Imaging prices at Refugio County Memorial Hospital

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

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

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ProcedureCash priceGross charge× Medicare
Abdomen 2 views (74019) $342.99 $428.74 3.3×
Ankle 2 views (73600) $294.21 $367.76 3.4×
Bone age studies (77072) $124 $155 1.2×
Bone Imaging 3 Phase (78315) $5,414.40 $6,768 13.5×
Bone survey complete (77075) $783.76 $979.70 7.5×
Cervical spine 2 or 3 views (72040) $323.20 $404 3.7×
Chest 1 view (71045) $178.50 $223.12 2.0×
Chest 3 views (71047) $329.60 $412 3.8×
Cine/Vid X-Ray Throat/Esoph - Fl Esoph Barium Swlw W/ Video & Speech (74230) $692.92 $866.15 3.9×
Clavicle complete (73000) $321.60 $402 3.7×
CT abdomen and pelvis without and with contrast (74178) $3,616.80 $4,521 10.3×
CT abdomen and pelvis without contrast (74176) $2,536.80 $3,171 10.6×
CT abdomen w contrast (74160) $2,417.92 $3,022.40 13.7×
CT abdomen w wo contrast (74170) $2,722.56 $3,403.20 15.5×
CT abdomen w/o contrast (74150) $1,539.35 $1,924.19 14.7×
CT angiography upper extremity lt (73206) $3,092.80 $3,866 17.6×
CT c-spine w/o contrast (72125) $2,360 $2,950 22.5×
CT cervical spine w&w/o contrast (72127) $2,722.56 $3,403.20 15.5×
CT cervical spine with contrast (72126) $2,499.28 $3,124.10 7.1×
CT chest w/wo contrast (71270) $2,722.56 $3,403.20 15.5×
CT chest with contrast (71260) $3,022.40 $3,778 17.2×
CT head/brain with contrast (70460) $2,165.12 $2,706.40 12.3×
CT head/brain without and with contrast (70470) $2,464 $3,080 14.0×
CT iac w contrast (70481) $2,647.68 $3,309.60 15.0×
CT lower ext w/o (73700) $2,285.20 $2,856.50 21.8×
CT lower extremity w wo contrast (73702) $2,563.20 $3,204 14.5×
CT lower extremity with contrast (73701) $2,197.76 $2,747.20 12.5×
CT lumbar spine w & w/o contrast (72133) $2,722.56 $3,403.20 15.5×
CT lumbar spine w/o contrast (72131) $2,360 $2,950 22.5×
CT lumbar spine with contrast (72132) $2,488.96 $3,111.20 7.1×
CT maxillofacial w contrast (70487) $2,240 $2,800 12.7×
CT maxillofacial w/o contrast (70486) $2,472 $3,090 23.5×
CT maxillofacial w/wo contrast (70488) $2,722.56 $3,403.20 15.5×
CT neck soft tissue w contrast (70491) $2,488.96 $3,111.20 14.1×
CT orbit sella/post fossa/ear w/o & w/contr matr (70482) $2,977.28 $3,721.60 16.9×
CT orbits w/o contrast (70480) $2,263.68 $2,829.60 21.6×
CT pelvis w & w/o contrast (72194) $2,722.56 $3,403.20 15.5×
CT pelvis w/o contrast (72192) $2,360 $2,950 22.5×
CT soft tissue neck w/o & w/contrast material (70492) $2,782.72 $3,478.40 15.8×
CT soft tissue neck w/o contrast (70490) $2,838.40 $3,548 27.0×
CT thoracic spine w/contrast (72129) $3,111.20 $3,889 17.7×
CT thoracic spine w/o contrast (72128) $2,360 $2,950 22.5×
CT thoracic spine w/wo contrast (72130) $2,722.56 $3,403.20 15.5×
CT thorax w/o contrast (71250) $2,080 $2,600 19.8×
CT upper extremity w/o & w/contrast material (73202) $3,204 $4,005 18.2×
CT upper extremity w/o contrast rt (73200) $1,828 $2,285 17.4×
CT upper extremity with contrast (73201) $2,197.76 $2,747.20 6.3×
Cta Abdl Aorta&Bi Iliofem W/Contrast&Postp (75635) $3,635.84 $4,544.80 20.6×
Cta Abdomen (74175) $3,380.48 $4,225.60 19.2×
CTA abdomen pelvis (74174) $3,577.34 $4,471.68 10.2×
CTA chest (71275) $2,612 $3,265 14.8×
Cta Head (70496) $2,360 $2,950 13.4×
CTA lwr ext w&w/o contrast (73706) $2,505.49 $3,131.86 14.2×
Cta Neck (70498) $2,360 $2,950 13.4×
Cta Pelvis (72191) $4,271.20 $5,339 24.2×
Cystography minimum 3 views rs&i (74430) $858.40 $1,073 2.4×
Dxa bone density study axial skeleton (77085) $656.80 $821 6.3×
Esophagus (74220) $3,606.40 $4,508 20.5×
Foot 2 views (73620) $249.86 $312.32 2.9×
Forearm 2 views (73090) $325.76 $407.20 3.7×
Hand 2 views (73120) $325.76 $407.20 3.1×
Hand 3 views (73130) $404.16 $505.20 4.6×
Humerus Min 2 Views Left (73060) $325.76 $407.20 3.7×
Knee 3 views (73562) $482.40 $603 5.5×
MRA head w & w/o contrast (70546) $3,661.44 $4,576.80 10.4×
MRA head w/o contrast (70544) $2,169.60 $2,712 9.1×
MRA head with contrast (70545) $3,120 $3,900 8.9×
MRA neck w contrast (70548) $3,644.80 $4,556 10.4×
Mra Neck W/O &W/Contrast Material (70549) $4,055.04 $5,068.80 11.6×
MRA neck w/o contrast (70547) $2,735.36 $3,419.20 11.4×
MRI abdomen w contrast (74182) $3,618.16 $4,522.70 10.3×
MRI abdomen w/o & w/contrast material (74183) $3,833.60 $4,792 10.9×
MRI abdomen w/o contrast (74181) $3,368.96 $4,211.20 14.1×
MRI any jnt lwr ext with con lt (73722) $4,939.20 $6,174 6.3×
MRI any jt upper extremity w/contrast matrl (73222) $3,971.20 $4,964 5.0×
MRI c-spine with contrast (72142) $4,560 $5,700 13.0×
MRI cervical spine w/o contrast (72141) $3,696 $4,620 15.4×
MRI chest w/o & w/contrast material (71552) $4,273.28 $5,341.60 12.2×
MRI chest w/o contrast (71550) $3,147.52 $3,934.40 13.1×
MRI chest with contrast (71551) $4,760 $5,950 6.0×
MRI Forearm w/ Contrast Bilateral 73219 (73219) $4,600 $5,750 13.1×
MRI lower extrem oth/thn jt w/contrast matrl (73719) $3,811.20 $4,764 10.9×
MRI lower extrem oth/thn jt w/o contr matrl (73718) $3,419.20 $4,274 14.3×
MRI orbit face &/neck w/o contrast (70540) $3,397.76 $4,247.20 14.2×
MRI orbit/face/neck w&w/o cont (70543) $4,259.68 $5,324.60 12.2×
MRI orbit/face/neck w/contrast (70542) $4,724.80 $5,906 13.5×
MRI pelvis w contrast (72196) $3,799 $4,748.75 10.8×
MRI pelvis w/o & w/contrast material (72197) $4,163.84 $5,204.80 11.9×
MRI pelvis w/o contrast (72195) $2,482.56 $3,103.20 10.4×
MRI scan of arm joint before and after contrast (73223) $5,204.80 $6,506 14.9×
MRI scan of leg joint before and after contrast (73723) $5,204.80 $6,506 14.9×
MRI spinal canal cervical w/o & w/contr matrl (72156) $4,096 $5,120 11.7×
MRI spinal canal lumbar w/contrast material (72149) $4,785 $5,981.25 13.7×
MRI spinal canal lumbar w/o & w/contr matrl (72158) $4,163.84 $5,204.80 11.9×
MRI spinal canal thoracic w/contrast matrl (72147) $4,560 $5,700 13.0×
MRI spinal canal thoracic w/o & w/contr matrl (72157) $4,163.84 $5,204.80 11.9×
MRI thoracic spine w/o contrast (72146) $2,956.80 $3,696 12.3×
MRI tmj (70336) $3,799 $4,748.75 15.8×
MRI upper ext joint w/o contrast (73221) $2,950 $3,687.50 12.3×
MRI upper extrem other than jt w/o & w/contras (73220) $4,040 $5,050 11.5×
MRI upper extremity oth than jt w/o contr matrl (73218) $3,333.76 $4,167.20 13.9×
Neck soft tissue (70360) $233.02 $291.28 2.7×
Ob Us Follow-Up Per Fetus - Us Ob Follow Up Transabdominal Approach (76816) $312.20 $390.25 3.0×
Pelvis 1 or 2 views (72170) $260.48 $325.60 2.5×
Pr MRI, lower extr, w/o contrast f/u by contrast (73720) $4,134.96 $5,168.70 11.8×
Pulmonary Perfusion Imaging Particulate (78580) $1,864 $2,330 4.6×
Pulmonary Ventilation & Perfusion Imaging (78582) $1,732 $2,165 3.2×
Radex entir thrc lmbr crv sac spi w/skull 2/3 vw (72082) $327.04 $408.80 3.1×
Radex hips bilateral with pelvis 2 views (73521) $652.80 $816 6.2×
Radex mastoids compl minimum 3 views pr side (70130) $572.60 $715.75 5.5×
Radiolog exam mandible compl minimum 4 views (70110) $379.21 $474.01 3.6×
Radiologic Exam Abdomen 1 View - Xr Abdomen 1 View (74018) $272 $340 3.1×
Radiologic Exam Chest 2 Views - Xr Chest 2 Views (71046) $315.20 $394 3.6×
Radiologic Examination Femur Minimum 2 Views - Xr Femur 2+ Vw Lt (73552) $364.80 $456 4.2×
Ribs bilateral 3 views (71110) $462.97 $578.71 4.4×
Sacroiliac Joints < 3 Views (72200) $260.48 $325.60 2.5×
Scapula complete (73010) $326.04 $407.56 3.1×
Spine thoracic 3 views (72072) $401.45 $501.81 3.8×
Tmj unilateral (70328) $214.40 $268 2.5×
Ultrasound, abdomen limited (76705) $664.80 $831 6.3×
Unlisted Ultrasound Procedure (76999) $331.20 $414 3.8×
Upper Extremity Infant (73092) $361.90 $452.38 3.4×
Urography (pyelography), intravenous, with or without KUB, with or without tomography (74400) $1,071.60 $1,339.50 6.1×
Us abdl aorta screen aaa (76706) $501.22 $626.52 4.8×
Us compl joint r-t w/image documentation (76881) $732.16 $915.20 7.0×
Us ob transvaginal (76817) $617.60 $772 5.9×
Us pelvic non ob complete (76856) $723.20 $904 6.9×
Us pelvic nonobstetric image dcmtn limited/f/u (76857) $512 $640 4.9×
Us pregnancy ltd (76815) $732 $915 7.0×
Us pregnant uterus 14 wk transabdl 1/1st gestat (76801) $732.16 $915.20 7.0×
Us retroperitoneal complete (76770) $806.40 $1,008 7.7×
Us retroperitoneal limited (76775) $544.12 $680.15 5.2×
Us scrotum and contents (76870) $723.20 $904 6.9×
Us soft tissue head/neck (76536) $904 $1,130 8.6×
Us xtr non-vasc lmtd (76882) $367.68 $459.60 3.5×
Wrist 2 views (73100) $325.76 $407.20 3.7×
X-Ray Abdomen,Comp Acute Series - Xr Abdomen 2 Vws With Chest 1 View (74022) $396.16 $495.20 3.8×
X-Ray Ac Jts - Xr Acromioclavicular Joints Bilateral (73050) $296.49 $370.61 3.4×
X-Ray Ankle 3+ Vw - Xr Ankle 3+ Views Right (73610) $357.88 $447.35 4.1×
X-Ray Elbow 2 Vw - Xr Elbow 1-2 Views Right (73070) $325.76 $407.20 3.7×
X-Ray Elbow 3+ Vw - Xr Elbow 3+ Views Right (73080) $404.16 $505.20 4.6×
X-ray exam hip uni 1 view (73501) $260.48 $325.60 3.0×
X-Ray Exam Hip Uni 2-3 Views (73502) $327.04 $408.80 3.7×
X-Ray Facial Bones 3+ Vw - Xr Facial Bones 3+ Views (70150) $414.72 $518.40 3.9×
X-Ray Facial Bones <3 Vw - Xr Facial Bones 1-2 Views (70140) $328.22 $410.28 3.8×
X-Ray Foot 3+ Vw - Xr Foot 3+ Views Right (73630) $505.20 $631.50 5.8×
X-Ray Heel - Xr Calcaneus 2 Views Right (73650) $325.76 $407.20 3.7×
X-Ray Jaw <4 Vw - Xr Mandible < 4 Views (70100) $321.60 $402 3.7×
X-Ray Knee Bilat Standing - Xr Knees Anteroposterior Standing Bilat (73565) $304.14 $380.17 3.5×
X-Ray Leg, Infant - Xr Lower Extremity 2+ Views Infant Left (73592) $452.60 $565.75 5.2×
X-Ray Lumbar Spine 2/3 Vw - Xr Lumbar Spine 2-3 Views (72100) $454.40 $568 4.3×
X-Ray Lumbar Spine 6+ Vw - Xr Lumbar Spine 6+ Vws Including Bending (72114) $650.22 $812.78 6.2×
X-Ray Nasal Bones - Xr Nasal Bones (70160) $272.62 $340.78 3.1×
X-Ray Nose-Rectum Child F.B. - Xr Nose to Rectum Foreign Body Peds (76010) $357.40 $446.75 4.1×
X-Ray Orbits - Xr Orbits Complete 4+ Views (70200) $553.60 $692 5.3×
X-Ray Pelvis 3+ Vw - Xr Pelvis 3+ Views (72190) $323.20 $404 3.1×
X-Ray Ribs 2 Vw Unilat - Xr Ribs 2 Views Right (71100) $390.40 $488 4.5×
X-Ray Ribs, Chest 3+ Vw - Xr Ribs 2 Vws Lt W/ Chest Anteroposterior (71101) $430.72 $538.40 4.1×
X-Ray Sacroiliac Jts 3+ Vw - Xr Sacroiliac Joints 3+ Views (72202) $345.60 $432 3.3×
X-Ray Sacrum/Coccyx 2+ Vw - Xr Sacrum Coccyx 2+ Views (72220) $323.20 $404 3.7×
X-Ray Shoulder 2+ Vw - Xr Shoulder 2+ Views Right (73030) $407.20 $509 4.7×
X-Ray Sinuses 3+ Vw - Xr Paranasal Sinuses 3+ Views (70220) $430.72 $538.40 4.9×
X-Ray Sinuses <3 Vw - Xr Paranasal Sinuses 1-2 Views (70210) $201.60 $252 2.3×
X-Ray Skull 4+ Vw - Xr Skull Complete 4+ Views (70260) $515.20 $644 4.9×
X-Ray Skull <4 Vw - Xr Skull 1-3 Views (70250) $391.20 $489 3.7×
X-Ray Spine One View - Xr Spine (72020) $202.18 $252.72 2.3×
X-Ray Sterno-Clavicluar Jt - Xr Sternoclavicular Joints 3+ Views (71130) $325.60 $407 3.7×
X-Ray Sternum 2+ Vw - Xr Sternum 2+ Views (71120) $264.58 $330.73 3.0×
X-Ray Thoracic Spine 2 Vw - Xr Thoracic Spine 2 Views (72070) $330.87 $413.59 3.2×
X-Ray Toe(S) - Xr Toes 2+ Views Right (73660) $276.32 $345.40 3.2×
X-Ray Wrist 3+ Vw - Xr Wrist 3+ Views Right (73110) $404.16 $505.20 4.6×
Xr c-spine 6 or more views (72052) $577.92 $722.40 5.5×
Xr chest 4+ views (71048) $457.92 $572.40 4.4×
Xr finger(s) 2+ views (73140) $266.56 $333.20 3.0×
Xr shoulder 1 view (73020) $252.16 $315.20 2.9×
Xr spine cervical 4 or 5 views (72050) $449.28 $561.60 4.3×
Xr tibia/fibula 2 views (73590) $306.85 $383.56 3.5×
Xr tmj bilateral (70330) $404 $505 4.6×
Xray knee 1 or 2 views rt (73560) $404.16 $505.20 4.6×