Imaging prices at Samaritan Hospital

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

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

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ProcedurePosted cashPosted gross× Medicare
Abdomen 1 View (74018) $164 $205 1.9×
Acute Gastrointestinal Blood Loss Imaging (78278) $1,179 $1,474 2.9×
Ankle 2 views (73600) $195 $244 2.2×
Bone Imaging 3 Phase (78315) $1,347 $1,684 3.4×
Bone Imaging Limited Area (78300) $1,153 $1,441 2.9×
Bone Imaging Multiple Areas (78305) $980 $1,225 2.4×
Bone Imaging Whole Body (78306) $980 $1,225 2.4×
Bone survey infant (77076) $398 $498 3.8×
Cat Scan Follow-Up Study (76380) $1,034 $1,293 11.9×
Chest 1 view (71045) $154 $192 1.8×
Chest 2 views (71046)
range across 2 matching MRF lines		 $139–$200 $174–$250 varies
Chest 3 views (71047) $154 $192 1.8×
Clavicle complete (73000) $234 $293 2.7×
Computed Tomography Thorax Lw Dose Lng Ca Scr C- (71271) $1,262 $1,578 12.1×
Contrast X-Ray Bladder (74430) $324 $405 0.9×
CT abdomen and pelvis without and with contrast (74178) $3,157 $3,946 9.0×
CT abdomen and pelvis without contrast (74176) $2,526 $3,157 10.6×
CT abdomen w contrast (74160) $1,421 $1,776 8.1×
CT abdomen w wo contrast (74170) $1,578 $1,973 9.0×
CT abdomen w/o contrast (74150) $1,262 $1,578 12.1×
CT Angio Abdomen and Pelvis (74174) $3,157 $3,946 9.0×
CT Angio Chest (71275) $1,421 $1,776 8.1×
CT Angio Head (70496) $1,698 $2,123 9.7×
CT Angio Neck (70498) $1,698 $2,123 9.7×
CT cervical spine w/ contrast (72126) $1,421 $1,776 4.1×
CT cervical spine w/o contrast (72125) $1,262 $1,578 12.1×
CT cervical spine w/wo cont (72127) $1,578 $1,973 9.0×
CT chest w contrast (71260) $1,421 $1,776 8.1×
CT chest w/wo contrast (71270) $1,578 $1,973 9.0×
CT head/brain with contrast (70460) $1,421 $1,776 8.1×
CT head/brain without and with contrast (70470) $1,578 $1,973 9.0×
CT iac w contrast (70481) $1,421 $1,776 8.1×
CT l-spine w&w/o contrast (72133) $1,578 $1,973 9.0×
CT lower ext w/o (73700) $1,262 $1,578 12.1×
CT lower extremity w/contrast material (73701) $1,421 $1,776 8.1×
CT lumbar spine w contrast (72132) $1,421 $1,776 4.1×
CT lumbar spine w/o contrast (72131) $1,262 $1,578 12.1×
CT maxillofacial w contrast (70487) $1,421 $1,776 8.1×
CT maxillofacial wo contrast (70486) $1,262 $1,578 12.1×
CT neck tissue combo (70492) $1,578 $1,973 9.0×
Ct Orbit/Ear/Fossa W/O&W/Dye (70482) $1,578 $1,973 9.0×
CT orbits w/o contrast (70480) $1,262 $1,578 12.1×
CT pelvis w&w/o contrast (72194) $1,578 $1,973 9.0×
CT pelvis w/o contrast (72192) $1,262 $1,578 12.1×
CT scan of leg combo (73702) $1,578 $1,973 9.0×
CT scans face/jaw combo (70488) $1,578 $1,973 9.0×
CT soft tissue neck w contrast (70491) $1,421 $1,776 8.1×
CT soft tissue neck w/o contrast (70490) $1,262 $1,578 12.1×
CT thoracic spine w contrast (72129) $1,421 $1,776 8.1×
CT thoracic spine w/o contrast (72128) $1,262 $1,578 12.1×
CT thoracic spine w/wo cont (72130) $1,578 $1,973 9.0×
CT thorax w/o contrast (71250) $1,262 $1,578 12.1×
CT upper ext wo (73200) $1,262 $1,578 12.1×
CT upper extremity w/o & w/contrast material (73202) $1,578 $1,973 9.0×
CT upper extremity with contrast (73201) $1,421 $1,776 4.1×
Cta Abdl Aorta&Bi Iliofem W/Contrast&Postp (75635) $1,698 $2,123 9.7×
Cta Abdomen (74175) $1,578 $1,973 9.0×
CTA head&neck c+ w/noncontrast img&post-pxessing (70471) $1,698 $2,123 4.9×
CTA pelvis (72191) $1,578 $1,973 9.0×
Dxa Bone Density Axial (77080) $300 $375 2.9×
Esophagram (74220) $300 $375 1.7×
Fetal Biophysical Profile W/O Non-Stress Testing (76819) $451 $564 4.3×
Fluoroscopy up to 1 hr (76000) $438 $547 1.8×
Foot 2 views (73620) $174 $218 2.0×
Forearm 2 views (73090) $174 $218 2.0×
Gastric emptying imaging study (78264) $1,179 $1,474 2.9×
Gated Heart Planar Single (78472) $1,562 $1,952 3.9×
Hand 2 views (73120) $167 $209 1.6×
Hepatobiliary System Imaging (78226) $1,464 $1,830 3.7×
Hysterosalpingogram (74740) $351 $439 1.5×
Infant hip ultrasound, limited static exam (76886) $390 $487 4.5×
Joint Survey Single View (77077) $89 $111 0.8×
K Flow/Funct Image W/Drug (78708) $968 $1,210 1.8×
K Flow/Funct Image W/O Drug (78707) $968 $1,210 1.8×
Kidney Imaging Morphoogy W/Vascular Flow (78701) $960 $1,200 2.4×
Knee 3 Views (73562) $178 $222 2.0×
Liver & Spleen Imaging Static Only (78215) $949 $1,186 2.4×
Liver & Spleen Imaging W/Vascular Flow (78216) $1,121 $1,401 2.8×
Liver imaging w/vascular flow (78202) $1,330 $1,663 2.4×
Lung Perf&Ventilat Diferentl (78598) $963 $1,204 1.8×
Lung Ventilation Imaging (78579) $917 $1,146 2.3×
Magnetic Image Jaw Joint (70336) $1,578 $1,973 6.6×
Meckels Divert Exam (78290) $1,077 $1,346 2.7×
Mra Head W/O & W/Contrast Material (70546) $2,052 $2,565 5.9×
MRA head w/o contrast (70544) $1,578 $1,973 6.6×
MRA neck w contrast (70548) $1,815 $2,269 5.2×
Mra Neck W/O &W/Contrast Material (70549) $2,052 $2,565 5.9×
MRA neck w/o contrast (70547) $1,578 $1,973 6.6×
MRI abdomen w contrast (74182) $1,815 $2,269 5.2×
MRI abdomen w/o contrast (74181) $1,578 $1,973 6.6×
MRI any jt lower extrem w/contrast material (73722) $1,815 $2,269 2.3×
MRI any jt lower extrem w/o & w/contrast matrl (73723) $2,052 $2,565 5.9×
MRI any jt upper extremity w/contrast matrl (73222) $1,815 $2,269 2.3×
MRI bone marrow blood supply (77084) $1,235 $1,544 5.2×
MRI cervical spine w contrast (72142) $1,815 $2,269 5.2×
MRI cervical spine w/o cont (72141) $1,578 $1,973 6.6×
MRI chest w/o contrast (71550) $1,578 $1,973 6.6×
MRI chest with contrast (71551) $1,815 $2,269 2.3×
MRI chest wo w contrast (71552) $2,314 $2,892 6.6×
MRI lower extrem oth/thn jt w/contrast matrl (73719) $1,815 $2,269 5.2×
MRI lower extrem oth/thn jt w/o & w/contr matr (73720) $2,052 $2,565 5.9×
MRI lower extrem oth/thn jt w/o contr matrl (73718) $1,578 $1,973 6.6×
MRI lumbar spine w contrast (72149) $1,815 $2,269 5.2×
Mri Neck Spine W/O & W/Dye (72156) $2,052 $2,565 5.9×
MRI orbit face &/neck w/o contrast (70540) $1,578 $1,973 6.6×
MRI orbit face neck w contrast (70542) $1,815 $2,269 5.2×
Mri Orbt/Fac/Nck W/O &W/Dye (70543) $2,052 $2,565 5.9×
MRI pelvis w contrast (72196) $1,815 $2,269 5.2×
MRI pelvis w/o & w contrast (72197) $2,052 $2,565 5.9×
MRI pelvis w/o contrast (72195) $1,578 $1,973 6.6×
MRI thoracic spine w/o contrast (72146) $1,578 $1,973 6.6×
MRI upper extremity oth than jt w/contr matrl (73219) $1,815 $2,269 5.2×
MRI upper extremity oth than jt w/o contr matrl (73218) $1,578 $1,973 6.6×
Mri Uppr Extremity W/O&W/Dye (73220) $2,052 $2,565 5.9×
MRI, abdomen, combo (74183) $2,052 $2,565 5.9×
MRI, dorsal spine combo (72157) $2,052 $2,565 5.9×
MRI, dorsal spine contrast (72147) $1,815 $2,269 5.2×
MRI, joint upper extrem (73221) $1,578 $1,973 6.6×
MRI, joint upper extrem combo (73223) $2,052 $2,565 5.9×
MRI, lumbar spine combo (72158) $2,052 $2,565 5.9×
Nonvascular Shunt X-Ray (75809) $407 $509 3.9×
Parathyroid Planar Imaging (78070) $1,055 $1,319 2.6×
Pelvis 1 or 2 views (72170) $184 $230 1.8×
Pulmonary Perfusion Imaging Particulate (78580) $1,135 $1,419 2.8×
Radex Abd Compl Aqt Abd W/S/E/D Views 1 View Ch (74022) $562 $703 5.4×
Radex Ankle Complete Minimum 3 Views (73610) $214 $268 2.5×
Radex Calcaneus Minimum 2 Views (73650) $186 $232 2.1×
Radex elbow complete minimum 3 views (73080) $222 $278 2.5×
Radex Facial Bones Complete Minimum 3 Views (70150) $291 $364 2.8×
Radex fingr minimum 2 views (73140) $170 $213 2.0×
Radex foot complete minimum 3 views (73630) $191 $239 2.2×
Radex Hand Minimum 3 Views (73130) $214 $268 2.5×
Radex Mastoids Compl Minimum 3 Views PR Side (70130) $190 $237 1.8×
Radex Nasal Bones Complete Minimum 3 Views (70160) $214 $268 2.5×
Radex Ribs Unilateral 2 Views (71100) $230 $287 2.6×
Radex shoulder complete minimum 2 views (73030) $195 $244 2.2×
Radex Spine 1 View Specify Level (72020) $218 $272 2.5×
Radex Sternum Minimum 2 Views (71120) $186 $232 2.1×
Radex Toe Minimum 2 Views (73660) $173 $216 2.0×
Radex Wrist Complete Minimum 3 Views (73110) $214 $268 2.5×
Radiologic Exam Abdomen 3+ Views - Xr Abdomen 3+ Views (74021) $331 $414 3.2×
Radiologic exam colon double contrast study (74280) $622 $777 3.5×
Radiologic exam colon single contrast study (74270) $480 $600 2.7×
Radiologic Exam Small Int Single Contrast Study (74250) $397 $496 2.3×
Radiologic exam swallow function contrast study (74230) $362 $452 2.1×
Radiologic exam teeth complete full mouth (70320) $74 $93 0.3×
Radiologic exam upr gi trc double contrast study (74246) $452 $565 2.6×
Radiologic examination femur minimum 2 views (73552) $230 $287 2.6×
Radiologic examination knee 1/2 views (73560) $154 $192 1.8×
Radiologic examination tibia & fibula 2 views (73590) $169 $211 1.9×
Rp Loclzj Tum Spect 1 Area Single Day Imaging (78803)
range across 2 matching MRF lines		 $1,201–$1,310 $1,501–$1,638 varies
Scapula (73010) $199 $249 1.9×
Shoulder 1 view (73020) $154 $192 1.8×
Shoulder Arthrography (73040) $648 $810 1.9×
Skull less than 4 views (70250) $180 $225 1.7×
Thoracic spine 3 views (72072) $278 $348 2.7×
Ultrasound Breast Limited (76642) $369 $461 4.2×
Ultrasound Elastography Parenchyma (76981) $500 $625 4.8×
Ultrasound Exam Aaa Screen (76706) $534 $667 5.1×
Ultrasound, abdomen limited (76705) $451 $564 4.3×
Urethrocystogram voiding (74455)
range across 7 matching MRF lines		 $5–$73 $6–$91 varies
Us breast unilateral complete (76641) $369 $461 3.5×
Us chest (76604) $479 $599 4.6×
Us complete joint (76881) $429 $536 4.1×
Us exam, pelvic, limited (76857) $92 $115 0.9×
Us head (76506) $479 $599 4.6×
Us lmtd joint/oth nonvasc xtr strux r-t w/img (76882) $429 $536 4.1×
Us ob detailed single fetus (76811) $519 $649 2.2×
Us ob limited 1 or more fetuses (76815) $290 $362 2.8×
Us ob transvaginal (76817) $298 $373 2.8×
Us pelvic non ob complete (76856) $484 $605 4.6×
Us pg uter img f&mat 14 wk tabdl 1/1st gestation (76801) $452 $565 4.3×
Us preg uterus real time f/u trnsabdl per fetus (76816) $261 $326 2.5×
Us retroperitoneal complete (76770) $565 $706 5.4×
Us retroperitoneal limited (76775) $534 $667 5.1×
Us scrotum and contents (76870) $590 $738 5.6×
Us thyroid (76536) $489 $611 4.7×
Wrist 2 views (73100) $176 $220 2.0×
X-Ray Ac Jts - Xr Acromioclavicular Joints Bilateral (73050) $527 $659 6.0×
X-Ray Elbow 2 Vw - Xr Elbow 1-2 Views Right (73070) $214 $268 2.5×
X-Ray Exam Entire Spi 1 Vw (72081) $190 $237 2.2×
X-Ray Exam Hip Uni 1 View (73501) $161 $201 1.8×
X-Ray Exam Hip Uni 2-3 Views (73502) $178 $222 2.0×
X-Ray Exam Hips Bi 5/> Views (73523) $226 $282 2.2×
X-Ray Exam Neck Spine 2-3 Vw (72040) $230 $287 2.6×
X-Ray Exam Neck Spine 6/>Vws (72052) $342 $428 3.3×
X-Ray Exam Unilat Ribs/Chest (71101)
range across 8 matching MRF lines		 $8–$934 $10–$1,168 varies
X-ray eye for foreign body (70030) $230 $287 2.6×
X-ray humerus (73060) $177 $221 2.0×
X-ray IV pyelogram (ivp) (74400) $469 $586 2.7×
X-ray IV pyelogram+tomography (74415) $734 $918 4.2×
X-Ray Jaw <4 Vw - Xr Mandible < 4 Views (70100) $214 $268 2.5×
X-Ray Lumbar Spine 2/3 Vw - Xr Lumbar Spine 2-3 Views (72100) $258 $322 2.5×
X-Ray Sacroiliac Jts 3+ Vw - Xr Sacroiliac Joints 3+ Views (72202) $195 $244 1.9×
X-Ray Sacrum/Coccyx 2+ Vw - Xr Sacrum Coccyx 2+ Views (72220) $291 $364 3.3×
X-Ray Sinuses 3+ Vw - Xr Paranasal Sinuses 3+ Views (70220) $233 $291 2.7×
X-Ray Skull 4+ Vw - Xr Skull Complete 4+ Views (70260) $245 $306 2.3×
X-Ray Urinary Tract Exam With Contrast Material (74420) $458 $573 1.3×
X-Rays Bone Length Studies (77073) $246 $307 2.3×
X-Rays Bone Survey Complete (77075) $377 $471 3.6×
Xr c-spine 4 or 5 views (72050) $282 $352 2.7×

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.