Imaging prices at Sedgwick County Memorial Hospital

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

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

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ProcedurePosted cashPosted gross× Medicare
Abdomen 1 View (74018) $235 $235 2.6×
Abdomen 2 views (74019) $393 $393 3.6×
Acute Gastrointestinal Blood Loss Imaging (78278) $1,989 $1,989 4.7×
Ankle 2 views (73600) $205 $205 2.2×
Bone Imaging 3 Phase (78315) $1,904 $1,904 4.5×
Bone Imaging Limited Area (78300) $1,546 $1,546 3.7×
Bone Imaging Multiple Areas (78305) $1,724 $1,724 4.1×
Bone Imaging Whole Body (78306) $1,838 $1,838 4.4×
Bone survey infant (77076) $550 $550 5.0×
Chest 1 view (71045) $235 $235 2.6×
Chest 2 views (71046) $293 $293 3.2×
Chest 3 views (71047) $366 $366 4.0×
Clavicle complete (73000) $263 $263 2.9×
Computed Tomography Thorax Lw Dose Lng Ca Scr C- (71271) $2,092 $2,092 19.0×
CT abdomen and pelvis without and with contrast (74178) $7,151 $7,151 19.4×
CT abdomen and pelvis without contrast (74176) $4,604 $4,604 18.3×
CT abdomen w contrast (74160) $2,994 $2,994 16.2×
CT abdomen w wo contrast (74170) $3,811 $3,811 20.6×
CT abdomen w/o contrast (74150) $2,304 $2,304 20.9×
CT Angio Abdomen and Pelvis (74174) $8,469 $8,469 23.0×
CT Angio Chest (71275) $7,049 $7,049 38.1×
CT Angio Head (70496) $7,049 $7,049 38.1×
Ct Angio Lwr Extr W/O&W/Dye (73706) $2,994 $2,994 16.2×
CT Angio Neck (70498) $7,049 $7,049 38.1×
Ct Angio Upr Extrm W/O&W/Dye (73206) $5,341 $5,341 28.9×
CT bone density (77078) $219 $219 2.4×
CT cervical spine w/ contrast (72126) $2,994 $2,994 8.1×
CT cervical spine w/o contrast (72125) $2,304 $2,304 20.9×
CT cervical spine w/wo cont (72127) $4,235 $4,235 22.9×
CT chest w contrast (71260) $2,994 $2,994 16.2×
CT chest w/wo contrast (71270) $4,235 $4,235 22.9×
CT head/brain with contrast (70460) $5,419 $5,419 29.3×
CT head/brain without and with contrast (70470) $7,366 $7,366 39.8×
CT heart no contrast quant eval coronry calcium (75571) $174 $174 1.9×
CT iac w contrast (70481) $2,994 $2,994 16.2×
CT l-spine w&w/o contrast (72133) $3,811 $3,811 20.6×
CT lower ext w/o (73700) $2,304 $2,304 20.9×
CT lower extremity w/contrast material (73701) $2,428 $2,428 13.1×
CT lumbar spine w contrast (72132) $2,994 $2,994 8.1×
CT lumbar spine w/o contrast (72131) $2,304 $2,304 20.9×
CT maxillofacial w contrast (70487)
range across 2 matching MRF lines		 $3,403–$3,845 $3,403–$3,845 varies
CT maxillofacial wo contrast (70486) $2,304 $2,304 20.9×
CT neck tissue combo (70492) $3,811 $3,811 20.6×
Ct Orbit/Ear/Fossa W/O&W/Dye (70482) $3,811 $3,811 20.6×
CT orbits w/o contrast (70480) $2,304 $2,304 20.9×
CT pelvis w&w/o contrast (72194) $3,811 $3,811 20.6×
CT pelvis w/o contrast (72192) $2,304 $2,304 20.9×
CT scan of leg combo (73702) $5,341 $5,341 28.9×
CT scans face/jaw combo (70488) $3,811 $3,811 20.6×
CT soft tissue neck w contrast (70491) $2,994 $2,994 16.2×
CT soft tissue neck w/o contrast (70490) $2,304 $2,304 20.9×
CT thoracic spine w contrast (72129) $3,683 $3,683 19.9×
CT thoracic spine w/o contrast (72128) $2,304 $2,304 20.9×
CT thoracic spine w/wo cont (72130) $3,811 $3,811 20.6×
CT thorax w/o contrast (71250)
range across 3 matching MRF lines		 $2,092–$2,304 $2,092–$2,304 varies
CT upper ext wo (73200) $2,304 $2,304 20.9×
CT upper extremity w/o & w/contrast material (73202) $3,683 $3,683 19.9×
CT upper extremity with contrast (73201) $2,994 $2,994 8.1×
Cta Abdl Aorta&Bi Iliofem W/Contrast&Postp (75635) $3,811 $3,811 20.6×
Cta Abdomen (74175) $7,049 $7,049 38.1×
CTA pelvis (72191) $4,235 $4,235 22.9×
Fetal Biophysical Profile W/O Non-Stress Testing (76819) $732 $732 6.6×
Fluoroscopy up to 1 hr (76000) $569 $569 2.3×
Foot 2 views (73620) $205 $205 2.2×
Forearm 2 views (73090) $235 $235 2.6×
Gastric emptying imaging study (78264) $1,838 $1,838 4.4×
Gated Heart Planar Single (78472) $3,187 $3,187 7.6×
Hand 2 views (73120) $205 $205 1.9×
Hepatobil Syst Image W/Drug (78227) $2,826 $2,826 4.9×
Hepatobiliary System Imaging (78226) $2,532 $2,532 6.0×
Ht Muscle Image Spect Sing (78451) $2,652 $2,652 1.9×
K Flow/Funct Image Multiple (78709) $2,880 $2,880 5.0×
K Flow/Funct Image W/Drug (78708) $2,857 $2,857 5.0×
K Flow/Funct Image W/O Drug (78707) $2,826 $2,826 4.9×
Kidney Imaging Morphol (78700) $2,377 $2,377 5.6×
Kidney Imaging Morphoogy W/Vascular Flow (78701) $2,692 $2,692 6.4×
Knee 3 Views (73562) $321 $321 3.5×
Liver & Spleen Imaging Static Only (78215) $1,584 $1,584 3.8×
Liver & Spleen Imaging W/Vascular Flow (78216) $2,470 $2,470 5.9×
Lung Perf&Ventilat Diferentl (78598) $4,866 $4,866 8.5×
Lung perfusion differential (78597) $3,927 $3,927 9.3×
Lung Ventilation Imaging (78579) $3,756 $3,756 8.9×
Magnetic Image Jaw Joint (70336) $3,328 $3,328 13.2×
Meckels Divert Exam (78290) $3,444 $3,444 8.2×
Mra Head W/O & W/Contrast Material (70546) $5,560 $5,560 15.1×
MRA head w/o contrast (70544) $3,428 $3,428 13.6×
MRA head with contrast (70545) $3,503 $3,503 9.5×
MRA neck w contrast (70548) $3,503 $3,503 9.5×
Mra Neck W/O &W/Contrast Material (70549) $5,560 $5,560 15.1×
MRA neck w/o contrast (70547) $3,428 $3,428 13.6×
MRI abdomen w contrast (74182) $3,403 $3,403 9.2×
MRI abdomen w/o contrast (74181) $3,328 $3,328 13.2×
MRI any jt lower extrem w/contrast material (73722) $3,403 $3,403 4.1×
MRI any jt lower extrem w/o & w/contrast matrl (73723) $5,400 $5,400 14.7×
MRI any jt upper extremity w/contrast matrl (73222) $3,403 $3,403 4.1×
MRI cervical spine w contrast (72142) $3,403 $3,403 9.2×
MRI cervical spine w/o cont (72141) $3,328 $3,328 13.2×
MRI chest w/o contrast (71550) $3,328 $3,328 13.2×
MRI chest with contrast (71551) $3,403 $3,403 4.1×
MRI chest wo w contrast (71552) $5,400 $5,400 14.7×
MRI lower extrem oth/thn jt w/contrast matrl (73719) $3,403 $3,403 9.2×
MRI lower extrem oth/thn jt w/o & w/contr matr (73720) $5,400 $5,400 14.7×
MRI lower extrem oth/thn jt w/o contr matrl (73718) $3,328 $3,328 13.2×
MRI lumbar spine w contrast (72149) $3,403 $3,403 9.2×
Mri Neck Spine W/O & W/Dye (72156) $5,400 $5,400 14.7×
MRI orbit face &/neck w/o contrast (70540) $3,328 $3,328 13.2×
MRI orbit face neck w contrast (70542) $3,403 $3,403 9.2×
Mri Orbt/Fac/Nck W/O &W/Dye (70543) $5,400 $5,400 14.7×
MRI pelvis w contrast (72196) $3,403 $3,403 9.2×
MRI pelvis w/o & w contrast (72197) $5,400 $5,400 14.7×
MRI pelvis w/o contrast (72195) $3,328 $3,328 13.2×
MRI thoracic spine w/o contrast (72146) $3,328 $3,328 13.2×
MRI upper extremity oth than jt w/contr matrl (73219) $3,403 $3,403 9.2×
MRI upper extremity oth than jt w/o contr matrl (73218) $3,328 $3,328 13.2×
Mri Uppr Extremity W/O&W/Dye (73220) $5,400 $5,400 14.7×
MRI, abdomen, combo (74183) $5,400 $5,400 14.7×
MRI, dorsal spine combo (72157) $5,400 $5,400 14.7×
MRI, dorsal spine contrast (72147) $3,403 $3,403 9.2×
MRI, joint upper extrem (73221) $3,328 $3,328 13.2×
MRI, joint upper extrem combo (73223)
range across 8 matching MRF lines		 $3,403–$5,400 $3,403–$5,400 varies
MRI, lumbar spine combo (72158) $5,400 $5,400 14.7×
Myocardial Spect Multiple Studies (78452) $5,669 $5,669 4.2×
Neck soft tissue (70360) $366 $366 4.0×
Oph US Dx B-Scan&Quan a-Scan Sm Pt Enctr (76510) $252 $252 1.8×
Parathyroid Planar Imaging (78070) $1,311 $1,311 3.1×
Parathyroid planar imaging w/wo subtraction (78071) $1,515 $1,515 3.6×
Pelvis 1 or 2 views (72170) $263 $263 2.4×
Pulmonary Perfusion Imaging Particulate (78580) $3,756 $3,756 8.9×
Radex Abd Compl Aqt Abd W/S/E/D Views 1 View Ch (74022) $482 $482 4.4×
Radex Ankle Complete Minimum 3 Views (73610) $263 $263 2.9×
Radex Calcaneus Minimum 2 Views (73650) $263 $263 2.9×
Radex elbow complete minimum 3 views (73080) $293 $293 3.2×
Radex Facial Bones Complete Minimum 3 Views (70150) $437 $437 4.0×
Radex fingr minimum 2 views (73140) $205 $205 2.2×
Radex foot complete minimum 3 views (73630) $263 $263 2.9×
Radex Hand Minimum 3 Views (73130) $263 $263 2.9×
Radex lower extremity infant minimum 2 views (73592) $321 $321 3.5×
Radex Nasal Bones Complete Minimum 3 Views (70160) $293 $293 3.2×
Radex Ribs Unilateral 2 Views (71100) $366 $366 4.0×
Radex shoulder complete minimum 2 views (73030) $235 $235 2.6×
Radex Sinuses Paransl < 3 Views (70210) $235 $235 2.6×
Radex Spine 1 View Specify Level (72020) $263 $263 2.9×
Radex Sternum Minimum 2 Views (71120) $321 $321 3.5×
Radex Temporomandble Jt Opn & Clsd Mouth Bilat (70330) $509 $509 5.5×
Radex Toe Minimum 2 Views (73660) $205 $205 2.2×
Radex upper extremity infant minimum 2 views (73092) $321 $321 2.9×
Radex Wrist Complete Minimum 3 Views (73110) $263 $263 2.9×
Radiolog exam mandible compl minimum 4 views (70110) $437 $437 4.0×
Radiologic Exam Abdomen 3+ Views - Xr Abdomen 3+ Views (74021) $462 $462 4.2×
Radiologic exam knee complete 4/more views (73564) $366 $366 3.3×
Radiologic exam pelvis compl minimum 3 views (72190) $263 $263 2.4×
Radiologic exam swallow function contrast study (74230) $361 $361 2.0×
Radiologic examination femur 1 view (73551) $240 $240 2.6×
Radiologic examination femur minimum 2 views (73552) $293 $293 3.2×
Radiologic examination knee 1/2 views (73560) $263 $263 2.9×
Radiologic examination tibia & fibula 2 views (73590) $293 $293 3.2×
Ribs bilateral 3 views (71110) $437 $437 4.0×
Scapula (73010) $293 $293 2.7×
Shoulder 1 view (73020) $235 $235 2.6×
Skull less than 4 views (70250) $366 $366 3.3×
Sternoclavicular joints (71130) $321 $321 3.5×
Testicular Imaging W/Flow (78761) $1,311 $1,311 3.1×
Thoracic spine 2 views (72070) $410 $410 3.7×
Thoracolumbar 2 views (72080) $410 $410 4.5×
Thyroid Imaging With Vascular Flow (78013) $1,311 $1,311 3.1×
Thyroid Uptake W/Blood Flow Sngle/Mult Quan Meas (78014) $1,693 $1,693 4.0×
Ultrasound Breast Limited (76642) $732 $732 8.0×
Ultrasound, abdomen limited (76705)
range across 3 matching MRF lines		 $56–$732 $56–$732 varies
Unlisted us procedure (76999) $732 $732 8.0×
Upper gi w/o kub (74240)
range across 2 matching MRF lines		 $362–$747 $362–$747 varies
Ureteral Reflux Study (78740) $1,408 $1,408 3.3×
Us breast unilateral complete (76641) $732 $732 6.6×
Us chest (76604)
range across 3 matching MRF lines		 $56–$732 $56–$732 varies
Us complete joint (76881) $732 $732 6.6×
Us exam, pelvic, limited (76857) $732 $732 6.6×
Us lmtd joint/oth nonvasc xtr strux r-t w/img (76882) $732 $732 6.6×
Us ob detailed single fetus (76811) $732 $732 2.9×
Us ob limited 1 or more fetuses (76815) $732 $732 6.6×
Us ob transvaginal (76817) $732 $732 6.6×
Us pelvic non ob complete (76856) $732 $732 6.6×
Us pg uter img f&mat 14 wk tabdl 1/1st gestation (76801) $732 $732 6.6×
Us preg uterus real time f/u trnsabdl per fetus (76816) $732 $732 6.6×
Us retroperitoneal complete (76770) $732 $732 6.6×
Us retroperitoneal limited (76775)
range across 3 matching MRF lines		 $56–$356 $56–$356 varies
Us scrotum and contents (76870) $732 $732 6.6×
Us thyroid (76536) $732 $732 6.6×
Wrist 2 views (73100) $205 $205 2.2×
X-Ray Ac Jts - Xr Acromioclavicular Joints Bilateral (73050) $366 $366 4.0×
X-Ray Bend Only L-S Spine (72120) $410 $410 3.7×
X-Ray Elbow 2 Vw - Xr Elbow 1-2 Views Right (73070) $235 $235 2.6×
X-Ray Exam Entire Spi 1 Vw (72081) $410 $410 4.5×
X-Ray Exam Entire Spi 2/3 Vw (72082) $844 $844 7.7×
X-Ray Exam Hip Uni 1 View (73501) $293 $293 3.2×
X-Ray Exam Hip Uni 2-3 Views (73502) $410 $410 4.5×
X-Ray Exam Hips Bi 2 Views (73521) $820 $820 7.4×
X-Ray Exam L-S Spine Bending (72114) $524 $524 4.8×
X-Ray Exam Neck Spine 2-3 Vw (72040) $366 $366 4.0×
X-Ray Exam Neck Spine 6/>Vws (72052) $554 $554 5.0×
X-Ray Exam Unilat Ribs/Chest (71101) $494 $494 4.5×
X-ray eye for foreign body (70030) $294 $294 3.2×
X-ray humerus (73060) $293 $293 3.2×
X-Ray Jaw <4 Vw - Xr Mandible < 4 Views (70100) $293 $293 3.2×
X-Ray Knee Bilat Standing - Xr Knees Anteroposterior Standing Bilat (73565) $235 $235 2.6×
X-Ray Lumbar Spine 2/3 Vw - Xr Lumbar Spine 2-3 Views (72100) $410 $410 3.7×
X-ray nose-rectum child f.b. (76010) $176 $176 1.9×
X-Ray Ribs, Chest 4+ Vw - Xr Ribs 3 Vws Bil W/ Chest Posteroanterior (71111) $580 $580 5.3×
X-Ray Sacroiliac Jts 3+ Vw - Xr Sacroiliac Joints 3+ Views (72202) $366 $366 3.3×
X-Ray Sacrum/Coccyx 2+ Vw - Xr Sacrum Coccyx 2+ Views (72220) $366 $366 4.0×
X-Ray Sinuses 3+ Vw - Xr Paranasal Sinuses 3+ Views (70220) $437 $437 4.8×
X-Ray Skull 4+ Vw - Xr Skull Complete 4+ Views (70260) $509 $509 4.6×
X-Ray Stress View (77071) $205 $205 2.2×
X-ray thoracic spine 4 vw (72074) $784 $784 7.1×
X-Ray Tmj Unilat (70328) $437 $437 4.8×
X-Rays Bone Survey Complete (77075) $1,161 $1,161 10.5×
Xr c-spine 4 or 5 views (72050) $509 $509 4.6×
Xr facial bones less than 3 views (70140) $293 $293 3.2×

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.