Imaging prices at Aultman Alliance Community Hospital

Alliance, OH · every code in this section with a posted price and a Medicare benchmark.

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

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ProcedurePosted cashPosted gross× Medicare
Abdomen 1 View (74018) $245.70 $546 3.0×
Abdomen 2 views (74019) $454.05 $1,009 4.6×
Acute Gastrointestinal Blood Loss Imaging (78278) $355.05 $789 0.9×
Ankle 2 views (73600) $142.65 $317 1.7×
Bone age studies (77072) $127.35 $283 1.3×
Bone Imaging 3 Phase (78315) $383.40 $852 1.0×
Bone Imaging Whole Body (78306) $377.10 $838 1.0×
Bone survey infant (77076) $258.30 $574 2.6×
Card Bl Pool Gated Spect Rest Wal Motn Ejct Frct (78494) $1,475.55 $3,279 3.9×
Cerebrospinal Fluid Scan (78630) $456.75 $1,015 0.9×
Chest 1 view (71045) $174.60 $388 2.1×
Chest 2 views (71046) $174.60 $388 2.1×
Chest 4 or more views (71048) $320.85 $713 3.2×
Clavicle complete (73000) $88.20 $196 1.1×
Computed Tomography Thorax Lw Dose Lng Ca Scr C- (71271) $255.60 $568 2.6×
Contrast X-Ray Bladder (74430) $327.15 $727 1.0×
CT abdomen and pelvis without and with contrast (74178) $1,335.15 $2,967 4.0×
CT abdomen and pelvis without contrast (74176) $1,037.70 $2,306 4.6×
CT abdomen w contrast (74160) $726.30 $1,614 4.4×
CT abdomen w wo contrast (74170) $835.20 $1,856 5.0×
CT abdomen w/o contrast (74150) $626.40 $1,392 6.3×
CT Angio Abdomen and Pelvis (74174) $1,236.60 $2,748 3.7×
CT Angio Chest (71275) $608.85 $1,353 3.7×
CT Angio Head (70496) $586.80 $1,304 3.5×
CT angio hrt w/3d image (75574) $591.75 $1,315 1.8×
CT Angio Neck (70498) $586.80 $1,304 3.5×
Ct Angio Upr Extrm W/O&W/Dye (73206)
range across 2 matching MRF lines		 $856.80–$2,560.95 $1,904–$5,691 varies
CT cervical spine w/ contrast (72126) $658.80 $1,464 2.0×
CT cervical spine w/o contrast (72125) $572.40 $1,272 5.8×
CT cervical spine w/wo cont (72127) $777.15 $1,727 4.7×
CT chest w contrast (71260) $601.65 $1,337 3.6×
CT chest w/wo contrast (71270) $777.15 $1,727 4.7×
CT head/brain with contrast (70460) $579.60 $1,288 3.5×
CT head/brain without and with contrast (70470) $661.05 $1,469 4.0×
CT heart contrast eval cardiac structure&morph (75572) $1,022.40 $2,272 3.1×
CT heart no contrast quant eval coronry calcium (75571) $339.75 $755 4.1×
CT iac w contrast (70481) $525.15 $1,167 3.2×
CT l-spine w&w/o contrast (72133) $777.15 $1,727 4.7×
CT lower ext w/o (73700) $472.50 $1,050 4.8×
CT lower extremity w/contrast material (73701) $601.65 $1,337 3.6×
CT lumbar spine w contrast (72132) $683.55 $1,519 2.1×
CT lumbar spine w/o contrast (72131) $594 $1,320 6.0×
CT maxillofacial w contrast (70487) $511.65 $1,137 3.1×
CT maxillofacial wo contrast (70486) $495.45 $1,101 5.0×
CT neck tissue combo (70492) $878.40 $1,952 5.3×
Ct Orbit/Ear/Fossa W/O&W/Dye (70482) $661.05 $1,469 4.0×
CT orbits w/o contrast (70480) $456.30 $1,014 4.6×
CT pelvis w/o contrast (72192) $567 $1,260 5.7×
CT scan of leg combo (73702) $697.50 $1,550 4.2×
CT scans face/jaw combo (70488) $653.40 $1,452 3.9×
CT soft tissue neck w contrast (70491) $519.30 $1,154 3.1×
CT soft tissue neck w/o contrast (70490) $397.35 $883 4.0×
CT thoracic spine w contrast (72129) $683.55 $1,519 4.1×
CT thoracic spine w/o contrast (72128) $594 $1,320 6.0×
CT thoracic spine w/wo cont (72130) $777.15 $1,727 4.7×
CT thorax w/o contrast (71250) $472.50 $1,050 4.8×
CT upper ext wo (73200) $472.50 $1,050 4.8×
CT upper extremity with contrast (73201) $601.65 $1,337 1.8×
Cta Abdl Aorta&Bi Iliofem W/Contrast&Postp (75635) $608.85 $1,353 3.7×
Dxa Bone Density Axial (77080) $295.65 $657 3.0×
Dxa bone density study (77085) $197.55 $439 2.0×
Dxa bone density study 1/>sites appendiclr skel (77081) $123.30 $274 1.5×
Esophagram (74220) $248.85 $553 1.5×
Fetal Biophysical Profile W/O Non-Stress Testing (76819) $404.55 $899 4.1×
Fluoroscopy up to 1 hr (76000) $295.65 $657 1.3×
Foot 2 views (73620) $142.65 $317 1.7×
Forearm 2 views (73090) $116.10 $258 1.4×
Gastric emptying imaging study (78264) $355.05 $789 0.9×
Gated Heart Planar Single (78472) $406.35 $903 1.1×
Hand 2 views (73120) $142.65 $317 1.4×
Hepatobil Syst Image W/Drug (78227) $841.95 $1,871 1.6×
Hepatobiliary System Imaging (78226) $841.95 $1,871 2.2×
Ht Muscle Image Spect Sing (78451) $562.95 $1,251 0.5×
Hysterosalpingogram (74740) $368.10 $818 1.6×
K Flow/Funct Image Multiple (78709) $891.90 $1,982 1.7×
K Flow/Funct Image W/Drug (78708) $627.30 $1,394 1.2×
K Flow/Funct Image W/O Drug (78707) $1,030.05 $2,289 2.0×
Knee 3 Views (73562) $246.60 $548 3.0×
Liver & Spleen Imaging Static Only (78215) $392.40 $872 1.0×
Liver & Spleen Imaging W/Vascular Flow (78216) $392.40 $872 1.0×
Lung Perf&Ventilat Diferentl (78598) $908.55 $2,019 1.8×
Lung Ventilat&Perfus Imaging (78582) $908.55 $2,019 1.8×
Lung Ventilation Imaging (78579) $581.40 $1,292 1.5×
Lymph System Imaging (78195) $475.65 $1,057 0.9×
Magnetic Image Jaw Joint (70336) $1,048.05 $2,329 4.6×
Meckels Divert Exam (78290) $355.05 $789 0.9×
Mr safety determination physician/other qhp (76016) $72 $160 0.9×
Mr safety implant&/fb assmt clin staf 1st 15 min (76014) $19.80 $44 0.7×
Mr safety implt electronics prepj supvj phys/qhp (76018) $75.15 $167 0.8×
Mr safety implt pos&/immoblj (76019) $48.60 $108 0.9×
Mr safety med physics xm customization plng&mntr (76017) $197.55 $439 0.9×
Mra Head W/O & W/Contrast Material (70546) $1,496.70 $3,326 4.5×
MRA head w/o contrast (70544) $1,084.50 $2,410 4.8×
MRA head with contrast (70545) $1,106.55 $2,459 3.4×
MRA neck w contrast (70548) $1,246.95 $2,771 3.8×
Mra Neck W/O &W/Contrast Material (70549) $1,435.50 $3,190 4.3×
MRA neck w/o contrast (70547) $1,084.50 $2,410 4.8×
MRI abdomen w contrast (74182) $1,242 $2,760 3.8×
MRI abdomen w/o contrast (74181) $1,048.05 $2,329 4.6×
MRI any jt lower extrem w/contrast material (73722) $1,204.65 $2,677 1.6×
MRI any jt lower extrem w/o & w/contrast matrl (73723) $1,386 $3,080 4.2×
MRI any jt upper extremity w/contrast matrl (73222) $1,204.65 $2,677 1.6×
MRI cervical spine w contrast (72142) $1,246.95 $2,771 3.8×
MRI cervical spine w/o cont (72141) $1,084.50 $2,410 4.8×
MRI chest w/o contrast (71550) $1,048.05 $2,329 4.6×
MRI chest with contrast (71551) $1,126.80 $2,504 1.5×
MRI chest wo w contrast (71552) $1,435.05 $3,189 4.3×
MRI lower extrem oth/thn jt w/contrast matrl (73719) $1,169.10 $2,598 3.5×
MRI lower extrem oth/thn jt w/o & w/contr matr (73720) $1,344.15 $2,987 4.1×
MRI lower extrem oth/thn jt w/o contr matrl (73718) $1,017 $2,260 4.5×
MRI lumbar spine w contrast (72149) $1,204.65 $2,677 3.6×
Mri Neck Spine W/O & W/Dye (72156) $1,485.90 $3,302 4.5×
MRI orbit face &/neck w/o contrast (70540) $1,084.50 $2,410 4.8×
MRI orbit face neck w contrast (70542) $750.60 $1,668 2.3×
Mri Orbt/Fac/Nck W/O &W/Dye (70543) $1,485.90 $3,302 4.5×
MRI pelvis w contrast (72196) $1,300.95 $2,891 3.9×
MRI pelvis w/o & w contrast (72197) $1,393.20 $3,096 4.2×
MRI pelvis w/o contrast (72195) $1,017 $2,260 4.5×
MRI thoracic spine w/o contrast (72146) $1,048.05 $2,329 4.6×
MRI upper extremity oth than jt w/contr matrl (73219) $1,169.10 $2,598 3.5×
MRI upper extremity oth than jt w/o contr matrl (73218) $1,017 $2,260 4.5×
Mri Uppr Extremity W/O&W/Dye (73220) $1,344.15 $2,987 4.1×
MRI, abdomen, combo (74183) $1,393.20 $3,096 4.2×
MRI, dorsal spine combo (72157) $1,435.05 $3,189 4.3×
MRI, dorsal spine contrast (72147) $1,204.65 $2,677 3.6×
MRI, joint upper extrem (73221) $1,048.05 $2,329 4.6×
MRI, joint upper extrem combo (73223) $1,386 $3,080 4.2×
MRI, lumbar spine combo (72158) $1,435.05 $3,189 4.3×
Myocardial Spect Multiple Studies (78452) $2,009.70 $4,466 1.6×
Neck soft tissue (70360) $146.70 $326 1.8×
Parathyroid Planar Imaging (78070) $431.10 $958 1.1×
Parathyroid planar imaging w/wo subtraction (78071) $1,189.80 $2,644 3.1×
Pelvis 1 or 2 views (72170) $139.05 $309 1.4×
PET image w/CT, full body (78816) $2,620.35 $5,823 1.9×
PET imaging CT attenuation skull base mid-thigh (78815) $2,620.35 $5,823 1.9×
Pulmonary Perfusion Imaging Particulate (78580) $323.55 $719 0.9×
Radex Abd Compl Aqt Abd W/S/E/D Views 1 View Ch (74022) $454.05 $1,009 4.6×
Radex abscess/fistula/sinus tract rs&i (76080) $207.45 $461 0.4×
Radex Ankle Complete Minimum 3 Views (73610) $157.95 $351 1.9×
Radex Calcaneus Minimum 2 Views (73650) $109.35 $243 1.3×
Radex elbow complete minimum 3 views (73080) $157.95 $351 1.9×
Radex Facial Bones Complete Minimum 3 Views (70150) $147.15 $327 1.5×
Radex fingr minimum 2 views (73140) $89.10 $198 1.1×
Radex foot complete minimum 3 views (73630) $157.95 $351 1.9×
Radex Hand Minimum 3 Views (73130) $157.95 $351 1.9×
Radex lower extremity infant minimum 2 views (73592) $117 $260 1.4×
Radex Nasal Bones Complete Minimum 3 Views (70160) $123.75 $275 1.5×
Radex Ribs Unilateral 2 Views (71100) $136.35 $303 1.7×
Radex shoulder complete minimum 2 views (73030) $160.65 $357 2.0×
Radex Sinuses Paransl < 3 Views (70210) $140.40 $312 1.7×
Radex Spine 1 View Specify Level (72020) $225.90 $502 2.7×
Radex Sternum Minimum 2 Views (71120) $109.35 $243 1.3×
Radex Temporomandble Jt Opn & Clsd Mouth Bilat (70330) $243.90 $542 3.0×
Radex Toe Minimum 2 Views (73660) $89.10 $198 1.1×
Radex upper extremity infant minimum 2 views (73092) $94.50 $210 1.0×
Radex Wrist Complete Minimum 3 Views (73110) $196.20 $436 2.4×
Radiolog exam mandible compl minimum 4 views (70110) $185.85 $413 1.9×
Radiologic Exam Abdomen 3+ Views - Xr Abdomen 3+ Views (74021) $454.05 $1,009 4.6×
Radiologic exam colon double contrast study (74280) $435.15 $967 2.6×
Radiologic exam colon single contrast study (74270) $395.55 $879 2.4×
Radiologic Exam Esophagus Double Contrast Study (74221) $311.40 $692 1.9×
Radiologic exam pelvis compl minimum 3 views (72190) $362.70 $806 3.7×
Radiologic Exam Small Int Single Contrast Study (74250) $288.90 $642 1.7×
Radiologic exam swallow function contrast study (74230) $253.35 $563 1.5×
Radiologic exam upr gi trc double contrast study (74246) $280.80 $624 1.7×
Radiologic examination femur minimum 2 views (73552) $246.60 $548 3.0×
Radiologic examination knee 1/2 views (73560) $223.20 $496 2.7×
Radiologic Examination Osseous Survey Limited (77074) $297.45 $661 3.0×
Radiologic examination tibia & fibula 2 views (73590) $117 $260 1.4×
Rp Loclzj Tum Plnr Whole Body 2+ Days Imaging (78804) $2,235.15 $4,967 4.4×
Rp Loclzj Tum Spect 1 Area Single Day Imaging (78803) $1,287 $2,860 2.5×
Rp loclzj tum spect CT 2area 1d img/1 ar img>2+d (78832) $3,341.70 $7,426 2.5×
Rp loclzj tum spect w/CT 1 area/acquisj 1day img (78830) $1,415.70 $3,146 1.2×
Scapula (73010) $117 $260 1.2×
Screening Digital Breast Tomosynthesis Bi (77063) $80.10 $178 3.4×
Shoulder 1 view (73020) $146.25 $325 1.8×
Skull less than 4 views (70250) $142.65 $317 1.4×
Sternoclavicular joints (71130) $88.20 $196 1.1×
Thoracic spine 2 views (72070) $142.65 $317 1.4×
Thoracic spine 3 views (72072) $157.95 $351 1.6×
Thoracolumbar 2 views (72080) $225.90 $502 2.7×
Thyroid Uptake W/Blood Flow Sngle/Mult Quan Meas (78014) $864.90 $1,922 2.3×
Ultrasound Breast Limited (76642)
range across 2 matching MRF lines		 $314.55–$347.40 $699–$772 varies
Ultrasound Elastography Parenchyma (76981) $544.50 $1,210 5.5×
Ultrasound Exam Aaa Screen (76706) $411.30 $914 4.2×
Ultrasound, abdomen limited (76705) $179.10 $398 1.8×
Upper gi w/o kub (74240) $362.70 $806 2.2×
Us breast unilateral complete (76641)
range across 2 matching MRF lines		 $347.40–$485.55 $772–$1,079 varies
Us chest (76604) $229.05 $509 2.3×
Us exam, pelvic, limited (76857) $260.10 $578 2.6×
Us lmtd joint/oth nonvasc xtr strux r-t w/img (76882) $203.40 $452 2.1×
Us ob detailed single fetus (76811) $404.55 $899 1.8×
Us ob limited 1 or more fetuses (76815) $306.90 $682 3.1×
Us ob transvaginal (76817) $113.40 $252 1.1×
Us pelvic non ob complete (76856) $310.05 $689 3.1×
Us pg uter img f&mat 14 wk tabdl 1/1st gestation (76801) $113.40 $252 1.1×
Us preg uterus real time f/u trnsabdl per fetus (76816) $289.80 $644 2.9×
Us retroperitoneal complete (76770) $416.25 $925 4.2×
Us retroperitoneal limited (76775) $211.50 $470 2.1×
Us scrotum and contents (76870) $196.65 $437 2.0×
Us thyroid (76536) $233.55 $519 2.4×
Vertebral fracture assessment via dxa (77086) $82.35 $183 1.0×
Wrist 2 views (73100) $196.20 $436 2.4×
X-Ray Ac Jts - Xr Acromioclavicular Joints Bilateral (73050) $131.85 $293 1.6×
X-ray antegrade pyelogram tube (74425) $328.50 $730 1.0×
X-Ray Elbow 2 Vw - Xr Elbow 1-2 Views Right (73070) $142.65 $317 1.7×
X-Ray Exam Breast Specimen (76098) $69.30 $154 0.1×
X-Ray Exam Entire Spi 1 Vw (72081) $223.20 $496 2.7×
X-Ray Exam Entire Spi 2/3 Vw (72082) $246.60 $548 2.5×
X-Ray Exam Hip Uni 1 View (73501) $142.20 $316 1.7×
X-Ray Exam Hip Uni 2-3 Views (73502) $162.45 $361 2.0×
X-Ray Exam Hip Uni 4/> Views (73503) $371.70 $826 3.8×
X-Ray Exam Hips Bi 3-4 Views (73522) $371.70 $826 3.8×
X-Ray Exam Hips Bi 5/> Views (73523) $706.50 $1,570 7.1×
X-Ray Exam Neck Spine 2-3 Vw (72040) $154.35 $343 1.9×
X-Ray Exam Neck Spine 6/>Vws (72052) $240.30 $534 2.4×
X-Ray Exam Unilat Ribs/Chest (71101) $314.55 $699 3.2×
X-ray eye for foreign body (70030) $150.30 $334 1.8×
X-ray humerus (73060) $114.75 $255 1.4×
X-Ray Lumbar Spine 2/3 Vw - Xr Lumbar Spine 2-3 Views (72100) $222.75 $495 2.3×
X-ray nose-rectum child f.b. (76010) $236.70 $526 2.9×
X-Ray Ribs, Chest 4+ Vw - Xr Ribs 3 Vws Bil W/ Chest Posteroanterior (71111) $307.35 $683 3.1×
X-Ray Sacroiliac Jts 3+ Vw - Xr Sacroiliac Joints 3+ Views (72202) $88.20 $196 0.9×
X-Ray Sacroiliac Jts <3 Vw - Xr Sacroiliac Joints 1-2 Views (72200) $247.95 $551 2.5×
X-Ray Sacrum/Coccyx 2+ Vw - Xr Sacrum Coccyx 2+ Views (72220) $131.85 $293 1.6×
X-Ray Sinuses 3+ Vw - Xr Paranasal Sinuses 3+ Views (70220) $208.35 $463 2.5×
X-Ray Skull 4+ Vw - Xr Skull Complete 4+ Views (70260) $174.60 $388 1.8×
X-ray thoracic spine 4 vw (72074) $208.35 $463 2.1×
X-Ray Tmj Unilat (70328) $220.50 $490 2.7×
X-Rays Bone Length Studies (77073) $209.25 $465 2.1×
X-Rays Bone Survey Complete (77075) $399.15 $887 4.0×
Xr c-spine 4 or 5 views (72050) $208.35 $463 2.1×
Xr facial bones less than 3 views (70140) $142.20 $316 1.7×
Xr orbits complete 4 views (70200) $174.15 $387 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.