Imaging prices at SSM Health St. Anthony Hospital - Shawnee

Shawnee, OK · every code in this section with a posted price and a Medicare benchmark.

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

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ProcedureCash priceGross charge× Medicare
3-D radiotherapy plan dose-volume histograms (77295) $1,975.60 $3,592 1.5×
Abdomen 2 views (74019) $292.05 $531 2.9×
Acute gastrointestinal blood loss imaging (78278) $759 $1,380 2.0×
Angiography extremity bilateral rs&i (75716) $1,977.25 $3,595 0.7×
Angiography extremity unilateral rs&i (75710) $1,751.20 $3,184 0.6×
Angiography pulmonary bilateral slctv rs&i (75743) $1,751.20 $3,184 0.6×
Angiography visceral slctv/supraslctv rs&i (75726) $2,917.20 $5,304 0.5×
Angrph Cath F-Up Std Tcat Other Than Thrombylsis (75898) $1,751.20 $3,184 0.6×
Ankle 2 views (73600) $287.65 $523 3.4×
Antegrade urography radiological supvj & interpj (74425) $433.95 $789 1.3×
Aortogram thoracic (75605) $2,917.20 $5,304 0.5×
Aortography abdl bi iliofem low extrem cath rs&i (75630) $2,428.25 $4,415 0.8×
Aortography abdominal serialography rs&i (75625) $2,115.85 $3,847 0.7×
Arthrogram elbow (73085) $620.95 $1,129 1.9×
Arthrogram hip (73525) $440 $800 1.3×
Arthrogram shoulder (73040) $388.85 $707 1.2×
Arthrogram wrist (73115) $492.25 $895 1.5×
Arthrography knee lt (73580) $568.70 $1,034 1.7×
Basic radiation dosimetry calculation (77300) $275.55 $501 2.1×
Bone &/Joint Imaging Limited Area (78300) $389.40 $708 1.0×
Bone &/joint imaging whole body (78306) $961.40 $1,748 2.5×
Bone age studies (77072) $207.35 $377 2.1×
Bone Imaging 3 Phase (78315) $1,095.05 $1,991 2.8×
Bone survey complete (77075) $794.75 $1,445 7.9×
Brain Imaging Pet Metabolic Evaluation (78608) $2,175.80 $3,956 1.6×
Cervical spine 2 or 3 views (72040) $397.10 $722 4.7×
Chest 1 view (71045) $222.75 $405 2.7×
Chest 3 views (71047) $281.60 $512 3.4×
Cine/Vid X-Ray Throat/Esoph - Fl Esoph Barium Swlw W/ Video & Speech (74230) $668.80 $1,216 4.0×
Clavicle complete (73000) $308 $560 3.7×
Computed Tomography Thorax Lw Dose Lng Ca Scr C- (71271) $70.40 $128 0.7×
Continuing medical physics consltj pr wk (77336) $349.25 $635 2.7×
CT abdomen and pelvis without and with contrast (74178) $2,949.65 $5,363 8.8×
CT abdomen and pelvis without contrast (74176) $2,245.10 $4,082 9.8×
CT abdomen w contrast (74160) $1,647.25 $2,995 9.8×
CT abdomen w wo contrast (74170) $1,783.10 $3,242 10.6×
CT abdomen w/o contrast (74150) $1,234.20 $2,244 12.3×
CT angiography upper extremity lt (73206) $785.95 $1,429 4.7×
CT c-spine w/o contrast (72125) $1,994.85 $3,627 19.8×
CT cervical spine w&w/o contrast (72127) $2,568.50 $4,670 15.2×
CT cervical spine with contrast (72126) $2,446.40 $4,448 7.3×
CT chest w/wo contrast (71270) $1,619.75 $2,945 9.6×
CT chest with contrast (71260) $1,474.55 $2,681 8.7×
CT head/brain with contrast (70460) $1,288.65 $2,343 7.6×
CT head/brain without and with contrast (70470) $1,630.75 $2,965 9.7×
CT iac w contrast (70481) $1,177.55 $2,141 7.0×
CT lower ext w/o (73700) $1,801.25 $3,275 17.9×
CT lower extremity w wo contrast (73702) $2,011.90 $3,658 11.9×
CT lower extremity with contrast (73701) $1,137.40 $2,068 6.7×
CT lumbar spine w & w/o contrast (72133) $2,191.75 $3,985 13.0×
CT lumbar spine w/o contrast (72131) $1,829.30 $3,326 18.2×
CT lumbar spine with contrast (72132) $2,133.45 $3,879 6.4×
CT maxillofacial w contrast (70487) $1,096.15 $1,993 6.5×
CT maxillofacial w/o contrast (70486) $1,053.25 $1,915 10.5×
CT maxillofacial w/wo contrast (70488) $1,146.75 $2,085 6.8×
CT neck soft tissue w contrast (70491) $1,207.25 $2,195 7.2×
CT orbit sella/post fossa/ear w/o & w/contr matr (70482) $1,238.05 $2,251 7.3×
CT orbits w/o contrast (70480) $1,119.80 $2,036 11.1×
CT pelvis w & w/o contrast (72194) $1,348.05 $2,451 8.0×
CT pelvis w/o contrast (72192) $1,100.55 $2,001 10.9×
CT soft tissue neck w/o & w/contrast material (70492) $1,340.90 $2,438 7.9×
CT soft tissue neck w/o contrast (70490) $1,177 $2,140 11.7×
CT thoracic spine w/contrast (72129) $2,231.90 $4,058 13.2×
CT thoracic spine w/o contrast (72128) $1,707.20 $3,104 17.0×
CT thoracic spine w/wo contrast (72130) $2,241.25 $4,075 13.3×
CT thorax w/o contrast (71250) $1,472.90 $2,678 14.6×
CT upper extremity w/o & w/contrast material (73202) $2,063.60 $3,752 12.2×
CT upper extremity w/o contrast rt (73200) $1,342 $2,440 13.3×
CT upper extremity with contrast (73201) $1,965.70 $3,574 5.9×
Cta Abdl Aorta&Bi Iliofem W/Contrast&Postp (75635) $785.95 $1,429 4.7×
Cta Abdomen (74175) $2,586.10 $4,702 15.3×
CTA abdomen pelvis (74174) $2,849.55 $5,181 8.5×
CTA chest (71275) $1,724.25 $3,135 10.2×
Cta Head (70496) $735.90 $1,338 4.4×
CTA lwr ext w&w/o contrast (73706) $785.95 $1,429 4.7×
Cta Neck (70498) $735.90 $1,338 4.4×
Cta Pelvis (72191) $897.60 $1,632 5.3×
Cystography minimum 3 views rs&i (74430) $514.25 $935 1.5×
Dxa bone density study 1/> sites axial skel (77080) $51.68 $93.97 0.5×
Echoencephalography real time imaging (76506) $519.75 $945 5.2×
Esophagus (74220) $369.60 $672 2.2×
Fetal Biophysical Profile W/O Non-Stress Testing (76819) $214.50 $390 2.1×
Fluoroscopy up to 1 hr (76000) $204.60 $372 0.9×
Foot 2 views (73620) $238.70 $434 2.9×
Forearm 2 views (73090) $319 $580 3.8×
Gated Heart Planar Single (78472) $838.20 $1,524 2.2×
Hand 2 views (73120) $234.30 $426 2.3×
Hand 3 views (73130) $297.55 $541 3.6×
Hepatobil Syst Imag Inc Gb W/Pharma Intervenj (78227) $1,388.20 $2,524 2.7×
Hepatobiliary syst imaging including gallbladder (78226) $574.75 $1,045 1.5×
Ht muscle image spect sing (78451) $1,863.40 $3,388 1.5×
Humerus Min 2 Views Left (73060) $346.50 $630 4.1×
Hysterosalpingogram (74740) $408.10 $742 1.8×
Kidney Img Morphology Vascular Flow 1 W/O Rx (78707) $1,518 $2,760 2.9×
Kidney img morphology vascular flow 1 w/rx (78708) $1,531.20 $2,784 2.9×
Knee 3 views (73562) $388.30 $706 4.6×
Lymphoscintigraphy (78195) $669.90 $1,218 1.3×
Mammary ductogram or galactogram single (77053) $437.25 $795 1.9×
Meckels Diverticulum (78290) $873.95 $1,589 2.3×
Mlc imrt design & construction per imrt plan (77338) $627.55 $1,141 1.7×
MRA head w & w/o contrast (70546) $3,317.60 $6,032 9.9×
MRA head w/o contrast (70544) $1,353 $2,460 5.9×
MRA neck w contrast (70548) $1,599.95 $2,909 4.8×
Mra Neck W/O &W/Contrast Material (70549) $1,904.10 $3,462 5.7×
MRA neck w/o contrast (70547) $290.95 $529 1.3×
MRI abdomen w/o & w/contrast material (74183) $2,861.10 $5,202 8.5×
MRI abdomen w/o contrast (74181) $1,574.10 $2,862 6.9×
MRI any jnt lwr ext with con lt (73722) $1,758.35 $3,197 2.3×
MRI any jt upper extremity w/contrast matrl (73222) $1,791.35 $3,257 2.4×
MRI breast w/o contrast bilateral (77047) $1,408.55 $2,561 6.1×
MRI c-spine with contrast (72142) $2,141.70 $3,894 6.4×
MRI cervical spine w/o contrast (72141) $1,824.90 $3,318 8.0×
MRI chest w/o & w/contrast material (71552) $2,417.80 $4,396 7.2×
MRI Forearm w/ Contrast Bilateral 73219 (73219) $1,767.70 $3,214 5.3×
MRI lower extrem oth/thn jt w/contrast matrl (73719) $1,649.45 $2,999 4.9×
MRI lower extrem oth/thn jt w/o contr matrl (73718) $1,529 $2,780 6.7×
MRI orbit face &/neck w/o contrast (70540) $1,883.20 $3,424 8.2×
MRI orbit/face/neck w&w/o cont (70543) $3,419.90 $6,218 10.2×
MRI pelvis w/o & w/contrast material (72197) $3,076.70 $5,594 9.2×
MRI pelvis w/o contrast (72195) $1,695.10 $3,082 7.4×
MRI scan of arm joint before and after contrast (73223) $1,947.55 $3,541 5.8×
MRI scan of leg joint before and after contrast (73723) $2,861.10 $5,202 8.5×
MRI spinal canal cervical w/o & w/contr matrl (72156) $2,218.70 $4,034 6.6×
MRI spinal canal lumbar w/contrast material (72149) $1,934.35 $3,517 5.8×
MRI spinal canal lumbar w/o & w/contr matrl (72158) $2,141.70 $3,894 6.4×
MRI spinal canal thoracic w/contrast matrl (72147) $1,934.35 $3,517 5.8×
MRI spinal canal thoracic w/o & w/contr matrl (72157) $2,241.25 $4,075 6.7×
MRI thoracic spine w/o contrast (72146) $1,895.30 $3,446 8.3×
MRI upper ext joint w/o contrast (73221) $1,535.16 $2,791.20 6.7×
MRI upper extrem other than jt w/o & w/contras (73220) $2,868.25 $5,215 8.5×
MRI upper extremity oth than jt w/o contr matrl (73218) $1,576.85 $2,867 6.9×
Myelogram Cervical (72240) $876.70 $1,594 1.2×
Myelogram Lumbar (72265) $1,024.10 $1,862 1.4×
Myocardial Spect Multiple Studies (78452) $2,020.15 $3,673 1.6×
Neck soft tissue (70360) $301.95 $549 3.6×
Nm gastric emptying study (78264) $1,154.45 $2,099 3.0×
Ntsty modul radthx pln dose-vol histos (77301) $3,084.40 $5,608 2.3×
Nuclear Rx Oral Admin (79005) $377.30 $686 1.7×
Ob Us Follow-Up Per Fetus - Us Ob Follow Up Transabdominal Approach (76816) $323.95 $589 3.2×
Osseous survey infant (77076) $993.85 $1,807 9.9×
Osseous survey limited (77074) $500.50 $910 5.0×
Parathyroid imaging (78070) $444.95 $809 1.2×
Pelvis 1 or 2 views (72170) $311.30 $566 3.1×
PET image w/CT, skull-thigh (78815) $1,886.50 $3,430 1.4×
PET imaging CT for attenuation limited area (78814) $1,886.50 $3,430 1.4×
PET imaging for CT attenuation whole body (78816) $1,886.50 $3,430 1.4×
Pr MRI, lower extr, w/o contrast f/u by contrast (73720) $1,714.90 $3,118 5.1×
Pulmonary Perfusion Imaging Particulate (78580) $934.45 $1,699 2.4×
Pulmonary Ventilation & Perfusion Imaging (78582) $922.90 $1,678 1.8×
Radex abscess/fistula/sinus tract rs&i (76080) $374 $680 0.7×
Radex Entir Thrc Lmbr Crv Sac Spi W/Skull 1 Vw - Xr Scoliosis 1 Vw (72081) $103.95 $189 1.2×
Radex entir thrc lmbr crv sac spi w/skull 2/3 vw (72082) $156.20 $284 1.6×
Radex hips bilateral with pelvis 2 views (73521) $482.35 $877 4.8×
Radex X-Ray Exam Entire Spi 6/> Vw - Xr Entire Spine 6+ Vw (72084) $372.35 $677 3.7×
Radiation treatment delivery 1 mev >= complex (77412) $436.70 $794 0.8×
Radiation treatment delivery 1 mev >= simple (77402) $253.55 $461 2.6×
Radiolog exam mandible compl minimum 4 views (70110) $302.50 $550 3.0×
Radiologic Exam Abdomen 1 View - Xr Abdomen 1 View (74018) $232.65 $423 2.8×
Radiologic Exam Chest 2 Views - Xr Chest 2 Views (71046) $250.25 $455 3.0×
Radiologic exam colon single contrast study (74270) $492.25 $895 2.9×
Radiologic Exam Esophagus Double Contrast Study (74221) $395.45 $719 2.3×
Radiologic exam upr gi trc double contrast study (74246) $398.20 $724 2.4×
Radiologic exam upr gi trc single contrast study (74240) $367.95 $669 2.2×
Radiologic Examination Femur Minimum 2 Views - Xr Femur 2+ Vw Lt (73552) $441.10 $802 5.3×
Radiological examination surgical specimen (76098) $364.65 $663 0.7×
Ribs bilateral 3 views (71110) $334.40 $608 3.3×
Rp loclzj tum plnr whole body single day imaging (78802) $1,172.05 $2,131 2.2×
Rp loclzj tum spect 1 area single day imaging (78803) $1,739.10 $3,162 3.3×
Rp Therapy Intravenous Administration (79101) $509.30 $926 2.3×
Sacroiliac Joints < 3 Views (72200) $323.40 $588 3.2×
Scapula complete (73010) $312.95 $569 3.1×
Screening digital breast tomosynthesis (77063) $70.95 $129 3.0×
Shuntogram indwelling nonvascular shunt rs&i (75809) $411.95 $749 4.1×
Small bowel series (74250) $359.15 $653 2.1×
Spec medical radj physics consltj (77370) $397.65 $723 3.1×
Spec telethx port pln parts hemibdy tot bdy (77321) $471.35 $857 1.3×
Special dosimetry (77331) $209 $380 1.6×
Special treatment procedure (77470) $1,084.60 $1,972 2.0×
Spine thoracic 3 views (72072) $437.25 $795 4.3×
Tbs Technical Calculation Only (77091) $128.70 $234 1.5×
Telethx isodose pln cplx w/basic dosimetry (77307) $636.35 $1,157 1.8×
Telethx isodose pln smpl w/dosimetry calculation (77306) $334.40 $608 0.9×
Ther rad simulaj-aided field setting complex (77290) $785.95 $1,429 2.2×
Ther rad simulaj-aided field setting simple (77280) $430.65 $783 3.3×
Thoracolumbar 2 views (72080) $292.60 $532 3.5×
Thyroid carcinoma metastases img whole body (78018) $902 $1,640 1.7×
Thyroid Uptake W/Blood Flow Sngle/Mult Quan Meas (78014) $586.85 $1,067 1.5×
Treatment devices simple (77332) $234.85 $427 1.8×
Tx devices design & construction complex (77334) $624.25 $1,135 1.7×
Ultrasound, abdomen limited (76705) $504.35 $917 5.0×
Umbilical-artery Doppler (OB) (76820) $168.85 $307 1.7×
Upper Extremity Infant (73092) $223.30 $406 2.2×
Urethrocystography retrograde rs&i (74450) $374 $680 1.6×
Urethrocystography voiding (74455) $433.95 $789 1.9×
Urography (pyelography), intravenous, with or without KUB, with or without tomography (74400) $164.45 $299 1.0×
Us abdl aorta screen aaa (76706) $485.65 $883 4.8×
Us breast unilateral complete (76641) $395.45 $719 3.9×
Us breast unilateral limited (76642) $365.75 $665 4.4×
Us chest (76604) $506 $920 5.0×
Us compl joint r-t w/image documentation (76881) $418.55 $761 4.2×
Us kidney transplant (76776) $702.35 $1,277 7.0×
Us ob transvaginal (76817) $526.35 $957 5.2×
Us pelvic non ob complete (76856) $454.30 $826 4.5×
Us pelvic nonobstetric image dcmtn limited/f/u (76857) $317.90 $578 3.2×
Us pregnancy ltd (76815) $452.10 $822 4.5×
Us pregnant uterus 14 wk transabdl 1/1st gestat (76801) $440.55 $801 4.4×
Us retroperitoneal complete (76770) $547.80 $996 5.4×
Us retroperitoneal limited (76775) $436.15 $793 4.3×
Us scrotum and contents (76870) $506 $920 5.0×
Us soft tissue head/neck (76536) $457.05 $831 4.5×
Us spinal canal and contents (76800) $372.35 $677 3.7×
Us xtr non-vasc lmtd (76882) $319 $580 3.2×
Venogram extremity bilateral (75822) $2,154.90 $3,918 1.4×
Venography caval inferior serialography rs&i (75825) $1,751.20 $3,184 0.6×
Venography caval superior serialography rs&i (75827) $1,532.85 $2,787 1.0×
Wrist 2 views (73100) $244.20 $444 2.9×
X-Ray Abdomen,Comp Acute Series - Xr Abdomen 2 Vws With Chest 1 View (74022) $518.65 $943 5.2×
X-Ray Ac Jts - Xr Acromioclavicular Joints Bilateral (73050) $386.10 $702 4.6×
X-Ray Ankle 3+ Vw - Xr Ankle 3+ Views Right (73610) $338.25 $615 4.0×
X-Ray Colon Air Contrast - Fl Barium Enema Air Contrast (74280) $560.45 $1,019 3.3×
X-Ray Elbow 2 Vw - Xr Elbow 1-2 Views Right (73070) $323.95 $589 3.9×
X-Ray Elbow 3+ Vw - Xr Elbow 3+ Views Right (73080) $372.35 $677 4.4×
X-ray exam entire spi 4/5 vw (72083) $328.90 $598 3.3×
X-ray exam hip uni 1 view (73501) $291.50 $530 3.5×
X-Ray Exam Hip Uni 2-3 Views (73502) $328.35 $597 3.9×
X-ray exam hip uni 4/> views (73503) $494.45 $899 4.9×
X-Ray Exam Hips Bi 3-4 Views (73522) $493.35 $897 4.9×
X-Ray Exam Hips Bi 5/> Views (73523) $674.30 $1,226 6.7×
X-ray exam of femur 1 (73551) $383.35 $697 4.6×
X-Ray Facial Bones 3+ Vw - Xr Facial Bones 3+ Views (70150) $411.95 $749 4.1×
X-Ray Facial Bones <3 Vw - Xr Facial Bones 1-2 Views (70140) $308 $560 3.7×
X-Ray Foot 3+ Vw - Xr Foot 3+ Views Right (73630) $311.30 $566 3.7×
X-Ray Heel - Xr Calcaneus 2 Views Right (73650) $228.80 $416 2.7×
X-Ray Jaw <4 Vw - Xr Mandible < 4 Views (70100) $64.35 $117 0.8×
X-Ray Knee 4+ View - Xr Knee 4+ Views Right (73564) $414.70 $754 4.1×
X-Ray Knee Bilat Standing - Xr Knees Anteroposterior Standing Bilat (73565) $410.30 $746 4.9×
X-Ray Leg, Infant - Xr Lower Extremity 2+ Views Infant Left (73592) $329.45 $599 3.9×
X-Ray Lumbar Spine 2/3 Vw - Xr Lumbar Spine 2-3 Views (72100) $386.86 $703.38 3.8×
X-Ray Lumbar Spine 6+ Vw - Xr Lumbar Spine 6+ Vws Including Bending (72114) $530.20 $964 5.3×
X-Ray Lumbar Spine Flex/Exten - Xr Lumbar Spine 4+ Views W/ Flex Ext (72120) $370.15 $673 3.7×
X-Ray Nasal Bones - Xr Nasal Bones (70160) $309.10 $562 3.7×
X-Ray Nose-Rectum Child F.B. - Xr Nose to Rectum Foreign Body Peds (76010) $214.50 $390 2.6×
X-Ray Orbits - Xr Orbits Complete 4+ Views (70200) $365.20 $664 3.6×
X-Ray Pelvis 3+ Vw - Xr Pelvis 3+ Views (72190) $358.05 $651 3.6×
X-Ray Retrograde Pyelogram - Fl Pyelogram Retrograde (74420) $602.25 $1,095 1.8×
X-Ray Ribs 2 Vw Unilat - Xr Ribs 2 Views Right (71100) $325.60 $592 3.9×
X-Ray Ribs, Chest 3+ Vw - Xr Ribs 2 Vws Lt W/ Chest Anteroposterior (71101) $353.10 $642 3.5×
X-Ray Ribs, Chest 4+ Vw - Xr Ribs 3 Vws Bil W/ Chest Posteroanterior (71111) $386.65 $703 3.8×
X-Ray Sacroiliac Jts 3+ Vw - Xr Sacroiliac Joints 3+ Views (72202) $341 $620 3.4×
X-Ray Sacrum/Coccyx 2+ Vw - Xr Sacrum Coccyx 2+ Views (72220) $312.95 $569 3.7×
X-Ray Shoulder 2+ Vw - Xr Shoulder 2+ Views Right (73030) $375.10 $682 4.5×
X-Ray Sinuses 3+ Vw - Xr Paranasal Sinuses 3+ Views (70220) $425.70 $774 5.1×
X-Ray Sinuses <3 Vw - Xr Paranasal Sinuses 1-2 Views (70210) $235.30 $427.82 2.8×
X-Ray Skull 4+ Vw - Xr Skull Complete 4+ Views (70260) $469.15 $853 4.7×
X-Ray Skull <4 Vw - Xr Skull 1-3 Views (70250) $292.60 $532 2.9×
X-Ray Spine One View - Xr Spine (72020) $336.05 $611 4.0×
X-Ray Sterno-Clavicluar Jt - Xr Sternoclavicular Joints 3+ Views (71130) $323.40 $588 3.9×
X-Ray Sternum 2+ Vw - Xr Sternum 2+ Views (71120) $323.40 $588 3.9×
X-Ray Thoracic Spine 2 Vw - Xr Thoracic Spine 2 Views (72070) $282.15 $513 2.8×
X-Ray Thoracic Spine 4 Vw - Xr Thoracic Spine Complete 4+ Views (72074) $534.05 $971 5.3×
X-Ray Toe(S) - Xr Toes 2+ Views Right (73660) $241.45 $439 2.9×
X-Ray Wrist 3+ Vw - Xr Wrist 3+ Views Right (73110) $303.05 $551 3.6×
Xr c-spine 6 or more views (72052) $515.35 $937 5.1×
Xr finger(s) 2+ views (73140) $223.30 $406 2.7×
Xr shoulder 1 view (73020) $259.05 $471 3.1×
Xr spine cervical 4 or 5 views (72050) $457.05 $831 4.5×
Xr tibia/fibula 2 views (73590) $339.90 $618 4.1×
Xr tmj bilateral (70330) $323.40 $588 3.9×
Xray knee 1 or 2 views rt (73560) $298.65 $543 3.6×