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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ProcedureCash priceGross charge× Medicare
Abdomen 2 views (74019) $374 $468 3.4×
Ankle 2 views (73600) $262 $328 2.9×
Bone &/joint imaging whole body (78306) $1,857 $2,321 4.5×
Bone age studies (77072) $246 $307 2.3×
Bone Imaging 3 Phase (78315) $2,123 $2,654 5.1×
Bone survey complete (77075) $844 $1,055 7.8×
Cervical spine 2 or 3 views (72040) $355 $444 3.9×
Chest 1 view (71045) $270 $337 3.0×
Chest 3 views (71047) $350 $438 3.9×
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 angiography upper extremity lt (73206) $3,145 $3,931 17.3×
CT c-spine w/o contrast (72125) $2,321 $2,901 21.4×
CT cervical spine w&w/o contrast (72127) $2,531 $3,164 13.9×
CT cervical spine with contrast (72126) $2,414 $3,018 6.7×
CT chest w/wo contrast (71270) $2,752 $3,440 15.1×
CT chest with contrast (71260) $2,519 $3,149 13.8×
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 lower ext w/o (73700) $2,120 $2,650 19.5×
CT lower extremity w wo contrast (73702) $2,516 $3,145 13.8×
CT lower extremity with contrast (73701) $2,252 $2,815 12.4×
CT lumbar spine w & w/o contrast (72133) $2,623 $3,279 14.4×
CT lumbar spine w/o contrast (72131) $2,269 $2,836 20.9×
CT lumbar spine with contrast (72132) $2,302 $2,877 6.4×
CT maxillofacial w contrast (70487) $2,142 $2,677 11.8×
CT maxillofacial w/o contrast (70486) $1,784 $2,230 16.4×
CT maxillofacial w/wo contrast (70488) $2,326 $2,907 12.8×
CT neck soft tissue w contrast (70491) $2,286 $2,857 12.6×
CT orbit sella/post fossa/ear w/o & w/contr matr (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 for measuring calcium and other minerals in bone (77078) $416 $520 4.6×
CT soft tissue neck w/o & w/contrast material (70492) $2,660 $3,325 14.6×
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 contrast (72130) $2,501 $3,126 13.7×
CT thorax w/o contrast (71250) $2,253 $2,816 20.8×
CT upper extremity w/o & w/contrast material (73202) $2,341 $2,926 12.9×
CT upper extremity w/o contrast rt (73200) $1,999 $2,499 18.4×
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 abdomen pelvis (74174) $5,515 $6,894 15.2×
CTA chest (71275) $3,207 $4,009 17.6×
Cta Head (70496) $2,843 $3,554 15.6×
CTA head&neck c+ w/noncontrast img&post-pxessing (70471) $6,240 $7,800 17.2×
CTA lwr ext w&w/o contrast (73706) $3,374 $4,217 18.5×
Cta Neck (70498) $3,683 $4,604 20.2×
Cta Pelvis (72191) $2,963 $3,704 16.3×
Dxa bone density study 1/> sites axial skel (77080) $490 $613 4.5×
Dxa bone density study 1/>sites appendiclr skel (77081) $248 $310 2.7×
Echoencephalography real time imaging (76506) $497 $621 4.6×
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×
Hand 2 views (73120) $289 $361 2.7×
Hand 3 views (73130) $342 $428 3.8×
Hepatobil Syst Imag Inc Gb W/Pharma Intervenj (78227) $1,883 $2,354 3.3×
Ht muscle image spect sing (78451) $3,724 $4,655 2.8×
Humerus Min 2 Views Left (73060) $328 $410 3.6×
Kidney img morphology vascular flow 1 w/rx (78708) $2,038 $2,548 3.6×
Knee 3 views (73562) $397 $496 4.4×
MRA head w & w/o contrast (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 & w/contrast material (74183) $3,874 $4,843 10.7×
MRI abdomen w/o contrast (74181) $3,112 $3,890 12.6×
MRI any jnt lwr ext with con lt (73722) $2,922 $3,652 3.6×
MRI any jt upper extremity w/contrast matrl (73222) $3,114 $3,892 3.8×
MRI c-spine with contrast (72142) $3,334 $4,167 9.2×
MRI cervical spine w/o contrast (72141) $2,370 $2,962 9.6×
MRI chest w/o & w/contrast material (71552) $2,722 $3,403 7.5×
MRI chest w/o contrast (71550) $2,226 $2,783 9.0×
MRI chest with contrast (71551) $2,438 $3,048 3.0×
MRI Forearm w/ Contrast Bilateral 73219 (73219) $2,938 $3,672 8.1×
MRI lower extrem oth/thn jt w/contrast matrl (73719) $2,890 $3,612 8.0×
MRI lower extrem oth/thn jt w/o contr matrl (73718) $2,552 $3,190 10.3×
MRI orbit face &/neck w/o contrast (70540) $3,131 $3,914 12.6×
MRI orbit/face/neck w&w/o cont (70543) $3,749 $4,686 10.3×
MRI orbit/face/neck w/contrast (70542) $3,428 $4,285 9.5×
MRI pelvis w contrast (72196) $2,867 $3,584 7.9×
MRI pelvis w/o & w/contrast material (72197) $3,613 $4,516 10.0×
MRI pelvis w/o contrast (72195) $2,563 $3,204 10.3×
MRI scan of arm joint before and after contrast (73223) $3,697 $4,621 10.2×
MRI scan of leg joint before and after contrast (73723) $3,229 $4,036 8.9×
MRI spinal canal cervical w/o & w/contr matrl (72156) $4,038 $5,047 11.1×
MRI spinal canal lumbar w/contrast material (72149) $3,344 $4,180 9.2×
MRI spinal canal lumbar w/o & w/contr matrl (72158) $3,869 $4,836 10.7×
MRI spinal canal thoracic w/contrast matrl (72147) $3,360 $4,200 9.3×
MRI spinal canal thoracic w/o & w/contr matrl (72157) $4,009 $5,011 11.1×
MRI thoracic spine w/o contrast (72146) $2,803 $3,504 11.3×
MRI tmj (70336) $2,453 $3,066 9.9×
MRI upper ext joint w/o contrast (73221) $2,529 $3,161 10.2×
MRI upper extrem other than jt w/o & w/contras (73220) $3,286 $4,108 9.1×
MRI upper extremity oth than jt w/o contr matrl (73218) $2,590 $3,238 10.5×
Myocardial Spect Multiple Studies (78452) $4,330 $5,412 3.2×
Neck soft tissue (70360) $337 $421 3.7×
Nm gastric emptying study (78264) $1,942 $2,427 4.7×
Ob Us Follow-Up Per Fetus - Us Ob Follow Up Transabdominal Approach (76816) $360 $450 3.3×
Osseous survey limited (77074) $681 $851 6.3×
Parathyroid imaging (78070) $1,326 $1,657 3.2×
Pelvis 1 or 2 views (72170) $322 $402 3.0×
Pr MRI, lower extr, w/o contrast f/u by contrast (73720) $3,081 $3,851 8.5×
Pulmonary Ventilation & Perfusion Imaging (78582) $2,793 $3,491 5.0×
Radex Entir Thrc Lmbr Crv Sac Spi W/Skull 1 Vw - Xr Scoliosis 1 Vw (72081) $265 $331 2.9×
Radex entir thrc lmbr crv sac spi w/skull 2/3 vw (72082) $426 $533 3.9×
Radex hips bilateral with pelvis 2 views (73521) $521 $651 4.8×
Radex mastoids compl minimum 3 views pr side (70130) $225 $281 2.1×
Radiolog exam mandible compl minimum 4 views (70110) $490 $613 4.5×
Radiologic Exam Abdomen 1 View - Xr Abdomen 1 View (74018) $304 $380 3.4×
Radiologic Exam Abdomen 3+ Views - Xr Abdomen 3+ Views (74021) $410 $512 3.8×
Radiologic Exam Chest 2 Views - Xr Chest 2 Views (71046) $309 $386 3.4×
Radiologic Examination Femur Minimum 2 Views - Xr Femur 2+ Vw Lt (73552) $354 $443 3.9×
Ribs bilateral 3 views (71110) $437 $546 4.0×
Rp loclzj tum spect 1 area single day imaging (78803) $3,069 $3,836 5.4×
Scapula complete (73010) $330 $412 3.0×
Screening digital breast tomosynthesis (77063) $109 $136 4.7×
Small bowel series (74250) $533 $666 2.9×
Spine thoracic 3 views (72072) $517 $646 4.8×
Thoracolumbar 2 views (72080) $288 $360 3.2×
Thyroid uptake measurement (78012) $799 $999 1.9×
Tmj unilateral (70328) $267 $334 3.0×
Ultrasound, abdomen limited (76705) $642 $803 5.9×
Upper Extremity Infant (73092) $250 $313 2.3×
Urography (pyelography), intravenous, with or without KUB, with or without tomography (74400) $694 $867 3.8×
Us abdl aorta screen aaa (76706) $704 $880 6.5×
Us breast unilateral complete (76641) $466 $582 4.3×
Us breast unilateral limited (76642) $372 $465 4.1×
Us chest (76604) $507 $634 4.7×
Us compl joint r-t w/image documentation (76881) $598 $748 5.5×
Us ob transvaginal (76817) $517 $646 4.8×
Us pelvic non ob complete (76856) $750 $937 6.9×
Us pelvic nonobstetric image dcmtn limited/f/u (76857) $357 $446 3.3×
Us pregnancy ltd (76815) $458 $572 4.2×
Us pregnant uterus 14 wk transabdl 1/1st gestat (76801) $614 $768 5.7×
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 soft tissue head/neck (76536) $563 $704 5.2×
Us transrectal (76872) $689 $861 6.3×
Us xtr non-vasc lmtd (76882) $524 $655 4.8×
Wrist 2 views (73100) $289 $361 3.2×
X-Ray Abdomen,Comp Acute Series - Xr Abdomen 2 Vws With Chest 1 View (74022) $559 $699 5.1×
X-Ray Ac Jts - Xr Acromioclavicular Joints Bilateral (73050) $321 $401 3.6×
X-Ray Ankle 3+ Vw - Xr Ankle 3+ Views Right (73610) $334 $418 3.7×
X-Ray Elbow 2 Vw - Xr Elbow 1-2 Views Right (73070) $289 $361 3.2×
X-Ray Elbow 3+ Vw - Xr Elbow 3+ Views Right (73080) $336 $420 3.7×
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 5/> Views (73523) $521 $651 4.8×
X-ray exam of femur 1 (73551) $272 $340 3.0×
X-ray eye for foreign body (70030) $255 $319 2.8×
X-Ray Facial Bones 3+ Vw - Xr Facial Bones 3+ Views (70150) $460 $575 4.2×
X-Ray Facial Bones <3 Vw - Xr Facial Bones 1-2 Views (70140) $307 $384 3.4×
X-Ray Foot 3+ Vw - Xr Foot 3+ Views Right (73630) $351 $439 3.9×
X-Ray Heel - Xr Calcaneus 2 Views Right (73650) $234 $293 2.6×
X-Ray Jaw <4 Vw - Xr Mandible < 4 Views (70100) $278 $348 3.1×
X-Ray Knee 4+ View - Xr Knee 4+ Views Right (73564) $400 $500 3.7×
X-Ray Knee Bilat Standing - Xr Knees Anteroposterior Standing Bilat (73565) $254 $317 2.8×
X-Ray Leg, Infant - Xr Lower Extremity 2+ Views Infant Left (73592) $246 $308 2.7×
X-Ray Lumbar Spine 2/3 Vw - Xr Lumbar Spine 2-3 Views (72100) $482 $603 4.4×
X-Ray Lumbar Spine 6+ Vw - Xr Lumbar Spine 6+ Vws Including Bending (72114) $623 $779 5.7×
X-Ray Lumbar Spine Flex/Exten - Xr Lumbar Spine 4+ Views W/ Flex Ext (72120) $452 $565 4.2×
X-Ray Nasal Bones - Xr Nasal Bones (70160) $345 $431 3.8×
X-Ray Nose-Rectum Child F.B. - Xr Nose to Rectum Foreign Body Peds (76010) $366 $457 4.1×
X-Ray Orbits - Xr Orbits Complete 4+ Views (70200) $446 $557 4.1×
X-Ray Pelvis 3+ Vw - Xr Pelvis 3+ Views (72190) $414 $518 3.8×
X-Ray Ribs 2 Vw Unilat - Xr Ribs 2 Views Right (71100) $354 $442 3.9×
X-Ray Ribs, Chest 3+ Vw - Xr Ribs 2 Vws Lt W/ Chest Anteroposterior (71101) $422 $527 3.9×
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 Shoulder 2+ Vw - Xr Shoulder 2+ Views Right (73030) $366 $457 4.1×
X-Ray Sinuses 3+ Vw - Xr Paranasal Sinuses 3+ Views (70220) $409 $511 4.5×
X-Ray Sinuses <3 Vw - Xr Paranasal Sinuses 1-2 Views (70210) $266 $333 2.9×
X-Ray Skull 4+ Vw - Xr Skull Complete 4+ Views (70260) $425 $531 3.9×
X-Ray Skull <4 Vw - Xr Skull 1-3 Views (70250) $279 $349 2.6×
X-Ray Spine One View - Xr Spine (72020) $298 $373 3.3×
X-Ray Sterno-Clavicluar Jt - Xr Sternoclavicular Joints 3+ Views (71130) $275 $344 3.0×
X-Ray Sternum 2+ Vw - Xr Sternum 2+ Views (71120) $346 $432 3.8×
X-Ray Thoracic Spine 2 Vw - Xr Thoracic Spine 2 Views (72070) $382 $477 3.5×
X-Ray Toe(S) - Xr Toes 2+ Views Right (73660) $248 $310 2.7×
X-Ray Wrist 3+ Vw - Xr Wrist 3+ Views Right (73110) $330 $412 3.7×
Xr c-spine 6 or more views (72052) $638 $798 5.9×
Xr chest 4+ views (71048) $389 $486 3.6×
Xr finger(s) 2+ views (73140) $186 $233 2.1×
XR Mastoids < 3 Views Bilateral (70120) $213 $266 2.0×
Xr shoulder 1 view (73020) $250 $313 2.8×
Xr spine cervical 4 or 5 views (72050) $518 $647 4.8×
Xr tibia/fibula 2 views (73590) $317 $396 3.5×
Xr tmj bilateral (70330) $330 $413 3.7×
Xray knee 1 or 2 views rt (73560) $318 $398 3.5×