Imaging prices at Jennie M Melham Memorial Medical Center
Broken Bow, NE · every code in this section with a posted price and a Medicare benchmark.
209 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) | $326.79 | $326.79 | 3.6× |
| Abdomen 2 views (74019) | $413.22 | $413.22 | 3.8× |
| Ankle 2 views (73600) | $287.06 | $287.06 | 3.2× |
| Arthrogram hip (73525) | $371 | $371 | 1.0× |
| Bone age studies (77072) | $221 | $221 | 2.0× |
| Bone Imaging 3 Phase (78315) | $2,188.75 | $2,188.75 | 5.3× |
| Bone Imaging Limited Area (78300) | $1,235 | $1,235 | 3.0× |
| Bone Imaging Multiple Areas (78305) | $1,382 | $1,382 | 3.3× |
| Bone Imaging Whole Body (78306) | $2,015.96 | $2,015.96 | 4.9× |
| Bone survey infant (77076) | $597 | $597 | 5.5× |
| Chest 1 view (71045) | $296.75 | $296.75 | 3.3× |
| Chest 2 views (71046) | $347.85 | $347.85 | 3.8× |
| Chest 4 or more views (71048) | $391 | $391 | 3.6× |
| Clavicle complete (73000) | $314.54 | $314.54 | 3.5× |
| Computed Tomography Thorax Lw Dose Lng Ca Scr C- (71271) | $899 | $899 | 8.3× |
| CT abdomen and pelvis without and with contrast (74178) | $5,573.85 | $5,573.85 | 15.4× |
| CT abdomen and pelvis without contrast (74176) | $4,016.18 | $4,016.18 | 16.2× |
| CT abdomen w contrast (74160) | $2,800.56 | $2,800.56 | 15.4× |
| CT abdomen w wo contrast (74170) | $3,358.15 | $3,358.15 | 18.4× |
| CT abdomen w/o contrast (74150) | $2,374.94 | $2,374.94 | 21.9× |
| CT Angio Abdomen and Pelvis (74174) | $5,255.68 | $5,255.68 | 14.5× |
| CT Angio Chest (71275) | $3,481.05 | $3,481.05 | 19.1× |
| CT Angio Head (70496) | $3,041.90 | $3,041.90 | 16.7× |
| Ct Angio Lwr Extr W/O&W/Dye (73706) range across 2 matching MRF lines |
$2,251–$4,431 | $2,251–$4,431 | varies |
| CT Angio Neck (70498) | $3,125.86 | $3,125.86 | 17.2× |
| Ct Angio Upr Extrm W/O&W/Dye (73206) range across 2 matching MRF lines |
$2,251–$4,502 | $2,251–$4,502 | varies |
| CT cervical spine w/ contrast (72126) | $2,189 | $2,189 | 6.0× |
| CT cervical spine w/o contrast (72125) | $2,443.86 | $2,443.86 | 22.5× |
| CT cervical spine w/wo cont (72127) | $2,357 | $2,357 | 12.9× |
| CT chest w contrast (71260) | $2,817.52 | $2,817.52 | 15.5× |
| CT chest w/wo contrast (71270) | $3,167.14 | $3,167.14 | 17.4× |
| CT head/brain with contrast (70460) | $2,463.87 | $2,463.87 | 13.5× |
| CT head/brain without and with contrast (70470) | $2,621.26 | $2,621.26 | 14.4× |
| CT iac w contrast (70481) | $2,654.26 | $2,654.26 | 14.6× |
| CT l-spine w&w/o contrast (72133) | $2,891.95 | $2,891.95 | 15.9× |
| CT lower ext w/o (73700) | $2,109.29 | $2,109.29 | 19.4× |
| CT lower extremity w/contrast material (73701) | $2,525.80 | $2,525.80 | 13.9× |
| CT lumbar spine w contrast (72132) | $2,776.18 | $2,776.18 | 7.7× |
| CT lumbar spine w/o contrast (72131) | $2,473.63 | $2,473.63 | 22.8× |
| CT maxillofacial w contrast (70487) | $2,342.92 | $2,342.92 | 12.9× |
| CT maxillofacial wo contrast (70486) | $2,022.30 | $2,022.30 | 18.6× |
| CT neck tissue combo (70492) | $2,932.83 | $2,932.83 | 16.1× |
| Ct Orbit/Ear/Fossa W/O&W/Dye (70482) | $2,158 | $2,158 | 11.8× |
| CT orbits w/o contrast (70480) | $2,273.99 | $2,273.99 | 20.9× |
| CT pelvis w&w/o contrast (72194) | $2,944.95 | $2,944.95 | 16.2× |
| CT pelvis w/o contrast (72192) | $2,222.89 | $2,222.89 | 20.5× |
| CT scan of leg combo (73702) range across 2 matching MRF lines |
$2,336–$4,673 | $2,336–$4,673 | varies |
| CT scans face/jaw combo (70488) | $2,587.07 | $2,587.07 | 14.2× |
| CT soft tissue neck w contrast (70491) | $2,558.01 | $2,558.01 | 14.0× |
| CT soft tissue neck w/o contrast (70490) | $2,265.46 | $2,265.46 | 20.9× |
| CT thoracic spine w contrast (72129) | $2,616 | $2,616 | 14.4× |
| CT thoracic spine w/o contrast (72128) | $2,466.32 | $2,466.32 | 22.7× |
| CT thoracic spine w/wo cont (72130) | $2,349 | $2,349 | 12.9× |
| CT thorax w/o contrast (71250) | $2,250.44 | $2,250.44 | 20.7× |
| CT upper ext wo (73200) | $2,154.84 | $2,154.84 | 19.8× |
| CT upper extremity w/o & w/contrast material (73202) | $2,227 | $2,227 | 12.2× |
| CT upper extremity with contrast (73201) | $2,496.14 | $2,496.14 | 6.9× |
| Cta Abdl Aorta&Bi Iliofem W/Contrast&Postp (75635) | $3,537.45 | $3,537.45 | 19.4× |
| Cta Abdomen (74175) | $3,646.58 | $3,646.58 | 20.0× |
| Dxa Bone Density Axial (77080) | $539.08 | $539.08 | 5.0× |
| Dxa bone density study 1/>sites appendiclr skel (77081) | $193 | $193 | 2.1× |
| Fetal Biophysical Profile W/O Non-Stress Testing (76819) | $510.90 | $510.90 | 4.7× |
| Fluoroscopy up to 1 hr (76000) | $718.36 | $718.36 | 2.9× |
| Foot 2 views (73620) range across 2 matching MRF lines |
$283.07–$406 | $283.07–$406 | varies |
| Forearm 2 views (73090) | $336.18 | $336.18 | 3.7× |
| Gated Heart Planar Single (78472) | $1,607 | $1,607 | 3.9× |
| Hand 2 views (73120) range across 2 matching MRF lines |
$296.45–$508 | $296.45–$508 | varies |
| Hepatobil Syst Image W/Drug (78227) | $2,278.51 | $2,278.51 | 4.0× |
| Hepatobiliary System Imaging (78226) | $1,420 | $1,420 | 3.4× |
| Ht Muscle Image Spect Sing (78451) | $1,026 | $1,026 | 0.8× |
| Hysterosalpingogram (74740) | $640 | $640 | 2.6× |
| Infant hip ultrasound with hip movement (dynamic) (76885) | $366 | $366 | 4.1× |
| K Flow/Funct Image Multiple (78709) | $1,114 | $1,114 | 2.0× |
| K Flow/Funct Image W/Drug (78708) | $1,114 | $1,114 | 2.0× |
| Kidney Imaging Morphol (78700) | $310 | $310 | 0.7× |
| Knee 3 Views (73562) | $403.15 | $403.15 | 4.5× |
| Lung Ventilat&Perfus Imaging (78582) | $1,706 | $1,706 | 3.0× |
| Meckels Divert Exam (78290) | $1,071 | $1,071 | 2.6× |
| Mra Head W/O & W/Contrast Material (70546) | $3,804.85 | $3,804.85 | 10.5× |
| MRA head w/o contrast (70544) | $3,676.80 | $3,676.80 | 14.8× |
| MRA head with contrast (70545) | $3,646 | $3,646 | 10.1× |
| MRA neck w contrast (70548) | $3,399 | $3,399 | 9.4× |
| Mra Neck W/O &W/Contrast Material (70549) | $4,024 | $4,024 | 11.1× |
| MRI abdomen w/o contrast (74181) | $3,289 | $3,289 | 13.3× |
| MRI any jt lower extrem w/contrast material (73722) | $2,433 | $2,433 | 3.0× |
| MRI any jt lower extrem w/o & w/contrast matrl (73723) | $3,893.54 | $3,893.54 | 10.7× |
| MRI any jt upper extremity w/contrast matrl (73222) | $2,293 | $2,293 | 2.8× |
| MRI cervical spine w contrast (72142) | $3,357.80 | $3,357.80 | 9.3× |
| MRI cervical spine w/o cont (72141) | $3,339.35 | $3,339.35 | 13.5× |
| MRI chest w/o contrast (71550) | $2,823 | $2,823 | 11.4× |
| MRI chest with contrast (71551) | $2,947 | $2,947 | 3.6× |
| MRI chest wo w contrast (71552) | $3,739.20 | $3,739.20 | 10.3× |
| MRI lower extrem oth/thn jt w/contrast matrl (73719) | $2,466 | $2,466 | 6.8× |
| MRI lower extrem oth/thn jt w/o & w/contr matr (73720) | $3,583.96 | $3,583.96 | 9.9× |
| MRI lower extrem oth/thn jt w/o contr matrl (73718) | $2,878.28 | $2,878.28 | 11.6× |
| MRI lumbar spine w contrast (72149) | $3,171 | $3,171 | 8.8× |
| Mri Neck Spine W/O & W/Dye (72156) | $4,578.05 | $4,578.05 | 12.6× |
| MRI orbit face &/neck w/o contrast (70540) | $3,012 | $3,012 | 12.2× |
| Mri Orbt/Fac/Nck W/O &W/Dye (70543) | $4,256.70 | $4,256.70 | 11.8× |
| MRI pelvis w contrast (72196) | $3,315.20 | $3,315.20 | 9.2× |
| MRI pelvis w/o & w contrast (72197) | $3,779.40 | $3,779.40 | 10.4× |
| MRI pelvis w/o contrast (72195) | $3,238.13 | $3,238.13 | 13.1× |
| MRI thoracic spine w/o contrast (72146) | $3,646.18 | $3,646.18 | 14.7× |
| MRI upper extremity oth than jt w/contr matrl (73219) | $2,313 | $2,313 | 6.4× |
| MRI upper extremity oth than jt w/o contr matrl (73218) | $2,144 | $2,144 | 8.7× |
| Mri Uppr Extremity W/O&W/Dye (73220) | $3,559.90 | $3,559.90 | 9.8× |
| MRI, abdomen, combo (74183) | $4,291.22 | $4,291.22 | 11.8× |
| MRI, dorsal spine combo (72157) | $4,493.12 | $4,493.12 | 12.4× |
| MRI, dorsal spine contrast (72147) | $3,105 | $3,105 | 8.6× |
| MRI, joint upper extrem (73221) range across 2 matching MRF lines |
$2,726.74–$2,726.75 | $2,726.74–$2,726.75 | varies |
| MRI, joint upper extrem combo (73223) | $3,067.50 | $3,067.50 | 8.5× |
| MRI, lumbar spine combo (72158) | $4,360.70 | $4,360.70 | 12.0× |
| Myocardial Spect Multiple Studies (78452) | $4,712.11 | $4,712.11 | 3.5× |
| Neck soft tissue (70360) | $380.21 | $380.21 | 4.2× |
| Nonvascular Shunt X-Ray (75809) | $293 | $293 | 2.7× |
| Optic foramina (70190) | $254 | $254 | 2.8× |
| Parathyroid Planar Imaging (78070) | $1,400 | $1,400 | 3.4× |
| Pelvis 1 or 2 views (72170) | $357.79 | $357.79 | 3.3× |
| PET image w/CT, full body (78816) | $5,129 | $5,129 | 3.5× |
| PET imaging CT attenuation skull base mid-thigh (78815) | $7,423.20 | $7,423.20 | 5.0× |
| Pulmonary Perfusion Imaging Particulate (78580) | $1,706 | $1,706 | 4.1× |
| Radex Abd Compl Aqt Abd W/S/E/D Views 1 View Ch (74022) | $569.27 | $569.27 | 5.2× |
| Radex Ankle Complete Minimum 3 Views (73610) | $352.30 | $352.30 | 3.9× |
| Radex Calcaneus Minimum 2 Views (73650) | $274.71 | $274.71 | 3.0× |
| Radex elbow complete minimum 3 views (73080) | $369.92 | $369.92 | 4.1× |
| Radex Facial Bones Complete Minimum 3 Views (70150) | $510.52 | $510.52 | 4.7× |
| Radex fingr minimum 2 views (73140) | $258.74 | $258.74 | 2.9× |
| Radex foot complete minimum 3 views (73630) | $370 | $370 | 4.1× |
| Radex Hand Minimum 3 Views (73130) | $370.34 | $370.34 | 4.1× |
| Radex lower extremity infant minimum 2 views (73592) range across 2 matching MRF lines |
$303.05–$319 | $303.05–$319 | varies |
| Radex Mastoids Compl Minimum 3 Views PR Side (70130) | $334 | $334 | 3.1× |
| Radex Nasal Bones Complete Minimum 3 Views (70160) | $396.95 | $396.95 | 4.4× |
| Radex Ribs Unilateral 2 Views (71100) | $342.81 | $342.81 | 3.8× |
| Radex shoulder complete minimum 2 views (73030) | $368.69 | $368.69 | 4.1× |
| Radex Sinuses Paransl < 3 Views (70210) | $338.03 | $338.03 | 3.7× |
| Radex Spine 1 View Specify Level (72020) | $277 | $277 | 3.1× |
| Radex Sternum Minimum 2 Views (71120) | $336.57 | $336.57 | 3.7× |
| Radex Toe Minimum 2 Views (73660) | $253.83 | $253.83 | 2.8× |
| Radex upper extremity infant minimum 2 views (73092) | $319 | $319 | 2.9× |
| Radex Wrist Complete Minimum 3 Views (73110) | $348.73 | $348.73 | 3.9× |
| Radiolog exam mandible compl minimum 4 views (70110) | $506.23 | $506.23 | 4.7× |
| Radiologic exam knee complete 4/more views (73564) | $415.17 | $415.17 | 3.8× |
| Radiologic exam pelvis compl minimum 3 views (72190) | $400 | $400 | 3.7× |
| Radiologic examination femur 1 view (73551) | $259.20 | $259.20 | 2.9× |
| Radiologic examination femur minimum 2 views (73552) | $378.62 | $378.62 | 4.2× |
| Radiologic examination knee 1/2 views (73560) | $391.81 | $391.81 | 4.3× |
| Radiologic examination tibia & fibula 2 views (73590) | $343.67 | $343.67 | 3.8× |
| Ribs bilateral 3 views (71110) | $422 | $422 | 3.9× |
| Scapula (73010) | $355.36 | $355.36 | 3.3× |
| Screening Digital Breast Tomosynthesis Bi (77063) | $85.80 | $85.80 | 3.7× |
| Shoulder 1 view (73020) | $270.43 | $270.43 | 3.0× |
| Skull less than 4 views (70250) | $394.47 | $394.47 | 3.6× |
| Sternoclavicular joints (71130) | $422 | $422 | 4.7× |
| Thoracic spine 2 views (72070) | $393.10 | $393.10 | 3.6× |
| Thoracic spine 3 views (72072) | $506.46 | $506.46 | 4.7× |
| Ultrasound Breast Limited (76642) | $453.95 | $453.95 | 5.0× |
| Ultrasound Exam Aaa Screen (76706) | $760 | $760 | 7.0× |
| Ultrasound, abdomen limited (76705) | $734.72 | $734.72 | 6.8× |
| Umbilical-artery Doppler (OB) (76820) | $283 | $283 | 2.6× |
| Us breast unilateral complete (76641) range across 2 matching MRF lines |
$539.24–$620.82 | $539.24–$620.82 | varies |
| Us chest (76604) | $386 | $386 | 3.6× |
| Us exam, pelvic, limited (76857) | $307.65 | $307.65 | 2.8× |
| Us head (76506) | $539 | $539 | 5.0× |
| Us lmtd joint/oth nonvasc xtr strux r-t w/img (76882) | $593.79 | $593.79 | 5.5× |
| Us ob limited 1 or more fetuses (76815) | $487.39 | $487.39 | 4.5× |
| Us ob transvaginal (76817) | $580 | $580 | 5.3× |
| Us pelvic non ob complete (76856) | $870.87 | $870.87 | 8.0× |
| Us pg uter img f&mat 14 wk tabdl 1/1st gestation (76801) | $730.05 | $730.05 | 6.7× |
| Us preg uterus real time f/u trnsabdl per fetus (76816) | $409.07 | $409.07 | 3.8× |
| Us retroperitoneal complete (76770) | $927.92 | $927.92 | 8.5× |
| Us retroperitoneal limited (76775) | $520 | $520 | 4.8× |
| Us scrotum and contents (76870) | $758.74 | $758.74 | 7.0× |
| Us thyroid (76536) | $680.27 | $680.27 | 6.3× |
| Wrist 2 views (73100) range across 2 matching MRF lines |
$278.03–$443 | $278.03–$443 | varies |
| X-Ray Ac Jts - Xr Acromioclavicular Joints Bilateral (73050) | $340.47 | $340.47 | 3.8× |
| X-Ray Elbow 2 Vw - Xr Elbow 1-2 Views Right (73070) | $300.56 | $300.56 | 3.3× |
| X-Ray Exam Entire Spi 2/3 Vw (72082) | $520.82 | $520.82 | 4.8× |
| X-Ray Exam Entire Spi 4/5 Vw (72083) | $475 | $475 | 4.4× |
| X-Ray Exam Hip Uni 1 View (73501) | $255.49 | $255.49 | 2.8× |
| X-Ray Exam Hip Uni 2-3 Views (73502) | $323.50 | $323.50 | 3.6× |
| X-Ray Exam Hip Uni 4/> Views (73503) | $242 | $242 | 2.2× |
| X-Ray Exam Hips Bi 2 Views (73521) | $503.32 | $503.32 | 4.6× |
| X-Ray Exam Hips Bi 3-4 Views (73522) | $498.75 | $498.75 | 4.6× |
| X-Ray Exam Hips Bi 5/> Views (73523) | $604.10 | $604.10 | 5.6× |
| X-Ray Exam L-S Spine Bending (72114) | $691 | $691 | 6.4× |
| X-Ray Exam Neck Spine 2-3 Vw (72040) | $373.42 | $373.42 | 4.1× |
| X-Ray Exam Neck Spine 6/>Vws (72052) | $716.34 | $716.34 | 6.6× |
| X-Ray Exam Unilat Ribs/Chest (71101) | $437.55 | $437.55 | 4.0× |
| X-ray eye for foreign body (70030) | $253 | $253 | 2.8× |
| X-ray humerus (73060) | $341.87 | $341.87 | 3.8× |
| X-ray IV pyelogram (ivp) (74400) | $623 | $623 | 3.4× |
| X-Ray Jaw <4 Vw - Xr Mandible < 4 Views (70100) | $253 | $253 | 2.8× |
| X-Ray Knee Bilat Standing - Xr Knees Anteroposterior Standing Bilat (73565) | $279 | $279 | 3.1× |
| X-Ray Lumbar Spine 2/3 Vw - Xr Lumbar Spine 2-3 Views (72100) | $462.79 | $462.79 | 4.3× |
| X-ray nose-rectum child f.b. (76010) | $293 | $293 | 3.2× |
| X-Ray Ribs, Chest 4+ Vw - Xr Ribs 3 Vws Bil W/ Chest Posteroanterior (71111) | $586.38 | $586.38 | 5.4× |
| X-Ray Sacroiliac Jts 3+ Vw - Xr Sacroiliac Joints 3+ Views (72202) | $380.90 | $380.90 | 3.5× |
| X-Ray Sacroiliac Jts <3 Vw - Xr Sacroiliac Joints 1-2 Views (72200) | $211 | $211 | 1.9× |
| X-Ray Sacrum/Coccyx 2+ Vw - Xr Sacrum Coccyx 2+ Views (72220) | $337.46 | $337.46 | 3.7× |
| X-Ray Sinuses 3+ Vw - Xr Paranasal Sinuses 3+ Views (70220) | $408 | $408 | 4.5× |
| X-Ray Skull 4+ Vw - Xr Skull Complete 4+ Views (70260) | $417 | $417 | 3.8× |
| X-ray thoracic spine 4 vw (72074) | $450 | $450 | 4.1× |
| X-Ray Urinary Tract Exam With Contrast Material (74420) | $421 | $421 | 1.2× |
| X-Rays Bone Length Studies (77073) | $355 | $355 | 3.3× |
| X-Rays Bone Survey Complete (77075) | $1,052.37 | $1,052.37 | 9.7× |
| Xr c-spine 4 or 5 views (72050) | $550.74 | $550.74 | 5.1× |
| Xr facial bones less than 3 views (70140) | $302.16 | $302.16 | 3.3× |
| XR Mastoids < 3 Views Bilateral (70120) | $253 | $253 | 2.3× |
| Xr orbits complete 4 views (70200) | $459.80 | $459.80 | 4.2× |
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.