Imaging prices at West Holt Memorial Hospital

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

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

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ProcedurePosted cashPosted gross× Medicare
Abdomen 1 View (74018) $304 $380 3.4×
Abdomen 2 views (74019) $374 $468 3.4×
Ankle 2 views (73600) $262 $328 2.9×
Bone age studies (77072) $246 $307 2.3×
Bone Imaging 3 Phase (78315) $2,123 $2,654 5.1×
Bone Imaging Whole Body (78306) $1,857 $2,321 4.5×
Chest 1 view (71045) $270 $337 3.0×
Chest 2 views (71046) $309 $386 3.4×
Chest 3 views (71047) $350 $438 3.9×
Chest 4 or more views (71048) $389 $486 3.6×
Clavicle complete (73000) $314 $392 3.5×
Computed Tomography Thorax Lw Dose Lng Ca Scr C- (71271) $960 $1,200 8.8×
CT abdomen and pelvis without and with contrast (74178) $5,253 $6,566 14.5×
CT abdomen and pelvis without contrast (74176) $3,774 $4,717 15.2×
CT abdomen w contrast (74160) $2,567 $3,209 14.1×
CT abdomen w wo contrast (74170) $2,950 $3,687 16.2×
CT abdomen w/o contrast (74150) $2,218 $2,773 20.4×
CT Angio Abdomen and Pelvis (74174) $5,515 $6,894 15.2×
CT Angio Chest (71275)
range across 5 matching MRF lines		 $3,207–$4,048 $4,009–$5,060 varies
CT Angio Head (70496) $2,843 $3,554 15.6×
Ct Angio Lwr Extr W/O&W/Dye (73706) $3,374 $4,217 18.5×
CT Angio Neck (70498) $3,683 $4,604 20.2×
Ct Angio Upr Extrm W/O&W/Dye (73206) $3,145 $3,931 17.3×
CT bone density (77078) $416 $520 4.6×
CT cervical spine w/ contrast (72126) $2,414 $3,018 6.7×
CT cervical spine w/o contrast (72125) $2,321 $2,901 21.4×
CT cervical spine w/wo cont (72127) $2,531 $3,164 13.9×
CT chest w contrast (71260) $2,519 $3,149 13.8×
CT chest w/wo contrast (71270) $2,752 $3,440 15.1×
CT head/brain with contrast (70460) $2,225 $2,781 12.2×
CT head/brain without and with contrast (70470) $2,497 $3,121 13.7×
CT iac w contrast (70481) $2,345 $2,931 12.9×
CT l-spine w&w/o contrast (72133) $2,623 $3,279 14.4×
CT lower ext w/o (73700) $2,120 $2,650 19.5×
CT lower extremity w/contrast material (73701) $2,252 $2,815 12.4×
CT lumbar spine w contrast (72132) $2,302 $2,877 6.4×
CT lumbar spine w/o contrast (72131) $2,269 $2,836 20.9×
CT maxillofacial w contrast (70487) $2,142 $2,677 11.8×
CT maxillofacial wo contrast (70486) $1,784 $2,230 16.4×
CT neck tissue combo (70492) $2,660 $3,325 14.6×
Ct Orbit/Ear/Fossa W/O&W/Dye (70482) $2,512 $3,140 13.8×
CT orbits w/o contrast (70480) $2,080 $2,600 19.2×
CT pelvis w&w/o contrast (72194) $2,593 $3,241 14.2×
CT pelvis w/o contrast (72192) $2,210 $2,763 20.4×
CT scan of leg combo (73702) $2,516 $3,145 13.8×
CT scans face/jaw combo (70488) $2,326 $2,907 12.8×
CT soft tissue neck w contrast (70491) $2,286 $2,857 12.6×
CT soft tissue neck w/o contrast (70490) $1,978 $2,473 18.2×
CT thoracic spine w contrast (72129) $2,393 $2,991 13.1×
CT thoracic spine w/o contrast (72128) $2,371 $2,964 21.8×
CT thoracic spine w/wo cont (72130) $2,501 $3,126 13.7×
CT thorax w/o contrast (71250) $2,253 $2,816 20.8×
CT upper ext wo (73200)
range across 12 matching MRF lines		 $1,999–$2,134 $2,499–$2,668 varies
CT upper extremity w/o & w/contrast material (73202) $2,341 $2,926 12.9×
CT upper extremity with contrast (73201) $2,198 $2,748 6.1×
Cta Abdl Aorta&Bi Iliofem W/Contrast&Postp (75635) $3,302 $4,128 18.1×
Cta Abdomen (74175) $3,057 $3,821 16.8×
CTA head&neck c+ w/noncontrast img&post-pxessing (70471) $6,240 $7,800 17.2×
CTA pelvis (72191) $2,963 $3,704 16.3×
Dxa Bone Density Axial (77080) $490 $613 4.5×
Dxa bone density study 1/>sites appendiclr skel (77081) $248 $310 2.7×
Fetal Biophysical Profile W/O Non-Stress Testing (76819) $458 $572 4.2×
Fluoroscopy up to 1 hr (76000) $628 $785 2.5×
Foot 2 views (73620) $268 $335 3.0×
Forearm 2 views (73090) $293 $366 3.2×
Gastric emptying imaging study (78264) $1,942 $2,427 4.7×
Hand 2 views (73120) $289 $361 2.7×
Hepatobil Syst Image W/Drug (78227) $1,883 $2,354 3.3×
Ht Muscle Image Spect Sing (78451) $3,724 $4,655 2.8×
K Flow/Funct Image W/Drug (78708) $2,038 $2,548 3.6×
Knee 3 Views (73562) $397 $496 4.4×
Lung Ventilat&Perfus Imaging (78582) $2,793 $3,491 5.0×
Magnetic Image Jaw Joint (70336) $2,453 $3,066 9.9×
Mra Head W/O & W/Contrast Material (70546) $3,177 $3,971 8.8×
MRA head w/o contrast (70544) $2,618 $3,272 10.6×
MRA head with contrast (70545) $2,870 $3,588 7.9×
MRA neck w contrast (70548) $3,498 $4,372 9.7×
Mra Neck W/O &W/Contrast Material (70549) $3,966 $4,958 10.9×
MRA neck w/o contrast (70547) $1,985 $2,481 8.0×
MRI abdomen w contrast (74182) $3,210 $4,013 8.9×
MRI abdomen w/o contrast (74181) $3,112 $3,890 12.6×
MRI any jt lower extrem w/contrast material (73722) $2,922 $3,652 3.6×
MRI any jt lower extrem w/o & w/contrast matrl (73723) $3,229 $4,036 8.9×
MRI any jt upper extremity w/contrast matrl (73222) $3,114 $3,892 3.8×
MRI cervical spine w contrast (72142) $3,334 $4,167 9.2×
MRI cervical spine w/o cont (72141) $2,370 $2,962 9.6×
MRI chest w/o contrast (71550) $2,226 $2,783 9.0×
MRI chest with contrast (71551) $2,438 $3,048 3.0×
MRI chest wo w contrast (71552) $2,722 $3,403 7.5×
MRI lower extrem oth/thn jt w/contrast matrl (73719) $2,890 $3,612 8.0×
MRI lower extrem oth/thn jt w/o & w/contr matr (73720) $3,081 $3,851 8.5×
MRI lower extrem oth/thn jt w/o contr matrl (73718) $2,552 $3,190 10.3×
MRI lumbar spine w contrast (72149) $3,344 $4,180 9.2×
Mri Neck Spine W/O & W/Dye (72156) $4,038 $5,047 11.1×
MRI orbit face &/neck w/o contrast (70540) $3,131 $3,914 12.6×
MRI orbit face neck w contrast (70542) $3,428 $4,285 9.5×
Mri Orbt/Fac/Nck W/O &W/Dye (70543) $3,749 $4,686 10.3×
MRI pelvis w contrast (72196) $2,867 $3,584 7.9×
MRI pelvis w/o & w contrast (72197) $3,613 $4,516 10.0×
MRI pelvis w/o contrast (72195) $2,563 $3,204 10.3×
MRI thoracic spine w/o contrast (72146) $2,803 $3,504 11.3×
MRI upper extremity oth than jt w/contr matrl (73219)
range across 7 matching MRF lines		 $2,938–$3,114 $3,672–$3,892 varies
MRI upper extremity oth than jt w/o contr matrl (73218)
range across 9 matching MRF lines		 $2,529–$2,590 $3,161–$3,238 varies
Mri Uppr Extremity W/O&W/Dye (73220)
range across 7 matching MRF lines		 $3,286–$3,697 $4,108–$4,621 varies
MRI, abdomen, combo (74183) $3,874 $4,843 10.7×
MRI, dorsal spine combo (72157) $4,009 $5,011 11.1×
MRI, dorsal spine contrast (72147) $3,360 $4,200 9.3×
MRI, joint upper extrem (73221) $2,529 $3,161 10.2×
MRI, joint upper extrem combo (73223) $3,697 $4,621 10.2×
MRI, lumbar spine combo (72158) $3,869 $4,836 10.7×
Myocardial Spect Multiple Studies (78452) $4,330 $5,412 3.2×
Neck soft tissue (70360) $337 $421 3.7×
Parathyroid Planar Imaging (78070) $1,326 $1,657 3.2×
Pelvis 1 or 2 views (72170) $322 $402 3.0×
Radex Abd Compl Aqt Abd W/S/E/D Views 1 View Ch (74022) $559 $699 5.1×
Radex Ankle Complete Minimum 3 Views (73610) $334 $418 3.7×
Radex Calcaneus Minimum 2 Views (73650) $234 $293 2.6×
Radex elbow complete minimum 3 views (73080) $336 $420 3.7×
Radex Facial Bones Complete Minimum 3 Views (70150) $460 $575 4.2×
Radex fingr minimum 2 views (73140)
range across 10 matching MRF lines		 $186–$232 $233–$290 varies
Radex foot complete minimum 3 views (73630) $351 $439 3.9×
Radex Hand Minimum 3 Views (73130) $342 $428 3.8×
Radex lower extremity infant minimum 2 views (73592) $246 $308 2.7×
Radex Mastoids Compl Minimum 3 Views PR Side (70130) $225 $281 2.1×
Radex Nasal Bones Complete Minimum 3 Views (70160) $345 $431 3.8×
Radex Ribs Unilateral 2 Views (71100) $354 $442 3.9×
Radex shoulder complete minimum 2 views (73030) $366 $457 4.1×
Radex Sinuses Paransl < 3 Views (70210) $266 $333 2.9×
Radex Spine 1 View Specify Level (72020) $298 $373 3.3×
Radex Sternum Minimum 2 Views (71120) $346 $432 3.8×
Radex Temporomandble Jt Opn & Clsd Mouth Bilat (70330) $330 $413 3.7×
Radex Toe Minimum 2 Views (73660) $248 $310 2.7×
Radex upper extremity infant minimum 2 views (73092) $250 $313 2.3×
Radex Wrist Complete Minimum 3 Views (73110) $330 $412 3.7×
Radiolog exam mandible compl minimum 4 views (70110) $490 $613 4.5×
Radiologic Exam Abdomen 3+ Views - Xr Abdomen 3+ Views (74021) $410 $512 3.8×
Radiologic exam knee complete 4/more views (73564) $400 $500 3.7×
Radiologic exam pelvis compl minimum 3 views (72190) $414 $518 3.8×
Radiologic Exam Small Int Single Contrast Study (74250) $533 $666 2.9×
Radiologic examination femur 1 view (73551) $272 $340 3.0×
Radiologic examination femur minimum 2 views (73552) $354 $443 3.9×
Radiologic examination knee 1/2 views (73560) $318 $398 3.5×
Radiologic Examination Osseous Survey Limited (77074) $681 $851 6.3×
Radiologic examination tibia & fibula 2 views (73590) $317 $396 3.5×
Ribs bilateral 3 views (71110) $437 $546 4.0×
Rp Loclzj Tum Spect 1 Area Single Day Imaging (78803)
range across 2 matching MRF lines		 $1,942–$4,196 $2,427–$5,245 varies
Scapula (73010) $330 $412 3.0×
Screening Digital Breast Tomosynthesis Bi (77063) $109 $136 4.7×
Shoulder 1 view (73020) $250 $313 2.8×
Skull less than 4 views (70250) $279 $349 2.6×
Sternoclavicular joints (71130) $275 $344 3.0×
Thoracic spine 2 views (72070) $382 $477 3.5×
Thoracic spine 3 views (72072) $517 $646 4.8×
Thoracolumbar 2 views (72080) $288 $360 3.2×
Thyroid Uptake Measurement (78012) $799 $999 1.9×
Ultrasound Breast Limited (76642) $372 $465 4.1×
Ultrasound Exam Aaa Screen (76706) $704 $880 6.5×
Ultrasound, abdomen limited (76705) $642 $803 5.9×
Us breast unilateral complete (76641) $466 $582 4.3×
Us chest (76604) $507 $634 4.7×
Us complete joint (76881) $598 $748 5.5×
Us exam, pelvic, limited (76857) $357 $446 3.3×
Us head (76506) $497 $621 4.6×
Us lmtd joint/oth nonvasc xtr strux r-t w/img (76882) $524 $655 4.8×
Us ob limited 1 or more fetuses (76815) $458 $572 4.2×
Us ob transvaginal (76817) $517 $646 4.8×
Us pelvic non ob complete (76856) $750 $937 6.9×
Us pg uter img f&mat 14 wk tabdl 1/1st gestation (76801) $614 $768 5.7×
Us preg uterus real time f/u trnsabdl per fetus (76816) $360 $450 3.3×
Us retroperitoneal complete (76770) $752 $940 6.9×
Us retroperitoneal limited (76775) $704 $880 6.5×
Us scrotum and contents (76870) $640 $800 5.9×
Us thyroid (76536) $563 $704 5.2×
Us transrectal (76872) $689 $861 6.3×
Wrist 2 views (73100) $289 $361 3.2×
X-Ray Ac Jts - Xr Acromioclavicular Joints Bilateral (73050) $321 $401 3.6×
X-Ray Bend Only L-S Spine (72120) $452 $565 4.2×
X-Ray Elbow 2 Vw - Xr Elbow 1-2 Views Right (73070) $289 $361 3.2×
X-Ray Exam Entire Spi 1 Vw (72081) $265 $331 2.9×
X-Ray Exam Entire Spi 2/3 Vw (72082) $426 $533 3.9×
X-Ray Exam Hip Uni 1 View (73501) $337 $421 3.7×
X-Ray Exam Hip Uni 2-3 Views (73502) $355 $444 3.9×
X-Ray Exam Hip Uni 4/> Views (73503) $425 $531 3.9×
X-Ray Exam Hips Bi 2 Views (73521) $521 $651 4.8×
X-Ray Exam Hips Bi 5/> Views (73523) $521 $651 4.8×
X-Ray Exam L-S Spine Bending (72114) $623 $779 5.7×
X-Ray Exam Neck Spine 2-3 Vw (72040) $355 $444 3.9×
X-Ray Exam Neck Spine 6/>Vws (72052) $638 $798 5.9×
X-Ray Exam Unilat Ribs/Chest (71101) $422 $527 3.9×
X-ray eye for foreign body (70030) $255 $319 2.8×
X-ray humerus (73060) $328 $410 3.6×
X-ray IV pyelogram (ivp) (74400) $694 $867 3.8×
X-Ray Jaw <4 Vw - Xr Mandible < 4 Views (70100) $278 $348 3.1×
X-Ray Knee Bilat Standing - Xr Knees Anteroposterior Standing Bilat (73565) $254 $317 2.8×
X-Ray Lumbar Spine 2/3 Vw - Xr Lumbar Spine 2-3 Views (72100) $482 $603 4.4×
X-ray nose-rectum child f.b. (76010) $366 $457 4.1×
X-Ray Ribs, Chest 4+ Vw - Xr Ribs 3 Vws Bil W/ Chest Posteroanterior (71111) $538 $672 5.0×
X-Ray Sacroiliac Jts 3+ Vw - Xr Sacroiliac Joints 3+ Views (72202) $426 $532 3.9×
X-Ray Sacrum/Coccyx 2+ Vw - Xr Sacrum Coccyx 2+ Views (72220) $334 $417 3.7×
X-Ray Sinuses 3+ Vw - Xr Paranasal Sinuses 3+ Views (70220) $409 $511 4.5×
X-Ray Skull 4+ Vw - Xr Skull Complete 4+ Views (70260) $425 $531 3.9×
X-Ray Tmj Unilat (70328) $267 $334 3.0×
X-Rays Bone Survey Complete (77075) $844 $1,055 7.8×
Xr c-spine 4 or 5 views (72050) $518 $647 4.8×
Xr facial bones less than 3 views (70140) $307 $384 3.4×
XR Mastoids < 3 Views Bilateral (70120) $213 $266 2.0×
Xr orbits complete 4 views (70200) $446 $557 4.1×

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.