Imaging prices at Teton Valley Hospital
Driggs, ID · every code in this section with a posted price and a Medicare benchmark.
215 codes. Prices are the hospital's own posted facility charges.
Compare against other hospitals interactively →
| Procedure | Posted cash | Posted gross | × Medicare |
|---|---|---|---|
| Abdomen 1 View (74018) range across 2 matching MRF lines |
$172.80–$222.40 | $216–$278 | varies |
| Abdomen 2 views (74019) | $280.80 | $351 | 2.7× |
| Ankle 2 views (73600) | $89.60 | $112 | 1.0× |
| Arthrogram hip (73525) | $661.60 | $827 | 1.9× |
| Arthrogram Wrist (73115) | $941.60 | $1,177 | 2.7× |
| Cat Scan Follow-Up Study (76380) | $747.64 | $934.55 | 8.7× |
| Chest 1 view (71045) | $244.80 | $306 | 2.8× |
| Chest 2 views (71046) | $276.80 | $346 | 3.2× |
| Chest 3 views (71047) | $324 | $405 | 3.8× |
| Chest 4 or more views (71048) range across 2 matching MRF lines |
$407.24–$419.20 | $509.05–$524 | varies |
| Cholecystography Oral Contrast (74290) | $173.68 | $217.10 | 1.0× |
| Clavicle complete (73000) | $214.40 | $268 | 2.5× |
| Computed Tomography Thorax Lw Dose Lng Ca Scr C- (71271) | $148.80 | $186 | 1.4× |
| Contrast X-Ray Bladder (74430) | $395.65 | $494.56 | 1.1× |
| Contrast X-Ray Of Elbow (73085) | $864.80 | $1,081 | 2.5× |
| CT abdomen and pelvis without and with contrast (74178) | $2,562.40 | $3,203 | 7.4× |
| CT abdomen and pelvis without contrast (74176) | $1,811.20 | $2,264 | 7.7× |
| CT abdomen w contrast (74160) | $1,512.80 | $1,891 | 8.7× |
| CT abdomen w wo contrast (74170) | $1,863.20 | $2,329 | 10.8× |
| CT abdomen w/o contrast (74150) | $1,151.20 | $1,439 | 11.1× |
| CT Angio Abdomen and Pelvis (74174) | $2,808.80 | $3,511 | 8.1× |
| CT Angio Chest (71275) | $1,996.80 | $2,496 | 11.5× |
| CT Angio Head (70496) | $1,780 | $2,225 | 10.3× |
| Ct Angio Lwr Extr W/O&W/Dye (73706) | $1,808.80 | $2,261 | 10.4× |
| CT Angio Neck (70498) | $1,840 | $2,300 | 10.6× |
| CT cervical spine w/ contrast (72126) | $1,875.20 | $2,344 | 5.4× |
| CT cervical spine w/o contrast (72125) | $1,258.40 | $1,573 | 12.2× |
| CT cervical spine w/wo cont (72127) | $2,060 | $2,575 | 11.9× |
| CT chest w contrast (71260) | $1,545.60 | $1,932 | 8.9× |
| CT chest w/wo contrast (71270) | $1,736 | $2,170 | 10.0× |
| CT head/brain with contrast (70460) | $1,297.60 | $1,622 | 7.5× |
| CT head/brain without and with contrast (70470) | $1,473.60 | $1,842 | 8.5× |
| CT iac w contrast (70481) | $1,400.80 | $1,751 | 8.1× |
| CT l-spine w&w/o contrast (72133) | $1,908 | $2,385 | 11.0× |
| CT lower ext w/o (73700) range across 2 matching MRF lines |
$1,081.60–$1,114.40 | $1,352–$1,393 | varies |
| CT lower extremity w/contrast material (73701) | $1,684 | $2,105 | 9.7× |
| CT lumbar spine w contrast (72132) | $1,795.20 | $2,244 | 5.2× |
| CT lumbar spine w/o contrast (72131) | $1,299.20 | $1,624 | 12.6× |
| CT maxillofacial w contrast (70487) | $1,394.40 | $1,743 | 8.0× |
| CT maxillofacial wo contrast (70486) | $1,060.80 | $1,326 | 10.3× |
| CT neck tissue combo (70492) | $1,401.60 | $1,752 | 8.1× |
| Ct Orbit/Ear/Fossa W/O&W/Dye (70482) | $1,728.92 | $2,161.15 | 10.0× |
| CT orbits w/o contrast (70480) range across 2 matching MRF lines |
$904–$1,145.60 | $1,130–$1,432 | varies |
| CT pelvis w&w/o contrast (72194) | $1,747.20 | $2,184 | 10.1× |
| CT pelvis w/o contrast (72192) | $1,156 | $1,445 | 11.2× |
| CT scan of leg combo (73702) | $1,988.80 | $2,486 | 11.5× |
| CT scans face/jaw combo (70488) | $1,670.40 | $2,088 | 9.6× |
| CT soft tissue neck w contrast (70491) | $1,303.20 | $1,629 | 7.5× |
| CT soft tissue neck w/o contrast (70490) | $1,100.80 | $1,376 | 10.7× |
| CT thoracic spine w contrast (72129) | $1,609.60 | $2,012 | 9.3× |
| CT thoracic spine w/o contrast (72128) | $1,285.60 | $1,607 | 12.4× |
| CT thoracic spine w/wo cont (72130) | $1,969.60 | $2,462 | 11.4× |
| CT thorax w/o contrast (71250) | $1,179.20 | $1,474 | 11.4× |
| CT upper ext wo (73200) | $1,060.80 | $1,326 | 10.3× |
| CT upper extremity w/o & w/contrast material (73202) | $2,019.20 | $2,524 | 11.7× |
| CT upper extremity with contrast (73201) | $1,604 | $2,005 | 4.7× |
| Cta Abdl Aorta&Bi Iliofem W/Contrast&Postp (75635) | $2,001.60 | $2,502 | 11.6× |
| Cta Abdomen (74175) | $1,863.20 | $2,329 | 10.8× |
| Dxa Bone Density Axial (77080) | $387.20 | $484 | 3.7× |
| Dxa bone density study (77085) | $399.84 | $499.80 | 3.9× |
| Dxa bone density study 1/>sites appendiclr skel (77081) | $212.80 | $266 | 2.5× |
| Esophagram (74220) | $461.60 | $577 | 2.7× |
| Fetal Biophys Profile W/Nst (76818) | $298.80 | $373.50 | 2.9× |
| Fetal Biophysical Profile W/O Non-Stress Testing (76819) | $243.96 | $304.95 | 2.4× |
| Fluoroscopy up to 1 hr (76000) | $373.60 | $467 | 1.6× |
| Foot 2 views (73620) | $89.60 | $112 | 1.0× |
| Forearm 2 views (73090) | $243.20 | $304 | 2.8× |
| Hand 2 views (73120) | $160 | $200 | 1.5× |
| Hysterosalpingogram (74740) | $539.20 | $674 | 2.3× |
| Joint Survey Single View (77077) | $118.20 | $147.75 | 1.1× |
| Knee 3 Views (73562) | $192 | $240 | 2.2× |
| Magnetic Image Jaw Joint (70336) | $1,696.80 | $2,121 | 7.2× |
| Mammary ductogram or galactogram single (77053) range across 2 matching MRF lines |
$347.72–$358.40 | $434.65–$448 | varies |
| Mra Head W/O & W/Contrast Material (70546) | $2,338.40 | $2,923 | 6.8× |
| MRA head w/o contrast (70544) | $1,384.80 | $1,731 | 5.9× |
| MRA head with contrast (70545) | $1,844 | $2,305 | 5.4× |
| MRA neck w contrast (70548) | $1,928 | $2,410 | 5.6× |
| Mra Neck W/O &W/Contrast Material (70549) | $2,312 | $2,890 | 6.7× |
| MRA neck w/o contrast (70547) | $1,816 | $2,270 | 7.7× |
| MRI abdomen w contrast (74182) | $1,973.60 | $2,467 | 5.7× |
| MRI abdomen w/o contrast (74181) | $1,987.20 | $2,484 | 8.4× |
| MRI any jt lower extrem w/contrast material (73722) range across 2 matching MRF lines |
$1,885.60–$2,535.20 | $2,357–$3,169 | varies |
| MRI any jt lower extrem w/o & w/contrast matrl (73723) | $1,828 | $2,285 | 5.3× |
| MRI any jt upper extremity w/contrast matrl (73222) | $2,000 | $2,500 | 2.6× |
| MRI cervical spine w contrast (72142) | $1,936 | $2,420 | 5.6× |
| MRI cervical spine w/o cont (72141) | $1,426.40 | $1,783 | 6.1× |
| MRI chest w/o contrast (71550) | $1,890.40 | $2,363 | 8.0× |
| MRI chest with contrast (71551) | $1,964.80 | $2,456 | 2.5× |
| MRI chest wo w contrast (71552) | $2,964 | $3,705 | 8.6× |
| MRI lower extrem oth/thn jt w/contrast matrl (73719) | $1,717.60 | $2,147 | 5.0× |
| MRI lower extrem oth/thn jt w/o & w/contr matr (73720) | $1,877.60 | $2,347 | 5.4× |
| MRI lower extrem oth/thn jt w/o contr matrl (73718) | $1,390.40 | $1,738 | 5.9× |
| MRI lumbar spine w contrast (72149) | $1,563.20 | $1,954 | 4.5× |
| Mri Neck Spine W/O & W/Dye (72156) | $2,051.20 | $2,564 | 6.0× |
| MRI orbit face &/neck w/o contrast (70540) | $1,700.80 | $2,126 | 7.2× |
| MRI orbit face neck w contrast (70542) | $1,628 | $2,035 | 4.7× |
| Mri Orbt/Fac/Nck W/O &W/Dye (70543) | $1,946.40 | $2,433 | 5.6× |
| MRI pelvis w contrast (72196) | $1,999.20 | $2,499 | 5.8× |
| MRI pelvis w/o & w contrast (72197) | $2,116.80 | $2,646 | 6.1× |
| MRI pelvis w/o contrast (72195) | $1,603.20 | $2,004 | 6.8× |
| MRI thoracic spine w/o contrast (72146) | $1,403.20 | $1,754 | 6.0× |
| MRI upper extremity oth than jt w/contr matrl (73219) | $2,026.40 | $2,533 | 5.9× |
| MRI upper extremity oth than jt w/o contr matrl (73218) | $1,391.20 | $1,739 | 5.9× |
| Mri Uppr Extremity W/O&W/Dye (73220) | $1,872 | $2,340 | 5.4× |
| MRI, abdomen, combo (74183) | $2,090.40 | $2,613 | 6.1× |
| MRI, dorsal spine combo (72157) | $1,979.20 | $2,474 | 5.7× |
| MRI, dorsal spine contrast (72147) | $1,839.20 | $2,299 | 5.3× |
| MRI, joint upper extrem (73221) | $1,362.40 | $1,703 | 5.8× |
| MRI, joint upper extrem combo (73223) | $1,882.40 | $2,353 | 5.5× |
| MRI, lumbar spine combo (72158) | $2,013.60 | $2,517 | 5.8× |
| Myelogram Lumbar (72265) | $1,359.02 | $1,698.77 | 1.8× |
| Neck soft tissue (70360) | $276.80 | $346 | 3.2× |
| Nonvascular Shunt X-Ray (75809) range across 2 matching MRF lines |
$68–$124.80 | $85–$156 | varies |
| Ob us nuchal meas 1 gest (76813) | $277.40 | $346.75 | 2.7× |
| Pelvis 1 or 2 views (72170) | $276.80 | $346 | 2.7× |
| Radex Abd Compl Aqt Abd W/S/E/D Views 1 View Ch (74022) | $352.80 | $441 | 3.4× |
| Radex abscess/fistula/sinus tract rs&i (76080) | $424.84 | $531.05 | 0.8× |
| Radex Ankle Complete Minimum 3 Views (73610) | $219.20 | $274 | 2.5× |
| Radex Calcaneus Minimum 2 Views (73650) | $168.80 | $211 | 2.0× |
| Radex elbow complete minimum 3 views (73080) | $269.60 | $337 | 3.1× |
| Radex Facial Bones Complete Minimum 3 Views (70150) | $243.20 | $304 | 2.4× |
| Radex fingr minimum 2 views (73140) | $165.60 | $207 | 1.9× |
| Radex foot complete minimum 3 views (73630) | $190.40 | $238 | 2.2× |
| Radex Hand Minimum 3 Views (73130) range across 2 matching MRF lines |
$264.80–$396.80 | $331–$496 | varies |
| Radex lower extremity infant minimum 2 views (73592) | $153.60 | $192 | 1.8× |
| Radex Nasal Bones Complete Minimum 3 Views (70160) | $140.80 | $176 | 1.6× |
| Radex Ribs Unilateral 2 Views (71100) | $249.60 | $312 | 2.9× |
| Radex shoulder complete minimum 2 views (73030) | $219.20 | $274 | 2.5× |
| Radex Sinuses Paransl < 3 Views (70210) | $108 | $135 | 1.3× |
| Radex Spine 1 View Specify Level (72020) | $276.80 | $346 | 3.2× |
| Radex Sternum Minimum 2 Views (71120) | $218.40 | $273 | 2.5× |
| Radex Temporomandble Jt Opn & Clsd Mouth Bilat (70330) | $291.20 | $364 | 3.4× |
| Radex Toe Minimum 2 Views (73660) | $196 | $245 | 2.3× |
| Radex upper extremity infant minimum 2 views (73092) | $93.60 | $117 | 0.9× |
| Radex Wrist Complete Minimum 3 Views (73110) | $250.40 | $313 | 2.9× |
| Radiolog exam mandible compl minimum 4 views (70110) | $282.40 | $353 | 2.7× |
| Radiologic exam colon double contrast study (74280) | $602.18 | $752.73 | 3.5× |
| Radiologic exam colon single contrast study (74270) | $332.62 | $415.78 | 1.9× |
| Radiologic exam knee complete 4/more views (73564) | $219.20 | $274 | 2.1× |
| Radiologic exam pelvis compl minimum 3 views (72190) | $329.60 | $412 | 3.2× |
| Radiologic Exam Small Int Single Contrast Study (74250) | $428.80 | $536 | 2.5× |
| Radiologic exam swallow function contrast study (74230) | $483.20 | $604 | 2.8× |
| Radiologic exam upr gi trc double contrast study (74246) | $500.80 | $626 | 2.9× |
| Radiologic examination femur 1 view (73551) | $251.20 | $314 | 2.9× |
| Radiologic examination femur minimum 2 views (73552) | $252.80 | $316 | 2.9× |
| Radiologic examination knee 1/2 views (73560) | $168.80 | $211 | 2.0× |
| Radiologic Examination Osseous Survey Limited (77074) | $278.40 | $348 | 2.7× |
| Radiologic examination tibia & fibula 2 views (73590) | $252.80 | $316 | 2.9× |
| Ribs bilateral 3 views (71110) | $347.20 | $434 | 3.4× |
| Scapula (73010) | $228.80 | $286 | 2.2× |
| Sella turcica (70240) | $109.76 | $137.20 | 1.3× |
| Shoulder 1 view (73020) range across 2 matching MRF lines |
$194.40–$196 | $243–$245 | varies |
| Shoulder Arthrography (73040) | $996.80 | $1,246 | 2.9× |
| Skull less than 4 views (70250) | $278.40 | $348 | 2.7× |
| Speech evaluation, complex (70371) | $393.96 | $492.45 | 1.7× |
| Sternoclavicular joints (71130) | $225.60 | $282 | 2.6× |
| Therapeutic Enema Rdctj Intussusception/Obstrcj (74283) | $225.12 | $281.40 | 1.3× |
| Thoracic spine 2 views (72070) | $309.60 | $387 | 3.0× |
| Thoracic spine 3 views (72072) | $335.20 | $419 | 3.2× |
| Ultrasound Breast Limited (76642) range across 3 matching MRF lines |
$272–$544 | $340–$680 | varies |
| Ultrasound Exam Aaa Screen (76706) | $418.40 | $523 | 4.1× |
| Ultrasound, abdomen limited (76705) | $486.40 | $608 | 4.7× |
| Unlisted Dx Radiographic Procedure (76499) range across 2 matching MRF lines |
$119.20–$196 | $149–$245 | varies |
| Upper gi w/o kub (74240) range across 2 matching MRF lines |
$413.60–$516 | $517–$645 | varies |
| Urethrocystogram voiding (74455) | $447.24 | $559.05 | 1.9× |
| Urethrocystography retrograde (74450) | $474.28 | $592.85 | 2.0× |
| Us bone density measurement (76977) | $180 | $225 | 1.7× |
| Us breast unilateral complete (76641) range across 2 matching MRF lines |
$342.40–$665.60 | $428–$832 | varies |
| Us complete joint (76881) range across 2 matching MRF lines |
$443.20–$445.60 | $554–$557 | varies |
| Us exam, pelvic, limited (76857) | $375.20 | $469 | 3.6× |
| Us lmtd joint/oth nonvasc xtr strux r-t w/img (76882) | $388 | $485 | 3.8× |
| Us ob detailed single fetus (76811) | $672.80 | $841 | 2.9× |
| Us ob limited 1 or more fetuses (76815) | $204.80 | $256 | 2.0× |
| Us ob transvaginal (76817) | $428.80 | $536 | 4.2× |
| Us pelvic non ob complete (76856) | $604 | $755 | 5.8× |
| Us pg uter img f&mat 14 wk tabdl 1/1st gestation (76801) range across 2 matching MRF lines |
$463.20–$626.40 | $579–$783 | varies |
| Us preg uterus real time f/u trnsabdl per fetus (76816) | $193.60 | $242 | 1.9× |
| Us retroperitoneal complete (76770) | $544.80 | $681 | 5.3× |
| Us scrotum and contents (76870) | $476.80 | $596 | 4.6× |
| Us thyroid (76536) | $495.20 | $619 | 4.8× |
| Vertebral fracture assessment via dxa (77086) | $196 | $245 | 2.3× |
| Wrist 2 views (73100) | $176.80 | $221 | 2.1× |
| X-Ray Ac Jts - Xr Acromioclavicular Joints Bilateral (73050) | $197.60 | $247 | 2.3× |
| X-Ray Bend Only L-S Spine (72120) | $368.80 | $461 | 3.6× |
| X-Ray Elbow 2 Vw - Xr Elbow 1-2 Views Right (73070) | $211.20 | $264 | 2.5× |
| X-Ray Exam Entire Spi 1 Vw (72081) | $288 | $360 | 3.3× |
| X-Ray Exam Entire Spi 2/3 Vw (72082) | $338.40 | $423 | 3.3× |
| X-Ray Exam Entire Spi 4/5 Vw (72083) | $412 | $515 | 4.0× |
| X-Ray Exam Hip Uni 1 View (73501) | $196.80 | $246 | 2.3× |
| X-Ray Exam Hip Uni 2-3 Views (73502) | $204.80 | $256 | 2.4× |
| X-Ray Exam Hips Bi 2 Views (73521) | $226.40 | $283 | 2.2× |
| X-Ray Exam L-S Spine Bending (72114) | $340 | $425 | 3.3× |
| X-Ray Exam Neck Spine 2-3 Vw (72040) | $270.40 | $338 | 3.1× |
| X-Ray Exam Neck Spine 6/>Vws (72052) | $474.40 | $593 | 4.6× |
| X-Ray Exam Unilat Ribs/Chest (71101) | $293.60 | $367 | 2.8× |
| X-ray eye for foreign body (70030) | $95.20 | $119 | 1.1× |
| X-ray humerus (73060) | $249.60 | $312 | 2.9× |
| X-ray IV pyelogram (ivp) (74400) | $715.88 | $894.85 | 4.1× |
| X-Ray Jaw <4 Vw - Xr Mandible < 4 Views (70100) | $199.14 | $248.92 | 2.3× |
| X-Ray Knee Bilat Standing - Xr Knees Anteroposterior Standing Bilat (73565) | $140.80 | $176 | 1.6× |
| X-Ray Lumbar Spine 2/3 Vw - Xr Lumbar Spine 2-3 Views (72100) | $301.60 | $377 | 2.9× |
| X-ray nose-rectum child f.b. (76010) | $147.20 | $184 | 1.7× |
| X-Ray Ribs, Chest 4+ Vw - Xr Ribs 3 Vws Bil W/ Chest Posteroanterior (71111) | $460 | $575 | 4.5× |
| X-Ray Sacroiliac Jts 3+ Vw - Xr Sacroiliac Joints 3+ Views (72202) | $168.80 | $211 | 1.6× |
| X-Ray Sacrum/Coccyx 2+ Vw - Xr Sacrum Coccyx 2+ Views (72220) | $294.40 | $368 | 3.4× |
| X-Ray Sinuses 3+ Vw - Xr Paranasal Sinuses 3+ Views (70220) | $311.20 | $389 | 3.6× |
| X-Ray Skull 4+ Vw - Xr Skull Complete 4+ Views (70260) | $476 | $595 | 4.6× |
| X-ray thoracic spine 4 vw (72074) | $374.40 | $468 | 3.6× |
| X-Ray Tmj Unilat (70328) | $163.60 | $204.50 | 1.9× |
| X-Ray Urinary Tract Exam With Contrast Material (74420) | $592.70 | $740.87 | 1.7× |
| X-Rays Bone Length Studies (77073) range across 2 matching MRF lines |
$248–$426.40 | $310–$533 | varies |
| X-Rays Bone Survey Complete (77075) | $396 | $495 | 3.8× |
| Xr c-spine 4 or 5 views (72050) | $380 | $475 | 3.7× |
| Xr facial bones less than 3 views (70140) | $93.72 | $117.15 | 1.1× |
| Xr orbits complete 4 views (70200) | $240.80 | $301 | 2.3× |
A range means this hospital published different amounts on matching machine-readable-file lines. We show the lowest–highest posted amount because we cannot tell from the published file which line would apply to a particular visit.