Visits & medical services prices at Grand Itasca Clinic and Hospital

Grand Rapids, MN · every code in this section with a posted price and a Medicare benchmark.

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

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ProcedureCash priceGross charge× Medicare
Actigraphy testing recording analysis i&r (95803) $197.86 $465.54 3.3×
Airway inhalation treatment (94640) $276.25 $650 1.2×
Ambulatory Bp Analysis (93788) $141.53 $333 1.0×
Ambulatory Bp Recording (93786) $214.63 $505 1.6×
Appl Modality 1/> Areas Ultrasound Ea 15 Min (97035) $55.28 $130.06 3.8×
Application on-body injector (96377) $125.16 $294.50 2.6×
Bedside Swallowing Eval (92610) $193.80 $456 2.3×
Behavioral and qualitative analysis of voice and resonance (92524) $237 $557.65 2.2×
Bfb traing w/EMG &/manometry 1st 15 min cntct (90912) $204 $480 2.5×
Bfb training ea addl 15 min (90913) $82.03 $193 2.5×
Biofeedback training any modality (90901) $108.38 $255 2.6×
Brief Emotional/Behavioral Assessment (96127) $9.78 $23 0.3×
Brncdilat rspse spmtry pre&post-brncdilat admn (94060) $242.38 $570.28 0.6×
Canalith Repositioning Procedure (95992) $109.90 $258.58 2.7×
Cardiac Stress Tst,Tracing Only (93017) $450.52 $1,060.05 2.0×
Cardiopulmonary resuscitation (92950) $461.76 $1,086.50 2.1×
Cardioversion (92960) $767.78 $1,806.53 1.1×
Caregiver Training Strategies&Tq Ea Addl 15 Min (97551) $38.25 $90 1.5×
Cbt 1st hour (94644) $159.38 $375 1.2×
Chemo Hormon Antineopl Sq/Im (96402) $65.42 $153.92 0.9×
Chemo IV push addl drug (96411) $106.25 $250 1.4×
Chemo prolong 8+ hrs infuse w/pump (96416) $245.70 $578.11 0.7×
Chemother, IV infusion, 1 hr (96413) $250.66 $589.78 0.7×
Chemother, IV infusion, ea add hr (96415) $54.38 $127.94 0.7×
Chemother,Non-Hormone Anti-Neopl, Sub-Q/Im (96401) $207.62 $488.50 2.8×
Chemotx admn IV nfs tq ea seql nfs to 1 hr (96417) $123.59 $290.80 1.7×
Chemotx admn IV push tq 1/1st sbst/drug (96409) $193.38 $455 0.6×
Color/duplex Doppler, complete (93975) $497.25 $1,170 2.0×
Color/duplex Doppler, limited (93976) $230.35 $542 2.1×
Comprehensive Hearing Test (92557) $70.98 $167 0.5×
Conditioning Play Audiometry (92582) $157.68 $371 1.2×
Cont Gluc Monitoring Patient Provided Equipment (95249) $126.65 $298 2.1×
Continuous Glucose Monitoring (95250) $279.23 $657 2.0×
Cpap/bipap (94660) $335.04 $788.30 1.5×
Cpt initial (94667) $147.48 $347 1.1×
Critical care (99291) $1,023.25 $2,407.64 1.2×
Debridement Open Wound 20 Sq Cm< (97597) $127.10 $299.04 0.6×
Developmental tst admin phys/qhp 1st hour (96112) $263.50 $620 2.0×
Distrt prod evokd otoacoustic emsns comp/dx eval (92588) $24.58 $57.84 0.1×
Dup-Scan Aorta Ivc Iliac Vascl/Bpgs Complete (93978) $473.03 $1,113 1.9×
Dup-scan aorta ivc iliac vascl/bpgs uni/lmtd (93979) $269.45 $634 2.5×
Dup-Scan Lxtr Art/Artl Bpgs Compl Bi Study (93925) $473.03 $1,113 1.9×
Dup-Scan Lxtr Art/Artl Bpgs Uni/Lmtd Study (93926) $265.63 $625 2.5×
Dup-Scan Uxtr Art/Artl Bpgs Compl Bi Study (93930) $520.20 $1,224 2.1×
Dup-Scan Uxtr Art/Artl Bpgs Uni/Lmtd Study (93931) $220.15 $518 2.0×
Dup-Scan Xtr Veins Complete Bilateral Study (93970) $524.45 $1,234 2.1×
Dup-scan xtr veins unilateral/limited study (93971) $270.30 $636 2.5×
Duplex scan extracranial art compl bi study (93880) $403.33 $949 1.6×
Echo Heart Xthoracic,Limited (93308) $471.89 $1,110.32 1.9×
Echo transesophageal (93312) $928.20 $2,184 1.6×
Echo Transthoracic - Congenital Tte Complete (93303) $664.70 $1,564 1.2×
EKG rhythm strip (93041) $96.48 $227 1.6×
Electrocardiogram Tracing (93005) $94.28 $221.83 1.5×
EMG two extremities (95861) $156.40 $368 1.1×
Er level 1 (99281) $218.96 $515.19 2.5×
Er level ii (99282) $254.14 $597.95 1.6×
Er level iii (99283) $304.83 $717.24 1.1×
Er level IV (99284) $528.92 $1,244.52 1.2×
Er level v (99285) $751.71 $1,768.72 1.2×
Eval speech sound production (92522) $211.65 $498 1.9×
Evaluate Pt Use Of Inhaler (94664) $246.50 $580 1.1×
Evaluation for prescription for speech-generating augmentative and alternative communication device, face-to-face with… (92607) $364.23 $857 3.0×
Evaluation of speech fluency (92521) $251.60 $592 1.9×
Exercise tst brncspsm (94617) $155.55 $366 1.1×
External ECG rec>48hr<7d recording (93242) $23.28 $54.75 0.6×
External ECG rec>7d<15d recording (93246) $23.38 $55.01 0.6×
External Ecg Scanning Analysis Report (93226) $178.50 $420 2.9×
Gastroesophag reflx test w/telemtry ph eltrd (91035) $835.55 $1,966 0.9×
Holter Monitor (93225) $162.35 $382 1.2×
Imm admn sarscov2 vaccine single dose (90480) $25.76 $60.61 0.6×
Immune Admin Oral/Nasal (90473) $9.02 $21.22 0.1×
Immunization Admin (90471) $13.30 $31.28 0.2×
Interrog dev eval scrms phys/qhp in person (93291) $61.63 $145 2.1×
Iontophoresis 15 min (97033) $65.03 $153 3.4×
Irrig drug delivery device (96523) $49.37 $116.14 0.8×
IV infusion hydration each additional hour (96361) $93.52 $220.04 1.9×
IV infusion hydration initial 31 min-1 hour (96360) $217.84 $512.56 1.0×
IV infusion ther proph addl sequential to 1 hr (96367) $180.24 $424.09 2.4×
IV infusion, therap/proph/diagnost,initial,1st hour (96365) $278.18 $654.52 1.3×
IV infusion, therap/proph/diagnost,initial,ea add hour (96366) $119.04 $280.10 2.5×
IV push ea addl new drug (96375) $75.01 $176.48 1.6×
IV push initial (96374) $217.79 $512.42 1.0×
Manual therapy 15 min (97140) $66.77 $157.09 2.4×
Massage 15 min (97124) $76.08 $179 2.6×
Maximum voluntary ventilation (94200) $155.55 $366 2.6×
Mechanical traction (97012) $62.69 $147.50 4.4×
Med Nutr Ther, Subsq, Indiv, Ea 15 Min (97803) $84.15 $198 2.7×
Medical nutrition assmt&ivntj indiv each 15 mi (97802) $87.55 $206 2.4×
Methacholine challenge (94070) $376.55 $886 1.0×
Motility study esophagus (91010) $1,013.20 $2,384 2.6×
Motion Fluor Eval Swlng Funcj C/V Rec (92611) $263.10 $619.06 2.9×
Multiple Sleep Latency Test (95805) $1,318.35 $3,102 1.5×
Nasopharyngoscopy (92511) $140.68 $331 0.7×
Negative Pressure Wound Therapy Dme </= 50 Sq Cm (97605) $67 $157.64 0.3×
Negative Pressure Wound Therapy Dme >50 Sq Cm (97606) $88.12 $207.33 0.2×
Newborn resuscitation (99465) $737.63 $1,735.58 1.1×
Non-Invas Physiologic Std Extremity Art 2 Level (93922) $220.16 $518 1.6×
Noninvasive Ear/Pulse Oximetry Overnight Monitor (94762) $180.63 $425 1.4×
Orthotics Mgmt & Trainj Initial Enctr Ea 15 Mins (97760) $80.19 $188.67 1.7×
Osteopathic Manipulative Tx 1-2 Body Regions (98925) $26.56 $62.50 1.2×
Osteopathic manipulative tx 3-4 body regions (98926) $30.18 $71 1.4×
Osteopathic manipulative tx 5-6 body regions (98927) $33.16 $78 1.5×
Ot Community/Work Reintegration Trainj Ea 15 Min (97537) $73.95 $174 2.3×
Ot eval high complex 60 min (97167) $191.25 $450 1.9×
Ot eval low complex 30 min (97165) $154.46 $363.42 1.5×
Ot eval mod complex 45 min (97166) $169.04 $397.72 1.7×
Ot Orthotics/Prosth Mgmt &/Trainj Sbsq Enctr 15 Min (97763) $105.18 $247.46 2.1×
Ot Prosthetic Training, Each 15 Min (97761) $90.95 $214 2.3×
Ot re-evaluation (97168) $99.88 $235 1.5×
Ot therapeutic activity 15 min (97530) $75.91 $178.60 2.2×
Outpatient Cardiac Rehab W/Cont Ecg Monitoring (93798) $156.42 $368.03 1.2×
Outpatient Cardiac Rehab W/O Cont Ecg Monitor (93797) $157.70 $371.06 1.2×
Paraffin bath pt (97018) $73.95 $174 12.3×
Pentamidine Aersl Inhalation Pneumocystis/Proph (94642) $314.93 $741 1.4×
Percutaneous tests w/allergenic extracts (95004) $6.38 $15 0.0×
Peripheral arterial disease rehab per session (93668) $92.23 $217 1.5×
Phlebotomy therapeutic (99195) $186.15 $438 1.4×
Phys/qhp svcs op pulm rehab w/cont oximtry mntr (94626) $75.23 $177 1.2×
Phys/qhp svcs op pulm rehab wo cont oximtry mntr (94625) $75.23 $177 1.2×
Plethysmography (94726) $227.50 $535.28 0.6×
Pm device eval in person (93288) $105.40 $248 2.7×
Pm device progr eval dual (93280) $83.30 $196 2.2×
Pm device progr eval multi (93281) $63.33 $149 1.6×
Pm device progr eval sngl (93279) $70.98 $167 1.8×
Polysom 6/>Yrs Sleep W/Cpap 4/> Addl Param Attnd (95811) $1,519.72 $3,575.82 1.7×
Polysom <6 yrs 4/> paramtrs (95782) $1,719.98 $4,047 1.9×
Prepj& allergen immunotherapy 1/mlt antigen (95165) $22.60 $53.17 0.5×
Prgrmg Eval Implantable Dfb - Cardiac Device Clinic Icd Biv Chamber (93284) $89.25 $210 2.3×
Prof Svcs Allg Immntx X W/Prv Allgic Xtrcs 1 Njx (95115) $19.98 $47 0.4×
Prof Svcs Allg Immntx X W/Prv Allgic Xtrcs Njxs (95117) $22.96 $54.02 0.5×
Programming device evaluation (in person) with iterative adjustment of the implantable device to test the function of… (93282) $76.50 $180 2.0×
Programming device evaluation (in person) with iterative adjustment of the implantable device to test the function of… (93283) $83.73 $197 2.2×
Psychiatric diagnostic evaluation (90791) $157.36 $370.24 0.9×
Psytx crisis initial 60 min (90839) $194.02 $456.50 1.1×
Pt Aquatic Therapy/Exercises (97113) $82.03 $193 2.2×
Pt Electrical Stimulation (97032) $56.89 $133.84 3.9×
Pt eval high complex 45 min (97163) $167.55 $394.23 1.7×
Pt eval low complex 20 min (97161) $134.53 $316.52 1.4×
Pt eval mod complex 30 min (97162) $144.50 $340 1.5×
Pt gait training 15 min (97116) $69.65 $163.86 2.4×
Pt Neuromusc Reeducat,1+ Areas, Ea 15 Min (97112) $69.72 $164.04 2.1×
Pt Physical Performance Test (97750) $75.65 $178 2.2×
Pt re-evaluation (97164) $97.01 $228.25 1.4×
Pt Self-Care/Home Mgmt Training Each 15 Minutes (97535) $82.30 $193.64 2.5×
Pulmonary Service/Procedure (94799) $134.73 $317 1.0×
Pulmonary stress test simple (94618) $354.28 $833.59 2.6×
Pure Tone Audiometry Air & Bone (92553) $90.10 $212 0.7×
Pure Tone Audiometry Air Only (92552) $68.43 $161 0.5×
Refill/Maint Portable Pump (96521) $241.68 $568.66 1.1×
Remote 30 Day Ecg Rev/Report - Cardiac Event Monitor (93270) $251.60 $592 6.5×
Respiratory flow volume loop (94375) $208.68 $491 0.9×
Rmvl Devital Tiss N-Slctv Dbrdmt W/O Anes 1 Sess (97602) $181.26 $426.50 0.9×
Rt Chest Wall Manipulation,Subsequent (94668) $155.98 $367 1.1×
Sensory Integration Ea 15 Min (97533) $90.86 $213.76 1.5×
Slp caregiver training 1st 30 min (97550) $76.50 $180 1.4×
Slp Stdy Unatnd W/Hrt Rate/O2 Sat/Resp/Slp Time (95800) $1,360.19 $3,200.44 6.1×
Smoking cessation > 10 min (99407) $27.20 $64 0.7×
Speech Audiometry Complete (92556) $82.04 $193.04 1.3×
Speech audiometry threshold (92555) $52.70 $124 0.9×
Speech sound lang comprehen (92523) $321.30 $756 1.4×
Spirometry (94010) $134.73 $317 0.6×
Standardized Cognitive Performance Testing (96125) $279.02 $656.50 2.7×
Stress echo (93350) $920.13 $2,165 1.6×
Ther ivntj cog funcj cntct 1st 15 minutes (97129) $74.80 $176 3.3×
Ther Ivntj Cog Funcj Cntct Ea Addl 15 Minutes (97130) $58.23 $137 2.8×
Ther Sp-Genratj Dev Prgrmg&Modificaj (92609) $265.63 $625 2.6×
Therapeutic prophylactic/dx injection subq/im (96372) $89.06 $209.54 1.2×
Tobacco Use Cessation Intermediate 3-10 Minutes (99406) $19.55 $46 0.5×
Trans Care Mgmt 14 Day Disch (99495) $149.18 $351 1.1×
Trans Care Mgmt 7 Day Disch (99496) $165.75 $390 1.2×
Tte w/doppler, complete (93306) $704.99 $1,658.79 1.3×
Tx Speech Lang Voice Commj &/Auditory Proc Ind (92507) $162.78 $383.01 2.1×
Tx Swallowing Dysfunction&/Oral Funcj Feeding (92526) $228.20 $536.92 2.7×
Tympanometry (92567) $31.82 $74.84 0.8×
Tympanometry And Reflex Threshold Measurements (92550) $42.49 $99.96 0.2×
Vasc Non-Invasive Lower Extrem Art Stress/Rest, Complete,Bilateral (93924) $362.53 $853 1.6×
Vasopneumatic device (97016) $65 $152.92 5.4×
Vent mgmt inpat init day (94002) $752.25 $1,770 1.2×
Ventilation Assist & Mgmt Inpatient Ea Sbsq Da (94003) $723.35 $1,702 1.1×
Visual reinforcement audiometry (vra) (92579) $67.15 $158 0.3×
Vital capacity, total (94150) $180.63 $425 1.4×
Wheelchair Mgmt Ea 15 Min (97542) $73.86 $173.78 2.4×