Imaging prices at Ascension St. John Nowata

Nowata, OK · every code in this section with a posted price and a Medicare benchmark.

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

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ProcedureCash priceGross charge× Medicare
Abdomen 2 views (74019) $158.73 $429 1.6×
Angiography extremity bilateral rs&i (75716) $3,674.84 $9,932 1.2×
Angiography extremity unilateral rs&i (75710) $1,500.35 $4,055 0.5×
Ankle 2 views (73600) $115.26 $311.50 1.4×
Antegrade urography radiological supvj & interpj (74425) $297.67 $804.50 0.9×
Aortogram thoracic (75605) $2,701.56 $7,301.50 0.5×
Arthrogram elbow (73085) $258.63 $699 0.8×
Arthrogram hip (73525) $248.64 $672 0.7×
Arthrogram shoulder (73040) $267.14 $722 0.8×
Arthrogram wrist (73115) $248.64 $672 0.7×
Arthrography knee lt (73580) $372.96 $1,008 1.1×
Bone age studies (77072) $170.57 $461 1.7×
Bone survey complete (77075) $330.04 $892 3.3×
Cardiac MRI w/w/o contrast & further seq (75561) $884.49 $2,390.50 2.6×
Cerebrospinal Fluid Flow W/O Matl Shunt Evaltj (78645) $350.02 $946 0.7×
Cervical spine 2 or 3 views (72040) $148.46 $401.25 1.8×
Chest 1 view (71045) $86.03 $232.50 1.0×
Chest 3 views (71047) $130.80 $353.50 1.6×
Cine/Vid X-Ray Throat/Esoph - Fl Esoph Barium Swlw W/ Video & Speech (74230) $240.41 $649.75 1.4×
Clavicle complete (73000) $121.18 $327.50 1.4×
Computed Tomography Thorax Lw Dose Lng Ca Scr C- (71271) $952.66 $2,574.75 9.5×
CT abdomen and pelvis without and with contrast (74178) $1,216.01 $3,286.50 3.6×
CT abdomen and pelvis without contrast (74176) $920.93 $2,489 4.0×
CT abdomen w contrast (74160) $1,019.81 $2,756.25 6.0×
CT abdomen w wo contrast (74170) $1,093.17 $2,954.50 6.5×
CT abdomen w/o contrast (74150) $954.97 $2,581 9.5×
CT angio hrt w/3d image (75574) $1,166.70 $3,153.25 3.5×
CT angiography upper extremity lt (73206) $1,229.70 $3,323.50 7.3×
CT c-spine w/o contrast (72125) $826.21 $2,233 8.2×
CT cervical spine w&w/o contrast (72127) $920.65 $2,488.25 5.5×
CT cervical spine with contrast (72126) $855.16 $2,311.25 2.5×
CT chest w/wo contrast (71270) $1,043.49 $2,820.25 6.2×
CT chest with contrast (71260) $1,108.34 $2,995.50 6.6×
CT head/brain with contrast (70460) $883.28 $2,387.25 5.2×
CT head/brain without and with contrast (70470) $1,065.14 $2,878.75 6.3×
CT heart no contrast quant eval coronry calcium (75571) $277.50 $750 3.3×
CT iac w contrast (70481) $753.23 $2,035.75 4.5×
CT limited/localized follow up study (76380) $275 $743.25 3.3×
CT lower ext w/o (73700) $823.25 $2,225 8.2×
CT lower extremity w wo contrast (73702) $790.69 $2,137 4.7×
CT lower extremity with contrast (73701) $989.29 $2,673.75 5.9×
CT lumbar spine w & w/o contrast (72133) $715.30 $1,933.25 4.2×
CT lumbar spine w/o contrast (72131) $843.69 $2,280.25 8.4×
CT lumbar spine with contrast (72132) $902.80 $2,440 2.7×
CT maxillofacial w contrast (70487) $741.48 $2,004 4.4×
CT maxillofacial w/o contrast (70486) $756 $2,043.25 7.5×
CT maxillofacial w/wo contrast (70488) $786.90 $2,126.75 4.7×
CT neck soft tissue w contrast (70491) $917.14 $2,478.75 5.4×
CT orbit sella/post fossa/ear w/o & w/contr matr (70482) $1,023.14 $2,765.25 6.1×
CT orbits w/o contrast (70480) $790.88 $2,137.50 7.9×
CT pelvis w & w/o contrast (72194) $813.08 $2,197.50 4.8×
CT pelvis w/o contrast (72192) $943.69 $2,550.50 9.4×
CT soft tissue neck w/o & w/contrast material (70492) $1,042.01 $2,816.25 6.2×
CT soft tissue neck w/o contrast (70490) $725.29 $1,960.25 7.2×
CT thoracic spine w/contrast (72129) $859.79 $2,323.75 5.1×
CT thoracic spine w/o contrast (72128) $843.69 $2,280.25 8.4×
CT thoracic spine w/wo contrast (72130) $715.30 $1,933.25 4.2×
CT thorax w/o contrast (71250) $952.66 $2,574.75 9.5×
CT upper extremity w/o & w/contrast material (73202) $738.24 $1,995.25 4.4×
CT upper extremity w/o contrast rt (73200) $793.65 $2,145 7.9×
CT upper extremity with contrast (73201) $885.60 $2,393.50 2.6×
Cta Abdl Aorta&Bi Iliofem W/Contrast&Postp (75635) $1,528.75 $4,131.75 9.1×
Cta Abdomen (74175) $1,341.62 $3,626 8.0×
CTA abdomen pelvis (74174) $2,483.63 $6,712.50 7.4×
CTA chest (71275) $1,499.24 $4,052 8.9×
Cta Head (70496) $1,328.95 $3,591.75 7.9×
CTA lwr ext w&w/o contrast (73706) $1,329.13 $3,592.25 7.9×
Cta Neck (70498) $1,315.72 $3,556 7.8×
Cta Pelvis (72191) $1,012.14 $2,735.50 6.0×
Cystography minimum 3 views rs&i (74430) $265.85 $718.50 0.8×
Doppler Fetal Mid Cerebral Artery (76821) $220.98 $597.25 2.2×
Dxa bone density study 1/> sites axial skel (77080) $109.34 $295.50 1.1×
Dxa bone density study 1/>sites appendiclr skel (77081) $80.11 $216.50 1.0×
Echoencephalography real time imaging (76506) $226.26 $611.50 2.3×
Esophagus (74220) $221.54 $598.75 1.3×
Fetal Biophysical Profile W/O Non-Stress Testing (76819) $294.06 $794.75 2.9×
Fluoroscopy up to 1 hr (76000) $164.47 $444.50 0.7×
Foot 2 views (73620) $116.09 $313.75 1.4×
Forearm 2 views (73090) $117.66 $318 1.4×
Hand 2 views (73120) $120.16 $324.75 1.2×
Hand 3 views (73130) $131.35 $355 1.6×
Humerus Min 2 Views Left (73060) $124.23 $335.75 1.5×
Hysterosalpingogram (74740) $252.25 $681.75 1.1×
Joint Survey, Single View - Xr Joint Anteroposterior 2+ Joints (77077) $284.16 $768 2.8×
Knee 3 views (73562) $121.82 $329.25 1.5×
Mammary ductogram or galactogram multiple (77054) $233.56 $631.25 1.0×
Mammary ductogram or galactogram single (77053) $171.22 $462.75 0.7×
Manual appl stress pfrmd phys/qhp joint films (77071) $45.70 $123.50 0.5×
MRA head w & w/o contrast (70546) $838.98 $2,267.50 2.5×
MRA head w/o contrast (70544) $599.59 $1,620.50 2.6×
MRA head with contrast (70545) $686.07 $1,854.25 2.0×
MRA neck w contrast (70548) $624.38 $1,687.50 1.9×
Mra Neck W/O &W/Contrast Material (70549) $915.20 $2,473.50 2.7×
MRA neck w/o contrast (70547) $587.47 $1,587.75 2.6×
MRI abdomen w contrast (74182) $954.14 $2,578.75 2.8×
MRI abdomen w/o & w/contrast material (74183) $1,188.35 $3,211.75 3.5×
MRI abdomen w/o contrast (74181) $979.02 $2,646 4.3×
MRI any jnt lwr ext with con lt (73722) $1,113.05 $3,008.25 1.5×
MRI any jt upper extremity w/contrast matrl (73222) $1,025.64 $2,772 1.4×
MRI breast w/o contrast bilateral (77047) $869.96 $2,351.25 3.8×
MRI breast w/o contrast unilat (77046) $663.69 $1,793.75 2.9×
MRI c-spine with contrast (72142) $972.27 $2,627.75 2.9×
MRI cardiac w/o contrast (75557) $717.52 $1,939.25 3.1×
MRI cervical spine w/o contrast (72141) $963.02 $2,602.75 4.2×
MRI chest w/o & w/contrast material (71552) $1,182.06 $3,194.75 3.5×
MRI chest w/o contrast (71550) $901.97 $2,437.75 3.9×
MRI chest with contrast (71551) $927.41 $2,506.50 1.2×
MRI Forearm w/ Contrast Bilateral 73219 (73219) $927.04 $2,505.50 2.8×
MRI lower extrem oth/thn jt w/contrast matrl (73719) $976.80 $2,640 2.9×
MRI lower extrem oth/thn jt w/o contr matrl (73718) $1,025.64 $2,772 4.5×
MRI orbit face &/neck w/o contrast (70540) $932.86 $2,521.25 4.1×
MRI orbit/face/neck w&w/o cont (70543) $1,270.49 $3,433.75 3.8×
MRI orbit/face/neck w/contrast (70542) $940.26 $2,541.25 2.8×
MRI pelvis w contrast (72196) $842.49 $2,277 2.5×
MRI pelvis w/o & w/contrast material (72197) $1,192.60 $3,223.25 3.6×
MRI pelvis w/o contrast (72195) $889.67 $2,404.50 3.9×
MRI scan of arm joint before and after contrast (73223) $1,070.87 $2,894.25 3.2×
MRI scan of leg joint before and after contrast (73723) $1,070.87 $2,894.25 3.2×
MRI spectroscopy (76390) $442.89 $1,197 5.3×
MRI spinal canal cervical w/o & w/contr matrl (72156) $1,276.04 $3,448.75 3.8×
MRI spinal canal lumbar w/contrast material (72149) $1,054.87 $2,851 3.1×
MRI spinal canal lumbar w/o & w/contr matrl (72158) $1,396.84 $3,775.25 4.2×
MRI spinal canal thoracic w/contrast matrl (72147) $972.27 $2,627.75 2.9×
MRI spinal canal thoracic w/o & w/contr matrl (72157) $1,390.28 $3,757.50 4.1×
MRI thoracic spine w/o contrast (72146) $976.62 $2,639.50 4.3×
MRI tmj (70336) $372.68 $1,007.25 1.6×
MRI upper ext joint w/o contrast (73221) $1,025.64 $2,772 4.5×
MRI upper extrem other than jt w/o & w/contras (73220) $1,124.43 $3,039 3.4×
MRI upper extremity oth than jt w/o contr matrl (73218) $966.16 $2,611.25 4.2×
Myelogram Cervical (72240) $436.60 $1,180 0.6×
Myelogram Lumbar (72265) $482.85 $1,305 0.6×
Myelogram thoracic (72255) $464.81 $1,256.25 0.6×
Myelography 2 or more regions (72270) $542.14 $1,465.25 0.7×
Neck soft tissue (70360) $109.15 $295 1.3×
Ob Us Follow-Up Per Fetus - Us Ob Follow Up Transabdominal Approach (76816) $446.22 $1,206 4.4×
Osseous survey infant (77076) $158.36 $428 1.6×
Osseous survey limited (77074) $240.22 $649.25 2.4×
Pelvis 1 or 2 views (72170) $116 $313.50 1.2×
Perineogram (74775) $160.95 $435 0.7×
Peritoneogram rs&i (74190) $295.26 $798 0.6×
Pr MRI, lower extr, w/o contrast f/u by contrast (73720) $1,070.87 $2,894.25 3.2×
Radex abscess/fistula/sinus tract rs&i (76080) $245.22 $662.75 0.5×
Radex Entir Thrc Lmbr Crv Sac Spi W/Skull 1 Vw - Xr Scoliosis 1 Vw (72081) $143.38 $387.50 1.7×
Radex entir thrc lmbr crv sac spi w/skull 2/3 vw (72082) $148.46 $401.25 1.5×
Radex hips bilateral with pelvis 2 views (73521) $107.67 $291 1.1×
Radex mastoids compl minimum 3 views pr side (70130) $93.61 $253 0.9×
Radiolog exam mandible compl minimum 4 views (70110) $113.31 $306.25 1.1×
Radiologic Exam Abdomen 1 View - Xr Abdomen 1 View (74018) $116.83 $315.75 1.4×
Radiologic Exam Abdomen 3+ Views - Xr Abdomen 3+ Views (74021) $158.73 $429 1.6×
Radiologic Exam Chest 2 Views - Xr Chest 2 Views (71046) $118.40 $320 1.4×
Radiologic exam colon single contrast study (74270) $287.68 $777.50 1.7×
Radiologic exam upr gi trc double contrast study (74246) $321.62 $869.25 1.9×
Radiologic exam upr gi trc single contrast study (74240) $299.98 $810.75 1.8×
Radiologic Examination Femur Minimum 2 Views - Xr Femur 2+ Vw Lt (73552) $116.09 $313.75 1.4×
Radiologic Examination Salivary Gland Calculus (70380) $53.47 $144.50 0.6×
Radiological examination surgical specimen (76098) $209.61 $566.50 0.4×
Ribs bilateral 3 views (71110) $197.49 $533.75 2.0×
Sacroiliac Joints < 3 Views (72200) $120.71 $326.25 1.2×
Saline Infus Sonohysterography W/Color Doppler (76831) $242.07 $654.25 1.1×
Scanogram (77073) $150.41 $406.50 1.5×
Scapula complete (73010) $129.78 $350.75 1.3×
Screening digital breast tomosynthesis (77063) $34.97 $94.50 1.5×
Shuntogram indwelling nonvascular shunt rs&i (75809) $99.25 $268.25 1.0×
Sialogram (70390) $168.72 $456 0.7×
Small bowel series (74250) $172.14 $465.25 1.0×
Spine thoracic 3 views (72072) $172.24 $465.50 1.7×
Ther rad simulaj-aided field setting complex (77290) $647.59 $1,750.25 1.8×
Ther rad simulaj-aided field setting simple (77280) $350.76 $948 2.7×
Therapeutic Enema (74283) $254.19 $687 1.5×
Thoracolumbar 2 views (72080) $141.43 $382.25 1.7×
Tmj unilateral (70328) $57.44 $155.25 0.7×
Tomogram (76100) $240.59 $650.25 2.4×
Treatment device intermediate (77333) $298.50 $806.75 2.3×
Tx devices design & construction complex (77334) $447.24 $1,208.75 1.2×
Ultrasound elastography first target lesion (76982) $114.33 $309 1.1×
Ultrasound, abdomen limited (76705) $362.60 $980 3.6×
Umbilical-artery Doppler (OB) (76820) $340.03 $919 3.4×
Unlisted Ultrasound Procedure (76999) $74.09 $200.25 0.9×
Upper Extremity Infant (73092) $83.53 $225.75 0.8×
Urethrocystography retrograde rs&i (74450) $257.15 $695 1.1×
Urethrocystography voiding (74455) $269.36 $728 1.2×
Urography (pyelography), intravenous, with or without KUB, with or without tomography (74400) $330.32 $892.75 2.0×
Urograpy infusion drip &/bolus techq w/wo tomo (74415) $322.92 $872.75 1.9×
Us breast unilateral complete (76641) $347.62 $939.50 3.5×
Us breast unilateral limited (76642) $347.62 $939.50 4.2×
Us chest (76604) $263.90 $713.25 2.6×
Us compl joint r-t w/image documentation (76881) $205.63 $555.75 2.0×
Us elastography parenchyma (76981) $114.33 $309 1.1×
Us guided compression repair (76936) $699.76 $1,891.25 3.4×
Us infant hips dynamic (76885) $175.75 $475 2.1×
Us infant hips limited static (76886) $93.80 $253.50 1.1×
Us kidney transplant (76776) $398.49 $1,077 4.0×
Us ob detailed single fetus (76811) $479.89 $1,297 2.1×
Us ob transvaginal (76817) $272.04 $735.25 2.7×
Us pelvic non ob complete (76856) $485.35 $1,311.75 4.8×
Us pelvic nonobstetric image dcmtn limited/f/u (76857) $301.27 $814.25 3.0×
Us pregnancy ltd (76815) $350.02 $946 3.5×
Us pregnant uterus 14 wk transabdl 1/1st gestat (76801) $488.77 $1,321 4.9×
Us retroperitoneal complete (76770) $400.16 $1,081.50 4.0×
Us retroperitoneal limited (76775) $277.13 $749 2.8×
Us scrotum and contents (76870) $299.15 $808.50 3.0×
Us soft tissue head/neck (76536) $408.02 $1,102.75 4.1×
Us spinal canal and contents (76800) $175.01 $473 1.7×
Us transrectal (76872) $295.45 $798.50 2.9×
Us xtr non-vasc lmtd (76882) $154.75 $418.25 1.5×
Us, eye b-scan (76512) $256.50 $693.25 2.6×
Vertebral fracture assessment via dxa (77086) $87.14 $235.50 1.0×
Wrist 2 views (73100) $123.21 $333 1.5×
X-Ray Abdomen,Comp Acute Series - Xr Abdomen 2 Vws With Chest 1 View (74022) $199.80 $540 2.0×
X-Ray Ac Jts - Xr Acromioclavicular Joints Bilateral (73050) $117.94 $318.75 1.4×
X-Ray Ankle 3+ Vw - Xr Ankle 3+ Views Right (73610) $134.87 $364.50 1.6×
X-Ray Colon Air Contrast - Fl Barium Enema Air Contrast (74280) $340.40 $920 2.0×
X-Ray Elbow 2 Vw - Xr Elbow 1-2 Views Right (73070) $112.94 $305.25 1.3×
X-Ray Elbow 3+ Vw - Xr Elbow 3+ Views Right (73080) $119.14 $322 1.4×
X-ray exam entire spi 4/5 vw (72083) $195.36 $528 1.9×
X-ray exam hip uni 1 view (73501) $100.27 $271 1.2×
X-Ray Exam Hip Uni 2-3 Views (73502) $122.10 $330 1.5×
X-ray exam hip uni 4/> views (73503) $161.69 $437 1.6×
X-Ray Exam Hips Bi 3-4 Views (73522) $159.19 $430.25 1.6×
X-ray exam of femur 1 (73551) $110.54 $298.75 1.3×
X-ray exam of small bowel - fl small bowel series enteroclysis tube (74251) $425.78 $1,150.75 2.5×
X-ray eye for foreign body (70030) $45.70 $123.50 0.5×
X-Ray Facial Bones 3+ Vw - Xr Facial Bones 3+ Views (70150) $95.18 $257.25 0.9×
X-Ray Facial Bones <3 Vw - Xr Facial Bones 1-2 Views (70140) $60.03 $162.25 0.7×
X-Ray Foot 3+ Vw - Xr Foot 3+ Views Right (73630) $136.99 $370.25 1.6×
X-Ray Heel - Xr Calcaneus 2 Views Right (73650) $110.08 $297.50 1.3×
X-ray IV pyelogram+drip infusn (74410) $292.12 $789.50 1.7×
X-Ray Jaw <4 Vw - Xr Mandible < 4 Views (70100) $81.12 $219.25 1.0×
X-Ray Knee 4+ View - Xr Knee 4+ Views Right (73564) $151.61 $409.75 1.5×
X-Ray Knee Bilat Standing - Xr Knees Anteroposterior Standing Bilat (73565) $89.82 $242.75 1.1×
X-Ray Leg, Infant - Xr Lower Extremity 2+ Views Infant Left (73592) $113.96 $308 1.4×
X-Ray Lumbar Spine 2/3 Vw - Xr Lumbar Spine 2-3 Views (72100) $148.46 $401.25 1.5×
X-Ray Lumbar Spine 6+ Vw - Xr Lumbar Spine 6+ Vws Including Bending (72114) $266.22 $719.50 2.6×
X-Ray Lumbar Spine Flex/Exten - Xr Lumbar Spine 4+ Views W/ Flex Ext (72120) $192.03 $519 1.9×
X-Ray Nasal Bones - Xr Nasal Bones (70160) $95.37 $257.75 1.1×
X-Ray Nose-Rectum Child F.B. - Xr Nose to Rectum Foreign Body Peds (76010) $66.51 $179.75 0.8×
X-Ray Orbits - Xr Orbits Complete 4+ Views (70200) $74.93 $202.50 0.7×
X-Ray Pelvis 3+ Vw - Xr Pelvis 3+ Views (72190) $127.74 $345.25 1.3×
X-Ray Retrograde Pyelogram - Fl Pyelogram Retrograde (74420) $289.25 $781.75 0.9×
X-Ray Ribs 2 Vw Unilat - Xr Ribs 2 Views Right (71100) $172.88 $467.25 2.1×
X-Ray Ribs, Chest 3+ Vw - Xr Ribs 2 Vws Lt W/ Chest Anteroposterior (71101) $206.74 $558.75 2.1×
X-Ray Ribs, Chest 4+ Vw - Xr Ribs 3 Vws Bil W/ Chest Posteroanterior (71111) $225.61 $609.75 2.2×
X-Ray Sacroiliac Jts 3+ Vw - Xr Sacroiliac Joints 3+ Views (72202) $129.04 $348.75 1.3×
X-Ray Sacrum/Coccyx 2+ Vw - Xr Sacrum Coccyx 2+ Views (72220) $124.32 $336 1.5×
X-Ray Shoulder 2+ Vw - Xr Shoulder 2+ Views Right (73030) $131.91 $356.50 1.6×
X-Ray Sinuses 3+ Vw - Xr Paranasal Sinuses 3+ Views (70220) $95.37 $257.75 1.1×
X-Ray Sinuses <3 Vw - Xr Paranasal Sinuses 1-2 Views (70210) $70.67 $191 0.8×
X-Ray Skull 4+ Vw - Xr Skull Complete 4+ Views (70260) $115.35 $311.75 1.1×
X-Ray Skull <4 Vw - Xr Skull 1-3 Views (70250) $95.37 $257.75 0.9×
X-Ray Spine One View - Xr Spine (72020) $120.99 $327 1.4×
X-Ray Sterno-Clavicluar Jt - Xr Sternoclavicular Joints 3+ Views (71130) $125.80 $340 1.5×
X-Ray Sternum 2+ Vw - Xr Sternum 2+ Views (71120) $114.33 $309 1.4×
X-Ray Thoracic Spine 2 Vw - Xr Thoracic Spine 2 Views (72070) $148.46 $401.25 1.5×
X-Ray Thoracic Spine 4 Vw - Xr Thoracic Spine Complete 4+ Views (72074) $175.01 $473 1.7×
X-Ray Toe(S) - Xr Toes 2+ Views Right (73660) $100.46 $271.50 1.2×
X-Ray Wrist 3+ Vw - Xr Wrist 3+ Views Right (73110) $131.91 $356.50 1.6×
Xr arthrogram ankle (73615) $258.63 $699 0.8×
Xr c-spine 6 or more views (72052) $217.93 $589 2.2×
Xr chest 4+ views (71048) $119.33 $322.50 1.2×
Xr finger(s) 2+ views (73140) $120.16 $324.75 1.4×
XR Mastoids < 3 Views Bilateral (70120) $48.01 $129.75 0.5×
Xr shoulder 1 view (73020) $112.02 $302.75 1.3×
Xr spine cervical 4 or 5 views (72050) $184.82 $499.50 1.8×
Xr tibia/fibula 2 views (73590) $116.09 $313.75 1.4×
Xr tmj bilateral (70330) $101.47 $274.25 1.2×
Xray knee 1 or 2 views rt (73560) $155.40 $420 1.9×