Imaging prices at Sullivan County Community Hospital
Sullivan, IN · every code in this section with a posted price and a Medicare benchmark.
179 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) | $271.67 | $362.23 | 3.0× |
| Ankle 2 views (73600) | $251.84 | $335.79 | 2.7× |
| Bone age studies (77072) | $281.25 | $375 | 2.5× |
| Bone Imaging 3 Phase (78315) | $1,622.73 | $2,163.64 | 3.8× |
| Bone Imaging Whole Body (78306) | $1,171.88 | $1,562.50 | 2.8× |
| Bone survey infant (77076) | $397.50 | $530 | 3.6× |
| Chest 1 view (71045) range across 2 matching MRF lines |
$93.75–$203.75 | $125–$271.66 | varies |
| Chest 2 views (71046) | $250.99 | $334.65 | 2.7× |
| Chest 3 views (71047) | $200.25 | $267 | 2.2× |
| Clavicle complete (73000) | $262.50 | $350 | 2.9× |
| Computed Tomography Thorax Lw Dose Lng Ca Scr C- (71271) | $247.34 | $329.79 | 2.2× |
| CT abdomen and pelvis without and with contrast (74178) | $4,562.01 | $6,082.68 | 12.4× |
| CT abdomen and pelvis without contrast (74176) | $3,342.82 | $4,457.09 | 13.2× |
| CT abdomen w contrast (74160) | $2,271 | $3,028 | 12.2× |
| CT abdomen w wo contrast (74170) | $2,942.07 | $3,922.76 | 15.9× |
| CT abdomen w/o contrast (74150) | $1,690.73 | $2,254.31 | 15.3× |
| CT Angio Abdomen and Pelvis (74174) | $4,529.25 | $6,039 | 12.3× |
| CT Angio Chest (71275) | $2,802 | $3,736 | 15.1× |
| CT Angio Head (70496) | $2,891.99 | $3,855.98 | 15.6× |
| Ct Angio Lwr Extr W/O&W/Dye (73706) | $2,879.50 | $3,839.33 | 15.5× |
| CT Angio Neck (70498) | $2,893.89 | $3,858.52 | 15.6× |
| Ct Angio Upr Extrm W/O&W/Dye (73206) | $2,757.75 | $3,677 | 14.9× |
| CT cervical spine w/ contrast (72126) | $2,091 | $2,788 | 5.7× |
| CT cervical spine w/o contrast (72125) | $1,644.21 | $2,192.28 | 14.9× |
| CT cervical spine w/wo cont (72127) | $2,701.50 | $3,602 | 14.6× |
| CT chest w contrast (71260) | $2,267.32 | $3,023.09 | 12.2× |
| CT chest w/wo contrast (71270) | $2,726.38 | $3,635.17 | 14.7× |
| CT head/brain with contrast (70460) | $2,122.50 | $2,830 | 11.4× |
| CT head/brain without and with contrast (70470) | $2,887.76 | $3,850.35 | 15.6× |
| CT heart no contrast quant eval coronry calcium (75571) | $40.28 | $53.70 | 0.4× |
| CT iac w contrast (70481) range across 2 matching MRF lines |
$2,091–$2,154 | $2,788–$2,872 | varies |
| CT l-spine w&w/o contrast (72133) | $2,742.38 | $3,656.50 | 14.8× |
| CT lower ext w/o (73700) | $1,644.14 | $2,192.18 | 14.9× |
| CT lower extremity w/contrast material (73701) | $2,126 | $2,834.67 | 11.5× |
| CT lumbar spine w/o contrast (72131) | $1,641 | $2,188 | 14.8× |
| CT maxillofacial w contrast (70487) range across 2 matching MRF lines |
$1,941–$1,984.88 | $2,588–$2,646.50 | varies |
| CT maxillofacial wo contrast (70486) range across 2 matching MRF lines |
$1,841.24–$1,847.95 | $2,454.98–$2,463.93 | varies |
| CT neck tissue combo (70492) | $2,916.94 | $3,889.25 | 15.7× |
| CT orbits w/o contrast (70480) range across 2 matching MRF lines |
$1,845.60–$1,846.97 | $2,460.80–$2,462.63 | varies |
| CT pelvis w/o contrast (72192) | $1,984.20 | $2,645.60 | 17.9× |
| CT scans face/jaw combo (70488) | $2,937 | $3,916 | 15.8× |
| CT soft tissue neck w contrast (70491) | $2,524.28 | $3,365.71 | 13.6× |
| CT soft tissue neck w/o contrast (70490) | $2,387.25 | $3,183 | 21.6× |
| CT thoracic spine w/o contrast (72128) | $1,643.04 | $2,190.72 | 14.9× |
| CT thoracic spine w/wo cont (72130) | $2,783.25 | $3,711 | 15.0× |
| CT thorax w/o contrast (71250) | $1,641.90 | $2,189.20 | 14.8× |
| CT upper ext wo (73200) | $1,844.80 | $2,459.73 | 16.7× |
| CT upper extremity with contrast (73201) | $2,112 | $2,816 | 5.7× |
| Cta Abdl Aorta&Bi Iliofem W/Contrast&Postp (75635) | $4,164.24 | $5,552.32 | 22.4× |
| Cta Abdomen (74175) | $2,829 | $3,772 | 15.2× |
| Dxa Bone Density Axial (77080) | $389.03 | $518.70 | 3.5× |
| Esophagram (74220) | $352.94 | $470.58 | 1.9× |
| Fetal Biophys Profile W/Nst (76818) | $461.25 | $615 | 4.2× |
| Fetal Biophysical Profile W/O Non-Stress Testing (76819) | $381.59 | $508.78 | 3.4× |
| Fluoroscopy up to 1 hr (76000) | $253.31 | $337.75 | 1.0× |
| Foot 2 views (73620) | $192 | $256 | 2.1× |
| Forearm 2 views (73090) | $262.04 | $349.38 | 2.8× |
| Gastric emptying imaging study (78264) | $1,075.39 | $1,433.85 | 2.5× |
| Hand 2 views (73120) | $285.51 | $380.68 | 2.6× |
| Hepatobil Syst Image W/Drug (78227) | $1,262.69 | $1,683.58 | 2.2× |
| Hepatobiliary System Imaging (78226) | $1,267.75 | $1,690.33 | 3.0× |
| Hysterosalpingogram (74740) range across 2 matching MRF lines |
$189–$561 | $252–$748 | varies |
| Knee 3 Views (73562) | $274.60 | $366.13 | 3.0× |
| Lung Ventilat&Perfus Imaging (78582) | $1,342.13 | $1,789.50 | 2.3× |
| Lymph System Imaging (78195) | $1,061.25 | $1,415 | 1.8× |
| MRA head w/o contrast (70544) | $2,580 | $3,440 | 10.2× |
| MRA neck w contrast (70548) | $2,692.35 | $3,589.80 | 7.3× |
| Mra Neck W/O &W/Contrast Material (70549) | $2,973.75 | $3,965 | 8.1× |
| MRA neck w/o contrast (70547) | $2,577.75 | $3,437 | 10.2× |
| MRI abdomen w contrast (74182) | $3,318 | $4,424 | 9.0× |
| MRI abdomen w/o contrast (74181) | $2,599.61 | $3,466.14 | 10.3× |
| MRI any jt lower extrem w/contrast material (73722) | $3,318 | $4,424 | 4.0× |
| MRI any jt lower extrem w/o & w/contrast matrl (73723) | $3,639 | $4,852 | 9.9× |
| MRI any jt upper extremity w/contrast matrl (73222) | $3,253.50 | $4,338 | 3.9× |
| MRI cervical spine w contrast (72142) | $3,253.50 | $4,338 | 8.8× |
| MRI cervical spine w/o cont (72141) | $2,570.58 | $3,427.44 | 10.2× |
| MRI lower extrem oth/thn jt w/contrast matrl (73719) | $3,221.25 | $4,295 | 8.7× |
| MRI lower extrem oth/thn jt w/o & w/contr matr (73720) | $3,585.75 | $4,781 | 9.7× |
| MRI lower extrem oth/thn jt w/o contr matrl (73718) | $2,575.20 | $3,433.60 | 10.2× |
| MRI lumbar spine w contrast (72149) | $3,269.63 | $4,359.50 | 8.9× |
| Mri Neck Spine W/O & W/Dye (72156) | $3,585.75 | $4,781 | 9.7× |
| MRI orbit face &/neck w/o contrast (70540) | $2,616 | $3,488 | 10.4× |
| Mri Orbt/Fac/Nck W/O &W/Dye (70543) | $3,639 | $4,852 | 9.9× |
| MRI pelvis w/o & w contrast (72197) | $3,596.40 | $4,795.20 | 9.7× |
| MRI pelvis w/o contrast (72195) | $2,573.50 | $3,431.33 | 10.2× |
| MRI thoracic spine w/o contrast (72146) | $2,565 | $3,420 | 10.2× |
| MRI upper extremity oth than jt w/o contr matrl (73218) | $2,577.75 | $3,437 | 10.2× |
| MRI, abdomen, combo (74183) | $3,612.38 | $4,816.50 | 9.8× |
| MRI, dorsal spine combo (72157) | $3,572.44 | $4,763.25 | 9.7× |
| MRI, dorsal spine contrast (72147) | $3,269.63 | $4,359.50 | 8.9× |
| MRI, joint upper extrem (73221) | $2,574.51 | $3,432.68 | 10.2× |
| MRI, joint upper extrem combo (73223) | $3,525 | $4,700 | 9.5× |
| MRI, lumbar spine combo (72158) | $2,951.81 | $3,935.75 | 8.0× |
| Myocardial Spect Multiple Studies (78452) | $2,585.91 | $3,447.88 | 1.9× |
| Neck soft tissue (70360) | $214.43 | $285.91 | 2.3× |
| Parathyroid Planar Imaging (78070) | $1,181.58 | $1,575.44 | 2.8× |
| Pelvis 1 or 2 views (72170) | $262.61 | $350.14 | 2.4× |
| Pulmonary Perfusion Imaging Particulate (78580) | $1,216.35 | $1,621.80 | 2.9× |
| Radex Abd Compl Aqt Abd W/S/E/D Views 1 View Ch (74022) | $503.21 | $670.94 | 4.5× |
| Radex Ankle Complete Minimum 3 Views (73610) | $251.42 | $335.22 | 2.7× |
| Radex Calcaneus Minimum 2 Views (73650) | $262.50 | $350 | 2.9× |
| Radex elbow complete minimum 3 views (73080) | $263.47 | $351.29 | 2.9× |
| Radex Facial Bones Complete Minimum 3 Views (70150) | $272.40 | $363.20 | 2.5× |
| Radex fingr minimum 2 views (73140) | $162.09 | $216.12 | 1.8× |
| Radex foot complete minimum 3 views (73630) | $262.86 | $350.48 | 2.9× |
| Radex Hand Minimum 3 Views (73130) | $262.75 | $350.33 | 2.9× |
| Radex Nasal Bones Complete Minimum 3 Views (70160) | $274.88 | $366.50 | 3.0× |
| Radex Ribs Unilateral 2 Views (71100) | $262.55 | $350.06 | 2.9× |
| Radex shoulder complete minimum 2 views (73030) | $262.90 | $350.53 | 2.9× |
| Radex Spine 1 View Specify Level (72020) | $214.34 | $285.79 | 2.3× |
| Radex Sternum Minimum 2 Views (71120) | $211.50 | $282 | 2.3× |
| Radex Toe Minimum 2 Views (73660) | $215.05 | $286.73 | 2.3× |
| Radex Wrist Complete Minimum 3 Views (73110) range across 2 matching MRF lines |
$234.97–$274.24 | $313.29–$365.65 | varies |
| Radiolog exam mandible compl minimum 4 views (70110) | $274.88 | $366.50 | 2.5× |
| Radiologic Exam Abdomen 3+ Views - Xr Abdomen 3+ Views (74021) | $417.59 | $556.79 | 3.8× |
| Radiologic exam colon double contrast study (74280) | $698.75 | $931.67 | 3.8× |
| Radiologic exam colon single contrast study (74270) | $356.63 | $475.50 | 1.9× |
| Radiologic exam knee complete 4/more views (73564) | $316.69 | $422.25 | 2.9× |
| Radiologic Exam Small Int Single Contrast Study (74250) | $444.75 | $593 | 2.4× |
| Radiologic exam swallow function contrast study (74230) | $265.77 | $354.36 | 1.4× |
| Radiologic exam upr gi trc double contrast study (74246) | $702.38 | $936.50 | 3.8× |
| Radiologic examination femur 1 view (73551) | $222.75 | $297 | 2.4× |
| Radiologic examination femur minimum 2 views (73552) | $263 | $350.67 | 2.9× |
| Radiologic examination knee 1/2 views (73560) | $263.13 | $350.84 | 2.9× |
| Radiologic Examination Osseous Survey Limited (77074) | $680.25 | $907 | 6.1× |
| Radiologic examination tibia & fibula 2 views (73590) | $262.13 | $349.51 | 2.8× |
| Ribs bilateral 3 views (71110) | $355.50 | $474 | 3.2× |
| Scapula (73010) | $263.70 | $351.60 | 2.4× |
| Screening Digital Breast Tomosynthesis Bi (77063) | $55.13 | $73.51 | 2.4× |
| Skull less than 4 views (70250) | $258.75 | $345 | 2.3× |
| Sternoclavicular joints (71130) | $262.88 | $350.50 | 2.9× |
| Thoracic spine 3 views (72072) | $274.88 | $366.50 | 2.5× |
| Thoracolumbar 2 views (72080) | $276.94 | $369.25 | 3.0× |
| Thyroid Uptake W/Blood Flow Sngle/Mult Quan Meas (78014) | $895.13 | $1,193.50 | 2.1× |
| Ultrasound Breast Limited (76642) | $234.75 | $313 | 2.5× |
| Ultrasound Exam Aaa Screen (76706) | $617.90 | $823.87 | 5.6× |
| Ultrasound, abdomen limited (76705) range across 4 matching MRF lines |
$746.12–$806.42 | $994.82–$1,075.22 | varies |
| Upper gi w/o kub (74240) | $680.93 | $907.90 | 3.7× |
| Us breast unilateral complete (76641) | $432.03 | $576.04 | 3.9× |
| Us chest (76604) | $751.50 | $1,002 | 6.8× |
| Us complete joint (76881) | $548.54 | $731.38 | 5.0× |
| Us exam, pelvic, limited (76857) range across 2 matching MRF lines |
$702–$723.75 | $936–$965 | varies |
| Us ob detailed single fetus (76811) | $931.50 | $1,242 | 3.7× |
| Us ob limited 1 or more fetuses (76815) range across 2 matching MRF lines |
$289.07–$294 | $385.42–$392 | varies |
| Us ob transvaginal (76817) range across 2 matching MRF lines |
$598.35–$612.75 | $797.80–$817 | varies |
| Us pelvic non ob complete (76856) | $1,040.57 | $1,387.42 | 9.4× |
| Us pg uter img f&mat 14 wk tabdl 1/1st gestation (76801) range across 2 matching MRF lines |
$917.81–$931.50 | $1,223.75–$1,242 | varies |
| Us preg uterus real time f/u trnsabdl per fetus (76816) range across 2 matching MRF lines |
$675.55–$684.75 | $900.73–$913 | varies |
| Us retroperitoneal complete (76770) range across 2 matching MRF lines |
$995.37–$996.90 | $1,327.16–$1,329.20 | varies |
| Us scrotum and contents (76870) | $973.86 | $1,298.48 | 8.8× |
| Us spinal canal and contents (76800) | $711 | $948 | 6.4× |
| Us thyroid (76536) range across 2 matching MRF lines |
$742.63–$747 | $990.17–$996 | varies |
| Wrist 2 views (73100) | $261.50 | $348.67 | 2.8× |
| X-Ray Ac Jts - Xr Acromioclavicular Joints Bilateral (73050) | $214.88 | $286.50 | 2.3× |
| X-Ray Elbow 2 Vw - Xr Elbow 1-2 Views Right (73070) | $249.55 | $332.73 | 2.7× |
| X-Ray Exam Breast Specimen (76098) | $343.50 | $458 | 0.6× |
| X-Ray Exam Entire Spi 1 Vw (72081) | $253.11 | $337.48 | 2.7× |
| X-Ray Exam Entire Spi 2/3 Vw (72082) | $321.75 | $429 | 2.9× |
| X-Ray Exam Hip Uni 1 View (73501) range across 2 matching MRF lines |
$215.18–$226.01 | $286.90–$301.34 | varies |
| X-Ray Exam Hip Uni 2-3 Views (73502) | $275.56 | $367.41 | 3.0× |
| X-Ray Exam Hips Bi 2 Views (73521) | $356.81 | $475.74 | 3.2× |
| X-Ray Exam Hips Bi 3-4 Views (73522) | $395.28 | $527.04 | 3.6× |
| X-Ray Exam L-S Spine Bending (72114) | $490.57 | $654.09 | 4.4× |
| X-Ray Exam Neck Spine 2-3 Vw (72040) | $263.07 | $350.76 | 2.9× |
| X-Ray Exam Neck Spine 6/>Vws (72052) | $488.75 | $651.67 | 4.4× |
| X-Ray Exam Unilat Ribs/Chest (71101) | $265.81 | $354.41 | 2.4× |
| X-ray eye for foreign body (70030) | $123.75 | $165 | 1.3× |
| X-ray humerus (73060) | $263.52 | $351.36 | 2.9× |
| X-Ray Lumbar Spine 2/3 Vw - Xr Lumbar Spine 2-3 Views (72100) | $274.79 | $366.39 | 2.5× |
| X-ray nose-rectum child f.b. (76010) | $181.50 | $242 | 2.0× |
| X-Ray Ribs, Chest 4+ Vw - Xr Ribs 3 Vws Bil W/ Chest Posteroanterior (71111) | $450.75 | $601 | 4.1× |
| X-Ray Sacroiliac Jts 3+ Vw - Xr Sacroiliac Joints 3+ Views (72202) | $193.52 | $258.03 | 1.7× |
| X-Ray Sacrum/Coccyx 2+ Vw - Xr Sacrum Coccyx 2+ Views (72220) | $263.66 | $351.55 | 2.9× |
| X-Ray Sinuses 3+ Vw - Xr Paranasal Sinuses 3+ Views (70220) | $274.28 | $365.71 | 3.0× |
| X-Ray Skull 4+ Vw - Xr Skull Complete 4+ Views (70260) | $272.81 | $363.75 | 2.5× |
| X-Ray Tmj Unilat (70328) | $635.25 | $847 | 6.9× |
| X-Rays Bone Length Studies (77073) | $480.54 | $640.72 | 4.3× |
| Xr c-spine 4 or 5 views (72050) | $394.50 | $526 | 3.6× |
| Xr orbits complete 4 views (70200) | $249 | $332 | 2.3× |
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.