Visits & medical services prices at Mountainview Medical Center
White Sulphur Spring, MT · every code in this section with a posted price and a Medicare benchmark.
79 codes. Prices are the hospital's own posted facility charges.
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| Procedure | Posted cash | Posted gross | × Medicare |
|---|---|---|---|
| Admn Sarscov2 Vacc 1 Dose (90480) range across 5 matching MRF lines |
$24.74–$35.29 | $30.92–$44.11 | varies |
| Advncd Care Plan 30 Min (99497) | $202.78 | $253.47 | 2.0× |
| Airway Inhalation Treatment (94640) range across 3 matching MRF lines |
$41.72–$193.55 | $52.15–$241.94 | varies |
| Brief Emotional/Behav Assmt (96127) | $7.94 | $9.92 | 0.2× |
| Brncdilat rspse spmtry pre&post-brncdilat admn (94060) | $557.60 | $697 | 1.5× |
| Canalith repositioning proc (95992) range across 2 matching MRF lines |
$32.85–$125.43 | $41.06–$156.79 | varies |
| Cardiopulmonary resuscitation (92950) range across 2 matching MRF lines |
$736.25–$1,065.58 | $920.31–$1,331.97 | varies |
| Cardioversion (92960) range across 2 matching MRF lines |
$379.70–$1,508.22 | $474.63–$1,885.28 | varies |
| Chemo Admin Peritoneal Cavity (96446) | $677.17 | $846.46 | 2.0× |
| Chemo Anti-Neopl Sq/Im (96401) | $264.60 | $330.75 | 3.6× |
| Chemo Hormon Antineopl Sq/Im (96402) | $216.72 | $270.90 | 2.9× |
| Chemo Ia Push (96420) | $553.56 | $691.95 | 1.6× |
| Chemo Intralesional Over 7 (96406) | $386.40 | $483 | 1.8× |
| Chemo intralesional up to 7 (96405) | $211.68 | $264.60 | 2.9× |
| Chemo IV infusion addl hr (96415) | $248.64 | $310.80 | 3.4× |
| Chemo IV push addl drug (96411) | $304.03 | $380.04 | 4.1× |
| Chemother Prolong Infuse W/Pump (96416) | $769.44 | $961.80 | 2.3× |
| Chemotherapy Admin Intra-Arterial Infus </1 Hr (96422) | $175.50 | $219.38 | 0.5× |
| Chemotherapy Admn Intraarterial Infusion Ea Hr (96423) | $34.33 | $42.91 | 0.7× |
| Chemotherapy Into Cns (96450) | $833.28 | $1,041.60 | 2.5× |
| Chemotherapy Intracavitary (96440) | $273.54 | $341.92 | 0.8× |
| Chemotx Admn Ia Nfs >8 Hr Prtble Impltbl Pmp (96425) | $273.54 | $341.92 | 0.8× |
| Chemotx admn IV nfs tq ea seql nfs to 1 hr (96417) | $309.96 | $387.45 | 4.2× |
| Chemotx admn IV nfs tq up 1 hr 1/1st sbst/drug (96413) | $727.44 | $909.30 | 2.2× |
| Chemotx admn IV push tq 1/1st sbst/drug (96409) | $465.36 | $581.70 | 1.4× |
| Chemotx Njx Subarachnd/Intraventr Rsvr 1/Mult (96542) | $577.92 | $722.40 | 1.7× |
| Chron Care Mgmt Srvc 20 Min (99490) | $48.39 | $60.49 | 0.5× |
| Complex chronic care mgmt svc 1st 60 min cal mo (99487) | $221.21 | $276.51 | 1.2× |
| Critical care first hour (99291) range across 2 matching MRF lines |
$669.58–$2,151.52 | $836.97–$2,689.40 | varies |
| Debridement Open Wound 20 Sq Cm< (97597) range across 4 matching MRF lines |
$185.22–$414.96 | $231.53–$518.70 | varies |
| Electrocardiogram Tracing (93005) range across 2 matching MRF lines |
$140.28–$162.02 | $175.35–$202.53 | varies |
| Emergency Dept Visit Level 2 (99282) range across 2 matching MRF lines |
$104.65–$378.96 | $130.81–$473.70 | varies |
| Emergency Dept Visit Level 3 (99283) range across 2 matching MRF lines |
$157.44–$626.51 | $196.80–$783.14 | varies |
| Emergency Dept Visit Level 4 (99284) range across 2 matching MRF lines |
$288.94–$998.34 | $361.18–$1,247.93 | varies |
| Er level 1 (99281) range across 4 matching MRF lines |
$54.64–$227.18 | $68.30–$283.97 | varies |
| Er level v (99285) range across 2 matching MRF lines |
$420.46–$1,484.26 | $525.57–$1,855.33 | varies |
| Evaluate pt use of inhaler (94664) | $39.78 | $49.73 | 0.2× |
| Im Adm Intransl/Oral 1 Vaccine (90473) | $35.29 | $44.11 | 0.5× |
| Immunization administration (90471) range across 7 matching MRF lines |
$35.29–$68.26 | $44.11–$85.32 | varies |
| Irrig Drug Delivery Device (96523) range across 2 matching MRF lines |
$104.16–$162 | $130.20–$202.50 | varies |
| IV infusion hydration each additional hour (96361) range across 4 matching MRF lines |
$32.02–$159.60 | $40.03–$199.50 | varies |
| IV infusion hydration initial 31 min-1 hour (96360) range across 4 matching MRF lines |
$83.44–$444.70 | $104.30–$555.88 | varies |
| IV infusion ther proph addl sequential to 1 hr (96367) range across 3 matching MRF lines |
$53.19–$148.73 | $66.49–$185.91 | varies |
| IV infusion therapy prophylaxis/dx ea hour (96366) range across 3 matching MRF lines |
$96.60–$175.56 | $120.75–$219.45 | varies |
| IV push initial (96374) range across 4 matching MRF lines |
$93.14–$287.89 | $116.42–$359.86 | varies |
| Med Nutr Ther, Subsq, Indiv, Ea 15 Min (97803) | $48 | $60 | 1.5× |
| Medical nutrition assmt&ivntj indiv each 15 mi (97802) | $56 | $70 | 1.5× |
| Medical nutrition therapy grp2/ indiv ea 30 mi (97804) | $48 | $60 | 2.8× |
| Neg Pressure Wound Therapy Non Dme </= 50 Sq Cm (97607) | $578.76 | $723.45 | 1.4× |
| Neg Pressure Wound Therapy Non Dme >50 Sq Cm (97608) | $682.08 | $852.60 | 1.6× |
| Negative Pressure Wound Therapy Dme </= 50 Sq Cm (97605) | $333.48 | $416.85 | 1.6× |
| Negative Pressure Wound Therapy Dme >50 Sq Cm (97606) | $494.68 | $618.35 | 1.2× |
| Nonphysician Telephone Assessment 11-20 Min (98967) | $57.12 | $71.40 | 2.3× |
| Nonphysician Telephone Assessment 21-30 Min (98968) | $84 | $105 | 2.4× |
| Nonphysician Telephone Assessment 5-10 Min (98966) | $34.44 | $43.05 | 2.5× |
| Osteopathic Manipulative Tx 1-2 Body Regions (98925) range across 2 matching MRF lines |
$25.02–$26.88 | $31.27–$33.60 | varies |
| Osteopathic manipulative tx 3-4 body regions (98926) | $28.56 | $35.70 | 1.3× |
| Outpatient Cardiac Rehab W/Cont Ecg Monitoring (93798) | $240 | $300 | 1.8× |
| Outpatient Cardiac Rehab W/O Cont Ecg Monitor (93797) | $215.03 | $268.79 | 1.6× |
| Phlebotomy therapeutic (99195) | $326.94 | $408.67 | 2.4× |
| Phys/qhp svcs op pulm rehab w/cont oximtry mntr (94626) | $76.98 | $96.22 | 1.3× |
| Phys/qhp svcs op pulm rehab wo cont oximtry mntr (94625) | $68.98 | $86.22 | 1.1× |
| Prof Svcs Allg Immntx X W/Prv Allgic Xtrcs 1 Njx (95115) | $22.32 | $27.90 | 0.5× |
| Prof svcs allg immntx x w/prv allgic xtrcs njxs (95117) | $26.20 | $32.75 | 0.5× |
| Psychiatric diagnostic evaluation (90791) | $216.72 | $270.90 | 1.2× |
| Psytx Crisis Initial 60 Min (90839) | $219.24 | $274.05 | 1.2× |
| Refill/Maint Pump/Resvr Syst (96522) | $556.08 | $695.10 | 2.6× |
| Rmvl Devital Tiss N-Slctv Dbrdmt W/O Anes 1 Sess (97602) range across 2 matching MRF lines |
$80.53–$288.12 | $100.66–$360.15 | varies |
| Spirometry (94010) range across 2 matching MRF lines |
$83.44–$304 | $104.30–$380 | varies |
| Subcutaneous Infusion Each Additional Hour (96370) | $118.44 | $148.05 | 2.5× |
| Subcutaneous infusion initial 1 hr w/pump set-up (96369) | $446.88 | $558.60 | 2.1× |
| Subq Infusion Additional Pump Infusion Site (96371) | $53.19 | $66.49 | 0.7× |
| Ther/Proph/Diag Inj Ia (96373) | $252.84 | $316.05 | 1.2× |
| Ther/Proph/Diag Inj Sc/Im (96372) range across 4 matching MRF lines |
$33.96–$102.89 | $42.45–$128.61 | varies |
| Ther/Proph/Diag Iv Inf Init (96365) range across 3 matching MRF lines |
$326.76–$494.76 | $408.45–$618.45 | varies |
| Tobacco Use Cessation Intensive >10 Minutes (99407) | $69.86 | $87.32 | 1.8× |
| Tobacco Use Cessation Intermediate 3-10 Minutes (99406) | $35.90 | $44.88 | 0.9× |
| Tx/Pro/Dx Inj New Drug Addon (96375) range across 3 matching MRF lines |
$111.72–$193.41 | $139.65–$241.76 | varies |
| Upr/L Xtremity Art 2 Levels (93922) | $777.84 | $972.30 | 5.7× |
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.