Imaging prices at Summit Healthcare Regional Medical Center

Show Low, AZ · every code in this section with a posted price and a Medicare benchmark.

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

Compare against other hospitals interactively →

ProcedureCash priceGross charge× Medicare
3-D radiotherapy plan dose-volume histograms (77295) $4,360.28
Abdomen 2 views (74019) $252.91
Acute gastrointestinal blood loss imaging (78278) $2,621.53
Angiography extremity bilateral rs&i (75716) $5,681.34
Angiography extremity unilateral rs&i (75710) $10,605.18
Angiography pelvic slctv/supraslctv rs&i (75736) $5,693.34
Angiography pulmonary bilateral slctv rs&i (75743) $5,693.34
Angiography visceral slctv/supraslctv rs&i (75726) $18,058.73
Angrph Cath F-Up Std Tcat Other Than Thrombylsis (75898) $10,833.11
Angrph pulmonary nonslctv cath/ven njx rs&i (75746) $10,833.11
Ankle 2 views (73600) $559.37
Antegrade urography radiological supvj & interpj (74425) $1,325.07
Aortogram thoracic (75605) $12,780.68
Aortography abdl bi iliofem low extrem cath rs&i (75630) $6,401.83
Aortography abdominal serialography rs&i (75625) $5,235.37
Aortography thoracic w/o serialography rs&i (75600) $4,073.42
Arthrogram elbow (73085) $972.40
Arthrogram hip (73525) $936.58
Arthrogram shoulder (73040) $1,510.45
Arthrogram wrist (73115) $1,318.79
Arthrography knee lt (73580) $1,505.85
Basic radiation dosimetry calculation (77300) $358.47
Bone &/Joint Imaging Limited Area (78300) $2,127.77
Bone &/joint imaging whole body (78306) $4,152.70
Bone age studies (77072) $304.16
Bone Imaging 3 Phase (78315) $5,968.35
Bone survey complete (77075) $1,207.24
Card Bl Pool Gated Spect Rest Wal Motn Ejct Frct (78494) $3,731.09
Cervical spine 2 or 3 views (72040) $543.62
Chest 1 view (71045) $258.18
Cine/Vid X-Ray Throat/Esoph - Fl Esoph Barium Swlw W/ Video & Speech (74230) $1,090.48
Clavicle complete (73000) $425.58
Computed Tomography Thorax Lw Dose Lng Ca Scr C- (71271) $542.11
Continuing medical physics consltj pr wk (77336) $1,121.78
CT abdomen and pelvis without and with contrast (74178) $9,099
CT abdomen and pelvis without contrast (74176) $6,309.96
CT abdomen w contrast (74160) $5,674.36
CT abdomen w wo contrast (74170) $6,213.92
CT abdomen w/o contrast (74150) $5,465.86
CT angio hrt w/3d image (75574) $3,664.32
CT angiography upper extremity lt (73206) $5,497.19
CT c-spine w/o contrast (72125) $4,295.87
CT cervical spine w&w/o contrast (72127) $5,605.80
CT cervical spine with contrast (72126) $5,079.70
CT chest w/wo contrast (71270) $5,602.30
CT chest with contrast (71260) $4,822.74
CT head/brain with contrast (70460) $2,602.98
CT head/brain without and with contrast (70470) $5,112.21
CT heart contrast eval cardiac structure&morph (75572) $3,664.32
CT heart no contrast quant eval coronry calcium (75571) $901.42
CT iac w contrast (70481) $3,973.64
CT lower ext w/o (73700) $3,425.91
CT lower extremity w wo contrast (73702) $3,553.99
CT lower extremity with contrast (73701) $3,594.59
CT lumbar spine w & w/o contrast (72133) $6,535.82
CT lumbar spine w/o contrast (72131) $5,271.47
CT lumbar spine with contrast (72132) $5,902.79
CT maxillofacial w contrast (70487) $3,671.28
CT maxillofacial w/o contrast (70486) $3,839.54
CT maxillofacial w/wo contrast (70488) $4,217.43
CT neck soft tissue w contrast (70491) $4,224.76
CT orbit sella/post fossa/ear w/o & w/contr matr (70482) $4,505.53
CT orbits w/o contrast (70480) $3,443.33
CT pelvis w & w/o contrast (72194) $6,403.47
CT pelvis w/o contrast (72192) $5,335.96
CT soft tissue neck w/o & w/contrast material (70492) $4,203.18
CT soft tissue neck w/o contrast (70490) $3,940.41
CT thoracic spine w/contrast (72129) $3,988.47
CT thoracic spine w/o contrast (72128) $2,739.39
CT thoracic spine w/wo contrast (72130) $4,327.89
CT thorax w/o contrast (71250) $4,022.72
CT upper extremity w/o & w/contrast material (73202) $4,210.78
CT upper extremity w/o contrast rt (73200) $4,063.12
CT upper extremity with contrast (73201) $4,008.83
Cta Abdl Aorta&Bi Iliofem W/Contrast&Postp (75635) $4,142.90
Cta Abdomen (74175) $4,365.46
CTA abdomen pelvis (74174) $8,316.10
CTA chest (71275) $4,597.26
Cta Head (70496) $2,827.82
CTA lwr ext w&w/o contrast (73706) $5,911.29
Cta Neck (70498) $3,543.03
Cta Pelvis (72191) $1,622.21
Cystography minimum 3 views rs&i (74430) $1,007.27
Dxa bone density study 1/> sites axial skel (77080) $854.59
Dxa bone density study 1/>sites appendiclr skel (77081) $266.28
Dxa bone density study axial skeleton (77085) $511.70
Echoencephalography real time imaging (76506) $1,023.94
Esophagus (74220) $1,071.92
Fetal biophysical profile non-stress testing (76818) $1,047.26
Fetal Biophysical Profile W/O Non-Stress Testing (76819) $546.09
Fluoroscopy up to 1 hr (76000) $933.28
Foot 2 views (73620) $587.72
Forearm 2 views (73090) $511.38
Hand 2 views (73120) $449.59
Hand 3 views (73130) $605.20
Hepatobil Syst Imag Inc Gb W/Pharma Intervenj (78227) $3,762.14
Hepatobiliary syst imaging including gallbladder (78226) $3,454.36
Humerus Min 2 Views Left (73060) $634.26
Hysterosalpingogram (74740) $1,514.92
Kidney Img Morphology Vascular Flow 1 W/O Rx (78707) $3,137.52
Kidney img morphology vascular flow 1 w/rx (78708) $3,034.07
Knee 3 views (73562) $645.90
Lymphoscintigraphy (78195) $1,376.28
Mammary ductogram or galactogram multiple (77054) $1,065.24
Mammary ductogram or galactogram single (77053) $1,197.05
Meckels Diverticulum (78290) $1,381.35
Mlc imrt design & construction per imrt plan (77338) $2,000.64
MRA head w/o contrast (70544) $2,871.68
MRA neck w contrast (70548) $3,521.54
Mra Neck W/O &W/Contrast Material (70549) $3,580.61
MRA neck w/o contrast (70547) $3,463.70
MRI abdomen w contrast (74182) $4,151.78
MRI abdomen w/o & w/contrast material (74183) $5,174.01
MRI abdomen w/o contrast (74181) $3,462.91
MRI any jnt lwr ext with con lt (73722) $4,526.33
MRI any jt upper extremity w/contrast matrl (73222) $5,234.05
MRI breast w/o contrast bilateral (77047) $2,775.03
MRI breast w/o contrast unilat (77046) $1,890.62
MRI c-spine with contrast (72142) $5,927.74
MRI cervical spine w/o contrast (72141) $5,673.51
MRI chest w/o & w/contrast material (71552) $4,779.27
MRI chest w/o contrast (71550) $4,256.78
MRI chest with contrast (71551) $4,168.31
MRI Forearm w/ Contrast Bilateral 73219 (73219) $3,442.04
MRI lower extrem oth/thn jt w/contrast matrl (73719) $4,223.82
MRI lower extrem oth/thn jt w/o contr matrl (73718) $3,786.65
MRI orbit face &/neck w/o contrast (70540) $3,437.83
MRI orbit/face/neck w&w/o cont (70543) $4,609.58
MRI orbit/face/neck w/contrast (70542) $3,178.47
MRI pelvis w contrast (72196) $4,333.43
MRI pelvis w/o & w/contrast material (72197) $4,984.95
MRI pelvis w/o contrast (72195) $3,750.90
MRI scan of arm joint before and after contrast (73223) $5,898.35
MRI scan of leg joint before and after contrast (73723) $4,867.42
MRI spinal canal cervical w/o & w/contr matrl (72156) $6,173.01
MRI spinal canal lumbar w/contrast material (72149) $5,655.62
MRI spinal canal lumbar w/o & w/contr matrl (72158) $6,096.37
MRI spinal canal thoracic w/contrast matrl (72147) $5,241.72
MRI spinal canal thoracic w/o & w/contr matrl (72157) $5,650.51
MRI thoracic spine w/o contrast (72146) $4,878.91
MRI upper ext joint w/o contrast (73221) $5,029.65
MRI upper extrem other than jt w/o & w/contras (73220) $4,521.21
MRI upper extremity oth than jt w/o contr matrl (73218) $3,347.22
Myelogram Cervical (72240) $2,771.71
Myocardial Spect Multiple Studies (78452) $6,598.14
Neck soft tissue (70360) $614.74
Nm cisternogram (78630) $2,809.04
Nm gastric emptying study (78264) $2,908.62
Ntsty modul radthx pln dose-vol histos (77301) $3,931.52
Nuclear medicine of heart muscle at rest with stress (78454) $4,938.72
Nuclear Rx Oral Admin (79005) $3,157.54
Ob Us Follow-Up Per Fetus - Us Ob Follow Up Transabdominal Approach (76816) $546.09
Osseous survey infant (77076) $525.22
Osseous survey limited (77074) $983.30
Parathyroid imaging (78070) $2,346.09
Pelvis 1 or 2 views (72170) $503.38
Pr MRI, lower extr, w/o contrast f/u by contrast (73720) $4,627.25
Pulmonary Perfusion Imaging Particulate (78580) $2,129.34
Pulmonary Ventilation & Perfusion Imaging (78582) $2,165.04
Radex abscess/fistula/sinus tract rs&i (76080) $1,925.57
Radex Entir Thrc Lmbr Crv Sac Spi W/Skull 1 Vw - Xr Scoliosis 1 Vw (72081) $863.75
Radex entir thrc lmbr crv sac spi w/skull 2/3 vw (72082) $277.89
Radex hips bilateral with pelvis 2 views (73521) $736.80
Radex X-Ray Exam Entire Spi 6/> Vw - Xr Entire Spine 6+ Vw (72084) $1,006.83
Radiation treatment delivery 1 mev >= complex (77412) $695.46
Radiation treatment delivery 1 mev >= simple (77402) $487.72
Radiation tx delivery 1 mev >= intermediate (77407) $546.57
Radiolog exam mandible compl minimum 4 views (70110) $732.44
Radiologic Exam Abdomen 1 View - Xr Abdomen 1 View (74018) $258.18
Radiologic Exam Abdomen 3+ Views - Xr Abdomen 3+ Views (74021) $379.85
Radiologic Exam Chest 2 Views - Xr Chest 2 Views (71046) $243.18
Radiologic exam colon single contrast study (74270) $1,536.88
Radiologic Exam Esophagus Double Contrast Study (74221) $728.59
Radiologic exam upr gi trc double contrast study (74246) $728.59
Radiologic exam upr gi trc single contrast study (74240) $922.42
Radiologic Examination Femur Minimum 2 Views - Xr Femur 2+ Vw Lt (73552) $675.76
Radiological examination surgical specimen (76098) $788.59
Rp loclzj tum spect 1 area single day imaging (78803) $4,703.03
Saline Infus Sonohysterography W/Color Doppler (76831) $1,203.10
Scanogram (77073) $275.08
Scapula complete (73010) $481.58
Screening digital breast tomosynthesis (77063) $79.04
Simulation intermediate (77285) $905.30
Small bowel series (74250) $1,410.97
Spec medical radj physics consltj (77370) $1,425.58
Spec telethx port pln parts hemibdy tot bdy (77321) $879.02
Special dosimetry (77331) $418.18
Special treatment procedure (77470) $2,568.06
Spine thoracic 3 views (72072) $683.72
Stereotactic body radiation delivery (77373) $7,242.80
Telethx isodose pln cplx w/basic dosimetry (77307) $1,370.19
Telethx isodose pln smpl w/dosimetry calculation (77306) $780.66
Ther rad simulaj-aided field setting complex (77290) $1,442.14
Ther rad simulaj-aided field setting simple (77280) $695.62
Thyroid carcinoma metastases img whole body (78018) $2,858.19
Thyroid Uptake W/Blood Flow Sngle/Mult Quan Meas (78014) $1,226.15
Treatment device intermediate (77333) $897.34
Treatment devices simple (77332) $706.28
Tumor Imaging Whole Body - Nm Tumor Local Whole Body Mult Days (78804) $4,312.12
Tx devices design & construction complex (77334) $1,378.17
Ultrasound, abdomen limited (76705) $1,811.37
Umbilical-artery Doppler (OB) (76820) $406.28
Unlisted Diagnostic Radiographic Procedure (76499) $268.28
Unlisted genitourinary procedure, diagnostic nuclear medicine UNSCHEDULED (78799) $1,394.28
Unlisted magnetic resonance procedure (76498) $319.14
Upper Extremity Infant (73092) $304.16
Urethrocystography retrograde rs&i (74450) $889.55
Urethrocystography voiding (74455) $1,276.92
Us abdl aorta screen aaa (76706) $371.36
Us breast unilateral complete (76641) $644.20
Us breast unilateral limited (76642) $548.56
Us chest (76604) $660.65
Us compl joint r-t w/image documentation (76881) $676.76
Us guided compression repair (76936) $2,013.99
Us infant hips dynamic (76885) $507.05
Us kidney transplant (76776) $1,480.29
Us ob detailed single fetus (76811) $857.97
Us ob transvaginal (76817) $833.99
Us pelvic non ob complete (76856) $2,191.72
Us pelvic nonobstetric image dcmtn limited/f/u (76857) $957.73
Us pregnancy ltd (76815) $553.27
Us pregnant uterus 14 wk transabdl 1/1st gestat (76801) $826.84
Us retroperitoneal complete (76770) $1,532.18
Us retroperitoneal limited (76775) $2,294.50
Us scrotum and contents (76870) $1,276.42
Us soft tissue head/neck (76536) $1,215.43
Us spinal canal and contents (76800) $839.61
Us xtr non-vasc lmtd (76882) $438.72
Venogram extremity bilateral (75822) $4,139.47
Venography caval inferior serialography rs&i (75825) $6,567.83
Venography caval superior serialography rs&i (75827) $2,487.11
Venography extremity unilateral rs&i (75820) $5,242.28
Venography venous sinus/jugular cath rs&i (75860) $10,833.11
Vertebral fracture assessment via dxa (77086) $282.36
Wrist 2 views (73100) $583.39
X-Ray Abdomen,Comp Acute Series - Xr Abdomen 2 Vws With Chest 1 View (74022) $964.56
X-Ray Ac Jts - Xr Acromioclavicular Joints Bilateral (73050) $445.22
X-Ray Ankle 3+ Vw - Xr Ankle 3+ Views Right (73610) $645.90
X-Ray Colon Air Contrast - Fl Barium Enema Air Contrast (74280) $1,916.02
X-Ray Elbow 2 Vw - Xr Elbow 1-2 Views Right (73070) $322.34
X-Ray Elbow 3+ Vw - Xr Elbow 3+ Views Right (73080) $645.90
X-ray exam entire spi 4/5 vw (72083) $971.07
X-ray exam hip uni 1 view (73501) $348.50
X-Ray Exam Hip Uni 2-3 Views (73502) $622.64
X-Ray Exam Hips Bi 3-4 Views (73522) $808.34
X-Ray Exam Hips Bi 5/> Views (73523) $879.88
X-ray exam of femur 1 (73551) $589.92
X-ray eye for foreign body (70030) $333.60
X-Ray Facial Bones 3+ Vw - Xr Facial Bones 3+ Views (70150) $631.36
X-Ray Facial Bones <3 Vw - Xr Facial Bones 1-2 Views (70140) $497.57
X-Ray Foot 3+ Vw - Xr Foot 3+ Views Right (73630) $660.43
X-Ray Heel - Xr Calcaneus 2 Views Right (73650) $464.12
X-Ray Knee 4+ View - Xr Knee 4+ Views Right (73564) $727.33
X-Ray Knee Bilat Standing - Xr Knees Anteroposterior Standing Bilat (73565) $397.25
X-Ray Leg, Infant - Xr Lower Extremity 2+ Views Infant Left (73592) $276.52
X-Ray Lumbar Spine 2/3 Vw - Xr Lumbar Spine 2-3 Views (72100) $788.42
X-Ray Lumbar Spine 6+ Vw - Xr Lumbar Spine 6+ Vws Including Bending (72114) $1,330.84
X-Ray Lumbar Spine Flex/Exten - Xr Lumbar Spine 4+ Views W/ Flex Ext (72120) $490.30
X-Ray Nasal Bones - Xr Nasal Bones (70160) $618.27
X-Ray Orbits - Xr Orbits Complete 4+ Views (70200) $885.85
X-Ray Pelvis 3+ Vw - Xr Pelvis 3+ Views (72190) $552.84
X-Ray Retrograde Pyelogram - Fl Pyelogram Retrograde (74420) $1,121.96
X-Ray Ribs 2 Vw Unilat - Xr Ribs 2 Views Right (71100) $709.88
X-Ray Ribs, Chest 3+ Vw - Xr Ribs 2 Vws Lt W/ Chest Anteroposterior (71101) $657.54
X-Ray Ribs, Chest 4+ Vw - Xr Ribs 3 Vws Bil W/ Chest Posteroanterior (71111) $798.62
X-Ray Sacroiliac Jts 3+ Vw - Xr Sacroiliac Joints 3+ Views (72202) $603.72
X-Ray Sacrum/Coccyx 2+ Vw - Xr Sacrum Coccyx 2+ Views (72220) $703.34
X-Ray Shoulder 2+ Vw - Xr Shoulder 2+ Views Right (73030) $674.99
X-Ray Sinuses 3+ Vw - Xr Paranasal Sinuses 3+ Views (70220) $512.11
X-Ray Sinuses <3 Vw - Xr Paranasal Sinuses 1-2 Views (70210) $413.96
X-Ray Skull 4+ Vw - Xr Skull Complete 4+ Views (70260) $797.16
X-Ray Skull <4 Vw - Xr Skull 1-3 Views (70250) $613.91
X-Ray Sterno-Clavicluar Jt - Xr Sternoclavicular Joints 3+ Views (71130) $472.86
X-Ray Sternum 2+ Vw - Xr Sternum 2+ Views (71120) $605.18
X-Ray Thoracic Spine 2 Vw - Xr Thoracic Spine 2 Views (72070) $657.54
X-Ray Thoracic Spine 4 Vw - Xr Thoracic Spine Complete 4+ Views (72074) $1,455.92
X-Ray Toe(S) - Xr Toes 2+ Views Right (73660) $461.21
X-Ray Wrist 3+ Vw - Xr Wrist 3+ Views Right (73110) $627.01
Xr arthrogram ankle (73615) $1,238.24
Xr c-spine 6 or more views (72052) $1,185.41
Xr chest 4+ views (71048) $440.68
Xr finger(s) 2+ views (73140) $417.59
XR Mastoids < 3 Views Bilateral (70120) $245.99
Xr shoulder 1 view (73020) $295.43
Xr spine cervical 4 or 5 views (72050) $1,197.05
Xr tibia/fibula 2 views (73590) $523.02
Xr tmj bilateral (70330) $483.02
Xray knee 1 or 2 views rt (73560) $358.69