Imaging prices at Rainy Lake Medical Center

International Falls, MN · every code in this section with a posted price and a Medicare benchmark.

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

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ProcedureCash priceGross charge× Medicare
Abdomen 2 views (74019) $329.10 $427.39 3.1×
Acute gi blood loss imaging (78278) $1,450.68 $1,884 3.5×
Ankle 2 views (73600) $151.83 $197.18 1.7×
Bone &/Joint Imaging Limited Area (78300) $902.01 $1,171.43 2.2×
Bone &/joint imaging whole body (78306) $1,580.85 $2,053.05 3.8×
Bone age studies (77072) $158.56 $205.92 1.5×
Bone Imaging 3 Phase (78315) $1,450.68 $1,884 3.5×
Bone survey complete (77075) $437.49 $568.16 4.1×
Bone survey infant (77076) $706.28 $917.24 6.5×
Bowel imaging (78290) $924.42 $1,200.54 2.2×
Brain Imaging Pet Metabolic Evaluation (78608) $4,234.55 $5,499.41 2.9×
Card Bpi Gtd =Brm Plnr 1 Std Rest/Strs (78472) $1,052.66 $1,367.08 2.6×
Cervical spine 2 or 3 views (72040) $342.35 $444.61 3.8×
Chest 1 view (71045) $190.06 $246.83 2.1×
Cine/Vid X-Ray Throat/Esoph - Fl Esoph Barium Swlw W/ Video & Speech (74230) $571.27 $741.90 3.2×
Clavicle complete (73000) $158.56 $205.92 1.8×
Computed Tomography Thorax Lw Dose Lng Ca Scr C- (71271) $1,361.90 $1,768.70 12.6×
CT abdomen and pelvis without and with contrast (74178) $3,738.09 $4,854.65 10.4×
CT abdomen and pelvis without contrast (74176) $2,544.99 $3,305.17 10.3×
CT abdomen w contrast (74160) $1,361.90 $1,768.70 7.5×
CT abdomen w wo contrast (74170) $2,127.66 $2,763.19 11.8×
CT abdomen w/o contrast (74150) $1,361.90 $1,768.70 12.6×
CT angio lwr extr w/o&w/dye (73706) $2,838.78 $3,686.72 15.7×
CT angiography upper extremity lt (73206) $1,817.90 $2,360.90 10.0×
CT c-spine w/contrast (72126) $1,872.45 $2,431.75 5.2×
CT c-spine w/o contrast (72125) $1,361.90 $1,768.70 12.6×
CT cervical spine w&w/o contrast (72127) $2,001.97 $2,599.96 11.1×
CT chest w contrast (71260) $1,817.90 $2,360.90 10.0×
CT chest w/wo contrast (71270) $2,127.66 $2,763.19 11.8×
CT head/brain without and with contrast (70470) $1,872.45 $2,431.75 10.3×
CT lower ext w/o (73700) $1,361.90 $1,768.70 12.6×
CT lower extremity w wo contrast (73702) $2,947.96 $3,828.51 16.3×
CT lower extremity w/contrast material (73701) $1,361.90 $1,768.70 7.5×
CT lumbar spine w & w/o contrast (72133) $2,001.97 $2,599.96 11.1×
CT lumbar spine w/contrast (72132) $1,872.45 $2,431.75 5.2×
CT lumbar spine w/o contrast (72131) $1,361.90 $1,768.70 12.6×
CT maxillofacial w contrast (70487) $1,361.90 $1,768.70 7.5×
CT maxillofacial w/wo contrast (70488) $1,872.45 $2,431.75 10.3×
CT maxillofacial wo contrast (70486) $1,361.90 $1,768.70 12.6×
CT orbit sella/post fossa/ear w/o & w/contr matr (70482) $1,872.45 $2,431.75 10.3×
CT orbits w/o contrast (70480) $1,361.90 $1,768.70 12.6×
CT pelvis w/o contrast (72192) $1,361.90 $1,768.70 12.6×
CT pelvis w/wo contrast (72194) $1,939.89 $2,519.33 10.7×
CT scan of arm combo (73202) $2,514.49 $3,265.56 13.9×
CT soft tissue neck w contrast (70491) $1,361.90 $1,768.70 7.5×
CT soft tissue neck w/o & w/contrast material (70492) $1,872.45 $2,431.75 10.3×
CT soft tissue neck w/o contrast (70490) $1,199.92 $1,558.33 11.1×
CT thoracic spine w/contrast (72129) $1,872.45 $2,431.75 10.3×
CT thoracic spine w/o contrast (72128) $1,361.90 $1,768.70 12.6×
CT thoracic spine w/wo contrast (72130) $2,001.97 $2,599.96 11.1×
CT thorax w/o contrast (71250) $1,361.90 $1,768.70 12.6×
CT unlisted procedure (76497) $5,852 $7,600 65.2×
CT upper ext wo (73200) $1,361.90 $1,768.70 12.6×
CT upper extremity with contrast (73201) $1,361.90 $1,768.70 3.8×
Cta Aa&Bi Iliofem Lxtr Rs&I C-/C+ Post-Pxessing (75635) $2,838.78 $3,686.72 15.7×
Cta Abdomen (74175) $1,361.90 $1,768.70 7.5×
CTA abdomen pelvis (74174) $2,544.99 $3,305.17 7.1×
CTA chest (71275) $1,817.90 $2,360.90 10.0×
Cta Head (70496) $1,671.19 $2,170.37 9.2×
CTA head&neck c+ w/noncontrast img&post-pxessing (70471) $2,157.18 $2,801.53 6.0×
Cta Neck (70498) $1,672.24 $2,171.73 9.2×
Cta Pelvis (72191) $1,817.90 $2,360.90 10.0×
Cystography minimum 3 views rs&i (74430) $677.02 $879.24 1.9×
Dxa bone density study 1/> sites axial skel (77080) $350.83 $455.62 3.3×
Dxa bone density study 1/>sites appendiclr skel (77081) $255.26 $331.50 2.8×
Esophagus (74220) $467.86 $607.60 2.6×
Facial bones min 3 views (70150) $236.19 $306.73 2.2×
Fetal Biophysical Profile W/O Non-Stress Testing (76819) $488.80 $634.80 4.5×
Fluoroscopy up to 1 hr (76000) $371.11 $481.96 1.5×
Foot 2 views (73620) $151.83 $197.18 1.7×
Forearm 2 views (73090) $158.56 $205.92 1.8×
Hand 2 views (73120) $151.83 $197.18 1.4×
Hepatobil Syst Imag Inc Gb W/Pharma Intervenj (78227) $1,765.55 $2,292.92 3.2×
Hepatobiliary syst imaging including gallbladder (78226) $1,052.66 $1,367.08 2.6×
Hysterosalpingogram (74740) $1,473.32 $1,913.40 6.0×
Joint Survey, Single View - Xr Joint Anteroposterior 2+ Joints (77077) $104.72 $136 1.0×
Kidney Img Morphology Vascular Flow 1 W/O Rx (78707) $1,108.84 $1,440.05 2.0×
Kidney img morphology vascular flow 1 w/rx (78708) $1,450.68 $1,884 2.6×
Knee 3 views (73562) $212.51 $275.98 2.4×
Lung perf&ventilat diferentl (78598) $1,429.33 $1,856.27 2.6×
Lung perfusion differential (78597) $1,021.16 $1,326.17 2.5×
Lung ventilation imaging (78579) $1,021.16 $1,326.17 2.5×
Lymphoscintigraphy (78195) $924.42 $1,200.54 1.6×
Magnetic resonance (eg, proton) imaging, any joint of upper extremity; with contrast material(s) Non-Facility (73222) $2,900.96 $3,767.47 3.6×
Magnetic resonance (eg, proton) imaging, upper extremity, other than joint; with contrast material(s) Non-Facility (73219) $2,037.73 $2,646.40 5.7×
Magnetic resonance (eg, proton) imaging, upper extremity, other than joint; without contrast material(s), followed by… (73220) $3,802.91 $4,938.84 10.6×
MRA head w & w/o contrast (70546) $3,143.68 $4,082.69 8.7×
MRA head w/o contrast (70544) $2,903.21 $3,770.39 11.8×
MRA neck w contrast (70548) $3,268.04 $4,244.20 9.1×
Mra Neck W/O &W/Contrast Material (70549) $3,437.79 $4,464.66 9.5×
MRA neck w/o contrast (70547) $2,240.18 $2,909.32 9.1×
MRI abdomen w contrast (74182) $2,849.65 $3,700.84 7.9×
MRI abdomen w/o & w/contrast material (74183) $2,977.90 $3,867.39 8.3×
MRI abdomen w/o contrast (74181) $2,621.43 $3,404.45 10.6×
MRI any jt lower extrem w/contrast material (73722) $2,896.12 $3,761.19 3.6×
MRI any jt lower extrem w/o & w/contrast matrl (73723) $2,853.09 $3,705.30 7.9×
MRI c-spine with contrast (72142) $3,025.13 $3,928.74 8.4×
MRI cervical spine w/o contrast (72141) $2,875.89 $3,734.92 11.7×
MRI lower extrem oth/thn jt w/contrast matrl (73719) $2,037.73 $2,646.40 5.7×
MRI lower extrem oth/thn jt w/o & w/contr matr (73720) $3,118.36 $4,049.81 8.7×
MRI lower extrem oth/thn jt w/o contr matrl (73718) $2,604.05 $3,381.88 10.6×
MRI orbit face &/neck w/o contrast (70540) $2,117.68 $2,750.23 8.6×
MRI orbit face neck w contrast (70542) $2,240.18 $2,909.32 6.2×
MRI orbit/face/neck w&w/o cont (70543) $3,202.80 $4,159.47 8.9×
MRI pelvis w/contrast (72196) $2,520.25 $3,273.05 7.0×
MRI pelvis w/o & w/contrast material (72197) $2,976.76 $3,865.91 8.3×
MRI pelvis w/o contrast (72195) $2,117.68 $2,750.23 8.6×
MRI spinal canal cervical w/o & w/contr matrl (72156) $3,025.13 $3,928.74 8.4×
MRI spinal canal lumbar w/contrast material (72149) $2,520.25 $3,273.05 7.0×
MRI spinal canal lumbar w/o & w/contr matrl (72158) $3,025.13 $3,928.74 8.4×
MRI spinal canal thoracic w/contrast matrl (72147) $2,855.06 $3,707.86 7.9×
MRI spinal canal thoracic w/o & w/contr matrl (72157) $3,025.13 $3,928.74 8.4×
MRI thoracic spine w/o contrast (72146) $2,855.20 $3,708.04 11.6×
MRI up ext w/o contrast (73218) $2,037.73 $2,646.40 8.3×
MRI upper ext joint w/o contrast (73221) $2,280.87 $2,962.16 9.3×
MRI, joint upper extrem combo (73223) $2,853.09 $3,705.30 7.9×
Myocardial Spect Multiple Studies (78452) $2,293.03 $2,977.95 1.7×
Myocardial spect single study at rest or stress (78451) $1,429.33 $1,856.27 1.1×
Neck soft tissue (70360) $158.56 $205.92 1.8×
Nm gastric emptying study (78264) $1,052.66 $1,367.08 2.6×
Osseous survey limited (77074) $437.49 $568.16 4.1×
Parathyroid Planar Imaging (78070) $1,137.47 $1,477.23 2.8×
Pelvis 1 or 2 views (72170) $158.56 $205.92 1.5×
PET image w/CT, skull-thigh (78815) $4,440.33 $5,766.66 3.0×
PET imaging for CT attenuation whole body (78816) $4,646.22 $6,034.04 3.1×
Pulmonary Perfusion Imaging Particulate (78580) $1,041.31 $1,352.35 2.5×
Pulmonary Ventilation & Perfusion Imaging (78582) $1,429.33 $1,856.27 2.6×
Radex Ankle Compl Minimum 3 Views (73610) $219.37 $284.89 2.4×
Radex Calcaneus Minimum 2 Views (73650) $145.08 $188.41 1.6×
Radex Elbw Compl Minimum 3 Views (73080) $273.27 $354.89 3.0×
Radex Entir Thrc Lmbr Crv Sac Spi W/Skull 1 Vw - Xr Scoliosis 1 Vw (72081) $416.01 $540.27 4.6×
Radex entir thrc lmbr crv sac spi w/skull 2/3 vw (72082) $517.14 $671.61 4.8×
Radex Entir Thrc Lmbr Crv Sac Spi W/Skull 4/5 Vw (72083) $672.29 $873.10 6.2×
Radex fingr minimum 2 views (73140) $127.11 $165.07 1.4×
Radex Foot Compl Minimum 3 Views (73630) $219.37 $284.89 2.4×
Radex Hand Minimum 3 Views (73130) $163.08 $211.79 1.8×
Radex Hip Unilateral With Pelvis 1 View (73501) $145.08 $188.41 1.6×
Radex Hip Unilateral With Pelvis Minimum 4 Views (73503) $173.14 $224.85 1.6×
Radex Hips Bilateral With Pelvis 2 Views (73521) $146.17 $189.83 1.4×
Radex Hips Bilateral With Pelvis Minimum 5 Views (73523) $265.73 $345.10 2.5×
Radex Humerus Minimum 2 Views (73060) $173.14 $224.85 1.9×
Radex Kne 1/2 Views (73560) $171 $222.07 1.9×
Radex Kne Compl 4/More Views (73564) $251.87 $327.10 2.3×
Radex Mndbl Compl Minimum 4 Views (70110) $190.06 $246.83 1.8×
Radex Nasal Bones Complete Minimum 3 Views (70160) $348.25 $452.27 3.9×
Radex Pelvis Compl Minimum 3 Views (72190) $179.95 $233.70 1.7×
Radex Sho Compl Minimum 2 Views (73030) $173.14 $224.85 1.9×
Radex Spine Lumbosacral Only Bending 2/3 Views (72120) $257.54 $334.46 2.4×
Radex Temporomandble Jt Opn & Clsd Mouth Bilat (70330) $272.13 $353.41 3.0×
Radex Toe Minimum 2 Views (73660) $142.78 $185.42 1.6×
Radex upper extremity infant minimum 2 views (73092) $193.41 $251.18 1.8×
Radex Wrst Compl Minimum 3 Views (73110) $163.08 $211.79 1.8×
Radex X-Ray Exam Entire Spi 6/> Vw - Xr Entire Spine 6+ Vw (72084) $222.71 $289.23 2.1×
Radiologic Exam Abdomen 1 View - Xr Abdomen 1 View (74018) $158.56 $205.92 1.8×
Radiologic Exam Abdomen 3+ Views - Xr Abdomen 3+ Views (74021) $424.69 $551.54 3.9×
Radiologic exam chest 2 views (71046) $200.21 $260.01 2.2×
Radiologic exam colon single contrast study (74270) $677.02 $879.24 3.7×
Radiologic exam upr gi trc double contrast study (74246) $498.16 $646.95 2.8×
Radiologic exam upr gi trc single contrast study (74240) $444.21 $576.89 2.5×
Radiologic examination femur 1 view (73551) $140.55 $182.52 1.6×
Radiologic examination tibia & fibula 2 views (73590) $158.56 $205.92 1.8×
Ribs bilateral 3 views (71110) $236.19 $306.73 2.2×
Rp loclzj tum spect 1 area single day imaging (78803) $1,424.86 $1,850.46 2.5×
Saline Infus Sonohysterography W/Color Doppler (76831) $1,029.85 $1,337.46 4.2×
Scapula (73010) $158.56 $205.92 1.5×
Screening Digital Breast Tomosynthesis Bi (77063) $41.15 $53.44 1.8×
Shoulder 1 view (73020) $145.08 $188.41 1.6×
Small bowel series (74250) $394.71 $512.60 2.2×
Spine thoracic 3 views (72072) $222.71 $289.23 2.1×
Testicular Imaging With Vascular Flow (78761) $1,450.68 $1,884 3.5×
Thoracolumbar 2 views (72080) $131.55 $170.84 1.5×
Thyroid imaging w/blood flow (78013) $661.24 $858.75 1.6×
Thyroid Uptake W/Blood Flow Sngle/Mult Quan Meas (78014) $1,286.56 $1,670.85 3.1×
Ultrasound breast complete (76641) $510.59 $663.10 4.7×
Ultrasound Exam Aaa Screen (76706) $459.90 $597.27 4.3×
Ultrasound, abdomen limited (76705) $278.05 $361.10 2.6×
Umbilical-artery Doppler (OB) (76820) $215.48 $279.84 2.0×
Unlisted ultrasound procedure (76999) $323.84 $420.56 3.6×
Urethrocystogram voiding (74455) $868.23 $1,127.56 3.5×
Us breast unilateral limited (76642) $401.37 $521.25 4.5×
Us chest (76604) $130.57 $169.57 1.2×
Us compl joint r-t w/image documentation (76881) $548.87 $712.81 5.1×
Us lmtd joint/oth nonvasc xtr strux r-t w/img (76882) $323.84 $420.56 3.0×
Us ob limited (76815) $246.25 $319.80 2.3×
Us ob transvaginal (76817) $528.53 $686.39 4.9×
Us pelvic non ob complete (76856) $582.57 $756.58 5.4×
Us pelvic nonobstetric image dcmtn limited/f/u (76857) $467.86 $607.60 4.3×
Us pg uter img f&mat 14 wk tabdl 1/1st gestation (76801) $467.86 $607.60 4.3×
Us pg uter r-t img f-up tabdl appr pr fetus (76816) $462.23 $600.29 4.3×
Us retroperitoneal complete (76770) $459.90 $597.27 4.3×
Us retroperitoneal limited (76775) $488.05 $633.83 4.5×
Us scrotum and contents (76870) $557.82 $724.44 5.2×
Us soft tissue head/neck (76536) $429.59 $557.90 4.0×
Vertebral fracture assessment via dxa (77086) $109.28 $141.91 1.2×
Wrist 2 views (73100) $151.83 $197.18 1.7×
X-Ray Abdomen,Comp Acute Series - Xr Abdomen 2 Vws With Chest 1 View (74022) $479.06 $622.15 4.4×
X-Ray Ac Jts - Xr Acromioclavicular Joints Bilateral (73050) $201.30 $261.42 2.2×
X-Ray Colon Air Contrast - Fl Barium Enema Air Contrast (74280) $868.23 $1,127.56 4.8×
X-Ray Elbow 2 Vw - Xr Elbow 1-2 Views Right (73070) $158.56 $205.92 1.8×
X-Ray Exam Hip Uni 2-3 Views (73502) $173.14 $224.85 1.9×
X-Ray Exam Hips Bi 3-4 Views (73522) $247.44 $321.34 2.3×
X-ray exam of femur 2/> (73552) $173.14 $224.85 1.9×
X-ray eye for foreign body (70030) $379.61 $493 4.2×
X-Ray Facial Bones <3 Vw - Xr Facial Bones 1-2 Views (70140) $171.77 $223.07 1.9×
X-Ray Knee Bilat Standing - Xr Knees Anteroposterior Standing Bilat (73565) $212.51 $275.98 2.4×
X-ray leg, infant (73592) $193.41 $251.18 2.2×
X-Ray Lumbar Spine 2/3 Vw - Xr Lumbar Spine 2-3 Views (72100) $201.30 $261.42 1.9×
X-Ray Lumbar Spine 6+ Vw - Xr Lumbar Spine 6+ Vws Including Bending (72114) $453.37 $588.78 4.2×
X-ray nose-rectum child f.b. (76010) $187.78 $243.86 2.1×
X-Ray Orbits - Xr Orbits Complete 4+ Views (70200) $267.74 $347.71 2.5×
X-Ray Ribs 2 Vw Unilat - Xr Ribs 2 Views Right (71100) $173.14 $224.85 1.9×
X-Ray Ribs, Chest 3+ Vw - Xr Ribs 2 Vws Lt W/ Chest Anteroposterior (71101) $479.06 $622.15 4.4×
X-Ray Ribs, Chest 4+ Vw - Xr Ribs 3 Vws Bil W/ Chest Posteroanterior (71111) $554.44 $720.05 5.1×
X-Ray Sacroiliac Jts 3+ Vw - Xr Sacroiliac Joints 3+ Views (72202) $203.59 $264.40 1.9×
X-Ray Sacrum/Coccyx 2+ Vw - Xr Sacrum Coccyx 2+ Views (72220) $173.14 $224.85 1.9×
X-Ray Sinuses 3+ Vw - Xr Paranasal Sinuses 3+ Views (70220) $236.19 $306.73 2.6×
X-Ray Skull 4+ Vw - Xr Skull Complete 4+ Views (70260) $272.13 $353.41 2.5×
X-Ray Skull <4 Vw - Xr Skull 1-3 Views (70250) $190.06 $246.83 1.8×
X-Ray Spine One View - Xr Spine (72020) $158.62 $206 1.8×
X-Ray Sterno-Clavicluar Jt - Xr Sternoclavicular Joints 3+ Views (71130) $200.21 $260.01 2.2×
X-Ray Sternum 2+ Vw - Xr Sternum 2+ Views (71120) $193.41 $251.18 2.2×
X-Ray Thoracic Spine 2 Vw - Xr Thoracic Spine 2 Views (72070) $193.41 $251.18 1.8×
X-Ray Thoracic Spine 4 Vw - Xr Thoracic Spine Complete 4+ Views (72074) $301.67 $391.77 2.8×
Xr c-spine 4 or 5 views (72050) $272.13 $353.41 2.5×
Xr c-spine 6 or more views (72052) $341.85 $443.96 3.2×