Imaging prices at Cheyenne County Hospital

St. Francis, KS · every code in this section with a posted price and a Medicare benchmark.

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

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ProcedurePosted cashPosted gross× Medicare
Abdomen 1 View (74018) $192.74 $226.75 2.4×
Abdomen 2 views (74019) $260.95 $307 2.7×
Acute Gastrointestinal Blood Loss Imaging (78278) $565.25 $665 1.5×
Ankle 2 views (73600) $179.35 $211 2.2×
Bone Imaging 3 Phase (78315) $493 $580 1.3×
Bone Imaging Limited Area (78300) $408 $480 1.1×
Bone Imaging Multiple Areas (78305) $448.80 $528 1.2×
Bone Imaging Whole Body (78306) $467.50 $550 1.3×
Cat Scan Follow-Up Study (76380) $654.50 $770 8.2×
Chest 1 view (71045) $176.79 $207.99 2.2×
Chest 2 views (71046) $215.05 $253 2.7×
Chest 3 views (71047) $238 $280 3.0×
Chest 4 or more views (71048)
range across 2 matching MRF lines		 $225.42–$259.25 $265.20–$305 varies
Clavicle complete (73000) $192.35 $192.35 2.4×
Computed Tomography Thorax Lw Dose Lng Ca Scr C- (71271) $654.50 $770 6.8×
CT abdomen and pelvis without and with contrast (74178) $697 $820 2.2×
CT abdomen and pelvis without contrast (74176) $654.50 $770 3.0×
CT abdomen w contrast (74160) $675.75 $795 4.2×
CT abdomen w wo contrast (74170) $697 $820 4.3×
CT abdomen w/o contrast (74150) $654.50 $770 6.8×
CT Angio Abdomen and Pelvis (74174) $2,459.05 $2,893 7.7×
CT Angio Chest (71275)
range across 4 matching MRF lines		 $1,636.25–$1,700 $1,925–$2,000 varies
CT Angio Head (70496) $1,657.50 $1,950 10.3×
Ct Angio Lwr Extr W/O&W/Dye (73706) $1,592.90 $1,874 9.9×
CT Angio Neck (70498)
range across 2 matching MRF lines		 $1,678.75–$1,700 $1,975–$2,000 varies
Ct Angio Upr Extrm W/O&W/Dye (73206) $1,592.90 $1,874 9.9×
CT cervical spine w/ contrast (72126) $675.75 $795 2.1×
CT cervical spine w/o contrast (72125) $654.50 $770 6.8×
CT cervical spine w/wo cont (72127) $697 $820 4.3×
CT chest w contrast (71260) $675.75 $795 4.2×
CT chest w/wo contrast (71270) $697 $820 4.3×
CT head/brain with contrast (70460) $675.75 $795 4.2×
CT head/brain without and with contrast (70470) $697 $820 4.3×
CT heart no contrast quant eval coronry calcium (75571) $120 $120 1.5×
CT iac w contrast (70481) $675.75 $795 4.2×
CT l-spine w&w/o contrast (72133) $697 $820 4.3×
CT lower ext w/o (73700) $654.50 $770 6.8×
CT lower extremity w/contrast material (73701) $675.75 $795 4.2×
CT lumbar spine w contrast (72132) $675.75 $795 2.1×
CT lumbar spine w/o contrast (72131) $654.50 $770 6.8×
CT maxillofacial w contrast (70487) $675.75 $795 4.2×
CT maxillofacial wo contrast (70486) $654.50 $770 6.8×
CT neck tissue combo (70492) $697 $820 4.3×
Ct Orbit/Ear/Fossa W/O&W/Dye (70482) $697 $820 4.3×
CT orbits w/o contrast (70480) $654.50 $770 6.8×
CT pelvis w&w/o contrast (72194) $697 $820 4.3×
CT pelvis w/o contrast (72192) $654.50 $770 6.8×
CT scan of leg combo (73702) $697 $820 4.3×
CT scans face/jaw combo (70488) $697 $820 4.3×
CT soft tissue neck w contrast (70491) $675.75 $795 4.2×
CT soft tissue neck w/o contrast (70490) $654.50 $770 6.8×
CT thoracic spine w contrast (72129) $675.75 $795 4.2×
CT thoracic spine w/o contrast (72128) $654.50 $770 6.8×
CT thoracic spine w/wo cont (72130) $697 $820 4.3×
CT thorax w/o contrast (71250) $654.50 $770 6.8×
CT upper ext wo (73200) $654.50 $770 6.8×
CT upper extremity w/o & w/contrast material (73202) $697 $820 4.3×
CT upper extremity with contrast (73201) $675.75 $795 2.1×
Cta Abdl Aorta&Bi Iliofem W/Contrast&Postp (75635) $1,787.55 $2,103 11.1×
Cta Abdomen (74175) $1,718.70 $2,022 10.7×
CTA head&neck c+ w/noncontrast img&post-pxessing (70471) $3,251.25 $3,825 10.1×
CTA pelvis (72191) $1,062.50 $1,250 6.6×
Dxa Bone Density Axial (77080) $271.07 $318.91 2.8×
Esophagram (74220) $422.45 $497 2.6×
Fetal Biophys Profile W/Nst (76818) $193.04 $227.11 2.0×
Fetal Biophysical Profile W/O Non-Stress Testing (76819) $193.04 $227.11 2.0×
Fluoroscopy up to 1 hr (76000) $420.75 $495 1.9×
Foot 2 views (73620) $170 $200 2.1×
Forearm 2 views (73090) $195.50 $230 2.4×
Gastric emptying imaging study (78264) $565.25 $665 1.5×
Gated Heart Planar Single (78472) $756.50 $890 2.1×
Hand 2 views (73120) $185.09 $217.75 1.9×
Hepatobil Syst Image W/Drug (78227) $586.50 $690 1.2×
Ht Muscle Image Spect Sing (78451) $586.50 $690 0.5×
Infant hip ultrasound with hip movement (dynamic) (76885) $488.75 $575 6.1×
Infant hip ultrasound, limited static exam (76886) $132 $132 1.6×
K Flow/Funct Image Multiple (78709) $854.25 $1,005 1.7×
K Flow/Funct Image W/Drug (78708) $935 $1,100 1.9×
K Flow/Funct Image W/O Drug (78707) $803.25 $945 1.6×
Kidney Imaging Morphol (78700) $1,710.20 $2,012 4.7×
Kidney Imaging Morphoogy W/Vascular Flow (78701) $722.50 $850 2.0×
Knee 3 Views (73562) $213.35 $251 2.7×
Liver & Spleen Imaging Static Only (78215) $442.30 $520.35 1.2×
Liver & Spleen Imaging W/Vascular Flow (78216) $510 $600 1.4×
Lung Perf&Ventilat Diferentl (78598) $1,493.45 $1,757 3.0×
Lung Ventilat&Perfus Imaging (78582) $1,676.20 $1,972 3.4×
Magnetic Image Jaw Joint (70336) $752.25 $885 3.4×
Meckels Divert Exam (78290) $399.50 $470 1.1×
Mra Head W/O & W/Contrast Material (70546) $905.25 $1,065 2.8×
MRA head w/o contrast (70544) $879.75 $1,035 4.0×
MRA head with contrast (70545) $884 $1,040 2.8×
MRA neck w contrast (70548) $884 $1,040 2.8×
Mra Neck W/O &W/Contrast Material (70549) $905.25 $1,065 2.8×
MRA neck w/o contrast (70547) $879.75 $1,035 4.0×
MRI abdomen w contrast (74182) $731 $860 2.3×
MRI abdomen w/o contrast (74181) $709.75 $835 3.2×
MRI any jt lower extrem w/contrast material (73722) $731 $860 1.0×
MRI any jt lower extrem w/o & w/contrast matrl (73723) $752.25 $885 2.3×
MRI any jt upper extremity w/contrast matrl (73222) $731 $860 1.0×
MRI Breast W/O Contrast Bilateral (77047) $752.77 $885.61 3.4×
MRI Breast Without Contrast Material Unilateral (77046) $752.77 $885.61 3.4×
MRI cervical spine w contrast (72142) $731 $860 2.3×
MRI cervical spine w/o cont (72141) $709.75 $835 3.2×
MRI chest w/o contrast (71550) $709.75 $835 3.2×
MRI chest with contrast (71551) $731 $860 1.0×
MRI chest wo w contrast (71552) $752.25 $885 2.3×
MRI lower extrem oth/thn jt w/contrast matrl (73719) $731 $860 2.3×
MRI lower extrem oth/thn jt w/o & w/contr matr (73720) $752.25 $885 2.3×
MRI lower extrem oth/thn jt w/o contr matrl (73718) $709.75 $835 3.2×
MRI lumbar spine w contrast (72149) $731 $860 2.3×
Mri Neck Spine W/O & W/Dye (72156) $752.25 $885 2.3×
MRI orbit face &/neck w/o contrast (70540) $709.75 $835 3.2×
MRI orbit face neck w contrast (70542) $731 $860 2.3×
Mri Orbt/Fac/Nck W/O &W/Dye (70543) $752.25 $885 2.3×
MRI pelvis w contrast (72196) $731 $860 2.3×
MRI pelvis w/o & w contrast (72197) $752.25 $885 2.3×
MRI pelvis w/o contrast (72195) $709.75 $835 3.2×
MRI thoracic spine w/o contrast (72146) $709.75 $835 3.2×
MRI upper extremity oth than jt w/contr matrl (73219) $731 $860 2.3×
MRI upper extremity oth than jt w/o contr matrl (73218) $709.75 $835 3.2×
Mri Uppr Extremity W/O&W/Dye (73220) $752.25 $885 2.3×
MRI, abdomen, combo (74183) $752.25 $885 2.3×
MRI, dorsal spine combo (72157) $752.25 $885 2.3×
MRI, dorsal spine contrast (72147) $731 $860 2.3×
MRI, joint upper extrem (73221) $709.75 $835 3.2×
MRI, joint upper extrem combo (73223) $752.25 $885 2.3×
MRI, lumbar spine combo (72158) $752.25 $885 2.3×
Myocardial Spect Multiple Studies (78452) $2,010.32 $2,365.08 1.7×
Neck soft tissue (70360) $184.45 $217 2.3×
Ob us nuchal meas 1 gest (76813) $196.35 $231 2.0×
Optic foramina (70190) $228.65 $269 2.9×
Parathyroid Planar Imaging (78070) $500.18 $588.45 1.4×
Pelvis 1 or 2 views (72170) $189.55 $223 2.0×
Pulmonary Perfusion Imaging Particulate (78580) $1,202.75 $1,415 3.3×
Radex Abd Compl Aqt Abd W/S/E/D Views 1 View Ch (74022) $418.20 $492 4.3×
Radex Ankle Complete Minimum 3 Views (73610) $198.90 $234 2.5×
Radex Calcaneus Minimum 2 Views (73650) $195.50 $230 2.4×
Radex elbow complete minimum 3 views (73080) $238 $280 3.0×
Radex Facial Bones Complete Minimum 3 Views (70150) $324.70 $382 3.4×
Radex fingr minimum 2 views (73140) $186 $186 2.3×
Radex foot complete minimum 3 views (73630) $192.10 $226 2.4×
Radex Hand Minimum 3 Views (73130) $194.65 $229 2.4×
Radex lower extremity infant minimum 2 views (73592) $198.06 $233.01 2.5×
Radex Mastoids Compl Minimum 3 Views PR Side (70130)
range across 2 matching MRF lines		 $341.70–$683.40 $402–$804 varies
Radex Nasal Bones Complete Minimum 3 Views (70160) $211.35 $248.65 2.6×
Radex Ribs Unilateral 2 Views (71100) $191.25 $225 2.4×
Radex shoulder complete minimum 2 views (73030) $200.60 $236 2.5×
Radex Sinuses Paransl < 3 Views (70210) $180 $180 2.2×
Radex Spine 1 View Specify Level (72020) $238.04 $280.05 3.0×
Radex Sternum Minimum 2 Views (71120) $206.55 $243 2.6×
Radex Toe Minimum 2 Views (73660) $201.45 $237 2.5×
Radex upper extremity infant minimum 2 views (73092) $185.09 $217.75 1.9×
Radex Wrist Complete Minimum 3 Views (73110) $204 $240 2.5×
Radiolog exam mandible compl minimum 4 views (70110) $301.75 $355 3.1×
Radiologic Exam Abdomen 3+ Views - Xr Abdomen 3+ Views (74021) $257.55 $303 2.7×
Radiologic exam colon double contrast study (74280) $1,525.75 $1,795 9.5×
Radiologic exam knee complete 4/more views (73564) $309.40 $364 3.2×
Radiologic exam pelvis compl minimum 3 views (72190) $270.30 $318 2.8×
Radiologic exam swallow function contrast study (74230) $434.78 $511.50 2.7×
Radiologic examination femur 1 view (73551) $185 $185 2.3×
Radiologic examination femur minimum 2 views (73552) $261.80 $308 3.3×
Radiologic examination knee 1/2 views (73560) $181 $181 2.3×
Radiologic examination tibia & fibula 2 views (73590) $245.65 $289 3.1×
Rp loclzj tum plnr 1 area single day imaging (78800) $650.25 $765 1.8×
Scapula (73010) $185.09 $217.75 1.9×
Screening Digital Breast Tomosynthesis Bi (77063) $125.29 $125.29 5.4×
Shoulder 1 view (73020)
range across 2 matching MRF lines		 $180–$195.50 $180–$230 varies
Skull less than 4 views (70250) $204 $240 2.1×
Sternoclavicular joints (71130) $194.65 $229 2.4×
Thoracic spine 2 views (72070) $208.25 $245 2.2×
Thyroid Imaging With Vascular Flow (78013) $380.12 $447.20 1.0×
Thyroid Uptake W/Blood Flow Sngle/Mult Quan Meas (78014) $558.37 $656.90 1.5×
Ultrasound Breast Limited (76642) $299.20 $352 3.7×
Ultrasound Exam Aaa Screen (76706) $216.75 $255 2.3×
Ultrasound, abdomen limited (76705) $179.35 $211 1.9×
Ureteral Reflux Study (78740) $552.50 $650 1.5×
Urethrocystography retrograde (74450) $420.75 $495 1.9×
Us breast unilateral complete (76641) $340 $400 3.5×
Us chest (76604) $186 $186 1.9×
Us complete joint (76881) $300.90 $354 3.1×
Us exam, pelvic, limited (76857) $165.35 $165.35 1.7×
Us lmtd joint/oth nonvasc xtr strux r-t w/img (76882) $299.20 $352 3.1×
Us ob limited 1 or more fetuses (76815) $285.60 $336 3.0×
Us ob transvaginal (76817) $202.30 $238 2.1×
Us pelvic non ob complete (76856) $197.77 $197.77 2.1×
Us pg uter img f&mat 14 wk tabdl 1/1st gestation (76801) $238.85 $281 2.5×
Us preg uterus real time f/u trnsabdl per fetus (76816) $193.04 $227.11 2.0×
Us retroperitoneal complete (76770) $278.80 $328 2.9×
Us retroperitoneal limited (76775) $198 $198 2.1×
Us scrotum and contents (76870) $197.77 $197.77 2.1×
Us spinal canal and contents (76800) $198 $198 2.1×
Us thyroid (76536) $688.50 $810 7.2×
Us transrectal (76872) $162.11 $162.11 1.7×
Wrist 2 views (73100) $186 $186 2.3×
X-Ray Ac Jts - Xr Acromioclavicular Joints Bilateral (73050)
range across 2 matching MRF lines		 $250.75–$501.50 $295–$590 varies
X-Ray Bend Only L-S Spine (72120) $333.20 $392 3.5×
X-Ray Elbow 2 Vw - Xr Elbow 1-2 Views Right (73070) $190 $190 2.4×
X-Ray Exam Entire Spi 1 Vw (72081) $188 $188 2.3×
X-Ray Exam Entire Spi 2/3 Vw (72082) $247.73 $291.45 2.6×
X-Ray Exam Hip Uni 1 View (73501) $194.46 $228.78 2.4×
X-Ray Exam Hip Uni 2-3 Views (73502) $247.84 $291.58 3.1×
X-Ray Exam Hip Uni 4/> Views (73503) $304.30 $358 3.2×
X-Ray Exam Hips Bi 2 Views (73521) $270.30 $318 2.8×
X-Ray Exam Hips Bi 3-4 Views (73522) $297.50 $350 3.1×
X-Ray Exam Hips Bi 5/> Views (73523) $297.50 $350 3.1×
X-Ray Exam L-S Spine Bending (72114) $416.50 $490 4.3×
X-Ray Exam Neck Spine 2-3 Vw (72040) $227.80 $268 2.8×
X-Ray Exam Neck Spine 6/>Vws (72052) $387.60 $456 4.0×
X-Ray Exam Unilat Ribs/Chest (71101) $285.60 $336 3.0×
X-ray eye for foreign body (70030) $228.65 $269 2.9×
X-ray humerus (73060) $196.35 $231 2.5×
X-ray IV pyelogram (ivp) (74400) $670.23 $788.50 4.2×
X-Ray Jaw <4 Vw - Xr Mandible < 4 Views (70100) $222.70 $262 2.8×
X-Ray Knee Bilat Standing - Xr Knees Anteroposterior Standing Bilat (73565) $184.54 $184.54 2.3×
X-Ray Lumbar Spine 2/3 Vw - Xr Lumbar Spine 2-3 Views (72100) $260.10 $306 2.7×
X-Ray Ribs, Chest 4+ Vw - Xr Ribs 3 Vws Bil W/ Chest Posteroanterior (71111) $390.15 $459 4.1×
X-Ray Sacroiliac Jts 3+ Vw - Xr Sacroiliac Joints 3+ Views (72202) $206.55 $243 2.1×
X-Ray Sacrum/Coccyx 2+ Vw - Xr Sacrum Coccyx 2+ Views (72220) $220.15 $259 2.8×
X-Ray Sinuses 3+ Vw - Xr Paranasal Sinuses 3+ Views (70220) $322.15 $379 4.0×
X-Ray Skull 4+ Vw - Xr Skull Complete 4+ Views (70260) $322.15 $379 3.4×
X-Rays Bone Survey Complete (77075) $705.08 $829.50 7.3×
Xr c-spine 4 or 5 views (72050) $328.95 $387 3.4×
Xr facial bones less than 3 views (70140) $256.56 $301.83 3.2×
XR Mastoids < 3 Views Bilateral (70120) $233.75 $275 2.4×

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.