Visits & medical services prices at Bear Lake Memorial Hospital

Montpelier, ID · every code in this section with a posted price and a Medicare benchmark.

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

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ProcedureCash priceGross charge× Medicare
Airway inhalation treatment (94640) $133.45 $157 0.6×
Appl Modality 1/> Areas Ultrasound Ea 15 Min (97035) $90.53 $106.50 6.3×
Assessment of aphasia per hr (96105) $283.05 $333 2.9×
Bedside Swallowing Eval (92610) $283.05 $333 3.3×
Behavioral and qualitative analysis of voice and resonance (92524) $261.38 $307.50 2.4×
Brncdilat rspse spmtry pre&post-brncdilat admn (94060) $295.38 $347.50 0.8×
Canalith Repositioning Procedure (95992) $150.45 $177 3.7×
Cardiac Stress Tst,Tracing Only (93017) $128.78 $151.50 0.6×
Cardiopulmonary resuscitation (92950) $907.80 $1,068 4.3×
Cardioversion (92960) $578 $680 0.9×
Chemo Hormon Antineopl Sq/Im (96402) $184.45 $217 2.6×
Chemo IV push addl drug (96411) $247.56 $291.25 3.5×
Chemother, IV infusion, 1 hr (96413) $601.80 $708 1.8×
Chemother, IV infusion, ea add hr (96415) $194.23 $228.50 2.7×
Chemother,Non-Hormone Anti-Neopl, Sub-Q/Im (96401) $218.88 $257.50 3.1×
Chemotherapy, unspecified procedure (96549) $115.60 $136 2.5×
Chemotx admn IV nfs tq ea seql nfs to 1 hr (96417) $253.73 $298.50 3.6×
Chemotx admn IV push tq 1/1st sbst/drug (96409) $343.83 $404.50 1.1×
Cpap/bipap (94660) $437.33 $514.50 2.0×
Cpt initial (94667) $102.85 $121 0.8×
Critical care (99291) $1,121.58 $1,319.50 1.4×
Debridement Open Wound 20 Sq Cm< (97597) $74.38 $87.50 0.4×
Distort Product Evoked Otoacoustic Emisns Limitd (92587) $243.53 $286.50 1.1×
Dup-Scan Aorta Ivc Iliac Vascl/Bpgs Complete (93978) $723.78 $851.50 3.1×
Dup-Scan Lxtr Art/Artl Bpgs Compl Bi Study (93925) $969.43 $1,140.50 4.1×
Dup-Scan Lxtr Art/Artl Bpgs Uni/Lmtd Study (93926) $670.65 $789 6.5×
Dup-Scan Uxtr Art/Artl Bpgs Compl Bi Study (93930) $988.13 $1,162.50 4.2×
Dup-Scan Uxtr Art/Artl Bpgs Uni/Lmtd Study (93931) $688.93 $810.50 6.7×
Dup-Scan Xtr Veins Complete Bilateral Study (93970) $1,001.30 $1,178 4.2×
Dup-scan xtr veins unilateral/limited study (93971) $456.24 $536.75 4.4×
Duplex scan extracranial art compl bi study (93880) $1,008.10 $1,186 4.3×
Echo Heart Xthoracic,Limited (93308) $709.75 $835 3.0×
Electrocardiogram Tracing (93005) $194.65 $229 3.3×
Er level 1 (99281) $130.69 $153.75 1.6×
Er level ii (99282) $289.85 $341 1.9×
Er level iii (99283) $414.80 $488 1.5×
Er level IV (99284) $685.52 $806.50 1.7×
Er level v (99285) $872.74 $1,026.75 1.5×
Eval speech sound production (92522) $252.88 $297.50 2.3×
Evaluate Pt Use Of Inhaler (94664) $115.60 $136 0.5×
Evaluation of speech fluency (92521) $304.30 $358 2.3×
External ECG rec>48hr<7d recording (93242) $54.40 $64 1.5×
External ECG rec>7d<15d recording (93246) $104.98 $123.50 2.8×
Holter Monitor (93225) $103.28 $121.50 0.8×
Imm admn sarscov2 vaccine single dose (90480) $48.03 $56.50 1.2×
Immunization Admin (90471) $99.03 $116.50 1.4×
Iontophoresis 15 min (97033) $193.38 $227.50 10.2×
Irrig drug delivery device (96523) $224.83 $264.50 3.9×
IV infusion hydration each additional hour (96361) $119.43 $140.50 2.6×
IV infusion hydration initial 31 min-1 hour (96360) $480.25 $565 2.3×
IV infusion ther proph addl sequential to 1 hr (96367) $250.33 $294.50 3.5×
IV infusion, therap/proph/diagnost,initial,1st hour (96365) $447.95 $527 2.1×
IV infusion, therap/proph/diagnost,initial,ea add hour (96366) $110.50 $130 2.4×
IV push ea addl new drug (96375) $229.50 $270 5.0×
IV push initial (96374) $229.50 $270 1.1×
Manual therapy 15 min (97140) $112.20 $132 4.0×
Massage 15 min (97124) $104.98 $123.50 3.5×
Mechanical traction (97012) $70.55 $83 4.9×
Neg press wound tx >50 cm (97608) $607.75 $715 1.5×
Neg Pressure Wound Therapy Non Dme </= 50 Sq Cm (97607) $622.63 $732.50 1.6×
Negative Pressure Wound Therapy Dme </= 50 Sq Cm (97605) $54.83 $64.50 0.3×
Negative Pressure Wound Therapy Dme >50 Sq Cm (97606) $259.68 $305.50 0.6×
Newborn resuscitation (99465) $592.88 $697.50 0.9×
Non-Invas Physiologic Std Extremity Art 2 Level (93922) $410.13 $482.50 3.1×
Noninvasive Ear/Pulse Oximetry Overnight Monitor (94762) $141.95 $167 1.1×
Orthotics Mgmt & Trainj Initial Enctr Ea 15 Mins (97760) $109.86 $129.25 2.4×
Osteopathic Manipulative Tx 1-2 Body Regions (98925) $70.98 $83.50 3.3×
Ot Community/Work Reintegration Trainj Ea 15 Min (97537) $94.35 $111 2.9×
Ot Contrast Bath Ea 15 Min (97034) $74.38 $87.50 5.3×
Ot eval high complex 60 min (97167) $284.33 $334.50 2.8×
Ot eval low complex 30 min (97165) $227.38 $267.50 2.3×
Ot eval mod complex 45 min (97166) $253.30 $298 2.5×
Ot re-evaluation (97168) $227.38 $267.50 3.3×
Ot therapeutic activity 15 min (97530) $136.85 $161 3.9×
Outpatient Cardiac Rehab W/Cont Ecg Monitoring (93798) $166.18 $195.50 1.3×
Paraffin bath pt (97018) $70.13 $82.50 11.7×
Pentamidine Aersl Inhalation Pneumocystis/Proph (94642) $181.90 $214 0.8×
Phlebotomy therapeutic (99195) $183.82 $216.25 1.4×
Phys/qhp svcs op pulm rehab wo cont oximtry mntr (94625) $58.34 $68.63 1.0×
Polysom 6/>Yrs Sleep W/Cpap 4/> Addl Param Attnd (95811) $3,189.63 $3,752.50 3.8×
Psytx crisis initial 60 min (90839) $226.95 $267 1.3×
Pt Asstv Technol Assmt Dir Cntct W/Reprt Ea 15 Min (97755) $61.20 $72 1.6×
Pt eval high complex 45 min (97163) $249.05 $293 2.5×
Pt eval low complex 20 min (97161) $197.63 $232.50 2.0×
Pt eval mod complex 30 min (97162) $223.55 $263 2.3×
Pt gait training 15 min (97116) $104.98 $123.50 3.6×
Pt Neuromusc Reeducat,1+ Areas, Ea 15 Min (97112) $116.66 $137.25 3.6×
Pt Physical Performance Test (97750) $143.86 $169.25 4.3×
Pt re-evaluation (97164) $213.35 $251 3.2×
Pt Self-Care/Home Mgmt Training Each 15 Minutes (97535) $28.05 $33 0.9×
Refill/Maint Portable Pump (96521) $376.55 $443 1.8×
Refill/Maint Pump/Resvr Syst (96522) $391.85 $461 1.9×
Remote 30 Day Ecg Rev/Report - Cardiac Event Monitor (93270) $103.28 $121.50 2.8×
Rmvl Devital Tiss N-Slctv Dbrdmt W/O Anes 1 Sess (97602) $181.48 $213.50 0.9×
Rt Chest Wall Manipulation,Subsequent (94668) $133.45 $157 1.0×
Sensory Integration Ea 15 Min (97533) $81.60 $96 1.3×
Sleep study unattended (95806) $675.33 $794.50 3.2×
Speech sound lang comprehen (92523) $514.25 $605 2.3×
Spirometry (94010) $110.50 $130 0.5×
Standardized Cognitive Performance Testing (96125) $287.73 $338.50 2.8×
Stress echo (93350) $1,055.28 $1,241.50 2.0×
Subcut infusion, therap/proph/diagnost,initial,1st hour (96369) $320.45 $377 1.5×
Subcutaneous Infusion Each Additional Hour (96370) $128.35 $151 2.8×
Ther ivntj cog funcj cntct 1st 15 minutes (97129) $37.40 $44 1.7×
Ther Ivntj Cog Funcj Cntct Ea Addl 15 Minutes (97130) $35.70 $42 1.7×
Ther Sp-Genratj Dev Prgrmg&Modificaj (92609) $106.25 $125 1.0×
Therapeutic prophylactic/dx injection subq/im (96372) $76.93 $90.50 1.1×
Tte w/doppler, complete (93306) $1,340.03 $1,576.50 2.5×
Tx Speech Lang Voice Commj &/Auditory Proc Ind (92507) $245.65 $289 3.2×
Tx Swallowing Dysfunction&/Oral Funcj Feeding (92526) $283.05 $333 3.4×
Upr/lxtr art stdy 3+ lvls (93923) $935 $1,100 4.4×
Vasc Duplex Scan Extracranial,Limited (93882) $799.85 $941 7.7×
Vasopneumatic device (97016) $102.85 $121 8.6×
Vent mgmt inpat init day (94002) $1,272.03 $1,496.50 2.1×
Ventilation Assist & Mgmt Inpatient Ea Sbsq Da (94003) $915.45 $1,077 1.5×
Wheelchair Mgmt Ea 15 Min (97542) $93.50 $110 3.0×