Visits & medical services prices at Evanston Regional Hospital

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

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

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ProcedureCash priceGross charge× Medicare
Aep hearing status deter broadband stimuli i&r (92651) $112.84 $188.07 0.5×
Aerosol inhalation pentamidine (94642) $242.10 $403.50 1.1×
Airway inhalation treatment (94640) $210.09 $350.15 0.9×
Application of a modality to 1 or more areas; contrast baths, each 15 minutes Other Outpatient (97034) $53.58 $89.31
Application of a modality to 1 or more areas; diathermy (eg, microwave) Other Outpatient (97024) $44.92 $74.86
Application of a modality to 1 or more areas; electrical stimulation (manual), each 15 minutes Other Outpatient (97032) $53.58 $89.31
Application of a modality to 1 or more areas; iontophoresis, each 15 minutes Other Outpatient (97033) $53.58 $89.31
Application of a modality to 1 or more areas; ultrasound, each 15 minutes Other Outpatient (97035) $53.58 $89.31
Application of a modality to 1 or more areas; vasopneumatic devices Other Outpatient (97016) $47 $78.33
Assessment of aphasia (96105) $210.55 $350.92
Assistive technology assessment (eg, to restore, augment or compensate for existing function, optimize functional tasks… (97755) $62.88 $104.80
Behavioral & qualit analysis voice and resonance (92524) $215.45 $359.08
Bipap initial day (94660) $643.59 $1,072.65 2.9×
Breathing capacity test (94010) $185.40 $309 0.8×
Bronchodilation responsiveness, spirometry as in 94010, pre- and post-bronchodilator administration (94060) $221.18 $368.64 0.6×
Canalith repositioning (95992) $162.66 $271.10
Car seat/bed test inft thru 12 mo 60 min (94780) $270.12 $450.20 7.1×
Cardiovascular stress test (93017) $765.05 $1,275.09 3.5×
Cardioversion elective external (92960) $1,576.15 $2,626.91 2.3×
Chemo IV infusion addl hr (96415) $1,391.12 $2,318.54 18.9×
Chemotherapy administration, intravenous infusion technique; up to 1 hour, single or initial substance/drug (96413) $2,434.48 $4,057.46 7.2×
Chest physiotherapy initial (94667) $91.01 $151.68 0.7×
Color/duplex Doppler, complete (93975) $525.55 $875.92 2.2×
Color/duplex Doppler, limited (93976) $372.21 $620.35 3.5×
Community/work reintegration training (eg, shopping, transportation, money management, avocational activities and/or… (97537) $63.78 $106.30
Cpr (92950) $1,024.49 $1,707.49 4.6×
Critical care ill/injured patient init 30-74 min (99291) $2,654.96 $4,424.94 3.1×
Debridement open wound 20 sq cm< (97597) $379.24 $632.06 1.9×
Delivery/birthing room resuscitation (99465) $632 $1,053.33 0.9×
Duplex scan of aorta, inferior vena cava, iliac vasculature, or bypass grafts; complete study Age Under 21 (93978) $525.55 $875.92 2.2×
Duplex scan of aorta, inferior vena cava, iliac vasculature, or bypass grafts; unilateral or limited study Age Under 21 (93979) $372.21 $620.35 3.5×
Duplex scan of extracranial arteries; complete bilateral study Age Under 21 (93880) $824.70 $1,374.50 3.4×
Duplex scan of extracranial arteries; unilateral or limited study Age Under 21 (93882) $254.66 $424.44 2.4×
Duplex scan of extremity veins including responses to compression and other maneuvers; complete bilateral study Age… (93970) $1,044.15 $1,740.25 4.3×
Duplex scan of extremity veins including responses to compression and other maneuvers; unilateral or limited study Age… (93971) $698.42 $1,164.03 6.5×
Duplex scan of lower extremity arteries or arterial bypass grafts; complete bilateral study Age Under 21 (93925) $637.93 $1,063.22 2.6×
Duplex scan of lower extremity arteries or arterial bypass grafts; unilateral or limited study Age Under 21 (93926) $465.53 $775.89 4.4×
Duplex scan of upper extremity arteries or arterial bypass grafts; complete bilateral study Age Under 21 (93930) $637.93 $1,063.22 2.6×
Duplex scan of upper extremity arteries or arterial bypass grafts; unilateral or limited study Age Under 21 (93931) $465.53 $775.89 4.4×
ECG monit/reprt up to 48 hrs (93226) $517.28 $862.13 8.6×
ECG/monitoring and analysis (93271) $312.02 $520.04 3.2×
Echo tthrc r-t 2d w/wo m-mode rest&strs cont ECG (93351) $2,121.80 $3,536.34 3.8×
Echocardiography, transthoracic, real-time with image documentation (2D), includes M-mode recording, when performed,… (93307) $611.31 $1,018.85 2.5×
EKG 12 lead tracing only (93005) $192 $320 3.2×
Emergency department visit high mdm (99285) $1,891.05 $3,151.75 3.1×
Emergency department visit low mdm (99283) $694.82 $1,158.03 2.5×
Emergency department visit may not req phys/qhp (99281) $192.93 $321.55 2.2×
Emergency department visit moderate mdm (99284) $1,223.57 $2,039.28 2.9×
Emergency department visit straightforward mdm (99282) $445.10 $741.84 2.8×
Esophageal motility (manometric study of the esophagus and/or gastroesophageal junction) study with interpretation and… (91010) $816.35 $1,360.58 2.1×
Eval of Oral and Pharyngeal Swallowing - Eval of Oral and Pharyngeal Swallowing Fx Chg (92610) $204.19 $340.32
Evaluate pt use of inhaler (94664) $75.74 $126.24 0.3×
Evaluation of speech fluency (92521) $215.45 $359.08
Evaluation of speech sound production articulate (92522) $215.45 $359.08
External ECG rec>48hr<7d recording (93242) $502.19 $836.98 13.2×
External ECG rec>7d<15d recording (93246) $502.19 $836.98 13.2×
External electrocardiographic recording up to 48 hours by continuous rhythm recording and storage; recording (includes… (93225) $517.28 $862.13 3.8×
Fluidotherapy (97022) $47 $78.33
Gas dilut/washout lung vol w/wo distrib vent&vol (94727) $88.99 $148.32 0.4×
Gastroesophag reflx test w/telemtry ph eltrd (91035) $1,016.90 $1,694.84 1.2×
Gi transit & pres meas wireless capsule w/interp (91112) $1,156.42 $1,927.36 1.2×
Hot/cold pack (97010) $42.34 $70.56
Immunization administration (90471) $83.60 $139.33 1.1×
Injection,Therap/Proph/Diagnost, IV Push, Ea Add, New Drug (96375) $195.59 $325.98 4.1×
Injection,Therap/Proph/Diagnost, IV Push, Initial Drug (96374) $284.29 $473.82 1.3×
Insertion and placement of flow directed catheter (eg, Swan-Ganz) for monitoring purposes with Cardiac Cath (93503) $2,223.79 $3,706.32 1.4×
Irrigaj implntd venous access drug delivery syst (96523) $186.41 $310.68 3.1×
IV infusion hydration each additional hour (96361) $182.81 $304.68 3.8×
IV infusion hydration initial 31 min-1 hour (96360) $296.15 $493.58 1.4×
IV infusion ther proph addl sequential to 1 hr (96367) $183.50 $305.84 2.5×
IV infusion therapy/prophylaxis /dx 1st to 1 hr (96365) $443.72 $739.53 2.0×
IV tx, each additional hour (96366) $237.26 $395.44 5.0×
Manipulation chest wall, such as cupping, percussing, and vibration to facilitate lung function; subsequent (94668) $76.36 $127.27 0.6×
Maximum voluntary ventilation (94200) $55.79 $92.99 0.9×
Mechanical traction therapy (97012) $47 $78.33
Medical nutrition assmt&ivntj indiv each 15 mi (97802) $89.40 $149
Medical nutrition therapy; re-assessment and intervention, individual, face-to-face with the patient, each 15 minutes… (97803) $57.31 $95.52
Methacholine challenge (94070) $132.87 $221.45 0.3×
Motion fluoroscopic evaluation of swallowing function by cine or video recording Other Outpatient (92611) $247.64 $412.73
Negative pressure wound therapy dme </= 50 sq cm (97605) $134.71 $224.52 0.7×
Negative pressure wound therapy dme >50 sq cm (97606) $196.84 $328.07 0.5×
Nerve conduction studies 1-2 studies (95907) $480 $800 2.2×
Nerve conduction studies 11-12 studies (95912) $480 $800 1.3×
Nerve conduction studies 13/> studies (95913) $480 $800 1.3×
Nerve conduction studies 3-4 studies (95908) $480 $800 2.2×
Nerve conduction studies 5-6 studies (95909) $480 $800 2.2×
Nerve conduction studies 7-8 studies (95910) $480 $800 1.3×
Nerve conduction studies 9-10 studies (95911) $480 $800 1.3×
Non-invasive physiologic study extremity 3 levels (93923) $293.72 $489.53 1.3×
Noninvasive ear/pulse oximetry overnight monitor (94762) $342.14 $570.23 2.6×
Nonphysician qualified health care professional online digital assessment and management, for an established patient,… (98970) $10.43 $17.39
Nonphysician qualified health care professional online digital assessment and management, for an established patient,… (98971) $20.86 $34.77
Nonphysician qualified health care professional online digital assessment and management, for an established patient,… (98972) $31.30 $52.17
Occupational therapy eval high complex 60 mins (97167) $98.35 $163.92
Occupational therapy eval low complex 30 mins (97165) $210.55 $350.92
Occupational therapy eval mod complex 45 mins (97166) $210.55 $350.92
Oral function therapy (92526) $106.78 $177.97
Ot manual therapy ea 15 min (97140) $118.62 $197.71
Ot neuromuscular re-education (97112) $71.75 $119.59
Ot paraffin bath (97018) $47 $78.33
Ot re-evaluation (97168) $98.35 $163.92
OT Therapeutic Activities Charges (97530) $56.96 $94.94
Ot wheelchair management (97542) $68.31 $113.85
Outpatient cardiac rehab w/cont ECG monitoring (93798) $148.69 $247.82 1.1×
Outpatient cardiac rehab w/o cont ECG monitor (93797) $148.69 $247.82 1.1×
Phlebotomy therapeutic (99195) $92.91 $154.85 0.7×
Physical therapy evaluation high complex 45 mins (97163) $210.55 $350.92
Physical therapy evaluation low complex 20 mins (97161) $210.55 $350.92
Physical therapy evaluation mod complex 30 mins (97162) $210.55 $350.92
Polysom 6/>yrs sleep w/cpap 4/> addl param attnd (95811) $3,531.40 $5,885.67 4.0×
Polysom <6 yrs sleep w/cpap/bilvl vent 4/> param (95783) $1,809.98 $3,016.63 2.1×
Polysomnography; any age, sleep staging with 1-3 additional parameters of sleep, attended by a technologist (95808) $3,531.40 $5,885.67 4.0×
Pr gastric motility manometric studies (91020) $870.60 $1,451 2.3×
Pt gait training 15 min (97116) $63.50 $105.83
Pt physical performance test (97750) $62.88 $104.80
Pt re-evaluation (97164) $98.35 $163.92
Pt Work Hardening/conditioningwork Reconditioning Initial Charge (97545) $154.95 $258.25
Pulmonary stress testing (94618) $64.89 $108.15 0.5×
Remote 30 day ECG rev/report (93270) $117.77 $196.28 3.1×
Respiratory flow volume loop (94375) $139.96 $233.26 0.6×
Self-care/home management training (eg, activities of daily living (ADL) and compensatory training, meal preparation,… (97535) $61.66 $102.76
Sensory integrative techniques to enhance sensory processing and promote adaptive responses to environmental demands,… (97533) $70.12 $116.86
Sleep study unattended (95806) $529.64 $882.73 2.4×
Speech sound lang comprehen (92523) $215.45 $359.08
Temp transcutaneous pacing (92953) $582.36 $970.60 0.9×
Therapeutic procedure, 1 or more areas, each 15 minutes; aquatic therapy with therapeutic exercises Other Outpatient (97113) $112.14 $186.89
Therapeutic prophylactic/dx injection subq/im (96372) $113.29 $188.81 1.5×
Tobacco use cessation intermediate 3-10 minutes (99406) $37.08 $61.80 1.0×
Tte f-up or lmtd (93308) $354.95 $591.58 1.5×
Tte w/doppler complete (93306) $1,712.53 $2,854.21 3.1×
Tx of Speech/Lang/Voice/Comm/Auditory Chg (92507) $209.92 $349.87
Unlisted diagnostic gastroenterology procedure (91299) $593.69 $989.49 4.5×
Upr/l xtremity art 2 levels (93922) $177.59 $295.98 1.3×
Ventilation ip/obs initial day (94002) $412.10 $686.83 0.7×
Ventilator subsequent day (94003) $343.42 $572.37 0.5×
Vital capacity total (94150) $55.79 $92.99 0.4×
Work hardening/conditioning; each additional hour (List separately in addition to code for primary procedure) (97546) $77.48 $129.14
Wound(s) care non-selective (97602) $104.78 $174.63 0.5×