Visits & medical services prices at Memorial Hospital of Carbon County
Rawlins, WY · every code in this section with a posted price and a Medicare benchmark.
107 codes. Prices are the hospital's own posted facility charges.
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| Procedure | Posted cash | Posted gross | × Medicare |
|---|---|---|---|
| Advncd Care Plan 30 Min (99497) range across 2 matching MRF lines |
$93.75–$140.25 | $125–$187 | varies |
| Airway Inhalation Treatment (94640) range across 7 matching MRF lines |
$108.75–$141 | $145–$188 | varies |
| Allg test perq & ic drug/biol immed react w/ i&r (95018) range across 2 matching MRF lines |
$23.25–$42.75 | $31–$57 | varies |
| Anogenital Xm Magnify Child/Suspect Trauma W Img (99170) range across 3 matching MRF lines |
$418.50–$494.25 | $558–$659 | varies |
| Brief Emotional/Behav Assmt (96127) | $54.75 | $73 | 1.4× |
| Brncdilat rspse spmtry pre&post-brncdilat admn (94060) range across 5 matching MRF lines |
$76.50–$522 | $102–$696 | varies |
| Canalith repositioning proc (95992) range across 2 matching MRF lines |
$90–$111 | $120–$148 | varies |
| Car seat/bed test 60 min (94780) | $169.50 | $226 | 4.4× |
| Cardiopulmonary resuscitation (92950) range across 2 matching MRF lines |
$549–$1,099.50 | $732–$1,466 | varies |
| Cardioversion (92960) range across 4 matching MRF lines |
$321–$1,130.25 | $428–$1,507 | varies |
| Cardioversion elective internal (92961) range across 2 matching MRF lines |
$728.25–$874.50 | $971–$1,166 | varies |
| Cbt 1st hour (94644) | $308.25 | $411 | 2.3× |
| Chemo Anti-Neopl Sq/Im (96401) range across 2 matching MRF lines |
$179.25–$812.25 | $239–$1,083 | varies |
| Chemo Hormon Antineopl Sq/Im (96402) range across 2 matching MRF lines |
$90–$315 | $120–$420 | varies |
| Chemo IV infusion addl hr (96415) | $146.25 | $195 | 2.0× |
| Chemo IV push addl drug (96411) range across 2 matching MRF lines |
$182.25–$250.50 | $243–$334 | varies |
| Chemother Prolong Infuse W/Pump (96416) | $528 | $704 | 1.6× |
| Chemotherapy Admin Intra-Arterial Infus </1 Hr (96422) | $545.25 | $727 | 1.6× |
| Chemotherapy Admn Intraarterial Infusion Ea Hr (96423) | $61.50 | $82 | 1.3× |
| Chemotx admn IV nfs tq ea seql nfs to 1 hr (96417) | $172.50 | $230 | 2.3× |
| Chemotx admn IV nfs tq up 1 hr 1/1st sbst/drug (96413) | $408 | $544 | 1.2× |
| Chemotx admn IV push tq 1/1st sbst/drug (96409) | $291 | $388 | 0.9× |
| Chest Wall Manipulation (94668) | $121.50 | $162 | 0.9× |
| Chron Care Mgmt Srvc 20 Min (99490) | $175.50 | $234 | 1.7× |
| Complex chronic care mgmt svc 1st 60 min cal mo (99487) range across 2 matching MRF lines |
$147–$221.25 | $196–$295 | varies |
| Cpap Ventilation Cpap Initiation&Mgmt (94660) | $819 | $1,092 | 3.7× |
| Cpt initial (94667) | $93.75 | $125 | 0.7× |
| Critical care first hour (99291) range across 3 matching MRF lines |
$426.75–$1,875 | $569–$2,500 | varies |
| Debridement Open Wound 20 Sq Cm< (97597) range across 5 matching MRF lines |
$148.50–$3,867 | $198–$5,156 | varies |
| Dup-Scan Xtr Veins Complete Bilateral Study (93970) range across 8 matching MRF lines |
$369–$1,479.75 | $492–$1,973 | varies |
| Dup-scan xtr veins unilateral/limited study (93971) range across 13 matching MRF lines |
$142.50–$1,012.50 | $190–$1,350 | varies |
| Echo Heart Xthoracic,Limited (93308) range across 2 matching MRF lines |
$200.25–$660.75 | $267–$881 | varies |
| Echo transesophageal (93312) | $202.50 | $270 | 0.4× |
| Electrocardiogram Tracing (93005) range across 2 matching MRF lines |
$177.75–$265.50 | $237–$354 | varies |
| Emergency Dept Visit Level 2 (99282) range across 3 matching MRF lines |
$83.25–$317.25 | $111–$423 | varies |
| Emergency Dept Visit Level 3 (99283) range across 3 matching MRF lines |
$141.75–$560.25 | $189–$747 | varies |
| Emergency Dept Visit Level 4 (99284) range across 3 matching MRF lines |
$239.25–$912 | $319–$1,216 | varies |
| Er level 1 (99281) range across 3 matching MRF lines |
$42.75–$194.25 | $57–$259 | varies |
| Er level v (99285) range across 3 matching MRF lines |
$348–$1,347.75 | $464–$1,797 | varies |
| Evaluate pt use of inhaler (94664) | $163.50 | $218 | 0.7× |
| External ECG rec>48hr<7d recording (93242) | $63.75 | $85 | 1.7× |
| External ECG rec>7d<15d recording (93246) | $108 | $144 | 2.8× |
| Extracranial Bilat Study (93880) range across 2 matching MRF lines |
$369–$1,925.25 | $492–$2,567 | varies |
| Holter monitor recording (93225) | $465 | $620 | 3.4× |
| Im Adm Intransl/Oral 1 Vaccine (90473) | $62.25 | $83 | 0.8× |
| Immunization administration (90471) | $88.50 | $118 | 1.2× |
| Inital newborn e/m (99460) | $249 | $332 | 1.8× |
| Insert/Place Heart Catheter (93503) range across 2 matching MRF lines |
$174–$2,841 | $232–$3,788 | varies |
| Intracutaneous tests w/allergenic extracts (95024) range across 2 matching MRF lines |
$9.75–$14.25 | $13–$19 | varies |
| Irrig Drug Delivery Device (96523) range across 2 matching MRF lines |
$108–$117 | $144–$156 | varies |
| IV infusion hydration each additional hour (96361) range across 2 matching MRF lines |
$105–$154.50 | $140–$206 | varies |
| IV infusion hydration initial 31 min-1 hour (96360) range across 3 matching MRF lines |
$291–$352.50 | $388–$470 | varies |
| IV infusion ther proph addl sequential to 1 hr (96367) range across 2 matching MRF lines |
$99.75–$154.50 | $133–$206 | varies |
| IV infusion therapy prophylaxis/dx ea hour (96366) range across 2 matching MRF lines |
$104.25–$167.25 | $139–$223 | varies |
| IV push initial (96374) range across 2 matching MRF lines |
$215.25–$234 | $287–$312 | varies |
| Multiple Sleep Latency Test (95805) | $1,989.75 | $2,653 | 2.3× |
| Neg Pressure Wound Therapy Non Dme </= 50 Sq Cm (97607) range across 6 matching MRF lines |
$422.25–$655.50 | $563–$874 | varies |
| Neg Pressure Wound Therapy Non Dme >50 Sq Cm (97608) range across 5 matching MRF lines |
$222–$409.50 | $296–$546 | varies |
| Negative Pressure Wound Therapy Dme </= 50 Sq Cm (97605) range across 7 matching MRF lines |
$49.50–$247.50 | $66–$330 | varies |
| Negative Pressure Wound Therapy Dme >50 Sq Cm (97606) range across 6 matching MRF lines |
$54–$440.25 | $72–$587 | varies |
| Neuromuscular Reeducation (97112) | $103.50 | $138 | 3.2× |
| Newborn resuscitation (99465) | $514.50 | $686 | 0.8× |
| Orthc/Prostc Mgmt Sbsq Enc (97763) | $82.50 | $110 | 1.6× |
| Orthotics Mgmt & Trainj Initial Enctr Ea 15 Mins (97760) | $83.25 | $111 | 1.8× |
| Osteopathic Manipulative Tx 1-2 Body Regions (98925) range across 2 matching MRF lines |
$35.25–$52.50 | $47–$70 | varies |
| Osteopathic manipulative tx 3-4 body regions (98926) range across 2 matching MRF lines |
$49.50–$74.25 | $66–$99 | varies |
| Osteopathic manipulative tx 5-6 body regions (98927) range across 2 matching MRF lines |
$65.25–$97.50 | $87–$130 | varies |
| Osteopathic manipulative tx 7-8 body regions (98928) range across 2 matching MRF lines |
$79.50–$119.25 | $106–$159 | varies |
| Osteopathic manipulative tx 9-10 body regions (98929) range across 2 matching MRF lines |
$94.50–$141.75 | $126–$189 | varies |
| Ot manual therapy 15 min (97140) | $102.75 | $137 | 3.7× |
| Ot Prosthetic Training, Each 15 Min (97761) | $76.50 | $102 | 1.9× |
| Pentamidine Aersl Inhalation Pneumocystis/Proph (94642) | $302.25 | $403 | 1.4× |
| Percutaneous tests w/allergenic extracts (95004) range across 2 matching MRF lines |
$8.25–$17.25 | $11–$23 | varies |
| Phlebotomy therapeutic (99195) range across 2 matching MRF lines |
$104.25–$213 | $139–$284 | varies |
| Polysom 6/>Yrs Sleep W/Cpap 4/> Addl Param Attnd (95811) range across 2 matching MRF lines |
$1,217.25–$3,662.25 | $1,623–$4,883 | varies |
| Prepj& allergen immunotherapy 1/mlt antigen (95165) range across 2 matching MRF lines |
$17.25–$26.25 | $23–$35 | varies |
| Prof Svcs Allg Immntx X W/Prv Allgic Xtrcs 1 Njx (95115) | $26.25 | $35 | 0.5× |
| Prof svcs allg immntx x w/prv allgic xtrcs njxs (95117) | $32.25 | $43 | 0.7× |
| Psych diag eval w/med srvcs (90792) range across 3 matching MRF lines |
$114.75–$422.25 | $153–$563 | varies |
| Pt Eval High Complex (97163) | $260.25 | $347 | 2.7× |
| Pt eval low complex 20 min (97161) | $178.50 | $238 | 1.8× |
| Pt Eval Mod Complex (97162) | $213 | $284 | 2.2× |
| Pt gait training 15 min (97116) | $79.50 | $106 | 2.7× |
| Pt Re-Eval Est Plan Care (97164) | $128.25 | $171 | 1.9× |
| Pulmonary Stress Testing (94618) | $93 | $124 | 0.7× |
| Rmvl Devital Tiss N-Slctv Dbrdmt W/O Anes 1 Sess (97602) range across 5 matching MRF lines |
$138.75–$154.50 | $185–$206 | varies |
| Same day nb discharge (99463) | $181.50 | $242 | 1.3× |
| Self Care Mngment Training (97535) | $83.25 | $111 | 2.6× |
| Sleep study unattended (95806) range across 5 matching MRF lines |
$175.50–$513 | $234–$684 | varies |
| Spirometry (94010) range across 2 matching MRF lines |
$53.25–$224.25 | $71–$299 | varies |
| Temp transcutaneous pacing (92953) | $789 | $1,052 | 1.2× |
| Ther/Proph/Diag Inj Ia (96373) range across 2 matching MRF lines |
$215.25–$236.25 | $287–$315 | varies |
| Ther/Proph/Diag Inj Sc/Im (96372) range across 6 matching MRF lines |
$26.25–$100.50 | $35–$134 | varies |
| Ther/Proph/Diag Iv Inf Init (96365) range across 3 matching MRF lines |
$351–$435.75 | $468–$581 | varies |
| Therapeutic Activities (97530) | $91.50 | $122 | 2.6× |
| Tobacco Use Cessation Intensive >10 Minutes (99407) range across 2 matching MRF lines |
$47.25–$50.25 | $63–$67 | varies |
| Tobacco Use Cessation Intermediate 3-10 Minutes (99406) range across 2 matching MRF lines |
$22.50–$42.75 | $30–$57 | varies |
| Trans Care Mgmt 14 Day Disch (99495) | $573 | $764 | 4.2× |
| Trans Care Mgmt 7 Day Disch (99496) | $772.50 | $1,030 | 5.7× |
| Tte w/doppler, complete (93306) range across 3 matching MRF lines |
$402.75–$1,684.50 | $537–$2,246 | varies |
| Tx/Pro/Dx Inj New Drug Addon (96375) range across 2 matching MRF lines |
$100.50–$160.50 | $134–$214 | varies |
| Unlisted Special Dermatological Service/Px (96999) range across 2 matching MRF lines |
$55.50–$270.75 | $74–$361 | varies |
| Upr/L Xtremity Art 2 Levels (93922) range across 5 matching MRF lines |
$166.50–$181.50 | $222–$242 | varies |
| Upr/Lxtr Art Stdy 3+ Lvls (93923) range across 5 matching MRF lines |
$174.75–$248.25 | $233–$331 | varies |
| Vent Mgmt Inpat Init Day (94002) | $2,398.50 | $3,198 | 3.8× |
| Ventilation Assist & Mgmt Inpatient Ea Sbsq Da (94003) | $1,727.25 | $2,303 | 2.7× |
| Wheelchair Mgmt Ea 15 Min (97542) | $96.75 | $129 | 3.1× |
A range means this hospital published different amounts on matching machine-readable-file lines. We show the lowest–highest posted amount because we cannot tell from the published file which line would apply to a particular visit.