Visits & medical services prices at Ivinson Memorial Hospital

Laramie, WY · every code in this section with a posted price and a Medicare benchmark.

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

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ProcedureCash priceGross charge× Medicare
Acoustic immitance testing (92570) $253 $253 1.9×
Aerosol inhalation pentamidine (94642) $389 $389 1.7×
Airway inhalation treatment (94640) $196 $196 0.9×
Analyze pacemaker system (93724) $1,164 $1,164 3.7×
Appl on-body injector for timed subq injection (96377) $159 $159 3.3×
Application of a modality to 1 or more areas; electrical stimulation (manual), each 15 minutes Other Outpatient (97032) $65 $65
Application of a modality to 1 or more areas; iontophoresis, each 15 minutes Other Outpatient (97033) $98 $98
Application of a modality to 1 or more areas; ultrasound, each 15 minutes Other Outpatient (97035) $95 $95
Application of ultraviolet light to skin (96900) $94 $94 2.5×
Assessment of aphasia (96105) $323 $323
Basic vestibular evaluation (92540) $516 $516 2.3×
Behavioral & qualit analysis voice and resonance (92524) $156 $156
Bipap initial day (94660) $487.50 $487.50 2.2×
Breathing capacity test (94010) $169 $169 0.8×
Bronchodilation responsiveness, spirometry as in 94010, pre- and post-bronchodilator administration (94060) $442 $442 1.2×
Caloric vestibular test w/rec bi bithermal (92537) $429 $429 3.3×
Cardiovascular stress test (93017) $814 $814 3.7×
Cardioversion elective external (92960) $1,572 $1,572 2.3×
Chemo anti-neopl sq/im (96401) $307 $307 4.2×
Chemo hormon antineopl sq/im (96402) $299 $299 4.1×
Chemo IV infus each addl seq (96417) $240 $240 3.3×
Chemo IV infusion addl hr (96415) $204 $204 2.8×
Chemo IV push addl drug (96411) $348 $348 4.7×
Chemother prolong infuse w/pump (96416) $735 $735 2.2×
Chemotherapy administration, intravenous infusion technique; up to 1 hour, single or initial substance/drug (96413) $568 $568 1.7×
Chemotherapy administration; intravenous, push technique, single or initial substance/drug (96409) $485 $485 1.4×
Chest physiotherapy initial (94667) $121 $121 0.9×
Color/duplex Doppler, complete (93975) $1,262 $1,262 5.2×
Color/duplex Doppler, limited (93976) $670 $670 6.3×
Community/work reintegration training (eg, shopping, transportation, money management, avocational activities and/or… (97537) $128 $128
Comprehensive hearing test (92557) $138 $138 1.0×
Conditioning play audiometry (92582) $303 $303 2.3×
Cont gluc mntr physician/qhp provided equipment (95250) $452 $452 3.3×
Continuous inhalation treatment with aerosol medication for acute airway obstruction; first hour (94644) $347 $347 2.6×
Cpr (92950) $875 $875 4.0×
Critical care ill/injured patient init 30-74 min (99291) $2,602 $2,602 3.1×
Debridement open wound 20 sq cm< (97597) $283 $283 1.4×
Duplex scan artl infl&ven o/f hemo compl bi std (93985) $1,003 $1,003 4.1×
Duplex scan artl infl&ven o/f hemo compl uni std (93986) $303 $303 2.8×
Duplex scan of aorta, inferior vena cava, iliac vasculature, or bypass grafts; complete study Age Under 21 (93978) $1,200 $1,200 4.9×
Duplex scan of aorta, inferior vena cava, iliac vasculature, or bypass grafts; unilateral or limited study Age Under 21 (93979) $876 $876 8.2×
Duplex scan of extracranial arteries; complete bilateral study Age Under 21 (93880) $561 $561 2.3×
Duplex scan of extremity veins including responses to compression and other maneuvers; complete bilateral study Age… (93970) $1,145 $1,145 4.7×
Duplex scan of extremity veins including responses to compression and other maneuvers; unilateral or limited study Age… (93971) $749 $749 7.0×
Duplex scan of lower extremity arteries or arterial bypass grafts; complete bilateral study Age Under 21 (93925) $982 $982 4.0×
Duplex scan of lower extremity arteries or arterial bypass grafts; unilateral or limited study Age Under 21 (93926) $565 $565 5.3×
Duplex scan of upper extremity arteries or arterial bypass grafts; complete bilateral study Age Under 21 (93930) $1,163 $1,163 4.8×
Duplex scan of upper extremity arteries or arterial bypass grafts; unilateral or limited study Age Under 21 (93931) $500 $500 4.7×
Dx aly prgrmg&verif aud oi sound processr 1st 60 (92622) $373 $373 2.8×
ECG monit/reprt up to 48 hrs (93226) $589 $589 9.8×
Echo transesophageal (93312) $1,881 $1,881 3.4×
EEG 41-60 minutes (95812) $1,430 $1,430 6.5×
EEG awake & asleep (95819) $1,130 $1,130 5.1×
EKG 12 lead tracing only (93005) $329 $329 5.5×
Elec alys implt cplx cn npgt prgrmg (95977) $353 $353 3.6×
Elec alys implt npgt phys/qhp w/o programming (95970) $245 $245 1.8×
Elec alys implt smpl cn npgt prgrmg (95976) $122 $122 3.2×
Emergency department visit high mdm (99285) $1,305 $1,305 2.1×
Emergency department visit low mdm (99283) $630 $630 2.3×
Emergency department visit may not req phys/qhp (99281) $177 $177 2.1×
Emergency department visit moderate mdm (99284) $1,027 $1,027 2.4×
Emergency department visit straightforward mdm (99282) $356 $356 2.3×
Eval of Oral and Pharyngeal Swallowing - Eval of Oral and Pharyngeal Swallowing Fx Chg (92610) $177 $177
Evaluate pt use of inhaler (94664) $233 $233 1.0×
Evaluation of speech fluency (92521) $182 $182
Evaluation of speech sound production articulate (92522) $149 $149
Evoked auditory test limited (92587) $110 $110 0.5×
External electrocardiographic recording up to 48 hours by continuous rhythm recording and storage; recording (includes… (93225) $647 $647 4.8×
Fluidotherapy (97022) $166 $166
Hemodialysis procedure w/ phys/qhp evaluation (90935) $465 $465 0.7×
Hot/cold pack (97010) $41 $41
Immunization administration (90471) $110 $110 1.5×
Injection,Therap/Proph/Diagnost, IV Push, Ea Add, New Drug (96375) $97 $97 2.0×
Injection,Therap/Proph/Diagnost, IV Push, Initial Drug (96374) $99 $99 0.5×
Interrog dev eval pm/ldls pm phys/qhp in person (93288) $138 $138 3.6×
Intra-atrial recording (93602) $8,048 $8,048 1.0×
Irrigaj implntd venous access drug delivery syst (96523) $131 $131 2.2×
IV infusion hydration each additional hour (96361) $147 $147 3.1×
IV infusion hydration initial 31 min-1 hour (96360) $490 $490 2.3×
IV infusion ther proph addl sequential to 1 hr (96367) $153 $153 2.1×
IV infusion therapy/prophylaxis /dx 1st to 1 hr (96365) $485 $485 2.2×
IV tx, each additional hour (96366) $144 $144 3.0×
Lwr xtr vasc stdy bilat (93924) $1,069 $1,069 4.8×
Manipulation chest wall, such as cupping, percussing, and vibration to facilitate lung function; subsequent (94668) $110 $110 0.8×
Mechanical chest wall oscillation lung function (94669) $191 $191 0.9×
Mechanical traction therapy (97012) $81 $81
Medical nutrition assmt&ivntj indiv each 15 mi (97802) $67 $67
Medical nutrition group (97804) $57 $57
Medical nutrition therapy; re-assessment and intervention, individual, face-to-face with the patient, each 15 minutes… (97803) $72 $72
Motion fluoroscopic evaluation of swallowing function by cine or video recording Other Outpatient (92611) $288 $288
Nasopharyngoscopy (92511) $360 $360 1.8×
Negative pressure wound therapy dme </= 50 sq cm (97605) $257 $257 1.3×
Negative pressure wound therapy dme >50 sq cm (97606) $317 $317 0.8×
Non-invasive physiologic study extremity 3 levels (93923) $439 $439 2.0×
Noninvasive ear/pulse oximetry overnight monitor (94762) $193 $193 1.5×
Occupational therapy eval high complex 60 mins (97167) $437 $437
Occupational therapy eval low complex 30 mins (97165) $263 $263
Occupational therapy eval mod complex 45 mins (97166) $351 $351
Oral function therapy (92526) $191 $191
Oral speech device eval (92597) $489 $489
Orthotic(s) management and training (including assessment and fitting when not otherwise reported), upper… (97760) $73 $73
Ot manual therapy ea 15 min (97140) $108 $108
Ot neuromuscular re-education (97112) $74 $74
Ot paraffin bath (97018) $77 $77
Ot re-evaluation (97168) $210 $210
OT Therapeutic Activities Charges (97530) $74 $74
Ot wheelchair management (97542) $69 $69
Outpatient cardiac rehab w/cont ECG monitoring (93798) $213 $213 1.6×
Outpatient cardiac rehab w/o cont ECG monitor (93797) $190 $190 1.4×
Phlebotomy therapeutic (99195) $258 $258 1.9×
Phy/qhp op pulm rhb w/mntr (94626) $86 $86 1.4×
Phy/qhp op pulm rhb w/o mntr (94625) $86 $86 1.4×
Physical therapy evaluation high complex 45 mins (97163) $427 $427
Physical therapy evaluation low complex 20 mins (97161) $256 $256
Physical therapy evaluation mod complex 30 mins (97162) $343 $343
Polysom 6/>yrs sleep w/cpap 4/> addl param attnd (95811) $5,093 $5,093 5.8×
Positional nystagmus test, minimum of 4 positions, with recording (92542) $279 $279 2.1×
Pr tympanometry and reflex threshold measurements (92550) $158 $158 0.7×
Pt gait training 15 min (97116) $75 $75
Pt physical performance test (97750) $132 $132
Pt re-evaluation (97164) $202 $202
Pulm funct tst plethysmograp (94726) $209 $209 0.5×
Pulmonary stress testing (94618) $148 $148 1.1×
Self-care/home management training (eg, activities of daily living (ADL) and compensatory training, meal preparation,… (97535) $74 $74
Sleep study unattended (95806) $713 $713 3.2×
Speech audiometry threshold (92555) $38 $38 0.6×
Speech sound lang comprehen (92523) $276 $276
Standardized cognitive performance testing (96125) $311 $311
Stress tte only (93350) $1,249 $1,249 2.2×
Surfactant administration (94610) $995 $995 4.4×
Test for ability to detect and repeat spoken words with speech recognition (92556) $54 $54 0.9×
Test for hearing various pitches using earphone (92552) $71 $71 0.5×
Test for hearing various pitches using earphone and device placed against the bone (92553) $138 $138 1.0×
Ther ivntj cog funcj cntct 1st 15 minutes (97129) $135 $135
Ther ivntj cog funcj cntct ea addl 15 minutes (97130) $110 $110
Therapeutic procedure, 1 or more areas, each 15 minutes; massage, including effleurage, petrissage and/or tapotement… (97124) $54 $54
Therapeutic prophylactic/dx injection subq/im (96372) $121 $121 1.6×
Tilt table evaluation (93660) $2,024 $2,024 5.3×
Tte congenital complete (93303) $1,914 $1,914 3.4×
Tte f-up or lmtd (93308) $625 $625 2.6×
Tte w/doppler complete (93306) $1,958 $1,958 3.5×
Tx of Speech/Lang/Voice/Comm/Auditory Chg (92507) $197 $197
Tympanometry (92567) $121 $121 3.2×
Upr/l xtremity art 2 levels (93922) $374 $374 2.8×
Ventilation ip/obs initial day (94002) $1,377 $1,377 2.2×
Ventilator subsequent day (94003) $1,092 $1,092 1.7×
Visual reinforcement audiometry (vra) (92579) $39 $39 0.2×
Vital capacity total (94150) $186 $186 1.4×
Wound(s) care non-selective (97602) $172 $172 0.8×