Mt. San Rafael Hospital prices
Mt. San Rafael Hospital in Trinidad, CO publishes its standard charges, as every US hospital must under the federal Hospital Price Transparency Rule. Below is what its own file lists for common services, next to what it has agreed to accept from insurers.
What Mt. San Rafael Hospital publishes for common services
ER visit, level 3 (moderate): listed at $433 to $1,205. Insurers pay a median of $172, across 46 insurers.
If you were billed the list price, you may have been charged far more than insurers typically pay. See how to use these numbers below.
| Service | List price | Cash price | Insurers pay (median) |
|---|---|---|---|
| ER visit, level 1 (minor)CPT 99281, listed as "PRO FEE BRIEF EVAL" | $192 to $324 | - | $69.60$11.00 to $311, 46 insurers |
| ER visit, level 2 (low-moderate)CPT 99282, listed as "PRO FEE EVAL LOW COM" | $279 to $463 | - | $118$31.90 to $444, 46 insurers |
| ER visit, level 3 (moderate)CPT 99283, listed as "PRO FEE EVAL MED COM" | $433 to $1,205 | - | $172$51.28 to $1,156, 46 insurers |
| ER visit, level 4 (high)CPT 99284, listed as "PRO FEE EVAL MOD COM" | $642 to $1,787 | - | $201$94.83 to $1,715, 46 insurers |
| ER visit, level 5 (critical)CPT 99285, listed as "PRO FEE EVAL HIGH CO" | $1,007 to $2,605 | - | $141$101 to $2,500, 46 insurers |
| Office visit, established patient, low complexityCPT 99213, listed as "RHC EPF/EPF/LOW 2/3" | $138 to $188 | - | $102$52.50 to $180, 25 insurers |
| Office visit, established patient, moderate complexityCPT 99214, listed as "RHC DET/SET/MOD 2/3" | $96.00 to $305 | - | $110$26.88 to $292, 25 insurers |
| Routine venipuncture (blood draw)CPT 36415, listed as "COLL VENOUS BLD VENIPUNCTURE" | $24.50 to $64.00 | - | $8.83$3.00 to $61.44, 38 insurers |
| Vitamin B12 injectionCPT J3420, listed as "RHC VITAMIN B-12 TO 1000 MCG" | $24.50 to $27.00 | - | $23.52$23.52 to $25.92, 5 insurers |
| Comprehensive metabolic panelCPT 80053, listed as "COMPLETE METABO PROF" | $17.50 to $275 | - | $10.56$10.56 to $264, 38 insurers |
| Basic metabolic panelCPT 80048, listed as "BASIC METABOLIC PROFILE" | $187 to $196 | - | $8.46$8.46 to $188, 38 insurers |
| CBC with differentialCPT 85025, listed as "CBC W/AUTO DIFF" | $126 | - | $7.77$7.77 to $121, 38 insurers |
| Lipid panelCPT 80061, listed as "LIPID PANEL" | $39.50 to $198 | - | $13.39$13.39 to $190, 38 insurers |
| Hepatic function panelCPT 80076, listed as "HEPATIC FUNCTION PANEL" | $72.00 to $192 | - | $8.17$8.17 to $184, 38 insurers |
| X-ray, ankle, 3 viewsCPT 73610, listed as "ANKLE MIN 3 VIEWS" | $544 | - | $522$94.98 to $1,221, 10 insurers |
| CT abdomen, without contrastCPT 74176, listed as "CT ABD & PELIS W/O CONTRAST" | $4,446 | - | $4,268$190 to $4,268, 10 insurers |
| CT abdomen and pelvis, with contrastCPT 74177, listed as "CT ABD & PELVIS W/CONTRAST" | $5,027 | - | $4,826$293 to $4,826, 10 insurers |
| CT abdomen and pelvis, with and without contrastCPT 74178, listed as "CT ABD & PELVIS W/WO" | $6,200 | - | $5,952$327 to $5,952, 10 insurers |
| MRI brain, without contrastCPT 70551, listed as "MRI BRAIN WO CONTRAST" | $3,441 | - | $3,303$350 to $3,303, 10 insurers |
| MRI brain, with and without contrastCPT 70553, listed as "MRI BRAIN W/WO CONTRAST" | $5,144 | - | $4,938$535 to $4,938, 10 insurers |
| MRI pelvis, without contrastCPT 72195, listed as "MRI PELVIS WO CONTRAST" | $3,561 | - | $3,418$350 to $3,418, 10 insurers |
| MRI pelvis, with and without contrastCPT 72197, listed as "MRI PELVIS W/WO CONTRAST" | $6,822 | - | $6,549$535 to $6,549, 10 insurers |
| Complete echocardiogram with DopplerCPT 93306, listed as "US 2D ECHO TTE W/DOP" | $2,530 to $3,140 | - | $2,429$451 to $3,014, 10 insurers |
| Echocardiogram, completeCPT 93307, listed as "US 2-D ECHO(TTE);COMPLETE" | $440 | - | $422$264 to $1,221, 10 insurers |
| Electrocardiogram, tracing only (technical component)CPT 93005, listed as "EKG 12 LEAD TRACING" | $297 to $399 | - | $285$78.44 to $285, 10 insurers |
| Electrocardiogram, interpretation and report onlyCPT 93010, listed as "ELECTROCARDIOGRAM REPORT" | $40.50 to $59.50 | - | $14.04$7.85 to $14.04, 44 insurers |
| Laparoscopic cholecystectomyCPT 47562, listed as "LAPAROSCOPIC CHOLECYSTECTOMY" | $7,676 | - | $632$610 to $7,369, 46 insurers |
| Knee arthroscopy, meniscectomyCPT 29881, listed as "KNEE ARTHROSCOP SURG" | $3,616 | - | $527$329 to $3,471, 46 insurers |
Source: Mt. San Rafael Hospital's standard charges file, which the hospital dated July 23, 2026. Read on September 28, 2026. View the hospital's file (a large data file). Hospitals must publish this file under 45 CFR § 180.
List price
The hospital's full charge (its "gross charge") before any discount. Few people pay it, but it is often the starting point on a bill.
Cash price
What the hospital says it accepts from patients paying without insurance.
Insurers pay
The median of the per-service rates the hospital has negotiated with insurers, shown only when at least 3 insurers report one. Your plan's rate may differ.
How to use these numbers
Uninsured or paying yourself? You can ask Mt. San Rafael Hospital to bill you its published cash price, and ask about financial assistance, which nonprofit hospitals must offer.
Insured, and the hospital is in your network? Your share should be based on your plan's negotiated rate, not the list price. If your bill or explanation of benefits shows the list price, ask the billing office why.
These figures summarize what the hospital publishes. They are not a quote, and they don't include separate physician bills.
Check your Mt. San Rafael Hospital bill for errors
The free check looks for duplicate charges, unbundling, upcoding and surprise billing. Its price comparison uses national reference pricing, separate from the hospital's published prices above.
BillMender is a document-preparation tool, not a law firm, and does not provide legal advice. We don't guarantee any outcome or dollar amount. Estimates are based on public reference pricing, not your hospital's actual contract rates.