Visits & medical services prices at Carroll County Memorial Hospital

Carrollton, MO · every code in this section with a posted price and a Medicare benchmark.

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

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ProcedureCash priceGross charge× Medicare
Airway inhalation treatment (94640) $570
Allg tstg perq & ic venoms immed react w/ i&r (95017) $71.25 $85 2.5×
Analyze Neurostim Complex (95972) $82.50 $192.50 0.9×
Analyze neurostim no prog (95970) $48.75 $162.50 0.4×
Appl on-body injector for timed subq injection (96377) $5,925
Application of heat wave therapy (97024) $75
Assessment of aphasia (96105) $290
Behavioral and qualitative analysis of voice and resonance (92524) $305
Blink reflex test (95933) $146.25 $162.50 2.5×
Brncdilat rspse spmtry pre&post-brncdilat admn (94060) $26.25 $410 0.1×
Canalith Repositioning (95992) $71.25 $95 1.7×
Cardiac Stress Tst,Tracing Only (93017) $620
Cardiopulmonary resuscitation (92950) $423.75 $570 2.0×
Cardioversion (92960) $243.75 $325 0.4×
Cbt 1st hour (94644) $310
Chemo Hormon Antineopl Sq/Im (96402) $195
Chemo IV push addl drug (96411) $195
Chemo Iv Push Sngl Drug (96409) $630
Chemo prolong 8+ hrs infuse w/pump (96416) $980
Chemother, IV infusion, 1 hr (96413) $980
Chemother, IV infusion, ea add hr (96415) $195
Chemother,Non-Hormone Anti-Neopl, Sub-Q/Im (96401) $195
Chemotx admn IV nfs tq ea seql nfs to 1 hr (96417) $195
Color/duplex Doppler, complete (93975) $127.50 $755 0.5×
Color/duplex Doppler, limited (93976) $90 $500 0.9×
Cortical mapping 1st hr (95961) $506.25 $617.50 0.6×
Cpap initiation and management (94660) $570
Cpt initial (94667) $190
Critical care (99291) $502.50 $670 0.6×
Debridement Open Wound 20 Sq Cm< (97597) $112.50 $267.50 0.6×
Demo &/or eval,pt use,aerosol device (94664) $90
Dermatological procedure (96999) $63.75 $850 0.3×
Dup-Scan Aorta Ivc Iliac Vascl/Bpgs Complete (93978) $90 $627.50 0.4×
Dup-scan aorta ivc iliac vascl/bpgs uni/lmtd (93979) $56.25 $305 0.5×
Dup-Scan Lxtr Art/Artl Bpgs Compl Bi Study (93925) $90 $680 0.4×
Dup-scan lxtr art/artl bpgs uni/lmtd study (93926) $48.75 $192.50 0.5×
Dup-Scan Uxtr Art/Artl Bpgs Compl Bi Study (93930) $90 $782.50 0.4×
Dup-Scan Uxtr Art/Artl Bpgs Uni/Lmtd Study (93931) $56.25 $527.50 0.5×
Dup-scan xtr veins unilateral/limited study (93971) $52.50 $500 0.5×
Duplex scan extracranial art compl bi study (93880) $90 $730 0.4×
Ear and throat examination (92502) $210 $850 0.4×
Echo Heart Xthoracic,Limited (93308) $1,135
EEG awake drowsy (95816) $596.25 $632.50 2.8×
EEG cerebral death evaluation (95824) $78.75 $332.50 0.2×
EEG coma or sleep only (95822) $607.50 $640 2.8×
Eeg Extended Monitoring 61-119 Minutes (95813) $855 $805 4.0×
EKG (93005) $335
EKG rhythm strip (93041) $142.50
Elec alys nstim pls gen smpl sc/perph w/prgrmg (95971) $320
Electroencephalogram Extend Monitoring 41-60 Min (95812) $727.50 $720 3.4×
EMG cranial nerve bilat (95868) $228.75 $317.50 1.1×
EMG cranial nerve unilat (95867) $165 $275 0.8×
EMG four extremities (95864) $412.50 $440 3.2×
EMG one extremity (95860) $213.75 $207.50 1.6×
EMG thoracic paraspinal (95869) $131.25 $152.50 0.6×
EMG three extremities (95863) $360 $405 2.8×
EMG two extremities (95861) $296.25 $362.50 2.2×
Er level 1 (99281) $60 $260 0.7×
Er level ii (99282) $116.25 $465 0.8×
Er level iii (99283) $195 $775 0.7×
Er level IV (99284) $311.25 $1,185 0.7×
Er level v (99285) $427.50 $1,650 0.7×
Eval aud funcj cand/po surg implt dev 1st hr (92626) $125 $150 1.0×
Evaluation of speech fluency (92521) $360
Evaluation of speech sound production (92522) $305
Evaluation of swallowing function (92610) $305
Evaluation with prescription of speech-generating alternative (92607) $375
External ECG rec>48hr<7d recording (93242) $110
External ECG rec>7d<15d recording (93246) $180
Flow volume loop (94375) $33.75 $50 0.2×
Health Behavior Assessment/Re-Assessment (96156) $52.50 $135 0.5×
Holter Monitor Recording (93225) $415
Icd Device Interrogate (93289) $110
Immunization Admin (90471) $55
Immunotherapy, 2+ Injections (95117) $120
Ingestion challenge test initial 120 minutes (95076) $168.75 $680 0.5×
Intralesional Chemo Admin,8+ Lesn (96406) $97.50 $262.50 0.5×
Intralesional Chemo Admin,<8 Lesn (96405) $67.50 $100 0.9×
Irrigaj Implntd Venous Access Drug Delivery Syst (96523) $180
Ischemic limb exercise test (95875) $225 $315 1.7×
IV infusion hydration each additional hour (96361) $125
IV infusion hydration initial 31 min-1 hour (96360) $630
IV infusion, therap/proph/diagnost,add infusion,1st hour (96367) $195
IV infusion, therap/proph/diagnost,initial,1st hour (96365) $630
IV infusion, therap/proph/diagnost,initial,ea add hour (96366) $125
IV push initial (96374) $630
Maintenance of spinal canal or brain drug infusion pump (95990) $955
Manual therapy 15 min (97140) $140
Massage 15 min (97124) $140
Maximum voluntary ventilation (94200) $130
Mechanical traction (97012) $75
Med Nutr Ther, Subsq, Indiv, Ea 15 Min (97803) $23
Medical nutrition assmt&ivntj indiv each 15 mi (97802) $30
Motion Fluor Eval Swlng Funcj C/V Rec (92611) $460
Motor &/sens nrv cndj preconf eltrd array limb (95905) $116.25 $142.50 0.3×
Multiple sleep latency test (95805) $157.50 $1,135 0.2×
Needle EMG lmtd std musc 1 xtr/non-limb uni/bi (95870) $150 $170 1.1×
Needle EMG w/1 fiber electrode quan meas jitter (95872) $371.25 $412.50 1.7×
Neg press wnd tx </=50 sq cm (97607) $52.50 $990 0.1×
Neg press wound tx >50 cm (97608) $60 $535 0.1×
Negative Pressure Wound Therapy Dme </= 50 Sq Cm (97605) $545
Negative Pressure Wound Therapy Dme >50 Sq Cm (97606) $63.75 $990 0.2×
Nerve conduction studies 13/> studies (95913) $547.50 $645 1.5×
Nerve Conduction Studies 3-4 Studies (95908) $210 $420 1.0×
Nerve Conduction Studies 9-10 Studies (95911) $401.25 $547.50 1.1×
Nerve conduction studies; 1-2 studies (95907) $168.75 $277.50 0.8×
Nerve conduction studies; 11-12 studies (95912) $472.50 $595 1.3×
Nerve conduction studies; 5-6 studies (95909) $251.25 $447.50 1.2×
Nerve conduction studies; 7-8 studies (95910) $330 $500 0.9×
Neuromuscular junction test (95937) $142.50 $160 1.1×
Non-Invas Physiologic Std Extremity Art 2 Level (93922) $33.75 $307.50 0.3×
Non-Invasive Physiologic Study Extremity 3 Levls (93923) $52.50 $382.50 0.2×
Noninvasive Ear/Pulse Oximetry Overnight Monitor (94762) $205
Nonphysician qualified health care professional online digital assessment and management, for an established patient,… (98972) $105
Nonphysician qualified health care professional online digital assessment and management, for an established patient,… (98970) $40
Nonphysician qualified health care professional online digital assessment and management, for an established patient,… (98971) $70
Nonphysician Telephone Assessment 11-20 Min (98967) $85
Nonphysician Telephone Assessment 21-30 Min (98968) $125
Nonphysician Telephone Assessment 5-10 Min (98966) $42
Orthotics mgmt & traing initial enctr ea 15 mins (97760) $115
Osteopathic manipulative tx 1-2 body regions (98925) $45 $53.50 2.1×
Osteopathic manipulative tx 3-4 body regions (98926) $67.50 $68.50 3.1×
Ot Contrast Bath Ea 15 Min (97034) $95
Ot eval high complex 60 min (97167) $295
Ot eval low complex 30 min (97165) $295
Ot eval mod complex 45 min (97166) $295
Ot Prosthetic Training, Each 15 Min (97761) $140
Ot re-eval est plan care (97168) $190
Outpatient Cardiac Rehab W/Cont Ecg Monitoring (93798) $340
Paraffin bath (97018) $75
Patch/Application Test Specify Number Tests (95044) $15 $655 0.0×
Pdt dstr prmlg les skn illum/activj per day (96567) $273.75 $345 1.4×
Pentamidine Aersl Inhalation Pneumocystis/Proph (94642) $515
Percutaneous tests w/allergenic extracts (95004) $15.75 $660 0.0×
Phy/qhp op pulm rhb w/mntr (94626) $185
Phy/qhp op pulm rhb w/o mntr (94625) $185
Pm device eval in person (93288) $77.50
Polysom 6/>Yrs Sleep W/Cpap 4/> Addl Param Attnd (95811) $273.75 $2,062.50 0.3×
Prepj& allergen immunotherapy 1/mlt antigen (95165) $35
Prof Svcs Allg Immntx X W/Prv Allgic Xtrcs 1 Njx (95115) $100
Psychiatric diagnostic evaluation (90791) $292.50 $390 1.6×
Pt Aquatic Therapy/Exercises (97113) $140
Pt Electric Current Therapy (97033) $85
Pt eval high complex 45 min (97163) $295
Pt eval low complex 20 min (97161) $295
Pt Gait Training Therapy (97116) $140
Pt Infrared Therapy (97026) $75
Pt Neuromusc Reeducat,1+ Areas, Ea 15 Min (97112) $140
Pt Physical Therapy Evaluation Mod Complex 30 Mins (97162) $295
Pt re-evaluation (97164) $190
Pt Self-Care/Home Mgmt Training Each 15 Minutes (97535) $95
Pt Ultrasound Therapy (97035) $85
Pt Whirlpool Therapy (97022) $75
Pulm function test by gas (94727) $30 $240 0.1×
Pulmonary stress testing (94618) $310
Remote 30 Day Ecg Rev/Report - Cardiac Event Monitor (93270) $120
Rfl&Main Implt Pmp/Rsvr Dlvr Spi/Brn Phy/Qhp (95991) $93.75 $380 0.3×
Rmvl Devital Tiss N-Slctv Dbrdmt W/O Anes 1 Sess (97602) $545
Rx Sp-Genratj Augmnt&Comunicaj Dev Ea 30 Min (92608) $155
Rx/Physical Eeg Activaj Phys/Qhp Attendance (95954) $753.75 $667.50 2.0×
Sensory Integration Ea 15 Min (97533) $140
Sleep study unattended (95806) $116.25 $490 0.5×
Speech sound lang comprehen (92523) $615
Spirometry (94010) $19.50 $228 0.1×
Stress Tte Complete (93351) $2,475
Test for allergy using allergenic extract injected into skin (95024) $15 $80 0.3×
Test for allergy using combination of methods with drug or biological (95018) $15.75 $48 0.4×
Ther ivntj cog funcj cntct 1st 15 minutes (97129) $125
Ther/Proph/Diag Inj Sc/Im (96372) $195
Therapeutic Activities (97530) $140
Therapeutic phlebotomy (99195) $365
Tte W/Doppler Complete - Tte Complete W/ Contrast (93306) $2,060
Tx Speech Lang Voice Commj &/Auditory Proc Ind (92507) $390
Tx Swallowing Dysfunction&/Oral Funcj Feeding (92526) $260
Tx/Pro/Dx Inj New Drug Addon (96375) $125
Unlisted allergy/clinical immunologic service or procedure Cardiac Catheterization (95199) $35
Vasc Duplex Extrem Venous,Bilat (93970) $78.75 $775 0.3×
Vasc Non-Invasive Lower Extrem Art Stress/Rest, Complete,Bilateral (93924) $60 $645 0.3×
Vasopneumatic device (97016) $75
Ventilation assist & mgmt inpatient 1st day (94002) $1,500
Ventilation Assist & Mgmt Inpatient Ea Sbsq Da (94003) $1,500
Vital capacity total (94150) $252.50
Wada Activation Test Hemispheric Function W/Eeg (95958) $978.75 $1,765 1.1×
Wheelchair Mgmt Ea 15 Min (97542) $140
Xtrnl mobile cv telemetry w/technical support (93229) $80