Ascension St. Vincent Salem (St. Vincent Salem Hospital, Inc.)
911 N Shelby St, Salem, IN · Ascension · · NPI 1427388982
Published prices by procedure
Cash price is what you pay without insurance. The negotiated range spans the lowest to highest rate this hospital agreed with insurers.
| Procedure | Cash price | Gross charge | Negotiated range | Payers |
|---|---|---|---|---|
| X-ray acromioclavicular joints without or w/weighted distraction bilateral CPT 73050 | $272.40 | $454.00 | $4.59 – $58.67 | 22 |
| X-ray ankle 2 views (both sides) CPT 73600 | $448.80 | $748.00 | $3.45 – $250.00 | 23 |
| X-ray arthrogram shoulder supervision & interpretation (both sides) CPT 73040 | not published | not published | $13.77 – $213.54 | 22 |
| X-ray assay calculus CPT 82370 | not published | not published | $5.29 – $28.55 | 24 |
| X-ray bone age studies CPT 77072 | $239.40 | $399.00 | $3.01 – $250.00 | 23 |
| X-ray bone length studies CPT 77073 | $380.40 | $634.00 | $5.19 – $250.00 | 23 |
| X-ray bone survey complete CPT 77075 | $730.80 | $1,218.00 | $12.16 – $250.00 | 23 |
| X-ray bone survey infant CPT 77076 | $792.00 | $1,320.00 | $10.92 – $250.00 | 23 |
| X-ray cervical spine 2-3 views CPT 72040 | $277.20 | $462.00 | $4.59 – $250.00 | 23 |
| X-ray cervical spine 4-5 views CPT 72050 | $474.00 | $790.00 | $6.56 – $250.00 | 23 |
| X-ray cervical spine >= 6 views CPT 72052 | $451.20 | $752.00 | $8.22 – $250.00 | 23 |
| X-ray clavicle complete (both sides) CPT 73000 | $470.40 | $784.00 | $3.49 – $250.00 | 23 |
| X-ray colon abdominal radiograph(s) & delayed images single contrast study CPT 74270 | not published | not published | $16.76 – $253.34 | 23 |
| X-ray colon abdominal radiograph(s) & delayed images with glucagon double contrast study CPT 74280 | not published | not published | $22.91 – $351.77 | 23 |
| X-ray consultation CPT 76140 | not published | not published | $10.00 – $10.00 | 11 |
| X-ray elbow 2 views (both sides) CPT 73070 | $331.20 | $552.00 | $3.44 – $250.00 | 23 |
| X-ray elbow >= 3 views (both sides) CPT 73080 | $556.80 | $928.00 | $4.24 – $250.00 | 23 |
| Xray endovasc thor ao repr CPT 75956 | not published | not published | $192.40 – $279.91 | 21 |
| Xray endovasc thor ao repr CPT 75957 | not published | not published | $192.40 – $281.39 | 21 |
| X-ray esophogram chest radiograph(s) & delayed images single contrast study CPT 74220 | not published | not published | $10.39 – $250.00 | 23 |
| X-ray exam entire spi 4/5 vw CPT 72083 | $403.20 | $672.00 | $9.11 – $158.11 | 39 |
| X-ray exam entire spi 6/> vw CPT 72084 | $524.40 | $874.00 | $10.88 – $185.17 | 39 |
| X-ray exam of arm infant CPT 73092 | $254.40 | $424.00 | $3.49 – $250.00 | 23 |
| X-ray exam of eye sockets CPT 70200 | $320.40 | $534.00 | $5.66 – $60.81 | 22 |
| X-ray exam of femur 1 CPT 73551 | $246.00 | $410.00 | $3.75 – $250.00 | 21 |
| X-ray exam of jaw joint CPT 70328 | not published | not published | $3.74 – $45.73 | 22 |
| X-ray exam of jaw joint CPT 70332 | not published | not published | $11.95 – $213.54 | 22 |
| X-ray exam of mastoids CPT 70120 | not published | not published | $4.29 – $55.07 | 22 |
| X-ray exam of middle ear CPT 70134 | not published | not published | $5.97 – $76.62 | 22 |
| X-ray exam of penis CPT 74445 | not published | not published | $12.96 – $136.74 | 22 |
| X-ray exam of perineum CPT 74775 | not published | not published | $11.23 – $148.30 | 41 |
| X-ray exam of salivary gland CPT 70380 | not published | not published | $4.66 – $59.39 | 22 |
| X-ray exam of sinuses CPT 70210 | $235.20 | $392.00 | $3.91 – $45.01 | 22 |
| X-ray exam of tear duct CPT 70170 | not published | not published | $6.60 – $178.54 | 22 |
| X-ray exam of teeth CPT 70300 | not published | not published | $1.87 – $23.66 | 22 |
| X-ray exam of teeth CPT 70310 | not published | not published | $3.91 – $61.54 | 22 |
| X-ray exam si joints CPT 72200 | $124.80 | $208.00 | $3.69 – $42.86 | 22 |
| X-ray exam thorac spine4/>vw CPT 72074 | $367.20 | $612.00 | $5.79 – $250.00 | 23 |
| X-ray eye detection foreign body (both sides) CPT 70030 | $493.20 | $822.00 | $3.46 – $42.86 | 22 |
| X-ray facial bones complete > 3 views CPT 70150 | $357.60 | $596.00 | $5.46 – $250.00 | 23 |
| X-ray fallopian tube CPT 74742 | not published | not published | $19.37 – $226.78 | 20 |
| X-ray femur >=2 views (both sides) CPT 73552 | $489.60 | $816.00 | $4.37 – $250.00 | 21 |
| X-ray finger(s) >= 2 views (both sides) CPT 73140 | $374.40 | $624.00 | $3.38 – $250.00 | 23 |
| X-ray foot 2 views (both sides) CPT 73620 | $403.20 | $672.00 | $3.40 – $250.00 | 23 |
| X-ray forearm 2 views (both sides) CPT 73090 | $537.60 | $896.00 | $3.49 – $250.00 | 23 |
| X-ray hand 2 views (both sides) CPT 73120 | $387.60 | $646.00 | $3.45 – $250.00 | 23 |
| X-ray head for orthodontia CPT 70350 | not published | not published | $2.76 – $34.97 | 22 |
| X-ray heel/calcaneus > 2 views (both sides) CPT 73650 | $442.80 | $738.00 | $3.35 – $250.00 | 23 |
| X-ray hip uni w/wo pelvis min 4 views CPT 73503 | $362.40 | $604.00 | $6.95 – $74.47 | 20 |
| X-ray hip with pelvis when performed bilateral 2 views CPT 73521 | $264.60 | $441.00 | $5.33 – $250.00 | 21 |
| X-ray hip with pelvis when performed bilateral 3-4 views CPT 73522 | $362.40 | $604.00 | $6.59 – $250.00 | 21 |
| X-ray hip with pelvis when performed bilateral >= 5 views CPT 73523 | $462.00 | $770.00 | $7.64 – $80.94 | 20 |
| X-ray hip with pelvis when performed unilateral 1 view left CPT 73501 | $166.80 | $278.00 | $4.00 – $250.00 | 21 |
| X-ray humerus >= 2 views left CPT 73060 | $532.80 | $888.00 | $3.82 – $250.00 | 23 |
| X-ray joint survey 1 view CPT 77077 | not published | not published | $6.13 – $47.18 | 22 |
| X-ray knee 1-2 views (both sides) CPT 73560 | $520.80 | $868.00 | $3.64 – $250.00 | 23 |
| X-ray knee 3 views (both sides) CPT 73562 | $667.20 | $1,112.00 | $4.24 – $250.00 | 23 |
| X-ray knee ap standing bilateral CPT 73565 | $262.80 | $438.00 | $3.74 – $52.92 | 22 |
| X-ray lower extremities infant > 2 views (both sides) CPT 73592 | $211.20 | $352.00 | $3.49 – $250.00 | 23 |
| X-ray l/s-spine bend vw only 2-3 vw CPT 72120 | $400.80 | $668.00 | $6.03 – $58.67 | 22 |
| X-ray lumbosacral spine >= 4 views CPT 72110 | $500.40 | $834.00 | $6.74 – $250.00 | 23 |
| X-ray lumbosacral spine complete including bending views >= 6 views CPT 72114 | $388.20 | $647.00 | $8.73 – $96.75 | 22 |
| X-ray male genital tract CPT 74440 | not published | not published | $9.95 – $136.74 | 22 |
| X-ray mandible complete > 4 views CPT 70110 | $331.80 | $553.00 | $4.90 – $55.80 | 22 |
| X-ray mandible ltd <4 views CPT 70100 | $232.80 | $388.00 | $3.84 – $52.20 | 22 |
| X-ray measurement of pelvis CPT 74710 | not published | not published | $6.15 – $58.90 | 22 |
| X-ray nasal bones complete > 3 views CPT 70160 | $244.80 | $408.00 | $3.92 – $250.00 | 23 |
| X-ray neck soft tissue CPT 70360 | $195.60 | $326.00 | $3.36 – $250.00 | 23 |
| X-ray nose to rectum for foreign body child CPT 76010 | $266.40 | $444.00 | $3.60 – $250.00 | 23 |
| X-ray of mammary ducts CPT 77054 | $621.00 | $1,035.00 | $16.30 – $178.54 | 22 |
| X-ray optic foramina CPT 70190 | not published | not published | $4.49 – $52.20 | 22 |
| X-ray pelvis 1-2 views CPT 72170 | $146.40 | $244.00 | $3.46 – $250.00 | 23 |
| X-ray pelvis complete > 3 views CPT 72190 | $178.20 | $297.00 | $4.87 – $250.00 | 23 |
| Xray place dist ext thor ao CPT 75959 | not published | not published | $125.02 – $192.40 | 21 |
| Xray place prox ext thor ao CPT 75958 | not published | not published | $141.49 – $208.18 | 21 |
| X-ray retrograde pyelogram with or without kidney ureter bladder w/supervision & interpretation CPT 74420 | not published | not published | $12.99 – $250.00 | 42 |
| X-ray ribs 2 views left CPT 71100 | $313.20 | $522.00 | $4.17 – $250.00 | 23 |
| X-ray ribs 3 views bilateral CPT 71110 | $402.00 | $670.00 | $5.37 – $250.00 | 23 |
| X-ray ribs w/posterior anterior chest 3 views left CPT 71101 | $255.60 | $426.00 | $5.05 – $250.00 | 23 |
| X-ray ribs w/posterior anterior chest > 4 views bilateral CPT 71111 | $396.00 | $660.00 | $6.61 – $250.00 | 23 |
| X-ray sacroiliac joints >= 3 views CPT 72202 | $230.40 | $384.00 | $4.44 – $250.00 | 23 |
| X-ray sacrum/coccyx >= 2 views CPT 72220 | $285.60 | $476.00 | $3.86 – $250.00 | 23 |
| X-ray scapula complete (both sides) CPT 73010 | $496.80 | $828.00 | $3.64 – $250.00 | 23 |
| X-ray sella turcica CPT 70240 | not published | not published | $3.56 – $42.86 | 22 |
| X-ray shoulder 1 view (both sides) CPT 73020 | $336.00 | $560.00 | $3.07 – $34.97 | 22 |
| X-ray sinuses paranasal complete > 3 views CPT 70220 | $309.00 | $515.00 | $5.17 – $250.00 | 23 |
| X-ray sinus tract/fistula/abscess CPT 76080 | not published | not published | $8.35 – $250.00 | 23 |
| X-ray skull < 4 views CPT 70250 | $255.60 | $426.00 | $4.56 – $50.78 | 22 |
| X-ray skull > 4 views complete CPT 70260 | $384.00 | $640.00 | $6.34 – $250.00 | 23 |
| X-ray slg plne bdy sect without urogr CPT 76100 | not published | not published | $14.84 – $140.56 | 22 |
| X-ray small bowel multi serial images abdominal radiographs(s)&delayed images single contrast study CPT 74250 | not published | not published | $11.78 – $250.00 | 42 |
| X-ray small intestine follow-through study CPT 74248 | not published | not published | $11.34 – $128.50 | 20 |
| X-ray spine single view CPT 72020 | $215.40 | $359.00 | $3.02 – $250.00 | 23 |
| X-ray sternoclavicular joint(s) > 3 views CPT 71130 | $281.40 | $469.00 | $4.78 – $53.65 | 22 |
| X-ray sternum > 2 views CPT 71120 | $229.20 | $382.00 | $4.35 – $44.31 | 22 |
| X-ray surgical specimen CPT 76098 | $682.80 | $1,138.00 | $2.70 – $316.07 | 23 |
| X-ray swallowing function w/ciner/videoradiography neck radiographs(s)&delayed images contrast study CPT 74230 | not published | not published | $10.94 – $250.00 | 42 |
| X-ray temporomandibular joint open/closed mouth bilateral CPT 70330 | $384.00 | $640.00 | $5.86 – $74.47 | 22 |
| X-ray thoracic spine 2 views CPT 72070 | $307.20 | $512.00 | $4.41 – $250.00 | 23 |
| X-ray thoracic spine 3 views CPT 72072 | $387.60 | $646.00 | $4.92 – $250.00 | 23 |
A missing value means the hospital did not publish that price — it never means the price is zero. Real bills can add facility fees, supplies and professional fees; see our methodology.