Imaging prices at St. Mary's Good Samaritan Hospital
Greensboro, GA · every code in this section with a posted price and a Medicare benchmark.
201 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) | $116.35 | $179 | 1.5× |
| Abdomen 2 views (74019) | $247.65 | $381 | 2.7× |
| Acute Gastrointestinal Blood Loss Imaging (78278) | $1,146.60 | $1,764 | 3.3× |
| Ankle 2 views (73600) range across 3 matching MRF lines |
$115.05–$172.90 | $177–$266 | varies |
| Bone age studies (77072) | $195.65 | $301 | 2.1× |
| Bone Imaging 3 Phase (78315) | $1,326 | $2,040 | 3.8× |
| Bone Imaging Whole Body (78306) | $1,563.25 | $2,405 | 4.5× |
| Cardiac MRI w/w/o contrast & further seq (75561) | $768.95 | $1,183 | 2.5× |
| Chest 1 view (71045) | $18,835.83 | — | 247.0× |
| Chest 2 views (71046) | $154.05 | $237 | 2.0× |
| Chest 3 views (71047) | $193.70 | $298 | 2.5× |
| Clavicle complete (73000) range across 3 matching MRF lines |
$127.40–$191.10 | $196–$294 | varies |
| Computed Tomography Thorax Lw Dose Lng Ca Scr C- (71271) | $276.90 | $426 | 3.0× |
| Contrast X-Ray Bladder (74430) | $772.20 | $1,188 | 2.5× |
| CT abdomen and pelvis without and with contrast (74178) | $1,376.70 | $2,118 | 4.5× |
| CT abdomen and pelvis without contrast (74176) | $1,138.15 | — | 5.4× |
| CT abdomen w contrast (74160) | $1,386.45 | $2,133 | 9.0× |
| CT abdomen w wo contrast (74170) | $1,567.80 | $2,412 | 10.2× |
| CT abdomen w/o contrast (74150) | $1,341.60 | $2,064 | 14.6× |
| CT Angio Abdomen and Pelvis (74174) | $1,431.30 | $2,202 | 4.7× |
| CT Angio Chest (71275) | $2,157.35 | $3,319 | 14.0× |
| CT Angio Head (70496) | $1,556.10 | $2,394 | 10.1× |
| CT angio hrt w/3d image (75574) | $780 | $1,200 | 2.6× |
| Ct Angio Lwr Extr W/O&W/Dye (73706) range across 3 matching MRF lines |
$1,793.35–$2,690.35 | $2,759–$4,139 | varies |
| CT Angio Neck (70498) | $1,472.25 | $2,265 | 9.6× |
| Ct Angio Upr Extrm W/O&W/Dye (73206) | $378.30 | $582 | 2.5× |
| CT Cere Prfuj Alys C+ W/O CT/Cta Same Anatomy (70473) | $96.85 | $149 | 0.6× |
| CT cervical spine w/o contrast (72125) | $1,134.90 | $1,746 | 12.4× |
| CT cervical spine w/wo cont (72127) | $2,055.30 | $3,162 | 13.4× |
| CT chest w contrast (71260) | $1,370.20 | $2,108 | 8.9× |
| CT chest w/wo contrast (71270) | $1,532.05 | $2,357 | 10.0× |
| CT head/brain with contrast (70460) | $378.30 | $582 | 2.5× |
| CT head/brain without and with contrast (70470) | $1,509.30 | $2,322 | 9.8× |
| CT heart contrast eval cardiac structure&morph (75572) | $716.30 | $1,102 | 2.3× |
| CT iac w contrast (70481) | $1,328.60 | $2,044 | 8.6× |
| CT lower ext w/o (73700) range across 6 matching MRF lines |
$1,105–$1,657.50 | $1,700–$2,550 | varies |
| CT lower extremity w/contrast material (73701) range across 3 matching MRF lines |
$1,457.95–$2,187.25 | $2,243–$3,365 | varies |
| CT lumbar spine w contrast (72132) | $1,347.45 | $2,073 | 4.4× |
| CT lumbar spine w/o contrast (72131) | $1,203.15 | $1,851 | 13.1× |
| CT maxillofacial w contrast (70487) | $1,316.90 | $2,026 | 8.6× |
| CT maxillofacial wo contrast (70486) | $1,236.95 | $1,903 | 13.5× |
| CT neck tissue combo (70492) | $1,580.15 | $2,431 | 10.3× |
| Ct Orbit/Ear/Fossa W/O&W/Dye (70482) | $1,404.65 | $2,161 | 9.1× |
| CT orbits w/o contrast (70480) | $1,237.60 | $1,904 | 13.5× |
| CT pelvis w&w/o contrast (72194) | $1,103.05 | $1,697 | 7.2× |
| CT pelvis w/o contrast (72192) | $1,357.20 | $2,088 | 14.8× |
| CT scan of leg combo (73702) | $1,523.60 | $2,344 | 9.9× |
| CT scans face/jaw combo (70488) | $1,365.65 | $2,101 | 8.9× |
| CT soft tissue neck w contrast (70491) | $1,494.35 | $2,299 | 9.7× |
| CT soft tissue neck w/o contrast (70490) | $1,393.60 | $2,144 | 15.2× |
| CT thoracic spine w contrast (72129) | $400.40 | $616 | 2.6× |
| CT thoracic spine w/o contrast (72128) | $1,218.75 | $1,875 | 13.3× |
| CT thorax w/o contrast (71250) | $1,279.20 | — | 14.0× |
| CT upper ext wo (73200) range across 6 matching MRF lines |
$1,030.90–$1,546.35 | $1,586–$2,379 | varies |
| CT upper extremity w/o & w/contrast material (73202) | $1,291.55 | $1,987 | 8.4× |
| CT upper extremity with contrast (73201) range across 3 matching MRF lines |
$1,474.20–$2,211.30 | $2,268–$3,402 | varies |
| Cta Abdl Aorta&Bi Iliofem W/Contrast&Postp (75635) | $1,574.30 | $2,422 | 10.2× |
| Cta Abdomen (74175) | $1,414.40 | $2,176 | 9.2× |
| CTA head&neck c+ w/noncontrast img&post-pxessing (70471) | $96.85 | $149 | 0.3× |
| CTA pelvis (72191) | $1,509.95 | $2,323 | 9.8× |
| Dxa Bone Density Axial (77080) | $372.45 | $573 | 4.1× |
| Dxa bone density study (77085) | $247.65 | $381 | 2.7× |
| Dxa bone density study 1/>sites appendiclr skel (77081) | $182.65 | $281 | 2.4× |
| Esophagram (74220) | $417.95 | $643 | 2.7× |
| Fluoroscopy up to 1 hr (76000) | $34,367.14 | — | 164.4× |
| Foot 2 views (73620) range across 3 matching MRF lines |
$188.50–$282.75 | $290–$435 | varies |
| Forearm 2 views (73090) range across 6 matching MRF lines |
$120.90–$181.35 | $186–$279 | varies |
| Gastric emptying imaging study (78264) | $1,194.05 | $1,837 | 3.4× |
| Hand 2 views (73120) range across 6 matching MRF lines |
$211.25–$330.85 | $325–$509 | varies |
| Hepatobil Syst Image W/Drug (78227) | $723.45 | $1,113 | 1.5× |
| Hepatobiliary System Imaging (78226) | $723.45 | $1,113 | 2.1× |
| Ht Muscle Image Spect Sing (78451) | $2,037.10 | $3,134 | 1.8× |
| Joint Survey Single View (77077) | $219.70 | $338 | 2.4× |
| K Flow/Funct Image W/Drug (78708) | $1,309.10 | $2,014 | 2.8× |
| K Flow/Funct Image W/O Drug (78707) | $1,122.55 | $1,727 | 2.4× |
| Knee 3 Views (73562) range across 6 matching MRF lines |
$313.30–$450.45 | $482–$693 | varies |
| Lung Ventilat&Perfus Imaging (78582) | $780.65 | $1,201 | 1.6× |
| MRA head w/o contrast (70544) range across 2 matching MRF lines |
$1,957.15–$2,622.68 | — | varies |
| Mra Neck W/O &W/Contrast Material (70549) | $2,525.25 | $3,885 | 8.3× |
| MRA neck w/o contrast (70547) | $1,693.25 | $2,605 | 8.1× |
| MRI abdomen w contrast (74182) | $768.95 | $1,183 | 2.5× |
| MRI abdomen w/o contrast (74181) | $1,854.45 | $2,853 | 8.9× |
| MRI any jt lower extrem w/o & w/contrast matrl (73723) range across 3 matching MRF lines |
$2,077.40–$3,253.90 | $3,196–$5,006 | varies |
| MRI any jt upper extremity w/contrast matrl (73222) range across 3 matching MRF lines |
$1,571.70–$2,357.55 | $2,418–$3,627 | varies |
| MRI Breast W/O Contrast Bilateral (77047) | $468 | $720 | 2.2× |
| MRI cardiac w/o contrast (75557) | $700.70 | $1,078 | 3.4× |
| MRI cervical spine w contrast (72142) | $2,770.30 | $4,262 | 9.1× |
| MRI cervical spine w/o cont (72141) | $1,389.05 | $2,137 | 6.6× |
| MRI chest wo w contrast (71552) | $2,022.15 | $3,111 | 6.6× |
| MRI lower extrem oth/thn jt w/o & w/contr matr (73720) range across 3 matching MRF lines |
$2,499.90–$3,749.85 | $3,846–$5,769 | varies |
| MRI lower extrem oth/thn jt w/o contr matrl (73718) range across 6 matching MRF lines |
$1,554.80–$2,332.20 | $2,392–$3,588 | varies |
| MRI lumbar spine w contrast (72149) | $2,088.45 | $3,213 | 6.8× |
| Mri Neck Spine W/O & W/Dye (72156) | $2,510.95 | $3,863 | 8.2× |
| MRI orbit face &/neck w/o contrast (70540) | $522.60 | $804 | 2.5× |
| MRI orbit face neck w contrast (70542) | $768.95 | $1,183 | 2.5× |
| Mri Orbt/Fac/Nck W/O &W/Dye (70543) | $2,432.30 | $3,742 | 8.0× |
| MRI pelvis w/o & w contrast (72197) | $2,307.50 | $3,550 | 7.5× |
| MRI pelvis w/o contrast (72195) | $1,469.65 | $2,261 | 7.0× |
| MRI thoracic spine w/o contrast (72146) | $1,877.20 | $2,888 | 9.0× |
| MRI upper extremity oth than jt w/o contr matrl (73218) range across 3 matching MRF lines |
$1,437.15–$2,156.05 | $2,211–$3,317 | varies |
| MRI, abdomen, combo (74183) | $2,392 | $3,680 | 7.8× |
| MRI, dorsal spine combo (72157) | $2,663.05 | $4,097 | 8.7× |
| MRI, joint upper extrem (73221) | $1,265.55 | — | 6.1× |
| MRI, joint upper extrem combo (73223) range across 3 matching MRF lines |
$2,018.25–$3,027.05 | $3,105–$4,657 | varies |
| MRI, lumbar spine combo (72158) | $2,217.80 | $3,412 | 7.3× |
| Myelogram Lumbar (72265) | $1,575.60 | $2,424 | 2.3× |
| Myocardial Spect Multiple Studies (78452) | $2,037.10 | $3,134 | 1.8× |
| N-invas est c ffr sw aly CTA (75580) | $3,120 | $4,800 | 4.1× |
| Neck soft tissue (70360) | $163.80 | $252 | 2.1× |
| Nonvascular Shunt X-Ray (75809) | $415.35 | $639 | 4.5× |
| Parathyroid Planar Imaging (78070) | $815.10 | $1,254 | 2.3× |
| Pelvis 1 or 2 views (72170) | $154.05 | $237 | 1.7× |
| Pulmonary Perfusion Imaging Particulate (78580) | $1,244.75 | $1,915 | 3.6× |
| Quan&Charac C Atherosclerotc Plaq Asses Sev C Ds (75577) | $3,120 | $4,800 | 3.8× |
| Radex Abd Compl Aqt Abd W/S/E/D Views 1 View Ch (74022) | $309.40 | $476 | 3.4× |
| Radex Ankle Complete Minimum 3 Views (73610) range across 6 matching MRF lines |
$163.80–$245.70 | $252–$378 | varies |
| Radex Calcaneus Minimum 2 Views (73650) range across 3 matching MRF lines |
$132.60–$198.90 | $204–$306 | varies |
| Radex elbow complete minimum 3 views (73080) range across 6 matching MRF lines |
$167.70–$251.55 | $258–$387 | varies |
| Radex Facial Bones Complete Minimum 3 Views (70150) | $260 | $400 | 2.8× |
| Radex fingr minimum 2 views (73140) range across 3 matching MRF lines |
$141.70–$213.20 | $218–$328 | varies |
| Radex foot complete minimum 3 views (73630) range across 6 matching MRF lines |
$170.95–$256.75 | $263–$395 | varies |
| Radex Hand Minimum 3 Views (73130) range across 6 matching MRF lines |
$170.95–$256.75 | $263–$395 | varies |
| Radex Nasal Bones Complete Minimum 3 Views (70160) | $195 | $300 | 2.6× |
| Radex Ribs Unilateral 2 Views (71100) | $193.70 | $298 | 2.5× |
| Radex shoulder complete minimum 2 views (73030) range across 9 matching MRF lines |
$122.85–$184.60 | $189–$284 | varies |
| Radex Sinuses Paransl < 3 Views (70210) | $194.35 | $299 | 2.5× |
| Radex Spine 1 View Specify Level (72020) | $184.60 | $284 | 2.4× |
| Radex Sternum Minimum 2 Views (71120) | $163.15 | $251 | 2.1× |
| Radex Temporomandble Jt Opn & Clsd Mouth Bilat (70330) | $176.80 | $272 | 2.3× |
| Radex Toe Minimum 2 Views (73660) range across 3 matching MRF lines |
$90.35–$135.85 | $139–$209 | varies |
| Radex upper extremity infant minimum 2 views (73092) | $83.85 | $129 | 0.9× |
| Radex Wrist Complete Minimum 3 Views (73110) range across 9 matching MRF lines |
$151.45–$227.50 | $233–$350 | varies |
| Radiolog exam mandible compl minimum 4 views (70110) | $247.65 | $381 | 2.7× |
| Radiologic Exam Abdomen 3+ Views - Xr Abdomen 3+ Views (74021) | $247 | $380 | 2.7× |
| Radiologic exam colon double contrast study (74280) | $671.45 | $1,033 | 4.4× |
| Radiologic exam knee complete 4/more views (73564) range across 3 matching MRF lines |
$317.20–$475.80 | $488–$732 | varies |
| Radiologic exam pelvis compl minimum 3 views (72190) | $196.30 | $302 | 2.1× |
| Radiologic Exam Small Int Single Contrast Study (74250) | $405.60 | $624 | 2.6× |
| Radiologic exam swallow function contrast study (74230) | $232.05 | $357 | 1.5× |
| Radiologic exam upr gi trc double contrast study (74246) | $622.70 | $958 | 4.1× |
| Radiologic examination femur minimum 2 views (73552) range across 3 matching MRF lines |
$131.95–$198.25 | $203–$305 | varies |
| Radiologic examination knee 1/2 views (73560) range across 9 matching MRF lines |
$151.45–$227.50 | $233–$350 | varies |
| Radiologic examination tibia & fibula 2 views (73590) range across 6 matching MRF lines |
$107.25–$161.20 | $165–$248 | varies |
| Ribs bilateral 3 views (71110) | $241.15 | $371 | 2.6× |
| Rp Loclzj Tum Spect 1 Area Single Day Imaging (78803) | $2,783.30 | $4,282 | 5.8× |
| Scapula (73010) range across 3 matching MRF lines |
$117.65–$176.80 | $181–$272 | varies |
| Screening Digital Breast Tomosynthesis Bi (77063) range across 3 matching MRF lines |
$29.25–$44.20 | $45–$68 | varies |
| Shoulder 1 view (73020) range across 3 matching MRF lines |
$73.45–$110.50 | $113–$170 | varies |
| Shoulder Arthrography (73040) range across 3 matching MRF lines |
$910.65–$1,366.30 | $1,401–$2,102 | varies |
| Skull less than 4 views (70250) | $224.25 | $345 | 2.4× |
| Tbs technical calculation only (77091) | $177.45 | $273 | 2.3× |
| Thoracic spine 2 views (72070) | $156 | $240 | 1.7× |
| Thoracic spine 3 views (72072) | $214.50 | $330 | 2.3× |
| Thoracolumbar 2 views (72080) | $292.50 | $450 | 3.8× |
| Thyroid Uptake W/Blood Flow Sngle/Mult Quan Meas (78014) | $573.95 | $883 | 1.6× |
| Ultrasound Breast Limited (76642) range across 3 matching MRF lines |
$193.70–$290.55 | $298–$447 | varies |
| Ultrasound Exam Aaa Screen (76706) | $247.65 | $381 | 2.7× |
| Ultrasound, abdomen limited (76705) | $354.25 | $545 | 3.9× |
| Upper gi w/o kub (74240) | $473.20 | $728 | 3.1× |
| Us breast unilateral complete (76641) range across 3 matching MRF lines |
$267.80–$401.70 | $412–$618 | varies |
| Us chest (76604) | $224.90 | $346 | 2.5× |
| Us complete joint (76881) | $217.75 | $335 | 2.4× |
| Us exam, pelvic, limited (76857) | $164.45 | $253 | 1.8× |
| Us kidney transplant (76776) | $482.30 | $742 | 5.3× |
| Us lmtd joint/oth nonvasc xtr strux r-t w/img (76882) | $156.65 | $241 | 1.7× |
| Us ob transvaginal (76817) | $295.75 | $455 | 3.2× |
| Us pelvic non ob complete (76856) | $520 | $800 | 5.7× |
| Us pg uter img f&mat 14 wk tabdl 1/1st gestation (76801) | $351.65 | $541 | 3.8× |
| Us retroperitoneal complete (76770) | $556.40 | $856 | 6.1× |
| Us retroperitoneal limited (76775) | $276.90 | $426 | 3.0× |
| Us scrotum and contents (76870) | $520 | $800 | 5.7× |
| Us thyroid (76536) | $471.25 | $725 | 5.1× |
| Wrist 2 views (73100) range across 3 matching MRF lines |
$115.05–$172.90 | $177–$266 | varies |
| X-Ray Bend Only L-S Spine (72120) | $204.10 | $314 | 2.2× |
| X-Ray Elbow 2 Vw - Xr Elbow 1-2 Views Right (73070) range across 3 matching MRF lines |
$174.85–$274.30 | $269–$422 | varies |
| X-Ray Exam Entire Spi 1 Vw (72081) | $182 | $280 | 2.4× |
| X-Ray Exam Entire Spi 2/3 Vw (72082) | $237.25 | $365 | 2.6× |
| X-Ray Exam Hip Uni 1 View (73501) | $192.40 | $296 | 2.5× |
| X-Ray Exam Hip Uni 2-3 Views (73502) | $131.95 | $203 | 1.7× |
| X-Ray Exam Hips Bi 2 Views (73521) | $217.10 | $334 | 2.4× |
| X-Ray Exam Hips Bi 3-4 Views (73522) | $228.15 | $351 | 2.5× |
| X-Ray Exam Hips Bi 5/> Views (73523) | $248.30 | $382 | 2.7× |
| X-Ray Exam L-S Spine Bending (72114) | $471.25 | $725 | 5.1× |
| X-Ray Exam Neck Spine 2-3 Vw (72040) | $228.80 | $352 | 3.0× |
| X-Ray Exam Neck Spine 6/>Vws (72052) | $319.15 | $491 | 3.5× |
| X-Ray Exam Unilat Ribs/Chest (71101) | $220.35 | $339 | 2.4× |
| X-ray humerus (73060) | $120.90 | $186 | 1.6× |
| X-Ray Jaw <4 Vw - Xr Mandible < 4 Views (70100) | $244.40 | $376 | 3.2× |
| X-Ray Knee Bilat Standing - Xr Knees Anteroposterior Standing Bilat (73565) | $186.55 | $287 | 2.4× |
| X-Ray Lumbar Spine 2/3 Vw - Xr Lumbar Spine 2-3 Views (72100) | $208.65 | $321 | 2.3× |
| X-ray nose-rectum child f.b. (76010) | $85.80 | $132 | 1.1× |
| X-Ray Ribs, Chest 4+ Vw - Xr Ribs 3 Vws Bil W/ Chest Posteroanterior (71111) | $303.55 | $467 | 3.3× |
| X-Ray Sacroiliac Jts 3+ Vw - Xr Sacroiliac Joints 3+ Views (72202) | $311.35 | $479 | 3.4× |
| X-Ray Sacroiliac Jts <3 Vw - Xr Sacroiliac Joints 1-2 Views (72200) | $148.85 | $229 | 1.6× |
| X-Ray Sacrum/Coccyx 2+ Vw - Xr Sacrum Coccyx 2+ Views (72220) | $163.15 | $251 | 2.1× |
| X-Ray Sinuses 3+ Vw - Xr Paranasal Sinuses 3+ Views (70220) | $232.05 | $357 | 3.0× |
| X-Ray Skull 4+ Vw - Xr Skull Complete 4+ Views (70260) | $245.05 | $377 | 2.7× |
| X-Rays Bone Survey Complete (77075) | $633.10 | $974 | 6.9× |
| Xr c-spine 4 or 5 views (72050) | $282.75 | $435 | 3.1× |
| Xr facial bones less than 3 views (70140) | $182.65 | $281 | 2.4× |
| Xr orbits complete 4 views (70200) | $162.50 | $250 | 1.8× |
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.