▸ Hospital · CO · CCN 061321

Mt San Rafael Hospital

410 BENEDICTA AVE., TRINIDAD, CO, 81082

25 bedsCritical Access Hospitals2

Compliance grade

93/100

Procedures tracked

of 209 target codes

Payers

with negotiated rates

Rates published

1,024

last crawl 2026-05-22

▸ Compare with other hospitals All CO hospitals JSON Full cost report on HCRIS.io →

Source MRF: https://secure.claraprice.net/price-transparency/BQJH-1670278124636/machine-readable/352336501_crane-memorial-hospital_standardcharges.json · JSON

Procedures & rates

Procedure	Type	Code	Payers	Gross	Cash	Neg min	Neg median	Neg max
emergency
ED visit level 1	CPT	99281	2	$232	$162	$31	$93.5	$209
ED visit level 2	CPT	99282	2	$389	$272	$237	$255	$350
ED visit level 3	CPT	99283	2	$678	$475	$414	$444.5	$610
ED visit level 4	CPT	99284	2	$1,208	$846	$737	$792	$1,087
ED visit level 5	CPT	99285	2	$1,726	$1,208	$1,046	$1,128	$1,553
Critical care, first hour	CPT	99291	2	$2,475	$1,733	$1,510	$1,623	$2,228
imaging
CT head without contrast	CPT	70450	2	$1,610	$1,127	$687	$997	$1,449
CT head with contrast	CPT	70460	2	$1,842	$1,289	$787	$1,140.5	$1,658
CT head with and without contrast	CPT	70470	2	$2,305	$1,614	$984	$1,427	$2,075
CT neck with contrast	CPT	70491	2	$2,012	$1,408	$859	$1,245.5	$1,811
Chest X-ray single view	CPT	71045	2	$336	$235	$84	$136	$302
Chest X-ray 2 views	CPT	71046	2	$342	$239	$79	$138.5	$308
CT chest without contrast	CPT	71250	2	$1,695	$1,187	$724	$1,049.5	$1,526
CT chest with contrast	CPT	71260	2	$2,188	$1,532	$934	$1,355	$1,969
CT chest with and without contrast	CPT	71270	2	$2,651	$1,856	$1,132	$1,641.5	$2,386
Lumbosacral spine X-ray	CPT	72100	2	$249	$174	$64	$120.5	$224
CT cervical spine without contrast	CPT	72125	2	$1,957	$1,370	$836	$1,212	$1,761
CT thoracic spine without contrast	CPT	72128	2	$1,679	$1,175	$717	$1,039.5	$1,511
CT lumbar spine without contrast	CPT	72131	2	$1,737	$1,216	$742	$1,075.5	$1,563
CT pelvis without contrast	CPT	72192	2	$1,621	$1,135	$692	$1,003.5	$1,459
CT pelvis with contrast	CPT	72193	2	$1,922	$1,345	$821	$1,190	$1,730
Shoulder X-ray	CPT	73030	2	$463	$324	$124	$229.5	$417
Humerus X-ray	CPT	73060	2	$371	$260	$47	$154.5	$334
Hand X-ray 3 views	CPT	73130	2	$343	$240	$91	$169.5	$309
Knee X-ray 1-2 views	CPT	73560	2	$445	$312	$51	$182.5	$401
Ankle X-ray 3 views	CPT	73610	2	$278	$195	$79	$123.5	$250
CT abdomen without contrast	CPT	74150	2	$1,573	$1,101	$672	$974	$1,416
CT abdomen with contrast	CPT	74160	2	$1,852	$1,296	$791	$1,147	$1,667
CT abdomen with and without contrast	CPT	74170	2	$2,447	$1,713	$1,045	$1,515	$2,202
CT abdomen and pelvis without contrast	CPT	74176	2	$3,219	$2,253	$1,375	$1,993	$2,897
CT abdomen and pelvis with contrast	CPT	74177	2	$3,936	$2,755	$1,681	$2,437	$3,542
CT abdomen and pelvis with and without contrast	CPT	74178	2	$4,267	$2,987	$1,822	$2,642	$3,840
Abdominal ultrasound complete	CPT	76700	2	$919	$643	$392	$583	$827
Abdominal ultrasound limited	CPT	76705	2	$919	$643	$392	$583	$827
Retroperitoneal ultrasound complete	CPT	76770	2	$588	$412	$251	$373	$529
Obstetric ultrasound first trimester	CPT	76801	2	$760	$532	$325	$482.5	$684
Obstetric ultrasound after first trimester	CPT	76805	2	$760	$532	$325	$482.5	$684
Transvaginal ultrasound	CPT	76830	2	$601	$421	$257	$381.5	$541
Pelvic ultrasound complete	CPT	76856	2	$919	$643	$392	$583	$827
Scrotal ultrasound	CPT	76870	2	$720	$504	$307	$456.5	$648
EKG complete	CPT	93000	2	$83	$58	$51	$51.5	$75
EKG tracing only	CPT	93005	2	$101	$71	$51	$62	$91
lab
Basic metabolic panel (BMP)	CPT	80048	2	$242	$169	$62	$107	$218
Electrolyte panel	CPT	80051	2	$204	$143	$52	$90	$184
Comprehensive metabolic panel	CPT	80053	2	$326	$228	$84	$144.5	$293
Lipid panel	CPT	80061	2	$180	$126	$46	$79.5	$162
Renal function panel	CPT	80069	2	$338	$237	$87	$149.5	$304
Hepatic function panel	CPT	80076	2	$221	$155	$57	$98	$199
Urinalysis automated	CPT	81003	2	$43	$30	$11	$19	$39
Glucose quantitative	CPT	82947	2	$48	$34	$4	$12	$43
Hemoglobin A1c	CPT	83036	2	$184	$129	$47	$81.5	$166
Thyroid stimulating hormone (TSH)	CPT	84443	2	$273	$191	$56	$103	$246
Complete blood count with automated differential	CPT	85025	2	$80	$56	$20	$35	$72
Complete blood count without differential	CPT	85027	2	$80	$56	$20	$35	$72
Urine culture bacterial	CPT	87086	2	$20	$14	$5	$9	$18
Tissue exam by pathologist level IV	CPT	88305	2	$185	$130	$47	$92	$167
office
Office visit, new patient, 15-29 min	CPT	99202	2	$148	$104	$90	$91.5	$133
Office visit, new patient, 30-44 minutes	CPT	99203	2	$254	$178	$155	$157.5	$229
Office visit, new patient, 45-59 min	CPT	99204	2	$389	$272	$226	$237	$350
Office visit, new patient, 60-74 min	CPT	99205	2	$439	$307	$268	$272	$395
Office visit, established patient, 5 min	CPT	99211	2	$101	$71	$28	$38.5	$91
Office visit, established patient, 10-19 min	CPT	99212	2	$91	$64	$56	$56.5	$82
Office visit, established patient, 20-29 minutes	CPT	99213	2	$242	$169	$84	$123.5	$218
Office visit, established patient, 30-39 minutes	CPT	99214	2	$199	$139	$121	$124.5	$179
Office visit, established patient, 40-54 min	CPT	99215	2	$254	$178	$155	$157.5	$229
preventive
Upper GI endoscopy diagnostic	CPT	43235	2	$2,084	$1,459	$1,271	$1,290	$1,876
Upper GI endoscopy with biopsy	CPT	43239	2	$2,200	$1,540	$1,342	$1,362	$1,980
Sigmoidoscopy with biopsy	CPT	45331	2	$1,433	$1,003	$874	$887	$1,290
Colonoscopy diagnostic	CPT	45378	2	$2,315	$1,621	$1,412	$1,433.5	$2,084
Colonoscopy with biopsy	CPT	45380	2	$3,134	$2,194	$1,912	$1,940.5	$2,821
Colonoscopy with polyp removal	CPT	45385	2	$2,084	$1,459	$1,271	$1,290	$1,876
surgery
Laparoscopic cholecystectomy	CPT	47562	2	$7,687	$5,381	$4,689	$4,759.5	$6,918
Umbilical hernia repair age 5+	CPT	49585	2	$4,812	$3,368	$2,672	$2,935	$4,331
Lap inguinal hernia repair	CPT	49650	2	$7,625	$5,338	$4,651	$4,721	$6,863

Rate history available after the next quarterly refresh. We re-crawl all hospital MRFs each quarter to track rate changes over time.

Payer mix (top 2)

Payer	Codes covered	Median rate
Blue Cross Blue Shield	74	$245
UnitedHealthcare	74	$164.5