Imaging prices at Delta County Memorial Hospital

Delta, CO · every code in this section with a posted price and a Medicare benchmark.

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

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ProcedureCash priceGross charge× Medicare
Abdomen 2 views (74019) $259.05 $431.75 2.3×
Acute gastrointestinal blood loss imaging (78278) $1,221 $2,035 2.9×
Ankle 2 views (73600) $130.80 $218 1.4×
Antegrade urography radiological supvj & interpj (74425) $488.55 $814.25 1.3×
Arthrogram elbow (73085) $480.75 $801.25 1.3×
Arthrogram hip (73525) $440.23 $733.72 1.2×
Arthrogram shoulder (73040) $480.75 $801.25 1.3×
Arthrogram wrist (73115) $440.23 $733.72 1.2×
Arthrography knee lt (73580) $440.23 $733.72 1.2×
Bone &/Joint Imaging Limited Area (78300) $1,012.95 $1,688.25 2.4×
Bone &/joint imaging whole body (78306) $1,088.55 $1,814.25 2.6×
Bone age studies (77072) $149.55 $249.25 1.4×
Bone Imaging 3 Phase (78315) $1,003.05 $1,671.75 2.4×
Bone survey complete (77075) $709.20 $1,182 6.4×
Brain image w/flow 4 + views (78606) $926.85 $1,544.75 1.6×
Cervical spine 2 or 3 views (72040) $218.40 $364 2.4×
Chest 1 view (71045) $194.25 $323.75 2.1×
Chest 3 views (71047) $223.05 $371.75 2.4×
Cine/Vid X-Ray Throat/Esoph - Fl Esoph Barium Swlw W/ Video & Speech (74230) $218.05 $363.42 1.2×
Clavicle complete (73000) $156.30 $260.50 1.7×
Computed Tomography Thorax Lw Dose Lng Ca Scr C- (71271) $938.10 $1,563.50 8.5×
CT abdomen and pelvis without and with contrast (74178) $2,557.65 $4,262.75 6.9×
CT abdomen and pelvis without contrast (74176) $1,847.70 $3,079.50 7.3×
CT abdomen w contrast (74160) $1,198.05 $1,996.75 6.5×
CT abdomen w wo contrast (74170) $1,373.25 $2,288.75 7.4×
CT abdomen w/o contrast (74150) $1,023.15 $1,705.25 9.3×
CT angio hrt w/3d image (75574) $898.80 $1,498 2.4×
CT angiography upper extremity lt (73206) $1,241.85 $2,069.75 6.7×
CT c-spine w/o contrast (72125) $1,273.80 $2,123 11.6×
CT cervical spine w&w/o contrast (72127) $1,859.40 $3,099 10.0×
CT cervical spine with contrast (72126) $1,273.80 $2,123 3.5×
CT chest w/wo contrast (71270) $1,546.72 $2,577.88 8.4×
CT chest with contrast (71260) $1,151.10 $1,918.50 6.2×
CT head/brain with contrast (70460) $1,126.50 $1,877.50 6.1×
CT head/brain without and with contrast (70470) $1,268.25 $2,113.75 6.9×
CT iac w contrast (70481) $1,230.45 $2,050.75 6.7×
CT limited/localized follow up study (76380) $583.35 $972.25 6.4×
CT lower ext w/o (73700) $952.65 $1,587.75 8.6×
CT lower extremity with contrast (73701) $1,462.35 $2,437.25 7.9×
CT lumbar spine w & w/o contrast (72133) $1,497 $2,495 8.1×
CT lumbar spine w/o contrast (72131) $1,080.22 $1,800.38 9.8×
CT lumbar spine with contrast (72132) $1,431.52 $2,385.88 3.9×
CT maxillofacial w contrast (70487) $1,042.35 $1,737.25 5.6×
CT maxillofacial w/o contrast (70486) $1,273.80 $2,123 11.6×
CT maxillofacial w/wo contrast (70488) $780 $1,300 4.2×
CT neck soft tissue w contrast (70491) $1,010.55 $1,684.25 5.5×
CT orbit sella/post fossa/ear w/o & w/contr matr (70482) $1,509.60 $2,516 8.2×
CT orbits w/o contrast (70480) $995.70 $1,659.50 9.0×
CT pelvis w & w/o contrast (72194) $1,281.45 $2,135.75 6.9×
CT pelvis w/o contrast (72192) $918.15 $1,530.25 8.3×
CT soft tissue neck w/o & w/contrast material (70492) $1,144.80 $1,908 6.2×
CT soft tissue neck w/o contrast (70490) $660.30 $1,100.50 6.0×
CT thoracic spine w/contrast (72129) $1,487.10 $2,478.50 8.0×
CT thoracic spine w/o contrast (72128) $1,273.80 $2,123 11.6×
CT thoracic spine w/wo contrast (72130) $1,770.68 $2,951.14 9.6×
CT thorax w/o contrast (71250) $938.10 $1,563.50 8.5×
CT upper extremity w/o & w/contrast material (73202) $824.40 $1,374 4.5×
CT upper extremity w/o contrast rt (73200) $992.48 $1,654.12 9.0×
CT upper extremity with contrast (73201) $1,092.98 $1,821.62 3.0×
Cta Abdl Aorta&Bi Iliofem W/Contrast&Postp (75635) $2,100.90 $3,501.50 11.4×
Cta Abdomen (74175) $1,209.90 $2,016.50 6.5×
CTA abdomen pelvis (74174) $1,209.60 $2,016 3.3×
CTA chest (71275) $1,209.90 $2,016.50 6.5×
Cta Head (70496) $1,123.50 $1,872.50 6.1×
CTA lwr ext w&w/o contrast (73706) $527.84 $879.74 2.9×
Cta Neck (70498) $1,144.80 $1,908 6.2×
Cta Pelvis (72191) $527.84 $879.74 2.9×
Cystography minimum 3 views rs&i (74430) $440.23 $733.72 1.2×
Dxa bone density study 1/> sites axial skel (77080) $256.80 $428 2.3×
Dxa bone density study 1/>sites appendiclr skel (77081) $125.40 $209 1.4×
Echoencephalography real time imaging (76506) $315.30 $525.50 2.9×
Esophagus (74220) $297.75 $496.25 1.6×
Fetal Biophysical Profile W/O Non-Stress Testing (76819) $293.85 $489.75 2.7×
Fluoroscopy up to 1 hr (76000) $403.65 $672.75 1.6×
Foot 2 views (73620) $128.25 $213.75 1.4×
Forearm 2 views (73090) $187.50 $312.50 2.0×
Gated Heart Planar Single (78472) $1,469.40 $2,449 3.5×
Hand 2 views (73120) $130.31 $217.19 1.2×
Hand 3 views (73130) $202.65 $337.75 2.2×
Hepatobil Syst Imag Inc Gb W/Pharma Intervenj (78227) $1,033.05 $1,721.75 1.8×
Hepatobiliary syst imaging including gallbladder (78226) $571.35 $952.25 1.4×
Humerus Min 2 Views Left (73060) $202.65 $337.75 2.2×
Hysterosalpingogram (74740) $275.21 $458.69 1.1×
Kidney img morphology vascular flow 1 w/rx (78708) $1,003.05 $1,671.75 1.8×
Knee 3 views (73562) $225 $375 2.5×
Liver & Spleen Imaging W/Vascular Flow (78216) $742.50 $1,237.50 1.8×
Lung perf&ventilat diferentl (78598) $1,102.20 $1,837 1.9×
Lymphoscintigraphy (78195) $1,064.10 $1,773.50 1.9×
Mammary ductogram or galactogram multiple (77054) $451.95 $753.25 1.8×
Mammary ductogram or galactogram single (77053) $451.95 $753.25 1.8×
Meckels Diverticulum (78290) $877.20 $1,462 2.1×
MRA head w & w/o contrast (70546) $1,903.80 $3,173 5.2×
MRA head w/o contrast (70544) $1,735.35 $2,892.25 6.9×
MRA head with contrast (70545) $1,859.40 $3,099 5.1×
MRA neck w contrast (70548) $1,460.55 $2,434.25 4.0×
Mra Neck W/O &W/Contrast Material (70549) $1,735.35 $2,892.25 4.7×
MRA neck w/o contrast (70547) $1,333.80 $2,223 5.3×
MRI abdomen w contrast (74182) $2,262.15 $3,770.25 6.1×
MRI abdomen w/o & w/contrast material (74183) $2,382.45 $3,970.75 6.5×
MRI abdomen w/o contrast (74181) $2,014.80 $3,358 8.0×
MRI any jnt lwr ext with con lt (73722) $1,418.70 $2,364.50 1.7×
MRI any jt upper extremity w/contrast matrl (73222) $1,632.30 $2,720.50 2.0×
MRI bone marrow blood supply (77084) $1,552.50 $2,587.50 6.2×
MRI breast w/o contrast bilateral (77047) $1,908 $3,180 7.6×
MRI c-spine with contrast (72142) $1,884 $3,140 5.1×
MRI cervical spine w/o contrast (72141) $1,684.95 $2,808.25 6.7×
MRI chest w/o & w/contrast material (71552) $2,382.45 $3,970.75 6.5×
MRI chest w/o contrast (71550) $2,014.80 $3,358 8.0×
MRI chest with contrast (71551) $2,262.15 $3,770.25 2.7×
MRI Forearm w/ Contrast Bilateral 73219 (73219) $1,884 $3,140 5.1×
MRI lower extrem oth/thn jt w/contrast matrl (73719) $1,702.50 $2,837.50 4.6×
MRI lower extrem oth/thn jt w/o contr matrl (73718) $1,513.80 $2,523 6.0×
MRI orbit face &/neck w/o contrast (70540) $1,901.70 $3,169.50 7.6×
MRI orbit/face/neck w&w/o cont (70543) $2,633.85 $4,389.75 7.2×
MRI orbit/face/neck w/contrast (70542) $2,247.68 $3,746.12 6.1×
MRI pelvis w contrast (72196) $2,314.35 $3,857.25 6.3×
MRI pelvis w/o & w/contrast material (72197) $2,946.15 $4,910.25 8.0×
MRI pelvis w/o contrast (72195) $2,088 $3,480 8.3×
MRI scan of arm joint before and after contrast (73223) $2,029.20 $3,382 5.5×
MRI scan of leg joint before and after contrast (73723) $2,010.30 $3,350.50 5.5×
MRI spinal canal cervical w/o & w/contr matrl (72156) $2,259.45 $3,765.75 6.1×
MRI spinal canal lumbar w/contrast material (72149) $2,010.45 $3,350.75 5.5×
MRI spinal canal lumbar w/o & w/contr matrl (72158) $2,136.45 $3,560.75 5.8×
MRI spinal canal thoracic w/contrast matrl (72147) $1,864.80 $3,108 5.1×
MRI spinal canal thoracic w/o & w/contr matrl (72157) $2,011.35 $3,352.25 5.5×
MRI thoracic spine w/o contrast (72146) $1,758.60 $2,931 7.0×
MRI tmj (70336) $2,020.05 $3,366.75 8.0×
MRI upper ext joint w/o contrast (73221) $1,418.40 $2,364 5.6×
MRI upper extrem other than jt w/o & w/contras (73220) $2,010.30 $3,350.50 5.5×
MRI upper extremity oth than jt w/o contr matrl (73218) $1,651.50 $2,752.50 6.6×
Myelogram Lumbar (72265) $1,388.40 $2,314 1.7×
Myelography 2 or more regions (72270) $1,388.40 $2,314 1.7×
Myocardial Spect Multiple Studies (78452) $2,388.45 $3,980.75 1.7×
Neck soft tissue (70360) $147.30 $245.50 1.6×
Nm cisternogram (78630) $2,011.80 $3,353 3.5×
Nm gastric emptying study (78264) $951.60 $1,586 2.3×
Nuclear medicine study of heart muscle at rest with stress (78453) $1,561.77 $2,602.95 1.1×
Ob Us Follow-Up Per Fetus - Us Ob Follow Up Transabdominal Approach (76816) $130.32 $217.20 1.2×
Parathyrd planar w/wo subtrj (78071) $1,190.70 $1,984.50 2.8×
Parathyroid imaging (78070) $1,079.40 $1,799 2.6×
Pelvis 1 or 2 views (72170) $149.55 $249.25 1.4×
PET image w/CT, skull-thigh (78815) $5,017.20 $8,362 3.3×
PET imaging CT for attenuation limited area (78814) $5,017.20 $8,362 3.3×
PET imaging for CT attenuation whole body (78816) $5,017.20 $8,362 3.3×
Pr MRI, lower extr, w/o contrast f/u by contrast (73720) $2,054.70 $3,424.50 5.6×
Pulmonary Perfusion Imaging Particulate (78580) $842.10 $1,403.50 2.0×
Radex abscess/fistula/sinus tract rs&i (76080) $577.49 $962.48 1.0×
Radex entir thrc lmbr crv sac spi w/skull 2/3 vw (72082) $192.15 $320.25 1.7×
Radiolog exam mandible compl minimum 4 views (70110) $252.45 $420.75 2.3×
Radiologic Exam Abdomen 1 View - Xr Abdomen 1 View (74018) $218.10 $363.50 2.4×
Radiologic Exam Chest 2 Views - Xr Chest 2 Views (71046) $200.10 $333.50 2.2×
Radiologic exam colon single contrast study (74270) $453.15 $755.25 2.4×
Radiologic Exam Esophagus Double Contrast Study (74221) $382.80 $638 2.1×
Radiologic exam upr gi trc double contrast study (74246) $463.95 $773.25 2.5×
Radiologic exam upr gi trc single contrast study (74240) $431.40 $719 2.3×
Radiologic Examination Femur Minimum 2 Views - Xr Femur 2+ Vw Lt (73552) $225 $375 2.5×
Radiological examination surgical specimen (76098) $577.49 $962.48 1.0×
Ribs bilateral 3 views (71110) $320.10 $533.50 2.9×
Rp loclzj tum plnr whole body single day imaging (78802) $1,561.77 $2,602.95 2.7×
Saline Infus Sonohysterography W/Color Doppler (76831) $616.35 $1,027.25 2.4×
Scanogram (77073) $212.40 $354 1.9×
Scapula complete (73010) $155.25 $258.75 1.4×
Screening digital breast tomosynthesis (77063) $52.20 $87 2.2×
Sella turcica (70240) $96.75 $161.25 1.1×
Sialogram (70390) $338.10 $563.50 1.3×
Small bowel series (74250) $453.15 $755.25 2.4×
Spine thoracic 3 views (72072) $225 $375 2.0×
Thoracolumbar 2 views (72080) $225 $375 2.5×
Thyroid carcinoma metastases img whole body (78018) $994.80 $1,658 1.7×
Thyroid uptake measurement (78012) $951.60 $1,586 2.3×
Tmj unilateral (70328) $349.05 $581.75 3.8×
Tumor Imaging Whole Body - Nm Tumor Local Whole Body Mult Days (78804) $1,651.20 $2,752 2.9×
Tumor Imaging, Limited Area - Nm Tumor Localization Limited (78800) $1,079.40 $1,799 2.6×
Ultrasound, abdomen limited (76705) $282.90 $471.50 2.6×
Umbilical-artery Doppler (OB) (76820) $129.23 $215.38 1.2×
Unlisted fluoroscopic procedure (76496) $208.50 $347.50 2.3×
Unlisted magnetic resonance procedure (76498) $2,097.60 $3,496 22.8×
Unlisted miscellaneous px dx nuclear medicine (78999) $945 $1,575 2.2×
Unlisted Ultrasound Procedure (76999) $200.70 $334.50 2.2×
Upper Extremity Infant (73092) $173.70 $289.50 1.6×
Ureteral Reflux Study Rp Voiding Cystogram (78740) $702.45 $1,170.75 1.7×
Urethrocystography retrograde rs&i (74450) $303.38 $505.62 1.2×
Urethrocystography voiding (74455) $839.40 $1,399 3.3×
Urography (pyelography), intravenous, with or without KUB, with or without tomography (74400) $451.35 $752.25 2.4×
Us abdl aorta screen aaa (76706) $206.55 $344.25 1.9×
Us breast unilateral complete (76641) $176.10 $293.50 1.6×
Us breast unilateral limited (76642) $117.75 $196.25 1.3×
Us chest (76604) $239.10 $398.50 2.2×
Us compl joint r-t w/image documentation (76881) $479.25 $798.75 4.3×
Us guided compression repair (76936) $316.25 $527.09 1.4×
Us infant hips dynamic (76885) $228.15 $380.25 2.5×
Us kidney transplant (76776) $290.85 $484.75 2.6×
Us ob transvaginal (76817) $369.75 $616.25 3.4×
Us pelvic non ob complete (76856) $512.40 $854 4.6×
Us pelvic nonobstetric image dcmtn limited/f/u (76857) $383.55 $639.25 3.5×
Us pregnancy ltd (76815) $251.25 $418.75 2.3×
Us pregnant uterus 14 wk transabdl 1/1st gestat (76801) $409.35 $682.25 3.7×
Us retroperitoneal complete (76770) $561.45 $935.75 5.1×
Us retroperitoneal limited (76775) $335.10 $558.50 3.0×
Us scrotum and contents (76870) $439.20 $732 4.0×
Us soft tissue head/neck (76536) $477 $795 4.3×
Us spinal canal and contents (76800) $316.05 $526.75 2.9×
Us xtr non-vasc lmtd (76882) $166.35 $277.25 1.5×
Us, eye b-scan (76512) $424.35 $707.25 3.8×
Venography extremity unilateral rs&i (75820) $1,681.60 $2,802.66 1.0×
Wrist 2 views (73100) $96.75 $161.25 1.1×
X-Ray Abdomen,Comp Acute Series - Xr Abdomen 2 Vws With Chest 1 View (74022) $296.85 $494.75 2.7×
X-Ray Ac Jts - Xr Acromioclavicular Joints Bilateral (73050) $209.10 $348.50 2.3×
X-Ray Ankle 3+ Vw - Xr Ankle 3+ Views Right (73610) $192.15 $320.25 2.1×
X-Ray Colon Air Contrast - Fl Barium Enema Air Contrast (74280) $546.45 $910.75 3.0×
X-Ray Elbow 2 Vw - Xr Elbow 1-2 Views Right (73070) $128.25 $213.75 1.4×
X-Ray Elbow 3+ Vw - Xr Elbow 3+ Views Right (73080) $190.20 $317 2.1×
X-ray exam hip uni 1 view (73501) $90 $150 1.0×
X-Ray Exam Hip Uni 2-3 Views (73502) $187.50 $312.50 2.0×
X-Ray Exam Hips Bi 5/> Views (73523) $330 $550 3.0×
X-ray eye for foreign body (70030) $160.35 $267.25 1.7×
X-Ray Facial Bones 3+ Vw - Xr Facial Bones 3+ Views (70150) $320.70 $534.50 2.9×
X-Ray Foot 3+ Vw - Xr Foot 3+ Views Right (73630) $202.65 $337.75 2.2×
X-Ray Heel - Xr Calcaneus 2 Views Right (73650) $202.65 $337.75 2.2×
X-Ray Knee 4+ View - Xr Knee 4+ Views Right (73564) $264.45 $440.75 2.4×
X-Ray Leg, Infant - Xr Lower Extremity 2+ Views Infant Left (73592) $137.40 $229 1.5×
X-Ray Lumbar Spine 2/3 Vw - Xr Lumbar Spine 2-3 Views (72100) $265.50 $442.50 2.4×
X-Ray Lumbar Spine 6+ Vw - Xr Lumbar Spine 6+ Vws Including Bending (72114) $400.35 $667.25 3.6×
X-Ray Lumbar Spine Flex/Exten - Xr Lumbar Spine 4+ Views W/ Flex Ext (72120) $129.23 $215.38 1.2×
X-Ray Nasal Bones - Xr Nasal Bones (70160) $175.20 $292 1.9×
X-Ray Nose-Rectum Child F.B. - Xr Nose to Rectum Foreign Body Peds (76010) $160.35 $267.25 1.7×
X-Ray Pelvis 3+ Vw - Xr Pelvis 3+ Views (72190) $245.70 $409.50 2.2×
X-Ray Retrograde Pyelogram - Fl Pyelogram Retrograde (74420) $357 $595 1.0×
X-Ray Ribs 2 Vw Unilat - Xr Ribs 2 Views Right (71100) $259.05 $431.75 2.8×
X-Ray Ribs, Chest 3+ Vw - Xr Ribs 2 Vws Lt W/ Chest Anteroposterior (71101) $194.68 $324.48 1.8×
X-Ray Ribs, Chest 4+ Vw - Xr Ribs 3 Vws Bil W/ Chest Posteroanterior (71111) $225.21 $375.35 2.0×
X-Ray Sacroiliac Jts 3+ Vw - Xr Sacroiliac Joints 3+ Views (72202) $275.10 $458.50 2.5×
X-Ray Sacrum/Coccyx 2+ Vw - Xr Sacrum Coccyx 2+ Views (72220) $217.20 $362 2.4×
X-Ray Shoulder 2+ Vw - Xr Shoulder 2+ Views Right (73030) $209.10 $348.50 2.3×
X-Ray Sinuses 3+ Vw - Xr Paranasal Sinuses 3+ Views (70220) $255 $425 2.8×
X-Ray Sinuses <3 Vw - Xr Paranasal Sinuses 1-2 Views (70210) $96.75 $161.25 1.1×
X-Ray Skull 4+ Vw - Xr Skull Complete 4+ Views (70260) $325.35 $542.25 3.0×
X-Ray Skull <4 Vw - Xr Skull 1-3 Views (70250) $259.05 $431.75 2.3×
X-Ray Spine One View - Xr Spine (72020) $117.60 $196 1.3×
X-Ray Sterno-Clavicluar Jt - Xr Sternoclavicular Joints 3+ Views (71130) $214.20 $357 2.3×
X-Ray Sternum 2+ Vw - Xr Sternum 2+ Views (71120) $210.15 $350.25 2.3×
X-Ray Thoracic Spine 2 Vw - Xr Thoracic Spine 2 Views (72070) $183.45 $305.75 1.7×
X-Ray Toe(S) - Xr Toes 2+ Views Right (73660) $147.30 $245.50 1.6×
X-Ray Wrist 3+ Vw - Xr Wrist 3+ Views Right (73110) $147.30 $245.50 1.6×
Xr arthrogram ankle (73615) $440.23 $733.72 1.2×
Xr c-spine 6 or more views (72052) $370.80 $618 3.4×
Xr finger(s) 2+ views (73140) $140.25 $233.75 1.5×
Xr optic foramina (70190) $160.35 $267.25 1.7×
Xr shoulder 1 view (73020) $147.30 $245.50 1.6×
Xr spine cervical 4 or 5 views (72050) $336.15 $560.25 3.0×
Xr tibia/fibula 2 views (73590) $150 $250 1.6×
Xray knee 1 or 2 views rt (73560) $147.30 $245.50 1.6×