Imaging prices at HSHS St. Clare Memorial Hospital

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

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

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ProcedurePosted cashPosted gross× Medicare
Abdomen 1 View (74018) $310.86 $471 3.7×
Abdomen 2 views (74019) $332.64 $504 3.3×
Acute Gastrointestinal Blood Loss Imaging (78278) $1,316.70 $1,995 3.4×
Ankle 2 views (73600) $315.48 $478 3.7×
Arthrogram ankle (73615) $1,242.78 $1,883 3.7×
Arthrogram hip (73525) $1,657.92 $2,512 4.9×
Arthrogram Wrist (73115) $830.94 $1,259 2.5×
Bone age studies (77072) $506.22 $767 5.0×
Bone Imaging 3 Phase (78315) $1,665.18 $2,523 4.3×
Bone Imaging Whole Body (78306) $1,389.96 $2,106 3.6×
Bone marrow imaging limited area (78102) $731.28 $1,108 1.9×
Bone marrow imaging; whole body (78104) $951.06 $1,441 2.4×
Bone survey infant (77076) $391.38 $593 3.9×
Brain Image W/Flow < 4 Views (78601) $1,535.82 $2,327 4.0×
Brain Imaging Min 4 Static Views W Vascular Flow (78606) $1,828.86 $2,771 3.5×
Cardiac MRI w/w/o contrast & further seq (75561) $2,913.90 $4,415 8.6×
Cat Scan Follow-Up Study (76380) $769.56 $1,166 9.1×
Cerebrospinal Fluid Flow W/O Matl Shunt Evaltj (78645) $951.06 $1,441 1.8×
Chest 1 view (71045) $259.38 $393 3.1×
Chest 2 views (71046) $275.88 $418 3.3×
Chest 3 views (71047) $275.88 $418 3.3×
Chest 4 or more views (71048) $355.08 $538 3.5×
Clavicle complete (73000) $333.96 $506 4.0×
Computed Tomography Thorax Lw Dose Lng Ca Scr C- (71271) $769.56 $1,166 7.6×
Contrast X-Ray Bladder (74430) $785.40 $1,190 2.3×
Contrast X-Ray Of Elbow (73085) $900.90 $1,365 2.7×
Contrast X-Ray Of Knee Joint (73580) $955.68 $1,448 2.8×
CT abdomen and pelvis without and with contrast (74178) $3,550.14 $5,379 10.5×
CT abdomen and pelvis without contrast (74176) $2,544.96 $3,856 11.0×
CT abdomen w contrast (74160) $1,750.32 $2,652 10.3×
CT abdomen w wo contrast (74170) $2,091.54 $3,169 12.3×
CT abdomen w/o contrast (74150) $1,259.28 $1,908 12.4×
CT Angio Abdomen and Pelvis (74174) $3,358.08 $5,088 9.9×
CT Angio Chest (71275) $1,859.88 $2,818 10.9×
CT Angio Head (70496) $2,091.54 $3,169 12.3×
Ct Angio Lwr Extr W/O&W/Dye (73706) $2,002.44 $3,034 11.8×
CT Angio Neck (70498) $1,818.96 $2,756 10.7×
Ct Angio Upr Extrm W/O&W/Dye (73206) $1,818.96 $2,756 10.7×
CT cervical spine w/ contrast (72126) $1,539.12 $2,332 4.5×
CT cervical spine w/o contrast (72125) $1,357.62 $2,057 13.4×
CT cervical spine w/wo cont (72127) $1,818.96 $2,756 10.7×
CT chest w contrast (71260) $1,539.12 $2,332 9.0×
CT chest w/wo contrast (71270) $1,818.96 $2,756 10.7×
CT head/brain with contrast (70460) $1,770.12 $2,682 10.4×
CT head/brain without and with contrast (70470) $1,818.96 $2,756 10.7×
CT iac w contrast (70481) $1,770.12 $2,682 10.4×
CT l-spine w&w/o contrast (72133) $1,818.96 $2,756 10.7×
CT lower ext w/o (73700) $1,430.88 $2,168 14.1×
CT lower extremity w/contrast material (73701) $1,574.76 $2,386 9.2×
CT lumbar spine w contrast (72132) $1,562.88 $2,368 4.6×
CT lumbar spine w/o contrast (72131) $1,359.60 $2,060 13.4×
CT maxillofacial w contrast (70487) $1,624.92 $2,462 9.5×
CT maxillofacial wo contrast (70486) $1,271.16 $1,926 12.5×
CT neck tissue combo (70492) $2,091.54 $3,169 12.3×
Ct Orbit/Ear/Fossa W/O&W/Dye (70482) $1,818.96 $2,756 10.7×
CT orbits w/o contrast (70480) $1,351.02 $2,047 13.3×
CT pelvis w&w/o contrast (72194) $1,818.96 $2,756 10.7×
CT pelvis w/o contrast (72192) $1,259.28 $1,908 12.4×
CT scan of leg combo (73702) $1,818.96 $2,756 10.7×
CT scans face/jaw combo (70488) $1,679.04 $2,544 9.9×
CT soft tissue neck w contrast (70491) $1,595.22 $2,417 9.4×
CT soft tissue neck w/o contrast (70490) $1,259.28 $1,908 12.4×
CT thoracic spine w contrast (72129) $1,539.12 $2,332 9.0×
CT thoracic spine w/o contrast (72128) $1,448.04 $2,194 14.3×
CT thoracic spine w/wo cont (72130) $1,818.96 $2,756 10.7×
CT thorax w/o contrast (71250) $1,264.56 $1,916 12.5×
CT unlisted procedure (76497) $331.98 $503 3.9×
CT upper ext wo (73200) $1,335.18 $2,023 13.1×
CT upper extremity w/o & w/contrast material (73202) $1,846.68 $2,798 10.8×
CT upper extremity with contrast (73201) $1,770.12 $2,682 5.2×
Cta Abdl Aorta&Bi Iliofem W/Contrast&Postp (75635) $1,907.40 $2,890 11.2×
Cta Abdomen (74175) $1,994.52 $3,022 11.7×
CTA pelvis (72191) $1,818.96 $2,756 10.7×
Diskography lumbar (72295) $2,484.90 $3,765 1.3×
Dxa Bone Density Axial (77080) $592.02 $897 5.8×
Dxa bone density study 1/>sites appendiclr skel (77081) $544.50 $825 6.4×
Echo exam uterus (76831)
range across 2 matching MRF lines		 $279.18–$489.72 $423–$742 varies
Esophagram (74220) $516.12 $782 3.0×
Fetal Biophys Profile W/Nst (76818) $489.72 $742 4.8×
Fetal Biophysical Profile W/O Non-Stress Testing (76819) $398.64 $604 3.9×
Fetal MRI w/placntl matrnl plvc img sing/1st ges (74712) $2,233.44 $3,384 9.6×
Fluoroscopy up to 1 hr (76000) $517.44 $784 2.2×
Foot 2 views (73620) $319.44 $484 3.8×
Forearm 2 views (73090) $315.48 $478 3.7×
Gastric emptying imaging study (78264) $1,302.84 $1,974 3.4×
Gated Heart Planar Single (78472) $1,620.96 $2,456 4.2×
Gated Heart, Multiple (78473) $1,609.74 $2,439 4.1×
Hand 2 views (73120) $310.20 $470 3.1×
Hepatobil Syst Image W/Drug (78227) $1,587.96 $2,406 3.0×
Hepatobiliary System Imaging (78226) $1,663.20 $2,520 4.3×
Ht Muscle Image Spect Sing (78451) $3,072.96 $4,656 2.4×
Hysterosalpingogram (74740) $626.34 $949 2.7×
Infusion Ivp (74410) $747.78 $1,133 4.4×
Joint Survey Single View (77077) $151.14 $229 1.5×
K Flow/Funct Image Multiple (78709) $1,682.34 $2,549 3.2×
K Flow/Funct Image W/Drug (78708) $1,722.60 $2,610 3.3×
K Flow/Funct Image W/O Drug (78707) $1,682.34 $2,549 3.2×
Kidney Imaging Morphoogy W/Vascular Flow (78701) $1,170.18 $1,773 3.0×
Knee 3 Views (73562) $327.36 $496 3.9×
Liver & Spleen Imaging Static Only (78215) $951.06 $1,441 2.4×
Liver & Spleen Imaging W/Vascular Flow (78216) $1,243.44 $1,884 3.2×
Liver imaging static only (78201) $1,961.52 $2,972 3.7×
Liver imaging w/vascular flow (78202) $2,070.42 $3,137 3.9×
Lymph System Imaging (78195) $1,463.22 $2,217 2.8×
Magnetic Image Jaw Joint (70336) $3,107.94 $4,709 13.4×
Magnetic Resonance Elastography (76391) $1,535.16 $2,326 6.6×
Mammary ductogram or galactogram multiple (77054) $691.68 $1,048 3.0×
Mammary ductogram or galactogram single (77053) $691.68 $1,048 3.0×
Meckels Divert Exam (78290) $1,243.44 $1,884 3.2×
Mr safety determination physician/other qhp (76016) $203.94 $309 2.4×
Mr safety implant&/fb assmt clin staf 1st 15 min (76014) $65.34 $99 2.3×
Mr safety implt electronics prepj supvj phys/qhp (76018) $239.58 $363 2.6×
Mr safety implt pos&/immoblj (76019) $143.22 $217 2.5×
Mr safety med physics xm customization plng&mntr (76017) $718.08 $1,088 3.1×
Mra Head W/O & W/Contrast Material (70546) $2,667.72 $4,042 7.9×
MRA head w/o contrast (70544) $2,310 $3,500 10.0×
MRA neck w contrast (70548) $1,801.80 $2,730 5.3×
Mra Neck W/O &W/Contrast Material (70549) $2,080.98 $3,153 6.1×
MRA neck w/o contrast (70547) $1,716 $2,600 7.4×
MRI abdomen w contrast (74182) $2,789.16 $4,226 8.2×
MRI abdomen w/o contrast (74181) $2,656.50 $4,025 11.5×
MRI any jt lower extrem w/contrast material (73722) $2,542.32 $3,852 3.3×
MRI any jt lower extrem w/o & w/contrast matrl (73723) $2,669.70 $4,045 7.9×
MRI any jt upper extremity w/contrast matrl (73222) $2,542.32 $3,852 3.3×
MRI Breast W/O Contrast Bilateral (77047) $2,656.50 $4,025 11.5×
MRI cardiac w/o contrast (75557) $2,913.90 $4,415 12.6×
MRI cervical spine w contrast (72142) $1,906.08 $2,888 5.6×
MRI cervical spine w/o cont (72141) $1,815 $2,750 7.8×
MRI chest w/o contrast (71550) $2,656.50 $4,025 11.5×
MRI chest with contrast (71551) $2,845.92 $4,312 3.7×
MRI chest wo w contrast (71552) $3,036 $4,600 9.0×
MRI lower extrem oth/thn jt w/contrast matrl (73719) $2,311.32 $3,502 6.8×
MRI lower extrem oth/thn jt w/o & w/contr matr (73720) $2,669.70 $4,045 7.9×
MRI lower extrem oth/thn jt w/o contr matrl (73718) $2,420.88 $3,668 10.4×
MRI lumbar spine w contrast (72149) $2,571.36 $3,896 7.6×
Mri Neck Spine W/O & W/Dye (72156) $2,001.12 $3,032 5.9×
MRI orbit face &/neck w/o contrast (70540) $2,310 $3,500 10.0×
Mri Orbt/Fac/Nck W/O &W/Dye (70543) $2,934.36 $4,446 8.7×
MRI pelvis w contrast (72196) $2,504.70 $3,795 7.4×
MRI pelvis w/o & w contrast (72197) $2,893.44 $4,384 8.5×
MRI pelvis w/o contrast (72195) $2,277 $3,450 9.8×
MRI thoracic spine w/o contrast (72146) $2,295.48 $3,478 9.9×
MRI upper extremity oth than jt w/contr matrl (73219) $2,542.32 $3,852 7.5×
MRI upper extremity oth than jt w/o contr matrl (73218) $2,410.98 $3,653 10.4×
Mri Uppr Extremity W/O&W/Dye (73220) $2,669.70 $4,045 7.9×
MRI, abdomen, combo (74183) $3,375.24 $5,114 10.0×
MRI, dorsal spine combo (72157) $2,651.88 $4,018 7.8×
MRI, dorsal spine contrast (72147) $2,410.98 $3,653 7.1×
MRI, joint upper extrem (73221) $2,420.88 $3,668 10.4×
MRI, joint upper extrem combo (73223) $2,669.70 $4,045 7.9×
MRI, lumbar spine combo (72158) $2,700.06 $4,091 8.0×
Myelogram Lumbar (72265) $1,922.58 $2,913 2.5×
Myocardial Spect Multiple Studies (78452) $3,365.34 $5,099 2.7×
Neck soft tissue (70360) $316.80 $480 3.7×
Nm csf leak detection (78650) $1,828.86 $2,771 1.5×
Panoramic X-ray of jaws (70355) $315.48 $478 3.7×
Parathyroid Planar Imaging (78070) $1,170.18 $1,773 3.0×
Parathyroid planar imaging w/wo subtraction (78071) $1,609.74 $2,439 4.1×
Pelvis 1 or 2 views (72170) $326.04 $494 3.2×
Pulmonary Perfusion Imaging Particulate (78580) $1,226.28 $1,858 3.2×
Radex Abd Compl Aqt Abd W/S/E/D Views 1 View Ch (74022) $504.90 $765 5.0×
Radex abscess/fistula/sinus tract rs&i (76080) $687.72 $1,042 1.3×
Radex Ankle Complete Minimum 3 Views (73610) $315.48 $478 3.7×
Radex Calcaneus Minimum 2 Views (73650) $316.80 $480 3.7×
Radex elbow complete minimum 3 views (73080) $337.92 $512 4.0×
Radex Facial Bones Complete Minimum 3 Views (70150) $391.38 $593 3.9×
Radex fingr minimum 2 views (73140) $315.48 $478 3.7×
Radex foot complete minimum 3 views (73630) $335.94 $509 4.0×
Radex Hand Minimum 3 Views (73130)
range across 2 matching MRF lines		 $295.68–$388.74 $448–$589 varies
Radex lower extremity infant minimum 2 views (73592) $315.48 $478 3.7×
Radex Mastoids Compl Minimum 3 Views PR Side (70130) $315.48 $478 3.1×
Radex Nasal Bones Complete Minimum 3 Views (70160) $315.48 $478 3.7×
Radex Ribs Unilateral 2 Views (71100) $322.74 $489 3.8×
Radex shoulder complete minimum 2 views (73030) $315.48 $478 3.7×
Radex Sinuses Paransl < 3 Views (70210) $315.48 $478 3.7×
Radex Spine 1 View Specify Level (72020) $333.96 $506 4.0×
Radex Sternum Minimum 2 Views (71120) $333.96 $506 4.0×
Radex Temporomandble Jt Opn & Clsd Mouth Bilat (70330) $315.48 $478 3.7×
Radex Toe Minimum 2 Views (73660)
range across 2 matching MRF lines		 $315.48–$478 $478 varies
Radex upper extremity infant minimum 2 views (73092) $315.48 $478 3.1×
Radex Wrist Complete Minimum 3 Views (73110) $318.78 $483 3.8×
Radex X-Ray Exam Entire Spi 6/> Vw - Xr Entire Spine 6+ Vw (72084) $365.64 $554 3.6×
Radiolog exam mandible compl minimum 4 views (70110) $391.38 $593 3.9×
Radiologic exam colon double contrast study (74280) $916.08 $1,388 5.4×
Radiologic exam colon single contrast study (74270) $636.24 $964 3.7×
Radiologic exam knee complete 4/more views (73564) $363 $550 3.6×
Radiologic exam pelvis compl minimum 3 views (72190) $394.68 $598 3.9×
Radiologic Exam Small Int Single Contrast Study (74250) $597.96 $906 3.5×
Radiologic exam swallow function contrast study (74230) $523.38 $793 3.1×
Radiologic exam upr gi trc double contrast study (74246) $798.60 $1,210 4.7×
Radiologic examination femur 1 view (73551) $315.48 $478 3.7×
Radiologic examination femur minimum 2 views (73552) $322.74 $489 3.8×
Radiologic examination knee 1/2 views (73560) $315.48 $478 3.7×
Radiologic Examination Osseous Survey Limited (77074) $391.38 $593 3.9×
Radiologic examination tibia & fibula 2 views (73590) $330 $500 3.9×
Radiologic examination, internal auditory meati, complete Non-Facility (70134) $391.38 $593 0.7×
Ribs bilateral 3 views (71110) $391.38 $593 3.9×
Rp loclzj tum plnr 1 area single day imaging (78800) $877.80 $1,330 2.3×
Rp loclzj tum plnr 2+area 1+d img/1 area img>2+d (78801) $1,535.82 $2,327 4.0×
Rp Loclzj Tum Plnr Whole Body Single Day Imaging (78802) $1,508.10 $2,285 2.9×
Rp Loclzj Tum Spect 1 Area Single Day Imaging (78803) $1,682.34 $2,549 3.2×
Salivary Gland Imaging Serial Images (78231) $1,023.66 $1,551 2.6×
Scapula (73010) $353.10 $535 3.5×
Sella turcica (70240) $315.48 $478 3.7×
Shoulder 1 view (73020) $315.48 $478 3.7×
Shoulder Arthrography (73040) $1,657.92 $2,512 4.9×
Skull less than 4 views (70250) $326.70 $495 3.2×
Sternoclavicular joints (71130) $315.48 $478 3.7×
Testicular Imaging W/Flow (78761) $1,023.66 $1,551 2.6×
Thoracic spine 2 views (72070) $329.34 $499 3.2×
Thoracic spine 3 views (72072) $380.82 $577 3.8×
Thoracolumbar 2 views (72080) $432.96 $656 5.1×
Thyroid Imaging With Vascular Flow (78013) $694.98 $1,053 1.8×
Thyroid Met Imaging Body (78018) $1,493.58 $2,263 2.8×
Thyroid Uptake Measurement (78012) $463.98 $703 1.2×
Thyroid Uptake W/Blood Flow Sngle/Mult Quan Meas (78014) $1,097.58 $1,663 2.8×
Ultrasound Breast Limited (76642) $392.70 $595 4.6×
Ultrasound Exam Aaa Screen (76706) $386.76 $586 3.8×
Ultrasound, abdomen limited (76705) $578.16 $876 5.7×
Umbilical-artery Doppler (OB) (76820) $292.38 $443 2.9×
Unlisted us procedure (76999) $293.70 $445 3.5×
Urethrocystogram voiding (74455) $747.78 $1,133 3.2×
Us breast unilateral complete (76641) $546.48 $828 5.4×
Us chest (76604) $405.24 $614 4.0×
Us complete joint (76881) $566.28 $858 5.6×
Us exam, pelvic, limited (76857) $482.46 $731 4.8×
Us kidney transplant (76776) $573.54 $869 5.6×
Us lmtd joint/oth nonvasc xtr strux r-t w/img (76882) $384.78 $583 3.8×
Us ob detailed single fetus (76811) $650.10 $985 2.8×
Us ob limited 1 or more fetuses (76815) $335.28 $508 3.3×
Us ob transvaginal (76817) $440.22 $667 4.3×
Us pelvic non ob complete (76856) $615.12 $932 6.1×
Us pg uter img f&mat 14 wk tabdl 1/1st gestation (76801) $454.74 $689 4.5×
Us preg uterus real time f/u trnsabdl per fetus (76816) $321.42 $487 3.2×
Us retroperitoneal complete (76770) $566.28 $858 5.6×
Us retroperitoneal limited (76775) $517.44 $784 5.1×
Us scrotum and contents (76870) $578.16 $876 5.7×
Us spinal canal and contents (76800) $349.80 $530 3.4×
Us thyroid (76536) $552.42 $837 5.4×
Us transrectal (76872) $228.36 $346 2.2×
Wrist 2 views (73100) $315.48 $478 3.7×
X-Ray Ac Jts - Xr Acromioclavicular Joints Bilateral (73050) $315.48 $478 3.7×
X-ray antegrade pyelogram tube (74425) $616.44 $934 1.8×
X-Ray Bend Only L-S Spine (72120) $582.78 $883 5.7×
X-Ray Elbow 2 Vw - Xr Elbow 1-2 Views Right (73070) $315.48 $478 3.7×
X-Ray Exam Breast Specimen (76098) $397.98 $603 0.7×
X-Ray Exam Entire Spi 1 Vw (72081) $315.48 $478 3.7×
X-Ray Exam Entire Spi 2/3 Vw (72082) $380.82 $577 3.8×
X-Ray Exam Entire Spi 4/5 Vw (72083) $347.82 $527 3.4×
X-Ray Exam Hip Uni 1 View (73501) $363 $550 4.3×
X-Ray Exam Hip Uni 2-3 Views (73502) $363.66 $551 4.3×
X-Ray Exam Hip Uni 4/> Views (73503) $391.38 $593 3.9×
X-Ray Exam Hips Bi 2 Views (73521) $391.38 $593 3.9×
X-Ray Exam Hips Bi 3-4 Views (73522) $494.34 $749 4.9×
X-Ray Exam Hips Bi 5/> Views (73523) $515.46 $781 5.1×
X-Ray Exam L-S Spine Bending (72114) $582.78 $883 5.7×
X-Ray Exam Neck Spine 2-3 Vw (72040) $420.42 $637 5.0×
X-Ray Exam Neck Spine 6/>Vws (72052) $582.78 $883 5.7×
X-Ray Exam Unilat Ribs/Chest (71101) $477.18 $723 4.7×
X-ray eye for foreign body (70030) $268.62 $407 3.2×
X-ray humerus (73060) $315.48 $478 3.7×
X-Ray Jaw <4 Vw - Xr Mandible < 4 Views (70100) $315.48 $478 3.7×
X-Ray Knee Bilat Standing - Xr Knees Anteroposterior Standing Bilat (73565) $315.48 $478 3.7×
X-Ray Lumbar Spine 2/3 Vw - Xr Lumbar Spine 2-3 Views (72100) $363.66 $551 3.6×
X-ray nose-rectum child f.b. (76010) $279.84 $424 3.3×
X-Ray Ribs, Chest 4+ Vw - Xr Ribs 3 Vws Bil W/ Chest Posteroanterior (71111) $498.30 $755 4.9×
X-Ray Sacroiliac Jts 3+ Vw - Xr Sacroiliac Joints 3+ Views (72202) $363 $550 3.6×
X-Ray Sacrum/Coccyx 2+ Vw - Xr Sacrum Coccyx 2+ Views (72220) $330 $500 3.9×
X-Ray Sinuses 3+ Vw - Xr Paranasal Sinuses 3+ Views (70220) $391.38 $593 4.6×
X-Ray Skull 4+ Vw - Xr Skull Complete 4+ Views (70260) $391.38 $593 3.9×
X-ray thoracic spine 4 vw (72074) $347.82 $527 3.4×
X-Ray Urinary Tract Exam With Contrast Material (74420) $708.84 $1,074 2.1×
X-Rays Bone Length Studies (77073) $450.12 $682 4.4×
X-Rays Bone Survey Complete (77075) $516.12 $782 5.1×
Xr c-spine 4 or 5 views (72050) $467.28 $708 4.6×
Xr facial bones less than 3 views (70140) $315.48 $478 3.7×
Xr orbits complete 4 views (70200) $391.38 $593 3.9×

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.