Imaging prices at Providence Medical Center
Wayne, NE · every code in this section with a posted price and a Medicare benchmark.
205 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) | $256.50 | $270 | 2.8× |
| Abdomen 2 views (74019) | $320.15 | $337 | 2.9× |
| Ankle 2 views (73600) range across 4 matching MRF lines |
$307.80–$615.60 | $324–$648 | varies |
| Arthrogram hip (73525) | $1,081.10 | $1,138 | 3.0× |
| Arthrogram Wrist (73115) | $601.35 | $633 | 1.7× |
| Bone age studies (77072) | $205.20 | $216 | 1.9× |
| Bone Imaging 3 Phase (78315) | $1,842.05 | $1,939 | 4.4× |
| Bone Imaging Limited Area (78300) | $885.40 | $932 | 2.1× |
| Bone Imaging Multiple Areas (78305) | $1,436.40 | $1,512 | 3.5× |
| Bone Imaging Whole Body (78306) | $1,748.95 | $1,841 | 4.2× |
| Bone survey infant (77076) | $485.45 | $511 | 4.5× |
| Chest 1 view (71045) | $156.75 | $165 | 1.7× |
| Chest 2 views (71046) | $275.50 | $290 | 3.0× |
| Clavicle complete (73000) | $281.20 | $296 | 3.1× |
| Computed Tomography Thorax Lw Dose Lng Ca Scr C- (71271) | $237.50 | $250 | 2.2× |
| Contrast X-Ray Bladder (74430) | $462.65 | $487 | 1.3× |
| Contrast X-Ray Of Elbow (73085) | $888.25 | $935 | 2.5× |
| CT abdomen and pelvis without and with contrast (74178) | $5,148.05 | $5,419 | 14.2× |
| CT abdomen and pelvis without contrast (74176) | $2,580.20 | $2,716 | 10.4× |
| CT abdomen w contrast (74160) | $3,404.80 | $3,584 | 18.7× |
| CT abdomen w wo contrast (74170) | $3,880.75 | $4,085 | 21.3× |
| CT abdomen w/o contrast (74150) | $1,881.95 | $1,981 | 17.3× |
| CT Angio Abdomen and Pelvis (74174) | $4,881.10 | $5,138 | 13.5× |
| CT Angio Chest (71275) | $4,213.25 | $4,435 | 23.1× |
| CT Angio Head (70496) | $4,101.15 | $4,317 | 22.5× |
| Ct Angio Lwr Extr W/O&W/Dye (73706) | $4,872.55 | $5,129 | 26.8× |
| CT Angio Neck (70498) | $4,126.80 | $4,344 | 22.7× |
| CT cervical spine w/ contrast (72126) | $3,197.70 | $3,366 | 8.8× |
| CT cervical spine w/o contrast (72125) | $2,643.85 | $2,783 | 24.4× |
| CT cervical spine w/wo cont (72127) | $2,603.95 | $2,741 | 14.3× |
| CT chest w contrast (71260) | $2,835.75 | $2,985 | 15.6× |
| CT chest w/wo contrast (71270) | $3,319.30 | $3,494 | 18.2× |
| CT head/brain with contrast (70460) | $1,992.15 | $2,097 | 10.9× |
| CT head/brain without and with contrast (70470) | $2,700.85 | $2,843 | 14.8× |
| CT heart no contrast quant eval coronry calcium (75571) | $1,498.15 | $1,577 | 16.6× |
| CT iac w contrast (70481) | $2,150.80 | $2,264 | 11.8× |
| CT l-spine w&w/o contrast (72133) | $2,241.05 | $2,359 | 12.3× |
| CT lower ext w/o (73700) | $2,738.85 | $2,883 | 25.2× |
| CT lower extremity w/contrast material (73701) | $2,206.85 | $2,323 | 12.1× |
| CT lumbar spine w contrast (72132) | $3,364.90 | $3,542 | 9.3× |
| CT lumbar spine w/o contrast (72131) | $2,639.10 | $2,778 | 24.3× |
| CT maxillofacial w contrast (70487) | $2,304.70 | $2,426 | 12.7× |
| CT maxillofacial wo contrast (70486) | $2,152.70 | $2,266 | 19.8× |
| CT neck tissue combo (70492) | $3,292.70 | $3,466 | 18.1× |
| Ct Orbit/Ear/Fossa W/O&W/Dye (70482) | $2,268.60 | $2,388 | 12.5× |
| CT orbits w/o contrast (70480) | $2,252.45 | $2,371 | 20.7× |
| CT pelvis w&w/o contrast (72194) | $2,314.20 | $2,436 | 12.7× |
| CT pelvis w/o contrast (72192) | $1,910.45 | $2,011 | 17.6× |
| CT scan of leg combo (73702) | $2,304.70 | $2,426 | 12.7× |
| CT scans face/jaw combo (70488) | $2,694.20 | $2,836 | 14.8× |
| CT soft tissue neck w contrast (70491) | $2,829.10 | $2,978 | 15.5× |
| CT soft tissue neck w/o contrast (70490) | $2,288.55 | $2,409 | 21.1× |
| CT thoracic spine w contrast (72129) | $2,337 | $2,460 | 12.8× |
| CT thoracic spine w/o contrast (72128) | $2,654.30 | $2,794 | 24.5× |
| CT thoracic spine w/wo cont (72130) | $3,188.20 | $3,356 | 17.5× |
| CT thorax w/o contrast (71250) | $2,184.05 | $2,299 | 20.1× |
| CT unlisted procedure (76497) | $1,538.05 | $1,619 | 17.0× |
| CT upper ext wo (73200) | $2,632.45 | $2,771 | 24.2× |
| CT upper extremity w/o & w/contrast material (73202) | $2,130.85 | $2,243 | 11.7× |
| CT upper extremity with contrast (73201) | $2,071.95 | $2,181 | 5.7× |
| Cta Abdl Aorta&Bi Iliofem W/Contrast&Postp (75635) | $6,158.85 | $6,483 | 33.8× |
| Cta Abdomen (74175) | $4,327.25 | $4,555 | 23.8× |
| CTA pelvis (72191) | $4,140.10 | $4,358 | 22.7× |
| Esophagram (74220) | $950.95 | $1,001 | 5.2× |
| Fetal Biophys Profile W/Nst (76818) | $641.25 | $675 | 5.9× |
| Fetal Biophysical Profile W/O Non-Stress Testing (76819) | $345.80 | $364 | 3.2× |
| Fluoroscopy up to 1 hr (76000) | $577.60 | $608 | 2.3× |
| Foot 2 views (73620) range across 4 matching MRF lines |
$266–$532 | $280–$560 | varies |
| Forearm 2 views (73090) | $251.75 | $265 | 2.8× |
| Gastric emptying imaging study (78264) | $2,861.40 | $3,012 | 6.9× |
| Gated Heart Planar Single (78472) | $1,113.40 | $1,172 | 2.7× |
| Hand 2 views (73120) range across 4 matching MRF lines |
$286.90–$573.80 | $302–$604 | varies |
| Hepatobiliary System Imaging (78226) | $2,339.85 | $2,463 | 5.6× |
| Hysterosalpingogram (74740) | $706.80 | $744 | 2.9× |
| Infant hip ultrasound with hip movement (dynamic) (76885) | $449.35 | $473 | 5.0× |
| K Flow/Funct Image Multiple (78709) | $1,489.60 | $1,568 | 2.6× |
| K Flow/Funct Image W/Drug (78708) | $765.70 | $806 | 1.4× |
| K Flow/Funct Image W/O Drug (78707) | $1,143.80 | $1,204 | 2.0× |
| Knee 3 Views (73562) range across 4 matching MRF lines |
$380.95–$761.90 | $401–$802 | varies |
| Liver & Spleen Imaging Static Only (78215) | $1,328.10 | $1,398 | 3.2× |
| Lung Ventilat&Perfus Imaging (78582) | $1,982.65 | $2,087 | 3.5× |
| Meckels Divert Exam (78290) | $1,106.75 | $1,165 | 2.7× |
| Mra Head W/O & W/Contrast Material (70546) | $4,724.35 | $4,973 | 13.0× |
| MRA head w/o contrast (70544) | $3,638.50 | $3,830 | 14.7× |
| MRA neck w contrast (70548) | $3,265.15 | $3,437 | 9.0× |
| Mra Neck W/O &W/Contrast Material (70549) | $5,667.70 | $5,966 | 15.6× |
| MRA neck w/o contrast (70547) | $2,774.95 | $2,921 | 11.2× |
| MRI abdomen w/o contrast (74181) | $3,285.10 | $3,458 | 13.3× |
| MRI any jt lower extrem w/contrast material (73722) | $4,116.35 | $4,333 | 5.1× |
| MRI any jt lower extrem w/o & w/contrast matrl (73723) | $5,029.30 | $5,294 | 13.9× |
| MRI any jt upper extremity w/contrast matrl (73222) | $4,131.55 | $4,349 | 5.1× |
| MRI Breast W/O Contrast Bilateral (77047) | $1,103.90 | $1,162 | 4.5× |
| MRI Breast Without Contrast Material Unilateral (77046) | $1,075.40 | $1,132 | 4.3× |
| MRI cervical spine w contrast (72142) | $3,098.90 | $3,262 | 8.6× |
| MRI cervical spine w/o cont (72141) | $2,141.30 | $2,254 | 8.6× |
| MRI chest w/o contrast (71550) | $2,766.40 | $2,912 | 11.2× |
| MRI chest wo w contrast (71552) | $2,932.65 | $3,087 | 8.1× |
| MRI lower extrem oth/thn jt w/o & w/contr matr (73720) | $2,731.25 | $2,875 | 7.5× |
| MRI lower extrem oth/thn jt w/o contr matrl (73718) | $3,465.60 | $3,648 | 14.0× |
| MRI lumbar spine w contrast (72149) | $3,098.90 | $3,262 | 8.6× |
| Mri Neck Spine W/O & W/Dye (72156) | $3,824.70 | $4,026 | 10.6× |
| MRI orbit face &/neck w/o contrast (70540) | $3,554.90 | $3,742 | 14.3× |
| Mri Orbt/Fac/Nck W/O &W/Dye (70543) | $4,053.65 | $4,267 | 11.2× |
| MRI pelvis w contrast (72196) | $2,932.65 | $3,087 | 8.1× |
| MRI pelvis w/o & w contrast (72197) | $4,297.80 | $4,524 | 11.9× |
| MRI pelvis w/o contrast (72195) | $3,406.70 | $3,586 | 13.8× |
| MRI thoracic spine w/o contrast (72146) | $2,145.10 | $2,258 | 8.7× |
| MRI upper extremity oth than jt w/o contr matrl (73218) | $2,290.45 | $2,411 | 9.2× |
| Mri Uppr Extremity W/O&W/Dye (73220) | $2,911.75 | $3,065 | 8.0× |
| MRI, abdomen, combo (74183) | $4,353.85 | $4,583 | 12.0× |
| MRI, dorsal spine combo (72157) | $3,833.25 | $4,035 | 10.6× |
| MRI, dorsal spine contrast (72147) | $3,098.90 | $3,262 | 8.6× |
| MRI, joint upper extrem (73221) | $2,432 | $2,560 | 9.8× |
| MRI, joint upper extrem combo (73223) | $3,241.40 | $3,412 | 8.9× |
| MRI, lumbar spine combo (72158) | $3,807.60 | $4,008 | 10.5× |
| Myocardial Spect Multiple Studies (78452) | $2,626.75 | $2,765 | 2.0× |
| Neck soft tissue (70360) | $350.55 | $369 | 3.9× |
| Nonvascular Shunt X-Ray (75809) | $574.75 | $605 | 5.3× |
| Parathyroid planar imaging w/wo subtraction (78071) | $1,838.25 | $1,935 | 4.4× |
| Pelvis 1 or 2 views (72170) | $330.60 | $348 | 3.0× |
| PET image w/CT, full body (78816) | $6,005.90 | $6,322 | 4.0× |
| PET imaging CT attenuation skull base mid-thigh (78815) | $6,247.20 | $6,576 | 4.2× |
| Radex Abd Compl Aqt Abd W/S/E/D Views 1 View Ch (74022) | $463.60 | $488 | 4.3× |
| Radex Ankle Complete Minimum 3 Views (73610) range across 4 matching MRF lines |
$329.65–$659.30 | $347–$694 | varies |
| Radex Calcaneus Minimum 2 Views (73650) | $277.40 | $292 | 3.1× |
| Radex elbow complete minimum 3 views (73080) | $329.65 | $347 | 3.6× |
| Radex Facial Bones Complete Minimum 3 Views (70150) | $400.90 | $422 | 3.7× |
| Radex fingr minimum 2 views (73140) | $364.80 | $384 | 4.0× |
| Radex foot complete minimum 3 views (73630) range across 4 matching MRF lines |
$304–$608 | $320–$640 | varies |
| Radex Hand Minimum 3 Views (73130) range across 4 matching MRF lines |
$334.40–$668.80 | $352–$704 | varies |
| Radex Nasal Bones Complete Minimum 3 Views (70160) | $329.65 | $347 | 3.6× |
| Radex Ribs Unilateral 2 Views (71100) | $318.25 | $335 | 3.5× |
| Radex shoulder complete minimum 2 views (73030) range across 3 matching MRF lines |
$298.30–$596.60 | $314–$628 | varies |
| Radex Sinuses Paransl < 3 Views (70210) | $211.85 | $223 | 2.3× |
| Radex Spine 1 View Specify Level (72020) | $197.60 | $208 | 2.2× |
| Radex Sternum Minimum 2 Views (71120) | $281.20 | $296 | 3.1× |
| Radex Toe Minimum 2 Views (73660) | $310.65 | $327 | 3.4× |
| Radex Wrist Complete Minimum 3 Views (73110) | $380.95 | $401 | 4.2× |
| Radiolog exam mandible compl minimum 4 views (70110) | $343.90 | $362 | 3.2× |
| Radiologic exam colon double contrast study (74280) | $2,387.35 | $2,513 | 13.1× |
| Radiologic exam colon single contrast study (74270) | $1,607.40 | $1,692 | 8.8× |
| Radiologic Exam Esophagus Double Contrast Study (74221) | $1,021.25 | $1,075 | 5.6× |
| Radiologic exam knee complete 4/more views (73564) range across 4 matching MRF lines |
$412.30–$824.60 | $434–$868 | varies |
| Radiologic exam pelvis compl minimum 3 views (72190) | $436.05 | $459 | 4.0× |
| Radiologic Exam Small Int Single Contrast Study (74250) | $1,095.35 | $1,153 | 6.0× |
| Radiologic exam swallow function contrast study (74230) | $1,481.05 | $1,559 | 8.1× |
| Radiologic exam upr gi trc double contrast study (74246) | $1,261.60 | $1,328 | 6.9× |
| Radiologic examination femur minimum 2 views (73552) | $380 | $400 | 4.2× |
| Radiologic examination knee 1/2 views (73560) range across 6 matching MRF lines |
$329.65–$659.30 | $347–$694 | varies |
| Radiologic examination tibia & fibula 2 views (73590) range across 4 matching MRF lines |
$291.65–$583.30 | $307–$614 | varies |
| Ribs bilateral 3 views (71110) | $343.90 | $362 | 3.2× |
| Scapula (73010) | $355.30 | $374 | 3.3× |
| Screening Digital Breast Tomosynthesis Bi (77063) | $90.25 | $95 | 3.9× |
| Shoulder 1 view (73020) range across 4 matching MRF lines |
$223.25–$446.50 | $235–$470 | varies |
| Shoulder Arthrography (73040) | $1,014.60 | $1,068 | 2.8× |
| Skull less than 4 views (70250) | $243.20 | $256 | 2.2× |
| Sternoclavicular joints (71130) | $292.60 | $308 | 3.2× |
| Thoracic spine 2 views (72070) | $329.65 | $347 | 3.0× |
| Thoracolumbar 2 views (72080) | $312.55 | $329 | 3.5× |
| Thyroid Imaging With Vascular Flow (78013) | $664.05 | $699 | 1.6× |
| Ultrasound Breast Limited (76642) | $661.20 | $696 | 7.3× |
| Ultrasound Exam Aaa Screen (76706) | $625.10 | $658 | 5.8× |
| Ultrasound, abdomen limited (76705) | $931.95 | $981 | 8.6× |
| Unlisted us procedure (76999) | $489.25 | $515 | 5.4× |
| Upper gi w/o kub (74240) | $1,070.65 | $1,127 | 5.9× |
| Urethrocystogram voiding (74455) | $581.40 | $612 | 2.3× |
| Us breast unilateral complete (76641) | $672.60 | $708 | 6.2× |
| Us chest (76604) | $510.15 | $537 | 4.7× |
| Us complete joint (76881) | $115.90 | $122 | 1.1× |
| Us exam, pelvic, limited (76857) | $485.45 | $511 | 4.5× |
| Us kidney transplant (76776) | $437 | $460 | 4.0× |
| Us lmtd joint/oth nonvasc xtr strux r-t w/img (76882) range across 5 matching MRF lines |
$138.70–$714.40 | $146–$752 | varies |
| Us ob limited 1 or more fetuses (76815) | $608.95 | $641 | 5.6× |
| Us ob transvaginal (76817) | $612.75 | $645 | 5.6× |
| Us pelvic non ob complete (76856) | $855 | $900 | 7.9× |
| Us pg uter img f&mat 14 wk tabdl 1/1st gestation (76801) | $993.70 | $1,046 | 9.2× |
| Us preg uterus real time f/u trnsabdl per fetus (76816) | $681.15 | $717 | 6.3× |
| Us retroperitoneal complete (76770) | $711.55 | $749 | 6.6× |
| Us retroperitoneal limited (76775) | $281.20 | $296 | 2.6× |
| Us scrotum and contents (76870) | $766.65 | $807 | 7.1× |
| Us thyroid (76536) | $837.90 | $882 | 7.7× |
| Us transrectal (76872) | $564.30 | $594 | 5.2× |
| Wrist 2 views (73100) range across 4 matching MRF lines |
$329.65–$659.30 | $347–$694 | varies |
| X-Ray Ac Jts - Xr Acromioclavicular Joints Bilateral (73050) | $268.85 | $283 | 3.0× |
| X-Ray Bend Only L-S Spine (72120) | $415.15 | $437 | 3.8× |
| X-Ray Elbow 2 Vw - Xr Elbow 1-2 Views Right (73070) range across 4 matching MRF lines |
$277.40–$554.80 | $292–$584 | varies |
| X-Ray Exam Breast Specimen (76098) | $748.60 | $788 | 1.3× |
| X-Ray Exam Hip Uni 1 View (73501) | $309.70 | $326 | 3.4× |
| X-Ray Exam Hip Uni 2-3 Views (73502) | $455.05 | $479 | 5.0× |
| X-Ray Exam Hips Bi 2 Views (73521) | $391.40 | $412 | 3.6× |
| X-Ray Exam L-S Spine Bending (72114) | $643.15 | $677 | 5.9× |
| X-Ray Exam Neck Spine 2-3 Vw (72040) | $318.25 | $335 | 3.5× |
| X-Ray Exam Neck Spine 6/>Vws (72052) | $602.30 | $634 | 5.5× |
| X-Ray Exam Unilat Ribs/Chest (71101) | $354.35 | $373 | 3.3× |
| X-ray eye for foreign body (70030) | $218.50 | $230 | 2.4× |
| X-ray humerus (73060) | $298.30 | $314 | 3.3× |
| X-Ray Lumbar Spine 2/3 Vw - Xr Lumbar Spine 2-3 Views (72100) | $343.90 | $362 | 3.2× |
| X-ray nose-rectum child f.b. (76010) | $379.05 | $399 | 4.2× |
| X-Ray Sacroiliac Jts <3 Vw - Xr Sacroiliac Joints 1-2 Views (72200) | $342.95 | $361 | 3.2× |
| X-Ray Sacrum/Coccyx 2+ Vw - Xr Sacrum Coccyx 2+ Views (72220) | $292.60 | $308 | 3.2× |
| X-Ray Sinuses 3+ Vw - Xr Paranasal Sinuses 3+ Views (70220) | $325.85 | $343 | 3.6× |
| X-Ray Stress View (77071) | $701.10 | $738 | 7.8× |
| X-Ray Urinary Tract Exam With Contrast Material (74420) | $1,352.80 | $1,424 | 3.7× |
| X-Rays Bone Survey Complete (77075) | $827.45 | $871 | 7.6× |
| Xr c-spine 4 or 5 views (72050) | $436.05 | $459 | 4.0× |
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.