Imaging prices at UT Health East Texas Jacksonville Hospital

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

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

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ProcedureCash priceGross charge× Medicare
Abdomen 2 views (74019) $82.40 $824 0.8×
Acute gastrointestinal blood loss imaging (78278) $318.60 $3,186 0.8×
Ankle 2 views (73600) $82.40 $824 0.9×
Antegrade urography radiological supvj & interpj (74425) $127.70 $1,277 0.4×
Arthrogram shoulder (73040) $145.90 $1,459 0.4×
Bone &/joint imaging whole body (78306) $348.80 $3,488 0.9×
Bone age studies (77072) $82.40 $824 0.8×
Bone Imaging 3 Phase (78315) $383.70 $3,837 1.0×
Bone survey complete (77075) $175.50 $1,755 1.7×
Cervical spine 2 or 3 views (72040) $82.40 $824 0.9×
Chest 1 view (71045) $72.20 $722 0.8×
Chest 3 views (71047) $63.10 $631 0.7×
Cine/Vid X-Ray Throat/Esoph - Fl Esoph Barium Swlw W/ Video & Speech (74230) $135.60 $1,356 0.8×
Clavicle complete (73000) $82.40 $824 0.9×
Computed Tomography Thorax Lw Dose Lng Ca Scr C- (71271) $170.90 $1,709 1.6×
CT abdomen and pelvis without and with contrast (74178) $1,285.90 $12,859 3.7×
CT abdomen and pelvis without contrast (74176) $867.90 $8,679 3.6×
CT abdomen w contrast (74160) $755.90 $7,559 4.3×
CT abdomen w wo contrast (74170) $857.20 $8,572 4.9×
CT abdomen w/o contrast (74150) $578.70 $5,787 5.5×
CT angiography upper extremity lt (73206) $512.80 $5,128 2.9×
CT c-spine w/o contrast (72125) $562.10 $5,621 5.4×
CT cere prfuj alys c+ w/o CT/CTA same anatomy (70473) $57 $570 0.3×
CT cervical spine w&w/o contrast (72127) $691.40 $6,914 3.9×
CT cervical spine with contrast (72126) $618.30 $6,183 1.8×
CT chest w/wo contrast (71270) $857.20 $8,572 4.9×
CT chest with contrast (71260) $755.90 $7,559 4.3×
CT head/brain with contrast (70460) $734.10 $7,341 4.2×
CT head/brain without and with contrast (70470) $832.50 $8,325 4.7×
CT heart no contrast quant eval coronry calcium (75571) $29.50 $295 0.3×
CT iac w contrast (70481) $618.30 $6,183 3.5×
CT lower ext w/o (73700) $723.38 $7,233.75 6.9×
CT lower extremity w wo contrast (73702) $857.20 $8,572 4.9×
CT lower extremity with contrast (73701) $755.90 $7,559 4.3×
CT lumbar spine w & w/o contrast (72133) $691.40 $6,914 3.9×
CT lumbar spine w/o contrast (72131) $578.70 $5,787 5.5×
CT lumbar spine with contrast (72132) $636.60 $6,366 1.8×
CT maxillofacial w contrast (70487) $734.10 $7,341 4.2×
CT maxillofacial w/o contrast (70486) $562.10 $5,621 5.4×
CT maxillofacial w/wo contrast (70488) $832.50 $8,325 4.7×
CT neck soft tissue w contrast (70491) $734.10 $7,341 4.2×
CT orbit sella/post fossa/ear w/o & w/contr matr (70482) $832.50 $8,325 4.7×
CT orbits w/o contrast (70480) $562.10 $5,621 5.4×
CT pelvis w & w/o contrast (72194) $857.20 $8,572 4.9×
CT pelvis w/o contrast (72192) $578.70 $5,787 5.5×
CT soft tissue neck w/o & w/contrast material (70492) $832.50 $8,325 4.7×
CT soft tissue neck w/o contrast (70490) $562.10 $5,621 5.4×
CT thoracic spine w/contrast (72129) $66.60 $666 0.4×
CT thoracic spine w/o contrast (72128) $578.70 $5,787 5.5×
CT thoracic spine w/wo contrast (72130) $857.20 $8,572 4.9×
CT thorax w/o contrast (71250) $578.70 $5,787 5.5×
CT upper extremity w/o & w/contrast material (73202) $857.20 $8,572 4.9×
CT upper extremity w/o contrast rt (73200) $723.38 $7,233.75 6.9×
CT upper extremity with contrast (73201) $755.90 $7,559 2.2×
Cta Abdl Aorta&Bi Iliofem W/Contrast&Postp (75635) $654.70 $6,547 3.7×
Cta Abdomen (74175) $570.10 $5,701 3.2×
CTA abdomen pelvis (74174) $909.30 $9,093 2.6×
CTA chest (71275) $585.20 $5,852 3.3×
Cta Head (70496) $525.90 $5,259 3.0×
CTA head&neck c+ w/noncontrast img&post-pxessing (70471) $907 $9,070 2.6×
CTA lwr ext w&w/o contrast (73706) $684.12 $6,841.25 3.9×
Cta Neck (70498) $511.50 $5,115 2.9×
Cta Pelvis (72191) $559.70 $5,597 3.2×
Cystography minimum 3 views rs&i (74430) $221.80 $2,218 0.6×
Dxa bone density study 1/> sites axial skel (77080) $72.50 $725 0.7×
Dxa bone density study 1/>sites appendiclr skel (77081) $72.50 $725 0.8×
Dxa bone density study axial skeleton (77085) $40.70 $407 0.4×
Echo exam of fetal heart (76825) $180 $1,800 0.3×
Echo fetal cardiovasc w/wo m-mode repeat std (76826) $85.80 $858 0.4×
Echoencephalography real time imaging (76506) $120.50 $1,205 1.1×
Esophagus (74220) $66.60 $666 0.4×
Fetal biophysical profile non-stress testing (76818) $167.60 $1,676 1.6×
Fetal Biophysical Profile W/O Non-Stress Testing (76819) $126.10 $1,261 1.2×
Fluoroscopy up to 1 hr (76000) $121.20 $1,212 0.5×
Foot 2 views (73620) $82.40 $824 0.9×
Forearm 2 views (73090) $103 $1,030 1.2×
Hand 2 views (73120) $103 $1,030 1.0×
Hand 3 views (73130) $114 $1,140 1.3×
Hepatobil Syst Imag Inc Gb W/Pharma Intervenj (78227) $404.40 $4,044 0.7×
Hepatobiliary syst imaging including gallbladder (78226) $268 $2,680 0.7×
Ht muscle image spect sing (78451) $501.80 $5,018 0.4×
Humerus Min 2 Views Left (73060) $103 $1,030 1.2×
Hysterosalpingogram (74740) $348.50 $3,485 1.5×
Kidney img morphology vascular flow 1 w/rx (78708) $170 $1,700 0.3×
Knee 3 views (73562) $114 $1,140 1.3×
Liver & spleen imaging static only (78215) $139.20 $1,392 0.3×
MRA head w & w/o contrast (70546) $1,018.10 $10,181 2.9×
MRA head w/o contrast (70544) $752.60 $7,526 3.1×
MRA head with contrast (70545) $441.50 $4,415 1.3×
MRA neck w contrast (70548) $895.60 $8,956 2.6×
Mra Neck W/O &W/Contrast Material (70549) $348.10 $3,481 1.0×
MRA neck w/o contrast (70547) $752.60 $7,526 3.1×
MRI abdomen w contrast (74182) $137.30 $1,373 0.4×
MRI abdomen w/o & w/contrast material (74183) $1,057.50 $10,575 3.0×
MRI abdomen w/o contrast (74181) $781.80 $7,818 3.3×
MRI any jnt lwr ext with con lt (73722) $461.60 $4,616 0.6×
MRI any jt upper extremity w/contrast matrl (73222) $480.80 $4,808 0.6×
MRI c-spine with contrast (72142) $137.30 $1,373 0.4×
MRI cervical spine w/o contrast (72141) $752.60 $7,526 3.1×
MRI chest w/o & w/contrast material (71552) $1,018.10 $10,181 2.9×
MRI chest w/o contrast (71550) $781.80 $7,818 3.3×
MRI chest with contrast (71551) $266.40 $2,664 0.3×
MRI fetal sngl/1st gestation (74712) $85.80 $858 0.4×
MRI Forearm w/ Contrast Bilateral 73219 (73219) $859.90 $8,599 2.5×
MRI lower extrem oth/thn jt w/contrast matrl (73719) $501.60 $5,016 1.4×
MRI lower extrem oth/thn jt w/o contr matrl (73718) $781.80 $7,818 3.3×
MRI orbit face &/neck w/o contrast (70540) $752.60 $7,526 3.1×
MRI orbit/face/neck w&w/o cont (70543) $1,018.10 $10,181 2.9×
MRI orbit/face/neck w/contrast (70542) $480.20 $4,802 1.4×
MRI pelvis w contrast (72196) $859.90 $8,599 2.5×
MRI pelvis w/o & w/contrast material (72197) $1,057.50 $10,575 3.0×
MRI pelvis w/o contrast (72195) $781.80 $7,818 3.3×
MRI scan of arm joint before and after contrast (73223) $1,057.50 $10,575 3.0×
MRI scan of leg joint before and after contrast (73723) $1,057.50 $10,575 3.0×
MRI spinal canal cervical w/o & w/contr matrl (72156) $1,018.10 $10,181 2.9×
MRI spinal canal lumbar w/contrast material (72149) $930.20 $9,302 2.7×
MRI spinal canal lumbar w/o & w/contr matrl (72158) $1,057.50 $10,575 3.0×
MRI spinal canal thoracic w/contrast matrl (72147) $137.30 $1,373 0.4×
MRI spinal canal thoracic w/o & w/contr matrl (72157) $1,057.50 $10,575 3.0×
MRI thoracic spine w/o contrast (72146) $781.80 $7,818 3.3×
MRI tmj (70336) $85.80 $858 0.4×
MRI upper ext joint w/o contrast (73221) $977.25 $9,772.50 4.1×
MRI upper extrem other than jt w/o & w/contras (73220) $1,018.10 $10,181 2.9×
MRI upper extremity oth than jt w/o contr matrl (73218) $781.80 $7,818 3.3×
Myocardial Spect Multiple Studies (78452) $821 $8,210 0.6×
Neck soft tissue (70360) $73.70 $737 0.8×
Nm gastric emptying study (78264) $254.90 $2,549 0.6×
Nuclear Rx Oral Admin (79005) $147.30 $1,473 0.6×
Ob Us Follow-Up Per Fetus - Us Ob Follow Up Transabdominal Approach (76816) $111.10 $1,111 1.1×
Osseous survey infant (77076) $78.10 $781 0.7×
Osseous survey limited (77074) $127.70 $1,277 1.2×
Parathyrd planar w/wo subtrj (78071) $194.70 $1,947 0.5×
Pelvis 1 or 2 views (72170) $82.40 $824 0.8×
Pr MRI, lower extr, w/o contrast f/u by contrast (73720) $1,057.50 $10,575 3.0×
Pulmonary Perfusion Imaging Particulate (78580) $335.90 $3,359 0.8×
Pulmonary Ventilation & Perfusion Imaging (78582) $455.40 $4,554 0.8×
Radex abscess/fistula/sinus tract rs&i (76080) $167.60 $1,676 0.3×
Radex Entir Thrc Lmbr Crv Sac Spi W/Skull 1 Vw - Xr Scoliosis 1 Vw (72081) $66.50 $665 0.8×
Radex entir thrc lmbr crv sac spi w/skull 2/3 vw (72082) $223.40 $2,234 2.1×
Radex hips bilateral with pelvis 2 views (73521) $86 $860 0.8×
Radiolog exam mandible compl minimum 4 views (70110) $91.60 $916 0.9×
Radiologic Exam Abdomen 1 View - Xr Abdomen 1 View (74018) $72.20 $722 0.8×
Radiologic Exam Abdomen 3+ Views - Xr Abdomen 3+ Views (74021) $40.70 $407 0.4×
Radiologic Exam Chest 2 Views - Xr Chest 2 Views (71046) $82.40 $824 0.9×
Radiologic exam colon single contrast study (74270) $129.90 $1,299 0.7×
Radiologic exam upr gi trc double contrast study (74246) $78.50 $785 0.4×
Radiologic exam upr gi trc single contrast study (74240) $237 $2,370 1.3×
Radiologic Examination Femur Minimum 2 Views - Xr Femur 2+ Vw Lt (73552) $113.38 $1,133.75 1.3×
Radiological examination surgical specimen (76098) $165.30 $1,653 0.3×
Ribs bilateral 3 views (71110) $40.70 $407 0.4×
Rp loclzj tum plnr whole body single day imaging (78802) $487.10 $4,871 0.9×
Sacroiliac Joints < 3 Views (72200) $82.40 $824 0.8×
Scanogram (77073) $62.90 $629 0.6×
Scapula complete (73010) $82.40 $824 0.8×
Screening digital breast tomosynthesis (77063) $18.20 $182 0.8×
Shuntogram indwelling nonvascular shunt rs&i (75809) $38.40 $384 0.4×
Small bowel series (74250) $175.20 $1,752 1.0×
Speech evaluation complex (70371) $85.80 $858 0.4×
Spine thoracic 3 views (72072) $89.90 $899 0.9×
Therapeutic Enema (74283) $234 $2,340 1.3×
Thoracolumbar 2 views (72080) $82.40 $824 0.9×
Thyroid Uptake W/Blood Flow Sngle/Mult Quan Meas (78014) $275.80 $2,758 0.7×
Tmj unilateral (70328) $63.10 $631 0.7×
Ultrasound, abdomen limited (76705) $146.10 $1,461 1.4×
Umbilical-artery Doppler (OB) (76820) $67.70 $677 0.6×
Unlisted Diagnostic Radiographic Procedure (76499) $98.80 $988 1.1×
Upper Extremity Infant (73092) $91.20 $912 0.9×
Urethrocystography retrograde rs&i (74450) $90.40 $904 0.4×
Urethrocystography voiding (74455) $221.50 $2,215 0.9×
Urography (pyelography), intravenous, with or without KUB, with or without tomography (74400) $368.70 $3,687 2.1×
Us abdl aorta screen aaa (76706) $97.80 $978 0.9×
Us breast unilateral complete (76641) $128.12 $1,281.25 1.2×
Us breast unilateral limited (76642) $93.10 $931 1.1×
Us chest (76604) $95.50 $955 0.9×
Us compl joint r-t w/image documentation (76881) $42.80 $428 0.4×
Us elastography parenchyma (76981) $40.70 $407 0.4×
Us guided compression repair (76936) $98.60 $986 0.5×
Us kidney transplant (76776) $169.40 $1,694 1.6×
Us ob detailed single fetus (76811) $79.40 $794 0.3×
Us ob transvaginal (76817) $187.70 $1,877 1.8×
Us pelvic non ob complete (76856) $241.30 $2,413 2.3×
Us pelvic nonobstetric image dcmtn limited/f/u (76857) $100.80 $1,008 1.0×
Us pregnancy ltd (76815) $77.10 $771 0.7×
Us pregnant uterus 14 wk transabdl 1/1st gestat (76801) $167.40 $1,674 1.6×
Us retroperitoneal complete (76770) $145.20 $1,452 1.4×
Us retroperitoneal limited (76775) $229.10 $2,291 2.2×
Us scrotum and contents (76870) $138 $1,380 1.3×
Us soft tissue head/neck (76536) $174.70 $1,747 1.7×
Us spinal canal and contents (76800) $85.60 $856 0.8×
Us xtr non-vasc lmtd (76882) $40.70 $407 0.4×
Vascular flow imaging (78445) $92.30 $923 0.2×
Wrist 2 views (73100) $82.40 $824 0.9×
X-Ray Abdomen,Comp Acute Series - Xr Abdomen 2 Vws With Chest 1 View (74022) $136.20 $1,362 1.3×
X-Ray Ac Jts - Xr Acromioclavicular Joints Bilateral (73050) $91.20 $912 1.0×
X-Ray Ankle 3+ Vw - Xr Ankle 3+ Views Right (73610) $114 $1,140 1.3×
X-Ray Colon Air Contrast - Fl Barium Enema Air Contrast (74280) $152.10 $1,521 0.9×
X-Ray Elbow 2 Vw - Xr Elbow 1-2 Views Right (73070) $103 $1,030 1.2×
X-Ray Elbow 3+ Vw - Xr Elbow 3+ Views Right (73080) $91.20 $912 1.0×
X-ray exam entire spi 4/5 vw (72083) $193.10 $1,931 1.8×
X-ray exam hip uni 1 view (73501) $72.20 $722 0.8×
X-Ray Exam Hip Uni 2-3 Views (73502) $82.40 $824 0.9×
X-ray exam hip uni 4/> views (73503) $46.10 $461 0.4×
X-Ray Exam Hips Bi 3-4 Views (73522) $111.70 $1,117 1.1×
X-Ray Exam Hips Bi 5/> Views (73523) $127.70 $1,277 1.2×
X-ray exam of femur 1 (73551) $82.40 $824 0.9×
X-ray eye for foreign body (70030) $30.40 $304 0.3×
X-Ray Facial Bones 3+ Vw - Xr Facial Bones 3+ Views (70150) $91.20 $912 0.9×
X-Ray Facial Bones <3 Vw - Xr Facial Bones 1-2 Views (70140) $82.40 $824 0.9×
X-Ray Foot 3+ Vw - Xr Foot 3+ Views Right (73630) $114 $1,140 1.3×
X-Ray Heel - Xr Calcaneus 2 Views Right (73650) $103 $1,030 1.2×
X-Ray Jaw <4 Vw - Xr Mandible < 4 Views (70100) $29.30 $293 0.3×
X-Ray Knee 4+ View - Xr Knee 4+ Views Right (73564) $125.25 $1,252.50 1.2×
X-Ray Knee Bilat Standing - Xr Knees Anteroposterior Standing Bilat (73565) $91.30 $913 1.0×
X-Ray Leg, Infant - Xr Lower Extremity 2+ Views Infant Left (73592) $114 $1,140 1.3×
X-Ray Lumbar Spine 2/3 Vw - Xr Lumbar Spine 2-3 Views (72100) $82.40 $824 0.8×
X-Ray Lumbar Spine 6+ Vw - Xr Lumbar Spine 6+ Vws Including Bending (72114) $265.40 $2,654 2.5×
X-Ray Lumbar Spine Flex/Exten - Xr Lumbar Spine 4+ Views W/ Flex Ext (72120) $94.60 $946 0.9×
X-Ray Nasal Bones - Xr Nasal Bones (70160) $91.60 $916 1.0×
X-Ray Nose-Rectum Child F.B. - Xr Nose to Rectum Foreign Body Peds (76010) $100.20 $1,002 1.1×
X-ray of voice box or throat (70370) $114.10 $1,141 1.3×
X-Ray Orbits - Xr Orbits Complete 4+ Views (70200) $100.20 $1,002 1.0×
X-Ray Pelvis 3+ Vw - Xr Pelvis 3+ Views (72190) $68.30 $683 0.7×
X-Ray Ribs 2 Vw Unilat - Xr Ribs 2 Views Right (71100) $30.40 $304 0.3×
X-Ray Ribs, Chest 3+ Vw - Xr Ribs 2 Vws Lt W/ Chest Anteroposterior (71101) $91.20 $912 0.9×
X-Ray Ribs, Chest 4+ Vw - Xr Ribs 3 Vws Bil W/ Chest Posteroanterior (71111) $104.50 $1,045 1.0×
X-Ray Sacroiliac Jts 3+ Vw - Xr Sacroiliac Joints 3+ Views (72202) $40.70 $407 0.4×
X-Ray Sacrum/Coccyx 2+ Vw - Xr Sacrum Coccyx 2+ Views (72220) $82.40 $824 0.9×
X-Ray Shoulder 2+ Vw - Xr Shoulder 2+ Views Right (73030) $103 $1,030 1.2×
X-Ray Sinuses 3+ Vw - Xr Paranasal Sinuses 3+ Views (70220) $91.60 $916 1.0×
X-Ray Sinuses <3 Vw - Xr Paranasal Sinuses 1-2 Views (70210) $62.90 $629 0.7×
X-Ray Skull 4+ Vw - Xr Skull Complete 4+ Views (70260) $75.70 $757 0.7×
X-Ray Skull <4 Vw - Xr Skull 1-3 Views (70250) $91.60 $916 0.9×
X-Ray Spine One View - Xr Spine (72020) $62.90 $629 0.7×
X-Ray Sterno-Clavicluar Jt - Xr Sternoclavicular Joints 3+ Views (71130) $91.20 $912 1.0×
X-Ray Sternum 2+ Vw - Xr Sternum 2+ Views (71120) $82.40 $824 0.9×
X-Ray Thoracic Spine 2 Vw - Xr Thoracic Spine 2 Views (72070) $46.60 $466 0.4×
X-Ray Thoracic Spine 4 Vw - Xr Thoracic Spine Complete 4+ Views (72074) $63.10 $631 0.6×
X-Ray Toe(S) - Xr Toes 2+ Views Right (73660) $82.40 $824 0.9×
X-Ray Wrist 3+ Vw - Xr Wrist 3+ Views Right (73110) $114 $1,140 1.3×
Xr c-spine 6 or more views (72052) $118.60 $1,186 1.1×
Xr chest 4+ views (71048) $63.10 $631 0.6×
Xr finger(s) 2+ views (73140) $82.40 $824 0.9×
Xr shoulder 1 view (73020) $72.20 $722 0.8×
Xr spine cervical 4 or 5 views (72050) $118.60 $1,186 1.1×
Xr tibia/fibula 2 views (73590) $103 $1,030 1.2×
Xr tmj bilateral (70330) $98.80 $988 1.1×
Xray knee 1 or 2 views rt (73560) $90.25 $902.50 1.0×