Imaging prices at Ascension St. Vincent Randolph
Winchester, IN · every code in this section with a posted price and a Medicare benchmark.
225 codes. Prices are the hospital's own posted facility charges.
Compare against other hospitals interactively →
| Procedure | Posted cash | Posted gross | × Medicare |
|---|---|---|---|
| Abdomen 1 View (74018) | $276.60 | $461 | 3.0× |
| Abdomen 2 views (74019) | $290.40 | $484 | 2.6× |
| Ankle 2 views (73600) range across 2 matching MRF lines |
$256.80–$513.60 | $428–$856 | varies |
| Arthrogram ankle (73615) | $602.40 | $1,004 | 1.6× |
| Arthrogram hip (73525) | $801.60 | $1,336 | 2.2× |
| Arthrogram Wrist (73115) | $639 | $1,065 | 1.7× |
| Bone age studies (77072) | $239.40 | $399 | 2.2× |
| Bone survey infant (77076) | $427.80 | $713 | 3.9× |
| Cat Scan Follow-Up Study (76380) | $269.40 | $449 | 2.9× |
| Chest 1 view (71045) | $160.80 | $268 | 1.7× |
| Chest 2 views (71046) | $211.80 | $353 | 2.3× |
| Chest 3 views (71047) | $235.80 | $393 | 2.6× |
| Chest 4 or more views (71048) | $238.80 | $398 | 2.2× |
| Clavicle complete (73000) range across 2 matching MRF lines |
$296.40–$592.80 | $494–$988 | varies |
| Computed Tomography Thorax Lw Dose Lng Ca Scr C- (71271) | $574.80 | $958 | 5.2× |
| Contrast X-Ray Bladder (74430) | $570.60 | $951 | 1.5× |
| Contrast X-Ray Of Elbow (73085) | $751.20 | $1,252 | 2.0× |
| Contrast X-Ray Of Knee Joint (73580) | $792 | $1,320 | 2.1× |
| CT abdomen and pelvis without and with contrast (74178) | $4,149.60 | $6,916 | 11.2× |
| CT abdomen and pelvis without contrast (74176) | $2,568 | $4,280 | 10.2× |
| CT abdomen w contrast (74160) | $2,134.80 | $3,558 | 11.5× |
| CT abdomen w wo contrast (74170) | $2,562.60 | $4,271 | 13.8× |
| CT abdomen w/o contrast (74150) | $1,708.80 | $2,848 | 15.4× |
| CT Angio Abdomen and Pelvis (74174) | $5,665.80 | $9,443 | 15.3× |
| CT Angio Chest (71275) | $2,478.60 | $4,131 | 13.4× |
| CT Angio Head (70496) | $1,996.80 | $3,328 | 10.8× |
| Ct Angio Lwr Extr W/O&W/Dye (73706) range across 2 matching MRF lines |
$2,758.20–$5,516.40 | $4,597–$9,194 | varies |
| CT Angio Neck (70498) | $2,857.80 | $4,763 | 15.4× |
| Ct Angio Upr Extrm W/O&W/Dye (73206) | $2,912.40 | $4,854 | 15.7× |
| CT cervical spine w/ contrast (72126) | $2,485.20 | $4,142 | 6.7× |
| CT cervical spine w/o contrast (72125) | $1,854.60 | $3,091 | 16.8× |
| CT cervical spine w/wo cont (72127) | $2,980.80 | $4,968 | 16.1× |
| CT chest w contrast (71260) | $1,900.80 | $3,168 | 10.2× |
| CT chest w/wo contrast (71270) | $2,281.80 | $3,803 | 12.3× |
| CT head/brain with contrast (70460) | $1,426.20 | $2,377 | 7.7× |
| CT head/brain without and with contrast (70470) | $1,711.80 | $2,853 | 9.2× |
| CT heart no contrast quant eval coronry calcium (75571) | $366.60 | $611 | 4.0× |
| CT iac w contrast (70481) | $1,981.80 | $3,303 | 10.7× |
| CT l-spine w&w/o contrast (72133) | $2,834.40 | $4,724 | 15.3× |
| CT lower ext w/o (73700) range across 2 matching MRF lines |
$1,577.40–$3,154.80 | $2,629–$5,258 | varies |
| CT lower extremity w/contrast material (73701) range across 2 matching MRF lines |
$1,970.40–$3,940.80 | $3,284–$6,568 | varies |
| CT lumbar spine w contrast (72132) | $2,362.80 | $3,938 | 6.4× |
| CT lumbar spine w/o contrast (72131) | $1,890 | $3,150 | 17.1× |
| CT maxillofacial w contrast (70487) | $1,946.40 | $3,244 | 10.5× |
| CT maxillofacial wo contrast (70486) | $1,557 | $2,595 | 14.1× |
| CT neck tissue combo (70492) | $2,450.40 | $4,084 | 13.2× |
| Ct Orbit/Ear/Fossa W/O&W/Dye (70482) | $2,376.60 | $3,961 | 12.8× |
| CT orbits w/o contrast (70480) | $1,585.80 | $2,643 | 14.3× |
| CT pelvis w&w/o contrast (72194) | $2,295.60 | $3,826 | 12.4× |
| CT pelvis w/o contrast (72192) | $1,530 | $2,550 | 13.8× |
| CT scan of leg combo (73702) range across 2 matching MRF lines |
$2,364.60–$4,729.20 | $3,941–$7,882 | varies |
| CT scans face/jaw combo (70488) | $2,335.20 | $3,892 | 12.6× |
| CT soft tissue neck w contrast (70491) | $2,041.20 | $3,402 | 11.0× |
| CT soft tissue neck w/o contrast (70490) | $1,632.60 | $2,721 | 14.8× |
| CT thoracic spine w contrast (72129) | $2,290.20 | $3,817 | 12.3× |
| CT thoracic spine w/o contrast (72128) | $1,832.40 | $3,054 | 16.6× |
| CT thoracic spine w/wo cont (72130) | $2,748 | $4,580 | 14.8× |
| CT thorax w/o contrast (71250) | $1,521 | $2,535 | 13.8× |
| CT unlisted procedure (76497) | $685.20 | $1,142 | 7.4× |
| CT upper ext wo (73200) range across 2 matching MRF lines |
$1,664.40–$3,328.80 | $2,774–$5,548 | varies |
| CT upper extremity w/o & w/contrast material (73202) range across 2 matching MRF lines |
$2,496.60–$4,993.20 | $4,161–$8,322 | varies |
| CT upper extremity with contrast (73201) range across 2 matching MRF lines |
$2,079–$4,158 | $3,465–$6,930 | varies |
| Cta Abdomen (74175) | $2,988.60 | $4,981 | 16.1× |
| CTA pelvis (72191) | $2,676.60 | $4,461 | 14.4× |
| Dxa Bone Density Axial (77080) | $483 | $805 | 4.4× |
| Dxa bone density study 1/>sites appendiclr skel (77081) | $254.40 | $424 | 2.8× |
| Esophagram (74220) | $519 | $865 | 2.8× |
| Fetal Biophys Profile W/Nst (76818) | $961.80 | $1,603 | 8.7× |
| Fetal Biophysical Profile W/O Non-Stress Testing (76819) | $692.40 | $1,154 | 6.3× |
| Fetal MRI w/placntl matrnl plvc img sing/1st ges (74712) | $2,645.40 | $4,409 | 10.5× |
| Fluoroscopy up to 1 hr (76000) | $680.40 | $1,134 | 2.7× |
| Foot 2 views (73620) range across 2 matching MRF lines |
$258–$516 | $430–$860 | varies |
| Forearm 2 views (73090) range across 2 matching MRF lines |
$282.60–$565.20 | $471–$942 | varies |
| Hand 2 views (73120) range across 2 matching MRF lines |
$311.40–$622.80 | $519–$1,038 | varies |
| Knee 3 Views (73562) range across 2 matching MRF lines |
$378–$756 | $630–$1,260 | varies |
| Magnetic Image Jaw Joint (70336) | $2,986.80 | $4,978 | 11.8× |
| Mra Head W/O & W/Contrast Material (70546) | $3,406.80 | $5,678 | 9.2× |
| MRA head w/o contrast (70544) | $2,433.60 | $4,056 | 9.6× |
| MRA head with contrast (70545) | $2,920.20 | $4,867 | 7.9× |
| MRA neck w contrast (70548) | $3,792.60 | $6,321 | 10.3× |
| Mra Neck W/O &W/Contrast Material (70549) | $4,425 | $7,375 | 12.0× |
| MRA neck w/o contrast (70547) | $3,160.20 | $5,267 | 12.5× |
| MRI abdomen w contrast (74182) | $3,409.20 | $5,682 | 9.2× |
| MRI abdomen w/o contrast (74181) | $2,726.40 | $4,544 | 10.8× |
| MRI any jt lower extrem w/contrast material (73722) range across 2 matching MRF lines |
$2,273.40–$4,546.80 | $3,789–$7,578 | varies |
| MRI any jt lower extrem w/o & w/contrast matrl (73723) range across 2 matching MRF lines |
$2,727.60–$5,455.20 | $4,546–$9,092 | varies |
| MRI any jt upper extremity w/contrast matrl (73222) range across 2 matching MRF lines |
$2,452.20–$4,904.40 | $4,087–$8,174 | varies |
| MRI cardiac w/o contrast (75557) | $2,421.60 | $4,036 | 9.6× |
| MRI cervical spine w contrast (72142) | $2,772 | $4,620 | 7.5× |
| MRI cervical spine w/o cont (72141) | $2,217.60 | $3,696 | 8.8× |
| MRI chest w/o contrast (71550) | $2,612.40 | $4,354 | 10.3× |
| MRI chest with contrast (71551) | $3,265.80 | $5,443 | 3.9× |
| MRI chest wo w contrast (71552) | $3,919.20 | $6,532 | 10.6× |
| MRI lower extrem oth/thn jt w/contrast matrl (73719) range across 2 matching MRF lines |
$3,499.20–$6,998.40 | $5,832–$11,664 | varies |
| MRI lower extrem oth/thn jt w/o & w/contr matr (73720) range across 2 matching MRF lines |
$4,200–$8,400 | $7,000–$14,000 | varies |
| MRI lower extrem oth/thn jt w/o contr matrl (73718) range across 2 matching MRF lines |
$2,800.20–$5,600.40 | $4,667–$9,334 | varies |
| MRI lumbar spine w contrast (72149) | $2,496.60 | $4,161 | 6.8× |
| Mri Neck Spine W/O & W/Dye (72156) | $3,324.60 | $5,541 | 9.0× |
| MRI orbit face &/neck w/o contrast (70540) | $2,529 | $4,215 | 10.0× |
| MRI orbit face neck w contrast (70542) | $3,160.20 | $5,267 | 8.6× |
| Mri Orbt/Fac/Nck W/O &W/Dye (70543) | $3,792.60 | $6,321 | 10.3× |
| MRI pelvis w contrast (72196) | $3,307.20 | $5,512 | 9.0× |
| MRI pelvis w/o & w contrast (72197) | $3,967.80 | $6,613 | 10.7× |
| MRI pelvis w/o contrast (72195) | $2,645.40 | $4,409 | 10.5× |
| MRI spectroscopy (76390) | $1,719.60 | $2,866 | 18.7× |
| MRI thoracic spine w/o contrast (72146) | $2,851.80 | $4,753 | 11.3× |
| MRI upper extremity oth than jt w/contr matrl (73219) range across 2 matching MRF lines |
$3,159.60–$6,319.20 | $5,266–$10,532 | varies |
| MRI upper extremity oth than jt w/o contr matrl (73218) range across 2 matching MRF lines |
$2,528.40–$5,056.80 | $4,214–$8,428 | varies |
| Mri Uppr Extremity W/O&W/Dye (73220) range across 2 matching MRF lines |
$3,791.40–$7,582.80 | $6,319–$12,638 | varies |
| MRI, abdomen, combo (74183) | $4,089.60 | $6,816 | 11.1× |
| MRI, dorsal spine combo (72157) | $4,278 | $7,130 | 11.6× |
| MRI, dorsal spine contrast (72147) | $3,565.20 | $5,942 | 9.7× |
| MRI, joint upper extrem (73221) range across 2 matching MRF lines |
$1,961.40–$3,922.80 | $3,269–$6,538 | varies |
| MRI, joint upper extrem combo (73223) range across 2 matching MRF lines |
$2,942.40–$5,884.80 | $4,904–$9,808 | varies |
| MRI, lumbar spine combo (72158) | $2,995.20 | $4,992 | 8.1× |
| Neck soft tissue (70360) | $264 | $440 | 2.9× |
| Pelvis 1 or 2 views (72170) | $280.80 | $468 | 2.5× |
| Radex Abd Compl Aqt Abd W/S/E/D Views 1 View Ch (74022) | $514.20 | $857 | 4.6× |
| Radex Ankle Complete Minimum 3 Views (73610) range across 2 matching MRF lines |
$295.80–$591.60 | $493–$986 | varies |
| Radex Calcaneus Minimum 2 Views (73650) range across 2 matching MRF lines |
$295.20–$590.40 | $492–$984 | varies |
| Radex elbow complete minimum 3 views (73080) range across 2 matching MRF lines |
$367.20–$734.40 | $612–$1,224 | varies |
| Radex Facial Bones Complete Minimum 3 Views (70150) | $420.60 | $701 | 3.8× |
| Radex fingr minimum 2 views (73140) range across 2 matching MRF lines |
$238.20–$476.40 | $397–$794 | varies |
| Radex foot complete minimum 3 views (73630) range across 2 matching MRF lines |
$295.20–$590.40 | $492–$984 | varies |
| Radex Hand Minimum 3 Views (73130) range across 2 matching MRF lines |
$359.40–$718.80 | $599–$1,198 | varies |
| Radex lower extremity infant minimum 2 views (73592) range across 2 matching MRF lines |
$226.80–$453.60 | $378–$756 | varies |
| Radex Mastoids Compl Minimum 3 Views PR Side (70130) range across 2 matching MRF lines |
$319.20–$638.40 | $532–$1,064 | varies |
| Radex Nasal Bones Complete Minimum 3 Views (70160) | $321 | $535 | 3.5× |
| Radex Pharynx/Larx W/Fluor&/Magnification Tq (70370) | $349.80 | $583 | 3.8× |
| Radex Ribs Unilateral 2 Views (71100) | $340.20 | $567 | 3.7× |
| Radex shoulder complete minimum 2 views (73030) range across 2 matching MRF lines |
$259.80–$519.60 | $433–$866 | varies |
| Radex Sinuses Paransl < 3 Views (70210) | $297 | $495 | 3.2× |
| Radex sm int w/mlt srl imges via enteroclss tube (74251) | $723.60 | $1,206 | 3.9× |
| Radex Spine 1 View Specify Level (72020) | $300.60 | $501 | 3.3× |
| Radex Sternum Minimum 2 Views (71120) | $304.20 | $507 | 3.3× |
| Radex Temporomandble Jt Opn & Clsd Mouth Bilat (70330) | $403.20 | $672 | 4.4× |
| Radex Toe Minimum 2 Views (73660) range across 2 matching MRF lines |
$238.20–$476.40 | $397–$794 | varies |
| Radex upper extremity infant minimum 2 views (73092) range across 2 matching MRF lines |
$166.20–$332.40 | $277–$554 | varies |
| Radex Wrist Complete Minimum 3 Views (73110) range across 2 matching MRF lines |
$330–$660 | $550–$1,100 | varies |
| Radex X-Ray Exam Entire Spi 6/> Vw - Xr Entire Spine 6+ Vw (72084) | $696 | $1,160 | 6.3× |
| Radiolog exam mandible compl minimum 4 views (70110) | $464.40 | $774 | 4.2× |
| Radiologic Exam Abdomen 3+ Views - Xr Abdomen 3+ Views (74021) | $300 | $500 | 2.7× |
| Radiologic exam colon double contrast study (74280) | $962.40 | $1,604 | 5.2× |
| Radiologic exam colon single contrast study (74270) | $676.80 | $1,128 | 3.6× |
| Radiologic Exam Esophagus Double Contrast Study (74221) | $555 | $925 | 3.0× |
| Radiologic exam knee complete 4/more views (73564) range across 2 matching MRF lines |
$476.40–$952.80 | $794–$1,588 | varies |
| Radiologic exam pelvis compl minimum 3 views (72190) | $339.60 | $566 | 3.1× |
| Radiologic Exam Small Int Single Contrast Study (74250) | $610.20 | $1,017 | 3.3× |
| Radiologic exam swallow function contrast study (74230) | $485.40 | $809 | 2.6× |
| Radiologic exam upr gi trc double contrast study (74246) | $704.40 | $1,174 | 3.8× |
| Radiologic examination femur 1 view (73551) range across 2 matching MRF lines |
$153–$306 | $255–$510 | varies |
| Radiologic examination femur minimum 2 views (73552) range across 2 matching MRF lines |
$304.20–$608.40 | $507–$1,014 | varies |
| Radiologic examination knee 1/2 views (73560) range across 2 matching MRF lines |
$258–$516 | $430–$860 | varies |
| Radiologic Examination Osseous Survey Limited (77074) | $628.20 | $1,047 | 5.7× |
| Radiologic Examination Salivary Gland Calculus (70380) | $184.20 | $307 | 2.0× |
| Radiologic examination tibia & fibula 2 views (73590) range across 2 matching MRF lines |
$300.60–$601.20 | $501–$1,002 | varies |
| Ribs bilateral 3 views (71110) | $443.40 | $739 | 4.0× |
| Scapula (73010) range across 2 matching MRF lines |
$337.20–$674.40 | $562–$1,124 | varies |
| Screening Digital Breast Tomosynthesis Bi (77063) | $53.40 | $89 | 2.3× |
| Sella turcica (70240) | $106.20 | $177 | 1.2× |
| Shoulder 1 view (73020) range across 2 matching MRF lines |
$231.60–$463.20 | $386–$772 | varies |
| Shoulder Arthrography (73040) | $837.60 | $1,396 | 2.3× |
| Skull less than 4 views (70250) | $351 | $585 | 3.2× |
| Speech evaluation, complex (70371) | $786 | $1,310 | 3.1× |
| Sternoclavicular joints (71130) | $284.40 | $474 | 3.1× |
| Thoracic spine 2 views (72070) | $411 | $685 | 3.7× |
| Thoracic spine 3 views (72072) | $486.60 | $811 | 4.4× |
| Thoracolumbar 2 views (72080) | $385.20 | $642 | 4.2× |
| Ultrasound Breast Limited (76642) range across 2 matching MRF lines |
$476.40–$952.80 | $794–$1,588 | varies |
| Ultrasound Elastography Parenchyma (76981) | $547.20 | $912 | 4.9× |
| Ultrasound Exam Aaa Screen (76706) | $421.80 | $703 | 3.8× |
| Ultrasound, abdomen limited (76705) | $618.60 | $1,031 | 5.6× |
| Umbilical-artery Doppler (OB) (76820) | $349.80 | $583 | 3.2× |
| Upper gi w/o kub (74240) | $659.40 | $1,099 | 3.6× |
| Us breast unilateral complete (76641) range across 2 matching MRF lines |
$588–$1,176 | $980–$1,960 | varies |
| Us chest (76604) range across 2 matching MRF lines |
$219.60–$439.20 | $366–$732 | varies |
| Us complete joint (76881) | $534 | $890 | 4.8× |
| Us exam, pelvic, limited (76857) | $508.80 | $848 | 4.6× |
| Us lmtd joint/oth nonvasc xtr strux r-t w/img (76882) | $480.60 | $801 | 4.3× |
| Us ob detailed single fetus (76811) | $541.80 | $903 | 2.1× |
| Us ob limited 1 or more fetuses (76815) | $515.40 | $859 | 4.7× |
| Us ob transvaginal (76817) | $588.60 | $981 | 5.3× |
| Us pelvic non ob complete (76856) | $591.60 | $986 | 5.3× |
| Us pg uter img f&mat 14 wk tabdl 1/1st gestation (76801) | $543 | $905 | 4.9× |
| Us preg uterus real time f/u trnsabdl per fetus (76816) | $559.20 | $932 | 5.1× |
| Us retroperitoneal complete (76770) | $793.80 | $1,323 | 7.2× |
| Us retroperitoneal limited (76775) | $602.40 | $1,004 | 5.4× |
| Us scrotum and contents (76870) | $659.40 | $1,099 | 6.0× |
| Us spinal canal and contents (76800) | $393.60 | $656 | 3.6× |
| Us thyroid (76536) | $621 | $1,035 | 5.6× |
| Wrist 2 views (73100) range across 2 matching MRF lines |
$250.80–$501.60 | $418–$836 | varies |
| X-Ray Ac Jts - Xr Acromioclavicular Joints Bilateral (73050) | $361.20 | $602 | 3.9× |
| X-Ray Bend Only L-S Spine (72120) | $411 | $685 | 3.7× |
| X-Ray Elbow 2 Vw - Xr Elbow 1-2 Views Right (73070) range across 2 matching MRF lines |
$260.40–$520.80 | $434–$868 | varies |
| X-Ray Exam Breast Specimen (76098) | $682.80 | $1,138 | 1.2× |
| X-Ray Exam Entire Spi 1 Vw (72081) | $379.80 | $633 | 4.1× |
| X-Ray Exam Entire Spi 2/3 Vw (72082) | $519.60 | $866 | 4.7× |
| X-Ray Exam Entire Spi 4/5 Vw (72083) | $535.80 | $893 | 4.8× |
| X-Ray Exam Hip Uni 1 View (73501) | $170.40 | $284 | 1.9× |
| X-Ray Exam Hip Uni 2-3 Views (73502) | $270 | $450 | 2.9× |
| X-Ray Exam Hip Uni 4/> Views (73503) | $370.80 | $618 | 3.4× |
| X-Ray Exam Hips Bi 2 Views (73521) | $270 | $450 | 2.4× |
| X-Ray Exam Hips Bi 3-4 Views (73522) | $370.80 | $618 | 3.4× |
| X-Ray Exam Hips Bi 5/> Views (73523) | $471.60 | $786 | 4.3× |
| X-Ray Exam L-S Spine Bending (72114) | $573.60 | $956 | 5.2× |
| X-Ray Exam Neck Spine 2-3 Vw (72040) | $377.40 | $629 | 4.1× |
| X-Ray Exam Neck Spine 6/>Vws (72052) | $556.20 | $927 | 5.0× |
| X-Ray Exam Unilat Ribs/Chest (71101) | $344.40 | $574 | 3.1× |
| X-ray eye for foreign body (70030) range across 2 matching MRF lines |
$280.20–$560.40 | $467–$934 | varies |
| X-ray humerus (73060) range across 2 matching MRF lines |
$282.60–$565.20 | $471–$942 | varies |
| X-Ray Jaw <4 Vw - Xr Mandible < 4 Views (70100) | $262.20 | $437 | 2.8× |
| X-Ray Knee Bilat Standing - Xr Knees Anteroposterior Standing Bilat (73565) | $258 | $430 | 2.8× |
| X-Ray Lumbar Spine 2/3 Vw - Xr Lumbar Spine 2-3 Views (72100) | $397.80 | $663 | 3.6× |
| X-ray nose-rectum child f.b. (76010) | $276.60 | $461 | 3.0× |
| X-Ray Ribs, Chest 4+ Vw - Xr Ribs 3 Vws Bil W/ Chest Posteroanterior (71111) | $466.80 | $778 | 4.2× |
| X-Ray Sacroiliac Jts 3+ Vw - Xr Sacroiliac Joints 3+ Views (72202) | $357 | $595 | 3.2× |
| X-Ray Sacrum/Coccyx 2+ Vw - Xr Sacrum Coccyx 2+ Views (72220) | $331.80 | $553 | 3.6× |
| X-Ray Sinuses 3+ Vw - Xr Paranasal Sinuses 3+ Views (70220) | $427.20 | $712 | 4.6× |
| X-Ray Skull 4+ Vw - Xr Skull Complete 4+ Views (70260) | $463.80 | $773 | 4.2× |
| X-ray thoracic spine 4 vw (72074) | $258 | $430 | 2.3× |
| X-Rays Bone Length Studies (77073) | $379.20 | $632 | 3.4× |
| X-Rays Bone Survey Complete (77075) | $1,055.40 | $1,759 | 9.5× |
| Xr c-spine 4 or 5 views (72050) | $427.20 | $712 | 3.9× |
| Xr facial bones less than 3 views (70140) | $331.20 | $552 | 3.6× |
| Xr orbits complete 4 views (70200) | $393 | $655 | 3.6× |
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.