Imaging prices at Stephens Memorial Hospital

Breckenridge, TX · every code in this section with a posted price and a Medicare benchmark.

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

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ProcedureCash priceGross charge× Medicare
Abdomen 2 views (74019) $94.88 $135.55 0.9×
Acute gastrointestinal blood loss imaging (78278) $752.17 $1,074.53 1.9×
Ankle 2 views (73600) $197.40 $282 2.3×
Bone &/Joint Imaging Limited Area (78300) $506.44 $723.49 1.3×
Bone &/Joint Imaging Multiple Areas (78305) $618.79 $883.98 1.5×
Bone &/joint imaging whole body (78306) $666 $951.43 1.7×
Bone Imaging 3 Phase (78315) $759.75 $1,085.36 1.9×
Bone Marrow Imaging Limited Area (78102) $752.17 $1,074.53 1.9×
Bone survey complete (77075) $357.95 $511.35 3.4×
Cervical spine 2 or 3 views (72040) $165.50 $236.42 1.9×
Chest 1 view (71045) $175.64 $250.92 2.0×
Chest 3 views (71047) $143.04 $204.34 1.6×
Clavicle complete (73000) $155.70 $222.42 1.8×
Computed Tomography Thorax Lw Dose Lng Ca Scr C- (71271) $1,534.68 $2,192.40 14.6×
CT abdomen and pelvis without and with contrast (74178) $3,083.15 $4,404.50 8.8×
CT abdomen and pelvis without contrast (74176) $2,510.76 $3,586.80 10.5×
CT abdomen w contrast (74160) $1,536.14 $2,194.48 8.7×
CT abdomen w wo contrast (74170) $1,988.09 $2,840.12 11.3×
CT abdomen w/o contrast (74150) $1,292.12 $1,845.89 12.3×
CT angio hrt w/3d image (75574) $2,298.80 $3,284 6.6×
CT angiography upper extremity lt (73206) $1,975.90 $2,822.72 11.2×
CT c-spine w/o contrast (72125) $1,244.30 $1,777.56 11.8×
CT cervical spine w&w/o contrast (72127) $1,680 $2,400 9.5×
CT cervical spine with contrast (72126) $1,120 $1,600 3.2×
CT chest w/wo contrast (71270) $1,892.32 $2,703.32 10.7×
CT chest with contrast (71260) $1,274.04 $1,820.06 7.2×
CT head/brain with contrast (70460) $1,668.44 $2,383.48 9.5×
CT head/brain without and with contrast (70470) $1,954.33 $2,791.90 11.1×
CT iac w contrast (70481) $1,393.78 $1,991.11 7.9×
CT lower ext w/o (73700) $1,485.05 $2,121.50 14.1×
CT lower extremity w wo contrast (73702) $1,826.76 $2,609.65 10.4×
CT lower extremity with contrast (73701) $1,683.26 $2,404.65 9.6×
CT lumbar spine w & w/o contrast (72133) $2,291.66 $3,273.79 13.0×
CT lumbar spine w/o contrast (72131) $1,345.08 $1,921.53 12.8×
CT lumbar spine with contrast (72132) $1,959.83 $2,799.76 5.6×
CT maxillofacial w contrast (70487) $1,032.63 $1,475.19 5.9×
CT maxillofacial w/o contrast (70486) $1,210.72 $1,729.61 11.5×
CT maxillofacial w/wo contrast (70488) $1,338.60 $1,912.28 7.6×
CT neck soft tissue w contrast (70491) $1,640.08 $2,342.98 9.3×
CT orbit sella/post fossa/ear w/o & w/contr matr (70482) $1,734.80 $2,478.29 9.8×
CT orbits w/o contrast (70480) $1,372.60 $1,960.86 13.1×
CT pelvis w & w/o contrast (72194) $2,119.80 $3,028.29 12.0×
CT pelvis w/o contrast (72192) $1,304.25 $1,863.22 12.4×
CT soft tissue neck w/o & w/contrast material (70492) $1,711 $2,444.29 9.7×
CT soft tissue neck w/o contrast (70490) $1,370.40 $1,957.72 13.0×
CT thoracic spine w/contrast (72129) $2,391.28 $3,416.10 13.6×
CT thoracic spine w/o contrast (72128) $1,478.48 $2,112.10 14.1×
CT thoracic spine w/wo contrast (72130) $2,469.80 $3,528.29 14.0×
CT thorax w/o contrast (71250) $1,461.60 $2,088 13.9×
CT upper extremity w/o & w/contrast material (73202) $1,206.77 $1,723.96 6.8×
CT upper extremity w/o contrast rt (73200) $1,206.77 $1,723.96 11.5×
CT upper extremity with contrast (73201) $1,139.45 $1,627.78 3.3×
Cta Abdl Aorta&Bi Iliofem W/Contrast&Postp (75635) $2,361.10 $3,373 13.4×
Cta Abdomen (74175) $2,190.30 $3,129 12.4×
CTA abdomen pelvis (74174) $2,640.75 $3,772.50 7.5×
CTA chest (71275) $2,100 $3,000 11.9×
Cta Head (70496) $2,088.80 $2,984 11.9×
CTA lwr ext w&w/o contrast (73706) $1,828.68 $2,612.40 10.4×
Cta Neck (70498) $2,124.50 $3,035 12.1×
Cystography minimum 3 views rs&i (74430) $579.74 $828.20 1.7×
Dxa bone density study 1/> sites axial skel (77080) $332.20 $474.58 3.2×
Esophagus (74220) $379.40 $542 2.2×
Fetal biophysical profile non-stress testing (76818) $221.60 $316.58 2.1×
Fluoroscopy up to 1 hr (76000) $556.50 $795 2.3×
Foot 2 views (73620) $222.60 $318 2.5×
Forearm 2 views (73090) $277.20 $396 3.2×
Gated Heart Planar Single (78472) $503.53 $719.33 1.3×
Hand 2 views (73120) $254.72 $363.88 2.4×
Hand 3 views (73130) $202.94 $289.92 2.3×
Heart Infarct Image (78466) $685.86 $979.80 1.7×
Heart infarct image w ef (78468) $685.86 $979.80 1.3×
Hepatobil Syst Imag Inc Gb W/Pharma Intervenj (78227) $983.16 $1,404.52 1.8×
Hepatobiliary syst imaging including gallbladder (78226) $725.73 $1,036.76 1.8×
Ht muscle image spect sing (78451) $748.76 $1,069.65 0.6×
Humerus Min 2 Views Left (73060) $270.50 $386.42 3.1×
Hysterosalpingogram (74740) $455.60 $650.86 1.9×
Kidney Img Morphology Vascular Flow 1 W/O Rx (78707) $498.71 $712.44 0.9×
Kidney img morphology vascular flow 1 w/rx (78708) $386.80 $552.57 0.7×
Kidney Img Morphology Vascular Flow Multiple (78709) $805.38 $1,150.54 1.5×
Knee 3 views (73562) $258.30 $369 3.0×
Liver & spleen imaging static only (78215) $426.14 $608.77 1.1×
Lung perf&ventilat diferentl (78598) $668.93 $955.62 1.2×
Lung Ventilation Imaging (78579) $409.86 $585.52 1.0×
Lymphoscintigraphy (78195) $782.01 $1,117.15 1.4×
Meckels Diverticulum (78290) $541.65 $773.78 1.3×
MRA head w & w/o contrast (70546) $3,102.42 $4,432.02 8.9×
MRA head w/o contrast (70544) $1,590.76 $2,272.50 6.6×
MRA head with contrast (70545) $1,662.36 $2,374.79 4.7×
MRA neck w contrast (70548) $1,662.36 $2,374.79 4.7×
Mra Neck W/O &W/Contrast Material (70549) $2,817.24 $4,024.62 8.0×
MRI abdomen w/o & w/contrast material (74183) $2,696.34 $3,851.90 7.7×
MRI abdomen w/o contrast (74181) $1,934.36 $2,763.38 8.1×
MRI any jnt lwr ext with con lt (73722) $1,664.80 $2,378.29 2.1×
MRI c-spine with contrast (72142) $1,857.30 $2,653.29 5.3×
MRI cervical spine w/o contrast (72141) $1,620.52 $2,315.02 6.8×
MRI chest w/o & w/contrast material (71552) $2,396.54 $3,423.62 6.8×
MRI chest w/o contrast (71550) $1,217.78 $1,739.68 5.1×
MRI lower extrem oth/thn jt w/o contr matrl (73718) $1,524.38 $2,177.68 6.4×
MRI orbit face &/neck w/o contrast (70540) $1,330 $1,900 5.5×
MRI orbit/face/neck w&w/o cont (70543) $3,052.44 $4,360.62 8.7×
MRI pelvis w contrast (72196) $2,303.56 $3,290.79 6.6×
MRI pelvis w/o & w/contrast material (72197) $2,763.34 $3,947.62 7.9×
MRI pelvis w/o contrast (72195) $1,912.88 $2,732.68 8.0×
MRI scan of arm joint before and after contrast (73223) $2,290.84 $3,272.62 6.5×
MRI scan of leg joint before and after contrast (73723) $2,012.24 $2,874.62 5.7×
MRI spinal canal cervical w/o & w/contr matrl (72156) $2,695.44 $3,850.62 7.7×
MRI spinal canal lumbar w/contrast material (72149) $1,917.68 $2,739.54 5.5×
MRI spinal canal lumbar w/o & w/contr matrl (72158) $2,367.14 $3,381.62 6.8×
MRI spinal canal thoracic w/contrast matrl (72147) $2,064.68 $2,949.54 5.9×
MRI spinal canal thoracic w/o & w/contr matrl (72157) $2,673.39 $3,819.12 7.6×
MRI thoracic spine w/o contrast (72146) $1,563.92 $2,234.18 6.5×
MRI tmj (70336) $1,614.28 $2,306.10 6.7×
MRI upper ext joint w/o contrast (73221) $1,595.78 $2,279.68 6.7×
MRI upper extrem other than jt w/o & w/contras (73220) $2,066.44 $2,952.05 5.9×
MRI upper extremity oth than jt w/o contr matrl (73218) $1,934.80 $2,764 8.1×
Myocardial infarct spect (78469) $685.86 $979.80 1.3×
Myocardial Spect Multiple Studies (78452) $1,797.81 $2,568.30 1.4×
Neck soft tissue (70360) $250.42 $357.74 2.9×
Nm gastric emptying study (78264) $736.41 $1,052.01 1.8×
Nm peritoneal-venous shunt patency (78291) $533.76 $762.51 1.3×
Nuclear medicine of heart muscle at rest with stress (78454) $959.04 $1,370.06 0.7×
Nuclear medicine study of heart muscle at rest with stress (78453) $936.20 $1,337.44 0.7×
Nuclear medicine study of kidney and blood flow (78701) $459 $655.72 1.1×
Nuclear medicine study to assess blood clot in vein of both sides (78458) $410.40 $586.28 1.0×
Nuclear medicine study to assess blood clot in vein of side (78457) $410.40 $586.28 0.8×
Osseous survey infant (77076) $168.84 $241.20 1.6×
Parathyroid imaging (78070) $658.37 $940.53 1.6×
Pelvis 1 or 2 views (72170) $174.40 $249.13 1.7×
Pr heart first pass single,planar (78481) $975.26 $1,393.22 1.8×
Pr MRI, lower extr, w/o contrast f/u by contrast (73720) $2,012.24 $2,874.62 5.7×
Pulmonary Perfusion Imaging Particulate (78580) $524.06 $748.66 1.3×
Pulmonary Ventilation & Perfusion Imaging (78582) $733.38 $1,047.69 1.3×
Radex abscess/fistula/sinus tract rs&i (76080) $455.60 $650.86 0.8×
Radex Entir Thrc Lmbr Crv Sac Spi W/Skull 1 Vw - Xr Scoliosis 1 Vw (72081) $184.35 $263.36 2.1×
Radex entir thrc lmbr crv sac spi w/skull 2/3 vw (72082) $161.70 $231 1.5×
Radex mastoids compl minimum 3 views pr side (70130) $108.43 $154.90 1.0×
Radex X-Ray Exam Entire Spi 6/> Vw - Xr Entire Spine 6+ Vw (72084) $313.55 $447.92 3.0×
Radiolog exam mandible compl minimum 4 views (70110) $115.51 $165.01 1.1×
Radiologic Exam Abdomen 1 View - Xr Abdomen 1 View (74018) $103.26 $147.52 1.2×
Radiologic Exam Abdomen 3+ Views - Xr Abdomen 3+ Views (74021) $240.10 $343 2.3×
Radiologic Exam Chest 2 Views - Xr Chest 2 Views (71046) $133.28 $190.40 1.5×
Radiologic exam colon single contrast study (74270) $627.82 $896.88 3.6×
Radiologic exam upr gi trc single contrast study (74240) $408.20 $583.14 2.3×
Radiologic Examination Femur Minimum 2 Views - Xr Femur 2+ Vw Lt (73552) $210.95 $301.35 2.4×
Radiological examination surgical specimen (76098) $569.70 $813.85 1.0×
Rp loclzj tum plnr whole body single day imaging (78802) $1,238.25 $1,768.93 2.3×
Rp loclzj tum spect 1 area single day imaging (78803) $2,203.90 $3,148.43 4.0×
Sacroiliac Joints < 3 Views (72200) $199.46 $284.95 1.9×
Salivary gland imaging (78230) $533.76 $762.51 1.3×
Salivary gland imaging serial images (78231) $533.76 $762.51 1.3×
Scapula complete (73010) $155.70 $222.42 1.5×
Screening digital breast tomosynthesis (77063) $113.10 $161.57 4.8×
Sella turcica (70240) $102.07 $145.82 1.2×
Small bowel series (74250) $359.34 $513.34 2.0×
Spine thoracic 3 views (72072) $337.40 $482 3.2×
Spleen imaging only (78185) $177.83 $254.04 0.4×
Temporomandble Jt Arthrography Rs&I (70332) $591.88 $845.54 2.5×
Testicular Imaging With Vascular Flow (78761) $722.28 $1,031.83 1.8×
Thyroid carcinoma metastases img whole body (78018) $656.82 $938.30 1.2×
Thyroid Imaging With Vascular Flow (78013) $420.45 $600.64 1.0×
Thyroid uptake measurement (78012) $177.07 $252.95 0.4×
Thyroid Uptake W/Blood Flow Sngle/Mult Quan Meas (78014) $528.93 $755.62 1.3×
Tmj unilateral (70328) $99.40 $142 1.1×
Ultrasound, abdomen limited (76705) $578.45 $826.35 5.5×
Unlisted Diagnostic Radiographic Procedure (76499) $182.45 $260.64 2.1×
Upper Extremity Infant (73092) $233.47 $333.53 2.2×
Ureteral Reflux Study Rp Voiding Cystogram (78740) $722.28 $1,031.83 1.8×
Urethrocystography voiding (74455) $553.91 $791.30 2.3×
Urography (pyelography), intravenous, with or without KUB, with or without tomography (74400) $1,034.64 $1,478.05 5.9×
Us abdl aorta screen aaa (76706) $354.92 $507.03 3.4×
Us breast unilateral complete (76641) $417.20 $596 4.0×
Us breast unilateral limited (76642) $345.80 $494 4.0×
Us chest (76604) $141.71 $202.44 1.3×
Us compl joint r-t w/image documentation (76881) $403.90 $577 3.8×
Us fetal nuchal translucency 1st gestation (76813) $236.27 $337.53 2.2×
Us kidney transplant (76776) $356.88 $509.82 3.4×
Us ob transvaginal (76817) $230.50 $329.29 2.2×
Us pelvic non ob complete (76856) $611.10 $873 5.8×
Us pelvic nonobstetric image dcmtn limited/f/u (76857) $311.50 $445 3.0×
Us pregnant uterus 14 wk transabdl 1/1st gestat (76801) $145.30 $207.58 1.4×
Us retroperitoneal complete (76770) $609 $870 5.8×
Us retroperitoneal limited (76775) $224.45 $320.64 2.1×
Us scrotum and contents (76870) $770.70 $1,101 7.3×
Us soft tissue head/neck (76536) $384.79 $549.70 3.7×
Us spinal canal and contents (76800) $229.47 $327.82 2.2×
Us xtr non-vasc lmtd (76882) $403.20 $576 3.8×
Vascular flow imaging (78445) $410.40 $586.28 1.0×
Venogram extremity bilateral (75822) $1,334.55 $1,906.50 0.8×
Venography extremity unilateral rs&i (75820) $1,668.15 $2,383.07 1.1×
Wrist 2 views (73100) $217 $310 2.5×
X-Ray Abdomen,Comp Acute Series - Xr Abdomen 2 Vws With Chest 1 View (74022) $395.34 $564.78 3.8×
X-Ray Ac Jts - Xr Acromioclavicular Joints Bilateral (73050) $106.19 $151.70 1.2×
X-Ray Ankle 3+ Vw - Xr Ankle 3+ Views Right (73610) $278.60 $398 3.2×
X-Ray Colon Air Contrast - Fl Barium Enema Air Contrast (74280) $355.88 $508.40 2.0×
X-Ray Elbow 2 Vw - Xr Elbow 1-2 Views Right (73070) $202.30 $289 2.3×
X-Ray Elbow 3+ Vw - Xr Elbow 3+ Views Right (73080) $334.60 $478 3.8×
X-ray exam entire spi 4/5 vw (72083) $303.50 $433.58 2.9×
X-ray exam hip uni 1 view (73501) $214.20 $306 2.5×
X-Ray Exam Hip Uni 2-3 Views (73502) $225.40 $322 2.6×
X-Ray Exam Hips Bi 3-4 Views (73522) $328.66 $469.52 3.1×
X-ray exam of femur 1 (73551) $127 $181.42 1.5×
X-ray eye for foreign body (70030) $102.07 $145.82 1.2×
X-Ray Facial Bones 3+ Vw - Xr Facial Bones 3+ Views (70150) $108.43 $154.90 1.0×
X-Ray Facial Bones <3 Vw - Xr Facial Bones 1-2 Views (70140) $103.26 $147.52 1.2×
X-Ray Foot 3+ Vw - Xr Foot 3+ Views Right (73630) $263.20 $376 3.0×
X-Ray Heel - Xr Calcaneus 2 Views Right (73650) $121.80 $174 1.4×
X-ray IV pyelogram+drip infusn (74410) $393.46 $562.10 2.2×
X-Ray Jaw <4 Vw - Xr Mandible < 4 Views (70100) $107.68 $153.83 1.2×
X-Ray Knee 4+ View - Xr Knee 4+ Views Right (73564) $380.10 $543 3.6×
X-Ray Knee Bilat Standing - Xr Knees Anteroposterior Standing Bilat (73565) $241.67 $345.24 2.8×
X-Ray Leg, Infant - Xr Lower Extremity 2+ Views Infant Left (73592) $192.38 $274.83 2.2×
X-Ray Lumbar Spine 2/3 Vw - Xr Lumbar Spine 2-3 Views (72100) $203.30 $290.42 1.9×
X-Ray Lumbar Spine 6+ Vw - Xr Lumbar Spine 6+ Vws Including Bending (72114) $602.76 $861.08 5.7×
X-Ray Nasal Bones - Xr Nasal Bones (70160) $103.26 $147.52 1.2×
X-Ray Nose-Rectum Child F.B. - Xr Nose to Rectum Foreign Body Peds (76010) $173.48 $247.83 2.0×
X-Ray Orbits - Xr Orbits Complete 4+ Views (70200) $103.26 $147.52 1.0×
X-Ray Pelvis 3+ Vw - Xr Pelvis 3+ Views (72190) $251.92 $359.88 2.4×
X-Ray Retrograde Pyelogram - Fl Pyelogram Retrograde (74420) $546.16 $780.22 1.6×
X-Ray Ribs 2 Vw Unilat - Xr Ribs 2 Views Right (71100) $270.20 $386 3.1×
X-Ray Ribs, Chest 3+ Vw - Xr Ribs 2 Vws Lt W/ Chest Anteroposterior (71101) $352.80 $504 3.4×
X-Ray Ribs, Chest 4+ Vw - Xr Ribs 3 Vws Bil W/ Chest Posteroanterior (71111) $481.54 $687.92 4.6×
X-Ray Sacroiliac Jts 3+ Vw - Xr Sacroiliac Joints 3+ Views (72202) $86 $122.85 0.8×
X-Ray Sacrum/Coccyx 2+ Vw - Xr Sacrum Coccyx 2+ Views (72220) $285.60 $408 3.3×
X-Ray Shoulder 2+ Vw - Xr Shoulder 2+ Views Right (73030) $273.70 $391 3.1×
X-Ray Sinuses 3+ Vw - Xr Paranasal Sinuses 3+ Views (70220) $171.40 $244.86 2.0×
X-Ray Sinuses <3 Vw - Xr Paranasal Sinuses 1-2 Views (70210) $101.76 $145.37 1.2×
X-Ray Skull 4+ Vw - Xr Skull Complete 4+ Views (70260) $225.03 $321.47 2.1×
X-Ray Skull <4 Vw - Xr Skull 1-3 Views (70250) $105.25 $150.36 1.0×
X-Ray Sterno-Clavicluar Jt - Xr Sternoclavicular Joints 3+ Views (71130) $104.56 $149.37 1.2×
X-Ray Sternum 2+ Vw - Xr Sternum 2+ Views (71120) $104.52 $149.31 1.2×
X-Ray Thoracic Spine 2 Vw - Xr Thoracic Spine 2 Views (72070) $305.66 $436.65 2.9×
X-Ray Thoracic Spine 4 Vw - Xr Thoracic Spine Complete 4+ Views (72074) $352.80 $504 3.4×
X-Ray Toe(S) - Xr Toes 2+ Views Right (73660) $212.10 $303 2.4×
X-Ray Wrist 3+ Vw - Xr Wrist 3+ Views Right (73110) $259 $370 3.0×
Xr chest 4+ views (71048) $224.70 $321 2.1×
Xr Cholecystography Oral Contrast (74290) $198.66 $283.80 1.1×
Xr finger(s) 2+ views (73140) $240.80 $344 2.8×
Xr internal auditory meati complete (70134) $169.99 $242.84 0.3×
Xr optic foramina (70190) $102.07 $145.82 1.2×
Xr shoulder 1 view (73020) $234.50 $335 2.7×
Xr spine cervical 4 or 5 views (72050) $261.86 $374.08 2.5×
Xr tibia/fibula 2 views (73590) $283.50 $405 3.2×
Xr tmj bilateral (70330) $624.88 $892.68 7.1×
Xray knee 1 or 2 views rt (73560) $240.35 $343.35 2.7×