Visits & medical services prices at Sullivan County Community Hospital
Sullivan, IN · every code in this section with a posted price and a Medicare benchmark.
119 codes. Prices are the hospital's own posted facility charges.
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| Procedure | Posted cash | Posted gross | × Medicare |
|---|---|---|---|
| Advncd Care Plan 30 Min (99497) range across 2 matching MRF lines |
$189.75–$195 | $253–$260 | varies |
| Airway Inhalation Treatment (94640) range across 4 matching MRF lines |
$43.50–$57.75 | $58–$77 | varies |
| Appl Modality 1/> Areas Ultrasound Ea 15 Min (97035) range across 2 matching MRF lines |
$62.52–$62.66 | $83.36–$83.55 | varies |
| Assessment of aphasia per hr (96105) | $195.75 | $261 | 2.0× |
| Assmt & care planning pt w/cognitive impairment (99483) | $352.50 | $470 | 3.3× |
| Behavral qualit analys voice (92524) | $228 | $304 | 2.1× |
| Brief Emotional/Behav Assmt (96127) range across 2 matching MRF lines |
$12–$18.75 | $16–$25 | varies |
| Brncdilat rspse spmtry pre&post-brncdilat admn (94060) | $627.75 | $837 | 1.6× |
| Canalith repositioning proc (95992) | $82.88 | $110.50 | 2.0× |
| Cardiopulmonary resuscitation (92950) | $705 | $940 | 3.1× |
| Cardioversion (92960) | $789 | $1,052 | 1.1× |
| Chemo Anti-Neopl Sq/Im (96401) range across 2 matching MRF lines |
$123–$146.25 | $164–$195 | varies |
| Chemo IV infusion addl hr (96415) | $247.50 | $330 | 3.2× |
| Chemotx admn IV nfs tq up 1 hr 1/1st sbst/drug (96413) | $880.50 | $1,174 | 2.5× |
| Chest Wall Manipulation (94668) | $46.50 | $62 | 0.3× |
| Color/duplex Doppler, complete (93975) | $821.81 | $1,095.75 | 3.3× |
| Continuous Pulse Ox (94762) range across 2 matching MRF lines |
$96.75–$135 | $129–$180 | varies |
| Cpap Ventilation Cpap Initiation&Mgmt (94660) | $487.50 | $650 | 2.1× |
| Cpt initial (94667) | $72.75 | $97 | 0.5× |
| Critical care first hour (99291) range across 4 matching MRF lines |
$1,602–$2,750.03 | $2,136–$3,666.71 | varies |
| Debridement Open Wound 20 Sq Cm< (97597) range across 7 matching MRF lines |
$62.25–$405.75 | $83–$541 | varies |
| Dup-scan lxtr art/artl bpgs compl bi study (93925) | $1,089.37 | $1,452.49 | 4.3× |
| Dup-Scan Lxtr Art/Artl Bpgs Uni/Lmtd Study (93926) | $728.90 | $971.86 | 6.6× |
| Dup-Scan Xtr Veins Complete Bilateral Study (93970) | $1,094.85 | $1,459.80 | 4.3× |
| Dup-scan xtr veins unilateral/limited study (93971) | $668.28 | $891.04 | 6.0× |
| Duplex up extrem art bilat (93930) | $1,344.75 | $1,793 | 5.3× |
| Duplex up extrem art unilat/ltd (93931) | $886.13 | $1,181.50 | 8.0× |
| Echo Heart Xthoracic,Limited (93308) | $461.44 | $615.25 | 1.8× |
| Eeg 41-60 Minutes (95812) | $864 | $1,152 | 3.8× |
| EEG cerebral death evaluation (95824) | $864 | $1,152 | 2.2× |
| EEG extended monitoring 61-119 minutes (95813) | $864 | $1,152 | 3.8× |
| Electrical Stimulation Ea 15 Min (97032) | $83.25 | $111 | 5.7× |
| Electrocardiogram Tracing (93005) range across 2 matching MRF lines |
$271.93–$276 | $362.57–$368 | varies |
| Emergency Dept Visit Level 2 (99282) | $364.84 | $486.45 | 2.2× |
| Emergency Dept Visit Level 3 (99283) | $639.20 | $852.26 | 2.2× |
| Emergency Dept Visit Level 4 (99284) | $949.31 | $1,265.75 | 2.2× |
| Er level 1 (99281) | $20.25 | $27 | 0.2× |
| Er level v (99285) | $1,404.70 | $1,872.93 | 2.2× |
| Eval aud funcj cand/po surg implt dev 1st hr (92626) | $222 | $296 | 1.6× |
| Evaluate Speech Production (92522) | $228 | $304 | 2.0× |
| Evaluate Swallowing Function (92610) | $233.25 | $311 | 2.7× |
| Evaluation of speech fluency (92521) | $228 | $304 | 1.7× |
| Exercise test for bronchospasm (94617) | $112.50 | $150 | 0.8× |
| External ECG rec>48hr<7d recording (93242) | $603.75 | $805 | 15.3× |
| External ECG rec>7d<15d recording (93246) | $647.25 | $863 | 16.4× |
| External Ecg Scanning Analysis Report (93226) | $556.50 | $742 | 8.9× |
| Extracranial Bilat Study (93880) | $982.13 | $1,309.50 | 3.9× |
| Holter monitor recording (93225) | $556.50 | $742 | 4.0× |
| Immunization administration (90471) range across 6 matching MRF lines |
$27–$141.75 | $36–$189 | varies |
| Iontophoresis 15 min (97033) range across 2 matching MRF lines |
$84–$85.16 | $112–$113.55 | varies |
| Irrig Drug Delivery Device (96523) | $144 | $192 | 2.3× |
| IV infusion hydration each additional hour (96361) | $247.50 | $330 | 5.0× |
| IV infusion hydration initial 31 min-1 hour (96360) | $342 | $456 | 1.5× |
| IV infusion ther proph addl sequential to 1 hr (96367) | $247.50 | $330 | 3.2× |
| IV infusion therapy prophylaxis/dx ea hour (96366) | $247.50 | $330 | 5.0× |
| IV push initial (96374) | $204 | $272 | 0.9× |
| Motion Fluoroscopy/Swallow (92611) | $301.50 | $402 | 3.3× |
| Multiple Sleep Latency Test (95805) | $2,793 | $3,724 | 3.1× |
| Neg Pressure Wound Therapy Non Dme </= 50 Sq Cm (97607) range across 3 matching MRF lines |
$36.75–$878.25 | $49–$1,171 | varies |
| Neg Pressure Wound Therapy Non Dme >50 Sq Cm (97608) range across 3 matching MRF lines |
$46.50–$878.25 | $62–$1,171 | varies |
| Negative Pressure Wound Therapy Dme </= 50 Sq Cm (97605) range across 6 matching MRF lines |
$43.50–$478.50 | $58–$638 | varies |
| Negative Pressure Wound Therapy Dme >50 Sq Cm (97606) range across 4 matching MRF lines |
$54.75–$878.25 | $73–$1,171 | varies |
| Neuromuscular Reeducation (97112) range across 2 matching MRF lines |
$69.11–$69.14 | $92.14–$92.19 | varies |
| Nonphysician Telephone Assessment 11-20 Min (98967) | $48 | $64 | 1.9× |
| Nonphysician Telephone Assessment 21-30 Min (98968) | $64.50 | $86 | 1.9× |
| Nonphysician Telephone Assessment 5-10 Min (98966) | $33 | $44 | 2.4× |
| Oral Function Therapy (92526) | $177 | $236 | 2.1× |
| Orthotics Mgmt & Trainj Initial Enctr Ea 15 Mins (97760) range across 2 matching MRF lines |
$85.50–$85.55 | $114–$114.06 | varies |
| Ot eval high complexity (97167) | $256.50 | $342 | 2.6× |
| Ot Eval Low Complex (97165) | $252.45 | $336.60 | 2.5× |
| Ot Eval Moderate Complexity (97166) | $254.77 | $339.69 | 2.5× |
| Ot manual therapy 15 min (97140) range across 2 matching MRF lines |
$84.83–$84.87 | $113.11–$113.16 | varies |
| Ot paraffin bath (97018) | $56.07 | $74.76 | 9.3× |
| Ot Re-Eval Est Plan Care (97168) | $127.50 | $170 | 1.9× |
| Outpatient Cardiac Rehab W/Cont Ecg Monitoring (93798) range across 2 matching MRF lines |
$204–$213.75 | $272–$285 | varies |
| Outpatient Cardiac Rehab W/O Cont Ecg Monitor (93797) | $142.50 | $190 | 1.0× |
| Pentamidine Aersl Inhalation Pneumocystis/Proph (94642) | $184.50 | $246 | 0.8× |
| Physical Performance Test (97750) range across 2 matching MRF lines |
$68.21–$84.25 | $90.95–$112.33 | varies |
| Polysom 6/>Yrs Sleep W/Cpap 4/> Addl Param Attnd (95811) | $3,210.75 | $4,281 | 3.5× |
| Psychiatric diagnostic evaluation (90791) range across 6 matching MRF lines |
$174–$406.50 | $232–$542 | varies |
| Pt Eval High Complex (97163) | $252.59 | $336.78 | 2.6× |
| Pt eval low complex 20 min (97161) | $252.65 | $336.87 | 2.6× |
| Pt Eval Mod Complex (97162) | $252.94 | $337.25 | 2.6× |
| Pt gait training 15 min (97116) | $72.91 | $97.21 | 2.5× |
| Pt mechanical traction (97012) | $44.25 | $59 | 3.1× |
| Pt Re-Eval Est Plan Care (97164) | $125.84 | $167.79 | 1.9× |
| Pulm function test by gas (94727) | $196.50 | $262 | 0.9× |
| Pulmonary service/procedure (94799) range across 2 matching MRF lines |
$29.25–$84 | $39–$112 | varies |
| Pulmonary Stress Testing (94618) | $112.50 | $150 | 0.8× |
| Remote 30 Day Ecg Rev/Report (93270) | $171.75 | $229 | 4.3× |
| Rhythm Ecg 1-3 Leads Tracing Only W/O I&R (93041) range across 2 matching MRF lines |
$295.44–$300 | $393.92–$400 | varies |
| Rmvl Devital Tiss N-Slctv Dbrdmt W/O Anes 1 Sess (97602) range across 2 matching MRF lines |
$61.50–$478.50 | $82–$638 | varies |
| Rx sp-genratj augmnt&comunicaj dev 1st hr (92607) range across 2 matching MRF lines |
$193.50–$228 | $258–$304 | varies |
| Rx Sp-Genratj Augmnt&Comunicaj Dev Ea 30 Min (92608) | $113.25 | $151 | 2.4× |
| Self Care Mngment Training (97535) range across 2 matching MRF lines |
$69–$69.43 | $92–$92.57 | varies |
| Speech sound lang comprehen (92523) | $228 | $304 | 1.0× |
| Spirometry (94010) | $156.75 | $209 | 0.7× |
| Standardized Cognitive Performance Testing (96125) | $195.75 | $261 | 1.9× |
| Ther Ivntj Cog Funcj Cntct 1st 15 Minutes (97129) | $147 | $196 | 6.6× |
| Ther Ivntj Ea Addl 15 Min (97130) | $64.50 | $86 | 3.1× |
| Ther Sp-Genratj Dev Prgrmg&Modificaj (92609) | $143.25 | $191 | 1.4× |
| Ther/Proph/Diag Inj Sc/Im (96372) range across 13 matching MRF lines |
$27–$156.75 | $36–$209 | varies |
| Ther/Proph/Diag Iv Inf Init (96365) | $342 | $456 | 1.5× |
| Therapeutic Activities (97530) range across 2 matching MRF lines |
$69.38–$69.44 | $92.50–$92.58 | varies |
| Tobacco Use Cessation Intensive >10 Minutes (99407) | $87.75 | $117 | 2.2× |
| Tobacco Use Cessation Intermediate 3-10 Minutes (99406) range across 4 matching MRF lines |
$21.75–$87.75 | $29–$117 | varies |
| Tte w/doppler, complete (93306) | $1,487.81 | $1,983.75 | 2.6× |
| Tx Speech Lang Voice Commj &/Auditory Proc Ind (92507) | $141.75 | $189 | 1.9× |
| Tx Speech Language Voice Commj Auditry 2/>Indiv (92508) | $70.50 | $94 | 2.9× |
| Tx/Pro/Dx Inj New Drug Addon (96375) | $204 | $272 | 4.1× |
| Unlisted cardiovascular service/procedure (93799) | $48 | $64 | 0.4× |
| Upr/L Xtremity Art 2 Levels (93922) range across 4 matching MRF lines |
$72–$583.43 | $96–$777.91 | varies |
| Upr/Lxtr Art Stdy 3+ Lvls (93923) range across 2 matching MRF lines |
$72–$385.50 | $96–$514 | varies |
| Vasopneumatic device (97016) range across 2 matching MRF lines |
$84.66–$85.01 | $112.88–$113.34 | varies |
| Veeg 2-12 Hr Cont Mntr (95713) | $1,017.75 | $1,357 | 2.6× |
| Vent Mgmt Inpat Init Day (94002) range across 2 matching MRF lines |
$359.25–$534.75 | $479–$713 | varies |
| Ventilation Assist & Mgmt Inpatient Ea Sbsq Da (94003) range across 2 matching MRF lines |
$244.50–$246 | $326–$328 | varies |
| Vital capacity, total (94150) | $93.75 | $125 | 0.7× |
| Wheelchair Mgmt Ea 15 Min (97542) | $86.25 | $115 | 2.8× |
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.