Imaging prices at Salem Memorial District Hospital
Salem, MO · every code in this section with a posted price and a Medicare benchmark.
219 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) | $232.31 | $309.75 | 2.7× |
| Abdomen 2 views (74019) | $429.19 | $572.25 | 4.1× |
| Acute Gastrointestinal Blood Loss Imaging (78278) | $1,015.88 | $1,354.50 | 2.5× |
| Ankle 2 views (73600) | $141.75 | $189 | 1.6× |
| Bone Imaging 3 Phase (78315) range across 2 matching MRF lines |
$1,098.56–$1,326.94 | $1,464.75–$1,769.25 | varies |
| Bone Imaging Limited Area (78300) | $1,197 | $1,596 | 3.0× |
| Bone Imaging Whole Body (78306) | $1,197 | $1,596 | 3.0× |
| Brain Image W/Flow < 4 Views (78601) | $1,334.81 | $1,779.75 | 3.3× |
| Brain imaging < 4 static views (78600) | $724.50 | $966 | 1.8× |
| Chest 1 view (71045) range across 3 matching MRF lines |
$123.75–$141.75 | $165–$189 | varies |
| Chest 2 views (71046) | $200.81 | $267.75 | 2.3× |
| Chest 3 views (71047) | $200.81 | $267.75 | 2.3× |
| Chest 4 or more views (71048) | $220.50 | $294 | 2.1× |
| Cholecystography Oral Contrast (74290) | $273.75 | $365 | 1.6× |
| Clavicle complete (73000) | $157.50 | $210 | 1.8× |
| Computed Tomography Thorax Lw Dose Lng Ca Scr C- (71271) | $2,208.94 | $2,945.25 | 21.1× |
| Contrast X-Ray Bladder (74430) | $564 | $752 | 1.6× |
| CT abdomen and pelvis without and with contrast (74178) | $3,783.94 | $5,045.25 | 10.8× |
| CT abdomen and pelvis without contrast (74176) | $2,953.13 | $3,937.50 | 12.4× |
| CT abdomen w contrast (74160) | $1,338.75 | $1,785 | 7.6× |
| CT abdomen w wo contrast (74170) | $1,425.38 | $1,900.50 | 8.1× |
| CT abdomen w/o contrast (74150) | $1,216.69 | $1,622.25 | 11.6× |
| CT Angio Abdomen and Pelvis (74174) | $2,854.69 | $3,806.25 | 8.2× |
| CT Angio Chest (71275) range across 2 matching MRF lines |
$1,425.38–$2,079 | $1,900.50–$2,772 | varies |
| CT Angio Head (70496) | $2,031.75 | $2,709 | 11.6× |
| CT angio hrt w/3d image (75574) | $1,409.63 | $1,879.50 | 4.0× |
| CT Angio Neck (70498) | $1,425.38 | $1,900.50 | 8.1× |
| CT cervical spine w/ contrast (72126) | $1,941.19 | $2,588.25 | 5.6× |
| CT cervical spine w/o contrast (72125) | $1,216.69 | $1,622.25 | 11.6× |
| CT cervical spine w/wo cont (72127) | $2,031.75 | $2,709 | 11.6× |
| CT chest w contrast (71260) | $1,941.19 | $2,588.25 | 11.0× |
| CT chest w/wo contrast (71270) | $1,846.69 | $2,462.25 | 10.5× |
| CT head/brain with contrast (70460) | $1,941.19 | $2,588.25 | 11.0× |
| CT head/brain without and with contrast (70470) | $2,031.75 | $2,709 | 11.6× |
| CT heart contrast eval cardiac structure&morph (75572) | $1,409.63 | $1,879.50 | 4.0× |
| CT heart no contrast quant eval coronry calcium (75571) | $165.38 | $220.50 | 1.9× |
| CT hrt w/3d image congen (75573) | $1,409.63 | $1,879.50 | 4.0× |
| CT l-spine w&w/o contrast (72133) range across 2 matching MRF lines |
$1,878.19–$2,031.75 | $2,504.25–$2,709 | varies |
| CT lower ext w/o (73700) | $1,515.94 | $2,021.25 | 14.5× |
| CT lumbar spine w contrast (72132) | $1,575 | $2,100 | 4.5× |
| CT lumbar spine w/o contrast (72131) | $1,362.38 | $1,816.50 | 13.0× |
| CT maxillofacial wo contrast (70486) | $1,295.44 | $1,727.25 | 12.4× |
| CT neck tissue combo (70492) | $2,000.25 | $2,667 | 11.4× |
| Ct Orbit/Ear/Fossa W/O&W/Dye (70482) | $1,295.44 | $1,727.25 | 7.4× |
| CT orbits w/o contrast (70480) | $1,295.44 | $1,727.25 | 12.4× |
| CT pelvis w&w/o contrast (72194) | $2,031.75 | $2,709 | 11.6× |
| CT pelvis w/o contrast (72192) | $1,515.94 | $2,021.25 | 14.5× |
| CT soft tissue neck w contrast (70491) | $1,941.19 | $2,588.25 | 11.0× |
| CT soft tissue neck w/o contrast (70490) | $1,216.69 | $1,622.25 | 11.6× |
| CT thoracic spine w contrast (72129) | $1,575 | $2,100 | 9.0× |
| CT thoracic spine w/o contrast (72128) | $1,953 | $2,604 | 18.7× |
| CT thoracic spine w/wo cont (72130) | $1,941.19 | $2,588.25 | 11.0× |
| CT thorax w/o contrast (71250) | $1,515.94 | $2,021.25 | 14.5× |
| CT upper ext wo (73200) | $1,964.81 | $2,619.75 | 18.8× |
| Cta Abdl Aorta&Bi Iliofem W/Contrast&Postp (75635) range across 2 matching MRF lines |
$2,311.31–$3,102.75 | $3,081.75–$4,137 | varies |
| Cta Abdomen (74175) | $1,425.38 | $1,900.50 | 8.1× |
| Dxa Bone Density Axial (77080) | $275.63 | $367.50 | 2.6× |
| Dxa bone density study (77085) | $437.06 | $582.75 | 4.2× |
| Esophagram (74220) | $273.75 | $365 | 1.6× |
| Fetal Biophys Profile W/Nst (76818) | $547.31 | $729.75 | 5.2× |
| Fluoroscopy up to 1 hr (76000) | $352.50 | $470 | 1.5× |
| Foot 2 views (73620) | $141.75 | $189 | 1.6× |
| Forearm 2 views (73090) | $141.75 | $189 | 1.6× |
| Gastric emptying imaging study (78264) | $976.50 | $1,302 | 2.4× |
| Gated Heart Planar Single (78472) | $1,027.69 | $1,370.25 | 2.6× |
| Gated Heart, Multiple (78473) | $626.06 | $834.75 | 1.6× |
| Hand 2 views (73120) | $228.38 | $304.50 | 2.2× |
| Hepatobil Syst Image W/Drug (78227) | $1,307.25 | $1,743 | 2.4× |
| Hepatobiliary System Imaging (78226) | $1,039.50 | $1,386 | 2.6× |
| Ht Muscle Image Spect Sing (78451) | $2,001.75 | $2,669 | 1.5× |
| Hysterosalpingogram (74740) | $352.50 | $470 | 1.5× |
| Infusion Ivp (74410) range across 2 matching MRF lines |
$295.31–$437.06 | $393.75–$582.75 | varies |
| K Flow/Funct Image Multiple (78709) | $750 | $1,000 | 1.4× |
| K Flow/Funct Image W/Drug (78708) | $1,082.81 | $1,443.75 | 2.0× |
| K Flow/Funct Image W/O Drug (78707) | $750 | $1,000 | 1.4× |
| Kidney Imaging Morphol (78700) | $803.25 | $1,071 | 2.0× |
| Liver & Spleen Imaging Static Only (78215) | $803.25 | $1,071 | 2.0× |
| Liver & Spleen Imaging W/Vascular Flow (78216) | $984.38 | $1,312.50 | 2.5× |
| Lung Ventilat&Perfus Imaging (78582) | $1,681.31 | $2,241.75 | 3.1× |
| Lung Ventilation Imaging (78579) | $893.81 | $1,191.75 | 2.2× |
| Meckels Divert Exam (78290) | $570.94 | $761.25 | 1.4× |
| Mra Head W/O & W/Contrast Material (70546) | $1,874.25 | $2,499 | 5.4× |
| MRA head w/o contrast (70544) | $1,008 | $1,344 | 4.2× |
| MRA head with contrast (70545) | $1,130.06 | $1,506.75 | 3.2× |
| MRA neck w contrast (70548) | $1,130.06 | $1,506.75 | 3.2× |
| MRA neck w/o contrast (70547) | $1,008 | $1,344 | 4.2× |
| MRI abdomen w contrast (74182) | $2,744.44 | $3,659.25 | 7.9× |
| MRI abdomen w/o contrast (74181) range across 2 matching MRF lines |
$1,547.44–$2,476.69 | $2,063.25–$3,302.25 | varies |
| MRI any jt lower extrem w/contrast material (73722) | $2,744.44 | $3,659.25 | 3.5× |
| MRI any jt lower extrem w/o & w/contrast matrl (73723) | $3,130.31 | $4,173.75 | 9.0× |
| MRI any jt upper extremity w/contrast matrl (73222) | $2,744.44 | $3,659.25 | 3.5× |
| MRI cervical spine w contrast (72142) | $2,744.44 | $3,659.25 | 7.9× |
| MRI cervical spine w/o cont (72141) | $2,476.69 | $3,302.25 | 10.4× |
| MRI chest w/o contrast (71550) | $2,476.69 | $3,302.25 | 10.4× |
| MRI chest with contrast (71551) | $2,744.44 | $3,659.25 | 3.5× |
| MRI chest wo w contrast (71552) | $3,130.31 | $4,173.75 | 9.0× |
| MRI lower extrem oth/thn jt w/contrast matrl (73719) | $2,744.44 | $3,659.25 | 7.9× |
| MRI lower extrem oth/thn jt w/o & w/contr matr (73720) | $3,130.31 | $4,173.75 | 9.0× |
| MRI lower extrem oth/thn jt w/o contr matrl (73718) | $3,130.31 | $4,173.75 | 13.1× |
| MRI lumbar spine w contrast (72149) | $2,744.44 | $3,659.25 | 7.9× |
| Mri Neck Spine W/O & W/Dye (72156) | $3,130.31 | $4,173.75 | 9.0× |
| MRI orbit face &/neck w/o contrast (70540) | $2,476.69 | $3,302.25 | 10.4× |
| MRI orbit face neck w contrast (70542) | $2,744.44 | $3,659.25 | 7.9× |
| Mri Orbt/Fac/Nck W/O &W/Dye (70543) | $3,130.31 | $4,173.75 | 9.0× |
| MRI pelvis w/o & w contrast (72197) | $3,130.31 | $4,173.75 | 9.0× |
| MRI pelvis w/o contrast (72195) range across 2 matching MRF lines |
$2,476.69–$3,130.31 | $3,302.25–$4,173.75 | varies |
| MRI thoracic spine w/o contrast (72146) | $2,476.69 | $3,302.25 | 10.4× |
| MRI upper extremity oth than jt w/o contr matrl (73218) | $2,476.69 | $3,302.25 | 10.4× |
| Mri Uppr Extremity W/O&W/Dye (73220) | $3,130.31 | $4,173.75 | 9.0× |
| MRI, abdomen, combo (74183) | $3,130.31 | $4,173.75 | 9.0× |
| MRI, dorsal spine combo (72157) | $3,130.31 | $4,173.75 | 9.0× |
| MRI, dorsal spine contrast (72147) | $2,744.44 | $3,659.25 | 7.9× |
| MRI, joint upper extrem (73221) | $2,476.69 | $3,302.25 | 10.4× |
| MRI, joint upper extrem combo (73223) | $3,130.31 | $4,173.75 | 9.0× |
| MRI, lumbar spine combo (72158) | $3,130.31 | $4,173.75 | 9.0× |
| Myelogram Lumbar (72265) | $1,563.19 | $2,084.25 | 2.0× |
| Myocardial Imaging Infarct Avid Planar Qual/Quan (78466) range across 2 matching MRF lines |
$1,708.88–$4,290.38 | $2,278.50–$5,720.50 | varies |
| Myocardial Perfusion Planar 1 Study Rest/Stress (78453) | $2,001.75 | $2,669 | 1.5× |
| Myocardial Spect Multiple Studies (78452) range across 4 matching MRF lines |
$2,001.75–$2,082.94 | $2,669–$2,777.25 | varies |
| Nm unlisted gi procedure (78299) | $577.50 | $770 | 1.4× |
| Oph bmtry us echograpy a-scan io lens pwr cal (76519) | $166.50 | $222 | 1.6× |
| Pelvis 1 or 2 views (72170) | $166.50 | $222 | 1.6× |
| Pulmonary Perfusion Imaging Particulate (78580) | $893.81 | $1,191.75 | 2.2× |
| Radex Abd Compl Aqt Abd W/S/E/D Views 1 View Ch (74022) | $271.69 | $362.25 | 2.6× |
| Radex Ankle Complete Minimum 3 Views (73610) | $228.38 | $304.50 | 2.6× |
| Radex Calcaneus Minimum 2 Views (73650) | $141.75 | $189 | 1.6× |
| Radex elbow complete minimum 3 views (73080) | $181.13 | $241.50 | 2.1× |
| Radex Facial Bones Complete Minimum 3 Views (70150) | $204.75 | $273 | 2.0× |
| Radex fingr minimum 2 views (73140) | $141.75 | $189 | 1.6× |
| Radex foot complete minimum 3 views (73630) | $232.31 | $309.75 | 2.7× |
| Radex Hand Minimum 3 Views (73130) | $228.38 | $304.50 | 2.6× |
| Radex Mastoids Compl Minimum 3 Views PR Side (70130) | $208.69 | $278.25 | 2.0× |
| Radex Nasal Bones Complete Minimum 3 Views (70160) | $145.69 | $194.25 | 1.7× |
| Radex Ribs Unilateral 2 Views (71100) | $200.81 | $267.75 | 2.3× |
| Radex shoulder complete minimum 2 views (73030) | $252 | $336 | 2.9× |
| Radex Spine 1 View Specify Level (72020) | $123.75 | $165 | 1.4× |
| Radex Sternum Minimum 2 Views (71120) | $137.81 | $183.75 | 1.6× |
| Radex Temporomandble Jt Opn & Clsd Mouth Bilat (70330) | $248.06 | $330.75 | 2.8× |
| Radex Toe Minimum 2 Views (73660) | $141.75 | $189 | 1.6× |
| Radex Wrist Complete Minimum 3 Views (73110) | $141.75 | $189 | 1.6× |
| Radiolog exam mandible compl minimum 4 views (70110) | $208.69 | $278.25 | 2.0× |
| Radiologic exam colon double contrast study (74280) | $590.63 | $787.50 | 3.4× |
| Radiologic exam knee complete 4/more views (73564) range across 4 matching MRF lines |
$181.13–$196.88 | $241.50–$262.50 | varies |
| Radiologic exam pelvis compl minimum 3 views (72190) | $236.25 | $315 | 2.3× |
| Radiologic Exam Small Int Single Contrast Study (74250) | $350.44 | $467.25 | 2.0× |
| Radiologic exam swallow function contrast study (74230) | $338.63 | $451.50 | 1.9× |
| Radiologic exam upr gi trc double contrast study (74246) | $444.94 | $593.25 | 2.5× |
| Radiologic examination femur minimum 2 views (73552) | $196.88 | $262.50 | 2.3× |
| Radiologic examination knee 1/2 views (73560) | $141.75 | $189 | 1.6× |
| Radiologic examination tibia & fibula 2 views (73590) | $173.25 | $231 | 2.0× |
| Ribs bilateral 3 views (71110) | $252 | $336 | 2.4× |
| Rp loclzj tum plnr 1 area single day imaging (78800) | $1,197 | $1,596 | 3.0× |
| Rp Therapy Unlisted Procedure (79999) | $387.75 | $517 | 1.7× |
| Scapula (73010) | $173.25 | $231 | 1.7× |
| Sialogram (70390) | $352.50 | $470 | 1.5× |
| Skull less than 4 views (70250) | $166.50 | $222 | 1.6× |
| Sternoclavicular joints (71130) | $200.81 | $267.75 | 2.3× |
| Testicular Imaging W/Flow (78761) | $960.75 | $1,281 | 2.4× |
| Thoracic spine 2 views (72070) | $226.50 | $302 | 2.2× |
| Thoracic spine 3 views (72072) | $311.06 | $414.75 | 3.0× |
| Thyroid Uptake Measurement (78012) | $622.13 | $829.50 | 1.6× |
| Ultrasound Breast Limited (76642) range across 3 matching MRF lines |
$204.75–$307.13 | $273–$409.50 | varies |
| Ultrasound, abdomen limited (76705) range across 5 matching MRF lines |
$166.50–$590.63 | $222–$787.50 | varies |
| Unlisted Dx Radiographic Procedure (76499) range across 7 matching MRF lines |
$118.13–$181.13 | $157.50–$241.50 | varies |
| Unlisted Miscellaneous Px Dx Nuclear Medicine (78999) | $775.69 | $1,034.25 | 1.9× |
| Unlisted respiratory px dx nuclear medicine (78599) | $577.50 | $770 | 1.4× |
| Unlisted us procedure (76999) | $123.75 | $165 | 1.4× |
| Upper gi w/o kub (74240) | $326.81 | $435.75 | 1.9× |
| Ureteral Reflux Study (78740) | $952.88 | $1,270.50 | 2.4× |
| Urethrocystogram voiding (74455) | $393.75 | $525 | 1.6× |
| Urethrocystography retrograde (74450) | $346.50 | $462 | 1.4× |
| Us chest (76604) | $166.50 | $222 | 1.6× |
| Us complete joint (76881) range across 2 matching MRF lines |
$166.50–$307.13 | $222–$409.50 | varies |
| Us exam, pelvic, limited (76857) | $173.25 | $231 | 1.7× |
| Us head (76506) | $204.75 | $273 | 2.0× |
| Us lmtd joint/oth nonvasc xtr strux r-t w/img (76882) | $307.13 | $409.50 | 2.9× |
| Us ob limited 1 or more fetuses (76815) range across 2 matching MRF lines |
$326.81–$429.19 | $435.75–$572.25 | varies |
| Us ob transvaginal (76817) | $547.31 | $729.75 | 5.2× |
| Us pelvic non ob complete (76856) | $712.69 | $950.25 | 6.8× |
| Us pg uter img f&mat 14 wk tabdl 1/1st gestation (76801) | $547.31 | $729.75 | 5.2× |
| Us preg uterus real time f/u trnsabdl per fetus (76816) | $192.94 | $257.25 | 1.8× |
| Us retroperitoneal complete (76770) range across 3 matching MRF lines |
$307.13–$677.25 | $409.50–$903 | varies |
| Us scrotum and contents (76870) | $326.81 | $435.75 | 3.1× |
| Us thyroid (76536) range across 2 matching MRF lines |
$166.50–$555.19 | $222–$740.25 | varies |
| Vascular Flow Imaging (78445) | $577.50 | $770 | 1.4× |
| Venography extremity bilateral rs&i (75822) | $1,875 | $2,500 | 1.2× |
| Venography extremity unilateral rs&i (75820) | $1,125 | $1,500 | 0.7× |
| Venous thrombosis imaging (78457) | $750 | $1,000 | 1.4× |
| Venous Thrombosis Imaging Venogram Bilateral (78458) | $803.25 | $1,071 | 2.0× |
| Vertebral fracture assessment via dxa (77086) | $165.38 | $220.50 | 1.9× |
| Wrist 2 views (73100) | $141.75 | $189 | 1.6× |
| X-Ray Ac Jts - Xr Acromioclavicular Joints Bilateral (73050) | $216.56 | $288.75 | 2.5× |
| X-Ray Elbow 2 Vw - Xr Elbow 1-2 Views Right (73070) | $141.75 | $189 | 1.6× |
| X-Ray Exam Entire Spi 1 Vw (72081) | $287.44 | $383.25 | 3.3× |
| X-Ray Exam Hip Uni 2-3 Views (73502) | $157.50 | $210 | 1.8× |
| X-Ray Exam Hips Bi 2 Views (73521) | $236.25 | $315 | 2.3× |
| X-Ray Exam L-S Spine Bending (72114) | $244.13 | $325.50 | 2.3× |
| X-Ray Exam Neck Spine 2-3 Vw (72040) | $145.69 | $194.25 | 1.7× |
| X-Ray Exam Neck Spine 6/>Vws (72052) | $259.88 | $346.50 | 2.5× |
| X-Ray Exam Unilat Ribs/Chest (71101) | $270.75 | $361 | 2.6× |
| X-ray eye for foreign body (70030) | $123.75 | $165 | 1.4× |
| X-ray humerus (73060) | $173.25 | $231 | 2.0× |
| X-ray IV pyelogram (ivp) (74400) | $370.13 | $493.50 | 2.1× |
| X-ray IV pyelogram+tomography (74415) | $531.56 | $708.75 | 3.0× |
| X-Ray Lumbar Spine 2/3 Vw - Xr Lumbar Spine 2-3 Views (72100) range across 2 matching MRF lines |
$166.50–$295.31 | $222–$393.75 | varies |
| X-Ray Ribs, Chest 4+ Vw - Xr Ribs 3 Vws Bil W/ Chest Posteroanterior (71111) | $240 | $320 | 2.3× |
| X-Ray Sacroiliac Jts 3+ Vw - Xr Sacroiliac Joints 3+ Views (72202) | $236.25 | $315 | 2.3× |
| X-Ray Sacroiliac Jts <3 Vw - Xr Sacroiliac Joints 1-2 Views (72200) | $173.25 | $231 | 1.7× |
| X-Ray Sacrum/Coccyx 2+ Vw - Xr Sacrum Coccyx 2+ Views (72220) | $236.25 | $315 | 2.7× |
| X-Ray Sinuses 3+ Vw - Xr Paranasal Sinuses 3+ Views (70220) | $220.50 | $294 | 2.5× |
| X-Ray Skull 4+ Vw - Xr Skull Complete 4+ Views (70260) | $220.50 | $294 | 2.1× |
| X-ray thoracic spine 4 vw (72074) | $232.31 | $309.75 | 2.2× |
| X-Ray Tmj Unilat (70328) | $196.88 | $262.50 | 2.3× |
| X-Ray Urinary Tract Exam With Contrast Material (74420) | $564 | $752 | 1.6× |
| X-Rays Bone Length Studies (77073) | $166.50 | $222 | 1.6× |
| X-Rays Bone Survey Complete (77075) range across 3 matching MRF lines |
$444.94–$476.44 | $593.25–$635.25 | varies |
| Xr c-spine 4 or 5 views (72050) | $421.31 | $561.75 | 4.0× |
| Xr orbits complete 4 views (70200) | $204.75 | $273 | 2.0× |
| Xr Tomogram Single Plane (76100) | $271.69 | $362.25 | 2.6× |
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.