Imaging prices at San Luis Valley Health Regional Medical Center
Alamosa, CO · every code in this section with a posted price and a Medicare benchmark.
186 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) | $199.65 | $363 | 2.2× |
| Abdomen 2 views (74019) | $250.80 | $456 | 2.3× |
| Ankle 2 views (73600) | $161.15 | $293 | 1.8× |
| Arthrogram hip (73525) | $611.60 | $1,112 | 1.7× |
| Arthrogram Wrist (73115) | $611.60 | $1,112 | 1.7× |
| Bone age studies (77072) | $161.15 | $293 | 1.5× |
| Bone Imaging 3 Phase (78315) | $883.85 | $1,607 | 2.1× |
| Bone Imaging Limited Area (78300) | $1,396.45 | $2,539 | 3.3× |
| Bone Imaging Whole Body (78306) | $1,885.40 | $3,428 | 4.5× |
| Chest 1 view (71045) | $161.15 | $293 | 1.8× |
| Chest 2 views (71046) | $184.80 | $336 | 2.0× |
| Chest 3 views (71047) | $207.35 | $377 | 2.3× |
| Clavicle complete (73000) | $161.15 | $293 | 1.8× |
| Contrast X-Ray Of Knee Joint (73580) | $611.60 | $1,112 | 1.7× |
| CT abdomen and pelvis without and with contrast (74178) | $2,387 | $4,340 | 6.5× |
| CT abdomen and pelvis without contrast (74176) | $1,758.35 | $3,197 | 7.0× |
| CT abdomen w contrast (74160) | $1,082.40 | $1,968 | 5.8× |
| CT abdomen w wo contrast (74170) | $1,249.60 | $2,272 | 6.8× |
| CT abdomen w/o contrast (74150) | $618.75 | $1,125 | 5.6× |
| CT Angio Abdomen and Pelvis (74174) | $2,230.80 | $4,056 | 6.1× |
| CT Angio Chest (71275) | $2,341.90 | $4,258 | 12.7× |
| CT Angio Head (70496) | $2,339.70 | $4,254 | 12.6× |
| CT angio hrt w/3d image (75574) | $1,119.25 | $2,035 | 3.0× |
| Ct Angio Lwr Extr W/O&W/Dye (73706) | $2,230.80 | $4,056 | 12.1× |
| CT Angio Neck (70498) | $2,341.90 | $4,258 | 12.7× |
| Ct Angio Upr Extrm W/O&W/Dye (73206) | $2,230.80 | $4,056 | 12.1× |
| CT cervical spine w/o contrast (72125) | $818.95 | $1,489 | 7.4× |
| CT cervical spine w/wo cont (72127) | $933.35 | $1,697 | 5.0× |
| CT chest w contrast (71260) | $1,197.90 | $2,178 | 6.5× |
| CT chest w/wo contrast (71270) | $1,255.65 | $2,283 | 6.8× |
| CT head/brain with contrast (70460) | $1,333.75 | $2,425 | 7.2× |
| CT head/brain without and with contrast (70470) | $1,249.60 | $2,272 | 6.8× |
| CT heart no contrast quant eval coronry calcium (75571) | $567.60 | $1,032 | 6.2× |
| CT iac w contrast (70481) | $1,147.30 | $2,086 | 6.2× |
| CT l-spine w&w/o contrast (72133) | $1,197.35 | $2,177 | 6.5× |
| CT lower ext w/o (73700) | $665.50 | $1,210 | 6.0× |
| CT lower extremity w/contrast material (73701) range across 3 matching MRF lines |
$944.35–$944.90 | $1,717–$1,718 | varies |
| CT lumbar spine w contrast (72132) | $1,073.60 | $1,952 | 2.9× |
| CT lumbar spine w/o contrast (72131) | $818.95 | $1,489 | 7.4× |
| CT maxillofacial w contrast (70487) | $1,112.10 | $2,022 | 6.0× |
| CT maxillofacial wo contrast (70486) | $810.15 | $1,473 | 7.3× |
| CT orbits w/o contrast (70480) | $730.95 | $1,329 | 6.6× |
| CT pelvis w&w/o contrast (72194) | $1,249.60 | $2,272 | 6.8× |
| CT pelvis w/o contrast (72192) | $730.95 | $1,329 | 6.6× |
| CT scan of leg combo (73702) | $1,221 | $2,220 | 6.6× |
| CT soft tissue neck w contrast (70491) | $917.95 | $1,669 | 5.0× |
| CT soft tissue neck w/o contrast (70490) | $618.75 | $1,125 | 5.6× |
| CT thoracic spine w contrast (72129) | $871.20 | $1,584 | 4.7× |
| CT thoracic spine w/o contrast (72128) | $647.90 | $1,178 | 5.9× |
| CT thoracic spine w/wo cont (72130) | $933.35 | $1,697 | 5.0× |
| CT thorax w/o contrast (71250) | $772.75 | $1,405 | 7.0× |
| CT upper ext wo (73200) | $693 | $1,260 | 6.3× |
| CT upper extremity w/o & w/contrast material (73202) | $892.65 | $1,623 | 4.8× |
| CT upper extremity with contrast (73201) | $983.95 | $1,789 | 2.7× |
| Cta Abdl Aorta&Bi Iliofem W/Contrast&Postp (75635) | $1,728.65 | $3,143 | 9.3× |
| Cta Abdomen (74175) | $2,230.80 | $4,056 | 12.1× |
| Dxa Bone Density Axial (77080) | $290.95 | $529 | 2.6× |
| Dxa bone density study 1/>sites appendiclr skel (77081) | $290.95 | $529 | 3.2× |
| Esophagram (74220) | $328.90 | $598 | 1.8× |
| Fetal Biophysical Profile W/O Non-Stress Testing (76819) | $300.30 | $546 | 2.7× |
| Fluoroscopy up to 1 hr (76000) | $391.05 | $711 | 1.6× |
| Foot 2 views (73620) | $161.15 | $293 | 1.8× |
| Forearm 2 views (73090) | $161.15 | $293 | 1.8× |
| Gastric emptying imaging study (78264) | $883.85 | $1,607 | 2.1× |
| Hand 2 views (73120) range across 3 matching MRF lines |
$161.15–$321.20 | $293–$584 | varies |
| Hepatobil Syst Image W/Drug (78227) | $1,503.15 | $2,733 | 2.6× |
| Hepatobiliary System Imaging (78226) | $883.85 | $1,607 | 2.1× |
| Ht Muscle Image Spect Sing (78451) | $2,129.05 | $3,871 | 1.6× |
| Hysterosalpingogram (74740) | $590.70 | $1,074 | 2.3× |
| K Flow/Funct Image Multiple (78709) | $858.55 | $1,561 | 1.5× |
| Knee 3 Views (73562) range across 3 matching MRF lines |
$193.05–$384.45 | $351–$699 | varies |
| Lung Ventilat&Perfus Imaging (78582) | $883.85 | $1,607 | 1.5× |
| MRA head w/o contrast (70544) | $1,997.60 | $3,632 | 7.9× |
| Mra Neck W/O &W/Contrast Material (70549) | $2,361.70 | $4,294 | 6.4× |
| MRA neck w/o contrast (70547) | $1,997.60 | $3,632 | 7.9× |
| MRI abdomen w/o contrast (74181) | $1,614.25 | $2,935 | 6.4× |
| MRI any jt lower extrem w/contrast material (73722) | $1,593.90 | $2,898 | 1.9× |
| MRI any jt lower extrem w/o & w/contrast matrl (73723) | $2,180.75 | $3,965 | 5.9× |
| MRI any jt upper extremity w/contrast matrl (73222) | $1,668.70 | $3,034 | 2.0× |
| MRI cervical spine w contrast (72142) | $1,576.30 | $2,866 | 4.3× |
| MRI cervical spine w/o cont (72141) | $1,291.40 | $2,348 | 5.1× |
| MRI lower extrem oth/thn jt w/o & w/contr matr (73720) | $2,333.10 | $4,242 | 6.3× |
| MRI lower extrem oth/thn jt w/o contr matrl (73718) | $1,614.25 | $2,935 | 6.4× |
| Mri Neck Spine W/O & W/Dye (72156) | $2,389.75 | $4,345 | 6.5× |
| MRI orbit face &/neck w/o contrast (70540) | $1,473.45 | $2,679 | 5.9× |
| Mri Orbt/Fac/Nck W/O &W/Dye (70543) | $2,266.55 | $4,121 | 6.2× |
| MRI pelvis w/o & w contrast (72197) | $2,389.75 | $4,345 | 6.5× |
| MRI pelvis w/o contrast (72195) | $1,614.25 | $2,935 | 6.4× |
| MRI thoracic spine w/o contrast (72146) | $1,291.40 | $2,348 | 5.1× |
| MRI upper extremity oth than jt w/o contr matrl (73218) | $1,471.80 | $2,676 | 5.8× |
| Mri Uppr Extremity W/O&W/Dye (73220) | $1,911.80 | $3,476 | 5.2× |
| MRI, abdomen, combo (74183) | $2,060.85 | $3,747 | 5.6× |
| MRI, dorsal spine combo (72157) | $2,237.95 | $4,069 | 6.1× |
| MRI, joint upper extrem (73221) | $1,437.15 | $2,613 | 5.7× |
| MRI, joint upper extrem combo (73223) | $1,911.80 | $3,476 | 5.2× |
| MRI, lumbar spine combo (72158) | $1,939.30 | $3,526 | 5.3× |
| Myocardial Spect Multiple Studies (78452) | $2,846.80 | $5,176 | 2.1× |
| Neck soft tissue (70360) | $161.15 | $293 | 1.8× |
| Parathyroid planar imaging w/wo subtraction (78071) | $883.85 | $1,607 | 2.1× |
| Pelvis 1 or 2 views (72170) | $201.85 | $367 | 1.8× |
| PET image w/CT, full body (78816) | $4,561.70 | $8,294 | 3.0× |
| PET imaging CT attenuation skull base mid-thigh (78815) | $3,996.30 | $7,266 | 2.6× |
| Pulmonary Perfusion Imaging Particulate (78580) | $821.15 | $1,493 | 1.9× |
| Radex Abd Compl Aqt Abd W/S/E/D Views 1 View Ch (74022) | $336.60 | $612 | 3.1× |
| Radex Ankle Complete Minimum 3 Views (73610) range across 3 matching MRF lines |
$201.85–$403.15 | $367–$733 | varies |
| Radex Calcaneus Minimum 2 Views (73650) | $161.15 | $293 | 1.8× |
| Radex elbow complete minimum 3 views (73080) | $201.85 | $367 | 2.2× |
| Radex Facial Bones Complete Minimum 3 Views (70150) | $161.15 | $293 | 1.5× |
| Radex fingr minimum 2 views (73140) | $161.15 | $293 | 1.8× |
| Radex foot complete minimum 3 views (73630) range across 3 matching MRF lines |
$196.35–$294.25 | $357–$535 | varies |
| Radex Hand Minimum 3 Views (73130) | $201.85 | $367 | 2.2× |
| Radex Nasal Bones Complete Minimum 3 Views (70160) | $161.15 | $293 | 1.8× |
| Radex shoulder complete minimum 2 views (73030) | $226.05 | $411 | 2.5× |
| Radex Sinuses Paransl < 3 Views (70210) | $161.15 | $293 | 1.8× |
| Radex Spine 1 View Specify Level (72020) | $161.15 | $293 | 1.8× |
| Radex Sternum Minimum 2 Views (71120) | $161.15 | $293 | 1.8× |
| Radex Temporomandble Jt Opn & Clsd Mouth Bilat (70330) | $161.15 | $293 | 1.8× |
| Radex Toe Minimum 2 Views (73660) | $161.15 | $293 | 1.8× |
| Radex Wrist Complete Minimum 3 Views (73110) | $215.60 | $392 | 2.3× |
| Radiolog exam mandible compl minimum 4 views (70110) | $161.15 | $293 | 1.5× |
| Radiologic Exam Abdomen 3+ Views - Xr Abdomen 3+ Views (74021) | $336.60 | $612 | 3.1× |
| Radiologic exam colon double contrast study (74280) | $485.10 | $882 | 2.6× |
| Radiologic exam colon single contrast study (74270) | $328.90 | $598 | 1.8× |
| Radiologic exam knee complete 4/more views (73564) range across 3 matching MRF lines |
$201.85–$248.60 | $367–$452 | varies |
| Radiologic exam pelvis compl minimum 3 views (72190) | $242 | $440 | 2.2× |
| Radiologic Exam Small Int Single Contrast Study (74250) | $328.90 | $598 | 1.8× |
| Radiologic exam swallow function contrast study (74230) | $328.90 | $598 | 1.8× |
| Radiologic exam upr gi trc double contrast study (74246) | $328.90 | $598 | 1.8× |
| Radiologic examination femur 1 view (73551) | $141.35 | $257 | 1.5× |
| Radiologic examination femur minimum 2 views (73552) range across 3 matching MRF lines |
$161.15–$321.20 | $293–$584 | varies |
| Radiologic examination knee 1/2 views (73560) range across 3 matching MRF lines |
$201.85–$322.30 | $367–$586 | varies |
| Radiologic examination tibia & fibula 2 views (73590) range across 3 matching MRF lines |
$201.85–$250.25 | $367–$455 | varies |
| Scapula (73010) | $161.15 | $293 | 1.5× |
| Screening Digital Breast Tomosynthesis Bi (77063) | $56.65 | $103 | 2.4× |
| Shoulder 1 view (73020) | $161.15 | $293 | 1.8× |
| Shoulder Arthrography (73040) | $764.50 | $1,390 | 2.1× |
| Skull less than 4 views (70250) | $161.15 | $293 | 1.5× |
| Sternoclavicular joints (71130) | $161.15 | $293 | 1.8× |
| Thoracic spine 2 views (72070) | $161.15 | $293 | 1.5× |
| Thoracic spine 3 views (72072) | $161.15 | $293 | 1.5× |
| Thoracolumbar 2 views (72080) | $161.15 | $293 | 1.8× |
| Thyroid Uptake W/Blood Flow Sngle/Mult Quan Meas (78014) | $883.85 | $1,607 | 2.1× |
| Ultrasound Breast Limited (76642) | $232.10 | $422 | 2.5× |
| Ultrasound Exam Aaa Screen (76706) | $300.30 | $546 | 2.7× |
| Ultrasound, abdomen limited (76705) | $233.20 | $424 | 2.1× |
| Umbilical-artery Doppler (OB) (76820) | $202.40 | $368 | 1.8× |
| Urethrocystogram voiding (74455) | $521.40 | $948 | 2.1× |
| Urethrocystography retrograde (74450) | $521.40 | $948 | 2.1× |
| Us breast unilateral complete (76641) | $266.20 | $484 | 2.4× |
| Us exam, pelvic, limited (76857) | $109.45 | $199 | 1.0× |
| Us lmtd joint/oth nonvasc xtr strux r-t w/img (76882) | $198 | $360 | 1.8× |
| Us ob detailed single fetus (76811) | $350.35 | $637 | 1.4× |
| Us ob limited 1 or more fetuses (76815) | $175.45 | $319 | 1.6× |
| Us ob transvaginal (76817) | $202.40 | $368 | 1.8× |
| Us pelvic non ob complete (76856) | $315.70 | $574 | 2.9× |
| Us pg uter img f&mat 14 wk tabdl 1/1st gestation (76801) | $253 | $460 | 2.3× |
| Us preg uterus real time f/u trnsabdl per fetus (76816) | $218.90 | $398 | 2.0× |
| Us retroperitoneal complete (76770) | $272.25 | $495 | 2.5× |
| Us scrotum and contents (76870) | $217.80 | $396 | 2.0× |
| Us thyroid (76536) | $251.35 | $457 | 2.3× |
| Wrist 2 views (73100) | $201.85 | $367 | 2.2× |
| X-Ray Ac Jts - Xr Acromioclavicular Joints Bilateral (73050) | $161.15 | $293 | 1.8× |
| X-Ray Bend Only L-S Spine (72120) | $161.15 | $293 | 1.5× |
| X-Ray Elbow 2 Vw - Xr Elbow 1-2 Views Right (73070) | $161.15 | $293 | 1.8× |
| X-Ray Exam Breast Specimen (76098) | $312.95 | $569 | 0.5× |
| X-Ray Exam Entire Spi 2/3 Vw (72082) | $435.05 | $791 | 3.9× |
| X-Ray Exam Hip Uni 1 View (73501) | $393.80 | $716 | 4.3× |
| X-Ray Exam Hip Uni 2-3 Views (73502) | $312.95 | $569 | 3.4× |
| X-Ray Exam Hips Bi 2 Views (73521) | $469.15 | $853 | 4.3× |
| X-Ray Exam Hips Bi 3-4 Views (73522) | $534.60 | $972 | 4.8× |
| X-Ray Exam L-S Spine Bending (72114) | $269.50 | $490 | 2.4× |
| X-Ray Exam Neck Spine 2-3 Vw (72040) | $199.10 | $362 | 2.2× |
| X-Ray Exam Neck Spine 6/>Vws (72052) | $394.35 | $717 | 3.6× |
| X-Ray Exam Unilat Ribs/Chest (71101) | $240.90 | $438 | 2.2× |
| X-ray eye for foreign body (70030) | $161.15 | $293 | 1.8× |
| X-ray humerus (73060) | $161.15 | $293 | 1.8× |
| X-Ray Knee Bilat Standing - Xr Knees Anteroposterior Standing Bilat (73565) | $161.15 | $293 | 1.8× |
| X-Ray Lumbar Spine 2/3 Vw - Xr Lumbar Spine 2-3 Views (72100) | $201.85 | $367 | 1.8× |
| X-ray nose-rectum child f.b. (76010) | $193.60 | $352 | 2.1× |
| X-Ray Ribs, Chest 4+ Vw - Xr Ribs 3 Vws Bil W/ Chest Posteroanterior (71111) | $254.10 | $462 | 2.3× |
| X-Ray Sacroiliac Jts 3+ Vw - Xr Sacroiliac Joints 3+ Views (72202) | $161.15 | $293 | 1.5× |
| X-Ray Sacrum/Coccyx 2+ Vw - Xr Sacrum Coccyx 2+ Views (72220) | $161.15 | $293 | 1.8× |
| X-Ray Sinuses 3+ Vw - Xr Paranasal Sinuses 3+ Views (70220) | $217.25 | $395 | 2.4× |
| X-Rays Bone Survey Complete (77075) | $435.05 | $791 | 3.9× |
| Xr c-spine 4 or 5 views (72050) | $336.60 | $612 | 3.1× |
| Xr orbits complete 4 views (70200) | $165 | $300 | 1.5× |
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.