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.
Compare against other hospitals interactively →
| Procedure | Posted cash | Posted gross | × Medicare |
|---|---|---|---|
| Acupuncture 1/> ndles w/o elec stimj init 15 min (97810) | — | $166.50 | — |
| Airway Inhalation Treatment (94640) range across 8 matching MRF lines |
— | $18–$641.50 | — |
| Appl Modality 1/> Areas Ultrasound Ea 15 Min (97035) range across 8 matching MRF lines |
$67.20–$75.95 | $96–$108.50 | varies |
| Application on-body injector (96377) | — | $108.50 | — |
| Assessment of aphasia per hr (96105) | — | $594.50 | — |
| Behavral qualit analys voice (92524) | — | $335 | — |
| Brncdilat rspse spmtry pre&post-brncdilat admn (94060) range across 4 matching MRF lines |
— | $755.50–$760 | — |
| Canalith repositioning proc (95992) | $111.30 | $159 | 2.7× |
| Cardiac Stress Tst,Tracing Only (93017) | — | $1,068 | — |
| Cardiopulmonary resuscitation (92950) range across 6 matching MRF lines |
— | $1,077–$2,161.50 | — |
| Cardioversion (92960) range across 6 matching MRF lines |
— | $544–$1,565.50 | — |
| Cbt 1st hour (94644) | — | $423.50 | — |
| Chemo Anti-Neopl Sq/Im (96401) | — | $170.50 | — |
| Chemo Hormon Antineopl Sq/Im (96402) | — | $137 | — |
| Chemo IV infusion addl hr (96415) | — | $256 | — |
| Chemo IV push addl drug (96411) | — | $352.50 | — |
| Chemotx admn IV nfs tq ea seql nfs to 1 hr (96417) | — | $328 | — |
| Chemotx admn IV nfs tq up 1 hr 1/1st sbst/drug (96413) | — | $936 | — |
| Chemotx admn IV push tq 1/1st sbst/drug (96409) | — | $526 | — |
| Chest Wall Manipulation (94668) | — | $205 | — |
| Color/duplex Doppler, complete (93975) | — | $702.50 | — |
| Community/Work Reintegration Trainj Ea 15 Min (97537) range across 12 matching MRF lines |
$86.10–$201.95 | $123–$288.50 | varies |
| Cont gluc mntr physician/qhp provided equiptment (95250) | — | $648 | — |
| Cont Gluc Mntr Pt Prov Eqp (95249) | — | $296 | — |
| Continuous Pulse Ox (94762) | — | $358.50 | — |
| Cpap Ventilation Cpap Initiation&Mgmt (94660) range across 30 matching MRF lines |
— | $49.50–$584.50 | — |
| Cpt initial (94667) | — | $285.50 | — |
| Critical care first hour (99291) range across 8 matching MRF lines |
— | $789–$4,347 | — |
| Debridement Open Wound 20 Sq Cm< (97597) range across 17 matching MRF lines |
— | $90.50–$457 | — |
| 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 Xtr Veins Complete Bilateral Study (93970) | — | $1,487 | — |
| Dup-scan xtr veins unilateral/limited study (93971) range across 4 matching MRF lines |
— | $1,366.50–$1,444 | — |
| Duplex Scan Hemodialysis Access (93990) | — | $558.50 | — |
| Duplex up extrem art bilat (93930) range across 4 matching MRF lines |
— | $902.50–$1,444 | — |
| Duplex up extrem art unilat/ltd (93931) range across 6 matching MRF lines |
— | $569.50–$1,444 | — |
| ECG/monitoring and analysis (93271) | — | $903 | — |
| Echo Heart Xthoracic,Limited (93308) | — | $921 | — |
| Echo tthrc r-t 2d w/wo m-mode rest&strs cont ECG (93351) | — | $4,216 | — |
| Electrical Stimulation Ea 15 Min (97032) | $56.35 | $80.50 | 3.8× |
| Electrocardiogram Tracing (93005) range across 7 matching MRF lines |
— | $296.50–$399 | — |
| Emergency Dept Visit Level 2 (99282) range across 4 matching MRF lines |
— | $278.50–$462.50 | — |
| Emergency Dept Visit Level 3 (99283) range across 4 matching MRF lines |
— | $433–$1,204.50 | — |
| Emergency Dept Visit Level 4 (99284) range across 4 matching MRF lines |
— | $641.50–$1,786.50 | — |
| Er level 1 (99281) range across 5 matching MRF lines |
— | $192–$323.50 | — |
| Er level v (99285) range across 4 matching MRF lines |
— | $1,007–$2,604.50 | — |
| Evaluate pt use of inhaler (94664) | — | $196 | — |
| Evaluate Speech Production (92522) | — | $320 | — |
| Evaluate Swallowing Function (92610) range across 5 matching MRF lines |
$383.95 | $528.50–$548.50 | 4.5× |
| Evaluation of speech fluency (92521) range across 5 matching MRF lines |
$315 | $395–$450 | 2.4× |
| External ECG rec>48hr<7d recording (93242) | — | $162 | — |
| External ECG rec>7d<15d recording (93246) | — | $269 | — |
| Extracranial Bilat Study (93880) range across 4 matching MRF lines |
— | $1,781–$2,124.50 | — |
| Extracranial Uni/Ltd Study (93882) | — | $1,290.50 | — |
| Flexible endoscopic eval swallow c/v rec (92612) | — | $1,399.50 | — |
| Group Therapeutic Procedures (97150) range across 6 matching MRF lines |
$41.65–$82.25 | $59.50–$117.50 | varies |
| Holter monitor recording (93225) | — | $1,029.50 | — |
| Im Adm Intransl/Oral 1 Vaccine (90473) | — | $52.50 | — |
| Immunization administration (90471) range across 10 matching MRF lines |
— | $52.50–$118.50 | — |
| Iontophoresis 15 min (97033) range across 5 matching MRF lines |
$55.65 | $79.50–$138 | 2.9× |
| Irrig Drug Delivery Device (96523) range across 8 matching MRF lines |
— | $88.50–$108.50 | — |
| IV infusion hydration each additional hour (96361) range across 5 matching MRF lines |
— | $238.50–$243 | — |
| IV infusion hydration initial 31 min-1 hour (96360) range across 4 matching MRF lines |
— | $479–$489.50 | — |
| IV infusion ther proph addl sequential to 1 hr (96367) range across 6 matching MRF lines |
— | $142–$479 | — |
| IV infusion therapy prophylaxis/dx ea hour (96366) range across 7 matching MRF lines |
— | $109.50–$193 | — |
| IV push initial (96374) range across 6 matching MRF lines |
— | $294.50–$453.50 | — |
| Mechanical chest wall oscillation per session (94669) | — | $59 | — |
| Med Nutr Ther, Subsq, Indiv, Ea 15 Min (97803) range across 4 matching MRF lines |
— | $48–$63 | — |
| Medical nutrition assmt&ivntj indiv each 15 mi (97802) range across 4 matching MRF lines |
— | $48–$49.50 | — |
| Methacholine challenge (94070) | — | $641.50 | — |
| Motion Fluoroscopy/Swallow (92611) range across 6 matching MRF lines |
$318.15–$331.10 | $454.50–$473 | varies |
| Multiple Sleep Latency Test (95805) range across 4 matching MRF lines |
— | $1,638.50–$2,900.50 | — |
| Nasopharyngoscopy (92511) range across 4 matching MRF lines |
— | $238.50–$242 | — |
| Neg Pressure Wound Therapy Non Dme </= 50 Sq Cm (97607) | — | $1,946.50 | — |
| Negative Pressure Wound Therapy Dme </= 50 Sq Cm (97605) range across 6 matching MRF lines |
— | $138–$200 | — |
| Negative Pressure Wound Therapy Dme >50 Sq Cm (97606) range across 5 matching MRF lines |
— | $162–$296.50 | — |
| Neurobehavioral Status Exam (96116) | $502.25 | $717.50 | 2.2× |
| Neuromuscular Reeducation (97112) range across 6 matching MRF lines |
$97.30–$98 | $139–$140 | varies |
| Newborn resuscitation (99465) | — | $585.50 | — |
| Oral Function Therapy (92526) range across 5 matching MRF lines |
$307.30 | $313.50–$439 | 3.7× |
| Oral Speech Device Eval (92597) | — | $594.50 | — |
| Orthc/Prostc Mgmt Sbsq Enc (97763) | — | $170.50 | — |
| Orthotics Mgmt & Trainj Initial Enctr Ea 15 Mins (97760) range across 6 matching MRF lines |
$112–$142.10 | $160–$203 | varies |
| Osteopathic Manipulative Tx 1-2 Body Regions (98925) | — | $88.50 | — |
| Osteopathic manipulative tx 3-4 body regions (98926) | — | $121.50 | — |
| Ot Contrast Bath Ea 15 Min (97034) range across 6 matching MRF lines |
$47.60–$53.20 | $68–$76 | varies |
| Ot eval high complexity (97167) | — | $287.50 | — |
| Ot Eval Low Complex (97165) | — | $288.50 | — |
| Ot Eval Moderate Complexity (97166) | — | $287.50 | — |
| Ot manual therapy 15 min (97140) range across 6 matching MRF lines |
$93.10–$97.30 | $133–$139 | varies |
| Ot paraffin bath (97018) range across 6 matching MRF lines |
$53.90–$59.85 | $77–$85.50 | varies |
| 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 | — |
| Phlebotomy therapeutic (99195) range across 4 matching MRF lines |
— | $313.50–$319 | — |
| Phys/qhp svcs op pulm rehab wo cont oximtry mntr (94625) | — | $228.50 | — |
| Physical Performance Test (97750) | $249.20 | $356 | 7.4× |
| 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) range across 4 matching MRF lines |
— | $31–$64 | — |
| Prof svcs allg immntx x w/prv allgic xtrcs njxs (95117) range across 4 matching MRF lines |
— | $31–$64 | — |
| Pt Eval High Complex (97163) range across 5 matching MRF lines |
$72.10 | $103–$427.50 | 0.7× |
| Pt eval low complex 20 min (97161) | — | $323.50 | — |
| Pt Eval Mod Complex (97162) | — | $369.50 | — |
| Pt gait training 15 min (97116) | $75.25 | $107.50 | 2.6× |
| Pt mechanical traction (97012) | $95.90 | $137 | 6.7× |
| Pt Re-Eval Est Plan Care (97164) | — | $213 | — |
| Pulmonary service/procedure (94799) range across 4 matching MRF lines |
— | $102.50–$328 | — |
| Pulmonary Stress Testing (94618) range across 4 matching MRF lines |
— | $165.50–$1,261.50 | — |
| Refill/Maint Portable Pump (96521) | — | $694 | — |
| Rem mntr physiol param 1st dev supply ea 30 d (99454) | — | $221 | — |
| Rem mntr physiol param 1st set up pt educaj eqp (99453) | — | $92 | — |
| Rem Mntr Physiol Param Dev Sply W/Rec 2-15 Days (99445) | — | $221 | — |
| Remote 30 Day Ecg Rev/Report (93270) range across 4 matching MRF lines |
— | $399–$456.50 | — |
| Rmvl Devital Tiss N-Slctv Dbrdmt W/O Anes 1 Sess (97602) range across 7 matching MRF lines |
$118.65 | $169.50–$236.50 | 0.6× |
| Rx sp-genratj augmnt&comunicaj dev 1st hr (92607) | — | $458.50 | — |
| 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 sound lang comprehen (92523) | — | $563 | — |
| Spin/Brain Pump Refil & Main (95991) | — | $192 | — |
| Spirometry (94010) range across 8 matching MRF lines |
— | $76–$314.50 | — |
| Standardized Cognitive Performance Testing (96125) | — | $346 | — |
| Stress Tte Only (93350) | — | $1,871.50 | — |
| Temp transcutaneous pacing (92953) | — | $516 | — |
| Ther Ivntj Cog Funcj Cntct 1st 15 Minutes (97129) range across 4 matching MRF lines |
— | $75–$76 | — |
| Ther Ivntj Ea Addl 15 Min (97130) | — | $73 | — |
| Ther Px 1/> Areas Each 15 Minutes Massage (97124) range across 6 matching MRF lines |
$80.85–$87.15 | $115.50–$124.50 | varies |
| Ther Sp-Genratj Dev Prgrmg&Modificaj (92609) | — | $342 | — |
| Ther/Proph/Diag Inj Sc/Im (96372) range across 9 matching MRF lines |
— | $52.50–$126 | — |
| Ther/Proph/Diag Iv Inf Init (96365) range across 5 matching MRF lines |
— | $579–$590.50 | — |
| Therapeutic Activities (97530) range across 10 matching MRF lines |
$79.10–$158.90 | $91.50–$227 | varies |
| 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 Cardiovagal Innervaj Parasymp (95921) | — | $331 | — |
| Tstg ans funcj vasomotor adrenergic innervaj (95922) | — | $419.50 | — |
| Tte w/doppler, complete (93306) range across 6 matching MRF lines |
— | $2,530–$3,140 | — |
| Tte W/O Doppler Complete (93307) | — | $440 | — |
| Tx Speech Lang Voice Commj &/Auditory Proc Ind (92507) range across 4 matching MRF lines |
— | $91.50–$375 | — |
| Tx Speech Language Voice Commj Auditry 2/>Indiv (92508) | — | $155.50 | — |
| Tx/Pro/Dx Inj New Drug Addon (96375) range across 6 matching MRF lines |
— | $142–$269 | — |
| Unlisted cardiovascular service/procedure (93799) | — | $1,282.50 | — |
| Upr/L Xtremity Art 2 Levels (93922) range across 3 matching MRF lines |
— | $291–$412 | — |
| Vasopneumatic device (97016) | $65.10 | $93 | 5.4× |
| Vent Mgmt Inpat Init 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) range across 6 matching MRF lines |
$95.90–$97.30 | $137–$139 | varies |
A range means this hospital published different amounts on matching machine-readable-file lines. We show the lowest–highest posted amount because we cannot tell from the published file which line would apply to a particular visit.