This study analyzes trends in the utilization and costs of imaging modalities for pediatric renal anomalies, utilizing data from the Merative™ Marketscan® Commercial Database from 2007 to 2021. A cohort of 1,769 patients, primarily aged 0-5 years and diagnosed with conditions such as hydronephrosis and vesicoureteral reflux, was examined. The results revealed that renal ultrasound (US) was the most frequently utilized imaging method (63.39%), while DMSA and MAG3 scans were less common (less than 5% and 7.87%, respectively). Notably, renal US was also associated with lower costs compared to other imaging techniques. The findings provide valuable insights into the patterns of imaging utilization and costs for children with renal anomalies.