Imaging prices at Weisbrod Memorial County Hospital

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

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

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ProcedureCash priceGross charge× Medicare
Ankle 2 views (73600) $160.80 $268 1.8×
Clavicle complete (73000) $160.80 $268 1.8×
Computed tomographic angiography, abdomen and pelvis, with contrast material(s), including noncontrast images, if… (74174) $1,001.40 $1,669 2.7×
Computed tomographic angiography, abdomen, with contrast material(s), including noncontrast images, if performed, and… (74175) $525.60 $876 2.8×
Computed tomographic angiography, chest (noncoronary), with contrast material(s), including noncontrast images, if… (71275) $525.60 $876 2.8×
Computed tomographic angiography, lower extremity, with contrast material(s), including noncontrast images, if… (73706) $525.60 $876 2.8×
Computed tomographic angiography, neck, with contrast material(s), including noncontrast images, if performed, and… (70498) $524.70 $874.50 2.8×
Computed tomography, cervical spine; without contrast material, followed by contrast material(s) and further sections… (72127) $735.60 $1,226 4.0×
Computed tomography, lower extremity; without contrast material Age Under 21 (73700) $293.40 $489 2.7×
Computed tomography, lower extremity; without contrast material, followed by contrast material(s) and further sections… (73702) $735.60 $1,226 4.0×
Computed tomography, lumbar spine; without contrast material, followed by contrast material(s) and further sections Age… (72133) $735.60 $1,226 4.0×
Computed tomography, maxillofacial area; with contrast material(s) Age Under 21 (70487) $525.60 $876 2.8×
Computed tomography, maxillofacial area; without contrast material Age Under 21 (70486) $293.40 $489 2.7×
Computed tomography, orbit, sella, or posterior fossa or outer, middle, or inner ear; with contrast material(s) Age… (70481) $525.60 $876 2.8×
Computed tomography, orbit, sella, or posterior fossa or outer, middle, or inner ear; without contrast material Age… (70480) $293.40 $489 2.7×
Computed tomography, orbit, sella, or posterior fossa or outer, middle, or inner ear; without contrast material,… (70482) $735.60 $1,226 4.0×
Computed tomography, soft tissue neck; without contrast material followed by contrast material(s) and further sections… (70492) $735.60 $1,226 4.0×
Computed tomography, thoracic spine; without contrast material, followed by contrast material(s) and further sections… (72130) $735.60 $1,226 4.0×
Computed tomography, thorax, diagnostic; without contrast material, followed by contrast material(s) and further… (71270) $735.60 $1,226 4.0×
CT abdomen and pelvis without and with contrast (74178) $661.20 $1,102 1.8×
CT abdomen and pelvis without contrast (74176) $598.80 $998 2.4×
CT abdomen w & w/o contrast (74170) $732.60 $1,221 4.0×
CT abdomen w/contrast (74160) $525.60 $876 2.8×
CT abdomen w/o contrast (74150) $293.40 $489 2.7×
CT cervical spine w/contrast (72126) $525.60 $876 1.4×
CT cervical spine w/o contrast (72125) $293.40 $489 2.7×
CT chest w/contrast (71260) $525.60 $876 2.8×
CT extremity upper w & w/o contrast (73202) $735.60 $1,226 4.0×
CT extremity upper w/o contrast (73200) $293.40 $489 2.7×
CT head/brain with contrast (70460) $525.60 $876 2.8×
CT head/brain without and with contrast (70470) $735.60 $1,226 4.0×
CT l-spine w/contrast (72132) $525.60 $876 1.4×
CT lower extremity w/dye (73701) $525.60 $876 2.8×
CT lumbar spine w/o contrast (72131) $293.40 $489 2.7×
CT maxillofacial w/wo contrast (70488) $735.60 $1,226 4.0×
CT neck w/contrast (70491) $525.60 $876 2.8×
CT neck w/o contrast (70490) $293.40 $489 2.7×
CT pelvis w & w/o contrast (72194) $735.60 $1,226 4.0×
CT pelvis w/o contrast (72192) $293.40 $489 2.7×
CT thoracic spine w/contrast (72129) $525.60 $876 2.8×
CT thoracic spine w/o contrast (72128) $293.40 $489 2.7×
CT thorax lung cancer scr c- (71271) $160.80 $268 1.5×
CT thorax w/o contrast (71250) $293.40 $489 2.7×
CT upper extremity w/dye (73201) $525.60 $876 1.4×
CTA head w contrast (70496) $525.60 $876 2.8×
MRI pelvis w/o contrast (72195) $1,500 $2,500 6.0×
Ob us limited fetus(s) (76815) $278.40 $464 2.5×
Radex entir thrc lmbr crv sac spi w/skull 2/3 vw (72082) $293.40 $489 2.7×
Radex hip unilateral with pelvis 1 view (73501) $160.80 $268 1.8×
Radex hip unilateral with pelvis 2-3 views (73502) $194.40 $324 2.1×
Radex hip unilateral with pelvis minimum 4 views (73503) $231.60 $386 2.1×
Radex hips bilateral with pelvis minimum 5 views (73523) $278.40 $464 2.5×
Radex spine cervical 2 or 3 views (72040) $160.80 $268 1.8×
Radex spine cervical 4 or 5 views (72050) $225.60 $376 2.0×
Radex spine cervical 6 or more views (72052) $225.60 $376 2.0×
Radex spine thoracolumbar junction min 2 views (72080) $160.80 $268 1.8×
Radiologic exam chest 3 views (71047) $231.60 $386 2.5×
Radiologic examination femur minimum 2 views (73552) $160.80 $268 1.8×
Radiologic examination, ankle; complete, minimum of 3 views Age Under 21 (73610) $194.40 $324 2.1×
Radiologic examination, complete acute abdomen series, including 2 or more views of the abdomen (eg, supine, erect,… (74022) $350.40 $584 3.2×
Radiologic examination, elbow; 2 views Age Under 21 (73070) $160.80 $268 1.8×
Radiologic examination, elbow; complete, minimum of 3 views Age Under 21 (73080) $194.40 $324 2.1×
Radiologic examination, facial bones; less than 3 views Age Under 21 (70140) $160.80 $268 1.8×
Radiologic examination, foot; complete, minimum of 3 views Age Under 21 (73630) $194.40 $324 2.1×
Radiologic examination, hand; minimum of 3 views Age Under 21 (73130) $194.40 $324 2.1×
Radiologic examination, knee; both knees, standing, anteroposterior Age Under 21 (73565) $278.40 $464 3.0×
Radiologic examination, knee; complete, 4 or more views Age Under 21 (73564) $231.60 $386 2.1×
Radiologic examination, mandible; partial, less than 4 views Age Under 21 (70100) $160.80 $268 1.8×
Radiologic examination, mastoids; complete, minimum of 3 views per side Age Under 21 (70130) $293.40 $489 2.7×
Radiologic examination, nasal bones, complete, minimum of 3 views Age Under 21 (70160) $160.80 $268 1.8×
Radiologic examination, ribs, bilateral; including posteroanterior chest, minimum of 4 views Age Under 21 (71111) $349.20 $582 3.2×
Radiologic examination, ribs, unilateral; including posteroanterior chest, minimum of 3 views Age Under 21 (71101) $293.40 $489 2.7×
Radiologic examination, sacroiliac joints; less than 3 views Age Under 21 (72200) $293.40 $489 2.7×
Radiologic examination, shoulder; complete, minimum of 2 views Age Under 21 (73030) $194.40 $324 2.1×
Radiologic examination, sinuses, paranasal, less than 3 views Age Under 21 (70210) $160.80 $268 1.8×
Radiologic examination, skull; less than 4 views Age Under 21 (70250) $293.40 $489 2.7×
Radiologic examination, spine, lumbosacral; 2 or 3 views Age Under 21 (72100) $293.40 $489 2.7×
Radiologic examination, spine, lumbosacral; complete, including bending views, minimum of 6 views Age Under 21 (72114) $420 $700 3.8×
Radiologic examination, wrist; complete, minimum of 3 views Age Under 21 (73110) $194.40 $324 2.1×
Radiologic examination; humerus, minimum of 2 views Age Under 21 (73060) $160.80 $268 1.8×
Radiologic examination; orbits, complete, minimum of 4 views Age Under 21 (70200) $293.40 $489 2.7×
Radiologic examination; toe(s), minimum of 2 views Age Under 21 (73660) $160.80 $268 1.8×
Scapula complete (73010) $293.40 $489 2.7×
Ultrasound, abdomen limited (76705) $234.60 $391 2.1×
Ultrasound, limited, joint or focal evaluation of other nonvascular extremity structure(s) (eg, joint space,… (76882) $293.40 $489 2.7×
Ultrasound, pelvic (nonobstetric), real time with image documentation; complete Age Under 21 (76856) $293.40 $489 2.7×
Ultrasound, pregnant uterus, real time with image documentation, fetal and maternal evaluation, first trimester (< 14… (76801) $293.40 $489 2.7×
Umbilical-artery Doppler (OB) (76820) $278.40 $464 2.5×
Us abdominal aorta real time screen study aaa (76706) $293.40 $489 2.7×
Us breast uni real time with image complete (76641) $244.20 $407 2.2×
Us chest (76604) $293.40 $489 2.7×
Us compl joint r-t w/image documentation (76881) $293.40 $489 2.7×
Us exam, pelvic, limited (76857) $234.60 $391 2.1×
US OB Follow-Up/Repeat (76816) $278.40 $464 2.5×
Us retroperitoneal complete (76770) $293.40 $489 2.7×
Us retroperitoneal ltd (76775) $234.60 $391 2.1×
Us scrotum (76870) $293.40 $489 2.7×
Us soft tissue head/neck (76536) $293.40 $489 2.7×
X-ray exam of finger(s) (73140) $160.80 $268 1.8×
X-ray exam of knee 1 or 2 (73560) $160.80 $268 1.8×
X-ray heel (73650) $160.80 $268 1.8×
Xr abdomen 1 view (74018) $160.80 $268 1.8×
Xr abdomen 2 views (74019) $293.40 $489 2.7×
Xr chest 1 view (71045) $160.80 $268 1.8×
Xr chest 2 views (71046) $194.40 $324 2.1×
Xr eye foreign body (70030) $160.80 $268 1.8×
Xr facial bones 3+ views (70150) $293.40 $489 2.7×
Xr foot arthritis pa only bilateral - report(ortho pro) (73620) $160.80 $268 1.8×
Xr forearm 2 views (73090) $160.80 $268 1.8×
Xr hand 2v (73120) $160.80 $268 1.5×
Xr neck soft tissue (70360) $160.80 $268 1.8×
Xr o knee w/ merchant view bilat - report(ortho pro) (73562) $194.40 $324 2.1×
Xr pelvis 1-2 views (72170) $293.40 $489 2.7×
Xr pelvis min 3 view (72190) $349.20 $582 3.2×
Xr sacrum/coccyx 2+ views (72220) $160.80 $268 1.8×
Xr shoulder 1 view (73020) $160.80 $268 1.8×
Xr sinuses 3+ views (70220) $194.40 $324 2.1×
Xr skull min 4 view (70260) $349.20 $582 3.2×
Xr spine 1 view (72020) $160.80 $268 1.8×
Xr spine thoracic 3v (72072) $349.20 $582 3.2×
Xr sternum 2+ views (71120) $160.80 $268 1.8×
Xr t-spine 2 views (72070) $293.40 $489 2.7×
Xr tibia/fibula 2 views (73590) $160.80 $268 1.8×
Xr tmj bilateral (70330) $160.80 $268 1.8×
Xr wrist 2 views (73100) $160.80 $268 1.8×