Visits & medical services prices at Pike County Memorial Hospital

Louisiana, MO · every code in this section with a posted price and a Medicare benchmark.

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

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ProcedureCash priceGross charge× Medicare
Airway inhalation treatment (94640) $80 $100 0.4×
Analyze neurostim no prog (95970) $240 $300 1.8×
Behavioral and qualitative analysis of voice and resonance (92524) $220 $275 2.0×
Brncdilat rspse spmtry pre&post-brncdilat admn (94060) $382.40 $478 1.0×
Canalith Repositioning (95992) $81.60 $102 2.0×
Cardiac Stress Tst,Tracing Only (93017) $583.20 $729 2.7×
Cardiopulmonary resuscitation (92950) $384 $480 1.8×
Cardioversion (92960) $384 $480 0.6×
Cbt 1st hour (94644) $176 $220 1.3×
Chemo Hormon Antineopl Sq/Im (96402) $37.60 $47 0.5×
Chemo IV push addl drug (96411) $53.60 $67 0.7×
Chemo Iv Push Sngl Drug (96409) $96.80 $121 0.3×
Chemo prolong 8+ hrs infuse w/pump (96416) $123.20 $154 0.4×
Chemother, IV infusion, 1 hr (96413) $434.40 $543 1.3×
Chemother, IV infusion, ea add hr (96415) $84 $105 1.2×
Chemother,Non-Hormone Anti-Neopl, Sub-Q/Im (96401) $70.40 $88 1.0×
Chemotx admn IV nfs tq ea seql nfs to 1 hr (96417) $62.40 $78 0.9×
Chronic care mgmt svcs staff 1st 20 min cal mo (99490) $96.10 $120.12 0.9×
Color/duplex Doppler, complete (93975) $457.60 $572 1.9×
Color/duplex Doppler, limited (93976) $326.40 $408 3.1×
Comprehensive Hearing Test (92557) $64 $80 0.5×
Cpap initiation and management (94660) $659.20 $824 3.0×
Cpt initial (94667) $204.80 $256 1.5×
Critical care (99291) $705.60 $882 0.9×
Debridement Open Wound 20 Sq Cm< (97597) $50.40 $63 0.3×
Demo &/or eval,pt use,aerosol device (94664) $47.20 $59 0.2×
Dup-Scan Aorta Ivc Iliac Vascl/Bpgs Complete (93978) $457.60 $572 1.9×
Dup-Scan Lxtr Art/Artl Bpgs Compl Bi Study (93925) $247.20 $309 1.0×
Dup-scan lxtr art/artl bpgs uni/lmtd study (93926) $244.80 $306 2.3×
Dup-Scan Uxtr Art/Artl Bpgs Compl Bi Study (93930) $572 $715 2.4×
Dup-Scan Uxtr Art/Artl Bpgs Uni/Lmtd Study (93931) $340 $425 3.2×
Dup-scan xtr veins unilateral/limited study (93971) $244.80 $306 2.3×
Duplex scan extracranial art compl bi study (93880) $395.20 $494 1.7×
Echo Heart Xthoracic,Limited (93308) $395.20 $494 1.7×
EKG (93005) $148 $185 2.5×
EKG rhythm strip (93041) $53.60 $67 0.9×
Elec alys implt cplx cn npgt prgrmg (95977) $480 $600 5.0×
Elec Alys Implt Smpl Cn Npgt Prgrmg (95976) $272 $340 7.3×
EMG one extremity (95860) $104 $130 0.8×
EMG two extremities (95861) $576.80 $721 4.3×
Er level 1 (99281) $140 $175 1.7×
Er level ii (99282) $240 $300 1.6×
Er level iii (99283) $360 $450 1.3×
Er level IV (99284) $520 $650 1.2×
Er level v (99285) $680 $850 1.1×
Evaluation of swallowing function (92610) $301.60 $377 3.6×
Evaluation with prescription of speech-generating alternative (92607) $320 $400 2.6×
External ECG rec>48hr<7d recording (93242) $351.20 $439 9.4×
External ECG rec>48hr<7d scanning alys w/report (93243) $351.20 $439 2.6×
External ECG rec>7d<15d recording (93246) $351.20 $439 9.4×
External ECG rec>7d<15d scanning alys w/report (93247) $351.20 $439 2.6×
External Ecg Scanning Analysis Report (93226) $413.60 $517 7.0×
Flow volume loop (94375) $140.80 $176 0.7×
Health Behavior Assessment/Re-Assessment (96156) $128 $160 1.3×
Holter Monitor Recording (93225) $351.20 $439 2.6×
Imm Admn Sarscov2 Vaccine Single Dose (90480) $32 $40 0.8×
Immuniz admin,intranasal/oral,1 vac/tox (90473) $24 $30 0.3×
Immunization Admin (90471) $76.80 $96 1.1×
Immunotherapy, 2+ Injections (95117) $28.80 $36 0.6×
Irrigaj Implntd Venous Access Drug Delivery Syst (96523) $88 $110 1.5×
IV infusion hydration each additional hour (96361) $44 $55 0.9×
IV infusion hydration initial 31 min-1 hour (96360) $177.60 $222 0.8×
IV infusion, therap/proph/diagnost,add infusion,1st hour (96367) $40.80 $51 0.6×
IV infusion, therap/proph/diagnost,initial,1st hour (96365) $204 $255 1.0×
IV infusion, therap/proph/diagnost,initial,ea add hour (96366) $40.80 $51 0.9×
IV push initial (96374) $204 $255 1.0×
Manual therapy 15 min (97140) $88 $110 3.2×
Massage 15 min (97124) $81.60 $102 2.7×
Mechanical traction (97012) $60 $75 4.2×
Motion Fluor Eval Swlng Funcj C/V Rec (92611) $216 $270 2.4×
Multiple Family Group Psychotherapy (90849) $42.40 $53 0.2×
Nasopharyngoscopy (92511) $248.80 $311 1.2×
Negative Pressure Wound Therapy Dme </= 50 Sq Cm (97605) $104.40 $130.50 0.5×
Negative Pressure Wound Therapy Dme >50 Sq Cm (97606) $84 $105 0.2×
Nerve conduction studies 13/> studies (95913) $2,496 $3,120 6.7×
Nerve Conduction Studies 3-4 Studies (95908) $864 $1,080 4.0×
Nerve Conduction Studies 9-10 Studies (95911) $1,920 $2,400 5.1×
Nerve conduction studies; 1-2 studies (95907) $81.60 $102 0.4×
Nerve conduction studies; 11-12 studies (95912) $2,304 $2,880 6.2×
Nerve conduction studies; 5-6 studies (95909) $1,296 $1,620 6.0×
Nerve conduction studies; 7-8 studies (95910) $1,728 $2,160 4.6×
Non-Invas Physiologic Std Extremity Art 2 Level (93922) $470.40 $588 3.5×
Non-Invasive Physiologic Study Extremity 3 Levls (93923) $370.40 $463 1.7×
Noninvasive Ear/Pulse Oximetry Overnight Monitor (94762) $148 $185 1.1×
Osteopathic manipulative tx 1-2 body regions (98925) $41.60 $52 1.9×
Osteopathic manipulative tx 3-4 body regions (98926) $58.40 $73 2.7×
Osteopathic manipulative tx 5-6 body regions (98927) $63.20 $79 2.9×
Osteopathic manipulative tx 7-8 body regions (98928) $76 $95 3.5×
Osteopathic manipulative tx 9-10 body regions (98929) $79.20 $99 3.7×
Ot eval high complex 60 min (97167) $200 $250 2.0×
Ot eval low complex 30 min (97165) $172 $215 1.7×
Ot eval mod complex 45 min (97166) $177.60 $222 1.8×
Ot re-eval est plan care (97168) $96 $120 1.4×
Outpatient Cardiac Rehab W/Cont Ecg Monitoring (93798) $176.80 $221 1.4×
Outpatient cardiac rehab w/o cont ECG monitor (93797) $124 $155 1.0×
Percutaneous tests w/allergenic extracts (95004) $5.60 $7 0.0×
Plethysmography (94726) $185.60 $232 0.5×
Pm device progr eval dual (93280) $39.20 $49 1.0×
Pm device progr eval sngl (93279) $39.20 $49 1.0×
Polysom 6/>Yrs Sleep W/Cpap 4/> Addl Param Attnd (95811) $2,099.20 $2,624 2.4×
Prgrmg Eval Implantable Dfb - Cardiac Device Clinic Icd Biv Chamber (93284) $52 $65 1.4×
Principal care mgmt svc 1st 30 staff cal mo (99426) $162 $202.50 1.6×
Prof Svcs Allg Immntx X W/Prv Allgic Xtrcs 1 Njx (95115) $20 $25 0.4×
Programming of dual lead implantable defibrillator system (93283) $52 $65 1.4×
Programming of single lead implantable defibrillator system (93282) $52 $65 1.4×
Psych diag eval w/med srvcs (90792) $158.40 $198 0.9×
Psychiatric diagnostic evaluation (90791) $264 $330 1.5×
Psycl tst eval phys/qhp 1st (96130) $200 $250 0.9×
Psytx crisis initial 60 min (90839) $140 $175 0.8×
Pt Aquatic Therapy/Exercises (97113) $128.80 $161 3.5×
Pt Electric Current Therapy (97033) $76 $95 4.0×
Pt Electrical Stimulation (97032) $95.20 $119 6.5×
Pt eval high complex 45 min (97163) $191.20 $239 2.0×
Pt eval low complex 20 min (97161) $163.20 $204 1.7×
Pt Gait Training Therapy (97116) $87.20 $109 3.0×
Pt Neuromusc Reeducat,1+ Areas, Ea 15 Min (97112) $85.60 $107 2.6×
Pt Physical Performance Test (97750) $268 $335 7.9×
Pt Physical Therapy Evaluation Mod Complex 30 Mins (97162) $172 $215 1.8×
Pt re-evaluation (97164) $96 $120 1.4×
Pt Self-Care/Home Mgmt Training Each 15 Minutes (97535) $88 $110 2.7×
Pt Ultrasound Therapy (97035) $62.40 $78 4.3×
Pulmonary stress testing (94618) $132 $165 1.0×
Pure Tone Audiometry, Air (92552) $32 $40 0.2×
Refill/maint, portable pump (96521) $120 $150 0.6×
Rem mntr physiol param 1st dev supply ea 30 days (99454) $112.80 $141 3.0×
Rem mntr physiol param 1st set up pt educaj eqp (99453) $51.74 $64.68 0.4×
Remote 30 Day Ecg Rev/Report - Cardiac Event Monitor (93270) $387.20 $484 10.4×
Rmvl Devital Tiss N-Slctv Dbrdmt W/O Anes 1 Sess (97602) $840 $1,050 4.2×
Sensory Integration Ea 15 Min (97533) $81.60 $102 1.3×
Sleep study unattended (95806) $741.60 $927 3.4×
Speech sound lang comprehen (92523) $480 $600 2.1×
Spirometry (94010) $207.20 $259 1.0×
Standardized Cognitive Performance Testing (96125) $304 $380 3.0×
Stress echo (93350) $1,469.60 $1,837 2.7×
Stress Tte Complete (93351) $1,120 $1,400 2.0×
Subcut infusion, therap/proph/diagnost,ea add hour (96370) $16.80 $21 0.4×
Subcut infusion, therap/proph/diagnost,initial,1st hour (96369) $140 $175 0.7×
Ther Sp-Genratj Dev Prgrmg&Modificaj (92609) $280 $350 2.7×
Ther/prop/diag inj/inf proc (96379) $89 $111.25 1.9×
Ther/Proph/Diag Inj Sc/Im (96372) $96.80 $121 1.3×
Therapeutic Activities (97530) $88 $110 2.5×
Therapeutic phlebotomy (99195) $668.80 $836 5.0×
Trans Care Mgmt 14 Day Disch (99495) $108 $135 0.8×
Trans Care Mgmt 7 Day Disch (99496) $132 $165 1.0×
Tte W/Doppler Complete - Tte Complete W/ Contrast (93306) $1,469.60 $1,837 2.7×
Tx Speech Lang Voice Commj &/Auditory Proc Ind (92507) $300.80 $376 4.0×
Tx Swallowing Dysfunction&/Oral Funcj Feeding (92526) $300.80 $376 3.6×
Tx/Pro/Dx Inj New Drug Addon (96375) $88.80 $111 1.9×
Tympanometry (92567) $37.60 $47 1.0×
Unlisted pulmonary service/procedure (94799) $76 $95 0.6×
Vasc Duplex Extrem Venous,Bilat (93970) $425.60 $532 1.8×
Vasc Non-Invasive Lower Extrem Art Stress/Rest, Complete,Bilateral (93924) $608 $760 2.8×
Vasopneumatic device (97016) $50.40 $63 4.2×
Ventilation assist & mgmt inpatient 1st day (94002) $744.80 $931 1.2×
Wheelchair Mgmt Ea 15 Min (97542) $60 $75 1.9×