Imaging prices at Lafayette Hospital and Clinics

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

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

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ProcedurePosted cashPosted gross× Medicare
Abdomen 1 View (74018) $217.60 $272 2.6×
Abdomen 2 views (74019) $260.80 $326 2.6×
Ankle 2 views (73600) $239.20 $299 2.8×
Arthrogram hip (73525) $521.60 $652 1.5×
Arthrogram Wrist (73115) $471.20 $589 1.4×
Bone age studies (77072) $182.40 $228 1.8×
Bone Imaging 3 Phase (78315) $1,604.80 $2,006 4.1×
Bone Imaging Limited Area (78300) $887.20 $1,109 2.3×
Bone Imaging Whole Body (78306) $1,436 $1,795 3.7×
Bone survey infant (77076) $369.60 $462 3.6×
Chest 1 view (71045) $239.20 $299 2.8×
Chest 2 views (71046) $282.40 $353 3.3×
Clavicle complete (73000) $260.80 $326 3.1×
Computed Tomography Thorax Lw Dose Lng Ca Scr C- (71271) $652.80 $816 6.4×
Contrast X-Ray Of Knee Joint (73580) $521.60 $652 1.5×
CT abdomen and pelvis without and with contrast (74178) $2,523.20 $3,154 7.4×
CT abdomen and pelvis without contrast (74176) $2,175.20 $2,719 9.4×
CT abdomen w contrast (74160) $1,740 $2,175 10.2×
CT abdomen w wo contrast (74170) $2,175.20 $2,719 12.8×
CT abdomen w/o contrast (74150) $1,304.80 $1,631 12.8×
CT Angio Abdomen and Pelvis (74174) $3,044.80 $3,806 9.0×
CT Angio Chest (71275) $2,653.60 $3,317 15.6×
CT Angio Head (70496) $2,175.20 $2,719 12.8×
Ct Angio Lwr Extr W/O&W/Dye (73706) $1,913.60 $2,392 11.2×
CT Angio Neck (70498) $2,609.60 $3,262 15.3×
Ct Angio Upr Extrm W/O&W/Dye (73206) $1,740 $2,175 10.2×
CT cervical spine w/ contrast (72126) $2,392 $2,990 7.1×
CT cervical spine w/o contrast (72125) $869.60 $1,087 8.6×
CT cervical spine w/wo cont (72127) $2,609.60 $3,262 15.3×
CT chest w contrast (71260) $2,000.80 $2,501 11.7×
CT chest w/wo contrast (71270) $2,436 $3,045 14.3×
CT head/brain with contrast (70460) $1,455.20 $1,819 8.5×
CT head/brain without and with contrast (70470) $1,722.40 $2,153 10.1×
CT iac w contrast (70481) $1,024.80 $1,281 6.0×
CT l-spine w&w/o contrast (72133) $2,255.20 $2,819 13.2×
CT lower ext w/o (73700) $1,304.80 $1,631 12.8×
CT lower extremity w/contrast material (73701) $1,522.40 $1,903 8.9×
CT lumbar spine w contrast (72132) $2,027.20 $2,534 6.0×
CT lumbar spine w/o contrast (72131) $1,740 $2,175 17.1×
CT maxillofacial w contrast (70487) $1,565.60 $1,957 9.2×
CT maxillofacial wo contrast (70486) $1,435.20 $1,794 14.1×
CT neck tissue combo (70492) $2,336.80 $2,921 13.7×
Ct Orbit/Ear/Fossa W/O&W/Dye (70482) $2,296 $2,870 13.5×
CT orbits w/o contrast (70480) $956.80 $1,196 9.4×
CT pelvis w&w/o contrast (72194) $2,175.20 $2,719 12.8×
CT pelvis w/o contrast (72192) $1,565.60 $1,957 15.4×
CT scan of leg combo (73702) $1,565.60 $1,957 9.2×
CT soft tissue neck w contrast (70491) $1,722.40 $2,153 10.1×
CT soft tissue neck w/o contrast (70490) $1,565.60 $1,957 15.4×
CT thoracic spine w/o contrast (72128) $1,740 $2,175 17.1×
CT thorax w/o contrast (71250) $1,304.80 $1,631 12.8×
CT upper ext wo (73200) $1,740 $2,175 17.1×
CT upper extremity with contrast (73201) $1,392 $1,740 4.1×
Cta Abdl Aorta&Bi Iliofem W/Contrast&Postp (75635) $3,480 $4,350 20.4×
Cta Abdomen (74175) $1,304.80 $1,631 7.7×
Dxa Bone Density Axial (77080) $652.80 $816 6.4×
Dxa bone density study (77085) $739.20 $924 7.3×
Dxa bone density study 1/>sites appendiclr skel (77081) $260.80 $326 3.1×
Esophagram (74220) $260.80 $326 1.5×
Fetal Biophysical Profile W/O Non-Stress Testing (76819) $506.40 $633 5.0×
Fluoroscopy up to 1 hr (76000) $565.60 $707 2.4×
Foot 2 views (73620) $239.20 $299 2.8×
Forearm 2 views (73090) $304.80 $381 3.6×
Gastric emptying imaging study (78264) $1,816 $2,270 4.7×
Hand 2 views (73120) $260.80 $326 2.6×
Hepatobil Syst Image W/Drug (78227) $1,647.20 $2,059 3.1×
Hepatobiliary System Imaging (78226) $1,647.20 $2,059 4.2×
Ht Muscle Image Spect Sing (78451) $2,322.40 $2,903 1.8×
Infant hip ultrasound with hip movement (dynamic) (76885) $412.80 $516 4.9×
K Flow/Funct Image W/Drug (78708) $1,773.60 $2,217 3.4×
K Flow/Funct Image W/O Drug (78707) $1,520 $1,900 2.9×
Knee 3 Views (73562) $304.80 $381 3.6×
Lung Ventilat&Perfus Imaging (78582) $2,111.20 $2,639 4.0×
Lung Ventilation Imaging (78579) $869.60 $1,087 2.2×
Magnetic Image Jaw Joint (70336) $3,300.80 $4,126 14.2×
Mra Head W/O & W/Contrast Material (70546) $3,480 $4,350 10.3×
MRA head w/o contrast (70544) $2,609.60 $3,262 11.3×
Mra Neck W/O &W/Contrast Material (70549) $2,784 $3,480 8.2×
MRA neck w/o contrast (70547) $3,156.80 $3,946 13.6×
MRI abdomen w contrast (74182) $2,784 $3,480 8.2×
MRI abdomen w/o contrast (74181)
range across 2 matching MRF lines		 $2,609.60–$3,423.20 $3,262–$4,279 varies
MRI any jt lower extrem w/contrast material (73722) $2,784 $3,480 3.7×
MRI any jt lower extrem w/o & w/contrast matrl (73723) $3,044.80 $3,806 9.0×
MRI any jt upper extremity w/contrast matrl (73222) $2,609.60 $3,262 3.4×
MRI Breast W/O Contrast Bilateral (77047) $2,296 $2,870 9.9×
MRI cervical spine w contrast (72142) $2,609.60 $3,262 7.7×
MRI cervical spine w/o cont (72141) $2,419.20 $3,024 10.4×
MRI chest w/o contrast (71550) $3,480 $4,350 15.0×
MRI chest wo w contrast (71552) $2,296 $2,870 6.8×
MRI lower extrem oth/thn jt w/o & w/contr matr (73720) $2,609.60 $3,262 7.7×
MRI lower extrem oth/thn jt w/o contr matrl (73718) $2,175.20 $2,719 9.4×
Mri Neck Spine W/O & W/Dye (72156) $3,480 $4,350 10.3×
MRI orbit face &/neck w/o contrast (70540) $3,156.80 $3,946 13.6×
Mri Orbt/Fac/Nck W/O &W/Dye (70543) $3,259.20 $4,074 9.6×
MRI pelvis w contrast (72196) $2,609.60 $3,262 7.7×
MRI pelvis w/o & w contrast (72197) $3,480 $4,350 10.3×
MRI pelvis w/o contrast (72195) $2,175.20 $2,719 9.4×
MRI thoracic spine w/o contrast (72146) $2,419.20 $3,024 10.4×
MRI upper extremity oth than jt w/o contr matrl (73218) $2,175.20 $2,719 9.4×
Mri Uppr Extremity W/O&W/Dye (73220) $3,044.80 $3,806 9.0×
MRI, abdomen, combo (74183)
range across 2 matching MRF lines		 $3,044.80–$3,362.40 $3,806–$4,203 varies
MRI, dorsal spine combo (72157) $3,480 $4,350 10.3×
MRI, joint upper extrem (73221) $2,175.20 $2,719 9.4×
MRI, joint upper extrem combo (73223) $3,480 $4,350 10.3×
MRI, lumbar spine combo (72158) $3,480 $4,350 10.3×
Myocardial Spect Multiple Studies (78452) $4,012 $5,015 3.2×
Neck soft tissue (70360) $304.80 $381 3.6×
Ophthalmic US Dx Corneal Pachymetry Uni/Bi (76514) $130.40 $163 4.6×
Parathyroid Planar Imaging (78070) $1,773.60 $2,217 4.6×
Pelvis 1 or 2 views (72170) $260.80 $326 2.6×
PET image w/CT, full body (78816) $4,349.60 $5,437 3.1×
PET imaging CT attenuation skull base mid-thigh (78815) $3,480 $4,350 2.5×
Pulmonary Perfusion Imaging Particulate (78580) $1,013.60 $1,267 2.6×
Radex Abd Compl Aqt Abd W/S/E/D Views 1 View Ch (74022) $304.80 $381 3.0×
Radex Ankle Complete Minimum 3 Views (73610) $260.80 $326 3.1×
Radex Calcaneus Minimum 2 Views (73650) $260.80 $326 3.1×
Radex elbow complete minimum 3 views (73080) $304.80 $381 3.6×
Radex Facial Bones Complete Minimum 3 Views (70150) $304.80 $381 3.0×
Radex fingr minimum 2 views (73140) $260.80 $326 3.1×
Radex foot complete minimum 3 views (73630) $260.80 $326 3.1×
Radex Hand Minimum 3 Views (73130) $304.80 $381 3.6×
Radex lower extremity infant minimum 2 views (73592) $260.80 $326 3.1×
Radex Nasal Bones Complete Minimum 3 Views (70160) $326.40 $408 3.9×
Radex Ribs Unilateral 2 Views (71100) $326.40 $408 3.9×
Radex shoulder complete minimum 2 views (73030) $320 $400 3.8×
Radex Sinuses Paransl < 3 Views (70210) $173.60 $217 2.1×
Radex Spine 1 View Specify Level (72020) $130.40 $163 1.5×
Radex Sternum Minimum 2 Views (71120) $260.80 $326 3.1×
Radex Temporomandble Jt Opn & Clsd Mouth Bilat (70330) $307.20 $384 3.6×
Radex Toe Minimum 2 Views (73660) $130.40 $163 1.5×
Radex upper extremity infant minimum 2 views (73092) $173.60 $217 1.7×
Radex Wrist Complete Minimum 3 Views (73110) $260.80 $326 3.1×
Radiolog exam mandible compl minimum 4 views (70110) $435.20 $544 4.3×
Radiologic exam colon double contrast study (74280) $869.60 $1,087 5.1×
Radiologic exam colon single contrast study (74270) $435.20 $544 2.6×
Radiologic Exam Esophagus Double Contrast Study (74221) $565.60 $707 3.3×
Radiologic exam knee complete 4/more views (73564) $326.40 $408 3.2×
Radiologic Exam Small Int Single Contrast Study (74250) $348 $435 2.0×
Radiologic exam swallow function contrast study (74230) $435.20 $544 2.6×
Radiologic exam upr gi trc double contrast study (74246) $435.20 $544 2.6×
Radiologic examination femur 1 view (73551) $148 $185 1.8×
Radiologic examination femur minimum 2 views (73552) $260.80 $326 3.1×
Radiologic examination knee 1/2 views (73560) $282.40 $353 3.3×
Radiologic examination tibia & fibula 2 views (73590) $260.80 $326 3.1×
Ribs bilateral 3 views (71110) $391.20 $489 3.9×
Rp Loclzj Tum Plnr Whole Body Single Day Imaging (78802) $3,378.40 $4,223 6.4×
Rp Loclzj Tum Spect 1 Area Single Day Imaging (78803) $1,740 $2,175 3.3×
Scapula (73010) $217.60 $272 2.1×
Screening Digital Breast Tomosynthesis Bi (77063) $43.20 $54 1.8×
Shoulder 1 view (73020) $196 $245 2.3×
Shoulder Arthrography (73040) $834.40 $1,043 2.5×
Skull less than 4 views (70250) $287.20 $359 2.8×
Sternoclavicular joints (71130) $304.80 $381 3.6×
Tbs techl prep&transmis data alys pfrmd elsewhr (77090) $96 $120 1.1×
Tbs technical calculation only (77091) $184.80 $231 2.2×
Thoracic spine 2 views (72070) $217.60 $272 2.1×
Thoracic spine 3 views (72072) $260.80 $326 2.6×
Thyroid Uptake W/Blood Flow Sngle/Mult Quan Meas (78014) $869.60 $1,087 2.2×
Ultrasound Breast Limited (76642) $316.80 $396 3.7×
Ultrasound Exam Aaa Screen (76706) $391.20 $489 3.9×
Ultrasound, abdomen limited (76705) $604 $755 5.9×
Urethrocystogram voiding (74455) $435.20 $544 1.9×
Us breast unilateral complete (76641)
range across 2 matching MRF lines		 $382.40–$574.40 $478–$718 varies
Us chest (76604) $359.20 $449 3.5×
Us complete joint (76881) $521.60 $652 5.1×
Us exam, pelvic, limited (76857) $633.60 $792 6.2×
Us head (76506) $521.60 $652 5.1×
Us lmtd joint/oth nonvasc xtr strux r-t w/img (76882) $338.40 $423 3.3×
Us ob limited 1 or more fetuses (76815) $521.60 $652 5.1×
Us ob transvaginal (76817) $348 $435 3.4×
Us pelvic non ob complete (76856) $591.20 $739 5.8×
Us pg uter img f&mat 14 wk tabdl 1/1st gestation (76801) $506.40 $633 5.0×
Us preg uterus real time f/u trnsabdl per fetus (76816) $348 $435 3.4×
Us retroperitoneal complete (76770) $676 $845 6.7×
Us retroperitoneal limited (76775) $633.60 $792 6.2×
Us scrotum and contents (76870) $570.40 $713 5.6×
Us spinal canal and contents (76800) $521.60 $652 5.1×
Us thyroid (76536) $528 $660 5.2×
Us transrectal (76872) $485.60 $607 4.8×
Vertebral fracture assessment via dxa (77086) $96 $120 1.1×
Wrist 2 views (73100) $239.20 $299 2.8×
X-Ray Ac Jts - Xr Acromioclavicular Joints Bilateral (73050) $260.80 $326 3.1×
X-Ray Elbow 2 Vw - Xr Elbow 1-2 Views Right (73070) $239.20 $299 2.8×
X-Ray Exam Entire Spi 1 Vw (72081) $225.60 $282 2.7×
X-Ray Exam Entire Spi 2/3 Vw (72082) $391.20 $489 3.9×
X-Ray Exam Hip Uni 1 View (73501) $260.80 $326 3.1×
X-Ray Exam Hip Uni 2-3 Views (73502) $304.80 $381 3.6×
X-Ray Exam Hips Bi 2 Views (73521) $348 $435 3.4×
X-Ray Exam L-S Spine Bending (72114) $608.80 $761 6.0×
X-Ray Exam Neck Spine 2-3 Vw (72040) $326.40 $408 3.9×
X-Ray Exam Neck Spine 6/>Vws (72052) $348 $435 3.4×
X-Ray Exam Unilat Ribs/Chest (71101) $348 $435 3.4×
X-ray eye for foreign body (70030) $260.80 $326 3.1×
X-ray humerus (73060) $239.20 $299 2.8×
X-Ray Jaw <4 Vw - Xr Mandible < 4 Views (70100) $130.40 $163 1.5×
X-Ray Lumbar Spine 2/3 Vw - Xr Lumbar Spine 2-3 Views (72100) $348 $435 3.4×
X-ray nose-rectum child f.b. (76010) $368.80 $461 4.4×
X-Ray Ribs, Chest 4+ Vw - Xr Ribs 3 Vws Bil W/ Chest Posteroanterior (71111) $435.20 $544 4.3×
X-Ray Sacroiliac Jts 3+ Vw - Xr Sacroiliac Joints 3+ Views (72202) $217.60 $272 2.1×
X-Ray Sacroiliac Jts <3 Vw - Xr Sacroiliac Joints 1-2 Views (72200) $173.60 $217 1.7×
X-Ray Sacrum/Coccyx 2+ Vw - Xr Sacrum Coccyx 2+ Views (72220) $304.80 $381 3.6×
X-Ray Sinuses 3+ Vw - Xr Paranasal Sinuses 3+ Views (70220) $239.20 $299 2.8×
X-Ray Skull 4+ Vw - Xr Skull Complete 4+ Views (70260) $389.60 $487 3.8×
X-Ray Tmj Unilat (70328) $204.80 $256 2.4×
X-Ray Urinary Tract Exam With Contrast Material (74420) $869.60 $1,087 2.6×
X-Rays Bone Length Studies (77073) $435.20 $544 4.3×
X-Rays Bone Survey Complete (77075) $676.80 $846 6.7×
Xr c-spine 4 or 5 views (72050) $391.20 $489 3.9×
Xr facial bones less than 3 views (70140) $173.60 $217 2.1×

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.