Imaging prices at Grisell Memorial Hospital

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

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

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ProcedureCash priceGross charge× Medicare
Abdomen 2 views (74019) $269.33 $283.50 2.8×
Ankle 2 views (73600) $196.56 $206.91 2.5×
Bone age studies (77072) $230.65 $242.79 2.4×
Bone survey complete (77075) $897.75 $945 9.3×
Cardiac MRI w/w/o contrast & further seq (75561) $870.79 $916.62 2.7×
Cervical spine 2 or 3 views (72040) $269.33 $283.50 3.4×
Chest 1 view (71045) $204.51 $215.27 2.6×
Clavicle complete (73000) $202.52 $213.18 2.5×
Computed Tomography Thorax Lw Dose Lng Ca Scr C- (71271) $757.14 $796.99 7.9×
CT abdomen and pelvis without and with contrast (74178) $757.14 $796.99 2.4×
CT abdomen and pelvis without contrast (74176) $742.72 $781.81 3.4×
CT abdomen w contrast (74160) $936.62 $985.92 5.8×
CT abdomen w wo contrast (74170) $957.60 $1,008 5.9×
CT abdomen w/o contrast (74150) $915.88 $964.08 9.5×
CT angiography upper extremity lt (73206) $1,861.96 $1,959.95 11.5×
CT c-spine w/o contrast (72125) $945.63 $995.40 9.8×
CT cervical spine w&w/o contrast (72127) $987.53 $1,039.50 6.1×
CT cervical spine with contrast (72126) $957.60 $1,008 3.0×
CT chest w/wo contrast (71270) $957.60 $1,008 5.9×
CT chest with contrast (71260) $945.63 $995.40 5.9×
CT head/brain without and with contrast (70470) $957.60 $1,008 5.9×
CT iac w contrast (70481) $945.63 $995.40 5.9×
CT lower ext w/o (73700) $933.66 $982.80 9.7×
CT lower extremity w wo contrast (73702) $957.60 $1,008 5.9×
CT lower extremity with contrast (73701) $948.48 $998.40 5.9×
CT lumbar spine w & w/o contrast (72133) $957.60 $1,008 5.9×
CT lumbar spine w/o contrast (72131) $933.66 $982.80 9.7×
CT lumbar spine with contrast (72132) $945.63 $995.40 2.9×
CT maxillofacial w contrast (70487) $945.63 $995.40 5.9×
CT maxillofacial w/o contrast (70486) $933.66 $982.80 9.7×
CT maxillofacial w/wo contrast (70488) $957.60 $1,008 5.9×
CT neck soft tissue w contrast (70491) $945.63 $995.40 5.9×
CT orbit sella/post fossa/ear w/o & w/contr matr (70482) $957.60 $1,008 5.9×
CT orbits w/o contrast (70480) $933.66 $982.80 9.7×
CT pelvis w & w/o contrast (72194) $957.60 $1,008 5.9×
CT pelvis w/o contrast (72192) $933.66 $982.80 9.7×
CT soft tissue neck w/o & w/contrast material (70492) $957.60 $1,008 5.9×
CT soft tissue neck w/o contrast (70490) $933.66 $982.80 9.7×
CT thoracic spine w/contrast (72129) $945.63 $995.40 5.9×
CT thoracic spine w/o contrast (72128) $933.66 $982.80 9.7×
CT thoracic spine w/wo contrast (72130) $957.60 $1,008 5.9×
CT thorax w/o contrast (71250) $933.66 $982.80 9.7×
CT upper extremity w/o & w/contrast material (73202) $957.60 $1,008 5.9×
CT upper extremity w/o contrast rt (73200) $889.20 $936 9.2×
CT upper extremity with contrast (73201) $897.75 $945 2.8×
Cta Abdomen (74175) $1,615.65 $1,700.68 10.0×
CTA abdomen pelvis (74174) $2,820.10 $2,968.53 8.8×
CTA chest (71275) $1,825.43 $1,921.50 11.3×
Cta Head (70496) $1,825.43 $1,921.50 11.3×
Cta Neck (70498) $1,825.43 $1,921.50 11.3×
Cta Pelvis (72191) $302.98 $318.93 1.9×
Doppler Echo Fetal Puls Spectral F/U/Repeat (76828) $180.99 $190.52 1.9×
Doppler Echo Fetal Spectral Display Complete (76827) $180.99 $190.52 1.9×
Dxa bone density study 1/> sites axial skel (77080) $363.89 $383.04 3.8×
Dxa bone density study 1/>sites appendiclr skel (77081) $262.14 $275.94 3.3×
Fetal biophysical profile non-stress testing (76818) $215.46 $226.80 2.2×
Fetal Biophysical Profile W/O Non-Stress Testing (76819) $192.66 $202.80 2.0×
Foot 2 views (73620) $202.52 $213.18 2.5×
Forearm 2 views (73090) $214.44 $225.72 2.7×
Hand 2 views (73120) $171.40 $180.42 1.8×
Hand 3 views (73130) $224.96 $236.80 2.8×
Humerus Min 2 Views Left (73060) $226.49 $238.41 2.8×
Knee 3 views (73562) $246.38 $259.35 3.1×
MRA head w & w/o contrast (70546) $1,047.95 $1,103.11 3.3×
MRA head w/o contrast (70544) $1,028 $1,082.10 4.7×
MRA head with contrast (70545) $1,037.98 $1,092.61 3.2×
MRA neck w contrast (70548) $1,037.98 $1,092.61 3.2×
Mra Neck W/O &W/Contrast Material (70549) $1,047.95 $1,103.11 3.3×
MRA neck w/o contrast (70547) $1,028 $1,082.10 4.7×
MRI abdomen w contrast (74182) $1,065.33 $1,121.40 3.3×
MRI abdomen w/o & w/contrast material (74183) $1,077.30 $1,134 3.4×
MRI abdomen w/o contrast (74181) $870.79 $916.62 4.0×
MRI any jnt lwr ext with con lt (73722) $893.48 $940.50 1.2×
MRI any jt upper extremity w/contrast matrl (73222) $953.04 $1,003.20 1.3×
MRI bone marrow blood supply (77084) $837.90 $882 3.8×
MRI breast w/o contrast bilateral (77047) $752.30 $791.89 3.4×
MRI breast w/o contrast unilat (77046) $752.30 $791.89 3.4×
MRI c-spine with contrast (72142) $885.78 $932.40 2.8×
MRI cardiac w/o contrast (75557) $862.50 $907.89 3.9×
MRI cervical spine w/o contrast (72141) $873.81 $919.80 4.0×
MRI chest w/o & w/contrast material (71552) $861.84 $907.20 2.7×
MRI chest w/o contrast (71550) $837.90 $882 3.8×
MRI chest with contrast (71551) $853.63 $898.56 1.2×
MRI Forearm w/ Contrast Bilateral 73219 (73219) $893.48 $940.50 2.8×
MRI lower extrem oth/thn jt w/contrast matrl (73719) $881.56 $927.96 2.7×
MRI lower extrem oth/thn jt w/o contr matrl (73718) $869.65 $915.42 4.0×
MRI orbit face &/neck w/o contrast (70540) $933.66 $982.80 4.3×
MRI orbit/face/neck w&w/o cont (70543) $957.60 $1,008 3.0×
MRI orbit/face/neck w/contrast (70542) $945.63 $995.40 2.9×
MRI pelvis w contrast (72196) $945.63 $995.40 2.9×
MRI pelvis w/o & w/contrast material (72197) $957.60 $1,008 3.0×
MRI pelvis w/o contrast (72195) $933.66 $982.80 4.3×
MRI scan of arm joint before and after contrast (73223) $953.04 $1,003.20 3.0×
MRI scan of leg joint before and after contrast (73723) $952.87 $1,003.02 3.0×
MRI spinal canal cervical w/o & w/contr matrl (72156) $897.75 $945 2.8×
MRI spinal canal lumbar w/contrast material (72149) $945.63 $995.40 2.9×
MRI spinal canal lumbar w/o & w/contr matrl (72158) $957.60 $1,008 3.0×
MRI spinal canal thoracic w/contrast matrl (72147) $945.63 $995.40 2.9×
MRI spinal canal thoracic w/o & w/contr matrl (72157) $957.60 $1,008 3.0×
MRI thoracic spine w/o contrast (72146) $933.66 $982.80 4.3×
MRI tmj (70336) $870.79 $916.62 4.0×
MRI upper ext joint w/o contrast (73221) $881.56 $927.96 4.0×
MRI upper extrem other than jt w/o & w/contras (73220) $953.04 $1,003.20 3.0×
MRI upper extremity oth than jt w/o contr matrl (73218) $869.65 $915.42 4.0×
Neck soft tissue (70360) $213.74 $224.99 2.7×
Ob Us Follow-Up Per Fetus - Us Ob Follow Up Transabdominal Approach (76816) $192.66 $202.80 2.0×
Osseous survey infant (77076) $180.99 $190.52 1.9×
Osseous survey limited (77074) $180.99 $190.52 1.9×
Pelvis 1 or 2 views (72170) $219.34 $230.88 2.3×
Pr MRI, lower extr, w/o contrast f/u by contrast (73720) $948.48 $998.40 3.0×
Pr sono bone density measure,peripheral (76977) $180.99 $190.52 1.9×
Radex hips bilateral with pelvis 2 views (73521) $395.01 $415.80 4.1×
Radiolog exam mandible compl minimum 4 views (70110) $287.19 $302.31 3.0×
Radiologic Exam Abdomen 1 View - Xr Abdomen 1 View (74018) $222.96 $234.69 2.8×
Radiologic Exam Chest 2 Views - Xr Chest 2 Views (71046) $249.50 $262.63 3.1×
Radiologic Examination Femur Minimum 2 Views - Xr Femur 2+ Vw Lt (73552) $263.34 $277.20 3.3×
Ribs bilateral 3 views (71110) $269.33 $283.50 2.8×
Sacroiliac Joints < 3 Views (72200) $238.30 $250.84 2.5×
Saline Infus Sonohysterography W/Color Doppler (76831) $654.60 $689.05 3.0×
Scapula complete (73010) $180.99 $190.52 1.9×
Screening digital breast tomosynthesis (77063) $128.70 $135.47 5.5×
Spine thoracic 3 views (72072) $333.68 $351.24 3.5×
Thoracolumbar 2 views (72080) $261.88 $275.66 3.3×
Tmj unilateral (70328) $149.85 $157.74 1.9×
Ultrasound, abdomen limited (76705) $269.33 $283.50 2.8×
Unlisted Diagnostic Radiographic Procedure (76499) $149.85 $157.74 1.9×
Unlisted Ultrasound Procedure (76999) $149.85 $157.74 1.9×
Upper Extremity Infant (73092) $180.99 $190.52 1.9×
Us abdl aorta screen aaa (76706) $245.94 $258.88 2.6×
Us breast unilateral complete (76641) $170.79 $179.78 1.8×
Us breast unilateral limited (76642) $157.11 $165.38 2.0×
Us chest (76604) $183.84 $193.52 1.9×
Us compl joint r-t w/image documentation (76881) $210.67 $221.76 2.2×
Us fetal nuchal translucency 1st gestation (76813) $180.99 $190.52 1.9×
Us infant hips dynamic (76885) $654.60 $689.05 8.2×
Us infant hips limited static (76886) $149.85 $157.74 1.9×
Us kidney transplant (76776) $180.99 $190.52 1.9×
Us ob detailed single fetus (76811) $411.40 $433.05 1.9×
Us ob transvaginal (76817) $209.48 $220.50 2.2×
Us pelvic non ob complete (76856) $269.33 $283.50 2.8×
Us pelvic nonobstetric image dcmtn limited/f/u (76857) $209.48 $220.50 2.2×
Us pregnancy ltd (76815) $209.48 $220.50 2.2×
Us pregnant uterus 14 wk transabdl 1/1st gestat (76801) $215.46 $226.80 2.2×
Us retroperitoneal complete (76770) $250.71 $263.90 2.6×
Us retroperitoneal limited (76775) $209.48 $220.50 2.2×
Us scrotum and contents (76870) $209.48 $220.50 2.2×
Us soft tissue head/neck (76536) $795.58 $837.45 8.3×
Us spinal canal and contents (76800) $180.99 $190.52 1.9×
Us transrectal (76872) $191.52 $201.60 2.0×
Us xtr non-vasc lmtd (76882) $210.67 $221.76 2.2×
Wrist 2 views (73100) $178.70 $188.10 2.2×
X-Ray Abdomen,Comp Acute Series - Xr Abdomen 2 Vws With Chest 1 View (74022) $359.31 $378.22 3.7×
X-Ray Ac Jts - Xr Acromioclavicular Joints Bilateral (73050) $269.33 $283.50 3.4×
X-Ray Ankle 3+ Vw - Xr Ankle 3+ Views Right (73610) $229.55 $241.63 2.9×
X-Ray Elbow 2 Vw - Xr Elbow 1-2 Views Right (73070) $208.48 $219.45 2.6×
X-Ray Elbow 3+ Vw - Xr Elbow 3+ Views Right (73080) $249.44 $262.58 3.1×
X-ray exam hip uni 1 view (73501) $233.88 $246.18 2.9×
X-Ray Exam Hip Uni 2-3 Views (73502) $285.33 $300.35 3.6×
X-Ray Exam Hips Bi 3-4 Views (73522) $180.99 $190.52 1.9×
X-Ray Exam Hips Bi 5/> Views (73523) $180.99 $190.52 1.9×
X-ray exam of femur 1 (73551) $239.40 $252 3.0×
X-ray eye for foreign body (70030) $172.74 $181.83 2.2×
X-Ray Facial Bones 3+ Vw - Xr Facial Bones 3+ Views (70150) $313.69 $330.20 3.3×
X-Ray Facial Bones <3 Vw - Xr Facial Bones 1-2 Views (70140) $296.78 $312.40 3.7×
X-Ray Foot 3+ Vw - Xr Foot 3+ Views Right (73630) $226.34 $238.26 2.8×
X-Ray Heel - Xr Calcaneus 2 Views Right (73650) $208.48 $219.45 2.6×
X-Ray Knee 4+ View - Xr Knee 4+ Views Right (73564) $356.56 $375.32 3.7×
X-Ray Knee Bilat Standing - Xr Knees Anteroposterior Standing Bilat (73565) $215.46 $226.80 2.7×
X-Ray Leg, Infant - Xr Lower Extremity 2+ Views Infant Left (73592) $187.62 $197.49 2.3×
X-Ray Lumbar Spine 2/3 Vw - Xr Lumbar Spine 2-3 Views (72100) $299.25 $315 3.1×
X-Ray Lumbar Spine 6+ Vw - Xr Lumbar Spine 6+ Vws Including Bending (72114) $407.39 $428.83 4.2×
X-Ray Lumbar Spine Flex/Exten - Xr Lumbar Spine 4+ Views W/ Flex Ext (72120) $317.56 $334.27 3.3×
X-Ray Nasal Bones - Xr Nasal Bones (70160) $244.48 $257.35 3.1×
X-Ray Orbits - Xr Orbits Complete 4+ Views (70200) $247.96 $261.01 2.6×
X-Ray Pelvis 3+ Vw - Xr Pelvis 3+ Views (72190) $184.71 $194.43 1.9×
X-Ray Ribs 2 Vw Unilat - Xr Ribs 2 Views Right (71100) $245.39 $258.30 3.1×
X-Ray Ribs, Chest 3+ Vw - Xr Ribs 2 Vws Lt W/ Chest Anteroposterior (71101) $330.61 $348.01 3.4×
X-Ray Ribs, Chest 4+ Vw - Xr Ribs 3 Vws Bil W/ Chest Posteroanterior (71111) $405.94 $427.31 4.2×
X-Ray Sacroiliac Jts 3+ Vw - Xr Sacroiliac Joints 3+ Views (72202) $197.37 $207.76 2.1×
X-Ray Sacrum/Coccyx 2+ Vw - Xr Sacrum Coccyx 2+ Views (72220) $236.81 $249.27 3.0×
X-Ray Shoulder 2+ Vw - Xr Shoulder 2+ Views Right (73030) $238.26 $250.80 3.0×
X-Ray Sinuses 3+ Vw - Xr Paranasal Sinuses 3+ Views (70220) $321.37 $338.28 4.0×
X-Ray Sinuses <3 Vw - Xr Paranasal Sinuses 1-2 Views (70210) $207.08 $217.98 2.6×
X-Ray Skull 4+ Vw - Xr Skull Complete 4+ Views (70260) $349.05 $367.42 3.6×
X-Ray Skull <4 Vw - Xr Skull 1-3 Views (70250) $240.60 $253.26 2.5×
X-Ray Sterno-Clavicluar Jt - Xr Sternoclavicular Joints 3+ Views (71130) $149.85 $157.74 1.9×
X-Ray Sternum 2+ Vw - Xr Sternum 2+ Views (71120) $239.88 $252.51 3.0×
X-Ray Thoracic Spine 2 Vw - Xr Thoracic Spine 2 Views (72070) $269.33 $283.50 2.8×
X-Ray Toe(S) - Xr Toes 2+ Views Right (73660) $178.37 $187.76 2.2×
X-Ray Wrist 3+ Vw - Xr Wrist 3+ Views Right (73110) $260.89 $274.62 3.3×
Xr c-spine 6 or more views (72052) $449.01 $472.64 4.7×
Xr finger(s) 2+ views (73140) $179.55 $189 2.2×
Xr optic foramina (70190) $149.85 $157.74 1.9×
Xr shoulder 1 view (73020) $202.52 $213.18 2.5×
Xr spine cervical 4 or 5 views (72050) $381.34 $401.41 4.0×
Xr tibia/fibula 2 views (73590) $234.15 $246.47 2.9×
Xr tmj bilateral (70330) $149.85 $157.74 1.9×
Xray knee 1 or 2 views rt (73560) $214.44 $225.72 2.7×