Imaging prices at Republic County Hospital

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

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

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ProcedurePosted cashPosted gross× Medicare
Abdomen 1 View (74018) $217.50 $290 2.7×
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×
Arthrogram hip (73525) $495.75 $661 1.5×
Bone age studies (77072) $241.50 $322 2.5×
Bone Imaging 3 Phase (78315) $487.50 $650 1.3×
Bone Imaging Limited Area (78300) $405.75 $541 1.1×
Bone Imaging Multiple Areas (78305) $342.75 $457 0.9×
Bone Imaging Whole Body (78306) $468.75 $625 1.3×
Bone survey infant (77076) $250.50 $334 2.6×
Cat Scan Follow-Up Study (76380) $675 $900 8.4×
Chest 1 view (71045) $260.25 $347 3.3×
Chest 2 views (71046) $288 $384 3.6×
Chest 3 views (71047) $369 $492 4.6×
Chest 4 or more views (71048) $514.50 $686 5.4×
Clavicle complete (73000) $241.50 $322 3.0×
Computed Tomography Thorax Lw Dose Lng Ca Scr C- (71271) $675 $900 7.0×
Contrast X-Ray Bladder (74430) $430.50 $574 1.3×
Contrast X-Ray Of Knee Joint (73580) $331.50 $442 1.0×
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 Angio Abdomen and Pelvis (74174) $900 $1,200 2.8×
CT Angio Chest (71275) $1,012.50 $1,350 6.3×
CT Angio Head (70496) $1,012.50 $1,350 6.3×
Ct Angio Lwr Extr W/O&W/Dye (73706) $900 $1,200 5.6×
CT Angio Neck (70498) $1,012.50 $1,350 6.3×
Ct Angio Upr Extrm W/O&W/Dye (73206) $1,012.50 $1,350 6.3×
CT cervical spine w/ contrast (72126) $900 $1,200 2.8×
CT cervical spine w/o contrast (72125) $900 $1,200 9.4×
CT chest w contrast (71260) $900 $1,200 5.6×
CT chest w/wo contrast (71270) $1,012.50 $1,350 6.3×
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 l-spine w&w/o contrast (72133) $1,012.50 $1,350 6.3×
CT lower ext w/o (73700) $900 $1,200 9.4×
CT lower extremity w/contrast material (73701) $900 $1,200 5.6×
CT lumbar spine w contrast (72132) $900 $1,200 2.8×
CT lumbar spine w/o contrast (72131) $900 $1,200 9.4×
CT maxillofacial w contrast (70487) $900 $1,200 5.6×
CT maxillofacial wo contrast (70486) $900 $1,200 9.4×
CT neck tissue combo (70492) $1,012.50 $1,350 6.3×
Ct Orbit/Ear/Fossa W/O&W/Dye (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 scan of leg combo (73702) $1,012.50 $1,350 6.3×
CT scans face/jaw combo (70488) $1,012.50 $1,350 6.3×
CT soft tissue neck w contrast (70491) $900 $1,200 5.6×
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 cont (72130) $1,012.50 $1,350 6.3×
CT thorax w/o contrast (71250) $900 $1,200 9.4×
CT upper ext wo (73200) $900 $1,200 9.4×
CT upper extremity w/o & w/contrast material (73202) $1,012.50 $1,350 6.3×
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 head&neck c+ w/noncontrast img&post-pxessing (70471) $2,025 $2,700 6.3×
CTA pelvis (72191) $1,012.50 $1,350 6.3×
Dxa Bone Density Axial (77080) $260.25 $347 2.7×
Dxa bone density study 1/>sites appendiclr skel (77081) $68.25 $91 0.9×
Esophagram (74220) $406.50 $542 2.5×
Fetal Biophys Profile W/Nst (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×
Gastric emptying imaging study (78264) $381.75 $509 1.0×
Gated Heart Planar Single (78472) $803.25 $1,071 2.2×
Hand 2 views (73120) $217.50 $290 2.3×
Hepatobil Syst Image W/Drug (78227) $717 $956 1.4×
Hepatobiliary System Imaging (78226) $618 $824 1.7×
Ht Muscle Image Spect Sing (78451) $787.50 $1,050 0.7×
Hysterosalpingogram (74740) $718.50 $958 3.3×
K Flow/Funct Image W/Drug (78708) $669.75 $893 1.3×
Kidney Imaging Morphoogy W/Vascular Flow (78701) $285.75 $381 0.8×
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×
Lung Ventilat&Perfus Imaging (78582) $618 $824 1.2×
Magnetic Image Jaw Joint (70336) $1,350 $1,800 6.2×
Mra Head W/O & W/Contrast Material (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 contrast (74181) $1,350 $1,800 6.2×
MRI any jt lower extrem w/contrast material (73722) $1,350 $1,800 1.9×
MRI any jt lower extrem w/o & w/contrast matrl (73723) $1,462.50 $1,950 4.6×
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 cardiac w/o contrast (75557) $1,350 $1,800 6.2×
MRI cervical spine w contrast (72142) $1,350 $1,800 4.2×
MRI cervical spine w/o cont (72141) $1,350 $1,800 6.2×
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 chest wo w contrast (71552) $1,181.25 $1,575 3.7×
MRI lower extrem oth/thn jt w/contrast matrl (73719) $1,350 $1,800 4.2×
MRI lower extrem oth/thn jt w/o & w/contr matr (73720) $1,462.50 $1,950 4.6×
MRI lower extrem oth/thn jt w/o contr matrl (73718) $1,350 $1,800 6.2×
MRI lumbar spine w contrast (72149) $1,350 $1,800 4.2×
Mri Neck Spine W/O & W/Dye (72156) $1,462.50 $1,950 4.6×
MRI orbit face &/neck w/o contrast (70540) $1,350 $1,800 6.2×
MRI orbit face neck w contrast (70542) $1,350 $1,800 4.2×
Mri Orbt/Fac/Nck W/O &W/Dye (70543) $1,462.50 $1,950 4.6×
MRI pelvis w contrast (72196) $1,350 $1,800 4.2×
MRI pelvis w/o & w contrast (72197) $1,462.50 $1,950 4.6×
MRI pelvis w/o contrast (72195) $1,350 $1,800 6.2×
MRI thoracic spine w/o contrast (72146) $1,350 $1,800 6.2×
MRI upper extremity oth than jt w/contr matrl (73219) $1,350 $1,800 4.2×
MRI upper extremity oth than jt w/o contr matrl (73218)
range across 2 matching MRF lines		 $1,012.50–$1,350 $1,350–$1,800 varies
Mri Uppr Extremity W/O&W/Dye (73220) $1,462.50 $1,950 4.6×
MRI, abdomen, combo (74183) $1,462.50 $1,950 4.6×
MRI, dorsal spine combo (72157) $1,462.50 $1,950 4.6×
MRI, dorsal spine contrast (72147) $1,350 $1,800 4.2×
MRI, joint upper extrem (73221) $1,350 $1,800 6.2×
MRI, joint upper extrem combo (73223) $1,462.50 $1,950 4.6×
MRI, lumbar spine combo (72158) $1,462.50 $1,950 4.6×
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×
Nuclear Rx Oral Admin (79005) $252 $336 1.2×
Parathyroid Planar Imaging (78070) $603.75 $805 1.6×
Pelvis 1 or 2 views (72170) $212.25 $283 2.2×
Pulmonary Perfusion Imaging Particulate (78580) $405.75 $541 1.1×
Radex Abd Compl Aqt Abd W/S/E/D Views 1 View Ch (74022) $585.75 $781 6.1×
Radex abscess/fistula/sinus tract rs&i (76080) $638.25 $851 1.3×
Radex Ankle Complete Minimum 3 Views (73610) $250.50 $334 3.1×
Radex Calcaneus Minimum 2 Views (73650) $217.50 $290 2.7×
Radex elbow complete minimum 3 views (73080) $250.50 $334 3.1×
Radex Facial Bones Complete Minimum 3 Views (70150) $321 $428 3.3×
Radex fingr minimum 2 views (73140) $217.50 $290 2.7×
Radex foot complete minimum 3 views (73630) $250.50 $334 3.1×
Radex Hand Minimum 3 Views (73130) $250.50 $334 3.1×
Radex Mastoids Compl Minimum 3 Views PR Side (70130) $321 $428 3.3×
Radex Nasal Bones Complete Minimum 3 Views (70160) $279 $372 3.5×
Radex Ribs Unilateral 2 Views (71100) $297.75 $397 3.7×
Radex shoulder complete minimum 2 views (73030) $260.25 $347 3.3×
Radex Sinuses Paransl < 3 Views (70210) $212.25 $283 2.7×
Radex Spine 1 View Specify Level (72020) $204 $272 2.5×
Radex Sternum Minimum 2 Views (71120) $279 $372 3.5×
Radex Temporomandble Jt Opn & Clsd Mouth Bilat (70330) $321 $428 4.0×
Radex Toe Minimum 2 Views (73660) $217.50 $290 2.7×
Radex Wrist Complete Minimum 3 Views (73110) $250.50 $334 3.1×
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 3+ Views - Xr Abdomen 3+ Views (74021) $406.50 $542 4.2×
Radiologic exam colon double contrast study (74280) $1,039.50 $1,386 6.4×
Radiologic exam colon single contrast study (74270) $1,039.50 $1,386 6.4×
Radiologic exam knee complete 4/more views (73564) $321 $428 3.3×
Radiologic exam pelvis compl minimum 3 views (72190) $260.25 $347 2.7×
Radiologic Exam Small Int Single Contrast Study (74250) $552.75 $737 3.4×
Radiologic exam swallow function contrast study (74230) $325.50 $434 2.0×
Radiologic exam upr gi trc double contrast study (74246) $514.50 $686 3.2×
Radiologic examination femur 1 view (73551)
range across 2 matching MRF lines		 $288–$331.50 $384–$442 varies
Radiologic examination femur minimum 2 views (73552) $288 $384 3.6×
Radiologic examination knee 1/2 views (73560) $217.50 $290 2.7×
Radiologic Examination Osseous Survey Limited (77074) $325.50 $434 3.4×
Radiologic examination tibia & fibula 2 views (73590) $288 $384 3.6×
Ribs bilateral 3 views (71110) $369 $492 3.8×
Scapula (73010) $241.50 $322 2.5×
Screening Digital Breast Tomosynthesis Bi (77063) $75 $100 3.2×
Shoulder 1 view (73020) $193.50 $258 2.4×
Shoulder Arthrography (73040) $747 $996 2.3×
Sialogram (70390) $647.25 $863 2.9×
Skull less than 4 views (70250) $212.25 $283 2.2×
Sternoclavicular joints (71130) $279 $372 3.5×
Thoracic spine 2 views (72070) $250.50 $334 2.6×
Thoracic spine 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×
Ultrasound Breast Limited (76642) $258.75 $345 3.2×
Ultrasound Exam Aaa Screen (76706) $135 $180 1.4×
Ultrasound, abdomen limited (76705) $236.25 $315 2.5×
Umbilical-artery Doppler (OB) (76820) $450 $600 4.7×
Upper gi w/o kub (74240) $444.75 $593 2.8×
Urethrocystogram voiding (74455) $336 $448 1.5×
Us breast unilateral complete (76641) $390 $520 4.1×
Us chest (76604) $750 $1,000 7.8×
Us complete joint (76881) $173.25 $231 1.8×
Us exam, pelvic, limited (76857) $153.75 $205 1.6×
Us lmtd joint/oth nonvasc xtr strux r-t w/img (76882) $126 $168 1.3×
Us ob limited 1 or more fetuses (76815) $240 $320 2.5×
Us ob transvaginal (76817) $240 $320 2.5×
Us pelvic non ob complete (76856) $216.75 $289 2.3×
Us pg uter img f&mat 14 wk tabdl 1/1st gestation (76801) $292.50 $390 3.0×
Us preg uterus real time f/u trnsabdl per fetus (76816) $240 $320 2.5×
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 thyroid (76536) $487.50 $650 5.1×
Us transrectal (76872) $110.25 $147 1.1×
Venography extremity bilateral rs&i (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 Ac Jts - Xr Acromioclavicular Joints Bilateral (73050) $297.75 $397 3.7×
X-ray antegrade pyelogram tube (74425) $477 $636 1.5×
X-Ray Bend Only L-S Spine (72120) $477 $636 5.0×
X-Ray Elbow 2 Vw - Xr Elbow 1-2 Views Right (73070) $217.50 $290 2.7×
X-Ray Exam Breast Specimen (76098) $78.75 $105 0.2×
X-Ray Exam Entire Spi 1 Vw (72081) $331.50 $442 4.1×
X-Ray Exam Entire Spi 2/3 Vw (72082) $354.75 $473 3.7×
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 2 Views (73521) $369 $492 3.8×
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 L-S Spine Bending (72114) $501 $668 5.2×
X-Ray Exam Neck Spine 2-3 Vw (72040) $260.25 $347 3.3×
X-Ray Exam Neck Spine 6/>Vws (72052) $369 $492 3.8×
X-Ray Exam Unilat Ribs/Chest (71101) $369 $492 3.8×
X-ray eye for foreign body (70030) $68.25 $91 0.9×
X-ray humerus (73060) $250.50 $334 3.1×
X-ray IV pyelogram (ivp) (74400) $444.75 $593 2.8×
X-Ray Jaw <4 Vw - Xr Mandible < 4 Views (70100) $212.25 $283 2.7×
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 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 Sacroiliac Jts <3 Vw - Xr Sacroiliac Joints 1-2 Views (72200) $297.75 $397 3.1×
X-Ray Sacrum/Coccyx 2+ Vw - Xr Sacrum Coccyx 2+ Views (72220) $279 $372 3.5×
X-Ray Sinuses 3+ Vw - Xr Paranasal Sinuses 3+ Views (70220) $321 $428 4.0×
X-Ray Skull 4+ Vw - Xr Skull Complete 4+ Views (70260) $321 $428 3.3×
X-Ray Tmj Unilat (70328) $250.50 $334 3.1×
X-Rays Bone Length Studies (77073) $274.50 $366 2.9×
X-Rays Bone Survey Complete (77075) $600 $800 6.2×
Xr c-spine 4 or 5 views (72050) $350.25 $467 3.6×
Xr facial bones less than 3 views (70140) $217.50 $290 2.7×
XR Mastoids < 3 Views Bilateral (70120) $212.25 $283 2.2×
Xr orbits complete 4 views (70200) $321 $428 3.3×

A range means this hospital published different amounts on matching machine-readable-file lines. We show the lowest–highest posted amount because we cannot tell from the published file which line would apply to a particular visit.