Imaging prices at Bon Secours Community Hospital

Port Jervis, NY · every code in this section with a posted price and a Medicare benchmark.

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

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ProcedurePosted cashPosted gross× Medicare
3-D radiotherapy plan dose-volume histograms (77295) $8,974 $8,974 5.2×
Abdomen 1 View (74018) $1,488 $1,488 13.7×
Abdomen 2 views (74019) $2,089 $2,089 16.0×
Acute Gastrointestinal Blood Loss Imaging (78278) $6,860 $6,860 13.7×
Ankle 2 views (73600) $1,488 $1,488 13.7×
Arthrogram ankle (73615) $1,320 $1,320 3.0×
Arthrogram hip (73525) $7,115 $7,115 16.3×
Arthrogram Wrist (73115) $806 $806 1.9×
Basic radiation dosimetry calculation (77300) $2,676 $2,676 15.9×
Bone age studies (77072) $2,089 $2,089 16.0×
Bone Imaging 3 Phase (78315) $6,860 $6,860 13.7×
Bone Imaging Limited Area (78300) $6,860 $6,860 13.7×
Bone Imaging Multiple Areas (78305) $2,616 $2,616 5.2×
Bone Imaging Whole Body (78306) $6,860 $6,860 13.7×
Bone marrow imaging limited area (78102) $1,857 $1,857 3.7×
Bone marrow imaging; multiple areas (78103) $2,747 $2,747 5.5×
Bone marrow imaging; whole body (78104) $1,808 $1,808 3.6×
Bone survey infant (77076) $1,178 $1,178 9.0×
Brain Imaging Min 4 Static Views W Vascular Flow (78606) $6,374 $6,374 9.4×
Cardiac MRI w/w/o contrast & further seq (75561) $7,115 $7,115 16.3×
Cat Scan Follow-Up Study (76380) $2,484 $2,484 22.9×
Cerebrospinal Fluid Scan (78630) $8,795 $8,795 13.0×
Chest 1 view (71045) $1,488 $1,488 13.7×
Chest 2 views (71046) $1,488 $1,488 13.7×
Chest 3 views (71047) $1,488 $1,488 13.7×
Clavicle complete (73000) $1,488 $1,488 13.7×
Computed Tomography Thorax Lw Dose Lng Ca Scr C- (71271) $1,488 $1,488 11.4×
Continuing medical physics consltj pr wk (77336) $2,676 $2,676 15.9×
Contrast X-Ray Bladder (74430) $7,115 $7,115 16.3×
Contrast X-Ray Of Elbow (73085) $1,327 $1,327 3.0×
Contrast X-Ray Of Knee Joint (73580) $946 $946 2.2×
CT abdomen and pelvis without and with contrast (74178) $7,115 $7,115 16.3×
CT abdomen and pelvis without contrast (74176) $4,342 $4,342 14.6×
CT abdomen w contrast (74160) $3,396 $3,396 15.5×
CT abdomen w wo contrast (74170) $3,457 $3,457 15.8×
CT abdomen w/o contrast (74150) $2,089 $2,089 16.0×
CT Angio Abdomen and Pelvis (74174) $7,115 $7,115 16.3×
CT Angio Chest (71275) $3,500 $3,500 16.0×
CT Angio Head (70496) $3,503 $3,503 16.0×
CT angio hrt w/3d image (75574) $3,396 $3,396 7.8×
Ct Angio Lwr Extr W/O&W/Dye (73706) $3,500 $3,500 16.0×
CT Angio Neck (70498) $3,503 $3,503 16.0×
Ct Angio Upr Extrm W/O&W/Dye (73206) $3,500 $3,500 16.0×
CT bone density (77078) $2,484 $2,484 22.9×
CT Cere Prfuj Alys C+ W/O CT/Cta Same Anatomy (70473) $1,076 $1,076 4.9×
CT cervical spine w/ contrast (72126) $7,115 $7,115 16.3×
CT cervical spine w/o contrast (72125) $2,089 $2,089 16.0×
CT cervical spine w/wo cont (72127) $3,396 $3,396 15.5×
CT chest w contrast (71260) $3,396 $3,396 15.5×
CT chest w/wo contrast (71270) $3,396 $3,396 15.5×
CT head/brain with contrast (70460) $3,396 $3,396 15.5×
CT head/brain without and with contrast (70470) $3,396 $3,396 15.5×
CT heart contrast eval cardiac structure&morph (75572) $3,396 $3,396 7.8×
CT heart no contrast quant eval coronry calcium (75571) $1,488 $1,488 13.7×
CT hrt w/3d image congen (75573) $3,498 $3,498 8.0×
CT iac w contrast (70481) $3,374 $3,374 15.4×
CT l-spine w&w/o contrast (72133) $3,396 $3,396 15.5×
CT lower ext w/o (73700) $2,089 $2,089 16.0×
CT lower extremity w/contrast material (73701) $3,396 $3,396 15.5×
CT lumbar spine w contrast (72132) $7,115 $7,115 16.3×
CT lumbar spine w/o contrast (72131) $2,089 $2,089 16.0×
CT maxillofacial w contrast (70487) $3,396 $3,396 15.5×
CT maxillofacial wo contrast (70486) $2,089 $2,089 16.0×
CT neck tissue combo (70492) $3,396 $3,396 15.5×
Ct Orbit/Ear/Fossa W/O&W/Dye (70482) $3,457 $3,457 15.8×
CT orbits w/o contrast (70480) $2,076 $2,076 15.9×
CT pelvis w&w/o contrast (72194) $4,139 $4,139 18.9×
CT pelvis w/o contrast (72192) $2,089 $2,089 16.0×
CT scan of leg combo (73702) $3,396 $3,396 15.5×
CT scans face/jaw combo (70488) $3,396 $3,396 15.5×
CT soft tissue neck w contrast (70491) $3,396 $3,396 15.5×
CT soft tissue neck w/o contrast (70490) $2,089 $2,089 16.0×
CT thoracic spine w contrast (72129) $3,396 $3,396 15.5×
CT thoracic spine w/o contrast (72128) $2,089 $2,089 16.0×
CT thoracic spine w/wo cont (72130) $4,378 $4,378 20.0×
CT thorax w/o contrast (71250) $2,089 $2,089 16.0×
CT upper ext wo (73200) $2,089 $2,089 16.0×
CT upper extremity w/o & w/contrast material (73202) $4,815 $4,815 22.0×
CT upper extremity with contrast (73201) $7,115 $7,115 16.3×
Cta Abdl Aorta&Bi Iliofem W/Contrast&Postp (75635) $3,500 $3,500 16.0×
Cta Abdomen (74175) $3,503 $3,503 16.0×
CTA head&neck c+ w/noncontrast img&post-pxessing (70471) $4,734 $4,734 10.9×
CTA pelvis (72191) $3,500 $3,500 16.0×
Dxa Bone Density Axial (77080) $2,089 $2,089 16.0×
Echo exam of fetal heart (76825) $1,798 $1,798 2.6×
Echo exam uterus (76831) $2,463 $2,463 8.3×
Echo Guide For Artery Repair (76936) $1,129 $1,129 4.2×
Echograp Trans R Pros Study (76873) $662 $662 5.1×
Esophagram (74220) $3,396 $3,396 15.5×
Fetal Biophysical Profile W/O Non-Stress Testing (76819) $2,089 $2,089 16.0×
Fluoroscopy up to 1 hr (76000) $4,342 $4,342 14.6×
Foot 2 views (73620) $1,488 $1,488 13.7×
Forearm 2 views (73090) $1,488 $1,488 13.7×
Gastric emptying imaging study (78264) $6,860 $6,860 13.7×
Gated Heart Planar Single (78472) $6,860 $6,860 13.7×
Hand 2 views (73120) $2,089 $2,089 16.0×
Hepatobil Syst Image W/Drug (78227) $8,297 $8,297 12.2×
Hepatobiliary System Imaging (78226) $6,860 $6,860 13.7×
Ht Muscle Image Spect Sing (78451) $23,705 $23,705 14.7×
Hysterosalpingogram (74740) $4,342 $4,342 14.6×
Infant hip ultrasound with hip movement (dynamic) (76885) $1,488 $1,488 13.7×
K Flow/Funct Image W/Drug (78708) $8,795 $8,795 13.0×
K Flow/Funct Image W/O Drug (78707) $3,437 $3,437 5.1×
Knee 3 Views (73562) $1,488 $1,488 13.7×
Leveen/Shunt Patency Exam (78291) $2,561 $2,561 5.1×
Liver & Spleen Imaging Static Only (78215) $2,838 $2,838 5.7×
Liver imaging static only (78201) $4,533 $4,533 6.7×
Lung Perf&Ventilat Diferentl (78598) $8,795 $8,795 13.0×
Lung perfusion differential (78597) $6,860 $6,860 13.7×
Lung Ventilat&Perfus Imaging (78582) $8,795 $8,795 13.0×
Lung Ventilation Imaging (78579) $1,808 $1,808 3.6×
Lymph System Imaging (78195) $8,795 $8,795 13.0×
Magnetic Image Jaw Joint (70336) $4,342 $4,342 14.6×
Mlc imrt design & construction per imrt plan (77338) $7,084 $7,084 15.2×
Mr safety determination physician/other qhp (76016) $313 $313 2.9×
Mr safety implant&/fb assmt clin staf 1st 15 min (76014) $87 $87 2.4×
Mr safety implt electronics prepj supvj phys/qhp (76018) $326 $326 2.7×
Mr safety implt pos&/immoblj (76019) $211 $211 2.9×
Mr safety med physics xm customization plng&mntr (76017) $858 $858 2.9×
Mra Head W/O & W/Contrast Material (70546) $7,115 $7,115 16.3×
MRA head w/o contrast (70544) $4,342 $4,342 14.6×
MRA head with contrast (70545) $5,588 $5,588 12.8×
MRA neck w contrast (70548) $7,115 $7,115 16.3×
Mra Neck W/O &W/Contrast Material (70549) $7,115 $7,115 16.3×
MRA neck w/o contrast (70547) $4,342 $4,342 14.6×
MRI abdomen w contrast (74182) $7,115 $7,115 16.3×
MRI abdomen w/o contrast (74181) $4,342 $4,342 14.6×
MRI any jt lower extrem w/contrast material (73722) $12,687 $12,687 13.0×
MRI any jt upper extremity w/contrast matrl (73222) $12,687 $12,687 13.0×
MRI Breast W/O Contrast Bilateral (77047) $4,813 $4,813 16.2×
MRI cardiac w/o contrast (75557) $4,342 $4,342 14.6×
MRI cervical spine w contrast (72142) $7,115 $7,115 16.3×
MRI cervical spine w/o cont (72141) $4,342 $4,342 14.6×
MRI chest w/o contrast (71550) $4,342 $4,342 14.6×
MRI chest with contrast (71551) $5,204 $5,204 5.3×
MRI chest wo w contrast (71552) $7,115 $7,115 16.3×
MRI lower extrem oth/thn jt w/contrast matrl (73719) $6,125 $6,125 14.1×
MRI lower extrem oth/thn jt w/o & w/contr matr (73720) $7,115 $7,115 16.3×
MRI lower extrem oth/thn jt w/o contr matrl (73718) $4,342 $4,342 14.6×
MRI lumbar spine w contrast (72149) $7,115 $7,115 16.3×
Mri Neck Spine W/O & W/Dye (72156) $7,115 $7,115 16.3×
MRI orbit face &/neck w/o contrast (70540) $4,342 $4,342 14.6×
MRI orbit face neck w contrast (70542) $7,160 $7,160 16.4×
Mri Orbt/Fac/Nck W/O &W/Dye (70543) $7,115 $7,115 16.3×
MRI pelvis w contrast (72196) $5,065 $5,065 11.6×
MRI pelvis w/o & w contrast (72197) $7,115 $7,115 16.3×
MRI pelvis w/o contrast (72195) $4,342 $4,342 14.6×
MRI thoracic spine w/o contrast (72146) $4,342 $4,342 14.6×
MRI upper extremity oth than jt w/contr matrl (73219) $4,776 $4,776 11.0×
MRI upper extremity oth than jt w/o contr matrl (73218) $4,342 $4,342 14.6×
Mri Uppr Extremity W/O&W/Dye (73220) $7,115 $7,115 16.3×
MRI, abdomen, combo (74183) $7,115 $7,115 16.3×
MRI, dorsal spine combo (72157) $7,115 $7,115 16.3×
MRI, dorsal spine contrast (72147) $7,115 $7,115 16.3×
MRI, joint upper extrem (73221) $4,342 $4,342 14.6×
MRI, joint upper extrem combo (73223) $7,115 $7,115 16.3×
MRI, lumbar spine combo (72158) $7,115 $7,115 16.3×
Myelogram cervical (72240) $2,667 $2,667 2.7×
Myelogram Lumbar (72265) $2,667 $2,667 2.7×
Myocardial Spect Multiple Studies (78452) $24,380 $24,380 15.1×
N-invas est c ffr sw aly CTA (75580) $5,769 $5,769 5.4×
Neck soft tissue (70360) $1,488 $1,488 13.7×
Nm csf leak detection (78650) $7,000 $7,000 4.3×
Ntsty modul radthx pln dose-vol histos (77301) $33,564 $33,564 19.4×
Optic foramina (70190) $399 $399 3.7×
Panoramic X-ray of jaws (70355) $1,488 $1,488 13.7×
Parathyroid imaging w/tomographic spect & CT (78072) $2,216 $2,216 3.3×
Parathyroid Planar Imaging (78070) $6,860 $6,860 13.7×
Parathyroid planar imaging w/wo subtraction (78071) $6,860 $6,860 13.7×
Pelvis 1 or 2 views (72170) $2,089 $2,089 16.0×
Pet Image W/Ct Lmtd (78814) $7,453 $7,453 4.2×
PET image w/CT, full body (78816) $8,831 $8,831 4.9×
PET imaging CT attenuation skull base mid-thigh (78815) $8,831 $8,831 4.9×
Pet Imaging Limited Area Chest Head/Neck (78811) $4,927 $4,927 3.0×
Pulmonary Perfusion Imaging Particulate (78580) $6,860 $6,860 13.7×
Radex Abd Compl Aqt Abd W/S/E/D Views 1 View Ch (74022) $2,089 $2,089 16.0×
Radex Ankle Complete Minimum 3 Views (73610) $1,488 $1,488 13.7×
Radex Calcaneus Minimum 2 Views (73650) $1,488 $1,488 13.7×
Radex elbow complete minimum 3 views (73080) $1,488 $1,488 13.7×
Radex Facial Bones Complete Minimum 3 Views (70150) $2,089 $2,089 16.0×
Radex fingr minimum 2 views (73140) $1,488 $1,488 13.7×
Radex foot complete minimum 3 views (73630) $1,488 $1,488 13.7×
Radex Hand Minimum 3 Views (73130) $1,488 $1,488 13.7×
Radex lower extremity infant minimum 2 views (73592) $1,488 $1,488 13.7×
Radex Mastoids Compl Minimum 3 Views PR Side (70130) $1,178 $1,178 9.0×
Radex Nasal Bones Complete Minimum 3 Views (70160) $1,488 $1,488 13.7×
Radex Ribs Unilateral 2 Views (71100) $1,488 $1,488 13.7×
Radex shoulder complete minimum 2 views (73030) $1,488 $1,488 13.7×
Radex Sinuses Paransl < 3 Views (70210) $1,488 $1,488 13.7×
Radex Spine 1 View Specify Level (72020) $1,488 $1,488 13.7×
Radex Sternum Minimum 2 Views (71120) $1,488 $1,488 13.7×
Radex Temporomandble Jt Opn & Clsd Mouth Bilat (70330) $1,488 $1,488 13.7×
Radex Toe Minimum 2 Views (73660) $1,488 $1,488 13.7×
Radex upper extremity infant minimum 2 views (73092) $2,089 $2,089 16.0×
Radex Wrist Complete Minimum 3 Views (73110) $1,488 $1,488 13.7×
Radiation treatment delivery level 1 (77402) $8,000 $8,000 62.8×
Radiation treatment delivery level 2 (77407) $9,500 $9,500 19.7×
Radiation treatment delivery level 3 (77412) $11,000 $11,000 15.9×
Radiolog exam mandible compl minimum 4 views (70110) $2,089 $2,089 16.0×
Radiologic Exam Abdomen 3+ Views - Xr Abdomen 3+ Views (74021) $2,089 $2,089 16.0×
Radiologic exam colon double contrast study (74280) $2,849 $2,849 13.0×
Radiologic exam colon single contrast study (74270) $3,396 $3,396 15.5×
Radiologic exam knee complete 4/more views (73564) $2,089 $2,089 16.0×
Radiologic exam pelvis compl minimum 3 views (72190) $2,089 $2,089 16.0×
Radiologic Exam Small Int Single Contrast Study (74250) $3,396 $3,396 15.5×
Radiologic exam swallow function contrast study (74230) $3,203 $3,203 14.6×
Radiologic examination femur 1 view (73551) $1,488 $1,488 13.7×
Radiologic examination femur minimum 2 views (73552) $1,488 $1,488 13.7×
Radiologic examination knee 1/2 views (73560) $1,488 $1,488 13.7×
Radiologic examination tibia & fibula 2 views (73590) $1,488 $1,488 13.7×
Ribs bilateral 3 views (71110) $1,384 $1,384 10.6×
Rp loclzj tum plnr 1 area single day imaging (78800) $2,709 $2,709 5.4×
Rp loclzj tum plnr 2+area 1+d img/1 area img>2+d (78801) $2,709 $2,709 5.4×
Rp Loclzj Tum Plnr Whole Body 2+ Days Imaging (78804) $23,705 $23,705 35.0×
Rp Loclzj Tum Plnr Whole Body Single Day Imaging (78802) $23,705 $23,705 35.0×
Rp Loclzj Tum Spect 1 Area Single Day Imaging (78803) $23,705 $23,705 35.0×
Rp loclzj tum spect 2 area/sep acquisj img (78831) $23,705 $23,705 14.7×
Rp loclzj tum spect w/CT 1 area/acquisj 1day img (78830) $23,705 $23,705 14.7×
Rp Therapy Intravenous Administration (79101) $4,424 $4,424 15.2×
Scapula (73010) $2,089 $2,089 16.0×
Screening Digital Breast Tomosynthesis Bi (77063) $151 $151 6.5×
Shoulder 1 view (73020) $1,488 $1,488 13.7×
Shoulder Arthrography (73040) $1,217 $1,217 2.8×
Skull less than 4 views (70250) $2,089 $2,089 16.0×
Special dosimetry (77331) $2,676 $2,676 15.9×
Special Physics Consult (77370) $2,455 $2,455 14.6×
Special teletherapy port plan (77321) $2,401 $2,401 5.1×
Special treatment procedure (77470) $2,242 $2,242 3.3×
Stereotactic Body Radiation Delivery (77373) $32,648 $32,648 14.6×
Sternoclavicular joints (71130) $1,488 $1,488 13.7×
Telethx isodose pln cplx w/basic dosimetry (77307) $7,084 $7,084 15.2×
Telethx isodose pln smpl w/dosimetry calculation (77306) $2,644 $2,644 5.7×
Testicular Imaging W/Flow (78761) $1,672 $1,672 3.4×
Ther Rad Simulaj-Aided Field Setting Complex (77290) $7,084 $7,084 15.2×
Ther rad simulaj-aided field setting simple (77280) $2,676 $2,676 15.9×
Thoracic spine 2 views (72070) $2,089 $2,089 16.0×
Thoracic spine 3 views (72072) $2,089 $2,089 16.0×
Thyroid Met Imaging Body (78018) $8,795 $8,795 13.0×
Thyroid Uptake W/Blood Flow Sngle/Mult Quan Meas (78014) $6,471 $6,471 13.0×
Tx Devices Design & Construction Complex (77334) $7,084 $7,084 15.2×
Tx devices design & construction intermediate (77333) $945 $945 5.6×
Tx devices design & construction simple (77332) $2,676 $2,676 15.9×
Ultrasound Breast Limited (76642)
range across 3 matching MRF lines		 $1,488–$2,232 $1,488–$2,232 varies
Ultrasound Exam Aaa Screen (76706) $2,089 $2,089 16.0×
Ultrasound, abdomen limited (76705) $2,089 $2,089 16.0×
Upper gi w/o kub (74240) $3,396 $3,396 15.5×
Urethrocystogram voiding (74455) $4,342 $4,342 14.6×
Us breast unilateral complete (76641) $2,089 $2,089 16.0×
Us chest (76604) $2,089 $2,089 16.0×
Us complete joint (76881) $3,134 $3,134 24.0×
Us exam, pelvic, limited (76857) $2,089 $2,089 16.0×
Us head (76506) $2,089 $2,089 16.0×
Us kidney transplant (76776) $2,089 $2,089 16.0×
Us lmtd joint/oth nonvasc xtr strux r-t w/img (76882) $2,089 $2,089 16.0×
Us ob detailed single fetus (76811) $4,342 $4,342 14.6×
Us ob limited 1 or more fetuses (76815) $2,089 $2,089 16.0×
Us ob transvaginal (76817) $2,089 $2,089 16.0×
Us pelvic non ob complete (76856) $2,089 $2,089 16.0×
Us pg uter img f&mat 14 wk tabdl 1/1st gestation (76801) $2,089 $2,089 16.0×
Us retroperitoneal complete (76770) $2,089 $2,089 16.0×
Us retroperitoneal limited (76775) $2,089 $2,089 16.0×
Us scrotum and contents (76870) $2,089 $2,089 16.0×
Us spinal canal and contents (76800) $2,089 $2,089 16.0×
Us thyroid (76536) $2,089 $2,089 16.0×
Us transrectal (76872) $2,089 $2,089 16.0×
Wrist 2 views (73100) $1,488 $1,488 13.7×
X-Ray Ac Jts - Xr Acromioclavicular Joints Bilateral (73050) $1,488 $1,488 13.7×
X-Ray Bend Only L-S Spine (72120) $2,089 $2,089 16.0×
X-Ray Elbow 2 Vw - Xr Elbow 1-2 Views Right (73070) $1,488 $1,488 13.7×
X-Ray Exam Breast Specimen (76098) $8,973 $8,973 13.2×
X-Ray Exam Entire Spi 1 Vw (72081) $1,488 $1,488 13.7×
X-Ray Exam Entire Spi 2/3 Vw (72082) $2,089 $2,089 16.0×
X-Ray Exam Hip Uni 1 View (73501) $1,488 $1,488 13.7×
X-Ray Exam Hip Uni 2-3 Views (73502) $1,488 $1,488 13.7×
X-Ray Exam Hip Uni 4/> Views (73503) $2,089 $2,089 16.0×
X-Ray Exam Hips Bi 2 Views (73521) $2,089 $2,089 16.0×
X-Ray Exam Neck Spine 2-3 Vw (72040) $1,488 $1,488 13.7×
X-Ray Exam Neck Spine 6/>Vws (72052) $2,089 $2,089 16.0×
X-Ray Exam Unilat Ribs/Chest (71101) $2,089 $2,089 16.0×
X-ray eye for foreign body (70030) $1,488 $1,488 13.7×
X-ray humerus (73060) $1,488 $1,488 13.7×
X-Ray Jaw <4 Vw - Xr Mandible < 4 Views (70100) $1,392 $1,392 12.8×
X-Ray Knee Bilat Standing - Xr Knees Anteroposterior Standing Bilat (73565) $1,488 $1,488 13.7×
X-Ray Lumbar Spine 2/3 Vw - Xr Lumbar Spine 2-3 Views (72100) $2,089 $2,089 16.0×
X-Ray Ribs, Chest 4+ Vw - Xr Ribs 3 Vws Bil W/ Chest Posteroanterior (71111) $2,089 $2,089 16.0×
X-Ray Sacroiliac Jts 3+ Vw - Xr Sacroiliac Joints 3+ Views (72202) $2,089 $2,089 16.0×
X-Ray Sacrum/Coccyx 2+ Vw - Xr Sacrum Coccyx 2+ Views (72220) $1,488 $1,488 13.7×
X-Ray Sinuses 3+ Vw - Xr Paranasal Sinuses 3+ Views (70220) $1,488 $1,488 13.7×
X-Ray Skull 4+ Vw - Xr Skull Complete 4+ Views (70260) $2,089 $2,089 16.0×
X-Rays Bone Length Studies (77073) $2,089 $2,089 16.0×
X-Rays Bone Survey Complete (77075) $2,089 $2,089 16.0×
Xr c-spine 4 or 5 views (72050) $2,089 $2,089 16.0×
Xr facial bones less than 3 views (70140) $1,488 $1,488 13.7×
Xr orbits complete 4 views (70200) $2,089 $2,089 16.0×

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.