Visits & medical services prices at Melissa Memorial Hospital

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

123 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) $161.60 $202 1.5×
Airway inhalation treatment (94640) $167.20 $209 0.7×
Appl on-body injector for timed subq injection (96377) $92.80 $116 1.9×
Application of a modality to 1 or more areas; contrast baths, each 15 minutes Other Outpatient (97034) $72 $90
Application of a modality to 1 or more areas; electrical stimulation (manual), each 15 minutes Other Outpatient (97032) $32 $40
Application of a modality to 1 or more areas; iontophoresis, each 15 minutes Other Outpatient (97033) $76.80 $96
Application of a modality to 1 or more areas; ultrasound, each 15 minutes Other Outpatient (97035) $114.40 $143
Application of a modality to 1 or more areas; vasopneumatic devices Other Outpatient (97016) $76 $95
Assessment of aphasia (96105) $280.80 $351
Behav assmt w/score & docd/stand instrument (96127) $48 $60 1.2×
Behavioral & qualit analysis voice and resonance (92524) $235.20 $294
Bipap initial day (94660) $539.20 $674 2.3×
Breathing capacity test (94010) $128.80 $161 0.6×
Bronchodilation responsiveness, spirometry as in 94010, pre- and post-bronchodilator administration (94060) $510.40 $638 1.3×
Canalith repositioning (95992) $83.60 $104.50
Cardiopulmonary exercise testing (94621) $420 $525 1.1×
Cardiovascular stress test (93017) $517.60 $647 2.3×
Cardioversion elective external (92960) $198.40 $248 0.3×
Chemo anti-neopl sq/im (96401) $244 $305 3.2×
Chemo hormon antineopl sq/im (96402) $194.40 $243 2.6×
Chemo IV infus each addl seq (96417) $224.80 $281 3.0×
Chemo IV infusion addl hr (96415) $165.60 $207 2.2×
Chemo IV push addl drug (96411) $212.80 $266 2.8×
Chemother prolong infuse w/pump (96416) $645.60 $807 1.9×
Chemotherapy administration, intravenous infusion technique; up to 1 hour, single or initial substance/drug (96413) $716.80 $896 2.1×
Chemotherapy administration; intravenous, push technique, single or initial substance/drug (96409) $461.60 $577 1.3×
Color/duplex Doppler, complete (93975) $1,085.60 $1,357 4.3×
Community/work reintegration training (eg, shopping, transportation, money management, avocational activities and/or… (97537) $92 $115
Cont gluc mntr physician/qhp provided equipment (95250) $229.60 $287 1.6×
Cont gluc mntr pt prov eqp (95249) $75.20 $94 1.2×
Cpr (92950) $388 $485 1.7×
Critical care ill/injured patient init 30-74 min (99291) $754.40 $943 0.9×
Debridement open wound 20 sq cm< (97597) $252.80 $316 1.2×
Duplex scan of aorta, inferior vena cava, iliac vasculature, or bypass grafts; complete study Age Under 21 (93978) $479.20 $599 1.9×
Duplex scan of aorta, inferior vena cava, iliac vasculature, or bypass grafts; unilateral or limited study Age Under 21 (93979) $554.40 $693 5.0×
Duplex scan of extracranial arteries; complete bilateral study Age Under 21 (93880) $963.20 $1,204 3.8×
Duplex scan of extremity veins including responses to compression and other maneuvers; complete bilateral study Age… (93970) $1,159.60 $1,449.50 4.6×
Duplex scan of extremity veins including responses to compression and other maneuvers; unilateral or limited study Age… (93971) $764 $955 6.9×
Duplex scan of lower extremity arteries or arterial bypass grafts; complete bilateral study Age Under 21 (93925) $828 $1,035 3.3×
Duplex scan of lower extremity arteries or arterial bypass grafts; unilateral or limited study Age Under 21 (93926) $587.20 $734 5.3×
Duplex scan of upper extremity arteries or arterial bypass grafts; complete bilateral study Age Under 21 (93930) $849.60 $1,062 3.4×
Duplex scan of upper extremity arteries or arterial bypass grafts; unilateral or limited study Age Under 21 (93931) $566.40 $708 5.1×
ECG monit/reprt up to 48 hrs (93226) $441.60 $552 7.1×
EKG 12 lead tracing only (93005) $224 $280 3.6×
EKG rhythm strip (93041) $96.80 $121 1.6×
Emergency department visit high mdm (99285) $666.40 $833 1.1×
Emergency department visit low mdm (99283) $297.60 $372 1.0×
Emergency department visit may not req phys/qhp (99281) $112 $140 1.3×
Emergency department visit moderate mdm (99284) $449.60 $562 1.0×
Emergency department visit straightforward mdm (99282) $181.60 $227 1.1×
Endoscopy swallow (fees) vid (92612) $141.60 $177
Evaluate pt use of inhaler (94664) $101.60 $127 0.4×
Evaluation of speech sound production articulate (92522) $280.80 $351
Exercise test for bronchospasm, including pre- and post-spirometry and pulse oximetry; with electrocardiographic… (94617) $248 $310 1.8×
Exercise tst brncspsm wo ECG (94619) $184 $230 3.0×
External electrocardiographic recording up to 48 hours by continuous rhythm recording and storage; recording (includes… (93225) $344.80 $431 2.5×
Hot/cold pack (97010) $12 $15
Imm admn sarscov2 vaccine single dose (90480) $18.40 $23 0.4×
Immunization administration (90471) $126.80 $158.50 1.7×
Injection,Therap/Proph/Diagnost, IV Push, Ea Add, New Drug (96375) $111.20 $139 2.3×
Injection,Therap/Proph/Diagnost, IV Push, Initial Drug (96374) $206.40 $258 0.9×
Irrigaj implntd venous access drug delivery syst (96523) $135.20 $169 2.2×
IV infusion hydration each additional hour (96361) $132.80 $166 2.7×
IV infusion hydration initial 31 min-1 hour (96360) $351.20 $439 1.6×
IV infusion ther proph addl sequential to 1 hr (96367) $147.20 $184 1.9×
IV infusion therapy/prophylaxis /dx 1st to 1 hr (96365) $397.60 $497 1.8×
IV tx, each additional hour (96366) $133.20 $166.50 2.7×
Medical nutrition assmt&ivntj indiv each 15 mi (97802) $41.60 $52
Medical nutrition group (97804) $28 $35
Medical nutrition therapy; re-assessment and intervention, individual, face-to-face with the patient, each 15 minutes… (97803) $46.40 $58
Nasopharyngoscopy (92511) $271.20 $339 1.3×
Neg pressure wound therapy non dme </= 50 sq cm (97607) $364.80 $456 0.9×
Neg pressure wound therapy non dme >50 sq cm (97608) $532.80 $666 1.2×
Negative pressure wound therapy dme </= 50 sq cm (97605) $328 $410 1.5×
Negative pressure wound therapy dme >50 sq cm (97606) $364 $455 0.8×
Noninvasive ear/pulse oximetry overnight monitor (94762) $236 $295 1.7×
Occupational therapy eval high complex 60 mins (97167) $255.20 $319
Occupational therapy eval low complex 30 mins (97165) $273.60 $342
Occupational therapy eval mod complex 45 mins (97166) $273.60 $342
Oral function therapy (92526) $225.60 $282
Orthotic(s) management and training (including assessment and fitting when not otherwise reported), upper… (97760) $110.40 $138
Osteopath manj 1-2 regions (98925) $59.60 $74.50 2.6×
Osteopath manj 3-4 regions (98926) $83.20 $104 3.7×
Ot manual therapy ea 15 min (97140) $144.80 $181
Ot neuromuscular re-education (97112) $99.60 $124.50
Ot paraffin bath (97018) $52 $65
Ot re-evaluation (97168) $189.60 $237
OT Therapeutic Activities Charges (97530) $100.80 $126
Ot wheelchair management (97542) $137.60 $172
Outpatient cardiac rehab w/cont ECG monitoring (93798) $212 $265 1.6×
Outpatient cardiac rehab w/o cont ECG monitor (93797) $92 $115 0.7×
Phlebotomy therapeutic (99195) $179.20 $224 1.3×
Phy/qhp op pulm rhb w/mntr (94626) $40 $50 0.6×
Phy/qhp op pulm rhb w/o mntr (94625) $28 $35 0.4×
Physical therapy evaluation high complex 45 mins (97163) $268 $335
Physical therapy evaluation low complex 20 mins (97161) $271.20 $339
Physical therapy evaluation mod complex 30 mins (97162) $271.20 $339
Polysom 6/>yrs sleep w/cpap 4/> addl param attnd (95811) $3,422.40 $4,278 3.8×
Pt gait training 15 min (97116) $85.60 $107
Pt physical performance test (97750) $67.20 $84
Pt re-evaluation (97164) $189.60 $237
Pulmonary stress testing (94618) $96 $120 0.7×
Range of motion measurements and report (separate procedure); hand, with or without comparison with normal side Other… (95852) $144.80 $181
Refilling and maintenance of portable pump (96521) $340 $425 1.5×
Remote 30 day ECG rev/report (93270) $112 $140 2.8×
Self-care/home management training (eg, activities of daily living (ADL) and compensatory training, meal preparation,… (97535) $110.40 $138
Speech sound lang comprehen (92523) $372.80 $466
Standardized cognitive performance testing (96125) $216.80 $271
Stress tte only (93350) $492 $615 0.9×
Temp transcutaneous pacing (92953) $899.20 $1,124 1.3×
Ther ivntj cog funcj cntct 1st 15 minutes (97129) $60 $75
Ther ivntj cog funcj cntct ea addl 15 minutes (97130) $80 $100
Ther/proph/diag inj ia (96373) $369.60 $462 1.6×
Therapeutic procedure, 1 or more areas, each 15 minutes; massage, including effleurage, petrissage and/or tapotement… (97124) $84 $105
Therapeutic prophylactic/dx injection subq/im (96372) $102.40 $128 1.3×
Tobacco use cessation intermediate 3-10 minutes (99406) $28 $35 0.7×
Transthoracic echocardiography for congenital cardiac anomalies; follow-up or limited study Age Under 21 (93304) $717.60 $897 1.2×
Tte congenital complete (93303) $1,038.40 $1,298 1.8×
Tte f-up or lmtd (93308) $598.40 $748 2.4×
Tte w/doppler complete (93306) $1,918.80 $2,398.50 3.3×
Tx of Speech/Lang/Voice/Comm/Auditory Chg (92507) $253.60 $317
Upr/l xtremity art 2 levels (93922) $417.60 $522 3.0×
Wound(s) care non-selective (97602) $250.80 $313.50 1.2×