Imaging prices at Starr County Memorial Hospital

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

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

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ProcedureCash priceGross charge× Medicare
Abdomen 2 views (74019) $420 $420 4.0×
Ankle 2 views (73600) $350 $350 4.0×
Bone age studies (77072) $420 $420 4.0×
Cervical spine 2 or 3 views (72040) $350 $350 4.0×
Chest 1 view (71045) $225 $225 2.6×
Chest 3 views (71047) $350 $350 4.0×
Cine/Vid X-Ray Throat/Esoph - Fl Esoph Barium Swlw W/ Video & Speech (74230) $800 $800 4.5×
Clavicle complete (73000) $350 $350 4.0×
Contrast Xray Throat/Cerv Esopha - Fl Esophagus Pharynx (74210) $800 $800 4.5×
CT abdomen and pelvis without and with contrast (74178) $1,832 $1,832 5.2×
CT abdomen and pelvis without contrast (74176) $1,200 $1,200 5.0×
CT abdomen w contrast (74160) $900 $900 5.1×
CT abdomen w wo contrast (74170) $900 $900 5.1×
CT abdomen w/o contrast (74150) $525 $525 5.0×
CT c-spine w/o contrast (72125) $525 $525 5.0×
CT chest w/wo contrast (71270) $900 $900 5.1×
CT chest with contrast (71260) $900 $900 5.1×
CT head/brain with contrast (70460) $900 $900 5.1×
CT head/brain without and with contrast (70470) $900 $900 5.1×
CT iac w contrast (70481) $900 $900 5.1×
CT lower ext w/o (73700) $525 $525 5.0×
CT lower extremity w wo contrast (73702) $900 $900 5.1×
CT lower extremity with contrast (73701) $900 $900 5.1×
CT lumbar spine w & w/o contrast (72133) $900 $900 5.1×
CT lumbar spine w/o contrast (72131) $900 $900 8.6×
CT lumbar spine with contrast (72132) $1,850 $1,850 5.3×
CT maxillofacial w/o contrast (70486) $525 $525 5.0×
CT maxillofacial w/wo contrast (70488) $900 $900 5.1×
CT neck soft tissue w contrast (70491) $900 $900 5.1×
CT orbit sella/post fossa/ear w/o & w/contr matr (70482) $900 $900 5.1×
CT orbits w/o contrast (70480) $525 $525 5.0×
CT pelvis w & w/o contrast (72194) $900 $900 5.1×
CT pelvis w/o contrast (72192) $525 $525 5.0×
CT soft tissue neck w/o & w/contrast material (70492) $900 $900 5.1×
CT soft tissue neck w/o contrast (70490) $525 $525 5.0×
CT thoracic spine w/contrast (72129) $900 $900 5.1×
CT thoracic spine w/o contrast (72128) $525 $525 5.0×
CT thoracic spine w/wo contrast (72130) $900 $900 5.1×
CT thorax w/o contrast (71250) $525 $525 5.0×
CT upper extremity w/o contrast rt (73200) $525 $525 5.0×
Cystography minimum 3 views rs&i (74430) $1,475 $1,475 4.2×
Dxa bone density study 1/> sites axial skel (77080) $420 $420 4.0×
Dxa bone density study 1/>sites appendiclr skel (77081) $350 $350 4.0×
Esophagus (74220) $800 $800 4.5×
Fetal biophysical profile non-stress testing (76818) $420 $420 4.0×
Fluoroscopy up to 1 hr (76000) $950 $950 4.0×
Foot 2 views (73620) $350 $350 4.0×
Forearm 2 views (73090) $350 $350 4.0×
Hand 2 views (73120) $420 $420 4.0×
Hand 3 views (73130) $350 $350 4.0×
Humerus Min 2 Views Left (73060) $350 $350 4.0×
Knee 3 views (73562) $350 $350 4.0×
MRA head w & w/o contrast (70546) $1,800 $1,800 5.1×
MRA head w/o contrast (70544) $1,200 $1,200 5.0×
MRA head with contrast (70545) $1,800 $1,800 5.1×
MRA neck w contrast (70548) $1,800 $1,800 5.1×
Mra Neck W/O &W/Contrast Material (70549) $1,800 $1,800 5.1×
MRA neck w/o contrast (70547) $1,200 $1,200 5.0×
MRI abdomen w contrast (74182) $1,800 $1,800 5.1×
MRI abdomen w/o & w/contrast material (74183) $1,800 $1,800 5.1×
MRI abdomen w/o contrast (74181) $1,200 $1,200 5.0×
MRI any jnt lwr ext with con lt (73722) $3,000 $3,000 3.8×
MRI any jt upper extremity w/contrast matrl (73222) $3,000 $3,000 3.8×
MRI c-spine with contrast (72142) $1,800 $1,800 5.1×
MRI cervical spine w/o contrast (72141) $1,200 $1,200 5.0×
MRI chest w/o & w/contrast material (71552) $1,800 $1,800 5.1×
MRI chest w/o contrast (71550) $1,200 $1,200 5.0×
MRI chest with contrast (71551) $3,000 $3,000 3.8×
MRI Forearm w/ Contrast Bilateral 73219 (73219) $1,800 $1,800 5.1×
MRI lower extrem oth/thn jt w/contrast matrl (73719) $1,800 $1,800 5.1×
MRI lower extrem oth/thn jt w/o contr matrl (73718) $1,200 $1,200 5.0×
MRI orbit face &/neck w/o contrast (70540) $1,200 $1,200 5.0×
MRI orbit/face/neck w&w/o cont (70543) $1,800 $1,800 5.1×
MRI orbit/face/neck w/contrast (70542) $1,800 $1,800 5.1×
MRI pelvis w contrast (72196) $1,800 $1,800 5.1×
MRI pelvis w/o & w/contrast material (72197) $1,800 $1,800 5.1×
MRI pelvis w/o contrast (72195) $1,200 $1,200 5.0×
MRI scan of arm joint before and after contrast (73223) $1,800 $1,800 5.1×
MRI scan of leg joint before and after contrast (73723) $1,800 $1,800 5.1×
MRI spinal canal cervical w/o & w/contr matrl (72156) $1,800 $1,800 5.1×
MRI spinal canal lumbar w/contrast material (72149) $1,800 $1,800 5.1×
MRI spinal canal lumbar w/o & w/contr matrl (72158) $1,200 $1,200 3.4×
MRI spinal canal thoracic w/contrast matrl (72147) $1,800 $1,800 5.1×
MRI spinal canal thoracic w/o & w/contr matrl (72157) $1,800 $1,800 5.1×
MRI thoracic spine w/o contrast (72146) $1,200 $1,200 5.0×
MRI tmj (70336) $1,200 $1,200 5.0×
MRI upper ext joint w/o contrast (73221) $1,200 $1,200 5.0×
MRI upper extrem other than jt w/o & w/contras (73220) $1,800 $1,800 5.1×
MRI upper extremity oth than jt w/o contr matrl (73218) $1,200 $1,200 5.0×
Neck soft tissue (70360) $350 $350 4.0×
Osseous survey limited (77074) $420 $420 4.0×
Pelvis 1 or 2 views (72170) $420 $420 4.0×
Pr MRI, lower extr, w/o contrast f/u by contrast (73720) $1,800 $1,800 5.1×
Radex Entir Thrc Lmbr Crv Sac Spi W/Skull 1 Vw - Xr Scoliosis 1 Vw (72081) $420 $420 4.8×
Radex entir thrc lmbr crv sac spi w/skull 2/3 vw (72082) $420 $420 4.0×
Radex mastoids compl minimum 3 views pr side (70130) $420 $420 4.0×
Radiolog exam mandible compl minimum 4 views (70110) $420 $420 4.0×
Radiologic Exam Abdomen 1 View - Xr Abdomen 1 View (74018) $350 $350 4.0×
Radiologic Exam Chest 2 Views - Xr Chest 2 Views (71046) $350 $350 4.0×
Radiologic exam colon single contrast study (74270) $800 $800 4.5×
Radiologic exam upr gi trc double contrast study (74246) $800 $800 4.5×
Radiologic Examination Femur Minimum 2 Views - Xr Femur 2+ Vw Lt (73552) $350 $350 4.0×
Ribs bilateral 3 views (71110) $420 $420 4.0×
Sacroiliac Joints < 3 Views (72200) $420 $420 4.0×
Scapula complete (73010) $420 $420 4.0×
Sella turcica (70240) $350 $350 4.0×
Small bowel series (74250) $800 $800 4.5×
Spine thoracic 3 views (72072) $420 $420 4.0×
Tmj unilateral (70328) $350 $350 4.0×
Ultrasound, abdomen limited (76705) $420 $420 4.0×
Unlisted Ultrasound Procedure (76999) $420 $420 4.8×
Us abdl aorta screen aaa (76706) $420 $420 4.0×
Us breast unilateral complete (76641) $420 $420 4.0×
Us breast unilateral limited (76642) $350 $350 4.0×
Us chest (76604) $420 $420 4.0×
Us compl joint r-t w/image documentation (76881) $420 $420 4.0×
Us elastography parenchyma (76981) $420 $420 4.0×
Us infant hips dynamic (76885) $350 $350 4.0×
Us pelvic non ob complete (76856) $420 $420 4.0×
Us pelvic nonobstetric image dcmtn limited/f/u (76857) $420 $420 4.0×
Us pregnancy ltd (76815) $420 $420 4.0×
Us pregnant uterus 14 wk transabdl 1/1st gestat (76801) $420 $420 4.0×
Us retroperitoneal complete (76770) $420 $420 4.0×
Us scrotum and contents (76870) $420 $420 4.0×
Us soft tissue head/neck (76536) $420 $420 4.0×
Us spinal canal and contents (76800) $420 $420 4.0×
Us xtr non-vasc lmtd (76882) $420 $420 4.0×
Vertebral fracture assessment via dxa (77086) $350 $350 4.0×
Wrist 2 views (73100) $350 $350 4.0×
X-Ray Abdomen,Comp Acute Series - Xr Abdomen 2 Vws With Chest 1 View (74022) $420 $420 4.0×
X-Ray Ac Jts - Xr Acromioclavicular Joints Bilateral (73050) $350 $350 4.0×
X-Ray Ankle 3+ Vw - Xr Ankle 3+ Views Right (73610) $350 $350 4.0×
X-Ray Colon Air Contrast - Fl Barium Enema Air Contrast (74280) $800 $800 4.5×
X-Ray Elbow 2 Vw - Xr Elbow 1-2 Views Right (73070) $350 $350 4.0×
X-Ray Elbow 3+ Vw - Xr Elbow 3+ Views Right (73080) $350 $350 4.0×
X-ray exam hip uni 1 view (73501) $350 $350 4.0×
X-Ray Exam Hip Uni 2-3 Views (73502) $350 $350 4.0×
X-Ray Exam Hips Bi 3-4 Views (73522) $420 $420 4.0×
X-ray eye for foreign body (70030) $250 $250 2.9×
X-Ray Facial Bones 3+ Vw - Xr Facial Bones 3+ Views (70150) $420 $420 4.0×
X-Ray Facial Bones <3 Vw - Xr Facial Bones 1-2 Views (70140) $350 $350 4.0×
X-Ray Foot 3+ Vw - Xr Foot 3+ Views Right (73630) $350 $350 4.0×
X-Ray Heel - Xr Calcaneus 2 Views Right (73650) $350 $350 4.0×
X-Ray Jaw <4 Vw - Xr Mandible < 4 Views (70100) $350 $350 4.0×
X-Ray Knee 4+ View - Xr Knee 4+ Views Right (73564) $420 $420 4.0×
X-Ray Lumbar Spine 2/3 Vw - Xr Lumbar Spine 2-3 Views (72100) $420 $420 4.0×
X-Ray Nasal Bones - Xr Nasal Bones (70160) $350 $350 4.0×
X-Ray Orbits - Xr Orbits Complete 4+ Views (70200) $420 $420 4.0×
X-Ray Retrograde Pyelogram - Fl Pyelogram Retrograde (74420) $1,475 $1,475 4.2×
X-Ray Ribs 2 Vw Unilat - Xr Ribs 2 Views Right (71100) $350 $350 4.0×
X-Ray Sacroiliac Jts 3+ Vw - Xr Sacroiliac Joints 3+ Views (72202) $420 $420 4.0×
X-Ray Sacrum/Coccyx 2+ Vw - Xr Sacrum Coccyx 2+ Views (72220) $350 $350 4.0×
X-Ray Shoulder 2+ Vw - Xr Shoulder 2+ Views Right (73030) $350 $350 4.0×
X-Ray Sinuses 3+ Vw - Xr Paranasal Sinuses 3+ Views (70220) $350 $350 4.0×
X-Ray Sinuses <3 Vw - Xr Paranasal Sinuses 1-2 Views (70210) $350 $350 4.0×
X-Ray Skull 4+ Vw - Xr Skull Complete 4+ Views (70260) $420 $420 4.0×
X-Ray Skull <4 Vw - Xr Skull 1-3 Views (70250) $420 $420 4.0×
X-Ray Sternum 2+ Vw - Xr Sternum 2+ Views (71120) $350 $350 4.0×
X-Ray Toe(S) - Xr Toes 2+ Views Right (73660) $350 $350 4.0×
X-Ray Wrist 3+ Vw - Xr Wrist 3+ Views Right (73110) $350 $350 4.0×
Xr finger(s) 2+ views (73140) $350 $350 4.0×
Xr shoulder 1 view (73020) $350 $350 4.0×
Xr tibia/fibula 2 views (73590) $350 $350 4.0×
Xr tmj bilateral (70330) $350 $350 4.0×
Xray knee 1 or 2 views rt (73560) $350 $350 4.0×