Imaging prices at Sullivan County Memorial Hospital

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

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

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ProcedureCash priceGross charge× Medicare
Abdomen 2 views (74019) $321 $321 3.1×
Ankle 2 views (73600) $261 $261 3.0×
Bone survey complete (77075) $321 $321 3.1×
Cervical spine 2 or 3 views (72040) $261 $261 3.0×
Chest 1 view (71045) $261 $261 3.0×
Chest 3 views (71047) $261 $261 3.0×
Cine/Vid X-Ray Throat/Esoph - Fl Esoph Barium Swlw W/ Video & Speech (74230) $541 $541 3.1×
Clavicle complete (73000) $261 $261 3.0×
Computed Tomography Thorax Lw Dose Lng Ca Scr C- (71271) $500 $500 4.8×
CT abdomen and pelvis without and with contrast (74178) $2,211 $2,211 6.3×
CT abdomen and pelvis without contrast (74176) $1,401 $1,401 5.9×
CT abdomen w contrast (74160) $1,082 $1,082 6.2×
CT abdomen w wo contrast (74170) $1,082 $1,082 6.2×
CT abdomen w/o contrast (74150) $641 $641 6.1×
CT c-spine w/o contrast (72125) $641 $641 6.1×
CT cervical spine w&w/o contrast (72127) $2,211 $2,211 12.6×
CT cervical spine with contrast (72126) $2,211 $2,211 6.3×
CT chest w/wo contrast (71270) $1,082 $1,082 6.2×
CT chest with contrast (71260) $1,082 $1,082 6.2×
CT head/brain with contrast (70460) $1,082 $1,082 6.2×
CT head/brain without and with contrast (70470) $1,082 $1,082 6.2×
CT iac w contrast (70481) $1,082 $1,082 6.2×
CT lower ext w/o (73700) $641 $641 6.1×
CT lower extremity w wo contrast (73702) $1,082 $1,082 6.2×
CT lower extremity with contrast (73701) $1,082 $1,082 6.2×
CT lumbar spine w & w/o contrast (72133) $1,082 $1,082 6.2×
CT lumbar spine w/o contrast (72131) $641 $641 6.1×
CT lumbar spine with contrast (72132) $2,211 $2,211 6.3×
CT maxillofacial w contrast (70487) $1,082 $1,082 6.2×
CT maxillofacial w/o contrast (70486) $641 $641 6.1×
CT maxillofacial w/wo contrast (70488) $1,082 $1,082 6.2×
CT neck soft tissue w contrast (70491) $1,082 $1,082 6.2×
CT orbit sella/post fossa/ear w/o & w/contr matr (70482) $1,082 $1,082 6.2×
CT orbits w/o contrast (70480) $641 $641 6.1×
CT pelvis w & w/o contrast (72194) $1,082 $1,082 6.2×
CT pelvis w/o contrast (72192) $641 $641 6.1×
CT scan for measuring calcium and other minerals in bone (77078) $521 $521 6.0×
CT soft tissue neck w/o & w/contrast material (70492) $1,082 $1,082 6.2×
CT soft tissue neck w/o contrast (70490) $641 $641 6.1×
CT thoracic spine w/o contrast (72128) $641 $641 6.1×
CT thoracic spine w/wo contrast (72130) $1,082 $1,082 6.2×
CT thorax w/o contrast (71250) $641 $641 6.1×
CT upper extremity w/o & w/contrast material (73202) $1,082 $1,082 6.2×
CT upper extremity w/o contrast rt (73200) $641 $641 6.1×
CT upper extremity with contrast (73201) $2,211 $2,211 6.3×
Cta Abdl Aorta&Bi Iliofem W/Contrast&Postp (75635) $2,000 $2,000 11.4×
CTA abdomen pelvis (74174) $2,211 $2,211 6.3×
CTA chest (71275) $1,082 $1,082 6.2×
Cta Head (70496) $1,082 $1,082 6.2×
Cta Neck (70498) $1,082 $1,082 6.2×
Cystography minimum 3 views rs&i (74430) $1,105 $1,105 3.2×
Dxa bone density study 1/> sites axial skel (77080) $321 $321 3.1×
Dxa bone density study 1/>sites appendiclr skel (77081) $261 $261 3.0×
Esophagus (74220) $541 $541 3.1×
Fetal Biophysical Profile W/O Non-Stress Testing (76819) $428 $428 4.1×
Foot 2 views (73620) $261 $261 3.0×
Forearm 2 views (73090) $261 $261 3.0×
Hand 2 views (73120) $321 $321 3.1×
Hand 3 views (73130) $261 $261 3.0×
Humerus Min 2 Views Left (73060) $261 $261 3.0×
Knee 3 views (73562) $261 $261 3.0×
MRA head w/o contrast (70544) $1,401 $1,401 5.9×
Mra Neck W/O &W/Contrast Material (70549) $2,211 $2,211 6.3×
MRI abdomen w contrast (74182) $2,211 $2,211 6.3×
MRI abdomen w/o & w/contrast material (74183) $2,211 $2,211 6.3×
MRI abdomen w/o contrast (74181) $1,401 $1,401 5.9×
MRI any jt upper extremity w/contrast matrl (73222) $4,445 $4,445 5.7×
MRI c-spine with contrast (72142) $2,211 $2,211 6.3×
MRI cervical spine w/o contrast (72141) $1,401 $1,401 5.9×
MRI chest w/o contrast (71550) $1,401 $1,401 5.9×
MRI lower extrem oth/thn jt w/contrast matrl (73719) $2,211 $2,211 6.3×
MRI lower extrem oth/thn jt w/o contr matrl (73718) $1,401 $1,401 5.9×
MRI orbit face &/neck w/o contrast (70540) $1,401 $1,401 5.9×
MRI orbit/face/neck w&w/o cont (70543) $2,211 $2,211 6.3×
MRI orbit/face/neck w/contrast (70542) $2,211 $2,211 6.3×
MRI pelvis w/o & w/contrast material (72197) $2,211 $2,211 6.3×
MRI pelvis w/o contrast (72195) $1,401 $1,401 5.9×
MRI scan of arm joint before and after contrast (73223) $2,211 $2,211 6.3×
MRI scan of leg joint before and after contrast (73723) $2,211 $2,211 6.3×
MRI spinal canal cervical w/o & w/contr matrl (72156) $2,211 $2,211 6.3×
MRI spinal canal lumbar w/contrast material (72149) $2,211 $2,211 6.3×
MRI spinal canal lumbar w/o & w/contr matrl (72158) $2,211 $2,211 6.3×
MRI spinal canal thoracic w/contrast matrl (72147) $2,211 $2,211 6.3×
MRI spinal canal thoracic w/o & w/contr matrl (72157) $2,211 $2,211 6.3×
MRI thoracic spine w/o contrast (72146) $1,401 $1,401 5.9×
MRI upper ext joint w/o contrast (73221) $1,401 $1,401 5.9×
MRI upper extremity oth than jt w/o contr matrl (73218) $1,401 $1,401 5.9×
Neck soft tissue (70360) $261 $261 3.0×
Ob Us Follow-Up Per Fetus - Us Ob Follow Up Transabdominal Approach (76816) $428 $428 4.1×
Osseous survey limited (77074) $321 $321 3.1×
Pelvis 1 or 2 views (72170) $321 $321 3.1×
Pr MRI, lower extr, w/o contrast f/u by contrast (73720) $2,211 $2,211 6.3×
Radex abscess/fistula/sinus tract rs&i (76080) $1,509 $1,509 2.8×
Radex entir thrc lmbr crv sac spi w/skull 2/3 vw (72082) $321 $321 3.1×
Radex mastoids compl minimum 3 views pr side (70130) $321 $321 3.1×
Radiolog exam mandible compl minimum 4 views (70110) $321 $321 3.1×
Radiologic Exam Abdomen 1 View - Xr Abdomen 1 View (74018) $261 $261 3.0×
Radiologic Exam Chest 2 Views - Xr Chest 2 Views (71046) $261 $261 3.0×
Radiologic exam colon single contrast study (74270) $541 $541 3.1×
Radiologic exam upr gi trc single contrast study (74240) $360 $360 2.0×
Radiologic Examination Femur Minimum 2 Views - Xr Femur 2+ Vw Lt (73552) $261 $261 3.0×
Ribs bilateral 3 views (71110) $321 $321 3.1×
Scanogram (77073) $321 $321 3.1×
Scapula complete (73010) $321 $321 3.1×
Sella turcica (70240) $261 $261 3.0×
Small bowel series (74250) $541 $541 3.1×
Spine thoracic 3 views (72072) $321 $321 3.1×
Thoracolumbar 2 views (72080) $261 $261 3.0×
Tmj unilateral (70328) $261 $261 3.0×
Ultrasound, abdomen limited (76705) $428 $428 4.1×
Unlisted Diagnostic Radiographic Procedure (76499) $261 $261 3.0×
Unlisted Ultrasound Procedure (76999) $348 $348 4.0×
Urethrocystography retrograde rs&i (74450) $701 $701 2.9×
Urethrocystography voiding (74455) $701 $701 2.9×
Urography (pyelography), intravenous, with or without KUB, with or without tomography (74400) $541 $541 3.1×
Us abdl aorta screen aaa (76706) $428 $428 4.1×
Us breast unilateral complete (76641) $428 $428 4.1×
Us breast unilateral limited (76642) $348 $348 4.0×
Us compl joint r-t w/image documentation (76881) $428 $428 4.1×
Us ob transvaginal (76817) $428 $428 4.1×
Us pelvic non ob complete (76856) $428 $428 4.1×
Us pelvic nonobstetric image dcmtn limited/f/u (76857) $428 $428 4.1×
Us pregnancy ltd (76815) $428 $428 4.1×
Us pregnant uterus 14 wk transabdl 1/1st gestat (76801) $428 $428 4.1×
Us retroperitoneal complete (76770) $428 $428 4.1×
Us retroperitoneal limited (76775) $428 $428 4.1×
Us scrotum and contents (76870) $428 $428 4.1×
Us soft tissue head/neck (76536) $428 $428 4.1×
Us xtr non-vasc lmtd (76882) $428 $428 4.1×
Vertebral fracture assessment via dxa (77086) $261 $261 3.0×
Wrist 2 views (73100) $261 $261 3.0×
X-Ray Ac Jts - Xr Acromioclavicular Joints Bilateral (73050) $261 $261 3.0×
X-Ray Ankle 3+ Vw - Xr Ankle 3+ Views Right (73610) $261 $261 3.0×
X-Ray Elbow 2 Vw - Xr Elbow 1-2 Views Right (73070) $261 $261 3.0×
X-Ray Elbow 3+ Vw - Xr Elbow 3+ Views Right (73080) $261 $261 3.0×
X-Ray Exam Hip Uni 2-3 Views (73502) $268 $268 3.1×
X-ray exam hip uni 4/> views (73503) $321 $321 3.1×
X-Ray Exam Hips Bi 5/> Views (73523) $321 $321 3.1×
X-Ray Facial Bones 3+ Vw - Xr Facial Bones 3+ Views (70150) $321 $321 3.1×
X-Ray Facial Bones <3 Vw - Xr Facial Bones 1-2 Views (70140) $261 $261 3.0×
X-Ray Foot 3+ Vw - Xr Foot 3+ Views Right (73630) $261 $261 3.0×
X-Ray Heel - Xr Calcaneus 2 Views Right (73650) $261 $261 3.0×
X-Ray Knee 4+ View - Xr Knee 4+ Views Right (73564) $321 $321 3.1×
X-Ray Knee Bilat Standing - Xr Knees Anteroposterior Standing Bilat (73565) $261 $261 3.0×
X-Ray Lumbar Spine 2/3 Vw - Xr Lumbar Spine 2-3 Views (72100) $321 $321 3.1×
X-Ray Lumbar Spine 6+ Vw - Xr Lumbar Spine 6+ Vws Including Bending (72114) $321 $321 3.1×
X-Ray Lumbar Spine Flex/Exten - Xr Lumbar Spine 4+ Views W/ Flex Ext (72120) $321 $321 3.1×
X-Ray Nasal Bones - Xr Nasal Bones (70160) $261 $261 3.0×
X-Ray Orbits - Xr Orbits Complete 4+ Views (70200) $321 $321 3.1×
X-Ray Ribs 2 Vw Unilat - Xr Ribs 2 Views Right (71100) $261 $261 3.0×
X-Ray Ribs, Chest 3+ Vw - Xr Ribs 2 Vws Lt W/ Chest Anteroposterior (71101) $321 $321 3.1×
X-Ray Ribs, Chest 4+ Vw - Xr Ribs 3 Vws Bil W/ Chest Posteroanterior (71111) $321 $321 3.1×
X-Ray Sacroiliac Jts 3+ Vw - Xr Sacroiliac Joints 3+ Views (72202) $321 $321 3.1×
X-Ray Sacrum/Coccyx 2+ Vw - Xr Sacrum Coccyx 2+ Views (72220) $261 $261 3.0×
X-Ray Shoulder 2+ Vw - Xr Shoulder 2+ Views Right (73030) $261 $261 3.0×
X-Ray Sinuses 3+ Vw - Xr Paranasal Sinuses 3+ Views (70220) $261 $261 3.0×
X-Ray Sinuses <3 Vw - Xr Paranasal Sinuses 1-2 Views (70210) $261 $261 3.0×
X-Ray Skull 4+ Vw - Xr Skull Complete 4+ Views (70260) $321 $321 3.1×
X-Ray Skull <4 Vw - Xr Skull 1-3 Views (70250) $321 $321 3.1×
X-Ray Spine One View - Xr Spine (72020) $261 $261 3.0×
X-Ray Sterno-Clavicluar Jt - Xr Sternoclavicular Joints 3+ Views (71130) $261 $261 3.0×
X-Ray Sternum 2+ Vw - Xr Sternum 2+ Views (71120) $261 $261 3.0×
X-Ray Thoracic Spine 2 Vw - Xr Thoracic Spine 2 Views (72070) $321 $321 3.1×
X-Ray Toe(S) - Xr Toes 2+ Views Right (73660) $261 $261 3.0×
X-Ray Wrist 3+ Vw - Xr Wrist 3+ Views Right (73110) $261 $261 3.0×
Xr c-spine 6 or more views (72052) $321 $321 3.1×
Xr finger(s) 2+ views (73140) $261 $261 3.0×
Xr shoulder 1 view (73020) $261 $261 3.0×
Xr spine cervical 4 or 5 views (72050) $321 $321 3.1×
Xr tibia/fibula 2 views (73590) $261 $261 3.0×
Xr tmj bilateral (70330) $261 $261 3.0×
Xray knee 1 or 2 views rt (73560) $261 $261 3.0×