Imaging prices at Gothenburg Health

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

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

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ProcedurePosted cashPosted gross× Medicare
Abdomen 1 View (74018) $324 $360 3.6×
Acute Gastrointestinal Blood Loss Imaging (78278) $1,148 $1,275 2.8×
Acute venous thrombosis imaging, peptide Non-Facility (78456) $1,800 $2,000 1.3×
Ankle 2 views (73600) $261 $290 2.9×
Bone age studies (77072) $252 $280 2.3×
Bone Imaging 3 Phase (78315)
range across 2 matching MRF lines		 $2,160–$2,181 $2,400–$2,423 varies
Bone Imaging Limited Area (78300)
range across 2 matching MRF lines		 $945–$1,122 $1,050–$1,247 varies
Bone Imaging Multiple Areas (78305)
range across 2 matching MRF lines		 $1,278–$1,473 $1,420–$1,637 varies
Bone Imaging Whole Body (78306)
range across 2 matching MRF lines		 $1,823–$1,850 $2,025–$2,055 varies
Bone survey infant (77076) $501 $557 4.6×
Cat Scan Follow-Up Study (76380) $1,611 $1,790 17.8×
Chest 1 view (71045) $288 $320 3.2×
Chest 2 views (71046) $356 $395 3.9×
Clavicle complete (73000) $306 $340 3.4×
Computed Tomography Thorax Lw Dose Lng Ca Scr C- (71271) $1,810 $2,011 16.7×
CT abdomen and pelvis without and with contrast (74178) $5,535 $6,150 15.3×
CT abdomen and pelvis without contrast (74176) $4,163 $4,625 16.8×
CT abdomen w contrast (74160) $2,700 $3,000 14.8×
CT abdomen w wo contrast (74170) $3,060 $3,400 16.8×
CT abdomen w/o contrast (74150) $2,430 $2,700 22.4×
CT Angio Abdomen and Pelvis (74174) $5,760 $6,400 15.9×
CT Angio Chest (71275) $3,330 $3,700 18.3×
CT Angio Head (70496) $3,150 $3,500 17.3×
Ct Angio Lwr Extr W/O&W/Dye (73706) $2,700 $3,000 14.8×
CT Angio Neck (70498) $3,105 $3,450 17.0×
Ct Angio Upr Extrm W/O&W/Dye (73206) $2,970 $3,300 16.3×
CT cervical spine w/ contrast (72126) $3,038 $3,375 8.4×
CT cervical spine w/o contrast (72125) $2,453 $2,725 22.6×
CT cervical spine w/wo cont (72127) $2,700 $3,000 14.8×
CT chest w contrast (71260) $2,565 $2,850 14.1×
CT chest w/wo contrast (71270) $3,128 $3,475 17.2×
CT head/brain with contrast (70460) $2,340 $2,600 12.8×
CT head/brain without and with contrast (70470) $3,150 $3,500 17.3×
CT heart no contrast quant eval coronry calcium (75571) $135 $150 1.5×
CT iac w contrast (70481) $2,430 $2,700 13.3×
CT l-spine w&w/o contrast (72133) $2,610 $2,900 14.3×
CT lower ext w/o (73700) $2,295 $2,550 21.1×
CT lower extremity w/contrast material (73701) $2,520 $2,800 13.8×
CT lumbar spine w contrast (72132) $2,700 $3,000 7.5×
CT lumbar spine w/o contrast (72131) $2,430 $2,700 22.4×
CT maxillofacial w contrast (70487) $2,340 $2,600 12.8×
CT maxillofacial wo contrast (70486) $1,980 $2,200 18.2×
CT neck tissue combo (70492) $2,790 $3,100 15.3×
Ct Orbit/Ear/Fossa W/O&W/Dye (70482) $2,520 $2,800 13.8×
CT orbits w/o contrast (70480) $2,340 $2,600 21.6×
CT pelvis w&w/o contrast (72194) $2,970 $3,300 16.3×
CT pelvis w/o contrast (72192) $2,408 $2,675 22.2×
CT scan of leg combo (73702) $3,150 $3,500 17.3×
CT scans face/jaw combo (70488) $2,610 $2,900 14.3×
CT soft tissue neck w contrast (70491) $2,475 $2,750 13.6×
CT soft tissue neck w/o contrast (70490) $2,160 $2,400 19.9×
CT thoracic spine w contrast (72129) $2,430 $2,700 13.3×
CT thoracic spine w/o contrast (72128) $2,453 $2,725 22.6×
CT thoracic spine w/wo cont (72130) $2,673 $2,970 14.7×
CT thorax w/o contrast (71250) $2,385 $2,650 22.0×
CT unlisted procedure (76497) $5,850 $6,500 64.7×
CT upper ext wo (73200) $2,160 $2,400 19.9×
CT upper extremity w/o & w/contrast material (73202) $2,700 $3,000 14.8×
Cta Abdl Aorta&Bi Iliofem W/Contrast&Postp (75635) $3,510 $3,900 19.3×
Cta Abdomen (74175) $3,353 $3,725 18.4×
CTA head&neck c+ w/noncontrast img&post-pxessing (70471) $6,255 $6,950 17.3×
Doppler Echo Fetal Puls Spectral F/U/Repeat (76828) $180 $200 1.7×
Doppler Echo Fetal Spectral Display Complete (76827) $185 $205 1.7×
Doppler Fetal Mid Cerebral Artery (76821) $224 $249 2.1×
Dxa Bone Density Axial (77080) $495 $550 4.6×
Dxa bone density study 1/>sites appendiclr skel (77081) $243 $270 2.7×
Echo exam of fetal heart (76825) $667 $741 1.2×
Echocardiography, fetal, cardiovascular system, real time with image documentation (2D), with or without M-mode… (76826) $371 $412 1.5×
Fetal Biophys Profile W/Nst (76818)
range across 2 matching MRF lines		 $277–$365 $308–$406 varies
Fluoroscopy up to 1 hr (76000) $675 $750 2.7×
Foot 2 views (73620) $270 $300 3.0×
Forearm 2 views (73090) $293 $325 3.2×
Gastric emptying imaging study (78264) $1,620 $1,800 3.9×
Gated Heart Planar Single (78472) $1,625 $1,805 3.9×
Hand 2 views (73120) $270 $300 2.5×
Hepatobil Syst Image W/Drug (78227) $1,868 $2,075 3.3×
Hepatobiliary System Imaging (78226)
range across 2 matching MRF lines		 $1,440–$1,590 $1,600–$1,767 varies
Ht Muscle Image Spect Sing (78451) $2,183 $2,425 1.6×
K Flow/Funct Image Multiple (78709) $1,418 $1,575 2.5×
K Flow/Funct Image W/Drug (78708) $1,350 $1,500 2.4×
K Flow/Funct Image W/O Drug (78707) $1,368 $1,520 2.4×
Knee 3 Views (73562) $383 $425 4.2×
Liver & Spleen Imaging Static Only (78215) $900 $1,000 2.2×
Liver & Spleen Imaging W/Vascular Flow (78216) $1,080 $1,200 2.6×
Liver imaging w/vascular flow (78202) $1,530 $1,700 2.7×
Lung Perf&Ventilat Diferentl (78598) $1,980 $2,200 3.5×
Lung Ventilat&Perfus Imaging (78582) $1,890 $2,100 3.4×
Lung Ventilation Imaging (78579) $1,193 $1,325 2.9×
Meckels Divert Exam (78290) $1,215 $1,350 2.9×
Mra Head W/O & W/Contrast Material (70546) $3,690 $4,100 10.2×
MRA head w/o contrast (70544)
range across 2 matching MRF lines		 $3,420–$4,512 $3,800–$5,013 varies
MRA neck w contrast (70548) $3,374 $3,749 9.3×
Mra Neck W/O &W/Contrast Material (70549) $3,870 $4,300 10.7×
MRA neck w/o contrast (70547) $3,218 $3,575 13.0×
MRI abdomen w contrast (74182) $3,510 $3,900 9.7×
MRI abdomen w/o contrast (74181) $3,083 $3,425 12.4×
MRI any jt lower extrem w/contrast material (73722)
range across 2 matching MRF lines		 $3,330–$3,420 $3,700–$3,800 varies
MRI any jt lower extrem w/o & w/contrast matrl (73723) $3,488 $3,875 9.6×
MRI any jt upper extremity w/contrast matrl (73222) $3,420 $3,800 4.2×
MRI cervical spine w/o cont (72141) $3,600 $4,000 14.5×
MRI chest w/o contrast (71550) $3,420 $3,800 13.8×
MRI chest wo w contrast (71552) $3,780 $4,200 10.4×
MRI lower extrem oth/thn jt w/o contr matrl (73718) $2,880 $3,200 11.6×
MRI lumbar spine w contrast (72149) $4,500 $5,000 12.4×
Mri Neck Spine W/O & W/Dye (72156) $4,963 $5,514 13.7×
MRI orbit face &/neck w/o contrast (70540) $3,240 $3,600 13.1×
MRI orbit face neck w contrast (70542) $3,600 $4,000 9.9×
Mri Orbt/Fac/Nck W/O &W/Dye (70543) $3,870 $4,300 10.7×
MRI pelvis w contrast (72196) $3,420 $3,800 9.4×
MRI pelvis w/o & w contrast (72197) $4,050 $4,500 11.2×
MRI pelvis w/o contrast (72195) $3,150 $3,500 12.7×
MRI thoracic spine w/o contrast (72146) $3,600 $4,000 14.5×
MRI upper extremity oth than jt w/o contr matrl (73218) $2,700 $3,000 10.9×
Mri Uppr Extremity W/O&W/Dye (73220) $3,510 $3,900 9.7×
MRI, abdomen, combo (74183) $4,230 $4,700 11.7×
MRI, dorsal spine combo (72157) $5,132 $5,702 14.2×
MRI, joint upper extrem (73221) $2,588 $2,875 10.4×
MRI, joint upper extrem combo (73223) $3,690 $4,100 10.2×
MRI, lumbar spine combo (72158) $4,140 $4,600 11.4×
Myocardial Spect Multiple Studies (78452) $4,005 $4,450 3.0×
Neck soft tissue (70360) $324 $360 3.6×
Ob us nuchal meas 1 gest (76813) $277 $308 2.6×
Optic foramina (70190) $270 $300 3.0×
Parathyroid Planar Imaging (78070) $1,215 $1,350 2.9×
Pelvis 1 or 2 views (72170) $347 $385 3.2×
Pulmonary Perfusion Imaging Particulate (78580) $990 $1,100 2.4×
Radex Abd Compl Aqt Abd W/S/E/D Views 1 View Ch (74022) $545 $605 5.0×
Radex Ankle Complete Minimum 3 Views (73610) $342 $380 3.8×
Radex Calcaneus Minimum 2 Views (73650) $266 $295 2.9×
Radex elbow complete minimum 3 views (73080) $338 $375 3.7×
Radex Facial Bones Complete Minimum 3 Views (70150) $437 $485 4.0×
Radex fingr minimum 2 views (73140) $252 $280 2.8×
Radex foot complete minimum 3 views (73630) $360 $400 4.0×
Radex Hand Minimum 3 Views (73130) $374 $415 4.1×
Radex lower extremity infant minimum 2 views (73592) $248 $275 2.7×
Radex Mastoids Compl Minimum 3 Views PR Side (70130) $311 $345 2.9×
Radex Nasal Bones Complete Minimum 3 Views (70160) $338 $375 3.7×
Radex Ribs Unilateral 2 Views (71100) $360 $400 4.0×
Radex shoulder complete minimum 2 views (73030) $520 $578 5.8×
Radex Sinuses Paransl < 3 Views (70210) $297 $330 3.3×
Radex Spine 1 View Specify Level (72020) $338 $375 3.7×
Radex Sternum Minimum 2 Views (71120) $338 $375 3.7×
Radex Temporomandble Jt Opn & Clsd Mouth Bilat (70330) $253 $281 2.8×
Radex Toe Minimum 2 Views (73660) $248 $275 2.7×
Radex upper extremity infant minimum 2 views (73092) $270 $300 2.5×
Radex Wrist Complete Minimum 3 Views (73110) $338 $375 3.7×
Radiolog exam mandible compl minimum 4 views (70110) $450 $500 4.1×
Radiologic Exam Abdomen 3+ Views - Xr Abdomen 3+ Views (74021) $495 $550 4.6×
Radiologic exam knee complete 4/more views (73564) $405 $450 3.7×
Radiologic exam pelvis compl minimum 3 views (72190) $405 $450 3.7×
Radiologic examination femur minimum 2 views (73552) $351 $390 3.9×
Radiologic examination knee 1/2 views (73560) $333 $370 3.7×
Radiologic Examination Osseous Survey Limited (77074) $720 $800 6.6×
Radiologic examination tibia & fibula 2 views (73590) $320 $355 3.5×
Ribs bilateral 3 views (71110) $477 $530 4.4×
Rp loclzj tum plnr 1 area single day imaging (78800) $1,035 $1,150 2.5×
Rp loclzj tum plnr 2+area 1+d img/1 area img>2+d (78801) $1,193 $1,325 2.9×
Scapula (73010) $320 $355 2.9×
Shoulder 1 view (73020) $261 $290 2.9×
Skull less than 4 views (70250) $333 $370 3.1×
Sternoclavicular joints (71130) $270 $300 3.0×
Thoracic spine 2 views (72070) $387 $430 3.6×
Thoracic spine 3 views (72072) $513 $570 4.7×
Thoracolumbar 2 views (72080) $360 $400 4.0×
Ultrasound Breast Limited (76642) $405 $450 4.5×
Ultrasound, abdomen limited (76705) $711 $790 6.5×
Umbilical-artery Doppler (OB) (76820) $180 $200 1.7×
Us breast unilateral complete (76641) $585 $650 5.4×
Us chest (76604) $585 $650 5.4×
Us complete joint (76881) $675 $750 6.2×
Us kidney transplant (76776) $765 $850 7.0×
Us lmtd joint/oth nonvasc xtr strux r-t w/img (76882) $563 $625 5.2×
Us ob detailed single fetus (76811) $540 $600 2.2×
Us pelvic non ob complete (76856) $788 $875 7.3×
Us retroperitoneal complete (76770) $810 $900 7.5×
Us retroperitoneal limited (76775) $603 $670 5.6×
Us scrotum and contents (76870) $698 $775 6.4×
Us thyroid (76536) $912 $1,013 8.4×
Us transrectal (76872) $684 $760 6.3×
Wrist 2 views (73100) $261 $290 2.9×
X-Ray Ac Jts - Xr Acromioclavicular Joints Bilateral (73050) $287 $319 3.2×
X-Ray Elbow 2 Vw - Xr Elbow 1-2 Views Right (73070) $284 $315 3.1×
X-Ray Exam Entire Spi 4/5 Vw (72083) $518 $575 4.8×
X-Ray Exam Hip Uni 1 View (73501) $279 $310 3.1×
X-Ray Exam Hip Uni 2-3 Views (73502) $360 $400 4.0×
X-Ray Exam L-S Spine Bending (72114) $630 $700 5.8×
X-Ray Exam Neck Spine 2-3 Vw (72040) $360 $400 4.0×
X-Ray Exam Unilat Ribs/Chest (71101) $432 $480 4.0×
X-ray eye for foreign body (70030) $279 $310 3.1×
X-ray humerus (73060) $324 $360 3.6×
X-Ray Jaw <4 Vw - Xr Mandible < 4 Views (70100) $243 $270 2.7×
X-Ray Knee Bilat Standing - Xr Knees Anteroposterior Standing Bilat (73565) $234 $260 2.6×
X-Ray Lumbar Spine 2/3 Vw - Xr Lumbar Spine 2-3 Views (72100) $473 $525 4.4×
X-Ray Ribs, Chest 4+ Vw - Xr Ribs 3 Vws Bil W/ Chest Posteroanterior (71111) $527 $585 4.9×
X-Ray Sacroiliac Jts 3+ Vw - Xr Sacroiliac Joints 3+ Views (72202) $374 $415 3.4×
X-Ray Sacrum/Coccyx 2+ Vw - Xr Sacrum Coccyx 2+ Views (72220) $338 $375 3.7×
X-Ray Sinuses 3+ Vw - Xr Paranasal Sinuses 3+ Views (70220) $423 $470 4.7×
X-Ray Skull 4+ Vw - Xr Skull Complete 4+ Views (70260) $495 $550 4.6×
X-Ray Tmj Unilat (70328) $185 $205 2.0×
X-Rays Bone Survey Complete (77075) $990 $1,100 9.1×
Xr c-spine 4 or 5 views (72050) $518 $575 4.8×
Xr facial bones less than 3 views (70140) $297 $330 3.3×
XR Mastoids < 3 Views Bilateral (70120) $270 $300 2.5×
Xr orbits complete 4 views (70200) $450 $500 4.1×

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.