Imaging prices at Vandalia Health Mon Stonewall Jackson Memorial Hospital

Weston, WV · every code in this section with a posted price and a Medicare benchmark.

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

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ProcedureCash priceGross charge× Medicare
Abdomen 2 views (74019) $302.75 $605.49 3.0×
Acute gi blood loss imaging (78278) $1,135.75 $2,271.50 3.0×
Ankle 2 views (73600) $250.24 $500.47 3.0×
Bone &/joint imaging whole body (78306) $1,135.75 $2,271.50 3.0×
Bone age studies (77072) $302.75 $605.49 3.0×
Bone Imaging 3 Phase (78315) $1,135.75 $2,271.50 3.0×
Bone survey complete (77075) $302.75 $605.49 3.0×
Bowel imaging (78290) $1,135.75 $2,271.50 3.0×
Card Bpi Gtd =Brm Plnr 1 Std Rest/Strs (78472) $1,135.75 $2,271.50 3.0×
Cervical spine 2 or 3 views (72040) $250.24 $500.47 3.0×
Chest 1 view (71045) $250.24 $500.47 3.0×
Cine/Vid X-Ray Throat/Esoph - Fl Esoph Barium Swlw W/ Video & Speech (74230) $505.96 $1,011.91 3.0×
Clavicle complete (73000) $250.24 $500.47 3.0×
Computed Tomography Thorax Lw Dose Lng Ca Scr C- (71271) $302.75 $605.49 3.0×
CT abdomen and pelvis without and with contrast (74178) $1,059.02 $2,118.03 3.2×
CT abdomen and pelvis without contrast (74176) $674.77 $1,349.53 2.9×
CT abdomen w contrast (74160) $505.96 $1,011.91 3.0×
CT abdomen w wo contrast (74170) $505.96 $1,011.91 3.0×
CT abdomen w/o contrast (74150) $302.75 $605.49 3.0×
CT angio hrt w/3d image (75574) $854.05 $1,708.10 2.6×
CT angio lwr extr w/o&w/dye (73706) $505.96 $1,011.91 3.0×
CT c-spine w/o contrast (72125) $302.75 $605.49 3.0×
CT cervical spine w&w/o contrast (72127) $505.96 $1,011.91 3.0×
CT chest w contrast (71260) $505.96 $1,011.91 3.0×
CT chest w/wo contrast (71270) $505.96 $1,011.91 3.0×
CT head/brain with contrast (70460) $505.96 $1,011.91 3.0×
CT head/brain without and with contrast (70470) $505.96 $1,011.91 3.0×
CT heart contrast eval cardiac structure&morph (75572) $854.05 $1,708.10 2.6×
CT heart w/o contrast quant eval coronary calcium (75571) $210.57 $421.14 2.5×
CT hrt w/3d image congen (75573) $854.05 $1,708.10 2.6×
CT iac w contrast (70481) $505.96 $1,011.91 3.0×
CT lower ext w/o (73700) $302.75 $605.49 3.0×
CT lower extremity w wo contrast (73702) $505.96 $1,011.91 3.0×
CT lower extremity w/contrast material (73701) $505.96 $1,011.91 3.0×
CT lumbar spine w & w/o contrast (72133) $505.96 $1,011.91 3.0×
CT lumbar spine w/contrast (72132) $1,059.02 $2,118.03 3.2×
CT lumbar spine w/o contrast (72131) $302.75 $605.49 3.0×
CT maxillofacial w contrast (70487) $505.96 $1,011.91 3.0×
CT maxillofacial w/wo contrast (70488) $505.96 $1,011.91 3.0×
CT maxillofacial wo contrast (70486) $302.75 $605.49 3.0×
CT orbit sella/post fossa/ear w/o & w/contr matr (70482) $505.96 $1,011.91 3.0×
CT orbits w/o contrast (70480) $302.75 $605.49 3.0×
CT pelvis w/o contrast (72192) $302.75 $605.49 3.0×
CT pelvis w/wo contrast (72194) $505.96 $1,011.91 3.0×
CT scan of arm combo (73202) $505.96 $1,011.91 3.0×
CT soft tissue neck w contrast (70491) $505.96 $1,011.91 3.0×
CT soft tissue neck w/o & w/contrast material (70492) $505.96 $1,011.91 3.0×
CT soft tissue neck w/o contrast (70490) $302.75 $605.49 3.0×
CT thoracic spine w/o contrast (72128) $302.75 $605.49 3.0×
CT thoracic spine w/wo contrast (72130) $505.96 $1,011.91 3.0×
CT thorax w/o contrast (71250) $302.75 $605.49 3.0×
CT upper ext wo (73200) $302.75 $605.49 3.0×
CT upper extremity with contrast (73201) $1,059.02 $2,118.03 3.2×
Cta Aa&Bi Iliofem Lxtr Rs&I C-/C+ Post-Pxessing (75635) $505.96 $1,011.91 3.0×
Cta Abdomen (74175) $505.96 $1,011.91 3.0×
CTA abdomen pelvis (74174) $1,059.02 $2,118.03 3.2×
CTA chest (71275) $505.96 $1,011.91 3.0×
Cta Head (70496) $505.96 $1,011.91 3.0×
Cta Neck (70498) $505.96 $1,011.91 3.0×
Cystography minimum 3 views rs&i (74430) $1,059.02 $2,118.03 3.2×
Dxa bone density study 1/> sites axial skel (77080) $302.75 $605.49 3.0×
Esophagus (74220) $505.96 $1,011.91 3.0×
Facial bones min 3 views (70150) $302.75 $605.49 3.0×
Fetal biophysical profile non-stress testing (76818) $302.75 $605.49 3.0×
Fetal Biophysical Profile W/O Non-Stress Testing (76819) $302.75 $605.49 3.0×
Fluoroscopy up to 1 hr (76000) $674.77 $1,349.53 2.9×
Foot 2 views (73620) $250.24 $500.47 3.0×
Forearm 2 views (73090) $250.24 $500.47 3.0×
Hand 2 views (73120) $302.75 $605.49 3.0×
Hepatobil Syst Imag Inc Gb W/Pharma Intervenj (78227) $1,488.41 $2,976.82 2.9×
Hepatobiliary syst imaging including gallbladder (78226) $1,135.75 $2,271.50 3.0×
Hysterosalpingogram (74740) $674.77 $1,349.53 2.9×
Joint Survey, Single View - Xr Joint Anteroposterior 2+ Joints (77077) $302.75 $605.49 3.0×
Kidney img morphology vascular flow 1 w/rx (78708) $1,488.41 $2,976.82 2.9×
Knee 3 views (73562) $250.24 $500.47 3.0×
Liver & spleen imaging static only (78215) $1,135.75 $2,271.50 3.0×
Magnetic resonance (eg, proton) imaging, any joint of upper extremity; with contrast material(s) Non-Facility (73222) $2,204.85 $4,409.70 2.9×
Magnetic resonance (eg, proton) imaging, upper extremity, other than joint; without contrast material(s), followed by… (73220) $1,059.02 $2,118.03 3.2×
MRA head w & w/o contrast (70546) $1,059.02 $2,118.03 3.2×
MRA head w/o contrast (70544) $674.77 $1,349.53 2.9×
MRA head with contrast (70545) $1,059.02 $2,118.03 3.2×
Mra Neck W/O &W/Contrast Material (70549) $1,059.02 $2,118.03 3.2×
MRA neck w/o contrast (70547) $674.77 $1,349.53 2.9×
MRI abdomen w contrast (74182) $1,059.02 $2,118.03 3.2×
MRI abdomen w/o & w/contrast material (74183) $1,059.02 $2,118.03 3.2×
MRI abdomen w/o contrast (74181) $674.77 $1,349.53 2.9×
MRI any jt lower extrem w/contrast material (73722) $2,137.08 $4,274.16 2.8×
MRI any jt lower extrem w/o & w/contrast matrl (73723) $1,059.02 $2,118.03 3.2×
MRI c-spine with contrast (72142) $1,059.02 $2,118.03 3.2×
MRI cervical spine w/o contrast (72141) $674.77 $1,349.53 2.9×
MRI chest w/o & w/contrast material (71552) $1,059.02 $2,118.03 3.2×
MRI chest w/o contrast (71550) $674.77 $1,349.53 2.9×
MRI lower extrem oth/thn jt w/o & w/contr matr (73720) $1,059.02 $2,118.03 3.2×
MRI lower extrem oth/thn jt w/o contr matrl (73718) $674.77 $1,349.53 2.9×
MRI orbit face &/neck w/o contrast (70540) $674.77 $1,349.53 2.9×
MRI orbit/face/neck w&w/o cont (70543) $1,059.02 $2,118.03 3.2×
MRI pelvis w/o & w/contrast material (72197) $1,059.02 $2,118.03 3.2×
MRI pelvis w/o contrast (72195) $674.77 $1,349.53 2.9×
MRI spinal canal cervical w/o & w/contr matrl (72156) $1,059.02 $2,118.03 3.2×
MRI spinal canal lumbar w/contrast material (72149) $1,059.02 $2,118.03 3.2×
MRI spinal canal lumbar w/o & w/contr matrl (72158) $1,059.02 $2,118.03 3.2×
MRI spinal canal thoracic w/contrast matrl (72147) $1,059.02 $2,118.03 3.2×
MRI spinal canal thoracic w/o & w/contr matrl (72157) $1,059.02 $2,118.03 3.2×
MRI temporomandibular joint (70336) $674.77 $1,349.53 2.9×
MRI thoracic spine w/o contrast (72146) $674.77 $1,349.53 2.9×
MRI up ext w/o contrast (73218) $674.77 $1,349.53 2.9×
MRI upper ext joint w/o contrast (73221) $674.77 $1,349.53 2.9×
MRI, joint upper extrem combo (73223) $1,059.02 $2,118.03 3.2×
Myocardial Spect Multiple Studies (78452) $3,910.20 $7,820.40 3.1×
Myocardial spect single study at rest or stress (78451) $3,910.20 $7,820.40 3.1×
N-invas est c ffr sw aly CTA (75580) $2,245.85 $4,491.69 2.7×
Neck soft tissue (70360) $250.24 $500.47 3.0×
Nm gastric emptying study (78264) $1,135.75 $2,271.50 3.0×
Osseous survey limited (77074) $302.75 $605.49 3.0×
Parathyroid Planar Imaging (78070) $1,135.75 $2,271.50 3.0×
Pelvis 1 or 2 views (72170) $302.75 $605.49 3.0×
Pulmonary Perfusion Imaging Particulate (78580) $1,135.75 $2,271.50 3.0×
Pulmonary Ventilation & Perfusion Imaging (78582) $1,488.41 $2,976.82 2.9×
Quan&charac c atherosclerotc plaq asses sev c ds (75577) $2,031.65 $4,063.30 2.3×
Radex abscess/fistula/sinus tract rs&i (76080) $1,519.16 $3,038.32 2.9×
Radex Ankle Compl Minimum 3 Views (73610) $250.24 $500.47 3.0×
Radex Calcaneus Minimum 2 Views (73650) $250.24 $500.47 3.0×
Radex Elbw Compl Minimum 3 Views (73080) $250.24 $500.47 3.0×
Radex Entir Thrc Lmbr Crv Sac Spi W/Skull 1 Vw - Xr Scoliosis 1 Vw (72081) $250.24 $500.47 3.0×
Radex entir thrc lmbr crv sac spi w/skull 2/3 vw (72082) $302.75 $605.49 3.0×
Radex fingr minimum 2 views (73140) $250.24 $500.47 3.0×
Radex Foot Compl Minimum 3 Views (73630) $250.24 $500.47 3.0×
Radex Hand Minimum 3 Views (73130) $250.24 $500.47 3.0×
Radex Hip Unilateral With Pelvis 1 View (73501) $250.24 $500.47 3.0×
Radex Hip Unilateral With Pelvis Minimum 4 Views (73503) $302.75 $605.49 3.0×
Radex Humerus Minimum 2 Views (73060) $250.24 $500.47 3.0×
Radex Kne 1/2 Views (73560) $250.24 $500.47 3.0×
Radex Kne Compl 4/More Views (73564) $302.75 $605.49 3.0×
Radex Mndbl Compl Minimum 4 Views (70110) $302.75 $605.49 3.0×
Radex Nasal Bones Complete Minimum 3 Views (70160) $250.24 $500.47 3.0×
Radex Sho Compl Minimum 2 Views (73030) $250.24 $500.47 3.0×
Radex Temporomandble Jt Opn & Clsd Mouth Bilat (70330) $250.24 $500.47 3.0×
Radex Toe Minimum 2 Views (73660) $250.24 $500.47 3.0×
Radex Wrst Compl Minimum 3 Views (73110) $250.24 $500.47 3.0×
Radiologic Exam Abdomen 1 View - Xr Abdomen 1 View (74018) $250.24 $500.47 3.0×
Radiologic exam chest 2 views (71046) $250.24 $500.47 3.0×
Radiologic exam colon single contrast study (74270) $505.96 $1,011.91 3.0×
Radiologic Exam Esophagus Double Contrast Study (74221) $505.96 $1,011.91 3.0×
Radiologic exam upr gi trc double contrast study (74246) $505.96 $1,011.91 3.0×
Radiologic exam upr gi trc single contrast study (74240) $505.96 $1,011.91 3.0×
Radiologic examination tibia & fibula 2 views (73590) $250.24 $500.47 3.0×
Radiologic examination, mastoids; complete, minimum of 3 views per side Non-Facility (70130) $302.75 $605.49 3.0×
Radiological examination surgical specimen (76098) $1,519.16 $3,038.32 2.9×
Ribs bilateral 3 views (71110) $302.75 $605.49 3.0×
Saline Infus Sonohysterography W/Color Doppler (76831) $674.77 $1,349.53 2.9×
Scapula (73010) $302.75 $605.49 3.0×
Screening Digital Breast Tomosynthesis Bi (77063) $71.30 $142.60 3.0×
Shoulder 1 view (73020) $250.24 $500.47 3.0×
Small bowel series (74250) $505.96 $1,011.91 3.0×
Spine thoracic 3 views (72072) $302.75 $605.49 3.0×
Thyroid imaging w/blood flow (78013) $1,135.75 $2,271.50 3.0×
Thyroid uptake measurement (78012) $1,135.75 $2,271.50 3.0×
Thyroid Uptake W/Blood Flow Sngle/Mult Quan Meas (78014) $1,135.75 $2,271.50 3.0×
Tmj unilateral (70328) $250.24 $500.47 3.0×
Ultrasound breast complete (76641) $302.75 $605.49 3.0×
Ultrasound Exam Aaa Screen (76706) $302.75 $605.49 3.0×
Ultrasound, abdomen limited (76705) $302.75 $605.49 3.0×
Umbilical-artery Doppler (OB) (76820) $302.75 $605.49 3.0×
Urethrocystogram voiding (74455) $674.77 $1,349.53 2.9×
Us breast unilateral limited (76642) $250.24 $500.47 3.0×
Us chest (76604) $302.75 $605.49 3.0×
Us compl joint r-t w/image documentation (76881) $302.75 $605.49 3.0×
Us infant hips w manipulation (76885) $250.24 $500.47 3.0×
Us lmtd joint/oth nonvasc xtr strux r-t w/img (76882) $302.75 $605.49 3.0×
Us ob limited (76815) $302.75 $605.49 3.0×
Us ob transvaginal (76817) $302.75 $605.49 3.0×
Us pelvic non ob complete (76856) $302.75 $605.49 3.0×
Us pelvic nonobstetric image dcmtn limited/f/u (76857) $302.75 $605.49 3.0×
Us retroperitoneal complete (76770) $302.75 $605.49 3.0×
Us retroperitoneal limited (76775) $302.75 $605.49 3.0×
Us scrotum and contents (76870) $302.75 $605.49 3.0×
Us soft tissue head/neck (76536) $302.75 $605.49 3.0×
Venogram Extremity Unilateral (75820) $4,410.20 $8,820.39 2.9×
Wrist 2 views (73100) $250.24 $500.47 3.0×
X-Ray Abdomen,Comp Acute Series - Xr Abdomen 2 Vws With Chest 1 View (74022) $302.75 $605.49 3.0×
X-Ray Ac Jts - Xr Acromioclavicular Joints Bilateral (73050) $250.24 $500.47 3.0×
X-Ray Colon Air Contrast - Fl Barium Enema Air Contrast (74280) $505.96 $1,011.91 3.0×
X-Ray Elbow 2 Vw - Xr Elbow 1-2 Views Right (73070) $250.24 $500.47 3.0×
X-Ray Exam Hip Uni 2-3 Views (73502) $250.24 $500.47 3.0×
X-Ray Exam Hips Bi 3-4 Views (73522) $302.75 $605.49 3.0×
X-ray exam of femur 2/> (73552) $250.24 $500.47 3.0×
X-ray IV pyelogram (ivp) (74400) $505.96 $1,011.91 3.0×
X-Ray Knee Bilat Standing - Xr Knees Anteroposterior Standing Bilat (73565) $250.24 $500.47 3.0×
X-Ray Lumbar Spine 2/3 Vw - Xr Lumbar Spine 2-3 Views (72100) $302.75 $605.49 3.0×
X-Ray Orbits - Xr Orbits Complete 4+ Views (70200) $302.75 $605.49 3.0×
X-ray retrograde pyelogram (74420) $1,059.02 $2,118.03 3.2×
X-Ray Ribs 2 Vw Unilat - Xr Ribs 2 Views Right (71100) $250.24 $500.47 3.0×
X-Ray Ribs, Chest 3+ Vw - Xr Ribs 2 Vws Lt W/ Chest Anteroposterior (71101) $302.75 $605.49 3.0×
X-Ray Ribs, Chest 4+ Vw - Xr Ribs 3 Vws Bil W/ Chest Posteroanterior (71111) $302.75 $605.49 3.0×
X-Ray Sacroiliac Jts 3+ Vw - Xr Sacroiliac Joints 3+ Views (72202) $302.75 $605.49 3.0×
X-Ray Sacrum/Coccyx 2+ Vw - Xr Sacrum Coccyx 2+ Views (72220) $250.24 $500.47 3.0×
X-Ray Sinuses 3+ Vw - Xr Paranasal Sinuses 3+ Views (70220) $250.24 $500.47 3.0×
X-Ray Skull 4+ Vw - Xr Skull Complete 4+ Views (70260) $302.75 $605.49 3.0×
X-Ray Skull <4 Vw - Xr Skull 1-3 Views (70250) $302.75 $605.49 3.0×
X-Ray Spine One View - Xr Spine (72020) $250.24 $500.47 3.0×
X-Ray Sterno-Clavicluar Jt - Xr Sternoclavicular Joints 3+ Views (71130) $250.24 $500.47 3.0×
X-Ray Sternum 2+ Vw - Xr Sternum 2+ Views (71120) $250.24 $500.47 3.0×
Xr bone length studies (77073) $302.75 $605.49 3.0×
Xr c-spine 4 or 5 views (72050) $302.75 $605.49 3.0×
Xr c-spine 6 or more views (72052) $302.75 $605.49 3.0×
Xr chest 4+ views (71048) $302.75 $605.49 3.0×