Imaging prices at Phelps Memorial Health Center
Holdrege, NE · every code in this section with a posted price and a Medicare benchmark.
230 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) | $342 | $380 | 3.8× |
| Abdomen 2 views (74019) | $423 | $470 | 3.9× |
| Angiography extremity bilateral rs&i (75716) range across 2 matching MRF lines |
$523.80–$5,632.20 | $582–$6,258 | varies |
| Angiography extremity unilateral rs&i (75710) range across 2 matching MRF lines |
$505.80–$5,003.10 | $562–$5,559 | varies |
| Ankle 2 views (73600) | $279 | $310 | 3.1× |
| Arthrogram ankle (73615) | $384.30 | $427 | 1.1× |
| Arthrogram hip (73525) range across 2 matching MRF lines |
$345.60–$1,510.20 | $384–$1,678 | varies |
| Arthrogram Wrist (73115) range across 3 matching MRF lines |
$83.70–$908.10 | $93–$1,009 | varies |
| Bone age studies (77072) | $284.40 | $316 | 2.6× |
| Bone Imaging 3 Phase (78315) | $2,327.40 | $2,586 | 5.6× |
| Bone Imaging Limited Area (78300) | $1,749.60 | $1,944 | 4.2× |
| Bone Imaging Whole Body (78306) | $2,052 | $2,280 | 4.9× |
| Bone survey infant (77076) | $635.40 | $706 | 5.9× |
| Chest 1 view (71045) range across 2 matching MRF lines |
$37.80–$307.80 | $42–$342 | varies |
| Chest 2 views (71046) range across 2 matching MRF lines |
$361.80–$387 | $402–$430 | varies |
| Chest 3 views (71047) | $436.50 | $485 | 4.8× |
| Clavicle complete (73000) | $335.70 | $373 | 3.7× |
| Computed Tomography Thorax Lw Dose Lng Ca Scr C- (71271) | $1,986.30 | $2,207 | 18.3× |
| Contrast Exam Abdominl Aorta (75625) range across 2 matching MRF lines |
$520.20–$4,301.10 | $578–$4,779 | varies |
| Contrast X-Ray Bladder (74430) | $845.10 | $939 | 2.3× |
| Contrast X-Ray Of Elbow (73085) | $78.30 | $87 | 0.2× |
| Contrast X-Ray Of Knee Joint (73580) range across 3 matching MRF lines |
$80.10–$1,284.30 | $89–$1,427 | varies |
| CT abdomen and pelvis without and with contrast (74178) | $6,330.60 | $7,034 | 17.5× |
| CT abdomen and pelvis without contrast (74176) | $6,084 | $6,760 | 24.6× |
| CT abdomen w contrast (74160) | $2,652.30 | $2,947 | 14.6× |
| CT abdomen w wo contrast (74170) | $3,415.50 | $3,795 | 18.8× |
| CT abdomen w/o contrast (74150) | $2,620.80 | $2,912 | 24.1× |
| CT Angio Abdomen and Pelvis (74174) | $6,702.30 | $7,447 | 18.5× |
| CT Angio Chest (71275) | $3,363.30 | $3,737 | 18.5× |
| CT Angio Head (70496) | $3,348 | $3,720 | 18.4× |
| CT angio hrt w/3d image (75574) | $2,432.70 | $2,703 | 6.7× |
| Ct Angio Lwr Extr W/O&W/Dye (73706) | $2,761.20 | $3,068 | 15.2× |
| CT Angio Neck (70498) | $3,227.40 | $3,586 | 17.7× |
| Ct Angio Upr Extrm W/O&W/Dye (73206) | $3,008.70 | $3,343 | 16.5× |
| CT cervical spine w/ contrast (72126) | $2,844 | $3,160 | 7.9× |
| CT cervical spine w/o contrast (72125) | $2,583 | $2,870 | 23.8× |
| CT cervical spine w/wo cont (72127) | $2,928.60 | $3,254 | 16.1× |
| CT chest w contrast (71260) | $2,763 | $3,070 | 15.2× |
| CT chest w/wo contrast (71270) | $2,908.80 | $3,232 | 16.0× |
| CT head/brain with contrast (70460) | $2,463.30 | $2,737 | 13.5× |
| CT head/brain without and with contrast (70470) | $2,890.80 | $3,212 | 15.9× |
| CT heart no contrast quant eval coronry calcium (75571) | $111.60 | $124 | 1.2× |
| CT iac w contrast (70481) | $2,506.50 | $2,785 | 13.8× |
| CT l-spine w&w/o contrast (72133) | $3,380.40 | $3,756 | 18.6× |
| CT lower ext w/o (73700) range across 2 matching MRF lines |
$2,460.60–$4,920.30 | $2,734–$5,467 | varies |
| CT lower extremity w/contrast material (73701) | $2,569.50 | $2,855 | 14.1× |
| CT lumbar spine w contrast (72132) | $2,688.30 | $2,987 | 7.4× |
| CT lumbar spine w/o contrast (72131) | $2,543.40 | $2,826 | 23.4× |
| CT maxillofacial w contrast (70487) | $2,608.20 | $2,898 | 14.3× |
| CT maxillofacial wo contrast (70486) | $2,085.30 | $2,317 | 19.2× |
| CT neck tissue combo (70492) | $3,159 | $3,510 | 17.3× |
| Ct Orbit/Ear/Fossa W/O&W/Dye (70482) | $2,494.80 | $2,772 | 13.7× |
| CT orbits w/o contrast (70480) | $2,375.10 | $2,639 | 21.9× |
| CT pelvis w&w/o contrast (72194) | $3,365.10 | $3,739 | 18.5× |
| CT pelvis w/o contrast (72192) | $2,554.20 | $2,838 | 23.5× |
| CT scan of leg combo (73702) | $3,015 | $3,350 | 16.6× |
| CT scans face/jaw combo (70488) | $2,619.90 | $2,911 | 14.4× |
| CT soft tissue neck w contrast (70491) | $2,582.10 | $2,869 | 14.2× |
| CT soft tissue neck w/o contrast (70490) | $2,322 | $2,580 | 21.4× |
| CT thoracic spine w contrast (72129) | $2,907 | $3,230 | 16.0× |
| CT thoracic spine w/o contrast (72128) | $2,537.10 | $2,819 | 23.4× |
| CT thoracic spine w/wo cont (72130) | $2,593.80 | $2,882 | 14.2× |
| CT thorax w/o contrast (71250) | $2,553.30 | $2,837 | 23.5× |
| CT unlisted procedure (76497) | $2,699.10 | $2,999 | 29.9× |
| CT upper ext wo (73200) | $2,379.60 | $2,644 | 21.9× |
| CT upper extremity w/o & w/contrast material (73202) | $3,909.60 | $4,344 | 21.5× |
| CT upper extremity with contrast (73201) | $2,521.80 | $2,802 | 7.0× |
| Cta Abdl Aorta&Bi Iliofem W/Contrast&Postp (75635) | $3,522.60 | $3,914 | 19.3× |
| Cta Abdomen (74175) | $3,584.70 | $3,983 | 19.7× |
| CTA pelvis (72191) | $3,839.40 | $4,266 | 21.1× |
| Diskography lumbar (72295) | $205.20 | $228 | 0.1× |
| Esophagram (74220) | $714.60 | $794 | 3.9× |
| Fetal Biophysical Profile W/O Non-Stress Testing (76819) | $516.60 | $574 | 4.8× |
| Fluoroscopy up to 1 hr (76000) range across 3 matching MRF lines |
$79.20–$740.70 | $88–$823 | varies |
| Foot 2 views (73620) | $296.10 | $329 | 3.3× |
| Forearm 2 views (73090) | $310.50 | $345 | 3.4× |
| Gastric emptying imaging study (78264) | $1,915.20 | $2,128 | 4.6× |
| Gated Heart Planar Single (78472) | $2,185.20 | $2,428 | 5.3× |
| Hand 2 views (73120) range across 2 matching MRF lines |
$285.30–$569.70 | $317–$633 | varies |
| Hepatobil Syst Image W/Drug (78227) | $2,053.80 | $2,282 | 3.6× |
| Hepatobiliary System Imaging (78226) | $1,852.20 | $2,058 | 4.5× |
| Ht Muscle Image Spect Sing (78451) | $4,224.60 | $4,694 | 3.1× |
| Hysterosalpingogram (74740) | $738 | $820 | 3.0× |
| K Flow/Funct Image W/Drug (78708) | $1,762.20 | $1,958 | 3.1× |
| K Flow/Funct Image W/O Drug (78707) | $1,812.60 | $2,014 | 3.2× |
| Knee 3 Views (73562) | $459.90 | $511 | 5.1× |
| Lung perfusion differential (78597) | $3,074.40 | $3,416 | 7.4× |
| Lung Ventilat&Perfus Imaging (78582) | $2,538.90 | $2,821 | 4.5× |
| Lymph System Imaging (78195) | $2,069.10 | $2,299 | 3.7× |
| Mra Head W/O & W/Contrast Material (70546) | $3,339 | $3,710 | 9.2× |
| MRA head w/o contrast (70544) | $3,598.20 | $3,998 | 14.5× |
| MRA neck w contrast (70548) | $4,069.80 | $4,522 | 11.2× |
| Mra Neck W/O &W/Contrast Material (70549) | $3,984.30 | $4,427 | 11.0× |
| MRA neck w/o contrast (70547) | $3,165.30 | $3,517 | 12.8× |
| MRI abdomen w contrast (74182) | $3,470.40 | $3,856 | 9.6× |
| MRI abdomen w/o contrast (74181) | $3,483 | $3,870 | 14.1× |
| MRI any jt lower extrem w/contrast material (73722) | $3,474 | $3,860 | 4.3× |
| MRI any jt lower extrem w/o & w/contrast matrl (73723) | $3,734.10 | $4,149 | 10.3× |
| MRI any jt upper extremity w/contrast matrl (73222) | $3,242.70 | $3,603 | 4.0× |
| MRI Breast W/O Contrast Bilateral (77047) | $2,442.60 | $2,714 | 9.9× |
| MRI Breast Without Contrast Material Unilateral (77046) | $2,241 | $2,490 | 9.0× |
| MRI cervical spine w contrast (72142) | $4,255.20 | $4,728 | 11.7× |
| MRI cervical spine w/o cont (72141) | $4,079.70 | $4,533 | 16.5× |
| MRI chest w/o contrast (71550) | $3,598.20 | $3,998 | 14.5× |
| MRI chest wo w contrast (71552) | $3,982.50 | $4,425 | 11.0× |
| MRI lower extrem oth/thn jt w/contrast matrl (73719) | $2,309.40 | $2,566 | 6.4× |
| MRI lower extrem oth/thn jt w/o & w/contr matr (73720) | $3,149.10 | $3,499 | 8.7× |
| MRI lower extrem oth/thn jt w/o contr matrl (73718) | $2,882.70 | $3,203 | 11.6× |
| MRI lumbar spine w contrast (72149) | $3,463.20 | $3,848 | 9.6× |
| Mri Neck Spine W/O & W/Dye (72156) | $4,486.50 | $4,985 | 12.4× |
| MRI orbit face &/neck w/o contrast (70540) | $3,249 | $3,610 | 13.1× |
| Mri Orbt/Fac/Nck W/O &W/Dye (70543) | $4,027.50 | $4,475 | 11.1× |
| MRI pelvis w contrast (72196) | $3,344.40 | $3,716 | 9.2× |
| MRI pelvis w/o & w contrast (72197) | $4,113 | $4,570 | 11.4× |
| MRI pelvis w/o contrast (72195) | $3,402 | $3,780 | 13.7× |
| MRI thoracic spine w/o contrast (72146) | $4,079.70 | $4,533 | 16.5× |
| MRI upper extremity oth than jt w/o contr matrl (73218) | $3,112.20 | $3,458 | 12.6× |
| Mri Uppr Extremity W/O&W/Dye (73220) | $3,734.10 | $4,149 | 10.3× |
| MRI, abdomen, combo (74183) | $4,529.70 | $5,033 | 12.5× |
| MRI, dorsal spine combo (72157) | $4,592.70 | $5,103 | 12.7× |
| MRI, dorsal spine contrast (72147) | $3,629.70 | $4,033 | 10.0× |
| MRI, joint upper extrem (73221) | $2,669.40 | $2,966 | 10.8× |
| MRI, joint upper extrem combo (73223) | $4,233.60 | $4,704 | 11.7× |
| MRI, lumbar spine combo (72158) | $5,095.80 | $5,662 | 14.1× |
| Myocardial Spect Multiple Studies (78452) | $4,773.60 | $5,304 | 3.6× |
| Neck soft tissue (70360) | $344.70 | $383 | 3.8× |
| Nonvascular Shunt X-Ray (75809) | $852.30 | $947 | 7.9× |
| Parathyroid Planar Imaging (78070) | $1,278 | $1,420 | 3.1× |
| Parathyroid planar imaging w/wo subtraction (78071) | $1,613.70 | $1,793 | 3.9× |
| Pelvis 1 or 2 views (72170) | $348.30 | $387 | 3.2× |
| PET image w/CT, full body (78816) range across 2 matching MRF lines |
$9,334.80–$9,360 | $10,372–$10,400 | varies |
| PET imaging CT attenuation skull base mid-thigh (78815) | $5,844.60 | $6,494 | 3.9× |
| Pulmonary Perfusion Imaging Particulate (78580) | $1,750.50 | $1,945 | 4.2× |
| Radex Abd Compl Aqt Abd W/S/E/D Views 1 View Ch (74022) | $400.50 | $445 | 3.7× |
| Radex abscess/fistula/sinus tract rs&i (76080) | $2,389.50 | $2,655 | 4.2× |
| Radex Ankle Complete Minimum 3 Views (73610) range across 2 matching MRF lines |
$364.50–$728.10 | $405–$809 | varies |
| Radex Calcaneus Minimum 2 Views (73650) | $288 | $320 | 3.2× |
| Radex elbow complete minimum 3 views (73080) | $433.80 | $482 | 4.8× |
| Radex Facial Bones Complete Minimum 3 Views (70150) | $468 | $520 | 4.3× |
| Radex fingr minimum 2 views (73140) | $316.80 | $352 | 3.5× |
| Radex foot complete minimum 3 views (73630) range across 2 matching MRF lines |
$386.10–$771.30 | $429–$857 | varies |
| Radex Hand Minimum 3 Views (73130) | $419.40 | $466 | 4.6× |
| Radex lower extremity infant minimum 2 views (73592) | $268.20 | $298 | 3.0× |
| Radex Nasal Bones Complete Minimum 3 Views (70160) | $382.50 | $425 | 4.2× |
| Radex Ribs Unilateral 2 Views (71100) | $395.10 | $439 | 4.4× |
| Radex shoulder complete minimum 2 views (73030) range across 3 matching MRF lines |
$25.20–$670.50 | $28–$745 | varies |
| Radex Sinuses Paransl < 3 Views (70210) | $298.80 | $332 | 3.3× |
| Radex Spine 1 View Specify Level (72020) | $271.80 | $302 | 3.0× |
| Radex Sternum Minimum 2 Views (71120) | $351 | $390 | 3.9× |
| Radex Temporomandble Jt Opn & Clsd Mouth Bilat (70330) | $423.90 | $471 | 4.7× |
| Radex Toe Minimum 2 Views (73660) | $267.30 | $297 | 3.0× |
| Radex upper extremity infant minimum 2 views (73092) | $283.50 | $315 | 2.6× |
| Radex Wrist Complete Minimum 3 Views (73110) range across 3 matching MRF lines |
$25.20–$842.40 | $28–$936 | varies |
| Radiolog exam mandible compl minimum 4 views (70110) | $438.30 | $487 | 4.0× |
| Radiologic exam colon single contrast study (74270) | $859.50 | $955 | 4.7× |
| Radiologic exam knee complete 4/more views (73564) range across 2 matching MRF lines |
$32.40–$432.90 | $36–$481 | varies |
| Radiologic exam pelvis compl minimum 3 views (72190) | $446.40 | $496 | 4.1× |
| Radiologic Exam Small Int Single Contrast Study (74250) | $737.10 | $819 | 4.0× |
| Radiologic exam swallow function contrast study (74230) | $657 | $730 | 3.6× |
| Radiologic exam upr gi trc double contrast study (74246) | $1,201.50 | $1,335 | 6.6× |
| Radiologic examination femur 1 view (73551) | $330.30 | $367 | 3.7× |
| Radiologic examination femur minimum 2 views (73552) | $392.40 | $436 | 4.3× |
| Radiologic examination knee 1/2 views (73560) range across 2 matching MRF lines |
$401.40–$801.90 | $446–$891 | varies |
| Radiologic examination tibia & fibula 2 views (73590) range across 2 matching MRF lines |
$406.80–$927.90 | $452–$1,031 | varies |
| Ribs bilateral 3 views (71110) | $574.20 | $638 | 5.3× |
| Rp Loclzj Tum Spect 1 Area Single Day Imaging (78803) | $3,042 | $3,380 | 5.4× |
| Scapula (73010) | $345.60 | $384 | 3.2× |
| Screening Digital Breast Tomosynthesis Bi (77063) range across 2 matching MRF lines |
$54–$103.50 | $60–$115 | varies |
| Shoulder 1 view (73020) | $279 | $310 | 3.1× |
| Skull less than 4 views (70250) | $353.70 | $393 | 3.3× |
| Sternoclavicular joints (71130) | $344.70 | $383 | 3.8× |
| Thoracic spine 2 views (72070) | $420.30 | $467 | 3.9× |
| Thoracic spine 3 views (72072) | $541.80 | $602 | 5.0× |
| Thoracolumbar 2 views (72080) | $358.20 | $398 | 4.0× |
| Thyroid Uptake Measurement (78012) | $1,182.60 | $1,314 | 2.8× |
| Ultrasound Breast Limited (76642) range across 2 matching MRF lines |
$530.10–$1,060.20 | $589–$1,178 | varies |
| Ultrasound Exam Aaa Screen (76706) | $673.20 | $748 | 6.2× |
| Ultrasound, abdomen limited (76705) | $794.70 | $883 | 7.3× |
| Upper gi w/o kub (74240) range across 2 matching MRF lines |
$809.10–$1,103.40 | $899–$1,226 | varies |
| Urethrocystography retrograde (74450) | $49.50 | $55 | 0.2× |
| Us breast unilateral complete (76641) range across 2 matching MRF lines |
$730.80–$1,460.70 | $812–$1,623 | varies |
| Us chest (76604) | $604.80 | $672 | 5.6× |
| Us complete joint (76881) | $724.50 | $805 | 6.7× |
| Us exam, pelvic, limited (76857) | $77.40 | $86 | 0.7× |
| Us kidney transplant (76776) | $862.20 | $958 | 7.9× |
| Us lmtd joint/oth nonvasc xtr strux r-t w/img (76882) | $610.20 | $678 | 5.6× |
| Us ob limited 1 or more fetuses (76815) | $151.20 | $168 | 1.4× |
| Us ob transvaginal (76817) | $590.40 | $656 | 5.4× |
| Us pelvic non ob complete (76856) | $876.60 | $974 | 8.1× |
| Us pg uter img f&mat 14 wk tabdl 1/1st gestation (76801) | $691.20 | $768 | 6.4× |
| Us preg uterus real time f/u trnsabdl per fetus (76816) | $435.60 | $484 | 4.0× |
| Us retroperitoneal complete (76770) | $893.70 | $993 | 8.2× |
| Us scrotum and contents (76870) | $789.30 | $877 | 7.3× |
| Us spinal canal and contents (76800) | $961.20 | $1,068 | 8.9× |
| Us thyroid (76536) | $666 | $740 | 6.1× |
| Us transrectal (76872) range across 2 matching MRF lines |
$545.40–$751.50 | $606–$835 | varies |
| Venography extremity bilateral rs&i (75822) | $2,323.80 | $2,582 | 1.4× |
| Venography extremity unilateral rs&i (75820) range across 2 matching MRF lines |
$250.20–$1,197 | $278–$1,330 | varies |
| Wrist 2 views (73100) | $285.30 | $317 | 3.2× |
| X-Ray Ac Jts - Xr Acromioclavicular Joints Bilateral (73050) | $412.20 | $458 | 4.6× |
| X-Ray Aorta Leg Arteries (75630) range across 2 matching MRF lines |
$580.50–$10,801.80 | $645–$12,002 | varies |
| X-Ray Bend Only L-S Spine (72120) | $461.70 | $513 | 4.3× |
| X-Ray Elbow 2 Vw - Xr Elbow 1-2 Views Right (73070) | $331.20 | $368 | 3.7× |
| X-Ray Exam Breast Specimen (76098) | $308.70 | $343 | 0.5× |
| X-Ray Exam Entire Spi 1 Vw (72081) | $342 | $380 | 3.8× |
| X-Ray Exam Entire Spi 2/3 Vw (72082) | $582.30 | $647 | 5.4× |
| X-Ray Exam Hip Uni 1 View (73501) | $326.70 | $363 | 3.6× |
| X-Ray Exam Hip Uni 2-3 Views (73502) range across 3 matching MRF lines |
$30.60–$414 | $34–$460 | varies |
| X-Ray Exam Hips Bi 2 Views (73521) | $551.70 | $613 | 5.1× |
| X-Ray Exam Hips Bi 3-4 Views (73522) | $618.30 | $687 | 5.7× |
| X-Ray Exam Hips Bi 5/> Views (73523) | $525.60 | $584 | 4.8× |
| X-Ray Exam L-S Spine Bending (72114) | $658.80 | $732 | 6.1× |
| X-Ray Exam Neck Spine 2-3 Vw (72040) | $414 | $460 | 4.6× |
| X-Ray Exam Neck Spine 6/>Vws (72052) | $662.40 | $736 | 6.1× |
| X-Ray Exam Unilat Ribs/Chest (71101) | $568.80 | $632 | 5.2× |
| X-ray humerus (73060) | $426.60 | $474 | 4.7× |
| X-ray IV pyelogram (ivp) (74400) | $1,566.90 | $1,741 | 8.6× |
| X-Ray Knee Bilat Standing - Xr Knees Anteroposterior Standing Bilat (73565) | $270 | $300 | 3.0× |
| X-Ray Lumbar Spine 2/3 Vw - Xr Lumbar Spine 2-3 Views (72100) range across 2 matching MRF lines |
$30.60–$510.30 | $34–$567 | varies |
| X-ray nose-rectum child f.b. (76010) | $343.80 | $382 | 3.8× |
| X-Ray Ribs, Chest 4+ Vw - Xr Ribs 3 Vws Bil W/ Chest Posteroanterior (71111) | $535.50 | $595 | 4.9× |
| X-Ray Sacroiliac Jts 3+ Vw - Xr Sacroiliac Joints 3+ Views (72202) | $408.60 | $454 | 3.8× |
| X-Ray Sacroiliac Jts <3 Vw - Xr Sacroiliac Joints 1-2 Views (72200) | $395.10 | $439 | 3.6× |
| X-Ray Sacrum/Coccyx 2+ Vw - Xr Sacrum Coccyx 2+ Views (72220) | $360 | $400 | 4.0× |
| X-Ray Sinuses 3+ Vw - Xr Paranasal Sinuses 3+ Views (70220) | $474.30 | $527 | 5.2× |
| X-Ray Skull 4+ Vw - Xr Skull Complete 4+ Views (70260) | $480.60 | $534 | 4.4× |
| X-Rays Bone Length Studies (77073) | $378.90 | $421 | 3.5× |
| X-Rays Bone Survey Complete (77075) | $878.40 | $976 | 8.1× |
| Xr c-spine 4 or 5 views (72050) range across 2 matching MRF lines |
$38.70–$576 | $43–$640 | varies |
| Xr orbits complete 4 views (70200) | $572.40 | $636 | 5.3× |
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.