Imaging prices at Lakewood Health System

Staples, MN · every code in this section with a posted price and a Medicare benchmark.

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

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ProcedureCash priceGross charge× Medicare
3-D radiotherapy plan dose-volume histograms (77295) $2,094.67 $3,378.50 1.5×
Abdomen 2 views (74019) $115.01 $185.50 1.1×
Ankle 2 views (73600) $161.20 $260 1.8×
Arthrogram hip (73525) $410.44 $662 1.1×
Arthrogram knee (73580) $559.86 $903 1.6×
Arthrogram shoulder (73040) $183.83 $296.50 0.5×
Basic dosimetry (77300) $204.91 $330.50 1.5×
Bone &/Joint Imaging Limited Area (78300) $310 $500 0.8×
Bone &/joint imaging whole body (78306) $463.45 $747.50 1.1×
Bone age studies (77072) $31 $50 0.3×
Bone Imaging 3 Phase (78315) $439.89 $709.50 1.1×
Bone survey complete (77075) $253.27 $408.50 2.3×
Bone survey infant (77076) $300.70 $485 2.8×
Brain Imaging Pet Metabolic Evaluation (78608) $1,571.08 $2,534 1.1×
Cervical spine 2 or 3 views (72040) $98.89 $159.50 1.1×
Chest 1 view (71045) $63.24 $102 0.7×
Cine/Vid X-Ray Throat/Esoph - Fl Esoph Barium Swlw W/ Video & Speech (74230) $134.23 $216.50 0.7×
Clavicle complete (73000) $67.27 $108.50 0.7×
Computed Tomography Thorax Lw Dose Lng Ca Scr C- (71271) $451.98 $729 4.2×
Continuing medical physics consltj pr wk (77336) $422.22 $681 3.0×
CT abdomen and pelvis without and with contrast (74178) $1,102.36 $1,778 3.1×
CT abdomen and pelvis without contrast (74176) $710.83 $1,146.50 2.9×
CT abdomen w contrast (74160) $554.28 $894 3.1×
CT abdomen w wo contrast (74170) $607.60 $980 3.4×
CT abdomen w/o contrast (74150) $484.22 $781 4.5×
CT angio lwr extr w/o&w/dye (73706) $824.29 $1,329.50 4.6×
CT angiography upper extremity lt (73206) $783.37 $1,263.50 4.3×
CT c-spine w/contrast (72126) $992 $1,600 2.8×
CT c-spine w/o contrast (72125) $533.51 $860.50 4.9×
CT cervical spine w&w/o contrast (72127) $1,100.50 $1,775 6.1×
CT chest w contrast (71260) $558.93 $901.50 3.1×
CT chest w/wo contrast (71270) $552.42 $891 3.1×
CT head/brain with contrast (70460) $536.61 $865.50 3.0×
CT head/brain without and with contrast (70470) $571.64 $922 3.2×
CT heart w/o contrast quant eval coronary calcium (75571) $53.01 $85.50 0.6×
CT iac w contrast (70481) $566.68 $914 3.1×
CT lower ext w/o (73700) $865.52 $1,396 8.0×
CT lower extremity w wo contrast (73702) $595.51 $960.50 3.3×
CT lower extremity w/contrast material (73701) $538.78 $869 3.0×
CT lumbar spine w & w/o contrast (72133) $622.17 $1,003.50 3.4×
CT lumbar spine w/contrast (72132) $564.82 $911 1.6×
CT lumbar spine w/o contrast (72131) $517.08 $834 4.8×
CT maxillofacial w contrast (70487) $426.56 $688 2.4×
CT maxillofacial w/wo contrast (70488) $528.86 $853 2.9×
CT maxillofacial wo contrast (70486) $436.48 $704 4.0×
CT orbit sella/post fossa/ear w/o & w/contr matr (70482) $992 $1,600 5.5×
CT orbits w/o contrast (70480) $452.60 $730 4.2×
CT pelvis w/o contrast (72192) $452.91 $730.50 4.2×
CT soft tissue neck w contrast (70491) $506.54 $817 2.8×
CT soft tissue neck w/o & w/contrast material (70492) $570.09 $919.50 3.1×
CT soft tissue neck w/o contrast (70490) $413.54 $667 3.8×
CT thoracic spine w/o contrast (72128) $561.72 $906 5.2×
CT thoracic spine w/wo contrast (72130) $597.99 $964.50 3.3×
CT thorax w/o contrast (71250) $496 $800 4.6×
CT upper ext wo (73200) $446.40 $720 4.1×
CT upper extremity with contrast (73201) $538.78 $869 1.5×
Cta Aa&Bi Iliofem Lxtr Rs&I C-/C+ Post-Pxessing (75635) $659.37 $1,063.50 3.6×
Cta Abdomen (74175) $822.12 $1,326 4.5×
CTA abdomen pelvis (74174) $936.82 $1,511 2.6×
CTA chest (71275) $699.36 $1,128 3.9×
Cta Head (70496) $619.69 $999.50 3.4×
CTA head&neck c+ w/noncontrast img&post-pxessing (70471) $741.52 $1,196 2.1×
Cta Neck (70498) $520.49 $839.50 2.9×
Cta Pelvis (72191) $167.71 $270.50 0.9×
Cystography minimum 3 views rs&i (74430) $243.97 $393.50 0.7×
Dxa bone density study 1/> sites axial skel (77080) $73.47 $118.50 0.7×
Esophagus (74220) $287.06 $463 1.6×
Facial bones min 3 views (70150) $110.67 $178.50 1.0×
Fetal Biophysical Profile W/O Non-Stress Testing (76819) $134.54 $217 1.2×
Fluoroscopy up to 1 hr (76000) $179.80 $290 0.7×
Foot 2 views (73620) $156.52 $252.45 1.7×
Forearm 2 views (73090) $131.44 $212 1.5×
Hand 2 views (73120) $153.76 $248 1.4×
Hepatobil Syst Imag Inc Gb W/Pharma Intervenj (78227) $431.52 $696 0.8×
Hepatobiliary syst imaging including gallbladder (78226) $796.08 $1,284 1.9×
Hysterosalpingogram (74740) $288.61 $465.50 1.2×
Kidney img morphology vascular flow 1 w/rx (78708) $78.43 $126.50 0.1×
Knee 3 views (73562) $182.90 $295 2.0×
Lymphoscintigraphy (78195) $511.50 $825 0.9×
Magnetic resonance (eg, proton) imaging, any joint of upper extremity; with contrast material(s) Non-Facility (73222) $885.98 $1,429 1.1×
Magnetic resonance (eg, proton) imaging, upper extremity, other than joint; without contrast material(s), followed by… (73220) $736.56 $1,188 2.0×
Manual Appl Stress Pfrmd Phys/Qhp Joint Films (77071) $563.58 $909 6.3×
Mlc imrt design & construction per imrt plan (77338) $669.91 $1,080.50 1.7×
MRA head w & w/o contrast (70546) $1,002.23 $1,616.50 2.8×
MRA head w/o contrast (70544) $733.15 $1,182.50 3.0×
MRA neck w contrast (70548) $1,612 $2,600 4.5×
Mra Neck W/O &W/Contrast Material (70549) $966.58 $1,559 2.7×
MRA neck w/o contrast (70547) $1,267.28 $2,044 5.1×
MRI abdomen w contrast (74182) $1,732.28 $2,794 4.8×
MRI abdomen w/o & w/contrast material (74183) $1,771.96 $2,858 4.9×
MRI abdomen w/o contrast (74181) $727.57 $1,173.50 3.0×
MRI any jt lower extrem w/contrast material (73722) $1,032.30 $1,665 1.3×
MRI any jt lower extrem w/o & w/contrast matrl (73723) $1,127.78 $1,819 3.1×
MRI breast w/o contrast bilateral (77047) $1,068.57 $1,723.50 4.3×
MRI breast wo contrast unilateral (77046) $703.08 $1,134 2.9×
MRI c-spine with contrast (72142) $836.69 $1,349.50 2.3×
MRI cervical spine w/o contrast (72141) $744.31 $1,200.50 3.0×
MRI chest w/o & w/contrast material (71552) $396.80 $640 1.1×
MRI chest w/o contrast (71550) $660.61 $1,065.50 2.7×
MRI lower extrem oth/thn jt w/o & w/contr matr (73720) $736.56 $1,188 2.0×
MRI lower extrem oth/thn jt w/o contr matrl (73718) $1,207.76 $1,948 4.9×
MRI orbit face &/neck w/o contrast (70540) $651 $1,050 2.6×
MRI orbit/face/neck w&w/o cont (70543) $681.69 $1,099.50 1.9×
MRI pelvis w/o & w/contrast material (72197) $1,280.30 $2,065 3.6×
MRI pelvis w/o contrast (72195) $683.55 $1,102.50 2.8×
MRI spinal canal cervical w/o & w/contr matrl (72156) $977.43 $1,576.50 2.7×
MRI spinal canal lumbar w/contrast material (72149) $1,541.32 $2,486 4.3×
MRI spinal canal lumbar w/o & w/contr matrl (72158) $978.67 $1,578.50 2.7×
MRI spinal canal thoracic w/contrast matrl (72147) $1,541.32 $2,486 4.3×
MRI spinal canal thoracic w/o & w/contr matrl (72157) $1,018.04 $1,642 2.8×
MRI temporomandibular joint (70336) $447.33 $721.50 1.8×
MRI thoracic spine w/o contrast (72146) $788.64 $1,272 3.2×
MRI up ext w/o contrast (73218) $654.72 $1,056 2.7×
MRI upper ext joint w/o contrast (73221) $1,440.38 $2,323.20 5.8×
MRI, joint upper extrem combo (73223) $965.03 $1,556.50 2.7×
Myelogram Cervical (72240) $757.64 $1,222 0.9×
Myocardial Spect Multiple Studies (78452) $1,231.63 $1,986.50 0.9×
Neck soft tissue (70360) $57.66 $93 0.6×
Nm gastric emptying study (78264) $299.77 $483.50 0.7×
Ntsty modul radthx pln dose-vol histos (77301) $2,932.29 $4,729.50 2.1×
Parathyroid Planar Imaging (78070) $341.93 $551.50 0.8×
Parathyroid planar imaging w/wo subtraction (78071) $390.60 $630 0.9×
Pelvis 1 or 2 views (72170) $88.04 $142 0.8×
PET image w/CT, skull-thigh (78815) $1,724.53 $2,781.50 1.2×
PET imaging for CT attenuation whole body (78816) $1,925.41 $3,105.50 1.3×
Pulmonary Ventilation & Perfusion Imaging (78582) $697.50 $1,125 1.2×
Radex Ankle Compl Minimum 3 Views (73610) $173.60 $280 1.9×
Radex Calcaneus Minimum 2 Views (73650) $134.54 $217 1.5×
Radex Elbw Compl Minimum 3 Views (73080) $239.32 $386 2.7×
Radex Entir Thrc Lmbr Crv Sac Spi W/Skull 1 Vw - Xr Scoliosis 1 Vw (72081) $68.82 $111 0.8×
Radex entir thrc lmbr crv sac spi w/skull 2/3 vw (72082) $123.38 $199 1.1×
Radex fingr minimum 2 views (73140) $117.80 $190 1.3×
Radex Foot Compl Minimum 3 Views (73630) $182.28 $294 2.0×
Radex Hand Minimum 3 Views (73130) $211.42 $341 2.4×
Radex Hip Unilateral With Pelvis 1 View (73501) $93.62 $151 1.0×
Radex Hip Unilateral With Pelvis Minimum 4 Views (73503) $264.74 $427 2.5×
Radex Hips Bilateral With Pelvis 2 Views (73521) $127.72 $206 1.2×
Radex Hips Bilateral With Pelvis Minimum 5 Views (73523) $293.88 $474 2.7×
Radex Humerus Minimum 2 Views (73060) $137.64 $222 1.5×
Radex Kne 1/2 Views (73560) $159.34 $257 1.8×
Radex Kne Compl 4/More Views (73564) $213.28 $344 2.0×
Radex Mndbl Compl Minimum 4 Views (70110) $163.06 $263 1.5×
Radex Nasal Bones Complete Minimum 3 Views (70160) $79.98 $129 0.9×
Radex Pelvis Compl Minimum 3 Views (72190) $102.61 $165.50 1.0×
Radex Sho Compl Minimum 2 Views (73030) $185.60 $299.35 2.1×
Radex Sinuses Paransl < 3 Views (70210) $61.07 $98.50 0.7×
Radex Temporomandble Jt Opn & Clsd Mouth Bilat (70330) $171.43 $276.50 1.9×
Radex Toe Minimum 2 Views (73660) $152.52 $246 1.7×
Radex upper extremity infant minimum 2 views (73092) $75.95 $122.50 0.7×
Radex Wrst Compl Minimum 3 Views (73110) $211.42 $341 2.4×
Radex X-Ray Exam Entire Spi 6/> Vw - Xr Entire Spine 6+ Vw (72084) $68.20 $110 0.6×
Radiation Delivery Stereotactic Cranial Linear (77372) $9,115.86 $14,703 1.2×
Radiation treatment delivery level 1 (77402) $350.30 $565 3.3×
Radiation treatment delivery level 2 (77407) $584.66 $943 1.5×
Radiation treatment delivery level 3 (77412) $621.24 $1,002 1.1×
Radiologic Exam Abdomen 1 View - Xr Abdomen 1 View (74018) $82.46 $133 0.9×
Radiologic Exam Abdomen 3+ Views - Xr Abdomen 3+ Views (74021) $147.25 $237.50 1.4×
Radiologic exam chest 2 views (71046) $109.12 $176 1.2×
Radiologic Exam Esophagus Double Contrast Study (74221) $291.40 $470 1.6×
Radiologic exam upr gi trc double contrast study (74246) $398.04 $642 2.2×
Radiologic exam upr gi trc single contrast study (74240) $375.72 $606 2.1×
Radiologic examination femur 1 view (73551) $77.50 $125 0.9×
Radiologic examination tibia & fibula 2 views (73590) $164.92 $266 1.8×
Radiological examination surgical specimen (76098) $158.72 $256 0.3×
Ribs bilateral 3 views (71110) $135.16 $218 1.3×
Rp loclzj tum spect 1 area single day imaging (78803) $1,138.32 $1,836 2.0×
Sacroiliac Joints < 3 Views (72200) $879.78 $1,419 8.2×
Saline Infus Sonohysterography W/Color Doppler (76831) $402.69 $649.50 1.6×
Scapula (73010) $106.64 $172 1.0×
Screening Digital Breast Tomosynthesis Bi (77063) $75.33 $121.50 3.2×
Shoulder 1 view (73020) $178.56 $288 2.0×
Simulation intermediate (77285) $460.97 $743.50 1.2×
Small bowel series (74250) $187.55 $302.50 1.0×
Spec telethx port pln parts hemibdy tot bdy (77321) $360.53 $581.50 0.9×
Special dosimetry (77331) $223.51 $360.50 1.6×
Special Physics Consult (77370) $741.52 $1,196 5.3×
Special treatment procedure (77470) $888.46 $1,433 1.6×
Spine thoracic 3 views (72072) $122.45 $197.50 1.1×
Stereotactic Body Radiation Delivery (77373) $4,847.78 $7,819 2.6×
Telethx isodose pln cplx w/basic dosimetry (77307) $779.65 $1,257.50 2.0×
Telethx isodose pln smpl w/dosimetry calculation (77306) $615.97 $993.50 1.6×
Ther rad simulaj-aided field setting complex (77290) $810.96 $1,308 2.1×
Ther rad simulaj-aided field setting simple (77280) $495.69 $799.50 3.6×
Thoracolumbar 2 views (72080) $102.61 $165.50 1.1×
Thyroid Uptake W/Blood Flow Sngle/Mult Quan Meas (78014) $271.56 $438 0.7×
Tmj unilateral (70328) $88.04 $142 1.0×
Treatment device complex (77334) $425.94 $687 1.1×
Treatment device intermediate (77333) $276.83 $446.50 2.0×
Treatment devices simple (77332) $213.28 $344 1.5×
Ultrasound breast complete (76641) $267.22 $431 2.5×
Ultrasound, abdomen limited (76705) $213.28 $344 2.0×
Umbilical-artery Doppler (OB) (76820) $55.49 $89.50 0.5×
Urethrocystogram voiding (74455) $525.76 $848 2.1×
Us breast unilateral limited (76642) $233.12 $376 2.6×
Us chest (76604) $195.92 $316 1.8×
Us compl joint r-t w/image documentation (76881) $204.29 $329.50 1.9×
Us elastography parenchyma (76981) $124.93 $201.50 1.2×
Us hips infant static (76886) $223.82 $361 2.5×
Us infant hips w manipulation (76885) $139.81 $225.50 1.6×
Us lmtd joint/oth nonvasc xtr strux r-t w/img (76882) $180.73 $291.50 1.7×
Us ob limited (76815) $157.79 $254.50 1.5×
Us ob transvaginal (76817) $248.31 $400.50 2.3×
Us pelvic non ob complete (76856) $249.24 $402 2.3×
Us pelvic nonobstetric image dcmtn limited/f/u (76857) $193.75 $312.50 1.8×
Us pg uter img f&mat 14 wk tabdl 1/1st gestation (76801) $223.51 $360.50 2.1×
Us pg uter r-t img f-up tabdl appr pr fetus (76816) $146.94 $237 1.4×
Us retroperitoneal complete (76770) $253.27 $408.50 2.3×
Us retroperitoneal limited (76775) $220.10 $355 2.0×
Us scrotum and contents (76870) $190.34 $307 1.8×
Us soft tissue head/neck (76536) $145.08 $234 1.3×
Us transrectal (76872) $416.95 $672.50 3.9×
Wrist 2 views (73100) $148.80 $240 1.7×
X-Ray Abdomen,Comp Acute Series - Xr Abdomen 2 Vws With Chest 1 View (74022) $170.19 $274.50 1.6×
X-Ray Ac Jts - Xr Acromioclavicular Joints Bilateral (73050) $93 $150 1.0×
X-Ray Colon Air Contrast - Fl Barium Enema Air Contrast (74280) $575.36 $928 3.2×
X-Ray Elbow 2 Vw - Xr Elbow 1-2 Views Right (73070) $191.58 $309 2.1×
X-Ray Exam Hip Uni 2-3 Views (73502) $89.90 $145 1.0×
X-Ray Exam Hips Bi 3-4 Views (73522) $144.15 $232.50 1.3×
X-ray exam of femur 2/> (73552) $123.07 $198.50 1.4×
X-ray eye for foreign body (70030) $62.62 $101 0.7×
X-Ray Facial Bones <3 Vw - Xr Facial Bones 1-2 Views (70140) $72.23 $116.50 0.8×
X-Ray Jaw <4 Vw - Xr Mandible < 4 Views (70100) $88.35 $142.50 1.0×
X-Ray Knee Bilat Standing - Xr Knees Anteroposterior Standing Bilat (73565) $72.54 $117 0.8×
X-ray leg, infant (73592) $139.50 $225 1.6×
X-Ray Lumbar Spine 2/3 Vw - Xr Lumbar Spine 2-3 Views (72100) $1,368.34 $2,207 12.7×
X-Ray Lumbar Spine 6+ Vw - Xr Lumbar Spine 6+ Vws Including Bending (72114) $159.96 $258 1.5×
X-ray nose-rectum child f.b. (76010) $82.46 $133 0.9×
X-Ray Orbits - Xr Orbits Complete 4+ Views (70200) $131.44 $212 1.2×
X-Ray Ribs 2 Vw Unilat - Xr Ribs 2 Views Right (71100) $116.87 $188.50 1.3×
X-Ray Ribs, Chest 3+ Vw - Xr Ribs 2 Vws Lt W/ Chest Anteroposterior (71101) $118.42 $191 1.1×
X-Ray Ribs, Chest 4+ Vw - Xr Ribs 3 Vws Bil W/ Chest Posteroanterior (71111) $137.02 $221 1.3×
X-Ray Sacroiliac Jts 3+ Vw - Xr Sacroiliac Joints 3+ Views (72202) $138.88 $224 1.3×
X-Ray Sacrum/Coccyx 2+ Vw - Xr Sacrum Coccyx 2+ Views (72220) $124.93 $201.50 1.4×
X-Ray Skull <4 Vw - Xr Skull 1-3 Views (70250) $79.05 $127.50 0.7×
X-Ray Spine One View - Xr Spine (72020) $65.10 $105 0.7×
X-Ray Sterno-Clavicluar Jt - Xr Sternoclavicular Joints 3+ Views (71130) $176.70 $285 2.0×
X-Ray Sternum 2+ Vw - Xr Sternum 2+ Views (71120) $84.32 $136 0.9×
X-Ray Thoracic Spine 2 Vw - Xr Thoracic Spine 2 Views (72070) $100.75 $162.50 0.9×
X-Ray Thoracic Spine 4 Vw - Xr Thoracic Spine Complete 4+ Views (72074) $172.36 $278 1.6×
Xr bone length studies (77073) $66.34 $107 0.6×
Xr c-spine 4 or 5 views (72050) $198.40 $320 1.8×
Xr chest 4+ views (71048) $183.21 $295.50 1.7×