Imaging prices at Three Rivers Medical Center

Louisa, KY · every code in this section with a posted price and a Medicare benchmark.

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

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ProcedureCash priceGross charge× Medicare
Acute gastrointestinal blood loss imaging (78278) $2,141.54 $3,569.24 5.7×
Ankle 2 views (73600) $455.54 $759.24 5.6×
Antegrade urography radiological supvj & interpj (74425) $1,694.07 $2,823.45 5.2×
Bone &/Joint Imaging Limited Area (78300) $1,800.76 $3,001.26 4.8×
Bone &/joint imaging whole body (78306) $2,417.74 $4,029.57 6.4×
Bone age studies (77072) $144.59 $240.99 1.5×
Bone Imaging 3 Phase (78315) $2,067.49 $3,445.81 5.5×
Bone survey complete (77075) $1,449.10 $2,415.17 14.8×
Brain image w/flow 4 + views (78606) $2,846.97 $4,744.95 5.6×
Brain Imaging Vascular Flow Only (78610) $2,258.76 $3,764.60 4.4×
Cervical spine 2 or 3 views (72040) $545.03 $908.39 6.7×
Chest 1 view (71045) $822.29 $1,370.48 10.1×
Cine/Vid X-Ray Throat/Esoph - Fl Esoph Barium Swlw W/ Video & Speech (74230) $1,787.08 $2,978.46 10.9×
Clavicle complete (73000) $949.52 $1,582.52 11.6×
Computed Tomography Thorax Lw Dose Lng Ca Scr C- (71271) $214.16 $356.93 2.2×
CT abdomen and pelvis without and with contrast (74178) $4,579.71 $7,632.85 14.0×
CT abdomen and pelvis without contrast (74176) $3,201.20 $5,335.34 14.3×
CT abdomen w contrast (74160) $3,605.42 $6,009.04 21.9×
CT abdomen w wo contrast (74170) $4,510.80 $7,518 27.4×
CT abdomen w/o contrast (74150) $3,605.42 $6,009.04 36.8×
CT angiography upper extremity lt (73206) $4,475.60 $7,459.34 27.2×
CT c-spine w/o contrast (72125) $3,599.75 $5,999.58 36.7×
CT chest w/wo contrast (71270) $3,815.13 $6,358.55 23.2×
CT chest with contrast (71260) $3,733.69 $6,222.82 22.7×
CT head/brain with contrast (70460) $1,729.63 $2,882.71 10.5×
CT head/brain without and with contrast (70470) $2,301.79 $3,836.32 14.0×
CT heart no contrast quant eval coronry calcium (75571) $92.48 $154.13 1.1×
CT hrt w/3d image congen (75573) $1,200 $2,000 3.7×
CT iac w contrast (70481) $3,639.43 $6,065.72 22.1×
CT limited/localized follow up study (76380) $1,436.38 $2,393.96 17.6×
CT lower ext w/o (73700) $2,384.86 $3,974.78 24.3×
CT lower extremity w wo contrast (73702) $2,586.97 $4,311.62 15.7×
CT lower extremity with contrast (73701) $2,271.65 $3,786.09 13.8×
CT lumbar spine w/o contrast (72131) $1,524.38 $2,540.64 15.5×
CT lumbar spine with contrast (72132) $3,894.79 $6,491.31 11.9×
CT maxillofacial w contrast (70487) $2,336.09 $3,893.49 14.2×
CT maxillofacial w/o contrast (70486) $2,570.27 $4,283.78 26.2×
CT maxillofacial w/wo contrast (70488) $2,876.64 $4,794.40 17.5×
CT neck soft tissue w contrast (70491) $2,570.27 $4,283.78 15.6×
CT orbit sella/post fossa/ear w/o & w/contr matr (70482) $3,958.33 $6,597.21 24.1×
CT orbits w/o contrast (70480) $2,673.19 $4,455.32 27.3×
CT pelvis w & w/o contrast (72194) $3,816.92 $6,361.53 23.2×
CT pelvis w/o contrast (72192) $3,733.69 $6,222.82 38.1×
CT soft tissue neck w/o & w/contrast material (70492) $2,791.92 $4,653.20 17.0×
CT soft tissue neck w/o contrast (70490) $1,398.50 $2,330.83 14.3×
CT thoracic spine w/contrast (72129) $3,894.79 $6,491.31 23.7×
CT thoracic spine w/o contrast (72128) $2,946.74 $4,911.24 30.0×
CT thorax w/o contrast (71250) $3,050.26 $5,083.76 31.1×
CT upper extremity w/o & w/contrast material (73202) $2,586.97 $4,311.62 15.7×
CT upper extremity w/o contrast rt (73200) $2,498.08 $4,163.46 25.5×
CT upper extremity with contrast (73201) $2,271.65 $3,786.09 6.9×
Cta Abdl Aorta&Bi Iliofem W/Contrast&Postp (75635) $5,001.83 $8,336.38 30.4×
Cta Abdomen (74175) $5,124.14 $8,540.23 31.1×
CTA abdomen pelvis (74174) $5,420.06 $9,033.44 16.6×
CTA chest (71275) $3,733.69 $6,222.82 22.7×
Cta Head (70496) $5,124.14 $8,540.23 31.1×
CTA lwr ext w&w/o contrast (73706) $4,475.60 $7,459.34 27.2×
Cta Neck (70498) $5,124.14 $8,540.23 31.1×
Cta Pelvis (72191) $5,124.14 $8,540.23 31.1×
Cystography minimum 3 views rs&i (74430) $1,550.53 $2,584.21 4.7×
Dxa bone density study 1/> sites axial skel (77080) $854.93 $1,424.89 8.7×
Esophagus (74220) $1,078.85 $1,798.08 6.6×
Fetal Biophysical Profile W/O Non-Stress Testing (76819) $531.35 $885.58 5.4×
Fluoroscopy up to 1 hr (76000) $555.56 $925.94 2.5×
Foot 2 views (73620) $473.79 $789.65 5.8×
Forearm 2 views (73090) $663.84 $1,106.40 8.1×
Gated Heart Planar Single (78472) $4,932 $8,220 13.1×
Hand 2 views (73120) $435.89 $726.48 4.4×
Hand 3 views (73130) $646.12 $1,076.86 7.9×
Heart Infarct Image (78466) $2,712.90 $4,521.50 7.2×
Hepatobil Syst Imag Inc Gb W/Pharma Intervenj (78227) $2,685.88 $4,476.46 5.3×
Hepatobiliary syst imaging including gallbladder (78226) $2,685.88 $4,476.46 7.2×
Ht muscle image spect sing (78451) $1,619.66 $2,699.44 1.3×
Humerus Min 2 Views Left (73060) $646.12 $1,076.86 7.9×
Hysterosalpingogram (74740) $822.29 $1,370.48 3.7×
Joint Survey, Single View - Xr Joint Anteroposterior 2+ Joints (77077) $157.93 $263.21 1.6×
Kidney imaging morphology (78700) $2,550.76 $4,251.26 6.8×
Kidney img morphology vascular flow 1 w/rx (78708) $3,429.56 $5,715.93 6.7×
Knee 3 views (73562) $918.63 $1,531.05 11.3×
Liver & spleen imaging static only (78215) $2,417.74 $4,029.57 6.4×
Liver imaging static only (78201) $3,808.24 $6,347.07 7.5×
Liver imaging w/vascular flow (78202) $4,352.57 $7,254.29 8.5×
Lung Ventilation Imaging (78579) $2,262.97 $3,771.62 6.0×
Lymphoscintigraphy (78195) $2,942.08 $4,903.46 5.8×
Manual appl stress pfrmd phys/qhp joint films (77071) $145.30 $242.16 1.8×
Meckels Diverticulum (78290) $2,364.40 $3,940.66 6.3×
MRA head w/o contrast (70544) $4,239.56 $7,065.94 18.9×
Mra Neck W/O &W/Contrast Material (70549) $6,661.52 $11,102.54 20.3×
MRA neck w/o contrast (70547) $4,239.56 $7,065.94 18.9×
MRI abdomen w contrast (74182) $5,017.99 $8,363.32 15.3×
MRI abdomen w/o & w/contrast material (74183) $6,928.25 $11,547.09 21.2×
MRI abdomen w/o contrast (74181) $4,106.56 $6,844.26 18.3×
MRI any jnt lwr ext with con lt (73722) $4,607.72 $7,679.54 6.3×
MRI any jt upper extremity w/contrast matrl (73222) $4,147.26 $6,912.10 5.6×
MRI c-spine with contrast (72142) $2,993.66 $4,989.44 9.1×
MRI cervical spine w/o contrast (72141) $2,464.43 $4,107.38 11.0×
MRI chest w/o & w/contrast material (71552) $6,928.25 $11,547.09 21.2×
MRI chest w/o contrast (71550) $4,106.56 $6,844.26 18.3×
MRI chest with contrast (71551) $5,017.99 $8,363.32 6.8×
MRI lower extrem oth/thn jt w/contrast matrl (73719) $4,843.91 $8,073.19 14.8×
MRI lower extrem oth/thn jt w/o contr matrl (73718) $4,239.56 $7,065.94 18.9×
MRI orbit face &/neck w/o contrast (70540) $2,724.49 $4,540.81 12.2×
MRI orbit/face/neck w&w/o cont (70543) $6,473.41 $10,789.02 19.8×
MRI pelvis w contrast (72196) $5,017.99 $8,363.32 15.3×
MRI pelvis w/o & w/contrast material (72197) $6,313.03 $10,521.71 19.3×
MRI pelvis w/o contrast (72195) $4,106.56 $6,844.26 18.3×
MRI scan of arm joint before and after contrast (73223) $4,832.51 $8,054.18 14.8×
MRI scan of leg joint before and after contrast (73723) $5,663.40 $9,439 17.3×
MRI spinal canal cervical w/o & w/contr matrl (72156) $3,522.91 $5,871.52 10.8×
MRI spinal canal lumbar w/contrast material (72149) $2,993.66 $4,989.44 9.1×
MRI spinal canal lumbar w/o & w/contr matrl (72158) $3,874.92 $6,458.20 11.8×
MRI spinal canal thoracic w/contrast matrl (72147) $2,993.66 $4,989.44 9.1×
MRI spinal canal thoracic w/o & w/contr matrl (72157) $3,522.91 $5,871.52 10.8×
MRI thoracic spine w/o contrast (72146) $2,464.43 $4,107.38 11.0×
MRI tmj (70336) $3,832.46 $6,387.43 17.1×
MRI upper ext joint w/o contrast (73221) $2,527.07 $4,211.78 11.3×
MRI upper extrem other than jt w/o & w/contras (73220) $5,970.14 $9,950.23 18.2×
MRI upper extremity oth than jt w/o contr matrl (73218) $4,660.01 $7,766.69 20.8×
Myocardial infarct spect (78469) $3,095.80 $5,159.67 6.1×
Myocardial Spect Multiple Studies (78452) $4,199.56 $6,999.26 3.5×
Neck soft tissue (70360) $718.76 $1,197.93 8.8×
Nm gastric emptying study (78264) $1,301.70 $2,169.50 3.5×
Nm gastroesophageal reflux study (78262) $1,435.41 $2,392.35 3.8×
Nm peritoneal-venous shunt patency (78291) $2,806.26 $4,677.10 7.5×
Nuclear medicine of heart muscle at rest with stress (78454) $4,038.47 $6,730.79 3.3×
Nuclear medicine study to assess blood clot in vein of side (78457) $1,629.14 $2,715.24 3.2×
Ob Us Follow-Up Per Fetus - Us Ob Follow Up Transabdominal Approach (76816) $591.02 $985.03 6.0×
Osseous survey infant (77076) $2,829.07 $4,715.12 28.8×
Osseous survey limited (77074) $915.65 $1,526.09 9.3×
Pelvis 1 or 2 views (72170) $718.76 $1,197.93 7.3×
Pr heart first pass single,planar (78481) $3,254.08 $5,423.46 6.4×
Pr MRI, lower extr, w/o contrast f/u by contrast (73720) $6,473.41 $10,789.02 19.8×
Pr red cell survival study (78130) $2,445.12 $4,075.20 6.5×
Pulmonary Perfusion Imaging Particulate (78580) $2,262.97 $3,771.62 6.0×
Radex abscess/fistula/sinus tract rs&i (76080) $783.69 $1,306.15 1.5×
Radex Entir Thrc Lmbr Crv Sac Spi W/Skull 1 Vw - Xr Scoliosis 1 Vw (72081) $603.30 $1,005.50 7.4×
Radex entir thrc lmbr crv sac spi w/skull 2/3 vw (72082) $603.30 $1,005.50 6.2×
Radex hips bilateral with pelvis 2 views (73521) $919.16 $1,531.93 9.4×
Radex mastoids compl minimum 3 views pr side (70130) $821.24 $1,368.73 8.4×
Radex X-Ray Exam Entire Spi 6/> Vw - Xr Entire Spine 6+ Vw (72084) $1,206.59 $2,010.99 12.3×
Radiolog exam mandible compl minimum 4 views (70110) $647.52 $1,079.20 6.6×
Radiologic Exam Abdomen 1 View - Xr Abdomen 1 View (74018) $615.23 $1,025.38 7.5×
Radiologic Exam Abdomen 3+ Views - Xr Abdomen 3+ Views (74021) $964.79 $1,607.98 9.8×
Radiologic Exam Chest 2 Views - Xr Chest 2 Views (71046) $373.42 $622.37 4.6×
Radiologic exam colon single contrast study (74270) $1,138.51 $1,897.51 6.9×
Radiologic exam upr gi trc double contrast study (74246) $1,592.29 $2,653.82 9.7×
Radiologic exam upr gi trc single contrast study (74240) $1,412.60 $2,354.34 8.6×
Radiologic Examination Femur Minimum 2 Views - Xr Femur 2+ Vw Lt (73552) $728.24 $1,213.73 8.9×
Radiological examination surgical specimen (76098) $607.52 $1,012.54 1.2×
Ribs bilateral 3 views (71110) $1,824.98 $3,041.64 18.6×
Rp loclzj tum spect 1 area single day imaging (78803) $2,712.90 $4,521.50 5.3×
Scapula complete (73010) $827.04 $1,378.38 8.4×
Screening digital breast tomosynthesis (77063) $187.20 $312 8.0×
Sella turcica (70240) $362.89 $604.82 4.4×
Small bowel series (74250) $649.62 $1,082.70 3.9×
Speech evaluation complex (70371) $1,787.08 $2,978.46 8.0×
Spine thoracic 3 views (72072) $840.20 $1,400.33 8.6×
Spleen imaging only (78185) $915.65 $1,526.09 2.4×
Therapeutic Enema (74283) $930.04 $1,550.06 5.7×
Thyroid Imaging With Vascular Flow (78013) $1,348.73 $2,247.88 3.6×
Thyroid Uptake W/Blood Flow Sngle/Mult Quan Meas (78014) $2,234.89 $3,724.82 6.0×
Tumor Imaging, Limited Area - Nm Tumor Localization Limited (78800) $1,186.58 $1,977.64 3.2×
Ultrasound, abdomen limited (76705) $1,253.27 $2,088.79 12.8×
Unlisted Diagnostic Radiographic Procedure (76499) $85.64 $142.73 1.0×
Upper Extremity Infant (73092) $247.07 $411.79 2.5×
Ureteral Reflux Study Rp Voiding Cystogram (78740) $1,533.68 $2,556.14 4.1×
Urethrocystography voiding (74455) $1,550.53 $2,584.21 6.9×
Urography (pyelography), intravenous, with or without KUB, with or without tomography (74400) $1,054.62 $1,757.70 6.4×
Us breast unilateral complete (76641) $504.50 $840.84 5.1×
Us breast unilateral limited (76642) $504.50 $840.84 6.2×
Us chest (76604) $1,155 $1,925 11.8×
Us compl joint r-t w/image documentation (76881) $784.74 $1,307.90 8.0×
Us ob detailed single fetus (76811) $412.37 $687.29 1.8×
Us ob transvaginal (76817) $294.10 $490.17 3.0×
Us pelvic non ob complete (76856) $1,186.58 $1,977.64 12.1×
Us pregnancy ltd (76815) $1,344.52 $2,240.86 13.7×
Us pregnant uterus 14 wk transabdl 1/1st gestat (76801) $1,366.27 $2,277.12 13.9×
Us retroperitoneal complete (76770) $1,285.91 $2,143.18 13.1×
Us retroperitoneal limited (76775) $1,056.73 $1,761.22 10.8×
Us scrotum and contents (76870) $644.36 $1,073.94 6.6×
Us soft tissue head/neck (76536) $888.27 $1,480.45 9.1×
Us spinal canal and contents (76800) $713.50 $1,189.17 7.3×
Us xtr non-vasc lmtd (76882) $390.26 $650.44 4.0×
Venography extremity unilateral rs&i (75820) $1,420.68 $2,367.80 1.0×
Wrist 2 views (73100) $655.59 $1,092.65 8.0×
X-Ray Ac Jts - Xr Acromioclavicular Joints Bilateral (73050) $481.16 $801.94 5.9×
X-Ray Ankle 3+ Vw - Xr Ankle 3+ Views Right (73610) $655.59 $1,092.65 8.0×
X-Ray Colon Air Contrast - Fl Barium Enema Air Contrast (74280) $1,281.70 $2,136.16 7.8×
X-Ray Elbow 2 Vw - Xr Elbow 1-2 Views Right (73070) $655.59 $1,092.65 8.0×
X-Ray Elbow 3+ Vw - Xr Elbow 3+ Views Right (73080) $750.18 $1,250.29 9.2×
X-ray exam entire spi 4/5 vw (72083) $1,206.59 $2,010.99 12.3×
X-ray exam hip uni 1 view (73501) $524.33 $873.89 6.4×
X-Ray Exam Hip Uni 2-3 Views (73502) $637.33 $1,062.22 7.8×
X-ray exam hip uni 4/> views (73503) $956.01 $1,593.35 9.7×
X-Ray Exam Hips Bi 3-4 Views (73522) $919.16 $1,531.93 9.4×
X-Ray Exam Hips Bi 5/> Views (73523) $1,837.97 $3,063.28 18.7×
X-Ray Facial Bones 3+ Vw - Xr Facial Bones 3+ Views (70150) $567.15 $945.25 5.8×
X-Ray Facial Bones <3 Vw - Xr Facial Bones 1-2 Views (70140) $288.84 $481.40 3.5×
X-Ray Foot 3+ Vw - Xr Foot 3+ Views Right (73630) $646.12 $1,076.86 7.9×
X-Ray Heel - Xr Calcaneus 2 Views Right (73650) $588.03 $980.05 7.2×
X-ray IV pyelogram+drip infusn (74410) $1,874.81 $3,124.69 11.4×
X-Ray Knee 4+ View - Xr Knee 4+ Views Right (73564) $649.62 $1,082.70 6.6×
X-Ray Leg, Infant - Xr Lower Extremity 2+ Views Infant Left (73592) $247.07 $411.79 3.0×
X-Ray Lumbar Spine 2/3 Vw - Xr Lumbar Spine 2-3 Views (72100) $642.25 $1,070.42 6.5×
X-Ray Lumbar Spine 6+ Vw - Xr Lumbar Spine 6+ Vws Including Bending (72114) $1,065.86 $1,776.43 10.9×
X-Ray Lumbar Spine Flex/Exten - Xr Lumbar Spine 4+ Views W/ Flex Ext (72120) $529.25 $882.08 5.4×
X-Ray Nasal Bones - Xr Nasal Bones (70160) $288.84 $481.40 3.5×
X-Ray Nose-Rectum Child F.B. - Xr Nose to Rectum Foreign Body Peds (76010) $321.23 $535.39 3.9×
X-Ray Orbits - Xr Orbits Complete 4+ Views (70200) $1,196.06 $1,993.44 12.2×
X-Ray Pelvis 3+ Vw - Xr Pelvis 3+ Views (72190) $970.04 $1,616.74 9.9×
X-Ray Retrograde Pyelogram - Fl Pyelogram Retrograde (74420) $1,362.06 $2,270.10 4.2×
X-Ray Ribs 2 Vw Unilat - Xr Ribs 2 Views Right (71100) $904.06 $1,506.77 11.1×
X-Ray Ribs, Chest 3+ Vw - Xr Ribs 2 Vws Lt W/ Chest Anteroposterior (71101) $1,186.58 $1,977.64 12.1×
X-Ray Ribs, Chest 4+ Vw - Xr Ribs 3 Vws Bil W/ Chest Posteroanterior (71111) $1,617.56 $2,695.94 16.5×
X-Ray Sacroiliac Jts 3+ Vw - Xr Sacroiliac Joints 3+ Views (72202) $724.03 $1,206.71 7.4×
X-Ray Sacrum/Coccyx 2+ Vw - Xr Sacrum Coccyx 2+ Views (72220) $662.26 $1,103.76 8.1×
X-Ray Shoulder 2+ Vw - Xr Shoulder 2+ Views Right (73030) $946.36 $1,577.26 11.6×
X-Ray Sinuses 3+ Vw - Xr Paranasal Sinuses 3+ Views (70220) $970.04 $1,616.74 11.9×
X-Ray Sinuses <3 Vw - Xr Paranasal Sinuses 1-2 Views (70210) $157.93 $263.21 1.9×
X-Ray Skull 4+ Vw - Xr Skull Complete 4+ Views (70260) $1,302.76 $2,171.26 13.3×
X-Ray Spine One View - Xr Spine (72020) $516.96 $861.60 6.3×
X-Ray Sterno-Clavicluar Jt - Xr Sternoclavicular Joints 3+ Views (71130) $652.79 $1,087.98 8.0×
X-Ray Sternum 2+ Vw - Xr Sternum 2+ Views (71120) $673.84 $1,123.06 8.3×
X-Ray Toe(S) - Xr Toes 2+ Views Right (73660) $409.56 $682.62 5.0×
X-Ray Wrist 3+ Vw - Xr Wrist 3+ Views Right (73110) $637.16 $1,061.94 7.8×
Xr c-spine 6 or more views (72052) $529.25 $882.08 5.4×
Xr chest 4+ views (71048) $488.53 $814.22 5.0×
Xr finger(s) 2+ views (73140) $491.16 $818.61 6.0×
Xr shoulder 1 view (73020) $219 $365 2.7×
Xr spine cervical 4 or 5 views (72050) $840.20 $1,400.33 8.6×
Xr tibia/fibula 2 views (73590) $681.56 $1,135.92 8.3×
Xr tmj bilateral (70330) $796.33 $1,327.21 9.8×
Xray knee 1 or 2 views rt (73560) $574.52 $957.54 7.0×