Imaging prices at Park Place Surgical Hospital

Lafayette, LA · every code in this section with a posted price and a Medicare benchmark.

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

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ProcedureCash priceGross charge× Medicare
Abdomen 2 views (74019) $92.84 $109.40 1.0×
Ankle 2 views (73600) $77.28 $109.40 1.0×
Antegrade urography radiological supvj & interpj (74425) $309.81 $797.37 1.0×
Arthrogram hip (73525) $309.81 $686.76 1.0×
Arthrogram shoulder (73040) $309.81 $854.70 1.0×
Cervical spine 2 or 3 views (72040) $77.28 $109.40 1.0×
Chest 1 view (71045) $77.28 $109.40 1.0×
Clavicle complete (73000) $77.28 $109.40 1.0×
Cystography minimum 3 views rs&i (74430) $309.81 $797.37 1.0×
Diskogram cervical (72285) $1,734.07 $1,701.71 1.0×
Diskography lumbar (72295) $1,734.07 $1,701.71 1.0×
Fluoroscopy up to 1 hr (76000) $211.88 $1,002.79 1.0×
Foot 2 views (73620) $77.28 $109.40 1.0×
Forearm 2 views (73090) $77.28 $109.40 1.0×
Hand 2 views (73120) $92.84 $109.40 1.0×
Hand 3 views (73130) $77.28 $109.40 1.0×
Humerus Min 2 Views Left (73060) $77.28 $109.40 1.0×
Hysterosalpingogram (74740) $211.88 $729.31 1.0×
Interstitial radiation source applic complex (77778) $618.49 $1,221.58 1.0×
Knee 3 views (73562) $77.28 $109.40 1.0×
Pelvis 1 or 2 views (72170) $92.84 $109.40 1.0×
Radex abscess/fistula/sinus tract rs&i (76080) $485.23 $451.87 1.0×
Radiolog exam mandible compl minimum 4 views (70110) $92.84 $109.40 1.0×
Radiologic Exam Abdomen 1 View - Xr Abdomen 1 View (74018) $77.28 $109.40 1.0×
Radiologic Exam Abdomen 3+ Views - Xr Abdomen 3+ Views (74021) $92.84 $109.40 1.0×
Radiologic Exam Chest 2 Views - Xr Chest 2 Views (71046) $77.28 $109.40 1.0×
Radiological examination surgical specimen (76098) $485.23 $170.17 1.0×
Sacroiliac Joints < 3 Views (72200) $92.84 $109.40 1.0×
Saline Infus Sonohysterography W/Color Doppler (76831) $211.88 $638.14 1.0×
Scapula complete (73010) $92.84 $109.40 1.0×
Spec medical radj physics consltj (77370) $119.36 $663.32 1.0×
Special dosimetry (77331) $119.36 $369.29 1.0×
Special treatment procedure (77470) $490.67 $1,603.77 1.0×
Spine thoracic 3 views (72072) $92.84 $254.44 1.0×
Thoracolumbar 2 views (72080) $77.28 $109.40 1.0×
Tomogram (76100) $92.84 $652 1.0×
Unlisted fluoroscopic procedure (76496) $77.28 $600 1.0×
Urethrocystography retrograde rs&i (74450) $211.88 $364.65 1.0×
Urethrocystography voiding (74455) $211.88 $696.51 1.0×
Urography (pyelography), intravenous, with or without KUB, with or without tomography (74400) $155.76 $797.37 1.0×
Urograpy infusion drip &/bolus techq w/wo tomo (74415) $155.76 $797.37 1.0×
Us compl joint r-t w/image documentation (76881) $92.84 $347.89 1.0×
Us transrectal (76872) $92.84 $820.47 1.0×
Us transrectal prostate volume (76873) $92.84 $613.83 1.0×
Venography caval superior serialography rs&i (75827) $1,397.89 $1,762.49 1.0×
Venography extremity unilateral rs&i (75820) $1,397.89 $1,033.19 1.0×
Wrist 2 views (73100) $77.28 $109.40 1.0×
X-Ray Ac Jts - Xr Acromioclavicular Joints Bilateral (73050) $77.28 $114.70 1.0×
X-Ray Ankle 3+ Vw - Xr Ankle 3+ Views Right (73610) $77.28 $109.40 1.0×
X-Ray Elbow 2 Vw - Xr Elbow 1-2 Views Right (73070) $77.28 $109.40 1.0×
X-Ray Elbow 3+ Vw - Xr Elbow 3+ Views Right (73080) $77.28 $109.40 1.0×
X-ray exam hip uni 1 view (73501) $77.28 $109.40 1.0×
X-Ray Exam Hip Uni 2-3 Views (73502) $77.28 $120 1.0×
X-ray eye for foreign body (70030) $77.28 $109.40 1.0×
X-Ray Facial Bones 3+ Vw - Xr Facial Bones 3+ Views (70150) $92.84 $109.40 1.0×
X-Ray Facial Bones <3 Vw - Xr Facial Bones 1-2 Views (70140) $77.28 $109.40 1.0×
X-Ray Foot 3+ Vw - Xr Foot 3+ Views Right (73630) $77.28 $109.40 1.0×
X-Ray Heel - Xr Calcaneus 2 Views Right (73650) $77.28 $109.40 1.0×
X-Ray Jaw <4 Vw - Xr Mandible < 4 Views (70100) $77.28 $109.40 1.0×
X-Ray Knee 4+ View - Xr Knee 4+ Views Right (73564) $92.84 $109.40 1.0×
X-Ray Knee Bilat Standing - Xr Knees Anteroposterior Standing Bilat (73565) $77.28 $109.40 1.0×
X-Ray Leg, Infant - Xr Lower Extremity 2+ Views Infant Left (73592) $77.28 $145.87 1.0×
X-Ray Lumbar Spine 2/3 Vw - Xr Lumbar Spine 2-3 Views (72100) $92.84 $109.40 1.0×
X-Ray Lumbar Spine 6+ Vw - Xr Lumbar Spine 6+ Vws Including Bending (72114) $92.84 $182.33 1.0×
X-Ray Nasal Bones - Xr Nasal Bones (70160) $77.28 $109.40 1.0×
X-Ray Orbits - Xr Orbits Complete 4+ Views (70200) $92.84 $109.40 1.0×
X-Ray Retrograde Pyelogram - Fl Pyelogram Retrograde (74420) $309.81 $797.37 1.0×
X-Ray Ribs 2 Vw Unilat - Xr Ribs 2 Views Right (71100) $77.28 $109.40 1.0×
X-Ray Ribs, Chest 3+ Vw - Xr Ribs 2 Vws Lt W/ Chest Anteroposterior (71101) $92.84 $109.40 1.0×
X-Ray Ribs, Chest 4+ Vw - Xr Ribs 3 Vws Bil W/ Chest Posteroanterior (71111) $92.84 $371.29 1.0×
X-Ray Sacrum/Coccyx 2+ Vw - Xr Sacrum Coccyx 2+ Views (72220) $77.28 $109.40 1.0×
X-Ray Shoulder 2+ Vw - Xr Shoulder 2+ Views Right (73030) $77.28 $109.40 1.0×
X-Ray Sinuses 3+ Vw - Xr Paranasal Sinuses 3+ Views (70220) $77.28 $109.40 1.0×
X-Ray Sinuses <3 Vw - Xr Paranasal Sinuses 1-2 Views (70210) $77.28 $109.40 1.0×
X-Ray Skull 4+ Vw - Xr Skull Complete 4+ Views (70260) $92.84 $170.17 1.0×
X-Ray Skull <4 Vw - Xr Skull 1-3 Views (70250) $92.84 $109.40 1.0×
X-Ray Spine One View - Xr Spine (72020) $77.28 $109.40 1.0×
X-Ray Sternum 2+ Vw - Xr Sternum 2+ Views (71120) $77.28 $109.40 1.0×
X-Ray Thoracic Spine 2 Vw - Xr Thoracic Spine 2 Views (72070) $92.84 $121.55 1.0×
X-Ray Toe(S) - Xr Toes 2+ Views Right (73660) $77.28 $109.40 1.0×
X-Ray Wrist 3+ Vw - Xr Wrist 3+ Views Right (73110) $77.28 $109.40 1.0×
Xr arthrogram ankle (73615) $309.81 $668.54 1.0×
Xr c-spine 6 or more views (72052) $92.84 $164.09 1.0×
Xr chest 4+ views (71048) $92.84 $109.40 1.0×
Xr finger(s) 2+ views (73140) $77.28 $145.87 1.0×
Xr optic foramina (70190) $77.28 $109.40 1.0×
Xr shoulder 1 view (73020) $77.28 $109.40 1.0×
Xr spine cervical 4 or 5 views (72050) $92.84 $164.09 1.0×
Xr tibia/fibula 2 views (73590) $77.28 $109.40 1.0×
Xray knee 1 or 2 views rt (73560) $77.28 $109.40 1.0×