Imaging prices at LewisGale Hospital Montgomery

Blacksburg, VA · every code in this section with a posted price and a Medicare benchmark.

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

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ProcedureCash priceGross charge× Medicare
Acute gi blood loss imaging (78278) $3,072 $3,072 7.9×
Angiography extremity bilateral rs&i (75716) $7,111 $7,111 2.3×
Angiography extremity unilateral rs&i (75710) $6,445 $6,445 2.1×
Angiography pelvic slctv/supraslctv rs&i (75736) $7,700 $7,700 1.4×
Angiography pulmonary bilateral slctv rs&i (75743) $7,111 $7,111 2.3×
Angiography pulmonary unilateral slctv rs&i (75741) $7,111 $7,111 2.3×
Angiography visceral slctv/supraslctv rs&i (75726) $17,055 $17,055 3.1×
Ankle 2 views (73600) $1,076 $1,076 12.7×
Aortogram thoracic (75605) $17,055 $17,055 3.1×
Aortography abdl bi iliofem low extrem cath rs&i (75630) $7,404 $7,404 2.4×
Aortography abdominal serialography rs&i (75625) $7,111 $7,111 2.3×
Arthrogram elbow (73085) $1,548 $1,548 4.5×
Arthrogram hip (73525) $1,548 $1,548 4.5×
Arthrogram knee (73580) $1,928 $1,928 5.7×
Arthrogram shoulder (73040) $1,548 $1,548 4.5×
Arthrogram wrist (73115) $1,178 $1,178 3.5×
Bone &/Joint Imaging Limited Area (78300) $3,474 $3,474 8.9×
Bone &/joint imaging whole body (78306) $6,091 $6,091 15.6×
Bone age studies (77072) $540 $540 5.3×
Bone Imaging 3 Phase (78315) $6,468 $6,468 16.6×
Bone survey complete (77075) $2,299 $2,299 22.5×
Bone survey infant (77076) $1,138 $1,138 11.2×
Card Bpi Gtd =Brm Plnr 1 Std Rest/Strs (78472) $3,569 $3,569 9.2×
Cervical spine 2 or 3 views (72040) $1,568 $1,568 18.5×
Chest 1 view (71045) $772 $772 9.1×
Chest xray 3 views (71047) $1,781 $1,781 21.0×
Cine/Vid X-Ray Throat/Esoph - Fl Esoph Barium Swlw W/ Video & Speech (74230) $2,422 $2,422 14.2×
Clavicle complete (73000) $1,187 $1,187 14.0×
Computed Tomography Thorax Lw Dose Lng Ca Scr C- (71271) $183 $183 1.8×
CT abdomen and pelvis without and with contrast (74178) $7,729 $7,729 22.7×
CT abdomen and pelvis without contrast (74176) $5,977 $5,977 25.7×
CT abdomen w contrast (74160) $4,394 $4,394 25.7×
CT abdomen w wo contrast (74170) $5,387 $5,387 31.5×
CT abdomen w/o contrast (74150) $3,675 $3,675 36.0×
CT angio hrt w/3d image (75574) $714 $714 2.1×
CT angio lwr extr w/o&w/dye (73706) $3,815 $3,815 22.3×
CT angiography upper extremity lt (73206) $3,420 $3,420 20.0×
CT c-spine w/contrast (72126) $4,085 $4,085 12.0×
CT c-spine w/o contrast (72125) $4,190 $4,190 41.1×
CT cervical spine w&w/o contrast (72127) $4,271 $4,271 25.0×
CT chest w contrast (71260) $4,606 $4,606 26.9×
CT chest w/wo contrast (71270) $5,416 $5,416 31.6×
CT head/brain with contrast (70460) $4,362 $4,362 25.5×
CT head/brain without and with contrast (70470) $5,466 $5,466 31.9×
CT heart contrast eval cardiac structure&morph (75572) $714 $714 2.1×
CT heart w/o contrast quant eval coronary calcium (75571) $176 $176 2.1×
CT iac w contrast (70481) $2,844 $2,844 16.6×
CT limited/localized follow up study (76380) $855 $855 10.1×
CT lower ext w/o (73700) $2,732 $2,732 26.8×
CT lower extremity w wo contrast (73702) $3,154 $3,154 18.4×
CT lower extremity w/contrast material (73701) $3,059 $3,059 17.9×
CT lumbar spine w & w/o contrast (72133) $4,271 $4,271 25.0×
CT lumbar spine w/contrast (72132) $3,476 $3,476 10.2×
CT lumbar spine w/o contrast (72131) $3,942 $3,942 38.6×
CT maxillofacial w contrast (70487) $4,269 $4,269 24.9×
CT maxillofacial w/wo contrast (70488) $4,915 $4,915 28.7×
CT maxillofacial wo contrast (70486) $2,288.50 $2,288.50 22.4×
CT orbit sella/post fossa/ear w/o & w/contr matr (70482) $4,380 $4,380 25.6×
CT orbits w/o contrast (70480) $2,481 $2,481 24.3×
CT pelvis w/o contrast (72192) $4,291 $4,291 42.1×
CT pelvis w/wo contrast (72194) $4,918 $4,918 28.7×
CT scan of arm combo (73202) $3,101 $3,101 18.1×
CT soft tissue neck w contrast (70491) $4,362 $4,362 25.5×
CT soft tissue neck w/o & w/contrast material (70492) $5,466 $5,466 31.9×
CT soft tissue neck w/o contrast (70490) $4,240 $4,240 41.6×
CT thoracic spine w/contrast (72129) $4,190 $4,190 24.5×
CT thoracic spine w/o contrast (72128) $3,942 $3,942 38.6×
CT thorax w/o contrast (71250) $4,506 $4,506 44.2×
CT upper ext wo (73200) $2,374 $2,374 23.3×
CT upper extremity with contrast (73201) $2,603 $2,603 7.6×
Cta Aa&Bi Iliofem Lxtr Rs&I C-/C+ Post-Pxessing (75635) $5,913 $5,913 34.6×
Cta Abdomen (74175) $5,446 $5,446 31.8×
CTA abdomen pelvis (74174) $10,180 $10,180 29.9×
CTA chest (71275) $5,486 $5,486 32.1×
Cta Head (70496) $5,360 $5,360 31.3×
CTA head&neck c+ w/noncontrast img&post-pxessing (70471) $12,186 $12,186 35.8×
Cta Neck (70498) $4,808 $4,808 28.1×
Cta Pelvis (72191) $4,736 $4,736 27.7×
Cystography minimum 3 views rs&i (74430) $1,869 $1,869 5.5×
Dxa bone density study 1/> sites axial skel (77080) $2,163 $2,163 21.2×
Esophagus (74220) $1,869 $1,869 10.9×
Facial bones min 3 views (70150) $2,394 $2,394 23.5×
Fetal biophysical profile non-stress testing (76818) $1,986 $1,986 19.5×
Fetal Biophysical Profile W/O Non-Stress Testing (76819) $1,986 $1,986 19.5×
Fluoroscopy up to 1 hr (76000) $2,042 $2,042 8.8×
Foot 2 views (73620) $1,076 $1,076 12.7×
Forearm 2 views (73090) $1,493 $1,493 17.6×
Hand 2 views (73120) $1,156 $1,156 11.3×
Hepatobil Syst Imag Inc Gb W/Pharma Intervenj (78227) $5,626 $5,626 10.6×
Hepatobiliary syst imaging including gallbladder (78226) $4,053 $4,053 10.4×
Hysterosalpingogram (74740) $1,483 $1,483 6.4×
Joint Survey, Single View - Xr Joint Anteroposterior 2+ Joints (77077) $557 $557 5.5×
Kidney Img Morphology Vascular Flow Multiple (78709) $6,240 $6,240 11.8×
Knee 3 views (73562) $1,151 $1,151 13.6×
Lymphoscintigraphy (78195) $6,091 $6,091 11.5×
Magnetic resonance (eg, proton) imaging, any joint of upper extremity; with contrast material(s) Non-Facility (73222) $7,214 $7,214 9.4×
Magnetic resonance (eg, proton) imaging, upper extremity, other than joint; without contrast material(s), followed by… (73220) $8,101 $8,101 23.8×
Mr safety determination physician/other qhp (76016) $218 $218 2.6×
Mr safety implant&/fb assmt clin staf 1st 15 min (76014) $25 $25 0.9×
Mr safety implt electronics prepj supvj phys/qhp (76018) $228 $228 2.5×
Mr safety implt pos&/immoblj (76019) $148 $148 2.6×
MRA head w & w/o contrast (70546) $7,673 $7,673 22.5×
MRA head w/o contrast (70544) $6,808 $6,808 29.2×
MRA neck w contrast (70548) $7,673 $7,673 22.5×
Mra Neck W/O &W/Contrast Material (70549) $7,673 $7,673 22.5×
MRA neck w/o contrast (70547) $6,808 $6,808 29.2×
MRI abdomen w contrast (74182) $6,808 $6,808 20.0×
MRI abdomen w/o & w/contrast material (74183) $7,858 $7,858 23.1×
MRI abdomen w/o contrast (74181) $6,808 $6,808 29.2×
MRI any jt lower extrem w/contrast material (73722) $7,214 $7,214 9.4×
MRI any jt lower extrem w/o & w/contrast matrl (73723) $7,673 $7,673 22.5×
MRI breast w/o contrast bilateral (77047) $6,808 $6,808 29.2×
MRI c-spine with contrast (72142) $7,214 $7,214 21.2×
MRI cervical spine w/o contrast (72141) $6,808 $6,808 29.2×
MRI chest w/o & w/contrast material (71552) $7,673 $7,673 22.5×
MRI chest w/o contrast (71550) $6,808 $6,808 29.2×
MRI chest with contrast (71551) $7,214 $7,214 9.4×
MRI lower extrem oth/thn jt w/contrast matrl (73719) $7,214 $7,214 21.2×
MRI lower extrem oth/thn jt w/o & w/contr matr (73720) $8,391 $8,391 24.7×
MRI lower extrem oth/thn jt w/o contr matrl (73718) $7,699 $7,699 33.1×
MRI orbit face &/neck w/o contrast (70540) $7,214 $7,214 31.0×
MRI orbit face neck w contrast (70542) $7,214 $7,214 21.2×
MRI orbit/face/neck w&w/o cont (70543) $7,774 $7,774 22.8×
MRI pelvis w/contrast (72196) $7,214 $7,214 21.2×
MRI pelvis w/o & w/contrast material (72197) $7,781 $7,781 22.9×
MRI pelvis w/o contrast (72195) $6,808 $6,808 29.2×
MRI spinal canal cervical w/o & w/contr matrl (72156) $7,673 $7,673 22.5×
MRI spinal canal lumbar w/contrast material (72149) $7,498 $7,498 22.0×
MRI spinal canal lumbar w/o & w/contr matrl (72158) $8,133 $8,133 23.9×
MRI spinal canal thoracic w/contrast matrl (72147) $7,214 $7,214 21.2×
MRI spinal canal thoracic w/o & w/contr matrl (72157) $7,673 $7,673 22.5×
MRI temporomandibular joint (70336) $7,214 $7,214 31.0×
MRI thoracic spine w/o contrast (72146) $6,808 $6,808 29.2×
MRI up ext w/o contrast (73218) $7,321 $7,321 31.4×
MRI upper ext joint w/o contrast (73221) $6,808 $6,808 29.2×
MRI, joint upper extrem combo (73223) $7,781 $7,781 22.9×
Myelogram Cervical (72240) $2,673 $2,673 3.5×
Myelogram Lumbar (72265) $2,171 $2,171 2.8×
Myelogram thoracic (72255) $2,077 $2,077 2.7×
Myelography 2 or more regions (72270) $4,186 $4,186 5.5×
Myocardial Spect Multiple Studies (78452) $11,893 $11,893 9.4×
Neck soft tissue (70360) $975 $975 11.5×
Nm cisternogram (78630) $5,273 $5,273 10.0×
Nm gastric emptying study (78264) $5,382 $5,382 13.8×
Nuclear Rx Oral Admin (79005) $1,491 $1,491 6.5×
Osseous survey limited (77074) $1,088 $1,088 10.7×
Parathyroid Planar Imaging (78070) $6,091 $6,091 15.6×
Pelvis 1 or 2 views (72170) $1,483 $1,483 14.5×
PET image w/CT, skull-thigh (78815) $23,037 $23,037 16.5×
PET imaging for CT attenuation whole body (78816) $24,000 $24,000 17.2×
Pulmonary Perfusion Imaging Particulate (78580) $4,278 $4,278 11.0×
Pulmonary Ventilation & Perfusion Imaging (78582) $3,749 $3,749 7.1×
Radex Ankle Compl Minimum 3 Views (73610) $1,493 $1,493 17.6×
Radex Calcaneus Minimum 2 Views (73650) $1,070 $1,070 12.6×
Radex Elbw Compl Minimum 3 Views (73080) $1,493 $1,493 17.6×
Radex Entir Thrc Lmbr Crv Sac Spi W/Skull 1 Vw - Xr Scoliosis 1 Vw (72081) $1,601 $1,601 18.9×
Radex entir thrc lmbr crv sac spi w/skull 2/3 vw (72082) $1,435 $1,435 14.1×
Radex fingr minimum 2 views (73140) $1,074 $1,074 12.6×
Radex Foot Compl Minimum 3 Views (73630) $1,493 $1,493 17.6×
Radex Hand Minimum 3 Views (73130) $1,493 $1,493 17.6×
Radex Hip Unilateral With Pelvis 1 View (73501) $1,081 $1,081 12.7×
Radex Hip Unilateral With Pelvis Minimum 4 Views (73503) $2,061 $2,061 20.2×
Radex Hips Bilateral With Pelvis 2 Views (73521) $1,138 $1,138 11.2×
Radex Hips Bilateral With Pelvis Minimum 5 Views (73523) $1,493 $1,493 14.6×
Radex Humerus Minimum 2 Views (73060) $1,180 $1,180 13.9×
Radex Kne 1/2 Views (73560) $1,090 $1,090 12.8×
Radex Kne Compl 4/More Views (73564) $1,725 $1,725 16.9×
Radex Mndbl Compl Minimum 4 Views (70110) $1,725 $1,725 16.9×
Radex Nasal Bones Complete Minimum 3 Views (70160) $1,037 $1,037 12.2×
Radex Sho Compl Minimum 2 Views (73030) $1,703 $1,703 20.1×
Radex Sinuses Paransl < 3 Views (70210) $1,074 $1,074 12.6×
Radex Temporomandble Jt Opn & Clsd Mouth Bilat (70330) $1,375 $1,375 16.2×
Radex Toe Minimum 2 Views (73660) $1,007 $1,007 11.9×
Radex upper extremity infant minimum 2 views (73092) $1,248 $1,248 12.2×
Radex Wrst Compl Minimum 3 Views (73110) $1,493 $1,493 17.6×
Radex X-Ray Exam Entire Spi 6/> Vw - Xr Entire Spine 6+ Vw (72084) $2,817 $2,817 27.6×
Radiologic Exam Abdomen 1 View - Xr Abdomen 1 View (74018) $1,147 $1,147 13.5×
Radiologic Exam Abdomen 3+ Views - Xr Abdomen 3+ Views (74021) $2,579 $2,579 25.3×
Radiologic exam chest 2 views (71046) $1,187 $1,187 14.0×
Radiologic exam colon single contrast study (74270) $2,710 $2,710 15.8×
Radiologic exam upr gi trc double contrast study (74246) $2,714 $2,714 15.9×
Radiologic exam upr gi trc single contrast study (74240) $2,235 $2,235 13.1×
Radiologic examination femur 1 view (73551) $1,493 $1,493 17.6×
Radiologic examination tibia & fibula 2 views (73590) $1,493 $1,493 17.6×
Radiological examination surgical specimen (76098) $1,002 $1,002 1.9×
Ribs bilateral 3 views (71110) $2,473 $2,473 24.2×
Rp loclzj tum plnr whole body single day imaging (78802) $5,273 $5,273 10.0×
Rp loclzj tum spect 1 area single day imaging (78803) $4,657 $4,657 8.8×
Rp Therapy Intravenous Administration (79101) $1,134 $1,134 5.0×
Scapula (73010) $1,180 $1,180 11.6×
Screening Digital Breast Tomosynthesis Bi (77063) $84 $84 3.6×
Shoulder 1 view (73020) $1,187 $1,187 14.0×
Small bowel series (74250) $1,997 $1,997 11.7×
Spine thoracic 3 views (72072) $1,568 $1,568 15.4×
Thoracolumbar 2 views (72080) $1,525 $1,525 18.0×
Thyroid carcinoma metastases img whole body (78018) $4,722 $4,722 8.9×
Thyroid Uptake W/Blood Flow Sngle/Mult Quan Meas (78014) $3,245 $3,245 8.3×
Tmj unilateral (70328) $919 $919 10.8×
Ultrasound breast complete (76641) $1,173 $1,173 11.5×
Ultrasound Exam Aaa Screen (76706) $696 $696 6.8×
Ultrasound, abdomen limited (76705) $2,611 $2,611 25.6×
Umbilical-artery Doppler (OB) (76820) $1,074 $1,074 10.5×
Urethrocystogram voiding (74455) $2,847 $2,847 12.2×
Urethrocystography retrograde rs&i (74450) $2,539 $2,539 10.9×
Us breast unilateral limited (76642) $821 $821 9.7×
Us chest (76604) $2,038 $2,038 20.0×
Us compl joint r-t w/image documentation (76881) $1,311 $1,311 12.9×
Us elastography parenchyma (76981) $608 $608 6.0×
Us infant hips w manipulation (76885) $1,133 $1,133 13.3×
Us lmtd joint/oth nonvasc xtr strux r-t w/img (76882) $307 $307 3.0×
Us ob detailed single fetus (76811) $2,746 $2,746 11.8×
Us ob limited (76815) $1,311 $1,311 12.9×
Us ob transvaginal (76817) $1,354 $1,354 13.3×
Us pelvic non ob complete (76856) $2,728 $2,728 26.7×
Us pelvic nonobstetric image dcmtn limited/f/u (76857) $873 $873 8.6×
Us pg uter img f&mat 14 wk tabdl 1/1st gestation (76801) $996 $996 9.8×
Us pg uter r-t img f-up tabdl appr pr fetus (76816) $873 $873 8.6×
Us retroperitoneal complete (76770) $2,501 $2,501 24.5×
Us retroperitoneal limited (76775) $2,215 $2,215 21.7×
Us scrotum and contents (76870) $2,340 $2,340 22.9×
Us soft tissue head/neck (76536) $2,340 $2,340 22.9×
Us spinal canal and contents (76800) $813 $813 8.0×
Venogram extremity bilateral (75822) $3,713 $3,713 2.4×
Venogram Extremity Unilateral (75820) $2,804.50 $2,804.50 1.8×
Venography caval inferior serialography rs&i (75825) $7,111 $7,111 2.3×
Venography caval superior serialography rs&i (75827) $7,111 $7,111 4.6×
Venography renal unilateral selective rs&i (75831) $9,678 $9,678 3.1×
Venography venous sinus/jugular cath rs&i (75860) $9,678 $9,678 3.1×
Wrist 2 views (73100) $1,076 $1,076 12.7×
X-Ray Abdomen,Comp Acute Series - Xr Abdomen 2 Vws With Chest 1 View (74022) $1,869 $1,869 18.3×
X-Ray Ac Jts - Xr Acromioclavicular Joints Bilateral (73050) $1,371 $1,371 16.1×
X-Ray Colon Air Contrast - Fl Barium Enema Air Contrast (74280) $3,694 $3,694 21.6×
X-Ray Elbow 2 Vw - Xr Elbow 1-2 Views Right (73070) $1,090 $1,090 12.8×
X-Ray Exam Hip Uni 2-3 Views (73502) $1,648 $1,648 19.4×
X-Ray Exam Hips Bi 3-4 Views (73522) $1,483 $1,483 14.5×
X-ray exam of femur 2/> (73552) $2,233 $2,233 26.3×
X-Ray Facial Bones <3 Vw - Xr Facial Bones 1-2 Views (70140) $1,512 $1,512 17.8×
X-ray IV pyelogram (ivp) (74400) $2,446 $2,446 14.3×
X-Ray Jaw <4 Vw - Xr Mandible < 4 Views (70100) $1,008 $1,008 11.9×
X-ray leg, infant (73592) $1,308 $1,308 15.4×
X-Ray Lumbar Spine 2/3 Vw - Xr Lumbar Spine 2-3 Views (72100) $1,877 $1,877 18.4×
X-Ray Lumbar Spine 6+ Vw - Xr Lumbar Spine 6+ Vws Including Bending (72114) $2,235 $2,235 21.9×
X-ray nose-rectum child f.b. (76010) $907 $907 10.7×
X-Ray Orbits - Xr Orbits Complete 4+ Views (70200) $1,725 $1,725 16.9×
X-ray retrograde pyelogram (74420) $3,018 $3,018 8.9×
X-Ray Ribs 2 Vw Unilat - Xr Ribs 2 Views Right (71100) $1,894 $1,894 22.3×
X-Ray Ribs, Chest 3+ Vw - Xr Ribs 2 Vws Lt W/ Chest Anteroposterior (71101) $2,300 $2,300 22.5×
X-Ray Ribs, Chest 4+ Vw - Xr Ribs 3 Vws Bil W/ Chest Posteroanterior (71111) $2,884 $2,884 28.3×
X-Ray Sacroiliac Jts 3+ Vw - Xr Sacroiliac Joints 3+ Views (72202) $1,398 $1,398 13.7×
X-Ray Sacrum/Coccyx 2+ Vw - Xr Sacrum Coccyx 2+ Views (72220) $1,525 $1,525 18.0×
X-Ray Sinuses 3+ Vw - Xr Paranasal Sinuses 3+ Views (70220) $1,781 $1,781 21.0×
X-Ray Skull 4+ Vw - Xr Skull Complete 4+ Views (70260) $2,394 $2,394 23.5×
X-Ray Skull <4 Vw - Xr Skull 1-3 Views (70250) $1,124 $1,124 11.0×
X-Ray Spine One View - Xr Spine (72020) $1,147 $1,147 13.5×
X-Ray Sterno-Clavicluar Jt - Xr Sternoclavicular Joints 3+ Views (71130) $1,008 $1,008 11.9×
X-Ray Sternum 2+ Vw - Xr Sternum 2+ Views (71120) $1,180 $1,180 13.9×
X-Ray Thoracic Spine 4 Vw - Xr Thoracic Spine Complete 4+ Views (72074) $2,268 $2,268 22.2×
Xr bone length studies (77073) $1,021 $1,021 10.0×
Xr c-spine 4 or 5 views (72050) $2,323 $2,323 22.8×
Xr c-spine 6 or more views (72052) $2,817 $2,817 27.6×
Xr chest 4+ views (71048) $2,670 $2,670 26.2×
Xr urogram antegrade (74425) $1,751 $1,751 5.1×