Imaging prices at Essentia Health St. Mary's Hospital - Superior
Superior, WI · every code in this section with a posted price and a Medicare benchmark.
205 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) | $210.62 | $285 | 2.5× |
| Abdomen 2 views (74019) | $285.99 | $387 | 2.8× |
| Acute Gastrointestinal Blood Loss Imaging (78278) | $1,306.55 | $1,768 | 3.3× |
| Ankle 2 views (73600) | $222.44 | $301 | 2.6× |
| Arthrogram hip (73525) | $362.11 | $490 | 1.1× |
| Bone age studies (77072) | $222.44 | $301 | 2.2× |
| Bone Imaging 3 Phase (78315) | $1,379.71 | $1,867 | 3.5× |
| Bone Imaging Limited Area (78300) | $974.74 | $1,319 | 2.5× |
| Bone Imaging Whole Body (78306) | $1,224.52 | $1,657 | 3.1× |
| Cat Scan Follow-Up Study (76380) | $444.14 | $601 | 5.2× |
| Chest 1 view (71045) | $226.13 | $306 | 2.7× |
| Chest 2 views (71046) | $231.31 | $313 | 2.7× |
| Chest 3 views (71047) | $199.53 | $270 | 2.3× |
| Clavicle complete (73000) | $204.70 | $277 | 2.4× |
| Computed Tomography Thorax Lw Dose Lng Ca Scr C- (71271) | $850.59 | $1,151 | 8.3× |
| CT abdomen and pelvis without and with contrast (74178) | $2,955.26 | $3,999 | 8.7× |
| CT abdomen and pelvis without contrast (74176) | $2,197.05 | $2,973 | 9.4× |
| CT abdomen w contrast (74160) | $1,511.99 | $2,046 | 8.8× |
| CT abdomen w wo contrast (74170) | $1,742.56 | $2,358 | 10.2× |
| CT abdomen w/o contrast (74150) | $1,178.70 | $1,595 | 11.5× |
| CT Angio Abdomen and Pelvis (74174) | $2,844.41 | $3,849 | 8.3× |
| CT Angio Chest (71275) | $1,933.22 | $2,616 | 11.3× |
| CT Angio Head (70496) | $1,916.97 | $2,594 | 11.2× |
| Ct Angio Lwr Extr W/O&W/Dye (73706) | $1,885.93 | $2,552 | 11.0× |
| CT Angio Neck (70498) | $1,894.80 | $2,564 | 11.1× |
| Ct Angio Upr Extrm W/O&W/Dye (73206) | $1,648.71 | $2,231 | 9.6× |
| CT cervical spine w/ contrast (72126) | $1,524.56 | $2,063 | 4.5× |
| CT cervical spine w/o contrast (72125) | $1,435.14 | $1,942 | 14.1× |
| CT chest w contrast (71260) | $1,559.29 | $2,110 | 9.1× |
| CT chest w/wo contrast (71270) | $1,590.33 | $2,152 | 9.3× |
| CT head/brain with contrast (70460) | $1,297.68 | $1,756 | 7.6× |
| CT head/brain without and with contrast (70470) | $1,589.59 | $2,151 | 9.3× |
| CT iac w contrast (70481) | $1,312.46 | $1,776 | 7.7× |
| CT l-spine w&w/o contrast (72133) | $1,618.41 | $2,190 | 9.4× |
| CT lower ext w/o (73700) | $1,314.68 | $1,779 | 12.9× |
| CT lower extremity w/contrast material (73701) | $1,539.34 | $2,083 | 9.0× |
| CT lumbar spine w contrast (72132) | $1,553.38 | $2,102 | 4.6× |
| CT lumbar spine w/o contrast (72131) | $1,457.31 | $1,972 | 14.3× |
| CT maxillofacial w contrast (70487) | $1,415.18 | $1,915 | 8.3× |
| CT maxillofacial wo contrast (70486) | $1,391.54 | $1,883 | 13.6× |
| CT neck tissue combo (70492) | $1,484.65 | $2,009 | 8.7× |
| CT orbits w/o contrast (70480) | $1,196.44 | $1,619 | 11.7× |
| CT pelvis w/o contrast (72192) | $1,334.63 | $1,806 | 13.1× |
| CT scan of leg combo (73702) | $1,547.47 | $2,094 | 9.0× |
| CT soft tissue neck w contrast (70491) | $1,415.18 | $1,915 | 8.3× |
| CT soft tissue neck w/o contrast (70490) | $1,141.02 | $1,544 | 11.2× |
| CT thoracic spine w contrast (72129) | $1,439.57 | $1,948 | 8.4× |
| CT thoracic spine w/o contrast (72128) | $1,423.31 | $1,926 | 13.9× |
| CT thoracic spine w/wo cont (72130) | $1,574.07 | $2,130 | 9.2× |
| CT thorax w/o contrast (71250) | $1,339.07 | $1,812 | 13.1× |
| CT unlisted procedure (76497) range across 2 matching MRF lines |
$4,097.02–$5,616.40 | $5,544–$7,600 | varies |
| CT upper ext wo (73200) | $1,264.43 | $1,711 | 12.4× |
| CT upper extremity w/o & w/contrast material (73202) | $1,607.32 | $2,175 | 9.4× |
| CT upper extremity with contrast (73201) | $1,520.12 | $2,057 | 4.5× |
| Cta Abdl Aorta&Bi Iliofem W/Contrast&Postp (75635) | $2,205.92 | $2,985 | 12.9× |
| Cta Abdomen (74175) | $1,966.48 | $2,661 | 11.5× |
| CTA pelvis (72191) | $1,503.86 | $2,035 | 8.8× |
| Dilation ureters/urethra rs&i (74485) | $1,356.80 | $1,836 | 0.7× |
| Dxa Bone Density Axial (77080) | $398.32 | $539 | 3.9× |
| Dxa bone density study 1/>sites appendiclr skel (77081) | $192.88 | $261 | 2.3× |
| Fetal Biophysical Profile W/O Non-Stress Testing (76819) | $495.13 | $670 | 4.8× |
| Fluoroscopy up to 1 hr (76000) | $459.66 | $622 | 2.0× |
| Foot 2 views (73620) | $202.49 | $274 | 2.4× |
| Forearm 2 views (73090) | $206.92 | $280 | 2.4× |
| Gastric emptying imaging study (78264) | $1,361.24 | $1,842 | 3.5× |
| Hand 2 views (73120) | $219.48 | $297 | 2.1× |
| Hepatobil Syst Image W/Drug (78227) | $1,545.25 | $2,091 | 2.9× |
| Hepatobiliary System Imaging (78226) | $1,370.11 | $1,854 | 3.5× |
| Ht Muscle Image Spect Sing (78451) | $1,629.50 | $2,205 | 1.3× |
| K Flow/Funct Image W/Drug (78708) | $1,304.34 | $1,765 | 2.5× |
| Knee 3 Views (73562) | $247.56 | $335 | 2.9× |
| Lung Ventilat&Perfus Imaging (78582) | $1,246.69 | $1,687 | 2.4× |
| Meckels Divert Exam (78290) | $1,041.99 | $1,410 | 2.7× |
| Mra Head W/O & W/Contrast Material (70546) | $2,564.33 | $3,470 | 7.5× |
| MRA head w/o contrast (70544) | $2,189.66 | $2,963 | 9.4× |
| MRA neck w contrast (70548) | $2,021.16 | $2,735 | 5.9× |
| Mra Neck W/O &W/Contrast Material (70549) | $2,764.60 | $3,741 | 8.1× |
| MRA neck w/o contrast (70547) | $1,822.37 | $2,466 | 7.8× |
| MRI abdomen w contrast (74182) | $2,402.49 | $3,251 | 7.0× |
| MRI abdomen w/o contrast (74181) | $2,179.31 | $2,949 | 9.3× |
| MRI any jt lower extrem w/o & w/contrast matrl (73723) | $2,568.76 | $3,476 | 7.5× |
| MRI any jt upper extremity w/contrast matrl (73222) | $2,313.07 | $3,130 | 3.0× |
| MRI cervical spine w/o cont (72141) | $2,116.50 | $2,864 | 9.1× |
| MRI chest w/o contrast (71550) | $1,809.07 | $2,448 | 7.8× |
| MRI chest wo w contrast (71552) | $2,398.79 | $3,246 | 7.0× |
| MRI lower extrem oth/thn jt w/contrast matrl (73719) | $2,225.87 | $3,012 | 6.5× |
| MRI lower extrem oth/thn jt w/o & w/contr matr (73720) | $2,617.54 | $3,542 | 7.7× |
| MRI lower extrem oth/thn jt w/o contr matrl (73718) | $2,114.28 | $2,861 | 9.1× |
| Mri Neck Spine W/O & W/Dye (72156) | $2,785.29 | $3,769 | 8.2× |
| MRI orbit face &/neck w/o contrast (70540) | $1,591.07 | $2,153 | 6.8× |
| Mri Orbt/Fac/Nck W/O &W/Dye (70543) | $2,757.95 | $3,732 | 8.1× |
| MRI pelvis w contrast (72196) | $1,869.67 | $2,530 | 5.5× |
| MRI pelvis w/o & w contrast (72197) | $2,827.41 | $3,826 | 8.3× |
| MRI pelvis w/o contrast (72195) | $2,115.76 | $2,863 | 9.1× |
| MRI thoracic spine w/o contrast (72146) | $2,126.84 | $2,878 | 9.1× |
| MRI upper extremity oth than jt w/contr matrl (73219) | $2,389.93 | $3,234 | 7.0× |
| MRI upper extremity oth than jt w/o contr matrl (73218) | $2,134.97 | $2,889 | 9.2× |
| Mri Uppr Extremity W/O&W/Dye (73220) | $2,597.58 | $3,515 | 7.6× |
| MRI, abdomen, combo (74183) | $2,948.61 | $3,990 | 8.7× |
| MRI, dorsal spine combo (72157) | $2,766.08 | $3,743 | 8.1× |
| MRI, joint upper extrem (73221) | $2,143.84 | $2,901 | 9.2× |
| MRI, joint upper extrem combo (73223) | $2,610.89 | $3,533 | 7.7× |
| MRI, lumbar spine combo (72158) | $2,917.57 | $3,948 | 8.6× |
| Myocardial Spect Multiple Studies (78452) | $2,837.02 | $3,839 | 2.2× |
| Neck soft tissue (70360) | $206.92 | $280 | 2.4× |
| Optic foramina (70190) | $79.81 | $108 | 0.9× |
| Parathyroid Planar Imaging (78070) | $1,351.63 | $1,829 | 3.5× |
| Parathyroid planar imaging w/wo subtraction (78071) | $691.70 | $936 | 1.8× |
| Pelvis 1 or 2 views (72170) | $227.61 | $308 | 2.2× |
| Pulmonary Perfusion Imaging Particulate (78580) | $702.79 | $951 | 1.8× |
| Radex Abd Compl Aqt Abd W/S/E/D Views 1 View Ch (74022) | $346.59 | $469 | 3.4× |
| Radex Ankle Complete Minimum 3 Views (73610) | $235 | $318 | 2.8× |
| Radex Calcaneus Minimum 2 Views (73650) | $192.14 | $260 | 2.3× |
| Radex elbow complete minimum 3 views (73080) | $238.70 | $323 | 2.8× |
| Radex Facial Bones Complete Minimum 3 Views (70150) | $254.96 | $345 | 2.5× |
| Radex fingr minimum 2 views (73140) | $194.36 | $263 | 2.3× |
| Radex foot complete minimum 3 views (73630) | $221.70 | $300 | 2.6× |
| Radex Hand Minimum 3 Views (73130) | $220.22 | $298 | 2.6× |
| Radex lower extremity infant minimum 2 views (73592) | $149.28 | $202 | 1.8× |
| Radex Mastoids Compl Minimum 3 Views PR Side (70130) | $253.48 | $343 | 2.5× |
| Radex Nasal Bones Complete Minimum 3 Views (70160) | $218.74 | $296 | 2.6× |
| Radex Ribs Unilateral 2 Views (71100) | $214.31 | $290 | 2.5× |
| Radex shoulder complete minimum 2 views (73030) | $239.44 | $324 | 2.8× |
| Radex Sinuses Paransl < 3 Views (70210) | $182.53 | $247 | 2.1× |
| Radex Spine 1 View Specify Level (72020) | $225.40 | $305 | 2.7× |
| Radex Sternum Minimum 2 Views (71120) | $255.69 | $346 | 3.0× |
| Radex Temporomandble Jt Opn & Clsd Mouth Bilat (70330) | $247.56 | $335 | 2.9× |
| Radex Toe Minimum 2 Views (73660) | $185.49 | $251 | 2.2× |
| Radex upper extremity infant minimum 2 views (73092) | $153.71 | $208 | 1.5× |
| Radex Wrist Complete Minimum 3 Views (73110) | $233.52 | $316 | 2.7× |
| Radiolog exam mandible compl minimum 4 views (70110) | $263.82 | $357 | 2.6× |
| Radiologic Exam Abdomen 3+ Views - Xr Abdomen 3+ Views (74021) | $274.91 | $372 | 2.7× |
| Radiologic exam knee complete 4/more views (73564) | $281.56 | $381 | 2.8× |
| Radiologic exam pelvis compl minimum 3 views (72190) | $282.30 | $382 | 2.8× |
| Radiologic examination femur 1 view (73551) | $243.87 | $330 | 2.9× |
| Radiologic examination femur minimum 2 views (73552) | $245.35 | $332 | 2.9× |
| Radiologic examination knee 1/2 views (73560) | $230.57 | $312 | 2.7× |
| Radiologic Examination Osseous Survey Limited (77074) | $285.25 | $386 | 2.8× |
| Radiologic examination tibia & fibula 2 views (73590) | $227.61 | $308 | 2.7× |
| Ribs bilateral 3 views (71110) | $251.26 | $340 | 2.5× |
| Scapula (73010) | $240.91 | $326 | 2.4× |
| Screening Digital Breast Tomosynthesis Bi (77063) | $65.03 | $88 | 2.8× |
| Shoulder 1 view (73020) | $206.18 | $279 | 2.4× |
| Skull less than 4 views (70250) | $235 | $318 | 2.3× |
| Sternoclavicular joints (71130) | $181.79 | $246 | 2.1× |
| Thoracic spine 2 views (72070) | $260.87 | $353 | 2.6× |
| Thoracic spine 3 views (72072) | $306.68 | $415 | 3.0× |
| Thoracolumbar 2 views (72080) | $239.44 | $324 | 2.8× |
| Thyroid Uptake Measurement (78012) | $528.38 | $715 | 1.4× |
| Thyroid Uptake W/Blood Flow Sngle/Mult Quan Meas (78014) | $667.32 | $903 | 1.7× |
| Ultrasound Breast Limited (76642) | $351.02 | $475 | 4.1× |
| Ultrasound Exam Aaa Screen (76706) | $413.84 | $560 | 4.1× |
| Ultrasound, abdomen limited (76705) | $467.79 | $633 | 4.6× |
| Umbilical-artery Doppler (OB) (76820) | $318.51 | $431 | 3.1× |
| Us breast unilateral complete (76641) | $447.83 | $606 | 4.4× |
| Us chest (76604) | $378.37 | $512 | 3.7× |
| Us complete joint (76881) | $438.97 | $594 | 4.3× |
| Us exam, pelvic, limited (76857) | $339.20 | $459 | 3.3× |
| Us head (76506) | $307.42 | $416 | 3.0× |
| Us kidney transplant (76776) | $419.75 | $568 | 4.1× |
| Us lmtd joint/oth nonvasc xtr strux r-t w/img (76882) | $374.67 | $507 | 3.7× |
| Us ob limited 1 or more fetuses (76815) | $401.28 | $543 | 3.9× |
| Us ob transvaginal (76817) | $408.67 | $553 | 4.0× |
| Us pelvic non ob complete (76856) | $489.22 | $662 | 4.8× |
| Us pg uter img f&mat 14 wk tabdl 1/1st gestation (76801) | $453.01 | $613 | 4.4× |
| Us preg uterus real time f/u trnsabdl per fetus (76816) | $458.92 | $621 | 4.5× |
| Us retroperitoneal complete (76770) | $526.17 | $712 | 5.2× |
| Us retroperitoneal limited (76775) | $418.27 | $566 | 4.1× |
| Us scrotum and contents (76870) | $481.09 | $651 | 4.7× |
| Us spinal canal and contents (76800) | $394.63 | $534 | 3.9× |
| Us thyroid (76536) | $474.44 | $642 | 4.6× |
| Vein X-Ray Chest (75827) | $1,441.05 | $1,950 | 0.9× |
| Venography extremity unilateral rs&i (75820) | $931.14 | $1,260 | 0.6× |
| Wrist 2 views (73100) | $213.57 | $289 | 2.5× |
| X-Ray Ac Jts - Xr Acromioclavicular Joints Bilateral (73050) | $185.49 | $251 | 2.2× |
| X-Ray Bend Only L-S Spine (72120) | $245.35 | $332 | 2.4× |
| X-Ray Elbow 2 Vw - Xr Elbow 1-2 Views Right (73070) | $203.96 | $276 | 2.4× |
| X-Ray Exam Entire Spi 1 Vw (72081) | $239.44 | $324 | 2.8× |
| X-Ray Exam Entire Spi 2/3 Vw (72082) | $348.81 | $472 | 3.4× |
| X-Ray Exam Hip Uni 1 View (73501) | $240.18 | $325 | 2.8× |
| X-Ray Exam Hip Uni 2-3 Views (73502) | $276.39 | $374 | 3.3× |
| X-Ray Exam Hips Bi 2 Views (73521) | $317.77 | $430 | 3.1× |
| X-Ray Exam Hips Bi 3-4 Views (73522) | $320.73 | $434 | 3.1× |
| X-Ray Exam Hips Bi 5/> Views (73523) | $410.88 | $556 | 4.0× |
| X-Ray Exam L-S Spine Bending (72114) | $393.15 | $532 | 3.8× |
| X-Ray Exam Neck Spine 2-3 Vw (72040) | $248.30 | $336 | 2.9× |
| X-Ray Exam Neck Spine 6/>Vws (72052) | $359.89 | $487 | 3.5× |
| X-Ray Exam Unilat Ribs/Chest (71101) | $298.56 | $404 | 2.9× |
| X-ray eye for foreign body (70030) | $248.30 | $336 | 2.9× |
| X-ray humerus (73060) | $227.61 | $308 | 2.7× |
| X-Ray Jaw <4 Vw - Xr Mandible < 4 Views (70100) | $226.13 | $306 | 2.7× |
| X-Ray Knee Bilat Standing - Xr Knees Anteroposterior Standing Bilat (73565) | $230.57 | $312 | 2.7× |
| X-Ray Lumbar Spine 2/3 Vw - Xr Lumbar Spine 2-3 Views (72100) | $266.04 | $360 | 2.6× |
| X-ray nose-rectum child f.b. (76010) | $161.10 | $218 | 1.9× |
| X-Ray Ribs, Chest 4+ Vw - Xr Ribs 3 Vws Bil W/ Chest Posteroanterior (71111) | $357.68 | $484 | 3.5× |
| X-Ray Sacroiliac Jts 3+ Vw - Xr Sacroiliac Joints 3+ Views (72202) | $227.61 | $308 | 2.2× |
| X-Ray Sacroiliac Jts <3 Vw - Xr Sacroiliac Joints 1-2 Views (72200) | $242.39 | $328 | 2.4× |
| X-Ray Sacrum/Coccyx 2+ Vw - Xr Sacrum Coccyx 2+ Views (72220) | $226.87 | $307 | 2.7× |
| X-Ray Sinuses 3+ Vw - Xr Paranasal Sinuses 3+ Views (70220) | $232.78 | $315 | 2.7× |
| X-ray thoracic spine 4 vw (72074) | $113.81 | $154 | 1.1× |
| X-Ray Urinary Tract Exam With Contrast Material (74420) | $775.21 | $1,049 | 2.3× |
| X-Rays Bone Survey Complete (77075) | $586.77 | $794 | 5.7× |
| Xr c-spine 4 or 5 views (72050) | $321.46 | $435 | 3.1× |
| Xr facial bones less than 3 views (70140) | $250.52 | $339 | 2.9× |
| XR Mastoids < 3 Views Bilateral (70120) | $253.48 | $343 | 2.5× |
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.