Imaging prices at Westfields Hospital and Clinic

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

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

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ProcedurePosted cashPosted gross× Medicare
Abdomen 1 View (74018) $126.24 $240 1.4×
Abdomen 2 views (74019) $126.24 $240 1.2×
Acute Gastrointestinal Blood Loss Imaging (78278) $1,042.53 $1,982 2.5×
Ankle 2 views (73600) $234.07 $445 2.6×
Arthrogram ankle (73615) $226.18 $430 0.6×
Bone age studies (77072) $125.19 $238 1.1×
Bone Imaging 3 Phase (78315) $822.14 $1,563 2.0×
Bone Imaging Limited Area (78300) $663.81 $1,262 1.6×
Bone Imaging Whole Body (78306) $1,053.58 $2,003 2.5×
Bone survey infant (77076) $140.44 $267 1.3×
Brain Imaging Pet Metabolic Evaluation (78608) $2,707.32 $5,147 1.8×
Chest 1 view (71045) $160.96 $306 1.8×
Chest 2 views (71046) $183.57 $349 2.0×
Chest 3 views (71047) $104.67 $199 1.1×
Chest 4 or more views (71048) $230.91 $439 2.1×
Clavicle complete (73000) $126.24 $240 1.4×
Computed Tomography Thorax Lw Dose Lng Ca Scr C- (71271) $409.75 $779 3.7×
Contrast X-Ray Bladder (74430) $276.15 $525 0.8×
CT abdomen and pelvis without and with contrast (74178) $1,700.56 $3,233 4.7×
CT abdomen and pelvis without contrast (74176) $1,785.24 $3,394 7.1×
CT abdomen w contrast (74160) $1,493.31 $2,839 8.1×
CT abdomen w wo contrast (74170) $1,449.66 $2,756 7.9×
CT abdomen w/o contrast (74150) $978.89 $1,861 8.9×
CT Angio Abdomen and Pelvis (74174) $1,482.79 $2,819 4.1×
CT Angio Chest (71275) $1,662.16 $3,160 9.0×
CT Angio Head (70496) $1,370.76 $2,606 7.5×
CT angio hrt w/3d image (75574) $1,277.65 $2,429 3.5×
Ct Angio Lwr Extr W/O&W/Dye (73706) $1,542.76 $2,933 8.4×
CT Angio Neck (70498) $1,498.57 $2,849 8.2×
Ct Angio Upr Extrm W/O&W/Dye (73206) $1,305.53 $2,482 7.1×
CT cervical spine w/ contrast (72126) $1,561.17 $2,968 4.3×
CT cervical spine w/o contrast (72125) $1,517.51 $2,885 13.9×
CT chest w contrast (71260) $787.42 $1,497 4.3×
CT chest w/wo contrast (71270) $1,494.37 $2,841 8.1×
CT colonography screening (74263) $1,277.65 $2,429 5.1×
CT Colonogrphy Dx Image Postprocess W/Contrast (74262) $882.63 $1,678 4.8×
CT colonogrphy dx image postprocess w/o contrast (74261) $1,277.65 $2,429 11.7×
CT head/brain with contrast (70460) $871.58 $1,657 4.7×
CT head/brain without and with contrast (70470) $1,158.25 $2,202 6.3×
CT heart contrast eval cardiac structure&morph (75572) $229.34 $436 0.6×
CT heart no contrast quant eval coronry calcium (75571) $52.07 $99 0.6×
CT iac w contrast (70481) $1,115.12 $2,120 6.1×
CT l-spine w&w/o contrast (72133) $1,344.98 $2,557 7.3×
CT lower ext w/o (73700) $1,293.43 $2,459 11.8×
CT lower extremity w/contrast material (73701) $2,102.42 $3,997 11.4×
CT lumbar spine w contrast (72132) $1,219.79 $2,319 3.3×
CT lumbar spine w/o contrast (72131) $1,115.12 $2,120 10.2×
CT maxillofacial w contrast (70487) $1,115.12 $2,120 6.1×
CT maxillofacial wo contrast (70486) $983.09 $1,869 9.0×
CT neck tissue combo (70492) $1,494.37 $2,841 8.1×
Ct Orbit/Ear/Fossa W/O&W/Dye (70482) $1,062.52 $2,020 5.8×
CT orbits w/o contrast (70480) $1,300.27 $2,472 11.9×
CT pelvis w&w/o contrast (72194) $945.22 $1,797 5.1×
CT pelvis w/o contrast (72192) $854.22 $1,624 7.8×
CT scan of leg combo (73702) $2,254.96 $4,287 12.3×
CT scans face/jaw combo (70488) $1,062.52 $2,020 5.8×
CT soft tissue neck w contrast (70491) $1,157.73 $2,201 6.3×
CT soft tissue neck w/o contrast (70490) $1,115.12 $2,120 10.2×
CT thoracic spine w contrast (72129) $1,561.17 $2,968 8.5×
CT thoracic spine w/o contrast (72128) $1,115.12 $2,120 10.2×
CT thorax w/o contrast (71250) $1,115.12 $2,120 10.2×
CT unlisted procedure (76497) $339.80 $646 3.7×
CT upper ext wo (73200) $844.23 $1,605 7.7×
CT upper extremity w/o & w/contrast material (73202) $1,024.12 $1,947 5.6×
CT upper extremity with contrast (73201) $1,157.73 $2,201 3.2×
Cta Abdl Aorta&Bi Iliofem W/Contrast&Postp (75635) $569.13 $1,082 3.1×
Cta Abdomen (74175) $1,603.77 $3,049 8.7×
CTA head&neck c+ w/noncontrast img&post-pxessing (70471) $428.69 $815 1.2×
CTA pelvis (72191) $946.27 $1,799 5.2×
Dxa Bone Density Axial (77080) $236.70 $450 2.2×
Dxa bone density study 1/>sites appendiclr skel (77081) $77.85 $148 0.9×
Echo exam uterus (76831) $426.06 $810 1.7×
Esophagram (74220) $304.55 $579 1.7×
Fetal Biophys Profile W/Nst (76818) $426.59 $811 3.9×
Fetal Biophysical Profile W/O Non-Stress Testing (76819) $216.71 $412 2.0×
Fluoroscopy up to 1 hr (76000) $331.91 $631 1.3×
Foot 2 views (73620) $126.24 $240 1.4×
Forearm 2 views (73090) $131.50 $250 1.4×
Gastric emptying imaging study (78264) $733.77 $1,395 1.8×
Gated Heart Planar Single (78472) $1,061.47 $2,018 2.5×
Hand 2 views (73120) $106.25 $202 1.0×
Hepatobil Syst Image W/Drug (78227) $1,023.07 $1,945 1.8×
Hepatobiliary System Imaging (78226) $1,023.07 $1,945 2.4×
Ht Muscle Image Spect Sing (78451) $1,020.97 $1,941 0.8×
Hysterosalpingogram (74740) $363.99 $692 1.5×
Joint Survey Single View (77077) $184.63 $351 1.7×
K Flow/Funct Image W/Drug (78708) $744.82 $1,416 1.3×
K Flow/Funct Image W/O Drug (78707) $487.08 $926 0.9×
Knee 3 Views (73562) $177.26 $337 1.9×
Lung Ventilat&Perfus Imaging (78582) $1,574.84 $2,994 2.8×
Lymph System Imaging (78195) $856.85 $1,629 1.5×
Magnetic Image Jaw Joint (70336) $1,314.47 $2,499 5.3×
Meckels Divert Exam (78290) $908.40 $1,727 2.2×
Mlc imrt design & construction per imrt plan (77338) $235.65 $448 0.6×
Mra Head W/O & W/Contrast Material (70546) $2,042.98 $3,884 5.6×
MRA head w/o contrast (70544) $2,022.47 $3,845 8.1×
MRA head with contrast (70545) $928.39 $1,765 2.5×
MRA neck w contrast (70548) $2,062.97 $3,922 5.6×
Mra Neck W/O &W/Contrast Material (70549) $2,676.29 $5,088 7.3×
MRA neck w/o contrast (70547) $2,022.47 $3,845 8.1×
MRI abdomen w contrast (74182) $2,444.32 $4,647 6.7×
MRI abdomen w/o contrast (74181) $2,039.83 $3,878 8.2×
MRI any jt lower extrem w/contrast material (73722) $2,095.58 $3,984 2.6×
MRI any jt lower extrem w/o & w/contrast matrl (73723) $2,042.98 $3,884 5.6×
MRI any jt upper extremity w/contrast matrl (73222) $1,428.09 $2,715 1.7×
MRI cervical spine w contrast (72142) $1,520.67 $2,891 4.2×
MRI cervical spine w/o cont (72141) $1,520.67 $2,891 6.1×
MRI chest w/o contrast (71550) $1,568.53 $2,982 6.3×
MRI chest wo w contrast (71552) $1,955.67 $3,718 5.4×
MRI lower extrem oth/thn jt w/contrast matrl (73719) $2,095.58 $3,984 5.7×
MRI lower extrem oth/thn jt w/o & w/contr matr (73720) $1,847.84 $3,513 5.1×
MRI lower extrem oth/thn jt w/o contr matrl (73718) $1,570.64 $2,986 6.3×
MRI lumbar spine w contrast (72149) $1,774.20 $3,373 4.9×
Mri Neck Spine W/O & W/Dye (72156) $2,054.56 $3,906 5.6×
MRI orbit face &/neck w/o contrast (70540) $2,028.78 $3,857 8.1×
MRI orbit face neck w contrast (70542) $1,684.78 $3,203 4.6×
Mri Orbt/Fac/Nck W/O &W/Dye (70543) $1,908.85 $3,629 5.2×
MRI pelvis w contrast (72196) $2,444.32 $4,647 6.7×
MRI pelvis w/o & w contrast (72197) $2,042.98 $3,884 5.6×
MRI pelvis w/o contrast (72195) $1,755.26 $3,337 7.0×
MRI thoracic spine w/o contrast (72146) $1,382.33 $2,628 5.5×
MRI upper extremity oth than jt w/contr matrl (73219) $1,677.41 $3,189 4.6×
MRI upper extremity oth than jt w/o contr matrl (73218) $1,570.64 $2,986 6.3×
Mri Uppr Extremity W/O&W/Dye (73220) $1,570.64 $2,986 4.3×
MRI, abdomen, combo (74183) $1,907.80 $3,627 5.2×
MRI, dorsal spine combo (72157) $1,585.89 $3,015 4.3×
MRI, dorsal spine contrast (72147) $2,417.50 $4,596 6.6×
MRI, joint upper extrem (73221) $1,570.64 $2,986 6.3×
MRI, joint upper extrem combo (73223) $1,908.85 $3,629 5.2×
MRI, lumbar spine combo (72158) $1,778.93 $3,382 4.9×
Myocardial Spect Multiple Studies (78452) $1,640.59 $3,119 1.2×
Neck soft tissue (70360) $107.83 $205 1.2×
Nuclear Rx Oral Admin (79005) $737.98 $1,403 3.0×
Ophthalmic ultrasound dx b-scan w/wo a-scan (76512)
range across 2 matching MRF lines
$82.06–$224.60 $156–$427 varies
Parathyroid imaging w/tomographic spect & CT (78072) $690.11 $1,312 1.2×
Parathyroid planar imaging w/wo subtraction (78071) $485.50 $923 1.2×
Pelvis 1 or 2 views (72170) $140.44 $267 1.3×
PET image w/CT, full body (78816) $3,772.47 $7,172 2.5×
PET imaging CT attenuation skull base mid-thigh (78815) $3,885.04 $7,386 2.6×
Pulmonary Perfusion Imaging Particulate (78580) $791.10 $1,504 1.9×
Quan&Charac C Atherosclerotc Plaq Asses Sev C Ds (75577) $640.67 $1,218 0.7×
Radex abscess/fistula/sinus tract rs&i (76080) $331.91 $631 0.6×
Radex Ankle Complete Minimum 3 Views (73610) $258.79 $492 2.8×
Radex Calcaneus Minimum 2 Views (73650) $129.92 $247 1.4×
Radex elbow complete minimum 3 views (73080) $201.46 $383 2.2×
Radex Facial Bones Complete Minimum 3 Views (70150) $303.50 $577 2.8×
Radex fingr minimum 2 views (73140) $125.19 $238 1.4×
Radex foot complete minimum 3 views (73630) $126.24 $240 1.4×
Radex Hand Minimum 3 Views (73130) $125.19 $238 1.4×
Radex lower extremity infant minimum 2 views (73592) $132.55 $252 1.5×
Radex Nasal Bones Complete Minimum 3 Views (70160) $162.01 $308 1.8×
Radex Ribs Unilateral 2 Views (71100) $257.21 $489 2.8×
Radex shoulder complete minimum 2 views (73030) $285.62 $543 3.1×
Radex Sinuses Paransl < 3 Views (70210) $125.71 $239 1.4×
Radex Spine 1 View Specify Level (72020)
range across 2 matching MRF lines
$140.44–$201.46 $267–$383 varies
Radex Sternum Minimum 2 Views (71120) $166.74 $317 1.8×
Radex Temporomandble Jt Opn & Clsd Mouth Bilat (70330) $229.86 $437 2.5×
Radex Toe Minimum 2 Views (73660) $115.19 $219 1.3×
Radex upper extremity infant minimum 2 views (73092) $144.12 $274 1.3×
Radex Wrist Complete Minimum 3 Views (73110) $180.94 $344 2.0×
Radiation treatment delivery level 3 (77412) $272.47 $518 0.5×
Radiologic Exam Abdomen 3+ Views - Xr Abdomen 3+ Views (74021) $126.24 $240 1.2×
Radiologic exam colon double contrast study (74280) $451.83 $859 2.5×
Radiologic exam colon single contrast study (74270) $344 $654 1.9×
Radiologic exam knee complete 4/more views (73564) $275.62 $524 2.5×
Radiologic exam pelvis compl minimum 3 views (72190) $161.48 $307 1.5×
Radiologic Exam Small Int Single Contrast Study (74250) $312.44 $594 1.7×
Radiologic exam swallow function contrast study (74230) $396.08 $753 2.2×
Radiologic examination femur 1 view (73551) $104.67 $199 1.1×
Radiologic examination femur minimum 2 views (73552) $148.33 $282 1.6×
Radiologic examination knee 1/2 views (73560) $127.82 $243 1.4×
Radiologic examination tibia & fibula 2 views (73590) $147.81 $281 1.6×
Ribs bilateral 3 views (71110) $325.59 $619 3.0×
Rp Loclzj Tum Spect 1 Area Single Day Imaging (78803) $1,896.76 $3,606 3.3×
Scapula (73010) $171.48 $326 1.6×
Screening Digital Breast Tomosynthesis Bi (77063) $209.35 $398 9.0×
Shoulder 1 view (73020) $178.84 $340 2.0×
Skull less than 4 views (70250) $207.77 $395 1.9×
Sternoclavicular joints (71130) $180.94 $344 2.0×
Thoracic spine 2 views (72070) $201.46 $383 1.8×
Thoracic spine 3 views (72072) $201.46 $383 1.8×
Thoracolumbar 2 views (72080) $241.43 $459 2.6×
Thyroid Met Imaging Body (78018) $1,034.64 $1,967 1.8×
Thyroid Uptake W/Blood Flow Sngle/Mult Quan Meas (78014) $880 $1,673 2.1×
Ultrasound Breast Limited (76642)
range across 2 matching MRF lines
$45.24–$325.59 $86–$619 varies
Ultrasound Exam Aaa Screen (76706) $185.68 $353 1.7×
Ultrasound, abdomen limited (76705)
range across 3 matching MRF lines
$64.70–$329.80 $123–$627 varies
Unlisted Dx Radiographic Procedure (76499) $81 $154 0.9×
Upper gi w/o kub (74240) $290.88 $553 1.6×
Urethrocystogram voiding (74455) $347.69 $661 1.4×
Urethrocystography retrograde (74450) $282.46 $537 1.1×
Us breast unilateral complete (76641) $343.48 $653 3.1×
Us chest (76604)
range across 3 matching MRF lines
$62.07–$244.59 $118–$465 varies
Us complete joint (76881) $128.87 $245 1.2×
Us exam, pelvic, limited (76857)
range across 3 matching MRF lines
$31.56–$527.58 $60–$1,003 varies
Us kidney transplant (76776) $371.36 $706 3.4×
Us lmtd joint/oth nonvasc xtr strux r-t w/img (76882)
range across 4 matching MRF lines
$35.77–$527.58 $68–$1,003 varies
Us ob detailed single fetus (76811)
range across 2 matching MRF lines
$201.46–$223.02 $383–$424 varies
Us ob limited 1 or more fetuses (76815)
range across 4 matching MRF lines
$59.96–$396.08 $114–$753 varies
Us ob transvaginal (76817)
range across 2 matching MRF lines
$86.26–$352.42 $164–$670 varies
Us pelvic non ob complete (76856)
range across 2 matching MRF lines
$136.23–$156.22 $259–$297 varies
Us pg uter img f&mat 14 wk tabdl 1/1st gestation (76801)
range across 2 matching MRF lines
$114.67–$396.08 $218–$753 varies
Us preg uterus real time f/u trnsabdl per fetus (76816)
range across 2 matching MRF lines
$97.84–$142.55 $186–$271 varies
Us retroperitoneal complete (76770) $355.58 $676 3.2×
Us retroperitoneal limited (76775)
range across 4 matching MRF lines
$37.35–$527.58 $71–$1,003 varies
Us scrotum and contents (76870) $283.51 $539 2.6×
Us thyroid (76536)
range across 4 matching MRF lines
$49.44–$358.21 $94–$681 varies
Us transrectal (76872)
range across 2 matching MRF lines
$69.43–$373.46 $132–$710 varies
Wrist 2 views (73100) $125.71 $239 1.4×
X-Ray Ac Jts - Xr Acromioclavicular Joints Bilateral (73050) $235.12 $447 2.6×
X-ray antegrade pyelogram tube (74425) $437.63 $832 1.2×
X-Ray Bend Only L-S Spine (72120) $267.21 $508 2.4×
X-Ray Elbow 2 Vw - Xr Elbow 1-2 Views Right (73070) $186.73 $355 2.0×
X-Ray Exam Breast Specimen (76098) $340.85 $648 0.6×
X-Ray Exam Entire Spi 1 Vw (72081) $154.64 $294 1.7×
X-Ray Exam Entire Spi 2/3 Vw (72082) $112.04 $213 1.0×
X-Ray Exam Hip Uni 1 View (73501) $148.33 $282 1.6×
X-Ray Exam Hip Uni 2-3 Views (73502) $148.33 $282 1.6×
X-Ray Exam Hip Uni 4/> Views (73503) $69.43 $132 0.6×
X-Ray Exam Hips Bi 2 Views (73521) $247.22 $470 2.3×
X-Ray Exam Hips Bi 3-4 Views (73522) $247.22 $470 2.3×
X-Ray Exam Hips Bi 5/> Views (73523) $466.56 $887 4.3×
X-Ray Exam L-S Spine Bending (72114) $252.48 $480 2.3×
X-Ray Exam Neck Spine 2-3 Vw (72040) $182 $346 2.0×
X-Ray Exam Neck Spine 6/>Vws (72052) $274.05 $521 2.5×
X-Ray Exam Unilat Ribs/Chest (71101) $388.19 $738 3.5×
X-ray eye for foreign body (70030) $78.37 $149 0.9×
X-ray humerus (73060) $161.48 $307 1.8×
X-Ray Jaw <4 Vw - Xr Mandible < 4 Views (70100) $207.77 $395 2.3×
X-Ray Knee Bilat Standing - Xr Knees Anteroposterior Standing Bilat (73565) $127.82 $243 1.4×
X-Ray Lumbar Spine 2/3 Vw - Xr Lumbar Spine 2-3 Views (72100) $241.43 $459 2.2×
X-ray nose-rectum child f.b. (76010) $59.96 $114 0.7×
X-Ray Ribs, Chest 4+ Vw - Xr Ribs 3 Vws Bil W/ Chest Posteroanterior (71111) $338.74 $644 3.1×
X-Ray Sacroiliac Jts 3+ Vw - Xr Sacroiliac Joints 3+ Views (72202) $161.48 $307 1.5×
X-Ray Sacroiliac Jts <3 Vw - Xr Sacroiliac Joints 1-2 Views (72200) $183.57 $349 1.7×
X-Ray Sacrum/Coccyx 2+ Vw - Xr Sacrum Coccyx 2+ Views (72220) $161.48 $307 1.8×
X-Ray Sinuses 3+ Vw - Xr Paranasal Sinuses 3+ Views (70220) $222.50 $423 2.4×
X-Ray Skull 4+ Vw - Xr Skull Complete 4+ Views (70260) $244.59 $465 2.2×
X-ray thoracic spine 4 vw (72074) $229.34 $436 2.1×
X-Ray Tmj Unilat (70328) $120.45 $229 1.3×
X-Rays Bone Survey Complete (77075) $125.71 $239 1.1×
Xr c-spine 4 or 5 views (72050) $241.96 $460 2.2×
Xr facial bones less than 3 views (70140) $164.11 $312 1.8×
Xr orbits complete 4 views (70200) $184.10 $350 1.7×

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.