Imaging prices at Missouri Delta Medical Center

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

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

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ProcedureCash priceGross charge× Medicare
Abdomen 2 views (74019) $87.13 $348.50 0.8×
Acute gastrointestinal blood loss imaging (78278) $544.31 $2,177.25 1.4×
Angiography extremity bilateral rs&i (75716) $34.88 $139.50 0.0×
Angiography extremity unilateral rs&i (75710) $3,750.63 $15,002.50 1.2×
Ankle 2 views (73600) $139.25 $557 1.6×
Antegrade urography radiological supvj & interpj (74425) $388.69 $1,554.75 1.1×
Aortography abdominal serialography rs&i (75625) $409.50 $1,638 0.1×
Arthrogram elbow (73085) $496.06 $1,984.25 1.4×
Arthrogram hip (73525) $496.06 $1,984.25 1.4×
Arthrogram shoulder (73040) $496.06 $1,984.25 1.4×
Arthrogram wrist (73115) $496.06 $1,984.25 1.4×
Arthrography knee lt (73580) $496.06 $1,984.25 1.4×
Bone &/Joint Imaging Limited Area (78300) $486.75 $1,947 1.2×
Bone &/joint imaging whole body (78306) $486.75 $1,947 1.2×
Bone age studies (77072) $139.25 $557 1.3×
Bone Imaging 3 Phase (78315) $552.88 $2,211.50 1.4×
Bone survey complete (77075) $488.75 $1,955 4.7×
Brain imaging < 4 static views w vascular flow (78601) $816.19 $3,264.75 2.0×
Brain Imaging Pet Metabolic Evaluation (78608) $2,155.25 $8,621 1.5×
Cervical spine 2 or 3 views (72040) $139.25 $557 1.6×
Chest 1 view (71045) $87.13 $348.50 1.0×
Chest 3 views (71047) $98.50 $394 1.1×
Cine/Vid X-Ray Throat/Esoph - Fl Esoph Barium Swlw W/ Video & Speech (74230) $186.13 $744.50 1.1×
Clavicle complete (73000) $87.13 $348.50 1.0×
Computed Tomography Thorax Lw Dose Lng Ca Scr C- (71271) $189.94 $759.75 1.8×
Contrast Xray Throat/Cerv Esopha - Fl Esophagus Pharynx (74210) $149 $596 0.8×
CT abdomen and pelvis without and with contrast (74178) $1,220.69 $4,882.75 3.5×
CT abdomen and pelvis without contrast (74176) $1,073.84 $4,295.38 4.5×
CT abdomen w contrast (74160) $506.75 $2,027 2.9×
CT abdomen w wo contrast (74170) $548.31 $2,193.25 3.1×
CT abdomen w/o contrast (74150) $525.75 $2,103 5.0×
CT angiography upper extremity lt (73206) $342.88 $1,371.50 2.0×
CT c-spine w/o contrast (72125) $689.38 $2,757.50 6.6×
CT cervical spine w&w/o contrast (72127) $510.94 $2,043.75 2.9×
CT cervical spine with contrast (72126) $473.13 $1,892.50 1.4×
CT chest w/wo contrast (71270) $473.13 $1,892.50 2.7×
CT chest with contrast (71260) $556.38 $2,225.50 3.2×
CT head/brain with contrast (70460) $532.18 $2,128.75 3.0×
CT head/brain without and with contrast (70470) $606.06 $2,424.25 3.4×
CT iac w contrast (70481) $271.76 $1,087 1.5×
CT limited/localized follow up study (76380) $197.13 $788.50 2.3×
CT lower ext w/o (73700) $689.38 $2,757.50 6.6×
CT lower extremity w wo contrast (73702) $505.06 $2,020.25 2.9×
CT lower extremity with contrast (73701) $473.13 $1,892.50 2.7×
CT lumbar spine w & w/o contrast (72133) $505.06 $2,020.25 2.9×
CT lumbar spine w/o contrast (72131) $689.38 $2,757.50 6.6×
CT lumbar spine with contrast (72132) $473.13 $1,892.50 1.4×
CT maxillofacial w contrast (70487) $453.88 $1,815.50 2.6×
CT maxillofacial w/o contrast (70486) $407.53 $1,630.12 3.9×
CT maxillofacial w/wo contrast (70488) $485.50 $1,942 2.8×
CT neck soft tissue w contrast (70491) $515.31 $2,061.25 2.9×
CT orbit sella/post fossa/ear w/o & w/contr matr (70482) $755.06 $3,020.25 4.3×
CT orbits w/o contrast (70480) $483.62 $1,934.50 4.6×
CT pelvis w & w/o contrast (72194) $517.31 $2,069.25 2.9×
CT pelvis w/o contrast (72192) $527.25 $2,109 5.0×
CT soft tissue neck w/o & w/contrast material (70492) $421.81 $1,687.25 2.4×
CT soft tissue neck w/o contrast (70490) $483.56 $1,934.25 4.6×
CT thoracic spine w/contrast (72129) $353.13 $1,412.50 2.0×
CT thoracic spine w/o contrast (72128) $689.38 $2,757.50 6.6×
CT thoracic spine w/wo contrast (72130) $510.94 $2,043.75 2.9×
CT thorax w/o contrast (71250) $535.94 $2,143.75 5.1×
CT upper extremity w/o & w/contrast material (73202) $505.06 $2,020.25 2.9×
CT upper extremity w/o contrast rt (73200) $670.69 $2,682.75 6.4×
CT upper extremity with contrast (73201) $473.13 $1,892.50 1.4×
Cta Abdl Aorta&Bi Iliofem W/Contrast&Postp (75635) $910.31 $3,641.25 5.2×
Cta Abdomen (74175) $125.81 $503.25 0.7×
CTA abdomen pelvis (74174) $882.47 $3,529.88 2.5×
CTA chest (71275) $613.25 $2,453 3.5×
Cta Head (70496) $715.31 $2,861.25 4.1×
CTA lwr ext w&w/o contrast (73706) $343.06 $1,372.25 2.0×
Cta Neck (70498) $716.44 $2,865.75 4.1×
Cystography minimum 3 views rs&i (74430) $388.69 $1,554.75 1.1×
Diskogram cervical (72285) $4,881.88 $19,527.50 2.5×
Esophagus (74220) $164.56 $658.25 0.9×
Fetal biophysical profile non-stress testing (76818) $223.53 $894.12 2.1×
Fetal Biophysical Profile W/O Non-Stress Testing (76819) $231 $924 2.2×
Fluoroscopy up to 1 hr (76000) $233.75 $935 1.0×
Foot 2 views (73620) $87.13 $348.50 1.0×
Forearm 2 views (73090) $87.13 $348.50 1.0×
Gastric emptying imaging study (eg, solid, liquid, or both); with small bowel and colon transit, multiple days Age… (78266) $353.25 $1,413 0.6×
Gated Heart Planar Single (78472) $547.25 $2,189 1.4×
Hand 2 views (73120) $139.25 $557 1.3×
Hand 3 views (73130) $87.13 $348.50 1.0×
Heart Infarct Image (78466) $547.25 $2,189 1.4×
Hepatobil Syst Imag Inc Gb W/Pharma Intervenj (78227) $572.63 $2,290.50 1.1×
Hepatobiliary syst imaging including gallbladder (78226) $546.50 $2,186 1.4×
Ht muscle image spect sing (78451) $1,670.75 $6,683 1.3×
Humerus Min 2 Views Left (73060) $87.13 $348.50 1.0×
Hysterosalpingogram (74740) $493.75 $1,975 2.1×
Joint Survey, Single View - Xr Joint Anteroposterior 2+ Joints (77077) $139.25 $557 1.3×
Kidney imaging morphology (78700) $616.25 $2,465 1.5×
Kidney Img Morphology Vascular Flow 1 W/O Rx (78707) $616.25 $2,465 1.1×
Kidney img morphology vascular flow 1 w/rx (78708) $616.25 $2,465 1.1×
Knee 3 views (73562) $139.25 $557 1.6×
Liver & spleen imaging static only (78215) $546.50 $2,186 1.4×
Liver & Spleen Imaging W/Vascular Flow (78216) $546.50 $2,186 1.4×
Liver imaging w/vascular flow (78202) $546.50 $2,186 1.0×
Lymphoscintigraphy (78195) $541.63 $2,166.50 1.0×
Meckels Diverticulum (78290) $479 $1,916 1.2×
MRA head w & w/o contrast (70546) $921.94 $3,687.75 2.6×
MRA head w/o contrast (70544) $416.18 $1,664.75 1.7×
MRA head with contrast (70545) $749.31 $2,997.25 2.1×
MRA neck w contrast (70548) $576.31 $2,305.25 1.6×
Mra Neck W/O &W/Contrast Material (70549) $921.94 $3,687.75 2.6×
MRA neck w/o contrast (70547) $576.44 $2,305.75 2.4×
MRI abdomen w contrast (74182) $863 $3,452 2.5×
MRI abdomen w/o & w/contrast material (74183) $863 $3,452 2.5×
MRI abdomen w/o contrast (74181) $721.28 $2,885.12 3.0×
MRI any jnt lwr ext with con lt (73722) $863 $3,452 1.1×
MRI any jt upper extremity w/contrast matrl (73222) $863 $3,452 1.1×
MRI c-spine with contrast (72142) $806.50 $3,226 2.3×
MRI cervical spine w/o contrast (72141) $795.19 $3,180.75 3.3×
MRI Forearm w/ Contrast Bilateral 73219 (73219) $863 $3,452 2.5×
MRI lower extrem oth/thn jt w/contrast matrl (73719) $863 $3,452 2.5×
MRI lower extrem oth/thn jt w/o contr matrl (73718) $735.38 $2,941.50 3.1×
MRI orbit face &/neck w/o contrast (70540) $543.88 $2,175.50 2.3×
MRI orbit/face/neck w&w/o cont (70543) $909.06 $3,636.25 2.6×
MRI orbit/face/neck w/contrast (70542) $829.81 $3,319.25 2.4×
MRI pelvis w contrast (72196) $863 $3,452 2.5×
MRI pelvis w/o & w/contrast material (72197) $711.50 $2,846 2.0×
MRI pelvis w/o contrast (72195) $501.72 $2,006.88 2.1×
MRI scan of arm joint before and after contrast (73223) $863 $3,452 2.5×
MRI scan of leg joint before and after contrast (73723) $863 $3,452 2.5×
MRI spectroscopy (76390) $728.69 $2,914.75 8.4×
MRI spinal canal cervical w/o & w/contr matrl (72156) $881 $3,524 2.5×
MRI spinal canal lumbar w/contrast material (72149) $829.81 $3,319.25 2.4×
MRI spinal canal lumbar w/o & w/contr matrl (72158) $924.13 $3,696.50 2.6×
MRI spinal canal thoracic w/contrast matrl (72147) $577.50 $2,310 1.7×
MRI spinal canal thoracic w/o & w/contr matrl (72157) $924.13 $3,696.50 2.6×
MRI thoracic spine w/o contrast (72146) $707.06 $2,828.25 3.0×
MRI tmj (70336) $565.50 $2,262 2.4×
MRI upper ext joint w/o contrast (73221) $827 $3,308 3.5×
MRI upper extrem other than jt w/o & w/contras (73220) $863 $3,452 2.5×
MRI upper extremity oth than jt w/o contr matrl (73218) $735.38 $2,941.50 3.1×
Myocardial Spect Multiple Studies (78452) $1,797.63 $7,190.50 1.4×
Neck soft tissue (70360) $87.13 $348.50 1.0×
Nm gastric emptying study (78264) $479 $1,916 1.2×
Nuclear medicine of heart muscle at rest with stress (78454) $1,670.75 $6,683 1.3×
Nuclear medicine study of heart muscle at rest with stress (78453) $1,670.75 $6,683 1.3×
Nuclear medicine study of stomach to assess emptying small bowel movement (78265) $308.44 $1,233.75 0.8×
Ob Us Follow-Up Per Fetus - Us Ob Follow Up Transabdominal Approach (76816) $142.88 $571.50 1.4×
Osseous survey infant (77076) $449.19 $1,796.75 4.3×
Parathyroid imaging (78070) $413.06 $1,652.25 1.0×
Pelvis 1 or 2 views (72170) $139.25 $557 1.3×
PET image w/CT, skull-thigh (78815) $2,155.25 $8,621 1.5×
PET imaging for CT attenuation whole body (78816) $2,218.75 $8,875 1.5×
Pr MRI, lower extr, w/o contrast f/u by contrast (73720) $863 $3,452 2.5×
Pulmonary Perfusion Imaging Particulate (78580) $462.75 $1,851 1.2×
Pulmonary Ventilation & Perfusion Imaging (78582) $707.19 $2,828.75 1.3×
Radex abscess/fistula/sinus tract rs&i (76080) $474.75 $1,899 0.9×
Radex entir thrc lmbr crv sac spi w/skull 2/3 vw (72082) $186.50 $746 1.8×
Radex hips bilateral with pelvis 2 views (73521) $173.88 $695.50 1.7×
Radex mastoids compl minimum 3 views pr side (70130) $139.25 $557 1.3×
Radiolog exam mandible compl minimum 4 views (70110) $133.94 $535.75 1.3×
Radiologic Exam Abdomen 1 View - Xr Abdomen 1 View (74018) $87.13 $348.50 1.0×
Radiologic Exam Abdomen 3+ Views - Xr Abdomen 3+ Views (74021) $139.25 $557 1.3×
Radiologic Exam Chest 2 Views - Xr Chest 2 Views (71046) $107.44 $429.75 1.2×
Radiologic exam colon single contrast study (74270) $267.31 $1,069.25 1.5×
Radiologic exam upr gi trc double contrast study (74246) $252.63 $1,010.50 1.4×
Radiologic exam upr gi trc single contrast study (74240) $233.72 $934.88 1.3×
Radiologic Examination Femur Minimum 2 Views - Xr Femur 2+ Vw Lt (73552) $87.13 $348.50 1.0×
Radiological examination surgical specimen (76098) $493.75 $1,975 0.9×
Ribs bilateral 3 views (71110) $235.06 $940.25 2.2×
Rp loclzj tum plnr whole body single day imaging (78802) $367.38 $1,469.50 0.7×
Sacroiliac Joints < 3 Views (72200) $87.13 $348.50 0.8×
Scanogram (77073) $139.25 $557 1.3×
Scapula complete (73010) $87.13 $348.50 0.8×
Screening digital breast tomosynthesis (77063) $60 $240 2.6×
Shuntogram indwelling nonvascular shunt rs&i (75809) $151.81 $607.25 1.4×
Sialogram (70390) $493.75 $1,975 2.1×
Small bowel series (74250) $210.60 $842.38 1.2×
Spine thoracic 3 views (72072) $139.25 $557 1.3×
Spleen imaging only (78185) $541.56 $2,166.25 1.4×
Testicular Imaging With Vascular Flow (78761) $616.25 $2,465 1.5×
Thoracolumbar 2 views (72080) $88.31 $353.25 1.0×
Thyroid carcinoma metastases img whole body (78018) $595.19 $2,380.75 1.1×
Thyroid Imaging With Vascular Flow (78013) $278.25 $1,113 0.7×
Thyroid uptake measurement (78012) $277.19 $1,108.75 0.7×
Thyroid Uptake W/Blood Flow Sngle/Mult Quan Meas (78014) $413.06 $1,652.25 1.0×
Tmj unilateral (70328) $87.13 $348.50 1.0×
Tomogram (76100) $128.75 $515 1.2×
Tumor Imaging Whole Body - Nm Tumor Local Whole Body Mult Days (78804) $367.38 $1,469.50 0.7×
Ultrasound, abdomen limited (76705) $224.56 $898.25 2.1×
Unlisted Ultrasound Procedure (76999) $136.13 $544.50 1.6×
Upper Extremity Infant (73092) $139.25 $557 1.3×
Ureteral Reflux Study Rp Voiding Cystogram (78740) $616.25 $2,465 1.5×
Urethrocystography retrograde rs&i (74450) $439.81 $1,759.25 1.8×
Urethrocystography voiding (74455) $370.06 $1,480.25 1.5×
Urography (pyelography), intravenous, with or without KUB, with or without tomography (74400) $355.88 $1,423.50 2.0×
Us abdl aorta screen aaa (76706) $38.88 $155.50 0.4×
Us breast unilateral complete (76641) $180.81 $723.25 1.7×
Us breast unilateral limited (76642) $110.50 $442 1.3×
Us chest (76604) $197.50 $790 1.9×
Us compl joint r-t w/image documentation (76881) $56.38 $225.50 0.5×
Us fetal nuchal translucency 1st gestation (76813) $153.13 $612.50 1.5×
Us infant hips limited static (76886) $112.13 $448.50 1.3×
Us ob transvaginal (76817) $222.12 $888.50 2.1×
Us pelvic non ob complete (76856) $243.88 $975.50 2.3×
Us pelvic nonobstetric image dcmtn limited/f/u (76857) $134.25 $537 1.3×
Us pregnancy ltd (76815) $216.34 $865.38 2.1×
Us pregnant uterus 14 wk transabdl 1/1st gestat (76801) $231 $924 2.2×
Us retroperitoneal complete (76770) $180.63 $722.50 1.7×
Us retroperitoneal limited (76775) $247.82 $991.25 2.4×
Us scrotum and contents (76870) $236.19 $944.75 2.3×
Us soft tissue head/neck (76536) $217.75 $871 2.1×
Us spinal canal and contents (76800) $145.13 $580.50 1.4×
Us xtr non-vasc lmtd (76882) $136.13 $544.50 1.3×
Venography extremity unilateral rs&i (75820) $1,212.25 $4,849 0.8×
Wrist 2 views (73100) $87.13 $348.50 1.0×
X-Ray Abdomen,Comp Acute Series - Xr Abdomen 2 Vws With Chest 1 View (74022) $139.25 $557 1.3×
X-Ray Ac Jts - Xr Acromioclavicular Joints Bilateral (73050) $278.44 $1,113.75 3.2×
X-Ray Ankle 3+ Vw - Xr Ankle 3+ Views Right (73610) $139.25 $557 1.6×
X-Ray Colon Air Contrast - Fl Barium Enema Air Contrast (74280) $208.13 $832.50 1.2×
X-Ray Elbow 2 Vw - Xr Elbow 1-2 Views Right (73070) $87.13 $348.50 1.0×
X-Ray Elbow 3+ Vw - Xr Elbow 3+ Views Right (73080) $87.13 $348.50 1.0×
X-ray exam hip uni 1 view (73501) $87.13 $348.50 1.0×
X-Ray Exam Hip Uni 2-3 Views (73502) $87.13 $348.50 1.0×
X-ray exam hip uni 4/> views (73503) $148 $592 1.4×
X-ray eye for foreign body (70030) $87.13 $348.50 1.0×
X-Ray Facial Bones 3+ Vw - Xr Facial Bones 3+ Views (70150) $139.25 $557 1.3×
X-Ray Facial Bones <3 Vw - Xr Facial Bones 1-2 Views (70140) $95.54 $382.12 1.1×
X-Ray Foot 3+ Vw - Xr Foot 3+ Views Right (73630) $87.13 $348.50 1.0×
X-Ray Heel - Xr Calcaneus 2 Views Right (73650) $87.13 $348.50 1.0×
X-Ray Jaw <4 Vw - Xr Mandible < 4 Views (70100) $87.13 $348.50 1.0×
X-Ray Knee 4+ View - Xr Knee 4+ Views Right (73564) $139.25 $557 1.3×
X-Ray Leg, Infant - Xr Lower Extremity 2+ Views Infant Left (73592) $208.84 $835.38 2.4×
X-Ray Lumbar Spine 2/3 Vw - Xr Lumbar Spine 2-3 Views (72100) $139.25 $557 1.3×
X-Ray Lumbar Spine 6+ Vw - Xr Lumbar Spine 6+ Vws Including Bending (72114) $146.63 $586.50 1.4×
X-Ray Nasal Bones - Xr Nasal Bones (70160) $87.13 $348.50 1.0×
X-Ray Nose-Rectum Child F.B. - Xr Nose to Rectum Foreign Body Peds (76010) $87.13 $348.50 1.0×
X-Ray Orbits - Xr Orbits Complete 4+ Views (70200) $139.25 $557 1.3×
X-Ray Pelvis 3+ Vw - Xr Pelvis 3+ Views (72190) $139.25 $557 1.3×
X-Ray Retrograde Pyelogram - Fl Pyelogram Retrograde (74420) $388.69 $1,554.75 1.1×
X-Ray Ribs 2 Vw Unilat - Xr Ribs 2 Views Right (71100) $87.13 $348.50 1.0×
X-Ray Ribs, Chest 3+ Vw - Xr Ribs 2 Vws Lt W/ Chest Anteroposterior (71101) $139.25 $557 1.3×
X-Ray Ribs, Chest 4+ Vw - Xr Ribs 3 Vws Bil W/ Chest Posteroanterior (71111) $139.25 $557 1.3×
X-Ray Sacroiliac Jts 3+ Vw - Xr Sacroiliac Joints 3+ Views (72202) $139.25 $557 1.3×
X-Ray Sacrum/Coccyx 2+ Vw - Xr Sacrum Coccyx 2+ Views (72220) $87.13 $348.50 1.0×
X-Ray Shoulder 2+ Vw - Xr Shoulder 2+ Views Right (73030) $139.25 $557 1.6×
X-Ray Sinuses 3+ Vw - Xr Paranasal Sinuses 3+ Views (70220) $139.25 $557 1.6×
X-Ray Sinuses <3 Vw - Xr Paranasal Sinuses 1-2 Views (70210) $87.13 $348.50 1.0×
X-Ray Skull 4+ Vw - Xr Skull Complete 4+ Views (70260) $139.25 $557 1.3×
X-Ray Skull <4 Vw - Xr Skull 1-3 Views (70250) $139.25 $557 1.3×
X-Ray Spine One View - Xr Spine (72020) $80.50 $322 0.9×
X-Ray Sterno-Clavicluar Jt - Xr Sternoclavicular Joints 3+ Views (71130) $88.31 $353.25 1.0×
X-Ray Sternum 2+ Vw - Xr Sternum 2+ Views (71120) $87.13 $348.50 1.0×
X-Ray Thoracic Spine 2 Vw - Xr Thoracic Spine 2 Views (72070) $139.25 $557 1.3×
X-Ray Thoracic Spine 4 Vw - Xr Thoracic Spine Complete 4+ Views (72074) $139.25 $557 1.3×
X-Ray Toe(S) - Xr Toes 2+ Views Right (73660) $87.13 $348.50 1.0×
X-Ray Wrist 3+ Vw - Xr Wrist 3+ Views Right (73110) $87.13 $348.50 1.0×
Xr arthrogram ankle (73615) $496.06 $1,984.25 1.4×
Xr c-spine 6 or more views (72052) $150.44 $601.75 1.4×
Xr chest 4+ views (71048) $233.75 $935 2.2×
Xr finger(s) 2+ views (73140) $87.13 $348.50 1.0×
XR Mastoids < 3 Views Bilateral (70120) $87.13 $348.50 0.8×
Xr shoulder 1 view (73020) $87.13 $348.50 1.0×
Xr spine cervical 4 or 5 views (72050) $139.25 $557 1.3×
Xr tibia/fibula 2 views (73590) $87.13 $348.50 1.0×
Xr tmj bilateral (70330) $173.88 $695.50 2.0×
Xray knee 1 or 2 views rt (73560) $87.13 $348.50 1.0×