Imaging prices at Medicine Lodge Memorial Hospital

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

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

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ProcedureCash priceGross charge× Medicare
Abdomen 2 views (74019) $273.90 $273.90 2.8×
Ankle 2 views (73600) $218.74 $218.74 2.7×
Bone Imaging 3 Phase (78315) $527 $527 1.4×
Bone survey complete (77075) $929.45 $929.45 9.7×
Cervical spine 2 or 3 views (72040) $220.95 $220.95 2.8×
Chest 1 view (71045) $218.90 $218.90 2.7×
Clavicle complete (73000) $197.20 $197.20 2.5×
Computed Tomography Thorax Lw Dose Lng Ca Scr C- (71271) $632.54 $632.54 6.6×
CT abdomen and pelvis without and with contrast (74178) $716.64 $716.64 2.2×
CT abdomen and pelvis without contrast (74176) $686 $686 3.1×
CT abdomen w contrast (74160) $806.25 $806.25 5.0×
CT abdomen w wo contrast (74170) $700 $700 4.3×
CT abdomen w/o contrast (74150) $798.50 $798.50 8.3×
CT angiography upper extremity lt (73206) $1,265.30 $1,265.30 7.8×
CT c-spine w/o contrast (72125) $838.76 $838.76 8.7×
CT chest w/wo contrast (71270) $731.12 $731.12 4.5×
CT chest with contrast (71260) $647.92 $647.92 4.0×
CT head/brain with contrast (70460) $632.54 $632.54 3.9×
CT head/brain without and with contrast (70470) $632.54 $632.54 3.9×
CT limited/localized follow up study (76380) $617.67 $617.67 7.7×
CT lower ext w/o (73700) $591.27 $591.27 6.1×
CT lower extremity w wo contrast (73702) $1,043.30 $1,043.30 6.5×
CT lumbar spine w & w/o contrast (72133) $632.54 $632.54 3.9×
CT lumbar spine w/o contrast (72131) $633 $633 6.6×
CT maxillofacial w contrast (70487) $1,060.90 $1,060.90 6.6×
CT maxillofacial w/o contrast (70486) $632.54 $632.54 6.6×
CT maxillofacial w/wo contrast (70488) $758.65 $758.65 4.7×
CT neck soft tissue w contrast (70491) $632.54 $632.54 3.9×
CT orbits w/o contrast (70480) $1,060.90 $1,060.90 11.0×
CT pelvis w & w/o contrast (72194) $709.20 $709.20 4.4×
CT pelvis w/o contrast (72192) $632.54 $632.54 6.6×
CT soft tissue neck w/o & w/contrast material (70492) $632.54 $632.54 3.9×
CT soft tissue neck w/o contrast (70490) $632.54 $632.54 6.6×
CT thoracic spine w/o contrast (72128) $851.60 $851.60 8.9×
CT thoracic spine w/wo contrast (72130) $632.54 $632.54 3.9×
CT thorax w/o contrast (71250) $650.40 $650.40 6.8×
CT upper extremity w/o & w/contrast material (73202) $616.27 $616.27 3.8×
CT upper extremity w/o contrast rt (73200) $628.07 $628.07 6.5×
Cta Abdl Aorta&Bi Iliofem W/Contrast&Postp (75635) $1,727.81 $1,727.81 10.7×
CTA abdomen pelvis (74174) $2,355.99 $2,355.99 7.3×
CTA chest (71275) $1,581.37 $1,581.37 9.8×
Cta Head (70496) $1,601.63 $1,601.63 9.9×
CTA lwr ext w&w/o contrast (73706) $1,265.30 $1,265.30 7.8×
Cta Neck (70498) $1,603.20 $1,603.20 9.9×
Dxa bone density study 1/> sites axial skel (77080) $258.72 $258.72 2.7×
Fluoroscopy up to 1 hr (76000) $323.73 $323.73 1.5×
Foot 2 views (73620) $218.74 $218.74 2.7×
Forearm 2 views (73090) $252.76 $252.76 3.2×
Hand 2 views (73120) $218.74 $218.74 2.3×
Hand 3 views (73130) $252.76 $252.76 3.2×
Humerus Min 2 Views Left (73060) $252.76 $252.76 3.2×
Kidney imaging morphology (78700) $842 $842 2.3×
Knee 3 views (73562) $252.76 $252.76 3.2×
MRA head w/o contrast (70544) $875.50 $875.50 4.0×
MRA neck w contrast (70548) $875.50 $875.50 2.7×
Mra Neck W/O &W/Contrast Material (70549) $875.50 $875.50 2.7×
MRA neck w/o contrast (70547) $875.50 $875.50 4.0×
MRI abdomen w contrast (74182) $727.49 $727.49 2.3×
MRI abdomen w/o & w/contrast material (74183) $727.49 $727.49 2.3×
MRI abdomen w/o contrast (74181) $727.49 $727.49 3.3×
MRI any jnt lwr ext with con lt (73722) $727.49 $727.49 1.0×
MRI any jt upper extremity w/contrast matrl (73222) $727.49 $727.49 1.0×
MRI cervical spine w/o contrast (72141) $727.49 $727.49 3.3×
MRI lower extrem oth/thn jt w/o contr matrl (73718) $727.49 $727.49 3.3×
MRI orbit face &/neck w/o contrast (70540) $727.49 $727.49 3.3×
MRI orbit/face/neck w&w/o cont (70543) $727.49 $727.49 2.3×
MRI orbit/face/neck w/contrast (70542) $727.49 $727.49 2.3×
MRI pelvis w contrast (72196) $727.49 $727.49 2.3×
MRI pelvis w/o & w/contrast material (72197) $727.49 $727.49 2.3×
MRI pelvis w/o contrast (72195) $727.49 $727.49 3.3×
MRI scan of arm joint before and after contrast (73223) $727.49 $727.49 2.3×
MRI scan of leg joint before and after contrast (73723) $703.74 $703.74 2.2×
MRI spinal canal cervical w/o & w/contr matrl (72156) $727.49 $727.49 2.3×
MRI spinal canal lumbar w/contrast material (72149) $727.49 $727.49 2.3×
MRI spinal canal lumbar w/o & w/contr matrl (72158) $727.49 $727.49 2.3×
MRI spinal canal thoracic w/contrast matrl (72147) $727.49 $727.49 2.3×
MRI spinal canal thoracic w/o & w/contr matrl (72157) $727.49 $727.49 2.3×
MRI thoracic spine w/o contrast (72146) $727.49 $727.49 3.3×
MRI upper ext joint w/o contrast (73221) $727.49 $727.49 3.3×
MRI upper extrem other than jt w/o & w/contras (73220) $727.49 $727.49 2.3×
MRI upper extremity oth than jt w/o contr matrl (73218) $727.29 $727.29 3.3×
Neck soft tissue (70360) $178.56 $178.56 2.2×
Nuclear medicine study of kidney and blood flow (78701) $957 $957 2.6×
Pelvis 1 or 2 views (72170) $218.74 $218.74 2.3×
Pr MRI, lower extr, w/o contrast f/u by contrast (73720) $703.74 $703.74 2.2×
Radex hips bilateral with pelvis 2 views (73521) $329.20 $329.20 3.4×
Radiolog exam mandible compl minimum 4 views (70110) $291.61 $291.61 3.0×
Radiologic Exam Abdomen 1 View - Xr Abdomen 1 View (74018) $218.90 $218.90 2.7×
Radiologic Exam Chest 2 Views - Xr Chest 2 Views (71046) $273.90 $273.90 3.4×
Radiologic Examination Femur Minimum 2 Views - Xr Femur 2+ Vw Lt (73552) $313.24 $313.24 3.9×
Sacroiliac Joints < 3 Views (72200) $269.83 $269.83 2.8×
Scapula complete (73010) $245.30 $245.30 2.6×
Tmj unilateral (70328) $147.50 $147.50 1.8×
Ultrasound, abdomen limited (76705) $286 $286 3.0×
Urography (pyelography), intravenous, with or without KUB, with or without tomography (74400) $629.06 $629.06 3.9×
Us abdl aorta screen aaa (76706) $209.45 $209.45 2.2×
Us chest (76604) $473 $473 4.9×
Us compl joint r-t w/image documentation (76881) $200.75 $200.75 2.1×
Us ob transvaginal (76817) $370.15 $370.15 3.8×
Us pelvic non ob complete (76856) $289.85 $289.85 3.0×
Us pelvic nonobstetric image dcmtn limited/f/u (76857) $142.45 $142.45 1.5×
Us pregnancy ltd (76815) $407 $407 4.2×
Us pregnant uterus 14 wk transabdl 1/1st gestat (76801) $261.25 $261.25 2.7×
Us retroperitoneal complete (76770) $283.25 $283.25 2.9×
Us retroperitoneal limited (76775) $298.65 $298.65 3.1×
Us scrotum and contents (76870) $268.40 $268.40 2.8×
Us soft tissue head/neck (76536) $707.85 $707.85 7.4×
Us xtr non-vasc lmtd (76882) $261.80 $261.80 2.7×
Wrist 2 views (73100) $218.74 $218.74 2.7×
X-Ray Ac Jts - Xr Acromioclavicular Joints Bilateral (73050) $202.96 $202.96 2.5×
X-Ray Ankle 3+ Vw - Xr Ankle 3+ Views Right (73610) $252.76 $252.76 3.2×
X-Ray Elbow 2 Vw - Xr Elbow 1-2 Views Right (73070) $252.76 $252.76 3.2×
X-ray exam hip uni 1 view (73501) $196.33 $196.33 2.5×
X-Ray Exam Hip Uni 2-3 Views (73502) $273.64 $273.64 3.4×
X-ray exam of femur 1 (73551) $227.70 $227.70 2.8×
X-ray eye for foreign body (70030) $112.81 $112.81 1.4×
X-Ray Facial Bones <3 Vw - Xr Facial Bones 1-2 Views (70140) $261.82 $261.82 3.3×
X-Ray Foot 3+ Vw - Xr Foot 3+ Views Right (73630) $252.76 $252.76 3.2×
X-Ray Heel - Xr Calcaneus 2 Views Right (73650) $252.76 $252.76 3.2×
X-Ray Jaw <4 Vw - Xr Mandible < 4 Views (70100) $245.30 $245.30 3.1×
X-Ray Knee 4+ View - Xr Knee 4+ Views Right (73564) $302.50 $302.50 3.1×
X-Ray Knee Bilat Standing - Xr Knees Anteroposterior Standing Bilat (73565) $184.41 $184.41 2.3×
X-Ray Lumbar Spine 2/3 Vw - Xr Lumbar Spine 2-3 Views (72100) $273.96 $273.96 2.8×
X-Ray Nasal Bones - Xr Nasal Bones (70160) $261.82 $261.82 3.3×
X-Ray Nose-Rectum Child F.B. - Xr Nose to Rectum Foreign Body Peds (76010) $179.30 $179.30 2.2×
X-Ray Pelvis 3+ Vw - Xr Pelvis 3+ Views (72190) $187.55 $187.55 2.0×
X-Ray Ribs 2 Vw Unilat - Xr Ribs 2 Views Right (71100) $329.19 $329.19 4.1×
X-Ray Sacrum/Coccyx 2+ Vw - Xr Sacrum Coccyx 2+ Views (72220) $329.19 $329.19 4.1×
X-Ray Shoulder 2+ Vw - Xr Shoulder 2+ Views Right (73030) $253.50 $253.50 3.2×
X-Ray Sinuses 3+ Vw - Xr Paranasal Sinuses 3+ Views (70220) $307 $307 3.8×
X-Ray Skull 4+ Vw - Xr Skull Complete 4+ Views (70260) $291.61 $291.61 3.0×
X-Ray Skull <4 Vw - Xr Skull 1-3 Views (70250) $197.84 $197.84 2.1×
X-Ray Spine One View - Xr Spine (72020) $236.37 $236.37 3.0×
X-Ray Sterno-Clavicluar Jt - Xr Sternoclavicular Joints 3+ Views (71130) $203.90 $203.90 2.5×
X-Ray Sternum 2+ Vw - Xr Sternum 2+ Views (71120) $224.29 $224.29 2.8×
X-Ray Thoracic Spine 2 Vw - Xr Thoracic Spine 2 Views (72070) $272.96 $272.96 2.8×
X-Ray Toe(S) - Xr Toes 2+ Views Right (73660) $197.20 $197.20 2.5×
X-Ray Wrist 3+ Vw - Xr Wrist 3+ Views Right (73110) $252.76 $252.76 3.2×
Xr c-spine 6 or more views (72052) $399.63 $399.63 4.2×
Xr finger(s) 2+ views (73140) $197.20 $197.20 2.5×
XR Mastoids < 3 Views Bilateral (70120) $245.30 $245.30 2.6×
Xr shoulder 1 view (73020) $216.66 $216.66 2.7×
Xr spine cervical 4 or 5 views (72050) $388.24 $388.24 4.0×
Xr tibia/fibula 2 views (73590) $252.76 $252.76 3.2×
Xr tmj bilateral (70330) $285.65 $285.65 3.6×
Xray knee 1 or 2 views rt (73560) $252.76 $252.76 3.2×