Imaging prices at Ste. Genevieve County Memorial Hospital

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

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

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ProcedureCash priceGross charge× Medicare
Abdomen 2 views (74019) $108.25 $216.50 1.0×
Acute gastrointestinal blood loss imaging (78278) $399.88 $799.75 1.0×
Ankle 2 views (73600) $113.50 $227 1.3×
Arthrogram elbow (73085) $209.75 $419.50 0.6×
Arthrogram hip (73525) $210 $420 0.6×
Arthrogram shoulder (73040) $29 $58 0.1×
Bone &/Joint Imaging Limited Area (78300) $376.75 $753.50 0.9×
Bone &/joint imaging whole body (78306) $396.38 $792.75 1.0×
Bone age studies (77072) $71.88 $143.75 0.7×
Bone Imaging 3 Phase (78315) $444.25 $888.50 1.1×
Bone survey complete (77075) $245.75 $491.50 2.3×
Brain image w/flow 4 + views (78606) $33.50 $67 0.1×
Brain Imaging Minimum 4 Static Views (78605) $28.50 $57 0.1×
Cervical spine 2 or 3 views (72040) $131.75 $263.50 1.5×
Chest 1 view (71045) $58.50 $117 0.7×
Chest 3 views (71047) $15 $30 0.2×
Cine/Vid X-Ray Throat/Esoph - Fl Esoph Barium Swlw W/ Video & Speech (74230) $165.88 $331.75 0.9×
Clavicle complete (73000) $88 $176 1.0×
Computed Tomography Thorax Lw Dose Lng Ca Scr C- (71271) $1,072.50 $2,145 10.2×
CT abdomen and pelvis without and with contrast (74178) $1,541.50 $3,083 4.4×
CT abdomen and pelvis without contrast (74176) $1,311.88 $2,623.75 5.5×
CT abdomen w contrast (74160) $1,454.75 $2,909.50 8.3×
CT abdomen w wo contrast (74170) $797.62 $1,595.25 4.5×
CT abdomen w/o contrast (74150) $661.62 $1,323.25 6.3×
CT angio hrt w/3d image (75574) $127.50 $255 0.4×
CT angiography upper extremity lt (73206) $588.50 $1,177 3.3×
CT c-spine w/o contrast (72125) $758.75 $1,517.50 7.2×
CT cervical spine w&w/o contrast (72127) $667.25 $1,334.50 3.8×
CT cervical spine with contrast (72126) $797.38 $1,594.75 2.3×
CT chest w/wo contrast (71270) $704.12 $1,408.25 4.0×
CT chest with contrast (71260) $673.25 $1,346.50 3.8×
CT colonography screening (74263) $59 $118 0.2×
CT head/brain with contrast (70460) $664 $1,328 3.8×
CT head/brain without and with contrast (70470) $719.75 $1,439.50 4.1×
CT heart contrast eval cardiac structure&morph (75572) $93.50 $187 0.3×
CT heart no contrast quant eval coronry calcium (75571) $29 $58 0.3×
CT hrt w/3d image congen (75573) $136 $272 0.4×
CT iac w contrast (70481) $828.62 $1,657.25 4.7×
CT limited/localized follow up study (76380) $210.25 $420.50 2.4×
CT lower ext w/o (73700) $1,195 $2,390 11.4×
CT lower extremity w wo contrast (73702) $1,266.50 $2,533 7.2×
CT lower extremity with contrast (73701) $1,266.50 $2,533 7.2×
CT lumbar spine w & w/o contrast (72133) $775.75 $1,551.50 4.4×
CT lumbar spine w/o contrast (72131) $626.50 $1,253 6.0×
CT lumbar spine with contrast (72132) $1,453.25 $2,906.50 4.2×
CT maxillofacial w contrast (70487) $663.50 $1,327 3.8×
CT maxillofacial w/o contrast (70486) $620.50 $1,241 5.9×
CT maxillofacial w/wo contrast (70488) $825.62 $1,651.25 4.7×
CT neck soft tissue w contrast (70491) $670.50 $1,341 3.8×
CT orbit sella/post fossa/ear w/o & w/contr matr (70482) $830.38 $1,660.75 4.7×
CT orbits w/o contrast (70480) $667.38 $1,334.75 6.4×
CT pelvis w & w/o contrast (72194) $824.12 $1,648.25 4.7×
CT pelvis w/o contrast (72192) $626.75 $1,253.50 6.0×
CT soft tissue neck w/o & w/contrast material (70492) $831 $1,662 4.7×
CT soft tissue neck w/o contrast (70490) $632 $1,264 6.0×
CT thoracic spine w/contrast (72129) $1,303.25 $2,606.50 7.4×
CT thoracic spine w/o contrast (72128) $639.38 $1,278.75 6.1×
CT thoracic spine w/wo contrast (72130) $820.62 $1,641.25 4.7×
CT thorax w/o contrast (71250) $628.88 $1,257.75 6.0×
CT upper extremity w/o & w/contrast material (73202) $1,266.50 $2,533 7.2×
CT upper extremity w/o contrast rt (73200) $1,195 $2,390 11.4×
CT upper extremity with contrast (73201) $1,266.50 $2,533 3.6×
Cta Abdl Aorta&Bi Iliofem W/Contrast&Postp (75635) $1,002.12 $2,004.25 5.7×
Cta Abdomen (74175) $773 $1,546 4.4×
CTA abdomen pelvis (74174) $1,323.62 $2,647.25 3.8×
CTA chest (71275) $843 $1,686 4.8×
Cta Head (70496) $706 $1,412 4.0×
CTA head&neck c+ w/noncontrast img&post-pxessing (70471) $2,635 $5,270 7.5×
CTA lwr ext w&w/o contrast (73706) $620.75 $1,241.50 3.5×
Cta Neck (70498) $706 $1,412 4.0×
Cta Pelvis (72191) $615.38 $1,230.75 3.5×
Cystography minimum 3 views rs&i (74430) $366.75 $383.75 1.0×
Doppler Fetal Mid Cerebral Artery (76821) $170 $340 1.6×
Dxa bone density study 1/> sites axial skel (77080) $164.75 $329.50 1.6×
Dxa bone density study 1/>sites appendiclr skel (77081) $103.25 $206.50 1.2×
Dxa bone density study axial skeleton (77085) $306.50 $613 2.9×
Echoencephalography real time imaging (76506) $34.50 $69 0.3×
Esophagus (74220) $314.25 $628.50 1.8×
Fetal biophysical profile non-stress testing (76818) $77 $154 0.7×
Fetal Biophysical Profile W/O Non-Stress Testing (76819) $421 $842 4.0×
Fluoroscopy up to 1 hr (76000) $113 $226 0.5×
Foot 2 views (73620) $113.50 $227 1.3×
Forearm 2 views (73090) $160.25 $320.50 1.8×
Gated Heart Planar Single (78472) $641.25 $1,282.50 1.6×
Hand 2 views (73120) $113.50 $227 1.1×
Hand 3 views (73130) $167 $334 1.9×
Heart Infarct Image (78466) $380.75 $761.50 1.0×
Hepatobil Syst Imag Inc Gb W/Pharma Intervenj (78227) $527.38 $1,054.75 1.0×
Hepatobiliary syst imaging including gallbladder (78226) $458.25 $916.50 1.1×
Ht muscle image spect sing (78451) $392.73 $785.46 0.3×
Humerus Min 2 Views Left (73060) $167.75 $335.50 1.9×
Hysterosalpingogram (74740) $146.75 $293.50 0.6×
Kidney imaging morphology (78700) $310.62 $621.25 0.8×
Kidney Img Morphology Vascular Flow 1 W/O Rx (78707) $474.50 $949 0.9×
Kidney img morphology vascular flow 1 w/rx (78708) $486.38 $972.75 0.9×
Kidney Img Morphology Vascular Flow Multiple (78709) $581.38 $1,162.75 1.1×
Knee 3 views (73562) $180.50 $361 2.1×
Liver & spleen imaging static only (78215) $366.50 $733 0.9×
Liver & Spleen Imaging W/Vascular Flow (78216) $395.62 $791.25 1.0×
Liver imaging static only (78201) $508.50 $531 0.9×
Liver imaging w/vascular flow (78202) $566 $591.50 1.0×
Lung perf&ventilat diferentl (78598) $44.50 $89 0.1×
Lymphoscintigraphy (78195) $543.62 $1,087.25 1.0×
Mammary ductogram or galactogram multiple (77054) $24.50 $49 0.1×
Mammary ductogram or galactogram single (77053) $19 $38 0.1×
Meckels Diverticulum (78290) $418 $836 1.0×
MRA head w & w/o contrast (70546) $1,036.75 $2,073.50 3.0×
MRA head w/o contrast (70544) $771.75 $1,543.50 3.2×
MRA head with contrast (70545) $715.88 $1,431.75 2.0×
MRA neck w contrast (70548) $894.75 $1,789.50 2.6×
Mra Neck W/O &W/Contrast Material (70549) $1,045.50 $2,091 3.0×
MRA neck w/o contrast (70547) $815.50 $1,631 3.4×
MRI abdomen w contrast (74182) $901 $1,802 2.6×
MRI abdomen w/o & w/contrast material (74183) $1,953.50 $3,907 5.6×
MRI abdomen w/o contrast (74181) $749.38 $1,498.75 3.1×
MRI any jnt lwr ext with con lt (73722) $898.25 $1,796.50 1.1×
MRI any jt upper extremity w/contrast matrl (73222) $898.25 $1,796.50 1.1×
MRI breast w/o contrast bilateral (77047) $1,265.75 $2,531.50 5.3×
MRI breast w/o contrast unilat (77046) $1,117.50 $2,235 4.7×
MRI c-spine with contrast (72142) $902.50 $1,805 2.6×
MRI cervical spine w/o contrast (72141) $856 $1,712 3.6×
MRI chest w/o & w/contrast material (71552) $899.75 $1,799.50 2.6×
MRI chest w/o contrast (71550) $817 $1,634 3.4×
MRI chest with contrast (71551) $730.12 $1,460.25 0.9×
MRI Forearm w/ Contrast Bilateral 73219 (73219) $898 $1,796 2.6×
MRI lower extrem oth/thn jt w/contrast matrl (73719) $834.62 $1,669.25 2.4×
MRI lower extrem oth/thn jt w/o contr matrl (73718) $1,535.50 $3,071 6.4×
MRI orbit face &/neck w/o contrast (70540) $852.88 $1,705.75 3.6×
MRI orbit/face/neck w&w/o cont (70543) $1,054.75 $2,109.50 3.0×
MRI orbit/face/neck w/contrast (70542) $898 $1,796 2.6×
MRI pelvis w contrast (72196) $901 $1,802 2.6×
MRI pelvis w/o & w/contrast material (72197) $1,056.25 $2,112.50 3.0×
MRI pelvis w/o contrast (72195) $782.50 $1,565 3.3×
MRI scan of arm joint before and after contrast (73223) $817.12 $1,634.25 2.3×
MRI scan of leg joint before and after contrast (73723) $912 $1,824 2.6×
MRI spinal canal cervical w/o & w/contr matrl (72156) $1,024.62 $2,049.25 2.9×
MRI spinal canal lumbar w/contrast material (72149) $902.50 $1,805 2.6×
MRI spinal canal lumbar w/o & w/contr matrl (72158) $1,134.75 $2,269.50 3.2×
MRI spinal canal thoracic w/contrast matrl (72147) $731.62 $1,463.25 2.1×
MRI spinal canal thoracic w/o & w/contr matrl (72157) $1,052.12 $2,104.25 3.0×
MRI thoracic spine w/o contrast (72146) $801.25 $1,602.50 3.4×
MRI tmj (70336) $893.75 $1,787.50 3.7×
MRI upper ext joint w/o contrast (73221) $1,708.50 $3,417 7.1×
MRI upper extrem other than jt w/o & w/contras (73220) $912 $1,824 2.6×
MRI upper extremity oth than jt w/o contr matrl (73218) $1,708.50 $3,417 7.1×
Myelogram Cervical (72240) $279 $558 0.4×
Myelogram Lumbar (72265) $352.38 $704.75 0.4×
Myelogram thoracic (72255) $477.50 $955 0.6×
Myocardial infarct spect (78469) $404.50 $809 0.7×
Myocardial Spect Multiple Studies (78452) $1,870.25 $3,740.50 1.4×
Neck soft tissue (70360) $95.75 $191.50 1.1×
Nm gastric emptying study (78264) $359.50 $719 0.9×
Nuclear medicine of heart muscle at rest with stress (78454) $71.50 $143 0.1×
Ob Us Follow-Up Per Fetus - Us Ob Follow Up Transabdominal Approach (76816) $448.25 $896.50 4.3×
Osseous survey infant (77076) $191.25 $382.50 1.8×
Osseous survey limited (77074) $95.75 $191.50 0.9×
Parathyrd planar w/spect&CT (78072) $1,370 $2,740 2.5×
Parathyroid imaging (78070) $375.50 $751 0.9×
Pelvis 1 or 2 views (72170) $80.12 $160.25 0.8×
PET image w/CT, skull-thigh (78815) $1,822.38 $3,644.75 1.3×
PET imaging for CT attenuation whole body (78816) $1,823.12 $3,646.25 1.3×
Pr MRI, lower extr, w/o contrast f/u by contrast (73720) $912 $1,824 2.6×
Prq Transhepatc Portograpy Hemodyn Eval Rs&I (75885) $138 $276 0.0×
Pulmonary Perfusion Imaging Particulate (78580) $367.75 $735.50 0.9×
Pulmonary Ventilation & Perfusion Imaging (78582) $542 $1,084 1.0×
Radex abscess/fistula/sinus tract rs&i (76080) $186.75 $373.50 0.3×
Radex entir thrc lmbr crv sac spi w/skull 2/3 vw (72082) $111.12 $222.25 1.1×
Radex hips bilateral with pelvis 2 views (73521) $12 $24 0.1×
Radex mastoids compl minimum 3 views pr side (70130) $117.12 $234.25 1.1×
Radiolog exam mandible compl minimum 4 views (70110) $126.88 $253.75 1.2×
Radiologic Exam Abdomen 1 View - Xr Abdomen 1 View (74018) $82.50 $165 0.9×
Radiologic Exam Abdomen 3+ Views - Xr Abdomen 3+ Views (74021) $155.50 $311 1.5×
Radiologic Exam Chest 2 Views - Xr Chest 2 Views (71046) $67 $134 0.8×
Radiologic exam colon single contrast study (74270) $230.38 $460.75 1.3×
Radiologic Exam Esophagus Double Contrast Study (74221) $184.12 $368.25 1.0×
Radiologic exam upr gi trc double contrast study (74246) $237.25 $474.50 1.4×
Radiologic exam upr gi trc single contrast study (74240) $415.50 $831 2.4×
Radiologic Examination Femur Minimum 2 Views - Xr Femur 2+ Vw Lt (73552) $165.50 $331 1.9×
Radiologic Examination Salivary Gland Calculus (70380) $33 $66 0.4×
Radiological examination surgical specimen (76098) $254.25 $508.50 0.5×
Ribs bilateral 3 views (71110) $13.50 $27 0.1×
Rp loclzj tum plnr 2+area 1+d img/1 area img>2+d (78801) $3,854.38 $7,708.75 9.6×
Rp loclzj tum plnr whole body single day imaging (78802) $4,059.88 $8,119.75 7.5×
Rp loclzj tum spect 1 area single day imaging (78803) $838 $1,676 1.5×
Sacroiliac Joints < 3 Views (72200) $9 $18 0.1×
Saline Infus Sonohysterography W/Color Doppler (76831) $185.88 $371.75 0.8×
Scanogram (77073) $246.25 $492.50 2.4×
Scapula complete (73010) $167 $334 1.6×
Screening digital breast tomosynthesis (77063) $40.25 $80.50 1.7×
Sella turcica (70240) $65 $130 0.7×
Shuntogram indwelling nonvascular shunt rs&i (75809) $244 $488 2.3×
Sialogram (70390) $311.62 $623.25 1.3×
Small bowel series (74250) $317.62 $635.25 1.8×
Spine thoracic 3 views (72072) $118.51 $237.02 1.1×
Testicular Imaging With Vascular Flow (78761) $38 $76 0.1×
Thoracolumbar 2 views (72080) $138.75 $277.50 1.6×
Thyroid Imaging With Vascular Flow (78013) $509.25 $528.75 1.3×
Thyroid Uptake W/Blood Flow Sngle/Mult Quan Meas (78014) $421.62 $843.25 1.1×
Tomogram (76100) $290.50 $581 2.8×
Tumor Imaging Whole Body - Nm Tumor Local Whole Body Mult Days (78804) $8,175.75 $16,351.50 15.0×
Tumor Imaging, Limited Area - Nm Tumor Localization Limited (78800) $9,124.50 $18,249 22.8×
Ultrasound, abdomen limited (76705) $376 $752 3.6×
Umbilical-artery Doppler (OB) (76820) $301 $602 2.9×
Urethrocystography retrograde rs&i (74450) $192.12 $384.25 0.8×
Urethrocystography voiding (74455) $253 $506 1.1×
Urography (pyelography), intravenous, with or without KUB, with or without tomography (74400) $261.62 $523.25 1.5×
Urograpy infusion drip &/bolus techq w/wo tomo (74415) $26.50 $53 0.2×
Us abdl aorta screen aaa (76706) $188.75 $377.50 1.8×
Us breast unilateral complete (76641) $448.25 $896.50 4.3×
Us breast unilateral limited (76642) $336.25 $672.50 3.9×
Us chest (76604) $240.50 $481 2.3×
Us compl joint r-t w/image documentation (76881) $230 $460 2.2×
Us elastography parenchyma (76981) $260 $520 2.5×
Us infant hips dynamic (76885) $149.50 $299 1.7×
Us ob detailed single fetus (76811) $256.25 $512.50 1.1×
Us ob transvaginal (76817) $376 $752 3.6×
Us pelvic non ob complete (76856) $275.75 $551.50 2.6×
Us pelvic nonobstetric image dcmtn limited/f/u (76857) $160.38 $320.75 1.5×
Us pregnancy ltd (76815) $155.25 $310.50 1.5×
Us pregnant uterus 14 wk transabdl 1/1st gestat (76801) $314.25 $628.50 3.0×
Us retroperitoneal complete (76770) $278 $556 2.7×
Us retroperitoneal limited (76775) $245.25 $490.50 2.3×
Us scrotum and contents (76870) $43.50 $87 0.4×
Us soft tissue head/neck (76536) $255.62 $511.25 2.4×
Us spinal canal and contents (76800) $182.25 $364.50 1.7×
Us transrectal (76872) $233.50 $467 2.2×
Us xtr non-vasc lmtd (76882) $196.62 $393.25 1.9×
Venography extremity unilateral rs&i (75820) $385.25 $770.50 0.2×
Vertebral fracture assessment via dxa (77086) $250 $500 2.9×
Wrist 2 views (73100) $113.50 $227 1.3×
X-Ray Abdomen,Comp Acute Series - Xr Abdomen 2 Vws With Chest 1 View (74022) $140.62 $281.25 1.3×
X-Ray Ac Jts - Xr Acromioclavicular Joints Bilateral (73050) $183 $366 2.1×
X-Ray Ankle 3+ Vw - Xr Ankle 3+ Views Right (73610) $167 $334 1.9×
X-Ray Colon Air Contrast - Fl Barium Enema Air Contrast (74280) $313.75 $627.50 1.8×
X-Ray Elbow 2 Vw - Xr Elbow 1-2 Views Right (73070) $113.50 $227 1.3×
X-Ray Elbow 3+ Vw - Xr Elbow 3+ Views Right (73080) $167 $334 1.9×
X-ray exam entire spi 4/5 vw (72083) $197.88 $395.75 1.9×
X-ray exam hip uni 1 view (73501) $208.75 $417.50 2.4×
X-Ray Exam Hip Uni 2-3 Views (73502) $179 $358 2.1×
X-ray exam hip uni 4/> views (73503) $13.50 $27 0.1×
X-Ray Exam Hips Bi 3-4 Views (73522) $14 $28 0.1×
X-Ray Exam Hips Bi 5/> Views (73523) $153.38 $306.75 1.5×
X-ray exam of femur 1 (73551) $43.88 $87.75 0.5×
X-ray exam of small bowel - fl small bowel series enteroclysis tube (74251) $479.38 $958.75 2.7×
X-Ray Facial Bones 3+ Vw - Xr Facial Bones 3+ Views (70150) $129 $258 1.2×
X-Ray Foot 3+ Vw - Xr Foot 3+ Views Right (73630) $167 $334 1.9×
X-ray guide gu dilation - ir nephrostomy dilation (74485) $204.88 $409.75 0.1×
X-Ray Heel - Xr Calcaneus 2 Views Right (73650) $85.12 $170.25 1.0×
X-Ray Knee 4+ View - Xr Knee 4+ Views Right (73564) $224.25 $448.50 2.1×
X-Ray Knee Bilat Standing - Xr Knees Anteroposterior Standing Bilat (73565) $85.25 $170.50 1.0×
X-Ray Lumbar Spine 2/3 Vw - Xr Lumbar Spine 2-3 Views (72100) $122.50 $245 1.2×
X-Ray Lumbar Spine 6+ Vw - Xr Lumbar Spine 6+ Vws Including Bending (72114) $196 $392 1.9×
X-Ray Lumbar Spine Flex/Exten - Xr Lumbar Spine 4+ Views W/ Flex Ext (72120) $157.50 $315 1.5×
X-Ray Nasal Bones - Xr Nasal Bones (70160) $95.25 $190.50 1.1×
X-Ray Nose-Rectum Child F.B. - Xr Nose to Rectum Foreign Body Peds (76010) $161.75 $323.50 1.9×
X-Ray Orbits - Xr Orbits Complete 4+ Views (70200) $91 $182 0.9×
X-Ray Pelvis 3+ Vw - Xr Pelvis 3+ Views (72190) $108.62 $217.25 1.0×
X-Ray Retrograde Pyelogram - Fl Pyelogram Retrograde (74420) $285.25 $570.50 0.8×
X-Ray Ribs 2 Vw Unilat - Xr Ribs 2 Views Right (71100) $10.50 $21 0.1×
X-Ray Ribs, Chest 3+ Vw - Xr Ribs 2 Vws Lt W/ Chest Anteroposterior (71101) $231 $462 2.2×
X-Ray Ribs, Chest 4+ Vw - Xr Ribs 3 Vws Bil W/ Chest Posteroanterior (71111) $251.75 $503.50 2.4×
X-Ray Sacroiliac Jts 3+ Vw - Xr Sacroiliac Joints 3+ Views (72202) $101.25 $202.50 1.0×
X-Ray Sacrum/Coccyx 2+ Vw - Xr Sacrum Coccyx 2+ Views (72220) $97 $194 1.1×
X-Ray Shoulder 2+ Vw - Xr Shoulder 2+ Views Right (73030) $180.50 $361 2.1×
X-Ray Sinuses 3+ Vw - Xr Paranasal Sinuses 3+ Views (70220) $117.88 $235.75 1.4×
X-Ray Sinuses <3 Vw - Xr Paranasal Sinuses 1-2 Views (70210) $75.75 $151.50 0.9×
X-Ray Skull 4+ Vw - Xr Skull Complete 4+ Views (70260) $137.25 $274.50 1.3×
X-Ray Skull <4 Vw - Xr Skull 1-3 Views (70250) $90.88 $181.75 0.9×
X-Ray Spine One View - Xr Spine (72020) $91.12 $182.25 1.0×
X-Ray Sterno-Clavicluar Jt - Xr Sternoclavicular Joints 3+ Views (71130) $104.12 $208.25 1.2×
X-Ray Sternum 2+ Vw - Xr Sternum 2+ Views (71120) $91.25 $182.50 1.0×
X-Ray Thoracic Spine 2 Vw - Xr Thoracic Spine 2 Views (72070) $92.38 $184.75 0.9×
X-Ray Toe(S) - Xr Toes 2+ Views Right (73660) $87 $174 1.0×
X-Ray Wrist 3+ Vw - Xr Wrist 3+ Views Right (73110) $185.25 $370.50 2.1×
Xr c-spine 6 or more views (72052) $178.75 $357.50 1.7×
Xr chest 4+ views (71048) $187.25 $374.50 1.8×
Xr Cholecystography Oral Contrast (74290) $378.75 $757.50 2.2×
Xr finger(s) 2+ views (73140) $72.50 $145 0.8×
Xr spine cervical 4 or 5 views (72050) $192.75 $385.50 1.8×
Xr tibia/fibula 2 views (73590) $164 $328 1.9×
Xr tmj bilateral (70330) $130.25 $260.50 1.5×
Xray knee 1 or 2 views rt (73560) $157.75 $315.50 1.8×