Imaging prices at Franciscan Healthcare

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

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

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ProcedurePosted cashPosted gross× Medicare
Abdomen 1 View (74018) $491 $491 5.4×
Abdomen 2 views (74019)
range across 2 matching MRF lines		 $378–$618 $378–$618 varies
Acute Gastrointestinal Blood Loss Imaging (78278) $2,710 $2,710 6.5×
Ankle 2 views (73600) $408 $408 4.5×
Arthrogram ankle (73615) $1,264 $1,264 3.5×
Arthrogram hip (73525) $927 $927 2.6×
Bone age studies (77072) $277 $277 2.6×
Bone Imaging 3 Phase (78315) $3,822 $3,822 9.2×
Bone Imaging Limited Area (78300) $1,846 $1,846 4.4×
Bone Imaging Multiple Areas (78305) $2,549 $2,549 6.1×
Bone Imaging Whole Body (78306) $3,415 $3,415 8.2×
Bone survey infant (77076) $1,010 $1,010 9.3×
Brain Imaging Min 4 Static Views W Vascular Flow (78606) $1,867 $1,867 3.3×
Brain Imaging Minimum 4 Static Views (78605) $1,594 $1,594 2.8×
Brain Imaging Pet Metabolic Evaluation (78608) $7,851 $7,851 5.3×
Cat Scan Follow-Up Study (76380) $1,928 $1,928 21.3×
Chest 1 view (71045) $390 $390 4.3×
Chest 2 views (71046) $533 $533 5.9×
Chest 3 views (71047) $542 $542 6.0×
Chest 4 or more views (71048) $1,928 $1,928 17.8×
Clavicle complete (73000) $541 $541 6.0×
Contrast X-Ray Bladder (74430) $785 $785 2.2×
CT abdomen and pelvis without and with contrast (74178) $8,208 $8,208 22.7×
CT abdomen and pelvis without contrast (74176) $6,612 $6,612 26.7×
CT abdomen w contrast (74160) $4,532 $4,532 24.9×
CT abdomen w wo contrast (74170) $5,709 $5,709 31.3×
CT abdomen w/o contrast (74150) $4,067 $4,067 37.5×
CT Angio Abdomen and Pelvis (74174) $7,142 $7,142 19.7×
CT Angio Chest (71275) $4,673 $4,673 25.7×
CT Angio Head (70496) $3,443 $3,443 18.9×
CT Angio Neck (70498) $3,904 $3,904 21.4×
Ct Angio Upr Extrm W/O&W/Dye (73206) $3,839 $3,839 21.1×
CT cervical spine w/ contrast (72126) $3,757 $3,757 10.4×
CT cervical spine w/o contrast (72125) $3,600 $3,600 33.2×
CT chest w contrast (71260) $4,168 $4,168 22.9×
CT chest w/wo contrast (71270) $4,193 $4,193 23.0×
CT head/brain with contrast (70460) $3,731 $3,731 20.5×
CT head/brain without and with contrast (70470) $4,548 $4,548 25.0×
CT heart no contrast quant eval coronry calcium (75571) $165 $165 1.8×
CT iac w contrast (70481) $3,959 $3,959 21.7×
CT l-spine w&w/o contrast (72133) $4,212 $4,212 23.1×
CT lower ext w/o (73700) $3,239 $3,239 29.8×
CT lower extremity w/contrast material (73701)
range across 14 matching MRF lines		 $3,319–$3,485 $3,319–$3,485 varies
CT lumbar spine w contrast (72132) $3,875 $3,875 10.7×
CT lumbar spine w/o contrast (72131) $3,792 $3,792 34.9×
CT maxillofacial w contrast (70487) $3,338 $3,338 18.3×
CT maxillofacial wo contrast (70486) $3,131 $3,131 28.8×
CT neck tissue combo (70492) $4,073 $4,073 22.4×
Ct Orbit/Ear/Fossa W/O&W/Dye (70482) $4,230 $4,230 23.2×
CT orbits w/o contrast (70480) $3,591 $3,591 33.1×
CT pelvis w&w/o contrast (72194) $4,358 $4,358 23.9×
CT pelvis w/o contrast (72192) $4,150 $4,150 38.2×
CT scan of leg combo (73702) $3,765 $3,765 20.7×
CT scans face/jaw combo (70488) $3,705 $3,705 20.3×
CT soft tissue neck w contrast (70491) $3,900 $3,900 21.4×
CT soft tissue neck w/o contrast (70490) $3,607 $3,607 33.2×
CT thoracic spine w contrast (72129) $3,973 $3,973 21.8×
CT thoracic spine w/o contrast (72128) $3,861 $3,861 35.6×
CT thoracic spine w/wo cont (72130) $4,513 $4,513 24.8×
CT thorax w/o contrast (71250) $4,028 $4,028 37.1×
CT upper ext wo (73200) $2,942 $2,942 27.1×
CT upper extremity w/o & w/contrast material (73202)
range across 14 matching MRF lines		 $3,497–$3,672 $3,497–$3,672 varies
CT upper extremity with contrast (73201) $2,977 $2,977 8.2×
Cta Abdl Aorta&Bi Iliofem W/Contrast&Postp (75635)
range across 2 matching MRF lines		 $5,111–$5,998 $5,111–$5,998 varies
Cta Abdomen (74175) $5,228 $5,228 28.7×
Dxa Bone Density Axial (77080) $865 $865 8.0×
Dxa bone density study (77085) $1,035 $1,035 9.5×
Dxa bone density study 1/>sites appendiclr skel (77081) $339 $339 3.8×
Echo Guide For Artery Repair (76936) $925 $925 4.1×
Esophagram (74220) $940 $940 5.2×
Fetal Biophys Profile W/Nst (76818) $1,022 $1,022 9.4×
Fetal Biophysical Profile W/O Non-Stress Testing (76819) $637 $637 5.9×
Fluoroscopy up to 1 hr (76000) $1,074 $1,074 4.3×
Foot 2 views (73620) $395 $395 4.4×
Forearm 2 views (73090) $494 $494 5.5×
Gastric emptying imaging study (78264) $3,455 $3,455 8.3×
Gated Heart Planar Single (78472) $3,434 $3,434 8.3×
Hand 2 views (73120) $450 $450 4.1×
Hepatobil Syst Image W/Drug (78227) $3,407 $3,407 6.0×
Hepatobiliary System Imaging (78226) $2,721 $2,721 6.6×
Ht Muscle Image Spect Sing (78451) $6,281 $6,281 4.7×
Hysterosalpingogram (74740) $1,371 $1,371 5.5×
Infant hip ultrasound with hip movement (dynamic) (76885) $1,029 $1,029 11.4×
K Flow/Funct Image Multiple (78709) $3,437 $3,437 6.1×
K Flow/Funct Image W/Drug (78708) $3,144 $3,144 5.6×
K Flow/Funct Image W/O Drug (78707) $2,680 $2,680 4.8×
Kidney Imaging Morphoogy W/Vascular Flow (78701) $2,393 $2,393 5.8×
Knee 3 Views (73562) $634 $634 7.0×
Liver & Spleen Imaging Static Only (78215) $2,707 $2,707 6.5×
Liver & Spleen Imaging W/Vascular Flow (78216) $2,945 $2,945 7.1×
Lung Perf&Ventilat Diferentl (78598) $5,377 $5,377 9.5×
Lung perfusion differential (78597) $2,349 $2,349 5.7×
Lung Ventilat&Perfus Imaging (78582) $3,839 $3,839 6.8×
Lung Ventilation Imaging (78579) $3,990 $3,990 9.6×
Lymph System Imaging (78195) $3,215 $3,215 5.7×
Magnetic Image Jaw Joint (70336) $5,019 $5,019 20.3×
Meckels Divert Exam (78290) $2,384 $2,384 5.7×
Mra Head W/O & W/Contrast Material (70546) $5,925 $5,925 16.4×
MRA head w/o contrast (70544) $5,094 $5,094 20.6×
MRA head with contrast (70545) $5,529 $5,529 15.3×
MRA neck w contrast (70548) $4,965 $4,965 13.7×
Mra Neck W/O &W/Contrast Material (70549) $5,392 $5,392 14.9×
MRA neck w/o contrast (70547) $4,355 $4,355 17.6×
MRI abdomen w/o contrast (74181) $4,079 $4,079 16.5×
MRI any jt lower extrem w/contrast material (73722)
range across 8 matching MRF lines		 $4,212–$4,423 $4,212–$4,423 varies
MRI any jt lower extrem w/o & w/contrast matrl (73723)
range across 8 matching MRF lines		 $4,690–$4,925 $4,690–$4,925 varies
MRI any jt upper extremity w/contrast matrl (73222) $4,082 $4,082 5.0×
MRI bone marrow blood supply (77084) $3,595 $3,595 14.5×
MRI cervical spine w contrast (72142) $6,572 $6,572 18.1×
MRI cervical spine w/o cont (72141) $6,300 $6,300 25.4×
MRI chest wo w contrast (71552) $5,436 $5,436 15.0×
MRI lower extrem oth/thn jt w/contrast matrl (73719)
range across 8 matching MRF lines		 $4,449–$4,671 $4,449–$4,671 varies
MRI lower extrem oth/thn jt w/o & w/contr matr (73720) $4,890 $4,890 13.5×
MRI lower extrem oth/thn jt w/o contr matrl (73718) $4,139 $4,139 16.7×
MRI lumbar spine w contrast (72149) $6,308 $6,308 17.4×
Mri Neck Spine W/O & W/Dye (72156) $7,162 $7,162 19.8×
MRI orbit face &/neck w/o contrast (70540) $6,002 $6,002 24.2×
Mri Orbt/Fac/Nck W/O &W/Dye (70543) $6,702 $6,702 18.5×
MRI pelvis w contrast (72196) $5,348 $5,348 14.8×
MRI pelvis w/o & w contrast (72197) $5,605 $5,605 15.5×
MRI pelvis w/o contrast (72195) $4,760 $4,760 19.2×
MRI thoracic spine w/o contrast (72146) $6,417 $6,417 25.9×
MRI upper extremity oth than jt w/contr matrl (73219) $4,243 $4,243 11.7×
MRI upper extremity oth than jt w/o contr matrl (73218) $3,776 $3,776 15.2×
Mri Uppr Extremity W/O&W/Dye (73220) $5,010 $5,010 13.8×
MRI, abdomen, combo (74183) $6,161 $6,161 17.0×
MRI, dorsal spine combo (72157) $7,162 $7,162 19.8×
MRI, dorsal spine contrast (72147) $6,760 $6,760 18.7×
MRI, joint upper extrem (73221) $4,053 $4,053 16.4×
MRI, joint upper extrem combo (73223) $4,448 $4,448 12.3×
MRI, lumbar spine combo (72158) $7,027 $7,027 19.4×
Myocardial Spect Multiple Studies (78452) $7,755 $7,755 5.8×
Neck soft tissue (70360) $492 $492 5.4×
Nm csf leak detection (78650) $1,867 $1,867 1.4×
Nonvascular Shunt X-Ray (75809) $866 $866 8.0×
Nuclear Rx Oral Admin (79005) $3,172 $3,172 13.1×
Ob us nuchal meas 1 gest (76813) $458 $458 4.2×
Parathyroid Planar Imaging (78070) $1,943 $1,943 4.7×
Parathyroid planar imaging w/wo subtraction (78071) $1,916 $1,916 4.6×
Pelvis 1 or 2 views (72170) $500 $500 4.6×
Pet Image W/Ct Lmtd (78814) $10,219 $10,219 6.9×
PET image w/CT, full body (78816) $9,462 $9,462 6.4×
PET imaging CT attenuation skull base mid-thigh (78815) $9,935 $9,935 6.7×
Pet Imaging Limited Area Chest Head/Neck (78811) $10,219 $10,219 7.6×
Pulmonary Perfusion Imaging Particulate (78580) $2,220 $2,220 5.3×
Radex Abd Compl Aqt Abd W/S/E/D Views 1 View Ch (74022)
range across 3 matching MRF lines		 $647–$897 $647–$897 varies
Radex abscess/fistula/sinus tract rs&i (76080) $2,653 $2,653 4.7×
Radex Ankle Complete Minimum 3 Views (73610) $548 $548 6.1×
Radex Calcaneus Minimum 2 Views (73650) $410 $410 4.5×
Radex elbow complete minimum 3 views (73080) $562 $562 6.2×
Radex Facial Bones Complete Minimum 3 Views (70150) $713 $713 6.6×
Radex fingr minimum 2 views (73140) $378 $378 4.2×
Radex foot complete minimum 3 views (73630) $586 $586 6.5×
Radex Hand Minimum 3 Views (73130) $563 $563 6.2×
Radex lower extremity infant minimum 2 views (73592) $338 $338 3.7×
Radex Mastoids Compl Minimum 3 Views PR Side (70130) $801 $801 7.4×
Radex Nasal Bones Complete Minimum 3 Views (70160) $569 $569 6.3×
Radex Ribs Unilateral 2 Views (71100) $559 $559 6.2×
Radex shoulder complete minimum 2 views (73030) $500 $500 5.5×
Radex Sinuses Paransl < 3 Views (70210) $488 $488 5.4×
Radex sm int w/mlt srl imges via enteroclss tube (74251) $1,193 $1,193 6.5×
Radex Spine 1 View Specify Level (72020) $460 $460 5.1×
Radex Sternum Minimum 2 Views (71120) $553 $553 6.1×
Radex Temporomandble Jt Opn & Clsd Mouth Bilat (70330) $874 $874 9.7×
Radex Toe Minimum 2 Views (73660) $378 $378 4.2×
Radex upper extremity infant minimum 2 views (73092) $480 $480 4.4×
Radex Wrist Complete Minimum 3 Views (73110) $554 $554 6.1×
Radiolog exam mandible compl minimum 4 views (70110) $723 $723 6.7×
Radiologic exam colon double contrast study (74280) $1,632 $1,632 9.0×
Radiologic exam colon single contrast study (74270) $1,004 $1,004 5.5×
Radiologic Exam Esophagus Double Contrast Study (74221) $1,188 $1,188 6.5×
Radiologic exam knee complete 4/more views (73564) $690 $690 6.4×
Radiologic exam pelvis compl minimum 3 views (72190) $664 $664 6.1×
Radiologic Exam Small Int Single Contrast Study (74250) $1,014 $1,014 5.6×
Radiologic exam swallow function contrast study (74230) $879 $879 4.8×
Radiologic exam upr gi trc double contrast study (74246) $1,368 $1,368 7.5×
Radiologic examination femur 1 view (73551) $548 $548 6.1×
Radiologic examination femur minimum 2 views (73552) $548 $548 6.1×
Radiologic examination knee 1/2 views (73560) $565 $565 6.3×
Radiologic Examination Osseous Survey Limited (77074) $1,283 $1,283 11.8×
Radiologic examination tibia & fibula 2 views (73590) $567 $567 6.3×
Ribs bilateral 3 views (71110) $764 $764 7.0×
Rp loclzj tum plnr 2+area 1+d img/1 area img>2+d (78801) $2,153 $2,153 5.2×
Rp Loclzj Tum Plnr Whole Body Single Day Imaging (78802) $3,827 $3,827 6.8×
Rp Loclzj Tum Spect 1 Area Single Day Imaging (78803) $4,673 $4,673 8.3×
Scapula (73010) $523 $523 4.8×
Screening Digital Breast Tomosynthesis Bi (77063) $75 $75 3.2×
Sella turcica (70240) $338 $338 3.7×
Shoulder 1 view (73020) $420 $420 4.6×
Shoulder Arthrography (73040) $1,063 $1,063 2.9×
Skull less than 4 views (70250) $466 $466 4.3×
Sternoclavicular joints (71130) $503 $503 5.6×
Testicular Imaging W/Flow (78761) $1,772 $1,772 4.3×
Thoracic spine 2 views (72070) $721 $721 6.6×
Thoracic spine 3 views (72072) $806 $806 7.4×
Thoracolumbar 2 views (72080) $919 $919 10.2×
Thyroid Imaging With Vascular Flow (78013) $1,257 $1,257 3.0×
Thyroid Uptake Measurement (78012) $1,035 $1,035 2.5×
Thyroid Uptake W/Blood Flow Sngle/Mult Quan Meas (78014) $2,398 $2,398 5.8×
Ultrasound Breast Limited (76642)
range across 3 matching MRF lines		 $591–$689 $591–$689 varies
Ultrasound Elastography Parenchyma (76981) $400 $400 3.7×
Ultrasound Exam Aaa Screen (76706) $1,138 $1,138 10.5×
Ultrasound, abdomen limited (76705) $966 $966 8.9×
Umbilical-artery Doppler (OB) (76820) $399 $399 3.7×
Unlisted magnetic resonance procedure (76498) $6,192 $6,192 68.5×
Upper gi w/o kub (74240) $859 $859 4.7×
Urethrocystogram voiding (74455) $784 $784 3.2×
Us breast unilateral complete (76641) $839 $839 7.7×
Us chest (76604) $877 $877 8.1×
Us complete joint (76881) $929 $929 8.6×
Us exam, pelvic, limited (76857) $507 $507 4.7×
Us head (76506) $946 $946 8.7×
Us kidney transplant (76776) $1,190 $1,190 11.0×
Us lmtd joint/oth nonvasc xtr strux r-t w/img (76882) $874 $874 8.1×
Us ob detailed single fetus (76811) $1,224 $1,224 4.9×
Us ob limited 1 or more fetuses (76815) $772 $772 7.1×
Us ob transvaginal (76817) $801 $801 7.4×
Us pelvic non ob complete (76856) $1,397 $1,397 12.9×
Us pg uter img f&mat 14 wk tabdl 1/1st gestation (76801) $1,027 $1,027 9.5×
Us preg uterus real time f/u trnsabdl per fetus (76816) $512 $512 4.7×
Us retroperitoneal complete (76770) $1,121 $1,121 10.3×
Us retroperitoneal limited (76775) $1,125 $1,125 10.4×
Us scrotum and contents (76870) $1,067 $1,067 9.8×
Us thyroid (76536) $1,000 $1,000 9.2×
Us transrectal (76872) $1,019 $1,019 9.4×
Vertebral fracture assessment via dxa (77086) $207 $207 2.3×
Wrist 2 views (73100) $378 $378 4.2×
X-Ray Ac Jts - Xr Acromioclavicular Joints Bilateral (73050) $492 $492 5.4×
X-Ray Bend Only L-S Spine (72120) $916 $916 8.4×
X-Ray Elbow 2 Vw - Xr Elbow 1-2 Views Right (73070) $491 $491 5.4×
X-Ray Exam Entire Spi 1 Vw (72081) $623 $623 6.9×
X-Ray Exam Entire Spi 2/3 Vw (72082) $597 $597 5.5×
X-Ray Exam Hip Uni 1 View (73501) $372 $372 4.1×
X-Ray Exam Hip Uni 2-3 Views (73502) $545 $545 6.0×
X-Ray Exam Hips Bi 2 Views (73521) $722 $722 6.7×
X-Ray Exam L-S Spine Bending (72114) $1,316 $1,316 12.1×
X-Ray Exam Neck Spine 2-3 Vw (72040) $615 $615 6.8×
X-Ray Exam Neck Spine 6/>Vws (72052) $1,369 $1,369 12.6×
X-Ray Exam Unilat Ribs/Chest (71101) $694 $694 6.4×
X-ray eye for foreign body (70030) $345 $345 3.8×
X-ray humerus (73060) $550 $550 6.1×
X-Ray Knee Bilat Standing - Xr Knees Anteroposterior Standing Bilat (73565) $421 $421 4.7×
X-Ray Lumbar Spine 2/3 Vw - Xr Lumbar Spine 2-3 Views (72100) $809 $809 7.5×
X-ray nose-rectum child f.b. (76010) $544 $544 6.0×
X-Ray Ribs, Chest 4+ Vw - Xr Ribs 3 Vws Bil W/ Chest Posteroanterior (71111) $920 $920 8.5×
X-Ray Sacroiliac Jts 3+ Vw - Xr Sacroiliac Joints 3+ Views (72202) $563 $563 5.2×
X-Ray Sacroiliac Jts <3 Vw - Xr Sacroiliac Joints 1-2 Views (72200) $678 $678 6.2×
X-Ray Sacrum/Coccyx 2+ Vw - Xr Sacrum Coccyx 2+ Views (72220) $509 $509 5.6×
X-Ray Sinuses 3+ Vw - Xr Paranasal Sinuses 3+ Views (70220) $638 $638 7.1×
X-Ray Skull 4+ Vw - Xr Skull Complete 4+ Views (70260) $723 $723 6.7×
X-Ray Stress View (77071) $389 $389 4.3×
X-Ray Urinary Tract Exam With Contrast Material (74420) $792 $792 2.2×
X-Rays Bone Length Studies (77073) $545 $545 5.0×
X-Rays Bone Survey Complete (77075) $1,528 $1,528 14.1×
Xr c-spine 4 or 5 views (72050) $907 $907 8.4×
Xr facial bones less than 3 views (70140) $458 $458 5.1×
XR Mastoids < 3 Views Bilateral (70120) $547 $547 5.0×
Xr myelogram posterior fossa (70010) $798 $798 2.2×
Xr orbits complete 4 views (70200) $763 $763 7.0×

A range means this hospital published different amounts on matching machine-readable-file lines. We show the lowest–highest posted amount because we cannot tell from the published file which line would apply to a particular visit.