Imaging prices at Gundersen Tri-county Hospital and Clinics

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

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

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ProcedurePosted cashPosted gross× Medicare
Abdomen 1 View (74018) $139.48 $220 1.7×
Abdomen 2 views (74019) $236.48 $373 2.3×
Ankle 2 views (73600) $157.87 $249 1.9×
Arthrogram hip (73525) $1,224.89 $1,932 3.6×
Bone age studies (77072) $188.30 $297 1.9×
Bone Imaging 3 Phase (78315) $971.92 $1,533 2.5×
Bone Imaging Whole Body (78306) $971.92 $1,533 2.5×
Bone survey infant (77076) $922.47 $1,455 9.1×
Cat Scan Follow-Up Study (76380) $629.56 $993 7.4×
Chest 1 view (71045) $133.77 $211 1.6×
Chest 2 views (71046) $175.62 $277 2.1×
Chest 3 views (71047) $188.30 $297 2.2×
Chest 4 or more views (71048) $268.18 $423 2.6×
Clavicle complete (73000) $154.06 $243 1.8×
Computed Tomography Thorax Lw Dose Lng Ca Scr C- (71271) $242.19 $382 2.4×
CT abdomen and pelvis without and with contrast (74178) $2,889.77 $4,558 8.5×
CT abdomen and pelvis without contrast (74176) $1,257.86 $1,984 5.4×
CT abdomen w contrast (74160) $1,426.50 $2,250 8.4×
CT abdomen w wo contrast (74170) $1,426.50 $2,250 8.4×
CT abdomen w/o contrast (74150) $876.82 $1,383 8.6×
CT Angio Abdomen and Pelvis (74174) $2,169.55 $3,422 6.4×
CT Angio Chest (71275) $1,341.54 $2,116 7.9×
CT Angio Head (70496) $1,426.50 $2,250 8.4×
Ct Angio Lwr Extr W/O&W/Dye (73706) $1,378.32 $2,174 8.1×
CT Angio Neck (70498) $1,427.13 $2,251 8.4×
Ct Angio Upr Extrm W/O&W/Dye (73206) $2,157.50 $3,403 12.7×
CT cervical spine w/o contrast (72125) $876.82 $1,383 8.6×
CT chest w contrast (71260) $1,427.13 $2,251 8.4×
CT chest w/wo contrast (71270) $1,427.13 $2,251 8.4×
CT head/brain with contrast (70460) $1,319.35 $2,081 7.7×
CT head/brain without and with contrast (70470) $1,426.50 $2,250 8.4×
CT iac w contrast (70481) $1,427.13 $2,251 8.4×
CT lower ext w/o (73700) $876.82 $1,383 8.6×
CT lower extremity w/contrast material (73701) $1,426.50 $2,250 8.4×
CT lumbar spine w contrast (72132) $2,676.11 $4,221 7.9×
CT lumbar spine w/o contrast (72131) $877.46 $1,384 8.6×
CT maxillofacial w contrast (70487) $1,426.50 $2,250 8.4×
CT maxillofacial wo contrast (70486) $876.82 $1,383 8.6×
CT neck tissue combo (70492) $1,427.13 $2,251 8.4×
Ct Orbit/Ear/Fossa W/O&W/Dye (70482) $1,427.13 $2,251 8.4×
CT orbits w/o contrast (70480) $876.82 $1,383 8.6×
CT pelvis w&w/o contrast (72194) $1,427.13 $2,251 8.4×
CT pelvis w/o contrast (72192) $876.82 $1,383 8.6×
CT scan of leg combo (73702) $1,426.50 $2,250 8.4×
CT scans face/jaw combo (70488) $1,426.50 $2,250 8.4×
CT soft tissue neck w contrast (70491) $1,427.13 $2,251 8.4×
CT soft tissue neck w/o contrast (70490) $876.82 $1,383 8.6×
CT thoracic spine w/o contrast (72128) $876.19 $1,382 8.6×
CT thorax w/o contrast (71250) $877.46 $1,384 8.6×
CT upper ext wo (73200) $877.46 $1,384 8.6×
CT upper extremity w/o & w/contrast material (73202) $1,426.50 $2,250 8.4×
CT upper extremity with contrast (73201) $1,559.01 $2,459 4.6×
Cta Abdl Aorta&Bi Iliofem W/Contrast&Postp (75635) $1,427.13 $2,251 8.4×
Cta Abdomen (74175) $1,427.13 $2,251 8.4×
CTA head&neck c+ w/noncontrast img&post-pxessing (70471) $2,021.83 $3,189 6.0×
Dxa Bone Density Axial (77080) $282.13 $445 2.8×
Dxa bone density study (77085) $510.37 $805 5.0×
Dxa bone density study 1/>sites appendiclr skel (77081) $105.88 $167 1.3×
Esophagram (74220) $355.04 $560 2.1×
Fetal Biophys Profile W/Nst (76818) $550.95 $869 5.4×
Fetal Biophysical Profile W/O Non-Stress Testing (76819) $367.09 $579 3.6×
Fluoroscopy up to 1 hr (76000) $413.37 $652 1.8×
Foot 2 views (73620) $148.99 $235 1.8×
Forearm 2 views (73090) $154.06 $243 1.8×
Gastric emptying imaging study (78264) $1,002.35 $1,581 2.6×
Gated Heart Planar Single (78472) $1,181.14 $1,863 3.0×
Hand 2 views (73120) $133.14 $210 1.3×
Hepatobil Syst Image W/Drug (78227) $1,195.72 $1,886 2.3×
Ht Muscle Image Spect Sing (78451) $2,655.19 $4,188 2.1×
Infant hip ultrasound with hip movement (dynamic) (76885) $251.70 $397 3.0×
Knee 3 Views (73562) $201.61 $318 2.4×
Lung Ventilat&Perfus Imaging (78582) $1,927.99 $3,041 3.7×
Magnetic Image Jaw Joint (70336) $1,983.79 $3,129 8.6×
Mra Head W/O & W/Contrast Material (70546) $3,383.66 $5,337 10.0×
MRA head w/o contrast (70544) $1,983.79 $3,129 8.6×
MRA neck w contrast (70548) $3,422.97 $5,399 10.1×
Mra Neck W/O &W/Contrast Material (70549) $3,249.88 $5,126 9.6×
MRI abdomen w/o contrast (74181) $1,959.69 $3,091 8.5×
MRI any jt lower extrem w/contrast material (73722) $2,580.38 $4,070 3.4×
MRI any jt lower extrem w/o & w/contrast matrl (73723) $3,199.16 $5,046 9.4×
MRI any jt upper extremity w/contrast matrl (73222) $2,552.48 $4,026 3.4×
MRI cervical spine w contrast (72142) $2,839.69 $4,479 8.4×
MRI cervical spine w/o cont (72141) $1,983.79 $3,129 8.6×
MRI chest w/o contrast (71550) $1,983.79 $3,129 8.6×
MRI chest with contrast (71551) $3,141.47 $4,955 4.1×
MRI chest wo w contrast (71552) $3,249.88 $5,126 9.6×
MRI lower extrem oth/thn jt w/contrast matrl (73719) $2,722.40 $4,294 8.0×
MRI lower extrem oth/thn jt w/o & w/contr matr (73720) $3,249.88 $5,126 9.6×
MRI lower extrem oth/thn jt w/o contr matrl (73718) $1,983.79 $3,129 8.6×
MRI lumbar spine w contrast (72149) $2,801.01 $4,418 8.3×
Mri Neck Spine W/O & W/Dye (72156) $3,374.15 $5,322 10.0×
MRI orbit face &/neck w/o contrast (70540) $1,983.79 $3,129 8.6×
MRI orbit face neck w contrast (70542) $2,704.01 $4,265 8.0×
Mri Orbt/Fac/Nck W/O &W/Dye (70543) $3,387.46 $5,343 10.0×
MRI pelvis w contrast (72196) $2,769.31 $4,368 8.2×
MRI pelvis w/o & w contrast (72197) $3,249.88 $5,126 9.6×
MRI pelvis w/o contrast (72195) $1,983.79 $3,129 8.6×
MRI thoracic spine w/o contrast (72146) $1,983.15 $3,128 8.6×
MRI upper extremity oth than jt w/contr matrl (73219) $2,722.40 $4,294 8.0×
MRI upper extremity oth than jt w/o contr matrl (73218) $1,983.15 $3,128 8.6×
Mri Uppr Extremity W/O&W/Dye (73220) $3,249.88 $5,126 9.6×
MRI, abdomen, combo (74183) $3,209.31 $5,062 9.5×
MRI, dorsal spine combo (72157) $3,131.33 $4,939 9.2×
MRI, dorsal spine contrast (72147) $2,524.59 $3,982 7.5×
MRI, joint upper extrem (73221) $1,983.15 $3,128 8.6×
MRI, joint upper extrem combo (73223) $3,202.33 $5,051 9.5×
MRI, lumbar spine combo (72158) $3,326.60 $5,247 9.8×
Myocardial Spect Multiple Studies (78452) $2,167.01 $3,418 1.7×
Neck soft tissue (70360) $155.96 $246 1.8×
Oph bmtry us echograpy a-scan io lens pwr cal (76519) $379.13 $598 3.7×
Pelvis 1 or 2 views (72170) $147.09 $232 1.4×
PET image w/CT, full body (78816) $3,071.73 $4,845 2.2×
PET imaging CT attenuation skull base mid-thigh (78815) $3,067.93 $4,839 2.2×
Radex Abd Compl Aqt Abd W/S/E/D Views 1 View Ch (74022) $285.93 $451 2.8×
Radex Ankle Complete Minimum 3 Views (73610) $183.86 $290 2.2×
Radex Calcaneus Minimum 2 Views (73650) $154.06 $243 1.8×
Radex elbow complete minimum 3 views (73080) $204.78 $323 2.4×
Radex Facial Bones Complete Minimum 3 Views (70150) $240.29 $379 2.4×
Radex fingr minimum 2 views (73140) $173.72 $274 2.1×
Radex foot complete minimum 3 views (73630) $177.52 $280 2.1×
Radex Hand Minimum 3 Views (73130) $179.42 $283 2.1×
Radex lower extremity infant minimum 2 views (73592) $180.06 $284 2.1×
Radex Nasal Bones Complete Minimum 3 Views (70160) $187.03 $295 2.2×
Radex Ribs Unilateral 2 Views (71100) $185.76 $293 2.2×
Radex shoulder complete minimum 2 views (73030) $168.01 $265 2.0×
Radex Sinuses Paransl < 3 Views (70210) $164.84 $260 2.0×
Radex Spine 1 View Specify Level (72020) $133.14 $210 1.6×
Radex Sternum Minimum 2 Views (71120) $183.86 $290 2.2×
Radex Temporomandble Jt Opn & Clsd Mouth Bilat (70330) $268.82 $424 3.2×
Radex Toe Minimum 2 Views (73660) $168.01 $265 2.0×
Radex upper extremity infant minimum 2 views (73092) $188.30 $297 1.9×
Radex Wrist Complete Minimum 3 Views (73110) $204.78 $323 2.4×
Radex X-Ray Exam Entire Spi 6/> Vw - Xr Entire Spine 6+ Vw (72084) $584.55 $922 5.8×
Radiolog exam mandible compl minimum 4 views (70110) $228.24 $360 2.2×
Radiologic exam colon double contrast study (74280) $834.98 $1,317 4.9×
Radiologic exam colon single contrast study (74270) $440 $694 2.6×
Radiologic exam knee complete 4/more views (73564) $232.68 $367 2.3×
Radiologic exam pelvis compl minimum 3 views (72190) $180.06 $284 1.8×
Radiologic Exam Small Int Single Contrast Study (74250) $417.17 $658 2.4×
Radiologic exam swallow function contrast study (74230) $363.92 $574 2.1×
Radiologic exam upr gi trc double contrast study (74246) $490.72 $774 2.9×
Radiologic examination femur 1 view (73551) $157.87 $249 1.9×
Radiologic examination femur minimum 2 views (73552) $161.67 $255 1.9×
Radiologic examination knee 1/2 views (73560) $163.57 $258 1.9×
Radiologic Examination Osseous Survey Limited (77074) $270.72 $427 2.7×
Radiologic examination tibia & fibula 2 views (73590) $154.06 $243 1.8×
Ribs bilateral 3 views (71110) $236.48 $373 2.3×
Rp loclzj tum spect w/CT 1 area/acquisj 1day img (78830) $1,187.48 $1,873 0.9×
Scapula (73010) $163.57 $258 1.6×
Screening Digital Breast Tomosynthesis Bi (77063) $31.70 $50 1.4×
Shoulder 1 view (73020) $129.97 $205 1.5×
Shoulder Arthrography (73040) $495.79 $782 1.5×
Skull less than 4 views (70250) $203.51 $321 2.0×
Sternoclavicular joints (71130) $211.76 $334 2.5×
Thoracic spine 2 views (72070) $190.20 $300 1.9×
Thoracic spine 3 views (72072) $282.13 $445 2.8×
Thoracolumbar 2 views (72080) $209.22 $330 2.5×
Thyroid Uptake Measurement (78012) $909.79 $1,435 2.3×
Thyroid Uptake W/Blood Flow Sngle/Mult Quan Meas (78014) $1,134.86 $1,790 2.9×
Ultrasound Exam Aaa Screen (76706)
range across 2 matching MRF lines		 $45.01–$164.84 $71–$260 varies
Ultrasound, abdomen limited (76705) $443.80 $700 4.4×
Umbilical-artery Doppler (OB) (76820) $311.29 $491 3.1×
Unlisted Miscellaneous Px Dx Nuclear Medicine (78999) $679.65 $1,072 1.8×
Upper gi w/o kub (74240) $431.12 $680 2.5×
Urethrocystogram voiding (74455) $360.11 $568 1.6×
Urethrocystography retrograde (74450) $304.32 $480 1.3×
Us breast unilateral complete (76641) $525.59 $829 5.2×
Us chest (76604) $251.70 $397 2.5×
Us complete joint (76881) $388.01 $612 3.8×
Us exam, pelvic, limited (76857) $427.32 $674 4.2×
Us kidney transplant (76776) $523.68 $826 5.2×
Us lmtd joint/oth nonvasc xtr strux r-t w/img (76882) $129.97 $205 1.3×
Us ob limited 1 or more fetuses (76815) $251.70 $397 2.5×
Us ob transvaginal (76817) $414 $653 4.1×
Us pelvic non ob complete (76856) $523.68 $826 5.2×
Us pg uter img f&mat 14 wk tabdl 1/1st gestation (76801) $522.42 $824 5.1×
Us preg uterus real time f/u trnsabdl per fetus (76816) $481.84 $760 4.7×
Us retroperitoneal complete (76770) $551.58 $870 5.4×
Us retroperitoneal limited (76775) $450.14 $710 4.4×
Us scrotum and contents (76870) $521.78 $823 5.1×
Us thyroid (76536) $483.74 $763 4.8×
Wrist 2 views (73100) $168.01 $265 2.0×
X-Ray Ac Jts - Xr Acromioclavicular Joints Bilateral (73050) $206.05 $325 2.4×
X-Ray Elbow 2 Vw - Xr Elbow 1-2 Views Right (73070) $152.79 $241 1.8×
X-Ray Exam Entire Spi 2/3 Vw (72082) $279.59 $441 2.8×
X-Ray Exam Hip Uni 1 View (73501) $142.02 $224 1.7×
X-Ray Exam Hip Uni 2-3 Views (73502) $216.19 $341 2.6×
X-Ray Exam Hips Bi 3-4 Views (73522) $231.41 $365 2.3×
X-Ray Exam L-S Spine Bending (72114) $289.74 $457 2.9×
X-Ray Exam Neck Spine 2-3 Vw (72040) $216.19 $341 2.6×
X-Ray Exam Neck Spine 6/>Vws (72052) $375.33 $592 3.7×
X-Ray Exam Unilat Ribs/Chest (71101) $282.13 $445 2.8×
X-ray eye for foreign body (70030) $142.65 $225 1.7×
X-ray humerus (73060) $168.01 $265 2.0×
X-ray IV pyelogram (ivp) (74400) $440 $694 2.6×
X-Ray Jaw <4 Vw - Xr Mandible < 4 Views (70100) $172.45 $272 2.0×
X-Ray Knee Bilat Standing - Xr Knees Anteroposterior Standing Bilat (73565) $179.42 $283 2.1×
X-Ray Lumbar Spine 2/3 Vw - Xr Lumbar Spine 2-3 Views (72100) $225.70 $356 2.2×
X-ray nose-rectum child f.b. (76010) $180.06 $284 2.1×
X-Ray Ribs, Chest 4+ Vw - Xr Ribs 3 Vws Bil W/ Chest Posteroanterior (71111) $236.48 $373 2.3×
X-Ray Sacroiliac Jts 3+ Vw - Xr Sacroiliac Joints 3+ Views (72202) $204.78 $323 2.0×
X-Ray Sacrum/Coccyx 2+ Vw - Xr Sacrum Coccyx 2+ Views (72220) $168.01 $265 2.0×
X-Ray Sinuses 3+ Vw - Xr Paranasal Sinuses 3+ Views (70220) $213.02 $336 2.5×
X-Ray Skull 4+ Vw - Xr Skull Complete 4+ Views (70260) $267.55 $422 2.6×
X-ray thoracic spine 4 vw (72074) $254.23 $401 2.5×
X-Ray Tmj Unilat (70328) $93.20 $147 1.1×
X-Rays Bone Length Studies (77073) $289.74 $457 2.9×
X-Rays Bone Survey Complete (77075) $277.69 $438 2.7×
Xr c-spine 4 or 5 views (72050) $304.95 $481 3.0×
Xr facial bones less than 3 views (70140) $161.67 $255 1.9×
Xr orbits complete 4 views (70200) $248.53 $392 2.4×

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.