Imaging prices at Sublette County Health

Pinedale, WY · every code in this section with a posted price and a Medicare benchmark.

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

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ProcedureCash priceGross charge× Medicare
Abdomen 2 views (74019) $334.80 $372 3.1×
Acute gastrointestinal blood loss imaging (78278) $1,561.50 $1,735 3.8×
Ankle 2 views (73600) $284.40 $316 3.2×
Arthrogram hip (73525) $972 $1,080 2.7×
Arthrogram shoulder (73040) $883.80 $982 2.5×
Arthrogram wrist (73115) $765 $850 2.1×
Arthrography knee lt (73580) $1,143 $1,270 3.2×
Bone &/Joint Imaging Limited Area (78300) $1,300.50 $1,445 3.2×
Bone &/joint imaging whole body (78306) $1,765.80 $1,962 4.3×
Bone age studies (77072) $477 $530 4.5×
Bone Imaging 3 Phase (78315) $1,929.60 $2,144 4.7×
Bone survey complete (77075) $990 $1,100 9.3×
Brain image w/flow 4 + views (78606) $2,006.10 $2,229 3.6×
Brain Imaging Pet Metabolic Evaluation (78608) $6,864.30 $7,627 4.7×
Cervical spine 2 or 3 views (72040) $333.90 $371 3.8×
Chest 1 view (71045) $274.50 $305 3.1×
Chest 3 views (71047) $368.10 $409 4.1×
Clavicle complete (73000) $278.10 $309 3.1×
Computed Tomography Thorax Lw Dose Lng Ca Scr C- (71271) $774 $860 7.2×
CT abdomen and pelvis without and with contrast (74178) $4,393.80 $4,882 12.3×
CT abdomen and pelvis without contrast (74176) $3,123.90 $3,471 12.8×
CT abdomen w contrast (74160) $1,951.20 $2,168 10.9×
CT abdomen w wo contrast (74170) $2,529 $2,810 14.1×
CT abdomen w/o contrast (74150) $1,494 $1,660 14.0×
CT angiography upper extremity lt (73206) $2,233.80 $2,482 12.5×
CT c-spine w/o contrast (72125) $2,070.90 $2,301 19.4×
CT cervical spine w&w/o contrast (72127) $2,790 $3,100 15.6×
CT cervical spine with contrast (72126) $2,265.30 $2,517 6.4×
CT chest w/wo contrast (71270) $2,700 $3,000 15.1×
CT chest with contrast (71260) $2,452.50 $2,725 13.7×
CT colonography w/o cntrst (74261) $2,302.20 $2,558 21.6×
CT head/brain with contrast (70460) $1,909.80 $2,122 10.7×
CT head/brain without and with contrast (70470) $2,174.40 $2,416 12.1×
CT heart no contrast quant eval coronry calcium (75571) $1,151.10 $1,279 12.9×
CT iac w contrast (70481) $3,084.30 $3,427 17.2×
CT limited/localized follow up study (76380) $505.80 $562 5.7×
CT lower ext w/o (73700) $1,687.50 $1,875 15.8×
CT lower extremity w wo contrast (73702) $2,348.10 $2,609 13.1×
CT lower extremity with contrast (73701) $1,883.25 $2,092.50 10.5×
CT lumbar spine w & w/o contrast (72133) $2,520 $2,800 14.1×
CT lumbar spine w/o contrast (72131) $2,025 $2,250 19.0×
CT lumbar spine with contrast (72132) $2,236.50 $2,485 6.3×
CT maxillofacial w contrast (70487) $2,906.10 $3,229 16.2×
CT maxillofacial w/o contrast (70486) $1,717.20 $1,908 16.1×
CT maxillofacial w/wo contrast (70488) $3,410.10 $3,789 19.0×
CT neck soft tissue w contrast (70491) $1,927.80 $2,142 10.8×
CT orbit sella/post fossa/ear w/o & w/contr matr (70482) $1,632.60 $1,814 9.1×
CT orbits w/o contrast (70480) $1,728 $1,920 16.2×
CT pelvis w & w/o contrast (72194) $2,340 $2,600 13.1×
CT pelvis w/o contrast (72192) $1,652.40 $1,836 15.5×
CT soft tissue neck w/o & w/contrast material (70492) $2,160 $2,400 12.1×
CT soft tissue neck w/o contrast (70490) $1,629.90 $1,811 15.3×
CT thoracic spine w/contrast (72129) $2,313.90 $2,571 12.9×
CT thoracic spine w/o contrast (72128) $2,122.20 $2,358 19.9×
CT thoracic spine w/wo contrast (72130) $3,060 $3,400 17.1×
CT thorax w/o contrast (71250) $1,661.40 $1,846 15.6×
CT unlisted procedure (76497) $1,545.30 $1,717 17.4×
CT upper extremity w/o & w/contrast material (73202) $1,957.50 $2,175 10.9×
CT upper extremity w/o contrast rt (73200) $1,368 $1,520 12.8×
CT upper extremity with contrast (73201) $1,665 $1,850 4.7×
Cta Abdl Aorta&Bi Iliofem W/Contrast&Postp (75635) $2,844.90 $3,161 15.9×
Cta Abdomen (74175) $2,073.60 $2,304 11.6×
CTA abdomen pelvis (74174) $3,951 $4,390 11.1×
CTA chest (71275) $2,819.70 $3,133 15.7×
Cta Head (70496) $2,461.50 $2,735 13.7×
CTA lwr ext w&w/o contrast (73706) $2,626.65 $2,918.50 14.7×
Cta Neck (70498) $2,682.90 $2,981 15.0×
Cta Pelvis (72191) $1,980 $2,200 11.0×
Dxa bone density study 1/> sites axial skel (77080) $503.10 $559 4.7×
Dxa bone density study 1/>sites appendiclr skel (77081) $275.40 $306 3.1×
Fetal Biophysical Profile W/O Non-Stress Testing (76819) $665.10 $739 6.2×
Fluoroscopy up to 1 hr (76000) $673.20 $748 2.8×
Foot 2 views (73620) $260.10 $289 2.9×
Forearm 2 views (73090) $325.80 $362 3.7×
Gated Heart Planar Single (78472) $3,410.10 $3,789 8.3×
Hand 2 views (73120) $268.20 $298 2.5×
Hand 3 views (73130) $426.60 $474 4.8×
Heart Infarct Image (78466) $2,011.50 $2,235 4.9×
Hepatobil Syst Imag Inc Gb W/Pharma Intervenj (78227) $2,137.50 $2,375 3.9×
Hepatobiliary syst imaging including gallbladder (78226) $1,607.40 $1,786 3.9×
Ht muscle image spect sing (78451) $4,108.50 $4,565 3.1×
Humerus Min 2 Views Left (73060) $320.40 $356 3.6×
Kidney imaging morphology (78700) $1,849.50 $2,055 4.5×
Kidney img morphology vascular flow 1 w/rx (78708) $1,745.10 $1,939 3.1×
Knee 3 views (73562) $455.85 $506.50 5.1×
Liver & spleen imaging static only (78215) $2,150.10 $2,389 5.3×
Lung Ventilation Imaging (78579) $847.80 $942 2.1×
Lymphoscintigraphy (78195) $1,491.30 $1,657 2.7×
Meckels Diverticulum (78290) $1,665.90 $1,851 4.1×
Mr safety implant pos&/immoblj supvj phys/qhp (76019) $134.10 $149 2.2×
Mr safety implant&/fb assmt clin staf 1st 15 min (76014) $45 $50 1.5×
Mr safety implt electronics prepj supvj phys/qhp (76018) $206.10 $229 2.1×
MRA head w & w/o contrast (70546) $3,150 $3,500 8.8×
MRA head w/o contrast (70544) $2,126.70 $2,363 8.7×
MRA head with contrast (70545) $2,430 $2,700 6.8×
MRA neck w contrast (70548) $2,700 $3,000 7.6×
Mra Neck W/O &W/Contrast Material (70549) $3,285.90 $3,651 9.2×
MRA neck w/o contrast (70547) $2,457.90 $2,731 10.1×
MRI abdomen w contrast (74182) $4,096.80 $4,552 11.5×
MRI abdomen w/o & w/contrast material (74183) $5,294.70 $5,883 14.9×
MRI abdomen w/o contrast (74181) $3,510 $3,900 14.4×
MRI any jnt lwr ext with con lt (73722) $4,080.60 $4,534 5.1×
MRI any jt upper extremity w/contrast matrl (73222) $3,510 $3,900 4.4×
MRI c-spine with contrast (72142) $3,225.60 $3,584 9.0×
MRI cervical spine w/o contrast (72141) $2,574.90 $2,861 10.6×
MRI chest w/o & w/contrast material (71552) $3,537 $3,930 9.9×
MRI chest w/o contrast (71550) $2,025 $2,250 8.3×
MRI chest with contrast (71551) $2,835 $3,150 3.5×
MRI Forearm w/ Contrast Bilateral 73219 (73219) $3,780 $4,200 10.6×
MRI lower extrem oth/thn jt w/contrast matrl (73719) $3,510 $3,900 9.8×
MRI lower extrem oth/thn jt w/o contr matrl (73718) $2,475 $2,750 10.2×
MRI orbit face &/neck w/o contrast (70540) $1,854 $2,060 7.6×
MRI orbit/face/neck w&w/o cont (70543) $2,969.10 $3,299 8.3×
MRI orbit/face/neck w/contrast (70542) $2,342.70 $2,603 6.6×
MRI pelvis w contrast (72196) $2,880 $3,200 8.1×
MRI pelvis w/o & w/contrast material (72197) $3,537 $3,930 9.9×
MRI pelvis w/o contrast (72195) $2,528.10 $2,809 10.4×
MRI scan of arm joint before and after contrast (73223) $4,091.40 $4,546 11.5×
MRI scan of leg joint before and after contrast (73723) $3,994.20 $4,438 11.2×
MRI spinal canal cervical w/o & w/contr matrl (72156) $3,818.70 $4,243 10.7×
MRI spinal canal lumbar w/contrast material (72149) $3,499.20 $3,888 9.8×
MRI spinal canal lumbar w/o & w/contr matrl (72158) $3,654.90 $4,061 10.3×
MRI spinal canal thoracic w/contrast matrl (72147) $3,486.60 $3,874 9.8×
MRI spinal canal thoracic w/o & w/contr matrl (72157) $3,644.10 $4,049 10.2×
MRI thoracic spine w/o contrast (72146) $2,436.30 $2,707 10.0×
MRI tmj (70336) $1,618.20 $1,798 6.6×
MRI upper ext joint w/o contrast (73221) $2,775.15 $3,083.50 11.4×
MRI upper extrem other than jt w/o & w/contras (73220) $4,530.60 $5,034 12.7×
MRI upper extremity oth than jt w/o contr matrl (73218) $2,591.55 $2,879.50 10.6×
Myocardial Spect Multiple Studies (78452) $4,194.90 $4,661 3.2×
Neck soft tissue (70360) $322.20 $358 3.6×
Nm gastric emptying study (78264) $1,548 $1,720 3.8×
Nuclear Rx Oral Admin (79005) $1,827.90 $2,031 7.7×
Ob Us Follow-Up Per Fetus - Us Ob Follow Up Transabdominal Approach (76816) $316.80 $352 3.0×
Osseous survey infant (77076) $239.40 $266 2.2×
Osseous survey limited (77074) $565.20 $628 5.3×
Parathyroid imaging (78070) $1,472.40 $1,636 3.6×
Pelvis 1 or 2 views (72170) $313.20 $348 2.9×
PET image w/CT, skull-thigh (78815) $6,131.70 $6,813 4.2×
PET imaging for CT attenuation whole body (78816) $6,124.50 $6,805 4.2×
Pr MRI, lower extr, w/o contrast f/u by contrast (73720) $3,912.30 $4,347 11.0×
Pulmonary Perfusion Imaging Particulate (78580) $1,204.20 $1,338 2.9×
Pulmonary Ventilation & Perfusion Imaging (78582) $1,817.10 $2,019 3.3×
Radex Entir Thrc Lmbr Crv Sac Spi W/Skull 1 Vw - Xr Scoliosis 1 Vw (72081) $281.70 $313 3.2×
Radex entir thrc lmbr crv sac spi w/skull 2/3 vw (72082) $441.90 $491 4.1×
Radex hips bilateral with pelvis 2 views (73521) $500.40 $556 4.7×
Radex mastoids compl minimum 3 views pr side (70130) $740.70 $823 6.9×
Radex X-Ray Exam Entire Spi 6/> Vw - Xr Entire Spine 6+ Vw (72084) $787.50 $875 7.4×
Radiolog exam mandible compl minimum 4 views (70110) $329.40 $366 3.1×
Radiologic Exam Abdomen 1 View - Xr Abdomen 1 View (74018) $268.20 $298 3.0×
Radiologic Exam Abdomen 3+ Views - Xr Abdomen 3+ Views (74021) $382.50 $425 3.6×
Radiologic Exam Chest 2 Views - Xr Chest 2 Views (71046) $336.60 $374 3.8×
Radiologic exam upr gi trc single contrast study (74240) $873.90 $971 4.9×
Radiologic Examination Femur Minimum 2 Views - Xr Femur 2+ Vw Lt (73552) $283.50 $315 3.2×
Radiological examination surgical specimen (76098) $710.10 $789 1.3×
Ribs bilateral 3 views (71110) $561.60 $624 5.3×
Rp loclzj tum plnr 2+area 1+d img/1 area img>2+d (78801) $2,479.50 $2,755 6.1×
Rp loclzj tum spect 1 area single day imaging (78803) $2,281.50 $2,535 4.1×
Sacroiliac Joints < 3 Views (72200) $315 $350 2.9×
Saline Infus Sonohysterography W/Color Doppler (76831) $1,015.20 $1,128 4.2×
Scanogram (77073) $479.70 $533 4.5×
Scapula complete (73010) $336.60 $374 3.2×
Screening digital breast tomosynthesis (77063) $71.55 $79.50 3.1×
Sella turcica (70240) $199.80 $222 2.2×
Spine thoracic 3 views (72072) $432 $480 4.0×
Spleen imaging only (78185) $904.50 $1,005 2.2×
Thoracolumbar 2 views (72080) $414 $460 4.7×
Thyroid carcinoma metastases img whole body (78018) $1,676.70 $1,863 3.0×
Thyroid Imaging With Vascular Flow (78013) $559.80 $622 1.4×
Thyroid Uptake W/Blood Flow Sngle/Mult Quan Meas (78014) $1,628.10 $1,809 4.0×
Tmj unilateral (70328) $315.90 $351 3.6×
Ultrasound, abdomen limited (76705) $668.70 $743 6.3×
Umbilical-artery Doppler (OB) (76820) $345.60 $384 3.2×
Upper Extremity Infant (73092) $478.35 $531.50 4.5×
Urethrocystography voiding (74455) $772.20 $858 3.2×
Urography (pyelography), intravenous, with or without KUB, with or without tomography (74400) $838.80 $932 4.7×
Us abdl aorta screen aaa (76706) $524.70 $583 4.9×
Us breast unilateral complete (76641) $621.90 $691 5.8×
Us breast unilateral limited (76642) $535.50 $595 6.0×
Us chest (76604) $472.50 $525 4.4×
Us compl joint r-t w/image documentation (76881) $457.20 $508 4.3×
Us infant hips dynamic (76885) $198 $220 2.2×
Us kidney transplant (76776) $630 $700 5.9×
Us ob detailed single fetus (76811) $994.50 $1,105 4.1×
Us ob transvaginal (76817) $554.40 $616 5.2×
Us pelvic non ob complete (76856) $756 $840 7.1×
Us pelvic nonobstetric image dcmtn limited/f/u (76857) $725.40 $806 6.8×
Us pregnancy ltd (76815) $441.90 $491 4.1×
Us pregnant uterus 14 wk transabdl 1/1st gestat (76801) $492.30 $547 4.6×
Us retroperitoneal complete (76770) $810 $900 7.6×
Us retroperitoneal limited (76775) $706.50 $785 6.6×
Us scrotum and contents (76870) $589.50 $655 5.5×
Us soft tissue head/neck (76536) $660.60 $734 6.2×
Us transrectal (76872) $350.10 $389 3.3×
Us xtr non-vasc lmtd (76882) $581.40 $646 5.4×
Wrist 2 views (73100) $294.30 $327 3.3×
X-Ray Abdomen,Comp Acute Series - Xr Abdomen 2 Vws With Chest 1 View (74022) $473.40 $526 4.4×
X-Ray Ac Jts - Xr Acromioclavicular Joints Bilateral (73050) $623.70 $693 7.0×
X-Ray Ankle 3+ Vw - Xr Ankle 3+ Views Right (73610) $431.10 $479 4.8×
X-Ray Elbow 2 Vw - Xr Elbow 1-2 Views Right (73070) $282.60 $314 3.2×
X-Ray Elbow 3+ Vw - Xr Elbow 3+ Views Right (73080) $378.90 $421 4.3×
X-ray exam entire spi 4/5 vw (72083) $540 $600 5.1×
X-ray exam hip uni 1 view (73501) $288 $320 3.2×
X-Ray Exam Hip Uni 2-3 Views (73502) $347.40 $386 3.9×
X-ray exam hip uni 4/> views (73503) $432.90 $481 4.1×
X-Ray Exam Hips Bi 3-4 Views (73522) $524.70 $583 4.9×
X-Ray Exam Hips Bi 5/> Views (73523) $540 $600 5.1×
X-ray exam of femur 1 (73551) $265.50 $295 3.0×
X-ray eye for foreign body (70030) $168.30 $187 1.9×
X-Ray Facial Bones 3+ Vw - Xr Facial Bones 3+ Views (70150) $351 $390 3.3×
X-Ray Facial Bones <3 Vw - Xr Facial Bones 1-2 Views (70140) $195.30 $217 2.2×
X-Ray Foot 3+ Vw - Xr Foot 3+ Views Right (73630) $419.40 $466 4.7×
X-Ray Heel - Xr Calcaneus 2 Views Right (73650) $278.10 $309 3.1×
X-Ray Jaw <4 Vw - Xr Mandible < 4 Views (70100) $380.25 $422.50 4.3×
X-Ray Knee 4+ View - Xr Knee 4+ Views Right (73564) $400.50 $445 3.7×
X-Ray Knee Bilat Standing - Xr Knees Anteroposterior Standing Bilat (73565) $176.40 $196 2.0×
X-Ray Leg, Infant - Xr Lower Extremity 2+ Views Infant Left (73592) $247.50 $275 2.8×
X-Ray Lumbar Spine 2/3 Vw - Xr Lumbar Spine 2-3 Views (72100) $401.40 $446 3.8×
X-Ray Lumbar Spine 6+ Vw - Xr Lumbar Spine 6+ Vws Including Bending (72114) $665.10 $739 6.2×
X-Ray Lumbar Spine Flex/Exten - Xr Lumbar Spine 4+ Views W/ Flex Ext (72120) $377.10 $419 3.5×
X-Ray Nasal Bones - Xr Nasal Bones (70160) $387.90 $431 4.4×
X-Ray Nose-Rectum Child F.B. - Xr Nose to Rectum Foreign Body Peds (76010) $279 $310 3.1×
X-Ray Orbits - Xr Orbits Complete 4+ Views (70200) $427.50 $475 4.0×
X-Ray Pelvis 3+ Vw - Xr Pelvis 3+ Views (72190) $375.30 $417 3.5×
X-Ray Renal Cyst Xlumbar+Contrst - Xr Renal Cyst Lumbar W Contrast (74470) $2,079 $2,310 3.7×
X-Ray Retrograde Pyelogram - Fl Pyelogram Retrograde (74420) $1,195.20 $1,328 3.4×
X-Ray Ribs 2 Vw Unilat - Xr Ribs 2 Views Right (71100) $281.70 $313 3.2×
X-Ray Ribs, Chest 3+ Vw - Xr Ribs 2 Vws Lt W/ Chest Anteroposterior (71101) $423.90 $471 4.0×
X-Ray Ribs, Chest 4+ Vw - Xr Ribs 3 Vws Bil W/ Chest Posteroanterior (71111) $612 $680 5.7×
X-Ray Sacroiliac Jts 3+ Vw - Xr Sacroiliac Joints 3+ Views (72202) $344.70 $383 3.2×
X-Ray Sacrum/Coccyx 2+ Vw - Xr Sacrum Coccyx 2+ Views (72220) $387 $430 4.4×
X-Ray Shoulder 2+ Vw - Xr Shoulder 2+ Views Right (73030) $405.90 $451 4.6×
X-Ray Sinuses 3+ Vw - Xr Paranasal Sinuses 3+ Views (70220) $477.90 $531 5.4×
X-Ray Sinuses <3 Vw - Xr Paranasal Sinuses 1-2 Views (70210) $168.30 $187 1.9×
X-Ray Skull 4+ Vw - Xr Skull Complete 4+ Views (70260) $447.30 $497 4.2×
X-Ray Skull <4 Vw - Xr Skull 1-3 Views (70250) $359.10 $399 3.4×
X-Ray Spine One View - Xr Spine (72020) $241.20 $268 2.7×
X-Ray Sterno-Clavicluar Jt - Xr Sternoclavicular Joints 3+ Views (71130) $271.80 $302 3.1×
X-Ray Sternum 2+ Vw - Xr Sternum 2+ Views (71120) $372.60 $414 4.2×
X-Ray Thoracic Spine 2 Vw - Xr Thoracic Spine 2 Views (72070) $392.40 $436 3.7×
X-Ray Thoracic Spine 4 Vw - Xr Thoracic Spine Complete 4+ Views (72074) $641.70 $713 6.0×
X-Ray Toe(S) - Xr Toes 2+ Views Right (73660) $230.40 $256 2.6×
X-Ray Wrist 3+ Vw - Xr Wrist 3+ Views Right (73110) $441.45 $490.50 5.0×
Xr c-spine 6 or more views (72052) $684.90 $761 6.4×
Xr chest 4+ views (71048) $378 $420 3.5×
Xr finger(s) 2+ views (73140) $264.60 $294 3.0×
XR Mastoids < 3 Views Bilateral (70120) $565.20 $628 5.3×
Xr shoulder 1 view (73020) $231.30 $257 2.6×
Xr spine cervical 4 or 5 views (72050) $497.70 $553 4.7×
Xr tibia/fibula 2 views (73590) $342 $380 3.8×
Xr tmj bilateral (70330) $407.70 $453 4.6×
Xray knee 1 or 2 views rt (73560) $381.15 $423.50 4.3×