Ascension Via Christi Hospital St. Teresa, Inc.
14800 St Teresa St, Wichita, KS · Ascension · · NPI 1023334950
Published prices by procedure
Cash price is what you pay without insurance. The negotiated range spans the lowest to highest rate this hospital agreed with insurers.
| Procedure | Cash price | Gross charge | Negotiated range | Payers |
|---|---|---|---|---|
| X-ray exam of penis CPT 74445 | not published | not published | $98.35 – $275.38 | 17 |
| X-ray exam of perineum CPT 74775 | not published | not published | $106.29 – $625.94 | 17 |
| X-ray exam of salivary gland CPT 70380 | not published | not published | $74.97 – $228.00 | 18 |
| X-ray exam of sinuses CPT 70210 | not published | not published | $56.10 – $228.00 | 18 |
| X-ray exam of tear duct CPT 70170 | not published | not published | $50.97 – $625.94 | 17 |
| X-ray exam of teeth CPT 70300 | not published | not published | $23.09 – $228.00 | 18 |
| X-ray exam of teeth CPT 70310 | not published | not published | $67.74 – $625.94 | 18 |
| X-ray exam si joints CPT 72200 | not published | not published | $53.85 – $275.38 | 18 |
| X-ray exam thorac spine4/>vw CPT 72074 | not published | not published | $90.11 – $275.38 | 18 |
| X-ray eye detection foreign body (both sides) CPT 70030 | not published | not published | $51.89 – $228.00 | 18 |
| X-ray facial bones complete > 3 views CPT 70150 | not published | not published | $78.56 – $275.38 | 18 |
| X-ray fallopian tube CPT 74742 | not published | not published | $105.02 – $105.02 | 1 |
| X-ray femur >=2 views (both sides) CPT 73552 | not published | not published | $81.43 – $228.00 | 17 |
| X-ray finger(s) >= 2 views (both sides) CPT 73140 | not published | not published | $57.81 – $228.00 | 18 |
| X-ray foot 2 views (both sides) CPT 73620 | not published | not published | $47.89 – $228.00 | 18 |
| X-ray forearm 2 views (both sides) CPT 73090 | not published | not published | $50.89 – $228.00 | 18 |
| X-ray hand 2 views (both sides) CPT 73120 | not published | not published | $49.89 – $275.38 | 18 |
| X-ray head for orthodontia CPT 70350 | not published | not published | $26.19 – $228.00 | 18 |
| X-ray heel/calcaneus > 2 views (both sides) CPT 73650 | not published | not published | $48.89 – $228.00 | 18 |
| X-ray hip uni w/wo pelvis min 4 views CPT 73503 | not published | not published | $98.35 – $275.38 | 17 |
| X-ray hip with pelvis when performed bilateral 2 views CPT 73521 | not published | not published | $92.27 – $275.38 | 17 |
| X-ray hip with pelvis when performed bilateral 3-4 views CPT 73522 | not published | not published | $98.35 – $275.38 | 17 |
| X-ray hip with pelvis when performed bilateral >= 5 views CPT 73523 | not published | not published | $98.35 – $275.38 | 17 |
| X-ray hip with pelvis when performed unilateral 1 view left CPT 73501 | not published | not published | $71.41 – $228.00 | 17 |
| X-ray humerus >= 2 views left CPT 73060 | not published | not published | $54.13 – $228.00 | 18 |
| X-ray joint survey 1 view CPT 77077 | not published | not published | $71.26 – $275.38 | 18 |
| X-ray knee 1-2 views (both sides) CPT 73560 | not published | not published | $51.89 – $228.00 | 18 |
| X-ray knee 3 views (both sides) CPT 73562 | not published | not published | $65.02 – $228.00 | 18 |
| X-ray knee ap standing bilateral CPT 73565 | not published | not published | $55.85 – $228.00 | 18 |
| X-ray lower extremities infant > 2 views (both sides) CPT 73592 | not published | not published | $52.85 – $228.00 | 18 |
| X-ray l/s-spine bend vw only 2-3 vw CPT 72120 | not published | not published | $91.11 – $275.38 | 18 |
| X-ray lumbosacral spine >= 4 views CPT 72110 | not published | not published | $98.35 – $275.38 | 18 |
| X-ray lumbosacral spine complete including bending views >= 6 views CPT 72114 | not published | not published | $98.35 – $275.38 | 18 |
| X-ray male genital tract CPT 74440 | not published | not published | $173.47 – $625.94 | 18 |
| X-ray mandible complete > 4 views CPT 70110 | not published | not published | $70.98 – $275.38 | 18 |
| X-ray mandible ltd <4 views CPT 70100 | not published | not published | $56.85 – $228.00 | 18 |
| X-ray nasal bones complete > 3 views CPT 70160 | not published | not published | $61.81 – $228.00 | 18 |
| X-ray neck soft tissue CPT 70360 | not published | not published | $48.89 – $228.00 | 18 |
| X-ray nose to rectum for foreign body child CPT 76010 | not published | not published | $49.89 – $228.00 | 18 |
| X-ray of mammary ducts CPT 77054 | not published | not published | $165.31 – $625.94 | 18 |
| X-ray optic foramina CPT 70190 | not published | not published | $66.02 – $228.00 | 18 |
| X-ray pelvis 1-2 views CPT 72170 | not published | not published | $45.93 – $275.38 | 18 |
| X-ray pelvis complete > 3 views CPT 72190 | not published | not published | $75.94 – $275.38 | 18 |
| X-ray retrograde pyelogram with or without kidney ureter bladder w/supervision & interpretation CPT 74420 | not published | not published | $157.19 – $924.78 | 17 |
| X-ray ribs 2 views left CPT 71100 | not published | not published | $57.10 – $228.00 | 18 |
| X-ray ribs 3 views bilateral CPT 71110 | not published | not published | $72.60 – $275.38 | 18 |
| X-ray ribs w/posterior anterior chest 3 views left CPT 71101 | not published | not published | $69.01 – $275.38 | 18 |
| X-ray ribs w/posterior anterior chest > 4 views bilateral CPT 71111 | not published | not published | $96.06 – $275.38 | 18 |
| X-ray sacroiliac joints >= 3 views CPT 72202 | not published | not published | $67.02 – $275.38 | 18 |
| X-ray sacrum/coccyx >= 2 views CPT 72220 | not published | not published | $55.10 – $228.00 | 18 |
| X-ray scapula complete (both sides) CPT 73010 | not published | not published | $51.89 – $275.38 | 18 |
| X-ray sella turcica CPT 70240 | not published | not published | $51.89 – $228.00 | 18 |
| X-ray shoulder 1 view (both sides) CPT 73020 | not published | not published | $41.93 – $228.00 | 18 |
| X-ray sinuses paranasal complete > 3 views CPT 70220 | not published | not published | $70.64 – $228.00 | 18 |
| X-ray sinus tract/fistula/abscess CPT 76080 | not published | not published | $96.06 – $1,419.82 | 18 |
| X-ray skull < 4 views CPT 70250 | not published | not published | $64.05 – $275.38 | 18 |
| X-ray skull > 4 views complete CPT 70260 | not published | not published | $82.18 – $275.38 | 18 |
| X-ray slg plne bdy sect without urogr CPT 76100 | not published | not published | $98.35 – $275.38 | 18 |
| X-ray small bowel multi serial images abdominal radiographs(s)&delayed images single contrast study CPT 74250 | not published | not published | $164.64 – $460.99 | 18 |
| X-ray small intestine follow-through study CPT 74248 | not published | not published | $154.19 – $154.19 | 1 |
| X-ray spine single view CPT 72020 | not published | not published | $41.93 – $228.00 | 18 |
| X-ray sternoclavicular joint(s) > 3 views CPT 71130 | not published | not published | $69.98 – $228.00 | 18 |
| X-ray sternum > 2 views CPT 71120 | not published | not published | $60.06 – $228.00 | 18 |
| X-ray surgical specimen CPT 76098 | not published | not published | $31.04 – $1,419.82 | 18 |
| X-ray swallowing function w/ciner/videoradiography neck radiographs(s)&delayed images contrast study CPT 74230 | not published | not published | $164.64 – $460.99 | 18 |
| X-ray temporomandibular joint open/closed mouth bilateral CPT 70330 | not published | not published | $81.43 – $228.00 | 18 |
| X-ray thoracic spine 2 views CPT 72070 | not published | not published | $60.06 – $275.38 | 18 |
| X-ray thoracic spine 3 views CPT 72072 | not published | not published | $72.60 – $275.38 | 18 |
| X-ray thoracolumbar spine >=2 views CPT 72080 | not published | not published | $64.05 – $228.00 | 18 |
| X-ray thoracolumbar spine including skull cervical & sacral spine 1 view CPT 72081 | not published | not published | $81.43 – $228.00 | 17 |
| X-ray thoracolumbar spine including skull cervical & sacral spine 2-3 views CPT 72082 | not published | not published | $98.35 – $275.38 | 17 |
| X-ray tibia/fibula 2 views (both sides) CPT 73590 | not published | not published | $48.89 – $228.00 | 18 |
| X-ray toe(s) > 2 views (both sides) CPT 73660 | not published | not published | $54.85 – $228.00 | 18 |
| X-ray upper gastrointestinal tract scout abdominal radiographs delayed images double contrast CPT 74246 | not published | not published | $164.64 – $460.99 | 18 |
| X-ray upper gastrointestinal tract scout abdominal radiographs delayed images single contrast study CPT 74240 | not published | not published | $164.64 – $460.99 | 18 |
| X-ray wrist 2 views (both sides) CPT 73100 | not published | not published | $52.85 – $228.00 | 18 |
| X-ray xm phrnx&/crv esoph c+ CPT 74210 | not published | not published | $154.63 – $460.99 | 18 |
| Xylose absorption test blood &/or urine CPT 84620 | not published | not published | $10.75 – $47.89 | 18 |
| Yersinia antibody CPT 86793 | not published | not published | $11.97 – $53.32 | 18 |
| Zika virus dna/rna amp probe CPT 87662 | not published | not published | $51.31 – $161.11 | 17 |
| Zika virus igm antibody CPT 86794 | not published | not published | $16.85 – $52.91 | 17 |
A missing value means the hospital did not publish that price — it never means the price is zero. Real bills can add facility fees, supplies and professional fees; see our methodology.