Imaging prices at Republic County Hospital

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

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

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ProcedureCash priceGross charge× Medicare
Abdomen 2 views (74019) $274.50 $366 2.9×
Acute gastrointestinal blood loss imaging (78278) $240 $320 0.7×
Ankle 2 views (73600) $325.50 $434 4.1×
Antegrade urography radiological supvj & interpj (74425) $477 $636 1.5×
Arthrogram hip (73525) $495.75 $661 1.5×
Arthrogram shoulder (73040) $747 $996 2.3×
Arthrography knee lt (73580) $331.50 $442 1.0×
Bone &/Joint Imaging Limited Area (78300) $405.75 $541 1.1×
Bone &/Joint Imaging Multiple Areas (78305) $342.75 $457 0.9×
Bone &/joint imaging whole body (78306) $468.75 $625 1.3×
Bone age studies (77072) $241.50 $322 2.5×
Bone Imaging 3 Phase (78315) $487.50 $650 1.3×
Bone survey complete (77075) $600 $800 6.2×
Cervical spine 2 or 3 views (72040) $260.25 $347 3.3×
Chest 1 view (71045) $260.25 $347 3.3×
Chest 3 views (71047) $369 $492 4.6×
Cine/Vid X-Ray Throat/Esoph - Fl Esoph Barium Swlw W/ Video & Speech (74230) $325.50 $434 2.0×
Clavicle complete (73000) $241.50 $322 3.0×
Computed Tomography Thorax Lw Dose Lng Ca Scr C- (71271) $675 $900 7.0×
CT abdomen and pelvis without and with contrast (74178) $1,012.50 $1,350 3.2×
CT abdomen and pelvis without contrast (74176) $900 $1,200 4.1×
CT abdomen w contrast (74160) $900 $1,200 5.6×
CT abdomen w wo contrast (74170) $1,012.50 $1,350 6.3×
CT abdomen w/o contrast (74150) $900 $1,200 9.4×
CT angiography upper extremity lt (73206) $1,012.50 $1,350 6.3×
CT c-spine w/o contrast (72125) $900 $1,200 9.4×
CT cervical spine with contrast (72126) $900 $1,200 2.8×
CT chest w/wo contrast (71270) $1,012.50 $1,350 6.3×
CT chest with contrast (71260) $900 $1,200 5.6×
CT head/brain with contrast (70460) $900 $1,200 5.6×
CT head/brain without and with contrast (70470) $1,012.50 $1,350 6.3×
CT heart no contrast quant eval coronry calcium (75571) $360 $480 4.5×
CT iac w contrast (70481) $900 $1,200 5.6×
CT limited/localized follow up study (76380) $675 $900 8.4×
CT lower ext w/o (73700) $900 $1,200 9.4×
CT lower extremity w wo contrast (73702) $1,012.50 $1,350 6.3×
CT lower extremity with contrast (73701) $900 $1,200 5.6×
CT lumbar spine w & w/o contrast (72133) $1,012.50 $1,350 6.3×
CT lumbar spine w/o contrast (72131) $900 $1,200 9.4×
CT lumbar spine with contrast (72132) $900 $1,200 2.8×
CT maxillofacial w contrast (70487) $900 $1,200 5.6×
CT maxillofacial w/o contrast (70486) $900 $1,200 9.4×
CT maxillofacial w/wo contrast (70488) $1,012.50 $1,350 6.3×
CT neck soft tissue w contrast (70491) $900 $1,200 5.6×
CT orbit sella/post fossa/ear w/o & w/contr matr (70482) $1,012.50 $1,350 6.3×
CT orbits w/o contrast (70480) $900 $1,200 9.4×
CT pelvis w & w/o contrast (72194) $1,012.50 $1,350 6.3×
CT pelvis w/o contrast (72192) $900 $1,200 9.4×
CT soft tissue neck w/o & w/contrast material (70492) $1,012.50 $1,350 6.3×
CT soft tissue neck w/o contrast (70490) $900 $1,200 9.4×
CT thoracic spine w/o contrast (72128) $900 $1,200 9.4×
CT thoracic spine w/wo contrast (72130) $1,012.50 $1,350 6.3×
CT thorax w/o contrast (71250) $900 $1,200 9.4×
CT upper extremity w/o & w/contrast material (73202) $1,012.50 $1,350 6.3×
CT upper extremity w/o contrast rt (73200) $900 $1,200 9.4×
CT upper extremity with contrast (73201) $900 $1,200 2.8×
Cta Abdl Aorta&Bi Iliofem W/Contrast&Postp (75635) $1,350 $1,800 8.4×
Cta Abdomen (74175) $1,012.50 $1,350 6.3×
CTA abdomen pelvis (74174) $900 $1,200 2.8×
CTA chest (71275) $1,012.50 $1,350 6.3×
Cta Head (70496) $1,012.50 $1,350 6.3×
CTA lwr ext w&w/o contrast (73706) $900 $1,200 5.6×
Cta Neck (70498) $1,012.50 $1,350 6.3×
Cta Pelvis (72191) $1,012.50 $1,350 6.3×
Cystography minimum 3 views rs&i (74430) $430.50 $574 1.3×
Dxa bone density study 1/> sites axial skel (77080) $260.25 $347 2.7×
Dxa bone density study 1/>sites appendiclr skel (77081) $68.25 $91 0.9×
Esophagus (74220) $406.50 $542 2.5×
Fetal biophysical profile non-stress testing (76818) $450 $600 4.7×
Fetal Biophysical Profile W/O Non-Stress Testing (76819) $374.25 $499 3.9×
Fluoroscopy up to 1 hr (76000) $325.50 $434 1.5×
Foot 2 views (73620) $217.50 $290 2.7×
Forearm 2 views (73090) $250.50 $334 3.1×
Gated Heart Planar Single (78472) $803.25 $1,071 2.2×
Hand 2 views (73120) $217.50 $290 2.3×
Hand 3 views (73130) $250.50 $334 3.1×
Hepatobil Syst Imag Inc Gb W/Pharma Intervenj (78227) $717 $956 1.4×
Hepatobiliary syst imaging including gallbladder (78226) $618 $824 1.7×
Ht muscle image spect sing (78451) $787.50 $1,050 0.7×
Humerus Min 2 Views Left (73060) $250.50 $334 3.1×
Hysterosalpingogram (74740) $718.50 $958 3.3×
Kidney img morphology vascular flow 1 w/rx (78708) $669.75 $893 1.3×
Knee 3 views (73562) $217.50 $290 2.7×
Liver & spleen imaging static only (78215) $405.75 $541 1.1×
Liver & Spleen Imaging W/Vascular Flow (78216) $456.75 $609 1.2×
MRA head w & w/o contrast (70546) $1,462.50 $1,950 4.6×
MRA head w/o contrast (70544) $1,350 $1,800 6.2×
MRA head with contrast (70545) $1,350 $1,800 4.2×
MRA neck w contrast (70548) $1,350 $1,800 4.2×
Mra Neck W/O &W/Contrast Material (70549) $1,462.50 $1,950 4.6×
MRA neck w/o contrast (70547) $1,350 $1,800 6.2×
MRI abdomen w contrast (74182) $1,350 $1,800 4.2×
MRI abdomen w/o & w/contrast material (74183) $1,462.50 $1,950 4.6×
MRI abdomen w/o contrast (74181) $1,350 $1,800 6.2×
MRI any jnt lwr ext with con lt (73722) $1,350 $1,800 1.9×
MRI any jt upper extremity w/contrast matrl (73222) $1,350 $1,800 1.9×
MRI bone marrow blood supply (77084) $885.75 $1,181 4.0×
MRI c-spine with contrast (72142) $1,350 $1,800 4.2×
MRI cardiac w/o contrast (75557) $1,350 $1,800 6.2×
MRI cervical spine w/o contrast (72141) $1,350 $1,800 6.2×
MRI chest w/o & w/contrast material (71552) $1,181.25 $1,575 3.7×
MRI chest w/o contrast (71550) $1,012.50 $1,350 4.6×
MRI chest with contrast (71551) $1,012.50 $1,350 1.4×
MRI Forearm w/ Contrast Bilateral 73219 (73219) $1,350 $1,800 4.2×
MRI lower extrem oth/thn jt w/contrast matrl (73719) $1,350 $1,800 4.2×
MRI lower extrem oth/thn jt w/o contr matrl (73718) $1,350 $1,800 6.2×
MRI orbit face &/neck w/o contrast (70540) $1,350 $1,800 6.2×
MRI orbit/face/neck w&w/o cont (70543) $1,462.50 $1,950 4.6×
MRI orbit/face/neck w/contrast (70542) $1,350 $1,800 4.2×
MRI pelvis w contrast (72196) $1,350 $1,800 4.2×
MRI pelvis w/o & w/contrast material (72197) $1,462.50 $1,950 4.6×
MRI pelvis w/o contrast (72195) $1,350 $1,800 6.2×
MRI scan of arm joint before and after contrast (73223) $1,462.50 $1,950 4.6×
MRI scan of leg joint before and after contrast (73723) $1,462.50 $1,950 4.6×
MRI spinal canal cervical w/o & w/contr matrl (72156) $1,462.50 $1,950 4.6×
MRI spinal canal lumbar w/contrast material (72149) $1,350 $1,800 4.2×
MRI spinal canal lumbar w/o & w/contr matrl (72158) $1,462.50 $1,950 4.6×
MRI spinal canal thoracic w/contrast matrl (72147) $1,350 $1,800 4.2×
MRI spinal canal thoracic w/o & w/contr matrl (72157) $1,462.50 $1,950 4.6×
MRI thoracic spine w/o contrast (72146) $1,350 $1,800 6.2×
MRI tmj (70336) $1,350 $1,800 6.2×
MRI upper ext joint w/o contrast (73221) $1,350 $1,800 6.2×
MRI upper extrem other than jt w/o & w/contras (73220) $1,462.50 $1,950 4.6×
MRI upper extremity oth than jt w/o contr matrl (73218) $1,181.25 $1,575 5.4×
Myelogram Cervical (72240) $2,762.25 $3,683 3.8×
Myelogram Lumbar (72265) $2,646 $3,528 3.7×
Myocardial Spect Multiple Studies (78452) $787.50 $1,050 0.7×
Neck soft tissue (70360) $189 $252 2.4×
Nm gastric emptying study (78264) $381.75 $509 1.0×
Nuclear medicine study of kidney and blood flow (78701) $285.75 $381 0.8×
Nuclear Rx Oral Admin (79005) $252 $336 1.2×
Ob Us Follow-Up Per Fetus - Us Ob Follow Up Transabdominal Approach (76816) $240 $320 2.5×
Osseous survey infant (77076) $250.50 $334 2.6×
Osseous survey limited (77074) $325.50 $434 3.4×
Parathyroid imaging (78070) $603.75 $805 1.6×
Pelvis 1 or 2 views (72170) $212.25 $283 2.2×
Pr MRI, lower extr, w/o contrast f/u by contrast (73720) $1,462.50 $1,950 4.6×
Pulmonary Perfusion Imaging Particulate (78580) $405.75 $541 1.1×
Pulmonary Ventilation & Perfusion Imaging (78582) $618 $824 1.2×
Radex abscess/fistula/sinus tract rs&i (76080) $638.25 $851 1.3×
Radex Entir Thrc Lmbr Crv Sac Spi W/Skull 1 Vw - Xr Scoliosis 1 Vw (72081) $331.50 $442 4.1×
Radex entir thrc lmbr crv sac spi w/skull 2/3 vw (72082) $354.75 $473 3.7×
Radex hips bilateral with pelvis 2 views (73521) $369 $492 3.8×
Radex mastoids compl minimum 3 views pr side (70130) $321 $428 3.3×
Radex X-Ray Exam Entire Spi 6/> Vw - Xr Entire Spine 6+ Vw (72084) $671.25 $895 7.0×
Radiolog exam mandible compl minimum 4 views (70110) $316.50 $422 3.3×
Radiologic Exam Abdomen 1 View - Xr Abdomen 1 View (74018) $217.50 $290 2.7×
Radiologic Exam Abdomen 3+ Views - Xr Abdomen 3+ Views (74021) $406.50 $542 4.2×
Radiologic Exam Chest 2 Views - Xr Chest 2 Views (71046) $288 $384 3.6×
Radiologic exam colon single contrast study (74270) $1,039.50 $1,386 6.4×
Radiologic exam upr gi trc double contrast study (74246) $514.50 $686 3.2×
Radiologic exam upr gi trc single contrast study (74240) $444.75 $593 2.8×
Radiologic Examination Femur Minimum 2 Views - Xr Femur 2+ Vw Lt (73552) $288 $384 3.6×
Radiological examination surgical specimen (76098) $78.75 $105 0.2×
Ribs bilateral 3 views (71110) $369 $492 3.8×
Sacroiliac Joints < 3 Views (72200) $297.75 $397 3.1×
Scanogram (77073) $274.50 $366 2.9×
Scapula complete (73010) $241.50 $322 2.5×
Screening digital breast tomosynthesis (77063) $75 $100 3.2×
Sialogram (70390) $647.25 $863 2.9×
Small bowel series (74250) $552.75 $737 3.4×
Spine thoracic 3 views (72072) $336 $448 3.5×
Thoracolumbar 2 views (72080) $369 $492 4.6×
Thyroid Imaging With Vascular Flow (78013) $483.75 $645 1.3×
Thyroid uptake measurement (78012) $292.50 $390 0.8×
Thyroid Uptake W/Blood Flow Sngle/Mult Quan Meas (78014) $675 $900 1.8×
Tmj unilateral (70328) $250.50 $334 3.1×
Ultrasound, abdomen limited (76705) $236.25 $315 2.5×
Umbilical-artery Doppler (OB) (76820) $450 $600 4.7×
Urethrocystography voiding (74455) $336 $448 1.5×
Urography (pyelography), intravenous, with or without KUB, with or without tomography (74400) $444.75 $593 2.8×
Us abdl aorta screen aaa (76706) $135 $180 1.4×
Us breast unilateral complete (76641) $390 $520 4.1×
Us breast unilateral limited (76642) $258.75 $345 3.2×
Us chest (76604) $750 $1,000 7.8×
Us compl joint r-t w/image documentation (76881) $173.25 $231 1.8×
Us ob transvaginal (76817) $240 $320 2.5×
Us pelvic non ob complete (76856) $216.75 $289 2.3×
Us pelvic nonobstetric image dcmtn limited/f/u (76857) $153.75 $205 1.6×
Us pregnancy ltd (76815) $240 $320 2.5×
Us pregnant uterus 14 wk transabdl 1/1st gestat (76801) $292.50 $390 3.0×
Us retroperitoneal complete (76770) $750 $1,000 7.8×
Us retroperitoneal limited (76775) $236.25 $315 2.5×
Us scrotum and contents (76870) $197.25 $263 2.1×
Us soft tissue head/neck (76536) $487.50 $650 5.1×
Us transrectal (76872) $110.25 $147 1.1×
Us xtr non-vasc lmtd (76882) $126 $168 1.3×
Venogram extremity bilateral (75822) $1,039.50 $1,386 0.7×
Venography extremity unilateral rs&i (75820) $684.75 $913 0.5×
Wrist 2 views (73100) $217.50 $290 2.7×
X-Ray Abdomen,Comp Acute Series - Xr Abdomen 2 Vws With Chest 1 View (74022) $585.75 $781 6.1×
X-Ray Ac Jts - Xr Acromioclavicular Joints Bilateral (73050) $297.75 $397 3.7×
X-Ray Ankle 3+ Vw - Xr Ankle 3+ Views Right (73610) $250.50 $334 3.1×
X-Ray Colon Air Contrast - Fl Barium Enema Air Contrast (74280) $1,039.50 $1,386 6.4×
X-Ray Elbow 2 Vw - Xr Elbow 1-2 Views Right (73070) $217.50 $290 2.7×
X-Ray Elbow 3+ Vw - Xr Elbow 3+ Views Right (73080) $250.50 $334 3.1×
X-ray exam entire spi 4/5 vw (72083) $401.25 $535 4.2×
X-ray exam hip uni 1 view (73501) $217.50 $290 2.7×
X-Ray Exam Hip Uni 2-3 Views (73502) $321 $428 4.0×
X-ray exam hip uni 4/> views (73503) $354.75 $473 3.7×
X-Ray Exam Hips Bi 3-4 Views (73522) $426 $568 4.4×
X-Ray Exam Hips Bi 5/> Views (73523) $449.25 $599 4.7×
X-ray exam of femur 1 (73551) $309.75 $413 3.9×
X-ray eye for foreign body (70030) $68.25 $91 0.9×
X-Ray Facial Bones 3+ Vw - Xr Facial Bones 3+ Views (70150) $321 $428 3.3×
X-Ray Facial Bones <3 Vw - Xr Facial Bones 1-2 Views (70140) $217.50 $290 2.7×
X-Ray Foot 3+ Vw - Xr Foot 3+ Views Right (73630) $250.50 $334 3.1×
X-Ray Heel - Xr Calcaneus 2 Views Right (73650) $217.50 $290 2.7×
X-Ray Jaw <4 Vw - Xr Mandible < 4 Views (70100) $212.25 $283 2.7×
X-Ray Knee 4+ View - Xr Knee 4+ Views Right (73564) $321 $428 3.3×
X-Ray Knee Bilat Standing - Xr Knees Anteroposterior Standing Bilat (73565) $250.50 $334 3.1×
X-Ray Lumbar Spine 2/3 Vw - Xr Lumbar Spine 2-3 Views (72100) $279 $372 2.9×
X-Ray Lumbar Spine 6+ Vw - Xr Lumbar Spine 6+ Vws Including Bending (72114) $501 $668 5.2×
X-Ray Lumbar Spine Flex/Exten - Xr Lumbar Spine 4+ Views W/ Flex Ext (72120) $477 $636 5.0×
X-Ray Nasal Bones - Xr Nasal Bones (70160) $279 $372 3.5×
X-Ray Orbits - Xr Orbits Complete 4+ Views (70200) $321 $428 3.3×
X-Ray Pelvis 3+ Vw - Xr Pelvis 3+ Views (72190) $260.25 $347 2.7×
X-Ray Ribs 2 Vw Unilat - Xr Ribs 2 Views Right (71100) $297.75 $397 3.7×
X-Ray Ribs, Chest 3+ Vw - Xr Ribs 2 Vws Lt W/ Chest Anteroposterior (71101) $369 $492 3.8×
X-Ray Ribs, Chest 4+ Vw - Xr Ribs 3 Vws Bil W/ Chest Posteroanterior (71111) $463.50 $618 4.8×
X-Ray Sacroiliac Jts 3+ Vw - Xr Sacroiliac Joints 3+ Views (72202) $325.50 $434 3.4×
X-Ray Sacrum/Coccyx 2+ Vw - Xr Sacrum Coccyx 2+ Views (72220) $279 $372 3.5×
X-Ray Shoulder 2+ Vw - Xr Shoulder 2+ Views Right (73030) $260.25 $347 3.3×
X-Ray Sinuses 3+ Vw - Xr Paranasal Sinuses 3+ Views (70220) $321 $428 4.0×
X-Ray Sinuses <3 Vw - Xr Paranasal Sinuses 1-2 Views (70210) $212.25 $283 2.7×
X-Ray Skull 4+ Vw - Xr Skull Complete 4+ Views (70260) $321 $428 3.3×
X-Ray Skull <4 Vw - Xr Skull 1-3 Views (70250) $212.25 $283 2.2×
X-Ray Spine One View - Xr Spine (72020) $204 $272 2.5×
X-Ray Sterno-Clavicluar Jt - Xr Sternoclavicular Joints 3+ Views (71130) $279 $372 3.5×
X-Ray Sternum 2+ Vw - Xr Sternum 2+ Views (71120) $279 $372 3.5×
X-Ray Thoracic Spine 2 Vw - Xr Thoracic Spine 2 Views (72070) $250.50 $334 2.6×
X-Ray Toe(S) - Xr Toes 2+ Views Right (73660) $217.50 $290 2.7×
X-Ray Wrist 3+ Vw - Xr Wrist 3+ Views Right (73110) $250.50 $334 3.1×
Xr c-spine 6 or more views (72052) $369 $492 3.8×
Xr chest 4+ views (71048) $514.50 $686 5.4×
Xr finger(s) 2+ views (73140) $217.50 $290 2.7×
XR Mastoids < 3 Views Bilateral (70120) $212.25 $283 2.2×
Xr shoulder 1 view (73020) $193.50 $258 2.4×
Xr spine cervical 4 or 5 views (72050) $350.25 $467 3.6×
Xr tibia/fibula 2 views (73590) $288 $384 3.6×
Xr tmj bilateral (70330) $321 $428 4.0×
Xray knee 1 or 2 views rt (73560) $217.50 $290 2.7×