comp Acute Series - Xr Abdomen 2 Vws With Chest 1 View (74022) $201.50 $403 1.9×
X-Ray Ac Jts - Xr Acromioclavicular Joints Bilateral (73050) $146.65 $293.30 1.7×
X-Ray Ankle 3+ Vw - Xr Ankle 3+ Views Right (73610) $148.30 $296.60 1.7×
X-Ray Colon Air Contrast - Fl Barium Enema Air Contrast (74280) $440.50 $881 2.5×
X-Ray Elbow 2 Vw - Xr Elbow 1-2 Views Right (73070) $131.20 $262.40 1.5×
X-Ray Elbow 3+ Vw - Xr Elbow 3+ Views Right (73080) $152.75 $305.50 1.7×
X-ray exam hip uni 1 view (73501) $234.30 $468.60 2.7×
X-Ray Exam Hip Uni 2-3 Views (73502) $123.75 $247.50 1.4×
X-ray exam hip uni 4/> views (73503) $151.60 $303.20 1.4×
X-Ray Exam Hips Bi 3-4 Views (73522) $205.65 $411.30 2.0×
X-Ray Facial Bones 3+ Vw - Xr Facial Bones 3+ Views (70150) $202.85 $405.70 1.9×
X-Ray Foot 3+ Vw - Xr Foot 3+ Views Right (73630) $147.75 $295.50 1.7×
X-Ray Heel - Xr Calcaneus 2 Views Right (73650) $125.70 $251.40 1.4×
X-Ray Knee 4+ View - Xr Knee 4+ Views Right (73564) $186.35 $372.70 1.8×
X-Ray Knee Bilat Standing - Xr Knees Anteroposterior Standing Bilat (73565) $128.45 $256.90 1.5×
X-Ray Leg, Infant - Xr Lower Extremity 2+ Views Infant Left (73592) $109.75 $219.50 1.3×
X-Ray Lumbar Spine 2/3 Vw - Xr Lumbar Spine 2-3 Views (72100) $187.45 $374.90 1.8×
X-Ray Lumbar Spine 6+ Vw - Xr Lumbar Spine 6+ Vws Including Bending (72114) $285.05 $570.10 2.7×
X-Ray Lumbar Spine Flex/Exten - Xr Lumbar Spine 4+ Views W/ Flex Ext (72120) $77.75 $155.50 0.7×
X-Ray Nasal Bones - Xr Nasal Bones (70160) $157.15 $314.30 1.8×
X-Ray Nose-Rectum Child F.B. - Xr Nose to Rectum Foreign Body Peds (76010) $66.15 $132.30 0.8×
X-Ray Orbits - Xr Orbits Complete 4+ Views (70200) $185.20 $370.40 1.8×
X-Ray Pelvis 3+ Vw - Xr Pelvis 3+ Views (72190) $164.30 $328.60 1.6×
X-Ray Retrograde Pyelogram - Fl Pyelogram Retrograde (74420) $352.80 $705.60 1.0×
X-Ray Ribs, Chest 3+ Vw - Xr Ribs 2 Vws Lt W/ Chest Anteroposterior (71101) $191.85 $383.70 1.8×
X-Ray Ribs, Chest 4+ Vw - Xr Ribs 3 Vws Bil W/ Chest Posteroanterior (71111) $243.65 $487.30 2.3×
X-Ray Sacroiliac Jts 3+ Vw - Xr Sacroiliac Joints 3+ Views (72202) $158.75 $317.50 1.5×
X-Ray Sacrum/Coccyx 2+ Vw - Xr Sacrum Coccyx 2+ Views (72220) $155.45 $310.90 1.8×
X-Ray Shoulder 2+ Vw - Xr Shoulder 2+ Views Right (73030) $159.85 $319.70 1.8×
X-Ray Sinuses 3+ Vw - Xr Paranasal Sinuses 3+ Views (70220) $191.30 $382.60 2.2×
X-Ray Sinuses <3 Vw - Xr Paranasal Sinuses 1-2 Views (70210) $116.35 $232.70 1.3×
X-Ray Skull 4+ Vw - Xr Skull Complete 4+ Views (70260) $221.10 $442.20 2.1×
X-Ray Skull <4 Vw - Xr Skull 1-3 Views (70250) $144.45 $288.90 1.4×
X-Ray Spine One View - Xr Spine (72020) $122.40 $244.80 1.4×
X-Ray Sterno-Clavicluar Jt - Xr Sternoclavicular Joints 3+ Views (71130) $139.50 $279 1.6×
X-Ray Sternum 2+ Vw - Xr Sternum 2+ Views (71120) $153.25 $306.50 1.8×
X-Ray Thoracic Spine 2 Vw - Xr Thoracic Spine 2 Views (72070) $169.25 $338.50 1.6×
X-Ray Toe(S) - Xr Toes 2+ Views Right (73660) $112.45 $224.90 1.3×
X-Ray Wrist 3+ Vw - Xr Wrist 3+ Views Right (73110) $148.85 $297.70 1.7×
Xr c-spine 6 or more views (72052) $266.80 $533.60 2.5×
Xr chest 4+ views (71048) $126.25 $252.50 1.2×
Xr finger(s) 2+ views (73140) $113.05 $226.10 1.3×
Xr shoulder 1 view (73020) $122.40 $244.80 1.4×
Xr spine cervical 4 or 5 views (72050) $237.60 $475.20 2.3×
Xr tibia/fibula 2 views (73590) $145.55 $291.10 1.7×
Xr tmj bilateral (70330) $188 $376 2.2×
Xray knee 1 or 2 views rt (73560) $135.10 $270.20 1.5×