Imaging prices at Ellett Memorial Hospital

Appleton City, MO · every code in this section with a posted price and a Medicare benchmark.

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

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ProcedureCash priceGross charge× Medicare
Abdomen 2 views (74019) $45.56 $60.75 0.4×
Acute gastrointestinal blood loss imaging (78278) $167.81 $223.75 0.4×
Ankle 2 views (73600) $53.81 $71.75 0.6×
Antegrade urography radiological supvj & interpj (74425) $60 $80 0.2×
Arthrogram shoulder (73040) $93 $124 0.3×
Arthrography knee lt (73580) $93 $124 0.3×
Bone &/Joint Imaging Limited Area (78300) $108.47 $144.62 0.3×
Bone &/Joint Imaging Multiple Areas (78305) $141.75 $189 0.4×
Bone &/joint imaging whole body (78306) $145.50 $194 0.4×
Bone age studies (77072) $33.66 $44.88 0.3×
Bone Imaging 3 Phase (78315) $171.66 $228.88 0.4×
Bone survey complete (77075) $89.25 $119 0.9×
Brain image w/flow 4 + views (78606) $109.22 $145.62 0.2×
Brain Imaging Minimum 4 Static Views (78605) $90 $120 0.2×
Cervical spine 2 or 3 views (72040) $38.25 $51 0.4×
Chest 1 view (71045) $30.94 $41.25 0.4×
Chest 3 views (71047) $64.12 $85.50 0.7×
Cine/Vid X-Ray Throat/Esoph - Fl Esoph Barium Swlw W/ Video & Speech (74230) $115.50 $154 0.7×
Clavicle complete (73000) $57 $76 0.7×
Computed Tomography Thorax Lw Dose Lng Ca Scr C- (71271) $1,085.25 $1,447 10.4×
Corpora cavernosography (74445) $197.25 $263 1.9×
CT abdomen and pelvis without and with contrast (74178) $224.06 $298.75 0.6×
CT abdomen and pelvis without contrast (74176) $193.22 $257.62 0.8×
CT abdomen w contrast (74160) $215.16 $286.88 1.2×
CT abdomen w wo contrast (74170) $237.56 $316.75 1.4×
CT abdomen w/o contrast (74150) $201.56 $268.75 1.9×
CT angiography upper extremity lt (73206) $293.72 $391.62 1.7×
CT c-spine w/o contrast (72125) $196.31 $261.75 1.9×
CT cervical spine w&w/o contrast (72127) $215.16 $286.88 1.2×
CT cervical spine with contrast (72126) $204.75 $273 0.6×
CT chest w/wo contrast (71270) $233.25 $311 1.3×
CT chest with contrast (71260) $210.75 $281 1.2×
CT head/brain with contrast (70460) $192.56 $256.75 1.1×
CT head/brain without and with contrast (70470) $215.16 $286.88 1.2×
CT iac w contrast (70481) $233.25 $311 1.3×
CT limited/localized follow up study (76380) $164.25 $219 1.9×
CT lower ext w/o (73700) $369.56 $492.75 3.5×
CT lower extremity w wo contrast (73702) $204.75 $273 1.2×
CT lower extremity with contrast (73701) $196.50 $262 1.1×
CT lumbar spine w & w/o contrast (72133) $215.16 $286.88 1.2×
CT lumbar spine w/o contrast (72131) $196.31 $261.75 1.9×
CT lumbar spine with contrast (72132) $204.75 $273 0.6×
CT maxillofacial w contrast (70487) $220.31 $293.75 1.3×
CT maxillofacial w/o contrast (70486) $192.56 $256.75 1.8×
CT maxillofacial w/wo contrast (70488) $238.41 $317.88 1.4×
CT neck soft tissue w contrast (70491) $233.25 $311 1.3×
CT orbit sella/post fossa/ear w/o & w/contr matr (70482) $244.50 $326 1.4×
CT orbits w/o contrast (70480) $996.66 $1,328.88 9.5×
CT pelvis w & w/o contrast (72194) $204.75 $273 1.2×
CT pelvis w/o contrast (72192) $185.72 $247.62 1.8×
CT soft tissue neck w/o & w/contrast material (70492) $244.50 $326 1.4×
CT soft tissue neck w/o contrast (70490) $216 $288 2.1×
CT thoracic spine w/contrast (72129) $204.75 $273 1.2×
CT thoracic spine w/o contrast (72128) $196.31 $261.75 1.9×
CT thoracic spine w/wo contrast (72130) $215.16 $286.88 1.2×
CT thorax w/o contrast (71250) $196.31 $261.75 1.9×
CT upper extremity w/o & w/contrast material (73202) $204.75 $273 1.2×
CT upper extremity w/o contrast rt (73200) $369.56 $492.75 3.5×
CT upper extremity with contrast (73201) $196.50 $262 0.6×
Cta Abdl Aorta&Bi Iliofem W/Contrast&Postp (75635) $419.81 $559.75 2.4×
Cta Abdomen (74175) $273.66 $364.88 1.6×
CTA abdomen pelvis (74174) $296.25 $395 0.8×
CTA chest (71275) $210.75 $281 1.2×
Cta Head (70496) $249 $332 1.4×
CTA lwr ext w&w/o contrast (73706) $319.41 $425.88 1.8×
Cta Neck (70498) $248.81 $331.75 1.4×
Cystography minimum 3 views rs&i (74430) $55.50 $74 0.2×
Dxa bone density study 1/> sites axial skel (77080) $38.25 $51 0.4×
Echoencephalography real time imaging (76506) $115.22 $153.62 1.1×
Esophagus (74220) $79.50 $106 0.5×
Fetal biophysical profile non-stress testing (76818) $181.50 $242 1.7×
Fetal Biophysical Profile W/O Non-Stress Testing (76819) $130.88 $174.50 1.2×
Fluoroscopy up to 1 hr (76000) $116.06 $154.75 0.5×
Foot 2 views (73620) $53.81 $71.75 0.6×
Forearm 2 views (73090) $53.81 $71.75 0.6×
Gastric mucosa imaging (78261) $118.31 $157.75 0.3×
Gated Heart Planar Single (78472) $170.72 $227.62 0.4×
Hand 2 views (73120) $53.81 $71.75 0.5×
Hand 3 views (73130) $193.59 $258.12 2.2×
Heart Infarct Image (78466) $119.91 $159.88 0.3×
Hepatobil Syst Imag Inc Gb W/Pharma Intervenj (78227) $144.56 $192.75 0.3×
Hepatobiliary syst imaging including gallbladder (78226) $144.56 $192.75 0.4×
Ht muscle image spect sing (78451) $190.31 $253.75 0.1×
Humerus Min 2 Views Left (73060) $61.69 $82.25 0.7×
Hysterosalpingogram (74740) $66.75 $89 0.3×
Kidney funcj study non-img radioisotopic study (78725) $66.75 $89 0.2×
Kidney imaging morphology (78700) $77.81 $103.75 0.2×
Kidney Img Morphology Vascular Flow 1 W/O Rx (78707) $163.22 $217.62 0.3×
Kidney img morphology vascular flow 1 w/rx (78708) $204.75 $273 0.4×
Kidney Img Morphology Vascular Flow Multiple (78709) $238.41 $317.88 0.4×
Knee 3 views (73562) $202.03 $269.38 2.3×
Liver & spleen imaging static only (78215) $82.50 $110 0.2×
Liver & Spleen Imaging W/Vascular Flow (78216) $96.56 $128.75 0.2×
Liver imaging static only (78201) $75.56 $100.75 0.1×
Lung perfusion differential (78597) $212.06 $282.75 0.5×
Lung Ventilation Imaging (78579) $82.50 $110 0.2×
Lymphoscintigraphy (78195) $204.75 $273 0.4×
Meckels Diverticulum (78290) $116.06 $154.75 0.3×
MRA head w & w/o contrast (70546) $303.66 $404.88 0.9×
MRA head w/o contrast (70544) $203.81 $271.75 0.9×
MRA head with contrast (70545) $201.56 $268.75 0.6×
MRA neck w contrast (70548) $201.56 $268.75 0.6×
Mra Neck W/O &W/Contrast Material (70549) $303.66 $404.88 0.9×
MRA neck w/o contrast (70547) $201.56 $268.75 0.8×
MRI abdomen w contrast (74182) $292.97 $390.62 0.8×
MRI abdomen w/o & w/contrast material (74183) $379.31 $505.75 1.1×
MRI abdomen w/o contrast (74181) $244.50 $326 1.0×
MRI any jnt lwr ext with con lt (73722) $274.31 $365.75 0.3×
MRI any jt upper extremity w/contrast matrl (73222) $274.31 $365.75 0.3×
MRI bone marrow blood supply (77084) $270.56 $360.75 1.1×
MRI breast w/o contrast bilateral (77047) $224.91 $299.88 0.9×
MRI c-spine with contrast (72142) $326.06 $434.75 0.9×
MRI cardiac w/o contrast (75557) $271.41 $361.88 1.1×
MRI cervical spine w/o contrast (72141) $270.56 $360.75 1.1×
MRI chest w/o & w/contrast material (71552) $297.56 $396.75 0.9×
MRI chest w/o contrast (71550) $244.50 $326 1.0×
MRI Forearm w/ Contrast Bilateral 73219 (73219) $274.31 $365.75 0.8×
MRI lower extrem oth/thn jt w/contrast matrl (73719) $271.41 $361.88 0.8×
MRI lower extrem oth/thn jt w/o contr matrl (73718) $454.12 $605.50 1.9×
MRI orbit face &/neck w/o contrast (70540) $227.16 $302.88 1.0×
MRI orbit/face/neck w&w/o cont (70543) $363 $484 1.0×
MRI orbit/face/neck w/contrast (70542) $271.41 $361.88 0.8×
MRI pelvis w contrast (72196) $292.97 $390.62 0.8×
MRI pelvis w/o & w/contrast material (72197) $379.31 $505.75 1.1×
MRI pelvis w/o contrast (72195) $245.81 $327.75 1.0×
MRI scan of arm joint before and after contrast (73223) $363 $484 1.0×
MRI scan of leg joint before and after contrast (73723) $1,120.31 $1,493.75 3.2×
MRI spinal canal cervical w/o & w/contr matrl (72156) $430.97 $574.62 1.2×
MRI spinal canal lumbar w/contrast material (72149) $301.50 $402 0.9×
MRI spinal canal lumbar w/o & w/contr matrl (72158) $396 $528 1.1×
MRI spinal canal thoracic w/contrast matrl (72147) $323.81 $431.75 0.9×
MRI spinal canal thoracic w/o & w/contr matrl (72157) $430.97 $574.62 1.2×
MRI thoracic spine w/o contrast (72146) $270.56 $360.75 1.1×
MRI tmj (70336) $249.75 $333 1.0×
MRI upper ext joint w/o contrast (73221) $454.31 $605.75 1.9×
MRI upper extrem other than jt w/o & w/contras (73220) $1,120.31 $1,493.75 3.2×
MRI upper extremity oth than jt w/o contr matrl (73218) $908.34 $1,211.12 3.8×
Myelogram Lumbar (72265) $119.25 $159 0.2×
Myocardial infarct spect (78469) $160.41 $213.88 0.3×
Myocardial Spect Multiple Studies (78452) $410.72 $547.62 0.3×
Neck soft tissue (70360) $30.94 $41.25 0.4×
Nm gastric emptying study (78264) $131.06 $174.75 0.3×
Nm gastroesophageal reflux study (78262) $116.06 $154.75 0.3×
Ob Us Follow-Up Per Fetus - Us Ob Follow Up Transabdominal Approach (76816) $147.75 $197 1.4×
Osseous survey infant (77076) $118.31 $157.75 1.1×
Osseous survey limited (77074) $77.81 $103.75 0.7×
Parathyroid imaging (78070) $140.72 $187.62 0.4×
Pelvis 1 or 2 views (72170) $30.94 $41.25 0.3×
Pr heart first pass single,planar (78481) $173.91 $231.88 0.3×
Pr MRI, lower extr, w/o contrast f/u by contrast (73720) $1,119.19 $1,492.25 3.2×
Pulmonary Perfusion Imaging Particulate (78580) $126 $168 0.3×
Pulmonary Ventilation & Perfusion Imaging (78582) $188.81 $251.75 0.3×
Radex abscess/fistula/sinus tract rs&i (76080) $93 $124 0.2×
Radex entir thrc lmbr crv sac spi w/skull 2/3 vw (72082) $48 $64 0.5×
Radex hips bilateral with pelvis 2 views (73521) $135 $180 1.3×
Radex mastoids compl minimum 3 views pr side (70130) $55.88 $74.50 0.5×
Radiolog exam mandible compl minimum 4 views (70110) $41.81 $55.75 0.4×
Radiologic Exam Abdomen 1 View - Xr Abdomen 1 View (74018) $30.94 $41.25 0.4×
Radiologic Exam Chest 2 Views - Xr Chest 2 Views (71046) $38.25 $51 0.4×
Radiologic exam colon single contrast study (74270) $116.06 $154.75 0.7×
Radiologic exam upr gi trc double contrast study (74246) $116.06 $154.75 0.7×
Radiologic exam upr gi trc single contrast study (74240) $116.06 $154.75 0.7×
Radiologic Examination Femur Minimum 2 Views - Xr Femur 2+ Vw Lt (73552) $61.69 $82.25 0.7×
Radiological examination surgical specimen (76098) $27.19 $36.25 0.0×
Ribs bilateral 3 views (71110) $45.66 $60.88 0.4×
Sacroiliac Joints < 3 Views (72200) $30.94 $41.25 0.3×
Scanogram (77073) $45.56 $60.75 0.4×
Scapula complete (73010) $385.22 $513.62 3.7×
Small bowel series (74250) $79.41 $105.88 0.5×
Spine thoracic 3 views (72072) $38.25 $51 0.4×
Testicular Imaging With Vascular Flow (78761) $122.16 $162.88 0.3×
Thoracolumbar 2 views (72080) $72.47 $96.62 0.8×
Thyroid Imaging With Vascular Flow (78013) $68.06 $90.75 0.2×
Thyroid uptake measurement (78012) $45.66 $60.88 0.1×
Thyroid Uptake W/Blood Flow Sngle/Mult Quan Meas (78014) $82.50 $110 0.2×
Tomogram (76100) $99.75 $133 1.0×
Ultrasound scan of cornea to determine thickness (76514) $30.75 $41 1.1×
Ultrasound, abdomen limited (76705) $101.16 $134.88 1.0×
Upper Extremity Infant (73092) $53.91 $71.88 0.5×
Urethrocystography voiding (74455) $59.72 $79.62 0.2×
Urography (pyelography), intravenous, with or without KUB, with or without tomography (74400) $82.50 $110 0.5×
Urograpy infusion drip &/bolus techq w/wo tomo (74415) $114 $152 0.6×
Us abdl aorta screen aaa (76706) $93.75 $125 0.9×
Us breast unilateral limited (76642) $185.81 $247.75 2.1×
Us chest (76604) $93 $124 0.9×
Us infant hips dynamic (76885) $126 $168 1.4×
Us ob detailed single fetus (76811) $240.66 $320.88 1.0×
Us ob transvaginal (76817) $115.88 $154.50 1.1×
Us pelvic non ob complete (76856) $118.31 $157.75 1.1×
Us pelvic nonobstetric image dcmtn limited/f/u (76857) $66.75 $89 0.6×
Us pregnancy ltd (76815) $110.81 $147.75 1.1×
Us pregnant uterus 14 wk transabdl 1/1st gestat (76801) $160.50 $214 1.5×
Us retroperitoneal complete (76770) $126 $168 1.2×
Us retroperitoneal limited (76775) $99.75 $133 1.0×
Us scrotum and contents (76870) $110.91 $147.88 1.1×
Us soft tissue head/neck (76536) $93.75 $125 0.9×
Us spinal canal and contents (76800) $188.81 $251.75 1.8×
Us transrectal (76872) $119.81 $159.75 1.1×
Us xtr non-vasc lmtd (76882) $46.50 $62 0.4×
Vascular flow imaging (78445) $85.31 $113.75 0.2×
Venography extremity unilateral rs&i (75820) $119.81 $159.75 0.1×
Venography venous sinus/jugular cath rs&i (75860) $197.25 $263 0.1×
Wrist 2 views (73100) $215.16 $286.88 2.5×
X-Ray Abdomen,Comp Acute Series - Xr Abdomen 2 Vws With Chest 1 View (74022) $55.50 $74 0.5×
X-Ray Ac Jts - Xr Acromioclavicular Joints Bilateral (73050) $36.94 $49.25 0.4×
X-Ray Ankle 3+ Vw - Xr Ankle 3+ Views Right (73610) $61.69 $82.25 0.7×
X-Ray Colon Air Contrast - Fl Barium Enema Air Contrast (74280) $167.06 $222.75 1.0×
X-Ray Elbow 2 Vw - Xr Elbow 1-2 Views Right (73070) $53.81 $71.75 0.6×
X-Ray Elbow 3+ Vw - Xr Elbow 3+ Views Right (73080) $61.69 $82.25 0.7×
X-ray exam hip uni 1 view (73501) $156.84 $209.12 1.8×
X-Ray Exam Hip Uni 2-3 Views (73502) $66.75 $89 0.8×
X-Ray Exam Hips Bi 3-4 Views (73522) $73.69 $98.25 0.7×
X-Ray Exam Hips Bi 5/> Views (73523) $238.88 $318.50 2.3×
X-ray eye for foreign body (70030) $31.22 $41.62 0.4×
X-Ray Facial Bones 3+ Vw - Xr Facial Bones 3+ Views (70150) $44.62 $59.50 0.4×
X-Ray Facial Bones <3 Vw - Xr Facial Bones 1-2 Views (70140) $33.66 $44.88 0.4×
X-Ray Foot 3+ Vw - Xr Foot 3+ Views Right (73630) $199.59 $266.12 2.3×
X-Ray Heel - Xr Calcaneus 2 Views Right (73650) $101.53 $135.38 1.2×
X-ray IV pyelogram+drip infusn (74410) $82.50 $110 0.5×
X-Ray Knee 4+ View - Xr Knee 4+ Views Right (73564) $270.84 $361.12 2.6×
X-Ray Knee Bilat Standing - Xr Knees Anteroposterior Standing Bilat (73565) $30.94 $41.25 0.4×
X-Ray Leg, Infant - Xr Lower Extremity 2+ Views Infant Left (73592) $53.81 $71.75 0.6×
X-Ray Lumbar Spine 2/3 Vw - Xr Lumbar Spine 2-3 Views (72100) $38.25 $51 0.4×
X-Ray Lumbar Spine 6+ Vw - Xr Lumbar Spine 6+ Vws Including Bending (72114) $62.91 $83.88 0.6×
X-Ray Nasal Bones - Xr Nasal Bones (70160) $30.94 $41.25 0.4×
X-Ray Nose-Rectum Child F.B. - Xr Nose to Rectum Foreign Body Peds (76010) $26.81 $35.75 0.3×
X-Ray Orbits - Xr Orbits Complete 4+ Views (70200) $48 $64 0.5×
X-Ray Pelvis 3+ Vw - Xr Pelvis 3+ Views (72190) $36.94 $49.25 0.4×
X-Ray Retrograde Pyelogram - Fl Pyelogram Retrograde (74420) $62.81 $83.75 0.2×
X-Ray Ribs 2 Vw Unilat - Xr Ribs 2 Views Right (71100) $205.50 $274 2.4×
X-Ray Ribs, Chest 3+ Vw - Xr Ribs 2 Vws Lt W/ Chest Anteroposterior (71101) $45.56 $60.75 0.4×
X-Ray Ribs, Chest 4+ Vw - Xr Ribs 3 Vws Bil W/ Chest Posteroanterior (71111) $76.31 $101.75 0.7×
X-Ray Sacroiliac Jts 3+ Vw - Xr Sacroiliac Joints 3+ Views (72202) $33.56 $44.75 0.3×
X-Ray Sacrum/Coccyx 2+ Vw - Xr Sacrum Coccyx 2+ Views (72220) $30.94 $41.25 0.4×
X-Ray Shoulder 2+ Vw - Xr Shoulder 2+ Views Right (73030) $194.53 $259.38 2.2×
X-Ray Sinuses 3+ Vw - Xr Paranasal Sinuses 3+ Views (70220) $41.81 $55.75 0.5×
X-Ray Sinuses <3 Vw - Xr Paranasal Sinuses 1-2 Views (70210) $31.22 $41.62 0.4×
X-Ray Skull 4+ Vw - Xr Skull Complete 4+ Views (70260) $52.50 $70 0.5×
X-Ray Skull <4 Vw - Xr Skull 1-3 Views (70250) $41.91 $55.88 0.4×
X-Ray Spine One View - Xr Spine (72020) $27 $36 0.3×
X-Ray Sternum 2+ Vw - Xr Sternum 2+ Views (71120) $36.94 $49.25 0.4×
X-Ray Teeth Single - Xr Teeth 1 View (70300) $22.31 $29.75 0.3×
X-Ray Thoracic Spine 2 Vw - Xr Thoracic Spine 2 Views (72070) $38.25 $51 0.4×
X-Ray Thoracic Spine 4 Vw - Xr Thoracic Spine Complete 4+ Views (72074) $38.25 $51 0.4×
X-Ray Toe(S) - Xr Toes 2+ Views Right (73660) $149.16 $198.88 1.7×
X-Ray Wrist 3+ Vw - Xr Wrist 3+ Views Right (73110) $53.81 $71.75 0.6×
Xr c-spine 6 or more views (72052) $62.81 $83.75 0.6×
Xr chest 4+ views (71048) $53.06 $70.75 0.5×
Xr Cholecystography Oral Contrast (74290) $55.50 $74 0.3×
Xr finger(s) 2+ views (73140) $46.31 $61.75 0.5×
XR Mastoids < 3 Views Bilateral (70120) $31.22 $41.62 0.3×
Xr shoulder 1 view (73020) $53.81 $71.75 0.6×
Xr spine cervical 4 or 5 views (72050) $53.06 $70.75 0.5×
Xr tibia/fibula 2 views (73590) $170.91 $227.88 2.0×
Xr tmj bilateral (70330) $42 $56 0.5×
Xray knee 1 or 2 views rt (73560) $185.62 $247.50 2.1×