Imaging prices at Pawnee County Memorial Hospital

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

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

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ProcedureCash priceGross charge× Medicare
Abdomen 2 views (74019) $320 $400 2.9×
Ankle 2 views (73600) $186 $233 2.1×
Bone &/Joint Imaging Multiple Areas (78305) $978 $1,222 2.4×
Bone &/joint imaging whole body (78306) $1,385 $1,731 3.3×
Bone Imaging 3 Phase (78315) $1,644 $2,055 4.0×
Bone survey complete (77075) $692 $865 6.4×
Cervical spine 2 or 3 views (72040) $294 $368 3.3×
Chest 1 view (71045) $234 $292 2.6×
Clavicle complete (73000) $247 $309 2.7×
Computed Tomography Thorax Lw Dose Lng Ca Scr C- (71271) $606 $757 5.6×
CT abdomen and pelvis without and with contrast (74178) $4,326 $5,408 11.9×
CT abdomen and pelvis without contrast (74176) $3,202 $4,002 12.9×
CT abdomen w contrast (74160) $2,163 $2,704 11.9×
CT abdomen w wo contrast (74170) $2,510 $3,137 13.8×
CT abdomen w/o contrast (74150) $1,817 $2,271 16.7×
CT c-spine w/o contrast (72125) $1,990 $2,488 18.3×
CT chest w/wo contrast (71270) $2,596 $3,245 14.3×
CT chest with contrast (71260) $2,077 $2,596 11.4×
CT head/brain with contrast (70460) $1,769 $2,211 9.7×
CT head/brain without and with contrast (70470) $2,163 $2,704 11.9×
CT iac w contrast (70481) $1,862 $2,328 10.2×
CT lower ext w/o (73700) $1,817 $2,271 16.7×
CT lower extremity w wo contrast (73702) $2,413 $3,016 13.2×
CT lower extremity with contrast (73701) $2,000 $2,500 11.0×
CT lumbar spine w/o contrast (72131) $1,990 $2,488 18.3×
CT maxillofacial w contrast (70487) $1,714 $2,143 9.4×
CT maxillofacial w/o contrast (70486) $1,514 $1,893 13.9×
CT maxillofacial w/wo contrast (70488) $1,723 $2,154 9.5×
CT neck soft tissue w contrast (70491) $1,990 $2,488 10.9×
CT orbit sella/post fossa/ear w/o & w/contr matr (70482) $2,077 $2,596 11.4×
CT orbits w/o contrast (70480) $1,690 $2,112 15.6×
CT pelvis w & w/o contrast (72194) $2,336 $2,920 12.8×
CT pelvis w/o contrast (72192) $1,817 $2,271 16.7×
CT soft tissue neck w/o & w/contrast material (70492) $2,250 $2,812 12.4×
CT soft tissue neck w/o contrast (70490) $1,636 $2,045 15.1×
CT thoracic spine w/o contrast (72128) $1,990 $2,488 18.3×
CT thoracic spine w/wo contrast (72130) $2,246 $2,808 12.3×
CT thorax w/o contrast (71250) $1,904 $2,380 17.5×
CT upper extremity w/o contrast rt (73200) $1,774 $2,217 16.3×
CTA abdomen pelvis (74174) $4,560 $5,700 12.6×
CTA chest (71275) $2,726 $3,407 15.0×
Dxa bone density study 1/> sites axial skel (77080) $380 $475 3.5×
Fetal Biophysical Profile W/O Non-Stress Testing (76819) $359 $449 3.3×
Foot 2 views (73620) $216 $270 2.4×
Forearm 2 views (73090) $242 $303 2.7×
Hand 3 views (73130) $275 $344 3.0×
Heart Infarct Image (78466) $2,431 $3,039 5.9×
Hepatobil Syst Imag Inc Gb W/Pharma Intervenj (78227) $1,558 $1,947 2.8×
Hepatobiliary syst imaging including gallbladder (78226) $1,260 $1,575 3.0×
Ht muscle image spect sing (78451) $2,840 $3,550 2.1×
Humerus Min 2 Views Left (73060) $251 $314 2.8×
Kidney imaging morphology (78700) $861 $1,076 2.1×
Kidney img morphology vascular flow 1 w/rx (78708) $1,101 $1,376 2.0×
Knee 3 views (73562) $298 $373 3.3×
Liver & spleen imaging static only (78215) $887 $1,109 2.1×
Lung Ventilation Imaging (78579) $816 $1,020 2.0×
Meckels Diverticulum (78290) $909 $1,136 2.2×
MRA head w/o contrast (70544) $2,553 $3,191 10.3×
Mra Neck W/O &W/Contrast Material (70549) $2,747 $3,434 7.6×
MRI abdomen w contrast (74182) $3,120 $3,900 8.6×
MRI abdomen w/o & w/contrast material (74183) $3,600 $4,500 9.9×
MRI abdomen w/o contrast (74181) $2,800 $3,500 11.3×
MRI any jnt lwr ext with con lt (73722) $2,770 $3,463 3.4×
MRI any jt upper extremity w/contrast matrl (73222) $2,077 $2,596 2.6×
MRI c-spine with contrast (72142) $2,942 $3,677 8.1×
MRI cervical spine w/o contrast (72141) $2,655 $3,319 10.7×
MRI chest with contrast (71551) $2,314 $2,893 2.8×
MRI Forearm w/ Contrast Bilateral 73219 (73219) $2,336 $2,920 6.4×
MRI lower extrem oth/thn jt w/contrast matrl (73719) $2,250 $2,812 6.2×
MRI lower extrem oth/thn jt w/o contr matrl (73718) $2,206 $2,758 8.9×
MRI orbit face &/neck w/o contrast (70540) $2,002 $2,503 8.1×
MRI orbit/face/neck w&w/o cont (70543) $2,791 $3,489 7.7×
MRI orbit/face/neck w/contrast (70542) $2,034 $2,542 5.6×
MRI pelvis w contrast (72196) $2,314 $2,893 6.4×
MRI pelvis w/o & w/contrast material (72197) $2,790 $3,488 7.7×
MRI pelvis w/o contrast (72195) $2,279 $2,849 9.2×
MRI scan of arm joint before and after contrast (73223) $2,790 $3,488 7.7×
MRI scan of leg joint before and after contrast (73723) $2,985 $3,731 8.2×
MRI spinal canal cervical w/o & w/contr matrl (72156) $3,461 $4,326 9.6×
MRI spinal canal lumbar w/contrast material (72149) $2,769 $3,461 7.6×
MRI spinal canal lumbar w/o & w/contr matrl (72158) $3,461 $4,326 9.6×
MRI spinal canal thoracic w/contrast matrl (72147) $2,942 $3,677 8.1×
MRI spinal canal thoracic w/o & w/contr matrl (72157) $3,461 $4,326 9.6×
MRI thoracic spine w/o contrast (72146) $2,655 $3,319 10.7×
MRI tmj (70336) $1,980 $2,475 8.0×
MRI upper ext joint w/o contrast (73221) $1,783 $2,229 7.2×
MRI upper extremity oth than jt w/o contr matrl (73218) $2,250 $2,812 9.1×
Myocardial Spect Multiple Studies (78452) $3,374 $4,218 2.5×
Neck soft tissue (70360) $259 $324 2.9×
Nuclear medicine of heart muscle at rest with stress (78454) $2,431 $3,039 1.8×
Ob Us Follow-Up Per Fetus - Us Ob Follow Up Transabdominal Approach (76816) $294 $368 2.7×
Pelvis 1 or 2 views (72170) $259 $324 2.4×
PET image w/CT, skull-thigh (78815) $4,992 $6,240 3.4×
PET imaging for CT attenuation whole body (78816) $6,240 $7,800 4.2×
Pr MRI, lower extr, w/o contrast f/u by contrast (73720) $2,314 $2,893 6.4×
Pulmonary Perfusion Imaging Particulate (78580) $861 $1,076 2.1×
Radex entir thrc lmbr crv sac spi w/skull 2/3 vw (72082) $415 $519 3.8×
Radiolog exam mandible compl minimum 4 views (70110) $278 $348 2.6×
Radiologic Exam Abdomen 1 View - Xr Abdomen 1 View (74018) $259 $324 2.9×
Radiologic Exam Chest 2 Views - Xr Chest 2 Views (71046) $282 $352 3.1×
Radiologic Examination Femur Minimum 2 Views - Xr Femur 2+ Vw Lt (73552) $294 $368 3.3×
Scapula complete (73010) $250 $312 2.3×
Screening digital breast tomosynthesis (77063) $69 $86 3.0×
Spine thoracic 3 views (72072) $415 $519 3.8×
Testicular Imaging With Vascular Flow (78761) $765 $956 1.8×
Thoracolumbar 2 views (72080) $261 $326 2.9×
Thyroid Imaging With Vascular Flow (78013) $854 $1,067 2.1×
Thyroid uptake measurement (78012) $866 $1,082 2.1×
Ultrasound, abdomen limited (76705) $562 $703 5.2×
Us abdl aorta screen aaa (76706) $502 $627 4.6×
Us breast unilateral complete (76641) $465.50 $581.50 4.3×
Us breast unilateral limited (76642) $329 $411 3.6×
Us chest (76604) $415 $519 3.8×
Us ob transvaginal (76817) $467 $584 4.3×
Us pelvic non ob complete (76856) $606 $757 5.6×
Us pelvic nonobstetric image dcmtn limited/f/u (76857) $331 $414 3.0×
Us pregnancy ltd (76815) $336 $420 3.1×
Us pregnant uterus 14 wk transabdl 1/1st gestat (76801) $519 $649 4.8×
Us retroperitoneal complete (76770) $606 $757 5.6×
Us retroperitoneal limited (76775) $519 $649 4.8×
Us scrotum and contents (76870) $588 $735 5.4×
Us soft tissue head/neck (76536) $519 $649 4.8×
Us xtr non-vasc lmtd (76882) $411 $514 3.8×
Vertebral fracture assessment via dxa (77086) $417 $521 4.6×
Wrist 2 views (73100) $208 $260 2.3×
X-Ray Abdomen,Comp Acute Series - Xr Abdomen 2 Vws With Chest 1 View (74022) $442 $553 4.1×
X-Ray Ac Jts - Xr Acromioclavicular Joints Bilateral (73050) $234 $292 2.6×
X-Ray Ankle 3+ Vw - Xr Ankle 3+ Views Right (73610) $277 $346 3.1×
X-Ray Elbow 2 Vw - Xr Elbow 1-2 Views Right (73070) $225 $281 2.5×
X-Ray Elbow 3+ Vw - Xr Elbow 3+ Views Right (73080) $259 $324 2.9×
X-ray exam hip uni 1 view (73501) $202 $253 2.2×
X-Ray Exam Hip Uni 2-3 Views (73502) $294 $368 3.3×
X-ray exam of femur 1 (73551) $254 $317 2.8×
X-ray eye for foreign body (70030) $187 $234 2.1×
X-Ray Facial Bones 3+ Vw - Xr Facial Bones 3+ Views (70150) $337 $421 3.1×
X-Ray Facial Bones <3 Vw - Xr Facial Bones 1-2 Views (70140) $259 $324 2.9×
X-Ray Foot 3+ Vw - Xr Foot 3+ Views Right (73630) $277 $346 3.1×
X-Ray Heel - Xr Calcaneus 2 Views Right (73650) $208 $260 2.3×
X-Ray Knee 4+ View - Xr Knee 4+ Views Right (73564) $311 $389 2.9×
X-Ray Lumbar Spine 2/3 Vw - Xr Lumbar Spine 2-3 Views (72100) $363 $454 3.3×
X-Ray Lumbar Spine 6+ Vw - Xr Lumbar Spine 6+ Vws Including Bending (72114) $567 $709 5.2×
X-Ray Lumbar Spine Flex/Exten - Xr Lumbar Spine 4+ Views W/ Flex Ext (72120) $252 $315 2.3×
X-Ray Nasal Bones - Xr Nasal Bones (70160) $290 $362 3.2×
X-Ray Orbits - Xr Orbits Complete 4+ Views (70200) $359 $449 3.3×
X-Ray Ribs 2 Vw Unilat - Xr Ribs 2 Views Right (71100) $245 $306 2.7×
X-Ray Ribs, Chest 3+ Vw - Xr Ribs 2 Vws Lt W/ Chest Anteroposterior (71101) $346 $433 3.2×
X-Ray Ribs, Chest 4+ Vw - Xr Ribs 3 Vws Bil W/ Chest Posteroanterior (71111) $396 $495 3.6×
X-Ray Sacroiliac Jts 3+ Vw - Xr Sacroiliac Joints 3+ Views (72202) $277 $346 2.6×
X-Ray Sacrum/Coccyx 2+ Vw - Xr Sacrum Coccyx 2+ Views (72220) $259 $324 2.9×
X-Ray Shoulder 2+ Vw - Xr Shoulder 2+ Views Right (73030) $295 $369 3.3×
X-Ray Sinuses 3+ Vw - Xr Paranasal Sinuses 3+ Views (70220) $278 $348 3.1×
X-Ray Sinuses <3 Vw - Xr Paranasal Sinuses 1-2 Views (70210) $238 $297 2.6×
X-Ray Skull 4+ Vw - Xr Skull Complete 4+ Views (70260) $330 $412 3.0×
X-Ray Skull <4 Vw - Xr Skull 1-3 Views (70250) $212 $265 2.0×
X-Ray Sterno-Clavicluar Jt - Xr Sternoclavicular Joints 3+ Views (71130) $219 $274 2.4×
X-Ray Sternum 2+ Vw - Xr Sternum 2+ Views (71120) $259 $324 2.9×
X-Ray Thoracic Spine 2 Vw - Xr Thoracic Spine 2 Views (72070) $303 $379 2.8×
X-Ray Wrist 3+ Vw - Xr Wrist 3+ Views Right (73110) $259 $324 2.9×
Xr shoulder 1 view (73020) $210 $262 2.3×
Xr spine cervical 4 or 5 views (72050) $429 $536 4.0×
Xr tibia/fibula 2 views (73590) $259 $324 2.9×
Xray knee 1 or 2 views rt (73560) $259 $324 2.9×