Imaging prices at Sampson Regional Medical Center

Clinton, NC · every code in this section with a posted price and a Medicare benchmark.

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

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ProcedureCash priceGross charge× Medicare
Abdomen 2 views (74019) $275.80 $394 2.8×
Acute gastrointestinal blood loss imaging (78278) $942.90 $1,347 2.5×
Ankle 2 views (73600) $203 $290 2.4×
Antegrade urography radiological supvj & interpj (74425) $468.30 $669 1.4×
Bone &/Joint Imaging Limited Area (78300) $629.30 $899 1.6×
Bone &/Joint Imaging Multiple Areas (78305) $1,332.80 $1,904 3.5×
Bone &/joint imaging whole body (78306) $1,559.60 $2,228 4.1×
Bone age studies (77072) $173.60 $248 1.7×
Bone Imaging 3 Phase (78315) $2,060.10 $2,943 5.4×
Bone survey complete (77075) $275.80 $394 2.8×
Cervical spine 2 or 3 views (72040) $301.70 $431 3.6×
Chest 1 view (71045) $212.80 $304 2.6×
Chest 3 views (71047) $263.20 $376 3.2×
Cine/Vid X-Ray Throat/Esoph - Fl Esoph Barium Swlw W/ Video & Speech (74230) $228.20 $326 1.4×
Clavicle complete (73000) $198.10 $283 2.4×
Computed Tomography Thorax Lw Dose Lng Ca Scr C- (71271) $180.60 $258 1.8×
CT abdomen and pelvis without and with contrast (74178) $5,294.80 $7,564 15.9×
CT abdomen and pelvis without contrast (74176) $4,195.80 $5,994 18.4×
CT abdomen w contrast (74160) $2,121.70 $3,031 12.7×
CT abdomen w wo contrast (74170) $2,650.20 $3,786 15.8×
CT abdomen w/o contrast (74150) $1,908.90 $2,727 19.1×
CT angiography upper extremity lt (73206) $1,806.70 $2,581 10.8×
CT c-spine w/o contrast (72125) $3,180.10 $4,543 31.8×
CT cervical spine w&w/o contrast (72127) $3,593.10 $5,133 21.4×
CT cervical spine with contrast (72126) $2,404.50 $3,435 7.2×
CT chest w/wo contrast (71270) $2,244.20 $3,206 13.4×
CT chest with contrast (71260) $1,499.40 $2,142 8.9×
CT head/brain with contrast (70460) $1,555.40 $2,222 9.3×
CT head/brain without and with contrast (70470) $2,593.50 $3,705 15.5×
CT iac w contrast (70481) $1,653.40 $2,362 9.9×
CT limited/localized follow up study (76380) $792.40 $1,132 9.5×
CT lower ext w/o (73700) $1,904 $2,720 19.1×
CT lower extremity w wo contrast (73702) $2,645.30 $3,779 15.8×
CT lower extremity with contrast (73701) $2,026.50 $2,895 12.1×
CT lumbar spine w & w/o contrast (72133) $3,282.30 $4,689 19.6×
CT lumbar spine w/o contrast (72131) $2,762.20 $3,946 27.6×
CT lumbar spine with contrast (72132) $2,404.50 $3,435 7.2×
CT maxillofacial w contrast (70487) $1,465.80 $2,094 8.7×
CT maxillofacial w/o contrast (70486) $2,121.70 $3,031 21.2×
CT maxillofacial w/wo contrast (70488) $2,779 $3,970 16.6×
CT neck soft tissue w contrast (70491) $2,124.50 $3,035 12.7×
CT orbit sella/post fossa/ear w/o & w/contr matr (70482) $2,412.20 $3,446 14.4×
CT orbits w/o contrast (70480) $1,653.40 $2,362 16.5×
CT pelvis w & w/o contrast (72194) $2,650.20 $3,786 15.8×
CT pelvis w/o contrast (72192) $1,908.90 $2,727 19.1×
CT scan for measuring calcium and other minerals in bone (77078) $449.40 $642 5.4×
CT soft tissue neck w/o & w/contrast material (70492) $2,554.30 $3,649 15.2×
CT soft tissue neck w/o contrast (70490) $2,261 $3,230 22.6×
CT thoracic spine w/contrast (72129) $1,841 $2,630 11.0×
CT thoracic spine w/o contrast (72128) $2,112.60 $3,018 21.1×
CT thoracic spine w/wo contrast (72130) $2,749.60 $3,928 16.4×
CT thorax w/o contrast (71250) $1,499.40 $2,142 15.0×
CT upper extremity w/o & w/contrast material (73202) $1,743.70 $2,491 10.4×
CT upper extremity w/o contrast rt (73200) $1,324.40 $1,892 13.3×
CT upper extremity with contrast (73201) $1,169 $1,670 3.5×
Cta Abdl Aorta&Bi Iliofem W/Contrast&Postp (75635) $2,636.20 $3,766 15.7×
Cta Abdomen (74175) $2,636.20 $3,766 15.7×
CTA abdomen pelvis (74174) $2,968 $4,240 8.9×
CTA chest (71275) $2,643.20 $3,776 15.8×
Cta Head (70496) $2,459.80 $3,514 14.7×
CTA head&neck c+ w/noncontrast img&post-pxessing (70471) $2,660 $3,800 8.0×
CTA lwr ext w&w/o contrast (73706) $1,806.70 $2,581 10.8×
Cta Neck (70498) $2,366.70 $3,381 14.1×
Cta Pelvis (72191) $2,783.90 $3,977 16.6×
Cystography minimum 3 views rs&i (74430) $455 $650 1.4×
Doppler Fetal Mid Cerebral Artery (76821) $163.80 $234 1.6×
Dxa bone density study 1/> sites axial skel (77080) $213.50 $305 2.1×
Dxa bone density study 1/>sites appendiclr skel (77081) $105.70 $151 1.3×
Dxa bone density study axial skeleton (77085) $163.80 $234 1.6×
Echoencephalography real time imaging (76506) $276.50 $395 2.8×
Esophagus (74220) $366.10 $523 2.2×
Fetal biophysical profile non-stress testing (76818) $375.20 $536 3.8×
Fetal Biophysical Profile W/O Non-Stress Testing (76819) $311.15 $444.50 3.1×
Fluoroscopy up to 1 hr (76000) $343.70 $491 1.5×
Foot 2 views (73620) $241.50 $345 2.9×
Forearm 2 views (73090) $268.10 $383 3.2×
Gated Heart Planar Single (78472) $1,395.10 $1,993 3.7×
Hand 2 views (73120) $180.60 $258 1.8×
Hand 3 views (73130) $343.70 $491 4.1×
Hepatobil Syst Imag Inc Gb W/Pharma Intervenj (78227) $1,611.40 $2,302 3.1×
Hepatobiliary syst imaging including gallbladder (78226) $1,611.40 $2,302 4.2×
Ht muscle image spect sing (78451) $3,619 $5,170 2.9×
Humerus Min 2 Views Left (73060) $229.60 $328 2.8×
Hysterosalpingogram (74740) $566.30 $809 2.5×
Kidney Img Morphology Vascular Flow 1 W/O Rx (78707) $1,874.60 $2,678 3.6×
Kidney img morphology vascular flow 1 w/rx (78708) $796.60 $1,138 1.5×
Kidney Img Morphology Vascular Flow Multiple (78709) $1,582.70 $2,261 3.0×
Knee 3 views (73562) $294 $420 3.5×
Liver & Spleen Imaging W/Vascular Flow (78216) $935.90 $1,337 2.4×
Lung perf&ventilat diferentl (78598) $768.60 $1,098 1.5×
Lung Ventilation Imaging (78579) $598.50 $855 1.6×
Lymphoscintigraphy (78195) $746.20 $1,066 1.4×
Meckels Diverticulum (78290) $616 $880 1.6×
MRA head w & w/o contrast (70546) $2,912.70 $4,161 8.7×
MRA head w/o contrast (70544) $1,789.20 $2,556 7.8×
MRA head with contrast (70545) $1,854.30 $2,649 5.6×
MRA neck w contrast (70548) $1,854.30 $2,649 5.6×
Mra Neck W/O &W/Contrast Material (70549) $2,669.80 $3,814 8.0×
MRA neck w/o contrast (70547) $1,789.90 $2,557 7.8×
MRI abdomen w contrast (74182) $2,236.50 $3,195 6.7×
MRI abdomen w/o & w/contrast material (74183) $3,143 $4,490 9.4×
MRI abdomen w/o contrast (74181) $2,482.90 $3,547 10.9×
MRI any jnt lwr ext with con lt (73722) $2,328.90 $3,327 3.1×
MRI any jt upper extremity w/contrast matrl (73222) $2,158.80 $3,084 2.9×
MRI c-spine with contrast (72142) $2,316.30 $3,309 6.9×
MRI cervical spine w/o contrast (72141) $2,636.20 $3,766 11.6×
MRI chest w/o & w/contrast material (71552) $2,431.10 $3,473 7.3×
MRI chest w/o contrast (71550) $1,915.20 $2,736 8.4×
MRI chest with contrast (71551) $2,071.30 $2,959 2.8×
MRI Forearm w/ Contrast Bilateral 73219 (73219) $2,158.80 $3,084 6.5×
MRI lower extrem oth/thn jt w/contrast matrl (73719) $1,537.90 $2,197 4.6×
MRI lower extrem oth/thn jt w/o contr matrl (73718) $2,461.20 $3,516 10.8×
MRI orbit face &/neck w/o contrast (70540) $1,675.10 $2,393 7.3×
MRI orbit/face/neck w&w/o cont (70543) $2,431.10 $3,473 7.3×
MRI orbit/face/neck w/contrast (70542) $2,225.30 $3,179 6.7×
MRI pelvis w contrast (72196) $2,232.30 $3,189 6.7×
MRI pelvis w/o & w/contrast material (72197) $2,552.90 $3,647 7.7×
MRI pelvis w/o contrast (72195) $2,400.30 $3,429 10.5×
MRI scan of arm joint before and after contrast (73223) $2,524.90 $3,607 7.6×
MRI scan of leg joint before and after contrast (73723) $3,028.20 $4,326 9.1×
MRI spinal canal cervical w/o & w/contr matrl (72156) $3,493 $4,990 10.5×
MRI spinal canal lumbar w/contrast material (72149) $2,524.90 $3,607 7.6×
MRI spinal canal lumbar w/o & w/contr matrl (72158) $3,493 $4,990 10.5×
MRI spinal canal thoracic w/contrast matrl (72147) $2,054.50 $2,935 6.2×
MRI spinal canal thoracic w/o & w/contr matrl (72157) $3,493 $4,990 10.5×
MRI thoracic spine w/o contrast (72146) $2,662.80 $3,804 11.7×
MRI tmj (70336) $1,977.50 $2,825 8.7×
MRI upper ext joint w/o contrast (73221) $2,645.30 $3,779 11.6×
MRI upper extrem other than jt w/o & w/contras (73220) $2,464.70 $3,521 7.4×
MRI upper extremity oth than jt w/o contr matrl (73218) $2,659.30 $3,799 11.7×
Myocardial Spect Multiple Studies (78452) $5,637.10 $8,053 4.6×
Neck soft tissue (70360) $236.60 $338 2.8×
Nm gastric emptying study (78264) $707.70 $1,011 1.9×
Nuclear medicine study of kidney and blood flow (78701) $1,687 $2,410 4.4×
Nuclear Rx Oral Admin (79005) $1,098.30 $1,569 4.9×
Ob Us Follow-Up Per Fetus - Us Ob Follow Up Transabdominal Approach (76816) $436.80 $624 4.4×
Osseous survey infant (77076) $182.70 $261 1.8×
Osseous survey limited (77074) $275.10 $393 2.8×
Parathyroid imaging (78070) $1,331.40 $1,902 3.5×
Pelvis 1 or 2 views (72170) $266.70 $381 2.7×
Pr gi endoscopic ultrasound (76975) $688.10 $983 3.0×
Pr MRI, lower extr, w/o contrast f/u by contrast (73720) $2,312.10 $3,303 6.9×
Pulmonary Perfusion Imaging Particulate (78580) $1,579.20 $2,256 4.1×
Pulmonary Ventilation & Perfusion Imaging (78582) $1,579.90 $2,257 3.0×
Radex abscess/fistula/sinus tract rs&i (76080) $566.30 $809 1.1×
Radex mastoids compl minimum 3 views pr side (70130) $203 $290 2.0×
Radiolog exam mandible compl minimum 4 views (70110) $320.60 $458 3.2×
Radiologic Exam Abdomen 1 View - Xr Abdomen 1 View (74018) $214.90 $307 2.6×
Radiologic Exam Chest 2 Views - Xr Chest 2 Views (71046) $244.30 $349 2.9×
Radiologic exam colon single contrast study (74270) $306.25 $437.50 1.8×
Radiologic exam upr gi trc double contrast study (74246) $567.70 $811 3.4×
Radiologic exam upr gi trc single contrast study (74240) $497.70 $711 3.0×
Radiologic Examination Femur Minimum 2 Views - Xr Femur 2+ Vw Lt (73552) $149.10 $213 1.8×
Radiologic Examination Salivary Gland Calculus (70380) $182.70 $261 2.2×
Radiological examination surgical specimen (76098) $756 $1,080 1.4×
Ribs bilateral 3 views (71110) $377.30 $539 3.8×
Rp loclzj tum plnr whole body single day imaging (78802) $1,212.40 $1,732 2.3×
Rp loclzj tum spect 1 area single day imaging (78803) $1,416.80 $2,024 2.7×
Sacroiliac Joints < 3 Views (72200) $184.80 $264 1.8×
Scanogram (77073) $305.90 $437 3.1×
Scapula complete (73010) $244.30 $349 2.4×
Screening digital breast tomosynthesis (77063) $67.20 $96 2.9×
Small bowel series (74250) $241.50 $345 1.4×
Spine thoracic 3 views (72072) $182.70 $261 1.8×
Testicular Imaging With Vascular Flow (78761) $747.60 $1,068 2.0×
Thoracolumbar 2 views (72080) $247.80 $354 3.0×
Thyroid carcinoma metastases img whole body (78018) $674.80 $964 1.3×
Thyroid Imaging With Vascular Flow (78013) $791.70 $1,131 2.1×
Thyroid uptake measurement (78012) $567.70 $811 1.5×
Thyroid Uptake W/Blood Flow Sngle/Mult Quan Meas (78014) $921.90 $1,317 2.4×
Tmj unilateral (70328) $104.30 $149 1.3×
Tomogram (76100) $707.70 $1,011 7.1×
Tumor Imaging, Limited Area - Nm Tumor Localization Limited (78800) $1,201.20 $1,716 3.1×
Ultrasound, abdomen limited (76705) $688.10 $983 6.9×
Umbilical-artery Doppler (OB) (76820) $163.80 $234 1.6×
Unlisted magnetic resonance procedure (76498) $2,431.10 $3,473 29.2×
Upper Extremity Infant (73092) $182.70 $261 1.8×
Ureteral Reflux Study Rp Voiding Cystogram (78740) $1,187.90 $1,697 3.1×
Urethrocystography retrograde rs&i (74450) $525 $750 2.3×
Urethrocystography voiding (74455) $566.30 $809 2.5×
Urography (pyelography), intravenous, with or without KUB, with or without tomography (74400) $733.60 $1,048 4.4×
Urograpy infusion drip &/bolus techq w/wo tomo (74415) $1,041.60 $1,488 6.2×
Us abdl aorta screen aaa (76706) $401.80 $574 4.0×
Us breast unilateral complete (76641) $241.50 $345 2.4×
Us breast unilateral limited (76642) $210 $300 2.5×
Us infant hips dynamic (76885) $441.70 $631 5.3×
Us ob transvaginal (76817) $431.90 $617 4.3×
Us pelvic non ob complete (76856) $668.50 $955 6.7×
Us pelvic nonobstetric image dcmtn limited/f/u (76857) $165.90 $237 1.7×
Us pregnancy ltd (76815) $288.05 $411.50 2.9×
Us pregnant uterus 14 wk transabdl 1/1st gestat (76801) $451.50 $645 4.5×
Us retroperitoneal complete (76770) $475.30 $679 4.8×
Us retroperitoneal limited (76775) $488.60 $698 4.9×
Us scrotum and contents (76870) $515.20 $736 5.2×
Us soft tissue head/neck (76536) $555.80 $794 5.6×
Us spinal canal and contents (76800) $334.60 $478 3.3×
Us transrectal (76872) $436.10 $623 4.4×
Us xtr non-vasc lmtd (76882) $441.70 $631 4.4×
Us, eye b-scan (76512) $459.20 $656 4.6×
Vascular flow imaging (78445) $566.30 $809 1.5×
Vasogram (74440) $427.70 $611 1.9×
Vertebral fracture assessment via dxa (77086) $109.20 $156 1.3×
Wrist 2 views (73100) $233.80 $334 2.8×
X-Ray Abdomen,Comp Acute Series - Xr Abdomen 2 Vws With Chest 1 View (74022) $413.70 $591 4.1×
X-Ray Ac Jts - Xr Acromioclavicular Joints Bilateral (73050) $275.80 $394 3.3×
X-Ray Ankle 3+ Vw - Xr Ankle 3+ Views Right (73610) $339.50 $485 4.1×
X-Ray Colon Air Contrast - Fl Barium Enema Air Contrast (74280) $706.30 $1,009 4.2×
X-Ray Elbow 2 Vw - Xr Elbow 1-2 Views Right (73070) $202.30 $289 2.4×
X-Ray Elbow 3+ Vw - Xr Elbow 3+ Views Right (73080) $279.30 $399 3.4×
X-ray exam hip uni 1 view (73501) $111.30 $159 1.3×
X-Ray Exam Hip Uni 2-3 Views (73502) $140.35 $200.50 1.7×
X-ray exam hip uni 4/> views (73503) $213.50 $305 2.1×
X-Ray Exam Hips Bi 5/> Views (73523) $265.30 $379 2.7×
X-ray exam of small bowel - fl small bowel series enteroclysis tube (74251) $334.60 $478 2.0×
X-ray eye for foreign body (70030) $273.70 $391 3.3×
X-Ray Facial Bones 3+ Vw - Xr Facial Bones 3+ Views (70150) $339.50 $485 3.4×
X-Ray Facial Bones <3 Vw - Xr Facial Bones 1-2 Views (70140) $206.50 $295 2.5×
X-Ray Foot 3+ Vw - Xr Foot 3+ Views Right (73630) $339.50 $485 4.1×
X-Ray Heel - Xr Calcaneus 2 Views Right (73650) $233.10 $333 2.8×
X-ray IV pyelogram+drip infusn (74410) $733.60 $1,048 4.4×
X-Ray Jaw <4 Vw - Xr Mandible < 4 Views (70100) $237.30 $339 2.9×
X-Ray Knee 4+ View - Xr Knee 4+ Views Right (73564) $342.30 $489 3.4×
X-Ray Knee Bilat Standing - Xr Knees Anteroposterior Standing Bilat (73565) $116.20 $166 1.4×
X-Ray Leg, Infant - Xr Lower Extremity 2+ Views Infant Left (73592) $182.70 $261 2.2×
X-Ray Lumbar Spine 2/3 Vw - Xr Lumbar Spine 2-3 Views (72100) $282.80 $404 2.8×
X-Ray Lumbar Spine 6+ Vw - Xr Lumbar Spine 6+ Vws Including Bending (72114) $560 $800 5.6×
X-Ray Lumbar Spine Flex/Exten - Xr Lumbar Spine 4+ Views W/ Flex Ext (72120) $182.70 $261 1.8×
X-Ray Nasal Bones - Xr Nasal Bones (70160) $247.80 $354 3.0×
X-Ray Nose-Rectum Child F.B. - Xr Nose to Rectum Foreign Body Peds (76010) $201.60 $288 2.4×
X-Ray Orbits - Xr Orbits Complete 4+ Views (70200) $385.70 $551 3.9×
X-Ray Pelvis 3+ Vw - Xr Pelvis 3+ Views (72190) $314.30 $449 3.1×
X-Ray Retrograde Pyelogram - Fl Pyelogram Retrograde (74420) $515.20 $736 1.5×
X-Ray Ribs 2 Vw Unilat - Xr Ribs 2 Views Right (71100) $345.80 $494 4.2×
X-Ray Ribs, Chest 3+ Vw - Xr Ribs 2 Vws Lt W/ Chest Anteroposterior (71101) $275.10 $393 2.8×
X-Ray Ribs, Chest 4+ Vw - Xr Ribs 3 Vws Bil W/ Chest Posteroanterior (71111) $403.20 $576 4.0×
X-Ray Sacroiliac Jts 3+ Vw - Xr Sacroiliac Joints 3+ Views (72202) $343.70 $491 3.4×
X-Ray Sacrum/Coccyx 2+ Vw - Xr Sacrum Coccyx 2+ Views (72220) $228.20 $326 2.7×
X-Ray Shoulder 2+ Vw - Xr Shoulder 2+ Views Right (73030) $320.60 $458 3.9×
X-Ray Sinuses 3+ Vw - Xr Paranasal Sinuses 3+ Views (70220) $378 $540 4.5×
X-Ray Sinuses <3 Vw - Xr Paranasal Sinuses 1-2 Views (70210) $256.90 $367 3.1×
X-Ray Skull 4+ Vw - Xr Skull Complete 4+ Views (70260) $468.30 $669 4.7×
X-Ray Skull <4 Vw - Xr Skull 1-3 Views (70250) $385.70 $551 3.9×
X-Ray Spine One View - Xr Spine (72020) $180.60 $258 2.2×
X-Ray Sterno-Clavicluar Jt - Xr Sternoclavicular Joints 3+ Views (71130) $207.20 $296 2.5×
X-Ray Sternum 2+ Vw - Xr Sternum 2+ Views (71120) $202.30 $289 2.4×
X-Ray Thoracic Spine 2 Vw - Xr Thoracic Spine 2 Views (72070) $282.10 $403 2.8×
X-Ray Toe(S) - Xr Toes 2+ Views Right (73660) $179.20 $256 2.2×
X-Ray Wrist 3+ Vw - Xr Wrist 3+ Views Right (73110) $341.60 $488 4.1×
Xr c-spine 6 or more views (72052) $621.60 $888 6.2×
Xr chest 4+ views (71048) $267.40 $382 2.7×
Xr Cholecystography Oral Contrast (74290) $287.70 $411 1.7×
Xr finger(s) 2+ views (73140) $166.60 $238 2.0×
Xr optic foramina (70190) $177.80 $254 2.1×
Xr shoulder 1 view (73020) $177.80 $254 2.1×
Xr spine cervical 4 or 5 views (72050) $525.70 $751 5.3×
Xr tibia/fibula 2 views (73590) $271.60 $388 3.3×
Xr tmj bilateral (70330) $242.90 $347 2.9×
Xray knee 1 or 2 views rt (73560) $236.60 $338 2.8×