Imaging prices at Mercy Hospital Lebanon

Lebanon, MO · every code in this section with a posted price and a Medicare benchmark.

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

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ProcedureCash priceGross charge× Medicare
Abdomen 2 views (74019) $376.35 $579 3.6×
Acute gastrointestinal blood loss imaging (78278) $1,026.35 $1,579 2.6×
Ankle 2 views (73600) $273.65 $421 3.1×
Arthrogram hip (73525) $1,380.60 $2,124 4.0×
Arthrogram shoulder (73040) $1,613.95 $2,483 4.6×
Arthrogram wrist (73115) $1,525.55 $2,347 4.4×
Bone &/Joint Imaging Limited Area (78300) $988 $1,520 2.5×
Bone &/Joint Imaging Multiple Areas (78305) $1,181.05 $1,817 2.9×
Bone &/joint imaging whole body (78306) $1,713.08 $2,635.50 4.3×
Bone age studies (77072) $209.95 $323 2.0×
Bone Imaging 3 Phase (78315) $1,790.10 $2,754 4.5×
Bone Marrow Imaging Limited Area (78102) $399.10 $614 1.0×
Bone survey complete (77075) $720.20 $1,108 6.9×
Brain image w/flow 4 + views (78606) $2,170.35 $3,339 4.0×
Cervical spine 2 or 3 views (72040) $356.20 $548 4.1×
Chest 1 view (71045) $244.40 $376 2.8×
Chest 3 views (71047) $352.30 $542 4.0×
Cine/Vid X-Ray Throat/Esoph - Fl Esoph Barium Swlw W/ Video & Speech (74230) $659.10 $1,014 3.8×
Clavicle complete (73000) $358.15 $551 4.1×
Computed Tomography Thorax Lw Dose Lng Ca Scr C- (71271) $995.15 $1,531 9.5×
CT abdomen and pelvis without and with contrast (74178) $3,630.90 $5,586 10.4×
CT abdomen and pelvis without contrast (74176) $2,429.70 $3,738 10.2×
CT abdomen w contrast (74160) $2,225.60 $3,424 12.7×
CT abdomen w wo contrast (74170) $2,386.80 $3,672 13.6×
CT abdomen w/o contrast (74150) $1,856.40 $2,856 17.7×
CT angiography upper extremity lt (73206) $1,714.70 $2,638 9.8×
CT c-spine w/o contrast (72125) $921.05 $1,417 8.8×
CT cervical spine w&w/o contrast (72127) $2,048.15 $3,151 11.7×
CT cervical spine with contrast (72126) $1,724.45 $2,653 4.9×
CT chest w/wo contrast (71270) $1,975.35 $3,039 11.2×
CT chest with contrast (71260) $1,806.35 $2,779 10.3×
CT head/brain with contrast (70460) $1,184.95 $1,823 6.7×
CT head/brain without and with contrast (70470) $1,619.15 $2,491 9.2×
CT heart no contrast quant eval coronry calcium (75571) $35.75 $55 0.4×
CT iac w contrast (70481) $1,617.85 $2,489 9.2×
CT limited/localized follow up study (76380) $618.80 $952 7.1×
CT lower ext w/o (73700) $1,086.15 $1,671 10.4×
CT lower extremity w wo contrast (73702) $1,287.65 $1,981 7.3×
CT lower extremity with contrast (73701) $1,171.95 $1,803 6.7×
CT lumbar spine w & w/o contrast (72133) $1,964.30 $3,022 11.2×
CT lumbar spine w/o contrast (72131) $1,458.60 $2,244 13.9×
CT lumbar spine with contrast (72132) $1,591.85 $2,449 4.6×
CT maxillofacial w contrast (70487) $1,860.95 $2,863 10.6×
CT maxillofacial w/o contrast (70486) $1,263.28 $1,943.50 12.1×
CT maxillofacial w/wo contrast (70488) $2,048.15 $3,151 11.7×
CT neck soft tissue w contrast (70491) $1,459.90 $2,246 8.3×
CT orbit sella/post fossa/ear w/o & w/contr matr (70482) $1,768 $2,720 10.1×
CT orbits w/o contrast (70480) $1,495.65 $2,301 14.3×
CT pelvis w & w/o contrast (72194) $2,068.30 $3,182 11.8×
CT pelvis w/o contrast (72192) $1,328.60 $2,044 12.7×
CT soft tissue neck w/o & w/contrast material (70492) $1,871.35 $2,879 10.7×
CT soft tissue neck w/o contrast (70490) $1,248 $1,920 11.9×
CT thoracic spine w/contrast (72129) $1,738.10 $2,674 9.9×
CT thoracic spine w/o contrast (72128) $991.25 $1,525 9.5×
CT thoracic spine w/wo contrast (72130) $2,455.70 $3,778 14.0×
CT thorax w/o contrast (71250) $900.90 $1,386 8.6×
CT upper extremity w/o & w/contrast material (73202) $1,415.70 $2,178 8.1×
CT upper extremity w/o contrast rt (73200) $1,077.05 $1,657 10.3×
CT upper extremity with contrast (73201) $1,175.85 $1,809 3.4×
Cta Abdl Aorta&Bi Iliofem W/Contrast&Postp (75635) $2,216.50 $3,410 12.6×
Cta Abdomen (74175) $2,524.60 $3,884 14.4×
CTA abdomen pelvis (74174) $2,754.05 $4,237 7.9×
CTA chest (71275) $1,195.35 $1,839 6.8×
Cta Head (70496) $1,180.40 $1,816 6.7×
CTA head&neck c+ w/noncontrast img&post-pxessing (70471) $2,967.90 $4,566 8.5×
CTA lwr ext w&w/o contrast (73706) $2,336.10 $3,594 13.3×
Cta Neck (70498) $1,157 $1,780 6.6×
Cta Pelvis (72191) $2,340.65 $3,601 13.3×
Cystography minimum 3 views rs&i (74430) $685.75 $1,055 2.0×
Doppler Echo Fetal Puls Spectral F/U/Repeat (76828) $466.70 $718 4.5×
Doppler Echo Fetal Spectral Display Complete (76827) $742.30 $1,142 7.1×
Doppler Fetal Mid Cerebral Artery (76821) $380.25 $585 3.6×
Dxa bone density study 1/> sites axial skel (77080) $233.35 $359 2.2×
Dxa bone density study 1/>sites appendiclr skel (77081) $162.50 $250 1.9×
Dxa bone density study axial skeleton (77085) $649.35 $999 6.2×
Echo exam of fetal heart (76825) $1,426.10 $2,194 2.6×
Echo fetal cardiovasc w/wo m-mode repeat std (76826) $926.90 $1,426 3.9×
Echoencephalography real time imaging (76506) $586.95 $903 5.6×
Esophagus (74220) $592.15 $911 3.4×
Fetal biophysical profile non-stress testing (76818) $777.40 $1,196 7.4×
Fetal Biophysical Profile W/O Non-Stress Testing (76819) $571.35 $879 5.5×
Fluoroscopy up to 1 hr (76000) $290.55 $447 1.2×
Foot 2 views (73620) $287.95 $443 3.3×
Forearm 2 views (73090) $306.80 $472 3.5×
Gastric emptying imaging study (eg, solid, liquid, or both); with small bowel and colon transit, multiple days Age… (78266) $4,037.80 $6,212 7.4×
Gated Heart Planar Single (78472) $962.65 $1,481 2.4×
Hand 2 views (73120) $273.65 $421 2.6×
Hand 3 views (73130) $334.75 $515 3.8×
Heart Infarct Image (78466) $1,901.90 $2,926 4.7×
Hepatobil Syst Imag Inc Gb W/Pharma Intervenj (78227) $1,884.24 $2,898.83 3.5×
Hepatobiliary syst imaging including gallbladder (78226) $1,726.40 $2,656 4.3×
Ht muscle image spect sing (78451) $3,413.48 $5,251.50 2.6×
Humerus Min 2 Views Left (73060) $302.25 $465 3.5×
Hysterosalpingogram (74740) $609.70 $938 2.6×
Kidney imaging morphology (78700) $553.80 $852 1.4×
Kidney Img Morphology Vascular Flow 1 W/O Rx (78707) $1,784.90 $2,746 3.3×
Kidney img morphology vascular flow 1 w/rx (78708) $1,485.22 $2,284.95 2.7×
Kidney Img Morphology Vascular Flow Multiple (78709) $1,683.50 $2,590 3.1×
Knee 3 views (73562) $334.10 $514 3.8×
Liver & spleen imaging static only (78215) $2,016.30 $3,102 5.0×
Liver & Spleen Imaging W/Vascular Flow (78216) $2,045.55 $3,147 5.1×
Lung perf&ventilat diferentl (78598) $1,550.25 $2,385 2.9×
Lung perfusion differential (78597) $1,198.60 $1,844 3.0×
Lymphoscintigraphy (78195) $819.65 $1,261 1.5×
Meckels Diverticulum (78290) $1,073.15 $1,651 2.7×
MRA head w & w/o contrast (70546) $3,070.60 $4,724 8.8×
MRA head w/o contrast (70544) $1,514.50 $2,330 6.3×
MRA head with contrast (70545) $2,765.75 $4,255 7.9×
MRA neck w contrast (70548) $2,518.10 $3,874 7.2×
Mra Neck W/O &W/Contrast Material (70549) $2,558.40 $3,936 7.3×
MRA neck w/o contrast (70547) $2,325.05 $3,577 9.7×
MRI abdomen w contrast (74182) $2,193.10 $3,374 6.3×
MRI abdomen w/o & w/contrast material (74183) $2,550.60 $3,924 7.3×
MRI abdomen w/o contrast (74181) $1,913.60 $2,944 8.0×
MRI any jnt lwr ext with con lt (73722) $2,737.80 $4,212 3.5×
MRI any jt upper extremity w/contrast matrl (73222) $3,034.20 $4,668 3.9×
MRI c-spine with contrast (72142) $2,672.80 $4,112 7.6×
MRI cervical spine w/o contrast (72141) $2,535.65 $3,901 10.6×
MRI chest w/o & w/contrast material (71552) $3,355.30 $5,162 9.6×
MRI chest w/o contrast (71550) $1,381.90 $2,126 5.8×
MRI Forearm w/ Contrast Bilateral 73219 (73219) $2,213.25 $3,405 6.3×
MRI lower extrem oth/thn jt w/contrast matrl (73719) $2,731.95 $4,203 7.8×
MRI lower extrem oth/thn jt w/o contr matrl (73718) $2,499.25 $3,845 10.5×
MRI orbit face &/neck w/o contrast (70540) $1,682.20 $2,588 7.0×
MRI orbit/face/neck w&w/o cont (70543) $3,806.72 $5,856.50 10.9×
MRI pelvis w contrast (72196) $2,496.65 $3,841 7.1×
MRI pelvis w/o & w/contrast material (72197) $2,635.75 $4,055 7.5×
MRI pelvis w/o contrast (72195) $2,259.40 $3,476 9.5×
MRI scan of arm joint before and after contrast (73223) $3,185.65 $4,901 9.1×
MRI scan of leg joint before and after contrast (73723) $3,218.80 $4,952 9.2×
MRI spinal canal cervical w/o & w/contr matrl (72156) $2,800.20 $4,308 8.0×
MRI spinal canal lumbar w/contrast material (72149) $2,461.55 $3,787 7.0×
MRI spinal canal lumbar w/o & w/contr matrl (72158) $2,632.50 $4,050 7.5×
MRI spinal canal thoracic w/contrast matrl (72147) $2,632.50 $4,050 7.5×
MRI spinal canal thoracic w/o & w/contr matrl (72157) $2,672.80 $4,112 7.6×
MRI thoracic spine w/o contrast (72146) $2,527.85 $3,889 10.6×
MRI upper ext joint w/o contrast (73221) $2,613 $4,020 10.9×
MRI upper extrem other than jt w/o & w/contras (73220) $2,807.35 $4,319 8.0×
MRI upper extremity oth than jt w/o contr matrl (73218) $1,653.60 $2,544 6.9×
Myelogram Lumbar (72265) $1,145.30 $1,762 1.5×
Myocardial Spect Multiple Studies (78452) $4,420.98 $6,801.50 3.4×
Neck soft tissue (70360) $209.30 $322 2.4×
Nm bone marrow multiple (78103) $1,380.60 $2,124 3.4×
Nm bone marrow wb (78104) $1,249.95 $1,923 3.1×
Nm gastric emptying study (78264) $1,081.28 $1,663.50 2.7×
Nuclear medicine study of kidney and blood flow (78701) $1,774.50 $2,730 4.4×
Ob Us Follow-Up Per Fetus - Us Ob Follow Up Transabdominal Approach (76816) $365.30 $562 3.5×
Orthopantogram (70355) $235.30 $362 2.7×
Osseous survey infant (77076) $362.05 $557 3.5×
Parathyrd planar w/wo subtrj (78071) $1,443 $2,220 3.6×
Parathyroid imaging (78070) $911.95 $1,403 2.3×
Pelvis 1 or 2 views (72170) $313.95 $483 3.0×
Pr MRI, lower extr, w/o contrast f/u by contrast (73720) $3,023.15 $4,651 8.7×
Pulmonary Perfusion Imaging Particulate (78580) $689.65 $1,061 1.7×
Pulmonary Ventilation & Perfusion Imaging (78582) $1,406.92 $2,164.50 2.6×
Radex Entir Thrc Lmbr Crv Sac Spi W/Skull 1 Vw - Xr Scoliosis 1 Vw (72081) $388.70 $598 4.5×
Radex entir thrc lmbr crv sac spi w/skull 2/3 vw (72082) $434.20 $668 4.1×
Radex hips bilateral with pelvis 2 views (73521) $412.75 $635 3.9×
Radex mastoids compl minimum 3 views pr side (70130) $250.25 $385 2.4×
Radex X-Ray Exam Entire Spi 6/> Vw - Xr Entire Spine 6+ Vw (72084) $731.90 $1,126 7.0×
Radiolog exam mandible compl minimum 4 views (70110) $611 $940 5.8×
Radiologic Exam Abdomen 1 View - Xr Abdomen 1 View (74018) $278.20 $428 3.2×
Radiologic Exam Abdomen 3+ Views - Xr Abdomen 3+ Views (74021) $519.35 $799 5.0×
Radiologic Exam Chest 2 Views - Xr Chest 2 Views (71046) $304.85 $469 3.5×
Radiologic exam colon single contrast study (74270) $794.30 $1,222 4.5×
Radiologic exam upr gi trc double contrast study (74246) $740.35 $1,139 4.2×
Radiologic exam upr gi trc single contrast study (74240) $527.80 $812 3.0×
Radiologic Examination Femur Minimum 2 Views - Xr Femur 2+ Vw Lt (73552) $356.85 $549 4.1×
Radiological examination surgical specimen (76098) $211.90 $326 0.4×
Ribs bilateral 3 views (71110) $291.20 $448 2.8×
Rp loclzj tum plnr whole body single day imaging (78802) $2,346.50 $3,610 4.3×
Rp loclzj tum spect 1 area single day imaging (78803) $2,224.62 $3,422.50 4.1×
Sacroiliac Joints < 3 Views (72200) $284.70 $438 2.7×
Saline Infus Sonohysterography W/Color Doppler (76831) $481 $740 2.0×
Scanogram (77073) $314.60 $484 3.0×
Scapula complete (73010) $378.95 $583 3.6×
Screening digital breast tomosynthesis (77063) $66.30 $102 2.8×
Small bowel series (74250) $431.60 $664 2.5×
Spine thoracic 3 views (72072) $462.15 $711 4.4×
Testicular Imaging With Vascular Flow (78761) $815.10 $1,254 2.0×
Thoracolumbar 2 views (72080) $349.05 $537 4.0×
Thyroid Imaging With Vascular Flow (78013) $626.60 $964 1.6×
Thyroid Uptake W/Blood Flow Sngle/Mult Quan Meas (78014) $960.38 $1,477.50 2.4×
Tmj unilateral (70328) $202.15 $311 2.3×
Tomogram (76100) $1,240.20 $1,908 11.8×
Tumor Imaging Whole Body - Nm Tumor Local Whole Body Mult Days (78804) $2,057.90 $3,166 3.8×
Tumor Imaging, Limited Area - Nm Tumor Localization Limited (78800) $601.90 $926 1.5×
Ultrasound, abdomen limited (76705) $700.70 $1,078 6.7×
Umbilical-artery Doppler (OB) (76820) $215.15 $331 2.1×
Upper Extremity Infant (73092) $222.95 $343 2.1×
Urethrocystography voiding (74455) $680.55 $1,047 2.8×
Urography (pyelography), intravenous, with or without KUB, with or without tomography (74400) $1,002.95 $1,543 5.7×
Urograpy infusion drip &/bolus techq w/wo tomo (74415) $1,068.60 $1,644 6.1×
Us abdl aorta screen aaa (76706) $245.70 $378 2.3×
Us breast unilateral complete (76641) $547.30 $842 5.2×
Us breast unilateral limited (76642) $434.20 $668 5.0×
Us chest (76604) $631.15 $971 6.0×
Us compl joint r-t w/image documentation (76881) $703.30 $1,082 6.7×
Us elastography parenchyma (76981) $367.90 $566 3.5×
Us fetal nuchal translucency 1st gestation (76813) $471.90 $726 4.5×
Us infant hips dynamic (76885) $616.85 $949 7.1×
Us infant hips limited static (76886) $387.40 $596 4.4×
Us kidney transplant (76776) $683.80 $1,052 6.5×
Us ob detailed single fetus (76811) $848.25 $1,305 3.5×
Us ob transvaginal (76817) $376.35 $579 3.6×
Us pelvic non ob complete (76856) $874.90 $1,346 8.4×
Us pelvic nonobstetric image dcmtn limited/f/u (76857) $551.85 $849 5.3×
Us pregnancy ltd (76815) $419.90 $646 4.0×
Us pregnant uterus 14 wk transabdl 1/1st gestat (76801) $733.20 $1,128 7.0×
Us retroperitoneal complete (76770) $945.10 $1,454 9.0×
Us retroperitoneal limited (76775) $469.30 $722 4.5×
Us scrotum and contents (76870) $763.10 $1,174 7.3×
Us soft tissue head/neck (76536) $785.20 $1,208 7.5×
Us spinal canal and contents (76800) $824.20 $1,268 7.9×
Us transrectal (76872) $1,070.55 $1,647 10.2×
Us xtr non-vasc lmtd (76882) $501.80 $772 4.8×
Venogram extremity bilateral (75822) $2,558.40 $3,936 1.6×
Venography extremity unilateral rs&i (75820) $2,200.90 $3,386 1.4×
Wrist 2 views (73100) $280.80 $432 3.2×
X-Ray Abdomen,Comp Acute Series - Xr Abdomen 2 Vws With Chest 1 View (74022) $527.15 $811 5.0×
X-Ray Ac Jts - Xr Acromioclavicular Joints Bilateral (73050) $276.90 $426 3.2×
X-Ray Ankle 3+ Vw - Xr Ankle 3+ Views Right (73610) $378.95 $583 4.3×
X-Ray Colon Air Contrast - Fl Barium Enema Air Contrast (74280) $1,260.35 $1,939 7.2×
X-Ray Elbow 2 Vw - Xr Elbow 1-2 Views Right (73070) $285.35 $439 3.3×
X-Ray Elbow 3+ Vw - Xr Elbow 3+ Views Right (73080) $384.15 $591 4.4×
X-ray exam entire spi 4/5 vw (72083) $555.75 $855 5.3×
X-ray exam hip uni 1 view (73501) $220.35 $339 2.5×
X-Ray Exam Hip Uni 2-3 Views (73502) $285.35 $439 3.3×
X-ray exam hip uni 4/> views (73503) $341.25 $525 3.3×
X-Ray Exam Hips Bi 3-4 Views (73522) $447.85 $689 4.3×
X-Ray Exam Hips Bi 5/> Views (73523) $757.90 $1,166 7.2×
X-ray exam of femur 1 (73551) $262.60 $404 3.0×
X-ray eye for foreign body (70030) $241.15 $371 2.8×
X-Ray Facial Bones 3+ Vw - Xr Facial Bones 3+ Views (70150) $270.40 $416 2.6×
X-Ray Facial Bones <3 Vw - Xr Facial Bones 1-2 Views (70140) $222.95 $343 2.6×
X-Ray Foot 3+ Vw - Xr Foot 3+ Views Right (73630) $351 $540 4.0×
X-Ray Heel - Xr Calcaneus 2 Views Right (73650) $263.90 $406 3.0×
X-ray IV pyelogram+drip infusn (74410) $976.30 $1,502 5.6×
X-Ray Jaw <4 Vw - Xr Mandible < 4 Views (70100) $241.15 $371 2.8×
X-Ray Knee 4+ View - Xr Knee 4+ Views Right (73564) $367.25 $565 3.5×
X-Ray Knee Bilat Standing - Xr Knees Anteroposterior Standing Bilat (73565) $205.40 $316 2.4×
X-Ray Leg, Infant - Xr Lower Extremity 2+ Views Infant Left (73592) $180.05 $277 2.1×
X-Ray Lumbar Spine 2/3 Vw - Xr Lumbar Spine 2-3 Views (72100) $387.40 $596 3.7×
X-Ray Lumbar Spine 6+ Vw - Xr Lumbar Spine 6+ Vws Including Bending (72114) $751.40 $1,156 7.2×
X-Ray Lumbar Spine Flex/Exten - Xr Lumbar Spine 4+ Views W/ Flex Ext (72120) $281.45 $433 2.7×
X-Ray Nasal Bones - Xr Nasal Bones (70160) $334.75 $515 3.8×
X-Ray Nose-Rectum Child F.B. - Xr Nose to Rectum Foreign Body Peds (76010) $286 $440 3.3×
X-Ray Orbits - Xr Orbits Complete 4+ Views (70200) $296.40 $456 2.8×
X-Ray Pelvis 3+ Vw - Xr Pelvis 3+ Views (72190) $370.50 $570 3.5×
X-Ray Retrograde Pyelogram - Fl Pyelogram Retrograde (74420) $637 $980 1.8×
X-Ray Ribs 2 Vw Unilat - Xr Ribs 2 Views Right (71100) $327.60 $504 3.8×
X-Ray Ribs, Chest 3+ Vw - Xr Ribs 2 Vws Lt W/ Chest Anteroposterior (71101) $385.45 $593 3.7×
X-Ray Ribs, Chest 4+ Vw - Xr Ribs 3 Vws Bil W/ Chest Posteroanterior (71111) $436.80 $672 4.2×
X-Ray Sacroiliac Jts 3+ Vw - Xr Sacroiliac Joints 3+ Views (72202) $380.90 $586 3.6×
X-Ray Sacrum/Coccyx 2+ Vw - Xr Sacrum Coccyx 2+ Views (72220) $365.95 $563 4.2×
X-Ray Shoulder 2+ Vw - Xr Shoulder 2+ Views Right (73030) $333.45 $513 3.8×
X-Ray Sinuses 3+ Vw - Xr Paranasal Sinuses 3+ Views (70220) $337.35 $519 3.9×
X-Ray Sinuses <3 Vw - Xr Paranasal Sinuses 1-2 Views (70210) $220.35 $339 2.5×
X-Ray Skull 4+ Vw - Xr Skull Complete 4+ Views (70260) $364.65 $561 3.5×
X-Ray Skull <4 Vw - Xr Skull 1-3 Views (70250) $200.20 $308 1.9×
X-Ray Spine One View - Xr Spine (72020) $164.45 $253 1.9×
X-Ray Sterno-Clavicluar Jt - Xr Sternoclavicular Joints 3+ Views (71130) $398.45 $613 4.6×
X-Ray Sternum 2+ Vw - Xr Sternum 2+ Views (71120) $334.10 $514 3.8×
X-Ray Thoracic Spine 2 Vw - Xr Thoracic Spine 2 Views (72070) $365.30 $562 3.5×
X-Ray Thoracic Spine 4 Vw - Xr Thoracic Spine Complete 4+ Views (72074) $858 $1,320 8.2×
X-Ray Toe(S) - Xr Toes 2+ Views Right (73660) $281.45 $433 3.2×
X-Ray Wrist 3+ Vw - Xr Wrist 3+ Views Right (73110) $345.80 $532 4.0×
Xr c-spine 6 or more views (72052) $555.10 $854 5.3×
Xr chest 4+ views (71048) $494.65 $761 4.7×
Xr finger(s) 2+ views (73140) $255.45 $393 2.9×
Xr shoulder 1 view (73020) $260 $400 3.0×
Xr spine cervical 4 or 5 views (72050) $458.90 $706 4.4×
Xr tibia/fibula 2 views (73590) $333.45 $513 3.8×
Xr tmj bilateral (70330) $371.80 $572 4.3×
Xray knee 1 or 2 views rt (73560) $261.30 $402 3.0×