Visits & medical services prices at Niobrara County Hospital District

Lusk, WY · every code in this section with a posted price and a Medicare benchmark.

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

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ProcedureCash priceGross charge× Medicare
Airway inhalation treatment (94640) $52 $65 0.2×
Allergy injection single (95115) $23.20 $29 0.5×
Application of a modality to 1 or more areas; electrical stimulation (manual), each 15 minutes Other Outpatient (97032) $58.40 $73
Application of a modality to 1 or more areas; ultrasound, each 15 minutes Other Outpatient (97035) $89.60 $112
Bipap initial day (94660) $440.80 $551 2.0×
Breathing capacity test (94010) $141.20 $176.50 0.6×
Bronchodilation responsiveness, spirometry as in 94010, pre- and post-bronchodilator administration (94060) $428 $535 1.1×
Cardioversion elective external (92960) $985.60 $1,232 1.5×
Color vision examination, extended, eg, anomaloscope or equivalent (92283) $113.60 $142 1.9×
Cpr (92950) $1,036.40 $1,295.50 4.7×
Critical care ill/injured patient init 30-74 min (99291) $1,080 $1,350 1.3×
Debridement open wound 20 sq cm< (97597) $153.20 $191.50 0.7×
ECG monit/reprt up to 48 hrs (93226) $294.40 $368 4.9×
EKG 12 lead tracing only (93005) $174.40 $218 2.9×
EKG rhythm strip (93041) $111.20 $139 1.8×
Emergency department visit high mdm (99285) $1,006.80 $1,258.50 1.7×
Emergency department visit low mdm (99283) $387.20 $484 1.4×
Emergency department visit may not req phys/qhp (99281) $179.20 $224 2.1×
Emergency department visit moderate mdm (99284) $664.80 $831 1.6×
Emergency department visit straightforward mdm (99282) $244.40 $305.50 1.6×
Eval of Oral and Pharyngeal Swallowing - Eval of Oral and Pharyngeal Swallowing Fx Chg (92610) $364 $455
Evaluate pt use of inhaler (94664) $68.80 $86 0.3×
External electrocardiographic recording up to 48 hours by continuous rhythm recording and storage; recording (includes… (93225) $397.60 $497 2.9×
Flexible endo swallow w/o c/v eval - eval of swallowing function w/o video & w/ endoscope (92700) $119.20 $149 4.0×
Immunization administration (90471) $28 $35 0.4×
Injection,Therap/Proph/Diagnost, IV Push, Ea Add, New Drug (96375) $173.60 $217 3.6×
Injection,Therap/Proph/Diagnost, IV Push, Initial Drug (96374) $228.80 $286 1.1×
Irrigaj implntd venous access drug delivery syst (96523) $184 $230 3.1×
IV infusion hydration each additional hour (96361) $123.20 $154 2.6×
IV infusion hydration initial 31 min-1 hour (96360) $270.40 $338 1.2×
IV infusion ther proph addl sequential to 1 hr (96367) $196 $245 2.7×
IV infusion therapy/prophylaxis /dx 1st to 1 hr (96365) $383.20 $479 1.8×
IV tx, each additional hour (96366) $162.40 $203 3.4×
Maximum voluntary ventilation (94200) $126.40 $158 2.1×
Mechanical traction therapy (97012) $48.80 $61
Occupational therapy eval high complex 60 mins (97167) $221.60 $277
Occupational therapy eval low complex 30 mins (97165) $141.60 $177
Occupational therapy eval mod complex 45 mins (97166) $165.60 $207
Oral function therapy (92526) $201.60 $252
Ot manual therapy ea 15 min (97140) $84 $105
Ot neuromuscular re-education (97112) $82.40 $103
Ot re-evaluation (97168) $112 $140
OT Therapeutic Activities Charges (97530) $87.20 $109
Phlebotomy therapeutic (99195) $200 $250 1.5×
Physical therapy evaluation high complex 45 mins (97163) $217.60 $272
Physical therapy evaluation low complex 20 mins (97161) $137.60 $172
Physical therapy evaluation mod complex 30 mins (97162) $169.60 $212
Professional services for allergen immunotherapy; 2 or more injections (95117) $28 $35 0.6×
Pt gait training 15 min (97116) $76 $95
Pt re-evaluation (97164) $125.60 $157
Respiratory flow volume loop (94375) $72 $90 0.3×
Self-care/home management training (eg, activities of daily living (ADL) and compensatory training, meal preparation,… (97535) $77.60 $97
Speech sound lang comprehen (92523) $471.20 $589
Temp transcutaneous pacing (92953) $109.60 $137 0.2×
Therapeutic prophylactic/dx injection subq/im (96372) $140 $175 1.9×
Tobacco use cessation intensive >10 minutes (99407) $76 $95 2.0×
Tobacco use cessation intermediate 3-10 minutes (99406) $36.80 $46 1.0×
Tx of Speech/Lang/Voice/Comm/Auditory Chg (92507) $236.80 $296
Vital capacity total (94150) $57.60 $72 0.4×