Imaging prices at Granville Medical Center

Oxford, NC · every code in this section with a posted price and a Medicare benchmark.

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

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ProcedureCash priceGross charge× Medicare
Abdomen 2 views (74019) $408 $510 3.9×
Acute gastrointestinal blood loss imaging (78278) $708 $885 1.8×
Ankle 2 views (73600) $163.20 $204 1.9×
Antegrade urography radiological supvj & interpj (74425) $374.40 $468 1.1×
Arthrogram elbow (73085) $300 $375 0.9×
Arthrogram hip (73525) $1,300 $1,625 3.7×
Arthrogram shoulder (73040) $332 $415 1.0×
Arthrogram wrist (73115) $324 $405 0.9×
Arthrography knee lt (73580) $420.80 $526 1.2×
Bone &/Joint Imaging Limited Area (78300) $399.20 $499 1.0×
Bone &/Joint Imaging Multiple Areas (78305) $932.80 $1,166 2.3×
Bone &/joint imaging whole body (78306) $1,092 $1,365 2.7×
Bone age studies (77072) $140.80 $176 1.4×
Bone Imaging 3 Phase (78315) $1,025.60 $1,282 2.6×
Bone Marrow Imaging Limited Area (78102) $504.80 $631 1.3×
Bone survey complete (77075) $536 $670 5.1×
Brain image w/flow 4 + views (78606) $821.60 $1,027 1.5×
Cerebrospinal Fluid Flow W/O Matl Shunt Evaltj (78645) $1,616 $2,020 3.0×
Cervical spine 2 or 3 views (72040) $138.40 $173 1.6×
Chest 1 view (71045) $440 $550 5.1×
Chest 3 views (71047) $220 $275 2.5×
Cine/Vid X-Ray Throat/Esoph - Fl Esoph Barium Swlw W/ Video & Speech (74230) $354.40 $443 2.0×
Clavicle complete (73000) $138.40 $173 1.6×
Computed Tomography Thorax Lw Dose Lng Ca Scr C- (71271) $979.20 $1,224 9.4×
CT abdomen and pelvis without and with contrast (74178) $6,120 $7,650 17.6×
CT abdomen and pelvis without contrast (74176) $4,161.60 $5,202 17.5×
CT abdomen w contrast (74160) $2,284 $2,855 13.1×
CT abdomen w wo contrast (74170) $3,672 $4,590 21.0×
CT abdomen w/o contrast (74150) $1,736.80 $2,171 16.7×
CT angio hrt w/3d image (75574) $2,448 $3,060 7.0×
CT angiography upper extremity lt (73206) $1,872.80 $2,341 10.7×
CT c-spine w/o contrast (72125) $3,900.80 $4,876 37.5×
CT cervical spine w&w/o contrast (72127) $1,820.80 $2,276 10.4×
CT cervical spine with contrast (72126) $2,175.20 $2,719 6.3×
CT chest w/wo contrast (71270) $2,544.80 $3,181 14.6×
CT chest with contrast (71260) $2,856 $3,570 16.4×
CT head/brain with contrast (70460) $2,322.40 $2,903 13.3×
CT head/brain without and with contrast (70470) $2,448 $3,060 14.0×
CT heart no contrast quant eval coronry calcium (75571) $131.20 $164 1.5×
CT iac w contrast (70481) $1,993.60 $2,492 11.4×
CT limited/localized follow up study (76380) $920 $1,150 10.6×
CT lower ext w/o (73700) $1,951.20 $2,439 18.7×
CT lower extremity w wo contrast (73702) $1,467.20 $1,834 8.4×
CT lower extremity with contrast (73701) $2,448 $3,060 14.0×
CT lumbar spine w & w/o contrast (72133) $2,185.60 $2,732 12.5×
CT lumbar spine w/o contrast (72131) $2,856 $3,570 27.4×
CT lumbar spine with contrast (72132) $2,175.20 $2,719 6.3×
CT maxillofacial w contrast (70487) $2,448 $3,060 14.0×
CT maxillofacial w/o contrast (70486) $2,448 $3,060 23.5×
CT maxillofacial w/wo contrast (70488) $1,861.60 $2,327 10.7×
CT neck soft tissue w contrast (70491) $2,856 $3,570 16.4×
CT orbit sella/post fossa/ear w/o & w/contr matr (70482) $1,939.20 $2,424 11.1×
CT orbits w/o contrast (70480) $1,949.60 $2,437 18.7×
CT pelvis w & w/o contrast (72194) $2,500 $3,125 14.3×
CT pelvis w/o contrast (72192) $2,002.40 $2,503 19.2×
CT scan for measuring calcium and other minerals in bone (77078) $958.40 $1,198 11.1×
CT soft tissue neck w/o & w/contrast material (70492) $2,329.60 $2,912 13.3×
CT soft tissue neck w/o contrast (70490) $1,951.20 $2,439 18.7×
CT thoracic spine w/contrast (72129) $1,576 $1,970 9.0×
CT thoracic spine w/o contrast (72128) $2,856 $3,570 27.4×
CT thoracic spine w/wo contrast (72130) $1,462.40 $1,828 8.4×
CT thorax w/o contrast (71250) $2,856 $3,570 27.4×
CT upper extremity w/o & w/contrast material (73202) $1,462.40 $1,828 8.4×
CT upper extremity w/o contrast rt (73200) $1,951.20 $2,439 18.7×
CT upper extremity with contrast (73201) $1,890.40 $2,363 5.4×
Cta Abdl Aorta&Bi Iliofem W/Contrast&Postp (75635) $2,448 $3,060 14.0×
Cta Abdomen (74175) $2,794.40 $3,493 16.0×
CTA abdomen pelvis (74174) $5,712 $7,140 16.4×
CTA chest (71275) $2,856 $3,570 16.4×
Cta Head (70496) $2,856 $3,570 16.4×
CTA lwr ext w&w/o contrast (73706) $2,040 $2,550 11.7×
Cta Neck (70498) $2,856 $3,570 16.4×
Cta Pelvis (72191) $1,705.60 $2,132 9.8×
Cystography minimum 3 views rs&i (74430) $292.80 $366 0.8×
Diskogram cervical (72285) $468.80 $586 0.2×
Diskography lumbar (72295) $468.80 $586 0.2×
Dxa bone density study 1/> sites axial skel (77080) $600 $750 5.8×
Dxa bone density study axial skeleton (77085) $600 $750 5.8×
Echoencephalography real time imaging (76506) $193.60 $242 1.9×
Esophagus (74220) $571.20 $714 3.3×
Fetal biophysical profile non-stress testing (76818) $366.40 $458 3.5×
Fetal Biophysical Profile W/O Non-Stress Testing (76819) $720 $900 6.9×
Fluoroscopy up to 1 hr (76000) $612 $765 2.6×
Foot 2 views (73620) $174.40 $218 2.0×
Forearm 2 views (73090) $169.60 $212 2.0×
Gated Heart Planar Single (78472) $846.40 $1,058 2.1×
Hand 2 views (73120) $168 $210 1.6×
Hand 3 views (73130) $408 $510 4.7×
Heart Infarct Image (78466) $464 $580 1.2×
Hepatobil Syst Imag Inc Gb W/Pharma Intervenj (78227) $2,400 $3,000 4.4×
Hepatobiliary syst imaging including gallbladder (78226) $1,036 $1,295 2.6×
Ht muscle image spect sing (78451) $1,687.20 $2,109 1.3×
Humerus Min 2 Views Left (73060) $122.40 $153 1.4×
Hysterosalpingogram (74740) $228.80 $286 1.0×
Kidney funcj study non-img radioisotopic study (78725) $393.60 $492 1.0×
Kidney Img Morphology Vascular Flow 1 W/O Rx (78707) $720.80 $901 1.3×
Kidney img morphology vascular flow 1 w/rx (78708) $704.80 $881 1.3×
Kidney Img Morphology Vascular Flow Multiple (78709) $1,199.20 $1,499 2.2×
Knee 3 views (73562) $240 $300 2.8×
Liver & spleen imaging static only (78215) $511.20 $639 1.3×
Liver & Spleen Imaging W/Vascular Flow (78216) $560.80 $701 1.4×
Liver imaging static only (78201) $511.20 $639 0.9×
Liver imaging w/vascular flow (78202) $619.20 $774 1.1×
Lung Ventilation Imaging (78579) $698.40 $873 1.8×
Lymphoscintigraphy (78195) $555.20 $694 1.0×
Mammary ductogram or galactogram multiple (77054) $673.60 $842 2.8×
Mammary ductogram or galactogram single (77053) $673.60 $842 2.8×
Manual appl stress pfrmd phys/qhp joint films (77071) $172 $215 2.0×
Meckels Diverticulum (78290) $464 $580 1.2×
MRA head w & w/o contrast (70546) $1,938.40 $2,423 5.6×
MRA head w/o contrast (70544) $3,344 $4,180 14.1×
MRA head with contrast (70545) $1,952 $2,440 5.6×
MRA neck w contrast (70548) $2,590.40 $3,238 7.5×
Mra Neck W/O &W/Contrast Material (70549) $4,012 $5,015 11.6×
MRA neck w/o contrast (70547) $3,264 $4,080 13.7×
MRI abdomen w contrast (74182) $1,988 $2,485 5.7×
MRI abdomen w/o & w/contrast material (74183) $4,012 $5,015 11.6×
MRI abdomen w/o contrast (74181) $3,277.60 $4,097 13.8×
MRI any jnt lwr ext with con lt (73722) $1,544.80 $1,931 2.0×
MRI any jt upper extremity w/contrast matrl (73222) $3,344 $4,180 4.3×
MRI bone marrow blood supply (77084) $1,282.40 $1,603 5.4×
MRI c-spine with contrast (72142) $1,600.80 $2,001 4.6×
MRI cervical spine w/o contrast (72141) $3,672 $4,590 15.5×
MRI chest w/o contrast (71550) $1,406.40 $1,758 5.9×
MRI Forearm w/ Contrast Bilateral 73219 (73219) $1,272 $1,590 3.7×
MRI lower extrem oth/thn jt w/contrast matrl (73719) $2,719.20 $3,399 7.8×
MRI lower extrem oth/thn jt w/o contr matrl (73718) $3,264 $4,080 13.7×
MRI orbit face &/neck w/o contrast (70540) $1,631.20 $2,039 6.9×
MRI orbit/face/neck w&w/o cont (70543) $4,012 $5,015 11.6×
MRI orbit/face/neck w/contrast (70542) $1,816.80 $2,271 5.2×
MRI pelvis w contrast (72196) $1,742.40 $2,178 5.0×
MRI pelvis w/o & w/contrast material (72197) $3,483.20 $4,354 10.0×
MRI pelvis w/o contrast (72195) $3,344 $4,180 14.1×
MRI scan of arm joint before and after contrast (73223) $3,672 $4,590 10.6×
MRI scan of leg joint before and after contrast (73723) $2,666.40 $3,333 7.7×
MRI spinal canal cervical w/o & w/contr matrl (72156) $4,012 $5,015 11.6×
MRI spinal canal lumbar w/contrast material (72149) $2,093.60 $2,617 6.0×
MRI spinal canal lumbar w/o & w/contr matrl (72158) $4,896 $6,120 14.1×
MRI spinal canal thoracic w/contrast matrl (72147) $1,700 $2,125 4.9×
MRI spinal canal thoracic w/o & w/contr matrl (72157) $4,681.60 $5,852 13.5×
MRI thoracic spine w/o contrast (72146) $3,672 $4,590 15.5×
MRI tmj (70336) $1,311.20 $1,639 5.5×
MRI upper ext joint w/o contrast (73221) $3,672 $4,590 15.5×
MRI upper extrem other than jt w/o & w/contras (73220) $1,920 $2,400 5.5×
MRI upper extremity oth than jt w/o contr matrl (73218) $3,264 $4,080 13.7×
Myelogram Cervical (72240) $576 $720 0.7×
Myelogram Lumbar (72265) $525.60 $657 0.7×
Myocardial Spect Multiple Studies (78452) $5,280 $6,600 4.1×
Neck soft tissue (70360) $134.40 $168 1.6×
Nm bone marrow multiple (78103) $687.20 $859 1.7×
Nm bone marrow wb (78104) $752 $940 1.9×
Nm gastric emptying study (78264) $1,760 $2,200 4.4×
Nm gastroesophageal reflux study (78262) $594.40 $743 1.5×
Nuclear medicine of heart muscle at rest with stress (78454) $1,059.20 $1,324 0.8×
Nuclear medicine of heart pumping function (78473) $1,084.80 $1,356 2.7×
Nuclear medicine study of kidney and blood flow (78701) $440 $550 1.1×
Nuclear medicine study of limited area for thyroid cancer (78015) $628 $785 1.6×
Nuclear Rx Oral Admin (79005) $722.40 $903 3.1×
Ob Us Follow-Up Per Fetus - Us Ob Follow Up Transabdominal Approach (76816) $740 $925 7.1×
Osseous survey infant (77076) $560 $700 5.4×
Parathyroid imaging (78070) $471.20 $589 1.2×
Pelvis 1 or 2 views (72170) $408 $510 3.9×
Pr MRI, lower extr, w/o contrast f/u by contrast (73720) $2,856 $3,570 8.2×
Pulmonary Perfusion Imaging Particulate (78580) $771.20 $964 1.9×
Pulmonary Ventilation & Perfusion Imaging (78582) $1,184 $1,480 2.2×
Radex abscess/fistula/sinus tract rs&i (76080) $186.40 $233 0.3×
Radex Entir Thrc Lmbr Crv Sac Spi W/Skull 1 Vw - Xr Scoliosis 1 Vw (72081) $205.60 $257 2.4×
Radex entir thrc lmbr crv sac spi w/skull 2/3 vw (72082) $239.20 $299 2.3×
Radex hips bilateral with pelvis 2 views (73521) $189.60 $237 1.8×
Radex mastoids compl minimum 3 views pr side (70130) $187.20 $234 1.8×
Radex X-Ray Exam Entire Spi 6/> Vw - Xr Entire Spine 6+ Vw (72084) $187.20 $234 1.8×
Radiolog exam mandible compl minimum 4 views (70110) $187.20 $234 1.8×
Radiologic Exam Abdomen 1 View - Xr Abdomen 1 View (74018) $360 $450 4.2×
Radiologic Exam Abdomen 3+ Views - Xr Abdomen 3+ Views (74021) $232.80 $291 2.2×
Radiologic Exam Chest 2 Views - Xr Chest 2 Views (71046) $440 $550 5.1×
Radiologic exam colon single contrast study (74270) $381.60 $477 2.2×
Radiologic exam upr gi trc single contrast study (74240) $452.80 $566 2.6×
Radiologic Examination Femur Minimum 2 Views - Xr Femur 2+ Vw Lt (73552) $156 $195 1.8×
Radiological examination surgical specimen (76098) $885.60 $1,107 1.6×
Ribs bilateral 3 views (71110) $290.40 $363 2.8×
Rp loclzj tum plnr 2+area 1+d img/1 area img>2+d (78801) $767.20 $959 1.9×
Rp loclzj tum plnr whole body single day imaging (78802) $889.60 $1,112 1.6×
Rp loclzj tum spect 1 area single day imaging (78803) $1,028.80 $1,286 1.9×
Sacroiliac Joints < 3 Views (72200) $112 $140 1.1×
Saline Infus Sonohysterography W/Color Doppler (76831) $322.40 $403 1.4×
Salivary gland imaging (78230) $508 $635 1.3×
Salivary gland imaging serial images (78231) $597.60 $747 1.5×
Scanogram (77073) $165.60 $207 1.6×
Scapula complete (73010) $156.80 $196 1.5×
Screening digital breast tomosynthesis (77063) $129.60 $162 5.5×
Small bowel series (74250) $357.60 $447 2.0×
Testicular Imaging With Vascular Flow (78761) $472 $590 1.2×
Thoracolumbar 2 views (72080) $176.80 $221 2.0×
Thyroid carcinoma metastases img whole body (78018) $876 $1,095 1.6×
Thyroid Imaging With Vascular Flow (78013) $458.40 $573 1.2×
Thyroid Uptake W/Blood Flow Sngle/Mult Quan Meas (78014) $543.20 $679 1.4×
Tomogram (76100) $120.80 $151 1.2×
Ultrasound, abdomen limited (76705) $740 $925 7.1×
Umbilical-artery Doppler (OB) (76820) $720 $900 6.9×
Upper Extremity Infant (73092) $94.40 $118 0.9×
Urethrocystography retrograde rs&i (74450) $236.80 $296 1.0×
Urethrocystography voiding (74455) $253.60 $317 1.1×
Urography (pyelography), intravenous, with or without KUB, with or without tomography (74400) $396 $495 2.3×
Urograpy infusion drip &/bolus techq w/wo tomo (74415) $556.80 $696 3.2×
Us abdl aorta screen aaa (76706) $740 $925 7.1×
Us breast unilateral complete (76641) $720 $900 6.9×
Us breast unilateral limited (76642) $332.80 $416 3.8×
Us chest (76604) $740 $925 7.1×
Us compl joint r-t w/image documentation (76881) $347.20 $434 3.3×
Us elastography parenchyma (76981) $336 $420 3.2×
Us infant hips dynamic (76885) $740 $925 8.5×
Us ob detailed single fetus (76811) $517.60 $647 2.2×
Us ob transvaginal (76817) $740 $925 7.1×
Us pelvic non ob complete (76856) $1,019.20 $1,274 9.8×
Us pelvic nonobstetric image dcmtn limited/f/u (76857) $335.20 $419 3.2×
Us pregnancy ltd (76815) $720 $900 6.9×
Us pregnant uterus 14 wk transabdl 1/1st gestat (76801) $740 $925 7.1×
Us retroperitoneal complete (76770) $740 $925 7.1×
Us retroperitoneal limited (76775) $189.60 $237 1.8×
Us scrotum and contents (76870) $740 $925 7.1×
Us soft tissue head/neck (76536) $740 $925 7.1×
Us spinal canal and contents (76800) $252 $315 2.4×
Us transrectal (76872) $720 $900 6.9×
Us xtr non-vasc lmtd (76882) $740 $925 7.1×
Vascular flow imaging (78445) $416.80 $521 1.0×
Venogram extremity bilateral (75822) $539.20 $674 0.3×
Venography extremity unilateral rs&i (75820) $508 $635 0.3×
Vertebral fracture assessment via dxa (77086) $160 $200 1.8×
Wrist 2 views (73100) $109.60 $137 1.3×
X-Ray Abdomen,Comp Acute Series - Xr Abdomen 2 Vws With Chest 1 View (74022) $160 $200 1.5×
X-Ray Ac Jts - Xr Acromioclavicular Joints Bilateral (73050) $310.40 $388 3.6×
X-Ray Ankle 3+ Vw - Xr Ankle 3+ Views Right (73610) $382.40 $478 4.4×
X-Ray Colon Air Contrast - Fl Barium Enema Air Contrast (74280) $520.80 $651 3.0×
X-Ray Elbow 2 Vw - Xr Elbow 1-2 Views Right (73070) $172 $215 2.0×
X-Ray Elbow 3+ Vw - Xr Elbow 3+ Views Right (73080) $408 $510 4.7×
X-ray exam entire spi 4/5 vw (72083) $187.20 $234 1.8×
X-ray exam hip uni 1 view (73501) $102.40 $128 1.2×
X-Ray Exam Hip Uni 2-3 Views (73502) $326.40 $408 3.8×
X-ray exam of femur 1 (73551) $112.80 $141 1.3×
X-ray exam of small bowel - fl small bowel series enteroclysis tube (74251) $173.60 $217 1.0×
X-ray eye for foreign body (70030) $130.40 $163 1.5×
X-Ray Facial Bones 3+ Vw - Xr Facial Bones 3+ Views (70150) $218.40 $273 2.1×
X-Ray Facial Bones <3 Vw - Xr Facial Bones 1-2 Views (70140) $126.40 $158 1.5×
X-Ray Foot 3+ Vw - Xr Foot 3+ Views Right (73630) $440 $550 5.1×
X-Ray Heel - Xr Calcaneus 2 Views Right (73650) $160 $200 1.8×
X-ray IV pyelogram+drip infusn (74410) $470.40 $588 2.7×
X-Ray Jaw <4 Vw - Xr Mandible < 4 Views (70100) $128.80 $161 1.5×
X-Ray Knee 4+ View - Xr Knee 4+ Views Right (73564) $281.60 $352 2.7×
X-Ray Knee Bilat Standing - Xr Knees Anteroposterior Standing Bilat (73565) $146.40 $183 1.7×
X-Ray Leg, Infant - Xr Lower Extremity 2+ Views Infant Left (73592) $94.40 $118 1.1×
X-Ray Lumbar Spine 2/3 Vw - Xr Lumbar Spine 2-3 Views (72100) $440 $550 4.2×
X-Ray Lumbar Spine 6+ Vw - Xr Lumbar Spine 6+ Vws Including Bending (72114) $325.60 $407 3.1×
X-Ray Nasal Bones - Xr Nasal Bones (70160) $164.80 $206 1.9×
X-Ray Orbits - Xr Orbits Complete 4+ Views (70200) $231.20 $289 2.2×
X-Ray Pelvis 3+ Vw - Xr Pelvis 3+ Views (72190) $200 $250 1.9×
X-Ray Retrograde Pyelogram - Fl Pyelogram Retrograde (74420) $489.60 $612 1.4×
X-Ray Ribs 2 Vw Unilat - Xr Ribs 2 Views Right (71100) $279.20 $349 3.2×
X-Ray Ribs, Chest 3+ Vw - Xr Ribs 2 Vws Lt W/ Chest Anteroposterior (71101) $220.80 $276 2.1×
X-Ray Ribs, Chest 4+ Vw - Xr Ribs 3 Vws Bil W/ Chest Posteroanterior (71111) $256.80 $321 2.5×
X-Ray Sacroiliac Jts 3+ Vw - Xr Sacroiliac Joints 3+ Views (72202) $138.40 $173 1.3×
X-Ray Sacrum/Coccyx 2+ Vw - Xr Sacrum Coccyx 2+ Views (72220) $172 $215 2.0×
X-Ray Shoulder 2+ Vw - Xr Shoulder 2+ Views Right (73030) $440 $550 5.1×
X-Ray Sinuses 3+ Vw - Xr Paranasal Sinuses 3+ Views (70220) $251.20 $314 2.9×
X-Ray Sinuses <3 Vw - Xr Paranasal Sinuses 1-2 Views (70210) $117.60 $147 1.4×
X-Ray Skull 4+ Vw - Xr Skull Complete 4+ Views (70260) $283.20 $354 2.7×
X-Ray Skull <4 Vw - Xr Skull 1-3 Views (70250) $146.40 $183 1.4×
X-Ray Spine One View - Xr Spine (72020) $134.40 $168 1.6×
X-Ray Sterno-Clavicluar Jt - Xr Sternoclavicular Joints 3+ Views (71130) $198.40 $248 2.3×
X-Ray Sternum 2+ Vw - Xr Sternum 2+ Views (71120) $153.60 $192 1.8×
X-Ray Thoracic Spine 2 Vw - Xr Thoracic Spine 2 Views (72070) $202.40 $253 1.9×
X-Ray Toe(S) - Xr Toes 2+ Views Right (73660) $148.80 $186 1.7×
X-Ray Wrist 3+ Vw - Xr Wrist 3+ Views Right (73110) $408 $510 4.7×
Xr arthrogram ankle (73615) $868 $1,085 2.5×
Xr c-spine 6 or more views (72052) $292.80 $366 2.8×
Xr chest 4+ views (71048) $208.80 $261 2.0×
Xr Cholecystography Oral Contrast (74290) $236 $295 1.4×
Xr finger(s) 2+ views (73140) $326.40 $408 3.8×
Xr optic foramina (70190) $140.80 $176 1.6×
Xr shoulder 1 view (73020) $172 $215 2.0×
Xr spine cervical 4 or 5 views (72050) $360.80 $451 3.5×
Xr tibia/fibula 2 views (73590) $173.60 $217 2.0×
Xr tmj bilateral (70330) $188.80 $236 2.2×
Xray knee 1 or 2 views rt (73560) $157.60 $197 1.8×