Imaging prices at Mercy Walworth Hospital & Medical Center
Lake Geneva, WI · every code in this section with a posted price and a Medicare benchmark.
215 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) | $299.75 | $399.67 | 3.5× |
| Abdomen 2 views (74019) | $314.74 | $419.66 | 3.0× |
| Angiography extremity bilateral rs&i (75716) | $4,433.76 | $5,911.68 | 1.4× |
| Angiography extremity unilateral rs&i (75710) | $3,542.64 | $4,723.52 | 1.1× |
| Ankle 2 views (73600) | $328.80 | $438.40 | 3.8× |
| Arthrogram hip (73525) | $811.67 | $1,082.23 | 2.4× |
| Arthrogram Wrist (73115) | $1,148.22 | $1,530.96 | 3.3× |
| Bone age studies (77072) | $289.39 | $385.85 | 2.8× |
| Bone Imaging 3 Phase (78315) | $2,049.58 | $2,732.77 | 5.2× |
| Bone Imaging Whole Body (78306) | $1,798.28 | $2,397.71 | 4.5× |
| Chest 1 view (71045) range across 2 matching MRF lines |
$184.03–$237.11 | $245.37–$316.15 | varies |
| Chest 2 views (71046) | $369.68 | $492.91 | 4.3× |
| Clavicle complete (73000) | $421.12 | $561.49 | 4.9× |
| Computed Tomography Thorax Lw Dose Lng Ca Scr C- (71271) | $1,120.60 | $1,494.14 | 10.8× |
| Continuing medical physics consltj pr wk (77336) | $453.95 | $605.27 | 3.4× |
| Contrast Exam Abdominl Aorta (75625) | $3,542.64 | $4,723.52 | 1.1× |
| Contrast X-Ray Bladder (74430) | $562.24 | $749.65 | 1.6× |
| CT abdomen and pelvis without and with contrast (74178) range across 2 matching MRF lines |
$5,719.32–$8,367.62 | $7,625.76–$11,156.82 | varies |
| CT abdomen and pelvis without contrast (74176) | $4,647.44 | $6,196.58 | 19.7× |
| CT abdomen w contrast (74160) | $2,367.63 | $3,156.84 | 13.6× |
| CT abdomen w wo contrast (74170) | $2,912.61 | $3,883.48 | 16.8× |
| CT abdomen w/o contrast (74150) | $1,987.94 | $2,650.59 | 19.2× |
| CT Angio Abdomen and Pelvis (74174) | $3,632.37 | $4,843.16 | 10.5× |
| CT Angio Chest (71275) | $3,946.08 | $5,261.44 | 22.7× |
| CT Angio Head (70496) | $3,612.82 | $4,817.09 | 20.8× |
| Ct Angio Lwr Extr W/O&W/Dye (73706) range across 2 matching MRF lines |
$1,952.34–$4,090.90 | $2,603.12–$5,454.53 | varies |
| CT Angio Neck (70498) | $3,370.57 | $4,494.09 | 19.4× |
| Ct Angio Upr Extrm W/O&W/Dye (73206) range across 2 matching MRF lines |
$3,318.79–$5,712.24 | $4,425.05–$7,616.32 | varies |
| CT cervical spine w/o contrast (72125) | $2,286.06 | $3,048.08 | 22.1× |
| CT cervical spine w/wo cont (72127) | $3,235.28 | $4,313.71 | 18.6× |
| CT chest w contrast (71260) | $2,493.32 | $3,324.43 | 14.4× |
| CT chest w/wo contrast (71270) | $3,164.86 | $4,219.82 | 18.2× |
| CT head/brain with contrast (70460) | $2,499.62 | $3,332.82 | 14.4× |
| CT head/brain without and with contrast (70470) | $2,801.60 | $3,735.47 | 16.1× |
| CT heart no contrast quant eval coronry calcium (75571) | $368.18 | $490.91 | 4.3× |
| CT iac w contrast (70481) | $2,239.25 | $2,985.67 | 12.9× |
| CT l-spine w&w/o contrast (72133) | $2,792.92 | $3,723.90 | 16.1× |
| CT lower ext w/o (73700) | $1,386.32 | $1,848.42 | 13.4× |
| CT lower extremity w/contrast material (73701) range across 2 matching MRF lines |
$1,283.15–$1,710.87 | $1,710.87–$2,281.16 | varies |
| CT lumbar spine w contrast (72132) | $2,649.16 | $3,532.21 | 7.7× |
| CT lumbar spine w/o contrast (72131) | $2,390.62 | $3,187.49 | 23.1× |
| CT maxillofacial w contrast (70487) | $2,216.12 | $2,954.83 | 12.8× |
| CT maxillofacial wo contrast (70486) | $1,878.48 | $2,504.64 | 18.2× |
| CT neck tissue combo (70492) | $2,771.08 | $3,694.77 | 16.0× |
| CT orbits w/o contrast (70480) | $1,976.56 | $2,635.42 | 19.1× |
| CT pelvis w&w/o contrast (72194) | $2,547.76 | $3,397.02 | 14.7× |
| CT pelvis w/o contrast (72192) range across 2 matching MRF lines |
$1,915.04–$2,049.10 | $2,553.39–$2,732.13 | varies |
| CT scan of leg combo (73702) | $1,825.37 | $2,433.83 | 10.5× |
| CT scans face/jaw combo (70488) | $2,371.14 | $3,161.52 | 13.7× |
| CT soft tissue neck w contrast (70491) | $2,212.42 | $2,949.90 | 12.8× |
| CT soft tissue neck w/o contrast (70490) | $1,951.60 | $2,602.13 | 18.9× |
| CT thoracic spine w contrast (72129) | $2,577.37 | $3,436.49 | 14.9× |
| CT thoracic spine w/o contrast (72128) | $2,160.62 | $2,880.83 | 20.9× |
| CT thorax w/o contrast (71250) | $2,139.95 | $2,853.27 | 20.7× |
| CT upper ext wo (73200) | $1,754.63 | $2,339.51 | 17.0× |
| CT upper extremity with contrast (73201) | $2,024.11 | $2,698.81 | 5.9× |
| Cta Abdl Aorta&Bi Iliofem W/Contrast&Postp (75635) | $5,096.84 | $6,795.79 | 29.4× |
| Cta Abdomen (74175) | $3,562.64 | $4,750.18 | 20.5× |
| CTA head&neck c+ w/noncontrast img&post-pxessing (70471) | $6,983.38 | $9,311.18 | 20.2× |
| CTA pelvis (72191) | $4,095.27 | $5,460.36 | 23.6× |
| Dxa Bone Density Axial (77080) | $599.53 | $799.37 | 5.8× |
| Dxa bone density study (77085) | $631.66 | $842.22 | 6.1× |
| Dxa bone density study 1/>sites appendiclr skel (77081) | $160.93 | $214.57 | 1.9× |
| Esophagram (74220) | $964.63 | $1,286.17 | 5.6× |
| Fetal Biophys Profile W/Nst (76818) range across 2 matching MRF lines |
$794.61–$987.90 | $1,059.48–$1,317.20 | varies |
| Fetal Biophysical Profile W/O Non-Stress Testing (76819) | $640 | $853.34 | 6.2× |
| Fluoroscopy up to 1 hr (76000) | $569.47 | $759.29 | 2.4× |
| Foot 2 views (73620) | $280.06 | $373.41 | 3.3× |
| Forearm 2 views (73090) | $358.89 | $478.52 | 4.2× |
| Gastric emptying imaging study (78264) | $3,196.74 | $4,262.32 | 8.1× |
| Gated Heart Planar Single (78472) | $1,632.93 | $2,177.24 | 4.1× |
| Hand 2 views (73120) range across 2 matching MRF lines |
$378.55–$378.58 | $504.73–$504.78 | varies |
| Hepatobil Syst Image W/Drug (78227) | $2,570.84 | $3,427.78 | 4.8× |
| Hepatobiliary System Imaging (78226) | $2,151.40 | $2,868.53 | 5.4× |
| Hysterosalpingogram (74740) | $1,958.30 | $2,611.06 | 8.3× |
| Infant hip ultrasound with hip movement (dynamic) (76885) | $708.63 | $944.84 | 8.2× |
| Joint Survey Single View (77077) | $394.22 | $525.63 | 3.8× |
| K Flow/Funct Image W/Drug (78708) | $1,196.67 | $1,595.56 | 2.2× |
| Knee 3 Views (73562) | $423.20 | $564.26 | 4.9× |
| Lung Ventilat&Perfus Imaging (78582) | $2,174.75 | $2,899.67 | 4.0× |
| Lymph System Imaging (78195) | $1,897.30 | $2,529.73 | 3.5× |
| Mra Head W/O & W/Contrast Material (70546) | $5,551.64 | $7,402.19 | 16.1× |
| MRA head w/o contrast (70544) | $3,875.56 | $5,167.42 | 16.4× |
| Mra Neck W/O &W/Contrast Material (70549) | $7,032.57 | $9,376.76 | 20.4× |
| MRA neck w/o contrast (70547) | $3,875.56 | $5,167.42 | 16.4× |
| MRI abdomen w/o contrast (74181) | $5,971.90 | $7,962.54 | 25.3× |
| MRI any jt lower extrem w/contrast material (73722) | $4,545.44 | $6,060.59 | 5.9× |
| MRI any jt lower extrem w/o & w/contrast matrl (73723) | $4,772.72 | $6,363.62 | 13.8× |
| MRI any jt upper extremity w/contrast matrl (73222) | $4,962.11 | $6,616.15 | 6.4× |
| MRI Breast W/O Contrast Bilateral (77047) | $6,898.62 | $9,198.16 | 29.2× |
| MRI cervical spine w contrast (72142) | $5,735.92 | $7,647.90 | 16.6× |
| MRI cervical spine w/o cont (72141) | $4,798.25 | $6,397.67 | 20.3× |
| MRI chest w/o contrast (71550) | $5,151.46 | $6,868.61 | 21.8× |
| MRI chest wo w contrast (71552) | $7,691.57 | $10,255.43 | 22.3× |
| MRI lower extrem oth/thn jt w/o & w/contr matr (73720) | $6,606.46 | $8,808.62 | 19.1× |
| MRI lower extrem oth/thn jt w/o contr matrl (73718) | $4,825.98 | $6,434.64 | 20.4× |
| MRI lumbar spine w contrast (72149) | $5,996.72 | $7,995.62 | 17.4× |
| Mri Neck Spine W/O & W/Dye (72156) | $6,673.60 | $8,898.13 | 19.3× |
| MRI orbit face &/neck w/o contrast (70540) | $5,177.45 | $6,903.27 | 21.9× |
| Mri Orbt/Fac/Nck W/O &W/Dye (70543) range across 2 matching MRF lines |
$6,208.18–$9,259.36 | $8,277.57–$12,345.82 | varies |
| MRI pelvis w/o & w contrast (72197) | $6,144.02 | $8,192.02 | 17.8× |
| MRI pelvis w/o contrast (72195) | $4,783.45 | $6,377.93 | 20.3× |
| MRI thoracic spine w/o contrast (72146) | $4,918.25 | $6,557.67 | 20.8× |
| MRI upper extremity oth than jt w/o contr matrl (73218) | $4,336.06 | $5,781.41 | 18.4× |
| Mri Uppr Extremity W/O&W/Dye (73220) | $6,122.50 | $8,163.34 | 17.7× |
| MRI, abdomen, combo (74183) | $8,496.81 | $11,329.08 | 24.6× |
| MRI, dorsal spine combo (72157) | $7,762.82 | $10,350.43 | 22.5× |
| MRI, dorsal spine contrast (72147) | $5,562.69 | $7,416.92 | 16.1× |
| MRI, joint upper extrem (73221) | $4,841.08 | $6,454.78 | 20.5× |
| MRI, joint upper extrem combo (73223) | $5,086.16 | $6,781.55 | 14.7× |
| MRI, lumbar spine combo (72158) | $7,649.90 | $10,199.86 | 22.2× |
| Myocardial Spect Multiple Studies (78452) | $4,512.98 | $6,017.31 | 3.5× |
| Neck soft tissue (70360) | $247.73 | $330.31 | 2.9× |
| Ob us nuchal meas 1 gest (76813) | $1,055.92 | $1,407.89 | 10.2× |
| Ophthalmic ultrasound dx b-scan w/wo a-scan (76512) | $224.44 | $299.26 | 2.2× |
| Pelvis 1 or 2 views (72170) | $442.90 | $590.53 | 4.3× |
| PET image w/CT, full body (78816) | $6,532.66 | $8,710.21 | 4.6× |
| PET imaging CT attenuation skull base mid-thigh (78815) | $5,875 | $7,833.34 | 4.2× |
| Pulmonary Perfusion Imaging Particulate (78580) | $1,240.58 | $1,654.11 | 3.1× |
| Radex Abd Compl Aqt Abd W/S/E/D Views 1 View Ch (74022) | $665.91 | $887.88 | 6.4× |
| Radex Ankle Complete Minimum 3 Views (73610) | $355.77 | $474.36 | 4.1× |
| Radex Calcaneus Minimum 2 Views (73650) | $200.36 | $267.14 | 2.3× |
| Radex elbow complete minimum 3 views (73080) | $406.59 | $542.12 | 4.7× |
| Radex Facial Bones Complete Minimum 3 Views (70150) | $502.02 | $669.36 | 4.9× |
| Radex fingr minimum 2 views (73140) | $314.29 | $419.05 | 3.7× |
| Radex foot complete minimum 3 views (73630) range across 2 matching MRF lines |
$328.94–$378.58 | $438.59–$504.78 | varies |
| Radex Hand Minimum 3 Views (73130) | $382.74 | $510.32 | 4.4× |
| Radex lower extremity infant minimum 2 views (73592) | $312.48 | $416.64 | 3.6× |
| Radex Nasal Bones Complete Minimum 3 Views (70160) | $318.44 | $424.58 | 3.7× |
| Radex Ribs Unilateral 2 Views (71100) | $387.93 | $517.24 | 4.5× |
| Radex shoulder complete minimum 2 views (73030) | $383.78 | $511.71 | 4.5× |
| Radex Spine 1 View Specify Level (72020) | $179.36 | $239.14 | 2.1× |
| Radex Sternum Minimum 2 Views (71120) | $244.78 | $326.38 | 2.8× |
| Radex Toe Minimum 2 Views (73660) range across 2 matching MRF lines |
$201.64–$202.26 | $268.86–$269.68 | varies |
| Radex upper extremity infant minimum 2 views (73092) | $333.99 | $445.32 | 3.2× |
| Radex Wrist Complete Minimum 3 Views (73110) range across 2 matching MRF lines |
$344.13–$344.36 | $458.84–$459.14 | varies |
| Radex X-Ray Exam Entire Spi 6/> Vw - Xr Entire Spine 6+ Vw (72084) | $262.18 | $349.57 | 2.5× |
| Radiolog exam mandible compl minimum 4 views (70110) | $409.71 | $546.28 | 4.0× |
| Radiologic exam colon double contrast study (74280) | $1,639.87 | $2,186.49 | 9.5× |
| Radiologic exam colon single contrast study (74270) | $1,362.92 | $1,817.23 | 7.9× |
| Radiologic Exam Esophagus Double Contrast Study (74221) | $1,090.13 | $1,453.51 | 6.3× |
| Radiologic exam knee complete 4/more views (73564) range across 2 matching MRF lines |
$460.14–$528.99 | $613.52–$705.32 | varies |
| Radiologic exam pelvis compl minimum 3 views (72190) | $465.05 | $620.07 | 4.5× |
| Radiologic Exam Small Int Single Contrast Study (74250) | $569.44 | $759.25 | 3.3× |
| Radiologic exam swallow function contrast study (74230) | $869.20 | $1,158.94 | 5.0× |
| Radiologic examination femur 1 view (73551) | $350.59 | $467.45 | 4.1× |
| Radiologic examination femur minimum 2 views (73552) | $415.93 | $554.57 | 4.8× |
| Radiologic examination knee 1/2 views (73560) range across 2 matching MRF lines |
$376.13–$376.52 | $501.51–$502.03 | varies |
| Radiologic examination tibia & fibula 2 views (73590) | $381.70 | $508.94 | 4.4× |
| Rp Loclzj Tum Spect 1 Area Single Day Imaging (78803) | $2,710.72 | $3,614.30 | 5.0× |
| Scapula (73010) | $410.74 | $547.66 | 4.0× |
| Screening Digital Breast Tomosynthesis Bi (77063) | $94.27 | $125.69 | 4.0× |
| Shoulder 1 view (73020) range across 2 matching MRF lines |
$277.57–$319.47 | $370.09–$425.96 | varies |
| Shoulder Arthrography (73040) | $1,232.38 | $1,643.17 | 3.6× |
| Skull less than 4 views (70250) | $311.17 | $414.89 | 3.0× |
| Sternoclavicular joints (71130) | $157.66 | $210.21 | 1.8× |
| Tbs technical calculation only (77091) | $239.92 | $319.89 | 2.8× |
| Thoracic spine 2 views (72070) | $353.69 | $471.59 | 3.4× |
| Thoracic spine 3 views (72072) | $455.35 | $607.13 | 4.4× |
| Thoracolumbar 2 views (72080) | $314.29 | $419.05 | 3.7× |
| Thyroid Uptake W/Blood Flow Sngle/Mult Quan Meas (78014) | $1,691.78 | $2,255.71 | 4.3× |
| Ultrasound Breast Limited (76642) range across 2 matching MRF lines |
$492.40–$656.54 | $656.54–$875.39 | varies |
| Ultrasound Exam Aaa Screen (76706) | $530.02 | $706.70 | 5.1× |
| Ultrasound, abdomen limited (76705) | $1,351.12 | $1,801.49 | 13.1× |
| Umbilical-artery Doppler (OB) (76820) | $716.02 | $954.69 | 6.9× |
| Upper gi w/o kub (74240) | $1,178.30 | $1,571.06 | 6.8× |
| Us breast unilateral complete (76641) | $865.74 | $1,154.32 | 8.4× |
| Us chest (76604) | $694.58 | $926.10 | 6.7× |
| Us complete joint (76881) | $1,191.28 | $1,588.38 | 11.5× |
| Us exam, pelvic, limited (76857) | $451.48 | $601.97 | 4.4× |
| Us lmtd joint/oth nonvasc xtr strux r-t w/img (76882) | $1,116.28 | $1,488.38 | 10.8× |
| Us ob limited 1 or more fetuses (76815) range across 2 matching MRF lines |
$203.20–$555.66 | $270.94–$740.88 | varies |
| Us ob transvaginal (76817) | $436.59 | $582.12 | 4.2× |
| Us pelvic non ob complete (76856) | $1,324.66 | $1,766.21 | 12.8× |
| Us pg uter img f&mat 14 wk tabdl 1/1st gestation (76801) | $1,055.09 | $1,406.79 | 10.2× |
| Us preg uterus real time f/u trnsabdl per fetus (76816) | $1,153.49 | $1,537.99 | 11.2× |
| Us retroperitoneal complete (76770) | $520.94 | $694.58 | 5.0× |
| Us retroperitoneal limited (76775) | $435.76 | $581.02 | 4.2× |
| Us scrotum and contents (76870) | $716.90 | $955.87 | 6.9× |
| Us spinal canal and contents (76800) | $665.63 | $887.51 | 6.4× |
| Us thyroid (76536) | $1,170.86 | $1,561.14 | 11.3× |
| Wrist 2 views (73100) range across 2 matching MRF lines |
$212.62–$244.78 | $283.49–$326.38 | varies |
| X-Ray Bend Only L-S Spine (72120) | $329.92 | $439.90 | 3.2× |
| X-Ray Elbow 2 Vw - Xr Elbow 1-2 Views Right (73070) | $382.74 | $510.32 | 4.4× |
| X-Ray Exam Breast Specimen (76098) | $217.47 | $289.96 | 0.4× |
| X-Ray Exam Entire Spi 1 Vw (72081) | $110.80 | $147.73 | 1.3× |
| X-Ray Exam Entire Spi 2/3 Vw (72082) | $201.31 | $268.41 | 1.9× |
| X-Ray Exam Entire Spi 4/5 Vw (72083) | $208.08 | $277.44 | 2.0× |
| X-Ray Exam Hip Uni 1 View (73501) | $623.37 | $831.16 | 7.2× |
| X-Ray Exam Hip Uni 2-3 Views (73502) range across 2 matching MRF lines |
$662.10–$761.33 | $882.80–$1,015.11 | varies |
| X-Ray Exam Hip Uni 4/> Views (73503) | $942.84 | $1,257.12 | 9.1× |
| X-Ray Exam Hips Bi 2 Views (73521) | $387.93 | $517.24 | 3.8× |
| X-Ray Exam Hips Bi 3-4 Views (73522) | $422.16 | $562.88 | 4.1× |
| X-Ray Exam Hips Bi 5/> Views (73523) | $507.20 | $676.27 | 4.9× |
| X-Ray Exam L-S Spine Bending (72114) | $581.63 | $775.51 | 5.6× |
| X-Ray Exam Neck Spine 2-3 Vw (72040) | $332.95 | $443.93 | 3.9× |
| X-Ray Exam Neck Spine 6/>Vws (72052) | $561.14 | $748.18 | 5.4× |
| X-Ray Exam Unilat Ribs/Chest (71101) | $524.20 | $698.94 | 5.1× |
| X-ray eye for foreign body (70030) range across 3 matching MRF lines |
$99.10–$362.11 | $132.13–$482.81 | varies |
| X-ray humerus (73060) range across 2 matching MRF lines |
$280.14–$322.58 | $373.52–$430.11 | varies |
| X-ray IV pyelogram (ivp) (74400) | $1,520.64 | $2,027.52 | 8.8× |
| X-Ray Knee Bilat Standing - Xr Knees Anteroposterior Standing Bilat (73565) | $480.25 | $640.33 | 5.6× |
| X-Ray Lumbar Spine 2/3 Vw - Xr Lumbar Spine 2-3 Views (72100) | $311.17 | $414.89 | 3.0× |
| X-ray nose-rectum child f.b. (76010) | $488.06 | $650.74 | 5.7× |
| X-Ray Ribs, Chest 4+ Vw - Xr Ribs 3 Vws Bil W/ Chest Posteroanterior (71111) | $848.46 | $1,131.28 | 8.2× |
| X-Ray Sacroiliac Jts 3+ Vw - Xr Sacroiliac Joints 3+ Views (72202) | $411.68 | $548.91 | 4.0× |
| X-Ray Sacroiliac Jts <3 Vw - Xr Sacroiliac Joints 1-2 Views (72200) | $392.08 | $522.77 | 3.8× |
| X-Ray Sacrum/Coccyx 2+ Vw - Xr Sacrum Coccyx 2+ Views (72220) | $418.01 | $557.35 | 4.9× |
| X-Ray Sinuses 3+ Vw - Xr Paranasal Sinuses 3+ Views (70220) | $504.10 | $672.13 | 5.9× |
| X-Ray Skull 4+ Vw - Xr Skull Complete 4+ Views (70260) | $399.71 | $532.95 | 3.9× |
| X-Ray Urinary Tract Exam With Contrast Material (74420) | $800.08 | $1,066.77 | 2.3× |
| X-Rays Bone Length Studies (77073) | $176.33 | $235.11 | 1.7× |
| X-Rays Bone Survey Complete (77075) | $814.23 | $1,085.64 | 7.9× |
| Xr c-spine 4 or 5 views (72050) | $538.66 | $718.21 | 5.2× |
| Xr orbits complete 4 views (70200) | $360.94 | $481.25 | 3.5× |
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.