Imaging prices at Gundersen St. Josephs Hospital and Clinics

Hillsboro, WI · every code in this section with a posted price and a Medicare benchmark.

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

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ProcedurePosted cashPosted gross× Medicare
Abdomen 1 View (74018) $177.26 $337 2.1×
Abdomen 2 views (74019) $247.22 $470 2.4×
Acute Gastrointestinal Blood Loss Imaging (78278) $853.17 $1,622 2.2×
Ankle 2 views (73600) $187.78 $357 2.2×
Bone age studies (77072) $67.85 $129 0.7×
Bone Imaging 3 Phase (78315) $1,021.49 $1,942 2.6×
Bone Imaging Limited Area (78300) $1,237.15 $2,352 3.2×
Bone Imaging Multiple Areas (78305) $1,542.76 $2,933 4.0×
Bone Imaging Whole Body (78306) $1,612.72 $3,066 4.2×
Bone survey infant (77076) $2,343.33 $4,455 23.1×
Chest 1 view (71045) $191.99 $365 2.3×
Chest 2 views (71046) $210.93 $401 2.5×
Chest 3 views (71047) $138.86 $264 1.6×
Chest 4 or more views (71048) $425.01 $808 4.2×
Clavicle complete (73000) $255.11 $485 3.0×
Computed Tomography Thorax Lw Dose Lng Ca Scr C- (71271) $163.59 $311 1.6×
CT abdomen and pelvis without and with contrast (74178) $3,182.30 $6,050 9.4×
CT abdomen and pelvis without contrast (74176) $2,027.73 $3,855 8.7×
CT abdomen w contrast (74160) $1,474.90 $2,804 8.7×
CT abdomen w wo contrast (74170) $2,078.75 $3,952 12.2×
CT abdomen w/o contrast (74150) $1,260.82 $2,397 12.4×
CT Angio Abdomen and Pelvis (74174) $1,654.80 $3,146 4.9×
CT Angio Chest (71275) $1,574.32 $2,993 9.2×
CT Angio Head (70496) $1,656.37 $3,149 9.7×
Ct Angio Lwr Extr W/O&W/Dye (73706) $1,019.39 $1,938 6.0×
CT Angio Neck (70498) $1,738.96 $3,306 10.2×
Ct Angio Upr Extrm W/O&W/Dye (73206) $878.42 $1,670 5.2×
CT cervical spine w/ contrast (72126) $1,216.11 $2,312 3.6×
CT cervical spine w/o contrast (72125) $1,126.69 $2,142 11.1×
CT cervical spine w/wo cont (72127) $1,503.83 $2,859 8.8×
CT chest w contrast (71260) $1,417.57 $2,695 8.3×
CT chest w/wo contrast (71270) $2,156.07 $4,099 12.7×
CT colonography screening (74263) $591.75 $1,125 2.6×
CT Colonogrphy Dx Image Postprocess W/Contrast (74262) $710.10 $1,350 4.2×
CT colonogrphy dx image postprocess w/o contrast (74261) $591.75 $1,125 5.8×
CT head/brain with contrast (70460) $1,384.43 $2,632 8.1×
CT head/brain without and with contrast (70470) $1,105.13 $2,101 6.5×
CT heart no contrast quant eval coronry calcium (75571) $158.33 $301 1.9×
CT iac w contrast (70481) $1,235.57 $2,349 7.3×
CT lower ext w/o (73700) $1,150.36 $2,187 11.3×
CT lower extremity w/contrast material (73701) $1,130.90 $2,150 6.6×
CT lumbar spine w contrast (72132) $1,117.22 $2,124 3.3×
CT lumbar spine w/o contrast (72131) $1,251.35 $2,379 12.3×
CT maxillofacial w contrast (70487) $1,142.47 $2,172 6.7×
CT maxillofacial wo contrast (70486) $1,097.24 $2,086 10.8×
CT neck tissue combo (70492) $1,427.04 $2,713 8.4×
Ct Orbit/Ear/Fossa W/O&W/Dye (70482) $1,543.81 $2,935 9.1×
CT orbits w/o contrast (70480) $1,142.47 $2,172 11.3×
CT pelvis w&w/o contrast (72194) $2,010.37 $3,822 11.8×
CT pelvis w/o contrast (72192) $1,241.89 $2,361 12.2×
CT scans face/jaw combo (70488) $1,427.04 $2,713 8.4×
CT soft tissue neck w contrast (70491) $1,384.43 $2,632 8.1×
CT soft tissue neck w/o contrast (70490) $954.16 $1,814 9.4×
CT thoracic spine w/o contrast (72128) $1,251.35 $2,379 12.3×
CT thorax w/o contrast (71250) $1,126.69 $2,142 11.1×
CT unlisted procedure (76497) $223.55 $425 2.6×
CT upper ext wo (73200) $1,035.69 $1,969 10.2×
CT upper extremity with contrast (73201) $446.57 $849 1.3×
Cta Abdl Aorta&Bi Iliofem W/Contrast&Postp (75635) $1,328.15 $2,525 7.8×
Cta Abdomen (74175) $1,654.27 $3,145 9.7×
CTA head&neck c+ w/noncontrast img&post-pxessing (70471) $1,542.23 $2,932 4.6×
CTA pelvis (72191) $1,099.34 $2,090 6.5×
Dxa Bone Density Axial (77080) $260.37 $495 2.6×
Dxa bone density study (77085) $488.65 $929 4.8×
Dxa bone density study 1/>sites appendiclr skel (77081) $46.81 $89 0.6×
Fetal Biophysical Profile W/O Non-Stress Testing (76819) $405.02 $770 4.0×
Fluoroscopy up to 1 hr (76000)
range across 2 matching MRF lines		 $377.14–$399.76 $717–$760 varies
Foot 2 views (73620) $187.78 $357 2.2×
Forearm 2 views (73090) $197.25 $375 2.3×
Gastric emptying imaging study (78264) $2,535.32 $4,820 6.5×
Hand 2 views (73120) $187.78 $357 1.8×
Hepatobil Syst Image W/Drug (78227) $1,504.36 $2,860 2.9×
Ht Muscle Image Spect Sing (78451) $1,460.70 $2,777 1.2×
Joint Survey Single View (77077) $172 $327 1.7×
K Flow/Funct Image W/Drug (78708) $641.19 $1,219 1.2×
K Flow/Funct Image W/O Drug (78707) $920.50 $1,750 1.7×
Knee 3 Views (73562) $255.11 $485 3.0×
Liver & Spleen Imaging Static Only (78215) $1,512.78 $2,876 3.9×
Liver & Spleen Imaging W/Vascular Flow (78216) $1,023.07 $1,945 2.6×
Lung Ventilat&Perfus Imaging (78582) $312.97 $595 0.6×
Lymph System Imaging (78195) $454.99 $865 0.9×
Magnetic Image Jaw Joint (70336) $1,878.35 $3,571 8.1×
Mra Head W/O & W/Contrast Material (70546) $3,494.22 $6,643 10.3×
MRA head w/o contrast (70544) $1,997.22 $3,797 8.6×
MRA head with contrast (70545) $2,524.80 $4,800 7.5×
MRA neck w contrast (70548) $1,878.35 $3,571 5.5×
Mra Neck W/O &W/Contrast Material (70549) $2,243.39 $4,265 6.6×
MRA neck w/o contrast (70547) $1,759.47 $3,345 7.6×
MRI abdomen w contrast (74182) $2,141.87 $4,072 6.3×
MRI abdomen w/o contrast (74181) $1,878.35 $3,571 8.1×
MRI any jt lower extrem w/contrast material (73722) $1,229.26 $2,337 1.6×
MRI any jt lower extrem w/o & w/contrast matrl (73723) $2,396.46 $4,556 7.1×
MRI cervical spine w contrast (72142) $2,600.02 $4,943 7.7×
MRI cervical spine w/o cont (72141) $1,592.73 $3,028 6.9×
MRI chest w/o contrast (71550) $1,544.34 $2,936 6.7×
MRI chest wo w contrast (71552) $1,878.35 $3,571 5.5×
MRI lower extrem oth/thn jt w/contrast matrl (73719) $1,602.72 $3,047 4.7×
MRI lower extrem oth/thn jt w/o & w/contr matr (73720) $1,997.22 $3,797 5.9×
MRI lower extrem oth/thn jt w/o contr matrl (73718) $1,443.87 $2,745 6.2×
MRI lumbar spine w contrast (72149) $2,404.35 $4,571 7.1×
Mri Neck Spine W/O & W/Dye (72156) $3,669.38 $6,976 10.8×
MRI orbit face &/neck w/o contrast (70540) $1,878.35 $3,571 8.1×
MRI orbit face neck w contrast (70542) $2,600.02 $4,943 7.7×
Mri Orbt/Fac/Nck W/O &W/Dye (70543) $3,494.22 $6,643 10.3×
MRI pelvis w contrast (72196) $1,736.85 $3,302 5.1×
MRI pelvis w/o & w contrast (72197) $2,411.71 $4,585 7.1×
MRI pelvis w/o contrast (72195) $1,636.91 $3,112 7.1×
MRI thoracic spine w/o contrast (72146) $2,216.56 $4,214 9.6×
MRI upper extremity oth than jt w/contr matrl (73219) $2,109.79 $4,011 6.2×
MRI upper extremity oth than jt w/o contr matrl (73218) $1,499.63 $2,851 6.5×
Mri Uppr Extremity W/O&W/Dye (73220) $1,878.35 $3,571 5.5×
MRI, abdomen, combo (74183) $2,202.89 $4,188 6.5×
MRI, dorsal spine combo (72157) $3,669.38 $6,976 10.8×
MRI, dorsal spine contrast (72147) $2,600.02 $4,943 7.7×
MRI, joint upper extrem (73221) $1,741.06 $3,310 7.5×
MRI, joint upper extrem combo (73223) $2,019.84 $3,840 6.0×
MRI, lumbar spine combo (72158) $3,302.75 $6,279 9.7×
Myocardial Spect Multiple Studies (78452) $2,219.19 $4,219 1.8×
Neck soft tissue (70360) $343.48 $653 4.1×
Ob us nuchal meas 1 gest (76813) $311.92 $593 3.1×
Oph bmtry us echograpy a-scan io lens pwr cal (76519) $275.62 $524 2.7×
Parathyroid Planar Imaging (78070) $2,621.58 $4,984 6.8×
Pelvis 1 or 2 views (72170) $177.26 $337 1.7×
PET image w/CT, full body (78816) $2,548.47 $4,845 1.8×
PET imaging CT attenuation skull base mid-thigh (78815) $2,545.31 $4,839 1.8×
Pulmonary Perfusion Imaging Particulate (78580) $1,456.49 $2,769 3.8×
Radex Abd Compl Aqt Abd W/S/E/D Views 1 View Ch (74022) $441.31 $839 4.3×
Radex Ankle Complete Minimum 3 Views (73610) $180.94 $344 2.1×
Radex Calcaneus Minimum 2 Views (73650) $212.50 $404 2.5×
Radex elbow complete minimum 3 views (73080) $201.46 $383 2.4×
Radex Facial Bones Complete Minimum 3 Views (70150) $452.36 $860 4.5×
Radex fingr minimum 2 views (73140) $173.58 $330 2.1×
Radex foot complete minimum 3 views (73630) $237.75 $452 2.8×
Radex Hand Minimum 3 Views (73130) $180.94 $344 2.1×
Radex lower extremity infant minimum 2 views (73592) $38.40 $73 0.5×
Radex Nasal Bones Complete Minimum 3 Views (70160) $255.11 $485 3.0×
Radex Ribs Unilateral 2 Views (71100) $244.59 $465 2.9×
Radex shoulder complete minimum 2 views (73030) $225.13 $428 2.7×
Radex Sinuses Paransl < 3 Views (70210) $130.45 $248 1.5×
Radex Spine 1 View Specify Level (72020) $255.11 $485 3.0×
Radex Sternum Minimum 2 Views (71120) $255.11 $485 3.0×
Radex Temporomandble Jt Opn & Clsd Mouth Bilat (70330) $344.53 $655 4.1×
Radex Toe Minimum 2 Views (73660) $175.16 $333 2.1×
Radex Wrist Complete Minimum 3 Views (73110) $197.25 $375 2.3×
Radiolog exam mandible compl minimum 4 views (70110) $418.17 $795 4.1×
Radiologic Exam Abdomen 3+ Views - Xr Abdomen 3+ Views (74021) $248.80 $473 2.5×
Radiologic exam knee complete 4/more views (73564) $276.15 $525 2.7×
Radiologic exam pelvis compl minimum 3 views (72190) $338.74 $644 3.3×
Radiologic Exam Small Int Single Contrast Study (74250) $303.50 $577 1.8×
Radiologic examination femur 1 view (73551) $173.05 $329 2.0×
Radiologic examination femur minimum 2 views (73552) $255.11 $485 3.0×
Radiologic examination knee 1/2 views (73560) $197.25 $375 2.3×
Radiologic Examination Osseous Survey Limited (77074) $1,200.33 $2,282 11.8×
Radiologic examination tibia & fibula 2 views (73590) $212.50 $404 2.5×
Ribs bilateral 3 views (71110) $145.70 $277 1.4×
Rp Loclzj Tum Spect 1 Area Single Day Imaging (78803) $1,214.53 $2,309 2.3×
Rp loclzj tum spect w/CT 1 area/acquisj 1day img (78830) $1,214.53 $2,309 1.0×
Scapula (73010) $276.15 $525 2.7×
Screening Digital Breast Tomosynthesis Bi (77063) $24.72 $47 1.1×
Shoulder 1 view (73020) $117.82 $224 1.4×
Skull less than 4 views (70250) $255.11 $485 2.5×
Sternoclavicular joints (71130) $337.69 $642 4.0×
Thoracic spine 2 views (72070) $255.11 $485 2.5×
Thoracic spine 3 views (72072) $295.09 $561 2.9×
Thoracolumbar 2 views (72080) $267.73 $509 3.2×
Thyroid Uptake W/Blood Flow Sngle/Mult Quan Meas (78014) $341.37 $649 0.9×
Ultrasound Breast Limited (76642) $165.69 $315 2.0×
Ultrasound Exam Aaa Screen (76706)
range across 2 matching MRF lines		 $56.28–$57.33 $107–$109 varies
Ultrasound, abdomen limited (76705) $373.46 $710 3.7×
Us breast unilateral complete (76641) $157.80 $300 1.6×
Us chest (76604) $101.52 $193 1.0×
Us complete joint (76881) $432.90 $823 4.3×
Us exam, pelvic, limited (76857) $410.28 $780 4.0×
Us lmtd joint/oth nonvasc xtr strux r-t w/img (76882) $142.55 $271 1.4×
Us ob detailed single fetus (76811) $862.64 $1,640 3.7×
Us ob limited 1 or more fetuses (76815) $446.05 $848 4.4×
Us ob transvaginal (76817) $372.41 $708 3.7×
Us pelvic non ob complete (76856) $756.39 $1,438 7.4×
Us pg uter img f&mat 14 wk tabdl 1/1st gestation (76801) $704.31 $1,339 6.9×
Us preg uterus real time f/u trnsabdl per fetus (76816) $769.01 $1,462 7.6×
Us retroperitoneal complete (76770) $793.73 $1,509 7.8×
Us retroperitoneal limited (76775) $371.88 $707 3.7×
Us scrotum and contents (76870) $660.66 $1,256 6.5×
Us thyroid (76536) $572.29 $1,088 5.6×
Wrist 2 views (73100) $187.78 $357 2.2×
X-Ray Ac Jts - Xr Acromioclavicular Joints Bilateral (73050) $282.46 $537 3.3×
X-Ray Elbow 2 Vw - Xr Elbow 1-2 Views Right (73070) $172 $327 2.0×
X-Ray Exam Breast Specimen (76098) $93.10 $177 0.2×
X-Ray Exam Entire Spi 1 Vw (72081) $167.27 $318 2.0×
X-Ray Exam Hip Uni 1 View (73501) $173.05 $329 2.0×
X-Ray Exam Hip Uni 2-3 Views (73502) $225.13 $428 2.7×
X-Ray Exam Hips Bi 3-4 Views (73522) $338.74 $644 3.3×
X-Ray Exam L-S Spine Bending (72114) $101.52 $193 1.0×
X-Ray Exam Neck Spine 2-3 Vw (72040) $225.13 $428 2.7×
X-Ray Exam Neck Spine 6/>Vws (72052) $418.17 $795 4.1×
X-Ray Exam Unilat Ribs/Chest (71101) $276.15 $525 2.7×
X-ray eye for foreign body (70030) $239.86 $456 2.8×
X-ray humerus (73060) $255.11 $485 3.0×
X-Ray Jaw <4 Vw - Xr Mandible < 4 Views (70100) $286.14 $544 3.4×
X-Ray Knee Bilat Standing - Xr Knees Anteroposterior Standing Bilat (73565) $219.87 $418 2.6×
X-Ray Lumbar Spine 2/3 Vw - Xr Lumbar Spine 2-3 Views (72100) $229.86 $437 2.3×
X-ray nose-rectum child f.b. (76010) $204.09 $388 2.4×
X-Ray Ribs, Chest 4+ Vw - Xr Ribs 3 Vws Bil W/ Chest Posteroanterior (71111) $418.17 $795 4.1×
X-Ray Sacroiliac Jts 3+ Vw - Xr Sacroiliac Joints 3+ Views (72202) $264.58 $503 2.6×
X-Ray Sacrum/Coccyx 2+ Vw - Xr Sacrum Coccyx 2+ Views (72220) $255.11 $485 3.0×
X-Ray Sinuses 3+ Vw - Xr Paranasal Sinuses 3+ Views (70220) $264.58 $503 3.1×
X-Ray Skull 4+ Vw - Xr Skull Complete 4+ Views (70260) $452.36 $860 4.5×
X-ray thoracic spine 4 vw (72074) $425.01 $808 4.2×
X-Rays Bone Survey Complete (77075) $2,343.33 $4,455 23.1×
Xr c-spine 4 or 5 views (72050) $286.67 $545 2.8×
Xr facial bones less than 3 views (70140) $264.58 $503 3.1×
Xr orbits complete 4 views (70200) $418.17 $795 4.1×

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.