Imaging prices at Gundersen St. Elizabeth's Hospital
Wabasha, MN · every code in this section with a posted price and a Medicare benchmark.
194 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) | $286.84 | $471 | 3.1× |
| Abdomen 2 views (74019) | $329.47 | $541 | 2.9× |
| Acute Gastrointestinal Blood Loss Imaging (78278) | $1,180.85 | $1,939 | 2.7× |
| Ankle 2 views (73600) | $266.74 | $438 | 2.8× |
| Arthrogram hip (73525) | $562.11 | $923 | 1.5× |
| Arthrogram Wrist (73115) | $526.79 | $865 | 1.4× |
| Bone age studies (77072) | $109.01 | $179 | 1.0× |
| Bone Imaging 3 Phase (78315) | $1,202.17 | $1,974 | 2.8× |
| Bone Imaging Limited Area (78300) | $876.96 | $1,440 | 2.0× |
| Bone Imaging Whole Body (78306) | $1,272.81 | $2,090 | 3.0× |
| Bone survey infant (77076) | $430.56 | $707 | 3.8× |
| Cat Scan Follow-Up Study (76380) | $566.98 | $931 | 6.0× |
| Chest 1 view (71045) | $279.53 | $459 | 3.0× |
| Chest 2 views (71046) | $309.98 | $509 | 3.3× |
| Chest 3 views (71047) | $222.29 | $365 | 2.4× |
| Clavicle complete (73000) | $266.74 | $438 | 2.8× |
| Computed Tomography Thorax Lw Dose Lng Ca Scr C- (71271) | $101.70 | $167 | 0.9× |
| CT abdomen and pelvis without and with contrast (74178) | $2,217.37 | $3,641 | 5.9× |
| CT abdomen and pelvis without contrast (74176) | $1,895.21 | $3,112 | 7.4× |
| CT abdomen w contrast (74160) | $1,579.75 | $2,594 | 8.4× |
| CT abdomen w wo contrast (74170) | $1,760.62 | $2,891 | 9.3× |
| CT abdomen w/o contrast (74150) | $1,420.80 | $2,333 | 12.6× |
| CT Angio Abdomen and Pelvis (74174) | $1,909.22 | $3,135 | 5.1× |
| CT Angio Chest (71275) | $1,920.18 | $3,153 | 10.2× |
| CT Angio Head (70496) | $1,571.22 | $2,580 | 8.3× |
| Ct Angio Lwr Extr W/O&W/Dye (73706) | $2,250.26 | $3,695 | 11.9× |
| CT Angio Neck (70498) | $1,543.21 | $2,534 | 8.2× |
| CT cervical spine w/ contrast (72126) | $1,789.24 | $2,938 | 4.8× |
| CT cervical spine w/o contrast (72125) | $1,342.85 | $2,205 | 11.9× |
| CT chest w contrast (71260) | $1,633.34 | $2,682 | 8.6× |
| CT chest w/wo contrast (71270) | $1,696.67 | $2,786 | 9.0× |
| CT colonography screening (74263) | $873.31 | $1,434 | 3.4× |
| CT colonogrphy dx image postprocess w/o contrast (74261) | $873.31 | $1,434 | 7.8× |
| CT head/brain with contrast (70460) | $1,214.96 | $1,995 | 6.4× |
| CT head/brain without and with contrast (70470) | $1,529.20 | $2,511 | 8.1× |
| CT iac w contrast (70481) | $675.99 | $1,110 | 3.6× |
| CT lower ext w/o (73700) | $1,387.91 | $2,279 | 12.3× |
| CT lower extremity w/contrast material (73701) | $1,343.45 | $2,206 | 7.1× |
| CT lumbar spine w contrast (72132) | $1,422.02 | $2,335 | 3.8× |
| CT lumbar spine w/o contrast (72131) | $1,502.40 | $2,467 | 13.3× |
| CT maxillofacial w contrast (70487) | $1,406.18 | $2,309 | 7.4× |
| CT maxillofacial wo contrast (70486) | $1,300.82 | $2,136 | 11.6× |
| CT neck tissue combo (70492) | $1,453.07 | $2,386 | 7.7× |
| CT orbits w/o contrast (70480) | $632.75 | $1,039 | 5.6× |
| CT pelvis w&w/o contrast (72194) | $1,543.21 | $2,534 | 8.2× |
| CT pelvis w/o contrast (72192) | $1,406.18 | $2,309 | 12.5× |
| CT scan of leg combo (73702) | $1,568.78 | $2,576 | 8.3× |
| CT scans face/jaw combo (70488) | $1,490.22 | $2,447 | 7.9× |
| CT soft tissue neck w contrast (70491) | $1,343.45 | $2,206 | 7.1× |
| CT soft tissue neck w/o contrast (70490) | $1,158.93 | $1,903 | 10.3× |
| CT thoracic spine w/o contrast (72128) | $1,343.45 | $2,206 | 11.9× |
| CT thorax w/o contrast (71250) | $1,406.18 | $2,309 | 12.5× |
| CT upper ext wo (73200) | $1,387.91 | $2,279 | 12.3× |
| CT upper extremity w/o & w/contrast material (73202) | $1,568.78 | $2,576 | 8.3× |
| CT upper extremity with contrast (73201) | $1,365.99 | $2,243 | 3.6× |
| Cta Abdl Aorta&Bi Iliofem W/Contrast&Postp (75635) | $1,784.37 | $2,930 | 9.4× |
| Cta Abdomen (74175) | $1,390.35 | $2,283 | 7.4× |
| CTA head&neck c+ w/noncontrast img&post-pxessing (70471) | $1,779.50 | $2,922 | 4.7× |
| CTA pelvis (72191) | $1,089.50 | $1,789 | 5.8× |
| Dxa Bone Density Axial (77080) | $246.04 | $404 | 2.2× |
| Dxa bone density study (77085) | $111.45 | $183 | 1.0× |
| Dxa bone density study 1/>sites appendiclr skel (77081) | $187.57 | $308 | 2.0× |
| Esophagram (74220) | $443.96 | $729 | 2.3× |
| Fetal Biophys Profile W/Nst (76818) | $652.85 | $1,072 | 5.8× |
| Fluoroscopy up to 1 hr (76000) | $233.25 | $383 | 0.9× |
| Foot 2 views (73620) | $266.74 | $438 | 2.8× |
| Forearm 2 views (73090) | $279.53 | $459 | 3.0× |
| Gastric emptying imaging study (78264) | $910.46 | $1,495 | 2.1× |
| Hand 2 views (73120) | $236.29 | $388 | 2.1× |
| Hepatobil Syst Image W/Drug (78227) | $1,116.91 | $1,834 | 1.9× |
| Joint Survey Single View (77077) | $161.39 | $265 | 1.4× |
| K Flow/Funct Image W/O Drug (78707) | $538.36 | $884 | 0.9× |
| Knee 3 Views (73562) | $261.87 | $430 | 2.8× |
| Magnetic Image Jaw Joint (70336) | $2,140.03 | $3,514 | 8.3× |
| Mra Head W/O & W/Contrast Material (70546) | $2,245.99 | $3,688 | 6.0× |
| MRA head w/o contrast (70544) | $2,140.03 | $3,514 | 8.3× |
| MRA neck w contrast (70548) | $2,140.03 | $3,514 | 5.7× |
| Mra Neck W/O &W/Contrast Material (70549) | $2,777.65 | $4,561 | 7.4× |
| MRA neck w/o contrast (70547) | $2,140.03 | $3,514 | 8.3× |
| MRI abdomen w/o contrast (74181) | $2,140.03 | $3,514 | 8.3× |
| MRI any jt lower extrem w/contrast material (73722) | $1,668.66 | $2,740 | 2.0× |
| MRI any jt lower extrem w/o & w/contrast matrl (73723) | $2,425.65 | $3,983 | 6.5× |
| MRI any jt upper extremity w/contrast matrl (73222) | $1,668.66 | $2,740 | 2.0× |
| MRI cervical spine w contrast (72142) | $2,140.03 | $3,514 | 5.7× |
| MRI cervical spine w/o cont (72141) | $2,140.03 | $3,514 | 8.3× |
| MRI chest w/o contrast (71550) | $2,140.03 | $3,514 | 8.3× |
| MRI chest wo w contrast (71552) | $2,777.04 | $4,560 | 7.4× |
| MRI lower extrem oth/thn jt w/o & w/contr matr (73720) | $2,971.92 | $4,880 | 7.9× |
| MRI lower extrem oth/thn jt w/o contr matrl (73718) | $1,668.66 | $2,740 | 6.5× |
| MRI lumbar spine w contrast (72149) | $2,140.03 | $3,514 | 5.7× |
| Mri Neck Spine W/O & W/Dye (72156) | $2,140.03 | $3,514 | 5.7× |
| MRI orbit face &/neck w/o contrast (70540) | $2,140.03 | $3,514 | 8.3× |
| Mri Orbt/Fac/Nck W/O &W/Dye (70543) | $2,777.04 | $4,560 | 7.4× |
| MRI pelvis w contrast (72196) | $2,140.03 | $3,514 | 5.7× |
| MRI pelvis w/o & w contrast (72197) | $2,777.04 | $4,560 | 7.4× |
| MRI pelvis w/o contrast (72195) | $2,140.03 | $3,514 | 8.3× |
| MRI thoracic spine w/o contrast (72146) | $2,140.03 | $3,514 | 8.3× |
| MRI upper extremity oth than jt w/o contr matrl (73218) | $1,668.66 | $2,740 | 6.5× |
| Mri Uppr Extremity W/O&W/Dye (73220) | $2,777.04 | $4,560 | 7.4× |
| MRI, abdomen, combo (74183) | $2,971.92 | $4,880 | 7.9× |
| MRI, dorsal spine combo (72157) | $2,140.03 | $3,514 | 5.7× |
| MRI, joint upper extrem (73221) | $1,668.66 | $2,740 | 6.5× |
| MRI, joint upper extrem combo (73223) | $2,594.95 | $4,261 | 6.9× |
| MRI, lumbar spine combo (72158) | $2,140.03 | $3,514 | 5.7× |
| Myocardial Spect Multiple Studies (78452) | $1,405.57 | $2,308 | 1.0× |
| Neck soft tissue (70360) | $233.25 | $383 | 2.5× |
| Pelvis 1 or 2 views (72170) | $266.74 | $438 | 2.4× |
| PET image w/CT, full body (78816) | $2,950.61 | $4,845 | 1.9× |
| PET imaging CT attenuation skull base mid-thigh (78815) | $2,946.95 | $4,839 | 1.9× |
| Radex Abd Compl Aqt Abd W/S/E/D Views 1 View Ch (74022) | $111.45 | $183 | 1.0× |
| Radex Ankle Complete Minimum 3 Views (73610) | $286.84 | $471 | 3.1× |
| Radex Calcaneus Minimum 2 Views (73650) | $236.29 | $388 | 2.5× |
| Radex elbow complete minimum 3 views (73080) | $329.47 | $541 | 3.5× |
| Radex Facial Bones Complete Minimum 3 Views (70150) | $329.47 | $541 | 2.9× |
| Radex fingr minimum 2 views (73140) | $266.74 | $438 | 2.8× |
| Radex foot complete minimum 3 views (73630) | $286.84 | $471 | 3.1× |
| Radex Hand Minimum 3 Views (73130) | $286.84 | $471 | 3.1× |
| Radex Nasal Bones Complete Minimum 3 Views (70160) | $279.53 | $459 | 3.0× |
| Radex Ribs Unilateral 2 Views (71100) | $219.85 | $361 | 2.3× |
| Radex shoulder complete minimum 2 views (73030) | $309.98 | $509 | 3.3× |
| Radex Sinuses Paransl < 3 Views (70210) | $222.29 | $365 | 2.4× |
| Radex Spine 1 View Specify Level (72020) | $216.20 | $355 | 2.3× |
| Radex Sternum Minimum 2 Views (71120) | $222.29 | $365 | 2.4× |
| Radex Temporomandble Jt Opn & Clsd Mouth Bilat (70330) | $221.07 | $363 | 2.4× |
| Radex Toe Minimum 2 Views (73660) | $266.74 | $438 | 2.8× |
| Radex upper extremity infant minimum 2 views (73092) | $196.71 | $323 | 1.7× |
| Radex Wrist Complete Minimum 3 Views (73110) | $286.84 | $471 | 3.1× |
| Radiolog exam mandible compl minimum 4 views (70110) | $311.20 | $511 | 2.8× |
| Radiologic exam colon double contrast study (74280) | $880.01 | $1,445 | 4.7× |
| Radiologic exam colon single contrast study (74270) | $752.72 | $1,236 | 4.0× |
| Radiologic exam knee complete 4/more views (73564) | $309.98 | $509 | 2.8× |
| Radiologic exam pelvis compl minimum 3 views (72190) | $323.99 | $532 | 2.9× |
| Radiologic Exam Small Int Single Contrast Study (74250) | $689.39 | $1,132 | 3.6× |
| Radiologic exam swallow function contrast study (74230) | $390.98 | $642 | 2.1× |
| Radiologic examination femur minimum 2 views (73552) | $266.13 | $437 | 2.8× |
| Radiologic examination knee 1/2 views (73560) | $266.74 | $438 | 2.8× |
| Radiologic examination tibia & fibula 2 views (73590) | $266.74 | $438 | 2.8× |
| Rp loclzj tum spect w/CT 1 area/acquisj 1day img (78830) | $1,450.64 | $2,382 | 1.0× |
| Scapula (73010) | $236.29 | $388 | 2.1× |
| Screening Digital Breast Tomosynthesis Bi (77063) | $19.49 | $32 | 0.8× |
| Shoulder 1 view (73020) | $266.74 | $438 | 2.8× |
| Shoulder Arthrography (73040) | $562.72 | $924 | 1.5× |
| Skull less than 4 views (70250) | $202.80 | $333 | 1.8× |
| Sternoclavicular joints (71130) | $236.29 | $388 | 2.5× |
| Thoracic spine 2 views (72070) | $381.23 | $626 | 3.4× |
| Thoracic spine 3 views (72072) | $415.34 | $682 | 3.7× |
| Thoracolumbar 2 views (72080) | $82.82 | $136 | 0.9× |
| Thyroid Uptake W/Blood Flow Sngle/Mult Quan Meas (78014) | $1,070.01 | $1,757 | 2.5× |
| Ultrasound Breast Limited (76642) | $505.47 | $830 | 5.4× |
| Ultrasound Exam Aaa Screen (76706) | $475.63 | $781 | 4.2× |
| Ultrasound, abdomen limited (76705) | $475.63 | $781 | 4.2× |
| Upper gi w/o kub (74240) | $689.39 | $1,132 | 3.6× |
| Urethrocystogram voiding (74455) | $674.77 | $1,108 | 2.6× |
| Us chest (76604) | $475.63 | $781 | 4.2× |
| Us complete joint (76881) | $398.29 | $654 | 3.5× |
| Us exam, pelvic, limited (76857) | $475.63 | $781 | 4.2× |
| Us lmtd joint/oth nonvasc xtr strux r-t w/img (76882) | $475.63 | $781 | 4.2× |
| Us ob limited 1 or more fetuses (76815) | $517.65 | $850 | 4.6× |
| Us ob transvaginal (76817) | $311.20 | $511 | 2.8× |
| Us pelvic non ob complete (76856) | $441.53 | $725 | 3.9× |
| Us pg uter img f&mat 14 wk tabdl 1/1st gestation (76801) | $651.63 | $1,070 | 5.8× |
| Us preg uterus real time f/u trnsabdl per fetus (76816) | $652.85 | $1,072 | 5.8× |
| Us retroperitoneal complete (76770) | $735.06 | $1,207 | 6.5× |
| Us retroperitoneal limited (76775) | $475.63 | $781 | 4.2× |
| Us scrotum and contents (76870) | $674.77 | $1,108 | 6.0× |
| Us thyroid (76536) | $603.52 | $991 | 5.4× |
| Wrist 2 views (73100) | $266.74 | $438 | 2.8× |
| X-Ray Ac Jts - Xr Acromioclavicular Joints Bilateral (73050) | $236.29 | $388 | 2.5× |
| X-Ray Elbow 2 Vw - Xr Elbow 1-2 Views Right (73070) | $250.30 | $411 | 2.7× |
| X-Ray Exam Breast Specimen (76098) | $204.62 | $336 | 0.3× |
| X-Ray Exam Hip Uni 1 View (73501) | $231.42 | $380 | 2.5× |
| X-Ray Exam Hip Uni 2-3 Views (73502) | $309.37 | $508 | 3.3× |
| X-Ray Exam Hip Uni 4/> Views (73503) | $751.51 | $1,234 | 6.7× |
| X-Ray Exam Hips Bi 3-4 Views (73522) | $111.45 | $183 | 1.0× |
| X-Ray Exam Hips Bi 5/> Views (73523) | $389.76 | $640 | 3.5× |
| X-Ray Exam Neck Spine 2-3 Vw (72040) | $309.98 | $509 | 3.3× |
| X-Ray Exam Neck Spine 6/>Vws (72052) | $443.96 | $729 | 3.9× |
| X-Ray Exam Unilat Ribs/Chest (71101) | $329.47 | $541 | 2.9× |
| X-ray eye for foreign body (70030) | $83.43 | $137 | 0.9× |
| X-ray humerus (73060) | $266.74 | $438 | 2.8× |
| X-Ray Jaw <4 Vw - Xr Mandible < 4 Views (70100) | $247.25 | $406 | 2.6× |
| X-Ray Knee Bilat Standing - Xr Knees Anteroposterior Standing Bilat (73565) | $255.78 | $420 | 2.7× |
| X-Ray Lumbar Spine 2/3 Vw - Xr Lumbar Spine 2-3 Views (72100) | $381.23 | $626 | 3.4× |
| X-ray nose-rectum child f.b. (76010) | $196.71 | $323 | 2.1× |
| X-Ray Ribs, Chest 4+ Vw - Xr Ribs 3 Vws Bil W/ Chest Posteroanterior (71111) | $360.53 | $592 | 3.2× |
| X-Ray Sacroiliac Jts 3+ Vw - Xr Sacroiliac Joints 3+ Views (72202) | $222.29 | $365 | 2.0× |
| X-Ray Sacrum/Coccyx 2+ Vw - Xr Sacrum Coccyx 2+ Views (72220) | $266.74 | $438 | 2.8× |
| X-Ray Sinuses 3+ Vw - Xr Paranasal Sinuses 3+ Views (70220) | $302.67 | $497 | 3.2× |
| X-Ray Skull 4+ Vw - Xr Skull Complete 4+ Views (70260) | $360.53 | $592 | 3.2× |
| X-Ray Tmj Unilat (70328) | $221.07 | $363 | 2.4× |
| X-Rays Bone Survey Complete (77075) | $109.01 | $179 | 1.0× |
| Xr c-spine 4 or 5 views (72050) | $373.93 | $614 | 3.3× |
| Xr facial bones less than 3 views (70140) | $246.04 | $404 | 2.6× |
| Xr orbits complete 4 views (70200) | $283.79 | $466 | 2.5× |