Imaging prices at Ogallala Community Hospital

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

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

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ProcedureCash priceGross charge× Medicare
Abdomen 2 views (74019) $292.23 $407 2.7×
Acute gastrointestinal blood loss imaging (78278) $1,139.47 $1,786 2.7×
Ankle 2 views (73600) $190.27 $265 2.1×
Arthrogram hip (73525) $673.89 $967 1.9×
Arthrogram shoulder (73040) $639.75 $918 1.8×
Bone &/Joint Imaging Limited Area (78300) $715.84 $1,122 1.7×
Bone &/Joint Imaging Multiple Areas (78305) $849.82 $1,332 2.0×
Bone &/joint imaging whole body (78306) $1,538.86 $2,412 3.7×
Bone age studies (77072) $172.32 $240 1.6×
Bone Imaging 3 Phase (78315) $1,769.17 $2,773 4.3×
Bone survey complete (77075) $353.97 $493 3.3×
Brain Imaging Vascular Flow Only (78610) $473.40 $742 0.8×
Cervical spine 2 or 3 views (72040) $337.46 $470 3.7×
Chest 1 view (71045) $140.14 $220 1.6×
Chest 3 views (71047) $303.21 $476 3.4×
Clavicle complete (73000) $254.17 $354 2.8×
Computed Tomography Thorax Lw Dose Lng Ca Scr C- (71271) $350.26 $549 3.2×
CT abdomen and pelvis without and with contrast (74178) $2,032.67 $3,186 5.6×
CT abdomen and pelvis without contrast (74176) $1,355.11 $2,124 5.5×
CT abdomen w contrast (74160) $1,087.15 $1,704 6.0×
CT abdomen w wo contrast (74170) $1,304.71 $2,045 7.2×
CT abdomen w/o contrast (74150) $869.59 $1,363 8.0×
CT angiography upper extremity lt (73206) $2,275.11 $3,566 12.5×
CT c-spine w/o contrast (72125) $1,889.76 $2,962 17.4×
CT cervical spine w&w/o contrast (72127) $2,834.63 $4,443 15.6×
CT cervical spine with contrast (72126) $2,362.51 $3,703 6.5×
CT chest w/wo contrast (71270) $1,454 $2,279 8.0×
CT chest with contrast (71260) $1,211.56 $1,899 6.7×
CT head/brain with contrast (70460) $1,146.89 $1,874 6.3×
CT head/brain without and with contrast (70470) $1,376.39 $2,249 7.6×
CT heart no contrast quant eval coronry calcium (75571) $117.03 $166 1.3×
CT iac w contrast (70481) $1,870.88 $3,057 10.3×
CT limited/localized follow up study (76380) $700.06 $993 7.7×
CT lower ext w/o (73700) $1,045.68 $1,639 9.6×
CT lower extremity w wo contrast (73702) $1,568.84 $2,459 8.6×
CT lower extremity with contrast (73701) $1,307.26 $2,049 7.2×
CT lumbar spine w & w/o contrast (72133) $2,991.58 $4,689 16.4×
CT lumbar spine w/o contrast (72131) $1,994.39 $3,126 18.4×
CT lumbar spine with contrast (72132) $2,493.30 $3,908 6.9×
CT maxillofacial w contrast (70487) $1,878.84 $3,070 10.3×
CT maxillofacial w/o contrast (70486) $1,503.07 $2,456 13.8×
CT maxillofacial w/wo contrast (70488) $2,254.61 $3,684 12.4×
CT neck soft tissue w contrast (70491) $1,260.11 $2,059 6.9×
CT orbit sella/post fossa/ear w/o & w/contr matr (70482) $2,244.82 $3,668 12.3×
CT orbits w/o contrast (70480) $1,496.34 $2,445 13.8×
CT pelvis w & w/o contrast (72194) $2,855.05 $4,475 15.7×
CT pelvis w/o contrast (72192) $1,903.15 $2,983 17.5×
CT scan for measuring calcium and other minerals in bone (77078) $414.70 $650 4.6×
CT soft tissue neck w/o & w/contrast material (70492) $1,512.25 $2,471 8.3×
CT soft tissue neck w/o contrast (70490) $1,007.96 $1,647 9.3×
CT thoracic spine w/contrast (72129) $2,512.44 $3,938 13.8×
CT thoracic spine w/o contrast (72128) $2,009.70 $3,150 18.5×
CT thorax w/o contrast (71250) $969.12 $1,519 8.9×
CT upper extremity w/o & w/contrast material (73202) $2,166.65 $3,396 11.9×
CT upper extremity w/o contrast rt (73200) $1,444.43 $2,264 13.3×
CT upper extremity with contrast (73201) $1,805.54 $2,830 5.0×
Cta Abdl Aorta&Bi Iliofem W/Contrast&Postp (75635) $2,105.84 $2,987 11.6×
Cta Abdomen (74175) $1,370.42 $2,148 7.5×
CTA abdomen pelvis (74174) $2,134.75 $3,346 5.9×
CTA chest (71275) $1,526.73 $2,393 8.4×
Cta Head (70496) $1,445.54 $2,362 7.9×
CTA lwr ext w&w/o contrast (73706) $1,647.32 $2,582 9.0×
Cta Neck (70498) $1,588.14 $2,595 8.7×
Cta Pelvis (72191) $2,997.96 $4,699 16.5×
Cystography minimum 3 views rs&i (74430) $387 $539 1.1×
Doppler Echo Fetal Spectral Display Complete (76827) $431.97 $510 4.0×
Dxa bone density study 1/> sites axial skel (77080) $325.97 $454 3.0×
Echo exam of fetal heart (76825) $914.76 $1,080 1.6×
Echo fetal cardiovasc w/wo m-mode repeat std (76826) $420.96 $497 1.7×
Echoencephalography real time imaging (76506) $439.59 $519 4.0×
Esophageal motility (78258) $630.98 $989 1.5×
Esophagus (74220) $313.77 $437 1.7×
Fetal biophysical profile non-stress testing (76818) $718.26 $848 6.6×
Fetal Biophysical Profile W/O Non-Stress Testing (76819) $661.51 $781 6.1×
Fluoroscopy up to 1 hr (76000) $538.50 $750 2.2×
Foot 2 views (73620) $222.58 $310 2.5×
Forearm 2 views (73090) $231.20 $322 2.6×
Gated Heart Planar Single (78472) $1,212.20 $1,900 2.9×
Hand 2 views (73120) $164.42 $229 1.5×
Hand 3 views (73130) $255.61 $356 2.8×
Heart Infarct Image (78466) $647.57 $1,015 1.6×
Hepatobil Syst Imag Inc Gb W/Pharma Intervenj (78227) $1,653.06 $2,591 2.9×
Hepatobiliary syst imaging including gallbladder (78226) $1,207.10 $1,892 2.9×
Ht muscle image spect sing (78451) $2,631.75 $4,125 2.0×
Humerus Min 2 Views Left (73060) $307.30 $428 3.4×
Kidney imaging morphology (78700) $488.07 $765 1.2×
Kidney Img Morphology Vascular Flow 1 W/O Rx (78707) $667.99 $1,047 1.2×
Kidney img morphology vascular flow 1 w/rx (78708) $508.49 $797 0.9×
Kidney Img Morphology Vascular Flow Multiple (78709) $1,059.08 $1,660 1.9×
Knee 3 views (73562) $275.71 $384 3.1×
Liver & spleen imaging static only (78215) $921.27 $1,444 2.2×
Liver & Spleen Imaging W/Vascular Flow (78216) $437.03 $685 1.1×
Lung perf&ventilat diferentl (78598) $991.45 $1,554 1.8×
Lung Ventilation Imaging (78579) $520.61 $816 1.3×
Lymphoscintigraphy (78195) $1,081.41 $1,695 1.9×
Meckels Diverticulum (78290) $1,082.69 $1,697 2.6×
Mr safety determination physician/other qhp (76016) $95.49 $133 1.1×
Mr safety implant pos&/immoblj supvj phys/qhp (76019) $224.73 $313 3.7×
Mr safety implant&/fb assmt clin staf 1st 15 min (76014) $27.28 $38 0.9×
Mr safety implt electronics prepj supvj phys/qhp (76018) $147.19 $205 1.5×
Mr safety med physics xm customization plng&mntr (76017) $349.67 $487 1.4×
MRA head w & w/o contrast (70546) $1,948.73 $3,179 5.4×
MRA head w/o contrast (70544) $1,298.95 $2,119 5.2×
MRA head with contrast (70545) $1,623.84 $2,649 4.5×
MRA neck w contrast (70548) $2,815.51 $4,593 7.8×
Mra Neck W/O &W/Contrast Material (70549) $3,378.24 $5,511 9.3×
MRA neck w/o contrast (70547) $2,252.16 $3,674 9.1×
MRI abdomen w contrast (74182) $2,774.06 $3,980 7.7×
MRI abdomen w/o & w/contrast material (74183) $3,328.87 $4,776 9.2×
MRI abdomen w/o contrast (74181) $2,219.25 $3,184 9.0×
MRI any jnt lwr ext with con lt (73722) $2,082.64 $2,988 2.6×
MRI any jt upper extremity w/contrast matrl (73222) $1,654.68 $2,374 2.0×
MRI bone marrow blood supply (77084) $1,635.86 $2,347 6.6×
MRI breast w/o contrast bilateral (77047) $1,253.21 $1,798 5.1×
MRI breast w/o contrast unilat (77046) $795.97 $1,142 3.2×
MRI c-spine with contrast (72142) $1,430.03 $2,170 3.9×
MRI cervical spine w/o contrast (72141) $1,144.02 $1,736 4.6×
MRI chest w/o & w/contrast material (71552) $3,017.31 $4,329 8.3×
MRI chest w/o contrast (71550) $2,011.54 $2,886 8.1×
MRI chest with contrast (71551) $2,514.78 $3,608 3.1×
MRI Forearm w/ Contrast Bilateral 73219 (73219) $2,021.30 $2,900 5.6×
MRI lower extrem oth/thn jt w/contrast matrl (73719) $1,548.73 $2,222 4.3×
MRI lower extrem oth/thn jt w/o contr matrl (73718) $1,238.57 $1,777 5.0×
MRI orbit face &/neck w/o contrast (70540) $2,074.27 $2,976 8.4×
MRI orbit/face/neck w&w/o cont (70543) $3,111.41 $4,464 8.6×
MRI orbit/face/neck w/contrast (70542) $2,592.84 $3,720 7.2×
MRI pelvis w contrast (72196) $1,801.05 $2,584 5.0×
MRI pelvis w/o & w/contrast material (72197) $2,161.40 $3,101 6.0×
MRI pelvis w/o contrast (72195) $1,440.70 $2,067 5.8×
MRI scan of arm joint before and after contrast (73223) $1,985.75 $2,849 5.5×
MRI scan of leg joint before and after contrast (73723) $2,498.74 $3,585 6.9×
MRI spinal canal cervical w/o & w/contr matrl (72156) $1,716.04 $2,604 4.7×
MRI spinal canal lumbar w/contrast material (72149) $1,430.03 $2,170 3.9×
MRI spinal canal lumbar w/o & w/contr matrl (72158) $1,716.04 $2,604 4.7×
MRI spinal canal thoracic w/contrast matrl (72147) $1,430.03 $2,170 3.9×
MRI spinal canal thoracic w/o & w/contr matrl (72157) $1,716.04 $2,604 4.7×
MRI thoracic spine w/o contrast (72146) $1,144.02 $1,736 4.6×
MRI tmj (70336) $2,158.61 $3,097 8.7×
MRI upper ext joint w/o contrast (73221) $1,323.60 $1,899 5.3×
MRI upper extrem other than jt w/o & w/contras (73220) $2,425.56 $3,480 6.7×
MRI upper extremity oth than jt w/o contr matrl (73218) $1,617.04 $2,320 6.5×
Myocardial Spect Multiple Studies (78452) $3,399.90 $5,329 2.5×
Neck soft tissue (70360) $223.30 $311 2.5×
Nm cisternogram (78630) $749.65 $1,175 1.3×
Nm gastric emptying study (78264) $1,370.42 $2,148 3.3×
Nm gastroesophageal reflux study (78262) $782.19 $1,226 1.9×
Nuclear medicine of heart pumping function (78473) $1,227.51 $1,924 3.0×
Nuclear medicine study to assess blood clot in vein of both sides (78458) $604.19 $947 1.5×
Ob Us Follow-Up Per Fetus - Us Ob Follow Up Transabdominal Approach (76816) $459.92 $543 4.2×
Osseous survey infant (77076) $356.85 $497 3.3×
Osseous survey limited (77074) $234.79 $327 2.2×
Parathyroid imaging (78070) $734.34 $1,151 1.8×
Pelvis 1 or 2 views (72170) $177.35 $247 1.6×
Pr MRI, lower extr, w/o contrast f/u by contrast (73720) $1,858.20 $2,666 5.1×
Pulmonary Perfusion Imaging Particulate (78580) $734.34 $1,151 1.8×
Pulmonary Ventilation & Perfusion Imaging (78582) $1,162.44 $1,822 2.1×
Radex abscess/fistula/sinus tract rs&i (76080) $513.37 $715 0.9×
Radex Entir Thrc Lmbr Crv Sac Spi W/Skull 1 Vw - Xr Scoliosis 1 Vw (72081) $249.15 $347 2.8×
Radex entir thrc lmbr crv sac spi w/skull 2/3 vw (72082) $357.56 $498 3.3×
Radex hips bilateral with pelvis 2 views (73521) $196.01 $273 1.8×
Radex mastoids compl minimum 3 views pr side (70130) $235.50 $328 2.2×
Radiolog exam mandible compl minimum 4 views (70110) $356.85 $497 3.3×
Radiologic Exam Abdomen 1 View - Xr Abdomen 1 View (74018) $161.55 $225 1.8×
Radiologic Exam Abdomen 3+ Views - Xr Abdomen 3+ Views (74021) $305.87 $426 2.8×
Radiologic Exam Chest 2 Views - Xr Chest 2 Views (71046) $294.29 $462 3.3×
Radiologic exam upr gi trc double contrast study (74246) $634.71 $884 3.5×
Radiologic exam upr gi trc single contrast study (74240) $478.19 $666 2.6×
Radiologic Examination Femur Minimum 2 Views - Xr Femur 2+ Vw Lt (73552) $198.17 $276 2.2×
Radiological examination surgical specimen (76098) $185.24 $258 0.3×
Ribs bilateral 3 views (71110) $328.13 $457 3.0×
Rp loclzj tum plnr 2+area 1+d img/1 area img>2+d (78801) $554.42 $869 1.3×
Rp loclzj tum spect 1 area single day imaging (78803) $1,046.96 $1,641 1.9×
Sacroiliac Joints < 3 Views (72200) $247.71 $345 2.3×
Scanogram (77073) $408.54 $569 3.8×
Scapula complete (73010) $192.42 $268 1.8×
Screening digital breast tomosynthesis (77063) $38.47 $49 1.6×
Sella turcica (70240) $129.24 $180 1.4×
Shuntogram indwelling nonvascular shunt rs&i (75809) $206.55 $307.50 1.9×
Small bowel series (74250) $432.95 $603 2.4×
Spine thoracic 3 views (72072) $366.90 $511 3.4×
Testicular Imaging With Vascular Flow (78761) $586.96 $920 1.4×
Thoracolumbar 2 views (72080) $188.12 $262 2.1×
Thyroid carcinoma metastases img whole body (78018) $1,419.55 $2,225 2.5×
Thyroid Imaging With Vascular Flow (78013) $620.14 $972 1.5×
Thyroid uptake measurement (78012) $386.63 $606 0.9×
Thyroid Uptake W/Blood Flow Sngle/Mult Quan Meas (78014) $844.07 $1,323 2.0×
Tmj unilateral (70328) $185.96 $259 2.1×
Tomogram (76100) $353.97 $493 3.3×
Tumor Imaging, Limited Area - Nm Tumor Localization Limited (78800) $523.80 $821 1.3×
Ultrasound, abdomen limited (76705) $754.68 $891 7.0×
Umbilical-artery Doppler (OB) (76820) $253.25 $299 2.3×
Upper Extremity Infant (73092) $252.74 $352 2.3×
Ureteral Reflux Study Rp Voiding Cystogram (78740) $537.83 $843 1.3×
Urethrocystography retrograde rs&i (74450) $510.50 $711 2.1×
Urethrocystography voiding (74455) $577.99 $805 2.3×
Urography (pyelography), intravenous, with or without KUB, with or without tomography (74400) $1,107.16 $1,542 6.1×
Urograpy infusion drip &/bolus techq w/wo tomo (74415) $1,000.17 $1,393 5.5×
Us abdl aorta screen aaa (76706) $325.25 $384 3.0×
Us breast unilateral complete (76641) $599.68 $708 5.5×
Us breast unilateral limited (76642) $492.11 $581 5.4×
Us chest (76604) $503.12 $594 4.6×
Us compl joint r-t w/image documentation (76881) $769.92 $909 7.1×
Us fetal nuchal translucency 1st gestation (76813) $356.59 $421 3.3×
Us ob detailed single fetus (76811) $528.53 $624 2.1×
Us ob transvaginal (76817) $583.58 $689 5.4×
Us pelvic non ob complete (76856) $885.12 $1,045 8.2×
Us pelvic nonobstetric image dcmtn limited/f/u (76857) $648.80 $766 6.0×
Us pregnancy ltd (76815) $452.30 $534 4.2×
Us pregnant uterus 14 wk transabdl 1/1st gestat (76801) $756.37 $893 7.0×
Us retroperitoneal complete (76770) $869.87 $1,027 8.0×
Us retroperitoneal limited (76775) $285.44 $337 2.6×
Us scrotum and contents (76870) $814.81 $962 7.5×
Us soft tissue head/neck (76536) $788.56 $931 7.3×
Us spinal canal and contents (76800) $344.73 $407 3.2×
Us transrectal (76872) $509.05 $601 4.7×
Us xtr non-vasc lmtd (76882) $496.34 $586 4.6×
Vascular flow imaging (78445) $515.50 $808 1.2×
Wrist 2 views (73100) $222.58 $310 2.5×
X-Ray Abdomen,Comp Acute Series - Xr Abdomen 2 Vws With Chest 1 View (74022) $353.97 $493 3.3×
X-Ray Ac Jts - Xr Acromioclavicular Joints Bilateral (73050) $270.69 $377 3.0×
X-Ray Ankle 3+ Vw - Xr Ankle 3+ Views Right (73610) $338.18 $471 3.7×
X-Ray Colon Air Contrast - Fl Barium Enema Air Contrast (74280) $727.33 $1,013 4.0×
X-Ray Elbow 2 Vw - Xr Elbow 1-2 Views Right (73070) $280.02 $390 3.1×
X-Ray Elbow 3+ Vw - Xr Elbow 3+ Views Right (73080) $345.36 $481 3.8×
X-ray exam hip uni 1 view (73501) $158.68 $221 1.8×
X-Ray Exam Hip Uni 2-3 Views (73502) $297.97 $415 3.3×
X-ray exam hip uni 4/> views (73503) $372.64 $519 3.4×
X-ray eye for foreign body (70030) $120.62 $168 1.3×
X-Ray Facial Bones 3+ Vw - Xr Facial Bones 3+ Views (70150) $328.84 $458 3.0×
X-Ray Facial Bones <3 Vw - Xr Facial Bones 1-2 Views (70140) $281.46 $392 3.1×
X-Ray Foot 3+ Vw - Xr Foot 3+ Views Right (73630) $318.79 $444 3.5×
X-Ray Heel - Xr Calcaneus 2 Views Right (73650) $168.01 $234 1.9×
X-Ray Jaw <4 Vw - Xr Mandible < 4 Views (70100) $337.46 $470 3.7×
X-Ray Knee 4+ View - Xr Knee 4+ Views Right (73564) $420.03 $585 3.9×
X-Ray Knee Bilat Standing - Xr Knees Anteroposterior Standing Bilat (73565) $377.67 $526 4.2×
X-Ray Leg, Infant - Xr Lower Extremity 2+ Views Infant Left (73592) $133.55 $186 1.5×
X-Ray Lumbar Spine 2/3 Vw - Xr Lumbar Spine 2-3 Views (72100) $269.25 $375 2.5×
X-Ray Lumbar Spine 6+ Vw - Xr Lumbar Spine 6+ Vws Including Bending (72114) $611.74 $852 5.6×
X-Ray Lumbar Spine Flex/Exten - Xr Lumbar Spine 4+ Views W/ Flex Ext (72120) $527.01 $734 4.9×
X-Ray Nasal Bones - Xr Nasal Bones (70160) $246.99 $344 2.7×
X-Ray Nose-Rectum Child F.B. - Xr Nose to Rectum Foreign Body Peds (76010) $97.65 $136 1.1×
X-Ray Orbits - Xr Orbits Complete 4+ Views (70200) $373.36 $520 3.4×
X-Ray Pelvis 3+ Vw - Xr Pelvis 3+ Views (72190) $265.66 $370 2.4×
X-Ray Renal Cyst Xlumbar+Contrst - Xr Renal Cyst Lumbar W Contrast (74470) $338.90 $472 0.6×
X-Ray Retrograde Pyelogram - Fl Pyelogram Retrograde (74420) $616.76 $859 1.7×
X-Ray Ribs 2 Vw Unilat - Xr Ribs 2 Views Right (71100) $282.17 $393 3.1×
X-Ray Ribs, Chest 3+ Vw - Xr Ribs 2 Vws Lt W/ Chest Anteroposterior (71101) $320.23 $446 2.9×
X-Ray Ribs, Chest 4+ Vw - Xr Ribs 3 Vws Bil W/ Chest Posteroanterior (71111) $402.80 $561 3.7×
X-Ray Sacroiliac Jts 3+ Vw - Xr Sacroiliac Joints 3+ Views (72202) $377.67 $526 3.5×
X-Ray Sacrum/Coccyx 2+ Vw - Xr Sacrum Coccyx 2+ Views (72220) $228.32 $318 2.5×
X-Ray Shoulder 2+ Vw - Xr Shoulder 2+ Views Right (73030) $318.79 $444 3.5×
X-Ray Sinuses 3+ Vw - Xr Paranasal Sinuses 3+ Views (70220) $312.33 $435 3.5×
X-Ray Sinuses <3 Vw - Xr Paranasal Sinuses 1-2 Views (70210) $198.89 $277 2.2×
X-Ray Skull 4+ Vw - Xr Skull Complete 4+ Views (70260) $338.90 $472 3.1×
X-Ray Skull <4 Vw - Xr Skull 1-3 Views (70250) $295.10 $411 2.7×
X-Ray Spine One View - Xr Spine (72020) $236.94 $330 2.6×
X-Ray Sterno-Clavicluar Jt - Xr Sternoclavicular Joints 3+ Views (71130) $264.22 $368 2.9×
X-Ray Sternum 2+ Vw - Xr Sternum 2+ Views (71120) $166.58 $232 1.8×
X-Ray Thoracic Spine 2 Vw - Xr Thoracic Spine 2 Views (72070) $353.97 $493 3.3×
X-Ray Thoracic Spine 4 Vw - Xr Thoracic Spine Complete 4+ Views (72074) $422.18 $588 3.9×
X-Ray Toe(S) - Xr Toes 2+ Views Right (73660) $184.53 $257 2.0×
X-Ray Wrist 3+ Vw - Xr Wrist 3+ Views Right (73110) $317.36 $442 3.5×
Xr c-spine 6 or more views (72052) $547.83 $763 5.0×
Xr chest 4+ views (71048) $342.71 $538 3.2×
Xr Cholecystography Oral Contrast (74290) $317.36 $442 1.7×
Xr finger(s) 2+ views (73140) $188.12 $262 2.1×
Xr internal auditory meati complete (70134) $352.54 $491 0.6×
Xr optic foramina (70190) $201.04 $280 2.2×
Xr shoulder 1 view (73020) $231.20 $322 2.6×
Xr spine cervical 4 or 5 views (72050) $464.55 $647 4.3×
Xr tibia/fibula 2 views (73590) $190.99 $266 2.1×
Xr tmj bilateral (70330) $280.02 $390 3.1×
Xray knee 1 or 2 views rt (73560) $226.17 $315 2.5×