Southeast Colorado Hospital District - Price List for Shoppable Services

Prices Posted and Effective as of 12-30-2020

Disclaimer: The Hospital determines its standard charges for patient items and services through the use of a chargemaster system, which is a list of charges for the components of patient care that go into every patient’s bill. These are the baseline rates for items and services provided at the Hospital. The chargemaster is similar in concept to the manufacturer’s suggested retail price (“MSRP”) on a particular product or good. The charges listed provide only a general starting point in determining the potential costs of an individual patient’s care at the Hospital. This list does not reflect the actual out-of-pocket costs that may be paid by a patient for any particular service, it is not binding, and the actual charges for items and services may vary. Individuals with questions about their out-of-pocket costs of service and other financial information should contact the hospital or consider contacting their insurers for further information. The cost of treatment also may be impacted by variables involved in a patient’s actual care, such as specific equipment or supplies required, the length of time spent in surgery or recovery, additional tests, or any changes in care or unexpected conditions or complications that arise.

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Service DescriptionService CodeCash PriceRates
Service DescriptionService CodeCash PriceRates
CT Scan
CT scanCPT 70450$889
CT scan of abdomen and pelvis with contrastCPT 74177$1,453
CT scan of pelvis with contrastCPT 72193$1,038
Ct angiograph pelv w/o&w/dyeCPT 72191$1,372
Ct head/brain w/dyeCPT 70460$846
Cardiology
Doppler color flow add-onCPT 93325$113
Doppler echo exam heartCPT 93321$85
Stress tte completeCPT 93351$770
Tte w/doppler completeCPT 93306$765
Clinic
Initial new patient preventative medicine evaluation (18-3... (Not Offered)CPT 99385--
Initial new patient preventative medicine evaluation (40-6... (Not Offered)CPT 99386--
New patient office or other outpatient visit, 30 minCPT 99203$164
New patient office or other outpatient visit, 45 minCPT 99204$222
New patient office or other outpatient visit, 60 minCPT 99205$315
Patient office consultation, 40 min (Not Offered)CPT 99243--
Patient office consultation, 60 min (Not Offered)CPT 99244--
EEG
Sleep studyCPT 95810$1,818
EKG
Ecg monit/reprt up to 48 hrsCPT 93225$262
Electrocardiogram tracingCPT 93005$132
Electrocardiogram, routine, with interpretation and report (Not Offered)CPT 93000--
Emergency Room
Application of long arm castCPT 29065$184
Blood transfusion serviceCPT 36430$931
Remove foreign body from eyeCPT 65220$291
Strep a ag iaCPT 87430$54
Ther/proph/diag inj iv pushCPT 96374$147
Treat shoulder dislocationCPT 23650$518
Tx/pro/dx inj same drug adonCPT 96376$116
Tx/proph/dg addl seq iv infCPT 96367$73
Wound closure by adhesiveHCPCS G0168$76
Imaging
Abdomial ultrasound of pregnant uterus (Not Offered)CPT 76805--
Mammography of both breasts (Not Offered)CPT 77066--
Mammography of one breast (Not Offered)CPT 77065--
Mammography, screening, bilateral (Not Offered)CPT 77067--
Ob us follow-up per fetusCPT 76816$269
Ultrasound breast completeCPT 76641$422
Ultrasound of abdomenCPT 76700$607
Ultrasound pelvis through vaginaCPT 76830$531
Us exam pelvic limitedCPT 76857$269
Inpatient Procedures
Cardiac valve or cardiothoracic procedure with cardiac cat... (Not Offered)DRG 216--
Cervical spinal fusion without CC or MCC (Not Offered)DRG 473--
Major joint replacement or reattachment of lower extremity... (Not Offered)DRG 470--
Spinal fusion except cervical without MCC (Not Offered)DRG 460--
Uterine and adnexa procedures for non-malignancy without C... (Not Offered)DRG 743--
Laboratory
Acute hepatitis panelCPT 80074$105
Alanine amino (alt) (sgpt)CPT 84460$81
Allg spec ige crude xtrc eaCPT 86003$18
Alpha-fetoprotein serumCPT 82105$146
Analgesics non-opioid 1 or 2CPT 80329$82
Androstanediol glucuronideCPT 82154$66
Antinuclear antibodiesCPT 86038$58
Antistreptolysin o titerCPT 86060$49
Antithrombin iii activityCPT 85300$34
Assay activated protein cCPT 85307$114
Assay alkaline phosphatasesCPT 84080$29
Assay bld/serum cholesterolCPT 82465$58
Assay glucose blood quantCPT 82947$58
Assay iga/igd/igg/igm eachCPT 82784$37
Assay nephelometry not specCPT 83883$168
Assay of acthCPT 82024$50
Assay of aldosteroneCPT 82088$85
Assay of ammoniaCPT 82140$28
Assay of amylaseCPT 82150$96
Assay of blood/uric acidCPT 84550$28
Assay of c-peptideCPT 84681$277
Assay of calciumCPT 82330$78
Assay of calcium in urineCPT 82340$47
Assay of ceruloplasminCPT 82390$43
Assay of ck (cpk)CPT 82550$81
Assay of copperCPT 82525$146
Assay of creatinineCPT 82565$48
Assay of digoxin totalCPT 80162$62
Assay of erythropoietinCPT 82668$101
Assay of estrogenCPT 82672$199
Assay of ferritinCPT 82728$123
Assay of folic acid serumCPT 82746$53
Assay of free testosteroneCPT 84402$206
Assay of free thyroxineCPT 84439$54
Assay of ggtCPT 82977$28
Assay of gonadotropin (fsh)CPT 83001$209
Assay of gonadotropin (lh)CPT 83002$275
Assay of insulinCPT 83525$46
Assay of ironCPT 83540$59
Assay of lactic acidCPT 83605$54
Assay of lipaseCPT 83690$96
Assay of lithiumCPT 80178$36
Assay of magnesiumCPT 83735$28
Assay of metanephrinesCPT 83835$205
Assay of parathormoneCPT 83970$74
Assay of phenytoin totalCPT 80185$43
Assay of phosphorusCPT 84100$81
Assay of prealbuminCPT 84134$151
Assay of progesteroneCPT 84144$62
Assay of proinsulinCPT 84206$342
Assay of prolactinCPT 84146$88
Assay of protein serumCPT 84155$71
Assay of protein urineCPT 84156$24
Assay of reninCPT 84244$83
Assay of serum albuminCPT 82040$36
Assay of serum potassiumCPT 84132$81
Assay of sex hormone globulCPT 84270$147
Assay of sirolimusCPT 80195$130
Assay of tacrolimusCPT 80197$173
Assay of thyroglobulinCPT 84432$53
Assay of total estradiolCPT 82670$157
Assay of total testosteroneCPT 84403$214
Assay of total thyroxineCPT 84436$86
Assay of troponin quantCPT 84484$79
Assay of urine creatinineCPT 82570$48
Assay of urine osmolalityCPT 83935$48
Assay of urine potassiumCPT 84133$28
Assay of urine sodiumCPT 84300$48
Assay of vancomycinCPT 80202$50
Assay of vitamin aCPT 84590$47
Assay of zincCPT 84630$113
Assay synovial fluid mucinCPT 83872$20
Assay test for blood fecalCPT 82274$45
Assay triiodothyronine (t3)CPT 84480$57
Automated reticulocyte countCPT 85045$24
Basic metabolic panelCPT 80048$179
Benzodiazepines1-12CPT 80346$161
Bilirubin directCPT 82248$67
Bilirubin totalCPT 82247$77
Blood culture for bacteriaCPT 87040$62
Blood gases any combinationCPT 82803$212
Blood smear interpretationCPT 85060$36
Blood test, clotting timeCPT 85610$61
Blood test, comprehensive group of blood chemicalsCPT 80053$334
Blood test, lipidsCPT 80061$163
Blood test, thyroid stimulating hormone (TSH)CPT 84443$53
Blood typing serologic aboCPT 86900$51
Blood typing serologic rh(d)CPT 86901$39
Body fluid cell countCPT 89051$27
C diff amplified probeCPT 87493$238
C-reactive proteinCPT 86140$60
Calculus spectroscopyCPT 82365$142
Capillary blood drawCPT 36416$34
Carcinoembryonic antigenCPT 82378$210
Ccp antibodyCPT 86200$254
Chorionic gonadotropin assayCPT 84703$62
Chorionic gonadotropin testCPT 84702$62
Chylmd trach dna amp probeCPT 87491$106
Clot inhibit prot c activityCPT 85303$58
Clot inhibit prot s freeCPT 85306$243
Coagulation assessment blood testCPT 85730$75
Col chromotography qual/quanCPT 82542$34
Collagen crosslinksCPT 82523$244
Collect blood from piccCPT 36592$87
Compatibility test antiglobCPT 86922$34
Compatibility test spinCPT 86920$67
Complete blood cell count (CBC), automated (Not Offered)CPT 85027--
Complete blood cell count (CBC), with differential white b...CPT 85025$96
Creatine mb fractionCPT 82553$128
Creatinine clearance testCPT 82575$137
Cultr bacteria except bloodCPT 87075$58
Culture aerobic identifyCPT 87077$86
Culture anaerobe ident eachCPT 87076$86
Culture othr specimn aerobicCPT 87070$306
Culture screen onlyCPT 87081$174
Culture type immunologicCPT 87147$46
Cytogenetics dna probeCPT 88271$178
Cytomeg dna quantCPT 87497$255
Detect agent nos dna ampCPT 87798$156
Dna antibody nativeCPT 86225$48
Dna/rna amplified probeCPT 87150$37
Draw blood off venous deviceCPT 36591$87
Drug screen quantalcoholsCPT 80320$200
Drug screening barbituratesCPT 80345$66
Drug screening buprenorphineCPT 80348$66
Drug screening cocaineCPT 80353$34
Drug scrn quan levetiracetamCPT 80177$154
Drug test prsmv chem anlyzrCPT 80307$319
Drug test prsmv dir opt obsCPT 80305$47
Epstein-barr capsid vcaCPT 86665$66
Epstein-barr nuclear antigenCPT 86664$66
Exam synovial fluid crystalsCPT 89060$58
F5 geneCPT 81241$218
Feces culture aerobic bactCPT 87045$23
Fibrin degradation quantCPT 85379$140
Genotype dna hiv reverse tCPT 87901$250
Genotype dna/rna hep cCPT 87902$302
Giardia ag iaCPT 87329$86
Glucose blood testCPT 82962$8
Glucose testCPT 82950$116
Glycosylated hemoglobin testCPT 83036$54
H pylori (c-13) breathCPT 83013$238
Helicobacter pylori antibodyCPT 86677$79
HemoglobinCPT 85018$8
Hep b core antibody totalCPT 86704$51
Hep b surface antibodyCPT 86706$49
Hepatitis a antibodyCPT 86708$50
Hepatitis b surface ag iaCPT 87340$39
Hepatitis c ab testCPT 86803$49
Hepatitis c revrs trnscrpjCPT 87522$470
Herpes simplex type 1 testCPT 86695$30
Herpes simplex type 2 testCPT 86696$30
Heterophile antibody screenCPT 86308$49
Heterophile antibody titerCPT 86309$45
Hfe geneCPT 81256$322
Hiv-1 ag w/hiv-1&2 ab ag iaCPT 87389$94
Hiv-1 quant&revrse trnscrpjCPT 87536$280
Hla typing a b or cCPT 86812$61
Hpylori stool ag iaCPT 87338$69
Immunoassay infectious agentCPT 86317$22
Immunoassay nonantibodyCPT 83516$179
Immunoassay tumor ca 125CPT 86304$148
Immunoassay tumor ca 15-3CPT 86300$133
Immunofix e-phoresis serumCPT 86334$38
Immunohisto antb 1st stainCPT 88342$235
Immunohisto antb addl slideCPT 88341$164
Influenza assay w/opticCPT 87804$46
Iron binding testCPT 83550$66
Jak2 geneCPT 81270$691
Kidney function panel testCPT 80069$139
Lactate (ld) (ldh) enzymeCPT 83615$230
Leukocyte assessment fecalCPT 89055$57
Liver function blood testCPT 80076$196
Mass spectrometry qual/quanCPT 83789$66
Microbe susceptible enzymeCPT 87185$57
Microbe susceptible micCPT 87186$98
Microsomal antibody eachCPT 86376$132
Mycoplasma antibodyCPT 86738$45
N.gonorrhoeae dna amp probCPT 87591$106
Nos each organism ag iaCPT 87449$46
Nuclear antigen antibodyCPT 86235$47
Obstetric blood test panel (Not Offered)CPT 80055--
Opioids & opiate analogs 3/4CPT 80363$66
Ova and parasites smearsCPT 87177$72
Particle agglut antbdy scrnCPT 86403$148
Phenotype infect agent drugCPT 87900$136
Procalcitonin (pct)CPT 84145$368
Protein e-phoresis serumCPT 84165$58
Q fever antibodyCPT 86638$98
Quantitative assay drugCPT 80299$441
Rbc antibody screenCPT 86850$74
Rbc sed rate automatedCPT 85652$67
Resp virus 12-25 targetsCPT 87633$473
Respiratory virus antibodyCPT 86756$101
Rheumatoid factor quantCPT 86431$51
Ria nonantibodyCPT 83519$104
Rubella antibodyCPT 86762$53
Rubeola antibodyCPT 86765$49
Shiga-like toxin ag iaCPT 87427$28
Smear complex stainCPT 87209$286
Smear gram stainCPT 87205$205
Smear wet mount saline/inkCPT 87210$52
Special stains group 1CPT 88312$258
Stool cultr aerobic bact eaCPT 87046$23
Strep a dna amp probeCPT 87651$53
Syphilis test non-trep qualCPT 86592$52
T cell absolute countCPT 86361$86
Tb test cell immun measureCPT 86480$142
Test for acetone/ketonesCPT 82009$46
Thyroglobulin antibodyCPT 86800$53
Tissue exam by pathologistCPT 88305$175
Tissue exam by pathologistCPT 88304$139
Total cortisolCPT 82533$74
Total prostate-specific antigen (PSA) testCPT 84153$66
Total prostate-specific antigen (PSA) testCPT 84154$66
Transferase (ast) (sgot)CPT 84450$81
Ur albumin quantitativeCPT 82043$40
Urinalysis testCPT 81003$43
Urinalysis testCPT 81002$25
Urinalysis test using microscopeCPT 81001$58
Urinalysis test using microscope (Not Offered)CPT 81000--
Urinalysis volume measureCPT 81050$33
Urine culture/colony countCPT 87086$78
Urine pregnancy testCPT 81025$56
Varicella-zoster antibodyCPT 86787$60
Vit d 1 25-dihydroxyCPT 82652$98
Vitamin b-12CPT 82607$53
Vitamin d 25 hydroxyCPT 82306$102
Wbc antibody identificationCPT 86021$86
Withdrawal of arterial bloodCPT 36600$87
Language Pathology
Evaluate swallowing functionCPT 92610$319
Oral function therapyCPT 92526$126
Speech sound lang comprehenCPT 92523$307
Speech/hearing therapyCPT 92507$101
MRI
MRI ScanCPT 70553$1,525
MRI scan of leg jointCPT 73721$2,085
MRI scan of lower spinal canalCPT 72148$2,085
Mri pelvis w/o & w/dyeCPT 72197$1,730
Medical and Surgical Supplies
Cast sup shrt leg fiberglassHCPCS Q4038$238
Other Procedures and Observation
Hospital observation per hrHCPCS G0378$49
Hydration iv infusion initCPT 96360$160
Ther/proph/diag inj sc/imCPT 96372$98
Ther/proph/diag iv inf addonCPT 96366$71
Other Therapeutic
Cardiac rehab/monitorCPT 93798$88
Medical nutrition indiv inCPT 97802$84
Peripheral vascular rehabCPT 93668$88
PhlebotomyCPT 99195$154
Pulmonary rehab w exerHCPCS G0424$132
Psychiatric
Family psychotherapy, including patient, 50 min (Not Offered)CPT 90847--
Family psychotherapy, not including patient, 50 min (Not Offered)CPT 90846--
Group psychotherapy (Not Offered)CPT 90853--
Psychotherapy, 30 min (Not Offered)CPT 90832--
Psychotherapy, 45 min (Not Offered)CPT 90834--
Psychotherapy, 60 min (Not Offered)CPT 90837--
Pulmonary Function
Evaluation of wheezingCPT 94060$607
Measure blood oxygen levelCPT 94762$222
Measure blood oxygen levelCPT 94761$160
Measure blood oxygen levelCPT 94760$77
Radiology
X-Ray of lower backCPT 72110$263
X-ray exam of heelCPT 73650$192
X-ray exam of jaw <4viewsCPT 70100$192
X-ray exam of nasal bonesCPT 70160$192
X-ray exam of pelvisCPT 72190$262
X-ray exam of sinusesCPT 70210$192
Respiratory
Airway inhalation treatmentCPT 94640$147
Cbt 1st hourCPT 94644$174
Chest wall manipulationCPT 94668$174
Chest wall manipulationCPT 94667$174
Evaluate pt use of inhalerCPT 94664$147
Mechanical chest wall oscillCPT 94669$147
Pos airway pressure cpapCPT 94660$294
Vent mgmt inpat subq dayCPT 94003$372
Surgical Procedures
Biopsy exam of esophagus, stomach or small bowel using an ...CPT 43239$522
Biopsy exam of large bowel using an endoscopeCPT 45380$1,607
Biopsy of prostate gland (Not Offered)CPT 55700--
Diagnostic exam of esophagus, stomach or small bowel using...CPT 43235$460
Diagnostic exam of large bowel using an endoscopeCPT 45378$1,528
Injection(s) of anesthetic into lower spine using imaging ... (Not Offered)CPT 64483--
Injection(s) of therapeutic substance (Not Offered)CPT 62322--
Injection(s) of therapeutic substance (Not Offered)CPT 62323--
Insertion of catheter into left heart for diagnosis (Not Offered)CPT 93452--
Mod sed oth phys/qhp <5 yrsCPT 99155$133
Obstetric care, planned cesarean delivery (Not Offered)CPT 59510--
Obstetric care, planned vaginal delivery (Not Offered)CPT 59400--
Obstetric care, planned vaginal delivery (post delivery by... (Not Offered)CPT 59610--
Removal of cataract with insertion of lens (Not Offered)CPT 66984--
Removal of gallbladder using an endoscope (Not Offered)CPT 47562--
Removal of one knee cartilage using an endoscope (Not Offered)CPT 29881--
Removal of one or more breast growth, open procedure (Not Offered)CPT 19120--
Removal of polyps or growths of large bowel using an endos... (Not Offered)CPT 45385--
Removal of recurring cataract in lens capsule using laser (Not Offered)CPT 66821--
Removal of tonsils and adenoid glands, patient younger tha... (Not Offered)CPT 42820--
Repair of groin hernia patient age 5 years or olderCPT 49505$2,566
Shaving of shoulder bone using endoscope (Not Offered)CPT 29826--
Surgical removal of prostate and surrounding lymph nodes u... (Not Offered)CPT 55866--
Ultrasound examination of lower large bowel using an endos... (Not Offered)CPT 45391--
Therapy
Apply multlay comprs lwr legCPT 29581$107
Community/work reintegrationCPT 97537$82
Elec stim other than woundHCPCS G0283$50
Electric stimulation therapyCPT 97014$74
Electrical stimulationCPT 97032$37
Gait training therapyCPT 97116$75
Manual therapy 1/> regionsCPT 97140$76
Mechanical traction therapyCPT 97012$38
Neg press wnd tx <=50 sq cmCPT 97607$56
Neg press wound tx <=50 cmCPT 97605$65
Neg press wound tx >50 cmCPT 97606$70
Neuromuscular reeducationCPT 97112$88
Orthc/prostc mgmt sbsq encCPT 97763$133
Orthotic mgmt&traing 1st encCPT 97760$124
Ot eval high complex 60 minCPT 97167$271
Ot eval low complex 30 minCPT 97165$181
Ot eval mod complex 45 minCPT 97166$226
Paraffin bath therapyCPT 97018$15
Physical performance testCPT 97750$87
Physical therapy, therapeutic exerciseCPT 97110$101
Pt eval high complex 45 minCPT 97163$256
Pt eval low complex 20 minCPT 97161$171
Pt eval mod complex 30 minCPT 97162$214
Pt re-eval est plan careCPT 97164$147
Rmvl devital tis 20 cm/<CPT 97597$91
Rmvl devital tis addl 20cm/<CPT 97598$64
Self care mngment trainingCPT 97535$86
Therapeutic activitiesCPT 97530$82
Ultrasound therapyCPT 97035$36
Vasopneumatic device therapyCPT 97016$30
Wheelchair mngment trainingCPT 97542$82
Wound(s) care non-selectiveCPT 97602$141
Uncategorized
Apply rigid leg castCPT 29445$258
Bls-emergencyHCPCS A0429$903
Cmplx rpr f/c/c/m/n/ax/g/h/fCPT 13132$643
Colon ca scrn not hi rsk indHCPCS G0121$304
Ground mileageHCPCS A0425$19
Insert drug implant deviceCPT 11981$104
Treat fracture radius/ulnaCPT 25605$687
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