Imaging prices at Tri Valley Health System
Cambridge, NE · every code in this section with a posted price and a Medicare benchmark.
209 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) | $448.20 | $498 | 5.0× |
| Abdomen 2 views (74019) | $563.40 | $626 | 5.2× |
| Acute Gastrointestinal Blood Loss Imaging (78278) | $2,381.40 | $2,646 | 5.7× |
| Ankle 2 views (73600) | $500.40 | $556 | 5.5× |
| Bone age studies (77072) | $188.10 | $209 | 1.7× |
| Bone Imaging 3 Phase (78315) | $2,819.70 | $3,133 | 6.8× |
| Bone Imaging Limited Area (78300) | $1,620 | $1,800 | 3.9× |
| Bone Imaging Whole Body (78306) | $2,340 | $2,600 | 5.6× |
| Brain Imaging Pet Metabolic Evaluation (78608) | $6,885.90 | $7,651 | 4.6× |
| Chest 1 view (71045) | $292.50 | $325 | 3.2× |
| Chest 2 views (71046) | $400.50 | $445 | 4.4× |
| Chest 3 views (71047) | $554.40 | $616 | 6.1× |
| Clavicle complete (73000) | $424.80 | $472 | 4.7× |
| Computed Tomography Thorax Lw Dose Lng Ca Scr C- (71271) | $1,593.90 | $1,771 | 14.7× |
| CT abdomen and pelvis without and with contrast (74178) | $5,810.40 | $6,456 | 16.0× |
| CT abdomen and pelvis without contrast (74176) | $4,250.70 | $4,723 | 17.2× |
| CT abdomen w contrast (74160) | $4,119.30 | $4,577 | 22.6× |
| CT abdomen w wo contrast (74170) | $4,669.20 | $5,188 | 25.6× |
| CT abdomen w/o contrast (74150) | $3,003.30 | $3,337 | 27.7× |
| CT Angio Abdomen and Pelvis (74174) | $5,840.10 | $6,489 | 16.1× |
| CT Angio Chest (71275) | $4,725.90 | $5,251 | 25.9× |
| CT Angio Head (70496) | $3,919.50 | $4,355 | 21.5× |
| Ct Angio Lwr Extr W/O&W/Dye (73706) | $2,617.20 | $2,908 | 14.4× |
| CT Angio Neck (70498) | $3,919.50 | $4,355 | 21.5× |
| Ct Angio Upr Extrm W/O&W/Dye (73206) | $2,900.70 | $3,223 | 15.9× |
| CT cervical spine w/ contrast (72126) | $4,157.10 | $4,619 | 11.5× |
| CT cervical spine w/o contrast (72125) | $3,190.50 | $3,545 | 29.4× |
| CT cervical spine w/wo cont (72127) | $4,394.70 | $4,883 | 24.1× |
| CT chest w contrast (71260) | $4,157.10 | $4,619 | 22.8× |
| CT chest w/wo contrast (71270) | $4,394.70 | $4,883 | 24.1× |
| CT head/brain with contrast (70460) | $3,681 | $4,090 | 20.2× |
| CT head/brain without and with contrast (70470) | $3,919.50 | $4,355 | 21.5× |
| CT iac w contrast (70481) | $3,919.50 | $4,355 | 21.5× |
| CT l-spine w&w/o contrast (72133) | $4,394.70 | $4,883 | 24.1× |
| CT lower ext w/o (73700) | $2,715.30 | $3,017 | 25.0× |
| CT lower extremity w/contrast material (73701) | $3,681 | $4,090 | 20.2× |
| CT lumbar spine w contrast (72132) | $4,157.10 | $4,619 | 11.5× |
| CT lumbar spine w/o contrast (72131) | $3,190.50 | $3,545 | 29.4× |
| CT maxillofacial w contrast (70487) | $3,206.70 | $3,563 | 17.6× |
| CT maxillofacial wo contrast (70486) | $2,242.80 | $2,492 | 20.7× |
| CT neck tissue combo (70492) | $3,919.50 | $4,355 | 21.5× |
| Ct Orbit/Ear/Fossa W/O&W/Dye (70482) | $4,157.10 | $4,619 | 22.8× |
| CT orbits w/o contrast (70480) | $2,952.90 | $3,281 | 27.2× |
| CT pelvis w&w/o contrast (72194) | $4,286.70 | $4,763 | 23.5× |
| CT pelvis w/o contrast (72192) | $2,811.60 | $3,124 | 25.9× |
| CT scan of leg combo (73702) | $3,919.50 | $4,355 | 21.5× |
| CT scans face/jaw combo (70488) | $3,442.50 | $3,825 | 18.9× |
| CT soft tissue neck w contrast (70491) | $3,681 | $4,090 | 20.2× |
| CT soft tissue neck w/o contrast (70490) | $2,715.30 | $3,017 | 25.0× |
| CT thoracic spine w contrast (72129) | $4,157.10 | $4,619 | 22.8× |
| CT thoracic spine w/o contrast (72128) | $3,190.50 | $3,545 | 29.4× |
| CT thoracic spine w/wo cont (72130) | $4,394.70 | $4,883 | 24.1× |
| CT thorax w/o contrast (71250) range across 2 matching MRF lines |
$1,972.80–$3,190.50 | $2,192–$3,545 | varies |
| CT upper ext wo (73200) | $2,715.30 | $3,017 | 25.0× |
| CT upper extremity w/o & w/contrast material (73202) | $3,919.50 | $4,355 | 21.5× |
| CT upper extremity with contrast (73201) | $3,681 | $4,090 | 10.2× |
| Cta Abdl Aorta&Bi Iliofem W/Contrast&Postp (75635) | $3,682.80 | $4,092 | 20.2× |
| Cta Abdomen (74175) | $5,238 | $5,820 | 28.8× |
| CTA pelvis (72191) | $4,919.40 | $5,466 | 27.0× |
| Dxa Bone Density Axial (77080) range across 2 matching MRF lines |
$95.40–$616.50 | $106–$685 | varies |
| Fetal Biophysical Profile W/O Non-Stress Testing (76819) | $530.10 | $589 | 4.9× |
| Fluoroscopy up to 1 hr (76000) range across 2 matching MRF lines |
$789.30–$983.70 | $877–$1,093 | varies |
| Foot 2 views (73620) | $378.90 | $421 | 4.2× |
| Forearm 2 views (73090) | $423 | $470 | 4.7× |
| Gastric emptying imaging study (78264) | $2,706.30 | $3,007 | 6.5× |
| Gated Heart Planar Single (78472) | $2,592 | $2,880 | 6.2× |
| Hand 2 views (73120) | $472.50 | $525 | 4.4× |
| Hepatobil Syst Image W/Drug (78227) | $2,530.80 | $2,812 | 4.5× |
| Hepatobiliary System Imaging (78226) | $2,241 | $2,490 | 5.4× |
| Ht Muscle Image Spect Sing (78451) | $5,407.20 | $6,008 | 4.0× |
| K Flow/Funct Image Multiple (78709) | $2,340 | $2,600 | 4.2× |
| K Flow/Funct Image W/Drug (78708) | $2,127.60 | $2,364 | 3.8× |
| K Flow/Funct Image W/O Drug (78707) | $2,127.60 | $2,364 | 3.8× |
| Knee 3 Views (73562) | $405 | $450 | 4.5× |
| Liver & Spleen Imaging Static Only (78215) | $2,550.60 | $2,834 | 6.1× |
| Lung Ventilation Imaging (78579) | $1,723.50 | $1,915 | 4.2× |
| Magnetic Image Jaw Joint (70336) | $4,146.30 | $4,607 | 16.7× |
| Meckels Divert Exam (78290) | $2,273.40 | $2,526 | 5.5× |
| Mra Head W/O & W/Contrast Material (70546) | $3,893.40 | $4,326 | 10.7× |
| MRA head w/o contrast (70544) | $3,522.60 | $3,914 | 14.2× |
| MRA head with contrast (70545) | $3,708 | $4,120 | 10.2× |
| MRA neck w contrast (70548) | $3,940.20 | $4,378 | 10.9× |
| Mra Neck W/O &W/Contrast Material (70549) | $4,356.90 | $4,841 | 12.0× |
| MRA neck w/o contrast (70547) | $3,522.60 | $3,914 | 14.2× |
| MRI abdomen w contrast (74182) | $4,078.80 | $4,532 | 11.3× |
| MRI abdomen w/o contrast (74181) | $3,708 | $4,120 | 15.0× |
| MRI any jt lower extrem w/contrast material (73722) | $3,244.50 | $3,605 | 4.0× |
| MRI any jt lower extrem w/o & w/contrast matrl (73723) | $3,708 | $4,120 | 10.2× |
| MRI any jt upper extremity w/contrast matrl (73222) | $3,476.70 | $3,863 | 4.3× |
| MRI cervical spine w contrast (72142) | $3,893.40 | $4,326 | 10.7× |
| MRI cervical spine w/o cont (72141) | $3,615.30 | $4,017 | 14.6× |
| MRI chest w/o contrast (71550) | $4,242.60 | $4,714 | 17.1× |
| MRI chest wo w contrast (71552) | $3,800.70 | $4,223 | 10.5× |
| MRI lower extrem oth/thn jt w/contrast matrl (73719) | $3,244.50 | $3,605 | 9.0× |
| MRI lower extrem oth/thn jt w/o & w/contr matr (73720) | $3,522.60 | $3,914 | 9.7× |
| MRI lower extrem oth/thn jt w/o contr matrl (73718) | $2,966.40 | $3,296 | 12.0× |
| MRI lumbar spine w contrast (72149) | $3,893.40 | $4,326 | 10.7× |
| Mri Neck Spine W/O & W/Dye (72156) | $4,542.30 | $5,047 | 12.5× |
| MRI orbit face &/neck w/o contrast (70540) | $3,151.80 | $3,502 | 12.7× |
| MRI orbit face neck w contrast (70542) | $3,429.90 | $3,811 | 9.5× |
| Mri Orbt/Fac/Nck W/O &W/Dye (70543) | $3,800.70 | $4,223 | 10.5× |
| MRI pelvis w contrast (72196) | $3,708 | $4,120 | 10.2× |
| MRI pelvis w/o & w contrast (72197) | $4,264.20 | $4,738 | 11.8× |
| MRI pelvis w/o contrast (72195) | $3,151.80 | $3,502 | 12.7× |
| MRI thoracic spine w/o contrast (72146) | $3,615.30 | $4,017 | 14.6× |
| MRI upper extremity oth than jt w/contr matrl (73219) | $3,429.90 | $3,811 | 9.5× |
| MRI upper extremity oth than jt w/o contr matrl (73218) | $2,966.40 | $3,296 | 12.0× |
| Mri Uppr Extremity W/O&W/Dye (73220) | $3,893.40 | $4,326 | 10.7× |
| MRI, abdomen, combo (74183) | $4,449.60 | $4,944 | 12.3× |
| MRI, dorsal spine combo (72157) | $4,542.30 | $5,047 | 12.5× |
| MRI, dorsal spine contrast (72147) | $3,893.40 | $4,326 | 10.7× |
| MRI, joint upper extrem (73221) | $2,688.30 | $2,987 | 10.9× |
| MRI, joint upper extrem combo (73223) | $3,986.10 | $4,429 | 11.0× |
| MRI, lumbar spine combo (72158) | $4,171.50 | $4,635 | 11.5× |
| Myocardial Spect Multiple Studies (78452) | $4,999.50 | $5,555 | 3.7× |
| Neck soft tissue (70360) | $458.10 | $509 | 5.1× |
| Parathyroid Planar Imaging (78070) | $1,723.50 | $1,915 | 4.2× |
| Pelvis 1 or 2 views (72170) | $419.40 | $466 | 3.9× |
| PET image w/CT, full body (78816) | $7,939.80 | $8,822 | 5.3× |
| PET imaging CT attenuation skull base mid-thigh (78815) | $6,885.90 | $7,651 | 4.6× |
| Pulmonary Perfusion Imaging Particulate (78580) | $1,850.40 | $2,056 | 4.5× |
| Radex Abd Compl Aqt Abd W/S/E/D Views 1 View Ch (74022) | $763.20 | $848 | 7.0× |
| Radex abscess/fistula/sinus tract rs&i (76080) | $2,817.90 | $3,131 | 5.0× |
| Radex Ankle Complete Minimum 3 Views (73610) | $460.80 | $512 | 5.1× |
| Radex Calcaneus Minimum 2 Views (73650) | $345.60 | $384 | 3.8× |
| Radex elbow complete minimum 3 views (73080) | $470.70 | $523 | 5.2× |
| Radex Facial Bones Complete Minimum 3 Views (70150) | $593.10 | $659 | 5.5× |
| Radex fingr minimum 2 views (73140) | $324.90 | $361 | 3.6× |
| Radex foot complete minimum 3 views (73630) | $479.70 | $533 | 5.3× |
| Radex Hand Minimum 3 Views (73130) | $479.70 | $533 | 5.3× |
| Radex lower extremity infant minimum 2 views (73592) | $365.40 | $406 | 4.0× |
| Radex Nasal Bones Complete Minimum 3 Views (70160) | $488.70 | $543 | 5.4× |
| Radex Ribs Unilateral 2 Views (71100) | $577.80 | $642 | 6.4× |
| Radex shoulder complete minimum 2 views (73030) | $530.10 | $589 | 5.9× |
| Radex Sinuses Paransl < 3 Views (70210) | $360.90 | $401 | 4.0× |
| Radex Spine 1 View Specify Level (72020) | $367.20 | $408 | 4.1× |
| Radex Sternum Minimum 2 Views (71120) | $470.70 | $523 | 5.2× |
| Radex Temporomandble Jt Opn & Clsd Mouth Bilat (70330) | $558 | $620 | 6.2× |
| Radex Toe Minimum 2 Views (73660) | $324.90 | $361 | 3.6× |
| Radex upper extremity infant minimum 2 views (73092) | $405 | $450 | 3.7× |
| Radex Wrist Complete Minimum 3 Views (73110) | $449.10 | $499 | 5.0× |
| Radiolog exam mandible compl minimum 4 views (70110) | $593.10 | $659 | 5.5× |
| Radiologic exam knee complete 4/more views (73564) | $679.50 | $755 | 6.3× |
| Radiologic Exam Small Int Single Contrast Study (74250) | $1,037.70 | $1,153 | 5.7× |
| Radiologic exam swallow function contrast study (74230) | $841.50 | $935 | 4.6× |
| Radiologic examination femur minimum 2 views (73552) | $675 | $750 | 7.5× |
| Radiologic examination knee 1/2 views (73560) | $597.60 | $664 | 6.6× |
| Radiologic Examination Osseous Survey Limited (77074) | $945 | $1,050 | 8.7× |
| Radiologic examination tibia & fibula 2 views (73590) | $441.90 | $491 | 4.9× |
| Ribs bilateral 3 views (71110) | $793.80 | $882 | 7.3× |
| Scapula (73010) | $458.10 | $509 | 4.2× |
| Screening Digital Breast Tomosynthesis Bi (77063) | $56.70 | $63 | 2.4× |
| Shoulder 1 view (73020) | $419.40 | $466 | 4.6× |
| Shoulder Arthrography (73040) | $1,802.70 | $2,003 | 5.0× |
| Skull less than 4 views (70250) | $428.40 | $476 | 3.9× |
| Sternoclavicular joints (71130) | $441.90 | $491 | 4.9× |
| Testicular Imaging W/Flow (78761) | $1,787.40 | $1,986 | 4.3× |
| Thoracic spine 2 views (72070) | $506.70 | $563 | 4.7× |
| Thoracic spine 3 views (72072) | $660.60 | $734 | 6.1× |
| Thyroid Imaging With Vascular Flow (78013) | $1,281.60 | $1,424 | 3.1× |
| Ultrasound Breast Limited (76642) | $458.10 | $509 | 5.1× |
| Ultrasound Exam Aaa Screen (76706) range across 2 matching MRF lines |
$812.70–$845.10 | $903–$939 | varies |
| Ultrasound, abdomen limited (76705) range across 2 matching MRF lines |
$766.80–$945 | $852–$1,050 | varies |
| Unlisted us procedure (76999) | $527.40 | $586 | 5.8× |
| Urethrocystogram voiding (74455) | $802.80 | $892 | 3.2× |
| Urethrocystography retrograde (74450) | $1,067.40 | $1,186 | 4.3× |
| Us breast unilateral complete (76641) range across 2 matching MRF lines |
$603–$1,066.50 | $670–$1,185 | varies |
| Us chest (76604) | $613.80 | $682 | 5.7× |
| Us complete joint (76881) | $662.40 | $736 | 6.1× |
| Us exam, pelvic, limited (76857) | $589.50 | $655 | 5.4× |
| Us ob limited 1 or more fetuses (76815) | $526.50 | $585 | 4.8× |
| Us ob transvaginal (76817) | $781.20 | $868 | 7.2× |
| Us pelvic non ob complete (76856) | $992.70 | $1,103 | 9.1× |
| Us pg uter img f&mat 14 wk tabdl 1/1st gestation (76801) | $828 | $920 | 7.6× |
| Us preg uterus real time f/u trnsabdl per fetus (76816) | $682.20 | $758 | 6.3× |
| Us retroperitoneal complete (76770) | $1,074.60 | $1,194 | 9.9× |
| Us scrotum and contents (76870) | $900.90 | $1,001 | 8.3× |
| Us thyroid (76536) | $841.50 | $935 | 7.8× |
| Wrist 2 views (73100) | $328.50 | $365 | 3.6× |
| X-Ray Ac Jts - Xr Acromioclavicular Joints Bilateral (73050) | $419.40 | $466 | 4.6× |
| X-Ray Elbow 2 Vw - Xr Elbow 1-2 Views Right (73070) | $378.90 | $421 | 4.2× |
| X-Ray Exam Breast Specimen (76098) | $253.80 | $282 | 0.4× |
| X-Ray Exam Entire Spi 2/3 Vw (72082) | $668.70 | $743 | 6.2× |
| X-Ray Exam Hip Uni 1 View (73501) | $315.90 | $351 | 3.5× |
| X-Ray Exam Hip Uni 2-3 Views (73502) | $461.70 | $513 | 5.1× |
| X-Ray Exam Hips Bi 2 Views (73521) | $647.10 | $719 | 6.0× |
| X-Ray Exam Hips Bi 3-4 Views (73522) | $642.60 | $714 | 5.9× |
| X-Ray Exam L-S Spine Bending (72114) | $872.10 | $969 | 8.0× |
| X-Ray Exam Neck Spine 2-3 Vw (72040) | $477.90 | $531 | 5.3× |
| X-Ray Exam Neck Spine 6/>Vws (72052) | $1,354.50 | $1,505 | 12.5× |
| X-Ray Exam Unilat Ribs/Chest (71101) | $792 | $880 | 7.3× |
| X-ray eye for foreign body (70030) | $387 | $430 | 4.3× |
| X-ray humerus (73060) | $458.10 | $509 | 5.1× |
| X-ray IV pyelogram (ivp) (74400) | $3,248.10 | $3,609 | 17.8× |
| X-Ray Jaw <4 Vw - Xr Mandible < 4 Views (70100) | $415.80 | $462 | 4.6× |
| X-Ray Knee Bilat Standing - Xr Knees Anteroposterior Standing Bilat (73565) | $337.50 | $375 | 3.7× |
| X-Ray Lumbar Spine 2/3 Vw - Xr Lumbar Spine 2-3 Views (72100) | $613.80 | $682 | 5.7× |
| X-ray nose-rectum child f.b. (76010) | $477.90 | $531 | 5.3× |
| X-Ray Ribs, Chest 4+ Vw - Xr Ribs 3 Vws Bil W/ Chest Posteroanterior (71111) | $729.90 | $811 | 6.7× |
| X-Ray Sacroiliac Jts 3+ Vw - Xr Sacroiliac Joints 3+ Views (72202) | $506.70 | $563 | 4.7× |
| X-Ray Sacroiliac Jts <3 Vw - Xr Sacroiliac Joints 1-2 Views (72200) | $420.30 | $467 | 3.9× |
| X-Ray Sacrum/Coccyx 2+ Vw - Xr Sacrum Coccyx 2+ Views (72220) | $437.40 | $486 | 4.8× |
| X-Ray Sinuses 3+ Vw - Xr Paranasal Sinuses 3+ Views (70220) | $612.90 | $681 | 6.8× |
| X-Ray Skull 4+ Vw - Xr Skull Complete 4+ Views (70260) | $577.80 | $642 | 5.3× |
| X-Ray Stress View (77071) | $370.80 | $412 | 4.1× |
| X-Ray Tmj Unilat (70328) | $531.90 | $591 | 5.9× |
| X-Rays Bone Survey Complete (77075) | $1,037.70 | $1,153 | 9.6× |
| Xr c-spine 4 or 5 views (72050) | $706.50 | $785 | 6.5× |
| Xr orbits complete 4 views (70200) | $632.70 | $703 | 5.8× |
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.