Visits & medical services prices at Intermountain Health Good Samaritan Hospital

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

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

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ProcedureCash priceGross charge× Medicare
Ablation av node (93650) $36,612
Acoustic Immit Test Tympanometry/Acoust Reflex/Decay (92570) $419.05
Acoustic reflex testing (92568) $345.05
Aep hearing status deter broadband stimuli i&r (92651) $980.90
Aep Neurodiagnostic I&R (92653) $1,190.20
Aep threshold estimation mlt frequencies i&r (92652) $980.90
Airway inhalation treatment (94640) $718.10
Analyze neurostim no prog (95970) $550.30
Appl on-body injector for timed subq injection (96377) $125.40
Application of heat wave therapy (97024) $56.25
Arrhythmia induction (93618) $6,339.35
Assessment of aphasia (96105) $916.65
Behavioral and qualitative analysis of voice and resonance (92524) $853.90
Bfb training 1st 15 min (90912) $157.10
Bfb training ea addl 15 min (90913) $63.10
Biofeedback training any modality (90901) $219.70
Breath Hydrogen/Methane Test (91065) $765
Brncdilat rspse spmtry pre&post-brncdilat admn (94060) $1,260.75
Bundle of his recording (93600) $36,612
C motor evoked upr&lwr limbs (95939) $3,365.55
Canalith Repositioning (95992) $229.95
Capsule endoscopy (91110) $2,973.40
Car seat/bed test 60 min (94780) $174.05
Cardiac Stress Tst,Tracing Only (93017) $2,274.95
Cardiopulmonary exercise testing (94621) $2,813.05
Cardiopulmonary resuscitation (92950) $2,895.85
Cardioversion (92960) $6,974.25
Caregiver training 1st 30 min (97550) $160.15
Caregiver Training Strategies&Tq Ea Addl 15 Min (97551) $79.45
Cath Cath Place/Coronary Angio, Img Super/Interp, Bypass Angio (93455) $25,305.55
Cath Cath Place/Coronary Angio, Img Super/Interp,W Right Heart Cath (93456) $26,999.20
Cath Perc Clos,Cong Interatrial Commun W/Impl (93580) $58,925.55
Cath Place/Coron Angio, Img Super/Interp, Bypass Angio,W L Hrt Ventric (93459) $32,614.55
Cath Place/Coron Angio, Img Super/Interp,W Left Heart Ventriculography (93458) $28,009.70
Cbt 1st hour (94644) $1,714.70
Chemo Admin Peritoneal Cavity (96446) $1,581.30
Chemo Hormon Antineopl Sq/Im (96402) $596.65
Chemo inj subarach/intravent (96542) $1,314.70
Chemo IV push addl drug (96411) $648.55
Chemo Iv Push Sngl Drug (96409) $1,416.35
Chemo prolong 8+ hrs infuse w/pump (96416) $2,576.85
Chemother, IV infusion, 1 hr (96413) $2,228
Chemother, IV infusion, ea add hr (96415) $797.10
Chemother,Ia Push Technique (96420) $1,941.45
Chemother,Non-Hormone Anti-Neopl, Sub-Q/Im (96401) $852.65
Chemotherapy, unspecified procedure (96549) $349.95
Chemotx Admn Cns Req Spinal Puncture (96450) $2,043.60
Chemotx admn IV nfs tq ea seql nfs to 1 hr (96417) $596.65
Chemotx Admn Pleural Cavity Req&W/Thoracnts (96440) $1,581.30
Color/duplex Doppler, complete (93975) $969.55
Color/duplex Doppler, limited (93976) $918.80
Comprehensive Hearing Test (92557) $1,172.50
Conditioning Play Audiometry (92582) $930.25
Coronary artery angio s&i (93454) $17,824.60
Cortical mapping 1st hr (95961) $9,506.90
Cpap initiation and management (94660) $789.40
Cpt initial (94667) $912.20
Critical care (99291) $17,763.85
Ctr motor ep std transcrnl motor stimj lwr limbs (95929) $1,400.75
Debridement Open Wound 20 Sq Cm< (97597) $624.40
Demo &/or eval,pt use,aerosol device (94664) $583.15
Developmental tst admin phys/qhp 1st hour (96112) $1,068.75
Dialysis other/than hemodialysis 1 phys/qhp eval (90945) $1,319.55
Dup-scan artl infl&ven o/f pen vsl compl (93980) $1,517.10
Dup-scan artl infl&ven o/f pen vsl f-up/lmtd std (93981) $1,100.35
Dup-Scan Lxtr Art/Artl Bpgs Compl Bi Study (93925) $2,357.70
Dup-scan lxtr art/artl bpgs uni/lmtd study (93926) $1,094.50
Dup-Scan Uxtr Art/Artl Bpgs Compl Bi Study (93930) $3,180.55
Dup-Scan Uxtr Art/Artl Bpgs Uni/Lmtd Study (93931) $1,361.75
Dup-scan xtr veins unilateral/limited study (93971) $2,137.25
Duplex hemodialysis access (93990) $929
Duplex scan artl infl&ven o/f hemo compl bi std (93985) $1,237.95
Duplex scan artl infl&ven o/f hemo compl uni std (93986) $444.50
Duplex scan extracranial art compl bi study (93880) $1,597.80
Echo Heart Xthoracic,Limited (93308) $2,462.60
Echo transesophageal (93312) $6,784.76
Echo Transthoracic - Congenital Tte Complete (93303) $3,059.37
Echo Transthoracic - Congenital Tte Limited (93304) $2,884.78
EEG awake asleep (95819) $2,909.85
EEG awake drowsy (95816) $2,909.85
EEG cerebral death evaluation (95824) $4,958.15
EEG coma or sleep only (95822) $2,909.85
EEG cont rec w/video by tech min 8 channels (95700) $1,462
Eeg Extended Monitoring 61-119 Minutes (95813) $2,909.85
Eeg W/O Vid 2-12 Hr Unmntr (95705) $2,909.85
EEG w/o vid by tech ea incr 12-26 hr intmt mntr (95709) $4,958.15
EEG w/o vid by tech ea incr 12-26hr unmonitored (95708) $4,958.15
EEG w/o vid tech ea incr 12-26 hr cont r-t mntr (95710) $4,958.15
EEG w/o video by tech 2-12 hr intermittent mntr (95706) $2,909.85
EEG w/o video by tech 2-12hr continuous r-t mntr (95707) $2,909.85
EKG (93005) $551.70
EKG rhythm strip (93041) $177.25
Elec alys implt brn npgt prgrmg 1st 15 min (95983) $327.55
Electroencephalogram Extend Monitoring 41-60 Min (95812) $2,909.85
EMG cranial nerve bilat (95868) $910.25
EMG cranial nerve unilat (95867) $854.40
EMG four extremities (95864) $586.65
EMG one extremity (95860) $373.50
EMG thoracic paraspinal (95869) $464.50
EMG three extremities (95863) $564.30
EMG two extremities (95861) $464.20
Endomyocardial biopsy (93505) $8,823.40
Ep & ablate supravent arrhyt (93653) $84,819.90
Ep & ablate ventric tachy (93654) $86,625
Ep Compre Electrophysiologic Arrhythmia Induction (93620) $23,280.60
Ep Compre Electrophysiologic W/O Arrhyt Induction (93619) $19,416.55
Ep Electrophysiologic F/U Study (93624) $36,612
Ep Ephys Eval Pacg Cvdfb Prgrmg/Reprgrmg Parameters (93642) $6,339.35
Ep Esophageal Recording Atria+Pacing (93616) $6,339.35
Ep Right Ventricular Recording (93603) $6,339.35
Er level 1 (99281) $807.15
Er level ii (99282) $1,815.10
Er level iii (99283) $4,774.75
Er level IV (99284) $5,609.85
Er level v (99285) $10,353.05
Esophageal recording (93615) $6,180.90
Eval&/Fitg Voice Prostc Dev Suplmnt Oral Speec (92597) $605.30
Evaluation of speech fluency (92521) $965.10
Evaluation of speech sound production (92522) $892.15
Evaluation of swallowing function (92610) $706.10
Evaluation with prescription of speech-generating alternative (92607) $1,105.40
Evoked Auditory Test,Comprehsv (92588) $821.70
Evoked auditory test,limited (92587) $807
Exhaled Air Analysis (94690) $985.75
External Ecg Scanning Analysis Report (93226) $2,313.80
Flexible Endoscopic Eval Swallow C/V Rec (92612) $599.30
Flexible ndsc eval swlng&laryn sens c/v rec (92616) $1,758.15
Flow volume loop (94375) $1,008.75
Gastroesophag reflx test w/telemtry ph eltrd (91035) $1,442.50
Group Therapeutic Procedures (97150) $173.20
Health Behavior Assessment/Re-Assessment (96156) $323.20
Health behavior ivntj fam w/pt f2f 1st 30 min (96167) $297.15
Health behavior ivntj indiv f2f 1st 30 min (96158) $299.80
Hemodialysis (90935) $7,317.15
Holter Monitor Recording (93225) $1,393.25
Hydrotherapy (97036) $278.30
Hypoxia Response Curve (94450) $807
Imaging of colon using capsule endoscope, with interpretation and report (91113) $2,394.65
Imm Admn Sarscov2 Vaccine Single Dose (90480) $59.64
Immuniz admin,intranasal/oral,1 vac/tox (90473) $21.17
Immunization Admin (90471) $130.50
Inhlj Brncl Challenge Tstg W/Histamine/Methachol (95070) $1,671.60
Ins swan ganz bedside (93503) $4,287.25
Interrogation of vad (93750) $287.37
Intra Atrial Recording (93602) $36,612
Intra-atrial pacing (93610) $36,612
Intraventricular pacing (93612) $36,612
Irrigaj Implntd Venous Access Drug Delivery Syst (96523) $325.75
IV infusion hydration each additional hour (96361) $243.80
IV infusion hydration initial 31 min-1 hour (96360) $664.60
IV infusion, therap/proph/diagnost,add infusion,1st hour (96367) $263.90
IV infusion, therap/proph/diagnost,initial,1st hour (96365) $666.80
IV infusion, therap/proph/diagnost,initial,ea add hour (96366) $443.05
IV push initial (96374) $595.85
Maintenance of spinal canal or brain drug infusion pump (95990) $1,150.15
Manual therapy 15 min (97140) $223.65
Massage 15 min (97124) $81.90
Maximum voluntary ventilation (94200) $340.25
Mechanical chest wall oscillation (94669) $840.25
Mechanical traction (97012) $127.05
Methacholine challenge (94070) $1,257
Motility study esophagus (91010) $2,310.25
Motion Fluor Eval Swlng Funcj C/V Rec (92611) $851.70
Multiple sleep latency test (95805) $4,958.15
Nasopharyngoscopy (92511) $658
Needle electromyography larynx (95865) $355.10
Needle EMG lmtd std musc 1 xtr/non-limb uni/bi (95870) $400.70
Needle EMG w/1 fiber electrode quan meas jitter (95872) $443.65
Neg press wnd tx </=50 sq cm (97607) $1,075
Neg press wound tx >50 cm (97608) $1,290
Negative Pressure Wound Therapy Dme </= 50 Sq Cm (97605) $624.40
Negative Pressure Wound Therapy Dme >50 Sq Cm (97606) $1,290
Nerve conduction studies 13/> studies (95913) $1,924.95
Nerve Conduction Studies 3-4 Studies (95908) $1,008.75
Nerve Conduction Studies 9-10 Studies (95911) $1,411.60
Nerve conduction studies; 1-2 studies (95907) $419.05
Nerve conduction studies; 11-12 studies (95912) $1,741.25
Nerve conduction studies; 5-6 studies (95909) $1,008.75
Nerve conduction studies; 7-8 studies (95910) $1,155
Neuromuscular junction test (95937) $421.40
Newborn resuscitation (99465) $2,033.70
Non-Invas Physiologic Std Extremity Art 2 Level (93922) $801.15
Non-Invasive Physiologic Study Extremity 3 Levls (93923) $1,196.15
Noninvasive Ear/Pulse Oximetry Overnight Monitor (94762) $1,902.80
Orthotics mgmt & traing initial enctr ea 15 mins (97760) $223.65
Oscillating Tracking Test (92545) $807
Osteopathic manipulative tx 1-2 body regions (98925) $77.85
Ot Community/Work Reintegration Trainj Ea 15 Min (97537) $281.15
Ot Contrast Bath Ea 15 Min (97034) $120.40
Ot eval high complex 60 min (97167) $470.40
Ot eval low complex 30 min (97165) $421.60
Ot eval mod complex 45 min (97166) $442.35
Ot Orthotics/Prosth Mgmt &/Trainj Sbsq Enctr 15 Min (97763) $218.15
Ot Prosthetic Training, Each 15 Min (97761) $344.45
Ot re-eval est plan care (97168) $358.35
Outpatient Cardiac Rehab W/Cont Ecg Monitoring (93798) $741.20
Outpatient cardiac rehab w/o cont ECG monitor (93797) $512.25
Paraffin bath (97018) $45.60
Pentamidine Aersl Inhalation Pneumocystis/Proph (94642) $689.75
Peripheral arterial disease rehab per session (93668) $356.15
Perq transcath closure pda (93582) $49,497.45
Phy/qhp op pulm rhb w/mntr (94626) $618.50
Phy/qhp op pulm rhb w/o mntr (94625) $651.05
Plethysmography (94726) $1,645
Polysom 6/>Yrs Sleep W/Cpap 4/> Addl Param Attnd (95811) $9,506.90
Prq balloon valvuloplasty aortic valve (92986) $15,683.05
Prq card revasc chronic 1vsl (92943) $41,207.04
Prq Card Stent W/Angio 1 Vsl (92928) $39,764.61
Prq Card Stent/Ath/Angio (92933) $51,477.35
Prq revasc byp graft 1 vsl (92937) $32,965.66
Prq trluml coronary angio/atherect one art/brnch (92924) $31,811.68
Prq trluml coronary angioplasty one art/branch (92920) $20,388
Pt Aquatic Therapy/Exercises (97113) $367.85
Pt Electric Current Therapy (97033) $191.95
Pt Electrical Stimulation (97032) $171.20
Pt eval high complex 45 min (97163) $444.70
Pt eval low complex 20 min (97161) $421.60
Pt Gait Training Therapy (97116) $179.15
Pt group caregiver training (97552) $73.25
Pt Infrared Therapy (97026) $58.65
Pt Neuromusc Reeducat,1+ Areas, Ea 15 Min (97112) $206.35
Pt Physical Performance Test (97750) $131.95
Pt Physical Therapy Evaluation Mod Complex 30 Mins (97162) $442.35
Pt re-evaluation (97164) $358.35
Pt Self-Care/Home Mgmt Training Each 15 Minutes (97535) $204.75
Pt Ultrasound Therapy (97035) $147.85
Pt Whirlpool Therapy (97022) $151.45
Pulm Funct Test Oscillometry (94728) $983.65
Pulm function test by gas (94727) $1,645
Pulmonary stress testing (94618) $886.95
Pure Tone Audiometry Air & Bone (92553) $673.65
Pure Tone Audiometry, Air (92552) $401.50
R & l hrt cath w/njx l ventriculog img s&i (93453) $10,656.05
R & L Hrt Cath Winjx Hrt Art& L Ventr Img (93460) $33,421.80
R hrt art/grft angio (93457) $8,524.85
R& L Hrt Cath W/Injec Hrt Art/Grft& L Vent I (93461) $8,524.85
Refill/maint, portable pump (96521) $960.75
Rem Interrog Scrms <30 D Phys/Qhp (93298) $117.50
Remote 30 Day Ecg Rev/Report - Cardiac Event Monitor (93270) $2,984.45
Right heart cath (93451) $11,324.30
Rmvl Devital Tiss N-Slctv Dbrdmt W/O Anes 1 Sess (97602) $628.50
Rt Chest Wall Manipulation,Subsequent (94668) $401.50
Select picture audiometry (92583) $198.75
Sensory Integration Ea 15 Min (97533) $289.80
Short-latency somatosens ep std lwr limbs (95926) $811.50
Short-Latency Somatosens Ep Std Trnk/Head (95927) $811.50
Short-latency somatosens ep std upr limbs (95925) $811.50
Sleep study unattended (95806) $1,462
Smoking cessation > 10 min (99407) $172.80
Somatosensory testing (95938) $1,783.55
Speech Audiometry Threshold (92555) $163.60
Speech Audiometry, Complete (92556) $293.30
Speech group therapy (92508) $194.35
Speech sound lang comprehen (92523) $1,207
Spirometry (94010) $646.75
Spontaneous Nystagmus Test (92541) $693.40
Standardized Cognitive Performance Testing (96125) $473.30
Stenger Test, Pure Tone (92565) $1,034.70
Stenger Test, Speech (92577) $1,393
Stress echo (93350) $3,348.20
Stress Tte Complete (93351) $3,118.77
Surfactant Admin Thru Tube (94610) $662.15
Temp transcutaneous pacing (92953) $2,357.25
Test for abnormal eye movement using a moving target with recording (92544) $693.40
Testing of autonomic (sympathetic) nervous system function (95923) $404.20
Testing of autonomic nervous system function heart rate (95921) $421.40
Ther ivntj cog funcj cntct 1st 15 minutes (97129) $177.65
Ther Ivntj Cog Funcj Cntct Ea Addl 15 Minutes (97130) $168.70
Ther Sp-Genratj Dev Prgrmg&Modificaj (92609) $930.25
Ther/Proph/Diag Inj Sc/Im (96372) $194.40
Therapeutic Activities (97530) $240.45
Therapeutic phlebotomy (99195) $664.05
Tilt Table Eval (93660) $5,776.45
Tobacco Use Cessation Intermediate 3-10 Minutes (99406) $118.20
Tone Decay Test (92563) $345.05
Transcran Doppler Intracran Art - Transcranial Doppler (93886) $3,134
Tstg Ans Funcj Vasomotor Adrenergic Innervaj (95922) $404.20
Tte W/Doppler Complete - Tte Complete W/ Contrast (93306) $7,300.05
Tx atrial fib pulm vein isol (93656) $101,492.45
Tx Speech Lang Voice Commj &/Auditory Proc Ind (92507) $837.85
Tx Swallowing Dysfunction&/Oral Funcj Feeding (92526) $834.10
Tx/Pro/Dx Inj New Drug Addon (96375) $256.75
Tympanometry (92567) $212.90
Unlisted Cardiovascular Service/Procedure (93799) $4,191.40
Unlisted noninvasive vascular diagnostic study (93998) $552.10
Unlisted pulmonary service/procedure (94799) $511.34
Vasc Duplex Extrem Venous,Bilat (93970) $3,438.70
Vasc Duplex Scan Extracranial,Limited (93882) $1,492.65
Vasc Non-Invasive Lower Extrem Art Stress/Rest, Complete,Bilateral (93924) $2,360.05
Vasopneumatic device (97016) $78.20
Veeg by tech 2-12 hours unmonitored (95711) $2,909.85
Veeg by tech 2-12 hr continuous r-t monitoring (95713) $4,958.15
Veeg by tech 2-12 hr intermittent monitoring (95712) $2,909.85
Veeg by tech ea incr 12-26 hr cont r-t mntr (95716) $9,506.90
Veeg by tech ea incr 12-26 hr intermittent mntr (95715) $4,958.15
Veeg Ea 12-26 Hr Unmntr (95714) $4,958.15
Ventilation assist & mgmt inpatient 1st day (94002) $5,550.90
Ventilation Assist & Mgmt Inpatient Ea Sbsq Da (94003) $4,711.90
Visual Evoked Potential Test (95930) $988.65
Visual reinforcement audiometry (vra) (92579) $930.25
Vital capacity total (94150) $502.85
Wada Activation Test Hemispheric Function W/Eeg (95958) $9,506.90
Wheelchair Mgmt Ea 15 Min (97542) $189.50
Xtrnl mobile cv telemetry w/technical support (93229) $2,100