Imaging prices at Ascension Saint Thomas River Park

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

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

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ProcedureCash priceGross charge× Medicare
Abdomen 2 views (74019) $152.46 $508.20 1.5×
Acute gastrointestinal blood loss imaging (78278) $649.53 $2,165.10 1.7×
Ankle 2 views (73600) $81.39 $271.30 1.0×
Arthrogram hip (73525) $254.55 $848.50 0.8×
Arthrogram shoulder (73040) $284.87 $949.55 0.9×
Arthrogram wrist (73115) $289.29 $964.30 0.9×
Arthrography knee lt (73580) $215.17 $717.22 0.6×
Bone &/Joint Imaging Limited Area (78300) $468.23 $1,560.75 1.2×
Bone &/joint imaging whole body (78306) $845.64 $2,818.80 2.2×
Bone age studies (77072) $76.47 $254.90 0.8×
Bone Imaging 3 Phase (78315) $995.70 $3,319 2.6×
Bone survey complete (77075) $378.47 $1,261.55 3.8×
Cervical spine 2 or 3 views (72040) $127.55 $425.15 1.5×
Chest 1 view (71045) $94.80 $316 1.1×
Cine/Vid X-Ray Throat/Esoph - Fl Esoph Barium Swlw W/ Video & Speech (74230) $191.10 $637 1.1×
Clavicle complete (73000) $122.61 $408.70 1.5×
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 angio hrt w/3d image (75574) $1,085.27 $3,617.55 3.3×
CT angiography upper extremity lt (73206) $941.18 $3,137.25 5.7×
CT c-spine w/o contrast (72125) $845.90 $2,819.65 8.5×
CT cervical spine with contrast (72126) $812.29 $2,707.62 2.5×
CT chest w/wo contrast (71270) $910.64 $3,035.45 5.5×
CT chest with contrast (71260) $792.81 $2,642.70 4.8×
CT head/brain with contrast (70460) $839.87 $2,799.55 5.0×
CT head/brain without and with contrast (70470) $843.75 $2,812.50 5.1×
CT heart contrast eval cardiac structure&morph (75572) $1,008.18 $3,360.60 3.0×
CT heart no contrast quant eval coronry calcium (75571) $101.15 $337.15 1.2×
CT iac w contrast (70481) $665.75 $2,219.15 4.0×
CT limited/localized follow up study (76380) $235.65 $785.50 2.9×
CT lower ext w/o (73700) $667.80 $2,226 6.7×
CT lower extremity w wo contrast (73702) $717.99 $2,393.30 4.3×
CT lower extremity with contrast (73701) $697.83 $2,326.10 4.2×
CT lumbar spine w & w/o contrast (72133) $861.47 $2,871.55 5.2×
CT lumbar spine w/o contrast (72131) $889.92 $2,966.40 9.0×
CT lumbar spine with contrast (72132) $887.04 $2,956.78 2.7×
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) $658.36 $2,194.52 4.0×
CT neck soft tissue w contrast (70491) $1,067.58 $3,558.60 6.4×
CT orbit sella/post fossa/ear w/o & w/contr matr (70482) $704.87 $2,349.55 4.2×
CT orbits w/o contrast (70480) $612.93 $2,043.10 6.2×
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) $1,128.96 $3,763.20 6.8×
CT soft tissue neck w/o contrast (70490) $727.71 $2,425.70 7.3×
CT thoracic spine w/contrast (72129) $745.70 $2,485.65 4.5×
CT thoracic spine w/o contrast (72128) $818.33 $2,727.75 8.2×
CT thoracic spine w/wo contrast (72130) $834.83 $2,782.75 5.0×
CT thorax w/o contrast (71250) $817.11 $2,723.70 8.2×
CT upper extremity w/o & w/contrast material (73202) $811.20 $2,704 4.9×
CT upper extremity w/o contrast rt (73200) $691.01 $2,303.35 7.0×
CT upper extremity with contrast (73201) $668.72 $2,229.05 2.0×
Cta Abdl Aorta&Bi Iliofem W/Contrast&Postp (75635) $1,153.47 $3,844.90 6.9×
Cta Abdomen (74175) $1,409.33 $4,697.75 8.5×
CTA abdomen pelvis (74174) $1,707.77 $5,692.55 5.2×
CTA chest (71275) $1,154.13 $3,847.10 6.9×
Cta Head (70496) $1,045.52 $3,485.05 6.3×
CTA lwr ext w&w/o contrast (73706) $731.48 $2,438.25 4.4×
Cta Neck (70498) $1,045.52 $3,485.05 6.3×
Cystography minimum 3 views rs&i (74430) $473.94 $1,579.80 1.4×
Dxa bone density study 1/> sites axial skel (77080) $161.37 $537.90 1.6×
Echoencephalography real time imaging (76506) $190.37 $634.55 1.9×
Esophagus (74220) $157.13 $523.75 0.9×
Fetal biophysical profile non-stress testing (76818) $308.31 $1,027.70 3.1×
Fetal Biophysical Profile W/O Non-Stress Testing (76819) $125.04 $416.80 1.3×
Fluoroscopy up to 1 hr (76000) $120.34 $401.10 0.5×
Foot 2 views (73620) $66.95 $223.15 0.8×
Forearm 2 views (73090) $109.55 $365.15 1.3×
Gated Heart Planar Single (78472) $801.98 $2,673.25 2.1×
Hand 2 views (73120) $87.17 $290.55 0.9×
Hand 3 views (73130) $112.23 $374.10 1.4×
Hepatobil Syst Imag Inc Gb W/Pharma Intervenj (78227) $906.36 $3,021.20 1.8×
Hepatobiliary syst imaging including gallbladder (78226) $906.36 $3,021.20 2.4×
Ht muscle image spect sing (78451) $1,895.22 $6,317.40 1.5×
Humerus Min 2 Views Left (73060) $109.14 $363.80 1.3×
Hysterosalpingogram (74740) $254.55 $848.50 1.1×
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) $607.40 $2,024.65 1.2×
Knee 3 views (73562) $153.18 $510.60 1.9×
Liver & spleen imaging static only (78215) $540.83 $1,802.75 1.4×
Lung perfusion differential (78597) $657.60 $2,192 1.7×
Lymphoscintigraphy (78195) $718.80 $2,396 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) $21.11 $70.35 0.8×
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) $858.83 $2,862.75 2.6×
Mra Neck W/O &W/Contrast Material (70549) $987.66 $3,292.20 3.0×
MRA neck w/o contrast (70547) $930.08 $3,100.25 4.1×
MRI abdomen w/o & w/contrast material (74183) $1,315.72 $4,385.70 4.0×
MRI abdomen w/o contrast (74181) $880.91 $2,936.35 3.9×
MRI any jnt lwr ext with con lt (73722) $1,150.11 $3,833.70 1.5×
MRI any jt upper extremity w/contrast matrl (73222) $926.37 $3,087.90 1.2×
MRI cervical spine w/o contrast (72141) $930.30 $3,101 4.1×
MRI chest w/o & w/contrast material (71552) $1,186.28 $3,954.25 3.6×
MRI chest w/o contrast (71550) $719.43 $2,398.10 3.2×
MRI lower extrem oth/thn jt w/contrast matrl (73719) $1,015.17 $3,383.90 3.1×
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) $986.96 $3,289.88 4.4×
MRI orbit/face/neck w&w/o cont (70543) $1,152.21 $3,840.70 3.5×
MRI orbit/face/neck w/contrast (70542) $1,001.88 $3,339.60 3.0×
MRI pelvis w contrast (72196) $930.30 $3,101 2.8×
MRI pelvis w/o & w/contrast material (72197) $1,270.25 $4,234.15 3.8×
MRI pelvis w/o contrast (72195) $840.23 $2,800.75 3.7×
MRI scan of arm joint before and after contrast (73223) $1,138.83 $3,796.10 3.4×
MRI scan of leg joint before and after contrast (73723) $972.87 $3,242.90 2.9×
MRI spinal canal cervical w/o & w/contr matrl (72156) $1,324.91 $4,416.35 4.0×
MRI spinal canal lumbar w/contrast material (72149) $965.33 $3,217.75 2.9×
MRI spinal canal lumbar w/o & w/contr matrl (72158) $1,356.98 $4,523.25 4.1×
MRI spinal canal thoracic w/contrast matrl (72147) $1,152.21 $3,840.70 3.5×
MRI spinal canal thoracic w/o & w/contr matrl (72157) $1,318.01 $4,393.35 4.0×
MRI thoracic spine w/o contrast (72146) $930.30 $3,101 4.1×
MRI upper ext joint w/o contrast (73221) $891.57 $2,971.90 3.9×
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) $912.90 $3,043 4.0×
Myocardial Spect Multiple Studies (78452) $1,179.27 $3,930.90 1.0×
N-Invas Est C Ffr Augmnt Sw Alys Cta I&R Phy/Qhp (75580) $2,413.53 $8,045.10 3.0×
Neck soft tissue (70360) $117.95 $393.15 1.4×
Nm gastric emptying study (78264) $681.48 $2,271.60 1.8×
Nuclear medicine study of kidney and blood flow (78701) $567.17 $1,890.55 1.5×
Nuclear Rx Oral Admin (79005) $584.60 $1,948.65 2.6×
Ob Us Follow-Up Per Fetus - Us Ob Follow Up Transabdominal Approach (76816) $201.17 $670.55 2.0×
Osseous survey infant (77076) $153.18 $510.60 1.5×
Parathyroid imaging (78070) $579.72 $1,932.40 1.5×
Pelvis 1 or 2 views (72170) $141.77 $472.55 1.4×
Pr MRI, lower extr, w/o contrast f/u by contrast (73720) $1,292.25 $4,307.50 3.9×
Pulmonary Perfusion Imaging Particulate (78580) $657.60 $2,192 1.7×
Pulmonary Ventilation & Perfusion Imaging (78582) $783.87 $2,612.90 1.5×
Radex abscess/fistula/sinus tract rs&i (76080) $174.78 $582.60 0.3×
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) $156.66 $522.20 1.6×
Radiolog exam mandible compl minimum 4 views (70110) $249.24 $830.80 2.5×
Radiologic Exam Abdomen 1 View - Xr Abdomen 1 View (74018) $139.08 $463.60 1.7×
Radiologic Exam Chest 2 Views - Xr Chest 2 Views (71046) $103.26 $344.20 1.2×
Radiologic exam colon single contrast study (74270) $279.33 $931.10 1.7×
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) $217.79 $725.95 1.3×
Radiologic Examination Femur Minimum 2 Views - Xr Femur 2+ Vw Lt (73552) $119.30 $397.65 1.4×
Radiological examination surgical specimen (76098) $142.64 $475.45 0.3×
Ribs bilateral 3 views (71110) $144 $480 1.5×
Rp loclzj tum plnr 2+area 1+d img/1 area img>2+d (78801) $721.88 $2,406.25 1.9×
Saline Infus Sonohysterography W/Color Doppler (76831) $361.50 $1,205 1.6×
Scanogram (77073) $65.90 $219.65 0.7×
Scapula complete (73010) $120.95 $403.15 1.2×
Screening digital breast tomosynthesis (77063) $32.45 $108.15 1.4×
Shuntogram indwelling nonvascular shunt rs&i (75809) $135.69 $452.30 1.4×
Small bowel series (74250) $257.81 $859.35 1.5×
Spine thoracic 3 views (72072) $181.37 $604.55 1.8×
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) $136.07 $453.55 1.6×
Thyroid Imaging With Vascular Flow (78013) $370.16 $1,233.85 1.0×
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×
Ultrasound elastography first target lesion (76982) $369.77 $1,232.55 3.7×
Ultrasound, abdomen limited (76705) $227.54 $758.45 2.3×
Umbilical-artery Doppler (OB) (76820) $228.42 $761.40 2.3×
Unlisted magnetic resonance procedure (76498) $736.64 $2,455.45 8.9×
Urethrocystography voiding (74455) $242.43 $808.10 1.1×
Urography (pyelography), intravenous, with or without KUB, with or without tomography (74400) $313.01 $1,043.35 1.9×
Us abdl aorta screen aaa (76706) $170.31 $567.70 1.7×
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) $207.68 $692.25 2.1×
Us compl joint r-t w/image documentation (76881) $287.31 $957.70 2.9×
Us infant hips limited static (76886) $120.57 $401.90 1.5×
Us ob detailed single fetus (76811) $322.76 $1,075.85 1.4×
Us ob transvaginal (76817) $354.47 $1,181.55 3.6×
Us pelvic non ob complete (76856) $353.40 $1,178 3.6×
Us pregnancy ltd (76815) $81.79 $272.62 0.8×
Us pregnant uterus 14 wk transabdl 1/1st gestat (76801) $253.16 $843.85 2.6×
Us retroperitoneal complete (76770) $253.96 $846.52 2.6×
Us retroperitoneal limited (76775) $252.51 $841.70 2.5×
Us scrotum and contents (76870) $317.94 $1,059.80 3.2×
Us soft tissue head/neck (76536) $244.98 $816.60 2.5×
Us spinal canal and contents (76800) $335.93 $1,119.75 3.4×
Us transrectal (76872) $181.01 $603.35 1.8×
Us transrectal prostate volume (76873) $241.58 $805.25 2.4×
Us xtr non-vasc lmtd (76882) $261.99 $873.30 2.6×
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) $48.18 $160.60 0.6×
Wrist 2 views (73100) $101.02 $336.70 1.2×
X-Ray Abdomen,Comp Acute Series - Xr Abdomen 2 Vws With Chest 1 View (74022) $191.36 $637.85 1.9×
X-Ray Ac Jts - Xr Acromioclavicular Joints Bilateral (73050) $144.06 $480.20 1.7×
X-Ray Ankle 3+ Vw - Xr Ankle 3+ Views Right (73610) $132.66 $442.20 1.6×
X-Ray Colon Air Contrast - Fl Barium Enema Air Contrast (74280) $359.24 $1,197.45 2.2×
X-Ray Elbow 2 Vw - Xr Elbow 1-2 Views Right (73070) $97.74 $325.80 1.2×
X-Ray Elbow 3+ Vw - Xr Elbow 3+ Views Right (73080) $137.70 $459 1.7×
X-ray exam hip uni 1 view (73501) $97.89 $326.30 1.2×
X-Ray Exam Hip Uni 2-3 Views (73502) $125.31 $417.70 1.5×
X-ray exam hip uni 4/> views (73503) $191.21 $637.35 1.9×
X-Ray Exam Hips Bi 3-4 Views (73522) $156.66 $522.20 1.6×
X-ray exam of femur 1 (73551) $93.91 $313.02 1.1×
X-ray eye for foreign body (70030) $102.81 $342.70 1.2×
X-Ray Facial Bones 3+ Vw - Xr Facial Bones 3+ Views (70150) $158.90 $529.65 1.6×
X-Ray Facial Bones <3 Vw - Xr Facial Bones 1-2 Views (70140) $105.11 $350.35 1.3×
X-Ray Foot 3+ Vw - Xr Foot 3+ Views Right (73630) $121.28 $404.25 1.5×
X-Ray Heel - Xr Calcaneus 2 Views Right (73650) $113.90 $379.65 1.4×
X-Ray Jaw <4 Vw - Xr Mandible < 4 Views (70100) $218.67 $728.90 2.6×
X-Ray Knee 4+ View - Xr Knee 4+ Views Right (73564) $146.13 $487.10 1.5×
X-Ray Knee Bilat Standing - Xr Knees Anteroposterior Standing Bilat (73565) $72.56 $241.85 0.9×
X-Ray Lumbar Spine 2/3 Vw - Xr Lumbar Spine 2-3 Views (72100) $172.35 $574.50 1.7×
X-Ray Lumbar Spine 6+ Vw - Xr Lumbar Spine 6+ Vws Including Bending (72114) $178.76 $595.85 1.8×
X-Ray Lumbar Spine Flex/Exten - Xr Lumbar Spine 4+ Views W/ Flex Ext (72120) $73.91 $246.35 0.7×
X-Ray Nasal Bones - Xr Nasal Bones (70160) $140.12 $467.05 1.7×
X-Ray Nose-Rectum Child F.B. - Xr Nose to Rectum Foreign Body Peds (76010) $68 $226.65 0.8×
X-Ray Orbits - Xr Orbits Complete 4+ Views (70200) $165.59 $551.95 1.7×
X-Ray Renal Cyst Xlumbar+Contrst - Xr Renal Cyst Lumbar W Contrast (74470) $283.65 $945.50 0.5×
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) $150.48 $501.60 1.8×
X-Ray Ribs, Chest 3+ Vw - Xr Ribs 2 Vws Lt W/ Chest Anteroposterior (71101) $205.92 $686.40 2.1×
X-Ray Ribs, Chest 4+ Vw - Xr Ribs 3 Vws Bil W/ Chest Posteroanterior (71111) $218.28 $727.60 2.2×
X-Ray Sacroiliac Jts 3+ Vw - Xr Sacroiliac Joints 3+ Views (72202) $170.60 $568.65 1.7×
X-Ray Sacrum/Coccyx 2+ Vw - Xr Sacrum Coccyx 2+ Views (72220) $185.07 $616.90 2.2×
X-Ray Shoulder 2+ Vw - Xr Shoulder 2+ Views Right (73030) $118.60 $395.32 1.4×
X-Ray Sinuses 3+ Vw - Xr Paranasal Sinuses 3+ Views (70220) $210.90 $703 2.6×
X-Ray Sinuses <3 Vw - Xr Paranasal Sinuses 1-2 Views (70210) $77.18 $257.25 0.9×
X-Ray Skull 4+ Vw - Xr Skull Complete 4+ Views (70260) $135.30 $451 1.4×
X-Ray Skull <4 Vw - Xr Skull 1-3 Views (70250) $121.58 $405.25 1.2×
X-Ray Spine One View - Xr Spine (72020) $92.33 $307.75 1.1×
X-Ray Sterno-Clavicluar Jt - Xr Sternoclavicular Joints 3+ Views (71130) $82.44 $274.80 1.0×
X-Ray Sternum 2+ Vw - Xr Sternum 2+ Views (71120) $126.65 $422.15 1.5×
X-Ray Thoracic Spine 2 Vw - Xr Thoracic Spine 2 Views (72070) $136.07 $453.55 1.4×
X-Ray Toe(S) - Xr Toes 2+ Views Right (73660) $86.73 $289.10 1.0×
X-Ray Wrist 3+ Vw - Xr Wrist 3+ Views Right (73110) $102.26 $340.85 1.2×
Xr c-spine 6 or more views (72052) $209.88 $699.60 2.1×
Xr finger(s) 2+ views (73140) $109.70 $365.65 1.3×
Xr shoulder 1 view (73020) $113.65 $378.82 1.4×
Xr spine cervical 4 or 5 views (72050) $209.88 $699.60 2.1×
Xr tibia/fibula 2 views (73590) $118.89 $396.30 1.4×
Xr tmj bilateral (70330) $118.41 $394.70 1.4×
Xray knee 1 or 2 views rt (73560) $109.86 $366.20 1.3×