Imaging prices at Missouri Baptist Sullivan Hospital

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

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

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ProcedurePosted cashPosted gross× Medicare
Abdomen 1 View (74018) $306.60 $511 3.5×
Abdomen 2 views (74019) $384.60 $641 3.7×
Ankle 2 views (73600) $306.60 $511 3.5×
Bone age studies (77072) $183.60 $306 1.8×
Bone Imaging 3 Phase (78315) $2,075.40 $3,459 5.2×
Bone Imaging Limited Area (78300) $597.60 $996 1.5×
Bone Imaging Whole Body (78306) $1,732.80 $2,888 4.3×
Bone survey infant (77076) $247.80 $413 2.4×
Cat Scan Follow-Up Study (76380) $362.40 $604 4.2×
Chest 1 view (71045) $141.60 $236 1.6×
Chest 2 views (71046) $330.60 $551 3.8×
Chest 4 or more views (71048) $364.80 $608 3.5×
Chg us nrv&acc strux 1 xtr compre w/img pr extremity (76883) $397.20 $662 3.8×
Clavicle complete (73000) $315.60 $526 3.6×
Computed Tomography Thorax Lw Dose Lng Ca Scr C- (71271) $945 $1,575 9.0×
Contrast X-Ray Bladder (74430) $417 $695 1.2×
Contrast X-Ray Of Elbow (73085) $476.40 $794 1.4×
CT abdomen and pelvis without and with contrast (74178) $3,631.20 $6,052 10.4×
CT abdomen and pelvis without contrast (74176) $1,948.20 $3,247 8.2×
CT abdomen w contrast (74160) $1,084.80 $1,808 6.2×
CT abdomen w wo contrast (74170) $1,577.40 $2,629 9.0×
CT abdomen w/o contrast (74150) $903 $1,505 8.6×
CT Angio Abdomen and Pelvis (74174) $3,994.20 $6,657 11.4×
CT Angio Chest (71275) $1,473.60 $2,456 8.4×
CT Angio Head (70496) $1,529.40 $2,549 8.7×
CT angio hrt w/3d image (75574) $1,737.60 $2,896 5.0×
Ct Angio Lwr Extr W/O&W/Dye (73706) $1,363.80 $2,273 7.8×
CT Angio Neck (70498) $1,746.60 $2,911 9.9×
Ct Angio Upr Extrm W/O&W/Dye (73206) $1,332.60 $2,221 7.6×
CT cervical spine w/ contrast (72126) $1,326.60 $2,211 3.8×
CT cervical spine w/o contrast (72125) $1,010.40 $1,684 9.6×
CT chest w contrast (71260) $1,272 $2,120 7.2×
CT chest w/wo contrast (71270) $1,339.80 $2,233 7.6×
CT head/brain with contrast (70460) $1,210.20 $2,017 6.9×
CT head/brain without and with contrast (70470) $1,390.20 $2,317 7.9×
CT heart no contrast quant eval coronry calcium (75571) $140 $170 1.6×
CT iac w contrast (70481) $1,375.80 $2,293 7.8×
CT l-spine w&w/o contrast (72133) $1,390.20 $2,317 7.9×
CT lower ext w/o (73700) $804 $1,340 7.7×
CT lower extremity w/contrast material (73701) $915.60 $1,526 5.2×
CT lumbar spine w contrast (72132) $1,246.20 $2,077 3.6×
CT lumbar spine w/o contrast (72131) $853.80 $1,423 8.2×
CT maxillofacial w contrast (70487) $1,150.80 $1,918 6.6×
CT maxillofacial wo contrast (70486) $1,017.60 $1,696 9.7×
CT neck tissue combo (70492) $1,587.60 $2,646 9.0×
Ct Orbit/Ear/Fossa W/O&W/Dye (70482) $1,870.20 $3,117 10.6×
CT orbits w/o contrast (70480) $1,125 $1,875 10.7×
CT pelvis w&w/o contrast (72194) $1,378.80 $2,298 7.8×
CT pelvis w/o contrast (72192) $720 $1,200 6.9×
CT scan of leg combo (73702) $1,239.60 $2,066 7.1×
CT scans face/jaw combo (70488) $1,232.40 $2,054 7.0×
CT soft tissue neck w contrast (70491) $1,218.60 $2,031 6.9×
CT soft tissue neck w/o contrast (70490) $784.20 $1,307 7.5×
CT thoracic spine w contrast (72129) $1,021.20 $1,702 5.8×
CT thoracic spine w/o contrast (72128) $893.40 $1,489 8.5×
CT thorax w/o contrast (71250) $895.20 $1,492 8.5×
CT upper ext wo (73200) $895.20 $1,492 8.5×
CT upper extremity w/o & w/contrast material (73202) $1,211.40 $2,019 6.9×
CT upper extremity with contrast (73201) $1,015.80 $1,693 2.9×
Cta Abdl Aorta&Bi Iliofem W/Contrast&Postp (75635) $1,222.80 $2,038 7.0×
Cta Abdomen (74175) $1,735.20 $2,892 9.9×
CTA pelvis (72191) $1,516.80 $2,528 8.6×
Dxa Bone Density Axial (77080) $369 $615 3.5×
Dxa bone density study (77085) $171 $285 1.6×
Dxa bone density study 1/>sites appendiclr skel (77081) $165.60 $276 1.9×
Esophagram (74220) $550.80 $918 3.1×
Fetal Biophys Profile W/Nst (76818) $599.40 $999 5.7×
Fetal Biophysical Profile W/O Non-Stress Testing (76819) $630 $1,050 6.0×
Fluoroscopy up to 1 hr (76000) $288.60 $481 1.2×
Foot 2 views (73620) $323.40 $539 3.7×
Forearm 2 views (73090) $313.20 $522 3.6×
Gastric emptying imaging study (78264) $1,717.20 $2,862 4.3×
Gated Heart Planar Single (78472) $1,904.40 $3,174 4.8×
Hand 2 views (73120) $303 $505 2.9×
Hepatobil Syst Image W/Drug (78227) $1,975.20 $3,292 3.6×
Hepatobiliary System Imaging (78226) $1,810.80 $3,018 4.5×
Hysterosalpingogram (74740) $472.80 $788 2.0×
Knee 3 Views (73562) $400.20 $667 4.6×
Liver & Spleen Imaging Static Only (78215) $465.60 $776 1.2×
Lung Ventilat&Perfus Imaging (78582) $1,231.20 $2,052 2.3×
Magnetic Image Jaw Joint (70336) $1,263.60 $2,106 5.3×
Magnetic Resonance Elastography (76391) $1,713 $2,855 7.2×
Mra Head W/O & W/Contrast Material (70546) $3,026.40 $5,044 8.7×
MRA head w/o contrast (70544) $2,176.80 $3,628 9.1×
MRA head with contrast (70545) $2,341.80 $3,903 6.7×
Mra Neck W/O &W/Contrast Material (70549) $2,622 $4,370 7.5×
MRA neck w/o contrast (70547) $1,366.80 $2,278 5.7×
MRI abdomen w contrast (74182) $1,670.40 $2,784 4.8×
MRI abdomen w/o contrast (74181) $1,444.80 $2,408 6.0×
MRI any jt lower extrem w/contrast material (73722) $2,236.20 $3,727 2.8×
MRI any jt lower extrem w/o & w/contrast matrl (73723) $2,328 $3,880 6.7×
MRI any jt upper extremity w/contrast matrl (73222) $2,755.80 $4,593 3.5×
MRI Breast W/O Contrast Bilateral (77047) $1,488 $2,480 6.2×
MRI cervical spine w/o cont (72141) $2,549.40 $4,249 10.7×
MRI chest w/o contrast (71550) $1,371.60 $2,286 5.7×
MRI chest wo w contrast (71552) $2,034.60 $3,391 5.8×
MRI lower extrem oth/thn jt w/o & w/contr matr (73720) $1,866 $3,110 5.3×
MRI lower extrem oth/thn jt w/o contr matrl (73718) $1,509.60 $2,516 6.3×
Mri Neck Spine W/O & W/Dye (72156) $2,810.40 $4,684 8.0×
MRI orbit face &/neck w/o contrast (70540) $1,481.40 $2,469 6.2×
Mri Orbt/Fac/Nck W/O &W/Dye (70543) $3,128.40 $5,214 9.0×
MRI pelvis w/o & w contrast (72197) $1,912.80 $3,188 5.5×
MRI pelvis w/o contrast (72195) $1,398.60 $2,331 5.9×
MRI thoracic spine w/o contrast (72146) $1,305.60 $2,176 5.5×
MRI upper extremity oth than jt w/o contr matrl (73218) $2,064 $3,440 8.6×
Mri Uppr Extremity W/O&W/Dye (73220) $2,858.40 $4,764 8.2×
MRI, abdomen, combo (74183) $2,789.40 $4,649 8.0×
MRI, dorsal spine combo (72157) $1,699.80 $2,833 4.9×
MRI, dorsal spine contrast (72147) $1,618.80 $2,698 4.6×
MRI, joint upper extrem (73221) $2,478.60 $4,131 10.4×
MRI, joint upper extrem combo (73223) $2,920.80 $4,868 8.4×
MRI, lumbar spine combo (72158) $2,909.40 $4,849 8.3×
Myocardial Spect Multiple Studies (78452) $4,739.40 $7,899 3.7×
N-invas est c ffr sw aly CTA (75580) $3,201 $5,335 3.7×
Neck soft tissue (70360) $269.40 $449 3.1×
Pelvis 1 or 2 views (72170) $244.80 $408 2.3×
PET image w/CT, full body (78816) $4,395.60 $7,326 3.1×
PET imaging CT attenuation skull base mid-thigh (78815) $3,396.60 $5,661 2.4×
Pulmonary Perfusion Imaging Particulate (78580) $679.20 $1,132 1.7×
Radex Abd Compl Aqt Abd W/S/E/D Views 1 View Ch (74022) $472.80 $788 4.5×
Radex abscess/fistula/sinus tract rs&i (76080) $630 $1,050 1.2×
Radex Ankle Complete Minimum 3 Views (73610) $388.20 $647 4.5×
Radex Calcaneus Minimum 2 Views (73650) $249.60 $416 2.9×
Radex elbow complete minimum 3 views (73080) $339.60 $566 3.9×
Radex Facial Bones Complete Minimum 3 Views (70150) $424.80 $708 4.1×
Radex fingr minimum 2 views (73140) $243 $405 2.8×
Radex foot complete minimum 3 views (73630) $357 $595 4.1×
Radex Hand Minimum 3 Views (73130) $339.60 $566 3.9×
Radex lower extremity infant minimum 2 views (73592) $202.20 $337 2.3×
Radex Nasal Bones Complete Minimum 3 Views (70160) $281.40 $469 3.2×
Radex Ribs Unilateral 2 Views (71100) $339 $565 3.9×
Radex shoulder complete minimum 2 views (73030) $372 $620 4.3×
Radex Spine 1 View Specify Level (72020) $189 $315 2.2×
Radex Sternum Minimum 2 Views (71120) $243 $405 2.8×
Radex Temporomandble Jt Opn & Clsd Mouth Bilat (70330) $280.20 $467 3.2×
Radex Toe Minimum 2 Views (73660) $261.60 $436 3.0×
Radex upper extremity infant minimum 2 views (73092) $355.20 $592 3.4×
Radex Wrist Complete Minimum 3 Views (73110) $326.40 $544 3.7×
Radex X-Ray Exam Entire Spi 6/> Vw - Xr Entire Spine 6+ Vw (72084) $621 $1,035 5.9×
Radiolog exam mandible compl minimum 4 views (70110) $421.20 $702 4.0×
Radiologic Exam Abdomen 3+ Views - Xr Abdomen 3+ Views (74021) $444 $740 4.2×
Radiologic exam colon double contrast study (74280) $618 $1,030 3.5×
Radiologic exam colon single contrast study (74270) $422.40 $704 2.4×
Radiologic Exam Esophagus Double Contrast Study (74221) $608.40 $1,014 3.5×
Radiologic exam knee complete 4/more views (73564) $447 $745 4.3×
Radiologic exam pelvis compl minimum 3 views (72190) $359.40 $599 3.4×
Radiologic Exam Small Int Single Contrast Study (74250) $358.20 $597 2.0×
Radiologic exam swallow function contrast study (74230) $376.80 $628 2.1×
Radiologic exam upr gi trc double contrast study (74246) $835.80 $1,393 4.8×
Radiologic examination femur 1 view (73551) $150 $250 1.7×
Radiologic examination femur minimum 2 views (73552) $291 $485 3.3×
Radiologic examination knee 1/2 views (73560) $324.60 $541 3.7×
Radiologic examination tibia & fibula 2 views (73590) $257.40 $429 3.0×
Ribs bilateral 3 views (71110) $463.20 $772 4.4×
Scapula (73010) $276 $460 2.6×
Screening Digital Breast Tomosynthesis Bi (77063) $30 $50 1.3×
Shoulder 1 view (73020) $159 $265 1.8×
Shoulder Arthrography (73040) $590.40 $984 1.7×
Skull less than 4 views (70250) $257.40 $429 2.5×
Speech evaluation, complex (70371) $630 $1,050 2.6×
Sternoclavicular joints (71130) $244.80 $408 2.8×
Thoracic spine 2 views (72070) $363 $605 3.5×
Thoracic spine 3 views (72072) $436.80 $728 4.2×
Thoracolumbar 2 views (72080) $300 $500 3.4×
Thyroid Imaging With Vascular Flow (78013) $462 $770 1.2×
Ultrasound Breast Limited (76642)
range across 4 matching MRF lines		 $538.20–$1,076.40 $897–$1,794 varies
Ultrasound Exam Aaa Screen (76706) $209.40 $349 2.0×
Ultrasound, abdomen limited (76705) $852 $1,420 8.1×
Upper gi w/o kub (74240) $732.60 $1,221 4.2×
Us breast unilateral complete (76641)
range across 2 matching MRF lines		 $723.60–$1,447.20 $1,206–$2,412 varies
Us chest (76604) $583.80 $973 5.6×
Us complete joint (76881) $577.80 $963 5.5×
Us exam, pelvic, limited (76857) $518.40 $864 5.0×
Us lmtd joint/oth nonvasc xtr strux r-t w/img (76882) $528 $880 5.0×
Us ob limited 1 or more fetuses (76815) $450.60 $751 4.3×
Us ob transvaginal (76817) $633.60 $1,056 6.1×
Us pelvic non ob complete (76856) $859.20 $1,432 8.2×
Us pg uter img f&mat 14 wk tabdl 1/1st gestation (76801) $703.20 $1,172 6.7×
Us preg uterus real time f/u trnsabdl per fetus (76816) $532.20 $887 5.1×
Us retroperitoneal complete (76770) $854.40 $1,424 8.2×
Us retroperitoneal limited (76775) $506.40 $844 4.8×
Us scrotum and contents (76870) $795.60 $1,326 7.6×
Us thyroid (76536) $733.20 $1,222 7.0×
Wrist 2 views (73100) $306.60 $511 3.5×
X-Ray Ac Jts - Xr Acromioclavicular Joints Bilateral (73050) $220.20 $367 2.5×
X-Ray Bend Only L-S Spine (72120) $354 $590 3.4×
X-Ray Elbow 2 Vw - Xr Elbow 1-2 Views Right (73070) $235.80 $393 2.7×
X-Ray Exam Entire Spi 1 Vw (72081) $478.80 $798 5.5×
X-Ray Exam Entire Spi 2/3 Vw (72082) $502.20 $837 4.8×
X-Ray Exam Hip Uni 1 View (73501) $156.60 $261 1.8×
X-Ray Exam Hip Uni 2-3 Views (73502) $340.80 $568 3.9×
X-Ray Exam Hip Uni 4/> Views (73503) $436.20 $727 4.2×
X-Ray Exam Hips Bi 2 Views (73521) $449.40 $749 4.3×
X-Ray Exam Hips Bi 3-4 Views (73522) $471.60 $786 4.5×
X-Ray Exam Hips Bi 5/> Views (73523) $535.20 $892 5.1×
X-Ray Exam L-S Spine Bending (72114) $654.60 $1,091 6.3×
X-Ray Exam Neck Spine 2-3 Vw (72040) $373.80 $623 4.3×
X-Ray Exam Neck Spine 6/>Vws (72052) $654 $1,090 6.2×
X-Ray Exam Unilat Ribs/Chest (71101) $361.20 $602 3.4×
X-ray eye for foreign body (70030) $214.80 $358 2.5×
X-ray humerus (73060) $264 $440 3.0×
X-Ray Jaw <4 Vw - Xr Mandible < 4 Views (70100) $115.80 $193 1.3×
X-Ray Knee Bilat Standing - Xr Knees Anteroposterior Standing Bilat (73565) $296.40 $494 3.4×
X-Ray Lumbar Spine 2/3 Vw - Xr Lumbar Spine 2-3 Views (72100) $403.80 $673 3.9×
X-ray nose-rectum child f.b. (76010) $189.60 $316 2.2×
X-Ray Ribs, Chest 4+ Vw - Xr Ribs 3 Vws Bil W/ Chest Posteroanterior (71111) $601.20 $1,002 5.7×
X-Ray Sacroiliac Jts 3+ Vw - Xr Sacroiliac Joints 3+ Views (72202) $398.40 $664 3.8×
X-Ray Sacroiliac Jts <3 Vw - Xr Sacroiliac Joints 1-2 Views (72200) $247.80 $413 2.4×
X-Ray Sacrum/Coccyx 2+ Vw - Xr Sacrum Coccyx 2+ Views (72220) $376.20 $627 4.3×
X-Ray Sinuses 3+ Vw - Xr Paranasal Sinuses 3+ Views (70220) $408.60 $681 4.7×
X-Ray Skull 4+ Vw - Xr Skull Complete 4+ Views (70260) $330.60 $551 3.2×
X-Ray Tmj Unilat (70328) $115.80 $193 1.3×
X-Rays Bone Length Studies (77073) $360.60 $601 3.4×
X-Rays Bone Survey Complete (77075) $588.60 $981 5.6×
Xr c-spine 4 or 5 views (72050) $546 $910 5.2×
Xr facial bones less than 3 views (70140) $261 $435 3.0×
Xr orbits complete 4 views (70200) $376.20 $627 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.