Imaging prices at Box Butte General Hospital

Alliance, NE · every code in this section with a posted price and a Medicare benchmark.

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

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ProcedureCash priceGross charge× Medicare
Abdomen 2 views (74019) $409.95 $455.50 3.8×
Acute gastrointestinal blood loss imaging (78278) $2,423.70 $2,693 5.8×
Ankle 2 views (73600) $324 $360 3.6×
Antegrade urography radiological supvj & interpj (74425) $740.70 $823 2.0×
Arthrogram hip (73525) $881.55 $979.50 2.4×
Arthrogram shoulder (73040) $881.55 $979.50 2.4×
Arthrogram wrist (73115) $943.20 $1,048 2.6×
Arthrography knee lt (73580) $1,399.50 $1,555 3.9×
Bone &/Joint Imaging Multiple Areas (78305) $1,831.50 $2,035 4.4×
Bone &/joint imaging whole body (78306) $2,317.50 $2,575 5.6×
Bone age studies (77072) $274.50 $305 2.5×
Bone Imaging 3 Phase (78315) $2,582.55 $2,869.50 6.2×
Bone survey complete (77075) $892.80 $992 8.2×
Brain Imaging Minimum 4 Static Views (78605) $1,660.50 $1,845 2.9×
Cervical spine 2 or 3 views (72040) $396.90 $441 4.4×
Chest 1 view (71045) $339.75 $377.50 3.8×
Cine/Vid X-Ray Throat/Esoph - Fl Esoph Barium Swlw W/ Video & Speech (74230) $643.95 $715.50 3.5×
Clavicle complete (73000) $333.90 $371 3.7×
Computed Tomography Thorax Lw Dose Lng Ca Scr C- (71271) $322.20 $358 3.0×
CT abdomen and pelvis without and with contrast (74178) $6,263.10 $6,959 17.3×
CT abdomen and pelvis without contrast (74176) $4,548.60 $5,054 18.4×
CT abdomen w contrast (74160) $2,903.40 $3,226 15.9×
CT abdomen w wo contrast (74170) $3,340.80 $3,712 18.3×
CT abdomen w/o contrast (74150) $2,501.10 $2,779 23.0×
CT angiography upper extremity lt (73206) $3,439.80 $3,822 18.9×
CT c-spine w/o contrast (72125) $2,612.25 $2,902.50 24.1×
CT cervical spine w&w/o contrast (72127) $3,434.40 $3,816 18.9×
CT cervical spine with contrast (72126) $2,817.90 $3,131 7.8×
CT chest w/wo contrast (71270) $3,538.80 $3,932 19.4×
CT chest with contrast (71260) $2,790.90 $3,101 15.3×
CT head/brain with contrast (70460) $2,497.50 $2,775 13.7×
CT head/brain without and with contrast (70470) $2,685.15 $2,983.50 14.7×
CT iac w contrast (70481) $3,029.85 $3,366.50 16.6×
CT limited/localized follow up study (76380) $1,503.90 $1,671 16.6×
CT lower ext w/o (73700) $2,458.35 $2,731.50 22.6×
CT lower extremity w wo contrast (73702) $3,466.80 $3,852 19.0×
CT lower extremity with contrast (73701) $2,594.25 $2,882.50 14.2×
CT lumbar spine w & w/o contrast (72133) $3,434.40 $3,816 18.9×
CT lumbar spine w/o contrast (72131) $2,542.05 $2,824.50 23.4×
CT lumbar spine with contrast (72132) $2,961 $3,290 8.2×
CT maxillofacial w contrast (70487) $2,654.10 $2,949 14.6×
CT maxillofacial w/o contrast (70486) $2,374.65 $2,638.50 21.9×
CT maxillofacial w/wo contrast (70488) $3,466.80 $3,852 19.0×
CT neck soft tissue w contrast (70491) $2,560.50 $2,845 14.1×
CT orbit sella/post fossa/ear w/o & w/contr matr (70482) $3,466.80 $3,852 19.0×
CT orbits w/o contrast (70480) $2,374.65 $2,638.50 21.9×
CT pelvis w & w/o contrast (72194) $3,466.80 $3,852 19.0×
CT pelvis w/o contrast (72192) $2,410.20 $2,678 22.2×
CT soft tissue neck w/o & w/contrast material (70492) $3,370.50 $3,745 18.5×
CT soft tissue neck w/o contrast (70490) $2,341.35 $2,601.50 21.6×
CT thoracic spine w/o contrast (72128) $2,547 $2,830 23.5×
CT thoracic spine w/wo contrast (72130) $3,538.80 $3,932 19.4×
CT thorax w/o contrast (71250) $2,547.90 $2,831 23.5×
CT upper extremity w/o & w/contrast material (73202) $3,466.80 $3,852 19.0×
CT upper extremity w/o contrast rt (73200) $2,341.35 $2,601.50 21.6×
CT upper extremity with contrast (73201) $2,691.90 $2,991 7.4×
Cta Abdl Aorta&Bi Iliofem W/Contrast&Postp (75635) $3,811.95 $4,235.50 20.9×
Cta Abdomen (74175) $3,506.40 $3,896 19.3×
CTA abdomen pelvis (74174) $6,114.15 $6,793.50 16.9×
CTA chest (71275) $3,539.25 $3,932.50 19.4×
Cta Head (70496) $3,405.60 $3,784 18.7×
CTA lwr ext w&w/o contrast (73706) $3,419.10 $3,799 18.8×
Cta Neck (70498) $3,405.60 $3,784 18.7×
Cta Pelvis (72191) $3,469.95 $3,855.50 19.1×
Cystography minimum 3 views rs&i (74430) $1,607.40 $1,786 4.4×
Dxa bone density study 1/> sites axial skel (77080) $607.50 $675 5.6×
Echoencephalography real time imaging (76506) $531 $590 4.9×
Esophagus (74220) $677.70 $753 3.7×
Fetal biophysical profile non-stress testing (76818) $594 $660 5.5×
Fetal Biophysical Profile W/O Non-Stress Testing (76819) $520.20 $578 4.8×
Fluoroscopy up to 1 hr (76000) $704.70 $783 2.8×
Foot 2 views (73620) $308.70 $343 3.4×
Forearm 2 views (73090) $324 $360 3.6×
Gated Heart Planar Single (78472) $2,117.70 $2,353 5.1×
Hand 2 views (73120) $324 $360 3.0×
Hand 3 views (73130) $426.15 $473.50 4.7×
Hepatobil Syst Imag Inc Gb W/Pharma Intervenj (78227) $2,040.30 $2,267 3.6×
Ht muscle image spect sing (78451) $3,963.15 $4,403.50 2.9×
Humerus Min 2 Views Left (73060) $340.20 $378 3.8×
Hysterosalpingogram (74740) $740.70 $823 3.0×
Kidney imaging morphology (78700) $1,493.10 $1,659 3.6×
Kidney Img Morphology Vascular Flow 1 W/O Rx (78707) $1,915.20 $2,128 3.4×
Kidney img morphology vascular flow 1 w/rx (78708) $1,791 $1,990 3.2×
Knee 3 views (73562) $405 $450 4.5×
Liver & Spleen Imaging W/Vascular Flow (78216) $1,812.60 $2,014 4.4×
Lung Ventilation Imaging (78579) $1,764 $1,960 4.2×
Lymphoscintigraphy (78195) $2,074.50 $2,305 3.7×
MRA head w & w/o contrast (70546) $4,132.80 $4,592 11.4×
MRA head w/o contrast (70544) $3,572.55 $3,969.50 14.4×
MRA head with contrast (70545) $3,989.70 $4,433 11.0×
Mra Neck W/O &W/Contrast Material (70549) $4,342.50 $4,825 12.0×
MRA neck w/o contrast (70547) $3,504.60 $3,894 14.1×
MRI abdomen w contrast (74182) $4,023.90 $4,471 11.1×
MRI abdomen w/o & w/contrast material (74183) $4,317.75 $4,797.50 11.9×
MRI abdomen w/o contrast (74181) $3,411.90 $3,791 13.8×
MRI any jnt lwr ext with con lt (73722) $3,764.25 $4,182.50 4.6×
MRI any jt upper extremity w/contrast matrl (73222) $3,764.25 $4,182.50 4.6×
MRI c-spine with contrast (72142) $3,989.70 $4,433 11.0×
MRI cervical spine w/o contrast (72141) $3,764.25 $4,182.50 15.2×
MRI chest with contrast (71551) $4,023.90 $4,471 4.9×
MRI Forearm w/ Contrast Bilateral 73219 (73219) $4,023.90 $4,471 11.1×
MRI lower extrem oth/thn jt w/contrast matrl (73719) $3,906 $4,340 10.8×
MRI lower extrem oth/thn jt w/o contr matrl (73718) $3,312.90 $3,681 13.4×
MRI orbit face &/neck w/o contrast (70540) $3,540.60 $3,934 14.3×
MRI orbit/face/neck w&w/o cont (70543) $4,152.15 $4,613.50 11.5×
MRI pelvis w contrast (72196) $4,023.90 $4,471 11.1×
MRI pelvis w/o & w/contrast material (72197) $4,275.90 $4,751 11.8×
MRI pelvis w/o contrast (72195) $3,312.90 $3,681 13.4×
MRI scan of arm joint before and after contrast (73223) $4,275.90 $4,751 11.8×
MRI scan of leg joint before and after contrast (73723) $4,152.15 $4,613.50 11.5×
MRI spinal canal cervical w/o & w/contr matrl (72156) $4,505.85 $5,006.50 12.4×
MRI spinal canal lumbar w/contrast material (72149) $3,873.60 $4,304 10.7×
MRI spinal canal lumbar w/o & w/contr matrl (72158) $4,382.55 $4,869.50 12.1×
MRI spinal canal thoracic w/contrast matrl (72147) $3,952.80 $4,392 10.9×
MRI spinal canal thoracic w/o & w/contr matrl (72157) $4,444.20 $4,938 12.3×
MRI thoracic spine w/o contrast (72146) $3,764.25 $4,182.50 15.2×
MRI tmj (70336) $3,877.65 $4,308.50 15.7×
MRI upper ext joint w/o contrast (73221) $3,312.90 $3,681 13.4×
MRI upper extrem other than jt w/o & w/contras (73220) $4,152.15 $4,613.50 11.5×
MRI upper extremity oth than jt w/o contr matrl (73218) $3,312.90 $3,681 13.4×
Myelogram Lumbar (72265) $1,386.90 $1,541 1.7×
Myelogram thoracic (72255) $3,311.10 $3,679 4.1×
Myocardial Spect Multiple Studies (78452) $4,546.35 $5,051.50 3.4×
Neck soft tissue (70360) $321.30 $357 3.6×
Nm gastric emptying study (78264) $2,223 $2,470 5.4×
Ob Us Follow-Up Per Fetus - Us Ob Follow Up Transabdominal Approach (76816) $576.45 $640.50 5.3×
Parathyrd planar w/wo subtrj (78071) $1,373.40 $1,526 3.3×
Parathyroid imaging (78070) $1,373.40 $1,526 3.3×
Pelvis 1 or 2 views (72170) $340.20 $378 3.1×
Pr MRI, lower extr, w/o contrast f/u by contrast (73720) $4,152.15 $4,613.50 11.5×
Pulmonary Perfusion Imaging Particulate (78580) $1,710.90 $1,901 4.1×
Pulmonary Ventilation & Perfusion Imaging (78582) $2,577.60 $2,864 4.6×
Radex abscess/fistula/sinus tract rs&i (76080) $1,609.20 $1,788 2.8×
Radex Entir Thrc Lmbr Crv Sac Spi W/Skull 1 Vw - Xr Scoliosis 1 Vw (72081) $334.35 $371.50 3.7×
Radex entir thrc lmbr crv sac spi w/skull 2/3 vw (72082) $608.40 $676 5.6×
Radex hips bilateral with pelvis 2 views (73521) $457.20 $508 4.2×
Radex mastoids compl minimum 3 views pr side (70130) $353.70 $393 3.3×
Radiolog exam mandible compl minimum 4 views (70110) $426.60 $474 3.9×
Radiologic Exam Abdomen 1 View - Xr Abdomen 1 View (74018) $341.10 $379 3.8×
Radiologic Exam Abdomen 3+ Views - Xr Abdomen 3+ Views (74021) $609.30 $677 5.6×
Radiologic Exam Chest 2 Views - Xr Chest 2 Views (71046) $388.35 $431.50 4.3×
Radiologic exam colon single contrast study (74270) $892.80 $992 4.9×
Radiologic exam upr gi trc double contrast study (74246) $954 $1,060 5.2×
Radiologic exam upr gi trc single contrast study (74240) $762.30 $847 4.2×
Radiologic Examination Femur Minimum 2 Views - Xr Femur 2+ Vw Lt (73552) $373.50 $415 4.1×
Radiologic Examination Salivary Gland Calculus (70380) $458.10 $509 5.1×
Radiological examination surgical specimen (76098) $255.60 $284 0.5×
Ribs bilateral 3 views (71110) $490.50 $545 4.5×
Rp loclzj tum plnr 2+area 1+d img/1 area img>2+d (78801) $2,069.10 $2,299 5.0×
Rp loclzj tum spect 1 area single day imaging (78803) $1,946.70 $2,163 3.5×
Scanogram (77073) $356.85 $396.50 3.3×
Scapula complete (73010) $485.10 $539 4.5×
Screening digital breast tomosynthesis (77063) $62.10 $69 2.7×
Small bowel series (74250) $725.85 $806.50 4.0×
Spine thoracic 3 views (72072) $522.90 $581 4.8×
Testicular Imaging With Vascular Flow (78761) $1,005.30 $1,117 2.4×
Thoracolumbar 2 views (72080) $376.20 $418 4.2×
Thyroid Imaging With Vascular Flow (78013) $1,425.60 $1,584 3.4×
Thyroid Uptake W/Blood Flow Sngle/Mult Quan Meas (78014) $1,652.85 $1,836.50 4.0×
Tomogram (76100) $740.70 $823 6.8×
Tumor Imaging, Limited Area - Nm Tumor Localization Limited (78800) $1,507.50 $1,675 3.6×
Ultrasound, abdomen limited (76705) $709.20 $788 6.5×
Umbilical-artery Doppler (OB) (76820) $227.70 $253 2.1×
Unlisted Diagnostic Radiographic Procedure (76499) $116.10 $129 1.3×
Upper Extremity Infant (73092) $408.15 $453.50 3.8×
Ureteral Reflux Study Rp Voiding Cystogram (78740) $1,782 $1,980 4.3×
Urethrocystography voiding (74455) $801.90 $891 3.2×
Us abdl aorta screen aaa (76706) $820.35 $911.50 7.6×
Us breast unilateral complete (76641) $552.15 $613.50 5.1×
Us breast unilateral limited (76642) $478.35 $531.50 5.3×
Us chest (76604) $557.55 $619.50 5.1×
Us compl joint r-t w/image documentation (76881) $892.80 $992 8.2×
Us fetal nuchal translucency 1st gestation (76813) $616.50 $685 5.7×
Us infant hips dynamic (76885) $531 $590 5.9×
Us kidney transplant (76776) $985.95 $1,095.50 9.1×
Us ob transvaginal (76817) $581.40 $646 5.4×
Us pelvic non ob complete (76856) $833.40 $926 7.7×
Us pelvic nonobstetric image dcmtn limited/f/u (76857) $554.40 $616 5.1×
Us pregnancy ltd (76815) $487.80 $542 4.5×
Us pregnant uterus 14 wk transabdl 1/1st gestat (76801) $677.70 $753 6.2×
Us retroperitoneal complete (76770) $844.20 $938 7.8×
Us retroperitoneal limited (76775) $658.80 $732 6.1×
Us scrotum and contents (76870) $740.25 $822.50 6.8×
Us soft tissue head/neck (76536) $740.25 $822.50 6.8×
Us spinal canal and contents (76800) $442.80 $492 4.1×
Us transrectal (76872) $787.95 $875.50 7.3×
Us xtr non-vasc lmtd (76882) $676.80 $752 6.2×
Venogram extremity bilateral (75822) $856.80 $952 0.5×
Venography extremity unilateral rs&i (75820) $783 $870 0.5×
Wrist 2 views (73100) $341.10 $379 3.8×
X-Ray Abdomen,Comp Acute Series - Xr Abdomen 2 Vws With Chest 1 View (74022) $598.50 $665 5.5×
X-Ray Ac Jts - Xr Acromioclavicular Joints Bilateral (73050) $394.20 $438 4.4×
X-Ray Ankle 3+ Vw - Xr Ankle 3+ Views Right (73610) $450.90 $501 5.0×
X-Ray Colon Air Contrast - Fl Barium Enema Air Contrast (74280) $1,087.20 $1,208 6.0×
X-Ray Elbow 2 Vw - Xr Elbow 1-2 Views Right (73070) $399.60 $444 4.4×
X-Ray Elbow 3+ Vw - Xr Elbow 3+ Views Right (73080) $412.20 $458 4.6×
X-ray exam hip uni 1 view (73501) $328.50 $365 3.6×
X-Ray Exam Hip Uni 2-3 Views (73502) $419.85 $466.50 4.6×
X-Ray Exam Hips Bi 3-4 Views (73522) $651.60 $724 6.0×
X-ray exam of femur 1 (73551) $337.50 $375 3.7×
X-ray eye for foreign body (70030) $252.90 $281 2.8×
X-Ray Facial Bones 3+ Vw - Xr Facial Bones 3+ Views (70150) $457.65 $508.50 4.2×
X-Ray Facial Bones <3 Vw - Xr Facial Bones 1-2 Views (70140) $328.50 $365 3.6×
X-Ray Foot 3+ Vw - Xr Foot 3+ Views Right (73630) $418.05 $464.50 4.6×
X-Ray Heel - Xr Calcaneus 2 Views Right (73650) $391.05 $434.50 4.3×
X-Ray Jaw <4 Vw - Xr Mandible < 4 Views (70100) $313.20 $348 3.5×
X-Ray Knee 4+ View - Xr Knee 4+ Views Right (73564) $538.20 $598 5.0×
X-Ray Knee Bilat Standing - Xr Knees Anteroposterior Standing Bilat (73565) $264.15 $293.50 2.9×
X-Ray Leg, Infant - Xr Lower Extremity 2+ Views Infant Left (73592) $461.70 $513 5.1×
X-Ray Lumbar Spine 2/3 Vw - Xr Lumbar Spine 2-3 Views (72100) $520.65 $578.50 4.8×
X-Ray Lumbar Spine 6+ Vw - Xr Lumbar Spine 6+ Vws Including Bending (72114) $677.70 $753 6.2×
X-Ray Lumbar Spine Flex/Exten - Xr Lumbar Spine 4+ Views W/ Flex Ext (72120) $561.60 $624 5.2×
X-Ray Nasal Bones - Xr Nasal Bones (70160) $376.20 $418 4.2×
X-Ray Nose-Rectum Child F.B. - Xr Nose to Rectum Foreign Body Peds (76010) $353.70 $393 3.9×
X-Ray Orbits - Xr Orbits Complete 4+ Views (70200) $462.60 $514 4.3×
X-Ray Pelvis 3+ Vw - Xr Pelvis 3+ Views (72190) $444.60 $494 4.1×
X-Ray Ribs 2 Vw Unilat - Xr Ribs 2 Views Right (71100) $338.40 $376 3.7×
X-Ray Ribs, Chest 3+ Vw - Xr Ribs 2 Vws Lt W/ Chest Anteroposterior (71101) $429.30 $477 4.0×
X-Ray Ribs, Chest 4+ Vw - Xr Ribs 3 Vws Bil W/ Chest Posteroanterior (71111) $553.95 $615.50 5.1×
X-Ray Sacroiliac Jts 3+ Vw - Xr Sacroiliac Joints 3+ Views (72202) $379.35 $421.50 3.5×
X-Ray Sacrum/Coccyx 2+ Vw - Xr Sacrum Coccyx 2+ Views (72220) $345.60 $384 3.8×
X-Ray Shoulder 2+ Vw - Xr Shoulder 2+ Views Right (73030) $447.30 $497 4.9×
X-Ray Sinuses 3+ Vw - Xr Paranasal Sinuses 3+ Views (70220) $407.25 $452.50 4.5×
X-Ray Sinuses <3 Vw - Xr Paranasal Sinuses 1-2 Views (70210) $271.80 $302 3.0×
X-Ray Skull 4+ Vw - Xr Skull Complete 4+ Views (70260) $444.60 $494 4.1×
X-Ray Skull <4 Vw - Xr Skull 1-3 Views (70250) $376.20 $418 3.5×
X-Ray Spine One View - Xr Spine (72020) $412.20 $458 4.6×
X-Ray Sterno-Clavicluar Jt - Xr Sternoclavicular Joints 3+ Views (71130) $412.20 $458 4.6×
X-Ray Sternum 2+ Vw - Xr Sternum 2+ Views (71120) $359.10 $399 4.0×
X-Ray Teeth Single - Xr Teeth 1 View (70300) $632.70 $703 7.0×
X-Ray Thoracic Spine 2 Vw - Xr Thoracic Spine 2 Views (72070) $382.95 $425.50 3.5×
X-Ray Thoracic Spine 4 Vw - Xr Thoracic Spine Complete 4+ Views (72074) $438.30 $487 4.0×
X-Ray Toe(S) - Xr Toes 2+ Views Right (73660) $264.15 $293.50 2.9×
X-Ray Wrist 3+ Vw - Xr Wrist 3+ Views Right (73110) $495.90 $551 5.5×
Xr arthrogram ankle (73615) $943.20 $1,048 2.6×
Xr c-spine 6 or more views (72052) $684 $760 6.3×
Xr finger(s) 2+ views (73140) $290.70 $323 3.2×
Xr shoulder 1 view (73020) $324 $360 3.6×
Xr spine cervical 4 or 5 views (72050) $532.35 $591.50 4.9×
Xr tibia/fibula 2 views (73590) $333.90 $371 3.7×
Xr tmj bilateral (70330) $542.70 $603 6.0×
Xray knee 1 or 2 views rt (73560) $526.50 $585 5.8×