Imaging prices at White Rock Medical Center

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

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

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ProcedureCash priceGross charge× Medicare
Abdomen 2 views (74019) $549.44 $808 5.2×
Acute gastrointestinal blood loss imaging (78278) $731 $1,075 1.8×
Angiography extremity bilateral rs&i (75716) $3,952.84 $5,813 1.2×
Angiography extremity unilateral rs&i (75710) $3,242.24 $4,768 1.0×
Angiography internal mammary rs&i (75756) $1,979.48 $2,911 0.6×
Angiography pelvic slctv/supraslctv rs&i (75736) $5,406.68 $7,951 1.0×
Angiography pulmonary bilateral slctv rs&i (75743) $3,158.60 $4,645 1.0×
Angiography visceral slctv/supraslctv rs&i (75726) $2,990.64 $4,398 0.5×
Angrph Cath F-Up Std Tcat Other Than Thrombylsis (75898) $1,623.16 $2,387 0.5×
Angrph pulmonary nonslctv cath/ven njx rs&i (75746) $3,158.60 $4,645 1.0×
Ankle 2 views (73600) $365.16 $537 4.2×
Antegrade urography radiological supvj & interpj (74425) $294.44 $433 0.8×
Aortogram thoracic (75605) $2,979.76 $4,382 0.5×
Aortography abdl bi iliofem low extrem cath rs&i (75630) $3,384.36 $4,977 1.1×
Aortography abdominal serialography rs&i (75625) $16,205.60 $23,831.76 5.1×
Arthrogram hip (73525) $379.44 $558 1.1×
Arthrogram shoulder (73040) $463.08 $681 1.3×
Arthrogram wrist (73115) $609.28 $896 1.7×
Arthrography knee lt (73580) $617.44 $908 1.8×
Bone &/Joint Imaging Limited Area (78300) $771.12 $1,134 1.9×
Bone &/joint imaging whole body (78306) $1,504.16 $2,212 3.7×
Bone age studies (77072) $410.72 $604 3.9×
Bone Imaging 3 Phase (78315) $1,939.36 $2,852 4.8×
Bone Marrow Imaging Limited Area (78102) $1,199.52 $1,764 3.0×
Bone survey complete (77075) $323 $475 3.1×
Brain imaging < 4 static views (78600) $760.24 $1,118 1.9×
Cervical spine 2 or 3 views (72040) $387.60 $570 4.4×
Chest 1 view (71045) $451.52 $664 5.2×
Chest 3 views (71047) $488.24 $718 5.6×
Cine/Vid X-Ray Throat/Esoph - Fl Esoph Barium Swlw W/ Video & Speech (74230) $535.84 $788 3.0×
Clavicle complete (73000) $314.84 $463 3.6×
Computed Tomography Thorax Lw Dose Lng Ca Scr C- (71271) $289.24 $425.36 2.8×
Contrast Xray Throat/Cerv Esopha - Fl Esophagus Pharynx (74210) $578.68 $851 3.3×
CT abdomen and pelvis without and with contrast (74178) $6,404.92 $9,419 18.3×
CT abdomen and pelvis without contrast (74176) $5,303.32 $7,799 22.1×
CT abdomen w contrast (74160) $3,509.48 $5,161 19.9×
CT abdomen w wo contrast (74170) $4,329.56 $6,367 24.6×
CT abdomen w/o contrast (74150) $2,822 $4,150 26.9×
CT angio hrt w/3d image (75574) $941.80 $1,385 2.7×
CT angiography upper extremity lt (73206) $3,980.72 $5,854 22.6×
CT c-spine w/o contrast (72125) $4,022.88 $5,916 38.3×
CT cervical spine w&w/o contrast (72127) $484.21 $712.08 2.7×
CT cervical spine with contrast (72126) $4,380.56 $6,442 12.5×
CT chest w/wo contrast (71270) $4,192.20 $6,165 23.8×
CT chest with contrast (71260) $3,493.84 $5,138 19.8×
CT head/brain with contrast (70460) $4,135.76 $6,082 23.5×
CT head/brain without and with contrast (70470) $5,917.36 $8,702 33.6×
CT heart contrast eval cardiac structure&morph (75572) $1,186 $1,744.12 3.4×
CT heart no contrast quant eval coronry calcium (75571) $102.68 $151 1.2×
CT iac w contrast (70481) $2,945.76 $4,332 16.7×
CT limited/localized follow up study (76380) $756.84 $1,113 8.7×
CT lower ext w/o (73700) $2,220.88 $3,266 21.1×
CT lower extremity with contrast (73701) $2,581.96 $3,797 14.7×
CT lumbar spine w & w/o contrast (72133) $4,711.04 $6,928 26.7×
CT lumbar spine w/o contrast (72131) $3,481.60 $5,120 33.2×
CT lumbar spine with contrast (72132) $4,486.64 $6,598 12.8×
CT maxillofacial w contrast (70487) $2,774.40 $4,080 15.7×
CT maxillofacial w/o contrast (70486) $2,438.48 $3,586 23.2×
CT maxillofacial w/wo contrast (70488) $3,516.28 $5,171 20.0×
CT neck soft tissue w contrast (70491) $4,811.68 $7,076 27.3×
CT orbit sella/post fossa/ear w/o & w/contr matr (70482) $3,695.80 $5,435 21.0×
CT orbits w/o contrast (70480) $2,225.64 $3,273 21.2×
CT pelvis w & w/o contrast (72194) $3,240.20 $4,765 18.4×
CT pelvis w/o contrast (72192) $2,569.04 $3,778 24.5×
CT soft tissue neck w/o & w/contrast material (70492) $5,687.52 $8,364 32.3×
CT soft tissue neck w/o contrast (70490) $4,051.44 $5,958 38.6×
CT thoracic spine w/contrast (72129) $2,278 $3,350 12.9×
CT thoracic spine w/o contrast (72128) $1,633.36 $2,402 15.6×
CT thoracic spine w/wo contrast (72130) $484.21 $712.08 2.7×
CT thorax w/o contrast (71250) $2,771 $4,075 26.4×
CT upper extremity w/o & w/contrast material (73202) $2,276.64 $3,348 12.9×
CT upper extremity w/o contrast rt (73200) $1,215.84 $1,788 11.6×
CT upper extremity with contrast (73201) $2,252.16 $3,312 6.4×
Cta Abdl Aorta&Bi Iliofem W/Contrast&Postp (75635) $3,704.64 $5,448 21.0×
Cta Abdomen (74175) $4,459.44 $6,558 25.3×
CTA abdomen pelvis (74174) $8,774.04 $12,903 25.0×
CTA chest (71275) $4,998.68 $7,351 28.4×
Cta Head (70496) $4,727.36 $6,952 26.8×
CTA lwr ext w&w/o contrast (73706) $4,156.16 $6,112 23.6×
Cta Neck (70498) $5,971.76 $8,782 33.9×
Cta Pelvis (72191) $3,402.04 $5,003 19.3×
Cystography minimum 3 views rs&i (74430) $497.76 $732 1.4×
Diskography lumbar (72295) $6,097.25 $8,966.55 3.1×
Dxa bone density study 1/> sites axial skel (77080) $346.80 $510 3.3×
Dxa bone density study 1/>sites appendiclr skel (77081) $186.32 $274 2.1×
Dxa bone density study axial skeleton (77085) $365.84 $538 3.5×
Echo exam of fetal heart (76825) $764.32 $1,124 1.4×
Echoencephalography real time imaging (76506) $422.96 $622 4.0×
Esophagus (74220) $429.08 $631 2.4×
Fetal biophysical profile non-stress testing (76818) $688.16 $1,012 6.6×
Fetal Biophysical Profile W/O Non-Stress Testing (76819) $369.24 $543 3.5×
Fluoroscopy up to 1 hr (76000) $326.40 $480 1.4×
Foot 2 views (73620) $365.16 $537 4.2×
Forearm 2 views (73090) $363.80 $535 4.2×
Gated Heart Planar Single (78472) $1,190.68 $1,751 3.0×
Hand 2 views (73120) $522.24 $768 5.0×
Hand 3 views (73130) $552.84 $813 6.3×
Hepatobil Syst Imag Inc Gb W/Pharma Intervenj (78227) $2,338.52 $3,439 4.3×
Hepatobiliary syst imaging including gallbladder (78226) $1,838.72 $2,704 4.6×
Ht muscle image spect sing (78451) $2,924.68 $4,301 2.2×
Humerus Min 2 Views Left (73060) $361.76 $532 4.1×
Hysterosalpingogram (74740) $558.28 $821 2.3×
Kidney Img Morphology Vascular Flow 1 W/O Rx (78707) $815.32 $1,199 1.5×
Kidney Img Morphology Vascular Flow Multiple (78709) $1,206.32 $1,774 2.2×
Knee 3 views (73562) $497.76 $732 5.7×
Liver & spleen imaging static only (78215) $1,559.24 $2,293 3.9×
Liver imaging static only (78201) $1,533.40 $2,255 2.8×
Liver imaging w/vascular flow (78202) $1,689.80 $2,485 3.1×
Lung Ventilation Imaging (78579) $1,429.36 $2,102 3.6×
Lymphoscintigraphy (78195) $1,437.52 $2,114 2.6×
Meckels Diverticulum (78290) $510 $750 1.3×
MRA head w/o contrast (70544) $3,901.16 $5,737 16.3×
MRA head with contrast (70545) $4,291.48 $6,311 12.2×
MRA neck w contrast (70548) $4,291.48 $6,311 12.2×
Mra Neck W/O &W/Contrast Material (70549) $4,506.36 $6,627 12.9×
MRA neck w/o contrast (70547) $3,901.16 $5,737 16.3×
MRI abdomen w/o & w/contrast material (74183) $4,862.68 $7,151 13.9×
MRI abdomen w/o contrast (74181) $4,464.88 $6,566 18.6×
MRI any jnt lwr ext with con lt (73722) $3,009 $4,425 3.8×
MRI any jt upper extremity w/contrast matrl (73222) $2,530.96 $3,722 3.2×
MRI cervical spine w/o contrast (72141) $4,451.28 $6,546 18.6×
MRI chest w/o & w/contrast material (71552) $4,001.12 $5,884 11.4×
MRI chest w/o contrast (71550) $2,936.92 $4,319 12.3×
MRI Forearm w/ Contrast Bilateral 73219 (73219) $2,691.44 $3,958 7.7×
MRI lower extrem oth/thn jt w/o contr matrl (73718) $2,471.80 $3,635 10.3×
MRI orbit face &/neck w/o contrast (70540) $2,465 $3,625 10.3×
MRI orbit/face/neck w&w/o cont (70543) $5,141.48 $7,561 14.7×
MRI pelvis w contrast (72196) $3,923.60 $5,770 11.2×
MRI pelvis w/o & w/contrast material (72197) $4,914.36 $7,227 14.0×
MRI pelvis w/o contrast (72195) $3,725.04 $5,478 15.5×
MRI scan of arm joint before and after contrast (73223) $2,657.44 $3,908 7.6×
MRI scan of leg joint before and after contrast (73723) $3,635.96 $5,347 10.4×
MRI spinal canal cervical w/o & w/contr matrl (72156) $7,215.48 $10,611 20.6×
MRI spinal canal lumbar w/contrast material (72149) $1,201.07 $1,766.28 3.4×
MRI spinal canal lumbar w/o & w/contr matrl (72158) $6,876.84 $10,113 19.6×
MRI spinal canal thoracic w/o & w/contr matrl (72157) $6,876.84 $10,113 19.6×
MRI thoracic spine w/o contrast (72146) $4,242.52 $6,239 17.7×
MRI tmj (70336) $1,948.88 $2,866 8.1×
MRI upper ext joint w/o contrast (73221) $2,278 $3,350 9.5×
MRI upper extrem other than jt w/o & w/contras (73220) $3,133.44 $4,608 8.9×
MRI upper extremity oth than jt w/o contr matrl (73218) $2,530.96 $3,722 10.6×
Myelogram Cervical (72240) $1,541.56 $2,267 2.0×
Myelogram Lumbar (72265) $1,505.52 $2,214 1.9×
Myelogram thoracic (72255) $1,570.12 $2,309 2.0×
Myelography 2 or more regions (72270) $2,169.20 $3,190 2.8×
Myocardial Spect Multiple Studies (78452) $5,013.64 $7,373 3.9×
Neck soft tissue (70360) $453.56 $667 5.2×
Nm bone marrow wb (78104) $1,345.04 $1,978 3.3×
Nm cisternogram (78630) $852.72 $1,254 1.6×
Nm gastric emptying study (78264) $1,521.16 $2,237 3.8×
Nuclear medicine study of limited area for thyroid cancer (78015) $1,367.48 $2,011 3.4×
Nuclear Rx Oral Admin (79005) $1,196.80 $1,760 5.1×
Ob Us Follow-Up Per Fetus - Us Ob Follow Up Transabdominal Approach (76816) $517.48 $761 4.9×
Osseous survey infant (77076) $339.32 $499 3.2×
Osseous survey limited (77074) $307.36 $452 2.9×
Parathyrd planar w/wo subtrj (78071) $1,392.64 $2,048 3.5×
Parathyroid imaging (78070) $1,238.96 $1,822 3.1×
Pelvis 1 or 2 views (72170) $371.28 $546 3.5×
Pr MRI, lower extr, w/o contrast f/u by contrast (73720) $3,106.24 $4,568 8.9×
Prq Transhepatc Portograpy Hemodyn Eval Rs&I (75885) $2,948.48 $4,336 0.9×
Pulmonary Perfusion Imaging Particulate (78580) $1,531.36 $2,252 3.8×
Pulmonary Ventilation & Perfusion Imaging (78582) $1,595.28 $2,346 2.9×
Radex abscess/fistula/sinus tract rs&i (76080) $477.36 $702 0.9×
Radex Entir Thrc Lmbr Crv Sac Spi W/Skull 1 Vw - Xr Scoliosis 1 Vw (72081) $207.40 $305 2.4×
Radex entir thrc lmbr crv sac spi w/skull 2/3 vw (72082) $363.80 $535 3.5×
Radex hips bilateral with pelvis 2 views (73521) $504.56 $742 4.8×
Radex X-Ray Exam Entire Spi 6/> Vw - Xr Entire Spine 6+ Vw (72084) $641.92 $944 6.1×
Radiolog exam mandible compl minimum 4 views (70110) $231.88 $341 2.2×
Radiologic Exam Abdomen 1 View - Xr Abdomen 1 View (74018) $502.52 $739 5.7×
Radiologic Exam Abdomen 3+ Views - Xr Abdomen 3+ Views (74021) $556.92 $819 5.3×
Radiologic Exam Chest 2 Views - Xr Chest 2 Views (71046) $472.60 $695 5.4×
Radiologic exam colon single contrast study (74270) $529.72 $779 3.0×
Radiologic exam upr gi trc double contrast study (74246) $924.12 $1,359 5.2×
Radiologic exam upr gi trc single contrast study (74240) $667.08 $981 3.8×
Radiologic Examination Femur Minimum 2 Views - Xr Femur 2+ Vw Lt (73552) $426.36 $627 4.9×
Radiological examination surgical specimen (76098) $226.44 $333 0.4×
Ribs bilateral 3 views (71110) $612 $900 5.8×
Rp loclzj tum plnr 2+area 1+d img/1 area img>2+d (78801) $1,395.36 $2,052 3.5×
Rp loclzj tum plnr whole body single day imaging (78802) $1,578.28 $2,321 2.9×
Saline Infus Sonohysterography W/Color Doppler (76831) $1,163.48 $1,711 4.9×
Scapula complete (73010) $259.76 $382 2.5×
Screening digital breast tomosynthesis (77063) $44.88 $66 1.9×
Shuntogram indwelling nonvascular shunt rs&i (75809) $436.07 $641.28 4.2×
Small bowel series (74250) $465.80 $685 2.6×
Speech evaluation complex (70371) $488.92 $719 2.0×
Spine thoracic 3 views (72072) $574.60 $845 5.5×
Thoracolumbar 2 views (72080) $228.48 $336 2.6×
Thyroid carcinoma metastases img whole body (78018) $1,504.16 $2,212 2.8×
Thyroid Imaging With Vascular Flow (78013) $697.68 $1,026 1.7×
Thyroid uptake measurement (78012) $775.20 $1,140 1.9×
Tumor Imaging Whole Body - Nm Tumor Local Whole Body Mult Days (78804) $2,746.52 $4,039 5.0×
Tumor Imaging, Limited Area - Nm Tumor Localization Limited (78800) $1,288.60 $1,895 3.2×
Ultrasound, abdomen limited (76705) $840.48 $1,236 8.0×
Upper Extremity Infant (73092) $376.04 $553 3.6×
Ureteral Reflux Study Rp Voiding Cystogram (78740) $1,215.16 $1,787 3.0×
Urethrocystography retrograde rs&i (74450) $718.76 $1,057 3.0×
Urethrocystography voiding (74455) $466.48 $686 1.9×
Urography (pyelography), intravenous, with or without KUB, with or without tomography (74400) $707.88 $1,041 4.0×
Us breast unilateral complete (76641) $400.52 $589 3.8×
Us breast unilateral limited (76642) $352.92 $519 4.0×
Us chest (76604) $320.28 $471 3.0×
Us compl joint r-t w/image documentation (76881) $662.32 $974 6.3×
Us guided compression repair (76936) $743.92 $1,094 3.4×
Us ob detailed single fetus (76811) $938.40 $1,380 3.9×
Us ob transvaginal (76817) $206.04 $303 2.0×
Us pelvic non ob complete (76856) $1,008.44 $1,483 9.6×
Us pelvic nonobstetric image dcmtn limited/f/u (76857) $416.84 $613 4.0×
Us pregnancy ltd (76815) $405.28 $596 3.9×
Us pregnant uterus 14 wk transabdl 1/1st gestat (76801) $1,092.08 $1,606 10.4×
Us retroperitoneal complete (76770) $1,054.68 $1,551 10.0×
Us retroperitoneal limited (76775) $289.24 $425.36 2.8×
Us scrotum and contents (76870) $843.88 $1,241 8.0×
Us soft tissue head/neck (76536) $768.40 $1,130 7.3×
Us spinal canal and contents (76800) $478.72 $704 4.6×
Us transrectal (76872) $318.92 $469 3.0×
Us xtr non-vasc lmtd (76882) $573.92 $844 5.5×
Venogram extremity bilateral (75822) $1,224 $1,800 0.8×
Venography caval inferior serialography rs&i (75825) $2,283.44 $3,358 0.7×
Venography caval superior serialography rs&i (75827) $1,719.72 $2,529 1.1×
Venography extremity unilateral rs&i (75820) $984.64 $1,448 0.6×
Wrist 2 views (73100) $316.20 $465 3.6×
X-Ray Abdomen,Comp Acute Series - Xr Abdomen 2 Vws With Chest 1 View (74022) $562.36 $827 5.4×
X-Ray Ac Jts - Xr Acromioclavicular Joints Bilateral (73050) $476.68 $701 5.5×
X-Ray Ankle 3+ Vw - Xr Ankle 3+ Views Right (73610) $413.44 $608 4.7×
X-Ray Colon Air Contrast - Fl Barium Enema Air Contrast (74280) $606.56 $892 3.4×
X-Ray Elbow 2 Vw - Xr Elbow 1-2 Views Right (73070) $403.92 $594 4.6×
X-Ray Elbow 3+ Vw - Xr Elbow 3+ Views Right (73080) $451.52 $664 5.2×
X-ray exam entire spi 4/5 vw (72083) $458.32 $674 4.4×
X-ray exam hip uni 1 view (73501) $360.40 $530 4.1×
X-Ray Exam Hip Uni 2-3 Views (73502) $420.24 $618 4.8×
X-ray exam hip uni 4/> views (73503) $289.24 $425.36 2.8×
X-Ray Exam Hips Bi 3-4 Views (73522) $539.92 $794 5.1×
X-ray exam of femur 1 (73551) $223.72 $329 2.6×
X-ray exam of small bowel - fl small bowel series enteroclysis tube (74251) $606.56 $892 3.4×
X-Ray Facial Bones 3+ Vw - Xr Facial Bones 3+ Views (70150) $259.08 $381 2.5×
X-Ray Facial Bones <3 Vw - Xr Facial Bones 1-2 Views (70140) $214.20 $315 2.5×
X-Ray Foot 3+ Vw - Xr Foot 3+ Views Right (73630) $413.44 $608 4.7×
X-Ray Heel - Xr Calcaneus 2 Views Right (73650) $208.76 $307 2.4×
X-Ray Jaw <4 Vw - Xr Mandible < 4 Views (70100) $137.36 $202 1.6×
X-Ray Knee 4+ View - Xr Knee 4+ Views Right (73564) $555.56 $817 5.3×
X-Ray Leg, Infant - Xr Lower Extremity 2+ Views Infant Left (73592) $376.04 $553 4.3×
X-Ray Lumbar Spine 2/3 Vw - Xr Lumbar Spine 2-3 Views (72100) $605.20 $890 5.8×
X-Ray Lumbar Spine 6+ Vw - Xr Lumbar Spine 6+ Vws Including Bending (72114) $769.08 $1,131 7.3×
X-Ray Lumbar Spine Flex/Exten - Xr Lumbar Spine 4+ Views W/ Flex Ext (72120) $461.04 $678 4.4×
X-Ray Nasal Bones - Xr Nasal Bones (70160) $263.16 $387 3.0×
X-Ray Nose-Rectum Child F.B. - Xr Nose to Rectum Foreign Body Peds (76010) $272.68 $401 3.1×
X-Ray Orbits - Xr Orbits Complete 4+ Views (70200) $237.32 $349 2.3×
X-Ray Pelvis 3+ Vw - Xr Pelvis 3+ Views (72190) $410.04 $603 3.9×
X-Ray Renal Cyst Xlumbar+Contrst - Xr Renal Cyst Lumbar W Contrast (74470) $778.60 $1,145 1.4×
X-Ray Retrograde Pyelogram - Fl Pyelogram Retrograde (74420) $553.52 $814 1.6×
X-Ray Ribs 2 Vw Unilat - Xr Ribs 2 Views Right (71100) $494.36 $727 5.7×
X-Ray Ribs, Chest 3+ Vw - Xr Ribs 2 Vws Lt W/ Chest Anteroposterior (71101) $284.92 $419 2.7×
X-Ray Sacroiliac Jts 3+ Vw - Xr Sacroiliac Joints 3+ Views (72202) $163.88 $241 1.6×
X-Ray Sacrum/Coccyx 2+ Vw - Xr Sacrum Coccyx 2+ Views (72220) $233.92 $344 2.7×
X-Ray Shoulder 2+ Vw - Xr Shoulder 2+ Views Right (73030) $424.32 $624 4.9×
X-Ray Sinuses 3+ Vw - Xr Paranasal Sinuses 3+ Views (70220) $294.44 $433 3.4×
X-Ray Sinuses <3 Vw - Xr Paranasal Sinuses 1-2 Views (70210) $131.24 $193 1.5×
X-Ray Skull 4+ Vw - Xr Skull Complete 4+ Views (70260) $433.16 $637 4.1×
X-Ray Skull <4 Vw - Xr Skull 1-3 Views (70250) $301.24 $443 2.9×
X-Ray Spine One View - Xr Spine (72020) $247.52 $364 2.8×
X-Ray Sternum 2+ Vw - Xr Sternum 2+ Views (71120) $192.44 $283 2.2×
X-Ray Thoracic Spine 2 Vw - Xr Thoracic Spine 2 Views (72070) $574.60 $845 5.5×
X-Ray Thoracic Spine 4 Vw - Xr Thoracic Spine Complete 4+ Views (72074) $284.92 $419 2.7×
X-Ray Toe(S) - Xr Toes 2+ Views Right (73660) $344.08 $506 3.9×
X-Ray Wrist 3+ Vw - Xr Wrist 3+ Views Right (73110) $363.80 $535 4.2×
Xr c-spine 6 or more views (72052) $526.32 $774 5.0×
Xr chest 4+ views (71048) $521.56 $767 5.0×
Xr finger(s) 2+ views (73140) $330.48 $486 3.8×
XR Mastoids < 3 Views Bilateral (70120) $325.04 $478 3.1×
Xr shoulder 1 view (73020) $344.76 $507 3.9×
Xr spine cervical 4 or 5 views (72050) $465.80 $685 4.4×
Xr tibia/fibula 2 views (73590) $363.80 $535 4.2×
Xr tmj bilateral (70330) $413.44 $608 4.7×
Xray knee 1 or 2 views rt (73560) $484.16 $712 5.5×