Imaging prices at Deaconess Gibson Hospital

Princeton, IN · every code in this section with a posted price and a Medicare benchmark.

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

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ProcedurePosted cashPosted gross× Medicare
Abdomen 1 View (74018) $92.22 $174 1.0×
Abdomen 2 views (74019) $183.91 $347 1.7×
Acute Gastrointestinal Blood Loss Imaging (78278) $558.09 $1,053 1.3×
Ankle 2 views (73600) $140.98 $266 1.5×
Bone age studies (77072) $137.80 $260 1.2×
Bone Imaging 3 Phase (78315) $1,320.23 $2,491 3.1×
Bone Imaging Limited Area (78300) $431.42 $814 1.0×
Bone Imaging Whole Body (78306) $1,158.58 $2,186 2.7×
Bone survey infant (77076) $183.91 $347 1.7×
Cat Scan Follow-Up Study (76380) $520.99 $983 5.7×
Chest 1 view (71045) $135.15 $255 1.5×
Chest 2 views (71046) $149.99 $283 1.6×
Chest 3 views (71047) $164.83 $311 1.8×
Chest 4 or more views (71048) $179.67 $339 1.6×
Clavicle complete (73000) $137.80 $260 1.5×
Computed Tomography Thorax Lw Dose Lng Ca Scr C- (71271) $906.83 $1,711 8.2×
Contrast X-Ray Bladder (74430) $159.53 $301 0.4×
Contrast X-Ray Of Knee Joint (73580) $305.28 $576 0.8×
CT abdomen and pelvis without and with contrast (74178) $2,096.15 $3,955 5.7×
CT abdomen and pelvis without contrast (74176) $1,557.14 $2,938 6.2×
CT abdomen w contrast (74160) $906.83 $1,711 4.9×
CT abdomen w wo contrast (74170) $1,078.55 $2,035 5.8×
CT abdomen w/o contrast (74150) $779.10 $1,470 7.0×
CT Angio Abdomen and Pelvis (74174) $785.99 $1,483 2.1×
CT Angio Chest (71275) $1,189.85 $2,245 6.4×
CT Angio Head (70496) $1,189.85 $2,245 6.4×
Ct Angio Lwr Extr W/O&W/Dye (73706) $1,078.55 $2,035 5.8×
CT Angio Neck (70498) $1,189.85 $2,245 6.4×
Ct Angio Upr Extrm W/O&W/Dye (73206) $1,078.55 $2,035 5.8×
CT cervical spine w/ contrast (72126) $906.83 $1,711 2.5×
CT cervical spine w/o contrast (72125) $779.10 $1,470 7.0×
CT cervical spine w/wo cont (72127) $1,078.55 $2,035 5.8×
CT chest w contrast (71260) $876.62 $1,654 4.7×
CT chest w/wo contrast (71270) $1,078.55 $2,035 5.8×
CT head/brain with contrast (70460) $906.83 $1,711 4.9×
CT head/brain without and with contrast (70470) $1,078.55 $2,035 5.8×
CT heart no contrast quant eval coronry calcium (75571) $28.09 $53 0.3×
CT iac w contrast (70481) $906.83 $1,711 4.9×
CT l-spine w&w/o contrast (72133) $1,272 $2,400 6.9×
CT lower ext w/o (73700) $779.10 $1,470 7.0×
CT lower extremity w/contrast material (73701) $906.83 $1,711 4.9×
CT lumbar spine w contrast (72132) $1,219 $2,300 3.3×
CT lumbar spine w/o contrast (72131) $1,197.80 $2,260 10.8×
CT maxillofacial w contrast (70487) $906.83 $1,711 4.9×
CT maxillofacial wo contrast (70486) $898.35 $1,695 8.1×
CT neck tissue combo (70492) $1,078.55 $2,035 5.8×
Ct Orbit/Ear/Fossa W/O&W/Dye (70482) $1,078.55 $2,035 5.8×
CT orbits w/o contrast (70480) $779.10 $1,470 7.0×
CT pelvis w&w/o contrast (72194) $1,078.55 $2,035 5.8×
CT pelvis w/o contrast (72192) $779.10 $1,470 7.0×
CT scan of leg combo (73702) $1,078.55 $2,035 5.8×
CT scans face/jaw combo (70488) $915.31 $1,727 4.9×
CT soft tissue neck w contrast (70491) $906.83 $1,711 4.9×
CT soft tissue neck w/o contrast (70490) $779.10 $1,470 7.0×
CT thoracic spine w contrast (72129) $906.83 $1,711 4.9×
CT thoracic spine w/o contrast (72128) $876.62 $1,654 7.9×
CT thoracic spine w/wo cont (72130) $1,078.55 $2,035 5.8×
CT thorax w/o contrast (71250) $780.16 $1,472 7.1×
CT upper ext wo (73200) $779.10 $1,470 7.0×
CT upper extremity w/o & w/contrast material (73202) $906.83 $1,711 4.9×
CT upper extremity with contrast (73201) $898.35 $1,695 2.4×
Cta Abdl Aorta&Bi Iliofem W/Contrast&Postp (75635) $1,189.85 $2,245 6.4×
Cta Abdomen (74175) $1,189.85 $2,245 6.4×
CTA pelvis (72191) $1,189.85 $2,245 6.4×
Dxa Bone Density Axial (77080) $239.56 $452 2.2×
Dxa bone density study 1/>sites appendiclr skel (77081) $183.38 $346 2.0×
Esophagram (74220) $127.20 $240 0.7×
Fetal Biophysical Profile W/O Non-Stress Testing (76819) $410.22 $774 3.7×
Foot 2 views (73620) $137.80 $260 1.5×
Forearm 2 views (73090) $140.98 $266 1.5×
Gastric emptying imaging study (78264) $506.68 $956 1.2×
Gastroesophageal Reflux Exam (78262) $421.35 $795 1.0×
Gated Heart Planar Single (78472) $535.83 $1,011 1.3×
Hand 2 views (73120) $137.80 $260 1.2×
Hepatobil Syst Image W/Drug (78227) $833.16 $1,572 1.5×
Hepatobiliary System Imaging (78226) $833.16 $1,572 2.0×
Ht Muscle Image Spect Sing (78451) $751.54 $1,418 0.5×
K Flow/Funct Image W/Drug (78708) $282.49 $533 0.5×
K Flow/Funct Image W/O Drug (78707) $665.15 $1,255 1.2×
Knee 3 Views (73562) $164.83 $311 1.8×
Liver & Spleen Imaging Static Only (78215) $660.91 $1,247 1.6×
Lung Perf&Ventilat Diferentl (78598) $571.87 $1,079 1.0×
Lung Ventilat&Perfus Imaging (78582) $904.71 $1,707 1.6×
Lymph System Imaging (78195) $890.93 $1,681 1.6×
Magnetic Image Jaw Joint (70336) $1,189.85 $2,245 4.7×
Mammary ductogram or galactogram single (77053) $444.14 $838 1.8×
Meckels Divert Exam (78290) $522.58 $986 1.2×
Mr safety determination physician/other qhp (76016) $192.39 $363 2.1×
Mr safety implant&/fb assmt clin staf 1st 15 min (76014) $60.95 $115 2.0×
Mr safety implt electronics prepj supvj phys/qhp (76018) $200.87 $379 2.0×
Mr safety med physics xm customization plng&mntr (76017) $330.72 $624 1.3×
Mra Head W/O & W/Contrast Material (70546) $1,378 $2,600 3.7×
MRA head w/o contrast (70544) $1,078.55 $2,035 4.3×
MRA head with contrast (70545) $1,168.12 $2,204 3.2×
MRA neck w contrast (70548) $1,168.12 $2,204 3.2×
Mra Neck W/O &W/Contrast Material (70549) $1,378 $2,600 3.7×
MRA neck w/o contrast (70547) $1,078.55 $2,035 4.3×
MRI abdomen w contrast (74182) $1,168.12 $2,204 3.2×
MRI abdomen w/o contrast (74181) $1,078.55 $2,035 4.3×
MRI any jt lower extrem w/contrast material (73722) $1,168.12 $2,204 1.4×
MRI any jt lower extrem w/o & w/contrast matrl (73723) $1,378 $2,600 3.7×
MRI any jt upper extremity w/contrast matrl (73222) $1,168.12 $2,204 1.4×
MRI cervical spine w/o cont (72141) $1,078.55 $2,035 4.3×
MRI chest w/o contrast (71550) $1,078.55 $2,035 4.3×
MRI chest with contrast (71551) $1,168.12 $2,204 1.4×
MRI chest wo w contrast (71552) $1,378 $2,600 3.7×
MRI lower extrem oth/thn jt w/o & w/contr matr (73720) $1,189.85 $2,245 3.2×
MRI lower extrem oth/thn jt w/o contr matrl (73718) $984.21 $1,857 3.9×
MRI lumbar spine w contrast (72149) $1,168.12 $2,204 3.2×
Mri Neck Spine W/O & W/Dye (72156) $1,378 $2,600 3.7×
MRI orbit face &/neck w/o contrast (70540) $1,078.55 $2,035 4.3×
MRI orbit face neck w contrast (70542) $1,168.12 $2,204 3.2×
Mri Orbt/Fac/Nck W/O &W/Dye (70543) $1,312.28 $2,476 3.6×
MRI pelvis w contrast (72196) $1,219 $2,300 3.3×
MRI pelvis w/o & w contrast (72197) $1,378 $2,600 3.7×
MRI pelvis w/o contrast (72195) $1,078.55 $2,035 4.3×
MRI thoracic spine w/o contrast (72146) $1,078.55 $2,035 4.3×
MRI upper extremity oth than jt w/contr matrl (73219) $1,219 $2,300 3.3×
MRI upper extremity oth than jt w/o contr matrl (73218) $984.21 $1,857 3.9×
Mri Uppr Extremity W/O&W/Dye (73220) $1,378 $2,600 3.7×
MRI, abdomen, combo (74183) $1,378 $2,600 3.7×
MRI, dorsal spine combo (72157) $1,378 $2,600 3.7×
MRI, dorsal spine contrast (72147) $1,168.12 $2,204 3.2×
MRI, joint upper extrem (73221) $984.21 $1,857 3.9×
MRI, joint upper extrem combo (73223) $2,079.72 $3,924 5.6×
MRI, lumbar spine combo (72158) $1,378 $2,600 3.7×
Myocardial Spect Multiple Studies (78452) $751.54 $1,418 0.5×
Neck soft tissue (70360) $92.22 $174 1.0×
Parathyroid Planar Imaging (78070) $477 $900 1.1×
Pelvis 1 or 2 views (72170) $131.44 $248 1.2×
Pulmonary Perfusion Imaging Particulate (78580) $414.46 $782 1.0×
Radex Abd Compl Aqt Abd W/S/E/D Views 1 View Ch (74022) $289.38 $546 2.6×
Radex abscess/fistula/sinus tract rs&i (76080) $69.43 $131 0.1×
Radex Ankle Complete Minimum 3 Views (73610) $164.83 $311 1.8×
Radex Calcaneus Minimum 2 Views (73650) $123.49 $233 1.3×
Radex elbow complete minimum 3 views (73080) $140.98 $266 1.5×
Radex Facial Bones Complete Minimum 3 Views (70150) $157.94 $298 1.4×
Radex fingr minimum 2 views (73140) $119.78 $226 1.3×
Radex foot complete minimum 3 views (73630) $140.98 $266 1.5×
Radex Hand Minimum 3 Views (73130) $140.98 $266 1.5×
Radex lower extremity infant minimum 2 views (73592) $137.80 $260 1.5×
Radex Mastoids Compl Minimum 3 Views PR Side (70130) $157.94 $298 1.4×
Radex Nasal Bones Complete Minimum 3 Views (70160) $157.94 $298 1.7×
Radex Ribs Unilateral 2 Views (71100) $183.91 $347 2.0×
Radex shoulder complete minimum 2 views (73030) $183.91 $347 2.0×
Radex Sinuses Paransl < 3 Views (70210) $46.11 $87 0.5×
Radex sm int w/mlt srl imges via enteroclss tube (74251) $457.92 $864 2.5×
Radex Spine 1 View Specify Level (72020) $87.98 $166 1.0×
Radex Sternum Minimum 2 Views (71120) $183.91 $347 2.0×
Radex Temporomandble Jt Opn & Clsd Mouth Bilat (70330) $183.91 $347 2.0×
Radex Toe Minimum 2 Views (73660) $119.78 $226 1.3×
Radex upper extremity infant minimum 2 views (73092) $137.80 $260 1.2×
Radex Wrist Complete Minimum 3 Views (73110) $140.98 $266 1.5×
Radiolog exam mandible compl minimum 4 views (70110) $204.05 $385 1.8×
Radiologic Exam Abdomen 3+ Views - Xr Abdomen 3+ Views (74021) $209.35 $395 1.9×
Radiologic exam colon double contrast study (74280) $508.80 $960 2.7×
Radiologic exam colon single contrast study (74270) $242.21 $457 1.3×
Radiologic Exam Esophagus Double Contrast Study (74221) $190.80 $360 1.0×
Radiologic exam knee complete 4/more views (73564) $179.67 $339 1.6×
Radiologic exam pelvis compl minimum 3 views (72190) $80.56 $152 0.7×
Radiologic Exam Small Int Single Contrast Study (74250) $94.87 $179 0.5×
Radiologic exam swallow function contrast study (74230) $206.70 $390 1.1×
Radiologic exam upr gi trc double contrast study (74246) $209.88 $396 1.1×
Radiologic examination femur minimum 2 views (73552) $142.57 $269 1.5×
Radiologic examination knee 1/2 views (73560) $149.99 $283 1.6×
Radiologic Examination Osseous Survey Limited (77074) $275.07 $519 2.5×
Radiologic examination tibia & fibula 2 views (73590) $149.99 $283 1.6×
Ribs bilateral 3 views (71110) $275.07 $519 2.5×
Rp Loclzj Tum Spect 1 Area Single Day Imaging (78803) $1,372.42 $2,589.47 2.4×
Scapula (73010) $137.80 $260 1.2×
Screening Digital Breast Tomosynthesis Bi (77063) $25.97 $49 1.1×
Shoulder 1 view (73020) $92.22 $174 1.0×
Shoulder Arthrography (73040) $457.92 $864 1.2×
Skull less than 4 views (70250) $157.94 $298 1.4×
Sternoclavicular joints (71130) $137.80 $260 1.5×
Therapeutic Enema Rdctj Intussusception/Obstrcj (74283) $424 $800 2.3×
Thoracic spine 2 views (72070) $213.06 $402 1.9×
Thoracic spine 3 views (72072) $179.67 $339 1.6×
Thoracolumbar 2 views (72080) $149.99 $283 1.6×
Thyroid Imaging With Vascular Flow (78013) $853.30 $1,610 2.0×
Thyroid Uptake Measurement (78012) $355.10 $670 0.8×
Thyroid Uptake W/Blood Flow Sngle/Mult Quan Meas (78014) $853.30 $1,610 2.0×
Ultrasound Breast Limited (76642)
range across 2 matching MRF lines		 $169.60–$203.52 $320–$384 varies
Ultrasound Elastography Parenchyma (76981) $107.59 $203 1.0×
Ultrasound Exam Aaa Screen (76706) $470.11 $887 4.3×
Ultrasound, abdomen limited (76705) $479.12 $904 4.3×
Unlisted magnetic resonance procedure (76498) $66.78 $126 0.7×
Upper gi w/o kub (74240) $275.07 $519 1.5×
Urethrocystogram voiding (74455) $183.91 $347 0.7×
Us breast unilateral complete (76641)
range across 2 matching MRF lines		 $239.56–$287.26 $452–$542 varies
Us chest (76604) $239.56 $452 2.2×
Us exam, pelvic, limited (76857) $316.94 $598 2.9×
Us lmtd joint/oth nonvasc xtr strux r-t w/img (76882) $323.83 $611 2.9×
Us ob limited 1 or more fetuses (76815) $318 $600 2.9×
Us ob transvaginal (76817) $338.67 $639 3.1×
Us pelvic non ob complete (76856) $272.95 $515 2.5×
Us pg uter img f&mat 14 wk tabdl 1/1st gestation (76801) $467.99 $883 4.2×
Us retroperitoneal complete (76770) $169.07 $319 1.5×
Us retroperitoneal limited (76775) $479.12 $904 4.3×
Us scrotum and contents (76870) $419.23 $791 3.8×
Us spinal canal and contents (76800) $251.75 $475 2.3×
Us thyroid (76536) $419.23 $791 3.8×
Us transrectal (76872) $314.29 $593 2.8×
Wrist 2 views (73100) $119.78 $226 1.3×
X-Ray Ac Jts - Xr Acromioclavicular Joints Bilateral (73050) $119.78 $226 1.3×
X-Ray Bend Only L-S Spine (72120) $149.99 $283 1.4×
X-Ray Elbow 2 Vw - Xr Elbow 1-2 Views Right (73070) $119.78 $226 1.3×
X-Ray Exam Breast Specimen (76098) $148.40 $280 0.3×
X-Ray Exam Entire Spi 1 Vw (72081) $119.78 $226 1.3×
X-Ray Exam Entire Spi 2/3 Vw (72082) $142.57 $269 1.3×
X-Ray Exam Hip Uni 1 View (73501) $88.51 $167 1.0×
X-Ray Exam Hip Uni 2-3 Views (73502) $137.80 $260 1.5×
X-Ray Exam Hip Uni 4/> Views (73503) $72.08 $136 0.7×
X-Ray Exam Hips Bi 2 Views (73521) $127.73 $241 1.2×
X-Ray Exam Hips Bi 3-4 Views (73522) $179.67 $339 1.6×
X-Ray Exam Hips Bi 5/> Views (73523) $333.90 $630 3.0×
X-Ray Exam L-S Spine Bending (72114) $239.56 $452 2.2×
X-Ray Exam Neck Spine 2-3 Vw (72040) $149.99 $283 1.6×
X-Ray Exam Neck Spine 6/>Vws (72052) $239.56 $452 2.2×
X-Ray Exam Unilat Ribs/Chest (71101) $275.07 $519 2.5×
X-ray eye for foreign body (70030) $137.80 $260 1.5×
X-ray humerus (73060) $140.98 $266 1.5×
X-ray IV pyelogram (ivp) (74400) $275.07 $519 1.5×
X-Ray Jaw <4 Vw - Xr Mandible < 4 Views (70100) $145.22 $274 1.6×
X-Ray Knee Bilat Standing - Xr Knees Anteroposterior Standing Bilat (73565) $172.78 $326 1.9×
X-Ray Lumbar Spine 2/3 Vw - Xr Lumbar Spine 2-3 Views (72100) $149.99 $283 1.4×
X-ray nose-rectum child f.b. (76010) $130.38 $246 1.4×
X-Ray Ribs, Chest 4+ Vw - Xr Ribs 3 Vws Bil W/ Chest Posteroanterior (71111) $366.23 $691 3.3×
X-Ray Sacroiliac Jts 3+ Vw - Xr Sacroiliac Joints 3+ Views (72202) $157.94 $298 1.4×
X-Ray Sacroiliac Jts <3 Vw - Xr Sacroiliac Joints 1-2 Views (72200) $208.82 $394 1.9×
X-Ray Sacrum/Coccyx 2+ Vw - Xr Sacrum Coccyx 2+ Views (72220) $149.99 $283 1.6×
X-Ray Sinuses 3+ Vw - Xr Paranasal Sinuses 3+ Views (70220) $157.94 $298 1.7×
X-Ray Skull 4+ Vw - Xr Skull Complete 4+ Views (70260) $204.05 $385 1.8×
X-ray thoracic spine 4 vw (72074) $292.03 $551 2.6×
X-Ray Tmj Unilat (70328) $121.90 $230 1.3×
X-Ray Urinary Tract Exam With Contrast Material (74420) $449.44 $848 1.2×
X-Rays Bone Length Studies (77073) $149.99 $283 1.4×
X-Rays Bone Survey Complete (77075) $508.80 $960 4.6×
Xr c-spine 4 or 5 views (72050) $209.35 $395 1.9×
Xr facial bones less than 3 views (70140) $209.35 $395 2.3×
Xr orbits complete 4 views (70200) $157.94 $298 1.4×

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.