Visits & medical services prices at Intermountain Health Platte Valley Hospital

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

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

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ProcedureCash priceGross charge× Medicare
Actigraphy testing, recording, analysis, interpretation, and report (minimum of 72 hours to 14 consecutive days of… (95803) $178.50
Administration of chemotherapy into artery using push technique (96420) $1,139.20
Administration of chemotherapy into fluid-filled space between the tissue that cover the brain and spinal cord (96450) $1,385.15
Aep hearing status deter broadband stimuli i&r (92651) $971.55
Aep neurodiagnostic interpretation and report (92653) $971.55
Aep threshold estimation mlt frequencies i&r (92652) $971.55
Airway inhalation treatment (94640) $711.25
Analyze pacemaker system (93724) $928.05
Appl on-body injector for timed subq injection (96377) $117.10
Application of a modality to 1 or more areas; contrast baths, each 15 minutes Other Outpatient (97034) $71.80
Application of a modality to 1 or more areas; electrical stimulation (manual), each 15 minutes Other Outpatient (97032) $101.90
Application of a modality to 1 or more areas; iontophoresis, each 15 minutes Other Outpatient (97033) $114.10
Application of a modality to 1 or more areas; ultrasound, each 15 minutes Other Outpatient (97035) $87.95
Application of a modality to 1 or more areas; vasopneumatic devices Other Outpatient (97016) $54.10
Assessment of aphasia (96105) $545.50
Behavioral & qualit analysis voice and resonance (92524) $510.60
Bfb training ea addl 15 min (90913) $48.90
Biofeedback training by any modality Other Outpatient (90901) $134.85
Biofeedback training, perineal muscles, anorectal or urethral sphincter, including EMG and/or manometry, when… (90912) $155.60
Biopsy of heart lining (93505) $8,739.40
Bipap initial day (94660) $656.92
Breath hydrogen/methane test (91065) $765
Breathing capacity test (94010) $498.10
Bronchial allergy tests (95070) $1,655.70
Bronchodilation responsiveness, spirometry as in 94010, pre- and post-bronchodilator administration (94060) $1,217.45
Bundle of his recording (93600) $36,263.35
Canalith repositioning (95992) $227.75
Car seat/bed test inft thru 12 mo 60 min (94780) $172.35
Cardiovascular procedure unlisted (93799) $7,361.88
Cardiovascular stress test (93017) $2,966.25
Cardioversion elective external (92960) $6,907.85
Catheter placement in coronary artery(s) for coronary angiography, including intraprocedural injection(s) for coronary… (93460) $33,103.50
Catheter placement in coronary artery(s) for coronary angiography, including intraprocedural injection(s) for coronary… (93459) $32,303.95
Catheter placement in coronary artery(s) for coronary angiography, including intraprocedural injection(s) for coronary… (93458) $27,742.95
Chemo anti-neopl sq/im (96401) $362.60
Chemo hormon antineopl sq/im (96402) $240.70
Chemo IV infus each addl seq (96417) $272
Chemo IV infusion addl hr (96415) $317.05
Chemo IV push addl drug (96411) $240.70
Chemother prolong infuse w/pump (96416) $1,346.90
Chemotherapy administration into pleural cavity, requiring and including thoracentesis (96440) $1,164.70
Chemotherapy administration into the peritoneal cavity via implanted port or catheter (96446) $1,566.25
Chemotherapy administration, intravenous infusion technique; up to 1 hour, single or initial substance/drug (96413) $1,296.20
Chemotherapy administration; intravenous, push technique, single or initial substance/drug (96409) $707.50
Chest physiotherapy initial (94667) $397.65
Color/duplex Doppler, complete (93975) $960.35
Color/duplex Doppler, limited (93976) $910.05
Compre electrophysiologic w/o arrhyt induction (93619) $19,231.60
Compre ep eval abltj atr fib pulm vein isolation (93656) $100,525.85
Comprehensive electrophysiologic evaluation including insertion and repositioning of multiple electrode catheters with… (93620) $23,058.90
Comprehensive electrophysiologic evaluation with insertion and repositioning of multiple electrode catheters, induction… (93653) $84,012.05
Comprehensive electrophysiologic evaluation with insertion and repositioning of multiple electrode catheters, induction… (93654) $85,800
Continuous inhalation treatment with aerosol medication for acute airway obstruction; first hour (94644) $1,143.10
Coronary art/grft angio s&i (93455) $25,064.55
Coronary artery angio s&i (93454) $17,654.85
Cpr (92950) $2,868.25
Critical care ill/injured patient init 30-74 min (99291) $16,756.90
Ctr motr ep std transcrnl motr stim upr&low limb (95939) $3,333.50
Debridement open wound 20 sq cm< (97597) $1,087.40
Developmental tst admin phys/qhp 1st hour (96112) $1,058.55
Dialysis one evaluation (90945) $1,306.95
Duplex hemodialysis access (93990) $920.15
Duplex scan of aorta, inferior vena cava, iliac vasculature, or bypass grafts; complete study Age Under 21 (93978) $1,389
Duplex scan of extracranial arteries; complete bilateral study Age Under 21 (93880) $1,654.25
Duplex scan of extracranial arteries; unilateral or limited study Age Under 21 (93882) $1,468.05
Duplex scan of extremity veins including responses to compression and other maneuvers; complete bilateral study Age… (93970) $3,405.95
Duplex scan of extremity veins including responses to compression and other maneuvers; unilateral or limited study Age… (93971) $1,587.70
Duplex scan of lower extremity arteries or arterial bypass grafts; complete bilateral study Age Under 21 (93925) $2,335.25
Duplex scan of lower extremity arteries or arterial bypass grafts; unilateral or limited study Age Under 21 (93926) $945.90
Duplex scan of upper extremity arteries or arterial bypass grafts; complete bilateral study Age Under 21 (93930) $3,150.25
Duplex scan of upper extremity arteries or arterial bypass grafts; unilateral or limited study Age Under 21 (93931) $1,348.75
ECG/monitoring and analysis (93271) $2,956
Echo transesophageal (93312) $6,751.66
Echocardiography, transesophageal, real-time with image documentation (2D) (with or without M-mode recording);… (93313) $1,723.15
EEG 41-60 minutes (95812) $2,909.85
EEG awake & asleep (95819) $2,909.85
EEG awake/drowsy (95816) $2,909.85
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 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 2-12 hr unmonitored (95705) $2,909.85
EEG w/o video by tech 2-12hr continuous r-t mntr (95707) $2,909.85
EKG 12 lead tracing only (93005) $546.45
Elec alys implt npgt phys/qhp w/o programming (95970) $379.75
Elec alys implt npgt smpl sp/pn npgt prgrmg (95971) $287.75
Electrode stimulation brain (95961) $9,506.90
Electrophysiologic evaluation of single or dual chamber transvenous pacing cardioverter-defibrillator (includes… (93642) $3,188.15
Electrophysiologic follow-up study with pacing and recording to test effectiveness of therapy, including induction or… (93624) $36,263.35
Emergency department visit high mdm (99285) $9,741.75
Emergency department visit low mdm (99283) $3,683.25
Emergency department visit may not req phys/qhp (99281) $761.35
Emergency department visit moderate mdm (99284) $5,556.40
Emergency department visit straightforward mdm (99282) $1,728.30
End tidal co2 mntrng (crbn dxde exp gas dtrmntn by infrared analyzer) (94799) $508.86
Endoscopy swallow (fees) vid (92612) $593.60
Ergonovine provocation test (93024) $1,077.60
Esophageal recording (93615) $3,188.15
Esophageal recording of atrial electrogram with or without ventricular electrogram(s); with pacing without Cardiac Cath (93616) $3,440.80
Eval of Oral and Pharyngeal Swallowing - Eval of Oral and Pharyngeal Swallowing Fx Chg (92610) $501.70
Evaluate pt use of inhaler (94664) $577.60
Evaluation for prescription for speech-generating augmentative and alternative communication device, face-to-face with… (92608) $262.45
Evaluation for prescription for speech-generating augmentative and alternative communication device, face-to-face with… (92607) $658.65
Evaluation of speech fluency (92521) $572.45
Evaluation of speech sound production articulate (92522) $530.90
External ECG rec>48hr<7d recording (93242) $1,532.80
External ECG rec>7d<15d recording (93246) $1,534.95
External electrocardiographic recording up to 48 hours by continuous rhythm recording and storage; recording (includes… (93225) $1,618.05
External mobile cardiovascular telemetry with electrocardiographic recording, concurrent computerized real time data… (93229) $2,080
Fluidotherapy (97022) $85.30
Gastroesophag reflx test w/cath ph eltrd plcmt (91034) $1,379.75
Gastrointestinal tract imaging, intraluminal (eg, capsule endoscopy), colon, with interpretation and report Age Under 21 (91113) $2,371.85
Gastrointestinal tract imaging, intraluminal (eg, capsule endoscopy), esophagus through ileum, with interpretation and… (91110) $3,072.55
Hemodialysis procedure w/ phys/qhp evaluation (90935) $2,249.45
Hot/cold pack (97010) $26
Im adm intransl/oral 1 vaccine (90473) $21.17
Imm admn sarscov2 vaccine single dose (90480) $59.16
Immunization administration (90471) $129.25
Induction of arrhythmia by electrical pacing without Cardiac Cath (93618) $3,649.60
Infrared therapy (97026) $34.85
Injection,Therap/Proph/Diagnost, IV Push, Ea Add, New Drug (96375) $188.50
Injection,Therap/Proph/Diagnost, IV Push, Initial Drug (96374) $590.20
Insertion and placement of flow directed catheter (eg, Swan-Ganz) for monitoring purposes with Cardiac Cath (93503) $4,246.40
Interrog dev eval pm/ldls pm phys/qhp in person (93288) $199
Interrogation device evaluation (in person) with analysis, review and report by a physician or other qualified health… (93291) $103.85
Interrogation device evaluation (in person) with analysis, review and report by a physician or other qualified health… (93261) $3,346.75
Interrogation vad in prson w/phys/qhp analysis (93750) $284.85
Intra-atrial pacing (93610) $36,263.35
Intra-atrial recording (93602) $36,263.35
Intracardiac catheter ablation of atrioventricular node function, atrioventricular conduction for creation of complete… (93650) $36,263.35
Intraventricular pacing (93612) $36,263.35
Irrigaj implntd venous access drug delivery syst (96523) $267.30
IV infusion hydration each additional hour (96361) $241.45
IV infusion hydration initial 31 min-1 hour (96360) $658.25
IV infusion ther proph addl sequential to 1 hr (96367) $236.95
IV infusion therapy/prophylaxis /dx 1st to 1 hr (96365) $633
IV tx, each additional hour (96366) $237.70
Lwr xtr vasc stdy bilat (93924) $2,337.60
Manipulation chest wall, such as cupping, percussing, and vibration to facilitate lung function; subsequent (94668) $314.80
Measurement of brain wave activity (EEG) to evaluate brain death (95824) $4,958.15
Mechanical chest wall oscillation lung function (94669) $812.35
Mechanical traction therapy (97012) $97
Medical nutrition assmt&ivntj indiv each 15 mi (97802) $120.10
Medical nutrition group (97804) $106.15
Medical nutrition therapy; re-assessment and intervention, individual, face-to-face with the patient, each 15 minutes… (97803) $112.75
Motion fluoroscopic evaluation of swallowing function by cine or video recording Other Outpatient (92611) $574.20
Multiple sleep latency (95805) $4,958.15
Nasopharyngoscopy (92511) $650.70
Needle electromyography 2 extremities with or without related paraspinal areas 95861 (95861) $574.75
Needle electromyography; 1 extremity with or without related paraspinal areas (95860) $462.45
Needle EMG lmtd std musc 1 xtr/non-limb uni/bi (95870) $496.10
Needle measurement of electrical activity in muscles on both sides of body (95868) $847.25
Neg pressure wound therapy non dme </= 50 sq cm (97607) $1,064.75
Neg pressure wound therapy non dme >50 sq cm (97608) $1,277.70
Negative pressure wound therapy dme </= 50 sq cm (97605) $700.40
Negative pressure wound therapy dme >50 sq cm (97606) $1,277.70
Non-invasive physiologic study extremity 3 levels (93923) $1,184.80
Noninvasive ear/pulse oximetry overnight monitor (94762) $853.95
Occupational therapy eval high complex 60 mins (97167) $465.90
Occupational therapy eval low complex 30 mins (97165) $417.55
Occupational therapy eval mod complex 45 mins (97166) $438.15
Oral function therapy (92526) $496.40
Oral speech device eval (92597) $392.90
Orthc/prostc mgmt sbsq enc (97763) $166.55
Orthotic(s) management and training (including assessment and fitting when not otherwise reported), upper… (97760) $221.50
Osteopath manj 1-2 regions (98925) $77.15
Ot manual therapy ea 15 min (97140) $219.40
Ot neuromuscular re-education (97112) $170.65
Ot paraffin bath (97018) $45.20
Ot re-evaluation (97168) $354.95
OT Therapeutic Activities Charges (97530) $164.30
Ot wheelchair management (97542) $187.70
Outpatient cardiac rehab w/cont ECG monitoring (93798) $649.05
Outpatient cardiac rehab w/o cont ECG monitor (93797) $411.25
Perq transcath closure pda (93582) $49,026.05
Phlebotomy therapeutic (99195) $462.55
Physical therapy evaluation high complex 45 mins (97163) $440.45
Physical therapy evaluation low complex 20 mins (97161) $417.55
Physical therapy evaluation mod complex 30 mins (97162) $438.15
Pm device progr eval multi (93281) $894.90
Polysom 6/>yrs sleep w/cpap 4/> addl param attnd (95811) $9,506.90
Polysomnography; any age, sleep staging with 1-3 additional parameters of sleep, attended by a technologist (95808) $9,506.90
Program eval implantable in persn dual ld pacer (93280) $801.60
Programming device evaluation (in person) with iterative adjustment of the implantable device to test the function of… (93260) $146.60
Programming device evaluation (in person) with iterative adjustment of the implantable device to test the function of… (93284) $834.60
Programming device evaluation (in person) with iterative adjustment of the implantable device to test the function of… (93283) $787.60
Prosthetic(s) training, upper and/or lower extremity(ies), initial prosthetic(s) encounter, each 15 minutes Other… (97761) $213.40
Prq trluml coronary angio/atherect one art/brnch (92924) $31,508.72
Prq trluml coronary angioplasty one art/branch (92920) $20,193.84
Prq trluml coronary byp grft revasc one vessel (92937) $31,508.72
Prq trluml coronary stent w/angio one art/brnch (92928) $39,385.89
Prq trluml coronry chronic occlus revasc one vsl (92943) $36,161.66
Prq trluml coronry stent/ath/angio one art/brnch (92933) $50,987.09
Pt gait training 15 min (97116) $116.70
Pt physical performance test (97750) $78.65
Pt re-evaluation (97164) $354.95
Pt Work Hardening/conditioningwork Reconditioning Initial Charge (97545) $1,347
Pulm funct tst plethysmograp (94726) $1,565.85
Pulmonary stress testing (94618) $878.50
R hrt art/grft angio (93457) $9,445.35
R hrt coronary artery angio (93456) $26,742.05
R&l hrt art/ventricle angio (93461) $9,445.35
R&l hrt cath w/ventriclgrphy (93453) $9,445.35
Refill/maint pump/resvr syst (96522) $711.05
Refilling and maintenance of portable pump (96521) $707.50
Rem interrog scrms <30 d phys/qhp (93298) $116.40
Remote 30 day ECG rev/report (93270) $2,956
Respiratory flow volume loop (94375) $999.15
Right heart cath o2 saturation & cardiac output (93451) $10,862.15
Right ventricular recording (93603) $3,649.60
Self-care/home management training (eg, activities of daily living (ADL) and compensatory training, meal preparation,… (97535) $175.75
Sensory integrative techniques to enhance sensory processing and promote adaptive responses to environmental demands,… (97533) $216.10
Short-latency somatosensory evoked potential study, stimulation of any/all peripheral nerves or skin sites, recording… (95938) $1,724.65
Sleep study unattended (95806) $1,462
Sleep study, unattended, simultaneous recording; heart rate, oxygen saturation, respiratory analysis (eg, by airflow or… (95800) $1,462
Sleep study, unattended, simultaneous recording; minimum of heart rate, oxygen saturation, and respiratory analysis… (95801) $555.05
Speech sound lang comprehen (92523) $1,144.20
Standardized cognitive performance testing (96125) $529.20
Stress tte only (93350) $3,243.50
Surfactant administration (94610) $655.85
Temp transcutaneous pacing (92953) $1,678.60
Testing of autonomic nervous system function; cardiovagal innervation (parasympathetic function), including 2 or more… (95921) $417.40
Ther ivntj cog funcj cntct 1st 15 minutes (97129) $126.90
Ther ivntj cog funcj cntct ea addl 15 minutes (97130) $114.55
Ther/proph/diag inj ia (96373) $589.55
Therapeutic procedure(s), group (2 or more individuals) Other Outpatient (97150) $120.40
Therapeutic procedure, 1 or more areas, each 15 minutes; aquatic therapy with therapeutic exercises Other Outpatient (97113) $247.30
Therapeutic procedure, 1 or more areas, each 15 minutes; massage, including effleurage, petrissage and/or tapotement… (97124) $81.10
Therapeutic prophylactic/dx injection subq/im (96372) $192.55
Therapeutic services for the use of speech-generating device, including programming and modification Other Outpatient (92609) $549.85
Tilt table evaluation (93660) $7,268.60
Tobacco use cessation intermediate 3-10 minutes (99406) $117.10
Transcath closure of asd (93580) $61,282.55
Transthoracic echocardiography for congenital cardiac anomalies; follow-up or limited study Age Under 21 (93304) $2,870.70
Tte congenital complete (93303) $3,044.44
Tte f-up or lmtd (93308) $2,728.15
Tte w/doppler complete (93306) $7,230.55
Tx of Speech/Lang/Voice/Comm/Auditory Chg (92507) $564.05
Unlisted modality (specify type and time if constant attendance) (97039) $111.80
Upr/l xtremity art 2 levels (93922) $793.55
Valvuloplasty aortic valve (92986) $15,533.70
Valvuloplasty mitral valve (92987) $31,395.85
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 by tech ea incr 12-26 hr unmonitored (95714) $4,958.15
Ventilation ip/obs initial day (94002) $1,906.70
Ventilator subsequent day (94003) $1,906.70
Vital capacity total (94150) $498.10
Wada activation test (95958) $9,506.90
Work hardening/conditioning; each additional hour (List separately in addition to code for primary procedure) (97546) $671.85
Wound(s) care non-selective (97602) $664.70