Imaging prices at Southwest Memorial Hospital

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

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

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ProcedureCash priceGross charge× Medicare
Abdomen 2 views (74019) $120 $240 1.1×
Acute gastrointestinal blood loss imaging (78278) $950 $1,899 2.3×
Acute venous thrombus image (78456) $822 $1,644 0.6×
Ankle 2 views (73600) $70 $140 0.8×
Arthrogram elbow (73085) $290 $579 0.8×
Arthrogram hip (73525) $334 $668 0.9×
Arthrogram shoulder (73040) $359 $718 1.0×
Arthrogram wrist (73115) $328 $655 0.9×
Arthrography knee lt (73580) $360 $719 1.0×
Bone &/Joint Imaging Limited Area (78300) $520 $1,040 1.2×
Bone &/joint imaging whole body (78306) $788 $1,576 1.9×
Bone survey complete (77075) $315 $629 2.9×
Cervical spine 2 or 3 views (72040) $120 $239 1.3×
Chest 1 view (71045) $84 $168 0.9×
Chest 3 views (71047) $195 $389 2.1×
Cine/Vid X-Ray Throat/Esoph - Fl Esoph Barium Swlw W/ Video & Speech (74230) $288 $575 1.6×
Clavicle complete (73000) $108 $216 1.2×
Computed Tomography Thorax Lw Dose Lng Ca Scr C- (71271) $827 $1,653 7.5×
Contrast Xray Throat/Cerv Esopha - Fl Esophagus Pharynx (74210) $209 $418 1.1×
CT abdomen and pelvis without and with contrast (74178) $2,117 $4,234 5.8×
CT abdomen and pelvis without contrast (74176) $1,407 $2,814 5.6×
CT abdomen w contrast (74160) $1,191 $2,381 6.4×
CT abdomen w wo contrast (74170) $1,448 $2,896 7.8×
CT abdomen w/o contrast (74150) $928 $1,855 8.4×
CT angio hrt w/3d image (75574) $1,400 $2,799 3.8×
CT angiography upper extremity lt (73206) $1,735 $3,470 9.4×
CT c-spine w/o contrast (72125) $1,012 $2,023 9.2×
CT cervical spine w&w/o contrast (72127) $1,220 $2,440 6.6×
CT cervical spine with contrast (72126) $1,143 $2,286 3.1×
CT chest w/wo contrast (71270) $1,232 $2,464 6.7×
CT chest with contrast (71260) $1,207 $2,413 6.5×
CT head/brain with contrast (70460) $1,083 $2,165 5.9×
CT head/brain without and with contrast (70470) $1,261 $2,521 6.8×
CT heart no contrast quant eval coronry calcium (75571) $234 $467 2.5×
CT iac w contrast (70481) $1,200 $2,399 6.5×
CT lower ext w/o (73700) $714 $1,428 6.5×
CT lower extremity w wo contrast (73702) $1,167 $2,334 6.3×
CT lower extremity with contrast (73701) $875 $1,750 4.7×
CT lumbar spine w & w/o contrast (72133) $1,219 $2,437 6.6×
CT lumbar spine w/o contrast (72131) $945 $1,889 8.6×
CT lumbar spine with contrast (72132) $962 $1,923 2.6×
CT maxillofacial w contrast (70487) $918 $1,835 5.0×
CT maxillofacial w/o contrast (70486) $935 $1,870 8.5×
CT maxillofacial w/wo contrast (70488) $1,152 $2,304 6.2×
CT neck soft tissue w contrast (70491) $1,088 $2,175 5.9×
CT orbit sella/post fossa/ear w/o & w/contr matr (70482) $1,407 $2,814 7.6×
CT orbits w/o contrast (70480) $1,027 $2,053 9.3×
CT pelvis w & w/o contrast (72194) $1,136 $2,272 6.1×
CT pelvis w/o contrast (72192) $928 $1,855 8.4×
CT soft tissue neck w/o & w/contrast material (70492) $1,136 $2,272 6.1×
CT soft tissue neck w/o contrast (70490) $745 $1,489 6.8×
CT thoracic spine w/contrast (72129) $998 $1,995 5.4×
CT thoracic spine w/o contrast (72128) $795 $1,589 7.2×
CT thoracic spine w/wo contrast (72130) $1,218 $2,435 6.6×
CT thorax w/o contrast (71250) $827 $1,653 7.5×
CT upper extremity w/o & w/contrast material (73202) $1,158 $2,315 6.3×
CT upper extremity w/o contrast rt (73200) $872 $1,743 7.9×
CT upper extremity with contrast (73201) $886 $1,771 2.4×
Cta Abdl Aorta&Bi Iliofem W/Contrast&Postp (75635) $1,796 $3,591 9.7×
Cta Abdomen (74175) $1,677 $3,354 9.1×
CTA abdomen pelvis (74174) $476 $951 1.3×
CTA chest (71275) $1,178 $2,355.50 6.4×
Cta Head (70496) $1,762 $3,524 9.5×
CTA head&neck c+ w/noncontrast img&post-pxessing (70471) $472 $943 1.3×
CTA lwr ext w&w/o contrast (73706) $1,732 $3,464 9.4×
Cta Neck (70498) $1,632 $3,263 8.8×
Cta Pelvis (72191) $1,195 $2,390 6.5×
Cystography minimum 3 views rs&i (74430) $329 $657 0.9×
Dacryocystography (70170) $310 $620 1.2×
Dxa bone density study 1/> sites axial skel (77080) $382 $764 3.5×
Dxa bone density study 1/>sites appendiclr skel (77081) $327 $653 3.6×
Dxa bone density study axial skeleton (77085) $364 $728 3.3×
Echoencephalography real time imaging (76506) $313 $626 2.8×
Esophagus (74220) $346 $692 1.9×
Fetal biophysical profile non-stress testing (76818) $351 $701 3.2×
Fetal Biophysical Profile W/O Non-Stress Testing (76819) $207.50 $414.50 1.9×
Fluoroscopy up to 1 hr (76000) $314 $628 1.2×
Foot 2 views (73620) $73 $145 0.8×
Forearm 2 views (73090) $108 $216 1.2×
Gated Heart Planar Single (78472) $886 $1,772 2.1×
Hand 2 views (73120) $89 $177 0.8×
Hand 3 views (73130) $124 $248 1.4×
Hepatobiliary syst imaging including gallbladder (78226) $898 $1,796 2.1×
Ht muscle image spect sing (78451) $1,350 $2,700 1.0×
Humerus Min 2 Views Left (73060) $119 $237 1.3×
Hysterosalpingogram (74740) $289 $578 1.1×
Kidney Img Morphology Vascular Flow 1 W/O Rx (78707) $676 $1,351 1.2×
Kidney img morphology vascular flow 1 w/rx (78708) $686 $1,371 1.2×
Knee 3 views (73562) $130 $260 1.4×
Liver & Spleen Imaging W/Vascular Flow (78216) $426 $852 1.0×
Lung Ventilation Imaging (78579) $494 $988 1.2×
Lymphoscintigraphy (78195) $986 $1,971 1.7×
Mammary ductogram or galactogram multiple (77054) $294 $587 1.2×
Mammary ductogram or galactogram single (77053) $241 $482 1.0×
Meckels Diverticulum (78290) $728 $1,456 1.7×
MRA head w & w/o contrast (70546) $2,325 $4,650 6.3×
MRA head w/o contrast (70544) $1,770 $3,540 7.0×
MRA neck w contrast (70548) $1,540 $3,080 4.2×
Mra Neck W/O &W/Contrast Material (70549) $2,455 $4,909 6.7×
MRA neck w/o contrast (70547) $878 $1,756 3.5×
MRI abdomen w contrast (74182) $1,934 $3,868 5.3×
MRI abdomen w/o & w/contrast material (74183) $2,625 $5,250 7.1×
MRI abdomen w/o contrast (74181) $1,427 $2,853 5.7×
MRI any jnt lwr ext with con lt (73722) $1,638 $3,276 2.0×
MRI any jt upper extremity w/contrast matrl (73222) $2,009 $4,018 2.4×
MRI c-spine with contrast (72142) $1,600 $3,200 4.3×
MRI cervical spine w/o contrast (72141) $1,518 $3,036 6.0×
MRI chest w/o & w/contrast material (71552) $1,317 $2,633 3.6×
MRI chest w/o contrast (71550) $1,066 $2,132 4.2×
MRI chest with contrast (71551) $1,317 $2,633 1.6×
MRI Forearm w/ Contrast Bilateral 73219 (73219) $1,845 $3,689 5.0×
MRI lower extrem oth/thn jt w/contrast matrl (73719) $1,890 $3,779 5.1×
MRI lower extrem oth/thn jt w/o contr matrl (73718) $1,718 $3,435 6.8×
MRI orbit face &/neck w/o contrast (70540) $1,579 $3,158 6.3×
MRI orbit/face/neck w&w/o cont (70543) $2,707 $5,414 7.4×
MRI orbit/face/neck w/contrast (70542) $1,803 $3,605 4.9×
MRI pelvis w/o & w/contrast material (72197) $2,397 $4,794 6.5×
MRI pelvis w/o contrast (72195) $1,851 $3,702 7.4×
MRI scan of arm joint before and after contrast (73223) $2,642 $5,284 7.2×
MRI scan of leg joint before and after contrast (73723) $1,821 $3,641 4.9×
MRI spinal canal cervical w/o & w/contr matrl (72156) $2,161 $4,322 5.9×
MRI spinal canal lumbar w/contrast material (72149) $1,583 $3,165 4.3×
MRI spinal canal lumbar w/o & w/contr matrl (72158) $2,138 $4,275 5.8×
MRI spinal canal thoracic w/contrast matrl (72147) $1,657 $3,313 4.5×
MRI spinal canal thoracic w/o & w/contr matrl (72157) $2,268 $4,535 6.2×
MRI thoracic spine w/o contrast (72146) $1,583 $3,166 6.3×
MRI tmj (70336) $1,726 $3,452 6.9×
MRI upper ext joint w/o contrast (73221) $1,467 $2,934 5.8×
MRI upper extrem other than jt w/o & w/contras (73220) $2,723 $5,446 7.4×
MRI upper extremity oth than jt w/o contr matrl (73218) $1,808 $3,615 7.2×
Myelogram Cervical (72240) $1,263 $2,526 1.5×
Myelogram Lumbar (72265) $1,263 $2,526 1.5×
Myelogram thoracic (72255) $1,263 $2,526 1.5×
Myocardial Spect Multiple Studies (78452) $1,735 $3,469 1.3×
Neck soft tissue (70360) $88 $175 1.0×
Nm cisternogram (78630) $850 $1,700 1.5×
Nm gastric emptying study (78264) $691 $1,381 1.6×
Nuclear medicine study of kidney and blood flow (78701) $647 $1,294 1.5×
Osseous survey limited (77074) $193 $386 1.8×
Parathyroid imaging (78070) $505 $1,009 1.2×
Pelvis 1 or 2 views (72170) $108 $216 1.0×
Pr MRI, lower extr, w/o contrast f/u by contrast (73720) $2,509 $5,017 6.8×
Pulmonary Perfusion Imaging Particulate (78580) $541 $1,082 1.3×
Radex abscess/fistula/sinus tract rs&i (76080) $615 $1,230 1.1×
Radex Entir Thrc Lmbr Crv Sac Spi W/Skull 1 Vw - Xr Scoliosis 1 Vw (72081) $81 $162 0.9×
Radex entir thrc lmbr crv sac spi w/skull 2/3 vw (72082) $91 $181 0.8×
Radex hips bilateral with pelvis 2 views (73521) $82 $163.50 0.7×
Radex mastoids compl minimum 3 views pr side (70130) $151 $301 1.4×
Radex X-Ray Exam Entire Spi 6/> Vw - Xr Entire Spine 6+ Vw (72084) $110 $219 1.0×
Radiolog exam mandible compl minimum 4 views (70110) $128 $255 1.2×
Radiologic Exam Abdomen 1 View - Xr Abdomen 1 View (74018) $90 $180 1.0×
Radiologic Exam Chest 2 Views - Xr Chest 2 Views (71046) $118 $236 1.3×
Radiologic exam colon single contrast study (74270) $413 $826 2.2×
Radiologic exam upr gi trc double contrast study (74246) $417 $834 2.3×
Radiologic exam upr gi trc single contrast study (74240) $284 $568 1.5×
Radiologic Examination Femur Minimum 2 Views - Xr Femur 2+ Vw Lt (73552) $81 $161 0.9×
Radiologic Examination Salivary Gland Calculus (70380) $107 $214 1.2×
Radiological examination surgical specimen (76098) $547 $1,093 0.9×
Ribs bilateral 3 views (71110) $139 $277 1.3×
Rp loclzj tum plnr whole body single day imaging (78802) $874 $1,747 1.5×
Rp loclzj tum spect 1 area single day imaging (78803) $1,180 $2,359 2.1×
Scapula complete (73010) $95 $189 0.9×
Screening digital breast tomosynthesis (77063) $108 $216 4.6×
Sella turcica (70240) $81 $161 0.9×
Shuntogram indwelling nonvascular shunt rs&i (75809) $372 $743 3.4×
Sialogram (70390) $279 $557 1.1×
Small bowel series (74250) $374 $748 2.0×
Speech evaluation complex (70371) $307 $613 1.2×
Spine thoracic 3 views (72072) $142 $283 1.3×
Temporomandble Jt Arthrography Rs&I (70332) $271 $541 1.1×
Therapeutic Enema (74283) $636 $1,271 3.4×
Thoracolumbar 2 views (72080) $101 $201 1.1×
Thyroid carcinoma metastases img whole body (78018) $856 $1,712 1.5×
Thyroid Imaging With Vascular Flow (78013) $446 $891 1.1×
Thyroid Uptake W/Blood Flow Sngle/Mult Quan Meas (78014) $515 $1,029 1.2×
Ultrasound, abdomen limited (76705) $320.50 $640.50 2.9×
Upper Extremity Infant (73092) $75 $150 0.7×
Urethrocystography retrograde rs&i (74450) $148 $296 0.6×
Urethrocystography voiding (74455) $253 $506 1.0×
Urography (pyelography), intravenous, with or without KUB, with or without tomography (74400) $463 $926 2.5×
Us breast unilateral complete (76641) $284.50 $568 2.6×
Us chest (76604) $232.50 $465 2.1×
Us compl joint r-t w/image documentation (76881) $378 $756 3.4×
Us fetal nuchal translucency 1st gestation (76813) $116 $231 1.1×
Us infant hips dynamic (76885) $354 $708 3.9×
Us ob detailed single fetus (76811) $589 $1,178 2.3×
Us ob transvaginal (76817) $329 $657 3.0×
Us pelvic non ob complete (76856) $339 $677 3.1×
Us pelvic nonobstetric image dcmtn limited/f/u (76857) $161 $321 1.5×
Us pregnancy ltd (76815) $161 $321 1.5×
Us pregnant uterus 14 wk transabdl 1/1st gestat (76801) $430 $860 3.9×
Us retroperitoneal complete (76770) $356 $712 3.2×
Us retroperitoneal limited (76775) $311 $622 2.8×
Us scrotum and contents (76870) $370 $739 3.4×
Us soft tissue head/neck (76536) $341 $681 3.1×
Us transrectal prostate volume (76873) $471 $942 4.3×
Us xtr non-vasc lmtd (76882) $161 $321 1.5×
Us, eye b-scan (76512) $161 $321 1.5×
Venogram extremity bilateral (75822) $1,964 $3,927 1.2×
Venography extremity unilateral rs&i (75820) $1,785 $3,570 1.1×
Wrist 2 views (73100) $114 $227 1.2×
X-Ray Abdomen,Comp Acute Series - Xr Abdomen 2 Vws With Chest 1 View (74022) $154 $308 1.4×
X-Ray Ac Jts - Xr Acromioclavicular Joints Bilateral (73050) $117 $234 1.3×
X-Ray Ankle 3+ Vw - Xr Ankle 3+ Views Right (73610) $90 $180 1.0×
X-Ray Colon Air Contrast - Fl Barium Enema Air Contrast (74280) $663 $1,325 3.6×
X-Ray Elbow 2 Vw - Xr Elbow 1-2 Views Right (73070) $106 $212 1.2×
X-Ray Elbow 3+ Vw - Xr Elbow 3+ Views Right (73080) $112 $224 1.2×
X-ray exam entire spi 4/5 vw (72083) $99 $197 0.9×
X-ray exam hip uni 1 view (73501) $83.50 $167 0.9×
X-Ray Exam Hip Uni 2-3 Views (73502) $130 $260 1.4×
X-ray exam hip uni 4/> views (73503) $143 $286 1.3×
X-Ray Exam Hips Bi 3-4 Views (73522) $106 $212 1.0×
X-Ray Exam Hips Bi 5/> Views (73523) $171 $341 1.6×
X-ray exam of small bowel - fl small bowel series enteroclysis tube (74251) $765 $1,529 4.1×
X-ray eye for foreign body (70030) $75 $149 0.8×
X-Ray Facial Bones 3+ Vw - Xr Facial Bones 3+ Views (70150) $142 $283 1.3×
X-Ray Facial Bones <3 Vw - Xr Facial Bones 1-2 Views (70140) $104 $208 1.1×
X-Ray Foot 3+ Vw - Xr Foot 3+ Views Right (73630) $85 $169 0.9×
X-Ray Heel - Xr Calcaneus 2 Views Right (73650) $73 $146 0.8×
X-ray IV pyelogram+drip infusn (74410) $158 $316 0.9×
X-Ray Jaw <4 Vw - Xr Mandible < 4 Views (70100) $100 $200 1.1×
X-Ray Knee 4+ View - Xr Knee 4+ Views Right (73564) $156 $311 1.4×
X-Ray Knee Bilat Standing - Xr Knees Anteroposterior Standing Bilat (73565) $101.50 $202 1.1×
X-Ray Leg, Infant - Xr Lower Extremity 2+ Views Infant Left (73592) $79 $158 0.9×
X-Ray Lumbar Spine 2/3 Vw - Xr Lumbar Spine 2-3 Views (72100) $130 $259 1.2×
X-Ray Lumbar Spine 6+ Vw - Xr Lumbar Spine 6+ Vws Including Bending (72114) $227 $453 2.1×
X-Ray Nasal Bones - Xr Nasal Bones (70160) $103 $206 1.1×
X-Ray Nose-Rectum Child F.B. - Xr Nose to Rectum Foreign Body Peds (76010) $83 $165 0.9×
X-ray of voice box or throat (70370) $205 $409 2.2×
X-Ray Orbits - Xr Orbits Complete 4+ Views (70200) $121 $241 1.1×
X-Ray Pelvis 3+ Vw - Xr Pelvis 3+ Views (72190) $112 $223 1.0×
X-Ray Ribs 2 Vw Unilat - Xr Ribs 2 Views Right (71100) $108 $216 1.2×
X-Ray Ribs, Chest 3+ Vw - Xr Ribs 2 Vws Lt W/ Chest Anteroposterior (71101) $131 $261 1.2×
X-Ray Ribs, Chest 4+ Vw - Xr Ribs 3 Vws Bil W/ Chest Posteroanterior (71111) $171 $342 1.6×
X-Ray Sacroiliac Jts 3+ Vw - Xr Sacroiliac Joints 3+ Views (72202) $115 $230 1.0×
X-Ray Sacrum/Coccyx 2+ Vw - Xr Sacrum Coccyx 2+ Views (72220) $102 $203 1.1×
X-Ray Shoulder 2+ Vw - Xr Shoulder 2+ Views Right (73030) $124 $248 1.4×
X-Ray Sinuses 3+ Vw - Xr Paranasal Sinuses 3+ Views (70220) $133 $265 1.4×
X-Ray Sinuses <3 Vw - Xr Paranasal Sinuses 1-2 Views (70210) $103 $205 1.1×
X-Ray Skull 4+ Vw - Xr Skull Complete 4+ Views (70260) $134 $268 1.2×
X-Ray Skull <4 Vw - Xr Skull 1-3 Views (70250) $124 $248 1.1×
X-Ray Spine One View - Xr Spine (72020) $117 $234 1.3×
X-Ray Sterno-Clavicluar Jt - Xr Sternoclavicular Joints 3+ Views (71130) $114 $227 1.2×
X-Ray Sternum 2+ Vw - Xr Sternum 2+ Views (71120) $108 $216 1.2×
X-Ray Thoracic Spine 2 Vw - Xr Thoracic Spine 2 Views (72070) $129 $257 1.2×
X-Ray Thoracic Spine 4 Vw - Xr Thoracic Spine Complete 4+ Views (72074) $156 $311 1.4×
X-Ray Toe(S) - Xr Toes 2+ Views Right (73660) $81 $161 0.9×
X-Ray Wrist 3+ Vw - Xr Wrist 3+ Views Right (73110) $114 $227 1.2×
Xr arthrogram ankle (73615) $299 $597 0.8×
Xr c-spine 6 or more views (72052) $216 $431 2.0×
Xr chest 4+ views (71048) $230 $459 2.1×
Xr finger(s) 2+ views (73140) $106 $211 1.2×
Xr internal auditory meati complete (70134) $948 $1,896 1.6×
Xr optic foramina (70190) $103 $205 1.1×
Xr shoulder 1 view (73020) $80 $159 0.9×
Xr spine cervical 4 or 5 views (72050) $211 $422 1.9×
Xr tibia/fibula 2 views (73590) $112 $224 1.2×
Xr tmj bilateral (70330) $133 $265 1.4×
Xray knee 1 or 2 views rt (73560) $95 $189 1.0×