Imaging prices at St. Elizabeth Hospital

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

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

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ProcedureCash priceGross charge× Medicare
Abdomen 2 views (74019) $413.14 $1,032.84 3.7×
Acute gastrointestinal blood loss imaging (78278) $1,306.26 $3,265.64 3.1×
Ankle 2 views (73600) $370.41 $926.01 4.0×
Antegrade urography radiological supvj & interpj (74425) $1,013.03 $2,532.57 2.8×
Arthrogram elbow (73085) $679.97 $1,699.92 1.8×
Arthrogram hip (73525) $485.47 $1,213.67 1.3×
Arthrogram shoulder (73040) $621.84 $1,554.60 1.7×
Arthrogram wrist (73115) $714.94 $1,787.33 1.9×
Arthrography knee lt (73580) $618.52 $1,546.29 1.7×
Bone &/Joint Imaging Limited Area (78300) $1,516.24 $3,790.59 3.6×
Bone &/Joint Imaging Multiple Areas (78305) $1,819.49 $4,548.72 4.3×
Bone &/joint imaging whole body (78306) $2,438.52 $6,096.30 5.8×
Bone age studies (77072) $261.53 $653.82 2.4×
Bone Imaging 3 Phase (78315) $2,056.37 $5,140.91 4.9×
Bone survey complete (77075) $816.28 $2,040.69 7.4×
Cervical spine 2 or 3 views (72040) $455.20 $1,138 5.0×
Chest 1 view (71045) $350.49 $876.21 3.8×
Cine/Vid X-Ray Throat/Esoph - Fl Esoph Barium Swlw W/ Video & Speech (74230) $724.21 $1,810.52 3.9×
Clavicle complete (73000) $392.86 $982.13 4.3×
Computed Tomography Thorax Lw Dose Lng Ca Scr C- (71271) $378.75 $946.87 3.4×
CT abdomen and pelvis without and with contrast (74178) $6,173.94 $15,434.85 16.8×
CT abdomen and pelvis without contrast (74176) $4,112.56 $10,281.38 16.3×
CT abdomen w contrast (74160) $2,823.41 $7,058.51 15.3×
CT abdomen w wo contrast (74170) $3,233.96 $8,084.90 17.5×
CT abdomen w/o contrast (74150) $2,162.89 $5,407.21 19.6×
CT angiography upper extremity lt (73206) $2,153.80 $5,384.48 11.6×
CT c-spine w/o contrast (72125) $2,302.40 $5,756 20.9×
CT cervical spine w&w/o contrast (72127) $2,667.05 $6,667.62 14.4×
CT cervical spine with contrast (72126) $2,575.72 $6,439.29 7.0×
CT chest w/wo contrast (71270) $3,006.70 $7,516.74 16.2×
CT chest with contrast (71260) $2,951.48 $7,378.69 16.0×
CT head/brain with contrast (70460) $2,599.28 $6,498.20 14.0×
CT head/brain without and with contrast (70470) $3,099.12 $7,747.79 16.7×
CT heart no contrast quant eval coronry calcium (75571) $2,039.17 $5,097.91 22.2×
CT iac w contrast (70481) $2,506.38 $6,265.95 13.5×
CT limited/localized follow up study (76380) $1,197.82 $2,994.54 13.0×
CT lower ext w/o (73700) $2,438.76 $6,096.90 22.1×
CT lower extremity w wo contrast (73702) $3,652.30 $9,130.74 19.7×
CT lower extremity with contrast (73701) $3,804.48 $9,511.20 20.6×
CT lumbar spine w & w/o contrast (72133) $2,541.47 $6,353.67 13.7×
CT lumbar spine w/o contrast (72131) $2,297.77 $5,744.42 20.8×
CT lumbar spine with contrast (72132) $2,514.54 $6,286.35 6.8×
CT maxillofacial w contrast (70487) $2,682.22 $6,705.53 14.5×
CT maxillofacial w/o contrast (70486) $2,051.57 $5,128.92 18.6×
CT maxillofacial w/wo contrast (70488) $3,218.65 $8,046.62 17.4×
CT neck soft tissue w contrast (70491) $2,972.56 $7,431.39 16.1×
CT orbit sella/post fossa/ear w/o & w/contr matr (70482) $2,968.84 $7,422.10 16.0×
CT orbits w/o contrast (70480) $2,369.10 $5,922.74 21.5×
CT pelvis w & w/o contrast (72194) $2,939.99 $7,349.97 15.9×
CT pelvis w/o contrast (72192) $1,949.69 $4,874.21 17.7×
CT soft tissue neck w/o & w/contrast material (70492) $3,335.39 $8,338.46 18.0×
CT soft tissue neck w/o contrast (70490) $2,220.11 $5,550.26 20.1×
CT thoracic spine w/contrast (72129) $2,446.41 $6,116.02 13.2×
CT thoracic spine w/o contrast (72128) $2,349.89 $5,874.72 21.3×
CT thoracic spine w/wo contrast (72130) $2,935.70 $7,339.23 15.9×
CT thorax w/o contrast (71250) $2,094.93 $5,237.31 19.0×
CT upper extremity w/o & w/contrast material (73202) $3,049.48 $7,623.70 16.5×
CT upper extremity w/o contrast rt (73200) $2,634.67 $6,586.66 23.9×
CT upper extremity with contrast (73201) $3,133.21 $7,833.02 8.5×
Cta Abdl Aorta&Bi Iliofem W/Contrast&Postp (75635) $3,372.01 $8,430.01 18.2×
Cta Abdomen (74175) $3,154.76 $7,886.88 17.0×
CTA abdomen pelvis (74174) $6,443.52 $16,108.80 17.5×
CTA chest (71275) $3,300.19 $8,250.47 17.8×
Cta Head (70496) $3,276.90 $8,192.25 17.7×
CTA lwr ext w&w/o contrast (73706) $4,694.56 $11,736.39 25.4×
Cta Neck (70498) $3,472.98 $8,682.44 18.8×
Cta Pelvis (72191) $3,288.78 $8,221.93 17.8×
Cystography minimum 3 views rs&i (74430) $745.79 $1,864.47 2.0×
Doppler Fetal Mid Cerebral Artery (76821) $449.14 $1,122.85 4.1×
Dxa bone density study 1/> sites axial skel (77080) $390.32 $975.78 3.5×
Dxa bone density study 1/>sites appendiclr skel (77081) $461.51 $1,153.77 5.0×
Dxa bone density study axial skeleton (77085) $549.47 $1,373.67 5.0×
Echoencephalography real time imaging (76506) $576.02 $1,440.03 5.2×
Esophagus (74220) $108.13 $270.32 0.6×
Fetal biophysical profile non-stress testing (76818) $816.42 $2,041.04 7.4×
Fetal Biophysical Profile W/O Non-Stress Testing (76819) $680.35 $1,700.86 6.2×
Fluoroscopy up to 1 hr (76000) $613.11 $1,532.76 2.4×
Foot 2 views (73620) $338.24 $845.59 3.7×
Forearm 2 views (73090) $434.85 $1,087.12 4.7×
Gated Heart Planar Single (78472) $1,966.28 $4,915.68 4.7×
Hand 2 views (73120) $347.30 $868.23 3.1×
Hand 3 views (73130) $464.12 $1,160.28 5.1×
Heart Infarct Image (78466) $1,184.10 $2,960.24 2.8×
Hepatobil Syst Imag Inc Gb W/Pharma Intervenj (78227) $2,137.75 $5,344.37 3.7×
Hepatobiliary syst imaging including gallbladder (78226) $1,983.36 $4,958.38 4.7×
Ht muscle image spect sing (78451) $4,375.49 $10,938.72 3.2×
Humerus Min 2 Views Left (73060) $394.27 $985.67 4.3×
Hysterosalpingogram (74740) $749.36 $1,873.38 3.0×
Kidney Img Morphology Vascular Flow 1 W/O Rx (78707) $1,903.17 $4,757.91 3.3×
Kidney img morphology vascular flow 1 w/rx (78708) $2,834.15 $7,085.36 4.9×
Kidney Img Morphology Vascular Flow Multiple (78709) $1,463.66 $3,659.15 2.6×
Knee 3 views (73562) $517.58 $1,293.93 5.6×
Liver & spleen imaging static only (78215) $1,157 $2,892.49 2.7×
Lung perfusion differential (78597) $1,731.93 $4,329.82 4.1×
Lung Ventilation Imaging (78579) $1,634.26 $4,085.65 3.9×
Lymphoscintigraphy (78195) $1,711.56 $4,278.90 3.0×
Meckels Diverticulum (78290) $1,194.83 $2,987.06 2.8×
Mr safety determination physician/other qhp (76016) $551.20 $1,378 6.0×
Mr safety implant pos&/immoblj supvj phys/qhp (76019) $551.20 $1,378 8.9×
Mr safety implant&/fb assmt clin staf 1st 15 min (76014) $551.20 $1,378 18.1×
Mr safety implt electronics prepj supvj phys/qhp (76018) $551.20 $1,378 5.5×
Mr safety med physics xm customization plng&mntr (76017) $551.20 $1,378 2.2×
MRA head w & w/o contrast (70546) $3,623.74 $9,059.33 9.8×
MRA head w/o contrast (70544) $2,367.94 $5,919.83 9.4×
MRA neck w contrast (70548) $2,826.97 $7,067.42 7.7×
Mra Neck W/O &W/Contrast Material (70549) $3,200.04 $8,000.09 8.7×
MRA neck w/o contrast (70547) $2,453.92 $6,134.79 9.7×
MRI abdomen w/o & w/contrast material (74183) $3,151.77 $7,879.41 8.6×
MRI abdomen w/o contrast (74181) $2,516 $6,290 10.0×
MRI any jnt lwr ext with con lt (73722) $2,612.74 $6,531.85 3.2×
MRI any jt upper extremity w/contrast matrl (73222) $2,815.10 $7,037.75 3.4×
MRI c-spine with contrast (72142) $2,797.52 $6,993.80 7.6×
MRI cervical spine w/o contrast (72141) $2,557.34 $6,393.35 10.2×
MRI chest w/o & w/contrast material (71552) $3,323.23 $8,308.06 9.0×
MRI chest w/o contrast (71550) $2,126.88 $5,317.18 8.5×
MRI Forearm w/ Contrast Bilateral 73219 (73219) $2,693.42 $6,733.55 7.3×
MRI lower extrem oth/thn jt w/contrast matrl (73719) $2,863.36 $7,158.40 7.8×
MRI lower extrem oth/thn jt w/o contr matrl (73718) $2,366.44 $5,916.10 9.4×
MRI orbit face &/neck w/o contrast (70540) $2,726.83 $6,817.07 10.8×
MRI orbit/face/neck w&w/o cont (70543) $3,512.73 $8,781.82 9.5×
MRI pelvis w contrast (72196) $2,287.50 $5,718.73 6.2×
MRI pelvis w/o & w/contrast material (72197) $3,126.39 $7,815.97 8.5×
MRI pelvis w/o contrast (72195) $1,448.58 $3,621.45 5.8×
MRI scan of arm joint before and after contrast (73223) $3,103.16 $7,757.90 8.4×
MRI scan of leg joint before and after contrast (73723) $3,135.29 $7,838.22 8.5×
MRI spinal canal cervical w/o & w/contr matrl (72156) $3,090.77 $7,726.92 8.4×
MRI spinal canal lumbar w/contrast material (72149) $3,072.90 $7,682.24 8.3×
MRI spinal canal lumbar w/o & w/contr matrl (72158) $3,468.35 $8,670.87 9.4×
MRI spinal canal thoracic w/contrast matrl (72147) $2,730.36 $6,825.88 7.4×
MRI spinal canal thoracic w/o & w/contr matrl (72157) $3,261.52 $8,153.80 8.9×
MRI thoracic spine w/o contrast (72146) $2,441.29 $6,103.21 9.7×
MRI tmj (70336) $2,397.09 $5,992.71 9.5×
MRI upper ext joint w/o contrast (73221) $2,359.65 $5,899.12 9.4×
MRI upper extrem other than jt w/o & w/contras (73220) $3,232.10 $8,080.23 8.8×
MRI upper extremity oth than jt w/o contr matrl (73218) $2,338.28 $5,845.70 9.3×
Myelogram Cervical (72240) $1,149.18 $2,872.95 1.4×
Myelogram Lumbar (72265) $1,127.59 $2,818.97 1.4×
Myelogram thoracic (72255) $884.24 $2,210.59 1.1×
Myelography 2 or more regions (72270) $1,306.79 $3,266.96 1.6×
Myocardial Spect Multiple Studies (78452) $5,311 $13,277.50 3.9×
N-Invas Est C Ffr Augmnt Sw Alys Cta I&R Phy/Qhp (75580) $6,745.74 $16,864.34 7.4×
Neck soft tissue (70360) $360.77 $901.91 3.9×
Nm adrenal scan (78075) $1,950.59 $4,876.47 1.4×
Nm bone marrow wb (78104) $1,675.27 $4,188.16 4.0×
Nm cisternogram (78630) $2,425.79 $6,064.46 4.2×
Nm gastric emptying study (78264) $1,665.11 $4,162.77 3.9×
Nuclear Rx Oral Admin (79005) $2,052.27 $5,130.66 8.3×
Ob Us Follow-Up Per Fetus - Us Ob Follow Up Transabdominal Approach (76816) $576.02 $1,440.03 5.2×
Osseous survey infant (77076) $403.40 $1,008.48 3.7×
Osseous survey limited (77074) $303.14 $757.83 2.7×
Parathyrd planar w/wo subtrj (78071) $2,803.81 $7,009.51 6.6×
Parathyroid imaging (78070) $1,838.38 $4,595.94 4.4×
Pelvis 1 or 2 views (72170) $339.82 $849.55 3.1×
PET image w/CT, skull-thigh (78815) $5,101.24 $12,753.09 3.4×
PET imaging CT for attenuation limited area (78814) $4,869.65 $12,174.12 3.2×
PET imaging for CT attenuation whole body (78816) $5,345.28 $13,363.20 3.5×
Pr MRI, lower extr, w/o contrast f/u by contrast (73720) $3,360.29 $8,400.71 9.1×
Pulmonary Perfusion Imaging Particulate (78580) $1,360.58 $3,401.44 3.2×
Pulmonary Ventilation & Perfusion Imaging (78582) $2,477.65 $6,194.11 4.3×
Radex entir thrc lmbr crv sac spi w/skull 2/3 vw (72082) $514.68 $1,286.68 4.7×
Radex hips bilateral with pelvis 2 views (73521) $827.60 $2,068.98 7.5×
Radiolog exam mandible compl minimum 4 views (70110) $602.90 $1,507.23 5.5×
Radiologic Exam Abdomen 1 View - Xr Abdomen 1 View (74018) $283.86 $709.64 3.1×
Radiologic Exam Abdomen 3+ Views - Xr Abdomen 3+ Views (74021) $420.17 $1,050.41 3.8×
Radiologic Exam Chest 2 Views - Xr Chest 2 Views (71046) $391.61 $979.02 4.3×
Radiologic exam colon single contrast study (74270) $996.51 $2,491.27 5.4×
Radiologic exam upr gi trc double contrast study (74246) $333.24 $833.10 1.8×
Radiologic exam upr gi trc single contrast study (74240) $699.78 $1,749.45 3.8×
Radiologic Examination Femur Minimum 2 Views - Xr Femur 2+ Vw Lt (73552) $111.85 $279.61 1.2×
Radiological examination surgical specimen (76098) $347.95 $869.86 0.6×
Rp loclzj tum spect 1 area single day imaging (78803) $2,944.09 $7,360.21 5.1×
Sacroiliac Joints < 3 Views (72200) $445.61 $1,114.01 4.0×
Scanogram (77073) $104.96 $262.40 1.0×
Scapula complete (73010) $401.08 $1,002.69 3.6×
Screening digital breast tomosynthesis (77063) $16 $40 0.7×
Small bowel series (74250) $682.35 $1,705.87 3.7×
Spine thoracic 3 views (72072) $564.18 $1,410.45 5.1×
Testicular Imaging With Vascular Flow (78761) $847.39 $2,118.47 2.0×
Thoracolumbar 2 views (72080) $518.07 $1,295.17 5.6×
Thyroid carcinoma metastases img whole body (78018) $2,527.89 $6,319.72 4.4×
Thyroid uptake measurement (78012) $480.33 $1,200.81 1.1×
Thyroid Uptake W/Blood Flow Sngle/Mult Quan Meas (78014) $1,655.31 $4,138.27 3.9×
Ultrasound, abdomen limited (76705) $616.34 $1,540.84 5.6×
Umbilical-artery Doppler (OB) (76820) $559.84 $1,399.60 5.1×
Unlisted Diagnostic Radiographic Procedure (76499) $461.51 $1,153.77 5.0×
Upper Extremity Infant (73092) $540.24 $1,350.60 4.9×
Urethrocystography voiding (74455) $899.40 $2,248.50 3.6×
Urography (pyelography), intravenous, with or without KUB, with or without tomography (74400) $216.95 $542.37 1.2×
Us abdl aorta screen aaa (76706) $576.02 $1,440.03 5.2×
Us breast unilateral complete (76641) $576.02 $1,440.03 5.2×
Us breast unilateral limited (76642) $345.61 $864.01 3.8×
Us chest (76604) $662.42 $1,656.03 6.0×
Us compl joint r-t w/image documentation (76881) $662.42 $1,656.03 6.0×
Us infant hips dynamic (76885) $345.61 $864.01 3.8×
Us ob transvaginal (76817) $576.02 $1,440.03 5.2×
Us pelvic non ob complete (76856) $691.22 $1,728.05 6.3×
Us pelvic nonobstetric image dcmtn limited/f/u (76857) $616.34 $1,540.84 5.6×
Us pregnancy ltd (76815) $576.02 $1,440.03 5.2×
Us pregnant uterus 14 wk transabdl 1/1st gestat (76801) $576.02 $1,440.03 5.2×
Us retroperitoneal complete (76770) $852.08 $2,130.20 7.7×
Us retroperitoneal limited (76775) $681.67 $1,704.16 6.2×
Us scrotum and contents (76870) $662.42 $1,656.03 6.0×
Us soft tissue head/neck (76536) $576.02 $1,440.03 5.2×
Us spinal canal and contents (76800) $345.61 $864.01 3.1×
Us transrectal (76872) $576.02 $1,440.03 5.2×
Us xtr non-vasc lmtd (76882) $345.61 $864.01 3.1×
Vertebral fracture assessment via dxa (77086) $63.95 $159.87 0.7×
Wrist 2 views (73100) $334.39 $835.97 3.6×
X-Ray Abdomen,Comp Acute Series - Xr Abdomen 2 Vws With Chest 1 View (74022) $506.65 $1,266.61 4.6×
X-Ray Ac Jts - Xr Acromioclavicular Joints Bilateral (73050) $756.89 $1,892.22 8.2×
X-Ray Ankle 3+ Vw - Xr Ankle 3+ Views Right (73610) $554.44 $1,386.08 6.0×
X-Ray Colon Air Contrast - Fl Barium Enema Air Contrast (74280) $1,098.10 $2,745.23 5.9×
X-Ray Elbow 2 Vw - Xr Elbow 1-2 Views Right (73070) $335.29 $838.21 3.7×
X-Ray Elbow 3+ Vw - Xr Elbow 3+ Views Right (73080) $471.75 $1,179.38 5.1×
X-ray exam hip uni 1 view (73501) $530.51 $1,326.27 5.8×
X-Ray Exam Hip Uni 2-3 Views (73502) $636.61 $1,591.51 6.9×
X-ray exam of femur 1 (73551) $78.98 $197.42 0.9×
X-ray eye for foreign body (70030) $540.18 $1,350.44 5.9×
X-Ray Facial Bones 3+ Vw - Xr Facial Bones 3+ Views (70150) $577.78 $1,444.44 5.2×
X-Ray Facial Bones <3 Vw - Xr Facial Bones 1-2 Views (70140) $380.56 $951.39 4.1×
X-Ray Foot 3+ Vw - Xr Foot 3+ Views Right (73630) $502.82 $1,257.06 5.5×
X-Ray Heel - Xr Calcaneus 2 Views Right (73650) $349.50 $873.74 3.8×
X-Ray Jaw <4 Vw - Xr Mandible < 4 Views (70100) $538.75 $1,346.86 5.9×
X-Ray Knee 4+ View - Xr Knee 4+ Views Right (73564) $726.58 $1,816.44 6.6×
X-Ray Knee Bilat Standing - Xr Knees Anteroposterior Standing Bilat (73565) $482.56 $1,206.38 5.3×
X-Ray Leg, Infant - Xr Lower Extremity 2+ Views Infant Left (73592) $404.59 $1,011.46 4.4×
X-Ray Lumbar Spine 2/3 Vw - Xr Lumbar Spine 2-3 Views (72100) $599.99 $1,499.97 5.4×
X-Ray Lumbar Spine 6+ Vw - Xr Lumbar Spine 6+ Vws Including Bending (72114) $1,127.18 $2,817.94 10.2×
X-Ray Nasal Bones - Xr Nasal Bones (70160) $445.50 $1,113.73 4.9×
X-Ray Nose-Rectum Child F.B. - Xr Nose to Rectum Foreign Body Peds (76010) $337.70 $844.25 3.7×
X-Ray Orbits - Xr Orbits Complete 4+ Views (70200) $668.52 $1,671.30 6.1×
X-Ray Pelvis 3+ Vw - Xr Pelvis 3+ Views (72190) $394.39 $985.97 3.6×
X-Ray Retrograde Pyelogram - Fl Pyelogram Retrograde (74420) $605.38 $1,513.44 1.6×
X-Ray Ribs 2 Vw Unilat - Xr Ribs 2 Views Right (71100) $563.47 $1,408.66 6.1×
X-Ray Ribs, Chest 3+ Vw - Xr Ribs 2 Vws Lt W/ Chest Anteroposterior (71101) $811.84 $2,029.58 7.4×
X-Ray Ribs, Chest 4+ Vw - Xr Ribs 3 Vws Bil W/ Chest Posteroanterior (71111) $942.57 $2,356.42 8.5×
X-Ray Sacroiliac Jts 3+ Vw - Xr Sacroiliac Joints 3+ Views (72202) $514.81 $1,287.01 4.7×
X-Ray Sacrum/Coccyx 2+ Vw - Xr Sacrum Coccyx 2+ Views (72220) $442.45 $1,106.12 4.8×
X-Ray Shoulder 2+ Vw - Xr Shoulder 2+ Views Right (73030) $569.74 $1,424.34 6.2×
X-Ray Sinuses 3+ Vw - Xr Paranasal Sinuses 3+ Views (70220) $592.47 $1,481.16 6.5×
X-Ray Skull <4 Vw - Xr Skull 1-3 Views (70250) $428.50 $1,071.25 3.9×
X-Ray Sterno-Clavicluar Jt - Xr Sternoclavicular Joints 3+ Views (71130) $448.14 $1,120.35 4.9×
X-Ray Sternum 2+ Vw - Xr Sternum 2+ Views (71120) $446.83 $1,117.07 4.9×
X-Ray Thoracic Spine 2 Vw - Xr Thoracic Spine 2 Views (72070) $470.16 $1,175.39 4.3×
X-Ray Thoracic Spine 4 Vw - Xr Thoracic Spine Complete 4+ Views (72074) $470.15 $1,175.36 4.3×
X-Ray Toe(S) - Xr Toes 2+ Views Right (73660) $318.46 $796.15 3.5×
X-Ray Wrist 3+ Vw - Xr Wrist 3+ Views Right (73110) $391.17 $977.91 4.3×
Xr arthrogram ankle (73615) $389.18 $972.94 1.1×
Xr c-spine 6 or more views (72052) $848.68 $2,121.68 7.7×
Xr finger(s) 2+ views (73140) $343.13 $857.82 3.7×
Xr shoulder 1 view (73020) $306.02 $765.04 3.3×
Xr spine cervical 4 or 5 views (72050) $692.87 $1,732.16 6.3×
Xr tibia/fibula 2 views (73590) $476.86 $1,192.16 5.2×
Xray knee 1 or 2 views rt (73560) $394.08 $985.20 4.3×