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.

128 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×
Allergy injection single (95115) $21.66 $38 0.5×
Application of a modality to 1 or more areas; electrical stimulation (manual), each 15 minutes Other Outpatient (97032) $53.58 $94
Application of a modality to 1 or more areas; iontophoresis, each 15 minutes Other Outpatient (97033) $79.23 $139
Application of a modality to 1 or more areas; ultrasound, each 15 minutes Other Outpatient (97035) $41.61 $73
Application of a modality to 1 or more areas; vasopneumatic devices Other Outpatient (97016) $41.61 $73
Bipap initial day (94660) $539.22 $946 2.4×
Bronchodilation responsiveness, spirometry as in 94010, pre- and post-bronchodilator administration (94060) $326.90 $573.50 0.9×
C motor evoked lwr limbs (95929) $538.08 $944 1.4×
C motor evoked uppr limbs (95928) $538.08 $944 0.6×
Canalith repositioning (95992) $34.77 $61
Cardiovascular procedure unlisted (93799) $503.88 $884 3.8×
Cardiovascular stress test (93017) $774.63 $1,359 3.5×
Cardioversion elective external (92960) $1,171.06 $2,054.50 1.7×
Chemo IV infusion addl hr (96415) $115.71 $203 1.6×
Chemotherapy administration, intravenous infusion technique; up to 1 hour, single or initial substance/drug (96413) $372.21 $653 1.1×
Chest physiotherapy initial (94667) $121.98 $214 0.9×
Color/duplex Doppler, complete (93975) $656.64 $1,152 2.7×
Cont gluc mntr physician/qhp provided equipment (95250) $295.26 $518 2.2×
Cont gluc mntr pt prov eqp (95249) $197.22 $346 3.3×
Continuous inhalation treatment with aerosol medication for acute airway obstruction; first hour (94644) $141.93 $249 1.0×
Cpr (92950) $1,059.06 $1,858 4.8×
Critical care ill/injured patient init 30-74 min (99291) $1,577.19 $2,767 1.9×
Ctr motr ep std transcrnl motr stim upr&low limb (95939) $2,789.58 $4,894 3.2×
Debridement open wound 20 sq cm< (97597) $101.74 $178.50 0.5×
Duplex scan of extracranial arteries; complete bilateral study Age Under 21 (93880) $787.17 $1,381 3.2×
Duplex scan of extremity veins including responses to compression and other maneuvers; complete bilateral study Age… (93970) $1,012.04 $1,775.50 4.2×
Duplex scan of extremity veins including responses to compression and other maneuvers; unilateral or limited study Age… (93971) $728.74 $1,278.50 6.8×
Duplex scan of lower extremity arteries or arterial bypass grafts; complete bilateral study Age Under 21 (93925) $885.21 $1,553 3.6×
Duplex scan of lower extremity arteries or arterial bypass grafts; unilateral or limited study Age Under 21 (93926) $663.48 $1,164 6.2×
Duplex scan of upper extremity arteries or arterial bypass grafts; complete bilateral study Age Under 21 (93930) $891.48 $1,564 3.7×
Duplex scan of upper extremity arteries or arterial bypass grafts; unilateral or limited study Age Under 21 (93931) $649.80 $1,140 6.1×
ECG monit/reprt up to 48 hrs (93226) $434.91 $763 7.2×
EEG 41-60 minutes (95812) $567.15 $995 2.6×
EEG extended monitoring 61-119 minutes (95813) $636.69 $1,117 2.9×
EKG 12 lead tracing only (93005) $187.53 $329 3.1×
Elec alys implt brn npgt prgrmg 1st 15 min (95983) $33.06 $58 0.3×
Elec alys implt npgt cplx sp/pn prgrmg (95972) $1,261.03 $2,212.33 13.0×
Emergency department visit high mdm (99285) $1,030.28 $1,807.50 1.7×
Emergency department visit low mdm (99283) $490.20 $860 1.8×
Emergency department visit may not req phys/qhp (99281) $201.21 $353 2.3×
Emergency department visit moderate mdm (99284) $706.80 $1,240 1.7×
Emergency department visit straightforward mdm (99282) $321.76 $564.50 2.1×
EMG thoracic paraspinal (95869) $142.50 $250 0.6×
Eval of Oral and Pharyngeal Swallowing - Eval of Oral and Pharyngeal Swallowing Fx Chg (92610) $139.94 $245.50
Evaluate pt use of inhaler (94664) $149.34 $262 0.7×
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 electrocardiographic recording up to 48 hours by continuous rhythm recording and storage; recording (includes… (93225) $361.10 $633.50 2.7×
Fluidotherapy (97022) $103.74 $182
Hot/cold pack (97010) $41.61 $73
Imaging of retina for detection or monitoring of disease; with remote clinical staff review and report, unilateral or… (92227) $10.83 $19 0.2×
Imaging of retina for detection or monitoring of disease; with remote physician or other qualified health care… (92228) $20.52 $36 0.5×
Immunization administration (90471) $22.80 $40 0.3×
Infrared therapy (97026) $29.07 $51
Injection,Therap/Proph/Diagnost, IV Push, Ea Add, New Drug (96375) $141.93 $249 3.0×
Injection,Therap/Proph/Diagnost, IV Push, Initial Drug (96374) $152.76 $268 0.7×
Intracutaneous (intradermal) tests with allergenic extracts, immediate type reaction, including test interpretation and… (95024) $7.41 $13 0.1×
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 ther proph addl sequential to 1 hr (96367) $254.22 $446 3.5×
IV infusion therapy/prophylaxis /dx 1st to 1 hr (96365) $307.80 $540 1.4×
IV tx, each additional hour (96366) $130.24 $228.50 2.7×
Manipulation chest wall, such as cupping, percussing, and vibration to facilitate lung function; subsequent (94668) $129.68 $227.50 1.0×
Medical nutrition assmt&ivntj indiv each 15 mi (97802) $64.98 $114
Medical nutrition therapy; re-assessment and intervention, individual, face-to-face with the patient, each 15 minutes… (97803) $41.04 $72
Multiple sleep latency (95805) $2,191.08 $3,844 2.5×
Muscle test 3 limbs (95863) $265.62 $466 2.0×
Muscle test larynx (95865) $242.82 $426 1.8×
Nasopharyngoscopy (92511) $37.05 $65 0.2×
Ndl EMG 4 xtr w/wo related paraspinal areas (95864) $1,181.04 $2,072 9.0×
Needle electromyography 2 extremities with or without related paraspinal areas 95861 (95861) $240.54 $422 1.8×
Needle electromyography cranial nrv muscle uni (95867) $189.81 $333 0.9×
Needle electromyography hemidiaphragm (95866) $195.51 $343 1.5×
Needle electromyography; 1 extremity with or without related paraspinal areas (95860) $166.44 $292 1.2×
Needle EMG lmtd std musc 1 xtr/non-limb uni/bi (95870) $163.59 $287 1.2×
Needle measurement of electrical activity in muscles on both sides of body (95868) $274.17 $481 1.2×
Needle oculoelectromyography, 1 or more extraocular muscles, 1 or both eyes, with interpretation and report (92265) $107.73 $189 1.8×
Neg pressure wound therapy non dme </= 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-invasive physiologic study extremity 3 levels (93923) $84.36 $148 0.4×
Noninvasive ear/pulse oximetry overnight monitor (94762) $41.04 $72 0.3×
Occupational therapy eval high complex 60 mins (97167) $189.81 $333
Occupational therapy eval low complex 30 mins (97165) $122.26 $214.50
Occupational therapy eval mod complex 45 mins (97166) $153.04 $268.50
Orthotic(s) management and training (including assessment and fitting when not otherwise reported), upper… (97760) $59 $103.50
Osteopath manj 1-2 regions (98925) $21.94 $38.50 1.0×
Osteopath manj 3-4 regions (98926) $33.06 $58 1.5×
Osteopath manj 9-10 regions (98929) $67.83 $119 3.1×
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×
Ot manual therapy ea 15 min (97140) $51.30 $90
Ot neuromuscular re-education (97112) $56.72 $99.50
Ot re-evaluation (97168) $145.35 $255
OT Therapeutic Activities Charges (97530) $58.71 $103
Ot wheelchair management (97542) $59.85 $105
Outpatient cardiac rehab w/cont ECG monitoring (93798) $164.73 $289 1.3×
Percutaneous tests w/allergenic extracts (95004) $6.27 $11 0.0×
Phlebotomy therapeutic (99195) $121.98 $214 0.9×
Phy/qhp op pulm rhb w/mntr (94626) $156.18 $274 2.6×
Physical therapy evaluation high complex 45 mins (97163) $170.72 $299.50
Physical therapy evaluation low complex 20 mins (97161) $119.42 $209.50
Physical therapy evaluation mod complex 30 mins (97162) $149.91 $263
Polysom 6/>yrs sleep w/cpap 4/> addl param attnd (95811) $3,047.79 $5,347 3.5×
Professional services for allergen immunotherapy; 2 or more injections (95117) $30.21 $53 0.6×
Pt gait training 15 min (97116) $58.71 $103
Pt physical performance test (97750) $144.78 $254
Pt re-evaluation (97164) $123.69 $217
Pulmonary stress testing (94618) $26.79 $47 0.2×
Respiratory flow volume loop (94375) $210.62 $369.50 1.0×
Rfl&main implt pmp/rsvr dlvr spi/brn phy/qhp (95991) $198.36 $348 0.6×
Self-care/home management training (eg, activities of daily living (ADL) and compensatory training, meal preparation,… (97535) $60.42 $106
Short-latency somatosensory evoked potential study, stimulation of any/all peripheral nerves or skin sites, recording… (95938) $1,182.18 $2,074 1.3×
Short-latency somatosensory evoked potential study, stimulation of any/all peripheral nerves or skin sites, recording… (95926) $372.78 $654 1.7×
Short-latency somatosensory evoked potential study, stimulation of any/all peripheral nerves or skin sites, recording… (95925) $372.78 $654 1.7×
Sleep study unattended (95806) $419.52 $736 1.9×
Therapeutic procedure, 1 or more areas, each 15 minutes; aquatic therapy with therapeutic exercises Other Outpatient (97113) $75.24 $132
Therapeutic procedure, 1 or more areas, each 15 minutes; massage, including effleurage, petrissage and/or tapotement… (97124) $53.58 $94
Therapeutic prophylactic/dx injection subq/im (96372) $86.64 $152 1.2×
Tobacco use cessation intermediate 3-10 minutes (99406) $25.65 $45 0.7×
Tte f-up or lmtd (93308) $491.91 $863 2.0×
Tte w/doppler complete (93306) $1,757.02 $3,082.50 3.1×
Tympanometry (92567) $53.01 $93 1.4×
Upr/l xtremity art 2 levels (93922) $419.52 $736 3.1×
Ventilation ip/obs initial day (94002) $972.99 $1,707 1.5×
Ventilator subsequent day (94003) $941.07 $1,651 1.5×
Vital capacity total (94150) $63.84 $112 0.5×