Visits & medical services prices at Memorial Hospital of Converse County

Douglas, WY · every code in this section with a posted price and a Medicare benchmark.

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

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ProcedureCash priceGross charge× Medicare
Airway inhalation treatment (94640) $149.34 $262 0.7×
Analyze Neurostim Complex (95972) $1,261.03 $2,212.33 13.0×
Brncdilat rspse spmtry pre&post-brncdilat admn (94060) $326.90 $573.50 0.9×
C motor evoked uppr limbs (95928) $538.08 $944 0.6×
C motor evoked upr&lwr limbs (95939) $2,789.58 $4,894 3.2×
Canalith Repositioning (95992) $34.77 $61 0.9×
Cardiac Stress Tst,Tracing Only (93017) $774.63 $1,359 3.5×
Cardiopulmonary resuscitation (92950) $1,059.06 $1,858 4.8×
Cardioversion (92960) $1,171.06 $2,054.50 1.7×
Cbt 1st hour (94644) $141.93 $249 1.0×
Chemother, IV infusion, 1 hr (96413) $372.21 $653 1.1×
Chemother, IV infusion, ea add hr (96415) $115.71 $203 1.6×
Color/duplex Doppler, complete (93975) $656.64 $1,152 2.7×
Cont Gluc Monitoring Patient Provided Equipment (95249) $197.22 $346 3.3×
Continuous Glucose Monitoring (95250) $295.26 $518 2.2×
Cpap initiation and management (94660) $539.22 $946 2.4×
Cpt initial (94667) $121.98 $214 0.9×
Critical care (99291) $1,577.19 $2,767 1.9×
Ctr motor ep std transcrnl motor stimj lwr limbs (95929) $538.08 $944 1.4×
Debridement Open Wound 20 Sq Cm< (97597) $101.74 $178.50 0.5×
Demo &/or eval,pt use,aerosol device (94664) $149.34 $262 0.7×
Dup-Scan Lxtr Art/Artl Bpgs Compl Bi Study (93925) $885.21 $1,553 3.6×
Dup-scan lxtr art/artl bpgs uni/lmtd study (93926) $663.48 $1,164 6.2×
Dup-Scan Uxtr Art/Artl Bpgs Compl Bi Study (93930) $891.48 $1,564 3.7×
Dup-Scan Uxtr Art/Artl Bpgs Uni/Lmtd Study (93931) $649.80 $1,140 6.1×
Dup-scan xtr veins unilateral/limited study (93971) $728.74 $1,278.50 6.8×
Duplex scan extracranial art compl bi study (93880) $787.17 $1,381 3.2×
Echo Heart Xthoracic,Limited (93308) $491.91 $863 2.0×
Eeg Extended Monitoring 61-119 Minutes (95813) $636.69 $1,117 2.9×
EKG (93005) $187.53 $329 3.1×
Elec alys implt brn npgt prgrmg 1st 15 min (95983) $33.06 $58 0.3×
Electroencephalogram Extend Monitoring 41-60 Min (95812) $567.15 $995 2.6×
EMG cranial nerve bilat (95868) $274.17 $481 1.2×
EMG cranial nerve unilat (95867) $189.81 $333 0.9×
EMG four extremities (95864) $1,181.04 $2,072 9.0×
EMG one extremity (95860) $166.44 $292 1.2×
EMG thoracic paraspinal (95869) $142.50 $250 0.6×
EMG three extremities (95863) $265.62 $466 2.0×
EMG two extremities (95861) $240.54 $422 1.8×
Er level 1 (99281) $201.21 $353 2.3×
Er level ii (99282) $321.76 $564.50 2.1×
Er level iii (99283) $490.20 $860 1.8×
Er level IV (99284) $706.80 $1,240 1.7×
Er level v (99285) $1,030.28 $1,807.50 1.7×
Evaluation of swallowing function (92610) $139.94 $245.50 1.6×
External ECG rec>48hr<7d recording (93242) $49.02 $86 1.3×
External ECG rec>7d<15d recording (93246) $49.02 $86 1.3×
External Ecg Scanning Analysis Report (93226) $434.91 $763 7.2×
Flow volume loop (94375) $210.62 $369.50 1.0×
Holter Monitor Recording (93225) $361.10 $633.50 2.7×
Img Retina Detcj/Mntr Ds Rem Phys/Qhp I&R Uni/Bi (92228) $20.52 $36 0.5×
Immunization Admin (90471) $22.80 $40 0.3×
Immunotherapy, 2+ Injections (95117) $30.21 $53 0.6×
IV infusion hydration each additional hour (96361) $121.41 $213 2.5×
IV infusion hydration initial 31 min-1 hour (96360) $248.52 $436 1.1×
IV infusion, therap/proph/diagnost,add infusion,1st hour (96367) $254.22 $446 3.5×
IV infusion, therap/proph/diagnost,initial,1st hour (96365) $307.80 $540 1.4×
IV infusion, therap/proph/diagnost,initial,ea add hour (96366) $130.24 $228.50 2.7×
IV push initial (96374) $152.76 $268 0.7×
Manual therapy 15 min (97140) $51.30 $90 1.9×
Massage 15 min (97124) $53.58 $94 1.8×
Med Nutr Ther, Subsq, Indiv, Ea 15 Min (97803) $41.04 $72 1.3×
Medical nutrition assmt&ivntj indiv each 15 mi (97802) $64.98 $114 1.8×
Multiple sleep latency test (95805) $2,191.08 $3,844 2.5×
Nasopharyngoscopy (92511) $37.05 $65 0.2×
Needle electromyography hemidiaphragm (95866) $195.51 $343 1.5×
Needle electromyography larynx (95865) $242.82 $426 1.8×
Needle EMG lmtd std musc 1 xtr/non-limb uni/bi (95870) $163.59 $287 1.2×
Needle oculography 1/ xoc musc 1/both eye w/i&r (92265) $107.73 $189 1.8×
Neg press wnd tx </=50 sq cm (97607) $579.69 $1,017 1.4×
Negative Pressure Wound Therapy Dme </= 50 Sq Cm (97605) $27.93 $49 0.1×
Negative Pressure Wound Therapy Dme >50 Sq Cm (97606) $408.69 $717 1.0×
Non-Invas Physiologic Std Extremity Art 2 Level (93922) $419.52 $736 3.1×
Non-Invasive Physiologic Study Extremity 3 Levls (93923) $84.36 $148 0.4×
Noninvasive Ear/Pulse Oximetry Overnight Monitor (94762) $41.04 $72 0.3×
Orthotics mgmt & traing initial enctr ea 15 mins (97760) $59 $103.50 1.3×
Osteopathic manipulative tx 1-2 body regions (98925) $21.94 $38.50 1.0×
Osteopathic manipulative tx 3-4 body regions (98926) $33.06 $58 1.5×
Osteopathic manipulative tx 5-6 body regions (98927) $43.32 $76 2.0×
Osteopathic manipulative tx 7-8 body regions (98928) $54.44 $95.50 2.5×
Osteopathic manipulative tx 9-10 body regions (98929) $67.83 $119 3.1×
Ot eval high complex 60 min (97167) $189.81 $333 1.9×
Ot eval low complex 30 min (97165) $122.26 $214.50 1.2×
Ot eval mod complex 45 min (97166) $153.04 $268.50 1.5×
Ot re-eval est plan care (97168) $145.35 $255 2.1×
Outpatient Cardiac Rehab W/Cont Ecg Monitoring (93798) $164.73 $289 1.3×
Percutaneous tests w/allergenic extracts (95004) $6.27 $11 0.0×
Phy/qhp op pulm rhb w/mntr (94626) $156.18 $274 2.6×
Polysom 6/>Yrs Sleep W/Cpap 4/> Addl Param Attnd (95811) $3,047.79 $5,347 3.5×
Prof Svcs Allg Immntx X W/Prv Allgic Xtrcs 1 Njx (95115) $21.66 $38 0.5×
Pt Aquatic Therapy/Exercises (97113) $75.24 $132 2.0×
Pt Electric Current Therapy (97033) $79.23 $139 4.2×
Pt Electrical Stimulation (97032) $53.58 $94 3.6×
Pt eval high complex 45 min (97163) $170.72 $299.50 1.7×
Pt eval low complex 20 min (97161) $119.42 $209.50 1.2×
Pt Gait Training Therapy (97116) $58.71 $103 2.0×
Pt Infrared Therapy (97026) $29.07 $51 4.4×
Pt Neuromusc Reeducat,1+ Areas, Ea 15 Min (97112) $56.72 $99.50 1.7×
Pt Physical Performance Test (97750) $144.78 $254 4.3×
Pt Physical Therapy Evaluation Mod Complex 30 Mins (97162) $149.91 $263 1.5×
Pt re-evaluation (97164) $123.69 $217 1.8×
Pt Self-Care/Home Mgmt Training Each 15 Minutes (97535) $60.42 $106 1.9×
Pt Ultrasound Therapy (97035) $41.61 $73 2.9×
Pt Whirlpool Therapy (97022) $103.74 $182 6.6×
Pulmonary stress testing (94618) $26.79 $47 0.2×
Remote dx retinal imaging (92227) $10.83 $19 0.2×
Rfl&Main Implt Pmp/Rsvr Dlvr Spi/Brn Phy/Qhp (95991) $198.36 $348 0.6×
Rt Chest Wall Manipulation,Subsequent (94668) $129.68 $227.50 1.0×
Short-latency somatosens ep std lwr limbs (95926) $372.78 $654 1.7×
Short-latency somatosens ep std upr limbs (95925) $372.78 $654 1.7×
Sleep study unattended (95806) $419.52 $736 1.9×
Somatosensory testing (95938) $1,182.18 $2,074 1.3×
Test for allergy using allergenic extract injected into skin (95024) $7.41 $13 0.1×
Ther/Proph/Diag Inj Sc/Im (96372) $86.64 $152 1.2×
Therapeutic Activities (97530) $58.71 $103 1.7×
Therapeutic phlebotomy (99195) $121.98 $214 0.9×
Tobacco Use Cessation Intermediate 3-10 Minutes (99406) $25.65 $45 0.7×
Tte W/Doppler Complete - Tte Complete W/ Contrast (93306) $1,757.02 $3,082.50 3.1×
Tx/Pro/Dx Inj New Drug Addon (96375) $141.93 $249 3.0×
Tympanometry (92567) $53.01 $93 1.4×
Unlisted Cardiovascular Service/Procedure (93799) $503.88 $884 3.8×
Vasc Duplex Extrem Venous,Bilat (93970) $1,012.04 $1,775.50 4.2×
Vasopneumatic device (97016) $41.61 $73 3.5×
Ventilation assist & mgmt inpatient 1st day (94002) $972.99 $1,707 1.5×
Ventilation Assist & Mgmt Inpatient Ea Sbsq Da (94003) $941.07 $1,651 1.5×
Vital capacity total (94150) $63.84 $112 0.5×
Wheelchair Mgmt Ea 15 Min (97542) $59.85 $105 1.9×