Visits & medical services prices at Keefe Memorial Hospital

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

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

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ProcedureCash priceGross charge× Medicare
Advance care planning first 30 mins (99497) $186 $186 1.7×
Airway inhalation treatment (94640) $186 $186 0.8×
Allergy injection single (95115) $25 $25 0.5×
Behav assmt w/score & docd/stand instrument (96127) $12 $12 0.3×
Behavioral & qualit analysis voice and resonance (92524) $227 $227
Bipap initial day (94660) $869 $869 3.8×
Breathing capacity test (94010) $274 $274 1.2×
Bronchodilation responsiveness, spirometry as in 94010, pre- and post-bronchodilator administration (94060) $557 $557 1.4×
Cardiovascular stress test (93017) $869.60 $1,087 3.8×
Cardioversion elective external (92960) $399 $399 0.6×
Chest physiotherapy initial (94667) $200 $200 1.4×
Chiropract manj 3-4 regions (98941) $38 $38 1.7×
Color/duplex Doppler, complete (93975) $641 $641 2.5×
Complex chronic care management services for two or more chronic conditions, first 60 minutes of clinical staff time… (99487) $337 $337 1.8×
Cpr (92950) $867 $867 3.8×
Critical care ill/injured patient init 30-74 min (99291) $699 $699 0.8×
Duplex hemodialysis access (93990) $352 $352 3.2×
Duplex scan of aorta, inferior vena cava, iliac vasculature, or bypass grafts; complete study Age Under 21 (93978) $983 $983 3.9×
Duplex scan of extracranial arteries; complete bilateral study Age Under 21 (93880) $1,224 $1,530 4.9×
Duplex scan of extracranial arteries; unilateral or limited study Age Under 21 (93882) $904.80 $1,131 8.2×
Duplex scan of extremity veins including responses to compression and other maneuvers; complete bilateral study Age… (93970) $1,185.60 $1,482 4.7×
Duplex scan of lower extremity arteries or arterial bypass grafts; complete bilateral study Age Under 21 (93925) $1,004 $1,255 4.0×
Duplex scan of upper extremity arteries or arterial bypass grafts; complete bilateral study Age Under 21 (93930) $952 $1,190 3.8×
Duplex scan of upper extremity arteries or arterial bypass grafts; unilateral or limited study Age Under 21 (93931) $856.80 $1,071 7.8×
ECG monit/reprt up to 48 hrs (93226) $492 $492 7.9×
ECG/monitoring and analysis (93271) $492 $492 4.9×
Echocardiography, transthoracic, real-time with image documentation (2D), includes M-mode recording, when performed,… (93307) $1,064.80 $1,331 4.2×
EKG 12 lead tracing only (93005) $335 $335 5.4×
Emergency department visit high mdm (99285) $829.50 $982.50 1.3×
Emergency department visit low mdm (99283) $503.50 $503.50 1.7×
Emergency department visit may not req phys/qhp (99281) $205 $205 2.3×
Emergency department visit moderate mdm (99284) $608.80 $723.50 1.4×
Emergency department visit straightforward mdm (99282) $281.50 $281.50 1.7×
Evaluate pt use of inhaler (94664) $170 $170 0.7×
External ECG rec>48hr<7d recording (93242) $186 $186 4.7×
External ECG rec>7d<15d recording (93246) $224 $224 5.7×
External electrocardiographic recording up to 48 hours by continuous rhythm recording and storage; recording (includes… (93225) $421 $421 3.0×
External mobile cardiovascular telemetry with electrocardiographic recording, concurrent computerized real time data… (93229) $271 $271 0.7×
Hot/cold pack (97010) $27 $27
Immunization administration (90471) $86 $86 1.1×
Injection,Therap/Proph/Diagnost, IV Push, Ea Add, New Drug (96375) $179 $179 3.6×
Injection,Therap/Proph/Diagnost, IV Push, Initial Drug (96374) $260 $260 1.2×
Irrigaj implntd venous access drug delivery syst (96523) $191 $191 3.1×
IV infusion hydration each additional hour (96361) $170 $170 3.4×
IV infusion hydration initial 31 min-1 hour (96360) $440 $440 2.0×
IV infusion ther proph addl sequential to 1 hr (96367) $193 $193 2.5×
IV infusion therapy/prophylaxis /dx 1st to 1 hr (96365) $440 $440 2.0×
IV tx, each additional hour (96366) $134 $134 2.7×
Manipulation chest wall, such as cupping, percussing, and vibration to facilitate lung function; subsequent (94668) $139 $139 1.0×
Medical nutrition assmt&ivntj indiv each 15 mi (97802) $75 $75
Negative pressure wound therapy dme </= 50 sq cm (97605) $428 $428 2.0×
Negative pressure wound therapy dme >50 sq cm (97606) $311 $311 0.7×
Non-invasive physiologic study extremity 3 levels (93923) $924.50 $1,050 4.1×
Noninvasive ear/pulse oximetry overnight monitor (94762) $474 $474 3.5×
Orthotic(s) management and training (including assessment and fitting when not otherwise reported), upper… (97760) $109 $109
Osteopath manj 1-2 regions (98925) $80 $80 3.5×
Osteopath manj 3-4 regions (98926) $113 $113 5.0×
Other physical medicine or rehabilitation service or procedure (97799) $101 $101
Outpatient cardiac rehab w/cont ECG monitoring (93798) $268 $268 2.0×
Outpatient cardiac rehab w/o cont ECG monitor (93797) $249 $249 1.8×
Phlebotomy therapeutic (99195) $304 $304 2.2×
Polysom 6/>yrs sleep w/cpap 4/> addl param attnd (95811) $2,722.30 $3,889 3.0×
Professional services for allergen immunotherapy; 2 or more injections (95117) $30 $30 0.6×
Prosthetic(s) training, upper and/or lower extremity(ies), initial prosthetic(s) encounter, each 15 minutes Other… (97761) $104 $104
Psych diag eval w/med srvcs (90792) $448 $448 2.4×
Psychiatric diagnostic evaluation (90791) $426 $426 2.3×
Psytx crisis initial 60 min (90839) $345 $345 1.8×
Pt physical performance test (97750) $127 $127
Pulmonary stress testing (94618) $312 $312 2.2×
Remote 30 day ECG rev/report (93270) $492 $492 12.5×
Stress tte only (93350) $2,303.70 $3,291 4.0×
Test for hearing various pitches using earphone (92552) $243 $243 1.7×
Ther/proph/diag inj ia (96373) $216 $216 1.0×
Therapeutic procedure, 1 or more areas, each 15 minutes; aquatic therapy with therapeutic exercises Other Outpatient (97113) $175 $175
Therapeutic prophylactic/dx injection subq/im (96372) $113 $113 1.5×
Tobacco use cessation intermediate 3-10 minutes (99406) $26 $26 0.7×
Tte w/doppler complete (93306) $1,896.80 $2,371 3.3×
Tx of Speech/Lang/Voice/Comm/Auditory Chg (92507) $155 $155
Tympanometry (92567) $99 $99 2.5×
Unlisted modality (specify type and time if constant attendance) (97039) $66.50 $66.50
Upr/l xtremity art 2 levels (93922) $577 $577 4.1×
Ventilation ip/obs initial day (94002) $1,281.60 $1,602 2.0×
Ventilator subsequent day (94003) $932 $1,165 1.4×