Visits & medical services prices at Mount San Rafael Hospital

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

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

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ProcedureCash priceGross charge× Medicare
Acupuncture 1/> ndles w/o elec stimj init 15 min (97810) $166.50
Airway inhalation treatment (94640) $257
Appl on-body injector for timed subq injection (96377) $108.50
Assessment of aphasia (96105) $594.50
Behavioral and qualitative analysis of voice and resonance (92524) $335
Brncdilat rspse spmtry pre&post-brncdilat admn (94060) $757.75
Canalith Repositioning (95992) $111.30 $159 2.7×
Cardiac Stress Tst,Tracing Only (93017) $1,068
Cardiopulmonary resuscitation (92950) $1,931
Cardioversion (92960) $596
Cbt 1st hour (94644) $423.50
Chemo Hormon Antineopl Sq/Im (96402) $137
Chemo IV push addl drug (96411) $352.50
Chemo Iv Push Sngl Drug (96409) $526
Chemother, IV infusion, 1 hr (96413) $936
Chemother, IV infusion, ea add hr (96415) $256
Chemother,Non-Hormone Anti-Neopl, Sub-Q/Im (96401) $170.50
Chemotx admn IV nfs tq ea seql nfs to 1 hr (96417) $328
Color/duplex Doppler, complete (93975) $702.50
Cont Gluc Monitoring Patient Provided Equipment (95249) $296
Continuous Glucose Monitoring (95250) $648
Cpap initiation and management (94660) $181.50
Cpt initial (94667) $285.50
Critical care (99291) $943.50
Debridement Open Wound 20 Sq Cm< (97597) $206
Demo &/or eval,pt use,aerosol device (94664) $196
Dup-Scan Lxtr Art/Artl Bpgs Compl Bi Study (93925) $1,436
Dup-scan lxtr art/artl bpgs uni/lmtd study (93926) $1,140.50
Dup-Scan Uxtr Art/Artl Bpgs Compl Bi Study (93930) $1,173.25
Dup-Scan Uxtr Art/Artl Bpgs Uni/Lmtd Study (93931) $929
Dup-scan xtr veins unilateral/limited study (93971) $1,405.25
Duplex hemodialysis access (93990) $558.50
Duplex scan extracranial art compl bi study (93880) $1,952.75
Echo Heart Xthoracic,Limited (93308) $921
EKG (93005) $308
Er level 1 (99281) $323.50
Er level ii (99282) $370.50
Er level iii (99283) $818.75
Er level IV (99284) $1,214
Er level v (99285) $1,805.75
Eval&/Fitg Voice Prostc Dev Suplmnt Oral Speec (92597) $594.50
Evaluation of speech fluency (92521) $315 $450 2.4×
Evaluation of speech sound production (92522) $320
Evaluation of swallowing function (92610) $383.95 $548.50 4.5×
Evaluation with prescription of speech-generating alternative (92607) $458.50
External ECG rec>48hr<7d recording (93242) $162
External ECG rec>7d<15d recording (93246) $269
Flexible Endoscopic Eval Swallow C/V Rec (92612) $1,399.50
Group Therapeutic Procedures (97150) $61.95 $88.50 3.4×
Holter Monitor Recording (93225) $1,029.50
Immuniz admin,intranasal/oral,1 vac/tox (90473) $52.50
Immunization Admin (90471) $102
Immunotherapy, 2+ Injections (95117) $47.50
Irrigaj Implntd Venous Access Drug Delivery Syst (96523) $90.50
IV infusion hydration each additional hour (96361) $238.50
IV infusion hydration initial 31 min-1 hour (96360) $484.25
IV infusion, therap/proph/diagnost,add infusion,1st hour (96367) $145.50
IV infusion, therap/proph/diagnost,initial,1st hour (96365) $590.50
IV infusion, therap/proph/diagnost,initial,ea add hour (96366) $124.50
IV push initial (96374) $444.50
Manual therapy 15 min (97140) $95.20 $136 3.4×
Massage 15 min (97124) $84 $120 2.8×
Mechanical chest wall oscillation (94669) $59
Mechanical traction (97012) $95.90 $137 6.7×
Med Nutr Ther, Subsq, Indiv, Ea 15 Min (97803) $55.50
Medical nutrition assmt&ivntj indiv each 15 mi (97802) $48.75
Methacholine challenge (94070) $641.50
Motion Fluor Eval Swlng Funcj C/V Rec (92611) $324.62 $463.75 3.5×
Multiple sleep latency test (95805) $2,269.50
Nasopharyngoscopy (92511) $240.25
Neg press wnd tx </=50 sq cm (97607) $1,946.50
Negative Pressure Wound Therapy Dme </= 50 Sq Cm (97605) $138
Negative Pressure Wound Therapy Dme >50 Sq Cm (97606) $162
Neurobehavioral Status Exam (96116) $502.25 $717.50 2.2×
Newborn resuscitation (99465) $585.50
Non-Invas Physiologic Std Extremity Art 2 Level (93922) $291
Noninvasive Ear/Pulse Oximetry Overnight Monitor (94762) $358.50
Orthotics mgmt & traing initial enctr ea 15 mins (97760) $127.05 $181.50 2.8×
Osteopathic manipulative tx 1-2 body regions (98925) $88.50
Osteopathic manipulative tx 3-4 body regions (98926) $121.50
Ot Community/Work Reintegration Trainj Ea 15 Min (97537) $90.30 $129 2.8×
Ot Contrast Bath Ea 15 Min (97034) $50.40 $72 3.6×
Ot eval high complex 60 min (97167) $287.50
Ot eval low complex 30 min (97165) $288.50
Ot eval mod complex 45 min (97166) $287.50
Ot Orthotics/Prosth Mgmt &/Trainj Sbsq Enctr 15 Min (97763) $170.50
Ot Prosthetic Training, Each 15 Min (97761) $82.25 $117.50 2.0×
Ot re-eval est plan care (97168) $199
Outpatient Cardiac Rehab W/Cont Ecg Monitoring (93798) $325
Paraffin bath (97018) $56.88 $81.25 9.5×
Phy/qhp op pulm rhb w/o mntr (94625) $228.50
Plethysmography (94726) $514
Polysom 6/>Yrs Sleep W/Cpap 4/> Addl Param Attnd (95811) $5,131
Polysom <6 yrs 4/> paramtrs (95782) $5,013.50
Polysom <6 Yrs Sleep W/Cpap/Bilvl Vent 4/> Param (95783) $5,624.50
Prof Svcs Allg Immntx X W/Prv Allgic Xtrcs 1 Njx (95115) $47.50
Pt Electric Current Therapy (97033) $55.65 $79.50 2.9×
Pt Electrical Stimulation (97032) $56.35 $80.50 3.8×
Pt eval high complex 45 min (97163) $72.10 $103 0.7×
Pt eval low complex 20 min (97161) $323.50
Pt Gait Training Therapy (97116) $75.25 $107.50 2.6×
Pt Neuromusc Reeducat,1+ Areas, Ea 15 Min (97112) $97.65 $139.50 3.0×
Pt Physical Performance Test (97750) $249.20 $356 7.4×
Pt Physical Therapy Evaluation Mod Complex 30 Mins (97162) $369.50
Pt re-evaluation (97164) $213
Pt Ultrasound Therapy (97035) $67.20 $96 4.7×
Pulmonary stress testing (94618) $713.50
Refill/maint, portable pump (96521) $694
Rem mntr physiol param 1st dev supply ea 30 days (99454) $221
Rem mntr physiol param 1st set up pt educaj eqp (99453) $92
Remote 30 Day Ecg Rev/Report - Cardiac Event Monitor (93270) $427.75
Remote Monitoring Of Physiologic Parameter(s) (Eg, Weight, Blood Pressure, Pulse Oximetry, Respiratory Flow Rate);… (99445) $221
Rfl&Main Implt Pmp/Rsvr Dlvr Spi/Brn Phy/Qhp (95991) $192
Rmvl Devital Tiss N-Slctv Dbrdmt W/O Anes 1 Sess (97602) $118.65 $220.50 0.6×
Rt Chest Wall Manipulation,Subsequent (94668) $205
Rx Sp-Genratj Augmnt&Comunicaj Dev Ea 30 Min (92608) $164
Sensory Integration Ea 15 Min (97533) $88.20 $126 1.5×
Sleep study attended (95807) $1,977.50
Sleep study unattended (95806) $1,977.50
Speech group therapy (92508) $155.50
Speech sound lang comprehen (92523) $563
Spirometry (94010) $219
Standardized Cognitive Performance Testing (96125) $346
Stress echo (93350) $1,871.50
Stress Tte Complete (93351) $4,216
Temp transcutaneous pacing (92953) $516
Testing of autonomic nervous system function heart rate (95921) $331
Ther ivntj cog funcj cntct 1st 15 minutes (97129) $75.50
Ther Ivntj Cog Funcj Cntct Ea Addl 15 Minutes (97130) $73
Ther Sp-Genratj Dev Prgrmg&Modificaj (92609) $342
Ther/Proph/Diag Inj Sc/Im (96372) $123
Therapeutic Activities (97530) $79.10 $113 2.3×
Therapeutic phlebotomy (99195) $316.25
Tobacco Use Cessation Intermediate 3-10 Minutes (99406) $34
Trans Care Mgmt 14 Day Disch (99495) $345
Trans Care Mgmt 7 Day Disch (99496) $500
Tstg Ans Funcj Vasomotor Adrenergic Innervaj (95922) $419.50
Tte W/Doppler Complete - Tte Complete W/ Contrast (93306) $2,776
Tte W/O Doppler Complete - Tte Complete No Doppler No Color (93307) $440
Tx Speech Lang Voice Commj &/Auditory Proc Ind (92507) $233.25
Tx Swallowing Dysfunction&/Oral Funcj Feeding (92526) $307.30 $439 3.7×
Tx/Pro/Dx Inj New Drug Addon (96375) $264
Unlisted Cardiovascular Service/Procedure (93799) $1,282.50
Unlisted pulmonary service/procedure (94799) $215.25
Vasc Duplex Extrem Venous,Bilat (93970) $1,487
Vasc Duplex Scan Extracranial,Limited (93882) $1,290.50
Vasopneumatic device (97016) $65.10 $93 5.4×
Ventilation assist & mgmt inpatient 1st day (94002) $2,459
Ventilation Assist & Mgmt Inpatient Ea Sbsq Da (94003) $1,326
Vital capacity total (94150) $33
Wheelchair Mgmt Ea 15 Min (97542) $96.60 $138 3.1×
Xtrnl Pt Activated Ecg Rec Dwnld 30 Days (93271) $903