Imaging prices at CHI Lisbon Health
Lisbon, ND · every code in this section with a posted price and a Medicare benchmark.
207 codes. Prices are the hospital's own posted facility charges.
Compare against other hospitals interactively →
| Procedure | Posted cash | Posted gross | × Medicare |
|---|---|---|---|
| Abdomen 1 View (74018) | $124.32 | $222 | 1.4× |
| Abdomen 2 views (74019) | $150.08 | $268 | 1.4× |
| Acute Gastrointestinal Blood Loss Imaging (78278) | $1,294.72 | $2,312 | 3.2× |
| Bone age studies (77072) | $105.84 | $189 | 1.0× |
| Bone Imaging 3 Phase (78315) | $1,288 | $2,300 | 3.2× |
| Bone Imaging Limited Area (78300) | $642.88 | $1,148 | 1.6× |
| Bone Imaging Multiple Areas (78305) | $844.48 | $1,508 | 2.1× |
| Bone Imaging Whole Body (78306) | $948.64 | $1,694 | 2.3× |
| Bone survey infant (77076) | $309.12 | $552 | 2.9× |
| Cat Scan Follow-Up Study (76380) | $606.48 | $1,083 | 6.8× |
| Chest 1 view (71045) | $93.52 | $167 | 1.1× |
| Chest 2 views (71046) | $120.96 | $216 | 1.4× |
| Chest 3 views (71047) | $150.08 | $268 | 1.7× |
| Chest 4 or more views (71048) | $199.92 | $357 | 1.9× |
| Cholecystography Oral Contrast (74290) | $234.64 | $419 | 1.3× |
| Computed Tomography Thorax Lw Dose Lng Ca Scr C- (71271) | $623.84 | $1,114 | 5.8× |
| Contrast X-Ray Of Knee Joint (73580) | $504 | $900 | 1.4× |
| CT abdomen and pelvis without and with contrast (74178) | $2,965.76 | $5,296 | 8.3× |
| CT abdomen and pelvis without contrast (74176) | $1,300.88 | $2,323 | 5.3× |
| CT abdomen w contrast (74160) | $1,979.60 | $3,535 | 11.0× |
| CT abdomen w wo contrast (74170) | $2,083.76 | $3,721 | 11.6× |
| CT abdomen w/o contrast (74150) | $1,021.44 | $1,824 | 9.6× |
| CT Angio Abdomen and Pelvis (74174) | $1,975.68 | $3,528 | 5.5× |
| CT Angio Chest (71275) | $1,974 | $3,525 | 11.0× |
| CT Angio Head (70496) | $1,707.44 | $3,049 | 9.5× |
| CT Angio Neck (70498) | $1,806.56 | $3,226 | 10.1× |
| CT cervical spine w/ contrast (72126) | $1,965.60 | $3,510 | 5.5× |
| CT cervical spine w/o contrast (72125) | $1,547.84 | $2,764 | 14.5× |
| CT cervical spine w/wo cont (72127) | $1,795.36 | $3,206 | 10.0× |
| CT chest w contrast (71260) | $1,559.60 | $2,785 | 8.7× |
| CT chest w/wo contrast (71270) | $1,902.32 | $3,397 | 10.6× |
| CT head/brain with contrast (70460) | $1,276.80 | $2,280 | 7.1× |
| CT head/brain without and with contrast (70470) | $1,418.48 | $2,533 | 7.9× |
| CT iac w contrast (70481) | $1,279.60 | $2,285 | 7.1× |
| CT l-spine w&w/o contrast (72133) | $2,423.68 | $4,328 | 13.5× |
| CT lower ext w/o (73700) | $914.48 | $1,633 | 8.6× |
| CT lower extremity w/contrast material (73701) | $1,692.88 | $3,023 | 9.4× |
| CT lumbar spine w contrast (72132) | $1,979.04 | $3,534 | 5.6× |
| CT lumbar spine w/o contrast (72131) | $1,533.84 | $2,739 | 14.4× |
| CT maxillofacial w contrast (70487) | $1,148.56 | $2,051 | 6.4× |
| CT maxillofacial wo contrast (70486) | $1,137.36 | $2,031 | 10.6× |
| CT neck tissue combo (70492) | $1,938.16 | $3,461 | 10.8× |
| Ct Orbit/Ear/Fossa W/O&W/Dye (70482) | $1,437.52 | $2,567 | 8.0× |
| CT orbits w/o contrast (70480) | $1,347.92 | $2,407 | 12.6× |
| CT pelvis w&w/o contrast (72194) | $3,492.16 | $6,236 | 19.5× |
| CT pelvis w/o contrast (72192) | $1,580.32 | $2,822 | 14.8× |
| CT scan of leg combo (73702) range across 2 matching MRF lines |
$2,150.40–$4,300.80 | $3,840–$7,680 | varies |
| CT scans face/jaw combo (70488) | $1,467.20 | $2,620 | 8.2× |
| CT soft tissue neck w contrast (70491) | $1,374.80 | $2,455 | 7.7× |
| CT soft tissue neck w/o contrast (70490) | $1,182.16 | $2,111 | 11.1× |
| CT thoracic spine w contrast (72129) | $1,344 | $2,400 | 7.5× |
| CT thoracic spine w/o contrast (72128) | $1,139.04 | $2,034 | 10.7× |
| CT thoracic spine w/wo cont (72130) | $1,685.60 | $3,010 | 9.4× |
| CT thorax w/o contrast (71250) | $1,169.84 | $2,089 | 11.0× |
| CT upper ext wo (73200) | $1,377.60 | $2,460 | 12.9× |
| CT upper extremity w/o & w/contrast material (73202) | $2,314.48 | $4,133 | 12.9× |
| CT upper extremity with contrast (73201) | $1,763.44 | $3,149 | 4.9× |
| Cta Abdl Aorta&Bi Iliofem W/Contrast&Postp (75635) | $1,678.88 | $2,998 | 9.4× |
| Cta Abdomen (74175) | $1,580.32 | $2,822 | 8.8× |
| CTA pelvis (72191) | $1,579.20 | $2,820 | 8.8× |
| Dxa Bone Density Axial (77080) | $423.36 | $756 | 4.0× |
| Dxa bone density study 1/>sites appendiclr skel (77081) | $127.12 | $227 | 1.4× |
| Echo exam uterus (76831) | $398.16 | $711 | 1.6× |
| Esophagram (74220) | $441.28 | $788 | 2.5× |
| Fetal Biophys Profile W/Nst (76818) | $370.16 | $661 | 3.5× |
| Fetal Biophysical Profile W/O Non-Stress Testing (76819) | $268.24 | $479 | 2.5× |
| Fluoroscopy up to 1 hr (76000) | $304.08 | $543 | 1.2× |
| Gastric emptying imaging study (78264) | $1,085.28 | $1,938 | 2.7× |
| Gated Heart Planar Single (78472) | $945.84 | $1,689 | 2.3× |
| Hepatobil Syst Image W/Drug (78227) | $1,970.08 | $3,518 | 3.6× |
| Hepatobiliary System Imaging (78226) | $1,437.52 | $2,567 | 3.5× |
| Ht Muscle Image Spect Sing (78451) | $1,674.40 | $2,990 | 1.3× |
| Hysterosalpingogram (74740) | $262.64 | $469 | 1.1× |
| Infant hip ultrasound with hip movement (dynamic) (76885) | $483.28 | $863 | 5.4× |
| Infant hip ultrasound, limited static exam (76886) | $369.04 | $659 | 4.2× |
| Joint Survey Single View (77077) | $295.12 | $527 | 2.8× |
| K Flow/Funct Image Multiple (78709) | $1,294.72 | $2,312 | 2.3× |
| K Flow/Funct Image W/Drug (78708) | $1,501.36 | $2,681 | 2.7× |
| K Flow/Funct Image W/O Drug (78707) range across 2 matching MRF lines |
$839.44–$949.76 | $1,499–$1,696 | varies |
| Liver & Spleen Imaging Static Only (78215) | $736.96 | $1,316 | 1.8× |
| Liver imaging static only (78201) | $710.64 | $1,269 | 1.3× |
| Lung Ventilat&Perfus Imaging (78582) | $1,384.32 | $2,472 | 2.5× |
| Lung Ventilation Imaging (78579) | $810.32 | $1,447 | 2.0× |
| Magnetic Image Jaw Joint (70336) | $2,135.28 | $3,813 | 8.8× |
| Meckels Divert Exam (78290) | $1,288 | $2,300 | 3.2× |
| Mra Head W/O & W/Contrast Material (70546) | $3,044.72 | $5,437 | 8.5× |
| MRA head w/o contrast (70544) | $2,013.76 | $3,596 | 8.3× |
| MRA head with contrast (70545) | $1,977.92 | $3,532 | 5.5× |
| MRA neck w contrast (70548) | $2,148.72 | $3,837 | 6.0× |
| Mra Neck W/O &W/Contrast Material (70549) | $3,487.12 | $6,227 | 9.8× |
| MRA neck w/o contrast (70547) | $2,016 | $3,600 | 8.3× |
| MRI abdomen w contrast (74182) | $2,302.72 | $4,112 | 6.5× |
| MRI abdomen w/o contrast (74181) | $1,609.44 | $2,874 | 6.6× |
| MRI any jt lower extrem w/contrast material (73722) | $2,425.36 | $4,331 | 3.0× |
| MRI any jt lower extrem w/o & w/contrast matrl (73723) | $2,550.24 | $4,554 | 7.2× |
| MRI cervical spine w contrast (72142) | $1,688.96 | $3,016 | 4.7× |
| MRI cervical spine w/o cont (72141) | $1,639.68 | $2,928 | 6.7× |
| MRI chest w/o contrast (71550) | $2,008.16 | $3,586 | 8.2× |
| MRI chest with contrast (71551) | $2,201.92 | $3,932 | 2.7× |
| MRI chest wo w contrast (71552) | $2,792.16 | $4,986 | 7.8× |
| MRI lower extrem oth/thn jt w/o & w/contr matr (73720) | $2,400.72 | $4,287 | 6.7× |
| MRI lower extrem oth/thn jt w/o contr matrl (73718) range across 2 matching MRF lines |
$1,789.76–$1,902.32 | $3,196–$3,397 | varies |
| MRI lumbar spine w contrast (72149) | $1,952.16 | $3,486 | 5.5× |
| Mri Neck Spine W/O & W/Dye (72156) | $2,770.88 | $4,948 | 7.8× |
| MRI orbit face &/neck w/o contrast (70540) | $1,884.40 | $3,365 | 7.7× |
| MRI orbit face neck w contrast (70542) | $2,059.12 | $3,677 | 5.8× |
| Mri Orbt/Fac/Nck W/O &W/Dye (70543) | $3,493.84 | $6,239 | 9.8× |
| MRI pelvis w contrast (72196) | $1,954.40 | $3,490 | 5.5× |
| MRI pelvis w/o & w contrast (72197) | $2,353.12 | $4,202 | 6.6× |
| MRI pelvis w/o contrast (72195) | $1,778.56 | $3,176 | 7.3× |
| MRI thoracic spine w/o contrast (72146) | $1,933.68 | $3,453 | 7.9× |
| Mri Uppr Extremity W/O&W/Dye (73220) | $3,230.64 | $5,769 | 9.1× |
| MRI, abdomen, combo (74183) | $2,475.76 | $4,421 | 6.9× |
| MRI, dorsal spine combo (72157) | $3,867.92 | $6,907 | 10.9× |
| MRI, dorsal spine contrast (72147) | $2,088.80 | $3,730 | 5.9× |
| MRI, joint upper extrem (73221) range across 2 matching MRF lines |
$1,859.76–$2,082.08 | $3,321–$3,718 | varies |
| MRI, joint upper extrem combo (73223) | $3,274.32 | $5,847 | 9.2× |
| MRI, lumbar spine combo (72158) | $3,295.04 | $5,884 | 9.2× |
| Myocardial Spect Multiple Studies (78452) | $2,232.16 | $3,986 | 1.7× |
| Neck soft tissue (70360) | $114.24 | $204 | 1.3× |
| Ob us nuchal meas 1 gest (76813) | $324.80 | $580 | 3.0× |
| Parathyroid Planar Imaging (78070) | $1,108.24 | $1,979 | 2.7× |
| Pelvis 1 or 2 views (72170) | $156.24 | $279 | 1.5× |
| Pulmonary Perfusion Imaging Particulate (78580) | $864.64 | $1,544 | 2.1× |
| Radex Abd Compl Aqt Abd W/S/E/D Views 1 View Ch (74022) | $194.88 | $348 | 1.8× |
| Radex abscess/fistula/sinus tract rs&i (76080) | $151.20 | $270 | 0.3× |
| Radex Facial Bones Complete Minimum 3 Views (70150) | $190.96 | $341 | 1.8× |
| Radex Nasal Bones Complete Minimum 3 Views (70160) | $126.56 | $226 | 1.4× |
| Radex Sinuses Paransl < 3 Views (70210) | $145.60 | $260 | 1.6× |
| Radex Spine 1 View Specify Level (72020) | $111.44 | $199 | 1.3× |
| Radex Sternum Minimum 2 Views (71120) | $160.16 | $286 | 1.8× |
| Radex Temporomandble Jt Opn & Clsd Mouth Bilat (70330) | $205.52 | $367 | 2.3× |
| Radex X-Ray Exam Entire Spi 6/> Vw - Xr Entire Spine 6+ Vw (72084) | $221.20 | $395 | 2.1× |
| Radiolog exam mandible compl minimum 4 views (70110) | $182 | $325 | 1.7× |
| Radiologic Exam Abdomen 3+ Views - Xr Abdomen 3+ Views (74021) | $169.68 | $303 | 1.6× |
| Radiologic exam colon double contrast study (74280) | $736.40 | $1,315 | 4.1× |
| Radiologic exam colon single contrast study (74270) | $581.28 | $1,038 | 3.2× |
| Radiologic exam pelvis compl minimum 3 views (72190) | $185.92 | $332 | 1.7× |
| Radiologic Exam Small Int Single Contrast Study (74250) | $442.40 | $790 | 2.5× |
| Radiologic exam swallow function contrast study (74230) | $530.88 | $948 | 3.0× |
| Radiologic exam upr gi trc double contrast study (74246) | $408.24 | $729 | 2.3× |
| Radiologic examination femur 1 view (73551) | $143.92 | $257 | 1.6× |
| Radiologic examination femur minimum 2 views (73552) | $169.12 | $302 | 1.9× |
| Radiologic Examination Osseous Survey Limited (77074) | $286.72 | $512 | 2.7× |
| Ribs bilateral 3 views (71110) | $154.56 | $276 | 1.4× |
| Rp Loclzj Tum Spect 1 Area Single Day Imaging (78803) | $1,103.76 | $1,971 | 2.0× |
| Screening Digital Breast Tomosynthesis Bi (77063) | $94.64 | $169 | 4.0× |
| Sella turcica (70240) | $151.76 | $271 | 1.7× |
| Skull less than 4 views (70250) | $168 | $300 | 1.6× |
| Sternoclavicular joints (71130) | $182 | $325 | 2.0× |
| Testicular Imaging W/Flow (78761) | $780.08 | $1,393 | 1.9× |
| Therapeutic Enema Rdctj Intussusception/Obstrcj (74283) | $539.84 | $964 | 3.0× |
| Thoracic spine 2 views (72070) | $133.84 | $239 | 1.3× |
| Thoracic spine 3 views (72072) | $148.40 | $265 | 1.4× |
| Thoracolumbar 2 views (72080) | $162.40 | $290 | 1.8× |
| Ultrasound Exam Aaa Screen (76706) | $364.56 | $651 | 3.4× |
| Ultrasound, abdomen limited (76705) range across 2 matching MRF lines |
$235.20–$443.52 | $420–$792 | varies |
| Umbilical-artery Doppler (OB) (76820) | $83.44 | $149 | 0.8× |
| Unlisted Dx Radiographic Procedure (76499) | $120.40 | $215 | 1.4× |
| Unlisted us procedure (76999) | $325.92 | $582 | 3.7× |
| Upper gi w/o kub (74240) range across 2 matching MRF lines |
$557.20–$684.88 | $995–$1,223 | varies |
| Ureteral Reflux Study (78740) | $868.56 | $1,551 | 2.1× |
| Urethrocystogram voiding (74455) | $538.16 | $961 | 2.2× |
| Us chest (76604) | $298.48 | $533 | 2.8× |
| Us exam, pelvic, limited (76857) | $343.84 | $614 | 3.2× |
| Us kidney transplant (76776) | $502.32 | $897 | 4.7× |
| Us lmtd joint/oth nonvasc xtr strux r-t w/img (76882) | $238 | $425 | 2.2× |
| Us ob limited 1 or more fetuses (76815) | $325.92 | $582 | 3.1× |
| Us ob transvaginal (76817) | $287.84 | $514 | 2.7× |
| Us pelvic non ob complete (76856) | $520.80 | $930 | 4.9× |
| Us pg uter img f&mat 14 wk tabdl 1/1st gestation (76801) | $334.88 | $598 | 3.1× |
| Us preg uterus real time f/u trnsabdl per fetus (76816) | $324.24 | $579 | 3.0× |
| Us retroperitoneal complete (76770) | $525.84 | $939 | 4.9× |
| Us retroperitoneal limited (76775) range across 2 matching MRF lines |
$315.28–$352.24 | $563–$629 | varies |
| Us scrotum and contents (76870) | $390.32 | $697 | 3.7× |
| Us thyroid (76536) | $452.48 | $808 | 4.2× |
| Us transrectal (76872) | $285.60 | $510 | 2.7× |
| Venography extremity bilateral rs&i (75822) | $450.24 | $804 | 0.3× |
| Vertebral fracture assessment via dxa (77086) | $202.16 | $361 | 2.3× |
| X-Ray Ac Jts - Xr Acromioclavicular Joints Bilateral (73050) | $245.84 | $439 | 2.8× |
| X-Ray Bend Only L-S Spine (72120) | $201.60 | $360 | 1.9× |
| X-Ray Exam Entire Spi 1 Vw (72081) | $68.88 | $123 | 0.8× |
| X-Ray Exam Entire Spi 2/3 Vw (72082) | $113.12 | $202 | 1.1× |
| X-Ray Exam Entire Spi 4/5 Vw (72083) | $214.48 | $383 | 2.0× |
| X-Ray Exam Hips Bi 2 Views (73521) | $163.52 | $292 | 1.5× |
| X-Ray Exam Hips Bi 3-4 Views (73522) | $223.44 | $399 | 2.1× |
| X-Ray Exam Hips Bi 5/> Views (73523) | $255.36 | $456 | 2.4× |
| X-Ray Exam L-S Spine Bending (72114) | $407.68 | $728 | 3.8× |
| X-Ray Exam Neck Spine 2-3 Vw (72040) | $157.36 | $281 | 1.8× |
| X-Ray Exam Neck Spine 6/>Vws (72052) | $258.16 | $461 | 2.4× |
| X-ray IV pyelogram (ivp) (74400) | $397.04 | $709 | 2.2× |
| X-ray IV pyelogram+tomography (74415) | $502.32 | $897 | 2.8× |
| X-Ray Jaw <4 Vw - Xr Mandible < 4 Views (70100) | $112.56 | $201 | 1.3× |
| X-Ray Knee Bilat Standing - Xr Knees Anteroposterior Standing Bilat (73565) | $175.84 | $314 | 2.0× |
| X-Ray Lumbar Spine 2/3 Vw - Xr Lumbar Spine 2-3 Views (72100) | $157.36 | $281 | 1.5× |
| X-ray nose-rectum child f.b. (76010) | $144.48 | $258 | 1.6× |
| X-Ray Ribs, Chest 4+ Vw - Xr Ribs 3 Vws Bil W/ Chest Posteroanterior (71111) | $189.28 | $338 | 1.8× |
| X-Ray Sacroiliac Jts 3+ Vw - Xr Sacroiliac Joints 3+ Views (72202) | $164.08 | $293 | 1.5× |
| X-Ray Sacroiliac Jts <3 Vw - Xr Sacroiliac Joints 1-2 Views (72200) | $142.80 | $255 | 1.3× |
| X-Ray Sacrum/Coccyx 2+ Vw - Xr Sacrum Coccyx 2+ Views (72220) | $138.88 | $248 | 1.6× |
| X-Ray Sinuses 3+ Vw - Xr Paranasal Sinuses 3+ Views (70220) | $171.36 | $306 | 1.9× |
| X-Ray Skull 4+ Vw - Xr Skull Complete 4+ Views (70260) | $224.56 | $401 | 2.1× |
| X-Ray Urinary Tract Exam With Contrast Material (74420) | $500.64 | $894 | 1.4× |
| X-Rays Bone Length Studies (77073) | $220.64 | $394 | 2.1× |
| X-Rays Bone Survey Complete (77075) | $340.48 | $608 | 3.2× |
| Xr c-spine 4 or 5 views (72050) | $215.60 | $385 | 2.0× |
| Xr facial bones less than 3 views (70140) | $176.40 | $315 | 2.0× |
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.