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.

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

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ProcedureCash priceGross charge× Medicare
Ablation av node (93650) $36,263.35
Actigraphy testing recording analysis i&r (95803) $178.50
Aep hearing status deter broadband stimuli i&r (92651) $971.55
Aep Neurodiagnostic I&R (92653) $971.55
Aep threshold estimation mlt frequencies i&r (92652) $971.55
Airway inhalation treatment (94640) $711.25
Analyze neurostim no prog (95970) $379.75
Appl on-body injector for timed subq injection (96377) $117.10
Arrhythmia induction (93618) $3,649.60
Assessment of aphasia (96105) $545.50
Behavioral and qualitative analysis of voice and resonance (92524) $510.60
Bfb training 1st 15 min (90912) $155.60
Bfb training ea addl 15 min (90913) $48.90
Biofeedback training any modality (90901) $134.85
Breath Hydrogen/Methane Test (91065) $765
Brncdilat rspse spmtry pre&post-brncdilat admn (94060) $1,217.45
Bundle of his recording (93600) $36,263.35
C motor evoked upr&lwr limbs (95939) $3,333.50
Canalith Repositioning (95992) $227.75
Capsule endoscopy (91110) $3,072.55
Car seat/bed test 60 min (94780) $172.35
Cardiac Stress Tst,Tracing Only (93017) $2,966.25
Cardiopulmonary resuscitation (92950) $2,868.25
Cardioversion (92960) $6,907.85
Cath Cath Place/Coronary Angio, Img Super/Interp, Bypass Angio (93455) $25,064.55
Cath Cath Place/Coronary Angio, Img Super/Interp,W Right Heart Cath (93456) $26,742.05
Cath Perc Clos,Cong Interatrial Commun W/Impl (93580) $61,282.55
Cath Place/Coron Angio, Img Super/Interp, Bypass Angio,W L Hrt Ventric (93459) $32,303.95
Cath Place/Coron Angio, Img Super/Interp,W Left Heart Ventriculography (93458) $27,742.95
Cbt 1st hour (94644) $1,143.10
Chemo Admin Peritoneal Cavity (96446) $1,566.25
Chemo Hormon Antineopl Sq/Im (96402) $240.70
Chemo IV push addl drug (96411) $240.70
Chemo Iv Push Sngl Drug (96409) $707.50
Chemo prolong 8+ hrs infuse w/pump (96416) $1,346.90
Chemother, IV infusion, 1 hr (96413) $1,296.20
Chemother, IV infusion, ea add hr (96415) $317.05
Chemother,Ia Push Technique (96420) $1,139.20
Chemother,Non-Hormone Anti-Neopl, Sub-Q/Im (96401) $362.60
Chemotx Admn Cns Req Spinal Puncture (96450) $1,385.15
Chemotx admn IV nfs tq ea seql nfs to 1 hr (96417) $272
Chemotx Admn Pleural Cavity Req&W/Thoracnts (96440) $1,164.70
Color/duplex Doppler, complete (93975) $960.35
Color/duplex Doppler, limited (93976) $910.05
Coronary artery angio s&i (93454) $17,654.85
Cortical mapping 1st hr (95961) $9,506.90
Cpap initiation and management (94660) $656.92
Cpt initial (94667) $397.65
Critical care (99291) $16,756.90
Debridement Open Wound 20 Sq Cm< (97597) $1,087.40
Demo &/or eval,pt use,aerosol device (94664) $577.60
Developmental tst admin phys/qhp 1st hour (96112) $1,058.55
Dialysis other/than hemodialysis 1 phys/qhp eval (90945) $1,306.95
Dup-Scan Aorta Ivc Iliac Vascl/Bpgs Complete (93978) $1,389
Dup-Scan Lxtr Art/Artl Bpgs Compl Bi Study (93925) $2,335.25
Dup-scan lxtr art/artl bpgs uni/lmtd study (93926) $945.90
Dup-Scan Uxtr Art/Artl Bpgs Compl Bi Study (93930) $3,150.25
Dup-Scan Uxtr Art/Artl Bpgs Uni/Lmtd Study (93931) $1,348.75
Dup-scan xtr veins unilateral/limited study (93971) $1,587.70
Duplex hemodialysis access (93990) $920.15
Duplex scan extracranial art compl bi study (93880) $1,654.25
Echo Heart Xthoracic,Limited (93308) $2,728.15
Echo r-t 2d w/probe placement only (93313) $1,723.15
Echo transesophageal (93312) $6,751.66
Echo Transthoracic - Congenital Tte Complete (93303) $3,044.44
Echo Transthoracic - Congenital Tte Limited (93304) $2,870.70
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) $546.45
Elec alys nstim pls gen smpl sc/perph w/prgrmg (95971) $287.75
Electroencephalogram Extend Monitoring 41-60 Min (95812) $2,909.85
EMG cranial nerve bilat (95868) $847.25
EMG one extremity (95860) $462.45
EMG two extremities (95861) $574.75
Endomyocardial biopsy (93505) $8,739.40
Ep & ablate supravent arrhyt (93653) $84,012.05
Ep & ablate ventric tachy (93654) $85,800
Ep Analyze Pacer Sys (93724) $928.05
Ep Compre Electrophysiologic Arrhythmia Induction (93620) $23,058.90
Ep Compre Electrophysiologic W/O Arrhyt Induction (93619) $19,231.60
Ep Electrophysiologic F/U Study (93624) $36,263.35
Ep Ephys Eval Pacg Cvdfb Prgrmg/Reprgrmg Parameters (93642) $3,188.15
Ep Esophageal Recording Atria+Pacing (93616) $3,440.80
Ep Right Ventricular Recording (93603) $3,649.60
Er level 1 (99281) $761.35
Er level ii (99282) $1,728.30
Er level iii (99283) $3,683.25
Er level IV (99284) $5,556.40
Er level v (99285) $9,741.75
Ergonovine provocation test (93024) $1,077.60
Esophageal recording (93615) $3,188.15
Eval&/Fitg Voice Prostc Dev Suplmnt Oral Speec (92597) $392.90
Evaluation of speech fluency (92521) $572.45
Evaluation of speech sound production (92522) $530.90
Evaluation of swallowing function (92610) $501.70
Evaluation with prescription of speech-generating alternative (92607) $658.65
External ECG rec>48hr<7d recording (93242) $1,532.80
External ECG rec>7d<15d recording (93246) $1,534.95
Flexible Endoscopic Eval Swallow C/V Rec (92612) $593.60
Flow volume loop (94375) $999.15
Gastroesophag Reflx Test W/Cath Ph Eltrd Plcmt (91034) $1,379.75
Group Therapeutic Procedures (97150) $120.40
Hemodialysis (90935) $2,249.45
Holter Monitor Recording (93225) $1,618.05
Imaging of colon using capsule endoscope, with interpretation and report (91113) $2,371.85
Imm Admn Sarscov2 Vaccine Single Dose (90480) $59.16
Immuniz admin,intranasal/oral,1 vac/tox (90473) $21.17
Immunization Admin (90471) $129.25
Inhlj Brncl Challenge Tstg W/Histamine/Methachol (95070) $1,655.70
Injection intra arterial (96373) $589.55
Ins swan ganz bedside (93503) $4,246.40
Interrog dev eval scrms phys/qhp in person (93291) $103.85
Interrogate subq defib (93261) $3,346.75
Interrogation of vad (93750) $284.85
Intra Atrial Recording (93602) $36,263.35
Intra-atrial pacing (93610) $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, therap/proph/diagnost,add infusion,1st hour (96367) $236.95
IV infusion, therap/proph/diagnost,initial,1st hour (96365) $633
IV infusion, therap/proph/diagnost,initial,ea add hour (96366) $237.70
IV push initial (96374) $590.20
Manual therapy 15 min (97140) $219.40
Massage 15 min (97124) $81.10
Mechanical chest wall oscillation (94669) $812.35
Mechanical traction (97012) $97
Med Nutr Ther, Subsq, Indiv, Ea 15 Min (97803) $112.75
Medical nutrition assmt&ivntj indiv each 15 mi (97802) $120.10
Mnt Group Ea 30 Min (97804) $106.15
Motion Fluor Eval Swlng Funcj C/V Rec (92611) $574.20
Multiple sleep latency test (95805) $4,958.15
Nasopharyngoscopy (92511) $650.70
Needle EMG lmtd std musc 1 xtr/non-limb uni/bi (95870) $496.10
Neg press wnd tx </=50 sq cm (97607) $1,064.75
Neg press wound tx >50 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-Invas Physiologic Std Extremity Art 2 Level (93922) $793.55
Non-Invasive Physiologic Study Extremity 3 Levls (93923) $1,184.80
Noninvasive Ear/Pulse Oximetry Overnight Monitor (94762) $853.95
Orthotics mgmt & traing initial enctr ea 15 mins (97760) $221.50
Osteopathic manipulative tx 1-2 body regions (98925) $77.15
Ot Contrast Bath Ea 15 Min (97034) $71.80
Ot eval high complex 60 min (97167) $465.90
Ot eval low complex 30 min (97165) $417.55
Ot eval mod complex 45 min (97166) $438.15
Ot Orthotics/Prosth Mgmt &/Trainj Sbsq Enctr 15 Min (97763) $166.55
Ot Prosthetic Training, Each 15 Min (97761) $213.40
Ot re-eval est plan care (97168) $354.95
Outpatient Cardiac Rehab W/Cont Ecg Monitoring (93798) $649.05
Outpatient cardiac rehab w/o cont ECG monitor (93797) $411.25
Paraffin bath (97018) $45.20
Perq transcath closure pda (93582) $49,026.05
Plethysmography (94726) $1,565.85
Pm device eval in person (93288) $199
Pm device progr eval dual (93280) $801.60
Pm device progr eval multi (93281) $894.90
Polysom 6/>Yrs Sleep W/Cpap 4/> Addl Param Attnd (95811) $9,506.90
Polysom Any Age Sleep Stage 1-3 Addl Param Attnd (95808) $9,506.90
Prgrmg Dev Eval Implantable Subq Lead Dfb System (93260) $146.60
Prgrmg Eval Implantable Dfb - Cardiac Device Clinic Icd Biv Chamber (93284) $834.60
Programming of dual lead implantable defibrillator system (93283) $787.60
Prq balloon valvuloplasty aortic valve (92986) $15,533.70
Prq Balloon Valvuloplasty Mitral Valve (92987) $31,395.85
Prq card revasc chronic 1vsl (92943) $36,161.66
Prq Card Stent W/Angio 1 Vsl (92928) $39,385.89
Prq Card Stent/Ath/Angio (92933) $50,987.09
Prq revasc byp graft 1 vsl (92937) $31,508.72
Prq trluml coronary angio/atherect one art/brnch (92924) $31,508.72
Prq trluml coronary angioplasty one art/branch (92920) $20,193.84
Pt Aquatic Therapy/Exercises (97113) $247.30
Pt Electric Current Therapy (97033) $114.10
Pt Electrical Stimulation (97032) $101.90
Pt eval high complex 45 min (97163) $440.45
Pt eval low complex 20 min (97161) $417.55
Pt Gait Training Therapy (97116) $116.70
Pt Infrared Therapy (97026) $34.85
Pt Neuromusc Reeducat,1+ Areas, Ea 15 Min (97112) $170.65
Pt Physical Performance Test (97750) $78.65
Pt Physical Therapy Evaluation Mod Complex 30 Mins (97162) $438.15
Pt re-evaluation (97164) $354.95
Pt Self-Care/Home Mgmt Training Each 15 Minutes (97535) $175.75
Pt Ultrasound Therapy (97035) $87.95
Pt Whirlpool Therapy (97022) $85.30
Pulmonary stress testing (94618) $878.50
R & l hrt cath w/njx l ventriculog img s&i (93453) $9,445.35
R & L Hrt Cath Winjx Hrt Art& L Ventr Img (93460) $33,103.50
R hrt art/grft angio (93457) $9,445.35
R& L Hrt Cath W/Injec Hrt Art/Grft& L Vent I (93461) $9,445.35
Refill/Maint Pump/Resvr Syst (96522) $711.05
Refill/maint, portable pump (96521) $707.50
Rem Interrog Scrms <30 D Phys/Qhp (93298) $116.40
Remote 30 Day Ecg Rev/Report - Cardiac Event Monitor (93270) $2,956
Right heart cath (93451) $10,862.15
Rmvl Devital Tiss N-Slctv Dbrdmt W/O Anes 1 Sess (97602) $664.70
Rt Chest Wall Manipulation,Subsequent (94668) $314.80
Rx Sp-Genratj Augmnt&Comunicaj Dev Ea 30 Min (92608) $262.45
Sensory Integration Ea 15 Min (97533) $216.10
Sleep study unattended (95806) $1,462
Slp Stdy Unatnd W/Hrt Rate/O2 Sat/Resp/Slp Time (95800) $1,462
Slp stdy unatnd w/min hrt rate/o2 sat/resp anal (95801) $555.05
Somatosensory testing (95938) $1,724.65
Speech sound lang comprehen (92523) $1,144.20
Spirometry (94010) $498.10
Standardized Cognitive Performance Testing (96125) $529.20
Stress echo (93350) $3,243.50
Surfactant Admin Thru Tube (94610) $655.85
Temp transcutaneous pacing (92953) $1,678.60
Testing of autonomic nervous system function heart rate (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 Sp-Genratj Dev Prgrmg&Modificaj (92609) $549.85
Ther/Proph/Diag Inj Sc/Im (96372) $192.55
Therapeutic Activities (97530) $164.30
Therapeutic phlebotomy (99195) $462.55
Tilt Table Eval (93660) $7,268.60
Tobacco Use Cessation Intermediate 3-10 Minutes (99406) $117.10
Tte W/Doppler Complete - Tte Complete W/ Contrast (93306) $7,230.55
Tx atrial fib pulm vein isol (93656) $100,525.85
Tx Speech Lang Voice Commj &/Auditory Proc Ind (92507) $564.05
Tx Swallowing Dysfunction&/Oral Funcj Feeding (92526) $496.40
Tx/Pro/Dx Inj New Drug Addon (96375) $188.50
Unlisted Cardiovascular Service/Procedure (93799) $7,361.88
Unlisted pulmonary service/procedure (94799) $508.86
Vasc Duplex Extrem Venous,Bilat (93970) $3,405.95
Vasc Duplex Scan Extracranial,Limited (93882) $1,468.05
Vasc Non-Invasive Lower Extrem Art Stress/Rest, Complete,Bilateral (93924) $2,337.60
Vasopneumatic device (97016) $54.10
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) $1,906.70
Ventilation Assist & Mgmt Inpatient Ea Sbsq Da (94003) $1,906.70
Vital capacity total (94150) $498.10
Wada Activation Test Hemispheric Function W/Eeg (95958) $9,506.90
Wheelchair Mgmt Ea 15 Min (97542) $187.70
Xtrnl mobile cv telemetry w/technical support (93229) $2,080
Xtrnl Pt Activated Ecg Rec Dwnld 30 Days (93271) $2,956