Imaging prices at Van Diest Medical Center

Webster City, IA · every code in this section with a posted price and a Medicare benchmark.

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

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ProcedurePosted cashPosted gross× Medicare
Abdomen 1 View (74018) $120 $150 1.4×
Abdomen 2 views (74019) $144 $180 1.4×
Acute Gastrointestinal Blood Loss Imaging (78278) $1,961.60 $2,452 5.1×
Ankle 2 views (73600) $106.40 $133 1.3×
Arthrogram Wrist (73115) $607.20 $759 1.8×
Bone age studies (77072) $107.20 $134 1.1×
Bone Imaging 3 Phase (78315) $1,151.20 $1,439 3.0×
Bone Imaging Limited Area (78300) $940 $1,175 2.4×
Bone Imaging Multiple Areas (78305) $1,151.20 $1,439 3.0×
Bone Imaging Whole Body (78306) $1,151.20 $1,439 3.0×
Bone survey infant (77076) $140.80 $176 1.4×
Brain Imaging Pet Metabolic Evaluation (78608) $3,688.80 $4,611 2.7×
Cat Scan Follow-Up Study (76380) $501.60 $627 6.0×
Chest 1 view (71045) $92 $115 1.1×
Chest 2 views (71046) $134.40 $168 1.6×
Chest 3 views (71047) $153.60 $192 1.8×
Chest 4 or more views (71048) $140.80 $176 1.4×
Clavicle complete (73000) $120.80 $151 1.4×
Computed Tomography Thorax Lw Dose Lng Ca Scr C- (71271) $316 $395 3.1×
Contrast X-Ray Bladder (74430) $277.60 $347 0.8×
Contrast X-Ray Of Knee Joint (73580) $578.40 $723 1.7×
CT abdomen and pelvis without and with contrast (74178) $2,540.80 $3,176 7.6×
CT abdomen and pelvis without contrast (74176) $1,488 $1,860 6.5×
CT abdomen w contrast (74160) $968 $1,210 5.7×
CT abdomen w wo contrast (74170) $1,337.60 $1,672 7.9×
CT abdomen w/o contrast (74150) $916.80 $1,146 9.1×
CT Angio Abdomen and Pelvis (74174) $1,936 $2,420 5.8×
CT Angio Chest (71275) $968 $1,210 5.7×
CT Angio Head (70496) $1,156 $1,445 6.9×
CT Angio Neck (70498) $1,156 $1,445 6.9×
Ct Angio Upr Extrm W/O&W/Dye (73206) $968 $1,210 5.7×
CT cervical spine w/ contrast (72126) $1,245.60 $1,557 3.7×
CT cervical spine w/o contrast (72125) $1,150.40 $1,438 11.4×
CT cervical spine w/wo cont (72127) $1,447.20 $1,809 8.6×
CT chest w contrast (71260) $968 $1,210 5.7×
CT chest w/wo contrast (71270) $1,337.60 $1,672 7.9×
CT head/brain with contrast (70460) $932 $1,165 5.5×
CT head/brain without and with contrast (70470) $1,303.20 $1,629 7.7×
CT heart no contrast quant eval coronry calcium (75571) $80 $100 1.0×
CT iac w contrast (70481) $1,232 $1,540 7.3×
CT l-spine w&w/o contrast (72133) $1,447.20 $1,809 8.6×
CT lower ext w/o (73700) $896.80 $1,121 8.9×
CT lower extremity w/contrast material (73701) $1,148.80 $1,436 6.8×
CT lumbar spine w contrast (72132) $1,366.40 $1,708 4.1×
CT lumbar spine w/o contrast (72131) $1,152 $1,440 11.5×
CT maxillofacial w contrast (70487) $1,232 $1,540 7.3×
CT maxillofacial wo contrast (70486) $944 $1,180 9.4×
CT neck tissue combo (70492) $1,324.80 $1,656 7.9×
Ct Orbit/Ear/Fossa W/O&W/Dye (70482) $1,298.40 $1,623 7.7×
CT orbits w/o contrast (70480) $727.20 $909 7.2×
CT pelvis w&w/o contrast (72194) $1,337.60 $1,672 7.9×
CT pelvis w/o contrast (72192) $916.80 $1,146 9.1×
CT scan of leg combo (73702) $1,273.60 $1,592 7.6×
CT scans face/jaw combo (70488) $1,202.40 $1,503 7.1×
CT soft tissue neck w contrast (70491) $1,156 $1,445 6.9×
CT soft tissue neck w/o contrast (70490) $944 $1,180 9.4×
CT thoracic spine w contrast (72129) $1,366.40 $1,708 8.1×
CT thoracic spine w/o contrast (72128) $1,140.80 $1,426 11.4×
CT thoracic spine w/wo cont (72130) $1,447.20 $1,809 8.6×
CT thorax w/o contrast (71250) $909.60 $1,137 9.1×
CT upper ext wo (73200) $896.80 $1,121 8.9×
CT upper extremity w/o & w/contrast material (73202) $1,056.80 $1,321 6.3×
CT upper extremity with contrast (73201) $1,148.80 $1,436 3.4×
Cta Abdl Aorta&Bi Iliofem W/Contrast&Postp (75635) $1,936 $2,420 11.5×
Cta Abdomen (74175) $968 $1,210 5.7×
CTA pelvis (72191) $968 $1,210 5.7×
Dxa Bone Density Axial (77080) $284 $355 2.8×
Dxa bone density study (77085) $244 $305 2.4×
Dxa bone density study 1/>sites appendiclr skel (77081) $284 $355 3.4×
Esophagram (74220) $223.20 $279 1.3×
Fetal Biophysical Profile W/O Non-Stress Testing (76819) $351.20 $439 3.5×
Fluoroscopy up to 1 hr (76000) $176.80 $221 0.8×
Foot 2 views (73620) $101.60 $127 1.2×
Forearm 2 views (73090) $105.60 $132 1.3×
Gastric emptying imaging study (78264) $1,151.20 $1,439 3.0×
Gated Heart Planar Single (78472) $1,151.20 $1,439 3.0×
Hand 2 views (73120) $101.60 $127 1.0×
Hepatobil Syst Image W/Drug (78227) $1,151.20 $1,439 2.2×
Hepatobiliary System Imaging (78226) $1,151.20 $1,439 3.0×
Ht Muscle Image Spect Sing (78451) $2,480 $3,100 2.0×
Hysterosalpingogram (74740) $664 $830 2.9×
K Flow/Funct Image W/O Drug (78707) $1,151.20 $1,439 2.2×
Knee 3 Views (73562) $117.60 $147 1.4×
Liver & Spleen Imaging Static Only (78215) $1,961.60 $2,452 5.1×
Lung Ventilat&Perfus Imaging (78582) $1,396 $1,745 2.7×
Magnetic Image Jaw Joint (70336) $1,312 $1,640 5.7×
Meckels Divert Exam (78290) $1,151.20 $1,439 3.0×
Mra Head W/O & W/Contrast Material (70546) $917.60 $1,147 2.7×
MRA head w/o contrast (70544) $856 $1,070 3.7×
MRA head with contrast (70545) $917.60 $1,147 2.7×
MRA neck w contrast (70548) $917.60 $1,147 2.7×
Mra Neck W/O &W/Contrast Material (70549) $917.60 $1,147 2.7×
MRA neck w/o contrast (70547) $856 $1,070 3.7×
MRI abdomen w contrast (74182) $1,366.40 $1,708 4.1×
MRI abdomen w/o contrast (74181) $1,275.20 $1,594 5.6×
MRI any jt lower extrem w/contrast material (73722)
range across 8 matching MRF lines		 $820–$1,312 $1,025–$1,640 varies
MRI any jt lower extrem w/o & w/contrast matrl (73723)
range across 8 matching MRF lines		 $816.80–$820 $1,021–$1,025 varies
MRI any jt upper extremity w/contrast matrl (73222) $820 $1,025 1.1×
MRI cervical spine w contrast (72142) $764.80 $956 2.3×
MRI cervical spine w/o cont (72141) $715.20 $894 3.1×
MRI chest w/o contrast (71550) $1,377.60 $1,722 6.0×
MRI lower extrem oth/thn jt w/contrast matrl (73719)
range across 8 matching MRF lines		 $1,224–$1,366.40 $1,530–$1,708 varies
MRI lower extrem oth/thn jt w/o & w/contr matr (73720)
range across 8 matching MRF lines		 $1,224–$1,312 $1,530–$1,640 varies
MRI lower extrem oth/thn jt w/o contr matrl (73718)
range across 8 matching MRF lines		 $816.80–$1,312 $1,021–$1,640 varies
MRI lumbar spine w contrast (72149) $764.80 $956 2.3×
Mri Neck Spine W/O & W/Dye (72156) $764.80 $956 2.3×
MRI orbit face &/neck w/o contrast (70540) $1,224 $1,530 5.3×
MRI orbit face neck w contrast (70542) $1,312 $1,640 3.9×
Mri Orbt/Fac/Nck W/O &W/Dye (70543) $1,312 $1,640 3.9×
MRI pelvis w contrast (72196) $1,312 $1,640 3.9×
MRI pelvis w/o & w contrast (72197) $1,312 $1,640 3.9×
MRI pelvis w/o contrast (72195) $1,224 $1,530 5.3×
MRI thoracic spine w/o contrast (72146) $713.60 $892 3.1×
MRI upper extremity oth than jt w/contr matrl (73219) $1,312 $1,640 3.9×
MRI upper extremity oth than jt w/o contr matrl (73218) $1,224 $1,530 5.3×
Mri Uppr Extremity W/O&W/Dye (73220) $1,312 $1,640 3.9×
MRI, abdomen, combo (74183) $1,366.40 $1,708 4.1×
MRI, dorsal spine combo (72157) $764.80 $956 2.3×
MRI, dorsal spine contrast (72147) $764.80 $956 2.3×
MRI, joint upper extrem (73221) $816.80 $1,021 3.6×
MRI, joint upper extrem combo (73223) $820 $1,025 2.4×
MRI, lumbar spine combo (72158) $764.80 $956 2.3×
Myelogram cervical (72240) $968.80 $1,211 1.3×
Myelogram Lumbar (72265) $949.60 $1,187 1.3×
Myocardial Spect Multiple Studies (78452) $2,000 $2,500 1.6×
Neck soft tissue (70360) $144 $180 1.7×
Optic foramina (70190) $120.80 $151 1.4×
Parathyroid planar imaging w/wo subtraction (78071) $988.80 $1,236 2.6×
Pelvis 1 or 2 views (72170) $120 $150 1.2×
PET image w/CT, full body (78816) $3,688.80 $4,611 2.7×
PET imaging CT attenuation skull base mid-thigh (78815) $3,688.80 $4,611 2.7×
Pulmonary Perfusion Imaging Particulate (78580) $904 $1,130 2.4×
Radex Abd Compl Aqt Abd W/S/E/D Views 1 View Ch (74022) $144 $180 1.4×
Radex abscess/fistula/sinus tract rs&i (76080) $664 $830 1.3×
Radex Ankle Complete Minimum 3 Views (73610) $116.80 $146 1.4×
Radex Calcaneus Minimum 2 Views (73650) $101.60 $127 1.2×
Radex elbow complete minimum 3 views (73080) $120.80 $151 1.4×
Radex Facial Bones Complete Minimum 3 Views (70150) $144 $180 1.4×
Radex fingr minimum 2 views (73140) $95.20 $119 1.1×
Radex foot complete minimum 3 views (73630) $116.80 $146 1.4×
Radex Hand Minimum 3 Views (73130) $160.80 $201 1.9×
Radex Mastoids Compl Minimum 3 Views PR Side (70130) $140.80 $176 1.4×
Radex Nasal Bones Complete Minimum 3 Views (70160) $144 $180 1.7×
Radex Ribs Unilateral 2 Views (71100) $117.60 $147 1.4×
Radex shoulder complete minimum 2 views (73030) $118.40 $148 1.4×
Radex Sinuses Paransl < 3 Views (70210) $120.80 $151 1.4×
Radex Spine 1 View Specify Level (72020) $160.80 $201 1.9×
Radex Sternum Minimum 2 Views (71120) $144 $180 1.7×
Radex Temporomandble Jt Opn & Clsd Mouth Bilat (70330) $144 $180 1.7×
Radex Toe Minimum 2 Views (73660) $95.20 $119 1.1×
Radex upper extremity infant minimum 2 views (73092) $140.80 $176 1.4×
Radex Wrist Complete Minimum 3 Views (73110) $116.80 $146 1.4×
Radiolog exam mandible compl minimum 4 views (70110) $144 $180 1.4×
Radiologic Exam Abdomen 3+ Views - Xr Abdomen 3+ Views (74021) $144 $180 1.4×
Radiologic exam colon double contrast study (74280) $437.60 $547 2.6×
Radiologic exam colon single contrast study (74270)
range across 2 matching MRF lines		 $379.20–$574.40 $474–$718 varies
Radiologic exam knee complete 4/more views (73564) $140.80 $176 1.4×
Radiologic exam pelvis compl minimum 3 views (72190) $130.40 $163 1.3×
Radiologic Exam Small Int Single Contrast Study (74250) $349.60 $437 2.1×
Radiologic exam swallow function contrast study (74230) $311.20 $389 1.8×
Radiologic exam upr gi trc double contrast study (74246) $363.20 $454 2.2×
Radiologic examination femur 1 view (73551) $117.60 $147 1.4×
Radiologic examination femur minimum 2 views (73552) $117.60 $147 1.4×
Radiologic examination knee 1/2 views (73560) $110.40 $138 1.3×
Radiologic examination tibia & fibula 2 views (73590) $116.80 $146 1.4×
Ribs bilateral 3 views (71110) $161.60 $202 1.6×
Scapula (73010) $140.80 $176 1.4×
Shoulder 1 view (73020) $120.80 $151 1.4×
Shoulder Arthrography (73040) $617.60 $772 1.8×
Skull less than 4 views (70250) $144 $180 1.4×
Sternoclavicular joints (71130) $153.60 $192 1.8×
Thoracic spine 2 views (72070) $140.80 $176 1.4×
Thoracic spine 3 views (72072) $161.60 $202 1.6×
Thyroid Imaging With Vascular Flow (78013) $952 $1,190 2.5×
Thyroid Uptake Measurement (78012) $952 $1,190 2.5×
Thyroid Uptake W/Blood Flow Sngle/Mult Quan Meas (78014) $1,151.20 $1,439 3.0×
Ultrasound Breast Limited (76642) $201.60 $252 2.4×
Ultrasound Exam Aaa Screen (76706) $416.80 $521 4.1×
Ultrasound, abdomen limited (76705) $301.60 $377 3.0×
Upper gi w/o kub (74240) $363.20 $454 2.2×
Urethrocystogram voiding (74455) $664 $830 2.9×
Urethrocystography retrograde (74450) $664 $830 2.9×
Us breast unilateral complete (76641) $288 $360 2.9×
Us chest (76604) $288 $360 2.9×
Us complete joint (76881) $315.20 $394 3.1×
Us exam, pelvic, limited (76857) $237.60 $297 2.4×
Us lmtd joint/oth nonvasc xtr strux r-t w/img (76882) $277.60 $347 2.8×
Us ob limited 1 or more fetuses (76815) $315.20 $394 3.1×
Us ob transvaginal (76817) $315.20 $394 3.1×
Us pelvic non ob complete (76856) $367.20 $459 3.7×
Us pg uter img f&mat 14 wk tabdl 1/1st gestation (76801) $419.20 $524 4.2×
Us preg uterus real time f/u trnsabdl per fetus (76816) $236.80 $296 2.4×
Us retroperitoneal complete (76770) $394.40 $493 3.9×
Us retroperitoneal limited (76775) $309.60 $387 3.1×
Us scrotum and contents (76870) $367.20 $459 3.7×
Us thyroid (76536) $315.20 $394 3.1×
Venography extremity unilateral rs&i (75820) $664 $830 0.4×
Vertebral fracture assessment via dxa (77086) $97.60 $122 1.2×
Wrist 2 views (73100) $101.60 $127 1.2×
X-Ray Ac Jts - Xr Acromioclavicular Joints Bilateral (73050) $118.40 $148 1.4×
X-Ray Elbow 2 Vw - Xr Elbow 1-2 Views Right (73070) $116 $145 1.4×
X-Ray Exam Breast Specimen (76098) $120.80 $151 0.2×
X-Ray Exam Entire Spi 4/5 Vw (72083) $140.80 $176 1.4×
X-Ray Exam Hip Uni 1 View (73501) $130.40 $163 1.6×
X-Ray Exam Hip Uni 2-3 Views (73502) $130.40 $163 1.6×
X-Ray Exam Hip Uni 4/> Views (73503) $130.40 $163 1.3×
X-Ray Exam Hips Bi 2 Views (73521) $130.40 $163 1.3×
X-Ray Exam Hips Bi 3-4 Views (73522) $130.40 $163 1.3×
X-Ray Exam Hips Bi 5/> Views (73523) $130.40 $163 1.3×
X-Ray Exam L-S Spine Bending (72114) $229.60 $287 2.3×
X-Ray Exam Neck Spine 2-3 Vw (72040) $124 $155 1.5×
X-Ray Exam Neck Spine 6/>Vws (72052) $237.60 $297 2.4×
X-ray eye for foreign body (70030) $123.20 $154 1.5×
X-ray humerus (73060) $144 $180 1.7×
X-ray IV pyelogram (ivp) (74400) $367.20 $459 2.2×
X-Ray Knee Bilat Standing - Xr Knees Anteroposterior Standing Bilat (73565) $111.20 $139 1.3×
X-Ray Lumbar Spine 2/3 Vw - Xr Lumbar Spine 2-3 Views (72100) $140.80 $176 1.4×
X-Ray Sacroiliac Jts 3+ Vw - Xr Sacroiliac Joints 3+ Views (72202) $160.80 $201 1.6×
X-Ray Sacrum/Coccyx 2+ Vw - Xr Sacrum Coccyx 2+ Views (72220) $160.80 $201 1.9×
X-Ray Sinuses 3+ Vw - Xr Paranasal Sinuses 3+ Views (70220) $144 $180 1.7×
X-Ray Skull 4+ Vw - Xr Skull Complete 4+ Views (70260) $214.40 $268 2.1×
X-Rays Bone Survey Complete (77075) $441.60 $552 4.4×
Xr c-spine 4 or 5 views (72050) $173.60 $217 1.7×
Xr facial bones less than 3 views (70140) $120.80 $151 1.4×
Xr orbits complete 4 views (70200) $181.60 $227 1.8×

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.