Imaging prices at Lake Martin Community Hospital

Dadeville, AL · every code in this section with a posted price and a Medicare benchmark.

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

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ProcedurePosted cashPosted gross× Medicare
Abdomen 1 View (74018)
range across 3 matching MRF lines		 $50.25–$81.75 $67–$109 varies
Abdomen 2 views (74019) $62.25 $83 0.7×
Acute Gastrointestinal Blood Loss Imaging (78278) $606 $808 1.7×
Ankle 2 views (73600) $54.75 $73 0.7×
Bone Imaging 3 Phase (78315) $602.25 $803 1.7×
Bone Imaging Limited Area (78300) $399 $532 1.2×
Bone Imaging Whole Body (78306) $523.50 $698 1.5×
Brain Imaging Min 4 Static Views W Vascular Flow (78606) $572.25 $763 1.2×
Brain Imaging Minimum 4 Static Views (78605) $346.50 $462 0.7×
Cat Scan Follow-Up Study (76380) $251.25 $335 3.3×
Chest 1 view (71045) $45 $60 0.6×
Chest 2 views (71046) $56.25 $75 0.7×
Chest 3 views (71047) $71.25 $95 0.9×
Chest 4 or more views (71048) $78 $104 0.9×
Cholecystography Oral Contrast (74290) $141 $188 0.9×
Clavicle complete (73000) $54 $72 0.7×
CT abdomen and pelvis without and with contrast (74178) $636 $848 2.1×
CT abdomen and pelvis without contrast (74176) $350.25 $467 1.7×
CT abdomen w contrast (74160) $427.50 $570 2.8×
CT abdomen w wo contrast (74170) $481.50 $642 3.2×
CT abdomen w/o contrast (74150) $261 $348 2.9×
CT Angio Abdomen and Pelvis (74174) $767.25 $1,023 2.5×
CT Angio Chest (71275) $525 $700 3.5×
CT Angio Head (70496) $513.75 $685 3.4×
Ct Angio Lwr Extr W/O&W/Dye (73706) $614.25 $819 4.0×
CT Angio Neck (70498) $513.75 $685 3.4×
Ct Angio Upr Extrm W/O&W/Dye (73206) $567.75 $757 3.7×
CT cervical spine w/ contrast (72126) $339 $452 1.1×
CT cervical spine w/o contrast (72125) $270 $360 3.0×
CT chest w contrast (71260) $340.50 $454 2.2×
CT chest w/wo contrast (71270) $402.75 $537 2.6×
CT head/brain with contrast (70460) $283.50 $378 1.9×
CT head/brain without and with contrast (70470) $332.25 $443 2.2×
CT heart no contrast quant eval coronry calcium (75571) $75 $100 1.0×
CT iac w contrast (70481) $386.25 $515 2.5×
CT lower ext w/o (73700) $269.25 $359 3.0×
CT lower extremity w/contrast material (73701) $336 $448 2.2×
CT lumbar spine w contrast (72132) $339.75 $453 1.1×
CT lumbar spine w/o contrast (72131) $269.25 $359 3.0×
CT maxillofacial w contrast (70487) $290.25 $387 1.9×
CT maxillofacial wo contrast (70486) $241.50 $322 2.7×
CT neck tissue combo (70492) $425.25 $567 2.8×
Ct Orbit/Ear/Fossa W/O&W/Dye (70482) $427.50 $570 2.8×
CT orbits w/o contrast (70480) $348 $464 3.8×
CT pelvis w&w/o contrast (72194) $468.75 $625 3.1×
CT pelvis w/o contrast (72192) $253.50 $338 2.8×
CT scans face/jaw combo (70488) $353.25 $471 2.3×
CT soft tissue neck w contrast (70491) $352.50 $470 2.3×
CT soft tissue neck w/o contrast (70490) $287.25 $383 3.2×
CT thoracic spine w/o contrast (72128) $270 $360 3.0×
CT thorax w/o contrast (71250) $276 $368 3.0×
CT upper ext wo (73200) $309 $412 3.4×
CT upper extremity with contrast (73201) $384.75 $513 1.3×
Cta Abdl Aorta&Bi Iliofem W/Contrast&Postp (75635) $767.25 $1,023 5.0×
Cta Abdomen (74175) $560.25 $747 3.7×
CTA pelvis (72191) $558.75 $745 3.7×
Dxa Bone Density Axial (77080) $67.50 $90 0.7×
Fluoroscopy up to 1 hr (76000) $72.75 $97 0.4×
Foot 2 views (73620) $48 $64 0.6×
Forearm 2 views (73090)
range across 2 matching MRF lines		 $49.50–$50.25 $66–$67 varies
Gastric emptying imaging study (78264) $577.50 $770 1.7×
Gated Heart Planar Single (78472) $397.50 $530 1.1×
Hand 2 views (73120) $52.50 $70 0.6×
Hepatobil Syst Image W/Drug (78227) $585 $780 1.2×
Ht Musc Image Planar Mult (78454) $756 $1,008 0.7×
Ht Muscle Image Spect Sing (78451) $588.75 $785 0.5×
K Flow/Funct Image Multiple (78709) $641.25 $855 1.4×
Kidney Imaging Morphol (78700) $297 $396 0.9×
Liver & Spleen Imaging Static Only (78215) $339 $452 1.0×
Liver imaging static only (78201) $330.75 $441 0.7×
Lung Perf&Ventilat Diferentl (78598) $893.25 $1,191 1.9×
Magnetic Image Jaw Joint (70336) $532.50 $710 2.6×
Meckels Divert Exam (78290) $572.25 $763 1.7×
Mra Head W/O & W/Contrast Material (70546) $639 $852 2.1×
MRA head w/o contrast (70544) $423 $564 2.0×
MRA head with contrast (70545) $441.75 $589 1.5×
MRA neck w contrast (70548) $476.25 $635 1.6×
Mra Neck W/O &W/Contrast Material (70549) $672 $896 2.2×
MRA neck w/o contrast (70547) $425.25 $567 2.1×
MRI abdomen w contrast (74182) $607.50 $810 2.0×
MRI abdomen w/o contrast (74181) $391.50 $522 1.9×
MRI any jt lower extrem w/contrast material (73722) $631.50 $842 0.9×
MRI any jt lower extrem w/o & w/contrast matrl (73723) $778.50 $1,038 2.6×
MRI any jt upper extremity w/contrast matrl (73222) $630 $840 0.9×
MRI cardiac w/o contrast (75557) $558.75 $745 2.7×
MRI cervical spine w contrast (72142) $546 $728 1.8×
MRI cervical spine w/o cont (72141) $377.25 $503 1.8×
MRI chest w/o contrast (71550) $681 $908 3.3×
MRI chest with contrast (71551) $752.25 $1,003 1.1×
MRI chest wo w contrast (71552) $952.50 $1,270 3.1×
MRI lower extrem oth/thn jt w/o & w/contr matr (73720) $675 $900 2.2×
MRI lower extrem oth/thn jt w/o contr matrl (73718) $444.75 $593 2.1×
MRI lumbar spine w contrast (72149) $537.75 $717 1.8×
Mri Neck Spine W/O & W/Dye (72156) $638.25 $851 2.1×
MRI orbit face &/neck w/o contrast (70540) $450.75 $601 2.2×
Mri Orbt/Fac/Nck W/O &W/Dye (70543) $667.50 $890 2.2×
MRI pelvis w contrast (72196) $537.75 $717 1.8×
MRI pelvis w/o & w contrast (72197) $676.50 $902 2.2×
MRI pelvis w/o contrast (72195) $460.50 $614 2.2×
MRI thoracic spine w/o contrast (72146) $377.25 $503 1.8×
MRI upper extremity oth than jt w/contr matrl (73219) $671.25 $895 2.2×
MRI upper extremity oth than jt w/o contr matrl (73218) $606 $808 2.9×
Mri Uppr Extremity W/O&W/Dye (73220) $675 $900 2.2×
MRI, abdomen, combo (74183) $677.25 $903 2.2×
MRI, dorsal spine combo (72157) $639.75 $853 2.1×
MRI, dorsal spine contrast (72147) $542.25 $723 1.8×
MRI, joint upper extrem (73221) $397.50 $530 1.9×
MRI, joint upper extrem combo (73223) $780 $1,040 2.6×
MRI, lumbar spine combo (72158) $637.50 $850 2.1×
Myelogram cervical (72240) $195 $260 0.3×
Myelogram Lumbar (72265) $180 $240 0.3×
Myelography thoracic (72255) $197.25 $263 0.3×
Myocardial Perfusion Planar 1 Study Rest/Stress (78453) $527.25 $703 0.5×
Myocardial Spect Multiple Studies (78452)
range across 2 matching MRF lines		 $818.25–$2,419.50 $1,091–$3,226 varies
Neck soft tissue (70360) $52.50 $70 0.7×
Nm unlisted gi procedure (78299) $299.25 $399 0.9×
Nonvascular Shunt X-Ray (75809) $61.50 $82 0.7×
Pelvis 1 or 2 views (72170) $48.75 $65 0.5×
Pulmonary Perfusion Imaging Particulate (78580) $412.50 $550 1.2×
Radex Ankle Complete Minimum 3 Views (73610) $60 $80 0.8×
Radex Calcaneus Minimum 2 Views (73650) $48.75 $65 0.6×
Radex elbow complete minimum 3 views (73080) $53.25 $71 0.7×
Radex Facial Bones Complete Minimum 3 Views (70150) $78.75 $105 0.9×
Radex fingr minimum 2 views (73140) $60.75 $81 0.8×
Radex foot complete minimum 3 views (73630) $56.25 $75 0.7×
Radex Hand Minimum 3 Views (73130) $60 $80 0.8×
Radex lower extremity infant minimum 2 views (73592) $52.50 $70 0.7×
Radex Mastoids Compl Minimum 3 Views PR Side (70130) $103.50 $138 1.1×
Radex Nasal Bones Complete Minimum 3 Views (70160) $62.25 $83 0.8×
Radex shoulder complete minimum 2 views (73030) $57 $76 0.8×
Radex sm int w/mlt srl imges via enteroclss tube (74251) $208.50 $278 1.4×
Radex Spine 1 View Specify Level (72020) $41.25 $55 0.5×
Radex Sternum Minimum 2 Views (71120) $56.25 $75 0.7×
Radex Temporomandble Jt Opn & Clsd Mouth Bilat (70330) $88.50 $118 1.2×
Radex Toe Minimum 2 Views (73660) $48.75 $65 0.6×
Radex upper extremity infant minimum 2 views (73092) $52.50 $70 0.6×
Radex Wrist Complete Minimum 3 Views (73110) $66.75 $89 0.9×
Radiolog exam mandible compl minimum 4 views (70110) $73.50 $98 0.8×
Radiologic Exam Abdomen 3+ Views - Xr Abdomen 3+ Views (74021) $72 $96 0.8×
Radiologic exam knee complete 4/more views (73564) $75 $100 0.8×
Radiologic exam pelvis compl minimum 3 views (72190) $69.75 $93 0.8×
Radiologic Exam Small Int Single Contrast Study (74250) $210 $280 1.4×
Radiologic exam swallow function contrast study (74230) $222.75 $297 1.5×
Radiologic exam upr gi trc double contrast study (74246) $240.75 $321 1.6×
Radiologic examination femur minimum 2 views (73552) $60 $80 0.8×
Radiologic examination knee 1/2 views (73560) $57.75 $77 0.8×
Radiologic Examination Osseous Survey Limited (77074) $110.25 $147 1.2×
Radiologic examination tibia & fibula 2 views (73590) $52.50 $70 0.7×
Radiologic examination, internal auditory meati, complete Non-Facility (70134) $97.50 $130 0.2×
Rp Loclzj Tum Spect 1 Area Single Day Imaging (78803)
range across 2 matching MRF lines		 $369–$607.50 $492–$810 varies
Scapula (73010) $48 $64 0.5×
Shoulder 1 view (73020) $37.50 $50 0.5×
Shoulder Arthrography (73040) $207.75 $277 0.7×
Skull less than 4 views (70250) $61.50 $82 0.7×
Spleen Imaging (78185) $296.25 $395 0.9×
Sternoclavicular joints (71130) $69 $92 0.9×
Thoracic spine 3 views (72072) $66 $88 0.7×
Thyroid Imaging With Vascular Flow (78013) $177 $236 0.5×
Thyroid Uptake Measurement (78012)
range across 2 matching MRF lines		 $138–$565.50 $184–$754 varies
Ultrasound Breast Limited (76642) $186.75 $249 2.5×
Ultrasound Exam Aaa Screen (76706) $196.50 $262 2.2×
Ultrasound, abdomen limited (76705) $159 $212 1.8×
Unlisted Dx Radiographic Procedure (76499)
range across 2 matching MRF lines		 $41.25–$189 $55–$252 varies
Upper gi w/o kub (74240)
range across 4 matching MRF lines		 $209.25–$320.25 $279–$427 varies
Us bone density measurement (76977) $12 $16 0.1×
Us breast unilateral complete (76641) $186.75 $249 2.1×
Us complete joint (76881) $135.75 $181 1.5×
Us exam, pelvic, limited (76857) $190.50 $254 2.1×
Us lmtd joint/oth nonvasc xtr strux r-t w/img (76882) $136.50 $182 1.5×
Us ob transvaginal (76817) $213.75 $285 2.4×
Us pg uter img f&mat 14 wk tabdl 1/1st gestation (76801) $243.75 $325 2.7×
Us retroperitoneal complete (76770) $197.25 $263 2.2×
Us retroperitoneal limited (76775) $196.50 $262 2.2×
Us scrotum and contents (76870) $182.25 $243 2.0×
Us thyroid (76536)
range across 4 matching MRF lines		 $198–$200.25 $264–$267 varies
Vertebral fracture assessment via dxa (77086) $60 $80 0.8×
Wrist 2 views (73100) $56.25 $75 0.7×
X-Ray Ac Jts - Xr Acromioclavicular Joints Bilateral (73050) $54 $72 0.7×
X-Ray Elbow 2 Vw - Xr Elbow 1-2 Views Right (73070) $48.75 $65 0.6×
X-Ray Exam Entire Spi 1 Vw (72081) $72 $96 1.0×
X-Ray Exam Entire Spi 4/5 Vw (72083) $135 $180 1.5×
X-Ray Exam Hip Uni 1 View (73501) $54.75 $73 0.7×
X-Ray Exam Hip Uni 2-3 Views (73502) $78 $104 1.0×
X-Ray Exam Hips Bi 2 Views (73521) $69 $92 0.8×
X-Ray Exam L-S Spine Bending (72114) $102.75 $137 1.1×
X-Ray Exam Neck Spine 2-3 Vw (72040) $66 $88 0.9×
X-Ray Exam Unilat Ribs/Chest (71101) $71.25 $95 0.8×
X-ray humerus (73060) $54 $72 0.7×
X-ray IV pyelogram (ivp) (74400) $219.75 $293 1.4×
X-ray IV pyelogram+tomography (74415) $261 $348 1.7×
X-Ray Knee Bilat Standing - Xr Knees Anteroposterior Standing Bilat (73565) $66 $88 0.9×
X-Ray Lumbar Spine 2/3 Vw - Xr Lumbar Spine 2-3 Views (72100) $66 $88 0.7×
X-Ray Ribs, Chest 4+ Vw - Xr Ribs 3 Vws Bil W/ Chest Posteroanterior (71111) $88.50 $118 1.0×
X-Ray Sacroiliac Jts 3+ Vw - Xr Sacroiliac Joints 3+ Views (72202) $66 $88 0.7×
X-Ray Sacrum/Coccyx 2+ Vw - Xr Sacrum Coccyx 2+ Views (72220) $54 $72 0.7×
X-Ray Sinuses 3+ Vw - Xr Paranasal Sinuses 3+ Views (70220) $63.75 $85 0.8×
Xr c-spine 4 or 5 views (72050) $87.75 $117 1.0×
Xr facial bones less than 3 views (70140) $54 $72 0.7×
Xr orbits complete 4 views (70200) $81 $108 0.9×
Xr Tomogram Single Plane (76100) $168.75 $225 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.