Northwest Community Hospital Menu
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| Diagnostic Imaging - X-Ray Of Wrist, 3 Or More Views (32000201) | $932.00 |
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| Diagnostic Imaging - X-Ray Of Wrist, 2 Views (32000200) | $896.00 |
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| Diagnostic Imaging - X-Ray Of Upper Spine, 6 Or More Views (32000118) | $870.00 |
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| Diagnostic Imaging - X-Ray Of Upper Leg, 2 Or More Views (32000194) | $1,074.00 |
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| Diagnostic Imaging - X-Ray Of Upper Leg, 1 View (32000195) | $658.00 |
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| Diagnostic Imaging - X-Ray Of Upper Leg, 1 View (32000185) | $329.00 |
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| Diagnostic Imaging - X-Ray Of Upper Digestive Tract With X-Ray Of Urinary System (32000174) | $821.00 |
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| Diagnostic Imaging - X-Ray Of Spine, 1 View (32000143) | $547.00 |
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| Diagnostic Imaging - X-Ray Of Spine For Scoliosis Evaluation, 4 Or 5 Views (32000186) | $743.00 |
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| Diagnostic Imaging - X-Ray Of Spine For Scoliosis Evaluation, 2 Or 3 Views (32000153) | $585.00 |
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| Diagnostic Imaging - X-Ray Of Spine For Scoliosis Evaluation, 1 View (32000158) | $357.00 |
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| Diagnostic Imaging - X-Ray Of Spinal Canal With Contrast Injection, Upper Back (32000032) | $4,066.00 |
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| Diagnostic Imaging - X-Ray Of Spinal Canal With Contrast Injection, Neck (32000031) | $2,534.00 |
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| Diagnostic Imaging - X-Ray Of Spinal Canal With Contrast Injection, Lower Back (32000030) | $2,404.00 |
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| Diagnostic Imaging - X-Ray Of Spinal Canal With Contrast Injection, 2 Or More Areas (32000029) | $2,827.00 |
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| Diagnostic Imaging - X-Ray Of Skull, 4 Or More Views (32000065) | $774.00 |
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| Diagnostic Imaging - X-Ray Of Shoulder Blade (32000140) | $545.00 |
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| Diagnostic Imaging - X-Ray Of Sacroiliac Joints, Fewer Than 3 Views (32000151) | $490.00 |
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| Diagnostic Imaging - X-Ray Of Sacroiliac Joints, 3 Or More Views (32000152) | $593.00 |
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| Diagnostic Imaging - X-Ray Of Ribs On Both Sides Of Body With X-Ray Of Chest, 4 Or More Views (32400006) | $672.00 |
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| Diagnostic Imaging - X-Ray Of Pelvis, 3 Or More Views (32000060) | $795.00 |
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| Diagnostic Imaging - X-Ray Of One Hip With Pelvis, 2 To 3 Views (32000056) | $1,686.00 |
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| Diagnostic Imaging - X-Ray Of Nose Bones, 3 Or More Views (32000135) | $590.00 |
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| Diagnostic Imaging - X-Ray Of Neck Arteries On One Side With Catheter Insertion (32300023) | $7,694.00 |
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| Diagnostic Imaging - X-Ray Of Neck Arteries On One Side With Catheter Insertion (32300024) | $4,569.00 |
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| Diagnostic Imaging - X-Ray Of Nasal Sinuses, 3 Or More Views (32000063) | $734.00 |
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| Diagnostic Imaging - X-Ray Of Nasal Sinuses, 1 To 2 Views (32000064) | $239.00 |
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| Diagnostic Imaging - X-Ray Of Middle Spine, 4 Or More Views (32000156) | $425.00 |
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| Diagnostic Imaging - X-Ray Of Middle And Lower Spine, 2 Or More Views (32000157) | $491.00 |
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| Diagnostic Imaging - X-Ray Of Mandible (Jaw Bone), 4 Or More Views (32000128) | $571.00 |
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| Diagnostic Imaging - X-Ray Of Mandible (Jaw Bone), 1 To 3 Views (32000127) | $257.00 |
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| Diagnostic Imaging - X-Ray Of Lower Spine (Lumbar And Sacral), With 2 Or 3 Bending Views Only (32000105) | $558.00 |
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| Diagnostic Imaging - X-Ray Of Lower Spine (Lumbar And Sacral) With Bending Views, 6 Or More Views (32000115) | $549.00 |
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| Diagnostic Imaging - X-Ray Of Knee, 4 Or More Views (32000204) | $1,298.00 |
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| Diagnostic Imaging - X-Ray Of Knee, 4 Or More Views (32000112) | $649.00 |
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| Diagnostic Imaging - X-Ray Of Kidney Arteries On One Side With Catheter Insertion (32300017) | $5,747.00 |
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| Diagnostic Imaging - X-Ray Of Kidney Arteries On One Side With Catheter Insertion (32300019) | $4,602.00 |
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| Diagnostic Imaging - X-Ray Of Kidney Arteries On Both Sides With Catheter Insertion (32300016) | $5,611.00 |
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| Diagnostic Imaging - X-Ray Of Kidney Arteries On Both Sides With Catheter Insertion (32300018) | $4,883.00 |
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| Diagnostic Imaging - X-Ray Of Jaw Joint, Both Sides (32000129) | $369.00 |
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| Diagnostic Imaging - X-Ray Of Infant Leg, 2 Or More Views (32000133) | $672.00 |
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| Diagnostic Imaging - X-Ray Of Infant Arm, 2 Or More Views (32000119) | $492.00 |
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| Diagnostic Imaging - X-Ray Of Head Artery On One Side With Catheter Insertion (32300028) | $9,805.00 |
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| Diagnostic Imaging - X-Ray Of Head And Neck Arteries On One Side With Catheter Insertion (32300022) | $4,975.00 |
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| Diagnostic Imaging - X-Ray Of Hand, 2 Views (32000181) | $552.00 |
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| Diagnostic Imaging - X-Ray Of Face Bones, 1 To 2 Views (32000051) | $320.00 |
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| Diagnostic Imaging - X-Ray Of Eye For Foreign Body (32000159) | $514.00 |
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| Diagnostic Imaging - X-Ray Of Elbow, 3 Or More Views (32000199) | $1,078.00 |
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| Diagnostic Imaging - X-Ray Of Elbow, 2 Views (32000198) | $852.00 |
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| Diagnostic Imaging - X-Ray Of Chest, 4 Or More Views (32400004) | $464.00 |
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| Diagnostic Imaging - X-Ray Of Chest, 2 Views (32400008) | $262.00 |
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| Diagnostic Imaging - X-Ray Of Breast Bone, 2 Or More Views (32000111) | $351.00 |
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| Diagnostic Imaging - X-Ray Of Breast And Collarbone Joint, 2 Or More Views (32000166) | $392.00 |
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| Diagnostic Imaging - X-Ray Of Both Shoulder To Collarbone Joints (32000141) | $427.00 |
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| Diagnostic Imaging - X-Ray Of Both Knees, Standing (32000132) | $459.00 |
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| Diagnostic Imaging - X-Ray Of Both Hips With Pelvis, 3 To 4 Views (32000184) | $777.00 |
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| Diagnostic Imaging - X-Ray Of Bone At Base Of Skull Cap (32000146) | $193.00 |
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| Diagnostic Imaging - X-Ray Of Bile Or Pancreatic Ducts With Contrast Injection During Surgery (32000169) | $430.00 |
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| Diagnostic Imaging - X-Ray Of Ankle, 2 Views (32000202) | $934.00 |
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| Diagnostic Imaging - X-Ray From Nose To Rectum Of Child To Identify Foreign Object, Single View (32000164) | $309.00 |
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| Diagnostic Imaging - X-Ray For Joint Survey Of 2 Or More Joints Using Single View (32000027) | $334.00 |
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| Diagnostic Imaging - Ultrasound Of Uterus (40200003) | $1,039.00 |
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| Diagnostic Imaging - Ultrasound Of Single Breast, Limited Study (40200056) | $1,244.00 |
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| Diagnostic Imaging - Ultrasound Of Single Breast, Limited Study (40200055) | $485.00 |
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| Diagnostic Imaging - Ultrasound Of Single Breast, Limited Study (40200030) | $485.00 |
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| Diagnostic Imaging - Ultrasound Of Single Breast, Complete Study (40200057) | $1,244.00 |
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| Diagnostic Imaging - Ultrasound Of Single Breast, Complete Study (40200051) | $659.00 |
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| Diagnostic Imaging - Ultrasound Of Single Breast, Complete Study (40200052) | $659.00 |
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| Diagnostic Imaging - Ultrasound Of Single Breast, Complete Study (40200053) | $494.00 |
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| Diagnostic Imaging - Ultrasound Of Single Breast, Complete Study (40200054) | $485.00 |
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| Diagnostic Imaging - Ultrasound Of Rectum (40200047) | $496.00 |
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| Diagnostic Imaging - Ultrasound Of Prostate (40200010) | $859.00 |
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| Diagnostic Imaging - Ultrasound Of Infant Hips Without Manipulation (40200032) | $634.00 |
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| Diagnostic Imaging - Ultrasound Of Fetal Umbilical Artery Flow Rate (40200026) | $233.00 |
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| Diagnostic Imaging - Ultrasound Of Female Pelvic Organs, Limited Study (40200036) | $885.00 |
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| Diagnostic Imaging - Ultrasound Of Arm Or Leg, Complete Joint Study (40200061) | $1,000.00 |
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| Diagnostic Imaging - Ultrasound Of Additional Fetus At Less Than 14 Weeks (40200017) | $799.00 |
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| Diagnostic Imaging - Ultrasound Of Additional Fetus At 14 Weeks Or Greater (40200019) | $878.00 |
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| Diagnostic Imaging - Ultrasound Guidance For Egg Aspiration (40200009) | $660.00 |
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| Diagnostic Imaging - Ultrasound Guidance For Drainage Of Heart Sac (40200005) | $715.00 |
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| Diagnostic Imaging - Ultrasound Guidance For Blood Vessel Repair (40200007) | $1,760.00 |
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| Diagnostic Imaging - Ultrasound Guidance For Amniocentesis (40200006) | $787.00 |
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| Diagnostic Imaging - Ultrasound Evaluation Of Blood Vessel During Diagnosis Or Treatment, Initial Vessel (40200016) | $900.00 |
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| Diagnostic Imaging - Ultrasound Evaluation Of Blood Vessel During Diagnosis Or Treatment, Each Additional Vessel (48100049) | $720.00 |
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| Diagnostic Imaging - Therapeutic Enema For Reduction Of Large Intestine Obstruction (32000078) | $1,819.00 |
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| Diagnostic Imaging - Screening Ultrasound Of Abdominal Aorta To Detect Bulging (40200025) | $838.00 |
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| Diagnostic Imaging - Screening Mammogram Of Both Breasts (40300004) | $629.00 |
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| Diagnostic Imaging - Screening Mammogram Of Both Breasts (40300009) | $527.00 |
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| Diagnostic Imaging - Screening Ct Scan Of Large Intestine (35200015) | $1,664.00 |
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| Diagnostic Imaging - Screening 3D Mammogram Of Both Breasts (40300012) | $129.00 |
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| Diagnostic Imaging - Screening 3D Mammogram Of Both Breasts (40300011) | $129.00 |
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| Diagnostic Imaging - Repositioning Of Vena Cava Filter (32000072) | $6,283.00 |
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| Diagnostic Imaging - Mri Study Of Chemical Composition (61000009) | $2,786.00 |
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| Diagnostic Imaging - Mri Scan Of Upper Spinal Canal, With Contrast (61200007) | $3,778.00 |
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| Diagnostic Imaging - Mri Scan Of Single Breast Without Contrast (61000051) | $3,369.00 |
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| Diagnostic Imaging - Mri Scan Of Single Breast With And Without Contrast (61000072) | $3,529.00 |
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| Diagnostic Imaging - Mri Scan Of Pelvis, With Contrast (61000042) | $3,695.00 |
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| Diagnostic Imaging - Mri Scan Of Middle Spinal Canal, With Contrast (61200001) | $3,324.00 |
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| Diagnostic Imaging - Mri Scan Of Lower Spinal Canal, With Contrast (61200004) | $3,521.00 |
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| Diagnostic Imaging - Mri Scan Of Leg, With Contrast (61000036) | $3,932.00 |
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| Diagnostic Imaging - Mri Scan Of Leg Joint, Without Contrast (61000060) | $6,970.00 |
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| Diagnostic Imaging - Mri Scan Of Leg Joint, With Contrast (61000032) | $3,784.00 |
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| Diagnostic Imaging - Mri Scan Of Jaw Joint (61000004) | $3,281.00 |
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| Diagnostic Imaging - Mri Scan Of Heart, Without Contrast (61000002) | $2,960.00 |
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| Diagnostic Imaging - Mri Scan Of Heart, With And Without Contrast (61000003) | $2,607.00 |
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| Diagnostic Imaging - Mri Scan Of Heart With Stress Imaging, With And Without Contrast (61000061) | $1,799.00 |
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| Diagnostic Imaging - Mri Scan Of Eye, Face, Or Neck, Without Contrast (61000040) | $1,938.00 |
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| Diagnostic Imaging - Mri Scan Of Eye, Face, Or Neck, With Contrast (61000039) | $2,791.00 |
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| Diagnostic Imaging - Mri Scan Of Chest, Without Contrast (61000028) | $2,638.00 |
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| Diagnostic Imaging - Mri Scan Of Chest, With Contrast (61000026) | $2,672.00 |
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| Diagnostic Imaging - Mri Scan Of Chest, With And Without Contrast (61000027) | $3,670.00 |
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| Diagnostic Imaging - Mri Scan Of Both Breasts Without Contrast (61000050) | $3,000.00 |
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| Diagnostic Imaging - Mri Scan Of Both Breasts With And Without Contrast (61000071) | $3,795.00 |
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| Diagnostic Imaging - Mri Scan Of Blood Flow Of Heart, Additional Component Of Other Procedure (61000062) | $1,799.00 |
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| Diagnostic Imaging - Mri Scan Of Arm, Without Contrast (61000046) | $3,542.00 |
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| Diagnostic Imaging - Mri Scan Of Arm, With Contrast (61000045) | $5,346.00 |
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| Diagnostic Imaging - Mri Scan Of Arm, With And Without Contrast (61000047) | $6,338.00 |
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| Diagnostic Imaging - Mri Scan Of Arm Joint, Without Contrast (61000070) | $6,748.00 |
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| Diagnostic Imaging - Mri Scan Of Arm Joint, Without Contrast (61000035) | $3,374.00 |
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| Diagnostic Imaging - Mri Scan Of Arm Joint, With Contrast (61000034) | $3,525.00 |
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| Diagnostic Imaging - Mri Scan Of Arm Joint, With And Without Contrast (61000033) | $4,363.00 |
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| Diagnostic Imaging - Mri Scan Of Abdomen, With Contrast (61000023) | $3,779.00 |
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| Diagnostic Imaging - Mra Scan Of Blood Vessels In Neck, With Contrast (61500005) | $3,000.00 |
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| Diagnostic Imaging - Mra Scan Of Blood Vessels In Head, With Contrast (61500003) | $2,401.00 |
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| Diagnostic Imaging - Mra Scan Of Blood Vessels In Head, With And Without Contrast (61500001) | $3,235.00 |
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| Diagnostic Imaging - Mra Scan Of Blood Vessels In Arm (61000008) | $4,133.00 |
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| Diagnostic Imaging - Miscellaneous Ultrasound Procedure (40200004) | $348.00 |
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| Diagnostic Imaging - Miscellaneous Mri Scan For Exam Or Guidance (61000049) | $3,554.00 |
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| Diagnostic Imaging - Miscellaneous Mri Scan For Exam Or Guidance (61000048) | $3,153.00 |
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| Diagnostic Imaging - Miscellaneous Mri Scan For Exam Or Guidance (61200014) | $2,030.00 |
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| Diagnostic Imaging - Miscellaneous Mri Scan For Exam Or Guidance (61200010) | $1,686.00 |
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| Diagnostic Imaging - Miscellaneous Mri Scan For Exam Or Guidance (61200015) | $1,686.00 |
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| Diagnostic Imaging - Miscellaneous Fluoroscopic Procedure For Exam Or Guidance (32000018) | $787.00 |
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| Diagnostic Imaging - Mammogram Of Single Breast (40100004) | $598.00 |
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| Diagnostic Imaging - Mammogram Of Single Breast (40100012) | $497.00 |
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| Diagnostic Imaging - Mammogram Of Both Breasts (40100003) | $731.00 |
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| Diagnostic Imaging - Mammogram Of Both Breasts (40100010) | $608.00 |
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| Diagnostic Imaging - Magnetic Resonance Angiography Of Pelvis W/o Contrast (61000017) | $2,574.00 |
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| Diagnostic Imaging - Magnetic Resonance Angiography Of Pelvis W/contrast (61000013) | $2,574.00 |
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| Diagnostic Imaging - Magnetic Resonance Angiography Of Pelvis W & W/o Contrast (61000021) | $2,574.00 |
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| Diagnostic Imaging - Magnetic Resonance Angiography Of One Breast W & W/o Contrast (61000053) | $4,991.00 |
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| Diagnostic Imaging - Magnetic Resonance Angiography Of Leg W/o Contrast (61000016) | $2,725.00 |
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| Diagnostic Imaging - Magnetic Resonance Angiography Of Leg W/contrast (61000012) | $3,171.00 |
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| Diagnostic Imaging - Magnetic Resonance Angiography Of Leg W & W/o Contrast (61000020) | $3,954.00 |
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| Diagnostic Imaging - Magnetic Resonance Angiography Of Leg W & W/o Contrast (61000059) | $3,954.00 |
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| Diagnostic Imaging - Magnetic Resonance Angiography Of Leg W & W/o Contrast (61000055) | $3,171.00 |
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| Diagnostic Imaging - Magnetic Resonance Angiography Of Chest W/o Contrast (61000015) | $2,352.00 |
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| Diagnostic Imaging - Magnetic Resonance Angiography Of Chest W/contrast (61000011) | $2,521.00 |
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| Diagnostic Imaging - Magnetic Resonance Angiography Of Chest W & W/o Contrast (61000019) | $4,443.00 |
N/A
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| Diagnostic Imaging - Magnetic Resonance Angiography Of Both Breasts W & W/o Contrast (61000052) | $5,372.00 |
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| Diagnostic Imaging - Magnetic Resonance Angiography Of Arm W/o Contrast (61000007) | $3,120.00 |
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| Diagnostic Imaging - Magnetic Resonance Angiography Of Arm W/contrast (61000005) | $3,487.00 |
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| Diagnostic Imaging - Magnetic Resonance Angiography Of Arm W & W/o Contrast (61000006) | $3,762.00 |
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| Diagnostic Imaging - Magnetic Resonance Angiography Of Abdomen W/contrast (61000010) | $3,170.00 |
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| Diagnostic Imaging - Low Dose Ct Scan For Lung Cancer Screening (35200033) | $308.00 |
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| Diagnostic Imaging - Limited Or Follow-Up Ct Scan (35200001) | $528.00 |
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| Diagnostic Imaging - Insertion Of Stents Into Vertebral Artery With Guidance (32300026) | $9,664.00 |
N/A
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| Diagnostic Imaging - Insertion Of Stents Into Vertebral Artery Through Catheterwith Guidance (32300020) | $9,716.00 |
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| Diagnostic Imaging - Injection Of Anesthetic Or Steroid Into Pelvic Joint (32000023) | $3,005.00 |
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| Diagnostic Imaging - Injection Of Air Or Other X-Ray Contrast Material Into Abdominal Cavity (32000001) | $665.00 |
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| Diagnostic Imaging - Guidance For Removal Of Obstructive Material From Within Catheter (32000074) | $273.00 |
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| Diagnostic Imaging - Guidance For Removal Of Obstructive Material From Around Catheter (32000073) | $575.00 |
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| Diagnostic Imaging - Guidance For Placement Of Long Intestinal Tube In Small Intestine (32000162) | $1,050.00 |
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| Diagnostic Imaging - Guidance For Dilation Of Ureter Or Urethra (32000163) | $3,112.00 |
N/A
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| Diagnostic Imaging - Guidance For Dilation Of Gastrointestinal Tract (32000196) | $552.00 |
N/A
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| Diagnostic Imaging - Guidance For Biopsy Procedure (32100006) | $1,063.00 |
N/A
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| Diagnostic Imaging - Guidance For Dilation Of Biliary Duct (32000106) | $1,870.00 |
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| Diagnostic Imaging - Follow-Up Ultrasound Of Fetus (40200021) | $710.00 |
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| Diagnostic Imaging - Fluoroscopic Guidance For Needle Insertion (32000033) | $1,018.00 |
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| Diagnostic Imaging - Exam For Fetal Well-Being With Non-Stress Testing (40200012) | $1,324.00 |
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| Diagnostic Imaging - Electrical Imaging To Measure Elasticity And Stiffness Of Liver (40200060) | $261.00 |
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| Diagnostic Imaging - Dual-Energy X-Ray For Spinal Bone Fracture Assessment (32000183) | $216.00 |
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| Diagnostic Imaging - Dual-Energy X-Ray For Spinal Bone Fracture Assessment (32000180) | $180.00 |
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| Diagnostic Imaging - Dual-Energy X-Ray For Bone Density Study And Spinal Bone Fracture Assessment (32000182) | $682.00 |
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| Diagnostic Imaging - Dual-Energy X-Ray For Bone Density Study (32000178) | $535.00 |
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| Diagnostic Imaging - Dual-Energy X-Ray For Bone Density Study (32000012) | $455.00 |
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| Diagnostic Imaging - Dual-Energy X-Ray For Bone Density Study (32000179) | $358.00 |
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| Diagnostic Imaging - Diagnostic Pet Scan With Ct Imaging, Whole Body (40400007) | $8,956.00 |
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| Diagnostic Imaging - Diagnostic Pet Scan With Ct Imaging, Skull Base To Mid-Thigh (40400009) | $4,860.00 |
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| Diagnostic Imaging - Diagnostic Pet Scan With Ct Imaging, Limited Area (40400008) | $3,627.00 |
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| Diagnostic Imaging - Diagnostic Pet Scan Of Heart, Single Study (40400004) | $4,856.00 |
N/A
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| Diagnostic Imaging - Diagnostic Pet Scan Of Heart, Multiple Studies (40400003) | $4,856.00 |
N/A
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| Diagnostic Imaging - Diagnostic Pet Scan Of Heart With Metabolic Evaluation (40400005) | $4,779.00 |
N/A
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| Diagnostic Imaging - Diagnostic Pet Scan Of Brain With Metabolic Evaluation (40400001) | $5,297.00 |
N/A
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| Diagnostic Imaging - Diagnostic Pet Scan Of Brain With Blood Flow Evaluation (40400002) | $6,465.00 |
N/A
|
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| Diagnostic Imaging - Ct Scan Of Upper Spine, With Contrast (35000018) | $1,805.00 |
N/A
|
|
||
| Diagnostic Imaging - Ct Scan Of Upper Spine, With And Without Contrast (35200019) | $2,029.00 |
N/A
|
|
||
| Diagnostic Imaging - Ct Scan Of Pelvis, With And Without Contrast (35200022) | $2,238.00 |
N/A
|
|
||
| Diagnostic Imaging - Ct Scan Of Neck, Without Contrast (35000024) | $2,006.00 |
N/A
|
|
||
| Diagnostic Imaging - Ct Scan Of Neck, With And Without Contrast (35000022) | $2,347.00 |
N/A
|
|
||
| Diagnostic Imaging - Ct Scan Of Middle Spine, With And Without Contrast (35200013) | $1,796.00 |
N/A
|
|
||
| Diagnostic Imaging - Ct Scan Of Lower Spine, With Contrast (35000015) | $1,805.00 |
N/A
|
|
||
| Diagnostic Imaging - Ct Scan Of Lower Spine, With And Without Contrast (35200018) | $1,995.00 |
N/A
|
|
||
| Diagnostic Imaging - Ct Scan Of Leg, With And Without Contrast (35000017) | $2,562.00 |
N/A
|
|
||
| Diagnostic Imaging - Ct Scan Of Large Intestine, Without Contrast (35200014) | $1,996.00 |
N/A
|
|
||
| Diagnostic Imaging - Ct Scan Of Heart With Evaluation Of Blood Vessel Calcium (35200017) | $89.00 |
N/A
|
|
||
| Diagnostic Imaging - Ct Scan Of Heart Structure With Contrast (35000011) | $2,305.00 |
N/A
|
|
||
| Diagnostic Imaging - Ct Scan Of Head Or Brain, With Contrast (35100002) | $1,635.00 |
N/A
|
|
||
| Diagnostic Imaging - Ct Scan Of Face, With And Without Contrast (35100006) | $1,851.00 |
N/A
|
|
||
| Diagnostic Imaging - Ct Scan Of Eye Or Ear, Without Contrast (35100009) | $1,540.00 |
N/A
|
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