Imaging prices at Keefe Memorial Hospital

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

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

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ProcedurePosted cashPosted gross× Medicare
Abdomen 1 View (74018) $333 $333 3.6×
Abdomen 2 views (74019) $412 $412 3.7×
Acute Gastrointestinal Blood Loss Imaging (78278) $913.60 $1,142 2.2×
Ankle 2 views (73600) $227 $227 2.5×
Arthrogram Wrist (73115) $605 $605 1.6×
Bone age studies (77072) $277 $277 2.5×
Bone Imaging 3 Phase (78315) $1,571.20 $1,964 3.7×
Bone Imaging Limited Area (78300) $908 $1,135 2.2×
Bone Imaging Multiple Areas (78305) $856 $1,070 2.0×
Bone Imaging Whole Body (78306) $1,399.20 $1,749 3.3×
Cardiac MRI w/w/o contrast & further seq (75561) $2,340.80 $3,344 6.4×
Chest 1 view (71045) $298 $298 3.2×
Chest 2 views (71046) $364 $364 4.0×
Chest 3 views (71047) $439 $439 4.8×
Chest 4 or more views (71048) $492 $492 4.5×
Clavicle complete (73000) $293 $293 3.2×
Computed Tomography Thorax Lw Dose Lng Ca Scr C- (71271) $2,374.40 $3,392 21.5×
Contrast X-Ray Bladder (74430) $852 $852 2.3×
CT abdomen and pelvis without and with contrast (74178) $3,395.40 $5,659 9.2×
CT abdomen and pelvis without contrast (74176) $3,055.50 $4,365 12.1×
CT abdomen w contrast (74160) $1,818.60 $2,598 9.8×
CT abdomen w wo contrast (74170) $2,183.30 $3,119 11.8×
CT abdomen w/o contrast (74150) $1,850.40 $2,313 16.8×
CT Angio Abdomen and Pelvis (74174) $2,519.30 $3,599 6.8×
CT Angio Chest (71275) $2,856 $4,080 15.4×
CT Angio Head (70496) $1,925.60 $2,407 10.4×
CT Angio Neck (70498) $1,925.60 $2,407 10.4×
Ct Angio Upr Extrm W/O&W/Dye (73206) $1,912.40 $2,732 10.3×
CT bone density (77078) $324 $324 3.5×
CT cervical spine w/ contrast (72126) $1,843.10 $2,633 5.0×
CT cervical spine w/o contrast (72125) $1,777.30 $2,539 16.1×
CT chest w contrast (71260) $1,874.60 $2,678 10.1×
CT chest w/wo contrast (71270) $2,374.40 $3,392 12.8×
CT head/brain with contrast (70460) $1,935.20 $2,419 10.5×
CT head/brain without and with contrast (70470) $1,891.40 $2,702 10.2×
CT iac w contrast (70481) $1,756.80 $2,196 9.5×
CT lower ext w/o (73700) $1,470.40 $1,838 13.3×
CT lower extremity w/contrast material (73701) $1,734.40 $2,168 9.4×
CT lumbar spine w/o contrast (72131) $1,723.20 $2,154 15.6×
CT maxillofacial w contrast (70487) $1,532.80 $1,916 8.3×
CT maxillofacial wo contrast (70486) $1,337.60 $1,672 12.1×
CT neck tissue combo (70492) $1,880.20 $2,686 10.2×
Ct Orbit/Ear/Fossa W/O&W/Dye (70482) $1,876.70 $2,681 10.1×
CT orbits w/o contrast (70480) $1,571.20 $1,964 14.2×
CT pelvis w&w/o contrast (72194) $2,183.30 $3,119 11.8×
CT pelvis w/o contrast (72192) $1,713.60 $2,142 15.5×
CT scan of leg combo (73702) $1,602.40 $2,003 8.7×
CT scans face/jaw combo (70488) $1,684 $2,105 9.1×
CT soft tissue neck w contrast (70491) $1,785 $2,550 9.6×
CT soft tissue neck w/o contrast (70490) $1,436 $1,795 13.0×
CT thoracic spine w/o contrast (72128) $1,701.60 $2,127 15.4×
CT thorax w/o contrast (71250) $1,917.60 $2,397 17.4×
CT upper ext wo (73200) $1,543.20 $1,929 14.0×
CT upper extremity w/o & w/contrast material (73202) $1,980 $2,475 10.7×
CT upper extremity with contrast (73201) $1,748 $2,185 4.7×
Cta Abdl Aorta&Bi Iliofem W/Contrast&Postp (75635) $1,957.20 $2,796 10.6×
Cta Abdomen (74175) $2,519.30 $3,599 13.6×
Dxa Bone Density Axial (77080) $536 $536 4.9×
Esophagram (74220) $537 $537 2.9×
Fetal Biophys Profile W/Nst (76818) $434 $434 3.9×
Foot 2 views (73620) $297 $297 3.2×
Forearm 2 views (73090) $267 $267 2.9×
Gastric emptying imaging study (78264) $1,532.80 $1,916 3.6×
Gated Heart Planar Single (78472) $1,300 $1,625 3.1×
Gated Heart, Multiple (78473) $1,904.80 $2,381 4.5×
Hand 2 views (73120) $202 $202 1.8×
Heart first pass single,planar (78481) $1,374.40 $1,718 2.4×
Hepatobil Syst Image W/Drug (78227) $1,833.60 $2,292 3.2×
Ht Musc Image Planar Mult (78454) $2,342.20 $3,346 1.7×
Ht Muscle Image Spect Sing (78451) $2,889.60 $4,128 2.1×
Infusion Ivp (74410) $552 $552 3.0×
K Flow/Funct Image Multiple (78709) $1,118.40 $1,398 2.0×
K Flow/Funct Image W/Drug (78708) $1,176 $1,470 2.1×
K Flow/Funct Image W/O Drug (78707) $1,178.40 $1,473 2.1×
Kidney Imaging Morphol (78700) $813.60 $1,017 1.9×
Kidney Imaging Morphoogy W/Vascular Flow (78701) $1,013.60 $1,267 2.4×
Knee 3 Views (73562) $411 $411 4.5×
Liver & Spleen Imaging Static Only (78215) $910.40 $1,138 2.2×
Liver & Spleen Imaging W/Vascular Flow (78216) $1,326.40 $1,658 3.1×
Liver imaging static only (78201) $1,094.40 $1,368 1.9×
Liver imaging w/vascular flow (78202) $1,326.40 $1,658 2.3×
Lymph System Imaging (78195) $1,243.20 $1,554 2.2×
Magnetic Image Jaw Joint (70336) $2,109.10 $3,013 8.4×
Meckels Divert Exam (78290) $930.40 $1,163 2.2×
Mra Head W/O & W/Contrast Material (70546) $2,394.70 $3,421 6.5×
MRA head w/o contrast (70544) $2,104.90 $3,007 8.4×
MRA head with contrast (70545) $1,992.80 $2,491 5.4×
MRA neck w contrast (70548) $2,104.90 $3,007 5.7×
Mra Neck W/O &W/Contrast Material (70549) $2,128.70 $3,041 5.8×
MRA neck w/o contrast (70547) $1,868.30 $2,669 7.4×
MRI abdomen w contrast (74182) $2,135 $3,050 5.8×
MRI abdomen w/o contrast (74181) $2,088.10 $2,983 8.3×
MRI any jt lower extrem w/contrast material (73722) $1,919.40 $2,742 2.3×
MRI any jt lower extrem w/o & w/contrast matrl (73723) $2,568.30 $3,669 7.0×
MRI any jt upper extremity w/contrast matrl (73222) $1,919.40 $2,742 2.3×
MRI bone marrow blood supply (77084) $2,027.90 $2,897 8.1×
MRI cardiac w/o contrast (75557) $2,340.80 $3,344 9.3×
MRI cervical spine w contrast (72142) $2,608.90 $3,727 7.1×
MRI cervical spine w/o cont (72141) $2,405.90 $3,437 9.6×
MRI chest w/o contrast (71550) $2,474.50 $3,535 9.8×
MRI chest with contrast (71551) $2,474.50 $3,535 3.0×
MRI chest wo w contrast (71552) $2,739.10 $3,913 7.4×
MRI lower extrem oth/thn jt w/contrast matrl (73719) $1,918 $2,740 5.2×
MRI lower extrem oth/thn jt w/o & w/contr matr (73720) $2,340.80 $3,344 6.4×
MRI lower extrem oth/thn jt w/o contr matrl (73718)
range across 2 matching MRF lines		 $1,935.50–$1,981.70 $2,765–$2,831 varies
MRI lumbar spine w contrast (72149) $2,503.20 $3,576 6.8×
Mri Neck Spine W/O & W/Dye (72156) $2,718.10 $3,883 7.4×
MRI orbit face &/neck w/o contrast (70540) $1,878.10 $2,683 7.5×
MRI orbit face neck w contrast (70542) $1,904 $2,720 5.2×
Mri Orbt/Fac/Nck W/O &W/Dye (70543) $2,121.70 $3,031 5.8×
MRI pelvis w contrast (72196) $2,382.80 $3,404 6.5×
MRI pelvis w/o & w contrast (72197) $2,410.80 $3,444 6.6×
MRI pelvis w/o contrast (72195) $1,999.90 $2,857 7.9×
MRI thoracic spine w/o contrast (72146) $2,036.30 $2,909 8.1×
MRI upper extremity oth than jt w/contr matrl (73219) $2,158.80 $3,084 5.9×
MRI upper extremity oth than jt w/o contr matrl (73218) $2,062.20 $2,946 8.2×
Mri Uppr Extremity W/O&W/Dye (73220) $2,340.80 $3,344 6.4×
MRI, abdomen, combo (74183) $2,392.60 $3,418 6.5×
MRI, dorsal spine combo (72157) $2,349.20 $3,356 6.4×
MRI, dorsal spine contrast (72147) $2,280.60 $3,258 6.2×
MRI, joint upper extrem (73221) $2,000.60 $2,858 7.9×
MRI, joint upper extrem combo (73223) $2,340.80 $3,344 6.4×
MRI, lumbar spine combo (72158) $2,977.10 $4,253 8.1×
Myocardial Imaging Infarct Avid Planar Qual/Quan (78466) $1,055.20 $1,319 2.5×
Myocardial Perfusion Planar 1 Study Rest/Stress (78453) $2,237.20 $3,196 1.6×
Myocardial Spect Multiple Studies (78452) $3,005.80 $4,294 2.2×
Neck soft tissue (70360) $348 $348 3.8×
Optic foramina (70190) $376 $376 4.1×
Parathyroid Planar Imaging (78070) $605 $605 1.4×
Pelvis 1 or 2 views (72170) $428 $428 3.9×
Pulmonary Perfusion Imaging Particulate (78580) $1,028 $1,285 2.4×
Radex Abd Compl Aqt Abd W/S/E/D Views 1 View Ch (74022) $546 $546 5.0×
Radex abscess/fistula/sinus tract rs&i (76080) $724 $724 1.3×
Radex Ankle Complete Minimum 3 Views (73610) $355 $355 3.9×
Radex Calcaneus Minimum 2 Views (73650) $288 $288 3.1×
Radex elbow complete minimum 3 views (73080) $300 $300 3.3×
Radex Facial Bones Complete Minimum 3 Views (70150) $408 $408 3.7×
Radex fingr minimum 2 views (73140) $229 $229 2.5×
Radex foot complete minimum 3 views (73630) $377 $377 4.1×
Radex Hand Minimum 3 Views (73130) $344 $344 3.7×
Radex Mastoids Compl Minimum 3 Views PR Side (70130) $376 $376 3.4×
Radex Nasal Bones Complete Minimum 3 Views (70160) $290 $290 3.2×
Radex Ribs Unilateral 2 Views (71100) $272 $272 3.0×
Radex shoulder complete minimum 2 views (73030) $350 $350 3.8×
Radex Sinuses Paransl < 3 Views (70210) $271 $271 3.0×
Radex Spine 1 View Specify Level (72020) $274 $274 3.0×
Radex Sternum Minimum 2 Views (71120) $293 $293 3.2×
Radex Temporomandble Jt Opn & Clsd Mouth Bilat (70330) $408 $408 4.4×
Radex Toe Minimum 2 Views (73660) $259 $259 2.8×
Radex Wrist Complete Minimum 3 Views (73110) $355 $355 3.9×
Radex X-Ray Exam Entire Spi 6/> Vw - Xr Entire Spine 6+ Vw (72084) $791 $791 7.2×
Radiolog exam mandible compl minimum 4 views (70110) $367 $367 3.3×
Radiologic Exam Abdomen 3+ Views - Xr Abdomen 3+ Views (74021) $501 $501 4.5×
Radiologic exam knee complete 4/more views (73564) $541 $541 4.9×
Radiologic exam pelvis compl minimum 3 views (72190) $436 $436 4.0×
Radiologic examination femur minimum 2 views (73552) $423 $423 4.6×
Radiologic examination knee 1/2 views (73560) $391 $391 4.3×
Radiologic Examination Salivary Gland Calculus (70380) $290 $290 3.2×
Radiologic examination tibia & fibula 2 views (73590) $397 $397 4.3×
Ribs bilateral 3 views (71110) $448 $448 4.1×
Rp loclzj tum plnr 1 area single day imaging (78800) $915.20 $1,144 2.2×
Rp loclzj tum plnr 2+area 1+d img/1 area img>2+d (78801) $1,176 $1,470 2.8×
Scapula (73010) $349 $349 3.2×
Screening Digital Breast Tomosynthesis Bi (77063) $62 $62 2.7×
Sella turcica (70240) $229 $229 2.5×
Shoulder 1 view (73020) $272 $272 3.0×
Skull less than 4 views (70250) $355 $355 3.2×
Sternoclavicular joints (71130) $253 $253 2.8×
Testicular Imaging W/Flow (78761) $908 $1,135 2.2×
Thoracic spine 2 views (72070) $406 $406 3.7×
Thoracic spine 3 views (72072) $546 $546 5.0×
Ultrasound Breast Limited (76642) $518 $518 5.6×
Ultrasound Exam Aaa Screen (76706) $660 $660 6.0×
Ultrasound, abdomen limited (76705) $778 $778 7.1×
Ureteral Reflux Study (78740) $972.80 $1,216 2.3×
Us breast unilateral complete (76641) $715 $715 6.5×
Us complete joint (76881) $709 $709 6.4×
Us exam, pelvic, limited (76857) $582 $582 5.3×
Us head (76506) $472 $472 4.3×
Us lmtd joint/oth nonvasc xtr strux r-t w/img (76882) $596 $596 5.4×
Us ob limited 1 or more fetuses (76815) $497 $497 4.5×
Us ob transvaginal (76817) $577 $577 5.2×
Us pelvic non ob complete (76856) $698 $698 6.3×
Us pg uter img f&mat 14 wk tabdl 1/1st gestation (76801) $677 $677 6.1×
Us preg uterus real time f/u trnsabdl per fetus (76816) $425 $425 3.9×
Us retroperitoneal complete (76770) $759 $759 6.9×
Us retroperitoneal limited (76775) $759 $759 6.9×
Us scrotum and contents (76870) $559 $559 5.1×
Us spinal canal and contents (76800) $715 $715 6.5×
Us thyroid (76536) $652 $652 5.9×
Wrist 2 views (73100) $207 $207 2.3×
X-Ray Ac Jts - Xr Acromioclavicular Joints Bilateral (73050) $300 $300 3.3×
X-Ray Bend Only L-S Spine (72120) $489 $489 4.4×
X-Ray Elbow 2 Vw - Xr Elbow 1-2 Views Right (73070) $295 $295 3.2×
X-Ray Exam Entire Spi 1 Vw (72081) $264 $264 2.9×
X-Ray Exam Entire Spi 2/3 Vw (72082) $587 $587 5.3×
X-Ray Exam Entire Spi 4/5 Vw (72083) $723 $723 6.6×
X-Ray Exam Hip Uni 1 View (73501)
range across 2 matching MRF lines		 $213–$283 $213–$283 varies
X-Ray Exam Hip Uni 2-3 Views (73502)
range across 4 matching MRF lines		 $404–$556 $404–$556 varies
X-Ray Exam Hips Bi 3-4 Views (73522) $586 $586 5.3×
X-Ray Exam L-S Spine Bending (72114) $663 $663 6.0×
X-Ray Exam Neck Spine 2-3 Vw (72040) $406 $406 4.4×
X-Ray Exam Neck Spine 6/>Vws (72052) $723 $723 6.6×
X-Ray Exam Unilat Ribs/Chest (71101) $465 $465 4.2×
X-ray eye for foreign body (70030) $264 $264 2.9×
X-ray humerus (73060) $288 $288 3.1×
X-Ray Jaw <4 Vw - Xr Mandible < 4 Views (70100) $290 $290 3.2×
X-Ray Knee Bilat Standing - Xr Knees Anteroposterior Standing Bilat (73565) $377 $377 4.1×
X-Ray Lumbar Spine 2/3 Vw - Xr Lumbar Spine 2-3 Views (72100) $494 $494 4.5×
X-Ray Ribs, Chest 4+ Vw - Xr Ribs 3 Vws Bil W/ Chest Posteroanterior (71111) $544 $544 4.9×
X-Ray Sacroiliac Jts 3+ Vw - Xr Sacroiliac Joints 3+ Views (72202) $411 $411 3.7×
X-Ray Sacroiliac Jts <3 Vw - Xr Sacroiliac Joints 1-2 Views (72200) $387 $387 3.5×
X-Ray Sacrum/Coccyx 2+ Vw - Xr Sacrum Coccyx 2+ Views (72220) $351 $351 3.8×
X-Ray Sinuses 3+ Vw - Xr Paranasal Sinuses 3+ Views (70220) $376 $376 4.1×
X-Ray Skull 4+ Vw - Xr Skull Complete 4+ Views (70260) $439 $439 4.0×
X-ray thoracic spine 4 vw (72074) $668 $668 6.1×
X-Ray Tmj Unilat (70328) $290 $290 3.2×
X-Ray Urinary Tract Exam With Contrast Material (74420) $930 $930 2.5×
X-Rays Bone Length Studies (77073) $380 $380 3.4×
Xr c-spine 4 or 5 views (72050) $590 $590 5.4×
Xr facial bones less than 3 views (70140) $376 $376 4.1×
Xr orbits complete 4 views (70200) $408 $408 3.7×

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.