Visits & medical services prices at Plains Memorial Hospital

Dimmitt, TX · every code in this section with a posted price and a Medicare benchmark.

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

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ProcedurePosted cashPosted gross× Medicare
Admn Sarscov2 Vacc 1 Dose (90480) $11 $14 0.3×
Advncd Care Plan 30 Min (99497) $113 $150 1.1×
Airway Inhalation Treatment (94640)
range across 3 matching MRF lines		 $30–$381 $40–$508 varies
Appl Modality 1/> Areas Ultrasound Ea 15 Min (97035) $44 $58 3.1×
Assessment of aphasia per hr (96105) $207 $276 2.1×
Behavral qualit analys voice (92524) $174 $232 1.6×
Brief Emotional/Behav Assmt (96127) $25 $33 0.7×
Brncdilat rspse spmtry pre&post-brncdilat admn (94060)
range across 2 matching MRF lines		 $30–$561 $40–$748 varies
Canalith repositioning proc (95992) $41 $54 1.0×
Cardiopulmonary resuscitation (92950) $561 $748 2.6×
Cardioversion (92960) $1,163 $1,550 1.8×
Cbt 1st hour (94644) $228 $304 1.7×
Chemo IV infusion addl hr (96415) $45 $60 0.6×
Chemo IV push addl drug (96411) $94 $125 1.3×
Chemotx admn IV nfs tq ea seql nfs to 1 hr (96417) $94 $125 1.3×
Chemotx admn IV nfs tq up 1 hr 1/1st sbst/drug (96413) $283 $377 0.9×
Chest Wall Manipulation (94668) $38 $50 0.3×
Chron Care Mgmt Srvc 20 Min (99490) $110 $147 1.1×
Color/duplex Doppler, complete (93975) $438 $584 1.8×
Color/duplex Doppler, limited (93976) $352 $469 3.4×
Complex chronic care mgmt svc 1st 60 min cal mo (99487) $239 $319 1.3×
Cpt initial (94667) $68 $90 0.5×
Critical care first hour (99291)
range across 2 matching MRF lines		 $394–$1,586 $525–$2,114 varies
Debridement Open Wound 20 Sq Cm< (97597) $135 $180 0.7×
Developmental tst admin phys/qhp 1st hour (96112) $266 $355 2.1×
Dup-scan aorta ivc iliac vascl/bpgs complete (93978) $438 $584 1.8×
Dup-scan lxtr art/artl bpgs compl bi study (93925) $438 $584 1.8×
Dup-Scan Lxtr Art/Artl Bpgs Uni/Lmtd Study (93926) $352 $469 3.4×
Dup-Scan Xtr Veins Complete Bilateral Study (93970) $438 $584 1.8×
Dup-scan xtr veins unilateral/limited study (93971) $352 $469 3.4×
Duplex up extrem art bilat (93930) $352 $469 1.5×
Duplex up extrem art unilat/ltd (93931) $352 $469 3.4×
Electrical Stimulation Ea 15 Min (97032) $49 $65 3.3×
Electrocardiogram Tracing (93005) $110 $146 1.9×
Emergency Dept Visit Level 2 (99282) $293 $390 1.9×
Emergency Dept Visit Level 3 (99283) $510 $680 1.9×
Emergency Dept Visit Level 4 (99284) $791 $1,055 1.9×
Er level 1 (99281) $158 $211 1.9×
Er level v (99285) $1,148 $1,530 1.9×
Evaluate pt use of inhaler (94664) $113 $150 0.5×
Evaluate Speech Production (92522) $199 $265 1.8×
Evaluate Swallowing Function (92610)
range across 2 matching MRF lines		 $161–$191 $214–$254 varies
Evaluation of speech fluency (92521) $160 $213 1.2×
Extracranial Bilat Study (93880) $438 $584 1.8×
Group Therapeutic Procedures (97150) $55 $73 3.0×
Holter monitor recording (93225) $228 $304 1.7×
Im Adm Intransl/Oral 1 Vaccine (90473) $11 $14 0.2×
Immunization administration (90471)
range across 2 matching MRF lines		 $11–$125 $14–$167 varies
Inital newborn e/m (99460) $2,789 $3,718 20.9×
Iontophoresis 15 min (97033) $58 $77 3.0×
Irrig Drug Delivery Device (96523) $114 $152 1.9×
IV infusion hydration each additional hour (96361) $85 $113 1.8×
IV infusion hydration initial 31 min-1 hour (96360) $383 $511 1.8×
IV infusion ther proph addl sequential to 1 hr (96367) $126 $168 1.7×
IV infusion therapy prophylaxis/dx ea hour (96366) $85 $113 1.8×
IV push initial (96374) $383 $511 1.8×
Multiple Family Group Psychotherapy (90849) $26 $35 0.1×
Negative Pressure Wound Therapy Dme >50 Sq Cm (97606) $191 $254 0.5×
Neuromuscular Reeducation (97112) $61 $81 1.9×
Oral Function Therapy (92526) $188 $250 2.2×
Oral Speech Device Eval (92597) $187 $249 2.6×
Orthc/Prostc Mgmt Sbsq Enc (97763) $84 $112 1.7×
Orthotics Mgmt & Trainj Initial Enctr Ea 15 Mins (97760) $69 $92 1.5×
Osteopathic Manipulative Tx 1-2 Body Regions (98925)
range across 2 matching MRF lines		 $51–$95 $68–$127 varies
Osteopathic manipulative tx 3-4 body regions (98926)
range across 2 matching MRF lines		 $68–$138 $90–$184 varies
Osteopathic manipulative tx 5-6 body regions (98927) $81 $108 3.7×
Ot Contrast Bath Ea 15 Min (97034) $44 $58 3.1×
Ot eval high complexity (97167) $348 $464 3.5×
Ot Eval Low Complex (97165)
range across 3 matching MRF lines		 $174–$185 $232–$246 varies
Ot Eval Moderate Complexity (97166) $261 $348 2.6×
Ot manual therapy 15 min (97140) $65 $87 2.3×
Ot paraffin bath (97018) $44 $58 7.3×
Ot Prosthetic Training, Each 15 Min (97761) $60 $80 1.5×
Ot Re-Eval Est Plan Care (97168) $128 $170 1.9×
Prof Svcs Allg Immntx X W/Prv Allgic Xtrcs 1 Njx (95115) $85 $113 1.8×
Prof svcs allg immntx x w/prv allgic xtrcs njxs (95117) $85 $113 1.8×
Psych diag eval w/med srvcs (90792) $285 $380 1.6×
Psychiatric diagnostic evaluation (90791) $285 $380 1.6×
Pt Asstv Technol Assmt Dir Cntct W/Reprt Ea 15 Min (97755) $66 $88 1.7×
Pt Eval High Complex (97163) $348 $464 3.6×
Pt eval low complex 20 min (97161) $183 $244 1.9×
Pt Eval Mod Complex (97162) $261 $348 2.7×
Pt gait training 15 min (97116) $58 $77 2.0×
Pt mechanical traction (97012) $49 $65 3.4×
Pt Re-Eval Est Plan Care (97164) $118 $157 1.7×
Pulmonary Stress Testing (94618) $152 $203 1.1×
Qnhp Ol Dig Assmt&Mgmt 11-20 (98971) $48 $64 2.1×
Qualified nonphysician health care professional online digital assessment and management, for an established patient,… (98972) $75 $100 2.2×
Qualified nonphysician health care professional online digital assessment and management, for an established patient,… (98970) $27 $36 2.2×
Rem mntr physiol param 1st dev supply ea 30 d (99454) $77 $102 2.1×
Rem mntr physiol param 1st set up pt educaj eqp (99453) $35 $47 0.3×
Rmvl Devital Tiss N-Slctv Dbrdmt W/O Anes 1 Sess (97602)
range across 3 matching MRF lines		 $68–$158 $90–$210 varies
Self Care Mngment Training (97535)
range across 4 matching MRF lines		 $63–$76 $84–$101 varies
Sensory Integration Ea 15 Min (97533) $63 $84 1.0×
Speech sound lang comprehen (92523) $347 $463 1.5×
Spirometry (94010) $83 $110 0.4×
Standardized Cognitive Performance Testing (96125)
range across 2 matching MRF lines		 $203–$213 $271–$284 varies
Temp transcutaneous pacing (92953) $312 $416 0.5×
Ther Ivntj Cog Funcj Cntct 1st 15 Minutes (97129)
range across 4 matching MRF lines		 $45–$49 $60–$65 varies
Ther Ivntj Ea Addl 15 Min (97130) $45 $60 2.1×
Ther Px 1/> Areas Each 15 Min Aqua Ther W/Xerss (97113) $77 $103 2.1×
Ther Px 1/> Areas Each 15 Minutes Massage (97124) $47 $63 1.6×
Ther/Proph/Diag Inj Sc/Im (96372)
range across 3 matching MRF lines		 $15–$126 $20–$168 varies
Ther/Proph/Diag Iv Inf Init (96365) $383 $511 1.8×
Therapeutic Activities (97530) $67 $89 1.9×
Tobacco Use Cessation Intensive >10 Minutes (99407) $26 $35 0.7×
Tobacco Use Cessation Intermediate 3-10 Minutes (99406) $14 $18 0.4×
Trans Care Mgmt 14 Day Disch (99495) $366 $488 2.7×
Trans Care Mgmt 7 Day Disch (99496) $496 $661 3.7×
Tte w/doppler, complete (93306) $986 $1,314 1.8×
Tx Speech Lang Voice Commj &/Auditory Proc Ind (92507) $185 $246 2.4×
Tx/Pro/Dx Inj New Drug Addon (96375) $85 $113 1.8×
Upr/L Xtremity Art 2 Levels (93922) $352 $469 2.6×
Upr/Lxtr Art Stdy 3+ Lvls (93923) $352 $469 1.6×
Vasopneumatic device (97016) $49 $65 4.1×
Wheelchair Mgmt Ea 15 Min (97542) $74 $99 2.4×
Whirlpool Therapy (97022) $49 $65 3.1×

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.