Imaging prices at Johnson Memorial Hospital

Stafford Springs, CT · every code in this section with a posted price and a Medicare benchmark.

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

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ProcedureCash priceGross charge× Medicare
Abdomen 2 views (74019) $296.45 $539 2.4×
Ankle 2 views (73600) $209.55 $381 2.0×
Bone &/Joint Imaging Limited Area (78300) $708.95 $1,289 1.5×
Bone &/joint imaging whole body (78306) $827.20 $1,504 1.7×
Bone age studies (77072) $145.75 $265 1.2×
Bone Imaging 3 Phase (78315) $882.20 $1,604 1.8×
Bone survey complete (77075) $386.10 $702 3.1×
Cervical spine 2 or 3 views (72040) $198.55 $361 1.9×
Chest 1 view (71045) $13,741.89 131.7×
Chest 3 views (71047) $234.85 $427 2.3×
Cine/Vid X-Ray Throat/Esoph - Fl Esoph Barium Swlw W/ Video & Speech (74230) $326.15 $593 1.6×
Clavicle complete (73000) $197.45 $359 1.9×
CT abdomen and pelvis without and with contrast (74178) $1,001.55 $1,821 2.4×
CT abdomen and pelvis without contrast (74176) $719.40 $1,308 2.5×
CT abdomen w contrast (74160) $838.75 $1,525 4.0×
CT abdomen w wo contrast (74170) $967.45 $1,759 4.6×
CT abdomen w/o contrast (74150) $658.35 $1,197 5.3×
CT angiography upper extremity lt (73206) $1,393.15 $2,533 6.6×
CT c-spine w/o contrast (72125) $741.95 5.9×
CT cervical spine with contrast (72126) $930.05 $1,691 2.2×
CT chest w/wo contrast (71270) $1,147.30 $2,086 5.5×
CT chest with contrast (71260) $1,047.20 $1,904 5.0×
CT head/brain with contrast (70460) $865.70 $1,574 4.1×
CT head/brain without and with contrast (70470) $948.20 $1,724 4.5×
CT iac w contrast (70481) $946 $1,720 4.5×
CT lower ext w/o (73700) $672.65 $1,223 5.4×
CT lower extremity w wo contrast (73702) $1,134.10 $2,062 5.4×
CT lower extremity with contrast (73701) $905.85 $1,647 4.3×
CT lumbar spine w & w/o contrast (72133) $347.05 $631 1.7×
CT lumbar spine w/o contrast (72131) $741.95 $1,349 5.9×
CT lumbar spine with contrast (72132) $930.05 $1,691 2.2×
CT maxillofacial w contrast (70487) $905.85 $1,647 4.3×
CT maxillofacial w/o contrast (70486) $669.35 $1,217 5.3×
CT maxillofacial w/wo contrast (70488) $996.60 $1,812 4.7×
CT neck soft tissue w contrast (70491) $996.60 $1,812 4.7×
CT orbit sella/post fossa/ear w/o & w/contr matr (70482) $1,026.30 $1,866 4.9×
CT orbits w/o contrast (70480) $787.05 6.3×
CT pelvis w & w/o contrast (72194) $1,015.30 $1,846 4.8×
CT pelvis w/o contrast (72192) $673.75 $1,225 5.4×
CT soft tissue neck w/o & w/contrast material (70492) $1,080.20 $1,964 5.1×
CT soft tissue neck w/o contrast (70490) $699.60 $1,272 5.6×
CT thoracic spine w/contrast (72129) $930.05 $1,691 4.4×
CT thoracic spine w/o contrast (72128) $741.95 $1,349 5.9×
CT thorax w/o contrast (71250) $675.95 $1,229 5.4×
CT upper extremity w/o & w/contrast material (73202) $1,624.70 $2,954 7.7×
CT upper extremity w/o contrast rt (73200) $634.70 $1,154 5.1×
CT upper extremity with contrast (73201) $865.70 $1,574 2.1×
Cta Abdl Aorta&Bi Iliofem W/Contrast&Postp (75635) $996.05 $1,811 4.7×
Cta Abdomen (74175) $955.90 $1,738 4.5×
CTA abdomen pelvis (74174) $1,053.80 $1,916 2.5×
CTA chest (71275) $1,098.90 $1,998 5.2×
Cta Head (70496) $1,268.30 $2,306 6.0×
CTA head&neck c+ w/noncontrast img&post-pxessing (70471) $2,379.85 $4,327 5.7×
CTA lwr ext w&w/o contrast (73706) $1,311.75 $2,385 6.2×
Cta Neck (70498) $1,206.70 $2,194 5.7×
Dxa bone density study 1/> sites axial skel (77080) $254.10 $462 2.0×
Dxa bone density study 1/>sites appendiclr skel (77081) $156.75 $285 1.5×
Esophagus (74220) $303.60 $552 1.4×
Fluoroscopy up to 1 hr (76000) $306.35 $557 1.1×
Foot 2 views (73620) $167.75 $305 1.6×
Forearm 2 views (73090) $417.45 4.0×
Hand 2 views (73120) $167.75 $305 1.3×
Hand 3 views (73130) $232.10 $422 2.2×
Hepatobil Syst Imag Inc Gb W/Pharma Intervenj (78227) $1,093.40 $1,988 1.7×
Hepatobiliary syst imaging including gallbladder (78226) $920.70 $1,674 1.9×
Ht muscle image spect sing (78451) $2,006.95 $3,649 1.3×
Humerus Min 2 Views Left (73060) $185.35 $337 1.8×
Kidney img morphology vascular flow 1 w/rx (78708) $1,345.85 $2,447 2.1×
Knee 3 views (73562) $408.10 3.9×
Liver & spleen imaging static only (78215) $755.15 $1,373 1.6×
Lung perfusion differential (78597) $490.60 $892 1.0×
MRA head w & w/o contrast (70546) $1,719.30 $3,126 4.1×
MRA head w/o contrast (70544) $1,080.20 $1,964 3.8×
Mra Neck W/O &W/Contrast Material (70549) $1,814.45 $3,299 4.3×
MRA neck w/o contrast (70547) $1,330.45 $2,419 4.7×
MRI abdomen w/o & w/contrast material (74183) $2,031.15 $3,693 4.9×
MRI abdomen w/o contrast (74181) $1,040.05 $1,891 3.6×
MRI any jnt lwr ext with con lt (73722) $1,783.10 $3,242 1.9×
MRI any jt upper extremity w/contrast matrl (73222) $1,526.25 $2,775 1.6×
MRI cervical spine w/o contrast (72141) $1,157.20 $2,104 4.0×
MRI chest w/o & w/contrast material (71552) $1,711.05 $3,111 4.1×
MRI Forearm w/ Contrast Bilateral 73219 (73219) $770.55 $1,401 1.8×
MRI lower extrem oth/thn jt w/o contr matrl (73718) $1,134.65 $2,063 4.0×
MRI orbit face &/neck w/o contrast (70540) $1,048.30 $1,906 3.7×
MRI orbit/face/neck w&w/o cont (70543) $1,934.90 $3,518 4.6×
MRI pelvis w/o & w/contrast material (72197) $1,976.70 $3,594 4.7×
MRI pelvis w/o contrast (72195) $1,080.20 $1,964 3.8×
MRI scan of arm joint before and after contrast (73223) $1,843.05 $3,351 4.4×
MRI scan of leg joint before and after contrast (73723) $2,351.25 $4,275 5.6×
MRI spinal canal cervical w/o & w/contr matrl (72156) $1,965.70 $3,574 4.7×
MRI spinal canal lumbar w/o & w/contr matrl (72158) $1,965.70 $3,574 4.7×
MRI spinal canal thoracic w/o & w/contr matrl (72157) $1,965.70 $3,574 4.7×
MRI thoracic spine w/o contrast (72146) $1,157.20 $2,104 4.0×
MRI upper ext joint w/o contrast (73221) $1,272.15 $2,313 4.4×
MRI upper extrem other than jt w/o & w/contras (73220) $2,097.15 $3,813 5.0×
MRI upper extremity oth than jt w/o contr matrl (73218) $1,080.20 $1,964 3.8×
Myocardial Spect Multiple Studies (78452) $2,886.95 $5,249 1.9×
Neck soft tissue (70360) $162.25 $295 1.6×
Nm gastric emptying study (78264) $820.05 $1,491 1.7×
Parathyrd planar w/spect&CT (78072) $1,020.80 $1,856 1.6×
Pelvis 1 or 2 views (72170) $172.70 $314 1.4×
Pr MRI, lower extr, w/o contrast f/u by contrast (73720) $1,972.30 $3,586 4.7×
Pulmonary Perfusion Imaging Particulate (78580) $790.90 $1,438 1.7×
Pulmonary Ventilation & Perfusion Imaging (78582) $1,057.10 $1,922 1.6×
Radex Entir Thrc Lmbr Crv Sac Spi W/Skull 1 Vw - Xr Scoliosis 1 Vw (72081) $176.55 $321 1.7×
Radex entir thrc lmbr crv sac spi w/skull 2/3 vw (72082) $194.15 $353 1.5×
Radex hips bilateral with pelvis 2 views (73521) $237.60 $432 1.9×
Radex X-Ray Exam Entire Spi 6/> Vw - Xr Entire Spine 6+ Vw (72084) $209.55 $381 1.7×
Radiolog exam mandible compl minimum 4 views (70110) $232.10 $422 1.9×
Radiologic Exam Abdomen 1 View - Xr Abdomen 1 View (74018) $232.10 2.2×
Radiologic Exam Abdomen 3+ Views - Xr Abdomen 3+ Views (74021) $210.10 $382 1.7×
Radiologic Exam Chest 2 Views - Xr Chest 2 Views (71046) $230.45 $419 2.2×
Radiologic exam colon single contrast study (74270) $388.85 $707 1.8×
Radiologic Exam Esophagus Double Contrast Study (74221) $325.05 $591 1.5×
Radiologic exam upr gi trc double contrast study (74246) $459.80 $836 2.2×
Radiologic exam upr gi trc single contrast study (74240) $459.80 $836 2.2×
Radiologic Examination Femur Minimum 2 Views - Xr Femur 2+ Vw Lt (73552) $185.35 $337 1.8×
Radiological examination surgical specimen (76098) $483.45 $879 0.7×
Ribs bilateral 3 views (71110) $269.50 $490 2.2×
Rp loclzj tum spect 1 area single day imaging (78803) $2,575.10 $4,682 4.0×
Rp loclzj tum spect CT 2area 1d img/1 ar img>2+d (78832) $3,017.85 $5,487 1.8×
Scanogram (77073) $232.10 $422 1.9×
Scapula complete (73010) $197.45 $359 1.6×
Screening digital breast tomosynthesis (77063) $51.70 $94 2.2×
Shuntogram indwelling nonvascular shunt rs&i (75809) $220 $400 1.8×
Spine thoracic 3 views (72072) $220 $400 1.8×
Thoracolumbar 2 views (72080) $173.80 $316 1.7×
Thyroid uptake measurement (78012) $824.45 $1,499 1.7×
Thyroid Uptake W/Blood Flow Sngle/Mult Quan Meas (78014) $746.90 $1,358 1.6×
Tmj unilateral (70328) $173.25 $315 1.7×
Tumor Imaging, Limited Area - Nm Tumor Localization Limited (78800) $512.05 $931 1.1×
Ultrasound, abdomen limited (76705) $393.80 $716 3.1×
Upper Extremity Infant (73092) $218.35 $397 1.7×
Us abdl aorta screen aaa (76706) $341.55 $621 2.7×
Us breast unilateral complete (76641) $214.50 $390 1.7×
Us breast unilateral limited (76642) $1,067 10.2×
Us chest (76604) $244.20 $444 1.9×
Us compl joint r-t w/image documentation (76881) $309.65 $563 2.5×
Us ob detailed single fetus (76811) $713.35 $1,297 2.5×
Us ob transvaginal (76817) $298.10 $542 2.4×
Us pelvic non ob complete (76856) $574.75 $1,045 4.6×
Us pelvic nonobstetric image dcmtn limited/f/u (76857) $250.80 $456 2.0×
Us pregnancy ltd (76815) $206.25 $375 1.6×
Us pregnant uterus 14 wk transabdl 1/1st gestat (76801) $328.90 $598 2.6×
Us retroperitoneal complete (76770) $417.45 $759 3.3×
Us retroperitoneal limited (76775) $341.55 $621 2.7×
Us scrotum and contents (76870) $423.50 $770 3.4×
Us soft tissue head/neck (76536) $309.65 $563 2.5×
Us xtr non-vasc lmtd (76882) $183.70 $334 1.5×
Us, eye b-scan (76512) $220 $400 1.8×
Wrist 2 views (73100) $898.70 8.6×
X-Ray Abdomen,Comp Acute Series - Xr Abdomen 2 Vws With Chest 1 View (74022) $261.80 $476 2.1×
X-Ray Ankle 3+ Vw - Xr Ankle 3+ Views Right (73610) $232.10 2.2×
X-Ray Elbow 2 Vw - Xr Elbow 1-2 Views Right (73070) $155.10 $282 1.5×
X-Ray Elbow 3+ Vw - Xr Elbow 3+ Views Right (73080) $209.55 $381 2.0×
X-ray exam entire spi 4/5 vw (72083) $217.80 $396 1.7×
X-ray exam hip uni 1 view (73501) $147.95 $269 1.4×
X-Ray Exam Hip Uni 2-3 Views (73502) $185.35 $337 1.8×
X-ray exam hip uni 4/> views (73503) $206.80 $376 1.7×
X-Ray Exam Hips Bi 3-4 Views (73522) $287.10 $522 2.3×
X-Ray Exam Hips Bi 5/> Views (73523) $206.80 $376 1.7×
X-ray exam of femur 1 (73551) $167.75 $305 1.6×
X-ray eye for foreign body (70030) $232.10 $422 2.2×
X-Ray Facial Bones 3+ Vw - Xr Facial Bones 3+ Views (70150) $232.10 $422 1.9×
X-Ray Facial Bones <3 Vw - Xr Facial Bones 1-2 Views (70140) $209.55 $381 2.0×
X-Ray Foot 3+ Vw - Xr Foot 3+ Views Right (73630) $217.80 $396 2.1×
X-Ray Heel - Xr Calcaneus 2 Views Right (73650) $185.35 $337 1.8×
X-Ray Jaw <4 Vw - Xr Mandible < 4 Views (70100) $143 $260 1.4×
X-Ray Knee 4+ View - Xr Knee 4+ Views Right (73564) $252.45 $459 2.0×
X-Ray Knee Bilat Standing - Xr Knees Anteroposterior Standing Bilat (73565) $232.10 $422 2.2×
X-Ray Lumbar Spine 2/3 Vw - Xr Lumbar Spine 2-3 Views (72100) $232.10 $422 1.9×
X-Ray Lumbar Spine 6+ Vw - Xr Lumbar Spine 6+ Vws Including Bending (72114) $327.80 $596 2.6×
X-Ray Lumbar Spine Flex/Exten - Xr Lumbar Spine 4+ Views W/ Flex Ext (72120) $217.80 $396 1.7×
X-Ray Nasal Bones - Xr Nasal Bones (70160) $185.35 $337 1.8×
X-Ray Nose-Rectum Child F.B. - Xr Nose to Rectum Foreign Body Peds (76010) $180.40 $328 1.7×
X-Ray Orbits - Xr Orbits Complete 4+ Views (70200) $177.65 $323 1.4×
X-Ray Pelvis 3+ Vw - Xr Pelvis 3+ Views (72190) $198.55 $361 1.6×
X-Ray Ribs 2 Vw Unilat - Xr Ribs 2 Views Right (71100) $203.50 $370 2.0×
X-Ray Ribs, Chest 3+ Vw - Xr Ribs 2 Vws Lt W/ Chest Anteroposterior (71101) $221.10 $402 1.8×
X-Ray Ribs, Chest 4+ Vw - Xr Ribs 3 Vws Bil W/ Chest Posteroanterior (71111) $240.90 $438 1.9×
X-Ray Sacroiliac Jts 3+ Vw - Xr Sacroiliac Joints 3+ Views (72202) $172.70 $314 1.4×
X-Ray Sacrum/Coccyx 2+ Vw - Xr Sacrum Coccyx 2+ Views (72220) $232.10 $422 2.2×
X-Ray Shoulder 2+ Vw - Xr Shoulder 2+ Views Right (73030) $361.08 3.5×
X-Ray Sinuses 3+ Vw - Xr Paranasal Sinuses 3+ Views (70220) $232.10 $422 2.2×
X-Ray Skull 4+ Vw - Xr Skull Complete 4+ Views (70260) $261.80 $476 2.1×
X-Ray Skull <4 Vw - Xr Skull 1-3 Views (70250) $232.10 $422 1.9×
X-Ray Sternum 2+ Vw - Xr Sternum 2+ Views (71120) $197.45 $359 1.9×
X-Ray Thoracic Spine 2 Vw - Xr Thoracic Spine 2 Views (72070) $219.45 $399 1.8×
X-Ray Toe(S) - Xr Toes 2+ Views Right (73660) $185.35 1.8×
X-Ray Wrist 3+ Vw - Xr Wrist 3+ Views Right (73110) $382.80 3.7×
Xr c-spine 6 or more views (72052) $285.45 $519 2.3×
Xr chest 4+ views (71048) $237.60 $432 1.9×
Xr finger(s) 2+ views (73140) $347.88 3.3×
Xr shoulder 1 view (73020) $133.10 $242 1.3×
Xr spine cervical 4 or 5 views (72050) $256.85 $467 2.0×
Xr tibia/fibula 2 views (73590) $185.35 $337 1.8×
Xray knee 1 or 2 views rt (73560) $231.82 2.2×