Imaging prices at Dolly Parton Children’s Hospital

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

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

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ProcedureCash priceGross charge× Medicare
Abdomen 2 views (74019) $406.80 $678 4.3×
Acute gastrointestinal blood loss imaging (78278) $854.40 $1,424 2.4×
Ankle 2 views (73600) $43.80 $73 0.6×
Antegrade urography radiological supvj & interpj (74425) $348 $580 1.1×
Aortography thoracic w/o serialography rs&i (75600) $732.60 $1,221 0.3×
Arthrogram hip (73525) $420.60 $701 1.3×
Arthrography knee lt (73580) $1,366.20 $2,277 4.3×
Bone &/Joint Imaging Limited Area (78300) $616.80 $1,028 1.7×
Bone &/joint imaging whole body (78306) $1,486.80 $2,478 4.1×
Bone age studies (77072) $243.60 $406 2.6×
Bone Imaging 3 Phase (78315) $1,732.20 $2,887 4.8×
Bone survey complete (77075) $445.20 $742 4.7×
Brain image w/flow 4 + views (78606) $989.40 $1,649 2.0×
Brain imaging < 4 static views w vascular flow (78601) $795.60 $1,326 2.2×
Cardiac MRI w/w/o contrast & further seq (75561) $1,362.60 $2,271 4.3×
Cerebrospinal Fluid Flow W/O Matl Shunt Evaltj (78645) $836.40 $1,394 1.7×
Cervical spine 2 or 3 views (72040) $273 $455 3.5×
Chest 1 view (71045) $252 $420 3.2×
Chest 3 views (71047) $324 $540 4.1×
Cine/Vid X-Ray Throat/Esoph - Fl Esoph Barium Swlw W/ Video & Speech (74230) $348 $580 2.2×
Clavicle complete (73000) $243.60 $406 3.1×
CT abdomen and pelvis without and with contrast (74178) $4,230.60 $7,051 13.4×
CT abdomen and pelvis without contrast (74176) $2,848.20 $4,747 13.2×
CT abdomen w contrast (74160) $2,390.40 $3,984 15.0×
CT abdomen w wo contrast (74170) $2,961.60 $4,936 18.6×
CT abdomen w/o contrast (74150) $1,982.40 $3,304 20.9×
CT angio hrt w/3d image (75574) $2,353.20 $3,922 7.4×
CT angiography upper extremity lt (73206) $1,314.60 $2,191 8.3×
CT c-spine w/o contrast (72125) $1,142.40 $1,904 12.0×
CT cervical spine w&w/o contrast (72127) $2,284.20 $3,807 14.4×
CT cervical spine with contrast (72126) $1,785 $2,975 5.6×
CT chest w/wo contrast (71270) $2,434.80 $4,058 15.3×
CT chest with contrast (71260) $2,097 $3,495 13.2×
CT head/brain with contrast (70460) $4,109.40 $6,849 25.8×
CT head/brain without and with contrast (70470) $4,644.60 $7,741 29.2×
CT heart contrast eval cardiac structure&morph (75572) $2,353.20 $3,922 7.4×
CT hrt w/3d image congen (75573) $2,353.20 $3,922 7.4×
CT iac w contrast (70481) $1,725.60 $2,876 10.8×
CT lower ext w/o (73700) $1,824.60 $3,041 19.2×
CT lower extremity w wo contrast (73702) $2,728.20 $4,547 17.1×
CT lower extremity with contrast (73701) $2,179.20 $3,632 13.7×
CT lumbar spine w & w/o contrast (72133) $2,434.80 $4,058 15.3×
CT lumbar spine w/o contrast (72131) $1,632.60 $2,721 17.2×
CT lumbar spine with contrast (72132) $1,948.80 $3,248 6.2×
CT maxillofacial w contrast (70487) $1,725.60 $2,876 10.8×
CT maxillofacial w/o contrast (70486) $1,440 $2,400 15.2×
CT maxillofacial w/wo contrast (70488) $2,153.40 $3,589 13.5×
CT neck soft tissue w contrast (70491) $1,159.80 $1,933 7.3×
CT orbit sella/post fossa/ear w/o & w/contr matr (70482) $2,153.40 $3,589 13.5×
CT orbits w/o contrast (70480) $1,440 $2,400 15.2×
CT pelvis w & w/o contrast (72194) $2,853.60 $4,756 17.9×
CT pelvis w/o contrast (72192) $1,996.80 $3,328 21.1×
CT soft tissue neck w/o & w/contrast material (70492) $1,446 $2,410 9.1×
CT soft tissue neck w/o contrast (70490) $969 $1,615 10.2×
CT thoracic spine w/contrast (72129) $2,360.40 $3,934 14.8×
CT thoracic spine w/o contrast (72128) $1,978.20 $3,297 20.9×
CT thoracic spine w/wo contrast (72130) $2,947.20 $4,912 18.5×
CT thorax w/o contrast (71250) $1,632.60 $2,721 17.2×
CT unlisted procedure (76497) $253.20 $422 3.2×
CT upper extremity w/o & w/contrast material (73202) $2,044.80 $3,408 12.8×
CT upper extremity w/o contrast rt (73200) $1,368.60 $2,281 14.4×
CT upper extremity with contrast (73201) $1,632.60 $2,721 5.2×
Cta Abdomen (74175) $2,353.20 $3,922 14.8×
CTA abdomen pelvis (74174) $2,353.20 $3,922 7.4×
CTA chest (71275) $2,353.20 $3,922 14.8×
Cta Head (70496) $1,151.40 $1,919 7.2×
CTA lwr ext w&w/o contrast (73706) $1,440 $2,400 9.0×
Cta Neck (70498) $1,746 $2,910 11.0×
Cta Pelvis (72191) $2,353.20 $3,922 14.8×
Cystography minimum 3 views rs&i (74430) $271.80 $453 0.9×
Doppler Echo Fetal Puls Spectral F/U/Repeat (76828) $388.20 $647 4.1×
Doppler Echo Fetal Spectral Display Complete (76827) $1,320 $2,200 13.9×
Dxa bone density study axial skeleton (77085) $142.80 $238 1.5×
Echo exam of fetal heart (76825) $492 $820 1.0×
Echo fetal cardiovasc w/wo m-mode repeat std (76826) $1,320 $2,200 6.1×
Echoencephalography real time imaging (76506) $526.20 $877 5.5×
Esophageal motility (78258) $902.40 $1,504 2.5×
Esophagus (74220) $348 $580 2.2×
Fluoroscopy up to 1 hr (76000) $651 $1,085 3.0×
Foot 2 views (73620) $38.40 $64 0.5×
Forearm 2 views (73090) $243.60 $406 3.1×
Full Mouth X-Ray Of Teeth - Xr Teeth Full Mouth (70320) $225.60 $376 1.0×
Gated Heart Planar Single (78472) $1,345.80 $2,243 3.7×
Hand 2 views (73120) $42 $70 0.4×
Hand 3 views (73130) $103.80 $173 1.3×
Hepatobil Syst Imag Inc Gb W/Pharma Intervenj (78227) $2,353.80 $3,923 4.8×
Hepatobiliary syst imaging including gallbladder (78226) $1,177.20 $1,962 3.2×
Ht muscle image spect sing (78451) $2,868.60 $4,781 2.4×
Humerus Min 2 Views Left (73060) $268.20 $447 3.4×
Joint Survey, Single View - Xr Joint Anteroposterior 2+ Joints (77077) $325.80 $543 3.4×
Kidney imaging morphology (78700) $436.80 $728 1.2×
Kidney Img Morphology Vascular Flow 1 W/O Rx (78707) $1,518 $2,530 3.1×
Kidney Img Morphology Vascular Flow Multiple (78709) $1,518 $2,530 3.1×
Knee 3 views (73562) $168.30 $280.50 2.1×
Liver & spleen imaging static only (78215) $880.80 $1,468 2.4×
Lung perfusion differential (78597) $1,720.20 $2,867 4.7×
Lymphoscintigraphy (78195) $579.60 $966 1.2×
Meckels Diverticulum (78290) $1,444.80 $2,408 4.0×
MRA head w & w/o contrast (70546) $3,274.80 $5,458 10.3×
MRA head w/o contrast (70544) $1,475.40 $2,459 6.8×
MRA neck w contrast (70548) $1,475.40 $2,459 4.7×
Mra Neck W/O &W/Contrast Material (70549) $2,582.40 $4,304 8.2×
MRA neck w/o contrast (70547) $1,404 $2,340 6.5×
MRI abdomen w contrast (74182) $2,364 $3,940 7.5×
MRI abdomen w/o & w/contrast material (74183) $3,383.40 $5,639 10.7×
MRI abdomen w/o contrast (74181) $1,524.60 $2,541 7.0×
MRI any jnt lwr ext with con lt (73722) $2,657.40 $4,429 3.7×
MRI any jt upper extremity w/contrast matrl (73222) $2,657.40 $4,429 3.7×
MRI bone marrow blood supply (77084) $1,524.60 $2,541 7.0×
MRI breast w/o contrast bilateral (77047) $819 $1,365 3.8×
MRI breast w/o contrast unilat (77046) $824.40 $1,374 3.8×
MRI c-spine with contrast (72142) $1,997.40 $3,329 6.3×
MRI cardiac w/o contrast (75557) $1,425 $2,375 6.6×
MRI cervical spine w/o contrast (72141) $1,665 $2,775 7.7×
MRI chest w/o & w/contrast material (71552) $2,120.40 $3,534 6.7×
MRI chest w/o contrast (71550) $1,524.60 $2,541 7.0×
MRI chest with contrast (71551) $1,606.20 $2,677 2.3×
MRI lower extrem oth/thn jt w/contrast matrl (73719) $2,589 $4,315 8.2×
MRI lower extrem oth/thn jt w/o contr matrl (73718) $1,818 $3,030 8.4×
MRI orbit face &/neck w/o contrast (70540) $3,120 $5,200 14.4×
MRI orbit/face/neck w&w/o cont (70543) $2,052 $3,420 6.5×
MRI orbit/face/neck w/contrast (70542) $1,554.60 $2,591 4.9×
MRI pelvis w contrast (72196) $1,606.20 $2,677 5.1×
MRI pelvis w/o & w/contrast material (72197) $3,383.40 $5,639 10.7×
MRI pelvis w/o contrast (72195) $1,524.60 $2,541 7.0×
MRI scan of arm joint before and after contrast (73223) $3,000 $5,000 9.5×
MRI scan of leg joint before and after contrast (73723) $3,000 $5,000 9.5×
MRI spectroscopy (76390) $1,700.40 $2,834 21.5×
MRI spinal canal cervical w/o & w/contr matrl (72156) $3,696 $6,160 11.7×
MRI spinal canal lumbar w/contrast material (72149) $1,828.80 $3,048 5.8×
MRI spinal canal lumbar w/o & w/contr matrl (72158) $3,383.40 $5,639 10.7×
MRI spinal canal thoracic w/contrast matrl (72147) $1,828.80 $3,048 5.8×
MRI spinal canal thoracic w/o & w/contr matrl (72157) $3,383.40 $5,639 10.7×
MRI thoracic spine w/o contrast (72146) $1,688.40 $2,814 7.8×
MRI tmj (70336) $1,524.60 $2,541 7.0×
MRI upper ext joint w/o contrast (73221) $1,524.60 $2,541 7.0×
MRI upper extrem other than jt w/o & w/contras (73220) $3,292.20 $5,487 10.4×
MRI upper extremity oth than jt w/o contr matrl (73218) $1,524.60 $2,541 7.0×
Myelogram Cervical (72240) $1,121.40 $1,869 1.6×
Myelogram Lumbar (72265) $961.80 $1,603 1.4×
Myelogram thoracic (72255) $961.80 $1,603 1.4×
Myelography 2 or more regions (72270) $1,438.20 $2,397 2.0×
Myocardial Spect Multiple Studies (78452) $2,868.60 $4,781 2.4×
Neck soft tissue (70360) $210 $350 2.7×
Nm cisternogram (78630) $1,554.60 $2,591 3.2×
Nm csf leak detection (78650) $1,130.40 $1,884 1.0×
Nm gastric emptying study (78264) $1,431.60 $2,386 3.9×
Nm gastroesophageal reflux study (78262) $1,033.80 $1,723 2.9×
Oph US Dx B-Scan&Quan a-Scan Sm Pt Enctr (76510) $54 $90 0.4×
Osseous survey infant (77076) $231.60 $386 2.4×
Parathyroid imaging (78070) $451.20 $752 1.2×
Pelvis 1 or 2 views (72170) $127.80 $213 1.3×
PET image w/CT, skull-thigh (78815) $2,162.40 $3,604 1.7×
PET imaging for CT attenuation whole body (78816) $2,162.40 $3,604 1.7×
Pr MRI, lower extr, w/o contrast f/u by contrast (73720) $3,147 $5,245 9.9×
Proton tx delivery simple w/o compensation (77520) $5,802.60 $9,671 11.6×
Pulmonary Perfusion Imaging Particulate (78580) $1,068.60 $1,781 2.9×
Radex abscess/fistula/sinus tract rs&i (76080) $285.60 $476 0.6×
Radex hips bilateral with pelvis 2 views (73521) $300.60 $501 3.2×
Radex mastoids compl minimum 3 views pr side (70130) $242.40 $404 2.6×
Radiolog exam mandible compl minimum 4 views (70110) $194.40 $324 2.0×
Radiologic Exam Abdomen 1 View - Xr Abdomen 1 View (74018) $307.20 $512 3.9×
Radiologic Exam Abdomen 3+ Views - Xr Abdomen 3+ Views (74021) $230.70 $384.50 2.4×
Radiologic Exam Chest 2 Views - Xr Chest 2 Views (71046) $288 $480 3.6×
Radiologic exam colon single contrast study (74270) $549.60 $916 3.5×
Radiologic exam teeth prtl exam < full mouth (70310) $88.80 $148 0.4×
Radiologic exam upr gi trc double contrast study (74246) $438.60 $731 2.8×
Radiologic exam upr gi trc single contrast study (74240) $428.40 $714 2.7×
Radiologic Examination Femur Minimum 2 Views - Xr Femur 2+ Vw Lt (73552) $268.20 $447 3.4×
Ribs bilateral 3 views (71110) $242.40 $404 2.6×
Rp loclzj tum plnr whole body single day imaging (78802) $2,714.40 $4,524 5.5×
Rp loclzj tum spect 1 area single day imaging (78803) $3,081 $5,135 6.3×
Rp loclzj tum spect 2 area/sep acquisj img (78831) $3,300 $5,500 2.8×
Sacroiliac Joints < 3 Views (72200) $163.20 $272 1.7×
Salivary gland imaging (78230) $897.60 $1,496 2.5×
Scanogram (77073) $363 $605 3.8×
Scapula complete (73010) $243.60 $406 2.6×
Shuntogram indwelling nonvascular shunt rs&i (75809) $475.80 $793 5.0×
Small bowel series (74250) $520.20 $867 3.3×
Speech evaluation complex (70371) $348 $580 1.6×
Spine thoracic 3 views (72072) $17.40 $29 0.2×
Testicular Imaging With Vascular Flow (78761) $414.60 $691 1.1×
Therapeutic Enema (74283) $726.60 $1,211 4.6×
Thoracolumbar 2 views (72080) $283.20 $472 3.6×
Thyroid Imaging With Vascular Flow (78013) $583.20 $972 1.6×
Tumor Imaging Whole Body - Nm Tumor Local Whole Body Mult Days (78804) $2,853.60 $4,756 5.8×
Ultrasound, abdomen limited (76705) $828.60 $1,381 8.7×
Unlisted Diagnostic Radiographic Procedure (76499) $6.60 $11 0.1×
Unlisted magnetic resonance procedure (76498) $2,700 $4,500 34.2×
Upper Extremity Infant (73092) $156.60 $261 1.7×
Ureteral Reflux Study Rp Voiding Cystogram (78740) $1,304.40 $2,174 3.6×
Urethrocystography retrograde rs&i (74450) $581.40 $969 2.7×
Urethrocystography voiding (74455) $630 $1,050 2.9×
Urography (pyelography), intravenous, with or without KUB, with or without tomography (74400) $397.80 $663 2.5×
Us breast unilateral complete (76641) $338.40 $564 3.6×
Us breast unilateral limited (76642) $256.80 $428 3.3×
Us chest (76604) $801.60 $1,336 8.5×
Us compl joint r-t w/image documentation (76881) $374.40 $624 3.9×
Us elastography parenchyma (76981) $374.40 $624 3.9×
Us infant hips dynamic (76885) $455.40 $759 5.8×
Us kidney transplant (76776) $387.60 $646 4.1×
Us pelvic non ob complete (76856) $451.20 $752 4.8×
Us pelvic nonobstetric image dcmtn limited/f/u (76857) $344.40 $574 3.6×
Us retroperitoneal complete (76770) $582 $970 6.1×
Us retroperitoneal limited (76775) $126 $210 1.3×
Us scrotum and contents (76870) $284.10 $473.50 3.0×
Us soft tissue head/neck (76536) $414 $690 4.4×
Us spinal canal and contents (76800) $526.20 $877 5.5×
Wrist 2 views (73100) $45 $75 0.6×
X-Ray Abdomen,Comp Acute Series - Xr Abdomen 2 Vws With Chest 1 View (74022) $577.80 $963 6.1×
X-Ray Ac Jts - Xr Acromioclavicular Joints Bilateral (73050) $298.80 $498 3.8×
X-Ray Ankle 3+ Vw - Xr Ankle 3+ Views Right (73610) $345.60 $576 4.4×
X-Ray Colon Air Contrast - Fl Barium Enema Air Contrast (74280) $712.80 $1,188 4.5×
X-Ray Elbow 2 Vw - Xr Elbow 1-2 Views Right (73070) $39.60 $66 0.5×
X-Ray Elbow 3+ Vw - Xr Elbow 3+ Views Right (73080) $268.20 $447 3.4×
X-ray exam hip uni 1 view (73501) $43.80 $73 0.6×
X-Ray Exam Hip Uni 2-3 Views (73502) $181.50 $302.50 2.3×
X-Ray Exam Hips Bi 5/> Views (73523) $82.20 $137 0.9×
X-ray exam of femur 1 (73551) $40.20 $67 0.5×
X-Ray Facial Bones 3+ Vw - Xr Facial Bones 3+ Views (70150) $363 $605 3.8×
X-Ray Foot 3+ Vw - Xr Foot 3+ Views Right (73630) $248.40 $414 3.1×
X-Ray Heel - Xr Calcaneus 2 Views Right (73650) $150.60 $251 1.9×
X-Ray Knee 4+ View - Xr Knee 4+ Views Right (73564) $219 $365 2.3×
X-Ray Lumbar Spine 2/3 Vw - Xr Lumbar Spine 2-3 Views (72100) $310.80 $518 3.3×
X-Ray Nasal Bones - Xr Nasal Bones (70160) $146.70 $244.50 1.9×
X-Ray Nose-Rectum Child F.B. - Xr Nose to Rectum Foreign Body Peds (76010) $142.20 $237 1.8×
X-ray of voice box or throat (70370) $348 $580 4.4×
X-Ray Orbits - Xr Orbits Complete 4+ Views (70200) $349.20 $582 3.7×
X-Ray Pelvis 3+ Vw - Xr Pelvis 3+ Views (72190) $310.80 $518 3.3×
X-Ray Retrograde Pyelogram - Fl Pyelogram Retrograde (74420) $762 $1,270 2.4×
X-Ray Ribs 2 Vw Unilat - Xr Ribs 2 Views Right (71100) $179.40 $299 2.3×
X-Ray Ribs, Chest 3+ Vw - Xr Ribs 2 Vws Lt W/ Chest Anteroposterior (71101) $57 $95 0.6×
X-Ray Sacrum/Coccyx 2+ Vw - Xr Sacrum Coccyx 2+ Views (72220) $268.20 $447 3.4×
X-Ray Shoulder 2+ Vw - Xr Shoulder 2+ Views Right (73030) $268.20 $447 3.4×
X-Ray Sinuses 3+ Vw - Xr Paranasal Sinuses 3+ Views (70220) $207 $345 2.6×
X-Ray Sinuses <3 Vw - Xr Paranasal Sinuses 1-2 Views (70210) $290.40 $484 3.7×
X-Ray Skull 4+ Vw - Xr Skull Complete 4+ Views (70260) $399 $665 4.2×
X-Ray Skull <4 Vw - Xr Skull 1-3 Views (70250) $277.80 $463 2.9×
X-Ray Spine One View - Xr Spine (72020) $273 $455 3.5×
X-Ray Sterno-Clavicluar Jt - Xr Sternoclavicular Joints 3+ Views (71130) $137.70 $229.50 1.7×
X-Ray Sternum 2+ Vw - Xr Sternum 2+ Views (71120) $172.80 $288 2.2×
X-Ray Thoracic Spine 2 Vw - Xr Thoracic Spine 2 Views (72070) $303 $505 3.2×
X-Ray Toe(S) - Xr Toes 2+ Views Right (73660) $199.80 $333 2.5×
X-Ray Wrist 3+ Vw - Xr Wrist 3+ Views Right (73110) $248.40 $414 3.1×
Xr c-spine 6 or more views (72052) $549 $915 5.8×
Xr chest 4+ views (71048) $360 $600 3.8×
Xr Cholecystography Oral Contrast (74290) $201.60 $336 1.3×
Xr finger(s) 2+ views (73140) $330.60 $551 4.2×
Xr myelogram posterior fossa (70010) $1,107 $1,845 3.5×
Xr optic foramina (70190) $194.40 $324 2.5×
Xr shoulder 1 view (73020) $29.40 $49 0.4×
Xr spine cervical 4 or 5 views (72050) $503.40 $839 5.3×
Xr tibia/fibula 2 views (73590) $222 $370 2.8×
Xr tmj bilateral (70330) $262.80 $438 3.3×
Xray knee 1 or 2 views rt (73560) $243.60 $406 3.1×