Imaging prices at Pike County Memorial Hospital

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

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

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ProcedurePosted cashPosted gross× Medicare
Abdomen 1 View (74018) $133.60 $167 1.5×
Abdomen 2 views (74019) $216 $270 2.1×
Acute Gastrointestinal Blood Loss Imaging (78278) $672 $840 1.7×
Ankle 2 views (73600) $130.40 $163 1.5×
Arthrogram ankle (73615) $308.80 $386 0.9×
Arthrogram hip (73525) $308.80 $386 0.9×
Arthrogram Wrist (73115) $179.20 $224 0.5×
Bone age studies (77072) $156 $195 1.5×
Bone Imaging 3 Phase (78315) $912.80 $1,141 2.3×
Bone Imaging Limited Area (78300) $612.80 $766 1.5×
Bone Imaging Multiple Areas (78305) $1,366.40 $1,708 3.4×
Bone Imaging Whole Body (78306)
range across 2 matching MRF lines		 $722.40–$872 $903–$1,090 varies
Bone marrow imaging limited area (78102) $542.40 $678 1.4×
Bone marrow imaging; whole body (78104) $595.20 $744 1.5×
Bone survey infant (77076) $166.40 $208 1.6×
Cardiovasc nucl exam unlisted (78499) $856.80 $1,071 2.1×
Chest 1 view (71045) $116.80 $146 1.3×
Chest 2 views (71046) $152 $190 1.7×
Chest 3 views (71047) $152 $190 1.7×
Chest 4 or more views (71048) $173.60 $217 1.7×
Clavicle complete (73000) $148.80 $186 1.7×
Contrast X-Ray Of Elbow (73085) $308.80 $386 0.9×
Contrast X-Ray Of Knee Joint (73580) $308.80 $386 0.9×
CT abdomen and pelvis without and with contrast (74178) $1,876.80 $2,346 5.4×
CT abdomen and pelvis without contrast (74176) $1,604.80 $2,006 6.7×
CT abdomen w contrast (74160) $877.60 $1,097 5.0×
CT abdomen w wo contrast (74170) $938.40 $1,173 5.3×
CT abdomen w/o contrast (74150) $802.40 $1,003 7.7×
CT Angio Abdomen and Pelvis (74174) $1,648 $2,060 4.7×
CT Angio Chest (71275) $958.40 $1,198 5.5×
CT Angio Head (70496) $988.80 $1,236 5.6×
CT Angio Neck (70498) $988.80 $1,236 5.6×
Ct Angio Upr Extrm W/O&W/Dye (73206) $802.40 $1,003 4.6×
CT cervical spine w/ contrast (72126) $877.60 $1,097 2.5×
CT cervical spine w/o contrast (72125) $802.40 $1,003 7.7×
CT cervical spine w/wo cont (72127) $938.40 $1,173 5.3×
CT chest w contrast (71260) $877.60 $1,097 5.0×
CT chest w/wo contrast (71270) $938.40 $1,173 5.3×
CT head/brain with contrast (70460) $877.60 $1,097 5.0×
CT head/brain without and with contrast (70470) $938.40 $1,173 5.3×
CT iac w contrast (70481) $826.40 $1,033 4.7×
CT l-spine w&w/o contrast (72133) $883.20 $1,104 5.0×
CT lower ext w/o (73700) $802.40 $1,003 7.7×
CT lower extremity w/contrast material (73701) $826.40 $1,033 4.7×
CT lumbar spine w contrast (72132) $826.40 $1,033 2.4×
CT lumbar spine w/o contrast (72131) $802.40 $1,003 7.7×
CT maxillofacial w contrast (70487) $877.60 $1,097 5.0×
CT maxillofacial wo contrast (70486)
range across 3 matching MRF lines		 $802.40–$877.60 $1,003–$1,097 varies
CT neck tissue combo (70492) $938.40 $1,173 5.3×
Ct Orbit/Ear/Fossa W/O&W/Dye (70482) $938.40 $1,173 5.3×
CT orbits w/o contrast (70480) $802.40 $1,003 7.7×
CT pelvis w&w/o contrast (72194) $938.40 $1,173 5.3×
CT pelvis w/o contrast (72192) $802.40 $1,003 7.7×
CT scan of leg combo (73702) $883.20 $1,104 5.0×
CT scans face/jaw combo (70488) $883.20 $1,104 5.0×
CT soft tissue neck w contrast (70491) $877.60 $1,097 5.0×
CT soft tissue neck w/o contrast (70490) $802.40 $1,003 7.7×
CT thoracic spine w contrast (72129) $877.60 $1,097 5.0×
CT thoracic spine w/o contrast (72128) $802.40 $1,003 7.7×
CT thoracic spine w/wo cont (72130) $883.20 $1,104 5.0×
CT thorax w/o contrast (71250) $802.40 $1,003 7.7×
CT upper ext wo (73200) $802.40 $1,003 7.7×
CT upper extremity w/o & w/contrast material (73202) $883.20 $1,104 5.0×
CT upper extremity with contrast (73201) $877.60 $1,097 2.5×
Cta Abdl Aorta&Bi Iliofem W/Contrast&Postp (75635) $1,648 $2,060 9.4×
Cta Abdomen (74175) $1,024.80 $1,281 5.8×
CTA pelvis (72191) $1,030.40 $1,288 5.9×
Dxa Bone Density Axial (77080) $320 $400 3.1×
Dxa bone density study (77085) $296 $370 2.8×
Dxa bone density study 1/>sites appendiclr skel (77081) $112.80 $141 1.3×
Echo exam uterus (76831) $148 $185 0.6×
Esophagram (74220) $212.80 $266 1.2×
Fluoroscopy up to 1 hr (76000) $252 $315 1.1×
Foot 2 views (73620) $95.20 $119 1.1×
Forearm 2 views (73090) $130.40 $163 1.5×
Gastric emptying imaging study (78264) $750.40 $938 1.9×
Gastroesophageal Reflux Exam (78262) $375.20 $469 0.9×
Gated Heart Planar Single (78472) $1,297.60 $1,622 3.2×
Gated Heart, Multiple (78473) $1,452 $1,815 3.6×
Hand 2 views (73120) $101.60 $127 1.0×
Hepatobil Syst Image W/Drug (78227) $741.60 $927 1.4×
Hepatobiliary System Imaging (78226) $735.20 $919 1.8×
Ht Musc Image Planar Mult (78454) $1,776.80 $2,221 1.4×
Hysterosalpingogram (74740) $432 $540 1.8×
Infant hip ultrasound, limited static exam (76886) $391.20 $489 4.5×
Knee 3 Views (73562) $116.80 $146 1.3×
Liver & Spleen Imaging Static Only (78215) $425.60 $532 1.1×
Liver & Spleen Imaging W/Vascular Flow (78216) $588 $735 1.5×
Liver imaging static only (78201) $425.60 $532 0.8×
Liver imaging w/vascular flow (78202) $564.80 $706 1.0×
Lung Ventilat&Perfus Imaging (78582) $1,532 $1,915 2.8×
Lymph System Imaging (78195) $700.80 $876 1.3×
Meckels Divert Exam (78290) $516.80 $646 1.3×
Mra Head W/O & W/Contrast Material (70546) $2,146.40 $2,683 6.1×
MRA head w/o contrast (70544) $1,524.80 $1,906 6.4×
MRA head with contrast (70545) $1,665.60 $2,082 4.8×
MRA neck w contrast (70548) $1,436 $1,795 4.1×
Mra Neck W/O &W/Contrast Material (70549) $1,524.80 $1,906 4.4×
MRA neck w/o contrast (70547) $1,524.80 $1,906 6.4×
MRI abdomen w contrast (74182) $1,667.20 $2,084 4.8×
MRI abdomen w/o contrast (74181) $1,511.20 $1,889 6.3×
MRI any jt lower extrem w/contrast material (73722) $1,435.20 $1,794 1.8×
MRI any jt lower extrem w/o & w/contrast matrl (73723) $1,665.60 $2,082 4.8×
MRI any jt upper extremity w/contrast matrl (73222) $1,436 $1,795 1.8×
MRI cervical spine w contrast (72142) $2,152.80 $2,691 6.2×
MRI cervical spine w/o cont (72141) $1,906.40 $2,383 8.0×
MRI chest w/o contrast (71550) $1,524.80 $1,906 6.4×
MRI chest with contrast (71551) $1,906.40 $2,383 2.4×
MRI chest wo w contrast (71552) $2,152.80 $2,691 6.2×
MRI lower extrem oth/thn jt w/contrast matrl (73719) $1,436 $1,795 4.1×
MRI lower extrem oth/thn jt w/o & w/contr matr (73720) $1,524.80 $1,906 4.4×
MRI lower extrem oth/thn jt w/o contr matrl (73718) $1,464 $1,830 6.1×
MRI lumbar spine w contrast (72149) $1,991.20 $2,489 5.7×
Mri Neck Spine W/O & W/Dye (72156) $2,280.80 $2,851 6.5×
MRI orbit face &/neck w/o contrast (70540) $1,220.80 $1,526 5.1×
MRI orbit face neck w contrast (70542) $1,525.60 $1,907 4.4×
Mri Orbt/Fac/Nck W/O &W/Dye (70543) $1,768.80 $2,211 5.1×
MRI pelvis w contrast (72196) $1,721.60 $2,152 4.9×
MRI pelvis w/o & w contrast (72197) $2,115.20 $2,644 6.1×
MRI pelvis w/o contrast (72195) $1,422.40 $1,778 6.0×
MRI thoracic spine w/o contrast (72146) $1,464 $1,830 6.1×
MRI upper extremity oth than jt w/contr matrl (73219) $1,436 $1,795 4.1×
MRI upper extremity oth than jt w/o contr matrl (73218) $1,464 $1,830 6.1×
Mri Uppr Extremity W/O&W/Dye (73220) $1,464 $1,830 4.2×
MRI, abdomen, combo (74183) $2,029.60 $2,537 5.8×
MRI, dorsal spine combo (72157) $2,254.40 $2,818 6.5×
MRI, dorsal spine contrast (72147) $2,073.60 $2,592 5.9×
MRI, joint upper extrem (73221) $1,422.40 $1,778 6.0×
MRI, joint upper extrem combo (73223) $1,768.80 $2,211 5.1×
MRI, lumbar spine combo (72158) $2,395.20 $2,994 6.9×
Myocardial Perfusion Planar 1 Study Rest/Stress (78453) $1,460 $1,825 1.1×
Myocardial Spect Multiple Studies (78452) $2,848 $3,560 2.2×
Neck soft tissue (70360) $89.60 $112 1.0×
Oph bmtry us echograpy a-scan io lens pwr cal (76519) $280 $350 2.7×
Parathyroid Planar Imaging (78070) $580.80 $726 1.5×
Pelvis 1 or 2 views (72170) $134.40 $168 1.3×
Pulmonary Perfusion Imaging Particulate (78580) $635.20 $794 1.6×
Radex Abd Compl Aqt Abd W/S/E/D Views 1 View Ch (74022) $180.80 $226 1.7×
Radex Ankle Complete Minimum 3 Views (73610) $167.20 $209 1.9×
Radex Calcaneus Minimum 2 Views (73650) $142.40 $178 1.6×
Radex elbow complete minimum 3 views (73080) $148.80 $186 1.7×
Radex Facial Bones Complete Minimum 3 Views (70150) $174.40 $218 1.7×
Radex fingr minimum 2 views (73140) $102.40 $128 1.2×
Radex foot complete minimum 3 views (73630) $130.40 $163 1.5×
Radex Hand Minimum 3 Views (73130) $130.40 $163 1.5×
Radex Mastoids Compl Minimum 3 Views PR Side (70130) $174.40 $218 1.7×
Radex Nasal Bones Complete Minimum 3 Views (70160) $142.40 $178 1.6×
Radex Ribs Unilateral 2 Views (71100) $142.40 $178 1.6×
Radex shoulder complete minimum 2 views (73030) $142.40 $178 1.6×
Radex Spine 1 View Specify Level (72020) $200.80 $251 2.3×
Radex Sternum Minimum 2 Views (71120) $125.60 $157 1.4×
Radex Temporomandble Jt Opn & Clsd Mouth Bilat (70330) $147.20 $184 1.7×
Radex Toe Minimum 2 Views (73660) $85.60 $107 1.0×
Radex Wrist Complete Minimum 3 Views (73110) $130.40 $163 1.5×
Radex X-Ray Exam Entire Spi 6/> Vw - Xr Entire Spine 6+ Vw (72084) $172 $215 1.6×
Radiolog exam mandible compl minimum 4 views (70110) $140 $175 1.3×
Radiologic Exam Abdomen 3+ Views - Xr Abdomen 3+ Views (74021) $164.80 $206 1.6×
Radiologic exam colon double contrast study (74280) $494.40 $618 2.8×
Radiologic exam colon single contrast study (74270) $303.20 $379 1.7×
Radiologic exam knee complete 4/more views (73564) $185.60 $232 1.8×
Radiologic Exam Small Int Single Contrast Study (74250) $280.80 $351 1.6×
Radiologic exam swallow function contrast study (74230) $200.80 $251 1.1×
Radiologic exam upr gi trc double contrast study (74246) $321.60 $402 1.8×
Radiologic examination femur 1 view (73551) $96 $120 1.1×
Radiologic examination femur minimum 2 views (73552) $130.40 $163 1.5×
Radiologic examination knee 1/2 views (73560) $108 $135 1.2×
Radiologic Examination Osseous Survey Limited (77074) $208 $260 2.0×
Radiologic examination tibia & fibula 2 views (73590) $128.80 $161 1.5×
Ribs bilateral 3 views (71110) $200.80 $251 1.9×
Rp Loclzj Tum Spect 1 Area Single Day Imaging (78803)
range across 2 matching MRF lines		 $851.20–$985.60 $1,064–$1,232 varies
Salivary Gland Imaging (78230) $1,187.20 $1,484 3.0×
Salivary Gland Imaging Serial Images (78231) $1,073.60 $1,342 2.7×
Scapula (73010) $142.40 $178 1.4×
Screening Digital Breast Tomosynthesis Bi (77063) $64 $80 2.7×
Shoulder 1 view (73020) $121.60 $152 1.4×
Shoulder Arthrography (73040) $237.60 $297 0.7×
Skull less than 4 views (70250) $142.40 $178 1.4×
Sternoclavicular joints (71130) $134.40 $168 1.5×
Thoracic spine 2 views (72070) $142.40 $178 1.4×
Thoracic spine 3 views (72072) $208 $260 2.0×
Thyroid Uptake W/Blood Flow Sngle/Mult Quan Meas (78014) $1,025.60 $1,282 2.6×
Ultrasound Breast Limited (76642) $108 $135 1.2×
Ultrasound Exam Aaa Screen (76706) $556 $695 5.3×
Ultrasound, abdomen limited (76705) $448 $560 4.3×
Unlisted fluoroscopic procedure (76496) $125.60 $157 1.4×
Unlisted us procedure (76999) $279.20 $349 3.2×
Urethrocystogram voiding (74455) $321.60 $402 1.3×
Us breast unilateral complete (76641) $140 $175 1.3×
Us chest (76604) $421.60 $527 4.0×
Us complete joint (76881) $473.60 $592 4.5×
Us exam, pelvic, limited (76857)
range across 2 matching MRF lines		 $160–$288 $200–$360 varies
Us lmtd joint/oth nonvasc xtr strux r-t w/img (76882) $391.20 $489 3.7×
Us ob limited 1 or more fetuses (76815) $482.40 $603 4.6×
Us ob transvaginal (76817) $482.40 $603 4.6×
Us pelvic non ob complete (76856) $518.40 $648 5.0×
Us pg uter img f&mat 14 wk tabdl 1/1st gestation (76801) $531.20 $664 5.1×
Us retroperitoneal complete (76770) $556 $695 5.3×
Us retroperitoneal limited (76775) $404.80 $506 3.9×
Us scrotum and contents (76870) $484.80 $606 4.6×
Us thyroid (76536) $448 $560 4.3×
Vascular Flow Imaging (78445) $332 $415 0.8×
Vertebral fracture assessment via dxa (77086) $112.80 $141 1.3×
Wrist 2 views (73100) $100.80 $126 1.2×
X-Ray Ac Jts - Xr Acromioclavicular Joints Bilateral (73050) $198.40 $248 2.3×
X-Ray Elbow 2 Vw - Xr Elbow 1-2 Views Right (73070) $130.40 $163 1.5×
X-Ray Exam Entire Spi 2/3 Vw (72082) $196 $245 1.9×
X-Ray Exam Entire Spi 4/5 Vw (72083) $120.80 $151 1.2×
X-Ray Exam Hip Uni 1 View (73501) $256 $320 2.9×
X-Ray Exam Hip Uni 2-3 Views (73502) $308 $385 3.5×
X-Ray Exam Hips Bi 2 Views (73521) $308 $385 2.9×
X-Ray Exam Hips Bi 3-4 Views (73522) $300 $375 2.9×
X-Ray Exam Hips Bi 5/> Views (73523) $346.40 $433 3.3×
X-Ray Exam L-S Spine Bending (72114) $224.80 $281 2.1×
X-Ray Exam Neck Spine 2-3 Vw (72040) $142.40 $178 1.6×
X-Ray Exam Neck Spine 6/>Vws (72052) $215.20 $269 2.1×
X-Ray Exam Unilat Ribs/Chest (71101) $258.40 $323 2.5×
X-ray eye for foreign body (70030) $95.20 $119 1.1×
X-ray humerus (73060) $140.80 $176 1.6×
X-ray IV pyelogram (ivp) (74400) $428 $535 2.4×
X-Ray Jaw <4 Vw - Xr Mandible < 4 Views (70100) $106.40 $133 1.2×
X-Ray Knee Bilat Standing - Xr Knees Anteroposterior Standing Bilat (73565) $185.60 $232 2.1×
X-Ray Lumbar Spine 2/3 Vw - Xr Lumbar Spine 2-3 Views (72100) $216 $270 2.1×
X-Ray Ribs, Chest 4+ Vw - Xr Ribs 3 Vws Bil W/ Chest Posteroanterior (71111) $276 $345 2.6×
X-Ray Sacroiliac Jts 3+ Vw - Xr Sacroiliac Joints 3+ Views (72202) $127.20 $159 1.2×
X-Ray Sacroiliac Jts <3 Vw - Xr Sacroiliac Joints 1-2 Views (72200) $117.60 $147 1.1×
X-Ray Sacrum/Coccyx 2+ Vw - Xr Sacrum Coccyx 2+ Views (72220) $142.40 $178 1.6×
X-Ray Sinuses 3+ Vw - Xr Paranasal Sinuses 3+ Views (70220) $136.80 $171 1.6×
X-Ray Skull 4+ Vw - Xr Skull Complete 4+ Views (70260) $166.40 $208 1.6×
X-Ray Tmj Unilat (70328) $132.80 $166 1.5×
X-Rays Bone Survey Complete (77075) $344.80 $431 3.3×
Xr c-spine 4 or 5 views (72050) $185.60 $232 1.8×
Xr orbits complete 4 views (70200) $185.60 $232 1.8×

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.