Visits & medical services prices at Melissa Memorial Hospital

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

122 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×
Assessment of aphasia (96105) $280.80 $351 2.9×
Behav assmt w/score & docd/stand instrument (96127) $48 $60 1.2×
Behavioral and qualitative analysis of voice and resonance (92524) $235.20 $294 2.1×
Brncdilat rspse spmtry pre&post-brncdilat admn (94060) $510.40 $638 1.3×
Canalith Repositioning (95992) $83.60 $104.50 2.1×
Cardiac Stress Tst,Tracing Only (93017) $517.60 $647 2.3×
Cardiopulmonary exercise testing (94621) $420 $525 1.1×
Cardiopulmonary resuscitation (92950) $388 $485 1.7×
Cardioversion (92960) $198.40 $248 0.3×
Chemo Hormon Antineopl Sq/Im (96402) $194.40 $243 2.6×
Chemo IV push addl drug (96411) $212.80 $266 2.8×
Chemo Iv Push Sngl Drug (96409) $461.60 $577 1.3×
Chemo prolong 8+ hrs infuse w/pump (96416) $645.60 $807 1.9×
Chemother, IV infusion, 1 hr (96413) $716.80 $896 2.1×
Chemother, IV infusion, ea add hr (96415) $165.60 $207 2.2×
Chemother,Non-Hormone Anti-Neopl, Sub-Q/Im (96401) $244 $305 3.2×
Chemotx admn IV nfs tq ea seql nfs to 1 hr (96417) $224.80 $281 3.0×
Color/duplex Doppler, complete (93975) $1,085.60 $1,357 4.3×
Cont Gluc Monitoring Patient Provided Equipment (95249) $75.20 $94 1.2×
Continuous Glucose Monitoring (95250) $229.60 $287 1.6×
Cpap initiation and management (94660) $539.20 $674 2.3×
Critical care (99291) $754.40 $943 0.9×
Debridement Open Wound 20 Sq Cm< (97597) $252.80 $316 1.2×
Demo &/or eval,pt use,aerosol device (94664) $101.60 $127 0.4×
Dup-Scan Aorta Ivc Iliac Vascl/Bpgs Complete (93978) $479.20 $599 1.9×
Dup-scan aorta ivc iliac vascl/bpgs uni/lmtd (93979) $554.40 $693 5.0×
Dup-Scan Lxtr Art/Artl Bpgs Compl Bi Study (93925) $828 $1,035 3.3×
Dup-scan lxtr art/artl bpgs uni/lmtd study (93926) $587.20 $734 5.3×
Dup-Scan Uxtr Art/Artl Bpgs Compl Bi Study (93930) $849.60 $1,062 3.4×
Dup-Scan Uxtr Art/Artl Bpgs Uni/Lmtd Study (93931) $566.40 $708 5.1×
Dup-scan xtr veins unilateral/limited study (93971) $764 $955 6.9×
Duplex scan extracranial art compl bi study (93880) $963.20 $1,204 3.8×
Echo Heart Xthoracic,Limited (93308) $598.40 $748 2.4×
Echo Transthoracic - Congenital Tte Complete (93303) $1,038.40 $1,298 1.8×
Echo Transthoracic - Congenital Tte Limited (93304) $717.60 $897 1.2×
EKG (93005) $224 $280 3.6×
EKG rhythm strip (93041) $96.80 $121 1.6×
Er level 1 (99281) $112 $140 1.3×
Er level ii (99282) $181.60 $227 1.1×
Er level iii (99283) $297.60 $372 1.0×
Er level IV (99284) $449.60 $562 1.0×
Er level v (99285) $666.40 $833 1.1×
Evaluation of speech sound production (92522) $280.80 $351 2.5×
Exercise tst brncspsm (94617) $248 $310 1.8×
External Ecg Scanning Analysis Report (93226) $441.60 $552 7.1×
Flexible Endoscopic Eval Swallow C/V Rec (92612) $141.60 $177 0.7×
Holter Monitor Recording (93225) $344.80 $431 2.5×
Imm Admn Sarscov2 Vaccine Single Dose (90480) $18.40 $23 0.4×
Immunization Admin (90471) $126.80 $158.50 1.7×
Injection intra arterial (96373) $369.60 $462 1.6×
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, therap/proph/diagnost,add infusion,1st hour (96367) $147.20 $184 1.9×
IV infusion, therap/proph/diagnost,initial,1st hour (96365) $397.60 $497 1.8×
IV infusion, therap/proph/diagnost,initial,ea add hour (96366) $133.20 $166.50 2.7×
IV push initial (96374) $206.40 $258 0.9×
Manual therapy 15 min (97140) $144.80 $181 5.2×
Massage 15 min (97124) $84 $105 2.8×
Med Nutr Ther, Subsq, Indiv, Ea 15 Min (97803) $46.40 $58 1.5×
Medical nutrition assmt&ivntj indiv each 15 mi (97802) $41.60 $52 1.1×
Mnt Group Ea 30 Min (97804) $28 $35 1.6×
Nasopharyngoscopy (92511) $271.20 $339 1.3×
Neg press wnd tx </=50 sq cm (97607) $364.80 $456 0.9×
Neg press wound tx >50 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×
Non-Invas Physiologic Std Extremity Art 2 Level (93922) $417.60 $522 3.0×
Noninvasive Ear/Pulse Oximetry Overnight Monitor (94762) $236 $295 1.7×
Orthotics mgmt & traing initial enctr ea 15 mins (97760) $110.40 $138 2.4×
Osteopathic manipulative tx 1-2 body regions (98925) $59.60 $74.50 2.6×
Osteopathic manipulative tx 3-4 body regions (98926) $83.20 $104 3.7×
Ot Community/Work Reintegration Trainj Ea 15 Min (97537) $92 $115 2.9×
Ot Contrast Bath Ea 15 Min (97034) $72 $90 5.1×
Ot eval high complex 60 min (97167) $255.20 $319 2.5×
Ot eval low complex 30 min (97165) $273.60 $342 2.7×
Ot eval mod complex 45 min (97166) $273.60 $342 2.7×
Ot re-eval est plan care (97168) $189.60 $237 2.8×
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×
Paraffin bath (97018) $52 $65 8.7×
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×
Polysom 6/>Yrs Sleep W/Cpap 4/> Addl Param Attnd (95811) $3,422.40 $4,278 3.8×
Pt Electric Current Therapy (97033) $76.80 $96 4.0×
Pt Electrical Stimulation (97032) $32 $40 2.2×
Pt eval high complex 45 min (97163) $268 $335 2.7×
Pt eval low complex 20 min (97161) $271.20 $339 2.8×
Pt Gait Training Therapy (97116) $85.60 $107 2.9×
Pt Neuromusc Reeducat,1+ Areas, Ea 15 Min (97112) $99.60 $124.50 3.0×
Pt Physical Performance Test (97750) $67.20 $84 2.0×
Pt Physical Therapy Evaluation Mod Complex 30 Mins (97162) $271.20 $339 2.8×
Pt re-evaluation (97164) $189.60 $237 2.8×
Pt Self-Care/Home Mgmt Training Each 15 Minutes (97535) $110.40 $138 3.4×
Pt Ultrasound Therapy (97035) $114.40 $143 8.0×
Pulmonary stress testing (94618) $96 $120 0.7×
Refill/maint, portable pump (96521) $340 $425 1.5×
Remote 30 Day Ecg Rev/Report - Cardiac Event Monitor (93270) $112 $140 2.8×
Rmvl Devital Tiss N-Slctv Dbrdmt W/O Anes 1 Sess (97602) $250.80 $313.50 1.2×
Rom meas&reprt hand w/wo comparison normal sid (95852) $144.80 $181 6.8×
Speech sound lang comprehen (92523) $372.80 $466 1.6×
Spirometry (94010) $128.80 $161 0.6×
Standardized Cognitive Performance Testing (96125) $216.80 $271 2.1×
Stress echo (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 2.7×
Ther Ivntj Cog Funcj Cntct Ea Addl 15 Minutes (97130) $80 $100 3.8×
Ther/Proph/Diag Inj Sc/Im (96372) $102.40 $128 1.3×
Therapeutic Activities (97530) $100.80 $126 2.9×
Therapeutic phlebotomy (99195) $179.20 $224 1.3×
Tobacco Use Cessation Intermediate 3-10 Minutes (99406) $28 $35 0.7×
Tte W/Doppler Complete - Tte Complete W/ Contrast (93306) $1,918.80 $2,398.50 3.3×
Tx Speech Lang Voice Commj &/Auditory Proc Ind (92507) $253.60 $317 3.3×
Tx Swallowing Dysfunction&/Oral Funcj Feeding (92526) $225.60 $282 2.7×
Tx/Pro/Dx Inj New Drug Addon (96375) $111.20 $139 2.3×
Vasc Duplex Extrem Venous,Bilat (93970) $1,159.60 $1,449.50 4.6×
Vasopneumatic device (97016) $76 $95 6.3×
Wheelchair Mgmt Ea 15 Min (97542) $137.60 $172 4.4×
Xers tst brncspsm pre&post spmtry&pls ox wo /ECG (94619) $184 $230 3.0×