Visits & medical services prices at Grand River Medical Center

Rifle, CO · every code in this section with a posted price and a Medicare benchmark.

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

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ProcedureCash priceGross charge× Medicare
Airway inhalation treatment (94640) $110 $220 0.5×
Allergy injection single (95115) $34.75 $69.50 0.7×
Ambulatory bp recording (93786) $161.50 $323 1.2×
Appl on-body injector for timed subq injection (96377) $70.75 $141.50 1.4×
Application of a modality to 1 or more areas; contrast baths, each 15 minutes Other Outpatient (97034) $125 $250
Application of a modality to 1 or more areas; diathermy (eg, microwave) Other Outpatient (97024) $11.50 $23
Application of a modality to 1 or more areas; electrical stimulation (manual), each 15 minutes Other Outpatient (97032) $137.50 $275
Application of a modality to 1 or more areas; iontophoresis, each 15 minutes Other Outpatient (97033) $164.50 $329
Application of a modality to 1 or more areas; ultrasound, each 15 minutes Other Outpatient (97035) $97.75 $195.50
Application of a modality to 1 or more areas; vasopneumatic devices Other Outpatient (97016) $41.50 $83
Assessment of aphasia (96105) $376.25 $752.50
Assistive technology assessment (eg, to restore, augment or compensate for existing function, optimize functional tasks… (97755) $98.50 $197
Behavioral & qualit analysis voice and resonance (92524) $315.25 $630.50
Biofeedback training by any modality Other Outpatient (90901) $114.50 $229
Bipap initial day (94660) $454 $908 2.0×
Breathing capacity test (94010) $147.50 $295 0.6×
Bronchodilation responsiveness, spirometry as in 94010, pre- and post-bronchodilator administration (94060) $296.75 $593.50 0.8×
Car seat/bed test inft thru 12 mo 60 min (94780) $48 $96 1.2×
Cardioversion elective external (92960) $778.50 $1,557 1.1×
Caregiver training 1st 30 min (97550) $64 $128
Caregiver training ea addl 15 (97551) $34.50 $69
Chemo anti-neopl sq/im (96401) $188 $376 2.5×
Chemo hormon antineopl sq/im (96402) $118.25 $236.50 1.6×
Chemo intralesional up to 7 (96405) $109.75 $219.50 1.4×
Chemo IV infus each addl seq (96417) $100 $200 1.3×
Chemo IV infusion addl hr (96415) $148.75 $297.50 2.0×
Chemo IV push addl drug (96411) $199.25 $398.50 2.6×
Chemother prolong infuse w/pump (96416) $563.75 $1,127.50 1.6×
Chemotherapy administration, intravenous infusion technique; up to 1 hour, single or initial substance/drug (96413) $563.75 $1,127.50 1.6×
Chemotherapy administration; intravenous, push technique, single or initial substance/drug (96409) $357 $714 1.0×
Chest physiotherapy initial (94667) $83.50 $167 0.6×
Color/duplex Doppler, complete (93975) $801 $1,602 3.2×
Concurrent chemotherapy (96549) $85.50 $171 1.7×
Cont gluc mntr pt prov eqp (95249) $94.25 $188.50 1.5×
Continuous inhalation treatment with aerosol medication for acute airway obstruction; first hour (94644) $165.50 $331 1.2×
Cpr (92950) $292 $584 1.3×
Critical care ill/injured patient init 30-74 min (99291) $1,906.50 $3,813 2.2×
Debridement open wound 20 sq cm< (97597) $272.50 $545 1.3×
Duplex scan of extracranial arteries; complete bilateral study Age Under 21 (93880) $771.25 $1,542.50 3.1×
Duplex scan of extremity veins including responses to compression and other maneuvers; complete bilateral study Age… (93970) $926 $1,852 3.7×
Duplex scan of extremity veins including responses to compression and other maneuvers; unilateral or limited study Age… (93971) $534 $1,068 4.8×
Duplex scan of lower extremity arteries or arterial bypass grafts; complete bilateral study Age Under 21 (93925) $889.75 $1,779.50 3.5×
Duplex scan of lower extremity arteries or arterial bypass grafts; unilateral or limited study Age Under 21 (93926) $741.50 $1,483 6.7×
Duplex scan of upper extremity arteries or arterial bypass grafts; unilateral or limited study Age Under 21 (93931) $759.50 $1,519 6.9×
Echo transesophageal (93312) $1,519.50 $3,039 2.6×
EKG 12 lead tracing only (93005) $139.50 $279 2.2×
EKG rhythm strip (93041) $100 $200 1.6×
Emergency department visit high mdm (99285) $1,222.25 $2,444.50 1.9×
Emergency department visit low mdm (99283) $523.50 $1,047 1.8×
Emergency department visit may not req phys/qhp (99281) $195.75 $391.50 2.2×
Emergency department visit moderate mdm (99284) $814.25 $1,628.50 1.8×
Emergency department visit straightforward mdm (99282) $279.25 $558.50 1.7×
End tidal co2 mntrng (crbn dxde exp gas dtrmntn by infrared analyzer) (94799) $98 $196 0.7×
Endoscopy swallow (fees) vid (92612) $237.25 $474.50
Eval of Oral and Pharyngeal Swallowing - Eval of Oral and Pharyngeal Swallowing Fx Chg (92610) $317.25 $634.50
Evaluate pt use of inhaler (94664) $83 $166 0.4×
Evaluation for prescription for speech-generating augmentative and alternative communication device, face-to-face with… (92607) $233.25 $466.50
Evaluation for prescription of non-speech-generating augmentative and alternative communication device, face-to-face… (92605) $337 $674
Evaluation of speech fluency (92521) $331.50 $663
Evaluation of speech sound production articulate (92522) $330.50 $661
External ECG rec>7d<15d recording (93246) $151.50 $303 3.8×
External electrocardiographic recording up to 48 hours by continuous rhythm recording and storage; recording (includes… (93225) $323 $646 2.3×
Flexible ndsc eval swlng&laryn sens c/v rec (92616) $273.50 $547
Fluidotherapy (97022) $74.50 $149
Fundus photography with interpretation and report (92250) $133.25 $266.50 0.9×
Group caregiver training strategies & technique (97552) $34.50 $69
Hot/cold pack (97010) $13.50 $27
Im adm intransl/oral 1 vaccine (90473) $18.92 $37.84 0.2×
Imm admn sarscov2 vaccine single dose (90480) $24.67 $49.34 0.6×
Immunization administration (90471) $36 $72 0.5×
Infrared therapy (97026) $38 $76
Ingestion challenge test initial 120 minutes (95076) $74.50 $149 0.2×
Injection,Therap/Proph/Diagnost, IV Push, Ea Add, New Drug (96375) $111.25 $222.50 2.3×
Injection,Therap/Proph/Diagnost, IV Push, Initial Drug (96374) $118.75 $237.50 0.5×
Irrigaj implntd venous access drug delivery syst (96523) $69.75 $139.50 1.1×
IV infusion hydration each additional hour (96361) $185 $370 3.7×
IV infusion hydration initial 31 min-1 hour (96360) $216.25 $432.50 1.0×
IV infusion ther proph addl sequential to 1 hr (96367) $142 $284 1.9×
IV infusion therapy/prophylaxis /dx 1st to 1 hr (96365) $213.50 $427 1.0×
IV tx, each additional hour (96366) $115.50 $231 2.3×
Low frequency non-thermal us (97610) $115.50 $231 0.5×
Manipulation chest wall, such as cupping, percussing, and vibration to facilitate lung function; subsequent (94668) $69.75 $139.50 0.5×
Mechanical traction therapy (97012) $41.50 $83
Medical nutrition assmt&ivntj indiv each 15 mi (97802) $87 $174
Medical nutrition group (97804) $22.50 $45
Medical nutrition therapy; re-assessment and intervention, individual, face-to-face with the patient, each 15 minutes… (97803) $53.50 $107
Motion fluoroscopic evaluation of swallowing function by cine or video recording Other Outpatient (92611) $377.50 $755
Neg pressure wound therapy non dme </= 50 sq cm (97607) $260.25 $520.50 0.6×
Neg pressure wound therapy non dme >50 sq cm (97608) $398.75 $797.50 0.9×
Negative pressure wound therapy dme </= 50 sq cm (97605) $260.50 $521 1.2×
Negative pressure wound therapy dme >50 sq cm (97606) $231.75 $463.50 0.5×
Nitric oxide expired gas determination (95012) $18.50 $37 0.5×
Noninvasive ear/pulse oximetry overnight monitor (94762) $186 $372 1.4×
Nonphysician qualified health care professional online digital assessment and management, for an established patient,… (98970) $20 $40
Nonphysician qualified health care professional online digital assessment and management, for an established patient,… (98971) $37.50 $75
Nonphysician qualified health care professional online digital assessment and management, for an established patient,… (98972) $49.75 $99.50
Occupational therapy eval high complex 60 mins (97167) $194.25 $388.50
Occupational therapy eval low complex 30 mins (97165) $194.25 $388.50
Occupational therapy eval mod complex 45 mins (97166) $194.25 $388.50
Ophthalmological services: medical examination and evaluation with initiation of diagnostic and treatment program;… (92002) $208.50 $417 1.5×
Oral function therapy (92526) $165.50 $331
Oral speech device eval (92597) $239 $478
Orthc/prostc mgmt sbsq enc (97763) $208.75 $417.50
Orthotic(s) management and training (including assessment and fitting when not otherwise reported), upper… (97760) $157 $314
Ot manual therapy ea 15 min (97140) $181 $362
Ot neuromuscular re-education (97112) $224 $448
Ot paraffin bath (97018) $25 $50
Ot re-evaluation (97168) $119 $238
OT Therapeutic Activities Charges (97530) $237 $474
Ot wheelchair management (97542) $367 $734
Outpatient cardiac rehab w/cont ECG monitoring (93798) $156.75 $313.50 1.2×
Outpatient cardiac rehab w/o cont ECG monitor (93797) $119 $238 0.9×
Percutaneous tests w/allergenic extracts (95004) $7 $14 0.0×
Peripheral vascular rehab (93668) $119 $238 1.9×
Phlebotomy therapeutic (99195) $139 $278 1.0×
Phy/qhp op pulm rhb w/mntr (94626) $119 $238 1.9×
Phy/qhp op pulm rhb w/o mntr (94625) $106.50 $213 1.7×
Physical therapy evaluation high complex 45 mins (97163) $181.50 $363
Physical therapy evaluation low complex 20 mins (97161) $181.50 $363
Physical therapy evaluation mod complex 30 mins (97162) $181.50 $363
Polysom 6/>yrs sleep w/cpap 4/> addl param attnd (95811) $2,777.75 $5,555.50 3.1×
Professional services for allergen immunotherapy; 2 or more injections (95117) $60 $120 1.2×
Prosthetic(s) training, upper and/or lower extremity(ies), initial prosthetic(s) encounter, each 15 minutes Other… (97761) $244.50 $489
Pt gait training 15 min (97116) $132.25 $264.50
Pt physical performance test (97750) $195.50 $391
Pt re-evaluation (97164) $103.50 $207
Pt Work Hardening/conditioningwork Reconditioning Initial Charge (97545) $292.50 $585
Pulm funct tst plethysmograp (94726) $290 $580 0.7×
Pulmonary stress testing (94618) $175.25 $350.50 1.2×
Range of motion measurements and report (separate procedure); each extremity (excluding hand) or each trunk section… (95851) $59 $118
Range of motion measurements and report (separate procedure); hand, with or without comparison with normal side Other… (95852) $43.50 $87
Remote 30 day ECG rev/report (93270) $209.50 $419 5.3×
Self-care/home management training (eg, activities of daily living (ADL) and compensatory training, meal preparation,… (97535) $233 $466
Sensory integrative techniques to enhance sensory processing and promote adaptive responses to environmental demands,… (97533) $227.50 $455
Sleep study, unattended, simultaneous recording; heart rate, oxygen saturation, respiratory analysis (eg, by airflow or… (95800) $375.75 $751.50 1.6×
Speech sound lang comprehen (92523) $315.25 $630.50
Standardized cognitive performance testing (96125) $601 $1,202
Surfactant administration (94610) $336 $672 1.5×
Ther ivntj cog funcj cntct 1st 15 minutes (97129) $75 $150
Ther ivntj cog funcj cntct ea addl 15 minutes (97130) $188.25 $376.50
Therapeutic procedure(s), group (2 or more individuals) Other Outpatient (97150) $56 $112
Therapeutic procedure, 1 or more areas, each 15 minutes; aquatic therapy with therapeutic exercises Other Outpatient (97113) $210.50 $421
Therapeutic procedure, 1 or more areas, each 15 minutes; massage, including effleurage, petrissage and/or tapotement… (97124) $162.75 $325.50
Therapeutic prophylactic/dx injection subq/im (96372) $140.75 $281.50 1.9×
Therapeutic service(s) for the use of non-speech-generating device, including programming and modification (92606) $150.50 $301
Therapeutic services for the use of speech-generating device, including programming and modification Other Outpatient (92609) $166 $332
Tobacco use cessation intensive >10 minutes (99407) $45.50 $91 1.2×
Tobacco use cessation intermediate 3-10 minutes (99406) $28.50 $57 0.7×
Tte f-up or lmtd (93308) $474.50 $949 1.9×
Tte w/doppler complete (93306) $1,246 $2,492 2.2×
Tx of Speech/Lang/Voice/Comm/Auditory Chg (92507) $170.25 $340.50
Tx speech language voice commj auditry 2/>indiv (92508) $74.75 $149.50
Ventilation ip/obs initial day (94002) $945.50 $1,891 1.5×
Ventilator subsequent day (94003) $756.50 $1,513 1.2×
Work hardening/conditioning; each additional hour (List separately in addition to code for primary procedure) (97546) $185.25 $370.50
Wound(s) care non-selective (97602) $113.50 $227 0.5×