Imaging prices at Sidney Regional Medical Center

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

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

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ProcedurePosted cashPosted gross× Medicare
Abdomen 1 View (74018) $434 $434 4.8×
Abdomen 2 views (74019) $555 $555 5.1×
Acute Gastrointestinal Blood Loss Imaging (78278) $2,234 $2,234 5.4×
Ankle 2 views (73600) $397 $397 4.4×
Arthrogram Wrist (73115) $1,236 $1,236 3.4×
Bone age studies (77072) $360 $360 3.3×
Bone Imaging 3 Phase (78315) $2,973 $2,973 7.2×
Bone Imaging Whole Body (78306) $2,614 $2,614 6.3×
Bone survey infant (77076) $757 $757 7.0×
Brain Imaging Pet Metabolic Evaluation (78608) $2,153 $2,153 1.4×
Cat Scan Follow-Up Study (76380) $1,260 $1,260 13.9×
Chest 1 view (71045) $352 $352 3.9×
Chest 2 views (71046) $455 $455 5.0×
Chest 3 views (71047) $667 $667 7.4×
Clavicle complete (73000) $423 $423 4.7×
Computed Tomography Thorax Lw Dose Lng Ca Scr C- (71271) $1,226 $1,226 11.3×
Contrast X-Ray Bladder (74430) $1,911 $1,911 5.3×
CT abdomen and pelvis without and with contrast (74178) $6,515 $6,515 18.0×
CT abdomen and pelvis without contrast (74176) $4,727 $4,727 19.1×
CT abdomen w contrast (74160) $3,344 $3,344 18.4×
CT abdomen w wo contrast (74170) $4,182 $4,182 23.0×
CT abdomen w/o contrast (74150) $2,799 $2,799 25.8×
CT Angio Abdomen and Pelvis (74174) $8,211 $8,211 22.7×
CT Angio Chest (71275) $3,800 $3,800 20.9×
CT Angio Head (70496) $3,601 $3,601 19.8×
Ct Angio Lwr Extr W/O&W/Dye (73706) $4,611 $4,611 25.3×
CT Angio Neck (70498) $3,494 $3,494 19.2×
Ct Angio Upr Extrm W/O&W/Dye (73206) $3,977 $3,977 21.8×
CT cervical spine w/ contrast (72126) $3,749 $3,749 10.3×
CT cervical spine w/o contrast (72125) $3,401 $3,401 31.3×
CT cervical spine w/wo cont (72127) $3,333 $3,333 18.3×
CT chest w contrast (71260) $3,137 $3,137 17.2×
CT chest w/wo contrast (71270) $3,931 $3,931 21.6×
CT head/brain with contrast (70460) $3,291 $3,291 18.1×
CT head/brain without and with contrast (70470) $3,358 $3,358 18.4×
CT iac w contrast (70481) $4,026 $4,026 22.1×
CT l-spine w&w/o contrast (72133) $4,396 $4,396 24.1×
CT lower ext w/o (73700) $2,346 $2,346 21.6×
CT lower extremity w/contrast material (73701) $3,354 $3,354 18.4×
CT lumbar spine w contrast (72132) $4,941 $4,941 13.6×
CT lumbar spine w/o contrast (72131) $3,364 $3,364 31.0×
CT maxillofacial w contrast (70487) $3,374 $3,374 18.5×
CT maxillofacial wo contrast (70486) $2,694 $2,694 24.8×
CT orbits w/o contrast (70480) $3,094 $3,094 28.5×
CT pelvis w&w/o contrast (72194) $3,989 $3,989 21.9×
CT pelvis w/o contrast (72192) $3,196 $3,196 29.4×
CT scan of leg combo (73702) $3,577 $3,577 19.6×
CT scans face/jaw combo (70488) $3,225 $3,225 17.7×
CT soft tissue neck w contrast (70491) $3,189 $3,189 17.5×
CT soft tissue neck w/o contrast (70490) $3,058 $3,058 28.2×
CT thoracic spine w contrast (72129) $3,496 $3,496 19.2×
CT thoracic spine w/o contrast (72128) $3,311 $3,311 30.5×
CT thoracic spine w/wo cont (72130) $3,370 $3,370 18.5×
CT thorax w/o contrast (71250) $3,291 $3,291 30.3×
CT upper ext wo (73200) $2,350 $2,350 21.6×
CT upper extremity with contrast (73201) $2,985 $2,985 8.2×
Cta Abdl Aorta&Bi Iliofem W/Contrast&Postp (75635) $4,139 $4,139 22.7×
Cta Abdomen (74175) $4,535 $4,535 24.9×
CTA pelvis (72191) $4,555 $4,555 25.0×
Dxa Bone Density Axial (77080) $768 $768 7.1×
Echograp Trans R Pros Study (76873) $795 $795 7.3×
Esophagram (74220) $962 $962 5.3×
Fetal Biophys Profile W/Nst (76818) $1,179 $1,179 10.9×
Fetal Biophysical Profile W/O Non-Stress Testing (76819) $688 $688 6.3×
Fluoroscopy up to 1 hr (76000) $813 $813 3.3×
Foot 2 views (73620) $356 $356 3.9×
Forearm 2 views (73090) $405 $405 4.5×
Gastric emptying imaging study (78264) $2,521 $2,521 6.1×
Gated Heart Planar Single (78472) $2,219 $2,219 5.3×
Hand 2 views (73120) $408 $408 3.8×
Hepatobil Syst Image W/Drug (78227) $2,787 $2,787 4.9×
Ht Muscle Image Spect Sing (78451) $3,999 $3,999 3.0×
K Flow/Funct Image W/Drug (78708) $2,220 $2,220 3.9×
K Flow/Funct Image W/O Drug (78707) $2,118 $2,118 3.8×
Knee 3 Views (73562) $534 $534 5.9×
Lung Perf&Ventilat Diferentl (78598) $2,341 $2,341 4.2×
Lung Ventilat&Perfus Imaging (78582) $3,144 $3,144 5.6×
Lymph System Imaging (78195) $2,669 $2,669 4.7×
Meckels Divert Exam (78290) $2,524 $2,524 6.1×
Mr safety determination physician/other qhp (76016) $92 $92 1.0×
Mr safety implant&/fb assmt clin staf 1st 15 min (76014) $26 $26 0.9×
Mr safety implt electronics prepj supvj phys/qhp (76018) $96 $96 1.0×
Mr safety implt pos&/immoblj (76019) $62 $62 1.0×
Mr safety med physics xm customization plng&mntr (76017) $251 $251 1.0×
Mra Head W/O & W/Contrast Material (70546) $6,538 $6,538 18.0×
MRA head w/o contrast (70544) $4,876 $4,876 19.7×
Mra Neck W/O &W/Contrast Material (70549) $5,462 $5,462 15.1×
MRI abdomen w/o contrast (74181) $4,579 $4,579 18.5×
MRI any jt lower extrem w/contrast material (73722) $4,646 $4,646 5.7×
MRI any jt lower extrem w/o & w/contrast matrl (73723) $5,128 $5,128 14.2×
MRI any jt upper extremity w/contrast matrl (73222) $4,955 $4,955 6.1×
MRI cervical spine w contrast (72142) $5,602 $5,602 15.5×
MRI cervical spine w/o cont (72141) $3,983 $3,983 16.1×
MRI chest w/o contrast (71550) $4,689 $4,689 18.9×
MRI chest wo w contrast (71552) $4,352 $4,352 12.0×
MRI lower extrem oth/thn jt w/o & w/contr matr (73720) $4,908 $4,908 13.5×
MRI lower extrem oth/thn jt w/o contr matrl (73718) $3,738 $3,738 15.1×
MRI lumbar spine w contrast (72149) $5,093 $5,093 14.1×
Mri Neck Spine W/O & W/Dye (72156) $5,908 $5,908 16.3×
Mri Orbt/Fac/Nck W/O &W/Dye (70543) $5,521 $5,521 15.2×
MRI pelvis w/o & w contrast (72197) $4,766 $4,766 13.2×
MRI pelvis w/o contrast (72195) $4,620 $4,620 18.6×
MRI thoracic spine w/o contrast (72146) $4,888 $4,888 19.7×
MRI upper extremity oth than jt w/o contr matrl (73218) $3,871 $3,871 15.6×
Mri Uppr Extremity W/O&W/Dye (73220) $5,363 $5,363 14.8×
MRI, abdomen, combo (74183) $5,754 $5,754 15.9×
MRI, dorsal spine combo (72157) $6,139 $6,139 16.9×
MRI, dorsal spine contrast (72147) $5,701 $5,701 15.7×
MRI, joint upper extrem (73221) $3,742 $3,742 15.1×
MRI, joint upper extrem combo (73223) $5,869 $5,869 16.2×
MRI, lumbar spine combo (72158) $5,928 $5,928 16.4×
Myelogram Lumbar (72265) $1,624 $1,624 2.0×
Myocardial Spect Multiple Studies (78452) $6,402 $6,402 4.8×
Neck soft tissue (70360) $430 $430 4.8×
Oph bmtry us echograpy a-scan io lens pwr cal (76519) $304 $304 2.8×
Ophthalmic ultrasound dx b-scan w/wo a-scan (76512) $378 $378 3.5×
Parathyroid Planar Imaging (78070) $1,814 $1,814 4.4×
Parathyroid planar imaging w/wo subtraction (78071) $2,026 $2,026 4.9×
Pelvis 1 or 2 views (72170) $434 $434 4.0×
Pet Image W/Ct Lmtd (78814) $7,782 $7,782 5.2×
PET image w/CT, full body (78816) $9,137 $9,137 6.2×
PET imaging CT attenuation skull base mid-thigh (78815) $8,400 $8,400 5.7×
Pet Imaging Limited Area Chest Head/Neck (78811) $2,184 $2,184 1.6×
Pulmonary Perfusion Imaging Particulate (78580) $1,759 $1,759 4.2×
Radex Abd Compl Aqt Abd W/S/E/D Views 1 View Ch (74022) $704 $704 6.5×
Radex Ankle Complete Minimum 3 Views (73610) $472 $472 5.2×
Radex Calcaneus Minimum 2 Views (73650) $374 $374 4.1×
Radex elbow complete minimum 3 views (73080) $455 $455 5.0×
Radex Facial Bones Complete Minimum 3 Views (70150) $638 $638 5.9×
Radex fingr minimum 2 views (73140) $349 $349 3.9×
Radex foot complete minimum 3 views (73630) $466 $466 5.2×
Radex Hand Minimum 3 Views (73130) $466 $466 5.2×
Radex lower extremity infant minimum 2 views (73592) $390 $390 4.3×
Radex Nasal Bones Complete Minimum 3 Views (70160) $482 $482 5.3×
Radex Ribs Unilateral 2 Views (71100) $414 $414 4.6×
Radex shoulder complete minimum 2 views (73030) $481 $481 5.3×
Radex Sinuses Paransl < 3 Views (70210) $432 $432 4.8×
Radex Spine 1 View Specify Level (72020) $419 $419 4.6×
Radex Sternum Minimum 2 Views (71120) $429 $429 4.7×
Radex Toe Minimum 2 Views (73660) $357 $357 4.0×
Radex upper extremity infant minimum 2 views (73092) $409 $409 3.8×
Radex Wrist Complete Minimum 3 Views (73110) $473 $473 5.2×
Radex X-Ray Exam Entire Spi 6/> Vw - Xr Entire Spine 6+ Vw (72084) $679 $679 6.3×
Radiolog exam mandible compl minimum 4 views (70110) $612 $612 5.6×
Radiologic Exam Abdomen 3+ Views - Xr Abdomen 3+ Views (74021) $569 $569 5.2×
Radiologic exam knee complete 4/more views (73564) $575 $575 5.3×
Radiologic exam pelvis compl minimum 3 views (72190) $587 $587 5.4×
Radiologic Exam Small Int Single Contrast Study (74250) $865 $865 4.7×
Radiologic exam swallow function contrast study (74230) $825 $825 4.5×
Radiologic exam upr gi trc double contrast study (74246) $1,140 $1,140 6.3×
Radiologic examination femur 1 view (73551) $396 $396 4.4×
Radiologic examination femur minimum 2 views (73552) $463 $463 5.1×
Radiologic examination knee 1/2 views (73560) $462 $462 5.1×
Radiologic Examination Osseous Survey Limited (77074) $1,063 $1,063 9.8×
Radiologic examination tibia & fibula 2 views (73590) $446 $446 4.9×
Ribs bilateral 3 views (71110) $649 $649 6.0×
Rp Loclzj Tum Spect 1 Area Single Day Imaging (78803) $3,838 $3,838 6.8×
Rp loclzj tum spect w/CT 1 area/acquisj 1day img (78830) $4,086 $4,086 3.0×
Scapula (73010) $464 $464 4.3×
Screening Digital Breast Tomosynthesis Bi (77063) $110 $110 4.7×
Shoulder 1 view (73020) $344 $344 3.8×
Skull less than 4 views (70250) $492 $492 4.5×
Thoracic spine 2 views (72070) $479 $479 4.4×
Thoracic spine 3 views (72072) $632 $632 5.8×
Thoracolumbar 2 views (72080) $428 $428 4.7×
Ultrasound Breast Limited (76642) $626 $626 6.9×
Ultrasound Exam Aaa Screen (76706) $776 $776 7.1×
Ultrasound, abdomen limited (76705) $855 $855 7.9×
Unlisted magnetic resonance procedure (76498) $3,514 $3,514 38.9×
Unlisted us procedure (76999) $809 $809 9.0×
Upper gi w/o kub (74240) $991 $991 5.4×
Urethrocystogram voiding (74455) $1,386 $1,386 5.6×
Us breast unilateral complete (76641) $802 $802 7.4×
Us chest (76604) $741 $741 6.8×
Us complete joint (76881)
range across 3 matching MRF lines		 $490–$924 $490–$924 varies
Us exam, pelvic, limited (76857) $712 $712 6.6×
Us kidney transplant (76776) $951 $951 8.8×
Us lmtd joint/oth nonvasc xtr strux r-t w/img (76882)
range across 3 matching MRF lines		 $393–$775 $393–$775 varies
Us ob limited 1 or more fetuses (76815) $696 $696 6.4×
Us ob transvaginal (76817) $823 $823 7.6×
Us pelvic non ob complete (76856) $1,114 $1,114 10.3×
Us pg uter img f&mat 14 wk tabdl 1/1st gestation (76801) $1,020 $1,020 9.4×
Us preg uterus real time f/u trnsabdl per fetus (76816) $514 $514 4.7×
Us retroperitoneal complete (76770) $1,103 $1,103 10.2×
Us retroperitoneal limited (76775)
range across 2 matching MRF lines		 $427–$819 $427–$819 varies
Us scrotum and contents (76870) $954 $954 8.8×
Us thyroid (76536) $859 $859 7.9×
Us transrectal (76872)
range across 3 matching MRF lines		 $781–$854 $781–$854 varies
Wrist 2 views (73100) $395 $395 4.4×
X-Ray Ac Jts - Xr Acromioclavicular Joints Bilateral (73050) $414 $414 4.6×
X-Ray Bend Only L-S Spine (72120) $686 $686 6.3×
X-Ray Elbow 2 Vw - Xr Elbow 1-2 Views Right (73070) $402 $402 4.4×
X-Ray Exam Breast Specimen (76098) $345 $345 0.6×
X-Ray Exam Entire Spi 1 Vw (72081) $419 $419 4.6×
X-Ray Exam Entire Spi 2/3 Vw (72082) $863 $863 7.9×
X-Ray Exam Hip Uni 1 View (73501) $374 $374 4.1×
X-Ray Exam Hip Uni 2-3 Views (73502) $400 $400 4.4×
X-Ray Exam Hips Bi 2 Views (73521) $627 $627 5.8×
X-Ray Exam Hips Bi 3-4 Views (73522) $594 $594 5.5×
X-Ray Exam Hips Bi 5/> Views (73523) $572 $572 5.3×
X-Ray Exam L-S Spine Bending (72114) $911 $911 8.4×
X-Ray Exam Neck Spine 2-3 Vw (72040) $463 $463 5.1×
X-Ray Exam Neck Spine 6/>Vws (72052) $817 $817 7.5×
X-Ray Exam Unilat Ribs/Chest (71101) $557 $557 5.1×
X-ray humerus (73060) $483 $483 5.3×
X-Ray Knee Bilat Standing - Xr Knees Anteroposterior Standing Bilat (73565) $387 $387 4.3×
X-Ray Lumbar Spine 2/3 Vw - Xr Lumbar Spine 2-3 Views (72100) $604 $604 5.6×
X-Ray Sacroiliac Jts 3+ Vw - Xr Sacroiliac Joints 3+ Views (72202) $506 $506 4.7×
X-Ray Sacroiliac Jts <3 Vw - Xr Sacroiliac Joints 1-2 Views (72200) $450 $450 4.1×
X-Ray Sacrum/Coccyx 2+ Vw - Xr Sacrum Coccyx 2+ Views (72220) $404 $404 4.5×
X-Ray Skull 4+ Vw - Xr Skull Complete 4+ Views (70260) $760 $760 7.0×
X-Ray Urinary Tract Exam With Contrast Material (74420)
range across 3 matching MRF lines		 $647–$1,806 $647–$1,806 varies
X-Rays Bone Length Studies (77073) $416 $416 3.8×
X-Rays Bone Survey Complete (77075) $1,332 $1,332 12.3×
Xr c-spine 4 or 5 views (72050) $648 $648 6.0×
Xr orbits complete 4 views (70200) $602 $602 5.5×

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.