Visits & medical services prices at Kit Carson County Memorial Hospital

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

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

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ProcedureCash priceGross charge× Medicare
Airway inhalation treatment (94640) $312.55 $367.71 1.4×
Application of a modality to 1 or more areas; electrical stimulation (manual), each 15 minutes Other Outpatient (97032) $110.31 $129.78
Application of a modality to 1 or more areas; iontophoresis, each 15 minutes Other Outpatient (97033) $136.58 $160.68
Application of a modality to 1 or more areas; ultrasound, each 15 minutes Other Outpatient (97035) $85.67 $100.79
Assessment of aphasia (96105) $162.72 $191.43
Behavioral & qualit analysis voice and resonance (92524) $267.51 $314.72
Bipap initial day (94660) $603.04 $709.46 2.6×
Breathing capacity test (94010) $279.70 $329.06 1.2×
Bronchodilation responsiveness, spirometry as in 94010, pre- and post-bronchodilator administration (94060) $267.84 $315.11 0.7×
Canalith repositioning (95992) $83.88 $98.68
Cardiovascular stress test (93017) $127.50 $150 0.6×
Cardioversion elective external (92960) $2,467.34 $2,902.75 3.5×
Chemo anti-neopl sq/im (96401) $172.56 $203.02 2.3×
Chemo hormon antineopl sq/im (96402) $122.26 $143.84 1.6×
Chemo IV infus each addl seq (96417) $358.52 $421.79 4.7×
Chemo IV infusion addl hr (96415) $316 $371.77 4.2×
Chemo IV push addl drug (96411) $330.98 $389.39 4.4×
Chemother prolong infuse w/pump (96416) $342.43 $402.86 1.0×
Chemotherapy administration, intravenous infusion technique; up to 1 hour, single or initial substance/drug (96413) $843.44 $992.28 2.4×
Chemotherapy administration; intravenous, push technique, single or initial substance/drug (96409) $649.24 $763.81 1.9×
Chest physiotherapy initial (94667) $204 $240 1.5×
Color/duplex Doppler, complete (93975) $969.83 $1,140.98 3.9×
Color/duplex Doppler, limited (93976) $561.88 $661.04 5.1×
Concurrent chemotherapy (96549) $87.06 $102.42 1.8×
Continuous inhalation treatment with aerosol medication for acute airway obstruction; first hour (94644) $470.67 $553.73 3.4×
Cpr (92950) $1,654.70 $1,946.70 7.3×
Cptrized oph dx img pst segment uni/bi retina (92134) $55.25 $65 0.9×
Critical care ill/injured patient init 30-74 min (99291) $1,529.25 $1,799.12 1.8×
Duplex scan of extracranial arteries; complete bilateral study Age Under 21 (93880) $1,136.18 $1,336.68 4.5×
Duplex scan of extremity veins including responses to compression and other maneuvers; complete bilateral study Age… (93970) $1,200.80 $1,412.71 4.8×
Duplex scan of extremity veins including responses to compression and other maneuvers; unilateral or limited study Age… (93971) $830.80 $977.41 7.5×
Duplex scan of lower extremity arteries or arterial bypass grafts; complete bilateral study Age Under 21 (93925) $1,028.67 $1,210.20 4.1×
Duplex scan of lower extremity arteries or arterial bypass grafts; unilateral or limited study Age Under 21 (93926) $669.23 $787.33 6.1×
Duplex scan of upper extremity arteries or arterial bypass grafts; complete bilateral study Age Under 21 (93930) $856.77 $1,007.96 3.4×
Duplex scan of upper extremity arteries or arterial bypass grafts; unilateral or limited study Age Under 21 (93931) $669.23 $787.33 6.1×
ECG monit/reprt up to 48 hrs (93226) $238.65 $280.76 3.8×
Echocardiography, transthoracic, real-time with image documentation (2D), includes M-mode recording, when performed,… (93307) $1,518.14 $1,786.05 6.0×
EKG 12 lead tracing only (93005) $173.74 $204.40 2.8×
EKG rhythm strip (93041) $68.94 $81.11 1.1×
Emergency department visit high mdm (99285) $1,190.56 $1,400.65 1.9×
Emergency department visit low mdm (99283) $445.08 $523.62 1.5×
Emergency department visit may not req phys/qhp (99281) $140.08 $164.80 1.6×
Emergency department visit moderate mdm (99284) $680.49 $800.58 1.5×
Emergency department visit straightforward mdm (99282) $247.05 $290.64 1.5×
Eval of Oral and Pharyngeal Swallowing - Eval of Oral and Pharyngeal Swallowing Fx Chg (92610) $382.52 $450.02
Evaluate pt use of inhaler (94664) $349.32 $410.97 1.5×
Evaluation of speech fluency (92521) $267.51 $314.72
Evaluation of speech sound production articulate (92522) $254.13 $298.98
Exercise test for bronchospasm, including pre- and post-spirometry and pulse oximetry; with electrocardiographic… (94617) $315.52 $371.20 2.2×
Ext ECG>48hr<7d scan a/r (93243) $121.69 $143.17 0.9×
External ECG rec>48hr<7d recording (93242) $74.42 $87.55 1.9×
External ECG rec>7d<15d recording (93246) $121.69 $143.17 3.1×
External ECG rec>7d<15d scanning alys w/report (93247) $245.14 $288.40 1.7×
External electrocardiographic recording up to 48 hours by continuous rhythm recording and storage; recording (includes… (93225) $238.65 $280.76 1.7×
Hot/cold pack (97010) $23.90 $28.12
Immunization administration (90471) $121.81 $143.30 1.6×
Injection,Therap/Proph/Diagnost, IV Push, Ea Add, New Drug (96375) $169.47 $199.38 3.4×
Injection,Therap/Proph/Diagnost, IV Push, Initial Drug (96374) $201.73 $237.33 0.9×
Interrog dev eval pm/ldls pm phys/qhp in person (93288) $199.75 $235 5.1×
Irrigaj implntd venous access drug delivery syst (96523) $187.54 $220.63 3.0×
IV infusion hydration each additional hour (96361) $130.89 $153.98 2.6×
IV infusion hydration initial 31 min-1 hour (96360) $410 $482.35 1.8×
IV infusion ther proph addl sequential to 1 hr (96367) $243.61 $286.60 3.2×
IV infusion therapy/prophylaxis /dx 1st to 1 hr (96365) $384.26 $452.07 1.7×
IV tx, each additional hour (96366) $171.90 $202.24 3.5×
Low frequency non-thermal us (97610) $349.32 $410.97 1.7×
Manipulation chest wall, such as cupping, percussing, and vibration to facilitate lung function; subsequent (94668) $272 $320 1.9×
Maximum voluntary ventilation (94200) $206.84 $243.34 3.3×
Mechanical chest wall oscillation lung function (94669) $440.33 $518.04 1.9×
Mechanical traction therapy (97012) $70.79 $83.28
Methacholine challenge (94070) $219.98 $258.80 0.6×
Motion fluoroscopic evaluation of swallowing function by cine or video recording Other Outpatient (92611) $297.85 $350.41
Neg pressure wound therapy non dme </= 50 sq cm (97607) $671.08 $789.50 1.6×
Neg pressure wound therapy non dme >50 sq cm (97608) $740.02 $870.61 1.7×
Nerve conduction studies 5-6 studies (95909) $471.75 $555 2.1×
Non-invasive physiologic study extremity 3 levels (93923) $682.10 $802.47 3.0×
Occupational therapy eval high complex 60 mins (97167) $191.21 $224.95
Occupational therapy eval low complex 30 mins (97165) $239.93 $282.27
Occupational therapy eval mod complex 45 mins (97166) $191.21 $224.95
Ophthalmic biometry (92136) $71.30 $83.88 0.5×
Oral function therapy (92526) $122.04 $143.58
Orthotic(s) management and training (including assessment and fitting when not otherwise reported), upper… (97760) $92.85 $109.23
Ot manual therapy ea 15 min (97140) $112.94 $132.87
Ot neuromuscular re-education (97112) $98.83 $116.27
Ot paraffin bath (97018) $88.25 $103.82
Ot re-evaluation (97168) $89.17 $104.91
OT Therapeutic Activities Charges (97530) $82.74 $97.34
Ot wheelchair management (97542) $112.15 $131.94
Outpatient cardiac rehab w/cont ECG monitoring (93798) $226.95 $267 1.7×
Outpatient cardiac rehab w/o cont ECG monitor (93797) $129.20 $152 1.0×
Phlebotomy therapeutic (99195) $348.50 $410 2.5×
Physical therapy evaluation high complex 45 mins (97163) $270.27 $317.96
Physical therapy evaluation low complex 20 mins (97161) $199.49 $234.69
Physical therapy evaluation mod complex 30 mins (97162) $245.45 $288.76
Polysom 6/>yrs sleep w/cpap 4/> addl param attnd (95811) $2,361.61 $2,778.37 2.6×
Pr unlisted therapeutic procedure specify (97139) $79.98 $94.09
Prosthetic(s) training, upper and/or lower extremity(ies), initial prosthetic(s) encounter, each 15 minutes Other… (97761) $38.61 $45.42
Psychiatric diagnostic evaluation (90791) $287.51 $338.25 1.5×
Pt gait training 15 min (97116) $82.26 $96.78
Pt physical performance test (97750) $82.74 $97.34
Pt re-evaluation (97164) $110.16 $129.60
Pulm funct tst plethysmograp (94726) $182.81 $215.07 0.5×
Pulmonary stress testing (94618) $244.72 $287.90 1.7×
Range of motion measurements and report (separate procedure); each extremity (excluding hand) or each trunk section… (95851) $38.61 $45.42
Range of motion measurements and report (separate procedure); hand, with or without comparison with normal side Other… (95852) $47.80 $56.24
Refilling and maintenance of portable pump (96521) $430.18 $506.09 1.9×
Remote 30 day ECG rev/report (93270) $85.41 $100.48 2.2×
Respiratory flow volume loop (94375) $344.25 $405 1.5×
Self-care/home management training (eg, activities of daily living (ADL) and compensatory training, meal preparation,… (97535) $97.67 $114.91
Sensory integrative techniques to enhance sensory processing and promote adaptive responses to environmental demands,… (97533) $67.11 $78.95
Speech sound lang comprehen (92523) $334.39 $393.40
Stress tte only (93350) $533.18 $627.27 0.9×
Temp transcutaneous pacing (92953) $1,080.15 $1,270.76 1.5×
Ther ivntj cog funcj cntct 1st 15 minutes (97129) $56.67 $66.67
Ther ivntj cog funcj cntct ea addl 15 minutes (97130) $54.18 $63.74
Ther/proph/diag inj ia (96373) $195.48 $229.98 0.9×
Therapeutic procedure, 1 or more areas, each 15 minutes; aquatic therapy with therapeutic exercises Other Outpatient (97113) $88.30 $103.88
Therapeutic prophylactic/dx injection subq/im (96372) $122.74 $144.40 1.6×
Therapeutic services for the use of speech-generating device, including programming and modification Other Outpatient (92609) $134.22 $157.90
Tobacco use cessation intensive >10 minutes (99407) $76.71 $90.25 1.9×
Tobacco use cessation intermediate 3-10 minutes (99406) $76.71 $90.25 1.9×
Transthoracic echocardiography for congenital cardiac anomalies; follow-up or limited study Age Under 21 (93304) $422.87 $497.49 0.7×
Tte w/doppler complete (93306) $1,676.76 $1,972.66 2.9×
Tx of Speech/Lang/Voice/Comm/Auditory Chg (92507) $203.16 $239.01
Upr/l xtremity art 2 levels (93922) $647.17 $761.38 4.6×
Ventilation ip/obs initial day (94002) $1,172.01 $1,378.84 1.8×
Ventilator subsequent day (94003) $1,172.01 $1,378.84 1.8×
Visual field examination, unilateral or bilateral, with interpretation and report; extended examination (eg, Goldmann… (92083) $131.75 $155 0.9×
Visual reinforcement audiometry (vra) (92579) $183.86 $216.30 0.8×
Vital capacity total (94150) $312.44 $367.58 2.3×