Imaging prices at Pomerene Hospital
Millersburg, OH · every code in this section with a posted price and a Medicare benchmark.
233 codes. Prices are the hospital's own posted facility charges.
Compare against other hospitals interactively →
| Procedure | Posted cash | Posted gross | × Medicare |
|---|---|---|---|
| Abdomen 1 View (74018) | $214.40 | $268 | 2.6× |
| Abdomen 2 views (74019) | $253.60 | $317 | 2.6× |
| Acute Gastrointestinal Blood Loss Imaging (78278) | $1,158.40 | $1,448 | 3.1× |
| Ankle 2 views (73600) | $176 | $220 | 2.1× |
| Arthrogram hip (73525) | $597.60 | $747 | 1.8× |
| Bone age studies (77072) | $207.20 | $259 | 2.1× |
| Bone Imaging 3 Phase (78315) range across 2 matching MRF lines |
$1,645.60–$1,721.60 | $2,057–$2,152 | varies |
| Bone Imaging Limited Area (78300) | $536.80 | $671 | 1.4× |
| Bone Imaging Whole Body (78306) range across 2 matching MRF lines |
$848.80–$924.80 | $1,061–$1,156 | varies |
| Cat Scan Follow-Up Study (76380) | $624 | $780 | 7.6× |
| Chest 1 view (71045) | $152 | $190 | 1.8× |
| Chest 2 views (71046) | $212.80 | $266 | 2.6× |
| Chest 3 views (71047) | $218.40 | $273 | 2.7× |
| Chest 4 or more views (71048) | $218.40 | $273 | 2.2× |
| Cholecystography Oral Contrast (74290) | $303.20 | $379 | 1.8× |
| Clavicle complete (73000) | $276 | $345 | 3.4× |
| Computed Tomography Thorax Lw Dose Lng Ca Scr C- (71271) | $208 | $260 | 2.1× |
| Contrast X-Ray Bladder (74430) | $579.20 | $724 | 1.8× |
| Contrast X-Ray Of Knee Joint (73580) | $688.80 | $861 | 2.1× |
| CT abdomen and pelvis without and with contrast (74178) | $2,051.20 | $2,564 | 6.2× |
| CT abdomen and pelvis without contrast (74176) | $1,180.80 | $1,476 | 5.2× |
| CT abdomen w contrast (74160) | $1,280 | $1,600 | 7.7× |
| CT abdomen w wo contrast (74170) | $1,520 | $1,900 | 9.2× |
| CT abdomen w/o contrast (74150) | $1,040 | $1,300 | 10.5× |
| CT Angio Abdomen and Pelvis (74174) | $1,426.40 | $1,783 | 4.3× |
| CT Angio Chest (71275) | $1,515.20 | $1,894 | 9.1× |
| CT Angio Head (70496) | $1,069.60 | $1,337 | 6.4× |
| Ct Angio Lwr Extr W/O&W/Dye (73706) | $942.40 | $1,178 | 5.7× |
| CT Angio Neck (70498) | $1,148 | $1,435 | 6.9× |
| Ct Angio Upr Extrm W/O&W/Dye (73206) | $1,092 | $1,365 | 6.6× |
| CT cervical spine w/ contrast (72126) | $1,247.20 | $1,559 | 3.8× |
| CT cervical spine w/o contrast (72125) | $1,124.80 | $1,406 | 11.4× |
| CT cervical spine w/wo cont (72127) | $1,515.20 | $1,894 | 9.1× |
| CT chest w contrast (71260) | $1,240 | $1,550 | 7.5× |
| CT chest w/wo contrast (71270) | $1,269.60 | $1,587 | 7.7× |
| CT head/brain with contrast (70460) | $1,069.60 | $1,337 | 6.4× |
| CT head/brain without and with contrast (70470) | $1,693.60 | $2,117 | 10.2× |
| CT iac w contrast (70481) | $1,069.60 | $1,337 | 6.4× |
| CT l-spine w&w/o contrast (72133) | $1,426.40 | $1,783 | 8.6× |
| CT lower ext w/o (73700) range across 15 matching MRF lines |
$880–$1,560 | $1,100–$1,950 | varies |
| CT lower extremity w/contrast material (73701) | $960 | $1,200 | 5.8× |
| CT lumbar spine w contrast (72132) | $1,314.40 | $1,643 | 4.0× |
| CT lumbar spine w/o contrast (72131) | $1,069.60 | $1,337 | 10.8× |
| CT maxillofacial w contrast (70487) | $1,092 | $1,365 | 6.6× |
| CT maxillofacial wo contrast (70486) | $888 | $1,110 | 9.0× |
| CT neck tissue combo (70492) | $1,336.80 | $1,671 | 8.1× |
| Ct Orbit/Ear/Fossa W/O&W/Dye (70482) | $1,247.20 | $1,559 | 7.5× |
| CT orbits w/o contrast (70480) | $913.60 | $1,142 | 9.2× |
| CT pelvis w&w/o contrast (72194) | $1,492.80 | $1,866 | 9.0× |
| CT pelvis w/o contrast (72192) | $958.40 | $1,198 | 9.7× |
| CT scan of leg combo (73702) | $1,040 | $1,300 | 6.3× |
| CT scans face/jaw combo (70488) | $1,336.80 | $1,671 | 8.1× |
| CT soft tissue neck w contrast (70491) | $1,158.40 | $1,448 | 7.0× |
| CT soft tissue neck w/o contrast (70490) | $880 | $1,100 | 8.9× |
| CT thoracic spine w contrast (72129) | $1,180.80 | $1,476 | 7.1× |
| CT thoracic spine w/o contrast (72128) | $869.60 | $1,087 | 8.8× |
| CT thoracic spine w/wo cont (72130) | $1,336.80 | $1,671 | 8.1× |
| CT thorax w/o contrast (71250) | $940 | $1,175 | 9.5× |
| CT unlisted procedure (76497) | $712.80 | $891 | 8.7× |
| CT upper ext wo (73200) | $880 | $1,100 | 8.9× |
| CT upper extremity w/o & w/contrast material (73202) | $1,158.40 | $1,448 | 7.0× |
| CT upper extremity with contrast (73201) | $960 | $1,200 | 2.9× |
| Cta Abdl Aorta&Bi Iliofem W/Contrast&Postp (75635) | $980.80 | $1,226 | 5.9× |
| Cta Abdomen (74175) | $1,024.80 | $1,281 | 6.2× |
| CTA pelvis (72191) | $980.80 | $1,226 | 5.9× |
| Dxa Bone Density Axial (77080) | $259.20 | $324 | 2.6× |
| Esophagram (74220) | $356.80 | $446 | 2.2× |
| Fetal Biophysical Profile W/O Non-Stress Testing (76819) | $329.60 | $412 | 3.3× |
| Fluoroscopy up to 1 hr (76000) | $268.80 | $336 | 1.2× |
| Foot 2 views (73620) | $164.80 | $206 | 2.0× |
| Forearm 2 views (73090) | $277.60 | $347 | 3.4× |
| Gastric emptying imaging study (78264) | $820 | $1,025 | 2.2× |
| Gated Heart Planar Single (78472) | $1,114.40 | $1,393 | 2.9× |
| Hand 2 views (73120) | $179.20 | $224 | 1.8× |
| Hepatobiliary System Imaging (78226) range across 3 matching MRF lines |
$1,440–$1,570.40 | $1,800–$1,963 | varies |
| Ht Muscle Image Spect Sing (78451) | $1,721.60 | $2,152 | 1.4× |
| Hysterosalpingogram (74740) | $445.60 | $557 | 2.0× |
| Infusion Ivp (74410) | $597.60 | $747 | 3.6× |
| K Flow/Funct Image Multiple (78709) | $801.60 | $1,002 | 1.6× |
| K Flow/Funct Image W/Drug (78708) | $1,024.80 | $1,281 | 2.0× |
| K Flow/Funct Image W/O Drug (78707) | $712.80 | $891 | 1.4× |
| Kidney Funcj Study Non-Img Radioisotopic Study (78725) | $534.40 | $668 | 1.4× |
| Kidney Imaging Morphoogy W/Vascular Flow (78701) | $757.60 | $947 | 2.0× |
| Knee 3 Views (73562) | $250.40 | $313 | 3.0× |
| Liver & Spleen Imaging Static Only (78215) | $534.40 | $668 | 1.4× |
| Liver & Spleen Imaging W/Vascular Flow (78216) | $1,158.40 | $1,448 | 3.1× |
| Lung Ventilat&Perfus Imaging (78582) | $936 | $1,170 | 1.8× |
| Lymph System Imaging (78195) | $869.60 | $1,087 | 1.7× |
| Meckels Divert Exam (78290) | $891.20 | $1,114 | 2.4× |
| Mra Head W/O & W/Contrast Material (70546) range across 2 matching MRF lines |
$2,400.80–$2,496.80 | $3,001–$3,121 | varies |
| MRA head w/o contrast (70544) | $1,620 | $2,025 | 7.2× |
| MRA head with contrast (70545) | $1,889.60 | $2,362 | 5.7× |
| MRA neck w contrast (70548) | $1,889.60 | $2,362 | 5.7× |
| Mra Neck W/O &W/Contrast Material (70549) | $2,496.80 | $3,121 | 7.6× |
| MRA neck w/o contrast (70547) | $1,620 | $2,025 | 7.2× |
| MRI abdomen w contrast (74182) | $1,889.60 | $2,362 | 5.7× |
| MRI abdomen w/o contrast (74181) | $1,709.60 | $2,137 | 7.6× |
| MRI any jt lower extrem w/contrast material (73722) | $2,089.60 | $2,612 | 2.8× |
| MRI any jt lower extrem w/o & w/contrast matrl (73723) | $2,339.20 | $2,924 | 7.1× |
| MRI any jt upper extremity w/contrast matrl (73222) | $1,956.80 | $2,446 | 2.6× |
| MRI cervical spine w contrast (72142) | $2,002.40 | $2,503 | 6.1× |
| MRI cervical spine w/o cont (72141) | $1,771.20 | $2,214 | 7.8× |
| MRI chest w/o contrast (71550) | $1,646.40 | $2,058 | 7.3× |
| MRI chest with contrast (71551) | $1,800 | $2,250 | 2.4× |
| MRI chest wo w contrast (71552) | $2,249.60 | $2,812 | 6.8× |
| MRI lower extrem oth/thn jt w/contrast matrl (73719) | $2,070.40 | $2,588 | 6.3× |
| MRI lower extrem oth/thn jt w/o & w/contr matr (73720) | $2,362.40 | $2,953 | 7.2× |
| MRI lower extrem oth/thn jt w/o contr matrl (73718) | $1,980 | $2,475 | 8.8× |
| MRI lumbar spine w contrast (72149) | $2,002.40 | $2,503 | 6.1× |
| Mri Neck Spine W/O & W/Dye (72156) | $2,264 | $2,830 | 6.9× |
| MRI orbit face &/neck w/o contrast (70540) | $1,889.60 | $2,362 | 8.4× |
| Mri Orbt/Fac/Nck W/O &W/Dye (70543) | $2,294.40 | $2,868 | 7.0× |
| MRI pelvis w contrast (72196) | $1,956.80 | $2,446 | 5.9× |
| MRI pelvis w/o & w contrast (72197) | $2,182.40 | $2,728 | 6.6× |
| MRI pelvis w/o contrast (72195) | $1,687.20 | $2,109 | 7.5× |
| MRI thoracic spine w/o contrast (72146) | $1,748.80 | $2,186 | 7.7× |
| MRI upper extremity oth than jt w/contr matrl (73219) | $1,776.80 | $2,221 | 5.4× |
| MRI upper extremity oth than jt w/o contr matrl (73218) | $1,642.40 | $2,053 | 7.3× |
| Mri Uppr Extremity W/O&W/Dye (73220) range across 9 matching MRF lines |
$2,076.80–$2,160 | $2,596–$2,700 | varies |
| MRI, abdomen, combo (74183) | $2,400 | $3,000 | 7.3× |
| MRI, dorsal spine combo (72157) | $2,275.20 | $2,844 | 6.9× |
| MRI, dorsal spine contrast (72147) | $2,002.40 | $2,503 | 6.1× |
| MRI, joint upper extrem (73221) range across 8 matching MRF lines |
$1,622.40–$1,703.20 | $2,028–$2,129 | varies |
| MRI, joint upper extrem combo (73223) | $2,227.20 | $2,784 | 6.7× |
| MRI, lumbar spine combo (72158) | $2,254.40 | $2,818 | 6.8× |
| Myelogram Lumbar (72265) | $917.60 | $1,147 | 1.2× |
| Myelography thoracic (72255) | $917.60 | $1,147 | 1.2× |
| Myocardial Spect Multiple Studies (78452) range across 4 matching MRF lines |
$2,600–$3,366.40 | $3,250–$4,208 | varies |
| Neck soft tissue (70360) | $280.80 | $351 | 3.4× |
| Nonvascular Shunt X-Ray (75809) | $136 | $170 | 1.4× |
| Optic foramina (70190) | $272.80 | $341 | 3.3× |
| Parathyroid Planar Imaging (78070) | $640 | $800 | 1.7× |
| Pelvis 1 or 2 views (72170) | $196 | $245 | 2.0× |
| Pulmonary Perfusion Imaging Particulate (78580) | $936 | $1,170 | 2.5× |
| Radex Abd Compl Aqt Abd W/S/E/D Views 1 View Ch (74022) | $284.80 | $356 | 2.9× |
| Radex abscess/fistula/sinus tract rs&i (76080) | $609.60 | $762 | 1.2× |
| Radex Ankle Complete Minimum 3 Views (73610) | $288.80 | $361 | 3.5× |
| Radex Calcaneus Minimum 2 Views (73650) | $267.20 | $334 | 3.2× |
| Radex elbow complete minimum 3 views (73080) | $280 | $350 | 3.4× |
| Radex Facial Bones Complete Minimum 3 Views (70150) | $316.80 | $396 | 3.2× |
| Radex fingr minimum 2 views (73140) | $229.60 | $287 | 2.8× |
| Radex foot complete minimum 3 views (73630) | $292 | $365 | 3.5× |
| Radex Hand Minimum 3 Views (73130) | $284.80 | $356 | 3.5× |
| Radex lower extremity infant minimum 2 views (73592) | $229.60 | $287 | 2.8× |
| Radex Mastoids Compl Minimum 3 Views PR Side (70130) | $320.80 | $401 | 3.2× |
| Radex Nasal Bones Complete Minimum 3 Views (70160) | $284.80 | $356 | 3.5× |
| Radex Ribs Unilateral 2 Views (71100) | $177.60 | $222 | 2.2× |
| Radex shoulder complete minimum 2 views (73030) | $284 | $355 | 3.4× |
| Radex Spine 1 View Specify Level (72020) | $200 | $250 | 2.4× |
| Radex Sternum Minimum 2 Views (71120) | $290.40 | $363 | 3.5× |
| Radex Temporomandble Jt Opn & Clsd Mouth Bilat (70330) | $363.20 | $454 | 4.4× |
| Radex Toe Minimum 2 Views (73660) | $231.20 | $289 | 2.8× |
| Radex upper extremity infant minimum 2 views (73092) | $235.20 | $294 | 2.4× |
| Radex Wrist Complete Minimum 3 Views (73110) | $280.80 | $351 | 3.4× |
| Radiolog exam mandible compl minimum 4 views (70110) | $312 | $390 | 3.2× |
| Radiologic Exam Abdomen 3+ Views - Xr Abdomen 3+ Views (74021) | $253.60 | $317 | 2.6× |
| Radiologic exam colon double contrast study (74280) | $468 | $585 | 2.8× |
| Radiologic exam colon single contrast study (74270) | $258.40 | $323 | 1.6× |
| Radiologic exam knee complete 4/more views (73564) | $328 | $410 | 3.3× |
| Radiologic Exam Small Int Single Contrast Study (74250) | $445.60 | $557 | 2.7× |
| Radiologic exam swallow function contrast study (74230) | $338.40 | $423 | 2.0× |
| Radiologic examination femur 1 view (73551) | $133.60 | $167 | 1.6× |
| Radiologic examination femur minimum 2 views (73552) | $174.40 | $218 | 2.1× |
| Radiologic examination knee 1/2 views (73560) | $199.20 | $249 | 2.4× |
| Radiologic examination tibia & fibula 2 views (73590) | $244.80 | $306 | 3.0× |
| Ribs bilateral 3 views (71110) | $200 | $250 | 2.0× |
| Rp Loclzj Tum Spect 1 Area Single Day Imaging (78803) | $1,721.60 | $2,152 | 3.4× |
| Scapula (73010) | $276 | $345 | 2.8× |
| Screening Digital Breast Tomosynthesis Bi (77063) | $56 | $70 | 2.4× |
| Shoulder Arthrography (73040) | $690.40 | $863 | 2.1× |
| Sialogram (70390) | $318.40 | $398 | 1.4× |
| Skull less than 4 views (70250) | $264 | $330 | 2.7× |
| Sternoclavicular joints (71130) | $290.40 | $363 | 3.5× |
| Thoracic spine 2 views (72070) | $222.40 | $278 | 2.2× |
| Thoracolumbar 2 views (72080) | $177.60 | $222 | 2.2× |
| Thyroid Uptake Measurement (78012) | $529.60 | $662 | 1.4× |
| Thyroid Uptake W/Blood Flow Sngle/Mult Quan Meas (78014) range across 2 matching MRF lines |
$600–$1,243.20 | $750–$1,554 | varies |
| Ultrasound Breast Limited (76642) | $278.40 | $348 | 3.4× |
| Ultrasound Exam Aaa Screen (76706) | $401.60 | $502 | 4.1× |
| Ultrasound, abdomen limited (76705) | $560 | $700 | 5.7× |
| Umbilical-artery Doppler (OB) (76820) | $329.60 | $412 | 3.3× |
| Unlisted fluoroscopic procedure (76496) | $275.20 | $344 | 3.3× |
| Unlisted magnetic resonance procedure (76498) | $1,394.40 | $1,743 | 16.9× |
| Upper gi w/o kub (74240) | $356.80 | $446 | 2.2× |
| Ureteral Reflux Study (78740) | $579.20 | $724 | 1.5× |
| Urethrocystogram voiding (74455) | $551.20 | $689 | 2.4× |
| Urethrocystography retrograde (74450) | $551.20 | $689 | 2.4× |
| Us breast unilateral complete (76641) | $320 | $400 | 3.2× |
| Us chest (76604) | $268 | $335 | 2.7× |
| Us complete joint (76881) | $321.60 | $402 | 3.3× |
| Us exam, pelvic, limited (76857) | $277.60 | $347 | 2.8× |
| Us head (76506) | $348.80 | $436 | 3.5× |
| Us lmtd joint/oth nonvasc xtr strux r-t w/img (76882) | $243.20 | $304 | 2.5× |
| Us ob limited 1 or more fetuses (76815) | $240.80 | $301 | 2.4× |
| Us ob transvaginal (76817) | $242.40 | $303 | 2.5× |
| Us pelvic non ob complete (76856) | $600 | $750 | 6.1× |
| Us pg uter img f&mat 14 wk tabdl 1/1st gestation (76801) | $291.20 | $364 | 2.9× |
| Us preg uterus real time f/u trnsabdl per fetus (76816) | $267.20 | $334 | 2.7× |
| Us retroperitoneal complete (76770) | $454.40 | $568 | 4.6× |
| Us retroperitoneal limited (76775) | $416 | $520 | 4.2× |
| Us scrotum and contents (76870) | $500 | $625 | 5.1× |
| Us spinal canal and contents (76800) | $222.40 | $278 | 2.2× |
| Us thyroid (76536) | $565.60 | $707 | 5.7× |
| Venography extremity bilateral rs&i (75822) | $1,289.60 | $1,612 | 0.9× |
| Venography extremity unilateral rs&i (75820) | $1,280 | $1,600 | 0.9× |
| Wrist 2 views (73100) | $174.40 | $218 | 2.1× |
| X-Ray Ac Jts - Xr Acromioclavicular Joints Bilateral (73050) | $445.60 | $557 | 5.4× |
| X-ray antegrade pyelogram tube (74425) | $597.60 | $747 | 1.8× |
| X-Ray Elbow 2 Vw - Xr Elbow 1-2 Views Right (73070) | $177.60 | $222 | 2.2× |
| X-Ray Exam Breast Specimen (76098) | $451.20 | $564 | 0.9× |
| X-Ray Exam Entire Spi 1 Vw (72081) | $156 | $195 | 1.9× |
| X-Ray Exam Entire Spi 2/3 Vw (72082) | $222.40 | $278 | 2.2× |
| X-Ray Exam Hip Uni 1 View (73501) | $133.60 | $167 | 1.6× |
| X-Ray Exam Hip Uni 2-3 Views (73502) | $200 | $250 | 2.4× |
| X-Ray Exam Hips Bi 3-4 Views (73522) | $312 | $390 | 3.2× |
| X-Ray Exam Neck Spine 2-3 Vw (72040) | $312 | $390 | 3.8× |
| X-Ray Exam Neck Spine 6/>Vws (72052) | $498.40 | $623 | 5.0× |
| X-Ray Exam Unilat Ribs/Chest (71101) | $320 | $400 | 3.2× |
| X-ray eye for foreign body (70030) | $200 | $250 | 2.4× |
| X-ray humerus (73060) | $253.60 | $317 | 3.1× |
| X-ray IV pyelogram (ivp) (74400) | $558.40 | $698 | 3.4× |
| X-Ray Lumbar Spine 2/3 Vw - Xr Lumbar Spine 2-3 Views (72100) | $284.80 | $356 | 2.9× |
| X-ray nose-rectum child f.b. (76010) | $231.20 | $289 | 2.8× |
| X-Ray Ribs, Chest 4+ Vw - Xr Ribs 3 Vws Bil W/ Chest Posteroanterior (71111) | $379.20 | $474 | 3.8× |
| X-Ray Sacroiliac Jts 3+ Vw - Xr Sacroiliac Joints 3+ Views (72202) | $284.80 | $356 | 2.9× |
| X-Ray Sacrum/Coccyx 2+ Vw - Xr Sacrum Coccyx 2+ Views (72220) | $284.80 | $356 | 3.5× |
| X-Ray Sinuses 3+ Vw - Xr Paranasal Sinuses 3+ Views (70220) | $303.20 | $379 | 3.7× |
| X-Ray Skull 4+ Vw - Xr Skull Complete 4+ Views (70260) | $348 | $435 | 3.5× |
| X-Rays Bone Length Studies (77073) | $184 | $230 | 1.9× |
| X-Rays Bone Survey Complete (77075) | $468 | $585 | 4.7× |
| Xr c-spine 4 or 5 views (72050) | $445.60 | $557 | 4.5× |
| Xr facial bones less than 3 views (70140) | $200 | $250 | 2.4× |
| Xr orbits complete 4 views (70200) | $272.80 | $341 | 2.8× |
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.