Imaging prices at Ascension Saint Thomas DeKalb

Smithville, TN · every code in this section with a posted price and a Medicare benchmark.

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

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ProcedureCash priceGross charge× Medicare
Abdomen 2 views (74019) $160.07 $533.55 1.6×
Acute gastrointestinal blood loss imaging (78278) $649.56 $2,165.20 1.7×
Angrph Cath F-Up Std Tcat Other Than Thrombylsis (75898) $982.62 $3,275.40 0.3×
Ankle 2 views (73600) $81.39 $271.30 1.0×
Arthrogram hip (73525) $267.26 $890.85 0.8×
Arthrogram shoulder (73040) $299.12 $997.05 0.9×
Arthrogram wrist (73115) $303.77 $1,012.55 0.9×
Arthrography knee lt (73580) $225.94 $753.15 0.7×
Bone &/Joint Imaging Limited Area (78300) $468.23 $1,560.75 1.2×
Bone &/joint imaging whole body (78306) $845.66 $2,818.85 2.2×
Bone age studies (77072) $80.31 $267.70 0.8×
Bone Imaging 3 Phase (78315) $995.72 $3,319.05 2.6×
Bone survey complete (77075) $397.41 $1,324.70 4.0×
Cervical spine 2 or 3 views (72040) $127.55 $425.15 1.5×
Chest 1 view (71045) $99.54 $331.80 1.2×
Cine/Vid X-Ray Throat/Esoph - Fl Esoph Barium Swlw W/ Video & Speech (74230) $200.67 $668.90 1.2×
Clavicle complete (73000) $128.76 $429.20 1.6×
CT abdomen and pelvis without and with contrast (74178) $2,001.08 $6,670.25 6.0×
CT abdomen and pelvis without contrast (74176) $1,721.63 $5,738.75 7.6×
CT abdomen w contrast (74160) $848.61 $2,828.70 5.1×
CT abdomen w wo contrast (74170) $963.39 $3,211.30 5.8×
CT abdomen w/o contrast (74150) $776.76 $2,589.20 7.8×
CT angiography upper extremity lt (73206) $988.25 $3,294.15 5.9×
CT c-spine w/o contrast (72125) $888.18 $2,960.60 8.9×
CT cervical spine with contrast (72126) $852.78 $2,842.60 2.6×
CT chest w/wo contrast (71270) $956.16 $3,187.20 5.7×
CT chest with contrast (71260) $832.46 $2,774.85 5.0×
CT head/brain with contrast (70460) $881.88 $2,939.60 5.3×
CT head/brain without and with contrast (70470) $885.95 $2,953.15 5.3×
CT heart no contrast quant eval coronry calcium (75571) $101.15 $337.15 1.2×
CT iac w contrast (70481) $699.03 $2,330.10 4.2×
CT limited/localized follow up study (76380) $247.43 $824.75 3.0×
CT lower ext w/o (73700) $701.21 $2,337.35 7.1×
CT lower extremity w wo contrast (73702) $753.90 $2,512.98 4.5×
CT lower extremity with contrast (73701) $732.74 $2,442.45 4.4×
CT lumbar spine w & w/o contrast (72133) $904.56 $3,015.20 5.4×
CT lumbar spine w/o contrast (72131) $934.41 $3,114.70 9.4×
CT lumbar spine with contrast (72132) $1,009.76 $3,365.85 3.0×
CT maxillofacial w contrast (70487) $622.91 $2,076.35 3.7×
CT maxillofacial w/o contrast (70486) $554.03 $1,846.75 5.6×
CT maxillofacial w/wo contrast (70488) $691.10 $2,303.65 4.2×
CT neck soft tissue w contrast (70491) $1,120.97 $3,736.55 6.7×
CT orbit sella/post fossa/ear w/o & w/contr matr (70482) $740.12 $2,467.05 4.4×
CT orbits w/o contrast (70480) $643.59 $2,145.30 6.5×
CT pelvis w & w/o contrast (72194) $926.10 $3,087 5.6×
CT pelvis w/o contrast (72192) $817.49 $2,724.95 8.2×
CT soft tissue neck w/o & w/contrast material (70492) $1,185.41 $3,951.35 7.1×
CT soft tissue neck w/o contrast (70490) $764.10 $2,547 7.7×
CT thoracic spine w/contrast (72129) $783.14 $2,610.45 4.7×
CT thoracic spine w/o contrast (72128) $859.25 $2,864.15 8.7×
CT thorax w/o contrast (71250) $770.84 $2,569.45 7.8×
CT upper extremity w/o contrast rt (73200) $725.55 $2,418.50 7.3×
CT upper extremity with contrast (73201) $668.72 $2,229.05 2.0×
Cta Abdl Aorta&Bi Iliofem W/Contrast&Postp (75635) $1,211.16 $4,037.20 7.3×
Cta Abdomen (74175) $1,479.80 $4,932.65 8.9×
CTA abdomen pelvis (74174) $1,707.77 $5,692.55 5.2×
CTA chest (71275) $1,211.85 $4,039.50 7.3×
Cta Head (70496) $1,097.79 $3,659.30 6.6×
CTA lwr ext w&w/o contrast (73706) $768.05 $2,560.15 4.6×
Cta Neck (70498) $1,097.79 $3,659.30 6.6×
Cystography minimum 3 views rs&i (74430) $497.66 $1,658.85 1.5×
Dxa bone density study 1/> sites axial skel (77080) $161.37 $537.90 1.6×
Echoencephalography real time imaging (76506) $199.89 $666.30 2.0×
Esophagus (74220) $165 $550 1.0×
Fetal biophysical profile non-stress testing (76818) $323.75 $1,079.15 3.3×
Fetal Biophysical Profile W/O Non-Stress Testing (76819) $131.31 $437.70 1.3×
Fluoroscopy up to 1 hr (76000) $121.87 $406.22 0.5×
Foot 2 views (73620) $70.29 $234.30 0.9×
Forearm 2 views (73090) $115.02 $383.40 1.4×
Gated Heart Planar Single (78472) $801.99 $2,673.30 2.1×
Hand 2 views (73120) $87.17 $290.55 0.9×
Hand 3 views (73130) $117.84 $392.80 1.4×
Hepatobil Syst Imag Inc Gb W/Pharma Intervenj (78227) $906.38 $3,021.25 1.8×
Hepatobiliary syst imaging including gallbladder (78226) $906.38 $3,021.25 2.4×
Ht muscle image spect sing (78451) $1,850.12 $6,167.05 1.5×
Humerus Min 2 Views Left (73060) $114.62 $382.05 1.4×
Hysterosalpingogram (74740) $267.26 $890.85 1.2×
Kidney Img Morphology Vascular Flow 1 W/O Rx (78707) $567.90 $1,893 1.1×
Kidney img morphology vascular flow 1 w/rx (78708) $750.63 $2,502.10 1.5×
Kidney Img Morphology Vascular Flow Multiple (78709) $607.47 $2,024.90 1.2×
Knee 3 views (73562) $160.85 $536.15 1.9×
Liver & spleen imaging static only (78215) $540.84 $1,802.80 1.4×
Lung perf&ventilat diferentl (78598) $642.36 $2,141.20 1.2×
Lung perfusion differential (78597) $657.60 $2,192 1.7×
Lymphoscintigraphy (78195) $718.83 $2,396.10 1.4×
Meckels Diverticulum (78290) $674.18 $2,247.25 1.8×
Mr safety determination physician/other qhp (76016) $75.90 $253 0.9×
Mr safety implant&/fb assmt clin staf 1st 15 min (76014) $19.61 $65.35 0.7×
Mr safety implt electronics prepj supvj phys/qhp (76018) $78.39 $261.30 0.9×
Mr safety med physics xm customization plng&mntr (76017) $208.35 $694.50 0.9×
MRA head w & w/o contrast (70546) $1,187.03 $3,956.75 3.6×
MRA head w/o contrast (70544) $780.39 $2,601.30 3.4×
MRA neck w contrast (70548) $901.76 $3,005.85 2.7×
Mra Neck W/O &W/Contrast Material (70549) $1,037.03 $3,456.75 3.1×
MRA neck w/o contrast (70547) $976.59 $3,255.30 4.3×
MRI abdomen w/o & w/contrast material (74183) $1,248.29 $4,160.95 3.8×
MRI abdomen w/o contrast (74181) $924.95 $3,083.15 4.1×
MRI any jnt lwr ext with con lt (73722) $1,207.62 $4,025.40 1.6×
MRI any jt upper extremity w/contrast matrl (73222) $972.71 $3,242.35 1.3×
MRI cervical spine w/o contrast (72141) $976.83 $3,256.10 4.3×
MRI chest w/o & w/contrast material (71552) $1,245.62 $4,152.05 3.8×
MRI chest w/o contrast (71550) $755.40 $2,518 3.3×
MRI lower extrem oth/thn jt w/contrast matrl (73719) $1,065.93 $3,553.10 3.2×
MRI lower extrem oth/thn jt w/o contr matrl (73718) $882.66 $2,942.20 3.9×
MRI orbit face &/neck w/o contrast (70540) $1,158.41 $3,861.35 5.1×
MRI orbit/face/neck w&w/o cont (70543) $1,152.21 $3,840.70 3.5×
MRI pelvis w contrast (72196) $976.83 $3,256.10 2.9×
MRI pelvis w/o & w/contrast material (72197) $1,333.79 $4,445.95 4.0×
MRI pelvis w/o contrast (72195) $882.27 $2,940.90 3.9×
MRI scan of arm joint before and after contrast (73223) $1,113.46 $3,711.52 3.4×
MRI scan of leg joint before and after contrast (73723) $1,021.52 $3,405.05 3.1×
MRI spinal canal cervical w/o & w/contr matrl (72156) $1,457.40 $4,858 4.4×
MRI spinal canal lumbar w/contrast material (72149) $1,013.60 $3,378.65 3.1×
MRI spinal canal lumbar w/o & w/contr matrl (72158) $1,424.84 $4,749.45 4.3×
MRI spinal canal thoracic w/o & w/contr matrl (72157) $1,383.93 $4,613.10 4.2×
MRI thoracic spine w/o contrast (72146) $976.83 $3,256.10 4.3×
MRI upper ext joint w/o contrast (73221) $936.15 $3,120.50 4.1×
MRI upper extrem other than jt w/o & w/contras (73220) $1,041.24 $3,470.80 3.1×
MRI upper extremity oth than jt w/o contr matrl (73218) $958.56 $3,195.20 4.2×
Myocardial Spect Multiple Studies (78452) $1,179.32 $3,931.05 1.0×
Neck soft tissue (70360) $123.83 $412.75 1.5×
Nm gastric emptying study (78264) $681.51 $2,271.70 1.8×
Nm gastroesophageal reflux study (78262) $366.68 $1,222.25 1.0×
Nuclear medicine study of kidney and blood flow (78701) $567.18 $1,890.60 1.5×
Nuclear Rx Oral Admin (79005) $584.61 $1,948.70 2.6×
Ob Us Follow-Up Per Fetus - Us Ob Follow Up Transabdominal Approach (76816) $211.22 $704.05 2.1×
Osseous survey infant (77076) $160.85 $536.15 1.6×
Parathyroid imaging (78070) $579.72 $1,932.40 1.5×
Pelvis 1 or 2 views (72170) $148.86 $496.20 1.5×
Pr MRI, lower extr, w/o contrast f/u by contrast (73720) $1,356.87 $4,522.90 4.1×
Pulmonary Perfusion Imaging Particulate (78580) $657.60 $2,192 1.7×
Pulmonary Ventilation & Perfusion Imaging (78582) $783.81 $2,612.70 1.5×
Radex abscess/fistula/sinus tract rs&i (76080) $183.54 $611.80 0.4×
Radex Entir Thrc Lmbr Crv Sac Spi W/Skull 1 Vw - Xr Scoliosis 1 Vw (72081) $127.17 $423.90 1.5×
Radex hips bilateral with pelvis 2 views (73521) $164.49 $548.30 1.7×
Radiolog exam mandible compl minimum 4 views (70110) $261.71 $872.35 2.6×
Radiologic Exam Abdomen 1 View - Xr Abdomen 1 View (74018) $146.03 $486.75 1.8×
Radiologic Exam Chest 2 Views - Xr Chest 2 Views (71046) $113.87 $379.55 1.4×
Radiologic exam colon single contrast study (74270) $293.31 $977.70 1.8×
Radiologic Exam Esophagus Double Contrast Study (74221) $173 $576.65 1.0×
Radiologic exam upr gi trc double contrast study (74246) $202.23 $674.10 1.2×
Radiologic exam upr gi trc single contrast study (74240) $228.68 $762.25 1.4×
Radiologic Examination Femur Minimum 2 Views - Xr Femur 2+ Vw Lt (73552) $125.25 $417.50 1.5×
Radiological examination surgical specimen (76098) $149.76 $499.20 0.3×
Ribs bilateral 3 views (71110) $151.20 $504 1.5×
Rp loclzj tum plnr 2+area 1+d img/1 area img>2+d (78801) $721.88 $2,406.25 1.9×
Rp loclzj tum spect 1 area single day imaging (78803) $772.52 $2,575.05 1.5×
Scanogram (77073) $69.21 $230.70 0.7×
Scapula complete (73010) $126.99 $423.30 1.3×
Screening digital breast tomosynthesis (77063) $32.45 $108.15 1.4×
Shuntogram indwelling nonvascular shunt rs&i (75809) $142.49 $474.95 1.4×
Small bowel series (74250) $257.81 $859.35 1.5×
Spine thoracic 3 views (72072) $190.44 $634.80 1.9×
Tbs Technical Calculation Only (77091) $129.47 $431.55 1.6×
Testicular Imaging With Vascular Flow (78761) $329.15 $1,097.15 0.9×
Thoracolumbar 2 views (72080) $142.88 $476.25 1.7×
Thyroid carcinoma metastases img whole body (78018) $436.38 $1,454.60 0.8×
Thyroid Imaging With Vascular Flow (78013) $370.16 $1,233.85 1.0×
Thyroid uptake measurement (78012) $251.84 $839.45 0.7×
Thyroid Uptake W/Blood Flow Sngle/Mult Quan Meas (78014) $801.02 $2,670.05 2.1×
Trabecular bone score (TBS), structural condition of the bone microarchitecture; technical preparation and transmission… (77090) $129.47 $431.55 1.6×
Tumor Imaging, Limited Area - Nm Tumor Localization Limited (78800) $168.95 $563.15 0.4×
Ultrasound, abdomen limited (76705) $227.54 $758.45 2.3×
Urethrocystography voiding (74455) $254.57 $848.55 1.1×
Urography (pyelography), intravenous, with or without KUB, with or without tomography (74400) $328.65 $1,095.50 2.0×
Us abdl aorta screen aaa (76706) $178.85 $596.15 1.8×
Us breast unilateral complete (76641) $173.48 $578.25 1.7×
Us breast unilateral limited (76642) $165.20 $550.65 2.0×
Us chest (76604) $218.07 $726.90 2.2×
Us compl joint r-t w/image documentation (76881) $301.68 $1,005.60 3.0×
Us infant hips limited static (76886) $126.59 $421.95 1.5×
Us ob detailed single fetus (76811) $338.91 $1,129.70 1.5×
Us ob transvaginal (76817) $372.18 $1,240.60 3.7×
Us pelvic non ob complete (76856) $371.07 $1,236.90 3.7×
Us pregnancy ltd (76815) $86.70 $289 0.9×
Us pregnant uterus 14 wk transabdl 1/1st gestat (76801) $253.16 $843.85 2.6×
Us retroperitoneal complete (76770) $239.15 $797.15 2.4×
Us retroperitoneal limited (76775) $252.51 $841.70 2.5×
Us scrotum and contents (76870) $333.84 $1,112.80 3.4×
Us soft tissue head/neck (76536) $245 $816.68 2.5×
Us spinal canal and contents (76800) $217.62 $725.40 2.2×
Us transrectal (76872) $190.08 $633.60 1.9×
Us transrectal prostate volume (76873) $253.65 $845.50 2.6×
Us xtr non-vasc lmtd (76882) $275.09 $916.95 2.8×
Venogram extremity bilateral (75822) $1,338.96 $4,463.20 0.9×
Venography extremity unilateral rs&i (75820) $1,338.96 $4,463.20 0.9×
Vertebral fracture assessment via dxa (77086) $50.60 $168.65 0.6×
Wrist 2 views (73100) $103.49 $344.95 1.3×
X-Ray Abdomen,Comp Acute Series - Xr Abdomen 2 Vws With Chest 1 View (74022) $200.93 $669.75 2.0×
X-Ray Ac Jts - Xr Acromioclavicular Joints Bilateral (73050) $151.28 $504.25 1.8×
X-Ray Ankle 3+ Vw - Xr Ankle 3+ Views Right (73610) $139.32 $464.40 1.7×
X-Ray Colon Air Contrast - Fl Barium Enema Air Contrast (74280) $377.21 $1,257.35 2.3×
X-Ray Elbow 2 Vw - Xr Elbow 1-2 Views Right (73070) $102.63 $342.10 1.2×
X-Ray Elbow 3+ Vw - Xr Elbow 3+ Views Right (73080) $144.60 $482 1.8×
X-ray exam hip uni 1 view (73501) $102.80 $342.65 1.2×
X-Ray Exam Hip Uni 2-3 Views (73502) $131.57 $438.55 1.6×
X-ray exam hip uni 4/> views (73503) $200.78 $669.25 2.0×
X-Ray Exam Hips Bi 3-4 Views (73522) $164.49 $548.30 1.7×
X-ray exam of femur 1 (73551) $96.20 $320.65 1.2×
X-ray eye for foreign body (70030) $107.96 $359.85 1.3×
X-Ray Facial Bones 3+ Vw - Xr Facial Bones 3+ Views (70150) $166.83 $556.10 1.7×
X-Ray Facial Bones <3 Vw - Xr Facial Bones 1-2 Views (70140) $110.36 $367.85 1.3×
X-Ray Foot 3+ Vw - Xr Foot 3+ Views Right (73630) $127.34 $424.45 1.5×
X-Ray Heel - Xr Calcaneus 2 Views Right (73650) $119.61 $398.70 1.4×
X-Ray Jaw <4 Vw - Xr Mandible < 4 Views (70100) $229.59 $765.30 2.8×
X-Ray Knee 4+ View - Xr Knee 4+ Views Right (73564) $153.44 $511.45 1.5×
X-Ray Knee Bilat Standing - Xr Knees Anteroposterior Standing Bilat (73565) $76.20 $254 0.9×
X-Ray Lumbar Spine 2/3 Vw - Xr Lumbar Spine 2-3 Views (72100) $180.96 $603.20 1.8×
X-Ray Lumbar Spine 6+ Vw - Xr Lumbar Spine 6+ Vws Including Bending (72114) $187.68 $625.60 1.9×
X-Ray Lumbar Spine Flex/Exten - Xr Lumbar Spine 4+ Views W/ Flex Ext (72120) $77.61 $258.70 0.8×
X-Ray Nasal Bones - Xr Nasal Bones (70160) $147.12 $490.40 1.8×
X-Ray Nose-Rectum Child F.B. - Xr Nose to Rectum Foreign Body Peds (76010) $71.43 $238.10 0.9×
X-Ray Orbits - Xr Orbits Complete 4+ Views (70200) $173.90 $579.65 1.8×
X-Ray Retrograde Pyelogram - Fl Pyelogram Retrograde (74420) $424.40 $1,414.65 1.3×
X-Ray Ribs 2 Vw Unilat - Xr Ribs 2 Views Right (71100) $158.01 $526.70 1.9×
X-Ray Ribs, Chest 3+ Vw - Xr Ribs 2 Vws Lt W/ Chest Anteroposterior (71101) $216.24 $720.80 2.2×
X-Ray Ribs, Chest 4+ Vw - Xr Ribs 3 Vws Bil W/ Chest Posteroanterior (71111) $229.20 $764 2.3×
X-Ray Sacroiliac Jts 3+ Vw - Xr Sacroiliac Joints 3+ Views (72202) $179.15 $597.15 1.8×
X-Ray Sacrum/Coccyx 2+ Vw - Xr Sacrum Coccyx 2+ Views (72220) $194.33 $647.75 2.4×
X-Ray Shoulder 2+ Vw - Xr Shoulder 2+ Views Right (73030) $122.02 $406.72 1.5×
X-Ray Sinuses 3+ Vw - Xr Paranasal Sinuses 3+ Views (70220) $221.45 $738.15 2.7×
X-Ray Sinuses <3 Vw - Xr Paranasal Sinuses 1-2 Views (70210) $81.03 $270.10 1.0×
X-Ray Skull 4+ Vw - Xr Skull Complete 4+ Views (70260) $142.10 $473.65 1.4×
X-Ray Skull <4 Vw - Xr Skull 1-3 Views (70250) $127.67 $425.55 1.3×
X-Ray Spine One View - Xr Spine (72020) $96.96 $323.20 1.2×
X-Ray Sterno-Clavicluar Jt - Xr Sternoclavicular Joints 3+ Views (71130) $86.57 $288.55 1.0×
X-Ray Sternum 2+ Vw - Xr Sternum 2+ Views (71120) $132.98 $443.25 1.6×
X-Ray Thoracic Spine 2 Vw - Xr Thoracic Spine 2 Views (72070) $142.88 $476.25 1.4×
X-Ray Toe(S) - Xr Toes 2+ Views Right (73660) $91.08 $303.60 1.1×
X-Ray Wrist 3+ Vw - Xr Wrist 3+ Views Right (73110) $125.58 $418.60 1.5×
Xr c-spine 6 or more views (72052) $220.38 $734.60 2.2×
Xr finger(s) 2+ views (73140) $115.19 $383.95 1.4×
Xr shoulder 1 view (73020) $116.42 $388.05 1.4×
Xr spine cervical 4 or 5 views (72050) $220.38 $734.60 2.2×
Xr tibia/fibula 2 views (73590) $124.85 $416.15 1.5×
Xr tmj bilateral (70330) $124.34 $414.45 1.5×
Xray knee 1 or 2 views rt (73560) $115.35 $384.50 1.4×