Imaging prices at AdventHealth Polk

Columbus, NC · every code in this section with a posted price and a Medicare benchmark.

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

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ProcedureCash priceGross charge× Medicare
Abdomen 2 views (74019) $474.39 $474.39 4.7×
Acute gastrointestinal blood loss imaging (78278) $2,216.55 $2,216.55 5.8×
Ankle 2 views (73600) $299.99 $299.99 3.6×
Antegrade urography radiological supvj & interpj (74425) $1,264.41 $1,264.41 3.8×
Arthrogram elbow (73085) $1,117.83 $1,117.83 3.4×
Arthrogram shoulder (73040) $1,318.91 $1,318.91 4.0×
Arthrography knee lt (73580) $1,110.27 $1,110.27 3.3×
Bone &/Joint Imaging Limited Area (78300) $1,628.76 $1,628.76 4.3×
Bone &/joint imaging whole body (78306) $2,026.50 $2,026.50 5.3×
Bone Imaging 3 Phase (78315) $1,931.58 $1,931.58 5.1×
Bone Marrow Imaging Limited Area (78102) $1,328.15 $1,328.15 3.5×
Bone survey complete (77075) $1,184.72 $1,184.72 11.9×
Cervical spine 2 or 3 views (72040) $440.48 $440.48 5.3×
Chest 1 view (71045) $348.20 $348.20 4.2×
Chest 3 views (71047) $485.84 $485.84 5.8×
Cine/Vid X-Ray Throat/Esoph - Fl Esoph Barium Swlw W/ Video & Speech (74230) $1,080.03 $1,080.03 6.4×
Clavicle complete (73000) $358.58 $358.58 4.3×
Computed Tomography Thorax Lw Dose Lng Ca Scr C- (71271) $1,146.18 $1,146.18 11.5×
CT abdomen and pelvis without and with contrast (74178) $5,321.72 $5,321.72 16.0×
CT abdomen and pelvis without contrast (74176) $4,487.07 $4,487.07 19.7×
CT abdomen w contrast (74160) $3,179.40 $3,179.40 19.0×
CT abdomen w wo contrast (74170) $3,419.43 $3,419.43 20.4×
CT abdomen w/o contrast (74150) $2,618.28 $2,618.28 26.2×
CT angio hrt w/3d image (75574) $3,568.85 $3,568.85 10.7×
CT angiography upper extremity lt (73206) $3,846.68 $3,846.68 22.9×
CT c-spine w/o contrast (72125) $1,902.29 $1,902.29 19.0×
CT cervical spine w&w/o contrast (72127) $3,331.76 $3,331.76 19.9×
CT cervical spine with contrast (72126) $2,988.30 $2,988.30 9.0×
CT chest w/wo contrast (71270) $3,419.43 $3,419.43 20.4×
CT chest with contrast (71260) $2,794.47 $2,794.47 16.7×
CT head/brain with contrast (70460) $2,485.88 $2,485.88 14.8×
CT head/brain without and with contrast (70470) $3,000.06 $3,000.06 17.9×
CT heart contrast eval cardiac structure&morph (75572) $2,728.74 $2,728.74 8.2×
CT heart no contrast quant eval coronry calcium (75571) $201.29 $201.29 2.4×
CT iac w contrast (70481) $2,610.20 $2,610.20 15.6×
CT limited/localized follow up study (76380) $1,136.31 $1,136.31 13.7×
CT lower ext w/o (73700) $1,976.31 $1,976.31 19.8×
CT lower extremity w wo contrast (73702) $2,626.05 $2,626.05 15.7×
CT lower extremity with contrast (73701) $2,168.15 $2,168.15 12.9×
CT lumbar spine w & w/o contrast (72133) $3,490.83 $3,490.83 20.8×
CT lumbar spine w/o contrast (72131) $2,469.08 $2,469.08 24.7×
CT lumbar spine with contrast (72132) $2,632.35 $2,632.35 7.9×
CT maxillofacial w contrast (70487) $2,411.75 $2,411.75 14.4×
CT maxillofacial w/o contrast (70486) $2,221.70 $2,221.70 22.2×
CT maxillofacial w/wo contrast (70488) $2,355.78 $2,355.78 14.1×
CT neck soft tissue w contrast (70491) $2,689.05 $2,689.05 16.0×
CT orbit sella/post fossa/ear w/o & w/contr matr (70482) $3,007.31 $3,007.31 17.9×
CT orbits w/o contrast (70480) $2,338.67 $2,338.67 23.4×
CT pelvis w/o contrast (72192) $2,304.23 $2,304.23 23.1×
CT soft tissue neck w/o & w/contrast material (70492) $3,222.24 $3,222.24 19.2×
CT soft tissue neck w/o contrast (70490) $2,338.67 $2,338.67 23.4×
CT thoracic spine w/contrast (72129) $2,592.56 $2,592.56 15.5×
CT thoracic spine w/o contrast (72128) $1,848.11 $1,848.11 18.5×
CT thoracic spine w/wo contrast (72130) $3,757.22 $3,757.22 22.4×
CT thorax w/o contrast (71250) $1,985.66 $1,985.66 19.9×
CT upper extremity w/o & w/contrast material (73202) $2,698.40 $2,698.40 16.1×
CT upper extremity w/o contrast rt (73200) $2,097.48 $2,097.48 21.0×
CT upper extremity with contrast (73201) $2,427.81 $2,427.81 7.3×
Cta Abdl Aorta&Bi Iliofem W/Contrast&Postp (75635) $4,190.45 $4,190.45 25.0×
Cta Abdomen (74175) $3,236 $3,236 19.3×
CTA abdomen pelvis (74174) $4,768.58 $4,768.58 14.3×
CTA chest (71275) $2,927.40 $2,927.40 17.5×
Cta Head (70496) $3,659.88 $3,659.88 21.8×
CTA lwr ext w&w/o contrast (73706) $3,846.68 $3,846.68 22.9×
Cta Neck (70498) $3,659.88 $3,659.88 21.8×
Cystography minimum 3 views rs&i (74430) $1,393.35 $1,393.35 4.2×
Dxa bone density study 1/> sites axial skel (77080) $739.73 $739.73 7.4×
Dxa bone density study 1/>sites appendiclr skel (77081) $473.87 $473.87 5.7×
Esophagus (74220) $907.31 $907.31 5.4×
Fluoroscopy up to 1 hr (76000) $838.85 $838.85 3.7×
Foot 2 views (73620) $308.49 $308.49 3.7×
Forearm 2 views (73090) $290.85 $290.85 3.5×
Hand 2 views (73120) $274.26 $274.26 2.7×
Hand 3 views (73130) $345.98 $345.98 4.2×
Hepatobil Syst Imag Inc Gb W/Pharma Intervenj (78227) $2,216.55 $2,216.55 4.3×
Hepatobiliary syst imaging including gallbladder (78226) $1,592.43 $1,592.43 4.2×
Humerus Min 2 Views Left (73060) $334.64 $334.64 4.0×
Kidney Img Morphology Vascular Flow 1 W/O Rx (78707) $1,490.37 $1,490.37 2.9×
Kidney img morphology vascular flow 1 w/rx (78708) $2,596.13 $2,596.13 5.0×
Knee 3 views (73562) $358.58 $358.58 4.3×
Liver & spleen imaging static only (78215) $2,045.30 $2,045.30 5.4×
Mr safety determination physician/other qhp (76016) $226.75 $226.75 2.7×
Mr safety implant pos&/immoblj supvj phys/qhp (76019) $151.01 $151.01 2.7×
Mr safety implant&/fb assmt clin staf 1st 15 min (76014) $63.32 $63.32 2.3×
Mr safety implt electronics prepj supvj phys/qhp (76018) $237.69 $237.69 2.6×
Mr safety med physics xm customization plng&mntr (76017) $624.82 $624.82 2.7×
MRA head w & w/o contrast (70546) $4,682.48 $4,682.48 14.0×
MRA head w/o contrast (70544) $3,163.86 $3,163.86 13.9×
Mra Neck W/O &W/Contrast Material (70549) $4,583.57 $4,583.57 13.7×
MRA neck w/o contrast (70547) $3,163.86 $3,163.86 13.9×
MRI abdomen w/o & w/contrast material (74183) $5,606.90 $5,606.90 16.8×
MRI abdomen w/o contrast (74181) $4,563.30 $4,563.30 20.0×
MRI any jnt lwr ext with con lt (73722) $3,476.76 $3,476.76 4.6×
MRI any jt upper extremity w/contrast matrl (73222) $4,674.92 $4,674.92 6.2×
MRI c-spine with contrast (72142) $4,184.57 $4,184.57 12.5×
MRI cervical spine w/o contrast (72141) $3,404.10 $3,404.10 14.9×
MRI chest w/o contrast (71550) $4,343.12 $4,343.12 19.0×
MRI Forearm w/ Contrast Bilateral 73219 (73219) $3,356.01 $3,356.01 10.1×
MRI lower extrem oth/thn jt w/o contr matrl (73718) $3,665.34 $3,665.34 16.1×
MRI orbit face &/neck w/o contrast (70540) $4,124.82 $4,124.82 18.1×
MRI orbit/face/neck w&w/o cont (70543) $5,541.27 $5,541.27 16.6×
MRI pelvis w contrast (72196) $4,696.13 $4,696.13 14.1×
MRI pelvis w/o & w/contrast material (72197) $5,496.54 $5,496.54 16.5×
MRI pelvis w/o contrast (72195) $4,565.61 $4,565.61 20.0×
MRI scan of arm joint before and after contrast (73223) $5,019.11 $5,019.11 15.1×
MRI scan of leg joint before and after contrast (73723) $4,046.39 $4,046.39 12.1×
MRI spinal canal cervical w/o & w/contr matrl (72156) $5,298.83 $5,298.83 15.9×
MRI spinal canal lumbar w/contrast material (72149) $3,906.21 $3,906.21 11.7×
MRI spinal canal lumbar w/o & w/contr matrl (72158) $4,669.46 $4,669.46 14.0×
MRI spinal canal thoracic w/contrast matrl (72147) $4,810.16 $4,810.16 14.4×
MRI spinal canal thoracic w/o & w/contr matrl (72157) $5,443.20 $5,443.20 16.3×
MRI thoracic spine w/o contrast (72146) $3,727.50 $3,727.50 16.3×
MRI tmj (70336) $435.44 $435.44 1.9×
MRI upper ext joint w/o contrast (73221) $3,309.39 $3,309.39 14.5×
MRI upper extrem other than jt w/o & w/contras (73220) $4,922.09 $4,922.09 14.8×
MRI upper extremity oth than jt w/o contr matrl (73218) $4,343.12 $4,343.12 19.0×
N-Invas Est C Ffr Augmnt Sw Alys Cta I&R Phy/Qhp (75580) $4,767.95 $4,767.95 5.8×
Neck soft tissue (70360) $463.38 $463.38 5.6×
Nm gastric emptying study (78264) $1,773.24 $1,773.24 4.6×
Osseous survey infant (77076) $696.89 $696.89 7.0×
Parathyroid imaging (78070) $2,019.26 $2,019.26 5.3×
Pelvis 1 or 2 views (72170) $440.48 $440.48 4.4×
Pr MRI, lower extr, w/o contrast f/u by contrast (73720) $5,606.90 $5,606.90 16.8×
Pulmonary Ventilation & Perfusion Imaging (78582) $1,702.68 $1,702.68 3.3×
Radex abscess/fistula/sinus tract rs&i (76080) $2,030.28 $2,030.28 3.9×
Radex Entir Thrc Lmbr Crv Sac Spi W/Skull 1 Vw - Xr Scoliosis 1 Vw (72081) $246.50 $246.50 3.0×
Radex entir thrc lmbr crv sac spi w/skull 2/3 vw (72082) $366.87 $366.87 3.7×
Radex hips bilateral with pelvis 2 views (73521) $707.18 $707.18 7.1×
Radex X-Ray Exam Entire Spi 6/> Vw - Xr Entire Spine 6+ Vw (72084) $880 $880 8.8×
Radiolog exam mandible compl minimum 4 views (70110) $427.46 $427.46 4.3×
Radiologic Exam Abdomen 1 View - Xr Abdomen 1 View (74018) $347.13 $347.13 4.2×
Radiologic Exam Abdomen 3+ Views - Xr Abdomen 3+ Views (74021) $503.16 $503.16 5.0×
Radiologic Exam Chest 2 Views - Xr Chest 2 Views (71046) $371.28 $371.28 4.5×
Radiologic exam colon single contrast study (74270) $828.03 $828.03 4.9×
Radiologic exam upr gi trc double contrast study (74246) $1,080.03 $1,080.03 6.4×
Radiologic exam upr gi trc single contrast study (74240) $880.43 $880.43 5.3×
Radiologic Examination Femur Minimum 2 Views - Xr Femur 2+ Vw Lt (73552) $330.75 $330.75 4.0×
Radiological examination surgical specimen (76098) $429.87 $429.87 0.8×
Ribs bilateral 3 views (71110) $551.57 $551.57 5.5×
Rp loclzj tum spect 1 area single day imaging (78803) $2,745.02 $2,745.02 5.3×
Sacroiliac Joints < 3 Views (72200) $427.77 $427.77 4.3×
Scanogram (77073) $559.13 $559.13 5.6×
Scapula complete (73010) $440.48 $440.48 4.4×
Screening digital breast tomosynthesis (77063) $105 $105 4.5×
Shuntogram indwelling nonvascular shunt rs&i (75809) $865.73 $865.73 8.7×
Small bowel series (74250) $907.31 $907.31 5.4×
Spine thoracic 3 views (72072) $550.31 $550.31 5.5×
Thoracolumbar 2 views (72080) $593.67 $593.67 7.1×
Thyroid Imaging With Vascular Flow (78013) $1,330.04 $1,330.04 3.5×
Tumor Imaging, Limited Area - Nm Tumor Localization Limited (78800) $2,061.36 $2,061.36 5.4×
Ultrasound, abdomen limited (76705) $899.75 $899.75 9.0×
Urography (pyelography), intravenous, with or without KUB, with or without tomography (74400) $1,352.40 $1,352.40 8.1×
Us abdl aorta screen aaa (76706) $517.23 $517.23 5.2×
Us breast unilateral complete (76641) $767.03 $767.03 7.7×
Us breast unilateral limited (76642) $511.04 $511.04 6.1×
Us chest (76604) $1,053.05 $1,053.05 10.5×
Us compl joint r-t w/image documentation (76881) $899.75 $899.75 9.0×
Us ob transvaginal (76817) $1,005.90 $1,005.90 10.1×
Us pelvic non ob complete (76856) $998.87 $998.87 10.0×
Us pelvic nonobstetric image dcmtn limited/f/u (76857) $912.24 $912.24 9.1×
Us pregnancy ltd (76815) $738.89 $738.89 7.4×
Us pregnant uterus 14 wk transabdl 1/1st gestat (76801) $977.03 $977.03 9.8×
Us retroperitoneal complete (76770) $1,092 $1,092 10.9×
Us retroperitoneal limited (76775) $899.75 $899.75 9.0×
Us scrotum and contents (76870) $899.75 $899.75 9.0×
Us soft tissue head/neck (76536) $960.44 $960.44 9.6×
Us transrectal (76872) $918.44 $918.44 9.2×
Us transrectal prostate volume (76873) $1,189.13 $1,189.13 11.9×
Us xtr non-vasc lmtd (76882) $675.47 $675.47 6.8×
Wrist 2 views (73100) $330.12 $330.12 4.0×
X-Ray Abdomen,Comp Acute Series - Xr Abdomen 2 Vws With Chest 1 View (74022) $733.22 $733.22 7.3×
X-Ray Ac Jts - Xr Acromioclavicular Joints Bilateral (73050) $468.51 $468.51 5.6×
X-Ray Ankle 3+ Vw - Xr Ankle 3+ Views Right (73610) $345.98 $345.98 4.2×
X-Ray Colon Air Contrast - Fl Barium Enema Air Contrast (74280) $828.03 $828.03 4.9×
X-Ray Elbow 2 Vw - Xr Elbow 1-2 Views Right (73070) $304.92 $304.92 3.7×
X-Ray Elbow 3+ Vw - Xr Elbow 3+ Views Right (73080) $334.64 $334.64 4.0×
X-ray exam entire spi 4/5 vw (72083) $696.89 $696.89 7.0×
X-ray exam hip uni 1 view (73501) $279.20 $279.20 3.4×
X-Ray Exam Hip Uni 2-3 Views (73502) $505.79 $505.79 6.1×
X-Ray Exam Hips Bi 3-4 Views (73522) $807.98 $807.98 8.1×
X-Ray Exam Hips Bi 5/> Views (73523) $377.37 $377.37 3.8×
X-ray exam of femur 1 (73551) $256.83 $256.83 3.1×
X-ray eye for foreign body (70030) $431.03 $431.03 5.2×
X-Ray Facial Bones 3+ Vw - Xr Facial Bones 3+ Views (70150) $436.38 $436.38 4.4×
X-Ray Facial Bones <3 Vw - Xr Facial Bones 1-2 Views (70140) $307.02 $307.02 3.7×
X-Ray Foot 3+ Vw - Xr Foot 3+ Views Right (73630) $345.98 $345.98 4.2×
X-Ray Heel - Xr Calcaneus 2 Views Right (73650) $281.82 $281.82 3.4×
X-Ray Jaw <4 Vw - Xr Mandible < 4 Views (70100) $311.96 $311.96 3.8×
X-Ray Knee 4+ View - Xr Knee 4+ Views Right (73564) $475.02 $475.02 4.8×
X-Ray Knee Bilat Standing - Xr Knees Anteroposterior Standing Bilat (73565) $334.64 $334.64 4.0×
X-Ray Leg, Infant - Xr Lower Extremity 2+ Views Infant Left (73592) $288.02 $288.02 3.5×
X-Ray Lumbar Spine 2/3 Vw - Xr Lumbar Spine 2-3 Views (72100) $551.57 $551.57 5.5×
X-Ray Lumbar Spine 6+ Vw - Xr Lumbar Spine 6+ Vws Including Bending (72114) $739.73 $739.73 7.4×
X-Ray Nasal Bones - Xr Nasal Bones (70160) $436.38 $436.38 5.2×
X-Ray Nose-Rectum Child F.B. - Xr Nose to Rectum Foreign Body Peds (76010) $435.44 $435.44 5.2×
X-Ray Orbits - Xr Orbits Complete 4+ Views (70200) $409.82 $409.82 4.1×
X-Ray Pelvis 3+ Vw - Xr Pelvis 3+ Views (72190) $576.14 $576.14 5.8×
X-Ray Retrograde Pyelogram - Fl Pyelogram Retrograde (74420) $1,435.25 $1,435.25 4.3×
X-Ray Ribs 2 Vw Unilat - Xr Ribs 2 Views Right (71100) $378 $378 4.5×
X-Ray Ribs, Chest 3+ Vw - Xr Ribs 2 Vws Lt W/ Chest Anteroposterior (71101) $606.59 $606.59 6.1×
X-Ray Ribs, Chest 4+ Vw - Xr Ribs 3 Vws Bil W/ Chest Posteroanterior (71111) $793.28 $793.28 7.9×
X-Ray Sacroiliac Jts 3+ Vw - Xr Sacroiliac Joints 3+ Views (72202) $427.77 $427.77 4.3×
X-Ray Sacrum/Coccyx 2+ Vw - Xr Sacrum Coccyx 2+ Views (72220) $440.48 $440.48 5.3×
X-Ray Shoulder 2+ Vw - Xr Shoulder 2+ Views Right (73030) $412.34 $412.34 5.0×
X-Ray Sinuses 3+ Vw - Xr Paranasal Sinuses 3+ Views (70220) $497.81 $497.81 6.0×
X-Ray Skull 4+ Vw - Xr Skull Complete 4+ Views (70260) $696.89 $696.89 7.0×
X-Ray Skull <4 Vw - Xr Skull 1-3 Views (70250) $426.41 $426.41 4.3×
X-Ray Spine One View - Xr Spine (72020) $275.31 $275.31 3.3×
X-Ray Sterno-Clavicluar Jt - Xr Sternoclavicular Joints 3+ Views (71130) $427.46 $427.46 5.1×
X-Ray Sternum 2+ Vw - Xr Sternum 2+ Views (71120) $334.64 $334.64 4.0×
X-Ray Thoracic Spine 2 Vw - Xr Thoracic Spine 2 Views (72070) $468.51 $468.51 4.7×
X-Ray Thoracic Spine 4 Vw - Xr Thoracic Spine Complete 4+ Views (72074) $591.36 $591.36 5.9×
X-Ray Toe(S) - Xr Toes 2+ Views Right (73660) $330.12 $330.12 4.0×
X-Ray Wrist 3+ Vw - Xr Wrist 3+ Views Right (73110) $440.48 $440.48 5.3×
Xr c-spine 6 or more views (72052) $770.49 $770.49 7.7×
Xr chest 4+ views (71048) $529.20 $529.20 5.3×
Xr finger(s) 2+ views (73140) $236.04 $236.04 2.8×
Xr spine cervical 4 or 5 views (72050) $739.73 $739.73 7.4×
Xr tibia/fibula 2 views (73590) $440.48 $440.48 5.3×
Xr tmj bilateral (70330) $620.97 $620.97 7.5×
Xray knee 1 or 2 views rt (73560) $307.34 $307.34 3.7×