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.

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ProcedureCash priceGross charge× Medicare
Abdomen 2 views (74019) $423 $470 3.9×
Angiography extremity bilateral rs&i (75716) $3,078 $3,420 0.9×
Angiography extremity unilateral rs&i (75710) $2,754.45 $3,060.50 0.8×
Ankle 2 views (73600) $279 $310 3.1×
Aortography abdl bi iliofem low extrem cath rs&i (75630) $5,691.15 $6,323.50 1.7×
Aortography abdominal serialography rs&i (75625) $2,410.65 $2,678.50 0.7×
Arthrogram elbow (73085) $78.30 $87 0.2×
Arthrogram hip (73525) $927.90 $1,031 2.6×
Arthrogram wrist (73115) $822.60 $914 2.3×
Arthrography knee lt (73580) $1,276.20 $1,418 3.5×
Bone &/Joint Imaging Limited Area (78300) $1,749.60 $1,944 4.2×
Bone &/joint imaging whole body (78306) $2,052 $2,280 4.9×
Bone age studies (77072) $284.40 $316 2.6×
Bone Imaging 3 Phase (78315) $2,327.40 $2,586 5.6×
Bone survey complete (77075) $878.40 $976 8.1×
Cervical spine 2 or 3 views (72040) $414 $460 4.6×
Chest 1 view (71045) $172.80 $192 1.9×
Chest 3 views (71047) $436.50 $485 4.8×
Cine/Vid X-Ray Throat/Esoph - Fl Esoph Barium Swlw W/ Video & Speech (74230) $657 $730 3.6×
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×
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 hrt w/3d image (75574) $2,432.70 $2,703 6.7×
CT angiography upper extremity lt (73206) $3,008.70 $3,343 16.5×
CT c-spine w/o contrast (72125) $2,583 $2,870 23.8×
CT cervical spine w&w/o contrast (72127) $2,928.60 $3,254 16.1×
CT cervical spine with contrast (72126) $2,844 $3,160 7.9×
CT chest w/wo contrast (71270) $2,908.80 $3,232 16.0×
CT chest with contrast (71260) $2,763 $3,070 15.2×
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 lower ext w/o (73700) $3,690.45 $4,100.50 34.0×
CT lower extremity w wo contrast (73702) $3,015 $3,350 16.6×
CT lower extremity with contrast (73701) $2,569.50 $2,855 14.1×
CT lumbar spine w & w/o contrast (72133) $3,380.40 $3,756 18.6×
CT lumbar spine w/o contrast (72131) $2,543.40 $2,826 23.4×
CT lumbar spine with contrast (72132) $2,688.30 $2,987 7.4×
CT maxillofacial w contrast (70487) $2,608.20 $2,898 14.3×
CT maxillofacial w/o contrast (70486) $2,085.30 $2,317 19.2×
CT maxillofacial w/wo contrast (70488) $2,619.90 $2,911 14.4×
CT neck soft tissue w contrast (70491) $2,582.10 $2,869 14.2×
CT orbit sella/post fossa/ear w/o & w/contr matr (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 soft tissue neck w/o & w/contrast material (70492) $3,159 $3,510 17.3×
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 contrast (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 extremity w/o & w/contrast material (73202) $3,909.60 $4,344 21.5×
CT upper extremity w/o contrast rt (73200) $2,379.60 $2,644 21.9×
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 abdomen pelvis (74174) $6,702.30 $7,447 18.5×
CTA chest (71275) $3,363.30 $3,737 18.5×
Cta Head (70496) $3,348 $3,720 18.4×
CTA lwr ext w&w/o contrast (73706) $2,761.20 $3,068 15.2×
Cta Neck (70498) $3,227.40 $3,586 17.7×
Cta Pelvis (72191) $3,839.40 $4,266 21.1×
Cystography minimum 3 views rs&i (74430) $845.10 $939 2.3×
Diskography lumbar (72295) $205.20 $228 0.1×
Esophagus (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) $82.80 $92 0.3×
Foot 2 views (73620) $296.10 $329 3.3×
Forearm 2 views (73090) $310.50 $345 3.4×
Gated Heart Planar Single (78472) $2,185.20 $2,428 5.3×
Hand 2 views (73120) $427.50 $475 3.9×
Hand 3 views (73130) $419.40 $466 4.6×
Hepatobil Syst Imag Inc Gb W/Pharma Intervenj (78227) $2,053.80 $2,282 3.6×
Hepatobiliary syst imaging including gallbladder (78226) $1,852.20 $2,058 4.5×
Ht muscle image spect sing (78451) $4,224.60 $4,694 3.1×
Humerus Min 2 Views Left (73060) $426.60 $474 4.7×
Hysterosalpingogram (74740) $738 $820 3.0×
Kidney Img Morphology Vascular Flow 1 W/O Rx (78707) $1,812.60 $2,014 3.2×
Kidney img morphology vascular flow 1 w/rx (78708) $1,762.20 $1,958 3.1×
Knee 3 views (73562) $459.90 $511 5.1×
Lung perfusion differential (78597) $3,074.40 $3,416 7.4×
Lymphoscintigraphy (78195) $2,069.10 $2,299 3.7×
MRA head w & w/o contrast (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 & w/contrast material (74183) $4,529.70 $5,033 12.5×
MRI abdomen w/o contrast (74181) $3,483 $3,870 14.1×
MRI any jnt lwr ext with con lt (73722) $3,474 $3,860 4.3×
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 w/o contrast unilat (77046) $2,241 $2,490 9.0×
MRI c-spine with contrast (72142) $4,255.20 $4,728 11.7×
MRI cervical spine w/o contrast (72141) $4,079.70 $4,533 16.5×
MRI chest w/o & w/contrast material (71552) $3,982.50 $4,425 11.0×
MRI chest w/o contrast (71550) $3,598.20 $3,998 14.5×
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 contr matrl (73718) $2,882.70 $3,203 11.6×
MRI orbit face &/neck w/o contrast (70540) $3,249 $3,610 13.1×
MRI orbit/face/neck w&w/o cont (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 material (72197) $4,113 $4,570 11.4×
MRI pelvis w/o contrast (72195) $3,402 $3,780 13.7×
MRI scan of arm joint before and after contrast (73223) $4,233.60 $4,704 11.7×
MRI scan of leg joint before and after contrast (73723) $3,734.10 $4,149 10.3×
MRI spinal canal cervical w/o & w/contr matrl (72156) $4,486.50 $4,985 12.4×
MRI spinal canal lumbar w/contrast material (72149) $3,463.20 $3,848 9.6×
MRI spinal canal lumbar w/o & w/contr matrl (72158) $5,095.80 $5,662 14.1×
MRI spinal canal thoracic w/contrast matrl (72147) $3,629.70 $4,033 10.0×
MRI spinal canal thoracic w/o & w/contr matrl (72157) $4,592.70 $5,103 12.7×
MRI thoracic spine w/o contrast (72146) $4,079.70 $4,533 16.5×
MRI upper ext joint w/o contrast (73221) $2,669.40 $2,966 10.8×
MRI upper extrem other than jt w/o & w/contras (73220) $3,734.10 $4,149 10.3×
MRI upper extremity oth than jt w/o contr matrl (73218) $3,112.20 $3,458 12.6×
Myocardial Spect Multiple Studies (78452) $4,773.60 $5,304 3.6×
Neck soft tissue (70360) $344.70 $383 3.8×
Nm gastric emptying study (78264) $1,915.20 $2,128 4.6×
Ob Us Follow-Up Per Fetus - Us Ob Follow Up Transabdominal Approach (76816) $435.60 $484 4.0×
Osseous survey infant (77076) $635.40 $706 5.9×
Parathyrd planar w/wo subtrj (78071) $1,613.70 $1,793 3.9×
Parathyroid imaging (78070) $1,278 $1,420 3.1×
Pelvis 1 or 2 views (72170) $348.30 $387 3.2×
PET image w/CT, skull-thigh (78815) $5,844.60 $6,494 3.9×
PET imaging for CT attenuation whole body (78816) $9,347.40 $10,386 6.3×
Pr MRI, lower extr, w/o contrast f/u by contrast (73720) $3,149.10 $3,499 8.7×
Pulmonary Perfusion Imaging Particulate (78580) $1,750.50 $1,945 4.2×
Pulmonary Ventilation & Perfusion Imaging (78582) $2,538.90 $2,821 4.5×
Radex abscess/fistula/sinus tract rs&i (76080) $2,389.50 $2,655 4.2×
Radex Entir Thrc Lmbr Crv Sac Spi W/Skull 1 Vw - Xr Scoliosis 1 Vw (72081) $342 $380 3.8×
Radex entir thrc lmbr crv sac spi w/skull 2/3 vw (72082) $582.30 $647 5.4×
Radex hips bilateral with pelvis 2 views (73521) $551.70 $613 5.1×
Radiolog exam mandible compl minimum 4 views (70110) $438.30 $487 4.0×
Radiologic Exam Abdomen 1 View - Xr Abdomen 1 View (74018) $342 $380 3.8×
Radiologic Exam Chest 2 Views - Xr Chest 2 Views (71046) $374.40 $416 4.1×
Radiologic exam colon single contrast study (74270) $859.50 $955 4.7×
Radiologic exam upr gi trc double contrast study (74246) $1,201.50 $1,335 6.6×
Radiologic exam upr gi trc single contrast study (74240) $956.25 $1,062.50 5.3×
Radiologic Examination Femur Minimum 2 Views - Xr Femur 2+ Vw Lt (73552) $392.40 $436 4.3×
Radiological examination surgical specimen (76098) $308.70 $343 0.5×
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×
Sacroiliac Joints < 3 Views (72200) $395.10 $439 3.6×
Scanogram (77073) $378.90 $421 3.5×
Scapula complete (73010) $345.60 $384 3.2×
Screening digital breast tomosynthesis (77063) $78.75 $87.50 3.4×
Shuntogram indwelling nonvascular shunt rs&i (75809) $852.30 $947 7.9×
Small bowel series (74250) $737.10 $819 4.0×
Spine thoracic 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, abdomen limited (76705) $794.70 $883 7.3×
Upper Extremity Infant (73092) $283.50 $315 2.6×
Urethrocystography retrograde rs&i (74450) $49.50 $55 0.2×
Urography (pyelography), intravenous, with or without KUB, with or without tomography (74400) $1,566.90 $1,741 8.6×
Us abdl aorta screen aaa (76706) $673.20 $748 6.2×
Us breast unilateral complete (76641) $1,095.75 $1,217.50 10.1×
Us breast unilateral limited (76642) $795.15 $883.50 8.8×
Us chest (76604) $604.80 $672 5.6×
Us compl joint r-t w/image documentation (76881) $724.50 $805 6.7×
Us kidney transplant (76776) $862.20 $958 7.9×
Us ob transvaginal (76817) $590.40 $656 5.4×
Us pelvic non ob complete (76856) $876.60 $974 8.1×
Us pelvic nonobstetric image dcmtn limited/f/u (76857) $77.40 $86 0.7×
Us pregnancy ltd (76815) $151.20 $168 1.4×
Us pregnant uterus 14 wk transabdl 1/1st gestat (76801) $691.20 $768 6.4×
Us retroperitoneal complete (76770) $893.70 $993 8.2×
Us scrotum and contents (76870) $789.30 $877 7.3×
Us soft tissue head/neck (76536) $666 $740 6.1×
Us spinal canal and contents (76800) $961.20 $1,068 8.9×
Us transrectal (76872) $648.45 $720.50 6.0×
Us xtr non-vasc lmtd (76882) $610.20 $678 5.6×
Venogram extremity bilateral (75822) $2,323.80 $2,582 1.4×
Venography extremity unilateral rs&i (75820) $723.60 $804 0.4×
Wrist 2 views (73100) $285.30 $317 3.2×
X-Ray Abdomen,Comp Acute Series - Xr Abdomen 2 Vws With Chest 1 View (74022) $400.50 $445 3.7×
X-Ray Ac Jts - Xr Acromioclavicular Joints Bilateral (73050) $412.20 $458 4.6×
X-Ray Ankle 3+ Vw - Xr Ankle 3+ Views Right (73610) $546.30 $607 6.0×
X-Ray Elbow 2 Vw - Xr Elbow 1-2 Views Right (73070) $331.20 $368 3.7×
X-Ray Elbow 3+ Vw - Xr Elbow 3+ Views Right (73080) $433.80 $482 4.8×
X-ray exam hip uni 1 view (73501) $326.70 $363 3.6×
X-Ray Exam Hip Uni 2-3 Views (73502) $411.30 $457 4.6×
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 of femur 1 (73551) $330.30 $367 3.7×
X-Ray Facial Bones 3+ Vw - Xr Facial Bones 3+ Views (70150) $468 $520 4.3×
X-Ray Foot 3+ Vw - Xr Foot 3+ Views Right (73630) $578.70 $643 6.4×
X-Ray Heel - Xr Calcaneus 2 Views Right (73650) $288 $320 3.2×
X-Ray Knee 4+ View - Xr Knee 4+ Views Right (73564) $232.65 $258.50 2.1×
X-Ray Knee Bilat Standing - Xr Knees Anteroposterior Standing Bilat (73565) $270 $300 3.0×
X-Ray Leg, Infant - Xr Lower Extremity 2+ Views Infant Left (73592) $268.20 $298 3.0×
X-Ray Lumbar Spine 2/3 Vw - Xr Lumbar Spine 2-3 Views (72100) $270.45 $300.50 2.5×
X-Ray Lumbar Spine 6+ Vw - Xr Lumbar Spine 6+ Vws Including Bending (72114) $658.80 $732 6.1×
X-Ray Lumbar Spine Flex/Exten - Xr Lumbar Spine 4+ Views W/ Flex Ext (72120) $461.70 $513 4.3×
X-Ray Nasal Bones - Xr Nasal Bones (70160) $382.50 $425 4.2×
X-Ray Nose-Rectum Child F.B. - Xr Nose to Rectum Foreign Body Peds (76010) $343.80 $382 3.8×
X-Ray Orbits - Xr Orbits Complete 4+ Views (70200) $572.40 $636 5.3×
X-Ray Pelvis 3+ Vw - Xr Pelvis 3+ Views (72190) $446.40 $496 4.1×
X-Ray Ribs 2 Vw Unilat - Xr Ribs 2 Views Right (71100) $395.10 $439 4.4×
X-Ray Ribs, Chest 3+ Vw - Xr Ribs 2 Vws Lt W/ Chest Anteroposterior (71101) $568.80 $632 5.2×
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 Sacrum/Coccyx 2+ Vw - Xr Sacrum Coccyx 2+ Views (72220) $360 $400 4.0×
X-Ray Shoulder 2+ Vw - Xr Shoulder 2+ Views Right (73030) $335.70 $373 3.7×
X-Ray Sinuses 3+ Vw - Xr Paranasal Sinuses 3+ Views (70220) $474.30 $527 5.2×
X-Ray Sinuses <3 Vw - Xr Paranasal Sinuses 1-2 Views (70210) $298.80 $332 3.3×
X-Ray Skull 4+ Vw - Xr Skull Complete 4+ Views (70260) $480.60 $534 4.4×
X-Ray Skull <4 Vw - Xr Skull 1-3 Views (70250) $353.70 $393 3.3×
X-Ray Spine One View - Xr Spine (72020) $271.80 $302 3.0×
X-Ray Sterno-Clavicluar Jt - Xr Sternoclavicular Joints 3+ Views (71130) $344.70 $383 3.8×
X-Ray Sternum 2+ Vw - Xr Sternum 2+ Views (71120) $351 $390 3.9×
X-Ray Thoracic Spine 2 Vw - Xr Thoracic Spine 2 Views (72070) $420.30 $467 3.9×
X-Ray Toe(S) - Xr Toes 2+ Views Right (73660) $267.30 $297 3.0×
X-Ray Wrist 3+ Vw - Xr Wrist 3+ Views Right (73110) $421.20 $468 4.7×
Xr arthrogram ankle (73615) $384.30 $427 1.1×
Xr c-spine 6 or more views (72052) $662.40 $736 6.1×
Xr finger(s) 2+ views (73140) $316.80 $352 3.5×
Xr shoulder 1 view (73020) $279 $310 3.1×
Xr spine cervical 4 or 5 views (72050) $307.35 $341.50 2.8×
Xr tibia/fibula 2 views (73590) $667.35 $741.50 7.4×
Xr tmj bilateral (70330) $423.90 $471 4.7×
Xray knee 1 or 2 views rt (73560) $601.65 $668.50 6.7×