Imaging prices at Gordon Memorial Hospital District
Gordon, NE · every code in this section with a posted price and a Medicare benchmark.
210 codes. Prices are the hospital's own posted facility charges.
Compare against other hospitals interactively →
| Procedure | Posted cash | Posted gross | × Medicare |
|---|---|---|---|
| Abdomen 1 View (74018) | $360 | $360 | 4.0× |
| Acute Gastrointestinal Blood Loss Imaging (78278) range across 2 matching MRF lines |
$1,750–$2,450 | $1,750–$2,450 | varies |
| Ankle 2 views (73600) | $335 | $335 | 3.7× |
| Bone age studies (77072) | $276 | $276 | 2.5× |
| Bone Imaging 3 Phase (78315) | $2,150 | $2,150 | 5.2× |
| Bone Imaging Limited Area (78300) | $1,850 | $1,850 | 4.5× |
| Bone Imaging Multiple Areas (78305) | $1,950 | $1,950 | 4.7× |
| Bone Imaging Whole Body (78306) | $2,050 | $2,050 | 4.9× |
| Chest 1 view (71045) | $360 | $360 | 4.0× |
| Chest 2 views (71046) | $415 | $415 | 4.6× |
| Chest 4 or more views (71048) | $375 | $375 | 3.5× |
| Clavicle complete (73000) | $385 | $385 | 4.3× |
| Computed Tomography Thorax Lw Dose Lng Ca Scr C- (71271) | $2,050 | $2,050 | 18.9× |
| CT abdomen and pelvis without and with contrast (74178) | $6,250 | $6,250 | 17.3× |
| CT abdomen and pelvis without contrast (74176) | $4,850 | $4,850 | 19.6× |
| CT abdomen w contrast (74160) range across 8 matching MRF lines |
$3,250–$3,550 | $3,250–$3,550 | varies |
| CT abdomen w wo contrast (74170) | $3,550 | $3,550 | 19.5× |
| CT abdomen w/o contrast (74150) range across 2 matching MRF lines |
$2,950–$3,550 | $2,950–$3,550 | varies |
| CT Angio Abdomen and Pelvis (74174) | $5,850 | $5,850 | 16.1× |
| CT Angio Chest (71275) | $4,050 | $4,050 | 22.2× |
| CT Angio Head (70496) | $3,650 | $3,650 | 20.0× |
| CT angio hrt w/3d image (75574) | $2,550 | $2,550 | 7.0× |
| CT Angio Neck (70498) | $3,550 | $3,550 | 19.5× |
| Ct Angio Upr Extrm W/O&W/Dye (73206) | $3,250 | $3,250 | 17.8× |
| CT cervical spine w/ contrast (72126) | $3,250 | $3,250 | 9.0× |
| CT cervical spine w/o contrast (72125) | $2,850 | $2,850 | 26.3× |
| CT cervical spine w/wo cont (72127) | $3,350 | $3,350 | 18.4× |
| CT chest w contrast (71260) | $3,050 | $3,050 | 16.7× |
| CT chest w/wo contrast (71270) | $3,650 | $3,650 | 20.0× |
| CT head/brain with contrast (70460) | $2,850 | $2,850 | 15.6× |
| CT head/brain without and with contrast (70470) | $3,200 | $3,200 | 17.6× |
| CT iac w contrast (70481) | $3,050 | $3,050 | 16.7× |
| CT l-spine w&w/o contrast (72133) | $3,350 | $3,350 | 18.4× |
| CT lower ext w/o (73700) range across 2 matching MRF lines |
$2,750–$3,050 | $2,750–$3,050 | varies |
| CT lower extremity w/contrast material (73701) | $3,050 | $3,050 | 16.7× |
| CT lumbar spine w contrast (72132) | $3,423 | $3,423 | 9.4× |
| CT lumbar spine w/o contrast (72131) | $2,850 | $2,850 | 26.3× |
| CT maxillofacial w contrast (70487) | $2,850 | $2,850 | 15.6× |
| CT maxillofacial wo contrast (70486) | $2,550 | $2,550 | 23.5× |
| CT neck tissue combo (70492) | $3,250 | $3,250 | 17.8× |
| Ct Orbit/Ear/Fossa W/O&W/Dye (70482) | $3,350 | $3,350 | 18.4× |
| CT orbits w/o contrast (70480) | $2,650 | $2,650 | 24.4× |
| CT pelvis w&w/o contrast (72194) | $3,750 | $3,750 | 20.6× |
| CT pelvis w/o contrast (72192) | $2,750 | $2,750 | 25.3× |
| CT scan of leg combo (73702) | $3,250 | $3,250 | 17.8× |
| CT scans face/jaw combo (70488) | $3,550 | $3,550 | 19.5× |
| CT soft tissue neck w contrast (70491) | $2,850 | $2,850 | 15.6× |
| CT soft tissue neck w/o contrast (70490) | $2,575 | $2,575 | 23.7× |
| CT thoracic spine w/o contrast (72128) | $2,850 | $2,850 | 26.3× |
| CT thoracic spine w/wo cont (72130) | $3,350 | $3,350 | 18.4× |
| CT thorax w/o contrast (71250) | $2,750 | $2,750 | 25.3× |
| CT upper ext wo (73200) | $2,750 | $2,750 | 25.3× |
| CT upper extremity w/o & w/contrast material (73202) | $3,250 | $3,250 | 17.8× |
| CT upper extremity with contrast (73201) range across 2 matching MRF lines |
$3,050–$3,250 | $3,050–$3,250 | varies |
| Cta Abdl Aorta&Bi Iliofem W/Contrast&Postp (75635) | $4,050 | $4,050 | 22.2× |
| Cta Abdomen (74175) | $4,550 | $4,550 | 25.0× |
| CTA head&neck c+ w/noncontrast img&post-pxessing (70471) | $7,100 | $7,100 | 19.6× |
| CTA pelvis (72191) | $3,050 | $3,050 | 16.7× |
| Dxa Bone Density Axial (77080) | $620 | $620 | 5.7× |
| Esophagram (74220) | $725 | $725 | 4.0× |
| Fetal Biophys Profile W/Nst (76818) | $685 | $685 | 6.3× |
| Fluoroscopy up to 1 hr (76000) | $750 | $750 | 3.0× |
| Foot 2 views (73620) | $360 | $360 | 4.0× |
| Forearm 2 views (73090) | $385 | $385 | 4.3× |
| Gastric emptying imaging study (78264) | $2,150 | $2,150 | 5.2× |
| Gated Heart Planar Single (78472) | $3,050 | $3,050 | 7.3× |
| Hand 2 views (73120) | $360 | $360 | 3.3× |
| Hepatobil Syst Image W/Drug (78227) | $2,450 | $2,450 | 4.3× |
| Hepatobiliary System Imaging (78226) | $2,050 | $2,050 | 4.9× |
| Ht Muscle Image Spect Sing (78451) | $2,750 | $2,750 | 2.0× |
| Knee 3 Views (73562) | $460 | $460 | 5.1× |
| Lung Perf&Ventilat Diferentl (78598) | $3,850 | $3,850 | 6.8× |
| Lung Ventilat&Perfus Imaging (78582) | $4,450 | $4,450 | 7.9× |
| Lung Ventilation Imaging (78579) | $2,550 | $2,550 | 6.1× |
| Lymphangiography extremity only unilateral rs&i (75801) | $72 | $72 | 0.1× |
| Magnetic Image Jaw Joint (70336) range across 2 matching MRF lines |
$18–$3,550 | $18–$3,550 | varies |
| Mr safety implant&/fb assmt clin staf 1st 15 min (76014) | $90 | $90 | 3.0× |
| Mra Head W/O & W/Contrast Material (70546) | $4,650 | $4,650 | 12.8× |
| MRA head w/o contrast (70544) | $4,050 | $4,050 | 16.3× |
| MRA neck w contrast (70548) | $4,250 | $4,250 | 11.7× |
| Mra Neck W/O &W/Contrast Material (70549) | $4,550 | $4,550 | 12.6× |
| MRA neck w/o contrast (70547) | $3,950 | $3,950 | 15.9× |
| MRI abdomen w contrast (74182) | $4,050 | $4,050 | 11.2× |
| MRI abdomen w/o contrast (74181) | $3,750 | $3,750 | 15.1× |
| MRI any jt lower extrem w/contrast material (73722) | $4,050 | $4,050 | 5.0× |
| MRI any jt lower extrem w/o & w/contrast matrl (73723) | $4,350 | $4,350 | 12.0× |
| MRI any jt upper extremity w/contrast matrl (73222) | $4,050 | $4,050 | 5.0× |
| MRI cervical spine w contrast (72142) | $4,350 | $4,350 | 12.0× |
| MRI cervical spine w/o cont (72141) | $4,050 | $4,050 | 16.3× |
| MRI chest w/o contrast (71550) | $4,250 | $4,250 | 17.2× |
| MRI chest with contrast (71551) | $4,550 | $4,550 | 5.6× |
| MRI chest wo w contrast (71552) | $4,850 | $4,850 | 13.4× |
| MRI lower extrem oth/thn jt w/contrast matrl (73719) | $3,550 | $3,550 | 9.8× |
| MRI lower extrem oth/thn jt w/o & w/contr matr (73720) | $4,150 | $4,150 | 11.5× |
| MRI lower extrem oth/thn jt w/o contr matrl (73718) | $3,250 | $3,250 | 13.1× |
| MRI lumbar spine w contrast (72149) | $4,350 | $4,350 | 12.0× |
| Mri Neck Spine W/O & W/Dye (72156) | $5,175 | $5,175 | 14.3× |
| MRI orbit face &/neck w/o contrast (70540) | $3,950 | $3,950 | 15.9× |
| MRI orbit face neck w contrast (70542) | $4,250 | $4,250 | 11.7× |
| Mri Orbt/Fac/Nck W/O &W/Dye (70543) | $4,550 | $4,550 | 12.6× |
| MRI pelvis w contrast (72196) | $4,050 | $4,050 | 11.2× |
| MRI pelvis w/o & w contrast (72197) | $4,650 | $4,650 | 12.8× |
| MRI pelvis w/o contrast (72195) | $3,650 | $3,650 | 14.7× |
| MRI thoracic spine w/o contrast (72146) | $4,050 | $4,050 | 16.3× |
| MRI upper extremity oth than jt w/contr matrl (73219) | $3,650 | $3,650 | 10.1× |
| MRI upper extremity oth than jt w/o contr matrl (73218) | $3,350 | $3,350 | 13.5× |
| Mri Uppr Extremity W/O&W/Dye (73220) | $4,450 | $4,450 | 12.3× |
| MRI, abdomen, combo (74183) | $5,030 | $5,030 | 13.9× |
| MRI, dorsal spine combo (72157) | $5,150 | $5,150 | 14.2× |
| MRI, dorsal spine contrast (72147) | $4,350 | $4,350 | 12.0× |
| MRI, joint upper extrem (73221) range across 2 matching MRF lines |
$2,996–$3,550 | $2,996–$3,550 | varies |
| MRI, joint upper extrem combo (73223) | $4,600 | $4,600 | 12.7× |
| MRI, lumbar spine combo (72158) | $4,950 | $4,950 | 13.7× |
| Myocardial Spect Multiple Studies (78452) | $4,850 | $4,850 | 3.6× |
| Neck soft tissue (70360) | $360 | $360 | 4.0× |
| Nonvascular Shunt X-Ray (75809) | $550 | $550 | 5.1× |
| Ophthalmic ultrasound dx b-scan w/wo a-scan (76512) | $521 | $521 | 4.8× |
| Parathyroid Planar Imaging (78070) | $1,950 | $1,950 | 4.7× |
| Parathyroid planar imaging w/wo subtraction (78071) | $2,250 | $2,250 | 5.4× |
| Pelvis 1 or 2 views (72170) | $395 | $395 | 3.6× |
| Pulmonary Perfusion Imaging Particulate (78580) | $2,350 | $2,350 | 5.7× |
| Radex Abd Compl Aqt Abd W/S/E/D Views 1 View Ch (74022) | $635 | $635 | 5.8× |
| Radex Ankle Complete Minimum 3 Views (73610) | $435 | $435 | 4.8× |
| Radex Calcaneus Minimum 2 Views (73650) | $320 | $320 | 3.5× |
| Radex elbow complete minimum 3 views (73080) | $460 | $460 | 5.1× |
| Radex Facial Bones Complete Minimum 3 Views (70150) | $505 | $505 | 4.7× |
| Radex fingr minimum 2 views (73140) range across 12 matching MRF lines |
$275–$285 | $275–$285 | varies |
| Radex foot complete minimum 3 views (73630) | $460 | $460 | 5.1× |
| Radex Hand Minimum 3 Views (73130) | $410 | $410 | 4.5× |
| Radex lower extremity infant minimum 2 views (73592) | $360 | $360 | 4.0× |
| Radex Nasal Bones Complete Minimum 3 Views (70160) | $385 | $385 | 4.3× |
| Radex Ribs Unilateral 2 Views (71100) | $410 | $410 | 4.5× |
| Radex shoulder complete minimum 2 views (73030) | $460 | $460 | 5.1× |
| Radex Sinuses Paransl < 3 Views (70210) | $310 | $310 | 3.4× |
| Radex Spine 1 View Specify Level (72020) | $410 | $410 | 4.5× |
| Radex Sternum Minimum 2 Views (71120) | $380 | $380 | 4.2× |
| Radex Temporomandble Jt Opn & Clsd Mouth Bilat (70330) | $360 | $360 | 4.0× |
| Radex Toe Minimum 2 Views (73660) range across 12 matching MRF lines |
$275–$285 | $275–$285 | varies |
| Radex upper extremity infant minimum 2 views (73092) | $360 | $360 | 3.3× |
| Radex Wrist Complete Minimum 3 Views (73110) | $460 | $460 | 5.1× |
| Radex X-Ray Exam Entire Spi 6/> Vw - Xr Entire Spine 6+ Vw (72084) | $565 | $565 | 5.2× |
| Radiolog exam mandible compl minimum 4 views (70110) | $470 | $470 | 4.3× |
| Radiologic Exam Abdomen 3+ Views - Xr Abdomen 3+ Views (74021) | $600 | $600 | 5.5× |
| Radiologic exam knee complete 4/more views (73564) | $510 | $510 | 4.7× |
| Radiologic exam pelvis compl minimum 3 views (72190) | $510 | $510 | 4.7× |
| Radiologic examination femur 1 view (73551) | $370 | $370 | 4.1× |
| Radiologic examination femur minimum 2 views (73552) | $425 | $425 | 4.7× |
| Radiologic examination knee 1/2 views (73560) | $410 | $410 | 4.5× |
| Radiologic Examination Osseous Survey Limited (77074) | $835 | $835 | 7.7× |
| Radiologic examination tibia & fibula 2 views (73590) | $435 | $435 | 4.8× |
| Red Cell Volume Determination Spx 1 Sampling (78120) | $4 | $4 | 0.0× |
| Ribs bilateral 3 views (71110) | $510 | $510 | 4.7× |
| Scapula (73010) | $460 | $460 | 4.2× |
| Screening Digital Breast Tomosynthesis Bi (77063) | $200 | $200 | 8.6× |
| Shoulder 1 view (73020) | $360 | $360 | 4.0× |
| Skull less than 4 views (70250) range across 2 matching MRF lines |
$350–$360 | $350–$360 | varies |
| Thoracic spine 2 views (72070) | $425 | $425 | 3.9× |
| Thoracic spine 3 views (72072) | $605 | $605 | 5.6× |
| Thyroid Imaging With Vascular Flow (78013) | $1,650 | $1,650 | 4.0× |
| Thyroid Uptake W/Blood Flow Sngle/Mult Quan Meas (78014) | $2,450 | $2,450 | 5.9× |
| Ultrasound Breast Limited (76642) | $505 | $505 | 5.6× |
| Ultrasound Exam Aaa Screen (76706) | $770 | $770 | 7.1× |
| Ultrasound, abdomen limited (76705) range across 2 matching MRF lines |
$820–$1,120 | $820–$1,120 | varies |
| Unlisted us procedure (76999) | $806 | $806 | 8.9× |
| Us breast unilateral complete (76641) | $685 | $685 | 6.3× |
| Us chest (76604) | $670 | $670 | 6.2× |
| Us complete joint (76881) | $820 | $820 | 7.6× |
| Us exam, pelvic, limited (76857) range across 2 matching MRF lines |
$630–$930 | $630–$930 | varies |
| Us lmtd joint/oth nonvasc xtr strux r-t w/img (76882) | $720 | $720 | 6.6× |
| Us ob limited 1 or more fetuses (76815) | $550 | $550 | 5.1× |
| Us ob transvaginal (76817) | $695 | $695 | 6.4× |
| Us pelvic non ob complete (76856) | $1,230 | $1,230 | 11.3× |
| Us pg uter img f&mat 14 wk tabdl 1/1st gestation (76801) | $820 | $820 | 7.6× |
| Us retroperitoneal complete (76770) range across 2 matching MRF lines |
$970–$1,270 | $970–$1,270 | varies |
| Us retroperitoneal limited (76775) | $720 | $720 | 6.6× |
| Us scrotum and contents (76870) | $1,120 | $1,120 | 10.3× |
| Us thyroid (76536) | $770 | $770 | 7.1× |
| Venous thrombosis imaging (78457) | $2,850 | $2,850 | 5.1× |
| Venous Thrombosis Imaging Venogram Bilateral (78458) | $3,250 | $3,250 | 7.8× |
| Wrist 2 views (73100) | $325 | $325 | 3.6× |
| X-Ray Ac Jts - Xr Acromioclavicular Joints Bilateral (73050) | $360 | $360 | 4.0× |
| X-Ray Bend Only L-S Spine (72120) | $560 | $560 | 5.2× |
| X-Ray Elbow 2 Vw - Xr Elbow 1-2 Views Right (73070) | $360 | $360 | 4.0× |
| X-Ray Exam Entire Spi 2/3 Vw (72082) | $450 | $450 | 4.1× |
| X-Ray Exam Entire Spi 4/5 Vw (72083) | $470 | $470 | 4.3× |
| X-Ray Exam Hip Uni 1 View (73501) | $360 | $360 | 4.0× |
| X-Ray Exam Hip Uni 2-3 Views (73502) | $410 | $410 | 4.5× |
| X-Ray Exam Hip Uni 4/> Views (73503) range across 3 matching MRF lines |
$250–$260 | $250–$260 | varies |
| X-Ray Exam Hips Bi 2 Views (73521) | $585 | $585 | 5.4× |
| X-Ray Exam Hips Bi 3-4 Views (73522) | $660 | $660 | 6.1× |
| X-Ray Exam L-S Spine Bending (72114) | $735 | $735 | 6.8× |
| X-Ray Exam Neck Spine 2-3 Vw (72040) | $435 | $435 | 4.8× |
| X-Ray Exam Neck Spine 6/>Vws (72052) | $710 | $710 | 6.5× |
| X-Ray Exam Unilat Ribs/Chest (71101) range across 4 matching MRF lines |
$28–$495 | $28–$495 | varies |
| X-ray eye for foreign body (70030) | $300 | $300 | 3.3× |
| X-ray humerus (73060) | $460 | $460 | 5.1× |
| X-ray IV pyelogram (ivp) (74400) range across 2 matching MRF lines |
$900–$1,550 | $900–$1,550 | varies |
| X-Ray Knee Bilat Standing - Xr Knees Anteroposterior Standing Bilat (73565) | $295 | $295 | 3.3× |
| X-Ray Lumbar Spine 2/3 Vw - Xr Lumbar Spine 2-3 Views (72100) | $535 | $535 | 4.9× |
| X-ray nose-rectum child f.b. (76010) | $340 | $340 | 3.8× |
| X-Ray Ribs, Chest 4+ Vw - Xr Ribs 3 Vws Bil W/ Chest Posteroanterior (71111) | $585 | $585 | 5.4× |
| X-Ray Sacroiliac Jts 3+ Vw - Xr Sacroiliac Joints 3+ Views (72202) | $485 | $485 | 4.5× |
| X-Ray Sacroiliac Jts <3 Vw - Xr Sacroiliac Joints 1-2 Views (72200) | $445 | $445 | 4.1× |
| X-Ray Sacrum/Coccyx 2+ Vw - Xr Sacrum Coccyx 2+ Views (72220) | $385 | $385 | 4.3× |
| X-Ray Sinuses 3+ Vw - Xr Paranasal Sinuses 3+ Views (70220) | $495 | $495 | 5.5× |
| X-Ray Skull 4+ Vw - Xr Skull Complete 4+ Views (70260) | $540 | $540 | 5.0× |
| X-Rays Bone Length Studies (77073) | $385 | $385 | 3.5× |
| X-Rays Bone Survey Complete (77075) | $735 | $735 | 6.8× |
| Xr c-spine 4 or 5 views (72050) | $585 | $585 | 5.4× |
| Xr facial bones less than 3 views (70140) | $350 | $350 | 3.9× |
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.