Imaging prices at Gouverneur Hospital
Gouverneur, NY · 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) | $191.26 | $294.25 | 1.8× |
| Abdomen 2 views (74019) | $317.33 | $488.20 | 2.4× |
| Acute Gastrointestinal Blood Loss Imaging (78278) | $644.48 | $991.51 | 1.3× |
| Ankle 2 views (73600) | $200.64 | $308.68 | 1.8× |
| Arthrogram hip (73525) | $753.38 | $1,159.04 | 1.7× |
| Arthrogram Wrist (73115) | $725.86 | $1,116.71 | 1.7× |
| Bone age studies (77072) | $146.13 | $224.82 | 1.1× |
| Bone survey infant (77076) | $861.71 | $1,325.71 | 6.6× |
| Chest 1 view (71045) | $204.91 | $315.24 | 1.9× |
| Chest 2 views (71046) | $276.45 | $425.31 | 2.5× |
| Chest 4 or more views (71048) | $229.09 | $352.45 | 1.8× |
| Chg us nrv&acc strux 1 xtr compre w/img pr extremity (76883) | $251.86 | $387.47 | 1.9× |
| Clavicle complete (73000) | $157.19 | $241.83 | 1.4× |
| Computed Tomography Thorax Lw Dose Lng Ca Scr C- (71271) | $247.40 | $380.61 | 1.9× |
| Contrast Xray Throat/Cerv Esopha (74210) | $333.59 | $513.22 | 1.5× |
| CT abdomen and pelvis without and with contrast (74178) | $3,267.99 | $5,027.68 | 7.5× |
| CT abdomen and pelvis without contrast (74176) | $1,900.31 | $2,923.55 | 6.4× |
| CT abdomen w contrast (74160) | $2,222.99 | $3,419.99 | 10.2× |
| CT abdomen w wo contrast (74170) | $2,584.13 | $3,975.58 | 11.8× |
| CT abdomen w/o contrast (74150) | $1,482.01 | $2,280.01 | 11.4× |
| CT Angio Abdomen and Pelvis (74174) | $4,313.73 | $6,636.51 | 9.9× |
| CT Angio Chest (71275) | $2,462.91 | $3,789.09 | 11.2× |
| CT Angio Head (70496) | $2,217.14 | $3,410.99 | 10.1× |
| Ct Angio Lwr Extr W/O&W/Dye (73706) | $2,116.03 | $3,255.43 | 9.7× |
| CT Angio Neck (70498) | $2,255.96 | $3,470.70 | 10.3× |
| Ct Angio Upr Extrm W/O&W/Dye (73206) | $2,042.14 | $3,141.76 | 9.3× |
| CT cervical spine w/o contrast (72125) | $1,199.23 | $1,844.97 | 9.2× |
| CT chest w contrast (71260) | $2,729.94 | $4,199.91 | 12.5× |
| CT chest w/wo contrast (71270) | $3,033.57 | $4,667.03 | 13.9× |
| CT colonography screening (74263) | $446.52 | $686.95 | 1.5× |
| CT head/brain with contrast (70460) | $2,091.48 | $3,217.66 | 9.6× |
| CT head/brain without and with contrast (70470) | $2,107.25 | $3,241.93 | 9.6× |
| CT iac w contrast (70481) | $1,580.90 | $2,432.15 | 7.2× |
| CT l-spine w&w/o contrast (72133) | $1,529.13 | $2,352.51 | 7.0× |
| CT lower ext w/o (73700) | $759.34 | $1,168.21 | 5.8× |
| CT lower extremity w/contrast material (73701) | $1,309.46 | $2,014.56 | 6.0× |
| CT lumbar spine w contrast (72132) | $2,047.53 | $3,150.04 | 4.7× |
| CT lumbar spine w/o contrast (72131) | $1,199.23 | $1,844.97 | 9.2× |
| CT maxillofacial w contrast (70487) | $1,449.78 | $2,230.43 | 6.6× |
| CT maxillofacial wo contrast (70486) | $1,199.23 | $1,844.97 | 9.2× |
| CT neck tissue combo (70492) | $1,724.85 | $2,653.61 | 7.9× |
| Ct Orbit/Ear/Fossa W/O&W/Dye (70482) | $1,009.89 | $1,553.67 | 4.6× |
| CT orbits w/o contrast (70480) | $1,363.32 | $2,097.41 | 10.4× |
| CT pelvis w/o contrast (72192) | $759.34 | $1,168.21 | 5.8× |
| CT scan of leg combo (73702) | $1,009.89 | $1,553.67 | 4.6× |
| CT scans face/jaw combo (70488) | $1,606.54 | $2,471.60 | 7.3× |
| CT soft tissue neck w contrast (70491) | $1,449.78 | $2,230.43 | 6.6× |
| CT soft tissue neck w/o contrast (70490) | $1,199.23 | $1,844.97 | 9.2× |
| CT thoracic spine w/o contrast (72128) | $1,199.23 | $1,844.97 | 9.2× |
| CT thorax w/o contrast (71250) | $1,597 | $2,456.92 | 12.2× |
| CT upper ext wo (73200) | $1,199.23 | $1,844.97 | 9.2× |
| CT upper extremity w/o & w/contrast material (73202) | $286.86 | $441.33 | 1.3× |
| CT upper extremity with contrast (73201) | $2,047.53 | $3,150.04 | 4.7× |
| Cta Abdl Aorta&Bi Iliofem W/Contrast&Postp (75635) | $2,462.91 | $3,789.09 | 11.2× |
| Cta Abdomen (74175) | $2,309.42 | $3,552.95 | 10.5× |
| CTA head&neck c+ w/noncontrast img&post-pxessing (70471) | $554 | $852.30 | 1.3× |
| CTA pelvis (72191) | $879.20 | $1,352.61 | 4.0× |
| Dxa Bone Density Axial (77080) | $493.27 | $758.88 | 3.8× |
| Fetal Biophysical Profile W/O Non-Stress Testing (76819) | $493.27 | $758.88 | 3.8× |
| Foot 2 views (73620) | $199.37 | $306.73 | 1.8× |
| Forearm 2 views (73090) | $157.19 | $241.83 | 1.4× |
| Hand 2 views (73120) | $186.59 | $287.06 | 1.4× |
| Joint Survey Single View (77077) | $272.50 | $419.23 | 2.1× |
| Knee 3 Views (73562) | $215.10 | $330.92 | 2.0× |
| Magnetic Image Jaw Joint (70336) | $1,234.49 | $1,899.21 | 4.1× |
| Mra Head W/O & W/Contrast Material (70546) | $1,544.71 | $2,376.48 | 3.5× |
| MRA head w/o contrast (70544) | $2,881.95 | $4,433.77 | 9.7× |
| Mra Neck W/O &W/Contrast Material (70549) | $4,280.03 | $6,584.66 | 9.8× |
| MRA neck w/o contrast (70547) | $2,642.74 | $4,065.75 | 8.9× |
| MRI abdomen w contrast (74182) | $3,057.03 | $4,703.12 | 7.0× |
| MRI abdomen w/o contrast (74181) | $2,282.34 | $3,511.29 | 7.7× |
| MRI any jt lower extrem w/contrast material (73722) | $2,282.34 | $3,511.29 | 2.3× |
| MRI any jt lower extrem w/o & w/contrast matrl (73723) | $4,929.48 | $7,583.81 | 11.3× |
| MRI Breast W/O Contrast Bilateral (77047) | $3,289.62 | $5,060.95 | 11.0× |
| MRI Breast Without Contrast Material Unilateral (77046) | $462.95 | $712.23 | 1.6× |
| MRI cervical spine w contrast (72142) | $2,642.74 | $4,065.75 | 6.1× |
| MRI cervical spine w/o cont (72141) | $2,501.71 | $3,848.79 | 8.4× |
| MRI chest w/o contrast (71550) | $1,067.55 | $1,642.38 | 3.6× |
| MRI chest with contrast (71551) | $2,193.68 | $3,374.90 | 2.2× |
| MRI chest wo w contrast (71552) | $1,963.67 | $3,021.03 | 4.5× |
| MRI lower extrem oth/thn jt w/contrast matrl (73719) | $2,758.86 | $4,244.40 | 6.3× |
| MRI lower extrem oth/thn jt w/o & w/contr matr (73720) | $3,696.19 | $5,686.44 | 8.5× |
| MRI lower extrem oth/thn jt w/o contr matrl (73718) | $1,561.11 | $2,401.71 | 5.2× |
| MRI lumbar spine w contrast (72149) | $3,043.12 | $4,681.72 | 7.0× |
| Mri Neck Spine W/O & W/Dye (72156) | $3,351.15 | $5,155.61 | 7.7× |
| MRI orbit face &/neck w/o contrast (70540) | $1,639.12 | $2,521.72 | 5.5× |
| MRI orbit face neck w contrast (70542) | $2,294.38 | $3,529.82 | 5.3× |
| Mri Orbt/Fac/Nck W/O &W/Dye (70543) | $2,642.74 | $4,065.75 | 6.1× |
| MRI pelvis w contrast (72196) | $3,057.03 | $4,703.12 | 7.0× |
| MRI pelvis w/o & w contrast (72197) | $3,696.93 | $5,687.59 | 8.5× |
| MRI pelvis w/o contrast (72195) | $2,282.34 | $3,511.29 | 7.7× |
| MRI thoracic spine w/o contrast (72146) | $2,282.34 | $3,511.29 | 7.7× |
| MRI upper extremity oth than jt w/contr matrl (73219) | $1,544.71 | $2,376.48 | 3.5× |
| MRI upper extremity oth than jt w/o contr matrl (73218) | $2,088.20 | $3,212.62 | 7.0× |
| Mri Uppr Extremity W/O&W/Dye (73220) | $3,681.54 | $5,663.91 | 8.5× |
| MRI, abdomen, combo (74183) | $3,696.93 | $5,687.59 | 8.5× |
| MRI, dorsal spine combo (72157) | $3,057.03 | $4,703.12 | 7.0× |
| MRI, dorsal spine contrast (72147) | $2,642.74 | $4,065.75 | 6.1× |
| MRI, joint upper extrem (73221) | $2,088.20 | $3,212.62 | 7.0× |
| MRI, joint upper extrem combo (73223) | $3,043.12 | $4,681.72 | 7.0× |
| MRI, lumbar spine combo (72158) | $4,077.13 | $6,272.51 | 9.4× |
| Myelogram cervical (72240) | $1,480.95 | $2,278.38 | 1.5× |
| Myelograpy 2/more regions rs&i (72270) | $2,162.45 | $3,326.85 | 2.2× |
| Neck soft tissue (70360) | $193.80 | $298.15 | 1.8× |
| Ob us nuchal meas 1 gest (76813) | $232.59 | $357.83 | 1.8× |
| Ophthalmic ultrasound dx b-scan w/wo a-scan (76512) | $287.69 | $442.60 | 2.2× |
| Pelvis 1 or 2 views (72170) | $227.06 | $349.33 | 1.7× |
| Radex abscess/fistula/sinus tract rs&i (76080) | $1,500.73 | $2,308.81 | 2.2× |
| Radex Ankle Complete Minimum 3 Views (73610) | $232.59 | $357.83 | 2.1× |
| Radex Calcaneus Minimum 2 Views (73650) | $276.45 | $425.31 | 2.5× |
| Radex elbow complete minimum 3 views (73080) | $173.82 | $267.42 | 1.6× |
| Radex Facial Bones Complete Minimum 3 Views (70150) | $184.47 | $283.80 | 1.4× |
| Radex fingr minimum 2 views (73140) | $176.36 | $271.32 | 1.6× |
| Radex foot complete minimum 3 views (73630) | $228.74 | $351.91 | 2.1× |
| Radex Hand Minimum 3 Views (73130) | $218.54 | $336.21 | 2.0× |
| Radex lower extremity infant minimum 2 views (73592) | $251.74 | $387.30 | 2.3× |
| Radex Mastoids Compl Minimum 3 Views PR Side (70130) | $237.53 | $365.43 | 1.8× |
| Radex Nasal Bones Complete Minimum 3 Views (70160) | $157.19 | $241.83 | 1.4× |
| Radex Ribs Unilateral 2 Views (71100) | $310.93 | $478.36 | 2.9× |
| Radex shoulder complete minimum 2 views (73030) | $226.20 | $348 | 2.1× |
| Radex Spine 1 View Specify Level (72020) range across 2 matching MRF lines |
$78.80–$201.96 | $121.23–$310.70 | varies |
| Radex Sternum Minimum 2 Views (71120) | $146.13 | $224.82 | 1.3× |
| Radex Temporomandble Jt Opn & Clsd Mouth Bilat (70330) | $355.25 | $546.54 | 3.3× |
| Radex Toe Minimum 2 Views (73660) | $176.36 | $271.32 | 1.6× |
| Radex upper extremity infant minimum 2 views (73092) | $296.89 | $456.76 | 2.3× |
| Radex Wrist Complete Minimum 3 Views (73110) | $157.19 | $241.83 | 1.4× |
| Radex X-Ray Exam Entire Spi 6/> Vw - Xr Entire Spine 6+ Vw (72084) | $272.50 | $419.23 | 2.1× |
| Radiolog exam mandible compl minimum 4 views (70110) | $195.53 | $300.81 | 1.5× |
| Radiologic Exam Abdomen 3+ Views - Xr Abdomen 3+ Views (74021) | $386.34 | $594.37 | 3.0× |
| Radiologic Exam Esophagus Double Contrast Study (74221) | $405.09 | $623.22 | 1.9× |
| Radiologic exam knee complete 4/more views (73564) | $299.88 | $461.35 | 2.3× |
| Radiologic exam pelvis compl minimum 3 views (72190) | $338.63 | $520.97 | 2.6× |
| Radiologic Exam Small Int Single Contrast Study (74250) | $222.80 | $342.77 | 1.0× |
| Radiologic exam swallow function contrast study (74230) | $162.72 | $250.34 | 0.7× |
| Radiologic exam upr gi trc double contrast study (74246) | $489.83 | $753.59 | 2.2× |
| Radiologic examination femur 1 view (73551) | $237.78 | $365.82 | 2.2× |
| Radiologic examination femur minimum 2 views (73552) | $157.19 | $241.83 | 1.4× |
| Radiologic examination knee 1/2 views (73560) | $257.69 | $396.45 | 2.4× |
| Radiologic Examination Osseous Survey Limited (77074) | $313.89 | $482.91 | 2.4× |
| Radiologic examination tibia & fibula 2 views (73590) | $221.49 | $340.76 | 2.0× |
| Ribs bilateral 3 views (71110) | $291.77 | $448.88 | 2.2× |
| Scapula (73010) | $157.19 | $241.83 | 1.2× |
| Screening Digital Breast Tomosynthesis Bi (77063) | $84.37 | $129.80 | 3.6× |
| Shoulder 1 view (73020) | $174.64 | $268.67 | 1.6× |
| Skull less than 4 views (70250) | $280.72 | $431.87 | 2.2× |
| Special treatment procedure (77470) | $1,404.72 | $2,161.10 | 2.0× |
| Sternoclavicular joints (71130) | $168.25 | $258.84 | 1.5× |
| Therapeutic Enema Rdctj Intussusception/Obstrcj (74283) | $315.69 | $485.68 | 1.4× |
| Thoracic spine 2 views (72070) | $261.14 | $401.75 | 2.0× |
| Thoracic spine 3 views (72072) | $291.77 | $448.88 | 2.2× |
| Thoracolumbar 2 views (72080) | $258.56 | $397.78 | 2.4× |
| Ultrasound Breast Limited (76642) | $356.52 | $548.49 | 3.3× |
| Ultrasound Elastography Parenchyma (76981) | $204.91 | $315.24 | 1.6× |
| Ultrasound Exam Aaa Screen (76706) | $187.41 | $288.33 | 1.4× |
| Ultrasound, abdomen limited (76705) | $728.36 | $1,120.56 | 5.6× |
| Umbilical-artery Doppler (OB) (76820) | $262.25 | $403.46 | 2.0× |
| Unlisted us procedure (76999) | $199.93 | $307.59 | 1.8× |
| Upper gi w/o kub (74240) | $391.87 | $602.88 | 1.8× |
| Urethrocystography retrograde (74450) | $548.60 | $844 | 1.8× |
| Us breast unilateral complete (76641) | $882.15 | $1,357.15 | 6.8× |
| Us chest (76604) | $574.20 | $883.39 | 4.4× |
| Us complete joint (76881) | $261.93 | $402.97 | 2.0× |
| Us exam, pelvic, limited (76857) | $486.02 | $747.73 | 3.7× |
| Us head (76506) | $477.92 | $735.26 | 3.7× |
| Us lmtd joint/oth nonvasc xtr strux r-t w/img (76882) | $493.27 | $758.88 | 3.8× |
| Us ob detailed single fetus (76811) | $668.49 | $1,028.45 | 2.2× |
| Us ob limited 1 or more fetuses (76815) | $493.27 | $758.88 | 3.8× |
| Us ob transvaginal (76817) | $717.31 | $1,103.55 | 5.5× |
| Us pelvic non ob complete (76856) | $944.78 | $1,453.51 | 7.2× |
| Us pg uter img f&mat 14 wk tabdl 1/1st gestation (76801) | $568.22 | $874.19 | 4.4× |
| Us preg uterus real time f/u trnsabdl per fetus (76816) | $801.23 | $1,232.66 | 6.1× |
| Us retroperitoneal complete (76770) | $995.44 | $1,531.44 | 7.6× |
| Us retroperitoneal limited (76775) | $736.47 | $1,133.03 | 5.6× |
| Us scrotum and contents (76870) | $619.34 | $952.83 | 4.7× |
| Us spinal canal and contents (76800) | $474.10 | $729.39 | 3.6× |
| Us thyroid (76536) | $707.93 | $1,089.12 | 5.4× |
| Wrist 2 views (73100) | $134.17 | $206.42 | 1.2× |
| X-Ray Ac Jts - Xr Acromioclavicular Joints Bilateral (73050) | $240.99 | $370.76 | 2.2× |
| X-Ray Bend Only L-S Spine (72120) | $278.17 | $427.95 | 2.1× |
| X-Ray Elbow 2 Vw - Xr Elbow 1-2 Views Right (73070) | $147.81 | $227.40 | 1.4× |
| X-Ray Exam Breast Specimen (76098) | $134.79 | $207.37 | 0.2× |
| X-Ray Exam Entire Spi 1 Vw (72081) | $120.13 | $184.82 | 1.1× |
| X-Ray Exam Entire Spi 2/3 Vw (72082) | $184.47 | $283.80 | 1.4× |
| X-Ray Exam Hip Uni 1 View (73501) | $199.93 | $307.59 | 1.8× |
| X-Ray Exam Hip Uni 2-3 Views (73502) | $265.80 | $408.92 | 2.4× |
| X-Ray Exam Hip Uni 4/> Views (73503) | $267.93 | $412.20 | 2.1× |
| X-Ray Exam Hips Bi 2 Views (73521) | $261.96 | $403.01 | 2.0× |
| X-Ray Exam Hips Bi 3-4 Views (73522) | $511.99 | $787.68 | 3.9× |
| X-Ray Exam Hips Bi 5/> Views (73523) | $278.99 | $429.22 | 2.1× |
| X-Ray Exam L-S Spine Bending (72114) | $540.95 | $832.23 | 4.1× |
| X-Ray Exam Neck Spine 2-3 Vw (72040) range across 2 matching MRF lines |
$236.54–$256.87 | $363.90–$395.19 | varies |
| X-Ray Exam Neck Spine 6/>Vws (72052) | $419.55 | $645.46 | 3.2× |
| X-Ray Exam Unilat Ribs/Chest (71101) | $281.58 | $433.20 | 2.2× |
| X-ray eye for foreign body (70030) | $237.78 | $365.82 | 2.2× |
| X-ray humerus (73060) | $208.72 | $321.10 | 1.9× |
| X-Ray Jaw <4 Vw - Xr Mandible < 4 Views (70100) | $215.10 | $330.92 | 2.0× |
| X-Ray Lumbar Spine 2/3 Vw - Xr Lumbar Spine 2-3 Views (72100) | $307.13 | $472.51 | 2.4× |
| X-ray nose-rectum child f.b. (76010) | $238.98 | $367.66 | 2.2× |
| X-Ray Ribs, Chest 4+ Vw - Xr Ribs 3 Vws Bil W/ Chest Posteroanterior (71111) | $556.31 | $855.86 | 4.3× |
| X-Ray Sacroiliac Jts 3+ Vw - Xr Sacroiliac Joints 3+ Views (72202) | $314.79 | $484.29 | 2.4× |
| X-Ray Sacrum/Coccyx 2+ Vw - Xr Sacrum Coccyx 2+ Views (72220) | $265.80 | $408.92 | 2.4× |
| X-Ray Sinuses 3+ Vw - Xr Paranasal Sinuses 3+ Views (70220) | $184.47 | $283.80 | 1.7× |
| X-Ray Skull 4+ Vw - Xr Skull Complete 4+ Views (70260) | $235.57 | $362.42 | 1.8× |
| X-Ray Tmj Unilat (70328) | $199.93 | $307.59 | 1.8× |
| X-Rays Bone Survey Complete (77075) | $517.11 | $795.56 | 4.0× |
| Xr c-spine 4 or 5 views (72050) | $328.43 | $505.27 | 2.5× |
| Xr orbits complete 4 views (70200) | $245.78 | $378.12 | 1.9× |
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.