Copper Queen Community Hospital

Shoppable services are the expected costs for an entire service.

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All Services Radiology Services

CPT 70110

X-ray of mandible, minimum of 4 views

Standard Charge $890.00

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CPT 70150

X-ray of bones of face, minimum of 3 views

Standard Charge $623.00

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CPT 70260

X-ray of skull, complete, minimum of 4 views

Standard Charge $1,067.00

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CPT 70360

X-ray of neck soft tissue

Standard Charge $115.00

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CPT 70450

CT scan head or brain without dye

Standard Charge $1,600.00

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CPT 70486

CT Scan of the face and jaw without dye

Standard Charge $1,892.00

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CPT 70491

CT scan of neck with dye

Standard Charge $2,131.00

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CPT 70544

Magnetic resonance angiography, head; without contrast material(s)

Standard Charge $1,731.00

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CPT 70551

MRI of brain stem without dye

Standard Charge $1,817.00

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CPT 70553

MRI scan of brain before and after contrast

Standard Charge $2,272.00

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CPT 71045

Single view X-Ray, Chest

Standard Charge $322.00

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CPT 71046

2 views, front and back

Standard Charge $447.00

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CPT 71250

CT scan of the thorax without dye

Standard Charge $1,421.00

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CPT 71260

CT scan of the thorax with dye

Standard Charge $1,600.00

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CPT 71275

Diagnostic Radiology (Diagnostic Imaging) Procedures of the Chest

Standard Charge $1,689.00

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CPT 72040

Radiologic examination of the neck/spine, 2-3 views

Standard Charge $534.00

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CPT 72050

Radiologic examination of the neck/spine, 4-5 views

Standard Charge $1,067.00

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CPT 72052

X-ray Lower Sacral Spine, 4 or More Views

Standard Charge $812.00

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CPT 72072

Radiologic examination of the middle spine, 3 views

Standard Charge $447.00

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CPT 72100

X-ray of the lower spine 2-3 views

Standard Charge $890.00

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CPT 72110

X-ray of lower and sacral spine, minimum of 4 views

Standard Charge $812.00

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CPT 72131

CT scan of lower spine without dye

Standard Charge $1,909.00

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CPT 72141

MRI of the neck or spine without dye

Standard Charge $1,817.00

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CPT 72146

MRI of chest and spine without dye

Standard Charge $1,817.00

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CPT 72148

MRI scan of lower spinal canal

Standard Charge $1,817.00

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CPT 72156

MRI of neck/spine with and without dye

Standard Charge $2,272.00

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CPT 72157

MRI of chest and spine with and without dye

Standard Charge $2,272.00

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CPT 72158

MRI of lower back with and without dye

Standard Charge $2,272.00

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CPT 72170

Radiologic examination of the pelvis

Standard Charge $322.00

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CPT 72192

CT of pelvis without dye

Standard Charge $1,244.00

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CPT 72193

CT scan, pelvis, with contrast

Standard Charge $1,421.00

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CPT 72197

MRI of pelvis before and after dye

Standard Charge $2,272.00

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CPT 72202

X-ray Sacroiliac Joints, 3 or More Views

Standard Charge $447.00

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CPT 73552

X-ray Femur, 2 Views

Standard Charge $252.00

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CPT 73650

Radiologic examination of the heel

Standard Charge $447.00

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CPT 74022

Serial radiologic examination of the abdomen

Standard Charge $890.00

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CPT 74150

CT of abdomen without dye

Standard Charge $2,308.00

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CPT 74160

CT of abdomen with dye

Standard Charge $2,486.00

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CPT 74170

CT of abdomen with and without dye

Standard Charge $3,196.00

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CPT 74176

CT of abdomen and pelvis without dye

Standard Charge $3,551.00

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CPT 74177

CT scan of abdomen and pelvis with contrast

Standard Charge $3,904.00

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CPT 74178

Computed tomography, abdomen and pelvis; without contrast material in one or both body regions, followed by contrast material(s) and further sections in one or both body regions

Standard Charge $3,904.00

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CPT 74181

MRI of abdomen without dye

Standard Charge $1,817.00

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CPT 74183

MRI of abdomen without and with dye

Standard Charge $2,272.00

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CPT 76536

Ultrasound of head and neck

Standard Charge $1,244.00

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CPT 76642

Limited ultrasound of the breast

Standard Charge $387.00

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CPT 76700

Ultrasound of abdomen with all areas scanned

Standard Charge $1,187.00

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CPT 76705

A diagnostic procedure that allows a provider to see the organs and other structures in the abdomen

Standard Charge $438.00

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CPT 76770

Ultrasound of back wall of the abdomen with all areas viewed

Standard Charge $641.00

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CPT 76775

Ultrasound of back wall of the abdomen with limited areas viewed

Standard Charge $1,421.00

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CPT 76801

Abdominal ultrasound of pregnant uterus (less than 14 weeks) single or first fetus

Standard Charge $999.00

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CPT 76805

Abdominal ultrasound of pregnant uterus (greater or equal to 14 weeks 0 days) single or first fetus

Standard Charge $1,421.00

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CPT 76817

Transvaginal ultrasound of uterus

Standard Charge $514.00

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CPT 76830

Ultrasound of the pelvis through vagina

Standard Charge $623.00

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CPT 76856

Complete ultrasound of the pelvis

Standard Charge $1,244.00

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CPT 76857

Limited ultrasound of the pelvis

Standard Charge $335.00

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CPT 76870

Ultrasound of the scrotum

Standard Charge $995.00

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CPT 76881

Ultrasound Joint Soft Tissue - Complete

Standard Charge $713.00

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CPT 77066

Mammography of both breasts

Standard Charge $800.00

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CPT 77067

Mammography of both breasts-2 or more views

Standard Charge $646.00

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CPT 77080

Scan to measure bone mineral density (BMD) at the spine and hip

Standard Charge $712.00

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