Imaging prices at Stevens Community Medical Center Inc

Morris, MN · every code in this section with a posted price and a Medicare benchmark.

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

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ProcedureCash priceGross charge× Medicare
Abdomen 2 views (74019) $267 $356 2.5×
Ankle 2 views (73600) $213.75 $285 2.4×
Arthrogram hip (73525) $449.62 $599.50 1.2×
Arthrogram knee (73580) $536.25 $715 1.5×
Arthrogram shoulder (73040) $451.12 $601.50 1.3×
Arthrogram wrist (73115) $197.62 $263.50 0.5×
Bone &/joint imaging whole body (78306) $741.38 $988.50 1.8×
Bone age studies (77072) $126.38 $168.50 1.2×
Bone Imaging 3 Phase (78315) $1,199.62 $1,599.50 2.9×
Bone survey complete (77075) $370.50 $494 3.4×
Bowel imaging (78290) $191.62 $255.50 0.5×
Cervical spine 2 or 3 views (72040) $213 $284 2.4×
Chest 1 view (71045) $226.88 $302.50 2.5×
Chest xray 3 views (71047) $306 $408 3.4×
Cine/Vid X-Ray Throat/Esoph - Fl Esoph Barium Swlw W/ Video & Speech (74230) $324.75 $433 1.8×
Clavicle complete (73000) $231.75 $309 2.6×
Computed Tomography Thorax Lw Dose Lng Ca Scr C- (71271) $289.50 $386 2.7×
Contrast Xray Throat/Cerv Esopha (74210) $74.25 $99 0.4×
CT abdomen and pelvis without and with contrast (74178) $1,631.25 $2,175 4.5×
CT abdomen and pelvis without contrast (74176) $1,477.50 $1,970 6.0×
CT abdomen w contrast (74160) $972.75 $1,297 5.4×
CT abdomen w wo contrast (74170) $613.12 $817.50 3.4×
CT abdomen w/o contrast (74150) $819.38 $1,092.50 7.6×
CT angio lwr extr w/o&w/dye (73706) $1,647.75 $2,197 9.1×
CT angiography upper extremity lt (73206) $1,673.62 $2,231.50 9.2×
CT c-spine w/contrast (72126) $1,038.75 $1,385 2.9×
CT c-spine w/o contrast (72125) $865.50 $1,154 8.0×
CT cervical spine w&w/o contrast (72127) $1,195.50 $1,594 6.6×
CT chest w contrast (71260) $853.50 $1,138 4.7×
CT chest w/wo contrast (71270) $1,191.38 $1,588.50 6.6×
CT head/brain with contrast (70460) $833.25 $1,111 4.6×
CT head/brain without and with contrast (70470) $904.12 $1,205.50 5.0×
CT heart w/o contrast quant eval coronary calcium (75571) $67.50 $90 0.8×
CT iac w contrast (70481) $1,050.38 $1,400.50 5.8×
CT lower ext w/o (73700) $828.75 $1,105 7.7×
CT lower extremity w wo contrast (73702) $1,158 $1,544 6.4×
CT lower extremity w/contrast material (73701) $977.62 $1,303.50 5.4×
CT lumbar spine w & w/o contrast (72133) $111 $148 0.6×
CT lumbar spine w/contrast (72132) $1,060.50 $1,414 2.9×
CT lumbar spine w/o contrast (72131) $862.50 $1,150 8.0×
CT maxillofacial w contrast (70487) $1,024.50 $1,366 5.7×
CT maxillofacial w/wo contrast (70488) $1,212.75 $1,617 6.7×
CT maxillofacial wo contrast (70486) $820.12 $1,093.50 7.6×
CT orbit sella/post fossa/ear w/o & w/contr matr (70482) $1,189.88 $1,586.50 6.6×
CT orbits w/o contrast (70480) $1,323 $1,764 12.3×
CT pelvis w/o contrast (72192) $837.38 $1,116.50 7.8×
CT pelvis w/wo contrast (72194) $1,147.88 $1,530.50 6.3×
CT scan of arm combo (73202) $1,269 $1,692 7.0×
CT soft tissue neck w contrast (70491) $993.75 $1,325 5.5×
CT soft tissue neck w/o & w/contrast material (70492) $1,177.50 $1,570 6.5×
CT soft tissue neck w/o contrast (70490) $841.88 $1,122.50 7.8×
CT thoracic spine w/contrast (72129) $1,011.75 $1,349 5.6×
CT thoracic spine w/o contrast (72128) $863.62 $1,151.50 8.0×
CT thoracic spine w/wo contrast (72130) $1,194.38 $1,592.50 6.6×
CT thorax w/o contrast (71250) $1,200.75 $1,601 11.1×
CT upper ext wo (73200) $885.75 $1,181 8.2×
CT upper extremity with contrast (73201) $199.88 $266.50 0.6×
Cta Aa&Bi Iliofem Lxtr Rs&I C-/C+ Post-Pxessing (75635) $1,845 $2,460 10.2×
Cta Abdomen (74175) $3,144.75 $4,193 17.4×
CTA abdomen pelvis (74174) $561.75 $749 1.6×
CTA chest (71275) $2,958.75 $3,945 16.3×
Cta Head (70496) $2,164.88 $2,886.50 12.0×
CTA head&neck c+ w/noncontrast img&post-pxessing (70471) $239.62 $319.50 0.7×
Cta Neck (70498) $1,815.38 $2,420.50 10.0×
Cystography minimum 3 views rs&i (74430) $817.50 $1,090 2.3×
Doppler Fetal Mid Cerebral Artery (76821) $276 $368 2.6×
Dxa bone density study 1/> sites axial skel (77080) $292.12 $389.50 2.7×
Dxa bone density study 1/>sites appendiclr skel (77081) $63.75 $85 0.7×
Dxa bone density study axial skeleton (77085) $274.88 $366.50 2.5×
Esophagus (74220) $600 $800 3.3×
Facial bones min 3 views (70150) $193.88 $258.50 1.8×
Fetal biophysical profile non-stress testing (76818) $316.50 $422 2.9×
Fetal Biophysical Profile W/O Non-Stress Testing (76819) $265.12 $353.50 2.5×
Fluoroscopy up to 1 hr (76000) $526.12 $701.50 2.1×
Foot 2 views (73620) $213.75 $285 2.4×
Forearm 2 views (73090) $231.75 $309 2.6×
Hand 2 views (73120) $92.25 $123 0.9×
Hepatobil Syst Imag Inc Gb W/Pharma Intervenj (78227) $836.62 $1,115.50 1.5×
Hepatobiliary syst imaging including gallbladder (78226) $825.75 $1,101 2.0×
Hysterosalpingogram (74740) $559.50 $746 2.3×
Kidney img morphology vascular flow 1 w/rx (78708) $1,166.25 $1,555 2.1×
Knee 3 views (73562) $249 $332 2.8×
Liver imaging w/vascular flow (78202) $552.75 $737 1.0×
Magnetic resonance (eg, proton) imaging, any joint of upper extremity; with contrast material(s) Non-Facility (73222) $1,367.25 $1,823 1.7×
Magnetic resonance (eg, proton) imaging, upper extremity, other than joint; with contrast material(s) Non-Facility (73219) $1,438.88 $1,918.50 4.0×
Magnetic resonance (eg, proton) imaging, upper extremity, other than joint; without contrast material(s), followed by… (73220) $1,210.50 $1,614 3.4×
Mammary ductogram or galactogram single (77053) $390.75 $521 1.6×
Manual Appl Stress Pfrmd Phys/Qhp Joint Films (77071) $88.50 $118 1.0×
MRA head w & w/o contrast (70546) $1,596 $2,128 4.4×
MRA head w/o contrast (70544) $1,241.25 $1,655 5.0×
MRA neck w contrast (70548) $1,291.88 $1,722.50 3.6×
Mra Neck W/O &W/Contrast Material (70549) $1,611 $2,148 4.5×
MRA neck w/o contrast (70547) $1,074.75 $1,433 4.4×
MRI abdomen w contrast (74182) $1,441.50 $1,922 4.0×
MRI abdomen w/o & w/contrast material (74183) $1,260.38 $1,680.50 3.5×
MRI abdomen w/o contrast (74181) $1,299.75 $1,733 5.3×
MRI any jt lower extrem w/contrast material (73722) $1,354.88 $1,806.50 1.7×
MRI any jt lower extrem w/o & w/contrast matrl (73723) $1,695.75 $2,261 4.7×
MRI c-spine with contrast (72142) $1,477.88 $1,970.50 4.1×
MRI cervical spine w/o contrast (72141) $1,297.88 $1,730.50 5.3×
MRI chest w/o & w/contrast material (71552) $3,383.25 $4,511 9.4×
MRI chest w/o contrast (71550) $1,577.62 $2,103.50 6.4×
MRI chest with contrast (71551) $150.75 $201 0.2×
MRI lower extrem oth/thn jt w/contrast matrl (73719) $1,413 $1,884 3.9×
MRI lower extrem oth/thn jt w/o & w/contr matr (73720) $1,740.38 $2,320.50 4.8×
MRI lower extrem oth/thn jt w/o contr matrl (73718) $1,089 $1,452 4.4×
MRI orbit face &/neck w/o contrast (70540) $2,514.75 $3,353 10.2×
MRI orbit face neck w contrast (70542) $1,424.62 $1,899.50 4.0×
MRI orbit/face/neck w&w/o cont (70543) $1,094.62 $1,459.50 3.0×
MRI pelvis w/contrast (72196) $1,851.75 $2,469 5.1×
MRI pelvis w/o & w/contrast material (72197) $1,266 $1,688 3.5×
MRI pelvis w/o contrast (72195) $976.88 $1,302.50 4.0×
MRI spinal canal cervical w/o & w/contr matrl (72156) $1,335.38 $1,780.50 3.7×
MRI spinal canal lumbar w/contrast material (72149) $1,483.88 $1,978.50 4.1×
MRI spinal canal lumbar w/o & w/contr matrl (72158) $1,674 $2,232 4.6×
MRI spinal canal thoracic w/contrast matrl (72147) $1,424.62 $1,899.50 4.0×
MRI spinal canal thoracic w/o & w/contr matrl (72157) $1,692.38 $2,256.50 4.7×
MRI temporomandibular joint (70336) $1,248.38 $1,664.50 5.1×
MRI thoracic spine w/o contrast (72146) $1,313.62 $1,751.50 5.3×
MRI up ext w/o contrast (73218) $1,376.25 $1,835 5.6×
MRI upper ext joint w/o contrast (73221) $1,343.62 $1,791.50 5.5×
MRI, joint upper extrem combo (73223) $1,624.50 $2,166 4.5×
Myelogram thoracic (72255) $1,632 $2,176 2.0×
Myocardial Spect Multiple Studies (78452) $4,047 $5,396 3.0×
Neck soft tissue (70360) $183 $244 2.0×
Nm gastric emptying study (78264) $817.50 $1,090 2.0×
Ophthalmic ultrasound, diagnostic; corneal pachymetry, unilateral or bilateral (determination of corneal thickness)… (76514) $41.25 $55 1.4×
Osseous survey limited (77074) $217.12 $289.50 2.0×
Parathyroid Planar Imaging (78070) $583.12 $777.50 1.4×
Parathyroid planar imaging w/wo subtraction (78071) $793.88 $1,058.50 1.9×
Pelvis 1 or 2 views (72170) $231.75 $309 2.1×
PET image w/CT, skull-thigh (78815) $3,500.25 $4,667 2.4×
PET imaging for CT attenuation whole body (78816) $2,731.12 $3,641.50 1.9×
Pulmonary Ventilation & Perfusion Imaging (78582) $811.88 $1,082.50 1.4×
Radex Ankle Compl Minimum 3 Views (73610) $234 $312 2.6×
Radex Calcaneus Minimum 2 Views (73650) $205.50 $274 2.3×
Radex Elbw Compl Minimum 3 Views (73080) $249 $332 2.8×
Radex Entir Thrc Lmbr Crv Sac Spi W/Skull 1 Vw - Xr Scoliosis 1 Vw (72081) $112.12 $149.50 1.2×
Radex entir thrc lmbr crv sac spi w/skull 2/3 vw (72082) $236.25 $315 2.2×
Radex fingr minimum 2 views (73140) $183 $244 2.0×
Radex Foot Compl Minimum 3 Views (73630) $234 $312 2.6×
Radex Hand Minimum 3 Views (73130) $234.75 $313 2.6×
Radex Hip Unilateral With Pelvis 1 View (73501) $205.50 $274 2.3×
Radex Hips Bilateral With Pelvis 2 Views (73521) $94.50 $126 0.9×
Radex Hips Bilateral With Pelvis Minimum 5 Views (73523) $510.75 $681 4.7×
Radex Humerus Minimum 2 Views (73060) $249 $332 2.8×
Radex Kne 1/2 Views (73560) $144.38 $192.50 1.6×
Radex Kne Compl 4/More Views (73564) $256.50 $342 2.4×
Radex Mndbl Compl Minimum 4 Views (70110) $157.50 $210 1.5×
Radex Nasal Bones Complete Minimum 3 Views (70160) $231.75 $309 2.6×
Radex Pelvis Compl Minimum 3 Views (72190) $166.50 $222 1.5×
Radex Sho Compl Minimum 2 Views (73030) $249 $332 2.8×
Radex Sinuses Paransl < 3 Views (70210) $256.50 $342 2.9×
Radex Spine Lumbosacral Only Bending 2/3 Views (72120) $184.88 $246.50 1.7×
Radex Temporomandble Jt Opn & Clsd Mouth Bilat (70330) $206.25 $275 2.3×
Radex Toe Minimum 2 Views (73660) $183 $244 2.0×
Radex upper extremity infant minimum 2 views (73092) $120 $160 1.1×
Radex Wrst Compl Minimum 3 Views (73110) $245.25 $327 2.7×
Radiologic Exam Abdomen 1 View - Xr Abdomen 1 View (74018) $240 $320 2.7×
Radiologic Exam Abdomen 3+ Views - Xr Abdomen 3+ Views (74021) $24 $32 0.2×
Radiologic exam chest 2 views (71046) $244.50 $326 2.7×
Radiologic exam colon single contrast study (74270) $734.25 $979 4.1×
Radiologic Exam Esophagus Double Contrast Study (74221) $400.50 $534 2.2×
Radiologic exam upr gi trc double contrast study (74246) $247.50 $330 1.4×
Radiologic exam upr gi trc single contrast study (74240) $400.50 $534 2.2×
Radiologic examination femur 1 view (73551) $100.50 $134 1.1×
Radiologic examination tibia & fibula 2 views (73590) $232.88 $310.50 2.6×
Radiologic examination, mastoids; complete, minimum of 3 views per side Non-Facility (70130) $164.62 $219.50 1.5×
Radiologic examination, mastoids; less than 3 views per side Non-Facility (70120) $129.75 $173 1.2×
Radiological examination surgical specimen (76098) $199.88 $266.50 0.4×
Ribs bilateral 3 views (71110) $339 $452 3.1×
Rp loclzj tum spect 1 area single day imaging (78803) $1,251 $1,668 2.2×
Rp loclzj tum spect w/CT 1 area 1 day imaging (78830) $1,269.38 $1,692.50 1.0×
Sacroiliac Joints < 3 Views (72200) $189 $252 1.8×
Scapula (73010) $73.50 $98 0.7×
Screening Digital Breast Tomosynthesis Bi (77063) $72 $96 3.1×
Shoulder 1 view (73020) $205.50 $274 2.3×
Sialogram (70390) $424.12 $565.50 1.7×
Small bowel series (74250) $225.75 $301 1.2×
Spine thoracic 3 views (72072) $319.50 $426 3.0×
Thoracolumbar 2 views (72080) $273.75 $365 3.0×
Thyroid imaging w/blood flow (78013) $201.38 $268.50 0.5×
Thyroid Uptake W/Blood Flow Sngle/Mult Quan Meas (78014) $699.38 $932.50 1.7×
Tmj unilateral (70328) $124.88 $166.50 1.4×
Ultrasound breast complete (76641) $253.12 $337.50 2.3×
Ultrasound Exam Aaa Screen (76706) $361.12 $481.50 3.3×
Ultrasound, abdomen limited (76705) $386.25 $515 3.6×
Umbilical-artery Doppler (OB) (76820) $265.50 $354 2.5×
Urethrocystogram voiding (74455) $379.88 $506.50 1.5×
Urography, infusion, drip technique and/or bolus technique; Non-Facility (74410) $98.25 $131 0.5×
Us breast unilateral limited (76642) $215.62 $287.50 2.4×
Us chest (76604) $188.25 $251 1.7×
Us hips infant static (76886) $67.88 $90.50 0.8×
Us infant hips w manipulation (76885) $79.88 $106.50 0.9×
Us lmtd joint/oth nonvasc xtr strux r-t w/img (76882) $214.12 $285.50 2.0×
Us ob limited (76815) $233.62 $311.50 2.2×
Us ob transvaginal (76817) $246 $328 2.3×
Us pelvic non ob complete (76856) $407.25 $543 3.8×
Us pelvic nonobstetric image dcmtn limited/f/u (76857) $94.50 $126 0.9×
Us pg uter img f&mat 14 wk tabdl 1/1st gestation (76801) $340.88 $454.50 3.2×
Us pg uter r-t img f-up tabdl appr pr fetus (76816) $188.25 $251 1.7×
Us retroperitoneal complete (76770) $366.38 $488.50 3.4×
Us retroperitoneal limited (76775) $269.62 $359.50 2.5×
Us scrotum and contents (76870) $279 $372 2.6×
Us soft tissue head/neck (76536) $405 $540 3.8×
Us spinal canal and contents (76800) $119.25 $159 1.1×
Us transrectal (76872) $540.75 $721 5.0×
Wrist 2 views (73100) $68.25 $91 0.8×
X-Ray Ac Jts - Xr Acromioclavicular Joints Bilateral (73050) $165 $220 1.8×
X-Ray Colon Air Contrast - Fl Barium Enema Air Contrast (74280) $507.38 $676.50 2.8×
X-Ray Elbow 2 Vw - Xr Elbow 1-2 Views Right (73070) $205.50 $274 2.3×
X-Ray Exam Hip Uni 2-3 Views (73502) $249 $332 2.8×
X-Ray Exam Hips Bi 3-4 Views (73522) $249 $332 2.3×
X-ray exam of femur 2/> (73552) $188.25 $251 2.1×
X-ray eye for foreign body (70030) $109.12 $145.50 1.2×
X-Ray Facial Bones <3 Vw - Xr Facial Bones 1-2 Views (70140) $223.50 $298 2.5×
X-ray IV pyelogram (ivp) (74400) $422.62 $563.50 2.3×
X-Ray Jaw <4 Vw - Xr Mandible < 4 Views (70100) $198.75 $265 2.2×
X-Ray Knee Bilat Standing - Xr Knees Anteroposterior Standing Bilat (73565) $213.75 $285 2.4×
X-ray leg, infant (73592) $120.38 $160.50 1.3×
X-Ray Lumbar Spine 2/3 Vw - Xr Lumbar Spine 2-3 Views (72100) $290.25 $387 2.7×
X-Ray Lumbar Spine 6+ Vw - Xr Lumbar Spine 6+ Vws Including Bending (72114) $282 $376 2.6×
X-ray nose-rectum child f.b. (76010) $58.50 $78 0.7×
X-Ray Orbits - Xr Orbits Complete 4+ Views (70200) $210.75 $281 2.0×
X-Ray Ribs 2 Vw Unilat - Xr Ribs 2 Views Right (71100) $249 $332 2.8×
X-Ray Ribs, Chest 3+ Vw - Xr Ribs 2 Vws Lt W/ Chest Anteroposterior (71101) $273.75 $365 2.5×
X-Ray Ribs, Chest 4+ Vw - Xr Ribs 3 Vws Bil W/ Chest Posteroanterior (71111) $367.50 $490 3.4×
X-Ray Sacroiliac Jts 3+ Vw - Xr Sacroiliac Joints 3+ Views (72202) $153 $204 1.4×
X-Ray Sacrum/Coccyx 2+ Vw - Xr Sacrum Coccyx 2+ Views (72220) $249 $332 2.8×
X-Ray Sinuses 3+ Vw - Xr Paranasal Sinuses 3+ Views (70220) $339 $452 3.8×
X-Ray Skull 4+ Vw - Xr Skull Complete 4+ Views (70260) $224.62 $299.50 2.1×
X-Ray Skull <4 Vw - Xr Skull 1-3 Views (70250) $273.75 $365 2.5×
X-Ray Spine One View - Xr Spine (72020) $117 $156 1.3×
X-Ray Sterno-Clavicluar Jt - Xr Sternoclavicular Joints 3+ Views (71130) $171.38 $228.50 1.9×
X-Ray Sternum 2+ Vw - Xr Sternum 2+ Views (71120) $160.12 $213.50 1.8×
X-Ray Thoracic Spine 2 Vw - Xr Thoracic Spine 2 Views (72070) $282.75 $377 2.6×
Xr bone length studies (77073) $169.88 $226.50 1.6×
Xr c-spine 4 or 5 views (72050) $387 $516 3.6×
Xr c-spine 6 or more views (72052) $261 $348 2.4×
Xr chest 4+ views (71048) $357 $476 3.3×