Imaging prices at Ascension Calumet Hospital
Chilton, WI · every code in this section with a posted price and a Medicare benchmark.
206 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) | $143.64 | $252 | 1.7× |
| Abdomen 2 views (74019) | $229.71 | $403 | 2.3× |
| Acute Gastrointestinal Blood Loss Imaging (78278) | $991.23 | $1,739 | 2.5× |
| Ankle 2 views (73600) range across 2 matching MRF lines |
$19.95–$63.27 | $35–$111 | varies |
| Arthrogram hip (73525) | $576.27 | $1,011 | 1.7× |
| Arthrogram Wrist (73115) | $674.31 | $1,183 | 2.0× |
| Bone age studies (77072) | $59.85 | $105 | 0.6× |
| Bone Imaging 3 Phase (78315) | $870.96 | $1,528 | 2.2× |
| Bone Imaging Limited Area (78300) | $453.15 | $795 | 1.2× |
| Bone Imaging Whole Body (78306) | $820.23 | $1,439 | 2.1× |
| Bone survey infant (77076) | $181.83 | $319 | 1.8× |
| Brain Imaging Pet Metabolic Evaluation (78608) | $2,107.29 | $3,697 | 1.5× |
| Chest 1 view (71045) | $120.27 | $211 | 1.4× |
| Chest 2 views (71046) | $156.18 | $274 | 1.8× |
| Chest 3 views (71047) | $178.98 | $314 | 2.1× |
| Chest 4 or more views (71048) | $224.58 | $394 | 2.2× |
| Clavicle complete (73000) range across 2 matching MRF lines |
$19.95–$63.84 | $35–$112 | varies |
| Computed Tomography Thorax Lw Dose Lng Ca Scr C- (71271) | $72.96 | $128 | 0.7× |
| Contrast X-Ray Of Knee Joint (73580) | $576.27 | $1,011 | 1.7× |
| CT abdomen and pelvis without and with contrast (74178) | $1,644.45 | $2,885 | 4.8× |
| CT abdomen and pelvis without contrast (74176) | $1,371.99 | $2,407 | 5.9× |
| CT abdomen w contrast (74160) | $845.88 | $1,484 | 4.9× |
| CT abdomen w wo contrast (74170) | $1,006.05 | $1,765 | 5.9× |
| CT abdomen w/o contrast (74150) | $595.65 | $1,045 | 5.8× |
| CT Angio Abdomen and Pelvis (74174) | $1,820.01 | $3,193 | 5.3× |
| CT Angio Chest (71275) | $1,371.99 | $2,407 | 8.0× |
| CT Angio Head (70496) | $1,374.84 | $2,412 | 8.0× |
| Ct Angio Lwr Extr W/O&W/Dye (73706) | $916.56 | $1,608 | 5.4× |
| CT Angio Neck (70498) | $1,309.29 | $2,297 | 7.6× |
| Ct Angio Upr Extrm W/O&W/Dye (73206) | $917.13 | $1,609 | 5.4× |
| CT cervical spine w/o contrast (72125) | $731.88 | $1,284 | 7.2× |
| CT chest w contrast (71260) | $914.28 | $1,604 | 5.3× |
| CT chest w/wo contrast (71270) | $1,097.25 | $1,925 | 6.4× |
| CT colonography screening (74263) | $1,719.69 | $3,017 | 7.4× |
| CT colonogrphy dx image postprocess w/o contrast (74261) | $1,063.62 | $1,866 | 10.4× |
| CT head/brain with contrast (70460) | $685.14 | $1,202 | 4.0× |
| CT head/brain without and with contrast (70470) | $845.88 | $1,484 | 4.9× |
| CT iac w contrast (70481) | $791.73 | $1,389 | 4.6× |
| CT lower ext w/o (73700) | $519.84 | $912 | 5.1× |
| CT lower extremity w/contrast material (73701) | $651.51 | $1,143 | 3.8× |
| CT lumbar spine w contrast (72132) | $823.08 | $1,444 | 2.4× |
| CT lumbar spine w/o contrast (72131) | $709.08 | $1,244 | 6.9× |
| CT maxillofacial w contrast (70487) | $670.32 | $1,176 | 3.9× |
| CT maxillofacial wo contrast (70486) | $548.91 | $963 | 5.4× |
| CT neck tissue combo (70492) | $803.13 | $1,409 | 4.7× |
| Ct Orbit/Ear/Fossa W/O&W/Dye (70482) | $907.44 | $1,592 | 5.3× |
| CT orbits w/o contrast (70480) | $669.18 | $1,174 | 6.6× |
| CT pelvis w/o contrast (72192) | $609.90 | $1,070 | 6.0× |
| CT scan of leg combo (73702) | $862.41 | $1,513 | 5.0× |
| CT scans face/jaw combo (70488) | $834.48 | $1,464 | 4.9× |
| CT soft tissue neck w contrast (70491) | $731.88 | $1,284 | 4.3× |
| CT soft tissue neck w/o contrast (70490) | $516.42 | $906 | 5.1× |
| CT thoracic spine w/o contrast (72128) | $548.91 | $963 | 5.4× |
| CT thoracic spine w/wo cont (72130) | $869.82 | $1,526 | 5.1× |
| CT thorax w/o contrast (71250) | $722.19 | $1,267 | 7.1× |
| CT upper ext wo (73200) | $518.70 | $910 | 5.1× |
| CT upper extremity w/o & w/contrast material (73202) | $859.56 | $1,508 | 5.0× |
| CT upper extremity with contrast (73201) | $644.10 | $1,130 | 1.9× |
| Cta Abdl Aorta&Bi Iliofem W/Contrast&Postp (75635) | $1,257.99 | $2,207 | 7.3× |
| Cta Abdomen (74175) | $1,143.42 | $2,006 | 6.7× |
| Dxa Bone Density Axial (77080) | $255.36 | $448 | 2.5× |
| Dxa bone density study 1/>sites appendiclr skel (77081) | $126.54 | $222 | 1.5× |
| Fluoroscopy up to 1 hr (76000) range across 2 matching MRF lines |
$30.21–$270.18 | $53–$474 | varies |
| Foot 2 views (73620) | $136.80 | $240 | 1.6× |
| Forearm 2 views (73090) range across 2 matching MRF lines |
$21.09–$153.90 | $37–$270 | varies |
| Gastric emptying imaging study (78264) | $825.93 | $1,449 | 2.1× |
| Gated Heart Planar Single (78472) range across 2 matching MRF lines |
$100.89–$2,350.11 | $177–$4,123 | varies |
| Hand 2 views (73120) | $106.02 | $186 | 1.0× |
| Hepatobil Syst Image W/Drug (78227) | $1,078.44 | $1,892 | 2.0× |
| Hepatobiliary System Imaging (78226) | $1,027.14 | $1,802 | 2.6× |
| Joint Survey Single View (77077) | $136.80 | $240 | 1.3× |
| K Flow/Funct Image W/Drug (78708) | $1,173.63 | $2,059 | 2.2× |
| Knee 3 Views (73562) range across 2 matching MRF lines |
$22.23–$159.03 | $39–$279 | varies |
| Lung Ventilat&Perfus Imaging (78582) | $1,549.26 | $2,718 | 2.9× |
| Magnetic Image Jaw Joint (70336) | $1,208.40 | $2,120 | 5.2× |
| Mra Head W/O & W/Contrast Material (70546) | $1,963.65 | $3,445 | 5.8× |
| MRA head w/o contrast (70544) | $1,897.53 | $3,329 | 8.1× |
| MRA neck w contrast (70548) | $1,641.03 | $2,879 | 4.8× |
| Mra Neck W/O &W/Contrast Material (70549) | $2,449.29 | $4,297 | 7.2× |
| MRA neck w/o contrast (70547) | $1,553.25 | $2,725 | 6.7× |
| MRI abdomen w/o contrast (74181) | $1,721.40 | $3,020 | 7.4× |
| MRI any jt lower extrem w/contrast material (73722) | $2,179.11 | $3,823 | 2.8× |
| MRI any jt lower extrem w/o & w/contrast matrl (73723) | $2,253.21 | $3,953 | 6.6× |
| MRI any jt upper extremity w/contrast matrl (73222) | $2,442.45 | $4,285 | 3.2× |
| MRI cervical spine w contrast (72142) | $2,155.74 | $3,782 | 6.3× |
| MRI cervical spine w/o cont (72141) | $2,005.26 | $3,518 | 8.6× |
| MRI chest w/o contrast (71550) | $1,575.48 | $2,764 | 6.8× |
| MRI chest wo w contrast (71552) | $2,321.61 | $4,073 | 6.8× |
| MRI lower extrem oth/thn jt w/o & w/contr matr (73720) | $2,498.31 | $4,383 | 7.3× |
| MRI lower extrem oth/thn jt w/o contr matrl (73718) | $1,406.76 | $2,468 | 6.0× |
| MRI lumbar spine w contrast (72149) | $2,221.86 | $3,898 | 6.5× |
| Mri Neck Spine W/O & W/Dye (72156) | $2,382.60 | $4,180 | 7.0× |
| MRI orbit face &/neck w/o contrast (70540) | $1,383.39 | $2,427 | 5.9× |
| Mri Orbt/Fac/Nck W/O &W/Dye (70543) | $1,993.29 | $3,497 | 5.9× |
| MRI pelvis w/o & w contrast (72197) | $2,014.38 | $3,534 | 5.9× |
| MRI pelvis w/o contrast (72195) | $1,411.32 | $2,476 | 6.1× |
| MRI thoracic spine w/o contrast (72146) | $1,866.75 | $3,275 | 8.0× |
| MRI upper extremity oth than jt w/o contr matrl (73218) | $1,439.82 | $2,526 | 6.2× |
| Mri Uppr Extremity W/O&W/Dye (73220) | $2,022.36 | $3,548 | 5.9× |
| MRI, abdomen, combo (74183) | $2,357.52 | $4,136 | 6.9× |
| MRI, dorsal spine combo (72157) | $2,474.94 | $4,342 | 7.3× |
| MRI, joint upper extrem (73221) | $2,348.40 | $4,120 | 10.1× |
| MRI, joint upper extrem combo (73223) | $2,533.08 | $4,444 | 7.4× |
| MRI, lumbar spine combo (72158) | $2,448.72 | $4,296 | 7.2× |
| Myocardial Spect Multiple Studies (78452) range across 2 matching MRF lines |
$198.93–$2,649.36 | $349–$4,648 | varies |
| Myocrd Img Pet Metab Eval Single Study Cncrnt CT (78429) | $1,901.52 | $3,336 | 1.4× |
| N-invas est c ffr sw aly CTA (75580) | $1,402.20 | $2,460 | 1.7× |
| Neck soft tissue (70360) | $61.56 | $108 | 0.7× |
| Parathyroid planar imaging w/wo subtraction (78071) | $686.28 | $1,204 | 1.8× |
| Pelvis 1 or 2 views (72170) range across 2 matching MRF lines |
$22.80–$134.52 | $40–$236 | varies |
| PET image w/CT, full body (78816) | $3,192 | $5,600 | 2.3× |
| PET imaging CT attenuation skull base mid-thigh (78815) | $3,064.32 | $5,376 | 2.2× |
| Pulmonary Perfusion Imaging Particulate (78580) | $661.20 | $1,160 | 1.7× |
| Radex Abd Compl Aqt Abd W/S/E/D Views 1 View Ch (74022) | $218.31 | $383 | 2.1× |
| Radex Ankle Complete Minimum 3 Views (73610) range across 2 matching MRF lines |
$21.09–$165.30 | $37–$290 | varies |
| Radex Calcaneus Minimum 2 Views (73650) range across 2 matching MRF lines |
$29.07–$62.70 | $51–$110 | varies |
| Radex elbow complete minimum 3 views (73080) range across 2 matching MRF lines |
$23.94–$179.55 | $42–$315 | varies |
| Radex Facial Bones Complete Minimum 3 Views (70150) | $106.02 | $186 | 1.0× |
| Radex fingr minimum 2 views (73140) range across 2 matching MRF lines |
$14.82–$106.02 | $26–$186 | varies |
| Radex foot complete minimum 3 views (73630) range across 2 matching MRF lines |
$21.66–$164.16 | $38–$288 | varies |
| Radex Hand Minimum 3 Views (73130) range across 2 matching MRF lines |
$20.52–$176.70 | $36–$310 | varies |
| Radex lower extremity infant minimum 2 views (73592) | $72.39 | $127 | 0.9× |
| Radex Nasal Bones Complete Minimum 3 Views (70160) | $75.81 | $133 | 0.9× |
| Radex Ribs Unilateral 2 Views (71100) | $211.47 | $371 | 2.5× |
| Radex shoulder complete minimum 2 views (73030) range across 2 matching MRF lines |
$21.66–$153.90 | $38–$270 | varies |
| Radex Sinuses Paransl < 3 Views (70210) | $67.83 | $119 | 0.8× |
| Radex Spine 1 View Specify Level (72020) | $138.51 | $243 | 1.6× |
| Radex Sternum Minimum 2 Views (71120) | $67.83 | $119 | 0.8× |
| Radex Toe Minimum 2 Views (73660) | $72.39 | $127 | 0.9× |
| Radex upper extremity infant minimum 2 views (73092) | $148.77 | $261 | 1.5× |
| Radex Wrist Complete Minimum 3 Views (73110) range across 2 matching MRF lines |
$19.38–$153.33 | $34–$269 | varies |
| Radex X-Ray Exam Entire Spi 6/> Vw - Xr Entire Spine 6+ Vw (72084) | $648.66 | $1,138 | 6.4× |
| Radiolog exam mandible compl minimum 4 views (70110) | $80.37 | $141 | 0.8× |
| Radiologic exam knee complete 4/more views (73564) range across 2 matching MRF lines |
$26.22–$224.58 | $46–$394 | varies |
| Radiologic exam pelvis compl minimum 3 views (72190) | $168.72 | $296 | 1.7× |
| Radiologic exam swallow function contrast study (74230) | $170.43 | $299 | 1.0× |
| Radiologic examination femur 1 view (73551) | $192.66 | $338 | 2.3× |
| Radiologic examination femur minimum 2 views (73552) range across 2 matching MRF lines |
$23.94–$222.87 | $42–$391 | varies |
| Radiologic examination knee 1/2 views (73560) range across 2 matching MRF lines |
$19.95–$145.35 | $35–$255 | varies |
| Radiologic examination tibia & fibula 2 views (73590) range across 2 matching MRF lines |
$19.38–$167.01 | $34–$293 | varies |
| Ribs bilateral 3 views (71110) | $422.37 | $741 | 4.1× |
| Rp Loclzj Tum Plnr Whole Body 2+ Days Imaging (78804) | $2,285.70 | $4,010 | 4.3× |
| Rp Loclzj Tum Spect 1 Area Single Day Imaging (78803) | $2,285.70 | $4,010 | 4.3× |
| Rp loclzj tum spect 2 area/sep acquisj img (78831) | $2,285.70 | $4,010 | 1.8× |
| Rp loclzj tum spect CT 2area 1d img/1 ar img>2+d (78832) | $2,594.07 | $4,551 | 1.9× |
| Rp loclzj tum spect w/CT 1 area/acquisj 1day img (78830) | $2,440.74 | $4,282 | 1.9× |
| Scapula (73010) | $68.40 | $120 | 0.7× |
| Screening Digital Breast Tomosynthesis Bi (77063) | $13.11 | $23 | 0.6× |
| Shoulder 1 view (73020) | $56.43 | $99 | 0.7× |
| Shoulder Arthrography (73040) | $576.27 | $1,011 | 1.7× |
| Skull less than 4 views (70250) | $149.34 | $262 | 1.5× |
| Sternoclavicular joints (71130) | $49.59 | $87 | 0.6× |
| Thoracic spine 2 views (72070) | $204.06 | $358 | 2.0× |
| Thoracic spine 3 views (72072) range across 2 matching MRF lines |
$42.18–$216.60 | $74–$380 | varies |
| Thoracolumbar 2 views (72080) | $214.89 | $377 | 2.5× |
| Thyroid Uptake W/Blood Flow Sngle/Mult Quan Meas (78014) | $706.80 | $1,240 | 1.8× |
| Ultrasound Breast Limited (76642) | $371.07 | $651 | 4.4× |
| Ultrasound Exam Aaa Screen (76706) | $271.89 | $477 | 2.7× |
| Ultrasound, abdomen limited (76705) | $593.94 | $1,042 | 5.8× |
| Unlisted magnetic resonance procedure (76498) | $1,457.49 | $2,557 | 17.2× |
| Us breast unilateral complete (76641) | $494.19 | $867 | 4.8× |
| Us chest (76604) | $314.64 | $552 | 3.1× |
| Us exam, pelvic, limited (76857) | $470.25 | $825 | 4.6× |
| Us kidney transplant (76776) | $493.05 | $865 | 4.8× |
| Us lmtd joint/oth nonvasc xtr strux r-t w/img (76882) | $202.35 | $355 | 2.0× |
| Us ob limited 1 or more fetuses (76815) | $343.71 | $603 | 3.4× |
| Us ob transvaginal (76817) | $285.57 | $501 | 2.8× |
| Us pelvic non ob complete (76856) | $607.05 | $1,065 | 5.9× |
| Us pg uter img f&mat 14 wk tabdl 1/1st gestation (76801) | $352.26 | $618 | 3.5× |
| Us retroperitoneal complete (76770) | $593.94 | $1,042 | 5.8× |
| Us retroperitoneal limited (76775) | $540.93 | $949 | 5.3× |
| Us scrotum and contents (76870) | $558.03 | $979 | 5.5× |
| Us thyroid (76536) | $518.13 | $909 | 5.1× |
| Wrist 2 views (73100) range across 2 matching MRF lines |
$20.52–$116.85 | $36–$205 | varies |
| X-Ray Ac Jts - Xr Acromioclavicular Joints Bilateral (73050) | $85.50 | $150 | 1.0× |
| X-Ray Bend Only L-S Spine (72120) | $138.51 | $243 | 1.4× |
| X-Ray Elbow 2 Vw - Xr Elbow 1-2 Views Right (73070) range across 2 matching MRF lines |
$21.66–$63.84 | $38–$112 | varies |
| X-Ray Exam Entire Spi 1 Vw (72081) | $107.73 | $189 | 1.3× |
| X-Ray Exam Entire Spi 2/3 Vw (72082) range across 2 matching MRF lines |
$60.99–$180.12 | $107–$316 | varies |
| X-Ray Exam Entire Spi 4/5 Vw (72083) | $340.86 | $598 | 3.3× |
| X-Ray Exam Hip Uni 1 View (73501) | $107.73 | $189 | 1.3× |
| X-Ray Exam Hip Uni 2-3 Views (73502) range across 2 matching MRF lines |
$23.94–$193.80 | $42–$340 | varies |
| X-Ray Exam Hips Bi 2 Views (73521) range across 2 matching MRF lines |
$27.93–$225.15 | $49–$395 | varies |
| X-Ray Exam Hips Bi 3-4 Views (73522) range across 2 matching MRF lines |
$32.49–$239.40 | $57–$420 | varies |
| X-Ray Exam Hips Bi 5/> Views (73523) | $284.43 | $499 | 2.8× |
| X-Ray Exam L-S Spine Bending (72114) | $237.12 | $416 | 2.3× |
| X-Ray Exam Neck Spine 2-3 Vw (72040) range across 2 matching MRF lines |
$27.93–$195.51 | $49–$343 | varies |
| X-Ray Exam Neck Spine 6/>Vws (72052) | $287.85 | $505 | 2.8× |
| X-Ray Exam Unilat Ribs/Chest (71101) | $243.39 | $427 | 2.4× |
| X-ray eye for foreign body (70030) | $63.27 | $111 | 0.7× |
| X-ray humerus (73060) range across 2 matching MRF lines |
$20.52–$152.19 | $36–$267 | varies |
| X-Ray Jaw <4 Vw - Xr Mandible < 4 Views (70100) | $74.10 | $130 | 0.9× |
| X-Ray Knee Bilat Standing - Xr Knees Anteroposterior Standing Bilat (73565) | $137.37 | $241 | 1.6× |
| X-Ray Lumbar Spine 2/3 Vw - Xr Lumbar Spine 2-3 Views (72100) range across 2 matching MRF lines |
$28.50–$210.90 | $50–$370 | varies |
| X-ray nose-rectum child f.b. (76010) | $33.63 | $59 | 0.4× |
| X-Ray Ribs, Chest 4+ Vw - Xr Ribs 3 Vws Bil W/ Chest Posteroanterior (71111) | $422.37 | $741 | 4.1× |
| X-Ray Sacroiliac Jts 3+ Vw - Xr Sacroiliac Joints 3+ Views (72202) | $78.09 | $137 | 0.8× |
| X-Ray Sacrum/Coccyx 2+ Vw - Xr Sacrum Coccyx 2+ Views (72220) | $164.73 | $289 | 1.9× |
| X-Ray Sinuses 3+ Vw - Xr Paranasal Sinuses 3+ Views (70220) | $84.36 | $148 | 1.0× |
| X-Ray Skull 4+ Vw - Xr Skull Complete 4+ Views (70260) | $206.34 | $362 | 2.0× |
| X-ray thoracic spine 4 vw (72074) | $239.40 | $420 | 2.3× |
| X-Rays Bone Length Studies (77073) | $74.67 | $131 | 0.7× |
| X-Rays Bone Survey Complete (77075) | $232.56 | $408 | 2.3× |
| Xr c-spine 4 or 5 views (72050) range across 2 matching MRF lines |
$49.02–$204.06 | $86–$358 | varies |
| Xr facial bones less than 3 views (70140) | $88.35 | $155 | 1.0× |
| Xr orbits complete 4 views (70200) | $93.48 | $164 | 0.9× |
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.