Visits & medical services prices at Davis County Hospital

Bloomfield, IA · every code in this section with a posted price and a Medicare benchmark.

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

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ProcedurePosted cashPosted gross× Medicare
Airway Inhalation Treatment (94640)
range across 2 matching MRF lines		 $60–$143 $60–$143 varies
Allg test perq & ic drug/biol immed react w/ i&r (95018) $37 $37 1.0×
Allg tstg perq & ic venoms immed react w/i&r (95017) $28 $28 1.0×
Appl Modality 1/> Areas Ultrasound Ea 15 Min (97035) $64 $64 4.5×
Assessment of aphasia per hr (96105) $323 $323 3.3×
Behavral qualit analys voice (92524) $380 $380 3.5×
Brncdilat rspse spmtry pre&post-brncdilat admn (94060)
range across 3 matching MRF lines		 $31–$1,055 $31–$1,055 varies
Canalith repositioning proc (95992) $132 $132 3.2×
Cardiac Stress Tst,Tracing Only (93017) $926 $926 4.5×
Cardiopulmonary resuscitation (92950)
range across 2 matching MRF lines		 $559–$1,038 $559–$1,038 varies
Cardioversion (92960) $568 $568 0.9×
Caregiver Training Strategies&Tq Ea Addl 15 Min (97551) $123 $123 4.7×
Chemo Anti-Neopl Sq/Im (96401) $188 $188 2.7×
Chemo Hormon Antineopl Sq/Im (96402) $241 $241 3.5×
Chemo IV infusion addl hr (96415) $163 $163 2.4×
Chemotx admn IV nfs tq up 1 hr 1/1st sbst/drug (96413) $514 $514 1.6×
Chest Wall Manipulation (94668) $172 $172 1.3×
Chron Care Mgmt Srvc 20 Min (99490) $100 $100 1.0×
Color/duplex Doppler, complete (93975) $1,068 $1,068 4.7×
Color/duplex Doppler, limited (93976) $1,068 $1,068 10.6×
Community/Work Reintegration Trainj Ea 15 Min (97537) $106 $106 3.3×
Cont Gluc Mntr Pt Prov Eqp (95249) $201 $201 3.5×
Continuous Pulse Ox (94762) $415 $415 3.4×
Cpap Ventilation Cpap Initiation&Mgmt (94660) $597 $597 2.8×
Cpt initial (94667) $172 $172 1.3×
Critical care first hour (99291) $739 $739 0.9×
Debridement Open Wound 20 Sq Cm< (97597)
range across 2 matching MRF lines		 $174–$347 $174–$347 varies
Dup-scan lxtr art/artl bpgs compl bi study (93925) $1,068 $1,068 4.7×
Dup-Scan Lxtr Art/Artl Bpgs Uni/Lmtd Study (93926) $671 $671 6.7×
Dup-Scan Xtr Veins Complete Bilateral Study (93970) $1,068 $1,068 4.7×
Dup-scan xtr veins unilateral/limited study (93971)
range across 2 matching MRF lines		 $752–$1,068 $752–$1,068 varies
Duplex up extrem art bilat (93930) $1,068 $1,068 4.7×
Duplex up extrem art unilat/ltd (93931)
range across 2 matching MRF lines		 $163–$671 $163–$671 varies
Echo Heart Xthoracic,Limited (93308) $813 $813 3.5×
Electrical Stimulation Ea 15 Min (97032) $64 $64 4.4×
Electrocardiogram Tracing (93005)
range across 2 matching MRF lines		 $109–$216 $109–$216 varies
Emergency Dept Visit Level 2 (99282) $179 $179 1.2×
Emergency Dept Visit Level 3 (99283)
range across 2 matching MRF lines		 $180–$269 $180–$269 varies
Emergency Dept Visit Level 4 (99284) $422 $422 1.1×
Er level 1 (99281) $117 $117 1.4×
Er level v (99285) $626 $626 1.1×
Evaluate pt use of inhaler (94664) $169 $169 0.8×
Evaluate Speech Production (92522) $390 $390 3.5×
Evaluate Swallowing Function (92610) $357 $357 4.2×
Evaluation of speech fluency (92521) $407 $407 3.1×
External ECG rec>48hr<7d recording (93242) $130 $130 3.6×
External ECG rec>48hr<7d scanning alys w/report (93243) $233 $233 1.8×
External Ecg Scanning Analysis Report (93226) $510 $510 9.0×
Extracranial Bilat Study (93880) $1,085 $1,085 4.7×
Flexible endoscopic eval swallow c/v rec (92612) $533 $533 2.7×
Group Therapeutic Procedures (97150) $70 $70 3.9×
Health Behavior Assessment/Re-Assessment (96156) $221 $221 2.3×
Holter monitor recording (93225) $474 $474 3.7×
Im Adm Intransl/Oral 1 Vaccine (90473) $19 $19 0.3×
Immunization administration (90471) $59 $59 0.9×
Ingestion challenge test initial 120 minutes (95076) $203 $203 0.6×
Intracutaneous tests w/allergenic extracts (95024) $18 $18 0.3×
Intraventricular pacing (93612)
likely a partial charge, not the full procedure		 $2,228 $2,228 0.3×
Iontophoresis 15 min (97033) $96 $96 5.0×
Irrig Drug Delivery Device (96523) $198 $198 3.5×
IV infusion hydration each additional hour (96361) $130 $130 2.9×
IV infusion hydration initial 31 min-1 hour (96360) $248 $248 1.2×
IV infusion ther proph addl sequential to 1 hr (96367) $188 $188 2.7×
IV infusion therapy prophylaxis/dx ea hour (96366) $130 $130 2.9×
IV push initial (96374) $166 $166 0.8×
Med Nutr Ther, Subsq, Indiv, Ea 15 Min (97803) $46 $46 1.4×
Medical nutrition assmt&ivntj indiv each 15 mi (97802) $54 $54 1.5×
Medical nutrition therapy grp2/ indiv ea 30 mi (97804) $25 $25 1.5×
Motion Fluoroscopy/Swallow (92611) $546 $546 6.0×
Multiple Sleep Latency Test (95805) $3,720 $3,720 4.5×
Negative Pressure Wound Therapy Dme </= 50 Sq Cm (97605) $236 $236 1.2×
Negative Pressure Wound Therapy Dme >50 Sq Cm (97606) $347 $347 0.9×
Neurobehavioral Status Exam (96116) $168 $168 0.8×
Neuromuscular Reeducation (97112) $119 $119 3.6×
O2 Uptk Exp Gas Alys W/Co2 Output % O2 Xtrc (94681) $301 $301 0.8×
Oral Function Therapy (92526) $266 $266 3.2×
Oral Speech Device Eval (92597) $287 $287 4.0×
Orthotics Mgmt & Trainj Initial Enctr Ea 15 Mins (97760)
range across 2 matching MRF lines		 $112–$126 $112–$126 varies
Osteopathic Manipulative Tx 1-2 Body Regions (98925) $64 $64 3.1×
Osteopathic manipulative tx 3-4 body regions (98926) $89 $89 4.3×
Osteopathic manipulative tx 5-6 body regions (98927) $106 $106 5.1×
Osteopathic manipulative tx 7-8 body regions (98928) $112 $112 5.4×
Osteopathic manipulative tx 9-10 body regions (98929) $129 $129 6.2×
Ot eval high complexity (97167) $272 $272 2.7×
Ot Eval Low Complex (97165) $272 $272 2.7×
Ot Eval Moderate Complexity (97166) $272 $272 2.7×
Ot manual therapy 15 min (97140) $109 $109 3.9×
Ot paraffin bath (97018) $40 $40 6.7×
Ot Prosthetic Training, Each 15 Min (97761) $111 $111 2.7×
Ot Re-Eval Est Plan Care (97168) $146 $146 2.1×
Ot rom hand (95852) $31 $31 1.4×
Outpatient Cardiac Rehab W/Cont Ecg Monitoring (93798) $190 $190 1.5×
Outpatient Cardiac Rehab W/O Cont Ecg Monitor (93797) $111 $111 0.9×
Patch/Application Test Specify Number Tests (95044) $19 $19 0.0×
Percutaneous tests w/allergenic extracts (95004) $16 $16 0.0×
Phlebotomy therapeutic (99195) $208 $208 1.6×
Phys/qhp svcs op pulm rehab w/cont oximtry mntr (94626) $213 $213 3.8×
Phys/qhp svcs op pulm rehab wo cont oximtry mntr (94625) $188 $188 3.3×
Physical Performance Test (97750) $74 $74 2.2×
Polysom 6/>Yrs Sleep W/Cpap 4/> Addl Param Attnd (95811) $3,720 $3,720 4.5×
Prepj& allergen immunotherapy 1/mlt antigen (95165) $28 $28 0.6×
Prepj& Antigen Allergen Immunotherapy 1 Insect (95145) $30 $30 0.7×
Prepj& antigen allergen immunotherapy 2 insect (95146) $53 $53 1.2×
Prepj& Antigen Allergen Immunotherapy 3 Insect (95147) $50 $50 0.7×
Prepj& antigen allergen immunotherapy 5 insect (95149) $92 $92 1.3×
Prof Svcs Allg Immntx X W/Prv Allgic Xtrcs 1 Njx (95115) $37 $37 0.8×
Prof svcs allg immntx x w/prv allgic xtrcs njxs (95117) $59 $59 1.3×
Professional services for the supervision of preparation and provision of antigens for allergen immunotherapy (specify… (95148) $72 $72 1.0×
Professional services for the supervision of preparation and provision of antigens for allergen immunotherapy; whole… (95170) $9 $9 0.2×
Pt Eval High Complex (97163) $272 $272 2.8×
Pt eval low complex 20 min (97161) $272 $272 2.8×
Pt Eval Mod Complex (97162) $272 $272 2.8×
Pt gait training 15 min (97116) $98 $98 3.4×
Pt group caregiver training (97552) $112 $112 5.1×
Pt mechanical traction (97012) $58 $58 4.0×
Pt Re-Eval Est Plan Care (97164) $146 $146 2.2×
Pulm function test by gas (94727) $310 $310 1.5×
Pulmonary service/procedure (94799) $253 $253 2.0×
Pulmonary Stress Testing (94618) $359 $359 2.8×
Rapid Desensitization Procedure Each Hour (95180) $649 $649 1.5×
Remote 30 Day Ecg Rev/Report (93270) $457 $457 12.7×
Respiratory flow volume loop (94375) $359 $359 1.7×
Rom Meas&Reprt Ea Xtr Ex Hand/Ea Trnk Sctj Spi (95851) $37 $37 1.4×
Same day nb discharge (99463) $292 $292 2.3×
Self Care Mngment Training (97535) $117 $117 3.6×
Sleep study unattended (95806) $550 $550 2.6×
Slp caregiver training 1st 30 min (97550) $269 $269 5.1×
Speech sound lang comprehen (92523) $556 $556 2.5×
Spirometry (94010)
range across 3 matching MRF lines		 $23–$359 $23–$359 varies
Standardized Cognitive Performance Testing (96125) $375 $375 3.6×
Stress Tte Only (93350) $2,306 $2,306 4.4×
Temp transcutaneous pacing (92953) $943 $943 1.5×
Ther Ivntj Cog Funcj Cntct 1st 15 Minutes (97129) $100 $100 4.5×
Ther Ivntj Ea Addl 15 Min (97130) $97 $97 4.6×
Ther Px 1/> Areas Each 15 Min Aqua Ther W/Xerss (97113) $142 $142 3.8×
Ther Px 1/> Areas Each 15 Minutes Massage (97124) $89 $89 3.0×
Ther/Proph/Diag Inj Sc/Im (96372) $81 $81 1.2×
Ther/Proph/Diag Iv Inf Init (96365) $379 $379 1.9×
Therapeutic Activities (97530) $119 $119 3.4×
Tobacco Use Cessation Intensive >10 Minutes (99407) $62 $62 1.7×
Tobacco Use Cessation Intermediate 3-10 Minutes (99406)
range across 2 matching MRF lines		 $33–$138 $33–$138 varies
Trans Care Mgmt 14 Day Disch (99495) $340 $340 2.7×
Trans Care Mgmt 7 Day Disch (99496) $479 $479 3.7×
Tstg ans funcj vasomotor adrenergic innervaj (95922) $252 $252 2.0×
Tte w/doppler, complete (93306) $1,885 $1,885 3.6×
Tx Speech Lang Voice Commj &/Auditory Proc Ind (92507) $198 $198 2.6×
Tx/Pro/Dx Inj New Drug Addon (96375) $117 $117 2.6×
Tympanometry (92567) $36 $36 1.0×
Unlisted Special Dermatological Service/Px (96999) $375 $375 1.9×
Upr/L Xtremity Art 2 Levels (93922) $457 $457 3.6×
Upr/Lxtr Art Stdy 3+ Lvls (93923) $747 $747 3.6×
Vent Mgmt Inpat Init Day (94002) $1,527 $1,527 2.6×
Ventilation Assist & Mgmt Inpatient Ea Sbsq Da (94003) $1,197 $1,197 2.0×
Vital capacity, total (94150) $253 $253 2.0×
Wheelchair Mgmt Ea 15 Min (97542) $67 $67 2.2×

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.