Imaging prices at Wichita County Health Center

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

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

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ProcedureCash priceGross charge× Medicare
Abdomen 2 views (74019) $327.20 $409 3.4×
Ankle 2 views (73600) $320.80 $401 4.0×
Bone survey complete (77075) $960 $1,200 10.0×
Cervical spine 2 or 3 views (72040) $327.20 $409 4.1×
Chest 1 view (71045) $308.80 $386 3.9×
Chest 3 views (71047) $332.80 $416 4.2×
Clavicle complete (73000) $320.80 $401 4.0×
Computed Tomography Thorax Lw Dose Lng Ca Scr C- (71271) $1,003.20 $1,254 10.4×
CT abdomen and pelvis without and with contrast (74178) $1,003.20 $1,254 3.1×
CT abdomen and pelvis without contrast (74176) $1,003.20 $1,254 4.6×
CT abdomen w contrast (74160) $1,003.20 $1,254 6.2×
CT abdomen w wo contrast (74170) $1,003.20 $1,254 6.2×
CT abdomen w/o contrast (74150) $1,003.20 $1,254 10.4×
CT c-spine w/o contrast (72125) $1,003.20 $1,254 10.4×
CT cervical spine w&w/o contrast (72127) $1,003.20 $1,254 6.2×
CT cervical spine with contrast (72126) $1,003.20 $1,254 3.1×
CT chest w/wo contrast (71270) $1,003.20 $1,254 6.2×
CT chest with contrast (71260) $1,003.20 $1,254 6.2×
CT head/brain with contrast (70460) $1,003.20 $1,254 6.2×
CT head/brain without and with contrast (70470) $1,003.20 $1,254 6.2×
CT iac w contrast (70481) $1,003.20 $1,254 6.2×
CT lower ext w/o (73700) $1,003.20 $1,254 10.4×
CT lower extremity w wo contrast (73702) $1,003.20 $1,254 6.2×
CT lower extremity with contrast (73701) $1,003.20 $1,254 6.2×
CT lumbar spine w & w/o contrast (72133) $1,003.20 $1,254 6.2×
CT lumbar spine w/o contrast (72131) $1,003.20 $1,254 10.4×
CT maxillofacial w contrast (70487) $1,003.20 $1,254 6.2×
CT maxillofacial w/o contrast (70486) $1,003.20 $1,254 10.4×
CT maxillofacial w/wo contrast (70488) $1,003.20 $1,254 6.2×
CT neck soft tissue w contrast (70491) $1,003.20 $1,254 6.2×
CT orbit sella/post fossa/ear w/o & w/contr matr (70482) $1,003.20 $1,254 6.2×
CT orbits w/o contrast (70480) $1,003.20 $1,254 10.4×
CT pelvis w & w/o contrast (72194) $1,003.20 $1,254 6.2×
CT pelvis w/o contrast (72192) $1,003.20 $1,254 10.4×
CT soft tissue neck w/o & w/contrast material (70492) $1,003.20 $1,254 6.2×
CT soft tissue neck w/o contrast (70490) $1,003.20 $1,254 10.4×
CT thoracic spine w/o contrast (72128) $1,003.20 $1,254 10.4×
CT thoracic spine w/wo contrast (72130) $1,003.20 $1,254 6.2×
CT thorax w/o contrast (71250) $1,003.20 $1,254 10.4×
CT upper extremity w/o & w/contrast material (73202) $1,003.20 $1,254 6.2×
CT upper extremity w/o contrast rt (73200) $1,003.20 $1,254 10.4×
CT upper extremity with contrast (73201) $1,003.20 $1,254 3.1×
Cta Abdl Aorta&Bi Iliofem W/Contrast&Postp (75635) $1,916 $2,395 11.9×
Cta Abdomen (74175) $1,819.20 $2,274 11.3×
CTA abdomen pelvis (74174) $2,612.80 $3,266 8.1×
CTA chest (71275) $1,753.60 $2,192 10.9×
Cta Head (70496) $1,777.60 $2,222 11.0×
CTA head&neck c+ w/noncontrast img&post-pxessing (70471) $3,554.40 $4,443 11.1×
Cta Neck (70498) $1,777.60 $2,222 11.0×
Dxa bone density study 1/> sites axial skel (77080) $304 $380 3.2×
Dxa bone density study 1/>sites appendiclr skel (77081) $304 $380 3.8×
Fetal biophysical profile non-stress testing (76818) $455.20 $569 4.7×
Fetal Biophysical Profile W/O Non-Stress Testing (76819) $455.20 $569 4.7×
Foot 2 views (73620) $320.80 $401 4.0×
Forearm 2 views (73090) $320.80 $401 4.0×
Hand 2 views (73120) $320.80 $401 3.3×
Hand 3 views (73130) $327.20 $409 4.1×
Ht muscle image spect sing (78451) $600 $750 0.5×
Humerus Min 2 Views Left (73060) $320.80 $401 4.0×
Knee 3 views (73562) $332.80 $416 4.2×
Mr safety implant&/fb assmt clin staf 1st 15 min (76014) $40 $50 1.5×
MRA head w & w/o contrast (70546) $1,017.60 $1,272 3.2×
MRA head w/o contrast (70544) $1,017.60 $1,272 4.6×
MRA neck w/o contrast (70547) $1,017.60 $1,272 4.6×
MRI abdomen w contrast (74182) $918.40 $1,148 2.9×
MRI abdomen w/o & w/contrast material (74183) $918.40 $1,148 2.9×
MRI abdomen w/o contrast (74181) $918.40 $1,148 4.2×
MRI any jnt lwr ext with con lt (73722) $918.40 $1,148 1.3×
MRI any jt upper extremity w/contrast matrl (73222) $918.40 $1,148 1.3×
MRI c-spine with contrast (72142) $918.40 $1,148 2.9×
MRI cervical spine w/o contrast (72141) $918.40 $1,148 4.2×
MRI chest w/o & w/contrast material (71552) $918.40 $1,148 2.9×
MRI chest w/o contrast (71550) $918.40 $1,148 4.2×
MRI chest with contrast (71551) $918.40 $1,148 1.3×
MRI Forearm w/ Contrast Bilateral 73219 (73219) $918.40 $1,148 2.9×
MRI lower extrem oth/thn jt w/contrast matrl (73719) $918.40 $1,148 2.9×
MRI lower extrem oth/thn jt w/o contr matrl (73718) $918.40 $1,148 4.2×
MRI orbit face &/neck w/o contrast (70540) $918.40 $1,148 4.2×
MRI orbit/face/neck w&w/o cont (70543) $918.40 $1,148 2.9×
MRI pelvis w contrast (72196) $918.40 $1,148 2.9×
MRI pelvis w/o & w/contrast material (72197) $918.40 $1,148 2.9×
MRI pelvis w/o contrast (72195) $918.40 $1,148 4.2×
MRI scan of arm joint before and after contrast (73223) $918.40 $1,148 2.9×
MRI scan of leg joint before and after contrast (73723) $918.40 $1,148 2.9×
MRI spinal canal cervical w/o & w/contr matrl (72156) $918.40 $1,148 2.9×
MRI spinal canal lumbar w/contrast material (72149) $918.40 $1,148 2.9×
MRI spinal canal lumbar w/o & w/contr matrl (72158) $918.40 $1,148 2.9×
MRI spinal canal thoracic w/contrast matrl (72147) $918.40 $1,148 2.9×
MRI spinal canal thoracic w/o & w/contr matrl (72157) $918.40 $1,148 2.9×
MRI thoracic spine w/o contrast (72146) $918.40 $1,148 4.2×
MRI tmj (70336) $918.40 $1,148 4.2×
MRI upper ext joint w/o contrast (73221) $918.40 $1,148 4.2×
MRI upper extrem other than jt w/o & w/contras (73220) $918.40 $1,148 2.9×
MRI upper extremity oth than jt w/o contr matrl (73218) $918.40 $1,148 4.2×
Myocardial Spect Multiple Studies (78452) $960 $1,200 0.8×
Neck soft tissue (70360) $327.20 $409 4.1×
Ob Us Follow-Up Per Fetus - Us Ob Follow Up Transabdominal Approach (76816) $455.20 $569 4.7×
Osseous survey limited (77074) $672 $840 7.0×
Pelvis 1 or 2 views (72170) $320.80 $401 3.3×
Pr MRI, lower extr, w/o contrast f/u by contrast (73720) $918.40 $1,148 2.9×
Radex Entir Thrc Lmbr Crv Sac Spi W/Skull 1 Vw - Xr Scoliosis 1 Vw (72081) $327.20 $409 4.1×
Radex entir thrc lmbr crv sac spi w/skull 2/3 vw (72082) $375.20 $469 3.9×
Radex hips bilateral with pelvis 2 views (73521) $332.80 $416 3.5×
Radex mastoids compl minimum 3 views pr side (70130) $368.80 $461 3.8×
Radiolog exam mandible compl minimum 4 views (70110) $368.80 $461 3.8×
Radiologic Exam Abdomen 1 View - Xr Abdomen 1 View (74018) $309.60 $387 3.9×
Radiologic Exam Abdomen 3+ Views - Xr Abdomen 3+ Views (74021) $332.80 $416 3.5×
Radiologic Exam Chest 2 Views - Xr Chest 2 Views (71046) $320.80 $401 4.0×
Radiologic Examination Femur Minimum 2 Views - Xr Femur 2+ Vw Lt (73552) $332.80 $416 4.2×
Ribs bilateral 3 views (71110) $418.40 $523 4.4×
Sacroiliac Joints < 3 Views (72200) $320.64 $400.80 3.3×
Scapula complete (73010) $327.20 $409 3.4×
Screening digital breast tomosynthesis (77063) $120 $150 5.1×
Sella turcica (70240) $332.80 $416 4.2×
Spine thoracic 3 views (72072) $375.20 $469 3.9×
Thoracolumbar 2 views (72080) $327.20 $409 4.1×
Tmj unilateral (70328) $332.80 $416 4.2×
Ultrasound, abdomen limited (76705) $455.20 $569 4.7×
Unlisted Diagnostic Radiographic Procedure (76499) $116 $145 1.4×
Upper Extremity Infant (73092) $320.80 $401 3.3×
Urography (pyelography), intravenous, with or without KUB, with or without tomography (74400) $738.40 $923 4.6×
Us abdl aorta screen aaa (76706) $455.20 $569 4.7×
Us breast unilateral complete (76641) $455.20 $569 4.7×
Us breast unilateral limited (76642) $455.20 $569 5.7×
Us chest (76604) $455.20 $569 4.7×
Us compl joint r-t w/image documentation (76881) $455.20 $569 4.7×
Us ob transvaginal (76817) $455.20 $569 4.7×
Us pelvic non ob complete (76856) $455.20 $569 4.7×
Us pelvic nonobstetric image dcmtn limited/f/u (76857) $455.20 $569 4.7×
Us pregnancy ltd (76815) $455.20 $569 4.7×
Us pregnant uterus 14 wk transabdl 1/1st gestat (76801) $455.20 $569 4.7×
Us retroperitoneal complete (76770) $455.20 $569 4.7×
Us retroperitoneal limited (76775) $455.20 $569 4.7×
Us scrotum and contents (76870) $455.20 $569 4.7×
Us soft tissue head/neck (76536) $737.60 $922 7.7×
Us xtr non-vasc lmtd (76882) $455.20 $569 4.7×
Wrist 2 views (73100) $320.80 $401 4.0×
X-Ray Abdomen,Comp Acute Series - Xr Abdomen 2 Vws With Chest 1 View (74022) $404.80 $506 4.2×
X-Ray Ac Jts - Xr Acromioclavicular Joints Bilateral (73050) $332.80 $416 4.2×
X-Ray Ankle 3+ Vw - Xr Ankle 3+ Views Right (73610) $327.20 $409 4.1×
X-Ray Elbow 2 Vw - Xr Elbow 1-2 Views Right (73070) $320.80 $401 4.0×
X-Ray Elbow 3+ Vw - Xr Elbow 3+ Views Right (73080) $332.80 $416 4.2×
X-ray exam hip uni 1 view (73501) $320.80 $401 4.0×
X-Ray Exam Hip Uni 2-3 Views (73502) $332.80 $416 4.2×
X-Ray Exam Hips Bi 3-4 Views (73522) $666.40 $833 6.9×
X-Ray Exam Hips Bi 5/> Views (73523) $666.40 $833 6.9×
X-ray exam of femur 1 (73551) $320.80 $401 4.0×
X-ray eye for foreign body (70030) $308.80 $386 3.9×
X-Ray Facial Bones 3+ Vw - Xr Facial Bones 3+ Views (70150) $332.80 $416 3.5×
X-Ray Facial Bones <3 Vw - Xr Facial Bones 1-2 Views (70140) $327.20 $409 4.1×
X-Ray Foot 3+ Vw - Xr Foot 3+ Views Right (73630) $327.20 $409 4.1×
X-Ray Heel - Xr Calcaneus 2 Views Right (73650) $320.80 $401 4.0×
X-Ray Jaw <4 Vw - Xr Mandible < 4 Views (70100) $332.80 $416 4.2×
X-Ray Knee 4+ View - Xr Knee 4+ Views Right (73564) $368.80 $461 3.8×
X-Ray Knee Bilat Standing - Xr Knees Anteroposterior Standing Bilat (73565) $320.80 $401 4.0×
X-Ray Leg, Infant - Xr Lower Extremity 2+ Views Infant Left (73592) $327.20 $409 4.1×
X-Ray Lumbar Spine 2/3 Vw - Xr Lumbar Spine 2-3 Views (72100) $327.20 $409 3.4×
X-Ray Lumbar Spine 6+ Vw - Xr Lumbar Spine 6+ Vws Including Bending (72114) $524.16 $655.20 5.5×
X-Ray Lumbar Spine Flex/Exten - Xr Lumbar Spine 4+ Views W/ Flex Ext (72120) $358.40 $448 3.7×
X-Ray Nasal Bones - Xr Nasal Bones (70160) $327.20 $409 4.1×
X-Ray Nose-Rectum Child F.B. - Xr Nose to Rectum Foreign Body Peds (76010) $308.80 $386 3.9×
X-Ray Orbits - Xr Orbits Complete 4+ Views (70200) $368.80 $461 3.8×
X-Ray Pelvis 3+ Vw - Xr Pelvis 3+ Views (72190) $368.80 $461 3.8×
X-Ray Ribs 2 Vw Unilat - Xr Ribs 2 Views Right (71100) $320.80 $401 4.0×
X-Ray Ribs, Chest 3+ Vw - Xr Ribs 2 Vws Lt W/ Chest Anteroposterior (71101) $332.80 $416 3.5×
X-Ray Ribs, Chest 4+ Vw - Xr Ribs 3 Vws Bil W/ Chest Posteroanterior (71111) $484 $605 5.0×
X-Ray Sacroiliac Jts 3+ Vw - Xr Sacroiliac Joints 3+ Views (72202) $327.20 $409 3.4×
X-Ray Sacrum/Coccyx 2+ Vw - Xr Sacrum Coccyx 2+ Views (72220) $327.20 $409 4.1×
X-Ray Shoulder 2+ Vw - Xr Shoulder 2+ Views Right (73030) $320.80 $401 4.0×
X-Ray Sinuses 3+ Vw - Xr Paranasal Sinuses 3+ Views (70220) $332.80 $416 4.2×
X-Ray Sinuses <3 Vw - Xr Paranasal Sinuses 1-2 Views (70210) $327.20 $409 4.1×
X-Ray Skull 4+ Vw - Xr Skull Complete 4+ Views (70260) $332.80 $416 3.5×
X-Ray Skull <4 Vw - Xr Skull 1-3 Views (70250) $327.20 $409 3.4×
X-Ray Spine One View - Xr Spine (72020) $320.80 $401 4.0×
X-Ray Sterno-Clavicluar Jt - Xr Sternoclavicular Joints 3+ Views (71130) $332.80 $416 4.2×
X-Ray Sternum 2+ Vw - Xr Sternum 2+ Views (71120) $320.80 $401 4.0×
X-Ray Thoracic Spine 2 Vw - Xr Thoracic Spine 2 Views (72070) $332.80 $416 3.5×
X-Ray Thoracic Spine 4 Vw - Xr Thoracic Spine Complete 4+ Views (72074) $418.40 $523 4.4×
X-Ray Toe(S) - Xr Toes 2+ Views Right (73660) $308.80 $386 3.9×
X-Ray Wrist 3+ Vw - Xr Wrist 3+ Views Right (73110) $327.20 $409 4.1×
Xr c-spine 6 or more views (72052) $524 $655 5.4×
Xr chest 4+ views (71048) $368.80 $461 3.8×
Xr finger(s) 2+ views (73140) $320.80 $401 4.0×
XR Mastoids < 3 Views Bilateral (70120) $332.80 $416 3.5×
Xr optic foramina (70190) $332.80 $416 4.2×
Xr shoulder 1 view (73020) $320.80 $401 4.0×
Xr spine cervical 4 or 5 views (72050) $418.40 $523 4.4×
Xr tibia/fibula 2 views (73590) $320.80 $401 4.0×
Xr tmj bilateral (70330) $666.40 $833 8.3×
Xray knee 1 or 2 views rt (73560) $320.80 $401 4.0×